Ac 439(1)WILLESDEN Borongh of Willwsden 19 5 1 THE 76th 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, 1952. 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 1951. I regret to report a setback in the health of the people as shown in the figures available for the year under review. The warning given in the previous report about the possible after-effects of the deterioration in the living conditions—housing and nutrition—seems to have been justified. There was a slight increase in the general and infant mortality, and in the number of tuberculosis cases. There has been a decline in the birth rate, and consequently the population is no longer reproducing itself; although it is, of course, still affected by a fairly large-scale movement of population into and out of the area. The increase in the death rate for cancer is in part probably due to the ageing population and in part to improved diagnosis, but there is also perhaps a rise in the true incidence of the disease. There was a marked increase in cancer of the lung and bronchus, particularly in males; cancer of the breast still remains at a high level and there was an appreciable increase in cancer of the uterus. There would appear to be a need for further health education of the public on the early diagnosis of cancer of organs in accessible sites, such as the breast, uterus, skin, larynx, bladder; since-the favourable prognosis of early treatment may save many lives. Although the winter was not severe and there was no widespread epidemic of influenza, there were striking increases in the deaths from pneumonia and bronchitis. It may well be that these are not unconnected in some way with the smoke nuisances from the power stations in the district. Deaths from accidents, other than street accidents, are probably in a large part preventable and local research into this question could be very helpful in the work of prevention. It is a pleasure to record that there were no deaths from measles, whooping cough, diphtheria or acute poliomyelitis during the year. Although there were no deaths from measles, the fact that there were over 2,000 cases indicates that it still presents an important infectious disease problem. It is significant to note that the three worst wards were Roundwood, Carlton and Stonebridge, with 199, 196 and 176 cases respectively, as compared with only 72 in Neasden. These differences are too large to be accounted for by differences in the child structure of the population alone; they clearly reflect living conditions, particularly the degree of overcrowding in the wards. It can be generally stated, however, that the preventive health services have now conquered the infectious diseases but for tuberculosis, which could be defeated too in one generation if general living standards were improved. Many lives of adults with tuberculosis and of infants generally could be saved if the standards of living were raised in the borough as a whole to reach the standards enjoyed by the people in the ward with the best tuberculosis and infant mortality rates. The time is rapidly approaching when the health of an area will not be determined almost entirely on the basis of a study of its mortality statistics, but upon its morbidity figures as well. Much valuable information contained in hospital, family doctor and clinic records is at present almost completely neglected. If it were abstracted, studied and co-ordinated, useful suggestions for improvements in the health of the community would doubtless emerge. It is disappointing to record no marked improvement in the provision of health services in the area. Restrictions of expenditure on new clinics and new houses must inevitably affect the health of the people. A new part-time maternity and child welfare clinic was opened in the Daisley Hall, a Church Hall in Sneyd Road, Cricklewood, on 6th February 1951, but one was closed in Princess Road, Kilburn, at the same time. This has resulted in a falling off in attendances of mothers and children from an area which is most in need of clinic facilities. One cannot record, too, any appreciable improvements in the living conditions of the area. Satisfactory housing accommodation still remains scarce and many houses are rapidly becoming slums. It is doubtful whether there has been an improvement in the nutritional standards of the people; the rising ccsts of food together with the economic hardships associated with redundancy may have serious effects on the health of the people in the future. Already there has been an increase in the infant and general death rate and in the number of tuberculosis cases. Despite many attempts of co-operation within the service, the setting up of a liaison committee and the friendly working together at officer level, there are still considerable difficulties in co-ordinating the work of the many health agencies in the area. Hospital and local health authority services appear to be somewhat remote from the influence of public opinion, and thus it is more difficult to organise them for the benefit of the people. In some instances the huge administrative machinery appears to have become over-burdened, and projects consequently take a considerable time before they receive official sanction. There is nothing more frustrating than to find that when a decision is arrived at, it no longer fits the situation for which it was designed because a change has occurred in the interval. Within its limitations, the work of the borough council has expanded by obtaining further improvements in environmental hygiene. Housing conditions, food hygiene, health education and the care of the aged have mainly engaged the attention of the public health department, and many councillors have shown an increasing interest in this work. I wish to thank all members of the staff, and particularly the sanitary inspectors, for the work they have carried out during the year. I have the honour to be, Your obedient servant, S. LEFF, Medical Officer of Health. 3 STATISTICS AND SOCIAL CONDITIONS OF AREA Population census, 1951 179,647 Population census, 1931 184,434 Pre-war population, 1938 187,600 Area of the district in acres 4,634.5 acres Number of inhabited houses (including flats) 43,395 Rateable value £1,651,643 General rate in the £ for the year 18s. 0d. Product of a 1d. rate £6,768 VITAL STATISTICS Live Births: Total Male Female Willesden Borough Council Legitimate 2380 1217 1163 Birth rate per 1,000 of the estimated resident population Illegitimate 179 94 85 Total 2559 1311 1248 14.24 Rate per 1,000 total (live and still) births Still births 57 28 29 21.79 Death rate per 1,000 estimated resident population Deaths 2032 1049 983 11.31 Death Rate of Infants Under One Year of Age: All infants per 1,000 live births 28.53 Legitimate infants per 1,000 legitimate live births 28.99 Illegitimate infants per 1,000 illegitimate live births 22.35 Death Rate of Infants Under Four Weeks of Age: All infants per 1,000 live births 20.32 Legitimate infants per 1,000 legitimate live births 21.01 Illegitimate infants per 1,000 illegitimate live births 11.17 Maternal Mortality: Deaths from puerperal causes— Puerperal sepsis 1 .39 per 1,000 registered total births Other puerperal causes Other maternal causes Nil Total maternal mortality rate .39 per 1,000 registered total births Deaths from: Males Females Total Cancer (all ages) 220 188 408 Measles (all ages) — — — Whooping cough (all ages) — — — Diarrhoea (under 2 years of age) - — - 4 Cause of Death: ] Males Females Total 1. Tuberculosis (respiratory) 31 15 46 2. Tuberculosis (other) 2 3 5 3. Syphilitic disease 7 2 9 4. Diphtheria — — — 5. Whooping cough — — — 6. Meningogoccal infections — 1 1 7. Acute poliomyelitis — — — 8. Measles — — — 9. Other infective and parasytic diseases — 1 1 10. Malignant neoplasm, stomach 34 28 62 11. Malignant neoplasm, lung, bronchus 70 8 78 12. Malignant neoplasm, breast — 29 29 13. Malignant neoplasm, uterus — 21 21 14. Other malignant and lymphatic neoplasms 113 99 212 15. Leukemia, aleukemia 3 3 6 16. Diabetes — 7 7 17. Vascular lesions of nervous system 88 130 218 18. Coronary disease, angina 159 93 252 19. Hypertension, with heart disease 38 48 86 20. Other heart disease 95 156 251 21. Other circulatory disease 32 34 66 22. Influenza 12 23 35 23. Pneumonia 49 53 102 24. Bronchitis 114 70 184 25. Other diseases of respiratory system 11 7 18 26. Ulcer of stomach and duodenum 17 2 19 27. Gastritis, enteritis and diarrhœa 7 5 12 28. Nephritis and nephrosis 6 8 14 29. Hyperplasia of prostate 14 — 14 30. Pregnancy, childbirth, abortion — 1 1 31. Congenital malformations 7 11 18 32. Other defined and ill defined diseases 95 90 185 33. Motor vehicle accidents 18 8 26 34. All other accidents 22 24 46 35. Suicide 5 3 8 36. Homicide and operations of war — — — Total 1049 983 2032 BIRTHS The trend towards hospital confinement has been accentuated; there was a further increase in the proportion of mothers having their babies in hospital (see table). The number confined in hospitals and nursing homes was actually less, but with the continuing fall in the birth rate the numbers confined at home showed a further marked reduction. The causes of the increase in the numbers of hospital confinements were discussed in the annual reports of 1949 and 1950. Medical reasons, overcrowding or an adverse social environment probably account for the majority of the hospital admissions, but some of them are determined not so much on an unbiased or planned choice but on the fact that the mother finds it cheaper to have her baby in hospital. It is essential that the question of hospital or domiciliary confinement should be determined on the basis of a planned and co-ordinated policy, otherwise the staff and arrangements for home confinements may be reduced or disbanded at a time when there may be a return of a greater demand for home confinements. Even if the birth rate in Willesden shows no further decline there will be very few home confinements if the hospitals admit the same numbers as they did in 1950. A closer co-operation between the local health and hospital authorities would go a long way to solve these problems to the benefit of the health services and the community. If it is decided that the hospital should be preferred to the home for the confinement, attempts should be made now to provide hospital facilities for general practitioner obstetricians and domiciliary mid wives in order that they may retain their skill and continue to help in this vital service. 5 Place of Confinement 1948 1949 1950 1951 Total notified live births 2968 2798 2735 2362 Born in institutions 2169 2177 2217 1977 Born at home 799 621 533 385 Percentage born in institutions 71.16 77.28 81.06 83.7 Institutions (i.e. hospitals, nursing homes) Central Middlesex Hospital 530 846 1023 884 Kingsbury Maternity Hospital 1098 890 733 716 Total 1628 1736 1756 1600 Larger hospitals outside Willesden 256 241 236 188 Smaller hospitals outside Willesden 135 144 172 152 Nursing homes, etc. 150 56 38 37 541 441 446 377 Total 2169 2177 2202 1977 Home County midwives 509 418 300 296 Queen Charlotte's midwives 111 86 87 19 Willesden District Nursing Association 179 117 146 70 Total 799 621 533 385 Infant Deaths The birth rate in Willesden has shown a further decline to 14 24 per 1,000 population as compared with the highest post-war rate of 21.94 in 1947, and with the pre-war rate of 16.13 in 1938. The illegitimate birth rate shows a slight increase (see table 1) to 69.94,per 1,000 registered live births; it has now reached the high war-time levels, but it is still well below the peak of 1945, when it was almost 1 per cent. of the total births. The infant mortality shows an unwelcome rise to 28.53 (see table 2), but for the second time (see 1949 annual report) the illegitimate infant mortality is less than the general infant death rate. Three-quarters of the infant deaths occur in the first four weeks of life (neo-natal period); the large reduction in the infant mortality during and since the war has been largely in the age period 1-12 months, particularly for infections (e.g. the mortality from gastro-enteritis to-day is only one-fifth of the pre-war rate (see table 3)). The death rate from birth injuries is now greater than before the war, but this is probably due to more accurate diagnosis rather than to an actual increase in the number of deaths. It is significant that as a result of improvements in methods of diagnosis, mortality attributed to ' other causes' has been halved. Apart from birth injuries there have been remarkable falls in the rates for all causes of death, including the neo-natal period. With the general reduction in the rates for all causes, the mortality for prematurity, although much less than before the war, is now responsible for one in four of infant deaths. It thus becomes the most important single cause of infant deaths to-day. The same conditions which are responsible for premature deaths probably account for stillbirths as well. Stillbirths also produce a great wastage of life and the rate has always been higher than 20 per 1,000 in Willesden (see table 2). Emphasis on the saving of infant lives is therefore shifting to the prevention of stillbirths and prematurity. It is unlikely that the place of treatment of prematurity, whether in the home or the hospital, has had any appreciable effect on the prognosis ; for although table 5 shows that more deaths generally take place in hospital they are largely due to the greater severity of the condition of the child. Arrangements have been made for the more severe home premature births to be admitted to the special premature unit at the Hammersmith Post Graduate Hospital, and a specially equipped ambulance with trained staff are sent for the baby. The best way of dealing with prematurity is to prevent it. It is known that there is a very definite social gradient in respect of prematurity; the death rate from prematurity is twice as great in Social Class V, the lowest economic group, as in Social Class I. The fall in prematurity and stillbirths during and since the war is probably due to improvements in social conditions, particularly in better nutrition following full employment and well-planned rationing. The different incidence of prematurity in the wards of Willesden can also be accounted for by these factors (see table 4). It is hoped that the increase in the mortality rate for prematurity (table 5) is not due to a deterioration in nutrition caused by the higher costs of living and the growth in redundancy. The comparison of the infant mortality in the wards shows similar differences as in the annual reports of 1949 and 1950. Three wards show a mortality of over 35 per 1,000, while three show a rate of under 20 per 1,000—the lowest was under 15 per 1,000. If the standards of living in the borough as a whole had been raised to those of the best ward, it would probably have resulted in a saving of 232 infants and 163 stillbirths during the post-war period 1946-51. 6 TABLE 1 Illegitimate Births 1936-51 Year Illegitimate births Registered live births Illegitimate birth rate per 1,000 registered live births 1936 163 2918 55.86 1937 206 3125 65.92 1938 183 3027 60.45 1939 171 3004 56.92 1940 127 2571 49.40 1941 122 2060 59.51 1942 174 2651 65.63 1943 203 2838 71.53 1944 183 2929 62.48 1945 269 2807 95.83 1946 230 3572 64.38 1947 266 3859 68.93 1948 186 3147 59.10 1949 159 2895 54.92 1950 171 2735 62.06 1951 179 2559 69.94 N.B.—The figures used in the tables in this report are those supplied by the Registrar General. TABLE 2 Infant Deaths and Still Births. Willesden and England and Wales, 1936-51. Year Population Births Willesden Deaths under 1 year Willesden Infant Death rate Willesden Infant death rate, England and Wales Still births Willesden Still birth rate Willesden Still birth rate, England and Wales 1936 190,000 2918 170 58.26 59 89 29.59 40 1937 188,030 3125 197 63.68 58 99 30.71 39 1938 187,600 3027 160 53.85 53 101 32.29 38 1939 188,000 3004 152 50.60 50 84 27.17 38 1940 152,030 2571 121 47.06 56 89 33.56 37 1941 127,230 2060 94 45.63 59 58 27.38 34 1942 138,600 2651 128 48.28 51 89 32.48 33 1943 144,430 2838 151 53.21 49 80 27.42 30 1944 139,510 2929 115 39.26 46 79 26.26 28 1945 161,954 2807 129 45.96 46 68 23.65 28 1946 170,550 3572 102 28.55 43 95 25.91 27 1947 175,900 3859 117 30.32 41 95 24.02 24 1948 179,900 3147 74 23.51 34 71 22.06 23 1949 181,120 2895 74 25.56 32 74 24.92 23 1950 181,700 2735 63 23.03 30 63 22.52 23 1951 179,647 (Census) 2559 73 28.53 30 57 21.79 23 TABLE 3 Causes of Infant Deaths in Willesden (based on Registrar General's figures) 1936-1939 1940-1945 1946-1951 1936-1939 1946-1951 Percentage reduction Deaths Rate Deaths Rate Deaths Rate Respiratory 106 9.14 140 9.59 82 4.37 52.19 Diarrhoea and enteritis 131 11.29 108 7.40 39 2.08 81.58 Other infections 34 2.93 40 2.73 18 0.96 67.23 Congenital malformations 83 7.16 89 6.10 83 4.42 38.27 Premature births 170 14.66 179 12.25 130 6.93 52.73 Injury at birth 21 1.81 33 2.26 47 2.55 +29.02 Other causes 134 11.10 149 9.40 104 5.59 49.07 All causes 679 56.24 738 46.54 503 26.80 52.31 TABLE 4 Premature Births (i.e. any baby lbs. or less) and Deaths by Wards. 1951 Carlton Kilburn Brondesbury Park Kensal Rise Manor Harlesden Stonebridge Roundwood Church End Willesden Green Mapesbury Neasden Cricklewood Total Births in home (Deaths in brackets) 5 2 - - 2 (1) 1 4 4 1 - 2 (1) 1 (1) 1 22 (3) Births in Hospital (Deaths in brackets) 13 (4) 13 (1) 4 (1) 3 8 (2) 6 10 (3) 16 (3) 9 12 (2) 15 (1) 4 (2) 10 (2) 123 (21) Total 18 (4) 15 (1) 4 (1) 3 10 (3) 7 14 (3) 20 (3) 10 12 (2) 17 (2) 5 (3) 11 (2) 145 (24) 7 TABLE 5 Premature Births and Deaths. (1946-1951) (Deaths in brackets) Year Births in home Births in Hospital Home births transferred to hospital 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) 1950 21 (0) 126 (18) 0 (0) 147 (18) 1951 22 (3) 123 (21) 2 (2) 145 (24) 8 TABLE 6 Infant Mortality and Still Birth Rates by Wards. 1936-1951 (Deaths in brackets) Ward Persons per acre 1948 I.M. rate 1936-39 I.M. rate 1940-45 I.M. rate 1946-51 Still birth rate 1946-51 Carlton 160 76.11 58.82 30.95 22.54 (50) (38) Kilburn 111 64.89 47.93 27.84 26.39 (38) (37) Brondesbury Park 39 35.22 31.16 28.36 26.79 (34) (33) Kensal Rise 104 40.90 45.13 18.27 21.64 (19) (23) Manor 74 56.31 38.68 30.69 19.42 (31) (20) Harlesden 92 75.88 54.36 35.24 28.91 (57) (49) Stone bridge 92 62.62 55.60 35.14 23.75 (52) (36) Round wood 101 66.29 69.60 35.19 21.74 (56) (36) Church End 71 47.51 41.10 30.56 27.78 (46) (43) Willesden Green 94 69.39 49.92 26.54 28.49 (38) (42) Mapesbury 54 39.25 52.80 17.78 20.97 (39) (47) Neasden 51 46.24 47.76 14.43 15.23 (14) (15) Cricklewood 55 41.71 48.26 23.71 23.94 (29) (30) Whole Borough 78 56.24 46.54 26.80 23.91 (503) (449) Still birth rate 1936-39 = 31.46 (Whole Borough) 1940-45 = 28.69 GENERAL PROVISION OF HEALTH SERVICES Public Health Laboratory Service The work in connection with the examination of specimens is carried out 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 (swabs from sore throats, faeces from suspected intestinal infections, cough plates and post-nasal swabs from suspected whooping cough cases, etc.) are delivered by private practitioners to the branch laboratory at the Neasden Hospital, the Health Department, 54, Winchester Avenue, N.W.6, or the Willesden Health Centre, 381, High Road, Willesden, N.W.10. They are then collected and taken to the Central Public Health Laboratory. A report is telephoned to the practitioner on the morning after receipt of the specimen and a written report is then sent. Samples of milk taken by the Sanitary Inspectors from dealers in the district are also forwarded to the laboratory for examination. The big increase in the number of specimens of faeces examined was the result of the extensive Sonne Dysentery outbreak at the beginning of the year. During the year 1951, the following work was carried out at the laboratory:— Throat/Nose Swabs: Organisms Found Diphtheria bacilli Hæmolytic streptococci 220* Vincent's angina 20* Negative 478 Total 710 * Both hæmolytic streptococci and Vincent's angina were found in 8 swabs. 9 Faeces: Shigella 672 Salmonella 25 Protozoa 2 Negative 2981 Total 3680 Sputum: T.B. (Smear) 392 Other organisms 25 Negative 1646 Total 2063 B.Pertussis: Cough plate - Post-nasal swab 3 Negative 18 Total 21 Milk Examinations: Pasteurised 264 Other Grades of milk Schools (pasteurised) Dealers' premises Total Pasteurised T.T. pasteurised Sterilised Samples 134 55 25 37 251 Satisfactory 129 47 25 37 238 Unsatisfactory 5 8 — — 13 Second sample taken—all satisfactory Ice Cream Tests: 8 Grade 1 6 Grade 2 2 Grade 3 - Grade 4 - Water Examination: Domestic supplies, etc. 1 Satisfactory 1 Unsatisfactory — Swimming pools 67 Satisfactory 67 Unsatisfactory — Miscellaneous : 1 110 Total: , 6924 Uncleanliness and Scabies There was a further reduction in the number of cases and attendances at the scabies and lice treatment centre. The number of cases in 1951 was 56 per cent. of 1950 and the number of attendances 50 per cent. The Council are considering alternative arrangements for this service because the local hospital management committee require the building for hospital purposes. 10 Cases Treated at the Scabies and Lice Treatment Centre, Neasden Hospital New cases treated Attendances Scabies Lice and nits Total Scabies Lice and nits Total Children under 5 years 16 14 30 36 (4) 14 50 Children 5-14 years 32 156 188 97 (2) 157 254 Adults: Men 16 5 21 143 (5) 42 185 Women 33 37 70 Grand totals 97 212 309 276 (11) 213 489 The numbers in the brackets relate to the attendance of contacts of scabies who on inspection showed no signs of infection but nevertheless received treatment. They are not included in the total. 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; the work of inspection of the establishments is performed by the Council's Sanitary Inspectors. During the year 1951, 22 premises were registered, 1 person was granted a licence, 21 a renewal of a licence, and 1 received exemption under section 363 of the Act. Health Education Health education has retained its position of popularity in the borough in 1951. Lectures on health are still in great demand at clubs, religious organisations, community associations, trade unions, co-operative and political parties, day nurseries and schools. Doctors, health visitors, sanitary inspectors, chief officers and their deputies, the public relations officer, the chairman of the Area Health Committee and his wife, and many outside lecturers have given invaluable help in this work. The public health department and the people of Willesden are very grateful for their assistance. 19 talks have been given to local organisations by the Medical Officer of Health and the Chief Sanitary Inspector. Keen interest has been shown in all the chosen subjects, and the attendances at the lectures have ranged from 20 to 120. In the schools a total of 271 health talks and film shows have been given to 960 pupils during the period under review. The subjects chosen cover a very wide range and the talks were given by the Area Medical Officer and members of his staff, the Chief Sanitary Inspector and his staff, the deputy Borough Engineer, the Public Relations Officer, and Dr. Toussaint of the Willesden Chest Clinic. Attendances at the lectures were from 20 to 150 pupils. At 9 day nursery parents' clubs there were 51 talks and 10 film shows given by the Area Medical Officer and his staff, the Chairman of the Area Health Committee, the Borough Housing Manager and others. Mothercraft classes and talks by doctors and health visitors are now given at all the health centres. Also, separate meetings of sanitary inspectors, doctors, health visitors and day nursery matrons and their deputies are held regularly, where health educational films are shown, often with the help of outside lecturers; many interesting discussions have taken place. Health education is helping the health worker and the people in their battle against disease; the foundation is being laid for a community of people with a clear understanding of how our main enemy— disease—can be defeated. Health Services of 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. 11 PREVALENCE OF, AND CONTROL OVER, INFECTIOUS AND OTHER DISEASES Infectious Diseases—Cases Notified and Confirmed Cases confirmed (notified in brackets) 1949 1950 1951 Diphtheria 8 (33) 1 (15) 1 (12) Scarlet fever 340 (325) 306 (317) 204 (211) Pneumonia 161 (175) 150 (164) 161 (172) Whooping cough 205 (212) 648 (650) 543 (550) Erysipelas 29 (35) 26 (29) 30 (31) Measles 985 (990) 2255 (2280) 1927 (1937) Other Infectious Diseases Notified During 1951 Disease Cases confirmed (number notified in brackets) Typhoid fever - (2) Dysentery 276 (302) Malaria 1 (1) Poliomyelitis and polio-encephalitis - (5) Cerebro-spinal fever 6 (7) Encephalitis lethargica - (-) In the last two years there has only been one case of diphtheria confirmed in each year. This success is largely due to diphtheria immunisation which became widespread in the borough at the beginning of the war. The fact that the number of cases of diphtheria has been reduced from 415 in 1938 to 1 in 1951 should not lead to an attitude of complacency. An outbreak of diphtheria in a child population unprotected by diphtheria immunisation might be quite serious, as was demonstrated in the outbreak in a school in 1948. Admittedly diphtheria immunisation is not the only answer and a study of figures on a world scale has revealed that there are other factors concerned, i.e. improved standards of living. Nevertheless, we cannot relv entirely on the operation of these other factors only, and we cannot therefore take the risk of leaving many children unimmunised. Diphtheria immunisation is generally brought to the notice of parents and school children in Willesden by doctors and health visitors. A special campaign was, however, organised for the four weeks from the 14th May, 1951, to 9th June, 1951. Advertisements were issued in the local press; posters were exhibited through out the district; film slides, exhibition stands and posters were on view at local cinemas; films were shown at schools; and special talks were given by clinic doctors and health visitors at schools, health clinics and to parents' clubs at day nurseries. The medical practitioners were informed of the health publicity and helped the campaign a great deal. The table shows the marked increase in the number of cases immunised both by the assistant medical officers of health in the local authority clinics and by medical practitioners in their surgeries. This welcome increase is a reflection of the success of the campaign and it is hoped that the numbers immunised will continue to remain high. Diphtheria Immunisation Comparison of completed cases and boosters 1950 and 1951 for the 5 months May-September. Health clinics Medical practitioners Total Completed cases Boosters Completed cases Boosters 1950 483 111 242 19 855 1951 998 2872 375 332 4577 Percentage 1951 compared with 1950 206.6 2587.3 154.9 1747.3 535.3 Measles 1937 cases were notified in 1951 (1927 confirmed), but a total of 2060 cases (1211 were children under 5 years of age) came to the notice of the health visitors. 12 Whooping Cough 550 cases were notified in 1951 (543 confirmed), but a total of 662 (349 were children under the age of 5 years) came to the notice of the health visitors. There were no deaths from whooping cough. Pneumonia and Influenza 172 cases of pneumonia were notified in 1951 (161 confirmed). There were 102 deaths from bronchopneumonia, lobar pneumonia and pneumonia (unspecified), and 35 deaths from influenza. Ophthalmia Neonatorum 1 case was notified in 1951 (a case rate of .39 per 1,000 registered live births); there was complete recovery with unimpaired vision. Puerperal Pyrexia 75 cases of puerperal pyrexia were notified during the year (73 confirmed). The definition of puerperal pyrexia was modified as from the 1st August, 1951, and a new form of notification introduced. Puerperal pyrexia now applies to any " febrile condition occurring in a woman in whom a temperature of 100 4 degrees Fahrenheit (or 38 degrees Centigrade) has occurred within fourteen days after childbirth or miscarriage." Food Poisoning 27 cases of food poisoning were notified during the year (10 confirmed). TUBERCULOSIS Tuberculosis still remains the most important infectious disease of the borough. Although there has been a decline in the incidence of tuberculosis in Great Britain since 1950, there is already some evidence from the Willesden figures that the decline may soon be halted. The death rates in Willesden show a further welcome reduction, although not so marked as in previous years. The main disappointing feature, however, is the continuing rise in the case rates over the past two years : they now show an increase over the pre-war rates (see Table I). The age groups most affected (see Table II) are those from 20-55. The age group 15-20, comprising in the main those who have just left school, show an appreciable increase in the numbers suffering from pulmonary tuberculosis but the striking increases begin with the age group 20-25 ; and they continue until 35 for females and until 55 for males. Greater attention is correctly directed to the younger age groups because it is particularly at this period that tuberculosis can be so harmful. The young adult finds that he has to leave his work or training at the critical period when he is learning a trade or building a home and a family. It must be appreciated, however, that tuberculosis attacks many people over the age of 55, and its influence at this age cannot be ignored. The general increase in the number of cases may be partly accounted for by earlier and more accurate diagnosis. Although to-day cases are more often detected in an earlier phase of the disease, a large proportion of cases (about one in five) still die unnotified, and together with those which die within a year of notification, make up almost half the cases which die from the disease (see Table III). Admittedly,the actual numbers of deaths are lower, but the percentages of undiagnosed or late diagnosed cases cannot be deemed satisfactory. There were not many mass miniature radiography surveys in the area or in the neighbourhood in 1951, and they did not make any appreciable contribution to the number of early cases detected. Mass miniature radiography could probably be used to a better purpose if attention was directed to the suspected sections of the community rather than to unselected groups. The following sections of the community should have special consideration : persons who are suspected of disease in the lungs, particularly those under the care of their family doctor; contacts of infectious cases of tuberculosis; persons whose lungs are subjected to noxious fumes and gas fumes; health workers, e.g. nurses and medical students; expectant mothers at ante-natal clinics; all hospital admissions and out-patients; and entrants to the armed forces. It must always be emphasised that a negative X-ray finding is no guarantee that the disease may not be contracted at a later date and consequently a further examination should be arranged as soon as symptoms warrant it, even if the previous X-ray was of recent date. Another danger in dealing with unselected groups is that many minimal shadows are revealed in persons who would have recovered apart from treatment, and thus needless anxiety is frequently caused and valuable time and energy wasted. Unfortunately, it is not possible at this stage to differentiate between those patients who have a high resistance and will recover without treatment and those who will not. Those without any symptoms at all are most likely to recover completely without treatment. 13 The gradual increase in the proportion of cases which have survived over five years (see Table III) is probably an indication of the improved results of treatment. Modern surgical methods, the new drugs (streptomycin, P.A.S., etc.), and the earlier detection of cases are responsible for some of this improvement. Full employment and better nutrition have also played a part. Undoubtedly modern methods of treatment have improved the prognosis in tuberculosis but one must not be too optimistic since included in the figures of recovery may be cases which would not have been discovered previously and yet would have recovered without treatment. The better prognosis may also result in an increase in the number of deaths in the future, when the increasing number of cases over the past few years who have had their lives prolonged with the new methods of treatment finally fail to make further progress. The new surgical methods (including lobectomy) and the new drugs, have an unchallenged place in the treatment of tuberculosis and should be provided for every patient who has the disease, but, by and large, the treatment of the moderate and advanced cases remains disappointing and consequently efforts must be directed to the discovery of the early cases and to the prevention of the disease. B.C.G. vaccination is a useful preventive measure. Although the exact degree of its effectiveness has not yet been determined, serious consideration should be given to its more extended use for T.B. negative cases (particularly school leavers) in areas where the rate is high. The best way of dealing with tuberculosis is to prevent it. The most important way of defeating tuberculosis is by improving the standards of living, particularly in the reduction of the amount of overcrowding and under-nourishment. There is an understandable tendency among research students to try and discover the exact significance of overcrowding as compared with malnutrition. In this country there is a higher correlation of tuberculosis with overcrowding, but the war experiences in other countries, particularly Malta, reveal the importance of nutrition. In Malta the tuberculosis rates rose in 1942 and 1943 when the island was almost completely cut off from food supplies, but they decreased again in 1944 when food supplies began to come in, although of course at this time there was no improvement in the overcrowding, which had been made worse by the destruction of dwellings. In practice, in peace-time, it is usually the people who are overcrowded who are under-nourished as well; consequently the question resolves itself into how to generally improve the standards of living, and not necessarily in concentrating on one aspect. Occupation is also probably a factor, but there is no evidence that it is of any great significance in Willesden. This may, however, be due to the fact that little research has been done on the effect of occupations on the evolution of the disease. The ward figures (see Table IV) again illustrate the importance of environmental conditions. Nine wards show an increase in their rates and one (Mapesbury) an increase of more than 50 per cent. The possible reason for the increase in Mapesbury has been discussed in the previous report: it had the largest increase in population and the largest number of families in requisitioned properties. The ward with the lowest rate (Cricklewood) had a pulmonary case rate of 1 per 1,000 as compared with the highest rate of 1.804 for the Carlton ward, where it was almost double. The wards with the lowest rates (Cricklewood and Neasden) are those that are least overcrowded in the borough, while the wards with the highest rates (Carlton and Stonebridge) are those with the greater number of families overcrowded. If the standards of living in Carlton were raised in 1946 to that of the best ward, there would have been a saving in the years under review of 24 lives and 61 cases; for the whole borough the saving would have been 150 lives and 326 cases. Since the treatment of tuberculosis is very costly, not only in medical treatment but also in production and in lives, it is much more economical in the long run to spend the money in improving housing and nutrition and thus preventing the disease. 14 TUBERCULOSIS 1936.1951 Table I Cases and deaths (Rates calculated per 1,000 population) Cases on Register Year Population New cases (Deaths in brackets) Case rates (Death rates in brackets) Pulmonary Non. pulmonary All forms Pulmonary Non. pulmonary All forms Pulmonary Non. pulmonary All forms 1936.39 Pre.war Period 1936 190,000 211 47 258 1.11 .168 1.358 655 152 807 (128) (16) (144) (.673) (.084) (.757) 1937 188,030 205 49 254 109 .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 876 189 1065 1162 .251 1.413 (472) (53) (525) (.626) ( .070) (.696) 1940.45 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 1099 (81) (16) (97) (.500) (.098) (.598) Total 1334 252 1586 1.544 .292 1.836 (534) (94) (628) (.619) (.108) (.727) 1946.51 Post.war period 1946 170,550 255 34 289 1.495 .199 1.694 1067 180 1247 (81) (15) (96) (.475) (.088) (.563) 1947 175,900 253 33 286 1.438 .188 1.626 1198 191 1389 (76) (12) (88) (.432) ( .068) (.500) 1948 179,900 243 27 270 1.351 150 1.501 1293 196 1489 (80) (11) (91) (.445) (.061) (.506) 1949 181,120 186 22 208 1.026 .121 1.147 1386 207 1593 (66) (9) (75) (.364) (.050) (.414) 1950 181,700 229 29 258 1.260 .159 1.419 1543 217 1760 (51) (4) (55) (.280) (.022) (.302) 1951 179,647 228 33 261 1.269 .184 1 453 1673 239 1912 (46) (5) (51) (.256) (.028) (.284) Total 1394 178 1572 1.304 .166 1.470 (400) (56) (456) (.374) (.052) (. 427) 15 Table II Tuberculosis 1951 Age Groups of New Cases Notified and Deaths Age periods New cases Deaths Respiratory Non-respiratory Respiratory Non-respiratory Male Female Male Female Male Female Male Female Under 1 - 1 - - - - - — 1 to 5 3 4 4 1 1 - - — 5 to 10 6 3 1 1 — - 1 — 10 to 15 1 6 1 4 — - — 1 15 to 20 8 9 2 3 — - — — 20 to 25 21 21 1 1 1 2 — — 25 to 35 27 28 2 4 3 3 - — 35 to 45 22 13 2 2 5 1 1 — 45 to 55 22 6 1 1 6 2 — — 55 to 65 17 2 1 1 11 3 — — 65 and upwards 6 2 — — 6 2 — 2 Totals 133 95 15 18 33 13 2 3 Table III Pulmonary Tuberculosis 1951 Period Between Notification and Death 1946 1947 1948 1949 1950 1951 1946-51 Total deaths 81 76 80 66 51 46 400 Period between notification and death: Percentage not notified 16.5 13.6 16.0 22.7 11.76 19.56 16.51 Percentage 0-12 months 39.5 34.1 34.1 25.7 35.30 15.22 32.11 Percentage 1-5 years 341 34.1 340 27.4 27.45 39.13 32.80 Percentage over 5 years 9.9 18.2 15.9 24.2 25.49 26.09 18.58 16 Table IV Tuberculosis Pre-War (1936-39) and Post-War (1946-51) Cases and Deaths by Wards 1936-39 1946-51 Changes in the Rates Death Rate (all forms) 1946-51 Ward Pulmonary Cases Nonpulmonary Cases Pulmonary Rate Combined Rate Pulmonary Cases Nonpulmonary Cases Pulmonary Combined Rate Pulmonary Rate Combined Rate Deaths Rate Carlton 113 31 1.781 2.270 135 22 1.804 2.098 +. 023 .172 46 .615 Kilburn 92 20 1.509 1.838 117 21 1.397 1.649 -.112 -.189 31 .418 Stone bridge 79 15 1.469 1.748 116 20 1.535 1.799 +. 066 + .051 45 .569 Round wood 71 14 1.442 1.726 99 17 1.497 1.754 +. 055 +. 028 38 .575 Brondesbury Park 63 16 1.262 1.583 89 6 1.201 1.282 -.061 -.301 30 .405 Kensal Rise 61 16 1.088 1.373 74 11 1.055 1.212 -.033 -.161 41 .585 Crickle wood 68 10 1.105 1.268 93 6 1.000 1.064 -.105 -.204 31 .333 Church End 58 16 .971 1.239 121 20 1.383 1.611 +.412 +.372 32 .366 Neasden 46 7 1.004 1.157 69 9 1.028 1.162 +. 024 +.005 37 .551 Willesden Green 56 9 .958 1.112 108 8 1.311 1.407 +.353 +.295 30 .364 Harlesden 61 8 .974 1.102 112 13 1.154 1.288 +.180 +.186 34 .350 Mapesbury 68 17 .852 1.065 188 15 1.506 1.626 +.654 +.561 37 .296 Manor 40 10 .764 .955 73 10 1.004 1.142 +.240 +.147 33 .454 Whole Borough 876 189 1162 1.413 1394 178 1.304 1.470 +.142 +.058 465 .435 17 Poliomyelitis There were no confirmed cases of poliomyelitis in Willesden during the year 1951. Smallpox There were no cases of smallpox occurring in the Borough during the year 1951. In May, 1951, notification was received that a passenger on the S.S. Ranchi had developed smallpox and that 11 contacts of the case were going to live in Willesden. They were all kept under observation and health visitors visited them daily; none of the contacts developed smallpox. 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 The Borough Engineer's Department deals with matters relating to the provision of dust-bins. House refuse is collected weekly, and trade refuse as often as necessary; the trader pays an agreed charge. The refuse is disposed of by controlled tipping at Twyford. HOUSEHOLD ARRANGEMENTS The Registrar General has published an analysis of a 1% sample of the Census 1951. Shared Dwellings and Overcrowding Willesden figures reveal a much higher proportion of households in shared dwellings (6 out of 10) as compared with the average in England and Wales (about 2 out of 10) and Greater London (about 4 out of 10). It is even higher than that in the County of London (5 out of 10). The number of persons per room (085) is higher than that in England and Wales and London; the percentage of persons living more than two per room (5 76) is almost three times the average in England and Wales and London. Also, the improvement in Willesden of 1951 as compared with 1931 is much less. Bathrooms The proportion of households without a fixed bath (6 out of 10) is higher than that in England and Wales, Greater London and the County uf Middlesex (all about 4 out of 10), but it is slightly less than that in the County of London. This is doubtless due to the greater age of the property in the County of London and Willesden. Water-Closets The number of households without a water closet (about 2 out of 10) is only slightly higher than that in England and Wales and the County of Middlesex, and slightly lower than that in Greater London and the County of London; in Willesden the proportion rises almost to three-quarters (68 per cent.) in dwellings occupied by three or more families. 18 CENSUS 1951 One Per Cent Sample Tables Private Households, Densities of Occupation and Household Arrangements (England and Wales, London, Middlesex and Willesden) (Percentages in brackets) Households Household without exclusive use of Persons per room Percentage of persons living more than 2 per room Total In shared dwellings Water. closet Fixed bath Both stove and sink 1951 1931 1951 1931 England and Wales 130435 19681 27974 58174 17927 0.73 0.83 2.16 6.94 (15.08) (21.44) (44.61) (13.65) Greater London 26479 9652 6480 12068 3386 0.77 0.89 1 71 9.46 (36.45) (24.47) (45.57) (12.78) County of London 11144 5759 3913 6908 1855 0.83 0.98 2.20 13.13 (51.67) (35.11) (61.98) (16.64) County of Middlesex 7017 2078 1280 2412 739 0.74 0.80 1.58 4.65 (29.61) (18.24) (34.37) (10.53) Willesden 566 344 138 337 66 0.85 0.92 5.76 8.95 (60.88) (22.61) (59.54) (11.64) Gardens Willesden is poorly equipped with public open spaces, 242 acres, compared with 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 Swimming Bath Samples taken Satisfactory Granville Road 20 20 Gladstone Park 24 24 King Edward's Park 23 23 The following improvements were carried out at Gladstone Park Baths when they were closed during the winter : a bigger and more satisfactory sanitary annexe for bathers and spectators of both sexes was installed; the bath surround was resurfaced and the drainage improved; and several small blocks of dressing boxes were removed to better positions, clear of the bath surrounds. 19 SANITARY SECTION Staff The authorised establishment of sanitary inspectors is one Chief Sanitary Inspector, one Deputy Chief Sanitary Inspector and 17 District Sanitary Inspectors. During the year, one Sanitary Inspector resigned and one died, and the vacancies were filled by the appointment of a qualified Pupil Sanitary Inspector and a qualified clerk in the Sanitary Inspector's Office. The authorised establishment of pupil sanitary inspectors is 6, and during the year there were 5 on the staff, The Rodent Officer and 4 operatives were employed in the destruction of rats and mice in dwelling houses, factories and other industrial buildings, and on bombed sites and waste lands. Two labourers were employed on vermin disinfestation, drain testing, and general duties. SANITARY INSPECTION OF THE AREA The Housing (Standards of Fitness) Sub-committee continued its work of dealing with defects in privately owned houses in the area by action under the Public Health Act, 1936, and the Housing Act, 1936. The defects are brought to the notice of the committee through tenants' complaints, and these were almost as many as the previous year. The general work of the committee was described in the annual report for 1949. It would appear that many more houses in the district are deteriorating and becoming slum property. Landlords maintain that it is not economical for them to repair houses to a reasonable standard when the rents are controlled and building costs have increased. Defects are therefore often not attended to in the early stages when the costs would be low, with the result that when they become more serious a much larger amount of money has to be spent on them. A solution will have to be found to this problem, otherwise many more houses will soon be fit only for demolition. The shortage of accommodation has again prevented the carrying out of a policy of getting rid of slum property, and tenants to-day are often prepared to put up with such property as they have no other place to go to. CLOSING AND DEMOLITION ORDERS Housing Act, 1936 (Sections 11 and 12) Closing orders : 2-11, Preston Place, Belton Road; 11, Granville Road (second floor); 1 and 2, Victoria Villas (basements) 13 (1) Demolition orders : 3, Rupert Road; 1 and 2, Bridge Place; 76, Canterbury Road 4 (8) (1950 figures in brackets) Some of the demolition orders made in 1950 (19, Grosvenor Gardens, 1, Avenue Road, 2, Rupert Road and 14, Victoria Villas) have not yet been complied with, because it has not been found possible to re-house the tenants living there. The demolition of 7, Rupert Road was carried out by the Borough Engineer in default of the owners. The owners of 32, Connaught Road appealed to the County Court against the demolition order. Prior to the hearing of the appeal the Borough Council agreed to the proposition made by the owners that the Council would re-house the existing tenants if the owners would do all the necessary repairs and adapt the house as three flats; the owners undertook to accept nominees from the Council's housing waiting list as tenants for the three flats. There has been considerable delay in the owners carrying out their agreement. The orders for demolition of the four properties made in 1951 have not yet been carricd out, too, because it has not been possible to re-house the tenants. Overcrowding There are no accurate figures of present day overcrowding in the area, but it is hoped that the census and a house-to-house inspection which is being carried out now will give some information on this. The number of licences issued to permit temporary overcrowding under section 61 of the Housing Act, 1936, were fewer in 1951 than in 1950. This was mainly due to the fact that landlords are no longer using this section to obtain an eviction because they know that the Court tends to deal sympathetically with the tenants. 1951 1950 Licences to permit temporary overcrowding in excess of the permitted number, section 61, Housing Act, 1936: licences issued 2 6 20 Housing Act, 1936 The Housing Department have supplied the following details of overcrowding in the area which have been based mainly on the statements of applicants for new houses:— (a) (i) Dwellings overcrowded at end of year 1,500 (ii) Families 1,500 (iii) Persons 5,250 (b) Overcrowding reported during the year 256 (c) (i) Overcrowding relieved during the year 159 (ii) Persons 798 (d) Dwelling houses which have again become overcrowded after the local authority have taken steps for the abatement of overcrowding No information (e) (i) Council houses found to be overcrowded at end of year 126 (ii) Families 183 (iii) Persons 1,054 (f) Overcrowding in Council houses relieved during the year 23 New Dwellings 1951 houses flats rebuilds Dwellings built by private builders 8 23 4 (excluding those built by the police authorities) Houses built by local authority 2 Flats built by local authority 70 Applicants on Council's waiting list at 31/12/51 10,397 Housing Defects 1951 1950 Premises inspected on complaint 4649 5441 In connection with infectious diseases 7 4 House-to-house (Housing Act, 1936, S.5) 190 220 Others 179 196 Total No. of premises 5025 5861 No. of inspections 27258 33900 Notices served under Public Health and Housing Acts, 1936 : Intimation notices served 2726 3113 Intimation notices complied with 2686 2848 Statutory notices served (P.H. Act, 1936) 1527 1804 Statutory notices complied with (P.H. Act, 1936) 1504 1658 Statutory notices served (H. Act, 1936) 105 95 Statutory notices complied with (H. Act, 1936) 135 67 †Non-compliance with statutory notices referred to Town Clerk (P.H. Act, 1936,s.93) 332 362 Referred to the Borough Engineer for work to be carried out in default of owners * 185 177 * 114 by B.E., 71 by owners. †Details of cases referred to the Town Clerk during the year: Work carried out 230 257 Work in hand 15 15 Court orders obtained 31 49 Summonses issued 5 - Summonses withdrawn—notices complied with 48 41 (7) (21) Work done by agreement—P.H. Act, 1936, s.275 3 - Total 332 362 (The figures in brackets are the notices withdrawn and re-served.) Certificates of disrepair under the Rent and Mortgage Interest (Restrictions) Acts, 1920-39 Applications received from tenants 45 73 Granted 42 66 Refused 3 6 Withdrawn — 1 SUMMARY OF NUISANCES, AND OF IMPROVEMENTS EFFECTED Water Supply and Water Service New cisterns provided 48 34 Cisterns cleansed, repaired, covered, etc. 103 133 Draw taps placed on mains 9 14 21 Drainage and Sewerage Water closets: Repaired, supplied with water or otherwise improved 572 627 New closets built 9 26 Provided with better ventilation 4 11 Drainsi: Examined, tested, exposed, etc. 329 495 Unstopped, repaired, trapped, etc. 441 547 New soil pipes or vent shafts fixed 19 59 Disconnecting traps or chambers inserted 29 61 Reconstructed 32 39 New manhole covers 68 94 Soil pipes or vent shafts repaired 157 201 Other Defects Smoke nuisances 13 13 Accumulation of refuse 99 124 Foul ditches, ponds, etc., and stagnant water 2 5 Fowls, pigs, etc., kept in an insanitary condition 10 20 Dampness 1633 2108 Yard and forecourts paved, repaved or repaired 284 265 Walls and ceilings cleansed 4764 6995 Verminous rooms disinfested 220 458 Leaky roof made watertight 1775 2013 Additional ventilation provided under floors 123 139 Dilapidated plaster repaired 3853 5593 Flooring and other woodwork repaired 1468 2625 Damp proof courses inserted 60 97 Water supply reinstated 33 59 Wash-house floors repaired or repaved 40 66 Fireplaces and stoves repaired 1045 1347 Decayed brickwork repaired and repointed 622 779 Sinks provided or replaced 196 182 Additional light and ventilation provided to staircase 8 11 Larders or food cupboards ventilated or provided 11 21 Gutters and/or rainwater pipes repaired or renewed 1286 1655 New sashcords and glass provided to doors and windows 2705 3954 Miscellaneous 810 997 Total nuisances abated 22880 31867 Periodic Inspections of Other Premises 1951 1950 No. inspected Inspections made No. inspected Inspections made Slaughterhouses (1 registered but not in use) — — 1 10 Common lodging houses 1 22 1 45 Offensive trades 4 6 4 4 Factories—with mechanical power 598 729 796 851 Notices served 83 181 Without mechanical power 81 104 78 153 Notices served 16 31 Workplaces—other than out-workers 11 11 10 10 Notices served 2 3 Home workers and outworkers 351 355 208 210 Inspection of food premises (includes re-visits) Baker 38 244 38 256 Bread and confectionery 38 279 38 209 Dairy 13 122 13 116 Butcher 114 792 114 744 Grocer and general store 315 1342 315 1745 Fishmonger and fish-fryer 61 442 61 435 Cafe and restaurant 149 925 150 1139 Greengrocer and fruiterer 126 808 127 710 Ice cream and sweet shop 181 695 181 748 Food stall 19 110 22 162 Public house 44 126 44 151 Works canteen 110 483 110 125 Food factory 14 172 14 136 Any other food premises 25 124 26 87 Total periodic inspections 2293 7891 2351 8046 22 SMOKE NUISANCE There was a slight increase in the number of complaints of smoke nuisances, particularly directed to the power stations. The Ministry of Health has been asked to call a meeting of the authorities concerned to investigate further the possibility of controlling the smoke and grit emitted from the power stations. Instruments for the measurement of the amount of atmospheric pollution have been placed near the power stations and at control points, and their readings will help in determining the amount and source of the pollution. The Sanitary Inspectors continued to co-operate with technical officers of the Ministry of Fuel and Power in the abatement of smoke nuisances arising from ordinary industrial boilers; the supply of unsuitable fuels has been largely responsible for these nuisances. The Coal Allocations Division of the Ministry of Fuel and Power have not found it possible to arrange for more suitable fuel to be allocated in all cases. BOMBED SITES The Council have a programme to clear up these sites and thus prevent nuisances. A number of bombed sites have now been fenced in, built on, or converted into public recreation grounds. The Health Department continue to deal with the nuisances on the other sites—getting rid of rats, clearing away refuse, etc. DISINFESTATION The sanitary inspectors inspect verminous premises and supervise the work of the disinfestors employed by the Council. Bedding materials are disinfested at the steam disinfector at the Neasden Hospital. Disinfestation (a) Verminous premises: Council properties 38 Private properties 172 Total 210 (b) * Verminous rooms: Council properties 85 Private properties 319 Disinfested by owners 16 Total 420 * Some rooms are treated more than once. (c) Bedding materials: 29 (d) Miscellaneous: Beetles in canteens, etc. 10 Houseflies — Ants 25 RODENT CONTROL Rodent control, as approved by the Ministry of Agriculture and Fisheries (Infestation Branch), has been carried out at the following properties :— Business premises 229 Borough Council properties 14 Private properties 555 Total 798 Other Inspections 1951 1950 No. inspected Inspections made No. inspected Inspections made Certificates under the Rent Acts — 43 — 68 Public house urinals 44 192 44 240 Mews and stables 29 112 28 72 Miscellaneous — 1048 — 1249 Smoke observations 25 165 18 122 Verminous rooms 106 113 234 326 Total other inspections 1673 2077 Total all inspections 36822 44023 23 The cost of rodent control at business premises (£739 19s. 7d.) was recovered from the occupiers. The total cost of rodent control at private dwellings was £530 5s. 1d. The service is free to occupiers of private dwellings; the Borough Council recovers 50% of the cost from the Ministry. The work of rodent control in the Council's sewers is carried out by the Borough Engineer's Department. Where surface rat infestation is due to faulty connections in house drainage systems, the Borough Engineer's Department arranges for the opening of the pavement. Ice Cream Premises The Food and Drugs Act, 1938, and the Ice Cream (Heat Treatment etc.) Regulations, 1947-51, control the manufacture and sale of ice cream. They regulate the conditions for the preparation, heat treatment, freezing and storage of ice cream. The shortage of equipment caused a postponement of the date (until 1st March, 1951) when indicating and recording thermometers had to be installed in ice cream manufactories; temperature records at all stages of manufacture must now be available for inspection at all times. The ice cream sold in the borough is largely pre-packed and manufactured outside the district. The standard of purity was high during the year. Eighteen premises were registered for storage for sale, bringing the total number to 267. In addition 19 premises remained on the register for manufacturingpurposes. They are frequently inspected; 8 samples of ice cream were taken and the results proved satisfactory. Registration of Ice Cream Premises Manufacture Storage for sale Premises registered at December 31st, 1950 19 249 Premises registered during the year 1951 — 18 Total 19 267 Milk and Dairies Regulations 1949 The milk trading methods in the Borough have undergone marked changes over a period of many years; the sale of loose milk by hand measure over the shop counter, and from churns carried in carts, are now things of the past. These methods were gradually replaced by milk delivered in bottles to the house; the traders purchased bulk milk either processed or raw, and then bottled the milk on their own premises. The next step has been the bottling of the milk by large processing and bottling dairies and its distribution in these bottles to dealers, who are now relieved of the job of storing the milk in bulk, filling the bottles and cleaning them : they merely act as distributors of full milk bottles and as collectors of the empties. The Milk and Dairies Regulations, 1949, made under sections 20 and 92 of the Foods and Drugs Act, 1938, exclude shops which sell milk in sealed bottles as delivered to the shop from the definition of dairies; the purveyor of milk must however still register with the local authority. An additional measure designed to ensure a safe milk supply for areas including Willesden was the Declaration of London (including Middlesex) district as a Specified Area by the Minister of Food in which he declared that all milk "sold by retail within these areas after 1st October, 1951, must be special designated milk, namely, sterilised milk, pasteurised milk, tuberculin tested milk, or accredited milk from a single herd." The sale of raw milk in Willesden is now prohibited. This regulation is. related specifically to the spread of bovine tuberculosis. The number of cases of bovine tuberculosis caused by infected milk is not definitely known; but the Royal Commission which investigated this problem in 1934, estimated that 1,5002,000 deaths and about 41,000 cases every year could be traced to this source of infection. It may be some considerable time before this country will have herds of dairy cattle free from tuberculosis, and the prohibition of the sale of raw milk is the only safe course of preventing the disease. The cost of pasteurisation is amply repaid in the saving of lives and in the costs of hospital treatment, etc. The only milk other than heat-treated milk which can be considered safe from tuberculosis is TuberculinTested Milk, produced from herds which are frequently tested for tuberculosis. The bottling and processing dairies and the premises selling bottled milk are regularly inspected. During 1951 four dairy premises were found to have defective walls and other defects, but all were remedied during the year. DAIRIES : REGISTRATION AND LICENCES Premises in Willesden 95 Dairymen 74 Licences issued: Pasteurised milk 79 Sterilised milk 83 Tuberculin tested milk 64 Premises outside Willesden 11 Dairymen 5 Licences issued: Pasteurised milk 11 Sterilised milk 11 Tuberculin tested milk 11 No application for registration of premises in connection with the manufacture of preserved food, etc., was received in 1951. 24 CLEAN FOOD The Willesden Clean Food Guild has played an important part in improving the standards of cleanliness in food handling in the district. It was formed in May, 1948, when it was known as the Willesden Hygienic Food Committee; it was re-named the Willesden Clean Food Guild in July, 1950. The committee of the Guild includes representatives of food traders and the Borough Council. The Guild awards certificates free to traders who reach the standards prescribed in the Codes of Practice and the Food Handling Byelaws, and these certificates are renewable annually. The number of traders receiving certificates increased from 302 to 321 at the end of 1951 (Tables I (A) and (B)). The number is not considered satisfactory, but it is higher than in most districts. 115 traders display the Guild's window plaque of membership. Improvements in Premises The majority of the large number of contraventions of the Byelaws and the Food and Drugs Act discovered in 1950 and 1951 have now been remedied (Tables II (A) and (B)); 160 traders were encouraged to provide constant hot water (of the 312 outstanding total defects at the end of 1951, 126 were in respect of the lack of constant hot water for washing). Only one trader was prosecuted for failing to comply with section 13 of the Food and Drugs Act and he was fined £15 and £1 1s. 0d. costs. All the other traders affected complied with the Act and Regulations after consultation with the Sanitary Inspectors. Cafes and Restaurants During the year a considerable amount of work has been carried out to raise the standards of hygiene in cafes and restaurants. Cafes which had been in operation for years without water supply or drainage have either closed or have now been supplied with main water, drainage, basins and sanitary accommodation. During the year, among many other improvements, equipment for the supply of constant hot water was supplied in 17 premises, defective walls were repaired in 12, 63 dirty walls and ceilings were cleansed and redecorated, and five premises were provided with main drainage. The following are typical examples. Examples of Improvements One cafe, a "temporary structure," had been in existence for about 30 years and was without water, drains, or means of heating. The proprietor sold the premises because he was unable to carry out the necessary improvements. The new owners have modernised and equipped the premises with all the necessary amenities and transformed what was previously a most unattractive and unhygienic place into one which is both clean and attractive. Another roadside cafe, a long established "temporary structure" without drainage or water supply, was demolished and a new permanent cafe built. The premises were fitted and equipped to a satisfactory standard and what was formerly a rat-ridden hovel is now a pleasant restaurant. A restaurant with no provision for hot water, and with limited space, was most unhygienic. The proprietor sold the premises and the new owner has repaired and redecorated the premises; he has made structural alterations to provide a reasonably satisfactory kitchen and a serving counter, and has installed new sinks with running hot water. Much remains to be done before the standard of hygiene and cleanliness in eating places can be considered satisfactory, but what has been achieved during the year brings this situation much nearer. Education in Food Hygiene Food hygiene education was continued during the year. Lectures illustrated by films, film strips and models of bacteriological cultures have been given to meetings of traders, school children, women's organisations and staffs of dairies and industrial canteens. Three film shows were arranged during the year for food traders and their staffs. The films shown were:— " The Good Housewife in her Kitchen." " Another Case of Poisoning." " Town Rats." " The Souring of Milk." The attendances were:— Harlesden Methodist Church Hall 110 (including about 80 members of a women's guild) St. Luke's Church Hall, Kilburn 7 St. Catherine's Church Hall, Neasden 17 About 1,200 letters of invitation were sent out for the three meetings, placards were exhibited and press announcements made, but the response was disappointing. A "Clean Food" stand was arranged for the Social Services section of the Willesden Show, September 18th and 19th, 1951. The display consisted of specimens of contaminated foods, bacteriological cultures, photographs of good and bad food handling habits and pamphlets dealing with food hygiene. It attracted large numbers of people, particularly family groups and older school children eager to see the exhibits and to ask questions of the person in charge. A "Clean Food Guild" display, setting out the aims of the Guild, was exhibited at the Electricity showrooms in the early months of the year. 25 The Public's Choice of Shop There was a considerable amount of controversy on the question of boycotting of shops which did not display a certificate. This followed a resolution passed by the Willesden East Labour Party in the following terms:— "the Party are fully behind the Clean Food Guild in their fight to improve the present appalling conditions in the handling and displaying of unwrapped foodstuffs and will instruct its members to boycott all shops that do not display a certificate of cleanliness issued by the Guild." The absence of a clean food certificate does not always indicate that the trader falls below the standards required by the committee. It is, therefore, hoped that many more of the 900 traders who have no certificates but have good standards of food hygiene will apply for certificates. In the meantime housewives might well consider expressing a preference for shops where they have some guarantee of receiving clean uncontaminated food. Summary Much remains to be done to ensure that the public gets clean, uncontaminated food. Many food handlers need to know more about the basic essentials of clean food handling. Willesden is well in the vanguard of clean food production, preparation, and distribution, but continual effort and attention is required to keep up and improve the standards. Contaminated Food The number of cases of contaminated food brought to the notice of the Council, and the extent of food poisoning and dysentery in the Borough, give some indication of the need for improving the hygiene of food handling in the district. During the year 1951, many cases of foreign bodies found in food were reported by members of the public. In some cases a caution was administered to the firm responsible, and in others the offenders were prosecuted with the following results:— Newspaper in loaf Fined £20. Costs £3 3s. 0d. Flies in loaf Case dismissed. Costs £3 3s. 0d. (paid by defendant) Coin in loaf Fined £5. Costs £2 2s. 0d. Flour contaminated by mice Fined £5. Costs £2 2s. 0d. Nail in bun Fined £5. Costs £2 2s. 0d. Paper in milk Fined £5. Costs £2 2s. 0d. Doubtless many more instances of contaminated food occurred in the district, but they are not all brought to the notice of the authority. Unfit and Adulterated Food In this .period of food shortages it is again disappointing to record the condemnation of large quantities of food unfit for human consumption (Table III). The Middlesex County Council supervise food adulteration, and this is another example of duplication of work. An intimate knowledge of food traders in the district helps in the discovery of both unsound and adulterated food, and consequently these duties should be carried out by the authority which has this knowledge—the district council (Table IV). Food Poisoning There was no outbreak of food poisoning during the year; 10 single cases of food poisoning were reported, but the sources of infection could not be traced. There were several outbreaks of Sonne dysentery in the borough during the year. Four day nurseries, several schools and 345 members of the general public were affected. The schools and day nurseries were visited by doctors, health visitors and sanitary inspectors, and suggestions were made for the more hygienic handling of the food. Sonne Dysentery 1951 Cases Symptomless carriers Total Curzon Crescent Dav Nursery (children) 5 (-) — (-) 5 Essex Road Dav Nursery (children) 15 (2) 5 (2) 24 19 (3) 20 (3) 45 Mortimer Road Day Nursery (children) 2 outbreaks 17 (7) 9 (-) 33 Total in day nurseries 56 (12) 34 (5) 107 Furness Road School 11 (-) 5 (-) 16 Bridge Road School 24 (5) 9 (-) 38 Acton Lane Primary School 1 (-) — (-) 1 Chamberlayne Road School 3 (-) — (-) 3 Furness Road School 1 (-) — (-) 1 Kensal Rise Junior School 4 (-) — (-) 4 Other schools 49 (-) 14 (-) 63 Total schools 93 (5) 28 (-) 126 (The numbers in brackets are additional and refer to staff). Other notifications 345 26 TABLE I (A) Statement of Applications for Registration Received to 31/12/51 During 1949 During 1950 During 1951 Totals Applications received 263 135 8 406 Premises registered and certificates issued 195 107 19 321 Applications deferred or refused 68 28 3 85 (14 previously refused, now issued with certificates) TABLE II (A) Report on Inspection of Food Premises During the Year Ended 31/12/51 Inspection of premises: Premises unsatisfactory on 31/12/50 349 Unsatisfactory during the year 263 Premises made satisfactory during the year 438 Unsatisfactory on 31/12/51 174 No. of inspections 2998 Re-visits 3666 Total 6664 TABLE I (B) Summary Trade No. in borough Applications received Certificates issued Deferred or refused Baker 38 12 4 8 Bread and confectionery 38 7 5 2 Butcher 114 44 38 6 Cafe or restaurant 149 67 43 24 Dairy 13 5 5 — Fishmonger or fish-fryer 61 18 11 7 Greengrocer and fruiterer 126 14 12 2 Grocer and general store 315 150 128 22 Ice cream and sweets 181 49 37 12 Works canteen 110 32 30 2 Food factory 14 8 8 — Totals 1159 406 321 85 27 TABLE II (B) Details of Defects Found Outstanding at 31/12/50 During the year Total Remedied during year Outstanding at 31/12/51 Lighting and ventilation 19 10 29 25 4 Constant hot water not provided 262 24 286 160 126 Inadequate refuse storage 21 40 61 60 1 Insufficient sanitary accommodation 24 8 32 20 12 Inadequate storage 21 27 48 40 8 Defective walls and ceilings 95 82 177 149 28 Dirty walls and ceilings 197 183 380 322 58 Dirtv hand towels 10 49 59 58 1 Generally bad conditions 18 7 25 20 5 Any other defects 183 212 395 326 69 Totals 850 642 1492 1180 312 TABLE III Food Unfit for Human Consumption Meat: Macaroni 10 lbs. Bacon 230 lbs. Macaroons 20 lbs. Cooked 527 lbs. Meat, pork luncheon 75 lbs. Tinned 7792 lbs. Fruit: Raw 1837 lbs. Tinned 11953 tins Fish: Raw 132 lbs. Tinned 1545 tins Bread, flour, cereals, etc. 436 lbs. Raw 1171 lbs. Preserves 1104 lbs. Cheese 180 lbs. Vegetables: Butter and fats 9 lbs. Tinned 5313 tins 4760 tins Raw 217 lbs. Soups 310 tins Mincemeat 31 lbs. Miscellaneous : Mix, cake 15 lbs. Biscuits 2420 lbs. Mixture, pastry 27 pkts. Cereal flour 66 pkts. Mustard, French 58 tins Chicken 1 tin Nuts 2 lbs. Chocolate 108 bars Pickles 7 bottles Chocolate, drinking ½ lb. Piemeat 6 lbs. Chocolate and sweets 208 lbs. Pies, meat 5 Chocolate vermecelli 32 lbs. Poultry 217 lbs. Chutney 32 bottles Powder, custard 590 pkts. Coffee essence 26 bottles Powder, lemon barley 12 lbs. Cream, salad 37 bottles Powder, soup 36 pkts. Crest 111 bars Powder, sponge sandwiches 3 pkts. Currants 70 lbs. Powder, Swiss roll 1 pkt. Dates with nuts 48 pkts. Puddings 43 lbs. Fruit, dried 219 lbs. Pulp, fruit 32 lbs. Fruit juices 123 Pulp, tomato 36 tons, 10 cwts. 66 lbs. Fruit juice 15 tins Rolls 4 pkts. Ham, tinned 1260 lbs. Sausage 80 lbs. Heinz strained food 71 pkts. Sugar 80 lbs. Jellies, table 9 lbs. Syrup, golden 44 lbs. Juice, jaffa 4 pkts. Tea 2 lbs. 28 TABLE IV List of Samples Taken During 1951 Article: No. of samples Unsatisfactory Milk 386 6 Almonds 1 — Bap (Scotch bread) 2 2 Beef 1 — Biscuits 2 — Bovril 1 1 Bread and butter 4 1 Butter snips 1 — Cake 6 1 Cheese 1 — Claret 1 — Cod liver oil 1 — Coffee and Chicory Essence 1 — Condensed and Evaporated Milk 3 — Cough mixture 2 1 Cream 3 — Cooked meat 14 — Fish 23 3 Fish cake 1 — Flour 2 — Gherkin 1 — Ginger wine 1 — Glauber salt 1 — Ham 1 1 Honey wheat crunch 1 — Ice cream 3 — Jelly 1 — Lemon Squash 1 — Marmalade 2 — Meat paste 1 — Meat pie 8 — Peaches (frozen) 1 — Orange juice and syrup 2 — Quinine 1 — Raspberry syrup 1 — Rice cake mixture 1 — Rhum raisin praline 1 — Saccharin tablets 1 — Sal volatile 1 — Salad cream 1 — Sausages 42 — Sausage meat and rolls 10 — Sherbet 1 — Sherry 1 — Sulphur tablets 2 — Tomato ketchup 2 1 Twilight rolls 1 — Vinegar 1 Whisky 9 Zinc ointment 2 - Curry powder 1 - Total 559 17 29 FACTORIES The number of factories in the Borough showed a slight increase during the year of one nonmechanical and nine mechanical factories. Table I shows the additions and deletions which again have been confined to small factories employing up to six workers. The general improvement in the sanitary conditions of factories for which the local authority is responsible (see 1949 annual report) has been maintained. The majority of the notices served have been for minor defects and have been complied with in all cases without legal action. Table II shows the number of factories inspected and the number of inspections, etc. Underground Rooms Used as Factories One underground room has ceased to be used as a factory during the year; there are now 15 underground rooms used as factories, only two of which are not used in conjunction with premises above ground. The local authority has special powers to deal with underground rooms used as bakehouses. Basement Bakehouses The local authority is responsible for the supervision of basement bakehouses under section 54 of the Factories Act, 1937. A basement bakehouse is defined as a bakehouse any baking room of which is so situated that the surface of the floor is more than three feet below the surface of the footway of the adjoining street or of the ground adjoining or nearest to the room; a baking room is defined as any room used for baking or for any process incidental thereto. At the beginning of 1951 there were fourteen bakehouses in Willesden, but baking was discontinued in four of them during the year. If they remain unused as bakehouses for a period exceeding twelve months they will not be allowed to be used again for baking. The remaining ten basement bakehouses have been regularly inspected and are maintained in a satisfactory condition. Outworkers and Homeworkers In February and August of each year, factory owners send lists to the local authority of the names and addresses of all persons who work at home for them on certain jobs; all persons who have worked for them during the previous six months are included. Out of 351 outworkers premises inspected during the year, only two notices (for minor matters) were served upon the occupiers. The packing of sweets in a house where conditions were unsuitable was stopped; and the factory no longer has outworkers in Willesden. TABLE I Type of factory No. at January 1st 1951 Added to register Deleted from register Total December 31st, 1951 Non-mechanical 78 9 8 79 Mechanical 796 59 51 804 Totals 874 68 59 883 TABLE II Type of factory No. inspected Inspections Unsatisfactory Outstanding from 1950 Made satisfactory during 1951 Outstanding at December 31st, 1951 Non-mechanical 81 104 18 11 26 3 Mechanical 598 729 82 9 85 6 Details of Defects Found in Non-Mechanical Factories: During 1951 Outstanding from 1950 Remedied during 1951 Outstanding at December 31st, 1951 Want of cleanliness 5 4 7 9 Overcrowding — — — - Unreasonable temperature 2 — 2 - Defective drainage of floors 2 — 2 - Sanitary accommodation: Insufficient 4 2 5 1 Unsuitable or defective 8 3 10 1 Not separate for sexes 1 1 1 1 Details of Defects of Sanitary Accommodation in Mechanical Factories: Insufficient 8 2 9 1 Unsuitable or defective 82 7 84 5 Not separate for sexes 2 1 3 — 30 NOISE NUISANCES Complaints of noise are dealt with in accordance with section 313, Middlesex County Council Act, 1944, as outlined in the 1950 annual report. There were five complaints of the amount of noise from factories during the year. Three of the nuisances were dealt with as follows:— (a) A firm were working with sheet metal, etc., in an open yard and were producing a clanging noise during the evenings and on Sundays. The neighbours complained, and after consultation with the Health Department, the management have arranged for the work to be restricted to normal hours and for it to be carried out mainly within the factory. (b) A firm making cutlery had machinery which produced much noise and vibration. A recognised noise consultant was recommended to the firm by the Health Department. In accordance with his advice, the firm mounted the machinery on resilient mountings and the noise and vibration were reduced considerably. (c) A motor garage servicing taxi cabs during the night disturbed nearby residents with the noise of the running of motor engines and the raising and lowering of a mechanical hoist. Representations by the Public Health Department produced a considerable reduction in the amount of noise. The other two cases of noise nuisance are being dealt with by structural alterations of the factory buildings. NATIONAL ASSISTANCE ACT, 1948 Generally speaking, it has become easier to obtain hospital admission for an aged patient, and the geriatric physician and his special almoner work closely with the area and borough health departments. Hostel admission for the aged and infirm has become, if anything, even more difficult, and the ever-growing waiting lists are reduced more often by death than by admissions to suitable homes. The extension of preventive work in keeping old people up and about as long as possible has made great strides during the year. The lead has been taken by the Willesden Old Folks' Association which was sponsored by Alderman H. Marshall, the Mayor, in 1950. This organisation is now responsible for a visiting service (40 old people are already receiving regular visits from voluntary workers), the establishment of old peoples' clubs, Christmas parties, assisting other charities in distributing parcels, supplying wireless sets, arranging " meals on wheels," etc. In short, it has accepted the responsibility of co-ordinating the work of the care of the aged in the borough, and is thus relieving hospitals and hostels of the heavy strain of long waiting lists, by easing the burden of the care of the aged in their own homes. Details of One Case Dealt With in 1951 Mr. P. Mr. P. was living with his step-daughter, who was at work all day. He was a very feeble old man and was not safe to be left by himself during the periods his step-daughter was at work. The Court order was obtained on the 17th September, 1951, and he was admitted to Central Middlesex Hospital on the 18th September, 1951. He died in that hospital on the 3rd October, 1951. Burial of Destitute Dead During the year arrangements have been made for the burial of 8 persons in accordance with section 50 of the National Assistance Act, 1948, at a total cost of £77 14s. 9d. Public Mortuary 420 bodies were dealt with at the Mortuary as follows:— Post-mortems 420 * Post-mortems and inquests 78 * Adjourned inquests 44 * Included in the 420. Licensing of Hawkers On April 1st, 1951, hawkers of food and premises used by them for storage accommodation became liable for registration under section 11 of the Middlesex County Council Act, 1950. 17 hawkers were registered in 1951. Common Lodging Houses In December, 1950, the keeper of the common lodging house at 1 and 2, Malvern Gardens applied for renewal of his licence but stated that he could not carry out works required under the Public Health Act and the bye-laws to render the premises fit. His licence was therefore renewed for the period of six months pending a decision on the future use of the premises. After due consideration, the Council were of the opinion that the premises were unfit for human habitation and were not capable of being rendered fit at a reasonable expense. The freeholder and the leaseholder of the premises were interviewed and they indicated that they wished to terminate the use of the accommodation as a common lodging house and to use the premises for an alternative purpose. The Council finally accepted the proposal submitted by the owner for the use of these premises for storage purposes as an alternative to their demolition, and the registration was renewed for a further period of one month in order to give the occupiers every opportunity to find alternative accommodation. 31 Slaughterhouse Licences One application for the renewal of slaughterhouse licence was received and granted. Rag, Flock and Other Filling Materials Act, 1951 The Rag, Flock and Other Filling Materials Act, 1951, and the Rag, Flock and Other Filling Materials Regulations, 1951, came into operation on the 1st November, 1951. The Regulations prescribe the standards of cleanliness for each kind of filling material to which the Act applies. They also specified the analysis for the purpose of test, the fixed fees which may be made by the analyst, and the form in which records should be kept by the occupiers of premises registered and licensed under the Act. The premises of manufacturers of rag flock and those used for storing rag flock require to be licensed by the local authority; the fee and the renewal fee is £1 0s. 0d. for a period not exceeding twelve months. The premises of persons carrying on business of upholstering, stuffing or lining of bedding, toys and baby carriages, etc., and others using materials to which the Act applies, have to be registered; only one fee of £1 0s. Od. is chargeable. Since the date of the operation of the Act three premises have been registered. There are no premises in Willesden which require to be licensed. Pet Animals Act, 1951 The Pet Animals Act, 1951, came into operation on the 1st April. 1952. The Act provides for a system of licensing and inspection by local authorities of pet shops: the main purpose of the Act is the protection of animals. Under section 1 of the Act, no person may Keep a pet shop unless he obtains a licence from the local authority on payment of a fee not exceeding 10s. 0d. The Council pays particular attention to the size, temperature, lighting, ventilation and cleanliness of the accommodation, the adequacy of food and drink for the animals, and the prevention of infectious diseases and the selling of animals at too early an age. Under the Act, it is an offence to sell animals as pets in any part of the street or public place except at a stall or barrow in the market. Also, they raiust tot be sold to children under 12 years of age. Under section 4 of the Act, the Sanitary Inspector have power to inspect premises and animals in respect of which licences have been granted, but the Shop Inspector under the control of the Town Clerk will be generally responsible for the details arising from This legislation. Staff Medical Examinations The Willesden Borough Council no longer employ assistant medical officers of health; they were transferred to the Middlesex County Council in 1948. Staff medical examinations are therefore carried out by the Medical Officer of Health. 74 staff medical examinations were carried out in 1951.