AC 439 (1) WILLESDEN Cokd by P.C. 23.10.56 m.b.e Wil 51 Borough of Millesden 1955 THE 80th ANNUAL HEALTH REPORT S. LEFF, M.D., D.P.H., Barrister-at-Law, Medical Officer of Health CONTENTS Page Aged—care of Laundry service 31 Publicity of services 32 S.O.S. card scheme 33 Talks to Old People's Associations 32 Voluntary services 32 Atmospheric pollution 24 Basement bakehouses 30 Bombed sites 25 Child guidance 51 Chiropody 54 Common lodging houses 33 Coroner's Court 33 Day nurseries 43 Dental service 53 Disinfestation 25: Factories 30 Food Clean Food Guild 26 Contaminated food 27 Education in food hygiene 27 Food poisoning 14 & 27 Ice cream 26 Improvements in premises 27 Registration of premises 26 Sampling 28 Unsound food 28 Hawkers—licensing of 33 Health education 9 Health visiting 39 Home help service 42 Home nursing 41 Hospitals Facilities 34 Liaison 34 Housing Closing orders 20 Defects 21 Demolition orders 20 Housing Repairs and Rent Act, 1954 22 New dwellings 21 Notices served 21 Overcrowding 21 Slum clearance 20 Survey 19 Immunisation against diphtheria 42 Infant mortality Neo-natal 5 1—12 months 4 Social class 4 Wards 4 Infectious diseases Diphtheria 10 Dysentery 13 Food poisoning 14 & 27 Measles 10 Meningococcal infection 13 Ophthalmia neonatorum 13 Paratyphoid 13 Pneumonia and influenza 11 Poliomyelitis 11 Puerperal pyrexia 14 Smallpox 13 Whooping cough 10 Page Introduction 1 Laboratory service 8 Massage and special treatment establishments 9 Maternity and child welfare Ante-natal care 34 Clinics 35 Welfare foods—distribution 37 Medical examination of staff 34 Midwifery service 37 Milk and Dairies 29 Mortuary 33 National Assistance Act, 1948 Burials 33 Removals to hospitals 31 Noise 31 Occupational health services 31 Outworkers and homeworkers 31 Personal health services 34 Pet Animals Act, 1951 34 Prematurity 5 Rag Flock and Other Filling Materials Act, 1951 33 Recuperative holiday homes 45 Rheumatism 52 Rodent control 25 Sanitary circumstances 18 Scabies 8 School health service Ascertainment 51 Audiometry 46 Medical inspections 47 Orthoptics 45 Special schools 51 Speech therapy 50 Tuberculin testing 45 Slaughterhouses 33 Staff Medical examinations 34 Sanitary section 19 Tuberculosis B.C.G. vaccination 15 Chest clinic 15 Factories and workshops 15 Hospital accommodation 15 Missed notifications 15 Morbidity and mortality 14 Prevention 14 Vaccination against smallpox 41 Vermin 25 Vital statistics Births 3 Deaths 3 Population 3 BOROUGH OF WILLESDEN Health Department, 54, Winchester Avenue, Kilburn, London, N.W.6. July, 1956. To the Mayor, Aldermen and Councillors of the Borough of Willesden. Mr. Mayor, lxidies and Gentlemen, I beg to submit the annual report of the health and sanitary circumstances of the borough for the year 1955. There has been a further slight decrease in the population, which is a healthy sign if it leads to a reduction in the overcrowding in the borough. The birth rate showed a slight rise, but so did the infant mortality, stillbirth and death-rates. The infant mortality for illegitimate infants reached a remarkably record low level of just over 5 per thousand. It is too early to say whether this is due to the special care given to mothers with illegitimate children in the past few years. The infant mortality was only just over 20 per thousand; the lowest rate 11.2, was in the Manor ward. The rate in the Carlton ward was almost three times as high as in the Manor ward, and it is clear that social conditions play an important part. Indeed, there were no deaths in Social Class I, and 49 deaths (ten of which were due to infection) in the lower social groups. Prematurity still takes a heavy toll and there were 20 deaths, 19 in the first week of life. More research is required into prematurity and congenital abnormalities, but there is no doubt, once again, that if social conditions were improved, the number of premature babies would be reduced. Now that more radioactive substances are discharged in the atmosphere, it is essential to study their effect on the occurence of congenital abnormalities and if' hereditary traits are affected. Although there has been an increase in the general death rate it is still at a low level—under 10 per thousand. Willesden has an ageing population and the increase in deaths from heart and vascular lesions is to be expected. The alarming increase in deaths is from cancer and from bronchitis. It is significant that the number of deaths from cancer of the lung is still on the increase and was double that of the next highest cause of death by cancer. The number of deaths is now almost four times as high as that for tuberculosis, and it is clear that preventive measures are urgently necessary. The association between cigarette smoking and cancer of the lung is now clearly established, and already much health education is being carried out in Willesden to present the facts to the public. Unless people act upon the advice to stop smoking, the number of cases of cancer of the lung and of bronchitis will continue to rise. The chances of a moderate smoker getting cancer of the lung are about 50 times as high as those of a non-smoker. At the same time, atmospheric pollution also has an important effect, and people living in towns have a nine times greater risk of' contracting cancer of the lung than people in the country. More research is required into this, and on the effects of dust and fumes, such as diesel oil at work. But it has to be regretted that more is not being done to reduce the quantity of sulphur compounds being discharged into the atmosphere. It is gratifying to report substantial advances in the battle against tuberculosis. Both the death rate and the number of notifications have fallen (there was a particularly low rate in Brondesbury Park ward). It is unlikely that the general decline in tuberculosis has been due to any large extent to the improvement in housing and other environmental conditions, although it is possible that the reduction in the rate in the Carlton ward may well be due to the rehousing in that area. However, now that the number of cases is small it is necessary to examine at least a number of years, and over the past three years Carlton still has the highest rate—more than double that of Brondesbury Park. School leavers are now being protected by B.C.G. vaccination, and as the tuberculosis declines, and the number of children who have never been in contact with the germ increases, more children require to be protected when they leave school. The talks that are given in schools and factories on tuberculosis encourage the people in the borough to play their part in the battle against the disease. Health education in general remains an important function of the health department. Talks in schools, in clinics, day nurseries and outside organisations have continued. But with the growth of a television-viewing public, there have been smaller attendances at the evening meetings. Consequently, an extension of the factory talks was organised, particularly to deal with the poliomyelitis outbreak. Results have been very successful indeed, and many people have for the first time had an opportunity of hearing about and asking questions on subjects which affect them intimately. The outbreak of poliomyelitis was a most unusual one and it is described fully in the report. Fortunately most of the cases were non-paralytic, the number of persons paralysed was less than in 1947, and the number of severe cases less than in three previous years. There were no deaths. Of the other infectious diseases, dysentery is perhaps the most prominent. Numbers were less than in previous years, but there were one or two outbreaks in institutions and day nurseries, which caused the usual considerable amount of administrative work before they were brought under control. There was a large outbreak of measles, but with no deaths, and the number of cases of whooping cough was the lowest for the past fifteen years. The outbreak of haemoyltic streptococci infection in the Central Middlesex Hospital is described in the report. Housing still presents the most important problem on the environmental side. The house-to-house survey in selected areas in all parts of the borough was almost completed, and attention is now being directed to slum clearance. The Council have decided to deal with five areas involving 234 houses, within the next five years, but much more work will have to be done to relieve the overcrowding in the borough, and provide reasonable housing accommodation. The Housing Repairs and Rents Act, 1954 has not been very sucessful in encouraging landlords to do repairs more readily. The occupational health service for Borough Council employees is working satisfactorily, and many improvements have been carried out on their conditions of work. The campaign for clean food continues, and the public is becoming more alive to the dangers of contaminated food and more instances are being reported to the department. There has been some extension of the work with old people, and health talks to them have resulted in some new provisions for them. However, the time has come for local authorities to accept the main responsibility for the care of old people, in addition to their statutory obligation to provide home helps and home nurses, etc., so that the work can be co-ordinated more efficiently with that of voluntary organisations. There has been a shortage of sanitary inspectors during the year, which has hampered the work of the department and has prevented much needed extensions in the field of the campaign for clean food and reduction in atmospheric pollution. The personal health services remain substantially as before. Two new church hall clinics were opened in areas; one in Kensal Rise, which was not provided for at all in the past, and the other in Kilburn, where a large district was rather isolated from the main clinic. Both these church hall clinics have been very successful but everyone is looking forward to the new clinic in Pound Lane, which will be the first for over 25 years. The main need in the present service is for more health visitors to do the essential work of health education of mothers and children in the clinic, general care of the child in the home, and for better liason with general practitioners. There is also a need for a much greater extension of the work of the child guidance clinic. The waiting list has increased, but all requests to the Regional Hospital Board for additional sessions for the psychiatrist have been rejected. This, among numerous other examples, underlines the need for an urgent reform of the local government administration, so that the personal health services can be run by the people who understand the needs of the local community. This has been a most interesting year for public health in Willesden, and my sincere thanks go to councillors, members of the staff and sanitary inspectors, who have played such an important role in 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, 1955 176,000 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) 43,885 Rateable value £1,690,603 General rate in the £ for the year 20s. 8d. Product of a 1d. rate (estimated) £6,750 VITAL STATISTICS Registered Live Births : Male Female Total Willesden Borough Council Legitimate 12 77 1148 2425 Birth rate per 1,000 estimated resident population Illegitimate 99 95 194 Total 1376 1243 2619 14.88 Rate per 1,000 (live and still) births Registered stillbirths 26 35 61 22.76 Death rate per 1,000 estimated resident population Deaths 870 823 1693 9.62 Death Rate of Infants Under One Year of Age : All infants per 1,000 live births 20.24 Legitimate infants per 1,000 legitimate live births 21.44 Illegitimate infants per 1,000 illegitimate live births 5.15 Death Rate of Infants Under Four Weeks of Age : All infants per 1,000 live births 14.51 Legitimate infants per 1,000 legitimate live births 15.67 Illegitimate infants per 1,000 illegitimate live births — Maternal Mortality : Deaths from puerperal causes— Puerperal sepsis Nil Other puerperal causes Other maternal causes 1 Maternal mortality rate 0.38 per 1,000 live births. Deaths from: Males Females Total Cancer (all ages) 183 183 366 Measles (all ages) — — — Whooping cough (all ages) — — — Diarrhoea (under 2 years of age) — — — 4 Cause of Death : Males Females Total 1. Tuberculosis (respiratory) 20 5 25 2. Tuberculosis (other) 1 1 2 3. Syphilitic disease 6 1 7 4. Diphtheria — — — 5. Whooping cough — — — 6. Meningococcal infections 2 — 2 7. Acute poliomyelitis — — — 8. Measles — — — 9. Other infective and parasytic diseases 3 1 4 10. Malignant neoplasm, stomach 25 22 47 11. Malignant neoplasm, lung, bronchus 77 19 96 12. Malignant neoplasm, breast — 48 48 13. Malignant neoplasm, uterus — 12 12 14. Other malignant and lymphatic neoplasms 81 82 163 15. Leukemia, aleukemia 2 4 6 16. Diabetes 8 7 15 17. Vascular lesions of nervous system 83 109 192 18. Coronary disease, angina 151 109 260 19. Hypertension, with heart disease 24 28 52 20. Other heart disease 63 96 159 21. Other circulatory disease 40 49 89 22. Influenza 5 2 7 23. Pneumonia 47 41 88 24. Bronchitis 75 60 135 25. Other diseases of respiratory system 11 4 15 26. Ulcer of stomach and duodenum 9 7 16 27. Gastritis, enteritis and diarrhoea 4 4 8 28. Nephritis and nephrosis 6 7 13 29. Hyperplasia of prostate 16 — 16 30. Pregnancy, childbirth, abortion — 1* — 31. Congenital malformations 9 3 12 32. Other defined and ill defined diseases 65 77 142 33. Motor vehicle accidents 8 4 12 34. All other accidents 20 15 35 35. Suicide 9 5 14 36. Homicide and operations of war — — — Total 870 823 1,693 *Interval between maternal condition and death exceeded 12 months. Births There was a slight increase in the birth rate for 1955, 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 The infant mortality rate remained at the low figure of 20 per thousand. 53 infants aged one year and under died in 1955 (see table 1), 39 in the neonatal period, the first month of life (37 in the first week). (a) By Wards A much lower figure was attained in the better wards which had rates lower than 20. However, the infant mortality in Carlton, the worst ward, was nearly three times as high as that in Manor, the best ward; Stonebridge and Roundwood also showed high figures. Improvement in social conditions in these wards would help to reduce the mortality to that in Manor and Cricklewood, where the low figures achieved were 11 and 12 respectively (see table 2). (b) By Social Class The number of deaths by social class gives a further illustration of the effects of environment on infant mortality. No deaths occurred in social class I, only 4 deaths in children of social class II, and the remaining 49 deaths were in the lower social groups (see table 3). (c) 1-12 Months (i) Infections disease and living conditions There has been considerable reduction in mortality from infection in recent years, but poor living conditions still play an important part in the cause of death from infections. It can be shown that many of these deaths could have been prevented if home conditions had been better. No child from social classes I and II died from inflection in 1955 (see table 8b). (ii) Deaths from infection 10 deaths occurred; all the deaths were due to respiratory infection (see tables 8a and b, and 9), and no child died from gastro-enteritis. Examples are given of cases whose deaths could probably have been prevented. One died from bronchitis from an overcrowded and mismanaged home. Another child died from bronchopneumonia who was the 9th illegitimate child in an overcrowded home. Two others died, one of bronchitis, the other of bronchopneumonia from overcrowded homes (one of the homes had five persons living in one room). 5 Investigations are carried out after every infant death and efforts are made to improve maternal insufficiency, poor home conditions and other contributory causes. (iii) Other deaths There were 4 other infant deaths, with causes due to rare conditions: one from congenital thrombocytopenia complicated by cerebral haemorrhage, one from progressive amyotonia congenita and one from cerebral tumour, and the fourth, aged 2 months, died from oesophageal stenosis, a condition which usually causes death in the neonatal period. (d) Neonatal period The neonatal mortality was 14 per 1,000 live births, more than half the total infant mortality. A new concept of infant mortality has been introduced to include stillbirths with deaths occurring in the first week of life. The causes of stillbirth and early neonatal deaths are often the same, and whether a baby dies just before, during or after birth is sometimes a matter of chance. The perinatal rate for 1955 was 37.4. The stillbirth rate is higher than neonatal rate, and the perinatal rate is almost twice as high. Deaths in the first week of life (i) Prematurity There were 170 premature births with 20 deaths, 19 in the first week of life. All the babies who died were born in hospital, and all were under 5 lbs. at birth. 20% were under 5 lbs., 25% under 4 lbs., and 50% were under 3 lbs. (1 unweighed). No cause for the prematurity could be found in 8 cases, 4 cases were due to maternal toxaemia one who was also a diabetic, 2 followed Caesarean section, and 3 were from multiple pregnancies, 3 followed complications of' pregnancy (antepartum haemorrhage and hydramnios) (see tables 4, 5, 6). There is still a great wastage of infant life from deaths due to premature birth. In addition 57.7% of the stillbirths occurring in hospital, and 57.1% of stillbirths at home were premature. Progress has been made in the saving of premature infants, but the real problem lies with the prevention of premature birth. (ii) Congenital malformations (see tables 7 and 9) The rate for congenital malformations is a little lower than last year. There were 7 deaths. No cause could be discovered in any of these cases, and none of the mothers suffered from rubella or apparent infection in early pregnancy. (iii) Injury at birth 3 cases died. One was in a breech presentation with extended legs (see table 9). (iv) Other causes (see table 9) Anoxia. 3 cases died, two due to maternal toxaemia and one was associated with trilene anaesthesia. Atelectasis. 3 cases, one with Rh. incompatibility. Two further deaths were due to miscellaneous causes, one from misadventure due to an overdose of chloral and another from neonatal pneumonia associated with long labour. Remaining neowatal deaths The one premature infant already listed who survived into the late neonatal period, and another who died from purulent bronchitis. 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, 1936-55. 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 25 44 16.7 24 1955 176,000 2619 53 20.2 25 61 22.8 23 6 2. Infant Mortality by Wards Ward Number of Deaths Total 1953-55 Rate 1953-55 1953 1954 1955 1. Carlton 11 13 2 26 29.5 2. Kilburn 5 4 9 18 25.9 3. Brondesbury Park — 4 3 7 13.0 4. Kensal Rise 2 1 5 8 21.3 5. Manor 2 1 2 5 11.2 6. Harlesden 5 2 3 10 16.6 7. Stonebridge 4 6 5 15 26.0 8. Roundwood 6 4 7 17 26.2 9. Church End 6 2 2 10 17.7 10. Willesden Green 4 2 6 12 19.7 11. Mapesbury 5 4 3 12 16.4 12. Gladstone 5 4 1 10 23.8 13. Cricklewood 1 1 3 5 12.0 14. Brentwater 4 2 2 8 21.9 60 50 53 163 20.7 3. Deaths by Social Class Social Class Group Neonatal 1-12 months Total 1951 England & Wales 1% sample (rates) I Nil Nil Nil 17.9 II 3 1 4 22.5 III 25 4 29 28.4 IV 3 7 10 34.5 V 8 2 10 41.1 4. Premature Births and Deaths (1946-55) (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) 1955 31 (0) 139 (20) 7 (0) 170 (20) 5. Premature Births and Deaths by Wards Ward Premature births notified Rate per 100 live births Deaths Carlton 16 5.9 1 Kilburn 16 7.0 3 Brondesbury Park 10 5.2 1 Kensal Rise 11 8.3 2 Manor 9 6.0 1 Harlesden 20 9.3 1 Stonebridge 14 7.7 4 Roundwood 15 6.8 3 Church End 14 8.2 - Willesden Green 8 4.2 2 Mapesbury 17 6.6 1 Gladstone 6 4.1 - Cricklewood 8 5.7 - Brentwater 6 4.8 1 Total 170 6.5 20 7 6. Causes of Death from Prematurity Unknown cause 8 Maternal toxaemia (1 diabetes) 4 Following Caesarean section. 2 Multiple pregnancy 3 Complication of pregnancy 3 Total 20 7. Congenital Malformations Multiple abnormalities 1 Hydrocephalus and spina bifida 1 Congenital heart 1 Mongolism and atelectasis 1 Duodenal atresia 1 Oesophageal stenosis 1 Congenital heart and bronchopneumonia 1 Total 7 8. Respiratory Infections (a) Causes Bronchopneumonia 6 Acute bronchitis and pneumonia 1 Bronchitis 1 Acute laryngitis and bronchopneumonia 1 Acute influenzal bronchitis 1 Total 10 (b) Deaths 1-12 Months by Social Class I Nil II Nil III 2 IV 7 V 1 9. Causes of Infant Deaths in Willesden (Based on Registrar General's figures) 1936-1939 1940-1945 1946-1950 1951-1955 1955 (1954 in brackets) Deaths Rate Deaths Rate Deaths Rate Deaths Rate Deaths Rate Neonatal 1-12 months Total Respiratory 106 8.1 140 8.8 68 4.2 53 4.1 3 (2) 10 (5) 13 (7) 4.9 (2.7) Diarrhoea and enteritis 131 10.0 108 6.8 37 2.3 12 1.0 -(-) — (2) — (2) -(0.8) Other infections 34 2.6 40 2.5 15 0.9 12 1.0 -(1) — (3) — (4) -(1.5) Congenital malformations 83 6.3 89 5.6 72 4.4 53 4.1 6(10) — (2) 7 (12) 2.7(4.6) Prematurity 170 13.0 179 11.1 99 6.1 110 8.4 20(12) — (—) 20 (12) 7.6(4.6) Injury at birth 21 1.6 33 2.1 43 2.7 27 2.0 3(6) — (—) 3 (6) 1.1 (2.3) Other causes 134 10.3 149 9.4 96 5.9 31 2.2 7(6) 3 (1) 10 (7) 3.9 (2.7) All causes 679 51.9 738 46.5 430 26.5 298 22.8 39 (37) 14 (13) 53 (50) 20.2 (19.2) 8 GENERAL PROVISION OF HEALTH SERVICES Public Health Laboratory Service The Public Health Laboratory Service examine bacteriological specimens (swabs from sore throats, faeces from intestinal infections, cough plates and post-nasal swabs from whooping cough cases, etc.) at the Central Public Health Laboratory, Colindale Avenue, N.W.9, and at the branch laboratory in Neasden Hospital, Brentfield Road, N.W.10. The specimens are sent by doctors 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, and are collected and taken to the Central Public Health Laboratory. A report by telephone is given to the doctor 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 1955 : — 129 Milk Examinations Schools (pasteurised) Dealers' premises Total Pasteurised T.T. pasteurised Sterilised Samples 46 65 6 12 129 Satisfactory 46 65 6 12 129 Unsatisfactory - - - - - 93 Ice Cream Tests : Grade 1 50 Grade 2 20 Grade 3 14 Grade 4 9 The nine grade 4 samples were manufactured in premises in an adjacent borough and the Medical Officer of Health was notified so that he could investigate the standards of hygiene of manufacture. 164 Water Examinations : Samples taken Satisfactory Unsatisfactory Brent Reservoir 2 — 2 Domestic supplies 4 4 — Swimming pools 158 155 3* *See page 18 (Sanitary Circumstances of the Area) Uncleanliness and Scabies All cases are now treated at Stonebridge Health Centre (see Annual Report, 1954). As compared with 1954, the number of children treated for lice and nits has more than doubled; the number of adults has remained about the same. There has been a reduction of almost 50 per cent, in the number of cases of scabies. Cases treated at Stonebridge Health Centre 1.1.55 to 31.12.55 New Cases treated Attendances Scabies Lice & Nits Total Scabies Lice & Nits Total Children under 5 years 4 10 14 9 10 19 Children 5-15 years 4 57 61 12 57 69 Adults ] Men 6 4 10 13 4 17 Women 7 19 26 18 19 37 Total 21 90 111 52 90 142 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 Act, 1944. During the year there were 20 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 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 42 lectures with 40 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, 208 health talks and film shows were given in 19 schools by the Area Medical Officer and members of his staff, and the Chief Sanitary Inspector and his staff. 1,310 school children attended these lectures with attendances of 30 to 200 pupils. 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. 110 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 8,412 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 health, cookery, sewing, chiropody, home nursing, first aid, travel, and make-up. The clubs have been held weekly at Kilburn Health Clinic. 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 9 day nursery parent clubs, 5 health talks were given by the Area Medical Officer and his staff, and 12 other meetings and social evenings were arranged. 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. The 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 16th to 26th August, 1955. The Council sent the Deputy 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. Religious, social, and political organisations continue to apply to the department for health lectures and all their requests have been answered. 18 talks were given to 17 organisations on 10 different subjects. 620 people attended the lectures, with attendances ranging from 10 to 50. The extension of' the habit of television-viewing has seriously affected attendance of audiences at meetings. This particularly applies to health education and new measures have to be considered to overcome the difficulty. For the past seven years health talks on a variety of subjects have been given to religious, social and political organisations, trade unions, and many clubs. The audiences have varied from about 20 to 80, but there has been a tendency for them to be less in the past year. One or two talks had already been given in factories by special request from the management, and it was thought that a ready and perhaps willing audience could be found there. At the end of 1954 it was decided to explore the possibility of giving health 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 to approximately 2,400 factory workers, the attendances ranging from 400 to 1,000. A new drive was made in 1955, and in the first six months of the year, 14 talks were given in factories on subjects including Influenza, Coughs and Colds; Cancer; Mass Miniature Radiography; A Good Meal; Accidents Will Happen; and Poisoned Fingers. With the outbreak of poliomyelitis in the beginning of July, 1955, a new stimulus was given to this work. Most factories were only too willing to provide facilities for a talk on this subject, and some of them approached the department direct. Altogether, by the end of the year, 112 talks in 77 factories were given by the medical officer of health and the deputy medical officer of health. Approximately 27,200 factory workers attended the talks 10 and attendances ranged from 20 to 4,000. Twenty factories were visited more than once and several had a series of talks. Co-operation with the factory management was not easy at first. Nine were written to, asking if they would like a health talk for their employees; six replied that they did not want talks and the other three did not reply at all. Telephoning for an appointment also produced negative results. Attempts were therefore made to visit the factory without appointment and a scheme of health talks was explained to the personnel manager or works manager. Immediately seven of the nine factories agreed to have health talks. There were, however, many difficulties yet to overcome. The first important thing was to avoid any interference with production, and so a talk in the lunch hour or tea break was suggested. When the lunch hour was staggered, it was agreed that two talks could be given. In some factories where there were no proper canteen facilities, talks were given in the workshop itself, usually during a tea break. In one large factory a talk was given over the public address system. Another large factory had a special meeting for departmental representatives, foreman, shop stewards and other key personnel, and then arranged for a typescript to be circulated throughout the works. Some factories actually arranged the talks during the production period, and one booked a hall for its 800 employees and the time was extended to allow for questions to be answered. The factory medical officer, a general practitioner, attended this talk, and generally where the firm employed a factory doctor he was approached and he invariably welcomed a talk, and occasionally came along to hear it. A small number of talks were given after working hours and were usually well attended, and one or two factories arranged for the last half hour of work to be devoted to the health talk. There is no doubt that this new approach to the problem of health education has produced very good results indeed. Many people have for the first time had an opportunity of hearing about and asking questions on subjects which affected them intimately. It is hoped that this is the beginning of a new method of health education which will become well established. Already factory managements have arranged for talks in the near future on Influenza, Coughs and Colds; Cancer and Tuberculosis. An enlightened citizen knowing his health problems and how to overcome them can play a much more active part in preventing accidents and the spread of' illness in the community. 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) 1951 1952 1953 1954 1955 Diphtheria 12 (1) 14 (1) 8 (1) 5 (2) 1 (-) Scarlet fever 211 (204) 262 (249) 217 (210) 182 (177) 135 (126) Pneumonia 172 (161) 126 (113) 228 (208) 102 (97) 124 (116) Whooping cough 550 (543) 330 (328) 453 (450) 295 (295) 177 (171) Erysipelas 31 (30) 27 (27) 22 (21) 13 (12) 13 (11) Measles 1937 (1927) 1528 (1520) 2392 (2383) 126 (124) 2,040 (2,026) Diphtheria One case was notified, but was not confirmed; the diagnosis was tonsilitis. This is the first year in which no case of diphtheria has occurred in the borough. Measles 2,040 cases were notified in 1955 (2,026 confirmed). There were no deaths during the year. Whooping Cough 177 cases were notified (171 confirmed). The incidence of whooping cough was the lowest of the last fifteen years, but the reduction cannot be attributed to whooping cough vaccination (see report for 1953). 11 Whooping Cough Cases and Deaths : Willesden and England and Wales Year Population Child population (estimated) Number of cases confirmed No. of deaths Case rate per 1,000 population Death rate per 1,000 population No of children vaccinated in Willesden 0—4 years 5—15 years 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 3.87 Nil .01 1163 1952 180,400 13,846 24,000 328 114,869 1 184 1.82 2.61 .00 .00 946 1953 178,500 13,455 24,000 450 157,842 —- 243 2.52 3.58 Nil .01 1,333 1954 177,300 13,110 23,857 295 105,901 1 130 1.66 2.39 .006 .002 1,198 1955 176,000 12,948 23,857 171 79,092 — 88 .97 1.80 Nil .00 1,020 Pneumonia and Influenza 124 cases of pneumonia were notified (116 confirmed). There were 92 deaths from bronchopneumonia, lobar pneumonia and pneumonia (unspecified), and 7 deaths from influenza. Other Infectious Diseases Disease Cases notified (number confirmed in brackets) Typhoid fever - Dysentery 140 (104) Malaria 1 (-) Poliomyelitis and polio-encephalitis 176 (136) Meningococcal infection 5 (4) Encephalitis 2 (2) Smallpox — - Paratyphoid 5 (4) Poliomyelitis For the whole year 176 notifications were received and 136 were confirmed (112 non-paralytic, 24 paralytic) ; 89 were in the age group 0-15 years and 47 over the age of 15 years. The largest outbreak of poliomyelitis recorded in Willesden occurred during the period of 16 weeks from the 13th July until the 31st October. 161 notifications were received, and 126 were confirmed (104 nonparalytic, 22 paralytic). The proportion of confirmed cases was higher than in any previous year, and much higher than in tl e two previous outbreaks in 1947 and 1949 ((see Table I). Table I Willesden 1947-55. Number of notifications confirmed. 1947 1948 1949 1950 1951 1952 1953 1954 July-Oct. 1955 Notifications 89 16 54 19 5 11 26 21 161 Confirmed 45 11 33 12 - 5 14 10 126 Percentage 50.5 68.7 61.1 63.1 — 45.4 53.8 47.6 78.2 The peak of the outbreak was reached early in the last week of July and in the first week of August, although the numbers remained fairly high in the last two weeks of August and the first week of September. They were then reduced rapidly, coming practically to an end in the middle of October (Table II). 12 Table II Willesden 1955. Weekly number of notifications Week ended : July August September October Nov, 16 23 30 6 13 20 27 3 10 17 24 1 8 15 22 29 5 Confirmed cases : Paralytic — — 1 5 — 1 1 6 4 2 2 — 1 — — — - Non-paralytic 2 6 22 11 4 9 10 6 10 4 6 6 2 4 — 1 - Total confirmed 2 6 23 16 4 10 11 12 14 6 8 6 3 4 — 1 - Total notified 2 7 29 20 5 11 12 16 17 6 12 9 7 5 2 1 - The proportion of paralytic cases was very low compared with the previous years (Table III). The experience of Willesden, was unique in the country, and in comparison with previous years. Table III Willesden (1947-55). Proportion of paralytic cases 1947 1948 1949 1950 1951 1952 1953 1954 July-Oct 1955 Non-paralytic 14 1 15 1 - 5 5 104 Paralytic 28 14 10 - 5 9 5 22 (11) (6) (5) (1) (3) (1) (5) Fatal 3 — 4 1 - - - - - Paralytic and fatal percentage of total 68.8 — 54-5 91-6 - 100.0 64.2 50.0 17.4 (In brackets—number of severe cases). The proportion of paralytic cases to uncorrected notifications in the country as a whole while lower than in previous years was not markedly so (Table IV). Table IV England and Wales—proportion of paralytic cases Week ending 15th October (41 st week) England and Wales 1951 1952 1953 1954 1955 For 41st week : Total uncorrected notifications 94 109 124 71 366 (57.4) (84.4) (63.7) (70.4) (41.6) From beginning of year to 41st week: Proportion of non-paralytic cases 41.5% 29.8% 34.6% 32.8% 46.3% (Percentage of paralytic cases in brackets) There was a marked difference between the proportions of paralytic and non-paralytic in Willesden and the surrounding districts. By 10th October Willesden had 105 non-paralytic cases and only 18 paralytic, a proportion of one-seventh, while the Neasden Infectious Diseases Hospital had had 161 non-paralytic cases and 91 paralytic, a proportion of about one-third. 85 per cent of the 161 non-paralytic cases admitted to the Neasden Infectious Diseases Hospital had their cerebro-spinal fluids examined and 58 per cent. were found abnormal, with a high protein content and an increase in lymphocytes, suggestive of poliomyelitis. It is interesting to note that while the paralytic cases were scattered throughout the borough, the non-paralytic cases were concentrated mainly in two out of the 13 wards. No action was taken until there had been five cases in the first week of the outbreak. On 21st July immunisations were stopped and general practitioners and hospitals were informed of this action, and only urgent tonsillectomies were advised to be done. Sanitary Inspectors visited the homes of notified cases, gave general advice on prevention and followed up contacts, who were given leaflets outlining the simple rules of prevention based on those in the Ministry of Health memorandum. Those handling food at work, and school children who were intimate contacts, were excluded for 21 days. Six adult contacts were excluded from work and issued with certificates under the National Insurance Act, 1948 (Circular 115/48) so that they could draw National Insurance; others were found alternative jobs which did not require the direct handling of food. To help counteract the scares, rumours, and panic often created by newspaper headlines, 81 lunchhour talks were given in 77 factories to audiences ranging from 20 to 4,000 with an average attendance of 250 (see pages 9-10). Many managements distributed leaflets to their workers, had some pinned on their notice boards and gave space in their works' journals on methods of prevention; they distributed special notices on the need for washing hands and some replaced roller towels with hand or paper towels. 13 As far as possible the life of the community was not interfered with. Swimming baths remained open, the Willesden baby show and carnival held on August Bank Holiday and the Annual Show held the second week-end in September were not cancelled and the schools opened as usual on 6th September. Each case was asked whether he or she had attended swimming baths, and there was no evidence that swimming baths favoured the spread of infection ; nor was there any increase in the number of cases after the Carnival and other events in Willesden where crowds gathered in the open air. The opening of the schools had no effect on the spread of infection among school children. Before the schools reopened on 6th September instructions on prevention were given to headmasters and canteen staff. Only 10 school children were notified subsequently, all from different schools unconnected with each other; the numbers notified were no higher than in previous weeks. There was only one case in the nine day nurseries The nursery remained open, but all new admissions were stopped for three weeks, the children were kept under observation by the health visitor and assistant medical officer, and the premises were disinfected. Generally it would appear that it is unnecessary to institute some of the heroic measures of the past, such as those carried out in some cities abroad (e.g. cancelling public meetings, closing swimming baths, cinemas and other places of entertainment). Infection apparently spreads mainly through intimate contact, and not by general association at work or in ordinary community life. One example of family spread was the infection attacking all four parents of two related families living in the same block of flats. They were removed to hospital, and the grandmother found it difficult to look after the seven children left behind, two of whom were twins aged 1£ years; so a home help was allocated to do night work, in addition to some assistance given during the day. Paratyphoid Fever Five cases were notified in 1955 (four confirmed). Meningococcal Infection 5 cases were notified in 1955, and 4 were confirmed. There were two deaths. A man of' 54 years died from meningococcal septicaemia. He was not notified. A boy of 2 years died from meningococcal meningitis but the diagnosis was not made until the post mortem examination. Dysentery The number of cases of dysentery was fewer than in, the previous year, yet the disease was much more prevalent than before the war. It is usually a mild disease, causing no deaths, but can cause some discomfort and disruption of the life of the community. There is no evidence yet of how it is spread, but none of the outbreaks in the borough has been traced to food. How far the disease is spread by symptomless excreters and convalescent carriers is not known. In the outbreaks, special precautions were taken for cleanliness and hygiene, but there was no evidence that there was any spread as a result of failure in these. In day nurseries, because they are relatively closed communities, all cases and carriers are excluded, but in. schools exclusions are usually restricted to cases, their contacts and convalescent carriers. Most symptomless excreters, if not contacts, are permitted to return to school. There are, however, no set rules, and sometimes convalescent carriers or contacts are allowed to return if the risk appears small. 140 cases were notified in 1955 (104 confirmed). There were five outbreaks of dysentery during the year. (1) On the 11th April an outbreak occurred at the hostel for homeless families, 91 Dartmouth Road. Altogether 35 mothers and children were affected, 10 with mild symptoms. Six of the children were attending Gladstone Park Day Nursery and the disease spread to other children in the Nursery; 6 children had symptoms; 1 child and 2 members of the staff were positive on routine swabbing. The hostel was not out of quarantine until 20th June, because the outbreak took a considerable time to clear up, mainly owing to overcrowded conditions and unsatisfactory washing accommodation. The outbreak at the Nursery soon cleared up and new admissions were commenced on the 13th May. (2) On the 9th September an outbreak occurred at the Essex Road Day Nursery. 1 child had symptoms and 35 other children were positive on routine swabbing. The child with symptoms and five carriers were admitted to isolation hospital. New admissions were accepted in the nursery on 19th October, 1955, when all the carriers had ceased to be infectious. (3) On the 20th September an outbreak occurred at the Chichester Road Day Nursery. 1 child had symptoms and 24 other children were positive on routine swabbing. Two carriers were admitted to the isolation hospital. The infection cleared up rapidly and new admissions were accepted in the nursery on the 17th October. (4) On the 7th November an outbreak occurred at the Longstone Avenue Day Nursery. 10 children had mild symptoms and another 16 were positive on routine swabbing. New admissions were accepted in the day nursery on the 19th December because the infection took some time to clear up. (5) On 17th November an outbreak occurred at the Curzon Crescent Nursery School. 14 children were affected, all with mild symptoms. The infection cleared up rapidly and the children were soon back at school. Smallpox There were no cases of smallpox. Ophthalmia Neonatorum Two cases were notified (0.76 per 1,000 live births); there were complete recovery with unimpaired vision. 14 Puerperal Pyrexia 147 cases of puerperal pyrexia were notified and confirmed. Since August 1st, 1951, puerperal pyrexia applies to any "febrile condition occuring 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." There was an outbreak of a streptococcal infection which began on the 15th March, 1955 in the maternity wards of the Central Middlesex Hospital. From the 15th March to 1st June, 42 patients were infected by Group A streptococci, but with the exception of two deaths of children and one woman who yielded positive blood culture, none of these patients had been seriously ill. Many of the staff were affected, and the organism B haemolytic streptococcus Group A Type 8/25 was resistant to all the sulphonamides tested (sulphathiazole, sulphadimidine, sulphadiazine, sulphamerazine, and sulphamegathene), but was sensitive to penicillin. Even after treatment with a million units of crystalline penicillin per day, a large number relapsed and three of the nursing staff had their tonsils removed, but their throat swabs still yielded haemolytic streptococci several weeks after their operation. The maternity wards were closed from the 5th to 23rd June, and the Public health staff supervised the disinfection of the wards, bedding, clothing and linen, and also of the two houses (91 and 99 York Road, Acton) where the pupil midwives lived. There were no further cases of' puerperal pyrexia that could be attributed to the outbreak after the wards were re-opened for admissions. At the meeting of the Central Middlesex Group Hospital Management Committee held on the 30th December, 1955, it was agreed that a Control of Infection Committee be set up, with the Medical Officer of Health. Food Poisoning 39 cases of food poisoning were notified (24 confirmed). TUBERCULOSIS Morbidity and Mortality It is gratifying to see that the death rate from tuberculosis this year has fallen below that of 1953, the previous lowest recorded in Willesden. Small fluctuations from year to year are not so important as the trend over the last 10 years, which has shown a decline of nearly two thirds in the death rate (Table I). In 1955, four-fifths of the deaths from respiratory tuberculosis occurred in men over 25 years of age, the majority of whom were over 45 (Table 2). This reflects the national experience, with more deaths occurring among middle-aged and elderly men, and far fewer deaths among young women. Because of the high incidence of chronic bronchitis and emphysema in men of this age, tuberculosis is often difficult to diagnose and treat. Perhaps of even greater significance than the falling death rate is a marked drop in the number of new notifications for the first time in many years. This has occurred at a time when concentrated efforts were being made for the detection of new cases, so that there is probably an actual decline in the incidence of tuberculosis (Table I). Most pleasing is the marked reduction in the number of new cases in children under 15 years of age (Table 2); there were only 5 new cases in the year under review, compared with 20 in 1954, and an average of 28 per annum over the last 4 years. Social conditions have not changed so much in recent years to account for this reduction. It is probable that modern chemotherapy is not only reducing the death rate in the more effective treatment of advanced cases, but is also reducing their infectivity and thus the total infectious pool. Mapesbury, Kilburn and Harlesden still have a high notification rate but there has been a drop in the rate in Carlton (Table 3). Prevention The principal source of infection is the adult human case, particularly middle-aged and elderly males. The search for and control of these patients is therefore an important preventive measure. Even the non-pulmonary cases are almost certainly due to the human bacillus, now that raw milk is unobtainable in London. Poor social conditions have a marked bearing on the incidence of tuberculosis, and this is demonstrated in the higher notification rate in the three more overcrowded wards of Mapesbury, Kilburn and Harlesden. Apart from infection at home it is known that the disease may be contracted at work. Routine radiography of factory workers, particularly when they are known to be contacts, is essential, and short talks at the factory have been given to emphasise this method of prevention. With the drop in the notification rate, the demand for admision to hospital has fallen, and it is now possible to admit without delay all those patients needing treatment. Early treatment of these patients together with the remarkable effects of long term chemotherapy in the home, have diminished the danger of known infectious cases. In Willesden, as elsewhere, it is the undiagnosed infectious patient who is the main source of danger. Health education, routine radiography, improving social conditions and B.C.G. vaccination, are the main preventative measures. The school doctors in their talks on tuberculosis to school leavers, the health visitors with their education in the home, and the Council with its rehousing programme are all contributing to this important work. 15 B.C.G. Vaccination The work of the Medical Research Council has now shown conclusively that B.C.G. vaccination of school leavers is a very successful additional measure in the prevention of tuberculosis. The unvaccinated tuberculin-negative school-leaver is five times more likely to develop tuberculosis than are his vaccinated contemporaries. The arrangements made in 1953 for vaccinating tuberculin-negative school leavers have been continued. Protection is afforded to young people who are more susceptible to tuberculosis and are embarking upon a more arduous industrial or commercial life where they will be more freely exposed to infection. The higher proportion of negatives to tuberculin skin-testing, necessary as a preliminary to B.C.G. vaccination, reveals a much larger group of children reaching school-leaving age in 1955 without having previously been infected with tuberculosis. In fact, the percentage of positives (of those infected), has dropped by two-thirds (Table 5), and now almost 80% of school-leavers require B.C.G. vaccination. This change may be accounted for by the reduction in the pool of infection and in the introduction of a more reliable method of skin testing (multiple puncture) during the year. The advantage of the new test lies not only in its greater reliability, but in its being more acceptable to the public, with only one attendance required instead of two. The acceptance rate for B.C.G. has therefore improved since the test was introduced, and with the larger number of children needing B.C.G. vaccination this year, have resulted in a much larger number of vaccinations being performed. Altogether 1279 school leavers were vaccinated—about 1 in 2 of the total school-leavers population as compared with 1 in 5 in 1954 (Table 6). Nevertheless, many children who required vaccination failed to attend. It is sincerely hoped that parents will co-operate more fully in the future and so help to protect their children. Children showing a positive tuberculin test (thus revealing previous infection) are all referred for X-ray examination as a precautionary measure. Only one such child (a school leaver) out of' 425 schoolchildren referred to the Chest Clinic was found to have pulmonary tuberculosis. Annual tuberculin testing was continued in the Infant Welfare Clinics as part of the routine yearly medical examinations of young children under 5 years of age, and it was repeated at their first medical inspection as school entrants. In such young children a positive tuberculin test has particular significance, because it may indicate a recent infection and the need for a close follow-up of the child and an investigation of the family. The child and the family are referred to the Chest Clinic for these examinations. Missed Notifications There has been a slight reduction in the proportion of persons who die from tuberculosis previously un-notified (Table 7). This provides another indication that the extent of infection in the community is less. Over the last five years, an increasing proportion of deaths among persons known to be tuberculous occurred more than 5 years after notification, demonstrating once again that modern chemotherapeutic treatment is effective in prolonging life. Chest Clinic The Chest clinic is the main centre for detecting new patients, a very large proportion of whom are referred for investigation by their family doctors. Factories and Workshops Arrangements were made to examine 111 contacts of infectious cases discovered in five factories and workshops. The reports on 109 were satisfactory but two X-rays were doubtful, resulting in further investigation. Fortunately only one of these persons proved to have tuberculosis. It has been shown that overcrowding in large workshops is an important factor in the spread of tuberculosis when an undetected sufferer is working there. The routine X-raying of all contacts when such a case is discovered is therefore of the greatest value: furthermore a repeat survey after an interval of some months may reveal patients not previously detected. Every effort is made to return non-infectious ex-tuberculous patients to suitable vacancies in industry. Several cases were referred during the year for training at the Government Training Centre at Perivale. Hospital Accommodation The hospital accommodation for tuberculous patients in Willesden was increased in 1954, and is now adequate for the immediate treatment of cases requiring hospitalization. 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 of beds (approximately 50) are available in the chest hospitals of the North West Metropolitan Regional Hospital Board. Co-operation Two 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. Questions relating to the follow-up of tuberculin-positive school entrants, factory contacts, regular routine X-ray of teachers and the spread of infection in overcrowded lodging houses were among the problems discussed. Further measures to improve the existing schemes and arrangements were suggested. 16 TABLES : TUBERCULOSIS 1. Notified Cases and Deaths Year Population New cases (Rates per 1,000 pop. in brackets) Deaths (Rates per 1,000 pop. in brackets) Cases on Register Pulmonary Nonpulmonary All forms Pulmonary Nonpulmonary All forms Pulmonary Nonpul monary All forms 1936 190,000 211 47 258 128 16 144 655 152 807 (1.11) (.168) (1.358) (.673) (.084) (.757) 1937 188,030 205 49 254 119 14 133 688 161 849 (1.09) (.261) (1.351) (.632) (.074) (.707) 1938 187,600 210 56 266 117 11 128 691 172 863 (1.119) (.298) (1.417) (.623) (.058) (.681) 1939 188,000 250 37 287 108 12 120 678 166 844 (1.329) (.197) (1.526) (.574) (.063) (.638) 1940 152,030 204 54 258 105 16 121 587 145 732 (1.324) (.355) (1.697) (.690) (.105) (.795) 1941 127,230 217 32 249 79 15 94 575 116 691 (1.705) (.252) (1.957) (.621) (.117) (.738) 1942 138,600 234 47 281 100 15 115 369 133 502 (1.688) (.339) (2.027) (.721) (.108) (.829) 1943 144,430 262 51 313 85 14 99 734 150 884 (1.814) (.353) (2.167) (.589) (.096) (.685) 1944 139,510 210 23 233 84 18 102 815 156 971 (1.505) (.165) (1.670) (.602) (.129) (.731) 1945 161,954 207 45 252 81 16 97 927 172 1099 (1.278) (.277) (1.556) (.500) (.098) (.598) 1946 170,550 255 34 289 81 15 96 1067 180 1247 (1.495) (.199) (1.694) (.475) (.088) (.563) 1947 175,900 253 33 286 76 12 88 1198 191 1389 (1.438) (.188) (1.626) (.432) (.068) (.500) 1948 179,900 243 27 270 80 11 91 1293 196 1489 (1.351) (.150) (1.501) (.445) (.061) (.506) 1949 181,120 186 22 208 66 9 75 1386 207 1593 (1.026) (.121) (1.147) (.364) (.050) (.414) 1950 181,700 229 29 258 51 4 55 1543 217 1760 (1.260) (,159) (1.419) (.280) (.022) (.302) 1951 179,647 228 33 261 46 5 51 1673 239 1912 (1.269) (.84) (1.453) (.256) (.028) (.284) 1952 180,400 229 27 256 29 4 33 1803 250 2053 (1.269) (.150) (1.419) (.161) (.022) (.183) 1953 178,500 216 29 245 24 1 25 1854 249 2103 (1.210) (.162) (1.372) (.134) (.006) (.140) 1954 177,300 229 33 262 33 4 37 1917 267 2184 (1.292) (.186) (1.478) (.186) (.023) (.209) 1955 176,000 152 23 175 25 2 27 1966 277 2243 (0.863) (.131) (.994) (.142) (.011) (.153) 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 - - — — 1 to 5 - 1 - 1 - - — — 5 to 10 - 1 - - - - — — 10 to 15 1 2 1 - - - — — 15 to 20 6 6 1 - - - — — 20 to 25 11 16 4 2 - - 1 — 25 to 35 15 21 2 3 2 1 — — 35 to 45 14 11 1 1 3 1 — — 45 to 55 14 7 2 2 5 1 — — 55 to 65 12 3 1 - 5 2 — 1 65 and upwards 9 2 — 1 5 — — — Totals 82 70 12 11 20 5 1 1 17 3. 1955 : Deaths and Cases by Wards Ward Pulmonary Cases NonPulmonary Cases Pulmonary Rate Combined Rate All Forms Deaths Rate Carlton 8 3 0.786 0.897 4 0.326 Kilburn 18 3 1.132 1.538 2 0.146 Brondesbury Park 4 — 0.316 0.316 4 0.316 Kensal Rise 12 — 1.048 1.048 2 0.175 Manor 12 1 0.901 0.976 2 0.150 Harlesden 16 3 1.134 1.347 2 0.142 Stonebridge 11 — 0.865 0.865 1 0.079 Roundwood 9 4 0.758 1.095 2 0.169 Church End 9 1 0.687 0.764 1 0.076 Willesden Green 12 2 0.889 1.037 1 0.074 Mapesbury 17 3 1.357 1.596 — — Gladstone 8 2 0.682 0.853 2 0.171 Cricklewood 7 1 0.606 0.693 — — Brentwater 9 — 0.778 0.778 4 0.346 Whole Borough 152 23 0.864 0.994 27 0.153 4. 1953-1955 : Deaths and Cases by Wards Ward Pulmonary Cases NonPulmonary Cases Pulmonary Rate Combined Rate All Forms Deaths Rate Carlton 72 8 1.934 2.149 11 0.295 Kilburn 56 11 1.366 1.634 11 0.268 Brondesbury Park 28 5 0.737 0.868 8 0.210 Kensal Rise 31 3 0.896 0.983 8 0.231 Manor 37 4 0.917 1.016 7 0.174 Harlesden 46 12 1.079 1.360 5 0.117 Stonebridge 43 5 1.118 1.248 8 0.208 Roundwood 39 9 1.085 1.336 5 0.139 Church End 37 6 0.928 1.078 6 0.150 Willesden Green 45 7 1.106 1.278 6 0.147 Mapesbury 64 8 1.704 1.917 3 0.080 Gladstone 35 5 0.989 1.130 6 0.170 Cricklewood 36 2 1.022 1.079 1 0.028 Brentwater 28 — 0.804 0.804 4 0.115 Whole Borough 597 85 1.123 1.282 89 0.167 5. Patch and Multiple Puncture Tuberculin Testing, 1953-1955 Children under 5 years School children (5 years) School leavers Tested Positive % Positive Tested Positive % Positive Tested Positive %. Positive 1953 1416 56 4.0 1018 384 38.0 1804 885 49.1 1954 1526 43 2.8 938 169 18.0 1868 1116 59.7 1955 1308 13 10 1537 32 2.1 2041 387 19.0 18 6. B.C.G. Vaccination of School Leavers 1953-1955 No. tested and found negative No. vaccinated 1953 587 456 *(32.5) †(77.7) 1954 447 391 (23.9) (87.5) 1955 1535 1279 (75.2) (83.3) * Percentage of total tested. † Percentage of negatives vaccinated. 7. Deaths : When Notified 1950 1951 1952 1953 1954 1955 1950-55 Deaths 51 46 29 25 37 27 215 Percentage not notified 12 20 21 28 19 15 19 Percentage notified before death: 0—12 months 35 15 21 8 11 15 18 1—5 years 27 39 31 28 30 26 30 Over 5 years 26 26 27 36 40 44 33 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 1 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. 19 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 158 samples were taken from swimming baths, three of which were unsatisfactory. This was due to a mechanical fault in the filter, which was speedily repaired. Swimming Bath Samples taken Satisfactory Granville Road 96 93 Gladstone Park 38 38 King Edward's Park 24 24 SANITARY SECTION Staff The authorised establishment of Sanitary Inspectors is Chief Sanitary Inspector, Deputy Chief Sanitary Inspector, 18 district Inspectors and 5 pupil Sanitary Inspectors. Four Inspectors resigned in 1955, and one was appointed to the post of Deputy Chief Sanitary Inspector, which became vacant on the retirement of the previous holder; two of the five vacancies were filled. At the end of the year there were still three vacancies, probably because the Country requires at least another 500 Sanitary Inspectors, and although the Council pays the London scale of salaries (which is higher than the N.J.C. scale), other authorities offer additional inducements such as housing accommodation or car allowances. Five pupil Sanitary Inspectors were on the staff at the beginning of the year. Two completed the course and received their certificate, and were appointed Sanitary Inspectors to the department. One new pupil Sanitary Inspector was appointed, but one vacancy still remains. The Rodent Officer and four operatives were employed in the destruction of rats and mice in the borough, and two labourers on vermin disinfestation, drain testing, and general duties. Sanitary Inspection of the Area The main aim of the Council is to preserve property which will otherwise deteriorate into slums and then require demolition. Many tenants inform the Public Health Department only when the defects are serious and costly to remedy. 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 and the survey commenced on the 1st April, 1954. At the end of 1955, 2890 (82 per cent.) of the houses in the planned survey had been inspected, and 3 out of' 4 had defects (Table 1). The main criterion in drawing up schedules of repair was to prevent houses deteriorating, shown by the attention paid to windows, roofs, brickwork, gutters and downpipes and walls and ceilings (Table 2). The Council served notices for remedying defects under the Public Health Act, 1936 (Table 3). 14 owners appealed against the notices, but agreement was reached on a modified schedule of repairs in 13 (11 were withdrawn and 2 adjourned by the Court); 1 appeal was upheld. TABLE 1 General Housing Survey, 1955 (1954 in brackets) Houses Inspected Re-inspections Total Inspections 1129 (1761) 745,1 (4640) 8580 (6401) Houses in all respects reasonably fit for human habitation 275 (407) Houses with slight defects 13 (30) Houses requiring action 841 (1324) Total 1129 (1761) 20 TABLE 2 Defects Requiring Action (1954 in brackets) Chimneys 166 (367) Roofs 409 (652) Gutters and downspouts 350 (672) Soil and vent pipes 112 (288) Brickwork 451 (677) Windows 653 (1081) Paving 229 (420) Water closets 231 (550) Drainage 22 (86) Walls and ceilings 605 (1020) Floors 277 (471) Totals 3505 (6284) TABLE 3 (1954 in brackets) Notices Served Results of action taken Section 9, Housing Act, 1936 592 (997) Work completed 1316* (367) Section 93, Public Health Act, 1936 24 (17) Work commenced or negotiations proceeding 407 - Section 39, Public Health Act, 1936 3 (5) Notices served, time limit not expired 49 - Section 45, Public Health Act, 1936 4 (14) Work to be carried our by the Borough Engineer in default 58 - Intimation notices 295, (247) Appeal outstanding - - Appeal upheld - (1) 918 (1280) 1830 (368) Total 2198 Total 2198 *Including 54, work carried out by Borough Engineer. Demolition and Closing Orders Housing Act, 1936 (Sections 11 and 12) Local Government (Miscellaneous Provisions)Act, 1953 (Section 10) (1954 in brackets) Demolition Orders—Section 11, Housing Act, 1936 1 (—) 2a and 2b Poplars Avenue Closing Orders—Section 12, Housing Act, 1936 6 (2) 850 Harrow Road (basement) 852 Harrow Road (basement) 856 Harrow Road (basement) 860 Harrow Road (basement) 862 Harrow Road (basement) 864 Harrow Road (basement) Closing Orders—Section 10, Local Government (Miscellaneous Provisions) Act, 1953 (2) Determination to Purchase Unfit House in Lieu of making a Demolition Order—Section 3, Housing Repairs and Rents Act, 1954 2 (—) 107, Cambridge Road Devonshire Chambers, Tennyson Road (At the end of the year negotiations for purchase were proceeding). Slum Clearance The Minister of Housing and Local Government required all local authorities to submit, by the 1st September, 1955, programmes for dealing, within the next five years, with unhealthy areas falling into the category described in section 25 of the Housing Act, 1936, and for dealing with individual unfit houses falling into the category described in section 11 of that Act. The Council submitted the following areas for clearance, i.e., Peel Road comprising 6 houses Granville Road comprising 50 houses Willesden Lane (part) comprising 23 houses Victoria Mews comprising 13 houses and 250 individual houses scattered throughout the Borough. 21 Since the programme was submitted, the Council have added 66 houses in Albert Road and 76 houses in Denmark Road to the list of Clearance areas. 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 realise that the Court is inclined to deal sympathetically with tenants Licences to permit temporary overcrowding in excess of the permitted number, section 61, Housing Act, 1936: licences issued 6 (5) (1954 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 1,991 (b) Overcrowding reported during the year 63 (c) (i) Overcrowding relieved during the year 58 (ii) Persons approx. 232 (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 53 (ii) Families 76 (iii) Persons 456 (f) Overcrowding in Council houses relieved duringthe year 10 New Dwellings 1955 Houses Flats Rebuilds Dwellings built by private builders (excluding those built by the police authorities) 3 14 Nil Built by local authority Nil 26 Nil Applicants on Council's waiting list at 31.12.55 10,645 Housing Defects 1955 1954 Premises inspected on complaint 3,319 3,522 For infectious diseases 607 419 Others (includes Lower Place survey, i.e., 133) 196 416 Under special survey (see page 19) 1,129 1,761 Total number of premises 5,251 6,118 No. of inspections (inclusive of Housing Survey) 22,296 22,950 Notices served under Public Health and Housing Acts, 1936 Inclusive of Housing Survey 1955 1954 Intimation notices served 2,009 2,277 Intimation notices complied with 1,910 1,918 Statutory notices served (Public Health Act, 1936) 965 1,111 Statutory notices complied with (Public Health Act, 1936) 983 989 Statutory notices served (Housing Act, 1936) 691 1,049 Statutory notices complied with (Housing Act, 1936) 1,060 370 Non-compliance with statutory notices referred to Town Clerk (Public Health Act, 1936, sec. 93) 147† 169† Referred to the Borough Engineer for work to be carried out in default of owners *129 work done by Borough Engineer. 244* 205 fDetails of cases referred to the Town Clerk during year. Work carried out 75 88 Work in hand 8 8 Court orders obtained 20 20 Summonses issued and outstanding at 31.12.55 3 - Summonses withdrawn—notices complied with 24 24 (8) (4) Proceedings pending 9 25 Total 147 169 (The figures in brackets are the notices withdrawn and reserved) 22 Housing Repairs and Rents Act, 1954 Certificates of Disrepair Under this Act, landlords may increase the rent when the house is in "good repair". On the application of a tenant a Sanitary Inspector inspects the house, and if it is not in good repair, the Council must issue a certificate. Until the defects are remedied, the landlord cannot claim an increase in rent. During the year there were 117 applications for certificates of disrepair and 110 were granted; 100 were revoked after repairs were carried out. A much larger number of applications was expected because of the number of' houses in disrepair, but many landlords have not claimed an increase in rent because they were afraid that the tenants' application for a certificate of disrepair might result in a notice from the Council to carry out extensive works to put the house in good repair. Consequently, houses which are much below the "good repair" standard have not 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 bad state of repair. Certificates of Disrepair under Housing Repairs and Rents Act, 1954 Applications received from tenants 123 Withdrawn by tenants 6 Number investigated 117 Granted 110 Refused 7 Applications for revocation certificates received from owners 106 Granted 100 Refused 6 Certificates of Disrepair under Rent and Mortgage Interest Restrictions Acts Applications received from tenants 4 Withdrawn Granted 4 Refused Applications for revocation certificates received from owner 2 Granted 2 Summary of Nuisances and of Improvements Effected Water Supply and Water Service Inclusive of Housing Survey 1955 1954 New cisterns provided 34 25 Cisterns cleansed, repaired, covered, etc 71 75 Draw taps placed on mains 29 1 Drainage and Sewerage Water Closets: Repaired, supplied with water or otherwise improved 828 631 New closets built 4 - Provided with better ventilation 3 3 Drains: Examined, tested, exposed, etc 187 267 Unstopped, repaired, trapped, etc. 376 316 New soilpipes or vent shafts fixed 92 77 Disconnecting traps or chambers inserted 24 21 Reconstructed 62 10 New manhole covers 88 57 Soilpipes or vent shafts repaired 386 162 23 Other Defects Smoke nuisances 9 6 Accumulation of refuse 100 105 Fowls, pigs, etc., kept in an insanitary condition 5 14 Dampness 1,673 895 Yard and forecourts paved, repaved or repaired 749 366 Walls and ceilings cleansed 3,143 2,090 Verminous rooms disinfested 325 246 Leaky roofs made watertight 1,990 1,176 Additional ventilation provided under floors 124 93 Dilapidated plaster repaired 3,364 2,011 Flooring and other woodwork repaired 2,173 1,147 Damp-proof courses inserted 309 75 Water supply reinstated 46 75 Wash-house floors repaired or repaved 127 57 Fireplaces and stoves repaired 1,444 809 Decayed brickwork repaired and repointed 2,532 995 Sinks provided or replaced 303 224 Additional light and ventilation to staircase 47 2 Larders or food cupboards ventilated or provided 53 4 Gutters and/or rainwater pipes repaired or renewed 1,982 1,136 New sashcords and glass provided to doors and windows 5,433 2,690 Miscellaneous 1,523 677 Total nuisances abated 16,538 29,638 Inspection of Other Premises 1955 1954 No. Inspections No. inspected Inspections made inspected made Offensive trades - — - - Power factories 787 850 654 727 Non-power factories 64 73 76 103 Workplaces—other than outworkers - - 5 5 Homeworkers and outworkers 236 236 405 405 Inspection of food premises (includes re-visits) Baker 36 113 38 203 Bread and confectionery 37 104 37 141 Dairy 10 35 10 73 Butcher 115 351 115 414 Grocer and general store 318 710 320 772 Fishmonger and fish-fryer 61 134 61 217 Cafe and restaurant 154 308 153 559 Greengrocer and fruiterer 123 237 126 269 Ice cream and sweet shop 180 328 183 407 Food stall 18 39 17 28 Public house 45 85 44 117 Works canteen 112 128 112 244 Food factory 13 48 13 40 Any other food premises 26 75 25 106 Total periodic inspections 2,335 3,854 2,395 4,831 Other Inspections 1955 1954 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 - 127 - 123 Public House urinals 44 147 44 301 Mews and stables 29 58 29 85 Miscellaneous - 1,967 - 1,490 Smoke observations 39 307 34 249 Verminous rooms 83 121 82 131 Total other inspections 2,727 2,379 Total all inspections (inclusive of Housing Survey) 28,877 30,160 TABLE 1 Monthly Deposits in Tons per square mile—1955 Power Station Acton Lane Taylors Lane Neasden Site Barrett's Green Road Minet Gardens Ascot Park Neasden Lane Press Road Wembley Trading Estate Town Hall January *33.95 85.53 38.10 41.59 43.01 39.05 37.17 February 33.93 41.49 17.42 25.18 25.95 20.55 20.12 March 36.68 57.79 21.07 26.28 19.22 23.21 24.43 April 38.44 †57.63 22.39 23.00 30.52 23.15 22.16 May 43.08 94.12 28.58 43.51 34.13 42.64 39.71 J une 36.38 51.03 24.03 26.44 30.58 24.99 27.43 July 29.76 16.50 18.01 19.81 18.03 29.21 9.02 August †3.87 26.84 20.5 19.22 †109.23 27.17 9.71 September 29.36 41.75 15.0 55.34 23.20 14.49 15.47 October 49.71 69.26 40.50 ‡ ‡ 36.52 23.18 November 24.52 40.82 ¶ 17.13 18.22 15.47 13.17 December 25.09 70.59 16.46 29.49 19.55 15.80 17.28 Total 413.77 653.35 262.91 326.99 371.64 312.25 258.85 *Collecting bowl broken—figures unreliable. †("Contaminated with extraneous matter—figures unreliable. ‡Contaminated with extraneous matter—no analysis made. ¶Deposit bowl broken. TABLE 2 Examination of Sulphur by Lead Peroxide Method, 1955 Expressed in Milligrams of SG3per Day per 100 Square Centimetres Site January February March April May June July August September October November December Minet Gardens 4.23 4.85 3.03 2.18 2.65 2.03 1.36 1.44 1.11 2.47 2.87 3.50 Town Hall 4.15 4.68 2.25 2.03 2.30 1.97 1.12 1.61 0.95 2.22 3.60 Nil* *Apparatus accidentally exposed to rain. 24 Smoke Nuisance The problems of atmospheric pollution continue to be of major importance for preventing chest disorders. Measurements of the grit and sulphur in the air have been carried out during the year, and the results in the areas surrounding the three power stations, especially Neasden Power Station, show a sligh improvement (Tables 1 and 2). The last two pulverised fuel furnaces at Neasden have now been converted to oil burning with a reduction in the amount of grit emitted. A public meeting was called in March for the purpose of discussing the problems of air pollution and the Council's methods of dealing with them. A new Act to control smoke arising from fuel burning is now being passed in Parliament, but it appears there will be no measures adopted to deal adequately with the emission of sulphur gases which are at least as harmful to health as smoke and grit. 25 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 nuisances, such at rats or refuse, on the remaining sites. DISINFESTATION The Sanitary Inspectors inspect verminous premises and supervise the work of the disinfestors employed by the Council (section 83 of the Public Heealth Act, 1936). There was a slight increase in this work as compared with the previous year. (a) Verminous premises: Council properties 25 County Council properties Private properties 123 Total 148 (b) Verminous rooms:* Council properties 55 County Council properties Private properties 270 Total 325 *Some rooms are treated more than once. (c) Bedding materials 27 (d) Miscellaneous: Beetles 12 Ants 8 Bluebottles 1 Since 1948 the disinfection and disinfestation of bed linen has been carried out at the Neasden Hospital (section 84 of the Public Health Act, 1936). The agreed charge was based on a proportion of the wages of the Hospital Management Committee's attendant engaged on the work and the cost of operating the steam disinfector at the hospital. Transport was provided by the Council. The Hospital Management Committee reviewed staffing arrangements in July, and suggested that they would continue to disinfect or disinfest bed linen at the hospital, but the Council should undertake the remainder of the work (disinfection of rooms, collection of clothing and bedding for treatment and delivery after treatment) carried out by the attendant. The Council agreed to do this and the existing scheme ended on the 5th December. 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 246 Borough Council properties 9 Private dwellings 978 Total 1,233 at the following cost: Business premises £1,300 14s. od. Private dwellings £1,830 4s. 7d. Total £3,130 18s. 7d. The cost of disinfestation at business premises is recovered from the occupiers, and in 1955, 105 had an annual agreement with the Council for regular inspection and disinfestation; 14 were new agreements and 91 were renewals. The service is free to occupiers of private dwellings, but the Borough Council recovers 50% of the cost from the Ministry 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. 26 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. Four applications for registration of premises for the manufacture of preserved food, etc., were received in 1955. Premises on register 31.12.54 No. of applications received No. of applications granted No. of applications refused No. of premises removed from registration during 1955 Total on register at 31.12.55 Inspections made Sale and storage of ice cream 297 17 17 - 4 310 324 1,038 Manufacture of ice cream 14 - - - - 14 75 Manufacture of preserved foods 121 4 4 - - 125 351 Fish curing 10 - - - - 10 35 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. Ninety-three samples were taken in 1955, nine of which were unsatisfactory (see page 8). Clean Food Guild The Willesden Clean Food Guild was formed in May, 1948, and certificates were issued to 369 food traders (about 32 per cent, of the total). The new Food and Drugs Act came into operation on 1st January, 1956. The Food Hygiene Regulations made under this Act incorporate many of the recommendations made by Clean Food Guilds. 1949 1950 1951 1952 1953 1954 1955 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 36 13 4 9 Bread and confectionery 37 7 5 2 Butcher 116 54 47 7 Cafe or restaurant 154 77 52 25 Dairy 3 5 5 - Fishmonger or fish-fryer 61 19 12 7 Greengrocer and fruiterer 123 18 16 2 Grocer and general store 318 175 148 27 Ice cream and sweets 180 53 41 12 Works canteen 112 33 31 2 Food factory 13 8 8 — Totals 1,153 462 369 93 Notices ("Wash your hands" and "Exclusion of dogs from food shops") continue to be issued free to food traders by the Guild and the Borough Council. 27 Improvements in Premises In 1955, an additional 25 traders were encouraged to provide constant hot water but 10 premises still have an unsatisfactory supply. 263 traders complied with requests or notices, and no legal action was therefore necessary. Inspections 2,695 Re-visits 865 Total 3,560 Premises unsatisfactory on 31.12.54 65 Unsatisfactory during the year 261 Premises made satisfactory during the year 288 Unsatisfactory on 31.12.55 38 Defects Outstanding at 31.12.54 During the year Total Remedied during year Outstanding at 31.12.55 Inadequate lighting and ventilation - 11 11 10 1 Constant hot water not provided 24 11 35 25 10 Inadequate refuse storage 2 49 51 45 6 Insufficient sanitary accommodation 1 6 7 5 2 Inadequate storage 2 18 20 19 1 Defective walls and ceilings 12 69 81 68 13 Dirty walls and ceilings 25 103 128 116 12 Dirty hand towels 3 52 55 50 5 Generally bad conditions 5 17 22 22 - Any other defects 19 137 156 137 19 Totals 93 473 566 497 69 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, and 33 had defective and dirty walls repaired and redecorated. Education in Food Hygiene Lectures and talks, illustrated with film shows, film-strips 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 was one outbreak of food poisoning during the year in a factory involving 40 workers. The causative organism was Clostridium welchii, isolated from a sample of Irish stew eaten at the staff canteen by all the affected people, who recovered quickly. The source of' the infection was not found, although it is possible that the mutton in the stew was already contaminated when it arrived at the canteen. The meat was cooked and left to cool overnight, the fat was removed, and barley and fresh vegetables were added, the mixture was heated and allowed to simmer until served at lunchtime. Instructions were given to the canteen staff that to prevent food poisoning, freshly cooked meat should preferably be served hot. If it has to be eaten the following day, it should be cooled rapidly (within 1 ½hours of preparation), stored in a refrigerator, and heated well before serving. Contaminated Food There was an increase in the number of specimens of contaminated food and dirty milk bottles dealt with by the Public Health Department. Members of the public reported 26 specimens of contaminated food, but no action was taken in 14 of them because the firm concerned did not appear to have been negligent. The Council prosecuted six firms and cautioned six. Five of the prosecutions were successful, with fines and costs amounting to £25.3.0 and £20.6.0. The sixth case was dismissed. Eleven dirty milk bottles were reported by other local authorities and the public Four were referred to other local authorities for action as the milk was bottled in their areas. The remaining 7 were reported to the Public Health Committee and the Council prosecuted 5 dairies and administered a caution to 2. Three prosecutions were successful, with fines and costs amounting to £22 and £9.13.6. One summons was dismissed and in the remaining cases the defendants were granted absolute discharge, but £11 costs were awarded to the Council. 28 Food Unfit for Human Consumption. Meat. Miscellaneous (continued). Bacon 3,348 ¾lbs. Chocolate marzipan 14 ozs. Cooked 28¾ lbs. Cocoa 16 lbs. Tinned 3,896 tins Coconut l½ lbs. Raw 3,1474½ lbs. Coffee 1 tin Cream 41tins Fish. Dried fruit (figs) 13½ lbs. Dried fruit (prunes) 11 lbs. Tinned 864 tins Dried fruit (raisins) 14¾ lbs. Raw 245 lbs. Dried fruit (sultanas) 21 lbs. Dried fruit salad 16 lbs. Vegetables. Fruit juice 1,193 tins Tinned 5,791 tins Gelatine 14 lbs. Raw 622 lbs. Ground cloves 3 tins Macaroni cheese 1 tin Fruit. Mayonnaise 8 jars Tinned 15,496 tins Mint sauce 1 jar Paste 5 jars Raw 354¼.lbs Pickled cabbage 3⅓ lbs. Bread, flour, cereals, etc. 1,824½ lbs. Pickles 5 jars Preserves 4114½ lbs. Pudding mixture 21 lbs. Cheese 135½ lbs. Soup 485 tins Butter and fats 4 lbs. Sponge pudding 7 tins Tinned milk 2,330 tins Stem ginger 1 jar Miscellaneous. Synthetic cream powder 7 lbs. Syrup 6 tins Biscuits ½ lb. Tomato juice 24 tins Candied peel 4 oz. Tomato pulp 39 tons, 19 cwts. 6 lbs. Chocolate 40 bars Vegetable salad 1 jar 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 The tomato pulp was used for pig food. 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 244 - Arrowroot 5 - Baking powder 1 - Biscuits 1 - Bread 1 - Butter 16 - Cakes 36 1 Cheese 1 - Chocolate drink 3 3 Coffee and chicory essence 1 - Cooked meat 34 - Cornflour 1 - Crab meat 1 - Cream 43 - Dried egg 1 - Drugs 50 - Egg vermicelli 1 - Fish 1 - Fish cakes and pastes 14 - Flour 4 - Fruit, tinned 1 - Fruit drink 4 - Fruit syrup 2 - Ice cream 48 - Jam 3 - Jelly 2 - Lard 1 - Margarine 7 - Marzipan 1 - Mayonnaise 2 - Meat 4 - Meat paste 4 - Meat pie 6 - 29 Article No. of' samples Unsatisfactory Minced meat 44 2 Non-brewed condiment 2 - Pears 1 - Sausages 34 - Scotch oats 1 - Shandy drink 1 - Soups 4 - Suet 1 - Sweets 13 - T omatoes 1 - Tripe 1 - Vinegar 32 - Wines and spirits 29 - Yoghourt 2 - Totals 710 7 Five retailers were responsible for the seven samples found to be unsatisfactory—two were prosecuted, two were officially cautioned, and no decision had been reached at the end of the year on the action to be taken in the remaining case. The three unsatisfactory samples of chocolate drink included two flavoured and sweetened skimmed milk, and one chocolate flavoured. The firm who sold the first two was prosecuted and fined £10 with 10 guineas costs, and action in the other case was still under consideration at the end of the year. The butcher who sold the two unsatisfactory samples of minced meat containing a prohibited preservative was fined £5 and £1.15 costs. Official cautions were issued to the bakers of the cream fancy cake, the filling of which was deficient in butter fat; and to the manufacturers of the sweets described as "milk drops", which contained only skimmed milk. Merchandise Marks Acts, 1887-1926 1,544 displays of articles were examined under the Merchandise Marks Acts, 1887-1926, and several infringements were detected, 5 of which were sufficiently serious to warrant action. Official cautions were issued to a firm of butchers and their shop manager f'or displaying Irish Turkeys and failing to mark their origin (the manager was unaware of the provisions of the Acts and had removed the identification discs). Three greengrocers were prosecuted; one displayed Guernsey tomatoes without indicating their origin, another falsely described Dutch tomatoes as English and displayed imported tomatoes and apples without indicating their origin, and the third displayed imported tomatoes and apples without indicating their origin. The fines and costs were £1 and one guinea; £30 and 6 guineas; and £2 and one guinea. Four summonses were issued against a butcher for failing to indicate the origin of imported meat and for falsely describing New Zealand lamb as English. He was fined £10 and 3 guineas costs. Labelling of Food Order, 1953 696 articles of food were examined under the Labelling of Food Order, 1953, but no substantial infringements were discovered. 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 tuberculin 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 113 Dairymen 88 Licenses issued Pasteurised milk 90 Sterilised milk 106 Tuberculin tested milk 74 Premises outside Willesden 12 Dairymen 6 Licenses issued Pasteurised milk 12 Sterilised milk 12 Tuberculin tested milk 12 30 Frequent inspections are made of the dairies. During the year some minor defects were found but were soon remedied. The 129 samples of milk taken in 1955 were all satisfactory. FACTORIES There are 902 factories in the borough, a decrease of 3 compared with the previous year (there was a decrease of 5 in power factories and an increase of 2 in non-power factories). Type of factory On register 1.1.55 Added to register Deleted from register Totals at 31.12.55 Non-power 78 4 9 73 Power 827 25 23 829 Total 905 29 32 902 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 were complied with without legal action. Factories Inspected, Defects Found, and Action Taken Type of factory Inspected Total Inspections Unsatisfactory Outstanding from 1954 Made satisfactory 1955 Outstanding 31.12.55 Non-power 64 73 9 9 - Power 787 850 63 17 69 11 Details of Defects in Non-power Factorie: During 1955 Outstanding from 1954 Remedied during 1955 Outstanding at 31.12.55 Want of cleanliness 9 - 9 - Overcrowding - - - Unreasonable temperature - - - - Inadequate ventilation - - - - Defective drainage of floors - - - - Sanitary accommodation: Insufficient 3 - 3 - Unsuitable or defective - - - - Not separate for sexes - - - - Details of Defects of Sanitary Accommodation in Power Factories: Insufficient - - - - Unsuitable or defective 62 20 76 6 Not separate for sexes - - - - 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 eight basement bakehouses in Wille6den. They have been regularly inspected and are satisfactory. 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. 31 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, together with those who have worked for them during the previous six months. 236 outworkers' premises were inspected in 1955, and three were found to be unsatisfactory. Notices were served and the defects remedied. NOISE NUISANCE The Borough Council are empowered to deal with noise nuisances under section 313 of the Middlesex County Council Act, 1944. Twenty-four complaints were received, but only nine could be considered as statutory nuisances. Four concerned noise from electric motors; at the request of the Health Department, three were placed upon resilient mounting and a baffle wall was built around the fourth. Complaints were also made about the noise of working machinery, etc. during the late evening and night. Late work has become more common, and managements have usually been persuaded to either stop the late work or make arrangements to lessen the noise. OCCUPATIONAL HEALTH SERVICE The Council introduced an occupational health service for their employees in April, 1954. Sanitary inspectors visit offices and workplaces 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, most of these defects had been remedied. Firstaid boxes have been provided at selected sites, and their contents, including a first aid leaflet (form 923) issued by the Factory Department, are based on the requirements of the Factories Act. Chief Officers nominated suitably qualified persons to be in charge of first-aid. Notices with names and addresses of the nearest medical practitioners and hospital are placed in a prominent position, so that in an emergency, cases can 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 ; eight were referred by chief officers. 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. 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. One case was removed to hospital under the Acts during 1955. Mrs. M.E.L., aged 74 years, occupied two rooms and a kitchen with her daughter. One room was full of old clothes and many oddments, and the kitchen and bedroom were in a very insanitary condition. Mrs. L. had been bedridden for a week and was in an emaciated and filthy condition. The daughter, who had recently returned from Shenley Mental Hospital, was incapable of looking after her mother and of keeping the place clean. An Order under the National Assistance (Amendment) Act, 1951, was obtained from a Justice of the Peace on the 16th July, 1955, and Mrs. L. was removed to the Central Middlesex Hospital the same day. The daughter was seen by the Welfare Officer and agreed to return to Shenley Hospital as a voluntary patient, and she went at the same time. It was not necessary to apply for an extension of1 the Order on the 6th August, since Mrs. L. was very ill. She died on the 20th August. 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. 32 No. of Old People using Laundry Service On register 1.1.55 New cases Died Admitted to hospital Recommenced after discharge from hospital On register 31.12.55 12 28 17 6 1 18 Talks to Old People's Associations The Medical Officer of' Health gave five talks to old people's associations. 310 old people attended and showed keen interest in the subjects ('Old Age', 'Nerves', 'Safety First in the Home' and 'Cleanliness in Food') chosen by the associations. They asked many questions and took the opportunity to raise other matters. For example, they asked whether the Council could pay towards the cost of window cleaning, the supply of dentures, spectacles and hearing aids. The Council unfortunately cannot do this, but the old people were told how they could obtain a grant from the National Assistance Board for window cleaning, and the supply of dentures and spectacles; they could obtain hearing aids free of charge under the National Health Service. They were also concerned that the nearest centres for repair of deaf aids were the Ear, Nose and Throat Hospital, Grays Inn Road, W.C.1 and St. Mary's Hospital, necessitating long journeys which many old people found difficult and could not afford to make. The Council raised this point with the Ministry of Health and the North West Metropolitan Regional Hospital Board, and a centre for repairs in charge of an electronics engineer will be organised at the Willesden General Hospital in the future. Voluntary Services for the Aged The care of the aged is an excellent example of how work of voluntary organisations 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 third anniversary on the 28th February, 1955. The Club is open daily from 1.30 p.m. to 10.0 p.m. The membership is now 525, and applications continue to be received. 120 members went to the theatre in February, and 198 members and helpers went for the day to Bognor Regis in September. Holidays at reduced rate were arranged for 30 members at Southend. Voluntary workers visited 40 old people weekly or fortnightly. This was greatly appreciated by lonely people, but more visitors are required The visitors often take small personal gifts to the old people and at Christmas they brought them 5/- or Christmas fare from the Association. Four well-attended Christmas parties were held at the Anson Hall, Cricklewood, and were very successful. More than 1,000 invitations were sent out, and 850 old people were given a high tea and entertainment and 2/- each. Because of the heavy cost of' the chiropody service, a charge of 2/- was introduced for treatment. Nevertheless, more people were treated in 1955; there were 460 on the register compared with 300 in, 1954. An average of 25 attended the two chiropodists in the Kilburn and Harlesden area each week, and altogether 100 (50 in 1954) people were treated in their own homes during the year. On the recommendation of the Welfare Officer, free coal was supplied to old people who could not afford it. On medical recommendation, financial aid was given to 10 old people. A branch club was opened on the 5th January at St. Martin's Church Hall, Kensal Rise, which meets every Wednesday afternoon from 2.0 p.m. to 4.0 p.m. The Association pays the rent of the hall, otherwise the Club is self-supporting. 20 members attended the first meeting and by the end of the year the membership was over 70. 41 members went for the day to Bognor Regis in June, and 41 went for a half-day to Windsor in September. 60 members attended a party given for the oldest member on her 91st birthday in March, and 72 members attended a very successful Christmas party. 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/-, but tea was increased from l½d. to 2d. per cup and coffee from 2½d. to 3d. per cup. 14,015 meals were served during the year, compared with 13,019 in 1954. The meals-on-wheels service organised from the same premises, served 4,501 meals during the year, compared with 5,298 in 1954. 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. The W.V.S. receives information from the Morning and Luncheon Club, the meals-on-wheels service and the National Assistance Board, of old people's needs, such as clothing or little extras of comfort, and were thus able to help another 200 old people during the year. Publicity of Services for the Aged 10,000 copies of a booklet describing all the services available for old people were published in February, and by the end of the year more than 6,200 has been distributed 33 S.OS. Card Scheme 225 S.O.S. cards were distributed. No reports were received of a card being used to summon help in an emergency, 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 9 persons during the year. The total cost to the Council was £105.3.0d. of' which £56.9.od. was recovered by the Borough Treasurer. The cases came to the notice of the department from the following:— Friends or relatives of deceased 6 Coroner's Officer 3 PUBLIC MORTUARY 419 bodies were dealt with at the mortuary as follows: — Post-mortems with inquests 86 Post-mortems 333 Total post-mortems 419 (Section 198, Public Health Act, 1936). The Coroner made use of the Coroner's Court attached to the Mortuary about the same as in the previous vear; two-thirds of the inquests on Willesden residents were held at Ealing. Inquests on Willseden Residents 1950 1951 1952 1953 1954 1955 At Kilburn 54 49 25 12 13 12 At Ealing - - 26 21 37 24 T otal 54 49 51 33 50 36 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 1955. Licences issued Hawkers premises Fruit and vegetables 19 Fish 3 Miscellaneous 1 Total 23 COMMON LODGING HOUSES There are now no common lodging houses in the district registered under section 237 of the Public Health Act, 1936. SLAUGHTERHOUSE LICENCES No slaughtering has been carried out since 1939. One application for renewal of slaughterhouse licence was received under section 57 of the Food and Drugs Act, 1938. The application was refused as repairs were necessary to render the premises suitable. The applicants were informed of the Council's decision and no proposals were received. 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.L 34 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 £1.0.Od. for a period not exceeding twelve months. The premises of persons carrying on business of upholstering, stuffing, or lining of' bedding, toys and baby carriages, and others using filling materials specified in the Act, have to be registered; only one fee of £1.0.0d. is chargeable. Premises Registered On register Registration Removed from Totals at 1.1.1955 approved register 31.12.1955 15 — . — 15 There are no premises in Willesden which require to be licensed for the manufacture or storage of rag flock. Unfortunately the Act does not cover the re-making of an article, and dirty materials can therefore be used in upholstering second-hand articles if they do not belong to the occupier. PET ANIMALS ACT, 1951 Pet shops must now have an annual licence on payment of a fee not exceeding 10/-. During 1954, 19 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 70 staff medical examinations were carried out by the Medical Officer of Health and Deputy Medical Officer of Health in 1955. 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. On the 8th March, 1955, a new pathological laboratory was opened at the Willesden General Hospital. Liaison with Hospitals The exchange of' medical officers between the Paediatric Out-Patients Department at the Central Middlesex Hospital and the local health authority was continued. This scheme has been working very satisfactorily and has 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 1955, 1,689 expectant mothers (65.3% 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, mid-wives, 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. 35 Health visitors conduct mothercraft classes (one afternoon a week at the main clinics) on the care of' the expectant mother, the birth, and the child. 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 1955, 116 mothercraft classes were held with an average attendance of 7 mothers a session; 162 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, and a health visitor conducts similar classes at Kilburn Health Qinic on one afternoon a week. (Table 4). The decline in attendance at ante-natal clinics, etc., is as a result of some hospitals arranging for expectant mothers to have their ante-natal care, mothercraft and relaxation exercises at the hospital. Health visitors and midwives encourage mothers to have post-natal examination six weeks after confinement, either at the hospital, at the clinic, or by general practitioners. Health visitors make followup visits where mothers fail to keep appointments at the hospital or clinics. Two additional church hall clinics were opened in May, 1955, one at St. Martin's Church Hall, Purves Road, Kensal Rise, N.W.10, and the other at St Luke's Church Hall, 47, Denmark Road, N.W.6. 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 four church hall clinics. The average number who attended each session was 29 (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. 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 and in Stonebridge Health Clinic on one evening a week. The mothers form their own Committees and run the clubs themselves with guidance given by the nursing staff. They arrange interesting programmes of lectures and demonstrations on health and homecraft which are given by assistant medical officers, health visitors and outside speakers. The Stonebridge mothers' club has proved to be very successful. The club has a membership of 30, with an average attendance of 15 mothers. A summer outing and visit to a theatre was arranged and the club gave a Christmas party to 50 children. A parents' handicraft exhibition was held in the autumn and there were 100 exhibits including knitting, needlework, painting, woodwork, leatherwork, rug-making, cake and jam making, all of a particularly high standard. Table 1 Ante-Natal Clinics Clinic No of sessions No. of new cases Total attendances Average attendanct per session A.N. P.N. A.N. P.N. Kilburn 150 342 19 1,174 19 7.9 Willesden 151 381 23 1,807 23 12.1 Stonebridge 172 532 23 2,646 23 15.5 Cricklewood (Sneyd Road) 51 185 47 674 64 14.5 Neasden (St. Catherine's) 51 98 30 501 30 10.4 Kensal Rise (St. Martin's) 33 87 7 389 10 12.1 South Kilburn (St. Luke's) 31 64 8 264 8 9.0 Totals: 1955 639 1,689 157 7,455 177 12.0 1954 613 1,911 266 8,838 284 14.9 36 Table 2 Births Hospital and Domiciliary 1954 1955 Total notified live births 2,608 2,526 Born in institutions 2,225 2,165 Born at home 383 361 Percentage born in institutions 84.3 85.7 Institutions Central Middlesex Hospital 995 864 Kingsbury Maternity Hospital 362 354 Larger hospitals outside Willesden 574 585 Smaller hospitals outside Willesden 271 335 Nursing homes, etc. 23 27 Total 2,225 2,165 Home County midwives 340 357 Willesden District Nursing Association 19 - Others 24 4 Total 383 361 Table 3 Mothercraft Clinic No. of sessions No. of new cases Total attendances Average attendance per session Kilburn 29 31 139 4.8 Willesden 37 44 260 7.0 Stonebridge 50 87 424 8.5 Totals: 1955 116 162 823 7.0 1954 126 205 1,152 10.8 Table 4 Relaxation Classes Clinic No. of sessions No. of new cases Total attendances Average attendance per session Stonebridge 1955 95 114 527 5.5 ,, 1954 95 107 909 10.7 Kilburn 1955 36 45 138 4.0 37 Table 5 Infant Welfare Clinics Clinic No. of sessions No. of 1st attendances under one year old (Percentages of total live births in brackets) No. of attendances T otal attendances Seen by doctor Average attedance per session Under 1 year 1—2 years 2—5 years Kilburn 318 453 5,038 661 815 6,514 3,541 20.5 Willesden 254 409 6,193 693 734 7,620 4,709 30.0 Stonebridge 367 511 6,149 785 626 7,560 3,957 20.5 Cricklewood (Sneyd Road) 102 400 3,096 697 499 4,292 1,577 42.1 Neasden (St. Catherine's) 100 269 4,082 882 641 5,605 1,345 56.0 Kensal Rise (St. Martin's) 67 144 2,354 380 225 2,959 974 44.2 South Kilburn (St. Luke's) 61 109 1,441 189 157 1,787 966 29.3 Totals: 1955 1,269 2,295 (90.9) 28,353 4,287 3,697 36,337 17,069 28.6 1954 1,101 2,166 (83.0) 28,922 4,414 4,034 37,370 18,954 33.9 DISTRIBUTION OF WELFARE FOODS During 1955 the number of sessions at three distribution centres was reduced because the W.V.S. found it difficult to provide the staff. There has been little or no inconvenience to the public as there is a centre open every dav. MIDWIFERY SERVICE At the beginning of the year, six midwives were employed in Willesden by the County Council. During the year, three midwives left, and as the number of bookings had been reduced, only two were replaced, making a total of five midwives. In addition, four or five pupil midwives work in Willesden for three months 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 293 mothers (90% of the 326 confinements) and pethidine was given to 103 mothers (32%). 255 of the 293 mothers who had gas and air anagelsia during labour had substantial relief from pain. (Table 2). Midwives work very closely with general practitioners. Midwives attended at 326 confinements; both a general practitioner and a midwife were booked for 225 and both were present at 46. (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 84 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 twice during the year for ante-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 administering 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. 38 Table 1 Midwives Clinics No. of sessions held No. of new cases Total attendances Average attendance per session 1955 309 513 3,420 11.1 1954 289 497 3,116 10.8 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 vear:— (a) When doctor was not present at delivery 244 - 244 (b) When doctor was present at delivery 49 49 Number of cases in which pethidine was administered in domiciliary practice duriner the year:- (a) When doctor was not present at delivery 78 - 78 (b) When doctor was present at delivery 25 - 25 Totals: 1955 1954 396 404 3 396 407 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 7 94 46 179 11,908 47 207 295 2. Voluntary organisations under arrangements with L.H.A. __ Totals: 1955 326 11,908 47 207 295 1954 358 10,166 14 81 311 Table 4 Medical Aid 1955 1954 (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 65 55 (ii) Others 19 35 (b) For cases in institutions - - Totals 84 90 39 Reasons for sending for Medical Aid For Mother For Child Ante-partum haemorrhage 6 Discharging eyes 5 Delayed 2nd stage of labour 3 Premature baby 5 Foetal distress 3 Still Birth 1 Malpresentation 8 Cold 1 Toxaemia 2 Projectile vomiting 1 Post-maturity 1 Ruptured membranes 2 Premature labour 4 Pyrexia 4 Retained placenta 4 Ruptured perineum 30 Spontaneous delivery 1 P.O.P. 1 Inflamation and pain of leg 1 Totals 70 14 Total 84 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. It is hoped, however, that even closer co-operation will exist in the future. During the year 17 general practitioners referred 25 families to health visitors for special reports and action. (Table 2.) The establishment of health visitors for the Willesden part of the area is 30, but there were only an equivalent of 108/11 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 102/11 temporary clinic nurses were employed at the end of the year, making a total of 2010/11 health visitors and clinic nurses. The Middlesex County Council introduced a sponsored scheme for student health visitors in September, 1955. Students receive their theoretical training at the Chiswick Polytechnic and their practical training in one of the areas. They must remain with the County Council as health visitors for two years after they qualify. There were three students in Willesden in 1955. There is still a general shortage of health visitors. 40 Table 1 Health Visiting Work of Health Visitors Year Expectant Mothers Children under 1 year Children 1—2 years Children 2—5 years Tuberculous Households General Ineffectual visits 1st visits Total visits 1st visits Total visits Total visits Total visits Total visits Total visits as health visitor Total visits as school nurse 1955 1,039 1,532 2,479 8,096 4,156 7,877 5 1,122 1,072 3,118 1954 945 1,391 2,653 10,788 4,049 8,120 701 733 4,837 Table 2 Cases Referred by General Practitioners Number referred Type of case Care of children Elderly persons General advice Hospital admission Home help Welfare foods Others 25 2 18 1 2 1 — 1 41 HOME NURSING The Area Health Office is responsible for the day to day administration of the Home Nursing Service in Willesden. The nurses are non-resident and receive many applications from hospitals and general practitioners by telephone in their own homes. The County Council runs a district nurse training home at 17, and 19, Park Avenue, Willesden. The candidates assist the home nurses in Willesden and gain experience in home nursing; they are included in the establishment of the 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. The establishment of home nurses has been maintained throughout the year. Home Nurses Establishment Nurses As at 1.1.55 As at 31.12.55 Whole time 19 19 Part-time 7 6 Candidates 6 8 Total whole time equivalent 26 27 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 1,242 2,045 95,022 304 610 Surgical 262 349 15,061 51 73 Infectious diseases 9 14 132 2 3 Tuberculosis 54 39 3,710 20 14 Maternal complications – 26 251 — 1 Others – 3 23 — — Total 1,567 2,476 377 701 Totals: 1955 4,043 114,199 1,078 1954 4,235 118,280 1,204 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 33.1 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 836 135 62 42 129 1,204 No. of persons re-vaccinated — — 7 45 310 362 Totals: 1955 836 135 69 87 439 1,566 1954 1,031 84 48 90 477 1,730 Approximate number of children (end of 1955) 0— 5 12,718 5—15 22,457 35,175 42 DIPHTHERIA IMMUNISATION Age at 31.12.55 Under 1 1 2 3 4 5-9 10-14 Totals Course of injections (whether primary or boosting) completed during last 5 years 1951-55 26 993 1,047 1,297 1,430 5,709 4,483 14,985 Course of injections (whether primary or boosting) completed during the period 1941-50 — — — — — 5,371 6,994 12,365 Approximate number of children (end of 1955) 0— 5 12,718 5—15 22,457 35,175 HOME HELP SERVICE There was a further increase in the number of new cases during the year, and in the number of cases being helped at any one time. 56 mothers booked a Home Help in advance for domiciliary confinement, but only 43 received help, the others made alternative arrangements. Six mothers who had not booked Home Help in advance, were provided with Home Helps at the request of the Midwife, usually where private arrangements had broken down. The full charge for the service was increased to 3/6 per hour, and the rate of pay for the Home Help to 2/101/8d. An extra 2d. per hour was granted to helpers working in homes where there were patients suffering from tuberculosis or other infectious disease. During the September poliomyelitis outbreak, a Home Help stayed in at night for 3 weeks in a home from which both parents had been admitted to Neasden Hospital with poliomyelitis leaving 5 young children including 18-month-old twins. Efforts had first been made to have the children admitted to hospital, or taken into child care, but these failed as they were poliomyelitis contacts. 95 Home Helps were employed at the end of 1955, compared with 89 at the end of 1954, and a male Home Help was employed for 4 months. The appointment of a third Assistant Organiser on a temporary basis, made it possible to double the number of home visits during 1955. This greatly improved the supervision of the Home Helps' work and enabled the organisers to keep each case more closely under review with proper adjustments in the amount of help allocated. This appointment was terminated on 31.12.55. Home Help Cases (1954 in brackets) Cases receiving help at 1.1.55 No. of new cases helped during year No. of cases receiving help at 31.12.55 Maternity - (3) 85 (71) 2 (-) Tuberculosis 44 (49) 17 (21) 36 (44) Chronic sick and aged 373 (371) 284 (218) 494 (373) Others 51 (38) 130 (145) 64 (51) Totals 493 (484) 516 (467) 596 (493) Staff (1954 in brackets) Position at 1.1.55 Appointments during 1955 Resignations during 1954 Position at 31.12.55 Whole time 5 (5) 2 (1) 5 (1) 2 (5) Part time 84 (82) 57 (38) 46 (36) 93 (84) Total 89 (87) 59 (39) 51 (37) 95 (89) 43 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. 596 applications for admission were made during the year but only 414 children were actually admitted. The majority of the remainder found the assessment too high (Table 2) or made alternative arrangements. Over 90% of the cases on the register were in the priority groups, 37% children from homes where the mother is the sole support. (Table 3.) Assessed Daily Charge. The maximum charge per day has remained at 9/-. Many applicants who feel unable to pay the assessed charge appeal, and attend a meeting of an Appeals sub-committee. The assessments, after all appeals, are shown in Table 4 (December, 1955). Attendances. Most of the day nurseries were used to their full capacity. The average daily attendance showed little alteration in 2—5 years age group from the previous year but there was a reduction in 0—2 years age group. (Table 1.) Infectious Diseases. Four nurseries had outbreaks of dysentery and some nurseries had cases of measles during the year. Other outbreaks were mainly isolated cases imported from families of the children attending. (Table 5.) 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 Gibbons Road Primary School gave a puppet show in both Essex Road and Chichester Road Day Nurseries. The County Council gave 3/- a head for each child attending the nursery towards the Christmas expenses. 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 equvalent 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 1 nursery nurse attended the Supplementary Child Care reserve course at Chiswick Polytechnic and was later appointed as warden. Six nurseries are approved as training schools for the 2 year National Examination Board course. The students attend Chiswick Polytechnic for two days weekly. 17 students were in training during the year and 4 of' them obtained the N.N.E.B. certificates. The remaining 13 students have not yet completed their training period. 44 Table 1 Day Nurseries—Attendances Day Nursery No. of approved places No. of children on register at 31.12.55 Attendances for the year Average daily attendances 0-2 years 2-5 years 0-2 years 2-5 years 0-2 years 2-5 years 0-2 years 2-5 years Chichester Road 18 32 18 36 3,337 6,786 13 27 Crest Road 25 25 28 28 5,605 5,444 22 21 Essex Road 25 25 24 27 5,233 6,034 21 24 Evefield 25 25 17 21 3,141 4,550 12 18 Gladstone Park 25 25 29 25 5,017 5,030 20 20 Longstone Avenue 25 25 29 25 3,867 4,643 15 18 Mortimer Road 25 25 26 28 5,108 6,080 20 24 Villiers Road 25 25 26 25 5,229 4,939 21 19 Wesley Road 15 25 16 25 2,168 5,577 8 22 Totals: 1955 208 232 213 240 38,705 49,083 152 193 1954 208 232 204 242 41,564 49,535 161 194 Table 2 Day Nurseries—Applications Nursery Applications received No. of children left No. admitted Chichester Road 95 44 47 Crest Road 52 38 55 Essex Road 67 49 45 Evefield 48 44 45 Gladstone Park 77 41 31 Longstone Avenue 66 44 55 Mortimer Road 78 52 60 Villiers Road 59 46 51 Wesley Road 54 32 25 Totals 596 390 414 Table 3 Day Nurseries—Priorities Nursery Unsupported Housing Medical Total Total on register Priorities as percentage of total Wesley Road 14 10 9 33 35 94 Longstone Avenue 11 17 9 37 44 84 Chichester Road 31 18 3 52 55 95 Evefield 15 15 4 34 37 92 Essex Road 28 13 9 50 52 96 Crest Road 15 29 8 52 54 96 Villiers Road 15 21 11 47 52 90 Mortimer Road 23 14 4 41 49 84 Gladstone Park 9 19 18 46 52 88 Totals 161 156 75 392 430 91 Table 4 Day Nurseries—Assessments Assessment December, 1955 2/- and under 225 Over 2/- and up to 4/- 85 Over 4/- 148 Total 458 45 Table 5 Day Nurseries—Infectious Diseases Nursery Measles Scarlet fever Chicken pox Dysentery Poliomyelitis Mumps German measles Chichester Road 20 2 – 22 – – – Essex Road 2 – 3 35 – – 1 Gladstone Park 34 – 2 18 – 5 1 Evefield 12 – 6 – 1 1 – Longstone Avenue — 1 — 13 — — 1 Mortimer Road — — — — — — 15 Villiers Road 20 — – 1 1 — 4 Wesley Road 25 1 — — — — 4 Crest Road 15 — — — 1 — — Totals 128 4 11 89 3 6 26 RECUPERATIVE HOLIDAY HOMES During the year the following recommendations were forwarded to the county health department for placing in suitable recuperative holiday homes:— Adults 122 Children 16 138 SCHOOL HEALTH SERVICE Tuberculin Testing. In January, 1955, tuberculin testing by the Heaf-gun method on school leavers was given a trial in the Stonebridge area, and was found to be more reliable than the Patch Test and equivalent to the Mantoux Test. At the commencement of the summer term, Heaf-gun testing was extended to all leavers. Orthoptics. Investigation and classification of the cases. Every new patient undergoes a detailed examination; a history is taken and tests are carried out to determine the presence or degree of binocular vision and the type of squint, so that an accurate diagnosis and prognosis can be made. The cases can be classified as follows:— (a) Children who can be cured by orthoptic treatment alone include : (1) those whose eyes are straight with glasses (or without glasses) at least part of the time; (2) children with very recent onset of squint (within the last few months), and (3) those with late onset of squint, 3½ years or more ago. (b) Children who need operation, cannot straighten their eyes at any time. They are often given some pre-operative exercises to improve their binocular vision. Methods of Treatment. 48 of the 67 cases referred required treatment (Table 1). Orthoptic treatment comprises:— (1) restoring good visual acuity, by occluding the eye with the better vision; (2) improving and developing binocular vision with the synoptophore, where the patient is trained to superimpose two dissimilar pictures, such as the lion and the cage, fuse two similar pictures (the child is taught to see one picture while adduction up to about +25° and about -5° are taught), and to fuse slightly dissimilar pictures, using stereoscopic vision. The child's accommodation is relaxed while using the synoptophore and he is trained for binocular vision for distance. However, a large number of children squint mostly for close work, and therefore it is very important to teach them to use binocular vision for near work. Picture books and reading exercises are used to achieve this. The close co-operation of' the ophthalmic surgeon and orthoptist is essential in achieving good results, more particularly so in cases that need operation. Results of Treatment. The 18 orthoptic cures were functional cures; single binocular vision has been restored with and without glasses for all distances and directions of gaze. The 7 cosmetic cures were very satisfactory in appearance; the children have acquired equal (or as nearly as possible equal) visual acuity and have been taught to alternate, so that their visual acuity does not deteriorate (table 2). The 10 observation cases were cures which are being watched closely before they are recorded as discharges. 46 Cases seen at Willesden Health Clinic : March—December, 1955 Table 1. Cases Seen No. Treated Placed on operation waiting list No treatment required Failed to attend Total 48 5 7 7 67 Table 2 Cases Treated Discharged cured Operation waiting list Observation Ceased to attend 25 (18 orthoptic) ( 7 cosmetic) 6 10 7 Audiometry. In 1955 the "sweep" method of testing was introduced, and this enabled all school children between, the ages of 7 and 11 years to be tested in school. This resulted in an increase of from 1,020 tests in 1954 to 4,393 in 1955. The children who failed the "sweep" test (132) were given a more thorough second test; 7 were then found to have normal hearing and the remaining 125 were referred to the Assistant Medical Officers at the Clinics for further investigation of their defective hearing, and only 8 did not accept the appointments offered. 21 children, after having wax removed, were found to have normal hearing, and 15 children were found to be already under observation at a hospital or a private doctor. In another 21 cases no action was needed at the time, but a further test was recommended after a given period. 16 children were found to be suffering from enlarged tonsils and were referred for operation; six have now had the operation and all but one have had their hearing improved. 5 children who were attending the Lower Place Special School for Physically Handicapped Pupils failed to pass the test, but their hearing loss was not sufficient to warrant any further action. 34 children were referred by the Assistant Medical Officers to the County Council's Ear, Nose and Throat Specialist, who recommended the following : 1 child to be placed at special school for the partially deaf. 1 child for breathing exercises. 9 children for a retest after 6 months. 3 children to hospital. Treatment was considered to be of little value in ' . 14 are waiting to see the Specialist. Handicapped Pupils. The waiting period for admission to special schools was reduced in 1955. Two new day special schools in Middlesex for physically handicapped and deaf pupils will soon be opened, providing accommodation for children who at present are placed in other Authorities' special schools. The County Council increased the establishment for Willesden from one to two full time physiotherapists, following a recommendation from the Willesden Divisional Executive and a report from H.M. Inspector. Many children attending Lower Place P.H. School who previously received treatment at hospitals, can now have it at school, with a saving of time spent out of class. Treatments at Lower Place Physically Handicapped School. Two physiotherapists attend daily, one in the mornings and one in the afternoons. The conditions treated included poliomyelitis, spasticity, athetosis, ataxia, muscular dystrophy, rheumatoid arthritis; respiratory conditions (mainly asthma and bronchiectasis) and associated orthopaedic defects of feet and posture. Treatment given included active exercises, manipulations, re-education of walking, co-ordination and balance exercises, heat, massage and general supervision of calipers, plasters, crutches and splints. Apparatus used included walking aids, suspension frame with slings and springs, walking bars, heat and electrical equipment. A swimming session is organised once a week throughout the year; many pupils learn to swim, and gain certificates for distances ranging from 10 to 440 yards. Certificates for Bronze Medal, Royal Life Saving Society 10 yds. 25 yds. 50 yds. 440 yds. 7 3 1 2 1 47 Statistics relating to the work of the school health service during 1955 are contained in the following tables:— Audiometry Total tested Absentees Failure Total Both ears One ear L. R. 4,393 362 35 51 46 132 Medical Inspections Periodic Medical Inspection Other Inspections Entrants Second age group Third age group Others Totals Special inspections Re-inspections Totals Totals: 1955 1,853 2,008 2,104 2,953 8,918 10,596 1,691 12,287 1954 2,900 2,359 2,240 2,339 9,838 10,835 1,810 12,645 Classification of the General Conditions of Pupils Age Groups No of pupils inspected A (Good) B (Fair) C (Poor) No. % No. % No. % Entrants 1,853 721 38.9 1,080 58.3 52 2.8 Second age group 2,008 899 44.8 1,091 54.3 18 0.9 Third age group 2,104 854 40.6 1,219 57.9 31 1.5 Others 2,953 1,238 41.9 1,685 57.1 30 1.0 Totals : 1955 8,918 3,712 41.6 5,075 56.9 131 1.5 1954 9,838 4,624 47.0 5,082 51.6 132 1.4 Defects Defect or Disease Periodic Inspections Special inspections No. of Defects No. of defects Requiring treatment Requiring observation Requiring treatment Skin 29 118 250 Eyes (a) Vision 370 303 87 (b) Squint 39 108 9 (c) Other 32 45 102 Ears (a) Hearing 14 81 103 (b) Otitis media 15 69 — (c) Other 16 23 64 Nose and throat 175 477 217 Speech 53 69 52 Cervical glands 25 173 6 Heart and circulation 4 76 1 Lungs 16 177 31 Developmental (a) Hernia 16 14 1 (b)Other 20 145 3 Orthopaedic (a) Posture 57 150 3 (b) Flat foot 43 136 3 (c)Other 81 204 54 Nervous System (a) Epilepsy — 20 — (b) Other — 60 3 Psychological (a) Development 7 69 8 (b) Stability 11 217 32 Other 613 183 608 Totals 1955 1,636 2,917 1,637 1954 2,309 2,789 3,614 48 Pupils Requiring Treatment Group For defective vision (excluding squint) For any of the other conditions recorded Total individual pupils Entrants 5 172 176 2nd age group 102 146 240 3rd age group 136 95 226 Other periodic inspections 127 189 310 Totals : 1955 370 602 952 1954 509 1,068 1,527 Minor Ailments 1955 1954 Diseases of skin : Ringworm (i) Scalp — 1 (ii) Body 1 — Scabies — — Impetigo 99 71 Other 318 475 Miscellaneous minor ailments 283 1,267 Nervous 38 31 Digestive 6 24 Respiratory 247 380 Skeletal 67 113 Circulatory 5 28 Infectious diseases 2 2 Pyrexia 1 8 Ductless Glands 4 4 Psychogenic 39 46 Helminthiasis 8 21 Developmental 10 19 Excretory 1 3 Debility 224 276 Colds and rheumatism 47 130 Minor injuries 483 604 Miscellaneous surgical 35 16 Miscellaneous 38 196 TOTALS 1,538 3,720 Eye Diseases, Defective Vision and Squint No. of cases dealt with during the year 1955 1954 External and other (excluding errors of refraction and squint) 40 120 Errors of refraction (including squint) 1,268 1,432 No. of pupils for whom spectacles were prescribed 637 694 Diseases and Defects of Ear, Nose and Throat No. of cases dealt with during the year 1955 1954 Received operative treatment for (a) Diseases of the ear — 3 (b) Adenoids and chronic tonsillitis 164 568 (c) Other nose and throat conditions 3 45 Received other forms of treatment 116 292 49 Orthopaedic and Postural Defects No. of cases dealt with during the year 1955 1954 No. treated as in-patients in hospitals 54 36 No. treated otherwise, e.g., in clinics or out-patient departments (a) By the county council 319 362 (b) Otherwise 504 508 Return of Handicapped Pupils (Year Ending 31st December, 1955) Category Ascertainment Distribution (as at last day of year) No. of ascertained cases known 1st day of year No. of new cases ascertained during year No. of ascertained cases known last day of year In special day schools In special residential schools In maintained primary and secondary schools In independent schools Not at school Total B G. B G. B G. B G. B G. B G. B G. B G. B G. Blind pupils 2 1 1 1 1 1 _ — — — 1 1 Partially-sighted pupils 16 8 — 1 13 9 12 6 1 3 – – – – – – 13 9 Deaf pupils 8 8 — — 8 6 — — 7 6 1 – – – – – 8 6 Partially deaf pupils 6 5 — 3 5 3 5 2 — — — 1 — — — — 5 3 Delicate pupils Diabetic pupils 68 40 44 49 43 37 4 1 37 33 2 – — — — — 43 37 Educ. sub-normal pupils 81 65 24 15 70 58 49 43 17 14 4 1 — — — — 70 58 Epileptic pupils 1 — 2 1 3 1 — — 3 1 – – – – – – 3 1 Maladjusted pupils 39 8 16 8 45 11 — — 37 8 8 1 — 2 — — 45 11 Physically handicapped pupils 41 23 7 4 33 19 23 16 4 1 – – – – 6 2 33 19 Pupils with speech defects 319 98 76 40 302 89 — — — — 284 85 — — 18 4 302 89 Pupils with multiple defects 25 18 10 2 31 19 31 19 – – – – – – – – 31 19 Totals 606 274 179 123 554 253 124 87 107 67 299 91 — 2 24 6 554 253 Grand Totals: 1955 880 302 807 211 174 390 2 30 807 1954 881 376 880 224 181 446 2 27 880 50 Speech Therapy Clinic or school No. of cases dealt with during the year Kilburn clinic 131 Willesden clinic 48 Stonebridge clinic 133 Lower Place special school for physically handicapped pupils 22 Leinster special school for educationally sub-normal pupils 11 Totals 1955 345 1954 372 Infestation with Vermin 1955 1954 Total no. of examinations 33,376 42,370 Total no. of pupils found to be infested 1,014 1,508 Total no. of individual pupils found to be infested for the first time during the current year 417 606 Number of individual pupils in respect of whom cleansing notices were issued under section 54/2, Education Act, 1944 38 128 Number of individual pupils in respect of whom cleansing notices were issued under section 54/3, Education Act, 1944 — 7 Employment of Children and Young Persons 1955 1954 No. of children medically examined in order to ascertain whether they were physically fit to undertake employment of a light nature outside school hours 288 118 No. of instances in which the state of health was found to be such that certificates were withheld 1 2 No. of children examined as to fitness to take part in entertainments 22 22 No. of cases in which certificates to take part in entertainments were withheld — — Medical Examination of Teachers 1955 1954 No. of teachers examined as to fitness for appointment 9 16 No. of students examined as to fitness for first appointment 36 28 No. of students examined as to fitness to undertake training course 49 28 51 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 31.12.55 Leinster Special School for Educationally Sub-Normal Pupils Willesden 31 33 5 Ealing 12 3 20 Totals 43 36 25 Lower Place Special School for Physically Handicapped Pupils Willesden 10 13 – Wembley 3 3 1 Harrow 2 1 – Ruislip-Northwood — 1 — Hayes and Harlington 1 1 — Ealing 4 4 — Acton 2 2 — Southall — — — Brentford and Chiswick — — — Heston and Isleworth 1 1 — Uxbridge 1 — — Totals 24 26 1 The Educational Sub-Normal Education Act, 1944—Sections 57(3), 57(4) and 57(5) 1955 1954 Cases dealt with under section 57, Education Act, 1944:— Sub-Section 3 10 11 Sub-Section 4 — — Sub-Section 5 26 28 Cases de-notified under section 8, Education (Miscellaneous Provisions) Act, 1948 1 1 CHILD GUIDANCE The staff of the Child Guidance Centre at 22, Brondesbury Villas was increased during the year by the addition of another psychiatric social worker and two part-time lay-psychotherapists. The number of medical sessions remained at four a week. 59 cases were seen (Table 1) and the waiting list of 33 had increased to 63 by the end of the year (Table 2). Emphasis throughout the year has been on treatment. To be effective, treatment has often to be intensive and prolonged, but the facilities available are inadequate and children have often had to wait several months before treatment could be started and their condition deteriorated in the meantime. 25 cases have received intensive treatment and have improved. Regular conferences have been held with the Assistant Medical Officers, Health Visitors, Speech Therapists and Probation Officers, in order to co-ordinate the many services now concerned with the mental health of children. A liaison between the Child Guidance Centre and an Infant and Maternity Welfare Clinic has also been started during the year. Table 1 (Reasons for referring the 59 cases seen) Lack of progress in school 10 Behaviour problem at home 20 Enuresis and encopresis 5 Non-attendance at school 2 Phobias 1 Stealing 10 Inhibited behaviour 5 Aggressive behaviour 6 59 52 Table 2 Waiting list at 1.1.55 Nos. seen New cases referred Waiting list at 31.12.55 33 59 89 63 RHEUMATISM The Rheumatism Clinic is held on the 2nd Tuesday of each month at the Willesden Health Clinic. It is situated centrally in the Borough and deals with children who normally attend the three main clinics. Rheumatism can be a serious disease requiring complete rest in bed followed by convalescence for several months. It can lead to permanent heart damage, interfere with children's normal activities, and interrupt their school life. Some children are left physically handicapped and have to attend a special school for many years. Family History. A history of rheumatism in the family is significant. Eighteen children gave a history of rheumatism and 11 suffered from the disease. Environmental Conditions. Dampness and rheumatism are closely related. Twelve children lived in damp homes and 7 of' them suffered from rheumatism. The dampness in the 12 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. Sixteen children had their tonsils and adenoids removed and 11 of them suffered from rheumatism. Rheumatism—Treatment Sent for convalescence 5 Referred to dental clinic 2 Referred to eye clinic 4 Referred to orthopaedic clinic 2 Referred to hospital 3 Special reports requested from hospital 12 Medicinal and vitamin therapy 9 Referred to Medical Officer of Health 12 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. Rheumatism Clinic The number of' children in 1955 attending the rheumatism clinic was 52. The number of those with rheumatism, heart trouble and non-rheumatism is shown below :— Rheumatism Non-rheumatism Total (1) Kilburn health clinic 12 (6) 7 19 (2) Willesden health clinic 6 (3) 8 14 (3) Stonebridge health clinic 10 (2) 9 19 Total 28 (11) 24 52 (In brackets—the number of children with heart complications.) Twenty-two of these children had been discharged from hospital or convalescent home after they had been treated for rheumatism. 53 SCHOOL DENTAL SERVICE There has been an increase in the number of School Dental Officers from an average of 4 in 1954 to an average of' 5 in 1955. The school dental service is responsible for inspecting and treating children who attend maintained schools. Children should be inspected and treated every year and preferably every six months. In 1949, owing to shortage of accommodation and difficulty in recruiting Dental Officers, only one-third of the school population were inspected and offered treatment, so that, in general, children were being inspected only once in three years and 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 down in the early years, when the first permanent teeth erupt and malformation of the 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 1955, 9,946 children in the restricted age group of approximately 10,000 were inspected at least once in the year and 7,625 required treatment. A further 1,937 children came direct to clinics as specials, 1,050 of whom were from the older age groups. Of a total of 15,351 inspections made both at school and at clinics, 11,643 children were found to require treatment, and 5,469 accepted treatment. (Table 1.) In October the number of sessions for orthodontics was increased from two to five sessions. In the course of the year, full time Dental Officers conducted 307 evening sessions as compared with 260 in 1954. PRIORITY DENTAL SERVICE In 1955, 13% of' the Dental Officers' time was spent in treatment of the priority groups 224 expectant mothers and 71 nursing mothers were treated. During the year, 807 children under five were inspected, including 231 at Day Nurseries; 623 required treatment and 429 had their treatment completed. (Table 2.) There is a slight decrease in the numbers of expectant and nursing mothers but treatment for children under five continues to increase and every opportunity is taken to explain to mothers the value of early and regular treatment for their children. 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) — 28 17 16 5—16 and over 13,386 9,784 8,548 Specials 1,937 1,842 1,829 Totals: 1955 15,351 11,643 10,393 1954 10,864 8,950 7,700 (b) Treatment 1955 1954 No. of pupils actually treated 5,469 4,856 No. of attendances for treatment 14,966 12,242 No. of half-days devoted to (a) Inspection 190 136 (b) Treatment 2,227½ 1,648 No. of fillings of (a) Permanent teeth 7,650 6,653 (b) Temporary teeth 4,937 4,375 No. of extractions of (a) Permanent teeth 611 659 (b) Teeth for orthodontia 252 270 (c) Temporary teeth 4,568 4,450 No. of anaesthetics (a) General 2,272 2,308 (b) Local 364 216 Other Operations 6,178 4,020 54 Table 2 Priority Dental Service Expectant Mothers Nursing Mothers Children under 5 1955 1954 1955 1954 1955 1954 No. examined 244 284 71 88 807 767 No. needing treatment 241 279 70 88 623 616 New cases commenced treatment 215 250 97 97 554 552 Cases made dentally fit 87 76 51 50 429 366 Extractions 251 359 142 120 521 519 Fillings 564 629 177 200 1,035 974 Scaling and gum treatment 158 150 56 66 — — Silver nitrate — — — — 716 424 Dentures 37 14 50 40 — – Total attendances 827 889 399 481 1,431 1,332 Appointments not kept 170 168 56 58 174 205 CHIROPODY For general description of service (see annual report 1953). The attendances for chiropody has been fairly steady throughout the year and a close liaison has been established with the orthopaedic department. School children should have their feet inspected at the ages of 12, 13 and 14 years because many foot troubles occur then and may not otherwise be discovered until the final medical examination, when, it is too late to arrange for adequate 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 61 6 79 85 4 127 131 Re-attendances 302 26 364 390 13 1,096 1,109 Defects Expectant and Nursing Mothers Boys Girls Corns 45 22 41 Hallux Valgus 1 — 6 Verrucae — 49 52 Onychocryptosis 4 10 11 Onychogryphosis 6 — — Hallux Rigidus — — 3 Injury to toe — 3 — Blisters — — 4 Chilblains — 1 4 Callosities 15 — — Metatarsalgis — — 1 Advice 2 1 4 Bursitis 1 — 6 Hammer Toes — 1 2