AC. 439 (1) WEH 39 BOROUGH OF WEMBLEY REPORT OF THE MEDICAL OFFICER OF HEALTH FOR THE YEAR 1958 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 1958 E. GRUNDY, M.D., M.R.C.S., D.P.H., Medical Officer of Health HEALTH COMMITTEE (May, 1958) The Mayor—Councillor R. A. PENNY, J.P. The Deputy Mayor—Alderman L. R. REECE, M.M. 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, N. M. LAMB, E. C. MEREDITH, M.P.S., F.S.M.C., W. T. PAVITT, B. D. ROBINS, T. C. WARDLE, 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, M.B., B.S., D.P.H. Chief Public Health Inspector: R. M. TURNER (a) (b) (c) Deputy Chief Public Health Inspector: C. DUERDEN (a) (b) (c) Public Health Inspectors: L. KLUTH (a) (b) (c) G. E. A. REYNOLDS (a) (b) (c) A. W. NICOL (a) (b) R. T. BEVAN (a) (b) (c) G. A. BUCKINGHAM (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. 3 BOROUGH OF WEMBLEY ANNUAL REPORT of the MEDICAL OFFICER OF HEALTH for the Year 1958 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 1958. This Report has been compiled in the following six chapters, three 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 6, Statistical Appendix A, Pages 7—13. „ II GENERAL HEALTH SERVICES, Pages 14—17. „ III INFECTIOUS DISEASES, Page 18, Statistical Appendix B, Pages 19—24. „ IV ENVIRONMENTAL HYGIENE, FOOD AND WATER, HOUSING, FACTORIES, ETC., Pages 25—33, Statistical Appendix C, Pages 34—51. V HISTORICAL SUMMARY, Pages 52—57. „ VI ADMINISTRATION OF THE DEPARTMENT AND STAFF, Page 58. 5 CHAPTER I. VITAL STATISTICS 1. The population of the Borough in mid-1958 was estimated by the Registrar-General to be 126,800 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 1958 there were recorded 1,520 live births, giving a crude birth rate of 11.99 per thousand estimated population. The RegistrarGeneral has provided boroughs with a comparability factor for this calculation which takes into account the relative proportion of women of child bearing age in the total community. When this factor of 1.01 is applied the standardised birth rate becomes 12.11, a more realistic figure, the origin of which, however, must be remembered when comparing it with past years. 3. The infantile mortality rate of 19.08 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. The number of deaths totalled 1,114, giving a crude death rate of 8.79 per thousand. The comparability factor when applied produces a standardised death rate of 10.28, a decrease on last year's figure and below the national rate. An increased number of deaths was recorded from Pneumonia, which is difficult to explain as the weather was not particularly severe and no extensive outbreak of Influenza or other upper respiratory diseases was experienced. The position is not unsatisfactory and surveillance will be continued. 6 STATISTICAL APPENDIX A. CERTAIN VITAL STATISTICS, 1958 from figures supplied by Registrar-General. (Some comparative 1957 figures within brackets.) Population Total 126,800 Live Births. Male. Female. Total. Live birth rate per 1,000 estimated population 11.99 Legitimate 751 714 1,465 (1,412) Illegitimate 23 32 55 (47) (11.44) Adjusted by Area Comparability Factor of Registrar-General 1.01 12.11 Stillbirths. Legitimate 10 13 23 Rate per 1,000 total (live and still) births 12.18 (11.64) Stillbirth rate per 1,000 estimated population 0.20 (25) Illegitimate 1 1 2 (-) (0.20) Deaths 612 502 1,114 Death rate per 1,000 estimated population— Crude rate 8.79 (1,173) (9.20) Adjusted by Area Comparability Factor of Registrar-General 1.17 Standardised rate 10.28 (10.86) 7 Infantile Mortality. Deaths of infants under one year of age:— Male. Female. Total. Legitimate 16 13 29 (24) 29 Illegitimate — — - (27) (3) Death rate of infants under one year of age: — All infants per 1,000 live births 19.08 (18.51) Legitimate infants per 1,000 legitimate live births 19.80 (17.00) Illegitimate infants per 1,000 live illegitimate births — (63.83) Maternal Mortality. Deaths from Pregnancy, Childbirth, Abortion - (-) Maternal mortality rate per 1,000 live births - (-) Maternal mortality rate per 1,000 total (live and still) births (-) 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 l mortality. Maternal mortality. Maternal mortality. Wembley 11.99 0.20 8.79 19.08 — — England and Wales 16.40 0.36 11.70 22.50 0.44 0.43 Area in acres 6,294 Estimated number of inhabited houses at end of 1958 38,500 Rateable Value, 31st December, 1958 £2,701,982 Estimate of the product of a penny rate 1958/59 £10,900 8 Causes of Deaths during the Year. Causes of Death. Male. Female. 1958. Total. 1. Tuberculosis, respiratory 5 2 7 2. Tuberculosis, other — 1 1 3. Syphilitic disease 3 1 4 4. Diphtheria — — — 5. Whooping Cough — — — 6. Meningococcal infections — — — 7. Acute poliomyelitis — — — 8. Measles — — — 9. Other infective and parasitic diseases 1 1 2 10. Malignant neoplasm, stomach 14 20 3-1 11. Malignant neoplasm, lung, bronchus 58 7 65 12. Malignant neoplasm, breast — 26 26 13. Malignant neoplasm, uterus — 9 9 14. Other Malignant and Lymphatic neoplasms 69 59 128 15. Leukaemia, aleukaemia 7 2 9 16. Diabetes 2 7 9 17. Vascular lesions of nervous system 62 75 137 18. Coronary disease, angina 143 67 210 19. Hypertension with heart disease 10 15 25 20. Other heart disease 46 52 98 21. Other circulatory disease 29 38 67 22. Influenza 1 4 5 23. Pneumonia 33 30 63 24. Bronchitis 38 17 55 25. Other diseases of respiratory system 5 1 6 26. Ulcer of stomach and duodenum 11 3 14 27. Gastritis, enteritis and diarrhoea 2 6 8 28. Nephritis and nephrosis 5 2 7 29. Hyperplasia of prostate 5 — 5 30. Pregnancy, childbirth, abortion — — — 31. Congenital malformations 5 3 8 32. Other defined and ill-defined diseases 41 40 81 33. Motor vehicle accidents 6 4 10 34. All other accidents 7 8 15 35. Suicide 4 2 6 36. Homicide — — — ALL CAUSES 612 502 1,114 9 The Principal Causes of Death. Disease. Total Number of deaths. 1. Heart disease and other diseases of circulatory system (18—21) 400 Vascular lesions of nervous system (17) 137 537 2. Malignant neoplasms (10—14) 262 3. Respiratory diseases:— (a) Influenza (22) 5 (b) Pneumonia (23) 63 (c) Bronchitis (24) 55 (d) Other respiratory diseases (25). 6 -129 4. Tuberculosis:— (a) Respiratory system (1) 7 (b) Other forms (2) 1 -8 5. Violent deaths:— (a) Suicide (35) 6 (b) Road traffic (33) 10 (c) Other violent causes (34) 15 -31 6. Congenital malformations (31) 8 Note: Numbers in brackets are index numbers allocated by Registrar-General for Annual Return of Causes of Deaths. 10  Percentage of total deaths under 1 year. Percentage of total deaths under 50 years. Percentage of deaths taking place in hospitals. 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 1958 2.86 12.42 57.89 SOME OTHER ESSENTIAL LOCAL STATISTICS. Birth Notifications (as supplied by Area Medical Officer). Notified by. At home. In Hospital. In Nursing Home. Totals. Doctors — 428 44 472 Midwives 315 784 — 1,099 Parents — - — — Totals 315 1,212 44 1,571 Percentages 20.1 77.1 2.8 100.0 Live births — 1,545 Still births — 26 11 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 11 - - - 11 - - - - - Pneumonia — 1 — — 1 1 — 3 1 6 Atelectasis 1 — — — 1 — — — — 1 Anaemia - - - - - 1 - - - 1 Exomphalos 1 — — — 1 — — — — 1 Multiple deformity — 1 — — 1 — — — — 1 Asphyxia Neonatorum 1 — — — 1 — — — — 1 Coronary Thrombosis - - - - - 1 - - - 1 Multiple lung abscesses . - - - - - 1 - - - 1 Pulmonary oedema - - - - - 1 - - - 1 Ruptured Spleen 1 — — — 1 — — — — 1 Interstitial Emphysema 1 — — — 1 — — — — 1 Cystitis and Pyelonephritis — 1 — — 1 — — — — 1 Misadventure - - - - - - - - - 1 16 3 — — 19 5 1 3 1 29 12 Infantile Mortality, 1954-1958. Year. Wembley. England & Wales. 1954 18.23 25.5 1955 17.18 24.9 1956 16.76 23.8 1957 18.51 23.0 1958 19.08 22.5 Infantile mortality during last five years (7,349 live births, 132 deaths under one year): 17.96 Maternal Mortality- Rate per 1,000 total births (live and still), 1954-1958:— Year. Wembley. England & Wales. 1954 0.66 0.69 1955 0.70 0.64 1956 1.31 0.57 1957 0.00 0.47 1958 0.00 0.43 Maternal mortality during last live years (7,486 total births, 4 maternal deaths): 0.53 13 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 West Hendon 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.) West Hendon 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 3406.) 14 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 provision of a new hospital at Northwick Park is, however, still under discussion between the Ministry and the Regional Hospital Board. 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. (WORdsworth 7724.) 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 111 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. 15 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. 16 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 1 case, an adult, was 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. Plans were prepared during the year by the Borough Engineer and Surveyor for the erection of a new Mortuary. Work was commenced in due course and the new building will be brought into operation in 1959. In the meantime the Harrow Corporation have permitted their Mortuary to be used for the reception of cases from Wembley which in 1958 amounted to 142 bodies. 17 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 West Hendon 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. 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 931 certificates received attention in the Department. 18 STATISTICAL APPENDIX B. 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 Tokvngton Total removed to hospital OT3 O O 2?s a " Ss rn m ft a Scarlet fever 73 3 6 6 5 9 6 4 1 9 4 18 8 7 08.80 Diphtheria Nil — — — — — - - - - - - - - 00.00 Pneumonia 64 6 3 1 5 10 4 8 8 3 3 3 10 16 25.0 Erysipelas 9 3 — 1 1 - — 2 1 - - - 1 1 11.1 Ophthalmia neonatorum 5 1 1 — — 1 2* - - - - - - 2 40.00 Meningococcal infection. Nil - - - - - - - - - - - - - 00.00 Dysentery 13 - 1 - 1 2 - - 1 - 2 1 5 2 15.30 Measles 875 120 51 101 138 35 80 29 34 101 135 17 34 6 00.60 Whooping cough 22 2 1 2 3 4 5 2 1 1 — — 1 - 00.00 Poliomyelitis:— Paralytic Nil — - - - - - - - - - - - - 00.00 Non-Paralytic Nil - - - - - - - - - - - - - 00.00 Typhoid fever 1 — — - - — - - - - - 1 - 1 100.00 Paratyphoid fever Nil - - - - - - - - - - - - - 00.00 Food Poisoning 17 - 4 - - 1 2 - 2 2 - 2 4 5 29.4 Puerperal Pyrexia 29 - - - - - 29* - - - - - - 29 100.00 Encephalitis:— Infective Nil - - - - - - - - - - - - - 00.00 Post Infectious Nil — — — — — — — — — — — — — 00.00 * Kingsbury Maternity Hospital cases. 19 20 Notifications of Selected Infectious Diseases according to sex and age as finally diagnosed. Age Group. Scarlet Whooping 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. Fever. Cough. 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 1 — 1 — — — 4 7 — — — — — — — — 0 4 2 — — — — — — 1 1 — — — — 1 — 1 — 2 — — 31 21 — — — — — — — — 5 5 2 — 1 — — — — 6 — — — — — 2 — 1 3 1 — — 49 32 — — — — — — — — 15 4 5 1 1 — — — — 4 2 1 — — — 3 3 2 1 3 — — 52 53 — — — — — — — — 45 13 8 3 3 — — — — — 1 — — — — 4 — 4 — 1 — — 65 66 — 1 — — — — — — 65 & over 7 14 — — — — — — — 2 — — — — 5 30 26 4 4 — — 252 216 2 1 10 3 6 1 1 — — 3 9 — — — — — — — — 15 1 — — — — — 4 3 2 — — — — — — — 25 & over 1 — — — — — 1 7 4 3 — — — — — — All ages 39 40 10 12 Nil 461 414 8 5 Nil Nil Nil All ages 33 31 4 5 Nil Nil 11 6 1 — Nil Monthly incidence of the Infectious Diseases. Disease. January. February. March. April. May. June. July. August. September. October. November. December. Total. Scarlet fever 3 11 11 3 5 12 9 1 — 1 10 13 79 Diphtheria — — — — — — — — — — — — Nil Pneumonia 10 18 5 3 3 2 3 — 3 2 3 12 64 Erysipelas 1 — 1 — 1 2 — 1 — 2 1 — 9 Dysentery 3 1 3 — 1 — 3 1 — 1 — — 13 Measles 6 14 23 120 167 274 139 50 8 1 15 58 875 Whooping cough 1 5 1 1 3 1 3 3 3 — — 1 22 Typhoid fever — — — — — — — — 1 — — — 1 Poliomyelitis:— Paralytic — — — — — — — — — — — — Nil Non-Paralytic — — — — — — — — — — — — Nil Encephalitis:— Infective — — — — — — — — — — — — Nil Postinfectious — — — — — — — — — — — — Nil Meningococcal infection — — — — — — — — — — — — Nil Food poisoning 1 3 — 1 2 — 4 2 3 — — 1 17 Winter Respiratory Diseases (October—March). Notifications of primary pneumonia and acute influenzal-pneumonia. Death certificates in which respiratory diseases mentioned. 1954-55 56 156 1955-56 57 187 1956-57 30 98 1957-58 71 172 1958-59 57 152 21 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 20 50 54 49 103 80 46 — 5 — 3 2 412 Mumps 2 2 4 10 22 38 8 — 6 14 9 3 118 German measles 2 — 2 21 30 36 4 — — 1 — 2 98 Tuberculosis. No. of Notifications. Pulmonary. Non-pulmonary. Male. Female. Male. Female. Under one year — — — — 1 to 4 years — 1 1 — 5 to 14 years — 2 — — 15 to 24 years 3 4 — — 25 to 34 years 2 2 — 2 35 to 44 years 1 1 1 1 45 to 54 years 5 4 — — 55 to 64 years 8 2 — — 65 and over 5 — 1 1 Totals 24 16 3 4 22  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 5 1 — — 55 to 64 years 6 3 — — 65 and over 3 — — — Totals 14 5 Nil Nil This includes deaths from all causes of cases on the Tuberculosis Register. No. admitted to hospitals or Sanatoria: No. discharged from hospitals or Sanatoria: 19 17 During the year 157 cases removed from register. At 31st December 824 names remained on register—759 pulmonary and 65 non-pulmonary. Of 6 deaths from tuberculosis, all were notified during life (100.00%). Food Poisoning Outbreaks. There was no outbreak of food poisoning during the year. 23 Bacteriological Service (at Central Public Health Laboratory). Examinations made. Quarter ending Total for 12 months. 31/3/58. 30/6/58. 30/9/58. 31/12/58. Throat and Nose Swabs. Diphtheria — — — — — Hæmolytic Streptococci 25 25 17 11 78 Vincents angina 3 3 — 2 8 Negative 92 85 25 81 283 Fæces. Shigella 12 — 3 — 15 Salmonella 12 — 16 2 30 Cl. Welchi — 2 — — 2 Paratyphi B 4 — — — 4 Negative 75 36 44 42 197 Urine. Negative 1 1 — — 2 Sputum. T.B. smear 3 7 — — 10 Other organisms — — — — — Negative 11 7 8 14 40 Pertussis. Per nasal swab — — — — — Negative 4 — 1 3 8 Blood. Paul Bunnel: Positive — — — — — Negative 2 — — — 2 Scabies. Only 9 cases of scabies, six adults and three children, were treated during the year. Laundry for the Incontinent Aged. No. of cases 38 Cost of Laundry £135 3s. 11d. 24 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 Rent Act, 1957 — 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 continued as the main 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. Proceedings were taken against the owners in respect of repairs required at two premises. In one case an Order was made under Section 94 of the Public Health Act, 1936, requiring the owner to 25 carry out the work within three months, and in the other case the owner was fined £2 2s. 0d., the Council were awarded £2 2s. 0d. costs, and an Order was made for the work to be carried out within twenty-eight days. 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. 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 1958 142 43 38 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 Rickmansworth 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. 26 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 106,253. Vale Farm, Wembley 82,954 5. LEGAL PROCEEDINGS IN CONNECTION WITH FOOD. A hawker was fined £2 0s. 0d. for selling food from a receptacle without being registered by the Borough Council under Section 11 of the Middlesex County Council Act, 1950. He had previously been warned and fined for the same offence. A firm of bakers were prosecuted on two occasions (1) for selling mouldy apple turnovers, for which they were fined £5 0s. 0d. and the Council awarded £3 3s. 0d. costs; and (2) for selling a mouldy loaf of broad, for which thev were fined £8 0s. 0d. and the Council awarded £3 3s. 0d. costs. A dairy company were lined £15 0s. 0d. and the Council awarded £2 2s. 0d. costs in respect of the sale of a bottle of milk containing foreign matter. Another dairy company were fined twice (a) £20 0s. 0d. and £3 3s. 0d. costs, in respect of the sale of a dirty bottle of milk from a vending machine; and (b) £20 0s. 0d. and £7 7s. 0d. costs, in respect of foreign matter in a bottle of milk. 27 6. CLEAN AIR ACT, 1956—SMOKE CONTROL AREAS. The first steps in the formation of a Smoke Control Area in the Borough were taken during the year, with a pilot survey of the proposed area to be known as the "Barn Hill No. 1 Smoke Control Area." The pilot survey was carried out in order that the following information required by the Minister to comply with Stage 1 in the establishment of a Smoke Control Area could be ascertained:— (1) A map showing the proposed area. (2) Particulars of the classes of buildings (domestic, commercial, industrial, etc.) to which the Order would apply, and the approximate number in each case. (3) The best guidance possible at this stage on the cost of any adaptations in private dwellings which would qualify for grant. (4) An approximate estimate of the amount of bituminous coal or other smoky fuel to be replaced, and, however roughly, the best estimate of the additional supplies of the various smokeless fuels that will be required, staling the basis of the calculations. (5) The date on which it is proposed to bring the Order into operation. In the pilot survey 124 domestic premises and 24 other premises were visited and the results of this survey showed that raw coal was being consumed in 71 dwellings visited and that 53 residents were living in smokeless houses. It was further found that in 69 premises adaptation of fuel appliances in one way or another would be required, while the very high proportion of 55 out of 124 would require no adaptation, and consequently no cost would be incurred. It was therefore estimated that the total expenditure required (other than administration costs) in making the area into a Smoke Control Area, would be £4,439, of which £1,775 would be borne by the National Exchequer and £1,332 by the Council. Ministry approval for a detailed survey of this area has been received and will proceed when circumstances permit. 28 7. CLEAN AIR ACT, 1956—SECTION 10. With the passing of the Clean Air Act, apart from the administrative work involved in formulating Smoke Control Areas the Department has had to give consideration on many occasions to advice and approval where industrial undertakings are considering the installation of new heating equipment. Under this Section, the Local Authority are to be satisfied that the height of the chimney is such that the products of combustion will be adequately dispersed and will not give rise to complaint of nuisance. Close co-operation has been maintained with the Borough Engineer and Surveyor where plans have been deposited and which include the installation of new plant. Advice has been given in every case on the suitable heights of chimneys. There has been a tendency in recent years for architects to ask for an absolute minimum height of stack in order that the height of the building shall be kept in perspective and plans have been received in which the proposed height of the stack was not more than 30 feet. When it has been explained to the firms concerned that the proper dispersal of the products of combustion and particularly of sulphur fumes inevitable with the combustion of most types of fuel must be borne in mind, active co-operation has been forthcoming and, in general, it has been possible to arrange for the erection of stacks to a minimum height of 50 feet. This figure has been taken as a basic unit for compartively small installations and has been increased or decreased according to prevailing circumstances, such as configuration of land, height of nearby buildings, etc. Large installations, of course, would require chimneys of considerably greater height. In arriving at a decision on the height of chimneys, there is a conflict between the aesthetic and planning points of view and the practical ones, so that a sensible balance must be struck between these factors having due regard to the health and comfort of the residents of the neighbourhood. There has been a certain degree of changeover in fuel use by industrialists in the Borough during the year and the practice of burning fuel oils of various viscosities has increased, with a resultant decrease in visible smoke but with sulphur fume output remaining much as before. 29 The storage of fuel oil also gives rise to some concern and in most cases it is possible with the co-operation of the persons concerned, for the requirements of the British Standards Specification regarding the storage and use of fuel oil to be complied with. This standard specification is not legally enforceable and therefore persuasion and co-operation are needed for it to be implemented. 8. PETROLEUM (CONSOLIDATION) ACT, 1928 — REVISION OF LICENSING REQUIREMENTS RELATING TO THE STORAGE OF PETROLEUM SPIRIT AND MIXTURES. During the year the Home Office issued as a guide for Local Authorities and to assist them in carrying out their licensing responsibilities under Section 3 of the Act, a Model Code of Principles of Construction and Licensing Conditions in respect of premises where Petroleum Spirit is stored. On this basis and having due regard to the Petroleum Regulations then in force in the Borough, a new Code of Principles and Conditions of Licence was adopted by the Council. The new Code groups premises into three categories according to the mode of storage, namely, those where the storage is of cans, drums or similar receptacles, those which arc petrol filling stations, and those comprising basement or sub-basement garages and underground car parks. The new requirements include items which were lacking in the previous licensing conditions and two of the most important items included in the new Code are the testing of underground tanks which are 20 or more years old, and the requirement that electrically operated meter pumps, both new and existing, should comply with the special conditions relating thereto. With the increasing use of mobile filling units in which a supply of a mixture of Petroleum spirit and lubricating oil is stored, it was necessary to include conditions of licence which applied particularly to this type of storage and during the year mobile filling units were subject to these conditions and approved for licensing. Consequent upon the adoption of the new principles of construction and Conditions of Licence, it became necessary to formulate a satisfactory test which could be applied to old existing tanks and after consultation with the Petroleum Companies and the Pump 30 Maintenance Companies, it was agreed that the ullage test as recommended by the Home Office should be considered adequate and that only in special cases would a pressure test with nitrogen be required. The full effect of these new conditions will not be felt until January, 1960 (when all underground tanks which arc over 20 years of age will have been satisfactorily tested or will be discontinued as storage accommodation, and all electrically operated meter pumps will have to comply with the special conditions relating thereto). 9. INDUSTRIAL EFFLUVIA. The Department is still very much concerned at the increase of industrial effluvia in various parts of the Borough. It is not on every occasion that residents in close proximity to the factories have cause for complaint, but it has been found that some industrial effluvia diffuse in the atmosphere and render the odour imperceptible nearby while others give rise to complaint considerable distances from the point of emission. Investigation of this type of complaint is often difficult and even after the source of emission has been ascertained methods of treatment have to be considered and tried experimentally before a satisfactory solution to the problem can be found. Sometimes, however, it is possible that a satisfactory answer to the problem can be given without extensive investigation and in these cases matters can very quickly be put right. In some cases, however, considerable physical and chemical investigation has to be carried out. This is usually done in collaboration with engineers and chemists employed by the industrial undertakings involved. At the same time information is gleaned from various other sources and applied to the problem in hand. Without exception, it is found that the management of industrial undertakings arc co-operative and willing to experiment and try out suggested methods of overcoming effluvia problems, notwithstanding the fact that it may involve them in quite considerable expense. Whilst some problems have been solved to the great satisfaction of all concerned, others are seemingly intractable for the time being, or at least the methods which have proved successful in one instance do not appear to be successful in another which seems to be similar in character. When this happens a fresh approach becomes necessary, and inevitably results in further delay. 31 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. No charge is made to householders in respect of treatment at private dwelling houses but in all other cases a charge is made on a time and materials basis. 831 premises were satisfactorily treated by the Council and 2 premises were known to have been treated privately. 11. RIVER POLLUTION. Regular sampling of the water in the main water-courses in the Borough is carried out by the Rivers Inspector employed by the Middlesex County Council and copies of the Analyst's Reports arc received in the Department. When these reports show that the river and streams in this area arc being polluted by industrial or domestic waste, the investigation of this type of complaint is difficult and extends over a long period of time. Most of the industrialists in the town have been made aware through the medium of Trade Effluent Agreements, that industrial waste should be discharged into the soil sewer system. Occasions do, however, arise, when through carelessness or ignorance industrial waste fluids find their way into the surface water sewers and from there pollute the river and streams. Where such pollution occurs in many cases the source of pollution can quickly be found and repetitions prevented. There are occasions when pollution by industrial waste appears to occur very sporadically and the tracing of such sources gives considerable difficulty and in some cases the problem is never solved. There is very little pollution caused by householders and where this occurs it is usually out of ignorance. Most residents arc aware that the rainwater which falls on the roof of their houses is discharged into a surface water sewer and thence to the nearest brook or stream, but in a moment of forgetfulness a bucketful of soapy water or some unwanted sump oil or other similar waste material, is poured into the rainwater gully and, in consequence, pollutes the nearest stream. These cases are particularly difficult to deal with but once the source is found an explanation to the householder results in ready compliance with our request for non-recurrence. 32 12. 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 29,440 tons. The separate collection of waste paper from business premises free of charge has been maintained. The amount collected from this sourcc during the year was 720 tons. Refuse Disposal. Refuse is disposed of by a Separation and Incineration Plant which has handled 30,619 tons. Salvage materials amounting to 3,792 tons were sold for £21,684. 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. 33 STATISTICAL APPENDIX C. Number of complaints rcccivcd and investigated 2,181 Visits made by Public Health Inspectors 26,113 (a) Dwelling Houses:— Visits under Public Health Acts 9,782 Visits under Housing Acts 189 Visits under Rent Acts 389 Visits re overcrowding 13 Visits to bug infested premises 14 Visits re other vermin (excluding rats and mice, see below) 21 Visits re cases of infectious disease 437 Visits to cases of food poisoning 35 (b) General Environmental Public Health:— Drains and sewers inspected 2,286 Drain and Sewer Test applied 79 Cesspools, etc. 2 Urinals, latrines, chemical closets 72 Stables, manure pits, etc. 10 Piggeries (number on register at end of year 2) 7 Ditches and streams 271 Open spaces, etc. 231 Yards 3,238 Public conveniences 68 Tents, vans and sheds 63 Factories—Mechanical 1,192 „ —Non-mechanical 21 Workplaces 26 Outworkers 26 Smoke observations—half hourly 191 „ „ —casual 1,643 „ „ —visits to plant 94 Cinemas, Dance Halls, Public Houses, etc. 154 Hairdressers (number of establishments on register at end of year 91) 27 Schools (number of private schools 19) 63 Markets 25 34 Rats and Mice 335 Swimming baths—visits 22 „ „ —Water examination 2 Chlorine tests 1 Elderly persons housing accommodation 398 Clean Air Act 280 (c) Food, including milk, meat, water:— Number of dairies registered at end of year 11 Number of distributors of milk registered, with premises in the Borough selling milk in properly closed and unopened receptacles 41 Number of distributors of milk registered whose premises are outside the Borough 18 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 86) 530 Slaughterhouse 85 Dairies and milk shops—visits 91 „ „ „ „ —milk samples taken 19 Fried fish shops (number on register at end of year 13) 46 Bakehouses (number on register at end of year 12) 102 Ice cream premises (number on register at end of year 220) 61 Ice cream—samples taken 13 Fishmongers and poulterers (number on register at end of year 29) 163 Greengrocers and fruiterers (number on register at end of year 97) 294 Grocers, etc. (number on register at end of year 271) 434 35 Restaurants, cafés, etc. (number on register at end of year 99) 347 Street vendors, hawkers, etc. (number on register at end of year 77) 31 Other food premises 267 Water supply—visits 63 „ „ —samples taken 4 (d) Other visits and inspections:— Massage establishments, etc. 40 Certificates lodged by Members of the Chartered Society of Physiotherapy 3 New Licences granted 1 Licences renewed 16 Noise nuisances 332 Dust nuisances 36 Effluvia nuisances 466 Petroleum stores 548 Miscellaneous 498 Number of written notices served 218 Number of statutory notices served 35 Nuisances abated and improvements effected. (a) Dwelling Houses:— Roofs repaired 220 External walls and chimney stacks repaired 85 Gutters and spouts repaired or renewed 141 Damp-proof courses provided 18 Dampness remedied 251 Yards paved or repaired 42 Internal walls and ceilings repaired 114 Doors repaired or renewed 43 Windows repaired or renewed 76 Floors repaired or renewed 94 Sub floor vent. provided or improved 30 Rooms cleansed or redecorated 202 36 Passages and staircases redecorated 48 Staircases repaired 31 Fireplaces and flues repaired or renewed 64 Cooking stoves repaired or renewed 4 Sinks and washbasins provided or renewed 54 Waste pipes repaired or renewed 44 Food stores provided or improved 6 Dustbins provided or renewed 96 Water supply improved or reinstated 50 W.C. walls, etc., cleansed 19 W.C. pans cleansed 13 W.C. pans repaired or renewed 54 W.C. structures repaired or renewed 7 W.C. lighting and ventilation improved 13 W.C. flush pipe joints repaired 34 Additional W.C.'s provided 3 (b) General Environmental Public Health:— Drains cleansed from obstruction 1,045 Drains repaired or renewed 110 New drains provided 38 New inspection chambers provided 46 Inspection chambers repaired 73 Soil pipes and vent. shafts repaired 39 W.C.'s repaired 30 W.C.'s cleansed 15 Cesspools emptied or repaired - Urinals and latrines—cleansed or emptied 18 Stables, manure pits—cleansed 3 Piggeries cleansed or limewashed — Pigsties repaired — Animal nuisances abated 14 Offensive accumulations removed 102 Ditches and streams—cleansed 26 „ „ „ —pollution remedied 16 Smoke nuisances abated 72 Improvements in boiler plant or fuel effected 36 Cinemas, Dance Halls, etc.— contraventions remedied 20 37 Hairdressers—contraventions remedied 6 Tents, Vans and Sheds—nuisance abated — „ „ „ „ —Removed 2 Schools—sanitary conditions improved 24 „ —urinals and W.C's cleansed or repaired 6 Markets—contraventions remedied 8 Noise nuisances abated 25 Dust nuisances abated 6 Effluvia nuisances abated 17 Petroleum—contraventions remedied (c) Eradication of bed bugs:— (i) Number of Council houses:— Found to be infested and subsequently infested 3 (ii) Number of other houses:— Found to be infested and subsequently infested 12 (i) by hydrogen cyanide — (ii) by liquid insecticides 12 Other vermin eradicated (not including rats and mice) 45 Verminous articles destroyed — (d) Meat and other Food Premises:— Meat shops, stalls, etc.—premises cleansed 52 „ „ „ „ —other contraventions remedied 55 Dairies—cleansed and distempered or painted 5 „ —premises repaired 5 „ —other contraventions remedied 5 Bakehouses — cleansed and distempered or painted 10 „ —sanitary conditions improved 5 „ —other contraventions remedied 6 38 Ice cream premises—cleansed and distempered or painted 4 „ „ „ —sanitary conditions improved 7 Fried fish shops—cleansed and distempered or painted 9 „ „ „ —sanitary conditions improved 3 „ „ „ —other contraventions remedied 19 Fishmongers, etc., contraventions remedied 26 Grocers, etc., contraventions remedied 82 Greengrocers, etc., contraventions remedied 51 Restaurants, Cafes, etc., contraventions remedied 107 Street hawkers, contraventions remedied 3 Other food premises, contraventions remedied 22 Public Houses improved 13 4,209 Unsound Food Surrendered:— 1,046 lbs. Beef. 1 tin Brisling. 232 lbs. Pork. 1 tin Prawns. 262 lbs. Lamb. 3,290 tins Fruit. 259 lbs. Bacon. 267 tins Fruit Juices. 7 lbs. Pigs' Kidney. 10 tins Jam. 29 lbs. Veal. 7 tins Marmalade. 74 lbs. Ox Tails. 1,161 tins Vegetables. 50 lbs. Heart. 5 tins Sweet Corn. 46 lbs. Liver. 49 tins Evaporated Milk. 30 lbs. Melts. 2 tins Condensed Milk. 60 lbs. Chicken. 9 tins Cream. 8 lbs. Prawns. 51 tins Tomato Purée. 25 Rabbits. 186 tins Tomato Paste. 5 stone Cod Fillet. 46 tins Tomato Juice. 39 3 stone Haddock Fillet. 4 tins Spinach Puree. 7 stone Whiting. 4 tins Mushroom Soup. 1 stone Skate. 8 tins Soup. 977 tins Ham. 6 tins Chicken Soup. 84 tins Luncheon Meat. 15 tins Asparagus Soup. 20 tins Brisket of Beef. 5 tins Ravioli. 5 tins Turkey Breast. 7 tins Apple and Raspberry Pie. 40 tins Tongue. 59 tins Corned Beef. 5 tins Mincemeat. 2 tins Chicken. 1 tin Milk Pudding. 9 tins Kidneys. 1 tin Creamed Rice. 68 tins Stewed Steak. 1 tin Strained Baby Food. 22 tins Frankfurters. 1 tin Apple and Gooseberry Pie. 12 tins Pork. 3 tins Veal & Ham Loaf. 9 pkts. Shredded Wheat. 2 tins Minced Beef Loaf. 24 pkts. Oats. 4 tins Veal. 14 pkts. Cereal. 1 tin Liver. 72 pkts. Soup. 1 tin Cocktail Sausages. 81 pkts. Dog Biscuits. 1 tin Pork & Liver Pate. 40 pkts. Biscuits. 1 tin Beef & Gravy Pie. 60 pkts. Pudding. 50 tins Shrimps. 15 pkts. Cakemix. 5 tins Crab. 24 pkts. Mixed Fruit. 4 tins Anchovies. 6 lbs. Butter. 37 tins Pilchards. 12 lbs. Lard. 7 tins Sild. 29 lbs. Margarine. 26 tins Sardines. 6 lbs. Cheese Trimmings. 14 tins Salmon. 1 carton Cheese. 9 tins Roes. 6 bottles Vinegar. 2 tins Lobster. 24 bottles Mayonnaise. 2 tins Tunny Fish. 48 bottles Soft Drinks. 40 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 44 - 10 304 30 Number inspected 44 — 10 304 30 All diseases except tuberculosis and cysticerci:— Whole carcases condemned - - - - - Carcases of which some part or organ was condemned 8 - - 2 - Percentage of the number inspected affected with disease other than tuberculosis and cysticerci 18.2 - - 6 - Tuberculosis only:— Whole carcases condemned - - - - - Carcases of which some part or organ was condemned - — - - 1 Percentage of the number inspected affected with tuberculosis - - - - 3.3 Cysticercosis:— Carcases of which some part or organ was condemned - - - - - Carcases submitted to treatment by refrigeration - - - - - Generalised and totally condemned - - - - - 41 Inspection of dwelling-houses during the year:— (a) (i) Total number of dwelling-houses inspected for housing defects (under Public Health or Housing Acts) 2,737 (ii) Number of inspections made for the purpose 10,491 (b) (i) Number of dwelling-houses (included under sub-head (i) above) which were inspected and recorded under the Housing Consolidated Regulations, 1925/1932 6 (ii) Number of inspections made for the purpose 25 (c) Number of dwelling-houses found not to be in all respects reasonably fit for human habitation 1,946 Remedy of defects during the year without service of formal notices:— Number of defective dwelling-houses rendered fit in consequence of informal action by the Local Authority or their officers 2,004 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 35 42 (ii) Number of dwelling-houses in which defects were remedied after service of formal notices:— (1) by owners 31 (2) by Local Authority in default of owners 1 (c) Proceedings under Section 16 of the Housing Act, 1957:— (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 2 (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 3 (ii) Number of separate tenements or underground rooms in respect of which Closing Orders were determined, the tenement or room having been rendered fit 1 Overcrowding. (a) Certificates issued to landlords, giving the mitted number of persons who may occupy a house 42 (b) Number of dwellings recorded as overcrowded at the end of the year 142 Number of families dwelling therein 149 Number of persons dwelling therein 725 (c) Number of new cases of overcrowding reported during the year 11 43 (d) (i) Number of cases of overcrowding relieved during the year 43 (1) by removal to unknown addresses 38 (2) rehoused by Council 5 (ii) Number of persons concerned in such cases 215 (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: (a) (1) by the Local Authority 44 (2) by other bodies or persons 70 (b) with State Assistance under the Housing Acts: (1) by the Local Authority 20 (2) by other bodies or persons Nil 44 Factories. Number of factory premises — 436. Premises. Number of:— Inspections. Written Notices. Occupiers Prosecuted. Factories with mech. power 1,184 3 — Factories without mech. power 27 — — Other Premises 2 — — Totals 1,213 3 - Defects found. Particulars. No. of defects:— Found. Remedied. Referred to H.M. Inspector. Referred by H.M Inspector. Want of cleanliness - - - - Overcrowding — — — — Unreasonable temperature 1 1 — — Inadequate ventilation — — — — Ineffective drainage of floors — — — — Sanitary Conveniences:— Insufficient 1 1 — 1 Unsuitable or defective 4 4 — 1 Not separate for the sexes — — — — Other offences 10 10 — — Totals 16 16 - 2 45 Outworkers. Number on register at end of year 321 Nature of work:— Making, repairing of:— Wearing apparel 235 Household linen 2 Lace, lace curtains, nets 5 Furniture hangings, curtains 2 Furniture and upholstery 4 Brass and brass articles 4 Fur pulling 2 Artificial flowers 3 Making of boxes or other receptacles or parts thereof, etc., of paper 8 Carding of buttons 2 Stuffed toys 3 Cosaques, Christmas crackers, Christmas stockings, etc. 29 Lampshades 21 Feather sorting 1 Offices. Number on the register— 332. No defects were found during the year. 46 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 1,946 Section 38 (1) (b)—temperature:— Number of shops in which a reasonable temperature was not maintained 84 Section 38 (2)—sanitary conveniences:— Number of shops in which sanitary conveniences were not suitable and sufficient 43 Number of certificates of exemption granted 2 Section 38 (4)—washing facilities:— Number of shops in which washing facilities were not suitable and sufficient 21 Number of certificates of exemption granted 2 Section 38 (5)-—facilities for meals:— Number of shops in which facilities provided were not suitable and sufficient 38 Disinfection of Premises and Articles. Disinfections for:— Infectious diseases 91 Cancer 1 Vermin (routine protection from) 60 Miscellaneous 39 191 47 Articles disinfected or destroyed:— Disinfected. Destroyed. Bedding and bedclothing 701 45 Wearing apparel (including 922 articles for abroad) 998 5 Carpets, rugs, cushions, curtains 18 — Others 56 11 1,773 61 The Prevention of Damage by Pests Act, 1949. Work carried out 1/4/58 to 31/3/59:— Rats. Mice. (1) Number of premises visited 2,186 208 (2) Number of visits by Public Health Inspectors 335 (3) Number of visits by Rodent Control Assistants 5,925 1,094 (4) Number of premises which received treatment by Rodent Control Assistants 634 197 (5) Number of premises satisfactorily treated privately 1 1 (6) Number of Council premises (included in (4) ) 5 7 48 Milk (Special Designations) Orders, Licences issued. Dealers. Supplementary. Tubcrculin tested 29 19 Pasteurised 29 18 Sterilised 39 20 Samples of designated milk taken. No. of samples taken. No. not satisfactory. Pasteurised 12 — Tuberculin tested 1 — T.T. (Pasteurised) 5 - Sterilised 1 — 19 - Laboratory Examinations re Food, Milk and Water. Examinations made Quarter ending Total for 12 months 31.3.58 30.6.58 30.9.58 31.12.58 Water - 1 3 - 4 Milk - 3 20 2 25 Ice Cream - - 13 - 13 Other Foods 5 4 1 6 16 49 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 1958:— Article. No. taken. Unsatisfactory. Milk, various 153 7 Soup 4 - Butter 44 - Cream 39 - Drugs 45 - Fish and Fish products 25 - Fruit (fresh and canned) 13 1 Fruit Syrups and drinks 4 - Ice Cream 28 - Margarine 22 - Meat and Meat products 70 - Liver 26 - Preserves 4 - Sausages 8 - Jelly 4 — Vinegar 28 1 Miscellaneous 24 2 541 11 50 Bye-laws in force throughout the Borough—December, 1958. 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. Spitting. Sale of Coal and Coke (M.C.C.). Employment Agencies (M.C.C.). Employment of Children (M.C.C.). 51 CHAPTER V. HISTORICAL SUMMARY. In presenting this report twenty-one years after the incorporation of the Borough the opportunity has been taken to highlight certain facets of the Department's work during this time. This chapter by no means represents a survey but rather notes on some of the more important changes effected during the period. +POPULATION. In the last twenty-one years the population of Wembley has shown a gradual trend of increase. The mid-year estimated population in 1937 was 114,700 and this increased steadily until the period immediately following the War when, in 1951, for the first time a slight decrease in population was noted. The maximum population achieved was the mid-year estimated population for 1950 at 132,700, but the census population showed a figure of 131,384 and this probably represents the maximum population achieved in the town. Since 1950 a gradual fall in population has resulted in the mid-year estimated population for 1958 being 126,800. This population trend is representative of the outer suburbs and it is probable that the stabilised population of the town will eventually rest at a figure of somewhere around 125/126,000. The comparability factors provided by the Registrar-General, which are used to relate local vital statistics to the national average has remained somewhere between 1.10 and 1.28 which indicates that the age group of the population was not seriously different from the national average. BIRTHS. The birth rate during the last twenty-one years has shown a substantial fall with only slight intermittent increases. In 1937 the number of births in the town was 1,934, giving a birth rate per thousand of 39.81. This was a year in which the birth rate was rather greater than the average for that period. The rate, apart from a peak in the Wartime years, has fallen consistently and has now reached what appears to be a fairly stabilised level at 11 to 12 per thousand of the population. 52 DEATHS. The death rate is not a truly reliable index of the healthiness of a district because it is seriously affected by the age grouping of the population, although when the comparability factor is applied this discrepancy is reduced to a minimum. The death rate in Wembley during the last twenty-one years has not changed so materially. It was, in the early years, somewhere around 9 per thousand, and even at the end of the period a variation of between 9 per thousand and 10 per thousand was not unusual. INFANTILE MORTALITY. This figure, which is obtained by equating the number of infants dying under one year of age per thousand live births, is always regarded as being a sound and reliable index of the healthy conditions in a district and a figure by which the quality of the health services and the wellbeing of the population can be judged. In 1937 the infantile mortality in Wembley was 43.62 and it is satisfactory to record that there has been a more or less continuous fall in this figure, which in 1956 reached the very low level of 16.76 per thousand and in 1958 was 19.1 per thousand live births. There can be no question that the children to-day are better endowed and have a substantially improved chance of living to the age of one year and therefore successfully passing through a phase of development which is hazardous, than had a child born even twenty-one years ago. This improvement is due in part only to the services provided, but to a material extent also to the improved standard of living in the community. MATERNAL MORTALITY. The number of deaths of women in childbirth during each year reaches such a low figure that to draw any conclusions from the statistics prepared in any one particular year would probably be misleading. The rate, however, of the last twenty-one years has shown some tendency to fall, apart from the years during the War when there was a substantial increase. The figure has fallen in recent years to a very low level and quite frequently years have been experienced in which there has been no puerperal death of a Wembley resident. 53 NOTIFIABLE INFECTIOUS DISEASE. During the review period considerable change in the annual incidence of infectious disease has occurred, and whilst it is difficult, in relation to some diseases, to account for the variation, there arc certain ones where it can be claimed that preventive measures merit some credit for the improvement. There is one condition where immunisation procedures can be claimed to have caused absolute extinction. In the early part of the period 1938/39 some 70 to 80 cases of Diphtheria occurred within the Borough each year, but over the period these figures have gradually dwindled until 1951, and from this date onwards no case of Diphtheria has been notified within the Borough. This extinction of a serious infectious disease can reasonably be claimed as the result of the immunisation programmei Two other minor diseases of childhood, Scarlet Fever and Whooping Cough, have decreased considerably in incidence since 1938, but the third one, Measles, seems to vary from year to year without any trend of diminution, and the only conclusion one can draw is that when susceptible children are available Measles attacks with unchanged virulence. There has not been the same reduction in the infectious diseases of adult life ; Pneumonia continues to occur in between 50 to 100 cases per annum, and such conditions as Puerperal Pyrexia and Erysipelas show an incidence fluctuating from year to year but not exhibiting a reduced trend-line. A few of the diseases of war-time cropped up locally during the years of conflict but these conditions such as Cerebro-spinal Fever, Encephalitis, and infections of the Enteric group, appear to be considerably reduced and only occur now as sporadic cases. Approximately 130 cases of Tuberculosis were notified annually in the late thirties; this figure rose during the war-time to a figure of round about 250 per year, but one is happy to report that the epidemic now appears to be on the decline and the number of cases notified annually in the last five years has averaged somewhere in the region of 80 and is still tending to diminish. The community can be assured that their preventive measures are of some avail and have in the past shown a certain amount of success. 54 A new notifiable infection which has come into prominence during the last few years, and certainly shows no signs of decline at the moment, is Poliomyelitis. In the early years of the period under review, notifications never exceeded 6 to 8, but of more recent years three times this annual incidence has been experienced and many of the cases have been of a most severe character, attacking adults and young adults rather than infants. This menacing newcomer is being countered by Anti-polio inoculation and it is to be hoped will in future come under control. INFANT WELFARE CLINICS. The Borough Council were responsible for the Child Welfare Clinics within the confines of the Borough during the early formative years when the services were developing and expanding. This was fortuitous but extremely favourable as the great attention paid by the Councils of those days has resulted in a service in Wembley which has few equals anywhere in the country. In 1937 all the clinics were held in Church halls or hired premises, but the Council were conscious of the need for better and more extensive and convenient provision, and by the middle of 1938 three ad hoc general purposes clinics were opened and functioning; the first one was in One Tree Hill, the second in Stag Lane, and the third in Pcrrin Road, which opened in October of that year; Monks Park Clinic was opened in April, 1939, and College Road Clinic followed. The Maternity and Child Welfare Committee and the Council displayed great foresight in these days as is shown by their compulsory acquisition of a site in London Road, intended ultimately as a central clinic for the Borough, which had to wait until 1948 before the culmination of the idea and the opening of the clinic. During the war-time years all clinical services continued to be offered to the public but mothers and babies were evacuated from the town in considerable numbers to avoid the risk of air attack. The amount of medical consultation was curtailed but the Welfare Clinics and services were utilised by the Government extensively for the supply of vitamin substances and accessory foods, felt to be so necessary during the time of dietetic restriction of the War years. 55 Between the end of the War and 1948 was a period of rebuilding of the services and rehabilitation of staff returning from military duties and at the time of transfer of these functions to the County Council in the year 1948 they were once again operating at a very high level of professional competence and efficiency. Since 1948 the County Council as Health Authority has been responsible for the operation of the services, but the Borough Council have been able to retain an interest through members nominated to serve on the No. 6 Area Health Committee. Alongside work in the Clinics, Health Visitors have, during the whole of the period under review performed their district duties of domiciliary visiting for young babies and expectant mothers. This work is unspectacular and routine, but none the less a basically important feature of the Health Services. The Borough Council were responsible from 1937 until 1948, when the control of Health Visiting was transferred to the County Council under the National Health Service Act. DOMICILIARY MIDWIFERY. At the date when Borough Status was granted to the Council, Domiciliary Midwifery in the district was undertaken by two District Nursing Associations on behalf of the Middlesex County Council, who were at that time local supervising authority under the Midwives Acts ; Kingsbury District Nursing Association served four Wards of the Borough and the Wembley Association the remaining eight Wards. It may seem strange when reviewed now, but at that time charges were made for confinement up to a maximum of three guineas and with a rebate of fees according to net family income. At this time also fourteen other Midwives in private work gave notice of their intention to practise midwifery within the boundaries of the Borough. Maternity Outfits for use in domiciliary confinements were provided and in 1940 the first mention is made of Emergency Maternity Units—Flying Squads, which could be obtained from the local hospitals. Puerperal infections in the early years caused tremendous anxiety, but fortunately the incidence of these conditions has decreased through the period, and the discoverey of sulphonamides and antibiotics has lessened their terrors. 56 During the war-time, as a result of evacuation, domiciliary confinements in the Borough fell materially but quickly reached normal figures at the termination of risk. In 1948 the National Health Service Act transferred the function of providing a Domiciliary Midwifery Service to the County Council, which became a Health Authority, and since this date midwives practising in the Borough have been wholly employed by the County Council, and the service has been provided for participants without charge to them. HOSPITALS. In 1937 the Borough Council itself was responsible under the Public Health Act, 1936, for the treatment in hospital of notifiable infectious diseases, and to this end arrangements were made with the Acton Borough Council for the use of their hospital to accept infectious diseases occurring in Wembley and requiring hospital treatment. The Local Government Act of 1929, placed upon County Councils the duty of providing beds of a general hospital character within their area, and Middlesex, under this Act, provided for the Wembley district two hospitals—(1) The Redhill Hospital at Edgware, and (2) The Central Middlesex Hospital at Park Royal. The voluntary provision of hospital beds continued alongside this until the National Health Service Act of 1946. Under Part II of this Act, the whole of the hospital beds in the country, voluntary, County Council, and Local Authority, were transferred to the Minister, who was to be responsible henceforward for all hospital services. The North-West Metropolitan Regional Hospital Board was formed and included within its territory the Wembley area, for the provision of all hospital services. Changes of an administrative character have occurred but so far in the area there has been little provision of additional beds. 57 CHAPTER VI. ADMINISTRATION, STAFF. During the year your Medical Officers acted professionally for the Council in performing 32 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 again depletion for a large part of the year owing to illness. This depletion of the staff has had serious repercussions on the work of the Department and although it was felt in 1957 I regret to say its effect on the work during 1958 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 ail 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. 58 Hendon Printing Works Limited 66, East Road, Burnt Oak, Edgware. Middx. Phone: EDG. 6181