AC 439(1) WEMBLEY WEM 19 BOROUGH OF WEMBLEY ANNUAL REPORT OF THE MEDICAL OFFICER OF HEALth FOR THE YEAR 1938 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 1938 A. G. MORISON, m.a.j m.d., d.p.h. Medical Officer of Health. 1 Constitution of Committees (November, 1938) PUBLIC HEALTH COMMITTEE. The Mayor—Alderman M. Campbell, j.p. The Deputy Mayor—Alderman e. j. G. Butler, j.p. Chairman—Alderman E. H. Everett. Vice-Chairman—Councillor W. R. Osborne. Aldermen A. W. Clarke, H. Gauntlett. Councillors R. S. Ball, C. Barton, Mrs. E. M. Iszatt, E. Lightley, b.sc., R. Ormsby-Taylor, G. h. Plymen, m.sc., ph.d., G. H. R. Rogers, L. R. Slowey, J. W. G. Snook, J. E. Turner. MATERNITY & CHILD WELFARE COMMITTEE. The Mayor—Alderman M. Campbell, j.p. The Deputy Mayor—Alderman E. J. G. Butler, j.p. Chairman—councillor J. W. G. snook. Vice-Chairman—Councillor W. J. B. Baylis. Aldermen A. w. Clarke, H. Gauntlett. Councillors E. T. Ashman, R. S. Ball, C. barton, Miss R. H. Howse, j.p., Mrs. E. m. iszatt, w. J. Knight, S. W. norgan, G. H. plymen, m.sc., ph.d., F. J. tucker, J. E. Turner. CO-OPTED MEMBERS— Mesdames Ashman, Clarke, Collier, Collison, Collyer, Empson, Neale, rowbottom. The Town Clerk Kenneth Tansley, Esq. 2 STAFF OF THE PUBLIC HEALTH DEPARTMENT. (31st December, 1938). Medical Officer of Health: a. g. morison, m.a., m.d., d.p.h. Assistant Medical Officers of Health: louise a. matheson, m.b., ch.b., d.c.h., m.m., d.p.h. Lorna G. Bach, m.r.c.s., l.r.c.p., d.p.h. Part-time Clinic Medical Officers : Mary King, m.r.c.s., l.r.c.p., d.p.h. 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. Temporary Honorary Deputy Medical Officer for A.R.P. purposes : H. M. Harris, b.a., m.r.c.s., l.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. 3 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. Miss F. M. Martlew, Health Visitor's Certificate. (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, Certificate Sanitary Inspector's Exam. Board. W. R. powley, A. H. basford, W. H. knapton, T. L. allison, P. B. D. Bunyan, Miss J. E. Watts, Miss J. R. Barker. 4 BOROUGH OF WEMBLEY. ANNUAL REPORT of the MEDICAL OFFICER OF HEALTH for the year 1938. To the Mayor, Aldermen and Councillors of the Borough. Mr. mayor, Ladies and Gentlemen, I beg to submit a report on the Health and Sanitary Circumstances of the Borough for the year, 1938. The Report is drawn up according to Circular 1728 of the Ministry of Health. In this Report the Public Health work recorded is that of a Borough which, within the space of a few years, has become one of the great towns in the outer London ring. Of the 126 County Boroughs and great towns Wembley is the 46th. Of the 83 County Boroughs in England and Wales, only 36 have a population greater than that of Wembley—47 having a less population. The Borough is, in population, the sixth of the 26 local authorities within the County of Middlesex. Since the Census year (1931) the population as estimated by the Registrar General has increased by 82.2 per cent. The estimate of 118,800, however, relates to Midsummer, 1938, and was then, probably, an under estimate. The activities recorded show the endeavour of a Local Authority to maintain the possibilities of all the natural amenities with which their district was gifted in the first place. 5 The birth rate for the year was 15.35, while the crude death rate was 6.77. With regard to the infantile mortality rate, the figure over a period of 5 years is 41.25, while the maternal mortality rate over the similar five-year period ending 31st December, 1938, was 1.468—both figures being considerably less than those for the country as a whole. The story told in the Report is one of continuous development and expansion with a constant endeavour to consolidate; and the best propaganda regarding Public Health is an efficient Health Service itself. While the Circular of the Ministry of Health does not specially ask that reference be made to the Air Raid Precautions services, it must be mentioned that for one or two years prior to the crisis, A.R.P. had been growing gradually in momentum, and since then an extraordinary call has been made upon the Department which has been readily answered by every member of the staff. Again during the year the staff has been augmented— one additional Assistant Medical Officer of Health has been appointed, together with one additional Health Visitor and four Clerical Officers. The Report is a record of a busy year. I gratefully acknowledge the constant help I received from both the technical and executive officers of the Department while, in addition, regarding a year so full of activity and unusual responsibility I desire to express my appreciation of the encouragement I have received from the Council. I have the honour to be, Mr. Mayor, Ladies and Gentlemen, Your obedient servant, A. G. MORISON, Medical Officer of Health. 15th July, 1938. 6 Section A STATISTICS AND SOCIAL CONDITIONS OF THE AREA. Area — Population — Inhabited Houses — Penny Rate — Social Conditions, Industries, Unemployment, Open Spaces, Assessments — Rainfall — Vital Statistics, Live Births, Still Births, Deaths — Deaths at Age Periods — Infantile Mortality — Maternal Mortality — Marriages. 7 STATISTICS AND SOCIAL CONDITIONS. Area in acres 6,300 Population, 1938 (Midsummer)— Estimated by Registrar-General 118,800 Population (Census) 1931— Wembley 48,561 Kingsbury 16,636 65,197 Percentage increase of population since 1931 (census year) 82.2 Estimated number of inhabited houses at end of 1938 29,900 Rateable value—31st December, 1938 £1,353,511 Sum represented by the product of a Penny Rate (estimated) £5,300 Industries.—No material change occurred in the social conditions of the area during the year. The industries in Wembley may be grouped as follows:- Engineering processes, Machinery making and repairing— Electrical and radio machinery—Motor-car engineering— Foundries, Metal works, Construction and building materials— Food manufacturers, milk treatment, ice factories—Clothing factories—Furniture, Upholstery, Glass, Cork making—Printing, Photography and such—Laundries, Dry cleaning—Sign writing and such—Paper goods—Amusements and sports equipment— Rubber works—Chemical and gas processes. Unemployment.—The following figures were supplied by the Divisonal Controller, Ministry of Labour, and the Divisional Education Officer:- Date. Number of Insured Persons age 16 to 64 years resident in the Borough of Wembley recorded as unemployed at Employment Exchanges. Males. Females. TotaL 4th April, 1938 994 459 1453 18th July, 1938 1169 451 1620 17th October, 1938 1121 494 1615 16th January, 1939 1151 524 1675 8 Date. Number of Juveniles who were recorded as unemployed at the Wembley and Kingsbury Employment Bureaux. Males. Females. Total. 31st March, 1938 66 52 99 30th June, 1938 72 48 114 30th September, 1938 75 87 159 31st December, 1938 47 71 146 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. Assessments—the Borough Treasurer has supplied the following information:- No. of Assessments. Houses and flats up to £30 rateable value 22,896 Houses and flats from £31 to £70 rateable value 11,636 Houses and flats over £70 rateable value 135 Shops and premises up to £50 rateable value 316 Shops and premises from £51 to £100 rateable value 661 Shops and premises over £100 rateable value 328 Offices 70 Banks 24 Public Houses and Off Licences 40 Cinemas 9 Halls 22 Advertisement Hoardings 38 Private Garages 263 Commercial Garages 80 Sports Grounds 67 Schools 24 Workshops (non-industrial) 96 Factories (industrial) 178 Crown Properties 18 Railways 16 Undertakings 16 Stadium and Empire Pool 2 Miscellaneous 204 Total 37,139 9 REGISTER OF RAINFALL DURING 1938. The Borough Engineer & Surveyor has supplied the following figures regarding rainfall during the year, the observations having been made at Vale Farm. The total rainfall for the year was low, and the longest dry spell (24 days) is also worthy of comment. Month. Total Rainfall inches. No. of days on which rain fell. January 2.18 22 February .39 7 March .27 4 April .22 5 May 1.46 11 June .30 5 July 1.20 11 August 4.63 10 September 1.30 11 October 2.16 18 November 2.94 17 December 2.66 15 Totals 19.71 136 Wettest day was 11th August with a fall of 2.12 ins. Wettest month was August with a fall of 4.63 ins. The average daily rainfall was .05 ins. Monthly Average 1.64 ins. Driest month was April with a fall of .22 ins. Longest dry spell—28th February—23rd March—24 days. Longest wet spell—8th-16th January—9 days. Total rainfall for 1935 was 29.69 ins. „ „ „1936 „ 26.59 „ „ „ „ 1937 „ 28.37 „ „ „ „1938 „ 19.71 „ 10 VITAL STATISTICS as supplied by the Registrar General. Live Births Male. Female. Total Legitimate 913 842 1,755 Birth Rate per 1,000 of estimated resident Illegitimate 27 42 69 tion 15.35 Still Births Male. Female. Total. Rate per 1,000 total (live & still) Legitimate 21 30 51 Illegitimate 1 1 2 births 28.24 Still Birth Rate per 1,000 estimated population 0.45 deaths. Male. Female. Total. 425 379 804 Death Rate per 1,000 estimated population:- Crude Rate 6.77 Adjusted by Areal Comparability Factor of Registrar-General (1.26) 8.53 Maternal mortality. Deaths from Puerperal Sepsis 3 Other Puerperal Causes - 3 Maternal Mortality Rate per 1,000 live births 1.64 Maternal Mortality Rate per 1,000 total (live and still) births 1.60 infantile mortality. Deaths of Infants under 1 year of age:- Male. Female. Total Legitimate 45 28 73 Illegitimate 3 3 6 79 Death Rate of Infants under 1 year of age:- All Infants per 1,000 live births 43.31 Legitimate Infants per 1,000 legitimate live births 40.02 Illegitimate Infants per 1,000 illegitimate liv births 86.96 Deaths from Cancer (all ages) 127 „ „ Measles (all ages) 4 „ „ Whooping Cough (all ages) l „ „ Diarrhoea (under 2 years) 11 11 COMPARATIVE VITAL STATISTICS 1938. 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 vlortality WEMBLEY 15.35 0.45 6.77 43.31 1.64 1.60 England & Wales 15.1 0.60 11.6 53 3.08 2.97 London 13.4 0.48 11.4 57 - - 126 County Boroughs and Great Towns including London 15.0 0.65 11.7 57 - - 148 smaller towns—resident populations 25,000 to 50,000 at Census 1931 15.4 0.60 11.0 51 - - BIRTHS AND DEATHS. The birth rate fell from 16.19 to 15.35 per 1,000 population, the comparative figure for England and Wales in 1938 being 15.1. As the Borough population becomes stabilised, so will the birth rate tend to approach that of the country as a whole, but it may be anticipated to remain higher than the general birthrate for some time. The crude death rate continues to remain at an arrestingly small figure. In 1938 it was 6.77 per 1,000 estimated population, while in the previous year it was 7.31, the comparative figure for England and Wales in 1938 being 11.6. The crude death rate for Wembley (6.77) was only 58.4 per cent of that of England and Wales (11.6). Births.—As regards births the following table shows the notifications (corrected for inward and outward transfers) by doctors, midwives or parents, together with the 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 197 727 179 1,103 Midwives 410 127 125 662 Parents 41 - 15 56 Totals 648 854 319 1,821 Percentages 35.59 46.90 17.51 100.00 Deaths.—Of the 808 deaths of Wembley residents, it is interesting to note that 384 (47.52%) of these occurred elsewhere than within the Borough boundaries, while 412 took place in hospital (50.99%). 12 The next table gives particulars of the causes of death:- CAUSES OF DEATH DURING YEAR 1938. as supplied by the Registrar General. 1937 Total. Causes of Death. M. F. Total. 838 All Causes 425 379 804 - Typhoid and paratyphoid fevers - - - - Measles 2 2 4 - Scarlet Fever - 1 1 - Whooping Cough 1 - 1 2 Diphtheria 2 1 3 36 Influenza 6 3 9 - Encephalitis lethargica - - - 1 Cerebro-Spinal fever - 1 1 46 Tuberculosis of respiratory system 23 16 39 12 Other tuberculosis 7 3 10 1 Syphilis - 2 2 4 General paralysis of insane, etc. - - - 116 Cancer 66 61 127 7 Diabetes 9 4 13 38 Cerebral haemorrhage 11 20 31 160 Heart disease 99 76 175 6 Aneurysm 1 1 2 62 Other circulatory 19 32 51 21 Bronchitis 12 8 20 55 Pneumonia 20 24 44 8 Other respiratory 4 1 5 9 Peptic Ulcer 6 4 10 12 Diarrhoea (under 2 years) 8 3 11 11 Appendicitis 5 4 9 2 Cirrhosis of liver - 4 4 2 Other liver diseases - 4 4 13 Other digestive 6 8 14 21 Nephritis 12 11 23 - Puerperal sepsis - 3 3 2 Other puerperal - - - 51 Congenital causes, etc. 30 22 52 21 Senility 7 10 17 19 Suicide 12 10 22 29 Other violence 22 7 29 71 Other defined causes 35 33 68 - Causes ill-defined - - - 13 The principal causes of death at all ages are recorded in the following table, along with the comparative numbers of deaths which occurred from the same causes in England and Wales during 1937:- Disease. Wembley total No. of deaths. Proportion per total 1,000 deaths. A comparative figure England and Wales (937—Proportion per total 1,000 deaths. Increase or decrease between proportions— Wembley (1938) England & Wales (1937). 1. Heart disease 177 220 254 — 34 2. Cancer—malignant disease 127 158 131 +24 3. Other diseases of circulatory system 82 102 56 + 46 4. Other diseases of digestive system 54 67 38 + 29 5. Violence (all forms, including injuries and accidents) 51 63 45 + 18 6. Premature birth and diseases of early infancy 47 58 30 + 28 7. Pneumonia (all forms) 44 55 58 - 3 8. Tuberculosis of respiratory system 39 48 47 + 1 9. Non-venereal diseases of genito-urinary system 23 29 46 - 17 10. Bronchitis 20 25 35 - 10 11. Old Age 17 21 33 - 12 12. Diarrhoea and enteritis 11 14 10 + 4 13. Other forms of tuberculosis 10 12 9 + 3 14. Influenza 9 11 37 - 26 As for the country as a whole, heart disease accounted for the largest proportion of deaths, and cancer came next in importance; while a remarkably close proportion of the deaths from heart disease and from other diseases of the circulatory system is revealed by adding together the deaths under the above headings 1 and 3—the proportion for Wembley being 322. and for England and Wales (1937) 310. 14 The places of the various causes of death differ in Wembley and in the country as a whole; for example, deaths from violence in Wembley had the fifth place with the proportionate figure of 63, while for the country as a whole these deaths had the sixth place with the proportionate figure of 45. Premature birth and diseases of early infancy had the sixth place with the proportionate figure of 58, the corresponding figures for the country as a whole, in 1937, being twelfth place and 30. Old age in Wembley had the eleventh place and the proportionate figure of 21 while for the country as a whole it also had eleventh place, but the proportionate figure of 33. These figures are a reflection of the age distribution of the inhabitants and do not in any way mean, for example, that the infantile mortality rate is high in Wembley, rather it is the reverse. The figures really mean that the death rate in Wembley is small, it being very nearly true to say that it could be smaller only by a decrease in the infantile mortality rate, while the infantile mortality rate is almost as low already as it can be (see page 18), unless, too, there be some new factor to arise influencing the killing diseases generally. Tuberculosis of the respiratory system accounted for 39 deaths, while the deaths from non-pulmonary tuberculosis numbered 10. The deaths from tuberculosis since 1934 have been according to the following table:- Year. Pulmonary. Non-Pulmonary. 1934 41 7 1935 45 11 1936 36 11 1937 46 12 1938 39 10 In 1938 tuberculosis of the respiratory system was eighth in the list of killing diseases in Wembley, while in the country as a whole it was fifth. Pneumonia was seventh in Wembley and in the country as a whole it was third, while bronchitis, both in Wembley and in the country as a whole, had the tenth place. 15 The next table gives the deaths at various age periods and shows that 34.16% of the deaths occurred amongst those who had not, so far, reached their 50th birthday:- Age Periods. Wembley No. of deaths 1938. Percentage of total deaths. A comparative figure, 1937. England & Wales percentage of total deaths. 0— 1 79 9.78 6.9 1— 4 13 1.61 2.2 5— 9 11 1.36 1.1 10—14 10 1.23 0.7 15—19 13 1.61 1.3 20—24 18 2.23 1.7 25—29 18 2.23 1.9 30—34 20 2.48 2.0 35—39 22 2.72 2.3 40—44 23 2.85 2.8 45—49 49 6.06 3.8 Totals: 0—49 276 34.16 26.8 50—54 51 6.31 5.4 55—59 70 8.66 7.1 60—64 76 9.41 9.7 65—69 77 9.53 11.4 70—74 85 10.52 12.8 75—79 74 9.16 12.1 80—84 54 6.68 8.7 85—89 34 4.21 4.4 90—94 9 1.11 1.3 95—99 2 .25 0.24 100— Totals: 808 100.00 0.02 100.00 (Registrar-General's figure 804) 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 1938 9.78 34.16 50.99 The figures suggest that the percentage of total deaths under 50 years of age is falling. This is another indication that the population of the Borough is becoming stabilised. 16 INFANTILE MORTALITY. Of the 79 deaths which occurred in children who never celebrated their first birthday, 35 occurred within the first week of life (44.3 per cent), while 47 occurred within the first four weeks of life (59.5 per cent). In the following table are shewn 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 I - 3 months 3 - 6 months 6 - 9 months 9 - 12 months Total Deaths under one year Prematurity 17 1 1 1 20 1 - - - 21 Congenital defects 5 1 1 2 9 3 1 - - 13 Gastro-enteritis - - - - - 2 2 2 2 8 Gastro-enteritis with pemphigus - - - - - - 1 - - 1 Broncho-pneumonia - 1 1 1 3 1 3 - - 7 Bropcho-pneumonia with gastro-enteritis - - - - - 1 2 - - 3 Broncho-pneumonia with whooping cough - - - - - - 1 - - 1 Broncho-pneumonia with gastritis - - - - - - - - 1 1 Bronchitis - - - 1 1 1 - - - 2 Atelectasis 3 - - - - - - - 3 Cerebral haemorrhage 2 - 1 - 3 - - - - 3 Haemorrhage of the new born 2 - - - 2 - - - - 2 Intra-cranial haemorrhage 2 - - - 2 - - - - 2 Birth injury - - - - - 1 - - - 1 Syncope-status lymphaticus - - - - - 1 - - - 1 Accident-burn - - - - - - - 1 - 1 Diarrhoea and vomiting - - - - - - - 1 - 1 Convulsions 1 - - - 1 - - - - 1 Enteritis - - - - - - 1 - - 1 Congenital specific disease - - - - - 1 - - - 1 Marasmus - - - -- - 1 - - - 1 Inhalation of vomit - - - - - - 1 - - 1 Asphyxia-precipitate labour 1 - - - 1 - - - - 1 Asphyxia-premature birth 1 - - - 1 - - - - 1 Asphyxia neonatorum 1 - - - 1 - - - - 1 35 3 4 5 47 13 12 4 3 79 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 live Births registered. Under 1.4 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 1938 25.77 7.13 32.9 6.59 3.82 43.31 England & Wales 1937 30 9 39 8 10 58 INFANTILE MORTALITY. Table showing Rates, 1934-38. Year. Wembley. England & Wales. 1934 39.90 59 1935 34.26 57 1936 45.14 59 1937 43.62 58 1938 43.31 53 Infantile mortality during 5 years, 1934-38 41.25 18 MATERNAL MORTALITY. Three deaths from Puerperal Sepsis were recorded in 1938, while no deaths occurred from other puerperal causes. Rate per 1,000 total births (live and still), 1934-1938. Year. Wembley. England & Wales. 1934 3.11 4.41 1935 0.00 3.93 1936 1.68 3.65 1937 1.03 3.11 1938 1.55 2.97 Maternal mortality during 5 years 1934-38 1.468 3.614 MARRIAGES. The Superintendent Registrar has supplied the following information concerning marriages which took place during 1938:- In Churches 765 At Registry Office, one or both parties being resident in the Borough 348 Total 1,113 19 Section B GENERAL PROVISION OF HEALTH SERVICES OF THE AREA. Laboratory Facilities — Ambulance Facilities — Nursing in the Home, Midwifery and Maternity Cases, General Sick Nursing — Clinic Services, the Council's new clinic buildings, Infant Welfare Clinics, Toddlers' Clinics, Eye Examination of Children Under 5 years, Ante-Natal Clinics, Post-Natal Clinics, Gynaecological Clinic & Birth Control Session, Dental Clinics — County Council Clinics — Hospitals — Nutrition — Milk — Other Services, Artificial Sunlight and Massage, Maternity Outfits, Convalescent Home Treatment, Home Helps — Maternity Hospital Accommodation — Domiciliary Midwives' Service — Health Visitors, Home Visiting, Puerperal Pyrexia, Still Births, Infant Life Protection. 21 LABORATORY FACILITIES. The Clinical Research Association continued to carry out bacteriological examinations for the detection of diphtheria, typhoid, etc., samples of milk and food being also examined at these laboratories. Water examinations have been carried out at the Counties Public Health Laboratories. With regard to puerperal infection arrangements were entered into with Queen Charlotte's Hospital (see page 48). The following table shows the examinations carried out during the year:- 22 23 QUARTER ENDING. 31/3/1938. 30/6/1938. 30/9/1938. 31/12/1938. Total for 12 months. Throat Swabs: Diphtheria 251 (of which 14 were positive) 174 (of which 21 were positive) 155 (of which 18 were positive) 135 (of which 9 were positive) 715 (of which 628.67% were positive) Haemolytic Streptococci 10 (of which 3 were positive) 4 (of which 2 were positive) 8 (of which 3 were positive) 3 (of which 2 were positive) 25 (of which 10 were positive) Vincents Angina 2 2 1 (positive) 1 (positive) 6 (of which 2 were positive) Sputum (tubercle bacilli) 48 (of which 4 were positive) 54 (of which 5 were positive) 28 (of which 3 were positive) 50 (of which 9 were positive) 180 (of which 2111.66% were positive) Blood 4 4 4 - 12 Faeces and Urine 4 11 5 - 20 Milks 93 95 113 30 331 Water 2 5 2 5 14 Rag Flock - 6 - - 6 Maternity Outfit - 1 - - 1 Films for special 3 - 2 6 11 bacteria Food 1 - - - 1 AMBULANCE FACILITIES. 1. Infectious Diseases.—The ambulance service of the Acton and Wembley Joint Isolation Hospital undertakes the removal of all infectious cases. Number of Infectious Disease Removals Carried Out, 1938—Quarters Ending. 31/3/1938. 30/6/1938. 30/9/1938. 31/12/1938. 153 126 120 104 Total 503. 2. Non.Infectious Cases.—The Ambulance service was described in the previous report (1937). During 1938 two Austin 20 h.p. ambulances were in commission and no charge was made for their appropriate use. The Chief Officer of the Fire Brigade and Ambulance Service has supplied the following information with regard to the 2,639 calls received : — General Removals (sickness, etc) 1,588 Maternity Removals 350 Accidents 395 Illnesses (sudden) 112 Not required on arrival 83 Malicious Calls 9 Out.District Calls attended 10 Passed to Acton Infectious Ambulance 28 Passed to other Authorities 36 Carried out by other Authorities for us 21 Miscellaneous 7 2,639 Total mileage of ambulances 23,850 NURSING IN THE HOME. The two District Nursing Associations in the Borough are the Wembley and Kingsbury Associations, both of which are affiliated to the Queen's Institute of District Nursing. The good work done by these Associations continued throughout the year and has been keenly appreciated by the Council. Contributions of £400 and £100 respectively were made to the Wembley and Kingsbury Associations. 24 The Associations have supplied the folio ing to their work in 1938:— wing figures relat. Cases. Visits. (1) Wembley District Nursing Association. Medical and Surgical 1,071 18,711 Maternity, Midwifery and Ante.Natal 263 3,347 Children under 5 150 913 Children over 5 68 427 1,552 23,398 (2) Kingsbury District Nursing Association. Maternity Cases on Books 136 Births attended 136 General Sick Cases:— Adults 226 Children 124 Visits. Ante.Natal Visits 1,262 Maternity Nursing 2,578 Sick Nursing:— Adults 2,920 Children 368 Welfare Visits:— Supervisory 136 Casual 335 7,599 Cases have been referred to the Associations from the various clinics, according to the agreement mentioned in last year's report:— Cases referred to Nursing Associations, 1938 153 Children under 1 year 89 Children over 1 year 49 Mothers 15 Treatments given:— Seven or fewer attendances 88 Over seven attendances 65 25 The following table shows statistically the services rendered by the Associations during the last four years:— 1935 1936 1937 1938 Kingsbury— Births attended 96 103 (2 midwifery) 94 136 General sick cases 222 248 250 350 Visits—sick nursing 2,686 2,488 2,329 3,759 No. of Nurses at end of year 2 2 2 3 Wembley— Births attended 29 112† 128 224 (4 midwifery nurses) General sick cases 266 981† 988 1,017 Visits—sick nursing 9,207 15,226† 17,060 20,051 No. of nurses at end of year 5 7 9 10 († 1/10/35—31/12/36 i.e. 15 months). (1) Midwifery and Maternity Case. The Kingsbury Association has had two nurses for this work, while four nurses nave been employed by the Wembley Association. There is no indication that domiciliary midwifery in Wembley is relatively on the increase, the facts are the reverse. During 1938, for example, 46.9 per cent of Wembley confinements took place in hospital, while the number of births notified by midwives was 410, the corresponding figures for 1937 being 39.8 per cent and 417. Of the 410 notifications by midwives, only 98 were notified by midwives in private practice not attached to the two Nursing Associations and not attached to nursing homes. These figures point out the limitations for increased demand for the domiciliary midwifery and maternity services of the two Associations. (2) General Sick Nursing. (a) Kingsbury District Nursing Association. The staff employed for general sick nursing services was only one nurse. In this regard the limitations of the possibilities of midwifery nurses assisting in general sick nursing has to be recognised. As a generalisation it may be said that nurses engaged in midwifery or maternity services should not act as general sick nurses at all. Already, on occasion, the Kingsbury Association had found itself compelled to engage temporarily another general nurse. This Association has just taken the important step forward of moving its nurses to a new nurses' home (1 Mersham Drive, Kingsbury) where more appropriate accommodation is available for the nurses to do their work. This should increase the demand for their services. 26 (b) Wembley District Nursing Association. The staff for general sick nursing services was six and the Association had asked the Queen's Institute of District Nurses for an additional general nurse. There appeared to be work for this additional nurse. The Association has in view building a new nurses' home and has acquired a site in Copland Avenue, Wembley. For the purposes of the Midwives' Acts, the County Council have arranged that the Kingsbury Association serve the four wards—Fryent, Roe Green, The Hyde and Chalkhill, and that the Wembley Association serve the other wards of the Borough. The work performed in the Borough by these two Associations cannot be over.estimated. CLINIC SERVICES. In April, the Council's first clinic building at One Tree Hill was opened; at Stag Lane in July, the next building was opened; and in October the Perrin Road clinic commenced to function. These were notable advances in the health services of the Borough, and now at the time of writing mention may be made that the Monks Park clinic was opened in April, 1939, while tenders have been accepted for both the College Road and Church Lane clinics. A public Local Inquiry has been held by the Ministry of Health regarding a Compulsory Purchase Order for the acquisition of a site for the final central clinic of the Borough in London Road. In January, 1936, a Special Committee—The Maternity and Child Welfare Services Investigation Sub.Committee—presented a report dealing with the clinic services of the Council. In this report the opinion was expressed that the time had arrived when consideration should be given by the Council to the establishment of permanent clinic buildings to meet the present and future needs of the Local Authority. At that time clinic sessions were being held in five temporarily rented premises, as follows:— (1) St. Andrew's Hall, Ealing Road. (2) Wesley House, Harrow Road. (3) Tokyngton Hall, Monks Park. (4) Kingsbury Free Church, Slough Lane. (5) Church Hall, Roe Green. 27 This Special Committee reported that in no case was the accommodation satisfactory and that it could not be made so without incurring considerable cost to the Council. The Committee was satisfied that it was highly desirable for clinic sessions to be conducted on more satisfactory lines than they then were, and it was convinced that this could only appropriately be done were adequate facilities and proper equipment provided. "This," the Committee said, "can only be secured by the Council providing and equipping their own premises." Alongside this opinion regarding the Wembley services may be put an observation from the Annual Report of the Chief Medical Officer of the Ministry of Health for the year 1935— "Excellent provision is now generally made for individual observation and advice to mothers on the care and bringing up of infants and young children. Good premises greatly help in the work of a centre, and it is satisfactory that the hired rooms, often dingy and ill.ventilated, so common a few years ago, are now frequently being replaced by well.planned airy and pleasant buildings." In due course, then, it became the policy of the Council to develop their clinic services with the erection of ad hoc clinic buildings on modern lines. The seven Council clinic buildings to which reference has already been made, will permit the substitution of all unsatisfactory make.shift premises. One Tree Hill Clinic Dental Surgery. 28 Stag Lane Clinic. Similar to the other clinics, Perrin Road Clinic is designed to provide facilities for all infant welfare sessions, toddlers' sessions, minor ailments treatment and ante.natal ancillary sessions (and, in addition, is provided with a branch office for the payment of rates with completely separate entrance). The accommodation provided includes a waiting hall, doctor's room, weighing and dressing room, toddlers' room, treatment and staff rooms, with the usual offices and an external shelter for the accommodation of prams. The external walls are finished with brown multi.coloured facings, the internal walls being constructed of flettons with sound proof partitions between the rooms. The flooring is of oak throughout, with the exception of in the lavatories, where it is of a jointless bituminous composition. The internal walls generally are finished with distemper, of lavatories, etc., being of glazed brick.work. The building is centrally heated by means of a hot water installation with a gas.fired boiler. The estimated cost of the clinic, excluding the medical fittings and furnishings, was £3,050. Furnishings have cost £300. 29 Already the residents of Wembley have proved ready to respond to the modern premises supplied by the Borough Council. For example:— 1936. 1937. 1938. The number of attendances by children under one year of age 22,558 25,831 31,567 The number of attendances at all the centres by children between the age of 1.5 years 12,499 16,808 20,206 THE NEED FOR MODERN CLINIC SERVICES IN WEMBLEY. The percentage of notified live births represented by the number of children who first attended at the centres during the year and who on the first attendance were under one year of age in 1938 was 78.7. (In this figure is excluded the number of children who were known to have previously attended a centre in another district). 1936. 1937. 1938. The number of attendances made by women at the ante-natal clinics 1,160 2,046 3,877 Total number of women who attended for the first time 479 615 953 Percentage of total notified births (live and still) represented by the total number of women who attended the clinics for the first time during the year 29.1% 36.3% 52.3% Early in the development of the Council's clinic services the Borough Council approached the County Council regarding the probability of the usefulness of the Borough Council's clinics to the County Council in relation to the County Council's school medical service, and already the County Council are using two of the Borough Council's clinics (One Tree Hill and Stag Lane). The County Council have further stated that they will have in mind the Perrin Road Clinic and the Monks Park Clinic when the matter of rearranging the work in these parts of the Borough comes up for the consideration of the County Education Authority. It is anticipated, too, that the County Education Authority will enter into agreement for the use of the London Road Clinic regarding minor ailments, dental, orthopaedic and other specialist services. 30 Voluntary Workers. As in previous years the Voluntary Workers have continued to give their highly valued services. The Workers co.operate with the Council's Officers in every way, and the tendency noted for some to specialise in the services to which they become attracted shows a keenness which adds to the efficiency of the clinics generally. The Council have again recorded their appreciation of the help they derive from the Voluntary Workers. That the main function of the clinic health services is health education and to act as a Bureau of Information, rather than as a treatment centre, is shown by the fact that during the year 693 individual and personal letters were written to medical colleagues relating to persons who were advised to consult their own doctors or to have advice at a hospital. The following figures relating to May, 1938, and June, 1939, indicate the growth of the Borough's maternity and child welfare services:— Clinics. Sessions per Week. 1839. 1938. Infant Welfare 14 12 Toddlers' 5 4 Ante-Natal 8 5 Post-Natal 2 (per month) — Gynaecological 2 (per month) 2 (per month) Dental 4 2 Birth Control Session 2 (per month) 2 (per month) Infant Welfare Clinics. Average attendances at the various sessions during 1938, of children under 1 year of age, are set out below:— Clinic. Total Attendances. Average Attendance per Session. Ealing Road 6,411 42 Perrin Road (removed from Wesley House, Sudbury) 4,218 42 Tokyngton 3,163 37 Stag Lane (removed from Bacon Lane) 9,204 46 Slough Lane 5,090 61 One Tree Hill (opened 20th April) 3,481 33 31 Toddlers' Clinics. The following figures are those concerning attendances of children between the ages of 1.5 years 1938:— Clinic. Total Attendances. Average Attendance per Session. Ealing Road 4,580 30 Perrin Road 3,714 37 Tokyngton 2,309 27 Slough Lane 1,821 22 Stag Lane 5,476 28 One Tree Hill 2.306 22 Eye Examination of Children Under Five Years. Arrangement has been made for the above service to be available at the County Council's school ophthalmic clinics. The following pamphlet is issued to the parents of those children who require this examination, which sets out the main parts of the scheme. "You are advised that your child should be examined by the County Council Eye Specialist at the County Council School Clinic, in accordance with the scheme of the County Council and the Wembley Council. NO CHARGE IS MADE FOR THIS EXAMINATION, the Wembley Council having arranged payment to the County Council. If, however, your child should require glasses, these will be provided at the County Clinic, and you will be required to repay to the Wembley Council an appropriate percentage of the cost—according to your economic circumstances. (The maximum charge for glasses is 5/. per pair). If glasses are advised for your child an Economic Circumstances Form will be sent to you, and on your returning this form to this Wembley Council Clinic, or to the Public Health Department, Forty Avenue, Wembley, duly completed, notice will be sent you of the amount, if any, you will be required to pay. If repairs to the glas'ses be required at any time this may be arranged for you by the Wembley Public Health Department, by applying to any one of the Borough Council's clinics. A contribution towards the payment of repairs may be called for from you—according to your economic circumstances. You will be informed of this amount, if any, in due course by the Public Health Department." 17 cases were referred up to 31st December. 32 Ante.Natal Clinics. The numbers attending the ante.natal clinics show a very gratifying increase:— Clinic. Total Attendances. Average Attendance per session. Ealing Road 1,456 24 Perrin Road (opened 14/10/38) 57 8 Slough Lane 1,053 20 Stag Lane (opened 1/7/38) 546 21 One Tree Hill (opened 20/4/38) 765 11 Total — 1938 3,877 Total — 1937 2,046 The number of individual women who attended the antenatal clinics during 1938 was 825, to be compared with 626 who attended in 1937, while there were, in addition, 76 attendances of Wembley patients at the Harrow Clinic (Kenton). The percentage of total notified births, live and still, represented by the total number of women who attended a clinic was 52.3—a rise from 36.3 in 1937 (increase of 44.08%). The earlier the expectant mother comes under medical supervision the better. This may be influenced to some extent, at any rate, by health education. The following facts are recorded so that in due course consideration may be given to the fruits of such health education. The greatest number of first attendances were in the 3rd month of pregnancy at Perrin Road, in the 4th month at Ealing Road, One Tree Hill and Stag Lane, while at Slough Lane the highest proportion attended at the 5th month. The following table shows the months at which patients were seen for the first time at the ante.natal clinics throughout the Borough. Months:— 1st 2nd 3rd 4th 5th 6th 7th 8th 9th No. of mothers seen for the first time:— 4 105 158 185 159 116 61 34 3 33 Of the 126 cases referred to various hospitals for medical reasons, 45 were referred because of the history of difficulty in previous pregnancies. 10 showed signs of early toxaemia, while 10 were referred because of concomitant heart disease. 34 cases were of contracted pelvis or other bony abnormality. 9 showed abnormality or infection of the genital tract. The other complications were—pulmonary tuberculosis (2 cases) epilepsy (2 cases), haematemesis (1 case), malnutrition (2 cases), Exophthalmic goitre (1 case), Asthma (1 case), glycosuria (1 case) threatened to miscarry (1 case), unusual ages for pregnancy (5 cases), twin pregnancy (1 case), trigeminal neuralgia (1 case). During 1938, 458 women were referred to various hospitals through the Public Health Department thus:— For medical reasons 126 Home conditions unsuitable 189 Patient desired hospital accommodation 143 Total 458 Much can be done to amplify health talks by distributing suitable pamphlets dealing with the topic which may have been discussed. The following pamphlet has been written containing advice to expectant mothers. "Pregnancy is a perfectly normal state, and there is no reason why the mother should not feel well and happy throughout its course. If she does not feel well or notices any worrying symptoms, she should consult her Doctor or Midwife. Morning Sickness. Before the mother's organs are adapted to the presence of the developing child, she may feel sick or actually be sick when getting up in the mornings. For this it is best to have on a bedside table some dry biscuits, which can be eaten while still lying down, followed by a glass of water or a cup of tea, (if this can be brought up to her). Half.an.hour after this she can get up. If the sickness persists or occurs later on in pregnancy, she must consult her Doctor or Midwife. Constipation. A good daily action of the bowels is essential both for the mother's health, and for that of her child. Eat plenty of vegetables and fresh fruit. Dried fruit such as prunes, figs and apricots are also useful. Liquid Paraffin is excellent; also simple aperients such as Senna Tea (made with cold water from pods), Cascara and Vegetable Laxatives may be useful. Ask your Doctor before taking any other drugs. 34 Indigestion. Generally speaking, fried food is much less digestible than boiled or steamed food, and is better avoided during pregnancy. Digestion may be helped by eating and drinking separately, that is to say, the mother should take her meal as dry as is palatable, avoiding gravy or soup, and later she may have the fluid part of the meal. If this does not help, the Doctor should be consulted. Teeth. It is always wise to have the teeth seen to at intervals, and especially during pregnancy any dental defects should be treated. The expectant mother should consult a Dentist, so that her mouth will be made clean and healthy before baby arrives. The state of the teeth has a very important bearing on the general health. Diet. An ordinary mixed Diet is what the mother requires, but she must also see that it contains all the things her child needs. Milk is more important than any other single item in the mother's food. She is well advised to have up to 2 pints every day to build up the baby's skeleton and teeth, and to protect her own teeth. If preferred, the milk can be taken with equal benefit in any prepared form, for example, milk puddings, junket Ovaltine, jellies made entirely with milk, blancmange, custards, groats made with milk, milk with soda water. All foods derived from milk are also excellent, for example, butter and cheese, and may be taken liberally. Vegetables. All vegetables are particularly good. Two helpings daily should be taken, if possible. Lettuce, carrots, watercress, tomatoes and spinach are especially valuable. The water in which the vegetables have been cooked need not be thrown away, but may be used in gravies or soups. It contains valuable salts for the baby's teeth. Fruit. Take some uncooked fruit every day. Cooked fruits and dried fruits are very good. Meat. Meat, fish, liver, etc., can be taken once daily, unless the Doctor advises otherwise. Seasoned or salted meat, such as bacon, ham and sausages are generally not advisable. Eggs. Eggs are excellent, and one may be taken daily, unless the Doctor advises otherwise. 35 Water. Plenty of water should be taken daily. Therefore DON'T EAT THINGS THAT DISAGREE WITH YOU. MAKE SURE YOUR DIET INCLUDES MILK, GREENS AND FRUIT. KEEP YOUR BOWELS WELL OPEN. Consult your Doctor if you don't feel well or notice any worrying symptoms such as — headache, sickness, trouble with your eye sight, swelling of the feet, discharge, red ' shows,' faintness, giddiness. ' Extra Nourishment' in the Winter, Cod Liver Oil or any similar preparation, for example, Malt, Emulsion or Virol is useful, but only if it agrees with the mother. Bemax may be taken with advantage at any time of the year." Regarding the clinics it is becoming increasingly common for doctors to advise their patients to call to see the various patterns of clothing displayed there. Such health education is ever in the forefront of the Council's services and this cooperation is very gratifying. Post natal clinics. Two sessions are now held monthly, one at One Tree Hill, the other at Stag Lane, the service being provided at the end of the year. First attendances 17 Total attendances 19 No. of sessions 4 Gynaecological Clinic. The number of patients attending during the year was:— New Cases 91 Subsequent attendances 111 Average attendance per session:— New Cases 4.0 Subsequent attendance 4.4 Birth Control. A report by Mrs. E. Fisher, M.D., D.P.H., follows:— During the year, January—December, 1938, 104 new patients visited the clinic as compared with 74 in the previous year, the total number of attendances being 210. A great proportion of the cases are nursing mothers who wish to defer further pregnancy till the baby has been weaned. One mother had had nine children in nine years; another had five 36 children under the age of six; a third had four under five years. Such cases of too rapidly recurring pregnancies are now becoming infrequent in areas where the health of the mothers is being actively supervised, as any consequent deterioration in the health of the mothers or babies is detected at the welfare centres and the existence of a birth control clinic brought to the notice of the mothers. More than one quarter of the patients gave a history of having had one or more miscarriages. One patient came because of her childlessness. The cause of her sterility was investigated and she was sent for appropriate treatment. That there is this "pro-baby" side to a birth control clinic is not always realised, and too many mothers are unaware that their childlessness is not necessarily unalterable, but may quite well be curable. Local doctors, hospitals, and clinics referred numerous cases to the birth control clinic because of existing disease which would be aggravated by further pregnancy, e.g., nephritis, pernicious anaemia, and heart disease. The success of scientific contraceptive methods demands a little care and perseverence on the part of the user. Patients are sometimes reluctant to take the small necessary amount of trouble required, but it must be remembered that just as the expenditure of a little energy is necessary for the hygiene of the teeth, or hair, or figure, the same is true for the hygiene of marriage. The intimate relationship between the various types of services (Maternity Welfare, Ante.Natal, Post.Natal and Gynaecological) are shown by the following facts. During the year 91 new cases attended the Gynaecological Clinic. Of these 45 had a child under one year of age while 25 others had a child between one and five years so that 70 of the 91 patients (77%) may quite well have been in attendance with their children at the Maternity and Child Welfare Clinics, 45 (50%) may have been, themselves as nursing mothers, patients requiring advice at the Maternity & Child Welfare Clinics. Regarding the birth control sessions in 1938 (January to November) 117 patients attended. Of these 56 had children under one year of age and 15 had children over one and under five years of age. That is to say, 71 (61%) of the women may quite well have been attending the Maternity and Child Welfare Clinics with their children, while 56 (48%) may have been themselves, as nursing mothers, requiring advice at the Maternity and Child Welfare Clinics. 37 Dental Clinics. With the opening of One Tree Hill clinic, and, in due course, Stag Lane clinic, the Council were able to terminate their lease of la Bridge Road. These two clinics now provide treatment conveniently for the northern and southern parts of the Borough, but the district will not be fully served until dental service be provided also in the central London Road clinic. In no part of the health services is it more clearly shown that if a service be appropriately given it will be appreciated by the public. The rise in the figures is shown below, but improvements in health and the value of a service as regards preventive medicine cannot be shown by figures. The routine examination by the Medical Officers always includes dental inspection and an individual talk on the necessity of dental care, while there is constant consultation between the Medical Officers and the Dental Officer at the clinics. The equipment provided in the dental surgeries is complete. A dental chair with childrens' attachment, spittoon, electric engine, lights, cabinet with full equipment of instruments, electric sterilizers, gas apparatus and all appropriate drugs, oxygen, etc., are provided. In the recovery rooms spittoons fitted with running water, chairs and recovery couch are pro. vided. The aim is to secure full dental fitness. During 1938 the numbers specially referred to the dental clinics by a Medical Officer were:— Expectant Mothers. Nursing Mothers. Pre-school children. 378 191 344 Numbers who received treatment 357 175 299 Numbers made dentally fit 315 159 268 Number of treatments— (a) fillings (i) in temporary teeth — — 91 (ii)in permanent teeth 130 55 — (b) number of teeth extracted 1836 1031 695 (c) number of administrations of general anaesthesia 361 186 215 (d) number of patients supplied with dentures 97 99 - (e) number of dentures supplied 151 159 — 38 Regarding the follow up of all cases advised to have dental treatment, those who may have failed to keep an appointment are visited by the Health Visitors, who explain the value of the treatment. At least two such visits are made, if necessary, while, in addition, a letter is addressed to all who have failed to keep their appointment. The capital expenditure for the equipment at these new clinics has been approximately £200 each, while the current expenditure for medical requisites, dressings, drugs, instruments, etc. has been approximately £80 (£40 at each clinic). A report by the Dental Officer is submitted:— Total attendances at Dental Clinics during 1938, with comparative figures for 1936 and 1937:— Children. Mothers. 1936 209 422 1937 413 846 1938 826 1,497 The above figures for 1938 may be divided as follows:— Conservative Treatment. Extractions. Children 607 219 Mothers 867 630 By the first table it will be seen that the number of attendances of both mothers and children have been nearly doubled. Good as this result is, it is to the second table that particular attention should be given. The point worthy of special mention is the fact that the greater proportion of treatment given was conservative. Not only does it prove how justified was the Maternity and Child Welfare Committee in recommending the provision of a modern Dental Surgery, but also that the Borough is in line with modern Dentistry, the aim being always to save and preserve teth and to extract them only when there is no alternative. Although a large proportion of the patients who attended the clinic had to have teeth extracted, it must be remembered that the modern facilities now available have only been in existence for just over a year, and it takes regular treatment over a longer period than that to preserve teeth. The clinic takes care of expectant mothers, nursing mothers, and children up to five years old, when they come under the care of the school clinics. Children's teeth are subsequently under observation and treatment up to the age of fourteen or fifteen, and it is between that age and the age at which the National Health Insurance benefit is obtainable, that neglect is so often so marked. 39 I include the above paragraph in this Report in the hope that something may be done to impress upon the Youth of Wembley the necessity and advantages of continuing the good work which the Borough has started. J. H. STEVENS. County Council Clinics. The Middlesex County Council Education Committee are the local Education Authority. The number of children on the rolls of the school registers on 31st December, 1937, was 11,466. A minor ailments clinic for school children was conducted at the Kingsbury Green Council school and the Wembley Hill Council school, once per week, while also at these schools an ophthalmic clinic was held weekly. The school medical services conducted also dental clinics at the same schools. Nursery classes for children between the ages of 4.5 years have been provided at the Vicars Green School. The Tuberculosis Dispensary continued to be conducted at Pound Lane, Willesden, by the County Council. The Venereal Disease services is also a responsibility of the County Council and the service is provided at the various London hospitals, information regarding all the hospitals providing treatment in the scheme, being displayed in appropriate places in the Borough. HOSPITALS. (1) Redhill County Hospital, Edgware. A new maternity block, having accommodation for 60 beds and including a separate unit for emergency cases, with its own labour room, was formally opened in October. In addition, a medical block with accommodation for 294 beds was also opened at the same time. A new reception and out.patients block has also been provided at this hospital. (2) Central Middlesex Hospital. A new maternity unit of 60 beds is almost ready for occupation (July, 1939). Generally it would be appreciated were there more easy reference to this hospital for the southern part of the Borough. Geographically the hospital is more accessible than is Redhill Hospital. (3) At the Wembley Hospital—the voluntary institution of the Borough, 20 beds were added during the year, now making a total provision of 83 beds. A new nurses home accommodating 56 nurses was formally opened by the Mayor. The Council made a contribution of 250 guineas to the hospital during the year. 40 NUTRITION. Much attention is paid to the dissemination of the newer knowledge of nutrition at the Council's clinics. During 1938 grants of liquid milk to the quantity of 17,090 gallons, costing £1,826 were made to mothers and children whose family financial circumstances were within the Council's economic scale. Grants of dried milk and other accessory foods amounting to £692 9s. 7d. were also made. In this regard dried milk and accessory foods are also available at the clinics for other families at cost price. Such, however, are always given only on recommendation of the Medical Officers, so that the child for whom the mother may purchase an accessory food at cost price will obtain only that food which appears appropriate to the child's special individual case. Milk.—Milk is granted according to the economic circumstances scale of the Council (vide Annual Report 1937):— 1937 1938 Number of families granted free milk during year 500 683 Average number of families receiving free milk in a month 211 293 Average number of new families receiving free milk in a month 25 34 Number of families who applied for milk grants during year, and whose economic circumstances were beyond the scale 62 107 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) 71 122 The figures for milk grants for 1938, in monthly periods, are as follows:— Month. No. of milk Grants Renewed. No. of new grants made. January 275 35 February 221 53 March 279 48 April 259 21 May 253 29 June 251 22 July 270 30 August 232 31 September 245 34 October 271 24 November 273 46 December 285 35 41 OTHER SERVICES. Artificial Sunlight and Massage. The arrangement described in the previous year's report remained throughout 1938. In the following table is incorporated the numbers treated and the conditions for which the persons were treated:— Children under 1 year 22 Children between 1 and 5 years 107 Mothers 1 Total 130 Debility 29 Rickets 32 Incipient Rickets 4 Delayed Dentition 20 No gain in weight 1 Glands in neck 2 Anaemia 7 Chronic Bronchitis 3 Malnutrition 6 Debility following — Pertussis 3 Pneumonia 1 Diphtheria 1 Knock knees 2 Bow legs 8 Massage after fracture 1 Torticollis 2 Hypotonia 7 Foot deformity 2 Spondylitis 1 Maternity Outfits. During the year 126 maternity outfits were supplied. Convalescent Home Treatment. For 23 cases convalescent home treatment was arranged, concerning whom the Council accepted responsibility for payment in whole or in part according to the economic circumstances of the family. Five mothers with 7 children, and 11 children unaccompanied were sent during the year. There has been some difficulty in placing mothers with children requiring this treatment, while also the number of homes able to accept very young children is limited. No case is sent to a home without the Department having received the observations of the Medical Officer of Health of the area in which a likely home is situated. 42 Home Helps. The scheme of Home Helps had been in operation since March, 1938. Up to the 31st December Home Helps had attended 27 confinements, while the number on the panel was six. At the beginning, the remuneration of Home Helps was 25/per week, when so employed, but experience gained in due course proved this figure to be insufficient, and in October the Council being desirous of encouraging the Home Help Service raised the weekly wage to 35/-, when so employed, and the service was again advertised. From the 1st January to the 30th June, 1939, the number of families attended by Home Helps has been 20, while the number of women on the panel of Home Helps is at present 12. MATERNITY HOSPITAL ACCOMMODATION. The Council had for some time pointed out to the County Council the lack of maternity bed accommodation at the County Hospitals, more particularly at Redhill Hospital. It is gratifying, therefore, to be able to report that during 1938 the number of confinements in the County hospitals increased considerably. The number of beds available in the County hospitals, however, is still insufficient fully to meet the demand, and, as was pointed out as likely to happen, already cases have been refused a bed in the maternity blocks when the home circumstances were not considered appropriate for confinement at home. It is to be repeated that it would be of great assistance to Wembley residents were maternity accommodation to become available for the southern part of the Borough at the Central Middlesex Hospital. 43 BIRTH NOTIFICATIONS, 1934/38. By whom Notified Place at which Birth occurred. Totals. At Home. In Hospitals. In Nursing Homes, etc. 1934 1935 1936 1937 1938 1934 1935 1936 1937 1938 1934 1935 1936 1937 1938 1934 1935 1936 1937 1938 DOCTORS 351 385 348 290 197 319 355 557 595 727 178 132 71 182 179 848 872 976 1,067 1,103 MIDWIVES 277 365 368 417 410 79 84 14 138 127 149 203 258 156 125 505 652 640 711 662 PARENTS 95 47 23 65 41 3 2 — 1 — 6 3 3 2 15 104 52 26 68 56 TOTALS 723 797 739 772 648 401 441 571 734 854 333 338 332 340 319 1,457 1,576 L,642 1,846 1,821 44 Wembley Births Taking Place in Hospital. (a) Middlesex County Council Hospitals:— 1935 1936 1937 1938 Redhill 118 143 167 248 Central Middlesex 18 10 1 4 North Middlesex 10 2 5 2 Hillingdon 1 1 — — Middlesex County Maternity Hospital, Bushey — — — 114 147 156 175 368 (b) London Hospitals:— Queen Charlotte's Hospital 182 Queen Mary's Hospital, Hampstead 83 University College Hospital 29 Royal Free Hospital 16 City of London Hospital 18 Princess Beatrice Hospital 6 St. Mary's Maternity Home 61 Charing Cross Hospital 4 Middlesex Hospital 29 Hammersmith Hospital 3 Other London Hospitals 47 (Mildmay 2, Royal Northern 8, St. Bartholomew's 6, Paddington 1, Perivale Maternity 1, New End 1, Guy's 1, Florence Nightingale 1, St. George's 3, Elizabeth Garrett Anderson 4, St. James's 1, St. Mary Abbotts2, Mile End 3, Westminster 5, Jewish Maternity 1, General Lying.in 2, German 2, Battersea Maternity 1, Mothers' Hospital 2) 478 Grand Total 846 In addition, 1 birth took place at Wembley Hospital and 1 birth took place at Willesden Maternity Hospital. Again, the number of women desiring hospital confinement has increased. The percentages of home and hospital confinements have been according to the following table:— 45  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% 1938 1,821 648 854 368 319 35.6% 46.9% 20.2% 17.5% DOMICILIARY MIDWIVES SERVICE. As was explained in the Report for 1937, the County Council are the Local Supervising Authority under the Midwives Acts. With the increased development of the Borough Council's general public health services, it would appear soon to be appropriate for them again to seek to become the Local Supervising Authority. The domiciliary midwives service is surely an intimate and personal one best supervised by those officers dealing with all the details of a modern health service. For example, the Borough Council's responsibilities deal with puerperal pyrexia and other infectious diseases. The Council's divorce from the control of this service can be of no help to the County Council, while, in fact, difficulties at times may arise in the Borough Council's officers obtaining all the information they should have relating to circumstances which may have important epidemiological significance in the cause or spread of such cases. Wembley is an isolated district bounded by four County districts all of which Councils are themselves the Local Supervising Authorities. 46 The County Medical Officer has given the information that there were 14 midwives resident in the Borough engaged in private practice, in addition to 10 midwives employed by the Wembley and Kingsbury District Nursing Associations. The number of Nursing Homes in the Borough was 7, providing in all 38 beds, 29 of which were maternity beds. HEALTH VISITORS. One additional Health Visitor was appointed during the year. As has been explained in previous reports the various duties of the Health Visitors are now fully co.ordinated, and endeavour has been made to increase the opportunity for home visiting. With the rapid development of the clinic services, however, this has been difficult, but with the recent appointment of two additional Health Visitors (May, 1939), it is anticipated more domiciliary visitation will now be possible. Much good work is done in a quiet way by the health visitors discussing domestic health problems—patient health education being the constant endeavour and it must be pointed out that there are a number of ways in which domiciliary visitation cannot be replaced by attendance at a clinic. The number of home visits paid during the year by the Health Visitors were : To expectant Mothers:— First Visits 955 Total Visits 2,448 To Children under 1 year of age:— First Visits 1,931 Total Visits 6,295 To Children between 1 and 5 years of age:— Total Visits 6,935 Special Visits:— Ophthalmia Neonatorum and other eye conditions 19 Puerperal Fever 16 Puerperal Pyrexia Measles 96 Whooping Cough 74 Diarrhoea 10 General (unclassified) 287 PUERPERAL PYREXIA. Puerperal Pyrexia means" any febrile condition occurring in a woman within 21 days after child birth or miscarriage in which a temperature of 100.4 degrees F., or more, has been sustained during a period of 24 hours, or has recurred during that period." 47 The scheme of the Borough Council as described in the report for 1937, remained in force during the year. With regard to bacteriological investigation with reference to puerperal infection, the Borough Council have entered into an agreement with Queen Charlotte's Hospital for the examination of swabs from obstetric patients or from their attendants or contacts, for the presence of haemolytic streptococci and for the grouping of the organism according to Lancefield's classification. 19 notifications of puerperal pyrexia were received during the year regarding Wembley residents. The following are the details:— Ante.Natal care given:— By hospital 7 By doctor 7 By midwife 1 Unconfirmed 4 Pyrexia developed:— within 4 days in 10 cases within 4.7 days in 1 case within 7.14 days in 6 cases within 14.21 days in 1 case after 21 days in 1 case Consultant called in by private medical practitioners 17. Some ascertained associated circumstances:— Mastitis or breast abscess 5 Forceps delivery 2 Influenza 2 Pyelitis 1 Septicaemia 1 Phthisis 1 Abortion (4th month) 1 Induction of labour and macerated foetus 1 Nil elicited 4 Haemolytic streptococci Group A was isolated in one case. Patients confined in hospital 7 Subsequently treated in hospital 13 Patients confined in nursing home 1 Subsequently treated in nursing home 1 Patients confined at home 11 Subsequently treated at home 5 One of the patients died 1 day after delivery, another 4 days after delivery and one 10 weeks after the confinement. 48 STILL BIRTHS. There were 53 cases of still births allotted to Wembley by the Registrar General. The Public Health Department investigated in detail 50 such cases during the year. The type of investigation was described in last year's report. Attendant Circumstances—50 cases. Long Labour 6 Breach presentation 5 Instrumental delivery 4 Eclampsia 2 Induction for toxaemia 2 Albuminuria 3 Hydramnios 2 Abnormality of umbilical cord 3 Placenta praevia 3 Fall before confinement 3 Ante partum haemorrhage 2 Second stillbirth with unexplained cause 2 Macerated foetus 2 Prematurity 1 Triplets 1 Twins 1 Nil elicited 8 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 934 To Foster Parents 648 At the end of the year there were on the register:— Foster Children 53 Foster Parents 45 Number of Foster Children who died during the year Nil In addition, during the year at least one special visit was paid by the Medical Officers to all homes where foster children were received. 49 Section C. SANITARY CIRCUMSTANCES OF THE AREA. Water — Drainage and Sewerage — Rivers and Streams — Closet Accommodation — Public Cleansing — Sanitary Inspection of the Area — Camping Sites, Tents, Vans and Sheds — Offensive Trades — Piggeries — Rag Flock Acts — Noise — Dust — Hairdressers — Establishments for Massage and Special Treatment — Rats and Mice Destruction Act — Shops Act — Factories Act 1937 —Offices — Smoke Abatement — Swimming Baths and Pools — Eradication of Bed Bugs — Schools, Private Schools—Mortuary—Byelaws in Force. 51 WATER. The public water supply has remained as in previous years, by two Statutory Undertakers—The Colne Valley Water Company and the Rickmansworth & Uxbridge Valley Water Company. The steps taken to ensure the purity of the water by these two Companies were described in the Report for 1937. In June the Colne Valley Water Company issued a warning to the public that owing to the unexampled drought the Company requested the assistance of all consumers by exercising the greatest economy in the use of water for gardening, motor washing and other non-domestic purposes. The public supply of water, however, was not curtailed for domestic purposes, nor in any other way which might have interfered with the public health. The Ministry of Health Circular 1684 was received in March. While no part of this circular can be considered unimportant, the paragraph relating to effective collaboration and co-operation between water undertakers and a Local Authority appears to be of most intimate significance to the Borough Council, having regard to the fact that, in Wembley, the water supply is by Statutory Undertakers. The Circular states that in such circumstances the water undertakers "should always be ready, on request, to furnish full information to the Local Authority, or its medical officer of health, as to the quality of the water supplied and the precautions taken to safeguard its wholesomeness." Herein, surely, is an implication that such a request should be made from time to time. In this regard, also, the Public Health Act, 1936, Section 111 seems relevant:— 111—It shall be the duty of every local authority (1) to take from time to time such steps as may be necessary for ascertaining the sufficiency and wholesomeness of the water supplies within their district; and The Circular, on the other hand, states that the Local Authority should make it their duty to bring to the notice of the water undertakers cases of enteric fever or other diseases likely to be water-bourne. The Circular also suggests Local Authorities making it their duty to bring to the notice of water undertakers any building developments or any other operations in their area which may effect the purity of a source of water supply. 52 A copy of the results of the examinations made by the Colne Valley Water Company within the Borough is received monthly, while, too, the Rickmansworth and Uxbridge Valley Water Co. send copies of the bacteriological examination of water taken from their Ickenham & West Drayton pumping stations monthly, together with a copy of the Chemical Analysis bi-monthly. The Medical Officer of Health was instructed to inform the Water Companies of notifications of enteric (typhoidfever) or other water-bourne diseases to the Water Company supplying the district while the Borough Engineer and Surveyor was instructed to bring to the notice of water undertakers any building developments or any other operations in this district which might affect the purity of a source of water supply. An informal conference of the appropriate officers of the Local Authorities supplied by these Companies was convened for the purpose of discussing the question of water supply having regard to the terms of Circular 1684. Such a meeting was held in October, at which a small Committee was appointed to consider and report upon the following matters:— (a) The general responsibilities of Local Authorities under the statutes with respect to water supply. (b) Standard of hardness. (c) Supply of drinking water to factories. The hardness of the water supply in one part of the Borough has come under consideration. There is probably more prejudice than real observation with regard to soft and hard waters as affecting the Public Health. An authoritative opinion is that given in the standard textbook "The Examination of Water and Water Supplies," by Thresh, Beale and Suckling. This opinion is that as regards the general health of the drinkers the softening of a hard water either by the lime process or by the base-exchange method has no material effect. Section 41 of The Factories Act, 1937, deals with the supply of drinking water, requiring that there be provided at suitable points an adequate supply of wholesome drinking water from a public main or from some other source approved in writing by the District Council, this approval not to be withheld except on the grounds of the unwholesomeness of the water. During the year one request for such a certificate was received, and after a full examination of the water had been made and the observations of the Medical Officer of Health in whose area was the source of the water had been received the request was granted. The number of confirmatory samples of the public water supplies taken during the year was 8 for full analysis with complete bacteriological examination while on 7 other occasions a bacteriological examination was made. 53 Typical results of the chemical and bacteriological examinations of water supplied by the Statutory Undertakers:— Chemical Results in parts per 100,000. Sample of Water Colne Valley Water Company. Sample of Water Rickmansworth & Uxbridge Valley Water Company. 18/10/38. 21/10/38. Reaction pH Neutral 7.4 7.2 Free Carbonic Acid 1.1 2.6 Electric Conductivity at 80O C. 485 530 Total Solids, dried at 180O C. 32.5 35.0 Chlorine in Chlorides 5.3 2.4 Alkalinity as Calcium Carbonate 13.0 22.5 Hardness: Total 13.0 26.0 Temporary 11.0 20.5 Permanent 2.0 5.5 Nitrogen in Nitrates 0.52 0.8 Nitrites Absent Minute trace Free Ammonia 0.0000 0.0000 Albuminoid Ammonia 0.0012 0.0012 Oxygen absorbed in 4 hrs. at 80O F. 0.010 0.010 Metals: Iron 0.003 0.005 Bacteriological Results. Number of Bacteria growing on Agar per c.c. or ml. in 1 day at 370 C 0 0 Number of Bacteria growing on Agar per c.c. or ml. in 2 days at 370 C 0 2 Number of Bacteria growing on Agar per c.c. or ml. in 3 days at 20O C 1 3 Bacillus Coli Absent in 100 c.c. 100 c.c. Bacillus Welchii (B. Enteritidis Sporogenes) Absent in 100 c.c. 100 c.c. Streptococci Absent in 100 c.c. 100 c.c. 54 DRAINAGE AND SEWERAGE. The Borough Engineer and Surveyor has supplied the information that sewerage works totalling approximately £15,000 have been carried out, including soil sewers, surface water sewers, and culverts. Work has also been commenced on the preparation of a comprehensive drainage map of the district. Consideration has been given to the abolition of cesspools, septic tanks and chemical closets throughout the district, and investigations have been made in order to ascertain the extent of the works required. Consideration was given to the risk, if any, which might arise from using the clinker of the filter beds at the old Sewage Disposal Works. In order to give an opinion the following observations were made:— (1) Temperature inside beds. The temperature was taken inside the delivery pipe at the centre of a clinker bed, precautions being taken to prevent draughts of air through the pipe, and was found to be 49 degrees F. The temperature was then taken outside the bed, in the shade, and was found to be 53 degrees F. On replacing the thermometer inside the delivery pipe, the temperature registered decreased to 51 degrees F. in a short time. Evidently the temperature inside the bed was less than the temperature outside at any instant. (2) Moisture inside beds. The beds were dry at the top and damp for the bottom four or five feet, as was shown by trial holes. (3) Animal or Vegetable growth inside beds. There was none inside the beds, although grass and small plants were growing on the tops and sides. (4) Foreign matter inside beds. There was a small amount of loamy deposit on the clinker in the lower parts of the beds. The Kingsbury Works ceased to receive sewage on the 28th February, 1936, and the Wembley Works on the 7th April, 1936. More than two years had elapsed, therefore, which seemed more than a sufficient time for pathogenic organisms to have disappeared, so that the opinion was given that the clinker from these percolating filters could be used for road construction and similar purposes. 55 RIVERS AND STREAMS. The details regarding rivers and streams in the Borough were given in the report for 1937. 519 inspections of watercourses were made during the year, as a result of which a number of cases of pollution were discovered and subsequently remedied. Owing to the fact that the surface water sewers in the Borough discharge into the open watercourses the possibility of pollution taking place by sewage inadvertently gaining access to the surface water sewers must always be kept in view. In a number of instances this has been found to be the case and prompt action has always been taken to abate any such nuisance. The Middlesex County Council are the rivers authority and have periodically cleansed the main rivers and streams during the year. The County Council, too, have continued their policy of straightening the course of the River Brent and of the lining of the banks and bed of the river with concrete. In August a fatality occurred in the Welsh Harp water. It must be pointed out that bathing in this water is not allowed. The owners of the water have made considerable efforts for some time past to prevent bathing in the reservoir, while from a public health point of view it cannot be too clearly stressed that this water is unsuitable for bathing purposes. Practically the whole of the surface water from Hendon finds its way into the Welsh Harp. Surface water sewers discharge into the Silk Stream, or the Brent, which in turn empty into the Welsh Harp. Certain surface water sewers from Willesden also discharge into this water. In 1935 the late Urban District Council had this matter under consideration and again last year the Borough Council resolved THAT notices be exhibited by the Council at the entrances to, and other suitable places in, the Welsh Harp Open Space, to the effect that the Welsh Harp water is the private property of the Grand Union Canal Company; that the public using the Welsh Harp Open Space have no right to bathe in the water and that bathing in the Reservoir is dangerous. 56 CLOSET ACCOMMODATION. The exceptions to all closet accommodation in the Borough being on the water carriage system of the West Middlesex Main Drainage Scheme were given in detail in the report for 1937. There is now no dwelling house provided with a pail closet. Only three pail closets remain in use in the Borough, two at a factory and one in connection with a caravan. The number of chemical closets has been reduced to 30, 19 belonging to the Borough Council. One cesspool and one septic tank have been abolished during the year. Cesspools cannot be condemned simply because of being cesspools, but there is always much against them. For example, their periodic emptying, with the disposal of the contents, has to be seen to, while any laxity in supervision or in maintenance of repair results in objectionable overflow or soakage. A vacuum tank of the gully emptier type is the best method of emptying a cesspool, while the most appropriate method of disposal of the contents is into a sewer. A septic tank is designed to retain the sewage, so that the solids are broken up, the insoluable matter settling out as sludge which also must be removed but at infrequent intervals. From a Public Health point of view there is really little between a cesspool and a septic tank. The septic tank takes the disintegration of sewage material a step further chemically, but the effluent may still be bacteriologically dangerous, for which reason chlorination of the effluent is sometimes practised. No doubt the cesspools and septic tanks are relics of the earlier development of the district when sewers were unavailable. From a public health point of view the elimination of all cesspools and septic tanks, as soon as becoming possible with the development of the Borough sewage system, should take place. While chemical closets have a container in which the contents are intended to be covered by a chemical disinfectant, they are virtually pail closets with the same social objections as to their use and the disposal of their contents. Further, such safety as the use of a disinfectant may give, is often lost by reason of insufficient supervision. These chemical closets should always be looked upon only as a temporary expedient for use in a town like Wembley perhaps for a few weeks. The Council have resolved "that the earliest possible steps should be taken to effect the removal of all cesspools, septic tanks and chemical closets in use in the Borough." 57 PUBLIC CLEANSING. The Director of Public Cleansing has supplied the following information. Refuse Collection. Two of the latest type 18 cu. yd. S. & D. Freighters were purchased during the year in order to cope with the growth of the Borough. The total number of refuse collecting vehicles is now 15. Refuse Disposal. Various extensions and improvements were carried out at the Refuse Disposal Works, the most important of which are as follows:— (1) Provision of two-speed gear for conveyor in one reception hopper. (2) Additional roadways and storage sheds. (3) Erection of buildings over elevating conveyor pit entrance. (4) Erection of building with roller shutters to enclose tin shoot and vehicle. Street Cleansing. Re-organisation of street cleansing beats and engagement of additional Orderlies in order to provide a minimum twiceweekly service throughout the Borough, has taken place. Gully Cleansing. During the whole of the year gully cleansing was carried out by the Council's gully emptier purchased in October, 1937. The machine is also used by the Borough Engineer and Surveyor for sewer flushing. General. Frequency of house refuse collection — generally once per week; twice weekly from certain flats. Frequency of gully emptying — Four times per year. Frequency of street cleansing—Minimum of twice per week. 58 SANITARY INSPECTION OF DISTRICT. 1936 1937 1938 Complaints received and investigated 770 970 1063 Dwelling Houses. Visits under Public Health Acts 2360 3738 4745 Visits under Housing Acts 165 282 541 Visits re overcrowding 2768 2679 1328 Visits to bug infested premises 112 117 Visits re other vermin 114 72 58 Visits to cases of infectious disease 683 1372 1569 General Sanitation—Inspections. Drains and sewers inspected 1302 1891 2826 Tests applied to drains and sewers 35 207 338 Cesspools, etc. 9 121 202 Urinals and latrines—private 141 42 206 Stables, manure pits 23 76 115 Piggeries 40 23 15 Ditches and streams 156 334 519 Open Spaces, etc., 142 226 222 Yards 2115 2226 3406 Public Conveniences 198 309 298 Water Supply—visits — 34 43 „ „ —samples taken 6 4 23 Tents, vans and sheds 79 101 124 Factories, mechanical 185 452 598 Factories, non-mechanical 15 64 64 Workplaces 12 45 269 Outworkers 2 201 164 Smoke observations (half hourly) 162 126 190 ” ” (casual) 575 1102 1304 „ „ (visits to plant) 61 188 171 Cinemas, Dance Halls, etc., 33 54 55 Hairdressers 61 181 253 Schools 21 68 105 Markets 42 50 60 Offensive Trades 72 92 115 Swimming Baths—Visits 7 6 20 „ „ —Water Samples taken for full examination 6 4 2 „ „ —Chlorine Examination made - - 28 Rag Flock—Samples taken — 3 6 Canal Boats — — 14 Noise and dust nuisances — 83 572 Massage establishments, etc., — — 53 59  Meat and Other Foods Inspection. 1936 1937 1938 Meat Shops, Stalls, etc. 347 457 579 Slaughterhouses 133 92 94 Cowsheds 26 33 17 Dairies and Milkshops—Visits 200 288 319 „ „ „ Bacteriological examinations made 198 234 322 Dairies and Milkshops—Filter Samples taken - - 270 Bakehouses 67 105 110 Ice Cream Premises 12 19 Fishmongers and Poulterers 195 224 Greengrocers and Fruiterers 288 425 Grocers 799 193 254 Restaurants, Cafes, etc. 236 295 Street Vendors, Hawkers, etc 4 7 Other Premises 27 13 General Miscellaneous 4019 995 690 TOTALS 17379 19727 24376 Notices served. 1936 1937 1938 Number of verbal notices given — 488 306 „ „ „ „ complied with — 459 280 „ „ written notices served — 488 764 ” ” ” ” complied with - 458 586 Number of statutory notices served 23 21 90 ” ” ” ” complied with 19 15 37 NUISANCES ABATED AND IMPROVEMENTS EFFECTED. (a) Dwelling Houses. 1936 1937 1938 Roofs repaired 23 29 54 External walls and chimney stacks repaired 21 28 54 Gutters and spouts repaired or renewed 27 20 45 Damp-proof courses provided — 3 3 Dampness remedied 25 52 64 Yards paved or repaired 12 21 38 Internal walls and ceilings repaired 43 45 68 Doors repaired or renewed 1 7 20 Windows repaired or renewed 30 37 72 Floors repaired or renewed 6 27 59 60 1936 1937 1938 Sub. floor vent. provided or improved 2 5 12 Rooms cleansed or redecorated 139 137 241 Passages and staircases redecorated 19 15 30 Staircases repaired — 4 10 Fireplaces repaired or renewed 23 26 Cooking stoves repaired or renewed 20 11 3 Wash coppers repaired or renewed 2 3 5 Sinks and wash basins provided or renewed 13 13 12 Waste pipes repaired or renewed 21 27 21 Food stores provided or improved 1 1 12 Dustbins provided or renewed 343 249 322 Water supply improved or reinstated 13 22 16 W.C.'s. cleansed or repaired 59 64 55 Additional W.C's. provided — 2 3 Verminous premises disinfested (Bugs) 59 71 46 Verminous premises disinfested (Other Vermin) 27 17 Overcrowding abated 2 76 80 Miscellaneous 101 23 7 (b) General Sanitation. 1936 1937 1938 Drains and sewers cleansed from obstruction 495 482 587 Drains and sewers repaired or renewed 37 64 72 New drains provided 3 31 30 New inspection chambers provided 15 22 Inspection chambers repaired 34 15 41 Soil pipes and vent. shafts repaired — — 7 W.C's. repaired — 8 8 W.C's. cleansed — 110 3 Cesspools emptied — 10 20 Cesspools repaired — 1 — Cesspools abolished — — 1 Urinals and latrines cleansed or emptied 27 24 5 Additional urinals or latrines provided - 3 - Urinals or latrines removed — — 2 Stable, manure pits, cleansed — 6 — Piggeries cleansed or limewashed — — 2 Pigstyes repaired — — 1 Animal nuisances abated 7 9 2 Offensive accumulations removed 66 76 74 61  1936 1937 1938 Ditches and streams cleansed 21 9 4 Yards cleansed or repaired — 26 10 Tents, vans, sheds, nuisances abated — — 1 Tents, vans, sheds removed 54 28 26 Smoke nuisances abated 34 28 14 Improvement in boiler plant or fuel effected - 10 6 Cinemas, Dance Halls, contraventions remedied 3 7 2 Hairdressers—contraventions remedied 7 32 28 Offensive trades—contraventions remedied - - 1 Schools—sanitary conditions improved - 1 - Schools—additional W.C's. or urinals provided - 4 6 Noise nuisances abated — 4 9 Conversion of pail closets to W.C's. — — 4 Burning of refuse discontinued — — 7 (c) Meat and Other Foods. 1936 1937 1938 Meat Shops & Stalls—Premises cleansed1 24 12 13 Meat Shops & Stalls—Other I contraventions remedied 13 24 Slaughterhouses—Contraventions remedied 4 2 2 Dairies—Cleansed and limewashed - 5 — —Premises repaired 1 1 1 —Other contraventions remedied 5 2 Bakehouses Cleansed and limewashed 16 12 Bakehouses—Sanitary conditions improved 10 5 4 Bakehouses—Other contraventions remedied 3 7 Ice Cream Premises—Cleansed and limewashed - 1 1 Ice Cream Premises—Sanitary conditions improved - - 2 Fried Fish Shops—Cleansed and limewashed - - 1 62 1936 1937 1938 Fried Fish Shops—Sanitary conditions improved 1 1 Fried Fish Shops—Other contraventions remedied 6 1 Fishmongers, etc.—Contraventions remedied 4 6 Grocers—Contraventions remedied 16 9 Greengrocers—Contraventions remedied 18 18 6 Restaurants, Cafes, etc.,— Contraventions remedied 21 13 Other food premises—Contraventions remedied 5 2 1828 2179 2496 CAMPING SITES, TENTS, VANS AND SHEDS. There are only four sites in the Borough used for moveable dwellings. In view of the fact that moveable dwellings and camping sites are dealt with under Part 6 of the Middlesex County Council Act, 1934, section 269 of the Public Health Act, 1936, is not in force in the Borough. Two sites have been licensed each for the use of one caravan each, each caravan being occupied by only one person; water supply and sanitary accommodation are available in each case. One application for the use of land by three caravans was refused ; the case is still pending at the present time. The remaining camping site is on part of the Barnhill Open Space owned by the Council, well away from dwelling houses. This site is provided with water supply off the public main, and with chemical closets, and is intended to be used only at weekends by members of authorised organisations, such as Boy and Rover Scouts. No use was made of this land as a camp during 1938. The total number of persons living permanently in moveable dwellings in the Borough during 1938 was 7 adults. On 26 occasions, gypsies vans were placed on land adjoining Fryent Way, but with the help of the Police they were removed within a short time. In past years, Wembley experienced considerable trouble from gypsy encampments, but there is now so little land available for them that the problem has for the most part disappeared. 63 OFFENSIVE TRADES. Number on the Register—13. During the year 115 inspections have been made of the 13 businesses carrying on the trade of fish frying, which is the only class of offensive trade now in the Borough. Two contraventions of the byelaws were found and remedied, and, generally speaking, the businesses were found to be well conducted. Three applications were received during the year to establish the trade of fish frying, one of which was granted, and the other two refused. PIGGERIES. There are now only three premises in the Borough where pigs are kept, two such premises having been removed during 1938. RAG FLOCK ACTS, 1911 and 1928. Six samples of rag flock were taken during the year under the above acts, and all were found to comply with the Rag Flock Regulations, 1912. The amount of soluble chlorine in the form of chlorides removed by thorough washing with distilled water at a temperature not exceeding 25 degrees Centigrade from 50 grammes of the samples was found to be as follows:— No. 1 sample—not to exceed 18 parts per 100,000 ” 2 ,, -,, ,, ,, 15 ,, ,, ,, ” 3 ,, -,, ,, ,, 5 ,, ,, ,, „ 4 „ —practically nil „ „ 5 „ —not to exceed 10 parts per 100,000 ,, 6 ,, -,, ,, ,, 20 ,, ,, ,, NOISE. There has been a large increase in the number of complaints received regarding noise. During 1938 no less than 518 visits were made. The majority of these complaints, naturally, are made by residents whose houses adjoin industrial zones. Whilst there must be some boundaries on which residential zones meet industrial zones, the difficulties are obvious where dwelling houses are in close proximity to factories. For example there are instances of factories on one side of a road, with residential dwellings immediately opposite. In other cases dwelling houses back on to factories, the gardens of the houses forming the only intervening space. 64 The industries which are responsible for complaint of noise in the Borough are not those usually classed as heavy industries. For example, noise was caused by the running of pumping machinery, while very considerable amelioration was obtained by enclosing that part of the factory where such machinery was installed by screens made of sound-absorbing material, and by the provision of double windows. In other instances noise from running machinery has been reduced by the erection of wooden fences and by the occupiers of the factories keeping particular windows and doors of the factory closed during the hours of work. In another case amelioration of the existing conditions has been achieved by the provision of efficient silencers on the air intake pipes attached to air compressor plant. Another noise nuisance has been overcome by the provision of new buildings, in which the engines are now running in special chambers partially partitioned by glass, the exhaust gases going into a specially constructed tunnel, lined with sound-absorbing material. The new arrangements have reduced the considerable noise to one now barely audible in the near vicinity. These are typical examples of achievement possible with the assistance of the occupiers of the factories. The results have been obtained without the service of statutory notices or recourse to legal proceedings. Section 106—Middlesex County Council (General Powers) Act, 1938, is now relevant to the subject of noise. The section is as follows:— 106— (1) A noise nuisance shall be liable to be dealt with as a statutory nuisance under the Act of 1936. Provided that no complaint shall be made to a justice under section 99 of the said Act unless it is signed by not less than three householders or occupiers of premises within hearing of the noise nuisance complained of. (2) For the purpose of this section a noise nuisance shall be deemed to exist where any person makes or continues or causes to be made or continued any excessive or unreasonable or unnecessary noise and where such noise (a) is injurious or dangerous to health; and (b) is capable of being prevented or mitigated having due regard to all the circumstances of the case. 65 Provided that if the noise is occasioned in the course of any trade, business or occupation it shall be a good defence that the best practicable means within the meaning of the said Act of preventing or mitigating it have been adopted. (3) Nothing contained in this section shall apply to a railway company the Transport Board or any statutory undertakers for the supply of water gas or electricity or their respective servants excercising statutory powers or to any mechanically propelled vessel on the Grand Union Canal. (4) Nothing in this section shall affect the powers of the Council or the Council of a Borough to make byelaws under Section 249 of the Act of 1933. (5) Section 56 (Noise nuisance) of the Act of 1930 is hereby repealed. While factory owners, on their attention being drawn to the nuisance from their factories, have always been found to be willing to co-operate in an endeavour to secure reduction or elimination of the noise, the solution is not always easy, and considerable expenditure is often involved. The circumstances generally call for much technical knowledge of the inspectors, and tact and understanding are necessary throughout in dealing with this question. It may be added that in making these inspections and observations regarding complaints of noise, no noise-measuring instruments have been used, the amount of noise being gauged by ear alone. DUST. During 1938, 504 observations of factories were made regarding the emission of dust. Section 92 (1) d. of the Public Health Act, 1936, enacts that any dust or effluvia caused by any trade, business, manufacture or process, and being prejudicial to the health of or a nuisance to the inhabitants of the neighbourhood may be dealt with as a nuisance. This was new to Public Health law and whilst it was not necessary to serve such a statutory notice during the year the section is a useful one. Nuisances from dust emission have been abated by such as the following means:— (1) Provision of filters of the dry bag type. (2) Spraying of coal with water prior to unloading. (3) Provision of air return pipe to a cement store where the cement is conveyed by pneumatic means. As with noise, this type of nuisance is often not easy to overcome, and in many cases the remedy is costly. 66 HAIRDRESSERS. Number on the Register—99. 253 visits were paid to hairdressers' premises and as a result in 10 premises contraventions of the byelaws were found and remedied. In 18 cases the byelaws were found to be not exhibited. This is a contravention of the Middlesex County Council Act, 1934 and this omission has also been remedied. The byelaws are made under the Middlesex County Council Act, 1934, and deal with the cleanliness of the premises and of the instruments, towels, equipment and materials used in the premises. ESTABLISHMENTS FOR MASSAGE AND SPECIAL TREATMENT. Byelaws for the regulation of licences for establishments for massage or special treatment came into force during the year. These byelaws deal with the fees or charges made at the establishments, the conduct of business and the keeping of records. Statistics:— (a) Members of the Chartered Society of Massage and Medical Gymnastics 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 (new) 3 do. (renewal) 1 (b) Applications for licences granted (new) 1 do. (renewals) 12 RATS AND MICE DESTRUCTION ACT, 1919. The Middlesex County Council are the authority under the above-named Act. 58 complaints relating to rats were received by the Department during the year, and were referred to that Authority. 67 SHOPS ACT, 1934, SECTION 10. The Chief Shops Inspector has supplied the following statistics relating to the arrangements for the health and comfort of shop workers, made in accordance with the provisions of the Shops Act:— Number of inspection visits 1,702 Section 10 (1) (b)—temperature Number of shops in which a reasonable temperature was not maintained 15 Section 10 (2)—sanitary conveniences Number of shops in which sanitary conveniences were not suitable and sufficient 2 Number of certificates of exemption granted Nil Section 10 (4)—washing facilities Number of shops in which washing facilities were not suitable and sufficient 12 Number of certificates of exemption granted Nil Section 10 (5)—facilities for meals Number of shops in which facilities provided were not suitable and sufficient 11 In all cases proper arrangements have now been made. FACTORIES ACT, 1937. This Act came into force on the 1st July. The following notes make reference to the administration of the Act so far as it concerns the Public Health Department:— The Act is divided into 14 Parts and 4 Schedules. Those parts which concern Local Authorities are:— Part I; Part II— (Section 34, dealing with means of escape in case of fire, to which no further reference need be made). Part III; Part IV; Part VII; Part VIII; Part XI; Part XII—(as regards offences, service of notices, etc. to which further reference need not be made). Part XIV—(dealing with interpretation of the expression "factory" and general interpretation, to which no further reference need be made). Third Schedule and Fourth Schedule (dealing with enactments repealed now requiring no further reference). Part I. By Section 8 the Local Authority must deal with sanitary conveniences and any regulations made thereunder with regard to all factories. In addition, the Local Authority must deal with cleanliness, overcrowding, temperature, ventilation and drainage of floors and any Order or Regulations thereunder as respects any factory in which mechanical power is not used (there are one or two exceptions defined by the Act or which may be dealt with by Order of the Secretary of State). The District Council must keep a register of all factories within their districts, with regard to which the duty of enforcing any of the above provisions is imposed upon them. 68 Observations on Part I. The provisions dealing with temperature and the drainage of floors in general (previously drainage of floors related only to those circumstances in which women were employed), are new. Cleanliness, overcrowding, temperature, ventilation, drainage of floors and sanitary conveniences are dealt with in more detail than previously. Part III. Section 41 deals with the supply of drinking water, requiring that there be provided at suitable points an adequate supply of wholesome drinking water from a public main, or from some other source approved in writing by the district council, such approval not to be withheld except on the grounds of the unwholesomeness of the water. Observations on Part III. This duty is not new, having dated from an Order gazetted 19th October, 1917. Part IV. Section 54 deals with basement bakehouses— (1) Any basement bakehouse which for a period exceeding 12 months is not used as a bakehouse shall not be so used again. (2) Within a year of the date of the commencement of the Act the Local Authority must review the basement bakehouses in their area and in every fifth succeeding year make such re-examination, and if the Council are not satisfied that the bakehouse is suitable as regards construction, height, light, ventilation and any hygienic respect, they must give notice that the certificate shall cease to have effect at a stated period not less than one month, after which period the basement bakehouse shall not be used as such. Provision is made for right of appeal to a court of summary jurisdiction. Observations on Part IV. The obligations of an examination within a year of the commencement of the Act and of an examination every five years of basement bakehouses are new. Part VII. Section 101 deals with tenement factories, these becoming, as regards sanitary conveniences, drainage of floors, etc., under the supervision of the Local Authority. Sections 107 and 108 deal with building operations and works of engineering construction and provide that the Local Authority shall enforce therewith the provisions with regard to sanitary conveniences and the supply of drinking water. Observations on Part VII. It is a new provrision to bring into the scope of the Act building operations and works of engineering construction. Part VIII. Sections 110 and 111 require the District Council to be informed of any outworkers, and where the District Council be of opinion that any place to which out-work is given is injurious or dangerous to the health of the persons employed therein, the Council may give notice that after the expiration of 69 10 days any work shall cease to be so given out. After such a notice it shall be an offence to give out any such work unless it is proved to the satisfaction of the Court dealing with the place that the place is not injurious or dangerous in the respects set forth in the notice. Observations on Part VIII. Only minor alterations in the present law have been made, for example, the time" one month" has been reduced to 10 days. Part XI. Section 128 provides that the Medical Officer of Health shall in his annual report deal with the administration of Part I and Part VIII of the Act and give notice to the Factory Inspector of any factory coming to his knowledge to which no abstract of this Act is fixed. Observations on Part XI. These duties are not new. Third Schedule. This Schedule re-enacts certain provisions of the Factory and Work Shops Act, 1901, with regard to Sanitary Regulations for bakehouses; penalty for bakehouses being unfit on sanitary grounds; limewashing and painting, and provision as to sleeping places near bakehouses. Observations on Third Schedule. As stated these provisions are not new. SUMMARY : As regards additional duties of the Public Health Department. The new provisions in the Act deal with:— Part I. (1) Temperature in factories. (2) Drainage of floors in general. Part IV. (3) The obligation of an examination within a year of the commencement of the Act, and examination every five years of basement bakehouses. Part VII. (4) Duties relating to building operations and works of engineering construction with regard to sanitary conveniences, and the supply of drinking water. Part I. (5) In addition to the above, the Act deals and in more detail with certain matters than Part VIII. in previous Acts. According to the information of the Department, there were on 31st December, 361 factories within the Borough. All plans of new factories and offices which are received by the Borough Engineer and Surveyor are referred to the Public Health Department to see that they comply with the requirements of the Acts and Orders relating to those matters which are the responsibility of the Department according to the Factories Act, 1937 and the Public Health Act, 1936. 70 The number of outworkers on the register at the end of 1938 was 69, and 164 visits were made to outworkers' premises during the year. In no case was work found to be carried out on unwholesome premises. The nature of the work carried out at these premises may be classified as follows: — Making of ladies' and children's dresses and underclothing 23 Tailoring 15 Sportswear and knitted articles 9 Boots and shoes 7 Nurses' uniforms and overalls 3 Millinery 2 Embroidery 3 Miscellaneous (ties, buttons, sewing and mending, fur trimming and such like, fur sewing, etc.) 7 69 Details regarding the Administration of the Factory & Workshop Act, 1901, and The Factories Act, 1937. 1. INSPECTIONS for purposes of provisions as to health, including inspections made by Sanitary Inspectors. Premises. Number of Inspections Written Notices. Occupiers prosecuted. (1) (2) (3) (4) * FACTORIES with mechanical power 702 42 - † FACTORIES without mechanical power 70 — - † OTHER PREMISES under the Act (including works of building and engineering construction but not including out-workers' premises). 5 - - TOTAL 777 42 - † Electrical stations should be reckoned as factories. * Includes 104 inspections of bakehouses with mechanical power. † Includes 6 inspections of bakehouses without mechanical power. 71 2. DEFECTS FOUND. Particulars. Number of defects. Number of defects in respect of which prosecutions were instituted. Found. Remedied. Referred to H.M. Inspector. (1) (2) (3) (4) (5) Want of cleanliness (S.I) 16 16(a) — — Overcrowding (S.2) — — — — Unreasonable temperature (S.3) — — — — Inadequate ventilation (S.4) 1 1(b) — — Ineffective drainage of floors (S.6) — 2(c) — — Sanitary Conveniences (S.7) insufficient unsuitable or defective not separate for sexes 1 1 — — 35 31 — — 3 3 — — Other offences 37 16 20 — (Not including offences relating to Home Work or offences under the sections mentioned in the Schedu'e to the Ministry of Health (Factories and Workshops Transfer of Powers) Order, 1921, and re-enacted in the Third Schedule to the Factories Act, 1937.) TOTAL 92 70 20 — (a) includes 2 defects found in 1937. (b) includes 1 defect found in 1937. (c) includes 2 defects found in 1937. OFFICES. Number on the Register—160. 253 visits were paid to offices during the year, and the numbers of defects found and remedied are set out in the table underneath. Most of the offices are modern, and are provided with ample light and ventilation. No case of overcrowding was found. Defects. Found Remedied Want of cleanliness — - Want of ventilation 1 - Overcrowding — - Sanitary accommodation insufficient unsuitable or defective not separate for the sexes — - 5 3 — — Obnoxious effluvia — — Other nuisances — — TOTAL 6 3 72 SMOKE ABATEMENT. 1936 1937 1938 Half-hourly observations of chimneys 162 126 190 Casual observations 575 1102 1304 Inspections of boiler plant and furnaces 71 188 171 While no abatement notices under Section 103, Public Health Act, 1936, were served during 1938, action taken by the authorised Officers according to Section 102 brought about the cessation of 34 smoke nuisances. Of these, 8 were effected by improvement in plant, 5 by improvement in fuel, and 21 by the exercise of greater care in the manipulation of the plant. Experience has continued to show that as a general rule greater improvements are achieved by personal visits and consultations than by the service of notices, and that factory proprietors are generally co-operative in their attitude to the advances made by the technical staff of the Public Health Department. SWIMMING BATH AND POOLS. The swimming baths open to the public in the Borough remained as described in the report for 1937. With regard to bacteriological control of these baths, both of which draw their water from the Colne Valley Water Company, it has to be realised that it is far more important to examine numerous samples by a simple test, than occasional samples by a more complicated test or series of tests. From the Vale Farm Swimming Bath two samples of water were submitted for full chemical and bacteriological examination, while, more important, were the 28 samples submitted to the orthotolidine test by members of the public health staff, all of which samples were found to be satisfactory. In addition, the Borough Engineer and Surveyor accepted the recommendation that such a test should be carried out three times daily by the resident staff. At the Empire Pool chemical and bacteriological examinations are made of samples of the water at weekly intervals, while the orthotolidine test is carried out at two-hourly intervals during the bathing season. ERADICATION OF BED BUGS. (1) Number of Council Houses:— (a) found to be infested 17 (b) subsequently disinfested 17 (2) Number of other Houses:— (a) found to be infested 49 (b) subsequently disinfested 49 117 visits were paid to verminous premises during the year. 73 The disinfestation of Council houses is carried out by the staff of the Housing Department of the Council, the routine being that described in the report for 1937. All premises continue to be inspected at the time of routine redecoration, while all vacant houses are examined prior to re-occupation to reveal infestation if this has occurred. Disinfestation of houses other than Council houses was carried out after notice from the Public Health Department, by the following methods : — By hydrogen cyanide 13 By sulphur 6 By liquid insecticides 30 Fumigation by hydrogen cyanide was carried out by a contractor, the arrangement being one between the owner or occupier and the contractor. The Hydrogen Cyanide (Fumigation of Buildings) Regulations, 1938, came into force on the 1st February, 1939. The Regulations call for a control which is very welcome. The following recommendations are taken from an article published in the Journal of Hygiene, January, 1939 (Page, Lubatty and Gloyns). All windows should be kept open for 24 hours unless this leads to the entry of rain or snow. A ventilation period of 24 hours is generally sufficient for an empty house of normal construction. A longer period may be required for a furnished house or for a house which (a) is damp, (b) contains an unusual proportion of dead space, (c) contains rooms without windows providing adequate communication with the open air. Fumigation of clothing and particularly of bedding in a house, as a regular practice, is definitely undesirable. Upholstered furniture should be placed in such a position as best to facilitate airing. Cushions, etc. should be spread out singly on furniture which is not upholstered. The customary tests with benzidine acetate-copper acetate should be made. A blue colour, in all air spaces, indicating a concentration of 0.01 oz./l,000 cu. ft., 0.0009% by vol., or less, gives a margin of safety. During the period of ventilation, all windows and other openings, should be so secured as to prevent the entry into the house of any unauthorised person. In addition, the premises should be kept under observation, continually, by a responsible person. 74 Houses, other than detached houses, should preferably be fumigated in blocks. Failing this, however, in the houses adjoining those being fumigated, a few floorboards should be removed in the upstairs rooms next to the fumigated house, and the windows of these rooms should be opened. In some instances it may be sufficient to ease the skirting boards instead of raising the floorboards. Bedding and clothing should be removed to the far side of the house. All rooms and cupboards, the roof space and the floor spaces in adjoining houses should be tested frequently during the fumigation and ventilation. SCHOOLS. The number of schools of the County Education Authority is the same as last year, 3 secondary schools and 26 elementary. There are in addition 28 private schools. The majority of the schools are of modern construction, being well lighted and ventilated, while all are supplied with water from the Water Company's mains. There are no schools in the Borough which are provided with earth or trough closets, all being provided with proper sanitary accommodation on the water carriage system. None of the schools was closed during the year by reason of the incidence of infectious disease, but pupils suffering from infectious disease or who had been in contact with such cases have been excluded in accordance with the regulations of the Middlesex County Council. Private Schools. In last year's Report, details were given as to the powers possessed by local authorities in the control of private schools. During the year in 6 schools additional sanitary accommodation was provided, while in 2 instances the numbers of pupils v/ere reduced so that the sanitary accommodation became sufficient; in 1 instance the available sanitary accommodation has been re-arranged, and in 3 cases the work of providing additional accommodation is now in progress. In 2 schools, both of which are in the same ownership, overcrowding of the classrooms was found to exist, and an additional wing is now being added to one of these schools in order that this overcrowding may be abated. Early in the year the attention of all principals of private schools in which there were laboratories or rooms used for practical work, was drawn to a pamphlet dealing with accidents in school laboratories. 75 The pamphlet dealt with the importance of the suggestions that dangerous chemicals should be kept in a locked cupboard, that the care, cleaning and fitting of apparatus should receive due attention, that correct manipulative technique should be required of the pupils, that all chemicals should be contained in bottles which are clearly labelled, that particular care must be taken with all experiments in which dangerous substances are used, that the use of high voltage electric power by pupils should be under the direct supervision of a teacher and should be restricted to senior classes. The pamphlet also suggested precautions with regard to machinery, and with regard to gas and electrical appliances. 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. The number of days during 1938 on which there were two bodies in the mortuary was 42. The days on which there were three bodies was 12 and on which there were four bodies was 1. As regards accommodation, then, the mortuary is doing no more than providing for the immediate necessities of Wembley. During 1938, 75 bodies were deposited; 58 post-mortem examinations were made, and 36 Coroner's inquests were held. The bodies were deposited by the following authorities : — Coroner 50 Police 17 From Wembley Hospital 8 Some inconvenience seemed to have arisen because of an undertaker in the Borough being unaware that the Mortuary Attendant is a member of the staff of the Public Health Department. During office hours any enquiries regarding the Mortuary Attendant are answered at the Public Health Department, while he is to be found either at the mortuary or upon the adjoining old burial ground of the Council (immediately adjacent to the grounds of St. John's Church, High Road). If there be any difficulty in finding the Mortuary Attendant, for example out of the ordinary working day, the Police are aware of how to make contact with him, and have kindly intimated that they are willing to assist in this way. The undertakers were informed accordingly. 76 BYE-LAWS IN FORCE THROUGHOUT THE BOROUGH DECEMBER, 1938. * Hoarding and Advertisements Petroleum Filling Stations Cleanliness of any premises used for the business of a hairdresser or barber Good Rule and Government of the County of Middlesex and for the prevention of nuisanceNew Streets Buildings Slaughterhouses Nuisances Offensive Trades Regulation of Licensed Establishments for Massage or Special Treatment 1926 1932 1935 1936 1936 1937 1937 1938 1938 1938 BYE-LAWS IN FORCE IN THE AREA WHICH COMPRISED THE 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 Public Conveniences New Streets and Buildings New Streets—Neeld (Wembley) Estate Smoke Abatement 1926 1928, 1929, 1933 1913 1930 BYELAWS IN FORCE IN THE AREA WHICH COMPRISED THE 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. 77 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. 78 Section D HOUSING. Inspection of Dwelling Houses — Overcrowding — New Houses — Provision of Houses for Tuberculous Persons. 79 INSPECTION OF DWELLING-HOUSES DURING THE YEAR. (1) (a) Total number of dwelling-houses inspected for housing defects (under Public Health or Housing Acts) 1944 (b) Number of inspections made for the purpose 4512 (2) (a) Number of dwelling-houses (included under head (1) above) which were inspected and recorded under the Housing Consolidated Regulations, 1925/1932 140 (b) Number of inspections made for the purpose 541 (3) Number of dwelling-houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation 16 (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 1010 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 937 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 2 (2) Number of dwelling-houses which were rendered fit after service of formal notices : — (a) by owners 2 (b) by Local Authority in default of owners Nil (b) Proceedings under Public Health Acts : — (1) Number of dwelling-houses in respect of which notices were served requiring defects to be remedied 40 (2) Number of dwelling-houses in which defects were remedied after service of formal notices : — (a) by owners 7 (b) by Local Authority in default of owners 24* * Includes compliance in 1938 with 9 notices served in 1937. 80 (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 11 (2) Number of dwelling-houses demolished in pursuance of Demolition Orders 3 (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 Housing Act, 1936, Section 62 deals with entries required to be made in rent books, information to be available 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 1938 986 Statistics re Overcrowding : — (a) Number of dwellings overcrowded at the end of the year 43 Number of families dwelling therein 44 Number of persons dwelling therein 275 (b) Number of new cases of overcrowding reported during the year 62 (c) (i) Number of cases of overcrowding relieved during the year (total) 80 (1) by removal of members of family 23 (2) by removal of families to other known addresses (not overcrowded) 32 (3) by removal to unknown addresses 22 (4) by removal to Council houses (included also in (2)) 23 (5) by re-arrangement of rooms amongst tenants 1 (6) by removal of sub-tenants 2 (ii) Number of persons concerned in such cases 474 (d) Particulars of any cases in which dwelling-houses have again become overcrowded after the Local Authority have taken steps for the abatement of overcrowding l 81 NEW HOUSES. The Borough Engineer and Surveyor has supplied the following information : — Number of new houses erected during the year: — (A) TOTAL, including numbers given separately under (B) 703 houses 411 flats (i) by the Local Authority 22 houses (ii) by other Local Authorities Nil (iii) by other bodies or persons 681 houses 411 flats (B) with State assistance under the Housing Acts : — (i) by the Local Authority 22 houses (ii) by other bodies or persons Nil Provision of Houses for Tuberculous Persons :— The following figures were up to date on the 9th December : — (1) Number of notified cases of tuberculosis living in Council Houses : — (a) so living when first notified 20 (b) removed to a Council house at a date after notification 7 27 (2) Total number of cases notified and then on the register (8/12/38) 573 (i.e. 4.71% of notified cases were living in Council houses). The opinion was expressed against the segregation of even small numbers of cases of tuberculosis, for example, in houses which might be built to house tuberculous persons by the Middlesex County Council. There are two reasons for this opinion. No justification can be seen for such a segregation for the sake of the public health, while, in addition, it is considered that such houses would soon become stigmatised, causing unnecessary sentimental pain to those suffering from tuberculosis. The number of such cases in Wembley is really small. An environmental form concerning all cases recently notified to be suffering from tuberculosis is received, and from consideration of these forms in 1937 two families, and in 1938 two other 82 families, were passed to the Borough Engineer for consideration regarding housing accommodation. This, of course, is only a reflection of the fact that housing conditions in Wembley are good. It may well be, however, that the Borough Council would find, on occasion, they would be better able to consider the tuberculous family applying for a Council house, were the County Council enabled to reimburse any additional expenditure in excess of that incurred in the provision of houses for the working classes under the Housing Acts, but it should be clearly understood that no definite house, much less a group of houses, however small, should be designated for the tuberculous. There is no special attribute of a house making it particularly appropriate for a tuberculous person. The fundamentals are—good aspect, good light and ventilation, etc. and enough bedrooms for appropriate separation of the infected individual as regards sleeping accommodation. These points, of course, are no more than are applicable to any well-sited, well planned and constructed house, but it is pertinent to add that the presence of a tuberculous person in a household may make appropriate sleeping arrangements impossible—the statutory definition of "overcrowding" being of no help in this regard. 83 Section E INSPECTION AND SUPERVISION OF FOOD. Food and Drugs Act, 1938— Milk (Special Designations) Orders 1936 and 1938— Cowsheds— Dairies and Milk Shops— Milk and Dairies (Consolidation) Act, 1915, Tuberculosis Order, 1925 — Slaughterhouses, Carcases Inspected and Condemned— Meat Shops, Stalls, etc.— Bakehouses— Other Food Premises — Unsound Food Surrendered & Destroyed— Food and Drugs (Adulteration) Act, 1928, etc., Chemical and Bacteriological Examination of Food — Food Poisoning— Shell Fish. 85 FOOD AND DRUGS ACT, 1938. In its passage through Parliament the Food and Drugs Bill was amended in so far as the definition of the Food and Drugs Authority was concerned, in its final form the Act defining the expression "Food and Drugs Authority" to mean: — (i) as respects a county borough, and also as respects any non-county borough or urban district which has according to the last published census for the time being a population of forty thousand or upwards, the local authority; and (ii) as respects any other area, the county council : Provided that— (a) if a county council satisfy the Minister that the area or areas in respect of which they would be the Food and Drugs authority would be rendered inconvenient in size, shape or situation for the efficient performance of their duties as the Food and Drugs authority, the Minister may direct that the county council shall be the Food and Drugs authority as respects the district or districts of any one or more of the local authorities who, but for such a direction would be Food and Drugs authorities under this Act, but were not such authorities under the law in force immediately before the commencement thereof. The duties of a Food and Drugs authority are easily and intimately related to the usual day-to-day responsibilities of a public health department. The attitude of the earlier legislation that the Food and Drugs Acts were matters for the police is now forgotten, and the service is rightly treated as a public health one. The service is not one necessarily more efficiently and economically administered by very large areas, for example, the densely populated area of the Middlesex County Council. Rather it is considered that it is one of minute detail appropriately administered by a public health department, the Medical Officer of Health thus co-ordinating the duties of the Sanitary Inspectorial staff, so that with the routine day-to-day food control and inspection of the area may go hand-in-hand all the appropriate sampling under the Food and Drugs Act. The reasons given by the Local Government and Public Health Consolidation Committee for proposing a change in the Food and Drugs Authorities throughout the country seemed to be quite clear, and as regards Wembley, very pertinent : — 86 "In our opinion the main factors in determining whether a local authority should be a Food and Drugs authority or not, are : — (a) the extent to which the routine work of food inspection and sampling in the area will represent something more than occasional duties for the officers engaged on the work, and (b) the standard which the authority have achieved in their public health arrangements. The first of these factors is mainly determined by the size of the population of the area and in this connection it Is worth recording that the figures set out in paragraph 36 of the Report of the Royal Commission indicate that the number of samples examined in a year is roughly 3 per 1,000 of the population. In judging the second it is relevant to consider whether the authority employ on the one hand a medical officer of health who is engaged exclusively in their employment, or exclusively in the employment of public authorities or on the other hand one who carried on a parttime practice." Having regard to the population a satisfactory number of samples to be taken in Wembley would have been 300 per annum, a number easily satisfying the Committee's criterion (a), while also, of course, criterion (b) would also have been respected. The Consolidation Committee recommended that Borough or Urban districts of a population of more than 40,000 should be the Food and Drugs Authorities, pointing out with regard to any suggestion that the authorities should remain the Councils of Counties and County Boroughs that the size of the population of an area 50 years ago is no criterion of fitness to administer the Acts to-day. (County Boroughs were constituted on a population basis of 50,000 in 1888). It seemed, however, that the Middlesex County Council still held the view that the Food and Drugs authority throughout the County should be the Council of the Administrative County. From a public health point of view it is to be noted that the total number of samples taken by the County Council as regards Wembley has been small, while, too, a preponderating proportion is milk. As the public health authority, the Borough Council also take samples of the graded milks during the year, making it redundant for the County Council to have taken such a large number of milk samples. Considering in detail the type of samples taken by the County Council, it is to be pointed out, 87 for example, that only one sample of cream, five of sausages,, one of butter, one of bottled fruit, etc., etc., have little public health significance, while, too, one can think of the condensed milks, common beverages, coffee, and all drugs which were not represented in the list for 1936 at all. It is suggested that a better sampling would have ben made by the staff of a public health department under the technical administration of the iVIedical Officer of Health. It is relevant also to note that all the Sanitary Inspectors of the Borough Council hold the special food certificate of the Royal Sanitary Institute, and have constant opportunity greater than that of the County's Inspectors of Weights and Measures to observe infringements of the Food and Drugs and Merchandise Marks Acts. Having considered the figures which were supplied by the Clerk of the County Council, it would seem that the costs of the service would have appeared likely to become less for Wembley had the Borough Council become the Authority. For example, for the £266 15s. 9d. mentioned in a letter, by the County Council, 142 samples were examined for Wembley, 52 by the County analyst and 90 by the officers of the Public Control Department. For the 142 samples to have cost £266 15s. 9d. the average cost for a sample must have been £1 17s. 6d. Were all these "formal" samples, (and they were not), and were they all examined by a public analyst, (and they were not), they would have cost 15/- per sample for analysis, that is to say, the administration cost alone per sample seems to have been £1 2s. 6d. For the aforementioned reasons, it was pointed out that were the Borough Council to become the Food and Drugs Authority both would there be a greater co-ordination of the responsibility with the general public health services of the Borough, and the administration costs would have been less than they are meantime through the County rate. In due course, the Medical Officer of Health attended upon the Select Committee of the House of Lords and the House of Commons, to which Committee his observations were submitted. The Middlesex County Council, however, made application for a direction under proviso (a) to Section 64 of the Food and Drugs Act, 1938, that they shall continue to be the Food and Drugs Authority for the County of Middlesex on and after the 1st October next as respects the districts of those local authorities who, but for such a direction would become Food and Drugs Authorities. The Minister has just intimated (July, 1939), that he has decided to grant the County Council's application. 88 MILK (SPECIAL DESIGNATIONS) ORDERS, 1936/1938. LICENCES ISSUED IN 1938. Designation Dealers Supplementary To Bottle To Pasteurise Tuberculin Tested 15 8 3 - Accredited 1 1 - - Pasteurised 26 12 - 3 The following is a classification of the samples of designated milk taken: — No. of samples taken. No. not up to standard. Tuberculin Tested 121 20 Pasteurised 155 4 T.T. (Pasteurised) 18 1 T.T. (Certified) 5 1 Accredited 18 - 317 26 Of the above 155 samples of Pasteurised milk, 29 were taken at the schools of the County Education Authority, and all of these samples were found to comply with the standard specified in the Milk (Special Designation) Orders 1936/1938. 25 samples of Pasteurised milk were also submitted to the Phosphatase test and reported satisfactory. Of the above 26 samples which were not up to standard, 7 were of milk bottled within the Borough, and 19 were bottled in other districts. In the latter cases the attention of the officers of the local authority of the district in which the milk was bottled was drawn to the unsatisfactory report. COWSHEDS. Owing to the continual building development, there remained at the end of the year only one farm producing milk for sale, this farm being licensed by the County Council for the production of Accredited milk. 17 visits were paid to cowsheds and the methods of production found to be satisfactory. 9 samples of milk were taken for examination from this one remaining farm and all of them were found to comply with the standard prescribed in the Milk (Special Designations) Orders 1936 & 1938. 89 DAIRIES AND MILK SHOPS. Number of dairies registered 29 Number of purveyors of milk registered, with premises in the Borough, selling milk in properly closed and unopened receptacles 35 Number of purveyors of milk registered, whose premises are outside the Borough 27 91 Number of dairies (included above) where milk is bottled, etc. 8 319 visits were paid to dairies and milk shops during the year. All the 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. Last year reference was made to the presence of particulate matter in the milk on arrival from other districts, and the assistance of the Public Health Departments of the districts from which the milk was sent was obtained with beneficial results. During 1938, 270 further filter samples were taken by the sanitary inspectors. In all cases where the samples were unsatisfactory, the attention of the Public Health Department of the District in which the milk had been produced was drawn to the matter, and the filter pads sent for inspection. Inspection of the filter pads over the period under review continued to show a steady improvement in the cleanliness of the milk sent into the Borough. MILK AND DAIRIES (CONSOLIDATION) ACT, 1915. TUBERCULOSIS ORDER, 1925. The Acting Chief Officer of the Public Control Department of the Middlesex County Council has submitted the following information regarding work carried out under the above statutes : — "During the year 1938, 25 samples of milk were taken from retailers in the Borough. The samples were submitted to the Lister Institute for animal inoculation tests for the presence of tubercle bacilli. Four of these samples were found to contain living tubercle bacilli : — 1. Traced to a farm in Hertfordshire; the Ministry of Agriculture reported— 'It is thought that the responsible animal was disposed of prior to the investigation.' 2. Traced to a farm in Buckinghamshire and one cow slaughtered under the Tuberculosis Order. 3 & 4. Traced to farms in Buckinghamshire (Reports not yet received)." 90 SLAUGHTERHOUSES. 94 visits have been paid to the one remaining licensed slaughterhouse, when carcases and organs have been inspected as set out in the accompanying table. With the small exception of the meat slaughtered at this private slaughter house practically the whole of the meat supply for Wembley is obtained from the London markets, and has already been inspected prior to its delivery to the local purveyors. There is no meat marking scheme in operation in the Borough under Part 111 of the Public Health (Meat) Regulations, 1924, no request having been made by butchers for the marking of meat. CARCASES INSPECTED AND CONDEMNED. Cattle, excluding Cows Cows Calves Sheep aud Lambs Pigs Number killed 76 6 46 381 53 Number inspected 76 6 46 381 53 All diseases except tuberculosis. Whole carcases condemned Nil Nil Nil Nil Nil Carcases of which some part or organ was condemned 2 Nil Nil 3 Nil Percentage of the number inspected affected with disease other than tuberculosis 2.6 0 0 .8 0 Tuberculosis only. Whole carcases condemned Nil Nil Nil Nil 1 Carcases of which some part or organ was condemned 11 1 Nil Nil 3 Percentage of the number inspected affected with tuberculosis 14.5 16.0 0 0 5.66 MEAT SHOPS, STALLS, ETC. Number on the Register — 78. 579 inspections were made of the meat shops and stalls, and 37 contraventions of the Public Health (Meat) Regulations, 1924, were remedied. The contraventions were as follows : — Want of cleanliness 16 Meat exposed to contamination 6 Sanitary accommodation unsatisfactory 2 Storage of refuse not satisfactory 13 91 BAKEHOUSES. Number on the Register — 24. 110 inspections of these premises were made during the year and as a result, 23 defects, as classified below, were found and remedied : — Cleansing and limewashing required 12 Sanitary accommodation not satisfactory 4 Storage of refuse not satisfactory 6 Drains required cleansing 1 There is now no "basement" bakehouse in use within the Borough. 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 91 and 92. On the coming into force on 1st January, 1939, of the Middlesex County Council (General Powers) Act, 1938, the Borough Council resolved to adopt immediately Section 70 and 71 of the Act which relate to notice of slaughter of animals unfit for food and the registration of hawkers of meat, fish, fruit and vegetables and premises. These sections are a valuable addition to the control of food and its storage. While it would appear likely that there will be but few notices of slaughter given to the Council under Section 70, the section is a useful one. With regard to Section 71, it may be looked upon as a distinct advance which will be most helpful in the routine control of food and its handling throughout the Borough. UNSOUND FOOD SURRENDERED AND DESTROYED 6 bovine heads and tongues 6 „ lungs 1 „ liver 1 „ liver 1 „ liver Internal organs of 2 beasts Internal organs and hindquarters of 1 beast 3 pigs' heads 2 pigs' plucks 1 pig's carcase and organs 3 sheeps' livers 19 lbs pigs' kidneys (frozen) 60 lbs. frozen rabbits 9 carcases veal 1½ cwts. cured ham 70 lbs. kippers 14 lbs. cured cod fillets 1 bag Brussels sprouts 1938. Tuberculosis ,, Distomatosis Cirrhosis Tuberculosis Tuberculosis Cirrhosis Unsound 92 31 packets jellies Unsound 56 lbs. pears „ 6 „ corned beef „ 3 „ tinned chicken & ham roll „ 2 — 1 lb. tins of raspberries „ 1 — 1 lb. tin of peaches „ 1 — 1 lb. „ „ grapefruit „ 1 — 1 lb. „ „ pineapple slices ,, 1 — 1 lb. „ „ peas „ 2 tins skimmed milk „ FOOD AND DRUGS (ADULTERATION) ACT, 1928. ARTIFICIAL CREAM ACT, 1929. PUBLIC HEALTH (CONDENSED MILK) REGULATIONS, 1923 and 1927. PUBLIC HEALTH (DRIED MILK) REGULATIONS, 1923 and 1927. PUBLIC HEALTH (PRESERVATIVES, ETC. IN FOOD) REGULATIONS, 1925 to 1927. The Middlesex County Council are the Authority for the administration of the above-named Statutes, and the Acting Chief Officer of the Public Control Department has supplied the following particulars of sampling in Wembley during 1938 : — Article No. taken. Adulterated. Milk Ill ' 2 Aspirin 2 — Camphorated Oil 3 — Castor Oil 1 — Cream Pastries 5 2 Gin 6 — Hake 1 — Lemon Sole 1 — Meat 9 — Minced Beef 3 — Preserves 1 — Sardines 2 — Sausages 18 6 Sheep's Liver 9 1 Sugar, granulated 1 — Whisky 4 — 177 11 CHEMICAL AND BACTERIOLOGICAL EXAMINATION OF FOOD. Chemical and bacteriological examination of food has been carried out by the Clinical Research Association. 93 FOOD POISONING. Only on two occasions during the year was any suspicion of such brought to the notice of the Public Health Department. (1) A male member of a household had partaken of a meat pastry and about two hours later complained of headache. Four hours later vomiting commenced which was repeated throughout the night being accompanied by diarrhoea. All the relevant circumstances were investigated, the meat pastry being traced to its source, and, at the same time, bacteriological investigation of faeces of the patient was also undertaken at the Ministry of Health. At the Ministry of Health laboratory no bacterial cause of food poisoning was found in the meat pastry, the pies were, in fact, practically free from living bacteria. The patient's excreta also proved negative on bacteriological examination. The bacteria of Sonne Dysentery, as well as the Salmonellas were not separated. It has to be remembered, of course, that these bacilli may disappear very rapidly after the acute stage of food poisoning has passed. The origin of the pie was without the Borough, but the Medical Officer of Health of the area was communicated with and no illness amongst the staff of the bakery was elicited. Throughout the investigation the Public Health Department obtained complete co-operation from the firm from which the pies had been bought. (2) A person was reported to have suffered from urticaria and to have been inclined to associate this with a "nerve food " which was being taken. A sample of the food was obtained and a partial chemical analysis of it revealed that it contained phosphates and casein, the sample being, therefore, of the sanatogen type, consisting of casein and glycerophosphates. Enquiry elicited that the patient had as a rule no undue reaction following the drinking of milk, suggesting the probability that the urticaria and nerve food were not, in fact, related. SHELLFISH. There are no shellfish beds or layings in the Borough. Enquiries were made in the latter part of the year of all the local fishmongers as to the sources of supply of the shellfish sold by them. Eleven fishmongers obtained supplies from Billingsgate Market, one firm obtained its supplies from Port Navas, near Falmouth, Cornwall, and from Helford River, near Falmouth. With regard to oysters, 5 firms stated that they had very little sale for oysters, but that special orders were executed when required, by obtaining their supplies from Billingsgate; whilst in 5 other cases the firms stated that they had no demand for oysters. No action was found to be necessary under the Public Health (Cleansing of Shellfish) Act, 1932, or the Public Health (Shellfish) Regulations, 1934. 94 Section F PREVALENCE OF, AND CONTROL OVER, INFECTIOUS AND OTHER DISEASES. Infectious Diseases, General procedure, Consultations with the Medical Officer of Health, the streptococcal infections, Middlesex County Council (General Powers) Act 1938, Public Health (Aircraft) Regulations 1938—Incidence of Infectious Diseases — Scarlet Fever, Oliver Goldsmith School—Diphtheria, the change of age incidence, Diphtheria Immunisation— Enteric Fever— Puerperal Pyrexia— Pneumonia —Erysipelas — Ophthalmia Neonatorum— Anterior Poliomyelitis, the nature of the disease— Cerebro Spinal Fever, Lymphocytic Meningitis— Dysentery — Encephalitis Lethargica, PolioEncephalitis— Smallpox — Non-notifiable Infectious Diseases, Measles— Joint Isolation Hospital Scheme (cases admitted to the hospital)— Supply of Anti-Toxin and prophylactics — Tuberculosis, New Cases and Mortality— Disinfection of Premises and Articles. 95 INFECTIOUS DISEASES. The procedure with regard to infectious diseases was considered in detail in the report for 1937. During 1938, 12 cases of contacts of infectious disease were reported by Port Medical Officers of Health, 8 such cases being related to enteric fever, while 4 were contacts of smallpox. In all cases the usual observations were made of the contacts and no untoward happenings took place. The Medical Officer of Health was called in consultation with the local Medical Profession on 37 occasions. The differentiation of the streptococcal infections into those which are not scarlet fever and those which are scarlet fever is one not now of much medical importance, although the Public Health Act, 1936, still makes notification necessary regarding a case of streptococcal infection showing a certain syndrome, the main part of which is a rash, and to which the name "scarlet fever" may be given. As long as the legal responsibilities are not more in accord with the present day medical attitude regarding the streptococcal infections, so will there continue to be attached to the syndrome "scarlet fever" a greater importance than it deserves, "scarlet fever" being, in fact, but one manifestation of an infection by the streptococci. From the medical point of view, importance is to be laid upon the streptococcal infection and not upon whether the infection in a particular case has caused a particular type of rash, or not. Such, no doubt, is the explanation of the fact that, of the 37 cases in which a second opinion was asked, no less than 17 were of streptococcal infections. The other diseases were—german measles (4), infantile paralysis (4), Diphtheria (2), chickenpox (2), tuberculous meningitis (2), pneumonia (1), encephalitis (1), measles (1), typhoid fever (1)—(observation proved negative), enema rash (1), urticaria (1). Due consideration was given to Sections 60 and 61 of the Middlesex County Council (General Powers) Act, 1938. The obligations imposed upon parents by these sections are practically similar to what had become the routine practice in Wembley, both as regards informing the Head Teachers of schools and as regards the advice given to families on the outbreak of notifiable disease amongst their members. To have statutory weight to such practice of course is valuable, and the Council resolved that immediately on the Act coming into force, these sections be adopted. 96 The following information is incorporated in the pamphlet left with the family in which there has occurred a notifiable disease :— Middlesex County Council (General Powers) Act, 1938. (1) The Headteacher of a School and Sunday School must be informed forthwith of the occurrence or suspicion of NOTIFIABLE DISEASE in a household—penalty twenty shillings. (2) Patients and other children excluded from school because of a NOTIFIABLE DISEASE must also be kept away from any Sunday School, Day School (e.g. Private School) or Place of Public Entertainment or Assembly unless a medical certificate be procured stating that they may attend without undue risk of communicating disease to others—penalty forty shillings. The NOTIFIABLE DISEASES above referred to are as regards the Borough of Wembley at the present time : - Smallpox, Cholera, Diphtheria, Membranous Croup, Erysipelas, Disease known as Scarlatina or Scarlet Fever, and Typhus Fever, Typhoid Fever, Enteric Fever or Relapsing Fever. The Public Health (Aircraft) Regulations, 1938, which came into operation on 1st July, 1938, lay down a certain routine to be complied with in order further to protect the public health, with regard especially to the diseases of plague, cholera, typhus fever and small-pox. 97 CASES OF INFECTIOUS DISEASE (OTHER THAN TUBERCULOSIS) NOTIFIED DURING THE YEAR, 1938. NOTIFIABLE DISEASE Total cases Notified at all ages. Cases Notified in the Whole District. Total removed to Hospital. % of cases removed to Hospital At all Ages—Years. Under 1 1-2 2-3 3-4 4-5 5-10 10-15 15-20 20-35 35-45 45-65 65 & over Scarlet Fever 417 - 2 16 17 23 248 61 17 21 6 5 1 330 79.13 Diphtheria 82 - - 1 4 7 36 21 — 7 6 — — 76 92.68 Enteric Fever 4 - - - - - - - - 3 1 — — 4 100.00 (including* Paratyphoid) Puerperal Pyrexia 26 - - - - - - - - 22 4 - - 20 76.92 (Excluding Willesden cases) 19 - - - - - - - - 15 4 — — 13 68.42 Pneumonia 74 2 3 7 2 4 9 6 3 9 11 15 3 — — Erysipelas 25 — — 1 — — — 1 — 7 .2 11 3 10 40.00 Ophthalmia Neonatorum 7 7 - - - - - - - - - - - 5 71.42 Acute Anterior Poliomyelitis 8 — 1 — — — 4 1 — 2 — — — 7 87.50 Cerebro-Spinal Fever 1 — — — — — — 1 — — — — — 1 100.00 Dysentery 15 — — 1 — 1 3 2 2 2 2 2 — 8 53.30 98 TABLE SHOWING NOTIFICATION OF INFECTIOUS DISEASE OCCURRING IN ELECTORAL WARDS 1938. DISEASE TOTAL Electoral Wards. Alperton Central Chalkhill Fryent The Hyde Kenton Preston Roe Green Sudbury Court Sudbury Tokyngton Wembley Pk. Scarlet Fever 417 47 38 8 12 86 17 20 22 34 18 74 41 Diphtheria 82 26 7 1 5 11 2 4 5 1 7 9 4 Enteric Fever 4 1 — — — 1 1 1 - - - - - (including Paratyphoid; Puerperal Pyrexia * 26 - - 1 3 - 3 2 5 - 1 3 1 Pneumonia 74 14 6 3 8 5 2 8 6 5 4 10 3 Erysipelas 25 3 2 — — 4 1 1 5 — 4 4 1 Ophthalmia Neonatorum 7 1 — — — 2 — — — — 3 1 — Acute Anterior Poliomyelitis 8 1 1 1 - - - 5 - - - - - Cerebro-Spinal Fever 1 — — — — — — — — — 1 — — Dysentery 15 2 1 - 1 5 - - - - 5 - 1 * (add 7 Willesden cases). 99 As in the previous year the Hyde Ward was responsible for the incidence of scarlet fever being greater in Wembley than in the country as a whole—scarlet fever being the only disease, the incidence of which was not considerably less than in the whole country. Rate Incidence per 1,000 Population. Wembley England & Wales. 126 County Boroughs and Great Towns including Tondon (1) Deaths. All causes 6.77 (based 11.6 on 804 deaths) 11.7 Typhoid and Paratyphoid fevers 0.00 0.00 0.00 Smallpox 0.00 0.00 - Measles 0.03 0.04 0.05 Scarlet Fever 0.008 0.01 0.01 Whooping Cough 0.008 0.03 0.03 Diphtheria 0.03 0.07 0.07 Influenza 0.08 0.11 0.10 Polio-Encephalitis 0.00 not available not available Cerebro-Spinal Fever 0.008 ,, ,, (2) Notifications. Smallpox 0.00 0.00 0.00 Scarlet Fever 3.50 2.41 2.60 Diphtheria 0.69 1.58 1.85 Enteric Fever 0.03 0.03 0.03 Erysipelas 0.21 0.40 0.46 Pneumonia 0.62 1.10 1.28 Dysentery 0.13 not available not available Acute Anterior Poliomyelitis .067 ,, ,, Cerebro-Spinal Fever .008 ,, ,, Scarlet Fever. There were 417 cases of Scarlet Fever notified with 1 death. 330 cases (79.13 per cent) were removed to hospital, while 87 were isolated at home. The incidence of Scarlet fever in monthly periods during the year was as follows January—32 cases, February—46, March—31, April—38, May—56, June—26, July—51, August— 26, September—21, October—35, November—32, December 23— Total 417. 100 Scarlet Fever—Oliver Goldsmith School. As in 1937, this school accounted for more than a normal share of the cases of scarlet fever throughout the schools in the Borough. The number of cases in 1938, however, was relatively considerably less than in 1937. From September until the end of the year in 1937 there had been 64 cases while, throughout all 1938, there were 60 cases. The next highest number at a school was at Park Lane where there were 33 cases throughout the year. 21.7% of the cases among the children attending Wembley schools belonged to Oliver Goldsmith School. Throughout the year at this school cases occurred now and again just when it had been hoped that the trouble had passed over. For example, in weekly periods the incidence was as follows 1, 0, 1, 1, 3, 0, 1, 0, 0, 0, 0, 0, 0, 1, 2, 0, 1, 3, 2, 1, 3, 3, 0, 1, 0, 2, 2, 0, 0, 0, 1, 0, 0, 0, 1, 0, 1, 2, 5, 1, 4, 1, 1, 1, 1, 4, 5, 2, 1, 1, 0, 0. This "slow tempo" is a striking feature of the epidemiology of scarlet fever and goes to show that the infection is disseminated by contact which must be relatively intimate or frequently repeated (Hobson: Medical Practice in Residential School, 1938). In order to see whether one definite type of streptococcus was causing the trouble, a representative number of nose and throat swabs were examined at the Ministry of Health laboratory through the co-operation of Dr. Thomas, Medical Superintendent of the Joint Isolation Hospital. The results of this special examination (typing), however, went to show that more than one type of streptococcus was present while, at the second swabbing of the same children, the type had sometimes changed, no doubt due to new and still more recent infections. The Divisional Education Officer supplied the return of attendances throughout the year at the school and at Fryent and Roe Green schools in the same neighbourhood, but it has been impossible statistically to come to a conclusion as to a likelihood of more absences from Oliver Goldsmith school being due to streptococcal illnesses than from these other schools in the northern area. Intensive search for missed cases was made continually, particular attention being paid to those classes in which there were the greater numbers of cases. For example, one child was admitted to hospital for the removal of tonsils and adenoids. A member of the staff had had scarlet fever in 1937, and when the throat was examined bacteriologically along with all 101 leagues, the swab gave practically a pure culture of streptococci showing B.Haemolysis and other characteristics compatible with Group A streptococci. The officer was advised to have the tonsils enucleated and remained away from school until the throat flora became normal. In another class, a child had a tonsil and adenoid operation. None of the children in the classes were found to be suffering from otorrhoea—a recognised possibility in the cause of the spread of scarlet fever. During the first and second quarters of 1939, only 7 and 4 cases respectively of scarlet fever have occurred at Oliver Goldsmith school, so that perhaps the "epidemic constitution" has spent itself. "The classical clinical picture of this disease is now generally accepted as a syndrome, the 'scarlet' feature of which, an erythematous rash, is only pathognomonic in a strictly limited sense. The 'scarlet' erythematous rash is a clinical feature which distinguishes an infection by Streptococcus pyogenes, in a proportion of individuals so infected. An erythematous rash may be present or absent in diseased states strictly comparable in all particulars and due to an infection by the same strain of S. Pyogenes, and its appearance depends not upon the portal of entry of the infection organism, but upon the susceptibility of the infected individual to an erythrogenic toxin, and the quantity of this toxin liberated by the organism. Its appearance is no guide as to the toxicity, infectivity, or liability to complications in any given case of infection. 'Scarlet fever' is a term so particular in its application, yet so general in its association with a multiplicity of diseased states, that its retention in clinical nomenclature leads to much confusion of thought and action." (Hobson). The experience at Oliver Goldsmith school has given cause for much interesting speculation, but an easy explanation of the circumstances has not been found. Perhaps those who carry in their throats the germs of scarlet fever are on occasion more numerous than is generally considered, or perhaps a small number of people who carry the germs carry them on occasion much longer than is generally considered. In this latter regard, a case during the year came under notice which seemed to suggest that a child who had been very strictly and conscientiously isolated at home for 57 days, infected her sister 21 days after release (a usual working rule for the liberation of cases of scarlet fever from isolation is, at the longest, 28 days). 102 DIPHTHERIA. During the year there were 82 cases of diphtheria, with 3 •deaths. The monthly incidence of diphtheria during 1938 was as follows :— January—8 cases, February—7, March—8, April —7, May—2, June—5, July—5, August—7, September—14, October—5, November—1, December—11, Total—82 cases. A remarkable change has been occurring throughout the Country in the age groups affected by diphtheria. In Wembley the age group 5-10 gave the largest number of cases (36), while in children between the ages of 2-5 years there were only 12 cases. It would appear that in consequence of the family unit becoming smaller, the children in the lower social grades are not now subjected to the same intensity of exposure in their pre-school life. An intensive examination of the subject shows that the lower social grades are now tending to have less suffering from diphtheria at the more tender ages as have done for a longer period those living in residential districts. The result has been that more children are tending to contract diphtheria during school life (Journal of Hygiene—March 1939). With regard to Wembley, it is to be pointed out that its population has the benefit of living in a residential district, while too, it must be benefiting from the general rise of the standard of living. Diphtheria Immunisation. Diphtheria Immunisation continues to be accepted but poorly. The numbers of children submitted to prophylactic treatment, however, increased as a result of a simple pamphlet setting out the advantages of the treatment, being distributed with the rate demand notices of the Council. The numbers treated since the inauguration of the scheme in 1935 are as follows: — Numbers Treated by Immunising Injections in Age Groups. Year 0-5 5-10 10-15 Over 15 Totals 1935 35 69 19 3 126 1936 108 178 36 5 327 1937 129 174 36 3 342 1938 207 241 58 4 510 Totals 479 662 149 15 1305 The number of children under 5 years of age who have received this treatment is small. 103 A pamphlet in the following terms has been distributed from the Public Health Department as often as opportunity occurs. "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 district. All children over one year of age should be protected from diphtheria by these injections. The Borough Council have arranged that this treatment may be given free by the family doctor to children over one year of age of families within the economic scale of the National Health Insurance Acts, (Incomes of £250 per annum or under). You are advised to consult your Doctor about the value of obtaining this protection from diphtheria, and how it may be obtained. The Borough Council's Public Health Officers will also give all information concerning the scheme and its value. The injection-treatment is quite simple and painless." Enteric Fever. Four cases of enteric fever occurred during the year. All the cases were removed to hospital. Two were removed to Hendon Isolation Hospital, one to the Hospital of St. John and St. Elizabeth and one to Wembley Hospital. There were no deaths. Puerperal Pyrexia. 26 cases were notified, but of these 7 had occurred at Willesden Maternity Hospital amongst Willesden residents. Reference has already been made to the Wembley cases on page 48. Pneumonia. Pneumonia was notified concerning the illness of 74 persons. During 1938 pneumonia (all forms) accounted for the deaths of 44 persons, while influenza was the cause of 7 other deaths. These figures show very distinctly the lesser incidence during the year of influenza, the deaths from pneumonia and influenza in 1937 having been 55 and 36 respectively. Erysipelas. 25 cases of erysipelas occurred, of which 15 were nursed at home. Of the 10 cases treated in hospital 6 were accommodated at Redhill County Hospital, 1 at Western L.C.C. Hospital, 1 at Watford Hospital and 2 at Acton and Wembley Isolation Hospital. 104 Ophthalmia Neonatorum. Seven cases were notified during the year. Two infants were removed to St. Margaret's Hospital, one to St. Mary's Hospital, one to the Royal London Ophthalmic Hospital, one to the Middlesex Hospital and two were nursed at home. In the five cases which can now be traced the vision was unimpaired— two cases having removed from the district. Anterior Poliomyelitis. Eight cases occurred in the 12 months—7 being removed to hospital. Some anxiety was caused by two cases quickly following one another on the opposite sides of the same street, while in the same district another case occurred, although it was impossible definitely to prove contact with the first two cases and the third. Although, as the name suggests, this disease is more common amongst children, it may occur in adults. The disease has a well marked seasonal prevalence in the Autumn, but isolated cases, and small outbreaks may occur in the winter time. The first symptoms may be headache, rise of temperature., sore throat, tonsillitis or a catarrhal cold. Sometimes the patient may have seemed to become quite well again and, perhaps, has been allowed to go about, but some muscle weakness may then show itself. If there be any such cases in the neighbourhood the family doctor should always be called to see any suspicious illness however simple it may appear. The cases require skilled nursing and for this reason alone are generally best admitted to hospital. PRECAUTIONS. The disease is an infectious one, and nose and throat secretions, urine and the excreta may spread it. Appropriate disinfecting treatment of clothing, handkerchiefs, eating and drinking utensils should be carried out. The patient should be isolated for about four weeks and children in the home must remain away from school for three weeks after isolation of the patient. Windows and doors of the home should be kept freely open to the sun and fresh air. While complete restriction need not be placed on adult members of the household, provided they remain well, the family should avoid gatherings of people, and visitors to the house should be discouraged for two or three weeks. The children should play in the open in a space away from other children. The family should gargle with a weak solution of permanganate of potash. 105 Any members of the infected household who appear to have a cold should remain isolated and be seen immediately by the family doctor. This disease is infectious, and while many are infected, few actually succumb to the invasion. The carrier condition is much more responsible for the spread of infection than is a patient himself while too it must be realised that the presence of these carriers helps in the formation of a protective immunity amongst the general population. There is no justification for alarmist action on the outbreak of a case in a district. While it be possible that the occurrence of one or two cases may be the beginning of an explosive epidemic, the probability in England is against it. But, of course, on the occurrence of the very first case, reasonable action requires to be taken by the Medical Officer of Health, and his action will be very similar regarding the first case to that which will be taken regarding individual cases which may be proved later to form part of an epidemic, Cerebro-Spinal Fever. One case of cerebro-spinal fever was notified in a female aged 10 years. The patient had been admitted to Redhill County Hospital where she died. Lymphocytic Meningitis. The following case is recorded in some detail, as both its occurrence and the action called for show the necessity for a continual lookout for the unusual case as well as of contact with other Health Departments throughout the country, even beyond this country on occasion. The medical officer of health was asked by a medical colleague to see a woman, aged 20, who had just arrived from Ireland. She was very ill, the doctor suspecting cerebro-spinal meningitis. There was present, however, a very arresting rash which had a dusky look immediately suggesting typhus fever, now a rare disease in this country. The advice of the Ministry of Health was sought and a medical officer visited the case. The differential diagnosis was decided to be typhus fever, cerebro-spinal fever or poliomyelitis, and the girl was admitted to an isolation hospital of the London County Council. Regarding cerebro-spinal fever, in due course the cerebro-spinal fluid did not indicate such a diagnosis, and, for a day or two, on clinical grounds the case was thought to be typhus fever. Again, however, the Weil Felix reaction (a reaction generally associated with typhus fever) was negative on repeated trial. The less usual virus infections were then considered. In a few days the information was obtained from a hospital in Surrey that another girl, who had been in Ireland with the Wembley patient, was ill with paralysis of both legs. Intensive examination of this latter patient revealed the disease to be "benign lymphocytic meningitis." 106 The final conclusion has been that these two cases were of this rare virus disease, in one giving the picture of myelitis and in the other of encephalitis. Regarding the occurrence of this case then, contact was made with the Ministry of Health and with the Medical Officers of Health of towns in Ireland, with various Medical Officers of Health throughout England into whose areas contacts of these girls had proceeded, with Medical Officers in charge of infectious disease hospitals who, in turn, were in co-operation with laboratory workers, while now the file in this department regarding the case has thirty letters and copies of letters attached to it. Dysentery. Fifteen cases of this disease were notified. There were no deaths. Seven were nursed at home and eight treated at hospital : — 5 — at Hendon Hospital. 1 — at Watford Hospital. 2 — at Queen Elizabeth Hospital. In 7 cases the infection was by Sonne Bacillus, in 1 other by a Salmonella. The other 7 cases were unidentified bacteriologically. Encephalitis Lethargica. Polio-Encephalitis. No notification of these diseases was received during 1938. 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 Diseases. The Head Teachers of the County Council's Schools, together with the information collected in the course of their duties by the Health Visitors and Sanitary Inspectors, are the only sources of information regarding the non-notifiable diseases. The figures obtained in this way, however, have an important relative value although the notifications may not be complete, the rise and fall of the various infections being demonstrated by the numbers thus reported to the Public Health Department. Measles. Measles tends to occur in epidemic form every alternate year. 1938 was in Wembley, as throughout the London area, a measles year. In the intervals the disease practically disappears. 107 In November, 1937, 60 cases of measles had been reported from the schools. In December the number was 37. In January, 1938, measles began to assume epidemic proportions in the Kingsbury area at Oliver Goldsmith School, and westwards in Kenton Council School and Uxendon Manor School. In February the disease showed itself in Fryent School, while, at the same time, it seemed to spread to Sudbury, and, later into March, to Barham School, whence the spread seemed to be eastwards to Park Lane, Wembley Hill and Oakington Manor, where, by April, the disease had spent itself, to the south-east to Lyon Park in March-April, disappearing southwards in March at Vicars Green School. To the above general picture there was an exception in the incidence at Preston Park School, which seemed to lag in the general spread southwards of the epidemic. Perhaps the boundaries of this district by the railways, limiting social intercourse amongst the children, may be some explanation of this. The only other exceptions occurred at Byron Court and Park Lane Schools where, in June, there were recurrences of the outbreak. Regarding the Borough as a whole, the statistics show that measles appeared in November, 1937, when it quickly assumed epidemic proportions reaching a high peak in March, gradually falling again to 11 cases in July, while in the last five months of the year only one isolated case was reported (see Table, page 109). While the disease was prevalent in the Borough for 9 months then (November, 1937—July, 1938), the incidence in the individual schools was only for short periods, generally at the. most only five to six weeks. Number of deaths 4 Cases sent to hospital 31 108 Non-Notifiable Diseases. Disease. January February March April i May June July August September October November December Measles 91 103 382 91 28 40 11 - 1 - - - Chicken Pox 94 11 51 52 62 167 19 1 8 1 2 1 Mumps 4 - 3 1 1 — 2 — 2 1 — — Whooping Cough 10 3 12 21 29 15 8 1 13 — 1 7 German Measles 1 1 2 — 6 39 13 — 1 — 1 — Scabies 2 — 1 2 — — — — — 1 1 — Impetigo — 2 3 1 1 2 — — 2 2 1 — Conjunctivitis — — 1 — — — — — — — — — Ringworm — - - - - - - - - - - - 109 ISOLATION HOSPITAL ACCOMMODATION. On the 13th April the Joint Committee of the Isolation Hospital of the Borough Councils of Acton and Wembley, met for the first time. The following report was presented in May to the Joint Committee by the Medical Officers of Health of the two Boroughs : — 1. "The greatest need and the most immediate want of the hospital is more single unit isolation places. There are now no such individual cubicles or cells. The single beds available are the side wards off wards 2, 3, and 4; these were not intended as cubicle wards, and their more appropriate use is to obtain quietness and nursing for any serious cases that require individual attention. The scheme approved by the Ministry of Health mentions that there should be at the hospital not less than 115 beds, of which not less than 40 shall be in cubicles. These cubicles cannot be satisfactorily obtained by any extension or adaptation of the present wards; additional new building will have to be considered. The question of whether or not the whole of the 40 beds should be provided in one pavilion is a matter for future discussion when the plans are considered. 2. An operation unit for the hospital is necessary. 3. Administrative Block and Nurses' Quarters. As the members of the Committee are aware, in addition to the building in the grounds of the hospital, there are two other buildings utilised to house the staff. The present building is not only insufficient, but inconvenient and unsatisfactory, and no adaptation will render it satisfactory as an up-to-date administrative block. A new building will have to be erected, which will meet not only present requirements, but future extensions, always keeping in view the growing recognition of the need for better accommodation for the hospital staff—nursing and domestic. 4. A resident medical officer is recognised as a necessity as soon as possible, and appropriate residential quarters for him will have to be provided. 5. A porter's lodge is necessary. We are of opinion that the Committee should firstly consider the advisability of appointing an architect who has had experience in the lay-out of isolation hospital buildings, so that the best use of the site may be made having regard to the new buildings necessary, and the possibilities of appropriate adaptation of the present wards to their best uses in the completed hospital." 110 Regarding a Resident Medical Officer, the Medical Officer of Health of Wembley presented in July a report to the Joint Committee. The population of the Boroughs of Acton and Wembley, according to the Registrar General's estimate Midsummer, 1937, was—Acton 69,100, Wembley 114,700—total population 183,000. The hospital had then 82 beds. For the hospital to serve such a large area, it must be ready at all times to receive the acutely ill, and there must be times when the number of acutely ill cases is such that the responsibilities and duties can only properly be undertaken by a Medical Officer. As long as there be no resident Medical Officer, there must be certain delegation of responsibilities to the Matron who, of course, is not medically trained. A resident Medical Officer's primary duty would be the medical care of the patients in the Hospital, as well as being responsible for the Hospital's general supervision. The ultimate capacity of the Hospital is to be a minimum of 115 beds (not less than 40 of which beds are to be in cubicles). That is to say, the Hospital will be ready, as it should be, to admit a wide range of cases suffering from various infections, or potential infections, making it inappropriate for them to be admitted to a General Hospital. The resident Medical Officer, then, should be one of some experience and standing, in the profession, and who should be directly responsible to the Joint Committee for the clinical supervision of the patients, as well as for the general control of the hospital. For such an officer as Resident Medical Superintendent a suitable house in or very near the hospital grounds, should be considered along with the imminent enlargement of the hospital. A junior Resident Medical Officer, working under the responsibility of the Medical Superintendent (the Medical Officer of Health for Acton) commenced duty on 1st February, 1939. The following cases were admitted to the hospital : — Scarlet Fever 296 Diphtheria 72 Measles 22 Erysipelas 2 Chickenpox 2 Whooping Cough 2 Diphtheria observations 9 Encephalitis 1 Impetigo 2 111 The number of cases of the infectious diseases which has to be reported as having found accommodation in the hospitals of adjacent Local Authorities is itself proof of the inadequacy of the present accommodation at the hospital. Agreement has now been reached between the two Borough Councils that the Joint Committee shall be responsible for finding accommodation for infectious diseases either at its own hospital or in neighbouring hospitals, except for small-pox, puerperal pyrexia, ophthalmia neonatorum and poliomyelitis (infantile paralysis). The hospitalisation for small-pox is the responsibility of the County Council, while the Borough Council have made arrangements as follows : — Regarding puerperal pyrexia— admission to Queen Charlotte's Isolation Hospital. Regarding ophthalmia neonatorum— admission to St. Margaret's L.C.C. Hospital. Regarding poliomyelitis— admission to the Royal National Orthopaedic Hospital, Stanmore. At the time of writing the Joint Committee is actively engaged in the consideration of new accommodation at the hospital. SUPPLY OF ANTI-TOXIN. The following stock is kept continually replenished at the Public Health Department : — Diphtheria, Tetanus (Globulins), Scarlatina. Meningococcus, Streptococcus (Polyvalent). In addition stock is kept at the Fire Station, St. John's Road, as follows : — Diphtheria, Tetanus (Globulins), Scarlatina. All issues of serum, etc., given to medical practitioners are entered, with the details, on a form so that the material issued, its quantity and serial number, can be checked at any time. In addition, diphtheria prophylactic and the fluid for Schicktest are issued to the local medical profession on request. Regarding diphtheria immunisation, the prophylactics approved are: — (1) Alum Precipitated Toxoid—two doses. (2) Toxoid Anti-Toxin Floccules—three doses. (3) Toxoid Anti-Toxin Mixture—three doses. All the above are supplied free of charge to the local medical profession. 112 TUBERCULOSIS. During 1938, 138 new cases of tuberculosis were notified. 116 of pulmonary tuberculosis, and 22 non-pulmonary. 121 cases were removed from the register during the 12 months, and at the 31st December, 592 names remained on the register, 493 of which were pulmonary and and 99 non-pulmonary. The institutional treatment of tuberculosis is the responsibility of the Middlesex County Council. 145 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. 113 New Cases and Mortality During 1938. Age Periods. New Cases Pulmonary Non-Pulmonary M. F. M. F. Under 1 year - - - - 1 to 4 years - 1 2 1 5 to 14 years 3 4 4 5 15 to 24 years 19 25 5 6 25 to 34 years 30 30 2 4 35 to 44 years 16 8 4 1 45 to 54 years 13 3 — 2 55 to 64 years 3 1 — — 65 years and over 3 1 1 - Total 87 73 18 19 Age Periods. Deaths Pulmonary Non-Pulmonary M. F. M. F. Under 1 year - - - - 1 to 4 years - — 1 — 5 to 14 years 1 — 1 2 15 to 24 years 6 5 1 1 25 to 34 years 3 5 1 — 35 to 44 years 5 3 1 1 45 to 54 years 5 1 — — 55 to 64 years 3 — 1 — 65 years and over 2 - - - Total 25 14 6 4 114 The Death Rate from tuberculosis was 0.413 per 1,000 population, the comparative figure for England and Wales in 1937 being .695. 49 deaths from tuberculosis were registered during the year. 17 of these had not been notified as suffering from tuberculosis during life (34.69 per cent). 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 1938. DISINFECTION OF PREMISES AND ARTICLES. During the year 846 disinfections were carried out after : — Infectious Diseases 602 Cancer 21 Miscellaneous 79 Vermin 9 Tuberculosis 135 Number of Articles Disinfected or Destroyed. Articles. Disinfected. Destroyed. Beds 147 17 Bolsters 381 9 Blankets 1540 11 Carpets — — Counterpanes 639 4 Covers 27 1 Curtains 8 — Cushions 194 14 Mattresses 798 30 Palliases 7 1 Pillows 1575 25 Rugs and Mats 61 — Sheets 1016 4 Wearing Apparel 378 10 Sundries 320 13 Bundles of Washing 76 — TOTAL 7167 139 115 Section G Information to the Local Medical Profession — Nursery Schools & Nursery Classes — Insurance against mistakes in Diagnosis— Refuse Disposal Works — The National Emergency — Library Books and Notifiable Diseases — Treloar Christmas Hamper Fund — Local Government and Other Officers Superannuation Art, 1922—Middlesex County Council (General Powers) Act, 1938. 117 INFORMATION TO THE LOCAL MEDICAL PROFESSION. 14th February—Maternity Services. A circular letter regarding Emergency Units (Flying Squads). For cases of grave obstetric abnormality in which removal to hospital seems undesirable (for example, certain cases of shock, haemorrhage or eclampsia), the Town Council have decided that in addition to the arrangement whereby the Private Medical Practitioner may call upon the services of the Consultant Obstetrician, he may, at the same time, call upon the services of a nurse from the Wembley or Kingsbury District Nursing Association— which ever be the more appropriate geographically. Details as to names and addresses and telephone numbers were given in the letter. 24th February— Diphtheria Immunisation. A letter giving the incidence of diphtheria in Wembley since 1935, together with the public's response to the Council's immunisation scheme. The comments of the medical profession were asked for upon certain points likely to cause an increase in the number of children receiving immunisation treatment. An opinion was also asked regarding the usefulness of a local Bulletin re infectious diseases. 2nd May—Local Bulletin. On the first Monday of each month since 2nd May, the statistics of all notifiable diseases in the Borough in weekly periods have been circulated, with in addition the incidence of these in the schools along with the non-notifiable infectious diseases reported to the Medical Officer of Health by the head teachers. 23rd May— Diphtheria Immunisation. A letter enclosing the Borough Council's amended scheme regarding diphtheria immunisation. 13th August— Poliomyelitis. A letter regarding the first case in the Borough of anterior poliomyelitis, stating that in an early case of doubtful diagnosis the Medical Officer of Health was allowed by the Borough Council to arrange for a consultant neurologist to see the case. 25th November— Public Health Services. A pamphlet as set out below was circulated to all medical practitioners practising in the Borough : — The following is tabulated for easy reference, the services enumerated being mentioned in more detail in M.O.H. Annual Reports (e.g. for 1937 circulated July, 1938). The information may be supplemented on application at the Public Health Department. 118 AMBULANCE: (a) Non-Infectious—under administration of Chief Officer of Fire Brigade. Journey not to be more than 15 miles in one direction beyond Wembley's boundary. Apart from accidents or sudden illnesses, medical certificate required that patient not in a fit state to travel in a vehicle other than an ambulance. A nurse is not provided. Address—Fire Station, St. John's Road. Telephone: Wembley 0100 or Arnold 2222. (b) Infectious—provided by Acton and Wembley Joint Hospital Committee, address, Isolation Hospital, Wales Farm Road, Acton. Telephone: Acorn 4231, or apply Public Health Department. ANTE-NATAL—See under Maternity Services. ANTI-TOXINS SUPPLIED—Anti-Diphtheria, Anti-Streptococcal and Anti-Tetanus serum available during office hours at Public Health Department, at at other times at Fire Station, St. John's Road. Telephone: Wembley 0100 or Arnold 2222. BIRTH CONTROL (Contraception)— A special session for married women in whom are medical reasons against pregnancy, held twice monthly. For place and time of session apply Public Health Department. (Times liable to change). BIRTHS— All births, live and still, must be notified to M.O.H. within 36 hours by medical practitioner in attendance at or within 6 hours of birth. Relevant stamped post-cards available from Public Health Department. CONFINEMENT AND LYING-IN— See under Hospitals, Laboratory Services and Maternity Services. DIPHTHERIA IMMUNISATION— For families within economic scale of N.H.I. Acts, Council supply fluids to and pay family doctor 10/- for course and 3/6d. for post-Schick test. For families beyond the N.H.I, scale fluids supplied free to doctors but no fee for medical service. For fluids and relevant cards apply Public Health Department. (Scheme circulated 23rd May, 1938). DISINFECTION. Cards supplied for communicating with Public Health Department when this service required re infectious diseases. Clothing, etc. infected with ringworm, scabies, etc. or infested, disinfected on request of medical attendant. Apply Public Health Department. HOSPITALS—(a) General— Middlesex County Council service—Redhill County Hospital, address, Redhill, Edgware, Middlesex. Telephone: Edgware 0011, and Central Middlesex Hospital, address, Acton Lane, N.W.10. Telephone Willesden 4664. (b) Special—for Puerperal Pyrexia service available at Queen Charlotte's Hospital, address, Isolation Block, Ravenscourt Square, W.6. Telephone : Riverside 6081 (Please inform 119 M.O.H. of the admission as soon as conveniently possible). For Ophthalmia Neonatorum— mother and infant may be admitted to St. Margaret's L.C.C. Hospital, address, Leighton Road, N.W.5. Telephone: Gulliver 2483. (Please inform M.O.H. of the admission as soon as conveniently possible). For Tuberculosis— Middlesex County Council service—communicate with Tuberculosis Officer, Pound Lane, Willesden, N.W.10. Telephone: Willesden 6254. For Small-Pox— see under Small Pox. Other Infectious Diseases admitted according to available accommodation to Acton and Wembley Joint Isolation Hospital, address, Wales Farm Road, Acton. Telephone : Acorn 4231 or apply Public Health Department. INFECTIOUS DISEASES— Notifiable to M.O.H. "on becoming aware"—Small-pox, Cholera, Diphtheria, Membranous Croup, Erysipelas, Scarlatina or Scarlet Fever, Typhus, Typhoid, Enteric or Relapsing Fever, Plague, Cerebrospinal Fever, Acute Poliomyelitis, Acute Encephalitis Lethargica, Acute Polioencephalitis, Ophthalmia Neonatorum, Puerperal Pyrexia, Malaria, Dysentery (including amoebic and bacillary) Acute Primary Pneumonia and Acute Influenzal Pneumonia, Tuberculosis all forms. N.B. Ophthalmia Neonatorum means "a purulent discharge from the eyes of an infant, commencing within 21 days of the date of its birth." Puerperal Pyrexia means "any febrile condition occurring in a woman within 21 days after child-birth or miscarriage, in which a temperature of 100.4 degrees F. or more has been sustained during a period of 24 hours or has recurred during that period." Since Public Health Act, 1936, Puerperal Pyrexia includes cases clinically recognised as Puerperal Fever. Re. Small-Pox see under Small-Pox. For any further information re infectious diseases apply Public Health Department. M.O.H. has authority to call consultant neurologist to aid in diagnosis of epidemic nervous disease (e.g. Cerebrospinal Fever, Acute Poliomyelitis, Encephalitis Lethargica). See also under Disinfection, Hospitals and Laboratory Services. For Books of forms of notification (special book for Puerperal Pyrexia) apply Public Health Department. LABORATORY SERVICES— Swabs for Diphtheria, Streptococci, Vincent's Angina, Sputum for Tubercle, blood for agglutination (e.g. Typhoid Group, Bacillus Abortus) faeces and urine (e.g. Typhoid, Dysentery, etc.) examination for meningococcus, films for Ophthalmia— service provided at Clinical Research Laboratories, address, Watergate House, York Buildings, W.C.2. Telephone: Temple Bar 8993. Re Puerperal Pyrexia— special service arranged for examination of swabs (e.g. from nose, throat, vagina and cervix) from patient or from contacts, for haemolytic streptococci and grouping of the 120 streptococci at Queen Charlotte's Hospital, address, Ravenscourt Square, W.6. Telephone: Riverside 6081. Swabs, sputum containers, etc. for all of above available at Public Health Department. MATERNITY SERVICES— Ante-Natal— Council's consultant obstetrician may be called by private practitioner in a case of doubt or difficulty during ante-natal period if patient too ill to attend a hospital. Communicate direct with Dr. J. W. Rait Bell, address, "Old Court," Hanger Lane, Ealing, W.5. Telephone: Perivale 1500. (Please inform M.O.H. as soon as conveniently possible). Confinement & Lying-in—Dr. Bell may be called in by the family doctor. Communicate direct with Dr. Bell, address and telephone number as above. (Please inform M.O.H. as soon as conveniently possible). In any case of grave emergency for whom removal to hospital seems undesirable, e.g. shock, eclampsia or haemorrhage, a nurse is also available by the doctor applying direct to the Wembley or Kingsbury District Nursing Association, addresses— Wembley— 80 Wembley Park Drive. Telephone: Wembley 4913. Kingsbury— 77 Boycroft Avenue, N.W.9. Telephone: Colindale 6445. (Please inform M.O.H. as soon as conveniently possible). Re. any Puerperal infection see in addition under Laboratory Services, Hospitals and Infectious Diseases. NERVOUS DISEASES— re. epidemic nervous diseases, e.g. Cerebrospinal Fever, Acute Poliomyelitis, Encephalitis Lethargica— see under Infectious Diseases. NOTIFIABLE DISEASES— See under Infectious Diseases. OPHTHALMIA NEONATORUM—see under Hospitals, Infectious Diseases and Laboratory Services. PUERPERAL PYREXIA— see under Hospitals, Infectious Diseases and Laboratory Services. SMALL-POX— For Small-pox or suspicion of, please communicate at once with M.O.H. as special responsibilities fall upon him immediately. SUB-NUTRITION— For expectant or nursing mothers and for cnildren under five years not attending Education Authority school, free milk (pasteurised) and dried milk foods, cod liver oil, etc., are granted at the Council's clinics according to an economic circumstances scale. Further particulars from Public Health Department. TUBERCULOSIS— Dispensary and Sanatorium or Hospital treatment— Middlesex County Council service. Apply, Tuberculosis Officer, Dr. O. Bruce, address, Pound Lane, Willesden. Telephone : Willesden 6254. Dispensary sessions— Monday, 121 Tuesday, Thursday— 10.0 a.m. Friday—2.0 p.m. On the first Tuesday in every month patients seen at 6.0 p.m. See Laboratory Services for examination of sputum. Sputum flasks granted free to necessitous cases having domiciliary treatment. Apply —Public Health Department. VENEREAL DISEASES— Applications for outfits for taking samples of blood, etc. and specimens for examination should be addressed to the Pathologist at the hospitals at which clinics are available for the free treatment of patients. Specimens to be submitted to the Pathologist who will send a report to the medical practitioner. For list of hospitals, and any other information, apply County Medical Officer, 10 Great George Street, Westminster, S.W.I. Telephone : Whitehall 4400. VOLUNTARY HOSPITALS— EMERGENCY BED SERVICE. Of course, this is not a public health Local Authority Service, but is referred to for your convenience : — "Doctors will assist by giving the information required in the following order : — 1. Doctor's Name. 2. Address. 3. Telephone No. 4. Patient's Name. 5. Address. 6. Age. 7. Sex. 8. Diagnosis. 9. Hospital Preferred. 10. If Ambulance Required. 10 Old Jewry, E.C.2. Telephone: Metropolitan 8781." April— Nursery Schools and Nursery Classes. A report was asked for on the above subject : — Confusion is apt to occur as to the scope and endeavour of Nursery Schools and Nursery Classes, unless their differences be clearly appreciated : — (a) Nursery schools have as their primary object the physical and medical nurture of debilitated children and those living under unsatisfactory home conditions. (b) This is obtained by a longer school day, usually 8.30 a.m. or 9.0 a.m. to 4.30 p.m., with no midday break, which avoids the risk of wet feet twice in one day in bad weather and the fatigue of the double journey. The hours of opening of a nursery class on the other hand, conform to those of a public elementary school. (c) Medical inspection is generally more frequent in a nursery school and arrangements for medical treatment more thorough and complete. (d) A midday dinner with a carefully selected dietary is an important feature of a nursery school day. In a nursery class the children usually go home to the midday meal. 122 (e) As a rule a nursery school is a detached unit, often being a structure of a semi-permanent character, by which economy is frequently obtained. A nursery class forms part of an infants' department and follows the lines of the architectural design of the department. (f) Nursery schools provide for children from 2-5 years whereas in nursery classes the age of admission is usually 3-5 years. Important results of training under suitable conditions between 2 and 3 years have been claimed by many observers. A nursery class, then, has no separate existence apart from the elementary school, while, however, its activities are based largely on play and social and sense training. The nursery class sets out to provide all-round care and training for the under-fives rather than instruction in the old sense. The following bare essentials stand out for the purpose : — (i) Adequate and suitable space, indoors and outdoors. (ii) Adequate and suitable cloakroom, lavatory and washing accommodation with hot and cold water available. (iii) The means of preparing and serving a simple midmorning lunch in a civilised way (milk lunches). (iv) Beds for use during a rest period (light, collapsible, low canvas beds with a blanket). (v) Adequate and suitable play material. It need hardly be said, then, that the R's have no place in the routine of the nursery class. Various Organisations concerned with young children under five are as follows : — (1) Infant Welfare Centres of the Local Authority under the Maternity and Child Welfare Acts. (2) Day Nurseries which may also be established under the Maternity and Child Acts, and which take charge of young children from even a month old to five years, while the mothers go out to work. Children may also be admitted when the Medical Officer of Health certifies the home conditions to be insanitary or unsatisfactory. (3) Clinics for Toddlers— as now provided by the Council. (4) Nursery Schools and Nursery Classes— provided under the Education Act by a Local Education Authority. The medical supervision given at the clinics cannot be considered inferior to the medical supervision given, say, in nursery schools or nursery classes; although, of course, for the debilitated child attending a nursery school the environment is suitably tempered, and the skilled supervision of the trained nursery teacher is not available for the child attending a toddlers' •clinic. 123 The Ministry of Health has stressed the importance of the home visits by Health Visitors, and an increase in this home visitation has been taking place in Wembley. Visits paid during the year to children between the ages of one and five have been —1935—3,572, 1936—5,700, 1937—6,745, 1938—6,935. It was considered that there was little evidence which could be passed to the Council pointing to any immediate necessity for the provision of nursery schools for debilitated children. As regards nursery classes, however, it was considered the case was entirely different. These nursery classes are very much in parallel with toddlers' clinics, in the endeavour to keep toddlers always healthy in bodily and mental development, and to anyone who has visited the Middlesex County Council school at Vicars Green, there can be no doubt about the good work of these nursery classes. In this regard, it is considered that the experiment being made at Vicars Green is a public health one of great importance. April—Insurance Against Mistakes in Diagnosis of Medical Officers. The Borough Council have insured by a policy which provides to indemnify the Council against all sums including law costs which the Council shall legally be liable to pay as compensation for damages following a wrongful diagnosis of a notifiable infectious disease or diseases, made for, or on behalf of the Council by their Medical Officer of Health or any Assistant Medical Officer of Health for the time being, or for any failure to diagnose any notifiable infectious disease by their Medical Officer of Health or Assistant Medical Officer of Health. The Council have also a policy which indemnifies the Council against all sums which they shall become legally liable to pay as compensation for (a) bodily injury or illness, fatal or otherwise, to any person other than persons in the employ of the Council, and (b) damage caused to property, other than property belonging to the Council. The indemnity given by the policy extends to protect the individual officers or other employees and the honorary or voluntary staff of the Council whilst engaged on the Council's business at the clinics. June—Rejuse Disposal Works. A report was asked for regarding working conditions at the Refuse Disposal Works. From the facts elicited regarding absences from duty no conclusion could be arrived at with regard to any effect on the health of men of the work performed by them. 124 A search of the literature was made by the Staff of the London School of Hygiene through the courtesy of Professor Sir Wilson Jameson, and it had to be admitted that no article could be found dealing specifically with the effect upon the health of workers in refuse destructors, at any rate, no statistics were available. Odours can be eliminated by heating all gases to a high temperature. Firemen can be relieved of the intense heat by the installation of ventilating fans. Some articles have mentioned that dust and grime associated with the occupations of stokers may produce some form of eczema of the ear; while as regards putrefactive odours some authorities say their effect upon resistence to disease is still unproven, but state that such gases may exert an effect upon the appetite. Another writer has stated that he could demonstrate no dust hazard resulting in sickness. Attention was drawn—(1) to the fine dust in the various parts of the Works; (2) to the ventilation of and the dust and heat accumulating in the incinerator house and clinker floor, and (3) the poor footwear of the men in certain parts of the Works. In due course all these points received the consideration of the Public Cleansing Committee. September—The National Emergency. A report was submitted on the action taken in Wembley regarding the casualty services. This dealt with general principles as to the important pivotal duty of the First Aid Posts and the necessity of a doctor and a trained nurse being present, if possible. The lay-out of the posts as adopted was described, along with the details of the personnel—doctors, trained nurses and other trained persons and the medical supplies. October—Library Books and Notifiable Diseases. On request the provisions dealing with notifiable diseases as to library books were circulated to all libraries within the Borough, as follows:— The Public Health Act, 1936, Section 155, is as follows:— (1) A person who knows that he is suffering from a notifiable disease shall not take any book, or cause any book to be taken for his use, or use any book taken, from any public or circulating library. (2) A person shall not permit any book which has been taken from a public or circulating library, and is under his control, to be used by any person whom he knows to be suffering from a notifiable disease. 125 (3) A person shall not return to any public or circulating library a book which he knows to have been exposed to infection from a notifiable disease, or permit any such book which is under his control to be so returned, but shall give notice to the local authority or, in the case of a library provided by a County Council, to that Council, that the book has been exposed to infection. (4) A person who contravenes any of the foregoing provisions of this section shall be liable to a fine not exceeding five pounds. (5) A local authority or, as the case may be, a county cil on receiving such a notice as aforesaid shall cause the book to be disinfected and returned to the library, or shall cause it to be destroyed. Advice when required regarding the above Section will be given at the Public Health Department. . December—Treloar Christmas Hamper Fund. The Mayoress distributed on Christmas Eve twelve hampers which had been allocated by the Treloar Crippled Children's Christmas Hamper Fund. Children considered suitable recipients for these gifts were revealed through the kind co-operation of a number of Wembley residents interested in the various charity organisations as well as from the information obtained in their duties by the officers of the public health department. LOCAL GOVERNMENT AND OTHER OFFICERS SUPERANNUATION ACT, 1922. During the year 125 examinations were made by the Medical Officer of Health of persons about to be appointed to the permanent staff of the Council. The Council have adopted the principle that with regard to his medical report as respects the admission of officers or employees into the Council's Superannuation Scheme, the Medical Officer of Health must be satisfied that an officer or employee, upon examination, is a first class life, having due regard to the duties which the officer or employee will be called upon to perform. In addition 46 examinations were made of candidates for recruitment in the Auxiliary Fire Service. 126 MIDDLESEX COUNTY COUNCIL (GENERAL POWERS) ACT, 1938. Sections relating to Public Health Department. Section 54—Power to order alteration of chimneys. Section 55—Further provisions as to working-class houses. Section 57—Sanitary conveniences used in common. Section 59—Information to be furnished in case of notifiable disease. Section 60—Parents, etc. to notify certain diseases. Section 61—Restrictions on attendance at schools and places of assembly. Section 62—Power to close schools and exclude children from entertainments. Section 63—Compensation to persons for ceasing employment to prevent spread of disease. Section 64—Removal of infirm and diseased persons in certain cases. Section 65—Entry into premises in case of disease. Section 66—Byelaws as to lodging-houses. Section 67—Sanitary conveniences for workmen engaged on buildings. Section 68—Discontinuance of offensive trade. Section 69—Byelaws as to stables. Section 70—Notice of slaughter of animals unfit for human food. Section 71—Registration of Hawkers of meat, fish, fruit and vegetables and premises. Section 72—Power to prohibit persons in advanced state of tuberculosis from selling, etc. food. Section 73—As to appeals. Section 106-Noise nuisance. Section 107-Byelaws as to pleasure fairs. Section 113-Supply of antidotes against notifiable disease. Section 124-Recovery of expenses from out-patiencs. 127 INDEX Page Ambulance facilities 24 Anterior poliomyelitis 105, 106 Anti-toxins, supply of 112 Artificial Cream Act, 1929 93 Artificial sunlight and massage 42 Assessments 9 Bakehouses 92 Bed bugs, eradication of 73, 74, 75 Births 11, 12, 44, 45, 46 Byelaws and Regulations 77, 78 Camping sites, tents, vans and sheds 63 Carcases inspected and condemned 91 Cerebro-spinal fever 106 Clinics, ante-natal 33, 34, 35, 36 ,, birth control 36, 37 ,, dental 38, 39, 40 ,, gynaecological 36 ,, infant welfare 31, 32, 33 ,, post natal 36 „ toddlers' 32 Clinic services 27, 28, 29, 30, 31 Closet accommodation 57 Committees, constitution of 2 Convalescent home treatment 42 County Council clinics 40 Cowsheds 89 Dairies and milk shops 90 Deaths 11, 12 Deaths, age periods 16 Deaths, causes of 13, 14, 15 Diphtheria 103 Diphtheria immunisation 103, 104 Disinfection of premises and articles 115 Domiciliary midwives service 46, 47 Drainage and sewerage 55 Dust 66 Dwelling houses, inspection of 80, 81 Dysentery 107 129 Page Encephalitis lethargica 107 Enteric fever 104 Erysipelas 104 Eye examination of children under 5 years 32 Factories Act, 1937 68, 69, 70, 71, 72 Food and Drugs Act, 1938 86, 87, 88 Food and Drugs (Adulteration) Act, 1928 93 Food, chemical and bacteriological examination of 93 Food poisoning 94 Food premises, other 92 Food, unsound surrendered and destroyed 92, 93 Hairdressers 67 Health visitors 47 Home helps 43 Hospitals 40 Industries 8 Infant Life Protection 49 Infantile mortality 11, 17, 18 Infectious diseases, control 96, 97, 98, 99, 100 Infectious diseases, non-notifiable 107, 108, 109 Information to the Local Medical Profession 118, 119, 120, 121, 122 Insurance against mistakes in diagnosis of Medical Officers 124 Isolation hospital accommodation 110, 111, 112 * Laboratory facilities 22, 23, 24 Library books and notifiable diseases 125, 126 Local Government and Other Officers Superannuation Act, 1922 126 Lymphocytic meningitis 106, 107 Marriages . 19 Massage and special treatment, establishments for 67 Maternal mortality 11, 19 Maternity hospital accommodation 43 Maternity outfits 42 Measles 107, 108 Meat shops, stalls, etc. 91 Middlesex County Council (General Powers) Act, 1938 127 Milk 41 Milk and Dairies (Consolidation) Act, 1915 90 Milk (Special Designations) Orders, 1936/1938 89 Mortuary 76 130 Page National emergency 125 New houses 82 Noise 64, 65, 66 Nuisances abated and improvements effected 60, 61, 62, 63 Nursery schools and nursery classes 122, 123, 124 Nursing in the home 24,25, 26, 27 Nutrition 41 Offensive trades 64 Offices 72 Open spaces 9 Ophthalmia neonatorum 105 Overcrowding 81 Piggeries 64 Pneumonia 104 Polio—encephalitis 107 Public Cleansing 58 Public Health Act, 1925, Section 62 115 Public Health Act, 1936, Section 172 115 Public Health (Condensed Milk) Regulations, 1923 and 1927 93 Public Health (Dried Milk) Regulations, 1923 and 1927 93 Public Health (Preservatives, etc., in food) Regulations, 1925-1927 93 Public Health (Prevention of Tuberculosis) Regulations, 1925 115 Puerperal pyrexia 47, 48 Rag Flock Acts, 1911 and 1928 64 Rainfall 10 Rats and Mice Destruction Act, 1919 67 Refuse disposal works 124, 125 Rivers and streams 56 Sanitary inspection of district 59, 60 Scarlet fever 100 Scarlet fever, Oliver Goldsmith School 101, 102 Schools 75, 76 Shellfish 94 Shops Act, 1934, Section 10 68 Slaughterhouses 91 Small-pox 107 Smoke abatement 73 Staff 3, 4 Still births 11, 49 Swimming bath and pools 73 131 Page Treloar Christmas hamper fund 126 Tuberculosis, dispensary 40 „ , mortality and new cases 15, 113, 114, 115 „ , provision of houses for tuberculous persons 82, 83 Tuberculosis Order, 1925 90 Unemployment 8, 9 Venereal diseases 40 Vital statistics 11, 12 Voluntary workers 31 Water 52, 53, 54 132