Brough of Willesden 19 5 4 AC 439(1) WIL 50 cut 16-9-551 THE 79th ANNUAL HEALTH REPORT S. LEFF, M.D., D.P.H., Barrister-at-Law, Medical Officer of Health CONTENTS Page Page Aged care of Introduction 1 Laundry service 34 Publicity of services 35 . Laboratory service 8 S.O.S. card scheme 35 Massage and special treatment establish- Voluntary services 34 ments 9 Atmospheric pollution 23 Maternity and child welfare Basement bakehouses 33 Ante-natal care 37 Bombed sites 27 Clinics 37 Child guidance 53 Welfare foods—distribution 39 Chiropody 57 Medical examination of staff 36 Common lodging houses 35 Mental health services 57 Coroner's Court 35 Midwifery service 39 Day nurseries 45 Dental service 54 Milk and Dairies 32 Disinfestation 27 Mortuary 35 Factories 32 National Assistance Act, 1948 Food Burials 35 Clean Food Guild 28 Removals to hospitals 34 Contaminated food 30Noise 33 Education in food hygiene Food poisoning 29 Occupational health service 33 Ice cream 28 Outworkers and home workers 33 Improvements 29 Personal health services 37 Registration of premises Sampling 30 Pet Animals Act, 1951 36 Unsound food 30 Prematurity 5 Hawkers licensing of 35 Flock and Other Filling Materials Act, Health education 9 1951 36 Health visiting 41 Recuperative holiday homes 47 Home help service 44 Rheumatism 53 Home nursing 43 Rodent control 27 Hospitals Sanitary circumstances 18 Facilities 37 Liaison 37 Scabies 8 Housing School health service Closing orders 20 Ascertainment 48 Defects 20 Audiometry 48 Demolition orders 20 Medical inspections 48 Housing Repairs and Rent Act, 1954 21 Orthoptics 48 New dwellings 20 Special schools 56 Notices served 21 Speech therapy 48 Overcrowding 20 Slaughterhouses 36 Survey Immunisation against diphtheria 44 Staff Medical examinations 36 Infant mortality Sanitary section 18 Neo-natal 3 1—12 months 4 Tuberculosis Social class 4 B.C.G. vaccination 12 Wards 4 Chest clinic 13 Detection of cases 13 Infectious diseases Factories and workshops 13 Diphteria Hospital accommodation 13 Dysentery Mass miniature radiography 13 Food poisoning 12 Morbidity and mortality 12 Measles 10 Prevention 12 Meningococcal infection 11 Ophthalmia neonatorum 11 Vaccination against smallpox 43 Paratyphoid 11 Vermin 27 Pneumonia and influenza 10 Poliomyelitis 11 Vital statistics 3 Puerperal pyrexia 12 Births 3 Smallpox 11 Deaths 3 Whooping cough 10 Population 3 BOROUGH OF WILLESDEN Health Department, 54, Winchester Avenue, Kilburn, London, N.W.6. July, 1955. To the Mayor, Aldermen and Councillors of the Borough of Willesden. Mr. Mayor, Ladies and Gentlemen, I beg to submit the annual report of the health and sanitary circumstances of the Borough for the year 1954. There has been a further slight decrease in the population due to a larger scale migration out of than into the Borough. Both the birth and death-rates were less than the previous year. Indeed, although Willesden has a high proportion of aged, the death-rate declined to a new low level of less than nine per thousand. There was a slight reduction in the number of deaths from cancer in the lungs in men, but unfortunately this was counterbalanced by the doubling of the number of deaths in women. However, it is very little different from the previous two years, and there are still four deaths in men to every one in women. This suggests that although cigarette smoking may play a part, working conditions may be primarily responsible. Dust at work probably also plays a part in causing the much higher number of deaths from bronchitis in men as compared with women, and together the numbers are probably higher than any borough or town of this size in other countries of the world. Atmospheric pollution is undoubtedly a contributory cause, and Willesden with its power stations, railway sidings, and concentrated industries suffers to a very marked degree from this. I regret to have to record an appreciable rise in the tuberculosis mortality for the first time since the end of the war. There was also an increase in the number of new cases, with the numbers on the register reaching a new high record of 2,184, as compared with 807 in 1936. This, however, probably results from the detection of more early cases, and on the whole there has been a marked decline in the tuberculosis mortality. Clearly, prevention lags behind treatment, and the marked differences between rates in different social classes and occupations shows where our main effort must be directed. In Willesden, people in a ward such as Carlton, where there is the most overcrowding among the poorer sections of the population, face a much greater risk of dying from tuberculosis than those who live in the better-class wards. The team-work has been improved and extended in the battle against tuberculosis in the detection of early cases in the homes, schools, and factories, in prevention with B.C.G. vaccination, and treatment in the home and hospital. But the disease can be conquered finally only when overcrowding and poverty, its great allies, are overcome. There has been a further welcome reduction in the numbers suffering from infectious diseases, such as scarlet fever, measles, diphtheria, poliomyelitis and whooping cough, but there has been a marked increase in the number suffering from dysentery. Fortunately the disease has been mild, but the occurrence of several outbreaks in institutions underlines the need for special precautions to be taken in reducing overcrowding and improving hygiene. Infant mortality declined to a record low figure of under 20 per thousand and in one ward, Cricklewood, was actually less than 10. On the other hand, in Carlton it was almost four times as high, and it is clear that overcrowded conditions played an important role in causing deaths from respiratory infections and gastro-enteritis, and general poverty in causing prematurity. Again, improvement in living conditions will produce a great saving of life. The illegitimate mortality was more than fifty per cent. as high as the legitimate mortality. The stillbirth rate, related to the neo-natal mortality, declined to a record low level of under 20 per thousand, much lower than that for the country as a whole. However, next to prematurity, congenital malformations caused the largest number of neo-natal deaths, and remain largely an unsolved problem. Further studies, including the effects of nuclear radiation, are therefore becoming more imperative. On the sanitary side, overcrowded dilapidated houses still remain the biggest problem. The Council extended its house-to-house survey to selected areas in all parts of the borough. The aim is gradually being achieved of preserving property which, if neglected, would rapidly deteriorate into slums and then require demolition. The house-to-house survey based on the Housing and Public Health Acts, of 1936, has proved much more effective in securing improvements to properties in a poor state of repair than the Housing Repairs and Rents Act, 1954, which does not seem to have been used much by landlords in Willesden to raise their housing standards and rents. The general improvement in the sanitary conditions of factories for which the local authority is responsible has been maintained. An interesting innovation was the introduction of an occupational service for Borough Council employees, which includes the supervision of working conditions and of firstaid equipment and arrangements, assistance given to employees suffering from disability or chronic illness and to those who have been regularly absent from work on account of sickness, and advice on suitable employment. There has been an appreciable extension in the services for the aged, and to determine their needs more accurately, a special survey of a large random sample is being conducted in association with the Social Medicine Research Unit of Oxford. There is an immediate need for more voluntary visitors, and extension of the 'Meals on Wheels' service, for more chiropody treatment, and the establishment of a night sitters-in service. Health education remains one of the most important tasks of the Department, and the introduction of lunch-hour talks in factories has produced a most encouraging response. The practice of good general hygiene and of preventive medicine can rescue the medical services from financial disaster by relieving them of much work. An enlightened citizen with a knowledge of the principles of health can play an active part in the battle against disease. There has been no marked extension of the personal health services, and the need for new clinics in Willesden is becoming more urgent as the old ones become over-burdened with work; it is 25 years since the last clinic was built in the borough and in the meantime both the population and the medical services have expanded. However, some very important new services were started during the year. A child guidance clinic, long overdue, is now doing excellent work in dealing with the behaviour problems in children; an orthoptist has been appointed to train children with squint; an additional speech therapist is now available to treat the difficult speech problems of the handicapped children attending Lower Place school; an audiometrician is testing the hearing of school children so that early deafness can be detected and treated; and finally, an orthodontist is now available in Willesden to help straighten malformed teeth and jaws. We still require more special schools, and extensions of the health visitor and home help services. Above all, there is an urgent need for the reform of local government so that the health services become part of community units with the personal health services becoming really 'personal' to the people who use them. This has been an eventful year in the history of the public health service in Willesden, thanks to the Councillors, members of the staff, and the sanitary inspectors who have contributed so much to the health and welfare of the people in the borough. I have the honour to be, Your obedient servant, S. LEFF, Medical Officer of Health. 3 STATISTICS AND SOCIAL CONDITIONS OF AREA Population estimated, 1954 177,300 Population census, 1951 179,647 Population census, 1931 184,434 Pre-war population, 1938 187,600 Area of the district in acres 4,635 acres Number of inhabited houses (including flats) 43,897 Rateable value £1,677,270 General rate in the £ for the year 21s. 3d. Product of a 1d. rate (estimated) £6,710 VITAL STATISTICS Registered Live Births: Male Female Total Willesden Borough Council Legitimate 1267 1149 2416 Birth rate per 1,000 estimated resident population Illegitimate 85 98 183 Total 1352 1247 2599 14.66 Registered Stillbirths 23 21 44 Rate per 1,000 (live and still) births 16.65 Deaths 839 736 1575 Death rate per 1,000 estimated resident population 8.88 Death Rate of Infants Under One Year of Age: All infants per 1,000 live births 19.24 Legitimate infants per 1,000 legitimate live births 18.21 Illegitimate infants per 1,000 illegitimate live births 32.79 Death Rate of Infants Under Four Weeks of Age : All infants per 1,000 live births 14.24 Legitimate infants per 1,000 legitimate live births 13.25 Illegitimate infants per 1,000 illegitimate live births 27.32 Maternal Mortality: Deaths from puerperal causes— Puerperal sepsis Nil Other puerperal causes Other maternal causes Nil Deaths from: Males Females Total Cancer (all ages) 172 159 331 Measles (all ages) — — — Whooping cough (all ages) 1 — 1 Diarrhoea (under 2 years of age) - - - 4 Cause of Death: Males Females Total 1. Tuberculosis (respiratory) 21 12 33 2. Tuberculosis (other) 2 2 4 3. Syphilitic disease 3 3 6 4. Diphtheria - - - 5. Whooping cough 1 - 1 6. Meningococcal infections 2 - 2 7. Acute poliomyelitis - - - 8. Measles - - - 9. Other infective and parasytic diseases 1 3 4 10. Malignant neoplasm, stomach 31 26 57 11. Malignant neoplasm, lung, bronchus 60 16 76 12. Malignant neoplasm, breast - 20 20 13. Malignant neoplasm, uterus - 8 8 14. Other malignant and lymphatic neoplasms 81 89 170 15. Leukemia, aleukemia 4 4 8 16. Diabetes 2 6 8 17. Vascular lesions of nervous system 71 126 197 18. Coronary disease, angina 143 74 217 19. Hypertension, with heart disease 27 22 49 20. Other heart disease 83 100 183 21. Other circulatory disease 40 36 76 22. Influenza 1 3 4 23. Pneumonia 32 28 60 24. Bronchitis 80 41 121 25. Other diseases of respiratory system 14 5 19 26. Ulcer of' stomach and duodenum 19 4 23 27. Gastritis, enteritis and diarrhoea 4 1 5 28. Nephritis and nephrosis 8 8 16 29. Hyperplasia of prostate 17 - 17 30. Pregnancy, childbirth, abortion - - - 31. Congenital malformations 6 7 13 32. Other defined and ill defined diseases 52 66 118 33. Motor vehicle accidents 9 6 15 34. All other accidents 17 12 29 35. Suicide 8 8 16 36. Homicide and operations of war - - - Total 839 736 1,575 Births There was a slight decrease in the birth rate for 1954, and it appears to be becoming stabilised at just under 15 per 1,000, a little below that of England and Wales. (Page 3.) Infant Mortality (a) By Wards The infant mortality declined to a record low figure of under 20 per 1,000 (table 1), a figure which was at one time considered to be the lowest possible attainable. A much lower rate, however, has often been attained in the better wards, and it is pleasing to record that as many as six wards had a rate below 20 for the years 1952-4 (table 2). However, it is disturbing to note that infant mortality in Carlton, the worst ward, is almost four times as high as in Cricklewood, the best ward. Stonebridge and Roundwood also still show a high rate. It is clear that an improvement in conditions in these wards would help to reduce the mortality to less than 10 per 1,000, the figure achieved in Cricklewood (table 2). (b) By Social Class The number of deaths in the social class groups gives a further illustration : the majority of infant deaths occur in the three lower social groups (table 3). This reflects the picture in the country. The review of the 1951 census one per cent. sample shows that although there has been a marked reduction in mortality during the past ten years, the social class differences have remained almost unchanged; the total infant mortality has remained more than twice as high among the children of parents in unskilled occupations as among the children of those in professional occupations, rather less than twice as high for stillbirths and deaths under four weeks of age, but four times as high for infants dying between four weeks and one year. (c) 1-12 Months (i) Infectious diseases and living conditions The big reduction in infant mortality has been largely in the age group 1-12 months, particularly from infections (table 4), and since bad living conditions are mainly responsible, infant mortality can be reduced still further. 5 (ii) Respiratory infections Many of the ten infants who died from various infections in the age group 1-12 months could probably have been saved (table 5). Examples are given in the seven infants who died from respiratory infection. One was the fourth child in an overcrowded home who had suffered periodically from bronchitis; one was the first baby of a coloured father and European mother living in one room, and had never attended an infant welfare clinic, he was taken ill suddenly and died on the way to hospital; one came from a very poor home and had never attended an infant welfare clinic; and another was illegitimate. It is clear that in all these cases overcrowded conditions may have played an important part. Respiratory infections are more likely to be spread to children who live in overcrowded ill-ventilated homes. (iii) Gastro-enteritis Similarly with the two children, both aged four months, who died from gastro-enteritis (table 5). One was in a family who had recently been evicted from their home and were living in overcroivded conditions, and the other was the seventh child in an unhygienic, overcroivded home where there had been a recent history of gastro-enteritis in the rest of the family. It is very difficult to maintain proper standards for clean food in overcrowded slum conditions, and consequently the germs of gastro-enteritis are more likely to breed there. (d) Neo-natal Mortality 0-1 Month The main problem today is to reduce the infant deaths in the first four weeks of life. There has been a marked reduction in respiratory infections and diarrhoea and enteritis in this age group as well, but the rate for injury at birth and congenital malformations remain relatively unchanged, and although that for prematurity has been reduced, it still remains high (table 4). The number of premature births has remained fairly stationary in the past ten years, and constantly shows a much higher rate in the poorer wards. (i) Prematurity There were 162 premature babies, with the largest number in the poorest ward, Carlton (table 6). Twelve died, four after ante-natal complications (table 7). Two followed Caesarean section for antepartum haemorrhage and maternal tuberculosis, one followed ante-partum haemorrhage, and another was one of twins with placenta prævia. (ii) Congenital Malformations The rate for congenital malformations remains approximately the same, and more research will be required before effective preventive measures can be introduced. Evidence is now available that environment may play a part in producing congenital malformations and further studies may help to determine how far nuclear radiation is a contributory factor (tables 4 and 8). (iii) Birth Injuries The rate for birth injury has remained practically the same, and it is possible some of the deaths may have been avoided (tables 4 and 9). There is no record of the number of infants who suffered birth injury and survived. Conclusions In conclusion, there is no doubt that a general improvement in living standards and improved obstetric services would help to reduce infant mortality still further, but more research is still required in the causes of congenital malformations and prematurity. Tables. Infant Mortality 1. Infant Deaths and Stillbirths : Willesden and England and Wales, 1936-54 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 58.3 59 89 29.6 40 1937 188,030 3125 197 63.7 58 99 30.7 30 1938 187,600 3027 160 53.9 53 101 32.3 38 1939 188,000 3004 152 50.6 50 84 27.2 38 1940 152,030 2571 121 47.1 56 89 33.6 37 1941 127,230 2060 94 45.6 59 58 27.4 34 1942 138,600 2651 128 48.3 51 89 32.5 33 1943 144,430 2838 151 53.2 49 80 27.4 30 1944 139,510 2929 115 39.3 46 79 26.3 28 1945 161,954 2807 129 46.0 46 68 23.7 28 1946 170,550 3572 102 28.6 43 95 25.9 27 1947 175,900 3859 117 30.3 41 95 24.0 24 1948 179,900 3147 74 23.5 34 71 22.1 23 1949 181,120 2895 74 25.6 32 74 24.9 23 1950 181,700 2735 63 23.0 30 63 22.5 23 1951 179,647 2559 73 28.5 30 57 21.8 23 1952 180,400 2611 62 23.8 28 66 24.7 23 1953 178,500 2655 60 22.6 27 58 21.4 22 1954 177,300 2599 50 19.2 26 44 16.7 24 6 2. Infant Mortality by Wards Ward Number of Deaths 1952-4 Total Rate 1952-4 1952 1953 1954 1. Carlton 5 11 13 29 32.9 2. Kilburn 3 5 4 12 17.9 3. Brondesbury Park 3 - 4 7 13.8 4. Kensal Rise 3 2 1 6 15.6 5. Manor 5 2 1 8 18.1 6. Harlesden 7 5 2 14 23.0 7. Stonebridge 7 4 6 17 28.0 8. Roundwood 7 6 4 17 25.8 9. Church End 6 6 2 14 23.4 10. Willesden Green 5 4 2 11 17.6 11. Mapesbury 5 5 4 14 20.2 12. Gladstone 2 5 4 11 26.6 13. Cricklewood 2 1 1 4 9.5 14. Brentwater 2 4 2 8 22.7 62 60 50 172 21.9 3. Infant Mortality by Social Class Social Class Group 1954 Nos. 1951 England & Wales 1% sample (rates) Group 1 1 17.9 Group 2 2 22.5 Group 3 15 28.4 Group 4 20 34.5 Group 5 12 41.1 All classes 50 29.9 4. Causes of Infant Deaths in Willesden (Based on Registrar General's figures) 1936-1939 1940-1945 1946-1950 1954 (1953 in brackets) Deaths Rate Deaths Rate Deaths Rate Deaths Rate Neonatal 1-12 mths. Total Respiratory 106 8.1 140 8.8 68 4.2 2 (3) 5 (7) 7 (10) 2.7 (3.8) Diarrhoea and enteritis 131 10.0 108 6.8 37 2.3 - (1) 2 (6) 2 (7) 0.8 (2.6) Other infections 34 2.6 40 2.5 15 0.9 1 (-) 3 (1) 4 (1) 1.5 (0.4) Congenital malformations 83 6.3 89 5.6 72 4.4 10 (11) 2 (1) 12 (12) 4.6 (4.5) Premature births 170 13.0 179 11.3 99 6.1 12 (21) . (-) 12 (21) 4.6 (7.9) Injury at birth 21 1.6 33 2.1 43 2.7 6 (6) . (-) 6 (6) 2.3 (2.3) Other causes 134 10.3 149 9.4 96 5.9 6 (1) 1 (2) 7 (3) 2.7 (1.1) All causes 679 51.9 738 46.5 430 26.5 37 (43) 13 (17) 50 (60) 19.2 (22.6 5. Infant Deaths from Respiratory and other Infections Neo-natal 1-12 months Total under 1 yr. Respiratory Infections: Bronchopneumonia 1 2 3 Acute bronchitis - 1 1 Acute tracheobronchitis - 1 1 Pneumonia of newborn 1 - 1 Whooping cough and bronchitis - 1 1 Other Infections: Purulent meningitis 1 - 1 B. proteus meningitis - 1 1 Cerebro-spinal meningitis - 1 1 Meningococcal infection - 1 1 Diarrhoea and enteritis - 2 2 Total 3 10 13 7 6. Premature Births and Deaths by Wards Column 1 *Figures in brackets—births in hospital Column 2 † Figures in brackets—deaths in hospital 1 2 Premature Ward Births Deaths Carlton 25 (19)* 3 (3)† Kilburn 17 (13) 1 (1) Brondesbury Park 10 (9) 2 (1) Kensal Rise 11 (10) — (—) Manor 8 (5) — (—) Harlesden 9 (8) — (—) Stonebridge 12 (8) 3 (2) Roundwood 9 (7) — (—) Church End 8 (7) — (—) Willesden Green 13 (11) 1 (1) Mapesbury 13 (12) — (—) Gladstone 17 (13) 2 (2) Cricklewood 4 (3) — (—) Brentwater 6 (6) — (—) Total 162 (131)1 12 (10) 7. Premature Births and Deaths (1946-54) (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) 1954 31 (2) 131 (10) 9 (0) 162 (12) 8. Congenital Malformations Congenital Malformation Neo-natal 1-12 months Total under 1 year Atelectasis 3 - 3 Spina bifida and meningocele 2 - 2 Spina bifida 1 - 1 Large encephalocele 1 - 1 Agenesis and microcephaly - 1 1 Congenital heart disease 2 1 3 Pseudo hermaphrodite 1 - 1 Total 10 2 12 9. Birth Injuries Cause Delivery Hospital Own Home Total Prolonged second stage Forceps - 1 1 Precipitate labour Natural forces 1 - 1 Cord round neck do. 1 - 1 Asphyxia (inhaled meconium) do. - 1 1 Cause unknown (twin) do. - 1 1 No information available do. - 1 1 Total 2 4 6 8 GENERAL PROVISION OF HEALTH SERVICES Public Health Laboratory Service The Public Health Laboratory Service carry out bacteriological examinations at the Central Public Health Laboratory, Colindale Avenue, N.W.9, and at the branch laboratory in Neasden Hospital, Brentfield Road, N.W.10. Private practitioners send specimens, such as swabs from sore throats, faeces from intestinal infections, and cough plates and post-nasal swabs from whooping cough cases to the branch laboratory in Neasden Hospital, the Health Department, 54, Winchester Avenue, N.W.6, the Willesden Health Centre 381, High Road, Willesden, N.W.10, the Kilburn Health Centre, 9, Willesden Lane, N.W.6, or the Stonebridge Health Centre, Harrow Road, N.W.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, ice cream from registered premises and water from domestic premises and swimming baths. The following results were obtained during 1954 163 Milk Examinations Schools (pasteurised) Dealers' premises Total Pasteurised T.T. pasteurised Sterilised Samples 53 65 17 28 163 Satisfactory 53 65 17 28 163 Unsatisfactory - - - - - 28 Ice Cream Tests : Grade 1 16 Grade 2 9 Grade 3 2 Grade 4 1 157 Water Examinations: Domestic supplies, etc 6 Swimming pools 151 Satisfactory 157 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. As compared with 1953, there has been a marked reduction in the numbers of school children treated for scabies or lice and nits. The number of children under 5 years treated has increased, while the number of adults has remained stationary. This is probably not a reflection of a real increase in incidence but of the greater convenience for people to attend at Stonebridge Health Centre as compared with the Kensington Cleansing Centre. Cases Treated at Stonebridge Health Centre 1.1.54 to 31.12.54 New Cases treated Attendances Scabies Lice & Nits Total Scabies Lice & Nits Total Children under 5 years 8 4 12 23 4 27 Children 5-15 years 10 29 39 20 29 49 Adults Men 7 3 10 16 3 19 Women 11 12 23 24 12 36 Total 36 48 84 83 48 131 9 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 22 licences renewed and 2 new licences 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 still mounting 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 27 lectures with 52 films and filmstrips. As far as possible, health education in the schools is linked with a hygiene or biology syllabus. Brains trusts 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, 171 health talks and film shows were given in 21 schools by the Area Medical Officer and members of his staff, the Chief Sanitary Inspector and his staff, the Public Relations Officer and others. 1,525 school children attended these lectures, with attendances of 30 to 200 pupils. Arrangements were made for parties of school children to visit a hospital, and a school for teaching and training the blind. 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. 126 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 8,098 mothers in their own homes by the health visitors during their routine visits. Mothers clubs, which were commenced in June, 1953, have been much appreciated. Talks were given on subjects such as cookery, sewing, chiropody, home nursing, first aid, travel and make-up. The clubs have been held weekly at Kilburn Health Clinic, and until October, 1954, monthly at Anson Road, Primary School. 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. At the nine-day nursery parent clubs, 5 health talks were given by the Area Medical Officer and his staff, and 18 other meetings and social evenings were arranged. Religious, social and political organisations continue to apply to the department for health lectures and all their requests have been answered. 33 talks were given to 27 organisations on 26 different subjects. 1,150 people attended the lectures, with attendances ranging from 10 to 85. 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 staff abreast with recent advances in technique in their special subjects. A summer school in Health Education was arranged by the Central Council for Health Education and held at Bangor from 17th to 27th August, 1954. The Council sent the Chief Sanitary Inspector as their representative, and much useful information was gained and passed on to his colleagues. During the year a party of students studying at the University of London Institute of Education for the Diploma in Health Education visited Willesden on several occasions in order to gain practical experience. At the end of the year it was decided to explore the possibility of giving talks to factory staff during lunch-hour breaks. Several factory managements were approached and the response was most encouraging. Four talks were given by the Medical Officer of Health; approximately 2,400 factory workers attended the talks, and attendances ranged from 400 to 1,000. It is hoped that this form of health education will become an important part of this work during 1955. 10 PREVALENCE AND CONTROL OF INFECTIOUS AND OTHER DISEASES The declining incidence and mortality of infectious diseases such as diphtheria, scarlet fever measles, whooping cough and typhoid fever in the past 50 years is not so much a reflection of better treatment as of improving living standards. 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 and sanitary inspectors have played an invaluable role in health education and in improving hygiene. Notifiable Infectious Diseases Cases notified (confirmed in brackets) 1950 1951 1952 1953 1954 Diphtheria 15 (1) 12 (1) 14 (1) 8 (1) 5 (2) Scarlet fever 317 (306) 211 (204) 262 (249) 217 (210) 182 (177) Pneumonia 164 (150) 172 (161) 126 (113) 228 (208) 102 (97) Whooping cough 650 (648) 550 (543) 330 (328) 453 (450) 295 (295) Erysipelas 29 (26) 31 (30) 27 (27) 22 (21) 13 (12) Measles 2280 ;2255) 1937 (1927) 1528 (1520) 2392 (2383) 126 (124) Diphtheria A boy of 5 years and a woman of 27 years, two of the five cases of diphtheria notified in 1954, were confirmed; they were unimmunised. Measles 126 cases were notified in 1954 (124 confirmed). There were no deaths from measles during the year. Whooping Cough 295 cases were notified and confirmed, with one death in a child of three months. The incidence of whooping cough was the lowest of the last five years, but the reduction cannot be attributed to whooping cough vaccination (see report for 1953). Pneumonia and Influenza 102 cases of pneumonia were notified (97 confirmed). There were 60 deaths from bronchopneumonia, lobar pneumonia and pneumonia (unspecified), and 4 deaths from influenza. 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 vaccinate in Willesder 0—4 5—15 Willesden England & Wales Willesden England & Wales Willesden England & Wales Willesden England & Wales 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 3.7 Nil .01 1163 1952 180,400 13,846 24,000 328 114,869 1 184 1.82 2.1 .00 .00 946 1953 178,500 13,455 24,000 450 157,842 - 243 2.52 3.8 Nil .01 1,333 1954 177,300 13,110 23,857 295 105,901 1 130 1.66 2.9 .006 .002 1,198 11 Poliomyelitis Poliomyelitis did not reach epidemic proportions in 1954. 21 patients were notified and were admitted to Neasden Hospital. Only ten actually had the disease confirmed, four in the age group 0-15 years and six over the age of 15 years. Five had the non-paralytic type of the disease, four had slight paralysis, and one, a man of 33 years, had severe paralysis; there were no deaths. Paratyphoid Fever Seven cases were notified in 1954 (six confirmed). On the 29th October, an outbreak of paratyphoid fever occurred at a hospital in the area; four children were affected but they were not seriously ill. Parents of the children, and 25 hospital staff who had been on duty since the 1st October, were interviewed, and their stools and urines were examined bacteriologically with negative results. Widal reactions were carried out; positive reactions were all due to recent T.A.B. inoculation. It was not possible to identify the source of infection. Meningococcal Infection Five cases were notified in 1954 (4 confirmed). There were two deaths of children under one year of age, but they were not diagnosed or notified until post-mortem examination. One, a boy of six months, died from cerebro-spinal meningitis, and the other, a boy of nine months, died from haemorrhage into the supra-renal glands as a result of meningococcal septicæmia. Dysentery 228 cases were notified in 1954 (200 confirmed). There were five outbreaks of dysentery during the year. (1) On January 19th, a member of the staff of the Central Middlesex Children's Homes was reported to be suffering from Sonne dysentery after she had been absent from duty for a week, and seven children who were positive on routine swabbing, were isolated from the remainder. They had no symptoms and admissions to the home were recommenced after 9th February. (2) On the 11th January, there was an outbreak of dysentery at the Connaught House Nursery affecting five children; their symptoms were very mild and two were transferred to the isolation hospital. Three members of the staff were found to be carriers and were sent home until clear of infection. Subsequently, on the 10th February, there was a recurrence among the staff, and six more children were found to be positive. Owing to staffing difficulties, it was decided to close the Nursery on the 18th February, and it was not reopened until the 11th March. (3) In March, there was an outbreak of dysentery at Acton Lane School; sixteen cases were notified from the 10th March to the 31st March, and three other cases occurred on the 12th April, 12th May and the 17th May. All but one had symptoms which were mild. It was not until the end of June that all cases had returned to school. (4) On the 7th May there was an outbreak of dysentery affecting five patients in the general hospital in the district. Three patients were removed to the Neasden Isolation Hospital; their symptoms were mild and the infection cleared up rapidly. (5) On the 1st J une there was an outbreak of dysentery at the Curzon Crescent Nursery School affecting fourteen children; two were removed to the Neasden Isolation Hospital. The symptoms were very mild and the children affected were soon free from infection and back at school. Smallpox There were no cases of smallpox. Ophthalmia Neonatorum One case was notified (-38 per 1,000 live births); there was complete recovery with unimpaired vision. Other Infectious Diseases Disease Cases notified (number confirmed in brackets) Typhoid fever - (-) Dysentery 228 (200) Malaria 3 (2) Poliomyelitis and polio-encephalitis 21 (10) Meningococcal infection 5 (4) Encephalitis — (-) Smallpox — (-) Paratyphoid 7 (6) 12 Puerperal Pyrexia 134 cases of puerperal pyrexia were notified and confirmed. Since August 1st, 1951, puerperal pyrexia applies to any "febrile condition occurring in a woman in whom a temperature of 100.4 degrees Fahrenheit (or 38 degrees centigrade) has occurred within fourteen days after childbirth or miscarriage". Food Poisoning 49 cases of food poisoning were notified (25 confirmed). TUBERCULOSIS Morbidity and Mortality For the first time since the end of the war there has been an appreciable rise in the tuberculosis mortality, with most of the deaths occurring below the age of 55 (Table 2). The case rate also showed an increase, and the number on the register reached a new high record of 2,184, almost three times the prewar figure. Every fortnight at least one person dies from tuberculosis in Willesden, and 10 new cases are discovered (Table 1). It is still hoped that this is merely a reflection of the detection of more early cases and that they are cured satisfactorily with the new forms of treatment including rest, control of cough, better diet and chemotherapy. But it must give rise to some anxiety that tuberculosis is not quite so much under control as it was thought to be. One conclusion clearly emerges f'rom these figures : the general decline in the mortality with an increase in notifications and morbidity must mean that prevention lags behind treatment. The fall in mortality is probably due to the introduction of chemotherapy, with more effective isolation of infectious cases and some improvement in social conditions, particularly nutrition. However, warning signs are now given by the rising case rates which cannot be attributed entirely to mass radiography and the detection of more early cases. The marked differences between rates in different social classes and occupations showed that there has been no marked improvement in social and working conditions (Table 3). The fact that there are so many infectious cases unknown to the Public Health Department indicates a serious menace in the possible spread of the disease. The rising costs of food may, in the future, have an effect in causing malnutrition and lowering resistance to disease. 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 4). Carlton had three times as many cases as Manor in 1954 (Table 5). 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 treatment. The reduction of overcrowding in homes, schools, factories, transport, and places of recreation and amusements, will help to prevent the spread of the disease. It is also important to remove the chronic infective cases from industry and provide sheltered workshops where they can earn their living without risk to others, particularly susceptible adolescents. The improvement in hospital facilities has resulted in the early removal of infective cases from the community. Finally, the improvement in health education and a knowledge of hygiene has permitted the treatment of cases in the home without placing 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 of 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.; they are X-rayed annually until the age of 21. It is gratifying to record that 9 out of 10 parents of school-leavers accepted the tests. The proportion who were negative to both the patch and 13 Mantoux tests was somewhat smaller than in the previous year, and so, although the proportion of acceptances was higher, the numbers vaccinated were actually smaller. Altogether, 391 (about 1 in 5) of the school-leavers were vaccinated, and probably less than 50 who required vaccination did not have it (Table 6). It is hoped that in subsequent years even more parents will give consent and thus help to protect their children. 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 (Table 6). Detection of Cases Missed Notifications The number of people who died unnotified is an indication that there must be many undetected infectious cases in the community. In the last five years 2 out of 10 who died were unnotified, 2 died within a year of notification, and another 3 died within five years (Table 7). Some of these must have been infectious and remained undetected, so that adequate precautions could not be taken to prevent the spread of infection. A study of all those who died unnotified reveals that further investigation of elderly patients suffering from bronchitis and emphysema is required. A letter was sent to the secretary of the medical committees of all hospitals in the area stressing the need for notifying all cases. Chest Clinic The centre for detecting cases and tracing and examining contacts is the chest clinic. This important work has been helped by the extension to the Pound Lane Clinic completed in March, 1953, providing a new X-ray department with an adjacent dark room, a miniature camera unit (Watson 5" x 4") added to the four valve set, and a separate chest screening stand 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. Mass Miniature Radiography The static M.M.R. unit established at the Central Middlesex Hospital in August, 1952, has also played an important part in detecting cases. Special emphasis is placed on the following groups : people with suspected diseases of' the lungs, particularly those under the care of their family doctor; contacts of infectious cases of tuberculosis; health workers, including 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 out-patients; and expectant mothers. The highest proportion of cases are found in those who are referred from their own doctor and the next highest in in-patients. In addition, other abnormalities such as cancer of the lung, bronchiectasis, and pleural effusion are also detected and can receive earlier treatment (Table 8). An evening session was arranged for the last Monday in each month from 6.0 to 8.30 p.m., commencing in May, and considerable publicity was given to this. Notices appeared in the Willesden Citizen and Willesden Chronicle, letters were sent to ten old people's clubs offering a talk on tuberculosis, circular letters were sent to all medical practitioners and to the secretary of the medical committee of all hospitals in the area. Wherever possible, old people are encouraged to attend day sessions, but if parties could be arranged, transport could probably be provided. All the special groups, including school-leavers, who cannot attend day sessions, may come to the evening sessions. Factories and Workshops A study of mortality in different occupations reveals the important role played by working conditions. Recent surveys have shown that overcrowding in large workshops is an important factor in the spread of the disease, particularly if there are undetected cases working there. It is therefore important to examine factory contacts of all infectious cases discovered, and try and determine where they contracted the disease and who else may have been infected. At the same time other abnormalities such as cancer of the lung and silicosis can be detected. Arrangements were made to examine contacts of infectious cases in 12 factories, workshops and offices and cases were found among the contacts (Table 9). The case found to be suffering from tuberculosis was admitted to Central Middlesex Hospital, and he has now been discharged but still attends for refills to his A.P.; he is unfit for work but is making good progress. When visiting factories for tracing contacts the medical officer of health encourages managers to employ non-infectious ex-tuberculosis patients on both his and the chest physician's recommendation. Whenever there are vacancies in industry suitable for tuberculous persons and the disablement resettlement officer requires a report, the sanitary inspector visits and reports whether working conditions are satisfactory. It was recommended that no recovered tuberculosis cases be referred to one particular factory during the year. Several cases were referred for training at the Government training centre at Perivale. Hospital Accommodation If more cases are to be discovered, it is also essential to provide hospital beds for them as required. Hospital accommodation has therefore been increased; there are 30 female and 28 male beds in the Central Middlesex Hospital and another 10 female and 10 male beds in Neasden Hospital. In addition, a number 14 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. CO-operation Four meetings were held during the year, when the chest physician, welfare officer, superintendent of health visitors, midwives and home nurses, home help organiser and chief sanitary inspector were present. Measures were discussed to help individual cases, together with suggestions for improvements in the scheme as a whole. TABLE 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 211 47 258 128 16 144 1936 190,000 (1.11) (.168) (1.358) (.673) (.084) (.757) 655 152 807 205 49 254 119 14 133 1937 188,030 (1.09) (.261) (1.351) (.632) (.074) (.707) 688 161 849 210 56 266 117 11 128 1938 187,600 (1.119) (.298) (1.417) (.623) (.058) (.681) 691 172 863 250 37 287 108 12 120 1939 188,000 (1.329) (.197) (1.526) (.574) (.063) (.638) 678 166 844 204 54 258 105 16 121 1940 152,030 (1.324) (.355) (1.697) (.690) (.105) (.795) 587 145 732 217 32 249 79 15 94 1941 127,230 (1.705) (.252) (1.957) (.621) (.117) (.738) 575 116 691 234 47 281 100 15 115 1942 138,600 (1.688) (.339) (2.027) (.721) (.108) (.829) 369 133 502 262 51 313 85 14 99 1943 144,430 (1.814) (.353) (2.167) (.589) (.096) (.685) 734 150 884 210 23 233 84 18 102 1944 139,510 (1.505) (.165) (1.670) (.602) (.129) (.731) 815 156 971 207 45 252 81 16 97 1945 161,954 (1.278) (.277) (1.556) (.500) (.098) (.598) 927 172 1099 255 34 289 81 15 96 1946 170,550 (1.495) (.199) (1.694) (.475) (.088) (.563) 1067 180 1247 253 33 286 76 12 88 1947 175,900 (1.438) (.188) (1.626) (.432) (.068) (.500) 1198 191 1389 243 27 270 80 11 91 1948 179,900 (1.351) (.150) (1.501) (.445) (.061) (.506) 1293 196 1489 186 22 208 66 9 75 1949 181,120 (1.026) (.121) (1.147) (.364) (.050) (.414) 1386 207 1593 229 29 258 51 4 55 1950 181,700 (1.260) (.159) (1.419) (.280) (.022) (.302) 1543 217 1760 228 33 261 46 5 51 1951 179,647 (1.269) (.184) (1.453) (.256) (.028) (.284) 1673 239 1912 229 27 256 29 4 33 1952 180,400 (1.269) (.150) (1.419) (.161) (.022) (.183) 1803 250 2053 216 29 245 24 1 25 1953 178,500 (1.210) (.162) (1.372) (.134) (.006) (.140) 1854 249 2103 229 33 262 33 4 37 1954 177,300 (1.292) (.186) (1.478) (.186) (.023) (.209) 1917 267 2184 15 TABLE 2 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 4 — — — — — — 5 to 10 5 4 3 1 — — 1 — 10 to 15 1 3 1 1 — — — — 15 to 20 5 10 — 1 — — — — 20 to 25 17 25 1 6 — — — — 25 to 35 26 30 — 6 3 3 — — 35 to 45 22 16 9 1 — 4 — — 45 to 55 19 8 — 1 7 3 — — 55 to 65 10 4 — 1 2 2 — 1 65 and upwards 12 5 — 1 8 1 1 1 Totals 120 109 14 19 20 13 2 2 TABLE 3 Respiratory Tuberculosis England and Wales, 1% Sample Standardised Mortality Ratios of Men aged 20-64 by Cause and Social Class, 1950 Social class I II III IV V 64 62 103 95 149 TABLE 4 1952-1954: Deaths and Cases by Wards Ward Pulmonary Cases NonPulmonary Cases Pulmonary Rate Combined Rate All Forms Deaths Rate Carlton 84 8 2.233 2.446 11 0.292 Kilburn 54 11 1.307 1.573 12 0.290 Brondesbury Park 41 6 1.075 1.232 7 0.183 Kensal Rise 29 6 0.834 1.007 5 0.144 Manor 35 4 0.859 0.957 7 0.172 Harlesden 52 12 1.208 1.487 8 0.186 Stonebridge 45 5 1.161 1.290 7 0.181 Roundwood 52 4 1.431 1.541 10 0.275 Church End 44 10 1.089 1.336 12 0.297 Willesden Green 55 4 1.340 1.437 4 0.097 Mapesbury 69 8 1.838 2.051 5 0.133 Gladstone 40 3 1.142 1.228 2 0.057 Cricklewood 42 6 1.175 1.342 5 0.140 Brentwater 32 2 0.896 0.952 — — Whole Borough 674 89 1.257 1.423 95 0.177 16 TABLE 5 1954: Deaths and Cases by Wards Ward Pulmonary Cases NonPulmonary Cases Pulmonary Rate Combined Rate All Forms Deaths Rate Carlton 34 3 2.744 2.986 5 0.404 Kilburn 17 5 1.245 1.612 6 0.440 Brondesbury Park 15 3 1.187 1.424 3 0.237 Kensal Rise 5 3 .433 .693 2 0.173 Manor 11 1 .820 .894 2 0.149 Harlesden 19 6 1.336 1.758 3 0.211 Stonebridge 19 3 1.477 1.711 4 0.311 Roundwood 13 1 1.086 1.170 1 0.084 Church End 12 3 .902 1.127 5 0.376 Willesden Green 17 2 1.258 1.406 2 0.148 Mapesbury 26 2 2.070 2.229 2 0.159 Gladstone 15 1 1.290 1.376 1 0.086 Cricklewood 13 — 1.103 1.103 1 0.085 Brentwater 13 — 1.101 1.101 — — Whole Borough 229 33 1.292 1.478 37 0.209 TABLE 6 Prevention of Tuberculosis in Children Report on Patch Testing for the year ended 31st December, 1954 No. tested Positive Percentage Children under 5 years 1,526 43 2.8 School children (5 years) *938 169 18.0 School-leavers 1,868 1,116 59.7 *No. of parents approached: 1,147; percentage accepted 81.8. B.C.G. Vaccination of School-leavers during the years 1953 and 1954. 1953 1954 (1) Number of children whose parents were approached 2,109 2,094 (2) Number of children from (1) whose parents consented 1,804 1,868 (85.5%) (89.2%) (3) Number of those in (2) negative to patch test 903 741 (50.1%) (40.0%) (4) Number of those in (3) who accepted Mantoux Test 770 662 (85.3%) (89.3%) (5) Number of those in (4) Mantoux tested found negative 587 447 (65.0%) (60.0%) (6) Number of those in (5) B.C.G. vaccinated 456 391 (77.7%) (87.5%) (7) Percentage of B.C.G. vaccination to (1) above 21.6% 18.7% TABLE 7 Deaths : When Notified 1949 1950 1951 1952 1953 1954 1949-54 Deaths 66 51 46 29 25 37 254 Percentage not notified 23 12 20 21 28 19 Percentage notified before death: 20 0—12 months 26 35 15 21 8 11 21 1—5 years 27 27 39 31 28 30 30 Over 5 years 24 26 26 27 36 40 29 17 TABLE 8 Mass Radiography Source No. Cases of active or presumed active tuberculosis Rate per 1,000 Out patients 11,678 41 3.5 In patients 2,279 13 5.7 Own doctor 7,653 89 11.6 Self referred 7,379 25 3.4 Staff and applicants for staff appointments 1,395 2 1.4 Area Medical Officers 2,647 7 2.6 33,031 177 5.3 In addition there were 7 known cases. Ante-natal Patients Total number of patients radiographed 2,918 Cases detected 11 = 3.7 per 1,000. (Included above under Out-patients and Area Medical Officers) Tuberculosis and Other Abnormalities Diagnoses: Pulmonary tuberculosis (active or presumed active unsuspected disease) 177 Neoplasm of lung 38 Bronchiectasis 103 Pleural effusion 19 Emphysema 378 Significant disease of heart or aorta 44 Total number of patients with significant abnormalities 759 TABLE 9 Contact-tracing Factories No. of factories 12 No. of contacts mass X-rayed 834 Satisfactory 792 After further X-ray : Not suffering from tuberculosis 23 Tuberculosis 1 Arrested tuberculosis 1 Referred to other chest clinic (home address outside area) 7* Further examination in 1955 (still at work) 8 Cancer of lung 1 Silicosis 1 42 *Ealing, Harrow, St. Marylebone, Uxbridge, Edgware (2) and Hampstead Chest Clinics. 18 SANITARY CIRCUMSTANCES OF THE AREA Water The Metropolitan Water Board and the Colne Valley Water Company supply Willesden with water of excellent quality. Sewage and Drainage Most of the sewage of the Borough is discharged into the London County Council main sewers, but a small amount from the Park Royal area is discharged into the West Middlesex Main Drainage system, Refuse Disposal The Borough Engineer's department deals with the provision of dust-bins. House refuse is collected weekly; trade refuse as often as required at an agreed charge. The refuse is disposed of by controlled tipping at Twyford. Household Arrangements The County Report of Middlesex (Census 1951; see Annual Report for 1953), reveals Willesden's housing problems as compared with the rest of the County. Willesden was developed first in the County, and so has the oldest property with all the usual defects. Shared Dwellings and Overcrowding 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 ten). The number of persons per room is higher than that of Greater London, England and Wales, and any district in the County, and the percentage of population and of households at densities over 1½ and 2 persons per room is the highest in the County, in some instances the percentage is more than double. 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. 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 79 79 Gladstone Park 36 36 King Edward's Park 36 36 SANITARY SECTION Staff The authorised establishment of Sanitary Inspectors was increased by one in June, 1954, and is now one Chief Sanitary Inspector, one Deputy Chief Sanitary Inspector, 18 District Sanitary Inspectors and 5 Pupil Sanitary Inspectors. The Council adopted the London scale of salaries for Sanitary Inspectors in January, 1954, and the three vacancies which existed at the beginning of the year and the additional post were filled. There were no resignations during the year. Five Pupil Sanitary Inspectors were on the staff in 1954. 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 aim of the Council is to try and preserve property which, if neglected, will deteriorate into slums and then require demolition. Far too often, tenants inform the Public Health Department only when the defects are serious and costly to remedy. 19 In March, 1954, the Council decided to organise house-to-house inspections in selected areas in the borough. Sanitary Inspectors made a preliminary survey so that the Council could determine the areas requiring immediate attention. They chose 64 roads containing about 4,230 houses. The survey commenced on the 1st April. At the end of the year, 42 per cent. of the houses in the planned survey had been inspected (Table 1); three out of four had defects (Table 2). The Council served notices for remedying defects under the Public Health Act, 1936, and the Housing Act, 1936. Eight owners appealed against the notices, but as agreement was reached on a modified schedule of repairs in six, four were withdrawn and two adjourned by the court; one appeal was upheld and one is still outstanding (Table 3). TABLE 1 General Housing Survey, 1954 Houses Inspected Re-inspections Total Inspections 1,761 4,640 6,401 Houses in all respects reasonable fit for human habitation 407 Houses with slight defects 30 Houses with slight defects requiring action 1,324 Total 1,761 TABLE 2 Defects Chimneys 367 Roofs 652 Gutters and downspouts 672 Soil and vent pipes 288 Brickwork 677 Windows 1,081 Paving 420 Water closets 550 Drainage 86 Walls and ceilings 1,020 Moors 471 Totals 6,284 TABLE 3 Notices Served Results of action taken Section 9, Housing Act, 1936 997 Work completed 367* Section 93, Public Health Act, 1936 17 Work commenced or negotiations proceeding 568 Section 39,Public Health Act, 1936 5 Notices served, time limit not expired 284 Section 45, Public Health Act, 1936 14 Work to be carried out by the Borough Engineer in default 59 Intimation notices 247 Appeal outstanding 1 Appeal upheld 1 1,280 1,280 *Including 43, work carried out by Borough Engineer. 20 Demolition and Closing Orders Housing Act, 1936 (Sections 11 and 12) Local Government (Miscellaneous Provisions) Act, 1953 (Section 10) Demolition Orders—Section 11, Housing Act, 1936 There were no demolition orders made during the year — (—)* Closing Orders—Section 12, Housing Act, 1936 2 ( 2)* 45, Chichester Road (basement) 5, Stafford Road (basement) Closing Orders, Section 10, Local Government (Miscellaneous Provisions) Act 1953 2 (—)* 8, Percy Road 43, Tubbs Road (*1953 in brackets) One closing order under Section 12, Housing Act, 1936 (99, Brondesbury Villas—basement), which was made in 1948 was cancelled. Demolition Orders Outstanding from previous years 1, Avenue Road (1950) and 76, Canterbury Road (1951) Closing Orders under Local Government (Miscellaneous Provisions) Act, 1953, were substituted for Demolition Orders. 32, Connaught Road, (1950). Demolition Order quashed by agreement in County Court after owners complied with their undertaking to carry out works. 1 and 2, Bridge Place (1951). Demolished by owners. Overcrowding There has been little change in the extent of overcrowding which still remains acute. The Council found it necessary to issue only a few licences 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. Licences to permit temporary overcrowding in excess of the permitted number, Section 61, Housing Act, 1936: licences issued 5 (4)* (*1953 in brackets) 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 2,147 (b) Overcrowding reported during the year 190 (c) (i) Overcrowding relieved during the year 97 (ii) Persons (approx.) 388 (d) Dwelling houses which have again become overcrowded after the local authority have taken steps for the abatement of overcrowding No information (e) (i) Council houses found to be overcrowded at end of year 138 (ii) Families 184 (iii) Persons 994 (f) Overcrowding in Council houses relieved during the year 12 New Dwellings, 1954 Houses Flats Rebuilds Dwellings built by private builders (excluding those built by the police authorities 3 2 1 house Built by local authority 8 12 Nil Applicants on Council's waiting list at 31.12.54 10,344 Housing Defects 1954 1953 Premises inspected on complaint 3,522 3,678 For infectious diseases 419 4 Others 416 314 Under special survey (see page 19) 1,761 429 Total number of premises 6,118 4,489 No. of inspections (inclusive of Housing Survey) 22,950 26,290 21 Notices Served under Public Health and Housing Acts, 1936 Inclusive of Housing Survey 1954 1953 Intimation notices served 2,277 1,926 Intimation notices complied with 1,918 2,012 Statutory notices served (Public Health Act, 1936) 1,111 967 Statutory notices complied with (Public Health Act, 1936) 989 1,050 Statutory notices served (Housing Act, 1936) 1,049 394 Statutory notices complied with (Housing Act, 1936) 370 535 Non-compliance with Statutory notices referred to Town Clerk (Public Health Act, 1936, Section 93) 169† 123† Referred to the Borough Engineer for work to be carried out in default of owners 205* 131 *120 work done by Borough Engineer. †Details of cases referred to the Town Clerk during year. Work carried out 88 101 Work in hand 8 — Court orders obtained 20 9 Summonses issued and outstanding at 31.12.54 — — Summonses withdrawn—notices complied with 24 12 (4) (1) Proceedings pending 25 — Total 169 123 (The figures in brackets are the notices withdrawn and reserved). Housing Repairs and Rents Act, 1954 Certificates of Disrepair This Act provides that landlords may increase the rent of their tenants when the house is in "good repair". On the application of tenants, Sanitary Inspectors inspect the dwellings and if it is not in good repair, the Council must issue a certificate. Until the defects are remedied, the landlord is not entitled to the increase. Between August 30th and the end of the year there were 95 applications for certificates of disrepair and 94 were granted; only 12 were revoked during the year. It was anticipated that there would be a much larger number of applications because there are many weekly tenancies in Willesden which are in disrepair. It appears that landlords in Willesden have not generally demanded an increase in rent, possibly because they might find it difficult to fulfil the conditions for putting the house in "good repair" and the tenants' application for a certificate of disrepair might produce a notice from the Council to carry out extensive repairs. Properties which have fallen much below the "good repair" standard do not seem to have been appreciably affected by this part of the 1954 Act. In Willesden the extensive use of the Housing Act, 1936, and the Public Health Act, 1936, has been much more effective in securing improvement to properties in a poor state of repair. Certificates of Disrepair under Housing Repairs and Rents Act, 1954 Applications received from tenants 114 Withdrawn by tenants 19 Number investigated 95 Granted 94 Refused 1 Applications for revocation certificates received from owners 12 Granted 12 Certificates of Disrepair under Rent and Mortgage Interest Restrictions Acts Applications received from tenants 19 Withdrawn 2 Granted 12 Refused 5 Application for revocation certificates received from owner 1 Granted 1 Summary of Nuisances and of Improvements Effected Water Supply and Water Service Inclusive of Housing Survey 1954 1953 New cisterns provided 25 29 Cisterns cleansed, repaired, covered, etc. 75 69 Draw Taps placed on mains 1 6 22 Drainage and Sewerage Water Closets: Repaired, supplied with water or otherwise improved 631 550 New closets built — 6 Provided with better ventilation 3 11 Drains: Examined, tested, exposed, etc. 267 240 Unstopped, repaired, trapped, etc. 316 341 New soilpipes or vent shafts fixed 77 42 Disconnecting traps or chambers inserted 21 24 Reconstructed 10 21 New manhole covers 57 79 Soilpipes or vent shafts repaired 162 185 Other Defects Smoke nuisances 6 5 Accumulation of refuse 105 98 Foul ditches, ponds, etc., and stagnant water — Fowls, pigs, etc., kept in an insanitary condition 14 22 Dampness 895 1,388 Yard and forecourts paved, repaved or repaired 366 370 Walls and ceiling cleansed 2,090 3,382 Verminous rooms disinfested 246 362 Leaky roofs made watertight 1,176 1,490 Additional ventilation provided under floors 93 122 Dilapidated plaster repaired 2,011 2,998 Flooring and other woodwork repaired 1,147 1,475 Damp proof courses inserted 75 56 Water supply reinstated 75 37 Wash-house floors repaired or repaved 57 Fireplaces and stoves repaired 809 1,170 Decayed brickwork repaired and repointed 995 929 Sinks provided or replaced 224 251 Additional light and ventilation to staircase 2 Larders or food cupboards ventilated or provided 4 69 Gutters and/or rainwater pipes repaired or renewed 1,136 1,202 New sashcords and glass provided to doors and windows 2,690 3,184 Miscellaneous 677 851 Total nuisance abated 16,538 21,100 Inspection of Other Premises 1954 1953 No. Inspected Inspections made No. Inspected Inspections made Slaughterhouse (1 registered but not in use) 1 1 — — Common lodging houses — — — — Offensive trades — — 1 1 Power factories 654 727 602 697 Non-power factories 76 103 71 95 Workplaces—other than outworkers 5 5 4 4 Homeworkers and outworkers 405 405 245 245 Inspection of food premises (includes re-visits) Baker 38 203 38 184 Bread and confectionery 37 141 38 107 Dairy 10 73 10 64 Butcher 115 414 115 364 Grocer and general store 320 772 315 826 Fishmonger and fish-fryer 61 217 60 197 Cafe and restaurant 153 559 151 511 Greengrocer and fruiterer 126 269 125 366 Ice cream and sweet shop 183 407 180 375 Food stall 17 28 19 17 Public house 44 117 44 71 Works canteen 112 244 111 253 Food factory 13 40 13 120 Any other food premises 25 106 25 117 Total periodic inspections 2,395 4,831 2,167 4,614 23 Other Inspections 1954 1953 No. Inspected Inspections made No. Inspected Inspections made Certificates of Disrepair under Housing Repairs and Rents Act, 1954, and Rent and Mortgage Interest Restrictions Acts — 123 — 26 Public house urinals 44 301 44 173 Mews and stables 29 85 29 94 Miscellaneous — 1,490 — 1,652 Smoke observations 34 249 29 177 Verminous rooms 82 131 109 192 Total other inspections 2,379 2,314 Total all inspections (inclusive of Housing Survey) 30,160 33,218 Smoke Nuisance The problem of atmospheric pollution was fully dealt with in the annual report of 1953. In the results of the measurement of grit and sulphur oxides in the atmosphere show that there is no improvement in the areas around the three power stations (Tables 1 and 2, Page 24, and Fig. Page 25). The Council considered the findings of the Beaver Committee and suggested the following amendments:— "Recommendation 1, para. 121. This recommendation is to the effect that, subject to certain exceptions, the emission of dark smoke from any chimney should be prohibited by law. The exceptions envisaged by the Committee would almost destroy the application of the general rule, and we feel that there should be no defence whatsoever against the emission of dark smoke for more than two minutes and that if under exceptional circumstances dark smoke is emitted for more than two minutes and there are extenuating circumstances, the owner of the chimney concerned should nevertheless be guilty of an offence and according to the bona fides of his explanation would receive a lighter or heavier penalty. We, however, feel that the only excuses for emitting dark smoke for a period of less than two minutes should be those envisaged in the report, namely, because such emission was solely due either:— (a) to lighting up a furnace from "cold", and in doing so using all reasonable care and efficiency; or (b) to temporary mechanical failure which could not have been foreseen, and where it was not reasonable to have standby equipment. We also consider that the implied sanction given to soot-blowing should be withdrawn and sootblowing should be made an offence. There can, in our view, be no excuse whatsoever for any person to have a licence to blow soot from his own property on to that of others. Recommendations 2 and 4; para. 121 These deal with new industrial installations. We consider that it is absolutely necessary that plans for the installation of any new fuel burning equipment should be submitted to and approved by the local authority, and we completely disagree with the view that the submission of these plans should not be compulsory. The installation of adequate equipment at the outset is a prerequisite of proper smoke control. The recommendation suggests that the highest duty on industrial users of solid fuel of a less rate than ten tons an hour is to take all reasonably practicable steps to prevent the emission of grit and dust. This does not agree with the general view set out in the report, and to place the duty no higher than that mentioned infers that the defence of reasonable practicable means will continue to be available. We suggest this defence should not apply. Recommendation 3, para. 121 In certain industrial processes in which the prevention of dark smoke, grit or harmful gases presents special technical difficulties the Report recommends that responsibility for ensuring that the best practicable means of prevention are used at all times should be vested in the Alkali Inspectorate and the provisions of the Alkali Acts should be extended accordingly. It is envisaged under the report that the control of power stations should pass to the Inspectorate, and is stated that air pollution knows no boundaries, but its origins are local. We feel there is no justification for this transfer whatsoever and at the most the Minister should hold default powers where a local authority fails to take any action. Recommendation 5, para. 121 It is suggested in this recommendation that the law for the control of smoke from railways should be brought up to date and strengthened; responsibility for enforcement resting with the local authorities. The report allows the British Transport Commission the defence that all practicable steps are taken to prevent an offence. We feel that this defence will largely nullify the efficacy of any new control, and should be deleted. 24 Recommendation 6, para. 122 It is recommended that the most practicable efficient methods of removing sulphur from flue gases should be adopted at all power stations in or near polluted areas. The only remedy suggested for sulphur is very intensive research. We are of the opinion that the Government should make it obligatory on every installation burning over 50,000 tons of fuel per annum to install gas-washing plant or other approved appliances, so as to remove not less than 90% sulphur from the gases, and further that this should be applied to existing as well as new installations. We recommend that, in addition, action should be taken to prevent the remainder of sulphur from the gases being deposited in the neighbourhood." Whether the recommendations of the Beaver Committee or amendments to them are incorporated in the new Act, one thing is abundantly clear—a new Act is urgently needed. Unless the Council is given greater powers to deal with atmospheric pollution it may have to face a situation similar to that in 1952, when there was a severe fog and the total deaths in Willesden during the nine week period were almost 50% more and deaths from bronchitis five times greater than in Dorset (Tables 3 and 4), Even in a year without a severe fog, total deaths in Willesden are 20% more, deaths from pneumonia 50% more, and from bronchitis two and a half times greater than in Dorset (Tables 3 and 5). Although, of course, overcrowding and poor housing conditions have a profound influence in producing these differences, atmospheric pollution undoubtedly plays an important part in causing a large number of deaths from bronchitis. TABLE 1 Monthly Deposits in Tons per square mile—1954 Power Station Acton Lane Taylors Lane Neasden Control Site Barrett's Green Road Minet Gardens Ascot Park Neasden Lane Press Road Wembley Trading Estate Town Hall January 21.96 42.32 18.11 24.26 13.25 16.53 15.67 February 40.66 83.15 24.30 41.45 33.27 35.66 24.93 March 31.38 52.56 18.44 31.68 18.59 23.74 21.77 April 16.40 20.35 12.31 14.15 33.47 12.09 10.20 May 27.85 47.42 21.37 26.18 - 26.80 19.10 June 23.58 56.23 13.93 16.40 28.53 12.08 11.19 July 12.18 59.51 8.03 13.41 25.25 11.72 9.55 August 21.37 31.15 19.89 21.73 29.99 19.36 19.56 September 22.19 53.75 13.63 25.75 25.45 11.95 14.52 October 20.68 117.42 17.75 26.61 25.02 19.46 13.76 November 45.74 89.01 52.59 50.40 55.28 41.16 37.01 December 22.95 67.37 25.88 28.83 30.02 18.74 21.57 Total 306.94 720.24 246.23 320.85 318.12 249.29 218.83 TABLE 2 Examination of Sulphur by Lead Peroxide Method, 1954 Expressed in Milligrams of SO, per Day per 100 Square Centimetres Site January February March April May June July August September October November December Minet Gardens 2.93 3.33 3.05 1.58 1.45 0.97 0.97 1 :48 1.92 3.39 3.96 3.42 Town Hall 3.08 3.28 2.95 1.41 1.05 0.65 0.67 1.26 1.41 1.92 3.55 3.02 25 TABLE 3 Total Deaths registered for weeks ended 15.11.52 to 10.1.53 inclusive, and corresponding period 1951/52 Dorset Actual. Willesden Standardised, Actual in Brackets. Week ended 1952/53 Corresponding period 1951/52 Dorset Willesden Dorset Willesden 15.11.52 55 63 (39) 49 56 (35) 22.11.52 61 81 (50) 55 56 (35) 29.11.52 62 79 (49) 54 64 (40) 6.12.52 69 119 (74) 65 66 (41) 13.12.52 86 169 (105) 64 92 (57) 20.12.52 70 108 (67) 63 99 (61) 27.12.52 55 97 (60) 56 66 (41) 3. 1.53 80 101 (63) 70 76 (47) 10. 1.53 77 90 (56) 82 85 (53) 615 907 (563) 558 660 (410) 26 TABLE 4 Deaths for weeks ended 15.11.52 to 10.1.53 inclusive and for corresponding period in 1951/52 Dorset Actual. Willesden Standardised, Actual in Brackets. Age groups 1952/53 1951/52 Pneumonia Bronchitis Other respiratory diseases Pneumonia Bronchitis Other respiratory diseases Dorset Willesden Dorset Willesden Dorset Willesden Dorset Willesden Dorset Willesden Dorset Willesden 0— 1 3 — (-) 1 2 (-) — — (-) 3 5 (3) — — (-) 1 — (-) 1— 5 — (-) — (1) — (-) 1 (-) 1 (-) — (-) 5—15 — — (-) — — (-) — 2 (1) — — (-) — — (-) — — (-) 15—25 — — (-) — — (-) — — (-) — — (-) — — (-) — — (-) 25—45 1 1 (1) 1 1 (1) 1 — (-) 4 1 (1) — — (-) — 1 (1) 45—65 7 16 (10) 8 35 (22) 1 — (-) 12 5 (3) 4 13 (8) — — (-) 65—75 17 10 (5) 9 46 (23) 1 — (-) 12 8 (4) 10 14 (7) 3 2 (1) 75 and over 34 25 (9) 14 95 (34) 3 8 (3) 19 20 (7) 15 47 (17) — — (-) Total 62 52 (25) 33 179 (81) 6 10 (4) 51 39 (18) 30 74 (32) 4 3 (2) TABLE 5 Deaths, 1951 Dorset Actual. Willesden Standardised, Actual in Brackets. Age groups Pneumonia Bronchitis Other respiratorv diseases Dorset Willesden Dorset Willesden Dorset Willesden 0— 1 13 18 (10) — 3 (2) 1 — (—) 1— 5 2 (1) 1 (—) — (—) 5—15 1 — (—) — — (—) 1 — (—) 15—25 1 — (—) — — (—) — — (—) 25—45 2 7 (5) — — (—) 3 1 (1) 45—65 17 28 (18) 30 74 (47) 9 13 (8) 65—75 36 41 (18) 32 118 (59) 10 10 (5) 75 and over 90 140 (50) 82 213 (76) 18 11 (4) Total 162 234 (102) 145 408 (184) 42 35 (18) 27 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 The Sanitary inspectors inspect verminous premises and supervise the work of the disinfestors employed by the Council (Section 83 of the Public Health Act, 1936). Bedding materials are disinfested at the steam disinfector at the Neasden Hospital (Section 84 of the Public Health Act, 1936). (a) Verminous premises: Council properties 19 County Council Properties — Private properties 105 Total 124 (b) Verminous rooms:* Council properties 41 County Council properties — Private properties 205 Total 246 *Some rooms are treated more than once. (c) Bedding materials 23 (d) Miscellaneous: Beetles in canteens, etc. 8 Ants 2 Crickets 1 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 194 Borough Council properties 22 Private dwellings 901 Total 1,117 at the following cost: Business premises £1,346 16s. 5d. Private dwellings £1,516 2s. 8d. Total £2,862 19s. 1d. The cost of disinfestation at business premises is recovered from the occupiers, and in 1954, 102 had an annual agreement with the Council for regular inspection and disinfestation; 14 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. 28 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 refuses or cancels a registration, the owner can appeal first to them and, if unsuccessful, to a court of summary jurisdiction. No applications for registration of premises for the manufacture of preserved food, etc., were received in 1954. Premises on register 31.12.53 No. of applications received No. of applications granted No. of applications refused No. of premises removed from registration during 1954 Total on register at 31.12.54 Inspections made Sale and storage of ice cream 281 22 22 — 6 297 311 916 Manufacture of ice cream 16 — — — 2 14 82 Manufacture of preserved foods 117 4 4 — — 121 304 Fish curing 10 — — — — 10 41 Ice Cream Ice cream sold within the Borough reaches a high standard of purity. Most of it is manufactured outside the district and is usually pre-packed. Twenty-eight samples were taken in 1954, and these proved to be satisfactory. Clean Food Guild The Willesden Clean Food Guild, formed in May, 1948, continued its work of improving food hygiene standards. Certificates are held by 369 food traders, about 32 per cent. of those eligible. During the year the Food and Drugs (Amendment) Act, 1954, became law, but the 'appointed day' when it will come into operation was not fixed. This created an atmosphere of uncertainty about the future of Clean Food Guilds generally, and their continuance depends to a large extent on the scope of the regulations to be made under the Act. 1949 1950 1951 1952 1953 1954 Totals Applications received 263 135 8 16 26 14 462 Premises registered and certificates issued 195 107 19 10 24 14 369 Applications deferred or refused 68 28 3 7 2 — 108 Previously refused, now issued with certificate — — 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 54 47 7 Cafe or restaurant 151 77 52 25 Dairy 10 5 5 — Fishmonger or fish-fryer 60 19 12 7 Greengrocer and fruiterer 125 18 16 2 Grocer and general store 315 175 148 27 Ice cream and sweets 180 53 41 12 Works canteen 111 33 31 2 Food factory 13 8 8 — Totals 1,156 462 369 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. 29 Improvements in Premises During the year contraventions of the Food and Drugs Act, 1938, and Food Handling Byelaws, discovered in the extensive surveys of 1950 and 1951 have been remedied with some exceptions in the provision of constant hot water supplies. In 1954, an additional 44 traders were encouraged to provide constant hot water but 24 premises still have an unsatisfactory supply. In all other cases traders complied with requests or notices, and legal action was not necessary. Inspections 2,650 Re-visits 938 Total 3,588 Premises unsatisfactory on 31.12.53 72 Unsatisfactory during the year 413 Premises made satisfactory during the year 420 Unsatisfactory on 31.12.54 65 Defects Outstanding at 31.12.53 During the year Total Remedied during year Outstanding at 31.12.54 Inadequate lighting and ventilation 4 11 15 15 — Constant hot water not provided 44 24 68 44 24 Inadequate refuse storage 5 66 71 69 2 Insufficient sanitary accommodation 5 8 13 12 1 Inadequate storage 3 10 13 11 2 Defective walls and ceilings 5 89 94 82 12 Dirty walls and ceilings 13 194 207 182 25 Dirty hand towels — 74 74 71 3 Generally bad conditions — 31 31 26 5 Any other defects 22 133 155 136 19 Totals 101 640 741 648 93 Cafes, Restaurants and Canteens Improvement in the standards of hygiene in cafes, restaurants and canteens continued during the year. Two premises were provided with running hot water, leaving 2 with unsatisfactory supply. In 71, defective and dirty walls were repaired and redecorated. Education in Food Hygiene Lectures and talks, illustrated with film shows, filmstrips and bacteriological cultures, were given to canteens staff, social and political organisations and school-leavers. The Public Health Department and the Clean Food Guild displayed in the Social Services section of the Willesden Show, two stands on food hygiene, which attracted many people. Food Poisoning There were three outbreaks of food poisoning:— (a) The first occurred among members of the same family; 5 were affected and they speedily recovered. The causative organism was staphylococcal enterotoxin, which was found in a specimen of ham purchased by the family from a grocer's shop in the borough. The ham had been cooked by the grocer in a pressure cooker about seven days before the outbreak and kept in a bowl in a refrigerator. An assistant at the shop, who was complaining of a sore throat at the time of the outbreak, was swabbed and staphylococcus aureus was isolated. The phage-type was of the same pattern as that isolated from the ham. The assistant was referred to his own doctor for treatment, and his infection soon cleared up. (b) The second occurred in a factory, and affected 35 workers. The causative organism was Clostridium Welchii which was found in specimens of stewed neck and breast of mutton eaten at the staff canteen by all the affected people, who speedily recovered. The source of the infection was not found, although it was possible that the meat was already contaminated when it arrived at the canteen. The mutton was cooked and left to cool overnight, reheated and served the next day. Instructions were given to the canteen staff that to prevent food poisoning freshly cooked meat should be served hot, or after it had been cooled rapidly within 1½ hours; only refrigerated pre-cooked meat can be served with safety the following day, and meatstuffs boiled or stewed a day ahead of requirements should be well heated before serving. (c) The third occurred among members of the same family; 6 were affected, and in two cases the illness was severe. The causative organism was salmonella typhi-murium. The family returned from holiday with two members unwell. Details of the cases were sent to the medical officer of health of the district in which the boarding house where the family stayed was situated, but the source of the infection could not be traced. 30 Contaminated Food More cases of contaminated food have been brought to the notice of the Public Health Department. Eleven samples of food with foreign bodies were reported by the public. A caution was administered to three firms, but no action was taken in the other 8, because 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. Bacon 4,534½ lbs. Cooked 246¼ lbs. Tinned 3,660¾ lbs. Raw 3,296¾ lbs. Fish. Tinned 6,155 tins Raw 1,216¾ lbs. Vegetables. Tinned 6,016 tins Raw 127½ lbs. Fruit. Tinned 17,529 tins Raw 100¾ lbs. Bread, flower, cereals, etc. 128¾ lbs. Preserves 721½ lbs. Cheese 747½ lbs. Butter and fats 266¼ lbs. Eggs 60 Tinned milk 4,066 tins Miscellaneous. Baby food 1 tin Biscuits 13½ lbs. Chocolate cream 8 ozs. Chocolate tea cakes 9 tins Christmas puddings 14 lbs. Cocoa 13 tins Coffee 13 tins Coffee 4 bottles Cream 20 tins Custard powder 123 pkts. Dried fruit—dates 134 lbs. Dried fruit—prunes 66½ lbs. Dried fruit—sultanas 171 lbs. Egg powder 7½ lbs. Figs 12 pkts. Flacked rice 210 lbs. Flavourings 124 bottles Fruit juice 160 tins Fruit squash 3 bottles Glucose 1 pkt. Iced lollies 72 Icing 31 tubes Jelly cream 2½ ozs. Jelly powder 37 pkts. Ketchup 3 jars Meat puddings 9 tins Mincemeat 24 tins Minerals 2 bottles Mint sauce 9 jars Nuts 4 pkts. Paste 64 jars Pickles 12 bottles Puddings 51 tins Pudding mixtures 403 pkts. Salad cream 1 tin Sandwich spread 5 jars Sauce 34 bottles Sausages 24 lbs. Soup 356 tins Spaghetti 6 tins Suet 24 pkts. Syrup 4 tins Tomato pulp 23 tons, 5 cwt. 90½ lbs. 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) Twelve retailers were responsible for the 12 samples found to be unsatisfactory—five were prosecuted, 3 officially cautioned; no action was taken against 4. The 4 unsatisfactory fish samples included two where smoked cod was sold as smoked haddock, one, haddock sold as hake, and one cod sold as hake. Thee fishmongers were prosecuted with fines and costs of £2 and £3 3s. 0d., £2 and £3 3s. 0d., and £1 (the shop manager was also fined £5 and £2 2s. 0d. costs for aiding and abetting); an official caution was issued for the remaining one. Official cautions were also issued to a retailer of 'pineapple jelly with added pineapple' deficient in pineapple, and to the importer of oranges containing an unauthorised preservative. The butcher who sold pigs' liver as lambs' liver was given an absolute discharge on payment of £3 3s. 0d. costs. No action was taken against three retailers for selling ice cream which was deficient in fat, sausages containing a permitted but undisclosed preservative, and a sample of 'pickled onions in vinegar' suspected of containing non-brewed condiment but not proved on further sampling. The unsatisfactory sample of rum contained 8% added water; the barman responsible was fined £10 with £4 18s. 0d. costs. At the end of 1953, a sample of cheese and macaroni was unsatisfactory because it contained a mixture of only about 50% cheese, and the ingredients were not listed on the packet. The manufacturers were fined £25 and £6 6s. 0d. costs on each count (Defence (Sale of Food) Regulations, 1943, and Labelling of Food Order, 1953). 31 Labelling of Food Order, 1953, and Merchandise Marks Acts, 1887-1953. 696 articles of food were examined under the Labelling of Food Order, 1953, but no infringements were discovered during the year. 2,087 displays of articles were examined under the Merchandise Marks Acts, 1887-1953, and several infringements were detected by the Department during the year. Two butchers who falsely described imported meat as English were fined £6 and £5 5s. 0d. costs, and £80 with no costs with an additional fine of £5 and £5 5s. Od. costs for failing to mark the origin of Australasian meat. A retailer who displayed imported turkeys without indicating their origin was fined £5 and £2 2s. 0d. costs. Two greengrocers who failed to mark the origin on imported tomatoes were fined £3 and £1 1s. 0d. costs, and £10 with no costs respectively. One of these was also fined £10 and £5 5s. Od. costs on a further summons concerning imported apples. Two other greengrocers were officially cautioned for similar offences. 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) 223 1 Acetic acid 1 — Almonds 1 — Arrowroot 10 — Butter 1 — Cakes 35 — Cake Mixture 2 — Cheese 1 — Chops 1 — Cocoa 1 — Coffee and Chicory essence 8 — Cooked meats 64 — Cream 5 — Curry powder 1 — Dressed crab 1 — Drugs 36 — Fish 39 4 Fish cake 3 — Fish paste 4 — Flavoured cherries 1 — Fruit drink 4 — Gelatine 1 — Ice cream 21 1 Iced lolly 2 — lams 3 — Jelly 7 1 Lard 2 — Liver 8 1 Margarine 1 — Meat paste 4 — Meat pie 13 — Minced meat 25 — Mint sauce 1 — Mustard 1 — Oranges 16 1 Peanut butter 1 — Pickles 2 1 Sausages 52 1 Sausage meat 3 — Self raising flour 1 — Soups 2 — Sweets 7 — Tea 1 — Tinned fruit 1 — Tripe 1 — Victoria plums 1 — Vinegar 32 — White pepper 1 — Wines and spirits 17 1 Yeast 1 — Total 670 12 32 Milk and Dairies Milk sales are regulated by the Food and Drugs Act, 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, or terberculin tested; the sale of raw milk has been prohibited since October, 1951. On October 1st, 1954, the provisions of paragraph 7 of Second Schedule to the Milk (Special Designations) (Pasteurised and Sterilised Milk) Regulations, 1949, came into force. This restricts the bottling of milk to the three premises in the borough where the milk is pasteurised. Dairies—Registration and Licences Premises in Willesden 110 Dairymen 86 Licences issued. Pasteurised milk 87 Sterilised milk 104 Tuberculin tested milk 74 Premises outside Willesden 12 Dairymen 6 Licences issued. Pasteurised milk 12 Sterilised milk 12 Tuberculin tested milk 12 Frequent inspections are made of the dairies. During the year some minor defects were found but were speedily remedied. Milk sold in the Borough is clean and pure. 163 samples of milk and 10 of single cream were taken in 1954; all were satisfactory. FACTORIES There are 905 factories in the Borough, an increase of 1 over the previous year—an increase of power factories from 825 to 827, but a decrease in non-power factories from 79 to 78. Type of factory On register 1.1.54 Added to register Deleted from register Totals at 31.12.54  Non-power 79 6 7 78 Power 825 34 32 827 Total 904 40 39 905 The general improvement in the sanitary conditions of factories for which the local authority is responsible (see 1949 annual report) has been maintained. Most notices were served for minor defects only, and they were complied with without legal action. Factories Inspected, Defects Found, and Action Taken Type of factory Inspected Total Inspections Unsatisfactory Outstanding from 1953 Made satisfactory 1954 Outstanding 31.12.54 Non-power 76 103 9 1 10 _ Power 654 727 81 5 69 17 33 Details of Defects in Non-Power Factories: During 1954 Outstanding from 1953 Remedied during 1954 Outstanding at 31.12.54 Want of cleanliness 4 — 4 — Overcrowding — — — — Unreasonable temperature — — — — Inadequate ventilation 2 1 3 — Defective drainage of floors — — — — Sanitary accommodation: Insufficient 1 — 1 — . Unsuitable or defective 4 — 4 — Not separate for sexes — — — — Details of Defects of Sanitary Accommodation in Power Factories : Insufficient 1 — 1 — Unsuitable or defective 86 5 71 20 Not separate for sexes 1 — 1 — There are 15 underground rooms used as factories; 13 are used 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 nine basement bakehouses in Willesden. They have been regularly inspected and are satisfactory, but one of them has not been used since June and it will be officially closed if it is not used for baking purposes for another 6 months. During the year 1 basement bakehouse which had not been used for baking purposes for over 12 months, was officially closed and may not be used again as a bakehouse. Outworkers and Homeworkers In February and August of each year, factory owners send to the local authority lists of the names and addresses of all persons who work at home for them on certain jobs, including those who have worked for them during the previous six months. 405 outworkers' premises were inspected in 1954, and two were found to be unsatisfactory. Notices were served and the defects remedied. NOISE NUISANCE The Borough Council deals with noise nuisances under Section 313 of the Middlesex County Council Act, 1944 (see 1950 annual report). Three complaints were outstanding at the beginning of the year (a) High-pitched whine and clanging from extractor fans in power station. The noise was reduced by lining with insulating material the walls and doors of the building housing the plant. (b) Noise at night from plastics-pressing machinery. After consultation, the management stopped night work. (c) Noise from cutting-in of refrigerator. This was investigated on several occasions but it did not constitute a statutory nuisance. Sixteen complaints were made during the year, but only twelve could be considered statutory nuisances. One was a further complaint about (a) above, and was made before the building was insulated. Four were about noise caused by motor-car repair firms working in Mews premises. After consultation, the owners reduced the degree of noise and altered the times of working. In the remaining seven the noise was reduced or abated by various simple methods, such as restricting the hours of operating machines to the daytime, keeping doors and windows of the factory closed during the night, and replacing worn parts. Occupational Health Service The Borough Council introduced an occupational health service for their employees in April. Sanitary inspectors visit offices and workplaces at least once a month to supervise working conditions, in particular canteens, rest rooms, cloakrooms and first aid equipment. They carried out a survey initially and notified defects to the chief officers concerned. By the end of the year, 50 per cent. of these defects had been remedied. Many defects had to be left until the beginning of the financial year 1955/56, because of the cost required to remedy them. Sites for first aid boxes were selected, and their contents, including a first aid leaflet (Form 923) issued by the Factory Department, were based on the requirements of' the 34 Factories Act. Chief Officers nominated suitably qualified persons to be in charge of first aid. Notices with the names and addresses of the nearest medical practitioners and hospital were placed in a prominent position so that in an emergency cases could be referred without delay. Chief officers referred to the medical officer of health employees who have been regularly absent from work on account of sickness. Employees suffering from disability or chronic illness may apply direct to the medical officer of' health; three were referred by chief officers, and one applied for a consultation. CARE OF THE AGED As the proportion of old people in the population increases, we must extend our medical and welfare services to care adequately for them. Most of them can manage to look after themselves; some, however, require help to keep them comfortable and happy in their own homes, and a small minority cannot be adequately cared for except in a hospital or institution. The local health authority provides home nurses and home helps and health visitors, who investigate the needs of old people and arrange for the necessary services to be given. Consultation often takes place between the medical practitioner, the geriatric physician, the welfare officer and the medical officer of health before an aged person requires to be admitted to a hospital or an institution. It is now easier to obtain 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 are used when the old person, against his own interests, refuses to go into a hospital or hostel. The provisions of the National Assistance Act, 1948, and the National Assistance (Amendment) Act, 1951, were outlined in the annual report for 1953. No action was necessary under the Acts during 1954. Laundry for the Aged The care of incontinent old people places a heavy burden on their relatives. The washing of soiled linen in cramped accommodation, with poor facilities for drying, is often the last straw, and the relatives then apply for the old person's admission to an institution. One way of postponing this unpopular event is to do their laundering. It is much more economical and humane to provide reasonable facilities for old people in their homes than to transfer them to institutions. In April, 1952, the Council organised a laundry service for incontinent old people free of charge, under Section 84 of the Public Health Act, 1936. The articles are laundered and ironed at a cost of 4¼d. per lb. at the Neasden Hospital by arrangement with the Central Middlesex Hospital Management Committee, and transport is provided by the Borough Council. Number of Old People using Laundry Service On register 1.1.54 New cases Died Admitted to hospital Left district Recovered On register 31.12.54 14 17 5 12 1 1 12 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 this work 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 it. The 49' Club organised by the Willesden Old Folks' Association, celebrated its second anniversary on the 28th February, 1954. The Club is open daily from 1.30 p.m. to 10.0 p.m. The membership is now 475, and applications continue to be received. 165 members and helpers went on a summer outing to Clacton on the 6th September, 1954. Voluntary workers made regular visits at weekly or fortnightly intervals to 36 old people. This service is greatly appreciated by lonely people, but many more visitors are required. The visitors delivered a gift of 5/- or Christmas fare from the Association to them at Christmas. Four well-attended Christmas parties were held at the Anson Hall, Cricklewood, and were thoroughly enjoyed. More than 1,000 invitations were sent out, and 860 old people attended the parties. A high tea and entertainment were provided and they were given a gift of 2/- each. There was a great extension in the free chiropody service. The Association arranged for 25 old people per week (compared with 8 in 1953) to be treated by the two chiropodists in the Kilburn and Harlesden areas free of charge. There were 250 on the Register for treatment, some of whom had regular monthly treatment. The chiropodist in Kilburn also visited old people confined to their homes. 50 old people were on Register for periodic treatment compared with 4 in 1953. On the recommendation of the Welfare Officer, free coal was supplied to old people who could not afford it. The Willesden Division of the British Red Cross Society, the Women's Voluntary Services, religious and other organisations in the area run clubs for the old folk, and their members visit them in their homes. The meals service organised by the Women's Voluntary Services is probably the most important service for old people. The Old Folks' Morning and Luncheon Club, which opened at the Presbyterian Hall, Granville Road, Kilburn, on the 31st January, 1952, provides old people with hot meals. The cost of a lunch was kept at 1/-, with tea at l½d. per cup and coffee 2½d. per cup. 13,019 meals were served during 35 the year, compared with 13,605 in 1953. The meals-on-wheels service organised from the same premises, served 5,298 meals during the year to old people in their homes, compared with 4,720 in 1953. This is an 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. discover the other needs of old people such as clothing or little extras of comfort. Publicity of Services for the Aged There are many services in the area available for old people, but no uniform way of presenting them to the public. In October the Council, after consultation with the Willesden Old Folks' Association, therefore decided to publish 10,000 copies of a booklet describing all the services available for old people. S.O.S. Card Scheme The Council also introduced an S.O.S. card scheme. An old person requiring help urgently can display a card in the window to attract attention. The cards will be distributed through the Willesden Old Folks' Association, the National Federation of Old Age Pensions Associations, and many old people's clubs to old people living alone. BURIAL OF THE DEAD In accordance with the provisions of' Section 50 of the National Assistance Act, 1948, arrangements were made for the burial of 8 persons during the year. The total cost to the Council was £95 2s. 6d. of which £12 was recovered by the Borough Treasurer. The cases came to the notice of the department from the following sources : Private doctor 1 Friends or relatives of deceased 6 Coroner's Officer 1 PUBLIC MORTUARY 425 bodies were dealt with at the mortuary as follows:— Post-mortem and inquests 78 Adjourned inquests 34 Total post-mortems 425 (Section 198 of the Public Health Act, 1936.) In 1950 and 1951 all inquests on Willesden residents whose bodies were sent to the Mortuary for post-mortem examination were held in the Coroner's Court attached to the Mortuary. In 1952 only 50 per cent. of these inquests were held in the court, and in 1953, 36 per cent. The remainder were held in the Coroner's Court at Ealing, with some inconvenience to relatives and friends of the deceased. From the 1st January, 1954, to the end of March, 1954, of 13 inquests held on Willesden residents, 12 were at Ealing and only 1 at Willesden. The Council therefore made representations to the Middlesex County Council and the Home Secretary. Although there was some improvement, three out of four inquests were held at Ealing. Inquests on Willesden Residents 1950 1951 1952 1953 1954 At Kilburn 54 49 25 12 13 (1)* At Ealing — — 26 21 37 (12)* 54 49 51 33 50 (13)* *Figures in brackets: 1.1.1954—31.3.1954. 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). One hawker was registered during 1954, making a total of 22. Fruit and vegetables 19 Fish 2 Miscellaneous 1 Total 22 COMMON LODGING HOUSES There are now no common lodging houses in the district registered under Section 237 of the Public Health Act, 1936. 36 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 1954. RAG FLOCK AND OTHER FILLING MATERIALS ACT, 1951 The Rag Flock and Other Filling Materials Act, 1951, and the Rag Flock and Other Filling Materials Regulations, 1951, came into operation on the 1st November, 1951. The Regulations specify the standards of cleanliness for the filling materials, the analysis for the tests, the fees which may be charged by the analyst, and the form of records to be kept by the occupiers of the premises registered and licensed under the Act. The premises of manufacturers of rag flock and those used for storing rag flock require to be licensed by the local authority; the fee and the renewal fee is £1 0s. 0d. for a period not exceeding twelve months. The premises of persons carrying on business of upholstering, stuffing or lining of bedding, toys and baby carriages, and other using filling materials specified in the Act, have to be registered; only one fee of £1 0s. 0d. is chargeable. Premises Registered On register 1.1.1954 Registration approved Removed from register Totals at 31.12.1954 7 9 1 15 Of the nine new registrations, seven were from persons employed on soft toy making in their own homes, and two from upholsterers. Three samples of materials used were submitted to the analyst and they proved to be up to standard. There are no premises in Willesden which required 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. PET ANIMALS ACT, 1951 Pet shops must now have an annual licence on payment of a fee not exceeding 10/-. During 1954, 16 were licensed, and they were inspected by both sanitary inspectors and Shops Act inspectors. Sanitary Inspectors inspect premises for size, temperature, lighting, ventilation and cleanliness, and for the precautions taken for preventing spread of infectious disease. STAFF MEDICAL EXAMINATIONS Forty-two staff medical examinations were carried out by the Medical Officer of Health and Deputy Medical Officer of Health in 1954. 37 HEALTH SERVICES OF OTHER AUTHORITIES IN THE AREA Hospitals 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 and 1953 reports. Liaison with Hospitals Arrangements were made for an Assistant Medical Officer of Health to attend the Paediatric Out-Patients Department at the Central Middlesex Hospital, and for the Paediatric House Physician to do the work of the Assistant Medical Officer of Health, as from the 2nd November, 1953. These arrangements have been working very satisfactory and have brought the work of the two departments more closely together. Personal Health Services 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 Care of the Expectant Mother. During 1954, 1,911 expectant mothers (72.0% of the total) attended the local ante-natal clinics staffed by assistant medical officers (Table 1). Expectant mothers require adequate ante-natal care throughout pregnancy, and close co-operation therefore exists between general practitioners, staffs of hospitals, assistant medical officers, midwives, and health visitors. Health visitors make the initial arrangements for hospital and domiciliary confinements at the local clinics. (Table 2.) Mothers booked for confinement in Paddington Hospital or at home, have specimens of blood taken by assistant medical officers for Wasserman reaction, blood grouping and Rhesus factor. All expectant mothers are invited to attend the mass X-ray unit at Central Middlesex Hospital. Health visitors conduct mothercraft classes on the care of the expectant mother, the birth, and the child (one afternoon a week at the main clinics). They arrange carefully planned programmes of talks and demonstrations, which are given by the assistant medical officers, health visitors and midwives. Mothers are encouraged to ask questions, and interesting discussions follow over a cup of tea. In addition, the health visitor in one clinic gives instruction in knitting, cutting out and sewing. In 1954, 126 mothercraft classes were held with an average attendance of 11 mothers a session; 205 mothers attended for the first time. (Table 3.) The physiotherapist conducts ante-natal relaxation classes on two afternoons a week in the orthopaedic department at Stonebridge health clinic. Mothers appreciate these classes very much, and arrangements have now been made for a class to be held once a week in the Kilburn health clinic. (Table 4.) Health visitors and midwives encourage mothers to have post-natal examination six weeks after confinement, either at the hospital, at the clinic, or by her general practitioner. Health visitors make follow-up visits where mothers fail to keep appointments at the hospital or clinic. Child Welfare Clinics. Child welfare sessions are held on five afternoons a week in the three main clinics and on two afternoons a week in the two Church Hall clinics. The average number who attended each session was 34, (Table 5.) Assistant medical officers and health visitors give advice on the feeding, hygiene and general management of infants and young children. The doctors immunise children under one year against diphtheria and whooping cough. Greeting cards are sent to children on their first and second birthdays, inviting their mothers to bring them to the clinic for routine yearly examinations and a tuberculin patch test. Mothers appreciate these greeting cards. When treatment is required, assistant medical officers inform general practitioners. A mothers' club is held in the Kilburn health clinic 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 and demonstrations on health and homecraft, which are given by assistant medical officers, health visitors, and outside speakers. 38 Table 1 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 153 481 52 1,857 52 12.5 Willesden 152 505 47 2,390 49 16.0 Stonebridge 204 602 47 3,087 47 15.4 Cricklewood 52 177 69 718 85 15.4 Neasden 52 146 51 786 51 16.1 Totals:1954 613 1,911 266 8,838 284 14.9 1953 588 1,850 302 9,184 322 16.2 Table 2 Births Hospital and Domiciliary 1953 1954 Total notified live births 2,642 2,608 Born in institutions 2,176 2,225 Born at home 466 383 Percentage born in institutions 82.4 84.3 Institutions Central Middlesex Hospital 1,175 995 Kingsbury Maternity Hospital 374 362 Larger hospitals outside Willesden 397 574 Smaller hospitals outside Willesden 202 271 Nursing homes, etc. 28 23 Total 2,176 2,225 Home County midwives 397 340 Queen Charlotte's midwives — — Willesden District Nursing Association 52 19 Others 17 24 Total 466 383 Table 3 Mothercraft Clinic No. of sessions No. of new cases Total attendances Average attendance per session Kilburn 41 56 354 10.0 Willesden 34 56 312 10.8 Stonebridge 51 93 486 11.6 Totals: 1954 126 205 1,152 10.8 1953 129 276 1,833 14.2 39 Table 5 Infant Welfare Clinics Clinic No. of sessions No. of 1st attendances under one year old (Percentages of total births in brackets) No. of attendances Total attendances Seen by doctor Average attedance per session Under 1 1—2 2—5 Kilburn 336 590 6,639 948 997 8,584 4,364 25.6 Willesden 256 483 7,270 792 118 9,180 5,492 35.9 Stonebridge 305 598 7,072 970 881 8,923 5,377 29.2 Cricklewood 104 250 3,526 720 466 4,712 1,639 45.3 Neasden 100 245 4,415 984 572 5,971 2,082 59.7 Totals: 1954 1,101 2,166 (81.7) 28,922 4,414 4,034 37,370 18,954 33.9 1953 1,254 2,437 (90.3) 28,953 4,515 3,640 37,108 18,912 29.6 DISTRIBUTION OF WELFARE FOODS In June, 1954, the local offices of the Ministry of Food were closed, and the Middlesex County Council then had the responsibility of distributing welfare foods, national dried milk, cod liver oil, orange juice and vitamin tablets. The Middlesex County Council took over distribution centres and opened others; nine centres are now available in Willesden. In addition, Smiths (M.A.) Limited of Cricklewood continued to distribute welfare foods at the factory for mothers working there, and from the 3rd August, 1954, facilities were provided at four day nurseries for mothers of children attending the nurseries. The W.V.S. helped to staff the centres; they not only continued to provide the staff at their own premises, but also undertook to run three other centres. MIDWIFERY SERVICES At the beginning of the year, seven midwives were employed in Willesden; five by the County Council and two maternity nurses by the Willesden District Nursing Association. In June, 1954, the Willesden District Nursing Association ceased to provide maternity nurses; the County Council appointed another midwife, making a total of six midwives. 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 work under the supervision of midwives who are approved midwife teachers. The general practitioner and the midwife supervise the care of the expectant mother. When a mother chooses both a general practitioner and a midwife for her confinement, the doctor supervises the care of the expectant mother, and arranges for the taking of a blood specimen and a routine chest X-ray. The midwife examines the mother at her special clinic (Table 1), visits her at home, and ensures that everything is prepared for the confinement. A mother who chooses a midwife only for her confinement attends the local health clinic, where the assistant medical officer makes the initial medical examination, takes a blood specimen, and arranges for a chest X-ray. She then attends the midwife's clinic regularly throughout her pregnancy, and is instructed on the use of the apparatus for gas and air analgesia. The assistant medical officer examines the mother again at the 36th week of pregnancy and gives a certificate of fitness for gas and air analgesia. The midwives administered analgesia to 287 mothers (80%), and pethidine was given to 117 mothers (33%) of the 358 confinements. 251 of the 287 mother who had gas and air analgesia during labour had substantial relief from pain. (Table 2.) Midwives work very closely with general practitioners. Midwives attended at 358 confinements; both a general practitioner and a midwife were booked for 195, and both were present at 55. (Table 3.) When a midwife attends a case on her own and requires help, she must call in a doctor, according to the rules of the Central Midwives Board. The midwives called in doctors 90 times. (Table 4). For serious emergencies, the midwife or doctor calls the Central Middlesex Hospital for the obstetric flying squad, consisting of an ambulance, a doctor, a nurse, two ambulance men, and blood transfusion apparatus. The flying squad was called out three times during the year, once for ante-partum haemorrhage and twice for post-partum haemorrhage. The Hammersmith Hospital premature baby unit provides a special ambulance for transporting premature babies who require treatment in their unit. The ambulance is accompanied by two qualified nurses with special training in the care of premature babies, and it carries a special equipment including a fitted cot and apparatus for administrating oxygen. The ambulance is sent for at the request of the doctor who has been called for medical aid by the midwife. Five babies were admitted to the unit during the year. Table 1 Midwives Clinics No. of sessions held No. of new cases Total attendances Average attendance per session 1954 289 497 3,116 12.5 1953 319 569 3,787 11.9 40 Table 2 Midwives—Administration of Gas and Air Analgesia 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 243 - 243 (b) When doctor was present at delivery 44 - 44 Number of cases in which pethidine was administered in domiciliary practice during the year:— (a) When doctor was not present at delivery 101 - 101 (b) When doctor was present at delivery 16 3 19 Totals : 1954 404 cases 3 cases 407 cases 1953 462 22 484 Table 3 Domiciliary Births 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 14th 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 1. County Council 6 155 38 140 9,751 12 63 300 2. Voluntary organisations under arrangements with L.H.A. in pursuance of Section 23 2 - 17 - 415 2 18 11 Totals : 1954 358 10,166 14 81 311 1953 435 13,876 43 260 375 Table 4 Medical Aid 1954 1953 (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 55 (ii) Others 35 39 (b) For cases in institutions — — Totals 90 94 41 Reasons for sending for Medical Aid For Mother For Child Ante-partum hæmorrhage 6 Asphyxiated baby (blue) 4 Delayed 2nd stage of labour 3 Asphyxiated baby (white) 3 Foetal distress 2 Cyanotic attack 1 Malpresentation 8 Discharging eyes 3 Miscarriage 1 Haemorrhage of' cord 1 Post-maturity 1 Jaundiced baby 1 Post-partum haemorrhage 3 Premature baby 5 Premature labour 4 Stillbirth 2 Pyrexia 3 Retained placenta 5 Ruptured perineum 34 Totals 70 20 Total 90 HEALTH VISITING The health visitor is the most important social worker for the care of expectant and nursing mothers and young children. Under the National Health Service Act 1946, her work has been extended to the whole family for their health education, and the prevention, care and after care of illness. Health visitors attend with the assistant medical officers at maternity and child welfare clinics, and at schools for medical inspections and routine hygiene inspections. They make enquiries for the special national surveys and help in the practical training of hospital student nurses and student health visitors from Middlesex, Battersea Polytechnic and the Royal College of Nursing. (Table 1.) The health visitors work in close co-operation with general practitioners, staffs of hospitals, children's officers, welfare officers, sanitary inspectors and other social workers. There has been closer co-operation with general practitioners since a document "The General Practitioner and the Health Visitor", was issued by the British Medical Association and The Society of Medical Officers of Health in January, 1954. General practitioners were informed of how health visitors could help them, and meetings were held to discuss suggestions outlined in the document. From June 24th, 1954, to 31st December, 1954, 17 general practitioners referred 28 families to health visitors for special reports and action. (Table2.) There is still a general shortage of health visitors. The establishment of health visitors for the Willesden part of the area is 30, but there were only an equivalent of 147/11 at the end of the year. To assist health visitors in their work temporary clinic nurses have been employed. They help at the clinic sessions and visit schools for medical inspections and routine hygiene inspections. An equivalent of 112/11 temporary clinic nurses were employed at the end of the year, making a total of 25 9/11 health visitors and clinic nurses. 42 Table 1 Health Visiting Work of Health Visitors 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 1954 945 1,391 2,653 10,788 4,049 8,120 701 733 4,837 1953 1,007 1,499 2,908 9,336 4,014 6,297 1,737 857 3,230 Table 2 Cases Referred by General Practitioners Number referred Type of case Care of children Elderly persons General advice Housing Home help Welfare foods Others 26 4 14 3 4 1 1 1 43 HOME NURSING On 30th June, 1954, the arrangements for administering the Willesden District Nursing Association Home Nursing Service for the County Council ceased; since 1st July, 1954, the Area Health Office has been responsible for the day-to-day administration. Before 1st July the nurses were resident in a nurses' home, but since 1st July they are non-resident and may be telephoned in their own homes for calls. The County Council has organised a district nurse training home for female candidates at 17 and 19, Park Avenue, Willesden, formerly used by the Association as a nurses training home. The candidates assist the home nurses in Willesden and gain experience in home nursing; they are included in the establishment of home nurses, and some are recruited into the service when they have finished their course. The home nurses work in close co-operation with general practitioners, who make the majority of the requests for home nursing care for their patients; many London hospitals also apply for home nursing care. The home nurses give various injections, general attention and care to medical and surgical cases, and nursing care to the aged and infirm. They exercise much common sense and ingenuity as well as nursing skill. Home Nurses Establishment Nurses As at 1.7.54 As at 31.12.54 Whole time 18 19 Part time 5 7 Candidates 7 6 Total whole time equivalent 241 26 Work of Home Nurses No. of New Cases Total No of home visits paid No. of cases on register at end of year Male Female Male Female Medical 1,412 2,038 96,625 353 667 Surgical 258 320 15,471 56 87 Infectious diseases 12 13 126 1 2 Tuberculosis 65 44 5,249 12 16 Maternal complications — 73 809 — 10 Others — — — — — Total 1,747 2,488 422 782 Totals : 1954 4,235 118,280 1,204 1953 5,046 121,192 651 SMALLPOX VACCINATION Some vaccinations are done by the staff at the health clinics, but most of them are carried out by general practitioners. The number of children under 1 year of age vaccinated, represents 39.2% of the total live births for the year. Under 1 year 1 year 2-4 years 5-14 years 15 years and over Total No. of persons primarily vaccinated 1,022 82 40 54 118 1,316 No. of persons re-vaccinated 9 2 8 36 359 414 Totals : 1954 1,031 84 48 90 477 1,730 1953 891 83 55 74 425 1,528 Approximate number of children (end of 1954) 0— 5 13,168 5—15 23,857 37,025 44 DIPHTHERIA IMMUNISATION Age at 31.12.54 Under 1 1 2 3 4 5-9 10-14 Totals Course of injections (whether primary or boosting) completed during last 5 years 1950-54 152 837 1,229 1,364 1,593 6,249 4,357 15,781 Course of injections (whether primary or boosting) completed during the period 1940-49 — — — — — 5,237 6,482 11,719 Approximate number of children (end of 1954) 0— 5 13,168 5—15 23,857 37,025 HOME HELP SERVICE There was an increase in the number of new cases receiving help during the year (Table 1). The number of new cases of tuberculosis, blind, chronic sick and aged remained about the same, but there was a marked increase in the number of maternity cases and those coming under the classification of 'Others! There has been a gradual increase in the total number of cases being dealt with at any one time. Although maternity cases normally require home help for a short period only, the total number of hours is large—42 had the services of a full-time home help. Many mothers restrict or do not have the services of a home help because of' the expense. Twelve booked a home help but then made other arrangements and cancelled their bookings. The assessments of tuberculosis cases now appear to be satisfactory, and there have not been the same difficulties as experienced in the past. Most old people receive help free of charge, but some have been assessed to pay a few pence per hour. When appeals have been made, the assessments have frequently been reduced or waived. 49 depend on the home help for their mid-day meals which are prepared for them on the days when the W.V.S. meals are not delivered. 75 per cent. of the old people depend on the home help to do their shopping. The number paying the full charge of 3/- per hour is small; they are limited to the maximum of four weeks home help as they are expected to obtain their own help privately. Establishment. The staffing position at the end of the year was almost equivalent to that at the beginning. As usual, there was a large turnover but less than in the previous year (Table 2). The average establishment for the year was 85.8. A male home help was employed from 20th January to 29th October and was preferred to a woman by many of the old men, but he resigned as he could not keep his family on the wages he received, an hourly rate of 2s. 7⅜d. Some home helps give up their work after a short period because they find it too hard; others give up because of changed domestic circumstances, such as leaving the district, having a baby, or finding more remunerative employment. Nevertheless it has been possible to recruit up to the full establishment of home helps. There is, however, a high proportion of absenteeism due to sickness, illness of children, etc., which makes it difficult to meet the demands fully at all times. No applicant eligible for help has been refused, but during the winter months when demand exceeds supply, help has to be reduced to many cases in order to provide for the emergencies that arise. During the year the home help organiser made 3,859 visits; one assistant organiser was absent for a period of nine weeks because of illness. Table 1 Home Help Cases (1953 in brackets) Cases receiving help at 1.1.54 No. of new cases helped during year No. of cases receiving help at 31.12.54 Maternity 3 (-) 71 (48) - (3) Tuberculosis 49 (55) 21 (20) 44 (49) Blind 23 (21) 12 (2) 25 (23) Chronic sick and aged 371 (350) 218 (211) 373 (371) Others 38 (37) 145 (95) 51 (38) Totals 484 (463) 467 (376) 493 (484) 45 Table 2. Staff (1953 in brackets) Position at 1.1.54 Appointments during 1954 Resignations during 1954 Position at 31.12.54 Whole time 5 (6) 1 (—) 1 (1) 5 (5) Part time 82 (70) 38 (65) 36 (53) 84 (82) Total 87 (76) 39 (65) 37 (54) 89 (87) DAY NURSERIES There are 9 day nurseries with a total of 440 approved places. (Table 1.) Rules of Admission. The main principle for admission to day nurseries is the health of the mother and child. Children from 0 to 5 years of age are accepted if:— (a) their mothers are unsupported. (b) the home conditions are unsatisfactory. (c) the mothers cannot look after their children adequately. The following conditions must also apply:— (a) there is no other satisfactory way of caring for the child. (b) that it will not affect the health of the child. (c) that it will assist in the support of the child. (d) that the mother of the child works for at least 30 hours per week. If after satisfying the above conditions, there are still some vacancies, the County Council will accept children over 2 years of age, where their parents are willing to pay the full cost. Application for Admission. The number of applications during the year (608) was almost double the number of children who left, but only two in three were admitted. The majority of the remainder found the assessment too high. (Table 2.) Almost half the children come from homes where the mother is the sole supporter, and altogether about three-quarters are priority cases. (Table 3.) Assessed Daily Charge. On the 1st December, 1952, the standard charge for day nursery accommodation was increased from 2/- to 9/- per day, with reductions according to means. Applicants who feel unable to pay the assessed daily charge can attend a meeting of an Appeals sub-committee, where they may obtain a reduction of the assessed charge. The assessments after all appeals, are shown in Table 4 (Feb., 1953). In November, 1953, the assessment scale was revised, and the assessments following appeals are shown in Table 4 (May, 1954). The two groups of assessment are not strictly comparable because there has been some change in the parents, due to admissions and discharges from the day nurseries during the period concerned. Attendances. Attendances of children at day nurseries in 1954 was 7% above those in 1953; almost reaching the high level of 1952, before the new scale of charges was introduced (Table 1). Most of the day nurseries were used to their full capacity. There is a considerable turn-over in the children attending the nurseries, and there is often an interval, while the parent is being assessed, until a vacancy can be filled. More than half the children who were in the nursery at the beginning of the year had left by the end of the year for reasons including going to school, leaving the district, mother having another baby or giving up work for various reasons. (Table 2.) Day Nursery Provision. Day nursery provision in the Kilburn area is inadequate and the premises are unsuitable. There is a waiting list for accommodation, even though some children in this area are placed in other nurseries at a considerable distance from their homes or the mother's work; many are placed with daily minders, and many more, knowing the difficulty of obtaining accommodation, do not even apply for admission to a day nursery. Infectious Diseases. There were very few outbreaks of infectious diseases in the nurseries, and one nursery had no cases at all; in three others it was restricted to one or two cases. The more serious outbreaks were imported from families of the children attending and were minor illnesses such as chicken pox and mumps. (Table 5.) 46 Christmas Parties. Christmas parties were held in all the day nurseries, with a special tea, a toy for each child, and an entertainment. Children from the Lower Place physically handicapped school gave a puppet show in both the Longstone Avenue and Chichester Road day nurseries. The County Council gave 3/- a head for each child attending the nursery. Welfare Foods. Since mothers find difficulty in collecting welfare foods from the various centres, arrangements were made in August, 1954 to distribute welfare foods to mothers at four day nurseries. The matrons encourage the mothers to take up these foods, and it also helps them to know which children require additional vitamins in the nursery. Staff. The staff is based on one non-domestic for every three children under 2, one for eight children over 2, but the total must not exceed one for every five children in the nursery. Two students are equivalent to one trained staff. Staff Establishment. Supervisory Matron 1 Matrons 9 Deputy Matrons 9 Wardens 9 Nursing Staff 54 Students 14 Domestic Staff (part time) 36 The number of staff employed during the year varied according to the number of children on the registers. During the year 3 nursery nurses attended the Supplementary child care reserve course at Chiswick Polytechnic and were later appointed as wardens. Six nurseries are approved as training schools for the 2 year National Nursery Examination Board course. The students attend Chiswick Polytechnic for two days weekly. Twenty students were in training during the year and 8 of them obtained the N.N.E.B. certificates. Table 1 Day Nurseries—Attendances Day Nursery No. of approved places No. of children on register at 31.12.54 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 year. Chichester Road 18 32 21 35 4,049 7,399 15 29 Crest Road 25 25 26 24 5,597 5,630 21 22 Essex Road 25 25 29 28 4,923 5,916 19 23 Evefield 25 25 13 20 3,716 3,949 15 15 Gladstone Park 25 25 28 27 5,073 4,365 20 17 Longstone Avenue 25 25 19 23 4,870 6,078 19 24 Mortimer Road 25 25 26 29 5,295 5,658 21 22 Villiers Road 25 25 27 28 5,228 5,765 20 23 Wesley Road 15 25 15 28 2,813 4,775 11 19 Totals : 1954 208 232 204 242 41,564 49,535 161 194 1953 208 232 202 225 37,943 47,172 148 185 47 Table 3 Day Nurseries—Priorities Nursery Unsupported Housing Medical Total Total on register Priorities as percentage of total Wesley Road 14 16 1 31 40 80 Longstone Avenue 23 11 — 34 59 58 Chichester Road 34 16 — 50 57 88 Evefield 15 15 — 30 44 68 Essex Road 30 10 3 43 59 73 Crest Road 20 19 — 39 54 72 Villiers Road 24 9 — 33 56 59 Mortimer Road 22 20 — 42 53 79 Gladstone Park 17 28 — 45 63 71 Totals 199 144 4 347 485 72 Table 4 Day Nurseries—Assessments Assessment February, 1933 May, 1954 2/- and under 226 226 Over 2/- and up to 4/- 114 80 Over 4/- 102 125 Totals 442 431 Table 5 Day Nurseries—Infectious Diseases Nursery Measles Scarlet fever Chicken pox Whooping cough Gastroenteritis Poliomyelitis Mumps Impetigo German measles Chichester Road — 1 16 2 — — — — — Essex Road — — 5 1 — 1 4 — — Gladstone Park — — — — — — 1 — — Evefield — — 3 — — — 1 — — Longstone Avenue — — 18 — — — — — — Mortimer Road — 2 — 1 — — 11 — — Villiers Road — — 1 — — — 1 — — Wesley Road 2 — — 1 1 — 2 7 8 Crest Road — — — — — — — — — Totals 2 3 43 5 1 1 20 7 8 RECUPERATIVE HOLIDAY HOMES During the year the following recommendations were forwarded to the county health department for placing in suitable recuperative holiday homes:— Adults 201 Children 29 230 48 SCHOOL HEALTH SERVICES Routine Medical Inspections. There has been a further increase in the number of inspections, particularly for the 7—8 age group, born during the peak years following the war. Orthoptics. In 1949 attention was drawn to the need for orthoptic treatment of school children. The ophthalmic surgeon estimated that 70 children annually require this treatment, and only a very small number could attend the Wembley clinic. The majority did not receive treatment because their parents could not arrange to take them to the Western ophthalmic hospital (no local hospital held orthoptic sessions). In June 1954 the County Council established a part-time orthoptic clinic in Willesden for two sessions each week. Additional sessions will soon be required, employing a full-time officer. Audiometry. Loss of hearing in school children is often the cause of education retardation, speech defects and inferiority complexes. About four times as many children with loss of hearing are detected by audiometry as by the ordinary routine medical inspection. The County Council in 1949, therefore, introduced an audiometry scheme in two areas, and then extended it to the rest of the county; in February, 1954 testing by a pure tone audiometer started in this area. Children between the ages of 7—11 have a routine test, other children are examined if hearing loss is suspected. They cannot have a complete investigation of hearing loss with the audiometer used, and so arrangements have been made for special cases to have a further test at Ealing with a comprehensive puretone audiometer. Audiometry Total tested by gramophone or Sweep Test Pure Tone Audiometer Passed Test Failed to pass test both ears 1,020 970 50 Ascertainment of Handicapped Pupils. The local education authority has a duty to examine any handicapped child over the age of 2 years, and to ascertain children under the categories of handicapped children specified in the School Health and Handicapped Pupils Regulations of 1953, namely:—blind, partially sighted, deaf, partially deaf, educationally sub-normal, epileptic, maladjusted, physically handicapped, delicate pupils, and those suffering from speech defect. Parents, health visitors, hospitals, private doctors and teachers usually refer children for examination. A medical officer of the authority examines them and the parent is invited to be present; a statutory form is then completed. The medical officer who examines educationally sub-normal children must be approved by the Ministry of Education; a psychiatrist examines maladjusted children. The Divisional Executive ascertains formally under Section 34 of the Education Act, 1944. Blind or partially sighted children are placed on the blind or partially sighted register. Handicapped children are recommended for special education, either in an ordinary school, day or residential special schools, or at home. The county education officer arranges many of the special placements, but the Divisional Executive arranges admissions to the two day special schools in Willesden, the physically handicapped and educationally sub-normal. Speech Therapy. Daily sessions of speech therapy become necessary at the Lower Place physically handicapped school with the admission of more spastic cases with speech defects; in addition the waiting list for children attending ordinary schools was growing. The County Council, therefore, increased the establishment for speech therapists by the equivalent of one whole-time officer; the two speech therapists working part-time in Wembley were transferred from other areas to work whole-time in Area 6. Children attending Lower Place school for physically handicapped pupils have now received much more needed attention and the general waiting list has been reduced considerably. Statistics relating to the work of the school health service during 1954 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: 1954 2,900 2,359 2,240 2,339 9,838 10,835 1,810 12,645 1953 3,008 2,326 2,194 2,486 10,014 13,714 1,603 15,317 49 Classification of the General Condition of Pupils Age Groups No of pupils inspected A (Good) B (Fair) C (Poor) No. % No. % No. % Entrants 2,900 1,246 43.0 1,600 55.2 54 1.8 Second age group 2,359 1,113 47.2 1,211 51.3 35 1.5 Third age group 2,240 1,066 47.6 1,151 51.4 23 1.0 Others 2,339 1,199 51.3 1,120 47.9 20 0.8 Totals: 1954 9,838 4,624 47.0 5,082 51.6 132 1.4 1953 10,014 4,413 44.1 5,448 54.4 153 1.5 Defects Defect or Disease Periodic Inspections Special inspections No. of Defects No. of defects Requiring treatment Requiring observation Requiring treatment Skin 63 113 473 Eyes (a) Vision 509 261 120 (b) Squint 67 81 9 (c) Other 25 41 201 Ears (a) Hearing 16 55 68 (b) Otitis media 28 66 4 (c) Other 6 23 134 Nose and throat 373 568 510 Speech 75 75 111 Cervical glands 48 131 15 Heart and circulation 7 67 23 Lungs 26 201 52 Developmental (a) Hernia 12 17 — (b) Other 21 129 4 Orthopaedic (a) Posture 55 164 12 (b) Flat foot 62 77 5 (c) Other 176 199 129 Nervous System (a) Epilepsy 1 12 — (b) Other 5 41 6 Psychological (a) Development 10 58 10 (b) Stability 17 220 41 Other 707 190 1,687 Totals: 1954 2,309 2,789 3,614 1953 2,730 3,028 5,076 Pupils Requiring Treatment Group For defective vision (excluding squint) For any of the other conditions recorded Total individual pupils Entrants 21 421 440 2nd age group 162 220 370 3rd age group 155 141 289 Other periodic inspections 171 286 428 Totals: 1954 509 1,068 1,527 1953 476 1,182 1,599 50 Minor Ailments 1954 1953 Diseases of skin: Ringworm (i) Scalp 1 — (ii) Body — — Scabies — — Impetigo 71 36 Other 475 519 Miscellaneous minor ailments 1,267 1,782 Nervous 31 8 Digestive 24 30 Respiratory 380 503 Skeletal 113 79 Circulatory 28 99 Infectious diseases 2 — Pyrexia 8 1 Ductless Glands 4 6 Psychogenic 46 15 Helminthiasia 21 35 Developmental 19 17 Excretory 8 4 Debility 276 212 Colds and rheumatism 130 233 Minor injuries 604 230 Miscellaneous surgical 16 12 Miscellaneous 196 1,075 TOTALS 3,720 4,896 Eye Diseases, Defective Vision and Squint No. of cases dealt with during the year 1954 1953 External and other (excluding errors of refraction and squint) 120 48 Errors of refraction (including squint 1,432 1,317 No. of pupils for whom spectacles were prescribed 694 598 Diseases and Defects of Ear, Nose and Throat No. of cases dealt with during the year 1954 1953 Received operative treatment for (a) Diseases of the ear 3 3 (b) Adenoids and chronic tonsillitis 568 341 (c) Other nose and throat conditions 45 6 Received other forms of treatment 292 148 51 Orthopaedic and Postural Defects No. of cases dealt with during the year 1954 1953 No. treated as in-patients in hospitals 36 36 No. treated otherwise, e.g., in clinics or out-patient departments (a) By the county council 362 369 (b) Otherwise 508 507 Return of Handicapped Pupils (Year Ending 31st December, 1954) Ascertainment Distribution (as at last day of year) Category 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 1 — — 2 1 — — 2 1 — — — — — — 2 1 Partially-sighted pupils 10 8 4 . 4 16 8 12 7 2 1 2 — — — — — 16 8 Deaf pupils 9 7 2 — 8 8 — — 7 6 1 2 — — — — 8 8 Partially deaf pupils 10 5 — 2 6 5 6 4 — — — 1 — — — — 6 5 Delicate pupils 80 50 83 81 68 40 1 — 59 30 8 10 — — — — 68 40 Diabetic pupils f Educ. sub-normal pupils 92 80 16 14 81 65 56 46 20 11 5 8 — — — — 81 65 Epileptic pupils 3 1 — — 1 — — — 1 — — — — — — — 1 — Maladjusted pupils 40 9 11 2 39 8 1 — 30 6 8 — — — — — 39 8 Physically handicapped pupils 52 37 7 8 41 23 31 17 2 3 3 2 — — 5 1 41 23 Pupils with speech defects 261 82 99 39 319 98 — — — — 303 93 — — 16 5 319 98 Pupils with multiple defects 26 15 1 3 25 18 25 18 — — — — — — 25 18 Totals 586 295 223 153 606 274 132 92 123 58 330 116 — — 21 6 606 274 Grand totals 1954 881 376 880 224 181 446 2 27 880 1953 804 609 881 265 189 402 2 21 881 52 Speech Therapy Clinic or school No. of cases dealt with during the year Kilburn clinic 139 Willesden clinic 85 Stonebridge clinic 115 Lower Place special school for physically capped pupils 24 Leinster special school for educationally sub-normal pupils 9 Totals 1954 372 1953 276 Infestation with Vermin 1954 1953 Total no. of examinations 42,370 39,912 Total no. of pupils found to be infested 1,508 1,904 Total no. of individual pupils found to be infested for the first time during the current year 606 675 Number of individual pupils in respect of whom cleansing notices were issued under section 54/2, Education Act, 1944 128 360 Number of individual pupils in respect of whom cleansing notices were issued under section 54/3, Education Act, 1944 7 32 Employment of Children and Young Persons 1954 1953 No. of children medically examined in order to ascertain whether they were physically fit to undertake employment of a light nature outside school hours 118 118 No. of instances in which the state of health was found to be such that certificates were withheld 2 - No. of children examined as to fitness to take part in entertainments 22 21 No. of cases in which certificates to take part in entertainments were withheld — — Medical Examination of Teachers 1954 1953 No. of teachers examined as to fitness for appointment 16 19 No. of students examined as to fitness for first appointment 28 2 No. of students examined as to fitness to undertake training course 28 33 53 The Educational Sub-Normal Education Act, 1944— Sections 57(3), 57(4) and 57(5) 1954 1953 Cases dealt with under section 57, Education Act, 1944:— Sub-Section 3 11 15 Sub-Section 4 - 1 Sub-Section 5 28 13 Cases de-notified under section 8, Education (Miscellaneous Provisions) Act, 1948 1 - CHILD GUIDANCE The child guidance clinic was opened at 22, Brondesbury Villas for four sessions a week in October, 1954. The educational psychologist was appointed in March, 1953, and the psychiatric social worker in July, 1954, but the psychiatrist was not appointed by the North-West Regional Hospital Board until September, 1954. Case conferences attended by health visitors and assistant medical officers started in November, 1954, and have been held at fortnightly intervals since. They have proved very valuable in dealing with difficult problems and in encouraging co-operation between different branches of the health sevice. Nineteen cases were seen (Table 1) and the waiting list of 45 was reduced to 33 at the end of the year (Table 2). Table 1 Reasons for referring the 19 cases seen Lack of progress in school 5 Behaviour problem at home 4 Enuresis and encopresis 3 Non-attendance at school 1 Phobias 1 Stealing 3 Inhibitive behaviour 1 Aggressive behaviour 1 19 Table 2 Waiting list at October, 1954 Nos. seen New cases referred Waiting list 31.12.54 45 19 7 33 RHEUMATISM The rheumatism clinic is held on the 2nd Tuesday of each month at Willesden health clinic, situated centrally in the Borough, and caters also for children who normally attend the Kilburn health clinic or Stonebridge health clinic. Rheumatism can be a serious disease requiring complete rest in bed followed by convalescence for several months. It may lead to permanent heart damage, interfere with the child's normal activities, and interrupt his school life. Some children are left physically handicapped and have to attend a special school for many years. 54 Rheumatism Clinics No. of children with heart trouble in brackets Rheumatism Not rheumatism Total (1) Kilburn health clinic 13 (8) 6 19 (2) Willesden health clinic 8 (4) 9 17 (3) Stonebridge health clinic 13 (3) 16 29 Total 34 (15) 31 65 Eighteen of these children had been discharged from hospital or convalescent home after they had been treated for rheumatism. Family History. A history of rheumatism in the family is significant. Eighteen children gave a history of rheumatism and 7 suffered from the disease. Environmental Conditions. Dampness and rheumatism are closely related. Sixteen children lived in damp homes and 7 of them suffered from rheumatism. The dampness in the 16 homes was investigated by the Medical Officer of Health and remedied as far as possible. Tonsils and Adenoids. Rheumatism may be associated with infected tonsils. Fifteen children had their tonsils and adenoids removed and 7 of them suffered from rheumatism. Rheumatism—T reatment Sent for convalescence 6 Referred to dental clinic 2 Referred to eye clinic 2 Referred to orthopaedic clinic 7 Referred to hospital 4 Special reports requested from hospital 8 Medicinal and vitamin therapy 14 Referred to Medical Officer of Health 16 The summary reveals the valuable contribution made by the rheumatism clinic for the better health and happiness of the children. In addition, other defects are also investigated and referred for treatment if required. DENTAL SERVICE The service has received setbacks in the past year because of staff changes, and the difficulties of obtaining dental staff to replace them; as a result both Monks Park (September, 1954—-January, 1955) and Kilburn clinics (May—July) were closed for three months. The clinic at High Road, Willesden is still heavily overburdened with work. The school dental service is responsible for inspecting and treating children who attend maintained schools. Children should be inspected and treated every year, preferably every six months. The opening of the clinic in October, 1954 at 22, Brondesbury Villas with two dental surgeries has improved the position in the Kilburn area. In 1949, owing to the shortage of accommodation and difficulty in recruiting dental officers, only 33% of the school population was inspected and offered treatment, so that children were being inspected only once in three years and their treatment was therefore not satisfactory. In February, 1952 a restricted scheme was introduced to deal yearly with children who had not reached their ninth birthday, in order to prevent dental decay which would only lead to more work in the future. The foundation of dental health is laid in the early years, when the first permanent teeth erupt, and malformation of jaws and irregularities of the teeth can be prevented by conserving the temporary teeth. Also it is generally more difficult for younger children to obtain treatment outside the service. In 1954, 8,266 children in this age group of about 10,000 were inspected in the schools, and another 2,362 children came direct to the clinics, 60% of whom came from the older age groups; four out of five of those inspected required treatment. (Table 1.) There is now an efficient service for young children, but more staff and accommodation are required to provide a similar service to older age groups. In October, the orthodontic service was commenced at Brondesbury Villas, Kilburn, with only two sessions per week; it is hoped to have more in future. 55 Priority Dental Service In 1954, 18% of the dental officers' time was devoted to the priority service, which treated expectant mothers 28%, nursing mothers 10% and children under five 62%. (Table 2.) During the year 767 children under 5 were inspected, including 236 inspected at nursery schools; 80% required treatment and 66% had their treatment completed. There is also an increase in the number of expectant and nursing mothers treated; every opportunity is taken to explain to the mothers the value of early and regular treatment for their children. Despite staffing difficulties, there has been a slight improvement in the priority service. Table 1 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) 236 122 133 5—16 and over 8,266 6,559 5,395 Specials 2,362 2,269 2,192 Totals: 1954 10,864 8,950 7,700 1953 11,557 9,840 8,936 (b) Treatment 1954 1953 No. of pupils actually treated 4,856 4,929 No. of attendances made for treatment 12,242 13,879 No. of half-days devoted to (a) Inspection 136 165 (b) Treatment 1,648 1,896 No. of fillings of (a) Permanent teeth 6,653 6,964 (b) Temporary teeth 4,375 5,540 No. of extractions of (a) Permanent teeth 659 683 (b) Permanent teeth for orthodontia 270 160 (c) Temporary teeth 4,450 4,787 No. of anaesthetics (a) General 2,308 2,585 (b) Local 216 214 Other Operations 4,020 4,450 Table 2 Priority Dental Service Expectant Mothers Nursing Mothers Children under 5 1954 1953 1954 1953 1954 1953 No. examined 284 281 88 68 767 790 No. needing treatment 279 279 88 67 616 609 New cases commenced treatment 250 248 97 85 552 512 Cases made dentally fit 76 78 50 53 366 410 Extractions 359 420 120 143 519 470 Fillings 629 600 200 182 974 1,107 Scalings and gum treatment 150 136 66 43 - - Silver nitrate - - - - 424 298 Dentures 14 21 40 43 - - Total attendances 889 938 481 440 1,322 1,329 Appointments not kept 168 180 58 83 205 205 56 SPECIAL SCHOOLS There are two special schools in Willesden, the Leinster special school for educationally sub-normal children, and the Lower Place school for physically handicapped children. The Leinster School caters for 135 Willesden and Ealing children who are backward and cannot learn in ordinary schools; they are brought to school by bus. They stay at school until 16 years of age to have the opportunity of catching up with children attending ordinary schools. All the staff are specially qualified; the usual school subjects are taught, but there is little paper work and the emphasis is on practical work. The children are taken to places of educational value and interest. A part-time speech therapist visits the school. Leavers conferences are held which are attended by the children, parents, head teacher, school medical officer, youth employment officer and representatives of the County mental health department. The children's progress is discussed and arrangements made to place them in the most suitable jobs. The Lower Place School caters for 160 physically handicapped children selected from about 160,000 school children of Middlesex. Most of the children live in Willesden because schools in other areas are much more modern and usually on one floor, so that children with mild or moderate defects can be more easily accommodated. Divisional Executives in these areas tend to recommend for Lower Place School the more severely handicapped children who require special care and treatment such as speech therapy or physiotherapy. Apart from the teaching staff, there is a state registered nurse, two welfare assistants, one wholetime speech therapist and one part-time physiotherapist. Following recommendations from the Willesden Divisional Executive and the Area Health Committee, the County Council has now approved the appointment of a whole-time physiotherapist. The orthopaedic surgeon visits the school once every six weeks. The work carried out by the physiotherapist is varied and includes treatment of spastics, postpoliomyelitis, progressive muscular diseases, ataxia, poor posture, asthma and other chest conditions. Treatments include plaster work, exercises, co-ordination, relaxation, breathing exercises, walking, stretching, manipulation, massage and heat treatment. The maintenance and use of crutches, calipers, back braces and splints are supervised. During the year, additional remedial apparatus has been obtained, and many children now have individual furniture suitable to their physical needs. The arrangements for the exclusive use of the swimming baths, one hour each week, have continued by permission of the Borough Council, and the number of children attending has increased from 27 to 30; six swimming certificates have been gained during the year. Children living in Willesden are also taken swimming during the school holidays. There are only two medical rooms which are used for the work of the nurse and her welfare assistants, the medical officer, the orthopaedic surgeon, the physiotherapist and speech therapist, and for a rest room for heart cases and others. Now that the physiotherapist and speech therapist are whole-time, they have been seriously hampered in carrying out their work efficiently with the shortage of rooms. All normal school subjects are taught and special attention is given to individual children. Educational visits to museums, art galleries, zoological gardens, Hampton Court, Windsor Castle, etc., are arranged. The length of stay varies from one to eleven years according to the child's physical defect, and the aim is rehabilitation from hospital to ordinary school life. Children are placed in employment with the co-operation of the youth employment officer after a conference with the parents, head teacher and school medical officer. COUNTY COUNCIL DAY SPECIAL SCHOOLS—ADMISSIONS 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 31.12.54 Leinster Special School for Educationally Sub-Normal Pupils Willesden 21 23 12 Ealing 14 4 12 Totals 35 27 24 Lower Place Special School for Physically Handicapped Pupils Willesden 14 12 4 Wembley 1 2 — Harrow 4 4 2 Ruislip-Northwood 2 — 1 Hayes and Harlington 1 1 — Ealing 5 4 — Acton 4 4 — Southall 1 1 — Brentford and Chiswick 2 3 — Heston and Isleworth — 1 — Totals 34 32 7 57 CHIROPODY For general description of services (see annual report 1953). There has been an increase in the number of attendances for chiropody, mainly because the service has become more widely known, and some cases have required longer treatment. The chiropody service must be extended to include the aged who suffer from painful feet, which may prevent them from staying up and about. Because of age and infirmity, many cannot treat themselves, nor attend a clinic. In any case, most of them cannot afford the cost of treatment. An efficient chiropody service for the aged could help to keep old people up and about as long as possible, so avoiding admission to an institution. Patients Seen Expectant and Nursing Mothers Boys Girls 0—5 School Total 0-5 School Total 1st attendances 78 11 79 90 9 148 157 Re-attendances 431 17 351 368 23 1,084 1,107 Defects Expectant and Nursing Mothers Boys Girls  Corns 65 37 92 Hallux Valgus 4 5 17 Verrucae 1 26 52 Onychocryptosis 22 24 16 Onychogryphosis 3 — — Masceration — 2 3 Hyperidrosis — 4 2 Blisters — 3 4 Valgus Ankles — 2 4 Callosities 36 — 1 Ganglion — — 1 Injury 1st nail — 2 — Bursitis 4 — — Hammer Toes 7 2 5 Septic conditions 1 — — MENTAL HEALTH SERVICES The day-to-day administration of the occupation centre at Bertie Road was delegated to the Local Area Health Committee in 1952, but the one at Neasden was entirely under the supervision of the Mental health committee. The day-to-day administration includes cleanliness surveys, medical inspections and treatment. In March, 1954 the County Council decided to revoke this delegation and the Mental health committee undertook complete responsibility for the two occupation centres. Difficulties have now arisen in carrying out such functions as cleanliness surveys.