WEN 22 BOROUGH OF WEMBLEY. INTERIM REPORT of the MEDICAL OFFICER OF HEALTH FOR THE YEAR 1941 A.G. MORISON, M.A., M.D., D.P.H., Medical Officer of Health. r BOROUGH OF WEMBLEY. INTERIM REPORT of the MEDICAL OFFICER OF HEALTH for the Year 1941 To the Mayor, Aldermen and Councillors of the Borough. Mr. Mayor, Ladies and Gentlemen, In accordance with Ministry of Health Circular No. 2604, the Annual Report on the Health Services of the Borough must again be an Interim one for the year, 1941; and as were the reports for 1939 and 1940 the present one is brief, details and figures already presented in monthly reports not being repeated. In accordance with the instructions of the Circular, too, certain essential statistics are omitted at present. During 1941 the activities of the Public Health Department continued to increase and intensify themselves, plans were set for possible war emergencies, the Casualty Civil Defence Organisation was called upon for constant adjustment in the light of experience, and in due course a story may be told of the various health services which, at any rate for the first three years of the war, were carried on with successful expansion and of the health of the community remaining good in spite of the total war now being waged. As the war goes on the public, in fact, must depend upon having wider and still more detailed health services, and the 1. statistics now submitted record the results of an endeavour on the part of one and all to rise to the responsibilities placed upon then. Health education has continued to be very readily received. Diphtheria immunisation, however, has not yet passed the 50% mark in children. Much attention has been paid to distributing detailed information regarding basic food principles. Such new activities as the opening of Day Nurseries, (December 1941), the distribution of supplementary clothing coupons for expectant mothers, co-operation with the Ministry of Food in their scheme for the distribution of fruit juices and Cod Liver Oil to young children at the Health Clinics, have all been a means of bringing the Health Department before the public, and the figures are proof that the public have readily received the services offered. 1. CIVIL DEFENCE. Civil Defence has of course continued to call for much responsibility in the Department, and those individual families either who have suffered in Wembley or who have been moved into the Borough have brought their special problems. The following information is disseminated as appropriate:- "The following particulars relate to the various health services available in this Borough. Anyone who has been having medical treatment is strongly advised to seek to have it continued as appropriate. Those entitled to medical benefit under the National Health Insurance Acts are able to obtain treatment from Doctors who are on the 2. Insurance list. In Wembley practically all the Doctors in general medical practice are on this list, a copy of which may be seen at the General Post Office, High Street, Wembley, or at the Public Health Department. When a person without sufficient means to provide a private Doctor either desires to attend a Doctor's Surgery or requires a Doctor to visit, the services of the local Relieving Officer should be sought and the Relieving Officer will pass on the request to the District Medical Officer. Relieving Officers:- Mr. Pedel, 2, Oxford Villas, Harrow Road, Sudbury, Wembley - ARNold 3253 Mr. Walton, 48, Station Road, Harrow - HARrow 1252 Mr. Ashmead, 168, The Broadway, West Hendon - HENdon 1302 and the District Medical Officers (also Public Vaccinators):- . Dr. Dyson, 5, High Road, Wembley. Dr. Routledge, 1, Colin Close, Sheaveshill Avenue, N.W. 9. HOSPITALS. Hospital advice and treatment is generally most appropriately sought through the doctor who has been consulted, as the doctor is aware of the various specialities treated at certain hospitals in and around London. Middlesex County Council's General Hospitals with out-patient departments:- Redhill County Hospital, Edgware, and The Central Middlesex County Hospital, Acton Lane, N.W. 10. Voluntary Hospitals:- The Wembley Hospital, Fairview Avenue. In-patient accommodation available for approved cases, and attention available for sudden accident cases. 3. TUBERCULOSIS or suspicion thereof:Tuberculosis Dispensary, Pound Lane, Willesden Mondays - 2.00 p.m. Tuesdays - 10.00 a.m. Thursdays- 10.00 a.m. Fridays - 10.00 a.m. Chest Clinic, Redhill Hospital. Edgware. Patients seen by appointment only - PHONE EDGivare 3406 VENEREAL DISEASES or suspicion thereof Special Clinics:Central Middlesex County Hospital. Acton Lane, Willesden, N.W. 10. Monday - Friday - 8.3O a.m. - 6.30 p.m. Saturday - 8.00 a.m. - 12 noon. West Middlesex County Hospital, Isleworth. As at Central Middlesex Hospital except Thursday - 8.30 a.m. - 7.OO p.m. In addition a list of London Hospitals is known to all doctors and the list may also be consulted at the Public Health Department. HEALTH CLINICS of the Wembley Borough Council for expectant and nursing mothers and children under 5 years. Dental services clinics for women requiring advice in the special women's diseases - diphtheria immunisation. Information regarding days and hours of attendance available at the Public Health Department, Town Hall. 4. One Tree Hill Clinic - Bridgewater Road. Ealing Road - St. Andrews Hall, Ealing Road. Perrin Road Clinic - Perrin Road. College Road Clinic - College Road. Monks Park Clinic - Monks Park. Stag Lane Clinic - 247, Stag Lane, N.W. 9. Slough Lane Clinic - Kingsbury Free Church, Slough Lane. SCHOOL CLINICS of Middlesex County Education Committee:- Wembley Hill School, Wembley Hill. Minor ailments- Monday at 9.30 a. m. Ophthalmic - Tuesday at 9.30 a.m. (by appointment only). Dental - Daily except Monday & Tuesday mornings (by appointment only). County Clinic. Stag Lane. Minor ailments - Monday at 9.30 a.m. Ophthalmic - Wednesday at 9.30 a.m. (by appointment only). Dental - Daily at 9-30 a.m. (by appointment only). Orthopaedic - 3rd Friday in every month in afternoon. Massage - Tuesday & Friday in the afternoon (by appointment only). AMBULANCE SERVICE. Contact No. 1 - Headquarters, Fire Station, Harrow Road, Wembley. WEMbley 2222. or No. 2 - Kingsbury Sub-Station, The Mall, Kenton Road, Harrow. WORdsworth 2096. Apart from accidents or sudden illness, a medical certificate is required that the patient is not a fit state to travel in a vehicle other than an ambulance. 5- DISTRICT NURSING ASSOCIATIONS:- Wembley District Nursing Association, 80, Wembley Park Drive. WEMbley 4913. Kingsbury District Nursing Association, 1, Mersham Drive, N.W. 9. COLindale 6445. REGISTRAR OF BIRTHS AND DEATHS:- Mr. F.H. Doubtfire, 26, Lewlands Road, Harrow - BYRon 2300 Mr. C.S. Wyles, 182, Burnt Oak Broadway, Edgware - EDGware 0024 Mrs. J. Clough, 55, Church Road, Hanwell - EALing 3331 A considerable amount of administrative duty has been called for with regard to the Casualty Services. These services were tested in the Battle of London and it may be justly claimed that the services proved themselves capable of giving all that was expected of them. As an indication of the multiplicity of the matters dealt with in circulars from the Central Authorities, and of the necessity for constant reconsideration it may be stated that during the year 361 "instructions" were issued to Depot Superintendents, the largest number in any one month being 56 and the smallest number 20; to the Sisters at the First Aid Posts 225 "instructions" were issued, the largest number in any one month being 42 and the smallest number 12; while 26 letters dealing with details of medical treatment referred to in circulars, with equipment and with the training of personnel and with other administrative matters were issued to the Medical Officers in Charge of the First Aid Posts. 6. 2. CERTAIN VITAL STATISTICS 1941. as supplied by the Registrar General. (Comparative 1940 figures within brackets). Live Births. Male Female Total Legitimate 810 (824) 737 (766) 1,547 (1,590) Illegitimate 32 (27) 44 (25) 76 (52) Stillbirths. Male Female Total Legitimate 27 (22) 18 (20) 45 (42) (Rate per 1,000 total Illegitimate 1 (2) 1 (-) 2 (2) (Live & Stillbirths) 28.14) (1940 - 32.32). Maternal Mortality. Deaths from Puerperal Sepsis 3 (2) Other Puerperal Causes 4 (3) Maternal Mortality Rate per 1,000 live births 4.42 (3.05) Maternal Mortality Rate per 1,000 total (Live & Still) Births 4.30 (2.97) 7. Infantile Mortality. Deaths of Infants under 1 year of age:- Male Female Total Legitimate 38 22 60 (54) (39) (93) Illegitimate 4 4 8 (2) (-) (2) Death rate of infants under 1 year of age:- All infants per 1,000 live births 42.89 (57.86) Legitimate infants per 1,000 legitimate live births 37.79 (58.49) Illegitimate infants per 1,000 live Illegitimate births 105.2 (38.46) Deaths from Cancer (all ages) 202 (185) " " Measles (all ages) 2 (l) " " Whooping Cough (all ages) 1 (l) " " Diarrhoea (under 2 years) 8 (20) 8. Causes of Deaths during the year. 1940 total Causes of Death M F Total 1159 All causes 536 519 1055 1 Typhoid & Para-typhoid Fevers — — — 1 Measles 1 1 2 — Scarlet Fever — — — 1 Whooping Cough 1 - 1 — Diphtheria - 3 3 9 Influenza 6 5 11 — Encephalitis Lethargica — - — 3 Cerebro-spinal Fever 3 2 5 42 Tuberculosis of respiratory system 37 27 64 7 Other Tuberculosis - 3 3 4 Syphilis 4 3 7 — General paralysis of insane etc. - — — 185 Cancer 98 104 202 7 Diabetes 5 10 15 - Cerebral Haemorrhage 39 37 76 243 Heart disease 97 124 221 - Aneurysm — - - 33 Other circulatory diseases 20 20 40 49 Bronchitis 26 22 48 55 Pneumonia 36 32 68 17 Other respiratory diseases 11 10 21 14 Peptic Ulcer 6 3 9 20 Diarrhoea (under 2 years) 5 3 8 8 Appendicitis 2 4 6 29 Other digestive diseases 10 12 22 28 Nephritis 9 11 20 2 Puerperal Sepsis — 3 3 3 Other Puerperal Causes — 4 4 21 Premature Births 13 8 21 28 Congenital Malformation; Birth Injury; Infant Dis. 7 4 11 10 Suicide 4 6 10 11 Road Traffic Accidents 8 2 10 121 Other violent causes 28 16 44 102 All other causes 60 40 100 9- The Number of deathes, other than from suicide and road traffic accidents, from violent causes is 44. Similar numbers in 1939 and 1940 were 43 and 121 respectively. The increase in 1940 was, of course, due to air raid casualties. 3• CERTAIN OTHER ESSENTIAL STATISTICS. Birth Notifications. At home. In Hospital. In Nursing Home. Totals Doctors 61 758 151 970 Midwives 466 23 78 576 Parents 2 — — 2 Totals 529 781 229 1,539 Percentages 34.37 50.75 14.88 100.00 10. Deaths. Percentage of total deaths under 1 year. Percentage of total deaths under 50 years of age. Percentage of deaths taking place in Hospitals. 1937 9.46 36.65 43.80 1938 9.78 34.60 50.99 1939 7.96 31.73 33.56 1940 7.00 33.61 35.37 1941 6.45 30.14 43.00 Infantile Mortality. Of the 67 deaths which occurred in children who never celebrated their first birthday, 26 occurred within the first week of life (38.8%) while 41 occurred within the first four weeks of life (61.2%). In the following table are shown the numbers of infant deaths from the various causes, according to age at death. 11. Deaths from stated causes at various ages under 1 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 one month , 1- 3 months 3 - 6 months 6 — 9 months 9 - 12 months Total deaths under 1 year Prematurity 15 - - - 16 - - - - 16 Congenital defects 1 — 1 - 2 - - — — 2 Gastro Enteritis — 1 3 1 5 — 1 1 - 7 Broncho Pneumonia do. with 2 — 3 1 6 - 2 l 4 13 Gastro-Enteritis 1 — — — 1 - 2 - - 3 Broncho Pneumonia with Prematurity 2 1 - 1 4 1 - - - 5 Bronchitis - — — — — 1 2 - 1 4 Atelectasis 1 - — — 1 - - - - 1 Haemorrhage of the new born — 1 — — 1 - 1 - - 2 Intra-cranial haemorrhage 1 - - - 1 - - - - 1 Accident — — - — — — - 1 - 1 Marasmus 1 — 1 — 2 3 - - - 5 Asphyxia Neonatorum 2 — — - 2 - - - - 2 Meningitis — — 1 - 1 2 - - - 3 Tuberculosis — — — — — — 1 - - l Lobar Pneumonia - - - - - - - - 1 l 26 4 9 3 41 7 9 3 6 67 12. Infantile Mortality 1937 - 1941. Year. Wembley. England & Wales. 1937 43.62 58 1938 43.31 53 1939 39.12 50 1940 57.86 55 1941 42.32 59 Infantile Mortality during 5 years (8753 births 394 deaths under 1 year). 45.01 In the previous year comment was made on the sudden rise to 57.86 per 1,000 in the Infant Mortality rate. Its return in 1941 to just over 40 is probably an indication that the 1940 figure was in fact, due to abnormal war and climatic conditions - (l) Gastro-Enteritis from the combination of the climatic conditions with the beginning of air raid conditions, and (2) the still further rise due to pneumonia, bronchitis and other respiratory complaints contemporaneous with hard weather conditions and the upset to normal family life by air raids and shelter conditions. Prematurity. In the analysis submitted on page 12 prematurity has been considered to be the first cause of death, if no abnormality or birth injury, congenital or otherwise, was mentioned in the death certificate. There were 16 such cases. Prematurity accounted for more than half of the deaths of infants in the first week of life, and in the second week period one other death occurred from prematurity. Of the neo-natal mortality in the first month of life prematurity accounted for 39% of the deaths. The stubborn core of infant mortality is still in the first week of life and its greatest cause 13 is prematurity. This is the greatest single factor in human mortality and possibly in human illness and so far it has not had the systematic study it deserves. While it is known that in the mother toxaemia, hydramnios and multiple pregnancy are the causes of premature confinement, and much research has been done on the prevention and treatment of illness in the ante-natal mother, the effect of such conditions on the unborn child are not yet understood to the same extent. In America (Chicago) it has lately been claimed that the infant mortality rate has been reduced to the 20's instead of remaining in the 50's by giving special consideration to the provision of facilities for "immature" infants under 5 lbs. in weight at birth. Such provision appears to consist of full hospital facilities for the mother and premature baby with adequate warned conveyance and specially trained staff and equipment on arrival at the hospital. New Zealand has also been giving special attention to the problem. Material reduction in the infant mortality rate must now depend upon research into the cause of the premature infant end its prevention or treatment. Maternal Mortality. Three deaths from puerperal sepsis were recorded in 1941, and four deaths occurred from other puerperal causes. Rate per 1,000 total births (Live and Still) 1937-1941 Year. Wembley. England & Wales. 1937 1.03 3.11 1938 1.55 2.97 1939 6.15 2.93 1940 2.63 2.16 1941 4.19 2.23 Maternal Mortality during 5 years (9029 births - 28 Maternal Deaths) 3.10 Marriages. In Churches 1,035 At Registry Office 336 14. 4. HEALTH SERVICES. Ambulance Service. (1) Infectious Diseases. Removals carried out:Quarter ending 31.3.41 30.6.41 30.9.41 31.12.41 51 24 10 32 Total 117. (2) Non-infectious cases. General removals (Sickness, etc.) 2,206 Maternity removals 173 Accidents 466 Illness (Sudden) 119 Not required on arrival 56 Malicious calls 3 Passed to Infectious Diseases Ambulance 1 Carried out by other Authorities 3 Carried out for other Authorities 1 Accidents carried out by other Authorities 1 Enemy Action Calls 3 Total: 3,032 The general rule with regard to this service is that the journey is not to be more than 15 miles in any one direction beyond the Borough boundary. In order to make the fullest use of the hospital service throughout the London Region several of the hospitals have been grouped not only geographically but also from the point of view of the type of case which the hospitals may most appropriately admit, and occasionally the hospital quite appropriate for 15. a Wembley patient may now be beyond the abovementioned 15 miles limit. In such' cases the Civil Defence end Fire Brigade Committee have agreed that the ambulance service may be provided for a journey up to about 30 miles from Wembley, provided the Medical Officer of Health and the Chief Officer of the Fire Brigade be satisfied that arrangements have been made by the doctor in charge of the patient in accordance with the various war-time agreements existing between hospitals either Voluntary, Municipal or other Local Authority. Maternity and Child Welfare Clinics. Number of attendances by children under 1 year of age 28,771 Number of attendances at all the Health Centres by children between the ages of 1 - 5 19,541 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 1 year of age in 1941 was 96.9 (in this figure is excluded the number of children who were known to have previously attended a centre in another district). Number of attendances made by women at the ante-natal clinics 7,199 Total number of women who attended for the first time 1,364 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 88.6 16. Infant welfare Clinics. Attendances of children under 1 year of age. Clinic. Total Attendances. Average attendance per session. Ealing Road 5,078 49 Monks Park 2,993 30 One Tree Hill 4,101 36 Perrin Road 4,165 40 Slough Lane 4,944 48 Stag Lane 7,130 47 Toddlers Clinics. Attendances of children of between the ages 1 - 5 years. Clinic. Total Attendances. Average attendance per session. Ealing Road 3,532 28 Monks Park 2,414 24 One Tree Hill 1,950 15 Perrin Road 3,554 30 Slough Lane 3,986 38 Stag Lane 3,886 26 Special Eye Examination of children under 5 years. 90 children referred to Middlesex County Ophthalmic Surgeon. (1940 - 69). 17. Ante-Natal Clinics. Attendances of expectant mothers. Clinic. Total Attendances. Average attendance per session. Ealing Road 1,130 22 Perrin Road 1,100 22 Slough Lane 837 16 Stag Lane 1,796 18 One Tree Hill 1,501 15 Monks Park 811 16 Number of attendances of ante-natal patients at the Harrow Clinic during 1941 79 Special consideration has been given to the development of the ante-natal clinic services and the co-operation existing with the doctors and midwives in family practice is particularly gratifying. The main aim of the ante-natal clinic is the maintenance of good health and the prevention of the illnesses or complications of pregnancy. The advice given falls mainly under the following headings:- (1) The maintenance of good health and the prevention of illness. (2) The preparation for motherhood. (3) The dissemination of information regarding social welfare, (4) Consideration of the arrangements for confinement, and (5) Co—operation with the family medical attendant or midwife, and with the County and other hospitals. 18. The endeavour is that the advice always be topical and during the war the officers, especially the Health Visitors, have kept themselves up to date regarding the policy of the Ministry of Food. Advice is given upon the milk schemes and priority egg schemes end mothers are assisted in their applications for such special foods. Accessory vitamin and mineral foods are advised as necessary. The importance of cleanliness of the mouth is stressed and proper dental treatment is available. The importance of rest and exercise and of suitable clothing is pointed out; when necessary special maternity belts may be supplied at cost price. Talks on the general hygiene of the body are given. Books are lent and booklets sold. Baby garments are displayed, suitable patterns being available. The economy of home-made garments, cot mattresses, etc. is discussed. The washing of baby garments is demonstrated. The necessity of a cot and pram for the baby is pointed out and practical assistance is available - especially through the Voluntary Helpers Association. The mothers are assisted in their applications for supplementary clothing coupons. Appropriate cases may be referred to Societies such as The Army, Navy and Air Force Families Association, to The Army Welfare Officer, to The Citizens Advice Bureau and to The Poor Man's Lawyer. Advice is given regarding maternity benefit under the National Health Insurance Acts as well as there being a miscellany of appropriate addresses, forms of certificates and such-like pertinent information. If a hospital confinement be appropriate, assistance to find a hospital is given, and the ambulance service explained. 19. The various services of the Council such as the Home Help Service are considered and explained. If a home confinement be desired, the suitability of the home and the best arrangements possible are discussed at a visit to the home by the Health visitor. Special sterilised Maternity Outfits are provided according to the Council's Economic Circumstances scale. Various reports regarding hone circumstances and records of progress are given to the hospitals, while the family doctor or midwife is always informed of any deviation from the normal throughout the pregnancy. During the year 522 women were referred to various hospitals for arrangements regarding confinement For medical reasons 140 Home conditions unsuitable 133 Patients desired hospital accommodation 249 Wembley births taking place in Hospital - (a) Middlesex County Council. Redhill 351 Central Middlesex 34 Hillingdon 1 Middlesex County Maternity Hospital, Bushey 221 West Middlesex 1 608 / . . 20 (b) Other Hospitals. City of London 5 Queen Charlotte's 28 Middlesex 4 St. Mary's 11 Queen Mary1 s 83 University College 3 Royal Northern 1 Bearstead Memorial 3 Hammersmith 1 Paddington 2 Willesden Maternity 27 Emergency Hospital, Wokingham 1 County Hospital, Huntingdon 1 Twyford House Emergency Hospital, Thorley 1 Davenport House, Oxford (Evacuee Hospital) 1 Oldchurch County Hospital, Romford 1 173 Year. Total No. No. of No. of No. of Births in of Births births births births in Private notified,.at home. in hos- M.C.C. Nursing pital. hospitals Homes and (inc. pre-at Private ceding Addresses. column.) 1937 1,846 772 734 175 340 41.8% 39.8% 9.5a 18.4% 1938 1,821 648 854 368 319 35.6% 46.9% 20.2% 17.5% 1939 1,782 505 960 619 318 28.3% 53.9% 34.7% 17.8% 1940 1,576 578 749 607 240 37.3% 47.52 35.5% 15.2% 1941 1,539 529 781 608 229 34.4% 50.7% 39.5% 14.9% 21 Since 1938 about half the births has been taking place in hospital and the percentage of births in Middlesex County Hospitals has risen very quickly from 20.2% in 1938 to 39.5% in 1941. The figure mentioned as the "target" one by the County Council (the Hospital Authority) is 40%. While the figure 40% is sufficient to include all women in whose cases it has been considered necessary to admit to hospital for medical reasons or for serious unsuitability of the home environment, it is far from accommodating all women who have desired admission to hospital. Quite apart from war conditions there has been, in recent years, a growing demand on the part of women themselves to have their confinements in hospital. Apart from the necessity of a hospital bed for certain medical abnormalities and illness and unsuitable home environment the problem as to the general policy - confinement at home or confinement in hospital - is not entirely a medical one, but there is no doubt at all upon the attitude of the women themselves, and if that demand is to be met the Hospital Authority must look forward to having to provide many additional maternity beds. Post-Natal Clinics. Clinic. Total Average attendance Attendances. per session. Stag Lane 73 4 One Tree Hill 168 8 22 Gynaecological Clinics. Clinic. Total Average attendance Attendances. per session. Stag Lane 53 3 One Tree Hill 115 10 Birth Control Sessions. Clinic. Total Average attendance Attendances. per session. Perrin Road 150 13 Stag Lane 90 8 Maternity Outfits. Number of Maternity Outfits supplied during the year 382 Home Helps. No. of cases attended 38 No. of Home Helps (Dec. 1941) on panel 4 Prior to the entry of women into war-time industry this scheme was developing in a way much appreciated by the public, but during the last twelve to eighteen months it has become increasingly difficult to obtain a sufficient number of women to undertake this important service. Convalescent Home Treatment. Convalescent home treatment has been arranged for 8 persons. 23 Ultra Violet Light and Massage. Number of children treated during the year - 38 Milk. Number of milk grants renewed 511 Number of new grants made 138 649 Government Milk Scheme introduced in July, 1940. Obstetric Consultant Service. Consultant called in by private medical practitioners - 10 Dental Services, 24 Numbers referred to the dental clinic by Medical Officers. Expectant Mothers. Nursing Mothers. Pre-School Children. 721 170 513 Expectant Mothers. Nursing Mothers. Pre-School Children. Nos. who received treatment 593 159 482 Nos. made dentally fit 534 137 396 Nos. of treatments - (a) Fillings (i) in temporary teeth - - 327 (ii) in permanent teeth 228 77 - (b) No. of teeth extracted 1,698 476 685 (c) No. of administrations of general anaesthesia 404 100 219 (d) No. of patients supplied with dentures 1 95 35 - (e) No. of dentures supplied 141 54 — Total attendances at Dental Clinics. Children. Mothers. 1939 1,093 1,772 1940 1,171 1,729 1941 972 1,709 25 The above figures for 1941 may be divided as follows:- Domiciliary Visits by Health Visitors. (1) HOME VISITS: (a) To children under 1 year 1,908-First visits 4,810-Revisits (b) To children between the ages of 1 - 5 years 580-First visits 11,171-Revisits (c) To Expectant Mothers 1,087-First visits 1,735-Revisits (d) To Nursing Mothers 716-First visits 704-Revisits (e) Other special visits 4,559 Analysis of Special Cases included In (e) above. Children: Ophthalmia Neonatorum (Notified) 16 Other eye conditions 10 Pemphigus Neonatorum 4 Measles 2,048 Whooping Cough 788 Tuberculosis Pulmonary Non-Pulmonary Glands 4 Bones Skin 26 Consultations. Conservative treatment. Extractions. Children 430 323 219 Expectant Mothers 646 254 499 Nursing Mothers 138 63 110 Ringworm 1 Dysentery 3 Poliomyelitis 5 Infantile deaths 31 Other special e.g. Vermin Head pediculi Body 673 Scabies 562 Mothers: Puerperal Pyrexia (Notified) 15 Still Birth 44 Home Help Supervision 106 Other Special 843 (e.g. Day Nursery; Diphtheria Immunisation; Home condition Forms, re: A.N. Patients; Hospital arrangements). 5. INFECTIOUS DISEASES. Diphtheria Immunisation. Year. 0-5 5-10 10-15 Over 15 TOTALS. 1937 129 174 36 3 342 1938 238 267 65 5 575 1939 181 214 63 4 462 1940 249 152 44 5 450 1941 2454 2102 998 32 5586 3251 2909 1206 49 7415 Even with the intensive drive for the public to be protected against diphtheria having gone on unabated - since the very beginning of 1941 over half of the children under 5 years of age and over half of the children between 5 ana 15 years of age in Wembley have not yet had this protective treatment by which diphtheria 27 might be practically abolished (August, 1942). Parents are advised to consider seriously having their children immunised when about 10 or 11 months of age. Up to the end of June, 1942, just over 2,500 Wembley children under 5 years of age and just over 5,500 children between the ages of 5 and 15 years had been protected. In May 107, in June 108 and in July 101 children under 5 years of age were treated, and of the children between 5 and 15 years in May 74, in June 94 and in July 76 were treated. These numbers are still not big enough. The Public Health Committee has consistently made every endeavour to bring before the public the fact that this safe and easy treatment is available from the family doctor or free at the Health Clinics, and while it may truly be stated that in Wembley the position is as satisfactory as in most of the Middlesex Local Authorities it is still short of the desideratum that at least 75% of the child population be protected for the incidence of diphtheria to be reduced at all comparably to what has been effected in Canada and in the United States of America. Measles. Number of Notifications 1,750 Number Admitted to Hospital 23 Number of Deaths 2 According to pre-war experience, it was expected that 1940 would be a melsles year but not till the last week of November, 1940, was the number of cases 21, and the typical epidemic peak of 219 cases in a week was reached in February, 1941. 28 The epidemic continued until the end of April (5 months epidemic period). 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 38 5 7 8 4 4 3 6 5 13 14 20 - 127 9? 72.4 Diphtheria 14 2 4 - 4 3 2 2 3 5 6 - 1 51 37 90.2 Enteric Fever — - - 2 - - - 1 2 l 2 2 1 11 10 90.9 Pneumonia 12 20 8 6 4 12 6 16 5 13 11 25 5 143 51 35.6 Erysipelas 3 1 2 3 — 3 - 2 - 2 2 4 - 22 5 22.7 Ophthalmia Neonatorum - - - 1 - - - - - - - - - 1 - - Puerperal Pyrexia l — 1 4 - 2 1 1 1 1 - 1 - 13 8 61.5 Acute Poliomyelitis 2 — 2 - 1 - - 3 - - — — - 8 7 87.5 Dysentery - — — - - - - - - — 1 — - 1 1 100.0 Polio Encephalitis 1 - - - - - - - - - - - - 1 1 100.0 Cerebro-spinal Fever 3 2 — 2 1 1 - l - 2 3 - - 15 14 93.3 Measles 148 90 171 273 123 66 103 117 165 164 146 183 1 1750 23 1.3 Whooping Cough 116 34 86 108 52 28 26 40 43 65 101 43 5 747 11 1.4 Food Poisoning 2 - 1 1 - - - - - 1 2 - - 7 2 28.5 Encephalitis Lethargica - - - - - - n- - - - 1 — - l 1 100.0 29. At the time of writing (September, 1942) a second epidemic has just faded out which commenced at the end of March, had a peak incidence in June of cases in a week and lasted until the end August (5 months epidemic period). The number of cases in this epidemic, however, has been much smaller than in that of 1041. A similar smaller epidemic has occurred in other areas and it is difficult to suggest an explanation for it, especially in a neutral area as is Wembley, in which the child population has not moved to any extent comparable with that going on in evacuation or reception areas. Whooping Cough. In the second half of 1940 the number of cases of whooping cough began to increase, but the largest number in any one week was 18. Throughout 1941 the disease, however, was very prevalent, several, peaks of about 30 cases per week being recorded during 1941 and on to March, 1942. At the time of writing, the rather prevailing incidence of whooping cough seems to have disappeared. Cerebro-spinal Meningitis. During the year 15 cases were notified. In 1940 the figure was 17. In both the war years, then, there was considerable rise in the number of cases locally. This is in confirmation of the position in the Country as a whole and in accord with the previous war-time experience. Typhoid or Enteric Fever. In war-time the occurrence of one case of typhoid fever or of the para-typhoid 30 diseases is an anxiety as the possibility of water or food spread must ever be borne in mind. While being still satisfied that up to the present there has been no occasion for panic or mass immunisation against the enteric group of diseases in this Borough, the opinion has been expressed to the Public Health Committee that the chances of falling a victim to the germs of the enteric group of illness seem to be greater now than they were at the beginning of the war. This risk can undoubtedly be reduced by protective inoculation. In Wembley in 1937 there were 3 cases of enteric illness, in 1938, 4; in 1939, 3; in 1940, 5; and in 1941, 7. While the number of food poisoning cases has remained small, there have been one or two circumstances in which the possibilities of food poisoning in association with communal canteens had to be carefully examined. In one or two of the large provincial towns such occurrences, definitely proved to be due to the food poisoning organisms, have occurred. The possibility of serious disturbance to the public health services with regard to environmental hygiene and the interference with normal day-to-day personal hygiene undoubtedly adds to the potentiality of the risk of enteric or enteric-like diseases. Experience points to the wisdom of accepting the offer of the Ministry of Health through local health authorities, of inoculation against the typhoid and para-typhoid group of illnesses. Such inoculation treatment is available free at the Council's Health Clinics. The number accepting this service so far has been very small - during the year, 1941, the number was 345, and between 1st January and 8th August, 1942, 33. 31 Food Poisoning. Much misunderstanding exists in the minds of the public as to the cause of food poisoning. Contrary to popular belief, in none of its forms is it necessarily associated with decomposing foods. The illness may be due to the consumption of food infected with disease-producing bacteria as specific for example as those causing typhoid fever and bearing no relation to the saprophytic organisms generally found in dead organic matter. Food contaminated with harmful metal or other chemicals has given rise to cases of food poisoning while poisonous plants have been eaten in the belief that they were the wholesome food which they resembled, with dire results. In the course of the year, seven cases were notified. There was no single outbreak involving the public at large, nor indeed, the members of more than one family. The cases, which included examples of each type mentioned above, demanded very full enquiries and careful investigation, but satisfactory conclusions were not always reached because of the difficulty of obtaining either bacteriological or chemical confirmation. Often by the time the cases were brought to the notice of the Public Health Department, the person had recovered from the malady, which is frequently of sudden onset and generally of brief duration so that the suspected food was not available for examination and bacteriological proof had become impossible. In December 1940 four persons of one family became ill, suffering from vomiting and diarrhoea about four hours after the Sunday dinner. At first their joint of beef was suspected but a 32 sample submitted to the Bacteriologist did not contain disease producing organisms. Detailed enquiry and questioning revealed that the daughter on preparing the meal in her mother's absence had flavoured it with daffodil bulbs instead of onions, with the unfortunate illness notified. A woman and her daughter noticed a metallic taste on talcing some lemonade and were attacked with diarrhoea and vomiting. The dregs of the drink smelt strongly of paraffin and gave the solution of the cause of the illness. Full enquiry exonerated the premises where the lemonade was manufactured. In the majority of cases illness or discomfort was merely transient but two persons, a mother and daughter, suffered so severely that removal to hospital was necessary and the daughter's illness proved fatal. These two cases were, in fact, the only ones in which the presence of food poisoning organisms (bacillus enteritidis of Gaertner) were clearly demonstrated as the cause of the illness. In spite of the most careful search of the house and yard for any suspicious article or circumstances no sample of any suspicious food could be found for examination, but the fullest enquiry showed that the public food supplies remained unaffected and this particular occurrence was limited to the one household. Tuberculosis. No. of Notifications. Pulmonary. Non-Pulmonary. Male. Female. Male. Female. 89 53 9 10 No. of Deaths. Pulmonary. Non-Pulmonary. Male. Female. Male. Female. 40 24 2 1 33 No, admitted to Hospitals Ho. discharged from or Sanatoria. Hospitals or Sanatoria. 92 84 A detailed analysis of the statistics for the 5 years 1937-1941 confirms the observation already made that for the female the danger period regarding tuberculosis is in young womanhood. 5 year period 1937-1941. Pulmonary. Male. Female. No. of Notifications 359 252 No. of Deaths 132 102 Notifications. Deaths. Pulmonary. Pulmonary. Male %. Female %. Age Periods, Male %. Female . 0.00 0.00 Under 1 year. O.76 0.00 1.11 .40 1-4 years. 0.00 1.96 3.06 5.16 5-14 years. 1.52 1.96 25.07 34.92 15 - 24 years. 18.94 ' 22.55 26.44 37.30 25 - 34 years. 21.97 38.24 18.94 9.52 35 - 44 years. 21.97 14.71 17.24 9.13 45 - 54 years. 16.67 1O.78 5.57 2.38 55 - 64 years. 12.12 6.86 2.51 1.19 65 and over. 6.06 2.94 The Middlesex County Council is the responsible authority for the treatment of tuberculosis. 6. ENVIRONMENTAL HYGIENE, FOOD MP WATER. Number of complaints received and investigated 1,401 (a) Visits to dwelling houses, including billets 6,595 (b) General sanitation inspections (including 1,874 visits to air raid shelters) 12,381 (c) Meat and other food inspections 3,290 Notices served: Verbal 345 Written 521 Statutory 20 Nuisances abated and improvements effected. (a) Dwelling Houses 825 (b) General sanitation (including air raid shelters, 267) 2,349 (c) Meat and other food premises 319 Some Housing Details. "Permitted Number" certificates issued 29 Number of dwellings overcrowded at the end of the year 18 Number of new cases of overcrowding reported during the year 9 Number of cases of overcrowding relieved during the year 6 In consequence of a number of complaints made regarding overcrowding, and requests for housing accommodation the Public Health Committee early in 1942 caused a survey to be made of overcrowding conditions in the Borough. It was not possible to carry out a detailed survey such as was done in 1935/36, but use 35. was made of the current records in the possession of the Rehousing Officer. These records give the number of rooms the number 0f persons occupying each house take Borough in September, 1941, and cases Which appeared to be on the threshold of over crowing were investigated by the Sanitary Inspectors. As a result 63 cases of overcrowding of which the Public Health Department had no previous knowledge were found, making a total of 79 overcrowded dwellings known in the Borough. Particularly in view of such overcrowding the Council decided to make representation to the Ministry of Health for permission to erect new houses but so far such consent has not been received. Total number of dwelling houses inspected for housing defects (under Public Health or Housing Acts) 2,735 Number of inspections made for the purpose 4,926 Number of dwelling houses (included under sub-head (l) above) which were inspected and recorded under the Housing Consolidated Regulations 1925/1932 12 Number of inspections made for the purpose 12 Number of dwelling houses found not to be in all respects reasonably fit for human habitation 791 Remedy of defects during the year without service of formal notices. Number of defective dwelling houses rendered fit in consequence of informal action 773 36 Outworkers. Number on the register 31.12.41 128 Number of visits paid to premises 79 Offices. Number on the Register 223 Number of visits paid 130 Defects found 2; Defects remedied 2 Dairies and Milk Shops. Number of Dairies Registered 28 Number of purveyors of milk registered with premises in the Borough, selling milk in properly closed and unopened receptacles 48 Number of purveyors of milk registered whose premises are outside the Borough 24 Number of Dairies (included above) where milk is bottled, etc. 8 37 Milk (Special Designations) Regulations 1936 to 1942. Licences issued. Samples taken. Samples not satisfactory. Pasteurised 34 49 7 Tuberculin Tested 23 34 10 T.T. (Pasteurised) - 8 2 Accredited 1 12 - 58 103 19 The percentages of unsatisfactory samples of the designated milks during the last five years are as follows 1937 1938. 1939. 1940. 1941. 5 8 3.3.3 11 18 For some time it has been felt that there has been deterioration due to- war conditions, in the condition of milk as supplied to the consumer. The interval between the milking at the farm and delivery of milk to the consumer together with the care in the handling and processing of milk at milking and up to the time of delivery are the points upon which the condition of milk as received by the consumer depends. The recent White Paper (Cmd. 6362) gives the Government policy with regard to milk. The interval between milking at the farm and delivery of the milk to the consumer is a matter concerning which the new rationalisation scheme should give help. The care in the handling and processing of milk at milking and up to the time of delivery is a matter in which the advisory assistance to be made available should assist. The labour difficulties of purveyors of milk, concerning which representation has been made on various occasions to the Public Health Committee is also referred to in the Command Paper, which takes note of the appreciable reduction in the number of dairymen available throughout the country. The Government policy is declared to be for as much milk as is possible to be pasteurised, either at a collection depot or by wholesalers or retailers. Perhaps it is owing to war-time conditions and limitations that the policy of compulsory pasteurisation of all milk has not been adopted. The protection necessary to prevent milk being a vehicle for the spread of 38. certain diseases (e.g. tuberculosis) is efficient pasteurisation or, in its absence, the boiling of milk. CONCLUSION. The efficiency of a Health Department cannot be gauged by figures alone; but it must be particularly gratifying to the Council to have proof of the acceptance by the public of their still expanding health services. The war has fostered a mutual understanding greater than ever between those interested in health and social welfare. The Public Health Department has had added duties and responsibilities since the war commenced with regard to the health and morale of the community. The staff are keenly appreciative of their opportunity. Again it is a very pleasant duty to record the assistance and co-operative attitude of the Voluntary Workers in the clinic services. May I respectfully thank the Council for their ready understanding of the endeavour of the members of the Department to administer the Council's services to the best of their ability. I have the honour to be, Mr. Mayor, Ladies and Gentlemen, Your obedient Servant, A.G. MORISON, Medical Officer of Health. 39 7.9.42