Ac 4390 wenBLE 1 WWM 29 BOROUGH OF WEMBLEY REPORT OF THE MEDICAL OFFICER OF HEALTH FOR THE YEAR 1948 E. GRUNDY, M.D., M.R.C.S., D.P.H., Medical Officer of Health BOROUGH OF WEMBLEY REPORT OF THE MEDICAL OFFICER OF HEALTH FOR THE YEAR 1948 E. GRUNDY, M.D., M.R.C.S., D.P.H., Medical Officer of Health BOROUGH OF WEMBLEY ANNUAL REPORT of the MEDICAL OFFICER OF HEALTH for the Year 1948 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 1948. 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. Chapter I VITAL STATISTICS, Page 4, Statistical Appendix A, Pages 5—11. „ II GENERAL HEALTH SERVICES, Pages 12—13, Statistical Appendix B, Pages 14—15. „ III MATERNITY AND CHILD WELFARE SERVICES, Pages 16—20, Statistical Appendix C, Pages 21—31. „ IV SCHOOL HEALTH SERVICES, Pages 32—34, Statistical Appendix D, Pages 35—40. „ V INFECTIOUS DISEASES, Pages 41 — 43, Statistical Appendix E, Pages 44—51. „ VI ENVIRONMENTAL HYGIENE, FOOD AND WATER, HOUSING, FACTORIES, ETC., Pages 52—55, Statistical Appendix F, Pages 56—68. „ VII ADMINISTRATION OF THE DEPARTMENT, STAFF AND SUMMARY, Page 69. 3 CHAPTER. 1. VITAL STATISTICS. 1. The population of the Borough mid-1948 was estimated by the Registrar-General to be 131,700. In 1931 (the last census 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, 1948) estimate of the Registrar-General is that the population is 132,600. Wembley is the fifth largest County district in Middlesex, those of greater population being according to size — Harrow, Ealing, Willesden and Hendon. 2. In 1948, 1,821 live births were recorded, giving a birth rate of 13.83 per thousand. The number of deaths was 1,042 giving a crude death rate of 7.92 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 21.97, the previously lowest figure having been 23.26 in 1947. 3. Prematurity of birth was again the main cause of the deaths in 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, 1948, from figures supplied by Registrar-General. (Some comparative 1947 figures within brackets.) Live Births. Male. Female. Total. Live birth rate per 1,000 estimated population 13.83 (17.15) Legitimate 889 875 1,764 (2,190) Illegitimate 27 30 57 (89) Stillbirths. Legitimate 17 23 40 (30) Rate per 1,000 total (live and still) births Illegitimate - - (3) 21.49 (14.27) Stillbirth rate per 1,000 estimated population 0.30 (0.25) Deaths 526 516 1,042 (1,124) Death rate pet 1,000 estimated population — Crude rate 7.92 (8.46) Infantile Mortality. Deaths of infants under one year of age:— Male. Female. Total. 40 (53) Legitimate 20 19 39 (50) Illegitimate 1 — 1 (3) Death rate of infants under one year of age:— All infants per 1,000 live births 21.97 (23.26) Legitimate infants per 1,000 legitimate live-births 22.11 (22.83) Illegitimate infants per 1,000 live illegitimate births 17.54 (33.71) 5 Deaths from: Cancer (all ages) 237 (213) Measles (all ages) — (2) Whooping cough (all ages) 3 (2) Diarrhoea (under 2 years) 2 (3) Maternal Mortality. Deaths from puerperal sepsis 1 (-) Other puerperal causes 1 (3) Maternal mortality rate per 1,000 live births 1.09 (1.32) Maternal mortality rate per 1,000 total (live and still) births 1.07 (1.30) Per 1,000 population. Per 1,000 Live Births. Per 1,000 total births (live and still). Birth rate. Still Birth rate. Infantile Maternal Death rate. mortality. mortality. Maternal mortality. Wembley 13.83 0.30 7.92 21.97 1.09 1.07 England and Wales 17.90 0.42 10.80 34.00 — 1.02 London 20.10 0.39 11.60 31.00 — — 126 County Boroughs, etc. 20.00 0.52 11.60 39.00 — — 148 Smaller towns, etc. 19.20 0.43 10.70 32.00 — — 6 Causes of Deaths during the Year. 1947. Total. Causes of Death. Male. Female. 1948. Total. 1,124 All causes 526 516 1,042 — Typhoid and para-typhoid fevers — 1 1 — Cerebro-spinal fever — — — — Scarlet fever — — — 2 Whooping cough 2 1 3 — Diphtheria — — — 49 Tuberculosis of respiratory system 26 13 39 10 Other forms of tuberculosis 6 — 6 2 Syphilitic diseases 2 1 3 11 Influenza 1 3 4 2 Measles — — — 1 Ac: polio myel: and polio-enceph: 1 — 1 1 Acute infectious enceph: — — — 5 Cancer of buc: cav: and cesoph:(M) 5 — 5 16 „ uterus (F) — 15 15 30 Cancer of stomach and duodenum 16 11 27 27 Cancer of breast — 37 37 135 Cancer of all other sites 98 55 153 8 Diabetes 4 5 9 117 Intra-cranial vascular lesions 47 66 113 253 Heart disease 135 136 271 64 Other dis: of circ: system 19 19 38 54 Bronchitis 30 24 54 52 Pneumonia 18 18 36 18 Other respiratory diseases 5 11 16 14 Ulcer of stomach or duodenum 11 2 13 3 Diarrhoea under two years 2 — 2 5 Appendicitis — 3 3 31 Other digestive diseases 14 19 33 30 Nephritis 13 9 22 — Puerperal and post-abort: sepsis — 1 1 3 Other maternal causes — 1 1 8 Premature birth 3 6 9 33 Congenital malf: birth injury and infant diseases 14 12 26 18 Suicide 11 4 15 12 Road traffic accidents 7 2 9 22 Other violent causes 9 6 15 88 All other causes 27 35 62 7 The Principal Causes of Death. Disease. Total Number of deaths. 1. Heart disease and other diseases of circulatory system 309 Intra-cranial vascular lesions 113 422 2. Cancer 237 3. Respiratory diseases:— (a) Bronchitis 54 (b) Pneumonia 36 (c) Other respiratory diseases 16 106 4. Digestive Diseases:— (a) Appendicitis 3 (b) Other digestive diseases 33 (c) Ulcer 13 49 5. Tuberculosis:— (a) Respiratory system 39 (b) Other forms 6 45 6 Violent deaths:— (a) Suicide 15 (b) Road traffic 9 (c) Other violent causes 15 39 7. Premature births 9 Congenital malf: birth injury and infant diseases 26 35 8  Percentage of total deaths under 1 year. Percentage of total deaths under 50 years. Percentage of deaths taking place in hospitals. 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 1948 3.48 19.44 37.04 SOME OTHER ESSENTIAL LOCAL STATISTICS. Birth Notifications. Notified by. At home In Hospital. In Nursing Home. Totals. Doctors 14 671 261 946 Midwives 442 411 43 896 Parents 1 — — 1 Totals 457 1,082 304 1,843 Percentages 24.8 58.7 16.5 100 Live births 1,805. Still births 38. Infantile Mortality. Deaths from stated causes at various ages under one year. Cause of death (extracted from weekly returns of local Registrars, and from inward transfers of RegistrarGeneral). Under 1 week 1 — 2 weeks 2 — 3 weeks 3 — 4 weeks Total under one month 1 — 3 months 3 — 6 months 6 — 9 months 9 — 12 months Total deaths under 1 year Prematurity 9 1 — — 10 — — — — 10 Congenital defects 3 — — — 3 — 1 — — 4 Broncho pneumonia — 1 — — 1 — — 2 1 4 Atelectasis 3 1 — — 4 — — — — 4 Gastro-enteritis - - - - - - - 1 — 1 Birth injuries 8 — — — 8 — — 1 — 9 Diseases of the new Born 2 — — — 2 — — — — 2 Meningitis — — — 1 1 — — — — 1 Acute bronchitis - - - - - - - - 1 1 Accidental death - - - - - - - - 1 1 Pertussis — — — — — 1 — — — 1 25 3 - 1 29 1 1 4 3 38 Infantile Mortality, 1944-1948. Year. Wembley. England & Wales. 1944 35.50 46 1945 36.75 46 1946 26.37 43 1947 23.26 41 1948 21.97 34 Infantile mortality during last five years (10,410 live births, 294 deaths under one year): 28.24. 10 Maternal Mortality. Rate per 1,000 total births (live arid still), 1944-1948:— Year. Wembley. England & Wales. 1944 0.91 1.93 1945 1.08 1.79 1946 0.45 1.43 1947 1.30 1.17 1948 1.07 1.02 Maternal mortality during last five years (10,623 total births —10 maternal deaths): 0.94. 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'e Churchyard — Ascertainment and treatment of verminous premises and verminous people, arrangement with Royal Borough of Kensington — Massage and Special Treatment, registration of premises. 2. 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 revision and issue of an up-to-date edition of a similar booklet is contemplated by the Health Authority. 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. 3. 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. 4. The consistently high level of the services provided until July by the District Nursing Associations (Wembley and Kingsbury) should be mentioned as they are indeed an asset to the public health of the Borough, providing, as they do, both general 12 nursing services and maternity services. Since the 5th July these services have been provided by the Middlesex County Council. 5. VERMINOUS CONDITIONS. Only 4 cases, all adults, 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. U STATISTICAL APPENDIX B. Period up to 4th July, 1948. Ambulance Service. Accident or sudden illness removals 429 General sickness removals 4,016 Maternity removals 243 Total 4,688 Included in above:— (a) Number of removals carried out for other Authorities 37 (b) Number of removals carried out by other Authorities for Wembley 85 Domestic Help Scheme—Ministry of Health Circular No. 179/44. Period up to 4th July, 1948. No. of families to whom service given. Assessment re recovery of cost. Full. 2/-d. per hour. l/8d. per hour. l/4d. per hour. l/-d. per hour. 8d. per hour. 4d. per hour. Free. 135 82 2 7 3 8 6 4 23 Full-time. Part-time. No. of domestic helps on Council's Panel on 4/7/48 9 1 Provision of Insulin. Number of persons who received free insulin in accordance with the Council's scheme until July:—37. Total cost of insulin provided £180 5s. 3d. 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 953 18,119 Maternity 108 2,493 Midwifery 180 4,927 Ante-natal and Post-natal 320 2,676 Miscarriage 20 143 Children under 5 33 166 Children over 5 25 102 Tuberculosis 36 814 14 Kingsbury District Nursing Association. Cases. Visits. Medical 174 2,153 Surgical 118 2,276 Maternity 33 653 Midwifery 121 2,349 Ante-natal 155 1,358 Miscarriage 9 83 Children under five 48 309 Children over five 7 31 Tuberculosis 5 191 Casual — 151 Mortuary. No. of bodies deposited 104 No. of post-mortem examinations carried out 102 No. of Coroner's inquests held 25 Bodies were deposited by order: — Coroner 86 By Police 14 Wembley Hospital 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 8 Renewals19 15 CHAPTER III. MATERNITY AND CHILD WELFARE. 1. SERVICES PROVIDED, Notification of births — For premature infants special equipment on loan, Paediatrician 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, arrangement 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 16 Hospitals—Home Helps—Specialist Medical Services, Gynaicological and Post-Natal Clinics, Birth Control Sessions for married women requiring birth control advice for medical reasons, ophthalmic cases, orthopedic cases, child guidance cases, speech difficulty eases referred to Special Clinics — Clinic for children showing deafness or defective speech from deafness, or allergie asthma, etc., conditions, at Metropolitan Ear, Nose and Throat Hospital—Economic Circumstances Scale according to which Milk and Accessory Poods, 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, on the opening of Vale Farm Day 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. The Gynæcological and Post-Natal Clinics were started in November, 1945, and five Clinics are held each month at four different centres in the Borough and an average of 10 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 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. The Gynaecological cases seen have been varied and many cases have been sent to Redhill Hospital for operation. A considerable number of patients complaining of sterility have been investigated and many have become pregnant. These Clinics are performing a most useful part of the Health Services of the Borough. In the future they may well need considerable expansion. 3. During the year 1948, 170 new patients attended the Birth Control Clinics, 13 sessions being held at Stag Lane and 10 at Perrin Road. There were 590 re-attendances. 11 applicants were refused advice as having no medical grounds for family limitation. 17 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. No failures of the methods advised were reported during the year. 4. HOME HELP SERVICE. 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 high 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 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 1948, Home Helps were supplied in 123 maternity cases, compared with 27 in 1938 (the first complete year). The provision of white overalls to be 18 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 call 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. 5. INFANT DEATHS. During 1948 the total number of Wembley children who died without reaching their first birthday was 42, and, of this number, 34 did not survive the first month of life. Despite the comparatively low infant death rate of recent years in Wembley, Dr. Morison, the late Medical Officer, suggested 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 1948. An attempt was thereby 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 brought to the notice of parents. The following results obtained from the Health Visitors' enquiry visits are interesting. Total number of deaths under one year—42. Of this number 34 did not survive the first month of life and the remaining 8 died between one and nine months. Of the total 42 babies it was possible for infant death enquiryvisits to be made regarding 35 cases—34 died while still in the 19 care of the hospital or private medical practitioner and before the usual primary visit by the Health Visitor had been made; 2 died at home due to fatal illness, 4 in hospital and 2 deaths were caused by an accident at home. Of the 8 babies who died over one month — 6 had been seen by the Medical Officer at the Child Welfare Clinic and had been visited by the Area Health Visitors. The standard of home care in all cases was satisfactory and only in three cases were housing problems present. Causes of Infant Deaths. 0—4 weeks:— Prematurity and General Debility 21 Congenital malformations and birth injuries 8 Other causes 5 Total 34 4 weeks—12 months:— Pneumonia and Whooping Cough 4 Congenital heart 1 Accidents 2 Gastro-enteritis 1 Total 8 An infant mortality rate of 21 for 1948 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. 6. 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. 20 STATISTICAL APPENDIX C. Health Clinics. (Comparative 1947 figures within brackets.) Total number of children who first attended at the Clinics during the year, and who on the date of their first attendance were under one year of age 1,777 (2,093) 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 304 (271) 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 1,444 (2) Over one year of age 4,461 5,905 (6,261) Number of attendances by children under one year of age 38,117 (41,694) Number of attendances at all the Health Clinics by children between the ages of 1—5 years 16,288 (14,498) 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 1948 97.0 (92.7) (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 9,469 (11,215) Total number of women who attended for the first time 1,334 (1,551) 21 Percentage of total notified births (live and still) represented by the total number of women who attended the Clinics for the first time during the year 72.4 (68.5) Attendances at the various Health Clinics. Children under one year of age. Total Average attendance Clinic. attendances. per session. Stag Lane 8,386 55 Slough Lane 5,486 38 College Road 5,183 34 Ealing Road 4,224 40 Perrin Road 5,809 37 Monks Park 4,733 47 One Tree Hill 4,296 43 Children between the ages 1—5 years. Clinic. Total attendances. Average attendance per session. Stag Lane 2,004 14 Slough Lane 2,707 18 College Road 3,800 25 Ealing Road 1,197 11 Perrin Road 2,816 18 Monks Park 2,252 22 One Tree Hill 1,512 15 Domiciliary Nursing. Children referred for treatment to the Wembley and Kingsbury District Nursing Associations. Children under one year 9 Children over one year 3 Treatments given — Seven or fewer attendances 8 Over seven attendances 4 Specialist Clinic Services. Eye Clinics (Wembley Hill and Stag Lane (County) Clinics). 48 children referred. 22 Orthopedic Clinic (Stag Lane (County) Clinic). 74 children referred. 26 appliances supplied. Clinic for Defective Speech. 15 cases referred. Child Guidance Clinic. 1 case referred to Middlesex County Council Clinic, Harrow. Dental Clinic. See page 29. Artificial Sunlight and Massage Treatment. Number referred by Medical Officers: 113 (under one year, 9; over one year, 104). Reasons for treatment:— Debility, anaemia, etc. 62 Recurrent colds 16 Rickets 12 Bowed legs 9 Delayed dentition 4 Knock knees 7 Flat feet 2 Torticollis 1 Total 113 Ante - Natal Clinics. The months of pregnancy at which women attended for the first time:— 1st 2nd 3rd 4th 5th 6th 7th 8th 9th 42 438 404 219 100 57 28 21 3 Attendances of Expectant Mothers: — Total. Average attendance Clinic. attendances. per session. Stag Lane 2,463 16 Slough Lane 966 19 College Road 832 16 Ealing Road 1,077 23 Perrin Road 1,484 14 Monks Park 1,263 12 One Tree Hill 1,384 13 23 Special Blood Tests at Redhill Hospital. 261 examinations. X-Ray Ante-Natal Examinations. Number of women referred: 37. Supply of Sheets for Expectant Mothers: Ministry of Health Circular No. 154/44. Number of dockets issued: 727. Unmarried Mothers (Ministry of Health Circular No. 2866). 7 cases dealt with. Hospital Confinements. 641 women referred, to various hospitals:— (i) Medical reasons for reference to hospital:— (a) Regarding current pregnancy — Abnormality of maternal pelvis 42 Elderly primipara 29 Maternal ill-health 25 Cardiac abnormality 13 Tuberculosis 5 Toxaemia 4 Miscellaneous 29 147 (b) Regarding previous pregnancies— Abnormal obstetric history 60 Abnormal medical history 15 75 222 (ii) Home conditions unsuitable 279 (iii) Mothers desired hospital accommodation 140 Total 641 24 Wembley births taking place in hospital. (a) Middlesex County Council Hospitals:— Redhill 273 Central Middlesex 383 Maternity Hospital, Bushey 98 West Middlesex 1 North Middlesex 1 Hillingdon 2 758 (b) London Hospitals:— Queen Mary's 129 Queen Charlotte's 57 University College 26 St. Mary's 23 Middlesex 14 Elizabeth Garrett Anderson 10 City of London 7 St. George's 5 Royal Northern 4 Hospital of St. John and Elizabeth 3 Princess Beatrice 3 St. Thomas's 3 Royal Free 3 Hammersmith 3 Mothers 3 Paddington 2 Westminster 2 Charing Cross 1 Guy's 1 Hackney 1 King's College 1 Mile End 1 St. Barts. 1 303 25 (c) Other Hospitals:— Brocket Hall 10 Willesden Maternity 6 Bearstead Memorial 5 Perivale 3 Wembley 2 Queen Mary's, Stratford 1 27 Total 1,088 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. 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 1,205 909 436 27.8% 53.0% 40.0% 19.2% 1947 2,264 686 1,086 802 492 30.3% 48.0% 35.4% 21.7% 1948 1,843 457 1,088 758 298 24.8% 59.0% 41.1% 16.2% Puerperal Pyrexia. Number of notifications received: 3 (excluding 13 Willesden Maternity Hospital cases—Willesden residents). Number of women removed to hospital: 3. Obstetric Consultant Service. Consultant called in by private medical practitioners: 4, 26 Premature Infants (excluding Willesden Infants born in Willesden Maternity Hospital). (a) The total number who were born:— (i) at home 18 (ii) in Hospital or Nursing Home 2 (b) The number of those born at home:— (i) who were nursed entirely at home 13 (ii) who died during the first 24 hours — (iii) who survived at the end of one month 15 (c) The number of those born in Hospital or Nursing Home:— (i) who died during the first 24 hours — (ii) who survived at the end of one month 1 Stillbirths. 40 cases allotted to Wembley by Registrar-General. Detailed investigation made in 35 cases. Multipara 18 Primipara 17 35 Ante-natal supervision given by — Hospital and/or Clinic 28 Private medical attendant 5 No ante-natal supervision 2 35 Attendant circumstances — Instrumental delivery 2 Breech delivery 3 Prematurity 1 Foetal abnormality incompatible with separate existence 9 Ante-partum haemorrhage 3 Prolapsed cord 2 Ehesus factor 2 Other 13 35 27 Post-Natal Clinics. Clinic. First attendances. Reattendances. Aver. att'dance per session. Stag Lane 150 8 7 Perrin Road 42 3 4 One Tree Hill 52 8 5 Monks Park 56 6 6 Totals 300 25 - Test feeding scales issued on loan to 250 mothers. Special Milk Grants. Liquid milk: Nil supplied. Grants of dried milk and other accessory foods amounting to £7 12s. 7d. made during the period 1st January to 4th July, 1948. Maternity Outfits. Number of maternity outfits supplied: 4.r).r). Gynaecology Clinics. Clinic. First attendances. Reattendances. Aver, att'dance per session. Stag Lane 45 60 4 Perrin Road 36 3 3 One Tree Hill 18 24 4 Monks Park 29 11 4 Totals 328 98 — Birth Control Sessions. Clinic. First attendances. Reattendances. Aver. att'dance per session. Stag Lane 105 367 36 Perrin Road 65 223 29 Totals 170 590 — 28 Home Helps. Number of Families Attended. By full-time personnel. By personnel on approved panel. Economic circumstances scale of families. Fulltime Parttime Fulltime Parttime Free 10/- 20/- 30/- 40/- 60/- 70/- 84/- per week 96 3 22 2 4 2 7 15 16 9 4 18 With effect from 5/7/48 (M.C.C. assessment) 48 99 24 123 Domiciliary Nursing. Mothers referred for treatment to the Wembley and Kings bury Nursing Associations: 2. Dental Services—Mothers and Children. Expectant and Nursing mothers Children under 5 years. Numbers who received treatment 607 511 Numbers of treatments:— (a) Fillings:— (i) in temporary teeth — 1,280 (ii) in permanent teeth 1,961 — (b) Number of teeth extracted 1,170 499 (c) Number of administrations of general anaesthesia (nitrous oxide) 233 206 (d) Number of persons supplied with dentures 135 - (e) Number of dentures supplied 209 — Total attendances at Dental Clinics last live years:— Children. Mothers. 1944 451 882 1945 621 1,547 1946 1,080 2,942 1947 1,326 2,680 1948 1,608 2,532 29 Domiciliary Visits by Health Visitors. Home Visits. (a) To children under one year 2,15-4 First visits 6,121 Revisits (b) To children between the ages of 1—5 years 8,444 Total visits (c) To expectant mothers 1,117 First visits 1,342 Revisits (d) To nursing mothers 1,820 First visits 706 Revisits (e) Other special visits 2,775 Analysis of special visits included in (e) above:— Infectious diseases:— Measles 657 Whooping cough 748 Tuberculosis 27 Ophthalmia neonatorum (1) other (1) 2 Other 14 Diphtheria immunisation 49 Scabies Re Day nursery children 764 Home Help and Domestic Help supervision 137 Re Stillbirths 36 Re verminous conditions 6 Defaulting re treatment advised 196 General—e.g., infantile deaths, premature babies, home conditions, negligent care 128 Child Life Protection. Visits by Health Visitors:— To foster children 236 To foster parents 202 30 At the end of the year on register:— Foster children 17 Foster parents 14 Adoption of Children (Regulation) Act, 1939. Number of visits to children proposed for adoption 219 Number of children received for proposed adoption 36 31 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. The figures in Appendix D show a slight decrease in the number of routine medical inspections at the schools—6,492 in 1947, 6,092 in 1948. Since the commencement of the Autumn Term in September, arrangements have been made for all children to be examined at the following ages:— 5 years—on entry into school life, 7— 8 years—intermediate group in the Primary Schools, 10—11 years—last year in Primary Schools, and from then, once every two years in the Secondary Schools, these examinations to include the final examination before leaving school life. 3. The following is Miss RichnelPs report on speech theraphy for the year 1948:— Eight sessions have been held weekly in the Borough throughout the year, for at Stag Lane County Clinic and four at One Tree Hill Clinic. At the two Centres:— 68 new cases were referred, of which:— 6.1 attended for interviews. 7 failed to attend first or subsequent appointments. 32 In addition:— 32 follow-up interviews were arranged. 22 attended. 10 failed. A total of 85 have received treatment. Of these:— 18 were discharged, cured. 6 were discharged, much improved. 4 were discharged temporarily but are to be admitted for further treatment after a rest period. 2 left school, improved. 5 left the district. 1 was discharged at his parents' request. 6 failed, attendance. Of the 43 who are continuing treatment:— 16 are making very good progress. 23 are making satisfactory progress. 2 are making very little progress. 2 have attended for only a very short time. There are 6 on the Waiting List for immediate treatment and 3 awaiting preliminary interviews. From December 1st, time has been allocated by Middlesex County Council for school visiting. The number of sessions used for this purpose in Wembley is and will be two in every three weeks. 4. 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 at school to the mother's efforts at home. The general cleanliness 33 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 1948 was 0.61. 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. 5. HANDICAPPED PUPILS. A table is presented in the Appendix giving the numbers of handicapped pupils known to the department — 59 males and 55 females have been dealt with. 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. 6. 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. 34 STATISTICAL APPENDIX D. PRIMARY AND SECONDARY SCHOOLS. Return of Medical Inspections during the Year. (a) Periodic Medical Inspections. Number of code inspections:— Entrants 2,034 2nd Age Group 883 3rd Age Group 747 Total 3,664 Number of other routine inspections 2,652 Grand Total 6,316 (b) Other Inspections. Number of special inspections 1,914 Number of re-inspections 2,201 Total 4,115 (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 121 202 307 2nd Age Group 77 69 138 3rd Age Group 24 38 58 Total 222 309 503 Other routine inspections 146 159 290 Grand Total 368 468 793 Note.—Pupils requiring treatment for defective vision and for other conditions appear once only in the column headed "Total." 35 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 39 48 404 15 Eyes:- Vision 368 42 106 11 Squint 26 39 9 1 Other 6 19 86 10 Ears:— Hearing 7 17 11 2 Otitis media 5 25 16 2 Other 13 25 88 6 Nose or Throat 71 279 132 27 Speech 23 54 8 2 Cervical glands 6 70 8 3 Heart and circulation 18 71 19 4 Lungs 25 134 64 16 Developmental:— Hernia 7 13 5 2 Other 6 27 3 4 Orthopaedic:— Posture 23 29 4 3 Flat foot 23 17 11 2 Other 72 91 93 9 Nervous system:— Epilepsy — 6 1 - Other 9 55 38 28 Psychological:— Development 3 44 15 14 Stability 5 33 1 — Other 81 91 382 111 Totals 836 1,229 1,504 272 36 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 2,034 911 44.8 1,109 54.5 14 0.7 2nd Age Group 883 373 42.2 497 56.3 13 1.5 3rd Age Group 747 371 49.6 362 48.5 14 1.9 Other routine inspections 2,652 998 37.6 1,613 60.8 41 1.6 Totals 6,316 2,653 42.0 3,581 56.7 82 1.3 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:— Bingworm:— Scalp:— (i) X-Bay treatment — (ii) Other 2 Body 1 Scabies 6 Impetigo 24 Other skin disease 316 Minor eye defects (External and other, but excluding cases falling in Group II.) 76 Minor ear defects 93 Miscellaneous (e.g., Minor injuries, bruises, sores, chilblains, etc.) 668 Total 1,186 37 (b) Defective Vision and Squint (excluding minor eye defects treated as minor ailments). Defect or Disease. Number of Defects dealt with under the Authority's Scheme. Errors of refraction (including squint) 1,030 Other defect or disease of the eyes 317 Total 1,347 No. of pupils for whom spectacles were:— (a) Prescribed 670 (b) Known to have been obtained 510 (c) Treatment of Defects of Nose and Throat. Number of Defects. Received other than operative treatment 30 (d) Orthopædic and Postural Defects. Number of Pupils Treated. Non-residential treatment at orthopaedic clinics. Under the Authority's scheme 212 Dental Inspection and Treatment. (1) Number of pupils who were inspected by the dental surgeons:— (a) Routine age groups:— 5 384 6 466 7 304 8 477 9 630 10 639 11 656 12 380 13 441 14 397 15 188 16 plus 122 Total 5,093 (b) Specials 2,042 (c) Grand Total 7,135 38 (2) Found to require treatment 5,490 (3) Actually treated 4,340 (4) Attenances made by pupils for treatment 13,548 *(5) Half-days devoted to:— Inspection 63 Treatment 1,709 Total 1,772 (6) Fillings:— Permanent teeth 7,633 Temporary teeth 2,812 Total 10,445 (7) Extractions:— Permanent teeth 977 Temporary teeth 5,575 Total 6,552 (8) Administrations of general anesthetics for extractions (all schools) 2,094 (9) Other operations:— Permanent teeth 4,974 Temporary teeth 1,517 Total 6,491 * 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 54,128 (ii) Number of individual pupils found unclean 334 (iii) Percentage of pupils found unclean 0.61 39 Handicapped Pupils (March, 1949) ascertained since July, 1945. Category. At Special School. At Maintained School. At Independent School. Not at School. Totals. M. F. M. F. M. F. M. F. M. F. A — 1 - - - - - - - 1 B 1 4 - - - - - 1 1 5 C 3 2 - - - - - - 3 2 D - 3 - - - - - - - 3 E 2 14 4 2 - - 1 - 7 16 F - - - - - - - - - - G 11 4 16 6 — — — 2 27 12 H 2 2 - - - - - - 2 2 I 2 — 1 1 — — — — 3 1 J 6 5 3 1 — — ry 1 7 16 13 K - - - - - - - - - - 27 35 24 10 — — 8 10 59 55 40 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, Neasden after 4/7/49, re puerperal pyrexia and ophthalmia neonatorum, London County Council, re poliomyelitis at Royal National Orthopaedic Hospital, re smallpox, Middlesex County Council, Emergency Bed Service after 4/7/49 — Notification of tuberculosis—Compilation of tuberculosis register—Weekly and quarterly returns to Ministry of Health and County Medical Officer — Authentication of travellers' inoculation state — Preventive medicine, diphtheria immunisation, anti-typhoid 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—from 5/7/48, diphtheria only. 2. A circumscribed outbreak of aeute Poliomyelitis occurred in the Borough during the year, when 5 cases in all were notified, 4 in August and 1 in December. No comment is felt to be necessary on this small outbreak. 3. The supervision of contacts landing from ship or aeroplane called for routine surveillance of 10 persons regarding smallpox, 5 persons regarding cholera and 2 persons regarding typhus fever. 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, there fore, of any member of the family who has not been successfully 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 being 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 school-children and those over school age. If there be an infant in the household under the age of twelve 41 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. It is very unusual to receive notification of a case of cholera in this country and the one notified in May calls for comment. The infection was acquired in the bacteriological laboratory of a London Hospital where cholera vaccine was under preporation and in view of the fact that the patient travelled home to Wembley in public transport to her place of residence, the Borough is fortunate that no secondary infections occurred. 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 64.94. 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, by 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 session* are referred to 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 750 children received the additional reinforcing dose and 843 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. 6. The investigation into the value of vaccines in preventing Whooping Cough have continued in Wembley—and in other areas 42 —during the past year. Over 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—continued to the end of the year and it is hoped 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. 7. DAY NURSERIES. The incidence of the infectious diseases is again tabulated. Any case of Whooping Cough or Measles in a day nursery appears to offer a focus from which infection can spread, but the numbers of cases notified during the year are not so large as to cause undue apprehension. 8. FOOD POISONING. Nine cases of food poisoning were notified and 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. 43 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 269 12 4 27 55 65 35 21 11 1 21 6 11 175 65.05 Diphtheria 2 1 — — — — — 1 — — — — — 2 100.00 Pneumonia 109 46 — 3 4 8 7 5 16 2 8 6 4 15 13.76 Erysipelas 35 3 2 2 3 8 2 1 3 3 2 1 5 8 22.86 Ophthalmia neonatorum Nil - - - - - - - - - - - - - - Cerebro-spinal fever 1 — — — — — 1 — — — — — — 1 100.00 Dysentery 59 11 6 — 7 3 4 2 4 2 11 4 5 13 22.03 Measles 1,307 95 77 87 112 155 163 101 141 75 144 46 111 31 2.37 Whooping cough 648 126 53 40 28 66 44 56 47 32 60 34 62 23 3.55 Acute poliomyelitis 5 1 1 — 1 — 1 — — — — — 1 5 100.00 Acute polioencephalitis 1 — — — — 1 — — — — - — — 1 100.00 Malaria 2 1 - - - - - - 1 - - - - - 00.00 Typhoid fever Nil - - - - - - - - - - - - - - Paratyphoid fever 1 1 - - - - - - - - - - - 1 100.00 Cholera 1 — — — — — — — 1 — — — — 1 100.00 Pemphigus neonatorum 1 - - - - - - 1 - - - - - - 00.00 44 Notifications of Selected 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. Typhoid 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 — — 28 38 — — 9 15 — — — — 0 19 11 24 7 - - - - - - - - 1 14 11 81 73 — — 157 151 — — — — 5 6 9 7 5 1 1 - - - - - - 3 37 28 85 104 — — 177 163 — 1 1 — 15 5 7 18 11 6 8 — 1 — — — — 5 64 75 115 103 1 — 304 294 1 — — — 45 1 1 18 7 6 9 — — — 1 — — 10 13 11 4 3 — — 6 13 — — — — 65 & over — — 8 4 1 3 - - - - - - 15 4 6 1 1 — 1 4 2 1 — — — Unstated - - - - - - - - - - - - 25 & over 3 2 4 8 — — 3 9 2 — — — All ages 136 133 318 330 1 1 660 647 4 1 1 — All ages 31 28 75 34 14 21 — 1 — 1 Nil Ol Monthly incidence of the Infectious Diseases. Disease. January. February. March. April. May. June. July. August. September. October. November. December. Total. Scarlet fever 11 9 35 24 31 68 32 9 11 11 19 9 269 Diphtheria 1 - - - - - - - 1 - - - 2 Pneumonia 20 14 18 9 5 1 7 1 — 5 15 14 109 Erysipelas 5 — 2 3 4 3 — 6 2 2 6 2 35 Pemphigus neonatorum - - - - - - - 1 - - - - 1 Cerebro-spinal fever 1 - - - - - - - - - - - 1 Dvsenterv 7 30 11 5 2 1 1 — — — — 2 59 Measles 56 145 380 247 212 83 33 18 5 9 39 80 1307 Whooping cough 52 67 118 90 62 69 73 47 36 12 6 16 648 Acute poliomyelitis - - - - - - - 4 - - - 1 5 Acute polioencephalitis - - - - - - - 1 - - - - 1 Malaria - - - 1 - - - - - - - - 1 Cholera - - - - 1 - - - - - - - 1 Winter Respiratory Diseases (October—March). Notifications of primary pneumonia and acute influenzal-pneumonia. Death certificates in which respiratory diseases mentioned. 1944-45 93 92 1945-46 93 70 1946-47 100 116 1947-48 82 90 1948-49 97 123 46 Infectious Diseases—Day Nurseries. Disease. January. February. March. April. May. June. July. August. September. October. November. December. Total. (a) Children:— Scarlet fever — — 1 1 2 2 — 1 — — — — 7 Chicken-pox 11 — — — .1 13 21 2 — — — — 48 Mumps 5 — 1 - 1 2 1 — — — — 10 German measles — — 2 1 1 — — 3 1 — — — 8 Measles — 6 15 21 4 - - - - - - 18 64 Whooping cough — 1 — — — 8 29 10 5 2 — — 55 Dysentery — 12 - - - - - - - - - - 12 (b) Staff:— Nil 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. i August. September. October. November. December. Total. Chicken-pox 27 41 24 11 28 22 13 — 1 2 16 8 193 Mumps 13 31 65 33 17 47 3 — — 1 9 7 226 German measles 2 1 2 2 3 3 9 — — 1 1 3 27 47 Diphtheria Immunisation. Numbers treated (five years period):— Year. 0—5 5—10 10—15 Over 15 Totals. 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 1948 1,859 106 31 2 1,998 The percentage of the child population considered immunised on the 31st December:— Children under 5 years 64.94% Children between 5 and 15 years 70.98% Vaccination against Small-pox. Number of infants vaccinated at Health Clinics: To 4/7/48—252. From 5/7/48—176. Tuberculosis. No. of Notifications. Pulmonary. N on-pulmonary. Male. Female. Male. Female. Under one year — 1 — — 1 to 4 years 2 2 1 3 5 to 14 years 5 4 1 3 15 to 24 years 20 28 1 — 25 to 34 years 19 15 — 1 35 to 44 years 143 10 2 — 45 to 54 years 13 8 — — 55 to 64 years 8 2 1 1 65 and over 4 — 1 - Totals 85 70 7 8 48 49 No. of Deaths. Pulmonary. Non-pulmonary. Male. Female. Male. Female. Under one year - - - - 1 to 4 years - - - - 5 to 14 years - - - - 15 to 24 years 4 1 - - 25 to 34 years 4 9 - - 35 to 44 years 4 1 1 - 45 to 54 years 5 - 1 - 55 to 64 years 5 1 - - 65 and over 6 - - - Totals 28 12 2 Nil No. admitted to hospitals No. discharged from hospitals or Sanatoria: or Sanatoria: 59 120 During the year 111 cases removed from register. At 31st December 951 names remained on register-—840 pulmonary and 111 non-pulmonary. Of 42 deaths from tuberculosis, 11 not notified during life (26.19%). 50 Bacteriological Service (at Central Public Health Laboratory). Examinations Quarter ending Total for 12 months. made. 31/3/48. 30/6/48. 30/9/48. 31/12/48. Throat and Nose Swabs. Diphtheria 2 - - - 2 Hæmolytic Streptococci 49 84 48 29 210 Vincents angina 4 2 1 - 7 Negative 109 91 94 70 364 Fæces. Shigella 78 29 1 1 109 Salmonella - 3 2 12 17 Protozoa 7 7 - 1 15 Negative 475 83 29 61 648 Sputum. T.B. smear 5 5 4 3 17 Other organisms 5 4 - 1 10 Negative 11 22 7 6 46 Pertussis. Cough plate 1 - - - 1 Post-nasal swab 29 21 32 1 83 Negative 175 119 130 96 520 51 Scabies. Treatment sessions. No. of Oases Reported. Total —132. Numbers affected in Individual Families. 1 person in 17 families. 4 persons in 9 familes. 2 persons in 11 families. 6 persons in 3 families. 3 persons in 13 families. 7 recurrent cases—1 in 1 family, 2 in 1 family, 4 in 1 family. Imperial College Reported. January 27 July 4 February 16 August 10 March 15 September 9 April 7 October 11 May 32 November 7 June 8 December 6 85 47 52 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 of 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. XIVth OLYMPIAD. Whilst it is well known that many of the events were staged at the Wembley Stadium and Empire Pool, it may not be generally known that the holding of these events brought in its train considerable additional duties to the local authority and its officers, and gave rise to a certain amount of anxiety. Several months before the Olympiad was due to take place a code of Medical Arrangements and Accommodation Standards was drawn up and adopted by the Council, and subsequently approved by the Olympiad Medical Committee. This code set out in detail arrangements for Medical Attention, Hospitals (including Isolation Hospitals), Ambulances, Laboratory Services, Disinfection and Disinfestation and Public Cleansing. 53 Standards were prescribed relating to sleeping accommodation, sanitary and washing accommodation, and meals accommodation at hostels and camps; appropriate standards were also prescribed for dressing rooms used by competitors. Three County secondary schools in the Borough were used as hostels for competitors taking part in the Olympic Games, and were occupied by contingents from various parts of the world. At each of the schools, a resident Warden was in charge (the wardens being members of the teaching staff at the schools who acted voluntarily in this capacity), and a general practitioner was nominated to pay routine visits to examine any person reporting sick, and generally to have medical charge of each hostel. A Sanitary Inspector also visited each hostel daily to see that the prescribed sanitary formula was observed, and to advise, where necessary. Special arrangements were made by the Public Cleansing Department for dealing with the removal of refuse and salvage. The secondary schools proved to be very adaptable as hostels as they are provided with ample modern sanitary accommodation, washing facilities including shower baths, gymnasiums, fully equipped kitchens, and dining halls. Rooms were set apart for use as writing rooms, rest rooms and recreation rooms. Classrooms were used as dormitories, and the beds were arranged so that there should be not less than three feet between the beds, and that there should be not less than 55 square feet of floor space per person. A large tented camp was sited at Northwick Park, which was operated by the Y.M.C.A. for the reception of visitors, both from this country and abroad, and provided accommodation for 500 visitors. A sanitary code was drawn up well in advance of the camp being erected, and discussions took place with the Y.M.C.A. authorities with regard to the code and the disposition of necessary sanitary services. This camp site was on land which had previously been used as a golf course, with a slight slope running from N.W. to S.E., the sanitary and ablution accommodation being placed on the S.E. side. Special marquees were provided for these latter purposes and chemical closets which were emptied daily by a contractor were separately screened to give privacy. A dry ditch, the bottom of which was forked over, provided adequate means of disposal for waste water from ablution tents without giving rise to any nuisance. A piped water supply was temporarily laid on from the Colne Valley Water Company's supply. Befuse was collected daily by the Public Cleansing Department. Marquees containing 54 24 beds spaced at well over 3 feet apart were provided for sleeping, whilst separate marquees were also provided for cooking, recreation, writing, etc. A resident Camp Commandant was in charge of the camp during the whole of the time, and very cordial relations were maintained between the Commandant and the Council's officers whose duties brought them into daily contact. The same remarks apply equally to the wardens of the hostels, and the Stadium and Empire Pool authorities. In short, every endeavour was made to cater for the comfort of visitors and to maintain as high a sanitary standard as the circumstances would permit. It is pleasing to be able to record that no untoward incidents arose such, for example, as outbreaks of infectious disease, and it seems reasonable to assume that this freedom from incidents may, in some measure at least, be ascribed to the careful planning before, and the constant watchfulness of all concerned during the occupation of the hostels and camp. 3. WATER SUPPLY. The Colne Valley Water Co. supply with water the major part of the borough and the Rickmansworth and Uxbridge Water Co. supply a very small area in the southern end of the district. These supplies are sampled bacteriologically at frequent intervals at various points 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. Concern has, however, been expressed by the Council on more than one occasion relating to the hardness of the water supplied by the Colne Valley Water Co. This hardness during the war and since has been of the order of 20—22 parts per 100,000, whereas before the war it was in the region of 14 parts per 100,000. Approaches were made to the supply company who have pointed out that whilst the water is softened it has not been possible to reduce the hardness to its pre-war state, for a number of technical reasons. At the present time the Council, together with other local authorities within the same supply area, are pursuing the matter. 4. HOUSING. The housing situation still remains a serious one but is fully appreciated by the Council. During the year under review, however, 307 cases of overcrowding were relieved, of which 248 were provided with accommodation by the Council. At the end of the year overcrowding cases in accordance with the Housing Act standard numbered 602. 1,665 visits were paid by Sanitary Inspectors in connection with investigations into overcrowding. 55 3. FACTORIES ACT, 1937. No material change has taken place in the types of industries in the borough, which were given in some detail in the previous annual report. The particulars relating to inspections and the defects found and remedied are set out in the statistical appendix. Outworkers. 246 visits to outworkers' premises were made during the year. 6. SMOKE ABATEMENT. The position with regard to smoke remained much the same as in the previous year. It cannot be said that atmospheric pollution is heavy in Wembley, by comparison with a good many industrial towns, but nevertheless action by the Public Health Department was from time to time necessary. The managers of industrial establishments are generally quite co-operative in their efforts to overcome smoke emissions but the technical difficulties with which they are sometimes faced have to be appreciated and it is sometimes not possible to effect remedies at a moment's notice; this latter reservation applies more particularly to instances in which alterations or repairs to plant become necessary. 7. BATS AND MICE (DESTRUCTION) ACT, 1919. The Department continued to carry out rodent control on the lines formulated in previous years. A free service was provided to householders in respect of treatment at private dwellinghouses but in all other eases a charge is made, the charge having relation to the amount of labour and materials used. Three Rodent Control Assistants, all of whom have been trained at the Infestation Branch of the Ministry of Food, are employed on this work. Details of work done are given in the statistical appendix. Two maintenance treatments of the sewers were carried out by the Borough Engineer and Surveyor's Department during the year, in accordance with Ministry of Food Circular N.S. 11. 56 STATISTICAL APPENDIX F. Number of complaints received and investigated 3,297 Visits made by Sanitary Inspectors 29,175 (a) Dwelling Houses:— Visits under Public Health Acts 9,375 Visits under Housing Acts 16 Visits re overcrowding 1,665 Visits to bug infested premises 72 Visits re other vermin (excluding rats and mice, see below) 85 Visits re cases of infectious disease 1,035 Visits to cases of food poisoning 34 (b) General Environmental Public Health:- Drains and sewers inspected 2,754 Drain and Sewer Test applied 591 Cesspools, etc. 11 Urinals, latrines, chemical closets 124 Stables, manure pits, etc. 56 Piggeries (number on register at end of year 12) 49 Ditches and streams 174 Open spaces, etc. 268 Yards 2,218 Public conveniences 199 Tents, vans and sheds 134 Factories—Mechanical 955 Non-mechanical 36 Workplaces 277 Outworkers 246 Smoke observations—half hourly 73 „ „ casual 888 „ „ visits to plant 71 Cinemas, Dance Halls, etc. (number on register at end of year 27) 143 Hairdressers (number of establishments on register at end of year 90) 91 Schools (number of private schools 18) 107 Markets 78 Rats and Mice 269 Swimming baths—visits 76 „ „ water examination 10 „ „ chlorine tests 35 Mortuary 13 Olympic Hostels 20 Refuse Tips 27 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) 766 Cowsheds 5 Dairies and milk shops—visits 263 „ „ „ „ milk samples taken 139 „ „ „ „ sediment tests 2 Fried fish shops (number on register at end of year 18) 194 Bakehouses (number on register at end of year 20) 180 Ice cream premises (number on register at end of year 104) 585 Ice cream—samples taken 268 Fishmongers and poulterers (number on register at end of year 26) 498 Greengrocers and fruiterers (number on register at end of year 93) 527 Grocers (number on register at end of year 228) 1,055 Restaurants, cafes, etc. (number on register at end of year 130) 823 Street vendors, hawkers, etc. (number on register at end of year 48) 164 58 Other food premises 60 Water supply—visits 77 „ „ samples taken 39 (d) Other visits and inspections:— Massage establishments, etc. 30 Certificates lodged by Members of the Chartered Society of Physiotherapists 2 New Licences granted 8 Licences renewed 19 Noise nuisances 312 Dust nuisances 78 Effluvia nuisances 38 Petroleum stores 248 Miscellaneous 549 Number of verbal notices served 238 Number of verbal notices complied with 210* Number of written notices served 646 Number of written notices complied with 611* Number of statutory notices served 189 Number of statutory notices complied with 191* * Includes a number of notices served in 1947 and completed in 1948. Legal Proceedings. In 2 cases legal proceedings were instituted for failure to comply with nuisance aibatement 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 1 case awarded the Council costs. Nuisances abated and improvements effected. (a) Dwelling Houses:— Roofs repaired 321 External walls and chimney stacks repaired 139 Gutters and spouts repaired or renewed 221 Damp-proof courses provided 38 Dampness remedied 275 Yards paved or repaired 67 Internal walls and ceilings repaired 569 Doors repaired or renewed 101 Windows repaired or renewed 269 Floors repaired or renewed 157 59 Sub floor vent. provided or improved 7.1 Rooms cleansed or redecorated 453 Passages and staircases redecorated 76 Staircases repaired 35 Fireplaces and flues repaired or renewed 119 Cooking stoves repaired or renewed 20 Wash coppers repaired or renewed 1 Sinks and washbasins provided or renewed 75 Waste pipes repaired or renewed 69 Food stores, provided or improved 6 Dustbins provided or renewed 367 Water supply improved or reinstated 118 W.C. walls, etc., cleansed 37 W.C. pans cleansed 21 W.C. pans repaired or renewed 69 W.C. structures repaired or renewed 25 W.C. lighting and ventilation improved 6 W.C. flush pipe joints repaired 57 Additional W.C's. provided 19 W.C. cistern repaired 1 (b) General Environmental Public Health:— Drains cleansed from obstruction 781 Drains repaired, or renewed 143 New drains provided 30 New inspection chambers provided 27 Inspection chambers repaired 76 Soil pipes and vent, shafts repaired 42 W.C's. repaired 16 W.C's. cleansed 24 Urinals and latrines cleansed or emptied 22 „ „ „ additional ones provided 1 Stables, manure pits, cleansed 8 „ „ „ repaired or renewed 3 Piggeries cleansed or limewashed 6 Pigsties repaired 1 Animals nuisances abated 12 Offensive accumulations removed 53 Ditches and streams cleansed 5 „ „ „ pollution remedied 7 Yards cleansed or repaired 57 Tents, vans and sheds—nuisances abated 62 Smoke nuisances abated 1 Improvements in boiler plant or fuel effected 5 Cinemas, Dance Halls, etc.—contraventions remedied 6 Hairdressers—contraventions remedied 6 60 Markets—contraventions remedied 2 Schools—sanitary conditions improved 8 „ urinals and W.C's. cleansed or repaired 7 „ additional W.C's. or urinals provided 5 Noise nuisances abated 2 Effluvia nuisances abated 1 Water tanks covered .1 (c) Eradication of bed bugs:— (i) Number of Council houses:— Found to be infested and subsequently disinfested 19 (ii) Number of other houses:— Found to be infested and subsequently disinfested 25 (i) by hydrogen cyanide - (ii) by sulphur - (iii) by liquid insecticides 25 Other vermin eradicated 26 Verminous articles destroyed 4 (d) Meat and other Food Premises:— Meat shops, stalls, etc.—premises cleansed 53 „ „ „ „ other contraventions remedied 18 Dairies—cleansed and limewashed 9 „ premises repaired 3 „ other contraventions remedied 2 Bakehouses cleansed and limewashed 28 „ sanitary conditions improved 7 „ other contraventions remedied 6 Ice cream premises cleansed and limewashed 23 „ „ „ sanitary conditions improved 5 Fried fish shops cleansed and limewashed 12 „ „ „ sanitary conditions improved 5 „ „ „ other contraventions remedied 5 Fishmongers, etc., contraventions remedied 41 Grocers, etc., contraventions remedied 59 Greengrocers, etc., contraventions remedied 37 Restaurants, Cafes, etc., contraventions remedied 71 Street hawkers, contraventions remedied 5 Other food premises, contraventions remedied 1 5,686 61 (e) Unsound food surrendered:— Fish: 52 jars and 107 tins Herrings. 123 tins Hake, Cod, Snoek, Whiting. 209 tins Pilchards. 188 tins Sardines. 21 tins Crab, Lobster. 279 tins Salmon. 7 tins Shell Fish. 20 tins Miscellaneous Fish. 44 tins Fish Roes and 17 jars. 239 tins Mussels. 1 jar and 8 tins Anchovies. 88½ stone Round Fish (Cod, Hake, etc.). 241 stone Fillets and Smoked, Fish. 125 stone Flat Fish. 3½ stone Herrings. 32¼ stone Kippers. Meat: 1,622 lbs. Beef. 95 lbs. Mutton. 49 lbs. Liver, Kidneys. 1,051 lbs. Rabbits. 117 Rabbits. 12 lbs. Pork. 2 Ducks. 38½ lbs. Bacon. 67 lbs. Sausages. 12 Fowls. 72 Meat Pies. 142 tins Luncheon Meat, Tongue, Brawn, etc. 31 tins Stewed Steak. 46 tins Bacon. 4 tins Meat and Vegetables. 8 tins Sausages. 8 tins Chickens, Rabbits, etc. 13—2 lb. tins Corned Mutton. 17—6 lb. tins Corned Mutton. 662—12 oz. tins Corned Beef. 494— 6 lb. tins Corned Beef. Fruit and Vegetables: 508 tins various Fruits. 39 bottles various Fruits. 26 tins Fruit Salads. 62 75 tins Fruit Juices. 7 lbs. Apples. 66 lbs. Lemons. 79 lbs. Prunes. 200 lbs. Oranges. 96 cases Grapefruit. 31½ lbs. Dates. 248 lbs. Dried Peas. 865 tins Vegetables 37 tins Spaghetti. 14 bottles Cabbage. 12 tins Hors D'Œuvres. 14 tins and 34 bottles Gherkins. Milk: 868 tins Evaporated Milk. 396 tins Full Cream Milk. 30 tins Condensed Milk. 157 tins Skimmed Milk. 3 tins Household Milk. 12 quarts Liquid Milk. 2 cwts. Milk Powder. Miscellaneous: 99 tins and 6 jars Jams. 7 tins Lemon Curd. 178 tins and 2 jars Marmalade. 15 tins Syrup. 45 tins Grapefruit Marmalade. 9 tins Miscellaneous, Apple Jelly, etc. 932 jars Piccalilli. 2 tins Olives. 185 jars Pickles. 390 jars Ketchups and Sauces. 11 bottles Vinegar. 11—1 gallon tins Tomato Puree. 14 lbs. Gravy Browning. 40 tins Meat Paste. 120 jars Fish Paste. 2 tins Sandwich Spread. 269 tins Soup. 17 lbs. Biscuits. 135 lbs. Cake. 100 Bread Rolls. 36 Sausage Rolls. 180 Mars Bars. 69 packets Semolina. 7 lbs. Chocolate Spread. 63 20 lbs. Marzipan. 45 lbs. Cereals. 18 tins Puddings. 127 packets Sponge Mixtures, Puddings, etc. 90 lbs. Tea. 120 lbs. Cheese. 109 boxes Cheese. 11 lbs. Butter. 7 lbs. Margarine. 49 lbs. Sugar. 118 lbs. Dried Eggs. 1,867 Shell Eggs. 72 lbs. Flour. 116 bottles Gravy Salt. 14 bottles Flavouring. 21 lbs. Almonds. 28 lbs. Cream of Tartar. 3 tins Mustard. 80 bottles Coffee Essence. 13 jars Marmite. 4 bottles Cordials. 3 lbs. Cocoa. 14 lbs. Salt. 1 jar Ginger. Inspection of dwelling-houses during the year:— (a) (i) Total number of dwelling - houses inspected for housing defects (under Public Health or Housing Acts) 4,422 (ii) Number of inspections made for the purpose 11,213 (b) (i) Number of dwelling-houses (included under sub-head (1) above) which were inspected and recorded under the Housing Consolidated Regulations, 1925/1932 2 (ii) Number of inspections made for the purpose 7 (c) Number of dwelling-houses found not to be in all respects reasonably fit for human habitation 2,194 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 2,329 64 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 None (ii) Number of dwelling-houses which were rendered fit after service of formal notices:— (1) by owners) (2) by Local Authority in default of None owners (b) Proceedings under Public Health Acts:— (i) Number of dwelling-houses in respect of which notices were served requiring defects to be remedied 177 (ii) Number of dwelling-houses in which defects were remedied after service of formal notices:— (1) by owners 110* (2) by Local Authority in default of owners 63† * Includes compliance in 1948 with 45 notices served in 1947. † Includes compliance in 1948 with 12 notices served in 1947. (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 None (ii) Number of dwelling-houses demolished in pursuance of Demoiition Orders 65 (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 None (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 26 (b) Number of dwellings recorded as overcrowded at the end of the year 602 Number of families dwelling therein 704 Number of persons dwelling therein 2,998 (c) Number of new eases of overcrowding ported during the year 446 (d) (i) Number of cases of overcrowding relieved during the year Total 307 (1) by removals of sub-tenants/lodgers, members of family 32 (2) by removal of families to other known addresses (not overcrowded) 253 (3) by removal to unknown addresses 22 (4) rehoused by Council (included also in (2) above):— In requisitioned premises 25 In Council houses 206 In temporary bungalows 17 (ii) Number of persons concerned in such cases 1,654 (e) Particulars of any cases in which dwellinghouses have again become overcrowded after the Local Authority have taken steps for the abatement of overcrowding 3 66 Factories. Number of factory premises — 509. Number of:— Premises. Inspections. Written Notices. Occupiers Prosecuted. *Factories with mech. power 1,128 12 - Factories without mech. power 43 - - Other premises 5 - - Totals 1,176 12 - *Includes 160 inspections of bakehouses with mech. power. Defects found. No. of defects:— Particulars. Found. Remedied. Referred by H.M. Inspector. Prosecutions. Want of cleanliness 5 7 2 - Overcrowding - - - - Unreasonable temperature - - - - Inadequate ventilation 1 1 - - Ineffective drainage of floors - - - - Sanitary Convenience:— Insufficient 5 5 1 - Unsuitable or defective 25 25 3 - Not separate for the sexes 1 2 1 - Other offences 18 20 - - Totals 55 60 7 - Outworkers. Number on register at end of year ...... ...... 168 Nature of work:— Making, repairing of:— Wearing apparel ...... ...... 125 Household linen ...... ...... 7 Umbrellas ...... ...... 1 Cardboard boxes ...... 5 Carding of buttons ...... ..... 7 Toys ...... ...... 9 67 Lace ...... ...... 4 Curtains, etc. ...... ...... 3 Furniture and upholstery ...... ...... 2 Brass articles ...... ...... 1 Feather sorting ...... ...... 2 Christmas cards, crackers ...... ...... 2 Offloes. Number on the register — 301. Defects. Found. Remedied. Want of cleanliness ...... ...... 1 1 Want of ventilation ...... ...... - - Overcrowding ...... ...... 1 2 Sanitary accommodation:— Insufficient ...... ...... 1 8 Unsuitable or defective ...... ...... 5 2 Not separate sexes ...... ...... ...... ...... Obnoxious effluvia ...... ...... — — Other nuisances ...... ...... — — Totals ...... ...... 8 8 Disinfection of Premises and Articles. Disinfections for:— Infectious diseases ...... ...... 459 Cancer ...... ...... 27 Vermin (routine protection from) ...... ...... 32 Miscellaneous ...... ...... 40 Articles disinfected or destroyed-;— Disinfected. Destroyed. Bedding and bedclothing 2,364 45 Wearing apparel 53 12 Carpets, rugs, cushions 52 Nil Others 14 Nil Rats and Mice (Destruction) Act, 1919. Work carried out during the year:— (1) Number of premises visited 1,898 (2) Number of visits by Sanitary Inspectors 211 68 (3) Number of visits by Rodent Control Assistants 9,823 (4) Number of premises found to be infested 721 (5) Number of premises which received treatment by Rodent Control Assistants 716 (6) Number of premises satisfactorily treated privately 41 (7) Number of Council premises (included in (5)) 37 Milk (Special Designations) Orders. Licences issued. Dealers. Supplementary. To Bottle. To Pasteurise. Tuberculin tested 15 9 1 - Accredited - - - - Pasteurised 27 10 - 1 Samples of designated milk taken. No. of samples taken. No. not satisfactory Pasteurised 69 - Tuberculin tested 13 2 T.T. (Pasteurised) 21 1 103 3 Laboratory Examinations re Food, Milk and Water. Examinations made. Quarter ending Total for 12 months 31.3.48 30.6.48 30.9.48 31.12.48 Water 12 11 16 10 49 Milk 24 39 38 38 139 Food 2 4 6 1 13 Ice Cream 36 90 92 50 268 Chemical tests for chlorine content of Swimming Pool water made by inspectors, 35. 69 CHAPTER VII. ADMINISTRATION, STAFF, SUMMARY. 1. The tremendous spate of social legislation which became operative in the year has changed the scope of local government more perhaps than in any period of the past. The Health Department was affected more in this re-arrangement than other departments of the Council. The National Health Service Act of 1946, the National Assistance Act of 1948, and the Children Act of 1948, removed from the Council of the Borough and its Health Department very many duties which had been so thoroughly performed in the past. Most of the functions became the responsibility of the Middlesex County Council, the new Local Health Authority on the 5th July, and indeed all the property and all the staff relating to certain parts of the health service were on this day transferred to the County Council. So far as possible the preceding report has recorded the work performed by the department during twelve difficult months and it may well be the final year in which the Annual Report of the Medical Officer of Health takes its present form. 2. The Area Health Administration proposed by the County Council combined the County Districts of Wembley and Willesden to form Area No. 6 and whilst there has been little time to assess the advantages which might accrue from the alteration one can at least say that the services available to the public have been maintained at a level which, in all the circumstances, must reflect credit on all workers in this field of social endeavour. 3. During the year, and from many causes, staff, particularly professional staff, have been very difficult to obtain, and one hopes the inducements to enter the health services of local authorities will become more stabilised and sufficiently attractive to enlist the finest quality of personnel. 4. Finally, I should be failing in my duty if I did not express my most sincere thanks to all members of the department who have worked unremittingly to ensure smooth and effective operation during the period of transfer and for their constant application and loyalty during a very anxious time. I have the honour to be, Mr. Mayor, Ladies and Gentlemen, Your obedient servant, E. GRUNDY, Medical Officer of Health. HENDON PRINTING WORKS LIMITED, 44, VICTORIA ROAD, LONDON, N.W. 4 (14418)