LIBRARY WEM 28 BOROUGH OF WEMBLEY * REPORT OF THE MEDICAL OFFICER OF HEALTH FOR THE YEAR 1947 * A. G. MORISON, M.A., M.D., D.P.H., Medical Officer of Health BOROUGH OF WEMBLEY * REPORT OF THE MEDICAL OFFICER OF HEALTH FOR THE YEAR 1947 * A. G. MORISON, M.A., M.D., D.P.H., Medical Officer of Health BOROUGH OF WEMBLEY * ANNUAL REPORT of the MEDICAL OFFICER OF HEALTH for the Year 1947 * To the Mayor, Aldermen and Councillors of the Borough. Mr. Mayor, Ladies and Gentlemen, I have the honour to submit the Annual Report on the Health of the Borough for 3947. This Report has been compiled in the following seven chapters, six with a statistical appendix, in which the figures relating to the functions of the Public Health Department have been collected together according to the relevant services. Some account of the considerable development of the services during the last ten-year period is presented:— Chapter I VITAL STATISTICS, Page 4, Statistical Appendix A, Pages 5—11. „ II GENERAL HEALTH SERVICES, Pages 12—15, Statistical Appendix B, Pages 16—17. „ III MATERNITY AND CHILD WELFARE SERVICES, Pages 18—24, Statistical Appendix C, Pages 25—35. „ IV SCHOOL HEALTH SERVICES, Pages 36—39, Statistical Appendix D, Pages 40—49. „ V INFECTIOUS DISEASES, Pages 50—52, Statistical Appendix E, Pages 53—60. „ VI ENVIRONMENTAL HYGIENE, FOOD AND WATER, HOUSING, FACTORIES, ETC., Pages 61—66, Statistical Appendix F, Page 67—81. „ VII ADMINISTRATION OF THE DEPARTMENT, STAFF AND DEVELOPMENT, Pages 82—84. 3 CHAPTER T. VITAL STATISTICS. 1. The population of the Borough mid-1947 was estimated by the Registrar-General to be 132,870. In .1931 (the last eensii9 date) the population of the two districts, Wembley and Kingsbury, was 65,197; in '1937 the population had become 114,700, while the last (December, 11947) estimate of the Registrar-General is that the population is 134,390. Wembley is the fifth largest County district in Middlesex, those of greater population being according to size—Harrow, Ealing, Willesden and Hendon. 2. In 1947, 2,279 live births were recorded, giving a birth rate of 17.15 per thousand; this is the largest number of births so far recorded to Wembley. The number of deaths was 1,124 giving a crude death rate of 8.46 per thousand estimated population. The infantile mortality rate was exceedingly low, the death rate of infants per thousand live births being the record one of 23.26, the previously lowest figure having been 26.37 in 1946. In the five years 1933-1937 the infantile mortality rate was in the neighbourhood of 40, tending to exceed 40 (largest rate 193645.14, smallest rate 1935—34.26). The corresponding figures for the five years 1943-1947 were consistently under 37, the largest being in 1943—37.17, the smallest this year (1947)—23.26. The maternal mortality rate per thousand live Ibirths was 1.32. In the five years 1933-11937 the maternal mortality rate was averaging just over 2, largest rate 1933—5.85, smallest rate 193'5—0.0. In the five years 1943-1947 the maternal mortality rate was 1.19; highest figure 1943—2.35, lowest figure 1946—0.45. Judged by such criteria then, the services provided by the Borough have proved themselves. 3. Prematurity of 'birth was again the main cause of the deaths is very young infants. Regarding the figures submitted in the statistics on infantile mortality and on survival of premature infants, it has to be pointed out that the figures in the former table are those regarding births to Wembley residents whether the birth took place in Wembley or elsewhere, whereas the figures relating to survival of premature infants at the end of 24 hours and at the end of a month are only of births taking place within the Borough boundary. Much consideration is being given to the problem of prematurity and the possibility of saving premature births at the present time, and from the Wembley figures it is obvious that attack on this problem is now practically the only way one may expect a decrease in infant mortality rates in the Borough. 4 STATISTICAL APPENDIX A. CERTAIN VITAL STATISTICS, 1947, from figures supplied by Registrar-General. (Some comparative 1946 figures within brackets.) Live Births. Male. Female. Total. Legitimate 1,141 1,049 2,190 (2,151) Illegitimate 42 47 89 (86) Live birth rate per 1,000 estimated population17.15 (17.28) Stillbirths. Legitimate .15 15 30 (48) Illegitimate 12 3 (2)Rate per 1,000 total (live and still)birhts 14.27 (21.86) Stillbirth rate per 1,000 estimated population 0.25(0.38) Deaths 554 570 1,124 (1,042) Death rate per 1,000 estimated population — Crude rate 8.46 (8.02) Infantile Mortality. Death rate of infants under one year of age:— All infants per 11,000 live births 23.26 (26.37) Legitimate infants per 1,000 legitimate live-births 22.83 (24.64) Illegitimate infants per 1,000 live illegitimate births 33.7l (69.77) 5 Deaths of infants under one year of age:— Male. Female. Total.   Legitimate 23 27 50 (53) 53 Illegitimate 3 — 3 (59) (6) Deaths from: Cancer (all ages) 213 (197) Measles (all ages) 2 (—) Whooping cough (all ages) 2 (2) Diarrhoea (under 2 years) 3 (5) Maternal Mortality. Deaths from puerperal sepsis — (1) Other puerperal causes 3 (—) Maternal mortality rate per 1,000 live births 1.32 (0.45) Maternal mortality rate per 1,000 total (live and still) births 1.30 (0.44) Per 1,000 total Per 1,000 births (live Per 1,000 population. Live Births, and still). Still Infantile Maternal Birth Birth Death mor mor- Maternal rate. rate. rate. tality. tality. mortality. Wembley 17.15 0.25 8.46 23.26 1.32 1.30 England and Wales 20.50 0.50 112.00 41.00 — 1.17 London 22.70 0.49 12.80 37.00 — — 126 County Boroughs, etc. 23.30 0.62 13.00 47.00 — — 148 Smaller towns, etc. 22.20 0.54 11.90 36.00 — — 6 Causes of Deaths during the Year. 1946. Total. Causes of Death. Male. Female. 1947. Total.  1,042 All causes 554 570 1,124 — Typhoid and para-typhoid fevers — — — 1 Cerebro-spinal fever — — — — Scarlet fever — — — 2 Whooping cough — 2 2 — Diphtheria — — — 43 Tuberculosis of respiratory system 29 20 49 8 Other forms of tuberculosis 5 5 10 12 Syphilitic diseases 1 1 2 9 Influenza 5 6 11 — Measles 1 1 2 — Ac: polio-myel: and polio-enceph: 1 — 1 — Acute infectious enceph: 1 — 1 6 Cancer of buc: cav: and cesoph:(M) 5 — 5 4 „ uterus (F) — 16 16 30 Cancer of stomach and duodenum 16 14 30 19 Cancer of breast — 27 27 138 Cancer of all other sites 80 55 135 9 Diabetes 3 5 8 111 Intra-cranial vascular lesions 43 74 117 257 Heart disease 1121 132 253 54 Other dis: of circ: system 29 35 64 41 Bronchitis 32 22 54 44 Pneumonia 34 18 52 14 Other respiratorv diseases 10 8 18 13 Ulcer of stomach or duodenum 8 6 14 5 Diarrhoea under two years 2 1 3 4 Appendicitis 4 1 5 27 Other digestive diseases 14 17 31 31 Nephritis 16 14 30 1 Puerperal and post-abort: sepsis — — — — Other maternal causes — 3 3 18 Premature birth 5 3 8 24 Congenital malf: birth injury and infant diseases 13 20 33 17 Suicide 10 8 18 13 Road traffic accidents 9 3 12 23 Other violent causes 13 9 22 63 All other causes 44 44 88 7 The Principal Causes of Death. Disease. Total Number of deaths.  1. Heart disease and other diseases of circulatory system 317 Intra-cranial vascular lesions 117 434 2. Cancer 213 3. Respiratory diseases:— (a) Bronchitis 54 (b) Pneumonia 52 (c) Other respiratory diseases 18 124 4. Tuberculosis:— (a) Respiratory system 49 (b) Other forms 10 59 5. Violent deaths:— (a) Suicide 18 (b) Road traffic 12 (c) Other violent causes 22 52 6. Digestive Diseases:— (a) Appendicitis 5 (b) Other digestive diseases 31 (c) Ulcer 14 50 7. Premature births 8 Congenital malf: birth injury and infant diseases 33 41 8  Percentage of total deaths under 1 year. Percentage of total deaths under 50 years. Percentage of deaths taking place in hospitals.  1943 7.61 25.59 52.17 1944 7.06 29.18 45.87 1945 6.44 22.26 45.50 1946 5.22 20.60 39.19 1947 4.65 20.88 38.25 SOME OTHER ESSENTIAL LOCAL STATISTICS. Birth Notifications. Notified by. At home. In Hospital. In Nursing Home. Totals.  Doctors 22 738 406 1,166 Midwives 601 348 85 1,094 Parents 3 — 1 4 Totals 686 1,086 492 2,264 Percentages 30.3 48.0 21.7 100 Live births — 2,228. Still 'births — 36. 9 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 9 Total deaths under 1 year  Prematurity 6 3 — — 9 1 — — - 10 Congenital defects* 5 1 1 — 7 — 1 — — 9 Broncho pneumonia. 1 1 — 1 3 1 2 — 1 7 Atelectasis 9 1 — — 10 — — — — 10 Gastro-enteritis — — — — — 2 — — — 2 Birth injuriest 4 — — — 4 — — — — 4 Violent deaths — — — — — — — — 1 1 Diseases of the new Born‡ 3 — — — 3 — — — — 3 Meningitis — 2 — — 2 — — — — 2 Acute bronchitis — — — — — — 1 — — 1 Accidental death — — — — — — 1 — — 1 Miliary tuberculosis — — — — — — — 1 — 1 Cerebral degeneration — — — — — — — 1 — 1 Exhaustion — — — — — 1 — — — 1 28 8 1 1 38 5 5 2 3 53 * Included in congenital defects are Ac. hydrocephalus (1), defects of heart (4), multiple deformities (1), meningocele (1), cretinism (1), neonatal pyaemia (1). † Included in birth injuries are sub-dural haemorrhage (1), cerebral haemorrhage (1), intra-eranial haemorrhage (1), laceration of tentorium (1). ‡ Included in diseases of the new born are:—erythroblastosis faetalis (2). 10 Infantile Mortality, 1943-1947. Vear. Wembley. England & Wales.  1943 37.17 49 1944 35.50 46 1145 36.75 46 1946 26.37 43 1947 23.26 41 Infantile mortality during last live years (10,660 live births, 331 deaths under one year): 31.05. Maternal Mortality. Rate per 1,000 total births (live and still), 1943-1947:— Year. Wem'bley. England & Wales.  1943 2.35 2.29 1944 0.91 1.93 1945 1.08 1.79 1946 0.45 1.43 1947 1.30 1.17 Maternal mortality during last live years (10,890 total births . —13 maternal deaths): 1.19. 11 CHAPTER II. GENERAL HEALTH SERVICES. 1. SERVICES PROVIDED, Health education—Collation of various health services of Voluntary and Local Authorities— Ambulance service for accident and sick cases and maternity removals to hospital—Domestic Help Scheme under Ministry of Health Circular No. 179/44 — Insulin — Laboratory service at Central Public Health Laboratory, Colindale — Mortuary at St. John's Churchyard— Ascertainment and treatment of verminous premises and verminous people, arrangement with Royal Borough of Kensington — Massage and Special Treatment, registration of premises. 2. DEVELOPMENT 10 YEARS, 1937-1947, (a) New services provided — Domestic Helps, Insulin, Laboratory service, registration of Massage and Special Treatment premises, Health education; (b) Expansion of existing services—association with University of London, with Royal College of Nursing, distribution of magazine " Better Health," routine demonstrations at Clinics, issue of booklet to Local Medical Profession, ambulances 1937, '2, 1947, 5 and ambulance car, calls 1937—2,483, 1947—9,242. 3. In accordance with Ministry of Health Circular No. 185/45 a report on a programme of capital expenditure has been submitted, dealing with the Disinfecting Station at Alperton Lane, which is small but efficient. The Council decided that in due course the housing of the Public Health vans attached to the Disinfecting Station would be considered along with the garage . accommodation of the Department of Pulblic Cleansing. Had it not been for the War the Mortuary in St. John's Churchyard by this time would have been completely replaced by a new building. 4. HEALTH EDUCATION. The publication " Better Health " is on sale at the various Clinics. From one angle, regarding health education, reference may be made to the courses of study attended by the Public Health Officers during the year. Two Health Visitors attended the course in London of the Women Public Health Officers' Association, and two the course of the Central Council for Health Education at Oxford, the Council being satisfied that to maintain an up-to-date and efficient Health Visitors' service facilities should enable all in their health education duties to be abreast with current information and methods, otherwise recent medical and educational advancement might be lost to the public. The Council have authorised that arrangements may be made for places at appropriate refresher courses for four Health Visitors 12 annually, generally two in London and two in the provinces. Medical Officers attended the Annual Congress of the "Royal Sanitary Institute and the Conference of the National Society of Maternity and Child Welfare Association, the Chief Sanitary Inspector attended the Annual Conferences of the Sanitary Inspectors' Association and the National Smoke Abatement Society. With the concurrence of the Council the Medical Officer of Health has conducted classes in Public Health Administration for medical practitioners attending the Public Health Course of the London School of Hygiene and Tropical Medicine and the Borough has been approved by the University of London for such tuition. The Royal College of Nursing has also been sending to Wembley Student Health Visitors for the practical part of their training, while request has been received from Battersea Polytechnic for Student Sanitary Inspectors to be given practical experience and tuition in Wembley. Miss V. Matthews, Superintendent Health Visitor, has contributed the following:— Health education has been continued during 1947 in many different ways. Individual teaching takes place in the home, in the Clinics and, when the opportunity presents itself, at School Medical Inspections, and is thoroughly pursued by the Medical Officers and Health Visitors. Dental Officers also take advantage of every chance to teach the necessity of the care of the teeth and, in general, the public have become more widely aware that dental sepsis frequently spells general ill-health. Posters relating to various subjects are regularly displayed at all Health Clinics and informative leaflets distributed to the public and sometimes to older school-children. The blackboard is frequently used to bring some point of topical interest to the notice of those attending the Clinics. Group teaching has been extended and now takes its place as an important part of the Ante-Natal Clinic in all buildings which are suitable (all but the two Church Halls). Mothers attend the Mothercraft Class immediately prior to the Doctor's Ante-Natal Session. This has proved the best time for all concerned but the arrangement does limit somewhat the full success of the appointments-time scheme. An average attendance at the class is 10 mothers, and it is obvious that all cannot see the Doctor at the same time. However, the majority of those who enjoy attending the classes are women expecting their first babies and the visit to the Ante-Natal Clinic provides for them an opportunity for exchange of view with others, as well as for obtaining the necessary medical advice, discussion regarding baby clothes, etc., and the collection of the Government vitamin preparations. 13 For mothers who have other children and whose knowledge of the details related to the subject is well grounded, an attempt is made to eliminate unnecessary waiting, by an appointments system. As a finale to attendance at the complete course of 6 Mothercraft Classes, a mother will sometimes offer to bring her young baby as a model for the baby's bathing demonstration, the Health Visitor conducting the demonstration bathing the baby, and explaining the details step by step. This is the most popular of the series and gives great satisfaction to all since many young expectant mothers have not so far seen a young baby bathed. It is impossible to assess the full value of this teaching. Each mother in the group gains in knowledge, companionship and confidence and contributes to the general air of friendliness which is the aim of every branch of the Maternity and Child Welfare Services. Many friendships are formed during the period of waiting and continue through attendance at Infant Welfare Sessions, Vaccination and, later, Diphtheria Immunisation Sessions. 5. HEALTH SERVICES BOOKLET. For some years a booklet has been issued to the Local Medical Profession giving information regarding the various Health Services available. The services mentioned in this booklet are not all Borough Council services, rather endeavour is made to collect together information which may be helpful, reference also being made to the Ministry of Health services, Middlesex County Council services, Voluntary Hospital services and to those of other voluntary agencies. A four-weekly bulletin has continued to be circulated to the Local Medical Profession giving the incidence locally of the infectious diseases, together with a note on any topical public health matter as seems appropriate. 6. The Central Public Health Laboratory at Colindale, has been conducted by the Medical Research Council on behalf of the Ministry of Health. This Laboratory has 'been used to the fullest extent, replacing the service given during the War at the Middlesex Hospital. The services available at this Laboratory are a most important asset to both Medical Practitioners in the treatment of individual cases and to the Public Health alike. The types and numbers of specimens examined are tabulated in Appendix E, but, in addition, the easy access to the Specialist Bacteriologists at Colindale, is of the greatest value to the health services. 7. The consistently high level of the services provided by the District Nursing Associations (Wembley and Kingsbury) 14 should be mentioned as they are indeed an asset to the public health of the Borough, providing, as they do, both general nursing services and maternity services. The appropriate Committees of the Council have always the greatest interest in receiving the periodic reports on this good work. 8. VERMINOUS CONDITIONS. Only 1!) cases, 13 adults and 6 school pupils, were referred to Kensington Medicinal Baths for treatment more intensive than could be given at the Clinics or in the homes. The generalisation remains true that infestation is scarcely a Public Health problem in Wembley. The response of the mothers to the advice given through the School Health Services is most gratifying. 9. ESTABLISHMENTS FOR MASSAGE AND SPECIAL TREATMENT. Licensing of these establishments has continued pending changes in legislation enacted in the National Health Service Act. 15 STATISTICAL APPENDIX B. Ambulance Service. Accident or sudden illness removals 816 Sick removals 7,991 Maternity removals 435 Total 9,242 Included in above:— (a) Number of removals carried out for other Authorities 65 (b) Number of removals carried out by other Authorities for Wembley 115 Domestic Help Scheme—Ministry of Health Circular No. 179/44. Assessment re recovery of cost. No. of families to 2/-d. l/8d. l/4d. l/-d. 8d. 4d. whom service given. Full, per per per per per per Free. hour. hour. hour. hour. hour. hour. 135 88 4 6 8 8 6 4 11 Full-time. Part-time. No. of domestic helps on Council's Panel on 31/12/47 3 1 Provision of Insulin. Number of persons who received free insulin in accordance with the Council's scheme:—31. Total cost of insulin provided £253 5s. l0d. 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 and Surgical 1,275 15,944 Maternity 172 3,394 Midwifery 275 6,336 Ante-natal and Post-natal 398 2,515 Miscarriage 18 99 16 Kingsbury District Nursing Association. Medical 147 2,335 Surgical 97 1,653 Maternity 40 811 Midwifery 175 3,235 Ante-natal 220 1,662 Children under five 51 299 Children over five 15 49 Tuberculosis 8 285 Casual — 268 Mortuary. No. of bodies deposited 75 No. of post-mortem examinations carried out 68 No. of Coroner's inquests held 12 Bodies were deposited (by order:— Coroner 46 By Police 23 Wembley Hospital 2 Private Undertaker 4 Establishments for Massage and Special Treatment. (a) Members of the Chartered Society of Physiotherapists who have lodged with the Local Authority a certificate signed by two resident medical practitioners that they are suitable persons to carry on such an establishment 2 (b) Licences granted:— New 2 Renewals 16 17 CHAPTER III. MATERNITY AND CHILD WELFARE. 1. SERVICES PROVIDED, Notification of births — For premature infants special equipment on loan, Pasdiatrician available, supply of expressed breast milk may be available at County Maternity Units, provision of Home Help, ambulances provided with heating device—Health Visitor Domiciliary Service from end of lying-in period, Borough divided into 16 Health Visitor areas— Infant Death enquiries to obtain information regarding possibilities of further reduction in infantile mortality—Child Life Protection, advice to foster parents, Health Visitor's enquiries re applications to keep foster-child, register of foster-parents and foster-children—Adoption of Children (Regulation) Act, 1939, responsibilities of Council limited to Section 7 and explanatory Circular Ministry of Health No. 2790, preliminary visit re suitability of proposed home, monthly visitation after receipt of child —Clinic Services, Routine Clinic Sessions Infant Welfare and Toddlers, Ante-Natal, Dental, Diphtheria Immunisation — Test Feeding Scales loaned for investigation of sufficiency, etc., of breast feeding—pamphlets giving general and dietary advice to Expectant Mothers—Hospitalisation for confinement arranged as appropriate and possible, and for puerperal pyrexia — Be home confinements coupon equivalent certificates for necessary additional sheets according to Ministry of Health arrangements, panel of consultants available for abnormal ante-natal and puerperal cases in private practice, arangement with County Hospitals for Specialist Obstetric Medical Officer in confinement cases, Emergency Maternity Units (Flying Squads) for any case of grave emergency, e.g., shock, haemorrhage or eclampsia available from Redhill County Hospital — Examination of blood for Wassermann reaction offered to all women attending Ante-Natal Clinics — Special Scheme re Unmarried Mothers, arrangements with British Red Cross Society through Middlesex County Council at PreNatal Home, 16, The Park, Golders Green prior to confinement, and at B.R.C.S. Hostel, Marylands, Hendon, for mothers and babies for two or three months after confinement — Complete Dental Scheme, extractions, conservative treatment and artificial dentures, nitrous oxide anaesthesia available — Special foods, nutrients, drugs, dressings, etc., at Clinics, sterile dressing drums treated at Redhill County Hospital—Services available from the Clinics, Sunlight and Massage treatment at Wembley Hospital, Redhill and Central Middlesex County Hospitals, and Marlborough Hill Clinic, Harrow, Convalescent Home treatment, domiciliary nursing by arrangement with Wembley and Kingsbury District Nursing Associations, sterilised Maternity Outfits, X-ray examinations at Wembley Hospital, Redhill and Central Middlesex County 18 Hospitals—Home Helps—Specialist Medical Services, Gynagcological and Post-Natal Clinics, Birth Control Sessions for married women requiring birth control advice for medical reasons, ophthalmic cases, orthopaedic cases, child guidance cases, speech difficulty cases referred to Special Clinics — Clinic for children showing deafness or defective speech from deafness, or allergic asthma, etc., conditions, at Metropolitan Ear, Nose and Throat Hospital—Economic Circumstances Scale according to which Milk and Accessory Foods, Artificial Dentures, Convalescent Treatment, Maternity Outfits, and Home and Domestic Helps available, scale depending on number in family and net income per head of family—Nursery Service 368 places, until the closure of District Road Nursery, Nurseries open daily, Monday to Saturday, opening and closing times as demand requires, daily charge 1/- per child, inclusive of all food given (morning lunch, midday dinner, and tea), Medical Officers attend the Nurseries regularly and all the Services of the Clinics available for children. 2. DEVELOPMENT 10 YEARS, 1937-1947, (a) New services provided—Premature infant scheme, Adoption of Children (Regulation) Act, 1939, Toddler Clinics, Diphtheria Immunisation Sessions, test feeding scales on loan, coupons re sheets in home confinements, panel of Consultants for abnormal confinements, Emergency Maternity Unit, blood examinations at Ante-Nata^ Clinics, Scheme for Unmarried Mothers, Specialist Clinics, Day Nursery Services; (b) Expansion of existing services—5 new Health Clinic premises, 2 Clinic premises of Middlesex County Council now administered by the Borough:— Weekly Sessions held:— 1937. 1947. Infant Welfare 11 17 Ante-Natal 1½ 12 Dental 2 55 Gynaecological ½ 1½ Percentage of Expectant Mothers attending Ante-Natal Clinics 36.3 68.5 Number of attendances:— Children under 1 year 25,838 41,694 Children 1—5 years 16,808 14,498 Expectant Mothers 2,046 11,215 Dental Clinics—total attendances 1,259 4,006 Dentures supplied 63 117 Maternity Outfits supplied 18 609 19 Number of visits of Health Visitors:— 1937. 1947. To Expectant Mothers 1,861 3,093 To children under 1 year 6,034 8,958 To children 1—5 years 6,745 9,133 3. In their consideration of the programme of capital expenditure the Council submitted to the Ministry of Health the following propositions:— £ (a) 1947/48—5 day Nurseries, estimated cost £5,000 each, total 25,000 (b) 1948/49—1 Day Nursery 5,000 Health Centres:— (i) The Avenue, to serve Barn Hill and Chalkhill districts 7,000 (ii) Regal Way to serve Kenton district 7,000 Total £44,000 4. The statistics continue to show the high acceptance by the public of the various services, their development being demonstrated in Paragraph 2. 5. Mr. J. D. Flew has contributed the following paragraphs on the Gynaecology and Post-Natal Clinics:— The Gynaecological and Post-Natal Clinics were started in November, 1945, and I have had the pleasure of being in charge of them. Five Clinics are held each month at four different centres in the Borough and an average of 15 patients is seen at each session. Each patient comes by appointment and the number of defaulters has been very small. About 70% are Post-Natal cases and I find that much can be done to relieve them of the minor discomforts, such as backache and vaginal discharge, which so frequently follow childbirth. These symptoms are due to a variety of causes, the commonest of which is infection of the torn cervix, cured by electrical cauterisation. After improvement of these symptoms the patient's general health often improves and all patients seem to be very grateful for the attention given to these matters. 20 The Gynaecological cases seen have been varied and many cases have been sent to Dr. Kosser and Dr. Hose at Redhill for operation. One very early case of carcinoma of the cervix was detected and several other suspects proved negative. A considerable number of patients complaining of sterility have been investigated and many have become pregnant. I am certain that these Clinics are performing a most useful part of the Health Services of the Borough. In the future they may well need considerable expansion. 6. The following is Dr. Fisher's report on the Birth Control Clinics:— During the year 1947, 145 new patients attended the Birth Control Clinics, 11 sessions being held at Stag Lane and 12 at Perrin Road. There were 404 re-attendances. 8 applicants were refused advice as having no medical grounds for family limitation. The greater proportion of patients sought advice because they had a baby of less than a year old and were anxious to space their pregnancies. Among the pathological conditions calling for prevention of further pregnancy for a time were 3 cases of heart disease; 2 of persistent hypertension; 1 suspected tuberculosis; 6 recent toxaemia of pregnancy; 9 patients had recently had a surgical operation or were awaiting operation; 9 were suffering from anxiety neurosis or other nervous disturbance. No failures of the methods advised were reported during the year. 7. As in previous recent years the number of maternity hospital beds has been totally inadequate to meet the demand. It is still true, however, that the bed required for strictly medical reasons has always somehow been found, but the scarcity of hospital beds has meant the conduction of confinements in home circumstances well 'below the standard which had been attained in the pre-war years, and the hospitals themselves have had the greatest strain put upon their accommodation. In endeavour to ease the situation the Middlesex County Council have taken over the Acton and Wembley Isolation Hospital for adaptation as a Maternity Annexe, but progress in this plan has been slow. The Maternity and Child Welfare Committee has been much interested in the endeavour at Wembley Hospital to provide a Maternity Unit. A proposed lay-out has now been generally approved by the Ministry of Health of a simple brick building for 20 beds. This scheme is of a temporary nature, the Wembley Hospital Authority having had in mind for some time the 21 vision of a much larger scheme, perhaps ultimately of about 75 beds. Such accommodation would be an asset, indeed, to the Borough's Health Services. 8. ROYAL COLLEGE OF OBSTETRICIANS AND GYNAECOLOGISTS AND POPULATION INVESTIGATING COMMITTEE. In common with some 400 Maternity and Child Welfare Authorities, the Maternity Questionnaire Survey of this Committee was completed by the Health Visitors. This is an endeavour to obtain a sample giving an undistorted picture of the social and economic problems of child-bearing. A comprehensive report of this Inquiry is expected soon. 9. HOME HELP SERVICE (by Miss V. Matthews, Superintendent Health Visitor). At a time when social services are being extended and while many Authorities are commencing a Home Help Service, a review of the scheme working in Wembley may afford an opportunity of judging the measure of success which has been achieved since the Council set out to establish a Service in 1937. The service provides capable " home managers" who, where necessary, take practically complete charge of the home during the fourteen days following the mother's confinement. The great majority are cases of home confinement but in exceptional circumstances Helps are provided when the confinement takes place in hospital. With the existing shortage of hospital accommodation and the increasing birth rate the need for such women to carry out this work is obviously great. The work involves all the usual duties of a housewife with, in addition, the care of a patient in bed. The recently delivered mother needs special attention and the provision of well cooked meals, and her room requires daily cleaning. By careful explanation care is taken to ensure that no midwifery nursing procedure is undertaken by the Home Help. Preparation for the daily visit of the midwife, shopping, cooking and washing are all in the day's work of a Home Help, and other children in the family (if any) require attention also. Necessary qualifications for the work include, of course, honesty, cleanliness and common sense, but such accomplishments as the ability to cook, launder and manage children happily, together with a sense of humour and a desire to help others, are more than useful attributes. Results suggest that in Wembley good progress has been made in attracting suitable women for the work. Wembley Home Helps are Council employees, financial recovery being made according to the economic circumstances 22 scale. In 1937 only those families who came within the Council's free scale were considered for this service; extension has now been made to include all income groups. During 1947, Home Helps were supplied in 164 maternity eases, compared with 27 in 1938 (the first complete year); 5 are full-time staff, 7 others, not wishing to work full-time, act as Home Helps in one or two cases per month and are paid only for the weeks during which they are at work. The provision of white overalls to be worn in the homes, improves the standard of hygiene and adds dignity to the work, whilst also protecting the Home Help's personal clothing. Supervision is exercised by the Health Visitors who eall at the home during the time the Home Help is in attendance. The organisation of this service is attended with considerable difficulties, some almost impossible to overcome these days. Among the latter the question of exactly when the baby will arrive, confronts all who handle maternity services. On some days " late" babies and " early" babies arrive almost together. At times the Home Helps are usefully employed in the Council's Day Nurseries whilst waiting for their services to ;be required. Another unavoidable difficulty causing disappointment occurs when a Home Help falls ill, but this fortunately is infrequent. Change of plans, miscarriage, admission to hospital, etc., may all occur after early application for the Home Help has been made, and if the appropriate cancellation be delayed disorganisation in the service is inevitable. On the whole the Home Helps are warmly greeted and a high degree of satisfaction is evident from the many letters of thanks received in respect of their services. 10. INFANT DEATHS. During 1947 the total number of Wembley children who died without reaching their first birthday was 53, and, of this number, 38 did not survive the first month of life. Despite the comparatively low infant death rate of 26 per 1,000 registered births published in respect of Wembley for 1946, Dr. Morison, the late Medical Officer, suggested at the end of that year that an enquiry regarding the social conditions of each case of infant death might be undertaken, with a view to exploring the possibility of the existence of any factor affecting the cause of infant deaths. A special visit was therefore made by the Health Visitor for the district, to parents who had suffered the loss of a young child under twelve months of age during 1947. An attempt was therefoy made to ascertain whether special care or further health education regarding personal hygiene was indicated in any case, or if greater knowledge of preventive measures should be 23 brought to the notice of parents. The following results obtained from the Health Visitors' enquiry visits are interesting. Of the total of 53 babies it was found possible to make visits to the homes of 46, after information regarding the child's death had been received. Of these 46, only 16 had been previously seen by a Medical Officer or a Health Visitor of the Maternity and Child Welfare Services of Wembley. The remaining 30 babies died whilst still under the care of hospital, nursing home or private medical practitioner and before the usual primary visit by the Health Visitor had been made—the normal time for this is during the third week following the baby's birth. In every case investigated there was evidence that early medical attention had been obtained and in only 6 cases was the fatal illness treated entirely at home; one death was caused by an accident in the home; in 8 cases were housing problems present; in 3 only was the standard of home care and cleanliness assessed at less than satisfactory. It seems safe to assume that housing and general home conditions and care do not form a major problem regarding the rearing of babies in this locality. The day-to-day teaching persistently pursued for many years has, perhaps, achieved a measure of success. There will probably, however, always be many Varying standards of personal hygiene though the standard attained is probably higher than was thought possible twenty years ago. An infant mortality rate of 23 for 1947 is certainly a figure to be quoted with pride by the health visiting staff, whose work brings them daily into such close contact with parents at times of joy and of heartbreak. The work of health education can be tedious and exacting and the workers are much encouraged by evidence that their efforts are not in vain. Much remains to be done and all efforts must be continued to bring about still greater reductions in the death rate among children of all ages, and to raise the standard of understanding as well as of physical care given to every child in every home. 11. I wish to record our indebtedness to the Voluntary Helpers at the Clinics who have given such excellent services in innumerable and always so unobtrusive ways. They have continued to arrange for the distribution of the Government's vitamin accessory products, while their co-operation with all the personnel of the Department has been the fullest and of the greatest value and assistance. 24 STATISTICAL APPENDIX C. Health Clinics. (Some comparative 1946 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 2,093 (1,981) 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 271 (243) 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 1,863 (2) Over one year of age 4,398 6,261 (6,130) Number of attendances by children under one year of age 41,694 (36,820) Number of attendances at all the Health Clinics by children between the ages of 1—5 years 14,498 (16,515) 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 1947 92.7 (88.7) (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.) Number of attendances at the ante-natal Clinics 11,215 (11,81.4) Total number of women who attended for the first time 1,551 (1,905) 25 Percentage of total notilied births (live and still) represented by the total number of women who attended the Clinics for the first time during the year 68.5 (&3.8) Attendances at the various Health Clinics. Children under one year of age. Clinic. Total attendances. Average attendance per session.  Stag Lane 8,949 59 Slough Lane 6,032 59 College Road 5,908 39 Ealing Road 4,143 42 Perrin Road 6,397 41 Monks Park 5,486 56 One Tree Hill 4,779 47 Children between the ages 1—5 years. Clinic. Total attendances. Average attendance per session.  Stag Lane 1,762 12 Slough Lane 2,664 26 College Road 3,333 22 Ealing Road 1,246 12 Perrin Road 2,375 15 Monks Park 1,819 19 One Tree Hill 1,299 13 Domiciliary Nursing. Children referred for treatment to the Wembley and Kingsbury District Nursing Associations. Children under one year 6 Children over one year 5 Treatments given — Seven or fewer attendances 11 Over seven attendances — Specialist Clinic Services. Eye Clinics (Wembley Hill and Stag Lane (County) Clinics). 105 children referred. 26 Orthopedic Clinic (Stag Lane (County) Clinic). 70 children referred. 29 appliances supplied. Clinic for Defective Speech. 10 cases referred. Child Guidance Clinic. 2 cases referred to Middlesex County Council Clinic, Harrow. Dental Clinic. See page ??. Artificial Sunlight and Massage Treatment. Number referred by Medical Officers: 90 (under one year, 7; over one year, 83). Reasons for treatment:— Debility, anaemia, etc. 38 Recurrent colds 23 Rickets 12 Bowed legs 6 Delayed dentition 7 Knock knees 2 Chronic bronchitis 1 Torticollis 1 Total 90 Ante - Natal Clinics. The months of pregnancy at which women attended for the first time:— 1st 2nd 3rd 4th 5th 6th 7th 8th 9th 23 531 474 231 128 78 33 15 — Attendances of Expectant Mothers:— Clinic. Total attendances Average attendant per session.  Stag Lane 2,976 19 Slough Lane 955 18 College Road 999 19 Ealing Road 1,288 25 Perrin Road 1,646 16 Monks Park 1,677 16 One Tree Hill 1,674 16 27 Special Blood Tests at Redhill Hospital. 398 examinations. X-Ray Ante-Natal Examinations. Number of women referred: 78. Supply of Sheets for Expectant Mothers: Ministry of Health Circular No. 154/44. Number of dockets issued: 1,170. Unmarried Mothers (Ministry of Health Circular No. 2866). 9 cases dealt with. Hospital Confinements. 734 women referred to various hospitals:— (i) Medical reasons for reference to hospital:— (a) Regarding current pregnancy — Abnormality of maternal pelvis 71 Elderly primipara 15 Maternal ill-health 20 Cardiac abnormality 29 Tuberculosis 5 Toxaemia 7 Miscellaneous 9 156 (b) Regarding previous pregnancies — Abnormal obstetric history 65 Abnormal medical history 49 114 270 (ii) Home conditions unsuitable 292 (iii) Mothers desired hospital accommodation 172 Total 734 38 Wembley births taking place in hospital. (a) Middlesex County Council Hospitals:— Redhill 322 Central Middlesex 349 Maternity Hospital, Bushey 122 West Middlesex 5 North Middlesex 1 Chiswick 3 802 (b) London Hospitals:— Queen Mary's 101 Queen Charlotte's 45 St. Mary's 46 University College 7 Middlesex 14 Charing Cross 7 City of London 8 Royal Free 2 Elizabeth Garrett Anderson 2 Hammersmith 3 Princess Beatrice 2 St. Thomas's 1 Royal Northern 6 German 1 Westminster 4 London 1 King's College 1 Annie McCall (Battersea) 1 St. George's 3 Metropolitan 1 256 29 (c) Other Hospitals:— Brocket Hall 11 Bearstead Memorial 4 Wembley 4 Willesden Maternity 2 One at each of the following:— Perivale Maternity; New Cross, Wolverhampton; Happyland Maternity, Berks.; Pembury County, Kent; Manor Emergency, Somerset; Wellington Maternity, Somerset; The Grange, High Wycombe 7 28 Total 1,086 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.  1943 2,037 657 1,034 740 346 32.2% 50.8% 36.3% 17% 1944 2,018 601 1,080 816 337 29.8% 53.5% 40.4% 16.7% 1945 1,909 542 1,068 798 299 28.4% 55.9% 41.8% 15.7% 1946 2,272 631 1,205 909 456 27.8% 53.0% 40.0% 19.2% 1947 2,264 686 1,086 802 492 30.3% 48.0% 35.4% 21.7% Puerperal Pyrexia. Number of notifications received: 8 (excluding 21 Willesde Maternity Hospital cases—Willesden residents). Number of women removed to hospital: 8. Obstetric Consultant Service. Consultant called in by private medical practitioners: 10, 30 Premature Infants (excluding Willesden infants born in Willesden Maternity Hospital). (a) The total number who were born:— (i) at home 31 (ii) in Hospital or Nursing Home 6 (b) The number of those born at home:— 1 i) who were nursed entirely at home 22 (ii) who (lied during the first 24 hours 1 (iii) who survived at the end of one month 30 (c) The number of those 'born in Hospital or Nursing Home:— (i) who died during the first 24 hours 3 (ii) who survived at the end of one month 4 Stillbirths. 33 cases allotted to Wembley by Registrar-General. Detailed investigation made in 34 cases. Multipara 10 Primipara 24 34 Ante-natal supervision given by — Hospital and/or Clinic 23 Private medical attendant 10 Information incomplete 1 34 Attendant circumstances— Instrumental delivery 5 Breech delivery 6 Prematurity 7 Foetal abnormality incompatible with separate existence 4 Ante-partum hgemorrhage 4 No abnormal cause or circumstance elicited 8 34 31 Post-Natal Clinics. Clinic. First attendances. Reattendances Aver, att'dance . per session.  Stag Lane 186 11 8 Perrin Road 79 15 8 One Tree Hill 86 9 8 Monks Park 66 4 8 Totals 417 39 — Test feeding scales issued on loan to 282 mothers. Special Milk Grants. Liquid milk: Nil supplied. Grants of dried milk and other accessory foods amounting to £12 19s. 2£d. made during the year. Maternity Outfits. Number of maternity outfits supplied: 609. Gynaecology Clinics. Clinic. First attendances. Reattendances. Aver, att'dance . per session.  Stag Lane 29 61 4 Perrin Road 30 23 4 One Tree Hill 33 20 4 Monks Park 16 4 2 Totals 108 108 — Birth Control Sessions. Clinic. First attendances. Reattendances Aver, att'dance . per session.  Stag Lane 81 215 27 Perrin Road 64 189 21 Totals 145 404 — 32 Home Helps. Number of Families Attended. By By full-time personnel on Economic personnel. approved panel. circumstances scale of families. Full- Part- Full- Part- Free 10/- 20/- 30/- 40/- 60/- 70/- 84/time time time time per week 96 3 62 3 2 15 21 43 28 19 6 30 99 65 164 Domiciliary Nursing. Mothers referred for treatment to the Wembley and Kingsbury Nursing Associations: 3. Dental Services—Mothers and Children. Expectant and Nursing mothers. Children under 5 years.  Numbers who received treatment 726 458 Numbers made dentally fit 643 508 Numbers of treatments:— (a) Fillings:— (i) in temporary teeth — 1,133 (ii) in permanent teeth 2,060 — (b) Numfber of teeth extracted 1,542 330 (c) Number of administrations of general anaesthesia (nitrous oxide) 258 150 (d) Number of persons supplied with dentures 117 — (e) Number of dentures supplied 191 Total attendances at Dental Clinics last five years:— Children. Mothers.  1943 643 1,303 1944 451 882 1945 621 1,547 1946 1,080 2,942 1947 1,326 2,680 33 Domiciliary Visits by Health Visitors. Home Visits. (a) To children under one year 2,505 First visits 6,453 Revisits (b) To children between the ages of 1—5 years 9,133 Total visits (c) To expectant mothers 1,407 First visits 1,686 Revisits (d) To nursing mothers 1,987 First visits 1,039 Revisits (e) Other special visits 3,173 Analysis of special visits included in (e) above:— Infectious diseases:— Measles 732 Whooping cough 599 Tuberculosis 25 Ophthalmia neonatorum (10) other (6) 16 Puerperal pyrexia 5 Diphtheria immunisation 96 Scabies 88 Re Day nursery children 947 Home Help and Domestic Help supervision 21l Re Stillbirths 38 Re verminous conditions 29 Defaulting re treatment advised 277 General—e.g., infantile deaths, premature babies, home conditions, negligent care 110 Child Life Protection. Visits by Health Visitors:— To foster children 318 To foster parents 279 34 At the end of the year on register:— Foster children 20 Foster parents 19 Adoption of Children (Regulation) Act, 1939. Number of notifications received under Section 7 (3) 17 Number of visits to children proposed for adoption 332 Number of children received for proposed, adoption 62 45 CHAPTER IV. SCHOOL HEALTH SERVICES. 1. SERVICES PROVIDED, Schools (22) allocated in 5 areas to Medical Officers; Health Visitors allocated to particular schools—Periodic routine and special inspections conducted at schools—Clinic Services, Minor Ailments (treatment, issue of accessory nutrients, etc.), Dental, Ophthalmic, Orthopaedic, Speech Therapy, for further specialist opinion (e.g., tonsils and adenoids, cardiac and chest conditions, skin conditions, ringworm), specialist examinations (e.g., X-ray) pupils referred to County Hospitals (Redhill or Central Middlesex, or Chest Clinics)—Child Guidance Clinic at 2, St. John's Road, Harrow—Ascertainment of handicapped pupils, recommendation re special schools (boarding and day)—Advise parents of children about to leave school regarding the Disabled Persons (Employment) Act, 1944—Ascertainment and recommendation regarding children incapable of receiving education at school — Cleanliness, general scrutiny, ascertainment and advice given—Supervision of private schools regarding sanitary accommodation and avoidance of overcrowding. 2. DEVELOPMENT. Until July, 1945, this service was administered independently by the Middlesex County Council— service now dealt with under Scheme of Divisional Administration of Education (July, 1945), the Borough being an " Excepted District" according to Education Act, 11944. 3. Continuing progress in the integration of the School Health Services was made during the year. The figures in Appendix D show a large increase in the number of routine medical inspections at the schools—4,751 in 1946, 6,492 in 1947. It is anticipated that this figure may be still further increased in .1948. Routine inspections are now being undertaken according to a scheme by which all children are examined within six months of their entry into school life. The 10-year old group is being examined before the pupils enter the Secondary Schools, while the 14/15-year old group has been examined as far as possible during the term immediately before leaving school. Grammar School pupils were being examined annually and Secondary Modern School pupils were examined more frequently. With more examinations only a slight increase in defects have been ascertained and treated (see Appendix). 4. The following is Miss RichnelPs report for the year 1947:— During the earlier part of 1947, two sessions weekly were held at both Stag Lane County Clinic and at One Tree Hill Borough Clinic. From September onwards, after the appointment of an Assistant Speech Therapist by the County Council, it was possible to double these sessions at both clinics. 36 In addition to the regular treatment of individual cases, time is allocated for preliminary interviews with diagnosis, for giving advice to parents of children too young for treatment, for reviewing cases where no defect was noted at the first interview and for following up cases which have been discharged:— 139 such appointments were made. 18 failed to attend either the first or subsequent appointments of which 2 refused treatment by writing or telephoning. Of the 19 pre-sehool children who were included in this scheme, only 7 have received regular treatment at the Centres. Altogether a total of 78 have received treatment either for long or short periods. Of these:— 12 were discharged cured. 6 were discharged much improved. 2 left the district. 5 failed to attend after making satisfactory progress. 9 failed after 2 or 3 visits. Of the 44 who require a further period of treatment:— 17 are making very good progress. 18 are making some progress. 6 have attended only for a very short time. 3 have made very little progress. There are 22 eases which are still under observation, and 12 on the waiting list for immediate treatment. 16 school departments have been visited during the latter part of the year. 5. Routine hygiene examinations have been carried out during the year in every Education Authority school in the Borough. As soon as possible after the commencement of each school term, a Health Visitor visits the schools and conducts an individual examination of each child. Where facilities are available children are seen apart from their school-mates, but in several Infant Departments shortage of accommodation makes this desirable standard difficult to attain. The purpose of the inspection is certainly not solely to ascertain the existence of verminous conditions. The children are encouraged to develop independence regarding all aspects of their personal toilet and appearance and much support is added 37 at school to the mother's efforts at home. The general cleanliness of teeth, nails, wrists and also ears, are points carelessly missed by the average school boy and girl. Attention must also be paid to the tidiness of clothing and to the proper fastening of boots and shoes. Where head infestation is discovered a personal visit, is made to the parent and detailed advice regarding treatment is given at once. The co-operation of parents over the matter of cleansing heads unfortunately infested, has been, with few exceptions, so good that to date it has been unnecessary to issue a notice of compulsory cleansing (Section 54, Education Act, 1944). Difficulties occur where the root cause of the trouble is a family one. Teenage daughters who do not adequately brush and comb their permanently waved hair, are the most common of all. These offenders are usually at work and often harbour head-lice unbeknown to mother and pass on the trouble to the school-children Where it is discovered at a routine examination in school. A systematic method of following up every discovered case has been adopted and the percentage of total school-children in the district found to be in need of treatment during 1947 was 1.17 This figure is recorded with the hope that, low as it may appear, it will soon be much lower. Thanks are due to the co-operation of Head Teachers and their staffs who have so willingly given every possible help to the two Health Assistants and thereby enabled them to carry through a comprehensive system of inspection. 6. HANDICAPPED PUPILS. A table is presented in the Appendix giving the numbers of handicapped pupils known to the department —169 males and 86 females have been dealt with. The large number of pupils classified as suffering from speech defect (Category K) is an indication of the value of the services of the 'Speech Therapist. On her services becoming available the ascertainment of the children who would benefit has been much stimulated. Generally, it is pertinent to remark upon the present insufficient number of places, both in residential and in day schools, for handicapped children. Many of the children recorded as being in attendance at maintained schools are, in fact, awaiting appropriate places in special schools. 7. The services of the Health Assistants dealing with cleanliness matters are also showing good results. Schools are visited at least once every school term. The number of pupils examined shows considerable increase (see Appendix D). To begin with a 38 high standard was purposely aimed at, the percentage of pupils requiring advice being, in 1946 2.9, in 1947 1.17. 8. It is considered most important that the Medical Officers and Health Visitors on their visits to the schools and at the Clinic Sessions use every opportunity for a complete co-operation with the parents and teachers and there is evidence that this is being gradually obtained, for example, the number of pupils attending Clinic Sessions has increased considerably. 39 STATISTICAL APPENDIX D. PRIMARY SCHOOLS. Return of Medical Inspections during the Year. (a) Routine Medical Inspections. Number of code inspections:— Entrants 1,180 2nd Age Group 547 Total 1,727 Number of other routine inspections 1,116 Grand Total 2,843 (b) Other Inspections. Number of special inspections and re-inspections 2,248 (c) Pupils found to Require Treatment. Number of individual pupils found at routine medical inspection to require treatment (excluding uncleanliness and dental diseases). For defective Vision. (Excluding squint). For all other conditions recorded in next Table. Total.  Prescribed groups:— Entrants 48 50 98 2nd Age Group 40 27 67 Total 88 77 165 Other routine inspections 160 189 349 Grand Total . 248 266 514 Note.—Pupils requiring treatment for defective vision and for other conditions appear once only in the column headed " TotaL" 40 Return of Defects found by Medical Inspection during the Year. Defect or Disease. Routine Inspections. Special Inspections. No. of Defects. No. of Defects. Requiring treatment. Requiring to be kept under observation, but not requiring treatment. Requiring treatment. Requiring to be kept under observation, but not requiring treatment. (1) (2) (3) (4) (5)  Skin 22 11 165 8 Eves:— Vision 248 17 46 3 Squint 4 7 9 — Other 5 7 32 8 Ears:— Hearing 6 1 4 — Otitis media 2 2 5 — Other 4 6 14 3 Nose or Throat 35 28 65 16 Speech 6 3 8 1 Cervical glands 2 4 4 2 Heart and circulation 7 16 4 6 Lungs 15 29 34 6 Developmental:— Hernia 7 1 — — Other 2 7 — — Orthopaedic:— Posture 14 11 1 — Flat foot 12 9 4 — Other 30 29 14 1 Nervous system:— Epilepsy 1 — — — Other 6 13 16 3 Psychological:— Development 3 1 2 3 Stability — 2 - — Other 83 19 55 43 Totals 514 223 482 103 41 Classification of the Nutrition of Pupils Inspected during the Year in the Routine Age Groups. Age-groups. Number of Pupils Inspected. A. (Good). No. % B. (Fair). No. % C. (Poor). No. %  Entrants 1,180 570 48.31 590 50.00 20 1.69 2nd Age Group 547 304 55.57 239 43.69 4 0.74 Other routine inspections 1,116 533 47.75 537 48.11 46 4.14 Totals 2,843 1 ,407 49.49 1,366 48.04 70 2.47 Return of Defects Treated during the Year, (a) Minor Ailments (excluding Uncleanliness). Disease or Defect. Number of Defects treated or under treatment during the year.  Skin:— Ringworm:— Scalp:— (i) X-Ray treatment — (ii) Other — Body 3 Scabies 13 Impetigo 33 Other skin disease 248 Minor eye defects (External and other, but cluding cases falling in Group II.) 42 Minor ear defects 47 Miscellaneous (e.g., Minor injuries, bruises, sores, chilblains, etc.) 215 Total 601 42 (1)) Defective Vision and Squint (excluding minor eye defects treated as minor ailments). Number of Defects Defect or Disease. dealt with under the Authority's Scheme. Errors of refraction (including squint) 755 Other defect or disease of the eyes 31 Total 786 No. of pupils for whom spectacles were:— (a) Prescribed 400 (b) Obtained 452 (c) Treatment of Defects of Nose and Throat. Number of Defects. Received other than operative treatment 28 (d) Orthopaedic and Postural Defects. Number of Pupils Treated. Non-residential treatment at orthopasdic clinics. Under the Authority's scheme 213 Dental Inspection and Treatment. (1) Number of pupils who were inspected by the dental surgeons:— (a) Routine age groups:— 5 457 6 803 7 675 8 672 9 876 10 976 11 471 12 57 13 1 14 — 15 — Total. 4,988 (b) Specials 1,478 (c) Grand Total 6,466 43 (2) Found to require treatment 4,867 (3) Actually treated 3,514 (4) Attendances made by pupils for treatment 12,031 *(5) Half-days devoted to:— Inspection 69 Treatment 1,786 Total 1,855 (6) Fillings:— Permanent teeth 7,247 Temporary teeth 2,460 Total 9,707 (7) Extractions:— Permanent teeth 825 Temporary teeth 4,106 Total 4,931 (8) Administrations of general anaesthetics for extractions (all schools) 1,428 (9) Other operations:— Permanent teeth 4,802 Temporary teeth 1,660 Total 6,462 * Including Secondary Schools. Uncleanliness and Verminous Conditions. (i) Total number of examinations of pupils in the schools by school nurses and all other authorised persons 33,824 (ii) Number of individual pupils found unclean 471 (iii) Percentage of pupils found unclean 1.42 44 SECONDARY SCHOOLS. (a) Total No. of code inspections 3,649 (b) No. of special inspections and re-inspections 1,308 (c) Pupils found to require treatment:— No. of individual pupils found at routine medical inspections to require treatment (excluding uncleanliness and dental disease). Defective Vision For all other conditions (excluding squint). recorded in next Table. Total. 286 200 486 45 SECONDARY SCHOOLS. Return of Defects found by Medical Inspection during the Year. Defect or Disease. Routine Inspections. Special Inspections. No. of Defects. No. of Defects. Requiring treatment. Requiring to be kept under observation, but not requiring treatment. Requiring treatment. Requiring to be kept under observation, but not requiring treatment. (1) (2) (3) (4) (5) Skin 23 18 78 3 Eyes:— Vision 286 14 21 4 Squint 1 2 1 — Other 5 1 19 2 Ears:— Hearing 2 4 1 2 Otitis media 1 — — — Other 11 7 12 3 Nose or Throat 12 21 9 2 Speech 6 2 1 — Cervical glands — — — — Heart and circulation 5 36 5 — Lungs 5 28 — 6 Developmental:— Hernia 1 - 1 - Other 1 3 1 — Orthopaedic:— Posture 24 17 3 — Flat foot 22 11 7 1 Other 49 46 13 2 Nervous system:— Epilepsy — 1 2 — Other 2 8 2 1 Psychological:— Development 1 3 3 4 Stability — — — — Other 29 14 48 8 Totals 486 236 227 38 46 Classification of the Nutrition of Pupils inspected during the Year. Total No. Inspected. A. (Good). B. (Fair). C. (Poor). No. % No. % No. % 3,649 1,864 51.07 1,746 47.83 39 1.10 Return of Defects Treated during the year, (a) Minor Ailments (excluding Uncleanliness). Disease or Defect. Number of Defects treated, or under treatment during the year. Skin:— Ringworm:— Scalp:— (i) X-Ray treatment — (ii) Other — Body — Scabies 4 Impetigo 6 Other skin disease 41 Minor eye defects 9 Minor ear defects 5 Miscellaneous 63 Total 128 (b) Defective Vision and Squint (excluding Minor Eye Defects treated as Minor Ailments). Disease or Defect. Number of Defects dealt with Errors of refraction (including squint) 281 Other defect or disease of the eyes 51 Total 332 47 No. of pupils for whom spectacles were:— (a) Prescribed 201 (b) Obtained 150 (c) Treatment of Defects of Nose and Throat. Number of Defects dealt with. Received other than operative treatment 7 Dental Inspection and Treatment. (1) Num6er of pupils who were inspected by dental surgeons:— (a), Routine age groups:— 11 103 12 366 13 496 14 391 15 202 16 119 17 53 18 11 19 — Total 1,741 (b) Specials 43 (c) Grand Total 1,784 (2) Found to require treatment 1,096 (3) Actually treated 439 (4) Attendances made by pupils for treatment 1,504 (5) Fillings:— Permanent teeth 1,208 Temporary teeth 20 Total 1,228 (6) Extractions:— Permanent teeth 275 Temporary teeth 88 Total 363 48 (7) Other operations:— Permanent teeth 600 Temporary teeth 14 Total 614 Uncleanliness and Verminous Conditions. (i) Total number of examinations of pupils in the school by school nurses and all other authorised persons 8,639 (ii) Number of individual pupils found unclean 29 (iii) Percentage of pupils found unclean 0.33 Total—Males 169; Females 86. * Multiple Disability—Categories J and K. 49 Handicapped Pupils (20th January, 1948) ascertained since July, 1945. Category. At Special School. At Maintained School. At Independent School. Not at School. M. F. M. F. M. F. M. F. A — 1 - - - - - - B — 2 — — — 1 — — C 2 2 - - - - - - D — 1 - - - - - - E 17 11 12 6 — — — — F - - - - - - - - G 4 1 8 2 — — 2 1 H — 1 1 1 — — — 2 I 1 — 20 12 3 — 2 3 J 3 — — 3 — — 3 3 K — — 70 27 3 — 18 5 L - - - - - - - 1 27 19 111 51 6 1 25 15 CHAPTER V. INFECTIOUS DISEASES. 1. SERVICES PROVIDED, Notification, investigation, pamphlets issued on the various infectious diseases, exclusion from school of patients and contacts, advice re milk handlers— Disinfection — Hospitalisation generally at Hendon Isolation Hospital, re puerperal pyrexia and ophthalmia neonatorum, London County Council, re poliomyelitis at Royal National Orthopaedic Hospital, re smallpox, Middlesex County Council—Notification of tuberculosis—Compilation of tuberculosis register—Weekly and quarterly returns to Ministry of Health and County Medical Officer — Preventive medicine, diphtheria immunisation, antityphoid inoculation, whooping cough immunisation (for children about to enter, or in, Day Nurseries), anti-smallpox vaccination— Food poisoning notification and investigation—Scabies, arrangements with Royal Borough of Kensington—Complete bacteriological service available at Central Public Health Laboratory, Colindale, outfits distributed from Public Health Department—anti-toxins available diphtheria, tetanus, scarlatina. 2. A circumscribed outbreak of acute Poliomyelitis occurred in the Borough during the year, when 26 cases in all were notified. The main incidence fell in August and September but notifications were received from March to October. Many of the cases were frank examples of the disease and several were followed, by more Gr less extensive degrees of paralysis. At the onset of the cooler weather, fortunately, the outbreak appeared to 'become self limited. 3. The supervision of contacts landing from ship or aeroplane called for routine surveillance of 26 persons regarding smallpox and 9 persons regarding cholera. Constant vigilance must be given to persons arriving from infected foreign areas and this supervision must be given with discretion and understanding. Many such ask advice on the pertinence of vaccination for the members of their families. It is always wise to reinforce previous vaccination at intervals. Vaccination, therefore, of any member of the family who has not been successfuly re-vaccinated within the last two or three years would be a wise proceeding. With regard to those who have never, so far, been vaccinated, however, the advice is given that vaccination should not be performed unless there has actually been contact with smallpox and, of course, the position generally is that the person ibeing supervised has only been a contact or a possible contact, and is not suffering from smallpox. This advice about waiting for actual contact with smallpox before vaccination for the first time applies especially to 50 school-children and those over school age. If there be an infant in the household under the age of twelve months and not yet vaccinated, vaccination should immediately be considered along with the re-vaccination of those who have been vaccinated previously but not within the last two or three years. 4. DIPHTHERIA IMMUNISATION. In spite of the most intensive and continual advice regarding the prevention of diphtheria by immunisation, the percentage of the child population under five considered immunised on the 31st December was no more than 53.44. One cannot accept such a figure with complacency. Diphtheria immunisation is discussed with the parents of all children who are approaching ten months, either at the Clinic or in the home, often at both opportunities, fby the Health Visitors. A birthday card is sent to each individual child at the first birthday, full particulars of the local scheme being set out. The Health Visitor checks at the first visit to each child after the first birthday the position regarding diphtheria immunisation having been accepted or arranged for. Any defaulters from the sessions are referred fo the Health Visitors who pay special visit to the home and again stress the importance of immunisation. It is true to remark that consents obtained only after great persuasion arc generally from those families who repeatedly fail to keep their appointments. An explanatory leaflet is given to the parents after the final dose of immunisation pointing out the need for another injection just before the child enters school life, while also the teachers take the -opportunity when interviewing parents of entry children to mention the importance of this reinforcing dose and an explanatory pamphlet has been provided. Routine medical examination as school entrant provides further opportunity of stressing the value of diphtheria immunisation— a full course (2 injections) if the child has never been immunised, or a reinforcing dose to carry the child through the next 5—6 years. Posters are displayed and topical slogans shown on the blackboard at all the Clinics continually. During the first six months 566 children received the additional reinforcing dose and 515 during the second six months. Much credit is due to both the Health Visitors and the School Teachers in their endeavour to obtain a fully protected child population. 5. The investigation into the value of vaccines in preventing Whooping Cough have continued in Wembley—and in other areas —during the past year. Some 900 children have now been inoculated in Wembley and each child is being visited monthly by special investigators who keep careful notes of all coughs and colds and of any cases of Whooping Cough which occur in the vaccinated children. The investigation—the plan of which was described in the Report for 1946—will continue for one year more 51 when it will be possible to present conclusive evidence of the efficacy or otherwise of the vaccines used. The Medical Research Council—who are running this investigation in collaboration with the Medical Officer of Health—have been greatly encouraged in this new method of approach to problems of preventive medicine by the interest and co-operation of the parents in Wembley, who are themselves active collaborators in the investigation, and already that collaboration has led to increased knowledge of the mode of spread and of methods of early diagnosis. 6. DAY NURSERIES. The incidence of the infectious diseases is again tabulated. Our individual experience in the Borough, of course, is still too limited for general conclusions, but it has been only in measles that one has felt the introduction of a case of infection gives grounds for fear of much spread. The monthly incidence of the infections tabulated in the Appendix indicates the absence of epidemic spread in any of the Nurseries. 7. FOOD POISONING. Only 6 cases of food poisoning were notified but food poisoning has shown some general increase in the last few years. This may be due to more communal feeding, to difficulties in maintaining the highest standards in personal hygiene and in the processing of food products. The intimate association between the Central Public Health Laboratory at Colindale and the Public Health Department should assist in solving some of the food poisoning problems and helping in their prevention, but co-operation at every angle is necessary. Information should be given at the earliest possible time, samples of relevantly suspected food should be preserved and submitted for examination, and even then it is not always possible to ascertain the cause. 52 53 STATISTICAL APPENDIX E. Cases of infectious diseases notified in Wards and removals to Hospitals. Disease. Total Alperton Central Chalkhill Fryent The Hyde Roe Green Kenton Preston Sudbury Court Sudbury Wemblev Park Tokyngton Total removed to hospital Percentage of cases removed to hospital Scarlet fever 207 8 3 22 35 73 22 7 1 8 12 4 12 147 71.01 Diphtheria 5 — 1 1 — — — 1 — — — 1 1 3 60.00 Pneumonia 123 34 4 8 9 14 12 8 9 6 12 2 5 27 21.95 Erysipelas 29 3 2 1 1 3 7 — 5 2 2 — 3 4 13.79 Ophthalmia neonatorum 1 — — — — — — — 1 — — — — — 00.00 Cerebro-spinal fever 3 2 — — 1 — — — — — — — — 3 100.00 Dysentery 7 — — 1 — — — — 5 — — 1 — 1 14.29 Measles 1,305 122 60 113 139 104 138 174 182 50 93 68 62 32 2.45 Whooping cough 531 124 35 19 41 59 64 21 19 29 55 19 46 15 2.82 Acute poliomyelitis 26 4 2 2 2 4 1 2 1 1 4 1 2 26 100.00 Acute polioencephalitis 1 - - - - - - - - - 1 - - 1 100.00 Malaria 2 1 - - - - - - - - - 1 - - 00.00 Typhoid fever 1 - - - - - - - - - - - - 1 100.00 Paratyphoid fever 1 — — — — — — — — — 1 — — — 00.00 54 Notifications of Infectious Diseases according to sex and age as finally diagnosed. Age group. Scarlet fever. Whooping cough. Diphtheria. Measles. Acute poliomye litis. Acute polioencepha litis. Age group. Dysentery. Acute pneumonia. Erysipelas. Cerebrospinal fever. Paratyphoid fever. Typhoic fever M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. 0 — — 27 34 — — 16 25 1 — — — 0 2 — 12 11 — — 1 — — — — — 1 19 9 63 52 1 — 155 135 2 — — 5 2 1 10 6 - - - - - - - - 3 19 23 74 98 — — 150 168 4 3 —. — 15 — 1 19 20 1 2 — 1 — 1 — 1 5 42 41 67 98 — 1 279 307 — 1 — — 45 • 1 — 21 15 7 12 - - - - - - 10 8 18 3 4 1 — 12 17 3 1 — — 65 & over — — 3 6 4 3 — 1 — — — — 15 8 8 2 1 — 1 11 10 2 1 — — Unstated - - - - - - - - - - - - 25 & over 4 8 5 3 — 1 7 13 2 4 1 — All ages 100 107 241 290 2 3 630 675 14 12 1 — All ages 5 2 65 58 12 17 1 2 — 1 — 1 Monthly incidence of the Infectious Diseases. Disease. January. February. March. April. May. June. July. August. September. October. Novem'ber. December. Total. Scarlet fever 24 24 31 14 55 11 15 5 4 12 5 7 207 Diphtheria — 1 — 1 — — — — 1 1 — 1 5 Pneumonia 18 28 16 9 10 4 8 — — 9 7 14 123 Erysipelas 1 4 1 3 2 2 2 1 3 3 o 5 29 Ophthalmia neonatorum — 1 - - - - - - - - - - 1 Cerebro-spinal fever — — 1 1 — — — — 1 — — — 3 Dysentery — — 5 — — — — — 2 — — — 7 Measles 246 406 307 132 70 66 50 22 2 1 1 2 1305 Whooping cough 85 77 62 36 49 62 35 38 20 12 24 31 531 Acute poliomyelitis — — 1 — — 1 — 9 6 2 4 3 26 Acute polioencephalitis - - - - - - - 1 - - - - 1 Malaria 2 - - - - - - - - - - - 2 Winter Respiratory Diseases (October—March). Notifications of primary pneumonia and acute influenza l-pneumonia. Death certificates in which respiratory diseases mentioned. 1943-44 151 170 1944-45 93 92 1945-46 93 70 1946-47 100 116 1947-48 82 90 55 Infectious Diseases—Day Nurseries. Disease. January. February. March. April. May. June. July. August. September. October. November. December. Total. (a) Children:— Scarlet fever — — 2 — 23 — — 1 — 1 — — 27 Chicken-pox 1 3 20 5 1 — 2 1 2 — 1 2 38 Mumps 3 10 1 4 7 — 2 2 — 4 2 — 35 German measles — — — 4 6 1 6 1 — — — — 18 Measles 51 5 1 1 — 6 12 5 — — — — 81 Whooping cough 13 11 7 10 4 9 5 — 1 5 8 — 73 Infective hepatitis (jaundice) 1 1 (b) Staff:— Infective hepatitis (jaundice) - 1 1 - - - - - - - - - 2 Scarlet fever 1 - - - - - - 1 - - - - 2 Consultations regarding infectious disease, between the Medical Officer of Health and the local Medical Profession continued whereby the considerable experience of the department is placed at the disposal of residents. Non-notifiable Infectious Diseases in School Children. Information obtained from the head teachers:— Disease. January. February. March. April. May. June. July. August. September. October. November. December. Total. Chicken-pox 18 17 73 16 24 57 62 — 2 10 16 15 310 Mumps 14 15 6 1 5 25 36 — 2 12 24 5 145 German measles — 11 1 2 2 2 3 — 1 1 — — 23 Infective jaundice 2 2 4 3 1 2 - - - - - - 14 56 Diphtheria Immunisation. Numbers treated (five years period):— [Year. 0—5 5—10 10—15 Over 15 Totals. 1943 1,722 431 254 4 2,411 1944 1,314 61 29 — 1,404 1945 1,839 69 17 2 1,927 1946 1,629 133 48 3 1,813 1947 1,641 83 26 7 1,757 The percentage of the child population considered immunised on the 31st December:— Children under 5 years 53.44% Children between 5 and 15 years 63.48% Vaccination against Small-pox. Number of infants vaccinated at Health Clinics: 481. Tuberculosis. No. of Notifications. Pulmonary. N on-pulmonary. Male. Female. Male. Female. Under one year — 1 — — 1 to 4 years 1 2 — — 5 to 14 years 5 4 1 2 15 to 24 years 15 29 1 5 25 to 34 years 9 22 1 1 35 to 44 years 15 9 1 3 45 to 54 years 10 4 — — 55 to 64 years 8 1 1 — 65 and over 2 — — — Totals 65 72 5 11 57 No. of Deaths. Pulmonary. Non-pulmonary. Male. Female. Male. Female. Under one year — 1 — — 1 to 4 years — — 1 1 5 to 14 years 1 — 1 — 15 to 24 years — 5 1 1 25 to 34 years 4 5 1 — 35 to 44 years 15 8 — 1 45 to 54 years 5 3 1 — 55 to 64 years 7 1 1 — 65 and over 5 2 1 — Totals 37 25 7 3 No. admitted to hospitals No. discharged from hospitals or Sanatoria: or Sanatoria: 87 96 During the year 134 cases removed from register. At 31st December 859 names remained on register—758 pulmonary and 101 non-pulmonary. Of 72 deaths from tuberculosis, 8 not notified during life (11.11%). 58 Bacteriological Service (at Middlesex Hospital and Central Public Health Laboratory (from 22/4/46) ). Examinations made. Quarter ending Total for 12 months. 31/3/47. 30/6/47. 30/9/47. 31/12/47. Throat and Nose Swabs. Diphtheria Hæmolytic 2 1 3 2 8 Streptococci Vincents 43 94 31 45 213 angina 2 2 1 5 10 Negative 74 315 102 76 567 Fæces. Shigella 7 1 - - 8 Salmonella — 6 7 1 14 Protozoa 7 7 Negative 103 36 48 41 228 Sputum. T.B. smear Other 7 4 2 2 15 organisms 3 4 — 7 Negative 12 14 7 6 39 Pertussis. Cough plate Post-nasal 3 — — 1 4 swab 6 18 1 2 27 Negative 40 61 36 73 210 59 Scabies. Treatment sessions. No. of Cases Reported. Wembley Hospital. Imperial College of Science. January 35 June 16 February 18 July 23 March 37 August 1 April 36 September 20 May 12 October 16 June 10 November 29 December 36 148 141 Total — 289 Numbers affected in Individual Families. 1 person in 27 families. 5 persons in 11 families. 2 persons in 26 families. 6 persons in 5 families. 3 persons in 20 families. 7 persons in 1 family. 4 persons in 14 families. 8 persons in 1 family. 6 recurrent cases—1 in 2 families, 2 in 2 families. 60 CHAPTER VI. ENVIRONMENTAL HYGIENE, FOOD AND WATER, HOUSING, FACTORIES, ETC. 1. SERVICES PROVIDED, Ascertainment, investigation and abatement of nuisances—Scrutiny re sewers and drains— Sanitary circumstances of special premises (Public Houses, Cinemas, Dance Halls) — Co-ordination regarding Local Land Charges, etc., registers—Supervision of food, ascertainment and condemnation of unfit food — Routine periodic examination or public water supplies — Middlesex County Council Act, 1944, registration of hawkers of meat, meat food products, fish, fruit, vegetables and premises—Registration under Milk and Dairies Acts—Supervision under Milk (Special Designations) Orders — Housing, overcrowding, disrepair, ascertainment and action thereon—Ascertainment and supervision of movable dwellings under Middlesex County Council Act—Supervision of domestic refuse bins—Factories and workplaces and outworkers, supervision regarding smoke — Noise and dust nuisances — Supervision of petroleum storage—Rats and Mice (Destruction) Act, 1919, ascertainment of infestations and dealing therewith, pamphlet available regarding poisoning, trapping, rat proofing—Supervision under Hydrogen Cyanide (Fumigation of Buildings) Regulations, 1938 —Cleansing of verminous premises, pamphlets distributed on the protection against house flies, the destruction of ants—Use of D.D.T. preparations—Borough byelaws relevant to Sanitary Inspectors, Good rule and government and prevention of nuisances, Nuisances, Offensive trades, Slaughterhouses, Ventilation and lighting of stables, Building byelaws, Public sanitary conveniences, Removal of offensive matter, etc., through the streets, Removal of house refuse. 2. DEVELOPMENT 10 YEARS, 1937 - 1947, (a) New services provided—Under Food and Drugs Act, 1938, particularly Sections 13 and 14, inspection of offices according to Public Health Act, 1936, ascertainment and treatment of infestation under Rats and Mice (Destruction) Act, 1919, responsibilities under Hydrogen Cyanide (Fumigation of Buildings) Regulations, 1938, supervision of petroleum storage; (b) Expansion of existing services:— 1937. 1947. Complaints received 970 3,201 Visits by Inspector 19,727 26,311 1937. 1947. Number of Informal Notices served 976 1,090 Number of Statutory Notices served 90 157 61 Nuisances abated, improvements effected, defects remedied 2,179 4,382 Factories inspections 666 923 Dwellinghouses inspected for housing defects 1,830 4,524 Number of defective dwellinghouses rendered fit in consequence of informal action 664 1,822 Inspections of food premises 1,930 4,814 Water examinations 11 106 Chlorine examination Swimming Baths — 81 3. The figures submitted in the Appendix, together with the development shown in Paragraph 2 are an indication of the constant endeavour to protect the food supply and the circumstances under which food is handled and processed. The record of food ascertained to be unsound and which was surrendered must be amplified by pointing out that especially in the present circumstances mere condemnation and destruction of food is not enough; alternative uses must (be considered, for example, for animal feeding or for industrial processes, while, in addition, certain foodstuffs may (be re-processed and thus made fit for human consumption. Knowledge of such processes is gradually increasing and the Public Health Officer must keep himself up to date regarding such possibilities. This means continual co-operation and discussion between the Ministry's Salvage Officers and the Sanitary Inspectors. All of the Sanitary Inspectors attended a Course of lectures and demonstrations which were given by Dr. Cruickshank and Dr. Hobbs at the Central Pulblic Health Laboratory on Food Hygiene. These courses are of inestimable value to Technical Officers, both as a refresher course and from the point of view of acquiring knowledge of the latest developments in food bacteriology. The Manageresses of the school canteens and of a number of works canteens also attended a some what similar course adapted to the needs of the service which they represent. In addition to this educational aspect, the Department collaborated with the Central Public Health Laboratory by accompanying bacteriologists from the Laboratory to canteen and cafe kitchens to study kitchen practice and equipment and numerous bacteriological examinations were made of rinse water, swabbings of crockery and cutlery, with a view to collating the information obtained in connection with research !being carried out in relation to Food Hygiene. The Council have been anxious regarding ice cream, especially in view of various epidemics during the year in other parts of the country. Prior to the recent Ice Cream (Heat Treatment, 62 etc.) Regulations, 1947, practically all possibility of control in the cleanly handling and distribution of ice cream from a barrow or cart disappeared on the ice cream being deposited into the barrow or cart; for example, control of the cleanliness and good health of the person selling ice cream on the street from the barrow, the barrow being surrounded by children and other members of the public, possible and real buyers. To eliminate dangers from such absence of control it was considered that ice cream from a barrow or cart on the street should be sold wrapped, and representation was accordingly made to the Minister enquiring if the Council could deal witn the position by byelaw. The Minister, however, informed the Council that such a matter would appear to fall for consideration under his regulation-making powers in Section 8 (1) of the Food and Drugs Act, 1938, and could not appropriately be dealt with under byelaws. Now (from 1st May,1947) the Ice Cream (Heat Treatment, etc.) Regulations, 1947, are in force and a pamphlet has been distributed to all persons registered, pointing out duties and obligations with regard to premises and their cleanliness, the cleanliness of utensils, cleanliness of persons engaged in its preparation, storage and sale, reporting the occurrence of milk-borne diseases, the avoidance of delay in a mix being frozen. In view of the possibility of ice cream becoming infected with various disease germs and so acting as a vehicle in the spread of some dangerous illnesses, such points as these require constant care and the strictest vigilance. Failure in any one of these essentials may be the beginning of the train of circumstances leading to disastrous results, for example, the spread of typhoid fever, dysentery and similar diseases. Additional precautions are recommended such as that any person suffering from diarrhœa, realising the danger of spread, should Obtain medical advice before resuming employment in connection with ice cream, as also should any person suffering from whitlow or such like septic skin conditions. A blood test is available which may assist to detect any chronic typhoid or enteric carrier condition and proprietors of ice cream premises are informed as a routine that arrangements will be made for this test on application to the Public Health Department. This test is carried out at the Central Public Health Laboratory, Colindale. Constant attention was given to the cleanliness of milk under the Special Designations Orders. With recent developments in the industry the larger firms are supplying a still greater number of the public. In the report for the year 1936 it was remarked that 92.6% of the milk delivered in Wembley was either tuberculin tested, pasteurised or sterilised, the percentage of the milk 63 delivered which was pasteurised being 89.13%. A review was made in January,1947, as to the position and it is safe to say that about 98.5% of the milk consumed in Wembley is now heat treated under regulation. It is still not well enough understood that in circumstances as they are to-day the only safe milk is an efficiently heat treated supply. 4. Ministry of Health Circular No. 13/47 requests some information regarding the public water supply. The water supply to the Borough is by the Colne Valley Water Company and the Rickmansworth and Uxbridge Water Company. These supplies are sampled bacteriologically at frequent intervals at various points (106 examinations were made in the twelve months), and copies of the bacteriological reports forwarded to the Water Companies, while also the Water Companies submit periodically their results. The water supply remained bacteriologically satisfactory and generally sufficient in quantity. 5. HOUSING. The seriousness of the housing situation is fully appreciated by the Council and they are only too well aware of their limited possibilities towards its amelioration, but such possibilities are governed by the difficulties of the situation in the country generally. Overcrowding is a continually growing circumstance locally and only 62 cases could be relieved during the year. At the beginning of the year overcrowding in accordance with the Housing Act standard numbered 383, and on the 31st December 463. At the present time the Public Health Department is reviewing all cases which, according to the records in the Housing Department, suggest that families may be overcrowded. This has become necessary in connection with the Council's "points" scheme with regard to the allocation of Council properties, which pays regard amongst other circumstances, to overcrowding. Further, the Housing Act standards are low and minimum standards and do not take into account the difficulties and inconveniences which occur when a house planned and intended for only one family is accommodating two, three or more family units. With regard to disrepair and its remedy, the shortage of both materials and manpower necessitate continual adjustment as to practicability and the slogan "First things first" is not always a very satisfactory answer to the families dwelling in constantly trying surroundings. 6. FACTORIES ACT, 1937. Mr. R.M. Turner, Chief Sanitary Inspector, has contributed the following:— The industries in the Borough continue to be very similar in character to those which prevailed prior to the War, there being no heavy industries. The principal industries are light engineer- 64 ing, manufacture of electrical radio equipment, motor manufacture and repairs, glassworks, printing works, manufacture of carburettors, manufacture of fibre board, manufacture of food products, laundries, etc. The majority of the factories are mechanical factories and therefore largely come under the surveillance of His Majesty's Inspector of Factories, with the exception of the provisions of the Act relating to sanitary conveniences. No great difficulties are experienced with factory proprietors who are usually found to be very co-operative in meeting the requirements of the Act and Regulations. The usual difficulties experienced are related to delays similar to those experienced in connection with house repairs due to labour and material shortages found in connection with building work. Outworkers. Although a substantial number of visits was made to premises in which outwork is carried on, no infringement of Section 111 of the Factories Act, 1937, was found relating to outwork in unwholesome premises. 7.—SMOKE ABATEMENT (by Mr. R. M. Turner). The majority of the factory chimneys in the Borough are provided in connection with boiler plants which do not normally give rise to nuisance to the same extent as those connected with the pottery and steel industries. Where smoke nuisances have been detected visits are always made to the plant and the Works Manager and the boiler attendant have been interviewed. Experience shows that more beneficial results are obtained by this line of action than by the mere serving of Notices. The difficulties experienced during the year have been largely due to the quality of the coal supplied and to the problem of replacement of worn plant and parts. In one or two instances the services of a Technical Officer from the Ministry of Fuel and Power have been invoked. This Technical Officer, in addition to giving general advice, is in a position to assist in securing more suitable grades of fuel where such assistance is warranted. The problem of smoke and grit emissions from the Generating Power Station in the adjoining Borough of Willesden is still causing great concern to both Councils in spite of the fact that some of the remedial works which it was thought would abate the nuisance, have been carried out. The matter has been the subject of a further joint deputation of the two Local Authorities to the Ministry of Health. 8. RATS AND MICE (DESTRUCTION) ACT, 1919 (by Mr. R. M. Turner). Rodent control has continued to be carried out during the year with effective results. As from the 1st April, 65 1946, the Council decided to provide a free service to householders in respect of private dwellinghouses. This free service has proved to be more efficient in operation than the previous scheme whereby householders were required to pay for the service performed in the eradication of rats and mice. The methods of control advocated by the Ministry of Food are carried out in the Borough. During the year under review, the Council continued to operate the Act in accordance with Ministry of Food Circular N.S. 12, whereby the Council received !by way of financial assistance 60% of the cost of treating private houses. Four Rodent Control Assistants have been employed on this work during the major part of the year; all of these Assistants were trained at the infestation branch of the Ministry of Food. Rodent Control has been passed from the Ministry of Food to the Ministry of Agriculture and Circular N.S. 12 is no longer in operation. Under Local Authority Circular N.S. 19, Local Authorities have become eligible for a consolidated grant of 50% of the approved net expenditure under certain conditions laid down by the Ministry of Agriculture and Fisheries, and the Council have intimated to the Ministry their desire to avail themselves of the opportunity of receiving this new form of grant. Two maintenance treatments of sewer manholes were carried out by the Borough Engineer and Surveyor's Department during the year, in accordance with Ministry of Food Circular N.S. 11. The total estimate of rats killed in the Borough during the year was 5,346 (excluding sewers). But the organisation aims at much more than is reflected by any such figure—total elimination of the rodent population and rat proofing to prevent any re-infestation. 66 STATISTICAL APPENDIX F. Number of complaints received and investigated 3,201 Visits made by Sanitary Inspectors 26,311 (a). Dwelling Houses:— Visits under Public Health Acts 9,176 Visits under Housing Acts 67 Visits are overcrowding 560 Visits to bug infested premises 189 Visits are other vermin (excluding rats and mice, see below) 59 Visits are cases of infectious disease 1,343 Visits to cases of food poisoning 63 (b) General Environmental Public Health:— Drains and sewers inspected 2,872 Drain and Sewer Test applied 198 Cesspools, etc. 3 Urinals, latrines, chemical closets 31 Stables, manure pits, etc. 107 Piggeries (number on register at encl of year 13) 57 Ditches and streams 274 Open spaces, etc. 183 Yards 2,122 Public conveniences 91 Tents, vans and sheds 94 Factories—Mechanical 891 Non-mechanical 23 Workplaces 125 Outworkers 124 Smoke observations—half hourly 68 „ „ casual 618 „ „ visits to plant 46 Cinemas, Dance Halls, etc. (number on register at end of year 27) 137 Hairdressers (number of establishments on register at end of year 89) 53 Schools (number of private schools 18) 110 Markets 15 Rats and Mice 260 Swimming' baths—visits 120 „ „ water examination 45 „ „ chlorine tests 81 Council premises 61 A.R.P. Shelters 28 67 (c) Food, including milk, meat, water:— Number of dairies registered at end of year 26 Number of purveyors of milk registered, with premises in the Borough selling milk in properly closed and unopened receptacles 3 Number of purveyors of milk registered whose premises are outside the Borough 18 Number of dairies (included above) where milk bottled, etc. 5 Inspection visits made to:— Meat shops, stalls, etc. (number on register at end of year 78) 680 Cowsheds 7 Dairies and milk shops—visits 310 „ „ „ „ milk samples taken 119 Fried fish shops (number on register at end of year 17) 155 Bakehouses (number on register at end of year 20) 156 Ice cream premises (number on register at end of year 93) 572 Fishmongers and poulterers (number on register at end of year 25) 353 Greengrocers and fruiterers (number on register at end of year 88) 383 Grocers (number on register at end of year 228) 987 Restaurants, cafes, etc. (number on register at end of year 119) 612 Street vendors, hawkers, etc. (number on register at end of year 33) 258 Other food premises 111 Water supply—visits 221 „ „ samples taken 61 68 (d) Other visits and inspections:— Massage establishments, etc. 43 Certificates lodged by Members of the Chartered Society of Physiotherapists 2 New Licences granted 2 Licences renewed 16 Noise nuisances 01 Dust nuisances 3 Effluvia nuisances 34 Petroleum stores 326 Miscellaneous 416 Number of verbal notices served 325 Number of verbal notices complied with 230* Number of written notices served 722 Number of written notices complied with 623* Number of statutory notices served 157 Number of statutory notices complied with 116* * Includes a number of notices served in 1946 and completed in 1947. Legal Proceedings. In 9 cases legal proceedings were instituted for failure to comply with nuisance abatement notices served under Section 93 of the Public Health Act, 1936, in connection with essential repairs to houses. The Magistrates in each case made nuisance orders and in 8 cases awarded the Council costs. Nuisances abated and improvements effected. (a) Dwelling Houses:— Roofs repaired 220 External walls and chimney stacks repaired 103 Gutters and spouts repaired or renewed 124 Damp-proof courses provided 32 Dampness remedied 200 Yards paved or repaired 58 Internal walls and ceilings repaired 408 Doors repaired or renewed 73 Windows repaired or renewed 233 Floors repaired or renewed 115 Sub floor vent. provided or improved 63 Rooms cleansed or redecorated 270 Passages and staircases redecorated 45 Staircases repaired 13 69 Fireplaces and flues repaired or renewed 47 Cooking stoves repaired or renewed 5 Wash coppers repaired or renewed 1 Sinks and washbasins provided or renewed 30 Waste pipes repaired or renewed 35 Food stores; provided or improved 2 Dustbins provided or renewed 206 Water supply improved or reinstated 145 W.C. walls, etc., cleansed 25 W.C. pans cleansed 6 W.C. pans repaired or renewed 76 W.C. structure repaired or renewed 14 W.C. flush pipe joints repaired 34 Additional W.C. s. provided 3 Oversite cleared of rubbish 1 (b) General Environmental Public Health:— Drains cleansed from obstruction 986 Drains repaired or renewed 121 New drains provided 29 New inspection chambers provided 23 Inspection chambers repaired 66 Soil pipes and vent. shafts repaired 34 W.C.s. repaired 5 W.C.s. cleansed 8 Urinals and latrines cleansed or emptied 10 „ „ „ additional ones provided 9 Stables, manure pits, cleansed 10 „ „ „ repaired or renewed 1 Piggeries cleansed or limewashed 1 Animals nuisances abated 4 Offensive accumulations removed 42 Ditches and streams cleansed 4 „ „ „ pollution remedied 2 Yards cleansed or repaired 48 Tents, vans and sheds—nuisances abated 7 Smoke nuisances abated 5 Improvements in boiler plant or fuel effected 6 Cinemas, Dance Halls, etc.—contraventions remedied 4 Hairdressers—contraventions- remedied 4 Schools—sanitary conditions improved 3 „ urinals and W.C.s cleansed or repaired 1 „ additional W.C.s. urinals provided 1 70 Noise nuisances abated 7 Effluvia nuisances abated 1 Water tanks covered 2 (c) Eradication of bed bugs:— (i) Number of Council houses:— Found to be infested and subsequently disinfested 7 (ii) Number of other houses:— Found to be infested and subsequently disinfested 44 (i) by hydrogen cyanide — (ii) by sulphur — (iii) by liquid insecticides 44 Other vermin eradicated 11 Verminous articles destroyed — (d) Meat and other Food Premises:— Meat shops, stalls, etc.—premises cleansed 35 „ „ „ „ other contraventions remedied 27 Dairies—cleansed and limewashed 14 „ premises repaired 1 „ other contraventions remedied 4 Bakehouses cleansed and limewashed 21 „ sanitary conditions improved 7 „ other contraventions remedied — Ice cream premises cleansed and limewashed 14 „ „ „ sanitary conditions improved 6 Fried lish shops cleansed and limewashed 8 „ „ „ sanitary conditions improved 2 „ „ „ other contraventions remedied 1 Fishmongers, etc., contraventions remedied 10 Grocers, etc., contraventions remedied 32 Greengrocers, etc., contraventions remedied 13 Restaurants, Cafes, etc., contraventions remedied 45 Street hawkers, contraventions remedied 2 Other food premises, contraventions remedied 3 4,382 71 (e) Unsound food surrendered:— 2,135 lbs. Beef. 25 lbs. Lamb. 40 lbs. Sheeps' liver. 40 lbs. Veal. 20 lbs. Whale meat. 46 lbs. Sausages. 180 lbs. Sausage meat. 12 Chickens. 62 Rabbits. 12 lbs. Galantine. 10 lbs. Bacon. 36 lbs. Ham. 2,344 lbs. Corned beef. Tinned Meat. Mutton 5—21 lb. tins. Stewed steak 205 tins. Sausage meat 37 tins. Spam 61 tins. Lambs' tongues 11—1 lb. 1 6 lb. tins. Ox tongues 1—6 lb. tin. Brisket beef 4 tins. Steak and kidney pudding 21 tins. Corned mutton 7—6 lb. 1—2 lb. 3¾lb. tins. Minced beef loaf 24—12 oz. tins. Roast beef 3—5¾lb. tins. Veal loaf 38 tins. Pork loaf 2—¾ lb. tins. Meat roll 5 tins. Vienna sausage 151 tins. Corned beef 159—6 lb. 100—¾ lb. tins. Bacon 8 tins. Pressed beef 1—5¾lb. tin. Stewed steak and macaroni 3 tins. Irish stew 58—1 lb. tins. Boned chicken 3—1 lb. tins. Chef roll 1 tin. Meat and Vegetable ration 23—1 lb. 2—2 lb. tins. Pork luncheon meat 32—¾lb. 1 —6 1b. 9— 2½ lb. tins. Ham loaf 2 tins. Soup 121 tins. 72 Fish. Smoked haddock fillets 82 satones. Skate 22 stones. Plaice 17 stones. Rolsen 7 stones. Cod fillets 14 stones. Bream fillets 10 stones. Herrings 15½ stones. Roes 108 lbs. Cod 17 stones. Catfish 7 stones. Crayfish 25 lbs. Mackerel 6 stones. Kippers 26 stones. Halibut 5 stones. Witches 6 stones. Melts 12 stones. Dog fish 6 stones. Tinned Fish. Salmon 242 tins. Herrings 25 tins. Herrings titbits 204 tins. Pilchards 104 tins. Dressed crab 3 tins. Prawns 2 tins. Sardines 173 tins. Brislings 5 tins. Snoek 6 tins. Sild 4 tins. Mackerel 7 tins. Shrimps 12 tins. Kipper snacks 2 tins. Crawfish 8 tins. Hake 41 tins. Swedish hors dœuuvres 11 tins. Rollmops 20 jars. Chad 2 tins. Anchovies 2 tins. Whiting 115 tins. Chinchards 1 tin. Eels 2 jars. Mussels 67 jars. Fish cakes 2 jar. 155 lbs. 73 Fruit. Pineapples 2. White cherries 60 lbs. Dark cherries 20 lbs. Oranges ½ case. Prunes 83 lbs. Dates 527—9 oz. packets. Dates 124 lbs. Dates 21 boxes. Potatoes 16 lbs. Tomatoes 56 lbs. Tinned Fruit and Vegetables. Plums 72 tins. Apricots 22 tins. Peaches 127 tins. Grapes 8 tins. Greengages 1 tin. Fruit cocktail 44 tins. Pears 24 tins. Damsons 3 tins. Apples 10 tins. Gooseberries 3 tins. Rhubarb 7 tins. Grapefruit 69 tins. Apple pulp 11 tins. Fruit juices 39 tins. Carrots 64 tins. Potatoes 50 tins. Spinach 12 tins. Spinach puree 1 tin. Tomatoes 118 tins. Mixed vegetables 18 tins. Spaghetti 17 tins. Macaroni 39 tins. Pork and Beans 2 tins. Macaroni and cheese 6 tins. Vegetarian beans 13 tins. peas 292 tins. Beans 159—½ lb. 396—1 lb. tins. Beetroot 90 tins. Dutch gherkins 14 jars. Silverskin onions 1 jars. Parsnips 25 tins. 74 Miscellaneous. Butter beans 341 lbs. Dried peas 58 lbs. Raisins 1½ lbs. Cheese 13 packets. Cheese 40 boxes. Cheese 103 lbs. Oatmeal 63 lbs. Semolina 35 packets. Macaroni 1,450 lbs. Spaghetti 20 lbs. Barley 29 lbs. Shredded wheat 8 packets. Oats 7 packets. Cake flour 121 lbs. Gerbers meal 26 lbs. Wheat flakes 17 packets. All Bran 9 packets. Mixed fruit pudding 3 tins. Treacle pudding 3 tins. Date pudding 1 tin. Pudding Mixture 30 packets. Cake Mixture 36 packets. Eatwell Mixture 1lb. Honey bread party loaf 1 tin. Benger's food 20 tins. Custard food 1 packet. Crystallised jellies 1 packet. Calves foot jelly 1 jar. Cod liver oil 1 bottle. Orange juice 31 bottles. Tomato juice 6 bottles. Chocolates 770 bars. Chocolates 20 boxes. Chocolates 7 lbs. Sweets 179½ lbs. Malt spread 1 carton. Crumpets 4½ trays. Chocolate Swiss rolls 1,130. Bread 1 loaf. Meat pies 24. Biscuits 613 lbs. Evaporated milk 4,663 tins. Condensed milk 197 tins. Household—dried milk 10 tins. Shell eggs (chicken) 1,338. Shell eggs (duck) 138. 75 Dried eggs 14 packets. Jams 403 tins. Marmalade 141 tins. Apple jelly 1 jar. Pastes 7 jars. Potted meat 107 jars. Marmite 3 jars. Herring spread 104 tins. Cods liver and roe paste 55 tins. Meat extract 1 jar. Pilchoric 1 tin. Horseradish cream 2 jars. Pickles 84 bottles. Chutney 30 bottles. Pickled cucumbers 13 jars. Sauce 15 bottles. Piccalilli 358 jars. Pickled onions 104 jars. Pickled cabbage 1 jar. Olives 1 jar. Pate fois gras 3 tins. Sandwich spread 1 jar. Tea 26 lbs. Butter 20 lbs. Flour 765 lbs. Sugar—loaf 14 lbs. Sugar—granulated 1,247½ lbs. Sugar—demerara 7 lbs. Coffee with chicory 34 bottles. Inspection of dwelling-houses during the year:— (a) (i) Total number of dwelling-houses spected for housing defects (under Public Health or Housing Acts) 4,524 (ii) Number of inspections made for the purpose 10,051 (b) (i) Number of dwelling-houses (included under sub-head (1) above) which were inspected and recorded under the Housing Consolidated Regulations, 1925/1932 11 (ii) Number of inspections made for the purpose 35 (c) Number of dwelling-houses found not to be in all respects reasonably fit for human habitation 1,832 76 Remedy of defects during the year without service of formal notices:— Number of defective dwelling-houses rendered fit in consequence of informal action by the Local Authority or their officers 1,822 Action under statutory powers during the year:— (a) Proceedings under Sections 9, 10 and 16 of the Housing Act, 1936:— (i) Number of dwelling-houses in respect of which notices were served requiring repairs Nil (ii) Number of dwelling-houses which were rendered fit after service of formal notices:— (1) by owners (2) by Local Authority in default of Nil owners (b) Proceedings under Public Health Acts:— (i) Number of dwelling-houses in respect of which notices were served requiring defects to be remedied 144 (ii) Number of dwelling-houses in which defects were remedied after service of formal notices:— (1) by owners 73* (2) by Local Authority in default of owners 36† * Includes compliance in .1947 with 14 notices served in 1946. † Includes compliance in 1947 with 5 notices served in 1946. (c) Proceedings under Sections 11 and 13 of the Housing Act, 1936:— (i) Number of dwelling-houses in respect of which Demolition Orders were made Nil (ii) Number of dwelling-houses demolished in pursuance of Demolition Orders 77 (d) Proceedings under Section 12 of the Housing Act, 1936:— (i) Number of separate tenements or underground rooms in respect of which Closing Orders were made Nil (ii) Number of separate tenements or underground rooms in respect of which Closing Orders were determined, the tenement or room having been rendered fit Overcrowding. (a) Certificates issued to landlords, giving the permitted number of persons who may occupy a house 69 (b) Number of dwellings recorded as overcrowded at the end of the year 463 Number of families dwelling therein 570 Number of persons dwelling therein 2,565 (c). Number of new cases of overcrowding ported during the year 142 (d) (i) Number of cases of overcrowding relieved during the year Total 62 (1) by removals of sub-tenants/lodgers 1 (2) by removal of families to other known addresses (not overcrowded) 55 (3) by removal to unknown addresses 6 (4) rehoused by Council (included also in (2) above) in requisitioned premises 13 Council houses 14 Temporary bungalows 26 (ii) Number of persons concerned in such cases 317 (e) Particulars of any cases in which dwellinghouses have again become overcrowded after the Local Authority have taken steps for the abatement of overcrowding Nil 78 Factories. Number of factory premises — 522. Number of:— Premises. Inspections. Written Notices. Occupiers Prosecuted. *Factories with mech. power 891 10 Factories without mech. power 23 — — Other premises 9 — — Totals 923 10 — * Includes 141 inspections of bakehouses with mech. power. Defects found. Particulars. No. of defects:— Found. Remedied Referred . to H.M. Inspector. Prosecutions. Want of cleanliness 7 3 1 Overcrowding — — — - Unreasonable temperature — — — — Inadequate ventilation — — — — Ineffective drainage of floors — — — — Sanitary Convenience:— Insufficient 5 7 — — Unsuitable or defective 43 34 — - Not separate for the sexes 4 2 — — Other offences 27 23 1 - Totals 86 69 2 - Outworkers. Number on register at end of year 170 Nature of work:— Making, repairing of:— Wearing apparel 137 Household linen 15 Umbrellas 1 Cardboard boxes 4 Carding of buttons 5 Toys 8 79 Offices. Number on the register — 290. Defects. Found. Remedied. Want of cleanliness — — Want of ventilation — — Overcrowding 1 — Sanitary accommodation:— Insufficient 2 — Unsuitable or defective 1 — Not separate sexes 1 2* Obnoxious effluvia — - Other nuisances 2 1 Totals 7 3 * One defect found in 1946 remedied in 1947. Disinfection of Premises and Articles. Disinfections for:— Infectious diseases 514 Cancer 34 Vermin (routine protection from) 73 Miscellaneous 25 Articles disinfected or destroyed:— Disinfected. Destroyed. Bedding and bedclothing 2,532 45 Wearing apparel 31 Nil Carpets, rugs, cushions 61 1 Others 1 Nil Rats and Mice (Destruction) Act, 1919. Work carried out during the year:— (1) Number of premises visited 2,556 (2) Number of visits by Sanitary Inspectors 260 (3) Number of visits by Rodent Control Assistants 12,863 (4) Number of premises found to be infested 847 (5) Number of premises which received treatment by Rodent Control Assistants 807 80 (6) Number of premises satisfactorily treated privately (7) Number of Council premises (included in ( 5) ) Milk (Special Designations) Orders. Licences issued. Supple- To To Dealers, mentary. Bottle. Pasteurise. Tuberculin tested 15 8 1 — Accredited — — — — Pasteurised 27 9 — 1 Samples of designated milk taken. No. of samples No. not taken. satisfactory. Pasteurised 56 4 Tuberculin tested 12 3 T.T. (Pasteurised) 21 2 T.T. (Certified) 2 91 9 Laboratory Examinations re Food, Milk and Water. Examinations made. 31.3.47 Quarter 30.6.47 ending 30.9.47 31.12.47 Total for 12 months Water 16 15 64 11 106 Milk 31 31 30 27 119 Food 1 1 — 3 5 Chemical tests for chlorine content of Swimming Pool water made by inspectors, 81. 81 CHAPTER VII. ADMINISTRATION, STAFF, SUMMARY. 1. The previous chapters give a report on the work of the Department in 1947, both generally and in detail in certain particulars, as well as being a review of the development and expansion during the last ten years of the Borough's Health Services. Such an expansion is all the more remarkable because of the dominating priority of Air Raid Precautions and Civil Defence in the seven years 1938 - 1945. 2. Administratively, the Department is divided into five sections dealing with (1) Staff, supplies, equipment, finance, etc., (2) infectious diseases and hospitalisation, (3) Maternity and Child Welfare, (4) School Health services and Day Nurseries, (5) Environmental hygiene and food. These five sections are in no sense watertight compartments, the professional technical Officers having duties in all the sections, some in some sections more than in others according to their specialities. The clerical staff overflow into all five sections under the day to day supervision and co-ordination of the Chief Clerk; the professional technical staff being, as far as possible, relieved of clerical duties which may be delegated to these Officers. Some de-centralisation of administration of the Clinic Services has taken place, with considerable benefit. There are several matters occurring constantly at the Clinics which may appropriately be dealt with on behalf of the Medical Officers and Health Visitors by a clerical Officer, relieving them for their more technical responsibilities to those seeking professional advice. At Stag Lane Clinic four Health Visitors and at One Tree Hill Clinic three Health Visitors now have their centres, being assisted by two clerical Officers one at each centre. The saving in time spent on travelling to and from the Town Hall alone, along with the many arrangements (hospitalisation, consultation appointments, letters are other services, etc., etc.) being dealt with immediately by the clerical Officers at the Clinics have been a great advantage, especially since so many extra responsibilities have been undertaken under the Education Act, 1944. 3. Various booklets are issued and kept up to date for the information and general guidance of the staff, to the Medical Officers, the Health Visitors, the Sanitary Inspectors, and the Clerical Officers, while, in addition, booklets are also compiled dealing comprehensively with the School Health Services and the Day Nursery Services. 82 4. An indication of the considerable growth in the work of the Department is shown by the staff:— December, 1947. Staff. Full-time. Part-time. Medical Officers 5 7 Auxiliary Staff:— Speech Therapists 2 Physiotherapist — 1 Dental Officers 5 1 (Specialist) Dental Attendants 5 1 Orthodontists — 3 Orthodontist Attendants 1 1 Panel of Anaesthetists for Dental Sessions — 5 Health Visitors 19 — Ancillary Staff 2 7 Home and Domestic Helps 8 3 Sanitary Inspectors 7 — Ancillary Staff 8 — Nurseries Personnel 60 19 Ancillary Domestic Staff — 27 Ambulance Personnel 17 — Clerical Officers 21 — Totals 158 77 Full-time Personnel— 158. Professional, Technical and Ancillary. Clerical Administrative. 137 21 86% 14% With the co-ordination throughout the five sections of the Department it will be noted that it has been possible to arrange administration with only 14% of the full-time Officers being clerical administrative while, in addition, of course, clerical administrative duties fall upon these Officers with regard to the 77 part-time Officers detailed above. 83 5. During these ten years the most important addition to the responsibilities of the Department has been, of course, the assumption of the School Health Services under the Education Act, 1944. This service is now fully co-ordinated with the other Health Services of the Council. The Day Nursery Service is also a new one, as was the assumption by the Department of responsibility for the Ambulance Service. Under the Rats and Mice Destruction Act, complete delegation from the County Council increased considerably the duties of the inspectorial section. The growth in population, the expansion of the services and the constant addition of duties by the Ministry of Health have meant periodic survey and adjustment and absorption of details. 6. With the very deepest regret this Report records the death of Dr. Alexander Gavin Morison, Medical Officer of Health since 1937, who died on the 16th July of this year. Dr. Morison was the architect of the very fine personal health services which exist in the Borough and the greatest praise is due to him for his unrelenting enthusiasm in the interests of the citizens of Wembley during the ten years of his office. He was widely popular and a recognised leader in preventive medicine, and his gentle kindly advice was equally valued by his colleagues as by his patients. Every person in the Department regrets his passing and we are inspired to maintain as his memorial the services he built in the Borough. I have the honour to be, Mr. Mayor, Ladies and Gentlemen, Your obedient servant, E. GRUNDY, Medical Officer of Health. Appointed October, 1947. July, 1948. 84