WEM 25 BOROUGH OF WEMBLEY INTERIM REPORT OF THE MEDICAL OFFICER OF HEALTH FOR THE YEAR 1944 A. G. MORISON, M.A., M.D., D.P.H. Medical Officer of Health. July , 1945. BOROUGH OF WEMBLEY ANNUAL REPORT of the MEDICAL OFFICER OF HEALTH for the Year 1944 To the Mayor, Aldermen and Councillors of the Borough. Mr. Mayor, Ladies and Gentlemen, In accordance with Ministry of Health Circular No. 49/45, the Annual Report on the Health of the Borough for 1944 is again an interim one, and, as formerly in the war years, is mainly statistical in form, the pattern being similar to the Report for 1943. Matters already presented in detail to the various Committees are mentioned again in this report only shortly. (A). CERTAIN VITAL STATISTICS, 1944, from figures supplied by Registrar-General. (Some comparative 1943 figures within brackets.) Live Births. Male. Female. Total. Legitimate 1,102 954 2,056 Live birth rate per 1,000 estimated population 18.58 (l,994) Illegitimate 47 38 85 (77) (17.6) Stillbirths. Legitimate 23 25 48 Rate per 1,000 total (live and still) births 24.16 (26.79) Stillbirth rate per 1,000 estimated population 0.46. (53) Illegitimate 1 4 5 (4) Deaths 566 511 1,077 Death rate per 1,000 estimated population — Crude rate 9.34 2 Infantile Mortality. Deaths of infants under one year of age:- Male Female Total. Legitimate 46 27 73 76 (77) (72) Illegitimate 3 - 3 (5) Death rate of infants under one year of age:— All infants per 1,000 live births 35.50 (37.18) Legitimate infants per 1,000 legitimate live births 35.51 (36.11) Illegitimate infants per . 1,000 live illegitimate births 35.30 (65.00) Deaths from: Cancer (all ages) 183 Measles (all ages) - Whooping cough (all ages) 2 Diarrhœa (under 2 years) 5 Maternal Mortality. Deaths from puerperal sepsis 1 (3) Other puerperal causes 1 (2) Maternal mortality rate per 1,000 live births 0.93 (2.41) „„„ 1,000 total (live and still) births 0.91 (2.35) Per 1,000 population. Per l,000 Live Births. Per 1,000 total births (live and still) Birth rate. Still Birth rate. Death rate. Infantile mortality. Maternal mortality Maternal mortality. Wembley 18.58 0.46 9.34 35.50 0.93 0.91 England and Wales 17.60 0.50 11.60 46.00 — — London 15.00 0.42 15.70 61.00 —- — 126 County Boroughs, etc. 20.30 0.64 13.70 52.00 - — 148 Smaller towns, etc. 20.90 0.61 12.40 44.00 — — 3 Causes of Deaths during the Year. 1943. Total. Causes of Death. Male. Female. Total 1,016 All causes 566 511 1,077 — Typhoid and para-typhoid fevers — — — 2 Cerebro-spinal fever 1 1 2 1 Scarlet fever — — — —- Whooping - cough 1 1 2 — Diphtheria — 1 1 58 Tuberculosis of respiratory system 25 27 52 7 Other forms of tuberculosis 6 7 13 10 Syphilitic diseases 8 1 9 28 Influenza 1 4 5 1 Measles — — — — Ac: polio-myel: and polio-enceph: — — — — Acute infectious enceph: — 2 2 — Cancer of buc: cav: and œsoph: (M) — — — 13 „ uterus (F) 9 11 20 28 Cancer of stomach and duodenum 15 14 29 21 Cancer of breast — 24 24 121 Cancer of all other sites 60 58 118 11 Diabetes 2 6 8 100 Intra-cranial vascular lesions 33 54 87 204 Heart disease 121 101 222 44 Other dis: of circ: system 33 33 66 42 Bronchitis 26 19 45 63 Pneumonia 38 21 59 13 Other respiratory diseases 9 7 16 9 Ulcer of stomach or duodenum 10 4 14 14 Diarrhœa under two years 2 3 5 4 Appendicitis — 3 3 22 Other digestive diseases 10 10 20 19 Nephritis 12 8 20 3 Puerperal and post-abort: sepsis — 1 1 2 Other maternal causes — 1 1 21 Premature birth 12 3 15 25 Congenital malf: birth injury and infant diseases 21 9 30 15 Suicide 5 7 12 10 Road traffic accidents 8 — 8 27 Other violent causes 49 38 87 78 All other causes 49 32 81 Of the 1,077 deaths, 583 (that is, 54.13%) occurred elsewhere than within the Borough boundary, and 494 took place in hospital (that is, 45.87%). 4 The Principal Causes of Death. Disease. Total number of deaths. 1. Heart disease and other diseases of circulatory system. 288 Intra-cranial vascular lesions 87 375 2. Cancer 191 3. Violent deaths:- (a) Suicide 12 (b) Road traffic 8 (c) Other violent causes 87 107 4. Respiratory diseases:.— (a) Bronchitis 59 (b) Pneumonia 16 (c) Other respiratory diseases 14 89 5. Tuberculosis:— (a) Respiratory system 52 (b) Other forms 13 65 6. Premature births:— 15 Congenital malf.: birth injury and infant diseases 30 45 7. Digestive Diseases:— (a) Appendicitis 3 (b) Other digestive diseases 20 (c) Ulcer 14 37 8. Acute infectious diseases:— (a) Cerebro-spinal fever 2 (b) Scarlet fever 1 (c) Influenza 5 (d) Measles 2 10 The four main causes of. natural death remained in order as in the previous year, but violence as a cause of death became third in number (107). This abnormal figure, of course, was due to air raids. 5  Percentage of total deaths under 1 year. Percentage of total deaths under 50 years. Percentage of deaths taking place in hospitals. 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 1944 7.06 29.18 45.87 (B.) CERTAIN OTHER ESSENTIAL LOCAL STATISTICS. Birth Notifications. Notified by. At home. In Hospital. In Nursing Home. Totals. Doctors 99 847 313 1,259 Mid wives 500 233 24 757 Parents 2 — — 2 Totals 601 1,080 337 2,018 Percentages 29.8 53.5 16.7 100 Live births — 1974. Still births — 44. 6 Infantile Mortality. Deaths from stated causes at various ages under one year. Cause of death (extracted from weekly returns of local Registrars, and from inward transfers of RegistrarGeneral). 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 14 3 — 2 19 1 —- - -— 20 Broncho-pneumonia - 1 2 - 3 2 7 3 - 15 Atelectasis 8 - - - 8 - - - - 8 Congenital defects 4 2 — — 6 1 —- — 1 8 Gastro-enteritis — 1 — — 1 1 — 2 1 5 Violent deaths - - - - - - 1 2 — 3 Subarachnoid hæm:— 1 1 — — 2 — — — — 2 Hæmorrhagic disease 2 —- —- — 2 — — — — 2 Pneumonia — 1 — — 1 — — 1 — 2 German measles (with broncho-pneumonia) — — —- — — — 1 — — 1 Icterus neonatorum 1 — — — 1 — — — — 1 Convulsions — — — — — — 1 - — 1 Bronchitis - - - - - - - 1 — 1 Whooping cough — — — — — 1 — — — 1 Toxic hepatitis — — — — — 1 — — — 1 Icterus grav: neon: 1 — — — 1 — — — — 1 Strepto: mening: — — — 1 1 — — — — 1 Strangulated femoral hernia — — — — — 1 — — — 1 Staphylococcal septicæmia — — — 1 1 — — — — 1 Intussusception — — — — — — — — 1 1 31 9 2 4 46 8 10 9 3 76 Of the 76 deaths which occurred in children who never celebrated their first birthday, 31 (i.e., -10.8%) occurred within the first week of life, while 46 (i.e., 60.53%) occurred within the first four weeks of life. 7 Prematurity. Previous reports have indicated the necessity of research into the possibility of saving the premature child. On receipt of Ministry of Health Circular No. 174/44, certain services have been provided, together with equipment on loan, to assist in the medical and nursing care of such infants. The following arrangements are available:— (1) Equipment on Loan: Special cots, with mattress and blankets, cot thermometer, hot-water bottles (rubber), special feeding-bottles and teats. With the kind co-operation of the District Nursing Associations, this equipment is kept available at the headquarters of the Wembley District Nursing Association and of the Kingsbury District Nursing Association. (2) Pædiatrician: A paediatrician may be called in by the medical attendant, the Borough Council paying the fee. The medical attendant may desire consultation with a consultant paediatrician (for example, a paediatrician on the staff of one of the London voluntary hospitals), or it may be possible, depending on the circumstances at the hospital at the time, for the Medical Director, Central Middlesex County Hospital, Acton Lane, N.W. 10, to arrange for that hospital's pædiatrician to answer such a call. (3) A Supply of Expressed Breast Milk may be most valuable in such cases, but in the present circumstances it has been impossible to arrange a definite scheme. There is sometimes, however, a small supply of expressed breast milk at the Middlesex County Council's Maternity Units at Redhill and Central Middlesex County Hospitals, and the Medical Directors at these hospitals are ready to assist as far as is in their power. The Medical Attendant, therefore, may apply to the Medical Directors at these hospitals. (4) Home Helps: On request to the Public Health Department, endeavour is made to provide a Home Help. The Borough Council recover a proportion of the Help's wage, according to the family's economic circumstances. It is to be realised, however, that this service is very difficult to provide at the present time, especially in an urgent emergency. (5) While, of course, the doctor in attendance will decide whether domiciliary or hospital supervision is appropriate, with regard to hospitalisation the Circular lays appropriate emphasis on the necessity of careful conveyance to hospital, with a nurse in attendance, particular attention being paid to the maintenance of heat on the journey (hot-water bottles for basket or other carrier). The Borough ambulances are all provided with a heating device, and written instructions for it3 8 use are posted in the ambulances. The District Nursing Assbciations by arrangement provide a nurse for the journeys to hospital. (6) A new card for the notification of births has been provided, in which, may be inserted the birth, weight of all infants under 5½ pounds. Figures from 18th April to 31st December:— (i) Total number of premature babies who were reported born at home 12 (ii) Total number of these born at home who were nursed entirely at home 10 (iii) Who died during the first 24 hours Nil (iv) Who survived at the end of one month 8 Infantile Mortality, 1940-1944. Year. Wembley. England & Wales. 1940 57.86 55 1941 42.32 59 1942 34.16 49 1943 37.17 49 1944 35.50 46 Infantile mortality during last five years (9,465 live births, 384 deaths under one year): 40.57 Maternal Mortality. One death from puerperal sepsis was recorded in 1944, and one death occurred from other puerperal causes. Rate per 1,000 total births (live and still) 1940-1944. Year. Wembley. England & Wales. 1940 2.97 2.16 1941 4.30 2.23 1942 2.43 2.01 1943 2.35 2.29 1944 0.91 1.93 Maternal mortality during last five years (9,732 total births—24 maternal deaths): 2.47. Marriages. In churches 739 At Registry Office 204 9 (C.) HEALTH SERVICES. Co-operation with the local medical profession continued to be thorough throughout the year, the Council's Medical Officers endeavouring always to give the fullest assistance and information to the family doctor, who is informed of any advice or service offered to anyone. Letters were addressed to the local profession early in the year with regard to influenza, and later on dyesntery, malaria, post-vaccinal encephalitis, the hospitalisation or home treatment of scarlet fever cases, the provision of anti-toxins, sera, etc., the Council's scheme of service for premature infants, for Domestic Home Helps, and with regard to Civil Defence for the distribution of special anti-gas respirators for hospital bed cases, and the Council's instructions to their officers for the following-up of children returning to the Borough after having been evacuated. Provision of Insulin. Number of patients who received free insulin in accordance with the Borough Council's scheme:—17. Total cost of insulin provided £68 15s. 8d. Ambulance Service. The two ambulances at Barham Park and one at Kingsbury Depot continued to be manned entirely by Civil Defence personnel, the Transport Superintendent being responsible for the vehicles being in running order and repair. Removals Undertaken. (i) Accident calls or sudden illnesses on the street are answered immediately, the patient being conveyed to the nearest hospital for treatment before being taken home. (ii) Free removals are carried out within 15 miles of the Borough boundary, providing a medical certificate is presented that the patient is not in a fit state to travel in a vehicle other than an ambulance. During the war the Council have made the ambulance service available for a distance up to 30 miles beyond the Borough boundary, providing that the Medical Officer of Health is satisfied that the person is being removed to hospital beyond the 15-mile limit according to arrangements already made by the doctor in charge of the person through the various emergency arrangements now existing between hospitals either voluntary or local authority. 10 (iii) Maternity cases: Expectant mothers are told of the ambulance services at the ante-natal clinics in cases where arrangements are made for hospital confinement. A midwife is supplied for the journey, by agreement with the District Nursing Associations. Reciprocal arrangements exist with the neighbouring Local Authorities whereby, according to circumstances, mutual aid is given or received, Accident removals 619 Sick removals 2,430 Maternity removals 442 Total 3,491 Much help during the year was received from the Volunteer Car Pool, administered from the Palace of Arts. According to Home Security Circular No. 180/42 Medical Officers might call upon the Car Pool for urgent medical purposes thus:— For conveying patients to or from hospital, or to or from any place which has to be visited for the purposes of treatment. For conveyance of urgent medical supplies, or conveyance of medical, nursing, or other professional staff for the benefit of sick persons. Removal of Infectious Diseases. Ambulance stationed at Acton and Wembley Joint Isolation Hospital. Removals carried out:— Quarters ending 31.3.44 30.6.44 30.9.44 31.12.44 156 115 30 58 Total — 359. Health Clinics. It is a very pleasant duty to acknowledge the day-to-day assistance so consistently received from the Voluntary Helpers at the Clinics. (Some comparative 1943 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 one year of age 1,894 (1,857) 11 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 104 (189) Total number of children under five years of age who attended at the Clinics during the year, and who at the end of the year were: (1) Under one year of age 1,816 (2) Over one year of age 3,957 5,773 (5,699) Number of attendances by children under one year of age 33,226 (42,833) Number of attendances at all the Health Clinics by children between the ages of 1—5 years 14,437 (21,194) 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 one year of age in 1944 95.9 (93.5) (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 10,488 (11,328) Total number of women who attended for the first time 1,562 (1,670) 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 77.4 (82.0) The decrease in the number of ante-natal attendances was due to evacuation, while, in spite of air-raid conditions, 95.9 per cent. was attained for the infants under one year. Slough Lane Clinic. The necessary repairs after air-raid damage were not completed until October. 12 Attendances at the various Health Clinics. Children under one year of age. Clinic. Total attendances. Average attendance per session. Stag Lane 7,554 50 Slough Lane 3,169 31 College Road 5,692 40 Ealing Road 3,645 35 Perrin Road 4,689 30 Monks Park 4,448 43 One Tree Hill 4,029 31 Children between the ages 1—5 years. Clinic. Total attendances. Average attendance per session. Stag Lane 2,814 19 Slough Lane 1,213 12 College Road 3,159 22 Ealing Road 1,806 17 Perrin Road 1,786 12 Monks Park 2,137 21 One Tree Hill 1,522 12 Domiciliary Nursing. Children referred for treatment to the Wembley and Kingsbury District Nursing Associations. Children under one year 48 Children over one year 19 Treatments given — Seven or fewer attendances 52 Over seven attendances 15 Eye Clinic. 80 children referred to Middlesex County Council Ophthalmic Clinics. Orthopædic Clinic. 113 children referred to Middlesex County Council Orthopaedic Clinic. 28 appliances were supplied. 13 Clinics for Children showing Deafness, Defective Speech and Allergic Conditions. Arrangements were made with the Metropolitan Ear, Nose and Throat Hospital for consultant advice and treatment for children showing deafness or defective speech, and for children showing allergic asthma and allied conditions. Number of cases referred 2 Child Guidance Clinic. One case referred to Middlesex County Council Clinic, Harrow. Dental Clinic. See page 20. Artificial Sunlight and Massage Treatment. Number referred by Medical Officers: 120 (under one year, 3; over one year, 117). Reasons for treatment:— Rickets 44 Debility, anæmia, etc. 32 Delayed dentition 8 Recurrent colds 8 Chronic bronchitis 2 Bowed legs 19 Knock knees 6 Dental caries 1 Total 120 Convalescent Treatment. Number of cases referred: 3. 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 8 398 564 282 147 61 42 14 2 14 Attendances of Expectant Mothers:— Clinic. Total attendances. Average attendance per session. Stag Lane 3,229 21 Slough Lane 1,109 22 College Road 872 18 Ealing Road 1,035 20 Perrin Road 1,306 13 Monks Park 1,296 25 One Tree Hill 1,641 16 In accordance with the latest practice, a blood test is offered to all ante-natal mothers, unless they are having this test performed at hospital. The special examination is done at the laboratory of Redhill County Hospital; 385 such blood examinations were made during the year, of which 3 required further special investigation. X-Ray Ante - Natal Examinations. Number of ante-natal patients referred: 101. Supply of Sheets for Expectant Mothers: Ministry of Health Circular No. 154/44. This Circular was issued in November, giving a priority to buy sheets in the cases of expectant mothers being confined in their own homes. All State Certified Midwives practising in Wembley were informed by a letter of the scheme, and the appropriate dockets are issued at the Clinics or at the Public Health Department, Town Hall. Number of dockets issued 1944: 38. Hospital Confinements. During the year 775 women were referred to various hospitals for arrangements regarding confinement:— Medical reasons for reference to hospital:— (a) Regarding current pregnancy — Abnormality of maternal pelvis 59 Elderly primipara 40 Maternal ill-health 30 Cardiac abnormality 15 Toxæmia 10 Tuberculosis 10 Threatened miscarriage 11 Miscellaneous 10 185 15 (b) Regarding previous pregnancies— Abnormal obstetric history 94 Abnormal medical history 20 114 299 Home conditions unsuitable 321 Mothers desired hospital accommodation 155 Total 775 Wembley births taking place in hospital. (a) Middlesex County Council Hospitals:— Redhill 360 Central Middlesex 243 Maternity Hospital, Bushey 211 West Middlesex 1 Chiswick Hospital (Annexe of West Middlesex) 2 North Middlesex 1 818 (b) London Hospitals:— Queen Mary's (evacuated to Oxford) 51 St. Mary's 48 Queen Charlotte's 41 City of London 30 Charing Cross 21 University College 20 Middlesex Hospital 12 Hammersmith Hospital 4 Elizabeth Garrett Anderson 4 Royal Northern 3 St. Bartholomew's 3 Westminster Hospital 2 One at each of the following hospitals:— Paddington Hospital, South London Hospital, Mothers' Hospital, King's College Hospital, Queen Mary's Hospital (Stratford), Royal Free Hospital, Sheffield Street Hospiltal Mildmay Hospital and St. Olaf's Hospital 9 248 16 (c) Otter Hospitals:— Willesden Maternity 5 Wembley 3 Bearstead Memorial 2 One at each of the following hospitals — Perivale, Wellhouse, Sussex and Ashwood Maternity 4 14 Total 1,080 Five-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 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 31.5% 54.1% 40.9% 14.3% 1943 2,037 657 1,034 740 346 32.2% 50,8% 36.3% 17.0% 1944 2,018 601 1,080 816 337 29.8% 53.5% 40.4% 16.7% Puerperal Pyrexia. Number of notifications received: 11 (excluding 10 Willesden Maternity Hospital cases— Willesden residents). Number of women removed to hospital: 7. Obstetric Consultant Service. Consultant called in by private medical practitioners: 7. 17 Stillbirths. There were 53 cases of stillbirths allotted to Wembley by the Registrar-General. Detailed investigation was made in 44 cases. Multipara 20 Primipara 24 44 Ante-natal supervision given by — Hospital and/or Clinic 27 Private medical attendant 14 No supervision 2 Information incomplete 1 44 Attendant circumstances — Instrumental delivery 8 Long labour 4 Prematurity 5 Breech delivery 2 Twin pregnancy 2 Ante-partum hæmorrhage 1 Fœtal abnormality incompatible with separate existence 5 No abnormal cause or circumstance elicited 17 44 Post-Natal Clinics. Clinic. First attendances. Reattendances. Aver. att'dance per session. Stag Lane 70 26 4 College Road 10 4 1 Perrin Road 40 11 2 One Tree Hill 55 25 3 Totals 175 66 10 Much attention was given to the importance of breast feeding. Test feeding scales issued on loan to 266 mothers. 18 Gynæcological Clinics. Clinic. First attendances. Reattendances Aver. att'dance per session. Stag Lane 26 33 3 College Road 7 4 1 Perrin Road 23 14 2 One Tree Hill 26 27 . 2 Totals 82 78 — Birth Control Sessions. Clinic. First attendances. Reattendances. Aver. att'dance per session. Stag Lane 55 102 13 Perrin Road 48 118 14 Total 103 220 - Special Milk Grants. Liquid milk: Nil supplied. Grants of dried milk and other accessory foods amounting to £31 19s. 6d., were made during the year. Maternity Outfits. Number of maternity outfits supplied: 536. Home Helps. Some extensions to this valuable service were made. Sometimes families are met with where it would be of real assistance to them to have even an hour or two's help during the day, and for such the Council pay Is. 6d. per hour. Nowadays it is equally difficult for all families, whatever their economic circumstances, to obtain domestic assistance. The Council therefore made the service available for families beyond the 100 per cent. level of the economic scale. 19 Nnumber of Cases Attended. By the By Council's personnel on full-time the Council's personnel approved panel. Full- Part- Full- Part- time. time. time. time. 52 6 41 2 58 43 Economic circumstances of families. Special Free 25% 50% 75% 100% full cost .25 29 9 18 11 9 101 Convalescent Home Treatment. Number of women referred: 2. Domiciliary Nursing. Mothers referred for treatment to the Wembley and Kingsbury District Nursing Association: 3. Dental Services—Women and Children. Expectant mothers. t Nursing mothers. Children under 5 year. Numbers referred for treatment 512 86 278 Numbers who received treatment 416 72 236 Numbers made dentally fit 378 68 235 Numbers of treatments— (a) Fillings: (i) in temporary teeth — — 287 (ii) in permanent teeth 227 47 - (b) Number of teeth extracted 1,041 164 180 (c) Number of administrations of general an£esthesia (nitrous oxide) 203 31 82 (d) Numbers of persons supplied with dentures 52 14 — (e) Number of dentures supplied 80 21 — The above figures may be divided as follows:— Consultation Conservative treatment. Extractions. Children 72 294 85 Mothers 164 347 371 20 Total attendances at Dental Clinics last five years. Children. Mothers. 1940 1,171 1,729 1941 972 1,709 1942 869 1,870 1943 643 1,303 1944 451 882 Unmarried Mothers—Arrangements with Middlesex County Council—Ministry of Health Circular No. 2866. The Council's scheme is that where other arrangements are inappropriate or impossible application will be made to the Middlesex County Council, which Public Health Department sees tu the details of admission with the British Red Cross Society — (a) For mother prior to confinement, Pre-Natal Home, 16, The Park, Golders Green. (b) For mothers and babies for 2 or 3 months after baby born,- after mother's discharge from hospital, admission to British Red Cross Hospital, Maryland, Hendon. The financial arrangement of the Middlesex County Council is for participating Authorities in the scheme to guarantee, on the basis of population, a sum equal to nine occupied beds at 35s. per week, each Authority also paying 35s. per week per admission for both above types of case from their areas. No case was so dealt with during the year. Domiciliary Visits by Health Visitors. Home Visits. (a) To children under one year 2,272 First visits 5,937 Revisits (b) To children between the ages of 1—5 years 8,681 Total visits (c) To expectant mothers 1,158 First visits 2,040 Revisits (d) To nursing mothers 906 First visits 593 Revisits (e) Other special visits 2,480 Analysis of special cases included in (e) above:— Diphtheria immunisation 95 Infectious diseases: Measles 252 German measles 10 Whooping-cough 580 21 Tuberculosis 13 Ophthalmia neonatorum (15) others (22) 37 Puerperal pyrexia 12 Scarlet fever 2 Pemphigus neonatorum l Dysentery 2 Epidemic diarrhoea 1 Scabies 320 Re Day Nursery children 619 Home Help supervision 167 Daily minders 9 Be stillbirths 48 Be verminous conditions 98 Impetigo, etc. 34 Be adoption of children 43 Evacuation 30 Defaulting re treatment advised 37 General—e.g., infantile deaths, premature babies, home conditions, negligent care 70 Child Life Protection. Visits by Health Visitors— To foster children 417 To foster parents 355 \ At the end of the year there were on the register— Foster children 26 Foster parents 21 Adoption of Children (Regulation) Act, 1939. Number of notifications received under Section 7 (3) 9 Number of visits to children proposed for adoption 41 Number of children received for proposed adoption 12 RushclifTe Report—Nurses'Salaries, etc. This Report was sent to Local Authorities along with Ministry of Health Circular No. 2893, stating that the Minister welcomed these new recommendations as to salaries, emoluments and conditions of service of nurses employed in certain services (including health visitors and State-registered nurses in residential and day nurseries). The Council adopted the recommendations of the Report entirely. It deals with remuneration, uniform, transport, leave—annual and sicla—and post-certificate leave. 22 Domestic Help Scheme—Ministry of Health Circular No. 179/44. The Government had become concerned in regard to persons sick or infirm who might be unable to obtain necessary domestic assistance, and the Minister of Labour and National Service had undertaken to assist in finding suitable persons for this work. This service is intended for a different class of case from that assisted by the Council's Home Help Scheme in connection with their Maternity and Child Welfare Services, such home helps being allocated to families during the confinement of the mother and for incapacity immediately afterwards. The types of cases to be considered with the domestic help service are, for example: (a) Where the housewife falls sick or must have an operation. (b) Where the wife is suddenly called away to see her husband in hospital, and arrangements have to be made to look after the children. (c) With elderly people who are infirm or one of whom suddenly falls ill. (d) Where .several members of the family are ill at the same time—e.g., during an influenza epidemic. The Council pay domestic helps, for full-time service, £3 per week, with approved' bus and train fares, the hours of duty being 8 a.m. to 6 p.m., with two hours off for any personal affairs daily (47-hour week), and for women unable to give such weekly fulltime service Is. 6d. per hour, with approved' bus and train fares. The Council recover all or a portion of these amounts, according to the economic circumstances of the families assisted, the Ministry of Health reimbursing full cost of the scheme, minus such recoveries from the families made by the Borough Council. The supply of domestic helps has remained very definitely limited, but endeavour is made to place the available women with the most urgent families, and in these cases the scheme is of distinct value. The scheme has been functioning since February, 1945. No. of families to whom Assessment re recovery of cost, service given. Full 100% 75% 50% 25% Free 29 Period 19.2.45—26.5.45 25 1 — 1 1 1 Full-time Part-time. No. of domestic helps on Council's Panel on 26.5.45 4 5 23 Nursing in the Home—Wembley and Kingsbury District Nursing Associations. The Associations have supplied the following figures relating to their work during the year:— Wembley District Nursing Association. Cases. Visits. Medical 967 Surgical 208 General nursing 22,229 Maternity 149 3,329 Midwifery 167 3,344 Ante-natal 311 3,668 Children under 5 24 113 Children over 5 53 460 Kingsbury District Nursing Association. Cases. Visits. Medical 166 1,949 Surgical 49 3,014 Maternity 64 1,403 . Midwifery 153 3,541 Ante-natal 250 1,709 Children under 5 81 721 Children over 5 18 80 These Associations provide a service of the greatest value to the public health of the Borough, and the Council continue to show the keenest interest in their work, contributing materially to their funds— £1,342 3s. 10d. to the Wembley District Nursing Association. 805 6s. 3d. to the Kingsbury „ „ (D.) NATIONAL HEALTH SERV ICE — MINISTRY OF HEALTH COMMAND PAPER 6502. A report was submitted to the Public Health and Maternity and Child Welfare Committees in April. Part 1 of this statement was factual. In Part 2 some general observations were made, and in Part 3 reference was made to points which seemed to have relation to the present health services of the Council. General Observations. While the Paper is entitled "A National Health Service," the plan is limited to personal health (or clinical medicine). The 24 Paper itself states that good housing, sanitation, conditions in school and at work, diet and nutrition, economic security, and so on, are all "fundamental," but they are not dealt with in the White Paper. Industrial medicine is not dealt with, nor is environmental hygiene. The school medical service is not dealt with, except that the Paper points to two sections of this service: (a) School medical inspection, which will remain with the education services, and (b) school medical treatment, which will in due course be given up by the education authority and taken over by the proposed new health service.. Evidently there is not to be a focal co-ordination in one Ministry of the present responsibilities concerning medical health problems of other Ministries, for example. Points which seem to have relation to the present Health Services of this Council. Isolation hospital responsibilities will pass to the new joint Authorities. The Maternity and Child Welfare Services (excluding Maternity Hospital services but evidently including domiciliary midwifery services) will fall to be provided by the Local Authority under the Education Act. Under that Act arrangements are now being made for delegating much of the practical care of the school medical service to the Borough Council. The White Paper's mention of the family practitioner beginning to undertake many duties at present performed by his colleagues in the public health service probably refers to the services now given at the Borough Council's Health Clinics— Ante-Natal, Post-Natal and Infant Welfare Clinics. Consultant services are to be available from the hospitals and provided by the new Joint Health Authority. Ambulances are dealt with only as an ancillary hospital service, and as such will be dealt with by the new Joint Authority. Whether there may be ambulance services not connected with hospitals is not dealt with in the White Paper. A home nursing service is mentioned. Responsibility for sectoring it will normally be exercised by County and County Borough Councils. 25 26 (E) INFECTIOUS DISEASES. CASES OF INFECTIOUS DISEASES NOTIFIED BN WARDS AND REMOVALS TO HOSPITAL. Disease. Total Alperton Central Chalkhill Fryent The Hyde Roe Green Kenton Preston Sudbury Gourt Sudbury Wembley Park Tokyngton Total removed to hospital Percentage of cases removed to hospital Scarlet fever 835 80 14 12 23 29 69 41 34 11 37 13 22 204 60.89 Diphtheria 6 — — — — 1 — — — — 2 1 2 5 83.33 Pneumonia 153 12 7 15 17 13 19 5 19 11 11 6 18 37 24.18 Erysipelas 27 2 2 3 2 4 3 2 2 2 1 1 3 6 22.22 Ophthalmia neonatorum 5 1 — — — - 1 1 1 — 1 — — 4 80.00 Cerebrospinal fever 2 — 1 — — — — - 1 — - - - 2 100.00 Dysentery 101 24 10 1 2 6 5 11 17 5 7 8 5 19 18.81 Measles 513 22 24 36 60 12 101 47 77 16 85 11 22 13 2.05 Whooping-cough 534 29 24 37 50 92 94 44 43 10 76 12 23 8 1.49 Acute poliomyelitis 1 - - — — — — — 1 — — - — 1 100.00 Malaria 3 1 2 — — — — — — — — 1 1 2 40.00 Paratyphoid 1 1 — — — — — — — — — — — 1 100.00 NOTIFICATIONS OF INFECTIOUS DISEASES ACCORDING TO SEX AND AGE. Ago group. Scarlet fever. Whooping cough. Diphtheria. Measles. Acute poliomyelitis. Dysentery. Acute pneumonia. Erysipelas. Cerebrospinal fever. Paratyphoid fever. M F M F M F M F M F M F M F M F M F M F 0— 1 20 25 5 2 0— 26 35 7 17 1— 8 .11 61 89 1 1 48 46 5— 5 5 20 10 3— 25 21 56 69 48 37 15— 3 18 127 23 2 12 1 1 1 5— 76 75 106 94 2 158 135 45— . 3 2 19 9 4 4 10— 34 38 1 1 4 7 1 65 and over 2 7 11 1 3 15— 12 14 1 1 3 8 Unstated. 1 1 1 2 1 25 and over 4 16 3 8 1 3 9 All ages 160 175 248 286 3 3 269 244 1 All ages 38 63 81 72 8 19 1 1 — 1 27 Winter Respiratory Diseases. Winter period considered to begin week ending first Saturday in October, and to end week ending last Saturday in March. For the period under review the absence of an influenza epidemic is to be noted. Notifications Death certifi- of primary cates in which pneumonia and acute respiratory diseases influenzal-pneumonia. mentioned. 1940-41 82 107 1941-42 101 135 1942-43 92 105 1943-44 151 170 1944-45 93 92 These local figures are in accord with the general observations for the country given in the monthly bulletin of the Ministry of Health, June, 1945. Serious, moderate and mild illness rates in the winter months of 1944-45 were less than half as great as in the winter preceding. For non-catarrhal illnesses of these grades the monthly incidence rate was between 5 and 6 per 100, compared with 11 to 16 in the previous winter. Colds and influenza, regardless of any other illness, showed an average monthly attack rate of 18 per cent, both amongst men and women, compared with 22 per cent. in the previous winter. Less than 4 per cent, of people per month were laid up as much as a day on this account, compared with about 8 per cent. in the previous winter. Non-catarrhal minor ailment rates in the winter months were about 13 to 15 per 100 monthly, compared with 15 to 21 in the previous winter. Dysentery. In March there was a sharp rise in dysentery notifications. Quite often, as is usual, more than one member of the family were affected, and the acute phase of the illness generally lasted only a few days. A number of cases were in children attending one of the day nurseries, and in order to prevent spread it was considered necessary to keep the infected children from this nursery until they had become bacteriologically clear. The cases were practically all of Sonne infection. Bacillary dysentery is common and widespread throughout the country. While 'fatal infections may occur more especially in infants and old people, the disease is usually mild, the causal organisms being of the Sonne or Flexner types in most cases; Shiga infections are often severe, however, but their occurrence is much less frequent than is either Sonne or Flexner dysentery. Sonne dysentery is now considered endemic in this country. 28 The person suffering from dysentery should not be considered free without bacteriological confirmation. As a routine the following suggestion was made with regard to Sonne dysentery. After the person had shown no clinical signs of activity (no loose stools) for three days another specimen might be submitted to the bacteriologist, and this repeated at three-day intervals until three specimens in sequence had been reported negative. While special cases may require more intensive bacteriological control, this suggestion was considered sufficient as a generalisation. The opinion is given that there must be many cases of loose motions due to indiscretion in diet, etc., which are not due to specific infection by one of the dysentery group of organisms. The essence of the prevention of spread of dysentery is routine detailed attention to the principles of personal hygiene, careful hand-washing after closet and after attention to a patient, hand washing immediately prior to preparing food, the exclusion of possibilities of flies or dust alighting on food, and the washing of food utensils in really hot water. An infant's napkins should be immediately dealt with after soiling by boiling, and the toddler's chamber must be considered a very potential source of spread unless thoroughly cleansed and disinfected after being used. Bacteriological examinations made:— 1944 + Sonne + Morgan No.1 + Typhimurium + Thompson + Gaertner + T.B. Others Negative Urine Jan. 6 - - - - - - 14 1 Feb. 6 - - - - - - 12 — March. 63 13 - - - 1 - 44 — April. 57 11 - - - — 1 106 — May. 23 9 - - - - - 90 1 June. 17 21 1 - — - 2 42 - July. 5 12 1 1 — - — 19 — Aug. — 5 - — 1 — — 15 — Sept. 2 11 - - - - - 24 — Oct. 1 4 - - - - — 11 - Nov. - 5 - - - - - 15 — Dec. - 3 - - - - - 12 - 180 94 2 1 1 1 3 404 2 29 Non-notifiable Infectious Diseases in School Children. Information regarding these was obtained throughout the year from the head teachers in the Borough. Disease. January February March April May June July August September October November December Total. Chicken-pox 17 18 75 36 11 15 2 — 9 8 1 192 Mumps 9 17 7 5 6 19 7 - 3 1 51 13 138 German measles 24 87 241 109 88 19 1 - - - 6 -- 575 Infective jaundice 2 — 1 3 3 2 - - - 1 - - 12 Consultations regarding infectious disease, between the Medical Officer of Health and the local medical profession: 12. 7 cases of suspicion of small-pox: diagnosis chicken-pox. 3 cases of difficult rashes: (i) a septic rash. (ii) Rubella or German measles, (iii) scarlet fever. 1 case of suspicion of typhoid fever: Diagnosis not confirmed. 1 case of vaccinal complication in an infant recently — vaccinated. 12 Diphtheria Immunisation. Numbers treated (five years period):— Year. 0—5 5—10 10—15 Over 15 Totals. 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 1944 . l,314 61 29 Nil 1,404 The percentage of the child population considered immunised on the 31st December was Children under 5 years 50.82% Children between 5 and 15 years 83.92% 30 The parents of children under two years who have received a course of immunisation injections are advised that in order that the child should remain protected against diphtheria during the susceptible years, another injection should be given just before entry to school at five years of age. Such a reinforcing dose was given to &8 children. The various methods by which the public is kept aware of the importance of immunisation against this fatal disease were repeated throughout the year, and it is safe to say there can be no reason for any family having neglected to consider the value of diphtheria immunisation. Vaccination against Small-pox. Dr. Dyson, Public Vaccinator, continued to attend the Clinics to vaccinate infants. Number of infants vaccinated at Health Clinics: 410. Small-pox at Mount Vernon Hospital, March-April. In connection with this occurrence, 44 contacts were referred for supervision in Wembley — Number of visits made to contacts 170 Number of inspections of contacts at Public Health Offices 20 In appropriate cases vaccination was advised, and all accepted this. In one contact case request was made to the Ministry of Health for a Specialist Medical Officer to visit, when the opinion that the case might be incubating small-pox was confirmed. The person was kept under observation, with all precautions being taken, and in a few days' time it was able to be said definitely that the case was not small-pox. In another case a patient in Wembley Hospital, a Medical Officer from the Ministry of Health confirmed the opinion that the woman was not suffering from any notifiable infectious disease, but from an acute skin condition (erythema multiforme). During the outbreak five other cases of doubt were seen by the Medical Officer of Health at the request of the Family Practitioner. None of them was considered a case of small-pox. 31 Tuberculosis. No. of Notifications. Pulmonary. Non-pulmonary. Male. Female. Male. Female. Under one year 1 - - - 1 to 4 years 1 2 — — 5 to 14 years 3 2 3 4 15 to 24 years 24 19 5 2 25 to 34 years 20 25 1 2 35 to 44 years 24 6 - 1 45 to 54 years 19 4 — 2 55 to 64 years 11 4 - — 65 and over 1 — — - Totals 104 62 9 11 No. of Deaths. Pulmonary. Non-pulmonary. Male. Female. Male. Female Under one year 1 — - — 1 to 4 years — — — 1 5 to 14 years — — — 2 15 to 24 years 1 4 — — 25 to 34 years 8 11 1 2 35 to 44 years 5 5 — 1 45 to 54 years 5 3 1 1 55 to 64 years 9 3 — — 65 and over 3 1 — 1 Totals 32 27 2 8 No. admitted to hospitals or Sanatoria: No. discharged from hospitals or Sanatoria: 98. 76. During the year 195 cases were removed from the register, and at 3.1st December 744 names remained on the register— 647 pulmonary and 97 non-pulmonary. Of the 69 deaths from tuberculosis during the year, 12 had not been notified during life (that is, 17.39%). 32 Notifications and Deaths from Tuberculosis in 5-Year Period. Notifications. Deaths. Pulmonary. NonPulmonary. Pulmonary. NonPulmonary. 1940 100 25 56 7 1941 142 19 64 3 1942 150 34 60 10 1943 133 19 64 5 1944 166 20 59 10 During l939 and since, each death as reported has been scrutinised to ascertain if the person had been on the Tuberculosis Register, and, if so, to note the cause of death as reported on the death certificate. This investigation is continuing and producing some interesting figures. For the sir years ending 31st December, 1944 — Total number of deaths 368 Cause of death: Pulmonary tuberculosis 321 87.23% Non-pulmonary 37 10.05% Other causes than tuberculosis 10 2.72% 368 Interval between notification and death:— Notified after death 81 22.01% 45.1% Under six months 85 85 23.09% 6 months to 1 year 39 10.60% 1 year to 2 years 45 12.23% 2 years to 5 years 64 17.40% 5 years to 10 years 42 11.41% Over 10 years 12 3.26% 368 It is to be noted that 45.1% of the deaths occurred within six months of notification, or actually before the person had been notified. Number of cases on the register Dec., 1944— Pulmonary 647 86.96% Non-pulmonary 97 13.04% 744 33 Number of cases removed from the register as recovered during the six-year period — Pulmonary 79 Non-pulmonary 47 12.6 The Ministry of Health Scheme providing mass miniature radiography has been operating in the Borough, mostly at the larger factory premises. Special arrangements, with the kind co-operation of the management at one factory, allowed the service to be offered to the Council's staff, and it is pleasing to record that 190 of the staff accepted the opportunity and were x-rayed. Bacteriological Service (at Middlesex Hospital). Examinations made Quarter ending Total for 12 months 31.3.44 30.6.44 30.9.44 31.12.44 Throat swabs— Diphtheria 69 65 (of which 2 were positive) 41 54 (of which 4 were positive) 229 (of which 6—2.61% were positive) Hemolytic streptococci 38 (of which 23 were positive) 32 (of which 14 were positive) 20 (of which 10 were positive) 42 (of which 13 were positive) 132 (of which 60 — 45.45% were positive) Vincents angina 19 (of which 5 were positive) 19 (of which 1 was positive) 19 (of which 7 were positive) 23 (of which 1 was positive) 80 (of which 14 were positive) Other swabs 3 5 1 6 15 Nasal swabs— Diphtheria 7 10 (of which 1 was positive) 4 7 28 (of which 1—3.57% was Hæmolytic streptococci 6 2 1 4 positive) 13 Vincents angina - 1 i- 1 2 Sputum (tubercle bacilli) 36 (of which 4 were positive) 33 (of which 4 were positive) 16 of which 3 were positive) 25 (of which 4 were positive) 110 (of which 15 — 13.63% were positive) 34 Examinations made Quarter ending Total for 12 months 31.3.44 30.6.44 30.9.44: 31.12.44 Faeces and urine 165 374 99 50 688 (See page 29) Blood 6 6 1 2 15 Films and swabs for special bacteria 2 5 - - 7 Other specimens Nil Nil 2 6 8 Jaundice (infective hepatitis). The number of cases fell considerably in 1944, but the infection seemed to be smouldering still in the town. Reported Cases in Monthly Periods. January 6 July 6 February — August 2 March 11 September — April 6 October 2 May 8 November 1 June 5 December 1 Total — 48. Age Incidence. 0— 5 years 1 5—10 years 18 10—15 years 12 Over 15 years 15 Age unknown 2 Scabies. The treatment sessions at Wembley Hospital continued throughout the year. No. of Cases of Scabies Reported. January 77 July 63 February 40 August 56 March 89 September 85 April 26 October 78 May 81 November 56 June 39 December 54 Total —744. Numbers affected in Individual Families. 1 person in 205 families. 5 persons in 8 families. 2 persons in 109 families 6 persons in 4 families. 3 persons in 54 families 7 persons in 1 family. 4 persons in 18 families 8 persons in 2 families. 35 There were 42 recurrent cases—1 in 16 families, 2 in 4 families, 3 in 2 families, 5 in 1 family, and 7 in 1 family. Verminous Conditions. Thirty-nine cases of verminous heads were reported-14 referred from health clinics, 3 by factory welfare officers, 5 by private medical practitioners, 4 by school medical officer, 5 by hospital doctors, 4 by health visitors, and 4 came directly to the Town Hall for advice. Thirty-five of these cases received treatment at Kensington Medicinal Baths, and the other four were treated by the Education Authority. One case of body lice was reported by a factory welfare officer, and received treatment at Kensington Medicinal Baths. In their Health Education talks at the Clinics and at their home visits the health visitors take the opportunity as occasion arises and appears appropriate to have a word regarding attention to the hair, etc. For the under fives, wearing the hair short is the best advice; for the adolescent girl a word is given regarding permanent waving always requiring day-to-day combing and brushing. Special Sacker combs are available at the Clinics and given on loan when required. Lethane Hair Oil preparations are advocated. The obviously clean family need not be worried on the above points, but infestation is a family condition, so that if one person be accidentally affected the chances are that someone else in the family has also become infested, however slightly, and the health visitors advise appropriately. If infestation be beyond the assistance of the health visitors, persons are referred to the Royal Borough of Kensington's Clinic, Medicinal Baths, Bletchynden Mews, North Kensington, W. 10. With the kind co-operation of the Food Executive Officer, a letter addressed to the parents of every family was handed as they returned from evacuation, pointing out the importance of diphtheria immunisation, as it might have been that immunisation treatment had not been commenced or had been interrupted because of evacuation. In the absence of the usual home surroundings, too, it was pointed out that it may have been that families were unable to give their customary attention to personal hygiene and bathing. If, therefore, parents were in any doubt about contagious skin conditions or troubles, advice and assistance at the clinics for both adults and children was offered. This letter had the very useful result of making it possible for the health officers to assist families as they returned from evacuation. 36 Disinfection of Premises and Articles. Disinfections for:— Infectious diseases 451 Cancer 7 Vermin (routine protection from) 97 Miscellaneous 50 Articles disinfected or destroyed:— Disinfected.. Destroyed. Bedding and bedclothing 3,610 12 Wearing apparel 69 6 Carpets, rugs, cushions 137 5 Others 51 4 Towels and gowns from Wembley Hospital re Scabies Scheme 66 lots (F.) ENVIRONMENTAL HYGIENE, FOOD AND WATER. Number of verbal notices given 244 „ „ „ complied with 235* „ written notices served 334 „ „ „ complied with 383* „ statutory notices served 21 „ „ „ complied with 26* * Includes a number of notices served in 1943 and completed in 1944. Number of complaints received and investigated 1,838 General sanitation inspections (including 939 visits to air-raid shelters) 22,363 Nuisances abated and improvements effected (including air-raid shelters: 8) 2,342 Some Housing Details. Visits to dwelling-houses 7,497 Nuisances abated and improvements effected 1,003 Total number of dwelling-houses inspected for defects (under Public Health or Housing Acts) 2,344 Number of inspections made for the purpose 4,910 Number of dwelling-houses (included in above) which were inspected and recorded uncler the Housing Consolidated Regulations, 1925-32 Nil 37 Number of inspections made for the purpose Nil Number of dwelling-houses found not to be in all respects fit for human habitation 1,185 Number of defective dwelling-houses rendered fit in consequence of informal action 1,219 Proceedings under Public Health Acts. (1) Number of dwelling-houses in respect of which statutory notices were served requiring defects to be remedied 18 (2) Number of dwelling-houses in which defects were remedied after service of formal notices— (a) By owners 10† (b) By Local Authority in default of owners 14* †Includes compliance in 1944 of 4 notices served in 1943. *Includes compliance in 1944 of 7 notices served in 1943. 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 54 Number of dwellings overcrowded at end of year 129 Number of families dwelling therein 133 Number of persons dwelling therein 694 Number of new eases of overcrowding reported during the year 31 Number of overcrowded families relieved during the year 16 (1) by removal of members of family 2 (2) „ of families to other known address 10 (3) ,, to unknown addresses 1 (4) „ to Council houses (included also in (2)) 2 (5) „ to requisitioned premises (also included in (2)) 7 (6) „ of sub-tenants to requisitioned premises 1 (7) by rearrangement of rooms in house 1 (8) by removal of lodger 1 (9) Number of persons included in such relieved cases 99 38 Disinfestatlon. Visits paid re vermin or suspicion of— For bed bugs 120 For other vermin 176 296 Verminous premises disinfested—For bugs 47 For other vermin 33 80 Council houses disinfested 39 (method employed: liquid insecticides) Verminous articles destroyed 3 Some time before D-Day it was expected that, the Empire Pool might be required for war refugees, and anxiety was felt regarding the possibility of introduction of insect spread disease (typhus fever especially, perhaps). Accordingly preparations were made to provide means of disinfestation of clothing and bedding on a large scale. The demand seemed likely to be too heavy for the Council's normal disinfestation services, so a mobile field apparatus (Millbank Disinfestor) was installed near the premises, and the Council's sanitary inspectors gave intensive instruction on the problem and the working of this special apparatus. In fact, this special war demand did not materialise, but as a result of damage by flying-bombs in London and around, the building was utilised for the reception of operatives drafted to the London area to assist in war damage repairs. The sanitary inspectors instructed a team of workers in the use of the apparatus, and its routine use did much to prevent any spread of accidental infestation. At one time some ,12,000 sets of bedclothing were treated every five days, this large number being necessary because of the constant daily change of personnel. Rats and Mice (Destruction) Act, 1919. As from the 1st February, 1944, duties under this Act were delegated by the Middlesex County Council to the Borough Council. Information regarding infestation may be obtained from complaint to the Public Health Department, or revealed in the sanitary inspectors' visits in their districts to premises or factories or waste dumps or lands, etc. Two rodent control assistants work under the direction of the district inspectors in their areas, each inspector being responsible to the Chief Sanitary Inspector for rodent infestation work and control. A real preventive attitude in the campaign against rat and mice infestation is adopted, largely on the advice of the Infestation Department of the Ministry of Food. Mere alleviation of infestation is not considered enough, actual elimination of all rats and all mice is the aim, and is largely achieved. At the present time 39 (July, 1945) a systematic concentrated attack is about to be made on the sewer-rat population. Work performed 1st February, 1944, to 31st January, 1945:— (1) Number of premises visited 858 (2) „ visits made by sanitary inspectors 1,098 . (3) „ visits made by Rodent Control assistants 3,376 (4) „ premises found to be infested 500 (5) ” premises which have received ment by Rodent Control assistant 232 (6) „ premises which have received treatment privately 196 (7) „ Council-owned. premises included in (5) 37 Estimated number of rats and mice killed February to December 2,575 Outworkers. Number on the register 31.12.1944 82 Number of visits paid to premises 169 Offices. Number on the register 265 Number of visits paid 280 Defects found Nil Defects remedied 1* *from 1943. Meat and Other Food Premises. Number of inspections made: 3,044. Nuisances abated and improvements effected:— Meat shops, stalls, etc. Premises cleansed 29 „ „ „ Other contraventions remedied 8 Cowsheds: Contraventions remedied — Dairies: Cleansed and limewashed 10 „ Premises repaired 4 „ Other contraventions remedied 7 Bakehouses cleansed and limewashed 12 „ sanitary conditions improved 7 „ other contraventions remedied 4 Fried fish shops cleansed and limewashed 7 „ ” sanitary conditions improved 1 „ „ other contraventions remedied — Fishmongers, etc., contraventions remedied 23 Grocers „ „ 39 Greengrocers, etc. „ „ 39 Restaurants, cafes, etc. „ „ 23 Street vendors, hawkers, etc. „ 2 Other food premises „ „ 2 217 40 Dairies and Milk Shops. Number of dairies registered 28 Number of purveyors of milk registered with premises in the Borough, selling milk in properly closed and unopened receptacles 48 Number of purveyors of milk registered whose premises are outside the Borough 24 Number of dairies (included above) where milk is bottled, etc. 5 Milk )(Special Designations) Regulations, 1936 to 1942. Designation . Samples not of milk. Licences issued. Samples taken, satisfactory. Pasteurised 36 42 2 Tuberculin-tested 22 6 — T.T. (Pasteurised) — 15 — T.T. (Certified) — 2 — Accredited 2 6 — 60 71 2 The cleaning and sterilisation of milk bottles was the subject of a report submitted to the Ministry of Health by Drs. Betty Hobbs and G-. S. Wilson, of the London School of Hygiene and Tropical Medicine. The authors suggested a practical standard of bacteriological cleanliness for milk bottles, such standard being that the final mean based on 24 plate counts should not exceed 600 per bottle, reckoned as pints. On this report the Public Health Committee recommend the Council to support a resolution from Amersham pressing for legislation to be made to settle a standard of bacteriological count for all rinsing of churns, bottles, etc. Milk in Schools Scheme. The circumstances of children being excluded from school because of infectious diseases had, of course, been depriving the children of the opportunity of having their milk at school. This position was discussed with the Food Executive Officer (Mr. Cloote), and with his co-operation an arrangement was made whereby the Food Executive Officer is informed of school children who have been excluded from school because of infectious disease, and he allows the mother to have, on her request, additional milk from her dairyman during the time the children are so excluded. The case of children actually suffering from infectious disease is 41 met by the doctor in attendance giving the necessary certificate. This local arrangement has worked very well and is appreciated by the mothers. Food Poisoning. Two notifications were received regarding food poisoning. Laboratory Examinations re Food, Milk and Water (at Middlesex Hospital). Examinations made. Quarter ending Total for 12 months 3.1.3.44 30.6.44 30.9.44 31.12.44 Food 1 - - 1 2 Milk 22 27 14 10 73 Water 37 26 31 16 110 Chemical tests for chlorine content of Swimming Pool water made by inspectors, 44. The practice of fortnightly sampling of the public water supplies was continued throughout the year, and the results passed to the respective Water Companies, while also the Water Companies submitted periodically their results. The water supply remained bacteriologically satisfactory and sufficient in quantity, although there was call for economy from time to time, a call which in the circumstances was readily understood, and which was due also in part to the persistently low rainfall. There is no inhabited premises known to be without an internal water supply. \ (G) DAY NURSERIES. Carlyon Road Day Nursery was slightly damaged by enemy action on the night of Friday-Saturday, Jan. 21st-22nd. The nursery, however, was reoccupied as usual on the following Monday morning. On the night of the lst-2nd March the nursery was again struck, rebuilding entirely being necessary. Arrangements were made for the children to assemble at One Tree Hill Clinic each morning, where they were dispersed, in charge of nurses, by Civil Defence ambulances to the other Wembley nurseries, the children being brought back to One Tree Hill Clinic each evening in time for the mothers to call for them. This arrangement continued until 4th September. Harrowdene Road Nursery suffered damage in the early hours of 21st July, but the nursery was open again for the reception of children on the following morning. Woodstock Road Nursery was damaged on 16th July, but the nursery was made ready to receive children the next morning. 42 The daily cost (pence) per child-in-attendance 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):— Period 22nd September—21st December. Ealing Road Nursery 14.40d. Neeld Crescent Nursery ll.85d. Princes Avenue 12.28d. Carlyon Road Nursery 13.49d. Old Kenton Lane Nursery 12.29d. Harrowdene Road Nursery 11.72d. Woodstock Road Nursery 14.70d. District Road Nursery 12.54d. The children attending the nurseries have continued themselves to be the best proof of the good work done at these nurseries. The numbers of children in attendance, of course, were considerably reduced during the period of flying-bombs, but now (July, 1945) most of the nurseries actually have waiting lists again. The staffing problem, however, is acute, and it is now very difficult indeed to staff the nurseries, having regard to the constant resignations now being received. The incidence of infectious disease amongst both the children and the staff has continued to be watched. Infectious Diseases—Day Nurseries, 1944. Disease. January February March April May June July August September October November December Total. (a) Children:— Scarlet fever 2 1 1 - - - - - 1 - - - 5 Dysentery— B.Sonne 3 - 19 7 2 - - - - - - 1 32 B.Morgan No. 1 - - 3 3 1 - — - 2 1 — — 10 Chicken-pox 1 - 2 - — 1 1 2 — — — — 7 Mumps 3 9 3 4 — 4 3 - - - - - 26 German mpasles — 5 9 14 23 9 9 4 — 1 — 1 75 Measles - - - 2 15 3 1 6 12 4 — 29 72 Whooping-cough 5 3 — 4 2 2 — 1 5 5 8 7 42 (b) Staff: Dysentery— B.Sonne — 1 - - - - - - - - - - 1 German measles - - 1 - - - - - - - - - 1 43 Two outbreaks of whooping-cough—one at Princes Avenue, the other at Old Kenton Lane Nursery—provided an opportunity for further consideration of the results from immunisation treatment against whooping-cough. At Princes Avenue a case of whooping-cough occurred on the 18th September, and the last case of the outbreak occurred on the 11th November, while at Old Kenton Lane the first case occurred on the 11th October and the last on 2nd January, 1945. No. of children exposed No. who No. known No. who No. known to infection had to be had not to be (not pre- vaccine attacked. vaccine attacked. Nursery. viously course. course. attacked) Princes Avenue 40 22 6 (27.3%) 18 11 (61%) Old Kenton Lane .41 9 3 (33.3%) 32 11 (34%) These figures, of course, are still small, and while those at Princes Avenue give an attack rate of 27% amongst the immunised children and of 61% amongst the non-immunised, there is no such difference in the figures for Old Kenton Lane—33% amongst those immunised and 34% amongst those not immunised. Staff. Miss Bobbins passed the examination for the diploma of the National Society of Children's Nurseries with distinction. Four other trainees also passed the examination; four other students have recently (July, 1945) been successful. Three students have left the service to commence general nursing training at London hospitals after they had obtained the diploma of the National Society. Hendon Technical College has been giving courses of training for the student nursery nurses. In addition to a number of the Council's students attending this course, four students of the College have been attending Ealing Road and Harrowdene Road Nurseries one day a week for practical experience, while one student attended for two weeks during vacation for nursery teaching experience from Goldsmith's College University of London. Daily Minder Scheme. This scheme continued throughout the year to be practically unused. 44 Number of daily minders approved during 1944 1 „ approved daily minders at the end of the year 12 „ new children placed during 1944 1 „ children daily minded during 1944 5 „ children daily minded at the end of the year 5 (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 153 Number of letters sent to Doctors in. charge of First Aid Posts re medical matters 6 Number of instructions sent to Depot Superintendents 111 Number of letters sent to Sisters-in-Charge of First Aid Posts 103 The constantly changing personnel of Civil Defence, together with the many circulars received, continued to mean much administrative detail. With regard to personnel, the scrutiny of wages sheets, sickness and annual leave records, personnel returns re nominations, resignations, transfers, etc., the provision of statistics for the Civil Defence Committee and the County Council, the employment of part-time personnel, their hours and rota of duty, the various returns required, Civil Nursing Reserve uniform replacements, reimbursing of fares to personnel for travelling expenses for their hospital and scabies clinics duties, all meant much routine organisation throughout the year. It is a pleasure to record that whatever call was put upon the Casualty Services it was answered immediately and efficiently; and the strain during the flying-bomb and rocket periods was not light. Everyone acted in the most commendable manner. With a view to keeping first-aid training up to standard, a local first-aid refresher course, on the same lines as that run by the Group Training School, for all whole-time Civil Defence personnel who had already obtained their preliminary certificate was commenced. The instructors were nominated from the Ambulance and Rescue Service personnel who had already a Group School instructor's certificate. Each class was to be held on alternate days for two weeks, and on the conclusion of the course the County Medical Officer had agreed to set an examination through Group School instructors, and for a certificate to be issued by them to those personnel passing the examination. By this means 45 it was hoped to revise periodically training for all full-time Wardens, Rescue and Ambulance Service personnel. The Chief Warden and the Rescue Service Controller had kindly promised their full co-operation. Within a few days of the commencement of this course, however, we entered on the flying-bomb period, and the course had to be abandoned. Establishment. Ambulance Depots. December, 1944 70 plus 2 superintendents. January, 1945 40 plus .1 superintendent. First Aid Posts. December, 1944 58 plus 6 sisters-in-charge. January, 1945 27 plus 4 sisters-in-charge. First Aid Post No. 1 (Stag Lane) was closed on 19.11.44 „ ” No. 2 (Preston Manor) „ 15.12.44 „ „ No. 3 (Monks Park) „ 13.12.44 ” „ No. 6 (Claremont) „ 28.12.44 leaving only First Aid Post No. 5 (Imperial College Pavilion, East Lane) open after the end of the year. Particular duties continued to be undertaken by the Sanitary Inspectors—for example, periodic visits to the Ambulance and Rescue Depots, First Aid Posts, Wardens Posts, Wardens Headquarters, etc., re cleanliness and ventilation. Routine disinfection of mattresses and pillows at all Civil Defence Depots was carried out monthly. Air-raid shelters were inspected, static water tanks were kept under supervision with regard to the possibility of mosquito nuisance. On all air-raid damage incidents the inspectors satisfied themselves as to any damage to sewers or drains, or to the water supply. The Health Visitors were kept informed of all evacuee children under five years of age as they arrived in the Borough. Unaccompanied children were given the same supervision as if they had been foster children, while with regard to accompanied children the same supervision was given as is given to Wembley residents. By periodic visits to the rest centres they became acquainted with the personnel in charge, and when the centres were open worked with them, when the various services known to the Health Visitors were explained ancj offered as appropriate. Wembley became an official evacuation area at the time of the flying-bomb incidents. Evacuation in Official Parties. Unaccompanied children 695 Mothers and children 2,527 46 In addition, a further 6,096 persons received travel vouchers and billeting certificates, having found their own accommodation (1) SECTIONALISATION OF AND CO-ORDINATION IN THE HEALTH DEPARTMENT. The Department is sectionalised thus:— Section. 1—Supplies, Finance, etc. (miscellaneous services). „ 3—Infectious Diseases. „ 3—Maternity and Child Welfare and 5 Day Nurseries. „ 1—Environmental Hygiene (Sanitation, Housing, Factories, Food, Water, etc.). „ 6—Civil Defence. but these sections are not in any sense considered watertight. They overflow one into the other, and administratively are kept co-ordinated by constant exchange of information, mutual advice, discussion, etc., so that the department may always work harmoniously as a whole. The distribution of responsibility is in accordance with practical simplicity rather than by hard-and-fast rules. For example, the Section (3), dealing mostly with Maternity and Child Welfare, deals with death statistics, etc., because it obviously deals with other vital statistics such as the notification of births, and Section (2), Infectious Diseases, deals with the provision of insulin, etc., because in the main that section deals with the local medical profession. The Section (6), Civil Defence, has dealt with the Borough civil ambulances and the Volunteer Car Pool, because it dealt with all Civil Defence ambulance matters. Further, the professional and technical officers' responsibilities extend into all these sections, some more, some less. Section 1: Supplies, Finance, etc.—miscellaneous—ordering of equipment, goods and accounts, all financial matters. Section 2: Infectious diseases, hospitalisation and domiciliary visiting, action re school exclusion, etc., tuberculosis, diphtheria immunisation, food poisoning, etc., bacteriological laboratory specimens, knti-toxins supplied, scabies and vermin, list of local medical practitioners, insulin, respirators for persons with respiratory trouble. Section 3: Maternity and Child Welfare, notification of births, Clinic Health Services, Child Life Protection and Adoption of Children, death returns, disinfection of respirators (war gases). 47 Section 4: Environmental hygiene, sanitary complaints and nuisances, Land Charges, Searches, etc., Statutory Notices under Public Health and Housing Acts, sewers, closets, etc., food and milk; and premises and dairies, water, housing, factories, vermin, rats, etc.; swimming-baths, hairdressers, establishments for massage, private school premises, disinfectants, etc. Section 5: Day Nurseries and Daily Guardian Scheme. Section 6: All Civil Defence; general filing and more personal M.O.H. matters; Borough Civil Ambulances, Volunteer Car Pool. The above arrangements have proved fluid enough to allow a smooth assumption of the additional duties which are being continually imposed upon Health Departments. At the time of writing, of course, the largest extension in the services so far is taking place as on the 16th July, the provision of the School Medical Services is being undertaken by the Department according to delegation under the Education Act, 1944. The Staff (July, 1845) ((full-time). Medical Officers 4 Health Visitors 13 Home and Domestic Helps 8 Sanitary Inspectors 6 Disinfectors 2 Rodent Operatives 2 Sanitary Assistants 2 Mortuary Attendant 1 Clerical Officers 14 Forward 52 Forward 52 Day Nurseries. Matron & Sisters-in-Charge 8 Other nursing personnel 58 Wardens 6 Domestic personnel 11 Ambulance Service. Station Officer and Drivers 9 Attendants 8 Clerical and Telephone Operators 3 155 SUMMARY. Probably this is the last Report to be of an interim nature, and it is being compiled just at the end of hostilities in Europe. But even those short war-time Reports have given, in summary fashion, an indication of the increased health services which have fallen upon the Borough Council. Civil Defence, especially, filtered into all the sections of the Department, but the Ministry of Health has been providing through Local Authorities additional public health, and personal health and social services. The essential statistics for the Borough have continued throughout the war years to be satisfactory. This applies to the 48 birth rate, the persistently low infant mortality rate, while the maternal mortality rate has also been falling. Still more attention is now being paid to premature infants. The attendances of mothers and children at the health clinics themselves indicate an appreciation of the services provided, the expectant mothers coming to the clinics very early in their pregnancies. The Home Help (Maternity and Child Welfare) Service was extended during the year, while now, in addition, the Ministry's Domestic Help Service is being provided. An agreement with the Middlesex County Council has been made for the welfare of the unmarried mother both before and after her baby's birth. The infectious disease which showed rise in incidence was dysentery, while during last winter the relative incidence of the respiratory diseases fell. The local experience with regard to the efficacy of whooping-cough vaccine has been inconclusive, and before final opinion can be given still more observation must be made. The number of cases of scabies remained high but has lately shown a fall. The service provided at Wembley Hospital has been much appreciated, and it is considered that the fall in the numbers treated is a real indication of the numbers affected being less than in the earlier war years. Verminous conditions are scarcely a public health problem in the Borough. Of course, the Borough is not without its housing difficulties at this time, but the Council continue to be very sensitive about the position, and their Points Scheme—an endeavour to place applications according to essential priorities—is a model of its kind, and should assist greatly when the scarcity of housing accommodation is eased. The position of some families at the present time is most acute, especially regarding overcrowding. The service performed by the Day Nurseries is an important part of the public health. With the end of the war in Europe one may be allowed to express pride in the manner in which the personnel, full-time and part-time, of the Casualty Services responded to the trying experiences during the flving-bomb and rocket periods last year. With the delegation under the Education Act, 1944, by the County Council, still further duties and responsibilities will fall upon the Department, but this is an opportunity for a co-ordinate and still fuller health and welfare service to be provided. It is a very pleasant duty respectfully to acknowledge the services of all the officers of the Department throughout these extraordinary war years. I would like also to thank the Council for the way in which our endeavours have always been appreciated. I have the honour to be, Mr. Mayor, Ladies and Gentlemen, Your obedient Servant, A. G. MORISON, Medical Officer of Health. 49