AC 439 (1) WEMBLEY WEM 38 BOROUGH OF WEMBLEY REPORT OF THE MEDICAL OFFICER OF HEALTH FOR THE YEAR 1957 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 1957 E. GRUNDY, M.D., M.R.C.S., D.P.H., Medical Officer of Health HEALTH COMMITTEE (May, 1957) The Mayor—Alderman G. R. MARSHALL, J.P. The Deputy Mayor—Councillor R. A. PENNY Chairman—Councillor F. R. HILL, B.Sc. Vice-Chairman—Councillor Mrs. NEWLAND Aldermen: J. W. A. BILLAM, B.Sc., and C. H. SMITH, O.B.E., D.L.: Councillors: A. F. E. BUDD, W. R. DUDDEN, R. EVANS, H. W. HOW, N. M. LAMB, E. C. MEREDITH, M.P.S., F.S.M.C., W. T. PAVITT, Mrs. E. WYATT STAFF OF THE PUBLIC HEALTH DEPARTMENT Medical Officer of Health: E. GRUNDY, M.D., M.R.C.S., D.P.H. Deputy Medical Officer of Health: Dr. R. HALPERIN Chief Public Health Inspector: R. M. TURNER (a) (b) (c) Deputy Chief Public Health Inspector: H. YOUNG (a) ( b) (c) Public Health Inspectors: C. DUERDEN (a) (b) (c) L. KLUTH (a) (b) (c) G. E. A. REYNOLDS (a) (b) (c) E. POWER (a) (b) (c) (d) A. W. NICOL (a) (b) Senior Clerk: G. H. HUGHES (a) Second Clerk: A. J. HILL Personal Assistant to Medical Officer of Health: Miss F. H. CARRAN General Clerks: Mrs. H. NIXON R. MARKS (a) Certificate, Royal Sanitary Institute & S.I. Exam. Joint Board. (b) Certificate for Inspectors of Meat and Other Foods. (c) Certificate for Inspectors of Smoke. (d) Certificate, Sanitary Science. 3 BOROUGH OF WEMBLEY ANNUAL REPORT of the MEDICAL OFFICER OF HEALTH for the Year 1957 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 1957. 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, Pages 6 & 7, Statistical Appendix A, Pages 8—14. „ II GENERAL HEALTH SERVICES, Pages 15—18. „ III INFECTIOUS DISEASES, Pages 19—22, Statistical Appendix B, Pages 23—28. „ IV ENVIRONMENTAL HYGIENE, FOOD AND WATER, HOUSING, FACTORIES, ETC., Pages 29—36, Statistical Appendix, C, Pages 37—54. „ V ADMINISTRATION OF THE DEPARTMENT AND STAFF, Page 55. 5 CHAPTER I. VITAL STATISTICS 1. The population of the Borough in mid-1957 was estimated by the Register-General to be 127,500 and whilst this is considerably below 131,384 the census figure for 1951 it probably represents the most accurate figure attainable. It is an interesting observation that the population of Wembley and Kingsbury recorded in the census of 1931 was some 65,799, an inter-census increase of 99.7%. Wembley remains the fifth largest County District in Middlesex, those greater, according to population, being Harrow, Ealing, Willesden and Hendon. 2. In 1957 there were recorded 1,459 live births, giving a birth rate of 11.44 per thousand of the estimated population. The number of deaths was 1,173 giving a crude death rate of 9.2 per thousand. When the comparability factor (1.18) is applied the standardised death rate becomes 10.86, an increase on last year's figure but below the national rate of 11.5 per thousand of the population. 3. The infantile mortality rate of 18.51 is below the national rate for England and Wales, yet one feels some comment is not out of place. Prematurity continues to be the main cause of neonatal death and the emergency unit maintained at the Edgware General Hospital is of advantage in cases of prematurity, probably keeping this rate to an absolute minimum. 4. CANCER. Deaths from Cancer in the Borough during the year totalled two hundred and sixty and a feature of the deaths, becoming more conspicuous almost year by year, is the relative incidence of deaths from Cancer of the lung. There has been a considerable increase in this condition, as expressed both in the local and the national figures, and the inhalation of tobacco smoke has been strongly suspected, if not yet proved, to be the main cause. It is most interesting in this connection to refer to the Annual Report of my predecessor, in 1927, in which Dr. Charles E. Goddard reproduced eight "aphorisms and notes on smoking." In so doing he appeared to be amongst the pioneers preaching the sermon of moderation in the use of nicotine. It is true he did not in the Report 6 connect the smoking of tobacco with the incidence of Cancer of the lung, but it is equally true that anyone following the advice given in 1927 would see no reason to modify his behaviour in the light of advice given by experts in preventive medicine to-day. Smoking of tobacco has not yet been accepted as the only and absolute cause of the increased incidence of Cancer of the lung but is is undoubtedly one of the main precipitating factors, and those who smoke, particularly those who smoke cigarettes in large quantity and inhale the products of combustion, are subjecting themselves to a considerable hazard. 7 STATISTICAL APPENDIX A. CERTAIN VITAL STATISTICS, 1957 from figures supplied by Registrar-General. (Some comparative 1956 figures within brackets.) Population Total 127,500 Live Births. Male. Female. Total. Live birth rate per 1,000 estimated population 11.44 (11.63) Legitimate 722 690 1,412 (1,444) Illegitimate 29 18 47 (48) Stillbirths. Legitimate 13 12 25 Rate per 1,000 total (live and still) births 11.64 (11.86) Stillbirth rate per 1,000 estimated population 0.20 (0.22) (29) Illegitimate — (-) Deaths 622 551 1,173 Death rate per 1,000 estimated population — Crude rate 9.20 (9.04) (1,160) Adjusted by Area Comparability Factor of Registrar-General 1.18 Standardised rate 10.86 (10.67) Infantile Mortality. Deaths of infants under one year of age:— Male. Female. Total. 27 (25) Legitimate 16 8 24 (25) Illegitimate 1 2 3 (-) 8 Death rate of infants under one year of age:— All infants per 1,000 live births 18.51 (16.76) Legitimate infants per 1,000 legitimate live births 17.00 (17.31) Illegitimate infants per 1,000 live illegitimate births 63.83 (—) Maternal Mortality. Deaths from Pregnancy, Childbirth, Abortion — (2) Maternal mortality rate per 1,000 like births — (1.34) Maternal mortality rate per 1,000 total (live and still) births — (1.31) Per 1,000 population. Per 1,000 Live Births. Per 1,000 total births (live and still). Birth rate. Still Birth rate. Death rate. Infantile mortality. Maternal mortality. Maternal mortality. Wembley 11.44 0.20 9.20 18.51 — — England and Wales 16.10 0.37 11.50 23.12 0.48 0.47 London 16.20 0.33 11.40 21.90 — — 160 County Boroughs, etc. 16.10 0.37 11.50 23.50 — — 160 Smaller towns, etc. 16.00 0.38 11.40 23.50 — — Area in acres 6,294 Estimated number of inhabited houses at end of 1957 38,500 Rateable Value, 31st December, 1957 £2,681,621 Estimate of the product of a penny rate 1957/58 10,850 9 Causes of Deaths during the Year. Causes of Death. Male. Female. 1957. Total. 1. Tuberculosis, respiratory 4 2 6 2. Tuberculosis, other — 1 1 3. Syphilitic disease 1 — 1 4. Diphtheria — — — 5. Whooping Cough — — — 6. Meningococcal infections — — — 7. Acute poliomyelitis 2 2 4 8. Measles — — — 9. Other infective and parasitic diseases — 2 2 10. Malignant neoplasm, stomach 18 17 35 11. Malignant neoplasm, lung, bronchus 54 12 66 12. Malignant neoplasm, breast 1 28 29 13. Malignant neoplasm, uterus — 4 4 14. Other Malignant and Lymphatic neoplasms 63 63 126 15. Leukaemia, aleukaemia 5 6 11 16. Diabetes 2 5 7 17. Vascular lesions of nervous system 62 87 149 18. Coronary disease, angina 146 73 219 19. Hypertension with heart disease 12 14 26 20. Other heart disease 46 64 110 21. Other circulatory disease 35 41 76 22. Influenza 4 6 10 23. Pneumonia 25 13 38 24. Bronchitis 41 15 56 25. Other diseases of respiratory system 6 3 9 26. Ulcer of stomach and duodenum 9 2 11 27. Gastritis, enteritis and diarrhœa 1 7 8 28. Nephritis and nephrosis 5 6 11 29. Hyperplasia of prostate 8 — 8 30. Pregnancy, childbirth, abortion — — — 31. Congenital malformations 5 3 8 87 32. Other defined and ill-defined diseases 37 50 33. Motor vehicle accidents 12 6 18 34. All other accidents 10 14 24 35. Suicide 8 5 13 36. Homicide — — - ALL CAUSES 622 551 1,173 10 The Principal Causes of Death. Disease. Total Number of deaths. 1. Heart disease and other diseases of circulatory system (18—21) 431 Vascular lesions of nervous system (17) 149 580 2. Malignant neoplasms (10—14) 260 3. Respiratory diseases:— (a) Influenza (22) 10 (b) Pneumonia (23) 38 (c) Bronchitis (24) 56 (d) Other respiratory diseases (25) 9 113 4. Tuberculosis:— (a) Respiratory system (1) 6 (b) Other forms (2) 1 7 5. Violent deaths:— (a) Suicide (35) 13 (b) Road traffic (33) 18 (c) Other violent causes (34) 24 55 6. Congenital malformations (31) 8 Note: Numbers in brackets are index numbers allocated by Registrar-General for Annual Return of Causes of Deaths. 11 Percentage of total deaths under 1 year. Percentage of total deaths under 50 years. Percentage of deaths taking place in hospitals. 1953 2.67 13.88 34.07 1954 2.42 14.49 50.54 1955 2.30 10.74 49.61 1956 2.16 10.86 50.95 1957 2.30 10.14 52.34 SOME OTHER ESSENTIAL LOCAL STATISTICS. Birth Notifications (as supplied by Area Medical Officer). Notified by. At home. In Hospital. In Nursing Home. Totals. Doctors 1 430 33 464 Midwives 299 741 — 1,040 Parents — — — — Totals 300 1,171 33 1,504 Percentages 20.0 77.8 2.2 100.0 Live births —1,481 Still births — 23 12 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 5 year Prematurity 6 - - - 6 - - - - 6 Pneumonia 1 — — — 1 1 — — 1 3 Atelectasis 4 — — — 4 — — — — 4 Congenital heart disease 1 — — — 1 1 — — — 2 Intracranial haemorrhage 1 — — — 1 — — — — 1 Endocardial fibroelastosis - - - - - - 1 - - 1 Hydrocephalus — — 1 — 1 — — — — 1 Respiratory failure 3 — — — 3 — — — — 3 Haemorrhage of the umbilicus - 1 - - 1 - - - - 1 Neonatal asphyxia 1 — — — 1 — — — — 1 Meningitis 1 — — — 1 1 — — — 2 Tentorial tear 1 — — — 1 — — — — 1 Misadventure - - - - - - 1 - - 1 19 1 1 - 21 3 2 - 1 27 13 Infantile Mortality, 1953-1957 Year. Wembley. England & Wales. 1953 20.13 26.8 1954 18.23 25.5 1955 17.18 24.9 1956 16.76 23.8 1957 18.51 23.0 Infantile mortality during last five years (7,319 live births, 133 deaths under one year): 18.17 Maternal Mortality. Rate per 1,000 total births (live and still), 1953-1957:— Year. Wembley. England & Wales. 1953 0.65 0.76 1954 0.66 0.69 1955 0.70 0.64 1956 1.31 0.57 1957 0.00 0.47 Maternal mortality during last five years (7,467 total births, 5 maternal deaths): 0.66 14 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 and the Kingsbury Maternity Hospital are situated in the Borough and these hospitals are under the control of the Governors of Charing Cross 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 Hospital. Arrangements are made for the admission of tuberculous patients 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 2381.) 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 2251.) 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, 199, Station Road, Harrow, Middlesex. (HARrow 1075.) Edgware Chest Clinic, Edgware General Hospital, Edgware, Middlesex. (EDGware 4467/8.) 15 In August the Minister announced that the plan to build a new teaching hospital on the site at Northwick Park could no longer be regarded as appropriate, and that the Governors of Charing Cross were to be asked if they would agree to the transfer of the Charing Cross Hospital to a site in Fulham. Incidentally, the Wembley Hospital and the Kingsbury Hospital, situated within the boundaries of the Borough, would almost certainly in the future be allocated, for management purposes, to local Group Management Committees and removed from the sphere of the Charing Cross Hospital. This change of plan must be regarded as a prejudice to the hospital services of the Borough. The fact that no new hospital is to be constructed on the Northwick Park site means that no additional beds become immediately available for the neighbourhood, and the severance of control from the Governors of Charing Cross unfortunately terminates the association of the hospital services in this area with an important London teaching hospital. 2. AMBULANCE SERVICE. A service of ambulances and sitting case cars is maintained by the Middlesex County Council as Local Health Authority at:— No. 4 Depot. (ELGar 5506.) The accident service is obtained by dialling 999. 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 III of the National Health Service Act, 1946, are provided by the County 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.1. Telephone : TRAfalgar 7799. Area Medical Officer—Area No. 6—Wembley: E. Grundy, M.D., M.R.C.S., D.P.H., Area Health Office, 215, Chevening Road, N.W.6. Telephone: LADbroke 2411. 16 Clinics for Child Health: College Road, Wembley. Telephone No.: ARNold 1336. London Road, Wembley. Telephone No.: WEMbley 1021. 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. Library Clinic, Stag Lane, Kingsbury, N.W.9. Telephone No.: COLindale 6343. Day Nurseries: Princes Avenue, Kingsbury, N.W.9. Telephone No.: COLindale 4456. Vale Farm, Watford Road, Sudbury, Wembley. Telephone No.: ARNold 3162. Domestic Help. Provided on medical certificate in cases of sickness or maternity by application to the Area Health Office: 215, Chevening Rd., N.W.6. 17 Immunisation and Vaccination. By application to National Health Service practitioners who have entered the Scheme, or by arrangement with the Area Medical Officer : 215, Chevening Road, N.W.6. Telephone No. : LADbroke 2411. Midwifery and Home Nursing. By application to the Area Medical Officer: 215, Chevening Road, N.W.6. Telephone No.: LADbroke 2411. Outside office hours Home Nurses may be contacted in their own homes. School Health Service. Clinics at all the Child Health Clinics. 4. VERMINOUS CONDITIONS. Only 2 cases, both adults, were referred to a Health Centre for treatment more intensive than could be given in the home. 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. 5. MORTUARY. The Mortuary which was closed in 1955 has not yet been replaced although plans have been prepared by the Borough Engineer and Surveyor and discussions have taken place with appropriate officers of the Ministry. The Government ban on capital expenditure has, up to now, prevented the Corporation from going ahead with its plans to erect a new Mortuary at the rear of the Town Hall, but there are indications that the Corporation will be able to make some progress in the near future. In the meantime the Harrow Corporation have permitted their Mortuary to be used for the reception of cases from Wembley which in 1957 amounted to 164 bodies. 18 CHAPTER III. 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 Neasden Hospital or Hendon Isolation Hospital, re puerperal pyrexia and ophthalmia neonatorum, Emergency Bed Service, re smallpox as arranged by the Regional Hospital Board — Notification of tuberculosis — Authentication of travellers' inoculation state — Food poisoning notification and investigation — Scabies, arrangements with the Middlesex County Council — Complete bacteriological service available at Central Public Health Laboratory, Colindale, outfits distributed from Public Health Department. 2. INFLUENZA. During the year 1957 a new variant of the Influenza virus arose in the Far East, where extensive, although mild, outbreaks occurred. In the early Autumn of the year there was a very sudden and substantial increase in upper respiratory infections amongst all sections of the population, and it seemed probable that many, if not all, of these cases might be due to infection by the new Asian Influenza virus. The disease Influenza is not a notifiable infectious disease as the clinical picture varies so greatly that a clinical definition is not a feasible proposition. In order to ascertain the incidence, returns were asked for from the Head Teachers of each of the schools in the Borough, and it was found that at the height of the outbreak no less than 23.56 per cent. of all school children were absent from school, presumably largely due to upper respiratory infection. In the schools most seriously affected at the height of the outbreak 40.67 per cent. of children were absent. The Emergency Bed Service at this time and again eleven weeks later were unable to deal with 25 per cent. of the calls made on it for accommodation in hospital, and the Ministry of Labour reported a very substantial increase in absence from work on account of sickness. The infection, fortunately, was mild, consisting of upper respiratory symptoms with pyrexia for some thirty-six hours, followed by a rapid and complete recovery in almost 19 all cases. In the very aged, infection with the virus proved more serious and it will be seen from the statistics that Inflenza or complications of the disease caused ten deaths. All arrangements possible were made to deal with any subsequent waves of infection, which in previous outbreaks had been of a more serious clinical nature, but fortunately these secondary waves did not materialise and the end of the year left us confidently hoping that the population of the town had secured a substantial immunity to the Asian virus. 3. POLIOMYELITIS. The incidence of this infection has not been very great in Wembley expressed numerically, but a startling feature has been the attack rates in older persons. Of the total number of fifteen notifications of the paralytic form of the disease, no less than ten have been patients over the age of twenty-four years, representing a figure of sixty-six per cent. of the total notifications. This is rather an unusual age incidence. Another startling feature has been the months of the year in which the cases have been notified. Contrary to the normally expected occurrence of the disease in the summer months, seven of our cases have been notified during the part of the year when it is not usually prevalent. In addition to these unusual features the severity of the infection has been conspicuous. Of the fifteen cases notified, no fewer than three cases were rapidly fatal, and of those who managed to survive the initial viraemia eight suffered from severe paralysis necessitating very long treatment in hospital. Arrangements are made for the serious cases to be admitted immediately to the infectious diseases hospital and after the acute phase of the disease is past, transfer to an orthopaedic hospital, if required, is automatically arranged. Some disquiet was occasioned in one small outbreak where, on account of heavy notification of the non-paralytic form of the disease, in neighbouring districts the hospitals were unable to accept without further investigation all non-paralytic cases notified. The particular case involved was a child notified as non-paralytic Poliomyelitis, resident in a part of the Borough where considerable anxiety had arisen as a consequence of the disease. When it became known that the child was notified as a Poliomyelitis and had not been removed 20 to hospital, public agitation commenced and demonstrations occurred outside the residence of the child concerned. Scientifically there is doubt as to the value of hospitalisation of all non-paralytic Poliomyelitis, but until the public is educated to recognise this situation it is inevitable that all notified cases must be removed as expeditously as possible to hospital isolation. The National Immunisation Campaign against Poliomyelitis commenced in March, 1956, and before March, 1957, cards from 3,972 volunteers had been received. The County Council, through its Area Office, arranged for the inoculations to be given, and before the end of 1957 the general practitioners completed the immunisation of 1,068 children and the Assistant Medical Officers 2,214, giving a total of 3,282 children. The antigen used was British Type vaccine, and results are to be assessed on a national scale. 4. SMALLPOX. At 4.45 on the afternoon of July 1st, a telephone bell in one of the offices rang and the Department was requested to trace a man whose name was given and whose wife was said to live in Wembley, address unknown. At 9.00 that evening a report was being given to the Health Committee of the full circumstances of a suspected case of Smallpox. The man under investigation had returned from a business trip to Kano, on the 29th March, and on the 11th April called in his private doctor on account of intense abdominal pain suggestive of obstruction ; pyrexia, which was followed by extreme prostration and a temperature of 102°F. On the 13th April the patient developed an erythema, at which stage the practitioner, suspecting Smallpox, called in a consultant who, however, stated that the case was not one of clinical Smallpox. A short time afterwards vesicles appeared and the patient experienced an uneventful recovery. Fourteen days later the patient's daughter, aged eight, who had been vaccinated in infancy, developed a similar vesicular rash which was diagnosed as a second attack of Chicken Pox. The little girl, during the course of her illness, was visited by an uncle who subsequently was taken ill on the 13th May, admitted later to a hospital in Tottenham, and died on the 17th May, with a provisional diagnosis of Leukaemia. Post-mortem specimens were removed from this patient and taken to the laboratory in another hospital where a cleaner 21 was employed. The grandson of this cleaner subsequently developed a malady which was diagnosed as clinical Smallpox. As a result of this confirmed diagnosis it was suspected that the adult male resident of Wembley possibly might have innocently introduced the infection into the Country from West Africa. Intense epidemiological investigation followed of all cases of serious illness in the past three months, of cases of Chicken Pox, and, with the co-operation of general practitioners, of cases of sickness where the diagnosis had been in doubt. Despite this, however, no further nexus of infection was discovered. In an endeavour to substantiate the diagnosis of Smallpox some three or four months in arrears, blood samples were taken from the patient and the Haemagglutination-inhibition test was strongly suggestive that he had suffered from Smallpox. The possibility, however, of a strong reaction due to recent vaccination could not be excluded. Unfortunately it was impossible to secure a blood specimen for this test from the child patient, in whose case a strong positive would have been quite diagnostic of the disease. In examining the statistics no notification of Smallpox will be seen but it is strongly felt, on epidemiological grounds, that these two infections were Variola Major. 5. INTERNATIONAL CERTIFICATES OF IMMUNISATION. The Department continues to authenticate the International Certificates of Vaccination for travellers who have received inoculations from Wembley practitioners. It is necessary sometimes to arrange for immediate attention to these documents as, for example, the traveller who late one evening required a signature before 6.00 a.m. the following day. He was travelling to Australia by boat and it was suggested he could leave a forwarding address of the Shipping Agents at Port Said or some Port en route, and the authenticated document would be forwarded to the agents by registered air mail for collection on arrival. These arrangements, however, were not acceptable to the traveller and ultimately the certificate was authenticated and signed at 10.00 p.m. During the year 1,133 certificates received attention in the Department. 22 23 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 62 10 6 3 3 6 1 2 5 1 11 6 8 8 12.90 Diphtheria Nil — — — — — — — — — — — — — 00.00 Pneumonia 71 5 6 3 7 9 5 6 5 5 7 7 6 20 28.17 Erysipelas 19 4 1 — 1 5 — 1 2 1 1 — 3 4 21.05 Ophthalmia neonatorum 2 1 - - - - 1* - - - - - - 1 50.00 Meningococcal infection 1 1 - - - - - - - - - - - 1 100.00 Dysentery 16 1 2 3 1 1 — — 1 2 3 2 — 4 25.00 Measles 812 17 38 19 124 114 126 137 95 14 15 32 81 6 00.74 Whooping cough 169 37 13 15 16 22 10 10 7 13 11 4 11 4 02.37 Poliomyelitis:— Paralytic 14 1 — 1 4 1 2 — 4 — — 1 — 12 85.71 Non-Paralytic 3 - - - - 1 - - 1 - - - 1 2 66.67 Typhoid fever Nil - - - - - - - - - - - - - 00.00 Paratyphoid fever 1 - - - 1 - - - - - - - - - 00.00 Food Poisoning 23 3 5 1 1 — 2 2 2 1 6 — — 4 17.39 Puerperal Pyrexia 26 — 1 1 — — 24* — — — — — — 24 92.31 Encephalitis:— Infective Nil - - - - - - - - - - - - - 00.00 Post Infectious 1 - - - - - - - - - 1 - - 1 100.00 * Kingsbury Maternity Hospital cases. 24 Notifications of Selected Infectious Diseases according to sex and age as finally diagnosed. Age Group. Scarlet Fever. Whooping Cough. Diphtheria. Measles. Dysentery. Poliomyelitis. Meningococcal infection. Age Group. Acute pneumonia Erysipelas. Encephalitis Food Poisoning. Typhoid Fever Paratyphoid Fever. Paralytic. NonPara lytic. Acute infective. Postinfec tious. M. F. M. F. M. F. 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 - - 4 5 - - 5 10 - - - - - - 1 - 0 4 - - - - - - - 1 1 - - — — 1 — — 4 8 - — 29 35 - — — — — - — — 5 4 2 — 1 - - 1 — 3 2 — — — — 2 — 1 4 8 - — 42 45 - 1 — — — - — — 15 4 10 1 1 — - — — 5 8 — — — — 3 3 4 8 10 - — 59 42 - — — — — - — — 45 13 13 3 7 - - - - 3 - - - - - 4 6 — 16 16 - — 50 48 - 1 — — — - — — 65 & over 8 13 4 2 - - - - - - - - 1 - 5 22 13 34 40 - — 229 205 1 2 — 3 1 - - — 10 7 2 5 5 — — 4 3 1 — 1 2 - — — 15 1 2 — — - — 2 4 3 1 — 1 — - — — 25 & over 1 - 1 1 - - - - 2 4 4 5 - - - - A11 ages 40 22 76 93 Nil 420 392 6 10 4 10 3 — 1 — A11 ages 33 38 8 11 Nil 1 — 12 11 Nil 1 — Monthly incidence of the Infectious Diseases. Disease. January. February. March. April. May. June. July. August. September. October. November. December. Total. Scarlet fever 11 6 10 11 5 7 2 2 1 2 2 3 62 Diphtheria . — — — — — — — — — — — — Nil Pneumonia 7 1 10 8 4 3 2 1 2 12 11 10 71 Erysipelas 4 1 2 1 2 2 1 — 3 2 1 — 19 Dysentery 1 2 1 2 — — 4 4 — — 1 1 16 Measles 122 180 156 51 56 104 116 20 4 — — 3 812 Whooping cough 13 13 22 26 45 22 9 12 — 2 3 2 169 Paratyphoid fever - - - - - - 1 - - - - - 1 Poliomyelitis:— Paralytic 1 1 — — — 5 2 2 1 1 — 1 14 Non-Paralytic - - - - - - - - 2 - - 1 3 Encephalitis :— Infective - - - - - - - - - - - - Nil Post- Infectious - - - - - 1 - - - - - - 1 Meningococcal infection - 1 - - - - - - - - - - 1 Food poisoning 1 1 3 1 5 2 4 2 3 — — 1 23 Winter Respiratory Diseases (October—March). Notifications of primary pneumonia and acute influenzal-pneumonia. Death certificates in which respiratory diseases mentioned. 1953-54 40 163 1954-55 56 156 1955-56 57 187 1956-57 30 98 1957-58 71 172 25 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 19 28 36 37 79 81 36 — — — — 2 318 Mumps 4 18 19 3 37 50 8 — 1 6 14 46 206 German measles 4 2 35 21 23 5 - - 1 - - - 91 Tuberculosis. No. of Notifications. Pulmonary. Non-pulmonary. Male. Female. Male. Female. Under one year — — — — 1 to 4 years — — — — 5 to 14 years — — 1 — 15 to 24 year 5 5 1 1 25 to 34 years 6 6 — 2 35 to 44 years 3 3 1 1 45 to 54 years 6 1 — — 55 to 64 years 7 — 2 — 65 and over 5 — — 2 Totals 32 15 5 6 26  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 — — — — 25 to 34 years — 1 — — 35 to 44 years — — — — 45 to 54 years — 1 — — 55 to 64 years 3 — — — 65 and over 1 1 — 2 Totals 4 3 Nil 2 This includes deaths from all causes of cases on the Tuberculosis Register. No admitted to hospitals or Sanatoria: No. discharged from hospitals or Sanatoria: 17 35 During the year 174 cases removed from register. At 31st December 956 names remained on register — 883 pulmonary and 73 non-pulmonary. Of 10 deaths from tuberculosis, 8 were notified during life (80.00%). Food Poisoning Outbreaks. There was no outbreak of food poisoning during the year. 27 Bacteriological Service (at Central Public Health Laboratory). Examinations made. Quarter ending Total for 12 months. 31/3/57. 30/6/57. 30/9/57. 31/12/57. Throat and Nose Swabs. Diphtheria — — — — — Hæmolytic Streptococci 24 17 12 10 63 Vincents angina 1 - 1 1 3 Negative 106 65 59 57 287 Faeces. Shigella 1 — 6 7 14 Salmonella 4 — 12 — 16 Cl. Welchi — 1 — — 1 E. Coli — — — — — Negative 35 47 50 34 166 Urine. Negative - - - 1 1 Sputum. T.B. smear - 4 2 8 14 Other organisms - - - - - Negative 14 11 28 10 63 Pertussis. Per nasal swab - — - - - Negative 12 7 2 — 21 Blood. Paul Bunnel: Positive 1 — — 1 2 Negative - 2 - - 2 Scabies. Only 6 cases of scabies, five adults and one child, were treated during the year. Laundry for the Incontinent Aged. No. of cases 34 Cost of Laundry £168 12s. 7d. 28 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, 1950, registration of hawkers of food and premises—Registration under Milk and Dairies Regulations—Supervision under Milk (Special Designations) Regulations—Inspections under the Food Hygiene Regulations, 1955—Inspections and sampling under the Ice Cream (Heat Treatment, etc.) Regulations, 1947 and 1948—Housing, overcrowding, disrepair, ascertainment and action thereon—Issue of Certificates of Disrepair under the Housing Repairs and Rents Act, 1954—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 — Prevention of Damage by Pests Act, 1949, ascertainment of infestations and dealing therewith—Disinfestation of verminous premises — Identification of, and advice on methods of eradicating household pests — Borough bye-laws relevant to P.H. Inspectors, Good rule and government and prevention of nuisances, Nuisances, Offensive trades, Slaughterhouses, Ventilation and lighting of stables, Building bye-laws, Public sanitary conveniences, Removal of offensive matter, etc., through the streets, Removal of house refuse. 2. HOUSING. The Housing Act of 1957 was passed during the year, to consolidate many previous enactments relating to housing, and was the new statute under which a considerable amount of work in this sphere was undertaken in the Department during the year. Statistical details are included in the Appendix to this chapter. Legal Proceedings. Legal proceedings were taken against an owner in respect of two Premises requiring repair and following the service of statutory notices under Section 93 of the Public Health Act, 1936. The Court made 29 an order for the work to be carried out within twenty-eight days and the owner was find £5 0s. 0d. and ordered to pay costs of £2 2s. 0d. and 8/6d. and a witness fee of £1 0s. 0d. Eventually the Borough Council instructed a builder to carry out the work and the cost was recovered from the owner. Overcrowding. The number of cases of overcrowding known to the Health Department has shown a steady decrease as the following figures indicate. Year. Number of Cases of overcrowding on Register. Total Number of Cases of overcrowding relieved during the year. Number of Cases of overcrowding relieved during the year by removal to unknown addresses. 1948 602 307 22 1949 558 268 86 1950 516 133 6 1951 517 52 9 1952 456 102 2 1953 424 52 3 1954 303 133 95 1955 204 108 102 1956 169 47 42 1957 175 5 3 Household Pests. The number of bug-infested houses has shown a marked decrease in recent years and only 20 cases were recorded during 1957. With the advent of D.D.T. and B.H.C. which with their derivatives remain toxic to insects for long periods after their application, the control of insects has become a much easier problem. Fleas which in years past were quite a common pest are now very rarely encountered Despite this great decrease in the prevalence of insects parasitic to man the Department receives many enquiries with respect to other pests as to their identification and control. In most cases the Depart ment is able to indentify the species but in cases of doubt the Entymologists at the Natural History Museum at South Kensington 30 have readily given their advice. The commonest household pest: which form the subject of enquiries nowadays are carpet beetles, silver fish, ants, furniture beetles and scavanger beetles. It is also quite common to find that insects normally found in gardens and which do no real harm indoors have invaded the house and given cause for anxious concern to occupiers. The identification of such insects, advice on control and the assurance that they are harmless afford considerable relief to house occupiers. Rats and mice are dealt with later in this Report. 3. WATER SUPPLY. The water supply of the Borough, which is provided by the Colne Valley Water Co., except for a small area in the southern end of the district supplied by the Rickmans worth and Uxbridge Valley Water Co., remained satisfactory in quality and quantity. The supply is pumped from deep wells in. the chalk outside the Borough boundaries. All of the samples taken from piped supplies were reported as satisfactory. No tendency to plumbo solvent action has been detected. All dwelling houses in the Borough are provided with a mains water supply. There is a number of private wells in the Borough all in connection with industrial undertakings, but in no instance is the water from these sources used for drinking. The Council have continued to express their concern at the hardness of the public water supplies which have a total hardness range from 210—274 parts per million. Whilst there would not appear to be evidence of prejudicial effects to health from such hard water its detrimental effects on boilers and hot water systems are well-known. 4. SWIMMING POOLS. The two outdoor Swimming Pools have continued to be a source of enjoyment and healthy recreation. "Breakpoint" chlorination or superchlorination which was installed just prior to the 1951 season has made it possible to maintain a sparkling clear water, together with a minimum risk of infection. Attendances at the Pools during the year were:— Kingsbury 113,665 Vale Farm, Wembley 94,057 31 5. LEGAL PROCEEDINGS IN CONNECTION WITH FOOD. Legal proceedings were necessary in the following instances:— A bottle of milk containing a block of wood—defendants fined £25 0s. 0d. and £2 2s. 0d. costs. Smoking in food retail shop—defendant fined £5 0s. 0d. and £2 2s. 0d. costs. An appeal to Quarter Sessions was dismissed. Placing of foodstuff, namely poultry, on a tray on the forecourt so as to involve risk of contamination—defendant fined £5 0s 0d. and £5 5s. 0d. costs. In nine other cases of articles of food containing foreign matter warnings were sent to the manufacturers. 6. DRIED EGG POWDER. An interesting circumstance occurred during the year occasioned by the use of dried egg powder in the making of doughnuts. A substantial firm in the Borough has for many years engaged in preparing doughnut flour, incorporating in the mixture, pre-pasteurised dried egg imported from America. The Managing Director (Canadian by nationality) thought he would prefer to import dried egg prepared in Canada, and ordered a considerable quantity amounting to 9,000 pounds of the powder from that source. The examination of samples, however, of this importation, revealed the presence of Salmonella organisms in the bulk, and it was necessary to "hold up" this material and some doughnut mix already prepared with this dried egg, until further investigations had been made to determine the extent to which the organisms were distributed throughout the consignment. Whilst the published results of tests carried out at this time indicated that Salmonellae do not survive most baking processes, it is dangerous to have contaminated products in a bakehouse owing to the possibility of them coming into contact with non-baked material, e.g., synthetic cream. Ultimately it was found possible to release all but a small fraction of the original powder but the events set in train as a consequence of this incident are likely to be of great benefit to all firms using dried egg for the preparation of foodstuffs. 32 At the time no satisfactory methods of sterilising egg after drying was known; pasteurisation of the liquid egg before drying is effective but cannot be applied to the powder. However, experiments in Canada, using Ethylene Oxide, suggested that dried egg could be effectively sterilised, even after packaging in certain wrapping materials, and from recent imported samples treated by Ethylene Oxide in Canada it has not been found possible to isolate Salmonellae in any consignment. It seems therefore that this patented system of Ethylene Oxide treatment of egg after drying affords an important new method of sterilisation which could be used in the event of the discovery of pathogenic organisms in dried egg if the necessary plant were to be set up in this country, and should be of considerable value to Public Health Departments and to the trade users of imported dried egg. 7. THE KEEPING OF ANIMALS. The breeding of animals in suburban residential gardens can never be regarded as satisfactory on grounds of public health, although many residents, if they feel so disposed, do accommodate animals in the immediate neighbourhood of their residences. It is possible with great care to maintain a good standard of hygiene when an occasional animal or bird is kept as a pet in a small garden ; the standard of amenity, however, must be materially altered when the keeping of animals in the garden of a residence is undertaken for commercial purposes, and such a case during the year caused considerable difficulty. The establishment was a farm of some 150 head of mink and occasioned serious protest from neighbouring residents. The grinding of the food, the alleged stench, and the alleged nuisance from flies, were all the subject of complaint. Frequent visits were paid by the District Inspector and other members of the Council's staff, but on no occasion could the offence be regarded as reaching the magnitude of a statutory nuisance and it was felt that the animals were not kept "in such a way" or in such a place" as to warrant formal action under the Public Health Act. The Council, however, urged upon the owner of the farm that such use of the land was not in the best interests of the neighbourhood, and ultimately our difficulties were resolved by the owner removing to a rural area. This seems to be a good illustration of how the long and patient application of moral pressure, without resort to legal action, can finally have worthwhile results. 33 8. NOXIOUS EFFLUVIA. The proximity of industrial development to residential areas in Wembley has, during the year, occasioned several complaints of unpleasant odours emanating from factories to the disturbance and annoyance of residents. Where the noxious smell arises as a consequence of some industrial process, such as in engineering works, it is comparatively easy to make arrangements for the offending air, which is usually extracted by some ventilating system, to be discharged to the open air at such an altitude or situation as to minimise complaint by residents. Where the actual material manufactured emits an odour during the process of manufacture, then the size of the particulate cloud is consequently increased and difficulties in dealing with this type of offence are magnified proportionately. Very detailed investigations of methods of dealing with such effluvia have been undertaken in Wembley. There are many basic methods of dealing with the impregnated air, but in industrial application the following are most important. If it is possible to extract the odoriferous fumes and inject these into a furnace, when the suspended material which causes the odour will be burnt and probably completely oxidised to an inert particle or gas. Another method, successful where the particulate concentration is large, involves the passing of the extracted air over an oxy-catalyst which by chemical reaction oxidises the material causing the smell, burning this away, and by this combustion, maintains a temperature which in turn oxidises the next approaching contaminated air stream. It is known that some smells will counteract others and there are firms who specialise in the balancing of odours in such a way that no sensation is appreciable to the human sense of smell. This is an extremely abstruse and secret field of work but on occasions where industrial smells have been very offensive success has been achieved by reducing the intensity of the odour below the threshold of complaint. A natural method is to extract the air contaminated with odoriferous particles and discharge this via a duct at high altitude, when dispersal and oxidation of the particulate content will occur before the gases return to ground level. The use of scrubbers, ultra violet ray, oxidising agents or absorption, also finds application in the industrial field. 34 Obviously any method is going to involve expense and most of them will entail considerable outlay on capital works. The Public Health Department therefore is at a disadvantage in negotiating with the factory ownership as it must keep in mind all the time the best practicable means of reducing the offence having regard to cost, and if the service of a statutory notice is contemplated must also indicate [he works required to abate any nuisance which may exist. This is an extremely specialised technical field and has called for much research and application on the part of the Inspectorate. 9. SEWERAGE AND DRAINAGE. The Preston Park scheme prepared by the Borough Engineer and Surveyor for the relief of surface water and sewage flooding was commenced in 1956 and completed in 1957. The scheme has also eliminated a number of sewage overflows into the surface water system. A similar scheme is being prepared for the North Kingsbury area to prevent sewage flooding and eliminate overflows. Work on the surface water system in the Stag Lane area has commenced. Two cesspools remain in the district, both of which receive only drainage from sports pavilions which are too remote from sewers for the premises to be connected. All dwelling houses are provided with water closets connected to the Council's sewers. 10. RODENT CONTROL. The Rodent Control Service which is confined to dealing with infestations by rats and mice has continued to operate during the year under review. A staff of three "Ministry trained" assistants has performed the necessary work. One member of the staff of this branch—Mr. H. Loadsman—who was working from year to year after normal retiring age, unfortunately passed away at the end of the year and opportunity is taken in this report to record his enthusiastic and loyal service during his 15 years in the Health Department. In all he had served the Corporation for 24 years. No charge is made to householders in respect of treatment at private dwelling houses Hut in all other cases a charge is made on a time and materials basis. 747 premises were satisfactorily treated by the Council and 6 premises were known to have been treated privately. 35 The following details of sewer treatment have been provided by the Borough Engineer and Surveyor. In February, 1957, a 10% test bait of sewer manholes was carried out; 370 manholes were baited and there were 27 "takes." In the treatment which followed (No. 22 February/March) 296 manholes were baited and there were 88 "takes." Treatment No. 23 was carried out in July, 1957 (manholes baited 135, "takes" 22) and No. 24 in November (manholes baited 40 and " takes" 4). No new developments in poisoning technique were introduced during the year and Warfarin has continued to produce good results. 11. PUBLIC CLEANSING. The Director of Public Cleansing has kindly supplied the following information:— Refuse Collection. House and Trade refuse is collected weekly, with the exception that refuse from certain blocks of flats is collected twice weekly. The amount of refuse collected during the year was 28,610 tons. The separate collection of waste paper from business premises free of charge has been maintained. The amount collected from this source during the year was 750 tons. Refuse Disposal. Refuse is disposed of by a Separation and Incineration Plant which has handled 29,660 tons. Salvage materials amounting to 3,491 tons were sold for £19,530. Street Cleansing. The new system of street sweeping by the use of pedestrian controlled electric trucks, each with an operator and four street orderlies, continues to give a frequency of sweeping of at least once every seven days. Public Conveniences. The increase in use of the free washing facilities at the two staffed Conveniences in the Borough has been maintained during the year. 36 STATISTICAL APPENDIX C. Number of complaints received and investigated 1,955 Visits made by Public Health Inspectors 19,640 (a) Dwelling Houses:— Visits under Public Health Acts 5,081 Visits under Housing Acts 246 Visits under Rent Acts 226 Visits re overcrowding 106 Visits to bug infested premises 32 Visits re other vermin (excluding rats and mice, see below) 56 Visits re cases of infectious disease 729 Visits to cases of food poisoning 33 (b) General Environmental Public Health:— Drains and sewers inspected 2,067 Drain and Sewer Test applied 103 Cesspools, etc. 2 Urinals, latrines, chemical closets 60 Stables, manure pits, etc. 17 Piggeries (number on register at end of year 2) 60 Ditches and streams 256 Open spaces, etc. 197 Yards 1,812 Public conveniences 57 Tents, vans and sheds 15 Factories—Mechanical 1,180 „ —Non-mechanical 34 Workplaces 221 Outworkers 116 Smoke observations—half hourly 200 „ „ —casual 1,570 „ „ —visits to plant 86 Cinemas, Dance Halls, Public Houses, etc. 140 Hairdressers (number of establishments on register at end of year 92) 49 Schools (number of private schools 19) 89 Markets 30 Rats and Mice 238 37 Swimming baths—visits 27 „ „ —Water examination 2 Chlorine tests 8 Elderly persons housing accommodation 349 (c) Food, including milk, meat, water:— Number of dairies registered at end of year 13 Number of distributors of milk registered, with premises in the Borough selling milk in properly closed and unopened receptacles 40 Number of distributors of milk registered whose premises are outside the Borough 20 Number of dairies (included above) where milk is bottled 1 Inspection visits made to:— Meat shops, stalls, etc. (number on register at end of year 83) 347 Slaughterhouse 95 Dairies and milk shops—visits 99 „ „ „ „ —milk samples taken 8 Fried fish shops (number on register at end of year 14) 73 Bakehouses (number on register at end of year 13) 86 Ice cream premises (number on register at end of year 217) 58 Ice cream—samples taken 5 Fishmongers and poulterers (number on register at end of year 28) 178 Greengrocers and fruiterers (number on register at end of year 97) 251 Grocers, etc. (number on register at end of year 267) 404 38 Restaurants, cafes, etc. (number on register at end of year 101) 363 Street vendors, hawkers, etc. (number on register at end of year 76) 45 Other food premises 400 Water supply—visits 94 „ „ —samples taken 13 (d) Other visits and inspections:— Massage establishments, etc 41 Certificates lodged by Members of the Chartered Society of Physiotherapy 4 New Licences granted 1 Licences renewed 17 Noise nuisances 332 Dust nuisances 62 Effluvia nuisances 333 Petroleum stores 382 Miscellaneous 477 Number of written notices served 230 Number of statutory notices served 20 Nuisances abated and improvements effected. (a) Dwelling Houses:— Roofs repaired 140 External walls and chimney stacks repaired 65 Gutters and spouts repaired or renewed 89 Damp-proof courses provided 6 Dampness remedied 79 Yards paved or repaired 12 Internal walls and ceilings repaired 113 Doors repaired or renewed 22 Windows repaired or renewed 54 Floors repaired or renewed 43 Sub floor vent. provided or improved 10 Rooms cleansed or redecorated 135 39 Passages and staircases redecorated 50 Staircases repaired 8 Fireplaces and flues repaired or renewed 26 Cooking stoves repaired or renewed 2 Sinks and washbasins provided or renewed 12 Waste pipes repaired or renewed 36 Food stores provided or improved 2 Dustbins provided or renewed 28 Water supply improved or reinstated 50 W.C. walls, etc., cleansed 5 W.C. pans cleansed 8 W.C. pans repaired or renewed 35 W.C. structures repaired or renewed 7 W.C. lighting and ventilation improved 5 W.C. flush pipe joints repaired 8 Additional W.C.'s provided 1 (b) General Environmental Public Health:— Drains cleansed from obstruction 986 Drains repaired or renewed 88 New drains provided 15 New inspection chambers provided Inspection chambers repaired 20 Soil pipes and vent. shafts repaired 23 W.C.'s repaired 37 W.C.'s cleansed 11 Cesspools emptied 1 Urinals and latrines—cleansed or emptied 6 Stables, manure pits—cleansed 3 „ „ „ —repaired 3 Piggeries cleansed or limewashed 3 Pigsties repaired 3 Animal nuisances abated 6 Offensive accumulations removed 71 Ditches and streams—cleansed 13 „ „ „ —pollution remedied 6 Smoke nuisances abated 40 Improvements in boiler plant or fuel effected 13 40 Cinemas, Dance Halls, etc. — contraventions remedied 3 Hairdressers—contraventions remedied 3 Tents, Vans and Sheds—nuisance abated 1 „ „ „ „ —Removed 1 Schools—sanitary conditions improved 3 „ —urinals and W.C's cleansed or repaired 1 Markets—contraventions remedied 4 Noise nuisances abated 15 Dust nuisances abated 3 Effluvia nuisances abated 5 Petroleum—contraventions remedied 9 (c) Eradication of bed bugs:— (i) Number of Council houses:— Found to be infested and subsequently dis- infested 12 (ii) Number of other houses:— Found to be infested and subsequently dis- infested 8 (i) by hydrogen cyanide — (ii) by liquid insecticides 8 Other vermin eradicated (not including rats and mice) 38 Verminous articles destroyed 14 (d) Meat and other Food Premises:— Meat shops, stalls, etc.—premises cleansed 44 „ „ „ „ —other contraventions remedied 19 Dairies—cleansed and distempered or painted 7 „ —premises repaired 3 „ —other contraventions remedied 3 Bakehouses — cleansed and distempered or painted 14 „ —sanitary conditions improved 7 „ —other contraventions remedied 4 41 Ice cream premises—cleansed and distempered or painted 3 „ „ „ —sanitary conditions improved 2 Fried fish shops—cleansed and distempered or painted 5 „ „ „ —sanitary conditions improved 1 „ „ „ —other contraventions remedied 4 Fishmongers, etc., contraventions remedied 19 Grocers, etc., contraventions remedied 28 Greengrocers, etc., contraventions remedied 31 Restaurants, Cafes, etc., contraventions remedied 56 Street hawkers, contraventions remedied 7 Other food premises., contraventions remedied 16 2,820 Unsound Food Surrendered:— 7 lbs. Fillet of Cod. 1 tin Sild. 8 stone Skate. 2 tins Roes. 2 stone Herrings. 2,941 tins Fruit. 1 stone Kippers. 71 lbs. Fruit. 14 stone Dog Fish. 72 tins Fruit Juice. 6½ stone Whiting. 9 tins Jam. 2 boxes Roes. 1 tin Conserve. 111½ lbs. Bacon. 8 tins Marmalade. 832 lbs. Beef. 872 tins Vegetables. 944 lbs. Pork. 15 pkts. Fish Fingers. 1 Beefsteak Pie. 12 pkts. Kippers. 3 lbs. Beef Sausages. 9 pkts. Haddock. 56 lbs. Liver. 12 pkts. Cod. 5½ lbs. Boiling Fowl. 11 pkts. Plaice. 23 lbs. Pigs' Plucks. 12 pkts. Beans. 18 lbs. Heart. 12 pkts. Peas. 212 lbs. Lamb. 4 pkts. Spinach. 42 37 lbs. Roasting Chicken. 10 pkts. Mixed Vegetables. 23½ lbs. Ham. 2 pkts. Chicken Pies. 1,502 lbs. Sow Meat. 1 bottle Pickled Onions. 15 lbs. Kidney. 45 tins Tomato Paste. 25 lbs. Veal. 207 tins Tomato Juice. 84 tins Corned Beef. 54 tins Tomato Puree. 144 tins Luncheon Meat. 17 tins Soup. 52 tins Stewed Steak. 2 pkts. Cereals. 357 tins Ham. 2 sacks Oats. 4 tins Sausages. 1 tin Rice. 310 tins Pork. 49 tins Evaporated Milk. 3 tins Liver. 10 tins Cream. 27 tins Tongue. 145 lbs. Cheese. 16 tins Veal. 4 lbs. Cheese Trimmings. 23 tins Chicken. 26 lbs. Butter. 9 tins Brisket of Beef . 218 pkts. Margarine. 1 tin Steak & Kidney Pie. 1 cwt. keg Tartaric Acid. 3 tins Beef Loaf. 2 cartons Dripping. 2 tins Turkey Breast. 14 cases Dripping. 4 tins Pressed Beef. 2 pkts. Custard Powder. 1 tin Frankfurters. 3 tins Spaghetti. 1 carton Suet. 1 tin Cocoa. 36 tins Pilchards. 1 jar Ham Paste. 19 tins Sardines. 5 jars Mincemeat. 1 tin Tuna. 1 bottle Sauce. 1 tin Herrings. 38—100 lb. bags Doughnut 1 tin Crawfish. Mix. 12 tins Shrimps. 1 pt. Ginger Beer. 3 tins Salmon. 1—10 oz. bottle Coffee. 4 tins Crab. 1—4 oz. bottle Olive Oil. 3 tins Brisling. 43 Slaughterhouse. There is one private Slaughterhouse licensed in the Borough. This was discontinued during the War and was brought back into operation in 1952. Particulars of inspections, etc., are as follows:— Carcases Inspected and Condemned. Cattle, excluding Cows. Cows. Calves. Sheep and Lambs. Pigs. Number killed 68 - 14 456 40 Number inspected 68 — 14 456 40 All diseases except tuberculosis and cysticerci:— Whole carcases condemned — — — — — Carcases of which some part or organ was condemned 3 - - 2 - Percentage of the number inspected affected with disease other than tuberculosis and cysticerci 4.4 - - 0.44 - Tuberculosis only:— Whole carcases condemned — — — — — Carcases of which some part or organ was condemned 1 - - - - Percentage of the number inspected affected with tuberculosis 1.5 - - - - Cysticercosis:— - - - - - Carcases of which some part or organ was condemned - - - - — Carcases submitted to treatment by refrigeration - - - - - Generalised and totally condemned - - - - — 44 Inspection of dwelling-houses during the year:— (a) (i) Total number of dwelling-houses inspected for housing defects (under Public Health or Housing Acts) 1,975 (ii) Number of inspections made for the purpose 5,465 (b) (i) Number of dwelling-houses (included under sub-head (i) above) which were inspected and recorded under the Housing Consolidated Regulations, 1925/1932 14 (ii) Number of inspections made for the purpose 46 (c) Number of dwelling-houses found not to be in all respects reasonably fit for human habitation 1,821 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 1,788 Action under statutory powers during the year:— (c) 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 20 45 (ii) Number of dwelling-houses in which defects were remedied after service of formal notices:— (1) by owners 22 (2) by Local Authority in default of owners 4 (c) Proceedings under Section 16 of the Housing Act, 1957 (i) Number of dwelling-houses in respect of which Demolition Orders were made (ii) Number of dwelling-houses demolished in pursuance of Demolition Orders 1 (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 One (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 mitted number of persons who may occupy a house 54 (b) Number of dwellings recorded as overcrowded at the end of the year 175 Number of families dwelling therein 197 Number of persons dwelling therein 874 (c) Number of new cases of overcrowding reported during the year 11 46 (d) (i) Number of cases of overcrowding relieved during the year 5 (1) by removal to unknown addresses 3 (2) rehoused by Council 2 (ii) Number of persons concerned in such cases 31 (e) Cases in which dwelling-houses have again become overcrowded after the Local Authority have taken steps for the abatement of overcrowding Nil New Houses. The Borough Engineer and Surveyor has kindly supplied the following information:— Number of new houses and flats erected during the year : (1) by the Local Authority None (2) by other bodies or persons 120 47 Factories. Number of factory premises — 459. Premises. Number of :— Inspections. Written Notices. Occupiers Prosecuted. Factories with mech. power 1,180 - - Factories without mech. power 34 3 — Other Premises — 1 — Totals 1,214 4 — Defects found. Particulars. No. of defects:— Found. Remedied Referred to H.M. Inspector. Referred by H.M Inspector. Want of cleanliness 1 1 - 1 Overcrowding — — — — Unreasonable temperature — — — — Inadequate ventilation — — — — Ineffective drainage of floors — — — - Sanitary Conveniences:— Insufficient 2 1 — — Unsuitable or defective 8 7 — 1 Not separate for the sexes — — — — Other offences 4 4 — - Totals 15 13 — 2 48 Outworkers. Number on register at end of year 524 Nature of work:— Making, repairing of:— Wearing apparel 362 Household linen 4 Lace, lace curtains, nets 13 Furniture hangings, curtains 3 Furniture and upholstery 4 Brass and brass articles 10 Fur pulling 3 Artificial flowers 5 Sacks 1 Making of boxes or other receptacles or parts thereof, etc., of paper 14 Carding of buttons 10 Stuffed toys 9 Cosaques, Christmas crackers, Christmas stockings, etc. 53 Lampshades 26 Baskets 4 Feather sorting 2 Textile weaving 1 Offices. Number on the register — 334. 49 Shops Act, 1950, Section 38. The Senior Shops Inspector has supplied the following statistics relating to the arrangements for the health and comfort of shop workers, made in accordance with the provisions of the Shops Act Number of inspection visits 1,414 Section 38 (1) (b)—temperature:— Number of shops in which a reasonable temperature was not maintained 24 Section 38 (2)—sanitary conveniences:— Number of shops in which sanitary conveniences were not suitable and sufficient 19 Number of certificates of exemption granted Nil Section 38 (4)—washing facilities:— Number of shops in which washing facilities were not suitable and sufficient 6 Number of certificates of exemption granted Nil Section 38 (5)—facilities for meals:— Number of shops in which facilities provided were not suitable and sufficient 3 Disinfection of Premises and Articles. Disinfections for:— Infectious diseases 99 Cancer 1 Vermin (routine protection from) 58 Miscellaneous 47 205 50 Articles disinfected or destroyed:— Disinfected. Destroyed. Bedding and bedclothing 649 49 Wearing apparel (including 918 articles for abroad) 975 12 Carpets, rugs, cushions, curtains 19 2 Others 63 7 1,706 70 The Prevention of Damage by Pests Act, 1949. Work carried out 1/4/57 to 31/3/58:— Rats. Mice. (1) Number of premises visited 1,666 171 (2) Number of visits by Public Health Inspectors 238 (3) Number of visits by Rodent Control Assistants 5,296 1,050 (4) Number of premises which received treatment by Rodent Control Assistants 584 163 (5) Number of premises satisfactorily treated privately 5 1 (6) Number of Council premises (included in (4) ) 8 6 51 Milk (Special Designations) Orders. Licences issued. Dealers. Supplementary. Tuberculin tested 28 19 Pasteurised 28 19 Sterilised 38 21 Samples of designated milk taken. No. of sample taken. :s No. not satisfactory. Pasteurised 3 — Tuberculin tested 2 2 T.T. (Pasteurised) 2 — Sterilised 1 — 8 2 Laboratory Examinations re Food, Milk and Water. Examinations made 31.3.57 Quarter 30.6.57 ending 30.9.57 31.12.57 Total for 12 months Water — 7 2 4 13 Milk — — — 8 8 Ice Cream — 2 3 — 5 Other Foods 5 — — — 5 52 Food and Drugs Act, 1955. The Middlesex County Council are the Authority for the administration of this Act, and the Chief Officer of the Public Control Department has supplied the following particulars of sampling in Wembley during 1957:— Article. No. taken. Unsatisfactory. Milk, various 120 1 Milk, new 72 2 Soup 5 3 Butter 35 — Cakes 5 1 Cream 35 — Drugs 48 2 Fish and Fish products 28 — Fruit (fresh and canned) 6 2 Fruit Squash, etc 5 — Ice Cream 24 — Margarine 20 — Cooked Meats 4 — Meat and Meat products 46 — Liver 19 — Preserves 4 — Sausages 10 — Sweets 6 — Jelly 4 — Vinegar 33 2 Miscellaneous 26 4 555 17 53 Bye-laws in force throughout the Borough—December, 1957. Relating to the following matters:— Offensive Trades and Fish Frying, Hairdressers' Premises. New Streets. Slaughterhouses. Licensed Establishments for Massage and Special Treatment. Removal through Streets of Offensive Matter. Deposit of Litter. Removal of House Refuse. Public Conveniences. Nuisances. Good Rule and Government. Ventilation and Lighting of Stables. Pleasure Grounds. Sale of Contraceptives in Slot Machines. Handling, Wrapping and Delivery of Food. Cycling on Footpaths. Buildings. Emission of Smoke. Spitting. Sale of Coal and Coke (M.C.C.). Employment Agencies (M.C.C.). Employment of Children (M.C.C.). 54 CHAPTER V. ADMINISTRATION, STAFF. During the year your Medical Officers acted professionally for the Council in performing 58 clinical examinations of actual or prospective staff and have provided a number of special reports to the various Committees of the Council. This helps in securing a medically sound personnel for all the activities of the Council and enables special consideration to be given to any unusual incidence of sickness, thereby maintaining a standard of efficiency difficult without such a service. So far as the Inspectorate is concerned, there was depletion for a large part of the year owing to illness, which culminated in the untimely death of one Inspector in the early part of 1957. This Inspector, Mr. Ernest Power, had rendered the Council loyal and efficient service for 10 years. Early in 1957 Mr. Harold Young, the Deputy Chief Inspector, was taken ill and unfortunately died some months later. Mr. Young was also a loyal and efficient officer who served the Council for 33 years. In addition to his Public Health duties, he devoted much of his spare time to Civil Defence. Both of these officers will be sadly missed in the Department, not only because of their wide knowledge, experience, and devotion to the service of the community, but also for their agreeable characters and other personal attributes. We deeply mourn their untimely deaths. This depletion of the staff has had serious repercussions on the work of the Department and although it was felt in 1956 I regret to say its effect on the work during 1957 has been more profound. Great credit is due to the remaining staff for their constant and earnest endeavours to cope with the unfortunate situation in which the Department was placed. In conclusion, I would express my thanks and appreciation to all members of the Council, especially those who serve on the Health Committee, and particularly the Chairman, for the admirable way in which they have directed the policy of the Department during the year. I have the honour to be, Mr. Mayor, Ladies and Gentlemen, Your obedient servant, E. GRUNDY, Medical Officer of Health. 55 Hendon Printing Works Limited 42/44, Victoria Road London, N.W.4 'Phone: SUN. 1004