LIBRARY AC 439 (1) WILLESDEN ' WIL 43 Borough of willesden 1947 THE 72nd ANNUAL HEALTH REPORT S. LEFF, M.D., D.P.H., Medical Officer of Health London : WIGHTMAN & CO. LTD., 179, Tottenham Court Road, W.l BOROUGH OF WILLESDEN Health Department, 54, Winchester Avenue, Kilburn, London, N.W.C. October, 1948. To the Corporation of Willesden. 1 beg to submit herewith the Annual Health Report for Willesden for the year 1947. VITAL STATISTICS. 3,753 live births were registered. 02 still births were registered. 1,846 deaths were registered. 118 children under 1 year of age died. The infantile mortality rate for the year was 31. CANCER. There were 311 deaths of Willesden residents from Cancer in 1947, as compared with 319 in 1946. The two Municipal Cancer Clinics were continued throughout the year. No new patients attended in 1947. At the end of 1947, 1 patients remained under observation. INFECTIOUS DISEASES. During the year 1947, 3,196 cases of infectious diseases were notified, as compared with 2,644 in the previous year. The following table gives the number of notifications of certain diseases included in the above total of 3,196, together with the corresponding figures for 1946 :— Table No. 1. Number of Cases Notified. No. of Notified Cases Confirmed. 1946 1947 1947 Diphtheria 101 63 12 Scarlet Fever 334 284 261 Pneumonia 458 263 248 Whooping Cough 384 589 571 Erysipelas 42 55 52 Measles 817 1,451 1,434 Diphtheria Immunisation.—The number of children who have completed a full course of immunisation since 1942 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. 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 1947 1,808 156 1,964 The approximate mid-year population, 1947, as supplied by the Ministry of Health, based on ration books, was 15,100 under 5 years of age and 20,830 between 5 and 15 years of age. It was estimated that 60 per cent, of those under 5 years and 74.5 per cent. of those between 5 and 15 years had been immunised at 31st December, 1947. 3 The Council first made arrangements for immunising Wiilesden 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, 1912, 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 by the personal contact of the Health Visitor with the mother in the clinics and in the home. When the Health Visitors visit children aged 9 months or over under the Maternity and Child Welfare Scheme they draw attention of mothers to the facilities existing for immunisation against diphtheria and whooping cough 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 and whooping cough 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' consent, 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 often bring their younger children to be immunised at the same time. There were 12 cases of diphtheria in Wiilesden in 1947. There were no deaths. Enteric Fever.—-1 cases were notified in 1947. Dysentery.—5 cases were notified in 1947. Malaria.—No cases were notified in 1947. Infectious Diseases of the Central Nervous System.—Poliomyelitis and Polio-encephalitis (see Special Report), Cerebro-spinal Fever and Encephalitis Lethargica.—92 cases of these diseases were notified in 1947, as against 17 in 1946, 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. 7 proved fatal, giving a fatality rate of 7 -6 per cent, of notified cases. 13 cases were notified as Cerebro-spinal Fever. Of these 13 cases 9 proved to be Cerebro-spinal Fever and 3 were found in hospital to be suffering from Poliomyelitis and 1 Cervical Adenitis. The ages of the 9 cases which proved to be Cerebro-spinal Fever were as follows :— Under 1 year of age . . 1 Between 10 and 15 years of age 0 Between 1 and 2 years of age. . 1 15 ,, 20 „ ,, 0 „2 „3 " „„ 1 „20 „35 „ „ 0 ,, 3 ,, 4 ,, ,, 1 ,, 35 ,, 4o tt ,, 0 4 „5 „ 1 „45 „65 „ 1 ,, 5 „10 „,, . . 3 65 years of age and over 0 The months in which the 9 cases occurred were as follows:— January, 1947 2 May, 1947 . . 0 September, 1917 0 February, 1947 . . 1 June, 1947 . . 1 October, 1947 1 March, 1947 . . . . 0 July, 1947 . . 0 November, 1947 1 April, 1947 . . 3 August, 1947 . . 0 December, 1947 0 2 of these 9 cases which proved to be Cerebro-spinal Fever died. These patients were aged 2 years and 63 years. In addition, 2 further deaths were recorded as Cerebro-spinal Fever. The patients were children of under 2 years of age. 79 cases of Poliomyelitis were notified. (See Special Report.) These include 6 cases of Polio-encephalitis. In addition, 2 deaths were recorded as Acute Poliomyelitis after post-mortem examination without inquest, one a child of 9 years and one adult of 29 years. There were no cases of Encephalitis Lethargica notified. Report on the Anterior Poliomyelitis Epidemic in 1947.—The epidemic in England and Wales was about four-and-a-half times greater than any previous epidemic. In Wiilesden the first case occurred on 17th June and was admitted to the Municipal Hospital on 27th June, when the onset of paralysis indicated the diagnosis. Altogether, 89 Wiilesden residents were notified as suffering from the disease, and of these 67 were admitted to the Municipal Hospital, where the diagnosis was confirmed in 28 patients, one of whom died. The average stay in the Municipal Hospital was 38i days. 16 confirmed cases were admitted to other hospitals, including one man admitted to the Central Middlesex County Hospital, with a diagnosis of botulism, who died, the post-mortem examination showing Polio-Encephalitis. One boy of 7 years died at home of Polio-Encephalitis before the arrival of a doctor, making 45 confirmed cases in all, with 3 deaths. 31 cases had paralysis ; 11 of these patients were transferred to the Royal National Orthopaedic Hospital at Stanmore on discharge from the Municipal Hospital, and 19 were discharged to their own homes and remained under the treatment and supervision of the Orthopaedic Department. One case in hospital died with paralysis. 4 3 cases were still in the Municipal Hospital and 4 in other hospitals at the end of the year. 29 notified cases, 18 of which were confirmed, were admitted to the Municipal Hospital from districts outside Willesden. The following table shows the age distribution of notifications, and of confirmed cases, among Willesden residents : Table No. 3. Age . Notifications Percentage Age Confirmed Cases Percentage 0 2 2.3 0 2 4.7 1 21 24.1 1 13 28.9 o 25 28.1 37.3 5 15 33.3 42.2 10 8 9.2 10 4 8.9 15 10 11.5 15 4 8.9 25 11 12.4 25.0 25 6 13.3 15.6 35 6 6.9 35 1 2.3 45 and over 5 5.7 45 and over 0 0 Totals 89 100 45 100 The percentages shown must be accepted with caution, as they are based on a small number of cases, but in the main they are similar to those for England and Wales. Efficient preventive measures against the disease were difficult because of the uncertainty as to the method of transmission and because the disease is often spread by healthy carriers and by mild or early cases, showing few signs of illness. The principal task of the Public Health Department was the early discovery of these cases and the supervision of contacts. General practitioners were circularised immediately the first cases occurred and were offered the facilities •of the Health Department and the Hospital for the diagnosis of suspected cases. Only 50 per cent, of the notified cases and 42 per cent. of patients sent to the Municipal Hospital proved to be suffering from the disease, which indicates that the general practitioners adequately used these facilities. The Health Visitors visited the home of each notified case to follow up contacts and give general advice on methods of prevention. All General Practitioners, Medical Officers and Health Visitors had an opportunity of seeing the Ministry of Health's film on Poliomyelitis. As there is evidence to show that children after tonsils operations are more susceptible to this disease, all ear, nose and throat operations were stopped at the commencement of the epidemic. This resulted in an increase in the waiting list of children for removal of tonsils and adenoids to about 800 at the end of the year. Swimming baths have been suggested as a possible means of spread of the infection, but the closure of Granville Road Baths on 28th July was due to the unsatisfactory state of the filters ; the Baths reopened on the 16th August, with a restriction on the numbers admitted. On 2nd August the two open-air baths, at Gladstone Park and King Edward VII Recreation Ground, were closed because the purification of the water was not entirely satisfactory, and in addition, in the case of the King Edward Baths, a confirmed case of Poliomyelitis had regularly used them. After the publicity given to the removal of pig bins from the streets of Leicester, more effective means of collection of swill from the Willesden bins were instituted by the Borough Engineer. No case of the disease occurred in the Day Nurseries, so that the question of their closure did not arise. The reopening of schools in September was not affected. To sum up, whilst Willesden had an incidence of 48.6 notified, and 24.6 confirmed cases per 100,000 living, a rate in excess of that of Greater London as a whole (20.6 notified cases per 100,000), the proportion of deaths (1.6 per 100,000 living) was not large. Willesden was fortunate in having adequate hospital facilities for the investigation and treatment of cases, an efficient team of Health Visitors in the investigation of cases and full co-operation from the local doctors with the Public Health Department. Pneumonia and Influenza.—26.3 cases of Pneumonia were notified in 1947, as compared with 458 in 1940 and 339 in 1945. Deaths from Broncho-Pneumonia, Lobar Pneumonia and Pneumonia (unspecified) numbered 103, as compared with 93 in 1946,114 in 1945 and 86 in 1944, and deaths from Influenza 11, as compared with 16 in 1946, 4 in 1945 and 9 in 1944. Whooping Cough.—589 cases were notified in 1947, but a total of 942 cases coming to their knowledge were visited by Health Visitors, 573 of which occurred in children under 5 years of age. There were 6 deaths from Whooping Cough in 1947. 4 of the children who died were under 1 year of age, 1 was between 1 and 5 years of age, and 1 was between 5 and 10 years of age. 5 The number of confirmed cases of whooping cough in Willesden in 1947 was 571, as compared with 377 in 1946. It has been estimated that between 60 and 70 per cent, of all children are affected by whooping cough, and over 1,000 children per year die of this complaint in England and Wales. Two-thirds of the children who suffer from this disease are under 5 years of age. In order to assist in combating the disease, the following measures were taken in 1947:— (1) With the permission of the Ministry of Health, combined whooping cough vaccination and diphtheria immunisation was commenced in Willesden, in November, 1947. Children who had previously been immunised against diphtheria were offered inoculation with whooping cough vaccine. In the last four weeks of the year 1947, 47 children received their first injection against diphtheria, and 57 their first injection of the combined diphtheria and whooping cough vaccine, making a total of 104 in all, 55 per cent. of whom received the combined immunisation. Since then, the number of children having combined immunisation has been over 90 per cent. (2) The early diagnosis of the disease has been facilitated by the examination of post-nasal pharyngeal swabs before the whoop develops. Arrangements were made with the local Public Health Laboratory for the special examination of post-nasal pharyngeal swabs of children with catarrhal symptoms. The local general medical practitioners were circularised to this effect and a meeting was arranged where they were addressed on this subject by a bacteriologist from the Laboratory. (3) Arrangements were made for the early admission into hospital of all children suffering from whooping cough whose home circumstances were unsatisfactory. Whooping Cough and Diphtheria Immunisation.—With the introduction of the combined whooping cough and diphtheria immunisation, the Health Visitor commences encouraging the mother, when the child is six months old, to have the child immunised at nine months, that is three months earlier than previously. The reason for this is that whooping cough usually takes the child earlier than diphtheria and protection has therefore to be given and is more effective at an early age. Immunisation sessions are held at Kilburn and Willesden Health Centres on Thursday and Friday afternoons at 2 p.m., and at Stonebridge Health Centre on Friday afternoon at 2 p.m. Sessions are also arranged at the Schools when required. Measles.—1,451 cases were notified in 1947, but a total of 1,808 cases were visited by the Health Visitors, 1,220 of which occurred in children under 5 years of age. There were 2 deaths from Measles in 1947. One of the children who died was 2 years of age, and one was 5 years of age. Tuberculosis.—The following table shows the number of cases of Tuberculosis on the register at the end of each year 1939-1947:— Table No. 4. Number of Cases of Tuberculosis on Register at end of Year. Pulmonary. Non-Pulmonary. Male. Female. Male. Female. 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 1947 660 538 92 99 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 22,510 occasions, nursing mothers 31,737, and children under 5 43,939, making a total at these clinics of 98,186 attendances in 1947. Out of the total number of 3,753 children registered as born alive in 1947, 2,480, or 66 per cent., subsequently attended the Municipal Health Centres. 6 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. 5. 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 1912 (2 Health Centres open 10J months, 3 Health Centres open 11 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 1946 (3 Health Centres open) 140,740 23,644 1947 (3 Health Centres open) 145,819* 21,305 •Includes attendances at Princess Road Infant Welfare Centre. Princess Road. Voluntary Centre.—The Council took over the Princess Road Voluntary Infant Welfare Centre in Kilburn as from 1st April, 1942. MATERNITY HOSPITAL. Bookings.—1,078 patients were booked during 1947 for confinement in the Willesden Maternity Hospital. The fees at which these 1,078 cases were booked varied from 31 at £15 to 100 free. The average fee per case was approximately £& 0s. 3d. During 1947, 363 applicants for confinement in the Willesden Maternity Hospital were unable to be booked for the reasons set out below :— Table No. 6.—Applications for Booking Refused. No beds available 219 Not resident in Willesden — Satisfactory social circumstances 114 363 Hospital Confinements.—During 1947, 1,246 women were confined in the Willesden Maternity Hospital. 510 births of Willesden residents were notified from outside Institutions—52 from St. Mary's Hospital, 86 from Queen Charlotte's Hospital, 29 from Middlesex Hospital, 25 from University College Hospital, 40 from Queen Mary's Maternity Home, and smaller numbers from other hospitals, 108 from a Nursing Home, and smaller numbers from other Nursing and Maternity Homes. These, together with some 731 in the Central Middlesex County Hospital, are approximately 65 per cent, of the births belonging to Willesden. It is to be noted that in 1947 many mothers desiring institutional confinement were unable to obtain beds. 363 applicants for the Willesden Maternity Hospital alone had to be refused. The following table shows the domiciliary and institutional confinements :— Table No. 7. 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 1,610 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 1947 911 192 2,504 3,607 7 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 bv the Council's Health Visitors in connection with women who are to be confined in these hospitals. 857 such requests were received in 1947. 624 Expectant Mothers booked for confinement in the Central Middlesex County Hospital were referred to the Willesden Health Centres for Ante-Natal care in 1947. Puerperal Pyrexia.—61 cases were notified in 1947. Maternal Mortality.—During 1947 there were 5 deaths classed to pregnancy and child-bearing--there was one case of post-abortive infection. The puerperal mortality rate was 1-30 per 1,000 registered total births. During 1947 there was one maternal death from non-puerperal causes. The total maternal mortality from all causes, including criminal abortion, was therefore 1 • 56 per 1,000 registered total births. Sterilised Accouchement Sets.—-These sets are supplied in accordance with the arrangements stated in the Annual Report for 1930, p. 10. During 1947, 195 were supplied free, 369 at full cost and 425 at part cost—a total of 989. 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 1947. 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 1947. Home Helps.—The Council provided the services of home helps in connection with 41 confinement cases in 1947. 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. 6 cases were inquired into during 1947. 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. The total number of cases admitted to the hostel from 1st January to 31st December, 1947, was 123. The average length of stay was 10-18 days. Of the 123 children (a) 58 were admitted because of the confinement of the mother ; and (b) 65 were emergency cases, e.g., where the mother had been admitted to hospital for operation or where the mother had been admitted to hospital suffering from nerve strain. Medical Care.—The health of the children is under the supervision of a Medical Officer from Stonebridge Health Centre, who visits weekly. Arrangements have also been made whereby a general practitioner is available in a case of emergency when a Medical Officer from the Health Centre is not available. Wherever possible, parents are advised to have their children inoculated against whooping cough and diphtheria before admission to the hostel. Staffing.—The staffing of the hostel has been a very big problem. Girls who would be quite happy to work in a day nursery object to having to work week-ends and nigbt duty. The appointment, in January, 1947, of two resident staff nurses relieved the situation. This service has been a real boon to the mothers in the district, and has assisted them in regaining their health. The service, however, requires extension as many children have had to be refused admission owing to shortage of accommodation. 8 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. Owing to the anterior poliomyelitis epidemic no operations for tonsils and adenoids were performed after June. 42 children were under treatment for Marasmus and 90 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. Arrangements were made with the orthopaedic surgeon and the physiotherapist for the treatment of cases of infantile paralysis at the hospital. Ophthalmia Neonatorum.—One case was notified in 1947. This gives a case rate of -27 per 1,000 registered live births. A private medical practitioner attended at the confinement. Complete recovery with unimpaired vision resulted with treatment at home. 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 Visitors. Teaching of Mothercraft at the Centres. This important part of the work of each Health Centre, which had been suspended on the outbreak of war, was recommenced on the 1st October, 1947. 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 5|lbs. or less. 173 such children were born in Willesden in 1947, 52 at home, and 121 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 by the Health Visitors. In 1947, out of a total of 1)8 deaths of children under 1 year of age who were Willesden residents, 20 were due to premature birth. In 1946, out of a total of 104, 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 1947, all were due to premature birth. 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. CHILD LIFE PROTECTION. At the end of 1947 there were 29 Foster Mothers and 43 Foster Children in Willesden. There has again been a great scarcity of Foster Mothers throughout the year. Women, even when not otherwise employed, 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. 15 persons gave notice under Section 7 (3) in 1947 in respect of 18 children. There were 4 children under supervision at the end of the year. 9 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. No new homes were registered in 1947. 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 1913 Annual Report. The Domestic Help Service has been extended to assist the aged and infirm (see below, Home Help Report). SOCIAL PROBLEMS GENERALLY. This subject was dealt with in the 1945 Annual Report. Progress has been made with the establishment of homes and hostels as indicated above. THE FIRST ANNUAL REPORT ON THE " HOME HELP SCHEME." In accordance with the Ministry of Health Circular 110 46, the Council agreed to appoint a full-time paid organiser, who came on duty on 27th January, 1947. Number of Staff.—The number of staff, as at 27th January, 1947, was one full-time member. The women were very slow at first to come forward as " Home Helps." It was a new scheme and not many were willing to do this kind of work. The Council then took steps to encourage the right type of person to be a Home Help. Advertisements were inserted in the local press, with wages at 2s. 6d. an hour for full or part-time work, travelling expenses and holidays with pay after 6 months' service. The Labour Exchanges were visited and also the Health Centres in the Borough to recruit staff. The response to the advertisement was very good and each woman was interviewed and the suitable ones were chosen. The number of applications for help has considerably increased, but fortunately the recruitment of additional staff has kept pace with the increasing demand. Table No. 8. Period Whole time Part time Equivalent to whole time Up to January, 1947 1 1 February—December, 1947 16 14 25 As at December, 1947 10 9 16 The full-time helpers usually do three cases a day. During the year ten Home Helps have resigned, the main reason being that the work was too hard. Several found the travelling from one job to another very fatiguing, especially during the inclement weather. One helper sustained an accident to her head and received workmen's compensation. As from 1st December a combined scheme has operated to include helps for maternity cases. Number and Type of Cases Dealt With.—The number of applicants and type of cases dealt with are as follows : Table No. 9. Period Number of Applications received Actuallyhelped Not helped for various reasons January—31st December, 1947 188 170 18 Period Type of Cases helped Aged Sick T.B. Blind Vlaternity Total January—31st December, 1947 69 85 7 5 4 170 Fees Paid by Applicants.—The fees paid by applicants (see Table 10 on page 10) indicate that all classes of the community are receiving this useful assistance from the Public Health Service. 10 Table No. 10.—Assessment of the 170 Cases. No. of Cases Assessment s. d. 62 2 6 5 2 0 1 1 9 1 1 8 15 1 6 20 1 0 24 0 6 42 Nil One case assessed free makes a voluntary payment During the year 814 home visits have been made in a supervisory capacity by the Domestic Organiser to the homes of the applicants. An initial visit is made following the application for help to assess the amount and type of help required, and to make sure that the application comes within the scheme. Subsequent visits are made, from time to time, to ascertain that Home Helps are carrying out their duties in a satisfactory manner, and that the selected help fits in with the household. In this way the smooth running of the scheme is maintained and helpers are used to the best advantage. Clerical Assistance.—A part-time Clerk was appointed to assist with the clerical work as from 3rd November, 1947. General Comments.—Although there have been many applications for the position of Domestic Help, it has been very difficult to select the right type of person. The person must not only be a good domestic help, but must also have the qualities of patience, cheerfulness and a kind spirit to assist the people with whom she comes into contact, i.e., the mother, the sick and the aged. The greatest difficulty has been the aged, many of whom live completely isolated from the world in most appalling conditions of dirt and squalor. It needs the character of a heroine to work under those conditions, and I am pleased to report that many of our Home Helps have taken on these arduous tasks without a murmur of protest. It has been shown by many letters of thanks, from those who have been assisted, that the service is deeplv appreciated by members of the public. The Home Help Service will be extended under the provisions of the National Health Service Act, 1946. Willesden residents have been fortunate in having a sufficient number of good Home Helps to deal with their expanding needs. This is largely due to the fact that the terms of service with the Willesden Corporation have been at least as good as those of outside agencies or of private work. THE SCHOOL MEDICAL SERVICE. During 1947, 4,223 children were medically inspected at routine inspections and 22.926 at special inspections and reinspections. Scabies.—See report on Uncleanliness and Scabies on pages 12-14. Uncleanliness.—During 1947 cleanliness inspections were carried out in the schools on 213 occasions. The total number of examinations and re-examinations made during the year was 19,621. See report on Uncleanliness and Scabies on pages 12-14. Medical Treatment in Willesden.—During the year 1947 school children were followed up by the Health Department on account of 11,342 medical defects and 5,974 dental defects. Of those defects found to require treatment, medical or dental treatment was obtained for 14,475 and domestic treatment was obtained for 1,080. 88 per cent. of the medical defects were treated, 78 per cent. receiving medical treatment and 9.5 per cent. domestic treatment; 94 per cent. of the dental defects followed up were treated. No record is available of defects requiring treatment which were not followed up. 85 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 15 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 53,218 attendances at the Health Centres. 11 HEALTH CENTRES. ATTENDANCES. Table No. 11. Medical and Dental Treatment—Attendances at Municipal Health Centres, 1947. Condition. Mothers and Children under Five. Total (Cols. 2-5). School Children. Grand Total (Cols. 7 and 8). Expectant Mothers. Nursing Mothers. Children under Five. 0—1. 1—5. Total (Cols. 4 and 5). (1) (2) (3) (4) (5) (6) (7) (8) (9) 1. Cleansing — — — — — — — 2. Throat, Nose and Ear Diseases o — 23 324 347 349 3,240 3,589 3. Minor Ailments 14 94 847 2,370 3,217 3,325 23,040 26,365 4. Eye Diseases 5 13 207 533 740 758 2,932 3,690 5. Skin Diseases 5 14 204 117 321 340 547 887 6. Artificial Sunlight Treatment — — — — — — — — 7. Orthopaedics.. 1 - 52 478 867 1,345 1,398 2,133 3,53) 8. Medical Consultations 21,305 34 36,091 10,681 46,772 102,087 18 102,705 9. Diphtheria Immunisations — 3 521 3,265 3,786 3,789 442 4,231 10. Total (1—9) 21,332 34,786 38,371 18,157 56,528 112,646 32,352 144,998 11. Dental Consultations 2,718 911 — 1,591 1,591 5,220 13,698 18,918 12. Total (10—11) 24,050 35,697 38,371 19,748 58,119 117,866 46,050 163,916 13. School for Mothers.. 239 — — — — 239 — 239 14. Nursery — — — — — — — — 15. Miscellaneous — — — — — 27,714 7,168 34,882 16. Grand Total (12—15) 24,289 35,697 38,371 19,748 58,119 145,819 53,218 199,037 Kilburn Health Centre. Willesden Health Centre. Stonebridge Health Centre. Mothers and Children under Five. School Children. Total. Mothers and Children under School Children. Total. Mothers and Children under Five. School Children. Total. Grand Total. (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) 17. Mcdical Attendances 29,803 8,477 38,280 36,381 9,798 46,179 42,527 14,077 56,604 f 144,998 18. Dental Attendances 1,018 3,106 4,124 1,598 3,628 5,226 2,604 6,964 9,568 18,918 19. School for Mothers — — — — — — 239 — 239 239 20. Nursery Attendances — — — — — — — — — — 21. Miscellaneous 12,788 1,876 14,664 6,138 1,952 8,090 8,788 3,340 12,128 34,882 22. Total 43,609 13,459 57,068 44,117 15,378 59,495 54,158 24,381 78,539 *199,037 * In addition the following attendances were made by adults—Cleansing and Treatment of Scabies—0, Skin Diseases—o. Varicose Ulcers—323 and Orthopaedics under Section 181 of the Public Health Act, 193C—57, making a total of 380, which together with the 199,037 above makes a grand total of 199,417. t Includes Princess Road—3,935 as from 1.4.47. 12 Table No. 12. Showing Attendances at the Municipal Health Centres each yeah since 1913. Year. Mothers and Children under 5 years. School Children. Total. School for Mothers, Talks to Mothers. Nursery. Miscellaneous. Grand Total. Medical. 1 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 389 389 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 I) 18,089 1918 32,169 1,165 33,334 15,811 2,403 18,211 51,548 14 220 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 1,074 3,812 81,759 1926 39,084 1,491 40,575 47,786 5,909 53,695 94,270 1,126 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 46,00.) 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 1,257 4,092 42,169 247,247 1938 114,769 5,265 120,034 67,811 11,541 79,352 199,386 1,877 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 81,321 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 1947 112,646 5,220 117,866 32,352 13,698 46,050 163,916 t239 - *35,262 199,417 * This includes the 380 attendances made by adults and others under Section 181 of the Public Health Act, 1936, which are shown in the footnote of Table No. 11. In addition 4,418 attendances were made at the Scabies and Lice Treatment Clinic. In 1947 no children were treated under the Council's Scheme by X-rays for Ringworm of the Scalp. 11 children under 5 years of age were treated under the Council's Scheme for the removal of Naevi. Table No. 13. Number of Individual Expectant and Nursing Mothers and Children who Attended the Municipal Health Centres in 1947. Public Elementary School Children 10,497 Children under 5 years of age 6,976 Expectant Mothers 4,376 Nursing Mothers .. 4,178 PRINCESS ROAD CENTRE. 2,247 attendances were made by Children under 1 year of age at the Medical Consultation Sessions in 1947, 371 by Children 1-5 years of age and 2,209 by Nursing Mothers, or a total of 4,827. 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. 13 Table No. 14. Treatment of Scabies and Lice at the Treatment Clinic, 1947. 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 176 16 192 675f 16 691 Children 5-14 years 333 182 515 1,417* 214 1,631 Adults M. 232 M. 10 M. 242 2,026$ 70 2,096 W. 370 W. 50 W. 420/ Totals 1,111 258 1,369 4,118 300 4,418 f 20 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. * 45 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. | 76 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. 15. Percentage of Children examined found Unclean at Routine Cleanliness Inspections. 1939 5.0 1942 5.1 1945 6.5 1940 5.5 1943 6.1 1946 5.8 1941 5.2 1944 6.8 1947 4.5 Table No. 16. Percentage of Individual Children examined found Unclean at Routine Cleanliness Inspections. 1939 3.8 1942 4.2 1945 5.4 1940 4.2 1943 4.8 1946 5.0 1941 4.2 1944 52 1947 5.2 Table No. 1/. Total Number of Individual School Children Cleansed at the Authority's Clinics. 1939 321 1942 189 1945 249 1940 476* 1943 348 1946 199 1941 219 1944 246 1947 182 * Increase largely due to cleansing immediately prior to evacuation. Table No. 18. Number of Cases of Scabies amongst School Children Treated at the Authority's Clinics. 1942 725 1944 786 1946 533 1943 1,228 1945 121 1947 333 CHILDREN UNDER 5 YEARS OF AGE. These generally come to light in connection with their elder brothers and sisters. In 1947, 176 were treated at the Centres for Scabies, making 675 attendances, and 16 were treated for Lice, making 16 attendances. The figures for 1946 were 336 treated for Scabies, making 1,362 attendances, and 47 treated for Lice, making 70 attendances, and for 1945, 481 treated for Scabies, making 1,624 attendances, and 29 treated for Lice, making 44 attendances. ADULTS. The figures in Table 19 indicate that in 1947 a lesser number of adults attended the treatment centre for either Scabies or Lice and Nits than in 1945 or 1946. 14 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. Tabi.e No. 19. 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 j 1.183 111 1,294 3,485 155 3,640 1946 350 668 15 91 1,018 106 1,124 3,454 147 3,601 1947 232 370 10 50 v 602 60 662 2,026 70 2,096 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. By far the most striking feature of the dermatological cases dealt with at the Clinics is the immense number of warts that nowadays present themselves for treatment. These were never rare, but during the last few years they have increased in number so enormously that they exceed all the other cases put together which are brought to the Dermatologist. Most commonly they occur on the hands, but almost as often on the feet, and a good many are found on other exposed parts, e.g., on the face and round the knees. The feet may be regarded as exposed parts because they are often bared when the children parade for bathing and when they change for sports of various kinds. Although not a dangerous complaint, warts are undoubtedly a great nuisance. Why they should have become so common of late years is by no means obvious. There is no doubt that they are an infectious condition, but that does not explain the reason of their great increase during the last ten years or so. Of course, community life and community activities, such as bathing, gymnastics and organised games, increase greatly the risk of infection. As yet the problem of preventing warts remains quite unsolved. It is now almost as urgent as the problem of the control of ringworm of the scalp used to be before the introduction of X-ray treatment. The only difference is that the period of treatment for warts is usually far shorter than that for ringworm of the scalp used to be, nor is the cosmetic effect of warts so important. On the other hand, warts on the plantar surface of the feet, where they are quite common, give rise to much pain and disability. Otherwise, the commonest complaints to come to the notice of the Dermatologist are birthmarks of varying degrees of severity. Some of these are treated successfully at the Clinic, and recently the " port-wine marks," which used to be extremely refractory, can often be removed by the application of Thorium X solution. This is a modern development of actinotherapy, which enables the superficial layers of the skin to be brought under the influence of rays with very slight penetrating power. But it cannot yet be said that the results of Thorium X treatment are regular. Sometimes they are brilliant, more often they are disappointing, and in any case the solution has to be employed several times, occasionally a dozen or more, to get real amelioration. Some of the deep-seated naevi or birthmarks are sent to the Radium Institute at Northwood for X-ray treatment. They usually do well. Scabies, which was such a problem during the war years, has now subsided and is only occasionally seen. It is satisfactorily dealt with at the Municipal Centre. Other common dermatoses of childhood, such as impetigo and teething rashes, are successfully treated by the Medical Officers of the Borough Clinics. Really, the only dermatological problem which now defies solution is that of the prevention of warts. 15 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. STATISTICS. Total annual attendances : 1947, 3,425 ; 1946, 3,181 ; 1945, 2,986. Analysis. Health Centre Maternity and Child Welfare School Children Total Number of Sessions Average Attendance 1 102 907 1,069 46 23.2 2 301 819 1,120 48 23.3 3 250 986 1,236 49 25.2 Refractions. Health Centre Without Mydriatic With Mydriatic Percentage Attendance Appointments Made Appointments Kept 1 338 84 75 89.3 2 329 135 120 88.9 3 332 110 104 94.5 The year 1947 has shown an appreciable increase in the total number of patients attending the Ophthalmic Clinics. As in the past, one session per week was held at each of the Health Centres, with an Optician in attendance, to take particulars of frame measurements, fit and adjust new spectacles and attend to repairs. The practice of free choice of an Optician has been maintained throughout, but the presence of an Optician on the spot undoubtedly facilitates the issue of new spectacles, and the speed with which repairs are executed. Chronic diseases such as blepharitis and recurrent corneal ulceration, although still seen, are less numerous than in the years before the war, and as a rule much less severe—an indication of a higher standard of general health and cleanliness. Another satisfactory trend is the earlier attendance of children with strabismus. The belief or hope that a child will grow out of a squint dies hard, however. Although this belief is, on occasion, justified, unfortunately the strabismus disappears only too frequently at the cost of one amblyopic eye. 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 134 cases during 1947, and in connection with such cases paid 630 visits. The 134 cases nursed during 1947 were new cases. 124 of these cases were referred by the Health Department, 9 by private doctors and 1 by a hospital. Ophthalmic cases received 9 visits. SANITARY SECTION. Staff.—During the year the staff of Sanitary Inspectors was increased, so that by December, 1947, the staff on duty consisted of the Chief Sanitary Inspector, the Deputy Chief Sanitary Inspector, and twelve District Sanitary Inspectors. Food Poisoning.—During the year six outbreaks of illness caused, or suspected of having been caused, by food poisoning were investigated. One of these outbreaks occurred at the Kilburn Polytechnic Canteen and 80 persons became ill. Another outbreak occurred in a factory canteen in Willesden, when 70 persons complained of illness following a midday meal. There has generally been an increase throughout the country in the number of cases of food poisoning. 16 At a meeting convened in London, in October, 1947, by the Central Council for Health Education, it was authoritatively stated that each year 5,000 people die directly as a result of an infection acquired from food. Many factors account for the increase both of cases and death, but the principal causes are : (a) the increased number of people open to risk by reason of the growth of communal feeding and catering. (b) a general laxity in the hygienic handling of food, due to the lack of training and interest in hygiene by staffs engaged in handling of food. (c) the shortage of equipment, i.e., facilities for personal washing ; washing machines for crockery and utensils ; insufficient hot water, soap, towels, etc. ; unsuitable premises. (d) the general shortage of foodstuffs, resulting in foodstuffs being offered for sale not as fresh and wholesome as would normally be the case ; the practice of hotels, restaurants and canteens to use up scraps of food in made-up dishes, and the consequential dangers attendant upon the preparation of made-up dishes by persons who do not appreciate the dangers of food poisoning. The problem of food poisoning is causing some anxiety, and in order that these matters shall be kept under greater control, the Sanitary Inspectors have paid more frequent visits to canteens, catering establishments and places where food is prepared and handled. Atmospheric Pollution.—The pollution of the atmosphere by smoke, grit and sulphur fumes, arising from the three power-stations in the Borough, continues to be a serious cause of complaint. In June, 1946, a deputation was received on this subject by the Ministry of Health, following which, the Council were informed by the Ministry that certain measures would be undertaken by the several Power Companies to mitigate the nuisance. These measures were, however, not carried through in most instances, and the nuisance continues with little improvement. Apart from the day-to-day breakdowns, fuel difficulties and other similar explanations vouchsafed by the Power-Station Authorities in accounting for the more serious emissions, it is submitted that the whole question of atmospheric pollution from power-stations needs to be given greater consideration from all the authorities concerned. It is evident that a considerable amount of research into the problems involved in grit, smoke and sulphur arrestation is required and it is lamentable that such research has not been undertaken with the same zest as research in efficient combustion has been carried out. It would appear that the production of electricity in greater volume and at the lowest cost has been the paramount consideration to the detriment of public health. It is yet to be realised that true economy must have as much regard for the health and comfort of the population as to the availability of cheap electric power. Apart from the power-stations, smoke nuisances from factory chimneys were not excessive. Where smoke emissions were observed, it has usually been found that the cause is due to inferior and unsuitable coal. In several instances of this kind, improvement has been effected through the collaboration of the Sanitary Inspectors, the officials of the Ministry of Fuel and Power and the firms concerned. Premises Inspected.—The number of premises inspected on complaint was 6,958, and the total inspections and re-inspections were 22,970. (The figures for 1946 were 7,473 and 21,624 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 provisions of Part I of the Act, relating to Sanitary Conveniences, are enforceable by the Borough Council. Tablf No. 20. Inspections, 1947. No. of premises inspected on complaint 6,958 No. of premises inspected in connection with infectious diseases 3 No. of periodical inspections of premises 2,217 Houses inspected from House-to-House (Housing Act). . — For certificates or reports under Rent Acts 42 Public House Urinals 224 Mews and Stables 58 Miscellaneous 949 Smoke Observations 148 Ministry of Health Circular 2845 (Inadequately Housed Families) 379 Total No. of primary inspections 10,978 Re-inspections (for all purposes) 11,992 Total No. of Inspections and Re-inspections 22,970 17 Table No 21 Disinfestation, 1947 The following table shows the detail of work done during the year in disinfesting dwelling-houses, other premises and chattels, most of which was carried out by the use of DDT Bedding materials found to be verminous have been disinfested in the steam disinfector at the Isolation Hospital No of applications to rooms in private dwelling-houses (Note : Some rooms treated more than once) 484 No of applications for beetle infestations in canteens, etc 7 (b) No of verminous rooms cleansed 241 No disinfested under Council's Scheme 261 No of primary inspections of verminous premises 151 No of re-inspections 216 (c) Disinfestation by HCN, carried out by Contractors No of removal disinfestations 38 No of premises disinfested by HCN — Disinfestation of bedding at Municipal Hospital (loads) 77 Table Showing Food Certified as Unfit for Human Consumption, 1947 Meat: Totals Totals Bacon 90¾lbs Cheese 235 lbs Cooked 88 „ Butter and Fats '0 „ Tinned 3,463 tins kggs 2,187 Raw 4,956 lbs Tinned Milk 6,760 tins Fish : Soups 351 „ Tinned 1,847 tins Miscellaneous Raw 9,639 lbs Tea 13 lbs Vegetables : Sweets 98 „ Tinned 3,895 tins Sugar 506 ,, Raw 5,250 lbs Rabbits 20 Fruit: Biscuits 48 lbs Tinned 909 tins Treacle Puddings 21 „ Raw 197 lbs Chicken 75 „ Bread, Flour and Cereals, etc 1,042 „ Cocoa 314 „ Preserves 1,680 „ Tomato Pulp 8,960 „ Table No 23 Factories with Mechanical Power Primary Inspections 91 Notices 10 Prosecutions Nil Abated 8 Factories without Power Primary Inspections 44 Notices 2 Abated 2 Work Places (other than Outworkers), including Building Operations Primary Inspections 32 Notices Nil PUBLIC MORTUARY During 1947 bodies were deposited at the Mortuary as follows :— Table No 24 From Willesden From Acton Total Post-mortems 333 63 396 Post-mortems and Inquests 89 23 112 Adjourned Inquests 25 5 30 Accommodations 5 — 5 MUNICIPAL HOSPITAL The 56th Annual Report on the Municipal Hospital appears later in this Report Your obedient Servant, S LEFF, Medical Officer of Health 18 THE FIFTY-SIXTH ANNUAL REPORT on the MUNICIPAL HOSPITAL By W F TWINING McMATH, MD, MRCP, DPH, Physician-Superintendent I beg to submit herewith the Annual Report on the Municipal Hospital for the year 1947 The total number of patients admitted to the hospital during the year was 1,158, as compared with 1,823 in 1946 This reduction is largely explained by the fact that on account of the Poliomyelitis epidemic the admission of Tonsil and Adenoid cases for operation was suspended for a considerable period CEREBRO-SPINAL FEVER There were 8 cases of Cerebro-spinal Fever admitted to Hospital during the year There were no deaths DIPHTHERIA 14 cases of authenticated Diphtheria were admitted during 1947 55 patients, who were certified as suffering from this disease, were finally diagnosed as: Streptococcal Tonsillitis 25, Streptococcal Tonsillitis and Quinsy 1, Tonsillitis 12, Vincent's Angina 4, Mumps 1, Ulcerative Pharyngitis 1, Scarlet Fever 3, Peritonsillar Abscess 2, Nutritional Anaemia 1, Catarrhal Laryngitis 4, Dental Abscess 1 No deaths occurred The following table compares the admissions during the past 28 years with the present year :— Average Average Total Admissions Total No of Deaths Admissions per Annum Deaths per Annum 1919-1939 7,636 636 375 18 1940-1945 (war years) 442 74 14 2 1946 64 64 — — 1947 14 14 The peak year was 1922, with 673 cases and 56 deaths ENTERIC FEVER There were 5 cases of this disease admitted during the year There were no deaths PUERPERAL INFECTIONS The 15 Puerperal cases admitted to Hospital were diagnosed as follows :— Puerperal Pyrexia 1 Breast Abscess 7 Puerperal Sepsis 2 Puerperal Sapraemia 2 Mastitis 2 Haematoma of Vagina 1 SCARLET FEVER 200 cases were admitted during the year, compared with 248 in 1946, 188 in 1945 and 312 in 1944 POLIOMYELITIS 45 authenticated cases of this disease were admitted during the year, under this heading, and were diagnosed as : Poliomyelitis (paralytic) 29, Poliomyelitis (non-paralytic) 16 There was 1 death of a paralytic case 52 patients who were admitted, certified as suffering from this disease, were diagnosed as : Meningococcal Meningitis 2, Muscular Strain 1, Tonsillitis 11, Gastro-enteritis 2, Pyelitis 1, Tubercular Meningitis 1, Fibrositis 1, Chronic Rheumatism and Aortic Stenosis 1, Contusion of Back 1, Osteomyelitis of Femur 1, Furuncle of Left Ear and Fibrositis 1, Measles 2, Influenza 10, Upper Respiratory Infection 3, Otitis Media 1, Cervical Adenitis 1, Hysterical Paralysis 2, B coli Pyelitis (acute) 1, Anxiety State 1, Right Pulmonary Collapse 1, Rheumatic Carditis 1, Postural Defect 1, Subarachnoid Haemorrhage 1, Rheumatic Fever 2, Sub-acute Rheumatism 1, Acute Bronchitis 1 19 OTHER DISEASES, 1947 Measles 123 Nutritional Anaemia Whooping Cough Acute Leukaemia Primary Broncho-Pneumonia 1 Rheumatic Fever Broncho-Pneumonia Sub-acute Rheumatism Unresolved Pneumonia Fibrositis Right Pulmonary Collapse 1 Chronic Rheumatic Aortic Stenosis Bronchitis 6 Rheumatic Carditis Acute Streptococcal Bronchitis 1 Sub-acute Bacterial Endocarditis Upper Respiratory Infection Osteomyelitis Asthma 1 Cavernous Sinus Thrombosis Tonsillitis 64 Cellulitis Haemolytic Streptococcus Carrier 1 Furuncle Left Ear and Fibrositis Ulcerative Pharyngitis 1 Carbuncle of Nose Pharyngitis 1 Carbuncle of Forearm Vincent's Angina 5 Dental Abscess Glandular Fever Cervical Adenitis German Measles Peritonsillar Abscess Chicken Pox 27 Stomatitis Mumps Acute Nephritis Erysipelas 26 Pyelitis Influenza 16 B coli Pyelitis Otitis Media 10 Bacilluria Frontal Sinusitis 1 Postural Defect Benign Lymphocytic Chorio-meningitis 1 Vaso-vago Attack Lymphocytic Meningitis 1 Still's Disease Virus Meningitis 1 Congenital Glaucoma Tubercular Meningitis Contusion of Back Suppurative Encephalitis 1 Muscular Strain Encephalomyelitis 1 NAD Anxiety State 2 Papular Urticaria Acute Toxic Psychosis I Benzyl-Benzoate Dermatitis Hysterical Paralysis Erythema Multiform Pseudo-paralysis right arm 1 Seborrhoeic Dermatitis Subarachnoid Haemorrhage 1 Impetigo Dysentery 4 Eczema Gastro-enteritis 17 Septic Spots Non-specific Enteritis 1 Catarrhal Laryngitis Non-specific Ulcerative Colitis 1 Acute Perforated Gastric Ulcer Ophthalmia Neonatorum Sub-acute Appendicitis Infective Hepatitis 1 Chronic Appendicitis Pulmonary Tuberculosis 1 ? Appendicitis Miliary Pulmonary Tuberculosis 1 Intestinal Colic Anaemia 1 Sub-acute Intestinal Obstruction 12 deaths occurred : 1 from Erysipelas, 3 from Whooping Cough, 1 from Sub-acute Bacterial Endocarditis, 2 from Tubercular Meningitis, 1 from Chronic Rheumatic Aortic Stenosis, 1 from Cavernous Sinus Thrombosis and 1 from Acute Streptococcal Bronchitis MARASMUS 45 infants, under one year of age, were admitted under this heading These were diagnosed as : Gastroenteritis 37, Prematurity 1, Feeding Difficulties 1, Congenital Heart Disease 1, Dysentery 1, Sonne Dysentery 1, B Coli Pyelitis 1, Meningococcal Septicaemia 1, Traumatic Tenosynovitis (left hand) 1 3 deaths occurred—1 from Prematurity, 1 from Congenital Heart Disease and 1 from Gastro-enteritis EAR, NOSE AND THROAT CASES (a) Health Centre Cases— Removal of Tonsils and/or Adenoids 322 Mastoidectomy -1 Miscellaneous 4 (b) Hospital Cases— Removal of Tonsils and /or Adenoids Mastoidectomy 3 Miscellaneous 1 CASES ADMITTED FROM OTHER AUTHORITIES During the year 1947, 99 cases were admitted from areas other than the Borough of Willesderi 20 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, 1 in 1946 and none in 1947 (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 1917 19 (4) Incidence rate per annum (taking 30 as average No of Probationer Nurses) 3-06 per cent (5) No of Nurses Schick Tested (1927-1947 inclusive) 554 (6) No of Nurses giving a positive reaction 222 (7) Percentage of Nurses giving a positive reaction 40-07 per cent Table No 25 Diseases No in Hospital on 31-12-46 Admitted Total under Treatment Discharged Recovered, or Transferred Died Mortality per cent Remaining in Hospital on 31-12-47 Cerebro-spinal Fever — 8 8 7 — — 1 Diphtheria 5 14 19 17 — 2 Enteric Fever — 5 5 3 — 2 Erysipelas 1 26 27 24 1 3-7 2 Measles o 123 125 119 — — 6 Puerperal Infections 1 15 16 15 — — 1 Scarlet Fever 13 200 213 187 — 26 Whooping Cough 1 64 65 58 5 7-7 2 Poliomyelitis — 45 45 37 1 2-2 7 Other Diseases 11 275 286 262 6 2-1 18 Marasmus 45 45 37 3 6-6 5 Tonsil and Adenoid Cases — 330 330 330 * — — Civilian Sick 14 14 11 3 — — Service Sick 8 8 7 1 — — Totals 48 1,158 1,206 1,114 20 — 72 TREATMENT CENTRE During the month of March, 1944, a Treatment Centre for Scabies and verminous conditions was opened at the Hospital During 1917 the following cases were treated :— Scabies cases and contacts 1,111 Verminous conditions 258 Other conditions 2 Total attendances 4,418 21 PUBLIC HEALTH LABORATORY Table No 26 Specimens Examined for 1947 Jan Feb Mar Apr May June July Aug Sep Oct Nov Dec Totals Nose and Throat Swabs 283 167 349 326 292 280 294 202 220 402 484 770 4,069 Sputum for TB 16 11 13 9 6 7 3 6 6 4 9 7 97 Blood for Widal 2 2 — 3 1 2 1 13 — — 24 Blood Counts 42 29 31 45 33 34 38 55 41 29 26 28 431 Blood Sed Rates 1 1 4 1 — 1 6 4 6 6 9 17 56 Urine 7 15 13 15 8 9 7 40 28 33 28 210 Faeces 18 10 10 11 7 17 7 12 24 112 58 66 352 Cerebro-spinal Fluid 5 6 7 7 3 10 9 28 19 10 14 8 126 Cough Plates & PN swabs 4 6 6 11 6 7 21 33 14 4 5 2 119 Miscellaneous 24 19 28 19 8 16 10 11 13 14 18 6 186 Totals 402 266 461 447 363 382 397 358 384 622 656 932 5,670 Table No 27 Positive Results Swabs for C Diphtheriae 127 Faeces for S Typhii 30 Sputum for B Tuberculosis 3 CSF for Meningococci 5 Faeces for S Dysenteriae 1 CSF for TB 2 Faeces for Salmonella 5 Blood for S Typhii (Widal +) i THE SEVENTEENTH ANNUAL REPORT on the WILLESDEN MATERNITY HOSPITAL for the Year 1947 By ARNOLD WALKER, MA, MB, BCh, FRCS, FRCOG During the year 1947, a larger number of patients were dealt with than in any previous year These included a larger number of emergency cases than in any previous year Deficiencies in the number of trained midwives have put a great strain on the existing staff, who have maintained a high standard in spite of difficulties There were no maternal deaths 22 Table No. 28. Statistical Details of the 1,256 Cases dealt with during 1947. Cases completed 1,256 Toxaemia of Pregnancy admitted for (a) Booked at the Health Centres 1,227 treatment 29 Discharged well 1,221 Eclampsia 1 Transferred 3 Organic Heart Disease 2 Delivered elsewhere 2 Puerperal Pyrexia 25 Died 0 Uterine Infection 5 (b) Admitted as Emergencies 29 Urinary Infection 3 Discharged well 28 Breast Infection 4 Transferred 1 Pulmonary Infection Died 0 Rheumatic Fever 1 Of the 1,227 booked cases, 574 were Carbuncle 1 primiparae and 653 were multiparae. Tuberculosis 1 Of the 29 emergency cases, 18 were Dental Abscess 1 primiparae and 11 were multiparae. No cause found 4 Presentations : Operations : Occipito Anterior 884 Forceps delivery. .• 72 Occipito Posterior 277 The forceps rate was therefore 5 • 74 per cent. Normal Breech 50 Caesarean Section 8 Complicated Breech 5 Pelvic Tumour 2 Twins 25 Placenta Praevia 2 Face 4 Toxaemia 1 Shoulder 1 Previous Caesarean 3 Miscarriages 8 Hysterotomy and Sterilisation 1 1 Ante-partum Haemorrhage : Induction of Premature Labour 11 Placenta Praevia 3 Toxaemia 10 Accidental Haemorrhage 1 Oedema 1 10 cases were admitted before labour Manual Removal of Placenta 8 on account of haemorrhage, in 9 of T ransfusion 34 which there was no further loss of Plasma only 3 blood. Blood only 22 Prolapse of Cord 5 Plasma and Blood 9 1,271 children were born to 1,246 mothers. Of these, 39 were stillborn and 13 died. THE EIGHTEENTH ANNUAL REPORT on the SUPERVISION OF MIDWIVES for the Year 1947. Table No. 29. Number of Midwives who gave Notice of their Intention to Practise in Willesden in 1946-17 respectively 1946 1947 In Willesden : 1. Private District Midwives 0 0 2. Municipal Midwives 12 18 3. Queen Charlotte's Hospital District Home, 40, Princess Road, Kilburn, N.W.6 6 4 4. Central Middlesex County Hospital, Acton Lane, N.W.10 27 29 5. Willesden District Nursing Association, 19, Park Avenue, N.W.2 0 0 Outside Willesden : 1. Private District Midwives 0 0 2. Willesden Maternity Hospital, Honevpot Lane, Kingsbury, N.W.9 5 7 Totals 50 58 In addition, 6 Mid-wives gave notice of their intention to act as Maternity Nurses under Section E(21) of the rules of the Central Midwives Board. 23 Table No 30—Number of Cases Attended by Midwives Practising and Living in Willesden during 1947 No of Cases Attended Emergency calls Cancelled cases As Midwife As Maternity Nurse Private District Midwives — — — Municipal Midwives 747 — 21 88 Midwives attached to Queen Charlotte's Hospital District Home, 40, Princess Road, NW6 149* — 4 31 Midwives attached to the Willesden District Nursing Association, 17-19, Park Avenue, NW2 — 210 — 17 Midwives at the Central Middlesex Countv Hospital, Acton Lane, NW10 1,632 233 — — Totals 2,528 443 25 136 *In addition, 76 cases outside Willesden were attended by Midwives from this Home In addition, the Municipal Midwives attended 133 cases, totalling 1,259 visits to mothers who were discharged from the Willesden Maternity Hospital before the tenth day of the puerperium Owing to the closure of wards in the Willesden Maternity Hospital, due to shortage of staff and redecoration, it was found necessary to discharge patients before the tenth day The Municipal Midwives supervised the post-natal care of these mothers in their homes up to at least the fourteenth day The number of cases attended by Midwives practising in Willesden, but living outside Willesden during 1947, was nil During the year ended 31st December, 1947, 367 notifications were received from Midwives practising in Willesden, in accordance with the rules of the Central Midwives Board (Section E) Of the 367 notifications, 365 were received from Midwives living in Willesden and 2 from Midwives practising in, but living outside, Willesden 320 of the notifications received were in respect of calling in Medical Aid, 259 in respect of the mother, and 61 in respect of the child Fees paid by the Council to Medical Practitioners called in by Midwives during the year ended 31st December, 1947, amounted to £437 4s 6d. The tenth 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 11, 4 of whom are 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 Tut Watling and Willesden Training School for Second-period Pupil Midwives—During the year 40 pupil midwives worked on the district Of the 747 confinements dealt with by the Municipal Midwives, the pupil midwives attended 677 under the direct or indirect supervision of the ?vlidwives 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 :— Medical Ante-Natal Clinics 357 Maternity and Child Welfare Clinics for mothers and babies 51 The Lecture Course at the Royal College of Midwives A Discussion Class, each week, taken by the Supervisor of Midwives at the Health Department Of the 40 pupil midwives, 27 sat for their final midwifery examination, 21 passed, 3 failed, but 2 passed at a subsequent examination Municipal District Midwives Ante-Natal Clinic—These Clinics were commenced in July, 1947, and have been much appreciated by both the expectant mothers and the Midwives They are very useful in bringing the Midwife in personal contact with other branches and members of the Midwifery Service, and have also played an important function in the education of both the mother and the pupil midwife From July to December, 1947, 50 of these Clinics were held and 952 attendances were made The Administration of Gas and Air Analgesia—The number of mothers to-whom gas and air analgesia was administered during labour increased from 7.7 per cent. for the first six months ended 27th June, 1947, to 54-3 per cent. for the last six months of the year This is a satisfactory method for providing the relief of pain during child-birth It is self-administered by the mother and supervised by the Midwife In order that the maximum relief can be obtained from this form of analgesia it is necessary for a mother to be taught the correct method of using the apparatus, and this is taught by the Midwives at the Ante-natal Clinics The majority of mothers who had gas and air analgesia appreciated it very much indeed 24 THIRTIETH ANNUAL REPORT for the YEAR 1947 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 immediate problem in Willesden is to acquire additional clinic accommodation for two further Dental Officers and one Orthodontist. Despite all efforts during the year, the heavy demand and prompt negotiations by outside agencies have prevented the procurement of suitable vacant premises for adaptation. This, together with the ban on the erection of new buildings, offers little prospect in the immediate future of making good the deficiencies in the dental service in Willesden. Thus, the service has, of necessity, been operated on the same limited scale as in previous years by only four full-time Dental Officers. During the year under review two Dental Officers were appointed on the permanent staff in place of the two engaged on a war-time temporary capacity. One of these permanent officers resigned his appointment in November. This changing of staff somewhat interrupted the service. The total number of sessions worked by the four Dental Officers amounted to 1,918, which were assigned to the different sections of the service as follows :— Treatment Sessions allocated to School Health Service 1,269 Routine Inspection Sessions allocated to School Health Service 123 Treatment Sessions allocated to Maternity and Child Welfare 501 Sessions allocated to Administration 14 Sessions allocated to Post-Graduate Instruction 11 Total 1,918 Included in the above total are 166 sessions attended by the Anaesthetist when 3,401 general anaesthetics were administered, which makes an average of over 20 cases per session. SCHOOL DENTAL SERVICE. Inspections. Routine.—8,752 children out of a total roll of approximately 20,000 were inspected at the schools during 123 visits, which is an average of 71 inspections per session. 6,216 or 71 per cent. were found defective and referred for treatment. Complete recording of all defects found was done as in former years and advice and instructions for the care of the teeth given to all parents attending the schools. Specials.—2,350 children were inspected at the Centres and of these 2,140 required treatment. While many of these cases are emergencies who have ignored advice given at routine inspections, a large and growing proportion are children whose parents have learned the value of preventative dentistry and seek advice on very slight evidence of defect as well as many leavers seeking a final examination. Treatment. Out of a total of 8,356 referred as defective, 5,541 were treated at the Centres, which is an acceptance rate of 66 per cent. 6,134 teeth were extracted, of which 893 were permanent. Out of this latter figure 139 were extracted for the relief of overcrowding. The total number of fillings done was 7,950, of which 6,080 were restorations to permanent teeth. Thus the ratio of permanent teeth filled to permanent teeth extracted on account of extensive caries is 8 to 1. Miscellaneous treatments such as root fillings, zinc oxide dressings, gum treatment, etc., amounted to 2,634. 13,797 attendances were recorded, which averages just over 2 visits per patient. It has been gratifying to have access to the Middlesex County Council Special Clinics and many cases requiring crowns, dentures and space retainers have been referred to them for their treatment. The total number of sessions taken up with the School Dental Service amounted to 1,392 and the average work done per session is estimated to the nearest decimal point as follows:— Attendances 10 Fillings 6 Extractions 4 Sundry operations 2 Total operations 12 25 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 Schools Children Total (a) Routine age-groups— Aged: 5 427 » 427 6 720 3 723 7 733 8 741 8 939 9 948 9 808 11 819 10 755 10 765 11 969 14 983 12 943 12 955 13 956 8 964 14 774 7 781 15 540 10 550 16 17 91 3 2 93 3 Total 8,658 94 8,752 (b) Specials 2,347 3 2,350 (c) Total (routine and specials) 11,005 97 11,102 2. Number found to require treatment 8,285 71 8,356 3. Number actually treated 5,522 19 5,541 4. Attendances made bv children for treatment 13,750 47 13,797 5. Half-days devoted to Inspection 121 2 123 Treatment 1,264 5 ' 1,269 Total 1,385 7 1,392 6. Fillings—Permanent teeth 6,058 22 6,080 Temporary teeth 1,869 1 1,870 Total 7,927 23 7,950 7. Extractions—Permanent teeth 888 5 893 Temporary teeth 5,220 21 5,241 Total .. 6,108 26 6,134 Administration of general anaesthetics for extractions. . 2,728 14 2,742 Local anaesthetics 169 — 169 Total .. 9. Other operations—Permanent teeth 2,897 1,708 14 6 2,911 1,714 Temporary teeth 918 2 920 Total 2,626 8 2,634 RETURN SHOWING THE NUMBER OF DENTAL DEFECTS REFERRED FOR FOLLOWING-UP, AND THE EXTENT TO WHICH REMEDIAL MEASURES WERE CARRIED OUT DURING 1947 AT HEALTH VISITOR'S LAST VISIT. Total number of defects coming under observation during 1947:— School Children Special Schools Children Total Brought forward 590 2 592 New during year 5,384 78 5,462 Total 5,974 80 6,054 Number of defects treated : Health Centre 5,522 19 5,541 Otherwise 68 59 127 Total 5,590 78 5,668 No report available 6 6 Number of defects for which no treatment has been undertaken at Health Visitor's final visit 73 73 Carried forward 294 2 296 Number not needing treatment 11 11 26 MATERNITY AND CHILD WELFARE. 1,744 mothers and infants were inspected during the year. 1,642 required treatment and of these 1,035 completed, and 205 partially completed, their treatment at the Centres. 1,912 teeth were removed and 2,180 fillings done, while 1,519 other operations were performed on the gums and teeth. 102 patients were supplied with dentures and one patient had a denture repaired. General anaesthetics were administered to 659 cases and local anaesthetics to 108. The total number of attendances recorded during 501 treatment sessions was 5,119, or an average of 10 cases per session. A summary of the work done is given in the table below. E.M. N.M. 0-5 Total Number inspected 817 211 716 1,744 Number brought forward from previous year 133 31 36 200 Total number under observation during year 950 212 752 1,944 Number completed. . 394 149 490 1,033 Number partially completed 132 35 38 205 Number not availing themselves of treatment 307 27 62 396 Number treated by other agencies 25 2 — 27 Number carried forward 76 27 78 181 Number with no defect 16 2 84 102 Number of attendances . . . . . . .. 2,712 816 1,591 5,119 Number of teeth removed 916 355 641 1,912 Number of teeth filled 1,190 326 664 2,180 Number of other operations on the gums and teeth 817 393 309 1,519 Number of general anaesthetics 286 100 273 659 Number of local anaesthetics 65 31 12 108 Number of treatment sessions — — — 501 Number of patients who received dentures during the year: At cost to Council At cost to Applicant At part cost to Applicant Total Dentures 14 40 48 102 Repairs 1 — — 1 Total 15 40 48 103 REPORT ON DAY NURSERIES FOR THE YEAR 1947. On 1st January, 1947, there were 12 Day Nurseries open in Willesden. In April, 1947, Olive Road Nursery was closed to release a housing site, and Braintcroft Nursery was closed in May to reopen as a nursery school. The remaining 10 Nurseries accommodate 490 children and the attendances for the year total 112,015. On the 31st December, 1947, the number of children awaiting admission to Day Nurseries in Willesden was 806. The areas with the longest waiting list are Kilburn, Harlesden and Cricklewood, and partly to satisfy the demand for nursery accommodation it would appear necessary to provide an additional nursery in each of the above areas as soon as possible, bearing in mind that the Kilburn area should take preference in being the first to have a second nursery established on account of its overcrowded conditions. Priority Waiting List.—Because of the long waiting list at the various nurseries, the Council, at its meeting on the 27th July, 1947, agreed to make certain cases priorities, and these are as follows :— (1) Where there is no father or no mother ; (2) Where one parent is a chronic invalid ; Consideration is to be given to the nature of the work of the mother, e.g., factory in preference to domestic work. 27 Increased Charges.—As from July, 1947, the cost of admission of a child to a Day Nursery was based on economic circumstances. Very needy cases were admitted free and the maximum cost was 7s. 7d. per child per day. Several mothers protested at the increased fees, and 24 children were removed from the Nurseries as a result of the increased charges. Staffing and Training.—Staff Establishment:— Supervisory Matron 1 Wardens 10 Supervisory Warden 1 Nursing Staff 62 Matrons 10 Students and Helpers 50 Deputy Matrons 10 Domestic Staff (mostly part-time) 40 New rates of pay were laid down by the Ministry of Health and the Ministry of Education, to take effect as from the 1st October, 1947. (Circular 168 47 and 157.) These increases in the salaries of Day Nursery Staff assisted in the retention of staff and enabled vacancies to be filled. From the young girls who apply for posts in Day Nurseries a selection is made of suitable candidates to train as Nursery Nurses. In this way trained staff are provided for the more senior posts in the Nurseries. The Student Nurses attend either at Acton or Hendon Technical College for two days weekly. The course is now extended to two years, and for this reason only three candidates will be eligible to sit for the National Nursery Examination in 194,S. Medical Supervision.—The Nurseries continue to be visited regularly by the Medical Officers for purposes ol medical inspection of children and genera! medical supervision. Infectious Diseases.—The following table shows the number of infectious diseases from which children in the Nurseries suffered during the year :— Diphtheria . . . . . . — Measles . . . . . . . . 79 Scarlet Fever . . . . . . 10 German Measies . . . . 1 Mumps . . . . . . . . 26 Erysipelas . . . . . . 1 Chicken Pox . . . . . . 44 Pneumonia . . . . . . 1 Whooping Cough . . . . 50 Apart from infectious disease the children appear to be in good health. Progress made by the tiny babies has been particularly noticeable. General Usefulness of Day Nurseries. (a) For Parents.—Economic conditions at present make it necessary for many mothers to go out to work who would normally stay at home with their children, and this service is the essential social service for the widow and the mother of an illegitimate child. The staff interest the mother in the life of the nursery, telling her how the children spend their time during the day, what they have to eat and anything special they have done that day. It is quite noticeable to the staff that the mother leaves her child with every confidence, knowing that every care and attention will be given to the child whilst she is at her work. (b) For Children.—Children appear to benefit greatly from the Nurseries. They get the maximum amount of fresh air and outdoor life, which is not always possible at home with the overcrowded conditions of the present day ; the generous amount of foods allowed to the Nurseries makes it possible for the children to be more adequately led than they could possibly be at home with the present-day rations. For the only chdd their is the companionship of other children and the provision of many toys for education and amusement. Although it is generally agreed that the best place for the young child is at home with the mother, the need for Nurseries does exist and the demand appears to increase daily. Parents' Evenings.—Arrangements are being made for parents to meet the staff one evening a month for social and educational purposes. Work of the Wardens. Special attention was paid throughout the year to improve the educational facilities available in the Day Nurseries. Wardens have been specially trained ; they have visited exhibitions and nursery schools and new methods have been introduced in the training of young children. Froebel and Montessori educational methods, as recognised by the Ministry of Education, have been applied. Psychological methods as advocated by Anna Fraed and Beuller, musical training according to Louie de Rusette, and physical training and rhythmics according to the methods of Loyland, have also been introduced. This very important work has not only provided useful occupation for the children whilst they were in the Nursery, but also prepared them for the next step of their entrance into school. The Day Nursery thus plays its part, not only in social welfare, but also from an educational point of view as well. 28 SPEECH THERAPY, 1947. Speech Therapy continued in the Borough in the form of Group Work. Centres were in operation and the children attended once or twice a week. There is still a growing list of cases requiring treatment and bv the end of 1947 there were approximately 10.) 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. During the year 1947 three persons were granted a licence, twelve persons a renewal of licence, and one person received exemption under Section 363 of the Act. RHEUMATISM CLINIC. A Rheumatism Clinic, for school children referred by the Health Centre Medical Officers as possible cases of rheumatism, was started in November. It is proposed to hold a monthly session at each Health Centre to be taken by the Deputy Medical Officer of Health. The objects of the Clinics are to ascertain the diagnosis of rheumatism as early as possible, and to secure the necessary treatment and special educational provision for these children. Parents will be advised on the home care and supervision of affected children. At the same time all possible measures will be used to rectify sanitary defects, overcrowding and other adverse social conditions which may contribute to the disease. Preliminary results have indicated that the Clinic will serve a useful purpose, and is already much appreciated by parents.