AC 439(1) WEMBLEY WEM 30 borough of wembley REPORT OF THE medical officer of health for the year 1949 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 1949 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 1949 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 1949. This Report has been compiled in the following five chapters, four 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—14, Statistical Appendix B, Page 15. „ III INFECTIOUS DISEASES, Pages 16 — 17, Statistical Appendix C, Pages 18 — 25. „ IV ENVIRONMENTAL HYGIENE, FOOD AND WATER, HOUSING, FACTORIES, ETC., Pages 26—34, Statistical Appendix D, Pages 35—47. „ V ADMINISTRATION OF THE DEPARTMENT, STAFF AND SUMMARY, Pages 48—49. 3 CHAPTER I. VITAL STATISTICS. 1. The population of the Borough mid-1949 was estimated by the Registrar-General to be 132,240—Civilian, 132,340—Total. 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, 1949, estimate of the Registrar-General is that the population is 132,720. Wembley is the fifth largest County district in Middlesex, those of greater population being according to size—Harrow, Ealing, Willesden and Hendon. 2. In 1949, 1,655 live births were recorded, giving a birth rate of 12.52 per thousand. The number of deaths was 1,075 giving a crude death rate of 8.14 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 21.75, the previously lowest figure having been 21.97 in 1948. 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, 1949 from figures supplied by Registrar-General. (Some comparative 1948 figures within brackets.) Population. Civilian 132,240 Total 132,340 Live Births. Male. Female. Total. Live birth rate per 1,000 estimated population 12.52 Legitimate 840 764 1,604 (1,764) illegitimate 30 21 51 (57) (13.83) Stillbirths. Legitimate 16 21 37 (40) Rate per 1,0(0 total (live and still) births 23.02 (21.49) Stillbirth rate per .1,000 estimated population 0.29 (0.30) Illegitimate 1 1 2 (-) Deaths 534 541 1,075 (1,042) Death rate per 1,000 estimated population — Crude rate 8.14 (7.92) Adjusted by Area Comparability Factor of Registrar General (1.17) Standardised Rate 9.52 Infantile Mortality. Deaths of infants under one year of age:— Male. Female. Total. Legitimate 23 13 36 (39) 36 (40) Illegitimate — — (1) Death rate of infants under one year of age:- All infants per 1,000 live births 21.75 (21.97) Legitimate infants per 1,000 legitimate live-births 22.44 (22.11) Illegitimate infants per 1,000 live illegitimate births — (17.54) 5 Deaths from: Cancer (all ages) 175 (237) Measles (all ages) - (-) Whooping Cough (all ages) - (3) Diarrhoea (under 2 years) 1 (2) Maternal Mortality. Deaths from puerperal sepsis - (1) Other puerperal causes 1 (1) Maternal mortality rate per 1,000 live births 0.60 (1.09) Maternal mortality rate per 1,000 total (live and still) births 0.59 (1.07) 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 12.52 0.29 8.14 21.75 0.60 0.59 England and Wales 16.70 0.39 11.70 32.00 - 0.98 London 18.50 0.37 12.20 29.00 - - 126 County Boroughs, etc. i. 18.70 0.47 12.50 37.00 - - 148 Smaller towns, etc ;. 18.00 0.40 11.60 30.00 - - 6 Causes of Deaths during the Year. 1948. Total. Causes of Death. Male. Female. 1949. Total. 1,042 All causes 534 541 1,075 1 Typhoid and para-typhoid fevers - - - - Oerebro-spinal fever 1 - 1 - Scarlet fever - - - 3 Whooping cough - - - - Diphtheria - - - 39 Tuberculosis of respiratory system 18 17 35 6 Other forms of tuberculosis 1 2 3 3 Syphilitic diseases 4 3 7 4 Influenza 5 3 8 - Measles - - - 1 Ac: polio-myel: and polio-enceph: - 1 1 - Acute infectious enceph: - - - 5 Cancer of buc: cav: and cesoph:(M) 3 - 3 15 „ uterus (F) - 4 4 27 Cancer of stomach and duodenum 18 15 33 37 Cancer of breast - 29 29 153 Cancer of all other sites 58 48 106 9 Diabetes 5 8 13 113 Intra-cranial vascular lesions 45 70 115 271 Heart disease 178 153 331 38 Other dis: of circ: system 19 42 61 54 Bronchitis 32 36 68 36 Pneumonia 22 20 42 16 Other respiratory diseases 13 12 25 13 Ulcer of stomach or duodenum 9 2 11 2 Diarrhœa under two years 1 - 1 3 Appendicitis 2 5 7 33 Other digestive diseases 11 6 17 22 Nephritis 10 8 18 1 Puerperal and post-abort: sepsis - - - 1 Other maternal causes - 1 1 9 Premature birth 6 3 9 26 Congenital malf: birth injury and infant diseases 15 7 22 15 Suicide 7 3 10 9 Road traffic accidents 5 3 8 15 Other violent causes 4 9 13 62 All other causes 42 31 73 7 The Principal Causes of Death. Disease. Total Number of deaths. 1. Heart disease and other diseases of circulatory system 331 Intra-cranial vascular lesions 115 446 2. Cancer 175 3. Respiratory diseases:— (a) Bronchitis 68 (b) Pneumonia 42 (c) Other respiratory diseases 25 135 4. Tuberculosis:— (a) Respiratory system 35 (b) Other forms 3 38 5. Digestive Diseases:— (a) Appendicitis 7 (b) Other digestive diseases 17 (c) Ulcer 11 35 6. Violent deaths:— (a) Suicide 10 (b) Road traffic 8 (c) Other violent causes 13 31 7. Premature births 9 Congenital malf: birth injury and infant diseases 22 31 8 Percentage Percentage of Percentage of of deaths total deaths total deaths taking place under 1 year. under 50 years. in hospitals. 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 1949 3.53 18.49 33.18 SOME OTHER ESSENTIAL LOCAL STATISTICS. Birth Notifications (as supplied by Area Medical Officer). Notified by. At home. In Hospital. In Nursing Home. Totals. Doctors 31 652 246 929 Midwives 368 398 10 776 Parents 3 - - 3 Totals 402 1,050 256 1,708 Percentages 23.5 61.5 15.0 100 Live births -1,680. Still births -28. 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 Total deaths under 1 year Prematurity 7 1 - - 8 1 - - - 9 Congenital defects 2 - 1 - 3 1 2 1 - 7 Broncho pneumonia - - - - - 1 - 3 - 4 Atelectasis 7 - - - 7 - - - - 7 Gastro-enteritis - - - - - - 1 - - 1 Birth injuries 4 - - - 4 - - - - 4 Diseases of the new Born 2 - - - 2 - - - - 2 Accidental death - - - 1 1 - - - - 1 Vascular disease - - - - - - 1 - - 1 22 1 1 1 25 3 4 4 - 36 Infantile Mortality, 1945-1949. year. Wembley. England & Wales. 1945 36.75 46 1946 26.37 43 1947 23.26 41 1948 21.97 34 1949 21.75 32 Infantile mortality during last five years (9,924 live births, 254 deaths under one year): 25.59. 10 Maternal Mortality. Rate per 1,000 total births (live and still), 1945-1949:- Year. Wembley. England & Wales. 1945 1.08 1.79 1946 0.45 1.43 1947 1.30 1.17 1948 1.07 1.02 1949 0.59 0.98 Maternal mortality during last five years (10,123 total births -9 maternal deaths): 0.89. 11 CHAPTER II. GENERAL HEALTH SERVICES. 1. HOSPITALS. The whole of Wembley lies within the area of the North West Metropolitan Regional Hospital Board but hospitals accepting the sick are administered by two Hospital Management Committees, the Central Middlesex Group Hospital Management Committee and the Hendon Group Hospital Management Committee, the two major general hospitals being the Central Middlesex Hospital and the Edgware General Hospital. The Wembley Hospital also accepts general cases but is under the control of the Governors of Charing Cross Hospital. Maternity cases from certain parts of the borough can be admitted additionally to the Kingsbury Maternity Hospital and bookings are undertaken through the Obstetric Out-Patients' Deparment of the Central Middlesex Hospital. Infectious diseases are normally accepted at the Neasden Hospital or, in case of necessity, at the Hendon Isolation Hospital. Cases of mental deficiency and mental disease are catered for at Shenley and Napsbury Hospitals and arrangements for the admission of tuberculous patients made to a variety of hospitals through the three Chest Clinics serving the area. A list of hospitals is included:- Central Middlesex Hospital, Acton Lane, N.W.10. (ELGar 5733.) Edgware General Hospital, Edgware, Middlesex. (EDGware 8181.) Wembley Hospital, Fairview Avenue, Wembley, Middlesex. (WEMbley 3136.) Kingsbury Maternity Hospital, Honeypot Lane, Kingsbury, N.W.9. (COLindale 6309.) Neasden Hospital, Brentfield Road, Neasden, N.W.10. (WILlesden 2117.) Hendon Isolation Hospital, Goldsmith Avenue, Hendon, N.W.9. (COLindale 8182.) Willesden Chest Clinic, Pound Lane, Willesden, N.W.10. (WILlesden 6254.) Harrow Chest Clinic, 53, Greenhill Crescent, Harrow, Middlesex. (HARrow 1075.) Edgware Chest Clinic, Edgware General Hospital, Edgware, Middlesex. (EDGware 3406.) 12 2. AMBULANCE SERVICE. A service of ambulances and sitting case cars is maintained by the Middlesex County Council as Local Health Authority, whose depots are:- Fire Station, Harrow Road, Wembley. (ARNold 2222 or WEMbley 2222.) Fire Station, The Mall, Kingsbury, N.W.9. (ARNold 2222 or WEMbley 2222.) The authority of a medical practitioner is required for service to be given, except in emergency and accident cases. 3. HEALTH SERVICES. Health Services under Part 111 of the National Health Service Act, 1946, are provided by the Comity Council and relevant details in so far as they apply to the borough are included below:- County Medical Officer: A. C. T. Perkins, M.C., M.D., D.P.H., 3, 5 & 7, Old Queen Street, S.W.I. Telephone: TRAfalgar 7799. Area Medical Officer—Area No. 6—Wembley: E. Grundy, M.D., M.R.C.S., D.P.H., Town Hall, Wembley. Telephone: ARNold 1212. Clinics for Child Health: College Road, Wembley. Telephone No.: ARNold 1336. St. Andrew's Church Hall, Ealing Road, Wembley. Telephone No.: WEMbley 3787. Monks Park, Wembley. Telephone No.: WEMbley 4842. One Tree Hill, Bridgewater Road, Alperton. Telephone No.: WEMbley 2435. Perrin Road, Sudbury, Wembley (Orthodontic). Telephone No.: ARNold 2500. Perrin Road, Sudbury, Wembley. Telephone No.: ARNold 6164. Kingsbury Free Church, Slough Lane, Kingsbury, N.W.9. Telephone No.: COLindale 4315. 245, Stag Lane, Kingsbury, N.W.9. Telephone No.: COLindale 6680. 245, Stag Lane, Kingsbury, N.W.9 (Dental). Telephone No.: COLindale 8729. Adjoining County Library, Stag Lane, Kingsbury, N.W.9. Telephone No.: COLindale 6343. 13 Day Nurseries. Carlyon Road, Alperton, Wembley. Telephone No.: PERivale 1990. 55, Ealing Road, Wembley. Telephone No.: WEMbley 3418. 129/131, Harrowdene Road, Wembley. Telephone No.: ARNold 2548. 34, Neeld Crescent, Wembley. Telephone No.: WEMbley 3471. " Ashley House," Old Kenton Lane, Kingsbury, N.W.9. Telephone No.: COLindale 5605. Princes Avenue, Kingsbury, N.W.9. Telephone No.: COLindale 4456. Vale Farm, Watford Road, Sudbury, Wembley. Telephone No.: ARNold 3162. Woodstock Road, Alperton, Wembley. Telephone No.: WEMbley 4799. Domestic Help. Provided on medical certificate in cases of sickness or maternity by application to the Area Office: Town Hall, Wembley. Immunisation and Vaccination. By application to National Health Service practitioners who have entered the Scheme, or by arrangement with the Area Medical Officer: Town Hall, Wembley. Telephone No.: ARNold 1212. Midwifery and Home Nursing. District Nurses' Homes. Wembley: Superintendent Nurse—80, Wembley Park Drive, Wembley. Telephone No.: WEMbley 4913. Kingsbury: Superintendent Nurse—1, Mersham Drive, Kingsbury, N.W.9. Telephone No.: COLindale 6445. School Health Service. Clinics at all the Child Health Clinics. 4. VERMINOUS CONDITIONS. Only 3 eases, 1 adult and 2 school children 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. 14 STATISTICAL APPENDIX B. Mortuary. No. of bodies deposited 118 No. of post-mortem examinations carried out 116 No. of Coroner's inquests held 29 Bodies were deposited by order:- Coroner 93 By Police 17 Wembley Hospital 7 By Undertakers 1 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 4 Renewals 19 15 CHAPTER 111. 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 or Neasden Hospital, re puerperal pyrexia and ophthalmia neonatorum, Emergency Bed Service, re poliomyelitis at Royal National Orthopaedic Hospital, re smallpox at Joyce G-reen Hospital, Dartford — Notification of tuberculosis—Compilation of tuberculosis register—Weekly and quarterly returns to Ministry of Health and County Medical Officer—Authentication of travellers' inoculation state—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-toxin available, diphtheria. 2. SMALLPOX. During the year we were unfortunate enough to have one case of Smallpox in the area, which was of the virulent Eastern type, and resulted in a very rapid death of the sufferer. It is of interest to record that the patient (an Australian lady) was in contact with Smallpox at sea round about the 24th March and landed in England from the S.S. Mooltan on the 3rd April. She was vaccinated before leaving the ship but, unfortunately, too long after the moment of contact with the virus to be of any avail. On landing in this country she was notified to the Department by the Port Health Authority, London, and placed under surveillance for a period of fourteen days. Naturally, her movements during this time were uncontrolled and before developing the disease she was in direct and indirect contact with many hundreds of persons in Wembley and in London. When the first evidence of illness became apparent it was thought that she could be suffering from the results of vaccinia and, indeed, this opinion persisted for some twenty-four hours, but an increase in the severity of her symptoms suggested that further precautions must be taken and the Smallpox consultant of the Regional Hospital Board was called to see the case, A diagnosis of Smallpox in its very early stages was made and within three hours the patient removed to isolation hospital where, I understand, she died before the typical focal rash had appeared. Scientific investigation of the condition was undertaken before removal and the Smallpox virus was cultured on the developing membranes of an incubated egg. Needless to say the notification necessitated the vaccination of many hundreds of contacts and their surveillance for the appropriate period, but one is happy to record that no secondary cases occurred as a result of contact with this individual patient, 16 3. FOOD POISONING. Fifteen cases of food poisoning were notified during the period under review and it seems pertinent to remark that this malady appears to be increasing in recent years, perhaps on account of communal feeding and possibly due to shortages of foods which are retained to form the basis of meals when perhaps it would be more prudent to discard them. Intimate association with the Central Public Health Laboratory at Colindale has been retained, resulting in the discovery of the mode of infection in several cases. An instance of an outbreak may be quoted which demonstrates clearly that such an occurrence may happen even if precautions are taken which would appear on the surface to be quite adequate and the outbreak also demonstrates that many cases of a minor character may occur without notification ever reaching the Health Department. The particular outbreak to be described occurred in one of the County Schools, where kitchen arrangements and facilities are perhaps better than the general average. On the 15th September a meal of stewed steak was served at midday in the school and during that evening and the succeeding night, of the 333 consumers at risk tfo fewer than 316 had suffered from diarrhoea and vomiting in varying degrees of severity. The majority had recovered sufficiently by the next morning to return to school and, on hearing of the outbreak from the Headmaster, immediate steps were taken to avoid any action in the kitchen or in the school dining room which might result in the consumption of any further infected material. On investigation it was found that the most likely source of the outbreak was from the stewed steak which had been cooked on the day preceding the 15th and left over night to cool from about 3 p.m. until the next morning. On the day of the outbreak this dish was warmed through and served and it is more than likely to have been the responsible food substance. It cannot be too strongly urged that any foodstuff which is capable of supporting bacterial growth should be cooked and eaten on the same day to avoid very serious risk. Other minor incidental infections were investigated but the one enumerated appears to be worthy of record in this report. As required by Ministry of Health Circular 2/50 I include in the statistical appendix a tabulated report of the outbreaks of food poisoning occurring during the year. 4. A circumscribed outbreak of acute Poliomyelitis occurred in the Borough during the year, when 11 cases in all were notified, Seven were non-paralytic and only two cases required prolonged hospital treatment. 5. The supervision of contacts landing from ship or aeroplane called for routine surveillance of 11 persons regarding smallpox and 6 persons regarding typhoid fever. Constant vigilance must be given to persons arriving from infected foreign areas and this supervision must be given with discretion and understanding. 17 18 STATISTICAL APPENDIX C. Cases of infectious disease 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 237 22 8 19 20 30 35 29 19 2 27 9 17 143 60.34 Diphtheria 1 - - - - - - - - - - - 1 1 100.00 Pneumonia 139 38 6 10 11 18 10 6 11 5 10 2 12 20 14.39 Erysipelas 26 1 3 3 1 1 2 1 4 1 - 4 5 7 26.92 Ophthalmia neonatorum Nil - - - - - - - - - - - - - - Cerebro-spinal fever 3 - - - - 2 - - - - 1 - - 3 100.00 Dysentery 5 - - 1 3 - - 1 - - - - - 3 60.00 Measles 1,146 240 50 96 137 105 64 93 134 34 79 44 70 17 1.68 Whooping cough 252 36 6 20 31 24 6 33 29 8 36 6 17 11 4.37 Acute poliomyelitis 11 - - 1 6 2 - - 1 - - - 1 10 90.91 Acute polioencephalitis 2 - 1 - 1 - - - - - - - - 2 100.00 Smallpox 1 - - - - - - - - - - 1 - 1 100.00 Paratyphoid fever 1 - - - 1 - - - - - - - - 1 100.00 Food Poisoning 15 5 1 - 3 1 - 1 - - 4 - - - 00.00 *Puerperal Pvrexia 1 - - - - - 1 - - - - - - 1 100.00 * Kingsbury Maternity Hospital case—Willesden Resident. 19 Notifications of Selected infectious Diseases according to sex and age as finally diagnosed. Age group. Scarlet fever Whooping cough. theria. Measles. Acute poliomye litis. Acute polioencepha_ litis. Age group. Dysentery. Acute pneumonia. Erysipelas. Cerebrospinal fever. Paraty Dhoid. fever. typhoid fever. Smallpox. Food Poisoning. M. . F. M. F. M. F. M. I. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. 0 - - 7 7 - - 9 14 - - - - 0 1 - 7 4 - - - - - - - - - - 2 3 1 10 6 33 36 - - 135 126 3 1 - - 5 - - 3 6 - - 1 1 - - - - - - 1 1 3 23 30 31 35 - - 170 170 - - - - 15 2 1 28 22 2 4 1 - 1 - - - - 1 1 2 5 72 67 48 48 - - 234 255 2 1 2 - 45 - - 29 24 5 9 - - - - - - - - - 5 10 12 10 1 2 - - 4 8 1 - - - 65 & over - 1 5 11 4 2 - - - - - - - - - - 15 3 - - 1 - - 4 9 1 1 - - Unstated - - - - - - - - - - 1 - - - - - 25 & over 2 2 1 2 - 1 3 5 1 - - - All ages 122 115 121 131 - 1 559 587 8 3 2 - All ages 3 2 72 67 11 15 2 1 1 - 1 - - 1 4 11 Monthly incidence of the Infectious Diseases. Disease. January. February. March. April. May. June. July. August. September October. November. December. Total. Scarlet fever 15 29 25 12 15 16 20 14 6 21 32 32 237 Diphtheria - - 1 - - - - - - - - - 1 Pneumonia 10 27 26 9 12 9 6 5 5 7 12 11 139 Ervsipelas - 2 1 3 2 1 - 1 4 3 5 4 26 Cerebro-spinal fever - - 1 1 1 - - - - - - - 3 Dysentery - - - - 3 - - 1 1 - - - 5 Measles 102 175 296 254 121 92 44 21 5 19 17 - 1146 Whooping cough 25 26 39 42 24 21 23 23 18 5 4 2 252 Acute poliomyelitis - - 1 - - - 1 2 3 - 2 2 11 Acute polioencephalitis - - - - - - - - - - 1 1 2 Smallpox - - - 1 - - - - - - - - 1 Winter Respiratory Diseases (October—March). Notifications of primary pneumonia and acute influenzal-pneumonia. Death certificates in which respiratory diseases mentioned. 1945-46 93 70 1946-47 100 116 1947-48 82 90 1948-49 97 123 1949-50 77 76 20 Infectious Diseases-Day Nurseries. Disease. January. February. March. April. May. June. July. August. September October. November. December. Total. (a) Children:- Scarlet fever - 3 - 2 - - - 1 - 1 - 1 8 Chicken-pox 1 - - - - 1 - - - 2 - - 4 Mumps - - - - - 2 - 2 - 1 - - 5 German measles - - 4 1 - - 2 - - - - 1 8 Measles 11 22 19 17 - 1 3 1 - - - - 74 Whooping cough 2 - - - 1 1 - - - - - - 4 Dysentry - - - - 1 - - - - - - - 1 Infective Hepatitis - - - - - - 1 - - - - - 1 (b) Staff Infective Hepatitis - - - - - - 1 - - - - - 1 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 63 36 18 29 11 7 36 - 4 6 2 4 : 216 Mumps 8 8 28 8 10 22 32 - 5 2 8 7 138 German measles 1 4 27 15 11 21 8 - - - 1 2 90 21 Tuberculosis. No. of Notifications. Pulmonary. Non-pulmonary. Male. Female. Male. Female. Under one year - - - 1 1 to 4 years - 2 - 1 5 to 1-4 years 11 3 1 1 15 to 24 years 12 17 2 - 25 to 34 years 15 21 - - 35 to 44 years 8 10 1 2 45 to 54 years 10 1 - - 55 to 64 years 11 4 - - 65 and over 2 1 - - Totals 69 59 4 5 22 No. of Deaths. Pulmonary. Non-pulmonary. Male. Female. Male. Female Under one year - - - - 1 to 4 years - - 1 1 5 to 14 years - - - - 15 to 24 years 1 4 - 1 25 to 34 years 5 5 - - 35 to 44 years 7 4 - - 45 to 54 years 3 3 - - 55 to 64 years 8 3 - - 65 and over 4 1 - - Totals 28 20 1 2 No. admitted to hospitals or Sanatoria: 43 No, discharged from hospitals or Sanatoria: 91 During the year 212 cases removed from register. At 31 st December 920 names remained on register—826 pulmonary and 94 non-pulmonary. Of 51 deaths from tuberculosis, 8 not notified during life (15.69%). Food Poisoning Outbreaks. Total Organisms or number of Number of Number of other agents Food outbreaks. cases. deaths, responsible. involved. 1 316 Nil * Stewed steak. The anaerobic spore-bearing bacillus isolated from the meat suspected of causing food-poisoning has proved to be a very heat resistant strain of CI. weJchii. Of the usual toxins traces of Type A only are produced. 23 Bacteriological Service (at Central Public Health Laboratory). Examinations made. Quarter ending Total for 12 months. 31/3/49. 30/6/49. 30/9/49. 31/12/49. Throat and Nose Swabs. Diphtheria - - 3 - 3 Hemolytic Streptococci 58 39 (nonvirulent) 43 30 170 Vincents angina 3 3 1 7 14 Negative 143 101 164 87 495 Fæces. Shigella 1 1 - 1 3 Salmonella - 4 5 3 12 Protozoa 1 6 - 1 8 Negative 32 39 47 28 146 Sputum. T.B. smear 1 1 - 1 3 Other organisms - 4 1 5 10 A D Negative 17 11 7 • 13 48 Pertussis. Cough plate - - 9 - 9 Post-nasal swab 8 16 49 1 74 Negative 82 44 58 26 210 24 Scabies. Treatment sessions. No. of Cases Reported. January 8 February 5 March 2 April 3 May 4 June - 22 July 2 August 1 September - October - November 4 December 1 8 Total — 30. Numbers affected in Individual Families. 1 person in 12 families. 6 persons in 1 family. 3 persons in 4 families. 6 recurrent cases—all in 1 family. 25 CHAPTER IV. 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; Regulations—Housing, overcrowding, disrepair, ascertainment and action thereon—Ascertainment and supervision Of movable dwell ings 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. THE MILK AND DAIRIES REGULATIONS, 1949; THE MILK (SPECIAL DESIGNATION) (RAW MILK) REGULATIONS, 1949; THE MILK (SPECIAL DESIGNATION) (PASTEURISED AND STERILISED MILK) REGULATIONS, 1949. These regulations came into force on the 1st October, 1949, and all previous regulations relating to milk, including special designations, were thereby revoked. The new regulations have brought about a number of changes. The Milk and Dairies Regulations, 1949. Under the Milk and Dairies Regulations, 1949, the Minister of Agriculture and Fisheries has accepted responsibility for the registration of all persons carrying on the trade of Dairy Farmers 26 and of all Dairy Farms, whereas previously this was the responsibility of Local Authorities. Provision has been made for an appeal to a specially constituted tribunal against any decision of the Minister of Agriculture and Fisheries to refuse or cancel registration of any Dairy Farmer or Dairy Farm. Registration of milk distributors (who are not producers) and of premises used as Dairies (not being Dairy Farms) remains with Local Authorities and there is a right of appeal to a Court of Summary Jurisdiction against the decision of a Local Authority to refuse or cancel registration. The above changes do not materially affect Wembley in view of the fact that there are no Dairy Farmers or Dairy Farms in the Borough. The powers for dealing with infected milk have been extended to include any disease communicable to man by consumption of milk but a distinction has been made between instances in which a Medical Officer of Health (a) has evidence which satisfies him, and (b) has reasonable grounds for suspecting that a person is suffering from a disease thus caused, or that milk is infected with such disease. In the first mentioned case (a), notice may be given, either stopping the sale of the milk for human consumption, or making sale conditional upon the milk being so treated as to satisfy the Medical Officer of Health that it may safely be used. In the second case (b), however, the notice may only provide for conditional sale. A copy of any notice served by the Medical Officer of Health must be sent to the Minister of Food and, where a notice is served in respect of milk obtained from registered premises in another district, a copy must also be sent to the Medical Officer of Health of that district. Under certain prescribed conditions compensation is payable to a person who sustains damage or loss by reason of a notice served upon him by a Medical Officer of Health. These regulations follow in many respects the corresponding provisions of the Milk and Dairies Order but a number of new requirements have been enacted, including the following. The walls of any room in which milk is handled and which are liable to splashing by milk or otherwise, are to be smooth and impervious; the temperature to which milk shall be cooled has been reduced by 5°F. to 50°F.; the depositing in a Milk Room of any articles except those used in connection with the treatment, handling, storage and distribution of milk is prohibited; a Milk Room must not be used for any purposes other than those connected with milk; washing facilities, including an adequate supply 27 of soap, clean towels, and clean water both hot and cold, must be provided; all milk vessels and appliances must be properly cleansed but the use of an approved oxidising agent is now permitted as an alternative to scalding with boiling water or steam; the leaving of bottles or cartons containing milk, on a public highway, except upon final delivery on a retail sale is prohibited; milk left at a collecting point shall, so far as practicable, be protected from the direct rays of the sun; the name and address of the retailer must be displayed on any stall, cart, barrow or other vehicle at, or from which, milk is sold or offered for sale. All of the milk distributors and dairies in the Borough have been reviewed to see that they comply with the new regulations and the registers have been checked and brought up to date. The Milk (Special Designation) (Raw Milk) Regulations, 1949. The designated raw milks recognised under these regulations are "Tuberculin Tested" and "Accredited In each case producers' licences are granted by the Minister of Agriculture and Fisheries whilst dealers'. licences are granted by the Local Authority. After 30th September, 1954, no producers' licences to use the designation "Tuberculin Tested" will be granted in respect of applications received after that date unless the herd in respect of which the licence is applied for is an attested herd. After 1st October, 1954, the designation "Accredited" will cease to be recognised and, in the meanwhile, the use of the designation in specified areas is restricted to milk produced from a single herd. (A "specified area" is an area in which it is obligatory to sell only designated milk by retail for human consumption under an Order made by the Minister of Food.) In the case of refusal or revocation of a dealer's licence by a Local Authority there is a right of appeal to the Minister of Food and, in certain cases, the Minister must refer them to a specially constituted Tribunal and must consider the report of that Tribunal before making his decision. Samples of the milk must satisfy the methylene blue reduction test. The Milk (Special Designation) (Pasteurised and Sterilised Milk) Regulations, 1949. Under these regulations, two designations are recognised, namely "pasteurised" and "sterilised", the latter being a new designation. Pasteurisation may be carried out by the "holder" process in which the milk is retained at a temperature of not less than 145°F. and not more than 150°F. for at least thirty minutes, after which it is immediately cooled to a temperature of not more than 50°F. or by the high-temperature-short-time process, in which milk is retained at a temperature of not less than 161°F. for at 28 least 15 seconds, after which it is immediately cooled to a temperature of not more than 50CF. But the regulations do make provision for any new method which may be found suitable in tli future which may be specified by the licensing authority with the approval of the Minister. At some future date to be fixed by the Minister, all pasteurised milk containers must be securely fastened with a cap or cover overlapping the lip of the container. As from the 1st October, 1954, pasteurised milk must be put into the containers in which it is to be delivered to the consumer at the premises where it is pasteurised. Samples of pasteurised milk must satisfy the prescribed methylene blue and phosphatase tests. Sterilised milk must be filtered or clarified, homogenised and heated to, and maintained at, such a temperature, not less than 212°F. for such a period as to ensure that it will comply with the prescribed turbidity test and the bottles must be sealed with an airtight seal. Licences to pasteurise or to sterilise milk are now granted by the Food and Drugs Authority, whereas dealers' licences are granted by the Local Authority. The new regulations have had the effect of taking away from the Borough Council the power to grant licences to pasteurise milk hitherto possessed by the Borough Council or to sterilise milk by reason of the fact that the Middlesex County Council are the Food and Drugs Authority for the whole of Middlesex. Thus the somewhat anomalous situation has been brought about that both officers from the County Council and the Sanitary Officers of the Borough Council are required to visit dairies in which pasteurisation or sterilisation is performed. In other words there is overlapping in the duties of the officers of the County Council and the Borough Council which could be a source of irritation to the licensees and is probably not in the best interests of efficient local administration. The number of dealers' licences to sell designated milk issued by the Borough Council during 1949 was 117 details of which are given in the statistical appendix. It is interesting to record that all of the milk sold in the Borough is designated milk and is either pasteurised or sterilised, with the exception of a small quantity of Tuberculin Tested milk. 3. CLEAN FOOD ASSOCIATION. A conference of persons interested in the formation of a Clean Food Association was held in the Town Hall on the 27th October, when it was more 29 than apparent that those concerned with the food industry in the town were anxious to move towards the formation of some body responsible for the recognition of firms which conducted their business in a hygienic and cleanly fashion. An executive committee was elected under the guidance of Mr. D. C. Mitchell, charged with the task of initiating The Wembley Clean Food Association and after much preliminary work the Inaugural meeting of the Association was held early in 1950. Much has already been achieved in this direction but more complete details of the Association's work will be recorded in future reports. 4. HOUSING. During the year, 268 cases of overcrowding were relieved of which 133 were provided with accommodation by the Council. The number of cases of overcrowding known to the Department at the end of the year was 558. Under the liaison which exists between the two Departments concerned, all cases of suspected overcrowding are referred from the Housing Department to the Health Department for investigation, and all cases coming to the knowledge of the Health Department are notified to the Housing Department. No less than 1,574 visits were made by Sanitary Inspectors during the year in connection with overcrowding, whilst the comparable figure for the previous year was 1,665. Similarly, medical certificates received in the Housing Department in support of applications for Council houses are submitted to the Medical Officer of Health for his opinion as to whether the cases come within the Council's scheme of priorities on medical grounds. In addition, where investigation shows that special medical grounds exist (with or without a medical certificate) the Housing Department is notified accordingly. Two houses were represented to the Council as being unfit for human habitation and Demolition Orders were made by the Council in accordance with Section 11 of the Housing Act, 1936. 5. RODENT CONTROL. The Prevention of Damage by Pests Act, 1949, which comes into force on the 31st March, 1950, has repealed the Rats and Mice (Destruction) Act, 1919, from that date. During 1949, however, the Council continued to operate their services under the old Act and have availed themselves of any financial grants which the Ministry of Agriculture and Fisheries have offered. These financial grants, now 50% of the net cost of the service, are subject briefly to the local authority providing a proper service, using the methods of extermination approved by the Ministry, and maintenance treatment of sewers being carried out twice a year. 30 Three Rodent Control Assistants, all of whom were trained at the Infestation Branch of the Ministry of Food, have continued to be employed in this service. Although the number of premises which has needed to be visited remains much the same as in previous years, the size of infestations has materially decreased. There has, however, been an increase in the number of complaints regarding the presence of mice. This increase in complaints does not necessarily mean that there has been an actual increase in the mice population, but is possibly due to the general public becoming more conscious of the need for mice extermination, both from the point of view of damage to foodstuffs and for hygienic reasons. The addition of Antu to the list of approved poisons is welcome, as it has been felt for some time that an additional poison would be valuable in those instances in which rats have shown prejudice against the poisons in general use. No observations can be made in this year's report upon its use as approval was only forthcoming at a date in 1950. A summary of work done is given in the statistical appendix. 6. MOSQUITOES. During August and September there were two manifestations of mosquito activity which engaged the attention of the Department. In the first a number of complaints were received from a more or less restricted area in the Alperton Ward that residents were suffering from mosquito bites. This area was in close proximity to a canal, but no evidence could be found that this afforded a breeding ground; indeed, the canal was teeming with small fish at the time and there would be little likelihood of mosquito eggs or larvae surviving. Attention was also given to the possibility of mosquitoes breeding in artificial ponds in gardens or stagnant water of any kind. Specimens of the mosquitoes were collected and sent to The Malaria Research Station, Horton Hospital, Epsom, Surrey, for identification. Some of them were identified as Culex Molestus, a species known to bite human beings, whilst the remainder were Culex Pipiens, a comparatively harmless variety. When it was known that Culex Molestus was responsible, it became apparent that a fresh search would be needed to discover the breeding ground, in view of its preference for breeding in darkness or semi-darkness. Publicity was therefore given to the matter in the local press, urging residents to look at water tanks and gullies—in fact, any place or receptacle containing water which was in semi-darkness. Ultimately, mosquitoes were discovered by one of the sanitary inspectors to be breeding in quite large numbers in disused air raid shelters, and confirmation was obtained that the larvae belonged to the species Culex Molestus. 31 The water was pumped out of the shelters, and the floors were treated with sawdust impregnated with sump oil to prevent any further breeding. The discovery of the breeding ground and its appropriate treatment soon effected a marked reduction in the number of mosquitoes invading the houses, but it must be admitted that the treatment of the breeding ground coincided with the period in the year when breeding normally tends to fall off. Thanks are due to Mr. Shute, Director of The Malaria Research Station, Horton Hospital, Epsom, Surrey, for his valued assistance and advice in dealing with the problem. The second outbreak occurred in the Wembley Park Area and Culex Molestus was identified as being responsible. In this instance the mosquitoes were found to be breeding in the Wealdstone Brook near a weir under a bridge. Under normal climatic conditions this would probably not have happened but as a result of a drought there was very little flow of water, with the result that the mosquito eggs and larvae were not washed away. It is perhaps a little ironical that during the past summer the Wealdstone Brook had not for some time been so free from oil pollution as compared with previous years, as a source of oil pollution had been discovered and remedied. Had the oil pollution continued, there is little doubt that mosquito breeding could not have taken place. However, as soon as the breeding ground was discovered, the rivers authority (the Middlesex County Council) were notified, and prompt action was taken to kill the larvae by means of spraying the surface of the water with oil. Very soon afterwards the weather changed, and a substantial fall of rain brought about a considerable flow of water in the Brook. Both of these incidents entailed a very large number of visits of investigation and many hours of work, although these remarks apply more particularly to the first outbreak. The experience gained in the first case enabled the second one to be dealt with much more expeditiously. 7. LEGAL PROCEEDINGS IN CONNECTION WITH FOOD. Three prosecutions were instituted in connection with the sale of food unfit for human consumption:- Cigarette end in loaf of bread—firm fined £5 and 10/- costs. Fly in loaf of bread—firm fined £5. Nail in loaf of bread—firm fined £3 and 10/- costs. In three instances legal proceedings were taken in respect of the sale of milk in dirty milk bottles; fines of £5 and £5 5s. Od. 32 costs were imposed in two cases and in the remaining case a line of £5 plus £3 3s. Od. was imposed. One other case' involving the sale of milk in a dirty bottle was dismissed by the Magistrates but no order was made as to payment of costs. 8. LEGAL PROCEEDINGS. In three cases legal proceedings were instituted against the owners 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 made Nuisance Orders in two cases but as the Orders were not complied with in the specified time the Council carried out the necessary work in default and charged the owners with the costs. In the remaining case the repairs, with the exception of decorations, were executed by the owner between the time the Summons was served and the case was heard, but the Magistrates awarded the Council £3 3s. Od. costs although they declined to make an Order for the outstanding work. Three Appeals by owners against Notices served by the Council to provide dustbins in accordance with Section 75 of the Public Health Act, 1936, were heard by the Magistrates. Two Appeals were dismissed with costs of 1J guineas and one guinea respectively. In the third case the Court upheld the Appeal but refused to allow costs. 9. 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. All dwelling houses in the Borough are provided with a mains water supply. 33 10. FACTORIES ACT, 1937. No material change has taken place in the types of industries in the borough, which were given in some detail in a previous annual report. The particulars relating to inspections and the defects found and remedied are set out in the statistical appendix. 482 visits to outworkers' premises were made during the year. 11. SLAUGHTERHOUSES. There are no slaughterhouses in use in the Borough. 34 STATISTICAL APPENDIX D. Number of complaints received and investigated 3,061 Visits made by Sanitary Inspectors 31,367 (a) Dwelling Houses:- Visits under Public Health Acts 7,320 Visits under Housing Acts 9 Visits re overcrowding 1,574 Visits to bug infested premises 93 Visits re other vermin (excluding rats and mice, see below) 714 Visits re cases of infectious disease 1,716 Visits to cases of food poisoning 29 (b) General Environmental Public Healths:- Drains and sewers inspected 2,948 Drain and Sewer Test applied 526 Cesspools, etc. 27 Urinals, latrines, chemical closets 100 Stables, manure pits, etc. 65 Piggeries (number on register at end of year 12) 57 Ditches and streams 315 Open spaces, etc. 414 Yards 2,428 Public conveniences 118 Tents, vans and sheds 112 Factories—Mechanical 1,372 Non-mechanical 49 Workplaces 278 Outworkers 482 Smoke observations—half hourly 98 „ „ casual 1,282 „ „ visits to plant 66 Cinemas, Dance Halls, Public Houses, etc. 153 Hairdressers (number of establishments on register at end of year 92) 129 Schools (number of private schools 16) 114 Markets 48 Rats and Mice 282 Swimming baths—visits 60 „ ,, water examination 5 „ „ chlorine tests 30 Council Premises 17 Fairgrounds 3 Refuse Tips 7 Shelters 8 35 (c) Food, including milk, meat, water:- Number of dairies registered at end of year 14 Number of distributors of milk registered, with premises in the Borough selling milk in properly closed and unopened receptacles 29 Number of distributors of milk registered whose premises are outside the Borough 22 Number of dairies (included above) where milk is bottled 4 Inspection visits made to:- Meat shops, stalls, etc. (number on register at end of year 79) 847 Cowsheds 17 Dairies and milk shops—visits 345 „ „ „ „ milk samples taken 138 „ „ „ „ sediment tests 3 Fried fish shops (number on register at end. of year 18) 286 Bakehouses (number on register at end of year 20) 235 Ice cream premises (number on register at end of year 132) 861 Ice cream—samples taken 356 Fishmongers and poulterers (number on register at end of year 31) 534 Greengrocers and fruiterers (number on register at end of year 93) 618 Grocers (number on register at end of year 232) 1,153 Restaurants, cafes, etc. (number on register at end of year 134) 841 Street vendors, hawkers, etc. (number on register at end of year 59) 158 36 Other food premises 181 Water supply—visits 105 „ „ samples taken 56 (d) Other visits and inspections:— Massage establishments, etc. 55 Certificates lodged by Members of the Chartered Society of Physiotherapists 2 New Licences granted 4 Licences renewed 19 Noise nuisances 384 Dust nuisances 231 Effluvia nuisances 40 Petroleum stores 386 Miscellaneous 485 Number of verbal notices served 222 Number of verbal notices complied with 141* Number of written notices served 386 Number of written notices complied with 337* Number of statutory notices served 95 Number of statutory notices complied with 102* * Includes a number of notices served in 1948 and completed in 1949 Nuisances abated and improvements effected. (a) Dwelling Houses:- Roofs repaired 222 External walls and chimney stacks repaired 103 Gutters and spouts repaired or renewed 180 Damp-proof courses provided 18 Dampness remedied 215 Yards paved or repaired 59 Internal walls and ceilings repaired 472 Doors repaired or renewed 104 Windows repaired or renewed 232 Floors repaired or renewed 142 Sub floor vent, provided or improved 62 Rooms cleansed or redecorated 306 Passages and staircases redecorated 66 Staircases repaired 25 37 Fireplaces and flues repaired or renewed 94 Cooking stoves repaired or renewed 15 Wash coppers repaired or renewed 5 Sinks and washbasins provided or renewed 33 Waste pipes repaired or renewed 55 Food stores, provided or improved 4 Dustbins provided or renewed 129 Water supply improved or reinstated 59 W.C. walls, etc., cleansed 19 W.C. pans cleansed 3 W.C. pans repaired or renewed 53 W.C. structures repaired or renewed 13 W.C. lighting and ventilation improved 2 W.C. flush pipe joints repaired 22 External pointing 13 Hot water tanks repaired 2 (b) General Environmental Public Health:— Drains cleansed from obstruction 864 Drains repaired or renewed 73 New drains provided 30 New inspection chambers provided 37 Inspection chambers repaired 50 Soil pipes and vent. shafts repaired 10 W.C's repaired 22 W.C's. cleansed 28 Cesspool emptied, etc. 2 Urinals and latrines cleansed or emptied 5 „ „ „ additional ones provided 5 Stables, manure pits, cleansed 9 „ „ „ repaired or renewed 2 Piggeries cleansed or limewashed 8 Pigsties repaired 1 Animals nuisances abated 10 Offensive accumulations removed 42 Ditches and streams cleansed 5 „ „ „ pollution remedied 3 Yards cleansed or repaired 40 Tents, vans and sheds—removed 22 Smoke nuisances abated 4 Improvements in boiler plant or fuel effected 7 Cinemas, Dance Halls, etc.—contraventions remedied 6 Hairdressers—contraventions remedied 9 Schools—sanitary conditions improved 3 Noise nuisances abated 4 Effluvia nuisances abated 2 School shelters closed 2 38 (c) Eradication of bed bugs:— (i) Number of Council houses:— Found to be infested and subsequently disinfested 17 (ii) Number of oilier houses:— Found to be infested and subsequently disinfested 22 (i) by hydrogen cyanide (ii) by sulphur (iii) by liquid insecticides 22 Other vermin eradicated 23 Verminous articles destroyed 5 (d) Meat and other Food Premises:— Meat shops, stalls, etc.— premises cleansed 44 „ „ „ „ other contraventions remedied 18 Dairies—cleansed and distempered or painted 10 „ premises repaired 5 „ other contraventions remedied 3 Bakehouses cleansed and distempered or painted 25 „ sanitary conditions improved 11 „ other contraventions remedied 4 Ice cream premises cleansed and distempered or painted 17 „ „ „ sanitary conditions improved 19 Fried fish shops cleansed and distempered or painted 5 „ „ „ sanitary conditions improved 5 „ „ „ other contraventions remedied 11 Fishmongers, etc., contraventions remedied 33 Grocers, etc., contraventions remedied 50 Greengrocers, etc., contraventions remedied 51 Restaurants, Cafes, etc., contraventions remedied 45 Street hawkers, contraventions remedied 4 Other food premises, contraventions remedied 4 4,485 39 (e) Unsound Food Surrendered. 1,368 lbs. Beef. 335 lbs. Mutton and Lamb. 47 lbs. Liver. 291 lbs. Pork Maw. 111 lbs. Cowheel. 27 lbs. Cooked Meat. 112 lbs. Ducks. 30 lbs. Minced Beef. 109 lbs. Sausages and Sausage Meat. 28 lbs. Spleens. 265 lbs. Whale Meat. 507 lbs. Rabbits. 53 lbs. Poultry. 8 lbs. Suet. 144 lbs. Bacon. 3 cwt. Belgian Salami. 483 lbs. Corned Beef. 156 lbs. Corned Mutton. 692 tins Meat. 15 tins Bacon. 286 tins Sausages. 40 Meat Pies. 239 lbs. Fish (Cod, Skate, Haddock, etc.). 31 lbs. Mussels. 1 box Oysters. 6 boxes Kippers. 137 tins Fish. 254 Fish Cakes. 108 tins Mussels. 21 tins Anchovies. 29 jars Fish. 110 tins Fish Roes. 914 tins Fruit. 77 jars Fruit. 514 lbs. Dates. 171 lbs. Figs. 1,145 tins Vegetables. 49 jars Vegetables. 19½ lbs. Dried Peas. 743 tins Milk. 2 cwts. Dried Milk. 252 tins Jam, etc. 729 tins Chocolate Spread. 24 one gallon tins Apple Puree. 21 jars Jam. 30 tins Date Paste. 40 454 bottles Sauces, Salad Cream, etc. 100 bottles Pickles. 149 tins Soup. 133 pkts. Soup. 161 jars Meat Paste, Fish Paste, etc. 45 tins Meat Paste, Fish Paste, etc. 64 lbs. Cake. 39 pkts. Breakfast Cereals. 1 sack Flour. 1 sack Barley. 33 lbs. Flour. 20 pkts Flour. 19 tins Puddings. 58 pkts. Cake Mixtures, etc. 72 lbs. Rolled Oats. 3 lbs. Chocolate. 6 lbs. Toffees. 90 lbs. Soya Beans. 44 tins Spaghetti. 4,439 Eggs. 144 lbs. Cheese. 102 boxes Cheese. 5 cwts. Macaroni. 18 lbs. Edible Seaweed. 4 tins Dried Egg. 198 tins Salami. 1 bottle Ginger Wine. 1 jar Peanut Butter. 2 bottles Vinegar. 1½ lbs. Cocoa. 7 pkts. Gravy Powder. 1 tin Ovaltine. 14 pkts. Semolina. 2 bottles Coffee. 496 jars French Mayen. Inspection of dwelling-houses during the year:— (a) (i) Total number of dwelling • houses spected for housing defects (under Public Health or Housing Acts) 8,122 (ii) Number of inspections made for the purpose 7,329 (b) (i) Number of dwelling-houses (included under sub-head (i) above) which were inspected and recorded under the Housing Consolidated Regulations, 1925/1932 3 41 (ii) Number of inspections made for the purpose 9 (c) Number of dwelling-houses found not to be in all respects reasonably fit for human habitation 1,738 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 1,708 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 owners None (b) Proceedings under Public Health Acts:— (i) Number of dwelling-houses in respect of which notices were served requiring defects to be remedied 81 (ii) Number of dwelling-houses in which defects were remedied after service of formal notices:— (1) by owners 75* (2) by Local Authority in default of owners 18 * Includes compliance in 1949 with 31 notices served in 1948. t Includes compliance in 1949 with 6 notices served in 1948. 42 (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 2 (ii) Number of dwelling-houses demolished in pursuance of Demolition Orders (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 (ii) Number of separate tenements or underground rooms in respect of which Closing Orders were determined, the tenement or room having been rendered fit None Overcrowding. (a) Certificates issued to landlords, giving the permitted number of persons who may occupy a house 29 (b) Number of dwellings recorded as overcrowded at the end of the year 558 Number of families dwelling therein 631 Number of persons dwelling therein 2,664 (c) Number of new cases of overcrowding ported during the year 224 (d) (i) Number of cases of overcrowding relieved during the year Total 268 (1) by removals of sub-tenants/lodgers, members of family 45 (2) by removal of families to other known addresses (not overcrowded) 137 (3) by removal to unknown addresses 86 (4) rehoused by Council (included also in (2) above):— In requisitioned premises 11 In Council houses 114 In temporary bungalows 8 43 (ii) Number of persons concerned in such cases 1,358 (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 Factories. Number of factory premises — 509. Premises. Number of:— Inspections. Written Notices. Occupiers Prosecuted. Factories with mech. power 1,372 14 — Factories without mech. power 49 — — Other premises 4 — — Totals 1,425 14 — Defects found. Particulars. No. of defects:— Found. Remedied. Referred by H.M. Inspector. Prosecutions. Want of cleanliness 3 5 — — Overcrowding — — — — Unreasonable temperature — — — — Inadequate ventilation — — — — Ineffective drainage of floors — — — -— Sanitary Convenience:— Insufficient 8 4 6 — Unsuitable or defective 26 18 5 — Not separate for the sexes — — — — Other offences 23 22 — — Totals 60 49 11 — 44 Outworkers. Number on register at end of year 441 Nature of work:— Making, repairing of:— Wearing apparel 189 Household linen 11 Lace, lace curtains and nets 4 Curtains and furniture hangings 1 Furniture and Upholstery 2 Brass and brass articles 12 Umbrellas, etc. 1 Making of boxes or other receptacles or parts thereof, etc., of paper 4 Feather sorting 1 Cording, etc., of buttons, etc. 10 Stuffed toys 11 Cosaques, Christmas crackers, Christmas stockings, etc. 195 Total 441 Offices. Number on the register — 301. Defects. Found. Remedied. Want of cleanliness — — Want of ventilation — — Overcrowding — — Sanitary accommodation:— Insufficient 1 — Unsuitable or defective 1 3 Not separate for the sexes — — Obnoxious effluvia — — Other nuisances 5 3 Totals 7 6 Disinfection of Premises and Articles. Disinfections for:— Infectious diseases 462 Cancer 31 Vermin (routine protection from) 48 Miscellaneous 32 45 Articles disinfected or destroyed:- Disinfected. Destroyed Bedding and bedclothing 2,459 35 Wearing apparel 261 14 Carpets, rugs, cushions 56 2 Others 44 7 Rats and Mice (Destruction) Act, 1910. Work carried out during the year:— Total. re Mice. (1) Number of premises visited 1,337 162 (2) Number of visits by Sanitary Inspectors 205 — (3) Number of visits by Rodent Control Assistants 9,256 1,179 (4) Number of premises found to be infested 827 140 (5) Number of premises which received treatment by Rodent Control Assistants 806 134 (6) Number of premises satisfactorily treated privately 21 15 (7) Number of Council premises (included in (5) ) 16 5 Milk (Special Designations) Orders. Licences issued. Dealers. Supplementary. To Bottle. To Pasteurise. Tuberculin tested 16 9 1 — Pasteurised 28 10 — 1 Sterilised 26 11 — — Samples of designated milk taken. No. of samples taken. No. not satisfactory. Pasteurised 74 2 Tuberculin tested 13 1 T.T. (Pasteurised) 20 — Sterilised 3 — 110 3 46 Laboratory Examinations re Food, Milk and Water. Examinations made. 31.3.49 Quarter ending 31.12.49 Total for 12 months 30.6.49 30.9.49 Water 8 8 6 34 56 Milk 49 40 22 27 138 Food 5 2 3 7 17 Ice Cream 80 120 105 51 356 Chemical tests for chlorine content of Swimming Pool water made by inspectors, 30. 47 CHAPTER V. ADMINISTRATION, STAFF, SUMMARY. Pressure of work in the Department has not decreased during this year. Indeed, the considerable changes necessitated by the National Health Service Act of 1946 have entailed much reorganisation. During the whole year I have been without a Deputy Medical Officer of Health, either part-time or whole-time, and medical cover necessary at times of statutory holidays and my annual holiday has necessitated my remaining on call more frequently, I feel, than is desirable. Mr. Ryan, who worked in the Department since 4th August, 1927, vacated his post as Chief Clerk on being appointed to a considerably more senior position with the Middlesex County Council and left the service of the Borough on the 30th April. No replacement could be obtained for Mr. Ryan until December, when Mr. F. H. H. Smith commenced duties in the capacity of Chief Clerk. The intervening time necessarily required considerable industry and application from those remaining members of the staff who maintained the work of the Department at its usual high level. It is interesting to record that field work undertaken by members of the staff provided information and inspired the contribution of articles to the medical press. The Sanitary Inspectors collaborated with Dr. Betty Hobbs of the Central Public Health Laboratory and one of them, Mr. L. Kluth, along with Dr. Hobbs, published a survey of catering establishments in the Monthly Bulletin of the Ministry of Health and the Public Health Laboratory Service. As a result of the investigations undertaken during the plague of mosquitoes in the summer, which necessitated our collaboration with the Malaria Research Laboratory at Epsom, Mr. P. G. Shute, M.B.E., F.R.E.S., Assistant Malaria Officer of the Ministry of Health, published a second memorandum on the culex molestus. It would be invidious to single out and thank any member of the staff for special mention as I am deeply indebted to each who has contributed in his own sphere to the successful conclusion of another year's work, but I would be neglecting a common courtesy if I did not record my grateful thanks to Mr. Turner, the Chief Sanitary Inspector, both for his assistance during the year and the very material help he has afforded me in the preparation of this report. 48 Finally, I wish to express the appreciation of myself and alt officers of the Department to the Chairman and members of the Highways, Works and Public Health Committee for their sympathetic and constructive assistance and help at all times both in committee and outside. I have the honour to be, Mr. Mayor, Ladies and Gentlemen, Your obedient servant, E. GRUNDY, Medical Officer of Health. 49 Hendon Printing Works Limited. 44, Victoria Road. Hendon, N.W. 4 50