AC 439 (1) WEMBLEY M WEM 18 BOROUGH OF WEMBLEY ANNUAL REPORT of the MEDICAL OFFICER OF HEALTH FOR THE YEAR 1937 A. G. MORISON, m.a., m.d., d.p.h,, Medical Officer of Health. BOROUGH OF WEMBLEY ANNUAL REPORT of the MEDICAL OFFICER OF HEALTH FOR THE YEAR 1937 A. G. MORISON, m.a., m.d., d.p.h., Medical Officer of Health. 1 Constitution of Committees URBAN DISTRICT OF WEMBLEY. (April, 1937). PUBLIC HEALTH COMMITTEE. Chairman of the Council—Councillor E. C. Leader, j.p., f.c.r.a. Vice-Chairman of the Council—Councillor J. Robertson. Chairman—Councillor E. H. Everett Vice-Chairman—Councillor F. R. white. Councillors C. Barton, L. Bishop, A. W. Clarke, H. Gauntlett, M. Levy, ll.b.(lond.), H. W. Pickering, G. H. Plymen, m.sc., ph.d., a. Rowbottom, H. S. Sirkett, J. W. G. Snook. MATERNITY & CHILD WELFARE COMMITTEE. Chairman of the Council—Councillor E. C. Leader, j.p., f.c.r.a. Vice-Chairman of the Council—Councillor J. Robertson. Chairman—Councillor Miss E. H. Howse, j.p. Vice-Chairman—Councillor H. Gauntlett. Councillors C. barton, a. w. Clarke, e. h. Everett, M. Levy, ll.b.(lond.), w. R. Osborne, H. w. Pickering, G. h. plymen, m.sc., ph.d., a. rowbottom, j. w. G. snook, h. j. Soar. CO-OPTED MEMBERS— Mesdames Clarke, Collier, Collison, Collyer, Empson, Neale, Rowbottom. 2 BOROUGH OF WEMBLEY. (November, 1937). PUBLIC HEALTH COMMITTEE. The Mayor—Alderman E. J. G. Butler, j.p. The Deputy Mayor—Alderman M. Campbell. Chairman—Alderman E. H. Everett. Vice-Chairman—Councillor C. Barton. Aldermen A. w. Clarke, H. Gauntlett. Councillors R. S. Ball, W. L. Harris, Mrs. e. M. Iszatt, W. J. knight, G. H. Plymen, m.sc., ph.d., G. H. R. Rogers, L. R. Slowey, J. W. G. Snook. MATERNITY & CHILD WELFARE COMMITTEE. The Mayor—Alderman E. J. G. Butler, j.p. The Deputy Mayor—Alderman M. Campbell. Chairman—Councillor Miss E. H. Howse, j.p. Vice-Chairman—Councillor J. W. G. Snook. Aldermen A. w. Clarke, E. H. Everett, H. Gauntlett. Councillors E. T. Ashman, C. Barton, W. J. B. Baylis, Mrs. E. M. Iszatt, W. J. Knight, C. H. Moseley, G. H. Plymen, m.sc., ph.d. CO-OPTED MEMBERS— Mesdames Clarke, Collier, Collison, Collyer, Empson, Neale, Rowbottom. The Town Qlerk Kenneth Tansley, Esq. 3 STAFF OF THE PUBLIC HEALTH DEPARTMENT. (31st December, 1937). Medical Officer of Health: A. G. Morison, m.a., m.d., d.p.h. Assistant Medical Officer of Health : Louise A. Matheson, m.b., ch.b., d.c.h., m.m., d.p.h. Part-time Clinic Medical Officers: Mary King, m.r.c.s., l.r.c.p., d.p.h. F. Elizabeth Millard Harvey, m.b., ch.b. Evelyn Fisher, b.a., m.d., d.p.h. Consultant Gynaecological and Obstetric Surgeon: John W. Rait Bell, l.p.c.p.i. & l.m., l.r.c.s.i. & l.m. Consultant Neurologist: C. M. Hinds Howell, m.a., m.d., f.r.c.p. Dental Officer: J. H. Stevens, l.d.s., r.c.s. Chief Sanitary Inspector: Robert M. Turner, m.s.i.a., a.r.s.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, m.s.i.a., Meat & Smoke Inspector's Certificates. W. combey, m.r.s.i., m.s.i.a. Meat, Smoke & Sanitary Science Certificates. M. G. Crook, m.s.i.a., Meat Inspector's Cert., Diploma Inst. Public Health & Hygiene. F. Winder, a.r.s.i., m.s.i.a., Meat, Smoke & San. Science Certificates. C. Duerden, m.s.i.a., Meat Inspector's Certificate. 4 Health Visitors: Miss V. L. Davies, Health Visitor's Cert., Registered Fever Nurse. Miss G. Ainscow, Health Visitor's Certificate. Miss M. H. Jones, Health Visitor's Cert., Registered Fever Nurse. Miss M. L. Dale, Health Visitor's Certificate. Miss M. E. Milner, Health Visitor's Cert., Sanitary Insp. Certificate. Miss D. S. Newman, Health Visitor's Certificate. Miss D. C. Binding, Health Visitor's Certificate. Miss A. K. Gallacher, Health Visitor's Certificate. Miss C. E. Davies, Health Visitor's Cert., Registered Fever Nurse. (All Health Visitors are State Registered Nurses and hold Certificates of the Central Midwives' Board). Chief Clerk: H. N. Ryan, Certificate Sanitary Inspector's Exam. Board. Clerical Officers: G. H. Hughes, Certificate Sanitary Inspector's Exam. Board. W. C. E. Keutenius, T. L. Allison, P. b. D. Bunyan, A. F. Cowan, Miss J. E. Watts. Mrs. E. Davies (Temporary appointment). 5 BOROUGH OF WEMBLEY ANNUAL REPORT of the MEDICAL OFFICER OF HEALTH for the year 1937. To the Mayor, Aldermen and Councillors of the Borough. Mr. Mayor, Ladies and Gentlemen, I beg to submit a Report on the Health and SanitaryCircumstances of the district for the year 1937—the year in which His Majesty was graciously pleased to grant a Charter incorporating Wembley as a Municipal Borough. This Report is drawn up according to Circular 1650 of the Ministry of Health. The vital statistics for the year are very gratifying. The birth rate was 16.19, and the crude death rate 7.31. The infantile mortality rate was 43.62, while the maternal mortality rate was also low, there being no deaths recorded from puerperal sepsis and two deaths from other puerperal causes. With regard to the infectious diseases, also, the figures are lower than throughout the country, both as regards notifications and deaths, with the one exception of notifications of scarlet fever. The Borough Council continue to develop their health services in the lines of the most progressive areas. This is at present especially true of the Maternity & Child Welfare services. With regard to 1937, it is premature to mention the completion of any of the Council's clinic buildings, but much progress was made. The One Tree Hill clinic is now in full working order, while the Stag Lane clinic will be opened, fully furnished, on the 1st July. The Perrin Road clinic is under construction, while the Minister of Health has approved of your plans for Monks Park clinic, is now considering those for the College Road clinic, and has approved of your appropriation for clinic purposes a site in Church Lane. 6 The Report contains information of the activities of the Public Health Department, and while I readily accept responsibility for the Report, it is my pleasure to recognise that herein is summarised the work well done relating to the duties delegated to the various Technical Officers of the Department. In the beginning of the year the Department gained much by becoming housed in one building in place of being scattered in three places as previously. With the continued growth of the personnel, however, the Department has again almost outgrown the present Public Health Offices, so that we eagerly look forward to the completion of the Town Hall buildings. The first full-time Assistant Medical Officer of Health was appointed during 1937. This was a financial economy giving, in addition, other advantages. The Borough had become too large and had been developing too rapidly for the general public health administration to be given adequate attention by the Medical Officer of Health had he continued to be overloaded with detail. With the growth of the population, the growth of legislation and the growth of the science of preventive medicine, the duties of the health department have increased. During the year, also, one additional Sanitary Inspector, one additional Health Visitor and two Clerical Officers were appointed. I gratefully acknowledge the help received from both the Technical and Executive Officers of the Department during the year. I have the honour to be, Mr. Mayor, Ladies and Gentlemen, Your obedient servant, A. G. MORISON, Medical Officer of Health. 25th June, 1938. 7 Section A. STATISTICS AND SOCIAL CONDITIONS OF THE AREA. Area — Population — Inhabited Houses — Penny Rate — Social Conditions, Industries, Unemployment, Open Spaces, Habitation of Houses — Rainfall — Vital Statistics, Live Births, Still Births, Deaths — Deaths at Age Periods — Infantile Mortality — Maternal Mortality — Marriages. 8 STATISTICS AND SOCIAL CONDITIONS. Area in acres 6,300 Population, 1937 (Midsummer)— Estimated by Registrar-General 114,700 Population (Census) 1931— Wembley 48,561 Kingsbury 16,636 65,197 Estimated number of inhabited houses at end of 1937 29,480 Rateable value—31st December, 1937 £1,271,714 Sum represented by the product of a Penny Rate (estimated) £4,661 SOCIAL CONDITIONS. Industries.—There has been little change in the social conditions of the area during the year. The industries may, for the most part, be described as of a light engineering type; for example, electrical and wireless apparatus, carburettors, baking and laundry machinery are made. Various food products are manufactured in the district; fibre board and paper goods, cosmetics and motor accessories are produced. There are heating and ventilating engineering works, printing works and laundries. According to the present information of the Department, there are 270 factories in Wembley and 70 other premises meantime known as work-shops which will, under the new Factories Act, 1937, on the 1st July, 1938, become factories. Unemployment.—Owing to Wembley's geographical position, many of the persons employed in industry may live in London or the surrounding districts, while many of those who live in Wembley work outside the Borough. Any problem of unemployment in Wembley then, is really part of a larger problem affecting the metropolitan area or, at any rate, the North Western area of Greater London. The following figures have been kindly supplied by the Managers of the Employment Labour Exchanges serving the Borough:— 9 Exchange Persons over 18 years of age, totally unemployed, resident in the Borough of Wembley, 4th April, 1938. Hendon Willesden 1,597 Harrow Acton 4 Total 1,601 Previous Comparative figures have been:— 1936 706 1935 1,200 1934 672 Open Spaces.—The Public Open Spaces (zoned as such in the Wembley and Kingsbury Planning Schemes) represent 346.57 acres. This figure does not include the 200 acres of the Fryent Way Regional Open Space recently acquired. Numbers of Inhabited Houses.—The Borough Treasurer has kindly supplied the following information:— Houses (Including Tenements and Flats) April, 1938. No. of Dwellings. Percentage of Total Dwellings. Rented Houses (excluding Council Houses) 4,215 13.36 28.01 Rented Houses (let in Tenements) 671 2.13 Rented Flats (excluding Council Flats 3,104 9.84 Council Houses 753 2.38 Council Flats 96 .30 Owner-Occupied Houses 20,149 63.92 63.95 Owner-Occupied Flats 8 .03 Incomplete Data 2,535 8.04 8.04 31,531 100.00 100.00 With regard to houses originally intended for one family but occupied by two or more families, an analysis of the returns made under Section 40 of the Rating and Valuation Act, 1925, reveals that the number of houses in the Borough thus occupied is 2,123. 10 REGISTER OF RAINFALL DURING 1937. The Borough Engineer & Surveyor has kindly supplied the following figures regarding rainfall during the year:— Month. Total Rainfall inches. No. of days on which rain fell. January 3.59 23 February 4.18 23 March 2.77 20 April 2.17 16 May 2.70 14 June 1.86 11 July .83 11 August 1.93 5 September 1.29 15 October 2.51 11 November 1.48 7 December 3.06 17 Totals 28.37 173 Wettest day was 13th August with a fall of 1.27 ins. Wettest month was February with a fall of 4.18 ins. The average daily rainfall was .08 ins. Driest month was July with a fall of .83 ins. Longest dry spell—17th-31st August—15 days. Longest wet spell—12th-25th January—14 days. Total rainfall for 1935 was 29.69 ins. „ „ „ 1936 „ 26.59 „ „ „ „ 1937 „ 28.37 „ VITAL STATISTICS as supplied by the Registrar General. Live Births Male. Female. Total Legitimate 941 869 1,810 Birth Rate per1,000 of estimated resident population 16.19 Illegitimate 26 21 47 1,857 11 Still Births Male. Female. Total. Legitimate 35 37 72 Rate per 1,000 total (live & still) births 39.81 Illegitimate 5 — 5 77 Still Birth Rate per 1,000 estimated population 0.67 Deaths. Male. Female. Total. 421 417 838 Death Rate per 1,000 estimated population:— Crude Rate 7.31 Adjusted by Areal Comparability Factor of Registrar-General 9.21 Maternal Mortality. Deaths from Puerperal Sepsis 0 Other Puerperal Causes 2 2 Maternal Mortality Rate per 1,000 live births 1.08 Maternal Mortality Rate per 1,000 total (live and still) births 1.03 Infantile Mortality. Deaths of Infants under 1 year of age:— Male. Female. Total. Legitimate 44 33 77 Illegitimate 2 2 4 81 Death Rate of Infants under 1 year of age:— All Infants per 1,000 live births 43.62 Legitimate Infants per 1,000 legitimate live births 42.54 Illegitimate Infants per 1,000 illegitimate live births 85.11 12 Deaths from Cancer (all ages) 116 „ „ Measles (all ages) Nil „ „ Whooping Cough (all ages) Nil „ „ Diarrhœa (under 2 years) 12 COMPARATIVE VITAL STATISTICS 1937. 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 16.19 0.67 7.31 43.62 1.08 1.03 England & Wales 14.9 0.60 12.4 58 3.23 3.11 London 13.3 0.54 12.3 60 — — 125 County Boroughs and Great Towns including London 14.9 0.67 12.5 62 - - 148 smaller towns—resident populations 25,000 to 50,000 at Census 1931 15.3 0.64 11.9 55 - - BIRTHS AND DEATHS. The figures for 1937 remained characteristic as of a new Outer London Borough. The birth rate had risen slightly (1936—16.07; 1937—16.19) and remained higher than that for England and Wales (1936— 14.8; 1937—14.9). The crude death rate was much lower than for the country as a whole, the areal Comparability Factor of the Registrar-General being 1.26. The crude death rate for Wembley (7.31) was only 58.1% that of England and Wales (12.4). As regards births the following table shows the notifications (corrected for inward and outward transfers) by doctors, midwives or parents, together with particulars as to where the confinements actually took place:— Place at which Birth occurred. By whom notified. At Home. In Hospital. In Nursing Homes, etc. Totals. Doctors 290 595 182 1,067 Midwives 417 138 156 711 Parents 65 1 2 68 Totals 772 734 340 1,846 13 Of the 838 deaths of Wembley residents, it is interesting to note that 367 (43.8%) of these occurred elsewhere than within the Borough boundaries. The next table gives particulars of the causes of death:— CAUSES OF DEATH DURING YEAR 1937 as supplied by the Registrar General. 1936 Total. Causes of Death. M. F. Total. 770 All Causes 421 417 838 — Typhoid and paratyphoid fevers - — — 1 Measles - — — 3 Scarlet Fever - — — 1 Whooping Cough - — — 6 Diphtheria 1 1 2 11 Influenza 17 19 36 1 Encephalitis lethargica — — — 1 Cerebro-Spinal fever 1 — 1 36 Tuberculosis of respiratory system 20 26 46 11 Other tuberculosis 5 7 12 1 Syphilis — 1 1 2 General paralysis of insane, etc. 3 1 4 108 Cancer 44 72 116 15 Diabetes 5 2 7 22 Cerebral hæmorrhage 18 20 38 143 Heart disease 91 69 160 5 Aneurysm 1 5 6 52 Other circulatory 31 31 62 21 Bronchitis 11 10 21 45 Pneumonia 31 24 55 11 Other respiratory 7 1 8 12 Peptic Ulcer 8 1 9 9 Diarrhœa (under 2 years) 6 6 12 5 Appendicitis 2 9 11 1 Cirrhosis of liver 2 — 2 5 Other liver diseases — 2 2 22 Other digestive 7 6 13 21 Nephritis 10 11 21 1 Puerperal sepsis — — — 2 Other puerperal — 2 2 47 Congenital causes, etc. 29 22 51 22 Senility 6 15 21 10 Suicide 12 7 19 37 Other violence 20 9 29 80 Other defined causes 33 38 71 — Causes ill-defined — — - 14 The principal certified causes of death at all ages (except congenital causes) are recorded in the following table, along with the comparative numbers of deaths which occurred from the same causes in England and Wales during 1936:— Disease. Wembley. Total No. of deaths. Proportion per total 1,000 deaths. A comparative figure. England & Wales 1936. Prop, per total 1,000 deaths. Heart and Circulatory Diseases 266 318 311 Cancer 116 139 134 Bronchitis, Pneumonia and other Respiratory diseases (excluding tuberculosis) 84 100 102 Tuberculosis, all forms 58 69 59 Violence, all forms, including injuries & accidents 48 57 46 Influenza 36 43 1937 — 0.39 per 1,000 population. Wembley — 0.313 per 1,000 population. 125 County Boroughs and Gt. Towns including London. Tuberculosis of the respiratory system accounted for 46 deaths, while the deaths from non-pulmonary tuberculosis numbered 12. The deaths from tuberculosis since 1934 have been according to the following table:— Year. Pulmonary. N on-Pulmonary. 1934 41 7 1935 45 11 1936 36 11 1937 46 12 15 The next table gives the deaths at various age periods and shows that 36.65% of the deaths occurred amongst those who had not, so far, reached their 50th birthday:— Age Periods. Wembley No. of deaths 1937. Percentage of total deaths. A comparative figure, 1936. England & Wales percentage of total deaths. 0— 1 79 9.46 7.1 1— 4 49 2.28 2.5 5— 9 6 0.72 1.2 10—14 6 0.72 0.8 15—19 12 1.44 1.3 20—24 23 2.75 1.8 25—29 24 2.88 1.9 30—34 30 3.59 2.0 35—39 29 3.47 2.3 40—44 35 4.19 2.8 45—49 43 5.15 3.8 Totals: 0—49 306 36.65 27.6 50—54 71 8.51 5.4 55—59 65 7.79 7.2 60—64 83 9.94 9.4 65—69 68 8.14 11.3 70—74 78 9.34 12.7 75—79 74 8.86 12.1 80—84 54 6.46 8.5 85—89 30 3.59 4.3 90—94 5 0.60 1.3 95—99 1 0.12 0.24 100— — — 0.02 Totals: 835 100.00 100.00 (Registrar-General's figure 838) Of these 835 deaths, 366 took place in hospital, representing 43.8% of the total. Percentage of total deaths under 1 year. Percentage of total deaths under 50 years of age. Percentage of deaths taking place in Hospitals. 1936 10.13 37.92 47.8 1937 9.46 36.65 43.8 16 INFANTILE MORTALITY. In the following table are shown the numbers of infant deaths from the various causes, according to age at death:— DEATHS FROM STATED CAUSES AT VARIOUS AGES UNDER ONE YEAR OF AGE. Cause of Death, (extracted from weekly returns of local Registrars, or from inward transfers of Registrar General. 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 Total Deaths under one year Prematurity 15 - - 1 16 - - - - 16 Congenital defects 3 — 1 1 5 7 1 - - 13 Broncho-Pneumonia 1 — - - 1 3 2 1 2 9 Gastro-Enteritis — 1 1 — 2 4 — 2 1 9 Convulsions 1 — - - 1 2 — — — 3 Cardiac Failure 2 — — - 2 1 — — — 3 Cerebral Haemorrhage 1 1 — - 2 — — — — 2 Asphyxia Neonatorum 2 — - - 2 — — — — 2 Marasmus 1 — - - 1 — 1 — — 2 Atelectasis 2 — — — 2 — — — — 2 Inanition 1 — — - 1 — — — 1 2 Bronchitis — — - - — — 1 — - 1 Inattention at Birth. (Inquest held) 1 - - - 1 - - - - 1 Asphyxia (inhalation of vomitus - accident - inquest held) - - - - - 1 - - - 1 Asphyxia (inhalation of liquid in Uterus) 1 - - - 1 - - - - 1 Asphyxia (Haemorrhage from oesophagus) 1 - - - 1 - - - - 1 Intra-cranial Haemorrhage 1 — — — 1 — — — — 1 Acute Gastritis — — — - — — 1 — — 1 Haemorrhage 1 — - — 1 — — — — 1 Jaundice of New Born 1 — — - 1 — — — — 1 Diarrhoea and Vomiting — — — - — — 1 — — 1 Congenital debility 1 — — — 1 — — — — 1 Pneumonia - - - - - - - 1 — 1 Fits 1 — - — 1 — — — — 1 Septicaemia — — — - — 1 — — — 1 Pyaemia — — 1 - 1 — — — — 1 Infective Jaundice — — - 1 1 — — — — 1 Intra-Peritoneal Haemorrhage (birth injury) 1 - - - 1 - - - - 1 Meningitis — — - - — — 1 — — 1 38 2 3 3 46 19 8 4 4 81 17 The next two tables show Infantile Mortality for the last 5 years in a comparative manner:— AGE DISTRIBUTION OF INFANT DEATHS. Year Deaths per 1,000 lives 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 1937 24.77 10.23 35.0 4.31 4.31 43.62 England & Wales 1936 30 9 39 8 11 59 INFANTILE MORTALITY Table showing Rates, 1933-1937. Year. Wembley. England & Wales 1933 50.66 64 1934 39.90 59 1935 34.26 57 1936 45.14 59 1937 43.62 58 Average 5 years 42.716 59.4 18 MATERNAL MORTALITY. No deaths from Puerperal Sepsis were recorded in 1937, while two deaths occurred from other puerperal causes. Rate per 1,000 total births (live and still), 1933-1937. Year. Wembley England & Wales 1933 5.85 4.23 1934 3.11 4.41 1935 0.00 3.93 1936 1.68 3.65 1937 1.03 3.11 Average 5 years 2.334 3.866 MARRIAGES. The Superintendent Registrar has kindly supplied the following information concerning marriages which took place during 1937:— In Churches and chapels 635 At Registry Office, one or both parties being resident in the Borough 339 Total 974 19 Section B. GENERAL PROVISION OF HEALTH SERVICES FOR THE AREA. Laboratory Facilities — Ambulance Facilities — Nursing in the Home — Clinic Services, Infant Welfare Clinics, Toddlers' Clinics, Ante-Natal Clinics, Dental Clinics, Gynaecological Clinic, Birth Control Session — County Council Clinics — Hospitals — Nutrition — Other Services, Milk, Artificial Sunlight and Massage, Maternity Outfits, Convalescence, Home Helps — Economic Circumstances Scale — Maternity Hospital Accommodation — Midwives' Act, 1936 — Maternal Mortality, the elements of an efficient Maternity Scheme — Health Visitors, Home Visiting, Puerperal Pyrexia, Still Births, Infant Life Protection — Prevention of Blindness — National Campaign to encourage the wider use of the Health Services — Local Government and Other Officers' Superannuation Act, 1922. 20 LABORATORY FACILITIES. No changes were made during the year concerning laboratory facilities. The Clinical Research Association continued to carry out the bacteriological examinations 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 table shows the examinations carried out:— 21 22 QUARTER ENDING. 31/3/1937. 30/6/1937. 30/9/1937. 31/12/1937. Total for 12 months. Throat Swabs: Diphtheria 161 (of which 7 were positive) 166 (of which 10 were positive) 123 (of which 7 were positive) 218 (of which 31 were positive) 668 (of which 55 were positive) Haemolytic Streptococci 3 (of which 2 were positive) 29 (of which 7 were positive) 23 (of which 5 were positive) 53 (of which 28 were positive) 108 (of which 42 were positive) Vincents Angina — 1 (positive) — — 1 (positive) Sputum— (tubercle bacilli) 49 (of which 1 was positive) 47 (of which 5 were positive) 36 (of which 4 were positive) 56 (of which 9 were positive) 188 (of which 19 were positive) Blood 5 6 — 3 14 Faeces and Urine 1 1 3 1 6 Milks 39 85 42 77 243 Water — 2 9 — 11 Rag Flock — - — 3 3 Butter — - 1 - 1 Maternity Outfit — - 1 - 1 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 service of the Acton Borough Council remained in force. No. of Removals carried out by Acton, 1987. Quarters Ending. 31/3/1937 30/6/1937 30/9/1937 31/12/1937 109 108 109 152 Total 478 (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. During the year two new ambulances were purchased in replacement of the existing vehicles, the models obtained being Austin 20 h.p. The Chief Officer of the Fire Brigade and Ambulance Services has kindly supplied the following information with regard to 2,483 calls he received: — General Removals (sickness, etc.) 1,458 Maternity Removals 355 Street Accidents 409 Street Illnesses 89 Not required on arrival 66 Malicious Calls 3 Out-District Calls attended 9 Passed to Acton Infectious Ambulance 32 Passed to other Authorities 26 Carried out by other Authorities for us 26 Miscellaneous 10 2,483 Total mileage of ambulances 22,926.2. Maternity Cases.—The Ambulance Services Sub-Committee have arranged that, with regard to those cases where admission to Hospital for confinement has been arranged through the Public Health Department, the names and addresses are forwarded to 23 the Chief Officer of the Fire Brigade, so that when a call comes concerning any such case, he is able forthwith to arrange for an ambulance. With regard to other cases who may have made their own arrangements for confinement at the London Hospitals, the Chief Officer of the Fire Brigade accepts a request for an ambulance on the production of the patient's hospital-card of admission. As the Ambulance Services Sub-Committee do not provide a nurse with the ambulance the following decisions have been made:— If a baby be already born when the ambulance arrives for the removal of the woman to hospital, the woman is not to be removed until at least one hour after the birth of the baby unless a doctor has advised that removal may take place before such an interval, and a doctor or certified midwife must accompany the patient in the ambulance to hospital. If there is no doctor in attendance, the midwife must be satisfied that the woman's condition is normal before the removal takes place, and the midwife must accompany the patient in the ambulance to hospital. At the preliminary booking of an ambulance for conveyance of the woman to hospital, she is informed that if the baby happens to be born before the ambulance arrives, the above rules will apply, and she is advised to acquaint herself of the name and address of a doctor or midwife of her choice, so that her relatives may be able to call upon the services of such doctor or midwife in the emergency of the baby's birth before the arrival of the ambulance. NURSING IN THE HOME. The Council do not supply directly any nursing-in-the-home service. The two District Nursing Associations in the Borough, however, do excellent work which is keenly appreciated by the Council, and the Council have contributed £400 and £100 respectively to 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 Wembley Association employed eight nurses and the Kingsbury Association two nurses during 1937. 24 The Associations have kindly supplied the following figures relating to their work in 1937:— (1) Wembley District Nursing Association. Cases. Visits. Medical and Surgical 831 15,842 Maternity, Midwifery and Ante-Natal 128 3,296 Children under 5 97 637 Children over 5 60 581 1,116 20,356 (2) Kingsbury District Nursing Association. Maternity Cases on Books 94 Births attended 94 General Sick Cases: — Adults 154 Children 96 Visits. Ante-Natal Visits 854 Maternity Nursing 1,692 Sick Nursing:— Adults 1,205 Children 982 Welfare Visits: — Supervisory (Babies) 142 5,413 Early in the year the Council arranged to pay for certain nursing services given by these Associations. Cases have been referred to the Associations from the various clinics, the Medical Officer advising the treatment required and indicating when the patient should be seen again. This facility has been a valuable adjunct to the Council's clinic services, and often appropriate nursing treatment at the early stages has prevented the necessity of attendance, say, at the out-patient department of a hospital later. Cases referred to Nursing Associations, 1937 57 Children under 1 year 21 Children over 1 year 28 Mothers 8 25 Treatments given:— Seven or fewer attendances 34 Over seven attendances 23 Conditions treated.—Moist umbilicus—treatment before operation of perineorrhaphy—inflammation of eye—sore buttocks— eczema—discharging ear—constipation—pediculosis—burns and scalds—threadworms—impetigo—scalp sores—cut forehead— septic abrasion—breast conditions—remove pessary—from gynaecological clinic for treatment—septic thumb. CLINIC SERVICES. At the commencement of the year it was shown that all sessions, except those at Sudbury where, however, the numbers were over-taxing the accommodation, were working beyond a capacity allowing the Medical Officers and Health Visitors to give their best services. The Maternity and Child Welfare Committee recommended three additional clinic sessions weekly. The numbers attending continued to grow, both at the Infant Welfare clinics and all the other clinics of the Council, until now (May, 1938) the Council have adopted the recommendations of the Maternity and Child Welfare Committee that the following sessions be held:— Infant Welfare Clinics 12 sessions per week Toddlers' Clinics 4 sessions per week Ante-Natal Clinics 5 sessions per week Gynaecological 2 sessions per month Dental Clinics 2 sessions per week Birth Control Session 2 sessions per month The total number of children who first attended at the centres during the year and who, on the date of their first attendance were under one year of age was 1,180, while of those between the ages of 1-5 years the corresponding number was 419. The total number of children under five years of age who attended at the centres during the year and who at the end of the year were (1) under one year of age was 1,096; and (2) over one year of age was 2,139. The percentage of notified live births represented by the number of children who attended at the centres during the year and who on their first attendance were under one year of age was 65.9 This number, however, is exclusive of those children who are known to have previously attended a centre in another district prior to coming to reside in Wembley. 26 Voluntary Workers.—With regard to the clinic services of the Borough, the efficient co-operation of the Voluntary Workers deserves special recognition. The value of their work cannot be over estimated and their keen interest in the duties of the clinic sessions is much appreciated by all the public health officers of the Council. The number of Voluntary Workers on the list has been about 60 throughout the year. This number alone is an indication of an active desire to participate in the Council's Maternity and Child Welfare work. The various clinic sessions conducted by the Council were as follows—(December, 1937). Description. Situation. Date and Time. Maternity and Child Welfare Clinics St. Andrew's Hall, Ealing Road Wednesday, 2-4 p.m. Thursday, 2-4 p.m. Tokyngton Hall, Monks Park 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. Toddlers (ages 1-5 yrs) St. Andrew's Hall, Ealing Road Wednesday, 9.30- 11.30 a.m. Tokyngton Hall, Monks Park Friday, 9.30-11.30 a.m. Ante-Natal Clinics St. Andrew's Hall, Ealing Road Thursday at 9.30 a.m. Kingsbury Free Church, Slough Lane Tuesdays fortnightly Dental Clinics 1a Bridge Road, Wembley Park Wednesday and Saturday mornings. Gynaecological Clinic do. 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. 27 Infant Welfare Clinics. Average attendances at the various clinic sessions during, 1937, of children under 1 year of age, are set out below:— Clinic Total Attendances Average Attendance per Session. 1936 1937 1936 1937 Ealing Road 7672 8582 72 83 Sudbury 3772 3746 38 36 Tokyngton 2575 2981 50 47 Bacon Lane 6067 7509 50 48 Slough Lane 2472 3013 49 57 Toddlers' Clinics. Circular 1550 of the Ministry of Health drew the attention of Local Authorities particularly to the need of supervision of children between the ages of 18 months and 5 years (toddlers). The Annual Report for 1935 of the Chief Medical Officer of the Ministry of Health similarly drew attention to the necessity for efficient medical supervision and care for the child from 1-5 years of age, pointing out that such supervision had not yet reached as high a level as had that of the infant. Both these official documents stressed the necessity of there being no gap between the good results obtained for children while under 1 year of age and their reception into the school medical service on their fifth birthday. Until about the age of 9-12 months the infant's problems are generally mainly dietetic, while as he passes his first birthday onwards to school age new considerations are gradually arising—early crippling orthopaedic conditions, rickets, eye and ear conditions, enlarged tonsils and adenoids and their sequelae, the after-effects of the infectious diseases such as whooping cough and measles and so on. There is, therefore, much in favour of a differentiation into the toddlers' group after about the age of 12 months. After consideration of this Circular, the Maternity and Child Welfare Committee recommended the institution of Toddlers' Clinics. These clinics have been much appreciated by the parents and the work they do is of distinct value. Closely associated with toddlers' clinics is the domiciliary visitation of the Health Visitors. During 1937 the number of 28 visits paid to children betwen the ages of 1-5 years was 6,745. The similar figure for 1936 was 5,700. At the time of writing, special toddlers' clinics are held at St. Andrew's Hall, Ealing Road, Tokyngton Church Hall, Monks Park, Kingsbury Church Hall, Bacon Lane and at One Tree Hill Clinic, Bridgewater Road, one session per week being held at each clinic. As the Council's clinics are completed these toddlers' clinics are to be increased in number. The following figures are those concerning children between the ages of one and five years who attended clinics during 1937. All of these, of course, did not attend a special toddlers' clinic, but the medical supervision and advice the mothers have had is similar to that given at the toddlers' clinics. The increase in these numbers is gratifying:— Clinic Total Attendances Average Attendance per Session. 1936 1937 1936 1937 Ealing Road 4732 5883 45 42 Sudbury 2125 2669 22 26 Tokyngton 1468 2264 29 35 Slough Lane 1368 1687 27 33 Bacon Lane 2806 4305 23 28 Ante-Natal Clinics. The numbers attending the Ante-Natal clinics grew appreciably throughout the year. The attendances were as follows—at Kingsbury 747, there being 243 new patients during the year, while at the Ealing Road Clinic 1,299 attendances were made, there being 380 new patients. Of those attending 277 were primigravidae and 349 multigravidae. There were, in addition, 27 attendances of Wembley patients at the Harrow Clinic (Kenton). The percentage of total notified births (live and still) represented by the total numbers of women attending the clinics was 36.3 while the corresponding figure for 1936 was 29.1 and for 1935 it was 22.7. An expectant mother should receive appropriate ante-natal advice in the early stages of pregnancy while, of course, she should be seen more often during the latter stages. 29 The following table shows the months at which patients were seen for the first time at the ante-natal clinics:— Months:— 1st 2nd 3rd 4th 5th 6th 7th 8th 9th No. of Mothers seen for the first time:— 3 51 123 117 104 121 90 13 1 With regard to the recommendations for Hospital Confinement, patients are classified as follows:— (a) Those requiring hospital bed for medical reasons. (b) Those requiring hospital bed for environmental reasons and (c) Those in which there are neither medical nor strictly environmental reasons, but who desire confinement in hospital. Numbers Dealt with at Ante-Natal Clinics—1937. Cases referred to various hospitals through Public Health Department:— For Medical reasons 66 Home Conditions unsuitable 161 Patient desired hospital accommodation 87 Total 314 An analysis of the medical reasons for hospital confinement indicates that in 15 cases the history of previous pregnancies justified a hospital confinement, for example, forceps delivery 4 (one with prematurity) — birth injuries resulting in death of baby — breech with extended legs, resulting in still birth — precipitate labour — acute hydramnios — ante-partum haemorrhage resulting in still birth — one week ante-natal in-patient treatment — last confinement 12 years ago — still birth with first child — Caesarean section. Disease or abnormality in the mother caused reference to hospital in 46 cases, as follows — mitral incompetence — hyperemesis with raised blood pressure — albuminuria — high blood pressure — contracted pelvis — small round pelvis — contracted outlet — old kyphosis (tuberculosis) — rheumatic heart — rheumatism old chorea — uterine fibroid — partial thyroidectomy — multiparity — obesity — elderly primigravida 30 — multiple burns — inguinal hernia — severe varicose veins — old phthisis in mother — neurasthenia — post-operation — general debility. Illness within the home (pulmonary tuberculosis) was also considered a sufficient reason for reference to hospital for confinement. Dental Clinics. Considerable benefit has been derived from the removal of the dental clinics to 1a Bridge Road. Both the previous premises at Alperton and at Kingsbury were unsatisfactory and appropriate equipment at the one clinic soon showed itself to be appreciated by the patients. The clinic equipment was obtained on the advice of the late Mr. Frank Lawrence, whose prestige in his profession was very high. He no more than commenced his duties with the Council before his untimely death. The rise in the figures at the dental sessions throughout the year reflect much to the credit of Mr. J. H. Stevens who succeeded Mr. Lawrence. The following table illustrates the number who attended, 1937:— Average attendance per session. Total attendances during year. Children. Mothers. Children. Mothers. 7 14 413 846 Comparative figure for 1936:- 209 422 A report by the Dental Officer is submitted:— "The Dental Clinic continued as in the previous year until May, when the Council opened their first modern surgery at la Bridge Road. This surgery was fitted with up-to-date equipment which naturally increased the scope of work that could be performed. This was proved to such an extent that the original one session per week had quickly to be increased to two, Wednesday morning being devoted entirely to conservative treatment and consultations, whilst Saturday morning continued with extractions. The premises at 1a Bridge Road were selected temporarily, being more or less equidistant from both Wembley and Kingsbury, until such time as the Clinics at One Tree Hill and Stag Lane, Kingsbury, were completed. 31 It is interesting to note with regard to the equipment that, whilst it is not extravagant in nature, it is nevertheless very modern and efficient, and entirely British in manufacture. During the year 63 mothers were supplied with dentures as against 32 for the previous year, whilst 413 children and 846 mothers received treatment in some form or other, which works out at approximately 7 children and 14 mothers per session. J. H. STEVENS." Gynaecological Clinic. The number of patients attending during the year was:— New Cases 134 Subsequent attendances 128 Average attendance per session:— New Cases 5.6 Subsequent attendance 5.3 This clinic has continued to perform a useful function more particularly with regard to difficulties in the post-natal period. Seventeen patients were referred to their private medical practitioners, while 27 were advised to attend hospital with an accompanying explanatory letter. In 14 of these surgical intervention seemed to be indicated. The conditions met with at this clinic were such as:— subinvolution of uterus (23 cases) — erosion of cervix (16 cases) — prolapse of uterus — retroverted uterus — menopausal disturbances — anaemia — phlebitis — nephritis — hernia — cyst of breast — obesity and hypothyroidism — rheumatism. Birth Control Session. During the year the number of new cases was 74, the total number of attendances being 133. A report by Mrs. E. Fisher, M.D., D.P.H., contains the following observations:— Since the inception of this service two cases of failure in the two years are known to have occurred, that is out of a total of 116 cases actually advised. Four patients were not given birth control advice as there was no medical reason contraindicating pregnancy. A satisfactory feature of the year's work has been the number of nursing mothers referred from the Infant Welfare Centres because the mother's present state of 32 health made pregnancy inadvisable. Private medical practitioners have also referred patients to the clinic. One patient whose anaemia and mal-nutrition were due to her having had nine children in nine years is an example of the possibilities of correct birth control advice with regard to preventive medicine. Multi-parity alone is sometimes the cause of continued poor health. The Middlesex County Council conduct a school clinic at the Wembley Hill and Kingsbury Green Schools, where minor ailments, defective vision and dental defects are dealt with. The Tuberculosis Dispensary.—A County Council service is conducted at the clinic, Pound Lane, Willesden. Venereal Disease.—There is no centre for the treatment of this disease in the district. This service, a responsibility of the County Council, is provided at the various London Hospitals. 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. At the Redhill County Hospital an important addition has been the extension of the maternity accommodation at the end of the year from 21 beds to 60 beds. At the time of writing this report extensions are also proceeding at the Central Middlesex Hospital, where the present maternity accommodation of 28 beds is to be increased to 60 beds. At the Wembley Hospital, the voluntary institution in the Borough, extensive alterations are in progress. The number of beds is being raised from 63 to 83, while too, a new nurses' home accommodating 56 nurses is almost completed. The Council have made a contribution of 250 guineas to the hospital during the year. The great London Voluntary Hospitals also supply both consultation and in-patient services to the inhabitants of the area. NUTRITION. Ministry of Health Circular 1519. The Minister of Health in Circular 1519 referred to the recently issued First Report of the Advisory Committee on 33 Nutrition, and in particular to the emphasis laid in Part 6 of the Report on the nutritional value of milk, and requested the Council to take early opportunity of reviewing their arrangements under the Maternity and Child Welfare Act, 1918, in the light of this report. The Report of the Advisory Committee is an authoritative contribution of the highest value to Medical Officers and Health Visitors in their important educational work. It will be their duty to acquaint themselves in detail with this Report and to see to the fullest dissemination of the new knowledge amongst the mothers in the Borough. This is no new endeavour of health officers, for the Report itself says "The diet of the people is now more in conformity with physiological principles than it was in pre-war years and one of the reasons for this advance is the educational work on nutrition carried out in health clinics and in schools throughout the country." The Circular dealt particularly with milk, mentioning certain limitations which, while they may have remained in some areas, are not now in force in Wembley, for example: limitation of the supply of milk to the last two or three months of pregnancy and to children up to the age of 18 months or two years. The Council had for some time allowed the supply of milk in appropriate cases irrespective of the stage of pregnancy and to children up to the age of 5 years. The Council accepted the recommendation that for expectant and nursing mothers two pints per day, and for children 1-2 pints per day, be granted according to medical recommendation. The Circular further asked that any economic scale in force in the district should be reviewed. This is dealt with in another paragraph (Page 38). The Council also adopted the recommendation that the milk granted by the Council must be pasteurised milk. The only practical way to reduce the incidence of bovine tuberculosis especially prevalent in children, is by pasteurisation, while, in the present state of our knowledge, the only way to reduce the risk to a minimum of outbreaks of infectious disease (for example, typhoid fever, certain enteritis conditions, scarlet fever, septic sore throat, diphtheria, etc.) is by efficient pasteurisation. In Wembley there need be no difficulty for any householder in obtaining pasteurised milk. The Circular mentioned the importance of giving accessory foods. Sufficient milk food and accessory milk food preparations are given at the various clinics, according to the opinion of the Medical Officer. For those whose family income 34 is within the economic scale such foods are supplied free, while to all others attending the clinics the foods as advised by the clinic Medical Officers are supplied at the price at which the Council buy. During 1937 grants of liquid milk to the value of £1,257 8s. 8d. 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 £521 Is. 11½d. were also made. The final paragraph of the Circular asked that Authorities consider the question of any local need for organising arrangements for the serving of meals. While this is a matter ever kept in mind by the Maternity and Child Welfare Committee, up to the present it has been considered that there is no need to make a recommendation. OTHER SERVICES. Milk.—Milk is granted according to an economic circumstances scale (see page 38). Number of families granted free milk during 1937 500 Average number of families receiving free milk in a month 211 Average number of new families receiving free milk in a month 25 Number of families who applied for milk grants during year, and whose economic circumstances were beyond the scale 62 Number of families to whom grant had been given during the year, but who had also in the year become outside the scale—(generally resumption of work) 71 Artificial Sunlight and Massage. The arrangements whereby artificial sunlight, X-ray examination and massage are given at the Wembley Hospital and at Redhill County Hospital continued throughout the year. Cases referred for this treatment either to Wembley Hospital or to Redhill County Hospital numbered 81, 9 being under one year of age and 72 between the ages of one and five years. 810 treatments were given. The causes for the treatments were:—rickets — anaemia — delayed dentition — torticollis — bowing tibiae — genu valgum — recurrent bronchitis — debility — general atonia. 35 Maternity Outfits. 18 maternity outfits were supplied during 1937. This service, however, has recently been revised, and during the last few months the number supplied has increased. Along with the outfit the following leaflet is given:— Maternity Outfit. Not to be opened except by the Doctor or Midwife at the time of confinement. Contents:— 1 Twill sheet, 60 inches x 36 inches. 1 Waterproof Paper Sheet, 30 inches x 36 inches. 4 Umbilical Pads, 5 inches x 5 inches. Linen Thread. 3 yards Plain Gauze (B.P.C.) 16 ozs. Cotton Wool. 1 dozen extra large Maternity Pads. 1 dozen medium size Maternity Pads. 1 Accouchement Sheet, 25 inches x 28 inches. Convalescent Home Treatment. The Council arrange in appropriate cases for change of environment at a convalescent home, accepting the responsibility of the payment in whole or in part, according to the economic circumstances of the family. During the year arrangements were made for the convalescence of 19 cases:— 2 children under one year of age; 14 between the ages of 1 and 5, and three mothers. The causes for the recommendation were:— debility — tonsillectomy — losing weight — post-influenzal debility — over-weight — debility after confinement — anaemia-mastoidectomy — pulmonary fibrosis — general poor health — under nourishment — malnutrition. A weekly progress report was obtained from the Convalescent Home in all cases, which showed the immediate benefit of this treatment while, too, at the subsequent attendances of the children at the clinics the value of convalescence was demonstrated. The average gain in weight of the children was 8 ounces per week. 36 Home Helps. A panel of suitable women has been set up. With regard to the mother, the duties of a Home Help are largely a matter of medical detail, the most important point being the prevention of injury or infection by the Home Help, who is admittedly ignorant of midwifery nursing procedure. Her work is under the general supervision of a Health Visitor. She prepares meals for the family, sees to the general cleanliness of the mother's room and the home, the washing and drying of soiled clothing, and to the children going to school properly dressed. She must not undertake those services to the mother and baby which properly fall upon the midwife. This service is available for those of economic circumstances not more than the Council's free scale figure, and for women who are incapacitated during pregnancy, or who need assistance in the home during the lying-in period, and in respect of the confinement, both to the woman having her baby at home and to the woman having her baby in Hospital for medical or environmental reasons. The remuneration of the Home Helps is 25/- per week when so employed. So far the Scheme is in its infancy, but the number of names on the panel is small. 37 38 ECONOMIC CIRCUMSTANCES SCALE. Col. 1. Net income per head of the family. Col. 2 Col. 3 Col. 4 Col. 5 Col. 6 (a) Number in Family— 1 15/6 — — — — 2 10/6 14/0 16/6 19/0 21/0 3 9/6 13/0 15/6 18/0 20/6 4 8/6 12/0 14/6 17/0 19/6 5 or over 7/6 11/0 13/6 16/0 18/6 (b) Milk & Accessory Foods Free — — — — (c) Dental Treatment Free { Full Cost } (d) Artificial Dentures Free 25% 50% 75% 100% (e) Artificial Sunlight & Massage Treatment Free 25% 50% 75% 100% (f) Maternity Outfits Free 25% 50% 75% 100% (g) Convalescent Home Free 25% 50% 75% 100% (h) Circumcision Free 25% 50% 75% 100% (i) Home Helps Free — — — — N.B.—Blank Space Indicates No Assistance Given. ECONOMIC CIRCUMSTANCES SCALE FOR MATERNITY AND CHILD WELFARE SERVICES. This scale has been revised, and, in certain respects, its method of application amended. The scale is set out hereunder, the various services given also being mentioned:— Method of Computing Net Family Income. TOTAL INCOME calculated thus:— Earnings of children under 15 years of age not to be reckoned. (a) From Earnings. Parents or guardians weekly earnings, the average for the last four weeks being taken if variable. (b) From Lodgers. Children over 15 years of age who are earning, living at home, and contributing to the family income to be reckoned as lodgers. Payments from lodgers. Proportion to be reckoned as income. Up to 12/- per week Nil Over 12/- per week 50% of surplus over 12/- (c) From Sub-letting. The whole of the amount received to be reckoned as income. (d) From Other Sources. Any pension; unemployment benefit; sickness benefit; public assistance, or income from any other source to be counted as income. From the above TOTAL INCOME the following DEDUCTIONS to be made:— (a) Rent, (including the full payment made to a Building Society, and rates if paid by the applicant). (b) Fares to and from employment of husband and wife if working. (c) Compulsory insurances (National Health and ment). NET FAMILY INCOME is the above TOTAL INCOME minus the above TOTAL DEDUCTIONS. NET INCOME PER HEAD is the NET FAMILY INCOME divided by the number of parents and children (re. expectant mother include the unborn child) living at home (not being lodgers). MATERNITY HOSPITAL ACCOMMODATION. The number of births notified in the Borough during the year corrected for transfers into and out of the district was:— (a) Live Births 1,789 (b) Still Births 57 (c) Total 1,846 The following table gives the notifications, together by whom notified, for the last four years:— 39 40 BIRTHS NOTIFICATIONS, 1934-1937. By whom Notified Place at which Birth occurred. Totals. At Home. In Hospitals. In Nursing Homes, etc. 1934 1935 1936 1937 1934 1935 1936 1937 1934 1935 1936 1937 1934 1935 1936 1937 DOCTORS 351 385 348 290 319 355 557 595 178 132 71 182 848 872 976 1,067 MIDWIVES 277 365 368 417 79 84 14 138 149 203 258 156 505 652 640 711 PARENTS 95 47 23 65 3 2 — 1 6 3 3 2 104 52 26 68 TOTALS 723 797 739 772 401 441 571 734 333 338 332 340 1,457 1,576 1,642 1,846 The number of women desiring hospital confinement has been increasing throughout the country for some time. The percentage of Wembley confinements at home were:— 1935 50.7 1936 45.0 1937 41.8 These figures are in no way exceptional for Wembley. In the neighbouring areas of Willesden and Harrow for example, institutional births were 60% and over 50% in 1936 respectively. The percentage of home and hospital confinements regarding Wembley families has been according to the following table:— 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 1934 1,457 723 401 - 333 49.6% 27.5% 22.9% 1935 1,576 797 441 147 338 50.7% 27.9% 9.3% 21.4% 1936 1,642 739 571 156 332 45.0% 34.8% 9.5% 20.2% 1937 1,846 772 734 175 340 * 41.8% 39.8% 9.5% 18.4% * 161 in Wembley, 179 outside Wembley During 1937, 314 cases were referred to various Hospitals through the Public Health Department. For Medical reasons 66 Home conditions unsuitable 161 Patient desired Hospital accommodation 87 Total 314 41 The Council have been concerned at the lack of maternitybed accommodation at the County Hospitals. For example, as regards Redhill Hospital during 1937 of the women recommended by the Public Health Department 3 admissions were refused on account of no beds being available; 45 were refused on account of "lack of medical grounds," or for reasons unstated; while 22 other cases referred to the hospital by telephone were not accepted. With the recent and impending extensions at the County Hospitals it is to be hoped that more accommodation will be available for Wembley residents. It would be of great assistance, too, were some maternity accommodation to become available for the southern part of the Borough at the Central Middlesex County Hospital where the accommodation is being extended to 60 maternity beds. WEMBLEY BIRTHS TAKING PLACE IN HOSPITAL. (a) Middlesex County Council Hospitals:— 1935 1936 1937 Redhill 118 143 167 Central Middlesex 18 10 1 North Middlesex — — 2 West Middlesex 10 2 5 Hillingdon 1 1 — 147 156 175 (b) London Hospitals:— Queen Charlotte's 143 178 209 Queen Mary's, Hampstead 44 56 77 University College 19 32 33 Royal Free 11 14 9 City of London 2 11 48 Princess Beatrice 3 6 14 St. Mary's 22 31 51 Charing Cross 7 21 23 Middlesex 11 22 20 Hammersmith — 3 12 Other London Hospitals 32 41 63 294 415 559 Annual Totals 441 571 734 42 MIDWIVES' ACT, 1936. DOMICILIARY MIDWIVES' SERVICE. The County Council are the Local Supervising Authority under the Midwives' Acts. Regarding Wembley, it may be pertinent to remark that the Borough is now a large isolated County District bounded by Harrow, Hendon, Willesden and Ealing, all of which Councils are themselves the Local Supervising Authorities. For the Borough of Wembley the County Council have arranged that the Kingsbury District Nursing Association shall serve the four wards of the Borough which formed previously the Kingsbury Urban District, and that the Wembley District Nursing Association shall serve the other eight Wards of the Borough, for these purposes the Kingsbury Association employing two midwives and the Wembley Association three midwives. The County Council's Scheme provides for a scale of charges up to a maximum of £3 3s. 0d. (rebatement to be according to the net capital income of the family after certain deductions have been made—rent, rates, taxes, insurances and hire purchase payments). The County Medical Officer of Health has kindly given the information that there are 19 midwives resident in Wembley engaged in private practice, in addition to those midwives employed by the Kingsbury and Wembley District Nursing Associations. The number of Nursing Homes in the Borough is 7, providing in all 38 beds, 29 of which are maternity beds. MATERNAL MORTALITY. Ministry of Health Circular 1622. The Ministry of Health's report on an Investigation into Maternal Mortality resulted from a detailed investigation in certain areas—45 in which the maternal mortality rate over a period of years had been in excess of the average, and 24 where the rate had been below normal. The great fall in the infant mortality rate has been rather in contrast to the number of deaths still taking place during the first four weeks of life. These neo-natal deaths result from ante-natal influences, congenital weaknesses and conditions after birth, for example, injury. It would seem, therefore, that the problems of maternal and early infant mortality are, in certain respects, inseparably interlocked, measures to reduce maternal mortality being also likely to effect a reduction in the death rate of infants in the first week or two of life. 43 The number of deaths from maternal causes is small compared with that from many other causes of death. Only 8% of the total deaths from all causes among women of child bearing age are due to pregnancy and child birth. These puerperal causes, however, are the second largest cause of mortality of women between the ages of 25 and 35, and, surely, if any such death be preventable it should be prevented. Probably also there has been a tendency for too much public attention to be directed to this mortality, and too little to the care of motherhood and the preservation of health. The recommendations of the Report are set out below, together with comments as regards the service in Wembley. They have been called by the Ministry of Health "the elements of an efficient maternity scheme of a Local Authority." 1. The establishment, under the direction of the Medical Officer of Health, of an adequate service of obstetric consultants; (a) to assist medical practitioners who undertake domiciliary midwifery, in cases of doubt or difficulty in the ante-natal period at the time of confinement and during the puerperium: Comment: The Council's Scheme is that the consultant obstetrician is available on request of a private practitioner in a case of doubt or difficulty during the ante-natal period too ill to attend a hospital, at confinement, or during the lying-in period. (b) to conduct consultative ante-natal and post-natal clinics to which patients may be referred by general practitioners, or from the routine ante-natal and postnatal clinics: Comment: Cases seen at the routine ante-natal and gynaecological clinics and requiring consultant advice are referred to their private medical practitioners, or to a Hospital appropriate for the individual case. (c) to exercise clinical supervision over the in-patient treatment of the maternity patients for whom the Local Authority assumes responsibility: 44 Comment: There are no beds provided by the Local Authority. For some time the Council had been desirous of cooperating with the Urban District of Harrow in the provision of a joint Maternity Hospital of 70 beds. It would appear, however, that as regards Wembley, the provision of Hospital beds for maternity cases is to be made by the County Council at their general hospitals. (d) to supervise the treatment of patients suffering from puerperal sepsis: Comment: There are no beds for the treatment of puerperal sepsis provided by the Local Authority, the arrangement being that such cases are admitted to Queen Charlotte's Hospital, (Isolation Block). (e) to be responsible for the emergency domiciliary service for cases of grave obstetric abnormality in which removal to Hospital is contra-indicated, (e.g. certain cases of shock, eclampsia or haemorrhage): Comment: In such domiciliary cases the Private Practitioner may call in the assistance of the Council's Consultant Obstetrician. The Council have, through the two District Nursing Associations, a Scheme whereby nursing services are also available for cases of grave obstetric abnormality in which removal to Hospital seems undesirable. (f) to assist the Medical Officer of Health in the confidential investigation of the circumstances associated with each maternal death occurring in the area: Comment: Investigation is made as far as possible. 2. The Local Supervising Authority, in consultation with the local medical profession, should, in future, be empowered to take steps to ensure that the best local obstetric skill is made available in all cases in which midwives are rerequired, under the rules of the Central Midwives' Board, to call in a Doctor: Comment: The Council is still not the Local Supervising Authority. 45 3. Emergency Units, (Flying Squads) should be provided, whereby members of the staffs of maternity departments will be available for the domiciliary treatment of maternity patients whose condition is too grave to justify their removal to Hospital: Comment: See Comment under 1(e) above. 4. Properly constructed, adequately equipped and suitably staffed maternity accommodation, (including a sufficient number of beds allocated to and reserved for ante-natal patients) should be provided to meet the needs of every area. Wherever practicable the accommodation should be provided in association with general hospitals: Comment: See Comment under 1(c) above. 5. Arrangements should be made for:— (a) adequate domiciliary visiting by Health Visitors of expectant mothers with a view to encouraging them to engage an attendant for the confinement, and place themselves under ante-natal supervision at an early stage of pregnancy: Comment: This is a routine duty of the Health Visitors. (b) the provision of ante-natal clinics in every district in which the number of expectant mothers justifies it. In sparsely populated areas other arrangements should be made for efficient medical domiciliary ante-natal supervision : Comment: The provision of ante-natal clinic sessions as necessary with growth of attendance, is the constant care of the Council. When all the clinics be built, it can be said that the Borough will be very well provided. (c) the establishment of consultative ante-natal clinics to serve every area Comment: Cases requiring consultative advice are referred to a Hospital which appears appropriate to the individual case. 6. Satisfactory arrangements for the accommodation and treatment of patients suffering from puerperal sepsis, and from abortion, are essential: 46 Such cases are admitted to Queen Charlotte's Hospital, Isolation Block. With regard to abortion, beds are obtained in a Hospital as individual cases arise. 7. The development of post-natal services, including the establishment of clinics and arrangements for in-patient treatment, is a matter of urgent necessity: Comment: These cases are seen at the Maternity and Infant Welfare Centres and at the Gynaecological Clinic. For cases requiring Hospital treatment, individual arrangements are made. It is pertinent to mention also that some postnatal patients are asked to attend for post natal examination at the Hospital at which the confinement took place. The Council have, in addition, decided to institute postnatal clinics at their various clinic buildings as completed. 8. The education of the woman herself, and of the general public, should constantly be borne in mind by all concerned with maternal welfare, as the whole-hearted co-operation of mothers is essential to the success of any measure desired to reduce maternal mortality: Comment: The education of the woman, and of the general public, is the constant duty of the Medical Officers and Health Visitors. 9. A service of Home Helps should, wherever practicable, be provided: Comment: The Council have instituted a service of Home Helps. 10. Adequate records should be kept in connection with any branch of a maternity service. Free interchange of such records between all professionally concerned is essential in order to secure continuity of supervision and treatment: Comment: The value of this recommendation is obvious and is in operation. 11. Arrangements should be made in every district to ensure that no expectant or nursing mother requiring extra nourishment on health grounds fails to receive it for such a period as may be necessary: 47 Comment: On consideration of the Ministry of Health Circular, 1519, "Nutrition" appropriate recommendations were adopted by the Council (see page 33). HEALTH VISITORS. Owing to the growth of the service, an additional Health Visitor was appointed during the year, the total number of Health Visitors at the end of the year being 9. In the allocation of duties, home visiting and clinic responsibilities are co-ordinated, so that each Health Visitor becomes fully acquainted with the detailed personnel of her area. The numbers of home visits paid during the year by the Health Visitors were:— To expectant Mothers:— First Visits 877 Total Visits 1,861 To Children under 1 year of age:— First Visits 1,902 Total Visits 6,034 To Children between 1 and 5 years of age:— Total Visits 6,745 Special Visits:— Ophthalmia Neonatorum and other eye conditions 8 Puerperal Fever 6 Puerperal Pyrexia 16 Measles 51 Whooping Cough 121 Diarrhoea 22 General (unclassified) 210 The Health Visitors investigate all notified cases of puerperal pyrexia as well as all cases of still-births. PUERPERAL PYREXIA. Prior to the Public Health Act, 1936, both puerperal fever and puerperal pyrexia were notifiable diseases. Now, however, cases which may clinically be recognised as puerperal fever are also notifiable as puerperal pyrexia. 48 Puerperal pyrexia means any febrile condition occurring in a woman within 21 days after child-birth or miscarriage in which a temperature of 100.4F. or more has been sustained during a period of 24 hours, or has recurred during that period. Particulars of the confinement are ascertained, as are those of any ante-natal care received. The occurrence of any illness in the family (for example, scarlet fever, erysipelas, impetigo, diphtheria, sore throat, tonsillitis, laryngitis, antral or skin infections), is noted. In many cases these details are kindly supplied directly by the Doctor in attendance, and it is the endeavour of the Public Health Department that the patient shall have the treatment, (specialist attendant, bacteriological examination, removal to Hospital) which the Family Doctor considers appropriate. No. of cases notified within 7 days of the birth 15 No. of cases notified between 7 and 14 days of the birth 6 No. of cases notified between 14 and 21 days of the birth 2 23 No cause ascertained for the pyrexia in 5 cases—Infection due to Haemolytic Streptococcus (Group B) 2 cases—to Streptococcus Viridans 1 case—to Bacillus Proteus 1 case—the other cases were associated with Influenza—with Mastitis and Thrombus of leg veins—with Stitch Abscess—and with instrumental delivery. STILL BIRTHS. Regarding still-births, each Health Visitor, in her area, reports upon the mother's health during the pregnancy, noting details of any ante-natal supervision and of any work performed during the pregnancy; whether the confinement took place at home or in hospital, and the occurrence of any abnormal circumstance at the confinement. The history of any previous pregnancies is ascertained; and if there be anything requring medical advice now, the mother is advised to consult her Doctor. The importance of early ante-natal care from the Family Doctor or at the municipal clinic in any future pregnancy is always stressed. There were 57 still-births during the year known to the Public Health Department. Causes of still-birth:—high blood pressure and toxaemia, albuminuria, delayed labour, uterine inertia, eclampsia, hydramnios, placenta praevia, abnormal presentation of child, postmaturity and maceration, prematurity, instrumental delivery, hydrocephalus. 49 INFANT LIFE PROTECTION. The work of visiting children placed in the care of fostermothers is carried out by the Health Visitors, all of whom have been appointed Infant Life Protection Visitors. Visits paid during 1937:— To Foster Children 1,299 To Foster Parents 842 At the end of the year there were on the register:— Foster Children 80 Foster Parents 53 Number of Foster Children who died during the year 2 On whom inquests were held Nil The circumstances of foster parents and prospective parents are carefully investigated, and when the environment appears unsuitable for the reception of children the advice is given not to pursue the matter. PREVENTION OF BLINDNESS. Ministry of Health Circular No. 1621. In this Circular the Minister of Health made his observations with regard to a report published in 1936, on the Prevention of Blindness by the Standing Committee on the Prevention of Blindness of the Union of Counties Associations for the Blind. The County Council are the Authority responsible for the welfare of blind persons in the County, while the Public Health Act, 1936, also confers on both County Councils and Local Sanitary Authorities power to make arrangements for assisting in the prevention of blindness, and, in particular, for the treatment of persons suffering from any disease of or injury to the eyes. The Circular dealt with Maternity and Child Welfare; children of and over school age; infectious diseases; venereal diseases; prevention of accidents; statistics on blindness and publication of information. Maternity and Child Welfare. The report of the Committee directed attention to the importance of a comprehensive and adequate scheme of. antenatal supervision. In Wembley appropriate cases attending the ante-natal clinics are referred to a Hospital for specialist examination. 50 The Committee expressed the view that the disease Ophthalmia Neonatorum requires constant attention and skilled nursing, and can most satisfactorily be treated in Hospitals, the ideal arrangement being the admission of both mother and child to Hospital. The arrangement in Wembley is that babies suffering from this complaint are admitted to the London County Council Hospital—St. Margaret's, Kentish Town. Cases considered not to require Hospital admission receive domiciliary treatment from the nurses of the Wembley District Nursing Association, the Council paying 1/6d. per visit as well as supplying all necessary gloves, aprons, etc., required. A sentence in the report itself with regard to domiciliary treatment is most impressive—"Such an arrangement can only be regarded as satisfactory when the home nursing provided is equal in effectiveness to the skilled nursing and constant attention already advocated for cases which are taken into Hospital." With regard to children under school age, reference was made in the Circular to the arrangements whereby some Local Authorities use the services of the school ophthalmic surgeon for the examination of children under school age. At the time of writing, the Council are in negotiation with the Middlesex County Council regarding such a service being given through their school ophthalmic service. The value of external eye conditions being able to receive treatment at a minor ailments clinic was also mentioned. At the time of writing, minor ailment treatments have commenced to be given at the Council's permanent clinic buildings, (One Tree Hill and Stag Lane). Infectious Diseases. The Minister endorsed the recommendation that there should be arrangements whereby a Medical Officer in charge of an Isolation Hospital should call in an Eye Specialist to advise on or treat any eye complications. Venereal Diseases. The value of close co-operation between the Maternity and Child Welfare Clinics and Venereal Diseases Treatment Centres was mentioned, with reference to the fact that many Maternity and Child Welfare Authorities systematically refer cases needing treatment to Maternity Hospitals or to Venereal Diseases Treatment Centres. Such a scheme operates in Wembley. 51 NATIONAL CAMPAIGN TO ENCOURAGE THE WIDER USE OF THE HEALTH SERVICES. In September, 1937, the Government launched a campaign to encourage the wider use of the Health Services throughout the country. The campaign was designed to extend over a period of six months, being divided into the following sections:— October, 1937 Inaugural Campaign November and December, 1937 Maternity & Child Welfare Services January, 1938 School Health Services February, 1938 Services for Adults and Adolescents March, 1938 Physical Fitness Local Authorities throughout the country were invited to co-operate in this campaign by the distribution and exhibition of the publications which were supplied free of charge, and by the arranging of Health Exhibitions. The Public Health Department received and distributed posters, display cards and some 3,000 leaflets issued for each of the group of services indicated above. Posters were displayed on Public Notice Boards throughout the Borough, and display cards and leaflets exhibited at the Council's Clinics, Offices; and through the co-operation of Cinema Managements, the Guild of Social Service and the Wembley Stadium Authorities, the widest possible area of distribution was obtained. In addition, the Middlesex County Council distributed through the schools and libraries in this Borough, posters and bookmarks published in connection with all the Services. A film entitled "One Hundred Years" prepared in conjunction with the Ministry of Health and the Board of Education by the Pearl Insurance Co. was shown in local cinemas. Invitations were received and accepted by members of the Council to see this interesting film showing development in Public Health work. LOCAL GOVERNMENT AND OTHER OFFICERS' SUPERANNUATION ACT, 1922. During the year 162 examinations were made by the Medical Officer of Health of persons about to be appointed to the permanent staff of the Council. 52 Section C. SANITARY CIRCUMSTANCES OF THE AREA. Water- Drainage and Sewerage- Rivers and StreamsCloset Accommodation- Public Cleansing- Sanitary Inspection of the Area- Tents, Vans and Sheds- Offensive Trades- Piggeries- Rag Flock Acts- NoiseHairdressers- Establishments for Massage and Special Treatment- Rats and Mice Destruction Act- Shops ActFactories, Workshops and Work-places- Smoke AbatementSwimming Baths and Pools- Eradication of Bed BugsSchools, Private Schools- Mortuary- Byelaws in Force- 53 WATER. The sources of public water supply remain the same as last year, by Statutory Undertakers, the major part of the district being supplied by the Oolne Valley Water Company. A small area in the southern part of the Borough comprising the Council's Manor Farm Housing Estate is supplied by the Rickmansworth & Uxbridge Water Company, while four cottages belonging to the London, Midland & Scottish Railway Company take their supply from the railway company's private main. The water from these sources is a continuous supply, and during the year was satisfactory in quality and quantity. The Colne Valley Water supply is softened and chlorinated by the chloramine process, the purity of supply being under the supervision of a resident chemical and bacteriological staff, which carries out examinations in modern laboratories situated at the Company’s works. The supply of the Rickmansworth and Uxbridge Water Company is also chlorinated by the chloramine process, and the company states that samples of water are taken from each of their pumping stations for analysis regularly each month. Samples of drinking water were taken by this Department and submitted to the Clinical Research Association for examination during the year. Appended is a table showing typical results of these chemical and bacteriological examinations. There are no private wells in the Borough used for the supply of water for domestic purposes. There are, however, 5 private wells in the district known to the Department which supply water for factory purposes, 2 factories have 2 wells each and 1 factory has 1 well. At none of these factories is the water used for drinking purposes, the water supply from the water company's mains being provided for this purpose. The wells, which are of considerable depth, are lined for a sufficient distance, and have not shown evidence of surface pollution. 54 55 CHEMICAL & BACTERIOLOGICAL WATER REPORTS. Chemical. Sample of Water Colne Valley Water Co. 25/5/37. Sample of Water Rickmansworth & Uxbridge Water Co. 31/8/37. Parts per 100,000 Grains per Gallon Parts per 100,000 Grains per Gallon Total solids (dried at 120° C) 30.0 21.0 44.5 31.2 Combined chlorine (as CI.) 4.20 2.94 1.70 1.19 equivalent to Sodium Chloride (NaCl) 6.93 4.85 2.81 1.97 Nitric nitrogen (nitrates) 0.52 0.36 0.62 0.43 Nitrous nitrogen (nitrites) Nil Nil Nil Nil Ammoniacal nitrogen Nil Nil 0.0008 0.0006 Albuminoid nitrogen 0.0030 0.0021 0.0012 0.0008 Oxygen absorbed in 4 hours at 27 ° C 0.035 0.025 0.010 0.007 Lead or Copper Nil Nil Nil Nil Temporary hardness (equivalent to CaCo3) 12.0 8.4 26.5 18.5 Permanent hardness ( „ „ „ ) 2.0 1.4 5.8 4.1 Total Hardness ( „ „ „ ) 14.0 9.8 32.3 22.6 Bacteriological. Average number of organisms producing visible colonies on gelatine plates, incubated at 20° C. for 3 days is found to be 16 per c.c. 22 per c.c. Average number of organisms producing visible colonies on agar plates, incubated at 37.5° C. for 2 days is found to be 3 per c.c. less than 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. CI. Welchii (spores) Not found in 100 c.c. Not found in 100 c.c. DRAINAGE AND SEWERAGE. The Borough Engineer & Surveyor has kindly supplied the following notes on sewerage works carried out during the year:— Sewerage works totalling approximately £18,000 in cost have been carried out including soil sewers, surface water sewers and culverts and a small pump and pump house for dealing with storm water. The most important sewerage scheme carried out has been the East Lane Surface Water Drainage Scheme costing approximately £13,000 which provided a new outfall sewer for the drainage of a large area of North Wembley. Sewage disposal now being taken over by the West Middlesex Drainage Board, no works of this nature have been necessary and the old sewage works are to be demolished. RIVERS AND STREAMS. The River Brent, which forms a boundary between this Borough and the Boroughs of Willesden and Ealing on the south east, provides the outfall for practically all of the watercourses in Wembley. The River Brent itself after flowing through adjoining districts eventually empties into the River Thames. The other rivers and streams are the Wealdstone Brook., Hendon Rural Brook, Wembley Brook, Preston Brook, Dors Close Brook, and a number of ditches discharging into the various brooks. The surface water sewers in the Borough discharge into the open water courses and a close watch is therefore kept for any evidence of pollution. Three hundred and thirty-four inspections of water courses were made during the year and as a result a number of cases of pollution were discovered. In most of these cases the pollution was due either to errors of construction not necessarily primarily in Wembley, or to the misuse of rain water gullies on private property. Every effort was made to trace the source of the nuisance, but in some cases this has been a difficult matter. The Middlesex County Council have continued to cleanse periodically the main rivers and streams in the Borough. 56 CLOSET ACCOMMODATION. There are now only 4 dwelling houses provided with pail closets; three houses previously so provided having been demolished during the year and one being now no longer used. There are three other pail closets in use in the Borough, 2 being at a factory which is below the level of the nearest sewer, the other being in connection with a caravan. In addition to the above there are 37 closets of a chemical type, all of which, with one exception, are on various sports grounds and open spaces. 26 of these are in the ownership of the Borough Council and it is hoped that as the development of the sports grounds and open spaces progresses these closets will be replaced, where necessary, by closets on the water carriage system. There are 8 cesspools and 5 septic tanks in the Borough. With the above exceptions all closet accommodation is on the water carriage system of the West Middlesex Main Drainage Scheme. PUBLIC CLEANSING. The following report has kindly been supplied by the Director of Public Cleansing:— The house refuse collection service is a weekly one with the exception of certain flats from which the refuse is removed twice weekly. 27 miles of streets are cleaned once weekly. 58½ „ „ „ „ „ twice weekly. 6¾ „ „ „ „ „ three times weekly. 6½ „ „ „ „ „ daily. Street gullies are cleansed four times per year. As noted in my last report, the Public Cleansing Services are now under the control of a separate Public Cleansing Department. The collection of refuse from the whole of the Borough is now carried out with mechanical vehicles. The last four horses used on refuse collection were disposed of at the end of March, 1937, being replaced by mechanical vehicles which, after a test, were proved to be more economical. The new Refuse Disposal Plant, put into operation on 1st October, 1936, deals satisfactorily and efficiently with the whole of the refuse of the Borough. 57 All refuse with a marketable value is extracted and the remainder burnt in a nine-cell incinerator. The Plant continues to be an attraction to representatives of other local authorities in this country and it has been inspected by several distinguished visitors from overseas. Other services controlled by the Public Cleansing Department are street cleansing, gritting, snow removal, gully cleansing and the supervision of public conveniences. Up to 30th September, 1937, the cleansing of gullies was carried out by contractors. From this date the work has been done by direct labour and a new petrol driven gully emptier was purchased for this purpose. SANITARY INSPECTION OF DISTRICT. 1937 1936 Complaints received and investigated 970 770 Dwelling Houses. Visits under Public Health Acts 3738 2360 Visits under Housing Acts 282 165 Visits re Overcrowding 2679 2768 Visits to bug infested premises 112 114 Visits re other vermin 72 Visits to cases of Infectious disease 1372 683 General Sanitation—Inspections. Drains 1891 1302 Drain Tests Applied 207 35 Cesspools, etc 121 9 UrinStls and Latrines 42 141 Stables, Manure Pits, etc 76 23 Piggeries 23 40 Ditches and Streams 334 156 Refuse Dumps, Open Spaces, etc 226 142 Yards 2226 2115 Public Conveniences 309 198 Water Supply—Visits 34 — „ „ -samples taken 4 6 Tents, Vans and Sheds 101 79 Factories 452 185 Worshops 64 15 Workplaces 45 12 Outworkers 201 2 Smoke Observations—(half hourly) 126 162 „ „—(Casual) 1102 575 „ „ —Visits to Plant 188 61 58 1937 1936 Cinemas, Dance Halls, etc 54 33 Hairdressers 181 61 Schools 68 21 Markets 50 42 Offensive Trades 92 72 Swimming Baths—Visits 6 7 „ ,, —Samples taken 4 6 Rag Flock—Samples taken 3 — Noise Nuisances 83 — Meat and Other Foods Inspection. Meat Shops, Stalls etc 457 347 Slaughterhouses 92 133 Cowsheds 33 26 Dairies and Milkshops—Visits 288 200 „ „ „ —Milk samples taken 234 198 Bakehouses (Factory) 96 59 „ (Workshop) 9 8 Ice Cream Premises 12 799 Fishmongers and Poulterers 195 Green grocers and Fruiterers 288 Grocers 193 Restaurants, Cafes, etc 236 Street Vendors, Hawkers, etc 4 Other Premises 27 Miscellaneous 995 4019 Totals 19727 17379 In the above table and the subsequent table of nuisances abated and improvements effected, comparative figures for 1936 are given. It is necessary to point out, however, that owing to an alteration in the classifications for the year 1937 the figures for 1936 are not now strictly comparable; for example, the figures given under the heading “ Miscellaneous” for 1936 included re-visits, which are now distributed throughout the various heads. 59 Notices served 1937. verbal 488 976 Total number of informal notices served written 488 Total number of informal notices complied verbal 459 |917 with written 458 Total number of Statutory notices served - 21 Total number of Statutory notices complied with - 15 Nuisances Abated and Improvements Effected. (a) Dwelling Houses. 1937 1936 Roofs repaired 29 23 External walls and chimney stacks repaired 28 21 Gutter and spouts repaired or renewed 20 27 Damp-proof courses provided 3 — Dampness remedied 52 25 Yards paved or repaired 21 12 Internal walls and ceilings repaired 45 43 Doors repaired or renewed 7 1 Windows repaired or renewed 37 30 Floors repaired or renewed 27 6 Sub floor vent, provided or improved 5 2 Rooms cleansed or redecorated 137 139 Passages and staircases redecorated 15 19 Staircases repaired 4 — Fireplaces repaired or renewed 23 | 20 Cooking stoves repaired or renewed 11 Wash Coppers repaired or renewed 3 2 Sinks and wash basins provided or renewed 13 13 Waste pipes repaired or renewed 27 21 Food stores provided or improved 1 1 Dust bins provided or renewed 249 343 Water supply improved or reinstated 22 13 W.C’s. cleansed or repaired 64 59 Additional W.C’s. provided 2 — Miscellaneous 23 101 Verminous Premises disinfested (Bugs) 71 59 „ „ „ (Other vermin) 27 Overcrowding abated 76 2 (b) General Sanitation. Drains cleansed from obstruction 482 495 Drains repaired or renewed 64 37 New drains provided 31 3 New inspection chambers provided 15 Inspection chambers repaired 15 34 60 1937 1936 W.C’s. repaired 8 — W.C’s. cleansed 110 — Cesspools emptied 10 — Cesspools repaired 1 — Urinals and latrines cleansed or emptied 24 27 Additional urinals or latrines provided 3 — Stables, manure pits, cleansed 6 — Animal nuisances abated 9 7 Offensive accumulations removed 76 66 Ditches and streams cleansed 9 21 Yards cleansed or repaired 26 — Tents, vans, sheds removed 28 54 Smoke nuisances abated 28 34 Improvements in boiler plant or fuel effected 10 — Cinemas, dance halls, etc.— Contraventions remedied 7 3 Hairdressers—Contraventions remedied 32 7 Schools—sanitary conditions improved 1 — „ —additional W.C’s. or urinals provided 4 — Noise nuisances abated 4 — (c) Meat and other Foods. Slaughterhouses 2 4 Meat shops, Stalls, etc.—Premises cleansed 12 24 „ „ „ „ —Other contraventions remedied 13 Dairies—Cleansed and limewashed 5 1 „ —Premises repaired 1 ,, —Other contraventions remedied 5 Bakehouses—Cleansed and limewashed 16 10 „ —Sanitary conditions improved 5 „ —Other contraventions remedied 3 Ice cream premises cleansed and limewashed 1 Fried Fish Shops 1 —Sanitary conditions improved 1 Fried Fish Shops —Other contraventions remedied 6 Fishmongers, etc.—Contraventions remedied 4 18 Grocers „ „ 16 Greengrocers „ „ 18 Restaurants, Cafes, etc. „ „ 21 Other food premises „ ,, 5 Total 2179 1828 61 TENTS, VANS AND SHEDS. 101 visits were paid to vans during the year, most of which were occupied by gypsies. In the majority of cases the vans were on land forming part of the regional open space in Fryent Way. With the help of the owners of the land and the police 28 vans were removed within a short time of their having been placed there. OFFENSIVE TRADES. The only type of offensive trade now carried on in Wembley is that of fish frying. There are 12 such businesses established in the district and 92 inspections of these premises were carried out during the year. They were generally found to be well conducted. The number of applications received during the year to carry on the trade of fish frying was 5, one of which was granted, one being withdrawn, and two were refused. One application was received from an owner of premises, but he did not propose himself to carry on the trade. He was informed that the Council would give further consideration to the matter when an application was received from the person who proposed to carry on the business. No such application was received. PIGGERIES. There has been a further fall in the number of piggeries in the district, five having been removed, five are still remaining. In 1897 Dr. Goddard, the late Medical Officer of Health, wrote “ We are gradually getting the piggeries of the district in better order, but there is much to be done” and he continued, evidently, to have to give the subject his attention. In 1903 he said “ It has not been a good year for the piggeries, the constant wet weather has made it nearly impossible to keep these premises in good sanitary condition at all times. I feel that we should unite and not be satisfied until they are pushed out of our district.” The 5 remaining piggeries are now only of individual concern—they are in themselves a public health matter of little moment, and with the further development of the district it seems likely their number is about to become still less. 62 RAG FLOCK ACTS, 1911 AND 1928. 3 samples of rag flock were taken under the above Acts, all of which complied with the Rag Flock Regulations, 1912. The samples were found to contain not more than 10 parts of chlorine per 100,000. NOISE. Complaints of noise are increasing. During 1937, 83 observations were made. “ In noise we are faced with an environmental problem which has markedly increased in significance in recent years with the development of mechanised civilisation. It must be recognised that individuals vary very much in their sensitiveness to noise, tJlit there is a general concensus of opinion that the widespread use of recent inventions, particularly radio sets, by the public, the increase of motor traffic and modern methods of building and road construction, have led to an increase in noise which is intolerable to many. Such noise is calculated not only to handicap the performance of work but to destroy the amenities of home life, and by disturbing rest and sleep contribute to ill-health in the community. Various measures may be taken to ensure that standards of noise are not exceeded in flats or other premises. They require to take account of the noise made by traffic and industrial noises and that made in the building itself by neighbours. They comprise questions of technique building and internal planning, town planning, legislation and education.” (League of Nations, Bulletin of the Health Organisation, August, 1937). HAIRDRESSERS. Number on the Register—93. 181 visits were paid to hairdressers' premises and, as a result, 32 contraventions of the byelaws relating to such businesses were found. In the majority of cases contraventions were remedied immediately on the attention of the hairdresser being drawn to them. In no case was it necessary to take legal proceedings. The byelaws are made under the Middlesex County Council Act of 1934, and deal with the cleanliness of the premises, and of the instruments, towels, equipment and materials used in the premises. 63 ESTABLISHMENTS FOR MASSAGE, ETC. During the year the Council adopted Part VII of the Middlesex County Council Act, 1934, which deals with Establishments for Massage and Special Treatment. In this regard up to May, 1938, the following numbers have been dealt with:— (a) Members of the Chartered Society of Massage and Medical Gymnastic who have lodged with the Local Authority a certificate signed by two resident medical practitioners that they are suitable persons to carry on such an establishment 3 (b) Applications for licences granted 14 Byelaws will become operative during 1938. RATS AND MICE DESTRUCTION ACT, 1919. The Middlesex County Council are the authority under this Act and 72 complaints received during the year in this Department, relating to rats, were referred to that authority. SHOPS ACT, 1934, SECTION 10. Arrangements for Health and Comfort of Shop Workers. The Shops Inspector has kindly supplied the following statistics. Number of inspection visits 2,374 Section 10 (1) (b)—Temperature. Number of shops in which a reasonable temperature was not maintained 48 Section 10 (2)—Sanitary Conveniences. Number of shops in which sanitary conveniences were not suitable and sufficient 17 Number of Certificates of exemption granted Nil Section 10 (4)—Washing Facilities. Number of shops in which washing facilities were not suitable and sufficient 21 Number of Certificates of exemption granted Nil In each case proper arrangements were made when the matter was brought to the notice of the occupier of the shop. FACTORIES, WORKSHOPS, WORKPLACES AND OUTWORKERS. The number of Factories, Workshops and Workplaces on the register, and the numbers of inspections of these premises are as follows:— 64 Inspections Factories 294 548 Workshops 77 73 Workplaces 75 45 The classification of the inspections and the defects found and remedied are given in the following table. All plans of new buildings intended to be used as factories, workshops or workplaces which are received by the Borough Engineer & Surveyor are referred to the Public Health Department to see that they comply with the requirements of the Acts and Orders relating to sanitary accommodation. The number of outworkers on the register was 54, and 201 visits to outworkers premises were made. In no case was work found to be carried out on unwholesome premises; nor was work found to be given out to any notified case of Tuberculosis. 1. INSPECTION OF FACTORIES, WORKSHOPS AND WORKPLACES. Including Inspections by Sanitary Inspectors. (Figures for 1936 given in Brackets). Premises. Inspections Written Notices Occupiers prosecuted. Factories (Including Factory Laundries) *548 (244) 52 (9) - (-) Workshops (Including Workshop Laundries) * 73 (23) 6 (-) - (-) Workplaces (Other than Outworkers' premises) 45 (-) - (-) - (-) Total 666 (279) 58 (9) - (-) 65 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 Public Health Acts: Want of Cleanliness 21 (19) (a)23 (15) - (-) - (-) Want of Ventilation 1 (8) (b) 5 (3) - (1) - (-) Overcrowding - (-) - (-) -(-) - (-) Want of Drainage of Floors 6 (-) 4 (-) - (-) - (-) Other Nuisances 4 (-) 4 (-) - (-) - (-) Sanitary accommodation, 1 nsufficient Unsuitable or 5 (4) 5 (4) - (-) - (-) defective not separate for 127 (8) (c)127 (6) - (-) - (-) sexes 3 (-) 3 (-) - (-) - (-) Offences under Factory & Workshop Acts: Illegal occupation of underground bakehouses (s.101) 1 (-) 1 (-) - (-) - (-) Other offences - (-) - (-) - (-) - (-) (Excluding offences relating to outwork and offences under the sections mentioned in the Schedule to the Ministry of Health (Factories & Workshops Transfer of Powers) Order 1921). TOTAL 168 (39) 172 (28) - (1) - (-) (a) 4 defects remedied in 1937 brought forward from previous year. (b) 4 defects remedied in 1937 brought forward from previous year. (c) 2 defects remedied in 1937 brought forward from previous year. SMOKE ABATEMENT. During 1937, 126 half-hourly observations on smoke emission were made and 1102 casual observations. In addition 188 visits were paid to boiler plants or furnaces. The corresponding figures for 1936 were 162 half-hourly observations, 575 casual observations and 71 inspections of boiler plants or furnaces. No statutory notices were served, and it was not necessary to take legal proceedings in any case. It is found by experience that greater improvements are achieved and more smoke nuisances abated by personal visits and consultations on the premises than by the service of notices. The factory owners and managers are, as a rule, only too anxious to avoid complaints and are willing to meet suggestions made by the technical staff. 66 The majority of the smoke nuisances in this area are found to be due either to unsuitable fuel or defective manipulation of the plant. SWIMMING BATHS AND POOLS. There are 2 swimming pools in the district which are open to the public, one at Vale Farm, Sudbury,- belonging to the Council and the other being the Empire Pool in the Exhibition grounds belonging to private enterprise. Both of these baths are constructed on modern lines and are well equipped, the Empire Pool being an indoor bath whilst the Vale Farm bath is an open air one. In both cases the water is supplied by the Colne Valley Water Company, and efficient, continuous filtration with chlorination is carried out. During the year 3 samples of water from the Vale Farm bath, and 1 from the Empire Pool were submitted to the Clinical Research Association for chemical and bacteriological examination. All of these samples were found to be satisfactory for bathing purposes. ERADICATION OF BED BUGS. (1) Number of Council Houses— (a) Found to be infested 15 (b) Subsequently disinfested 15 (2) Number of other Houses— (a) Found to be infested 50 (b) Subsequently disinfested 56 * * 6 of these were found infested in 1936. 112 visits were paid to verminous premises during the year. The disinfestation of Council houses is carried out by the staff of the Housing Department of the Council, and includes the removal of architraves, skirting, floor boards, and picture rails, the spraying of the walls and the treating of the woodwork and bedsteads with a blow lamp. The surfaces of the room are sprayed with an insecticide, and the bedding and other articles of furniture are destroyed when necessary. A spray is lent to the tenant, and a quantity of insecticide provided free of charge. 67 The homes of all prospective tenants for Council houses are visited by an enquiry officer of the Borough Engineer's Department and arrangements have been made for the furniture to be fumigated in a removal van with HCN gas, and for the bedding to be treated in a steam disinfector. The treatment by hydrogen cyanide gas is carried out by a contractor, while the steam treatment of bedding is done by the Public Health Department. All premises are carefully inspected at the time of routine redecoration and 6 cases of slight infestation were thus revealed during the year. After the premises have been treated a spray is lent to the tenant and a quantity of insecticide provided, and instructions given as to its use. All vacant houses are examined prior to re-occupation. So far as other premises are concerned 18 have been disinfested by hydrogen cyanide gas, 12 by sulphur, and 26 by liquid insecticides following notice from the Public Health Department. Any such work by hydrogen cyanide has been carried out by a contractor employed by the owner or occupier. SCHOOLS. The Middlesex County Council are the Education Authority. There are 3 secondary schools and 26 elementary schools in the Borough. In addition there are 24 private schools known to the Department. All the schools are supplied with water from the water company’s mains. The majority of the schools are of modern construction, being well lighted and ventilated and provided with up-to-date sanitary accommodation. No school was closed during 1937 by reason of the incidence of infectious disease. Individual scholars have been excluded from school on the occurrence of infectious disease in the home in accordance with the memorandum of the Middlesex County Council. Private Schools.—With regard to Private Schools, the first observation must be that the powers of Local Authorities from a Public Health point of view are distinctly limited. Local Authorities have no direct statutory power to ascertain the existence of all Private Schools in their areas. With regard to Wembley, however, there is no reason to think otherwise than that most of the Private Schools are known to the Health Department. Routine investigations on the incidence of 68 notifiable infectious disease reveal the names of certain Private Schools, while sometimes Principals of such Schools ask advice on matters of infectious disease. As regards the number of children attending Private Schools, Section 151 of the Public Health Act, 1936, states that, “The Principal of a school in which any scholar is suffering from a notifiable disease shall, if required by the Medical Officer of Health of the district, furnish to him within a reasonable time fixed by him a complete list of the names and addresses of the scholars, not being boarders, in or attending the school, or any specified department of the school.” In these rather indirect ways, ascertainment on the whole may be considered fairly complete in Wembley. Physical conditions in Private Schools are guarded only by the Public Health Acts. Part III (Section 92) of the Public Health Act, 1936, states that “any premises in such a state as to be prejudicial to health or a nuisance” may be dealt with as a statutory nuisance. As regards overcrowding, the power previously given by the Public Health Act, 1875, appears to have been lost in the new Act. The Board of Education, however, has stated as a minimum standard that there should be 10 sq. ft. of floor space for children under 11 years of age and 12 sq. ft. for children over 11 years. As regards sanitary accommodation, Section 44 of the Public Health Act, 1936, states that (1) If it appears to a Local Authority (a) that any building is without sufficient closet accommodation; or (b)., the Authority shall by notice to the owner of the building require him to provide a building with such closets or additional closets, or such substituted closets, being in each case either water closets or earth closets, as may be necessary. The Council have adopted the following standards in regard to accommodation in premises used as Private Schools, and the Medical Officer of Health has been instructed to report to the Public Health Committee all cases where these standards are not respected by Private Schools in the Borough:— (a) Overcrowding. Minimum standards of floor space per person:— Children under eleven years of age—10 sq. ft. Children over eleven years of age 12 sq. ft. 69 (b) Lavatory Accommodation. No. of Boys Minimum water- No. closets required of Girls Minimum waterclosets required 25 1 15 1 50 2 30 2 75 3 45 3 100 4 60 4 (provided there be sufficient urinal 75 5 space in addition—ratio 10-ft. per 100 boys). 100 6 MORTUARY. The Council's mortuary is at the old burial ground adjoining the Parish Church of St. John and consists of 3 cubicles and a fully equipped post mortem chamber. A full-time mortuary and burial ground attendant is employed by the Council. During 1937, 102 bodies were deposited; 68 post-mortem examinations were made and 36 Coroner's inquests were held. The bodies were deposited by the following authorities:— Coroner 68 Police 18 Medical Officer of Health 1 By Council Ambulance 2 At request of Relatives 9 From Wembley Hospital 2 From Barnet Hospital 2 BYE-LAWS IN FORCE THROUGHOUT THE BOROUGH OF WEMBLEY—DECEMBER, 1937. * Hoarding and Advertisements 1926 Petroleum Filling Stations 1932 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 1936 Buildings 1937 Slaughterhouses 1937 70 BYE-LAWS IN FORCE IN AREA COMPRISING FORMER URBAN DISTRICT OF WEMBLEY PRIOR TO 1st APRIL, 1934. 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 BYE-LAWS IN FORCE IN AREA COMPRISING FORMER URBAN DISTRICT OF KINGSBURY PRIOR TO 1st APRIL, 1934. New Streets and Buildings 1926, 1931 Smoke Emission 1933 * A bye-law repealing as from 29th December, 1937, these bye-laws in respect of the area to which the Wembley Planning Scheme No. 1 applies was made by the Urban District Council of Wembley on the 3rd November, 1937, and confirmed by the Secretary of State on the 29th December, 1937. 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. Recruitment Salaries and Conditions of Service of Council's Technical, Administrative and Clerical Staff. 71 Section D. HOUSING. Inspection of Dwelling Houses— Overcrowding— New Housesv 72 INSPECTION OF DWELLING-HOUSES DURING THE YEAR. (1) (a) Total number of dwelling-houses inspected for housing defects (under Public Health or Housing Acts) 1830 (b) Number of inspections made for the purpose 4020 (2) (a) Number of dwelling-houses (included under subhead (1) above) which were inspected and recorded under the Housing Consolidated Regulations, 1925 83 (b) Number of inspections made for the purpose 282 (3) Number of dwelling-houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation 10 (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 665 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 664 ACTION UNDER STATUTORY POWERS DURING THE YEAR. (a) Proceedings under Sections 9, 10 and 16 of the Housing Act, 1936:— (1) Number of dwelling-houses in respect of which notices were served requiring repairs Nil (2) Number of dwelling-houses which were rendered fit after service of formal notices:— (a) By owners * 1 (b) By Local Authority in default of owners Nil * Includes compliance in 1937 of 1 notice served in 1936. (b) Proceedings under Public Health Acts:— (1) Number of dwelling-houses in respect of which notices were served requiring defects to be remedied 19 73 (2) Number of dwelling-houses in which defects were remedied after service of formal notices:— (a) By owners 8 (b) By Local Authority in default of owners 1 (c) Proceedings under Section 11 and 13 of the Housing Act, 1936:— (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 1 (d) Proceedings under Section 12 of the Housing Act, 1936:— (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 OVERCROWDING. The Minister of Health fixed the 1st July, 1937, as the “appointed day” on which the provisions of sections 6 (2), 59, 60 and 64 of the Housing Act, 1936, should come into force in the Borough, and the 1st January, 1937, was fixed as the “ appointed day” under section 62 of the Act. Section 6 (2) of the Housing Act, 1936, provides that as from the “appointed day” any byelaw for fixing the number of persons who may occupy a house suitable for occupation or occupied by persons of the working classes shall cease to have effect. Section 59 deals with offences in relation to overcrowding. Section 60 defines the power of the Minister to increase the permitted number temporarily to meet exceptional conditions. Section 64 defines the duty of the landlord to inform the local authority of overcrowding Section 62 deals with entries in rent books, information and certificates with respect to permitted numbers. With regard to this section, certificates have been issued by the Department to landlords, giving the permitted number of persons who may occupy a house, as follows:— 1936 397 1937 3614 74 Statistics re Overcrowding. (a) Number of dwellings overcrowded at the end of the year 61 Number of families dwelling therein 63 Number of persons dwelling therein 404 (b) Number of new cases of overcrowding reported during the year 29 (c) (i) Number of cases of overcrowding relieved during the year Total 82 (1) by removal of members of family 26 (2) by removal of families to other known addresses (not overcrowded) 9 (3) by removal to unknown addresses 45 (4) by removal to Council houses (included also in (2) 3 (5) by re-arrangement of rooms amongst tenants of the house 2 (ii) Number of persons concerned in such cases 490 (d) Particulars of any cases in which dwellinghouses have again become overcrowded after the Local Authority have taken steps for the abatement of overcrowding Nil NEW HOUSES. The Borough Engineer & Surveyor has kindly supplied the following information:— Numbers of new houses erected during the year:— (a) Total, including numbers given separately under (b) 977 houses 449 flats 48 shops. (i) by the Local Authority—none. (ii) By other Local Authorities—none. (iii) 977 houses, 449 flats, 48 shops. (b) With State assistance under the Housing Acts (i) By the Local Authority—none. (ii) By other bodies or persons—none. 75 Section E. INSPECTION AND SUPERVISION OF FOOD. Milk (Special Designations) Order— Cowsheds— Dairies and Milk Shops— Milk and Dairies (Consolidation) Act, 1915, Tuberculosis Order, 1925— Slaughterhouses, Carcasses Inspected and Condemned— Meat Shops, etc.— Bakehouses— Other Food Premises— Unsound Food Surrendered— Food and Drugs (Adulteration) Act, 1928, etc.— Shell-Fish. 76 MILK (SPECIAL DESIGNATIONS) ORDER, 1936. LICENCES ISSUED 1937. Designation Dealers Supplementary To Bottle To Pasteurise Tuberculin Tested 17 5 3 - Accredited 3 2 - - Pasteurised 24 7 - 3 Tuberculin Tested milk is milk from cows which havepassed a veterinary examination and a tuberculin test; it is bottled on the farm or elsewhere; and it may be raw, or pasteurised. If it is bottled on the farm, it may be described on the bottle caps or cartons as Tuberculin Tested Milk (Certified). If it is pasteurised it is described as Tuberculin Tested Milk (Pasteurised). It must satisfy certain bacteriological tests. Accredited milk is raw milk from cows which have passed a veterinary examination; it is bottled on the farm or elsewhere. It must satisfy the same bacteriological tests as raw Tuberculin Tested milk. Pasteurised milk is milk which has been retained at a temperature of 145 deg. to 150 deg. F. for at least thirty minutes; and does not contain more than 100,000 bacteria per millilitre. The following is a classification of the samples of graded milk taken. No. of samples taken Not up to Standard Tuberculin Tested 82 6 Pasteurised 116 5 T.T. (Pasteurised) 10 - Accredited 11 - 219 11 Of the above 116 samples of Pasteurised milk, 47 were taken at the schools of the Education Authority. 77 9 samples of Pasteurised milk were submitted to the Phosphatase test and were reported as being satisfactory. In all cases where samples were not up to standard, further samples were taken, which were found to be satisfactory. Regarding the 11 unsatisfactory samples, only one unsatisfactory sample was found which had been bottled within the Borough of Wembley. COWSHEDS. At the end of the year there remained only two farms producing milk for sale, one of which was licensed for the production of Tuberculin Tested milk and one for the production of Accredited milk. 33 visits were paid to cowsheds, the methods of production being satisfactory. DAIRIES AND MILK SHOPS. Number of dairies registered 28 Number of purveyors of milk registered, with premises in the Borough, selling milk in properly closed and unopened receptacles 25 Number of purveyors of milk registered, whose premises are outside the Borough 26 79 Number of dairies (included above) where milk is bottled, etc 8 288 visits were paid to dairies and milk shops during the year and the premises were generally found to comply with the Milk and Dairies Order 1926. All premises registered as dairies where milk is bottled are provided with a steam plant for the cleansing and sterilising of the utensils and containers used. During the course of inspection of dairies it had been noticed that some of the milk coming into the district on occasion appeared to reveal the presence of particulate matter. Upon drawing the attention of the dairymen to this it was learned that they themselves were not entirely satisfied with the condition of some of the milk being received by them It was felt that some good would accrue from informing the officers of the local authorities in whose districts the milk was produced. Samples from the churns have accordingly been 78 taken on arrival in Wembley and tested for sediment. In all cases where the sample has been unsatisfactory, the attention of the Public Health Department of the district in which the milk had been produced has been drawn to the matter, and the filter pads sent for inspection. The inspectors of the districts concerned have visited the farms from which unsatisfactory samples had been produced and in a number of instances defects have been found in the methods of production. It is pleasing to be able to report that as a result of this co-operation with inspectors of other local authorities, there has been a marked improvement in the condition of the milk on its arrival at dairies in this area. This supervision by the inspectorial staff of the milk sent into the Borough has been a Public Health measure of considerable value. MILK AND DAIRIES (CONSOLIDATION) ACT, 1915. TUBERCULOSIS ORDER, 1925. The Acting Chief Officer of the Public Control Department of the Middlesex County Council has kindly supplied the following particulars of the work carried out during the year by the County Council under the Milk and Dairies (Consolidation) Act, 1915, and the Tuberculosis Order, 1925. During the year 1937, 28 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, but none of these samples was found to contain living 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, and 430 inspections of cattle were made. One cow was found to be suffering from tuberculosis, and was slaughtered under the Tuberculosis Order 1925. SLAUGHTERHOUSES. There is now only one licensed slaughterhouse in the area and 92 visits of inspection have been made, when carcases and organs have been examined as set out in the accompanying table. There is no meat marking scheme in operation in the district under Part III of the Public Health (Meat) Regulations 1924, no request having been made by butchers for the marking of meat. 79 CARCASES INSPECTED AND CONDEMNED. Cattle excluding Cows Cows Calves Sheep and Lambs Pigs Number killed 90 14 44 446 181 Number inspected 87 14 44 440 181 All diseases except Tuberculosis. Whole carcases condemned Nil Nil Nil Nil 1 Carcases of which some part or organ was condemned 3 Nil Nil Nil Nil Percentage of the number inspected affected with disease other than tuberculosis 3.4 Nil Nil Nil 0.6 Tuberculosis only Whole carcases condemned Nil Nil Nil Nil 1 Carcases of which some part or organ was condemned 3 6 Nil Nil 4 Percentage of the number inspected affected with tuberculosis 3.4 42.8 Nil Nil 2.7 MEAT SHOPS, STALLS ETC. In addition to the inspection of meat at the slaughterhouse, 457 inspections of the 83 butchers' shops in the Borough were made, when meat offered for retail sale was inspected. During the course of these inspections information was sufficient to remedy 25 contraventions of the Public Health (Meat) Regulations 1924. The contraventions were made up as follows:— Want of cleanliness 12 Inadequate storage for trimmings, bones etc 7 Meat exposed to contamination 3 Sanitary accommodation unsatisfactory 1 Structural defects 2 BAKEHOUSES. There are 33 bakehouses in the Borough, and 105 inspections of these premises were made during the year. As a result of these inspections informal action was taken with regard to the following 24 circumstances. 80 Cleansing and limewashing 16 Lighting improved 1 Storage of refuse improved 2 Drains cleansed 2 Yards cleansed and accumulations removed 3 OTHER FOOD PREMISES. The number of inspections of the various other food premises, and of the contraventions found and remedied are set out in the tables given on pages 59 and 61. UNSOUND FOOD SURRENDERED AND DESTROYED, 1937. 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:— 8 bovine lungs Tuberculosis 2 „ heads „ 3 „ mesenteries „ 1 „ liver „ 1 „ head Actinomycosis 1 „ liver Angioma ½ „ liver Distomatosis 1 pig’s carcase and organs Tuberculosis 1 pig’s carcase and organs Swine Fever 4 pig’s heads Tuberculosis 24 chickens Unsound 6 lbs corned beef „ 557 lbs rabbits „ 17½ lbs cooked ham „ 9 lbs herring roes „ 35 lbs smoked fillets „ 112 lbs fish fillets „ 1 case (28 lbs) of pears Unsound 81 FOOD AND DRUGS (ADULTERATION) ACT, 1928, the ARTIFICIAL CREAM ACT, 1929, the PUBLIC HEALTH (CONDENSED MILK) REGULATIONS, 1923 and 1927, the PUBLIC HEALTH (DRIED MILK) REGULATIONS, 1923 and 1927, and the PUBLIC HEALTH (PRESERVATIVES ETC. IN FOOD) REGULATIONS, 1925 to 1927. The Middlesex County Council are the Authority for the administration of these Acts, and the Acting Chief Officer of the Public Control Department has kindly supplied the following details relating to samples taken in the Borough during 1937. Article No. taken. Adulteration. Milk 121 - Butter 1 - Cream 5 - Gin 5 - Grape-fruit, bottled 1 - Lard 1 - Meat 1 - Minced Beef 3 - Pepper 1 - Sausages 10 - Sheep's Liver 14 2 Vinegar 4 - Whisky 2 1 169 3 CHEMICAL AND BACTERIOLOGICAL EXAMINATION OF FOOD. The chemical and bacteriological examination of food is carried out by the Clinical Research Association. SHELLFISH. There are no shellfish beds or layings in the Borough, and fresh supplies are obtained from Billingsgate Market, London. From enquiries made of local fishmongers it has been found that the shellfish purchased by them has been accompanied by a certificate of origin. No action has been found to be necessary under the Public Health (Shell-fish) Regulations, 1934, or the Public Health (Cleansing of Shell-fish) Act, 1932. 82 Section F. PREVALENCE OF, AND CONTROL OVER, INFECTIOUS AND OTHER DISEASES. Infectious Diseases, their control and incidence— Scarlet Fever— Diphtheria, Diphtheria Immunisation— Enteric Fever— Puerperal Fever and Pyrexia— Pneumonia— Erysipelas— Ophthalmia Neonatorum— Anterior Poliomyelitis— Cerebro Spinal Fever— Dysentery— Encephalitis Lethargica, PolioEncephalitis, Smallpox— Non-notifiable Infectious Diseases— Isolation Hospital Accommodation— Supply of Anti-Toxin— Tuberculosis, New Cases and Mortality— Disinfection of Premises and Articles. 83 INFECTIOUS DISEASES. The Public Health Act, 1936, came into operation on the 1st October, 1937. Two changes with regard to the notification of infectious disease were made— (1) continued fever and (2) puerperal fever were omitted from the list of “ notifiable diseases.” The diseases notifiable to the Medical Officer of Health in Wembley are as follows:— (1) “Notifiable diseases,” as defined by the Public Health Act, 1936, Small-Pox, Cholera, Diphtheria, Membranous Croup, Erysipelas, Scarlatina or Scarlet Fever, Fevers known by any of the following names:— Typhus, Typhoid, Enteric or Relapsing. (2) Other infectious diseases having been made “ notifiable” diseases according to the powers given under the Public Health Act, 1936—None. (3) Infectious diseases notifiable under separate procedures, e.g. various Orders and Regulations:— Plague, Cerebrospinal Fever, Acute Poliomyelitis, Acute Encephalitis Lethargica, Acute Polioencephalitis, Ophthalmia Neonatorum, Puerperal Pyrexia (N.B. Now including cases clinically recognised as Puerperal Fever), Malaria, Dysentery (including amoebic and bacillary), Acute Primary Pneumonia and Acute Influenzal Pneumonia, Tuberculosis, all forms. Other changes were introduced by the Act according to the following letters which are sent by the Medical Officer of Health, one to the occupier of the premises, the other to the owner, when a case of “ notifiable disease ” has occurred:— (a) To the Occupier. Notification having been received under Section 144 of the Public Health Act, 1936, that an inmate of the above premises is suffering from a notifiable disease, I hereby give you notice of the provisions of Section 156 and Section 158 of the Public Health Act, 1936. These sections provide as follows:— “ 156—(1) A person who places, or causes or permits to be placed in a dustbin or ashpit any matter which he knows to have been exposed to infection from a notifiable disease, and which has not been disinfected, shall be liable to a fine not exceeding five pounds —(2) The local authority shall give notice of the provisions of this section to the occupier of any house in which they are aware that there is a person suffering from a notifiable disease.” 84 “ 158—(1) if a person ceases to occupy a house or part of a house in which to his knowledge a person has within six weeks previously been suffering from a notifiable disease and either— (a) fails to have the house, or part of the house, and all articles therein liable to retain infection, disinfected to the satisfaction of the medical officer of health of the district or some other registered medical practitioner, as testified by a certificate signed by him; or (b) fails to give the owner of the house, or the part of the house, notice of the previous existence of the disease; or (c) on being questioned by the owner as to whether within the preceding six weeks there has been therein any person suffering from any notifiable disease, makes a false answer to such question, he shall be liable, in the case of an offence under paragraph (a) or paragraph (b) of this subsection, to a fine not exceeding twenty pounds and, in the case of an offence under paragraph (c) to a fine not exceeding twenty pounds or to imprisonment for a term not exceeding one month. —(2) The local authority shall give notice of the provisions of this section to the occupier and also to the owner of any house in which they are aware that there is a person suffering from a notifiable disease.” (b) To the Owner: Notification having been received under Section 144 of the Public Health Act, 1936, that an inmate of the above premises is suffering from a notifiable disease, I hereby give you notice of the provisions of Section 158 of the Public Health Act, 1936. This Section provides as follows:— “ 158—(1) if a person ceases to occupy a house or part of a house in which to his knowledge a person has within six weeks previously been suffering from a notifiable disease and either— (a) fails to have the house, or part of the house, and all articles therein liable to retain infection, disinfected to the satisfaction of the medical officer of 85 health of the district or some other registered medical practitioner, as testified by a certificate signed by him; or (b) fails to give the owner of the house, or the part of the house, notice of the previous existence of the disease: or (c) on being questioned by the owner as to whether within the preceding six weeks there has been therein any person suffering from any notifiable disease, makes a false answer to such question, he shall be liable, in the case of an offence under paragraph (a) or paragraph (b) of this subsection, to a fine not exceeding twenty pounds and, in the case of an offence under paragraph (c) to a fine not exceeding twenty pounds or to imprisonment for a term not exceeding one month. —(2) The local authority shall give notice of the provisions of this section to the occupier and also to the owner of any house in which they are aware that there is a person suffering from a notifiable disease.” Appropriate investigation is carried out concerning all cases notified; and in order to facilitate the enquiries which are made by the District Inspectors, a number of cards have been prepared detailing relevant questions according to the particular diseases notified. Weekly visits are paid by the Sanitary Inspectors, upon these cases treated at home, aiming at impressing the importance of continued appropriate isolation. Leaflets have been prepared dealing with scarlet fever, diphtheria, typhoid and enteric fever, dysentery, whooping cough, mumps, measles, chicken-pox and influenza. These are distributed at the clinics, and left at the homes by the District Inspectors, and by the Health Visitors in their domiciliary visitation. With regard to che incidence of the infectious diseases, three maps are kept up-to-date from day-to-day. The first map is an ordinary street map of Wembley, and on it are pinned flags of different colours, each colour meaning a different disease, showing the actual location of an infectious disease as it occurs. On another diagram are similarly pinned all the infectious diseases according to the schools which the children victims attend, while on a third diagram the diseases are pinned according to the milk supply of the family. 86 Routine enquiry as to the health and employment of contacts is made. During 1937 fourteen cases of exposure to typhoid fever were reported from Port Medical Officers of Health. Two cases proved to belong to another district and were transferred to the care of other Medical Officers of Health. The other 12 cases were kept under observation by the Public Health Department for the usual incubation-period time. The Medical Officer of Health was called in consultation by the local Medical Profession, on 24 occasions during 1937. 87 88 CASES OF INFECTIOUS DISEASE (OTHER THAN TUBERCULOSIS) NOTIFIED DURING THE YEAR, 1937 NOTIFIABLE DISEASE Total cases Notified at all ages. Cases Notified in the Whole District. At all Ages—Years Total removed to Hospital. % of cases removed to Hospital 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 420 - 7 14 23 17 264 52 8 26 8 1 - 329 78.3 Diphtheria 72 2 2 2 2 5 30 8 4 11 2 4 - 66 91.6 Enteric Fever (including Paratyphoid) 3 - - - - - 1 1 - 1 - - - 2 66.6 ( Puerperal Fever 6 - - - - - - - - 6 - - - 5 83.3 I Puerperal Pyrexia 17 - - - - - - - - 16 1 - - 13 76.4 Pneumonia 115 4 6 1 1 - 13 2 4 21 26 23 14 - - Erysipelas 24 - - - 1 - 1 - - 3 4 11 4 13 54.1 Ophthalmia Neonatorum 3 3 - - - - - - - - - - - Nil Nil Acute Anterior Poliomyelitis 3 - 1 - - - 1 1 - - - - - 2 66.6 Cerebro-Spinal Fever 1 - - - - - - - - - - - - 1 100.0 Dysentery 8 - 1 - - - 3 2 - 1 - 1 - 2 25.0 * From 1st Octob r, 1937, notifiable as “ puerperal pyrexia.” 89 TABLE SHOWING NOTIFICATION OF INFECTIOUS DISEASE OCCURRING IN ELECTORAL WARDS, 1937. Electoral Wards. DISEASE TOTAL Alperton Central Chalkhill Fryent The Hyde Kenton Preston Roe Green Sudbury Court Sudbury Tokyngton Wembley Pk. Unclassified Scarlet Fever 420 32 8 21 21 104 18 32 16 61 42 39 26 - Diphtheria 72 30 2 4 2 9 4 2 4 1 4 6 4 - Enteric Fever (including Paratyphoid) 3 - - - - 1 1 - - - - 1 - - Puerperal Fever 6 2 - 2 - - - - - - - - 1 1 Puerperal Pyrexia 17 2 - 2 1 2 - 1 1 1 3 1 1 1 Pneumonia 115 15 8 7 7 20 3 6 6 7 13 14 9 - Erysipelas 24 2 - 4 1 2 3 1 4 1 4 - 2 - Ophthalmia Neonatorum 3 - - - - - - - - - - - - - Acute Anterior Poliomyelitis 3 - 1 - - - 1 - - - - - 1 - Cerebro-Spinal Fever 1 - - - - - - - - - 1 - - - Dysentery 8 2 - - - - - 1 - - 5 - - - The statistics with regard to the infectious diseases showed a rise in the incidence of scarlet fever for 1937. The increase in the number of cases occurred for the most part in the Hyde Ward, and, in particular, amongst children attending the Oliver Goldsmith School. The occurrence, however, is better described as having been due to a low endemicity rather than that it was an epidemic. Throughout the whole period careful observation of the possibilities of spread was made and close co-operation maintained between the County Council school medical service and the public health services of the Borough. There can be little doubt that there was a certain persistency of the infection from a number of very mild cases, or perhaps cases in whom the recognisable signs of scarlet fever were absent. Every help was given by the Headmaster and Teachers of the school, while all possible channels of infection were gradually eliminated. Rate Incidence per 1,000 Population. Wembley England & Wales. 125 County Boroughs and Great Towns including London. (1) Deaths. All causes 7.28 (based on 835 deaths) 12.4 12.5 Typhoid and Paratyphoid fevers 0.00 0.00 0.01 Smallpox 0.00 0.00 - Measles 0.00 0.02 0.03 Scarlet Fever 0.00 0.01 0.01 Whooping Cough 0.00 0.04 0.04 Diphtheria 0.02 0.07 0.08 Influenza 0.31 0.45 0.39 Polio-Encephalitis 0.01 not not available available Cerebro-Spinal Fever 0.01 ” ” (2) Notifications. Smallpox 0.00 0.00 - Scarlet Fever 3.66 2.33 2.56 Diphtheria 0.63 1.49 1.81 Enteric Fever 0.03 0.05 0.06 Erysipelas 0.21 0.37 0.43 Pneumonia 1.00 1.36 1.58 Dysentery 0.07 not not available available Acute Anterior Poliomyelitis 0.03 ” ” Cerebro-Spinal Fever 0.01 ” ” 90 Scarlet Fever. There were 420 cases of Scarlet Fever notified, with no deaths, during 1937; 329 cases (78.3%) were removed to hospital, while 91 were isolated at home. In a population so well housed as is Wembley, probably a larger percentage of cases of Scarlet Fever might quite well be nursed at home, especially so long as the disease maintains its present mild type. Every case, of course, requires individual consideration as to the advisability of either home or hospital isolation. Regarding the 329 hospital cases, there were 28 “ return cases” (8.5%), and there was 1 “return case” in connection with the 91 patients nursed at home (1.09%). The percentage of “ return cases ” is a varying one, seeming to depend in part on the virulence of the germs which may be causing scarlet fever in the district. Scarlet fever is but one manifestation of infection by streptococci and its occurrence from an epidemiological point of view must be dealt with accordingly. It is wrong to allow a case of scarlet fever to remain at home if there be an imminent confinement in the family, as it is also wrong if there be a possibility of the infected environment causing spread of the disease by allowing the contamination of milk or such like foods to take place. The incidence of scarlet fever in monthly periods during the year was as follows:— January—19 cases, February—29 cases, March—33 cases, April—31 cases, May—29 cases, June— 29 cases, July—29 cases, August—16 cases, September—60 cases, October—61 cases, November—33 cases, December—51 cases. Total—420 cases. Diphtheria. During the year there were 72 cases of diphtheria, with 2 deaths. For some time the number of cases of diphtheria in Wembley has been small. In 1935 there were 95 cases, and in 1936 there were only 37 cases. The numbers in monthly periods rose slightly in October, November and December, 1937, while, however, one is glad to note that the disease did not reach epidemic proportions. The monthly incidence of diphtheria during 1937 was as follows:— January—5 cases, February—6 cases, March—3 91 cases, April—6 cases, May—8 cases, June—No cases, July—5 cases, August—2 cases, September—3 cases, October—14 cases, November—11 cases, December—9 cases. Total—72 cases. This freedom, however, cannot be expected always to remain, and in such a quiet period the value of active immunisation against diphtheria must not be forgotten. The Council's immunisation scheme provides for immunisation treatment to be carried out by the family doctor. An analysis of cases immunised since the beginning of the scheme is as follows:— Numbers Treated by Immunising Injections in Age Groups. Year 0-5 5-9 9-14 Over 14 Totals 1935 35 64 22 5 124 1936 108 157 55 7 327 1937 108 105 38 7 258 Totals 249 326 115 19 709 These numbers are small, and in particular the number of children treated under 5 years of age is very low. At the time of writing certain changes have been made in the Council’s immunisation scheme:— (1) For members of families wit'-jii the economic scale of the National Health Insurance Acts, the Borough Council will pay to the family medical practitioner carrying out a course of immunisation-treatment against diphtheria—10/- per person so treated. For a post-Schick test there will be paid, in addition, 3/6d. per patient tested; and with regard to persons over eight years of age, for a pre-Schick test there will also be paid3/6d. per person tested. (2) A course of immunisation-treatment shall consist ofeither (a)—a first dose of 0.2 c.c. Alum Precipitated Toxoid, followed in not less than two weeks, and not more than three weeks, by a second dose of 0.5 c.c. Alum Precipitated Toxoid; or (b)—three doses, each of 1 c.c., at fortnightly intervals of Toxoid Anti-Toxin Floccules; or (c)—three doses, each of 1 c.c., at fortnightly intervals of Toxoid Anti-Toxin Mixture. 92 The choice between these courses must depend on the preference of the medical practitioner, and special circumstances may indicate, for example, smaller doses than the above. (3) Children under one year not to be given immunisationtreatment, nor to be Schick-tested. For children between the ages of one and eight years a pre-Schick test to be omitted. For persons over eight years a pre-Schick test should be considered. In all cases a Schick test to be advised by the medical practitioner three months after the immunisation course. (4) The immunisation and test-fluids will be as supplied to the medical practitioner, free of charge, by the public health department. Notice is drawn to the “ Directions for Using” supplied with each package, for example, the warning that, notwithstanding immunisation, a sore throat should always be seen by a doctor in order to avoid error in a certain percentage of “immunised” persons whose immunity does not persist at a sufficiently high level always to prevent diphtheria. Under no circumstances may the contents of any one container be used for more than one person. While the prophylactic should be kept in a cool, dark place, storage below freezing point is dangerous. The optimum temperature is between 32 deg. and 40 deg. F. (5) At the doctor's request for immunisation- or test-fluids at the public health department, a card will be supplied, the return of which, in due course, duly completed will be the only necessity as regards the doctor's account. (6) With regard to persons whose income (or the family income) is without the scale of the National Health Insurance Acts, the Borough Council will supply on request to the family medical practitioner the immunisation- and test-fluids free of charge but will not make any payment to the doctor giving the treatment or making the test. The family doctor, however, is expected, as in (5), to return the details of the treatment given and the tests made on the card, so that the Borough Council may have some information as to the value of their scheme. 93 Diphtheria is always a serious disease in a child and causes great anxiety to the parents, but it can be avoided by immunisation-injections. This freedom takes some weeks to develop after the treatment has been given so that it is unwise to put off until there has been actual exposure to the disease or an outbreak in the Borough. Enteric Fever.—Three cases of enteric fever occurred during the year (2 para-typhoid B and one of the mixed infection of typhoid fever and para-typhoid (B). Two of the cases were removed to hospital, one to the Willesden Isolation Hospital, the other to the Ealing Isolation Hospital. The third case was isolated at home. There were no deaths. Puerperal Fever and Pyrexia.—Reference has already been made to these diseases on page 48. Six cases were notified as puerperal fever. Five of these were removed to Queen Charlotte's Isolation Hospital and one was nursed at home. Seventeen cases of puerperal pyrexia were notified, one of which occurred in Willesden Maternity Hospital. Five cases were nursed at home; four were removed to Queen Charlotte’s Isolation Block; one to the Mothers' Hospital; two to Redhill Hospital; two to St. Mary's Hospital; one to West Middlesex County Hospital; and one to St. George's Hospital. No deaths from puerperal sepsis were recorded in 1937. Pneumonia.—Pneumonia was notified concerning the illness of 115 persons. Reference to the Liiiuenza epidemic throughout the country at the end of 1936 and the beginning of 1937 was made in the Annual Report for 1936. During 1937 pneumonia (all forms) accounted for the deaths of 55 persons, while influenza was the cause of 36 other deaths. Wembley seems to have suffered from the influenza epidemic in the early part of the year very similarly to the country as a whole. (See table, page 15). Erysipelas.—24 cases of erysipelas occurred, of which 11 were nursed at home. Of the 13 cases treated in hospital 1 was accommodated at Redhill County, 1 at University College, 4 at Willesden Isolation and 7 at Acton Isolation Hospitals. There were no deaths. Ophthalmia Neonatorum.—Three cases were notified in 1937, and in each case the child was treated at home under the family doctor. The vision in all cases was unimpaired. 94 Anterior Poliomyelitis. Only three cases of this disease occurred in the 12 months. One was isolated at home, one at the Wembley Hospital and one at Paddington Green Children's Hospital. Recent enquiry elicits that two of these cases still require treatment, which is being carried out under the family doctor in one case and at the Paddington Green Children's Hospital in the other case. The third case made a very good recovery, with a slight residual weakness of the shoulder muscles. Cerebro-Spinal Fever.—One case of cerebro-spinal fever was notified in a male aged 30 years. The patient was removed to Redhill County Hospital where he died. Dysentery.—Eight cases of this disease were notified. There were no deaths. Six were nursed at home and two treated at hospital—one at Redhill and the other at the Princess Louise Hospital. In two cases the infection was by Sonne Bacillus, in one other by Flexner (atypical) Bacillus. The five other cases were unidentified bacteriologically. Encephalitis Lethargica. Polio-Encephalitis. No notification of these diseases was received during 1937. Regarding one death, however, the cause is ascribed to polio-encephalitis. Small-Pox. The Middlesex County Council are responsible for the provision of hospital accommodation for smallpox occurring within the Borough. No case occurred during the year. 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. The following table sets out the monthly incidence of such cases, having been compiled in the main from the returns received from the Head Teachers. 95 96 Non-Notifuible Diseases. Disease. January February Mr- x ch April May June 1 July August September October November December Measles 1 - - 2 10 36 24 - 1 2 60 37 Chicken Pox 34 12 19 9 2 10 18 - 10 25 38 33 Mumps 60 83 110 155 133 75 44 - 4 7 1 - Whooping Cough 63 42 32 33 8 27 22 - - - 1 2 German Measles - - - - 1 2 1 - - - - - Glandular Fever - - 1 - - - - - - 1 - - ISOLATION HOSPITAL ACCOMMODATION. The arrangements with the Borough of Acton remained throughout 1937, that infectious diseases, as far as possible, be treated at the Acton Isolation Hospital. The following cases were admitted to this hospital:— Scarlet Fever 321 Diphtheria 60 Measles 4 Erysipelas 7 Chickenpox 1 Whooping Cough 5 Tonsilitis 1 Eczema 1 Influenza 1 SUPPLY OF ANTI-TOXIN. The Borough Council continued to supply free of charge to any medical practitioner for use in the Borough, diphtheria anti-toxin, tetanus anti-toxin and anti-streptococcal serum, as well as diphtheria prophylactic and the fluid for Schick test. During office hours these are to be obtained from the Public Health Department, and at all other times from the Ambulance House adjoining the Fire Station in St. John's Road. TUBERCULOSIS. During 1937, 128 new cases of tuberculosis were notified, 109 of pulmonary tuberculosis, and 19 non-pulmonary. 106 cases were removed from the register during the 12 months, and at the 31st December, 517 names remained on the register, 435 of which were pulmonary and 82 non-pulmonary. The institutional treatment of tuberculosis is the responsibility of the Middlesex County Council. 123 patients were admitted to hospitals or sanatoria during the year, while in the same period, 107 patients were discharged. An environmental form concerning all cases is received through the courtesy of the County Tuberculosis Officer, and appropriate action is taken when called for. 97 New Cases and Mortality During 1937. Age Periods New Cases Pulmonary N on-Pulmonary M. F. M. F. Under 1 year ... - - - - 1 to 4 years ... 1 - - - 5 to 14 years ... 3 1 5 3 15 to 24 years ... 18 15 - 1 25 to 34 years ... 16 19 3 1 35 to 44 years ... 15 4 1 2 45 to 54 years ... 10 2 - 1 55 to 64 years ... 3 1 2 - 65 years and over 1 - - - Total 67 42 11 8 Age Periods Deaths Pulmonary N on-Pulmonary M. F. M. F. Under 1 year - - - - 1 to 4 years - 1 - 1 5 to 14 years - - 2 1 15 to 24 years 3 3 1 2 25 to 34 years 5 13 - - 35 to 44 years 5 2 1 1 45 to 54 years 5 5 - 1 55 to 64 years 2 1 - 1 65 years and over - 1 1 - Total 20 26 5 7 The Death Rate from tuberculosis was 0.505 per 1,000 population, the comparative figure for England and Wales in 1936 being .69. 58 deaths from tuberculosis were registered during the year. 15 of these had not been notified as suffering from tuberculosis during life (25.86 per cent). 98 PUBLIC HEALTH (PREVENTION OF TUBERCULOSIS) REGULATIONS, 1925. PUBLIC HEALTH ACT, 1925—SECTION 62. PUBLIC HEALTH ACT, 1936—SECTION 172. No action was taken under the above during 1937. DISINFECTION OF PREMISES AND ARTICLES. During the year 749 disinfections were carried out after: — Infectious Diseases 692 Cancer 28 Miscellaneous 27 Vermin 2 Number of .Articles Disinfected or Destroyed. Articles Disinfected. oyed Beds 179 13 Bolsters 395 6 Blankets 1,653 6 Carpets 3 2 Counterpanes 787 8 Covers 39 1 Curtains 2 - Cushions 233 8 Mattresses 752 31 Palliases 4 — Pillows 1,454 22 Rugs and Mats 60 3 Sheets 1,012 5 Wearing Apparel 817 8 Sundries 469 10 Bundles of Washing 111 - TOTAL 7,970 123 99 100 INDEX Page Ambulance facilities 23 Ante-natal clinics 29, 30 Anterior Poliomyelitis 95 Antitoxin, supply of 97 Area 9 Artificial Cream Act, 1929 82 Artificial sunlight and massage 35 Bakehouses 80, 81 Birth Control session 32, 33 Births 13, 40 Byelaws in force 70, 71 Carcases inspected and condemned 80 Cerebro-spinal fever 95 Chemical and bacteriological examination of food 82 Clinic services 26 Closet accommodation 57 Committees, constitution of 2, 3 Convalescence 36 County Council clinics 33 Cowsheds 78 Dairies and milk shops 78 Deaths 12, 13 Deaths at age periods 16 Deaths, causes of 14 Dental clinics 31, 32 Diphtheria 91, 92 Diphtheria immunisation 92, 93, 94 Disinfection of premises and articles 99 Drainage and sewerage 56 Dysentery 95 101 Page Economic circumstances scale 38, 39 Elements of an efficient Maternity Scheme 43 Encephalitis Lethargica 95 Enteric Fever 94 Eradication of Bed Bugs 67 Erysipelas 94 Establishments for massage and special treatment 64 Factories, workshops and workplaces 64 Food and Drugs (Adulteration) Act, 1928 82 Gynaecological clinic 32 Habitation of houses 10 Hairdressers 63 Health Visitors 48 Home Helps 37 Home visiting 48, 50 Hospitals 33 Industries 9 Infantile mortality 12, 17, 18 Infant life protection 50 Infant welfare clinics 28 Infectious diseases, their control and incidence 84, 85, 86 87, 88, 89, 90 Inhabited house 9, 10 Inspection of dwelling houses 73 Isolation hospital accommodation 97 Laboratory facilities 21, 22 Live births 11 Local Government and Other Officers' Superannuation Act, 1922 52 Marriages 19 Maternal Mortality 12, 19, 43, 44, 45, 46, 47, 48 Maternity hospital accommodation 39, 40, 41, 42 Maternity outfits 36 Meat shops 80 Midwives Act, 1936 43 Milk 35 Milk and Dairies (Consolidation) Act, 1915 79 Milk (Special Designations) Order 77, 78 Mortuary 70 102 Page National Campaign to encourage the wider use of the Health Services 52 New houses 75 Noise 63 Non-notifiable infectious diseases 95, 96 Nursing in the home 24 Nutrition 33, 34, 35 Offensive trades 62 Open spaces 10 Ophthalmia neonatorum 94 Other food premises 81 Overcrowding 74, 75 Penny rate 9 Piggeries 62 Pneumonia 94 Polioencephalitis 95 Population 9 Prevention of blindness 50 Private schools 68, 69, 70 Public Cleansing 57 Public Health (Condensed Milk) Regulations, 1922 and 1927 82 Public Health (Dried Milk) Regulations, 1923 and 1927 82 Public Health (Preservatives, etc. in Food) Regulations 82 Public Health (Prevention of Tuberculosis) Regulations, 1925 99 Puerperal pyrexia 48, 94 Rag Flock Acts 63 Rainfall 11 Rateable value 9 Rats and Mice Destruction Act 64 Rivers and streams 56 Sanitary inspection of the area 58, 59 Scarlet fever 91 Schools 68 Shellfish 82 Shops Act 64 Slaughterhouses 79 Smallpox 95 Smoke abatement 66 103 Page Social conditions 9 Staff 4, 5 Still births 12, 49 Swimming baths and pools 67 Tents, vans and sheds 62 Toddlers' clinics 28 Tuberculosis, new cases and mortality 15, 97, 98 Tuberculosis Order, 1925 79 Unemployment 9, 10 Unsound food surrendered 81 Vital statistics 11, 12, 13 Water 54, 55 104