WEM 23 BOROUGH OF WEMBLEY. INTERIM REPORT of the MEDICAL OFFICER OF HEALTH FOR THE YEAR 1942 A.G. MORISON, M.A., M.D., D.P.H., Medical Officer of Health. 1 Infantile Mortality. Deaths of Infants under 1 year of age:- Legitimate Male Female Total 41 25 66 (38) (22) (6o) Illegitimate 2 - 2 (4) (4) (8) Death rate of Infants under 1 year of age:- All infants per 1,000 live births 34.16 (42.89) Legitimate infants per 1,000 legitimate live births(37.79) Illegitimate infants per 1,000 live illegitimate births 27.40 (105.2) Deaths from - Cancer (all ages) 179 (202) " " Measles (all ages) 2 (2) " " Whooping Cough (all ages) 2 (1) " " Diarrhoea (under 2 years) 12 (8) Maternal Mortality. Deaths from Puerperal Sepsis 2 (3) Other Puerperal Causes 3 (4) Maternal Mortality Rate per 1,000 live births 2.52 (4.42) Maternal Mortality Rate per 1,000 total (Live and Still) births 2.43 (4.30) 2. Causes of Deaths during the year. 1941 Total Causes of Death. Male Female Total 1,055 All causes- 545 496 1,041 - Typhoid & Para-typhoid Fevers — — 5 Cerebro-spinal Fever 2 1 3 - Scarlet Fever - - - 1 Whooping Cough 2 - 2 3 Diphtheria 3 — 3 64 Tuberculosis of respiratory system 30 21 51 3 Other forms of Tuberculosis 7 5 12 7 Syphilitic diseases 2 1 3 11 Influenza 3 5 8 2 Measles 1 l 2 - Ac: polio-myel: & polio-enceph - - - - Acute infectious enceph: - — - 15 Cancer of buc:cav:& oesoph (M) uterus (F) 11 16 27 27 Cancer of stomach & duodenum 13 10 23 21 Cancer of breast - 18 18 139 Cancer of all other sites 64 47 111 15 Diabetes 3 6 9 76 Intra-cranial vascular lesions 37 52 89 221 Heart disease 125 124 249 40 Other dis: of circ: system 15 27 42 48 Bronchitis 33 23 56 68 Pneumonia 24 30 54 21 Other resp: diseases 10 5 15 9 Ulcer of stomach or duodenum 14 2 16 8 Diarrhoea under 2 years 6 6 12 6 Appendicitis 9 4 13 22 Other digestive diseases 14 15 29 20 Nephritis 11 9 20 3 Puerperal & post-abort: sepsis - 2 2 4 Other maternal causes — 3 3 21 Prem: birth 13 2 15 11 Congenital malf: birth injury & infant diseases 21 11 32 10 Suicide 3 3 6 10 Road traffic accidents 7 - 7 44 Other violent causes 17 10 27 100 All other causes 45 37 82 3 Of the 1,041 deaths 522 (that is 49.86% occurred elsewhere than within the Borough boundary and 510 took place in hospital (that is 48.71%). The principal causes of Death. Disease. Total.number of deaths. 1. Heart disease and other diseases of circ: system Intra-cranial vascular lesions 291 380 82 2. Cancer 179 3. Respiratory diseases:- (a) Bronchitis 56) 125 « (b) Pneumonia 54) (c) Other respiratory diseases 15) 4. Tuberculosis: - (a) Respiratory system 51 63 (b) Other forms 12 5. Digestive diseases (a) Appendicitis 13 (b) Other digestive diseases 29 (c) Ulcer 16 58 6. Premature births Congenital mail: birth injury & infant diseases 15 47 - 32 7. Violent deaths (a) Suicide 6 40 (b) Road traffic 7 (c) Other violent causes 27 4 Percentage of total deaths under 1 year. Percentage of total deaths under 50 years. Percentage of deaths taking place in Hospitals. 1933 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 1942 6.40 26.55 48.71 B. CERTAIN OTHER ESSENTIAL STATISTICS. Birth Notifications. Notified by At home. In. Hospital. In Nursing Totals. Home. Doctors 90 830 182 1,102 Midwives 521 221 97 839 Parents 1 - l Totals 612 1,051 2-79 1,942 Percentages 31.5 54.1 14.4 100 5 Infantile Mortality, 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 13 2 - 1 16 2 - - - 18 Congenital defects 12 1 - 2 15 1 - 3 1 20 Gastro-Enteritis - - 3 2 5 2 - l - 8 Broncho-Pneumonia do with - - l 1 2 1 - - 1 4 Gastro-Enteritis - - - - - 1 1 - 1 3 Bronchitis - - - - - 1 - - 1 2 Atelectasis 2 - - - 2 - - - - 2 Intra-cranial haemorrhage 3 - - - 3 - 1 - - 4 Accident 1 - - - 1 - 1 - - 2 Meningitis - 1 - - 1 - - l - 2 - Intestinal Obstruction - _ - - - 1 - - - Violence - - - - - -• - l - 1 31 4 4 6 45 9 3 6 4 67 Of the 67 deaths which occurred in children who never celebrated their first birthday, 31 occurred within the first week of life (that is 46%) while 45 occurred within the first four weeks of life (that is 67%) 6 Infantile Mortality 1938-1942 . Year. Wembley. England & Wales. 1938 43.31 53 1939 39.12 50 1940 57.86 55 1941 42.32 59 1942 34.16 49 Infantile Mortality during last 5 years (8,864 live births - 381 deaths under 1 year). 42.98 Maternal Mortality. Two deaths from puerperal sepsis were recorded in 1942, and three deaths occurred from other puerperal causes. Marriages. In Churches 806 At Registry Office 340 7 Rate per 1,000 total births (Live and Still) 1938-1942. Year. Wembley. England & Wales. 1938 1.60 2.97 1939 5.96 2-93 1940 2.97 P-.16 1941 4.30 2.23 1942 2.43 2.01 Maternal Mortality during last 5 years (9A30 total births - 31 Maternal deaths). 3.39 c. HEALTH SERVICES. The Economic Circumstances Scale, according to which recovery is made for certain services given, was revised in October, 1942 the previous revision having been made in February, 1938. Ambulance Service. (1) Infectious Diseases. Removals carried out:Quarters ending 31.3.42 3O. 6.42 30.9.42 3l.12.42 115 105 78 108 Total:- 406 (2) Non-infectious cases. General removals 3,543 Street Accidents 517 Street Illnesses 71 Maternity removals 348 Out-district calls 94 Total 4,573 8 Health Clinics. (Comparative 1941 figures within brackets). Total number of children who first attended at the Clinics during the year who, on the date of their first were under 1 year of age 1,789 Total number of children who first attended at the Clinics during the year and who, on the date of their first attendance were between the ages of 1 - 5 years 485 Total number of children under 5 years of age who attended at the Clinics during the year and who at the end of the year were:- (1) Under 1 year of age 1,773 (2) Over " " " " 4,011 Total 5,784 Number of attendances by children under 1 year of age 40,005 (28,771) Number of attendances at all the Health Clinics by children between the ages of 1 - 5 years 21,149 (19,541) The percentage of notified live births represented by the number of children who first attended at the Clinics during the year and who on the first attendance were under 1 year of age in 1942 93.7 (96.9) (This number is exclusive of those children who are known previously to have attended a Centre in another district prior to coming to reside in Wembley). Number of attendances at the ante-natal Clinics 9,936 (7,199) Total number of women who attended for the first time 1,686 (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 86.8 ( 88.6) 9 Attendances at the various Health Clinics. Children under 1 year of age. Clinic. Total Attendances. Average attendance per session. Ealing Road 4,406 42 Perrin Road 6,019 41 Monks Park 3,826 37 Stag Lane 8,432 55 Slough Lane 6,780 57 One Tree Hill 5,466 40 College Road 4,874 49 (opened 5.1.42) Children between the ages 1-5 years. Clinic. Total Attendances. Average attendance per session. Ealing Road 2,563 24 Perrin Road 2,895 20 Monks Park 2,812 27 Stag Lane 3,961 26 Slough Lane 3,907 33 One Tree Hill 2,097 16 College Road 2,977 30 (opened 5.1.42) Eye Clinic for children under 5 years. 119 children referred to Middlesex County Council Ophthalmic Clinics. (1941 - 90) 10 Orthopaedic Clinic for children under 5 years. 137 children referred to Middlesex County Council Orthopaedic Clinic - (arrangement between Middlesex County Eiducation Committee and Borough Council - April 1942). Dental Clinic. See Page 16. Artificial Sunlight and Massage Treatment. Now available at Wembley Hospital, Redhill and Central Middlesex Hospitals and at Marlborough Hill Clinic, Harrow Hospital. Number referred by Medical Officers - 60 (under 1 year - 8, over 1 year - 52) Reasons for Treatment Rickets 26 Anaemia 2 Delayed Dentition 5 Recurrent Bronchitis 6 Infantile Paralysis 1 Debility 12 Flat feet 2 General Hypotonia 1 Bowed legs 4 Knock knees 1 Total 60 . -• r Convalescent Treatment. Number of cases referred - 4 (under 1 year - 1, over 1 year - 3) Reasons for Treatment Anaamia 1 Debility 1 Malnutrition 2 Total 4 11. Ante-Natal Clinics. The months of pregnancy at which women were seen for the first time:- 1st 2nd 3rd 4th 5th 6th 7th 8th 9th 4 273 523 399 223 126 62 22 - (3 not pregnant) Number of these who were primiparous women 879 " " " " " multiparous " 753 Attendances of Expectant Mothers. Clinic. First Attendances. Reattendances. Average attendance per session. Ealing Road 156 815 18 One Tree Hill 301 1,680 19 Monks Park 152 848' 20 Perrin Road 238 1,268 15 Slough Lane 200 914 21 Stag Lane 464 1,864 22 College Road 162 786 18 (opened 5.1.421) Hospital confinements. During the year 833 women were referred to various hospitals for arrangements regarding confinement:- For medical reasons 252 Home conditions unsuitable 264 Patients desired hospital accommodation 317 The number of available hospital beds for confinement remains insufficient. Representation has been made both to the ministry of Health and to the County Council regarding the matter. 12 Wembley births taking place in hospital. (a) Middlesex County Council Hospitals:- Redhill 356 Central Middlesex 259 Hillingdon 1 Maternity Hospital, Bushey 175 West Middlesex 4 795 (b) Other Hospitals:- Queen Mary's 88 Queen Charlotte's 44 Willesden Maternity 35 St. Mary's 23 University College 16 City of London 11 Middlesex 9 London Fever 6 Bearstead Memorial 5 Royal Free 5 Wembley 4 Mothers' Hospital 2 1 each at St. Mary Abbotts, Royal Northern, North Western, St. Bartholomew's, Dulwich, Hammersmith, Paddington and Guy's 8 256 i 13 5-Year Review. Year. Total No. of births notified. No. of births at home No. of births . in hospital. No. of births in M.C.C. hospitals (inc.preceding column). Births in Private Nursing Homes and at Private Addresses outside Wembley. 1938 1,821 648 854 368 319 35.6% 46.9% 20.2% 17.5% 1939 1,782 505 960 619 318 28.355, 53-9% 34.72 17.8£ 1940 1,576 578 749 607 240 37.32 47.5% 35.5% 15.2% 1941 1,539 529 781 608 229 34.4% 50.7% 39.5% 14.9% 1942 1,942 612 1,051 795 279 31.5% 54.1% 40.9% 14.3% Puerperal Pyrexia. Number of notifications received - 15 (excluding 10 Willesden Maternity Hospital cases - Willesden residents). Number of women removed to Hospital - 10. Obstetric Consultant Service. Consultant called in by private medical practitioners - 8. 14 Post-Natal Clinics. New cases 295 Subsequent attendances 93 Average attendance per session:- New cases 4.4 Subsequent attendances 1.4 Gynaecological Clinics. New cases 128 Subsequent attendances 121 Average attendance per session:- New cases 2.0 Subsequent attendances 1.9 Birth Control Sessions. New cases 112 Reattendances l8l Total attendances 293 Maternity Outfits. Number of Maternity Outfits supplied - 510. Home Helps. / No. of cases attended 49 No. of Home Helps (Dec. 1942) on panel 3 Convalescent Home Treatment. Number of Mothers referred - 3 15 Dental Services - women and children. Numbers referred to the Dental Clinic by Medical Officers. Expectant Mothers. Nursing Mothers. Children under 5 years. Numbers referred for treatment 769 176 395 Numbers who received treatment 618 152 332 Numbers made aentaly fit 591 146 326 Numbers of treatments- (a) Fillings (i) in temporaru teeth (ii) in permanemt teeth - 292 - 79 394 - (b) Number of teeth extracted 1,681 458 390 (c) Number of teeth administration of general anaesthesia (nitrous oxide) 4 93 127 142 (d) Number of persons supplied with dentures ons __82 38 - (e) Number of dentures supplied 120 56 - The above figures for 1942 may be divided as follows:- 16. consultations. Conservative treatment. Extractions. Children 423 306 140 Mothers 873 370 627 Total attendances at Cental Clinics last 5 years. Children. Mothers. 1938 826 1,497 1939 1,093 1,772 1940 1,171 1,729 1941 972 1,709 1942 869 1,870 17 Domiciliary Visits by Health Visitors. Home Visits (a) To children under 1 year 2,138 First Visits 5,251 Revisits (b) To children between the ages of 1-5 years 485 First Visits 8,949 Revisits (c) To Expectant Mothers 1,314 First Visits 2,311 Revisits (d) To Nursing Mothers 640 First Visits 475 Revisits (e) Other Special Visits 4,714 Analysis of Special Cases included in (e) above:- Children: Ophthalmia Neonatorum (notified) 11 Other eye conditions 14 Pemphigus Neonatorum 3 Measles 1,696 Whooping Cough 758 Tuberculosis - Pulmonary 10 Non-Pulmonary)Glands - )Bones 1 )Skin. - Poliomyelitis 3 Infantile Deaths 28 Other Special 64 Scabies 1,020 Mothers: Puerperal Pyrexia 17 Still Birth 53 Home Kelp Supervision 85 Prospective Day Nursery children 632 Daily Minders (informal) 31 Other Special (e.g. Diphtheria Immunisation, Home condition forms re A.N. Patients Hospital arrangements) 288 18 Disease. Total. Alperton. Central. Chalkhill. _ _ Fryent. The Hyde. Kenton. Preston. Roe Green. Sudbury Court. Sudbury. Tokyngton. Wembley Park. Total removed to Hospital. Percentage of cases removed to Hospital. INFECTIOUS DISEASES. Scarlet Fever 248 39 18 12 19 24 17 17 27 19 27 23 6 177 71.37 Diphtheria 12 3 2 - - 1 1 1 1 - - 2 1 11 91.67 Enteric Fever 2 - - 1 - - 1 - - - - - - 1 50.00 Pneumonia 134 16 4 4 9 13 3 29 15 8 9 16 8 49 36.57 Erysipelas 29 2 1 - - 5 2 2 5 1 4 6 1 10 34.48 Ophthalmia Neonatorum 7 1 - 1 1 - 1 - - 1 1 1 - 2 28.57 Acute Poliomyelitis 2 - - - - - - 1 - 1 - - - 1 50.00 Encephalitis Lethargica 1 - - - - - - - - - - - 1 1 100.00 Cerebro Spinal Meningitis 8 l - - l - 2 - 1 - - 2 1 8 100.00 Dysentery 4 l - - l 1 - - 1 - - - - 4 100.00 Measles 1,491 237 60 43 129 105 134 111 253 54 182 104 79 31 2.08 Whooping Cough 603 76 42 9 26 44 76 65 55 36 80 45 49 19 3.15 Polio Encephalitis 1 l - - — - - - - - - - - 1 100.00 19. Winter respiratory diseases. Winter period considered to begin week ending first Saturday in October and to end week ending last Saturday in March. Notifications of primary Pneumonia and acute InfluenzalPneumonia. Death certificates in which respiratory diseases mentioned. 1938-39 75 86 1939-40 61 106 1940-41 82 107 1941-42 101 135 1942-43 92 105 Non-notifiable Infectious Diseases School Children. Disease. January February March April May June July August September October November December Total ChickenPox 13 55 100 28 35 78 19 - 8 16 « 34 34 420 Mumps 48 144 165 46 98 78 47 — 16 8 10 2 662 German Measles 1 4 1 1 - 1 1 - - 2 - 2 13 Infective Jaundice - - - - - 1 4 2 4 23 21 44 99 20. Diphtheria Immunisation. Year. 0-5 5-10 10 - 15 Over 15 Totals. 1938 238 267 65 5 575 1939 181 214 63 4 462 1940 249 152 44 5 450 1941 2,454 2,102 998 32 5,586 1942 987 489 272 10 1,758 4,109 3,224 1,442 56 8,831 The percentage of the child population considered immunised on the 31st December, 1942, was - Under 5 years 58.5% Between 5 and 15 years 55.82% Intensive advice regarding the importance of immunisation against Diphtheria is given constantly to the individual Mothers of children as they are met at the Clinics, or by visits of the Health Officers to the homes. At the Wembley Hospital Fete in August literature relating to Diphtheria immunisation, as well as to the general health services of the Borough, was displayed. Two slides are in constant circulation amongst the various cinemas in the Borough - one gives the general advice to parents to have their children protected, while the second slide gives the addresses of the various Health Clinics throughout the town. The Managers or Welfare Officers at the factories in the town have been asked to display an appropriate pamphlet in a suitable place at their works (174 letters sent in June, 1942, to the larger factories). The 21. Health Visitors are visiting the homes of children who, it would appear, have not, so far, been immunised. The names of such children have been obtained through the courtesy of the Executive Food Officer. In these ways, surely, almost every family in the Borough must have been advised regarding the importance of Diphtheria immunisation. Tuberculosis. No. of Notifications. Pulmonary. Non-Pulmonary. Male. Female. Male. Female. Under 1 - - - - 1-4 1 1 3 — 5-14 4 3 3 6 15 - 24 18 32 2 3 25 - 34 25 23 2 4 35 - 44 13 7 2 4 45 - 54 7 6 — 1 55 - 64 5 1 — 3 65 & over 3 1 1 - Totals 76 74 13 21  No. of Deaths, Pulmonary. Non-Pulmonary. Male. Female. Male. Female. Under 1 - - - - 1-4 - — — — 5-14 — — 2 — 15 - 24 4 8 — 1 25 -34 12 7 1 — 35-44 4 3 1 — 45-54 7 2 1 2 55-64 7 2 1 1 65 & over 2 2 — - Totals 36 24 6 4 22. No. admitted to Hospitals No. discharged from or Sanatoria. Hospitals or Sanatoria. 145 100 During 1942, 112 cases were removed from register and at 3st December, 629 names remained on register - 535 Pulmonary and 94 Non-Pulmonary. Of the 70 deaths from Tuberculosis during the year, 20 had not been notified during life (that is 28.57%). Notifications and Deaths from Tuberculosis' in 5-year period 1938-1942. Notification. Pulmonary. Non-Pulmonary. 1938 160 37 1939 100 22 1940 100 25 1941 142 19 1942 150 34 Deaths. Pulmonary. Non-Pulmonary. 1938 39 10 1939 48 9 1940 56 7 1941 64 3 1942 60 10 23. 24. Bacteriological Service (at Middlesex Hospital). Examinations made. Quarter ending Total for 12 Months. 31.3.42 30.6.42 30.9.42 31.12.42 Throat swabs:- Diphtheria 64 (of which nil was positive) 74 (of which nil was positive) 76 (of which nil was positive) 65 (of which 1 was positive) 279 (of which 1 - .4% was positive) Haemolytic ) Streptococci) 9 7 (of which 4 were positive) 1 (Positive) 1 18 (of which 5 - 27.78% were positive) Vincents Angina 4 4 1 1 10 Sputum (Tubercle Bacilli) 34 (of which 3 were positive) 35 (of which 1 was positive) 18 (of which 5 were positive) 25 (of which 4 were positive) 112 (of which 13 - 11.61% were positive) Faeces and Urine 6 13 7 7 33 Blood 5 4 — 7 16 Films for Special Bacteria l 2 — - 3 Jaundice (infective Hepatitis). For the last twelve months an unusually large number of cases of Jaundice has been reported. The first intimation of the outbreak was in October when a private medical colleague requested help regarding a case. Since then the local medical profession in the Borough have supplied information of the occurrence of such cases while, in addition, the teachers in some schools have also been reporting cases. To the end of May, 1943, 300 cases, with one death, have been reported. The first 250 cases have been analysed in detail and Dr. Ford, late Deputy Medical Officer, has published an account of the Wembley experience in "The Lancet" (May 29th 1943). Sex incidence: 144 Males 106 Females Age incidence: 0 - 5 years 8 5-10 „ 116 10-15 „ 82 Over 15 „ 44 In the middle of November there was a sharp rise in the incidence falling mainly on 2 schools (Fryent School and Roe Green School). In Fryent School 78 known cases occurred amongst 77& children on the register and 2 of the staff were affected. No satisfactory explanation can be offered, so far, as to why this school was singled out for such a heavy attack. The figures regarding age incidence point to the relative escape of the children under 5 years of age. This has also been borne out by experience in the war-time Day Nurseries. At Neeld Crescent Day Nursery 25. (1943) one child aged 3 developed Infective Jaundice on 10th Hay. On the 7th June a member of the nursing staff became similarly ill, while 5 days later a voluntary part-time helper at the Nursery also became ill and on the 3rd August another full-time member of the staff has developed Jaundice. If these cases be connected then the first case in a young child may have commenced the sequence of 3 subsequent illnesses amongst the adult staff, while not one child has been infected. Further, at Carlyon Road Nursery 2 children aged 3½ years and 1¾ years developed Jaundice on 29th April and 1st July and there has been no subsequent case, either amongst the children or the staff. Our information points to the likelihood of a long incubation period for this illness, say 3 to 5 weeks. The condition in the main has been a mild one but one death has to be recorded in a boy aged 16 years. The disease certainly behaves clinically like an infection but it does not appear to be very infectious as is Measles or Chicken-Pox for example, but an infection surely it must be and children suffering from the disease should be excluded from school for a fortnight at least. The Ministry of Health and the Medical Research Council are conducting special investigation regarding the occurrence of Jaundice which has much increased throughout the country in general and all the information collected in Wembley has been submitted to the Ministry of Health. 26. Scabies. No. of cases of Scabies notified (January to December, 1942). January 32 February 35 March 42 April 50 May 58 June 34 July 33 August 40 September 30 October 73 November 72 December 45 Total 544 Information received from. Family Doctor 210 Borough Clinic M.O. 193 County School M.O. 73 Hospitals 38 Factory M.O. 18 Army M.O. 12 544 Numbers affected in individual Families. l person in 186 families. 2 persons „ 83 „ 3 „ „ 28 „ 4 „ „ 14 „ 5 „ „ 8 „ 6 „ „ 2 „ 27. Average flutter Scabies cases per week 10.5 Largest number in a week 30 Smallest " " " 1 Over 15 in 12 weeks. 9 Recurrent esses occurred in four families, 3 in one family, 2 in three families. During 1942 the arrangement regained with the Royal Borough of Kensington for the treatment of Scabies. In March, 1943 Wembley Hospital opened a Scabies Clinic in the premises of the Gas Cleansing rooms attached to the First Aid Post at the Hospital. With regard to Scabies, a pamphlet embodying the main points is distributed as is opportune. The following is extracted from this pamphlet. This condition always seems to become more common during war time, for example, when people may find that they are unable to maintain their usual standards of day-to-day cleanliness of person and clothing. The effective preventive measure is the common-sense one of routine baths and regular weekly changing of underclothing. At night on going to bed all the underclothing . worn in the daytime should always be taken off so that it may be spread out and thoroughly aired during the night. Inflammation of the skin is caused by the itch mite. The disease is marked by great irritation causing scratchings especially at night when the person is warm in bed. Very soon pimples or blisters occur going on to crustings, so that the affected areas take on an eczema-like appearance. When the condition is allowed to persist almost the whole body may become affected but the face and head are practically never attacked in adults, although in small children even these areas may suffer. 28. The fronts of the wrists, the webs and sides of the fingers, the backs of the elbows, the fronts of the armpits, the buttocks and the private parts, the fronts of the knees, the ankles and the back of the feet are common situations. The itch mites may be just visible to the naked eye but the condition requires the special knowledge of a doctor for its recognition. MODE OF SPREAD: The commonest method of spread is direct contact with a person suffering from Scabies. It is readily spread, for example, by sleeping in the same bed as one suffering from the complaint. Small children are often the first members of a family to be infected. This may be explained by the way children play with one another, putting their arms round each others necks for example, or as above suggested by sleeping with an infected person. A person may cause spread of the disease as long as living itch mites or their eggs are present in the skin, and if one member of the family unfortunately becomes infected it is almost certain that the condition will spread to other members, unless it be thoroughly dealt with immediately. TREATMENT: This requires the most careful attention to the strictest detail as will be explained by the doctor, and the treatment is always best given at a special treatment centre. If a person tries to treat himself it is almost certain to fail. In fact it is really impossible to apply the treatment correctly to oneself. Two attendances (sometimes three) for treatment are generally required, with a day 29 or two interval between them. With regard to children, generally they may be allowed to return to school after the first treatment. The Borough Council have entered into an arrangement for appropriate treatment to be carried out at Wembley Hospital. All particulars are given by Officers of the Public Health Department. Persons suffering from Scabies should not go to the Public Baths and should not send their underclothes or sheets or blankets to a laundry. These body and bed-clothes should be washed carefully at home. The mites are killed comparatively easily by ordinary washing and ironing with a hot iron is quite effective for clothing and blankets. The further precaution of having periods of a fortnight between putting on underclothing again or using blankets is a simple one which also ensures that any mites will be dead, while keeping garments for 2-3 days in a warm room will also kill the mites which cause the condition. There are sometimes unusual cases of Scabies transmitted to man from animals, for example horses, cats and dogs; and reinfection of persons may go on recurring until the offending animal has also been dealt with. 1. SCABIES IS A CONDITION REQUIRING CAREFUL AND SPECIAL TREATMENT. 2. THIS TREATMENT IS BEST GIVEN ONLY AT A SPECIAL CENTRE. A PERSON 'CANNOT UNAIDED APPLY THE APPROPRIATE TREATMENT CORRECTLY TO ONESELF. 30 3. THE BOROUGH COUNCIL HAVE MADE ARRANGEMENTS FOR THIS SPECIAL TREATMENT, PARTICULARS AVAILABLE FROM ANY OFFICER OF THE PUBLIC HEALTH DEPARTMENT. 4. IF ANY MEMBER OF THE FAMILY HAS SUSPICIOUS SIGNS CONSULT THE FAMILY DOCTOR AT ONCE AND ALSO ASK ADVICE IN CASE OF THE POSSIBILITY OF ANY OTHERS IN THE FAMILY BEING ALSO INFECTED. Verminous Conditions. Only 19 cases of body verminous conditions requiring special advice and assistance were found during the year - 8 were referred from hospitals, 5 from private medical practitioners, 3 the Health Clinics, 2 by factory Medical Officers and 1 by a school Medical Officer, but the Health Officers are ready always to assist Welfare Officers of factories for example. Ministry of Health Circular 2831 (2nd July, 1943) asks that a special reference to the steps taken under this circular should be included in this annual report. In their Health Education talks at the Clinics and at the Home visits, the Health Visitors always take the opportunity as occasion arises and appears appropriate, to give a word of advice regarding attention to general cleanliness and to personal habits including attention to the hair. For children under 5 years probably the best general advice is that the hair should be worn short. The adolescent girl requires a word regarding the necessity of day to day combing and brushing of the hair, as evidently there is a tendency with the present day permanent waving method of hairdressing rather to neglect this fundamental necessity. Special metal combs are 31. available at the Clinics and are given on loan when required. LETHANE hair oil preparations are advocated, and it is never to be forgotten that infestation tends to be a family condition rather than an individual infliction. At the present time, some families have unsatisfactory housing accommodation, so that it may be difficult for them to combat from day to day the possibility of accidental infestation in war-time conditions, but in Wembley, body infestation is really almost not a Public health problem. A pamphlet dealing with the main points is distributed as appropriate. The following is extracted from this pamphlet. The only safeguard against hair, skin or clothing becoming infested with vermin (lice and nits) is constant attention to general cleanliness. The daily washing of the skin and brushing and combing of the hair, with regular frequent changing (never less than at weekly periods) of underclothing, and the frequent shampooing of the hair - these are the simple but essential rules for keeping free from vermin and nits. In time of war conditions may force these rules to be broken and persons may become infested. If one of a family be found infested all the family should examine themselves carefully in case they also have accidentally become infested. Instructions for use of Lethane hair oil. (i) Amount to be applied to each head varies from about half a teaspoonful in the case of a child with short hair, to about two teaspoonfuls for a woman with long thick hair. 32. (ii) Method of application - part the hair with one hand and apply the liquid to the scalp itself with a dropper held in the other hand. This should be done in about eight places, four on each side. Then spread the oil evenly over the scalp by gently rubbing with the fingers. Do not distribute by combing as this tends to draw the special oil away from the scalp. (iii) Do not apply oftener than once a week. (iv) The head should not be washed for a week after treatment unless the scalp becomes much reddened. If this occurs the hair oil should be washed off at once. (v) After this one week's interval, the head should be thoroughly washed with soap and water and carefully combed out to remove nits. Remember to burn the combings and nits removed. There are special combs available concerning which advice is given by Officers of the Public Health Department. The problem of long hair in women and girls can of course be much simplified by shingling and this generally should be done. All articles which can be washed are easily cleansed by boiling or thorough washing in hot soapy water. Clothes which cannot be washed or boiled may be disinfested by slowly ironing with a hot iron, paying special attention to pockets, seams and creases. After ironing, the garment should be brushed thoroughly. Leather articles can be cleansed by soaking for 5 minutes in soapy water, to which has been added Cresol or similar disinfectant in the strength of 3 teaspoonfuls to a pint of water. If no facilities exist at home for carrying out the treatment of clothing, arrangements may 33 be made for disinfestation by applying to the Public Health Department or at any of the Health Clinics. On receipt of Circular 2831 the opportunity was taken again to inform by letter, the local medical profession, the hospitals, the school Medical Officers, the Midwives and the Welfare Officers of factories of the schemes available and the assistance which may be obtained from the Public Health Officers with regard to both infestation and Scabies. (8l letters sent to the larger factories July, 1934). Venereal Disease. The Middlesex County Council is the authority responsible for this service. Posters are shown on the Council's Notice Boards throughout the Borough, at the Health Clinics, Swimming Pools, the Public Conveniences while information is given at the Public Health Department regarding treatment centres and the hours of attendances. The Middlesex County Council conducts special Clinics at the Central Middle sex Hospital, the "West Middlesex Hospital and at the Hillingdon Hospital. In addition, a list of London Hospitals undertaking this treatment has been distributed to all doctors and may be consulted at the Public Health Department. Disinfection of Premises and Articles. Disinfections for:- Infectious Diseases 433 Cancer 28 Vermin (routine protection from) 309 Miscellaneous 127 34 Articles disinfected:- Disinfected. Destroyed Beds 184 4 Bolsters 388 1 Blankets 2,619 — Carpets 1 — Counterpanes 681 2 Covers 22 — Cushions 120 2 Mattresses 1,769 7 Palliasses 41 — Pillows 2,052 11 Rugs and Mats 40 — Sheets 900 3 Wearing Apparel 605 6 Sundries 273 — Totals 9,695 36 E. ENVIRONMENTAL HYGIENE, FOOD AND WATER, Number of verbal notices given 391 „ „ „ „ complied with 232 „ „ written notices served 509 „ „ „ „ complied with 536 " " statutory notices served 53 „ „ „ „ complied with 30 Number of complaints received and investigated 1,613 General sanitation inspections (including 1,239 visits to Air Raid Shelters) 11,187 Nuisances abated and improvements effected (including Air Raid Shelters - 15) 1,525 35. Some Housing Details. Visits to dwelling houses 7,552 Nuisances abated and improvements effected 1,241 Total number of dwelling houses inspected for defects (under Public Health or Housing Acts) 2,229 Number of inspections made for the purpose 4,921 Number of dwelling houses (included in above) which were inspected and recorded under the Housing Consolidated Regulations 1925/1932 14 Number of inspections made for the purpose 71 Number of dwelling houses found not to be in all respects reasonably fit for human habitation 1,619 Number of defective dwelling houses rendered fit in consequence of informal action 1,626 Proceedings under Public Health Acts. (1) Number of dwelling houses in respect of which notices were served requiring defects to be remedied 41 (2) Number of dwelling houses in which defects were remedied after service of formal notices - (a) By owners 17 (b) By Local Authority in default of owners 8 x x Includes compliance in 1942 of 2 Notices served in 1941. Proceedings under Sections 11 and 13 of the Housing Act, 1936. Number of dwelling houses in respect of which Demolition Orders were made 7 36. Overcrowding. Number of certificates issued giving the number of persons who may occupy a house 17 Number of dwellings overcrowded at end of year 85 „ „ families dwelling therein 86 " " persons " " 490 " " new cases of overcrowding reported during the year 88 " " overcrowded families relieved during the year 21 (1) by removal of members of family 9 (2) " " " families to other known address 3 (3) " " to unknown addresses 5 (4) " " " Council houses (included also in 2) - (5) " " of sub-tenants and lodgers 4 (6) Number of persons included in such relieved cases 150 Disinfestation. Visits paid re vermin or suspicion of - for Bed Bugs 178) "other ) Vermin 92) 270 Verminous premises disinfested - for Bugs 54) " other ) Vermin 25) 79 Council houses disinfested 13 Methods employed - hydrogen cyanide 0 sulphur 1 The others were disinfested by liquid insecticides. Verminous articles destroyed 12 37- Outworkers. Number on the register 31.12.1942 125 " of visits paid to premises 121 Offices. Number on the Register 234 Nun be r of visits paid 280 Defects found 2. Defects remedied 1. Meat and other Foods. Number of inspections made - 3, 435 Nuisances abated and improvements effected:- Meat Shops, Stalls &c. Premises cleansed 51 " " " " Other traventions remedied 19 Cowsheds - contraventions remedied 1 Dairies - cleansed and limewashed 18 " premises repaired 5 " other contraventions remedied 8 Bakehouses cleansed and limewashed 37 " sanitary conditions improved 8 " other contraventions remedied 8 Fried Fish Shops cleansed and limewashed 11 " " " sanitary conditions improved 2 n n ii other contra- ventions remedied 4 Fishmongers &c., contraventions " 9 Grocers " " 59 Greengrocers &c. " " 51 Restaurants, Cafes &c. " " 29 Other Food premises " " 4 324 38. Dairies and Milk Shops. Number of Dairies registered 28 " " purveyors of milk registered with premises in the Borough, selling milk in properly closed and unopened receptacles 48 " " purveyors of milk registered whose premises are outside the Borough 24 " " Dairies (included above) where milk is bottled, etc. 5 Milk (Special Designations) Regulations 19^6 to 1942. Designation of Milk. Licences issued. Samples taken. Samples not satisfactory. Pasteurised 34 64 4 Tuberculin Tested 23 33 5 T.T. (Pasteurised) - 7 - T.T. (Certified) — 1 — Accredited 2 13 — 59 118 9 Food Poisoning. In order to deal convincingly with suspected food poisoning outbreaks it is generally essential to secure bacteriological confirmation of contamination by toxic organisms or their products. While Laboratory facilities are available, in practice it has rarely been possible to submit early enough faeces samples and any portion at all of a suspected foodstuff. The result is that many cases reported as food poisoning are not so confirmed and other evidence, e.g. other people having eaten the 39. same meals without ill effect, often suggests that cases of diarrhoea (and vomiting) thought at first to be food poisoning must have been due to other unidentified causes. Illustrative of this was a complaint received that an outbreak of "food poisoning" had occurred amongst persons who had partaken of a canteen meal in a local factory• Fourteen employees stated they had suffered from diarrhoea, and six of these detailed their symptoms to the Sanitary Inspector. The suspected meal had been sent in bulk from an adjoining cafe. It was found that the cafe had also served some three hundred persons with a similar lunch prepared under identical conditions and evidently without complaint. This was checked by enquiry at the offices of a Services detachment which comprised a high proportion of these customers. The cafe could in these circumstances be regarded as most probably exonerated and consideration had to be given to the possibility of contamination at the factory. Here again, fifty such meals were served and while it was quite possible that more than fourteen persons had suffered some not reporting - the majority had experienced no ill effect. All but three "cases" were at work on the day following and no samples of faeces could be obtained. In the case of only two absentees was medical evidence obtainable, one was visited by the Medical Officer of Health of the district in Which she resided and he found her to be suffering from tonsillitis. The other was certified by her medical attendant to be suffering from gastroenteritis but any investigation of this case was blocked by the impossibility of discovering her whereabouts. Thus while nothing other than the canteen meal was suspected there was absence 40 of any causative organism demonstrated by the Laboratory and all the available evidence indicated that the sources of the illnesses might have been elsewhere than in this particular food supply. Altogether there were 7 notifications in the year from medical practitioners while from other sources of information investigations were always made but in no case was any foodstuff proved culpable. The constant attention to food premises which is given by the Sanitary Inspectors does much to safeguard the public health of the Borough. During the year 25 inspections were made on the suspicion of food poisoning occurrences. Laboratory Examinations re Food, Milk and Water (at Middlesex Hospital) Examinations made. Quarter ending Total for 12 months 31.3.42 30.6.42 30.9.42 31.12.42 Food 2 1 - 3 6 Milk 28 38 46 18 130 Water 15 20 45 16 96 Chemical tests for chlorine content of Swimming Pool water made by Inspectors - 213. 41 F. DAI NURSERIES. The first war-time Day Nursery was opened at 55 Ealing Road on 2nd December, 1941, while the eighth Nursery is due to be opened at the beginning of September, 1943. Nursery. Date of Number of opening. children's places. Ealing Road December, 1941 40 Neeld Crescent January, 1942 3& Princes Avenue August " 40 ( 50 in July 1943) Carlyon Road " " 40 (50 in July 1943) Old Kenton Lane January, 1943 45 Harrowdene Road February " 47 District Road Mid-August " 50 Woodstock Road Beginning September, " 50 Daily cost (pence) per child-in-attendance of all foods (as purchased uncooked) provided at the Nurseries (all food provided for staff reckoned as part of the cost of feeding the children). First observation made from date of opening of Nurseries. To 30.6.42 From 1.7.42 to 30.9.42 Ealing Road 9.58 8.97 Neeld Crescent 8.82 8.48 To 30.4.43 Princes Avenue 9.75 Carlyon Road 8.89 42. To 31.5.43 Old Kenton Lane 9.73 Harro'.vdene Road 13.82 x x This higher figure due to fact of low attendances of children for first 3 months while full staff employed. The possible introduction of infectious disease to Nursery communities of very young children is always an anxiety, and the exclusion of children from the Nursery may also interfere with the Mothers' war work. From our experience routine action has now been decided upon but every individual set of circumstances requires individual consideration. The following Table gives the incidence of the main infectious diseases in the Nurseries with the pertinent details after considering which, along with the experience of the infections amongst the general child population in the Borough, it has been decided to take the action indicated in the Table. The parents, of course, must themselves always decide, but we are satisfied to assist by the advice as indicated. 43 INFECTIOUS DISEASES IN DAY NURSERIES FROM 2.12.41 TO l^.S.47. Disease. No. of introductions. Only one Case. Nos. attacked. Nos. susceptible. Length of Outbreak (more than one Case). Action re new admissions who have not had disease. Measles 10 2 109 48% 229 Average 6 weeks Longest 9 „ Under 2's NO. Over 2's tell parent and allow in if no chest weaknesses. Whooping Cough 5 1 41 40% 102 Average 10 „ Longest 15 „ Under 2's NO. Over 2's tell parents and allow in if no chest weaknesses. Chicken Pox 5 3 35 - 8 weeks and 14 weeks. Tell parents and let them decide. Scarlet Fever 6 2 14 - 4 weeks, 1 week, and 3 weeks. Routine cessation of all admissions for one week. 44. Mumps 3 1 7 - 1 week and 2 weeks. Tell parents and lot them decide. German Measles Almost always a very mild illness. Tell parents and let them decide. Diphtheria There has been no introduction. As all children over one year should have been immunised on entry special consideration will always be required. Epidemic Jaundice 2 cases so far: 1 on 29.4.43 and the other on 10.5.43 - at two different Nurseries. Exclude individual child attacked for minimum of two weeks. (See note on Page 25). Regarding new admissions tell parents and let them decide. This may require further consideration as knowledge of disease develops. 45. Irnunis-rtion treatment for Nursery Children. Immunisation against Diphtheria is now on sure ana sound medical foundation. All children over 10 months should be immunised unless there be some individual contra indication. This advice has been accepted almost universally for all the children immediately on admission, if they had not been already treated. Regarding Whooping Cough a valuable prophylactic vaccine is available, but the number of injections necessary is, so far, 4 or 5 and while the experience is, at least, that the severity of the attacks may thus be lessened and in many cases the illness prevented, certain research work is still going on. Lately the use of a special alum precipitated vaccine by two injections at a month's interval is reported to have given promising results. The parents of the children at the Nurseries have been offered Whooping Cough prophylaxis and this has been very well accepted. The numbers are, of course, still small but our experience has pointed so far towards definite success, and there have been no untoward reactions. No. on entering Nurseries not protected by previous attack. No. treated with full, course vaccine. No.known to have been subsequently attacked. No. not treated with full course vaccine. f- No.known to have been subsequently attacked. 326 206 6 120 35 i.e. 2.9% i.e. 29% 46. In considering any significance of these figures it must be taken into consideration that in them are contained the figures relating to two Nurseries in which there was actually no introduction of Whooping Cough at all, and that at another Nursery only two cases had occurred. The special observations made at Ealing Road Nursery should be recorded. The Nursery opened on 2nd December, 1941, and the first case occurred on 6th January, 1942. Between this date and 24th April, 1942, there were 17 cases. Another outbreak v/ith 10 cases was experienced between 12th January, 1943, and 1st April, 1943. Ealing Road Nursery. No. on entering Nursery not protected by previous attack. No. treated with full course vaccine. No. known to have been subsequently attacked. No. not treated with full course vaccine. No. known to have been subsequently attacked. 58 35 4 23 23 Regarding all these figures it must be emphasised that further experience is required and factors taking note of the length of exposure and its varying risk in each individual child and the interval since immunisation treatment all require some consideration for any such figures to have statistical significance. It is also to be remembered that when a child leaves the Nursery the necessity of reliable and trained observation is lost, a most important point in any statistical evaluation. 47. Between 2nd December, 1941, and l6th June, 1943, there have been 135 cases of Measles amongst children attending the Nurseries and 4 of these have suffered from Otitis Media (that is 2.96%). Student Nurses. At the time of writing (August, 1943) 18 Student Nurses are engaged in the six Nurseries open. All the Nurseries are affiliated with the National Society of Children's Nurseries and all the Student Nurses are prepared for the National Society's Diploma for Nursery Nurses. The syllabus of subjects dealt with by lectures to the Students is given below. Subject No. of Lectures Lecturer Details Food M.O.H. Principles of a balanced diet Preservation of food - Deficiency and shortage. Food 4 Miss Gregg (Nursery Nurse) Milk - Breast feeding Composition of human milk. Test weighing Weaning - Diet of nursing mother. Cows milk Composition Types - Sources of contamination. Dietaries for all ages up to five years. Food 1 Mrs. Griffith (Sister-in- Charge) Food vitamins. 48. Subject No. of Lectures Lecturer Details Home Nursing & First Aid 3 Mrs. Ridge (Sister-in- Charge) Charting of T.P.R. Blanket bathing. Invalid Diet. Bandaging. Treatment of cuts - burns bleeding sprains. Concussion. Foreign bodies in eye - nose ear. Prevention of accidents. Design and materials used. Ages 0-1) Summer and Winter 1-2) 2-5) Head and foot gear - Bed clothing General care of clothes Packing. Sanitation 3 Chief Sanitary Inspector Water - Prevention of contamination Cleansing stations Public Baths Care of Drains etc. 49 Subject No. of Lectures Lecturer Details Common Ailments & Diseases 2 Mrs. Griffith (Sister-in- Charge) Colds Bronchitis Adenoids Discharging eyes and ears Sore buttocks. „ 3 Mrs. Scarsbrook (Sister-in- Charge) Constipation Diarrhoea Colic Vomiting Faulty posture or gait Thrush - Skin rashes - Bed wetting Intestinal worms Ringworm. Deficiency Diseases 3 Mrs. Wilson (Sister-inCharge) Rickets Scurvy Anaemia. Physical Development 5 Assistant M.O.H. The Normal infant - General care and appearance, and activity Helplessness and dependence Rapid development - Importance of first month - Weight and height charts - Walking and talking Measures for ensuring good bones and teeth. The premature baby. Twins. 50. Subject No. of Lectures Lecturer Details Infectious Diseases 5 Assistant M.O.H. Vaccination Diphtheria immunisation. Incubation and quarantine Isolation and disinfection. Measles - Scarlet Fever - Diphtheria Whooping Cough Chicken Pox Influenza. Mental Development 4 Miss Thomas (Psychologist Mental Health Emergency Committee) Habit - Routine and rest Environment and its adaptation Individuality and temperament Normal behaviour at various ages Speech; backwardness; stammering Nervous and backward children — Fear - Occupation and play - Choice of toys and playthings. Anatomy & Physiology 10 Matron Description of skeleton and position of organs. Mechanism of circulation and respiration Elementary principles of digestion and nervous systems Excretion - Eyes; nose; teeth; ears. 51- Subject No. of Lectures Lecturer Details Hygiene 5 Matron Need for personal cleanliness Baths - Nasal hygiene - Care of hair and nails. -- - - - Attention to bowels, skin, bladder. Exercise, rest and sleep. Sun bathing. Ventilation Temperature Quality of air Different forms of heating and lighting. Precautions against fire. Furnishing, decoration and cleanliness of Nurseries. Protection against accidents (window guards, safety straps). Parasites. Cooking 4 Mrs. Champion (Diploma, Domestic Science, Board of Education). Cooking of children's diets Meat, Fish, etc. Milk puddings, Fruit, Junkets. ! 52. G. CIVIL DEFENCE. Number of Circulars from Ministry of Health Ministry of Home Security, London Region Middlesex County Council and miscellaneous received in Health Department 656 Number of letters sent to Doctors in charge of First Aid Posts re medical matters 22 Number of instructions sent to Depot Superintendents 220 Number of letters sent to Sisters-in-Charge of First Aid Posts 242 Personnel (Dec. 1942). Full time. Part time. Two Ambulance Depots 102 66 Six First Aid Posts (fixed) 51 100 Two Mobile Units (1 heavy 1 light) 20 — Totals 173 166 Doctors-in-Charge First Aid Posts and heavy Mobile Unit - 7, Deputies - 6. Arrangements were made whereby the personnel might give voluntary service at the Central Middlesex Hospital, at the Day Nurseries, at the Scabies Clinic Wembley Hospital, at the County Orthopaedic Clinic, Stag Lane, while many have given much appreciated assistance in the making of garments for the children at the Day Nurseries. 53- H. PUBLIC HEALTH DEPARTMENT - FULL TIME STAFF, AUGUST 1943. (Figures in brackets refer to December 1938 - last pre-war year). Medical Specialist Technical (Medical Officers 4 (3) ) (Health Visitors 12 (10) ) (Sanitary Inspectors 6 (6) 30 (24) ) (Home Helps 3 (0) ) (Disinfectors etc. 5 (5) ) Day Nurseries 65 (0) Clerical Administrative Executive Civil Defence (Casualty Medical Service and also Manning Civil Ambulance Service) 152 (0)) ) 13 (10) 260 (34) SUMMARY. The public health was well maintained throughout still another full war year. The number of births recorded and the birth rate were the largest for any year, so far, in the Borough. The infantile mortality rate was the smallest, being 34.16 per thousand live births (1,988 live births), the previous lowest infantile mortality rate having been 34.26 in 1935 (1,605 live births). Forty six per cent of the infant deaths in 1942 took place within the first week of life, the period during which the nonpreventible deaths mostly occur. The percentages of deaths at stated ages show that the Borough's population is settling, and the percentages of total deaths under 1 year and under 50 years should be now expected to tend to fall for a number of years. The incidence of the infectious diseases was not abnormal except for a rise in the number of notifications of scarlet fever. The number of cases of cerebro spinal 54. meningitis fell from the high incidence in the first two years of the war. It had become usual to forecast a measles epidemic every two years but for some still unexplained reason outbreaks of measles have been occurring since the war began at much more frequent intervals. A number of cases of jaundice has been occurring in various parts of the country and its incidence in Wembley has been given some detailed observation. Tuberculosis continued to take its relatively higher toll at the most active periods of life and then more particularly amongst women. The various Health Services of the Borough were fully used and appreciated. After many setbacks College Road Clinic was opened at the beginning of the year; and the Council's scheme for Clinic premises now awaits the central Clinic in London Road and a peripheral Clinic in Church Lane. These would replace the only two remaining unsatisfactory premises. The Council entered into an agreement with Harrow Hospital for Sunlight and Massage treatment to be given at that Hospital's Clinic in Marlborough Hill, while an arrangement was entered into with the Middlesex County Council for the Education Committee's Orthopaedic scheme to be available for children under 5 years of age. A complete bacteriological service is provided at the Bland Sutton Institute, Middlesex Hospital. The demand for hospital beds for confinements is not satisfied and during the year it was impossible to provide Home Helps in sufficient numbers for domiciliary confinement cases. This service has lately been augmented by the appointment of three full-time Home Helps. In view of the discomfort ana unrest caused by scabies the ascertainment and treatment of such cases have become of considerable 55- importance in the war effort. The arrangement made by the Council would appear to be sufficient and are well used. The Importance of health education cannot be over-emphasised and at the Clinics especially every opportunity is taken to promote a health conscience, while the Health Visitors in their domiciliary visits have as a first responsibility the duty of inculcating the fundamental principles of healthy living. Diphtheria immunisation must be still more accepted if the possible victory over this disease is to be won. Constant attention was paid by the Sanitar Inspectors to the supervision of the food supply as the figures of this review show. With regard to housing the minimum essential is a healthy comfortable dwelling for every family and the Council have lately made representation to the Ministry of Health on the difficulties of abating overcrowding and of dealing appropriately with certain special cases. There are now eight War-time Day Nurseries in the Borough and their good work is best revealed by watching the obvious and constant progress in the health and development of the children. On experience we have been able to lay down procedure in order to avoid undue empty places in the Nurseries from an introduction of some of the infectious diseases. The experience with whooping cough vaccine has been promising. The Casualty Civil Defence Services and the many other immediate war-time arrangements, 56 dealing of course with war potentialities as well as with actual occurrences, has continued to call for constant attention and review from the public health points of view (food, water, sanitation, etc.). I cannot complete this report, the record of a very busy year, without respectfully acknowledging my debt to the staff of the Department. The various sections - one and all - have been an efficient and loyal team. The personnel to-day is almost eight times in number the personnel immediately before the war, and still the fullest coordination has been maintained throughout all the services. It is my pleasant duty also to bring to the notice of the Council the valuable work of the Voluntary Helpers in the Clinics. I have the honour to be, Mr. Mayor, Ladies and Gentlemen, Your obedient Servant, A.G. MORISON. Medical Officer of Health. 17th August, 1943. 57-