AC 439(1) WlLLESDEN Borough of Millesden 1949 THE 74th ANNUAL HEALTH REPORT S. LEFF, M.D., D.P.H., Barrister at Law, Medical Officer of Health . BOROUGH OF WILLESDEN Health Department, 54, Winchester Avenue, Kilburn, London, N.W.6. July, ig5o. To the Mayor, Aldermen and Councillors of the Borough of Willesden. Mr. Mayor, Ladies and Gentlemen, I beg to submit the Annual Report on the health and sanitary circumstances of the Borough for the year 1949. There have been many difficulties in compiling this report, as this is the first full year following the transfer of the Borough Council's personal health and hospital services to other authorities. The Borough Council, on the advice of their Medical Officer of Health, is responsible for safeguarding the health of the area and for applying the knowledge of public health and preventive medicine for the benefit of the community. The Medical Officer of Health is responsible for acquiring an accurate knowledge of the influences, social, environmental and industrial, in the area which may be harmful to the health of the people and he must know the agencies, official or unofficial, who can help in improving these conditions. The Borough Council cannot introduce improvements in the personal health services, because its duties are restricted to the impersonal environmental services; neither can it give advice to the responsible authorities, because the Borough Council is often ignorant of some of the services which they provide. The Borough Council is also handicapped by the fact that only 40 per cent of the time of the Medical Officer of Health is allocated to Borough Council duties. The Medical Officer of Health has no direct official contact with the many agencies responsible for the personal health services of the community; the local executive committee organising the work of the doctors, dentists, pharmacists, etc., the local welfare department caring for deprived children, and the local hospital management committee. He is, therefore, handicapped in giving advice on how the various agencies can co-operate to improve the health of the community. There is, therefore, no authority which can adequately survey the health services and needs of the people in the district and make arrangements for the various agencies to work harmoniously together. The fact that a few Willesden Councillors are appointed to the hospital management committees and the local area health committee does not solve this major problem. The Medical Officer of Health unofficially works in conjunction with the local health agencies, but cannot always obtain the necessary co-operation because the interests of these bodies often differ. There is no local authority responsible for resolving these differences in the interests of the public. During the year difficulties have arisen, particularly in the midwifery services and in the services dealing with old people. It is disappointing to note that there has been no appreciable extension of the health services during the year. There has been a further expansion of the work in environmental services; in the work of housing inspection and repairs and in the supervision of factories and food establishments. Unhealthy houses and overcrowding remain the major factors affecting adversely the health and welfare of the people in the Borough. The infectious diseases rates in the Borough have remained favourable. There was a decrease in the number of children who suffered from measles, diphtheria or whooping cough, but there was a slight increase in the number of scarlet fever cases. The anterior poliomyelitis epidemic was the only one of note and was far more severe than in 1948, but not so serious as in 1947. Tuberculosis, with the shortage of hospital and sanatorium accommodation, is still the most serious problem in the prevention of infectious diseases, for although there was a reduction in both the death and case rates, there was an increase in the number of cases on the tuberculosis register. There was a marked fall in the birth rate, but there was an increase in the general death rate, and in the infant mortality and still-birth rates for legitimate children; there was, however, a marked reduction in the infant mortality rates for illegitimate children. There is urgent need for improving facilities for the care of premature babies. I wish to thank all members of the staff, and particularly the sanitary inspectors, for the good work carried out during the year, and the members of the Health Committee and Borough Council for the interest they take in improving the health of the people in Willesden. I have the honour to be, Your obedient servant, S. LEFF, Medical Officer of Health. 3 STATISTICS AND SOCIAL CONDITIONS OF AREA. Population, 194 181,120 Population Census, 1931 184,434 Pre-war Population, 1938 187,600 Area of the District in acres 4.634.5 acres Number of Persons per acre 79 Number of Inhabited Houses 43,013 Rateable Value £1,629,271 General Rate for the year 16s. 6d. Product of a 1d. Rate £6,620 VITAL STATISTICS. Live Births: Total Male Female Willesden Borough Council Legitimate 2,736 1,379 1,357 Birth-rate per 1,000 of the estimated resident population. Illegitimate 159 74 85 2,895 1,453 1,442 15.98 Still Births 74 34 40 Rate per 1,000 total (live and still) births. 24.92 Deaths 1,880 948 932 Death-rate per 1,000 estimated resident population. 10.38 Death-Rate of Infants under One Year of Age: All infants per 1,000 live births 25.56 Legitimate infants per 1,000 legitimate live births 26.32 Illegitimate infants per 1,000 illegitimate live births 12.58 Maternal Mortality : Deaths from Puerperal causes— Other Puerperal causes 1.04 per 1,000 registered total births Other Maternal causes Nil Total Maternal Mortality rate 1.04 per 1,000 registered live births Deaths From: Males Females Total Cancer (all ages) 171 176 347 Measles (all ages) 1 1 2 Whooping Cough (all ages) - - - Diarrhœa (under 2 years of age) 3 - 3 4 Cause of Death : Males Females Total 1. Typhoid and Paratyphoid Fevers - - - 2. Cerebro-spinal Fever - 1 1 3. Scarlet Fever - - - 4. Whooping Cough - - - 5. Diphtheria - - - 6. Tuberculosis (Respiratory) 48 18 66 7. Tuberculosis (other forms) 3 6 9 8. Syphilitic Diseases 9 7 16 9. Influenza 10 5 15 10. Measles 1 1 2 11. Acute Poliomyelitis : Polio Encephalitis 2 1 3 12. Acute Infectious Encephalitis - - - 13. Cancer of Buccal Cavity and (Esophagous 15 20 35 14. Cancer of Stomach and Duodenum 23 26 49 15. Cancer of Breast 1 32 33 16. Cancer of all other sites 132 .98 230 17. Diabetes 7 5 12 18. Intra-Cranial Vascular Lesions 71 112 183 19. Heart Disease 256 253 509 20. Other Diseases of Circulation 48 65 113 21. Bronchitis 93 48 141 22. Pneumonia 41 45 86 23. Other Respiratory Diseases 12 18 30 24. Ulcer of Stomach or Duodenum 12 8 20 25. Diarrhoea (under 2 years) 3 - 3 26. Appendicitis 1 4 5 27. Other Digestive Disorders 18 23 41 28. Nephritis 19 21 40 29. Puerperal and Post Abortive Sepsis - 2 2 30. Other Maternal Causes - 1 1 31. Premature Birth 11 8 19 32. Congenital Malformation : Birth Injury Infantile Disorders 29 13 42 33. Suicide 6 8 14 34. Road Traffic Accidents 10 4 14 35. Other Violent Causes 20 22 42 36. All other Causes 47 57 104 WILLESDEN BIRTHS. Place of Confinement. 1947 1948 1949 Total number of registered Live Births 3,753 3,048 2,817 Number born in Institutions 2,504 2,169 2,177 Percentage born in Institutions 66.72 71.16 77.28 Institutions (i.e., Hospitals, Nursing Homes) where Births Occurred. Central Middlesex Hospital 731 530 846 Kingsbury Maternity Hospital 1,246 1,098 890 Total 1,977 1,628 1,736 Larger Hospitals outside Willesden 232 256 241 Smaller Hospitals outside Willesden 145 135 144 Nursing Homes 150 150 56 Total 2,504 2,169 2,177 Domiciliary Midwives. County Midwives 747 509 418 Queen Charlotte's Midwives 149 111 86 Willesden District Nursing Association 210 179 117 Total 1,106 799 621 5 THE FALL IN THE BIRTH RATE Effect on Place of Confinement The fall in the birth rate in Willesden in the three years 1947.49 had a profound effect on the place of confinement. The number of births dropped by almost 1,000, but there was an increase of 10 per cent in the number of mothers confined in institutions, as compared with a decrease of almost 50 per cent in the number confined at home. The fall in the birth rate in 1948 was reflected in the work of the Central Middlesex and Kingsbury Hospitals and the Domiciliary Midwives, but appeared to have no effect on the number of mothers confined in hospitals outside Willesden. The operation of the National Health Service Act from July 5th, 1948, soon had an effect on altering the balance between the various agencies. On July 5th, 1948, both the Central Middlesex Hospital and the Kingsbury Maternity Hospital came under the control of the Central Middlesex Hospital Management Committee. The falling birth rate had different effects in these hospitals. In 1949 the total number confined in these two hospitals was increased by 108—even in the face of the falling birth rate—but the number of mothers delivered in the Kingsbury Maternity Hospital was reduced by 208, while the number delivered in the Central Middlesex Hospital was increased by 316. The Central Middlesex Hospital increased their deliveries at the expense of the Kingsbury Maternity Hospital and the Domiciliary Midwives. In spite of the falling birth rate, the number delivered in outside hospitals such as Queen Charlotte's, St. Mary's, Guy's and Charing Cross, remained stationary at about 380, while the number confined in nursing homes fell by 94. The trend towards hospital confinement was probably due to the overcrowded conditions in the homes and the fact that hospital confinements are now free, and therefore cheaper than domiciliary confinements—where the mother has the expense of board, home help, extra linen and laundry. In addition, as a result of the increase in the number of confinements in the Central Middlesex Hospital, the Hospital Management Committee found it had empty beds in the Kingsbury Maternity Hospital, and therefore encouraged the mothers who had booked to have their babies at home, to transfer to hospital. Some of the Willesden mothers have become accustomed to seek hospital beds outside Willesden because of the previous shortage of beds in the Willesden hospitals. In the interests of the maternity services, consideration might have been given to encourage these mothers to transfer to the Kingsbury Maternity Hospital. Unfortunately, there is no central authority in Willesden or in the area which can make a continuous survey of the effect of the birth rate on all the maternity services and plan accordingly. There is a tendency for all the interested parties—the Management Committee and hospitals, and the Queen's District Nursing Association, the local authority and the Willesden District Nursing Association employing the midwives, to look at the problem from their point of view only. Illegitimate Birth Rate. Effect on Day Nursery Applications. Year Illegitimate Births Total Births Willesden 1912 130 4,075 31.90 1913 132 4,037 32.60 1914 149 4,115 36.20 1915 143 3,632 36.28 1916 117 3,668 31.89 1917 112 2,816 39.77 1918 150 2,651 56.58 1919 117 2,924 40.00 1920 148 4,232 34.97 1921 92 3,464 26.56 1922 94 3,160 29.75 1923 78 3,063 25.46 1924 79 2,843 27.79 1925 90 2,755 32.67 1926 83 2,700 30.74 1927 80 2,568 31.15 1928 101 2,666 37.88 1929 103 2,714 37.95 1930 93 2,869 32.42 1931 111 2,838 39.11 1932 108 2,745 39.34 1933 84 2,671 31 .45 1934 94 2,743 34.27 1935 100 2,848 35.11 1936 96 2,835 33.86 1937 145 3,058 47.41 1938 119 2,968 40.09 1939 121 2,738 44.19 1940 69 2,315 29.81 1941 76 1,758 43.23 1942 110 2,550 43.14 1943 127 2,657 47.80 1944 99 2,697 36.71 1945 143 2,627 54.43 1946 157 3,420 45.91 1947 174 3,753 46.36 1948 186 3,147 59. 10 1949 120 2,447 49.04 6 The fall in the birth rate had an effect also on the number of applications for admission to the Day Nurseries. This was particularly noticeable in the priority groups, because the illegitimate birth rate, though remaining high in 1949, was much lower than in 1948. Babies in the priority classes are accepted in the Day Nurseries at the early age of six weeks, and the additional care they receive probably accounts for the fact that for the first time in Willesden's history, the infant mortality rate for illegitimate babies was less than that for legitimate babies. Table 1 POPULATION CHANGES IN WILLESDEN, 1936.49. Infant Mortality and Still-birth Rates, Willesden and England and Wales, 1936.49. Year Population No. of Births in Willesden Died under 1 Year, Willesden Infant Death Rate, Willesden Infant Death Rate, England and Wales No. of Still.births, Willesden Still.birth Rate, Willesden Still.birth Rate, England and Wales (1) (2) (3) (4) (5) (6) (7) (8) 1936 190,000 2,835 170 59.96 59 86 29.44 40 1937 188,030 3,058 197 64.42 58 100 31.67 39 1938 187,600 2,968 160 53.91 53 101 32.91 38 1939 188,000 2,738 149 54.42 50 78 27.70 38 1940 152,030 2,315 120 51.84 56 85 35.42 37 1941 127,230 1,758 92 52.33 59 50 27.65 34 1942 138,600 2,550 130 50.98 51 84 31.89 33 1943 144,430 2,657 155 58.34 49 71 26.03 30 1944 139,510 2,697 114 42.26 46 74 26.71 28 1945 161,954 2,627 129 49.11 46 68 25.23 28 1946 170,550 3,420 104 30.41 43 92 26.20 27 1947 175,900 3,753 118 31.44 41 92 23.93 24 1948 179,900 3,147 74 23.51 34 71 22.56 23 1949 181,120 2,895 74 25.55 32 74 25.56 23 Population Changes in Willesden, 1936.49. (See Table /, Column i) The greatest development of Willesden took place between 1875 and 1914, when the population rose from 3,000 to 164,000. As the wealthy moved out of the borough, workers moved into their houses and they were soon followed by light industry, driven from the central areas of London by high running costs. With the improvements in the road system, new houses were built on all the available land in Cricklewood and Neasden, so that by 1938 practically the whole of Willesden was built up. There were many changes in the population between 1939 and 1945, due to evacuation in the periods of bombing. Nevertheless, more people were employed in Willesden during the war, for although some of the factories moved out of the district, several moved into the borough and existing engineering firms were expanded. The population fell by about 50,000 to its lowest level in 1941, gradually rose until 1943, suffered another slight fall in 1944 with the renewal of bombing, and by the end of the war was about 25,000 below pre.war level. There has been a gradual rise in the post.war period, and in 1949 the population was only 6,500 below that of 1938. The living conditions of the ward populations of Willesden vary considerably, ranging from the old dilapidated and crumbling three.storey and basement tenement houses of Carlton and Kilburn occupied by the poorer classes, to the large detached and semi.detached houses of Brondesbury Park, where the wealthy middle classes live. The other wards have mixed populations with bad, almost slum property in Church End and Stonebridge, fairly good middle class property in Cricklewood, and large typical private enterprise housing estates in Neasden. Unfortunately, the fate which has overtaken the houses in Carlton and Kilburn is spreading to the areas of Cricklewood and Brondesbury Park, because some of the houses in these areas are too large for people wanting to live in the district and too expensive for conversion into flats. The poorest and most overcrowded population live in the areas where the old type sub.divided terraced houses are most common, and these are found mainly in the southern part of the borough, particularly in Carlton, Kilburn and Harlesden. Infant Mortality and Still.birth Rates, Willesden and England and Wales, 1936.49. (See Table /, Columns 2.8) Except for minor differences, the infant mortality and still.birth rates in Willesden appear to follow very closely those of England and Wales. In Willesden the rise in the rate took place later, in 1943, whereas the big post.war reductions were more rapid. The reason for these differences is probably the movements of the population during the war due to evacuation in the periods of bombing. The rates in the whole borough do not mirror the effects of the war on the various sections of the community. The ward rates, on the other hand, give a better picture, for the social structure of Willesden's population is clearly reflected in the composition of the wards. The wards are inhabited in the main by mixed populations, but there are large concentrations of the poorer working class living in overcrowded conditions in Carlton (160 to the acre), Kilburn (111), Willesden Green (94), Harlesden (92), Stonebridge and Roundwood, and relatively large concentrations of middle class properties in Brondesbury Park (39 to the acre), Cricklewood (55), Mapesbury (54) and Neasden (51). Carlton and Brondesbury Park are the two wards which show the greatest differences in social class and structure. 7 Table 2 Infant Mortality and Still.birth Rates by Wards. Ward No. of Persons per Acre, 1948 Combined Rate, 1936.39 Combined Rate, 1940.45 Reduction 1940.45 compared with 1936.39 (Percentages in brackets) Combined Rate, 1946.49 Reduction 1946.49 compared with 1940.45 (Percentages in brackets) Reduction 1946.49 compared with 1936.39 (Percentages in brackets) Still.birth Rate, 1946.49* (1) (2) (3) (4) (5) (6) (7) Carlton 160 76.11 58.82 17.29 27.99 30.83 48.12 26.23 (23.50) (52.41) (63.22) Harlesden 92 75.88 54.36 21.52 38.00 16.36 37.88 32.47 Willesden Green (28.36) (30.01) (49.92) 94 69.39 49.92 19.47 29.21 20.71 40.18 27.30 (28.05) (41.48) (57.90) Roundwood 101 66.29 69.60 + 3.31 35.49 34.11 30.80 23.51 (+4.99) (49.00) (46.46) Kilburn 111 64.89 47.93 15.96 36.26 11.67 28.63 30.88 (23.05) (24.34) (44.12) Stonebridge 92 62.62 55.60 7.02 39.08 16.52 23.54 24.41 (11.21) (29.71) (37.59) Manor 74 56.31 38.68 17.63 32.78 5.90 23.53 19.89 (31.30) (15.25) (41.78) Church End 71 47.51 41.10 6.41 28.54 12.56 18.97 26.69 (13.49) (30.55) (39.92) Neasden 51 46.24 47.76 + 1.52 14.32 33.44 31.92 14.01 ( + 3.28) (70.01) (69.03) Cricklewood 55 41.71 48.26 +6.55 19.72 28.54 21.99 21.42 Kensal Rise (+15.70) (59.13) (52.72) 104 40.90 45.13 +4.23 19.10 26.03 21.80 21.01 (+10.34) (57.67) (53.30) Mapesbury 54 39.25 52.80 + 13.55 18.42 34.38 20.83 18.63 ( + 34.52) (65.11) (53.07) Brondesbury Park 39 35.22 31.16 4.06 22.80 8.36 12.42 25.33 (11.53) (26.82) (35.26) Whole Borough 78 58.27 51.35 6.92 27.43 23.92 30.84 24.29 (11.87) (46.58) (52.92) * Still.birth Rate, 1936.39=31.46. Still.birth.rate, 1940.45=28.69 The rates in the individual wards showed big contrasts and different trends. Carlton Ward, with the poorest population, and Brondesbury Park, with the richest population, illustrate the general course. In the period 1936.39 the infant mortality rate in Carlton was the highest in the borough, but fell markedly during the war years, with a still greater reduction in the post.war period. The rates in Brondesbury Park, on the other hand, show much smaller reductions. The infant mortality rates in the wards with the poorer populations, Harlesden, Willesden Green and Kilburn, show similar trends as in the Carlton Ward, except that the post.war falls in the rates were not so marked. The infant mortality rates in the wards with the middle class populations, Cricklewood, Mapesbury and Neasden, follow quite a different course. They all show an increase during the war years and a marked decline in the post.war years. During the war, the number and character of the ward populations were affected by the greater evacuation from the better.class areas and the varied effects of bombing and requisitioning in all areas. The differences in the infant mortality rates were therefore probably due to this factor, for in the better wards, populations with an average lower standard of living and therefore higher infant mortality rate were left behind, while in the poorer wards, the average lower standard of living was unaffected by evacuation. The national provision of milk and vitamin supplements during the war raised the standard of nutrition of the mothers, especially of the poorer classes, with a consequent reduction in the infant mortality rate; but in the best wards this fall in the infant mortality rate did not compensate for the rise due to the greater evacuation of the classes with a higher standard of living and lower infant mortality rate. In the post.war period, the average standard of living in the various wards was affected by the return from evacuation, and it rose in the best wards as some of the well.to.do returned to the borough; there was a consequent reduction in the infant mortality rates. Varied effects of bombing and requisitioning in all areas were also responsible for some of the changes. In the post.war period, the average standard of living of the Brondesbury Park population was particularly affected by the erection in this ward of by far the largest number of prefabricated houses in the borough (191 out of a total of 499) and by the placing of a large number of families (198) in requisitioned houses. Marked improvements in the post.war years are probably due to the improved nutrition of the mothers, improvements in maternal and infant care, and in the treatment. of infections, Rh. abnormalities and haemorrhages. 8 Table 3. Death Rate Under One Year per Thousand Live Births by Cause of Death in Willesden. 1936.39 1940.45 1946.49 1936.39 1946.49 Percentage Reduction Deaths Rate Deaths Rate Deaths Rate Respiratory 106 9.14 140 9.59 57 4.34 52.51 Diarrhoea and Enteritis 131 11.29 108 7.40 31 2.36 79.09 Other Infections 34 2.93 40 2.73 11 0.84 7.13 Congenital Malformations 83 7.16 89 6.10 60 4.57 36.17 Premature Births 170 14.66 179 12.25 83 6.33 56.82 Injury at Birth 21 1.81 33 2.26 35 2.67 + 32.21 Other Causes 131 11.29 151 10.34 93 7.09 37.20 All Causes 676 58.28 740 50.67 370 28.20 51.61 Table 3 shows that the most marked improvements took place in the death rates from infection and from prematurity, but there has been an increase in the rate from injuries at birth. In 1949, 18 of the 20 deaths from infection, and the majority of the deaths from prematurity, took place in the poorer wards (see Table 4). Prematurity. Table 4. Premature Births and Deaths by Wards. Carlton Kilburn Brondesbury Park Kensal Rise Manor Harlesden Stonebridge No. of Births in Home (Deaths in brackets) 4 0 2 3 0 3 1 No. of Births in Hospital (Deaths in brackets) 13(5) 5(2) 4(0) 10(2) 15(4) 12(1) 14(0) Roundwooc Church End Willesden Green Mapesbury Neasden Cricklewooc Total No. of Births in Home (Deaths in brackets) 8(1) 3(3) 3 2 0 1 30 (4) No. of Births in Hospital (Deaths in brackets) 13(0) 11(0) 14(0) 9(1) 4(2) 6(1) 130(18) Table 5. Premature Births and Deaths. Year Number of Births in Home (Deaths in brackets) Number of Births in Hospital (Deaths in brackets) Number of Home Births transferred to Hospital (Deaths in brackets) Total 1946 47(1) 128(18) 12 (10) 175 (29) 1947 52 (0) 121 (13) 4(4) 173 (17) 1948 47 (2) 149(19) 10(5) 196 (26) 1949 30 (4) 130 (18) 1 (0) 160 (22) There were 160 premature births with 22 deaths. Table 5 shows the urgent need for carrying out the recommendation suggested in the 1948 Report, i.e., the provision of a special premature unit at the hospital, and home nurses specially trained in the care of premature infants. Still Births The still.birth rates during the period under review showed similar trends as the infant mortality rate, although the decline was not so rapid. The still.birth rates for the wards in the period 1946.49 showed similar differences as in the infant mortality rate (see Table 2). There was a slight increase in the still.birth rate and the infant mortality rate in 1949, which was particularly marked for children who died in the first week ot life 9 In spite of the general decline in the infant mortality and still-birth rates, there is still room for considerable improvement—the differences in the rates are due to environmental and not to hereditary factors. For instance, in the period 1936-39, for every child under the age of one year that died in the Brondesbury Park Ward, two children died in the Carlton Ward. If the living conditions and nutrition of the mothers and children in Carlton had been raised to the same level as Brondesbury Park, 100 babies would have been saved during this period in Carlton alone, and if the same improvements had operated throughout the borough, the lives of 500 babies would have been saved. Similarly, in the period 1946-49, if the condition of the mothers and children in the Harlesden Ward had been improved to match those of the best ward, Neasden, 50 babies would have been saved in Harlesden, and in the whole borough there would have been a gain of more than 300 babies; a saving of 800 babies in the 8 years under review. The national saving for this period has been estimated at 100,000. GENERAL PROVISION OF HEALTH SERVICES. Public Health Laboratory Service. The work in connection with the examination of specimens is undertaken by the Public Health Laboratory Service at the Central Public Health Laboratory, Colindale Avenue, N.W.9, and at their branch laboratory at the Neasden Hospital, Brentfield Road, N.W.10. Specimens such as swabs from sore throats, feces from suspected intestinal infections, and cough plates and post-nasal swabs from suspected whooping cough cases are delivered by private practitioners to the branch laboratory at the Neasden Hospital or for collection and transfer to the Central Public Health Laboratory, to the Health Department, 54, Winchester Avenue, N.W.6, or the Willesden Health Centre, 381, High Road, Willesden, N.W.10. A presumptive report is telephoned to the practitioner on the morning after receipt of the specimen, and is followed bv a written report. Samples of milk taken by the Sanitary Inspectors from dealers in the district are also forwarded to the laboratory for examination. During the year 1949, the following work was carried out at the laboratory: Throat /Nose Swabs: Diphtheria Bacilli 15 Hemolytic Streptococci 293 Vincent's Angina 3 Negative 1,244 Total 1,555 Faeces: Shigella - Salmonella 12 Protozoa - Negative 62 Total 74 Sputum: T.B. Smear 318 Other Organisms 1 Negative 1,248 Total 1,567 Pertussi : Cough Plate — Post-nasal Swab 4 Negative 16 Total 20 Milk : Pasteurised \ 207 Other / Taken from Dealers' Premises Taken From Schools. T.T. Pasteurised Pasteurised Pasteurised No. taken 146 39 8 No. satisfactory 135 36 8 No. unsatisfactory in respect of Methyline Blue test only and second sample taken 11 3 - No. of second samples satisfactory 11 3 - 10 Ice Cream 9 Grade 1 2 Grade 2 3 Grade 3 4 Water: Domestic Supplies, etc. 8 Satisfactory 5 Unsatisfactory 3 Swimming Pools 131 Satisfactory Ill Unsatisfactory 20 Miscellaneous 156 Total 3,727 Uncleanliness and Scabies. Cases treated at the Scabies and Lice Treatment Centre, Neasden Hospital. No. of New Cases Treated Total No. of Attendances For Scabies For Lice and Nits Total For Scabies For Lice and Nits Total Children under 5 years 48 30 78 147* 38 185 Children, 5-14 years 85 282 367 402† 297 699 Adults: Men 46 9 551 362 ‡ 91 453 Women 86 72 158/ * † ‡ The numbers in this column include contacts, who on inspection showed no signs of infection, but nevertheless received treatment. The numbers were*—8, †—13, and ‡—12, respectively. Establishments for Massage and Special Treatment The registration of establishments for massage and special treatment is delegated to the Borough Council in accordance with Part XII of the Middlesex County Council Act, 1944, and the work of inspection of the establishments is performed by the Council's sanitary inspectors. During the year 1949, 20 premises were registered; 4 persons were granted a licence, 12 a renewal of a licence, 1 received exemption under Section 363 of the Act, and 3 received licences in respect of the transfer of their premises. Health Education One of the major weapons in the battle for health is knowledge. Ignorance of the fundamental facts of hygiene and how to maintain adequate health standards plays a large part in the spread of disease and infection. Health education provides the Public Health Department with its most useful ally in the fight against disease—an enlightened citizen. The Public Health Department cannot succeed in conquering disease unless the public assists in obtaining and maintaining satisfactory hygienic standards of living. The provision of ante-natal clinics, infant welfare centres, the improvement of conditions in the schools, homes, food establishments and factories, are all measures which directly or indirectly assist in the health education of the citizen. Lectures and film shows are more direct methods of bringing health education to the public. People who live and work in insanitary conditions find it difficult to apply the general rules of hygiene, but much can be done in educating them to maintain reasonable hygienic standards even in their difficult surroundings. The earlier health education is introduced in the life of the citizen, the more effective it becomes. Lectures with visual aids, such as films, film-strips and illustrated charts, were continued throughout the year in the secondary modern schools and in the parent clubs which are attached to all the day nurseries. In addition, local organisations, including religious bodies, trade union branches, community centres, Rotary clubs and British Legion branches, were approached by the Borough's Public Relations Officer, and meetings were arranged where the Medical Officer of Health or his representative gave a health talk, often illustrated with a film or film-strip. The following list of health talks has been sent to local organisations in Willesden: 1. " Housing and Health." A discussion of the requirements of a healthy home. 2. " Work and Health." A discussion of the effect of factory life on health. 3. " Are We Well-fed ? " A discussion on nutrition in home and canteen. 4. " Prevention is Better than Cure." A discussion of the modern advances in the control of tuberculosis and diphtheria. 5. " Health Centres." A discussion on their purpose and provision. 6. " Accidents Will Happen." (i) A discussion of some important causes of accidents at work, (ii) Alternative discussion of accidents in the home. 7. " The School Health Service." A discussion of its value to the community. 8. " The Care of Mothers and Children." A discussion on the work of the maternity and child welfare clinics. 9. " Food Hygiene." A discussion on the prevention of food poisoning. 10. " Rehabilitation," A discussion on retraining the disabled for work. 11. " Captain of the Men of Death." A discussion on tuberculosis. The most popular lectures chosen by the organisations were Nos. 1, 2, 4 and 5, and the least popular, Nos. 7 and 8. Nineteen lectures were given between the 3rd August, 1949, and 31st December, 1949. 11 Schools. Lectures on hygiene with films or film-strips were commenced in the schools in March, 1949. In the Spring Term of 1949, a series of five lectures was given experimentally in two secondary modern schools (a boys' school and a girls' school). Owing to the success of this experiment, it was decided to extend health education to all the pupils in the final year of the secondary modern schools and to the junior pupils in the two grammar schools, Willesden County and Kilburn Grammar Schools. Lectures were based mainly on films available from the Central Office of Information and film-strips purchased for the department; they were fitted in as far as possible with the hygiene or biology syllabus of the school. The lectures were given by all the members of the medical staff, two members of the dental staff and the Deputy Borough Engineer. At fifteen schools, 130 films health talks were given to approximately 1,585 pupils; the average attendance per lecture was 40 to 100 pupils. The following tables give in detail the films upon which the lectures were based: 1. " Modern Guide to Health." 2. " Defeat Diphtheria." 3. " Milk from Grange Hill Farm." 4. " A B C D of Health." " Dinner at School. " Hprp's Health " 6! " The Nose Has It." " Old Wives' Tales." 7. " Milk from Grange Hill Farm." " Water Service.' 8. "A B C D of Health." 9. " Your Very Good Health." " Charley's March of Time." 10. " Breath of Danger." " The Nose Has It." 11. " Your Children's Teeth." 12. " Your Children's Eyes." 13. " Unwanted Guests." " Modern Guide to Health." 14. " Round Figures." " Old Wives' Tales." 15. " Your Children's Ears." 16. " The Nose Has It." " Breath of Danger." " Defeat Diphtheria." 17. "Town and Country Planning." "New Town." 18. " The Londoners." 19. " Proud City." 20. " One Man's Story." 21. "The Nose Has It." " Modern Guide to Health." 22. " The Milky Way." 23. " Modern Guide to Health." " Old Wives' Tales." Parents' Clubs. The work of health education in the parents' clubs attached to the day nurseries was extended during the year, and there were 14 film shows and 31 talks given by the members of the medical staff, the Borough Librarian, the Borough Public Relations Officer, the Chief Sanitary Inspector and others. In addition, there were 26 meetings and social evenings. The following is a list of films shown at the film health talks: " A Start in Life." " The Nose Has It." " Playing with Fire." " Unwanted Guests." " New Town." " The World is Rich." " Defeat Diphtheria." " Your Children's Ears." " Breath of Danger." " Children on Trial." " Charley's March of Time." " Children Learning by Experience." " Double Thread." " Your Children's Sleep." " Highland Doctor." " Modern Guide to Health." " Your Very Good Health." " Old Wives' Tales." " Here's Health." " Penicillin." " Your Children's Meals." " Round Figures." " Your Children and You." Health Services of the other Authorities in the Area The hospital facilities provided by the North-West Metropolitan Regional Hospital Board, and the maternity and child welfare and school health services provided by the Middlesex County Council, remain substantially the same; they are described in the 1948 Report. PREVALENCE OF, AND CONTROL OVER, INFECTIOUS AND OTHER DISEASES. Infectious Diseases. Number of Cases Notified and Confirmed. Number of Cases Confirmed (number notified in brackets) 1948 1949 Diphtheria 15 (48) 8 (33) Scarlet Fever 306 (325) 340 (356) Pneumonia 180 (195) 161 (175) Whooping Cough 423 (435) 205 (212) Erysipelas 39 (43) 29 (35) Measles 1,281 (1,290) 985 (990) 12 Other Infectious Diseases Notified during 1949. Disease Number Confirmed (number notified in brackets) Typhoid Fever 2 (4) Dysentery 4 (6) Malaria. -(-) Poliomyelitis and Polio-Encephalitis 33 (54) Cerebro-spinal Fever 3 (5) No cases of encephalitis lethargica were notified. Measles. 990 cases were notified in 1949 (985 confirmed), but a total of 1,106 cases came to the notice of the health visitors; 635 occurred in children under 5 years of age. There were no deaths from measles in children under 1 year of age during the year. Whooping Cough. 212 cases were notified in 1949 (205 confirmed), but a total of 249 came to the notice of the health visitors; 144 occurred in children under the age of 5 years. There were no deaths from whooping cough in 1949 in children between the ages of 1 and 5 years. There was a fall in the number of cases of whooping cough, but it is too early to judge whether this was due to the increase in whooping cough vaccinations. Pneumonia and Influenza. 175 cases of pneumonia were notified in 1949 (161 confirmed). There were 86 deaths from bronchial pneumonia, lobar pneumonia and pneumonia (unspecified), and 15 deaths from influenza. Ophthalmia Neonatorum. 7 cases were notified in 1949, a case rate of 2.42 per 1,000 registered live births. There was complete recovery with unimpaired vision in all 7 cases. Puerperal Pyrexia. 57 cases of puerperal pyrexia were notified during the year; all were confirmed. Food Poisoning. 17 cases of food poisoning were notified during the year; 16 were confirmed. 13 TUBERCULOSIS. Table A Tuberculosis Case and Death Rates (per 1,000 estimated Resident Population) Cases on Register No. of New Cases (No. of Deaths in brackets) Case Rates (Death Rates in brackets) Pulmonary Non-Pulmonary All Forms Year Population Pulmonary Non-Pulmonary All Forms Pulmonary Non-Pulmonary All Forms 1936.39 Pre. WarPeriod 1936 190,000 211 47 258 Ml 168 1.358 655 152 807 (128) (16) (144) (-673) (.084) (-757) 1937 188,030 205 49 254 1 .09 -261 1.351 688 161 849 (119) (14) (133) (.632) (.074) (.707) 1938 187,600 210 56 266 1.119 .298 1.417 691 172 863 (117) (11) (128) (.623) (.058) (.681) 1939 188,000 250 37 287 1.329 . 197 1.526 678 166 844 (108) (12) (120) (.574) (. 063) (.638) Total 753,600 876 189 1,065 1.162 .251 1.413 (472) (53) (525) (.626) (.070) (.696) 1945-45 War period 1940 152,030 204 54 258 1.324 .355 1.697 587 145 732 (105) (16) (121) (.690) (.105) (.795) 1941 127,230 217 32 249 1.705 .252 1.957 575 116 691 (79) (15) (94) (.621) (.117) (.738) 1942 138,600 234 47 281 1.688 .339 2.027 369 133 502 (100) (15) (115) (.721) (.108) (.829) 1943 144,430 262 51 313 1.814 .353 2.167 734 150 884 (85) (14) (99) (.589) (.096) (.685) 1944 139,510 210 23 233 1.505 .165 1.670 815 156 971 (84) (18) (102) (.602) (.129) (.731) . 1945 161,954 207 45 252 1.278 .277 1.556 927 172 1,1099 (81) (16) (97) (. 500) (.098) (.598) Total 863,754 1,334 252 1,586 1.544 .292 1.836 (534) (94) (628) (.619) (.108) (.727) 1946.49— Post.war period 1946 170,550 255 34 289 1 .495 .199 1.694 1,067 180 1,247 (95) (11) (106) (.557) (.065) (.622) 1947 175,900 253 33 286 1 .438 . 188 1.626 1,198 191 1,389 (78) (9) (87) (.443) (.051) (.494) 1948 179,900 243 27 270 1.351 .150 1.501 1,293 196 1,489 (80) (11) (91) (.445) (.061) (.506) 1949 181,120 186 22 208 1.026 .121 1.147 1,386 207 1,593 (66) (9) (75) (. 364) (.050) (.414) Total 707,470 937 116 1,053 1.324 . 164 1.488 (319) (40) (359) (.451) (.056) (.507) The death rates, the case rates and the numbers on the tuberculosis register, illustrate the development of tuberculosis in Willesden. These figures remained fairly stationary in the pre-war period 1936.39, but the war brought increases which were continued into the post-war period. Deaths from Tuberculosis. (See Table A) The death rates from both forms of tuberculosis rose during the war, but in 1945 they were for the first time lower than in 1939, and they have been falling steadily ever since. Although a study of the death rates gives an indication of the struggle against tuberculosis, it does not give an accurate picture for any particular year, since many deaths occurring during the year are the result of infection contracted over five years previously. 14 Table B PULMONARY TUBERCULOSIS. Period between Notification and Death—Years 1945.49. Period between Notification and Death Percentage of Total Deaths 1945 1946 1947 1948 1949 1945.49 Not notified 9.4 16.5 13.6 16.0 22.7 15.2 0.12 months 41.7 39.5 34.1 34.1 25.7 35.6 1.5 years 35.4 34.1 34.1 34.0 27.4 33.3 Over 5 years 13.5 9.9 18.2 15.9 24.2 15.9 Total number of Deaths 96 91 88 94 66 435 The percentages of deaths from tuberculosis without previous notification rose during the year; almost 50 per cent of the deaths took place within a year of notification. It is impossible, on the basis of these figures, to estimate the number of people who contracted the disease yet remained undiagnosed, thus spreading the infection to other people. Numbers on the Tuberculosis Register. (See Table A). But for the early war years, when the population was reduced by evacuation, there has been a steady increase in the numbers on the register. The increase, however, is not a reliable guide, for it includes people who contracted the disease outside the district and moved in, and excludes those who have recovered, and those who contracted the disease in the district and moved out. It does, however, give an indication of the number of people in the district who, at any one time, are suffering from tuberculosis, and the doubling of the numbers on the register shows that there must be more active cases in the community today. Number of Gases of Tuberculosis. (See Table A). The number of cases detected during the year gives a better picture of the spread of the disease in the district even though some people died undiagnosed, and some were notified but later proved not to be suffering from the disease. It is presumed that these numbers did not fluctuate much from year to year. The case rates remained stationary in the pre.war period 1936.39, but during the war rose sharply because the resistance of the people to the disease was undermined by the stresses and strains of war. Overcrowding is an important factor in the spread of the disease, and although the decrease in the population during the war relieved overcrowding, the stresses and strains of war, especially in the periods of bombing, offset this; consequently the case rates rose. The stresses and strains of war were followed by post.war difficulties. Overcrowding was increased by the increase in requisitioning and the return of evacuees to accommodation reduced by bombing. The lack of hospital or sanatorium accommodation helped to spread infection—more persons had to be treated at home. In May, 1950, the waiting period for hospitals in Middlesex was: women 11 months, men 9| months, and children 6 months. In 1949, the number of new cases added to the register, other than those entering the district, showed a welcome fall, but although 1949 was a favourable year and 1939 a bad year, the case rates in the post.war period 1946.49 were higher than those of the pre.war period 1936.39. Comparative Statement of Tuberculosis Case Rate 1936.39—1946.1949 (See Table C). A study of case and death rates in the individual wards shows the effects of tuberculosis on different classes of the community. The case rates rose in the wards where overcrowding increased because of the greater return of evacuees and the reduction in the available accommodation by bombing and requisitioning. Carlton and Mapesbury were particularly affected as they both had relatively big increases in their population, and in addition, Mapesbury had by far the largest number of families in the Borough (347 out of 1,602) placed in requisitioned property. Carlton, Kilburn and Kensal Rise Wards, which had appreciable reductions in populations, with a consequent improvement in overcrowding, had a change in their case rates which compared favourably with the rest of the Borough. These wards, together with Cricklewood and Brondesbury Park (two middle.class wards) actually had a slight reduction in cases for the post.war period 1946.49, as compared with the pre.war period 1936.39. Nevertheless, Carlton and Kilburn, together with Stonebridge and Roundwood Wards, which had relatively small increases in the case rates in 1946.49, were still the worst wards in the Borough, for, in spite of some improvement in the living conditions of the people, they still remained the worst overcrowded in the Borough. If, in the period 1936.49, the housing and living conditions in the worst ward, Carlton, had been raised to that of the best ward, 131 people would have been saved from the scourge of tuberculosis; 84 in the period 1936.39, and 47 in the period 1946.49. Similarly, if the case and death rates for the Borough as a whole had been raised to those of the best ward, 641 persons would have been saved, with a reduction of approximately 250 in the number of deaths. The treatment of these cases, which includes sanatorium and clinic provision, and their loss to production, must have cost the community at least a million pounds. This money could have been spent on the improvement of the housing and living conditions of the people with much greater profit and with the relief of a great deal of misery and suffering. 15 Table C Comparative Statement of Tuberculosis Case Rate 1936.39—1946.49 Decrease or Increase in the Rates Death Rate 1946.49 Ward Pulmonary Rate No. of Pulmonary Cases Combined Rate No. of Non. Pulmonary Cases Pulmonary Rate No. of Pulmonary Cases Combined Rate No. of Non. Pulmonary Cases Pulmonary Rate Combined Rate All Forms Rate Carlton 1.781 113 2.270 31 1.801 89 2.030 11 + .020 -240 33 .669 Kilburn 1.509 92 1.838 20 1.437 80 1.724 16 -072 —114 30 .686 Stonebridge 1 .469 79 1.748 15 1.610 81 1.928 16 + .141 + .180 34 .611 Roundwood 1.442 71 1.726 14 1.578 69 1.829 11 + .136 + .103 32 .636 Brondesbury Park 1.262 63 1.583 16 1.352 66 1.454 5 + .090 -.129 23 .492 Kensal Rise 1.088 61 1.373 16 .984 46 1.155 8 -.104 -218 33 .573 Cricklewood 1.105 68 1.268 10 1.006 62 1.071 4 -.099 -.197 22 .494 Church End .971 58 1.239 16 1.475 85 1.683 12 + .504 + .444 23 .373 Neasden 1 .004 46 1.157 7 1 .031 46 1.189 7 + .027 + .032 31 .379 Willesden Green .958 56 1.112 9 1.362 69 1.336 4 + .305 + .224 24 .439 Harlesden .974 61 1.102 8 1.209 78 1.317 7 + .235 + .215 29 .449 Mapesbury .852 68 1.065 17 1.381 113 1.491 9 + .529 + .426 19 .389 Manor .764 40 .955 10 1.097 53 1.221 6 + .333 + .266 26 .538 Whole Borough 1.162 876 1.413 189 1.324 937 1.488 116 + .162 + .075 359 .507 16 REPORT ON POLIOMYELITIS. The epidemic commenced in the Borough on July 18th, 1949. Prior to this date, 3 cases of poliomyelitis had been notified, 2 of which were confirmed—one a girl of 18 years (paralytic) and one a girl of 17 years (non-paralytic). The total number of cases of poliomyelitis notified during the year was 57, and of these 33 were confirmed. This far exceeded the numbers in 1948, when there were 16 notifications (11 confirmed), but the epidemic did not reach the same proportions as in 1947, when there were 89 notifications (45 confirmed). There were, however, 4 deaths in 1949, as compared with 3 in 1947, and none in 1948. 54 cases were notified during the period July 18th to December 31st, 1949: 49 in Willesden, and 5 outside Willesden. Of the latter 5 cases, 1 was a boy who had returned to school from Willesden to Ipswich, 1 was a Willesden nursery nurse on holiday in the Isle of Wight, and 3 were admitted to London hospitals outside Willesden. 61-1 per cent of the notified cases were confirmed, as compared with 50-6 per cent for 1947 The majority of the cases occurred in the months of September and October. The epidemic virtually ceased on October 16th, as there were only 4 further cases, the last on November 30th. The following table shows the age distribution of notified and confirmed cases with the type of attack: Age Notifications Confirmed Cases Par Severe alytic Slight NonParalytic Abortive Fatal Percentage of Total Confirmed Cases Under 1 year 2 2 1 1 -* — — 6-06 1 year old 6 5 — 2 2 1 15-15 30-30 1-5 years 9 5 — 4 1 — 15-15 5-10 years 16 5 2 — 1 1 1 15-15 OA.O/I 10-15 years 5 3 1 — 2 — — 9-09 15-25 years 10 8 2 1 3 1 1 24-25 25-35 years 4 5 — — 3 — 2 15-15 Over 35 years 2 — — — — — — — Total 54 33 6 8 12 3 4 100 Percentage 18.2 24.2 36.4 9.1 12.1 0-1 years | 1-5 years School Age Adults 2 10 8 13 The number of cases in adults was greater than usual, 39.4 per cent, as compared with 15.6 per cent in 1947. Three adults (1 a man of 30 years, 1 a man of 29 years, and a girl of 19 years), and 1 boy aged 7½ years, died of the disease. The percentage of paralytic cases, 42.4 per cent, was, however, lower than in 1947 (68-8 per cent). The precautions taken were as outlined in the report of 1947, and the new film," Poliomyelitis Diagnosis and Management," was shown to general practitioners and members of the medical and nursing staff at the Town Hall on September 1st, 1949. The swimming baths were not closed during the epidemic, although their closure was recommended, because samples during the period of the epidemic showed that the water was contaminated, and the number of bathers had increased because of the hot weather. The day nurseries were not closed, as no cases occurred in them. The schools were re-opened in September as usual. The number of patients admitted to hospitals in London during the year was 55, and 32 were confirmed as suffering from the disease: 4 died, 3 were transferred to the Royal National Orthopaedic Hospital, and 25 were discharged to their homes. Of these 25 cases, 4 remained under the treatment and supervision of the Orthopaedic Treatment Department at Stonebridge Health Centre, 3 attended the out-patients' department of the Hospital for treatment, and 18 did not require any further treatment. 17 SMALLPOX. There were no cases of Smallpox during the year. Report on Contacts Resident in Willesden of a Fatal Case of Smallpox Which Occurred on S.S. " Mooltan." The onset of the above case of smallpox was April 1st, 1949. Contacts were vaccinated on board S.S. " Mooltan " on April 2nd, and were kept under observation until April 18th. The 14 contacts who came direct to Willesden on April 3rd, 1949, were vaccinated on the S.S. " Mooltan." Another contact disembarked at Marseilles, came to Willesden on April 5th, and was vaccinated by a private doctor on April 7 th. These 15 contacts were visited daily by a health visitor until April 18th, 1949. The vaccination was successful in all these contacts; 2 had a severe reaction, and 5 a mild malaise. All were reported to be well on April 18th. In addition, 3 contacts who had travelled to Sheffield came to live in Willesden on April 17th, 1949; their vaccination had been successful, and they were reported well on April 18th. Some laundry from the S.S. " Mooltan " was sent to a Hendon laundry on April 5th, 1949. All known infected articles had been destroyed aboard the ship, but the remaining articles of laundry were regarded as suspect, 3 Willesden residents who were employed in the receiving department of this laundry were seen daily up to May 21st, 1949, either by the Hendon authority at their place of work, or by the Willesden health visitor in their homes, 2 were successfully vaccinated on April 15th, and all 3 were reported well at April 31st. A contact of the S.S. " Mooltan " died of smallpox on April 10th, 1949; the onset was on April 9th, 1949. The 21 contacts of this patient who were residents of Willesden were vaccinated on April 15th; in 17 the vaccination was successful, and in 4 unsuccessful. These 21 persons were seen daily up to April 26th, 1949, either by the Wembley authority at their place of work, or by the Willesden health visitor in their homes. They were all reported to be well on April 26th, 1949. A passenger of the S.S. " Mooltan " who developed a modified course of smallpox (diagnosed on April 10th, 1949), attended a medical board at 30, Montague Street, W.C.I, on April 6th, 1949: 5 Willesden residents also attended the medical board on this date, but only 1 was vaccinated. They were all visited until April 30th, 1949, when they were all reported well. They were all visited until April 30th, 1949, when they were all reported well. Number of Willesden Contacts Number of Home Visits made by Health Visitors Number of Enquiries made by Telephone (a) Direct from the S.S. " Mooltan " from the Port of London 14 142 8 (b) From the Port of Marseilles 1 3 1 (c) Proceeded first to Sheffield, then to Willesden 3 15 - (d) Worked in Hendon laundry 3 9 — («) Contacts of the Wembley fatal case 21 28 — (/) Contacts of the case who attended a Medical Board 5 12 6 Total 47 209 15 Number of Vaccinations. Vaccinated on board S.S. " Mooltan " Vaccinated Elsewhere Total Successful Vaccination 18 24 42 38 SANITARY CIRCUMSTANCES OF THE AREA. Water. The Metropolitan Water Board and the Colne Valley Water Company supply Willesden with water of excellent quality. Sewage and Drainage. Most of the sewage of the Borough is discharged into the London County Council main sewers, but a small amount from the Park Royal area is discharged into the West Middlesex Main Drainage system. Refuse Disposal. House refuse is collected weekly—trade refuse as often as necessary; the trader pays an agreed charge. The refuse is disposed of by controlled tipping at Twyford. The duty of enforcing the provision of dust-bins is the responsibility of the Borough Engineer's Department. 18 Bathrooms. One in three Willesden families have no bathroom, and one in four have to share with another family. Less than half the Willesden families (41 per cent) have a bathroom of their own. Water Closets. Approximately one in four families (22 per cent) share a water closet; in dwellings occupied by three or more families almost three-quarters (68 per cent) share the water closet. Gardens. Willesden is poorly equipped with public open spaces—242 acres, as against an estimated need of 1,313 acres—yet one in four families have no garden at all and a large number have to share a garden. SWIMMING BATHS. The Borough has three swimming baths—one covered-in bath at Granville Road, open all the year round, and two open-air baths at King Edwards and Gladstone Park Baths,—open from May to September. Samples of the bath water were taken regularly by the Health Department for bacteriological examination, and the results of these tests were as follows: Bath No. of Samples Taken No. of Samples Reported as Satisfactory No. of Samples Reported as Unsatisfactory Percentage Granville Road 82 80 2 2.5 Gladstone Park 27 15 12 44.4 King Edward's Park 22 16 6 27.3 These results showed that the bath water at Gladstone Park Bath was often contaminated, thus confirming the need to carry out the recommendations of the 1948 Report: To improve the inadequate sanitary and shower bath facilities, the inefficient chlorination plant and the unsatisfactory surface drainage around the pool. A new plant introducing break-point chlorination treatment was installed at Gladstone Park at the close of the summer season. This should improve the standards of water purity, but the additional improvements are still required. SANITARY SECTION. Staff. In 1948, the authorised establishment for sanitary inspectors was increased from 16 to 19; at December 31st, 1949, the staff consisted of the Chief Sanitary Inspector, the Deputy Chief Sanitary Inspector and 16 District Sanitary Inspectors, with one vacancy. The additional staff were able to deal more speedily with complaints of nuisances, and increased the number of inspections in food premises and factories. Work in the repair of sanitary defects of houses was extended, and the Council authorised an increase in the number of pupil sanitary inspectors from 4 to 6 to assist the sanitary inspectors by revisiting premises after notices were served. There were 5 pupil sanitary inspectors on the staff at December 31st, 1949. One Rodent Officer and 4 operatives were employed to destroy rats and mice in dwelling houses, factories and other industrial buildings, on bombed sites and waste lands. Two labourers carried out vermin disinfestation, drain testing and general duties. SANITARY INSPECTION OF THE AREA. Inspections: 1949 1948 Number of dwelling houses inspected for housing defects (under P.H.A. or H.A. 1936): Number of premises inspected on complaint 5,971 6,898 Number of premises inspected in connection with infectious disease 10 2 Houses inspected—house-to-house—Housing Act, 1936 106 93 Number of dwelling houses—own observation 186 186 6,273 7,179 Number of inspections made for the purpose 32,771 30,401 19 Periodic Inspections: 1949 1948 Common lodging houses—number registered under Bye-laws 1 1 Number of inspections made 26 17 Offensive trades—number of premises in district 4 4 Number of inspections made " 7 4 Factories—with mechanical power—number of inspections 1,331 285 Notices served 58 27 Without mechanical power—number of inspections 122 84 Notices served 12 11 Work places—other than out-workers—number of inspections 22 23 Notices served 1 4 Homeworkers and outworkers 22 41 Inspection of food premises: Bakehouses 150 102 Milk and dairy shops 298 273 Butchers, provision and general shops 1,578 1,330 Fish shops (wet, fried and dried) 400 413 Eating houses 778 602 Greengrocers 278 288 Ice cream premises 352 243 Stalls 117 103 Total periodic inspections 5,481 3,805 1949 1948 Total periodic inspections 5,481 3,805 For certificates under the Rent Acts 53 54 Public House urinals 122 249 Mews and stables 80 75 Miscellaneous 848 1,107 Under Circular 2845 88 124 Smoke observations 218 240 Verminous rooms—number of primary inspections 174 185 number of re-inspections 262 322 Total number of inspections and re-inspections 40,097 36,562 Action taken by the service of notices under Public Health and Housing Acts. (see separate sheet.) Rent and Mortgage Interest (Restrictions) Acts: Number of applications received from tenants for certificates 94 83 Number of applications granted 72 77 Number of applications refused (work done) 21 6 Number of applications withdrawn 1 — SUMMARY OF NUISANCES ABATED AND IMPROVEMENTS EFFECTED. Water Supply and Water Service: 1949 1948 Cisterns—new ones provided 48 62 cleansed, repaired, covered, etc. 142 134 draw taps placed on mains 26 32 Drainage and Sewerage of Existing Buildings: Water closets—number of W.C.s substituted for dry receptacles - - repaired, supplied with water or otherwise improved 550 822 additional closets constructed 46 33 Drains—water closets aerially disconnected from sculleries, living rooms and bedrooms 5 8 examined, tested, exposed, etc. 621 522 unstopped, repaired, trapped, etc. 685 570 wastepipes, disconnected, repaired, etc. 616 778 new soilpipes or vent shafts fixed 66 70 disconnecting traps or chambers inserted 79 69 reconstructed .,. 66 56 new manhole covers 113 115 Cesspools—rendered impervious, emptied, etc., abolished and drain connecting to sewer 2 2 Existing soilpipes or vent .shafts - repaired . 205 214 20 Sundry Nuisances Abated. 1949 1948 Overcrowding (under Public Health Acts) 9 6 Smoke 18 48 Accumulation of refuse 117 120 Foul ditches, ponds, etc., and stagnant water 7 6 Fowls, pigs and other animals 55 31 Dampness 2,240 2,913 Yard and forecourts paved, repaved or repaired 222 174 Walls and ceilings cleansed 5,329 4,978 Verminous rooms disinfested 288 284 Leaky roof made watertight 1,900 2,657 Additional ventilation provided under floors 165 279 Dilapidated plaster repaired 4,664 6,020 Flooring and other woodwork repaired 2,057 2,418 Damp-proof courses inserted 173 214 Water supply reinstated 69 121 Wash-house floors repaired or repaved 45 40 Fireplaces and stoves repaired 1,279 1,525 Decayed brickwork repaired and repointed 646 658 Sinks provided or replaced 181 233 Additional light and ventilation provided to staircase 15 25 Larders or food cupboards ventilated or provided 22 16 Gutters and/or rainwater pipes repaired or renewed 1,101 1,923 New sash cords and glass provided to doors and windows 3,064 3,554 Miscellaneous 834 801 Total number of nuisances abated 27,770 32,531 Overcrowding : Licences to permit temporary overcrowding in excess of the permitted number— Section 61, Housing Act, 1936: Number of licences issued 3 - Housing Act, 1936—Sections 11 and 12: Closing Orders made: 9, 11 and 18, Avenue Close—first floor dwellings;40 Cambridge Avenue—basement 4 3 Demolition Orders made: 195, 197 and 199, Cambridge Road; 17, Granville Road; 101, Albert Road; 49, Melville Road 6 - In the cases of 17, Granville Road, 101, Albert Road and 49, Melville Road undertakings have been received from the owners to carry out schedules of works required by the Corporation. 195, 197 and 199, Cambridge Road will be demolished when tenants are re-housed. HOUSING. The Housing (Standards of Fitness) Sub-Committee continued the work of improving the conditions of houses in the area. Owing to shortage of staff, the majority of houses are only inspected on receipt of a complaint; there has been no systematic house-to-house inspection. Even this work put a strain on the staff, and the number of pupil sanitary inspectors was increased to make more frequent re-visits to premises so that the progress of work required under sanitary notices could be more adequately supervised. As the existing accommodation at 131, Salusbury Road is overcrowded, consideration was also given to the transfer of the Sanitary Inspectors' Offices to 54, Winchester Avenue or to a new office block, but no suitable site has been found for the erection of prefabricated accommodation, and it has been impossible to release 54, Winchester Avenue from its present use by the County Council. The Committee considered the question of a pictorial poster to inform tenants of their rights under the Health and Housing Acts, but after careful consideration, decided to re-issue the two posters issued in 1948 until stocks were exhausted. The following is the procedure adopted by the Council in dealing with unfit houses. The Sanitary Inspector serves an intimation notice, followed by a statutory notice if the work has not commenced within seven days after the receipt of the intimation notice. The question of whether the notice is served under the Public Health Act or Housing Act depends upon the nature of the defects and the condition of the house. If there are many defects and there is some doubt whether the house can be rendered fit at a reasonable cost, the Borough Engineer estimates the cost of repairs and the value of the house after the house has been rendered fit. The Committee consider these figures and decide whether they serve a housing notice under Section 9 or a demolition order under Section 11. Six demolition orders were made, but in three cases undertakings were received from the owners to carry out the schedule of works required by the Corporation. Grants from the War Damage Commission have permitted owners to undertake repairs of houses which were ripe for demolition. In the present difficult housing situation additional housing units are welcome, but it is doubtful whether it is in the interests of the nation's economy to repair these dilapidated houses at considerable cost. 21 Closing Orders were made on four premises; three were first floor dwellings in Avenue Close; one was a basement. Some of the buildings in Avenue Close collapsed during the year: there is urgent need for redeveloping the whole of this area. The Town Clerk is notified if the statutory notice is not complied with, and he arranges for the work to be done either by informal action or by Court Order, or by agreement under Section 275 of the Public Health Act, 1936. The work of carrying out repairs was referred to the Borough Engineer in default of the owners in 105 instances, but the work was subsequently carried out by the owners in 23. Some owners pleaded that delay was due to the War Damage Commission, but the Town Clerk communicated with the War Damage Commission and they replied that they did not give prior approval to works of war damage in most cases, and therefore the work required by sanitary notice should be carried out without delay. The Council asked the War Damage Commission to expedite all war damage claims on properties where sanitary notices were involved. Some owners delayed as long as possible complying fully with the statutory notice by carrying out sporadically small amounts of work over a period of time, thus causing unnecessary inconvenience to the tenants. The Committee instructed the Town Clerk to institute legal proceedings with the full statutory penalty in any such cases referred to him by the sanitary inspector. Although the number of complaints during 1949 was less than that in 1948, the work of the Sanitary Inspectors' Department increased; the additional staff made more frequent re-visits with a speeding up of the procedure. There was also an extension of the work of inspecting factories and food premises. The total number of inspections and re-inspections for 1949 was 40,097, an increase of 3,535 on 1948. In July, a deputation of tenants was received by the Committee concerning the housing conditions in Carlton. The deputation referred generally to the condition of premises in the area, and in particular to the danger to children from the lack of area railings. They also complained of the piecemeal efforts of landlords in remedying extensive sanitary defects in some properties, and they requested the Committee to intensify their efforts to improve housing conditions in Carlton. The Committee considered these matters and dealt with them. Because of the difficult housing situation, the Committee could not take any wide scale action under Sections 57-59 of the Housing Act for the abatement of overcrowding. The population in 1949 increased from 179,900 to 181,120; the number of houses and flats erected was as follows: Houses erected by private enterprise 3 Houses erected by local authority 54 Flats erected by local authority 38 Total number of applicants on Council's waiting list at December 31st, 1949 8,372 In order to avoid the provisions of the Rent Restrictions Act, some landlords commenced actions under Section 59, to evict tenants who had permitted overcrowding in their premises. This would have resulted in the eviction of a considerable number of families, and therefore the local authority sent a deputation to the Minister to explain the difficulties which would arise. The Minister of Health, under Circular 17/49, dated March 16th, 1949, asked the local authority to issue licences for periods not exceeding 12 months, authorising the temporary use of houses by persons in excess of the permitted number. The Committee instructed the Medical Officer of Health to report to the Chairman any case of a landlord attempting to evict tenants because of overcrowding offences, and at the same time to advise the tenants of their right to apply to the Council for the issue of a licence permitting the overcrowding. In two instances the Court drew the attention of the tenant to the provisions of this circular and refused to make an eviction order until the tenant had made an application to the Council; in both instances a licence was granted. Three licences were granted during the year. SMOKE NUISANCE. The whole question of smoke nuisance from the power stations in Willesden was brought to the limelight in February, 1949, by the public enquiry which was held by an inspector of the Ministry of Fuel and Power on the British Electricity Authority's plans for the proposed extension of the Acton Lane Power Station. The Council has received complaints of nuisances from smoke, soot, grit and sulphur from the three power stations in Willesden over a period of 20 years. Certain improvements have been effected by co-operation between the sanitary inspectors and the engineers at the power stations, and by the service of statutory notices for the abatement of smoke nuisances in some instances. Nevertheless, the nuisances continued throughout the years. About 20 years ago some of the chain grate furnaces in the Taylors Lane Power Station were converted to pulverised fuel furnaces and an assurance was given that this would practically eliminate any nuisance from smoke or grit. It was estimated that the much finer grit emitted from the pulverised fuel furnaces would be dispersed over far wider areas. Unfortunately, this theory did not work out in practice, and the food, clothes and homes of the people were invaded by large quantities of very fine grit. The Council therefore made further strong representations, and an electro-static precipitator was installed to arrest the fine grit. The Electricity Authority claimed that the smoke nuisance had been abated because 85 per cent of the grit was being extracted by this method, but the remaining 15 per cent of the grit which was cast out into the atmosphere continued to plague the neighbouring inhabitants. The power station was partially reconstructed a,nd equipped with modern grit-arresting machinery during the war, and although there has been some improvement, grit is still frequently cast out, and the nuisance is made worse by the water vapour emitted from the cooling towers. The nuisances arising from Acton Lane Power Station have been even worse than those from Taylors Lane. They have not been improved by the fact that the power station is situated on low ground close to a large railway junction in the centre of a large factory area. This station has been a constant source of nuisances during the last 20 years, often belching forth smoke, grit, sulphurous fumes, and water vapour. In foggy or icy weather, or under conditions when the wind and the humidity of the atmosphere are unfavourable, the surrounding air is heavily charged with smoke, grit, sulphurous fumes, and water vapour, which is not only an intolerable nuisance to the inhabitants of the neighbourhood but a serious menace and danger to traffic. 22 It was therefore with some misgiving that the Council received a notice from the British Electricity Authority that they intended to extend the Willesden (Acton Lane) Generating Station by the installation of (a) One 30,000 kW. M.C.R. turbo-alternator, complete with the necessary ancillary plant; (b) Two 240,000 lb./hr. boilers, complete with the necessary ancillary plant; and the construction of (a) One reinforced concrete cooling tower, having a cooling capacity of 2,250,000 gallons/hr. and a height of 230 ft. (b) The necessary buildings and civil engineering works; and the addition to the existing site of the Generating Station of a plot of land having an area of approximately 3½ acres. The reasons for extending the station were the increasing demand for electricity, the fact that the plant and existing station was reaching the end of its useful life, and the difficulty of finding an alternative suitable site with a constant supply of water and adequate facilities for the delivery of large quantities of coal and for the removal of ashes. The British Electricity Authority also has plans for the extension of Taylors Lane to increase the present output from 70 MW. to 90 MW. The proposal with regard to the Acton Lane Station was to remove the existing old plant as the new plant was installed so that the new station would gradually replace the present one. The Authority promised to take the following precautions to prevent nuisance: (1) Two High Efficiency Multi-Cyclone Grit and Dust Arrestors would be fitted to each boiler. (2) The chimney height would more than comply with the recommendation of the Chimney Emissions Committee and would obviate any nuisance from fumes. (3) The new coal store would not be any nearer to dwelling houses than the present coal store. All the handling operations of the coal from the railway wagons and into the station would be under cover to obviate dust nuisance. (4) The cooling towers would be liberally rated up to the highest modern standards, and consideration would be given to a design of the Irrigation System which would reduce, even further than present-day designs, the possibility of the precipitation of moisture from the towers. It was also proposed to couple all the towers to a common intake culvert so that the heat burden on the towers was shared whatever the load on the station. (5) The siting of the cooling towers relative to each other would ensure the best performance and minimise the possibility of precipitation. The proposed new towers would be further from the public highways than the existing towers. No definite guarantee could be given with regard to the sulphur nuisance; flue gas washing could not be instituted because it was very expensive and there was insufficient water on the site. The Authority promised to install in the future any newly discovered system to eliminate sulphur if it proved cheaper and more effective than the present methods. In the meantime, the Electricity Authority put their faith in the tall chimneys and the unbiased expert opinions which were satisfied that no nuisance from fumes could arise from them. The Council became alarmed at this new development, for they had previous experience of the British Electricity Authority's interminable delays in making any improvements. A sub-committee had been appointed in June, 1948, to attend informal meetings with the British Electricity Authority and the London Transport Executive to try to obtain improvements in the nuisances created by the various power stations. Several meetings were held under the chairmanship of a representative of the Ministry of Health, but, apart from general promises of action for the future, no practical progress was made. This sub-committee was instructed to protest against the extension of the power station in a residential area and, as a minimum, to obtain an assurance that before any construction commenced, all modern methods would be included to avoid the serious nuisance that the neighbourhood had suffered for many years. They were to press for an undertaking that effective grit-arresting plant and smoke and sulphur controlling equipment would be installed. Following these protests, the Minister of Fuel and Power held a Public Inquiry at the Acton Town Hall on February 22nd, at the Willesden Town Hall on February 28th, and at Gibbons Road School in the evening of the same day in order to give the public an opportunity to give evidence. The Willesden and Acton Councils were represented jointly by Counsel. At the inquiry the experts of the Electricity Authority stated that the present plant was nearing the end of its natural life and was out of date and unsatisfactory. They agreed that certain promises made to the Willesden Council were not carried out; because of lack of materials. The witnesses representing the public complained of the contamination of their food, the difficulty of keeping their homes clean, the rotting of their curtains, the failure to grow flowers in the gardens, and the general effect on their health: sulphur-gas fumes irritating their lungs and particles of grit entering their eyes. Some of the witnesses produced packages of grit which they had swept from their window ledges and from their attics. The Council pressed for the new station to be built in the open country, but if the Minister sanctioned the extension of the Acton Lane Power Station an assurance should be given that the existing plant would be taken completely out of use by a definite date and special up-to-date equipment installed to reduce the atmospheric pollution to a minimum. By an instrument dated September 28th, 1949, the Minister of Fuel and Power approved the extension of the Acton Lane Power Station, and the following assurances were obtained from the British Electricity Authority: (1) The whole of the existing plant would be taken out of commission by the end of 1959, or such later date as might be approved by the Minister; (2) The total output of the station would not at any time without the Minister's consent exceed 180 MW.; and (3) The cooling towers would be liberally rated up to the highest modern standards and all the towers would be coupled to a common intake culvert so that the heat burden of the towers would be shared whatever the load of the station. 23 The Council were, however, disappointed that the installation of a sulphur elimination plant was deferred until the Minister decided that it was reasonably practicable to provide it. The Council therefore asked the Minister to require the installation of a sulphur elimination plant at the earliest possible date. The Minister replied on November 23rd, 1949, that with the new high chimneys it was unlikely that any small quantity of sulphur which might be discharged in the atmosphere would be harmful to people and materials, and he felt that the Electricity Authority should not be involved in the increased costs of installing gas washing plants until there was evidence that a nuisance would arise from the extension of the power station. The Minister would, however, give fullest consideration to any representations which would be made to him by a responsible authority after the new plant was working. An indication of the difficulties that have arisen with the present power station at Acton Lane is given in the following typical reports of the Sanitary Inspector, dated May 20th, 1949, and July 12th, 1949: "20.5.49. P. M. Dense smoke coming from several short stacks. Visited station and saw Mr. Dobson, Chief Engineer, and Mr. Butter field, Deputy Chief Engineer. Washing plant is entirely out of action for the time being. Two chambers are badly in need of repairs, one is already being repaired and the fourth has not yet been completed. The roofs of two chambers which had collapsed and had been temporarily covered with corrugated iron. In addition, the main flue to the northern half of the station was undergoing repairs because the roof had collapsed in a number of places. Work was proceeding and some gas washing should be done in a few weeks. The whole of the repairs would take at least two months." " 12.7.49. 3.20 p.m. Dense smoke from North end boilers. Mr. Dobson stated these boilers were being pushed because of a breakdown on the high-pressure boilers which would not be repaired for a few days. Conditions were aggravated by the quality of coal which was very poor at present. * Repairs to the main flues and washing chambers should be completed in about a month." The problem of smoke nuisances from power stations is one confronting health authorities in many parts of the country. It may be necessary, as a matter of economics, that electricity should be produced in greater quantities an 1 at a low price, but it is essential that the health of the people should not be sacrificed in the process, otherwise the money saved in the cost of production of electricity will be spent in dealing with the harmful effects of the polluted atmosphere on both people and materials. It has been estimated that the smoke nuisance costs the country £80,000,000 per year. Bombed Sites: The number of bombed sites in the Borough is 100, and during the year residents living close to these bombed sites again complained of nuisances. Notices were served on the owners where nuisances, as defined under Section 92 of the Public Health Act, 1936, existed. Where the owners could not be traced, offensive material was removed by the Borough Engineer and rats were destroyed by the Rodent Officer. The Council now have a programme to clear up these sites and prevent the recurrence of nuisances. Disinfestation: The sanitary inspectors inspect verminous premises and supervise the work of the disinfectors employed by the Council. Furniture of tenants moving into new Council dwellings is disinfested by contractors; bedding materials are disinfested at the steam disinfectors at the Neasden Hospital. (a) Disinfestation of Verminous Premises: Number of primary inspections of verminous premises by sanitary inspectors 174 Number of re-inspections of verminous premises by sanitary inspectors 262 Total number of properties dealt with by disinfestors 226 Number of private premises supervised by sanitary inspectors 174 Number of Council properties supervised by Housing Department 52 Number of verminous rooms disinfested under Council's Scheme 453 Number of verminous rooms disinfested by owners 31 Total number of verminous rooms disinfested 484 *Some rooms are treated more than once. (b) Disinfestation of Possessions of Tenants moving into new Council Dwellings: Number of furniture disinfestations 94 Number of premises disinfested by H.C.N. — (c) Number of Loads of Bedding Disinfested at Neasden Hospital 36 (d) Miscellaneous Disinfestations: Number of treatments for beetle infestations in canteens, etc. 18 Number of treatments for wasp infestations 6 Number of treatments for ant infestation 16 24 Rodent Control: Rodent control, as approved by the Ministry of Agriculture and Fisheries (Infestation Branch) has been carried out at the following properties: Total number of premises treated 628 New agreements 19 Renewal of agreements 60 Business premises 81 Borough Council properties 16 Private dwellings 452 The cost of disinfestation at business premises is recovered from the occupiers, and amounted to £762 13s. 11d. The service is free to occupiers of private dwellings, but the Borough Council recovers 50 per cent of the cost in grant aid according to the terms of Circular No. N.S.I9. The total cost in 1949 was £583 18s. 9d. The work of rat disinfestation in the sewers is carried out by the Engineer's Department. Where outbreaks of rats have been detected in defective drains and nests of rats are suspected in the sewage system, co-operation has been obtained from the Engineer's Department in deciding whether to break open pavements. There has been a general increase in the work of disinfestation; 7 per cent in business premises and 32 per cent in private dwellings. Owing to the increase in the volume of work, an additional operator was engaged in June last, making a total of four for surface disinfestation. INSPECTION AND SUPERVISION OF FOOD. Unsound Food: Section 10 of the Food and Drugs Act, 1938, makes provision for the examination of food and the seizure of unsound food. The food trader usually calls in the sanitary inspector when he suspects that he has been supplied with unsound food, because he can obtain a credit note from the supplier if the sanitary inspector condemns the consignment as unfit for human consumption. Owing to general food shortages there is a greater temptation to market foods of doubtful quality. In view of this fact, it is unfortunate that in the sale of meat and bacon the responsibility of determining whether the food is fit for consumption is placed on the retailer; he is instructed to return all meat and bacon which he considers unsound and retains the remainder for sale to the public. The burden of making this decision is increased by the fact that his experience and training in detecting unsound food is generally not as extensive as that of the sanitary inspector. Fortunately, he often recognises his limitations and consults the sanitary inspector when he is in doubt. The public can play an important part in the campaign to prevent the sale of food unfit for human consumption, and they make greater use of the services of the Public Health Department as they become more aware of the dangers of unsound food. There has therefore been an increase in the work of the sanitary inspectors, and the following table gives a summary of the foodstuffs condemned as unfit for human consumption during the year 1949. In comparison with the previous years, the amounts have considerably increased. The fish and meat figures are almost twenty times, and poultry four times, those of 1937 and 1938; there has been a marked increase in the amounts of all the varieties of tinned foods. The only significant reduction is in the quantity of bacon. It is difficult to determine whether this is due to the fact that less bacon is being marketed, or the general quality supplied has improved, or that bacon of doubtful quality is reaching the consumer. It is to be regretted that so much food has to be condemned while there is a general scarcity but it is essential to protect the public from the dangers of unsound food. In addition, food of good quality has occasionally been spoilt by the insanitary conditions and careless handling in food premises; insects, cigarette ends, a lead pencil and pieces of glass have all been found in articles of food. The Gladstone Branch of the Amalgamated Engineering Union passed a resolution to the Council complaining of the unhygienic conditions in the sale of food locally. It is hoped that the activities of the Willesden Hygienic Food Committee will help to improve the conditions under which food is sold in the Borough. Food Unfit for Human Consumption: Meat: 1949 1948 1938 Bacon 101 lb. 284 lb. 295 lb. (1,020 lb. in 1937) Cooked 77 lb. 269 lb. - Tinned 1,520 tins 2,799 tins 965 tins Raw 4,968 lb. 2,488 lb. 262 lb. Fish: Tinned 1,584 tins 4,084 tins - Raw 4,349 lb. 7,165 lb. 222 (wet and dried) Vegetables: Tinned 3,271 tins 4,166 tins - Raw - - - Fruit: Tinned 1,813 tins 2,892 tins - Raw 279 lb. 1,359 lb. 111 lb. Bread, flour, cereals, etc 8,774 lb. 1,936 lb. - Preserves 689 lb. 3,889 lb. - Cheese 409 lb. 101 lb. - Butter and fats 11 lb. 53 lb. - Eggs 2,737 eggs 4,254 eggs - Tinned milk 5,071 tins 3,896 tins - Soups 269 tins, 1,248 packets 462 tins -- 25 Miscellaneous: 1949 1948 1938 Dried egg 28 lb. 2,020 lb. - Sugar 279 lb. 145 lb. - Fruit juice 38 tins 36 bottles - Tomato ketchup 3 bottles 984 bottles - Tomato pulp 9 tons 17 cwt. 76 lb. 67 tons 20 lb. - Christmas pudding 26 23 - Rabbits 621 lb. 34 lb. - Meat pies 71 1 - Dates 70 lb. 10 boxes - Pickles 55 bottles 2 bottles - Chocolate spread 47 cartons 17 tins - Spaghetti 237 tins 29 tins - Biscuits 10 lb. 65 lb. - Poultry 478 lb. — 142 lbs. Sauce 48 bottles — -- Chutney 91 bottles — - Syrup 458 lb. — - Tomato juice 2 tins — - Meat loaf 104 lb. — - Salad dressing 33 bottles — — Apple puree 1 tin — — Coffee and chicory essence 2 bottles — — Oatmeal 32 lb. — — Cereals 476 packets — — Offal 44 lb. — — Chocolate malt spread 45 cartons — — Gherkins 17 barrels — — Sultanas 30 lb. - — Currants 50 lb. - — Chocolate — 112 lb. — Fish paste — 9 tins — Sweets — 28 lb. — Cocoa powder — 224 lb. — Fish cakes — 207 — Coffee — 1 lb. — Golden syrup — 13 tins — Sausages—meat — 22 lb. — Meat puddings — 3 tins — Potted meat — 14 tins — Pastry mixture — 2 packets — Tea — 12 lb. — Chickens — 50 lb. — Sponge mixture — 1,320 packets — Haggis — 3 — Macaroni — 154 lb. — Meat lunch — 15 tins — Tinned rabbit '— 27 tins — Tinned turkey — 2 tins — Nuts — 19 lbs. — FOOD AND DRUGS ACT, 1938—SECTION 14. Ice Cream Premises Registered: Storage Manufacture for Sale Number of premises registered at December 31st, 1948 17 147 Number of premises registered during the year 1949 2 51 Total number of premises registered at December 31st, 1949 19 198 Premises Registered in connection with the Manufacture of Preserved Food, etc. During the year, two applications for the registration of premises for the sale and storage of preserved food were received; registration was granted in each case. Milk and Dairies Regulations, 1949: Number of dairymen on register (premises in Willesden) 123 Number of premises 142 Number of dairymen selling milk in Willesden from premises outside Willesden (supplementary licences) 10 26 Number of licences issued: Premises Premises in outside Willesden Willesden Pasteurised milk 61 7 Sterilised milk 72 3 Tuberculin Tested milk (heat treated milk not subject to licensing) 37 7 Total number of licences issued 170 17 Number of inspections made 298 During the year the interior walls and ceilings of 12 premises were cleaned after verbal intimation had been given without the service of formal notice. In 3 of these cases the defects were found during the year 1948. Food Poisoning: Although there was no serious outbreak of food poisoning reported during the year, there were 20 suspected cases. Thorough investigations were made in all these cases, and, where it was available, suspected food was collected and sent for bacteriological examination. It was impossible to establish with certainty the actual cause of infection in any of these cases, but the bacteriological reports showed that the food was contaminated. Owing to the time interval between the occurrence and the notification of a case, and the length of time required to make bacteriological examinations, it is often very difficult to determine the actual origin and spread of the germs. Four persons were taken to hospital suffering from gastritis following a meal of fish and chips. The cause of the illness was probably due to palm kernel oil used as a substitute for frying oil. Food is often contaminated in the home due to unsatisfactory methods of storing, preparing and serving. At the present time the facilities for storing, cooking and serving food in many homes are very poor, and bad housing conditions are often responsible for increasing the risks of food poisoning. Many families are living in one or two-room flats which are not provided with a well-ventilated larder. Special attention has therefore been given to the provision of properly ventilated food stores when Housing Act notices have been served. Lack of adequate washing facilities in the home makes it difficult to maintain a satisfactory standard of personal cleanliness; dirty cooking utensils, dirty plates and dirty food are not always due to lax and careless habits : they are often due to the absence of wash basins, sinks and hot water. This makes it almost impossible for even the most conscientious to maintain reasonable hygienic standards in the preparation and service of food in the home. The improvement in housing conditions with the provision of adequate washing facilities is an essential step in the prevention of ill health caused by infected food. Clean Food Campaign: The Willesden Hygienic Food Committee, which was first formed in May, 1948, and expanded in September, 1948, by the addition of six representatives of the Borough Council, continued its work of improving the hygienic standards of the preparation and distribution of food in the Borough. To prevent the spread of infection by contaminated food, it is essential to start with fresh, good quality food, and ensure that the utmost cleanliness is maintained in its preparation and distribution to the customer. Contamination of the food before it reaches the customer may lead to widespread epidemics involving many people. The campaign for clean food does not stop, however, with the traders; food can become contaminated in the home and spread disease in the family. Three major tasks confronted the Committee. Firstly, they had to encourage the food traders to improve the facilities in their premises for the clean handling of food. Secondly, they had to train food employees to appreciate the dangers of dirty and careless handling of food; and lastly, they had to educate housewives to prevent the spread of food poisoning germs in the home. The first task was probably the most important, for it was impossible to encourage employees in the food trade to maintain a high standard of cleanliness if there were inadequate washing facilities and insanitary conditions in the shop, canteen or preparation room. The Borough Council has statutory duties under Section 13 of the Food and Drugs Act, 1938, for the precautions to be taken to prevent the contamination of food in rooms where food is prepared or stored prior to sale. The Committee were anxious to stimulate the trader to set his own house in order and to avoid statutory action as far as possible. With this end in view, standard codes of practice for the hygienic preparation of food were drawn up by the Committee for each trade, and certificates of registration were issued to food traders who conformed to the appropriate code of practice. The traders were asked to display the certificates on their premises to encourage the public to give their custom to them as owners of approved premises. A fee of 10s. Od. was payable on registration; the certificate was renewable annually and subject to withdrawal in the event of non-compliance with the code. In March, 1949, approximately 1,400 traders were circularised, inviting them to apply for registration within a period of one month in the first instance. This period was chosen by the Committee so that all traders who were anxious to join, would have the opportunity of receiving their certificates on the same day—234 applications were received in the first month and certificates were issued to 154 traders—52 applications were rejected, and the remaining 28 traders were informed of the minor alterations and improvements which were required to bring their standards to the level of the code of practice. Table 1 is a summary of the improvements effected following inspections made after applications for certificates. Four of the sanitary inspectors attended a special course on food hygiene and food poisoning, and in the course of their inspections were able to give valuable advice to the traders on the hygienic handling of food. 27 The Committee continued to invite applications for registration in the subsequent months, but the response was rather disappointing (see Table II). This was partly due to the initial charge of 10s. Od. and to the fact that some traders knew that their standards were unsatisfactory and it would cost money to raise them. As usual, those who required most attention from the Public Health Department did not avail themselves of the advice and assistance offered. Visits by sanitary inspectors were not confined, however, to those who had made application for registration, and special efforts were made to improve establishments where the standards were low (see Table III). The following were examples of unsatisfactory premises: (1) An underground bakehouse, dark, dirty, with restricted accommodation, had a leaking glass roof covered with cobwebs dripping dirty rainwater on to baked products; (2) A kitchen where cooked meats were being prepared had a water closet as part of the kitchen opening directly into it; (3) A food factory with indescribably dirty walls, floors, and ceilings, had collections of refuse on the floor, restricted accommodation, grossly inadequate washing and sanitary facilities, and inadequate space for storage of dust-bins. The operation of Section 13 of the Food and Drugs Act, 1938, was handicapped by the fact that Subsection (h) dealing with the cleanliness to be observed by food employees was too general in character. Bye-laws under Section 15 of the Food and Drugs Act, 1938, which extended the provisions of Section 13 (h), were adopted by the Council and came into operation on March 1st, 1950. These bye-laws give details of the measures required to ensure cleanliness, and exclude those who are carriers of disease from handling, wrapping, or delivering food. Special conditions for the clean handling of food are made for stallholders and "barrow boys." The bye-laws also extend Sub-section (i) of Section 13 of the Food and Drugs Act, 1938, for washing facilities by requiring a notice to be fixed near every sanitary convenience requesting employees to wash their hands after using the convenience. The provision of adequate washing facilities is still, however, vague and there is no clarification of Sub-section (i) which refers to "suitable" washing basins within "reasonable" distance of the room, and a "sufficient" supply of soap, clean towels and clean water, both hot and cold. It is with regard to these qualifying adjectives that the main differences arise with the food traders, and it is felt that in certain specific instances it will be necessary to apply to a Court of Law in order to obtain a correct interpretation. In January, 1949, the Borough Council recommended that all food handlers should be afforded washing facilities free of charge at all public conveniences, but this recommendation has not yet been carried out in practice owing to the inadequacy of washing facilities in the public conveniences. The appeal to the employees has been mainly through posters, and in this respect, those supplied by the British Tourist and Holidays Board have been most helpful and have been widely distributed. Lectures of about 10 minutes' duration with opportunities for questions have been given by the sanitary inspectors to all the kitchen staffs in the school canteens, but little encouragement has been received from the food traders for the extension of this service to the staffs of factory canteens, restaurants, etc., even though the public health staff were willing to fit in with any arrangements the managements were prepared to make. Leaflets and pamphlets have been issued to the housewives, and a special leaflet was prepared by the Willesden Hygienic Food Committee for distribution to housewives by the food traders who possess the certificate of registration. Lectures with film shows and film-strips were arranged for groups of housewives and the work in this respect is to be considerably expanded in the coming year. During the whole of the campaign an antagonism between the housewife and the food trader has been noticeable; each has tended to accuse the other as the sole source of the spread of germs through food. One of the objects of the campaign was to neutralise this antagonism and prove that both have a part to play in the clean food campaign in encouraging and assisting the lax trader and the careless housewife in mending and improving their habits. 28 Table I. WILLESDEN HYGIENIC FOOD COMMITTEE, Improvements Effected following Inspections for Certificates. Walls and Ceilings Cleansed Walls and Ceilings Redecorated Lighting Improved Ventilation Improved Constant Hot Water Provided Hand Washing Facilities Improved Sanitary Accommodation Improved Unprotected Foods Covered Unsatisfactory Clothing Improved Equipment and Storage Towels made Satisfactory Total Improvements made Bakers - - - - 1 1 - - 1 1 - 4 Butchers 4 4 1 - 5 7 - - - 1 7 29 Cafes, etc 6 6 - 3 6 9 6 - - 2 8 46 Grocers 4 5 - 1 6 3 3 2 - - - 24 Ice Cream and Sweets - - 1 1 5 - 2 2 - 1 - 12 Fish Shops 3 2 - - 2 2 - - - - 1 10 Greengrocers 3 3 - - 2 - 1 - - - - 9 Totals 20 20 2 5 27 22 12 4 1 5 16 134 Table II WILLESDEN HYGIENIC FOOD COMMITTEE Report on Applications for Registration from March 16th—December 31st, 1949 Number of Applications received 263 Number of Premises Registered and Certificates issued 195 Number of Applications deferred or refused 68 Summary: Trade Number in Borough Applications Received Approved and Certificate Issued Deferred or Refused[/##3] Bakehouses 36 15 8 7 Butchers 118 28 20 8 Cafes and Restaurants 450 59 41 18 Dairies 105 8 8 - Fishmongers and Fish-fryers 49 20 14 6 Greengrocers and Fruiterers 127 8 3 5 Grocers and General Stores 434 86 69 17 Ice Cream and Sweetshops 435 39 32 7 Totals 1,754 263 195 68 20 Table III: Food Shops Inspected (other than those applying for Registration under Food Hygiene Scheme), 1949: Trade No. of Premises Visited Walls and Ceilings Dirty Lack of Ventilation Insufficient Refuse Accommoda tion Water Closet Accommoda tion Unsatisfactory Lack of Suitable Handwashing Facilities Trays, Fittings Dirty Drain Inlet in Building Clothing Dirty Insufficient Towels Vermin Total Baker 11 4 4 1 5 4 4 1 1 1 2 27 Butcher 35 33 1 3 6 3 5 1 - 3 - 55 Cafe and Restaurant 43 31 6 2 9 10 7 - 2 7 - 74 Dairy 7 1 -- - -- -- - - - - - 1 Fishmonger & Fish-fryer 18 10 -- - - 3 1 - - - - 14 Greengrocery and Fruit 9 7 - 4 1 2 - - - - - 14 Grocery and Provisions 56 37 1 - 1 3 - - - - - 42 Sweets and Ice Cream 11 2 - - - 1 - - - - - 3 Totals 190 125 12 10 22 26 17 2 3 11 2 230 REPORT ON FACTORY INSPECTION. The Factories Acts, 1937-48, have three main weaknesses. Firstly, they do not cover all factories; there are 11,000,000 persons who are not protected by the Acts: domestic workers, transport workers, office workers, electricians, painters, employees at cinemas and theatres, etc. Secondly, there are not enough factory inspectors to supervise the factories adequately. In 1948 the Ministry of Labour employed fewer than 400 factory inspectors to supervise over a quarter of a million factories; Willesden shares a staff of three factory inspectors with Paddington. Lastly, the local authorities with their specialised staff of sanitary inspectors have very few duties in respect of factories. The Willesden Borough Council has duties in the supervision of outworkers and basement bakehouses, the provision of sanitary conveniences in the case of all factories, and the supervision of cleanliness, overcrowding, temperature, ventilation, and drainage of floors in the case of factories in which mechanical power is not used. The local authority is also responsible for certifying that the provisions for escape in the case of fire are suitable. In brief, apart from the elementary duties of supervising the lavatory accommodation, the local authority has little power in the supervision of the large majority of factories, i.e., where mechanical power is used. Supervision of Sanitary Accommodation: The Council must see that sufficient and suitable sanitary conveniences, well-lit and separate for the sexes, are provided in all factories and that they are maintained and kept clean. The Sanitary Accommodation Regulations, 1938, also laid down rules of ventilation, privacy, screening, positioning, proper doors, and fastenings for the lavatories. There are 771 factories in the Borough of Willesden, 698 using mechanical power and 73 non-mechanical. The greater number of factories are in engineering (128), motor and cycle repair (71), dressmaking (60), and food manufacture (49). The factories vary in size from the employment of less than five persons to more than 1,500, the larger factories being in engineering, food manufacture, and printing. The majority of the factories are medium to small in size; more than half employ less than ten workers and less than one in ten (68) employ more than 100 workers. Some of the factories, especially in the Willesden Green area, are in converted houses or backyards. There are three main industrial areas in Willesden: (i) the north-east end of the North Circular Road area, (ii) the Park Royal area in the Stonebridge Ward, and (iii) the Church End area, where the main factories are British Thomson-Houston and Hall Telephone Accessories. In addition, there are 658 outworkers, the greatest number (285) employed in the making of clothes. 30 Factories with Mechanical. Power: A survey was made of all the factories in June, 1949, and 477 or approximately 70 per cent of the mechanical power factories were found to comply satisfactorily with the Sanitary Accommodation Order; 204 (about 30 per cent) were not entirely satisfactory. Defects Remedied in 125 Factories: Character of Defects Number Found Number Remedied Sanitary Accommodation: (a) Insufficient 10 9 (b) Unsuitable or defective 179 179 (c) Not separate for sexes 4 2 Total 193 190 The majority of the factories which were situated in converted premises failed to comply with the Order. Some of the buildings which have been adapted as factories were never meant to be used as such, and they can never be made satisfactory. Some have suffered war damage and have been rebuilt, but they are reinstated to their pre-war condition, which, in some cases, is regrettable. Factories without Mechanical Power: These are factories which the local authority is required to supervise for: (a) cleanliness, (b) overcrowding, (c) temperature, (d) ventilation, (e) drainage of floors, and (/) sanitary conveniences. 23 of the 73 factories, or approximately 30 per cent, satisfactorily complied with the Factories Act, 50, or approximately 70 per cent, did not comply. Of these 50, 10 were considered totally undesirable, 18 required a considerable amount of work to bring them up to a reasonable standard, and 22 had only minor defects. The non-mechanical power factories, like many of the smaller mechanical power factories, are generally situated in converted premises. Defects in 38 Factories: Character of Defects Number Found Number Remedied Want of cleanliness 11 8 Overcrowding 1 1 Unreasonable temperature - - Inadequate ventilation 3 3 Ineffective floor drainage 3 2 Sanitary Conveniences: (a) Insufficient 8 7 (b) Unsuitable or defective 32 31 (c) Not separate for sexes 1 1 Total 59 5.3 The number of factories which appeared to contravene the provisions of the Town and Country Planning Act was 46, and these were referred to the Borough Engineer; 35 of these were found to be contravening the Town Planning Act, and appropriate action was taken in every case. Six factories which were considered completely unsatisfactory were reported to H.M. Factory Inspector. No action, however, was taken under Section 4 of the Factories Act, 1948, which gives the Factory Inspector power to seek an order from a Court of Summary Jurisdiction to close factories in premises which prima facie do not permit of the conduct of work or processes with due regard to the safety, health and welfare of the workpeople. 31 Underground Rooms: At December 31st, 1949, there were 20 underground rooms in use as factories, 3 non-mechanical and 17 mechanical: 16 of the 17 underground factories were part of larger premises. Defects were found in 10 of the 17 mechanical factories; the water closet accommodation was insufficient in 2 of these factories; an additional water closet has been installed in one and a notice has been served upon the owner in the other. The other defects included insufficient lighting, insufficient ventilation and want of cleansing; a verbal notice was given at the time of inspection in two of the factories. The 3 non-mechanical factories have now ceased to operate. Factory owners have criticised the procedure where two sets of officials, factory and sanitary inspectors, visit the same premises. The sanitary inspector, restricted to the supervision of sanitary accommodation in mechanical factories, cannot maintain a keen interest in this work. The sanitary inspector is as well qualified to supervise the various requirements in mechanical factories as in non-mechanical factories and could have technical assistance in the more difficult cases. The numbers of sanitary inspectors would also make it possible to have better and more frequent supervision of factory premises. The fact that the local authority would be responsible for the supervision of factory premises would lead to better control of the safeguards for preserving the health and welfare of the workers in the factories. Classification of Factories Power Non-power Total Builders 7 5 12 Basket makers 1 1 2 Body and coach builders 17 - 17 Bottle-washing 2 - 2 Boot and shoe repairs 47 8 55 Brewers and bottling of beer, etc. 3 — 3 Brush makers 2 -- 2 Bedding and mattresses, etc. 9 - 9 Brass and other metal foundries 7 - 7 Cameras and optical instruments 5 - 5 Cosmetic manufacturers 6 - 6 Chocolate and sweet makers 2 - 2 Coffin makers 3 1 4 Cleaners and dyers 8 2 10 Cardboard box makers 2 - 2 Denture and dentist requisites 5 - 5 Dressmakers, tailors, etc. 58 2 60 Dolls, toys and fancy goods 21 2 23 Display works 2 - 2 Engineers—electric 37 2 39 Engineers—mechanical 89 - 89 Enamel plate manufacturers 1 - 1 Furniture and upholstery 10 2 12 Food factories (bakehouses, etc.) 49 - 49 Florists - 7 7 Glass workers, glazing, etc. 9 1 10 Gas manufacturers and workshops 1 3 4 Kitchen equipment, etc. 7 - 7 Furriers 3 1 4 Laundries 24 2 26 Leather goods (handbags, etc.) 12 - 12 Motor and cycle repairers 60 11 71 Motor accessories, etc. 12 - 12 Meters and instruments 10 - 10 Motor tyre repairs and retreading 7 - 7 Plating and polishing 9 - 9 Plastic goods 5 3 8 Paint and varnish makers 4 1 5 Paint and cellulose spraying 6 - 6 Pen, pencil and stationery makers 5 - 5 Printing, bookbinding, etc. 36 4 40 Photographic materials, etc. 9 2 11 Packers and warehouse 5 5 10 Opticians and lens grinding 9 - 9 Roof and sealing compounds 2 - 2 Scrap metal dealers, etc. 2 - 2 Shop fitters 2 - 2 Silversmiths 2 - 2 Sheet metal workers, etc. 15 - 15 Stonemasons 5 2 7 Sports goods, etc 4 - 4 Spring makers 7 — 7 Tool makers 4 - 4 Tiled fireplaces, etc. 5 1 6 Watch and clock repairers, etc 4 4 8 Woodworkers and joinery 20 1 21 Totals 698 73 771 32 Grouping of Factories: Firms employing: 1 to 5 319 6 to 10 125 11 to 25 132 26 to 50 70 51 to 100 57 101 to 200 35 201 to 300 12 301 to 400 3 401 to 500 6 501 to 750 6 751 to 1,000 1 1,001 to 2,000 5 Total 771 Names of firms employing 201 to 300: 12— Pritchards, Ltd., Alric Avenue 228 Ilfords, Ltd., Park Royal 252 U.D. Engineering Co., Ltd. 282 Park Wards, Coachbuilder 228 Luxfer, Ltd., Waxlow Road 225 Waterman Pen Co. 210 Gas Light and Coke Co. 253 Mickleover Transport 274 Thrupp & Maberley 275 Royal Society for Teaching the Blind 258 Patent Die Castings 206 Power Co., Taylors Lane 246 301 to 400: 3— Lyons, Park Royal 389 Mono Containers 350 McVitie & Price 400 401 to 500: 6— Lancashire Dynamo Crypto 418 Normands, Ltd. 412 Ascot Water Heaters 413 London Power Co., Acton Lane 402 Aron Electric Meters 459 Hall Telephone Accessories 492 501 to 750: 6— Electroflo, Park Royal 618 Rolls Razor Co., Ltd. 657 Mabie Todd & Co. 565 Addressograph 536 Kemps Biscuit Works 750 Water lows 600 751 to 1,000: 1— Guinness' Brewery 808 1,001 to 2,000: 5:— Park Royal Coach Works 1,808 Heinz Ltd. 1,950 B.T.H. Ltd. 1,167 Smith's, Cricklewood 1,972 M/A 2 Smiths, North Circular Road 1,110 Noise: There has been an increase in the number of complaints from residents concerning noise from factories. There are two main factors to account for this increase. Firstly, many factories are now working late hours in conformity with the export drive, and secondly, new machines causing a greater amount of noise and vibration have been installed and parts of old machines have become worn out and have not been replaced. The public have become more conscious of the effects of noise and vibration, and although they expect some intermittent noise in industrial areas,—noise of traffic, noise from radio sets and their neighbours, etc.,—they have found the constant noise and vibration from some factories unbearable, especially when it has disturbed their sleep. The public have one of two remedies for the abatement of noise nuisance: as private persons they may apply to the Court for an injunction to abate the noise; This may be an expensive procedure, however, and they usually adopt the alternative of asking the local authority to take action under the Middlesex County Council Act of 1944. Section 313 of this Act gives the local authority power to deal with noise as a statutory nuisance, except in the case of a railway company, the Transport Board or any statutory undertaking. To constitute a nuisance, the noise must be excessive or unreasonable and must be injurious or dangerous to health. It has not been easy to determine in a particular case whether a noise was injurious or dangerous to health, but guiding principles have been if the noise has unduly disturbed sleep or caused a marked amount of vibration in the living rooms. Difficulties have arisen where the person complaining has been of a nervous temperament and therefore more susceptible to noise, but fortunately there have been other factors in these cases which helped to make the final decision. 33 The decision that the noise is a nuisance, is only the first step in the proceedings, because the person charged has a good defence if he can show that he has taken the best practicable means to prevent or mitigate the nuisance, taking into consideration the cost and other relevant factors. To determine whether the best practicable means have been taken requires an expert knowledge of machinery, of the production of noise and vibration, and of the means required to mitigate them. Fortunately, the firms affected have been very co-operative and two welcomed the advice of a technical expert called in by the Council. One firm made fairly extensive and costly alterations and the nuisance was abated to the satisfaction of everyone concerned. The second firm had not completed the work required by the end of the year, but some improvement had been made. With the considerable invasion of factory premises in the residential areas in Willesden, an increase in the number of complaints is expected, but it is hoped that the co-operation which has been received will continue to the benefit of all parties. Persons in Need of Care and Attention—National Assistance Act, 1948, Section 47: There was an increase in the number of persons who were referred to the department requiring special care and attention. This was due to the increase in the proportion of old persons in the population and to the fact that relatives who were handicapped by overcrowded living conditions found it difficult to look after them. Local authorities responsible for housing have few houses suitable for the aged, and the special care and attention which some of them require, e.g., those who are doubly incontinent, can only be given in special homes or hostels, or in hospitals. There was an acute shortage of accommodation in these institutions during the year, and many relatives, doctors, and voluntary organisations applied to the Medical Officer of Health for assistance. Wherever possible, the special care and attention was given in the person's home by district nurses and home helps with the assistance of health visitors and general practitioners. Nevertheless, there are many aged in the Borough who require institutional treatment, but there is no accommodation for them. Section 47 of the National Assistance Act provides for the Borough Council to make application to the Court to obtain the removal to an institution of any person who is living in insanitary conditions and is not receiving proper care and attention. Owing to the shortage of accommodation in homes, hostels, and hospitals, Section 47 of the Act has not been operated as often as required. The Regional Hospital Board have the responsibility for providing accommodation in hospitals, and the local health authority in homes and hostels. There has been a close liaison with the Hospital Management Committee and most of the difficulties with regard to hospital admission have been overcome since the appointment of a geriatric physician. Excellent working arrangements have been maintained with the local welfare department, but accommodation in hostels for the aged and infirm has become more difficult to obtain. The border-line cases requiring admission present the most difficulties because of the opposing interests of the authorities concerned. Where there is some doubt as to whether an old person is sick or merely aged and infirm, the hospital and local authorities vie with one another in trying to pass the responsibility. The same applies to where an old person's condition alters and a transfer of institution is required. Before the change in administration there could be no dispute, because the local authority was responsible for both types of institution—hospital and hostel. In a few cases the persons died in their homes before Section 47 could be implemented and several of the people who were admitted voluntarily to hospital died within a fortnight of admission. It has been suggested that it would be preferable to leave these people to die in peace in their homes, but they were living under appalling conditions and they would have starved to death if they had not received attention. One person died of starvation within 48 hours of admission to hospital and another person was found collapsed on the floor; he had not had any food for three days. An increase in the general interest of neighbours in their fellow citizens would prevent such disasters, but the first essential is to increase the number of homes for aged persons. Many attempts were made during the year to start a "Meals on Wheels" service, as this would not only benefit the old people, but would save a considerable amount of money in expenditure on the home help service, because the home helpsspend a large part of their time shopping and cooking meals for old people. Although the Borough Council was willing to supply the meals through the Civic Restaurant Service and even give assistance in obtaining suitable vehicles, it was impossible to organise a service as there were not sufficient voluntary helpers to run it. The Borough Council have no statutory powers to organise a service themselves, but may assist financially voluntary workers who are prepared to organise a service. During the year 1948, the necessary Court Order was obtained in one case: a woman of 86 who was removed to Redhill House in March, 1949. She was sleeping on two chairs in most insanitary conditions and was dependent for food on scraps and cups of tea sent in by neighbours. The matter was urgent, as the neighbours had indicated that they would withdraw the little assistance they were giving if the authority took no action. The County Council reported that there was no accommodation available, but the Court declared that an emergency existed, and made an order for her immediate admission to Redhill House. Burial of the Destitute Dead The duty placed on the Council under Section 50 of the National Assistance Act, 1948, with regard to the burial of destitute dead was varied by the issue of Ministry of Health Circular 13 /49 on March 1st, 1949, in which the Ministry of Health asked that hospital management Committees and Boards of Governors of Teaching Hospitals should exercise their powers in the case of: (a) Deceased patients whose relatives cannot be traced; (b) Those whose relatives are traceable but were not, immediately before the patient's death, liable for his maintenance under Section 42 (1) of the National Assistance Act and are not willing to arrange for the burial; and (c) Those whose relatives are unable to obtain a death grant under the National Insurance Act, 1946, and cannot otherwise afford to arrange for burial. 34 These categories include the great majority of patients dying in hospital whose relatives themselves do not arrange to undertake the burial. The contract entered into with a local undertaker to carry out the burial of destitute persons was continued during the year, during which period 18 burials and 4 cremations were arranged. Public Mortuary: During 1949 bodies were deposited at the Mortuary as follows: From Willesden From Acton Total Post-mortems 303 55 358 Post-mortems and inquests 83 19 102 Adjourned inquests 32 - 32 Accommodations 1 - 1 Borough of Willesden With the compliments of the Medical Officer of Health Public Health Department 54 Winchester Avenue Kilburn, N.W.6. . With the Compliments of the Medical Officer of Health BOROUGH OF WILLESDEN. HEALTH DEPARTMENT. 54. WINCHESTER AVENUE, KILBURN. N.W-6 ■