WEM 24 BOROUGH OF WEMBLEY. INTERIM REPORT of the MEDICAL OFFICER OF HEALTH FOR THE YEAR 1943 Of A.G. MORISON, M.A., M.D., D.P.H., Medical Officer of Health. 1944. BOROUGH OF WEMBLEY. INTERIM REPORT of the MEDICAL OFFICER OF HEALTH for the Year 1943 To the Mayor, Aldermen and Councillors of the Borough. Mr. Mayor, Ladies and Gentlemen, In accordance with Ministry of Health Circular 10/44 the Annual Report on the Health Services The Borough for 1943 is again an Interim one, mainly statistical in form. To comply with the instructions of the Circular, however, certain essential figures are omitted. Matters Already presented in detail to the various comittees if mentioned again in this Report are referred to only shortly. CERTAIN VITAL STATISTICS 1943, from figures supplied by Registrar General. (some comparative 1942 figures within brackets). Live Births. Male Female Total Legitimate 1,027 967 1,994 Live (1,915) Birth Illegitimate 46 31 77 Rate (73) (-) Stillbirths. Legitimate 28 25 53 Rate per (62) 1,000 Illegitimate 1 3 4 total (4) (Live and Still) births 26.79 (32.13). Infantile Mortality. Deaths of Infants under 1 year of age:- Male Female Total Legitimate 47 25 72 (66) Illegitimate 3 2 5 (2) Death rate of Infants under 1 year of age:- All infants per 1,000 live births 37.18 (34.16) Legitimate infants per 1,000 legitimate live births 36.ll (34.46) Illegitimate infants per 1,000 live illegitimate births 65.OO (27.40) Deaths from - Cancer (all ages) 183 " " Measles (all ages) 1 " : Whooping cough (all ages) Nil " " Diarrhoea (under 2 years) 14 Maternal Mortality. Deaths from puerperal sepsis 3 (2) Other puerperal causes 2 (3) Maternal Mortality Rate per 1,000 live births 2.41 (2.52) Maternal Mortality Rate per 1,000 total (Live and Still) births 2.35 (2.43) 2. Causes of Deaths during the year. 1942 Total Causes of Death. Male Female Total 1,041 All causes 511 505 1,016 — Typhoid & para-typhoid fevers - - - 3 Cerebro-spinal fever - 2 2 — Scarlet fever - 1 1 2 Whooping cough - - - 3 Diphtheria - - — 51 Tuberculosis of respiratory system 32 26 58 12 Other forms of tuberculosis 1 6 7 3 Syphilitic diseases 6 4 10 8 Influenza 11 17 28 2 Measles 1 — 1 - Ac. polio-myel: & polio-enceph - - - — Acute infectious enceph: - - - — Cancer of buc: cav: & oesoph (m) - - - 27 uterus (F) 2 11 13 23 Cancer of stomach & duodenum 20 8 28 18 Cancer of breast — 21 21 111 Cancer of all other sites 68 53 121 9 Diabetes 4 7 11 89 Intra-cranial vascular lesions 36 64 100 249 Heart disease 106 98 204 42 Other dis: of circ: system 21 23 44 56 Bronchitis 24 18 42 54 Pneumonia 36 27 63 15 Other resp: diseases 9 4 13 16 Ulcer of stomach or duodenum 6 3 9 12 Diarrhoea under 2 years 10 4 14 13 Appendicitis 3 l 4 29 Other digestive diseases 11 11 22 20 Nephritis 9 10 19 2 Puerperal & post-abort: sepsis - 3 3 3 Other maternal causes - 2 2 15 Prem: birth 13 8 21 32 Congenital malf: birth injury & infant diseases 16 9 25 6 Suicide 7 8 15 7 Road traffic accidents 5 5 10 27 Other violent causes 17 10 27 82 All other causes 37 41 78 3. Of the 1,016 deaths 535 (that is 52.66%) occurred elsewhere than within the Borough boundary and 531 took place in hospital (that is 52.17%). The principal causes of Death. Disease. Total number of deaths. 1. Heart disease and other diseases of circ: system 248 Intra-cranial vascular lesions 100 348 2. Cancer 183 3. Respiratory diseases:- (a) Bronchitis 42 (b) Pneumonia 63 (c) Other respiratory diseases 13 118 4. Tuberculosis:- (a) Respiratory system 58 (b) Other forms 7 65 5. Violent deaths (a) Suicide 15 (b) Road traffic 10 (c) Other violent causes 12 52 6. Premature births 21 Congenital malf: birth injury & infant diseases 25 46 7. Digestive diseases:- (a) Appendicitis 4 (b) Other digestive diseases 22 (c) Ulcer 9 35 8. Acute infectious diseases:- (a) Cerebro-spinal fever 2 (b) Scarlet fever 1 (c) Influenza 28 (d) Measles 1 32 4. The four main causes of death remained as in the previous year; but afterwards in order came violent deaths, premature births, congenital malformations etc., and digestive diseases, instead of, as in 1942, digestive diseases, premature births, and violent deaths. Percentage of total deaths under 1 year. Percentage of total deaths under 50 years. Percentage of deaths taking place in Hospitals. 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 1943 7.61 25.59 52.17 B. CERTAIN OTHER ESSENTIAL LOCAL STATISTICS. Birth Notifications. Notified by. At home. In Hospital. In Nursing Home. Totals. Doctors 87 800 297 1,184 Midlives 564 234 49 847 Parents 6 — — 6 Totals 657 1,034 346 2,037 Percentages 32.25 50.76 16.99 100 Live births - 1,987. Stillbirths - 50. 5- Infantile Mortality. Deaths from stated causes at various ages under 1 year of Cause of Death (extracted from weekly returns of local Registrars, and 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 17 3 3 1 24 2 - - - 26 Congenital defects 6 1 - — 7 - 2 - - 9 Atelectasis 5 1 — - 6 - - - - 6 Asphyxia neonatorum 2 — — - 2 - - - - 2 Gastro-enteritis — — — — — 3 2 2 1 8 Neonatal diarrhoea — — — 1 1 - - - - l Pneumonia — — 1 1 2 2 2 3 1 10 Bronchitis 1 — — - 1 - - - - 1 Pulmonary abscesses — — 1 — 1 — — — — 1 Intra-cranial haemorrhage _ _ - 1 1 - - - - 1 Cerebral do. 2 — — — 2 - - - - 2 Convulsions 1 — — — 1 - - - - 1 Meningitis — — — — - - 1 1 - 2 Marasmus — — — — - - - 1 _ 1 Intussusception — — 1 — 1 _ - - _ 1 Septicaemia — — 1 — 1 - _ _ - 1 Measles — — — — - - - - 1 1 Tuberculosis — — — — - - _ 1 - 1 Hydrocephalus — — — — - - - - - 1 Violence (criminal) — — — — - 1 - -— — 1 34 5 7 4 50 8 8 8 3 77 Of the 77 deaths which occurred in children who never celebrated their first birthday, 34(i.e.44%) occurred within the first week of life while 50 (i.e. 65%) occurred within the first four weeks of life 6. Infantile Mortality 1939-1943 Year. Wembley. England & Wales. 1939 39.12 50 1940 57.86 55 1941 42.32 59 1942 34.16 49 1943 37.17 49 Infantile Mortality during last 5 years (9,111 live births - 379 deaths under 1 year). 41.60 Maternal Mortality. Three deaths from puerperal sepsis were recorded in 1943, and 2 deaths occurred from other puerperal causes. Rate per 1,000 total births (Live end Still) 1939-1943. Year. Wembley. England & Wales. 1939 5.96 2.93 1940 2.97 2.16 1941 4.30 2.23 1942 2.43 2.01 1943 2.35 2.29 Maternal Mortality during last 5 years (9,381 total births - 33 Maternal deaths). 3.52 Marriages. In Churches 554 At. Registry Office 220 7- C. ' HEALTH SERVICES. As expansion of the Health Services took place and on the occurrence of any special public health circumstance the local medical profession was kept informed. For example, circular letters dealt with the continued prevalence of jaundice, the arrangement with Wembley Hospital for the treatment of scabies, the provision of insulin according to Ministry of Health Circular No. 27the transference of the Borough Council's civilian ambulance service to the Public Health Department, the medical and nursing assistance made available for influenza according to suggestions by the Ministry of Health. A booklet was compiled and circulated giving the various Health Services available and certain other medical information. Provision of Insulin. Number of patients who received free insulin in accordance with the Borough Council's scheme (from 9th March to December) 9. Total cost of insulin provided - £28.16. 1. Ambulance Service. On l6th June the Borough civilian (noninfectious) ambulance service was transferred from the National Fire Service to the Public Health Department. The ambulances are stationed at the Civil Defence Ambulance Depots, 2 at Barham Park and 1 at Kingsbury, the vehicles being manned by the Civil Defence personnel. (1) Infectious Diseases. Removals carried out:Quarters ending 31.3.43 30.6.43 30.9.43 31.12.43 108 109 151 226 Total:- 594 8. (2) Non-infectious cases Accident removals 630 Sick removals 2,610 Maternity removals 464 Total 3,704 Health Clinics. (Some comparative 1942 figures within brackets). Total number of children who first attended at the Clinics during the year and who, on the date of their first attendance were under 1 year of age 1,857 (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 189 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 1,741 (2) Over " " " " 958 Total 5,699 (5,784) Number of attendances by children under 1 year of age 42,833 (40,005) Number of attendances at all the Health Clinics by children between the ages of 1 - 5 years 21,194 (21,149) 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 1943 93.5 (93.7) (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). 9 Number of attendances at the ante-natal Clinics 11,328 (9,936) Total number of women who attended for the first time 1,670 (1,686) Percentage of total notified births (Live ana Still) represented by the total number of women who attended the Clinics for the first time during the year 82.0 ( 86.8) Slough Lane Clinic. In October the Church was damaged in an air raid and since then the Clinic Sessions have had to be conducted at Stag Lane Clinic. While the distribution of special foods and the Government vitamin products was able to be continued at the Church it was impossible to hold the Ante-natal and Infant Welfare Sessions. At the time of writing (June 1944) the necessary repairs are still incompleted. Attendances at the various Health Clinics. Children under 1 year of a^e. Clinic. Total Attendances, Average attendance per session. Stag Lane 9,051 59.9 Slough Lane 6,387 62.0 College Road 6,060 60.6 Ealing Road 4,343 45.2 Perrin Road 6,623 42.7 Monks Park 4,742 45.6 One Tree Hill 1 5,842 38.7 10. Children between the ages 1-5 years. Clinic. Total Attendances. Average attendance per session. Stag Lane 4,534 30 Slough Lane 2,981 29 College Road 3,600 36 Ealing Road 2,359 25 Perrin Road 2,636 17 Monks Park 2,538 24 One Tree Hill 2,545 17 Domiciliary Nursing. Children referred for treatment to the Wembley and Kingsbury District Nursing Associations. Infants under 1 month 21 Children „1 year 50 „ over 1 „ 32 Eye Clinic. 89 children referred to Middlesex County Council Ophthalmic Clinics. Orthopaedic Clinic. 114 children referred to Middlesex County Council Orthopaedic Clinic. Child Guidance Clinic. An arrangement was entered into with the Middlesex County Education Committee according to which children may be referred to the County Child Guidance Clinic at 2 St. John's Road, Harrow. A report was submitted dealing with the subject of child guidance in general, its 11. history, the aims of the movement, the institution of special Clinics in this country, the type of problems dealt with and methods of dealing with them. Child guidance may be defined as a specialised investigation of those causes which disturb normal mental stability and social adjustment in children, and the application of suitable methods of prevention and treatment. Children referred to these Clinics are not congenitally nor incurably abnormal; they should be those who can be helped to adjust themselves to the community in which they live. One child was referred in 1943. Dental Clinic. See Page 19 Artificial Sunlight and Massage Treatment. Number referred by Medical Officers 117 (under 1 year 12, over 1 year 105) Reasons for Treatment Rickets 40 Anaemia 2 Delayed dentition 21 Recurrent bronchitis 4 Debili ty 39 General hypotonia 5 Bowed legs 4 Knock knees 2 Total 117 12. Convalescent Treatment. Number of cases referred 6 (under 1 year 1, over 1 year 5) Reasons for Treatment:- Anaemia 2 Debility following illness 2 Malnutrition 1 Congenital heart disease 1 Total 6 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 25 363 507 308 187 71 56 24 10 Attendances of Expectant Mothers. Clinic. Total Attendances. Average attendance per session. Stag Lane 3,055 22 Slough Lane 1,099 21 Individual College Road 1,053 21 women who Ealing Road 1,226 24 attended Perrin Road 1,636 16 1,673. Honks Park 1,348 26 3 not One Tree Hill 1,911 19 pregnant. The Council again made application to the Minister of Health to become the Local Supervising' Authority under the Midwives Acts. A full scheme was submitted at the request of the Minister but after the Mayor and Chairman of the Maternity and Child Welfare Committee had attended at the Ministry the application was refused for a second time. 13. X-Ray Ante-Natal Examinations. Number of Ante-natal patients referred 6l. Clothing Coupons for Expectant Mothers. The administration of this4 service was transferred to the Food Office on 24th July. Number of cases dealt with by the Public Health Department:- 1941 1,190 1942 2,259 1943 1,277 Total 4.726 Hospital Confinements. During the year 774 women were referred to various hospitals for arrangements regarding confinement Medical reasons for reference to hospital:- Abnormality of maternal pelvis 62 Age at first pregnancy elderly 41 " " " youthful 3 Previous abnormal pregnancy 35 " " labour or puerperium 33 Stillbirth previous confinement 17 Maternal ill-health (various causes) 32 Toxaemia 4 Heart disease 22 Tuberculosis 8 Other condi tions 17 274 Home conditions unsuitable 287 Mothers desired hospital accommodateon 213 It has continued to be impossible for all women who wish to be confined in hospital to # 14. obtain hospital accommodation. The Council have again approached both the Ministry of Health and the County Council regarding the matter. The County Hospitals have been able to admit only those women concerning whom there are medical reasons for hospitalisation and a limited number whose home conditions were unsatisfactory. Wembley births taking place in hospital. (a) Middlesex County Council Hospitals:- Redhill 318 Central Middles 240 Maternity Hospital, Bushey 175 West Middlesex 7 740 (b) London Hospitals Queen Mary's 68 Queen Charlotte's 56 St. Mary's 45 University Collage 32 City of London 18 Middlesex 18 Charing Cross 16 Royal Free 10 Paddington 5 St. Bartholomew's 4 Elizabeth Garrett Anderson Hammersmith 4 3 London l Mothers' Hospital l 281 (c) Other Hospitals':- Bearsteaa Memorial 9 Willesden Mt-Maternity 2 Wembley 1 Perivale 1 Total 1,034 15. Year Review. Year. Total Mo. 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 3 Homes and at Private Addresses outside Wembley. 1939 1,782 505 960 619 318 28.3% 53.9% 34.7% 17.8% 1940 1,576 578 749 607 240 37.3% 47.5% 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 31.52 54.1% 40.9% 14.3% 1943 2,037 657 1,034 740 346 32.2% 50.8% 36.3% 17.0% Puerperal Pyrexia. Number of notifications received 21 (excluding 18 Willesden Maternity Hospital cases Willesden residents). Number of women removed to Hospital 16. Obstetric Consultant Service. Consultant called in by private medical practitioners - 4. 16. Post-Natal Clinics, New cases 285 Subsequent attendances 102 Average attendance per session:- New cases 3.5 Subsequent attendances 1.5 Much attention is given to the importance of breast feeding. Test feeding scales issued on loan to 335 Mothers. Gynaecological Clinics. New cases 148 Subsequent attendances 132 Average attendance per session New cases 2.1 4 Subsequent attendances 1.9 Birth Control Sessions. New cases 128 Reattendances 221 Total attendances 349 Special Milk Grants, During the year grants of liquid silk to the value of £10.11. 6 were made to Mothers and children whose financial circumstances were within the free level of the Council's economic scale. Grants of dried milk and other accessory foods amounting to £77.12. 72 were also made. Maternity Outfits. Number of Maternity Outfits supplied - 617. 17. \ . Home Helps. Ministry of Health Circular No. 2729 dealt with the difficulties now experienced in regard to the provision of domestic assistance in the hone for women at the time of confinement and in accordance with the suggestion of the circular the Council resolved to employ three full-time Home Helps. Personnel for the service, however, is exceedingly difficult to provide and only for short periods have there been three Home Helps in the employment of the Council. When considering the circular the Council reviewed the payment for casual Home Helps and this has given some relief to the difficulties. No. of cases attended:- By full-time Home Helps 31 " part-time " " (casually engaged) 43 Convalescent Home Treatment. Number of Mothers referred - 1. Domiciliary Nursing. Mothers referred for treatment to the Wembley and Kingsbury District Nursing Association - 15. 18. 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 698 148 349 Numbers who received treatment 559 117 295 Numbers made dentally fit 522 115 284 Numbers of treatments - (a) Fillings (i) in temporary teeth - - 274 (ii) in permanent teeth 294 81 — (b) Number of teeth extracted. 1,495 269 253 (c) Number of administrations of general anaesthesia (nitrous oxide) 267 60 120 (d) Number of persons supplied with dentures 86 22 - (e) Number of dentures supplied 122 33 - The above figures way be divided as follows:- 19. Consultations. Conservative treatment. Extractions Children 189 336 118 Mothers 329 462 512 Total attendances at Dental Clinics last 5 years Children. Mothers. 1939 1,093 1,772 1940 1,171 1,729 1941 972 1,709 1942 869 1,870 1943 643 1,303 Domiciliary Visits by Health Visitors. Home Visits (a) To children under 1 year 2,307 First Visits 5,690 Revisits (b) To children between the ages of 1-5 years 9,480 Total Visits (c) To Expectant Mothers 1,196 First Visits 2,080 Revisits (d) To Nursing Mothers 705 First Visits 400 Revisits (e) Other Special Visits 4,542 20. Analysis of Special Cases included in (e) above:- Diphtheria immunisation 1,029 Infectious Diseases: Measles 1,144 Whooping Cough 335 Tuberculosis 29 Ophthalmia neonatorum (7) Others (18) 25 Puerperal pyrexia 14 Scarlet fever 6 Scabies 601 Re Day Nursery Children 834 Home Help supervision 135 Daily Minders 28 Re stillbirths 54 Assistance re verminous conditions 42 Impetigo 29 Re adoption of children 28 Child Life Protection. Visits by Health Visitors:- To foster children 538 " " parents 465 At the end of the year there were on the register:- Foster children 39 " parents 31 Number of foster children who died during the year 1 Number on whom inquests were helo Nil 21. Adoption of Children (Regulation) Act, 1939. This Act came into force on the 1st June, 1943. It deals with the registration of Adoption Societies, the Registration Authority being the Council of any County or County Borough. The Registration Authority has to be satisfied that the Society is a charitable association and may refuse registration in certain circumstances, having similarly power to cancel registration. The Secretary of State is given power to make regulations which may ensure that parents are told in ordinary language their own legal position and the effect of the adoption order. The regulations may also require the supervision of each case by a Case Committee. No application to the Court for an adoption order shall be made until three months after the child has been delivered into the care and possession of the proposed adopter. Section 7 of the Act deals with the protection of adopted children by Welfare Authorities such as the Borough Council, making it the duty of any person other than the child's parent or guardian or the person with whom the child is placed who participates in the arrangement for the placement of the child to notify in writing the Borough Council. The adopter must also inform the Borough Council of any change of residence and in the case of death of the child notify both the Welfare Authority (the Borough Council) and the Coroner. The Welfare Authority has power to make application to the Court to remove a child on the same grounds as those contained in the Child Life Protection Sections of the Public Health Acts, namely (a) regarding environment or (b) regarding the fitness of the proposed adopter. This Act for the most part places duties on the County Council but in addition, by Section 7, duties are imposed upon the Borough 22. Council in certain cases. To the end of the year no notification under Section 7 was received. Certain Adoption Societies, however, inform us of their having placed children and the children are visited systematically, while any relevant information regarding proposals to adopt are forwarded to the Secretary of the Middlesex Education Committee. The action by the Public Health Department:— (1) Notifications received under Section 7(3) are reported to the Maternity and Child Welfare Committee. (2) Health Visitors visit monthly, reporting on circumstances regarding environment, suitability as to health, etc. of the proposed adopter, and advice regarding the health and wellbeing of the child. (3) Health Visitors seek out in their domiciliary visiting any children concerning whom it is thought that a notice should have, been sent and, in addition, discreetly exercise such supervision as is possible for those children who have been placed by their parents for adoption. (4) The Medical Officer of Health passes relevant information to the Secretary, County Education Committee. 23. D. HEALTH EDUCATION. One of the most important duties of a Public Health Department must always be health education and the staff from time to time have taken full advantage of the opportunities the Committees offer for them to keep up to date. Health Visitors, for example, have attended the following courses during 1943:- 10 attended a refresher course on the Social Side of Tuberculosis Work for Health Visitors; 2 Health Visitors attended a course by the Yi'omen Public Health Officers Association on "How to teach"; and 1 attended the course for the Diploma in Nursing, University of London. From another point of view, four Student Health Visitors have attended at Wembley during their course of training, 3 from the Royal College of Nursing and 1 from the National Health Society. The Sanitary Inspectors have also kept their information up to date having attended, for example, refresher courses on food decontamination, on various points arising from the Infestation Order, 1939, and demonstrations with regard to rats and mice infestation, as well as certain courses at the London School of Hygiene on insect pests. The Day Nursery staff have continued their lectures and training to the students in preparation for entering for the examination for the Diploma of the National Society of Children's Nurseries. 24. The syllabus of talks given at the Health Clinics. Subjects dealt with. 1. Diet. Hew best to use the rationed foods and to choose foods on points, e.g. eggs and powdered eggs, the special Government rations of milk, cod liver oil and other vitamin preparations. The importance of breast feeding whenever possible is always stressed. Advice regarding bottle feeding, the preparation of the feeds, care of the bottle and teat is fully explained as is the care of the baby's mouth and skin. 2. General Hygiene. The importance of fresh air, exercise, rest and sleep, particularly for the expectant Mother. Appropriate patterns for special clothing; care of the teeth, hands and care of the breasts. At all of the clinics many specimen clothes of which patterns are available are displayed. The necessary equipment for the baby's cot is demonstrated. For the young children the importance of regular habits with rest and sleep periods, hand washing, care of teeth, the dangers of the dummy (for example, palate defects, jaw deformities, mouth breathing). The early signs of eye defects are explained, for example, squint; as of ear infections and discharge. In short a correct routine for the child's day is explained. Safety first principles for toddlers, fire guards, knives, scissors, safety straps, gas taps, etc., are emphasised. 25. 3. Preventive Medicine. E.g. The value of inoculation treatment against diphtheria and vaccination against small-pox is emphasised; while under general hygiene and personal cleanliness, the prevention of scabies and other such infestations and skin conditions, (impetigo, etc.) are explained. Special courses of 8 talks and demonstrations for women having their first babies were conducted at One Tree Hill Clinic. Most of these young women are working at the time they make their first attendance at the Ante-Natal Clinics so that a good deal of organisation has had to be made for the talks to suit the convenience of the expectant Mothers. The Mothers are invited to attend the Health Visitor's demonstration whether they may be due to see the doctor or not. Syllabus. (a) The Expectant Mother. Explanation of menstruation. Growth and development of the coming child. Special hygiene for the pregnant woman, e.g., the care of the breasts, clothing, maternity belts, shoes, etc. Re-adjustment of daily routine, e.g. exercise and rest periods. Diet and extras necessary in pregnancy. The Government rations and various accessory nutrients advised by the doctor are explained. (b) The Baby. Preparation of baby's clothes, cot and other necessary equipment. Model garments shown. 26. The importance of baby's bath, a demonstration is conducted. Baby's daily routine and management is gone into in detail. The value of breast feeding to the baby is explained. The baby's physical development in the early months after birth is explained as is the value of preventive medicine as at present evolved, e.g. vaccination against small-pox. The final lecture deals with the confinement, co-operation with the attendant and the necessary details of the care of the Mother during the important few weeks after the birth of the baby. It is a pleasure to record the valuable work of Health Education performed by the Health Visitors. On the blackboards at the clinics a note on some special topical subject appears every month. E. INFECTIOUS DISEASES. For figures giving incidence of infectious diseases as notified in Wards and numbers removed to hospital see Page 29. The incidence of scarlet fever was high throughout the year having been most prevalent in Roe Green Ward. Seventy-one 27. per cent of the cases were removed to hospital. Regarding hospitalisation for scarlet fever, previous reports have pointed out that where the home conditions are satisfactory to give adequate nursing, admission to hospital is neither necessary nor always best for the patient and the general standard of housing accommodation in Wembley is such that probably fewer than 71% of cases of scarlet fever in its present mild form require hospitalisation. These remarks deal only with the patient. With regard to the public health, hospitalisation becomes necessary only in unsatisfactory housing circumstances or where in the home there is a worker handling food, especially milk, and where a birth is about to take place in the family in which circumstance all possible action must be taken to prevent exposure to streptococcal infection. A letter was addressed to the local medical profession on these lines towards the end of the year when there was strain on available hospital accommodation for scarlet fever cases. In this letter, of course, the present exceptional circumstances with regard to the employment of women and to there being in most houses many more occupants than in normal times were admitted. The continued high incidence of measles outside the usual 2-yearly periodicity since the war was again to be noted in 1943. 28. 29. INFECTIOUS DISEASES. CASES OF INFECTIOUS DISEASES NOTIFIED IN WARDS, 1943, AND REMOVALS TO HOSPITAL. Disease. Total. Alperton. Central. ChaLKhill. Fryent. The Hyde. Roe Green. Kenton. Preston. Sudbury Court. Sudbury. Wembley Park. Tokyngton. Total removed to Hospital. Percentage of cases removed to Hospital. Scarlet Fever 541 45 17 52 47 62 103 46 59 15 31 32 32 385 71.16 Diphtheria 17 5 — 1 3 — 1 — 1 2 1 1 2 16 95.18 Enteric fever 1 — — — — — 1 — — — — — — 1 100.00 Pneumonia 211 16 6 9 13 25 35 19 15 9 22 10 30 63 29.86 Erysipelas 53 3 2 1 4 3 3 5 4 3 6 8 11 14 26.42 Ophthalmia neonatorum 3 1 — — — — — — — — 1 — 1 3 100.00 Cerebrospinal fever 8 — — 1 — — 1 — 2 2 1 — 1 5 62.50 Dysentery 22 4 1 3 2 4 3 l — — 1 1 2 18 81.82 Measles 1,276 126 68 57 93 76 105 90 126 148 109 59 219 18 1.41 Whooping cough 340 52 12 27 50 17 21 29 45 6 23 11 47 5 1.47 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 influenzaloneumonia. Death certificates in which respiratory diseases mentioned. 1939-40 61 106 1940-41 82 107 1941-42 101 135 1942-43 92 105 1943-44 151 170 Influenza. In December communication was received from the Ministry of Health with regard to the increase in influenza throughout the country. As a matter of fact, however, the local epidemic of influenza in Wembley had passed towards the end of November. The experience was that of a mild influenza, most of the victims being fit for work again in a matter of seven or eight days. According to the advice of the Ministry of Health a scheme was immediately arranged which fortunately was not required bat will be ready at any time if perchance influenza becomes epidemic in proportion again. The Divisional Secretary of the British Red Cross Society and the Divisional Superintendent of the St. John's Ambulance Brigade along with the Centre Organiser of the W.V.S. arranged to give the following assistance:- (a) If nursing assistance were required the joint Associations would endeavour to provide such assistance. 30. (b) If assistance in the manner of light domestic assistance or helping in the family shopping for example were required, the W.V.S. would consider their ability to so assist through their District Leaders. With regard to the medical personnel of the Services giving assistance to civilian doctors an arrangement was made whereby assistance might be made available by communicating the circumstances to the Secretary of the Local Medical War Committee, the Secretary of the Local Medical War Committee keeping himself in touch with the medical services of the Army and the Royal Air Force. Non-notifiable Infectious Diseases. Information regarding these was obtained throughout the year from the head teachers of the schools in the Borough. Disease. January. February. March. April. May. June. July. August. September. October. November. December. Total. Chickenpox 94 87 119 138 173 90 84 — 14 6 2 4 8ll Humps 8 2 6 45 20 6 4 — 2 8 6 6 113 German measles 1 1 5 59 89 23 33 — 3 — — — 214 Infective jaundice 91 35 7 49 22 12 7 8 25 16 8 4 284 31. Consultations regarding infectious disease, between the Medical Officer of Health and the local medical profession-12. Diphtheria Immunisation. The Medical Research Council published a special report on the epidemiology of diphtheria during the last 40 years by W.T. Russell, D.Sc., from which certain paragraphs were presented to the Public Health Committee in September. The conclusions of Dr. Russell's report are Irrefutable statistically. There is very strong evidence that immunisation, particularly since the inclusion of the pre-school children, has reduced the morbidity and the mortality from diphtheria in New York City and in Toronto. The statistical incidence of diphtheria in these cities in the best immunisation period is significantly better than might have been expected from the trend of morbidity and mortality in the pre-immunisation period. According to past experience the disease had a periodicity of 6 years in New York and of 4 years in Toronto. On this basis there should have been epidemics in both cities between 1930 and 1940 but none has occurred. The best explanation of this absence is that the Health Authorities in both cities by artificially immunising the school and pre-school children have prevented the occurrence of the epidemics. While the number of children who have received immunisation treatment in Wembley has been considerably increased in the last few years, it is to be emphasised that there is still a number of children not protected from diphtheria, a serious but assuredly preventible disease. 32. Numbers treated:- Year. 0-5. 5-10. 10-15. Over 15. Totals. 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 1943 1,722 431 254 4 2,411 The percentage of the child population considered immunised on the 31st December, was- Children under 5 years 54.58% " between 5 and 15 years 60.68% In the last annual report details were given of the various ways in which surely almost every family in the Borough must have been advised regarding the importance of diphtheria immunisation. All the methods of approach mentioned regarding that year were continued throughout 1943. Health Visitors made some 3,000 special visits in accordance with Ministry of Health Circular No. 2,713 in endeavour to explain the importance of diphtheria immunisation in those children concerning whom so far there was no record of their having been immunised. Vaccination against small-pox. War-time difficulties-part-time work of the Mothers, shopping queues and so on-might be responsible for a number of infants not being vaccinated against small-pox and an arrangement was made whereby Dr. Dyson, Public Vaccinator, attends the Health Clinics in rotation, his first attendance being at One Tree Hill Clinic in November. To the end of the year 34 infants were vaccinated at the Clinics (since 1st January 33. 1944 to end of May, 232 children have been vaccinated). Such a co-operative arrangement has been very helpful to the Mothers in the present abnormal war-time circumstances and it is a real practical public health service against a real war-time possibility - the introduction of small-pox into the Country - at any time. Tuberculosis. No. of Notifications. Pulmonary. Non-Pulmonary. Male. Female. Male. Female. Under 1 1 — — 1 1-4 3 1 1 1 5-14 3 1 1 2 15-24 11 28 — 3 25-34 14 16 1 2 34-44 15 6 1 2 45-54 7 6 — 3 55-64 13 6 1 — 65 & over — 2 — — Totals 67 66 5 14 No. of Deaths. Pulmonary. Non-Pulmonary. Male. Female. Male. Female. Under 1 — 1 — — 1-4 — — — 1 5-14 — 2 — — 15-24 6 5 1 1 25-34 1 7 — — 35-44 12 5 — — 45-54 6 4 — — 55-64 9 2 — 2 65 & over 2 2 — — Totals 36 28 1 4 34. No. admitted to Hospitals or Sanatoria. No. discharged from Hospitals or Sanatoria. 127 105 During the year 124 cases were removed from register and at 31st December, 698 names remained on register - 600 Pulmonary and 98 Non-Pulmonary. Of the 69 deaths from tuberculosis during the year, 7 had not been notified during life (that is 10.14%). Notifications and Deaths from tuberculosis in 5-year period. Notification. Deaths. Pulmonary. Non-Pulmonary. Pulmonary. Non-Pulmonary. 1939 100 22 48 9 1940 100 25 56 7 1941 142 19 64 3 1942 150 34 60 10 1943 133 19 64 5 Dr. Levwis-Faning has analysed the statistics of Middlesex with regard to pulmonary tuberculosis (British Medical Journal 27th November, 1943) and his conclusion is that there is no evidence, from the experience of the tuberculosis service of the County of Middlesex, of a lowered resistance to the disease to the point at which duration of the illness was shortened, and hence no evidence that lowered resistance was a causative factor in the increase of tuberculosis mortality which occurred 1940-1. 35. 36. Bacteriological Service (at Middlesex Hospital). Examinations made. Quarter ending Total for 12 months. 31.3.43 30.6.43 30.9.43 31.12.43 Throat swabss:Diphtheria 86 (of which 1 was positive) 80 (of which 3 were positive) 75 (of which 3 were positive) 108 (of which 1 was positive) 349 (of which 8 - 2.28% were positive) Haemolytic ) Streptococci) 31 (of which 18 were positive) 25 (of which 12 were positive) 24 (of which 8 were positive) 45 (of which 22 were positive) 125 (of which 60 - 48% were positive) Vincents) Angina ) 21 (of which 4 were positive) 14 (of which 1 was positive) 20 (of which 2 were positive) 18 (of which 1 was positive) 73 (of which 8 - 11% were positive) 37. Other swabs 2 l — 6 9 Nasal swabs Diphtheria 4 7 6 (of which 1 was positive) 17 (of which 1 was positive) 34 (of which 2 - 5-88% were positive) Haemolytic ) Streptococci) — — — 1 (positive) 1 Sputum (Tubercle Bacilli) 36 (of which 2 were positive) 25 (of which 3 were positive) 29 31 (of which 2 wore positive) 121 (of which 7 - 5.78% were positive) Faeces and Urine 18 19 35 53 125 Blood 5 3 5 13 26 Films and swabs for Special Bacteria 7 l — 2 10 Other specimens 7 2 5 — 14 Jaundice (infective hepatitis). Through the courtesy of the local medical profession the incidence of jaundice in the Borough has continued to be recorded. Since June 1942, 436 cases have occurred, the monthly incidence having been as follows. 1942 June 1 1943 June 12 July 4 July 7 August 2 August 8 Septamber 4 September 25 October 22 October 16 November 19 November 8 December 34 December 4 1943. January 91 1944 January 6 February 46 February — March 19 March 11 April 6l April 6 May 22 May 8 Total - 436 The above figures indicate an epidemi curve with its peak in January 1943, the greater incidence having arisen between October 1942 and May 1943. In September 1943 it looked as if Wembley was about to have another epidemic peak but fortunately this did not materialise and for some time now the number of cases has shown definite fall. Our figures continue to be submitted to a special Sub-Committee of the Medical Research Council which is investigating this major war medical problem. The age incidence for the 2 years is indicated by the following figures:- 0-5 years 16 5-10 " 161 10-15 " 137 Over 15 " 112 Age unknown 10 38. The relative escape of the child under 5 and the greater incidence among school children than amongst adults have been marked, and both are in accord with the experience of other areas in the Country. With regard to the Day Nurseries, for example, where the children are all of tender years and contact is intimate regarding the children both one with another and with the staff, the experience again indicates this relative immunity amongst young children. In 1943, 3 cases occurred amongst Nursery children, 1 in May and another in July at Carlyon Road and one other at Harrowdene Road Nursery. At both these Nurseries the attendance of children is generally over 40 and still no spread occurred. At Harrowdene Road Nursery in September, 2 members of the staff developed jaundice without any further spread amongst the children. Scabies. The request of the Ministry of Health in Circular No. 2,831 was answered fully in the Interim Report for 1942. No. of Cases of Scabies reported during the year. January 48 July 71 February 41 August 37 March 71 September 64 April 55 October 70 May 103 November 73 June 57 December 76 Total 791 39. Numbers affected in individual families. 1 person in 243 families. 2 persons " 98 " 3 " "42 " 4 " " 29 " 5 " " 6 " 6 " " 9 " 8 " " 1 family. 9" " 2 families. That only 14 recurrent cases occurred in three families (2 in 1 family and 6 in 2 families) indicates that our deliberate emission to disinfect clothing by the Borough Council's steam disinfector has been justified. The careful domestic washing according to the advice given has proved sufficient. In March Wembley Hospital opened a Scabies Clinic in the Gas Cleansing rooms attached to the First Aid Post at the Hospital. This has proved to be a considerable convenience to the families in Wembley when so many women are now in employment. A film produced by the Ministry of Information on behalf of the Ministry of Health dealing with the diagnosis and treatment of scabies was shown on 7th July at Wembley Hospital to an audience of 125 persons inducing members of the local medical profession, miidwives, the District Nursing Associations, Civil Defence personnel and the staff of the Public Health Department. Verminous Conditions. Twenty cases of verminous heads required special advice and treatment during the year7 were referred by factory Medical Officers, 5 by school Medical Officers, 3 by private 40. Medical Practitioners, 3 from the Health Clinics, and 2 by the Citizens' Advice Bureau. Nineteen of these cases received treatment at Kensington Medicinal Baths, and the other was treated at one of the Council's Health Clinics. Some other cases of early accidental occurrence have been met from time to time and advised but infestation in Wembley is not a Public Health problem. Disinfection of Premises and Articles. Disinfections for:- Infectious diseases 645 Cancer 13 Vermin (routine protection from) 235 Miscellaneous 79 Articles disinfected or destroyed:- Disinfected. Destroyed. Beds l82 4 Bolsters 371 3 Blankets 2,237 — Counterpanes 642 1 Covers 46 — Curtains 8 — Cushions 117 — Mattresses 848 12 Palliasses 34 — Pillows 1,914 8 Rugs and mats 65 — Sheets 1,010 2 Wearing apparel 469 1 Sundries 195 — Towels etc. from) Wembley Hospital) re Scabies) Scheme) 75 lots 41. F. ENVIRONMENTAL HIGIENE, FOOD AND WATER. Number of verbal notices given 290 ,, ,, ,, ,, complied with 376 x ,, ,, written notices served 465 ,, ,, ,, ,, complied with 456 ,, ,, statutory notices served 36 ,, ,, ,, ,, complied with 48 x x Includes a number of notices served in 1942, and completed in 1943. Number of complaints received and investigated 2,193 General sanitation inspections (including 784 visits to Air Raid Shelters) 11,217 Nuisances abated and improvements effected (including Air Raid . Shelters - 2) 1,301 Some Housing Details. Visits to dwelling houses 8,198 Nuisances abated and improvements effected 1,545 Total number of dwelling houses inspected for defects (under Public Health or Housing Acts) 2,541 Number of inspections made for the purpose 5,58l Number of dwelling houses (included in above) which were inspected and recorded under the Housing Consolidated Regulations 1925/1932 2 Number of inspections made for the purpose 19 Number of dwelling houses found not to be in all respects reasonably fit for human habitation 1,49© Number of defective dwelling houses rendered fit in consequence of informal action l,468 42. Proceedings under Public Health Acts. (1) Number cf dwelling houses in respect of which statutory notices were served requiring defects to be remedied 33 (2) Number of dwelling houses in which defects we re remedied after service of formal notices- (a) By owners 21 ø (b) By Local Authority in default of owners 17 X ø Includes compliance in 1943 of 5 Notices served in 1942. X Includes compliance in 1943 of 12 Notices served in 1942. Proceedings under Sections 11 and 13 of the Housing Act, 1936. Number of dwelling houses in respect of which Demolition Orders were made Nil Overcrowding. Number of certificates issued giving the number of persons who may occupy a house 48 Number of dwellings overcrowded at end of year 114 ,, ,, families dwelling therein 115 ,, ,, persons ,, ,, 615 ,, ,, new cases of overcrowding reported during the year 43 ,, ,, overcrowded families relieved during the year 14 (1) by removal of members of family 3 (2) ,, ,, ,, families to other known address 4 (3) ,, ,, to unknown addresses 7 (4) ,, ,, ,, Council houses (included also in 2) - (5) ,, ,, ,, requisitioned premises (also included in 2) 4 (6) ,, ,, of sub-tenants and lodgers - (7) Number of persons incluced in such relieved cases 75 43. The Council have been very sensitive of the increased overcrowding occurring in the Borough and have made representation on the matter to the Minister of Health. The figures in the Public Health Department indicate that the larger number of families requiring alternative accommodation because of overcrowding is in the main amongst those families for whom the "equivalent numbers" are 3½ 4 (child 0-1 year = no equivalent unit, child 1 year - 10 years = ½ unit, child over 10 years = 1 unit). Such families require always 2 bedrooms and generally 3. These facts were presented in a report to a joint meeting of the Public Health and the Housing and Works Committees in April, when the Joint Committee was considering the possible lay-outs for the adaptation of shops into flats. The opinion was there expressed that the vacant shop premises such as the Joint Committee had in mind might quite properly be a valuable temporary expedient providing housing accommodation for people much less well housed at the present time. Each individual shop premises, however, requires individual planning and sometimes the superficial area might suggest more rooms than are really appropriately possible because of these shop premises being in the main of narrow frontage and of comparatively large depth from front to back. Disinfestation. Visits paid re vermin or suspicion of - for bed bugs 178) ,, other vermin 152) 330 Verminous premises disinfested - for bugs 69) ,, other vermin 22) 91 Council houses disinfested 9 (Method employed - liquid insecticides) Hydrogen cyanide (Fumigation of Buildings) Regulations, 1938 Notices of Intention to Fumigate received 6 In one case on the advice given the Intention was withdrawn 44. Outworkers. Number on the register 31.12.1943 138 ,, of visits paid to premises 67 Offices. Number on the register 244 ,, of visits paid 200 Defects found 2. Defects remedied 2. Meat and other Food Premises. Number of inspections made - 3,079 Nuisances abated and improvements effected:- Meat Shops, Stalls &c. Premises cleansed 44 ,, ,, ,, ,, Other contraventions remedied 12 Cowsheds - contraventions remedied - Dairies - cleansed and limewashed 11 ,, premises repaired. 6 ,, other contraventions remedied 12 Bakehouses cleansed and limewashed 11 ,, sanitary conditions improved 2 ,, other contraventions remedied 3 Fried Fish Shops cleansed and limewashed 10 ,, ,, ,, sanitary conditions improved 2 ,, ,, ,, other contraventions remedied 2 Fishmongers &c., contraventions ,, 22 Grocers ,, ,, 87 Greengrocers &c. ,, ,, 51 Restaurants, Cafes &c. ,, ,, 34 Other Food premises ,, ,, 3 312 45. Dairies and Mjlk 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 1936 to 1942. Designation of Milk. Licences issued. Samples taken. Samples not satisfactory. Pasteurised 36 34 2 Tuberculin Tested 22 5 1 T.T. (Pasteurised) - 10 — T.T. (Certified) — — — Accredited 2 6 1 60 55 4 The Government's White Paper on measures to improve the quality of the Nation's milk supply was presented to Parliament in July ana its main arguments were reported to the Public Health Committee. The policy of the Government was outlined thus. All possible steps will be taken to improve the quality of milk as it leaves the farm. To this end the health of the animals in all dairy herds will be brought under State supervision, special attention being paid to those herds the milk from which is not heat 46. treated before sale to the consumer; the production and consumption of T.T, milk will be further encouraged. Concurrently with these measures arrangements will be made to subject to heat treatment as high a proportion of milk other than T.T. and some accredited milk as is practicable. Every effort will be made to provide all schools with heat treated milk, T.T. milk or milk exclusively from single accredited herds. This White Paper marks definite progress but some gaps would still remain. Accredited milk, for example, does not ensure safety for the consumer even in respect of tuberculosis. The bacteriological examination of accredited milk is restricted to tests for cleanliness and "there is no guarantee against the presence of tubercle and certain other pathogenic organisms. It is to be pointed out also that in the present state of the milk industry T.T. milk has only some guarantee regarding the absence of tubercle bacilli but none regarding the absence of certain other pathogenic germs. At the present time T.T. milk would be all the safer if it were heat-treated as well. Food Poisoning. Eleven notifications were received regarding food poisoning, one person being admitted to hospital. Laboratory Examinations re Food, Milk and Water (at Middlesex Hospital) Examinations made. Quarter ending Total for 12 months. 11.3.43 30.6.43 30.9.43 31.12.43 Food - 7 8 3 18 Milk 12 14 25 10 61 Water 25 12 13 15 68 47. Chemical tests for chlorine content of Swimming Pool water made by Inspectors - 78. Throughout the war period fortnightly samples of the public water supplies have been submitted for bacteriological examination and the results passed to the respective Water Companies, while also the Water Companies submit periodically their results to the Medical Officer of Health. The water supply has remained bacteriologically satisfactory and sufficient in quantity although there has been call for economy from time to time, a call which in the present circumstances is to be understood, and which is due also in part to the persistently low rainfall. DAY NURSERIES. The 8 Day Nurseries with 348 places have been well used and given gooa service throughcut the year. The Council have lately made representation to the Ministry of Health suggesting 2 other Nurseries, 1 in North Kingsbury, the other in Tokyngton, but the Minister so far has not consented to these additional Nurseries. Also the Day Nurseries Sub-Committee has had in mind the possible call for another Nursery in the Kenton area. Since March, 1944, the Carlyon Road Nursery has been out of action the premises having been badly damaged by air raid. At the time of writing (June 1944) the Nursery is still under repair and arrangements continue whereby the children assemble at One Tree Hill Clinic each morning and are dispersed in charge 48. of nurses by Civil Defence ambulances to the other Wembley Nurseries. The children are brought back to One Tree Hill Clinic each evening in time for the Mothers to call for them. The daily cost (pence) per child-inattendance of all foods (as purchased uncooked) provided at the Nurseries is shown in the following details (all food provided for staff reckoned as part of the cost of feeding the children):- d. Ealing Road Nursery Oct. 1942 to Sept. 1943 12.95 Neeld Crescent ,, ,, ,, ,, ,, ,, 10.77 Princes Avenue ,, May 1943 ,, ,, ,, 11.77 Carlyon Road ,, ,, ,, ,, ,, ,, 11.05 Old Kenton Lane ,, June ,, ,, ,, ,, 12.48 Harrowdene Road ,, ,, ,, ,, ,, ,, 13.18 Woodstock Road ,, Sept. ,, ,, Jan. 1944 12.00 District Road ,, Aug. ,, ,, ,, ,, 11.45 From January 1943 figures include full price for all milk used at Nursery, instead of specially reduced price of 1/- per gallon for milk for drinking purposes - the Ministry of Health now reimbursing Local Authorities direct, instead of as formerly Milk suppliers through the Ministry of Food. The incidence of infectious disease amongst both the children and the staff has continued to be watched and the figures from the opening of Ealing Road Nursery have been submitted to the National Society of Children's Nurseries to be collated with the observations of other representative authorities in the Country. With regard to the gastro-intestinal infections which are the most serious in young children, the following are the rules in endeavour 49. to prevent the spread of any infection which may inadvertently be introduced. 1. Whatever may be the duties of a member of the nursing staff she washes her hands thoroughly before preparing food, before giving food, after changing an infant. All staff pay strict attention to the fundaments of personal hygiene themselves, e.g. thorough hand washing after being at closet. Tweenies and toddlers all have their hands washed before food. No child of any age is fed in any room which is used for "potting". 2. The personnel whose duty it is for the week to attend to children's napkins ana to "pottie" routine do not have duties which require a "clean" member of the staff, for example the preparation and distribution of food. (Food, of course, includes the bottle feeds of bottle-fed infants, as well as the food of the tweenies and toddlers). "Clean" personnel for the week do not give napkin or "pottie" attention to any child. If circumstances have aemanced such attention from a "clean" person she is considered immediately to have joined the "unclean" personnel for the week. Changes from "clean" to "unclean" or "unclean" to' "clean" are made on resumption of the opening of the Nursery after the week-end break. This rule is made in order to take advantage of the break period available because of the week-end closure of the Nurseries. 3. Boiling of napkins. Every used napkin is boiled in the special copper provided. 4. Every child in the Nursery has always a "napkin area" covering (napkin or drawers). 50. 5- Re bottle feeds. (a) Milk Kitchen is kept for milk feeds only. No washing up of any kind is done except of bottles and teats and weaning cups and plates, in the Milk Kitchen. (b) Careful attention to feeding at the correct time at the correct intervals. (c) Care and preparation of the bottle (cleaning, scalding etc.) and of teat. Covering with glass-cloth. Teats are kept in a jar covered by a lid; both jar and lid are boiled daily. Bottles, teats, spoons, weaning cups, bowls are boiled daily and kept covered. Bottle feeds are measured by glass measure provided only. (Bottle markings are not reliable). Immunisation treatment against diphtheria and whooping cough has continued and the value of vaccination against small-pox is also stressed, it being pointed out that the best age for vaccination is about three months. The Mothers of all children under 12 months as they enter the Nurseries are tola of the advisability of universal infant vaccination in the absence of medical contraindication. 51. Infectious Diseases - Day Nurseries, 1943. Disease. January. February. March. April. May. June. July. August. September. October. November. December. Total. (a) Childrens:- Chicken-pox 5 12 9 - 2 20 4 - 4 1 1 2 60 Measles 1 9 6 4 12 3 1 - - - - - 36 Scarlet fever 3 - 1 - 2 3 2 2 4 6 2 3 28 Whooping cough 9 1 — 2 — — — — — 1 - 1 14 Mumps — — 2 1 5 5 — — — — — — 13 German measles — — — 1 2 — 2 — — — 1 — 6 Dysentery — — — — — — — 1 1 4 — — 6 Jaundice — — — — 1 — 1 — 1 — — — 3 (b) Staff - — 1 Rubella. 1 Chickenpox. — — — — 2 Jaundice. — — — 4 52. Student Nurses. Miss Belding, Ealing Road Nursery, was our first student to obtain the Diploma of the National Society of Children's Nurseries. Two students now await the results of their examinations and it is hoped to present 3 candidates in August and 8 in December for the Diploma. The London County Council with regard to their Child Care Reserve course of study have sent us 7 students to take practical training. Two school teachers have had a practical course in the Nurseries at the request of the Lecturer of Education, Diocesan Training College, Salisbury, and 2 Superintendent Matrons (Watford and Ipswich) attended for a week's practical course at the request of the Royal College of Nursing. One student from Vicars Green Nursery classes is taking her course of lectures with our students at the request of the Middlesex County Council. Two students have attended Wembley Hospital for a 3 weeks' course. On Saturdays the local Girl Guides give much assistance in the Nurseries. In the Sunmer Miss Simmons, Warden, District Road Nursery, attended 2 weeks' Summer School course of the Nursery Schools Association at Nottingham. It is a pleasant duty to record the assistance always so readily received from the Voluntary Helpers Association. In particular, mention may be made of the loan cf ^iancs made by this Association to the various Nurseries. 53 • Daily Hinder Scheme. At the request of the Ministry of Labour the Council adopted the Daily Minder Scheme in April 1943. The scheme, however, has not proved very acceptable in this area. Number of approved foster mothers 11 ,, ,, children placed 12 3 of whom have become of school age. H. CIVIL DEFENCE. Number of Circulars from Ministry of Health, Ministry of Home Security, London Region, Middlesex County Council and miscellaneous received in Health Department 417 Number of letters sent to Doctors in charge of First Aid Posts re medical matters 16 Number of instructions sent to Depot Superintendents 111 Number of letters sent to Sisters-inCharge of First Aid Posts 105 Personnel. Various reductions in the personnel have taken place from time to time. The present authorised full-time establishment is:- Ambulance Depots 72 First Aid Posts 64 54. As from the 1st March, 1943, Wembley Hospital undertook the treatment of walking wounded air raid casualties as part of their normal functions under the Emergency Hospital Scheme. For some time the National Fire Service had been finding difficulty in arranging personnel to man the civil ambulances during the whole 24 hours and at the request of the Column Officer an agreement was made according to which during the break periods of the National Fire Service personnel allocated to the ambulances, relief was provided from the staffs on duty at the Ambulance Depots. This afforded a useful introduction of the Civil Defence personnel to the duties of the Ambulance Service which on loth June, 1943 was transferred from the Wembley and Kingsbury Fire Stations to the 2 Civil Defence Ambulance Depots, the Civil Defence personnel manning the ambulances and the Service becoming one administered by the Public Health Department. With the continued reduction in ambulance personnel suitable ambulance attendants have been taught to drive so that in an emergency the greatest possible number of vehicles may be made available immediately. The role to be played by the part-time personnel at Ambulance Depots has continued to increase in importance and training has been given at the Depots over a period of 28 weeks according to - 55. The Syllabus. Organisation of Civil Defence local and regional action (1) On Alert. (2) On receipt of call up to and including arrival at loading bay. (3) Disposal of casualties. (4) Replacement of equipment. (5) Action when any individual hospital unable to accept cases. (6) Crash Raiding. Organisation of E.M.S. Hospital Scheme and First Aid as applied to Ambulance Service. Visit to First Aid Post to see service in operation. Visit to Control Centre. Topographical training. Safe driving and traffic control. Anti-gas revision course - 6 lectures. First Aid ,, ,, - 7 ,, Home Nursing full course - 7 ,, 56. SUMMARY. These eight short paragraphs are proof enough of the continued extension of the Borough's Health Services and, more important still, of their full acceptance by the public. The War has made a call for more public health activity which in Wembley has been fully answered. A.R.P. became a first priority after "Muhich" as long ago as 1938, Civil Defence has remained so ever since. It may well be claimed that the Public Health Services have played an ever increasingly important part in the lives of the citizens these last six years. Paragraphs A and B (Pages 1-7) have dealt with the statistics regarding births and mortality. Comparative figures are given for the previous year, while regarding some headings a 5-year review is presented. The number of births in Wembley during 1943 was the largest which has so far taken place (2,071). The deaths of young infants from prematurity was referred to in the interim report for 1941 and the figures for 1943 point again to this problem. In fact the subject has recently been considered by the Maternity and Child Welfare Committee according to Circular No. 20/44 of the Ministry of Health. The subject is one for further study and action. Paragraph C (Pages 8 - 23) dealt with the various Health Services provided by the borough Council together with the Hospital Services provided by the County Council and Voluntary Authorities in London ana around. A review of the work of the Health Visitors is also presented. 57. Paragraph D (Pages 24 - 27) gave some summary of the attention paid to health education• In Paragraph E (Pages 27 - 41) the incidence of infectious diseases was considered and observations made regarding scarlet fever, measles, influenza, and upon the Council's activities in preventive medicine, particularly diphtheria immunisation. A short review of the incidence of jaundice during two years is presented and the Council's scheme for treatment of scabies is reviewed. In Paragraph F (Pages 42 - 48) the year's work in environmental hygiene, food and water was detailed. Short observation is made regarding housing including overcrowding, food premises and milk. In Paragraph G (Pages 48 - 54) some observations were made regarding the successful work at the Day Nurseries. In Paragraph H (Pages 54 - 56) the notes indicated that continuous adaptation and adjustment is required in the Casualty Medical Services. But Civil Defence filters continuously into all the sections of the Department (Administration, Infectious Diseases, Maternity and Child Welfare, Environmental Hygiene, and Civil Defence). This review of the achievement in 1943 could not have been recorded had not the staff of the Public Health Department all individually worked very hard throughout, and as a team worked as a co-operative whole in complete harmony. 58. It is a very pleasant duty to point to the day to day assistance received from the voluntary helpers at the Clinics. I have the honour to be, Mr. Mayor, Ladies and Gentlemen, Your obedient Servant, A.G. MORISON. Medical Officer of Health. 23rd June, 1944. 59.