WIL 52 GOLD TYPE 23.10.57 Year AC439(1)WILLESDEN Borough of Willesden 1956 THE 81st ANNUAL HEALTH REPORT S. LEFF, M.D., D.P.H., Barrister-at-Law, Medical Officer of Health CONTENTS Page Aged—care of 13 Laundry service 14 Talks to Old People's Associations 14 Voluntary services 14 Atmospheric pollution 11 Bacteriological examinations 4 Basement bakehouses 13 Bombed sites 11 Census, 1951—Household arrangements 9 Child guidance 20 Chiropody 21 Common lodging houses 15 Coroner's Court 15 Day nurseries 18 Dental service 21 Disinfestation 11 Diphtheria immunisation 18 Factories 13 Food Contaminated food 12 Education in food hygiene 12 Food poisoning 12 Improvements in premises 11 Registration of premises 12 Sampling 12 Unsound food 12 Hawkers—licensing of 15 Health education 5 Health visiting 17 Home safety 21 Home help service 18 Home nursing 18 Hospitals Facilities 16 Liaison 16 Household arrangements—Census, 1951 9 Housing Closing orders 10 Defects 10 Demolition orders 10 Housing Repairs and Rents Act, 1954 10 New dwellings 10 Notices served 10 Overcrowding 10 Slum clearance 10 Survey 10 Infant mortality 4 Infectious diseases Dysentery 6 Food poisoning 6 Poliomyelitis 6 Puerperal pyrexia 6 Whooping cough 6 Laboratory service 4 Page Massage and special treatment establishments 5 Maternity and child welfare Ante-natal care 16 Clinics 16 Medical examination of staff 16 Midwifery service 17 Milk and Dairies 13 Mortuary 15 National Assistance Act, 1948 Burials 15 Removals to hospitals 14 Noise 13 Occupational health services 13 Outworkers and homeworkers 13 Public Health Laboratory Service 4 Pet Animals Act, 1951 16 Poliomyelitis inoculation 18 Prematurity 4 Rag Flock and Other Filling Materials Act, 1951 15 Recuperative holiday homes 19 Refuse disposal 9 Rheumatism 20 Rodent control 11 Sanitary circumstances 9 Scabies 5 School health service 19 Audiometry 20 Medical inspections 20 Orthoptics 20 Special schools 20 Slaughterhouses 15 Smallpox vaccination 18 Staff Medical examinations 16 Sanitary section 9 Swimming baths 9 Tuberculosis B.C.G. vaccination Chest clinic 8 Co-operation 8 Factories and workshops 8 Hospital accommodation 8 Missed notifications 8 Morbidity and mortality Prevention Vermin 11 Vital statistics Births 3 Deaths 3 Population 3 BOROUGH OF WILLESDEN Health Department, 54, Winchester Avenue, Kilburn, London, N.W.6. July, 1957. To the Mayor, Aldermen and Councillors of the Borough of Willesden. Mr. Mayor, Ladies and Gentlemen, I beg to submit the annual report of the health and sanitary circumstances of the borough for the year 1956. There has been a further slight decrease in the population but it is doubtful whether there has been any appreciable reduction in the overcrowding in the borough. Judging from day nursery applications and removals and housing inspections there is a continuous shift in population. The birth rate has shown another slight rise. The proportion delivered in hospital has increased, mainly due to the larger number of Willesden mothers delivered at the Central Middlesex Hospital. More mothers have also been delivered at home. The infant and general mortality showed a slight increase but there was a small reduction in the stillbirth rate. The death rate for illegitimate children showed a marked increase but as the numbers are small fluctuations in the rates from year to year are to be expected. The range in infant mortality between the wards is still high, the rate for 1954-6 is over three times as high in the worst ward compared with the ward with the lowest rate, again confirming the importance of social conditions, particularly in causing deaths from infections and prematurity. Representatives of the local authority, hospital and general practitioners have attended meetings to discuss measures based on advice given by the Ministry of Health for reducing maternal toxaemia. Improved antenatal care could also contribute to preventing infant deaths, but a reorganisation of the midwifery service is necessary and the report of the Cranbrook Committee is expected to make recommendations. There has been a slight increase in the general death rate but this is not unexpected since Willesden has an ageing population. Heart disease and vascular lesions head the list, with coronary disease and angina playing an important part. More research is required into the causation of coronary disease and the after-care of patients, but already we have some knowledge of how to prolong life. Cancer of the lung still remains the most important problem in the group of malignant diseases. It is most difficult and often impossible to cure when a diagnosis is made. However, it is one of the easiest of diseases to prevent. More and more evidence is accumulating which demonstrates the direct association between smoking and cancer of the lung. The answer is therefore within the power of those threatened with this dread disease. All they have to do is to give up smoking and remove this risk of their getting cancer of the lung. Bronchitis is still a major cause of death, and atmospheric pollution and work conditions contribute to this. A very successful meeting was held by the Council in the Stonebridge area to discuss clean air in Willesden, and the Clean Air Act, despite its limitations, was welcomed when it was passed in December, 1956. The Council is considering the establishment of smokeless zones, but while power stations and railway depots cause smoke nuisances in the area, it will be difficult to obtain improvement by concentrating mainly on the domestic chimney. Still more research is required on the effect of dust and fumes at work and on methods for eliminating hazards of this nature. We are gradually winning the battle against tuberculosis and there has been a further reduction in both the case and death rate. There are still marked differences between the various wards, and the worst ward has rates more than twice those of the best one. There have been many talks on tuberculosis in the schools and factories which have stimulated the public to play their part in conquering this disease. A higher proportion of school leavers are being vaccinated, and a closer liaison with the two mass miniature radiography units working in the district has ensured an improved supervision of factories where cases have occurred. In general, health education has been practised widely in the borough. In particular, factories have been visited and many interesting talks and discussions stimulated on various health subjects. 'Smoking and cancer of the lung', 'How to stop smoking', 'Flu, coughs and colds', 'Tuberculosis', and 'Rheumatism' have been the most favoured topics. An interesting innovation was an illustrated health talk given by Dr. Emrys Davies, Education Officer of the Central Council for Health Education, to 800 children who attended a Harlesden cinema on a Saturday morning. There were no serious outbreaks of infectious diseases during the year. The number of cases of poliomyelitis was low and there were no deaths. Poliomyelitis vaccination was carried out in May and June on some of the children aged 2-9 years who had been registered. Less than 10 per cent. of all children registered were vaccinated and it is difficult to assess the results. However, experience in other countries shows that the vaccination is both safe and effective, and, as the public have become aware of this, more parents are applying for vaccination. There was an increase in the number of cases of Sonne dysentery and there were 7 minor outbreaks in institutions, including schools and day nurseries. Improved sanitary accommodation and better hygiene would probably prevent many of the cases. Housing still remains the most important work of the department on the environmental side. A houseto-house survey in selected areas in all parts of the borough was completed, and attention has now been directed to slum clearance. This work is co-ordinated with that of the re-development scheme in the South Kilburn area, so that there can be phased rehousing of the inhabitants of the slum areas. The first slum clearance area in Willesden Lane and Winchester Avenue has already been dealt with, and official representations have now been made on two of the others. The campaign for clean food has been stimulated by the Food Hygiene Regulations, 1955, which came into operation on the 1st January, 1956. It has contributed considerably to a marked improvement in hygiene in the production and sale of food. For the first time for several years there was no outbreak of food poisoning in the borough. The public again helped by bringing a larger number of specimens of contaminated food to the Health Department. The occupational health service for borough council employees has resulted in many improvements in conditions of work and of medical advice given to employees suffering from disability or chronic illness. There has been an extension in the service for old people, and voluntary organisations have played a most important part in this. However, the time has come when local authorities must accept more responsibility for the care of old people, who are still deficient in many essential services, particularly chiropody, adequate housing, better nutrition, and facilities for recreation. Because of the large number of accidents taking place in the home, mostly affecting children under 5 years and people over 65 years of age, a Home Safety Committee was formed in November, 1956 to draw the attention of the public to this problem, and to introduce methods of preventing home accidents. The Chief Public Health Inspector, Mr. F. Taylor, retired in November after 31 years service with the Council. His pleasing personality and thorough knowledge of the district as a result of his long association will be missed by all in the department. This has been a most interesting year for public health in Willesden, and my sincere thanks go to councillors, members of the staff and public health 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, 1956 174,900 Population census, 1951 179,647 Population census, 1931 184,434 Pre-war population, 1938 187,600 Area of the district in acres 4,634 acres Number of inhabited houses (including flats) 43,063 Rateable value (1st April, 1956) £2,902,385 General rate in the pound for the year 1956/57 14s. 0d. Product of a penny rate (estimated) £11,700 VITAL STATISTICS Registered Live Births : Male Female Total Willesden Borough Council Legitimate 1,238 1,208 2,446 Birth rate per 1,000 estimated resident population Illegitimate 106 129 235 Total 1,344 1,337 2,681 15.3 Rate per 1,000 (live and still) births Registered Stillbirths : 23 35 58 21.2 Death rate per 1,000 estimated resident population Deaths : 862 870 1,732 9.9 Death Rate of Infants Under One Year of Age : All infants per 1,000 live births 22.8 Legitimate infants per 1,000 legitimate live births 20.9 Illegitimate infants per 1,000 illegitimate live births 42.6 Death Rate of Infants Under Four Weeks of Age : All infants per 1,000 live births 17.9 Legitimate infants per 1,000 legitimate live births 16.4 Illegitimate infants per 1,000 illegitimate live births 34.0 Maternal Mortality : Deaths from puerperal causes— Puerperal sepsis Nil Other puerperal causes Other maternal causes 5 Maternal mortality rate 1.8 per 1,000 live and still births. Deaths from : Males Females Total Cancer (all ages) 202 170 372 Measles (all ages) – – – Whooping cough (all ages) – – – Diarrhoea (under 2 years of age) –1 1 4 Births There was a slight increase in the birth rate for 1956, and it appears to be becoming stabilised at about 15 per 1,000, a little below that of England and Wales. Deaths There was a slight increase in the death rate for 1956, and it appears to be becoming stabilised at about 10 per 1,000, a little below that of England and Wales, which is about 11 per 1,000. The causes of death are shown in Table 1. Infant Mortality The infant mortality for 1956 was slightly above that for 1955 but still below that for England and Wales (table 2). (a) By Wards A much lower figure was attained in the better wards, but in the worst wards (Kensal Rise and Kilburn) it was more than three times as high as Manor, the best ward; Carlton, Stonebridge, Roundwood and Willesden Green also show high rates. It is clear that an improvement in the social conditions in these wards would help to reduce the mortality (table 3). (b) By Social Class The number of deaths by social class gives a further illustration of the effects of environment on infant mortality (table 4). The greatest reduction in infant mortality in the past few years has been for infants aged 1-12 months. The neonatal period (0-1 month) now accounts for more than two-thirds of the total infant mortality (table 5). An even better picture is obtained if one considers the perinatal mortality which includes stillbirths and deaths occurring during the first week of life, the causes for which are similar. The perinatal mortality for 1956 was slightly less than that for last year (table 2). Causes of death A further substantial reduction in infant mortality could be made if causes of prematurity and of congenital malformations could be eliminated. (a) Prematurity Prematurity is a major cause of infant death contributing 20% to the total; and it was associated with atelectasis as a cause of death in another 15% (tables 6, 7). Premature babies have a relatively high death rate; ten percent. of the premature infants died during the first week of life; in addition half the stillbirths were premature. The causes of prematurity are not fully understood, but unsatisfactory living conditions, pood maternal health and illegitimacy accounted for some, and complications of pregnancy (maternal toxaemia, placenta praevia and birth injury) for some of the others (table 8). (b) Congenital malformations (table 9). Most of the deaths from this cause occurred in the neonatal period. Now that there has been a general reduction in infant mortality there has been a proportionate increase in the number who die from congenital malformations. Preventive measures are taken to remove one of the causes of congenital malformation : arrangements are made to prevent expectant mothers, especially in the first three months of pregnancy, coming in contact with cases of German measles and other virus infections. (c) Respiratory, diarrhoea and enteritis, and other infections In the past years there has been a general reduction in the number of deaths from infections, but there are still a few preventable deaths most of which come from the lower Social Classes (table 10). With better health education, maternal care, and living conditions many of these deaths could have been prevented. (d) Other causes Ninety per cent. of the deaths classified under other causes occurred in the neonatal period, and lifty per cent. of these were attributed to atelectasis, most of them associated with prematurity. 1 infant died from accidental suffocation in a pillow. The health visitors are continually giving advice on how to avoid such unfortunate incidents. Conclusions There is no doubt that a general improvement in living standards and better maternal care would help to reduce infant mortality still further, but more research is still required in the causes of congenital malformations and prematurity. GENERAL PROVISION OF HEALTH SERVICES Public Health Laboratory Service (see table 11) Bacteriological specimens (swabs from sore throats, faeces from intestinal infections, cough plates and post-nasal swabs from whooping cough cases, etc.) are examined by the Public Health Laboratory Service at the Central Public Health Laboratory, Colindale, and at the branch laboratory in Neasden Hospital. 5 Specimens sent by doctors to the branch laboratories in Neasden Hospital, the Health Department, the Willesden Health Clinic, the Kilburn Health Clinic or the Stonebridge Health Clinic, 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. Samples of milk, ice cream, and water are sent by Public Health Inspectors. The Grade 4 ice cream samples were manufactured in premises in neighbouring boroughs; the Medical Officers of Health were notified so that they could investigate the methods of manufacture. The unsatisfactory samples of water were taken from the paddling pool at King Edward VII Park, and were due to sand from the sandpit near the paddling pool entering the pumping plant. Modifications to the filter plant were carried out which effected some improvement. Arrangements are being made for the water from the pool to pass continuously through the purification and chlorination plant of the adjoining swimming baths. Uncleanliness and Scabies (see table 12) As compared with 1955 there has been a decrease in the number of children treated for lice and nits, an increase in the number of adults treated for lice and nits and an increase in all age groups treated for scabies. The numbers treated are, however, still small and there is no evidence that there has been an increase in the prevalence of lice, nits and scabies in the community. Establishments for Massage and Special Treatment The registration of establishments for massage and special treatment is delegated to the Borough Council under Part XII of the Middlesex County Council Act, 1944. During the year 20 licences were renewed. 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 In the modern community it is essential that all citizens have a knowledge of the principles of health and are able to practise the simple rules of hygiene. This knowledge helps many people to avoid mental and physical disorders and relieves general practitioners and hospitals of some of their heavy burdens in dealing with the sick. The department's health education programme is based mainly on lectures illustrated by filmstrips and films. To ensure that the rising generation gets the best possible training in health, special attention is paid to health education in schools, linked, as far as possible, with a hygiene or biology syllabus. The Area Medical Officer and members of his staff and the Chief Public Health Inspector and his staff give the talks in schools (table 13). Brains trusts are held at the end of each term, which enable the children to ask questions which have not been adequately answered during the lectures. The questions which they put to the panel at these brains trusts show quite clearly that the children are interested in the subject and that they are gaining much useful knowledge of health matters. At the health clinics mothercraft classes are held and many talks, some of which are illustrated with film strips, are given by doctors, health visitors, midwives and clinic nurses. These talks are most useful in helping mothers to care for themselves and their babies. Health visitors give more specific individual health education in the mothers' homes during their routine visits (table 14). Mothers' clubs, which commenced in June, 1953, at the Kilburn Health Clinic, have been successful and were much appreciated. During the year, clubs were also started at the Stonebridge Health Clinic. Talks were given on subjects such as health, cookery, sewing, chiropody, home nursing and first aid. Health workers themselves need post-graduate education. Health education films are shown and lectures given, often by outside lecturers, to separate meetings of doctors, public health 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. During the year 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. After the Royal Society for the Promotion of Health Congress in May a party of Chinese and Czechoslovakian delegates visited Willesden. After being received by His Worship the Mayor they visited a school, a day nursery, and a health clinic. Talks have been given to religious, social and political organisations for a number of years but the extension of the habit of television viewing has affected the number of requests received by the Department and the size of the audiences at meetings. Nevertheless many talks were given to several organisations on different subjects (table 13) and they were well attended. To compensate the decrease in the number of lectures given to social, religious and political organisations the Department are arranging more talks to factory employees. The Medical Officer of Health and his deputy give these talks during lunch-hour breaks and they were well attended and were very useful (table 13). During October and November talks and film shows were given to old folks' associations as part of a campaign on the prevention of accidents to old people. Altogether one can look back on the year with the satisfaction of knowing that more and more people in Willesden are being enlisted in the battle against disease. 6 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 public health inspectors have played an invaluable role in health education and in improving hygiene. A summary of cases notified, confirmed and deaths from various diseases for 1955 and 1956 is shown in table 15. Whooping Cough (table 16) The incidence of whooping cough rose slightly in 1956 compared with the previous year, but it was still lower than for the years 1950 to 1954 inclusive. In spite of this rise, however, it continued to be lower than for England and Wales as it has been since 1947. This lower incidence, however, cannot be attributed to whooping cough vaccination (see report for 1953). Poliomyelitis In marked contrast with 1955, there was no outbreak in 1956 (table 17). Dysentery In common with the remainder of the country there was an increase in the number of cases of Sonne dysentery during the year. There were seven outbreaks. (1) An outbreak occurred at St. Mary's Church of England School on the 16th January. 5 children had symptoms and 9 were found to be carriers; 3 cases and 1 carrier were admitted to the isolation hospital. The infection took over three months to clear up and the last two symptomless carriers were not re-admitted to school until the 25th March. (2) Ten days after the first outbreak, dysentery appeared in Curzon Crescent Nursery School. 10 children had symptoms and another 26 were found to be carriers; 1 member of the staff had symptoms. The cases and most of the carriers were soon back at school, but 9 carriers took over two months to clear up. (3) Eighteen days after the second outbreak, dysentery appeared in Bridge Road School. 6 children had symptoms and 9 others were found to be carriers;1 case was admitted to isolation hospital. The infection took over two months to clear up and the last carrier was not re-admitted to school until the 27th April. (4) Ten days after the third outbreak, dysentery appeared in Chichester Road Day Nursery. 4 children had symptoms and 12 others were found to be carriers. 1 case was admitted to isolation hospital. The infection cleared up within a month and new admissions were accepted in the nursery on the 19th March. (5) Three days after the fourth outbreak, dysentery appeared in Mora Road School. 45 children had symptoms and 7 others were found to be carriers; 2 cases were admitted to the isolation hospital. The infection took two months to clear up. (6) One day after the fifth outbreak, dysentery appeared in the Hostel for Homeless Families, 91 Dartmouth Road. Altogether 17 mothers and children were affected; 1 mother and 6 children had symptoms and 1 mother and 10 children were found to be carriers. The infection took almost two months to clear up, mainly owing to overcrowded conditions, unsatisfactory washing accommodation, and the difficulty in getting mothers to submit specimens for bacteriological examination. (7) Ten weeks after the sixth outbreak, dysentery appeared in Gladstone Park Day Nursery. 12 children had symptoms and 6 were found to be carriers. After seven weeks new admissions were accepted in the nursery, when all the carriers had ceased to be infectious. Food Poisoning There were no outbreaks of food poisoning. Puerperal pyrexia Since 1st August, 1951, puerperal pyrexia applies to any "febrile condition occurring in a woman in whom a temperature of 100.4 degrees Fahrenheit (or 38 degrees Centigrade) has occurred within fourteen days after childbirth or miscarriage". On the 2nd October an outbreak of streptococcal infection began in the maternity wards of the Central Middlesex Hospital. In the first three weeks, 18 patients and 15 staff were affected, none of whom was seriously ill. The organism was B haemolytic streptococcus Group A, Type 28. 7 of the patients were babies who had an infection of their umbilical cords. Three meetings of the Control of Infection Committee were held. At the first meeting a report on the outbreak was considered and the following action was agreed:— (a) Routine admissions to the maternity ward were stopped from the 6th October. (b) Segregation beds were made available in O Block. (c) Patients with streptococcal infection were placed in a single bedded ward, and if Group A was isolated they were transferred to the segregation ward; if Group A was not isolated they remained in a single bedded ward. 7 (d) Segregation wards were fumigated as soon as they became empty. (e) Umbilical cords were covered with dressings. (f) All staff wore masks in the wards, and were careful when removing them. (g) Members of the staff found to have the infection were taken off duty and if Group A was isolated they were admitted to the Flora Baker Wing for four days intensive treatment with penicillin and streptomycin, until three negative swabs were obtained. (h) Mass swabbing was repeated. (i) Rooms of infected staff were fumigated. At the second meeting a progress report was given, and it was agreed that admissions should be re-commenced from the 22nd October. A further report was given at the third meeting. 13 babies, all born in the hospital since the 2nd September, had shown infections with different organisms after their discharge; none of these infections had been generalised. 3 of those who had infected cords were known to have been infected with B haemolytic streptococcus Group A, Type 28. There had been no umbilical infections since the cords had been covered with dressings. It was agreed that a segregation unit of six beds should be kept for infected or potentially infected patients and a separate return made of their occupancy. TUBERCULOSIS Mortality and Morbidity For the first time in the history of the borough there were no deaths from non-pulmonary tuberculosis. In addition, the marked decline in the death rate from respiratory tuberculosis has continued (tables 18 and 19). Elderly men were mostly affected; four out of every five deaths occurred in men, and half of them were over 65 years; there were no deaths under the age of 25 (table 20). There has been a further reduction in the number of newly notified cases. The improvement has occurred chiefly in young women from 20-25, among whom the number of new cases was half of that of last year. There was no significant change for men (table 20). Because of the fall in new notifications, less significance can be attached to the individual annual figures (table 21) but over a period of three years a high incidence is revealed in the more overcrowded wards, Carlton, Mapesbury, Kilburn, Roundwood, Stonebridge and Harlesden (table 22). Prevention The principal source of infection is the adult human case, particularly middle-aged and elderly males. The search for and supervision of these patients is therefore an important preventive measure, because they can easily spread the disease to their families and relatives in their homes and to their workmates and the public in the factories and shops. Apart from infection at home it is known that the disease may be contracted at work. Routine mass X-rays 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 admission 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, mass X-rays, improving social conditions and B.C.G. vaccination, are the main preventive 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. 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. B.C.G. vaccination is now a fully and widely accepted preventive measure and has recently been extended to school leavers throughout the whole country. Protection is afforded to young people who are more susceptible to tuberculosis with the stresses and strain of adolescence and when they are embarking upon a more arduous industrial or commercial life where they must be exposed more freely to hidden infection. 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 last 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 (table 24). 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. 8 Tuberculin skin testing has again revealed that four out of five school leavers are still free from infection (table 23). Children showing a positive tuberculin test (thus revealing previous infection) are all referred for X-ray examination as a precautionary measure; no active cases were found (see also Co-operation, para. 2). 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. It is satisfactory to report that only 1 per cent of these children under five had previously been infected. The low figure of 4 per cent was recorded for school entrants (table 23). Missed Notifications There has been a slight reduction in the proportion of persons who die from tuberculosis previously un-notified (table 25). This provides another indication that the extent of infection in the community is less, but there is still an undiagnosed pool of infection in the borough as indicated by the fact that one in four deaths still takes place in unnotified persons (table 25). Over the last five years, an increasing proportion of deaths among persons known to be tuberculous occurred more than five 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 Five factories and workplaces where active cases of tuberculosis had been discovered were visited, and arrangements were made for 38 immediate contacts from four of these places to attend for X-ray examination: the results were all satisfactory. The mass X-ray unit also visited one of the factories at the request of the management on the advice of the Medical Officer of Health. Six hundred and sixty-five employees (75 per cent of the total staff) were examined and all were found to be satisfactory. The staff at the fifth factory had already been X-rayed, but arrangements were made for them to be re-examined early in 1957. 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 tuberculosis patients in Willesden was increased in 1954, and is now adequate for the immediate treatment of cases requiring hospitalisation (see Report of 1955 for details). Co-operation Four meetings were held during the year. One ordinary committee meeting was attended by the Medical Officer of Health, the Chest Physician, Assistant Medical Officer, Welfare Officer, the Disablement Resettlement Officer, the Superintendent of Health Visitors, Midwives and Home Nurses, the Home Help Organiser and the Chief Public Health Inspector. Among the problems discussed were factory contacts, the spread of infection in overcrowded lodging houses, and compulsory removal of active cases to hospital. At two special meetings attended by the Medical Officer of Health, the Chest Physician and Assistant Medical Officer the scheme for the follow-up of tuberculin positive school leavers was revised; because school leavers with strongly positive reactions have shown a higher incidence in later years, arrangements were made for those with third degree Heaf reactions to be followed up by regular X-rays at the mass X-ray unit, and for those with fourth degree reactions to attend the Chest Clinic for regular X-rays, follow-up and investigation of contacts. A special meeting was arranged with the Physician-in-charge of Mass X-ray Unit 5A to discuss improvements in the scheme for the examination of factory contacts. Several changes were made, the main one being that contacts are now invited to attend for X-ray every six months for two years. Previously only one attendance was made. A special meeting was also arranged with the Physician-in-charge of Mass X-ray Unit 5B and arrangements are now made for talks on mass X-ray to be given by the Medical Officer of Health in factories just prior to the Unit operating there. 9 From the 4th to the 7th December, Mass Miniature Radiography Unit 5B operated from the forecourt of a hotel in Cricklewood. Six morning and afternoon and two evening public sessions were held. The Public Health Department was asked to arrange publicity in the Cricklewood area. Leaflets and jpsters were placed in two branch libraries and in two clinics. Posters were exhibited on 12 poster sites in the area and Public Health Inspectors arranged for 60 food shops to exhibit posters. Four thousand school children in six schools were given a leaflet to take home and a supply of leaflets was also sent to 40 doctors in the area for display in their surgery waiting rooms. The sessions were very successful and 1,626 people attended. It is interesting to note that of this number 1,049 had not previously had a chest X-ray. SANITARY CIRCUMSTANCES OF THE AREA Water The Metropolitan Water Board and the Colne Valley Water Company supply Willesden with pure water. 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. Refuse is disposed of by controlled tipping at Twyford : house refuse is collected weekly and trade refuse as often as required at an agreed charge. Household Arrangements The census report for the County of Middlesex 1951 and the Housing Report for England and Wales showed clearly Willesden's housing problems as compared with the rest of the country (see tables 26 and 27). (a) Shared dwellings and overcrowding. About six out of ten households in Willesden share a dwelling. This is higher than the average for the county and for Greater London (about three out of ten) and much higher than England and Wales (less than two out of ten). The number of persons per room is higher than that of Greater London, England and Wales, and any district in the County, and the percentage of population and of households at densities over 1½ and 2 persons per room is the highest in the County, in some instances the percentage is more than double. (b) 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 for the County of Middlesex. Gardens Willesden is poorly equipped with public open spaces: 242 acres compared with an estimated need of 1,313 acres; yet one in four families have no garden at all, and a large number have to share a garden. Swimming Baths All samples taken were found satisfactory. Swimming Bath Samples Taken Granville Road 94 Gladstone Park 42 King Edward's Park 42 SANITARY SECTION Staff The authorised establishment of Public Health Inspectors includes a Chief Public Health Inspector, a Deputy Chief Public Health Inspector, 18 District Inspectors and 5 pupil Public Health Inspectors. As mentioned in the introduction to the Report, the Chief Public Health Inspector, Mr. F. Taylor, retired in November after 31 years service with the Council. At the beginning of the year there were three vacancies for Inspectors, and during the year there were two resignations. Three were appointed during the year leaving two vacancies at the end of the year. 10 It is difficult to fill vacancies; the country requires at least another 500 Public Health Inspectors, and although the Council pays the London scales of salaries, which are higher than the N.J.C. scales, other authorities offer additional inducements such as housing accommodation or car allowances. 4 pupil Public Health Inspectors were on the staff at the beginning of the year; 2 qualified and received their certificates (one was appointed to Willesden and the second took up an appointment with another authority). One new pupil Public Health Inspector was appointed during the year, leaving two vacancies. The Rodent Officer and four operatives are 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 contact the Public Health Department only when defects are serious and costly to remedy. In March, 1954, the Council decided to organise house-to-house inspections in selected areas of the borough. The survey commenced on the 1st April, 1954, and was completed during 1956. 3 out of 4 of the houses were found to have defects (table 28). The schedules of repairs were drawn up on the basis of preventing houses becoming slums; special attention was paid to windows, roofs, brickwork, gutters, down-pipes, walls and ceilings (table 29). Notices under the Housing Act, 1936, and the Public Health Act, 1936, were served for these defects (table 30). Demolition and Closing Orders Housing Act, 1936, Local Government (Miscellaneous Provisions) Act, 1953. Details of demolition and closing orders made under the above Acts are shown in table 31. Slum Clearance During the year the Council added an area in Church End, including Holly Lane and Mayo Road and the whole of the Stonebridge area, to the proposals originally put forward in 1955 in accordance with the Government's five-year slum clearance programme. Surveys were carried out in the following areas:— Willesden Lane; Granville Road and Peel Road; Albert Road and Denmark Road. The first slum clearance area to be dealt with was in Willesden Lane and Winchester Avenue comprising 27 houses and three cleared sites. An official enquiry by the Ministry of Housing and Local Government was held early in 1957, and the outcome is awaited. The Council has now made further representations for slum clearance for the areas including Albert, Denmark and Canterbury Roads. These areas are being dealt with as soon as it is possible to rehouse their inhabitants. Slum clearance cannot be carried out in Willesden, a built-up borough, until the redevelopment schemes are completed and houses provided for those living in slum clearance areas. Overcrowding There has been little change in the extent of overcrowding which still remains acute. Very few licences under section 61 of the Housing Act, 1936, were issued to permit temporary overcrowding (table 32). Landlords do not now try and obtain eviction orders on the grounds of overcrowding because they realise that the Court usually deals sympathetically with tenants. The Housing and Estates Manager has kindly supplied the details of overcrowding in the area which have been based mainly on statements of housing applicants (table 32), and also details of new dwellings constructed during the year (table 33). Notices served under the Public Health and Housing Acts 1936 There was an increase in the number of notices served during the year compared with 1955 (table 35). Housing Repairs and Rents Act 1954—Certificates of Disrepair Details of certificates of disrepair issued to tenants and revocation certificates to owners are shown in table 36. The total number of certificates issued was only 20 per cent of those issued in 1955. Houses in Willesden which are below the " good repair " standard have not been appreciably affected by this part of the 1954 Act. The extensive use of the Housing Act, 1936, and the Public Health Act, 1936, has been much more effective in securing improvements to properties in a bad state of repair. Nuisances Abated and Improvements Effected A summary of nuisances abated and improvements effected is shown in table 37. Inspection of Factories, Outworkers Premises and Food Premises A summary of inspection of the above premises is shown in table 38. 11 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 slight improvement (tables 40 and 41). A public meeting was called in April for the purpose of discussing the problems of air pollution and the Council's methods of dealing with them. The Clean Air Act came into operation, in part, on 31st December, 1956, and the Council will be concerned during the coming year with the planning of smokeless zones. BOMBED SITES The Health Department continues to deal with nuisances such as rats or refuse on the few remaining bombed sites in the borough. DISINFESTATION The Public Health Inspectors inspect verminous premises and supervise the work of the disinfestors employed by the Council (section 83 of the Public Health Act, 1936) (table 42). There was a slight decrease in the work as compared with the previous year. Disinfection and disinfestation of bedding materials is carried out at the Neasden Hospital (section 84 of the Public Health Act, 1936) transport being provided by the Council. The remainder of the work, i.e., the disinfection and disinfestation of rooms, collection of clothing and bedding for treatment and delivery after treatments, is carried out by the Council's attendant. From the 23rd October until the end of the year temporary arrangements were made for bed linen to be treated at Hendon Isolation Hospital owing to a breakdown of the disinfecting plant at Neasden Hospital. 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 234 Borough Council properties 12 Private dwellings 917 Total 1,163 at the following cost: Business premises £1,433 2 1 Private dwellings £2,004 2 7 Total £3,437 4 8 The cost of disinfestation at business premises is recovered from the occupiers. In 1956, 113 had an annual agreement with the Council for regular inspection and disinfestation; 10 were new agreements and 103 were renewals. The service is free to occupiers of private dwellings; the Borough Council recovers 50 per cent 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. INSPECTION AND SUPERVISION OF FOOD AND FOOD PREMISES All food premises in the borough are regularly inspected by the Public Health Inspectors (Table 46). Improvements in Premises The Food Hygiene Regulations, 1955, came into operation on the 1st January, 1956. These regulations prescribe the conditions for the preparation, storage and sale of clean food. There has been a marked improvement in hygiene in the production and sale of food. Food premises were visited frequently by the Public Health Inspectors to bring them up to the standards of the new regulations. Unsatisfactory premises were improved by the traders following verbal or written notices. In some premises works are still either in progress or arrangements are being made for the works to be carried out (Tables 43 and 47). 12 Premises where Food is Prepared Premises which manufacture, store or sell ice-cream, or prepare or manufacture sausages, potted, pressed, pickled or preserved foods, including cooked meat or fish intended for sale, require to be registered by the Council. If the Council refuses or cancels a registration the owner can appeal first to them and if unsuccessful to a court of summary jurisdiction (Table 44). Ice-cream sold within the borough reaches a high standard of purity (Table 11). All the premises concerned were kept under constant observation; most of the ice-cream is manufactured outside the district, and is usually pre-packed. Education in Food Hygiene Lectures and talks, illustrated with film shows, film-strips and bacteriological cultures, are given to canteens staff, social and political organisations, and school-leavers. Food Poisoning It is pleasing to report that for the first time for several years there was no outbreak of food poisoning in the borough. This is probably a reflection of the general improvement in the handling, preparation, storage and sale of food. Food Unfit for Human Consumption More than 47 tons and 15,000 tins of food inspected by the Public Health Inspectors was found to be unfit for human consumption (Table 45). With the exception of the tomato pulp, which was used for pig food, all the food was dealt with as trade refuse by the Borough Engineer's Department, and deposited on the controlled refuse tip. Contaminated Food There was an increase in the number of specimens of contaminated food dealt with by the Health Department. These included a piece of metal in a chocolate toffee, a mouse in a packet of tea, maggots in a nut toffee bar, dirt in a bottle of orange juice, metal in a ½lb. packet of butter, a cigarette-end in a loaf, a piece of glass in a loaf, mouse excreta on a swiss bun, a nail in butter, a screw in a cake, metal millings in a swiss roll, and glass in a half-pint bottle of milk. Members of the public reported 34 specimens of contaminated food but no action was taken in 6 of them because there was no evidence that the firm concerned had been negligent. Of the remaining 28, 6 firms were prosecuted and 22 cautioned. Three of the prosecutions were successful with fines and costs amounting to £20.0.0 and £8.8.0. Two cases were dismissed and one case was dismissed after appeal. In addition, 5 dirty milk bottles and 1 dirty cream bottle were reported by other local authorities and the public. Two milk bottles were referred to other local authorities for action as the milk was bottled in their areas. The remaining 3 dirty milk bottles and the dirty cream bottle were reported to the Public Health Committee and the Council prosecuted two dairies and administered a caution to 2. The 2 prosecutions were successful with fines and costs amounting to £20 and £6.6.0. Clean Food—Sampling The Middlesex County Council is responsible for taking samples and for supervising the control of food adulteration (Table 48). The Chief Officer of the Public Control Department has kindly supplied the following information. Of the 13 retailers who were concerned in the 15 samples found to be unsatisfactory, 4 were prosecuted. 4 were officially cautioned, and 3 amended their labels; no action was possible against the other 2. Two greengrocers sold " Packham" pears as " William" pears. One was prosecuted on two counts and was fined £5 in each case with 5 guineas costs; the other was fined £10 with 3 guineas costs. Official cautions were issued to the retailers of the 2 samples of vinegar deficient in acetic acid and to the baker who sold a cake as a " cream bar" but containing imitation cream. A cake described as a " rum baba " contained only rum flavoured syrup, and the manufacturers amended their labels. The 2 samples of spirits which were described as " pure white spirit" contained ethyl alcohol and water with a very high proof spirit content. The importers communicated with the manufacturers, who amended the labels. Sweets described as "fairy drops (milk)", but containing only skimmed milk, were re-labelled. Three of the samples of milk contained glass. Two of the dairies were prosecuted, I was fined £15 and 5 guineas costs but the other was discharged without a fine. No action was taken in the other case because of insufficient evidence. The remaining 2 bottles contained aluminium foil bottle caps. An official caution was issued in one. Merchandise Marks Acts, 1887-1926 1,949 displays of articles of food were examined under the Mechandise Marks Acts, 1887-1926. Verbal cautions were given for minor infringements. 28 convictions were obtained against 10 retailers for describing incorrectly or not indicating the origin of imported foods. Labelling of Food Order, 1953 410 articles of pre-packed food were examined under the Labelling of Food Order, 1953. Several infringements were detected but no prosecutions were taken because the manufacturers took immediate steps to correct the unsatisfactory labels. 13 Milk and Dairies (Table 49) Milk sales are regulated by various Acts and Regulations (the Food and Drugs Act, 1955, the Milk and Dairies Regulations, 1949-1954, the Milk (Special Designation) (Pasteurised and Sterilised Milk) Regulations, 1949-1953, and the Milk (Special Designation) (Raw Milk) Regulations, 1949-1954). 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 1st October, 1954, the provisions of paragraph 7 of the Second Schedule to the Milk (Special Designation) (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. Frequent inspections are made of the dairies. During the year some minor defects were found but were soon remedied. FACTORIES There was an increase in the total number of factories in the borough compared with the previous year (Table 50). The Council supervise sanitary conveniences in all factories, and in addition, cleanliness, overcrowding, temperature, ventilation and drainage of floors in non-power factories. Details of inspections, defects found and action taken, are given in Table 51. Most notices were served for minor defects only and were complied with without legal action. 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 Willesden. They have been regularly inspected and are satisfactory. Outworkers and Homeworkers In February and August of each year, factory owners send to the local authority lists of 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. Inspections of these workers' homes were made by the Public Health Inspectors and notices were served in respect of any found to be unsatisfactory (Table 52). NOISE NUISANCE The Borough Council are empowered to deal with noise nuisances under section 313 of the Middlesex County Council Act, 1944. Eighteen complaints were received but only nine could be considered as statutory nuisances. Five concerned noise from electric motors of various kinds. All the nuisances were abated after consultations with the managements. Complaints were also made about the noise of working machinery, etc., during the late evening hours and night and on Sundays. These hours of work have become more common but managements have agreed either to stop the late or Sunday work or they have made arrangements to reduce the noise. OCCUPATIONAL HEALTH SERVICE The Council introduced an occupational health service for their employees in April, 1954. Public Health Inspectors visit offices and workplaces to supervise working conditions, particularly canteens, rest rooms, cloakrooms and first aid equipment. Any defects found are brought to the notice of the chief officer concerned. First-aid 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. Employees who have been regularly absent from work on account of sickness are referred by chief officers to the Medical Officer of Health. 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 community increases it becomes more urgent and necessary to extend our medical and welfare services to care adequately for them. Most old people are living alone but they can manage to look after themselves in spite of their deciencies in money, suitable living accommodation and general amenities. Some require help to keep them comfortable and happy in their own homes, while a small minority cannot be adequately cared for except in a hospital or old people's home. The local health authority provides home nurses and home helps, and health visitors investigate the needs of old people and arrange for the necessary services to be given. 14 Generally speaking, 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. Compulsory powers for removing old people to hospital or hostel are only used when absolutely necessary and then only after all other possibilities have been fully explored. 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 a hospital under the Acts during 1956. Miss E.M.L., aged 78 years, lived alone in a house consisting of 7 rooms, a scullery and a bathroom. The house could be distinguished from others in the road by its neglected state and a collection of dirty milk bottles in the porch. The passage was inches thick with rubbish and the rooms which were dusty and dirty, were crowded with books, papers, clothes, ornaments, pictures and furniture. The kitchen sink was full of dirty crockery, pots and pans, and scattered around were foods in various stages of decay. Miss L. was dressed in filthy ragged clothes and her face and arms were grimy. An order under the National Assistance (Amendment) Act, 1951, was obtained from a Justice of the Peace on the 22nd June, and Miss L. was removed to Redhill House, Edgware, the same day. It was not necessary to apply for an extension as she did not wish to leave the House when the order expired. Laundry for the Aged The care of incontinent old people places a heavy burden on their relatives. The washing of soiled bed linen and night clothes, particularly in cramped accommodation in winter, with inadequate facilities for drying, adds another intolerable strain on relatives which finally convinces them that the only place where the old people can receive reasonable care is in an institution. One way of postponing this unpopular event is to do their laundry. 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 4^d. per lb. at the Neasden Hospital by arrangement with the Central Middlesex Group Hospital Management Committee, and transport is provided by the Borough Council. The service has continued to be greatly appreciated by old people and their relatives. No. of Old People Using Laundry Service On register 1.1.56 New cases Died Removed from district Admitted to hospital Recommenced after discharge from hospital On register 31.12.56 18 41 16 1 11 2 33 Talks to Old People's Associations During October and November, the Medical Officer of Health and an assistant medical officer gave six talks and film shows to old people's associations on "Accidents in the Home", in conjunction with a campaign on the prevention of accidents to old people. 350 attended the talks and they showed keen interest and asked many questions. Voluntary Services for the Aged The care of the aged is an excellent example of how the 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 Folk's Association celebrated its fourth anniversary in February. The Club has a membership of 450 and is open daily from 1.30 p.m. to 10 p.m. The Council made a grant of £350 to the Association's funds and additional money was raised by a Flag Day. 60 members went to the theatre in February, and 200 members and helpers went for a day trip to Folkestone in September. Holidays at a reduced rate were arranged for 20 members at Southend. Voluntary workers visited 50 old people weekly or fortnightly. This service is greatly appreciated by lonely people but more visitors are required. The visitors often took small personal gifts to the old people; at Christmas they took 5/- each to 47 and Christmas dinner from the Association to 32. 150 packages of non-perishable foodstuffs were received for distribution by the Association from a school in the area after Harvest Thanksgiving. The same school sent 25 Christmas calenders made by children aged 7-8, and inscribed with their names and best wishes for 1957. A large industrial firm in the area asked for the names of 27 lonely old people and members of the staff took them Christmas parcels. The manager of a local branch of one of the Ministries sent a large parcel for distribution. 2 Christmas parties were held by the Association at Anson Hall, Cricklewood, and were very successful. More than 500 invitations were sent out and 420 people were given a high tea and entertainment and 2/- each. The chiropody service is still in great demand. 600 people were on the register in 1956, compared with 460 in 1955. An average of 24 attended the two chiropodists in the Kilburn and Harlesden area each week, and altogether 200 house-bound people had treatment in their own homes. A charge of 2/- is made for treatment and the Association pays 4/6d., the balance of the charge. The National Council for Welfare of Old People made a grant of £100 towards the cost of treatment, which in 1956 cost the Association more than £300. 15 On the recommendation of the Welfare Officer, free coal was supplied to old people who could not afford it. 10 cases were recommended to the Wireless for the Bed-ridden Society for the supply of free wireless sets. The Branch Club opened at St. Martin's Church Hall, Kensal Rise, in January, 1955, meets every Wednesday afternoon from 2 p.m. to 4 p.m. The Club is self-supporting but the Association pays the rent of the hall. 41 members went for a day trip to Margate in May and to Worthing in September. A Christmas party was held in December. Members who are ill are visited by the Secretary and letters are also sent. 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, in January, 1952, provides old people with hot meals. The cost of a lunch had to be increased from 1/- to 1/3 because of the rising cost of gas, electricity and food, but tea was kept at 2d. per cup and coffee at 3d. per cup. 9,492 dinners were prepared during the year; 3,717 were served in the Club and 4,775 were delivered by the Meals on Wheels Service, organised from the same premises. Only 2 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 Morning and Luncheon Club, the Meals on Wheels Service and the National Assistance Board inform the W.V.S. of some old people's needs, such as clothing or little extras of comfort, and a large number of old people received help from them during the year. 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 11 persons during the year. This cost £123.8.6 of which £12.9.6 was recovered from relatives. PUBLIC MORTUARY A post-mortem was performed on 489 bodies, followed by an inquest in 128. 72 inquests were held on Willesden residents but only 10 of these were held in the Coroner's Court attached to the mortuary. The remainder were held at Ealing. Inquests Held on Willesden Residents 1950 1951 1952 1953 1954 1955 1956 At Kilburn 54 49 25 12 13 12 10 At Ealing — — 26 21 37 24 62 Total 54 49 51 33 50 36 72 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). 23 licences have been issued to hawkers (19 selling fruit and vegetables, 3 selling fish and 1 selling miscellaneous foods). There were no new licences issued in 1956. 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 There are now no slaughterhouses in the district licensed under section 62 of the Food and Drugs Act, 1955. Slaughtering was last carried out in the borough in 1939; one licence was, however, renewed until 1955. RAG FLOCK AND OTHER FILLING MATERIALS ACT, 1951 The Rag Flock and Other Filling Materials Act and Regulations, 1951, came into operation on the 1st November, 1951. The Regulations specify the standards of cleanliness for the filling materials, the analysis for the tests, the fees which may be charged by the analyst, and the form of records to be kept by the occupiers of the premises registered and licensed under the Act. The premises of manufacturers of rag flock and those used for storing rag flock require to be licensed by the local authority; the fee and the renewal fee is £1.0.0. 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 £1.0.0 is chargeable. 16 There were no registrations during the year and the number of registered premises remains at sixteen. 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. Two samples of filling material were taken during the year and they proved to be satisfactory. PET ANIMALS ACT, 1951 The owners of pet shops must now obtain an annual licence costing 10/-. The shops are inspected by both Public Health Inspectors and Shops Act Inspector; Public Health Inspectors inspect premises for size, lighting, ventilation and cleanliness, and for the precautions taken for preventing spread of infectious disease. During 1956, 20 pet shops were licensed. STAFF MEDICAL EXAMINATIONS 53 staff medical examinations were carried out by the Medical Officer of Health and Deputy Medical Officer of Health in 1956. HEALTH SERVICES OF OTHER AUTHORITIES IN THE AREA Hospitals The hospital facilities provided by the North-West Metropolitan Regional Hospital Board, and the maternity and child welfare and school health services provided by the Middlesex County Council, remain substantially the same; they are described in the 1948 and 1953 reports. Liaison with Hospitals 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 1956, 1,671 expectant mothers (62 per cent of the total) attended the local ante-natal clinics staffed by assistant medical officers (Table 53). Expectant mothers require adequate ante-natal care throughout pregnancy, and close co-operation therefore exists between general practitioners, staffs of hospitals, assistant medical officers, midwives and health visitors. Health visitors make the initial arrangements for hospital and domiciliary confinements at the local clinics (Table 54). Mothers booked for confinement in Paddington Hospital or at home, have specimens of blood taken by assistant medical officers for Wasserman reaction, blood grouping and Rhesus factor. All expectant mothers are invited to attend the mass X -ray unit at Central Middlesex Hospital. Health visitors conduct mothercraft classes (o ne 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 (Table 55). 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 Clinic on one afternoon (Table 56). 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 follow-up visits where mothers fail to keep appointments at the hospital or clinics. 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 (Table 57). 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. 17 Assistant medical officers inform general practitioners if treatment is required. A Mothers' Club is held in Kilburn Health Clinic once a fortnight in the evening and in Stonebridge Health Clinic once a week. The mothers form their own committee and run the clubs themselves with the help of 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 clubs have had an active and interesting year. Outdoor activities have included a visit to a theatre, a visit to London Airport with a conducted tour of the buildings there and a day trip to Bognor. The Stonebridge Club also collected money for mentally handicapped children, and the old folk in Willesden. They also supported the sale of work in aid of the Royal College of Midwives Building Fund. MIDWIFERY SERVICE At the beginning of the year the Middlesex County Council employed five midwives for Willesden. During the year two midwives left and one was replaced, making a total of four midwives, with one vacancy at the end of the year. There is generally a shortage of midwives, and during the year midwives who work in the Wembley part of the area helped in Willesden. Four or five pupil midwives work in Willesden (under the supervision of midwives who are approved midwife teachers) for three months as part of their second period training for the Central Midwives' Board Examination. General practitioners and midwives supervise the care of expectant mothers. 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 58), visits her at home, and ensures that everything is prepared for the confinement. Mothers are encouraged to have both a general practitioner and a midwife for their confinement. A mother who chooses a midwife alone 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. Mothers who had gas and air analgesia during labour had substantial relief from pain (Table 59). Midwives work very closely with general practitioners who were present at many of the deliveries (Table 60). 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 (Table 61). 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 a doctor who has been called for medical aid by the midwife. Five babies were admitted to the unit during the year. 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, student health visitors from Middlesex, Battersea Polytechnic and the Royal College of Nursing and home nurse candidates who are in training (Table 62). Health Visitors work in close co-operation with general practitioners, staffs of hospitals, children's officers, welfare officers, public health inspectors, and other social workers. The co-operation with general practitioners continues to improve, 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 (Table 63). Some patients who attend diabetic clinics, require instruction on their treatment, diet and after care to be given in their homes, and arrangements have been made for this to be done by Health Visitors' instruction. Health Visitors are now attending the diabetic clinics at the Central Middlesex and Willesden General Hospitals, and they are responsible to the physicians in charge for the advice given to patients in their homes. There is a marked shortage of Health Visitors for the Willesden part of the area (table 64). Temporary clinic nurses have therefore been employed to help at the clinic sessions and visit schools for medical inspections and routine hygiene inspections. 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 1956. 18 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 Middlesex 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. Home nurses work in close co-operation with general practitioners, who make the majority of the requests for home nursing care. They give various injections, general attention and care to medical and surgical cases, and nursing care to the aged and infirm (Table 65). The establishment of home nurses has been maintained throughout the year (Table 66). SMALLPOX VACCINATION 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 32.5% of the total live births for the year (Table 67). DIPHTHERIA IMMUNISATION All children under one year old are offered protection against diphtheria, and private doctors and assistant medical officers of health immunise them; the material for immunisation is supplied free of charge by the Medical Research Council. Children usually receive reinforcing doses just before they start school. Table 68 shows the total number of children who have received protection against diphtheria during the last 15 years (1942-1956). The estimated percentage of children who have received an injection during their school life is 77.6. INOCULATION AGAINST POLIOMYELITIS In January, 1956, the Minister of Health announced the discovery of a vaccine for protection against paralytic poliomyelitis and decided that it should be given to children born between 1947-1954 inclusive. Parents were asked to register their children for inoculation by 31st March, 1956, and parental consent was received in respect of 23% of the total number eligible. There was not enough vaccine in May and June to inoculate all these children, and the Minister decided to limit vaccination to children born in November in each of the years 1951-1954 and in March in each of the years 1951-1954, with August in each of the years 1947-1954 as a reserve group. Less than 10% of all children registered were vaccinated from all of these groups (Table 69). HOME HELPS (Tables 70 and 71) Fewer new cases were helped during the year but there was little change in the total number still receiving help at the end of the year, mainly because more old people were having home helps. There was a further decrease in the number of T.B. cases helped, reflecting the general reduction in incidence, and improved methods of treatment. 64 mothers applied for help for a home confinement but only 45 actually received help; the remainder either made private arrangements or were admitted to hospital. The rate of pay for the home help was increased to 3/1.5/8d. but there was no increase in the maximum charge for the service (3/6d. per hour). Fewer home helps were employed at the end of 1956 as compared with the end of 1955. The total number of visits made in 1956 (3,856) was much less than in 1955 (5,803), mainly because of the reduction in staff from three assistant organisers to two. DAY NURSERIES There are 9 day nurseries with a total of 440 approved places. (Table 72). Rules of Admission The main principle for admission to day nurseries is the health of mother and child. Children fron: 0 to 5 years of age are accepted under the following conditions:— Their mothers are unsupported, they cannot look after their children adequately, or the home conditions are unsatisfactory. In addition, there must be no other satisfactory way of caring for the child, the child's health will not be affected, the mother will be assisted in the support of the child, and she will work for at least 30 hours per week. If there are still some vacancies, children over 2 years of age can be admitted where their parents are willing to pay the full cost. Application for Admission Of the 531 applications for admission made during the year only 390 children were actually admitted; the majority of the others found the assessment too high (Table 73). Over 98% of those on the register were in the priority groups. 44% of children from homes where the mother was the sole support (Table 74). 19 Assessed Daily Charge The maximum charge per day was increased from 9/- to 13/- from the 9th April. Of the 100 children who were paying 9/- per day at that time 44 children were removed from the nurseries because of the increased charge; 12 mothers gave up work entirely but the remainder made other arrangements for the care of their children (Table 75). Applicants unable to pay the assessed charges can appeal at a meeting of the Appeals Sub-committee. The final assessments are shown in Table 76 (October, 1956). Attendances Most of the day nurseries were used up to their full capacity. (Table 72). Infectious Diseases Two nurseries had outbreaks of dysentery and a few nurseries had outbreaks of measles and german measles during the year. There were a few more cases of infectious diseases involving one or two children who contracted their infection in their own homes from other members of the family (Table 77). Christmas Parties Christmas parties were held in all the day nurseries, with a special tea, a toy for each child, and an entertainment. The County Council gave 3/- a head for each child attending the nursery towards the Christmas celebrations. The Mayor gave toys from the Borough Christmas Tree for distribution to needy families attending the day nurseries. Staff The staff is based on one non-domestic for every three children under 2 and one for eight children over 2, but the total must not exceed one for every five children in the nursery. Two students are counted as one trained staff. The number of staff employed during the year varied according to the number of children on the registers and the establishment and position at the end of the year is shown in (Table 78). The number of nurseries approved as training schools for the 2-year Nursery Examination Board Course was reduced; only 5 nurseries are now approved. The students attend Chiswick Polytechnic for two days weekly. 14 students were in training during the year and 3 of them obtained the N.N.E.B. certificate. The remaining 11 students have not yet completed their training period. CONVALESCENCE Under Section 28 of the National Health Service Act, patients may be recommended for a short term stay in a convalescent holiday home. Normally these patients are those recovering from a serious illness or operation, and require only rest, fresh air and good food to complete treatment. Applications are received from Private Practitioners, Hospitals and from Clinics, and approved recommendations are forwarded to the County Medical Officer who arranges homes suitable to the individual cases. If a reduction in the standard charge of £4 14s. 6d. is required applicants have to complete an economic circumstances form and they are assessed by the Divisional Finance Officer. A request may also be made for payment of travelling expenses. Number of recommendations:— Adults 139 Children 23 162 SCHOOL HEALTH SERVICE (Tables 79-94) Routine Medical Inspection (Tables 79-84). As the Minister of Education has made changes in medical inspection returns beginning 1st January, 1956, the tables are in a different form from previous years. The former "Classification of the general condition of pupils" has been replaced by "Classification of the physical condition", and only two categories " Satisfactory " and " Unsatisfactory " are provided. The Minister of Education is making a further study of tonsillectomy, first obtaining information on the tonsillectomy rate. Medical Officers are recording at medical inspections those children who have had tonsillectomy (Table 84). 20 Orthoptics (Table 85) Methods of Treatment. 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 orthoptic cures were functional cures; single binocular vision has been restored with and without glasses for all distances and directions of gaze. The 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. The observation cases were cures which are being watched closely before they are recorded as discharges. Audiometry (Tables 86 and 87) Fewer children were tested in 1956 than in 1955 owing to the prolonged illness of the audiometer operator in the early part of the year. The children who failed the "sweep" test were given a more thorough second test; a few were then found to have normal hearing and the remainder were referred to the Assistant Medical Officers at the Clinics for further investigation of their defective hearing. Some children, after having wax removed, were found to have normal hearing and others were found to be already under observation at a hospital or a private doctor. In some no action was needed at the time but a further test was recommended after a given period, and children found to be suffering from enlarged tonsils and adenoids were referred for operation; one has now had the operation and an improvement in hearing has been noted. The remainder were referred by the Assistant Medical Officers to the County Council's Ear, Nose and Throat Specialist whose recommendations are given in Table 87. Handicapped Pupils (Tables 92, 93, and 94). A new day special school for deaf pupils was opened at Heston in April; Willesden children who had previously attended residential schools in various parts of the country or London Day Schools were transferred to this new school. Some physically handicapped children attending the Lower Place Day Special School and living in the western part of Middlesex were transferred to a new day special school at Heston which opened after Easter. This enabled all the children on the waiting list to be admitted and new cases can now be admitted within a few days. CHILD GUIDANCE During the past year 145 cases were seen of which 96 were new cases. The waiting list by the end of the year stood at 81 (Table 95). An analysis of the main symptoms and reasons for referral of the new cases is shown in Table 96. Owing to the work of the two part-time lay psychotherapists and the increase of medical sessions from 4 to 7, some 30 children per week were receiving intensive psychotherapy and many more were being supported by less frequent attendances. 9 maladjusted children were ascertained as in need of residential schooling. Links with some of the Infant and Maternity Welfare Centres and Day Nurseries were maintained throughout the year by the Psychiatric Social Worker and the Psychiatrist. Joint conferences were held with Assistant School Medical Officers and Health Visitors, Probation Officers, Welfare Officers, Speech Therapists and others. The Centre was visited by groups of Health Visitors, Psychologists and Nurses as part of their training schemes. RHEUMATISM (Tables 97 and 98) The Rheumatism Clinic was held on the third Tuesday of every month at the Willesden Health Clinic. This clinic is situated centrally and deals with children referred from 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 years. 21 The child's health, family history and environmental conditions are discussed with the parents. Consultations with specialists are arranged and up-to-date reports from hospitals obtained, non-rheumatic conditions are investigated, advice on sport and physical training given and convalescent treatment arranged. A history of rheumatism is significant. One-third of the children who attended the clinic gave a history of rheumatism and more than half of them suffered from the disease. Dampness and rheumatism are also closely related. One-third of the children who attended live in damp houses and 3 out of 4 were found to be suffering from the disease. The damp conditions were remedied through the Public Health Department. Rheumatism also occurs more frequently amongst children from the lower social income groups. 4 out of 5 children who attended came from social groups IV and V. SCHOOL DENTAL SERVICE (Table 99) There was an increase in the number of Dental Officers from an average of 5 in 1955 to an average of 5£ in 1956. The School Dental Service is responsible for inspecting and treating children who attend maintained schools. Children should be inspected every year and preferably every 6 months. In 1949, owing to shortage of accommodation and difficulty in recruiting Dental Officers, only onethird 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 up to 9 years of age (approximately 10,000 children) in order to prevent dental decay which would only lead to more work in the future. This scheme proved successful and in June, 1956, it was possible to raise the age limit in the restricted scheme to thirteen years of age (approximately 18,000 children). In 1956, of all the children inspected both at clinics and at schools 71% required treatment and 43% accepted treatment. In the course of the year 164 evening sessions were carried out by full time Dental Officers. PRIORITY DENTAL SERVICE (Table 100) In 1956, 13% of the Dental Officers' time was spent in treatment of the priority groups. The number of expectant mothers and nursing mothers treated in the year is practically the same as in 1955. There was an increase in the number of children under five inspected in the year but fewer required treatment than in 1955. Every opportunity is taken to explain the value of early and regular treatment to mothers. The ratio of fillings to extractions in the whole priority service is 2.3:1 and in the children under five 2.5: —. An average of 2-9 conservations are carried out for each child treated. CHIROPODY (Tables 101 and 102) There was a marked increase in attendance for Chiropody during 1956 particularly by Expectant and Nursing Mothers. Many young children between the ages of 11 and 15 years develop foot deformities through wearing casual shoes. Children's feet should be inspected when they first start school and again when they are about 11 or 12 years, because many deformities begin to develop at this age. A large number of children under five have been treated for conditions of their nails mainly on account of their shoes being too narrow, advice on shoes is always given. Much is being done to prevent foot troubles by Exhibitions in the Clinics and talks in the Schools. Proper fittings should be obtained from qualified assistants in shops. Many toe-nail conditions develop when the shoes are not fitted properly. Warts on the feet are prevalent amongst children attending for treatment. They are very painful if left untreated, and can spread from one person to another. Parents sometimes mistake them for corns. They should be treated early like all foot ailments. HOME SAFETY The Willesden Home Safety Committee was foimed in November, 1956. It is a voluntary Committee which has the support of both the Willesden Borough Council and the Middlesex County Council. The Willesden Council has made a grant of £100 to the funds of this Committee. The aim of the Committee is to reduce the number of accidents which occur in the homes in Willesden each year, mostly affecting children under 5 years and people over 65 years of age. The terms of reference of the Committee are:— (a) To carry on a continual propaganda campaign locally to inform the public of the extent and gravity of the home accident problem. (b) To enlist the support of all interested municipal and social organisations for this campaign. (c) To investigate local home accident cases and their causes. (d) To investigate possible remedies. (e) To participate in the National Home Safety campaign by appointing a representative to serve on the National Home Safety Committee which meets quarterly in London and/or to make use of this Committee by reporting progress and sending forward resolutions dealing with matters of home safety. The Committee is affiliated to the Royal Society for the Prevention of Accidents. 22 organisations are represented on the Committee, so ensuring that a large proportion of the public will be reached and made home-safety conscious. 22 TABLES Table 1 DEATHS Causes: Males Females Total 1. Tuberculosis (respiratory) 20 5 25 2. Tuberculosis (other) — — — 3. Syphilitic disease 5 3 8 4. Diphtheria — — — 5. Whooping cough — — — 6. Meningococcal infections — — — 7. Acute poliomyelitis — — — 8. Measles — — — 9. Other infective and parasytic diseases 4 3 7 10. Malignant neoplasm, stomach 23 15 38 11. Malignant neoplasm, lung, bronchus 74 15 89 12. Malignant neoplasm, breast — 34 34 13. Malignant neoplasm, uterus — 14 14 14. Other malignant and lymphatic neoplasms 105 92 197 15. Leukemia, aleukemia 3 3 6 16. Diabetes 2 6 8 17. Vascular lesions of nervous system 75 140 215 18. Coronary disease, angina 151 89 240 19. Hypertension, with heart disease 24 42 66 20. Other heart disease 70 101 171 21. Other circulatory disease 36 45 81 22. Influenza 2 5 7 23. Pneumonia 35 46 81 24. Bronchitis 91 53 144 25. Other diseases of respiratory system 11 2 13 26. Ulcer of stomach and duodenum 8 13 21 27. Gastritis, enteritis and diarrhoea 1 7 8 28. Nephritis and nephrosis 8 6 14 29. Hyperplasia of prostate 9 — 9 30. Pregnancy, childbirth, abortion — 5 5 31. Congenital malformations 5 9 14 32. Other defined and ill defined diseases 59 82 141 33. Motor vehicle accidents 15 8 23 34. All other accidents 17 18 35 35. Suicide 9 8 17 36. Homicide and operations of war — 1 1 TOTAL 862 870 1,732 23 Infant Mortality Table 2 Infant Mortality and Stillbirths: Willesden and England and Wales 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 1938 187,600 3,027 160 53.9 53 101 32.3 38 1946 170,550 3,572 102 28.6 43 95 25.9 27 1952 180,400 2,611 62 23.8 28 66 24.7 23 1953 178,-500 2,655 60 22.6 27 58 21.4 22 1954 177,300 2,599 50 19.2 25 44 16.7 24 1955 176,000 2,619 53 20.2 25 61 22.8 23 1956 174,900 2,681 61 22.7 24 58 21.2 23 Perinatal mortality 1955 37.4 1956 35.4 Table 3 Infant Mortality:—by Wards Ward Number of deaths Total 1954-56 Rate 1954-56 1954 1955 1956 1. Carlton 13 2 5 20 23.4 2. Kilburn 4 9 9 22 33.0 3. Brondesbury Park 4 3 4 11 19.6 4. Kensal Rise 1 5 8 14 36.5 5. Manor 1 2 2 5 10.3 6. Harlesden 2 3 5 10 15.9 7. Stonebridge 6 5 3 14 24.3 8. Roundwood 4 7 7 18 26.8 9. Church End 2 2 2 6 11.7 10. Willesden Green 2 6 6 14 23.5 11. Mapesbury 4 3 4 11 14.5 12. Gladstone 4 1 2 7 16.3 13. Cricklewood 1 3 3 7 16.8 14. Brentwater 2 2 1 5 14.0 50 53 61 164 20.8 Table 4 Infant Mortality:—by Social Class Social Class Group Neo-natal 1-12 months Total I 1 1 2 II 4 — 4 III 21 5 26 IV 5 1 6 V 15 6 21 Unclassified 2 — 2 Table 5 Infant Mortality—Causes (Based on Registrar General's Figures) 1936-1939 1940-1945 1946-1950 1951-1955 1956 (1955 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 (3) 5 (10) 8 (13) 3.0 (4.9) Diarrhoea and enteritis 131 10.0 108 6.8 37 2.3 12 1.0 1 (—) - (—) 1 (—) 0.4 (—) Other infections 34 2.6 40 2.5 15 0.9 12 1.0 - (—) 1 (—) 1 (—) 0.4 (—) Congenital malformations 83 6.3 89 5.6 72 4.4 53 4.1 9 (6) 5 (1) 14 (7) 5.2 (2.7) Prematurity 170 13.0 179 11.3 99 6.1 110 8.4 12 (20) - (—) 12 (20) 4.4 (7.6) Injury at birth 21 1.6 33 2.1 43 2.7 27 2.0 3 (3) - (—) 3 (3) 1.1 (1.1) Other causes 134 10.3 149 9.4 96 5.9 31 2.2 20 (7) 2 (3) 22 (10) 8.2 (3.9) All causes 679 51.9 738 46.5 430 26.5 298 22.8 48 (39) 13 (14) 61 (53) 22.7 (20.2) 24 Table 6 Premature births and deaths (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) 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) 1956 19 (0) 146 (12) 3 (0) 165 (12) Table 7 Premature births and deaths: —by Wards Ward Premature births notified Rate per 1,000 live births Deaths Carlton 19 6.5 2 Kilburn 21 9.7 3 Brondesbury Park 12 6.0 - Kensal Rise 10 7.5 1 Manor 10 5.9 - Harlesden 16 7.1 1 Stonebridge 9 4.8 2 Roundwood 12 4.9 2 Church End 10 6.4 - Willesden Green 13 6.6 - Mapesbury 12 4.4 - Gladstone 6 4.4 - Cricklewood 12 8.3 1 Brentwater 3 2.9 - Total 165 6.2 12 Table 8 Prematurity—cause of deaths No information 1 Unknown cause 2 Maternal toxaemia 1 Multiple pregnancy 2 Complication of pregnancy 2 Poor home conditions, health, illegitimacy 4 Total 12 Table 9 Infant Mortality:—Congenital malformations Spina bifida 1 Multiple abnormalities 5 Hydrocephalus 1 Congenital heart 3 Mongolism and atelectasis 1 Meningomyelocele 1 Imperforate anus and congenital atelectasis 1 Multiple osseous deformities 1 Total 14 25 Table 10 Infant Mortality: —Infections (a) Causes Pneumonia 5 Bronchitis 3 Otitis media 1 Gastro enteritis 1 Total 10 (b) By Social Class I Nil II 1 III 3 IV 2 V 4 GENERAL PROVISION OF HEALTH SERVICES Table 11 Bacteriological examination of milk, ice cream and water Milk examinations—154 Schools (pasteurised) Dealers' premises Total Pasteurised T.T. pasteurised Sterilised Samples 40 98 8 8 154 Satisfactory 40 96 8 8 152 Unsatisfactory — 2 — — 2 No. of second samples satisfactory — 2 — — 2 Ice Cream examinations—47 Grade 1 Grade 2 Grade 3 Grade 4 Total 4 23 9 11 47 Water examinations—202 Domestic supplies Swimming pools Paddling pool Total Samples 15 178 9 202 Satisfactory 15 178 — 193 Unsatisfactory 9 9 Table 12 Uncleanliness and Scabies New cases treated Attendances Scabies Lice and nits Total Scabies Lice and nits Total Children under 5 years 8 4 12 8 4 12 Children 5-15 years 8 41 49 13 50 63 Adults Men 7 5 12 7 6 13 Women 10 25 35 10 26 36 Total 33 75 108 38 86 124 26 HEALTH EDUCATION Table 13 Talks No. visited Total No. of talks Subjects Total attendances No. of attendances Schools 20 289 28 850 25—90 Factories 41 110 18 6,900 40—1,000 Religious, social and political organisations 30 35 18 1,330 10—230 Table 14 Mothercraft No. of clinics Total No. of classes s by health visitors 3 117 6,863 PREVALENCE AND CONTROL OF INFECTIOUS AND OTHER DISEASES Table 15 Infectious diseases—cases notified 1955 1956 Notified Confirmed Deaths Notified Confirmed Deaths Diphtheria 1 — — — — — Dysentery 140 104 — 314 223 — Erysipelas 13 11 — 25 25 — Encephalitis, acute 2 2 — 1 1 1 Food poisoning 39 24 — 36 15 — Malaria 1 — — 1 1 — Measles 2,040 2,026 — 1,184 1,180 — Meningococcal infection 5 4 2 4 4 — Ophthalmia neonatorum 2 2 — 2 2 — Paratyphoid fever 5 4 — — — — Pneumonia 124 116 92 110 107 79 Poliomyelitis and polioencephalitis 176 136 — 21 14 — Puerperal pyrexia 147 147 — 133 133 — Scarlet fever 135 126 — 115 108 — Smallpox — — — — — — Typhoid fever — — — — — — Whooping cough 177 171 — 226 226 — Table 16 Whooping Cough Cases and Deaths: Willesden and England and Wales Year Population Child population (estimated) Cases confirmed Deaths Case rate per 1,000 population Death rate per 1,000 population Children vaccinated in Willesden 0-4 years 5-15 years Willesden England & Wales Willesden England & Wales Willesden England & Wales Willesden England & Wales 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 1,615 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 1,163 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 1956 174,900 13,001 22,044 226 92,396 — 95 1.21 2.06 Nil .002 1,814 27 Table 17 Poliomyelitis 0—15 years 15 years and over Total Notified 17 4 21 Confirmed 12 2 14 Non-paralytic 5 — 5 Paralytic 7 2 9 Fatal — — — TUBERCULOSIS Table 18 Tuberculosis: Notified cases and deaths Year Population New cases Deaths Cases on register Pulmonary Non- pulmonary All forms Pulmonary Nonpulmonary All forms Pulmonary Nonpulmonary All forms 1938 187,600 210 56 266 117 11 128 691 172 863 1946 170,550 255 34 289 81 15 96 1,067 180 1,247 1952 180,400 229 27 256 29 4 33 1,803 250 2,053 1953 178,500 216 29 245 24 1 25 1,854 249 2,103 1954 177,300 229 33 262 33 4 37 1,917 267 2,184 1955 176,000 152 23 175 25 2 27 1,966 277 2,243 1956 174,900 140 23 163 25 — 25 1,993 291 2,284 Table 19 Tuberculosis: Case rate and death rate Year Population New cases Rate per 1,000 population Deaths Rate per 1,000 population Pulmonary Nonpulmonary All forms Pulmonary Nonpulmonary All forms 1938 187,600 1.12 .30 1.42 .62 .06 .68 1946 170,550 1.50 .20 1.69 .48 .09 .56 1952 180,400 1.27 .15 1.42 .16 .02 .18 1953 178,500 1.21 .16 1.37 .13 .01 .14 1954 177,300 1.29 .19 1.48 .19 .02 .21 1955 176,000 .86 .13 .99 .14 .01 .15 1956 174,900 .80 .13 .93 .14 — .14 28 Table 20 Tuberculosis: 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 1 — — — — — — 10 to 15 — — — — — — — — 15 to 20 2 4 — — — — — — 20 to 25 14 8 3 3 — — — — 25 to 35 13 18 4 2 3 1 — — 35 to 45 13 10 — 5 1 2 — — 45 to 55 22 4 1 1 4 1 — — 55 to 65 11 3 — — 2 — — — 65 and upwards 10 4 1 2 10 1 — — Totals 87 53 10 13 20 5 — — Table 21 Tuberculosis 1956: Deaths and cases by wards Ward Pulmonary cases Nonpulmonary cases Pulmonary rate Combined rate All forms Deaths Rate Carlton 19 2 1.56 1.72 3 0.25 Kilburn 17 4 1.26 1.55 1 0.07 Brondesbury Park 7 3 0.56 0.80 4 0.32 Kensal Rise 8 2 0.70 0.88 5 0.44 Manor 6 1 0.45 0.53 1 0.02 Harlesden 9 5 0.64 1.00 5 0.36 Stonebridge 11 — 0.87 0.87 1 0.08 Roundwood 18 3 1.59 1.78 1 0.09 Church End 10 — 0.77 0.77 1 0.08 Willesden Green 8 3 0.60 0.82 1 0.08 Mapesbury 8 — 0.64 0.64 1 0.08 Gladstone 7 — 0.60 0.60 — — Cricklewood 5 — 0.44 0.44 — — Brentwater 7 — 0.61 0.61 1 0.09 Whole Borough 140 23 0.80 0.93 25 0.14 Table 22 Tuberculosis 1954—1956: Deaths and cases by wards Ward Pulmonary cases Nonpulmonary cases Pulmonary rate Combined rate All forms Deaths Rate Carlton 61 8 1.66 1.87 12 0.33 Kilburn 52 12 1.27 1.57 9 0.22 Brondesbury Park 26 6 0.69 0.85 11 0.29 Kensal Rise 25 5 0.73 0.87 9 0.26 Manor 29 3 0.73 0.80 5 0.13 Harlesden 44 14 1.04 1.37 10 0.24 Stonebridge 41 3 1.07 1.15 6 0.16 Roundwood 40 8 1.12 1.35 4 0.11 Church End 31 4 0.79 0.89 7 0.18 Willesden Green 37 7 0.92 1.09 4 0.10 Mapesbury 51 5 1.36 1.49 3 0.08 Gladstone 30 3 0.85 0.94 3 0.09 Cricklewood 25 1 0.72 0.75 1 0.03 Brentwater 29 — 0.84 0.84 5 0.14 Whole Borough 521 79 0.99 1.14 89 0.17 29 Table 23 Tuberculin Testing, 1953-1956 Children under 5 years School children (5 years) School leavers Tested Positive % Positive Tested Positive % Positive Tested Positive % Positive 1953 1,416 56 4.0 1,018 384 38.0 1,804 885 49.1 1954 1,526 43 2.8 938 169 18.0 1,868 1,116 59.7 1955 1,308 13 1.0 1,537 32 2.1 2,041 387 19.0 1956 1,333 14 1.0 1,473 56 4.0 1,759 391 22.2 Table 24 Tuberculosis: B.C.G. vaccination of school leavers, 1953-1956 No. tested and found negative No. vaccinated 1953 587 *(32.5) 456 †(77.7) 1954 447 (23.9) 391 (87.5) 1955 1,535 (75.2) 1,279 (83.3) 1956 1,356 (77) 1,218 (90) *Percentage of total tested, †Percentage of negatives vaccinated. Table 25 Tuberculosis: Notification of deaths 1951 1952 1953 1954 1955 1956 1951-56 Deaths 46 29 25 37 27 25 189 Percentage not notified 20 21 28 19 15 24 21 Percentage notified before death: 0—12 months 15 21 8 11 15 20 15 1—5 years 39 31 28 30 26 4 26 Over 5 years 26 27 36 40 44 52 38 SANITARY CIRCUMSTANCES OF THE AREA Table 26 Census 1951. Private household arrangements (Percentages in brackets) Area No. of households Water closet Fixed bath Cooking stove Kitchen sink Sharing Without Sharing Without Sharing Without Sharing Without Middlesex 703,315 125,962 (18) 2,361 131,356 (35) 113,625 43,192 (7) 7,139 53,909 (11) 20,371 Willesden 57,182 13,621 (24) 120 16,442 (58) 16,592 3,520 (8) 1,005 4,495 (12) 2,130 Greater London *2,658,477 640,036 (24) 8,000 437,809 (46) 776,023 154,936 (8) 48,696 235,435 (13) 101,480 England and Wales *13,116,522 1,754,635 1 (21) 037,211 1,003,236 (45) 4,850,364 706,841 (7) 294,354 842,177 (12) 836,453 *Private households enumerated on houseboats are omitted from this Table. 30 Table 27 Census 1951. Housing of private households Middlesex Willesden Greater London England and Wales Structurally separate dwellings Occupied and vacant Number 603,831 38,843 2,180,442 12,389,448 Percentage increase or decrease (—) 1931-1951 68.2 22.7 37.2 31.8 Pecentage vacant unfurnished 0.55 0.51 0.74 1.12 Occupied Rooms per 1951 5.01 5.39 4.88 4.71 dwelling 1931 5.68 6.29 5.63 5.05 Percentage with 1—3 rooms only 11.7 16.9 19.1 15.7 Households Number 703,525 57,182 2,658,758 13,117,868 Percentage increase or decrease (—) 1931—1951 63.1 14.9 22.1 28.2 Percentage sharing a dwelling 28.5 57.8 34.2 14.3 Rooms per household 4.24 3.61 3.92 4.34 Percentage occupying 1—3 rooms only 32 54 42 26 Persons per household 1951 3.16 3.08 3.02 3.19 1931 3.66 3.60 3.57 3.72 Percentage of 1 person households 9.7 12.8 13.6 10.7 Density of occupation (persons per room) Persons per room 0.74 0.85 0.77 0.74 Percentage of population at density Over 2 1.8 4.1 2.0 2.2 Over 1½ 7.5 15.5 7.1 6.6 Percentage of households at density over 2 1.1 2.3 1.2 1.2 Over 1½ 4.8 9.9 4.6 3.9 Heads of household ; percentage non-married 21.4 25.3 25.4 24.1 SANITARY INSPECTION OF THE AREA Table 28 General Housing Survey, 1956 (1954 and 1955 in brackets) Houses inspected Re-inspections Total inspections 620 (2,890) 4,294 (12,091) 4,914 (14,981) Houses in all respects reasonably fit for human habitation 174 (682) Houses with slight defects 2 (43) Houses requiring action 444 (2,165) Total 620 (2,890) 31 Table 29 General Housing Survey, 1956 (1954 and 1955 in brackets) Chimneys 180 (533) Roofs 413 (1,061) Gutters and downspouts 479 (1,022) Soil and vent pipes 200 (400) Brickwork 367 (1,128) Windows 735 (1,734) Paving 253 (649) Water closets 265 (781) Drainage 30 (108) Walls and ceilings 663 (1,625) Floors 339 (748) Totals 3,924 (9,789) Table 30 General Housing Survey, 1956 (1954 and 1955 in brackets) Notices Served Section 9, Housing Act, 1936 336 (1,589) Section 93, Public Health Act, 1936 45 (41) Section 39, Public Health Act, 1936 30 (8) Section 45, Public Health Act, 1936 20 (18) Intimation notices 88 (542) 519 (2,198) Total 2,717 Appeals received 42 Upheld by Court 1 Work carried out after negotiations with owners 41 Table 31 Demolition and Closing Orders Housing Act, 1936 (sections 11 and 12) Loc al Government (Miscellaneous Provisions) Act, 1953 (section 10) (1955 in brackets) Demolition Orders—Section 11, Housing Act, 1936 — (1) Closing Orders—Section 12, Housing Act, 1936 4 (6) 93 Denmark Road (top floor) 1 Stafford Road (basement) 3 Stafford Road (basement) 7 Cambridge Place (basement) Closing Orders—Section 10, Local Government (Miscellaneous Provisions) Act, 1953 — (—) Table 32 Overcrowding (a) Dwellings overcrowded at end of year 1,942 (b) Overcrowding reported during the year 121 (c) (i) Overcrowding relieved during the year 40 (ii) Persons 116 (app.) (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 43 (ii) Families 64 (iii) Persons 384 (f) Overcrowding in Council houses relieved during the year 7 (g) Section 61, Housing Act, 1936—Licences issued 8 32 Table 33 New Dwellings, 1956 Houses Flats Rebuilds Dwellings built by private builders (excluding those built by the police authorities) 13 19 Nil Built by local authority Nil 75 Nil Applicants on Council's waiting list at 31.12.56 10,932 Table 34 Housing Defects 1956 1955 Premises inspected on complaint 3,479 3,319 For infectious diseases 604 607 Others 27 196 Under special survey (see Table 28) 620 1,129 Total number of premises inspected 4,730 5,251 No. of inspections and re-inspections (inclusive of Housing Survey) 19,548 22,296 Table 35 Notices served under Public Health and Housing Acts, 1936 Inclusive of Housing Survey 1956 1955 Intimation notices served 1,940 2,009 Intimation notices complied with 1,901 1,910 Statutory notices served (Public Health Act, 1936) 1,395 965 Statutory notices complied with (Public Health Act, 1936) 1,341 983 Statutory notices served (Housing Act, 1936) 436 691 Statutory notices complied with (Housing Act, 1936) 643 1,060 Non-compliance with statutory notices referred to Town Clerk (Public Health Act, 1936, sec. 93) †268 147 Referred to the Borough Engineer for work to be carried out in default of owners *331 244 *189 work done by Borough Engineer. †Details of cases referred to the Town Clerk during year:— Work carried out 122 75 Work in hand 1 8 Court orders obtained 35 20 Summonses withdrawn—notices complied with 72 24 (7) (8) Proceedings pending 31 9 Total 268 147 (The figures in brackets are the notices withdrawn and reserved.) Table 36 Certificates of Disrepair (a) Under Housing Repairs and Rents Act, 1954 Applications received from tenants 22 (123) Withdrawn by tenants — (6) Number investigated 22 (117) Granted 22 (110) Refused — (7) Applications for revocation certificates received from owners 28 (106) Granted 28 (100) Refused — (6) (b) Under Rent and Mortgage Interest Restrictions Acts Applications received from tenants 3 (4) Granted 3 (4) Refused — (-) Applications for revocation certificates received from owner 1 (2) Granted 1 (2) Refused — (—) (1955 in brackets) 33 Table 37 Summary of nuisances and of improvements effected Water supply and water service Inclusive of Housing Survey 1956 1955 New cisterns provided 37 34 Cisterns cleansed, repaired, covered, etc 94 71 Draw taps placed on mains 16 29 Drainage and sewerage Water closets: Repaired, supplied with water or otherwise improved 705 828 New closets built 10 4 Provided with better ventilation 8 3 Drains: Examined, tested, exposed, etc. 104 187 Unstopped, repaired, trapped, etc. 280 376 New soilpipes or vent shafts fixed 46 92 Disconnecting traps or chambers inserted 28 24 Reconstructed 77 62 New manhole covers 44 88 Soilpipes or vent shafts repaired 250 386 Other defects Smoke nuisances 18 9 Accumulation of refuse 71 100 Fowls, pigs, etc., kept in an insanitary condition 18 5 Dampness 1,223 1,673 Yard and forecourts paved, repaved or repaired 469 749 Walls and ceilings cleansed 1,904 3,143 Verminous rooms disinfested 238 325 Leaky roofs made watertight 1,626 1,990 Additional ventilation provided under floors 77 124 Dilapidated plaster repaired 2,667 3,364 Flooring and other woodwork repaired 1,940 2,173 Damp proof courses inserted 204 309 Water supply reinstated 103 46 Wash house floors repaired or repaved 129 127 Fireplaces and stoves repaired 1,098 1,444 Decayed brickwork repaired and repointed 1,627 2,532 Sinks provided or replaced 246 303 Additional light and ventilation to staircase 41 47 Larders or food cupboards ventilated or provided 16 53 Gutters and/or rainwater pipes repaired or renewed 1,517 1,982 New sashcords and glass provided to doors and windows 4,320 5,433 Miscellaneous 1,002 1,523 Total nuisances abated 22,253 29,638 34 Table 38 Inspection of factories, outworkers premises and food premises 1956 1955 No. inspected Inspections made No. inspected Inspections made Offensive trades — — — — Power factories 740 827 787 850 Non-power factories 45 48 64 73 Homeworkers and outworkers 170 170 236 236 Inspection of food premises (includes re-visits) Baker 36 111 36 113 Bread and confectionery 38 76 37 104 Dairy 3 45 10 35 Butcher 117 255 115 351 Grocer and general store 312 504 318 710 Fishmonger and fish-fryer 60 110 61 134 Cafe and restaurant 157 327 154 308 Greengrocer and fruiterer 120 183 123 237 Ice cream and sweet shop 178 277 180 328 Food stall 16 20 18 39 Public house 43 87 45 85 Works canteen 113 114 112 128 Food factory 13 14 13 48 Any other food premises 26 51 26 75 Total periodic inspections 2,187 3,219 2,335 3,854 Table 39 Other inspections 1956 1955 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 — 44 — 127 Public House urinals 44 114 44 147 Mews and stables 9 9 29 58 Miscellaneous — 1,587 — 1,967 Smoke observations 72 574 39 307 Verminous rooms 71 190 83 121 Total other inspections — 2,518 — 2,727 Total all inspections (including Housing Survey) 25,285 28,877 35 SMOKE NUISANCE Table 40 Examination of sulphur by lead peroxide method, (milligrams of S03 per day per 100 square centimetres) Site January February March April May June July August September October November December Minet Gardens 4.16 3.65 3.61 2.93 1 .03 1.46 0.43* 1.88 1.27 1.96 2.63 3.18 Town Hall 7.57* 3.90 4.66 3.15 0.97 1.37 1.05 1.75 1.10 1.98 2.69 3.02 *Damaged by rainwater. Table 41 Monthly deposits in tons per square mile Power Station Acton Lane Taylors Lane Neasden Site Barretts Green Road Minet Gardens Ascot Park Neasden Lane Press Road Wembley Trading Estate Town Hall January 42.68 76.72 32.92 37.25 33.14 35.50 35.99 February 33.30 32.64 9.91 20.21 9.71 12.94 16.00 March 36.82 32.84 24.76 27.31 32.58 21.27 25.16 April 36.15 45.07 21.27 23.43 21.87 14.49 22.19 May 24.82 21.01 14.95 15.64 21.87 15.54 13.53 June 23.92 31.68 17.45 20.98 21.64 20.88 15.57 July 32.64 48.61 26.47 26.74 27.64 24.59 22.58 August 35.06 73.57 28.44 32.21 27.63 29.93 24.59 September 32.87 48.09 27.85 24.12 26.05 25.42 15.70 October 29.36 96.07 25.78 32.41 22.73 31.64 23.51 November 22.86 42.98 15.05 19.39 12.69 18.21 18.01 December 32.87 151.08 26.18 29.56 27.50 28.84 25.88 Total 383.35 700.36 271.03 309.25 285.05 279.25 258.71 36 DISINFESTATION Table 42 (a) Verminous premises: Council properties County Council properties Private properties 15 2 102 Total 119 (b) Verminous rooms:* Council properties County Council properties Private properties 43 2 193 Total 238 *Some rooms are treated more than once. (c) Bedding materials (i) disinfested 20 (ii) disinfected 32 (d) Miscellaneous: Beetles 4 Ants 7 Cockroaches 5 INSPECTION AND SUPERVISION OF FOOD AND FOOD PREMISES Table 43 Food premises: Defects remedied Defects Outstanding at 31.12.55 Found during the year Total Remedied during year Outstanding at 31.12.56 Inadequate lighting and ventilation 1 24 25 11 14 Wash hand basins not provided 10 228 238 172 66 Inadequate refuse storage 6 46 52 45 7 Insufficient sanitary accommodation 2 31 33 32 1 Inadequate storage 1 25 26 17 9 Defective walls and ceilings 13 118 131 95 36 Dirty walls and ceilings 12 296 308 210 98 Dirty hand towels 5 31 36 35 1 Unsatisfactory conditions — 36 36 31 5 Any other defects 19 512 531 358 173 Totals 69 1,347 1,416 1,006 410 Table 44 Food premises: Registration Premises on register 31.12.55 Applications received Applications granted Applications refused Premises removed from register during 1956 Total on register at 31.12.56 Inspections made 1. Sale and storage of ice cream 310 13 13 — 1 3221 333 781 2. Manufacture of ice cream 14 — — — 3 11 55 3. Manufacture of preserved foods 125 — — — — 125 255 4. Fish curing 10 — — — — 10 27 37 Table 45 Food unfit for human consumption Meat Miscellaneous Bacon 949¼ lbs. Apricot pulp 2 cwt. 29 lbs. Cooked 37 lbs. Baked beans and pork 4 tins Tinned 3,256½ lbs. Biscuits 583 lbs. Raw 4,604½ lbs. Calves foot jelly 10 jars Fish Coffee 2 tins Tinned 799 tins Cream 13 tins Fowl 4 lbs. Raw 400 lbs. Fruit juice 149 tins Vegetables Milk coated raisins 3 lbs. Tinned 4,861 tins Milk coated peanuts 1 3/4 lbs. Raw 1,932 lbs. Orange squash 1 bottle Pickles 2 jars Fruit Ravioli 2 tins Tinned 7,974 tins Salad cream 2 jars Raw 73 lbs. Skinless pork sausages 334¼ lbs. Bread, flour, cereals, etc. 231 lbs. Soup 475 tins Preserves 430 lbs Spaghetti 2 tins Cheese 37 lbs. Sweets 27 pkts. Tinned Milk 1,551 tins Tomato pulp 2 tons, 10 cwt. 107 lbs. Table 46 Types of food premises Baker 36 Bread and confectionery 38 Dairy 3 Butcher 117 Grocer and general store 312 Fishmonger and fish fryer 60 Cafe and restaurant 157 Greengrocer and fruiterer 120 Ie cream and sweet shop 178 Food stall 16 Public house 43 Works canteen 113 Food factory 13 Other food premises 26 Total 1,232 Inspections and revisits: Inspections 2,174 Revisits 1,268 Total 3,442 Table 47 Improvements in food premises Premises unsatisfactory on 31.12.55 38 Unsatisfactory during the year 500 Premises made satisfactory during the year 408 Unsatisfactory on 31.12.56 130 38 Table 48 Food: Samples taken Article No. of samples Unsatisfactory Milk, various 234 5 Milk, new 7 - Bread 1 - Butter 40 - Cakes 27 2 Cooked meat and meat products (other than sausages) 29 - Coffee 2 - Cream 55 - Drugs 50 - Fish 7 - Fish, canned 1 - Fish products 11 - Flavouring 1 - Fruit, fresh 5 3 Fruit, canned 1 - Fruit, dried 12 - Fruit squashes 12 - Ice cream 40 - Margarine 39 - Meat 36 - Miscellaneous 11 - Pepper 2 - Preserves 4 - Sausages, etc. 15 - Soup 3 - Suet 2 - Sweets 10 1 Vinegar 39 2 Wines and spirits 16 2 Totals 712 15 Table 49 Dairies—Registration and Licences Premises in Willesden 115 Dairymen 89 Licences issued Pasteurised milk 94 Sterilised milk 107 Tuberculin tested milk 76 Premises outside Willesden 12 Dairymen 7 Licences issued Pasteurised milk 12 Sterilised milk 12 Tuberculin tested milk 12 FACTORIES Table 50 On register Type of factory On register 1.1.56 Added to register Deleted from register Totals at 31.12.56 Non-power 73 1 4 70 Power 829 29 22 836 Total 902 30 26 906 39 Table 51 Factories inspected, defects found, and action taken Type of factory Inspected Total inspections Total unsatisfactory and informal notice served Outstanding from 1955 Made satisfactory 1956 Outstanding 31.12.56 Non-power 45 48 2 — 2 — Power 740 827 91 11 83 19 Non-power factories: Details of defects During 1956 Outstanding from 1955 Remedied during 1956 Outstanding at 31.12.56 Want of cleanliness 2 — 2 — Overcrowding — — — — Unreasonable temperature — — — — Inadequate ventilation — — — — Defective drainage of floors 1 — 1 — Sanitary accommodation: Insufficient 2 — 2 — Unsuitable or defective — — — — Not separate for sexes — — — — Power factories: Details of defects of sanitary Accommodation Insufficient 2 — 2 — Unsuitable or defective 94 6 8.1 19 Not separate for sexes — — — — There are 15 underground rooms used as factories; 13 are used with premises above ground. Table 52 Outworkers and homeworkers Premises inspected Satisfactory Unsatisfactory and notice served Remedied 170 168 2 2 CARE OF MOTHERS AND YOUNG CHILDREN Table 53 Ante-natal Clinics Clinic Sessions New cases Attendances Average attendance per session Antenatal Postnatal Antenatal Postnatal Kilburn 136 233 16 1,155 16 8.6 Willesden 154 330 7 1,422 9 9.3 Stonebridge 150 574 28 3,070 28 20.6 Cricklewood (Sneyd Road) 51 205 17 678 20 13.7 Neasden (St. Catherine's) 52 75 3 286 6 5.6 Kensal Rise (St. Martin's) 51 142 1 646 1 12.7 South Kilburn (St. Luke's) 51 112 2 529 5 10.5 Totals 1956 645 1,671 74 7,786 85 12.2 1955 639 1,689 157 7,455 177 12.0 40 Table 54 Births Hospital and Domiciliary 1955 1956 Total notified live births 2,526 2,638 Born in institutions 2,165 2,262 Born at home 361 376 Percentage born in institutions 85.7 85.8 Institutions Central Middlesex Hospital 864 987 Kingsbury Maternity Hospital 354 321 Larger hospitals outside Willesden 585 639 Smaller hospitals outside Willesden 335 286 Nursing homes, etc. 27 29 Total 2,165 2,262 Home County Midwives 357 376 Others 4 — Total 361 376 Table 55 Mothercraft Clinic Sessions New cases Total attendances Average attendance per session Kilburn 30 51 176 5.9 Willesden 36 27 151 4.2 Stonebridge 51 67 384 7.5 Totals: 1956 1955 117 116 145 162 711 823 6.1 7.0 Table 56 Relaxation Classes Clinic Sessions New cases Total attendances Average attendance per session Stonebridge 1956 90 118 520 5.8 1955 95 114 527 5.5 Kilburn 1956 41 62 185 4.5 1955 36 45 138 4.0 Table 57 Infant Welfare Clinics Clinic Sessions First attendances (Under 1 year) Attendances Total attendances Seen by doctor Average attendance per session Under 1 year 1—2 years 2—5 years Kilburn 287 368 5,339 890 439 6,668 3,461 23.2 Willesden 252 401 4,802 681 575 6,058 3,285 24.0 Stonebridge 297 542 6,585 844 726 8,155 3,554 27.4 Cricklewood (Sneyd Road) 102 423 3,107 596 469 4,172 1,469 40.9 Neasden (St. Catherine's) 100 199 3,950 931 390 5,271 1,381 52.7 Kensal Rise (St. Martin's) 103 224 3,588 833 363 4,784 1,668 46.4 South Kilburn (St. Luke's) 102 222 2,564 404 210 3,178 1,615 31.2 Totals: 1956 1,243 2,379 29,935 5,179 3,172 38,286 16,433 30.8 1955 1,269 2,295 28,353 4,287 3,697 36,337 17,069 28.6 41 MIDWIFERY SERVICE Table 58 Midwives Clinics Sessions New Cases Total attendances Average attendance 1956 267 549 2,675 10.0 1955 309 513 3,420 11.1 Table 59 Midwives—Administration of gas and air analgesia Domiciliary midwives employed by local health authority Number of cases in which gas and air was administered by midwives in domiciliary practice during the year: (a) When doctor was not present at deliverv 216 (b) When doctor was present at delivery 48 Number of cases in which pethidine was administered in domiciliary practice during the year: (a) When doctor was not present at delivery 65 (b) When doctor was present at delivery 18 Totals: 1956 347 1955 396 Table 60 Domiciliary Births Attended by midwives Visits Visits made to mothers discharged from hospitals before 14th day Domiciliary cases where infant wholly breast fed at 14th day Dr. not booked Dr. booked Dr. present at delivery Dr. not present at delivery Dr. present at delivery Dr. not present at delivery Mothers Visits 1 113 55 228 11,266 22 111 288 Totals: 1956 327 11,266 22 111 288 1955 326 11,908 47 207 295 Table 61 Medical Aid 1956 1955 (a) 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 53 65 (ii) Others 11 19 Totals 64 84 42 Medical Aid For Mother For Child Retained Placenta 4 Discharging eyes 3 Pyloric Hurosis 1 Septic spots 1 Pyrexia 8 White asphyxia 1 Premature labour 6 Vomiting 1 Uterine Inertia 5 Premature baby 1 Foetal abnormality 1 Post-partum haemorrhage 5 Breech presentation 1 Pain in left calf 1 Ruptured perineum 12 Raised blood pressure 4 Threatened miscarriage 1 Albuminuria 1 Delayed 2nd stage 2 Ruptured membranes 1 Pain in right side 1 Prolonged labour and maternal distress 1 Raised temperature 1 Foetal distress 2 Toxaemia 1 Ante-partum hæmorrhage 1 Totals 57 7 43 HEALTH VISITING Table 62 Visits madf. by Health Visitors Year Expectant Mothers Children under 1 year Children 1—2 years Children 2—5 years Tuberculous Households General Ineffectual visits First Total First Total Total Total Total Total as health visitor Total as school nurse 1956 1,282 1,767 2,649 8,754 3,584 7,388 13 1,152 665 3,143 1955 1,039 1,532 2,479 8,095 4,156 7,877 5 1,122 1,072 3,118 Table 63 Cases referred by General Practitioners for:— Care of children Elderly persons General advice Hospital admission Home help Welfare foods Others Total 1 19 1 2 — — 4 27 44 Table 64 Establishment: Health Visitors Whole time equivalent as at: 31.12.55 31.12.56 Health Visitors (Whole time) 9 14 (Part time) 1 8/11 1 4/11 (Sponsored) 8/11 1 1/11 Clinic Nurses (Whole time) 10 10 Health Assistant (Part time) 2/11 2/11 Totals 21 7/11 26 7/11 HOME NURSING Table 65 Work: Home Nurses New Cases Visits Cases on register at end of year Male Female Male Female Medical 1,159 1,889 93,994 300 585 Surgical 188 344 15,751 31 71 Infectious 14 6 125 1 — Tuberculosis 60 52 5,256 21 23 Maternal complications — 37 352 — 5 Others — — — — — Total 1,421 2,328 353 684 Totals: 1956 3,749 115,478 1,037 1955 4,043 114,199 1,078 Table 66 Establishment: Home Nurses Nurses 1.1.56 31.12.56 Whole time 19 20 Part time 6 5 Candidates 8 8 Total whole time equivalent 27 27 SMALLPOX Table 67 Vaccination Under 1 year 1 year 2—4 years 5—14 years 15 years and over Total Primary Vaccinations 857 101 31 35 105 1,129 Re-vaccinations 1 1 5 43 304 354 Totals: 1956 858 102 36 78 409 1,483 1955 836 135 69 87 439 1,566 Approximate number of children (end of 1956) 0— 5 13,001 5—15 22,044 35,045 45 DIPHTHERIA Table 68 Immunisation Age at 31.12.56 Under 1 1 2 3 4 5—9 10—14 Totals Courses completed (primary or boosting) during last 5 years 1952-56 233 857 1,246 1,110 1,350 4,579 822 10,197 Courses completed (primary or boosting) during the period 1942-52 — — — — — 5,461 11,553 17,014 Approximate number of children (end of 1956) 0— 5 13,001 5—15 22,044 35,045 POLIOMYELITIS Table 69 Inoculations Year of Birth No. registered at 31.3.56 No. received two injections at 31.12.56 No. received one injection at 31.12.56 1947 908 103 1 1948 970 94 6 1949 905 51 6 1950 855 41 6 1951 527 38 6 1952 260 23 4 1953 198 30 1 1954 193 19 4 Totals: 4,816 399 34 HOME HELPS Table 70 Cases: Home Helps Cases receiving help at No. of new cases helped during No. of cases receiving help at 1.1.56 1.1.55 1956 1955 31.12.56 .55 Maternity 2 - 77 85 3 2 Tuberculosis 36 44 14 17 25 36 Chronic sick and aged 494 373 253 284 511 494 Others 64 51 84 130 45 64 Totals 596 493 428 516 584 596 46 Table 71 Staff: Home Helps Position at Appointments during Resignations during Position at 1.1.56 1.1.55 1956 1955 1956 1955 31.12.56 31.12.55 Whole time Part time 2 93 5 84 1 22 2 57 1 31 5 46 2 84 2 93 Total 95 89 23 59 32 51 86 95 DAY NURSERIES Table 72 Day Nurseries: Attendances Day Nursery Approved places Children on register at 31.12.56 Attendances for the year Average daily attendances 0-2 years 2-5 years 0-2 years 2-5 years 0-2 years 2-5 years 0-2 years 2-5 years Chichester Road 18 32 21 37 3,751 7,212 15 28 Crest Road 25 25 22 20 4,818 5,368 19 21 Essex Road 25 25 28 29 5,084 6,168 20 24 Evefield 25 25 16 16 3,295 3,218 13 13 Gladstone Park 25 25 28 22 6,184 4,612 24 18 Longstone Avenue 25 25 25 15 3,753 3,694 15 14 Mortimer Road 25 25 22 25 4,586 5,096 18 20 Villiers Road 25 25 24 24 4,514 5,041 18 20 Wesley Road 15 25 16 22 1,820 4,299 7 17 Totals: 1956 208 232 202 210 37,805 44,708 149 175 1955 208 232 213 240 38,705 49,083 152 193 Table 73 Day Nurseries: Applications Nursery Applications received Children admitted Children left Chichester Road 94 52 49 Crest Road 39 37 46 Essex Road 58 48 43 Evefield 35 34 39 Gladstone Park 61 51 53 Longstone Avenue 61 47 34 Mortimer Road 59 37 44 Villiers Road 78 58 69 Wesley Road 46 26 33 Totals 531 390 410 47 Table 74 Day Nurseries: Priorities Nursery Unsupported Mothers Medical reasons Bad Housing Total on Register Priorities as percentage of total Chichester Road 31 8 15 54 100 Crest Road 15 9 14 40 95 Essex Road 31 15 12 58 100 Evelield 18 7 4 29 100 Gladstone Park 10 16 17 45 95 Longstone Avenue 15 7 13 35 100 Mortimer Road 16 14 10 43 93 Villiers Road 19 13 11 43 100 Wesley Road 10 10 9 29 100 Totals 165 99 105 376 98 Table 75 Day Nurseries: Arrangements made by parents of children unable to afford fee after increase in maximum charge. Mothers gave up work 12 Children cared for by private minders 17 Mothers doing homework 1 Child attending nursery school, private schools and private nurseries 5 Arrangements unknown 9 Total 44 Table 76 Day Nurseries: Assessments Assessment October, 1956 Nil up to 4/- 250 4/3 up to 8/9 75 9/- up to 13/- 51 Total 376 Table 77 Day Nurseries: Infectious Diseases Number of cases Nursery Measles Scarlet Fever Chicken Pox Dysentery Mumps German Measles Whooping Cough Chichester Road — — — 14 4 11 1 Crest Road — — — — — 6 — Essex Road 1 — — 2 — — — Evefield — — 1 — — — 2 Gladstone Park 1 1 — 22 — 9 1 Longstone Avenue — — — — — — 6 Mortimer Road 21 — 1 — — — — Villiers Road 9 — — — — 2 — Wesley Road — — 1 — 1 — — Totals 32 1 3 38 5 28 10 48 Table 78 Day Nursery Staff Establishment Establishment Position as at: 31.12.55 31.12.56 Supervisory Matron 1 1 1 Matrons 9 8 9 Deputy Matrons 9 8 9 Wardens 9 6 6 Nursing Staff 51 56 45 Students 20 14 11 Domestic Staff (part time) 36 35 36 SCHOOL HEALTH SERVICE Table 79 Numbers of Pupils Attending Maintained Primary and Secondary Schools who were Medically Inspected Periodic age groups Additional periodic inspections Other inspections Entrants Age 10 & 11 years Leavers Totals Special inspections Re- inspections Totals 1956 2,108 2,082 2,135 4,217 2,418 6,926 1,936 1955 1,853 2,008 2,104 4,112 2,953 10,596 1,691 Table 80 Pupils Found to Require Treatment Periodic age groups inspected For defective vision (excluding squint) For any of the other conditions in Table 82 Total individual pupils Entrants 21 187 206 Age 10 and 11 years 116 155 258 Leavers 116 148 259 Total 253 490 723 Additional periodic inspections 131 183 311 Grand Total 384 673 1,034 Table 81 Classification of the Physical Condition of Pupils Periodic age groups inspected Number of pupils inspected Satisfactory Unsatisfactory Number % of column (2) Number % of column (2) Entrants 2,108 2,012 95.5 96 4.5 Age 10 & 11 years 2,082 2,028 97.4 54 2.6 Leavers 2,135 1,980 92.7 155 7.3 Additional periodic inspections 2,418 2,314 95.7 104 4.3 Total 8,743 8,334 95.3 409 4.7 49 Table 82 Defects Found by Medical Inspection Defect or disease Periodic inspections Entrants Leavers Total —including all other age groups inspected Special inspections (a) (b) (a) (b) (a) (b) (a) (b) Skin 13 34 18 30 53 137 198 64 Eyes (a) Vision 21 29 117 71 384 432 44 18 (b) Squint 13 47 1 12 34 126 4 2 (c) Other 10 14 4 5 28 33 99 38 Ears (a) Hearing 4 23 4 6 20 73 24 12 (b) Otitis media 4 35 3 8 13 84 2 5 (c) Other 1 5 1 2 6 21 38 23 Nose and throat 62 262 9 22 146 504 112 29 Speech 32 49 4 5 54 95 65 6 Lymphatic glands 14 88 — 12 24 149 3 9 Heart 1 35 2 7 4 87 1 1 Lungs 4 82 1 13 12 187 14 3 Developmental (a) Hernia 2 8 1 1 7 22 — — (b) Other 3 50 3 13 20 188 35 4 Orthopaedic (a) Posture 7 28 32 27 69 160 3 1 (b) Feet 9 47 13 22 50 178 2 1 (c) Other 14 72 43 33 99 229 36 36 Nervous system (a) Epilepsy 1 10 — 1 1 17 1 — (b) Other 2 9 — 5 2 40 4 3 Psychological (a) Development — 27 1 13 11 105 10 2 (b) Stability 1 111 — 35 5 297 19 20 Abdomen 1 6 6 3 11 25 4 2 Other 162 34 100 24 511 179 838 39 Totals 381 1,105 363 370 1,564 3,368 1,556 318 * (a) Requiring treatment (b) Requiring observation. 50 Table 83 Treatments: school health service Number of cases known to have been dealt with (i) Eye Diseases, Defective Vision and Squint (a) External and other, excluding errors of refraction and squint 81 (b) Errors of refraction (including squint) 1,324 Totals 1956 1,405 1955 1,308 (c) Number of pupils for whom spectacles spectacles were prescribed 1956 589 1955 637 (ii) Diseases and Defects of Ear, Nose and Throat Received operative treatment for: (a) diseases of the ear 1 (b) adenoids and chronic tonsillitis 215 (c) other nose and throat conditions 23 Received other forms of treatment 119 Totals 1956 358 1955 283 Total number of pupils in schools who are known to have been provided with hearing aids: (a) during the current year 1 (b) in previous years (excluding any pupils shown at (a) above who were provided with an aid in the previous year) 5 (iii) Orthopaedic and Postural Defects Number of pupils known to have been treated at clinics or at out-patient departments 1956 918 1955 823 (iv) Diseases of the Skin (Excluding Uncleanliness) Ringworm (i) Scalp — (ii) Body — Scabies 9 Impetigo 75 Other skin diseases 376 Total 1956 460 1955 418 (v) Child Guidance Treatment Number of pupils treated at child guidance clinics under arrangements made by the County Council (including children sent to the Tavistock and other hospital clinics under arrangements made by the County Council) 176 (vi) Speech Therapy Number of pupils treated by speech therapists under arrangements made by the authority 1956 361 1955 345 (vii ) Other Treatment Given (a) Number of miscellaneous minor ailments treated by the County Council 1,046 (b) Treatment other than (a) above and excluding convalescent treatment: 1. Lymphatic glands 4 2. Heart — 3. Lungs 81 4. Developmental (a) Hernia — (b) Other — 5. Nervous system (a) Epilepsy — (b) Other — 6. Psychological (a) Development — (b) Stability 41 7. Abdomen — 8. Other 12 Totals 1956 1,184 1955 1,538 51 Table 84 Pupils found at periodic medical inspection who have undergone tonsillectomy Periodic age group inspected Number of pupils inspected Number who have undergone tonsillectomy at any time Percentage of those inspected found to have had tonsillectomy Boys Girls Boys Girls Boys Girls Entrants 389 395 55 47 14.1 11.9 Age 10 and 11 years 424 318 38 89 32.5 28.0 Leavers 50 97 19 24 38.0 39.2 Other periodic inspections (by age group) 7—8 302 339 81 66 21.8 19.5 12—13 21 73 4 22 19.0 30.1 Totals 1,186 1,222 297 248 25.0 20.3 Table 85 Orthoptics—Cases seen at Willesden Health Clinic (a) Cases seen No. treated Placed on operation waiting list No treatment required Failed to attend Total 47 — 2 — 49 (b) Cases treated Discharged cured Operation waiting list Observation Ceased to attend 28 (23 orthoptic) 8 39 8 ( 5 cosmetic) Table 86 Audiometry : Children Tested Total tested Absentees Failure Total Both ears One ear L. R. 3,231 188 17 21 25 63 Table 87 Summary of Failures to pass Audiometer Test Passed at second test 4 Referred to Assistant Medical Officers 59 Normal Hearing after Removal of wax 6 Under observation by hospital or private doctor 11 No action—further test recommended after given period 10 Referred for Tonsils and Adenoids operation 5 Appointments not accepted 11 Referred by A.M.O.'s to Ear, Nose and Throat Specialist 16 Treatment considered of little value 9 Referred to hospital 2 Hearing improved after treatment 2 Recommended for Hearing Aid 1 Awaiting appointments 2 52 Table 88 Speech Therapy Clinic or School No. of cases dealt with during the year Kilburn clinic 151 Willesden clinic 63 Stonebridge clinic 107 Lower Place special school for physically handicapped pupils 29 Leinster special school for educationally subnormal pupils 15 Totals 1956 365 1955 345 Table 89 Infestation with Vermin 1956 1955 Total no. of examinations 34,611 33,376 Total no. of individual pupils found to be infested for the first time during the current year 701 417 Number of individual pupils in respect of whom cleansing notices were issued under section 54/2 Education Act, 1944 149 38 Number of individual pupils in respect of whom cleansing notices were issued under section 54/3 Education Act, 1944 21 — Table 90 Employment of Children and Young Persons 1956 1955 No. of children medically examined in order to ascertain whether they were physically fit to undertake employment of a light nature outside school hours 193 288 No. of instances in which the state of health was found to be such that certificates were withheld 1 No. of children examined as to fitness to take part in entertainments 10 22 No. of cases in which certificates to take part in entertainments were withheld 1 — Table 91 Medical Examination of Teachers 1956 1955 No. of teachers examined as to fitness for appointment 2 9 No. of students examined as to fitness for first appointment 43 36 No. of students examined as to fitness to undertake training course 46 49 53 Table 92 Return of Handicapped Pupils (Year Ended 31st December, 1956) Ascertainment Distribution (as at last day of Year) Category No. of ascertained cases known 1st day of Year No. of New Cases ascertained during year No. of ascertained Cases known last day of Year In Special Day Schools In Special Residential Schools In Maintained Primary and Secy. 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 1 1 — 1 — 2 — — — 2 — — — — — — — 2 Partially-Sighted Pupils 13 9 1 3 13 9 12 7 1 2 — — — — — — 10 9 Deaf Pupils 8 6 — 2 10 6 7 2 3 4 — — — — — — 2 6 Partially Deaf Pupils 5 3 1 — 2 3 1 — — 2 — — — — 1 1 10 3 Delicate Pupils 43 37 27 20 45 25 7 4 38 21 — — — — — — 45 25 Diabetic Pupils Educ. Sub-normal Pupils 70 58 14 13 74 56 53 40 11 12 10 4 — — — — 74 56 Epileptic Pupils 3 1 — — 3 1 — — 3 1 — — — — — — 3 1 Maladjusted Pupils 45 11 17 1 50 12 — — 41 11 8 — — — 1 1 50 12 Physically Handicapped Pupils 33 19 6 1 30 24 25 23 4 1 — — — — 1 — 30 24 Pupils with Speech Defects 302 89 78 41 307 97 — — — — 289 91 — — 18 6 307 97 Pupils with Multiple Defects 31 19 4 1 31 21 31 20 — — — — — — — 1 31 21 Total 554 253 148 83 565 256 136 96 101 56 307 95 — — 21 9 565 256 Grand Totals 1956 807 231 821 232 157 402 — 30 821 1955 880 302 807 211 174 390 2 30 807 54 Table 93 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 31.12.56 Leinster Special School for Educationally Sub-Normal Pupils Willesden 23 10 18 Ealing 7 6 15 Totals 30 16 33 Lower Place Special School for Physically Handicapped Pupils Willesden 7 7 Wembley 7 8 — Harrow 4 4 — Ealing 3 3 — Acton 3 3 — Hendon 5 5 — Totals 29 30 — Table 94 The Educational Sub-Normal Education Act, 1944 — Sections 57 (3), 57 (4) and 57 (5) 1956 1955 Cases dealt with under section 57, Education Act, 1944:— Sub-Section 3 10 10 Sub-Section 4 — — Sub-Section 5 20 26 Cases de-notified under section 8, Education (Miscellaneous Provisions) Act, 1948 1 1 CHILD GUIDANCE Table 95 Waiting list at 1.1.56 Total No. of cases seen New cases seen New cases referred Waiting list at 31.12.56 62 145 96 114 81 Table 96 Main symptoms Cases Aggressive behaviour 6 Anxiety—including night-terrors 12 Enuresis 12 Failure to progress at school 9 Habits, e.g., tics, thumb-sucking 4 Psychosomatic disorders 9 Psychotic features 6 Soiling 3 Speech difficulties 8 Stealing 19 Truancy and wandering 8 96 55 RHEUMATISM Table 97 Clinic—Attendances (Figures in brackets were those found to be suffering from disease) Total attendances History of rheumatism Dampness reported in home Children from Social Groups IV and V 46 (25) 15 (9) 16(12) 37 (17) Table 98 Rheumatism Treatment Sent for convalescence 4 Sent to special school for physically handicapped 1 Referred to dental clinic I Referred to eye clinic 1 Referred to orthopaedic clinic 3 Referred to specialist 10 Reports requested from hospitals 7 Medicaments and vitamins given 8 Referred to Medical Officer of Health 16 SCHOOL DENTAL SERVICE Table 99 Inspection and Treatment (a) Inspection Age Groups Inspected Required Treatment Referred for Treatment 1956 1955 1956 1955 1956 1955 Under 5 70 28 32 17 32 16 5—16 17,619 13,386 12,276 9,784 10,103 8,548 Specials 1,607 1.937 1,491 1,842 1,460 1,829 Total 19,296 15,351 13,799 11,643 11,595 10,393 (b) Treatment 1956 1955 No. of pupils actually treated: 5,898 5,469 No. of attendances 16,577 14,966 No. of half-days of Inspection 207½ 190 Treatment 2,279½ 2,221½ No. of fillings: (a) Permanent teeth 9,887 7.650 (b) Temporary teeth 4,582 4,937 No. of extractions of: (a) Permanent teeth 706 611 (b) Teeth for orthodontia 306 252 (c) Temporary teeth 4,058 4,568 No. of anaesthetics: (a) General 2,110 2,272 (b) Local 946 364 No. of other operations 7,037 6,178 56 PRIORITY DENTAL SERVICE Table 100 Expectant Mothers Nursing Mothers Children under 5 1956 1955 1956 1955 1956 1955 Number examined 220 244 78 71 849* 807 Number required treatment 212 241 76 70 574 623 Number of new cases commenced treatment 215 215 106 97 523 554 Dentally fit 68 87 52 51 365 429 Extractions 262 251 171 142 342 521 Fillings 647 564 264 177 874 1,035 Scaling and gum treatment 132 158 52 56 — — Silver nitrate — — — — 681 716 Dentures 23 37 52 50 — — Number of attendances 819 827 475 399 1,161 1,431 Number of appointments not kept 167 170 58 56 165 174 *including 377 at day nurseries CHIROPODY Table 101 Patients Seen Expectant and Nursing Mothers Boys Girls 0—5 yrs. School Total 0—5 yrs. School Total First attendances 43 16 69 85 8 127 135 Re-attendances 126 41 369 410 16 811 827 Table 102 Chiropody—Defects Expectant and Nursing Mothers Boys Girls Warts on Hands and Knees 1 11 11 Corns 26 19 37 Hallux Valgus — — 3 Varrucae — 33 67 Onychocryptosis — 1 2 Onychogryphosis 5 7 10 Hallux Rigidus 1 — — Blisters — — 2 Chilblains — 1 — Callosities 10 5 1 Advice — 1 5 Bursitis — — 1 Tinea — 1 1 Totals 43 79 140 DEANER PRINTERS LTD.(T.U.) LONDON