WEM 21 BOROUGH OF WEMBLEY. INTERIM REPORT of the MEDICAL OFFICER OF HEALTH FOR THE YEAR 1940 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 1940 To the Mayor, Aldermen and Councillors of the Borough. Mr. Mayor,Ladies and Gentlemen, I beg to Present an interim Report on the Health Services for the year 1940. In accordance with the Ministry of Health Circular No. 2314 this Report is again much curtailed, while the full statistics of the Department's work are being kept up to date as far as Possible. In an endeavour to be brief, too, details of the reasons of any changes and developments which have been dealt with in monthly reports to Committees are not repeated, nor are those figures which have been placed before the Committees from time to time. The demands upon the Health Services have been continually increased and extended, and since the year was an exceedingly hard one it is only my duty to report that everyone of the Officers in the Department worked to their utmost, as all have been conscious of the opportunity given to play an important part in the war effort. 1. GENERAL Population of the Borough Midsummer 1940 (Registrar General's estimate) 117,380 Number of inhabited houses at the end of 1940, according to the Rate Books (approximate) 33, 607 Rateable value at the 31st December, 1940 £1,414,695 Sum represented by the product of a penny rate £5 ,400 Rainfall,1940. By courtesy of Mr. R.M. Eadie on behalf of the British Rainfall Organisation, the rainfall for the year was recorded as 24.81 inches. Marriages. In Churches, Chapels and Synagogues 1095 At Registry Office, one or both parties being resident in the Borough 442 Total 1537 Deaths. Male. Female. Total. 573 586 1159 Death Rate per 1000 estimated population:- Crude Rate 9.87 Adjusted by Area Comparability Factor of Registrar General (1.28) 12.63 Death Rate for England and Wales 1940 14.3 2. Health Services (October 1941). (Circulated with additional details to local medical profession). 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. As a war-time expedient the Medical Officer of Health and the Chief Officer of the Fire Brigade may extend distance to 30 Miles in any one direction in special circumstances. 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 provided in maternity cases. (b) INFECTIOUS - provided by Acton and Wembley Joint Hospital Committee. ANTI-TOXINS SUPPLIED - Anti-Diphtheria, Anti-Scarlatina, Anti-Streptococcal, AntiMeningococcal and Anti-Tetanus serum available at Public Health Department and at Fire Stations. BIRTH CONTROL (CONTRACEPTION) - Special sessions for married women in whoa are medical reasons against pregnancy, held twice monthly at Stag Lane Clinic and Perrin Road Clinic. BIRTHS - All births, live and still, must be notified to Medical Officer of Health within 36 hours by medical practitioner or midwife in attendance at or within 6 hours of birth. Relevant stamped post-cards available from Public Health Department. DIPHTHERIA IMMUNISATION - (a) Special free immunisation sessions held at Council Health Clinics (b) For families within economic scale of £250 per annum Council supply fluids to and pay family doctor 10/- for course and 3/6d. for postSchick test. For families beyond this scale, fluids supplied free to doctors but no fee for Medical service. 3. DISINFECTION AND DISINFLATION- Cards, supplied to medical practitioners for communicating with Public Health Department when this service required re infectious diseases. Clothing, etc. infected with ringwonn, scabies, etc. or infested with vermin disinfected or disinfested on request of medical attendant. FOOD POISONING- Notifiable to Medical Officer of Health "on becoming aware or suspecting" that patient suffering from food poisoning. Special book of forms of notification available. Specimens of food, faeces (or rectal swab), blood, urine, vomitus, etc. may be sent for examination to the Emergency Public Health Laboratory, Bland Sutton Institute, Middlesex Hospital, W.l. HOME HELPS- A panel of women (home helps) approved by the Borough Council available to assist women incapacitated during pregnancy and to assist in the home during the lying-in period, both for the woman having her baby at home and to the woman having her baby in hospital for medical or environmental reasons. Service available to families free or with assistance according to an economic circumstances scale. HOSPITALS- (A) GENERAL - Middlesex County Council service - Redhill County Hospital and Central Middlesex Hospital, (b) SPECIAL - for PUERPERAL PYREXIA, service available at North Western Hospital, L.C.C.: Ambulance available at Acton and Wembley Joint Isolation Hospital. For OPHTHALMIA. NEONATORUM- mother and infant may be admitted to St. Margaret's L.C.C. Hospital. For INFANTILE PARALYSIS- the Royal National Orthopaedic Hospital, Stanmore. For TUBERCULOSIS- Middlesex County Council Service. Other INFECTIOUS DISEASES admitted according to available accommodation to Acton and Wembley Joint Isolation Hospital, or apply Public Health Department. 4. infectious diseases- notifiable to medical OFFICER OF HEALTH "on becoming aware" - Small-pox, Cholera, Diphtheria, Membranous Croup, Erysipelas, Scarlatina or Scarlet Fever, Typhus, Typhoid, Enteric or Relapsing Fever, Plague, Cerebro-spinal Fever, Acute Poliomyelitis, Acute Encephalitis Lethargica, Acute Polio-Encephalitis, Ophthalmia Neonatorum, Puerperal Pyrexia, Malaria, Dysentery (including amoebic and bacillary) Acute Primary Pneumonia and Acute Influenzal Pneumonia, Tuberculosis all forms, Measles and Whooping Cough. Medical Officer of Health has authority to call consultant neurologist to aid in diagnosis of epidemic nervous disease (e.g. Cerebro-spinal Fever, Acute Poliomyelitis, Encephalitis Lethargica). Books of forms of notification (special books for Puerperal Pyrexia, Measles and Whooping Cough) available at Public Health Department. LABORATORY SERVICES- Outfits kept at the Public Health Department. Throat swabs for Diphtheria, Streptococci, Vincent's Angina and similar swabs for Puerperal cases, sterile syringes in tin boxes for vein tap with test-tubes for blood culture or agglutination, e.g. typhoid group and bacillus abortus, sputum pots for tubercle, etc., faeces pots with spoons, test-tubes for urine examination, glass slides in small boxes for blood films, smears of pus, ophthalmia, etc. test-tubes for Cerebro-spinal fluid. Re Puerperal Pyrexia - examination of swabs (e.g. from nose, throat, vagina and cervix) from patient or from contacts for haemolytic streptococci and typing and grouping of the streptococci. Any other special outfits available on request. Swabs, etc. may be sent by post in appropriate containers and envelopes to the Emergency Public Health Laboratory, Bland Sutton Institute, Middlesex Hospital, London, W. l. Van calls at the Public Health Department daily, except Saturday and Sunday, at 10 a.m. In addition, transport of 5. material to the Laboratory at Middlesex Hospital will be arranged if the material be received at the Public Health Department before 3.45 P.m. (Monday to Friday). MATERNITY OUTFITS- Available on evidence that woman is receiving ante-natal supervision and granted according to an economic circumstances scale or at cost price. Form of certificate available at Public Health Department or at Borough Council's Clinics. Contents:- 1 waterproof paper sheet 1 twill sheet 60" x 36" 1 accouchement sheet 25" x 28" 4 umbilical pads linen thread 3 yds. plain gauze 1 lb. cotton wool 1 doz. extra large maternity pads 1 doz. large maternity pads MATERNITY SERVICES- ANTE-NATAL, CONFINEMENT and LYING-IN - One of the Council's Consultant Obstetricians may be called to the patient at home by private practitioner in. case of doubt or difficulty (1) at any time in the ante-natal period, the patient being too ill to attend hospital, (2) at the time of confinement and (3) during the lying-in period. Borough Council pay the Consultant Obstetricians £5. 5.0d. per consultation. Recovery made according to the following scale- Income up to £250 per annum- no recovery made Income between £250-£350- £1. 1. 0d. to be recovered. Income between £350-£450- £2. 2. 0d. to be recovered. Income between £450-£500- £3. 3. 0d. to be recovered. Income over £500- £5. 5. to be recovered. (Exceptional cases have individual special consideration). 6. EMERGENCY MATERNITY UNITS- FLYING SQUADSIn any case of grave emergency for whom removal to hospital seems undesirable, e.g. shock, haemorrhage or eclampsia, doctor may apply for assistance to Redhill County Hospital asking for emergency maternity unit, when the Obstetric Surgeon will be ready to proceed at once to the home by car or ambulance, taking with him all the necessary equipment for blood transfusion for example, instruments, sterilised dressings, gowns, towels, etc. and a trained nurse. After appropriate treatment has been given and circumstances make it advisable, patient may be transferred to Redhill Hospital for any further necessary treatment. SCABIES- On request of medical attendant disinfection of bedding and clothing arranged by Public Health Department at Council's Disinfection Station. Arrangements with Royal Borough of Kensington for treatment at the Medicinal Baths, Bletchyndon Mews, North Kensington, W.10, and on completion of treatment disinfection of bedding and underclothing at Council's Disinfection Station. SUB-NUTRITION- for expectant and nursing mothers and for children under 5 years not attending Education Authority Schools, free milk (pasteurised) and dried milk foods, cod liver oil, vitamin preparations etc. are granted at the Council's Clinics according to an economic circumstances scale or at cost price, on medical recommendation. TUBERCULOSIS- Dispensary and Sanatorium or Hospital treatment- Middlesex County Council service- (a) for southern part of WembleyTuberculosis Dispensary, Pound Lane, Willesden. Monday afternoons at 2 p.m. Tuesday, Thursday and Friday mornings at 10 a.m. (b) For Kenton and Kingsbury north of the Metropolitan Railway line running from Northwick Park Station to Preston Road 7. Station and then to Kingsbury Station and north of Kingsbury Road including the angular area between Kingsbury Road and Fryent Way immediately south of Kingsbury Station- Tuberculosis Officer, Chest Clinic, Redhill County Hospital, patients seen by appointment only. See LABORATORY SERVICES for examination of sputum. Sputum flasks and paper handkerchiefs granted free to necessitous cases having domiciliary treatment. VERMIN - Assistance of Health Visitors available to advise regarding disinfestation of head and body and Health Visitor would follow up case to see that instructions have been effectively carried out on request of private medical practitioner. For severe cases with secondary head or skin infection, endeavour will be made on request to find hospital accommodation for a few days. Disinfestation of bed and body clothing available at Council's disinfection station on application to Public Health Department. INFECTIOUS DISEASES. A remarkably low incidence of the infectious diseases maintained throughout 1940. In the country as a whole Cerebro-spinal Fever and German Measles reached relatively high epidemic proportions. In Wembley there were 17 cases of Cerebro-spinal Fever (3 in 1939 and 1 in 1938), and there was a definite local epidemic of German Measles. The usual experience with regard to Measles has been an epidemic prevalence every two years, but 1940 was not a "measles year" as expected. By November, however, the number of cases notified had begun to rise and, a typical epidemic peak was reached in February 1941. 8. To obtain comparative figures regarding the winter respiratory diseases, it is a custom of the Department to consider winter to begin at the week ending the first Saturday in October, and to end with the week ending the last Saturday in March. In the winter 1937/38 fifty-six cases, in 1938/39 seventy-five cases, in 1939/40 sixty-one cases, and in the winter 1940/41 eighty-two cases of Acute Primary Pneumonia and Acute Influenzal Pneumonia were notified while the numbers of deaths from allied respiratory diseases in those winters were 73, 86, 106 and 107. With regard to 1940, in the first three months there were 74 deaths and in the last three months 31 deaths, the peak incidence being in March, and while the number of deaths in the first quarter was definitely higher in 1940 than in 1938 or 1939 it was 2 less than in the first three months of 1941. Acton and Wembley Infectious Diseases Hospital. Admissions 1940. 1st quarter. 2nd quarter. 3rd quarter. 4th quarter Scarlet Fever 15 28 27 18 Diphtheria 6 4 7 9 Erysipelas 1 2 3 2 Measles — — 66 11 German Measles 13 5 — — Cerebro-spinal Meningitis 4 - 2 3 Encephalitis. Lethargica — 1 1 - Influenza — 1 Dysentery — — 4 — Whooping Cough - 1 - 3 Chicken-pox — - 2 3 Impetigo - - - l Mastoid - - 1 - Totals 39 43 113 50 9. Number of removals carried out by Infectious Diseases Ambulance for each quarter of the year 1940. 1st quarter. 40 2nd quarter. 12 3rd quarter. 14 4th quarter. 13 Total. 79 Diphtheria Immunisation. Year. 0-5 5-10 10-15 Over 15 Totals. 1936 108 178 36 5 327 1937 129 174 36 3 342 1938 207 241 58 4 510 1939 176 282 75 5 535 1940 249 152 44 5 450 Totals 869 1027 249 19 2164 With the intensive campaign during 1941 a large increase in the numbers immunised will be reported in the next annual review. 10. 11  Alperton Central Tokyngton Sudbury Sudbury Court Wembley Park Chalkhill Preston Kenton Fryent Roe Green The Hyde Empire Pool Emergency War Occupation TOTAL Total removed to Hospital % of cases removed to Hospital Scarlet Fever 13 4 6 8 1 5 31 3 3 26 11 5 - 116 (194) 79 60.34 Diphtheria 5 — 1 2 2 2 1 2 3 - 4 1 3 26 (69) 24 92.31 Enteric Fever — — — — — — - - - - - - - - (3) - - Pneumonia 7 5 16 10 8 5 10 12 3 4 7 12 2 101 (117) 22 21.78 Erysipelas 1 1 2 3 1 — 3 1 2 3 6 4 1 28 (21) 10 35.71 Opthalmia Neonatorum l - 1 l 1 - - - - - - - - 4 (5) 2 50.00 Puerperal Pyrexia l — 1 — — - - - - 1 - 1 - 4 (10) - - Acute Poliomyelitis — - — — — — - 1 - - - 1 - 2 (4) 2 100.00 Dysentery — - - 2 - - - - - - - - - 2 (1) 2 100.00 Cerebro-spinal Fever 2 4 - 1 - 2 2 2 2 1 - 1 - 17 (3) 17 100.00 Measles 55 19 15 28 12 7 13 69 55 26 114 42 73 528 (10) 79 14.96 Whooping Cough 10 15 14 21 12 6 2 42 42 3 13 30 5 215 (2) 7 3.26 Food Poisoning - - 2 - - - - - - 1 6 6 - 15(1) - - Encephalitis Lethargica - — - 1 - - - - - - 1 - - 2 (1) 2 100.00 Comparative figures in brackets for 1939. 12 TABLE OF NON-NOTIFIABLE DISEASES - SCHOOL CHILDREN - 1940. Jan. Feb. Mar. Apr. May. June . July. Aug. Sep. Oct. Nov. Dec. Total. Chicken-pox 1 2 — - - 3 8 — — 10 3 5 32 Mumps — 13 14 19 3 — — — — 1 — — 50 German Measles — 6 51 210 197 120 5 — — 1 — 1 591 DEATHS FROM CERTAIN INFECTIOUS DISEASES' (From Registrar General). Typhoid & Para-Typhoid Fevers 1 (-) Cerebro-spinal Fever 3 (l) Scarlet Fever - (-) Diphtheria - (2) Whooping Cough 1 (l) Measles 1 (l) Influenza 9 (13) Acute Poliomyelitis and Polio Encephalitis - (-) Acute Infective Encephalitis 1 (-) Pneumonia 55 (55) Diarrhoea (under 2 years) 20 (2) (Comparative figures in brackets for 1939). TUBERCULOSIS. New Cases Notified. Pulmonary. Non-Pulmonary. M. F. M. F. Total 56 44 13 12 (60) (40) (12) (10) Deaths. Pulmonary. Non-Pulmonary. M. F. M. F. Total 35 21 1 6 (25) (23) (4) (5) (Comparative figures in brackets for 1939). 13. MATERNITY MP CHILD WELFARE. STATISTICS as supplied by the Registrar General. LIVE BIRTHS Male Female Total Legitimate 824 766 1590 Birth rate per 1000 of estimated resident population 14.14 Illegitimate 27 25 52 Comparative rate for England and Wales 14.6 STILL BIRTHS Male Female Total Legitimate 22 20 42 Rate per Illegitimate 2 - 2 1000 total (Live & Still) births 32.32 Still Birth rate per 1000 estimated population 0.38 MTERNAL MORTALITY Deaths from Puerperal & Post.Abort.Sepsis 2 Other Maternal causes 3 5 Maternal Mortality per 1000 Live Births 3.05 Maternal Mortality rate per 1000 total (Live & Still) Births 2.97 INFANTILE MORTALITY Deaths of Infants under 1 year of ages:Male Female Total Legitimate 54 39 93 Illegitimate 2-2 Death rate of infants under 1 year of age:- All infants per 1000 Live Births 57.86 Legitimate infants per 1000 legitimate live births 58.49 Illegitimate infants per 1000 illegitimate live births 38.46 Infantile Mortality rate for England & Wales 55 14. That the Infantile Mortality rate should rise to 57.86, a figure even greater than that for England and Wales as a whole, must have some comment. In the first place the individual rate of a town of the size of Wembley is very sensitive when compared with that for the whole Country. The number of deaths in relation to 1660 births (in Wembley) cannot be compared with the number of deaths relating to 607,029 births (in England and Wales) without regard to the statistical "probable error". In the report for 1938 it was stated that it was very nearly true to say that the death rate in Wembley could be smaller only by a decrease in the Infantile Mortality rate, while the Infantile Mortality rate was almost as low already as it could be unless there be some new factor to arise influencing the killing diseases generally. The percentage of infant deaths occurring within the first month of life in the last four years is shown:- 1937 - 56.7; 1938 - 59-5; 1939 - 62.8; and 1940 - 61.9, while the percentage of infant deaths under one week may also be compared:- 1937 - 46.9; 1938 - 44.3; 1939 - 52.8; and 1940 - 30.4. These figures show that the rise in infant deaths has not occurred because of deaths in the group "Prematurity and Congenital Defects" in which the infants' chances of survival can scarcely be raised. From an individual analysis of deaths it becomes clear that the increased number of deaths occurred from Pneumonia, Bronchitis and Respiratory complaints together with a smaller increase from Gastro-Enteritis. Further, after plotting the infant deaths in monthly periods throughout the year it is found that the deaths from respiratory causes occurred in the first three months of the year, and to a slightly less extent in the last three months, that is, at the times when weather 15. conditions were the hardest, more especially in the beginning of 1940. The Gastro-Enteritis deaths occurred for the most part in August, September and October, and whether the climatic conditions or the beginning of air raid conditions were the more blame-worthy, only further research will be able to prove. At any rate the rise in Infantile Mortality seems to have occurred from preventable causes, calling for still more health education and care for the young infant. ENVIRONMENTAL HYGIENE, FOOD AND WATER. 1940 1939 Number of complaints received and investigated 1368 1238 (a) Visits to dwelling houses including billets 8536 7562 (b) General Sanitation 15064 10852 3239 3676 28207 22090 Notices served Verbal 427 342 Written 693 414 Statutory 48 45 Notices complied with Verbal 380 228 Written 586 454 Statutory 51 71 Nuisances abated and improvements effected - (a) Dwelling Houses 2129 1006 (b) General Sanitation 2791 1282 (c) Meat and other foods premises 359 128 5309 2416 16. 1940 1939 No. of dwelling houses overcrowded at end of year 15 22 No. of cases of overcrowding relieved during year 18 37 No. of houses becoming overcrowded again after steps had been taken tc abate the overcrowding Nil Nil Defects found - Found. Remedied. Want of cleanliness 3 3 Sanitary convenience (insufficient) 1 1 (unsuitable or defective) 39 33 Other offences 4 4 Total - 47 41 Factory inspections for purpose of provisions as to health Number of: Inspections. . Written Notices. Occupiers prosecuted. 497 9 - 21 — — Total 518 9 - Outworkers - No. on Register 31.12.40 96 No. of visits paid to outworkers' premises 117 Offices - No. on Register 204 No. of visits made 158 17. Found. Remedied. Sanitary accommodation (unsuitable or defective) 2 2 (not separate for the sexes) - Other nuisances 1 1 Total- 3 3 AIR RAID SHELTERS. All the public shelters are inspected by the Public Health Department at least once in every three months, visits being paid at more frequent intervals as individual cases or complaints require. Routine inspections are made at night time as well as during the day. At these' inspections the following headings are borne in mind, from a hygiene point of view:- "Shelter at for (nbr. persons) Bunks provided for Bunk spacing Feet between bunks Walls Floor Ceiling Woodwork Ventilation (Natural, through vent, mechanical, etc.) Dampness Heating - Absent/Present. Method Fumes If smoking allowed is there separate compartment - Yes/No. Lighting sufficient for reading and maintenance of cleanliness throughout/dimming arrangements for sleeping Sanitary Accommodation (state type) Water supply Canteen Washing facilities Cleanliness - General Dustbins provided Yes/No. - Beds & Bedding Are beds aired daily Yes/No. Reports of Vermin - Rats Mice Bugs Fleas Mosquitoes Reports of infectious or contagious disease Other special remarks 18. DRAINAGE AND SEWERAGE. Flooding in houses, is always against the public health and when the flooding is by dirty water from the roadways or, more important still, from soil sewage, the objections are obvious. Soil sewage flooding is always a serious matter, and while an epidemic of the intestinal diseases is generally due to the contamination of a water or milk supply, soil sewage flooding may account for sporadic cases of such diseases. The Borough Engineer kindly supplies the following information:- Daring 1940 the following sewerage schemes were carried out:- (1) Sudbury Heights Avenue and Barham Park, S.W. Sewer, and storm overflows District Road and Barham Park (£2,088). (2) Surface Water Sewer rear of Lawrence Crescent (£696). (3) Eleven miscellaneous small flood-prevention schemes. The surface water sewer Forty Lane and Bridge Road, etc., was commenced in July 1940 and is still in progress. During 1940 the preparation of floodprevention schemes was actively pursued, and apart from the above schemes, seven major schemes (total estimated cost £25,650) and four small schemes (total estimated cost £500) were prepared. There was no estate development in the 3orough in 1940, and there were no important sewerage extensions. HOUSING. The only houses built in 1940 were those built by private developers, the total number being 104 (classification (a) (3) of which 24 are flats. 19. MILK. Visits to Dairies and Milk Shops 364 Samples taken of designated milk. No. taken. No. not up to standard of orders. Tuberculin tested 33 2 Pasteurised 33 6 T.T. (Pasteurised) 3 1 T.T. (Certified) 2 — Accredited 10 - 81 9 PUBLIC WATER SUPPLY. Air raid damage was experienced in the Borough from the end of August, 1940, and up to the end of the year 284 special bacteriological examinations of water samples were made. These samples were taken for two reasons, either because of damage to water mains when the sample was taken at the nearest available house, or because of there being damage to a house sufficiently great to justify thinking of the possibility of damage to water services pipes off the water main. The results were submitted to the Ministry of Health. Accepted average standard based on samples taken by Public Health Department previous to 28th August, 1940 Plate Count agar 3 days at 22° C. 30 " " " 2 " 37° C. 10 Probable No. Coli Mac Conkey 3 days 370 C. 0 " " faecal coli per ml. 0 20. samples taken between. 28th August and 31st December, 1940:- 284 in number. Number which pass by accepted standard 150 i.e. 53% Number which fail (l) plate count only 67 " 24% (2) coli count only 21 " 7% (3) both plate and coli 46 " 16% (4) faecal coli 0 " 0% Summary of agar counts. (a) 3 days at 22° C. Number 50-99 100-149 150-199 Others under 50 230 33 9 4 1 @ 285 314 406 473 607 920 937 2430 (b) 2 days at 37° C. Number 10-14 15-19 20-24 25-29 30-39 40-50 Others under 10 201 29 20 11 8 3 5 1 @ 70 88 103 114 162 240 427 21. Summary of Coli Mac Conkey 3 days 37° C. per 100 ml. Nil. 1-2 3-10 Over 10 217 60 7 0 21% 3% o% Examinations repeated because of first report being unsatisfactory (49 in number). Returned to accepted standard within days 7 14 21 28 3542 49 59 (a) Where water main damage (14 in number) 21331211 (b) Where no ascertained water main damage (35 in number) 16 8 8 2 1 — — — The first point is the complete absence of faecal coli in every case. Secondly, the nonfaecal coli counts are small and thirdly the plate counts indicate that some disturbance occurs on war damage and a bomb near a water main appears to disturb it in some manner so that it took three weeks for 91.4% of the water in such pipes to return to normal, while where the main was actually damaged, only 43% of the water became normal in that time. Amongst the 14 cases of water main damage, 11 of the samples showed coli Mac Conkey; 3 did not, i.e. 3.6 in 1, while, in those 35 cases 22. where there was no ascertained water main damage, 22 showed coli Mac Conkey; 13 did not, that is, 1.7 in 1. Fortnightly samples are taken of the public water supplies in the Borough for examination at the Emergency Public Health Laboratories, copies being submitted to the Statutory Water Companies. These check samples confirm the consistently high bacteriological standard of the water supply. Abridged though this report is, it gives ample evidence that the work of the Public Health Department has gone on to the full, all in spite of the gradual absorption by H.M. Forces of the male personnel, and with constant changes in the temporary staff. In war conditions a Public Health Department has an opportunity of providing new and additional services as well as of giving its usual services from new angles. Wembley has now itself suffered air raid damage, and has received many who have suffered severely in other areas. Assistance and advice have been given regarding first aid repairs on damaged houses, more particularly with regard to the maintenance of sufficient light and ventilation. The Health Visitors have visited families received from other areas and distributed information regarding and given of the various services available in the district. The officers of this department have their places in the Rest Centres and other Schemes of the Borough, while reference is made in the report to the public shelters. view of housing difficulties, of temporary evacuations and removals and other war circum- 23- 24. stances, there has been a rise in the incidence of Scabies. Treatment has been made available for this skin complaint and families visited and advised. The supervision of food, of the milk supply, and of the public water supply, have all brought additional work. With regard to food for example, condemnation for destruction is only a last resort - the possibility of sorting or of diversion for animal feeding or for industrial purposes is first thought of, and schemes are worked out for the possibility of contamination by gas of food supplies. Cooking demonstrations have been given at the Health Clinics in co-operation with the Ministry of Food and Industrial undertakings. In short the personnel of the Department are in more intimate contact with the public than ever, and it is their constant endeavour to disseminate information regarding health and the prevention of disease at every opportunity. The diagram on page 24 indicates the working scheme according to which the duties of the department are spread. The essential principle underlying this delegation is ease of adjustment to prevailing circumstances at any time. The Medical Services of Civil Defence, for example, an entirely new subject, are now quite absorbed into the department and there is ready always a complete co-ordination and co-operation between the various sections. The excellent services of the Voluntary Helpers Association continued to be available throughout the year at the Health Clinics of the Council, and it is a very pleasant duty to - acknowledge their high worth. 25. I wish respectfully to thank the Council for their unfailing encouragement. I have the honour to be, Mr, Mayor, Ladies and Gentlemen, Your obedient Servant, A.G. MORISON, Medical Officer of Health. 31.l0.41 26.