AC39(1) wlLLE5DEN Borough of Millesden 1946 THE 71st ANNUAL HEALTH REPORT S. LEFF, M.D., 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, 1947. To the Corporation of Willesden. I beg to submit herewith the Annual Health Report for Willesden for the year 1946, in accordance with instructions received from the Ministry of Health and Ministry of Education that it should be a short report. VITAL STATISTICS. 3,420 live births were registered. 92 still births were registered. 1,799 deaths were registered. The infantile mortality rate for the year was 30, being the lowest on record. 104 children under 1 year of age died in 1946. CANCER. There were 319 deaths of Willesden residents from Cancer in 1946, as compared with 282 in 1945. The two Municipal Cancer Clinics were continued throughout the year. No new patient attended in 1946. At the end of 1946, 3 patients remained under observation. INFECTIOUS DISEASES. During the year 1946, 2,644 cases of infectious diseases were notified, as compared with 3,020 in the previous year. The following table gives the number of notifications of certain diseases included in the above total of 2,644, together with the corresponding figures for 1945:— Table No. 1. Number of Cases Notified. No. of Notified Cases Confirmed. 1945 1946 1946 Diphtheria 130 101 58 Scarlet Fever 253 334 308 Pneumonia 339 458 455 Whooping Cough 221 384 377 Erysipelas 31 42 37 Measles 1,568 817 805 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 1946 2,033 654 2,687 The approximate mid-year population, 1946, as supplied by the Ministry of Health, based on ration books, was 13,920 under 5 years of age and 20,390 between 5 and 15 years of age. It was estimated that 72 per cent. of those Under 5 years and 65 per cent. of those between 5 and 15 years had been immunised at 31st December, 1946. 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 58 cases of Diphtheria in Willesden in 1946 and there was 1 death, in an unimmunised child of 4 years. Enteric Fever.—5 cases were notified in 1946. Dysentery.—37 cases were notified as Dysentery in 1946. Malaria.—6 cases were notified in 1946. Infectious Diseases of the Central Nervous System.—Poliomyelitis and Polio-encephalitis, Cerebrospinal Fever and Encephalitis Lethargica.—17 cases of these diseases were notified in 1946, as against 20 in 1945, 16 in 1944, 20 in 1943, 35 in 1942, 29 in 1941, 38 in 1940, 18 in 1939, 24 in 1938, 22 in 1937 and 14 in 1936. 2 proved fatal, giving a fatality rate of 12'0 per cent, of notified cases. 15 cases were notified as Cerebro-spinal Fever. Of these 15 cases 13 proved to be Cerebro-spinal Fever and 1 was found in hospital to be suffering from Specific Enteritis and 1 from Broncho-Pneumonia. The ages of the 13 cases which proved to be Cerebro-spinal Fever were as follows:— Under 1 year of age 0 Between 10 and 15 years of age 2 Between 1 and 2 years of age 0 „ 15 „ 20 „ „ 1 " 2 " 20 35 " " 2 ,, 3 „ 4 „ . „ 1 " 35 ,, 45 „ „ 0 n 4 „ 5 „ 1 ,, 45 „ 65 ,, ,, .. 0 ,, 5 „ 10 ,, „ 3 65 years of age and over 0 The months in which the 13 cases occurred were as follows:— January, 1946 6 May, 1946 1 September, 1946 0 February, 1946 2 June, 1946 0 October, 1946 0 March, 1946 2 July, 1946 1 November, 1946 0 April, 1946 0 August, 1946 1 December, 1946 0 1 of these 13 cases which proved to be Cerebro-spinal Fever died. This patient was aged 2 years. In addition, one further death was recorded as Cerebo-spinal Fever. The patient was a child aged 22 months. One case of Poliomyelitis was notified, aged 3 years, and was discharged from hospital well. In addition, one death was recorded as Acute Poliomyelitis after post-mortem examination without inquest, aged 35 years. One case of Encephalitis Lethargica was notified, aged 2 years, and was found in hospital suffering from a Post-Epileptic attack. In addition, one death was recorded as Encephalitis Lethargica after post-mortem examination, aged 5 years. Pneumonia and Influenza.—458 cases of Pneumonia were notified in 1946, as compared with 339 in 1945 and 283 in 1944. Deaths from Broncho-Pneumonia, Lobar Pneumonia and Pneumonia (unspecified) numbered 93, as compared with 114 in 1945, 86 in 1944 and 130 in 1943, and deaths from Influenza 16, as compared with 4 in 1945, 9 in 1944 and 30 in 1943. Whooping Cough.—384 cases were notified in 1946, but a total of 565 cases coming to their knowledge were visited by Health Visitors, 409 of which occurred in children under 5 years of age. There were 4 deaths from Whooping Cough in 1946. 1 of the children who died was under 1 year of age, and 3 were between 1 and 5 years of age. Measles.—817 cases were notified in 1946, but a total of 1,088 cases were visited by the Health Visitors, ^85 of which occurred in children under 5 years of age. There was no death from Measles in 1946. 4 Tuberculosis.—The following table shows the number of cases of Tuberculosis on the register at the end of each year 1938-1946:— Table No. 3. Number of Cases of Tuberculosis on Register at end of Year. Pulmonary. N on-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 1946 595 472 88 92 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 23,734 occasions, nursing mothers 29,264, and children under 5 53,357, making a total at these clinics of 106,355 attendances in 1946. Out of the total number of 3,420 children registered as born alive in 1946, 2,270, or 66 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 1 ½months) 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 1946 (3 Health Centres open) 140,740 23,644 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 1,903 occasions and nursing mothers on 1,572 occasions during 1946. MATERNITY HOSPITAL. Bookings.—1,405 patients were booked during 1946 for confinement in the Willesden Maternity Hospital. The fees at which these 1,405 cases were booked varied from 45 at £15 to 114 free. The average fee per case was approximately £6 6s. 6d. During 1946, 652 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 642 Not resident in Willesden 10 652 5 Hospital Confinements.—During 1946, 1,187 women were confined in the Willesden Maternity Hospital. 451 births of Willesden residents were notified from outside Institutions—73 from St. Mary's Hospital, 58 from Queen Charlotte's Hospital, 25 from Middlesex Hospital, 22 from University College Hospital, 26 from Queen Mary's Maternity Home, and smaller numbers from other hospitals, 115 from a Nursing Home, and smaller numbers from other Nursing and Maternity Homes. These, together with some 711 in the Central Middlesex County Hospital, are approximately 69 per cent. of the births belonging to Willesden. It is to be noted that in 1946 many mothers desiring institutional confinement were unable to obtain beds. 642 applicants for the Willesden Maternity Hospital alone had to be refused. 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 1944 653 166 1,905 2,724 1945 524 130 2,010 2,664 1946 878 183 2,349 3,410 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. Antf.-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. 815 such requests were received in 1946. 678 Expectant Mothers booked for confinement in the Central Middlesex County Hospital were referred to the Willesden Health Centres for Ante-Natal care in 1946. Puerperal Pyrexia.—80 cases were notified in 1946. Maternal Mortality.—During 1946 there were 6 deaths classed to pregnancy and child-bearing—there were no cases of post-abortive infection. The puerperal mortality rate was 1-70 per 1,000 registered total births. During 1946 there were no maternal deaths from non-puerperal causes. The total maternal mortality from all causes, including criminal abortion, was therefore 1 • 70 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 1946, 208 were supplied free, 355 at full cost and 533 at part cost—a total of 1,096. 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 1946. 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 1946. Home Helps.—The Council provided the services of home helps in connection with 63 confinement cases in 1946. 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. 7 cases were inquired into during 1946. Report on Connaught Hostel. The above short-stay hostel was opened on September 2nd, 1946, and takes 12 children aged 0-5 years for short-stay periods during the confinement or illness of the mother. Up to 31st March, 1947, 61 cases were admitted. Reasons for admission: Confinement of mother, 44; illness of mother, 17. Average length of stay in hostel, 21 days. Payment is based on economic circumstances. The opening of this hostel has enabled several mothers to enter hospital for confinement and to undergo muchneeded operations without anxiety. One mother had been waiting for three years for an operation. Several mothers have needed rest during the ante-natal period, and the hostel has enabled them to be relieved during this time. The service requires extension to satisfy fully the needs of the district. 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. 34 children were under treatment for Marasmus and 154 for enlarged tonsils and adenoids and mastoid disease. 1 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 1946 was 4. This gives a case rate of 1 .2 per 1,000 registered live births. A district midwife attended the confinement in 1 case, 2 cases were born in hospital, and 1 in a nursing home. Treatment was obtained at a hospital in 2 cases. Complete recovery with unimpaired vision occurred in all 4 cases. 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. Arrangements have been made for obtaining knowledge of all children whose weight at birth is 5½lbs. or less. 176 such children were born in Willesden in 1946, 47 at home, and 129 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. 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 1946, out of a total of 104 deaths of children under 1 year of age who were Willesden residents, 23 were due to premature birth. In 1945, out of a total of 129, 27 were due to premature birth, in 1944 out of a total of 114, 31 were due to premature birth, and in 1943, out of a total of 155, 25 were due to premature birth. Taking only the deaths under 4 weeks of age in 1946, all 23 were due to premature birth; in 1945, all 27 were due to premature birth; in 1944, 30 out of a total of 70 were due to premature birth ; in 1943, 24 out of 61. 7 CHILD LIFE PROTECTION. At the end of 1046 there were 28 Foster Mothers and 44 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. 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 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 supervision as is possible without compulsory power in the course of her maternity and child welfare work. 14 persons gave notice under Section 7 (3) in 1946 in respect of 18 children. There were 7 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. It is hoped that the premises secured for the stay of mothers and illegitimate children will be ready for occupation in the near future. NURSING HOMES. 2 new homes were registered in 1946. The total number of homes on the register at the end of 1946 was 5, providing accommodation for 4 maternity patients and 20 other patients. AGED AND INFIRM PERSONS. The suitable care of aged and infirm persons was reported on in the 1943 Annual Report. The Domestic Help Service will shortly be extended to assist the aged and infirm (see below, Domestic Help Report). SOCIAL PROBLEMS GENERALLY. This subject was dealt with last year. Progress has been made with the establishment of homes and hostels as indicated above. DOMESTIC HELP. Here again the position remains unchanged and there is still no domestic help available. In June, 1946, the Ministry of Health issued Circular 110/46 which dealt with the development of adequate schemes for the provision of Home Helps and Domestic Helps. As the result of the suggestions contained in the circular, the Council agreed to appoint a full-time paid organiser, who came on duty January, 27th 1947. Since that date, up to and including March 31st, 1947, 39 persons were helped. 20 were old people and 19 for sickness or other reasons. THE SCHOOL MEDICAL SERVICE. During 1946, 4,596 children were medically inspected at routine inspections and 19,871 at special inspections and reinspections. 8 Scabies.-See report on Uncleanliness and Scabies on pages 9. 10 and 11. Uncleanliness.-During 1946 cleanliness inspections were carried out in the schools on 342 occasions. The total number of examinations and re-examinations made during the year was 34.351. See report on Uncleanliness and Scabies on pages 9. 10 and 11. Medical Treatment in Willesden.-During the year 1946 school children were followed up by the Health Department on account of 12.441 medical defects and 6.883 dental defects. Of those defects found to require treatment. medical or dental treatment was obtained for 15.495 and domestic treatment was obtained for 1.240. 91 per cent. of the medical defects were treated. 77 per cent. receiving medical treatment and 10 per cent. domestic treatment; 86 per cent. of the dental defects followed up were treated. No record is available of defects requiring treatment which were not followed up. 98 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 2 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 55.851 attendances at the Health Centres. HEALTH CENTRES. ATTENDANCES. Table No. 7. Medical and Dental Treatment-Attendances at Municipal Health Centres. 1946. Condition. (1) Mothers. and Children under Five. School Children. (8) Grand Total (Cols. 7 and 8). (9) Expectant Mothers. (2) Nursing Mothers. (3) Children under Five. Total (Cols. 2-5). (7) 0-1. (4) 1-5. (5) Total (Cols. 4 and 5). (6) 1. Cleansing - - - - - - 2. Throat. Nose and Ear Diseases ] - 14 565 579 580 4.749 5.329 3. Minor Ailments 31 69 536 2.423 2.959 3.059 25.499 28.558 4. Eye Diseases 17 21 166 548 714 752 3.013 3.765 5. Skin Diseases 25 28 222 160 382 435 549 984 6. Artificial Sunlight Treatment - - - - - - - - 7. Orthopaedics 16 78 499 1.532 2.031 2.125 3.639 5.764 8. Medical Consultations 23.644 29.068 29.566 13.175 42.741 95 453 95 453 9. Diphtheria Immunisations . 166 3.785 3.951 3.951 622 4 573 10. Total (1-9) 23.734 29.264 31.169 22.188 53.357 106.355 38.071 144.426 11. Dental Consultations 4.072 758 - 1.431 1.431 6.261 12.248 18.509 12. Total (10-11) 27.806 30.022 31.169 23.619 54.788 112.616 50 319 162 935 13.School for Mothers - - - - - - - - 14. Nursery - - - - - - - - 15. Miscellaneous - - - - - 28.124 5 532 33 656 16. Grand Total (12-15) 27.806 30.022 31.169 23.619 54.788 140.740 55.851 196.591 (1) Kilburn Health Centre. Willesden Health Centre. Stonebridge Health Centre. Mothers and Children under Five. (2) School Children (3) Total. (4) Mothers and Children under Five. (5) School Children. (6) Total. (7) Mothers and Children under Five. (8) School Children. (9) Total. (10) Grand Total. (11) 17. Medical Attendances 30.331 8.813 39.144 34.426 12.877 47.303 41 598 16 381 57 979 144 426 1.661 2 184 3 845 1 646 3 451 5 097 2 954 6 613 18 509 19. School for Mothers - - - - - - - - - - 20. Nursery Attendances - - - - - - - - - - 21. Miscellaneous 12.015 988 13.003 6.166 2.532 8.698 9.943 2.012 11.955 33.656 22. Total 44.007 11.985 55.992 42.238 18.860 61.098 54.495 25.006 79.501 *196.591 * In addition 3.514 attendances were made by Secondary School children and the following attendances by adults: Cleansing and Treatment of Scabies-15. Skin Diseases-21. Varicose Ulcers-308 and Orthopaedics under Section 181 of the Public Health Act. 1936--45. making a total of 3.903. which together with the 196.591 above makes a grand total of 200.494. 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 o 0 5,674 0 5,674 5,674 0 0 5,674 1915 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 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 1946 106,355 6,261 112,616 38,071 12,248 50,319 162,935 - - 37,559* 200,494 * This includes the 3,514 attendances made by Secondary and Technical School children and the 389 by adults and others under Section 181 of the Public Health Act, 1936, which are shown in the footnote of Table No. 7. In addition 7,781 attendances were made at the Scabies and Lice Treatment Clinic. In 1946, 6 School Children and 2 Children under 5 years of age were treated under the Council's Scheme by X-rays for Ringworm of the Scalp. 12 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 1946. Public Elementary School Children 9,921 Children under 5 years of age .. 7,290 Expectant Mothers. . 4,590 Nursing Mothers 3,674 PRINCESS ROAD CENTRE. 1,596 attendances were made by Children under 1 year of age at the Medical Consultation Sessions in 1946, 397 by Children 1-5 years of age and 1,572 by Nursing Mothers, or a total of 3,475. 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, 1946. 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 336 47 383 1,362† 70 1,432 Children 5.14 years 533 184 717 2,509* 239 2,748 Adults M. 350 M. 15 M. 365 W. 668 W. 91 W. 759/ 3,4541 147 3,601 Totals 1,887 337 2,224 7,325 456 7,781 † 37 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. * 59 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. ‡ 119 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 55 1943 6.1 1946 5.8 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 1946 50 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 1946 199 * 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 1946 533 CHILDREN UNDER 5 YEARS OF AGE. These generally come to light in connection with their elder brothers and sisters. In 1946, 336 were treated at the Centres for Scabies, making 1,362 attendances, and 47 were treated for Lice, making 70 attendances. The figures for 1945 were 481 treated for Scabies, making 1,624 attendances, and 29 treated for Lice, making 44 attendances, and for 1944, 402 treated for Scabies, making 1,235 attendances, and 53 treated for Lice, making 58 attendances. ADULTS. The figures in Table 15 indicate that in 1946 a lesser number of adults attended the treatment centre for either Scabies or Lice and Nits than in 1944 or 1945. 11 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 1946 350 668 15 91 1,108 106 1,124 3,454 147 3,601 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 3,460. Dermatological Department.—H. Hai.din-Davis, m.d., f.r.c.p., f.r.c.s., Dermatologist to the Council.— The work of the Dermatological 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 1946, 3,191 and 2,986 in 1945. Analysis. Centre Maternity and Child Welfare Pupils, Elementary Schools Secondary Schools Total Number of Sessions Average Attendance per Session 1 187 610 140 937 45 21 2 229 815 34 1,078 47 23 3 199 899 68 1,166 47 25 Totals 615 2,324 242 3,181 139 23 Refractions. Centre Without Mydriatic With Mydriatic Percentage Attendance Appointments Made Appointments Kept 1 252 95 85 89 2 304 147 129 88 3 313 128 103 80 Totals 869 370 317 86 The work of the Eye Department is now being carried out as in the years prior to the war, with a weekly session at each health centre, an optician being in attendance on each occasion, to take frame measurements, and give all necessary information regarding the free issue of spectacles, or the prices of more expensive styles, in the cases where these are selected by parents who wish to make use of his services. Free choice of optician is the rule, except when parents desire the standard free-issue spectacles. All glasses are checked by me before issue. The more immediate need of the Ophthalmic Clinics is an Orthoptic Department, with a trained Orthoptist in attendance. Detailed plans for such a department were drawn up before the war, but unfortunately could not be carried out. When times are more favourable, this matter should receive urgent attention, as many of the cases of squint attending the Health Centres would benefit from a course of Orthoptic training. 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 195 cases during 1946, and in connection with such cases paid 990 visits. Of the 195 cases nursed during 1946, 193 were new cases. 182 of these 193 new cases were referred by the Health Department for nursing, 4 by private doctors and 7 by hospitals, associations or private persons. Ophthalmic cases received 165 visits. SANITARY SECTION. At the commencement of the year, the Acting Chief Sanitary Inspector and nine District Sanitary Inspectors were on the staff. Owing to resignations, the year ended with a total of seven, including the Acting Chief Sanitary Inspector. The number of premises inspected on complaint was 7,473 and the total inspections and re-inspections were 21,624. These figures show a considerable increase on the previous year's figures in respect of initial inspections on complaint, but a decrease in the number of reinspections, due to shortage of staff. (The figures for 1945 were 5,660 and 30,256 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. Factories Act, 1937.—The provisioning of Part I of the Act, relating to Sanitary Conveniences, is enforceable by the District Council. Table No. 16. Inspections, 1946. No. of premises inspected on complaint 7,473 No. of premises inspected in connection with infectious diseases 6 No. of periodical inspections of premises 1,540 Houses inspected from House-to-House (Housing Act) - For certificates or reports under Rent Acts 13 Public House Urinals 168 Mews and Stables 28 Miscellaneous 895 Smoke Observations 276 Ministry of Health Circular 2845 (Inadequately Housed Families) 2,216 Total No. of primary inspections 12,615 Re-inspections (for all purposes) 9,009 Total No. of Inspections and Re-inspections 21,624 Table No. 17. Disinfestation, 1946. The following table shows the detail of work done during the year in disinfesting dwelling-houses, other premises and chattels. The use of sulphur dioxide and preparations containing pyrethrum and derris root was, to a large extent, superseded by the use of D.D.T. in liquid and powder forms, and much greater success in the eradication of vermin has been experienced. 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.) 482 No. of applications for beetle infestations in canteens, etc. - No. of street shelters disinfested (bays) 301 (b) No ot verminous rooms cleansed 292 No. disinfested under Council's Scheme 145 No. of primary inspections of verminous premises . 100 No. of re-inspections 155 (c) Disinfestation by H.C.N., carried out by Contractors. No. of removal disinfestations 20 No. of premises disinfested by H.C.N — Disinfestation of bedding at Municipal Hospital (loads) 59+4 moths 13 Table No. 18. Table Showing Food Certified as Unfit for Human Consumption, 1946. Meat: Totals Totals Bacon 283 lbs. Tinned Milk 7,195 tins Cooked 43 „ Soups 625 „ Tinned 3,505 „ Miscellaneous : Raw 1,685 „ Tea 9¾ lbs. Fish: Sweets 14 „ Tinned 1,867 tins Sugar 671 „ Raw 5,418 lbs. Meat Pies 5 Vegetables: Rabbits 1,113 Tinned 6,738 tins Chocolate 6½ „ Raw 112 lbs. Dates 1,218 „ Fruit: Porage Oats 28 pkts. Tinned 849 tins Biscuits 54 lbs. Raw 169 lbs. Fish Cakes 60 „ Bread, Flour and Cereals, etc. 5,431 „ Treacle Puddings 30 „ Preserves 819 „ Meat Pies 106 „ Cheese 297 „ Yeast 448 „ Butter and Fats 40" Chicken 113 „ Eggs 4,730 Ducks 12 „ Table No. 19. Factories with Mechanical Power. Primary Inspections 169 Notices 10 Prosecutions Nil Abated 6 Factories without Power. Primary Inspections 57 Notices 2 Abated 2 Work Places (other than Outworkers), including Building Operations Primary Inspections 51 Notices Nil PUBLIC MORTUARY. During 1946 bodies were deposited at the Mortuary as follows:— Table No. 20. From Willesden. From Acton. Total. Post-mortems 272 69 341 Post-mortems and Inquests 83 31 114 Adjourned Inquests 19 3 22 Accommodations 1 .—. . 1 MUNICIPAL HOSPITAL. The 55th Annual Report on the Municipal Hospital appears later in this Report. Your obedient Servant, S. LEFF, Medical Officer of Health. 14 THE FIFTY-FIFTH ANNUAL REPORT on the MUNICIPAL HOSPITAL By W. F. TWINING McMATH, M.D., M.R.C.P., D.P.H., Physician-Superintendent. I beg to submit herewith the Annual Report on the Municipal Hospital for the year 1946, which is the first, since I commenced duties on the 12th October, 1946, as Physician-Superintendent. During the year under review the Laboratory, which had been an integral part of the Hospital, and staffed by Hospital personnel, was taken over by the Medical Research Council, and since 15th July, 1946, has been directly managed by them, from the Central Public Laboratory, Hendon. The total number of patients admitted to Hospital during 1946 was 1,823, as compared with 1,774 in 1945. CEREBRO-SPINAL FEVER. 5 cases of Cerebro-spinal Fever were admitted to Hospital during the year. 1 death occurred. DIPHTHERIA. 64 cases of authenticated Diphtheria were admitted during 1946, and of these 6 were Service Sick. 39 patients, who were certified as suffering from this disease, were finally diagnosed as : Tonsillitis 26, Vincent's Angina 3, Catarrhal Laryngitis 3, Marasmus and Gastro-enteritis 1, Acute Rhinitis 1, Encephalitis 2, Sub-mental Abscess 1,. Scarlet Fever 1, Carbuncle in Nose 1. No deaths occurred. The following table compares the admissions during the past 27 years with the present year:— Total Admissions Average Admissions per Annum Total Deaths Average No. of Deaths per Annum 1919-1939 7,636 636 375 18 1940-1945 (War years) 442 74 14 2 1946 64 — — — The peak year was 1922, with 673 cases and 56 deaths. ENTERIC FEVER. There was 1 case of this disease admitted during the year. This patient died. PUERPERAL INFECTIONS The 32 Puerperal cases admitted to Hospital were diagnosed as follows:— Puerperal Pyrexia 18 Septicaemia 1 Perineal Sepsis 1 Breast Abscess 10 Miscarriage 1 Mastitis (bilateral) 1 SCARLET FEVER. 248 cases were admitted during the year, including 2 Service Sick, compared with 188 in 1945, 312 in 1944, and 453 in 1943. OTHER DISEASES. 1946. Measles 92 Catarrhal Laryngitis 4 Whooping Cough 43 Laryngitis and Bronchitis 1 Pneumonia 1 Meningitis 1 Broncho-Pneumonia 7 Benign Lymphocytic Meningitis 1 Bronchitis.. 12 Tubercular Meningitis 1 Tonsillitis 47 Encephalitis 3 Vincent's Angina 6 Oto-hydrocephalitis 1 Glandular Fever 2 Poliomyelitis 1 Rubella 4 Herpes Zoster 3 Chicken-Pox 35 Tubercular Peritonitis 1 Urticaria 5 Pelvic Peritonitis 1 Papular Rash, Non-infectious 1 Otitis Media 4 Drug Rash 1 Mastoiditis 1 Scabies 1 Otorrhoea 3 Impetigo 10 Mumps 10 Erythema Multiform 1 Bilateral Frontal Sinusitis 1 Septic Spots 1 Pharyngitis 1 15 Other Diseases—continued. Dermatitis 1 Rhinitis 2 Gastro-Enteritis 14 Cystitis 1 Enteritis 22 Nephritis 1 Dysentery 6 Sub-Mental Abscess 1 Sonne Dysentery 9 Septicaemia 1 Colitis 1 Peritonsillar Abscess 1 Diarrhoea 1 Appendix Abscess 1 Cyclical Vomiting 1 Carbuncle in Nose 1 Ulcerative Stomatitis 1 Thrombosis of Leg 1 Acidosis 1 Congestive Heart Failure 1 Malaria 1 Teething 1 Erysipelas.. 20 Prolapsed Rectum 1 Infective Hepatitis 2 Mai-Feeding 1 Icterus Gravis Neonatorum 1 Common Cold 2 Haemophilia 1 N.A.D 8 Influenza 3 14 deaths occurred, 1 from Acute Infective Hepatitis, 6 from Gastro-Enteritis, 1 from Whooping Cough and Convulsions, 1 from Tubercular Meningitis, 2 from Whooping Cough and Broncho-Pneumonia, 2 from Encephalitis and 1 from Congestive Heart Failure. MARASMUS CASES. 30 Marasmus infants were admitted during the year, and the total number under treatment was 31. The former may be classified as follows : 8 Marasmus, 2 Feeding Difficulties, 11 Gastro-Enteritis, 1 Stomatitis and Marasmus, 6 Enteritis, 1 Congenital Pyloric Stenosis, 1 Intestinal Colic. 1 death occurred. EAR, NOSE AND THROAT CASES. Under the Emergency Medical Service Scheme, children are admitted 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 738 Mastoidectomy 5 Miscellaneous 7 (b) Hospital Cases— Removal of Tonsils and/or Adenoids 16 Mastoidectomy6 Miscellaneous 3 2. Harrow General Hospital: Removal of Tonsils and/or Adenoids 261 SERVICE SICK Service Sick include men or women belonging to any of His Majesty's or Allied Forces, the Merchant Navy, Police and Prisoners of War. 18 patients coming under this category were admitted during the year, the large majority of which were suffering from infectious diseases as follows:— Urticaria 1 Enteritis 1 Chicken Pox 1 Measles 1 Malaria 1 Scarlet Fever 2 Diphtheria 6 Pulmonary Tuberculosis 1 Mumps 1 Rubella 1 P.U.O. ? Food Poisoning 1 Aortic Incompetence 1 CIVILIAN SICK. Civilian Sick patients are cases which have been transferred from another Sector Hospital on the authority of the Group Medical Officer. 2 such cases were admitted during the year: 1 Cancer of Colon, which died, and 1 Chronic Rheumatoid Arthritis. 8 deaths occurred. 16 TREATMENT CENTRE. During March, 1944, a Treatment Centre for Scabies and verminous conditions was opened at the Hospital. During 1946 the following cases were treated:— Scabies cases and contacts1,887 Verminous conditions337 Other conditions6 Total attendances 7,781 CASES ADMITTED FROM OTHER AUTHORITIES. During the year 1946, 75 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, 19 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, none in 1945, and 1 in 1946. (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 per cent. (3) No. of cases of Diphtheria occurring amongst Probationer Nurses from 1927 to 194619 (4) Incidence rate per annum (taking 30 as average No. of Probationer Nurses) 3.2 per cent. (5) No. of Nurses Schick Tested (1927-1946 inclusive)546 (6) No. of Nurses giving a positive reaction 220 (7) Percentage of Nurses giving a positive reaction 40.3 per cent. Table No. 21. Diseases. No. in Hospital on 31-12-45 Admitted. Total under Treatment. Discharged Recovered, or Transferred. Died. Mortality per cent. Remaining in Hospital on 31-12-46 Cerebro-spinal Fever - 5 5 4 1 20 - Diphtheria 18 58 76 71 — — 5 Enteric Fever - 1 1 - 1 100 Erysipelas 1 20 21 20 — — 1 Measles — 91 91 89 — 2 Puerperal Infections — 32 32 31 — — 1 Scarlet Fever 13 246 259 246 — — 13 Whooping Cough 7 43 50 45 4 8.0 1 Other Diseases 24 262 286 265 10 3.5 11 Marasmus 1 30 31 30 1 3.3 — Tonsil and Adenoid Cases (Willesden) 4 754 758 758 — — — Tonsil and Adenoid Cases (Harrow) 5 261 266 266 - - — Civilian Sick 23 2 25 3 8 14 Service Sick 2 18 20 20 - — — Totals 98 1,823 1,921 1,848 25 — 48 17 PUBLIC HEALTH LABORATORY. Table No. 22. Specimens Examined for 1946. Jan. Feb. Mar. Apr. May June July Aug. Sep. Oct. Nov. Dec. Total Nose and Throat Swabs 168 123 260 341 294 193 277 290 155 256 345 298 3,000 Sputum for T.B. 51 60 66 3 2 - 3 5 5 15 15 3 228 Blood. Widal 2 - - - 1 - - - 2 - - 2 7 Blood. Cultures - - - - - - - 3 1 2 - 6 12 Blood. Counts 33 20 ,4 14 9 - 11 35 48 47 56 25 312 Blood. Chemical 4 3 6 - 1 2 3 - - - 19 Blood. Urea 1 7 6 - - 2 5 1 3 4 29 Blood. W.R. and Kahn 1 1 1 - - - - 3 2 2 2 12 Urine, Chem., micro, and cult 7 7 13 4 5 1 3 7 20 12 17 9 105 Faeces, micro, and cult. 18 10 23 9 10 14 15 24 16 10 12 15 176 Cerebro-spinal Fluid 1 1 2 - - 2 1 2 7 6 2 4 28 Cough Plates - - - - - - - 1 - 5 - 6 12 Virulence Tests - 2 1 - - - - - 1 - - - 4 Miscellaneous 8 6 6 11 14 14 18 13 15 9 19 24 157 Total 292 231 396 395 335 224 329 384 281 365 471 398 4,101 Table No. 23. Positive Results. Swabs for C. Diphtheriae 50 C.S.F. for Meningococci 1 Sputum for B. Tuberculosis 18 Blood Culture for Typhoid 1 Faeces for B. Dysenteriae 4 Faeces for Salmonella 4 THE SIXTEENTH ANNUAL REPORT on the WILLESDEN MATERNITY HOSPITAL for the Year 1946. By ARNOLD WALKER, M.A., M.B., B.Ch., F.R.C.S., F.R.C.O.G. The year 1946 is noteworthy for the fact that more patients were dealt with than in any previous year. This has been done by discharging normal cases about the tenth instead of the fourteenth day, in accordance with the advice of the Minister of Health as an emergency measure, to cope with the marked rise in the birth rate. This measure was only adopted in June, and if it continues to be in force throughout 1947, a considerable increase in the number of cases dealt with will be recorded for 1947. Although the number of patients in the hospital at any one time remains about the same, the strain upon the midwives is much greater ; deliveries each month have gone up from about 90 to about 120, and almost all the patients in the lying-in wards are in bed. The concentration of newly delivered women increases the risk of infection and calls for most careful supervision. Although there has been a chronic shortage of staff midwives, and although the work has been disturbed by the presence of decorators for nearly eight months of the year, the puerperal pyrexia rate is the lowest recorded since the hospital opened. The credit for this belongs to the matron and the sisters. The stillbirth rate and neonatal death-rate are also the lowest recorded in these reports, but the maternal mortality rate has gone up. Three booked cases died, one from post-partum haemorrhage, one from pulmonary embolism and one from heart failure in a woman with advanced heart disease. Two emergency cases died, in neither of which was the cause of death clearly established. One was considered to be due to embolism and the other to paralytic ileus following a Caesarean Section. 18 Table No. 24. Statistical Details of the 1,189 Cases dealt with during 1946. Cases completed 1,189 Toxaemia of Pregnancy admitted for (a) Booked at the Health Centres 1,173 treatment 28 Discharged well 1,168 Organic Heart Disease admitted for Delivered elsewhere 2 treatment 4 Died 3 Puerperal Pyrexia 23 (b) Admitted as Emergencies 16 Uterine Infection 2 Discharged well 14 Urinary Infection 3 Died 2 Breast Infection 8 Of the 1,173 booked cases, 539 were Thrombo-phlebitis 1 primiparae and 634 were multiparae. Pulmonary Infection 3 1 Of the 16 emergency cases, 8 were Enteritis primiparae and 8 were multiparae. No cause found 5 Presentations : Operations performed: Occipito Anterior 844 Forceps delivery 36 Occipito Posterior 236 The forceps rate was therefore 3.1 percent. Normal Breech 48 Caesarean Section 11 Abnormal Breech 3 Previous Caesarean Section 3 Twins 17 Placenta Praevia 4 Triplets 1 Inertia 2 Face 4 Fimbrial Cyst T Shoulder 3 Flat Pelvis 1 Miscarriages 18 Hysterotomy 1 Hydatidiform Mole 1 Hysterectomy 1 Ante-partum Haemorrhage : Induction of Premature Labour 4 Placenta Praevia 5 Toxaemia 3 Accidental Haemorrhage 7 Rhesus Factor 1 15 cases were admitted before labour on account of haemorrhage, in 12 of which there was no further loss of blood. Manual Removal of Placenta 3 Transfusion.. 16 Blood only 4 Blood and Plasma 6 Prolapse of Cord 3 Plasma only 6 1,184 viable children were born to 1165 mothers. Of these, 32 were stillborn and 14 died. THE SEVENTEENTH ANNUAL REPORT on the SUPERVISION OF MIDWIVES for the Year 1946. 50 Midwives gave notice of their intention to practise in Willesden in 1946, 27 of these being in the Central Middlesex County Hospital. Midwives practising and living in Willesden attended 2,869 cases either in hospital or on the district as midwives or maternity nurses, as against 2,570 in 1945. In addition, 16 midwifery or maternity cases were attended in Willesden by midwives living outside Willesden. The 12 Municipal District Midwives attended 745 midwifery cases in 1946 and, in addition, answered 20 emergency calls and carried out ante-natal care of 64 cases which were subsequently confined elsewhere. Midwives attached to Queen Charlotte's Hospital District Home, Kilburn, attended 212 midwifery cases. 129 of these were Willesden residents attended on behalf of the Willesden Council with, in addition, 25 cases attended for ante-natal care only. 83 were cases attended outside Willesden. Midwives attached to the Willesden District Nursing Association attended 205 maternity cases on behalf of the Council. During the year 361 notifications were received from Midwives practising in Willesden in accordance with the rules of the Central Midwives' Board and of these, 313 notifications were in respect of medical aid, 254 in respect of the mother and 59 in respect of the child. The ninth 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 2 full-time relief midwives. 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 Nursing Association deals with the Maternity Nursing throughout Willesden. 19 The Watling and Willesden Training School for Second-period Pupil Midwives.-During the year 37 pupil midwives worked on the district. Of the 745 confinements dealt with by the Municipal Midwives, the pupil midwives attended 553 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 69 Maternity and Child Welfare Clinics for mothers and babies 75 The Lecture Courses. A Discussion Class, each week, taken by the Supervisor of Midwives at the Health Department. Of the 37 pupil midwives, 21 sat for their final midwifery examination, 19 passed, 2 failed, but passed at a subsequent examination. TWENTY-NINTH ANNUAL REPORT for the YEAR 1946 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 curtailment of the service which occurred at the Stonebridge Health Centre during the war ended in January, when the second dental surgery was refitted with its original equipment and a temporary whole-time officer appointed. The Borough's dental staff has now returned to its pre-war complement of four dental officers assisted by four nurses and a part-time anaesthetist. This small staff has to endeavour to cope with the dental needs of the present school population of approximately 19,800, in addition to the inspection and treatment of some 1,400 maternity and child welfare cases. The full requirements of the Borough for a complete school and maternity dental service cannot be satisfied without further clinic accommodation, with an operating staff of eleven dental officers. THE YEAR'S WORK. The total working sessions amounted to 2,050, which were utilised as follows: Treatment sessions at the Centres 1,854 Routine inspection sessions 181 Total number of administrative sessions 15 2,050 Sessions attended by the anaesthetist totalled 184, when 3,584 general anaesthetics were administered, making an average of 19.5 cases per session. 20 16,033 mothers, infants and school children were inspected. 11,572, or 72 per cent., were defective. 6,822, or nearly 59 per cent. of those defective, were treated at the Centres. 9,127 teeth were extracted, 10,274 fillings done and 5,087 incidental operations, producing a total of 24,18iS treatments for the year. 20,547 attendances were registered by these patients. SCHOOL DENTAL SERVICE. Inspections. Routine.-11,751 children out of a total of approximately 19,800 were inspected at the schools during 181 visits, an average of 65 per session. It was not found possible to complete the round of schools and some 8,(XX) children missed the annual routine inspection. 8,234 children, or 70 per cent., were found defective and referred for treatment. A record of all defects found was charted and " Care of the Teeth " pamphlets issued to scholars. Specials.-2,177 children were inspected at the Centres. Included in this figure are the cases of minor defect which has developed between the routine inspections together with leavers seeking a final examination. Every effort was made for these children to complete treatment and leave school with a healthy and sound dentition. Treatment. Out of a total of 9,662 routine and special cases referred as defective, 5,419, or 56 per cent., were treated at the Centres. 7,053 teeth were extracted, of which 959 were permanent, and of these permanent extractions 191 were removed for the purpose of relieving overcrowding and 768 on account of extensive caries. 6,267 fillings were done on permanent teeth and 1,818 on temporary teeth, making a total of 8,085. The ratio of fillings done on permanent teeth to diseased permanent teeth extracted was 8 to 1. 3,066 sundry treatments performed include 8 acrylic crowns, root fillings to anterior teeth, minor gum treatments, dressings of zinc oxides and sedatives, together with silver nitrate applications. 14,292 attendances were registered during 1,229 treatment sessions to perform this work. The total sessions allocated to the School Dental Service amounted to 1,410, and the average work done per session is as follows: Attendances 10 Fillings 5.7 Extractions 5 Sundry operations 2 Total operations 12.7 Table No. 25. Allocation of School Children to the Health Centres. Dental Officers No. of Schools App. No. per School Dental Officer Kilburn Health Centre 1 13 6,783 Willesden Health Centre 1 12 5,738 Stonebridge Health Centre 2 13 3,615 Orthodontics. All children requiring regulation appliances continue to be referred to Dental Hospitals and other Institutions. The facilities offered at these institutions improved during the year so that most of the Willesden children needing such treatment have been able to secure it. Incidence of Caries. The number of children found in routine inspection with carious teeth was 70 per cent., compared with 76 per cent, in 1938, that is, before the commencement of the present period of austerity. 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: School Children Special School Children Total (a) Routine age-groups- Aged: 5 443 - 443 6 1,117 3 1,120 7 1,086 5 1,091 8 1,423 7 1,430 9 1,030 16 1,046 10 1,115 17 1,132 11 1,350 15 1,365 12 1,105 19 1,124 13 1,212 14 1,226 14 1,146 11 1,157 15 350 9 359 16 226 1 227 17 22 - 22 18 9 - 9 Total 11,634 117 11,751 (b) Specials 2,167 10 2,177 (c) Total (routine and specials) 13,801 127 13,928 2. Number found to require treatment 9,569 93 9,662 3. Number actually treated 5,372 47 5,419 4. Attendances made by children for treatment 14,210 82 14,292 5. Half-days devoted to Inspection 179 2 181 Treatment 1,217 12 1,229 Total 1,396 14 1,410 6. Fillings-Permanent teeth 6,211 56 6,267 Temporary teeth 1,814 4 1,818 Total 8,025 60 8,085 7. Extractions-Permanent teeth 938 21 959 Temporary teeth 6,067 27 6,094 Total 7,005 48 7,053 8. Administration of general anaesthetics for extractions 2,867 19 2,886 Local anaesthetics 75 - 75 Total 2,942 19 2,961 9. Other operations-Permanent teeth 2,802 19 2,821 Temporary teeth 245 - 245 T otal 3,047 19 3,066 RETURN SHOWING THE NUMBER OF DENTAL DEFECTS REFERRED FOR FOLLOWING-UP, AND THE EXTENT TO WHICH REMEDIAL MEASURES WERE CARRIED OUT DURING 1946 AT HEALTH VISITOR'S LAST VISIT. Total number of defects coming under observation during 1946:- School Children Special Schools Children Total Brought forward 285 5 290 New during year 6,598 59 6,657 Total 6,883 64 6,947 Number of defects treated: Health Centre 5,372 47 5,419 Otherwise 541 10 551 Total 5,913 57 5,970 No report available 12 - 12 Number of defects for which no treatment has been undertaken a Health Visitor's final visit 276 3 279 Carried forward 590 2 592 Number not needing treatment 92 2 94 22 EXPECTANT AND NURSING MOTHERS AND CHILDREN UNDER FIVE. It is estimated that 625 sessions were utilised for the inspection and treatment of expectant and nursing mothers, and children under five years. Thus, rather more than one dental officer's time was taken up with this branch of the service. E.M. N.M. 0-5 Total Number inspected 1,305 200 600 2,105 Number brought forward from previous year 94 11 4 109 Total number under observation during year 1,399 211 604 2,214 Number completed.. 593 120 358 1,071 Number partially completed 253 19 60 332 Number not availing themselves of treatment 256 32 61 349 Number treated by other agencies 56 5 6 67 Number carried forward 133 31 36 200 Number with no defect 108 4 83 195 Number of attendances 4,068 756 1,431 6,255 Number of teeth removed 1,111 352 611 2,074 Number of teeth filled .. .. .. .. 1,558 210 421 2,189 Number of other operations on the gums and teeth 1,356 332 333 2,021 Number of general anaesthetics 358 92 248 698 Number of local anaesthetics 50 10 6 66 Number of treatment sessions - •- - 625 Number of patients who received dentures during the year: At cost to Council At cost to Applicant At part cost to Applicant Total Dentures 22 24 44 90 Repairs 1 - -- 1 Total 23 24 44 91 RECOMMENDATIONS. It is apparent from the foregoing remarks that the service as it stands is capable only of meeting about half the obligations required by the Education Act, 1944, and that extensions are urgently needed if all school children, mothers and infants are to receive adequate dental care. Of the four Dental Officers now engaged the equivalent of rather more than one is taken up with maternity and child welfare, leaving rather less than three Dental Officers to care for the school population of approximately 20,000, a figure which will increase with the raising of the school-leaving age. To overcome these deficiencies, it is recommended that during the interim period until new permanent allpurpose clinics have been constructed temporary premises be obtained to house four additional Dental Officers, one Orthodontic Specialist for the School Medical Service, and two officers for the Maternity and Child Welfare Service, making a total staff of eleven Dental Surgeons. It is also desirable that the existing arrangement for the supply of dentures should be modified to enable Dental Officers to undertake the chair-side work of denture construction, and that until the Authority has its own staffed laboratories, a contract should be made with a firm of technicians to carry out the laboratory work. REPORT ON WAR-TIME NURSERIES, 1946-1947 Number of Nurseries open on 1st April, 1946, 12. Number of Places open, 590. Attendances for year, 110,070. Staff Employed.-Matrons 12 Deputy Matrons 12 Nursery Nurses 23 Wardens 12 Nursery Assistants 46 Students 28 Cooks 12 Domestics (mostly part-time) 40 23 A new Supervisory Warden was appointed in November to fill the vacancy left by Miss Tyrrell. The toy-making class at Mortimer Road has continued under the direction of Miss Ross. Bunk-wood has been supplied for this purpose, through the co-operation of the Borough Engineer. During the year a grant of £200 for toys was made. This sum was used to provide a climbing frame for each nursery. These climbing frames are a source of endless pleasure to the children. Medical Supervision.-The children have been regularly inspected by the various Medical Officers, and have attended the Health Centres for dental and other treatment. Diphtheria immunisation has been carried out at each nursery. The mothers greatly appreciate this service. Clothing.-Overalls and knickers only have been provided this year as only three coupons per child may now be expended on such articles. Mrs. Baldwin continues her voluntary work of mending and making towels and napkins. Buildings, Repairs, Redecoration.-Constant minor damage has been caused to fences and windows by local children. Damage through burglaries has been considerable. Chain-link fences are to be erected, when supplies are available, to afford better protection to the Nurseries. Staffing.-All Nurseries have remained adequately staffed during the year. The quality of the Junior Staff is improving. Training of Students.-The National Nursery Examination Board has taken over the responsibility of the Students' Examination. Under the new scheme students from 15½ years attend Hendon Polytechnic from 9 a.m. to 5 p.m. on two days each week for general and vocational tuition. There is no practical examination, all results depend upon a written paper and an oral examination. The consequence of this change is that the elementary schoolgirl of average intelligence, who could usually pass the Nursery Nurses' Diploma, finds the new too examination difficult. Many a good practical nurse is lost in this way. Four candidates entered for the National Nursery Certificate, three passed, one failed. The Future of War-Time Nurseries.-A Joint Circular, issued by the Ministry of Health (221/45) and Ministry of Education (75), upon the Nursery provision for children under five years, was considered by the Council and resulted in the decision that as the present arrangements under the Ministry of Health cease on 31st March, 1946, War-time Nurseries continue on their present lines, admitting children 0 to 5 years, as and until Nursery Schools or classes for 2 to 5 year olds are provided by the Education Authority. SPEECH THERAPY, 1946. Speech Therapy continued in the Borough in the form of Group Work. Two Centres were started and the children attended once or twice a week. There is still a growing list of cases requiring treatment and by the end of 1946 there were approximately 100 children who had been examined and found to be requiring treatment, and a further fifty requiring re-examination. REPORT ON THE ESTABLISHMENTS FOR MASSAGE AND SPECIAL TREATMENT. The Council decided that as from the 1st May, 1946, the provisions of Part XII of The Middlesex County Council Act, 1944 (dealing with the Control of Establishments for Massage and Special Treatment), shall come into force in the Borough. By-laws were subsequently approved by the Minister of Health and adopted by the Council. Up to the 31st December, 1946, twelve persons had been granted a licence and one person had received exemption under Section 363 of the Act.