AC 439(1) WILLESDEW WIL 36 Borough of Willesden. 1940. THE 65th ANNUAL HEALTH REPORT. GEORGE F. BUCHAN, M.D., F.R.C.P., D.P.H., Medical Officer of Health. London: JAS. TRUSCOTT & SON, LTD., 11/12, Bury Street, St. Mary Axe, London, E.C.3. BOROUGH OF WILLESDEN. Health Department, 54, Winchester Avenue, Kilburn, London, N.W.6. August, 1941. To the Willesden Borough Council— The Local Sanitary Authority, and the Local Education Authority. I beg to submit herewith the Annual Health Report for Willesden for the year 1940, in accordance with instructions received from the Ministry of Health and Board of Education that it should be a short report. 3 VITAL STATISTICS. The estimated population of Willesden at Midsummer, 1940, was 210,686.* *This population has been calculated on the assumption that the average number of persons per inhabited house at Midsummer, 1940, was the same as estimated for November, 1935. It is not improbable that the population is too high, but it was thought desirable to make the records for the inter-censal years on the same basis as to population. The number of persons registered for food rationing at August, 1941, was approximately 120,500. This does not include Willesden residents who have become evacuees, or have joined the Services, and certain others, but these are included for the purposes of this report. In all the circumstances, it is probable that the population of Willesden is approximately 200,000. 2,315 live births were registered during 1940, giving a birth rate of 10.99 per 1,000 of the population as against 13.09 in 1939. 85 still births were registered, giving a still birth rate of 35.42 per 1,000 total live and still births. 2,137 deaths were registered in 1940, giving a death rate of 10.14 per 1,000 of the population. The 2,137 deaths include 236 deaths of civilians due to operations of war. Excluding these the death rate of 10.14 becomes 9.02. These figures compare with a total number of deaths of 1,831 and a death rate of 8.75 in 1939. The infantile mortality rate for the year 1940 was 51.84 per 1,000 births. 120 children under one year of age died in 1940. CANCER. There were 294 deaths of Willesden residents from Cancer in 1940 as compared with 299 in 1939. The two Municipal Cancer Clinics were continued throughout the year. 14 new patients attended these Clinics and the total attendances were 23. INFECTIOUS DISEASES. During the year 1940 1,170 cases of infectious disease were notified as compared with 1,936 in the previous year. The following table gives the number of notifications of certain diseases included in the above total of 1,170 together with the corresponding figures for 1939:— Table No. 1. Number of Cases notified. 1939 1940 Diphtheria 331 123 Scarlet Fever 245 104 Pneumonia 269 196 Whooping Cough 672 82 Erysipelas 48 31 The fall in Scarlet Fever and Diphtheria which occurred in the autumn of 1939 with the outbreak of war has continued up to the time of writing. Not only Scarlet Fever and Diphtheria but all infectious disease was notably low during 1940 with the exception of Cerebro-Spinal Meningitis. Enteric Fever.—Six cases were notified as Typhoid or Para-typhoid Fever during 1940 as against 3 in 1939, 11 in 1938, 10 in 1937, 10 in 1936, 10 in 1935, 7 in 1934 and 13 in 1933. All 6 cases were removed to hospital—4 to the Willesden Municipal Hospital and 2 to London hospitals. Of the 4 cases removed to the Willesden Municipal Hospital 2 were diagnosed as Para-typhoid Fever and recovered ; 1 was diagnosed as Enteritis and recovered, and 1 was diagnosed as Pleurisy with effusion and was transferred to the Central Middlesex County Hospital. One case removed to a London hospital was notified from there as a case of Para-typhoid Fever B. No further details are known. The other case removed to a London hospital was operated on for removal of 2 large gallstones and gall bladder. The patient died and the notification stated that typhoid bacilli had been found in a bile culture. No deaths from Typhoid or Para-typhoid Fever were recorded during the year. Malaria.—One case of Malaria was notified during 1940. The patient was an inmate of an emergency hospital at Epsom, and Malaria was induced for therapeutic purposes. Infectious Diseases of the Central Nervous System. Poliomyelitis and Polioencephalitis, Cerebro-Spinal Fever and Encephalitis Lethargica.—38 cases of these diseases were notified in 1940 as against 18 in 1939, 24 in 1938, 22 in 1937 and 14 in 1936. Seven proved fatal, giving a fatality rate of 18 per cent, of notified cases. 35 cases were notified as Cerebro-Spinal Fever. Of these 35 cases 4 were found in hospital not to be suffering from Cerebro-Spinal Fever. One of these 4 died, the death being certified after post-mortem as due to Tuberculous Meningitis and Miliary Tuberculosis. 4 The ages of the 31 cases which proved to be Cerebro-Spinal Fever were as follows Under 1 year of age 3 Between 1 and 2 years of age 3 „ 2 „ 3 „ „ 3 „ 3 „ 4 „ „ 4 „ 4 „ 5 „ „ 1 „ 5 „ 10 „ „ 2 „ 10 „ 15 „ „ 1 „ 15 „ 20 „ „ 0 „ 20 ,, 35 ,, „ 10 „ 35 „ 45 „ „ 2 „ 45 „ 65 „ „ 2 The months in which the 31 cases occurred were as follows :— December, 1939 1 January, 1940 2 February, 1940 6 March, 1940 6 April, 1940 2 May, 1940 2 June, 1940 4 July, 1940 0 August, 1940 0 September, 1940 4 October, 1940 1 November, 1940 December, 1940 1 Five of these 31 cases which proved to be Cerebro-Spinal Fever died. These patients were aged 4 years, 11 years (a brother and sister who took ill on the same day), 23 years, 2 years, 33 years. In addition there were 3 further deaths from Cerebro-Spinal Fever in Willesden residents. Three cases were notified as Encephalitis Lethargica. None of these were found in hospital to be suffering from Encephalitis Lethargica. One died, the death being certified as due to Tuberculous Meningitis. Whooping Cough.—82 cases were notified during the year but a total of 124 cases coming to their knowledge were visited by the Health Visitors, 91 of which occurred in children under 5 years of age. There were 2 deaths from Whooping Cough, one a child under 1 year of age, and one a child between 1 and 5 years of age. Measles.— 294 cases were notified during the year but 430 cases were visited by the Health Visitors. 268 of the 430 cases visited occurred in children under 5 years of age. There were 3 deaths from Measles, all in children between 1 and 5 years of age. MOTHERS AND CHILDREN UNDER FIVE YEARS. Municipal Centres.—On the outbreak of war one of the Council's three Municipal Health Centres—Health Centre (3)—was closed as a Health Centre and brought into use as a First Aid Post as stated in last year's Annual Report. During 1940 the Maternity and Child Welfare Work for the whole of Willesden had to continue to be carried out at the two remaining Health Centres, as the Government Departments have not yet sanctioned the arrangements for its much needed return to use as a Health Centre. At the Municipal Centres, expectant mothers attended the medical consultations and treatment Clinics on 15,389 occasions; nursing mothers 22,831 and children under five 40,992, making a total of 79,212 attendances. Out of the total number of 2,315 children registered as born alive during the year, 1,768 or 76 per cent. subsequently attended the Municipal Welfare Centres. 277 children between the ages of 1 and 5 years attended the Municipal Centres for the first time during the year, excluding transfers from other districts. Government Evacuation Scheme—Expectant Mothers.—The registration of expectant mothers for evacuation during the last month of pregnancy under the Government's Evacuation Scheme was carried out at the Health Centres in accordance with the Government plan. Maternity Hospital— Bookings.—1,141 patients were booked during 1940 for confinement in the Willesden Maternity Hospital. This is the largest number yet booked in any year. The fees at which these 1,141 cases were booked varied from 2 at £15 to 382 free. The average fee per case was approximately £2 5s. l½d. 5 During 1940, 197 applicants for confinement in the Willesden Maternity Hospital were unable to be booked for the reasons set out below:— Table No. 2.—Applications for Booking Refused. No beds available 153 Not resident in Willesden 44 197 Hospital Confinements.—During 1940,1,166 women were confined in the Willesden Maternity Hospital. In addition to these, a number of Willesden mothers were confined in Institutions outside Willesden, 197 births of Willesden residents being notified from such outside Institutions—44 from Queen Charlotte's Hospital and smaller numbers from other Hospitals, 20 from a Nursing Home and smaller numbers from other Nursing Homes. These, together with some 325 in the Central Middlesex County Hospital, are approximately 70 per cent, of the births belonging to Willesden and show the desire of the present-day mother for institutional confinement. The following table shows the demand for institutional confinement :— Table No. 3. Years. Domiciliary Births attended by Midwives. Domiciliary Births attended by Doctors. Births in hospitals and nursing homes. Total Births notified. (Note—Notified not registered.) 1931 515 1,174 1,110 2,799 1932 457 997 1,220 2,674 1933 532 776 1,357 2,665 1934 610 680 1,436 2,726 1935 589 568 1,706 2,863 1936 646 516 1,745 2,907 1937 760 465 1,906 3,131 1938 710 394 1,974 3,078 1939 703 257 1,789 2,749 1940 521 129 1,640 2,290 A report on the Willesden Maternity Hospital by Mr. Arnold Walker, F.R.C.S., the Council's Consultant Obstetrician, appears later in this report. Ante-Natal Work for Institutions not under the Council.—Requests are received from the Middlesex County Council and from various London Hospitals for home visits to expectant mothers, and for special reports by the Council's Health Visitors in connection with women who are to be confined in these Hospitals. 217 Expectant Mothers booked for confinement in the Central Middlesex County Hospital were referred to the Willesden Health Centres for Ante-natal care. Puerperal Pyrexia.—26 cases were notified during ,the year. All recovered. Maternal Mortality.—During 1940 there were 5 deaths classed to pregnancy and childbearing—1 to Puerperal Sepsis, and 4 to other puerperal causes. The puerperal mortality rate from Sepsis was, therefore, 0.42 per 1,000 registered total births. The total puerperal mortality rate was 2.08 per 1,000 registered total births. During 1940 there were, in addition, 2 maternal deaths from non-puerperal causes. There was no maternal death from criminal abortion. The total maternal mortality from all causes excluding criminal abortion, was thus 2.90 per 1,000 registered total births. The total maternal mortality from all causes including criminal abortion was 2.90 per 1,000 registered total births. Sterilised Accouchement Sets.—These sets are supplied in accordance with the arrangements stated in my Annual Report for 1930, p. 10. During 1940, 394 were supplied free, 4 at full cost and 131 at part cost. Specialist Help.—The Council accept responsibility for the payment of the fee of one of their specialists called in by a medical practitioner to assist him in connection with a difficult case of labour occurring in a Willesden resident. One such consultation was paid for in 1940. The services of the Council's Consultant Obstetrician are also available in cases of Puerperal Fever and Puerperal Pyrexia when desired by the practitioner in attendance. 6 Provision of Anesthetist.—The Council further accept responsibility for the payment of a fee to an anaesthetist called in by a medical practitioner in connection with confinement cases. No such fee was paid in 1940. Home Helps.—The Council provided the services of home helps in connection with 249 confinement cases. Maternal Mortality Investigations.—The Council has continued to take part in the investigation of deaths of mothers in childbirth for the Maternal Mortality Committee of the Ministry of Health. The investigations are carried out by the Council's Consultant Obstetrician. Seven cases were inquired into during 1940. Hospital Treatment of Children under 5 Years of Age. Treatment for children suffering from Marasmus and the operative treatment of enlarged tonsils and adenoids continued to be available at the Willesden Municipal Hospital throughout the year. 35 children were under treatment for Marasmus during the year and 85 for enlarged tonsils and adenoids, Mastoid Disease, Chronic Otorrhoea and Otitis Media. Nine of the children suffering from Marasmus died. Children have been admitted to hospital to a limited extent for orthopaedic conditions. Ophthalmia Neonatorum.—The number of cases of this disease notified during the year was 9, as against 18 last year. This gives a case rate of 3-9 per 1,000 registered live births. A district midwife attended at the confinement in 5 cases, 1 case was born in hospital and 3 were attended by private doctors at home. Treatment was obtained at a hospital in 4 cases and by a private doctor at home in 5 cases. Complete recovery with unimpaired vision occurred in all cases. Cases of inflammation of or discharge from the eyes of infants or of cases of ophthalmia neonatorum entering Willesden after notification elsewhere are also visited by the Health Nurses. Teaching of Mothercraft at the Centres. This important part of the work of each Health Centre had to be suspended on the outbreak « of war. CHILD LIFE PROTECTION. A number of foster children have been evacuated under the Government Scheme or privately with their Foster Mothers. At the end of the year there were 40 Foster Mothers and 50 Foster Children still in Willesden. No foster children died during the year. NURSING HOMES. One new home, providing accommodation for 5 patients other than maternity patients, was registered in 1940. The total number of homes on the register at the end of the year was 6, providing accommodation for 5 maternity patients and 23 other patients. THE SCHOOL MEDICAL SERVICE. Medical Inspection in the schools, which had been discontinued since 19/5/39, was recommenced on 27/9/40 for the half of Willesden served by Municipal Health Centre (1)—Kilburn, Cricklewood, Kensal Rise and part of Harlesden. 466 children were medically inspected at these routine inspections and 8,044 at special inspections and re-inspections during 1940. This does not include the medical inspection of children about to be evacuated to reception areas. Some dental inspections in schools recommenced on 15/2/40. Cleanliness inspections in schools recommenced in April, 1940, after the release of the School Nursing Staff from First Aid Posts. With the exception of artificial sunlight the Clinic treatment normally provided by the Council has been available. Owing to the continued use of Health Centre (3) as a First Aid Post and the failure of the Council to obtain sanction for its much needed return to use as a Health Centre, the work for the whole of Willesden has had to be carried out from the two remaining Health Centres. Scabies.—209 cases of Scabies amongst school children came to the notice of the Health Visitors during 1940. 201 of these were treated at the Municipal Clinics. In 1939 there were 178 cases under notice, of which 167 were treated at the Clinics. It should be remembered that at the end of 1940 there were only some 5,500 children on the rolls of Public Elementary Schools in Willesden instead of the normal peace-time number of some 18,000, but on the other hand children continued to be brought back to Willesden for the treatment of this condition. Uncleanliness.—(a)'Willesden.—Cleanliness inspections were carried out in the schools on 282 occasions during the year 1940, the average number of visits paid to each school by the Health Visitor being 12. The total number of examinations and re-examinations made during the year was 22,715. 7 The percentage of children found unclean at routine cleanliness inspections in 1940 was 5.5. The percentage of individual children found unclean at these inspections was 4.2. This is highly important work. In 1914, when it was first begun, the percentage of nitty or verminous children in the schools was as high as 20. In those days a child was not called nitty or verminous except there were many nits on the hair. In 1931, when a child with only a few nits was placed in this category, the percentage of nitty or verminous children in the schools had dropped to 3.6. It will therefore be noted that enormous improvement had been effected, far greater actually than the figures show. The first reverse in the steady decline which had been maintained since 1920 was in 1933, when the percentage rose to 4.1 after having fallen to 3.6 in 1931 and 1932. Table No. 4. Percentage of Nitty and Verminous individual children recorded upon routine cleanliness inspection at the Schools from year to year since 1914:— 1914 20% 1915 23% 1916-19 Results not recorded owing to war. 1920 11.9% 1921-25 7.9% 1926-30 4.6% 1931-35 3.8% 1936 4.0% 1937 4.2% 1938 3.8% 1939 3.8% 1940 4.2% Note.—Routine cleanliness inspections were discontinued from the end of the summer term, 1939, and recommenced in April, 1940. 476 individual school children were cleansed at the Authority's Clinics in 1940. This compares with a figure of 321 in 1939. The increase, notwithstanding evacuation, is accounted for to an appreciable extent by the return of children from reception areas for the purpose of cleansing and by the cleansing at the Health Centres of children found nitty and verminous immediately prior to evacuation to a reception area who would in normal times have been cleansed by their parents at home. (b) Reception Areas.—In last year's Annual Report the results of cleanliness inspections made by the Willesden Council's Health Visitors in reception areas from 28th September, 1939, to 20th April, 1940, were shown. The results of cleanliness inspections made by the Willesden Council's Health Visitors in reception areas from 20th April, 1940, to 22nd March, 1941, are as follows :— Table No. 5. Number Inspected. Number Nitty or Verminous. Percentage Nitty or Verminous. Willesden Evacuees 2,736 160 5.8% Other Evacuees 10,409 575 5.5% Natives 5,442 511 9.4% 59 Willesden evacuees, 329 other evacuees and 35 natives were cleansed by Willesden Health Visitors in reception areas during 1940. Medical Treatment in Willesden.—During the year 1940, school children were followed up by the Health Department on account of 5,072 medical defects and 2,240 dental defects. Of those defects found to require treatment, medical or dental treatment was obtained for 5,012 and domestic treatment was obtained for 742. 91 per cent, of the medical defects were treated, 74 per cent receiving medical treatment and 17 per cent, domestic treatment, 76 per cent. of the dental defects followed up were treated. No record is available of defects requiring treatment which were not followed up. 95 per cent. of the total medical defects treated and 99 per cent. of the total dental defects treated were dealt with by the Education Committee. The remainder, or 5 per cent. of the medical defects and 1 per cent. of the dental defects treated, were dealt with by private practitioners, voluntary hospitals or other charitable institutions, or Public Assistance. In connection with defects treated, the children concerned made 26,037 attendances at the Health Centres in 1940. 8 School Medical Service for Children sent to Reception Areas.—Eight of the School Nursing Staff have been working in Reception Areas during 1940. The complete equipment of one dental surgery is still on loan to a reception area. During the year the medical inspection of children for evacuation to Reception areas and under the Children's Overseas Reception Scheme was carried out in accordance with the requirements of Government departments. 4.6 of the children inspected for evacuation to reception areas were found nitty or verminous. HEALTH CENTRES. ATTENDANCES. Table No. 6. Medical and Dental Treatment—Attendances at Health Centres, 1940. Condition. Expectant Mothers. Mothers, and Children under Five. School Children. Grand Total (Cols. 7 and 8.) Nursing Mothers. Children under Five. Total (Cols. 2—5). 0—1. 1—5. Total (Cols. 4 and 5). (1) (2) (3) (4) (5) (6) (7) (8) (10) 1. Cleansing - 16 4 23 27 43 541 584 2. Throat, Nose and Ear Diseases 1 - 28 640 668 669 1,754 2,423 3. Minor Ailments 39 124 874 3,088 3,962 4,125 11,396 15,521 4. Eye Diseases - 3 182 408 590 593 1,387 1,980 5. Skin Diseases 14 20 155 128 283 317 252 569 6. Artificial Sunlight Treatment - - - - - - - - 7. Orthopædics - 1 133 645 778 779 660 1,439 8. Medical Consultations 15,335 22,667 23,258 11,426 34,684 72,686 - 72,686 9. Diphtheria Immunisation - - - 94 94 94 27 121 10. Total (1—9) 15,389 22,831 24,634 16,452 41,086 79,306 16,017 95,323 11. Dental Consultations 3,216 783 - 1,001 1,001 5,000 4,117 9,117 12. Total (10—11) 18,605 23,614 24,634 17,453 42,087 84,306 20,134 104,440 13. School for Mothers - - - - - - - - 14. Nursery - - - - - - - - 15. Miscellaneous - - - - - 43,475 5,930 49,405 16. Grand Total (12—15) 18,605 23,614 24,634 17,453 42,087 127,781 26,064 153,845* (l) Health Centre (1). Health Centre (2). Health Centre (3). Grand Total. (11) Mothers Mothers Mothers and School and School and School Children Children. Total. Children Children. Total. Children Children. Total under under under Five. Five. Five. (2) (3) (4) (5) (6) (7) (8) (9) (10) 17. Medical Attendances 27.543 5,919 33,462 50,984 9,438 60,422 779 660 1,439 95,323 18. Dental Attendances 2,499 1,751 4,250 2,501 2,366 4,867 — — — 9,117 19. School for Mothers — — — — — — — — — — 20. Nursery Attendances — — — — — — — — — — 21. Miscellaneous 19,626 1,922 21,548 23,849 4,008 27,857 — — — 49,405 22. Total 49,668 9,592 59,260 77,334 15,812 93,146 779 660 1,439 153,845* * In addition 317 attendances were made by secondary and technical school children and the following attendances by adults : Cleansing and treatment of Scabies 556, Skin Diseases 34, Diphtheria Immunisation 4, Varicose Ulcers 490, and Orthopaedics under Section 181 of the Public Health Act, 1936, 35, making a total of 1,436, which, together with the 153,845 above, makes a grand total of 155,281. 9 Table No. 7. Showing attendances at the Municipal Centres each year since 1913. Year. Mothers and Children under 5 years. School Children. Total. School for Mothers. Nursery. Miscellaneous. Grand Total. Medical. Dental. Total. Medical. Dental. Total. 1913 0 0 0 299 0 299 299 0 0 299 1914 0 0 0 2,517 0 2,517 2,517 0 0 2,517 1915 0 0 0 5,674 0 5,674 5,674 0 0 5,674 1916 389 0 389 9,593 0 9,593 9,982 0 0 9,982 1917 8,641 0 8,641 9,448 0 9,448 18,089 0 0 18,089 1918 32,169 1,165 33,334 15,811 2,403 18,214 51,548 44 220 51,812 1919 32,870 878 33,748 46,179 11,024 57,203 90,951 1,089 2,814 94,854 1920 51,468 1,823 53,291 64,588 10,670 75,258 128,549 2,354 3,452 134,355 1921 41,562 1,667 43,229 57,032 7,718 64,750 107,979 1,716 2,356 112,051 1922 27,505 894 28,399 39,989 7,025 47,014 75,413 1,616 2,190 79,219 1923 23,271 533 23,804 40,381 3,599 43,980 67,784 2,761 3,270 73,815 1924 17,082 520 17,602 34,845 2,460 37,305- 54,907 2,896 2,808 60,611 1925 26,119 936 27,055 41,695 5,123 46,818 73,873 4,074 3,812 81,759 1926 39,084 1,491 40,575 47,786 5,909 53,695 94,270 4,126 3,645 102,041 1927 40,958 1,593 42,551 47,199 6,583 53,782 96,333 3,847 3,291 103,471 1928 40,787 1,733 42,520 43,956 6,484 50,440 92,960 4,485 3,355 100,800 1929 43,419 1,598 45,017 39,698 6,307 46,005 91,022 4,523 3,446 98,991 1930 59,372 2,341 61,713 49,610 10,537 60,147 121,860 5,958 5,371 133,189 1931 76,395 3,473 79,868 65,942 15,180 81,122 160,990 6,928 6,985 21,884 196,787 1932 84,342 4,385 88,727 67,984 16,094 84,058 172,785 6,536 6,227 28,817 214,365 1933 84,782 4,791 89,573 71,587 15,652 87,239 176,812 5,297 5,268 27,256 214,633 1934 88,472 5,036 93,508 62,212 13,095 75,307 168,815 5,337 4,726 30,139 209,017 1935 92,666 5,596 98,262 63,666 12,447 76,113 174,375 5,343 5,299 32,553 217,570 1936 96,728 5,752 102,480 67,736 12,325 80,061 182,541 5,198 4,985 38,440 231,164 1937 108,715 5,143 113,858 71,621 11,250 82,871 196,729 4,257 4,092 42,169 247,247 1938 114,769 5,265 120,034 67,811 11,541 79,352 199,386 4,877 4,387 47,312 255,962 1939 102,225 5,492 107,717 44,683 7,485 52,168 159,885 3,067 2,943 52,147 218,042 1940 79,306 5,000 84,306 16,017 4,117 20,134 104,440 - - 50,841* 155,281 *This includes the 317 attendances made by Secondary and Technical School children and the 1,119 by adults and others under Section 181 of the Public Health Act, 1936, which are shown in the footnote to Table No. 6. Two School Children were treated under the Council's Scheme by X-rays for Ringworm of the Scalp. 4,365 Individual Public Elementary School Children attended the Municipal Centres during 19405,480 ,, Children under 5 years of age attended the Municipal Centres during 1940. 2,771 ,, Expectant Mothers ,, ,, ,, ,, ,, ,, 2,943 ,, Nursing Mothers „ „ „ „ „ „ UNCLEANLINESS AND SCABIES. There has been some increase in the number of these conditions coming to the notice of the Health Department in 1940. The position amongst school children has already been dealt with under the School Medical Service. Nursing mothers made 16 attendances for cleansing at the Council's Health Centres as against 6 in 1939 and 2 in 1938 ; and adults, male and female, other than those attending under the Maternity and Child Welfare Scheme made 556 attendances; 28 patients attending on account of verminous conditions and 128 on account of Scabies. In 1939 the corresponding attendances were 150, and in 1938, 104. There is no authority for the cleanliness inspection of children under 5 years of age, and these children are not generally inspected except in nursery classes or as foster children, and sometimes in connection with their nitty and verminous elder brothers and sisters. Children under 5 years made 27 attendances for cleansing in 1940, as against 4 in 1939 and 8 in 1938. SECONDARY AND JUNIOR TECHNICAL, ETC., SCHOOLS. The arrangement by which the Medical Staff of the Willesden Council carry out the inspection of pupils attending the Secondary and Technical Schools in Willesden, on behalf of the Middlesex County Council has been continued. The total number of pupils on the rolls of the Willesden Secondary and Technical Schools now included in this arrangement is approximately 3,000, but a number of these were evacuated during the year. 10 School Medical Inspection which had been discontinued as from 19th May, 1939, was recommenced at the end of 1940. 30 medical examinations and 41 special and re-examinations were carried out during the year 1940. No medical defects were found amongst the scholars submitted to routine medical inspection. The Middlesex County Council's scheme of treatment of scholars suffering from defective vision at the Willesden Council's Health Centres, and also that of dental inspection and treatment by the Council's dental staff, have been continued. 109 pupils were dentally inspected during the year, 101 were found to require treatment and 75 were treated at the Willesden Council's Dental Clinics. 317 attendances were made at the Clinics during the year for Medical and Dental Treatment. REPORTS OF SPECIALISTS ATTACHED TO THE COUNCIL'S HEALTH CENTRES. Eye Department.—Mr. B. R. Medlycott, m.b.b.s., m.r.c.s., l.r.c.p., d.o.m.s., Ophthalmic Surgeon to the Council reports as follows:— During the war the number of weekly sessions has been greatly reduced, but the normal routine is being followed with an optician in attendance at each session. One fact that is particularly noteworthy is the surprisingly low incidence of cases of conjunctivitis, blepharitis, and corneal ulcer, in spite of the difficulties of war-time feeding, and shelter life It is greatly to be regretted that plans for the development of an Orthoptic Department have been delayed, but it is hoped that this very useful addition to the ophthalmic services provided by the Health Centres will become available in the post war era. Mental Health.—In February, 1940, Dr. Reginald Lightwood, a consulting physician for children, began attending at Health Centres I and II to advise upon psychological problems in children. He has treated patients with abnormalities of behaviour, such as extreme disobedience, stealing, lying, truancy, etc. But for a few instances in which the parents were unwilling to co-operate, the results have been very satisfactory. Dr. Lightwood's belief is that many of these problems are much less complicated than others have thought and the adjustment of the parents' handling is usually sufficient to meet the situation. Enuresis is the commonest malady seen at the clinic ; nearly all such cases have been relieved. There have also been cases with faecal incontinence, which are not more difficult to treat than enuresis. Cases with habit spasm and stuttering have responded. The method followed is to obtain the confidence of both parent and child, to explain situations, to reassure the anxious and to employ non-hypnotic suggestion. This line of approach seems justified by the results. Skin Department.—H. Haldin-Davis, m.d., f.r.c.p., f.r.c.s. Orthopaedic Department.—J. A. Cholmeley, f.r.c.s. Ear, Nose and Throat Department.—g. H. Livingstone, f.r.c.s. The work of these departments has continued uneventfully throughout the year. PROVISION OF MEALS. Meals have been provided at the Council's Feeding Centres throughout the year. On 17th April, 1939, the Council opened a fifth feeding centre with seating accommodation for 250 in Percy Road, Kilburn. This Centre provides both breakfasts and dinners on seven days a week. The Voluntary Feeding Centre in South Kilburn was closed when the Percy Road Centre opened. After approximately half the Willesden School Children were sent to reception areas at the end of August, 1939, and the Schools closed, the one-third of a pint of milk previously given in School to all children receiving free meals was thereafter served in the feeding centres with the midday meal. 83,504 meals were supplied in 1940. 11 HOME NURSING SERVICE. The Home Nurse employed by the Council nursed 395 cases during the year, and in connection with such cases paid 2,958 visits. Of the 395 cases nursed during the year, 382 were new cases. 354 of these 382 new cases were referred by the Health Department for nursing, 11 by private doctors and 17 by Hospitals, Associations and private persons. Ophthalmia neonatorum received 74 visits and other ophthalmia cases 604 visits. SANITARY STAFF. During 1940 five members of the staff were engaged on billeting and rehousing homeless persons, three continued to man the Control Room, one lecturing on anti-gas measures and decontamination of foodstuffs. The remaining staff of four dealt with all complaints, food inspection at factories and other premises and the twice daily examination of all meat received at the Distributing Meat Depot No. 14. A considerable quantity of foodstuff was contaminated with broken glass as the result of enemy action, some of which it was possible to salvage after close inspection. Systematic spraying with disinfectant was carried out at all public shelters. PUBLIC MORTUARY. 148 bodies were deposited at the Mortuary during the year ending 31st December, 1940, as follows:—11 Accommodations, 92 Post-Mortems, 13 Post-Mortems and Inquests, and 32 Inquests only. MUNICIPAL HOSPITAL. The 49th Annual Report on the Municipal Hospital, written by Dr. Troup, appears later in this Report. Your obedient Servant, GEORGE F. BUCHAN, Medical Officer of Health. 12 THE FORTY-NINTH ANNUAL REPORT on the MUNICIPAL HOSPITAL For the year 1940 By ARTHUR G. TROUP, M.D., D.P.H., Medical Superintendent. Table No. 8. Cases in the Municipal Hospital during the Year 1940. Diseases. No. in Hospital on 1-1-40. Admitted. Total under treatment. Discharged recovered. Died. Mortality per cent. Remaining on 31-12-40. Cerebro-Spinal Fever 1 21 22 20 1 4.5 1 Diphtheria 9 80 89 73 2 2.2 14 Diphtheria (Carrier) - 2 2 2 - - - Enteric Fever - 1 1 1 - - - Erysipelas 2 16 18 16 1 5.5 1 Measles 1 74 75 53 2 2.6 20 Puerperal Infections - 19 19 19 - - - Scarlet Fever 13 95 108 101 - - 7 Whooping Cough 1 12 13 9 1 7.7 3 Other Diseases 1 152 153 144 6 - 3 Marasmus 5 34 39 28 8 20.5 3 Tonsil & Adenoid Cases - 169 169 169 - - - Civilian Sick 17 531 548 450 32 - 66 Service Sick - 52 52 48 1 - 3 Casualties - 63 63 49 11 - 3 Totals 50 1,321 1,371 1,182 65 - 124 13 Laboratory. The Bacteriological Laboratory was opened for work on 1st January, 1932. It undertakes the examination of the routine bacteriological specimens from the District, the Municipal Hospital and other local institutions. The total number of specimens showed a marked decline this year owing to the decreased incidence of Diphtheria. Table No. 9. No. Nature of Examination. Positive result. Negative result. Total. 1 Swabs for C. diphtheriæ 197 1,231 1,428 2 Typing of positive culture from 1 above - - 51 3 Sputum, etc.—Direct smears for M. tuberculosis 41 166 207 4 Sputum, etc.—Concentration with antiformin 13 149 162 5 Blood—Widal 3 4 7 6 Blood—Cultures - - 16 7 Blood—Counts - - 58 8 Blood—Films - - 45 9 Blood—Chemical examinations - - 38 10 Blood—Grouping - - 6 11 Urine—Chemical examinations - - 45 12 Urine—Microscopical examinations - - 74 13 Urine—Cultural examinations - - 58 14 Fæces—Chemical examinations - - 11 15 Fæces—Microscopical examinations - - 1 16 Fæces—Cultural examinations - - 27 17 Cerebro-Spinal Fluid—Chemical examination - - 42 18 Cerebro-Spinal Fluid—Microscopical examination - - 59 19 Cerebro-Spinal Fluid—Cultural examination - - 22 20 Direct smears of swabs, etc. - - 56 21 Cultures of swabs, etc. - - 169 22 Gastric contents from test meals - - 24 23 Water—Presumptive B. coli test - - 110 24 Water—Enumeration of total organisms - - 110 25 Drugs for sterility 3 5 8 26 Meningococcus serological grouping - - 6 27 Streptococcus serological grouping - - 7 28 Salmonella serological identifications - - 3 Total 2,850 Table No. 10. Sources of Specimens examined 1940. Willesden Municipal Hospital 1,488 Private Practitioners 725 Municipal Health Centres 355 Middlesex County Council Dispensary 12 Other Hospitals 50 Engineer's Department 220 Total 2,850 Table No. 11. Annual Number of Specimens. 1932 4,526 1933 5,908 1934 6,693 1935 7,774 1936 7,075 1937 6,305 1938 8,604 1939 6,528 1940 2,850 14 Service Sick. Service Sick include men or women belonging to any of the branches of His Majesty's or Allied Forces and the Police. Fifty-two patients coming under this category were admitted during the year, the large majority of whom were suffering from infectious disease. Rubella 30 Influenza 1 Tonsilitis 7 Hysteria 1 Diphtheria 3 Enteritis 1 Chicken-pox 3 Fractured Ankle 1 Scarlet Fever 1 Leukaemia 1 Measles 1 Paratyphoid Fever B. 1 Total 52 Bronchitis 1 The case of Leukaemia proved fatal. Civilian Sick. Civilian Sick patients are cases which have been transferred from other Sector Hospitals on the authority of the Group Medical Officer. Five hundred and thirty-one such patients have been admitted to the Willesden Municipal Hospital during the year. The majority of the surgical cases had been operated on before admission. The patients may be classified as follows :— General Surgical cases 89 Appendicitis 33 General Medical cases 88 Pulmonary Tuberculosis 24 Cancer 93 Fractures 16 Diseases of Women 73 Ear, Nose and Throat cases 67 Total 531 Hernia 48 Thirty-two deaths occurred, 16 from Cancer, 4 from Pulmonary Tuberculosis, 1 from Tetanus and 11 from other diseases. Air-Raid Casualties. Sixty-three air-raid casualties were admitted. The cases were chiefly multiple slight injuries or else too moribund for resuscitation. One-third of the cases, however, were of psycho-neurosis (shock) with or without concomitant disease. A. Psycho-neurosis (Shock). (1) Psycho-neurosis only14 (2) Psycho-neurosis with concomitant disease 7 Total21 Three deaths occurred, 2 from Cancer and 1 from Diabetes. B. Coal-gas Poisoning 2 C. Multiple Injuries. (1) Mainly head 20 (2) Mainly lower limb 7 (3) Mainly chest 2 (4) Mainly upper limb 1 (5) Mainly spine 2 Total 32 D. Moribund Cases (including 4 brought in dead) 8 15 THE TENTH ANNUAL REPORT on the WILLESDEN MATERNITY HOSPITAL. Report on the work from 1st January, 1940, to 31st December, 1940. By ARNOLD WALKER, M.A., M.B., B.Ch., F.R.C.S., F.R.C.O.G. Owing to the marked fall in the number of cases admitted during the first few months of the war, the number of cases booked for admission was increased and in spite of evacuation when air attacks started, the number of cases which has passed through the hospital during 1940 is a record. The total is 1,177 compared with 913 in 1939. The distribution of cases throughout the year has been irregular and, as might be expected, many patients cancelled their bookings and a number who were booked disappeared. As stated in the last report, the irregularity of the admissions has not resulted in overcrowding of the lying-in wards because patients were sent home as early as necessary to the care of the municipal midwives. Normally, patients remain in hospital for fourteen days after the birth of the baby, but normal cases have been sent home by ambulance as early as the tenth day. This procedure has worked satisfactorily although it has imposed additional work upon both the hospital and the domicilary midwives. One maternal death occurred during the year from puerperal mania. One interesting feature of 1940 has been the delivery of no less than four women of triplets. Triplets occur once in about six thousand births, so the incidence has been twenty times the normal. Unfortunately only four babies survived: one mother had three babies, all of which are doing well; one mother had three premature babies, one of which survived; and in the other two cases all the babies failed to survive on account of prematurity. One was classed as a miscarriage and the other as a premature birth. Statistical details of the 1,177 Cases dealt with during 1940. Cases completed 1,177 A. Booked at the Health Centres 1,155 Discharged well 1,141 Delivered elsewhere 12 Transferred 1 Died 1 B. Admitted as Emergencies 22 Discharged well 22 Of the 1,155 booked cases, 631 were primiparae and 524 were multipara. Of the 22 emergency cases, 7 were primiparae and 15 were multiparae. Presentations— Occipito Anterior 970 Occipito Posterior 113 Normal Breech 38 Complicated Breech 5 Twins 16 Triplets 3 Face 2 Shoulder 2 Miscarriages (including one case of triplets) 12 16 Statistical Details—(continued). Ante-partum Hæmorrhage— Placenta Prævia 4 Accidental Hæmorrhage 6 Prolapse of Cord 6 Organic Heart Disease 6 Toxaemia of Pregnancy admitted for treatment 26 Eclampsia 1 Hydramnios 1 Puerperal Pyrexia 34 Uterine Infection 5 Breast Infection 11 Urinary Infection 10 Thrombo-phlebitis 2 Pulmonary Infections 2 No cause found 4 Operations performed— Forceps delivery 47 The forceps rate was therefore 4 per cent. Caesarean Section 3 Disproportion 3 Manual Removal of Placenta 16 Hysterotomy and Sterilisation 1 Chronic Nephritis 1 Induction of Premature Labour 10 Toxaemia 9 Hydramnios 1 Blood Transfusion 9 Stored blood 7 Fresh blood 2 1,174 viable children were born to 1,152 mothers. Of these, 43 were stillborn and 21 died. 17 THE ELEVENTH ANNUAL REPORT on the SUPERVISION OF MIDWIVES for the Year ending 31st December, 1940. 35 Midwives gave notice of their intention to practise in Willesden in 1940, 11 of these being in the Central Middlesex County Hospital. Midwives practising and living in Willesden attended 1,700 cases either in hospital or on the district as midwives or maternity nurses as against 1,846 in 1939. 194 of these were outside Willesden. In addition 17 midwifery or maternity cases were attended in Willesden by midwives living outside Willesden. The 6 Municipal District Midwives attended 382 midwifery cases in 1940 and in addition answered 6 emergency calls during air raids and carried out ante-natal care of 122 cases which were subsequently confined elsewhere. Midwives attached to Queen Charlotte's Hospital District Home, Kilburn, attended 309 midwifery cases. 115 of these were Willesden residents attended on behalf of the Willesden Council with in addition 11 cases attended for ante-natal care only. 194 were cases attended outside Willesden. Midwives attached to the Willesden District Nursing Association attended 128 Maternity cases on behalf of the Council. During the year 178 notifications were received from Midwives practising in Willesden in accordance with the rules of the Central Midwives Board and of these 150 notifications were in respect of medical aid, 118 in respect of the mother and 32 in respect of the child. The third year's working of the Domiciliary Midwifery Scheme and the Second Period Training School for pupil midwives has, on the whole, been satisfactory. The reduction in the number of cases is the result of evacuation, for the most part. The number of whole-time Municipal Midwives remains at 6. In addition two and a half midwives are still allotted for the area served by Queen Charlotte's Hospital District Home. The Willesden District Nursing Association deals with the Maternity Nursing under an arrangement made with the Willesden Borough Council. The Watling and Willesden Training School for second-period Pupil Midwives.— During the year 24 pupil midwives worked on the district. Of the 382 confinements dealt with by the Municipal Midwives, the pupil midwives attended 298 under the direct or indirect supervision of the midwives. The pupil midwives took responsibility for the ante-natal care, attended and took responsibility for the labours and nursed the mothers and their babies during the 14 days immediately following labour. In addition to the work shown above in respect of the Municipal Midwives cases in Willesden, the pupil midwives attended Ante-Natal Clinics 141 Maternity and Child Welfare Clinics for mothers and babies 125 The Cullingworth lecture courses. A discussion class, each week, taken by the Supervisor of Midwives at the Health Department. Of the 24 pupil midwives, 19 sat for their final midwifery examination, 18 passed, 1 failed but passed at the next examination. 18 THE TWENTY-THIRD ANNUAL REPORT for the YEAR 1940, on DENTAL WORK in connection with SCHOOL CHILDREN, EXPECTANT and NURSING MOTHERS and CHILDREN under 5 years. By E. A. JENNINGS, L.D.S., R.C.S.Eng. The Dental Service has continued on restricted lines throughout the year. A minimum staff of two dental officers and two nurses have carried on the work at their respective centres at Kilburn and Willesden Green. THE YEAR'S WORK. The total working sessions amounted to 1,088, and were utilised as follows :— Treatment sessions at the Centres 1,015 Routine Inspection sessions 63 Administration sessions 10 Total 1,088 The Anaesthetist attended 109 times and administered anaesthetics to 2,236 patients which is an average of 20.5 patients per session. 6,554 mothers, infants, elementary and secondary school children were inspected. 5,536 were defective and 2,893 were treated at the centres. 8,275 teeth were removed, 4,166 fillings were done and 1,518 other operations, making a total of 13,959 treatments. 8.698 attendances were recorded by these patients. ELEMENTARY NURSERY AND SPECIAL SCHOOLS. In pekce-time the school population of Willesden is approximately 18,000. Since hostilities began 12,700 children have left our schools and 5,300 remain on the Willesden registers. Inspection. . Routine.—Although there have been temporary dislocations of routine school work, 3,658 children received oral examination during 62 visits—an average of 59 a session. Specials.—854 children were inspected at the centres and the necessary treatment carried out. 3.699 were found defective and 1,661, or nearly 45% were treated at the centres. Treatment. 4,569 teeth were extracted, of which 728 were permanent. There were 1,865 fillings done on permanent teeth and 327 on the milk series, making a total of 2,192 fillings. 477 incidental treatments, including root fillings to anterior teeth, minor gum treatments, silver nitrate and sedative dressings, were done. 432 sessions were assigned to treatment. WILLESDEN SECONDARY AND JUNIOR TECHNICAL, ETC., SCHOOLS. Inspection. One secondary school was visited when 29 scholars were examined. In addition 80 were inspected at the Centres, making a total of 109. 101 of these were defective and 75 of these were treated at the Willesden Centres. MATERNITY AND CHILD WELFARE. 1,153 mothers and infants received treatment at the Centres. This is the highest figure ever recorded and is 94 more than in 1939. The work done was of a similar nature to that described in previous reports, except that fewer dentures have been provided. A total of 3,635 teeth were extracted and 1,771 teeth were filled, for which 4,999 attendances were recorded and 554 treatment sessions allocated.