439(1)WEMBLEY WEM17 (hate Mu B. ) URBAN DISTRICT OF WEMBLEY ANNUAL REPORT OF THE MEDICAL OFFICER OF HEALTH FOR THE YEAR 1936 URBAN DISTRICT OF WEMBLEY ANNUAL REPORT OF THE MEDICAL OFFICER OF HEALTH FOR THE YEAR 1936 Constitution of Committees PUBLIC HEALTH COMMITTEE-1936-37. Chairman—Councillor E. H. EVERETT. Councillors— C. Barton, L. Bishop, A. W. Clarke, H. Gauntlett, M. Levy, W.B (LOND.) H. W. Pickering, J. Williamson, C.A., J.P. (Chairman of the Council). Councillors— G. H. Plymen, M.Sc., Ph.D., A. Rowbottom, H. S. Sirkett, J. W. G. Snook, F. R. White. E. C. Leader, F.C.R.A. (Vice-Chairman of the Council). MATERNITY & CHILD WELFARE COMMITTEE-1936-37. Chairman—Councillor Miss E. H. HOWSE, J.P. Councillors— C. Barton, A. W. Clarke, F. Costin, E. H. Everett, H. Gauntlett, M. Levy, W.B. (LONO.) J. Williamson, C.A., J.P. (Chairman of the Council). Councillors— H. W. Pickering, G. H. Plymen, M.Sc., Ph.d., A. Rowbottom, J. W. G. Snook, H. J. Soar. E. C. Leader, F.C.R.A. (Vice-Chairman of the Council). CO-OPTED MEMBERS : Mesdames Clarke, Collier, Collison, Collyer, Empson, Farquharson, Rowbottom. Clerk of the Council Kenneth Tansley, Esq. 2 STAFF OF THE PUBLIC HEALTH DEPARTMENT (31st December, 1936). Medical Officer of Health: A. G. MORI SON, M.A., M.D., D.P.H. (Commenced duty 1/9/36). Chief Sanitary Inspector: ROBERT M. TURNER, M.S.I.A., A.R.San.I., Sanitary Inspector's Cert. Royal San. Inst. ; Meat & Other Foods Inspector's Cert., Royal San. Inst., Smoke Inspector's Cert. Royal San. Inst. Sanitary Inspectors: H. Young, 1.3. M. G. Crook, 1.3.4. W. Combey, 1.3.5. F. Winder, 1.3.5. Health Visitors: Miss V. L. Davies, 6.7.8. Miss M. E. Milner, 2.6.7.8. Miss G. Ainscow, 6.7.8. Miss D. S. Newman, 6.7.8. Miss M. H. Jones, 6.7.8. Miss D. C. Binding, 6.7.8. Miss M. L. Dale, 6.7.8. Miss A. K. Gallagher, 6.7.8. 1. Cert. R.S.I. and S.I.E. Jt. Bd. 2. Cert., San. Insp. Exam. Bd. 3. Meat Inspector's Certificate. 4. First Class Cert. Meat Smithfield Tech. Inst. 5. Smoke Inspector's Certificate. 6. Health Visitor's Certificate. 7. Cert. of Central Midwives' Board. 8. State Registered Nurse. 3 Clerical Staff. Chief Clerk : H. N. RYAN. Clerks : G. H. Hughes, I. W. C. E. Keutenius. T. L. Allison. P. B. D. Bunyan. A. F. Cowan. Part Time Clinic Medical Officers. MARY KING, M.R.C.S. (Eng.), L.R.C.P. (Lond.), D.P.H. F. ELIZABETH MILLARD HARVEY, M.B., Ch.B. M. A. BLANDY, M.R.C.S., M.B., B.S., M.R.C.P. EVELYN FISHER, B.A., M.D., D.P.H. Consultant Gynœcological and Obstetric Surgeon. JOHN W. RAIT BELL, L.P.C.P.I. & L.M., L.R.C.S.I. & L.M. Dental Surgeon. CHARLES LAFFERTY, L.D.S. 4 URBAN DISTRICT COUNCIL OF WEMBLEY. ANNUAL REPORT of the MEDICAL OFFICER OF HEALTH for the year 1936. ■ To the Chairman and Members of the Urban District Council. Mr. Chairman, Madam and Gentlemen, I beg to submit a Report on the Health and Sanitary Circumstances of the district for the year 1936. This Report is drawn up on the lines advised in Circular 1561 of the Ministry of Health. It contains information of the activities of the Public Health Department, and is set out, as far as possible, under the following six main heads:— Section "A."—Statistics and Social Conditions of the Area. „ "B."—General Provision of Health Services for the Area. „ "C."—Sanitary Circumstances of the Area. „ "D."—Housing. „ "E."—Inspection and Supervision of Food. „ "F."—Prevalence of, and Control Over, Infectious and other Diseases. Matter which has appeared in previous reports is not repeated, and only that relating to 1936 is recorded, the presentation being mainly statistical in form. The work of the Department for the greater part of 1936 was the responsibility of the late Medical Officer of Health, Dr. C. E. Goddard. I commenced duty on the 1st September. 5 The Public Health Department of a new and rapidly growing area, as is Wembley, must be in rapid evolution. The population is a quickly growing one, and it has been the policy of the Council gradually to increase both its public health staff and its clinic activites. During 1936 1 additional Sanitary Inspector, 2 Health Visitors and 1 JuniorClerk were appointed. Important decisions have been made with regard to the provision of new clinic buildings, and the holding of additional clinic sessions, ante-natal, infant welfare and toddlers' clinics. Certain hospital provision has also been considered by the Council, and in due course an Infectious Diseases Hospital will be provided in conjunction with the Borough of Acton and administered by a Joint Hospital Committee. The Council, too, have had the provision of a Joint Maternity Hospital with the Urban District Council of Harrow under consideration. The position wth regard to such hospital, however, progressed but slowly in 1936. This Report records a year's work well done by the Technical Officers of the Department, and for its compilation I am indebted to Mr. Ryan and the clerical staff. I have the honour to be, Mr. Chairman, Madam and Gentlemen, Your obedient servant, A. G. MORISON, Medical Officer of Health. 4th September, 1937. 6 Section A Statistics and Social Conditions of the Area. 7 SUMMARY OF GENERAL STATISTICS. Area in acres 6,300 Population, 1936 (Midsummer)— Estimated by Registrar-General 107,550 Population (Census) 1931 — Wembley 48,561 Kingsbury 16,636 65,197 Number of inhabited houses at end of 1936 according to Rate Books (approx.) 29,307 Rateable value—31st December, 1936 £1,182, 513 Product of Penny Rate (estimated) £4,620 SOCIAL CONDITIONS OF THE AREA. There was little change in the social conditions of the area during the year. Wembley may now be considered a typical town of greater London, soon to become completely developed. To the planning and layout, as well as to the provision of Open Spaces and Playing Fields, much attention has been given by the Council. UNEMPLOYMENT. With regard to unemployment, the following numbers, as on the 19th April, 1937, have been kindly supplied by the Managers of the Employment Labour Exchanges serving this district:— Exchange. Persons over 18 years of age, totally unemployed, resident within the Urban District of Wembley, April, 1937. Hendon 261 Willesden 310 Acton 2 Harrow 133 Total 706 8 This figure shows a diminution on that on the similar date in 1936. The Report for 1935 gave the following figures:— 1936 1,200 1935 672 REGISTER OF RAINFALL DURING THE YEAR 1936. The Engineer and Surveyor has kindly supplied the following figures regarding rainfall during the year:— Month Total Rainfall inches. No. of days on which rain fell Heaviest Fall inches. January 4.81 20 .85 February 1.82 14 .37 March 1.32 16 .25 April 1.43 12 .30 May .55 5 .24 June 3.91 19 .56 July 3.14 26 .50 August .46 9 .09 September 2.79 17 .64 October 1.79 14 .39 November 2.96 19 .67 December 1.61 21 .28 Totals 26.59 192 — Wettest day was January 9th with a fall of .85 ins. Wettest month was January with a fall of 4.81 ins. The average daily rainfall was .075 ins. Driest month was August with a fall of .46 ins. Longest dry spell—April 27th to May 17th—20 days. Longest wet spell—October 29th to November 8th— 11 days, 1.73 ins. Total rainfall for the year 1935 was 29.69 ins. 9 VITAL STATISTICS. Live Births. Male. Female. Total. Legitimate 871 820 1691 Birth Rate per Illegitimate 17 20 37 1000 of estimated resident 1728 tion 16.07 Still Births. Male. Female. Total. Legitimate 26 26 52 Rate per 1000 Illegitimate 1 — 1 total (live & still) births 29.76 53 Still Birth Rate per 1,000 estimated population 0.49. Deaths. Male. Female. Total. 369 401 770 Death Rate per 1,000 estimated population:— Crude Rate 7.16 Adjusted by Areal Comparability Factor of Registrar-General 9.02 Maternal Mortality. Deaths from Puerperal Sepsis 1 Other Puerperal Causes 2 3 Maternal Mortality Rate per 1,000 live births 1.73 Maternal Mortality Rate per 1,000 total (live and still) births 1.68 Infantile Mortality. Deaths of Infants under 1 year of age:— Male. Female. Total. Legitimate 41 35 76 Illegitimate 1 1 2 78 Death Rate of Infants under 1 year of age:— All Infants per 1,000 live births 45.14 Legitimate Infants per 1,000 legitimate live births 44.94 Illegitimate Infants per 1,000 illegitimate live births 54.05 10 Deaths from Cancer (all ages) 108 „ „ Measles (all ages) 1 „ „ Whooping Cough (all ages) 1 „ „ Diarrhoea (under 2 years) 9 COMPARATIVE VITAL STATISTICS, 1936. per 1,000 population per 1.000 Live Births per 1,000 Total Births (live & still) Maternal Mortality Birth Rate Still Birth Rate Death Rate Infantile Mortality Maternal Mortality Wembley 16.07 0.49 7.16 45.14 1.73 1.68 England and Wales 14.8 0.61 12.1 59 3.81 3.65 London 13.6 0.53 12.5 66 - - 122 County Boroughs and Great Towns including London 14.9 0.67 12.3 63 - - 143 smaller towns— Resident population 25,000 to 50,000 at Census 1931 15.0 0.64 11.5 55 - - BIRTHS. The live births of children of Wembley-resident parents during 1936, born inside or outside the district, totalled 1,728, comprising 888 males and 840 females, and including 17 males and 20 females who were illegitimate. The total number of births in 1935 was 1,605. These figures give a live birth rate of 16.07, a slight decrease on the figure of 16.19 for the previous year, whilst the figures for England and Wales show an increase from 14.7 in 1935 to 14.8 in 1936. The age distribution of the inhabitants of Wembley is exceptional, with a tendency, no doubt, to become more stabilised as the district becomes more fully developed. It is to be anticipated that the district will continue to show a higher percentage distribution among the young adult class than does the population of the country as a whole. This factor, no doubt, makes for the higher birth rate in the district. 11 DEATHS. The total number of deaths of Wembley residents during 1936 was 770, while the estimated population was 107,550. The corresponding' figure for the previous year was 678, with an estimated population of 99,120. The deaths comprised 369 males and 401 females. These figures represent a crude death rate of 7.16 per 1,000 population, an increase of .32 on the figure last year, whilst the figures for England and Wales also show an increase from 11.7 in 1935 to 12.1 in 1936. The adjusted death rate for Wembley, using the Areal Comparability Factor of the Registrar-General, is 9.02 compared with 8.62 in 1935. The low death rate for the district may be commented upon as follows : The crude death rate in Wembley has been consistently low, probably for two reasons:— (a) the inherently low mortality due to relative healthiness and absence of black industrial conditions; and (b) the exceptional young adult age distribution of the population. The crude mortality rate will probably rise in due course as the population stabilises itself. One would expect that the crude death rate will always be less than that of England and Wales as a whole, but that there will be a gradual convergence towards the general death rate for the country. Meantime, the crude death rate is about 60 per cent. that of England and Wales. Because of the general ageing of the population, the general death rate for the country is bound to rise, and the Wembley death rate, no doubt, will also rise with it. 12 CAUSES OF DEATH DURING YEAR 1936. CAUSES OF DEATH. M. F. Total. ALL CAUSES 369 401 770 Typhoid and paratyphoid fevers — — — Measles 1 — 1 Scarlet Fever 2 1 3 Whooping Cough 1 — 1 Diptheria 5 1 6 Influenza 5 6 11 Encephalitis lethargica 1 — 1 Cerebro-Spinal fever — 1 1 Tuberculosis of respiratory system 21 15 36 Other tuberculosis 7 4 11 Syphilis 1 - 1 General paralysis of insane, etc. 2 — 2 Cancer 41 67 108 Diabetes 4 11 15 Cerebral haemorrhage 6 16 22 Heart disease 72 71 143 Aneurysm 2 3 5 Other circulatory 19 33 52 Bronchitis 10 11 21 Pneumonia 22 23 45 Other respiratory 4 7 11 Peptic Ulcer 8 4 12 Diarrhcea, etc (under 2 years) 6 3 9 Appendicitis 4 1 5 Cirrhosis of liver 1 — 1 Other liver diseases — 5 5 Other digestive 14 8 22 Nephritis 13 8 21 Puerperal sepsis — 1 1 Other puerperal — 2 2 Congenital causes, etc. 23 24 47 Senility 8 14 22 Suicide 6 4 10 Other violence 27 10 37 Other defined causes 33 47 80 Causes ill-defined - - - 13 Heart disease alone again appears as the principal cause of mortality, having accounted for 18.5 per cent. of the total deaths. Cancer, accounting for 14.0 per cent. of the deaths, was the next highest cause of mortality. Tuberculosis of the respiratory system accounted for 36 deaths, a decrease of 9 on the figure for 1935, and deaths from non-pulmonary tuberculosis numbered 11, the same figure as for the previous year. It is noted, therefore, that there was a decrease in the deaths from tuberculosis. The following tables are interesting. In them there may be seen a reflection of the exceptional age distribution of the population. Some of the main causes of death are firstly set out with a comparative figure for 1935 for the whole country:- Disease. Wembley. Total No. of deaths. Proportion per total 1,000 deaths. A comparative figure. England & Wales 1935. Prop, per total 1,000 deaths. Heart and Circulatory Diseases 200 260 295 Cancer 108 140 135 Bronchitis, Pneumonia and other Respiratory diseases (excluding tuberculosis) 77 100 99 Tuberculosis 47 61 62 Violence all forms, including suicide 47 61 46 14 The next table gives the deaths at various age periods and shows that 37.92 per cent. of the deaths occurred amongst those who had not, so far, reached their 50th birthday:— Age Periods. Wembley. No. of deaths 1936. Percentage of total deaths. A comparative figure, 1935. England & Wales percentage of total deaths. 0-1 78 10.13 7.1 1-4 22 2.85 2.4 5-9 10 1.30 1.3 10-14 7 0.91 0.9 15—19 10 1.30 1.3 20—24 24 3.12 2.0 25-29 27 3.51 2.1 30-34 27 3.51 2.2 35-39 28 3.64 2.4 40-44 22 2.85 2.9 45-49 37 4.80 4.0 Totals: 0-49 292 37.92 28.7 50-54 50 6.49 5.4 55-59 61 7.92 7.2 60-64 73 10.13 9.3 65-69 72 9.35 11.2 70—74 66 8.57 12.5 75-79 75 9.74 11.8 80—84 49 6.36 8.3 85—89 18 2.34 4.1 90—94 8 1.05 1.3 95—99 1 0.13 0.22 100— - - .02 Totals: 770 100.00% 100.00% Of the 770 deaths, 368 took place in hospital, representing 47.8 per cent. of the total. 15 MATERNAL MORTALITY. Rate per 1,000 total births (live and still), 1932—1936. Year Wembley England & Wales 1932 5.98 4.06 1933 5.85 4.23 1934 3.11 4.41 1935 0.00 3.93 1936 1.68 3.65 Average of Rates 3.32 4.06 16 In the following table are shown the numbers of infant deaths from the various causes:— INFANT DEATHS—1936. Causes of Death. Nett Deaths from stated causes at Various Ages under 1 year of Age. Total Deaths under One Year Under 1 week 1-2 weeks 2-3 weeks 3-4 weeks Total under 1 Month 1-3 Months 3-6 Months 6-9 Months 9-12 Months Pneumonia — - - - - 2 2 4 2 10 Prematurity 13 3 — 1 17 1 — - — 18 Congenital defects 11 1 1 2 15 — — — — 15 Atelectasis 2 — — — 2 — — — — 2 Marasmus - - - - - - - - - 1 Gastro Enteritis — — 1 — 1 4 3 2 — 10 Injury at Birth 5 — — — 5 — — — — 5 Inanition - - - - - - - - - 2 Bronchitis — — — — — 2 3 — — 5 Pemphigus Foliaceus — — 1 — 1 — — — — 1 Pericarditis 1 — — — 1 — — — — 1 Suffocation (overlaying) - — — — — 1 1 — — 2 Haemorrhage Neonatorum 2 - - - 2 - - - - 2 Tuberculosis (nonpulmonary) - - - - - - - 1 - 1 Meningitis—nontubercular - - - - - - - - 1 1 Diphtheria - - - - - - - - 1 1 Other causes — — — 1 1 — — — — 1 Totals 34 4 3 4 45 12 10 7 4 78 17 The next two tables show Infantile Mortality in a comparative manner:— INFANTILE MORTALITY. Table showing Rates, 1932-1936. Year Wembley England & Wales 1932 40.89 65 1933 50.66 64 1934 39.90 59 1935 34.26 57 1936 45.14 59 Average 5 years 42.17 60.8 AGE DISTRIBUTION OF INFANT DEATHS. Year Deaths per 1,000 live Births registered. Under 4 weeks 4 weeks to 3 months Total under 3 months 3—6 months 6—12 months Total under 1 year Wembley 1934 25.1 3.8 28.9 8.4 2.6 39.9 1935 20.5 8.1 28.6 2.5 3.1 34.2 1936 26.0 6.9 32.9 5.8 6.4 45.1 England & Wales 1935 30.39 9.12 39.51 7.69 9.74 56.94 18 MARRIAGES. The Superintendent Registrar for the area has kindly supplied the following information concerning marriages which took place in the Urban District of Wembley during 1936:- In churches, chapels and synagogues 535 At Registry Office, where one or both parties were resident in the district 306 Total 841 19 Section B. General Provision of Health Services for the Area, 21 LIST OF ACTS EITHER IN WHOLE, OR PART, ADOPTED, AND BYE-LAWS AND REGULATIONS IN FORCE IN THE URBAN DISTRICT OF WEMBLEY. (DECEMBER, 1936.) Adoptive Acts:— Infectious Disease (Prevention) Act, 1890. Public Health Acts (Amendment Act), 1890. Public Health Acts (Amendment Act), 1907. Baths and Washhouses Act, 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.). Bye-laws 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 Good Rule and Government of the County of Middlesex for the prevention of nuisance 1936 New Streets and Buildings 1936 Bye-laws 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 1928 New Streets and Buildings 1929 1933 New Streets—Neeld (Wembley) Estate 1913 Smoke Abatement 1930 Bye-laws in Force in Area comprising Former Urban District of Kingsbury:— New Streets and Buildings 1926 1931 Smoke Emission 1933 22 Bye-laws 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. LABORATORY FACILITIES. No changes were made during the year concerning laboratory facilities. The Clinical Research Association continued to carry out the examination of swabs for the detection of Diphtheria, Typhoid, etc. Samples of milk and food were also examined at these laboratories. The Royal Institute of Public Health carried out examinations of sputum for the detection of tubercle bacilli. The following examinations were made during the year:— Examinations of Swabs 675 ,, ,, Blood Specimens 15 ,, ,, Sputum 186 ,, ,, Graded Milks 198 ,, Water 11 ,, ,, Miscellaneous 9 AMBULANCE FACILITIES. (i) Infectious Disease.—The Council's arrangement whereby all cases of Infectious Disease occurring in the district are removed to hospital by the ambulance owned by the Acton Borough Council remained in force. 23 (ii) Non-Infectious Cases.—The ambulance service provided by the Council for accident and illness cases is administered by the Fire Brigade and Ambulance Committee. Two ambulances are provided for this service, and no charge is made for their appropriate use. The Chief Officer of the Fire Brigade and Ambulance Services has kindly supplied the following information with regard to 2,151 calls he received:— General Removals (sickness, etc.) 1,461 Maternity Removals 164 Street Accidents 310 Street Illnesses 93 Not required on arrival 62 Malicious Calls 9 Out-District Calls attended 4 Passed to Acton Infectious Ambulance 24 Carried out by other Authorities for us:— Removals 6 Maternity Removals 1 Accidents 11 Street Illnesses 3 Not required on arrival 3 2,151 Total Mileage (both Ambulances).—19,086.5. NURSING IN THE HOME. As regards Nursing in the Home, the Council have been particularly interested in the two Nursing Associations in the district—the Wembley District Nursing Association and the Kingsbury District Nursing Association. Both these Associations are affiliated to the Queen's Institute of District Nursing. The happy relationship between the Council and the Associations has remained, and early in 1937 an arrangement that the Council pay for certain nursing services given by the Association was made. Further details concerning this, however, will fall to be mentioned in the Report for 1937. The Council contributed £150 to the Wembley Association and £50 to the Kingsbury Association during the year. The public health value of the work of both Associations is undoubted. The Associations have kindly supplied the following figures relating to their work in 1936:— 24 25 The various Clinic Services provided by the Council during 1936 were as follows:— Description. Situation. . Date and Time. MATERNITY AND CHILD WELFARE CLINICS. St. Andrew's Hall, Ealing Road, Wembley. Wednesday, 2-4 p.m. Thursday, 2-4 p.m. Tokyngton Hall, Monks Park, Wembley. Tuesday, 2-4 p.m. Wesley House, Harrow Road, Sudbury. Monday, 2-4 p.m. Friday, 2-4 p.m. Kingsbury Free Church, Slough Lane. Tuesday, 2-4 p.m. Kingsbury Church Hall, Bacon Lane. Monday, 2-4 p.m. Wednesday, 2-4 p.m. Friday, 2-4 p.m. ANTE-NATAL CLINICS. St. Andrew's Hall, Ealing Road, Wembley. Thursday at 9.30 a.m. Kingsbury Free Church, Slough Lane. 2nd and last Friday in each month at 9.30 a.m. DENTAL CLINICS. Alperton Council School, Ealing Road. Fortnightly. Kingsbury Free Church, Slough Lane. GYNAECOLOGICAL CLINIC. 1 a, Bridge Road, Wembley Park. 2nd and last Friday in each month—10 a.m.— 12 noon. BIRTH CONTROL SESSION. do. 1st and 3rd Tuesday in each month—2.30 p.m. Wembley District Nursing Association. 13,467 visits were paid during 1936. Six nurses, under the control of a superintendent, are engaged while the Central Home is situated at 80, Wembley Park Drive. Kingsbury District Nursing Association. During 1936, 5,025 visits were paid by the nurses. The two nurses are accommodated at 77, Boycroft Avenue, Kingsbury. The Council do not supply directly any Nursing-in-theHome service. The Council also have an arrangement with Wembley Hospital by which artificial light treatment, X-Ray examination and massage treatment are given. In addition, the Middlesex County Council have a School Clinic at Wembley Hill School and at Kingsbury Green School, while the Tuberculosis Dispensary of the County Council is situated at Pound Lane, Willesden. There is no centre for the treatment of venereal disease in the district. This service, a responsibility of the County Council, is provided at the various London hospitals. GYNAECOLOGICAL CLINIC. During the year a step of distinct advance was taken by the Council opening a special Gynaecological Clinic. The reasons for recommending such a clinic have appeared in previous Reports. There follows a report on the work of the Clinic by Mrs. F. Elizabeth Harvey, M.B., Ch.B.:— I have the honour to report that in consequence of various cases requiring gynaecological attention and treatment being met with at the various welfare centres and ante-natal clinics, it was decided to open a special clinic for women in the district. This special clinic was opened on the 24th April, 1936, at 1a, Bridge Road, Wembley Park. It was adequately fitted up and equipped for the purpose, and it is staffed by one medical officer (myself) and one health visitor. The clinic is held twice monthly, namely, from 10 a.m. to noon on the second and last Fridays in each month. Its existence has been made known by advertisements in the local Press, and the co-operation of the local medical profession has also been sought. Since its inception it has held 23 sessions and the total number of patients attended amounted to 175, i.e., an average attendance of 7.6 patients per session. It is submitted that the wide variety of cases examined during the year demonstrates the need for the special clinic and the importance of the services rendered. 26 Of the cases attended, the medical ones were either referred to patients' individual medical attendants or were sent to hospital with an accompanying explanatory letter; the cases in which surgical treatment was indicated numbered seven, and these were sent to hospital. The remainder of the patients were treated at the clinic by myself, and in some cases, where special home treatment was required, the necessary arrangements were made for this to be given by the District Nurses. Amongst the diseases treated it is to be observed that some cases of subinvolution of the uterus, erosion of the cervix and prolapsus uteri have been treated and re-treated at several sessions, but although in the main the patients have attended with regularity it is felt that to treat adequately complaints of those kinds more frequent attendances would produce more speedy and effective results, as two attendances per mensem are not really sufficient; particularly as a patient may be for private reasons sometimes unable to have treatment at a particular session, which means of course an interval of a month between two treatments. I would not like to conclude this short resume of the year's work without placing upon record my appreciation of the assistance which has been rendered by the Health Visitors, and also that the patients have attended with commendable regularity and have seemed to welcome the advice and the attention which thev received. 26th April, 1937. . BIRTH CONTROL. Special sessions at which birth control advice is given were established at the same time as was the Gynaecological Clinic. A Report by Mrs. E. Fisher, M.D., D.P.H., is submitted:— The total number of attendances at the clinic since its opening (on the first and third Tuesdays of each month) has been 60. Of this number 46 are new cases and 14 are return visits. 27 This number is not large, but it is the usual experience that numbers at these clinics grow slowly but surely. It takes a considerable time for the idea to take root and spread that scientific birth control is commonly necessary nowadays for a healthy and satisfactory married life. Two-thirds of all the patients had already been practising some method of family limitation which for one reason or another they had found to be unsatisfactory. Seventeen of these were using a method which is now widely condemned by psychologists as being productive of various neurosis. In three cases it was considered that there was no medical reason to advise them upon contraceptive methods. The average age of the mothers receiving advice was 30.8 years and the average size of the family was 3.16 children, the numbers ranging from one child to eight. Up to the present no case of failure of the method has been reported. April, 1937. HOSPITALS. There is no Municipal Hospital in the district. The most nearly situated County Hospitals are:— (1) Redhill County Hospital, Edgware. (2) Central Middlesex County Hospital, Park Royal. To the Wembley Hospital, a voluntary institution having 63 beds, the Council again made a contribution of 250 guineas. The great London Voluntary Hospitals also supply both consultation and in-patient services to the inhabitants of the district. LOCAL GOVERNMENT AND OTHER OFFICERS' SUPERANNUATION ACT, 1922. During 1936, 68 examinations were made by the Medical Officer of Health of persons about to be appointed to the permanent staff of the Council. 28 29 MATERNITY AND CHILD WELFARE SERVICES. Average attendances at the various clinic sessions are set out below:— INFANT WELFARE CLINICS. Centre Sessions per week Average attendance per Session Total attendances during the year Children under 1 year 1—5 years Mothers Children under I year 1—5 years Mothers WEMBLEY St. Andrew's Hall, Ealing Road. 2 72 45 103 7672 4732 10908 SUDBURY Wesley House, Harrow Road. 2 38 22 54 3772 2125 5294 TOKYNGTON Tokyngton Church Hall, Monks Park. 1 50 29 72 2575 1468 3675 BACON LANE Church Hall, Bacon Lane. 3 50 23 82 6067 2806 9877 SLOUGH LANE Kingsbury Free Church, Slough Lane. 1 49 27 74 2472 1368 3680 Total 22,558 12,499 33,434 In addition, by arrangement with the Harrow Urban District Council, residents in the Kenton area attended the Clinic held at Elmwood Avenue, Kenton. Children 200 attendances. ANTE-NATAL CLINICS. Centre. Sessions. Average attendance per Session. Total attendances during year. WEMBLEY St. Andrew's Hall, Ealing Road. Once Weekly. 15 785 SLOUGH LANE, Kingsbury Free Church. Twice Monthly. 16 375 Attendances at Harrow Clinic (Kenton) 31 BIRTHS NOTIFIED TO MEDICAL OFFICER OF HEALTH. 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 1,595 (b) Still Births 47 (c) Total 1,642 That the percentage of notified live births represented by the number of children who attended at the centres during the year, and who on first attendance were under one year of age, was 80.4 compared with 66.2 in 1935 may be considered a satisfactory sign. The percentage of total notified births (live and still) represented by the total number of women who attended the clinic for the first time during the year was 29.1% compared with 22.7% in 1935. This figure is one which may be expected to increase as the Council's policy of providing permanent clinic buildings proceeds. It is to be realised, also, that the figures given in the table relating to attendances at the clinics are averages for the year, while the attendances were growing steadily throughout the year. At the end of December all the Infant Welfare Sessions were working beyond a capacity allowing the best possible services to be given. VOLUNTARY HELPERS. The Voluntary Helpers continued to give their valued assistance to the Maternity and Child Welfare Section of the Council's work by attending at the clinics and assisting in many ways in the detailed routine of the clinic services. They have given their unobtrusive help most freely, and their co-operation is much appreciated. DENTAL SERVICE. Dental Clinics continued to be held at Alperton School, Ealing Road, Wembley, and at the Kingsbury Free Church, Slough Lane, Kingsbury, sessions being held at each centre on alternate weeks. Expectant and nursing mothers and children have been referred from the Infant Welfare Centres, and by the Health Visitors, for treatment. The attendances during 1936 are shown in the table. 30 MIDWIFERY ASSISTANCE. Consultant—Gynecological and Obstetric Surgeon. During the year the services of the consultant, Dr. J. W. Rait-Bell, for complicated maternity cases, were sought by medical practitioners in nine cases. The Council's Scheme for assisting mothers desirous of having confinement at home, and who are unable to pay a midwife's fee, continued in operation during the year. The fee of a midwife in attendance on one mother war paid in 1936. Seventeen maternity outfits were supplied. MILK GRANTS. During 1936 grants of liquid mlik to the value of £666 7s. 2d. were made to mothers and children whose financial circumstances were within the adopted economic scale. Grants of dried milk and other accessory foods amounting to £372 17s. 1d. were also made. MASSAGE AND SUNLIGHT TREATMENT. The arrangements continued between the Council and the Wembley Hospital whereby cases referred from the clinics as requiring artificial sunlight or massage treatment are dealt with at the hospital. Charges were made to parents according to their financial circumstances. 31 DENTAL CLINICS. Centre. Day and Time. Average attendance per Session. Total attendances during year. Children Mothers Children Mothers WEMBLEY Alperton Council School, Ealing Road. Fortnightly, Saturdays at 9.30 a.m. 5 10 123 228 SLOUGH LANE, Kingsbury Free Church, Slough Lane. Fortnightly, Saturdays at 9.30 a.m. 4 8 86 194 Dentures have been supplied to expectant and nursing mothers, during the year 32 full or partial sets being supplied and appropriate repayment assessed according to the Council's economic scale. Nineteen sets were supplied free of charge. In the 13 other cases a portion of the cost was paid by the patient. During 1936, 105 cases were referred and 1,052 treatments given. CONVALESCENT HOME TREATMENT. The Council have allowed arrangements to be made in appropriate cases for change of environment at a convalescent home, and accepted responsibility for the payment in whole, or in part, for this convalescence according to their economic scale. During the year arrangements were made for the convalescence of 17 cases. MIDWIVES. The supervision of midwives and the registration of nursing homes in the district are responsibilities of the Middlesex County Council. The County Medical Officer of Health has kindly supplied the information that at the end of 1936 there were 30 midwives resident and practising in the district, and eight nursing homes registered for the reception of maternity cases. The passing of the Midwives Act, 1936, seemed to be an appropriate time for the Council to make application to the Minister of Health, under Section 62 of the Local Government Act, 1929, that the Council should become the local supervising authority under the Midwives Acts for the district in place of the County Council. The Council felt that there were already many points of contact with the practising midwives in this area and their maternity and child welfare services, and that were the Council to become the local supervising authority this contact would be strengthened and fuller gains obtained from the district's health services. The Minister of Health, however, in intimating that he did not propose to issue such an order desired it to be understood that the most important factor to be considered in connection with such an application was the number of cases attended each year by midwives in the homes of patients within the district, and, having regard to the small number of such cases in Wembley, the number of midwives required in the district would be too few to justify the establishment of a separate service for the district. The following table, drawn up from the notification of births received, would appear to be relevant:— 32 33 BIRTHS NOTIFICATIONS, 1934-1936. By whom Notified. Place at which Birth occurred. Totals. At Home. In Hospitals. In Nursing Homes, etc. 1934. 1935. 1936. 1934. 1935. 1936. 1934. 1935. 1936. 1934. 1935. 1936. DOCTORS 351 385 348 319 355 557 178 132 71 848 872 976 MIDWIVES 277 365 368 79 84 14 149 203 258 505 652 640 PARENTS 95 47 23 3 2 — 6 3 3 104 52 26 TOTALS 723 797 739 401 441 571 333 333 332 1457 1576 1642 HOSPITAL ACCOMMODATION FOR MATERNITY CASES. Previous reports have dealt with the proposition of a joint maternity hospital for Harrow and Wembley being provided by the two Urban District Councils—40 beds for Harrow patients and 30 beds for Wembley patients. Little material progress concerning this matter can be reported to have taken place in 1936. Throughout the year the difficulty of satisfying, on behalf of the Council, the demand for hospital beds for confinement was as great as ever. Such demands may arise because of some medical complication or anticipated abnormality, because of environmental unsuitability for confinement in the home, or because of the patient herself seeking hospital confinement although there may be strictly no medical reason for the confinement taking place in hospital rather than in the home. With regard to this third group of case, for some years there has been a steady increase in the percentage of births taking place in hospital throughout the country, and there appears to be no reason to anticipate a falling off in the desire of women to be confined in hospital. The demand for hospital maternity beds, as regards Wembley, has been met by the Health Department referring cases to the hospitals of the County Council and to the London hospitals. In 1936, 1,642 births were notified to the Medical Officer of Health. Of these 739 were born at home, 571 in hospital and 332 in private nursing homes or at private addresses other than the normal residence of the mother. These figures mean that 45 per cent. of the births took place at home, 34.8 per cent. in hospital, while the further 20.2 per cent. of the mothers made arrangements to enter a private nursing home or to have the confinement at the house of a friend. A certain number of the 20.2 per cent. treated otherwise than at home or in hospital would undoubtedly rather have had their confinement in hospital, while it is also true that the percentage of births in hospital would have been greater had there been hospital accommodation available nearer than London. The following statistics show the growing desire for confinement in hospital. 31 The position is that the County Council have declared their intention of increasing their maternity hospital accommodation, and have stated that they have based their present proposals upon the total number of beds which would enable 30—40 per cent. of all births occurring in the County to take place in County or Municipal hospitals. The points which still give the Wembley Council concern are, firstly, that the proposals of the County Council would be insufficient in the number of maternity beds supplied, and, secondly, that the hospital provision of beds would be better made by the two District Councils, this allowing the completion of their respective maternity and child welfare schemes by themselves providing also the appropriate hospital accommodation. There would seem to be much substance supporting the Council in holding this view. HEALTH VISITORS. By reason of the development of the service, the staff of Health Visitors was increased by two during the year, the total number of Health Visitors at the end of the year being eight. 35 STATISTICS RE BIRTHS NOTIFIED. Year. Total No. of births notified. No. of births at home. No. of births in hospital. No. of births in M.C.C. hospitals (included in preceding column). Births in private Nursing Homes, and at private addresses other than the normal residence of the mother. 1934 1457 723 401 - 333 49.6% 27.5% 22.9% 1935 1576 797 441 147 338 50.7% 27.9% 9.3% 21.4% 1936 1642 739 571 156 332 45.0% 34.8% 9.5% 20.2% The district has been divided into eight areas, each Health Visitor taking responsibility for one, all having rather over 200 births annually. In the allocation of duties, home visiting and clinic responsibilities have been coordinated, so that in due course each Health Visitor becomes fully acquainted with the detailed personnel of her district. The numbers of home visits paid during the year by the Health Visitors were:— To Expectant Mothers:— First Visits 700 Total Visits 1,196 To Children under 1 year of age:— First Visits 2,009 Total Visits 6,008 To Children between 1 and 5 years of age:— Total Visits 5,700 Special Visits:— Ophthalmia Neonatorum and other eye conditions 17 Puerperal Fever 3 Puerperal Pyrexia 7 Measles 148 Whooping Cough 93 Diarrhoea 46 General (unclassified) 337 INFANT LIFE PROTECTION. The work of visiting children placed in the care of foster-mothers is carried out by the Health Visitors, all of whom have been appointed Infant Life Protection Visitors. Visits paid during 1936:— To Foster Children 1,109 To Foster Parents 792 At the end of the year there were on the register:— Foster Children 82 Foster Parents 57 Number of Foster Children who died during the year Nil On whom inquests were held Nil The circumstances of foster parents and prospective parents have been carefully investigated, and when a house appears unsuitable for the reception of children the advice is given not to pursue the matter. 36 Sections C & D. Sanitary Circumstances of the Area and Housing. 37 The assistance of Mr. R. M. Turner, Chief Sanitary Inspector, in the writing of Sections C, D and E is gratefully acknowledged. SANITARY CIRCUMSTANCES OF THE AREA. Water. The whole of Wembley is served by a continuous supply of water. Much the greater area is supplied by the Colne Valley Water Company, a small area of Sudbury obtaining its supply from the Rickmansworth and Uxbridge Water Company. The London, Midland and Scottish Railway owns four cottages which obtain their supply from the Railway Company's private main. Samples of these waters were submitted to the Clinical Research Association for analysis during the year. Appended is a table showing results of chemical and bacteriological examination. There are no private wells in the district which are. used for the supply of water for domestic purposes. 38 39 CHEMICAL AND BACTERIOLOGICAL WATER REPORTS. CHEMICAL. Sample of Water. Colne Valley Water Co. 20/7/36. Sample of Water. L.M.S. Railway Supply. 16/12/36. Sample of Water. Rickmansworth & Uxbridge Public Supply. 12/8/36. Parts per 100,000 Grains per Gallon. Parts per 100,000 Grains per Gallon. Parts per 100,000 Grains per Gallon. Total Solids (dried at 120°C) 39.00 27.30 17.0 11.9 36.5 25.6 Combined chlorine 7.80 5.46 2.50 1.75 7.50 5.25 equivalent to Na CI 12.87 9.01 4.13 2.89 12.38 8.67 Nitric nitrogen (Nitrates) 0.50 0.35 0.46 0.32 0.50 0.35 Nitrous nitrogen (Nitrites) Nil Nil Nil Nil Nil Nil Ammoniacal nitrogen 0.0002 0.0001 0.0010 0.0007 0.0003 0.0002 Albuminoid nitrogen 0.0036 0.0025 0.0070 0.0049 0.0028 0.0020 Oxygen absorbed in 4 hours at 27°C 0.035 0.024 0.071 0.050 0.031 0.022 Lead or Copper Nil Nil Nil Nil Nil Nil Temporary hardness (equivalent to CaCo3) 15.0 10.5 3.5 2.4 16.0 11.2 Permanent hardness Nil Nil 4.5 3.2 Nil Nil Total hardness 15.0 10.5 8.0 5.6 16.0 11.2 BACTERIOLOGICAL. Average number of organisms producing visible colonies on gelatine plates, incubated at 200220C. for 3 days 24 per c.c. 44 colonies per c.c. 7 per c.c. Average number of organisms producing visible colonies on agar plates, incubated at 37.5°C. for 2 days 10 per c.c. 17 colonies per c.c. 3 per c.c. B. Coli Not found in 100 c.c. 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. Not found in 30 c.c. B. Welchii (spores) Not found in 100 c.c. Not found in 100 c.c. Not found in 100 c.c. BACTERIOLOGIST'S REMARKS: Results shew this water to be quite satisfactory for drinking purposes. Results shew this water to be quite satisfactory for drinking purposes. Results shew this water to be quite satisfactory for drinking purposes. Drainage and Sewerage. A very important event under this heading; for 1936 was the coming into operation of the West Middlesex Main Drainage Scheme into which all the soil sewage from Wembley now discharges. As a result the Council's two Sewage Disposal Works at Alperton and Kingsbury were closed down. Closet Accommodation. With a few exceptions water closet accommodation is provided in every house in the district. In a group of cases water-closet accommodation is shared by two houses, but the properties concerned are the subject of a clearance order, awaiting confirmation by the Minister of Health. Three houses provided with pail closets were demolished during the year, and at the end of 1936 there were eight houses with pail closets. Rivers and Streams. The various water courses in the district were kept under observation, and any cases of pollution have been promptly dealt with. There has been a marked improvement in their condition since the West Middlesex Main Drainage Scheme has been in operation. The streams are periodically cleansed by the Middlesex County Council. Public Cleansing. The Cleansing Superintendent has kindly supplied the following concerning the cleansing of the district which is carried out under his control:— Since the issue of the last Report, the re-organisation of the Public Cleansing Services under the control of the recently created Public Cleansing Department has been completed. The collection of refuse from the whole district is now carried out by direct labour and four modern vehicles have been purchased to carry out the work in the Kingsbury area, previously done by contractors. In former years refuse disposal was carried out by contractors who barged the refuse away from the district. This practice was discontinued on 30th September, 1936, when a new Refuse Disposal Plant, capable 40 of dealing with the continually increasing output of refuse from Wembley, was put into operation. All refuse with a marketable value is sorted and the remainder burnt. It is interesting to note that this Plant has been inspected by representatives of many local authorities in this country, also visitors from overseas, and all have been impressed by its efficiency and cleanliness. The supervision of public conveniences and street cleansing are also under the control of the Public Cleansing Department, and the latter service has been completely re-organised and modern equipment purchased. No refuse has been collected from earth closets, privies or cesspools. Tents, Vans and Sheds. A considerable amount of time was once again taken up in dealing with gipsies, and the remarks made in the 1935 Report apply to 1936. Sanitary Inspection of District. Inspections re Complaints 770 ,, of Slaughterhouses 133 ,, ,, Cowsheds 26 ,, ,, Dairies and Milkshops 200 ,, ,, Butchers' Shops 347 ,, ,, Markets 42 ,, ,, Other Food Premises 799 ,, ,, Bakehouses (Factory) 59 ,, ,, Bakehouses (Workshop) 8 ,, re Offensive Trades 72 ,, of Factories (not including Bakehouses) 185 ,, ,, Workshops ,, ,, ,, 15 ,, ,, Workplaces 12 ,, ,, Outworkers' Premises 2 ,, ,, Schools (Drainage, etc.) 21 ,, ,, Cesspools, etc. 9 ,, ,, Urinals and Latrines 141 ,, ,, Public Conveniences 198 ,, ,, Ditches, Streams, etc. 156 ,, ,, Stables and Manure Pits 23 ,, Piggeries 40 ,, ,, Tents, Vans, Sheds, etc. 79 ,, ,, Yards 2115 41 ,, ,, Refuse Dumps, Open Spaces, etc. 142 ,, ,, Cinemas, Dance Halls, etc. 33 ,, re Infectious Disease 683 ,, of Houses under Housing Regulations 25 ,, ,, Other Houses 557 ,, ,, Boiler Plant, etc. 71 ,, ,, Petroleum Stores 99 ,, ,, Mortuary 6 ,, ,, Swimming Baths 7 ,, ,, Hairdressers' Premises 61 ,, ,, Churchyards 3 ,, re Dust Bins 339 Overcrowding 2768 Verminous Premises 114 Miscellaneous 1780 Drains 1302 Drain Tests Applied 35 Smoke Observations (half-hour) 162 (casual) 575 Samples of Water taken 12 Samples of Milk taken 198 Revisits 2955 Total 17379 Total No. of Informal Notices served 636 ,, ,, ,, Statutory Notices served 23 Nuisances Abated and Defects Remedied. Drains Cleansed from Obstruction 495 New Drains and Inspection Chambers Provided 3 Drains Relaid or Repaired 34 Inspection Chambers Repaired 34 Soil Pipes and Ventilating Shafts Repaired 3 Yards Paved or Repaired 12 Floors of Dwellings Relaid or Repaired 6 Sub-Floor Ventilation Provided or Improved 2 Internal Walls and Ceilings Repaired 43 New Lavatory Basins Provided 8 Dampness Remedied 25 External Walls and Chimneys Repointed or Repaired 21 Roofs Reconstructed or Repaired 23 Windows Repaired or Additional Windows Provided 30 Spouts and Gutters Repaired or Renewed 27 New Sinks Provided 5 42 Sinkwaste Pipes Repaired or Renewed 21 Cooking Stoves and Firegrates Repaired or Renewed 20 Wash Coppers Repaired or Renewed 2 Ventilation of Food Stores Improved 1 Rooms Cleansed and Redecorated 139 Passages and Staircases Cleansed and Redecorated 19 W.C. Walls Cleansed 14 W.C. Structures Repaired or Rebuilt 8 W.C. Cisterns Repaired or Renewed 25 Fouled W.C.'s and Urinals Cleansed 27 Dustbins Supplied 343 Smoke Nuisances Abated 34 Nuisances from Animals Abated 7 Accumulations Removed 66 Tents and Vans Removed 54 Water Supply Improved 13 Ditches and Streams Cleansed 21 Verminous Premises Disinfected 59 Floors of Pigstyes Repaired and Walls Cleansed 36 Premises Demolished 4 W.C. Pedestals Provided 12 Overcrowding Abated 2 Referred to other Departments 31 New Door Fitted 1 Miscellaneous 28 Contraventions Remedied:— Slaughterhouses 4 Butchers' Shops 24 Cowsheds 2 Dairies and Milkshops 1 Bakehouses 10 Offensive Trades 1 Cinemas, Dance Halls, etc. 3 Hairdressers 7 Other Food Premises 18 Total 1828 Factories, Workshops, Workplaces and Outworkers. During 1936, 279 inspections were made of factories, workshops and workplaces. In matters which appeared to be the concern of H.M. Inspector of Factories, she was notified by this Department. 43 44 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) 244 9 — * Workshops (Including Workshop Laundries) 23 - - Workplaces (Other than Outworkers' premises) 12 - - Total 279 9 — *These figures include 59 visits to Factory Bakehouses and 8 visits to Workshop Bakehouses. 2.—DEFECTS FOUND IN FACTORIES, WORKSHOPS AND WORKPLACES. Particulars. Number of Defects Number of offences in respect of which prosecutions were instituted. Found Remedied Referred to H.M. Inspector Nuisances under the Public Health Acts: Want of Cleanliness 19 15 — — Want of Ventilation 8 3 1 — Overcrowding — — — — Want of drainage of floors — — — — Other Nuisances — — — — Sanitary accommo- dation insufficient 4 4 — — unsuitable or defective 8 6 - - not separate for sexes — - - - Offences under the Factory and Workshop Acts-.— Illegal occupation of underground bakehouses (S.101) — - - - Other offences — - — - Excluding offences relating to outwork and offences under the Sections mentioned in the Schedule to the Ministry of Health . (Factories and Workshops Transfer of Powers) Order, 1921. Total 39 28 1 — Shops Act, 1934, Section 10. Arrangements for Health and Comfort of Shop Workers. The Shops Inspector has kindly supplied the following information concerning work under the above Section of the Act during 1936:— No. of Inspection Visits.paid 1041 Section 10 (1) (b)—Temperature: Number of shops in which temperature was not suitable and sufficient 11 Section 10 (2)—Sanitary Conveniences: Number of Shops in which Sanitary Conveniences were not suitable and sufficient 24 Number of Certificates of exemption granted 6 Section 10 (4)—Washing Facilities: Number of Shops in which Washing Facilities were not suitable and sufficient 16 Number of Certificates of Exemption granted 2 Offensive Trades. The only offensive trade carried on in Wembley is that of fish frying. There are 12 fish friers in the district, and 72 visits were paid to these premises during the year. They were generally found to be well conducted. Smoke Abatement. Frequent observations were kept of the chimneys in the district. During 1936, 575 casual observations and 162 halfhourly observations were made. Generally speaking, it has been the experience to find that factory owners are willing to co-operate with the Department to abate smoke nuisances. Swimming Baths and Pools. The Council's bath at Vale Farm, Sudbury, has been referred to in previous Reports, as has also the Empire Pool, Wembley Park. During the year 5 samples of water from the Vale Farm bath were submitted to the Clinical Research Association for analysis, and 1 sample was taken from the Empire Pool. The Reports were satisfactory. 45 During the year the Council were engaged in the consideration of an additional swimming bath for the Kingsbury area, and by the end of the year the decision to proceed had been taken. The Ministry of Health Inquiry did not take place until 1937. The following scheme has been drawn up as giving appropriate headings for the examination and assessment of swimming baths and pools. It is based on the publications of the Ministry of Health:— 1. Physical Conditions: (a) Size of bath (depth for diving safety from any considerable height—7½ feet):— Length: Breadth: Depth : Structure of walls and bottom of bath: Bath surround : Any slope from the bath: Is surround effectively drained? (b) Ventilation of bath hall: Number of boxes: Any overcrowding in boxes? (c) Is water free from contamination on entering? Source of water. Any contamination from surface drainage, percolation, vegetation? (d) Contamination from bathers— Is shower, footbath, provided? Is there hot water and soap? Is there lavatory accommodation? (If mixed bathing, separate lavatories for sexes). Towels and costumes— If provided by owners of bath, are facilities adequate for washing and sterilising? 2. Purification of Water : (Standard : Efficient continuous filtration with continuous accurately controlled chlorination). (a) Is there constant flow of water into and out of bath? Springs, etc., is flow controlled by inlets and outlets? (b) Is there any method of purification? (i) Natural, e.g., spring sources compensating for evaporation and other losses. 46 (ii) Fill-and-empty system— What criterion used for need of re-fill? How often re-filled? Is bath cleansed and scrubbed down, and washed out when empty? (iii) Chemicals without filtration— What chemicals? What dose? What criterion for control of dose? (iv) Continuous filtration— What is the filter—Pressure Filter Rapid-gravity Filter Is filtration continuous when bath being used? What is the turn-over period? (Standard for indoor baths not more than four hours, for outdoor baths allow longer). What is the speed of filtration? (Standard 200 gals. per sq. ft. per hour). Any coagulant added? Nature and quantity— Any mechanical control of this added coagulant? Is water re-heated? (Standard temperature for baths 72°F.). Is water aerated? How? At what stage? 3. Chlorination: (Standard to be attained not less than .2 and not more than .5 parts of free chlorine per million parts of water). Is the bath water chlorinated? Is chlorination continuous? How is chlorination performed? Any estimation of chlorine content made by staff? (Standard : Three such readings per day.) What test do they use? How often do they use it? Is a record kept? Is chloramine used? 47 4. Alkalinity : (Standard—definitely alkaline to methyl orange, but free from caustic alkalinity). Any measurement made of this? Any standard attempted? 5. Clarity: (Standard—19 S.W.G. platinum wire to be seen through a depth of six feet). Any standard used? How often is water tested for clarity? 6. Cleansing Bottom of Bath : Method— How often used? 7. General: Is daily log kept of working of filters, etc., e.g., (a) Hours during which the plant is working. (b) Washing of each unit and the time taken. (c) Power consumed during each 24 hours for the filters only. (d) Weight of each chemical used, including the liquid chlorine gas. (e) Amount of make-up water taken from the mains. (f) Notes on the alkalinity, clarity and chlorine content of the bath water. (g) Notes on any unusual condition observed in the bath and of any defects or difficulties experienced with the filter plant. Eradication of Bed Bugs. Disinfestation measures regarding Council houses have provided for the removal of architraves, skirting boards, picture rails, etc. Wallpaper has been stripped and the woodwork and bedsteads subjected to blow-lamp. After the spraying of all surfaces with an insecticide the rooms have been sealed and fumigated. Where it has been found necessary bedding and articles of furniture have been destroyed. These measures are applied until the premises are free from vermin. A spray is loaned to the tenant and a quantity of 48 insecticide provided free of cost in order that disinfestation shall be complete. The Council have not used the method of fumigation by hydrogen cyanide gas. Other houses are visited upon receipt of a complaint of infestation and detailed advice given to the tenant and the owner is informed. The tenant is supplied with a quantity of insecticide free of cost. No cases have yet been found where belongings of new tenants to Council Houses have appeared to be infested. Applicants premises are inspected prior to the granting of a house. Should it be found necessarv to fumigate infested furniture the services of a specialist firm would have to be engaged. The fumigation of Council houses is carried out by the Council's own staff, but other houses are dealt with by the tenants or landlords of the premises, either by themselves or by a specialist finm on their behalf, and the case is not lost sight of until the Sanitary Inspector is satisfied that no evidence exists of bugs still being present. Figures for 1936:— 1. Number of Council Houses:— (a) found to be infested 19 (b) subsequently disinfested 19 2. Number of other Houses:— (a) found to be infested 56 (b) subsequently disinfested 47 Schools. The various elementarv and secondarv schools have been - subjected to periodical inspection. All of the schools in this area are provided with water supplies from the Water Company's mains. In addition private schools were inspected, classrooms measured and statements of suggested maximum numbers supplied to the Principals. The numbers supplied were based on the Board of Education Standard for Elementary Schools. No school was closed during 1936 by reason of the incidence of infectious disease. Individual scholars have been excluded from school on the occurrence of infectious disease in the home according to the memorandum of the Middlesex County Council. 41 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. 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 mortuary is available free of charge. An appreciable improvement has been carried out by the provision of a hot water installation. During 1936— 65 bodies were deposited 42 post-mortem examinations were made 28 Coroner's inquests were held in the schoolroom adjoining. A full-time mortuary and Burial Ground Attendant is employed by the Council. Rag Flock Acts, 1911 and 1928. No samples of Rag Flock were taken by the Council's Sanitary Officers during the year. REPORT ON THE PREVENTION AND ABATEMENT OF OVERCROWDING. Housing Act, 1935. The survey in Wembley was carried out on the lines suggested by the Ministry of Health and was commenced in December, 1935, and completed in March, 1936. Two men who had been previously unemployed were engaged to obtain the information on "Form A" and in every suspected case of overcrowding a visit was paid to the house by a Sanitary Inspector, who then completed "Form B." Number of families enumerated (Form A) 8659 Number of families enumerated (Form B) 723 Number of families found to be overcrowded 191 (2.2%) 50 51 The number of cases of overcrowding on the Council's Housing Estates were as follows:— Lyon Park Housing Estate 11 Manor Farm Housing Estate 1 Kingsbury Housing Estate 3 of these six cases had been abated. It is noteworthy that of the 8,659 houses surveyed, 1,034 (11.9%) houses primarily intended for one family were found to be occupied by more than one family. Schemes have been prepared and others are in course of preparation for the provision of houses to abate the overcrowding. Summary of Overcrowding Survey. No. of persons in family. Families Total. Overcrowded. Uncrowded. ½ — — — 1 1 143 144 1½ — 17 17 2 1 1873 1874 2½ 8 1158 1166 3 3 1724 1727 3½ 49 571 620 4 43 1214 1257 4½ 9 373 382 5 11 642 653 5½ 5 195 200 6 6 287 293 6½ 5 79 84 7 5 87 92 7½ 2 49 51 8 11 44 55 8½ 9 7 16 9 9 4 13 9½ 6 — 6 10 6 — 6 10½ 2 — 2 11 — 1 1 11½ — — — 12 • - - 191 8468 8659 Housing Act, 1935—Overcrowding, (a) Number of dwellings overcrowded at the end of the year 114 Number of families dwelling therein 126 Number of persons dwelling therein 726 (b) Number of new cases of overcrowding reported during the year 8 (c) Number of cases of overcrowding relieved during the year 85 Number of persons concerned in such cases 471 (d) Particulars of any cases in which dwelling-houses have again become overcrowded after the Local Authority have taken steps for the abatement of overcrowding nil The Engineer and Surveyor has kindly supplied the following information:— Number of new houses erected during the year:— (a) Total, including numbers given separately under (b):— (i) By the Local Authority 96 (ii) By other Local Authorities — (iii) By other bodies and persons— Houses 1206 Flats 636 (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 52 Inspection of Dwelling-Houses during the Year. (1) (a) Total number of dwelling-houses inspected for housing defects (under Public Health or Housing Acts) 1206 (b) No. of inspections made for the purpose 2525 (2) (a) Number of dwelling-houses (included under sub-head (1) above) which were inspected and recorded under the Housing Consolidated Regulations, 1925 25 (b) No. of inspections made for the purpose 165 (3) Number of dwelling-houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation 18 (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 766 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 896 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 5 53 (2) Number of dwelling-houses which were rendered fit after service of formal notices:— (a) By owners *5 (b) By Local Authority in default of owners †2 *Includes compliance in 1936 of 2 notices served in 1935. †Includes compliance in 1936 of 1 notice served in 1935. (b)—Proceedings under Public Health Acts:— (1) Number of dwelling-houses in respect of which notices were served requiring defects to be remedied 17 (2) Number of dwelling-houses in which defects were remedied after service of formal notices:— (a) By owners *13 (b) By Local Authority in default of owners 2 *Includes compliance in 1936 of 1 notice served in 1935. (c)—Proceedings under Section 19 and 21 of the Housing Act, 1930:— (1) Number of dwelling-houses in respect of which Demolition Orders were made 1 (2) Number of dwelling-houses demolished in pursuance of Demolition Orders *4 *3 Orders served in 1935. (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 56 INSPECTION AND SUPERVISION OF FOOD. MILK. The Chief Officer of the Public Control Department of the Middlesex County Council has kindly supplied the following information with regard to the Milk and Dairies (Consolidation) Act, 1915, and the Tuberculosis Order, 1925. During 1936 nine samples of milk were taken from retailers in the district. The samples were submitted to the Lister Institute for animal inoculation tests for the presence of tubercle bacilli. One of these samples was found to contain living tubercle bacilli and was traced to a farm in this district. The offending animal could not be discovered, but it was found that two cows which had gone dry subsequent to the taking of the sample had been sold for slaughter. Possibly one of these was the offender, though no report of any lesions could be obtained. 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. Four hundred and nine inspections of cows were carried out in Wembley, but none of these was found to be suffering from Tuberculosis. Milk (Special Designations) Order, 1923. Licences Issued, 1936. Designation. LICENCE. Dealers. Supplementary. To bottle. To Prsteurise. Certified 10 2 — — Grade A. T.T. 15 5 3 - Grade A. 2 1 - - Grade A. (Pasteurised) 7 - - - Pasteurised 24 5 - 2 During the year 198 samples of Graded Milk were taken as follows:— Grade A (T.T.) 59 Grade A Pasteurised 10 Grade A 11 Pasteurised 91 Tuberculin Tested 18 T.T. (Pasteurised 2 T.T. (Certified) 2 Accredited 3 Certified 2 198 CONSUMPTION OF MILK IN WEMBLEY. At the end of the year the co-operation of the trade was readily given in an effort to ascertain the average daily consumption of milk by the inhabitants, and the percentage of the various milks received in the homes. It would appear that the average daily consumption of milk in Wembley is about .7 pint per person. It is more easy to obtain the percentages of the various milks, and the investigation showed that 92.6 per cent of the milk delivered in Wembley is either Tuberculin Tested Pasteurised, or Sterilised. The percentage of the milk delivered which was pasteurised was 89.13 per cent. COWSHEDS. At one time a very large quantity of milk was produced in Wembley, but in 1936 only four farms produced milk for sale, one of which was licensed for the production of Certified Milk and one for the production of Grade A Milk. Twenty-six visits were paid to these cowsheds, which were found to be kept in a satisfactory condition. DAIRIES AND MILK SHOPS. All of these premises were inspected regularly and 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 1936, 200 visits were paid to these premises. 57 UNSOUND FOOD SURRENDERED AND DESTROYED, 1936. 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:— 21 pigs' heads Tuberculosis. 1 pig's liver ,, 1 pig's lungs ,, 2 pigs' plucks „ 1 pig s mesentery ,, 8 pigs' livers Cirrhosis. 2 bovine livers Distomatosis. 2 ,, mesenteries Tuberculosis. 2 ,, heads ,, 1 ,, tongue ,, 1 „ lungs ,, i ,, liver ,, 1 ,, spleen ,, 10½ lbs. tinned ham Unsound. 17½ lbs. cooked ham ,, 1 sack peas (64 lbs.) ,, 52 lbs. fish roes ,, 16 lbs. halibut ,, 49 lbs. plaice ,, I salmon (12 lbs.) ,, 38# lbs. smoked fillets ,, 21 lbs. fish fillets ,, 180 lbs. kippers ,, 6 tins tomatoes Blown. 10 ,, apricots ,, 3 ,, fruit cocktails ,, 2 ,, oranges ,, II ,, cherries ,, SALE OF FOODS AND DRUGS (ADULTERATION) ACT. The Chief Officer of the Public Control Department of the Middlesex County Council has kindly supplied the following facts relating to samples taken in the district during 1936:— 58 Article. No. taken. Adulteration. Milk 117 — Brandy 2 — Cream 1 — Gin 2 — Minced Beef 4 — Sausages 5 2 Whisky 2 — Butter 1 — Buttered Toast 1 1 Cod 1 1 Fruit (bottled) 1 — Fruit Cordial 1 — Hake 4 Lemon Sole 7 — Meat 1 — Olive Oil 1 — Sole 3 3 Totals 154 7 CHEMICAL AND BACTERIOLOGICAL EXAMINATION OF FOOD. Any chemical and bacteriological work required in connection with food would have been carried out by the Clinical Research Association. MEAT AND OTHER FOODS: SLAUGHTERHOUSES. During the year there were 4 licensed slaughterhouses in the district, but in only one instance was the slaughterhouse used regularly each week. In two cases the slaughterhouses were not used at all. Applications were received at the end of the year for the renewal of all the licences, but in the case of only one slaughterhouse was the licence renewed by the Council, the other three houses being considered unsatisfactory. 59 Inspections were made during the year and the following carcasses and organs were examined:— Beasts and Calves 91 Sheep 14 Pigs 718 INSPECTION OF OTHER FOODS. Special attention has been given to premises in which articles used for the food of man are prepared, stored, or sold, in order to see that they complied with the various Acts and Orders relating to such premises. It has generally been found that 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 1936, 1,255 inspections were made of Butchers, Markets, Bakehouses and other food premises. 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 1936. 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 310 1 - 10 18 28 155 39 13 32 12 1 1 251 3 Diphtheria 37 1 2 2 4 3 11 6 — 4 4 — — 35 6 Enteric Fever (including Paratyphoid) 9 - - 1 - - 1 2 1 2 2 - — 9 — Puerperal Fever 5 - - - - - - - - 5 - - - 5 1 Puerperal Pyrexia 17 - - - - - - - 1 15 1 — — 17 — Pneumonia 110 10 4 8 1 2 11 1 4 24 l6 21 8 — 45 Erysipelas 22 - - 1 1 - — — 1 6 3 10 — 6 — Ophthalmia Neonatorum 8 8 - - - - - - - - - - - 4 — Acute Anterior Poliomyelitis 15 - 2 1 3 - 6 2 — 1 - - — 10 — Encephalitis Lethargica 1 - - - - - - - - 1 - - - 1 — Polio-Encephalitis 1 - - - - - 1 - - - - - - 1 — Cerebro-Spinal Meningitis 1 1 - - - - - - - - - - - 1 — 63 TABLE SHOWING NOTIFICATION OF INFECTIOUS DISEASE OCCURRING IN ELECTORAL WARDS, 1936. DISEASE Total Electoral Wards. Alperton. Central. Chalkhill. Fryent. The Hyde. Kenton. Preston. Roe Green. Sudbury Court. Sudbury. Tokyngton. Wembley Park. Unclassified. Scarlet Fever 310 32 17 39 30 23 28 14 16 10 30 34 37 - Diphtheria 37 3 3 — 4 4 2 4 3 1 2 7 4 — Enteric Fever 9 — — 1 1 — 2 3 1 — 1 - - — Puerperal Fever 5 1 - — 2 — — 1 1 — — - — — Puerperal Pyrexia 17 1 1 2 3 — — — 1 — 1 2 1 5 Pneumonia I 10 13 6 7 14 22 3 3 7 5 16 8 5 1 Erysipelas 22 — 1 2 3 3 - 2 3 - 3 3 2 — Ophthalmia Neonatorum 8 1 — - 1 — — — — 1 3 1 — 1 Encephalitis Lethargica 1 — — - 1 — — — — — - — — — Polio-Encephalitis 1 - - - - 1 - - - - - - - - Acute Anterior Poliomyelitis 15 3 2 - - 7 - - 2 - - 1 - - Cerebro Spinal Meningitis 1 1 - - - - - - - - - - - - The year under review was singularly free from epidemic incidence of the infectious diseases. There was a small outbreak of Anterior Poliomyelitis (Infantile Paralysis) in August, while Influenza also showed itself at the very end of the year. Appropriate investigation has been made into all cases of notifiable disease occuring in the district in order to determine a possible source of infection as well as to give advice, for example, regarding contacts being seen by their own doctor if occasion arise. In addition, concerning those cases which are nursed at home a visit is paid once each week to ensure that the necessity of efficient isolation is understood and being maintained. Of Scarlet Fever there were 310 cases and of Diphtheria 37 cases, the monthy incidence of these two diseases being shown in the accompanying table. MONTHLY INCIDENCE OF SCARLET FEVER AND DIPHTHERIA DURING 1936. Month. Scarlet Fever. Diphtheria. January 28 1 February 28 4 March 23 2 April 39 3 May 37 3 June 26 4 July 18 1 August 18 3 September 27 1 October 19 2 November 27 4 December 20 9 Totals 310 37 SCARLET FEVER. There were 310 cases of Scarlet Fever notified, of which 251 were removed to hospital and 59 were isolated at home. Regarding the 251 hospital cases, there were 17 "return cases" (6.7%), and there were 4 "return cases" in connection with the 59 patients nursed at home (6.7%). In the 64 first place one must remember that such "return cases" are so designated only because of a chronological sequence. It is almost impossible to be satisfied as to the origin of any further case in a family. The figures do show, however, that the number of return cases in the families was very similar, whether the primary cases were isolated at home or in hospital. This again must not be taken as weighing against the value of hospital isolation of cases of scarlet fever, rather does it mean that if hospital or home isolation be chosen with due discretion there may be little additional spread of the disease. In particular, it must usually be wrong to allow a case of Scarlet Fever to remain at home if there be an imminent confinement in the family; and if there be a possibility of the infected environment causing spread of the disease by allowing the contamination of milk or other such like foods to take place, of course the case should go to hospital. DIPHTHERIA. With only 37 cases during the year the incidence of Diphtheria has been very small. In the previous year 95 cases were notified. In connection with this disease attention must be drawn to the Council's scheme making available Active Immunisation against Diphtheria. From the following figures the scheme would not appear to have received a very extensive acceptance. DIPHTHERIA IMMUNISATION. 1935. 1936. Number submitted to Immunisation treatment 107 303 Number of these under 5 years of age 31 97 Number submitted to Schick Test:— (a) Prior to Immunisation Treatment Nil 15 (b) After Immunisation Treatment Nil 20 It is to be noted that in 1936 only 97 of those treated were under the age of 5 years, while the optimum age for immunisation is certainly nearer the third year of life. The number submitted to the Schick Test after immunisation was also low. Without this test being performed it is impossible to tell if the patient has been effectively immunised, and after 65 dealing with large numbers it has been found that the ability to place a patient in the Schick-negative group as we'll as having given immunisation treatment gives the patient, statistically, chances of avoiding the disease twice as great again. "A study of the incidence of Diphtheria during a period of six years in a large city of child population of over 90,000, of whom 18,800 received immunisation treatment, proves statistically the value of this treatment, while still greater benefits won by those who are definitely known to have become Schick-negative are proved after considering 10,879 such treated and ascertained Schick-negative children. For treated children the risk of contracting clinical Diphtheria was less than one-third that of the untreated children. For treated children who were also proved to have become Schicknegative after treatment the risk was still further lowered, so that as compared with untreated children their incidence rate of clinical Diphtheria was less than one-sixth."—Journal of Hygiene, July, 1937 (recent publication of experience in City of Bristol by A. C. Mori son and L. Roberts). ENTERIC FEVER. Nine cases of "enteric fever" occurred during the year (4 Paratyphoid B.; 2 Typhoid Fever). All patients were isolated in hospital, the accommodation being at University College Hospital for 3 cases; Wembley Hospital for 2 cases; Middlesex Hospital for 2 cases, and 1 case each at St. Bartholomew's Hospital and Redhill County Hospital. One child seemed to have been infected in the Bournemouth epidemic. PUERPERAL FEVER. Five cases were notified as of puerperal fever. There was one death. All cases were treated at Queen Charlotte's Isolation Hospital. PUERPERAL PYREXIA. Of the 17 cases of Puerperal Pryexia which were notified, 5 occurred at the Willesden Maternity Hospital; these have only a statistical introduction to the Wembley records. The 12 Wembley cases all received hospital treatment, 6 being accommodated at Queen Charlotte's Isolation Hospital; 2 at St. Mary's Hospital; 2 at Redhill County Hospital, and one each at the Mothers' Hospital, Hackney, and at Paddington Hospital. 66 PNEUMONIA. Pneumonia in notifiable form accounted for the illness of 110 persons. Influenza attacked the country generally at the end of 1936. The infection took the form for the most part of a short sharp illness from which recovery was rapid. It would appear that death tended to occur in those over 50 years of age rather than in the young adult group which has suffered so badly in severe outbreaks of influenza. Numbers of Notifications of Influenzal and Acute Primary Pneumonia received were as follows:— Week ending. Notifications. 26/12/1936 2 2/1/1937 8 9/1/1937 16 16/1/1937 8 23/I/I937 14 3°/I/I937 4 6/2/1937 1 53 DEATHS FROM INFLUENZA AND PNEUMONIA OCCURRING IN WEMBLEY. Weeks ending 26th December, 1936—6th February, 1937. (Not adjusted for transfers). Week ending. Number of Deaths. Ages at Death. 0—15 years. 16—50 years. 51 and over. 26/12/1936 2 - - 2 2/1/1937 6 2 — 4 9/1/1937 8 2 3 3 16/1/1937 10 1 — 9 23/1/1937 10 1 2 7 30/1/1937 3 — 1 2 6/2/1937 Nil - - — Totals 39 6 6 27 67 ERYSIPELAS. Twenty-two cases of Erysipelas occurred, of which 16 were nursed at home. Of the 6 cases treated in hospital 2 were accommodated at the West Middlesex County Hospital, and 1 case each at Redhill County, Hillingdon County, Willesden Isolation and Acton Isolation Hospitals. OPHTHALMIA NEONATORUM. Of the 8 cases of Ophthalmia Neonatorum notifield 1 case occurred in a child born in the Willesden Maternity Hospital. It is worthy of note that in no case was the vision impaired. Home treatment was carried out in respect of 4 of the 7 Wembley babies, whilst of the remaining 3, 2 were accommodated at the Middlesex Hospital and the third at Queen Mary's Hospital, Hampstead. ANTERIOR POLIOMYELITIS. There were in all 15 cases of this disease in the twelve months. In the summer there was a small outbreak involving 7 cases. These have already been reported to the Council in a special report by Dr. Mary King. A visitor spent two nights in this district and in a few days on returning to his own home in Essex he was found to be suffering from Infantile Paralysis. In 13 days' time the Wembley friend's similar illness was notified. In 5 Wembley cases there was traced a connection to explain the spread of the disease, but there appears little doubt that the spread of this disease is due more to those who may become for a short time "carriers" of the virus without illness, or to those who may suffer from the disease in an abortive or atypical form. Concerning this small outbreak in 1936, considerable investigation was made. All possible contacts were visited and advised of the importance of the family doctor being called on the slightest suspicion of illness. With the concurrence of the County Medical Officer of Health the school in the district was visited and the causes of absences of the children in the classes considered. In all, the Sanitary Inspectors made 189 visits concerning this matter. ENCEPHALITIS LETHARGICA. The only case of Encephalitis Lethargica during the year occurred in a man aged 32 years. The case was accommodated at the St. Mary's Hospital, Paddington. 68 POLIO-ENCEPHALITIS. One case occurred in a girl of 8 years of age and she was removed to the Middlesex Hospital. It was the intensive investigation into the outbreak of Anterior Poliomyelitis which revealed the illness of this child. CEREBRO-SPINAL MENINGITIS. One case of Cerebro-Spinal Meningitis was notified in a child aged 10 months. The child was treated at the Princess Louise Hospital. SMALLPOX. The Middlesex County Council are responsible for the provision of hospital accommodation for cases of Smallpox occurring- in the district. No case occurred during the year. THE ISOLATION HOSPITAL. The arrangement of the Council with the Borough of Acton remains, that Infectious Diseases as far as is possible be treated at the Acton Isolation Hospital. During 1936 the following cases were admitted to the Acton Isolation Hospital:— Scarlet Fever 235 Diphtheria 28 Measles 32 Erysipelas 1 Chickenpox 1 Whooping Cough 1 Mumps 1 Acute Poliomyelitis 1 Negotiations concerning the Joint Isolation Hospital to serve both Acton and Wembley proceeded during the year. The Councils have decided that this hospital shall be administered by a Joint Hospital Committee. The hospital will comprise 115 beds, of which 40 are to be of cubicle type. It will be especially because of this material increase of cubicle accommodation that the new joint hospital will be of great value. Supply of Anti-Toxin. The Council supply free of charge to any practitioner for use in this district Diphtheria Anti-toxin, Tetanus Antitoxin, 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. 69 70 TUBERCULOSIS. New Cases and Mortality During 1936. Age Periods. New Cases. Deaths. Pulmonary. Non-Pulmonary. Pulmonary. Non-Pulmonary. M. F. M. F. M. F. M. F. Under 1 year — — 1 — — — — — 1 to 4 years 1 — 2 2 — — 3 1 5 to 14 years 2 2 3 2 — — — 1 15 to 24 years 24 20 5 5 4 4 2 1 25 to 34 years 19 30 2 6 7 7 1 — 35 to 44 years 14 11 2 — 4 3 — — 45 to 54 years 7 5 1 1 2 — 1 — 55 to 64 years 6 1 — 1 3 — — 1 65 years and over 4 1 — — 1 1 — — Total 77 70 16 17 21 15 7 4 47 deaths from Tuberculosis were registered during the year. 18 cases were not notified as suffering from Tuberculosis during life (38.3 per cent.). The Death Rate from Tuberculosis for the year 1936 was 0.44 per 1,000 population. The treatment of Tuberculosis is the responsibility of the Middlesex County Council. 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 1936. NON-NOTIFIABLE INFECTIOUS DISEASE. The only information available relating to the number of cases of non-notifiable infectious disease is that obtained from the weekly returns received from the Head Teachers of the County Council's schools in the district, and from the information collected in the course of the duties of the Health Visitors and Sanitary Inspectors. DISINFECTION OF PREMISES AND ARTICLES. During the year 593 disinfections were carried out after:— Notifiable Infectious Diseases 516 Cancer 25 Miscellaneous 51 Vermin 1 Number of Articles Disinfected or Destroyed. Articles. Disinfected. Destroyed. Beds 120 12 Bolsters 270 9 Blankets 1367 7 Carpets — 1 Counterpanes 445 3 Covers 11 — Curtains 3 - Cushions 99 6 Mattresses 588 23 Palliasses 1 - Pillows 1128 30 Rugs and Mats 46 - Sheets 731 4 Wearing Apparel 351 48 Sundries 161 22 Bundles of Washing 62 — Total 5383 165 71 INDEX. Abatement of Overcrowding 50, 51, 52 Acts—Adoptive in force 22, 23 Ambulance Facilities 23, 24 Ante-Natal Clinics 29 Anti-toxin 69 Area 8 Articles Disinfected 71 Birth Control 27, 28 Births 11, 30, 33, 35 Bugs 48, 49 Byelaws in force 22, 23 Causes of Death 13 Children Acts, 1908-32 36 Clinic and Treatment Centres 25, 26 Closet Accommodation 40 Committees—Constitution of 2 Comparative Vital Statistics 11 Consultant 31 Contraventions remedied 43 Convalescent Home Treatment 32 Cowsheds 57 Dairies and Milk Shops 57 Deaths 12, 13, 14, 15 Defects remedied 42, 43 Dental Clinics 30, 31 Dentures 30, 31 Diphtheria Immunisation 65, 66 Disinfection of Premises and Articles 71 Drainage and Sewerage 40 Dwelling Houses Inspected 53 Empire Pool 45 Factories 43, 44 Fish Frying 45 Food Adulteration 58, 59 Food Examination 59 Foster Children 36 Foster Parents 36 Gynaecological Clinic 26, 27 Gypsies 41 Health Visitors 35, 36 Hospitals 28 Housing Act, 1935 50, 51, 52 Houses—Number of inhabited 8 73 Housing Defects remedied 42, 43 Housing Statistics 52, 53, 54 Immunisation against Diphtheria 65, 66 Infant Life Protection 36 Infant Welfare Clinics 29 Infantile Mortality 17, 18 Infectious Disease—table of incidence 62 Infectious Disease—table showing ward incidence 63 Infectious Disease—notes on 64, 65, 66, 67, 68, 69, 71 Inspection of Dwelling Houses 53 Inspection of Other Foods 60 Isolation Hospital 69 Laboratory Facilities 23 Local Government and Other Officers' Superannuation Act 28 Marriages 19 Massage Treatment 31 Maternal Mortality 16 Maternity Accommodation 34, 35 Maternity and Child Welfare Committee 2 Maternity Outfits 31 Meat and other Foods 59, 60 Midwifery Assistance 31 Midwives 32, 33, 34, 35 Milk 55, 57 Milk Grants 31 Milk Licences 56 Milkshops 57 Mortuary 50 Non-notifiable Infectious Disease 71 Nuisances abated 42, 43 Nursing in the Home 24 Offensive Trades 45 Ophthalmia Neonatorum 68 Outworkers 43 Overcrowding 50, 51, 52 Population 8 Prevention of Overcrowding 50, 51, 52 Public Cleansing 40, 41 Public Conveniences 40, 41 Public Health Committee 2 Rag Flock 50 Rainfall 9 Rateable Value 8 Rats—destruction of 50 Regulations in force 22, 23 Rivers and Streams 40 74 Sanitary Circumstances of the Area 37, 38 Sanitary Inspection of the District 41, 42 Schools 49 Sewerage and Drainage 40 Shops Act, 1934 45 Slaughterhouses 59, 60 Smallpox 69 Smoke abatement 45 Social Conditions 7, 8, 9 Staff 3, 4 Statistics—General 7, 8, 9 Statistics—Vital 10, 11 Streams 40 Sunlight Treatment 31, 32 Swimming Baths 45, 46, 47, 48 Tents, Vans and Sheds 41 Tuberculosis 71 Tuberculosis—New Cases and Mortality 70 Unemployment 8, 9 Unsound Food surrendered 58 Vale Farm Swimming Bath 45 Vital Statistics 10, 11 Voluntary Helpers 30 Water 38, 39 Wembley Hospital 28 Workplaces 43, 44 Workshops 43, 44 75 WARDEN &. CO. LTD. PRINTERS HENDON N.W.4.