WIL 39 Ac 439 (1) WILLESDEN Borough of Willesden, 1943 THE 68th ANNUAL HEALTH REPORT GEORGE F. BUCHAN, M.D., F.R.C.P., D.P.H., Medical Officer of Health. London: WIGHTMAN & CO. LTD. 104, Regency Street, S.W.1. BOROUGH OF WILLESDEN Health Department, 54, Winchester Avenue, Kilburn, London, N.W.6. November, 1944. To the Corporation of Willesden. I beg to submit herewith the Annual Health Report for Willesden for the year 1943, in accordance with instructions received from the Ministry of Health and Ministry of Education that it should be a short report. VITAL STATISTICS. 2,657 live births were registered. 71 still births were registered. 1,814 deaths were registered. The infantile mortality rate for the year was 58. 155 children under one year of age died in 1943. CANCER. There were 334 deaths of Willesden residents from Cancer in 1943, as compared with 304 in 1942. The two Municipal Cancer Clinics were continued throughout the year. 4 new patients attended these Clinics in 1943 . 2 proved to be suffering from cancer, one of the breast and one of the uterus, and were treated in Hospital. 2 proved not to be suffering from cancer. The total attendances were 12. INFECTIOUS DISEASES. During the year 1943, 2,738 cases of infectious diseases were notified, as compared with 2,611 in the previous year. The following table gives the number of notifications of certain diseases included in the above total of 2,738 together with the corresponding figures for 1942:— Table No. 1. Number of Cases notified. 1942 1943 Diphtheria 186 136 Scarlet Fever 351 557 Pneumonia 225 439 Whooping Cough 460 238 Erysipelas 48 32 Measles 955 882 Diphtheria Immunisation.—The number of children who have completed a full course of immunisation since 1941 under the Council's scheme is as follows :— Table No. 2. Children under 5 years. Children 5 years of age and over but under 15 years. Total. 1941 1,186 813 1,999 1942 1,833 2,660 4,493 1943 1,691 2,520 4,211 The approximate estimated number of children in Willesden at 31st December, 1943, was 10,200 under 5 years of age and 17,000 between 5 and 15 years of age. It was estimated that 51 per cent. of those under 5 years and 52 per cent. of those between 5 and 15 years had been immunised at 31st December, 1943. The Council first made arrangements for immunising Willesden children against diphtheria in May, 1927. Immunisation was carried out at the Kilburn Health Centre and the Municipal Hospital. More recently, when the number of applicants has been large enough, immunisation sessions have been arranged in the schools. Since November, 1942, sessions have also been held regularly at each of the Council's Health Centres. 3 Pamphlets on diphtheria prevention and copies of the broadcast of the Chief Medical Officer of the Ministry of Health have been distributed in considerable quantities and notices and articles have been put in the Press. The most effective method, however, of ensuring the immunisation of the child population is the following:— When the Health Visitors visit children aged 9 months or over under the Maternity and Child Welfare Schem they draw the attention of mothers to the facilities existing for immunisation against diphtheria in order that they may think the matter over and have their children immunised at about one year of age if they so desire. The Health Visitors have this question of diphtheria immunisation in mind at each subsequent visit until the child has been immunised. Leaflets concerning diphtheria prevention with form on the back for parent's signature agreeing to have their children immunised have been sent to head teachers for distribution to their scholars. A high percentage of these forms are returned duly signed to the teachers. When immunisation sessions are held at the schools the mothers frequently take the opportunity of bringing any younger children not yet immunised and getting all their family dealt with at once. Enteric Fever.—No cases of Typhoid or Para-typhoid Fever were notified in 1943. Dysentery.—45 cases were notified as Dysentery in 1943. 1 occurred in January, 3 in February, 2 in March, 1 in April, 1 in May, 2 in June, 4 in July, 5 in August, 6 in September, 15 in October, 4 in November and 1 in December. 17 of these patients were nursed in the Municipal Hospital, 26 in other hospitals and 2 at home. Two died in hospital. One was aged 1½ months, death being attributed to infective enteritis, and one aged 8 weeks, death being attributed to gastro enteritis. The ages of the 45 patients were as follows:—three under 1 year, twenty-five 1 year but under 5 years, nine 5 years but under 10 years, one 10 years but under 15 years, three 15 years but under 20 years, one 20 years but under 35 years, one 35 years but under 40 years, and two 45 years but under 65 years. Malaria.—4 cases were notified in 1943. 1 case occurred in a man of 32 years who originally contracted the disease in North Africa in 1942. In the other 3 cases Malaria was induced for therapeutic purposes. 2 of these cases related to 1 patient, Malaria being induced twice. Infectious Diseases of the Central Nervous System.—Poliomyelitis and Polio-encephalitis, Cerebrospinal Fever and Encephalitis Lethargica.—20 cases of these diseases were notified in 1943 as against 35 in 1942, 29 in 1941, 38 in 1940, 18 in 1939, 24 in 1938, 22 in 1937 and 14 in 1936. Six proved fatal, giving a fatality rate of 30 per cent. of notified cases. 15 cases were notified as Cerebro-spinal Fever. Of these 15 cases 10 proved to be Cerebrospinal Fever, in 2 cases further information was not available and 3 were found in hospital not be suffering from Cerebro-spinal Fever; one of these was diagnosed as meningism and two, both fatal, as Tubercular Meningitis. The ages of the 10 cases which proved to be Cerebro-spinal Fever were as follows:— Under 1 year of age 2 Between 10 and 15 years of age 0 Between 1 and 2 years of age 1 „ 15 „ 20 „ „ 2 „ 2 „ 3 „ „ 0 „ 20 „ 35 „ „ 1 ,, 3 ,, 4 „ „ 2 ,, 35 ,, 45 ,, ,, 0 „ 4 „ 5 „ „ 0 „ 45 „ 65 „ „ 1 „ 5 ,, 10 ,, ,, 1 65 years of age and over 0 The months in which the 10 cases occurred were as follows:— December, 1942 1 May, 1943 0 September, 1943 3 January, 1943 1 June, 1943 0 October, 1943 0 February, 1943 2 July, 1943 0 November, 1943 0 March, 1943 1 August, 1943 0 December, 1943 1 April, 1943 1 Two of these 10 cases which proved to be Cerebro-spinal Fever died. These patients were aged 6 months and 18 years. In addition two further deaths of Willesden residents were recorded as Cerebro-spinal Fever but the cases were not notified. Four cases of Poliomyelitis were notified aged 10 months, 2 years, 8 years and 53 years. The case aged 2 years was diagnosed in hospital as Tonsillitis and recovered, the case aged 53 years was diagnosed in hospital as acute infective Polyneuritis and died. The two cases of Poliomyelitis were discharged from hospital one being referred for further treatment at the orthopaedic clinic. One case aged 6 years was notified as Encephalitis Lethargica and died. Pneumonia and Influenza.—439 cases of Pneumonia were notified in 1943 as compared with 225 in 1942. Deaths from Broncho Pneumonia, Lobar Pneumonia and Pneumonia (unspecified) numbered 130 as compared with 87 in 1942 and deaths from Influenza 36 as compared with 12 in 1942. The age groups of these 166 deaths from Pneumonia or Influenza were as follows:— 0—1 30 20—25 0 55—65 28 1—5 1 25—35 1 65—75 41 5—10 1 35—45 2 75—85 37 10—15 1 45—55 11 85 upwards 13 15—20 0 4 Whooping Cough.—238 cases were notified in 1943, but a total of 399 cases coming to their knowledge were visited by the Health Visitors, 286 of which occurred in children under 5 years of age. There were 3 deaths from Whooping Cough in 1943. Two of the children who died were under 1 year of age and one was between 1 and 5 years of age. Measles.—882 cases were notified in 1943, but a total of 1,195 cases were visited by the Health Visitors, 627 of which occurred in children under 5 years of age. There was 1 death from Measles in 1943. The child who died was under 1 year of age. Tuberculosis.—The following table shows the number of cases of Tuberculosis on the register at the end of each year 1938-1943:— Table No. 3. Number of Cases of Tuberculosis on Register at end of Year. Pulmonary. Non-Pulmonary Male. Female. Male. Female. 1938 361 330 80 92 1939 373 305 77 89 1940 337 250 61 84 1941 325 250 58 58 1942 361 278 68 65 1943 422 312 72 78 MOTHERS AND CHILDREN UNDER FIVE YEARS. Municipal Health Centres.—At the three Municipal Health Centres, expectant mothers attended the medical consultation and medical treatment Clinics on 18,207 occasions, nursing mothers 28,274, and children under five 47,410, making a total at these clinics of 93,891 attendances in 1943. Out of the total number of 2,657 children registered as born alive in 1943, 2,061, or 78 per cent., subsequently attended the Municipal Health Centres. The following table shows the total attendances of Expectant and Nursing Mothers and Children under 5 years of age at the Municipal Health Centres since 1938:— Table No. 4. Health Centre Attendances. Total attendances of Expectant and Nursing Mothers and Children under 5 years of age. Attendances of Expectant Mothers at Ante-Natal Clinics only. 1938 (3 Health Centres open) 158,893 15,351 1939 (3 Health Centres open 8 months, 2 Health Centres open 4 months) 153,810 14,305 1940 (2 Health Centres open) 127,781 15,335 1941 (2 Health Centres open) 113,863 13,949 1942 (2 Health Centres open 10½ months, 3 Health Centres open 1½ months) 138,189 19,157 1943 (3 Health Centres open) 146,071 18,142 Princess Road Voluntary Centre.—The Council took over the Princess Road Voluntary Infant Welfare Centre in Kilburn as from 1st April, 1942. Children under 5 years of age attended the Medical Consultations at this Centre on 1,069 occasions and nursing mothers on 778 occasions during 1943. 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.—1,199 patients were booked during 1943 for confinement in the Willesden Maternity Hospital. The fees at which these 1,199 cases were booked varied from 56 at £15 to 264 free. The average fee per case was approximately £4 17s. 5¼d. During 1943, 557 applicants for confinement in the Willesden Maternity Hospital were unable to be booked for the reasons set out below:— Table No. 5.—Applications for Booking Refused. No beds available 534 Not resident in Willesden 23 557 5 Hospital Confinements.—During 1943, 999 women were confined in the Willesden Maternity Hospital. 362 births of Willesden residents were notified from outside Institutions—53 from St. Mary's Hospital, 35 from Queen Charlotte's Hospital, 22 from Middlesex Hospital, 15 from Paddington Hospital, 13 from University College Hospital, and smaller numbers from other hospitals, 102 from a Nursing Home and smaller numbers from other Nursing Homes. These, together with some 519 in the Central Middlesex County Hospital, are approximately 69 per cent. of the births belonging to Willesden. It is to be noted that in 1943 many mothers desiring institutional confinement were unable to obtain beds. 534 applicants for the Willesden Maternity Hospital alone had to be refused. Some of these obtained beds in other hospitals, some solved their difficulty by registering for evacuation in the last month of pregnancy, and some had to be confined at home. The following table shows the domiciliary and institutional confinements:— Table No. 6. 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 1941 340 112 1,317 1,769 1942 663 163 1,788 2,614 1943 634 189 1,871 2,694 Reports on the Willesden Maternity Hospital by Mr. Arnold Walker, F.R.C.S., the Council's Consultant Obstetrician, appear 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. 461 such reports were supplied in 1943. 371 Expectant Mothers booked for confinement in the Central Middlesex County Hospital were referred to the Willesden Health Centres for Ante-Natal care in 1943. Puerperal Pyrexia.—64 cases were notified in 1943. Maternal Mortality.—During 1943 there were 3 deaths classed to pregnancy and child-bearing—1 to Puerperal Sepsis, a self-induced abortion, and 2 to other puerperal causes. The puerperal mortality rate from Sepsis was therefore, 0.37 per 1,000 registered total births. The total puerperal mortality rate was 1.10 per 1,000 registered total births. During 1943 there were, in addition, 3 maternal deaths from non-puerperal causes. The total maternal mortality from all causes including criminal abortion was 2.20 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 1943, 267 were supplied free, 170 at full cost and 294 at part cost—a total of 731. 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. No such consultations were paid for in 1943. 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. Provision of Anaesthetist.—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 fees were paid in 1943. Home Helps.—The Council provided the services of home helps in connection with 144 confinement cases in 1943. 6 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. 4 cases were inquired into during 1943. 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. 44 children were under treatment for Marasmus and 124 for enlarged tonsils and adenoids and mastoid disease. 8 of the children suffering from Marasmus died. Children were admitted to hospital to a limited extent for orthopaedic conditions. Ophthalmia Neonatorum.—The number of cases of this disease notified in 1943 was 8, this being the same figure as for 1942. This gives a case rate of 3.0 per 1,000 registered live births. A district midwife attended the confinement in 5 cases, and 3 cases were born in hospital. Treatment was obtained at a hospital in 4 cases, at the Municipal Health Centre in 2 cases and from a doctor at home in 2 cases. Complete recovery with unimpaired vision occurred in 7 cases. In 1 case the patient was still under treatment at the end of the year. 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 are still evacuated under the Government Scheme or privately with their Foster Mothers. At the end of 1943 there were 41 Foster Mothers and 64 Foster Children still in Willesden. One foster child died during the year. Post mortem and inquest held—"Subdural haemorrhage due to a blow on the head— Struck her head on an indoor air-raid shelter—Accidental death." There has been a great scarcity of Foster Mothers throughout the year. Women even when not otherwise occupied are unwilling to undertake the care of children in these difficult times and further they desire to be free whenever their husbands come home on leave. ADOPTION OF CHILDREN (REGULATION) ACT, 1939. This Act came into force on June 1st, 1943. It makes it unlawful for any body of persons to make any arrangements for the adoption of a child unless that body is a registered adoption society or a local authority. Adoption Societies have to be registered by the Councils of Counties or County Boroughs, and on September 8th, 1943, the Secretary of State issued the Adoption Societies Regulations, 1943, made under Section 4 of the Act. In carrying out the obligations placed upon them Adoption Societies make considerable demands on the services of Local Authorities' Officers. Section 7 of the Act is the section with which Willesden as the Welfare Authority is concerned. This section makes it the duty of any person, other than the child's parent or guardian or the person with whom the child is placed, who participates in the arrangements for the placing of the child, to notify in writing the Welfare Authority of the area in which the child is to be placed. It is illegal for the adopter or any other person concerned to give or receive any remuneration or reward. It is the duty of child protection visitors to visit and examine such children and the premises in which they are kept and further to seek out any children in respect of whom a notice should have been given. A child may be removed from the person with whom it is placed on the same grounds as a foster child. The provisions of Section 7 do not apply if the other person participating is a registered Adoption Society or a Local Authority or when the child is legally adopted or reaches 9 years of age. There are certain other exceptions. If a child is placed in the care and possession of another person by its parents without any other person in any way participating in the making of the arrangements it does not come within the provisions of Section 7 of the Act and the Health Visitor can then only exercise such supervision as is possible without compulsory power in the course of her maternity and child welfare work. Two persons gave notice under Section 7 (3) in 1943 and there were 2 " adopted " children under supervision at the end of the year. NURSING HOMES. No new homes were registered in 1943. The total number of homes on the register at the end of 1943 was 7, providing accommodation for 5 maternity a tients and 31 other patients. AGED AND INFIRM PERSONS. The suitable care of aged and infirm persons is a constant and increasing problem with which the Health Department has little power to deal, yet one which is brought as a matter of course to the Health Department to be solved. 7 A number of such cases came to notice in 1943. Some were eventually persuaded to go into hospital or institution, some became so ill that they were removed to hospital, some died. Three cases were dealt with under Section 64 of the Middlesex County Council (General Powers) Act, 1938, and were removed by order of the Court to institutions of the Middlesex County Council. One was a man of 85 years, deaf and with considerable impairment of sight, one a man of 87 years, crippled, weak and ill, and one a woman of 87 years who appeared to have lost all interest in the tidiness and cleanliness of her surroundings. In each case they lived alone, their rooms were incredibly dirty and untidy and they were unable to devote to themselves proper care and attention. In the interests of their health and for the prevention of serious nuisance to other persons residing in the same premises it was necessary to remove them to suitable institutions. In such cases a renewal of the order has to be applied for in respect of each period of three months during which the patient needs to be detained in the institution. In the case of the man of 85 years the order was renewed twice and then the Middlesex County Council took over responsibility for the patient as a public assistance case. The man of 87 died a week after admission to the institution.. In the case of the woman of 87 the medical officer of the institution reported at the end of the first three months that she had improved physically and mentally and was fit to be discharged but should not live alone. In these circumstances it was not possible to apply for a further order to detain her. Her subsequent fate was left with her relatives and is so far unknown. The above patients deeply resented removal from their homes and life-long associations and it appears to me rather inhuman to have to deal with old people in this way. The Local Authority should be enabled to make arrangements for a system of domestic help and personal care for the aged in their own homes and for the establishment of suitably designed and fitted houses and flats where the aged could be accommodated if it were unsuitable for them to remain in their own homes. It might be desirable to establish groups of small houses for 1 and 2 old people per house, two storey blocks of service flats with restaurant and caretaker's quarters on the upper storey and lift, and to take and suitably adapt and fit ground floors in ordinary houses in various parts of the district. Accommodation should also be available for elderly people for short stays whilst their own homes are cleaned or redecorated. One elderly lady was accommodated in such circumstances at the Municipal Hospital for a period in 1943, but this arrangement would not always be possible. THE SCHOOL MEDICAL SERVICE. On 28th August, 1942 the Board of Education issued Circular 1604 revising the arrangements to be made for the medical inspection of school children. Only two routine inspections are now required instead of three—(i) on or as soon as possible after admission to school; (ii) in the last year of school life—but increased attention is required to be paid to the children by the School Nurses. These revised arrangements came into operation on the reopening of the Stonebridge Health Centre in November, 1942. During 1943, 4,296 children were medically inspected at routine inspections and 19,479 at special inspections and re-inspections. Scabies.—See report on Uncleanliness and Scabies on pages 9 to 11. Uncleanliness.—(a) Willesden.—During 1943 cleanliness inspections were carried out in the schools on 493 occasions. The total number of examinations and re-examinations made during the year was 38,385. See report on Uncleanliness and Scabies on pages 9 to 11. (b) Reception Areas.—In the Annual Reports for 1940-1942 the results of cleanliness inspections made by the Willesden Council's Health Visitors in reception areas from 20th April, 1940, to 2nd January, 1943, were shown. The results of cleanliness inspections made by the Willesden Council's Health Visitors in reception areas during 1943 are as follows:— Table No. 7. Number Inspected. Number Nitty or Verminous. Percentage Nitty or Verminous. Willesden Evacuees 433 17 3.9% Other Evacuees 1,924 60 3.1% Natives 6,476 689 10.6% 8 Medical Treatment in Willesden.—During the year 1943 school children were followed up by the Health Department on account of 11,534 medical defects and 4,158 dental defects. Of those defects found to require treatment, medical or dental treatment was obtained for 11,304 and domestic treatment was obtained for 1,685. 89 per cent of the medical defects were treated, 74 per cent receiving medical treatment and 15 per cent domestic treatment; 72 per cent of the dental defects followed up were treated. No record is available of defects requiring treatment which were not followed up. 96 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 4 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 the defects treated, the children concerned made 51,855 attendances at the Health Centres. School Medical Service for Children sent to Reception Areas.—Three of the School Nursing Staff were working in Reception Areas during 1943. Medical Inspection of children for evacuation to Reception Areas in 1943 was carried out in accordance with the requirements of Government Departments. HEALTH CENTRES. ATTENDANCES. Table No. 8. Medical and Dental Treatment—Attendances at Municipal Health Centres, 1943. 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) (9) 1. Cleansing - 1 1 52 53 54 399 453 2. Throat, Nose and Ear Diseases - 1 19 616 635 636 5,073 5,709 3. Minor Ailments 34 90 693 4,252 4,945 5,069 27,449 32,518 4. Eye Diseases 1 5 158 413 571 577 3,805 4,382 5. Skin Diseases 30 44 219 220 439 513 573 1,086 6. Artificial Sunlight Treatment — — — — — — — — 7. Orthopaedics — 54 242 902 1,144 1,198 2,327 3,525 8. Medical Consultations 18,142 28,079 28,972 10,651 39,623 85,844 — 85,844 9. Diphtheria Immunisations . . — — — 2,846 2,846 2,846 688 3,534 10. Total (1—9) 18,207 28,274 30,304 19,952 50,256 96,737 40,314 137,051 11. Dental Consultations 3,223 983 — 742 742 4,948 7,575 12,523 12. Total (10—11) 21,430 29,257 30,304 20,694 50,998 101,685 47,889 149,574 13. School for Mothers — — — — — — — — 14. Nursery — — — - — — — — 15. Miscellaneous — — — — — 44,386 4,654 49,040 16. Grand Total (12—15) 21,430 29,257 30,304 20,694 50,998 146,071 52,543 198,614 Kilburn Health Centre. Willesden Health Centre. Stonebridge Health Centre. Mothers and Children under Five. School Children. Total. Mothers and Children under Five. School Children. T otal. Mothers and Children under Five. School Children. Total. Grand Total. (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) 17. Medical Attendances 29,885 11,724 41,609 34,506 12,807 47,313 32,346 15,783 48,129 137,051 18. Dental Attendances 1,765 2,053 3,818 1,860 2,748 4,608 1,323 2,774 4,097 12,523 19. School for Mothers — — — — — — — — — — 20. Nursery Attendances — — — — —. — — — — — 21. Miscellaneous 19,234 1,408 20,642 13,530 1,436 14,966 11,622 1,810 13,432 49,040 22. Total 50,884 15,185 66,069 49,896 16,991 66,887 45,291 20,367 65,658 *198,614 * In addition 3,210 attendances were made by Secondary and Technical school children and the following attendances by adults : Cleansing and Treatment of Scabies 3,324, Skin Diseases—28, Varicose Ulcers—353 and Orthopaedics under Section 181 of the Public Health Act, 1936—33, making a total of 6,948, which together with the 198,614 above makes a grand total of 205,562. 9 Table No. 9. Showing Attendances at the Municipal Health 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 67,964 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 1941 71,557 4,445 76,002 22,576 3,585 26,161 102,163 — — 44,202 146,365 1942 88,644 5,839 94,483 37,974 5,474 43,448 137,931 — — 50,956 188,887 1943 96,737 4,948 101,685 40,314 7,575 47,889 149,574 — 55,988* 205,562 *This includes the 3,210 attendances made by Secondary and Technical School children and the 3738 by adults and others under Section 181 of the Public Health Act, 1936, which are shown in the footnote of Table No. 8. In 1943, three School Children and one Child under 5 years of age were treated under the Council's Scheme by X-rays for Ringworm of the Scalp. Table No. 10. Number of Individuals who Attended the Municipal Health Centres in 1943. Public Elementary School Children 7,705 Children under 5 years of age 6,067 Expectant Mothers 3,632 Nursing Mothers 3,364 PRINCESS ROAD CENTRE 808 attendances were made by Children under 1 year of age at the Medical Consultation Sessions in 1943, 261 by Children 1-5 years of age and 778 by Nursing Mothers, or a total of 1,847, UNCLEANLINESS AND SCABIES. In January, 1940, the Ministry of Health issued a Memorandum on Scabies (Memo. 229/Med.) and a Memorandum on the Louse and how to deal with it (Memo. 230/Med.). Circular 1942 accompanying these memoranda stated that the memoranda briefly summarised the principal advice which would aid Local Authorities in making provision for preventing and curing these conditions and for securing the treatment and disinfestation of the members of households among whom pediculosis or scabies had been found to exist. In March, 1941, the Ministry of Health and Board of Education issued a joint circular—No. 2306 Ministry of Health and 1544 Board of Education—on Infestation by Lice with the view of emphasising the importance of a continued and extended campaign for the abolition of lice, a memorandum on the Incidence of Lice being enclosed. The circular required medical officers to report as to the incidence of lousiness in the area and as to the educative and administrative measures which in their view could most effectively be taken to deal with the problem. In November, 1941, the Ministry of Health issued a further circular—Circular 2517 on Scabies—enclosing the Scabies Order, 1941, made by the Minister of Health under Regulation 33A of the Defence (General) Regulations, 1939. This Order came into force on 28th October, 1941, and its provisions apply to persons suffering from scabies or in a verminous condition. It gives the Medical Officer of Health power on becoming aware of such a person to inspect any premises in which that person is or has recently been accommodated, to require the examination of any person who is or has recently been accommodated in the premises, and if necessary to require such person to submit to cleansing or treatment. 10 In December, 1941, the Board of Education issued Circular 1575 drawing attention to the foregoing and stressing the importance of the elimination of scabies among school children. In January and April, 1942, circular letters in connection with the treatment of scabies were received from officers of the Ministry of Health. In May, 1942, a further Circular No. 2645 was issued relative to the Scabies Order, 1941, and in June, 1942, Memo. 229/Med., a revised edition of the Memorandum on Scabies and how to deal with it. In March, 1943, the Ministry of Health issued Memo. 230A/Med. dealing with the use of Lethane hair oil in the control of head lice. In July, 1943, the Ministry of Health issued Circular 2831 on infestation by head lice—its primary object apparently being to urge that Health Visitors should concentrate on the eradication of this condition. The position in Willesden is as follows:— School Children. Since June, 1941, routine cleanliness inspections have been held in each school department twice a term instead of once a term, and the Health Visitors have continued to visit their schools weekly to re-examine children found nitty or verminous and to see cases specially referred by the teachers. Every effort is made by home visitation to improve the standard of cleanliness of the family. Cases of lice and scabies are treated at the Health Centres where they are under the care of Health Centre Doctors and are referred to the Council's Skin Specialist as necessary. Table No. 11. Percentage of Children examined found Unclean at Routine Cleanliness Inspections. 1938 5.6 1940 5.5 1942 5.1 1939 5.0 1941 5.2 1943 6.1 Table No. 12. Percentage of Individual Children examined found Unclean at Routine Cleanliness Inspections. 1938 3.8 1940 4.2 1942 4.2 1939 3.8 1941 4.2 1943 4.8 Table No. 13. Total Number of Individual School Children Cleansed at the Authority's Clinics. 1940 476* 1941 219 1938 379 *Increase largely due to cleansing immediately prior to evacuation 1942 189 1939 321 1943 348 Table No. 14. Number of Cases of Scabies amongst School Children Treated at the Authority's Clinics. 1941 396 1942 725 1943 1,228 Children under 5 years of age. These generally come to light in connection with their elder brothers and sisters. In 1943, 834 were treated at the Health Centres for scabies making 2,014 attendances, and 73 were treated for lice making 73 attendances. The figures for 1942 were 363 treated for Scabies making 977 attendances and 34 treated for lice making 34 attendances. Adults. The figures below indicate that there is a considerable increase in lice and scabies amongst adults, or in any case that a greater number of adults suffering from these conditions are coming to the notice of the Health Department. These adults mainly come to the notice of the Health Department as contacts with known cases amongst school children or as cases referred from hospitals or factories. One factor which is thought by workers amongst scabies to be keeping up the prevalence of this disease is the reluctance of the father of the family to admit that he has anything wrong with him and to continue at work without securing efficient treatment. Table No. 15. Attendances of Adults at Health Centres for Cleansing and Scabies. 1938 104 1940 556 1942 2,375 1939 150 1941 1,016 1943 3,243 The following table gives a picture of the work done at the Health Centres in respect of scabies and lice in 1943. The cases were followed up in their homes by the Health Visitors and necessary action taken as to cleansing, disinfection and examination of contacts and education as to cleanliness. Steel nit combs are sold at the Health Centres. Certain publications relative to lice and to scabies have been distributed. In the case of uncleanliness, especially of the aged, the Health Visitors have worked in conjunction with the Sanitary Inspectors and if necessary the patient has been admitted to hospital for a short period to enable the premises to be suitably cleansed. 11 Table No. 16. 1943. No. of Cases treated at the Health Centres. No. of Attendances made at the Health Centres. For Scabies. For Lice and Nits. Total. For Scabies. For Lice and Nits. Total. Children under 5 years 834 73 907 2,155† 73 2,228 Children 5-14 years 1,228 407 1,635 3,557* 411 3,968 Adults 913 127 1,040 3,116‡ 127 3,243 Total 2,975 607 3,582 8,828 611 9,439 † 141 of these attendances were made for the inspection of contacts who on inspection were found not to be suffering. * 104 of these attendances were made for the inspection of contacts who on inspection were found not to be suffering. ‡ 100 of these attendances were made for the inspection of contacts who on inspection were found not to be suffering. Although the arrangements at the Health Centres for the treatment of scabies and lice were adequate for the cases which had to be dealt with in normal times, they were quite inadequate and unsuitable for the cases requiring attention in 1941, 1942 and 1943. It was evident that little progress was likely to be made until arrangements were such that every member of a household in which a case of scabies came to light could be examined and if necessary treated at once and at the same time. After careful consideration the Council decided to erect a suitable building suitably staffed for dealing with these conditions in the Municipal Hospital grounds where such cases would not be crowded up with maternity and child welfare patients, where a doctor would be readily available and where all persons could be treated at once and return home in their own clothes after these had been disinfested at the hospital disinfecting station. Further, any severe cases could be immediately admitted to hospital. This proposal received the sanction of the Ministry of Health in January, 1943, and the Centre opened in March, 1944. It will now be possible to undertake a still more intensive campaign against these conditions than has hitherto been practicable. 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 Junior 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 Junior Technical Schools now included in this arrangement is approximately 3,000. In 1943 1,023 medical examinations and 396 special and re-examinations were carried out during the year. 200 pupils seen at routine medical inspections required treatment—118 on account of defective vision. The Middlesex County Council's scheme of treatment of scholars suffering from defective vision and orthopaedic defects at the Willesden Council's Health Centres, and also that of dental inspection and treatment by the Council's dental staff, have been continued. 2,104 pupils were dentally inspected during 1943, 1,399 were found to require treatment and 754 were treated at the Willesden Council's Dental Clinics. 3,210 attendances were made at the Clinics during the year for Medical and Dental Treatment. As from the 1st April, 1943, the Willesden Education Committee agreed to undertake the treatment of minor ailments for secondary and junior technical school children on behalf of the Middlesex County Council. REPORTS OF SPECIALISTS ATTACHED TO THE COUNCIL'S HEALTH CENTRES. Dermatological Department.—Report by H. Haldin-Davis, m.d., f.r.c.p., f.r.c.s.:—Since the outbreak of the War the chief subject of dermatological interest which has affected Willesden is the prevalence of scabies. The incidence of this disease was rising slightly before the War, but during the early part of the War its prevalence increased very greatly. It seemed to increase particularly quickly while the air attack on London was in full swing. During the recent months although cases are still quite common they do not seem to be quite so numerous as they were at one time. It is probable that the control of the disease has been helped by the researches by Mr. K. Mellanby. This observer has shown that the disease is almost exclusively spread by personal contact and the role played in its diffusion by infected blankets and clothing is not nearly so important as was formerly thought. The recognition of this fact has greatly lightened the labours of the Sanitary Department for it is no longer thought necessary to have all the clothes and bedding sterilised by heat for every family in which a case of scabies occurs—instead of that, the modern method is to treat all the members of the family for scabies whether they show clinical signs of the disease or not and this course appears to be effective. Most of the work in connection with the scabies epidemic has been done by the wholetime medical personnel of the Borough, but quite a number of cases have been referred to the Dermatological Specialist for his opinion either as regards diagnosis or the success of treatment. Certain difficulties have arisen of late in carrying on the Dermatological work of the Borough during the past year. Ringworm of the scalp which had been very nearly stamped out and of which the incidence was not more than half-a-dozen cases a year just before the War began, has now shown a distinct tendency to increase. It may be remembered that in 1914 over 120 cases occurring in Willesden were treated by the dermatologist appointed for the purpose by the then Willesden U.D.C. alone and many others in the district were dealt with by various London Hospitals. It will be seen therefore, that this disease had by 1939 been brought well under control. In the last two years, however, there has been a distinct tendency for it to increase. Owing to war-time conditions there is a good deal of difficulty in getting cases satisfactorily dealt with by X-Rays, the only effective and rapid method of treatment. 12 This difficulty is especially great in very young children, that is under the age of four years, whom it is difficult to induce to keep still during the X-Ray treatment. The Borough no longer has the facilities for treating cases with X-Rays and the various London hospitals refuse to undertake cases below school age. These cases are important because they occur in children whose mothers desire to leave them in charge of the various Day Nurseries in the Borough while they themselves go out to work. If not speedily cured they become dangerous sources of infection. At the present moment negotiations are going on with a view to getting these cases properly and promptly dealt with. Another difficulty that has recently arisen is in connection with the treatment of Naevi, or birth marks, in young babies. For many years these cases have been sent by the Borough Dermatologist to the Radium Department of the Royal Free Hospital where they were very successfully treated by the Radium Officer there, Mrs. H. M. Hill. In the course of about ten years no less than 265 cases were dealt with by her without any expense falling upon the Borough. Now, unfortunately, Mrs. Hill has had to terminate her tenure of office owing to ill-health, and the Radium Department of the Royal Free Hospital has closed down—at all events for the time being. Arrangements have now been entered into with the Radium Institute for the treatment of these cases. This involves a journey to Northwood, a journey which is no light matter for the mothers of infants under war-time conditions. With these two exceptions the work of the Dermatological Department has not been very much affected. It cannot be said that any form of skin disease (other than scabies) has either much diminished or increased during the last five years. The treatment of ulcerated legs by means of adhesive elastic bandages, which was started about 1932, has been extremely successful. Very few cases are now seen of the large ulcers which were formerly so common, because when tackled in the early stages varicose ulceration can usually now be cured without much difficulty. 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.—During 1943 Dr. Catherine Orr-Ewing and Mr. L. Mushin have carried on the work of this department in the absence of Mr. Medlycott, on War service. Dr. Orr-Ewing reports as follows:— " The main features of the year's work are: (1) The much more regular attendance of children at clinics—especially in keeping their refraction appointments—since they have settled down to normal life on their return from evacuation. (2) The increased co-operation of parents of "squinters," several of whom have had very successful operations performed at hospital. One or two of these have even gone as far as the Royal Eye Hospital, S.E., for orthoptic treatment after operation with satisfactory results. The ideal condition would be to have an Orthoptic Clinic in the Borough—where all these children could have post-operative or prophylactic training." Mr. L. Mushin reports as follows:— "Notes re Eye Clinic, Willesden: (1) The number of attendances at the Eye Clinic is increasing rapidly, owing to the return of children from the Evacuation centres, so that more clinics are becoming necessary. (2) The position as far as the provision of spectacles is concerned, which until recently involved considerable delay, is now much improved. (3) The incidence of phlyctenular conjunctivitis seems to be diminishing, associated with the general improvement of health of the school child, in spite of war conditions. (4) Cases of chronic blepharitis, which used to drag on for months, now respond rapidly, due to the introduction of the newer therapeutic compounds for local application. (5) Squint cases, in addition to being provided with the necessary correcting spectacles, may derive benefit, in suitable cases, from a course of orthoptic training, and the desirability of having a trained Orthoptist, working under the direction of the Ophthalmic Surgeon, with the provision of orthoptic apparatus, might be considered in the future, as well as arrangements for operative treatment in some cases." Mental Health.—Dr. Reginald Lightwood, m.d., f.r.c.p., d.p.h. 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. HOME NURSING SERVICE. The Home Nurse employed by the Council nursed 312 cases during 1943, and in connection with such cases paid 1,689 visits. Of the 312 cases nursed during 1943, 302 were new cases. 293 of these 302 new cases were referred by the Health Department for nursing, 6 by private doctors and 3 by hospitals, associations or private persons. Ophthalmia cases received 378 visits. SANITARY SECTION. During the year the Chief Sanitary Inspector and 11 District Sanitary Inspectors were on the staff. One of these commenced his duties on the 1st March, 1943. The Chief Sanitary Inspector, however, was away from duty from February because of illness and he died in November. A District Inspector was appointed temporary Deputy Chief Sanitary Inspector in February, 1943. The number of premises inspected on complaint was 3,783 and the total number of inspections and re-inspections was 24,216. In addition to ordinary sanitary work the Sanitary Inspectors were engaged on Civil Defence duties, such as Control Room work, Food Decontamination Training, Billeting and Supervision of Shelters. A special survey of the extent of rat infestation in the Borough was made following direction by the Minister of Food. 13 The following table shows the food certified as unfit for human consumption during the year:— Table No. 17. Table Showing Food Certified as Unfit for Human Consumption, 1943. Meat: Bread, flour and cereals, etc. 2,712 lbs. Bacon 668 ½ lbs. Preserves 848 „ Cooked 142 „ Cheese 529 „ Tinned 11,231 „ Butter and fats 110½ „ Raw 3,004 „ Eggs. 975 Fish: Tinned Milk 3,777 tins Tinned 934 „ Soups 441½ „ Raw 4,416 „ Sugar 33 lbs. Vegetables: Dried egg 266½ lbs. Tinned 1,051 tins Dried milk 431 „ Raw 52,867 lbs. Ducks and chickens 26 Fruit: Miscellaneous: Tinned 836 tins Assorted cans 549 Raw 31 lbs. Assorted goods 869 PUBLIC MORTUARY. During 1943 bodies were deposited at the Mortuary as follows:— Table No. 18. From Willesden. From Acton. Total. Post-Mortems 134 216 350 Post-Mortems and Inquests 42 76 118 Adjourned Inquests 6 12 18 Accommodations 3 — 3 MUNICIPAL HOSPITAL. The 52nd 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. 14 THE FIFTY-SECOND ANNUAL REPORT on the MUNICIPAL HOSPITAL By ARTHUR G. TROUP, M.D., D.P.H., Medical Superintendent. The total number of patients admitted to the Hospital during 1943 was 1,985, as compared with 1,678 in 1942. Cerebro-Spinal Fever. Seven cases of Cerebro-Spinal Fever were admitted to hospital during the year, and all recovered. Since the introduction of the Sulphonamide drugs, the decline in the mortality rate in this disease has been striking, and this is the first Annual Report in which no deaths have been recorded. During the past five years (1939-1943) we have treated 62 cases with 4 deaths, giving a mortality rate of 6.4 per cent. During the previous 20 years (1919-1938) we treated 55 cases with 22 deaths, a mortality rate of 40 per cent. Diphtheria. Only 72 cases of diphtheria were admitted to hospital during 1943. This is the lowest number recorded for the past 25 years. From 1919 to 1939, the average number of cases admitted per annum was 363, but since the outbreak of the War, this figure has dropped to 90. The 72 cases may be classified as follows: Faucial 39, Naso-Pharyngeal 6, Nasal 18, Laryngeal 2, Aural 1, and Carriers 6. Both the Laryngeal cases had to have the operation of Tracheotomy performed and both recovered. Two deaths occurred, giving a mortality rate of 3.0 per cent., the carrier cases being excluded from this calculation. Puerperal Infections. The 12 Puerperal cases which were admitted to hospital were diagnosed as follows:— Local Uterine Sepsis 1 Mastitis 3 Salpingitis 1 Mammary Abscess 7 No deaths occurred. Scarlet Fever. There was a large increase in the number of patients suffering from Scarlet Fever admitted during the year —453—as compared with 290 for 1942. The great majority of these cases were of a mild type. One death occurred, due to Purpura. An endeavour has been made to cut down the period of detention in hospital of the mild and uncomplicated cases. It used to be the custom to detain all Scarlet Fever patients for a minimum period of 6 weeks, and for the year 1926 the average length of the stay in hospital was 47.2 days. Later, the minimum detention period was fixed at 28 days, and last year this was reduced to 21 days. 237 patients, or over 50 per cent. of the total admissions, were discharged between the 21st and the 25th day, the average being 28.4 days. No criticism or complaint has been received, either from the General Practitioners or from the parents of the patients. Other Diseases. Tonsillitis 64 Erythema 2 Chicken Pox 27 Anaemia 2 Rubella 21 Bacilluria Sonne Dysentery 17 Anterior Poliomyelitis 1 Enteritis 8 Meningismus 1 Rhinitis 6 Mumps 1 Cellulitis 5 Catarrhal Jaundice 1 Bronchitis 4 Adenitis 1 Herpes 3 Influenza 1 Scabies 3 Pemphigus 1 Vincents Angina 3 Impetigo 1 Ophthalmia Neonatorum 3 Burn 1 Pemphigus Neonatorum 2 Dermatitis 1 Quinsy 2 Food Rash 1 Pneumonia 2 Drug Rash 1 Laryngitis 2 Stomatitis 1 General Exfoliative Dermatitis 2 Gingivitis 1 Tubercular Meningitis 2 Negative Cases 20 Total number: 216. Five deaths occurred, 3 from Enteritis and 2 from Tubercular Meningitis. 15 Marasmus Cases. 39 Marasmic infants were admitted during the year, and the total number under treatment was 46. The former may be classified as follows:— Gastro-Enteritis 33 Malnutrition 4 Nothing abnormal discovered 2 8 deaths occurred. Ear, Nose and Throat Cases. Under the Emergency Medical Service Scheme, children are admitted from the Middlesex Hospital and the Harrow General Hospital for treatment, in addition to children resident in the Borough of Willesden. (1) Willesden: (a) Health Centre Cases— Removal of Tonsils and/or Adenoids 525 Mastoidectomy 7 Antrum Punctures 4 (b) Hospital Cases— Removal of Tonsils and/or Adenoids 25 Mastoidectomy 20 Antrum Punctures 1 Miscellaneous 7 (2) Middlesex Hospital: Removal of Tonsils and/or Adenoids 121 Antrum Punctures 1 (3) Harrow General Hospital: Removal of Tonsils and/or Adenoids 237 Antrum Punctures 2 Service Sick. Service Sick include men or women belonging to any of the branches of His Majesty's or Allied Forces, the Merchant Navy and the Police. 66 patients coming under this category were admitted during the year, the majority of which were suffering from an infectious disease. Tonsillitis 12 Vincents Angina 3 Mumps 8 Dysentery 2 Chicken Pox 7 Whooping Cough 1 Scarlet Fever 7 Quinsy 1 Measles 7 Pulmonary Tuberculosis 1 Rubella 6 Erysipelas 1 Diphtheria 5 Stomatitis 1 Jaundice 3 Negative Cases 1 Total number: 66. Civilian Sick. Civilian Sick patients are cases which have been transferred from another Sector Hospital on the authority of the Group Medical Officer. 72 such patients have been admitted to the Willesden Municipal Hospital during the year. These cases may be classified as follows:— General Medical and Surgical Cases 19 Cancer Cases 53 Air Raid Casualties. No Air Raid casualties were admitted during 1943. Cases Admitted from Other Authorities. During the year 1943, 114 cases were admitted from areas other than the Borough of Willesden. Schick Test and Active Immunisation against Diphtheria. Nursing Staff. During 1926 a commencement was made in Schick Testing the Nursing Staff and immunising those nurses who proved susceptible to Diphtheria. Since that date, 18 cases of Diphtheria have occurred: 1 in 1927, 1 in 1928, 1 in 1929, 2 in 1930, none in 1931, 1 in 1932, none in 1933, 2 in 1934, 1 in 1935, 2 in 1936, 2 in 1937, 1 in 1938, 2 in 1939, none in 1940, 1 in 1941, none in 1942, and 1 in 1943. (1) Number of cases of Diphtheria occurring amongst Probationer Nurses during the first 8 months of 1926 9 (Before immunisation was carried out.) (2) Incidence rate per annum 45% (Taking 30 as average number of Probationer Nurses.) (3) Number of cases of Diphtheria occurring amongst Probationer Nurses from 1927 to 1943 18 (After immunisation was carried out.) (4) Incidence rate per annum 3.5% (Taking 30 as average number of Probationer Nurses.) (5) Number of Nurses Schick Tested (1927-1943 inclusive.) 432 (6) Number of Nurses giving a positive reaction 193 (7) Percentage of Nurses giving a positive reaction 44.6% 16 Table No. 19. Diseases. No. in Hospital on 1—1—43. Admitted. Total under Treatment. Discharged Recovered. Died. Mortality per cent. Remaining on 31-12-43 Cerebro-Spinal Fever - 7 7 7 — — — Diphtheria 6 66 72 58 2 2.8 12 Diphtheria Carriers — 6 6 6 — — — Enteric Fever — — — — — — — Erysipelas 1 14 15 12 — — 3 Measles 5 83 88 88 — — — Puerperal Infections 1 12 13 13 — — — Scarlet Fever 60 453 513 482 1 .19 30 Whooping Cough 12 52 64 54 5 7.8 5 Mixed Infections — 2 2 2 - — — Other Diseases 6 216 222 212 . 5 - 5 Marasmus 7 39 46 37 8 17.1 1 Ear, Nose and Throat Cases (Willesden.) — 536 536 526 — — 10 Ear, Nose and Throat Cases (Middlesex and Harrow.) — 361 361 361 — — — Civilian Sick 35 72 107 43 37 — 27 Service Sick 5 66 71 69 — — 2 Casualties — — — — — — — Totals 138 1,985 2,123 1,970 58 — 95 Laboratory. Table No. 20 Nature of Examination. Positive Result. Negative Result. Total. 1 Swabs for C. diphtheriae 190 1,561 1,751 2 Swabs for C. diphtheriae with typing — — 66 3 Sputum, etc., Direct examination for M. Tuberculosis 33 198 231 4 Sputum, etc., Concentration with antifornim — 1 1 5 Blood—Widal 1 1 2 6 Blood—Cultures — — 7 7 Blood—Counts — — 57 8 Blood—Films — — 53 9 Blood—Chemical examinations — — 107 10 Urine—Chemical examinations — — 129 11 Urine—Microscopical examinations — — 123 12 Urine—Cultural examinations — — 40 13 Faeces—Chemical examinations — — 1 14 Faeces—Microscopical examinations — — 3 15 Faeces—Cultural examinations — — 146 16 Cerebro-Spinal Fluid—Chemical examinations — — 11 17 Cerebro-Spinal Fluid—Microscopical examinations — — 17 18 Swabs, etc.—Direct smears — — 159 19 Swabs—Cultures — — 347 20 Water Presumptive B. coli test — — 48 21 Water—Enumeration of organisms — — 48 22 Drugs for sterility — — 3 23 Salmonella serological identifications — — 22 24 Preparation of vaccines — — 1 25 Cough Plates — 3 3 26 Hairs for Ringworm 1 — 1 Total 3,377 17 Table No. 21. Sources of Specimens Examined. Municipal Hospital 1,839 Engineer's Department 92 Private Practitioners 808 Health Centres 596 3,377 Middlesex County Council Dispensary 42 THE THIRTEENTH ANNUAL REPORT on the WILLESDEN MATERNITY HOSPITAL for the year 1943. By ARNOLD WALKER, M.A., M.B., B.Ch., F.R.C.S., F.R.C.O.G. The fall in the number of cases dealt with in 1943 is due to the reduction in the number booked over a period to allow wards to be closed in turn for repairs and decorations. Two deaths occurred during the year, both from incidental heart disease. The first was a case of infective endocarditis and the second a case of acute heart failure in a patient under the care of a cardiologist. Table No. 22. Statistical Details of the 1,000 Cases dealt with during 1943. Cases completed 1,000 Toxæmia of Pregnancy admitted for treatment 28 A. Booked at the Health Centres 988 Discharged well 984 Eclampsia 2 Transferred 2 Hydramnios 2 Died(l undelivered) 2 Puerperal Pyrexia 31 B. Admitted as Emergencies 12 Uterine Infection 5 Discharged well 10 Urinary Infection 10 Delivered elsewhere 2 Breast Infection 5 Of the 988 booked cases, 555 were Thrombo-phlebitis 3 primiparæ and 433 were multipara. Pulmonary Infection 1 Of the 12 emergency cases, 7 were Infective Endocarditis 1 primiparæ and 5 were multiparæ. No cause found 6 Presentations— Operations performed— Occipito Anterior 788 Forceps delivery 42 Occipito Posterior 438 The forceps rate was therefore 4.2 per cent. Normal Breech 32 Abnormal Breech 4 Caesarean Section 4 Twins 20 Placenta Praevia 2 Brow 1 Disproportion 2 Shoulder 2 Manual Removal of Placenta 5 Miscarriages 12 Induction of Premature Labour 7 Ante-partum Hæmorrhage— Toxæmia 5 Placenta Prxvia 6 Hydramnios 2 Accidental Hæmorrhage 3 Transfusions 8 Prolapse of Cord 3 Stored Blood 3 Dried Serum 5 1,005 viable children were born to 985 mothers. Of these 39 were stillborn and 17 died. 18 THE FOURTEENTH ANNUAL REPORT ON THE SUPERVISION OF MIDWIVES FOR THE Year 1943. 49 Midwives gave notice of their intention to practise in Willesden in 1943, 29 of these being in the Central Middlesex County Hospital. Midwives practising and living in Willesden attended 2,285 cases either in hospital or on the district as midwives or maternity nurses as against 2,411 in 1942. In addition 7 midwifery or maternity cases were attended in Willesden by midwives living outside Willesden. The 8 Municipal District Midwives attended 531 midwifery cases in 1943 and in addition answered 10 emergency calls and carried out ante-natal care of 83 cases which were subsequently confined elsewhere. Midwives attached to Queen Charlotte's Hospital District Home, Kilburn, attended 157 midwifery cases. 84 of these were Willesden residents attended on behalf of the Willesden Council with in addition 6 cases attended for ante-natal care only. 73 were cases attended outside Willesden. Midwives attached to the Willesden District Nursing Association attended 227 maternity cases on behalf of the Council. During the year 271 notifications were received from Midwives practising in Willesden in accordance with the rules of the Central Midwives Board and of these, 242 notifications were in respect of medical aid, 192 in respect of the mother and 50 in respect of the child. The sixth year's working of the Domiciliary Midwifery Scheme and the Second Period Training School for pupil midwives has been very satisfactory. The number of whole-time Municipal Midwives is 7, and a full-time relief midwife. In addition two and a half midwives are 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 34 pupil midwives worked on the district. Of the 531 confinements dealt with by the Municipal Midwives, the pupil midwives attended 379 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 91 Maternity and Child Welfare Clinics for mothers and babies 96 The lecture courses. A discussion class, each week, taken by the Supervisor of Midwives at the Health Department. Of the 34 pupil midwives, 23 sat for their final midwifery examination, 20 passed, 3 failed, 2 of whom passed at the next examination. TWENTY-SIXTH ANNUAL REPORT for the YEAR 1943 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 Authority's three dental centres have operated without interruption during the year, except for a brief period of five weeks when a vacancy arose by the resignation of one Dental Surgeon. This officer had served 12 years on the permanent staff here. He has now taken up work of a similar nature in a rural county. The vacancy was filled by the temporary appointment of a Dental Surgeon who is exempt from military service. The Willesden Council is extremely fortunate to have retained the services of three experienced surgeons and nurses throughout the year, as the heavy demands of the dental branches of H.M. Forces have created innumerable vacancies in the Public Health Services, and many areas are unable to maintain even a minimum staff. 19 precis of work done. The total working sessions amounted to 1,557, an increase of 410 over the previous year's figure of 1,147. Of these, 1,360 were utilised in treatment at the centres, 187 routine inspection sessions, and the remaining 10 were absorbed in administration. 14,146 mothers, infants, elementary and secondary school children were inspected, as compared with 8,407 for 1942. 10,569 of these were defective and 4,726 or 44.7 per cent. were treated at the centres. Whereas 1,147 more patients were treated fewer teeth were extracted (namely, 9,418 or 1.9 per patient, as against 9,832 or 2.7 per patient last year), the number of fillings increased by 3,177 to the total of 8,555. In addition 2,831 incidental treatments were included in the work. The Anaesthetist administered to 3,014 patients during 141 visits, which is an average of 21.4 cases per session. The total attendances recorded was 14,751 or 10.8 per session. ELEMENTARY AND SPECIAL SCHOOLS. The total number of children on roll in December, 1943, was 13,963, as compared with 12,727 in December, 1942. Inspection. Routine.—9,248 children received oral examination during 162 visits to the schools. Specials.—1,156 children were inspected at the centres and the necessary treatment carried out. 7,740 were found defective and 2,988 were treated at the centres, an increase of 811 on 1942. Treatment. 6,289 teeth were extracted, of which 1,012 were permanent. There were 3,740 fillings done on permanent teeth and 1,109 on the milk series, making a total of 4,849. 980 incidental treatments, including root fillings to anterior teeth, minor gum treatments, silver nitrate and sedative dressings were done. 694 sessions were assigned to these treatments. WILLESDEN SECONDARY AND JUNIOR TECHNICAL, ETC., SCHOOLS. Inspection. All secondary and technical schools were visited when 1,912 scholars were inspected. There were also 192 special inspections at the centres, making a total of 2,104 for the year. Of these 1,399 or 66 per cent. required treatment and 754 or 54 per cent. were treated at the centres. This represents an increase of 517 patients treated as compared with the previous year. The returns show a marked increase in the amount of treatment carried out. 1,723, the number of fillings done, is over three times, and the extraction figure of 455 exceeds twice the number done in 1942, also 499 other forms of treatment were undertaken. 2,228 attendances were registered, and 202 treatment sessions were estimated to complete this work. MATERNITY AND CHILD WELFARE. 1,638 mothers and infants were inspected at the centres, 208 of whom had no defects to be treated. 928 had their treatment completed but 56 only partially completed. 2,674 teeth were removed, 1,983 teeth filled which together with 1,352 other operations makes a total of 6,009 treatments for the year. 113 dentures were supplied, and there were repairs to 5 dentures. Attendances totalled 4,948 and the estimated number of treatment sessions for all this work was 464. REPORT ON WAR-TIME NURSERIES, 1943-1944. At the beginning of April, 1943, there were five nurseries open in Willesden, taking altogether 260 children from 0-5 years. Six nurseries were under construction to take a further 300 children. Five of these six nurseries were opened during the year, and the sixth on 4th April, 1944, making a total of 11 nurseries accommodating 560 children. Two further nurseries are now under construction and will take another 100 children. Attendances.—The total attendances from 1st April, 1943 to 1st April, 1944, amounted to 90,410. The number of mothers released for war work at the end of the year was 393. The number of staff now engaged in the nurseries is:— Nursing Staff — 106. Domestics— 40, mostly part-time. It must be borne in mind that most of the staff employed are unsuitable for any other type of war work. Twenty of the staff are students under 18 years of age. Teaching Staff.—There are three trained Teachers and eight Wardens. Excellent co-operation exists between the Education and Health services. 20 Medical Inspection. The children have been regularly examined by the Medical Officers from the various Health Centres. Many minor ailments have been treated and small defects righted. In this part of the work we have had the co-operation of the Clinic Matrons and Health Visitors. The Medical Officers take an active interest in the diet and health of the children. Immunisation against Diphtheria has been carried out in the nurseries, but there are still a few mothers with a prejudice against immunisation. Toys. The National Fire Service Station at Stonebridge Park have presented toys to Braintcroft and Wesley Road Nurseries. The toys were strong and most suitable for the children and were much appreciated. We were honoured by the presence of His Worship the Mayor and Mayoress at the Wesley Road presentation. The Education Department presented the nurseries with a magnificent collection of toys made by the various schools in Willesden. The toy situation which is always difficult has been eased by these efforts. Clothing, Etc. The W.V.S. have continued to make the garments for the new Nurseries, and Mrs. Baldwin to mark the new linen at Braintcroft Stores. The Neasden Housewives' Club continue to knit garments for the nurseries. Many garments have been knitted by the Senior Girls' Schools in Willesden. Building and Repairs. The type of building set up has been improved. Crest Road and Villiers Road are a great improvement on the fiat-roofed type of hut. Unfortunately many minor repairs are necessary to the Nurseries all the year round, and owing to the shortage of labour, repairs have to wait, causing much inconvenience and minor irritation. The air raids fortunately caused only minor damage at one nursery. Training of Students. During the year 20 Students have been placed in the nurseries for training. The practical training of 18 months is carried out at the nursery, and the students attend lectures at either Hammersmith School for Women, Lime Grove, or the North Western Polytechnic. Several students should be taking the National Society of Children's Nurseries Examination in November, 1944. Many more students could be placed in Willesden if suitable applicants were forthcoming. There seems to be a lack of interest for this career, probably due to the large call of industry. The elementary school girl is welcomed for training, but it is felt that 14 years is too young to embark upon this career, as the Diploma cannot be taken until the student is 17 years of age. The ideal age is 15½ to 16½ years. The raising of the school leaving age would bridge this gap. Training of Nursery Assistants. Eleven Nursery Assistants are attending lectures to enable them to sit for the Nursery Nurses' Diploma. The Nursery Assistants pay their own fees for the lectures and examination. When these assistants have obtained their diploma, they will be able to take a post of more responsibility and should be capable of holding a Staff Nurse's post in a War-time Nursery. REGISTERED DAILY GUARDIANS. The scheme of the Ministry of Labour and National Service for Registered Daily Guardians came into operation in Willesden in May, 1942, and is operated from the Health Centres. Suitable guardians are registered at the Health Centres and notified as to the number of daily children they may take and the Labour Exchange is informed. Mothers are put in touch with Guardians if necessary. The mother makes her own arrangements with the Guardian as regards the care and feeding of the children and the weekly sum payable. The Labour Exchange makes an additional payment to the Guardian of 4/- in respect of each child under five years cared for on four or more days a week and 2/— for one to three days per week. The Exchange looks into the question of whether the mother's employment is war work. The Coyncil's Health Visitors supervise the Registered Daily Guardians and pay not less than monthly visits to them. At the end of 1943 133 Daily Guardians were registered to take 202 children. Of these 133 guardians 90 actually had children in their care at the end of the year. These 90 had 118 children in their care thereby releasing 108 mothers for work. The guardians were not women who would have been out at work even if they had not taken daily children. Their care of these children was therefore not detracting from the war effort. The objections to this scheme are that the 4/- is an inadequate contribution from the Government and the forms deter some people from making use of the scheme. If a mother can get her child into a War-time Nursery for 1 /- per day or 6/- per week she is not likely to show much enthusiasm for a scheme under which she has to pay the bulk of the daily guardian's fee. At a nursery all food is supplied and the full rations are still available for home use. This is not so in the case of Daily Registered Guardians. Certain clothing is also supplied in the nurseries which saves wear and tear of the children's own clothing and a considerable amount of laundry work is done for them at the nursery.