AC 439 (1) WILLESDEN WIL 49 P.c Ach 27.9.54 my cm Borough of Willesden B 19 5 3 THE 78th ANNUAL HEALTH REPORT S. LEFF, M.D., D.P.H., Barrister-at-Law, Medical Officer of Health 66054 BOROUGH OF WILLESDEN Health Department, 54, Winchester Avenue, To the Mayor, Aldermen and Councillors of the Borough of Willesden. Kilburn, London, N.W.6. July, 1954, Mr. Mayor, Ladies and Gentlemen, I beg to submit the annual report on the health and sanitary circumstances of the Borough for the year 1953. There has been a slight decrease in the population, but this does not give a clear picture of the continuous fairly large-scale migration in and out of the Borough. The census figures reveal that Willesden is the worst district in the County for housing conditions and sanitary circumstances. The pollution of the atmosphere from the power stations, railway sidings and many industries in the area contribute to the illeffects that overcrowding and insanitary conditions produce on health. Cancer of the lung has now become one of the most important problems; in Willesden it kills three times as many as tuberculosis. The cause of the disease is still largely unknown, although there has already been some proof of its association with cigarette smoking, but it would not be surprising to find that dust and impurities in the air both inside and outside the factories play an important rôle. The large number of deaths from bronchitis, pneumonia and other respiratory diseases is also probably a reflection on atmospheric pollution, although, of course overcrowding and bad housing conditions also have a profound influence. The latest census figures of the Registrar General show conclusively that improvements in the conditions of the people in the poorer classes would soon produce a considerable reduction in the number of deaths from respiratory diseases, tuberculosis and gastric ulcer. The number of fatal accidents in the home has been reduced, but is still almost double that caused by motor vehicles. A survey of accidents in the home in Willesden has illustrated how much suffering could be avoided and many lives saved by introducing simple preventive measures and improving the care and environment of the young and the old. Despite the welcome reduction in the number of deaths from tuberculosis, it still remains the worst infectious disease in the Borough; the case rate is practically the same as it was before the war, while in all other infectious diseases, excepting anterior poliomyelitis, it has been reduced. Much has been done in the Borough to treat patients without delay by improving hospital bed provision, and by the new methods of treatment with antibiotics and artificial pneumothorax in the home. Liaison between the Public Health Department and the Chest Clinic has been particularly close during the year and has probably contributed to improvements in tracing contacts and caring for the patient in the home. B.C.G. vaccination of school leavers was started in the year, and will probably add its modest contribution to reducing tuberculosis in the Borough; but, above all, housing and nutrition must be improved if this disease is to be finally conquered. There has been a welcome reduction in infant mortality and in the stillbirth rate, but the number of children who died under the age of four weeks still remains high. The latest figures of the Registrar General provides confirmation of the experience in this area which has shown that although there has been a marked improvement in infant mortality, the differences between the various social classes remain as large as ever. Again, the conclusion to be drawn is that improvements in social conditions will save many infant lives, and in the cost of the curative services. Many houses in the area are old and have outlived their normal life. By extending their surveys of housing the Council are ensuring that preventive repairs are carried out to save these houses, and also avoiding heavy costs on them in the future. These improvements not only help the landlords in this respect, but also provide the tenants with better living conditions and so probably prevent their health deteriorating. It is hoped that the new Housing Repairs and Rents Bill, when it comes into operation, will help in improving the general sanitary conditions in the area, but if higher rents cause people to spend less money on food, the possible gain in health achieved by better housing may be out-weighed by the harm caused by malnutrition. For the first time since the Act, the Annual Report includes a section on the personal health services. This has been done to preserve information which may be of value in the future when Willesden once again is considered a large enough district for administering its own personal health services. There has been no striking improvement in the personal health services over the past five years. The main difficulty arises from the fact that no new clinic has been built in Willesden during the last 24 years, and with the health services expanding in character and popularity, there has been a serious pressure on the outdated clinics, two of which in converted houses have been in the Borough for almost 40 years. As an emergency, two church halls have been used as part-time clinics and the fact that they have already become overburdened with work illustrates the need for more clinics in the many areas of Willesden now without any. Also urgently needed in the area are clinics for the treatment of squint and for teeth and jaw irregularities, and for an extension of speech therapy. The serious shortage of health visitors has also hindered the very important work that they do in the care of mothers and children, and more recently of the aged, and in the care and after-care of illness. There has been a welcome reduction in the waiting list at both the physically handicapped and educationally subnormal day schools, but there is still a marked shortage of places for those children with defects who require residential accommodation, particularly if they have double defects. There is also need for more schools for the maladjusted and for grammar schools for children with physical defects. New schools are needed urgently to replace the two day schools in the area for handicapped pupils. The home-help and midwifery services are now running smoothly, but there are still people who require the home-help service and do not have it because of cost. There appears to be too high a proportion of mothers having their babies in hospital (more than 8 out of 10). Finally, a word on administration. The transfer of the personal health services to larger authorities has produced considerable delays in getting essential services to the people who require them; "the personal touch" which existed between elected representatives and the public has been largely lost, and the machinery of administration of a large authority is so cumbersome that by the time the solution of a particular problem is arrived at, it is often inappropriate, for the simple reason that the problem has changed its character in the time taken to deal with it. The Health Committee of the Borough Council have been very active during the year in improving housing conditions, food hygiene, health education, and the care of the aged. The Councillors, members of the staff, and the sanitary inspectors, have all contributed 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, 1953 178,500 Population census, 1951 179,697 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) 43,835 Rateable value £1,677,270 General rate in the £ for the year 21s. 6d. Product of a Id. rate (estimated) £6,830 VITAL STATISTICS Registered Live Births: Male Female Total Willesden Borough Council Legitimate 1296 1195 2491 Birth rate per 1,000 estimated resident population Illegitimate 84 80 164 Total 1380 1275 2655 14.87 Rate per 1,000 (live and still) births Registered Stillbirths 27 31 58 21.38 Death rate per 1,000 estimated resident population Deaths 902 799 1701 9.53 Death Rate of Infants Under One Year of Age: All infants per 1,000 live births 22.60 Legitimate infants per 1,000 legitimate live births 21.68 Illegitimate infants per 1,000 illegitimate live births 36.58 Death Rate of Infants Under Four Weeks of Age: All infants per 1,000 live births 15.82 Legitimate infants per 1,000 legitimate live births 14.85 Illegitimate infants per 1,000 illegitimate live births 30.49 Maternal Mortality: Deaths from puerperal causes— Puerperal sepsis 2 Other puerperal causes Other maternal causes 2 Total maternal mortality rate 1 47 per 1,000 registered total births Deaths from: Males Females Total Cancer (all ages) 191 173 364 Measles (all ages) 1 — 1 Whooping cough (all ages) — — — Diarrhoea (under 2 years of age) 1 — 1 4 Cause of Death: Males Females Total 1. Tuberculosis (respiratory) 17 7 24 2. Tuberculosis (other) 1 — 1 3. Syphilitic disease 10 — 10 4. Diphtheria — — — 5. Whooping cough — — — 6. Meningococcal infections 1 — 1 7. Acute poliomyelitis 1 — 1 8. Measles 1 — 1 9. Other infective and parasytic diseases 2 1 3 10. Malignant neoplasm, stomach 28 18 46 11. Malignant neoplasm, lung, bronchus 67 8 75 12. Malignant neoplasm, breast — 26 26 13. Malignant neoplasm, uterus — 14 14 14. Other malignant and lymphatic neoplasms 96 107 203 15. Leukemia, aleukemia 2 5 7 16. Diabetes 4 5 9 17. Vascular lesions or nervous system 67 103 170 18. Coronary disease, angina 146 91 237 19. Hypertension, with heart disease 25 25 50 20. Other heart disease 71 111 182 21. Other circulatory disease 55 38 93 22. Influenza 4 11 15 23. Pneumonia 45 40 85 24. Bronchitis 103 59 162 25. Other diseases of respiratory system 13 5 18 26. Ulcer of stomach and duodenum 16 1 17 27. Gastritis, enteritis and diarrhœa 7 8 15 28. Nephritis and nephrosis 9 5 14 29. Hyperplasia of prostate 10 — 10 30. Pregnancy, childbirth, abortion — 4 4 31. Congenital malformations 6 12 18 32. Other defined and ill defined diseases 61 74 135 33. Motor vehicle accidents 9 6 15 34. All other accidents 17 9 26 35. Suicide 8 6 14 36. Homicide and operations of war — — — Total 902 799 1,701 Infant Mortality Infant mortality and the stillbirth rate in Willesden showed a slight reduction compared with 1952. (see table 1). Sixty infants under the age of one year died in 1953, more than two out of three (43) in the first four weeks of life (the neo-natal period). Prematurity caused the highest number of deaths (21) and was associated with other causes in 7 (table 2). Ten deaths were from respiratory diseases, and 7 from diarrhoea and gastro-enteritis (four in the neo-natal period) (table 3). Congenital malformations caused 11 deaths in the neo-natal period and one in the age group 1—12 months (table 4). There were three deaths under "other causes"; 1 from sub-arachnoid haemorrhage and 2 from intestinal obstruction in the 1—12 months age group; the third infant died during the neo-natal period of kernicterus. There is a greater number of deaths in first-born infants (table 5). An analysis into the 23 deaths occuring in first-born infants shows prematurity, congenital malformation and birth injury as the main causes in the neo-natal period (table 6). Five of the six babies who died of birth injuries were delivered in hospital (table 7). Details of the abnormal deliveries are given in table 8; the four infant deaths which were associated with maternal toxaemia occurred in the neo-natal period. Some of these deaths appear to have been avoidable: an analysis of 52 infant deaths by social class and home environment shows that a large proporton occur in the lower social levels. 5 Social Class Group Group I — Group II 2 Group III 13 Group IV 24 Group V 13 Total 52 Of the 21 premature infants, 7 were first babies; 5 were illegitimate and none of the mothers had ante-natal care; 3 were associated with toxaemia in the mother; 2 were delivered by Caesarean section; 3 were twin pregnancies (both died in one case; one twin survived in the other); and in 1 the mother had a cerebral tumour removed during pregnancy. Though the infant mortality rate has dropped in recent years there still remains room for improvement, and further investigation of prematurity, congenital malformations and toxaemia of pregnancy is urgently required. Unfortunately, overcrowding and poor housing and social conditions still exist and play some part in maintaining the present rates. The Registrar General's statistics of' occupational mortality show that the decline of over 60 per cent, in infant mortality since 1921 is reflected to an almost equal extent in all classes, and that the differences between them have remained practically unchanged in the last 30 years. Prematurity A far greater number of premature babies survived than died, and most of them were born in hospital (table 9). They are higher in the wards where the poor sections of the population live (table 10). Births The birth rate in Willesden showed a slight increase (2.1 per cent.) over 1952; 14.87 per 1,000 as compared with 14.47 but it was still 4 per cent, below that of England and Wales (15.5). The total number of notified births increased during the year, but there was a slight decrease in the proportion of mothers having their babies in hospital, with a slight increase in the number of domiciliary confinements conducted by the County midwives. The main decrease in hospital confinements was in the Kingsbury Maternity Hospital, where the numbers were almost halved during the year. It appears that this hospital, which was originally built for Willesden mothers, is now being used mainly by mothers in other districts, and the stage is rapidly being reached where alternative accommodation for Willesden mothers will have to be found elsewhere. Already, the Central Middlesex Hospital has found it impossible to take them all, and to relieve the pressure the Paddington Hospital, on the 1st March, 1953, accepted seven applications weekly from mothers living mainly in the South Kilburn area. 1949 1950 1951 1952 1953 Total notified live births 2798 2735 2362 2587 2642 Born in institutions 2177 2202 1977 2209 2176 Born at home 621 533 385 378 466 Percentage born in institutions 77.28 81.06 83.70 85.39 82.36 Institutions Central Middlesex Hospital 846 1023 884 1098 1175 Kingsbury Maternity Hospital 890 733 716 674 374 Larger hospitals outside Willesden 241 236 188 238 397 Smaller hospitals outside Willesden 144 172 152 162 202 Nursing homes, etc. 56 38 37 37 28 441 446 337 437 627 Total 2177 2202 1977 2209 2176 Home County midwives 418 300 296 308 397 Queen Charlotte's midwives 86 87 19 — — Willesden District Nursing Association 117 146 70 70 52 Others — — — — 17 Total 621 533 385 378 466 Illegitimate Births The number of illegitimate births has decreased from 204 to 164. Six of the illegitimate children died under the age of one year, 3 from prematurity and 2 from gastro-enteritis. 6 Illegitimate Infant Deaths Cause of Death Age at Death Weight at Birth Where Born Age of Mother No. in Family Social Class Gastro-enteritis 5 mths. 6lbs. 12ozs. St. Mary's Hospital 27 years 1st IV Chronic volvulus of small intestine 6 mths. 7lbs. Not known Not known 1st V Prematurity 7 hours 1lb. New End Hospital Not known 1st V Gastro-eniteritis and renal infection 6 weeks 3 lbs. l0ozs. Paddington Hospital 23 years 2nd V Prematurity; bilateral atelectasis 1 day 2lbs. Home 18 years 1st V Prematurity 1 day 2lbs. l½ozs. Central Middlesex Hospital 28 years 1st V The health visitors and midwives have a close liaison with hospital maternity almoners, officers of the County Council's Children's Department, Moral Welfare Department, the County Court and Voluntary Welfare Organisations, for the care of the unmarried mother and her child. Advice was given on ante-natal care, place of confinement, admission to special home, requirements for the baby, and procedure for adoption, fostering or placement in a residential nursery. Tables. Infant Mortality 1. Infant Deaths and Stillbirths Willesden and England and Wales, 1936-53 Year Population Registered Births Willesden Deaths under 1 year Willesden Infant death rate Willesden Infant death rate England and Wales Registered 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 30 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 1953 178,500 2655 60 22.60 27 58 21.38 22 7 2. Causes of Infant Deaths in Willesden (Based on Registrar General's figures) 1936-1939 1940-1945 1946-1950 1953 (1952 in brackets) Deaths Rate Deaths Rate Deaths Rate Deaths Rate Neonatal 1-12 mths. Total Respiratory 106 9.14 140 9.59 68 4.19 3 (4) 7 (5) 10 (9) 3.77 (3.45) Diarrhœa and enteritis 131 11.29 108 7.40 37 2.22 1 (1) 6 (—) 7 (1) 2.64 (0.39) Other infections 34 2.93 40 2.73 15 0.92 - (-) 1 (4) 1 (4) .37 (1.53) Congenital malformations 83 7.16 89 6.10 72 4.44 11 (7) 1 (4) 12 (11) 4.52 (4.21) Premature births 170 14.66 179 12.25 99 6.11 21 (26) — (—) 21 (26) 7.91 (9.96) Injury at birth 21 1.81 33 2.26 43 2.71 6 (8) — (—) 6 (8) 2.26 (3.06) Other causes 134 11.10 149 9.40 97 5.98 1 (—) 2 (3) 3 (3) 1.13 (1.15) All causes 679 56.24 738 46.54 431 26.57 43 (46) 17 (16) 60 (62) 22.60 (23.75) 3. Infant Deaths from Respiratory and other Infections Neo-natal 1-12 months Total under 1 yr. Respiratory: Acute bronchitis — 2 2 Broncho-pneumonia 2 3 5 Lobar pneumonia 1 1 2 Pulmonary collapse — 1 1 3 7 10 Other Infections: Gastro-enteritis and diarrhœa 1 6 7 Influenzal meningitis — 1 1 Total 4 14 18 4. Congenital Malformations Neo-natal 1-12 months Total under 1 year Atelectasis 2 — 2 Congenital heart 1 1 2 Spina bifida 2 — 2 Meningomyelocele 2 — 2 incephalocele 1 — 1 Exomphalos 1 — 1 Malformation of bowel and obstruction 1 — 1 Polycystic disease of kidney 1 — 1 Total 11 1 12 5. Position of Child in Family 1 2 3 4 5 6 7 Not known Total Number of deaths 23 14 6 5 3 1 3 5 60 8 6. Causes of Infant Deaths Cause Neo-natal 1-12 months Total under 1 year Prematurity 7 — 7 Congenital malformation 6 — 6 Respiratory infection 1 3 4 Birth injury 4 — 4 Gastro-enteritis — 1 1 Intestinal obstruction — 1 1 Total 18 5 23 7. Hospital Deliveries Cause Delivery Weight Precipitate labour Natural forces (home delivery) Not weighed Precipitate labour (induced prematurity for toxæmia) Natural forces 2¼lb. Precipitate labour Natural forces 7lb. 2ozs. Premature labour (no apparent cause) Natural forces 41b. 12ozs. No apparent cause Natural forces 7lb. 4ozs. Premature labour (maternal toxæmia) Forceps delivery 51b. 5ozs. Total 5 All were neo-natal deaths 8. Abnormal Deliveries Delivery Reason Cause of death Neo-natal 1—12 months Caesarean section Toxæmia Prematurity 1 — Caesarean section Toxæmia Prematurity 1 — Forceps delivery Toxæmia Prematurity 1 — Forceps delivery Toxæmia Intracranial haemorrhage 1 — Forceps delivery Face presentation Congenital deformity — 1 Caesarean section Placenta prævia Gastro-enteritis — 1 Total 4 2 9 9. Premature Births and Deaths (1946-53) (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) 1953 31 (3) 143 (18) 7 (0) 174 (21) 10. 1953 Premature Births by Wards Carlton Kilburn Brondesbury Park Kensal Rise Manor Harlesden Stonebridge Roundwood Church End Willesden Green Mapesbury Gladsstone Cricklewood Brentwater Total Births in home 7 (2) 3 (-) 3 (-) 2 (-) - (-) 4 (-) 2 (-) 3 (-) 2 (-) 2 (-) 1 (-) 1 (1) 1 (-) - (-) 31 (3) Births in hospital 17 (2) 18 (4) 6 (-) 3 (-) 5 (-) 13 (-) 11 (1) 11 (-) 16 (1) 9 (2) 9 (2) 11 (3) 5 (-) 9 (3) 143 (18) T otal 24 (4) 21 (4) 9 (-) 5 (-) 5 (-) 17 (-) 13 (1) 14 (-) 18 (1) 11 (2) 10 (2) 12 (4) 6 (-) 9 (3) 174 (21) 10 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, fæces from intestinal infections, and cough plates and post-nasal swabs from whooping cough cases to the branch laboratory in Neasden Hospital, the Health Department, 54, Winchester Avenue, NW.6, the Willesden Health Centre, 381, High Road, Willesden, NW.10, the Kilburn Health Centre, 9, Willesden Lane, N.W.6, or the Stonebridge Health Centre, Harrow Road, NW.10. They are collected and taken to the Central Public Health Laboratory. The practitioner receives a report by 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 1953:— Organisms Found 364 Throat/Nose Swabs: Diphtheria bacilli — Haemolytic streptococci 133* Vincent's angina 10* Negative 227 *Both haemolytic streptococci and Vincent's angina were found in 6 swabs. 1798 Faeces Specimens: Shigella 283 Salmonella 27 Protozoa — Negative 1488 1899 Sputum Specimens: T.B. 320 Other organisms 59 Negative 1520 21 Post-Nasal Swabs: B. Pertussis 4 Negative 17 167 Milk Examinations Schools (pasteurised) Dealers' premises Total Pasteurised T.T. pasteurised Sterilised Samples 56 79 10 22 167 Satisfactory 56 79 10 22 167 Unsatisfactory - - - - - 16 Ice Cream Tests: Grade 1 12 Grade 2 4 Grade 3 — Grade 4 — 102 Water Examinations: Domestic Supplies, etc. 10 Swimming pools 92 Satisfactory 102 MISCELLANEOUS 147 Total number of examinations: 4514 11 Uncleanliness and Scabies Until 30th September, 1953, adults and children under five years of age with lice and nits or scabies were treated at Kensington Cleansing Centre and school children at Stonebridge Health Centre. This arrangement was found to be unsatisfactory; it was uneconomic, inconvenient for patients to travel to the Kensington Cleansing Centre and difficult to arrange treatment for a family when several members were suffering from scabies. Arrangements were therefore made for all cases to be treated at Stonebridge Health Centre. Cases Treated at the Kensington Borough Council Cleansing Centre 1.1.53 to 30.9.53 New Cases treated Attendances Scabies Lice & Nits Total Scabies Lice & Nits Total Children under 5 years 1 1 2 2 1 3 Adults Men 8 2 10 14 2 16 Women 7 12 19 11 12 23 Total 16 15 31 27 15 42 Cases Treated at Stonebridge Health Centre 1.1.53 to 31.12.53 New Cases treated Attendances Scabies Lice & Nits Total Scabies Lice & Nits Total Children under 5 years - 2 2 - 2 2 Children 5-15 years 22 101 123 68 101 169 Adults Men 2 — 2 2 — 2 Women 3 5 8 5 5 10 Total 27 108 135 75 108 183 Establishments for Massage 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. During the year there were 26 licences renewed and one new licence issued. In one case exemption from licensing was claimed under the Act for a registered member of the Chartered Society of Physiotherapy. All premises have been inspected and found to be satisfactory. Health Education The cost of the health services is mounting, mainly because of the increased expenditure on hospitals and other curative services. Unless more attention is paid to prevention, the health services may well be heading for serious financial difficulties. An enlightened citizen, with a knowledge of the principles of health and practising the simple rules of hygiene, can play an active part in improving the health services of an area. The department has based its health education mainly on 15 lectures with 53 film and filmstrips. As far as possible, health education in the schools is linked with a hygiene or biology syllabus. Brainstrusts are held at the end of each term, and the school children always display a keen interest and show clearly that they are gaining much useful knowledge of health. Altogether, 164 health talks and film shows were given in 18 schools by the Area Medical Officer and members of his staff, the Chief Sanitary Inspector and his staff, the Deputy Borough Engineer and others. 1,055 school children attended these lectures, with attendances ranging from 20 to 150. A well-informed mother is usually a capable mother. Caring adequately for her infant, she can relieve general practitioners and hospitals of some of their heavy burdens in dealing with the sick. There is no doubt that maternal and child welfare continue to play an important role in reducing illness and even death among mothers and children. 120 Mothercraft Classes were held at the three clinics—and many talks (some with filmstrips) were given by doctors, health visitors, midwives, and clinic nurses. Advice and help were also given to 6,707 mothers in their own homes by the health visitors during their routine visits. Mothers' clubs were commenced in June, and talks were given on subjects such as cookery, sewing, make-up, chiropody, home nursing, first aid and travel. The clubs have been held weekly at Kilburn Health Clinic, and monthly at Anson Road Primary School, and they have been much appreciated. The day-nurseries are also important meeting places for health workers and the public. Here, the staff and parents can come together and discuss the health of children under their care. 11 film shows and 26 talks were given at the nine day-nursery parent clubs by the Area Medical Officer and his staff, the Road Safety Officer, the Chief Sanitary Inspector and others. In addition, 28 meetings and social evenings were arranged. 12 Religious, social and political organisations continue to apply to the department for health lectures, and all their requests have been answered. Despite shortages of staff, 42 talks were given to 33 organisations on 21 different subjects. 1,420 people attended the lectures, with attendances ranging from 14 to 150. Health workers themselves need post-graduate education. Health education films were shown and lectures given, often by outside lecturers, to separate meetings of doctors, sanitary inspectors, health visitors, and day nursery matrons and their deputies. These meetings are held regularly, and the interesting discussions that follow many of them have been most valuable and keep the staff abreast with recent advances in technique in their special subjects. One can again look back on the year's work with satisfaction that health education has again achieved a usef-ul advance in promoting preventive medicine. Grateful thanks are due to the lecturers whose efforts and enthusiasm have largely contributed to this result. 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 improvement 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 rôle in health education and in improving hygiene. Notifiable Infectious Diseases Cases notified (confirmed in brackets) 1950 1951 1952 1953 Diphtheria 15 (1) 12 (1) 14 (1) 8 (1) Scarlet fever 317 (306) 211 (204) 262 (249) 217 (210) Pneumonia 164 (150) 172 (161) 126 (113) 228 (208) Whooping cough 650 (648) 550 (543) 330 (328) 453 (450) Erysipelas 29 (26) 31 (30) 27 (27) 22 (21) Measles 2280 (2255) 1937 (1927) 1528 (1520) 2392 (2383) Diphtheria In the past four 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 diptheria 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. Measles 2,392 cases were notified in 1953 (2,383 confirmed). At the end of 1952 the largest outbreak of measles for many years commenced in Willesden, and continued until the end of April, 1953. There was one death from measles in a child of 5 years. 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 pleasant illusion. There has been no significant reduction in whooping cough in Willesden in the last few years, but the case rate in Willesden, which was above that of England and Wales in 1947, has been consistently below it since that date (see table). There are many difficulties involved in interpreting the results. Firstly, whooping cough notifications, like Khose of measles, never reflect accurately the actual number of cases. 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 destroying 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. 13 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 of its value in the future, particularly if there is an increase in the number of young infants who are vaccinated. Whooping Cough Cases and Deaths : Willesden and England and Wales Year Population Child population (estimated) Number of cases confirmed No. of deaths Case rate per 1,000 population Death rate per 1,000 population No of children vaccinated in Willesden 0-4 5—15 Willesden England & Wales Willesden England & Wales Willesden England & Wales Willesden England & Wales 1936 190,000 - - 743 - 12 1918 3.91 — .06 .05 — 1937 188,030 — — 626 — 11 1600 3.33 — .06 .04 — 1938 187,600 — — 277 — 3 1052 1.48 — .02 .03 — 1939 188,000 — — 672 — 5 1229 3.57 — .03 .03 — 1940 152,030 — — 82 53,607 2 678 .54 1.34 .01 .02 — 1941 127,230 — — 505 173,330 5 2383 3.97 4.47 .04 .06 — 1942 138,600 10,000 15,500 460 66,016 4 799 3.32 1.73 .03 .02 — 1943 144,430 10,424 17,480 238 96,136 3 1114 1.65 2.54 .02 .03 — 1944 139,510 11,440 17,740 401 94,044 4 1054 2.87 2.49 .03 .03 — 1945 161,954 12,460 18,430 215 62,691 3 689 1.33 1.64 .02 .02 — 1946 170,550 13,191 20,389 377 92,936 4 808 2.21 2.29 .02 .02 — 1947 175,900 15,107 20,830 571 92,682 6 905 3.25 2.22 .03 .02 — 1948 179,900 15,544 20,663 423 146,410 2 748 2.35 3.42 .01 .02 — 1949 181,120 15,270 21,430 205 102,816 — 527 1.13 2.39 Nil .01 1615 1950 181,700 14,930 22,410 648 157,781 2 394 3.57 3.60 .01 .01 822 1951 179,647 13,847 22,995 543 169,441 — 456 3.02 3.87 Nil .01 1163 1952 180,400 13,846 24,000 328 114,869 1 184 1.82 2.61 .00 .00 946 11953 178,500 13,455 24,000 450 157,829 — 243 2-52 3.58 Nil .01 1,333 Pneumonia and Influenza 228 cases of pneumonia were notified in 1953 (208 confirmed). There were 85 deaths from broncho-pneumonia, lobar pneumonia and pneumonia (unspecified), and 15 deaths from influenza. Other Infectious Diseases Disease Cases notified (number confirmed in brackets) Typhoid fever - (-) Dysentery 180 (139) Malaria 2 (—) Poliomyelitis and polio-encephalitis 26 (14) Meningococcal infection 10 (6) Encephalitis 3 (2) Smallpox - (-) Poliomyelitis Poliomyelitis did not reach epidemic proportions in 1953. There were 26 notifications; 22 patients were admitted to Neasden Hospital, 3 to other hospitals, and one case (non-paralytic) was nursed at home. Only 14 actually had the disease confirmed, 11 in the age group 0-15 years and 3 over the age of 15 years. Five had the non-paralytic type of the disease, 6 had slight paralysis and 3 had severe paralysis. There was one death from the disease, a man aged 27 years, who was admitted to Central Middlesex Hospital on the 8th April, transferred to the Neasden Hospital the following day, and died the same evening. There were 3 notifications of encephalitis. 2 were confirmed, a woman of 63 years and a child of 2 years 3 months. The woman was admitted to the Central Middlesex Hospital on the 10th March suffering from cerebral anoxaemia ( Pacute encephalitis) and died on the 13th March; a diagnosis of acute encephalitis was made at the post mortem. The other notification was for a girl of 3 years, who was admitted to the Neasden Hospital and finally diagnosed as tonsillitis. Dysentery 180 cases were notified in 1953 (139 confirmed). There were 3 outbreaks of dysentery during the year:— (1) On the 15th June, 1953, six children were removed from the Central Middlesex Children's Homes to the Neasden Isolation Hospital. One child was found to be a carrier and isolated from the remaining children in the nursery. The infection cleared up rapidly and the home was out of quarantine on the 7th July, 1953. (2) On the 24th August, 1953, 3 members of the staff and 10 out of the 13 children in Connaught House Nursery were affected; only 1 adult and 1 child showed any symptoms. 7 children and 1 adult were removed to Neasden Isolation Hospital and the remaining 3 children were isolated in the Home. The infection cleared up rapidly and the Home was out of quarantine on 15th September, 1953. 14 (3) On the 16th November, 1953, 4 children developed symptoms at the Central Middlesex Children's Homes, Barretts Green Road, and were transferred to the Neasden Isolation Hospital. 8 other children were found to be carriers and isolated from the remaining 3 children in the nursery; they cleared up rapidly after a 5-day course of Chloromycetin. One member of the staff was also a carrier and was excluded from the nursery until clear of infection. The Home was again reopened for admissions on 5th December. Smallpox There were no cases of smallpox occurring in the Borough in 1953. Ophthalmia Neonatorum Three cases were notified in 1953 (1.13 per 1,000 live births); there was complete recovery with unimpaired vision in all three. Puerperal Pyrexia 150 cases of puerperal pyrexia were notified during the year (150 confirmed). Since August 1st, 1951, puerperal pyrexia applies to any "febrile condition occurring in a woman in whom a temperature of 100 4 degrees Farenheit (or 38 degrees centigrade) has occurred within fourteen days after childbirth or miscarriage". Food Poisoning 20 cases of food poisoning were notified during the year (9 confirmed). TUBERCULOSIS Morbidity and Mortality There has again been a welcome decline in mortality, which is now less than a quarter of that 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. However, the total number of cases on the register has increased, and the number of new cases has remained about the same for the past four years and is higher than in the years before the war. It is difficult to determine whether this increase is the result of more efficient diagnosis or a general deterioration in the tuberculosis situation. It may be that the new methods of treatment with antibiotics is responsible for the reduction in deaths and that a fatal termination is merely being postponed. It is hoped the reason is that more cases are being discovered earlier and therefore more patients are cured. The death rates in the next few years will be followed with some interest to decide this (see table I). The diagnosis of tuberculosis today is no longer a death sentence: an early diagnosis usually ensures a complete cure, and at the same time the spread of infection can be more effectively halted. Nevertheless, tuberculosis still remains the most important infectious disease in the Borough: every fortnight 10 people are notified and 1 dies. More than half the deaths are people under 55 years, and most patients are under 45 (see table II). Missed Notifications Although the disease is now more often detected in an earlier phase, many people still die unnotified, and together with those who die within a year of notification contribute almost one-third of the deaths; the actual number of deaths, however, was lower in 1953, and so fewer patients were involved (see table III). Prevention 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 more often to people who live and work in overcrowded conditions and whose resistance is lowered by poor nutrition. Wards such as Mapesbury and Carlton, where there is the most overcrowding among the poorer sections of the population, have rates well above the average, contrasting badly with Brentwater and Manor Wards (see table IV). Clearly, overcrowding and poverty must be relentlessly attacked if we are to conquer tuberculosis. Our main weapons of attack must be: improving resistance, detecting cases earlier, and preventing spread to susceptible contacts. There is no question that it is more economical to spend money on improving housing and nutrition than to spend it on the modern and costly methods of treating tuberculosis. 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 15 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 members 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. B.C.G. Vaccination Another way of increasing resistance is by B.C.G. vaccination. In this country where the incidence of tuberculosis is relatively low, B.C.G. vaccination must be selective. On January 1st, 1953, arrangements were made to commence vaccinating susceptible tuberculinnegative school-leavers to protect them before they enter the vulnerable age groups when they undergo 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. Those who are tuberculin-negative attend for a Mantoux test and if negative they are vaccinated with B.C.G. In addition, children have been tuberculin-tested at infant welfare clinics and at the periodic medical inspections at school. Those who have been positive have had an X-ray of the chest at the chest clinic, and their social and family history investigated to determine the source and extent of the infection. Mass Miniature Radiography Arrangements have 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. About 25 in every 1,000 persons examined by the M.M.R. unit during its first six months were found to have active tuberculosis. Out of 14,236 out-patients examined, 57 were found to be cases of active or presumed active tuberculosis; nine in-patients out of a total of 2,465 were found to be suffering from the disease. Doctors referred 4,719 patients for X-ray and 4,279 came of their own accord. Of the former, 91 were found to be suffering from tuberculosis, and of the latter, 14. Staff at the hospital and applicants for staff appointments were X-rayed, and of these seven out of 1,167 were found to have active tuberculosis. 536 patients referred by area medical officers were examined, of whom four were found to have tuberculosis. The rate of active cases per thousand X-ravs was 6-3, or 182 cases out of 27,420. Factories Arrangements were made to trace contacts of infective cases in 7 factories; and 365 employees attended for X-ray examinations. 337 were found satisfactory and in 28 some abnormality was detected. Of these 28, 19 were not suffering from tuberculosis, 6 had arrested tuberculosis, and no further action was taken, and further investigation was necessary in 3 as follows:— Case A. Home address outside district and details were sent to the Paddington Chest Clinic. Case B. To be re-examined in August, 1954. Case C. Treated at home, then admitted to Neasden Hospital on 23rd July, 1953, and discharged on 7th November, 1953. Now attending for refills, unfit for work, but making good progress. Chest Clinic 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 in June, 1952 and completed in March, 1953. During this period, 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 now has a new X-ray department with an adjacent dark room, and a miniature camera unit (Watson 5" x 4") added to the existing four valve set; a separate chest-screening stand has been made 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. Hospital Accommodation If more cases are to be discovered, it is also essentia! 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 Middlesex Hospital and another 20 male beds in Neasden Hospital. 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. 16 Co-operation 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. 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 improvements of the scheme as a whole in the area. Arrangements were made in home help cases for appeals against assessments to be dealt with promptly to avoid patients being alarmed by a high notice of assessment; notes and a talk were given to home helps on the spread and prevention of infection; the meals on wheels service was provided for some patients; deaths occurring within one year or before notification were investigated; arrangements were made to trace contacts of infective cases in factories (see page 15); and factory managers were encouraged to employ non-infectious ex-tuberculosis patients on the recommendation of both the chest physician and the medical officer of health. TABLES—TUBERCULOSIS 1. Notified Cases and Deaths Year Population New cases (Rates per 1,000 pop. in brackets) Deaths (Rates per 1,000 pop. in brackets) Cases on Register Pulmonary Nonpulmonary All forms Pulmonary Nonpulmonary All forms Pulmonary Nonpul monary All forms 1936 190,000 211 47 258 128 16 144 655 152 807 (1.1l) (.168) (1.358) (.673) (.084) (.757) 1937 188,030 205 49 254 119 14 133 688 161 849 (1.09) (.261) (1.351) (.632) (.074) (.707) 1938 187,600 210 56 266 117 11 128 691 172 863 (1.119) (.298) (1.417) (.623) (.058) (.681) 1939 188,000 250 37 287 108 12 120 678 166 844 (1.329) (.197) (1.526) (.574) (.063) (.638) 1940 152,030 204 54 258 105 16 121 587 145 732 (1.324) (.355) (1.697) (.690) (.105) (.795) 1941 127,230 217 32 249 79 15 94 575 116 691 (1.705) (.252) (1.957) (.621) (.117) (.738) 1942 138,600 234 47 281 100 15 115 369 133 502 (1.688) (.339) (2.027) (.721) (.108) (.829) 1943 144,430 262 51 313 85 14 99 734 150 884 (1.814) (.353) (2.167) (.589) (.096) (.685) 1944 139,510 210 23 233 84 18 102 815 156 971 (1.505) (.165) (1.670) (.602) (.129) (.731) 1945 161,954 207 45 252 81 16 97 927 172 1099 (1.278) (.277) (1.556) (.500) (.098) (.598) 1946 170,550 255 34 289 81 15 96 1067 180 1247 (1.495) (.199) (1.694) (.475) (.088) (.563) 1947 175,900 253 33 286 76 12 88 1198 191 1389 (1.438) (.188) (1.626) (.432) (.068) (.500) 1948 179,900 243 27 270 80 11 91 1293 196 1489 (1.351) (.150) (1.501) (.445) (.061) (.506) 1949 181,120 186 22 208 66 9 75 1386 207 1593 (1.026) (.121) (1.147) (.364) (.050) (.414) 1950 181,700 229 29 258 51 4 55 1543 217 1760 (1.260) (.159) (1.419) (.280) (.022) (.302) 1951 179,647 228 33 261 46 5 51 1673 239 1912 (1.269) (.184) (1.453) (.256) (.028) (.284) 1952 180,400 229 27 256 29 4 33 1803 250 2053 (1.269) (.150) (1.419) (.161) (.022) (.183) 1953 178,500 216 29 245 24 1 25 1854 249 2103 (1.210) (.162) (1.372) (.134) (.006) (.140) 17 II. New Cases and Deaths by Age Groups 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 — 5 to 10 2 2 1 — — — — — 10 to 15 1 2 — — — — — — 15 to 20 9 8 — 1 — — — — 20 to 25 8 20 3 4 — — — — 25 to 35 37 34 2 3 1 2 — — 35 to 45 22 11 3 3 2 2 — — 45 to 55 29 1 2 5 4 1 — — 55 to 65 9 5 2 — 5 — — — 65 and upwards 9 1 — — 5 2 — — Totals 129 87 13 16 17 7 1 — III. Deaths: When Notified 1948 1949 1950 1951 1952 1953 1948-53 Deaths 80 66 51 46 29 25 297 Percentage not notified 16.25 22.73 11.76 19.56 20.69 28.0 18.86 Percentage notified before death: 0—12 months 35.0 25.76 35.30 15.22 20.69 8.0 26.26 1—5 years 33.75 27.27 27.45 39.13 31.03 28.0 31.31 Over 5 years 15.0 24.24 25.49 26.09 27.59 36.0 23.57 Appendix to Table III Tuberculosis Cases Dying within One Year of Notification or who were Notified after Death J.M.; 1 year 10 months male. Notified 16.5.53; died 10.8.53. Admitted to Neasden Hospital with complications of measles and was later found to have miliary tuberculosis from which he died. The grounds of infection in this case were found to be a lodger (Irish) in the house. This man was hospitalised and sent to a sanatorium following his discovery. M.H. 25 years female. Died unnotified on 13.7.53. Cause of death—tuberculous broncho-pneumonia and renal failure due to maldevelopment of kidneys. Admitted Paddington Hospital on 22.6.53. H.F.H. 38 years male. Died unnotified on 25.1.53. Admitted to Central Middlesex Hospital in January, 1953, with a history of approximately a year's duration of cough, lassitude, loss of weight, but he had been quite unwilling to see a doctor until shortly before admission. On examination grossly cachectic and toxic with advanced pulmonary tuberculosis. F.T.H.; 52 years; male. Died unnotified. Illness commenced 1.5.53. Admitted to Central Middlesex Hospital 1.6.53. Died same day. Cause of death—tuberculous broncho-pneumonia. t W.B.; 59 years; male. Died unnotified on 27.1.53. Investigated at Chest Clinic in August, 1952. No evidence of tuberculosis found at that time. Admitted to Central Middlesex Hospital in January, 1953, with broncho-pneumonia from which he died. At post-mortem some evidence of chronic pulmonary tubercle was found. 18 L.M..; 66 years; female. Died unnotified on 17.7.53. Admitted Central Middlesex Hospital on 14.7.53 with a history that she had been suffering from chronic bronchitis and asthma for some time. Apparently no previous investigations had been made and she died rapidly from emphysema, pulmonary tuberculosis and right sided congestive cardiac failure. C.H.B. 67 years; male. Died unnotified on 29.1.53. Admitted Central Middlesex Hospital 27.1.53 with broncho-pneumonia from which he died. At post-mortem some evidence of chronic pulmonary tuberculosis was also found. History of chronic cough for some years but not previously investigated. W.E. W. 70 years; male. Notified 19.11.53; died 4.12.53. First sought medical advice at Manor House Hospital in August, 1953, but the true diagnosis of pulmonary tuberculosis was missed. He was later admitted to Central Middlesex Hospital in November, 1953, in very poor condition and died on 4.12.53. R.C.W.; 71 years; male. Died unnotified on 16.5.53. Under supervision at Paddington Chest Clinic since 1949 and Willesden Chest Clinic since 1951. IV. 1953 Death and Cases by Wards Ward Pulmonary Cases NonPulmonary Cases Pulmonary Rate Combined Rate All Forms Deaths Rate Carlton 30 2 2.385 2.545 2 .159 Kilburn 21 3 1.533 1.752 3 .219 Stonebridge 9 2 .758 .927 1 .078 Roundwood 14 — 1.039 1.039 4 .331 Brondesbury Park 14 2 1.086 1.241 3 .236 Kensal Rise 11 3 .910 1.158 — — Cricklewood 13 2 1.119 1.291 3 .253 Church End 17 4 1.242 1.534 2 .148 Willesden Green 16 2 1.117 1.257 — — Harlesden 16 3 1.380 1.639 3 .212 Mapesbury 21 3 1.684 1.924 1 .080 Manor 12 2 .943 1.100 3 .221 Gladstone 16 1 1.176 1.250 — — Brentwater 6 — .505 .505 — — Whole Borough 216 29 1.210 1.372 25 .140 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 are required at an agreed charge. The refuse is disposed of by controlled tipping at Twyford. Household Arrangements The County Report of Middlesex (Census 1951) reveals clearly the housing problems of Willesden as compared with the rest of the County. Because Willesden was developed first in the County, it has the oldest property with all the defects that arise therefrom. Shared Dwellings and Overcrowding In Willesden there is a much higher proportion of households in shared dwellings (six out of ten) than for the average of the County (three out of ten) and Greater London (four out of ten). It is much higher than that of England and Wales (two out of tern). 19 The number of persons per room and the percentage of population and of households at densities over 1£ and 2 persons per room is the highest in the County, in some instances the percentage is more than double. The number of persons per room is higher than that of Greater London, England and Wales, and any district in the County. Bathrooms The proportion of households either sharing or without a fixed bath (six out of ten) is almost double that of the average of the County, and is much higher than that of Greater London and England and Wales (about four out of ten). The proportion sharing or without a water closet, cooking stove or a kitchen sink is higher than the average of the County of Middlesex. Housing of Private Households Census 1951 One per cent, sample Middlesex Willesden Greater London England and Wales Structurally separate dwellings Occupied and vacant Number 603,831 38,843 — — Percentage increase or decrease (-) 1931—1951 68.2 22.7 - — Percentage vacant unfurnished 0.55 0.51 — — Occupied Rooms per dwelling 1951 5.01 5.39 — — 1931 5.68 6.29 — — Percentage with 1 or 2 rooms only 2.56 3.59 — — Households Number 703,525 57,182 26,479 130,435 Percentage increase or decrease (-) 1931—1951 63.1 14.9 — — Percentage sharing a dwelling 28.5 57.8 36.45 15.08 Rooms per household 4.24 3.61 — — Percentage occupying 1 or 2 rooms only 12.2 18.6 — — Persons per household 1951 3.16 3.08 — — 1931 3.66 3.60 — — Percentage of 1 person households 9.7 12.8 — — Density of occupation (persons per room) Persons per room 0.74 0.85 0.77 0.73 Percentage of population at density Over 2 1.8 4.1 1.71 2.16 Over 1½ 7.5 15.5 — — Percentage of households at density Over 2 1.1 2.3 - Over 1½ 4.8 9.9 — — Heads of household; percentage non-married 21.4 25.3 — — Private Households according to possession of certain household arrangements (Percentages in brackets) Area No. of households Water closet Fixed bath Cooking stove Kitchen sink Sharing Without Sharing Without Sharing Without Sharing Without 703,315 125,962 2,361 131,356 113,625 43,192 7,139 53,909 20,371 Middlesex Census 1951 (18) (35) (7) (11) Willesden 57,182 13,621 120 16,442 16,592 3,520 1,005 4,495 2,130 (24) (58) (8) (12) Greater London One per cent, sample 26,479 6,480 (24.47) 12,068 (45.57) 3,386 (12.78) England & Wales 130,435 27,974 (21.44) 58,174 (44.61) 17,927 (13.65) 20 21 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 All samples taken from the three swimming baths proved satisfactory. Swimming Bath Samples taken Satisfactory Granville Road 61 61 Gladstone Park 20 20 King Edward's Park 11 11 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 1953, and at the end of the year it had not been possible to fill the vacancies; 4 pupil sanitary inspectors were on the staff in 1953. The Rodent Officer and three 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 main problem is to try and preserve property which will deteriorate into slums if neglected and then most likely require demolition; many tenants inform the Public Health Department only when the defects are advanced and costly to remedy. In November, 1951, the Council decided to organise a house-to-house survey in selected areas to discover defects early before they deteriorated or caused extensive damage and so cost much more to repair. For instance, to remedy defective roofs or gutterspouts promptly is much cheaper than leaving them to cause dampness and damage to walls and rooms. A preliminary survey was made to determine the first area to receive attention, and on 14th February, 1952, four sanitary inspectors started the survey in selected roads in the Willesden Green ward. The Council served notices for remedying defects under the Public Health Act, 1936, or the Housing Act, 1936. As many as eight out of ten houses required some action which resulted in much preventive work being done (table 1). The main criterion in drawing up schedules of repairs was to prevent houses deteriorating; this is clearly indicated in the attention paid to windows, roofs, gutters and downspouts (table 2). Some repairs which normally would have been included in a regular house-to-house inspection were consequently omitted. The owners did not exactly welcome the sanitary inspectors with open arms, but most of them appreciated that the repair work was essential and that their properties were receiving necessary improvements which would save heavy repair bills in the future. Nineteen landlords carried out the work without notices being served, and 12 on intimation notices alone (table 3). Most owners carried out the repairs without any difficulty. Nineteen (involving 65 houses) appealed against the notices, but the majority of them came to an agreement on a modified schedule of repairs. Ten cases were taken to Court: 4 struck out (received out of time), 2 withdrawn, 1 arbitration (adjourned generally) 1 dismissed by Court of Appeal, 2 agreement reached in Court and adjourned generally. At the end of the year 1 case was awaiting hearing in Court. Work has now been completed on most of the notices (table 4). Table 1 1952 1953 Total Houses inspected 602 429 1031 Re-inspections 3206 5718 8924 Total inspections 3808 6147 9955 Houses in all respects reasonably fit for human habitation 82 108 190 Houses with slight defects 9 1 10 Houses requiring action 511 320 831 22 Table 2 Houses requiring action (Defects in brackets) 1952 1953 Total Chimneys 116 (125) 54 (54) 170 (179) Roofs 265 (265) 148 (148) 413 (413) Gutters and downspouts 248 (312) 140 (165) 388 (477) Soil and vent pipes 103 (103) 46 (46) 149 (149) Brickwork 296 (365) 136 (170) 432 (535) Windows 470 (849) 257 (420) 727 (1269) Paving 200 (228) 87 (92) 287 (320) Water closet accommodation 395 (629) 222 (280) 617 (909) Drainage 13 (13) 5 (5) 18 (18) Walls and ceilings 468 (1425) 271 (782) 739 (2207) Floors 194 (213) 113 (118) 307 (331) Total defects 4527 2280 6807 Overcrowding 7 2 9 Houses with T.B. cases 8 4 12 Table 3 Action Recommended 1952 1953 Total Section 9, Housing Act, 1936 464 308 772 Section 93, Public Health Act, 1936 34 6 40 Section 39, Public Health Act, 1936 2 1 3 Section 45, Public Health Act, 1936 2 2 4 Intimation notices 9 3 12 Total 511 320 831 Table 4 Results of Action Taken Work completed 664* Work commenced 60 Notices served but time limit not expired 7 Negotiations pending with owners 43 Outstanding appeal 1 Total 775 *Included in figure above Referred to Borough Engineer 24 work done by Borough Engineer 29 work done by owners Demolition and Closing Orders Housing Act, 1936 (Sections 11 and 12) 1953 There were no demolition orders made during the year (2)* Closing Orders : 3, Cardigan Road (basement) 53, Chichester Road (basement) 2 (1)* (*1952 in brackets) One closing order made in 1951, 2, Victoria Villas (basement) was determined, after the owner had carried out works to render the basement fit for human habitation. Demolition Orders outstanding from previous years 32, Connaught Road (1950). After much delay an undertaking to carry out the repairs was received from the owners, and at the end of the year work was almost completed. 1, Avenue Road (1950) and 76, Canterbury Road (1951). Closing orders are being substituted for demolition orders under Local Government (Miscellaneous Provisions) Act, 1953, sections 10 and 11. 1 and 2, Bridge Place (1951). It has not yet been possible to rehouse the tenants. 157, Willesden Lane (1952). Demolished by Borough Engineer in default of owner. Overcrowding There has been little change in the overcrowding problem which still remains acute. Only a few licences were issued to permit temporary overcrowding under Section 61 of the Housing Act; landlords are no longer using this section to obtain an eviction order because they know that the Court is inclined to deal sympathetically with the tenants. 23 1953 Licences to permit temporary overcrowding in excess of the permitted number, Section 61, Housing Act, 1936: licences issued 4 (3)* 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) Dwellings overcrowded at end of year 1745 (b) Overcrowding reported during the year 142 (c) (i) Overcrowding relieved during the year 75 (ii) Persons app. 268 (d) Dwelling houses which have again become overcrowding 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 75 (ii) Families 111 (iii) Persons 663 (f) Overcrowding in Council houses relieved during the year 15 New Dwellings, 1953 Houses Flats Rebuilds Dwellings built by private builders (excluding those built by the police authorities) 27 - 1 house 5 flats Built by local authority Nil 64 Nil Applicants on Council's waiting list at 31·12·53 9,856 *(1952 in brackets) Housing Defects 1953 1952 Premises inspected on complaint 3678 4310 In connection with infectious diseases 4 5 House-to-house (Housing Act, 1936, Section 5) 64 139 Others 314 150 Under special survey (see page 21) 429 602 Total No. of premises 4489 5206 No. of inspections (inclusive of Housing Survey) 26,290 27,695 Notices Served under Public Health and Housing Acts, 1936 Inclusive of Housine Survey 1953 1952 Intimation notices served 1926 2141 Intimation notices complied with 2012 2222 Statutory notices served (Public Health Act, 1936) 967 1024 Statutory notices complied with (Public Health Act, 1936) 1050 1200 Statutory notices served (Housing Act, 1936) 394 456 Statutory notices complied with (Housing Act, 1936) 535 202 Non-compliance with statutory notices referred to Town Clerk (Public Health Act, 1936, S.93) †123 †160 Referred to the Borough Engineer for work to be carried out in default of owners 131* 122 *75 by Borough Engineer, 56 by owners. fDetails of cases referred to the Town Clerk during year. Work carried out 101 115 Work in hand — 8 Court orders obtained 9 11 Summonses issued — 2 Summonses withdrawn—notices complied with 12 23 (1) (-) Work done by agreement—Public Health Act, 1936, Section 275 — 1 Total 123 160 (The figures in brackets are the notices withdrawn and re-served). Certificates of Disrepair under the Rent and Mortgage Interest (Restrictions) Acts, 1920-39 1953 1952 Applications received from tenants 21 37 Granted 16 28 Refused 4 9 Withdrawn 1 — 24 Summary of Nuisances, and of Improvements Effected Water Supply and Water Service Inclusive of Housing Survey 1953 1952 New cisterns provided 29 38 Cisterns cleansed, repaired, covered, etc 69 98 Draw taps placed on mains 6 8 Drainage and Sewerage Water Closets : Repaired, supplied with water or otherwise improved 550 508 New closets built 6 6 Provided with better ventilation 11 3 Drains : Examined, tested, exposed, etc 240 276 Unstopped, repaired, trapped, etc. 341 395 New soilpipes or vent shafts fixed 42 48 Disconnecting traps or chambers inserted 24 14 Reconstructed 21 21 New manhole covers 79 55 Soilpipes or vent shafts repaired 185 168 Other Defects Smoke nuisances 5 7 Accumulation of refuse 98 83 Foul ditches, ponds, etc., and stagnant water — — Fowls, pigs, etc., kept in an insanitary condition 22 16 Dampness 1388 1204 Yard and Forecourts paved, repaved or repaired 370 219 Walls and ceilings cleansed 3382 3205 Verminous rooms disinfested 362 492 Leaky roof made watertight 1490 1311 Additional ventilation provided under floors 122 141 Dilapidated plaster repaired 2998 2629 Flooring and other woodwork repaired 1475 1212 Damp proof courses inserted 56 84 Water supply reinstated 37 37 Wash-house floors repaired or repaved 25 32 Fireplaces and stoves repaired 1170 869 Decayed brickwork repaired and repointed 929 714 Sinks provided or replaced 251 163 Additional light and ventilation to staircase 11 3 Larders or food cupboards ventilated or provided 69 30 Gutters and/or rainwater pipes repaired or renewed 1202 979 New sashcords and glass provided to doors and windows 3184 2460 Miscellaneous 851 703 Total nuisances abated 21100 18231 Inspections of Other Premises 1953 1952 No. inspected Inspections made No. inspected Inspections made Slaughterhouses (1 registered but not in use) - - - - Common lodging houses - - - - Offensive trades 1 1 - - Power factories 602 697 647 766 Non-power factories 71 95 78 107 Workplaces——other than outworkers 4 4 7 7 Homeworkers and outworkers 245 245 316 318 Inspection of food premises (includes re-visits) Baker 38 184 38 132 Bread and confectionery 38 107 38 185 Dairy 10 64 10 94 Butcher 115 364 114 532 Grocer and general store 315 826 315 924 Fishmonger and fish-fryer 60 197 61 209 Cafe and restaurant 151 511 150 602 Greengrocer and fruiterer 125 366 126 461 Ice cream and sweet shop 180 375 181 643 Food stall 19 17 19 48 25 Public House 44 71 44 92 Works canteen 111 253 110 180 Food factory 13 120 14 14/ Any other food premises 25 117 25 80 Total periodic inspections 2167 4614 2293 5527 Other Inspections 1953 1952 No. inspected Inspections made No. inspected Inspections made Certificates under the Rent Acts — 26 — 63 Public house urinals 44 173 44 168 Mews and stables 29 94 29 103 Miscellaneous — 1652 - 2642 Smoke observations 29 177 26 174 Verminous rooms 109 192 266 270 Total other inspections 2,314 3,420 Total all inspections 33,218 36,642 (inclusive of Housing Survey) Smoke Nuisance The saying 'prevention is better than cure' is more often honoured in the breach than in the observance. Usually it is not until a death occurs that authorities are stimulated into action. Four thousand deaths was the price paid in the Greater London fog of last year before public interest was aroused in the smoke menace, a menace which has been increasing each year and is doing more harm than all the slum conditions of 100 years ago. The increased number of deaths from the London fog which lasted from December 5th—9th, extended for another two weeks, and particularly affected people over 45, although young children were also seriously affected. In the two weeks following the fog, deaths from bronchitis were ten times as many, from influenza seven times, from pneumonia five times, from pulmonary tuberculosis four-and-a-half times, and from other respiratory infections nearly six times as many as the average for the three weeks preceding the fog. Other patients died earlier than they would have done from disorders of the heart and circulation or cancer of the lung, and many children died from gastro-enteritis, which probably followed a respiratory infection. A recent experiment has shown that sulphur dioxide and trioxide in concentrations in the air which are ordinarily harmless can, when they are carried to the lungs in an aerosol, becomes very poisonous and kill an animal in four seconds. However serious and alarming these figures are, they are only part of the story. Ultra-violet light from the sun is cut off by smoke pollution, and damage is caused to buildings, which need increased cleaning and decoration, and to houses and their contents; there is also corrosion of metals and damage to crops, and interference with transport on the roads. The constant general pollution of the atmosphere has an important effect in producing chest conditions such as bronchitis and pneumonia, and recent research has pointed to its making an important contribution in producing cancer in the lung. The total financial damage is estimated at about £50 million a year, equivalent to 5s. per ton of coal used. The main cause of atmospheric pollution is the burning of coal which gives off tarry and sooty products, together with sulphur compounds and grit or fine ash particles. Although industrial smoke is less in the total than domestic, it is more concentrated in the areas where it is produced and therefore is probably a greater menace for those who live there. 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. To determine the actual cause of these nuisances, standard deposit gauges for measuring atmospheric pollution are 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 deposit gauge is designed to collect the solid and liquid material in the atmosphere and its analysis gives the amount of tarry matter, sulphite and sulphate and other chemicals. It collects only the larger particles of grit; the finer particles and smoke are often dispersed, dependent upon atmospheric conditions. It has been estimated that less than one-quarter of the smoke emitted and less than one-quarter of the sulphur dioxide deposited as sulphite and sulphate, are actually recorded by the deposit gauge. Nevertheless, the records give a good indication of the extent of atmospheric pollution. For estimating sulphur dioxide in the air, a cylinder of 100 sq. cubic centimetres surface is coated with a paste of lead peroxide and exposed for one month. An analysis of the sulphate formed gives an estimate of the sulphur dioxide in the air. 26 The table and graph 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. The amount of sulphur dioxide deposited on the gauge at Minet Gardens was in many months appreciably higher than that at the Town Hall. The Council had meetings with officers of the London Transport Board and discussed methods for reducing the nuisance from the Neasden Power Station. Arrangements were made for the Council's officers to meet the Chief Engineer at the Power Station to determine what further progress could be made. A special sub.committee of the Public Health Committee has been appointed to deal with smoke nuisances and the possibility of having "smokeless zones" in the Borough. Undoubtedly the amount of atmospheric pollution generally is increasing, and we are reaching the stage where it is just as great a menace to health as bad drains were in the past. And yet much less is being done today for the removal of this danger as compared with the efforts made in the past to improve water supply and drainage. Clearly, the nation is suffering from this smoke menace. Many millions of tons of coal are being wasted and being emitted from our chimneys only to cause more damage in buildings, increased need for washing, and what is most important, the deterioration of health of the people. Surely money spent on preventive measures would pay handsome dividends in better and cleaner air and better health standards. Monthly Deposits in Tons per square mile—1953 Power Station Acton Lane Taylors Lane Neasden Control Site Barrett's Green Road Minet Gardens Ascot Park Neasden Lane Press Road Wembley T rading Estate Town Hall January 22.49 104.89 19.92 27.50 27.17 16.92 17.61 February 41.36 71.58 38.49 40.79 45.63 29.47 27.53 March 40.67 40.83 23.25 26.58 29.56 35.63 20.19 April 30.88 56.24 16.96 27.74 39.50 26.77 13.83 May 22.78 19.59 17.78 17.06 22.20 21.24 14.59 June 26.58 40.69 16.13 18.52 20.38 17.88 15.08 July 18.41 54.88 10.87 14.71 41.32 11.82 9.78 August 17.25 48.02 13.00 14.45 30.89 13.60 13.60 September 25.12 58.43 11.82 25.22 34.07 20.22 18.64 October 26.54 36.61 20.68 22.83 29.72 27.53 19.62 November 20.65 56.87 15.38 23.73 46.69 23.34 14.39 December 35.40 48.45 13.70 27.75 21.57 22.23 11.39 Total 328.13 637.08 217.98 286.88 388.70 266.65 196.25 Examination of Sulphur by Lead Peroxide Method, 1953 Expressed in Milligrams of S02 per Day per 100 Square Centimetres Site January February March April May June July August September October November December Minet Gardens 3.42 2.72 2.97 1.87 1.29 1.01 1.02 1.02 1.75 2.81 2.71 3.0 Town Hall 2.77 2.60 3.07 1.64 1.19 0.79 0.57 0.81 1.22 2.61 2.58 3.1 27 1953 MONTHS OF THE YEAR BOMBED SITES Most of the bombed sites in the Borough have now been built on or converted into 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 steeam disinfector at the Neasden Hospital under Section 84 of the Public Health Act, 1936. (a) Verminous premises: Council properties 30 County Council properties 1 Private properties 142 Total 173 (b) Verminous rooms:* Council properties 80 County Council properties 2 Private properties 264 Disinfested by owners 14 Total 360 *Some rooms are treated more than once. 28 (c) Bedding material 16 (d) Miscellaneous: Beetles in canteens, etc 3 Houseflies 2 Ants 3 Wood lice 1 Weevils 2 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 186 Borough Council properties 20 Private dwellings 700 Total 906 at the following cost: Business premises £1,670 3s. 2d. Private dwellings £875 10s. 5d. Total £2,545 13s. 7d. The cost of disinfestation at business premises is recovered from the occupiers, and in 1953, 96 had an annual agreement with the Council for regular inspection and disinfestation; 8 were new agreements, and 88 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 registers 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. Four application for registration of premises for the manufacture of preserved food, etc., were received in 1953. Premises on register 31.12.52 No. of applications received No. of applications granted No. of applications refused No. of premises removed from registration during 1953 Total on register at 31.12.53 Inspections made Sale and storage of ice cream 233 48 48 - - 281 297 893 Manufacture of ice cream 17 - - - 1 16 73 Manufacture of preserved foods 117 4 4 - - 121 308 Fish curing 10 - - - - 10 37 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. Sixteen samples were taken in 1953, and these proved to be satisfactory. Clean Food Guild The Willesden Clean Food Guild, formed in May, 1948, extended its work of improving food hygiene standards. Certificates are held by 355 food traders, about 31 per cent, of those eligible. 328 qualify, but have not applied for a certificate. The campaign for clean food would be materially furthered if all those entitled to display a certificate co-operated with their colleagues in the Guild. 29  1949 1950 1951 1952 1953 Totals Applications received 263 135 8 16 26 448 Premises registered and certificates issued 195 107 19 10 24 355 Applications deferred or refused 68 28 3 7 2 108 Previously refused, now issued with certificates - - 14 1 - 15 Trade No. in Borough Applications received Certificates issued Deferred or refused Baker 38 13 4 9 Bread and confectionery 38 7 5 2 Butcher 115 50 43 7 Cafe or restaurant 151 75 50 25 Dairy 10 5 5 - Fishmonger or fish-fryer 60 18 11 7 Greengrocer and fruiterer 125 16 14 2 Grocer and general store 315 170 143 27 Ice cream and sweets 180 53 41 12 Works canteen 111 33 31 2 Food factory 13 8 8 — Totals 1,156 448 355 93 "Wash your hands" and "Exclusion of- dogs from food shops" notices continue to be issued free to food traders by the Guild and the Borough Council. Improvements in Premises During the year the contraventions of the Food and Drugs Act, 1938, and Food Handling Byelaws, discovered in the major surveys of 1950 and 1951 have been remidied with the exception of the provision of constant hot water supplies in some cases. One trader who failed to provide adequate means for heating water was summoned and fined £1 with one guinea costs. In 1953, an additional 65 traders were encouraged to provide constant hot water but 44 premises still have an unsatisfactory supply. In all other cases traders complied with requests or notices, and legal action was not necessary. Premises unsatisfactory on 31.12.42 84 Unsatisfactory during the year 301 Premises made satisfactory during the year 313 Unsatisfactory on 31.12.53 72 Inspections 2,486 Re-visits 1,086 Total 3,572 Defects Outstanding at 31.12.52 During the year Total Remedied during year Outstanding at 31.12.53 Inadequate lighting and ventilation 5 12 17 13 4 Constant hot water not provided 55 54 109 65 44 Inadequate refuse storage 6 55 61 56 5 Insufficient sanitary accommodation 9 18 27 22 5 Inadequate storage 1 30 31 28 3 Defective walls and ceilings 8 77 85 80 5 Dirty walls and ceilings 18 145 163 150 13 Dirty hand towels 1 38 39 39 - Generally bad conditions 7 9 16 16 - Any other defects 42 144 186 164 22 Totals 152 582 734 633 101 30 Cafes, Restaurants and Canteens Improvement in the standards of hygiene in cafes, restaurants and canteens continued during the year. Eight premises were provided with running hotwater, leaving 4 with an unsatisfactory supply. 32 defective and dirty walls were repaired and redecorated. Education in Food Hygiene The education of food handlers was given much attention during the year. Lectures and talks, illustrated with film shows, filmstrips and bacteriological cultures, were given to canteens staff, food traders, social and political organisations and school-leavers. A "Clean Food Week" was held from October 12th—17th. (1) A mobile cinema toured the main shopping centres, giving four film shows per day. The films were "Another Case of Poisoning", "The Good Housewife in her Kitchen", and "Fly about the House', and each show lasted about an hour. A Sanitary Inspector accompanied the van to introduce the films, give a short talk on food hygiene, and answer questions. About 3,500 people attended the shows. (2) 500 specially designed posters were displayed in shop windows and on public and private hoardings. (3) 22,000 leaflets were distributed in shops, schools, libraries and from the mobile cinema. (4) The Medical Officer of Health, Assistant Medical Officers, Sanitary Inspectors and the Hon. Secretary of the Guild gave 24 talks to trade union, social and church organisations, the Chamber of Commerce, mothercraft classes and school children. (5) Public visits were arranged to a large food factory, a brewery and two milk processing dairies. It was a successful Clean Food Week and shopkeepers and the public showed appreciation of the work of the Guild. The Public Health Department and the Clean Food Guild displayed two stands on food hygiene in the Social Services section of the Willesden Show. They attracted a great number of people. Food Poisoning One outbreak occurred in a factory and affected 25 workers. The causative organism appeared to be Clostridium Welchii which were found in specimens of braised beef which had been eaten at the staff canteen by all the affected people, who speedily recovered. Instructions were given to the kitchen staff that prevention of food poisoning lies in serving freshly cooked meat while hot or after cooling rapidly (within l-£ hours); only refrigerated pre-cooked meat can be served with safety the following day, and meatstuffs boiled or stewed a day ahead of requirements must be well heated before serving. Contaminated Food There have been more samples of contaminated food brought to the notice of the Public Health Department. 20 samples of food with foreign bodies were reported by the public. A caution was administered to four firms and the Borough Council prosecuted 2 others with the following results :— Nail in cake Fined £3 Costs £3.3.0 Paper in loaf Case dismissed Costs £3.3.0 In the other 14 the foreign bodies were either not harmful to health or there was insufficient evidence that the firm was responsible. Food Unfit for Human Consumption Meat. Miscellaneous. Bacon 3,894 lb. Biscuits 10 lb. Cooked 117 lb. Chicken 391 lb. Tinned 3,454 lb. Chicken and egg delight 48 lb. Raw 4,916 lb. Chocolate 11 lb. Pisu Chutney 5 jars Fish Coconut 6 lb. Tinned 1,289 tins Coconut drops 9 lb. Raw 593 tins Coffee 2 bottles Vegetables. 1 tin Tinned 5,890 tins. Cream 71 tins Raw 122 lb. gried fruit 404 b. Eggs (frozen) 35 lb. Fruit. Egg yolk 1,224 lb. Tinned 12,388 tins Fruit juice 28 bottles Raw 227 lb. 49 tins Fruit salad 802 jars Bread, flour, cereals, etc 117 lb. Grapefruit juice 1 tin Preserves 1,060 lb. Gravy powder 10 lb. Cheese 78 lb. Ham (tinned) 829 lb. Butter and fats ½ lb. Horseradish cream 24 tins Eggs 144 Jam 4 lb. Tinned milk 2,912 tins Lemon barley crystals 143 tins Soups 233 tins Lemon squash 7 bottles 31 Miscellaneous (continued). Salad cream 2 bottles Salt (celery) 402 jars Milk (full cream condensed) 2 tins Sauce 1 bottle Milk (full cream condensed un- Sausages 86 lb. sweetened) 6 tins Shrimps 19 gals. Milk powder 336 lb. Steak pudding 33 lb. Mustard ¼ lb. Steak pudding 22 tins Peach pulp 1 gall. Strained food (babies) 7½ lb. Pickled onions 2 jars Suet 1 lb. Porcine liver 38 lb. Sweets 73 lb. Pudding mixture 1 packet Synthetic cream 1½ lb. Pulp-tomato 305 tons, 15 cwt., 11 lbs. Synthetic cream 7 cartons Rabbit 122 lb. Vinegar ½ pint Method of Disposal of Food Unfit for Human Consumption With the exception of the tomato pulp, all food was dealt with as trade refuse by the Borough Engineer's Department and deposited on the controlled refuse tip. Part of the tomato pulp was used for pig food and the remainder was buried on the land of the owners. Clean Food (Sampling) The Middlesex County Council continues to take samples and supervise the control of food adulteration. The Chief Officer of the Public Control Department has kindly supplied the following information. Samples Taken Article. No. of samples Unsatisfactory Milk (various) 243 3 Almonds, ground 2 — Blackcurrent juice 1 1 Breakfast cereals 4 — Butter 1 — Cakes 17 — Cake mixture 1 — Chops 1 — Chicken cutlet 1 — Coffee 2 — Condensed milk 6 — Cooked meats 58 — Cream 18 — Curry powder 1 — Dried milk 1 — Dripping 1 — Drugs 18 — Fish 11 1 Fish paste 3 — Fruit squash 3 — Ice cream 19 — Jams 2 — Jelly 1 — Cheese and macaroni 1 1 Meat pies 13 — Minced meat 16 — Mincemeat 1 — Mustard 1 1 Non-brewed condiment 1 — Salad cream 1 — Salt 1 — Sausages and sausage meat 107 1 Sliced peaches 1 1 Shrimps 2 — Soups (tinned) 2 — Spirits (various) 39 — Stewing meat 4 — Suet 1 — Sweets (various) 9 — Synthetic cream powder 1 1 Tomato puree 1 — Tripe 1 — Victoria plums (tinned) 1 — Vinegar 61 11 Yogurt 1 — Total 681 21 32 Fourteen retailers were concerned in the 21 samples found to be unsatisfactory. Four were prosecuted, 6 were officially cautioned, no action was taken against 2, and action in the remaining case was still pending at the end of the year. A fish monger who sold smoked cod as smoked haddock was prosecuted and fined £2 and £2 2s. Od. costs. Eleven unsatisfactory samples of vinegar were all of non-brewed condiment; 5 retailers were involved, 3 were prosecuted with fines and costs of £1 and £3 17s. 6d.; £2 and £3 3s. Od.; and £2 and £2 2s. Od., one official caution was issued, and in the fifth case the seller died very shortly after the sample was obtained and no action was taken. The unsatisfactory sample of blackcurrant juice was sold by a well-known firm; after representations were made to the firm, the labelling of the bottles and the wording of advertisements in the national press were amended drastically to conform with the law. Official cautions were issued to a seller of mustard containing a prohibited preservative, to one selling sausages containing a permitted but undeclared preservative, to a firm selling sliced peaches in syrup with a declaration that vitamin C had been added but not the quantity, as required by the Labelling of Food Order, and to a firm selling synthetic cream powder because they used a misleading label and advertisement contrary to the Defence (Sale of Food) Regulations, stating that cream and not imitation cream could be made from the powder. Of the 3 unsatisfactory milk samples, 2 were sold by one restaurant and contained added water; an official caution was sent to the seller. The third sample had a slight deficiency in solids-—not-fat but it did not contain added water and was probably poor milk originally; no further action was taken. The unsatisfactory sample of cheese and macaroni was obtained at the end of the year, and action is still being considered. Milk and Dairies Milk sales are regulated by the Food and Drugs Acts, 1938 to 1950, and the Milk and Dairies Regulations, 1949, made under Sections 20 and 92 of the Food and Drugs Act, 1938. As Willesden is a specified area, all milk sold by retail has been sterilised, pasteurised, tuberculin tested or accredited; the sale of raw milk has been prohibited since October, 1951. Dairies—Registration and Licences Premises in Willesden 115 Dairymen 93 Licences issued. Pasteurised milk 89 Sterilised milk 108 Tuberculin tested milk 78 Premises outside Willesden 11 Dairymen 5 Licences issued. Pasteurised milk 11 Sterilised milk 11 Tuberculin tested milk 11 Frequent inspections are made of the dairies. During the year one dairy was found to have a broken manhole cover and another a choked gully; these defects were quickly remedied. Milk sold in the Borough is clean and pure. 167 samples were taken in 1953; all were satisfactory. FACTORIES The total number of factories in the Borough showed an increase of 10 over the previous year; there was an increase in non-power factories from 74 to 79 and an increase of power factories from 810 to 825, making a total of 904 factories. Type of factory On register 1.1.53 Added to register Deleted from register Totals at 31.12.53 Non-power 74 15 10 79 Power 810 44 29 825 Total 884 59 39 904 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. 33 The table shows the number of factories inspected, the defects found and the action taken. Type of factory Inspected Total Inspections Unsatisfactory Outstanding from 1952 Made satisfactory 1953 Outstanding 31.12.53 Non-power 71 95 11 2 12 1 Power 602 697 53 9 57 5 Defects in Non-Power Factories : During 1953 Outstanding from 1952 Remedied during 1953 Outstanding at 31.12.53 Want of cleanliness 4 - 4 - Overcrowding — — — — Unreasonable temperature — — — — Inadequate ventilation 3 — 2 1 Defective drainage of floors — — — — Sanitary accommodation: Insufficient 1 — 1 — Unsuitable or defective 7 2 9 — Not separate for sexes — — — — Defects of Sanitary Accommodation in Power Factories : Insufficient 1 — 1 — Unsuitable or defective 53 9 57 5 Not separate for sexes — - — — 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, but one of these has not been used since March and, should it not be used for baking purposes for over twelve months, will then become closed for the use of a bakehouse or work incidental thereto. 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. 245 outworkers' premises were inspected in 1953. Conclusions 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 power 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 bv dealing with cleanliness, overcrowding, temperature, ventilation and drainage of floors in power factories as well as in non-power 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 l actones 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 have now introduced an industrial medical service for their employees to cover environmental hygiene, first aid, and rehabilitation. NOISE NUISANCE As outlined in the 1950 annual report, the Borough Council deals with noise nuisances under Section 313 of the Middlesex County Council Act, 1944. Seventeen complaints were made, but only 10 could be considered as statutory nuisances. The owners co-operated in stopping or reducing the noise satisfactorily in 7 cases; 3 were still outstanding at the end of the year. 1 he following is a summary of the action taken in the 7 cases:— Noise from compressor used in melting aluminum. The owners called in a noise consultant and the compressors were soundproofed. (b) Noise from machinery was remedied by replacing worn bearings. 34 (c) Noise from stamping machines. The manufacturers of the machines were consulted by the firm and certain parts were replaced. (d) Noise from panel-beating, especially at night and weekends, was a temporary nuisance due to the execution of an urgent order. After consultation the night work and weekend work were given up. (e) Noise from electric motors and dynamos, boiler, air compressor, and buffing and polishing machines, The silencing of the boiler and air compressor was carried out, and the owners called in a noise consultant, who reported that all reasonable precautions were being taken to prevent noise. (f) Noise from heavy machinery and compressors used in building operations, especially at weekends, After consultation weekend work was given up and in a short time other building was completed. (g) Noise from circular saw and electric motor was remedied by replacing bearings and remounting the saw on a solid structure. The 3 outstanding cases were as follows :— (a) High-pitched whine and clanging from extractor fans in power station. (b) Noise from plastics-pressing machinery at night. (c) Noise from cutting-in of refrigerator. 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 old person, against his own interests, refuses to go into a hospital or hostel. The National Assistance Act, 1948, permits the removal to an institution of a person in need of care and attention by the Council; an order for removal is made by a court of summary jurisdiction, but seven clear days' notice of an intended application must be given. The National Assistance (Amendment) Act, 1951, permits immediate removal provided the medical officer of health and another registered medical practitioner certify that it is in the interests of the person to remove him without delay; the order in this case can be made either by a court of summary jurisdiction or by a single justice having such jurisdiction. The amending Act modifies the period from three months to three weeks for a person to be detained in the first instance. No action was necessary under the Acts during 1953. 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, adds another intolerable strain on relatives which often finally convinces them that the only place where the old person can receive reasonable care is in an institution. One way, therefore, of postponing this unpopular event, is to help relatives with the washing of the soiled linen of incontinents. It is much more economical 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 and ironed at the Neasden Hospital by arrangement with the Central Middlesex Hospital Management Committee at a cost of 4Jd, per lb., and transport is provided by the Borough Council. Twelve cases were brought forward from 1952, and another 23 were dealt with during the year. Eleven cases died, 8 were admitted to hospital, and 2 left the district; 14 cases were using the service on the 31st December, 1953. Voluntary Services for the Aged The care of the aged is an excellent example of how work of voluntary organisation supplements that of 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 Willesden Old Folks Association has grown from strength to strength, and it celebrated its first anniversary on the 28th February, 1953, at the Anson Hall, Cricklewood, when 300 members attended. 165 members and helpers went on a summer outing to Clacton on the 7th September, 1953. 35 Voluntary workers made regular visits at weekly or fortnightly intervals to 40 old people; there is however, a shortage of visitors. At Christmas the visitors delivered a gift from the Association of 5s. or Christmas fare to these old people. Arrangements were made with Messrs. J. Lyons & Son to deliver Frood Christmas dinners on Christmas Eve to 10 bed-ridden old people who paid 5s. each. Five well-attended Christmas parties (about 150 old people in each) were organised, and were thoroughly enjoyed. A high tea and entertainment were provided and they were all given a 2s. gift. There has been an extension in the free chiropody service for old people, and the Association now have arrangements with two local chiropodists, one in the Kilburn area and the other in the Harlesden area, to treat 8 old people free of charge weekly. The chiropodist in Kilburn also visits 4 old people who are confined to their homes. On the recommendation of the welfare officer free coal was supplied to old people who could not afford to buy it. The Willesden Division of the British Red Cross and many churches in the area also run clubs for the old folk and their members visit them in their homes. Probably the most important service for old people is the meals service organised by the Women's Voluntary Services. The Old Folks Morning and Luncheon Club, opened at the Presbyterian Hall, Granville Road, Kilburn, on the 31st January, 1952, provides old people with hot meals. The cost of a lunch is 1/-, and l^d. for a cup of coffee or tea. 13,605 meals were served during the year, as compared with 15,759 during 1952. The meals-on-wheels service organised from the same premises, served 4,720 meals during the year to old people in their homes, as compared with 2,628 during 1952. This is a considerable increase, but only two meals a week are supplied to each person. The aim is to give a hot meal to old people five days a week in all parts of the Borough. Through the Morning and Luncheon Club and the meals service, the W.V.S. get to know the old people who require more help, and they visit approximately 20 homes per week, providing clothes and other necessities. BURIAL OF DESTITUTE DEAD In accordance with the provisions of Section 50 of the National Assistance Act, 1948, arrangements were made for the burial of 14 persons during the year. The total cost to the Council was £155 13s. 0d., of which £58 16s. 4d. was recovered by the Borough Treasurer. The cases came to the notice of the department from the following sources:— St. Andrew's Hospital 3 Friends or relatives of deceased 10 Coroner's Officer 1 PUBLIC MORTUARY In accordance with Section 198 of the Public Health Act, 1936, 475 bodies were dealt with at the mortuary as follows :— Post-mortems and inquests 69 Adjourned inquests 28 Total post-mortems 475 LICENSING OF HAWKERS Hawkers of food and premises used by them for storage accommodation must be registered by the Council (Section 11 of the Middlesex County Council Act, 1950). Two hawkers were registered during 1953, making a total of 21. Fruit and vegetables 19 Fish 1 Miscellaneous 1 Total 21 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 157 of the Food and Drugs Act, 1938, but no slaughtering was carried out during 1953. 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. 36 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 Os. Od. 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 Os. Od. is chargeable. Seven premises were registered at 1st January, 1953, and 3 further registrations were approved during the year. Three premises were removed from the register as they ceased to be used under the Act; 2 of these were registered prior to 1st January, 1953. At the 31st December, therefore, there were still seven premises 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. Three samples of materials used were submitted to the analyst and they proved to be up to standard. PET ANIMALS ACT, 1951 Pet shops must now have an annual licence on payment of a fee not exceeding 10/-. During 1953, 14 were licensed, and they were inspected by both sanitary inspectors and Shops Act inspectors. Sanitary Inspectors inspect premises for adequacy of size, temperature, lighting, ventilation and cleanliness, and of precautions for preventing spread of infectious disease. STAFF MEDICAL EXAMINATIONS Forty-one staff medical examinations were carried out by the Medical Officer of Health in 1953. ACCIDENTS IN THE HOME For some years now, lectures have been devoted to this problem in programmes for health education in Willesden, but in order to extend this useful work it was felt desirable to examine the problem in detail. A six-months' investigation was therefore planned, and agreement was reached at the Health Services Liaison Committee (Central Middlesex Group) for the methods to be used by general practitioners, hospital and local authority staffs. All general practitioners and the two local hospitals were asked to notify to the Health Department any home accident that came to their notice, irrespective of its severity. Health visitors then visited every case and completed a special inquiry form. The response of the general practitioners to the appeal was fairly good—71 out of 118 agreed to notify home accidents; but in practice only 19 actually complied with the request; one notified 22 and the other 18 between 1 and 4 each. Of the two local hospitals, one a quarter the size of the other, the larger notified 46 cases and the smaller 212. 344 accidents were notified, but as 9 were not home accidents and a report could not be obtained in 51, the inquiry is based on 284 completed forms (see table I). The age groups most seriously affected are children under 5 years (about 1 in 3 of all accidents) and older people over 56 years (about 1 in 4), (see table II). Boys had more accidents than girls, probably because they are usually more adventurous; women had more accidents than men in the age groups 31—-55 because as housewives they are exposed to risks of home accidents over longer periods of the day; more women than men over 56 years of age had accidents, partly because of the higher proportion of women in these age groups (see table III). Falls accounted for the largest number of accidents, almost half the total, and affected particularly the under 5 group and those over 55. Burns and scalds came next, accounting for almost a quarter, with the largest number in the under 5 group (see table IV). The most common causes for falls for the group over the age of 15 were unexpected obstacles on the floor, and badly worn carpets and lino; with younger children there were more falls from chairs and tables. Burns and scalds in children under 5 were usually due to carelessness of adults. The main causes generally were falling into a fire (5), electric iron (4), hot poker (3), and "upset hot water" in scalds in the 0—5 group. The causes of all other accidents are clearly preventable and show an interesting change with increasing age. Swallowing of foreign bodies ceases to be a factor after the age of 10, and in the later age-groups a new factor arises in carelessness or mis-use of domestic instruments and tools, such as knives, choppers, tin-openers, sewing machines ("stitched finger" !), razors, shears, scissors, mangles and broken sashcords. Fractures resulted in a large proportion of the injuries (28 out of 141) from falls, and four deaths in old people demonstrate their seriousness. It was difficult to assess the severity of the injury by the duration of the treatment. Treatment lasted approximately from one day to eight weeks, with an average time per accident of 5—■6 days (see table IV). There were nine fatal accidents in the home in this period in the Borough, all in people over 60 years of age, as compared with only six fatal road accidents. From this investigation it would appear that the annual home accident rate in Willesden is at least 29 per 1,000 with 1 -74 per cent, fatality, and an average of 5-3 days treatment per case. As a result of this survey, an estimate can be made of the annual number of home accidents in Willesden; namely over 5,000, with 18 deaths and a loss of time on treatment of working days and school days of nearly 30,000. That this is probably an under-estimate is shown by the actual number of fatal accidents (other than road) caused in the previous years, reaching almost 50. In 1952 they totalled four times as many as road accidents. Clearly, there is much room for improvement in educating the population for the prevention of home accidents, and useful material has been gained from this survey to direct publicity and attention to preventable causes. 37 Table I Sources of Home Accident Notifications, Willesden Hospital I 212 Hospital II 46 General practitioners 64 Health clinics 17 Day nurseries 5 Total 344 Table II Home Accidents by Age-Groups, Willesden #]Age 0-5 6-10 11-15 16-20 21-30 31-55 56-70 71- Total all ages No. 86 (30-6) 21 (7-1) 13 (3-9) 4 (1-4) 22 (7-8) 66 (23-4) 38 (135) 34 (12-3) 284 (Percentages in brackets) Table III Home Accidents by Age-Groups and Sex, Willesden Age 0-5 6-10 11-15 16-20 21-30 31-55 56-70 71- Total all ages Male 52 (60.5) 9 (45.0) 6 (45.5) 1 (25.0) 9 (41.6) 14 (21.3) 8 (21.0) 7 (20.5) 106 (37.4) Female 34 (39.5) 12 (55.0) 7 (54.5) 3 (75.0) 13 (59.0) 52 (78.7) 30 (79.0) 27 (79.5) 178 (62.6) (Percentages in brackets) Table IV Burns and Scalds and Falls as Causes of Home Accidents, Willesden Ages 0-5 6-10 11-15 16-20 21-30 31-55 56-70 70- Total all ages Burns and scalds 30 (37) 5 (25) 2 (17) 2 (50) 7 (36) 11 (15) 3 (10) 3 (9) 63 (23.3) Falls 40 (46) 9 (40) 4 (25) 0 (-) 5 (23) 30 (45) 29 (75) 24 (80) 141 (51.0) Others 16 (17) 7 (35) 7 (59) 2 (50) 10 (41) 25 (40) 6 (15) 7 (11) 80 (25.7) (Percentages in brackets) 38 Table V Duration of Treatment for Accidental Injuries Ages 0-5 6-10 11-15 16-20 21-30 31-55 56-70 70- Total all ages Average time in days 4.4 4.8 3.3 6.0 5.4 6.0 5.9 5.9 5.3 39 HEALTH SERVICES OF OTHER AUTHORITIES IN THE AREA The hospital facilities provided by the North-West Metropolitan Regional Hospital Board, and the maternity and child welfare and school health services provided by the Middlesex County Council, remain substantially the same; they are described in the 1948 report. 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. The extension to the Willesden Chest Clinic was completed in March, 1953. On the 26th May, 1953, Mr. Orbach, Member of Parliament for East Willesden, and Chairman of the Central Middlesex Hospital Management Committee, opened1 St. Monica's Hospital, Brondesbury Park. The building was a children's hospital until the outbreak of war, and had been derelict' for fourteen years. Reconstruction was carried out and it has accommodation for 35 elderly women patients who need long-term treatment. The remainder of the report provides detailed information on the personal health services in the area since the operation of the National Health Service Act, 1946. CARE OF MOTHERS AND YOUNG CHILDREN (Section 22) National Health Service Act, 1946 Care of the Expectant Mother. During 1953, 1,850 expectant mothers attended at the local ante-natal clinics, staffed by the Assistant Medical Officers. This represents 68-8 per cent, of the total notified births. Expectant mothers require adequate ante-natal care throughout pregnancy and therefore close liaison exists between General Practitioners, staffs of hospitals, Assistant Medical Officers, Midwives and Health Visitors, and with the mothers themselves. Co-operation. The Health Visitors make arrangements at the local clinics for mothers for domiciliary confinements or for hospital bookings. They also inform mothers of the provisions made for them by the authorities. Temporary day nursery accommodation can be provided in certain cases. Blood Tests. Assistant Medical Officers take specimens of blood from mothers attending Paddington Hospital or those having home confinement for Wasserman reaction, blood grouping and determination of Rhesus factor. Chest X-Ray and Dental Care. All expectant mothers are invited to attend hospital for a chest X-ray, and there is a special dental service for them at the clinics. Mothercraft and Relaxation Classes. Mothercraft classes are held on one afternoon a week and conducted by the Health Visitors at main clinics. The Assistant Medical Officers, Health Visitors and Midwives give health talks, followed by discussion over a cup of tea. In addition, at one clinic instruction in knitting, cutting-out, and sewing, is given by the Health Visitor in charge of the mothercraft class, and at another clinic a fathercraft class is held once a term. A Mothers' Club is also held at one of the clinics on one afternoon a week. The mothers form their own committee and run the club themselves with guidance given by a Health Visitor. They arrange interesting programmes of lectures given by outside speakers, including: "Family Welfare", "Home Safety" and "Simple Dressmaking". Ante-natal relaxation classes are held on two afternoons a week by the Physiotherapist at the Orthopaedic Department at Stonebridge Health Clinic. These are well attended. For mothers who do not attend the relaxation classes, leaflets describing simple exercises are available at the clinics. Post-Natal Care. Mothers are encouraged to attend for a post-natal examination six weeks after confinement, and where this has not already been arranged by the hospital or General Practitioner, an appointment is given by a Health Visitor or a Midwife for the mother to attend at the clinic. Births Year 1953 1952 1951 1950 Total births (live and still) 2,699 2,646 2,390 2,664 Institutional births 2,228 2,256 1,998 2,136 Percentage of total 82.5 85-2 83.6 80.2 Domiciliary births 471 390 392 528 Percentage of total 17.5 14.8 16.4 19.8 40 Ante-Natal Clinics Clinic No of sessions No. of new cases Total attendances Average attendance per session A.N. P.N. A.N. P.N. Kilburn 151 492 65 2,088 65 14.3 Willesden 152 447 50 2,426 52 16.3 Stonebridge 183 584 51 2,889 50 16.0 Cricklewood 50 173 80 801 99 18.0 Neasden 52 154 56 980 56 19.9 Totals 1953 588 1,850 302 9,184 322 16.2 1952 622 1,708 377 9,073 398 15.2 1951 607 1,704 307 8,633 310 14.7 1950 608 1,661 355 8,895 356 15.2 1949 650 1,595 474 12,322 669 20.0 Infant Welfare Clinics Infant Welfare Sessions are held on five afternoons a week at the three main clinics, and on two afternoons a week at -the two Church Hall Clinics. Assistant Medical Officers and Health Visitors give advice to mothers on the feeding, hygiene and general management of infants and young children. Where medical treatment is indicated, the General Practitioner is informed by the Assistant Medical Officer. Immunisation against diphtheria and whooping cough is carried out by the Assistant Medical Officers at the clinics before the child is a year old; and a birthday greeting card is sent to every child on the first and second birthday, inviting mothers to bring their children to the clinic for a routine yearly examination and a tuberculin patch test. It was anticipated that when the National Health Service Act, 1946 came into force on 5th July, 1948 there would be a decline in the attendances at Maternity and Child Welfare Clinics, but this has not been the experience in this district. Of the total births notified the Percentage of Infants under One Year of Age who attended foe the first time during the year was : 1947 66% 1950 81% 1951 80.7% 1952 74.7% 1953 90.3% Infant Welfare Clinics Clinic No. of Sessions No. of 1st attendances under one year old No. of Attendances Total Attendances Seen by Doctor Average attendance per session Under 1 1—2 2—5 Kilburn 303 689 6,711 1,047 818 8,576 4,821 28.3 Willesden 408 631 7,543 1,203 822 9,568 5,884 23.4 Stonebridge 341 612 6,946 817 1,143 8,906 4,859 26.1 Cricklewood 101 258 3,461 674 414 4,549 1,667 45.0 Neasden 101 247 4,292 774 443 5,509 1,681 54.5 Totals 1953 1,254 2,437 28,953 4,515 3,640 37,108 18,912 29.6 1952 1,413 1,979 26,452 7,061 33,513 19,249 23.7 1951 1,532 1,930 25,768 7,484 33,252 18,377 21.7 1950 1,607 2,160 27,228 7,691 34,919 22,303 21.7 1949 1,626 2,120 29,666 8,915 38,581 22,906 23.7 MIDWIFERY SERVICE (SECTION 23) At the beginning of 1953 there were six Midwives employed direct by the County Council, and two Midwives acting as Maternity Nurses employed by the Willesden District Nursing Association. During the year two Midwives and one Maternity Nurse left, two Midwives commenced (one of whom has since left) and the number employed at the end of the year was five Midwives and one Maternity Nurse. In addition, four or five pupil Midwives work in Willesden for three months each, as part of their second period training for the Central Midwives Board Examination. They are attached to Midwives who are approved District Midwife Teachers. In 1953 Midwives attended 435 confinements, 357 as Midwives and 78 as Maternity Nurses; they administered Gas and Air Analgesia in 77-9 per cent, of the 435 mothers; 33-3 per cent, of all mothers had pethidine, some of whom had Gas and Air Analgesia as well. They sought medical aid in 94 cases. They also paid 260 visits to 43 midwifery cases who were discharged from hospital before the 14th day of puerperium. 41 Co-operation with General Practitioners The Midwives work very closely with the General Practitioners, 181 mothers booked both a General Practitioner and a County Council Midwife for their confinements and the General Practitioner was present at 25 of them. Supervision of Midwives The Non-Medical Supervisor of Midwives inspects Midwives Registers, equipment and drug books at regular intervals, and supervises the general work of the Midwives. Meetings of the Midwives in the district are held for discussing their work. The Midwives also meet Health Visitors at the Clinics to discuss cases and Health Visitors receive written reports from the Midwives on each completed midwifery case. Midwives Clinics—1953 No. of Sessions held No. of New Cases Total Attendances Average Attendance per session 319 569 3,787 11.9 Other Mothers' Clinics (a) Mothercraft Clinic No. of Sessions No. of New Cases Total Attendances Average attendance per session Kilburn 33 43 271 8.2 Willesden 40 105 673 16.8 Stonebridge 56 128 889 15.9 Totals 1953 129 276 1,833 14.2 1952 85 190 1,218 14.3 1951 124 181 764 6.2 1950 48 77 529 11.0 1949 46 72 549 12.0 Other Mothers' Clinics (b) Relaxation Clinic No. of Sessions No. of New Cases Total Attendances Average attendance per session Stonebridge, 1953 95 215 1,421 150 Totals 1952 48 101 674 14.0 Deliveries Attended by Midwives Midwives employed by: Number of domiciliary deliveries attended and visits made by midwives in the area Institutional confinements discharged before 14th day attended by domiciliary midwives Domiciliary cases where infant wholly breast fed at 14 th day Dr. not booked Dr. Booked No. of visits made Dr. present at delivery Dr. not present at delivery Dr. present at delivery Dr. not present at delivery No. of cases No. of visits County Council 4 184 25 156 12,292 34 163 311 Voluntary organisations under arrangements with L.H.A. in pursuance of section 23 - 13 53 - 1,584 9 97 64 TOTALS: 1953 435 13,876 43 260 1952 385 12,830 18 180 375 Not recorded 1951 401 Not recorded Not Recorded 1950 534 Not recorded Not Recorded 42 Medical Aid 1953 1952 1951 1950 (a) No. of Domiciliary Cases in which Medical Aid was summoned:— (i) Where the Medical Practitioner had arranged to provide the patient with maternity medical services under the National Health Service 55 56 48 106 (ii) Others 39 54 66 42 (b) For cases in Institutions — — — — Totals 94 110 114 148 Administration of Gas and Air Analgesia by Domiciliary Midwives Domiciliary Midwives employed directly by local health authority Domiciliary Midwives employed under Sec. 23 by voluntary organisations as agents of local health authority Total Number of cases in which gas and air was administered by midwives in domiciliary practice during the year:— (a) When doctor was not present at delivery 300 — 300 (b) When doctor was present at delivery 28 11 39 Number of cases in which pethidine was administered in domiciliary practice during the year:— (a) When doctor was not present at delivery 121 — 121 (b) When doctor was present at delivery 13 11 24 Totals: 1953 462 22 484 1952 320 42 362 1951 263 14 291† 1950 254 26 330† 1949 386 — 386 †Figure for 1951 includes 14 cases dealt with by Queen Charlotte's Midwives „ „ 1950 „ 50 „ „ „ „ „ „ „ HEALTH VISITING (Section 24) Under the National Health Service Act, 1946, it is the duty of every local health authority to make provision in their area for the visiting of persons in their homes by health visitors to give advice on the care of young children, expectant or nursing mothers and persons suffering from illness. The health visitors are now concerned with the health of the whole family and work together with general practitioners, staffs of hospitals, children's officers, welfare officers, sanitary inspectors and other social workers. They also attend at Maternity and Child Welfare clinics and at schools for routine Hygiene inspections, and medical inspections with the Assistant Medical Officers. They give health talks in schools and assist in carrying out enquiries in connection with special national surveys organised by the Medical Research Council, Ministry of Health and other bodies. The health visitors work from the three main clinics and prior to the 1946 Act, Willesden was divided into 22 districts, one for each health visitor. It is now desirable that the number of districts be increased because the duties of health visitors have been widened under the Act. This however, is impossible at the present time owing to the general shortage of health visitors. The establishment of health visitors for the Willesden part of the area is 30 but at the end of the year there were only 13.1/11 health visitors working in Willesden. To assist the health visitors in their work temporary clinic nurses are employed; their duties are mainly, assisting at the various clinic sessions, attendance at the schools for routine hygiene inspections and medical inspections. At the end of the year 9-8/11 temporary clinic nurses were employed in Willesden, making the total number of health visitors and clinic nurses 22.9/11. Health Visiting Year Expectant Mothers Children under 1 Children 1—2 Children 2—5 General Ineffectual Visits 1st Visits Total Visits 1st Visits Total Visits Total Visits Total Visits Total Visits as Health Visitor Total Visits as School Nurse 4,014 6,297 1953 1,007 1,499 2,908 9,336 10,311 1,737 857 3,230 1952 1,149 1,925 2,434 9,694 11,436 3,568 1,163 Not Recorded 1951 1,143 1,996 2,620 10,413 13,033 3,498 1,722 — 1950 1,090 2,022 3,071 9,381 12,557 3,655 3,888 — 1949 2,144 3,687 3,264 11,675 16,734 4,186 6,151 - 43 44 HOME NURSING (Section 25) During 1953 this Service was administered by the Willesden District: Nursing Association on an agency basis. The demand on the Home Nursing Service continues to increase; in 1953 there were 5,046 new cases with 121,192 home nursing visits. Home Nursing No. of New Cases Total No of home visits paid No. of cases on register at end of year Male Female Male Female Medical 1,573 2,371 96,594 171 397 Surgical 322 377 15,584 25 46 Infectious Diseases 32 48 436 — — Tuberculosis 112 75 6,961 4 8 Maternal Complications — 113 1,083 — — Others — 23 534 — — Total 2,039 3,007 200 451 Totals 1953 5,046 121,192 651 1952 4,401 105,964 612 1951 3,763 103,551 519 1950 3,250 92,912 500 1949 2,872 83,762 407 DIPHTHERIA IMMUNISATION During the year the Ministry of Health, in consultation with the Society of Medical Officers of Health, decided to introduce a new form of Annual Return for Diptheria Immunisation. Individual immunity tends to wane, and to assess how far a local population has been protected, account must be taken of the proportion of children of each age who have received at some time a course of injections, as well as the ages at which the courses were received. The new form provides more information on the number of children injected and when this was performed. Number of children aged under 15 at 31.12.53 who had completed a course of Diphtheria Immunisation. Age at 31.12.53 Under 1 1 2 3 4 5-9 10-14 Totals Course of injections (whether primary or boosting) completed during last 5 years 1949-53 86 1,106 1,332 1,555 1,628 6,985 4,446 17,138 Course of injections (whether primary or boosting) completed during the period 1939-48 — — — — — 5,082 5,382 10,464 Approximate number of children (end of 1953) 0— 5 12,186 5—15 24,105 36,291 SMALLPOX VACCINATION The following table shows the number of persons vaccinated or re-vaccinated during 1953. Under 1 year 1 year 2-4 years 5-14 years 15 years and over Total No. of persons primarily vaccinated 888 80 36 31 114 1,149 No. of persons re-vaccinated 3 3 19 43 311 379 Totals 1953 891 83 55 74 425 1,528 1952 900 84 72 92 681 1,829 1951 899 154 121 224 901 2,299 Approximate number of children (end of 1953) 0— 5 12,186 5—15 24,105 36,291 45 HOME HELP SERVICE 87 Home Helps (5 whole-time and 82 part-time), giving a total whole-time equivalent of 56.5, are at present assisting 557 persons, including 417 aged and 51 who are suffering from tuberculosis. A full-time Male Home Help is employed to assist old men living alone. At the beginning of the year, there were 76 persons employed (6 whole-time and 70 part-time). New cases are visited by the Organiser, to assess their needs, and they are revisited at intervals by the Organiser or Assistant Organisers, to supervise the work of the Home Helps. Midwives are asked to report on the work of Home Helps in maternity cases. Close co-operation exists between the Organiser, the W.V.S., the Superintendent Health Visitor, and the Area Welfare Officer; the Organiser attends meetings of the Old Peoples' Liaison Committee and the Tuberculosis Liaison Committee. Recruitment is very much easier than it was some years ago, the majority of staff being obtained through personal recommendations. 50 per cent. of the Willesden Home Helps are willing to help T.B. cases. The following tables show the number of cases provided with help during the year with comparative figures for previous years and details of the staff position:— Cases provided with help New Cases Old Cases Total Cases Maternity (including expectant mothers) 96 2 98 Tuberculous 26 49 75 Chronic Sick (including aged and infirm) 363 361 724 Others 115 49 164 Totals 1953 600 461 1,061 1952 543 418 961 1951 581 376 957 1950 650 188 838 1949 841 200 1,041 DAY NURSERIES On 5th July, 1948, the Middlesex County Council became responsible for the administration of the 96 day nurseries in the County; 10 were in Willesden, but one, College Road Day Nursery, was closed in December, 1950. The charge was 1/- per day for the meals and equipment used, and on 1st April, 1950 this was increased to 2/- per day, with remission in cases of hardship. In January, 1950, a scheme of priorities was introduced as follows:— 1. Mothers who were employed in industry vital to production for essential home needs or export. 2. Illness or confinement. 3. Unsupported mothers. Amendments were made in October, 1950; children under 2 years could not be admitted unless:— 1. Mothers were unsupported. 2. Home conditions were unsatisfactory from a health point of view. 3. Mother were incapable of undertaking the full care of their children. Other children could be admitted if accommodation was available, and the joint income did not exceed £6 per week. On the 1st December, 1952, the County Council, with the approval of the Ministry of Health, introduced a scale of charges with a maximum of 9/- per day, the estimated cost. A considerable fall in attendances resulted, and practically everyone appealed against the assessments On the 1st November, 1953, the County Council introduced a revised scale of charges. Most of the day nurseries are now being used to full capacity. Home Help Staff Whole-time Part-time Total Position at 1.1.53 6 70 76 Appointments during 1953 — 65 65 Resignations during 1953 1 53 54 Position at 31.12.53 5 82 87 46 Day Nurseries Day Nursery No. of approved places No. of children on register at 31.12.53 Attendances for the year Average daily attendances 0-2 years 2-5 years 0-2 years 2-5 years 0-2 years 2-5 years 0-2 years 2-5 years Chichester Road 18 32 21 34 4,109 6,351 16 25 Crest Road 25 25 27 25 5,038 6,204 19 24 Essex Road 25 25 23 28 4,861 5,738 19 23 Evefield 25 25 15 16 3,010 4,370 12 17 Gladstone Park 25 25 22 21 4,877 5,280 19 21 Longstone Avenue 25 25 32 30 4,391 5,294 17 21 Mortimer Road 25 25 24 22 4,568 4,634 18 18 Villiers Road 25 25 24 21 4,563 5,368 18 21 Wesley Road 15 25 14 28 2,526 3,933 10 15 Totals 1953 208 232 202 225 37,943 47,172 148 185 1952 208 232 193 247 42,843 58,257 167 227 1951 208 232 215 280 36,971 55,020 146 217 1950 233 257 219 297 41,830 61,314 164 241 1949 233 257 Not available 39,898 61,830 158 244 RECUPERATIVE HOLIDAY HOMES During the year the following recommendations were forwarded to the County Health Department for placing in suitable recuperative holiday homes:— Adults 293 Children 19 Total 312 SCHOOL HEALTH SERVICE Routine Medical Inspections. The 7—8 year age-group is examined in addition to the age groups required by the Ministry of Education—entrants, final-year pupils at primary schools, and leavers The inclusion of the 7—8 year agegroup since the middle of 1951 has ensured that attention is paid to pupils when they most need it— between the ages of 5 and 10. The number of medical inspections increased for 1953, particularly for the 7—8 year age-group, largely because they were the children born during the peak year for births following the end of the war. Orthopcedic Department. A visiting Orthopaedic Surgeon attends Stonebridge Clinic once every two weeks to examine and treat children, and he also visits Lower Place School periodically to give attention to the physically handicapped children attending there. There is one whole-time physiotherapist employed who works under the direction of the Orthopaedic Surgeon. Swimming. In the summer of 1949, the Amenities Committee of the Borough gave permission for the exclusive use of the swimming baths one hour each week for handicapped children from Lower Place School. The water (fresh) is heated to a temperature of 80°F. The children, selected by the Orthopaedic Surgeon and passed by the Senior Assistant School Medical Officer, are taken to the baths and given swimming exercises by three instructors, supervised by a physiotherapist and a doctor. Because water is denser than air, it is much easier for a child with weakness in a muscle or limb to use it in water. The child gradually gains more control over his weak or paralysed muscles and becomes generally more confident. Since 1949, 62 children have attended, 11 of whom have returned to ordinary school; 2 have left the district; 18 have now left school, and 2 have transferred to training college. At present (in 1953) 27 are attending, of whom 9 had poliomyelitis. Of the others, 4 are spastics, 5 have congenital defects, 5 are amputees, one has a tuberculous limb and 3 are asthma sufferers. No fewer than 20 of the children attending since 1949 have gained swimming certificates for 25 yards, and 7 for 100 yards. The children enjoy it immensely and many have found marked improvement in the use of their limbs and control of muscles, and have received great enjoyment when they have learned to swim. Some of the children who are still unable to walk without calipers and sticks have almost complete freedom of movement in the water. Speech Therctpy. There are two whole-time speech therapists employed, whose duties consist of treating children attending the clinics and Lower Place School for Physically Handicapped Pupils. Owing to the increase in the number of spastics and other children requiring speech training, the waiting list rose from 47 to 167, and on 30th September, 1953, a Medical Officer of the Ministry of Education visited Lower Place School and reported "that the number of children requiring speech therapy is such 47 that the time devoted to this work at present is inadequate, and that the position should be reviewed as soon as possible". Efforts were already being made to arrange for children who attended from other areas of the County to be treated in their own areas, but unfortunately this could not be done owing to transport difficulties and considerable loss of school time. Arrangements are being made for the two speech therapists working part-time in the Wembley part of the area and part-time in areas 7 and 9, to be employed whole-time in area 6, increasing the establishment by the equivalent of one whole-time. Child Guidance. A proposal to establish a Child Guidance Centre in Willesden at premises in South Kilburn was approved during the year. The premises selected for the purposes are being adapted, and it is expected that they will be fully equipped and staffed by about August, 1954. During 1953 an Educational Psychologist was appointed; his work in examining and assessing the intelligence of school children of all ages is proving very valuable. Statistics. Statistics relating to the work of the School Health Service during 1953 are contained in the following tables:— Medical Inspections Periodic Medical Inspections Other Inspections Entrants Second Age Group Third Age Group Others Totals Special Inspections Re-Inspections Totals Totals: 1953 3,008 2,326 2,194 2,486 10,014 13,714 1,603 15,317 1952 3,006 1,872 1,815 1,633 8,326 11,282 1,146 12,428 1951 2,662 1,819 1,707 628 6,816 13,652 592 14,244 1950 3,016 2,048 1,543 — 6,607 10,196 545 10,741 Classification of the General Condition of Pupils Age Groups No of Pupils Inspected A (Good) B (Fair) C (Poor) No. % No. % No. % Entrants 3,008 1,204 40.0 1,739 57.8 65 2.2 Second Age Group 2,326 1,061 45.6 1,224 52.6 41 1.8 Third Age Group 2,194 972 44.3 1,195 54.5 27 1.2 Others 2,486 1,176 47.3 1,290 51.9 20 .8 TOTALS: 1953 10,014 4,413 44.1 5,448 54.4 153 1.5 1952 8,326 2,969 35.7 5,120 61.5 237 2.8 1951 6,816 2,164 31.8 4,450 65.3 202 2.9 1950 6,607 1,929 29.2 4,399 66.6 279 4.2 1949 5,760 1,759 30.5 3,801 66.0 200 3.5 48 Defects Found by Medical Inspection Defect or Disease Periodic Inspections Special Inspections No. of Defects No. of Defects Requiring Treatment Requiring Observation Requiring Treatment Skin 56 80 290 Eyes (a) Vision 476 178 19 (b) Squint 69 80 9 (c) Other 34 46 173 Ears (a) Hearing 16 56 4 (b) Otitis Media 41 73 5 (c) Other 4 16 79 Nose and Throat 457 634 300 Speech 77 73 32 Cervical Glands 77 312 14 Heart and Circulation 8 73 2 Lungs 29 231 161 Developmental (a) Hernia 12 19 — (b) Other 13 116 7 Orthopaedic (a) Posture 48 180 5 (b) Flat Foot 66 139 3 (c) Other 220 218 43 Nervous System (a) Epilepsy 2 11 — (b) Other 2 35 6 Psychological (a) Development 12 73 2 (b) Stability 16 213 18 Other 995 172 3,904 TOTALS: 1953 2,730 3,028 5,076 1952 2,409 3,710 5,810 1951 1,783 2,070 38 1950 2,045 1,517 23 1949 1,620 1,673 17 Pupils Found to Require Treatment Group For Defective Vision (Excluding Squint) For any of the other conditions recorded Total Individual Pupils Entrants 20 465 479 2nd Age Group 137 228 355 3rd Age Group 149 139 280 Other Periodic Inspections 170 350 485 TOTALS: 1953 476 1,182 1,599 1952 339 1,211 1,472 1951 353 888 1,171 1950 315 1,044 1,275 1949 187 984 1,153 49 Minor Ailments 1953 1952 1951 1950 1949 Diseases of skin: Ringworm (i) Scalp — — 1 8 3 (ii) Body — — 1 11 7 Scabies — 4 15 23 40 Impetigo 36 20 33 48 63 Other 519 473 539 224 491 Miscellaneous Minor Ailments 1,782 2,171 3,282 3,438 Nervous 8 — — 1 Digestive 30 51 33 3 Respiratory 503 236 114 638 Skeletal 79 1 2 — Circulatory 99 8 11 264 Infectious Diseases — — — — Pyrexia 1 — 5 — Ductless Glands 6 36 42 14 6,331 Psychogenic 15 38 15 129 Helminthiasia 35 18 38 5 Developmental 17 — — — Excretory 4 — — — Debilitv 212 928 452 — Colds and Rheumatism 233 247 326 16 Minor Injuries 230 674 342 160 Miscellaneous Surgical 12 332 163 — Miscellaneous 1.075 871 976 737 TOTALS 4,896 6,108 6,390 5,719 6,935 Eye Diseases, Defective Vision and Squint No. of Cases dealt with during the year 1953 1952 1951 1950 1949 External and other (excluding Errors of Refraction and Squint) 48 81 121 197 359 Errors of Refraction (including Squint) 1,317 308 292 271 395 No. of Pupils for whom Spectacles were prescribed 598 132 176 240 205 Diseases and Defects of Ear, Nose and Throat No. of Cases dealt with during the year 1953 1952 1951 1950 1949 Received operative treatment for (a) Diseases of the Ear 3 1 — — — (b) Adenoids and Chronic Tonsillitis 341 94 219 218 45 (c) Other Nose and Throat Conditions 6 — — — 18 Received other forms of Treatment 148 — 2 23 4 50 Orthopaedic and Postural Defects No. of Cases dealt with during the year 1953 1952 1951 1950 1949 No. treated as In-Patients in Hospitals 36 40 34 9 — No. treated otherwise, e.g., in Clinics or Out-Patient Departments (a) By the County Council 369 467 300 674 534 (b) Otherwise 507 † † † † †Not recorded. Child Guidance No. of Cases dealt with during the year 1953 1952 1951 1950 1949 18 43 27 5 12 SPEECH THERAPY Clinic or School No. of Cases dealt with during the year Kilburn Clinic 116 Willesden Clinic 45 Stonebridge Clinic 75 Lower Place Special School for Physically Handicapped Pupils 27 Leinster Special School for Educationally Subnormal Pupils 13 TOTALS 1953 276 1952 296 1951 152 1950 101 1949 129 Infestation with Vermin 1953 1952 1951 1950 1949 Total No. of examinations 39,912 38,623 42,875 31,844 30,104 Total No. of pupils found to be infested 1,904 1,210 2,605 1,797 2,729 Total No. of individual pupils found to be infested for the first time during the current year 675 543 689 506 1,005 Number of individual pupils in respect of' whom cleansing notices were issued under Section 54/2, Education Act, 1944 360 286 631 664 1,209 Number of individual pupils in respect of whom cleansing notices were issued under Section 54/3, Education Act, 1944 32 — 18 45 108 51 Employment of Children and Young Persons 1953 1952 1951 1950 1949 No. of children medically examined in order to ascertain whether they were physically fit to undertake employment of a light nature outside school hours 118 137 171 132 53 No. of instances in which the state of health was found to be such that certificates were withheld — 1 1 1 3 No. of children examined as to fitness to take part in entertainments 21 20 34 32 42 No. of cases in which certificates to take part in entertainments were withheld — — 1 — — Medical Examination of Teachers 1953 1952 1951 1950 ] No. of Teachers examined as to Fitness for Appointment 19 3 14 67 103 No. of Students examined as to Fitness for First Appointment 2 — — — — No. of Students examined as to Fitness to undertake Training Course 33 † † † † †Not Recorded. The Educational Sub-Normal Education Act, 1944—- Sections 57(3), 57(4) and 57(5) 1953 1952 1951 1950 1949 Cases dealt with under Section 57, Education Act, 1944:- Sub-Section 3 15 20 15 8 8 Sub-Section 4 1 - - - - Sub-Section 5 13 24 17 25 4 Cases De-notified under Section 8, Education (Miscellaneous Provisions) Act, 1948 — — — 1 2 DENTAL SERVICE There has been a constant improvement in the work of the Priority Dental Service and the School Dental Service over the last 5 years, but there is an urgent need for further expansion. The School Dental Service is responsible for inspecting and treating children who attend the maintained schools within the Borough. Children should be inspected and treated at intervals not exceding one year, and, preferably, every six months. In 1949, owing to shortage of accommodation and difficulty in recruiting Dental Officers, only 33 per cent. of the total school population was inspected and offered treatment, so that children were being inspected only once in three years and their treatment was spasmodic and irregular and so not fully effective. 52 In February, 1952, a restricted scheme was introduced to deal with children who had not reached their ninth birthday, in order to prevent the deterioration of dental conditions which would only lead to more work in the future. In the early formative years the first permanent teeth erupt and the foundation of dental health is laid, and malformation of jaws and irregularity of teeth can be prevented by conserving temporary teeth. Also it is generally more difficult for younger children to obtain treatment outside the service. In 1953, the first complete year in which the restricted scheme was in operation, all the children in the selected age group (approximately 10,000) were inspected in the schools and offered treatment. In addition, direct application for treatment at the clinics was made by 2,251 children, 60 per cent, of whom were from the older age groups. There has been an increase in the number referred for treatment and in the number actually treated. Although 4 out of 5 children are found to require dental treatment, more permanent teeth are being saved. Between 1950 and 1953, the total number of teeth conserved has almost doubled, increasing from 5,732 to 10,647. The scheme is now giving an efficient service for young school children, but it is essential to provide more staff and accommodation to give similar facilities for all age groups. The difficulty in obtaining dental staffs is still acute but the opening of an additional surgery in Monks Park Clinic in 1951 eased the situation in the Stonebridge area, and the new clinic at Brondesbury Villas will help in the Kilburn area. The clinic at High Road, Willesden is still heavily overburdened with work. The Priority Dental Service There have also been improvements in the Dental Service for mothers and young children. It is especially encouraging to note the rise in the attendances of children under five years of age. The treatment carried out for this age group has almost doubled since 1949; fillings have increased from 693 to 1,107. Every opportunity is taken while treating expectant and nursing mothers to explain the value of early and regular treatment for children from the age of two and a half years. Dental Inspections and Treatment (a) Inspection Age Groups No. Inspected No. found to Require Treatment No. referred for treatment at the County Council's Dental Clinics Under 5 (Nursery Schools only) 81 52 50 5—16 and over 9,255 7,651 6,769 Specials 2,221 2,137 2,117 Totals: 1953 11,557 9,840 8,936 1952 9,643 8,465 8,048 1951 7,168 6,531 6,364 1950 6,323 5,944 5,944 1949 6,944 5,725 5,725 (b) Treatment 1953 1952 1951 1950 1949 No. of Pupils actually Treated 4,929 4,052 4,233 3,836 4,002 No. of Attendances made for Treatment 13,879 9,403 10,135 9,224 11,236 No. of Half-days devoted to (a) Inspection 165 117 55 31 49 (b) Treatment 1,896 1,297 1,448 1,235 1,239 No. of Fillings of (a) Permanent Teeth 6,964 4,191 5,422 5,053 4,790 (b) Temporary Teeth 5,540 3,010 1,811 1,555 1,446 No. of Extractions of (a) Permanent Teeth 683 734 960 903 649 (b) Permanent Teeth for Orthodontia 160 132 70 21 † (c) Temporary Teeth 4,787 5,135 5,271 5,315 5,141 No. of Anaesthetics (a) General 2,585 2,376 2,461 2,545 2,459 (b) Local 214 201 338 270 † Other Operations 4,450 2,336 2,561 2,009 2,004 †Not Recorded.  Expectant Mothers Nursing- Mothers 1953 1952 1951 1950 1949 1953 1952 1951 1950 1949 1953 1952 1951 1950 1949 No. Examined 281 294 289 406 377 68 71 73 76 87 790 603 | 725 674 679 No. needing treatment 279 287 279 400 370 67 69 71 76 83 609 572 680 626 628 New Cases commenced Treatment 248 237 202 269 246 85 74 75 71 72 512 600 598 499 463 Cases made Dentally Fit 78 73 96 132 † 53 26 38 42 † 410 414 459 443 † Extractions 420 390 269 476 427 143 126 83 93 134 470 614 729 698 632 Fillings 600 394 320 637 499 182 108 113 140 107 1,107 947 883 877 693 Scalings and Gum Treatment 136 76 84 130 335 43 17 29 41 90 — — — — — Silver Nitrate - - - - - — - - — — 298 318 255 322 223 Dentures 21 15 7 - - 43 28 27 3 — — — — — — Total Attendances 938 699 583 944 1,106 440 288 315 273 267 1,329 1,305 1,232 1,270 1,538 Appointments not kept 180 163 162 223 113 83 52 54 50 29 205 285 243 192 71 †Not Recorded. Return of Handicapped Pupils, Year Ended 31st December, 1953 Category Ascertainment Distribution (as at last day of year) No. of ascertained Cases known 1st day of year No. of New Cases ascertained during year No. of ascertained Cases known last day of year In Special Day Schools In Special Residential Schools In Maintained Primary and Secondary Schools In Independent Schools Not at School Total B G. B G. B G. B G. B G. B G. B G. B G. B G. Blind Pupils 3 2 - - 3 1 — — 3 1 - - — — — — 3 1 Partially-Sighted Pupils 11 9 — — 10 8 7 7 2 — 1 1 — — — — 10 8 Deaf Pupils 7 11 2 — 9 7 — — 7 6 2 1 — — — — 9 7 Partially Deaf Pupils 9 4 2 1 10 5 8 4 — — 2 1 — — — — 10 5 Delicate Pupils Diabetic Pupils 104 50 199 198 80 50 2 — 63 37 15 13 — — — — 80 50 Educ. Sub-normal Pupils 78 69 28 19 92 80 68 52 15 13 9 15 — — — — 92 80 Epileptic Pupils 4 2 — — 3 1 — — 3 1 - - - - - - 3 1 Maladjusted Pupils 36 10 9 — 40 9 1 — 27 7 11 — — 2 1 — 40 9 Physically Handicapped Pupils 54 36 12 15 50 36 44 31 2 2 3 2 - - 1 1 50 36 Pupils with Speech Defects 205 58 84 34 261 82 — — — — 247 79 — — 14 3 261 82 Pupils with Multiple Defects 27 12 3 3 26 15 26 15 - - - - - - - - 26 15 TOTALS 538 263 339 270 584 294 156 109 122 67 290 112 — 2 16 4 584 294 GRAND TOTALS 1953 801 609 878 265 189 402 2 20 878 1952 655 868 801 253 187 341 2 18 801 1951 798 625 655 231 162 254 2 6 655 1950 637 635 798 253 162 372 2 7 798 53 54 COUNTY COUNCIL DAY SPECIAL SCHOOLS County District in which Children reside No. of New Recommendations Received during the Year No. of Children Admitted during the Year No. of Children on Waiting List at 31.12.53 Leinster Special School for Educationally Sub-Normal Pupils Willesden 30 31 19 Ealing 4 2 19 Totals 34 33 38 Lower Place Special School for Physically Handicapped Pupils Willesden 30 32 4 Wembley 4 3 1 Harrow 6 4 2 Ruislip-Northwood 3 2 — Hayes and Harlington — — 1 Ealing 5 4 — Acton 5 4 2 Southall — — — Brentford and Chiswick 1 — 1 Heston and Isleworth 3 1 1 Area 10 1 1 — Totals 58 51 12 CHIROPODY The large number of foot ailments in adults are generally due to ill-fitting socks and shoes worn in childhood. Good posture cannot be maintained if feet are cramped and painful, and the school-child cannot give his best either mentally or physically, unless he has complete comfort and relaxation. The Chiropodist appointed in December, 1952 not only treats the various foot conditions of schoolchildren, but also deals with the much greater and more important problem of educating Parents, Schoolteachers and even members of the Nursing Profession on how these conditions arise and on methods of their prevention. More than twice as many girls than boys attend for treatment, mainly because their footwear is worse—court, casual and sling-back shoes. Girls in Secondary Modern Schools are the most likely to suffer as there appears to be no uniform dress regulation in force, and from an early age these children start to wear these types of fashion shoes which are harmful to the growing foot. Much is being done to try to rectify this by issuing pamphlets and giving lectures to expectant and nursing mothers, and trying to educate parents in the care of their children's feet. The results of this campaign cannot be assessed for several years. It would greatly benefit girls in Secondary Modern Schools if they wore either lace or bar-type shoes. The main conditions which have so far been treated in the Clinic are as follows:— Corns and Lesser Toe Defects. Successful results have been achieved in the treatment of these conditions, by correcting footwear, exercises and sometimes splinting. Hallux Valgus. Mild cases are treated and good results obtained. Severe cases are referred to the Orthopaedic Department. Nail Conditions. Onychocryptosis is the most common among school-children, and effective cures have been achieved. This condition will not occur if nails are cut properly. Verrucae. These are benign vascular neoplasm of an innocent nature, but are contagious and inoculable. There are various types and all give rise to pain and discomfort. The mode of infection is debatable, the most likely being the spread of the virus at swimming baths and in gymnasia where P.T. is performed with bare feet. There are various forms of treatment, but cautery is preferred, using a 60 per cent. Salicylic Acid Ointment. This method is practically painless and good results are obtained. Many expectant and nursing mothers have visited the Clinic with the usual adult foot complaints, corns, callosities, bunions, etc. These mothers have been given comfort which has lightened the burden of the long and arduous pre-natal months. Chiropody is an essential part of the Health Service. It is essential that school-children have good healthy feet, but it is equally important that the aged, who suffer with bad feet through osteo-arthritis, degenerative arthritis or just old age, should also be provided with a chiropody service. They cannot afford PREVENTION OF TUBERCULOSIS IN CHILDREN (1) Report, on Patch Testing-. Mantoux Testing and B.C.G. Vaccination for the year ended 31st December, 1953. children under 5 School children No.Patch Tested. Result Age Group. No.of Children offered. Patch Testing. No.Patch Tested. Result School leavers Mantoux Tested (i.e.those Neg. to Patch Test). Result of Mantoux Test. No.of Children B.0.G.Vaccinated (i.e. those neg. to Mantoux Test) Pos. Neg. Pos. Neg. 'pos, Neg. 1416 56 1260 Entrants (5 years old) 1625 1018 384 605 » 7-8 years old 982 808 359 404 10-11 years old 780 643 292 333 Leavers (15 years old) 2109 1804 885 903 770 173 587 456 1416 56 1260 5496 4273 1920 2245 770 - 173 587 456 (2) Cases referred to the Willesden Chest Clinic and results received for the year ended 31st December, 1953. Results received Age Group 1. No. referred 2. No evidence of disease in ctiest 3. Conditions found requiring further investigation 4. 0-5 years 56 34 2 5 years 384 319 17 8 years 359 338 5 11 years 292 254 4 15 years (leavers) 885 848 3 1976 1793 31 55 the luxury of visiting a Chiropodist, and on more than one occasion in the past a toe has become gangrenous with very serious consequences due to home treatment with a razor blade. An efficient chiropody service for the aged would enable old people to remain up and about as long as possible, and thus avoiding unnecessary admission to an institution. Number of Patients Seen Expectant and Nursing Mothers Boys Girls 0—5 School Total 0—5 School Total 1st attendances 65 1 76 77 7 157 164 Re-attendances 107 - 266 266 15 727 742 Summary of Defects Expectant and Nursing Mothers Boys Girls Corns 46 33 70 Hallux Valgus 1 2 2 Verrucae — 33 60 Onychocryptosis 20 12 18 Onychogryphosis — 1 — Masceration — 1 2 Hyperidrosis — 1 2 Blisters — — 2 Valgus Ankles — 1 4 Callosities 17 — 4 Ganglion — — 1 Injury 1st nail — 1 — Bursitis — 1 2 Hammer Toes 1 — 1 Septic conditions — 1 — MENTAL HEALTH SERVICES During 1952, the County Council delegated to the Area Health Committee for an experimental period of 12 months, the day-to-day administration of the Willesden Occupation Centre at Belton Hall, Bertie Road. This delegation was renewed for a further 12 months in 1953. The arrangement worked reasonably well, but to conform with other areas the day-to-day administration was transferred back to the Mental Health Committee on 31st March, 1954. -