A C 939 (1) WIL 41 58/16/2 Borough of Willesden 1945 THE 70th ANNUAL HEALTH REPORT GEORGE F. BUCHAN, M.D., F.R.G.P., D.P.H., Medical Officer of Health. London : WIGHTMAN & CO. LTD.. 104, Regency Street, S.W.I. BOROUGH OF WILLESDEN Health Department, 54, Winchester Avenue, Kilburn, London, N.W.I). June, 1946. To the Corporation of Willesden. I beg to submit herewith the Annual Health Report for Willesden for the year 1945, in accordance with instructions received from the Ministry of Health and Ministry of Education that it should be a short report. VITAL STATISTICS. 2,627 live births were registered. 08 still births were registered. 1,760 deaths were registered. The infantile mortality rate for the year was 49. 129 children under 1 year of age died in 1945. CANCER. There were 282 deaths of Willesden residents from Cancer in 1945, as compared with 319 in 1914. The two Municipal Cancer Clinics were continued throughout the year. 1 new patient attended in 1945. She was referred to Hospital for further diagnosis for a lump in the breast, but this was not considered to be cancerous. At the end of 1945, 5 patients remainded under observation. INFECTIOUS DISEASES. During the year 1945, 3,020 cases of infectious diseases were notified, as compared with 1,856 in the previous year. The following table gives the number of notifications of certain diseases included in the above total of 3,020, together with the corresponding figures for 1944:— Table No. 1. Number of Cases Notified. No. of Notified Cases Confirmed. 1944 1945 1945 Diphtheria 60 130 57 Scarlet Fever 402 253 223 Pneumonia 283 339 338 Whooping Cough 411 221 215 Erysipelas 49 31 27 Measles 250 1,568 1,550 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 1944 1,193 338 1,531 1945 1,983 493 2,476 The approximate mid-year population, 1945, as supplied by the Ministry of Health, based on ration books, was 12,460 under 5 years of age and 18,430 between 5 and 15 years of age. It was estimated that 79 per cent. of those under 5 years and 60 per cent. of those between 5 and 15 years had been immunised at 31st December, 1945. 3 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. 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 Scheme 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 1 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. They further endeavour to obtain the parents' consent to another single dose shortly before the child reaches 5 years of age. Leaflets concerning diphtheria prevention with form on the back for parents' 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. There were 57 cases of Diphtheria in Willesden in 1945 and there were 2 deaths, one in an unimmunised child of 2 years, and one in a child of 12 vears who had been immunised privately in Gloucestershire in 1940. Enteric Fever.—No cases were notified in 1945. Dysentery.—85 cases were notified as Dysentery in 1945. Malaria.—4 cases were notified in 1915. 1 case was induced for therapeutic reasons and in 3 cases the patients contracted the disease abroad. Infectious Diseases of the Central Nervous System.—Poliomyelitis and Polio-encephalitis, Cerebrospinal Fever and Encephalitis Lethargica.—20 cases of these diseases were notified in 1945, as against 16 in 1944, 20 in 1943, 3.) in 1942, 29 in 1941, 38 in 1940, 18 in 1939, 24 in 1938, 22 in 1937 and 14 in 1936. 1 proved fatal, giving a fatilitv rate of 5.0 per cent. of notified cases. 16 cases were notified as Cerebro-spinal Fever. Of these 16 cases 12 proved to be Cerebro-spinal Fever and I was found in hospital to be suffering from Acidosis, 1 from subarachroid haemorrhage, 1 from Encephalitis of unknown origin and in 1 case no definite diagnosis was established. The ages of the 12 cases which proved to be Cerebro-spinal Fever were as follows : Under 1 year of age 0 Between 10 and 15 years of age 0 Between 1 and 2 years of age 4 „ 15 „ 20 „ „ 2 „ 2 „ 3 „ „ 1 „ 20 „ 35 0 „ 3 „ 4 „ „ 0 „ 35 „ 45 „ „ 3 4 „ 5 0 „ 45 „ 65 „ 1 „ 5 „ 10 „ „ 0 65 years of age and over 1 The months in which the 12 cases occurred were as follows:— January, 1945 1 May, 194.) 1 September, 1945 1 February, 1945 0 June, 1945 2 October, 1945 0 March, 1945 2 July, 4945 1 November, 1945 0 April, 1945 3 August, 1945 1 December, 1945 0 1 of these 12 cases which proved to be Cerebro-spinal Fever died. This patient was aged 71 years. In addition, one further death was recorded as Cerebo-spinal Fever. The patient was an army pensioner aged 17 years, who had cerebro-spinal meningitis in 1920-21. Four cases of Poliomyelitis were notified, one aged 7 months, one aged 3 years, one aged 8 years, and one aged 25 vears. The case aged 7 months was discharged from the hospital well. The other three cases were referred for further out-patient treatment. Pneumonia and Influenza.—339 cases of Pneumonia were notified in 1945, as compared with 283 in 1944 and 139 in 1943. Deaths from Broncho-Pneumonia, Lobar Pneumonia and Pneumonia (unspecified) numbered 114, as compared with 86 in 1914, 130 in 1943 and 87 in 1942, and deaths from Influenza 4, as compared with 9 in 1941. 30 in 1943 and 12 in 1942. Whooping Cough.—221 cases were notified in 1945, but a total of 321 cases coming to their knowledge were visited by Health Visitors, 217 of which occurred in children under 5 years of age. There were 3 deathsfrom Whooping Cough in 1945. 2 of the children who died were under 1 year of age, and I was between I and 5 years of age. Measles.—1,568 cases were notified in 1945, but a total of 2,275 cases were visited by the Health Visitors, 1,233 of which occurred in children under 5 years of age. There were 3 deaths from Measles in 1945. 2 of the children who died were between 1 and 5 years of age and 1 was between 5 and 10 years of age. 4 Tuberculosis.—The following table shows the number of cases of Tuberculosis on the register at the end of each year 1938-1945:— 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 1944 446 369 76 80 1945 502 425 87 85 MOTHERS AND CHILDREN UNDER FIVE YEARS Municipal. Health Centres.—At the 3 Municipal Health Centres, expectant mothers attended the medical consultation and medical treatment Clinics on 16,529 occasions, nursing mothers 23,843, and children under 5 12,647, making a total at these clinics of 83,119 attendances in 1945. Out of the total number of 2,627 children registered as born alive in 1945, 1,837, or 70 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 1944 (3 Health Centres open) 117,731 16,680 1945 (3 Health Centres open) 119,429 16,586 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 1,817 occasions and nursing mothers on 1,373 occasions during 1945. 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.—1,158 patients were booked during 1945 for confinement in the Willesden Maternity Hospital. The fees at which these 1,158 cases were booked varied from 20 at £15 to 224 free. The average fee per case was approximately £4. 9s. 3d. During 1945, 438 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 129 Not resident in Willesden 9 438 5 Hospital Confinements.—During 1945, 1,026 women were confined in the Willesden Maternity Hospital. 468 births of Willesden residents were notified from outside Institutions—85 from St. Mary's Hospital, 49 from Queen Charlotte's Hospital, 29 from Middlesex Hospital, 29 from University College Hospital, and smaller numbers from other hospitals, 90 from a Nursing Home, and smaller numbers from other Nursing and Maternity Homes. These, together with some 529 in the Central Middlesex County Hospital, are approximately 75 per cent. of the births belonging to Willesden. It is to be noted that in 1945 many mothers desiring institutional confinement were unable to obtain beds. 429 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. (N ote—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 1944 653 166 1,905 2,724 1945 524 130 2,010 2,664 The 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. 551 such requests were received in 1945. 147 Expectant Mothers booked for confinement in the Central Middlesex County Hospital were referred to the Willesden Health Centres for Ante-Natal care in 1945. Puerperal Pyrexia. 62 cases were notified in 1945. Maternal Mortality.—During 1945 there were 4 deaths classed to pregnancy and child-bearing—2 to post-abortive infection and 2 to other puerperal causes. The puerperal mortalitv rate from Sepsis was therefore 0.71 per 1,000 registered total births. The total puerperal mortality rate was 1.48 per 1,000 registered total births. During 1945 there were, in addititon, 4 maternal deaths from non-puerperal causes. The total maternal mortality from all causes, including criminal abortion, was 2.97 per 1,000 registered total births. Sterilised Accouchement Sets. These sets are supplied in accordance with the arrangements stated in my Annual Report for 1980, p. 10. During 1945, 167 were supplied free, 161 at full cost and 380 at part cost—a total of 658. 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. One such consultation was paid for in 1945. 6 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 1945. Home Helps.—The Council provided the services of home helps in connection with 52 confinement cases in 1945. Difficulty was experienced in finding women willing to undertake this work and some mothers in need of home helps were unable to obtain them. Maternal Mortality Investigations.—The Council have 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 1945. 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. 60 children were under treatment for Marasmus and 133 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 1945 was 4. This gives a case rate of 1.5 per 1,000 registered live births. A district midwife attended the confinement in 1 case, and 3 cases were born in hospital. Treatment was obtained at a hospital in all 4 cases. Complete recovery with unimpaired vision occurred in 3 cases, In 1 case the patient removed from the district and no further information was obtainable. Cases of inflammation of 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. THE CARE OF PREMATURE INFANTS. The Ministry of Health issued Circular 20/44 on March 22nd, 1944, dealing with the Care of Premature Infants. 9 Arrangements have been made for obtaining knowledge of all children whose weight at birth is 5½lbs. or less. 140 such children were born in Willesden in 1945, 31 at home, and 109 in hospital. The services of a paediatrician are available if necessary. Midwives and Health Visitors give particular attention to these babies, and the services of home helps are provided if necessary and available. The proposals as to the provision of special staff and accommodation in the case of institutional treatment will be borne in mind by the Council when development of the Maternity Hospital is practicable. A paediatrician is attached to the Maternity Hospital. All discharges of such infants from the Willesden Maternity Hospital and Central Middlesex County Hospital are notified forthwith to the Health Department and followed up. In 1945, out of a total of 129 deaths of children under 1 year of age who were Willesden residents, 27 were due to premature birth. In 1944, out of a total of 114, 31 were due to premature birth, in 1943 out of a total of 155, 25 were due to premature birth, and in 1942, out of a total of 130, 33 were due to premature birth. Taking only the deaths under 4 weeks of age in 1945, all 27 were due to premature birth; in 1914, 30 out of a total of 70 were due to premature birth; in 1943, 24 out of 61, and in 1942, 31 out of 61. CHILD LIFE PROTECTION. At the end of 1945 there were 30 Foster Mothers and 58 Foster Children in Willesden. There has again 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. 7 ADOPTION OF CHILDREN (REGULATION) ACT, 1939. This \ct 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 parents 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 superv ision as is possible without compulsory power in the course of her maternity and child welfare work. 10 persons gave notice under Section 7 (3) in 1945 in respect of 15 children. There were 6 children under supervision at the end of the year. THE CARE OF ILLEGITIMATE CHILDREN. The Ministry of Health issued Circular 2866 dealing with this matter on October 1st, 1943, and a revised edition on November 16th, 1943. A report on the subject appeared in Appendix A of the 1944 Annual Health Report. Suitable premises have now been secured and it is hoped that a Short Stay Home will be opened about the middle of 1946, and a Hostel about the end of 1946. These would not be limited to illegitimate children. NURSING HOMES. No new homes were registered in 1945. The total number of homes on the register at the end of 1945 was 3, providing accommodation for 4 maternity patients and 15 other patients. AGED AND INFIRM PERSONS. The suitable care of aged and infirm persons was reported on in the 1943 Annual Report. The problem continues to cause concern. A number of such persons have come to notice during the year and so far there is no satisfactory way of dealing with them. SOCIAL PROBLEMS GENERALLY. This subject was dealt with last year. Progress has been made with the establishment of homes and hostels and it is hoped to open them in 1946 as indicated above. DOMESTIC HELP. Here again the position remains unchanged and there is still no domestic help available. THE SCHOOL MEDICAL SERVICE. During 1945, 3,365 children were medically inspected at routine inspections and 16,339 at special inspections and reinspections. 8 Scabies.—See report on Uncleanliness and Scabies on pages 9, 10 and 11. Uncleanliness.—During 1945 cleanliness inspections were carried out in the schools on 442 occasions. The total number of examinations and re-examinations made during the year was 34,913. See report on Uncleanliness and Scabies on pages 9, 10 and 11. Medical Treatment in Willesden.—During the year 1945 school children were followed up by the Health Department on account of 11,005 medical defects and 4,448 dental defects. Of those defects found to require treatment, medical or dental treatment was obtained for 10,907 and domestic treatment was obtained for 1,671. 91 per cent. of the medical defects were treated, 75 per cent. receiving medical treatment and 16 per cent. domestic treatment; 71 per cent. of the dental defects followed up were treated. No record is available of defects requiring treatment which were not followed up. 97 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 3 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 47,806 attendances at the Health Centres. School Medical Service for Children Sent to Reception Areas. 2 of the School Nursing Staff were working in Reception Areas during 1945, one until March 31st and one until July 31st, when they returned to Willesden. *In addition 3,468 attendances were made by Secondary and Technical School children and the following attendances by adults : Cleansing and Treatment of Scabies—83, Skin Diseases—39, Varicose Ulcers—146 and Orthopaedics under Section 181 of the Public Health Act, 1936—33, making a total of 4,069), which together with the 167,629 above makes a grand total of 171,698. In addition 8,763 attendances were made at the Scabies and Lice Treatment Clinic which prior to 1944 would have been included in above Tables. HEALTH CENTRES. ATTENDANCES. Table No. 7. Medical and Dental Treatment—Attendances at Municipal Health Centres, 1945. Condition. Mothers, and Children under Five. School Children. Grand Total (Cols. 7 and 8). Expectant Mothers. 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 2 — 1 23 24 26 66 92 2.Throat, Nose and Ear Diseases 2 — 18 588 606 608 3,575 4,183 3.Minor Ailments 7 44 576 2,760 3,336 3,387 24,002 27,389 4.Eye Diseases 2 10 196 499 695 707 3,229 3,936 5.Skin Diseases 27 39 152 188 340 406 600 1,006 6.Artificial Sunlight Treatment — — — — — — — — 7.Orthopaedics 3 51 322 1,277 1,599 1,653 3,190 1,843 8. Medical Consultations 16,586 23,699 24,711 11,336 36,047 76,332 — 76,332 9. Diphtheria Immunisations — — 77 3,515 3,592 3,592 394 3,986 10. Total (1—9) 16,629 23,843 26,053 20,186 46,239 86,711 35,056 121,767 11. Dental Consultations 3,188 647 — 944 944 4,779 8,452 13,231 12. Total (10—11) 19,817 24,490 26,053 21,130 47,183 91,490 43,508 134,998 13. School for Mothers — — — — — — — — 14. Nursery — — — — — — — — 16. Miscellaneous — — — — — 27,939 4,692 32,631 16. Grand Total (12—15) 19,817 24,490 26,053 21,130 47,183 119,429 48,200 167,629 Kilburn Health Centre. Willesden Health Centre. Stonebridge Health Centre Grand Total. Mothers and Children under Five. School Children Total. Mothers and Children under Five. School Children. Total. Mothers and Children under Five. School Children. Total. (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) 17. Medical Attendances 23,989 7,728 31,717 32,105 11,939 44,044 30,617 15,389 46,006 121,767 18. Dental Attendances 1,651 1,861 3,512 1,501 2,662 4,163 1,670 3,886 5,556 13,231 19. School for Mothers — — — — — — — — — — 20. Nursery Attendances — — — — — — — — — — 21. Miscellaneous 12,349 740 13,089 7,061 1,196 8,257 8,529 2,756 11,285 32,631 22. Total 37,989 10,329 48,318 40,667 15,797 56,464 40,816 22,031 62,847 *167,629 9 Table No. 8. 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 11,695 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 10,787 1,733 42,520 43,956 6,481 50,440 92,960 4,4185 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 5,14.3 113,858 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 11,511 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 13,448 137,931 — — 50,956 188,887 1943 96,737 4,948 101,685 40,314 7,575 47,889 149,574 — — 55,988 205,562 1944 80,017 4,304 84,321 28,797 7,582 36,379 120,700 — — 42,943 163,643 1945 86,711 4,779 91,490 35,056 8,452 43,508 134,998 — — 36,700* 171,698 * This includes the 3,468 attendances made by Secondary and Technical School children and the 601 by adults and others under Section 181 of the Public Health Act, 1986, which are shown in the footnote of Table No. 7. In addition 8,763 attendances were made at the newly opened Scabies and Lice Treatment Clinic which in previous years would have been included in above Tables. In 1945, 3 School Children and 2 Children under 5 years of age were treated under the Council's Scheme In X-rays for Ringworm of the Scalp. 13 children under 5 years of age were treated under the Council's Scheme for the removal of Naevi. Table No. 9. Number of Individual Expectant and Nursing Mothers and Children who Attended the Municipal Health Centres in 1945. Public Elementary School Children 7,945 Children under 5 years of age 6,710 Expectant Mothers 3,467 Nursing Mothers 3,302 PRINCESS ROAD CENTRE. 1,422 attendances were made by Children under 1 year of age at the Medical Consultation Sessions in 1945, 395 by Children 1.5 years of age and 1,373 by Nursing Mothers, or a total of 3,190. UNCLEANLINESS AND SCABIES. The following table shows the work done at the Scabies and Lice Treatment Clinic opened on March 16th, 1944. The cases were followed up in their homes by the Health Visitors and necessary action taken as to cleansing, disinfection, examination and treatment of contacts and education as to cleanliness. Steel nit combs can be obtained at the Health Centres. Certain publications relative to Lice and Scabies are distributed from time to time. In the case of uncleanliness, especially of the aged, the Health Visitors work in conjunction with the Sanitary Inspectors, and if necessary and practicable, patients are admitted to hospital for a short period to enable the premises to be suitably cleansed. 10 Table No. 10. Treatment of Scabies and Lice at the Treatment Clinic, 1945. No. of New Cases Treated. Total No. of Attendances Made. For Scabies. For Lice and Nits. Total. For Scabies. For Lice and Nits. Total. Children under 5 years 481 29 510 1,624† 44 1,668 Children 5-14 years 722 196 918 3,215* 240 3,455 Adults M. 279 M. 11 M. 290 3,485‡ 155 3,640 W. 90 W. 100 W. 1,001 Totals 2,386 336 2,722 8,324 439 8,763 † 75 of these attendances were made for the inspection of contacts who on inspection were found not to be suffering. Such contacts, nevertheless, usually receive treatment. * 91 of these attendances were made for the inspection of contacts who on inspection were found not to be suffering. Such contacts, nevertheless, usually receive treatment. ‡ 219 of these attendances were made for the inspection of contacts who on inspection were found not to be suffering. Such contacts, nevertheless, usually receive treatment. SCHOOL CHILDREN. Routine cleanliness inspections are held in each school department at least 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 Treatment Clinic or Health Centres where they are under the care of a doctor 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 1941 5.2 1944 6.8 1939 5.0 1942 5.1 1945 6.5 1940 5.5 1943 6.1 Table No. 12. Percentage of Individual Children examined found Unclean at Routine Cleanliness Inspections. 1938 3.8 1941 4.2 1944 5.2 1939 3.8 1942 4.2 1945 5.4 1940 4.2 1943 4.8 Table No. 13. Total Number of Individual School Children Cleansed at the Authority's Clinics. 1938 379 1941 219 1944 246 1939 321 1942 189 1945 249 1940 476* 1943 348 * Increase largely due to cleansing immediately prior to evacuation. Table No. 14. Number of Cases of Scabies amongst School Children Treated at the Authority's Clinics. 1941 396 1943 1,228 1945 722 1942 725 1944 786 CHILDREN UNDER 5 YEARS OF AGE. These generally come to light in connection with their elder brothers and sisters. In 1945, 481 were treated at the Centres for Scabies, making 1,624 attendances, and 29 were treated for Lice, making 44 attendances. The figures for 1944 were 402 treated for Scabies, making 1,235 attendances, and 55 treated for Lice, making 58 attendances, and for 1943, 834 treated for Scabies, making 2,014 attendances, and 73 treated for Lice, making 73 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. 11 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 or by private doctors. Every effort has been made to secure the attendance of the men as well as the women in a family and the appointment of a suitably qualified male attendant at the new Treatment Clinic has greatly contributed to the success of this effort. Table No. 15. Attendances of Adults at the Authority's Clinics for Cleansing and Scabies. Number Treated. Attendances. Scabies. Lice and Nits. Total. Scabies. Lice and Nits. Total. Men. Women. Men. Women. 1938 — – – – 104 1939 — — — — – 150 1940 — — — — – 556 1941 293 104 397 912 104 1,016 1942 568 88 656 2,287 88 2,375 1943 913 127 1,040 3,116 127 3,243 1944 274 822 3 116 1,096 119 1,215 2,683 148 2,831 1945 279 904 11 100 1,183 111 1,294 3,485 155 3,640 SECONDARY AND JUNIOR TECHNICAL, ETC., SCHOOLS. The arrangement by which the Medical and Dental Staff of the Willesden Council carried out the inspection of pupils attending the Secondary and Junior Technical Schools in Willesden on behalf of the Middlesex County Council continued until April, 1946, when the new Education Act of 1944 came into force. From that time onwards these Schools were dealt with under the Act in the same way as other Maintained Schools. The total number of pupils on the rolls of these Schools is approximately 3,000. Dermatological Department—H. Haldin-Davis, m.d., f.r.c.p., f.r.c.s., Dermatologist to the Council.— The work of the Dermatologicai Department has proceeded on normal lines throughout the year. Ophthalmic Department.—B. R. Medlycott, d.o.m.s., m.b., b.s.(Lond.), m.r.c.s., l.r.c.p., Ophthalmic Surgeon to the Council.—Total attendance in 1945, 2,980. Analysis. Centre Maternity and Child Welfare Pupils, Elementary Schools Secondary Schools Total Number of Sessions Average Attendance per Session 1 188 671 152 1,011 30 34 2 156 725 61 942 27 35 3 111 841 78 1,030 34 30 Totals 455 2,2 10 291 2,986 91 33 Refractions. Centre Appointments Made Appointments Kept Percentage Attendance 1 215 164 76 2 235 166 71 3 278 215 77 Totals 728 545 75 Until the beginning of October, 1945, Ophthalmic Clinics were usually held at fortnightly intervals, Miss Orr-Ewing being in attendance at Health Centres 1 and 2, and Mr. Mushin being in charge of the work at Health Centre 3. Mr. Medlycott resumed his duties as Ophthalmic Surgeon to the Council at the beginning ot October on demobilisation from the R.A.M.C., and during the last three months of the year the Eye Clinics have been held weekly at each centre, as in the past, greatly easing the congestion at each session, which had been increasing with the return of the children to the borough on the cessation of hostilities. Owing to the evacuation of the children, irregularity in the frequency of sessions held, and change in the Ophthalmic staff during the year, figures submitted for 1945, which are given above, do not afford an exact parallel to statistics reported in pre-war reports. 12 Ear, Nose and Throat Department.—G. H. Livingstone, f.r.c.s.— Mr. A. L. Pereira, f.r.c.s., has carried on the work of this department in the absence of Mr. Livingstone. HOME NURSING SERVICE. The Home Nurse employed by the Council nursed 209 cases during 1945, and in connection with such cases paid 1,048 visits. Of the 209 cases nursed during 1945, 208 were new cases. 201 of these 208 new cases were referred by the Health Department for nursing, 3 by private doctors and 4 by hospitals, associations or private persons. Ophthalmic cases received 289 visits. SANITARY SECTION. During the year the Acting Chief Sanitary Inspector and twelve District Sanitary Inspectors were on the staff. One District Sanitary Inspector retired on medical grounds; another was seconded for special duties in the housing section of the Sanitary Inspectors in connection with work of requisitioning empty properties under Circular 138/1945; and a third was seconded on special work in connection with the billeting of homeless persons. The number of premises inspected on complaint was 5,660 and the total inspections and reinspections were 30,256. These figures show a considerable increase on the previous year's figures of 2,887 and 18,084 respectively. Water.—The water supply of Willesden is derived from the mains of the Metropolitan Water Board and the Colne Valley Water Company. The service is constant and the water of excellent quality. Table No. 16. Inspections, 1945. No. of premises inspected on complaint 5,660 No. of premises inspected in connection with infectious diseases 3 No. of periodical inspections of premises 3,937 Houses inspected from House-to-House (Housing Act) — For certificates or reports under Rent Acts 19 Public House Urinals 462 Mews and Stables 190 Miscellaneous 2,190 Smoke Observations 311 Ministry of Health Circular 2845 (Inadequately Housed Families) 2,454 First Inspection of Vacant Property (Requisitioning) 1,488 Re-inspections 1,850 Total No. of primary inspections 18,564 Re-inspections (for all purposes) 11,692 Total No. of Inspections and Re-inspections 30,256 Table No. 17. Disinfestation, 1945. The following table shows the detail of work done during the year in disinfesting dwelling-houses, other premises and chattels. Insecticides used included pyrethrum and derris root proprietary preparations. Bedding materials found to be verminous have been de-infested in the steam disinfector at the Isolation Hospital. Other furniture found to be verminous has either been left in rooms under sulphur dioxide or, in bad cases has been treated in hydrogen-cyanide vans by a private firm. (a) No. of applications to rooms in private dwelling-houses (Note : Some rooms treated more than once.) 408 No. of applications for beetle infestations in canteens, etc. 20 No. of firewatchers' posts disinfested 4 No. of street shelters disinfested (bays) 1,669 (b) No. of verminous rooms cleansed 298 No. disinfested under Council's Scheme 97 No. of primary inspections of verminous premises 419 No. of re-inspections 516 (c) Disinfestation by H.C.N., carried out by Contractors. No. of removal disinfestations 15 No. of premises disinfested by H.C.N. 15 Disinfestation of bedding at Municipal Hospital (loads) 61 13 Table No. 18. Table Showing Food Certified as Unfit for Human Consumption, 1945. Meat: Totals Totals Bacon 218 lbs. Cheese 248½ lbs. Cooked 22 „ Butter and Fats 217 „ Tinned 11,511 „ Eggs 2,918 Raw 2,230½ „ Tinned Milk 3,741 tins Fish : Soups 129 „ Tinned 2,790 tins Miscellaneous : Raw 5,245 lbs. Egg Powder 395 lbs. Vegetables : Tea 45½ „ Tinned 3,535 tins Sweets 813| „ Raw 1,913 lbs. Trifles 120 Fruit: Sugar 816 „ Tinned 154 tins Meat Pies 144 Raw 3,181 lbs. Rabbits 239 Bread, Flour and Cereals, etc. 2,921½ „ Sausages 24 lbs. Preserves 798 „ Cream Powder 112 „ PUBLIC MORTUARY. During 1945 bodies were deposited at the Mortuary as follows :— Table No. 19. From Willesden. From Acton. Total. Post-mortems 115 168 283 Post-mortems and Inquests 67 69 136 Adjourned Inquests 13 11 24 Accommodations 3 — 3 MUNICIPAL HOSPITAL. The 54th Annual Report on the Municipal Hospital appears later in this Report. Your obedient Servant, GEORGE F. BUCHAN, Medical Officer of Health. 14 THE FIFTY-FOURTH ANNUAL REPORT on the MUNICIPAL HOSPITAL By C. M. H. ROTMAN, M.B., B.S., M.R.C.S., L.R.C.P., Acting Medical Superintendent. The total number of patients admitted to Hospital during 1945 was 1,774, as compared with 1,519 in 1911. CEREBRO-SPINAL FEVER. Only 2 cases of Cerebro-spinal Fever were admitted to Hospital during the year, and for the third successive year no deaths have occurred. DIPHTHERIA. 53 cases of authenticated Diphtheria were admitted during 1945, and of these 4 were Service Sick. 57 patients, who were certified as suffering from this disease, were finally diagnosed as: Tonsillitis 45, Vincent's Angina 3, Catarrhal Laryngitis and Bronchitis 1, Contact only 1, Encephalitis 1, Post-tonsillectomy Sloughs 2, Streptococcal Rhinitits 1, Common Cold 1, Acute Bronchitis 1, superficial abrasions of both knees 1. 2 deaths occurred. The following table compares the admissions during the past 26 years with the present year:— Average Average Total Admissions Total No. of Deaths Admissions per Annum Deaths per Annum 1919-1939 7.636 363 375 18 1940-1941 (War years) 378 75 12 2 1945 53 — 2 2 The peak year was 1922, with 673 cases and 56 deaths. ENTERIC FEVER. There were no cases of this disease admitted during the year. PUERPERAL INFECTIONS. ] The 15 Puerperal cases admitted to Hospital were diagnosed as follows:— Mammary abscess 9 Retained products of conception 1 Mastitis and Mammary abscess 3 Toxaemia of pregnancy and threatened Miscarriage 1 tion 1 SCARLET FEVER. 188 cases were admitted during the year, including 2 Service sick, compared with 312 in 1944 and 453 in 1943. OTHER DISEASES Tonsillitis 16 N.A.D 6 Feeding Difficulties 14 Teething 5 Colitis 2 Pyrexia of unknown origin 2 Chicken Pox 12 Pemphigus neonatorum 2 Rubella 3 Poliomyelitis 4 Enteritis 13 Gastro-enteritis 13 Scabies 9 Mumps 3 Conjunctivitis 3 Diarrhoea and Vomiting 12 Dermatitis 4 Urticaria 7 Whooping Cough 43 Pneumonia 25 Bronchitis 15 Dysentery 37 Impetigo 5 Erysipelas 16 Measles 20½ Herpes Zoster 1 Septic Spots 1 Pemphigus Vulgaris 1 Pharyngitis and Heart Failure 1 Infective Hepatitis 1 Polio Encephalitis without Paralysis 1 Clinical Maleria 1 Ophthalmia Neonatorum 1 Glandular Fever 2 Post-tonsillectomy Sloughs 2 Napkin Rash 1 Rectal Prolapse 1 Sub-mucous Polypus 1 Vincent's Angina 5 Common Cold 3 Excision of T's and A's 2 Petit Mal 1 Debility 2 Infantile Eczema 2 Cellulitis 1 Acute Laryngitis 1 Allergic reaction 2 Otitis Media 4 15 Other Diseases—continued. Meningismus 1 Colic 2 Congenital Syphilis 2 Streptococcal Rhinitis 1 Paralysis following Diphtheria 2 Congenital Pyloric Stenosis 2 Weils Disease 1 Carcinoma of Lung 1 Lichen Urticatus 1 Acidosis 1 Erythema 1 Multiple Cerebral Haemorrhage 1 Subarachnoid Haemorrhage 1 Encephalitis of unknown origin 2 Carcinoma of Pancreas 1 Weakness due to old injury 1 Streptococcal Throat 5 Pyelitis 1 Contact Scarlet Fever 2 Haemorrhage following removal of T's and A's 1 Contact Diphtheria 1 Cretinism 1 Carcinoma of Colon 3 T.B. Meningitis 1 Superficial abrasions of both knees 1 19 Deaths occurred: 1 from Chicken Pox, 2 from Diarrhoea and Vomiting, 2 from Whooping Cough, 2 from Pneumonia, 5 from Measles, 1 from Pharyngitis and Heart Failure, 2 from Congenital Syphilis, 1 from Weils Disease, 1 from Colic, 1 from Multiple Cerebral Haemorrhage, and 1 from T.B. Meningitis. MARASMUS CASES. 23 Marasmic infants were admitted during the year, and the total under treatment was 27. The former may be classified as follows : 19 Gastro-enteritis, 4 Malnutrition. 2 deaths occurred. EAR, NOSE AND THROAT CASES. Under the Emergency Medical Service Scheme, children are admitted from the Middlesex Hospital and from 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 491 Mastoidectomy 5 Miscellaneous 9 (b) Hospital Cases— Removal of Tonsils and/or Adenoids 7 Mastoidectomy 16 Miscellaneous 3 2. Middlesex Hospital : Removal of Tonsils and/or Adenoids 67 Miscellaneous 1 3. Harrow General Hospital : Removal of Tonsils and/or Adenoids 211 SERVICE SICK. Service Sick include men and women belonging to any of His Majesty's or Allied Forces, the Merchant Navy, Police and Prisoners of War. 66 patients coming under this category were admitted during the year, the large majority of whom were suffering from infectious diseases : Mumps 14 Infective Hepatitis 1 Rubella 9 Cerebral Haemorrhage 1 Diphtheria 1 Hysteria 1 Vincent's Angina 3 Catarrhal Jaundice 1 Chicken Pox 3 Localised Adenitis 1 Tonsillitis 4 Not diagnosed 1 Scarlet Fever 2 Malaria 1 Gingivitis 1 Diarrhoea 1 N.A.D 1 Miscarriage 1 Streptococcal Throat 1 Quinine Sensitivity 1 Scabies 1 Lichen Urticatus 1 Bronchial Catarrh 1 Erythema Multiform 1 Drug Rash 1 Measles 8 Allergic Rash 1 CIVILIAN SICK. Civilian Sick patients are cases which have been transferred from another Sector Hospital on the authority of the Group Medical Officer. 62 patients have been admitted to the Willesden Municipal Hospital during the year. These cases may be classified as follows : General Medical Cases 19, General Surgical Cases 5, Cancer Cases 38. AIR RAID CASUALTIES. One Air Raid Casualty was admitted during the year and was suffering from minor injuries only. CASES ADMITTED FROM OTHER AUTHORITIES. During the year 1945, 82 cases were admitted from areas other than the Borough of Willesden. 16 TREATMENT CENTRE. During March, 1944, a Treatment Centre for Scabies and verminous conditions was opened at the Hospital. During 1945 the following cases were treated :- Scabies cases and contacts 2,380 Verminous conditions 336 Other conditions 6 Total attendances 8,769 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, 1 in 1943, none in 1944, and none in 1945. (1) No. of cases of Diphtheria occurring amongst Probationer Nurses during the first 8 months of 1926 (before immunisation was carried out) 9 (2) Incidence rate per annum (taking 30 as average No. of Probationer Nurses) 45.0 per cent. (3) No. of cases of Diphtheria occurring amongst Probationer Nurses from 1927 to 1945 18 (4) Incidence rate per annum (taking 30 as average No. of Probationer Nurses) 3.3 per cent. (5) No. of Nurses Schick Tested (1927-1945 inclusive) 517 (6) No. of Nurses giving a positive reaction 211 (7) Percentage of Nurses giving a positive reaction 40.8 per cent. Table No. 20. Diseases. No. in Hospital on 1-1-45. Admitted. Total under Treatment. Discharged Recovered, or Transferred. Died. Mortality per cent. Remaining in Hospital on 31-12-15 Cerebro-spinal Fever 1 2 3 3 – – – Diphtheria 3 49 52 32 2 3.8 18 Enteric Fever – – – – – – – Erysipelas — 16 16 15 — – 1 Measles 12 201 213 208 5 2.3 – Puerperal Infections 1 15 16 16 – — – Scarlet Fever 14 186 200 187 – – 13 Whooping Cough 4 43 47 38 2 4.3 7 Mixed Infections – – – – – — — Other Diseases 10 326 336 300 12 3.6 24 Marasmus 4 23 27 24 2 7.1 1 Tonsil and Adenoid Cases (Middx.and Harrow Hospitals) — 279 279 274 – – 5 Tonsil and Adenoid Cases (Willesden) – 505 505 501 – – 4 Civilian Sick 35 (52 97 44 30 23 Service Sick 5 66 71 69 – – 2 Air Raid Casualties — 1 1 1 – — — Totals 89 1,774 1,863 1,712 53 – 98 17 Laboratory. Table No. 21 Nature of Examination. Positive Result. Negative Result. Total. 1 Swabs for C. diphtheriae 179 1,207 1,386 2 Typing of C. diphtheriae cultures — — 58 3 Sputum, etc., Direct examination for M. Tuberculosis 38 248 286 4 Sputum, etc., Cultures for M. Tuberculosis — — 171 5 Blood—Widal tests — — 10 6 Blood—Cultures — — 10 7 Blood—Counts — — 124 8 Blood—Films — —- 123 9 Blood—Chemical examinations — — 136 10 Urine—Microscopical examinations — — 60 11 Urine—Chemical examinations — — 78 12 Urine—Cultural examinations — — 34 13 Faeces—Microscopical examinations — — 15 14 Faeces—Chemical examinations — — 173 15 Faeces—Cultural examinations — — 139 16 Cerebro-spinal Fluid—Microscopical examinations — — 23 17 Cerebro-spinal Fluid—Chemical examinations — – 24 18 Cerebro-spinal Fluid—Cultural examinations — – 15 19 Swabs, etc.—Direct smears — – 137 20 Swabs, etc.—Cultures — — 559 21 Salmonella serological identifications — — 54 22 Virulence tests — — 6 23 Streptococcal Grouping — —- 2 Total 3,623 Table No. 22. Sources of Specimens Examined. Municipal Hospital 1,806 Private Practitioners 998 Health Centres 579 Chest Clinic 240 3,623 THE FIFTEENTH ANNUAL REPORT on the WILLESDEN MATERNITY HOSPITAL for the Year 1945. By ARNOLD WALKER, M.A., M.B., B.Ch., F.R.C.S., F.R.C.O.G. During 1945 the work of the Maternity Hospital went on normally. Over a thousand women were delivered without a maternal death, which maintained the maternal mortality rate for booked cases from the opening of the Hospital at a figure below one per thousand. The chief problem the Hospital had to face at the end of the year was the grave shortage of trained midwives. 18 Table No. 23. Statistical Details of the 1,029 Cases dealt with during 1945. Cases completed 1,029 Eclampsia 1 A. Booked at the Health Centres 1,020 Organic Heart Disease 2 Discharged well after delivery 1,014 Transferred 2 Puerperal Pyrexia 2!) Delivered elsewhere 3 Uterine Infection 1 Not pregnant 1 Urinary Infection 7 B. Admitted as Emergencies 9 Breast Infection 11 Discharged well after delivery Of the 1,020 booked cases, 458 were primigravidae and 562 were multigravidae. Of the 9 emergency cases, all were multigravidae. 9 Thrombo-phlebitis 1 Pulmonary Infection 4 Other infections 2 No cause found 3 Operations performed- Presentations— Forceps delivery The forceps rate was therefore 2.91 per cent. 30 Occipito Anterior 772 Occipito Posterior 175 Normal Breech 31 Caesarean Scction 8 Abnormal Breech 3 Contracted Pelvis 2 Twins 20 Triplets 1 Rigid cervix 2 Face 2 Previous Caesarean Section 1 Brow 1 Brow presentation 1 Shoulder 2 Placenta Praevia 1 Miscarriages 18 Acute intestinal obstruction 1 Ante-partum Haemorrhage— Manual Removal of Placenta 8 Placenta Praevia 4 Induction of Labour for Toxaemia 5 Accidental Haemorrhage 2 Transfusion 12 Prolapse of Cord 0 Blood 7 Toxaemia of Pregnancy admitted for treatment 17 Serum or Plasma 4 Blood and Serum or Plasma 1 1,030 viable children were born to 1,008 mothers. Of these, 30 were stillborn and 19 died. THE SIXTEENTH ANNUAL REPORT on the SUPERVISION OF MIDWIVES for the Year 1945. 52 Midwives gave notice of their intention to practise in Willesden in 1945, 31 of these being in the Central Middlesex County Hospital. Midwives practising and living in Willesden attended 2,570 cases either in hospital or on the district as midwives or maternity nurses, as against 2,091 in 1944. In addition, 19 midwifery or maternity cases were attended in Willesden by midwives living outside Willesden. The 8 Municipal District Midwives attended 432 midwifery cases in 1945 and, in addition, answered 10 emergency calls and carried out ante-natal care of 40 cases which were subsequently confined elsewhere. Midwives attached to Queen Charlotte's Hospital District Home, Kilburn, attended 157 midwifey cases. 85 of these were Willesden residents attended on behalf of the Willesden Council with, in addition, 8 cases attended for ante-natal care only. 72 were cases attended outside Willesden. Midwives attached to the Willesden District Nursing Association attended 166 maternity cases on behalf of the Council. During the year 163 notifications were received from Midwives practising in Willesden in accordance with the rules of the Central Midwives' Board and of these, 155 notifications were in respect of medical aid, 133 in respect of the mother and 22 in respect of the child. The eighth 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, under arrangements made with the Willesden Borough Council, Queen Charlotte's Hospital District Home deals with midwifery cases in the area allotted to the Home, and the Willesden District Nuring Association deals with the Maternity Nursing throughout Willesden. 19 The Watling and Willesden Training School for Second-period Pupil Midwives.—During the year 29 pupil midwives worked on the district. Of the 432 confinements dealt with by the Municipal Midwives, the pupil midwives attended 357 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 55 Maternity and Child Welfare Clinics for mothers and babies 38 The Lecture Courses. A Discussion Class, each week, taken by the Supervisor of Midwives at the Health Department. Of the 29 pupil midwives, 19 sat for their final midwifery examination, 17 passed, 2 failed, but one passed at a subsequent examination. TWENTY-EIGHTH ANNUAL REPORT for the YEAR 1945 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. SCHOOL MEDICAL SERVICE. The New Act.—The Education Act, 1944, makes provision for compulsory dental inspection of all children attending primary, secondary, nursery, special schools and County colleges, and offers treatment at Municipal Centres, free of charge, to all scholars. It becomes imperative for Local Education Authorities to secure adequate staff and clinic accommodation for the successful operation of the Act. Staff. The total school population of Willesden is approximately 21,000 and the recognised figure of allotment, subscribed to by the Ministry of Education to each dental officer, is not more than 3,000 children per year. Seven dental officers would thus be needed to cover the demands of the area and with the extension of the school-leaving age to 16 years this number would be increased to nine officers. Surgeries.—There are at present in Willesden four surgeries. It therefore becomes necessary to install for the School Medical Service a further five. The surgeries at Willesden Green and Stonebridge Park are fitted with electric bracket engines, pelton lamps, suitable dental cabinets, operating chairs, pedestal spitoons, nasal nitrous oxide and oxygen apparatus and are thus moderately equipped. The Kilburn Health Centre has had in use for some years a complete dental unit. This has proved to be a valuable addition and should be included in all surgeries. X-ray.—The Willesden General Hospital Authorities since 1934 have undertaken to do all dental X-ray work for the Council. This has proved to be a great help, but in order to enable the dental officers to make the fullest use of this indispensable auxiliary, X-ray machines should be installed in one or more of the Health Centres for the immediate use of the operating staff. Bacteriology.—Facilities are provided at the Willesden Isolation Hospital for bacteriological investigations. Anaesthesia.—Continuous nitrous oxide oxygen anaesthesia is used almost exclusively for the removal of teeth. This is administered by a specially appointed Anaethetist who attends each dental officer one session a week. Orthodontics.—The Council, in 1937, while deliberating on the question of the supply of orthodontic appliances, decided, with the consent of the Ministry of Education, to transfer children with irregular teeth to Hospital for complete treatment. In each case the parents would contribute towards the cost according to their means. No further developments have been made to deal with this form of treatment and the same conditions remain today as in 1937, except that this treatment is now free. 20 One of the duties of Local Authorities in future will be to provide orthodontic treatment for all children under their jurisdiction, and it may be incumbent upon them to see that treatment of this kind is done at the Health Centres by the school dental officers. Education.—Methods adopted for educating parents and children on the care of the teeth have been by the distribution of pamphlets at routine school inspections, by the exhibition of educational films at local cinemas, demonstrations and lectures provided by the Dental Board and talks to children and parents at schools and clinics. Some of these activities were discontinued at the outbreak of the war. Following Up.—Home visitation by Health Visitors is included in the School Dental Service. All parents of children who fail to keep appointments are seen and advised to complete the treatment. DENTAL STATISTICS FOR THE YEAR 1945. The service continued on the same restricted lines as in 1944. The staff of three dental officers, three nurses, and a part-time anaesthetist carried on the work at their respective centres. The total working sessions amounted to 1,525, and were utilised as follows: Treatment sessions at the Centrer 1,378 Routine inspection sessions 137 Administration sessions 10 Total 1,525 The Anaesthetist attended 131 times and administered anaesthetics to 2,687 patients, which is an average of 20.5 per session. 11,925 mothers, infants, primary and secondary school children were inspected. 9,248 were defective and 4,833 were treated at the Centres. 7,499 teeth were removed, 8,291 fillings were done and 3,554 other operations, making a total of 19,341 treatments. 15,441 attendances were made by these patients. PRIMARY, NURSERY AND SPECIAL SCHOOLS. The 1938 school population of Willesden was 18,700. The number on roll in December, 1945, was 15,641 compared with 5,300 during the peak of the evacuation in 1940. Inspection. Routine.—114 visits were made by the dental officers to the schools, when 7,254 scholars were inspected. 5,229 or 72 per cent. were found with carious teeth. The percentage in 1932 of children with defects was 68-7 per cent., in 1938, 76 per cent. Incidence of Decay.—There has apparently been little change in the incidence of decay in Willesden children during the war years, in spite of the fact that the majority were evacuated to all parts of the country. Complete recording of all defects found was done but " the care of the teeth " pamphlet, which was distributed to each child before the war, was temporarily suspended. Parents were invited to attend all dental inspections of their children. Special Cases.—1,072 children were inspected at the centres. Included in this figure are cases of minor defect which had developed between routine inspections, as well as those children leaving school and seeking a final treatment. Treatment. Out of a total of 6,301 defective, 3,104 or approximately 50 per cent., were treated at the Centres. 5,079 teeth were extracted, of which 664 were permanent. 3,563 fillings were done on permanent and 1,347 on temporary teeth. This is a ratio of 5 permanent fillings to 1 permanent extraction (including those permanent teeth extracted for regulation). Also 1,604 other operations were performed, including 11 jacket crowns, I denture, root fillings to anterior teeth, gum treatments, dressings of zinc oxide and other sedatives, and silver nitrate applications. Treatment sessions totalled 701. 21 TABLES DEALING WITH THE WORK ON SCHOOL CHILDREN DURING THE YEAR. Dental Inspection and Treatment. 1. Number of children who were inspected by the dentist: (a) Routine age groups Children attending Public Elementary Schools. Children attending Special Schools. Aged : 4 1 5 312 1 6 825 6 7 820 3 8 903 12 9 827 13 10 891 13 11 790 16 12 683 14 13 697 11 11 383 12 15 17 4 Total 7,149 105 (h) Specials 1,057 15 (c) Total (Routine and Specials) 8,206 120 2. Number found to require treatment 6,209 92 3. Number actually treated at the Authority's Health Centres 3,084 24 4. Attendances made by children for treatment 8,401 55 5. Half-days devoted to Inspection 112 2 Treatment 696 5 Total 808 7 6. Fillings—Permanent Teeth 3,529 34 Temporary Teeth 1,344 3 Total 1,873 37 7. Extractions Permanent Teeth 655 9 Temporary Teeth 4,381 34 Total 5,036 43 8. Administration of general anaesthetics for extractions. . 1,884 14 Local anaesthetics 124 4 Total 2,008 18 9. Other operations—Permanent Teeth 1,430 8 Temporary Teeth 166 — Total 1,596 8 RETURN SHOWING THE NUMBER OF DENTAL DEFECTS REFERRED FOR FOLLOWING-UP, AND THE EXTENT TO WHICH REMEDIAL MEASURES WERE CARRIED OUT DURING 1945 AT HEALTH VISITOR'S LAST VISIT. Total number of defects coming under observation during 1945:— Children attending Public Elementary Schools. Children attending Special Schools. Brought forward 395 5 New during year 4,053 31 Total 4,448 36 Number of defects treated : Health Centre 3,084 24 Otherwise 20 — Total 3,104 24 No report available 5 — Number of defects for which no treatment has been undertaken at Health Visitor's final visit 1,002 6 Carried forward 285 5 Number not needing treatment 52 1 22 WILLESDEN SECONDARY AND JUNIOR TECHNICAL SCHOOLS. Inspection.—1,858 pupils were inspected at the schools and 135 at the Health Centres, making a total of 1,993 inspections for the year. 23 visits were made to the schools, an average of 80 inspected per visit. The number of children with defects at routine dental inspection was 1,310, or 72 per cent., compared with 73 per cent. in 1938. Complete charting was done for all these scholars. Treatment.— 721 or 36 per cent. of the defective cases were treated at the Centres. The number of fillings amounted to 1,547 and the number of teeth removed was 303, of which 218 were permanent teeth. This is a ratio of 6 permanent fillings to 1 permanent tooth extracted. In addition, 15 jacket crowns and 2 dentures were supplied. There were also 636 sundry operations performed. The following figures give the returns of the average work done per session for primary and secondary school children combined. These are arrived at by dividing the total treatment and inspection sessions into the totals of the respective operations performed. Total Sessions—Inspection and Treatment, 1,058; Inspections, 9.7; Fillings, 6.1; Extractions, 5: Other Operations, 2. All restorations in posterior teeth were silver amalgam alloys, once lined in superficial cavaties and twice lined in these proximating the pulp. Cement fillings, other than in anterior teeth, were included in other operations. 1. Number of pupils who were inspected by the dentist : Willesden Secondary Schools. Willesden Junior Technical etc. Schools. Total. (a) Routine age groups « Aged : 11 104 – 104 12 218 — 218 13 260 — 260 14 282 65 347 15 252 236 488 16 131 211 342 17 58 25 83 18 12 1 13 19 3 — 3 Total 1,320 538 1,898 (b) Specials 123 12 135 1,443 550 1,993 2. Number found to require treatment 1,058 417 1,47. 3. Number actually treated at the Authority's Health Centres 449 272 721 4. Attendances made by pupils for treatment 1,348 862 2,210 5. Half-days devoted to Inspection 16 7 23 Treatment 141 79 220 Total 157 86 243 6. Fillings—Permanent Teeth 988 559 1,547 Temporary Teeth — Total 988 559 1,547 - - - 7. Extractions—Permanent Teeth 150 98 248 Temporary Teeth 45 10 55 Total 195 108 303 8. Administration of general anaesthetics for extractions 124 70 191 Administration of local anaesthetics 22 1 23 Total 146 71 217 9. Other operations—Permanent Teeth 351 275 626 Temporary Teeth 10 — 10 Total 361 275 636 23 EXPECTANT AND NURSING MOTHERS AND CHILDREN UNDER 5. Section 22 of the National Health Service Bill lays upon Local Authorities a duty " to make arrangements for the care, including in particular dental care, of expectant and nursing mothers and of children who have not attained the age of 5 years." Details of personal equipment and clinic accommodation to meet the Borough's obligations are awaiting further deliberations and are omitted from this report. The records of the year give the following details concerning the Maternity and Child Welfare section of the Clinic work. 1,204 mothers and 402 children were inspected during the year, in addition to 190 brought forward from 1944, making a total of 1,796. Of this number 821 were completed at the Clinics and 183 partially completed. Further details of the vear's work are given in the table below. E.M. N.M. 0-5 Total Number inspected 1,052 152 102 1,606 Number brought forward from previous year 146 20 24 190 Total number under observation during year 1,198 172 426 1,796 Number completed 467 104 250 821 Number partially completed 122 24 37 183 Number not availing themselves of treatment 380 29 86 495 Number treated by other agencies 45 1 8 54 Number carried forward 94 11 4 109 Number with no defect 90 3 41 134 Number of attendances 3,187 648 940 4,775 Number of teeth removed 1,321 253 543 2,117 Number of teeth filled 1,258 195 381 1,834 Number of other operations on the gums and teeth. 989 272 153 1,414 Number of general anaesthetics 320 77 198 595 Number of local anaesthetics 71 20 6 97 Number of treatment sessions – – — 457 At cost to Council At cost to Applicant At part cost to Applicant Total Number of patients who received dentures during the year 19 27 38 84 REPORT ON WAR-TIME NURSERIES, 1945-1946 Nurseries Open at Beginning of 1945. Cur/on Crescent 70 children Chichester Road 50 children Braintcroft 60 „ College Road 50 „ Wesley Road 40 „ Essex Road 50 „ Olive Road 40 „ Crest Road 50 „ Longstone Avenue 50 „ Villiers Road 50 „ " Evefield," Brentfield Road 50 „ In March, 1945, it was decided to open the already built Mortimer Road Nursery, to accommodate children from the Kensal Rise area who were waiting for vacancies at College Road Nursery. The spare vacancies were filled by children from the Kilburn area, who were conveyed by school " bus " to and from the nursery. The demand for nursery accommodation in the Kensal Rise area has risen during the year. In consequence, all vacancies at Mortimer Road Nursery are now filled by children from the immediate neighbourhood. The omnibus service has been discontinued. In April, 1945, the Olive Road Nursery was closed for redecoration. The children attending were transferred to a new building on the edge of Gladstone Park. In February, 1946, the Olive Road Nursery was reopened. On March 4th, 1946, the Curzon Crescent Nursery was returned to the Education Department, to be continued as a Nursery School for children aged 2-5 years. Total Attendances.—April, 1945, to April, 1946, 133,008. Teaching Staff.—In October, 1945, Miss J. Tyrell, Warden of Braintcroft Nursery, was appointed Supervisory Warden. This appointment has improved the care of the 2-5 year-olds. The Wardens now have regular meetings for discussion and toy mending. The travelling percussion band has proved very popular. Several puppet shows have been given during the year. Medical Inspection.—The Medical Officers of the various Health Centres have examined the children at regular intervals. Children have attended at Health Centres for Dental and other treatment. Diphtheria immunisation has now been carried out at each nursery. Toys.—Very few toys have been given to the Nurseries during the year. The allowance of 2s. (id. per child per year is quite inadequate. Suitable toys are almost non-existent in the Nurseries. 24 Clothing.—The W.V.S. have now discontinued their help in making garments. The Nursery staff have made up most of the garments with the aid of only one sewing machine. It is hoped to provide ready-made garments in future. Mrs. Baldwin continues to help with sewing. Building Repairs. Most of the Nurseries are in urgent need of redecoration and adequate fencing. Frequent burglaries cause considerable anxiety. Training of Students. In May, 1945, seven students sat for the Nursery Nurses' Diploma. Five students obtained the Diploma, two passed the practical section only. In November, 1945, three students entered, one obtained the Diploma, one passed in theory only, and one in practical section only. There are seven candidates for the May, 1946, examination. 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 4s. in respect of each child under, 5 years cared for on 4 or more days a week and 2s. for 1 to 3 days per week. The Exchange looks into the question of whether the mother's employment is war work. The Council's Health Visitors supervise the Registered Daily Guardians and pay not less than monthly visits to them. At the end of 1945 28 Daily Guardians were registered to take 41 children. This is half the number for the previous year. Of these 28 Guardians, 23 actually had children in their care at the end of the year. These 23 had 26 children in their care. The objections to this scheme are that the 4s. 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 1s. per day or 6s. per week she is not likely to show much enthusiasm for a scheme under which she has to pa\ 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. The Ministy of Labour and National Serv ice ceased to sponsor and give financial aid to this scheme after March 31st, 1946. REPORT ON SPEECH THERAPY. During the Autum term, which started on September 11th, 143 children have been examined for defective speech. Of this number 87 were selected as being likely to benefit from immediate treatment. 15 are to be reexamined in 6 months' time and 6 are to be re-examined in 12 months' time. These are mostly young children whose defects may clear up without special help. Six are to be given treatment after operations for Cleft Palate or Tonsils and Adenoids. 1 is to be given speech therapy after receiving medical treatment for ears. Of those who were not accepted for treatment : 18 were found to be suffering from only very slight defects, 4 seemed unlikely to benefit owing to very retarded mental condition, 1 were attending at a hospital, I had a parent who objected to treatment, and 1 had unsatisfactory home conditions which seemed to be the cause of the stammer. So far, one Centre has been established where 15 children have received treatment once or twice weekly. Of these, 3 show very great improvement, 6 are progressing satisfactorily, and 6 show only a slight improvement.