WIL 48 AC 439(1) WILLESDEN Borough of willesden 1952 THE 77th 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, 1953. 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 1952. The population has increased slightly, partly owing to the increase in the birth rate and the reduction in the general death rate, but in the main it is due to the fairly large-scale movement of population into and out of the district, with more coming in than leaving. The increase in the population only aggravates the very serious overcrowding in the area. The welcome reduction in infant mortality is slightly offset by the increase in the numbers and mortality of illegitimate infants. The increase in the stillbirth rate has resulted in a loss of life, for the first time, actually greater than in infants under one year of age. On the whole there has been a marked reduction in the loss of infant lives as compared with before the war, owing to improvements in nutrition and antenatal care. These have also led to an exceptionally low maternal mortality rate in the past few years. However, there is room for further improvements in ante-natal care and for research on the cause of congenital malformations and general morbidity in infants. Also, more attention could usefully be given to the care of illegitimate children. The decrease in the mortality for cancer cannot, by itself, inspire us with confidence that the disease is being conquered; there are no figures for the actual numbers of cases and these might well have increased, so leading to a higher mortality in the future. Although there has been a slight reduction in the mortality from cancer of the uterus and stomach, a marked increase for cancer of the breast is a bad sign and points to an urgent need for encouraging people to obtain advice and treatment early. The difficulty in cancer publicity is to achieve this aim without producing unfounded or exaggerated fears. The general reduction in the mortality from respiratory diseases, particularly influenza, pneumonia and bronchitis, conceals the temporary striking increase at the end of the year when there was severe fog. This suggests that atmospheric pollution may be an important factor in promoting diseases of the respiratory system; it may also be responsible for the increase in the incidence and mortality of cancer of the lung. The common infectious diseases such as measles, whooping cough and scarlet fever no longer present a problem of mortality, but they still contribute to much illness in the area. There was no epidemic of poliomyelitis in 1952, but it probably accounted for one death. Both diphtheria and typhoid can now be classified as rare diseases, but dysentery has become much more prevalent in the last few years. Cleaner food handling and better food hygiene standards could help to reduce its incidence, and renewed efforts are being made by the Council for more extensive health education, and improvements in food storage, preparation and distribution. Tuberculosis still remains the most important infectious disease in the borough, and although there is a rapid decline in the mortality, there is no diminution in the number of cases discovered. Tuberculosis presents both social and medical problems. Modern scientific medicine can nearly always save life or at least prolong it, but there must be improvements in both housing and nutrition before tuberculosis can be finally conquered. The continuing high rates for coronary diseases and hypertension, and the increase in mortality from ulcer of the stomach, reveals the need for further research into these disorders which are so often caused by social conditions. Until there is a unified service it will be difficult to combine the efforts of epidemiologists, specialists, general practitioners and other health workers for overcoming these very prevalent disabling disorders. Home accidents continue to levy a heavy toll, and education of the public has been intensified, but is must be remembered that the risk is greater in overcrowded, badly constructed homes and among the lower income groups. It has become impossible to compare health conditions in the different wards with previous years because of the changes made in their boundaries in 1952. Nevertheless there is again sufficient evidence to show that the spending of money on improving living conditions in the overcrowded wards of Roundwood, Carlton and Stonebridge, would pay dividends in reducing the incidence of tuberculosis, measles, whooping cough, pneumonia and other respiratory diseases. Overcrowding still remains the main social problem in the area and this must affect the health of the inhabitants by spreading infection and provoking mental disturbances. The problem of repair of obsolescent and dilapidated property was tackled vigorously by the Council during the year and there is no doubt that the policy of preventive repairs will save many houses deteriorating into slums. There are no figures for estimating the standard of nutrition of the people in the area, but it is doubtful whether with the rising costs of living it has improved or perhaps even been maintained. It is disappointing to record that although five years have passed since the introduction of the National Health Service, there has been no marked expansion of the health services in the area, and administrative difficulties still crowd in and hamper the efficient running of the health services. This problem cannot be solved until there is one health authority administering all the services in the area. By re-establishing the health committee and incorporating the Housing (Standards of Fitness) Sub-committee, the Borough Council provided excellent opportunities for the smoother running of the Health Department. There have been great advances in improving housing conditions, food hygiene, health education and the care of the aged, and the councillors, members of the staff and the sanitary inspectors have all made valuable contributions to the successes that have been achieved 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 estimated, 1952 180,400 Population census, 1951 179,647 Population census, 1931 184,434 Pre-war population, 1938 187,600 Area of the district in acres 4,634 acres Number of inhabited houses (including flats) 43,674 Rateable value £1,672,668 General rate in the £ for the year 18s. 2d. Product of a 1d. rate (estimated) £6,800 VITAL STATISTICS Live Births: Male Female Total Willesden Borough Council Legitimate 1208 1199 2407 Birth rate per 1,000 of the estimated resident population Illegitimate 106 98 204 Total 1314 1297 2611 14.47 Rates per 1,000 total (live and still) births Stillbirths 34 32 66 24.65 Death rate per 1,000 estimated resident population Deaths 935 928 1863 10.33 Death Rate of Infants Under One Year of Age: All infants per 1,000 live births 23.75 Legitimate infants per 1,000 legitimate live births 22.02 Illegitimate infants per 1,000 illegitimate live births 44.12 Death Rate of Infants Under Four Weeks of Age : All infants per 1,000 live births 17.62 Legitimate infants per 1,000 legitimate live births 16.20 Illegitimate infants per 1,000 illegitimate live births 34.31 Maternal Mortality : Deaths from puerperal causes— Puerperal sepsis Nil per 1,000 registered total births Other puerperal causes Other maternal causes 2 Total maternal mortality rate .75 per 1,000 registered total births Deaths from : Males Females Total Cancer (all ages) 172 179 351 Measles (all ages) — — — Whooping cough (all ages) 1 — 1 Diarrhoea (under 2 years of age) — 4 Cause of Death : Males Females Tota 1. Tuberculosis (respiratory) 19 10 29 2. Tuberculosis (other) — 4 4 3. Syphilitic disease 4 1 5 4. Diphtheria — 1 1 5. Whooping cough 1 — 1 6. Meningococcal infections 1 1 2 7. Acute poliomyelitis — — 8. Measles - - - 9. Other infective and parasytic diseases 2 1 3 10. Malignant neoplasm, stomach 29 21 50 11. Malignant neoplasm, lung, bronchus 57 18 75 12. Malignant neoplasm, breast — 40 40 13. Malignant neoplasm, uterus — 17 17 14. Other malignant and lymphatic neoplasms 86 83 169 15. Leukemia, aleukemia 3 6 9 16. Diabetes 4 8 12 17. Vascular lesions of nervous system 92 118 210 18. Coronary disease, angina 155 94 249 19. Hypertension, with heart disease 21 33 54 20. Other heart disease 85 141 226 21. Other circulatory disease 47 47 94 22. Influenza 7 5 12 23. Pneumonia 41 48 89 24. Bronchitis 103 72 175 25. Other diseases of respiratory system 9 7 16 26. Ulcer of stomach and duodenum 20 8 28 27. Gastritis, enteritis and diarrhcea 3 6 9 28. Nephritis and nephrosis 11 12 23 29. Hyperplasia of prostate 12 — 12 30. Pregnancy, childbirth, abortion — 2 2 31. Congenital malformations 7 12 19 32. Other defined and ill defined diseases 73 85 158 33. Motor vehicle accidents 8 5 13 34. All other accidents 28 20 48 35. Suicide 7 2 9 36. Homicide and operations of war — — — Total 935 928 1,863 Infant Mortality Infant mortality in Willesden showed a welcome reduction compared with 1951, but there was an increase in the stillbirth rate. Infant Deaths and Stillbirths. Willesden and England and Wales, 1936.52. Year Population Births Willesden Deaths under 1 year Willesden Infant death rate Willesden Infant death rate England and Wales Stillbirths Willesden Stillbirth rate Willesden Stillbirth 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 2559 73 28.53 30 57 21.79 23 1952 180,400 2611 62 23.75 28 66 24.65 23 5 Sixty.two deaths occurred in 1952, three.quarters (46) in the first four weeks of life (neo.natal period), most of them due to prematurity. Causes of Infant Deaths in Willesden (based on Registrar General's figures) 1936.1939 1940.1945 1946.1951 1952 Deaths Deaths Rate Deaths Rate Deaths Rate Neonatal 1.12 mths. Total Rate Respiratory 106 914 140 9.59 82 4.37 4 5 9 3.45 Diarrhoea and enteritis 131 11.29 108 7.40 39 2.38 1 — 1 0.39 Other infections 34 2.93 40 2.73 18 0.96 — 4 4 1.53 Congenital malformations 83 716 89 6.10 83 4.42 7 4 11 4 21 Premature births 170 14.66 179 12.25 130 6.93 26 .—. 26 9.96 Injury at birth 21 1.81 33 2.26 47 2.55 8 — 8 3.06 Other causes 134 11.10 149 9.40 104 5.59 — 3 3 1.15 All causes 679 56.24 738 46.54 503 26.80 46 16 62 23.75 It is pleasing to note that gastro.enteritis was the cause of only one infant death during the year. Nine deaths were due to respiratory infection and 4 to other infections. Neo.natal 1.12 months Total Respiratory : Ac. bronchitis and broncho.pneumonia — 2 2 Broncho.pneumonia 3 2 5 Broncho.pneumonia and whooping cough — 1 1 Empyema 1 — 1 Other Infections : Gastritis and broncho.pneumonia — 1 1 Chicken pox and whooping cough and pneumonia — 1 1 Meningococcal meningitis — 2 2 Total 4 9 13 Better nutrition and infant care have undoubtedly played an important part in the reduction of infant mortality. Now that there are fewer deaths of infants aged 1—12 months, more attention will have to be paid to the prevention of illness in this group. Further research is required particularly into the cause of congenital malformations, which produced 7 deaths in the neo.natal period and 4 in the group aged 1—12 months. Congenital malformations Neo.natal 1.12 months Total Congenital heart 1 2 3 Tracheo.oesophageal fistula 2 — 2 Spina bifida 3 — 3 Obstructive jaundice — 1 1 Atresia of rectum 1 — 1 Congenital bronchiectasis — 1 1 Total 7 4 11 There were 3 deaths under 'other causes', all in the age group 1—12 months : 1 was due to cellulitis and abscess formation, and 2 to asphyxia; in one the child's face was buried in a pillow, and in the other death was caused by inhalation of vomit. There are a greater number of deaths in first.born infants, and the rate is higher. Position of Child in family 1 2 3 4 5 6 Unknown Total Deaths 24 12 10 6 3 1 6 62 An examination of the 24 deaths of first.born infants reveals that apart from birth injuries the causes are similar to those in families with more children. 6 Cause Neo-natal 1-12 months Total Prematurity 5 — 5 Respiratory conditions 3 — 3 Congenital malformations 3 3 6 Birth injury 8 — 8 Other causes — 1 1 Gastro-enteritis 1 — 1 Total 20 4 24 An analysis of the birth injuries indicates that one or two were probably avoidable. Cause Delivery Weight No. Prolonged 2nd stage Forceps 7lb. 9oz. 1 Prolonged labour (3 days) Natural forces 91b. 4oz. 1 Precipitate labour (Induced prematurity for A.P.H.) Natural forces 61b. 6oz. 1 Mother had epileptic fit during second stage Natural forces 41b. 14oz. 1 No apparent cause Natural forces 61b. 6oz. 3 61b. 6oz. 81b. 7oz. No information available 1 Total (All neo-nj ital deaths) 8 Details of the abnormal deliveries where the infant died are given below. Delivery Reason Cause of death Neo-natal Position in family Caesarian section Toxaemia in mother Prematurity 1 4 Caesarian section Elderly primipara Broncho-pneumonia 1 1 Caesarian section Acute appendicitis Prematurity 1 2 Forceps delivery Prolonged 2nd stage Birth injury 1 1 Total 4 An analysis of infant mortality by wards demonstrates similar differences as in previous years, but owing to the changes made in the number and boundaries of the wards in March, 1952, they are not strictly comparable. An analysis of infant deaths by social class groups and home environment reveals that a large proportion occur in social class groups IV and V. Social Class Group Group I — Group II 7 Group III 20 Group IV 15 Group V 20 Total 62 Better maternal and infant care with prevention of birth injuries and prematurity, together with improved living conditions will assuredly remove many of the causes of still births and infant deaths. Prematurity A far greater number of premature babies survived than died, and most of them were born in hospital. Premature Births and Deaths (1946-1952) (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) 1952 38 (3) 137 (23) 8 (3) 175 (26) They are higher in the wards where the poor sections of the population live. 1952 only Carlton Kilburn Brondesbury Park Kensal Rise Manor Harlesden Stonebridge Roundwood Church End den Green Mapesbury Gladsstone Cricklewood Brentwater Total Births in home 7 (1) 2 (0) (0) 3 (0) 5 (0) 6 (0) - (-) 6 (0) 3 (0) - (0) 4 (0) 1 (0) - (0) 1 (0) 38 (1) Births in hospital 9 (2) 8 (0) 8 (1) 8 (2) 9 (1) 7 (0) 14 (4) 10 (2) 18 (4) 11 (2) 14 (3) 9 (2) 7 (2) 5 (0) 137 (25) Total 16 (3) 10 (0) 8 (1) 11 (2) 14 (1) 13 (0) 14 (4) 16 (2) 21 (4) 11 (2) 18 (3) 10 (2) 7 (2) 6 (0) 175 (26) Most of the deaths occur in families of social class IV and V, and improvements in their living conditions would probably save many lives. Births There was a further increase in the proportion of mothers having their babies in hospital, reaching a new high record. There was a further reduction in home confinements, but a slightly greater number was dealt with by county midwives, because they now practice in the South Kilburn area, transferred from mid. wives of Queen Charlotte's Hospital in June, 1951. 1949 1950 1951 1952 Total notified live births 2798 2735 2362 2587 Born in institutions 2177 2202 1977 2209 Born at home 621 533 385 378 Percentage born in institutions 77.28 81.06 83.70 85.39 Institutions Central Middlesex Hospital 846 1023 884 1098 Kingsbury Maternity Hospital 890 733 716 674 Larger Hospitals outside Willesden Smaller Hospitals outside Willesden 241 144 236 172 188 152 238 162 Nursing homes, etc 56 38 37 37 441 446 337 437 Total 2177 2202 1977 2209 Home County Midwives 418 300 296 308 Queen Charlotte's Midwives 86 87 19 — Willesden District Nursing Association 117 146 70 70 Total 621 533 385 378 At the beginning of the year, the Central Middlesex Hospital did not have enough maternity cases to fill their beds, but before the year ended, many mothers were refused admission because of shortage of accommodation. Medical factors and home conditions were considered when beds were booked for mothers, and some mothers were advised to have their confinement at home. It is significant that there was an increase in the number of births taking place in the smaller and larger hospitals outside Willesden. The time is rapidly approaching when the question of hospital or home confinement will have to be decided in an orderly fashion. On the one hand, mothers probably find it cheaper and more convenient to have their babies in hospital particularly where there is overcrowding in the home; on the other hand, it is more expensive for the nation, particularly when there is a shortage of general medical and surgical beds. In April, 1952, the control of Kingsbury Maternity Hospital passed to the Board of Governors of the Charing Cross Hospital, thus severing more completely an intimate relationship between the hospital and the borough which had existed for 20 years. Illegitimate Births The birth rate in Willesden showed a slight increase (1.6 per cent.) over 1951 ; 14.47 per 1,000 as compared with 14.24, but it was still 5.2 per cent, below that of England and Wales (15.3). The number of illegitimate births has increased from 179 to 204. As the death rate in illegitimate children is usually notoriously high, special attention was given to the 119 illegitimate births which came to the notice of health visitors in 1952; 84 were not known to them. Health visitors and midwives work very closely with hospital maternity almoners, officers of the County Council's Children's Department, Moral Welfare Department, the Court and voluntary welfare organisations. Additional help was given to mothers as soon as it was known that they were going to have an illegitimate child. Mothers were invited to attend the ante.natal clinic, and arrangements were made for hospital confinement unless they preferred to have the baby at home. They were given special invitations to attend mothercraft classes and thus meet other mothers. Where necessary they were referred to the County Council Moral Welfare Worker to arrange to go into a home before and after the confinement. They were informed how to obtain national health insurance allowances, affiliation orders, and baby clothes and perambulators from voluntary organisations. Advice was also given on the procedure for adoption, and for placing the child with a foster mother or in a residential or day nursery. Of the 119 illegitimate infants known to health visitors, 102 were born in hospital and 17 at home; 68 were first babies. It is interesting to note that a large number of mothers were over the age of 25, and that breast feeding was probably below the average for the district as a whole. 8 Age of Mother Breast Feeding of Infant Position of child in family; not all the children in the family illegitimate Under 20 years 20— 25 years 26— 30 years Over 30 years Unable _ to ascertain Never breast fed Less than 4 weeks Less than 2 mths. Less than 3 mths. Over 3 mths. Unable to ascertain 1st 2nd 3rd 4th 5 th 6th or over Unable to ascertain 18 41 27 18 13 19 28 18 10 20 23 68 17 11 7 2 6 8 vo 117 118 + 1 infant still born = 119 (Two twin pregnancies) 119 10 Both parents were living together in 48 cases and the mother was able to stay at home to look after the child. Where both parents were living together, 4 mothers had husbands living, 1 father had wife living, 6 were awaiting a divorce, 2 have married since birth of infant, and no information was available for 35. Nineteen infants were in the care of a relative and 13 in a day nursery, the 32 mothers going out to work. In general the infants were fairly well cared for, but 9 were admitted to a residential nursery, 5 were adopted and 1 was in the care of a foster mother; 9 died and 1 infant was stillborn. The following are examples of unsatisfactory homes The family with two other legitimate children, whose father is in prison, live in a poor and overcrowded home. The baby was adopted later. Parents living together with another illegitimate child in a poor home of only one furnished room. This family frequently changes its address. There are 5 other illegitimate children in the family living in a very poor home. The family is under constant supervision by both the health visitor and the N.S.P.C.C. The mother, a deserted wife, is living with the father of the child, and two other legitimate children in a very poor basement home. The father is out of work. The baby developed whooping cough and died. The mother, a deserted wife, has two other legitimate children, and is not living with the father of the child. She left the illegitimate baby in a cinema. The baby is now in a residential nursery. An unknown male child died when 7 days old in the Children's Home, Barretts Green Road. Problem families, such as those described above, present the most difficulties. Although the illegitimate infant death rate was much higher than last year, the actual number concerned (9) was small. The social class of the family where known was V. Most of the deaths could probably have been prevented; 4 were due to prematurity, 1 injury at birth, and the other in the age group 1—12 months died from broncho-pneumonia as a complication of whooping cough. Cause of Death (Registrar General's classification in brackets) Age at Death Weight at Birth Where Born Age of Mother No. in Family Social Class Asphyxia, sleeping in pram. Accidental death (Other causes) 5 mths. 41bs. 13^oz. Central Middlesex Hospital 21 years 1st V Atelectasis and cerebral haemorrhage. (Injury at birth) 2 hours Not known St. Joseph's Home, 34, West Gardens, High gate Not known Not known Not known (Prematurity) 26 weeks 1 day lib. 6oz. Central Middlesex Hospital 27 years 1st V (Prematurity) 33 weeks 6 days 41 bs. 6oz. Kingsbury Hospital 23 years 2nd V (Prematurity) 28 weeks 6 hours lib. lOoz. Central Middlesex Hospital 30 years 1st V Broncho-pneumonia and whooping cough (Respiratory) 3 mths. 41b. 2oz. Home 23 years 3rd V (Prematurity) 28 weeks 28 hours 21b. 3oz. Central Middlesex Hospital Not known Not known V Congenital heart (Congenital malformation) 6 mths. 51bs. Central Middlesex Hospital 24 years 1st V Broncho-pneumonia (Respiratory) 3 weeks Not known Hospital Not known Not known Not known Clearly, better ante-natal care might have prevented the deaths from prematurity, and better infant care could have saved the life of the baby who died from whooping cough. 11 GENERAL PROVISION OF HEALTH SERVICES Public Health Laboratory Service The Public Health Laboratory Service carry out bacteriological examinations at the Central Public Health Laboratory, Colindale Avenue, N.W.9, and at the branch laboratory in Neasden Hospital, Brentfield Road, N.W.10. Private practitioners send specimens, such as swabs from sore throats, faeces from intestinal infections and cough plates and post.nasal swabs from whooping cough cases to the branch laboratory in Neasden Hospilal, the Health Department, 54, Winchester Avenue, N.W.6, or the Willesden Health Centre, 381, High Road, Willesden, N.W.10. They are collected and taken to the Central Public Health Laboratory. The practitioner receives a report on the telephone the next morning, followed by a written report. The Sanitary Inspectors send samples of milk taken from dealers in the district. The following results were obtained during 1952:— Organisms Found 616 Throat/Nose Swabs : Diphtheria bacilli 1 Haemolytic streptococci 186* Vincent's angina 15* Negative 420 *Both htemolytic streptococci and Vincent's angina were found in 6 swabs. 2102 Faeces Specimens : Shigella 474 Salmonella 43 Protozoa — Negative 1585 1775 Sputum Specimens : T.B 279 Other organisms 6 Negative 1490 29 Post.Nasal Swabs : B. Pertussis 1 Negative 28 294 Milk Examinations Schools (pasteurised) Dealers' premises Total Pasteurised T.T. pasteurised Sterilised Samples 99 90 45 58 292 Satisfactory 98 89 45 58 290 Unsatisfactory 1 1 — — 2 Second sample, satisfactory 1 1 — — 2 61 Ice Cream Tests : Grade 1 38 Grade 2 14 Grade 3 4 Grade 4 5 405 Water Examinations: Domestic supplies, etc 3 Swimming pools 88 Satisfactory 91 Miscellaneous : 223 Total number of examinations : 5191. 12 Uncleanliness and Scabies There was again fewer children with lice and nits or scabies. The Middlesex County Council therefore decided to offer a lower payment for treating school children. The Borough Council then found it uneconomic to continue running the Scabies and Lice Treatment Centre at the Neasden Hospital and accordingly closed it on the 1st September, 1952. Cases Treated at the Scabies and Lice Treatment Centre from 1.1.52 to 30.8.52 The numbers in the brackets relate to the attendance of contacts of scabies who showed no signs of infection on inspection but nevertheless received treatment. They are not included in the total. New cases treated Attendances Scabies Lice and nits Total Scabies Lice and nits Total Children under 5 years 3 16 19 11 (-) 16 27 Children 5-15 years 5 78 83 31 (-) 78 109 Adults : Men 4 6 10 37 (2) 28 65 Women 8 20 28 Total 20 120 140 79 (2) 122 201 The Borough Council then made arrangements with the Kensington Borough Council for the treatment of adults and children under the age of 5 years at their cleansing centre; the Middlesex County Council organised treatment for school children at the Stonebridge Health Centre. Cases Treated at the Kensington Borough Council Cleansing Centre and Stonebridge Health Centre 1.9.52 to 31.12.52 New cases treated Attendances Scabies Lice and nits Total Scabies Lice and nits Total Children under 5 years 1 - 1 1 - 1 Children 5-15 years 4 28 32 9 28 37 Adults : Men - - — 10 3 13 (Women 5 3 8 Total 10 31 41 20 31 51 The reduction in the number of cases dealt with in the second half of the year was propably due partly to the altered arrangements which caused inconvenience to some families in adults and young children having to travel to Kensington, while school children had to go to Stonebridge. Establishments for Massa.ge and Special Treatment The registration of establishments for massage and special treatment is delegated to the Borough Council under Part XII of the Middlesex County Council Act, 1944. Sanitary Inspectors supervise the 26 establishments registered in Willesden. Five new licences were issued in 1952, 20 were renewed, and one establishment was exempted under section 363 of the Act as it was run by a registered member of the Chartered Society of Massage and Medical Gymnastics (now the Chartered Society of Physiotherapy). Health Education Doctors are today finding it more and more necessary to work with their colleagues and other health workers in a team. As the theory and practice of medicine develops in complexity, it becomes impossible for a doctor to treat his patients in splendid isolation. Also, with the development of social medicine, more and more health workers begin to recognise the need to encourage people to take an interest in their health and environment. The striking advances made in the reduction of infant and maternal mortality are undoubtedly due in no small degree to the general spread of knowledge of maternal and infant care. An extension of the knowledge of healthy living will help many people to avoid many mental and physical disorders. Environment and better nutrition have also played a part; it is not sufficient merely to educate the population to practise healthy habits of living in a standard environment, but also to help them overcome the difficulties of inferior standards of living : to gain their confidence it is also necessary to show that we are making serious efforts to improve these conditions. Moreover, social medicine draws attention to the social causes of diseases, which clearly need community action for their prevention. There have been many definitions of health education and many theories on how it should be presented to the people. The most successful forms of health education are those integrated with the public health work of the area; the diphtheria and tuberculosis campaigns in Willesden give striking examples of this. 13 It is essential to direct one's efforts to several groups in the community, acquiring allies throughout the campaign. Firstly, councillors are key people in any health education campaign, for not only do they have to sanction the essential expenditure, but also they are generally in close contact with the people and can therefore help to spread knowledge and answer questions. In all campaigns, and whenever any special public health work is planned, the chairmen of committees, such as health, area and education, are given full details; reports are then presented to the committees, and councillors are encouraged to ask questions. Secondly, organisations of the people, whether religious, social or political, are also of importance, because they usually have direct or indirect access to large sections of the population. Lectures with films and lllmstrips are given to organisations and general propaganda to the public is carried out by such means as posters, press publicity, films and leaflets. Thirdly, the co.operation of the staff and general practitioners is, of course of prime significance for it is through them that many people gain their first knowledge of the work of the department. All general practitioners in the area are circularised with an outline of the scheme. Special meetings are held of the various sections of the staff so that each member knows what the object of the work is and the scheme can be modified to deal with practical difficulties. The publicity campaign for a mass radiography survey in five wards is a typical example. Two meetings of local organisations and the press were held and were addressed by the Mayor, the chairman of the public health committee and the medical officer of health. Leaflets, with maps on the back to indicate the siting of the two M.M.R. units, were distributed by local political and religious organisations, the Red Cross and the boy scouts, etc., to every house and shop in the five wards. Leaflets were also placed at booking centres, health offices, clinics and shops. Posters were exhibited on sites and hoardings, and a large number were also displayed in shop windows (the total number was approximately 100). Large advertisements were displayed on six sites in the borough and were also placed in each issue of the three local newspapers for a period of three weeks. Display sets were exhibited in shop windows in prominent places, and sets of 12 panels on mass X.ray were on view at the health clinics. Lectures and film shows were given by the area medical officer, clinic doctors and the chest physician to 12 secondary modern schools and 13 local organisations. Talks were also given to mothercraft classes at clinics and parents' clubs at day nurseries. Slides were shown at two of the local cinemas, and all medical practitioners and religious organisations in the borough were informed of the unit's visit. The local press were very co.operative and reported the activities of the unit fully. There were nine centres for making appointments and they included the public health department, clinics, libraries, and public baths and a retail chemist's shop. The numbers of appointments made at the shop were particularly good, and those at the centres were generally quite good. The Mayor officially opened the two mass X.ray units and was X.rayed, together with the medical officer of health and the editor of a local newspaper. While the number of cases discovered was less than expected, the work was eminently successful in spreading a considerable amount of knowledge on tuberculosis among the population of Willesden, who will reap a useful harvest in the future in preventing the disease. A similar publicity campaign with help from cinemas, clinic doctors, health visitors, medical practitioners and the press, was carried out on diphtheria immunisation in February, 1952. The two diphtheria immunisation campaigns of May, 1951 and February, 1952 resulted in the completed cases being more than doubled and boosters almost 20 times greater than in the previous year. Completed cases Boosters May, 1950—April, 1951 867 241 May, 1951—April, 1952 2253 4580 Percentage increase 159.8 1800.4 Mothercraft classes are held at the clinics and these have become more popular this year. Talks with filmstrips are given by health visitors and doctors, and are very useful indeed in helping mothers to care for themselves and their babies. Nothing gives a mother more confidence than to know that her seemingly individual and unusual problem is shared by others, and that many mothers have found a satisfactory solution to the same problem. Health workers also learn from these discussions how to overcome some of the difficulties encountered in the homes. Health visitors give more specific individual health education in the mothers' homes. Parents' clubs are held at the nine day nurseries and they give an excellent opportunity for parents to meet the staff and have discussions on the problems of the children for whom they are jointly responsible. It is very difficult to obtain uniformity in handling a child if the mother and staff rarely meet each other. General health talks and film shows are given; 41 talks and 9 film shows were given by the area medical officer and his staff, the borough housing manager, the borough librarian, the public relations officer and others. Special attention is paid to the health education of school children. Every effort is made to link health talks with the biology and science syllabus. The doctors are now welcomed by the children and the teaching staff, and generally deal with subjects, such as the function of the brain and the kidneys, which are difficult for the ordinary lay teacher. After one or two lectures the teacher is sufficiently confident to give the lectures herself. The gaining of a basic knowledge of the workings of the body will help these 14 youngsters to live a more healthy life and also give them an understanding of the common mental and physical disorders, thus relieving the health services of much burdensome work in the future. A total of 207 health talks and film shows, with attendances of from 20 to 120, were given to 1,075 school children in 1952. The subjects covered a very wide range and were given by the area medical officer and members of his staff, the chief sanitary inspector and his staff, the deputy borough engineer, public relations officer and the chest physician. A brains trust at the end of each term enables school children to raise any health questions that have not been answered adequately during the course of lectures. Shortage of staff prevents the giving of talks to many organisations in the area. Nevertheless a total of 28 talks were given by the medical officer of health and the chief sanitary inspector. A list of 15 subjects is sent to the religious, social and political organisations in the area and it is significant that those usually chosen are associated with the more specific work of the public health department. The attendances at the lectures have ranged from 20 to 350. Altogether, one can look back on the year with the satisfaction of knowing that more and more people in Willesden are being enlisted in the battle against disease. They are beginning to recognise that the main enemy, ignorance, must be first defeated before any appreciable advance can be made. 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 Council Council, remain substantially the same; they are described in the 1948 report. The two ante-natal and child welfare clinics at Daisley Church Hall, Sneyd Road, Cricklewood, opened February, 1951, and at St. Catherine's Church Hall, Neasden, opened March, 1952, have proved very popular and they are well attended by mothers and children in the area. Building was commenced during the year for the extension of the Willesden Chest Clinic (see page 19). Mr. Orbach, M.P. for East Willesden, was appointed chairman of the Central Middlesex Hospital Management Committee at the beginning of 1952. In June, 1952, a £40,000 extension to St. Andrew's Hospital was opened by Cardinal Griffin, and named the Griffin Wing. It has 16 children's beds and 16 private beds in either single or small rooms, and a new X-ray department. The building cost £28,000 and the equipment £12,000. PREVALENCE AND CONTROL OF INFECTIOUS AND OTHER DISEASES The reduction in the incidence and mortality of infectious diseases such as diphtheria, scarlet fever, measles, whooping cough and typhoid fever in the past 50 years is as much a reflection of the improvements in living standards as in better methods of treatment. Better housing and better nutrition, improved ventilation and smaller families have helped to increase resistance and reduce the possibilities of spread of infection. Health visitors have played an invaluable role in health education and improvement in standards of hygiene. Notifiable Infectious Diseases Cases notified (confirmed in brackets) 1950 1951 1952 Diphtheria 15 (1) 12 (1) 14 (1) Scarlet fever 317 (306) 211 (204) 262 (249) Pneumonia 164 (150) 172 (161) 126 (113) Whooping cough 650 (648) 550 (543) 330 (328) Erysipelas 29 (26) 31 (30) 27 (27) Measles 2280 (2255) 1937 (1927) 1528 (1520) Diphtheria In the past three years there has been only one confirmed case of diphtheria annually. Because of the almost complete disappearance of this disease in the area, parents are becoming complacent. Outbreaks of diphtheria in other districts have shown that it is dangerous for parents to adopt this attitude, and they are taking a considerable risk if their children remain unimmunised. Another special campaign for diphtheria immunisation was therefore organised in February, 1952; again with satisfactory results (see page 13). Measles 1,528 cases were notified in 1952 (1,520 confirmed), but a total of 1,567 cases (805 were children under 5 years of age) came to the notice of the health visitors. At the end of the year the largest outbreak of measles for many years commenced in Willesden. The number of cases notified in the last week of the year was at least five times that of 1951. 15 Whooping Cough Whooping cough vaccination was started in Willesden in 1947 as a venture, with no controls for comparison. It was hoped that if whooping cough vaccination was effective, there would in time be a marked reduction in its incidence and mortality similar to what was experienced with diphtheria immunisation. It is far too early to judge the effectiveness of whooping cough vaccination owing to the relatively small number of children who have been protected up to date. In 1949 it appeared to have had an appreciable effect on the incidence, but the figures of the following years unfortunately dispelled this hopeful illusion. 1 here has been no significant reduction in whooping cough in Willesden in the last tew years. Year Population Child population Number of cases notified No. of deaths per 1,000 population Case rate Death rate No of children vaccinated Total immunised 0—4 5—15 Willesden England & Wales Willesden England & Wales Willesden England & Wales Willesden England & Wales 1936 190,000 - 743 12 2090 3.910 - .063 .051 - - 1937 188,030 - - 626 - 11 1600 3.329 - .058 .039 - — 193? 187,600 - - 277 - 3 1052 1.476 - .016 .026 - — 193' 188,000 - - 672 - 5 1229 3.574 - .026 .030 - — 1940 152,030 - - 82 53,607 2 2459 .539 1.280 .013 .017 - — 1941 127,230 - - 505 173,330 5 2065 3.969 4.151 .039 .062 - 1999 1942 138,600 10,000 15,500 460 66,016 4 1143 3.319 1.576 .029 .021 - 4493 1943 144,430 10,424 17,480 238 96,136 3 746 1.648 2.275 .021 .029 - 4211 1944 139,510 11,440 17,740 401 94,044 4 570 2.874 2.215 .029 .028 - 1531 1945 161,954 12,460 18,430 215 62,601 3 527 1.327 1.470 .018 .018 - 2476 1946 170,550 13,191 20,389 377 92,936 4 489 2.210 2.170 .023 .020 - 2687 1947 175,900 15,107 20,830 571 92,682 6 905 3.246 2.153 .034 .022 - 1964 1948 179,900 15,544 20,663 423 146,410 2 748 2.351 3.366 .011 .017 - 2609 1949 181,120 15,270 21,430 205 102,816 .— 527 1.132 2.325 — .012 1615 2465 1950 181,700 14,930 22,410 648 157,781 2 494 3.566 3.584 .015 .009 822 1886 1951 179,647 13,847 22,995 543 169,441 — 456 3.023 3.873 — .010 1163 2874 1952 180,400 13,846 24,000 328 114,868 1 492 1.818 2.623 .005 .011 946 1615 England England There are many difficulties involved in interpreting the results. Firstly, whooping cough notifications, like those of measles, never reflect accurately the actual number of cases present. Indeed, it has been estimated that they reach only 50 per cent, of the total. Since 1948, every child is provided with a doctor free, and it is likely that a higher proportion of cases of whooping cough has been notified than hitherto. Secondly, chloramphenicol undoubtedly has a beneficial effect if given in the early stages, and this would probably have had some effect in the last few years in reducing the mortality, and by killing the organisms in the early stages limit the extent of their spread. Finally, as whooping cough usually attacks children earlier than other infectious diseases, often before they are six months old, protection must be given very early if any useful result is to be expected. The Medical Research Council has already produced evidence to show that whooping cough vaccination is effective and we should be able to obtain more evidence if its value in the future, particularly if there is an increase in the number of young infants who are vaccinated. 330 cases were notified in 1952 (328 confirmed), but a total of 334 (172 were children under the age of 5 years) came to the notice of the health visitors. There was one death from whooping cough in an illegitimate child of under six months. Pneumonia and Influenza 126 cases of pneumonia were notified in 1952 (113 confirmed). There were 89 deaths from broncho.pneumonia, lobar pneumonia and pneumonia (unspecified), and 12 deaths from influenza. Other Infectious Diseases Disease Cases notified (number confirmed in brackets) Typhoid fever 11 (9) Dysentery 218 (160) Malaria 1 (1) Poliomyelitis and polio.encephalitis 11 (5) Meningococcal infection 13 (8) Encephalitis lethargica 2 (1) Smallpox — (-) 16 Poliomyelitis Poliomyelitis did not reach epidemic proportions in 1952. There were 11 notifications of poliomyelitis in 1952; 8 patients were admitted to Neasden Hospital and 3 to other hospitals. Only 5 actually had the disease; 2 in the age group 0-15 and 3 over the age of 15. Four had slight paralysis, and 1 who had a severe paralysis of the vocal cord attended a rehabilitation centre at Watford. There were two notifications of encephalitis; 1 was confirmed, a boy of 1| years (a fatal case). He was admitted to Central Middlesex Hospital suffering with pyrexia, but on post-mortem he was found to have had encephalitis (?) poliomyelitis. The other notification was for a boy aged 7\ years who was admitted to Neasden Hospital and finally diagnosed as chicken pox encephalomyelitis; he was discharged cured. Dysentery There was an outbreak of Sonne Dysentery among the Central Middlesex Hospital nursing staff from December 24th, 1951, to January 23rd, 1952. 58 nurses and 2 doctors were confined to bed with symptoms, and the bacillus dysentery Sonne was isolated in 21 cases, the last positive case occurring on January 4th. One case of dysentery and 4 carriers were found among the kitchen staff catering for the nurses home; there were no cases among hospital patients. A New Year's party for staff and friends was cancelled because the food provided would have come from the staff kitchen. Apart from general epidemiological precautions taken, a talk with a film strip on food hygiene was given by the Chief Sanitary Inspector and another sanitary inspector to the kitchen staff. In addition, advice was given on providing improved facilities for hand washing (individual towels and a wash-hand basin) and for the replacement of a defective sink and saucepans. Smallpox There were no cases of smallpox occurring in the borough in 1952. Ophthalmia Neonatorum Three cases were notified in 1952 (1 15 per 1,000 live births); there was complete recovery with unimpaired vision in all three. Puerperal Pyrexia 101 cases of puerperal pyrexia were notified during the year (101 confirmed). Since August 1st, 1951, puerperal pyrexia 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 41 cases of food poisoning were notified during the year (23 confirmed). 17 TUBERCULOSIS There has again been a welcome decline in the number of deaths from tuberculosis; it is now less than a third of before the war. This satisfactory result is probably due to improved methods of diagnosis and treatment; more patients are now detected in the early stages when they are most amenable to simple methods of treatment such as rest, control of cough, better diet and chemotherapy. The number of new cases has remained about the same for the past three years and is higher than in the years before the war; also, the total number of cases on the register has increased. Notified Cases and Deaths Year Population New cases in brackets) (Rates per 1,000 pop. Deaths (Rates per 1,000 pop. in brackets) Cases on Register Pulmonary Non. pulmonary All forms Pulmonary Non. pulmonary All forms Pulmonary Non. pul. :nonary All forms 1936 190,000 211 47 258 128 16 144 (1.11) (.168) (1.358) (.673) (.084) (.757) 655 152 807 1937 188,030 205 49 254 119 14 133 (109) (.261) (1.351) (.632) ( 074) (.707) 688 161 849 1938 187,600 210 56 266 117 11 128 (1119) (.298) (1.417) (.623) (.058) (.681) 691 172 863 1939 188,000 250 37 287 108 12 120 (1.329) (.197) (1.526) (.574) (.063) (.638) 678 166 844 1940 152,030 204 54 258 105 16 121 (1.324) (.355) (1.697) (.690) (105) (.795) 587 145 732 1941 127,230 217 32 249 79 15 94 (1.705) (.252) (1.957) (.621) (.117) (.738) 575 116 691 1942 138,600 234 47 281 100 15 115 (1.688) (.339) (2.027) (.721) (.108) (.829) 369 133 502 1943 144,430 262 51 313 85 14 99 (1.814) (.353) (2.167) (.589) (.096) (.685) 734 150 884 1944 139,510 210 23 233 84 18 102 (1.505) (165) (1.670) (.602) (.129) (.7 31) 815 156 971 1945 161,954 207 45 252 81 16 97 (1.278) (.277) (1.556) (.500) (.098) (.598) 927 172 1099 1946 170,550 255 34 289 81 15 96 (1.495) (.199) (1.694) (.475) ( 088) (.563) 88 1067 180 1247 1947 175,900 253 33 286 76 12 (1.438) (.188) (1.626) (.432) ( 068) (.500) 1198 191 1389 1948 179,900 243 27 270 80 11 91 (1.351) (.150) (1.501) (.445) (061) (.506) 1293 196 1489 1949 181,120 186 22 208 66 9 75 (1.026) (.121) (1.147) (.364) ( 050) (.414) 1386 207 1593 1950 181,700 229 29 258 51 4 55 (1.260) (.159) (1.419) (.280) ( 022) (.302) 1543 217 1760 1951 179,647 228 33 261 46 5 51 (1.269) (.184) (1.453) (.256) ( 028) (.284) 1673 239 1912 1952 180,400 229 27 256 29 4 33 (1 .269"! (.150) (1.419) (.161) ( 022) _ (.183) 1803 250 2053 The diagnosis of tuberculosis today is no longer a death sentence. This is most heartening, for an early diagnosis provides an almost certain guarantee of cure, and what is equally important, steps can be taken to prevent the spread of infection to relatives and friends. While an early diagnosis of tuberculosis cannot exactly be welcome, at least it need not be faced with the same dread as in previous years : indeed, one can be thankful that the disease has been discovered before it has caused irremediable damage. Nevertheless, tuberculosis still remains the most important infectious disease in the borough : five people are struck down every week and do not recover for months or even years, and at least one is killed every fortnight. More than half the deaths are people under 55 years, and the majority of patients are still under 45, at the vital period when they are trying to establish themselves in the industrial and commercial world and in the general social life of the community. 18 Age groups New cases Deaths Respiratory Non.respiratory Respiratory Non.respiratory Male Female Male Female Male Female Male Female Under 1 . . — . — — . . 1 to 5 3 3 1 2 — — . 1 5 to 10 1 2 3 4 — — . — 10 to 15 1 — — 1 — — . — 15 to 20 8 10 — 1 — 1 . — 20 to 25 12 22 2 — — 1 . — 25 to 35 31 37 1 3 3 3 . 1 35 to 45 21 13 3 2 1 2 . — 45 to 55 20 10 1 — 3 1 . — 55 to 65 16 4 — 1 4 — . — 65 and upwards 11 4 1 1 8 2 . 2 Totals 124 105 12 15 19 10 . 4 Although patients are now more often detected in an earlier phase of the disease, a large proportion (about 1 in 5) still die unnotified, and together with those who die within a year of notification make up almost half the deaths; the actual number of deaths, however, was much lower in 1952 and so fewer patients were involved. Nevertheless, the fact that 12 cases were either undiagnosed or diagnosed only within a year of death, is unsatisfactory, since some may have survived if they received earlier treatment, and they are likely to have spread disease to others. 1947 1948 1949 1950 1951 1952 1947.52 Deaths 76 80 66 51 46 29 348 Percentage not notified 13.6 160 22.7 11.76 19.56 20.69 16.99 Percentage notified before death : 0—12 months 34.1 34.1 25.7 35.30 15.22 20.69 29.00 1—5 years 34.1 340 27.4 27.45 39.13 31.03 32.18 Over 5 years 18.2 15.9 24.2 25.49 26.09 27.59 21.83 Prevention of the Disease Non.pulmonary tuberculosis is caused by drinking milk containing bovine tubercle bacilli, and can therefore be prevented by eliminating infected cows and milk. It is now an offence to sell raw milk in Willesden (see page 32). Pulmonary tuberculosis is mainly spread by droplet infection and therefore usually to people who live and work in overcrowded conditions and whose resistance is lowered by poor nutrition. The case rates by wards show the significance of environment : wards such as Roundwood, Mapesbury, Willesden Green and Carlton, where there is the most overcrowding among the poorer sections of the population, have rates well above the average, contrasting badly with Gladstone, Manor and Brondesbury Park wards. 1952 Ward Pulmonary Cases Non. Pulmonary Cases Pulmonary Rate Combined Rate All Forms Deaths Rate Carlton 20 3 1.581 1.818 4 .316 Kilburn 16 3 1.144 1.359 3 .215 Stonebridge 17 — 1.308 1.308 2 .154 Roundwood 25 3 2.037 2.281 5 .407 Brondesbury Park 12 1 .938 1.016 1 .078 Kensal Rise 13 — 1.118 1.118 3 .258 Cricklewood 16 4 1.322 1.653 1 .083 Church End 15 3 1.102 1.322 5 .367 Willesden Green 22 — 1.588 1.588 2 .144 Harlesden 17 3 1.173 1.379 2 .138 Mapesbury 22 3 1.759 1.999 2 .160 Manor 12 1 .875 .948 2 .146 Gladstone 9 1 .764 .849 1 .085 Brentwater 13 2 1081 1.247 — — Whole Borough 229 27 1.269 1.419 33 .183 19 Clearly, overcrowding and poverty must be relentlessly attacked if we are to conquer tuberculosis. Our main weapons of attack must be : improving the resistance of the population, detecting cases earlier, and preventing spread to susceptible contacts. There is no question that it is more economical in the long run to spend money on improving housing and nutrition and thus helping to prevent tuberculosis, than to spend money on modern methods of treatment, which are so costly, particularly when hospital or sanatorium is required. The role played by bad factory conditions and dust at work has not yet been studied in Willesden. Another way of increasing resistance of the people is by B.C.G. vaccination. Admittedly, the exact effect of B.C.G. has not yet been determined and there are some contradictory reports on its value, but it certainly has helped to raise the resistance of children and tuberculin.negative nurses. After all, typhoid vaccination and diphtheria immunisation proved their value even though the exact degree of their effectiveness has not been determined yet. In this country, where the incidence of tuberculosis is relatively low, selective B.C.G. vaccination must be the rule. Already vaccination is carried out in child contacts and susceptible tuberculin.negative nurses. Surely there is an unanswerable case for the vaccination of susceptible tuberculin.negative school. leavers to protect them before they enter the age groups which have an increased incidence of tuberculosis, due in the main to the stresses and strains of adolescence, the more arduous work and travelling in commerce or industry, and the greater risks of contact with infectious cases. As it is difficult to detect tuberculosis in early cases without X.rays, it is essential to have the general practitioners acting promptly in referring patients with suspicious symptoms to the chest physician. Meetings of general practitioners are held at the local hospital where the chest physician demonstrates the results of early diagnosis and treatment. Mass miniature radiography for special groups is also important. An attempt was made to use M.M.R. for detecting cases in five wards with the highest rates (Carlton, Kilburn, Roundwood, Harlesden and Church End); Stonebridge was deliberately omitted because it included the factory area where there had been M.M.R. surveys in the past. School.leavers were also offered the opportunity of being X.rayed. Two units were set up at Kilburn Grammar School and Roundwood Social Centre during the Easter holidays. The first two days were devoted to examination of school.leavers, teachers and domestic staff, and the rest of the period (7 days one unit and 13 days the other) was reserved for the public. To achieve a good response a widespread publicity campaign was undertaken (see page 13) and the local authority and regional hospital board contributed £50 each towards it. The total number X.rayed was 6,135, 83.4 per cent, of the capacity of the units (7,350); 1,490 were school children, about 75 per cent, of the school.leavers. A better response could probably have been obtained from school children if their fares had been paid. The school.leavers were also tuberculin.tested, but no accurate comparison can be made with the previous results obtained in the national survey in 1949, when methods were somewhat different. Since only about 10 per cent, of the adult population in the wards were X.rayed, it is quite likely that those suffering from unsuspected tuberculosis did not attend for X.ray. Of the 4,645 adults X.rayed, 240 were recalled for a large film; 29 showed partially calcified or minimal lesions that could be followed up while the people remained at work, and two (a man aged 70 and a woman aged 43) were sputum.positive, but their contacts, two adult and four child contacts, were free from the infection. None of the 1,490 children X.rayed had pulmonary tuberculosis; one school child had sarcoidosis. It was surprising to find only two positive cases in the survey; the public were however made aware of the importance of tuberculosis and how to conquer the disease. It would appear more profitable in the future to concentrate on suspected sections of the community rather than aim at the whole population indiscriminately. Arrangements have now been made for the examination of the following groups at the static M.M.R. unit established at the Central Middlesex Hospital in August, 1952 :—people with suspected diseases of the lungs, particularly those under the care of their family doctor; contacts of infectious cases of tuberculosis; health workers, for instance, nurses and medical students; people who come in frequent contact with children, namely teachers, domestic staff in schools and day nurseries; all hospital admissions and outpatients and expectant mothers. In addition, children will be tuberculin.tested at infant welfare clinics at yearly intervals and at the periodical medical inspections at school. Those showing evidence of infection, by converting from negative to positive, will be thoroughly investigated, together with their social and family history, to determine the source and extent of the infection. All school.leavers who are tuberculin.negative will have a Mantoux test, and if this is negative, they will be vaccinated with B.C.G. The centre for detecting cases is the chest clinic, and it is essential that facilities should be adequate for its increasing activities. Work was started on extensions to the clinic early in June, 1952. The Council provided accommodation at a temporary clinic at 159, Willesden Lane, and office staff were transferred to the clinic at the Neasden Hospital which had previously been used as a scabies and lice treatment centre. The Pound Lane clinic will be opened in the spring of 1953 with a new X.ray department, which will have an adjacent dark room and a miniature camera unit (Watson 5" x 4") added to the existing 4 valve set; a separate chest.screening stand will also be available in the main consulting room. Accommodation for patients in the waiting and dressing room cubicles has been increased and additional accommodation has also been provided for the medical and nursing staff. If more cases are to be discovered, it is also essential to provide hospital beds for them as required. Hospital accommodation has therefore been increased; there are 30 female and 28 male beds in the Central 20 Middlesex Hospital and another 20 male beds in Neasden Hospital. Since November, 1952, 10 male beds used previously for females in Neasden Hospital have been used for males. In addition, a number of beds (approximately 50) are available in the chest hospitals of the North.West Metropolitan Regional Hospital Board. As a result of the improvement in the bed situation and domiciliary treatment, the waiting list has been reduced to a few days only. Preventing the Spread of the Disease The reduction of overcrowding in homes, schools, factories, transport and places of recreation and amusement will help to prevent the spread of the disease. It is also important to remove the chronic infective cases from industry and provide sheltered workshops where they can earn their living without risk to others, particularly susceptible adolescents. The improvement in hospital facilities has resulted in the early removal of infective cases from the community. Finally, the improvement in health education and a knowledge of hygiene has permitted the treatment of cases in the home without placing mftmbers of the family at risk. Health visitors, home nurses and home helps have played a very important part in this, and it is probably true to say that where suitable precautions are taken, contacts in homes where a known case of tuberculosis is treated are safer than some members of the public who repeatedly come in contact with unknown cases. There has been a change of the method of assessment in home help cases which has affected some of them adversely. The chest physician commented on them as follows : "Receipt of the high assessments also give the patients a severe mental jolt just at a time when efforts have been made by the clinic staff to relieve anxiety following the diagnosis of a serious illness". Arrangements have now been made for appeals to be dealt with promptly to avoid patients being alarmed by a notice of a high assessment. Administration Monthly meetings are held with the chest physician, the welfare officer, the superintendent of health visitors, midwives and home nurses, the home help organiser and the chief sanitary inspector, where measures which will help individual cases are discussed, together with suggestions for improvement of the scheme as a whole in the area. Arrangements are now being made to trace contacts of infective cases in factories and to encourage factory managers to employ non.infectious ex.tuberculosis patients on the recommendation of both the chest physician and the medical officer of health. This has been a most interesting and eventful year in the battle against tuberculosis and it has shown conclusively that the co.operation of a team of health workers who are actually doing the work produces increasingly satisfactory results, and that one unit of administration would make things run even more smoothly. 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 the provision of dust.bins. House refuse is collected weekly; trade refuse as often as required at 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 (0.85) 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, and the improvement in Willesden comparing 1951 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 of 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. 21 CENSUS, 1951 One Per Cent. Sample Private Households, Densities of Occupation and Household Arrangements (Percentages in brackets) Households Households 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 56 56 Gladstone Park 22 22 King Edward's Park 10 10 Conditions in Gladstone Park Baths are better since the improvements made last year. SANITARY SECTION Staff The authorised establishment of sanitary inspectors is one Chief Sanitary Inspector, one Deputy Chief Sanitary Inspector, 17 district Sanitary Inspectors and 5 Pupil Sanitary Inspectors. Three sanitary inspectors resigned in 1952, and two qualified pupil sanitary inspectors and one outside sanitary inspector were appointed in their stead; only 3 pupil sanitary inspectors were on the staff in 1952. The Rodent Officer and four operatives were employed in the destruction of rats and mice on bomb sites and waste.lands, and in dwelling houses, factories and other industrial buildings. Two labourers were employed on vermin disinfestation, drain.testing, and general duties. Sanitary Inspection of the Area The work of the Housing (Standards of Fitness) Sub.committee was transferred to the Public Health Committee in May, 1952. The main problem facing the Council was to try and preserve property which, if neglected, would deteriorate into slums and possibly require demolition. Many tenants inform the Public Health Department only when the defects are advanced and costly to remedy. The Council therefore decided to carry out a house.to.house inspection under section 5 of the Housing Act, 1936, in selected areas of the Borough to find the defects in the early stages before they deteriorated or caused extensive damage and when they cost much less to repair. For instance, to remedy promptly defective roofs or gutter spouts is much cheaper than allowing them to progress and cause dampness to walls and rooms. 22 A preliminary survey was made to determine which area should have first consideration, and a houseto-house survey was commenced in selected roads in the Willesden Green ward on 14th February, 1952. Four sanitary inspectors carried out the work and notices were served under the Public Health Act, 1936, or the Housing Act, 1936, for remedying the defects. Only 82 houses were in all respects reasonably fit for human habitation and as many as 511 out of 602 (almost nine out of ten) required some action which resulted in much preventive work being done. Houses inspected 602 Re-inspections 3206 Total inspections 3808 Houses in all respects reasonably fit for human habitation 82 Houses with slight defects 9 Houses requiring action 511 The early repair of roofs, chimneys, gutters and downspouts, paving, brickwork and drainage, must lead inevitably to a considerable saving of costs in the future. Houses Requiring Action (Defects in brackets) Chimneys 116 (125) Roofs 265 (265) Gutters and downspouts 248 (312) Soil and vent pipes 103 (103) Brickwork 296 (365) Windows 470 (849)' Paving 200 (228) Water closet accommodation 395 (629) Drainage 13 (13) Walls and ceilings 468 (1425) Floors 194 (213) Total defects 4527 Overcrowding 7 Houses with T.B. cases 8 Action Recommended Section 9, Housing Act, 1936 464 Section 93, Public Health Act, 1936 34 Section 39, Public Health Act, 1936 2 Section 45, Public Health Act, 1936 2 Intimation notices 9 Total 511 437 notices were served by the end of 1952. 11 recommended under section 93, Public Health Act, 1936, have now been dealt with under section 9, Housing Act, 1936, and 8 landlords carried out the work without notices being served. Results of Action Taken Work completed 152 Work commenced 223 Referred to Borough Engineer *14 Notices served but time limit not expired 56 Total 445 *7 work done by Borough Engineer 7 work done by owners Landlords have generally co-operated in this work, and even where there have been appeals against the notices (36), satisfactory agreement was reached in all but one. Appeals against notices made by owners 36 Agreement reached (14 work done, 21 part done included in figures above) 35 To be heard in County Court 1 23 Closing and Demolition Orders Housing Act, 1936 (Sections 11 and 12) 1952 1951 Closing Orders: 19, College Parade, Salisbury Road (1 room closed—basement right front (scullery annexe)) 1 13 Demolition Orders 157, Willesden Lane 4, Chippenham Gardens 2 4 Three demolition orders made in 1950 were complied with in 1952: 19, Grosvenor Gardens, 2, Rupert Road and 14, Victoria Villas; the Borough Engineer demolished the last two named houses in default of the owners. Two demolition orders (on 32, Connaught Road and 1, Avenue Road) made in 1950 are still outstanding on account of legal difficulties. The owner of 32, Connaught Road appealed against the order, and the County Court judge adjourned the case so that the Council and the owner could reach an agreement on the work to be done. The owner contracted to repair the house and convert it into flats, and the Council agreed to rehouse the tenants on condition that the owner accepted two tenants from the Council's waiting list. A building licence was issued for the necessary work, and the selling price and rent of the two flats was fixed, but the owner has since stated that the rents fixed were too low, and he asks the Council to consider alternative proposals. The Council have referred the case back to the County Court judge. The tenants have now vacated 1, Avenue Road and part of the premises is being used as a store. Of the four demolition orders made in 1951, one (3, Rupert Road) was carried out by the Borough Engineer in default of the owner; the other three (1 and 2, Bridge Place and 76, Canterbury Road) have not been complied with because it has not been possible to rehouse the tenants. Of the two demolition orders made in 1952, one (4, Chippenham Gardens, a derelict vacant property) has been carried out, but the other (157, Willesden Lane) has not been complied with because It has not been possible to rehouse the tenants. Overcrowding There has been little change in the overcrowding problem, which still remains acute. There are no accurate figures of present.day overcrowding in the area, but it is hoped that the census and the house.to. house inspections will give some information on this. The number of licences issued to permit temporary overcrowding under section 61 of the Housing Act, remained low, because landlords are no longer using this section to obtain an eviction order because they known that the Court is inclined to deal sympathetically with the tenants. 1952 1951 Licences to permit temporary overcrowding in excess of the permitted number, section 61, Housing Act, 1936: licences issued 3 2 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 1821 (ii) Families 1500 (iii) Persons 5250 (b) Overcrowding reported during the year 204 (c) (i) Overcrowding relieved during the year 99 (ii) Persons 396 (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 81 (ii) Families 119 (iii) Persons 714 (f) Overcrowding in Council houses relieved during the year 27 New Dwellings, 1952 Houses Flats Rebuilds Dwellings built by private builders 9 Nil 10 (excluding those built by the police authorities) Built by local authority 16 2 — Applicants on Council's waiting list at 31.12.52 10,801 Housing Defects 1952 1951 Premises inspected on complaint 4310 4649 In connection with infectious diseases 5 7 House.to.house (Housing Act, 1936, S.5.) 139 190 Others 150 179 Under special survey (see page 22) 602 — Total No. of premises 5206 5025 No. of inspections (inclusive of Housing Survey) 27695 27258 24 Notices Served under Public Health and Housing Acts, 1936: 1952 Exclusive of Housing Survey Inclusive of Housing Survey 1951 Intimation notices served 2132 2141 2726 Intimation notices complied with 2213 2222 2686 Statutory notices served (P.H. Act, 1936) 1008 1024 1527 Statutory notices complied with (P.H. Act, 1936) 1185 1200 1504 Statutory notices served (H. Act, 1936) 44 456 105 Statutory notices complied with (H. Act, 1936) 63 202 135 Non-compliance with statutory notices referred to Town Clerk (P.H. Act, 1936, s.93) 159 160† 332 Referred to the Borough Engineer for work to be carried out in default of owners *66 by Borough Engineer, 56 by owners. 108 122* 185 † Details of Cases Referred to the Town Clerk during the year: 1952 1951 Work carried out 115 230 Work in hand 8 15 Court orders obtained 11 31 Summonses issued 2 5 Summonses withdrawn—notices complied with 23 48 (—) (7) Work done by agreement—P.H. Act, 1936, s.275 1 3 Total 160 332 (The figures in brackets are the notices withdrawn and re.served) Certificates of Disrepair under the Rent and Mortgage Interest (Restrictions,) Acts, 1920.39: 1952 1951 Applications received from tenants 37 45 Granted 28 42 Refused 9 3 Withdrawn — — Summary of Nuisances, and of Improvements Effected Water Supply and Water Service 1952 Exclusive of Housing Survey Inclusive of Housing Survey 1951 New cisterns provided 38 38 48 Cisterns cleansed, repaired, covered, etc 94 98 103 Draw taps placed on mains 8 8 9 Drainage and Sewerage Water Closets: Repaired, supplied with water or otherwise improved 454 508 572 New closets built 6 6 9 Provided with better ventilation 3 3 4 Drains: Examined, tested, exposed, etc. 272 226 329 Unstopped, repaired, trapped, etc. 376 395 441 New soilpipes or vent shafts fixed 42 48 19 Disconnecting traps or chambers inserted 14 14 29 Reconstructed 21 21 32 New manhole covers 50 55 68 Soilpipes or vent shafts repaired 141 168 157 Other Defects Smoke nuisances 7 7 13 Accumulation of refuse 76 83 99 Foul ditches, ponds, etc., and stagnant water — — 2 25 Fowls, pigs, etc., kept in an insanitary condition 16 16 10 Dampness 1050 1204 1633 Yard and forecourts paved, repaved or repaired 139 219 284 Walls and ceilings cleansed 2741 3205 4764 Verminous rooms disinfested 486 492 420* Leaky roof made watertight 1213 1311 1775 Additional ventilation provided under floors 118 141 123 Dilapidated plaster repaired 2198 2629 3853 Flooring and other woodwork repaired 958 1212 1468 Damp proof courses inserted 70 84 60 Water supply reinstated 35 37 33 Wash house floors repaired or repaved 32 32 40 Fireplaces and stoves repaired 713 869 1045 Decayed brickwork repaired and repointed 583 714 622 Sinks provided or replaced 135 163 196 Additional light and ventilation provided to staircase 1 3 8 Larders or food cupboards ventilated or provided 8 30 11 Gutters and/or rainwater pipes repaired or renewed 868 979 1286 New sashcords and glass provided to doors and windows 1924 2460 2705 Miscellaneous 502 703 810 Total nuisances abated 15,392 18,231 23,080 *This figure was erroneously shown in the 1951 report as 220. The total for that year has been amended accordingly. Periodic Inspections of Other Premises 1952 1951 No. inspected Inspections made No. inspected Inspections made Slaughterhouses (1 registered but not in use) — — — — Common lodging houses — — 1 22 Offensive trades — — 4 6 Factories—with mechanical power 647 766 598 729 Notices served 86 — 83 — Without mechanical power 78 107 81 104 Notices served 9 — 16 — Workplaces—other than outworkers 7 7 11 11 Notices served — — 2 — Homeworkers and outworkers 316 318 351 355 Inspection of food premises (includes re-visits) Baker 38 132 38 244 Bread and confectionery 38 185 38 279 Dairy 10 94 13 122 Butcher 114 532 114 792 Grocer and general store 315 924 315 1342 Fishmonger and fish-fryer 61 209 61 442 Cafe and restaurant 150 602 149 925 Greengrocer and fruiterer 126 461 126 808 Ice cream and sweet shop 181 643 181 695 Food stall 19 48 19 110 Public house 44 92 44 126 Works canteen 110 180 110 483 Food factory 14 147 14 172 Any other food premises 25 80 25 124 Total periodic inspections 2,388 5,527 2,293 7,891 Other Inspections 1952 1951 No. inspected Inspections made No. inspected Inspections made Certificates under the Rent Acts — 63 — 43 Public house urinals 44 168 44 192 Mews and stables 29 103 29 112 Miscellaneous — 2642 — 1048 Smoke observations 26 174 25 165 Verminous rooms 266 270 106 113 Total other inspections 3,420 1,673 Total all inspections (inclusive of Housing survey) 36,642 36,822 26 Smoke Nuisance Smoke and grit have continued to plague the people of Willesden. Much has been written on the harm smoke causes to vegetation, decorations, clean linen and health, but we still know very little about the actual effect of continual smoke pollution on the respiratory system. How far are diseases such as bronchitis, pneumonia, colds, influenza and tuberculosis caused or aggravated by smoke? How far are irritant substances emitted from chimneys responsible for producing cancer of the lungs? These questions still remain unanswered. It is significant, however, that the severe fog of December 5th—8th was directly responsible for a large number of deaths. Deaths Week Ending 1952 1951 15th November 39 35 22nd November 50 35 29th November 49 40 6th December 74 41 13th December 105 57 20th December 67 61 27th December 60 41 3rd January, 1953 63 47 If, as it is likely, atmospheric pollution is proved to have an appreciable influence in respiratory diseases, the Government might be encouraged to spend more money on reducing it. Three power stations add considerably to the smoke and grit in the atmosphere of Willesden. Those responsible for the operation of the power stations have always claimed that factories and domestic chimneys were mainly responsible for the heavy deposit of dust and grit on window sills and in rooms, the rotting of curtains and linen, and the foreign bodies in the eyes which have been so common in Willesden. This they have maintained despite clear evidence that when something has admittedly gone wrong in the station, these conditions have been aggravated in the areas where the complaints usually come. In October, 1952, a heavy cloud of soot descended on Neasden and Cricklewood, seeping into houses and coating sheets, pillows and furniture; some gardens, roofs and pavements were a quarter of an inch deep in soot. This was caused by blocking of the draught of an oil-fired boiler in the Neasden Power Station. It may be true that taking the country as a whole domestic and factory chimneys bear a greater responsibility for smoke and grit nuisances, but in areas where power stations are situated, they are indisputably the main cause of smoke and grit. To determine the actual cause of these nuisances, standard deposit gauges for measuring atmospheric pollution were placed to cover an area within a radius of one-quarter of a mile of each station, together with one at the town hall as a control. The table and graph show the results obtained. They clearly show that the power stations are mainly responsible for the atmospheric pollution in their areas and it is significant that the deposits are heavier near the power stations which are older and have not the advantage of modern equipment. 27 Monthly Deposits in tons per square mile Ten Months—March 1st, 1952, to December 31st, 1952 Power Station Acton Lane Taylors Lane Neasden Control Site Barrett's Green Road Minet Gardens Ascot Park Neasden Lane Press Road Wembley Trading Estate Town Hall March 33.03 41.36 26.51 28.60 24.69 33.98 21.17 April 32.13 53.59 22.75 23.33 27.67 20.32 20.32 May 28.81 40.99 19.00 25.55 29.59 26.34 18.74 June 20.15 36.65 17.15 22.10 30.88 21.57 19.30 July 16.79 29.76 9.88 11.47 16.84 13.83 11.85 August 21.01 26.41 15.47 14.58 28.04 20.41 13.57 September 24.63 30.98 19.82 19.12 23.40 21.73 16.70 October 21.21 45.24 23.41 24.49 27.93 21.04 19.89 November 44.59 28.73 24.86 23.76 28.93 38.33 28.39 December 30.10 72.11 26.74 34.80 39.74 23.61 18.54 Total 272.45 405.82 205.59 227.80 277.71 221.16 188.47 The extent of pollution in the winter months is partly due to the increased use of domestic fuel and partly to the increased need for power and therefore use of the stations. Efficient firegrates which give a more economical burning of fuel will help to remove domestic causes of atmospheric pollution, but until the power stations are modernised, or preferably transferred from the area, it is likely that atmospheric pollution will always be a problem in Willesden, to the detriment of housewives, food traders, and the many manufacturers whose work is spoiled by dust and grit. There can be no question that the removal of this nuisance would help appreciably in maintaining the health of the people in the area. BOMBED SITES The Council continued to fulfil their programme to clear up 103 bombed sites, and have now bought 61. Most bombed sites have been fenced in, built on or converted into public recreation grounds. The Health Department continue to deal with any nuisances, such as getting rid of rats and the clearing away of refuse, occurring in those sites still undeveloped. DISINFESTATION Under section 83 of the Public Health Act, 1936, 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 under section 84 of the Public Health Act, 1936. (a) Verminous premises: Council properties 39 County Council properties 1 Private properties 163 Total 203 (b) Verminous rooms:* Council properties 110 County Council properties 2 Private properties 356 Disinfested by owners 18 Total 486 *Some rooms are treated more than once. (c) Bedding materials: 43 (d) Miscellaneous: Beetles in canteens, etc 12 Houseflies 1 Ants — 28 RODENT CONTROL Rodent control, as approved by the Ministry of Agriculture and Fisheries (Infestation Branch) has been carried out in the properties below:— Business premises 209 Borough Council properties 38 Private dwellings 537 Total 784 at the following cost: Business premises £1,399 7s. 6d. Private dwellings £956 l1s. 7d. Total £2,355 19s. 1d. The cost of disinfestation at business premises is recovered from the occupiers, and in 1952, 107 had an annual agreement with the Council for regular inspection and disinfestation; ten were new agreements and 97 were renewals. The service is free to occupiers of private dwellings but the Borough Council recovers 50 per cent. 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 opening the pavement. CLEAN FOOD Premises where food is prepared The Borough Council maintains, a register of premises suitable for the manufacture, storage or sale of ice cream, and for the preparation or manufacture of sausages, potted, pickled or preserved ,foods, including cooked meat or fish intended for sale. If the Borough Council considers that the premises are, unsuitable and refuses to register them or cancels a registration, the owner can appeal first to them and, if unsuccessful, to a court of summary jurisdiction. No application for registration of premises for the manufacture of preserved food, etc. was received in 1952. Premises on register 31.12.51 No. of applications received No. of applications granted No. of applications refused No. of premises removed from registration during 1952 Total on register at 31.12.52 Sale and storage of ice cream 267 25 25 - 59 233 Manufacture of ice cream 19 - - - 2 17 Manufacture of preserved foods 126 9 117 Fish curing 10 - - - - 10 Ice Cream Ice cream sold within the borough generally reaches a high standard of purity. Most of it is manufactured outside the district and is usually pre-packed. There was a marked increase in the number of samples taken in 1952 (61 as compared with 8 in 1951) because faecal coli were found in samples of ice cream manufactured in the district. Frequent samples were taken from different parts of the plant machinery. Unsatisfactory equipment was replaced, wash-hand basins were installed, and talks on clean food handling were given to the staff. Faecal coli were soon excluded from the samples, which reached Grade I. CLEAN FOOD GUILD The Willesden Clean Food Guild has continued its work of improving the standard of cleanliness in food handling in the district. It is almost five years since the Guild was formed in May, 1948, when it was known as the Willesden Hygienic Food Committee. Ten new certificates were awarded in 1952, making a total of 331 representing about 29 per cent. of food traders in the borough. 1949 1950 1951 1952 Totals Applications received 263 135 8 16 422 Premises registered and certificates issued 195 107 19 10 331 Applications deferred or refused 68 28 3 7 106 Previously refused, now issued with certificates - - 14 1 15 29 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 48 41 7 Cafe or restaurant 149 70 45 25 Dairy 10 5 5 — Fishmonger or fish-fryer 61 18 11 7 Greengrocer and fruiterer 127 14 12 2 Grocer and general store 315 158 132 26 Ice cream and sweets 181 50 38 12 Works canteen 110 32 30 2 Food factory 14 8 8 - Totals 1,157 422 331 91 Improvements in Premises Most of the 1950 and 1951 contraventions of the Food and Drugs Act, 1938, and Food Handling Byelaws have now been remedied. A further 103 traders were encouraged to provide constant hot water, but there are still 55 with an unsatisfactory supply. Traders complied with requests made or notices served by the sanitary inspectors without legal action. Premises unsatisfactory on 31.12.51 174 Unsatisfactory during the year 261 Premises made satisfactory during the year 351 Unsatisfactory on 31.12.52 84 Inspections 2,747 Re-visits 1,582 Total 4,329 Defects Outstanding at 31.12.51 During the year Total Remedied during year Outstanding at 31.12.52 Inadequate lighting and ventilation 4 11 15 10 5 Constant hot water not provided 126 32 158 103 55 Inadequate refuse storage 1 35 36 30 6 Insufficient sanitary accommodation 12 7 19 10 9 Inadequate storage 8 19 27 26 1 Defective walls and ceilings 28 47 75 67 8 Dirty walls and ceilings 58 123 181 163 18 Dirty hand towels 1 44 45 44 1 Generally bad conditions 5 13 18 11 7 Any other defects 69 176 245 203 42 Totals 312 507 819 667 152 Cafes, Restaurants and Canteens There has been a further improvement in the standards of hygiene in restaurants and canteens. Another 8 premises were provided with a constant supply of hot water, leaving only 5 with an unsatisfactory supply. 48 defective and dirty walls were repaired and redecorated. Education in Food Hygiene Lectures with film shows, film strips, and specimen bacteriological cultures have been given to food traders, social and political organisations, staffs of dairies and industrial canteens, and school leavers. Two series of three weekly lectures were given to groups of food traders and their staffs at Harlesden Library and Willesden Green Co-operative Hall. Each series consisted of:— 1. A general talk on food hygiene by the Medical Officer of Health. 2. Film—"Another Case of Poisoning"—and exhibition followed by a talk by the Chief Sanitary Inspector. 3. Film strip—"Hygiene for the Food Handler" and lecture given by the sanitary inspector in charge of food hygiene. The lectures were held on Tuesdays from 5—5.30 p.m., a time suggested by the food traders as most convenient for releasing their staff. Traders in the two districts were approached in a shop-to-shop canvass and were then sent a personal letter. Notices of "Wash your hands" and "Exclusion of dogs from food shops", which have been distributed widely, are provided free by the Guild and the Borough Council. 30 The response was however disappointing; an average of 30 (15 from one firm) attended each week at Harlesden and 10 each week at Willesden Green. Two stands on food hygiene were displayed in the Social Services Section of the Willesden Show, one by the Public Health Department and the other by the Clean Food Guild. Many people who attended the Show showed great interest in them. Food Poisoning One small outbreak of food poisoning occurred in 1952, involving two families at a halfway house. There were 7 notifications but only 5 were confirmed, 2 cases and 3 carriers. The organism was salmonella typhi-murium, but as the time between the onset of the first case and notification was three weeks it proved too late to trace the source of infection. Contaminated Food There have been fewer samples of contaminated food brought to the notice of the Public Health Department. During the year 16 samples of food with foreign bodies were reported by the public. A caution was administered to 4 firms and the borough council prosecuted 3 others with the following results:— Cigarette end in cake icing Fined £10 Costs £3 3s. 0d. Wire in jam tart Fined £4 Costs £2 2s. 0d. Mouse excrement in loaf of bread Fined £30 Costs £9 9s. 0d. In the remainder there was either insufficient evidence that the firm was actually responsible for the foreign body, or the presence of the foreign body was not harmful or prejudicial to health. Unfit and Adulterated Food It is unfortunate that so much food had to be condemned as unfit for human consumption. Although the amount destroyed is relatively small it adds to the difficulties caused by food shortages. Food Unfit for Human Consumption Meat. Bacon 311 lbs. Cooked 182 lbs. Tinned 4,862 tins Raw 4,516 lbs. Fish. Tinned 1,772 tins Raw 636 lbs. Vegetables. Tinned 6,555 tins Raw 20 lbs. Fruit. Tinned 18,576 tins Raw 968 lbs. Bread, flour, cereals, etc 193 lbs. Preserves 1,085 lbs. Cheese 71 lbs. Butter and fats 23 lbs. Eggs 59 Tinned milk 1,539 tins Miscellaneous. Apricots, dried 177 lbs. Baby food 4 tins Beans, baked 5 tins Beans, butter 3 tins Biscuits 308 lbs. Cake, fruit 55 lbs. Candies 216 Cauliflowers 53 Chickens 5 lbs. Chickens, tinned 4 lbs. Chocolate 35 lbs. Chocolates 8¼ lbs. Chutney 2 jars Cod, fat 11 lbs. Cream, ice-blocks 20 Cream, salad 3 tins Coconut, dessicated ¼ lb. Coffee 4 tins Coffee, essence 28 bottles Confectionery 165 lbs. Corn on the cob 1 tin Dog food 3 tins Figs 18 pkts. Fruit, dried 57 lbs. Giblets 5 cases Ham, tinned 2,723 lbs. Horseradish 22 bottles Jam 1 lb. Miscellaneous (continued). Jellies 16 Juice, apple 10 bottles Juice, fruit 107 tins Malt extract 1 tin Malted milk 1 jar Malted milk tablets 30 tins Meat extract 1 pot Mincemeat 22 tins Noodles, egg 33 pkts. Nougat 312 bars Nuts 23 lbs. Olives 1 jar Paste, fish 5 tins Paste, meat 13 pots Paste, tomato 80 lbs. Pastry, mix 48 pkts. Peas 4 tins Pease, pudding 6 tins Peel, candied 64 lbs. Peel, candied 36 pkts. Pickles 1 jar Poultry 41 lbs. Powder, baking 22 tins Powder, custard 54 lbs. Prunes 722 lbs. Puddings, tinned 3 tins Pulp, fruit 30 lbs. Pulp, tomato 316 tons, 6 cwt. 8 lbs. Rabbits 480 lbs. Rice toasties 4 pkts. Salad, fruit 1 jar Salad, spread 3 tins Salad, vegetable 3 tins Salt 8 lbs. Sauce 41 bottles Sauce, mint 15 bottles Sauce, relish 5 bottles Sausages 7 lbs. Sausages, liver 140 lbs. Sausages, luncheon 120 lbs. Sausages, pork chipolata 3,320 lbs. Soups 310 tins Sponge mixture 40 pkts. Suet 14 lbs. Sultanas 13 lbs. Tea 2 lbs. Toffee crunch 5 lbs. Turkeys 61 lbs. Vermicelli egg 3 pkts. Xmas pudding 20 tins 31 The Middlesex County Council continues to take samples and supervise the control of food adulteration. Samples Taken Article. No. of samples Unsatisfactory Milk 232 1 Bovril 2 1 Bread 2 — Brynite (preservative) 1 — Butter 3 — Cakes (various) 10 — Camphorated oil 6 — Cheese 1 — Coffee 1 — Condensed milk 1 — Drugs 10 2 Figs 2 1 Fish 32 1 Fish cake 2 — Fish paste 3 — Flavouring powder 1 — Flour 2 — Fruit sauce 1 — Halva sweetmeat 1 — Horseradish 1 — Ice cream 1 — Jardox 1 — Jelly, from ham 4 4 Telly (various) 3 — Lobster (tinned) 1 — Lemon squash 1 — Meats cooked 35 — Meat pie 10 — Meat paste 2 — Meringue powder 1 — Mint sauce 1 — Mincemeat 1 — Nutmeg ground 1 — Omelette mixture 1 — Onion Powder 1 — Orange cordial 1 — Pineapple squash 2 — Plums (tinned) 3 — Rice 1 — Saccharin tablets 1 — Salad cream 1 — Salted almonds 1 — Sausages (various) 57 2 Sausage meat 6 — Sausage roll 8 — Stewed steak 1 — Synthetic cream 1 — Sweets 4 1 Tomato ketchup 1 — Tripe 3 — Vinegar 13 3 Wines and spirits 18 — White pepper 2 — Yoghourt 4 — Yorkshire pudding powder 1 — Total 508 16 It has been suggested that this service should be delegated to the Borough Council. The sanitary inspectors who are experienced food inspectors and have an intimate knowledge of local conditions could probably do this work more conveniently and more economically, particularly as the public are accustomed to make their complaints to the Public Health Department. On the other hand, it is suggested that the County's centralised service is more capable of organising uniform action in all districts and co-ordinating the work generally at a cost of less than £10,000 a year. While there might undoubtedly be a loss in central direction and co-ordination in the event of the transfer of these functions to the local authorities, there would be distinct advantages in fewer officials visiting traders, and what is probably the most important, in providing a service which is closer to the needs and influence of the public. 32 Milk and Dairies Milk sales are regulated by the Food and Drugs Act, 1938, and the Milk and Dairies Regulations, 1949, made under sections 20 and 92 of the Food and Drugs Act, 1938. As mentioned in the previous report, Willesden is now a specified area, and all milk sold by retail from October, 1951, has to be sterilised, pasteurised, tuberculin tested, or accredited; the sale of raw milk is now prohibited. Almost all the milk within the borough is processed and bottled by large dairies, but some of the milk is still bottled in the district. Dairies—Registration and Licences Premises in Willesden 106 Dairymen 82 Licences issued. Pasteurised milk 88 Sterilised milk 96 Tuberculin tested milk 75 Premises outside Willesden 10 Dairymen 4 Licences issued. Pasteurised milk 10 Sterilised milk 10 Tuberculin tested milk 10 Frequent inspections are made of the dairies. One dairy was found to have dirty walls and this defect was remedied speedily. Milk sold in the borough is clean and pure. 292 samples were taken in 1952; 290 were satisfactory and 2 unsatisfactory, but second samples were up to standard. FACTORIES The total number of factories in the borough showed an increase of 1 over the previous year, but there was a reduction in non-mechanical factories from 79 to 74 and increase of mechanical factories from 804 to 810, making a total of 884 factories. Type of factory 1.1.52 Added to register Deleted from register Total 31.12.52 Non-mechanical 79 1 6 74 Mechanical 804 47 41 810 Total 883 48 47 884 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. The table shows the number of factories inspected, the defects found and the action taken. Type of factory Inspected Total Inspections Unsatisfactory Outstanding from 1951 Made satisfactory 1952 Outstanding 31.12.52 Non-mechanical 78 107 9 3 10 2 Mechanical 647 766 86 6 83 9 Defects in Non-Mechanical Factories: During 1952 Outstanding from 1951 Remedied during 1952 Outstanding at 31.12.52 Want of cleanliness 6 2 8 — Overcrowding — — — — Unreasonable temperature — — x — — Inadequate ventilation 2 — 2 — Defective drainage of floor 1 — 1 — Sanitary accommodation: Insufficient 1 1 2 — Unsuitable or defective 8 1 7 2 Not separate for sexes 1 1 2 - Defects of Sanitary Accommodation in Mechanical Factories: Insufficient 1 1 2 - Unsuitable or defective 86 5 82 9 Not separate for sexes 2 2 33 Underground Rooms There are 15 underground rooms used as factories; only two are not used in conjunction with premises above ground. 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 the process incidental thereto. There are now ten basement bakehouses in Willesden; they have been regularly inspected and are satisfactory. The four, where baking was discontinued in 1951, have now remained unused for over twelve months and therefore cannot be used again for baking. 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. Of the 316 outworkers' premises inspected in 1952 only one notice for a defect (dirty walls and ceilings in the room where homework was carried on) was served upon the occupiers and it was soon remedied. As the number of factory inspectors is small, just over 300 to cover about one-quarter million factories, it would appear desirable to supplement them by the sanitary inspectors who already have to enter mechanical factories to inspect sanitary conveniences. In Willesden there are only two part-time factory inspectors. The 19 sanitary inspectors employed by the Borough Council could give appreciable assistance by dealing with cleanliness, overcrowding, temperature, ventilation and drainage of floors in mechanical factories as well as in non-mechanical ones. Technical assistance could be given them where required in the same way as it is given to the factory inspectors. Altogether there would appear to be need for an extension of the Factories Act to cover the 50 per cent. of the working population who at present have no protection, and also to unify the medical and preventive services which are responsible for the health of employees at their work. The Borough Council are considering an industrial medical service for their employees which would cover environmental hygiene, first aid, and rehabilitation. NOISE NUISANCES The Borough Council deals with noise nuisances under section 313 of the Middlesex County Council Act, 1944, as outlined in the 1950 Annual Report. There were 20 complaints referred to the Health Department during the year, but only 5 were nuisances that could be dealt with by the Council. No legal action was taken because the factory owners proved co-operative. The following is a summary of the action taken by the owners:— (a) Noise from press brake and from the machinery generally when working overtime in the evening and on Sundays. The owners provided shock absorbers to the press brake and restricted work to weekdays and not later than 6.30 p.m. (b) Noise from machinery generally. To blanket off the noise, the end wall was rebuilt and a second roof put in. (c) Noise from vibrating pipes and from engine which caused vibration as well. Rubber coverings were put on the pipes and the engine was shifted. Extractor fans and wireless were no longer used on night work. (d) Noise and vibration from diesel generator was stopped by mounting it on a 4-inch cork bed. (e) Noise caused by worn electric motor bearings and a badly mounted circular saw was remedied by replacing bearings and changing the mounting of the saw. CARE OF THE AGED With an increase in the number of old people in the population it is becoming more and more necessary to extend our medical and welfare services to care adequately for them. Most old people can manage to look after themselves, but some require help to keep them comfortable and happy in their own homes, while a small minority cannot be adequately cared for except in a hospital or institution. The local health authority provides home nurses and home helps; the health visitors often investigate the needs of old people and arrange for the necessary services to be given. When an aged person requires to be admitted to a hospital or an institution, consultation often takes place between the medical practitioner, the geriatric physician, the welfare officer and the medical officer of health. Generally speaking, it has become easier to obtain hospital admission for an aged patient, and the geriatric physician and his almoner work in close co-operation with the local health and district authorities. There is still, however, a great need for more hospital accommodation. Very exceptionally, compulsory powers may require to be used when the person, against his own interests, refuses to go into a hospital or hostel. In August, 1951, the National Assistance Amendment Act came into operation. This permitted the immediate removal to an institution of a person certified to be in need of care and attention by the Medical Officer of Health and another registered medical practitioner; the order for removal can be made either by 34 a court of summary jurisdiction or by a single justice having such jurisdiction. The amending act modifies the period from 3 months to 3 weeks for a person to be detained in the first instance. Only once in 1952 was action necessary under this Act. Miss M. B., aged 70, was ill, living alone in insanitary conditions. She was admitted to a hostel and later agreed to stay there as a voluntary patient. The kind of unfortunate occurrence that may happen, even when there is some supervision, is illustrated in the case of Miss S. A. W. (aged 83) who received fatal burns when her clothes caught alight. Miss S. A. W. was crippled and almost confined entirely to her armchair; the home help had left only about 15 minutes when the accident happened. Laundry for the Aged The care of incontinent old people places a particularly heavy burden on their relatives. The washing of soiled linen, particularly in cramped accommodation in winter, with inadequate facilities for drying, is frequently the last straw. It is often this additional unbearable strain which finally convinces relatives that the only place where the old person can receive reasonable care is in an institution. One way, therefore of postponing this often unpopular event, is to help relatives with the washing of the soiled linen of the incontinents. It is much more economic and humane to provide reasonable facilities for old people in their homes than to transfer them to institutions. Accordingly the Council organised a laundry service for aged incontinent persons in April, 1952, under section 84 of the Public Health Act, 1936, which gives powers to the authority to cleanse articles in so filthy a condition as to be dangerous to health. The articles are laundered at the Neasden Hospital by arrangement with the Central Middlesex Hospital Management Committee, and transport is provided by the Borough Council. At first the laundry was returned to the person dried but not ironed, and many did not use the service because of this. The hospital authorities were therefore approached and special arrangements were made on 31st October, 1952, for ironing the 500 pieces received weekly before they were returned to the home. The cost of laundering was increased to 4 ¼ d. per lb. Sixteen cases were dealt with up to 31st December, 1952; 2 have been admitted to hospital and 2 removed from the district, leaving 12 cases dealt with at the end of the year. This service has proved of inestimable value to old people and their relatives. Voluntary Services for the Aged The care of the aged is an excellent example of how the work of voluntary organisations supplements that of the local authorities. The main extension of the work of the care for the aged during the year was carried out by voluntary effort, and no praise can be too high for the voluntary helpers who spent time and energy on this work. The '49 Club' organised by the Old Folks' Association was opened by the Dowager Marchioness of Reading on the 28th February, 1952. In the first month of its opening there were 195 enrolled members, paying a membership fee of 6d. per month, with an average attendance of 50 per day; within three months the membership had increased to 250. A summer outing to Southend was organised on the 1st September, 1952, and 158 old people went. Five well-attended Christmas parties (about 100 old people in each) were organised and were thoroughly enjoyed. Regular visits by voluntary workers to about 40 old people were arranged in 1952, but there is a general shortage of visitors. Various charities are helped in their distribution of parcels to old people, and wireless sets are maintained for the aged sick who cannot afford their repair. In November, 1952, arrangements were made with a local chiropodist to treat six old people a week free of charge; appointments are made with the chiropodist by the '49 Club'. The club has proved a very great success and is well appreciated by old people. The Willesden Division of the British Red Cross Society and many churches in the area also run clubs for the old folk and visit them in their homes. Probably the most important service for old people in 1952 was the meals service organised by the Women's Voluntary Services. A club known as the Old Folks' Morning and Luncheon Club was opened at the Presbyterian Hall, Granville Road, Kilburn, N.W.6, on 31st January, 1952, where hot lunches are served on five days a week at a cost of 1s. a lunch; an average of 80 meals are served a day; 15,759 meals were served during 1952. Coffee and tea can be had during the morning at l ½d. per cup. The work of this club was extended to provide 'meals on wheels', and this service was commenced on 21 st March, 1952 for 2 days a week, and was extended on 10th August, 1952 to serve meals on four days a week. The areas covered are Harlesden, part of Stonebridge and Kensal Rise on Tuesdays and Thursdays, and Kilburn and Cricklewood on Wednesdays and Fridays. Each person receives two meals a week at a cost of 1s for the main meal and sweet. Approximately 24 meals a day are served to old people in their own homes; 2,628 meals were served during 1952. Unfortunately part of Stonebridge and Neasden cannot be covered at the present time on account of a shortage of voluntary workers, particularly drivers, and the aim must be to give a hot meal to old people five days a week, wherever they may live in the borough. It is hoped to extend this service to the people suffering from tuberculosis. Precautions will be taken to see there is no risk of infection. Burial of Destitute Dead Arrangements were made for the burial of 17 persons in 1952 in accordance with section 50 of the National Assistance Act, 1948, at a total cost of £196 l1s. 6d. 35 Common Lodging Houses There are now no common lodging houses in the district registered under section 237 of the Public Health Act, 1936. Slaughterhouse Licences One application for the renewal of a slaughterhouse licence was received and granted under section 57 of the Food and Drugs Act, 1938. 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 specify the standards of cleanliness for the filling materials, the analysis for the tests, the fees which may be charged by the analyst, and the form of records to be kept by the occupiers of the 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 10s. 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, and others using filling materials specified in the Act, have to be registered; only one fee of £1 0s. 0d. is chargeable. Since the date of the operation of the Act, seven premises have been registered. There are no premises in Willesden which require to be licensed for the manufacture or storage of rag flock. Unfortunately the Act does not cover the re-making of an article, and dirty materials can therefore be used in upholstering second-hand articles if they do not belong to the occupier. Four samples of materials used were submitted to the analyst and they proved to be up to standard. The amount of material in stock was so small in two firms that there was not enough to make up a sample for the requirements of the analyst. Pet Animals Act, 1951 The Pet Animals Act, 1951, was passed, with April 1st, 1952 as the operative date, to provide further protection for animals. Pet shops must now have a licence from the local authority, on payment of a fee not exceeding 10s. Fourteen shops have been licensed and are inspected by both the sanitary inspectors and Shops Act inspectors. The sanitary inspectors are responsible for seeing that the size, temperature, lighting, ventilation and cleanliness and measures for the prevention of infectious diseases are satisfactory. The shops inspector is responsible for seeing that there is no cruelty or neglect of pet animals and that there is sufficient food and drink for them. He is also responsible for seeing that they are not sold to children under 12 years of age, nor in any part of the street or public place, except at a stall or barrow in the market. Staff Medical Examinations Fifty-six staff medical examinations were carried out by the Medical Officer of Health in 1952. Public Mortuary In accordance with section 198 of the Public Health Act, 1936, 500 bodies were dealt with at the mortuary as follows:— Post-mortems and inquests 123 Adjourned inquests 52 Total post-mortems 500 Licensing of Hawkers Under section 11 of the Middlesex County Council Act, 1950 (operative date 1st April, 1951) hawkers of food and premises used by them for storage accommodation must be registered. Two hawkers were registered in 1952, making a total of 19. Fruit and vegetables 17 Fish 1 Miscellaneous 1 Total 19 With the Compliments of the Medical Officer of Health borough of willesden, health department. 54, winchester ave . kilburn. n.w.6