WEM 20 BOROUGH OF WEMBLEY. INTERIM REPORT of the MEDICAL OFFICER OF HEALTH FOR THE YEAR 1939 A. G. MORISON, M. A., M. D., D.P.H., Medical Officer of Health. BOROUGH OF WEMBLEY. INTERIM REPORT of the MEDICAL OFFICER OF HEALTH « for the Year 1939 To the mayor Aldermen and Councillors of the Borough. Ladies and Gentlemen, I beg to present an interim Report on the Health service for the year 1939. In accordance with the Ministry of health Circular 2067 this Report is much curtailed reference being made only to any special matter which may have arisen during the year. The statistics submitted are limited while, however, the usual tables are being kept up-to-date in the Department as far possible and in due course a report will be made dealing more fully with the period from the beginning of 1939 to the end of the last complete year after the war. The report for 1938 was a statement showing in come details the recent development of the Public Health service along modern lines not unworthy of the Borough's general phenomenal growth and advancement. That Report may be taken having given a complete survey of the position to the end of 1938. The war: while, of course, Public Health endeavour has at been allowed to lapse during 1939, undoubtedly the energy of the department was as far as possible diverted air raid precautions throughout the whole year both before and after the declaration of war. Gradually 1. - A. R. P. has become moulded into the Department and the position now is that the A. R. P. Casualty Service has become one of the sections of the Public Health Department (general administration, infectious diseases, maternity and child welfare, food, sanitation housing and A.R.P.) A.R.P. personnel is a continually changing one. The depots and first aid posts have changed in site and arrangement from time to time while, in addition, circulars and instructions have been constant, demanding literally daily attention and adjustment. Various returns must be submitted to the scheme-making authority - (Middlesex County Council) - with regard, for example, to the six first aid posts at Stag Lane County Clinic, Preston Manor County School, Monks Pari Borough Clinic, Wembley Hospital, Imperial College Pavilion, Claremont Avenue County School, to the two mobile units and to the five ambulance and stretcher party depots. The authorised establishment for these. posts and depots is some 600 (full-time), while at the present time approximately 500 volunteers are active members of the organisation on a part-time basis. To see to the enrolment of such a personnel, their attendance registers and time sheets, their absence due to illness or injury, their transfer, their constant resignations, their training, the arrangement of lectures by doctors and members of the first aid organisations, the recruitment of nursing auxiliaries the inspection of depots and posts, keeping up-to-date the duties imposed upon and the necessary information for the Casualty Service Controllers, requisitions regarding Medical Stores and their recording, the constant dissemination of instructions to the depots and posts - such with a hundred-and-one other details cannot do other than make a constant duty for every member of the Public Health Department. Besides introducing such a completely new subject as A.R.P. the war has brought new aspects on Public Health matters in general - for example the addition 2. duties from Wembley being a "neutral" area voluntary evacuation and reception having gone on constantly, called for unusual welfare services at the clinics and domiciliary services by the Health Visitors, and the supervision of billeting accommodation, housing and sanitary matters by the Sanitary Inspectors. In accordance with instructions there has been constant co-operation of the civil, Navy, Anny and Air Force authorities and every opportunity has been taken to share and exchange all information and advice, while pamphlets have been written and distributed dealing with particular subjects as have become necessary. During the intensive national campaign to obtain blood-donors Monks Park Clinic was loaned to the central authorities as an empanelling station where volunteers were registered and blood tests taken for the grouping of donors. The thanks of the authorities Were conveyed to the Council in a letter from the Group Officer in which it was stated that sufficient promises from prospective donors covering estimated requirements had been obtained at this centre. Infectious Diseases: From time to time at the meetings of the Public Health Committee reference has been made to the very low incidence of infectious disease during the whole of 1939, particularly after the temporary disorganisation of school attendance. Tentative opinion is that these factors are not unconnected - war, disorganisation of school attendance and absence of infectious disease-but in due course, perhaps, one will be able to give some time to the consideration of this low incidence of the infectious diseases during, at any rate, the first year of the war. The rather endemic incidence of Scarlet Fever at Oliver Goldsmith school during 1937 and 1938 has quite disappeared - as was forecast in the last report, the number of cases in quarterly periods during 1939 being only 7, 4, 1, 1. 3 At the beginning of the year the following memorandum was presented to the Town Clerk and Controller and other Chief Officers of the Council"In the first place I consider that all premises in use by the various parties now engaged in A.R.P. should be continuously and efficiently ventilated, without causing draught and kept clean. They should not be overheated and the spaces between beds should never be less than three feet. The congregation of personnel round a fire or other source of heat in close company should always be avoided. The kitchens, cooking ana eating utensils should be kept scrupulously clean and the latter washed in really hot water after every meal. Attention should be given to the refuse bins always being kept covered and being removed as frequently as possible. Regarding individuals themselves, I would say that active exercise in the open air should be taken whenever possible and that there should be avoidance of using "protective clothing" except in exercises and other such duty. If the men partake of a strenuous game such as football, a good wash down with a shower afterwards should be made available. If on returning from duty clothing be wet-especially footgear-facilities for changing and drying wet clothing should be provided. A person who has a cold should be told to keep away from his fellows otherwise he is likely to spread the trouble. The fatigue almost inevitably associated with irregular hours of duty can be minimised by the men themselves making judicious use of rest periods which may be available." As the Queen Charlotte's Maternity Hospital Isolation Block at Ravenscourt Square, Hammersmith, W.6, was taken over for A.R.P. purposes immediately on the declaration of war, the Borough Council entered into an agreement with the London County 4 Council whereby cases of Puerperal Pyrexia might be admitted to the London County Council's North Western Hospital. Whooping cough and measles became notifiable as from 23rd October, 1939• For some imperfectly understood reason the expected bi-annual epidemic of measles has not yet occurred. There was, however, at the beginning of 1940 some rise in the incidence of influenza and an unusually large epidemic of rubella (german measles) while, too, cerebro-spinal fever has made its appearance in the country. Wembley, however, has continued to escape lightly from this disease. The monthly bulletin regarding infectious diseases, notifiable and non-notifiable, has continued to be circulated amongst the medical practitioners in the area and has served a useful purpose. Diphtheria Immunisation continues to be very poorly accepted, no more poorly, it is true, than in the rest of the London area, but this sure weapon of preventive medicine against one of the killing diseases of children is still but scarcely used in this country. The Infectious Diseases hospital of the Acton and Wembley Joint Committee has now to await being modernised according to plans which had just been accepted on the outbreak of war. Maternity and Child Welfare: The war must take responsibility for the abrupt interruption of the Council's considered plan of permanent clinic buildings. At the beginning of September the College Pioad clinic had just been commenced and now, after 12 months, is still unfinished. There has been no further progress in the Church Lane clinic and the central clinic in London Road. 5 The war also interfered with the institution by the Middlesex County Council of an orthopaedic scheme, with which the Borough Council were ready to co-operate regarding children under 5 years. The few statistics given at the end of this report show the constant increase in the reception of the services available at all the clinics. The Medical Officers and Health Visitors have given much practical information regarding various foods, their value and application in the light of recent knowledge, more especially since v/ar broke out and, with the co-operation of the Voluntary Workers instruction regarding the making and knitting of clothing has been one of the special features of the work at the clinics. Special sessions have been held at which exercises have been taught to ante-natal patients. For this purpose the Health Visitors attended Redhill Hospita/ for refresher courses on the newer methods of physical exercises during the ante-natal period. In addition, the Voluntary Workers have undertaken the conduction of a small library, in which books and pamphlets specially chosen by the Medical Officers are available for consultation. Again, the number of women desiring hospital confinement has increased and it is pleasing to note the greater number of women which the hospital authority (Middlesex County Council) has been able to accommodate. An arrangement was entered into with the Wembley District Nursing Association by which this Association agreed to provide a nurse for the ambulance when a maternity case is being removed I to hospital or nursing home, at a cost of-7/6d* per patient attended. The excellent work of the two District Nursi^ I Associations has continued and the Council have I made grants of £1,000 to the 'Wembley Association and £500 to the Kingsbury Association for the year. 6 The following report is by Mrs. E. Fisher, M.D.,D.P.H., regarding Birth Control sessions:- "During the year 73 new cases attended the special clinic held at Stag Lane and * Perrin Road. The total number of attendances was 200. Two patients were not given contraceptive advice as it was considered they had no medical grounds for avoiding pregnancy. Only one patient of those receiving advice had no children. She had had chronic heart disease for some years. The size of the family varied from 1 child under 1 year to 6 children under nine years, the average nunber of pregnancies working out at 2.6. One patient came to the clinic because of sterility and was sent to hospital for the required operative treatment. The patients advised included patients with kidney disease, heart disease, uterine disorders, recent miscarriages and general debility. The percentage of patients returning to the clinic since its beginning. (June 193^) is 38.9. The question then arises, what is happening to the' rest? Some patients cease to take precautions not objecting to, or even being now desirous of further pregnancy. For example, two cases who wprc treated in 1937 returned this year for further advice, having meantime borne desired babies. Three failures (i.e. cases of undesired pregnancy) are known to have occurred since June, 1936, but it is possible that cases not reported may also have occurred, as this advice is not always fully followed. In two of the failure cases, for example, it is known that the patients had not fully carried out the directions given. All are encouraged to return to the clinic for any further help or advice they need, but do not always avail themselves of the opportunity." 7. A report by the Dental Officer, Mr. J. H. Stevens, is submitted:- "Up to the outbreak of war the number of patients attending the dental clinic continued to show a very satisfactory increase over the previous year. During September there was quite naturally a decrease, but as things settled down and people generally accustomed themselves to these new conditions so the attendances again became normal. In my last report I stressed the fact that conservative treatment rather than extractions was taking its rightful place and forming the major part of the work. I am happy to say that not only has this fact been maintained, but actually increased. The number of patients who received conservative treatment for the period covered by this report has risen by 25 per cent. Regarding conservative treatment to expectant mothers, one technical innovation used for the first time this year may be of interest. When the treatment consisted of 1, 2 or even 3 teeth to be extracted, together with a filling, the teeth-were extracted under gas and whilst the patient was still anaesthetised the cavity or cavities for the fillings were cut and a temporary dressing inserted, the permanent filling being inserted at a subsequent appointment. This method was found particularly beneficial for patients whose pregnancy was advanced and who were therefore rather more nervous of the drilling than usual." 8 Type of treatment received- Patients Patients receiving receiving conservative extraction treatment. treatment. Children 393 253 Mothers 427 722 General: Laboratory Facilities - Arrangements dealt with in previous reports regarding laboratory facilities continued until the outbreak of war when the Emergency Laboratory Service provided by the Ministry of Health and the Medical Research Council was instituted. The laboratory for this district is that for Sector 5-at first conducted at Merchant Taylors School, North wood and lately transferred to the Middlesex Hospital. London Underground Water: The Ministry of Health's letter, 31st Jan. 1939, asked to be furnished with a report dealing with the position in the Borough and any difficulties which may be encountered in dealing with the position, the Minister's attention having been drawn to the possibility of pollution from disused wells or borings of water obtained from the chalk Tinder London. Five private wells from the chalk are known to the Public Health Department which supply water for factory or industrial purposes only. Two factories have two sells each and one factory has one well. Six disused wells are known. The Council adopted the suggestion that the ministry of Health be informed of the position so far as Wembley is concerned and resolved that they are of the opinion that legislation should be introduced to provide (a) that all known or fresh wells or borings should be registered with the 9 local authority; (b) for a notification of the intention to close a well or boring to be forwarded to the local authority to enable the local authority to ensure that such a well or boring is effectually sealed; and (c) that it should be an obligation of the owners of borings into the chalk to keep any inspection eyelet at the top of the boring closed and to take such other reasonable steps as may be desirable for the prevention of water contamination. Sewerage and Sewage Disposal: The Borough Engineer and Surveyor has supplied the following information:- The only extensions of sewerage during 1939 have been those consequent upon the development of new estates, the only large one being the Sudbury Farm Estate, the sewers of which have been connected to those of adjoining streets. Certain flood prevention schemes have been carried out, as follows:- S.W. sewer between Deanscroft Avenue and Queens Walk. S.W. sewer Mount Pleasant. S.W. sewers Waltham Drive and Wimborne Drive, etc. S.W. sewer Forty Close. S.W. drain Town Hall. s.w. sewer Holm stall Avenue and Edgware Road. S.W. culverts Preston Park and College Road. Miscellaneous small works. Public Cleansing: The Director of Public Cleansis has supplied the following information:- There were no major developments in the Public Cleansing services in the year ended 31St December, 1939. It was possible to cater for the normal growth of the Borough without adding to the Department's transport or plant. One or two refinements are held in abeyance on account of the war. 10 Hydrogen Cyanide (Fumigation of Buildings) Regulations, 1938-came into force on the 1st February, 1939. Seven certificates of fumigation and clearance were received according to the Regulations. According to a letter from the Home Office, representation had been made urging "that the above regulations were not working satisfactorily and were in need of amendment. The following observations were submitted to the Home Office with the opinion that the Regulations cannot, at any rate, be considered too stringent:- (1) A house in a terrace of six houses was fumigated. The occupier of the house adjacent to that one which was fumigated, I understand, entered his house when the fumigation was actually taking place. (2) A house in a terrace of six houses was fumigated. In this case I was informed that one of the tenants in the risk area" had intimated that he was not going to move out of his house. (3) Regarding another notice of intention to fumigate, I had to bring to the notice of the fumigator that in the wall between the loft of the house and the one adjacent to it, there were some three or four loose bricks which could easily allow the penetration of gas. This house was also in a terrace of occupied houses and, again, an occupier in the risk area seemed to be undecided regarding vacating her house and handing over the keys. This house was not fumigated, but I cannot help thinking that the fumigators themselves might have found out all that I was able to bring to their notice prior to making arrangements so far as to send me notice of intention to fumigate. 11. (4) In another case I was not satisfied that the tenants in the risk area fully understood the necessity of vacation and giving up of the keys during the fumigation, while another tenant in the same risk area stated that he would refuse to give up his keys. (5) I have also been inconvenienced by not having the full 48 hours notice, because of the notice to fumigate being sent to a neighbouring Medical Officer of Healtha contingency which could always be avoided by finding out to which Authority the occupier of the premises pays his rates. (6) In no case so far (26th June, 1939) had I received under Regulation 8 (b) (ll) from the undertaker a certificate stating simply that it has been established by tests that the fumigation area is free from danger. One undertaker gave me the following certificate CLEARANCE CERTIFICATE. We hereby certify that we have fumigated with HCN. We certify that the space fumigated and also adjoining compartments (if any) are now free of any dangerous concentration of gas and are fit for occupation. We make, however, the express proviso that all windows, doors and other means of ventilation should be left open until tomorrow. (7) I have always advised that arrangements be made to obviate the necessity of the tenants returning to their homes the very same evening. The possibility of circumstances arising that it may be dangerous to return the same evening does 12. not seem to have been explained so far as I have been able to ascertain. Food and Drugs: The Food and Drugs Act, 1938 came into force on the 1st October, 1939• The appropriate sections were brought to the notice of the various purveyors of food, while the fact of food poisoning having become notifiable, was brought to the notice of the local medical profession. One case was notified in the year under review. Regarding the provision of washing facilities in food shops, the standard which has been accepted is that there be provided soap and clean towels, a suitable wash basin or sink with a supply of running water both hot and cold. If the hot water be not delivered over the basin or sink, a gas or electric heater with a kettle will suffice only if the hot water so provided be always of easy access-while the basin or sink must be reasonably near for the employees always to be able easily to wash their hands when necessary, having regard to the nature of the food handled. The one slaughterhouse in the Borough is not now in use because of emergency Government regulation. Some Statistics-not previously submitted in monthly reports. (The continuous growth in the number of attendances at the various clinicsmaternity and child welfare, toddlers, ante-natal, post-natal, gynaecological, birth control sessions and dental - was demonstrated in my monthly report submitted in February, 1940), 13 Estimated number of inhabited houses at the end of 1939 33,857 Rateable value:- Jlst December, 1939 £1,395,461 Sum represented by the product of a Penny Rate (estimated) £5,418 Notified live births 1,735 Comparative figure for 1938 1,768 Notified still births 47 Comparative figure for 1938 53 Total deaths 879 Comparative figure for 1938 808 Maternal mortality - Deaths from Puerperal Sepsis nil Comparative figure for 1938 3 Other Puerperal causes 9 Comparative figure for 1938 nil Infantile mortality - Total infant deaths under one year 70 Comparative figure for 1938 79 Infantile death rate per 1,000 live births 40.3 Comparative figure for 1938 43.31 Births taking place in hospital - Total No. of births notified. No. of births at home. No. of births in hospitals No. of births - in M.C.C. hospitals. Births in private Nursing Homes & at private addresses. 1939 1782 504 960 619 * 318 28.32% 53.92% X 34.72 inc. in preceding col. 17.8% 1938 1821 648 854 368 x 319 35.6% 46.956 X 20.2% ditto. 17.5% 14. Sanitation Section - No. of complaints received and investigated 1238 (a) Visits to dwelling houses 7562 including billets (b) General sanitation inspections 1O852 (c) Meat and other food inspections. 3676 22090 Verbal Written Statutorv Notices served - 342 414 45 Notices complied with- 228 454 71 Nuisances abated and Improvements effected- (a) Dwelling houses 1006 (b) General sanitation 1282 (c) Meat and other foods 128 2416 Number of dwellings overcrowded at the end of the year 22 No. of cases of overcrowding relieved during the year 37 No. of houses becoming overcrowded again after steps had been taken to abate the overcrowding nil Food and Drugs Act. 1938-The number of premises which have been registered up to the 30th June, 1940 is as follows Storage and sale of ice cream 31 Manufacture, storage and sale of ice cream 5 Preparation or manufacture of sausages intended for sale 7 Preparation or manufacture of potted, pressed, pickled or preserved food intended for sale 22 Preparation or manufacture of sausages, potted, pressed, pickled or preserved food intended for sale 42 15 Factories Act, 1937. (l) Number of factories within the Borough, 31.12.39- 374 Inspections for purposes of provisions as to health, including inspections made by Sanitary Inspector PREMISES Number of Inspections Written Notices Occupiers prosecuted FACTORIES with mechanical power 558 x 15 - / FACTORIES without mechanical power 35 - - / OTHER PREMISES under the Act (including works of building and engineering construction but not including out-workers premises). 6 - - Total 599 15 - / Electrical 'stations should be reckoned as factories. x Includes 72 inspections of bakehouses with mechanical power. 16. No. of defects. Particulars. Found. Remedied. Referred to H. M. Inspector. No. of defects in respect of which prosecutions were instituted . Want of cleanliness (S.I.) 19 20 a - - Overcrowding (S.2) - - - - Unreasonable temperature (S.3) - - - - Inadequate ventilation (S.4) 1 1 b - - Ineffective drainage of floors (S;6) - - - - Sanitary conveniences (S.7) (insufficient 3 3 - - (unsuitable or ( defective 24 26 - - (not separate ( for sexes 1 l - - Other offences 4 9 — — (not including offences relating to Home Work or offences under sections mentioned in the Schedule 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: 51 60 — . a - includes 2 defects found in 1938. b - „„1„„„„ 17. (2) Outworkers- No. on Register, 31.12.39 97 No. of visits paid to Outworkers' premises- 63 (3) Offices- No. on Register 194 No. of visits made 92 Defects found during the year:- Found. Remedied. Want of cleanliness — — Want of ventilation — 1 X Overcrowding — — Sanitary )insufficient 1 — accommodation)unsuitable or ) defective 1 3 + )not separate )for the sexes - - Obnoxious effluvia - — Other nuisances — — 2 4 x - defects found in 1938 + - 2 defects found in 1938 Milk & Dairies (Consolidation) Act. 1915. etc. The Chief Officer of the Public Control Department of the Middlesex County Council has submitted the following information During the year eight samples of milk were taken from retailers in the Borough. These samples were submitted to the Lister Institute for animal inoculation tests, but not one of these samples was found to contain living tubercle bacilli. 18. Short though this report must be at the present time, I cannot conclude without expressing my admiration for the way in which every member of the staff has responded to the constant and unusual calls throughout the year and I feel it is my duty to offer my thanks to all for the way in which the team has worked together. At a time like this I do not wish to mention names-all have given their best services. With regard to A. R. P. however, I may be allowed to mention the Honorary Liaison Medical Officer, Dr. H. M. Harris who has helped the Department in very many ways by co-ordinating our efforts with those of the local medical profession. I am very grateful, too, for the reception which the work of the Department has 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. 23.8.40. 19.