AC.439(1)WILLESDEN WIL 53 Borough of Willesden 1957 THE 82nd ANNUAL HEALTH REPORT S. LEFF, M.D., D.P.H., Barrister-at-Law, Medical Officer of Health CONTENTS Page Aged—care of 14 Laundry service 14 Voluntary services 14 Bacteriological examinations 5 Basement bakehouses 13 Bombed sites 11 Bronchitis Morbidity and mortality 7 Cancer of the lung Morbidity and mortality 7 Prevention and diagnosis 7 Treatment 8 Census 1951—household arrangements 8 Child guidance 21 Chiropody 22 Clean air 10 Common lodging houses 15 Coroner's court 15 Day nurseries 19 Dental service 22 Disinfestation 11 Diphtheria immunisation 19 Factories 13 Food Contaminated food 12 Education in food hygiene 12 Food poisoning 12 Improvements in premises 11 Registration of premises 11 Sampling 12 Unsound food 12 Hawkers—licensing of 15 Health education 5 Health visiting 18 Home safety 22 Home help service 19 Home nursing 18 Hospitals Facilities 16 Liaison 16 Household arrangements 8 Housing Closing orders 9 Defects Demolition orders 9 Housing Repairs and Rents Act 1954 and Rent Act, 1957 10 New dwellings 10 Notices served 10 Overcrowding 10 Slum clearance 9 Ice cream 5 Infant mortality 4 Infectious diseases Asian influenza 6 Dysentery 6 Food poisoning 6 Page Infectious diseases (cont'd) Poliomyelitis 6 Puerperal pyrexia 6 Whooping cough 6 Laboratory service 5 Massage and special treatment establishments 5 Maternity and child welfare Ante-natal care 16 Clinics 17 Medical examination of staff 16 Midwifery service 17 Milk and dairies 13 Mortuary 15 National Assistance Act, 1948 Burials 15 Removal to hospitals 14 Noise 13 Occupational health services 13 Outworkers and homeworkers 13 Pet Animals Act, 1951 16 Poliomyelitis innoculation 19 Prematurity 4 Public Health Laboratory Service 5 Rag, Flock and Other Filling Materials Act, 1951 16 Recuperative holiday homes 20 Refuse disposal 8 Rheumatism 22 Rodent control 11 Sanitary circumstances 8 Scabies 5 School health service Audiometry 21 Medical inspections 20 Special schools 21 Slaughterhouses 15 Smallpox vaccination 19 Staff Medical examinations 16 Sanitary section 9 Swimming baths 9 Tuberculosis B.C.G. Vaccination 8 Co-operation Factories and workshops 8 Morbidity and mortality 7 Vermin H Vital statistics Births Deaths Population 3 Welfare foods 18 BOROUGH OF WILLESDEN Health Department, 54, Winchester Avenue, Kilburn, London, N.W.6. July, 1958. To the Mayor, Aldermen and Councillors of the Borough of Willesden. Mr. Mayor, Ladies and Gentlemen, I beg to submit the annual report on the health and sanitary circumstances of the borough for the year 1957. There has been a slight reduction in the population, but overcrowding in the borough is probably as serious as ever. There is a continual shift in population and the tendency is for large families to come to live in the borough, with consequent difficulties in housing accommodation. The birth rate has shown another rise, but even so, there were fewer mothers delivered at home because still more (about nine out of ten) were delivered in institutions. The general death rate shows a slight decrease, and there is a further welcome reduction in the infant mortality rate. The stillbirth rate, however, remains approximately the same. Although prematurity is no longer responsible for so many infant deaths it still accounts for a large number and for many stillbirths. There were many more premature births in the worst wards and, in general, these wards showed an infant mortality rate more than double that of the best wards. In particular, some of the obvious preventable deaths came from the lower social classes. Maternal mortality is no longer a serious problem in the area. However, maternal complications are still prevalent and special preventive measures are taken. For example, doctors and midwives are well aware of the dangers of toxaemia, and mothers are encouraged to report the early symptoms immediately. Coronary disease still plays a large part in the death rate but there is no simple solution at present. It is unlikely that the reduction of fats in the diet would have any appreciable effect on the incidence of this disease. Respiratory diseases are the next group in importance, and in recent years there has been a complete reversal in the significance of cancer of the lung as compared with tuberculosis. This year the deaths from cancer of the lung were more than eight times those from tuberculosis. For the first time no female in the borough died of tuberculosis. Bronchitis still causes more deaths than cancer of the lung. Both bronchitis and cancer of the lung can be largely prevented. The answer lies in reduction of smoking from our chimneys, both industrial and domestic, and in giving up the smoking of cigarettes. The Council has been very active in the reduction of atmospheric pollution and the Minister has confirmed its first smokeless zone in Neasden. However, the Clean Air Act has many omissions and weaknesses and it is unlikely, by itself, to contribute much to a reduction in respiratory diseases. It is, however, a start, and the Council has taken the opportunity of intensifying their campaign for the reduction of smoke and dust emitted into the air. Health education for reducing the habit of cigarette smoking has been extended in the schools and factories. It is felt, however, that the main success will come from dealing with the young, rather than the old. It should be the responsibility of parents and teachers, as well as doctors, to ensure that school children do not accept the risk of cancer of the lung lightly by starting to smoke early in their lives. A new danger is the increase in radiation in the atmosphere, and it is advisable to have monitoring sites now, so that comparisons can be made to assess how this hazard develops in the future. Tuberculosis is becoming much less of a problem in the area. There are still marked differences between the various wards, and it is clear that housing, particularly overcrowding, and general social conditions still have an important effect in this disease. The rates in the worst wards are at least double those in the best ones. School leavers are still being vaccinated with B.C.G., and it is probable that this preventive measure is now helping materially to reduce the incidence of the disease. During the year, a factory survey was conducted by the Mass X-ray Unit and discovered 15 new cases of tuberculosis, three being Willesden residents. Other factories were also visited to X-ray contacts of infective cases. Many talks have been given on this subject, both in schools and in factories, so that the public are not only being made aware of the problems involved, but are helping to solve them. There were no serious outbreaks of infectious diseases during the year, and there was a most welcome marked reduction in the number of cases of dysentery, which was less than one-tenth of the previous year. There were a few more cases of poliomyelitis compared with the previous year, and two deaths, but there was no outbreak. There was an extension of the groups eligible for poliomyelitis vaccination, and many more children were done. It is too early to judge the results of vaccination, but now that we have a safe and effective vaccine it is more than likely that this disease, like tuberculosis, will soon be conquered. Asian influenza came to Willesden in September, and seriously affected several schools and factories in the borough. However, the disease was relatively mild, and there was no significant increase in deaths from influenza or other related diseases. Influenza vaccine was offered to health workers, but it arrived too late to have any marked effect in protecting them. Many talks were given to factory staffs on the subject, which helped to allay the general anxiety. Housing still remains the most important work of the department on the environmental side. Slum clearance surveys were carried out in three areas in South Kilburn, and the Minister confirmed the Willesden Lane Compulsory Purchase Order after a public inquiry had been held earlier in the year. Surveys were also started in the Holly Lane/Mayo Road Slum Clearance Area, and for the proposed Stonebridge Redevelopment Area. The Rent Act increased the burden of work of the Public Health Inspectors but contributed little to raising the standards of accommodation in the borough. Much work has been done in the department in promoting clean food. There was a small outbreak of food poisoning in a private school, and this illustrated once again how easy it is for infection to spread if simple precautions are not taken. The public are co-operating in bringing samples of contaminated food to the department. The occupational health service for borough council employees has made considerable progress in improving conditions of work, and medical advice has been given to employees suffering from disability or chronic illness. During the year, the survey of old people was completed. In general, there has been an extension of the many services for old people. The laundry service has been a real boon to them and their relatives. It is regretted that a chiropody service cannot yet be established for them. However, during the coming year the Council have many useful plans for improving the conditions of old people. Many voluntary workers have again helped the department immeasurably and the thanks of all health workers and councillors are extended to them. During the year, new diabetic and multiple sclerosis branches were established in Willesden, and many voluntary workers participated in the campaign for home safety, and in providing services for old people. Once again, 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 part 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, 1957 174,100 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, 1957) £2,797,033 General rate in the pound for the year 1957/58 16s. 4d. Product of a penny rate (estimated) £11,300 VITAL STATISTICS Registered Live Births: Male Female Total Willesden Borough Council Legitimate 1,307 1,285 2,592 Rate per 1,000 (live and still) resident population Illegitimate 154 130 284 Total 1,461 1,415 2,876 16.5 Rate per 1 ,000 (live a births nd still) Registered Stillbirths: 28 35 63 21.4 Death rate per 1,000 estimated resident population Deaths: 897 797 1,694 9.7 Death rate of infants under one year of age: All infants per 1,000 live births 16.7 Legitimate infants per 1,000 legitimate live births 16.6 Illegitimate infants per 1,000 illegitimate live births 17.6 Death rate of infants under four weeks of age: All infants per 1,000 live births 11.8 Legitimate infants per 1,000 legitimate live births 11-6 Illegitimate infants per 1,000 illegitimate live births 141 Maternal mortality: Deaths from puerperal causes- Puerperal sepsis 1 Other puerperal causes Other maternal causes 1 Maternity mortality rate •68 per 1,000 live and still births. Deaths from: Males Females Total Cancer (all ages) 233 172 405 Measles (all ages) — — — Whooping cough (all ages) — 1 1 Diarrhoea (under 2 years of age) — — — 4 Births There was an increase in the birth rate for 1957, and it is now a little above that of England and Wales. Deaths There was a slight decrease in the death rate for 1957, 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 1957 was less than that for England and Wales and for the previous year (Table 2). Compared with before the war the lives of at least one hundred babies are saved annually. A much lower figure was attained in the better wards; the rates in the three worst wards, Kilburn, Kensal Rise and Roundwood, were more than double those of the three best wards, Brentwater, Brondesbury Park and Church End. Improvements in the social conditions in the worst wards would help to reduce the mortality (Table 3). 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 4). An even better picture for comparison 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 1957 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 malformation could be eliminated. (a) Prematurity There has been a marked decline in the number of deaths from prematurity (Table 5), but it still contributed 10% to the total and with atelectasis was associated as a cause of death in another 17% (Table 4): it also was responsible for half the stillbirths. The causes of prematurity are not fully understood, but unsatisfactory living conditions, poor maternal health and illegitimacy accounted for some, and complications of pregnancy (maternal toxaemia, placenta praevia and birth injury) for some of the others. There were many more premature births in the worst wards than in the best wards (Table 6). (b) Congenital malformations (Tables 4 and 7) There were fewer deaths from congenital malformations. There is still a proportionately high number who die from this cause because of the further reduction in the general infant mortality. Radioactivity in the form of ingestion of radioactive dust or exposure to excessive X-rays are thought to contribute to the development of malformations. Preventive measures are taken to remove another cause of congenital malformation: arrangements are made to reduce the contact made by expectant mothers in the first three months of pregnancy 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 marked 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 8). Overcrowding is responsible for most of the infant deaths from respiratory infections. One infant, not immunised, died of whooping cough; this illustrates the need for all children to be immunised against whooping cough as well as diphtheria as early as possible. 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 50% of these were attributable to atelectasis, most of them associated with prematurity. One infant died from inhalation of vomit. The health visitors are continually giving advice on how to avoid such unfortunate incidents. One infant died from neglect at birth and was found in the street unidentified. 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. The National Birthday Trust Fund are conducting a survey into the causes of perinatal mortality. 5 GENERAL PROVISION OF HEALTH SERVICES Public Health Laboratory Service (Table 9) 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 Services at the Central Public Health Laboratory, Colindale, and at the branch laboratory in Neasden Hospital. Specimens delivered by doctors to the Health Department, the Health Clinics (or the branch laboratories in Neasden Hospital) 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. Four of the Grade 4 ice cream samples were manufactured in premises in a neighbouring borough ; the Medical Officer of Health was notified so that he could investigate the methods of manufacture. The fifth Grade 4 sample was manufactured in the borough from a cold mix. The methods of manufacture were investigated and suggestions were made for improvement. Three subsequent samples were Grade 1. Seven of the unsatisfactory samples of water came from the paddling pool at King Edward VII Park. Some improvement has resulted from modifications to the filter plant so that the water now flows continuously through the purification and chlorination plant of the nearby swimming bath. However, sand from the sandpit carried into the paddling pool still produces problems. New outlets will be provided in 1958 to make the cleansing of the pool more efficient. The remaining four unsatisfactory samples of water were taken from two swimming baths and two were due to a mechanical fault in the chlorinator and two to a mechanical fault in the filter, which were speedily repaired. Uncleanliness and scabies (Table 10) As compared with 1956 there has been a decrease in the number of children treated for scabies, but an increase in the number of adults treated. There has also been an increase in the number of children treated for lice and nits, but a decrease in the number of adults treated. However, the numbers treated are still small and there is no evidence of 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, 4 new licences were issued and 23 were renewed. Exemption from licensing was claimed in one case under the Act for a registered member of the Chartered Society of Physiotherapy. All the applicants are suitable persons to hold licences, and their premises were 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 practice 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 11). 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 doctors, midwives and nurses give many talks, some illustrated with filmstrips. These talks are most useful in helping mothers to care for themselves and their babies. Health visitors also give more specific individual health education in the mothers' homes during their routine visits (Table 12). Mothers' clubs held at the Kilburn and Stonebridge Health Clinics have been successful and much appreciated. 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 in keeping 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. 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 11) and they were well attended. 6 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 very useful (Table 11). To improve the efficiency of the home help service three series of five talks, together with a brains trust, were given to home helps. The talks dealt with hygiene in the home, diet and shopping, care of the sick, care of mothers and children, accidents and emergencies. The Chairman of the Home Safety Committee gave talks on Accidents in the Home to religious and social organisations (see page 22). During February and March a diphtheria immunisation campaign was held: the subject was introduced into mothercraft classes; posters were displayed at clinics, day nurseries, libraries, swimming baths, police stations, public conveniences, shops, factories, churches, and poster sites ; films were shown at two cinemas and slides at a third : a circular letter was sent to general practitioners : and advertisements were inserted in the local papers. 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. 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 a reflection mainly 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 notified and confirmed cases, and deaths from various diseases for 1956 and 1957 is shown in Table 13. Whooping cough (table 14) The incidence of whooping cough rose slightly in 1957 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). There was one death in a child of 10 months, associated with convulsions and broncho-pneumonia. Poliomyelitis In marked contrast with 1955, there was no outbreak in 1957 (Table 15). There were 2 deaths ; a girl aged 12 who died from encephalomyelitis, and a boy aged 5 years who died from polio-encephalomyelitis associated with toxaemia, cerebral oedema and cranial vein thrombosis. Dysentery There was a marked decrease in the number of cases of dysentery notified, compared with the previous year (see Table 13), yet in the country generally the disease was much more prevalent than before the war. It is usually a mild disease, causing no deaths, but can cause some disruption and discomfort in the life of the community. The only outbreak during the year occurred at the hostel for homeless families, 91, Dartmouth Road, on the 17th December. 28 mothers and children were affected, 12 with mild symptoms. Four children were admitted to Neasden Hospital. The hostel was in quarantine for two months, the outbreak taking some time to clear up. because of the overcrowded conditions and unsatisfactory washing accommodation. Food poisoning There was one outbreak of food poisoning in a private school (see page 12). A man aged 71 years died from acute bronchitis caused by salmonella typhi-murium ; the coroner held an inquest and the death was recorded as due to misadventure. The source of the infection was not traced. 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'. There was a slight increase in the number of cases in 1957, but no outbreak occurred in any institution. Asian Influenza In the early part of the year extensive outbreaks of influena occurred in several countries of the Far East. The virus responsible for the epidemics belonged to Influenza A. Group, but the strain isolated was different from that of past outbreaks. As most population groups had not previously been in contact with this type of virus, they has acquired no immunity, and the disease spread rapidly through Asia and Europe, reaching the British Isles in the late summer. 7 The epidemic appeared in Willesden about the third week in September. On the 23rd September, four schools reported absentee rates of more than 20 per cent.—42 per cent, of 320 pupils ; 32 per cent, of 311 ; 24 per cent, of 494 ; 21 per cent, of 427. The local office of the Ministry of Pensions and National Insurance reported that sickness claims received during the week ending 24th September, 1957, showed an increase of 30 per cent, on the figure for the previous week. It was difficult to ascertain precisely how many children were away because of influenza, but according to reports and messages reaching head teachers the majority of the children has symptoms of influenza. The disease reached its peak during the week ending 14th October, 1957, when 17 schools were affected ; of the total of 7,714 pupils involved, 1,672 or 22 per cent, were absent, the majority with influenza symptoms. Thereafter, attendances continued to improve and were back to normal after the half-term holiday on the 29th October. Unfortunately there is no precise information on the absentee rate of workers from factories, but the experience of influenza in those visited varied considerably. The Medical Officer gave 46 talks on Asian influenza to factory staffs during lunch-hour breaks, and more than 3,500 workers attended the talks. During the outbreak there was no significant increase in the number of notifications of acute primary or influenza pneumonia or deaths from influenza, influenzal pneumonia or broncho-pneumonia. Vaccination was offered to general practitioners, home nurses, ambulance staff and other health workers likely to come in contact with cases of influenza, but the material for vaccination arrived too late to have any appreciable effect in protecting health workers. Fortunately absenteeism among them was not at any time so high as to require special emergency arrangements. BRONCHITIS. CANCER OF THE LUNG. AND TUBERCULOSIS It has become increasingly clear of recent years that the more serious respiratory diseases must be considered together rather than separately. Common causes are at work ; for lungs already damaged may have a lowered resistance to infection or worse still to cancer. The major common factor is the exposure of lungs to smoke, from cigarettes and the atmosphere. Evidence for this has been accumulated over the last few years, particularly for cancer of the lung and also to a less extent for bronchitis and tuberculosis. The attack on tuberculosis has been very successful chiefly because of the wide use of new effective drugs. Not so with cancer of the lung where treatment is rarely successful except in the very earliest stages of the illness, and because cigarette smoking is still popular and widespread. Over the last ten years bronchitis and cancer of the lung have steadily assumed increasing importance as tuberculosis has declined (Tables 17. 18 and 19). In Willesden in 1957 the death rate from cancer of the lung was eight times that from tuberculosis. Early diagnosis of chest illness is still essential if treatment is to be effective, but a change in social habits is necessary if we are to eliminate these killing diseases. Health education and social reform can also help. Young people have been given talks on the major chest diseases and in particular on the dangers to health and life from smoking cigarettes. Mortality and morbidity For the first time there have been no deaths from tuberculosis among women (Table 20): 13 deaths occurred in men over the age of 35, 4 of these in elderly men not previously known to have tuberculosis (Table 20). There has been a rise in notifications of tuberculosis (Table 16) compared with last year but too much significance should not be attached to them as the overall figures are small. It does, however, indicate that tuberculosis has not yet been defeated. There has been a wide fluctuation in the deaths from bronchitis (Table 18) over the years with no apparent trend. Smoke has probably played an important part and was certainly responsible for the high peaks in 1952 and 1953 following the severe fog which caused 4,000 deaths in London during the winter. The sex difference in the numbers of deaths probably relates to the heavier smoking habits of middle-aged and elderly men and to a lesser extent to conditions of dust and smoke at work (Table 18). The most startling and tragic figures of all are found for deaths from cancer of the lung (Table 19). The death rate has more than doubled in the last 11 years, and there is a more marked sex difference: for every woman, six men died from lung cancer. Most of these cancers occurred in men over 45 years of age when they had already smoked enough cigarettes to produce the cancer. Prevention and diagnosis To prevent chest disease it is clear we must deal with smoke from cigarettes and the atmosphere. Measurement of smoke and other impurities in the air continues, and small improvements have been noted around power stations. It is hoped that the new Clean Air Act will encourage further improvements in the future. Some fifteen to twenty years of smoking is normally required before a cancer develops, but it is advisable to take no risk at all and therefore talks have been given to school children in their early teens when the environment to start smoking is favourable and the temptation becomes strong. Visual aids are also used to explain clearly the relationship between smoking and respiratory disease. It is hoped by these means to prevent young people smoking before the habit becomes difficult to break. Bronchitis cannot be diagnosed radiographically but X-ray surveys continue to play an important role in discovering early cases of tuberculosis and cancer. The combined efforts of Chest Clinic, Static X-ray units, general practitioners and the public health department ensure that most of the suspected cases are X-rayed early. 8 Treatment The treatment of cancer of the lung may still be said to be in its infancy, and hospital admission is therefore needed for nearly every case. There is no shortage of hospital beds at present notwithstanding the increasing number of cases, because fewer beds are now needed for tuberculosis. Beds for bronchitis sufferers are now also being provided at the sanatoria. Tuberculosis. Tuberculosis creates a special problem because of its infectious nature: nearly a third of the deaths occurred in elderly men previously unknown to the health authorities. They obviously form a small but significant minority of the population difficult to discover before others have been infected. In view of this "hard core" of tuberculosis infection, B.C.G. vaccination remains an important preventive measure offered to all school-leavers to raise their resistance to infection, very necessary during adolescence when the risk of infection is higher and many new stresses have to be faced. Approximately the same number of children (Table 24) have been tuberculin tested as in recent previous years and again about 80 per cent, were found to need B.C.G., and of these 92 per cent, accepted vaccination. Tuberculin testing of the younger children also continued and the results appear in Table 23. The proportion reacting remained about the same but over the years there has been a marked decline in school children, particularly entrants. This reflects the general decline in incidence. It also demonstrates that whereas in 1953 children generally came in contact with infection before they entered school, today most of the positives do so during their school life. Factories and workshops A factory survey was carried out in the borough by Mass X-ray Unit 5A. Meetings were held between the Medical Officer and his staff and the Physician-in-Charge of the Unit to discuss the programme and assistance to be given by the department. Lists of factories, the number of workers employed and a map showing the location of the large factories were provided. The Medical Officer gave 39 talks to factory staffs during lunch hour breaks to encourage attendance and answer questions. From January to May, the Unit visited 17 sites and examined 7,415 workers from 84 factories. Fifteen cases of tuberculosis were discovered, three of them being Willesden residents. They were referred to the Chest Clinic and are now receiving treatment. The remainder were referred to Chest Clinics in the districts where they lived. In addition to the above, 3 factories were visited by the Medical Officer and 173 immediate contacts of active cases were encouraged to attend for examination. Three cases with abnormalities were found and referred to the Chest Clinic for further investigation and treatment. Four factories were re-visited at six monthly intervals to encourage contacts of old cases to re-attend for examination. Sixty-four workers attended and they were all found to be satisfactory. Several cases were referred to the Government Training Centre at Perivale, and those who passed the course were found employment. C o-operation At the request of the Chest Physician special visits have been paid by the Medical Officer and his deputy to the homes of cases who failed to report for regular treatment. All their visits have been successful and treatment has been resumed. The need for integration of all services provided by Chest Physician, Medical Officer of Health, Welfare Officers, Disablement Resettlement Officer and Home Visitors is self-evident when dealing with diseases having such wide social implications as tuberculosis, bronchitis and cancer. The closest co-operation between all services for the patients and their families has continued throughout the year. 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 report for 1956). 9 (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 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 125 samples were taken, 4 of which were unsatisfactory (see Public Health Laboratory Service, page 5). Swimming bath Samples taken Satisfactory Unsatisfactory Granville Road 56 56 — Gladstone Park 34 32 2 King Edward's Park 35 33 2 SANITARY SECTION Staff The 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. Mr. C. G. Rothwell, Deputy Chief Public Health Inspector, was appointed Chief Inspector following the retirement of Mr. F. Taylor in November, 1956, and Mr. J. Mains, Area Public Health Inspector, Paddington, was appointed to fill the resultant vacancy. At the beginning of the year there were two vacancies for district Inspectors. There were two resignations and one retirement during the year. Three appointments were made, leaving two vacancies at the end of the year. Three Pupil Public Health Inspectors were on the staff at the beginning of the year. They qualified, received their certificates and were appointed to Willesden. Two new pupils were appointed, leaving three 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 majority of houses inspected during the year followed complaints from tenants; there was no systematic house-to-house inspection. Unfortunately many tenants contact the Public Health Department only when the defects are serious and costly to remedy. Demolition and Closing Orders Housing Act, 1957 Details of demolition and closing orders made under the above Act are shown in table 26. Slum Clearance Slum clearance surveys were carried out in three areas in South Kilburn: one with 155 properties in Albert, Denmark and Canterbury Roads, another with 52 premises in a triangular area bounded by parts of Canterbury and Peel Roads and Carlton Vale, and a third with 5 houses in Cambridge Avenue. The Minister of Housing and Local Government confirmed the Willesden Lane Compulsory Purchase Order, which had been the subject of a public inquiry earlier in the year. A start was made on surveys of the 191 houses in the Holly Lane/Mayo Road Slum Clearance scheme, and of 915 houses in the proposed Stonebridge Redevelopment Area. 10 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 27). 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 27), and also details of new dwellings constructed during the year (table 28). Notices served under the Public Health and Housing Acts 1936 There was a decrease in the number of notices served during the year compared with 1956 (table 30). Fewer inspections were made because of the shortage of Public Health Inspectors ; there were two vacancies both at the beginning and end of the year, and four Inspectors were engaged on special surveys (three on slum clearance and the proposed redevelopment area and one on a preliminary survey for a smoke control area). Housing Repairs and Rents Act, 1954 ; Rent Act, 1957 Details of certificates of disrepair issued to tenants and revocation certificates to owners under the Housing Repairs and Rents Act, 1954, are shown in table 31. The Rent Act, 1957, came into operation on the 6th July, 1957, and details of the applications received and certificates issued up to the end of the year are shown in table 31. Nuisances abated and improvements effected A summary of nuisances abated and improvements effected is shown in table 32. Inspection of factories, outworkers premises and food premises A summary of inspections of the above premises is shown in table 33. CLEAN AIR Measurements of grit and sulphur in the air have been carried out during the year and the results in the areas surrounding the three power stations show general improvement (tables 35, 36). In January and February there were excessive grit emissions from Acton Lane Power Station. The Council sent a warning letter to the superintendent. Frequent visits were made by the Public Health Inspectors and the grit arresting plant was completely overhauled. Several defects were found and after repair there were no further excessive emissions. The superintendent undertook to inspect the plant daily and report any defect to the department immediately. When the extension to the Acton Lane Power Station was approved in 1952 the British Electricity Authority (now the Central Electricity Authority) gave an assurance that the whole of the existing plant would be taken out of commission by the end of 1959 or such later date as might be approved by the Minister. The present position in the old station is that of the original 24 boilers 8 have been cut off and are being demolished, and in 1958 another 12 will gradually go out of commission and will subsequently be demolished. This will leave four modern boilers which are equipped with the latest type of grit arresting plant. Three cooling towers have been demolished and others will follow as they go out of use. Following a series of complaints regarding grit emissions from the Taylors Lane Power Station, the Clean Air Sub-committee, the officers, and three local residents met the Divisional Controller of the Central Electricity Authority and six members of his staff at the Town Hall on the 5th April, 1957. Following a lengthy discussion the Divisional Controller stated that due to the restriction on capital expenditure, the installation of an ash plant, which should abate the nuisance almost completely, had been delayed. However, authority had been given for the necessary expenditure, and the plant, if available, would be completely installed within eighteen months. The Divisional Controller assured the sub-committee that the work would be started as soon as possible. The station was closed from early August for two and a half months for major modifications and improvements. Unfortunately when the plant was brought into operation at the end of October a considerable quantity of fragmentary brickwork, together with some fly ash, was emitted from the stack. The plant was shut down and the inside of the stack was examined. It was found that the brickwork was flaking and steeplejacks scraped the inside and removed all the disintegrated brickwork. The plant was put back into service, and no further excessive emissions were observed. A successful public meeting was held at Anson Hall, Cricklewood. in February to discuss the problems of atmospheric pollution, and the Council's methods and proposals for dealing with them. More than 80 people attended the meeting, including representatives from 25 organisations. They were addressed by Mr. Arthur Blenkinsop, M.P., and Councillor Piddington, Chairman of the Council's Clean Air Subcommittee. After the addresses questions were invited from the audience and these were answered by the two speakers and the Chairman of the Public Health Committee, the Director of the Society for Clean Air, the Town Clerk, the Medical Officer of Health and the Chief Public Health Inspector, who were also present on the platform. Early in 1957, part of the Clean Air Act came into operation. The remainder of the Act will come into force in June, 1958. The Council have always considered clean air as a priority, and as long ago as 1930 appointed a number of Public Health Inspectors qualified as Smoke Inspectors. 11 A ten per cent, random sample survey was made of two districts selected by the Clean Air Subcommittee, and the Council then decided in December that their first smoke control area would be Neasden. The size of the area is 48-5 acres and includes 618 domestic premises, 65 shops, one builder's office and store, and a bakehouse. The Minister of Housing and Local Government is expected to give provisional approval to the scheme early in 1958, and a detailed survey will then be commenced. Two notifications of new boiler installations were received. 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 disinfestors employed by the Council (section 83 of the Public Health Act, 1936) (Table 37). There was a slight decrease in the work. The Council provide transport for clothing and bedding requiring disinfection and disinfestation at the Neasden Hospital (section 84 of the Public Health Act, 1936). The Council's attendant disinfects and disinfests rooms and collects and delivers the clothing and bedding. Temporary arrangements were made for bed linen to be treated at the Hendon Isolation Hospital from the 11th November until the 4th December owing to alterations to 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 257 Borough Council properties 7 Private dwellings 863 Total 1,127 at the following cost: Business premises £1,511 10 10 Private dwellings £2,142 19 2 Total £3,654 10 0 The cost of disinfestation at business premises is recovered from the occupiers. 120 had an annual agreement with the Council for regular inspection and disinfestation; 14 were new agreements and 106 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 faults in the connections of the house drains with the sewer, 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 41). Improvement in premises The Food Hygiene Regulations, 1955, which came into operation on the 1st January, 1956, prescribed standards for the preparation, storage and sale of clean food. There has been a marked improvement in hygiene in the production and sale of food. Public Health Inspectors visited food premises frequently and served verbal or written notices to improve their standards. Works in some premises are still either in progress or arrangements are being made for them to be carried out (tables 38, 42). 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, must 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 39). Premises where ice cream is manufactured are kept under constant supervision. Most of the ice cream sold in the borough is manufactured outside the district, and is usually pre-packed. The ice cream reaches a high standard of purity (table 9). 12 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 There was one outbreak of food poisoning during the year in a private school. 5 teachers and 25 pupils were affected, but they recovered quickly. The food causing the outbreak was braised steak, which was prepared with the remainder of the meal at a Kosher meals centre in Stepney and delivered to the school in sealed containers. The causative organism was Clostridium welchii, which was contained in raw meat brought into the meals centre. The reason for the outbreak was that the meat and gravy was cooked a day ahead of requirements and the gravy was not stored in a refrigerator but in a dry store. Meats and gravies which are prepared for consumption the following day should be cooled rapidly (within 1^ hours of preparation), stored in a refrigerator, and heated well before serving. Food unfit for human consumption More than 6 tons and 22,000 tins of food inspected by the Public Health Inspectors was found to be unfit for human consumption (table 40). 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 a decrease in the number of specimens of contaminated food dealt with by the department. These included a piece of wood in a packet of tea; maggots in a bar of chocolate; a piece of hemp in a tin of creamed rice; a nail in a bun ; mould in meat pies, cakes and bread : a piece of glass in a milk bottle : a piece of wire in a Yorkshire pudding. Members of the public reported 18 specimens of contaminated food. The firms responsible for sixteen of them were cautioned, but no action was taken in the other two because there was no evidence of contamination. The public and other local authorities reported five dirty milk bottles. Two bottles were referred to other local authorities for action because the milk was bottled in their areas. One firm was cautioned, but no action was taken in the other two: the foil caps had been destroyed and no other evidence of where the milk was bottled was available. Clean food—sampling The Middlesex County Council is responsible for taking samples and for supervising the control of food adulteration (table 43). The Chief Officer of the Public Control Department has kindly supplied the following information. Of the 15 retailers who were concerned in the 17 samples found to be unsatisfactory, 2 were prosecuted, 9 were cautioned, 1 changed the recipe of his product and no action was taken against the other 3. Two samples of milk contained splinters of glass. 1 dairy was officially cautioned but no action was taken against the other because of insufficient evidence. Official cautions were issued to the retailer of a sample of 'cream cheese' which on analysis was found to be whole milk cheese, to the retailers of herrings in jelly, and caviar, containing an unauthorised preservative (the caviar was also imitation), to the bakers of a bridge roll containing dirt and oil which came from the baking plant and was not harmful, and to the confectioner who sold a milk chocolate block made from skimmed milk and not whole milk. The manufacturers of a similar sample of milk chocolate block which contained only skimmed milk altered their recipe to justify the description. Three unsatisfactory samples of drugs were iodine. Two were not of the standard prescribed in the British Pharmacopoeia and a caution was sent to the chemists concerned. The other sample was deficient in iodine but a follow-up sample was genuine and no further action was taken. One greengrocer sold 'Packham Triumph' pears as 'William' pears and another sold 'Josephine de Malines' pears as 'William' pears. One was officially cautioned and the other was prosecuted and fined £2 and £1 costs. The manufacturer/retailer of ice cream who advertised his products as containing egg was prosecuted because no egg was used in the manufacture and he was fined £10 with £5.13.0 costs. He was also officially cautioned for selling two ices as "lemon" ices, but containing only water ice. No action was taken against a restaurant for the sample of scrambled egg which was of poor quality and generally unsatisfactory, as subsequent samples were satisfactory. Merchandise Marks Act, 1887-1953 1,022 displays of articles of food were examined under the Merchandise Marks Acts, 1887-1953. Verbal cautions were given for minor infringements. Two retailers who described "standard" grade eggs as "large" eggs were officially cautioned. iMbelling of Food Order, 1953 637 articles of pre-packed food were examined under the Labelling of Food Order, 1953. No infringements were detected. 13 Milk and Dairies (table 44) Milk sales are regulated by the Food and Drugs Act, 1955, the Milk and Daries Regulations, 19491954, the Milk (Special Designation) (Pasteurised and Sterilised Milk) Regulations, 1949-1953, and the Milk (Special Designation) (Raw Milk) Regulations, 1949-1954. Willesden has been a specified area since October, 1951: all milk sold by retail is sterilised, pasteurised, or tuberculin tested ; the sale of raw milk is prohibited. 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. 31 inspections were made of the three dairies and some minor defects were found. These were soon remedied. FACTORIES There was a decrease in the total number of factories in the borough compared with the previous year (table 45). 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 46. 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 47). NOISE NUISANCE The Borough Council deal with noise nuisances under section 313 of the Middlesex County Council Act, 1944. Fourteen complaints were received, but only six could be considered as coming under this section. Four were of noise from electric motors of various kinds and they were all diminished in volume after consultations with the managements. The other two complaints were about the noise made because of factories working early morning and late evening. The managements agreed to stop working at these times. OCCUPATIONAL HEALTH SERVICE The Council introduced an occupational health service for their employees in April, 1954. Public Health Inspectors visited all offices and workplaces during the year to supervise working conditions, particularly canteens, rest rooms, cloakrooms and first-aid equipment. Defects such as poor ventilation or lighting, defective water closet accommodation, dirty walls and ceilings, and inadequate firstaid equipment, were brought to the notice of the Chief Officer concerned. Suggestions were made for major improvements such as the cure of dampness, improvement of ventilation in the vehicle spraying room and water closet compartments, provision of messing facilities, installation of additional water closet accommodation, and alterations to boiler plant. 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 nominate 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. 14 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 deficiencies 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 the old people and arrange for the necessary services to be given. 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. No action was necessary under the Acts during 1957. 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 4Jd. 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 1.1.57 New cases Died Admitted to hospital Recommenced after discharge from hospital On register 31.12.57 33 18 15 8 3 31 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 Folks Association, celebrated its fifth anniversary in February. The Club has a membership of more than 450, and is open daily from 1.30 to 10.0 p.m. The Council made a grant of £350 to the Association's funds, several firms gave donations and additional money was raised by a Flag Day. Sixty members went to the theatre in March and two hundred members and helpers went for a day trip to Southend in July. Holidays at a reduced rate were arranged for twenty members at Southend. Voluntary workers visited 48 old people weekly or fortnightly. Lonely housebound old people greatly appreciate the services, which include shopping, reading, general conversation, tidying the room or attention to the hair. At Christmas the visitors took 5/- each to 72 old people and Christmas dinner from the Association to 56. Many more volunteers for visitors are required. Packages of food for distribution to the housebound were given by a school in the borough after Harvest Thanksgiving, by firms, the manager of a local branch of one of the Ministries, and private persons. The Christmas party was held at Anson Hall, Cricklewood, and was very successful. More than 300 invitations were sent out and 280 people were given a high tea and entertainment, and two shillings. Grants were also made to other organisations to help them arrange their own parties. The chiropody service is still in great demand. 600 people were on the register in 1957 ; an average of 50 attended the three chiropodists in the Kilburn, Harlesden and Willesden Green areas each week. The chiropodist in the Willesden Green area commenced giving treatment this year. In addition, 200 housebound 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 £200 towards the cost of treatment, which in 1957 cost the Association more than £300. On the recommendation of the Welfare Officer, free coal was supplied to old people who could not afford it, and financial assistance was given in several cases to help maintain and license wireless sets of the housebound. In October, the Middlesex Old People's Welfare Committee arranged a handicraft exhibition. Old people's clubs in Willesden provided 97 of the 677 entries. Willesden won three prizes, a first prize for a lampshade, a second prize for woodwork, and a third prize for tatting. 15 The branch club opened at St. Martin's Church Hall, Kensal Rise, in January, 1955, meets every Wednesday afternoon from 2-4 p.m. The club is self-supporting but the Association pays the rent of the hall. Members went for two day-trips in the summer to Hastings and Littlehampton. Two golden wedding parties and a tea party were held. Members who were ill were visited in their own homes or in hospital by the secretary and members. The Willesden Division of the British Red Cross Society, the Women's Voluntary Services, religious and other organisations in the area run clubs for old folk and their members visit them in their homes. The meals on wheels service, organised by the Women's Voluntary Services, is probably the most important service for old people. 5,764 meals were prepared and delivered from the headquarters of the organisation at 7 High Road, N.W.10, compared with 4,775 in 1956. Only two meals a week are supplied to each person ; the aim is to give a hot meal to old people five days a week in all parts of the borough. To extend the service would require a substantial sum of money, which is not yet available, but consultations with the Council may result in the provision of another vehicle for delivering meals, two food containers, and individual meals dishes. Unfortunately, the Women's Voluntary Services had to close the Old Folks Morning and Luncheon Club in January, 1957, because the Presbyterian Hall, Granville Road, was acquired by the local education authority. The Council, however, is hoping with the aid of a grant from the King George V Foundation to establish a non-residential club for old people on a site which is owned by the authority at the corner of Mortimer and College Roads. Discussions with the Women's Voluntary Services are proceeding on the basis that the capital cost will be subsidised by the Council, who will also bear the running and maintenance costs, in addition to providing the site at a nominal rent. The club will provide facilities for meals and recreation, and the preparation of meals for distribution through the meals on wheels service. 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 eleven persons during the year. This cost £137.4.8 of which £24.1.1 was recovered from relatives. PUBLIC MORTUARY Post-mortems were performed on 450 bodies, followed by an inquest in 95. 60 inquests were held on Willesden residents but only 20 of these were held in the Coroner's Court attached to the mortuary. The remainder were held at Ealing. Inquests held on Willesden residents 1951 1952 1953 1954 1955 1956 1957 At Kilburn 49 25 12 13 12 10 20 At Ealing — 26 21 37 24 62 40 Total 49 51 33 50 36 72 60 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 1957. 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. 16 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 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. There was one registration during the year and eight premises were removed from the register as they ceased to carry on business. The number of registered premises is now nine. Unfortunately the Act does not cover the re-making of an article, and dirty materials can therefore be used in upholstering second-hand articles if they do not belong to the occupier. Four samples of 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 Inspectors; Public Health Inspectors inspect premises for size, lighting, ventilation and cleanliness, and for the precautions taken for preventing spread of infectious disease. During 1957, 22 pet shops were licensed. STAFF MEDICAL EXAMINATIONS 39 staff medical examinations were carried out by the Medical Officer of Health and Deputy Medical Officer of Health in 1957. 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. A new dental department at the Willesden General Hospital was completed during the year and comprehensive consultant dental services are now available. A Department of Occupational Health was established at the Central Middlesex Hospital and will be maintained for three years with a grant of £15,000 from the Nuffield Foundation. Liaison with Hospitals The exchange of medical officers between the Paediatric Out-patients Department at the Central Middlesex Hospital and the local health authority continued. This scheme has been working very satisfactorily and has brought the work of the two departments more closely together. At the end of the year it was decided that certain selected patients who were attending Central Middlesex Hospital with varicose ulcers could be treated in their own homes by the home nurses. The Physician-in-Charge at the Hospital refers suitable cases to the Area Medical Officer and the necessary arrangements are made. The scheme relieves pressure on the hospital service and is advantageous to patients because it saves them travelling to and from the hospital. 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 1957 a little less than two-thirds of all expectant mothers attended the local ante-natal clinics staffed by assistant medical officers (Table 48). 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 49). Mothers book for confinement at home or in Paddington Hospital have specimens of blood taken by assistant medical officers for Wasserman reaction, blood grouping, and Rhesus factor; assistant medical officers and midwives carry out the tests for haemoglobin estimation. All expectant mothers are invited to attend the Mass X-ray unit at Central Middlesex Hospital. 17 Health visitors conduct mothercraft classes (one afternoon a week at the main clinics) on the birth and care of the expectant mother 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 50). The Physiotherapist conducts ante-natal relaxation classes on two afternoons a week in the orthopaedic department at Stonebridge Clinic, and a health visitor conducts similar classes at Kilburn Clinic on one afternoon (Table 51). The mothers enjoy these classes, and their association with other expectant mothers has a good psychological effect. There is no doubt that the exercises assist the mother at the time of the confinement; most of them report on their easy confinement and how they were able to practice what they had been taught. Some hospitals do the ante-natal care, mothercraft, and relaxation exercises for their own expectant mothers. Health visitors and midwives encourage mothers to have post-natal examinations 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 in three main clinics (5 afternoons a week), and in four church hall clinics (two afternoons a week in three and three afternoons a week in one). (Table 52.) 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, whooping cough and poliomyelitis. There was a large increase in the number of children vaccinated against poliomyelitis as more supplies of vaccine became available (Table 64). There was also a large increase in the number of children who were vaccinated against smallpox (Table 62), but the number immunised against diphtheria was almost the same as in 1956 (Table 63). It has become part of the health visitors' duties to give advice on immunisation against poliomyelitis to mothers in the health clinics and when visiting in the homes, and to discuss any special queries with them. Mothers of young babies are advised on immunisation against poliomyelitis at the same time as advice is given on protection against diphtheria, whooping cough and smallpox. 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. These greeting cards remind parents that the routine examination and patch test of their children are due, and many mothers attend with their children as a result of these invitation cards. Assistant medical officers inform general practitioners if treatment is required. A Mothers' Club is held in Kilburn Clinic once a fortnight in the evening and in Stonebridge Clinic once a week. The mothers form their own Committees 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. Outside activities have included visits to the theatre and television shows and a day trip to Chessington Zoo. A delightful Children's Christmas party for a number of voung children, and a visit to the Ice Show at Wembley for older children, were arranged. MIDWIFERY SERVICE At the beginning of the year the Middlesex County Council employed four midwives in Willesden. During the year one midwife left and was not replaced, making a total of three midwives, with two vacancies 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. Three or four 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 53), 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 54). Midwives work very closely with general practitioners who were present at some of the deliveries (Table 55). 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 56). 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 "flving squad" was called out three times during the year for ante-partum haemorrhage, following a miscarriage, and post-partum haemorrhage with third stage complete. 18 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 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. Three babies were admitted to the unit during the year. According to the Ministry of Health report (1952-1954) on confidential inquiries into maternal deaths in England and Wales, toxaemia of pregnancy accounted for nearly one quarter of the deaths of mothers directly due to pregnancy and childbirth. Inadequate ante-natal care was considered to be the largest avoidable cause and the number of deaths could be decreased by an improvement in the quality of prenatal supervision. Toxaemia of pregnancy was also considered to be a major cause of still births and neo-natal deaths. The report was carefully studied by the medical and nursing staff and it was agreed that efforts should be made to provide better ante-natal care especially in the early detection and treatment of toxaemia; prompter and more effective treatment of haemorrhage, especially through the use of "flying squads" and a more careful selection of cases for specialist care at hospital, especially women in the older age groups and higher parities. 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. During the year they gave 71 school talks to senior girls on Mothercraft; these talks were much appreciated by the girls, who showed interest and asked a number of intelligent questions. 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 57). Health Visitors work in close co-operation with general practitioners (Table 58), staffs of hospitals, children's officers, welfare officers, Public Health inspectors and other social workers. Some patients who attended diabetic clinics require instruction on their treatment, diet and aftercare to be given in their homes, and arrangements have been made for this to be done by health visitors' instruction. Health visitors attend 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. During the year health visitors supervised 15 patients, carefully selected by the physicians-in-charge, The health visitors gave useful assistance and advice to all of them and proved in practice how important is the social side in the treatment of diabetic patients. There is still a shortage of health visitors for the Willesden part of the area (Table 59). 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. Three students who were sponsored for Willesden qualified as health visitors and were appointed as health visitors to Willesden. In addition there were four students in Willesden in 1957. MINISTRY OF FOOD WELFARE FOODS The supply of national dried milk, orange juice, cod liver oil and vitamin 'A' and 'D' tablets are distributed from centres and clinics in the Borough. No alterations were made during 1957 in the number of sessions for the sale of these welfare foods. In August, 1955 the sessions at Kilburn Clinic were reduced from 10 to 7 per week, Memorial Hall, Acton Lane from 10 to 6 and the Neasden Methodist Church Hall from 4 to 3, because of a drop in sales. On the 21st March, 1957, as a result of the Welfare Foods (Great Britain) Amendment Order, 1957, the price of a 20-oz. tin of national dried milk, supplied against a milk token, was increased from lO^d. to 2/4d. Orange juice continued to be supplied at 5d. per bottle, and cod liver oil and vitamin tablets, free of charge. The Ministry of Health adopted the recommendation of the loint Committee on Welfare Foods (Ministry of Health Circular No. 15/57 (4.10.57) and as from the 1st November, 1957, orange juice, which previously had been available for children up to 5 years, was restricted to children up to the age of 2 years, including those attending day nurseries. 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. 19 The Middlesex County Council runs a district nurse training home at 17-19 Park Avenue, Willesden. The candidates assist the home nurses, and some are recruited into the service when they have finished their course. Home nurses give various injections and other treatments, and general care to patients and the aged and infirm (Table 60), in close co-operation with general practitioners, who make the majority of the requests for this work. As from January 1st, 1958, home nurses will provide special treatment for ulcers of legs to patients in their own homes under the supervision of general practitioners and the Physician-in-Charge of this department at the Central Middlesex Hospital. More patients will then be able to receive attention at the hospital and some of them will be saved the difficulties of travelling to and from the hospital for routine treatment. 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 43.5% of the total live births for the year (Table 62). 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 63 shows the total number of children who have received protection against diphtheria during the last 15 years (1943-1957). The estimated percentage of children who have received an injection during their school life is 78.6. INOCULATION AGAINST POLIOMYELITIS The registration and inoculation of children against poliomyelitis continued throughout the year. Early in 1957 it was announced that general practitioners would take part in the scheme, and parents were given the option of inoculation by their own doctor or at the local clinic. In May further groups of children were added to the list of those eligible for vaccination, namely, children born in 1955 and 1956, and those born in 1947 to 1954 not hitherto registered. In November further groups were added—expectant mothers, children born in the years 1943 to 1946, and children born in 1957 who had reached six months of age. General medical practitioners, ambulance personnel, hospital staff and their families, also became eligible for inoculation. During the year, increased supplies of British vaccine became available and the programme of clinic sessions was expanded accordingly. Supplies of Canadian Salk vaccine were expected to become available early in 1958, which would enable more children to be protected. Table No. 64 shows the number of children and others registered up to the end of 1957, together with the number who had received two injections (general practitioners and clinics) since the beginning of the scheme in January, 1956. HOME HELP (Tables 65 and 66) Compared with the previous year there was little change in the number of new cases, or of those still receiving help at the end of the year, but the weekly number of hours required was lower in many cases due to the rising cost of the service. The maximum charge was increased from 3/6d. to 4/0d. per hour, and the assessments according to scale, correspondingly higher. The rate of pay for home helps increased from 3/l5/8d. to 3/3½d. per hour. Recruitment of staff did not present great difficulty, but sickness of staff led to inadequate provision of help for temporary periods, for example during the outbreak of Asian 'Flu. A training scheme for home helps was commenced, a course of 5 lectures being given to groups of 10 helpers at fortnightly intervals. Home helps for the course are selected according to their seniority of service, those working 30 hours and over per week being considered first. DAY NURSERIES There are now 8 Day Nurseries with a total of 390 approved places (Table 67). Crest Road Day Nursery (50 approved places) was closed on the 30th August and the 42 children attending there were transferred to other nurseries and the County Council provided transport for 21 of them because journey by public transport was difficult. The number of children awaiting vacancies has increased during the year. The parents of children awaiting admission to Chichester Road and Gladstone Park Day Nurseries often accepted vacancies at Crest Road Day Nursery, and the mothers found work nearby. With the closure of Crest Road Day Nursery these mothers could not be accommodated and the number of children on the waiting list immediately increased. 23 of the 27 children awaiting admission were for Gladstone Park and Chichester Road Day Nursery. 20 Rules of Admission The main principle for admission to day nurseries is the health of the mother or child. Children from 0 to 5 years of age are accepted under the following conditions:— Their mothers are unsupported, cannot look after their children adequately, or the home conditions are unsatisfactory. In addition, there is 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 Less than two-thirds of the children of applicants were actually admitted (Table 68). Table 69 shows the reasons for non-admission of the remaining third. Practically all those on the registers were in the priority groups and almost one-half of the children came from homes where the mother was the sole support (Table 70). Assessed Daily Charge The maximum daily charge remains at 13/0d. Applicants unable to pay the assessed charges can appeal at a meeting of the Appeals Sub-committee. Attendances Most of the places in the day nurseries were filled regularly (Table 67). Infectious Diseases Two nurseries had outbreaks of measles and two had outbreaks of chickenpox. There were a few more cases of infectious disease involving one or two children who contracted their infection in their own homes from other members of the family (Table 71). 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 72. Five nurseries are approved as training schools for the 2-year Nursery Examination Board Course. The students attend Chiswick Polytechnic for 2 days weekly. Twenty-four students were in training during the year and 10 of these obtained the N.N.E.B. certificate. The remaining 14 students have not yet completed their period of training. 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 £5 5s. 0d. 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 104 Children 30 134 SCHOOL HEALTH SERVICE (Tables 73-88) Routine Medical Inspection (Tables 73-78). Children in the 12-13 age group attending Grammar Schools were included in routine medical inspections, which means these children will be seen once before their "Leavers" examination, which normally takes place during the year in which they attain the age of 16 years. 21 Audiometry (Tables 80-81) Almost twice the number of children were tested as a routine in 1957 as compared with 1956. This was due to the inclusion in the scheme of another age group, namely, the six to seven-year olds. A second audiometer operator for five sessions per week was appointed. A greater number of requests for special tests were received in 1957 from medical officers, speech therapists, etc., than in the previous year. Handicapped Pupils (Tables 86-88) A senior day school for partially deaf pupils was opened at Tottenham. Prior to this opening, only residential placement was available for children due for transfer from junior partially deaf units and who could not attend an ordinary school. The waiting list for admission to the Leinster Day Special School is still large and it is unlikely to be reduced while the school is housed in its present premises. The waiting period for all types of other special schools has been considerably reduced, and in most cases a vacancy is obtained by the end of the term in which the child is referred. CHILD GUIDANCE (Tables 89 and 89a) Dr. Higgins resigned from his post at the end of August, 1957. Dr. Stein then acted as locum tenens for four sessions per week, until he was appointed to the post in December for seven sessions per week, Treatment is mainly carried out by the psychiatrist and two part-time psychotherapists conducting regular weekly sessions for the children, assisted by the two full-time psychiatric social workers, who hold regular meetings with the parents. Shorter methods of treatment, up to six interviews, have been used for a number of children. The meetings with Assistant Medical Officers and health visitors at the Child Guidance Centre, and the psychotherapists at the maternal and child welfare clinics, have helped to resolve problems at an early stage and much useful preventive work has been done. Joint conferences at the Centre were held not only with the health staff of the other clinics, but also with probation officers, welfare officers, speech therapists, etc. Groups of health visitors, psychologists and nurses also visited the Centre as part of their training scheme. RHEUMATISM (Tables 90 and 91) The Rheumatism Clinic was held one Tuesday in each month at the Willesden Health Clinic for the whole area. Rheumatism can be a serious disease requiring prolonged treatment, and unfortunately may result in permanent heart damage with consequent interference with normal physical activities: children so affected may have to attend a special school for years. At the Rheumatism Clinic the family history and the environment conditions are investigated, consultations with specialists are arranged as required, advice on physical training and games is given, and convalescence recommended. The Public Health Department dealt with dampness in 12 cases when the condition was reported to exist. 21 of the 33 children attending the Clinic during the year were found to belong to Social Group IV and V. SCHOOL DENTAL SERVICE (Table 92) There has been a steady increase in the number of Dental Officers from an average of 5 in 1955 to 6½ in 1957. In addition there was the equivalent of half an orthodontist. In February, 1952 a restricted scheme was introduced, because of shortage of staff and accommodation, which dealt with children up to 9 years of age (approximately 10,000 children). In June, 1956 it was possible to raise the age limit to 13 years (18,000 children). Of these, 17,550 received a routine dental inspection, and 1,594 special cases were also inspected, a total of 19,144; 13,193 (69%) were referred for treatment, and of these 6,139 (46.5%) actually received treatment at the clinics. An average of 2.5 fillings and .76 extractions were carried out for each child treated, compared with 2.4 fillings and .86 extractions in 1956. In 201 orthodontic sessions, 437 cases made 1,628 attendances. In the course of the year 143 evening sessions were carried out by full-time Dental Officers. 22 PRIORITY DENTAL SERVICE (Table 93) In 1957 twelve per cent. of the Dental Officers' time was spent in the inspection and treatment of the priority groups. The number of expectant and nursing mothers was sixteen per cent. higher than in 1956 and there was a corresponding increase in treatment carried out. The ratio of fillings to extractions remains constant at 2.3:1. There has been a decrease of ten per cent. in the number of children under five years who have been inspected and treated. The ratio of fillings to extractions is 2.7:1. The average number of conservations (fillings and silver nitrate dressings) carried out for each child treated has increased from 2.9 in 1956 to 3.4 in 1957. Advice is given on diet and oral hygiene, so that good habits may be started at an early age. CHIROPODY (Table 94) During the past year there has been a further increase in the number of chiropody patients. The main problem is presented by the older school-girls who will insist on wearing ill-fitting shoes, with the result that they develop deformities, corns or callosities. Most boys wear sensible shoes and therefore do not suffer so much from foot ailments. A careful watch is being kept on children under five years of age, because crooked toes and deformed nails are often produced by small bootees and socks as well as shoes. Talks on care of the feet were given to expectant mothers and members of the Mothers' Clubs as well as school children. Foot infections such as warts and athletes foot were very common. Early treatment will prevent these infections from spreading and Health Education can play an important part. The number of expectant and nursing mothers taking advantage of chiropody treatment has increased, particularly for corns and callosities. With the extension of health education, more and more people are becoming foot conscious. HOME SAFETY The Willesden Home Safety Committee which was formed in November, 1956 has done valuable work during the year. It is a voluntary committee which has the support of both the Willesden Borough and the Middlesex County Councils. The Borough Council made an initial grant of £100 to the committee's funds, and provision for a further grant of £100 has been made in the annual estimates for 1957/58. The committee's aim is to reduce the number of accidents which occur in homes in Willesden each year, mostly affecting children under five years and people over 65 years of age. Its terms of reference were outlined in the report for 1956. Eighteen local organisations and the Willesden Borough Council are represented on the committee, which is affiliated to the Royal Society for the Prevention of Accidents and has a representative on the National Home Safety Committee. Four meetings were held during the year. A protest was sent to the British Medical Association about the house-to-house distribution of drugs for advertising purposes, because of the danger of these being picked up by young children. The Association promised to try and prevent this unsatisfactory practice. Articles on "Accidents in the Home" and "Home Safety" were published in the Willesden Civic Review and the Bulletin of the Willesden Youth Advisory Committee, and the local press co-operated in reporting on the committee's activities on several occasions. Talks were given in many schools and to various local organisations, the total attendances being approximately 600. The Housing and Estates Manager of the Willesden Borough Council kindly distributed 4,000 copies of a pamphlet entitled "Home and Everyday Accidents" with a new rent book issue, and a further 1,000 copies of this leaflet were distributed by members of the committee. A float decorated with posters and other propaganda items was entered in the Willesden Carnival. 1.500 leaflets and pamphlets were distributed and many enquiries were answered about the activities of the committee. The float received a 'highly commended' award from the judges. Three displays were exhibited at the Willesden Show, and more than 4,000 pamphlets were distributed. The Road Safety Officer exhibited films showing some aspects of the committee's work. During the National Home Safety Week, organised by the Royal Society for the Prevention of Accidents, from the 4th-9th November, 1957, members of the committee distributed 1,000 copies of a leaflet on the "Flammability of Apparel Fabrics". Posters were displayed on the Council's notice boards, in the public libraries, and in windows of committee members' houses. Several members attended the Home Safety Session of the National Home Safety Congress, which was organised by the Royal Society for the Prevention of Accidents at Central Hall, Westminster, from the 15th-l7th October, 1957. A sub-committee was set up to deal with the production of a Home Safety Handbook, and this will be published in July, 1958. 23 TABLES Table 1 DEATHS Causes: Males Females Total 1. Tuberculosis (respiratory) 13 — 13 2. Tuberculosis (other) — — — 3. Syphilitic disease 3 3 6 4. Diphtheria — — — 5. Whooping cough — 1 1 6. Meningococcal infections — — — 7. Acute poliomyelitis 1 1 2 8. Measles — — — 9. Other infective and parasytic diseases 1 2 3 10. Malignant neoplasm, stomach 34 23 57 11. Malignant neoplasm, lung, bronchus 93 16 109 12. Malignant neoplasm, breast 1 38 39 13. Malignant neoplasm, uterus — 13 13 14. Other malignant and lymphatic neoplasms 105 82 187 15. Leukemia, aleukemia 11 7 18 16. Diabetes 3 8 11 17. Vascular lesions of nervous system 96 121 217 18. Coronary disease, angina 159 86 245 19. Hypertension, with heart disease 17 18 35 20. Other heart disease 56 100 156 21. Other circulatory disease 43 58 101 22. Influenza 8 6 14 23. Pneumonia 29 54 83 24. Bronchitis 78 41 119 25. Other diseases of respiratory system 11 3 14 26. Ulcer of stomach and duodenum 8 7 15 27. Gastritis, enteritis and diarrhoea 2 7 9 28. Nephritis and nephrosis 4 10 14 29. Hyperplasia of prostate 12 — 12 30. Pregnancy, childbirth, abortion — 2 2 31. Congenital malformations 7 9 16 32. Other defined and ill-defined diseases 50 52 102 33. Motor vehicle accidents 20 3 23 34. All other accidents 17 15 32 35. Suicide 15 10 25 36. Homicide and operations of war – 1 1 TOTAL 897 797 1,694 24 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 54 53 101 32 38 1946 170,550 3,572 102 29 43 95 26 27 1952 180,400 2,611 62 24 28 66 25 23 1953 178,500 2,655 60 23 27 58 21 22 1954 177,300 2,599 50 19 25 44 17 24 1955 176,000 2,619 53 20 25 61 23 23 1956 174,900 2,681 61 23 24 58 21 23 1957 174,100 2,876 48 17 23 63 21 22 Perinatal mortality 1955 37 ,, ,, 1956 35 ,, ,, 1957 32 Table 3 Infant Mortality:—by Wards Ward Number of deaths Total 1955-57 Rate 1955-57 1955 1956 1957 Carlton 2 5 9 16 19 Kilburn 9 9 4 22 32 Brondesbury Park 3 4 — 7 12 Kensal Rise 5 8 3 16 40 Manor 2 2 4 8 16 Harlesden 3 5 3 11 16 Stonebridge 5 3 2 10 17 Roundwood 7 7 6 20 27 Church End 2 2 2 6 12 Willesden Green 6 6 2 14 22 Mapesbury 3 4 4 11 14 Gladstone 1 2 5 8 18 Cricklewood 3 3 3 9 21 Brentwater 2 1 1 4 11 53 61 48 162 20 25 Table 4 Infant Mortality—Causes (Based on Registrar General's Figures) 1936-1939 1940-1945 1946-1950 1951-1955 1957 (1956 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 2 (3) 7 (5) 9 (8) 3.1 (3.0) 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) 1 (1) 0.4 (0.4) Congenital malformations 83 6.3 89 5.6 72 4.4 53 4.1 3 (9) 4 (5) 7 (14) 2.4 (5.2) Prematurity 170 13.0 179 11.3 99 6.1 110 8.4 5 (12) - (-) 5 (12) 1.7 (4.4) 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 21 (20) 2 (2) 23 (22) 8.0 (8.2) All causes 679 51.9 738 46.5 430 26.5 298 22.8 34 (48) 14 (13) 48 (61) 16.7 (22.7) Table 5 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) 1957 25 (1) 169 (4) 6 (1) 194 (5) Table 6 Premature births by wards Ward Premature births notified Percentage of live births in brackets Carlton 34 (11.6) Kilburn 24 (9.4) Brondesbury Park 10 (5.3) Kensal Rise 16 (11.8) Manor 12 (6.3) Harlesden 16 (6.7) Stonebridge 9 (4.2) Roundwood 11 (4.2) Church End 9 (5.6) Willesden Green 17 (7.3) Mapesbury 17 (6.3) Gladstone 5 (3.2) Cricklewood 9 (6.1) Brentwater 5 (3.8) Total 194 (6.7) 26 Table 7 Infant Mortality: —Congenital malformations Urethral obstruction 1 Jejunal atresia 1 Hydrocephalus 1 Renal hyperplasia 1 Encephalocele 1 Meningomyelocele 2 Total 7 Table 8 Infant Mortality:—Infections (a) Causes Pneumonia 8 Bronchitis 1 Whooping cough 1 Total 10 (b) By Social Class I Nil II Nil III 1 IV 2 V 7 27 GENERAL PROVISION OF HEALTH SERVICES Table 9 Bacteriological examination of milk, ice cream and water Milk examinations—251 Schools (pasteurised) Dealers' premises Total Pasteurised T.T. pasteurised Sterilised Samples 72 129 16 34 251 Satisfactory 72 129 16 34 251 Unsatisfactory — — — — — Ice cream examinations—26 Grade 1 Grade 2 Grade 3 Grade 4 Total 18 2 1 5 26 Water examinations—146 Domestic supplies Swimming pools Paddling pool Total Samples 10 125 11 146 Satisfactory 10 121 4 135 Unsatisfactory — 4 7 11 Table 10 Uncleanliness and Scabies New cases treated Attendances Scabies Lice and nits Total Scabies Lice and nits Total Children under 5 years 8 2 10 11 2 13 Children 5-15 years 5 56 61 5 60 65 Adults Men 11 5 16 12 5 17 Women 13 11 24 15 11 26 Total 37 74 111 43 78 121 HEALTH EDUCATION Table 11 Talks No. visited Total No. of talks Subjects Total attendances No. of attendances Schools 19 352 36 970 25—120 Factories 55 127 15 10,890 20—4,000 Religious, social and political organisations 16 20 15 1,050 15—350 Table 12 Mothercraft No. of clinics Total No. of classes Visits by health visitors 3 121 27,046 28 PREVALENCE AND CONTROL OF INFECTIOUS AND OTHER DISEASES Table 13 Infectious diseases 1957 (1956 in brackets) Notified Confirmed Deaths Diphtheria 1 (-) – (-) – (–) Dysentery 22 (314) 13 (223) — (–) Erysipelas 21 (25) 20 (25) — (–) Encephalitis, acute 2 (1) 1 (1) — (1) Food poisoning 67 (36) 20 (15) 1 (–) Malaria, — (1) — (1) — (–) Measles 1.542 (1,184) 1,541 (1.180) — (–) Meningococcal infection 5 (4) 4 (4) – (–) Ophthalmia neonatorum — (2) — (2) — (–) Paratyphoid fever — (-) — (-) — (–) Pneumonia 99 (110) 98 (107) 83 (79) Poliomyelitis and polioencephalitis 35 (21) 22 (14) 2 (–) Puerperal pyrexia 142 (133) 142 (133) – (–) Scarlet fever 71 (115) 67 (108) – (–) Smallpox — (-) – (-) – (–) Typhoid fever — (-) — (-) – (–) Whooping cough 289 (226) 287 (226) 1 (–) Table 14 Whooping Cough Cases and Deaths: Willesden and England and Wales Cases confirmed Case rate per 1,000 population Children vaccinated in Willesden Year Willesden England & Wales Willesden England & Wales 1948 423 146,410 2.35 3.42 – 1949 205 102.816 1.13 2.39 1,615 1950 648 157,781 3.57 3.60 822 1951 543 169,441 3.02 3.87 1,163 1952 328 114,869 1.82 2.61 946 1953 450 157,842 2.52 3.58 1,333 1954 295 105,901 1.66 2.39 1,198 1955 171 79,092 .97 1.80 1,020 1956 226 92,396 1.21 2.06 1,814 1957 287 85,004 1.59 1.89 3,073 Table 15 Poliomyelitis 0—15 years 15 years and over Total Notified 27 8 35 Confirmed 17 5 22 Non-paralytic 4 — 4 Paralytic 13 5 18 Fatal 2 – 2 29 BRONCHITIS, CANCER OF LUNG AND TUBERCULOSIS Table 16 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 1957 174,100 159 25 184 13 — 13 2,027 295 2,322 Table 17 Tuberculosis: Case rate and death rate Year Population New cases Rate per 100,000 population Deaths Rate per 100,000 population Pulmonary Nonpulmonary All forms Pulmonary Nonpulmonary All forms 1938 187,600 112 30 142 62 6 68 1946 170,550 150 20 169 48 9 56 1952 180,400 127 15 142 16 2 18 1953 178,500 121 16 137 13 1 14 1954 177,300 129 19 148 19 2 21 1955 176,000 86 13 99 14 1 15 1956 174,900 80 13 93 14 — 14 1957 174,100 91 14 105 7 — 7 Table 18 Bronchitis: Deaths Year Males Females Total Rate per 100,000 population 1938 28 30 58 31 1946 81 55 136 80 1952 103 72 175 97 1953 103 59 162 91 1954 80 41 121 68 1955 75 60 135 77 1956 91 53 144 82 1957 78 41 119 68 30 Table 19 Malignant neoplasms lung and bronchus: Deaths Year Males Females Total Rate per 100,000 Population 1938 38 7 45 24 1946 41 8 49 29 1952 57 18 75 42 1953 67 8 75 42 1954 60 16 76 43 1955 77 19 96 55 1956 74 15 89 51 1957 93 16 109 63 Table 20 Tuberculosis: New cases and deaths by age groups (Deaths in brackets) Age groups New cases Respiratory Non-respiratory Male Female Male Female Under 1 1 (—) — (—) — (—) — (—) 1 to 5 2 (—) — (—) 1 (—) 5 to 10 — (—) 2 (—) — (—) — (—) 10 to 15 – (–) 1 (–) — (–) — (—) 15 to 20 4 (—) 4 (—) 2 (—) 2 (—) 20 to 25 11 (–) 15 (–) 1 (—) 3 (—) 25 to 35 20 (–) 22 (–) 4 (–) 4 (–) 35 to 45 11 (2) 12 (—) — (—) 1 (—) 45 to 55 18 (–) 5 (—) 2 (—) 2 (—) 55 to 65 14 (4) 5 (–) 1 (–) 1 (–) 65 and upwards 10 (7) 2 (–) 1 (–) – (–) Totals 91 (13) 68 (–) 11 (–) 14 (–) Table 21 Tuberculosis 1957: Cases by wards Ward Pulmonary cases Nonpulmonary cases Pulmonary rate per 1,000 Combined rate per 1,000 Carlton 14 1 1.14 1.23 Kilburn 14 3 1.04 1.27 Brondesbury Park 7 2 0.56 0.73 Kensal Rise 5 1 0.44 0.53 Manor 15 1 1.13 1.21 Harlesden 13 1 0.93 1.01 Stonebridge 15 1 1.21 1.29 Roundwood 12 2 1.02 1.19 Church End 12 — 0.93 0.93 Willesden Green 11 1 0.82 0.90 Mapesbury 14 5 111 1.50 Gladstone 9 2 0.77 0.95 Cricklewood 9 2 0.79 0.96 Brentwater 9 3 0.78 1.05 Whole Borough 159 25 0.91 1.05 31 Table 22 Tuberculosis 1955—1957: Cases by wards Ward Pulmonary cases Nonpulmonary cases Pulmonary rate per 1,000 Combined rate per 1,000 Carlton 41 6 1.12 1.28 Kilburn 49 10 1.21 1.45 Brondesbury Park 18 5 0.48 0.61 Kensal Rise 25 3 0.73 0.82 Manor 33 3 0.83 0.90 Harlesden 38 9 0.90 1.12 Stonebridge 37 1 0.98 1.01 Roundwood .39 9 1.10 1.36 Church End 31 1 0.79 0.82 Willesden Green 31 6 0.77 0.92 Mapesbury 39 8 1.04 1.20 Gladstone 24 4 0.69 0.80 Cricklewood 21 3 0.61 0.70 Brentwater 25 3 0.72 0.81 Whole Borough 451 71 0.86 0.99 Table 23 Tuberculin Testing, 1953-1957 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 1957 1,295 31 2.4 1,496 44 2.9 1,753 348 20.0 Table 24 Tuberculosis: B.C.G. vaccination of school leavers, 1953-1957 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) 1957 1,403 (80) 1,290 (92) * Percentage of total tested. † Percentage of negatives vaccinated. 32 Table 25 Tuberculosis: Notification of deaths 1952 1953 1954 1955 1956 1957 1952-57 Deaths 29 25 37 27 25 13 156 Percentage not notified 21 28 19 15 24 15 20 Percentage notified before death: 0—12 months 21 8 11 15 20 15 15 1—5 years 31 28 30 26 4 23 24 Over 5 years 27 36 40 44 52 47 41 SANITARY INSPECTION OF THE AREA Table 26 Demolition and Closing Orders Housing Act, 1957 (Sections 16 and 18) Demolition Orders, section 16 Housing Act, 1957 The Cottage, 2a St. Mary's Road. 1 Closing Orders, section 18 Housing Act. 1957 11 10 Acton Lane (basement) 127 Cambridge Road (basement) 13a Cambridge Avenue (basement) 39 Oxford Road (basement) 22 Cambridge Avenue (basement) 33a Victoria Road (basement) 90 Carlton Vale (basement) 19 College Parade (basement back room) 103 Carlton Vale (basement) 150 Kilburn Park Road (basement) 17 Brondesbury Villas (basement) Table 27 Overcrowding (a) Dwellings overcrowded at end of year 1914 (b) Overcrowding reported during the year 105 (c) (i) Overcrowding relieved during the year 71 (ii) Persons 135 (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 64 (ii) Families 85 (iii) Persons 510 (f) Overcrowding in Council houses relieved during the year 17 (g) Section 61. Housing Act, 1936—Licences issued 5 Table 28 New Dwellings, 1957 Houses Flats Rebuilds Dwellings built by private builders (excluding those built by the police authorities) 3 58 Nil Built by local authority 9 92 Nil Applicants on Council's waiting list at 31.12.57 10,864 33 Table 29 Housing Defects 1957 1956 Premises inspected on complaint 2,657 3,479 For infectious diseases 338 604 Others 195 27 Under special survey — 620 Total number of premises inspected 3,190 4,730 No. of inspections and re-inspections 12,558 19,548 Table 30 Notices served under Public Health Act, 1936 and Housing Act, 1957 Intimation notices served 1,208 1,940 Intimation notices complied with 1,277 1,901 Statutory notices served (Public Health Act, 1936) 956 1,395 Statutory notices complied with (Public Health Act, 1936) 957 1,341 Statutory notices served (Housing Act, 1957) 29 436 Statutory notices complied with (Housing Act, 1957) 69 643 Non-compliance with statutory notices referred to Town Clerk (Public Health Act, 1936, sec. 93) †147 268 Referred to the Borough Engineer for work to be carried out in default of owners *182 331 * 102 work done by Borough Engineer. t Details of cases referred to the Town Clerk during year:— Work carried out 71 122 Work in hand — 1 Court orders obtained 22 35 Summonses withdrawn—notices complied with 35 (4) 72 (7) Proceedings pending 15 31 Total 147 268 (The figures in brackets are the notices withdrawn and reserved) Table 31 Certificates of Disrepair (a) Housing Repairs and Rents Act, 1954 Applications received from tenants 6 Number investigated 6 Granted 6 Applications for revocation certificates received from owners 6 Granted 5 Refused 1 (b) Rent Act 1957 (date of operation 6th July, 1957) Applications (Form I) received and investigated 176 Agreed and proposal to issue Certificate of Disrepair (Form J) served 174 Refused 2 Undertakings (Form K) received from landlords 84 Accepted 83 Refused 1 Certificates of Disrepair (Form L) issued 33 Applications received for cancellation of Certificates of Disrepair (Form M) 4 Granted 3 Refused 1 34 Table 32 Summary of nuisances and of improvements effected Water suppply and water service 1957 1956 New cisterns provided 12 37 Cisterns cleansed, repaired, covered, etc. 33 94 Draw taps placed on mains 10 16 Drainage and sewerage Water closets: Repaired, supplied with water or otherwise improved 271 705 New closets built 2 10 Provided with better ventilation — 8 Drains: Examined, tested, exposed, etc. 71 104 Unstopped, repaired, trapped, etc. 197 280 New soilpipes or vent shafts fixed 18 46 Disconnecting traps or chambers inserted 22 28 Reconstructed 52 77 New manhole covers 22 44 Soilpipes or vent shafts repaired 61 250 Other defects Smoke nuisances 27 18 Accumulation of refuse 71 71 Fowls, pigs, etc., kept in an unsanitary condition 13 18 Dampness 525 1,223 Yard and forecourts paved, repaved or repaired 124 469 Walls and ceilings cleansed 570 1,094 Verminous rooms disinfested 285 238 Leaky roofs made watertight 662 1.626 Additional ventilation provided under floors 28 77 Dilapidated plaster repaired 955 2,667 Flooring and other woodwork repaired 510 1,940 Damp proof courses inserted 93 204 Water supply reinstated 26 103 Wash house floors repaired or repaved 13 129 Fireplaces and stoves repaired 282 1,098 Decayed brickwork repaired and repointed 329 1,627 Sinks provided or replaced 66 246 Additional light and ventilation to staircase 4 41 Larders or food cupboards ventilated or provided 2 16 Gutters and/or rainwater pipes repaired or renewed 568 1,517 New sashcords and glass provided to doors and windows 1,073 4,320 Miscellaneous 329 1,002 Total nuisances abated 7,326 22,253 35 Table 33 Inspection of factories, outworkers premises and food factories 1957 1956 No. Inspections No. Inspections inspected made inspected made Offensive trades — — — — Power factories 809 1,133 740 827 Non-power factories 72 106 45 48 Homeworkers and outworkers 251 251 170 170 Inspection of food premises (includes re-visits) Baker 30 122 36 111 Bread and confectionery 35 85 38 76 Dairy 3 31 3 45 Butcher 120 306 117 255 Grocer and general store 337 791 312 504 Fishmonger and fish-fryer 47 110 60 110 Cafe and restaurant 144 367 157 327 Greengrocer and fruiterer 126 297 120 183 fee cream and sweet shop 219 480 178 277 Food stall 10 24 16 20 Public House 43 86 43 87 Works canteen 113 168 113 114 Food factory 11 19 13 14 Any other food premises 31 76 26 51 Total periodic inspections 2,401 4,452 2,187 3,219 Table 34 Other inspections 1957 1956 No. Inspections No. Inspections inspected made inspected made Certificates of Disrepair under Housing Repairs and Rents Act, 1954 and Rent and Mortgage Interest Restrictions Acts – 33 – 44 Certificates of Disrepair under Rent Act, 1957 — 313 — — Public house urinals 44 122 44 114 Mews and stables 15 15 9 9 Miscellaneous — 2,009 — 1,587 Smoke observations 85 844 72 574 Verminous rooms 95 152 71 190 Total other inspections 3,488 2,518 Total all inspections 20,498 25,285* * Includes housing survey. 36 CLEAN AIR Table 35 Examination of sulphur by lead peroxide method, (milligrams of SO3 per day per 100 square centimetres) Site January February March April May June July August September October November December Minet Gardens 3.36 3.76 3.26 1.87 1.33 1-44 1.01 1.06 1.01 2.37 2.70 3.01 Town Hall 2.56 4.21 3.60 1.94 I -22 1-36 0.79 0.87 0.95 2.30 3.45 3.36 Table 36 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 32.67 226.78 14.75 27.94 24.06 20.25 13.80 February 32.77 91.93 18.96 27.00 26.34 16.00 16.20 March 29.73 56.93 16.89 23.86 23.52 23.38 21.63 April 15.70 23.06 11.16 11.36 11.99 10.43 9.51 May 26.11 29.33 20.48 20.64 20.48 18.44 17.05 June 19.45 27.90 14.62 17.27 12.09 13.89 12.18 July 23.43 31.15 15.87 22.33 20.64 17.22 18.44 August 20.41 25.35 19.96 18.56 22.20 19.33 16.63 September 30.69 35.85 23.70 27.53 27.17 23.58 24.89 October 40.26 55.67 21.17 25.85 27.50 21.40 19.99 November 30.16 36.48 17.78 29.33 23.86 27.39 27.06 December 33.86 77.04 19.42 29.19 18.89 23.05 23.71 Total 335.24 717.47 214.76 280.86 258.74 234.36 221.09 37 DISINFESTATION Table 37 (a) Verminous premises: Council properties 25 County Council properties 1 Private properties 99 Total 125 (b) Verminous rooms:* Council properties 66 County Council properties 2 Private properties 217 Total 285 *Some rooms are treated more than once. (c) Bedding materials (i) disinfested 17 (ii) disinfected 10 (d) Miscellaneous: Beetles 9 Ants 2 INSPECTION AND SUPERVISION OF FOOD AND FOOD PREMISES Table 38 Food premises: Defects remedied Defects Outstanding at 31.12.56 Found during the year Total Remedied during year Outstanding at 31.12.57 Inadequate lighting and ventilation 14 24 38 33 5 Wash hand basins not provided 66 121 187 171 16 Inadequate refuse storage 7 31 38 34 4 Insufficient sanitary accommodation 1 35 36 23 13 Inadequate storage 9 26 35 32 3 Defective walls and ceilings 36 107 143 113 30 Dirty walls and ceilings 98 251 349 323 26 Dirty hand towels 1 20 21 15 6 Unsatisfactory conditions 5 11 16 12 4 Any other defects 173 324 497 469 28 Totals 410 950 1,360 1,225 135 Table 39 Food premises: Registration Premises on register 31.12.56 Applications received Applications granted Applications refused Premises removed from register during 1957 Total on register at 31.12.57 Inspections made 1. Sale and storage of ice cream 322 30 30 – 1 351 362 819 2. Manufacture of ice cream 11 – – – – 11 61 3. Manufacture of preserved foods 125 5 5 – – 130 264 4. Fish curing 10 — — — 4 6 19 38 Table 40 Food unfit for human consumption Meat Miscellaneous Bacon 3.462½ lbs. Apricot pulp 2 cwt. 46 lbs. Beefex 3 Cooked 91½ lbs. Chicken pie 2½ lbs. Tinned 4,836 lbs. Cakes 14 Raw 3.1574½ lbs. Chocolates 69 lbs. Fish Cocoa ½ lb. Cordial 5 bottles Cream 127 tins Tinned 942 tins Creamed rice 5 tins Custard powder 4 pkts. Raw 463 lbs. Frozen fish fingers 35½ lbs. Vegetables Frozen peas and beans 59½ lbs. Fruit juice 112 tins Tinned 4.278 tins Honey 4 lbs. Ice cream 82 pkts. Raw — Jellies 6 pkts. Fruit Lemon pie filler 6 lbs. Lemonade crystals 7 tins Tinned 9.145 tins Meat pies 9 Raw Processed coffee 1 tin Salad cream 84 bottles Bread, flour, cereals, etc. 89½ lbs. Sausages 67½ lbs. Preserves 391 lbs. Soup (tins) 775 Soup (pkts.) 12 Cheese 25¾ lbs. Syrup 1 tin Tinned milk 2,562 tins Tomato pulp 5 tons, 15 cwt. 99 lbs. Table 41 Types of food premises Baker 30 Bread and confectionery 35 Dairy 3 Butcher 120 Grocer and general store 337 Fishmonger and fish fryer 47 Cafe and restaurant 144 Greengrocer and fruiterer 126 Ice cream and sweet shop 219 Food stall 10 Public house 40 Works canteen 113 School canteen 15 Food factory 7 Other food premises 31 Total 1,277 Inspections and revisits: Inspections 2,962 Revisits 1,686 Total 4,648 Table 42 Improvements in food premises Premises unsatisfactory on 31.12.56 130 Unsatisfactory during the year 466 Premises made satisfactory during the year 537 Unsatisfactory on 31.12.57 59 39 Table 43 Food:Samples taken Article No. of samples Unsatisfactory Milk 212 2 Butter 43 — Cakes 9 — Cheese 3 1 Cream 45 — Drugs 70 3 Fish and fish products 26 2 Fruit—fresh and canned 6 2 Fruit, dried 13 — Fruit squash, etc. 9 — Ice cream 41 3 Jelly 3 — Liver 19 — Margarine 31 — Meat and meat products 68 — Non-brewed condiment 5 — Preserves 7 — Sausages and sausage meat 11 — Scrambled egg 1 1 Spirits 4 — Sweets 16 2 Vinegar 36 — Miscellaneous 24 1 Total 702 17 Table 44 Dairies—Registration and Licences Premises in Willesden 126 Dairymen 103 Licences issued Pasteurised milk 101 Sterilised milk 112 Tuberculin tested milk 81 Premises outside Willesden 12 Dairymen 7 Licences issued Pasteurised milk 12 Sterilised milk 12 Tuberculin tested milk 12 FACTORIES Table 45 On register Type of factory On register 1.1.57 Added to register Deleted from register Totals at 31.12.57 Non-power 70 3 1 72 Power 836 33 60 809 Total 906 36 61 881 40 Table 46 Factories inspected, defects found, and action taken Type of factory Inspected Total inspections Total unsatisfactory and informal notice served Outstanding from 1956 Made satisfactory 1957 Outstanding 31.12.57 Non-power 72 106 5 — 2 3 Power 809 1,133 111 19 96 34 Non-power factories:Details of defects During 1957 Outstanding from 1956 Remedied during 1957 Outstanding at 31.12.57 Want of cleanliness 2 — 1 1 Overcrowding — — — — Unreasonable temperature — — — — Inadequate ventilation — — — — Defective drainage of floors — — — — Sanitary accommodation: Insufficient 3 — 1 2 Unsuitable or defective — — — — Not separate for sexes — — — — Power factories:Details of defects of sanitary Accommodation Insufficient 4 — 4 — Unsuitable or defective 101 19 87 33 Not separate for sexes 6 — 5 1 There are 15 underground rooms used as factories; 13 are used with premises above ground. Table 47 Outworkers and homeworkers Premises inspected Satisfactory Unsatisfactory and notice served Remedied 261 247 14 14 CARE OF MOTHERS AND YOUNG CHILDREN Table 48 Ante-natal Clinics Clinic Sessions New cases Attendances Average attendance per session Antenatal Postnatal Antenatal Postnatal Kilburn 103 324 22 1,339 22 13.2 Willesden 153 384 7 1,563 7 10.0 Stonebridge 150 556 11 3,589 11 24.0 Cricklewood (Sneyd Road) 53 221 13 586 13 11.3 Neasden (St. Catherine's) 51 58 1 287 1 5.7 Kensal Rise (St. Martin's) 53 160 2 802 2 15.2 South Kilburn (St. Luke's) 53 114 — 661 3 13.1 Totals: 1957 616 1,817 56 8,827 59 14.3 1956 645 1,671 74 7,786 85 12.2 41 Table 49 Births Hospital and Domiciliary 1957 1956 Total notified live births 2,796 2,638 Born in institutions 2,383 2,262 Born at home 413 376 Percentage born in institutions 84.5 85.8 Institutions Central Middlesex Hospital 964 987 Kingsbury Maternity Hospital 420 321 Larger hospitals outside Willesden 661 639 Smaller hospitals outside Willesden 320 286 Nursing homes, etc. 18 29 Totals 2,383 2,262 Home County Midwives 413 376 Others — — Totals 413 376 Table 50 Mothercraft Clinic Sessions New cases Total attendances Average attendance per session Kilburn 37 45 205 6 Willesden 38 48 206 6 Stonebridge 51 104 364 7 Totals: 1957 126 197 775 6 1956 117 145 711 6 Table 51 Relaxation Classes Clinic Sessions New cases Total attendances Average attendance per session Kilburn 36 70 203 6 Stonebridge 93 126 570 6 Totals: 1957 129 196 773 6 1956 131 180 705 5 Table 52 Child 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 267 438 5,432 1,063 458 6,953 3,107 26 Willesden 272 446 5,108 789 564 6,461 3,064 24 Stonebridge 286 599 7,691 1,123 804 9,618 4,043 34 Cricklewood (Sneyd Road) 103 409 3,376 663 468 4,507 1,662 44 Neasden (St. Catherine's) 100 232 4,601 975 498 6,074 1,352 61 Kensal Rise (St. Martin's) 104 260 4,025 695 481 5,201 1,567 50 South Kilburn (St. Luke's) 100 184 2,557 335 171 3,063 1,463 31 Totals: 1957 1,232 2,568 32,790 5,643 3,444 41,877 16,258 34 1956 1,243 2,379 29,935 5,179 3,172 38,286 16,433 31 42 MIDWIFERY SERVICE Table 53 Midwives' Clinics Sessions New Cases Total attendances Average attendance 1957 233 526 3,420 14.6 1956 267 549 2,675 10.0 Table 54 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 delivery 208 (b) When doctor was present at delivery 42 Number of cases in which pethidine was administered in domiciliary practice during the year: (a) When doctor was not present at delivery 56 (b) When doctor was present at delivery 17 Totals: 1957 323 1956 347 Table 55 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 — 20 73 274 12,855 26 124 335 Totals: 1957 367 12,855 26 124 335 1956 327 11,266 22 111 288 Table 56 Medical Aid 1957 1956 (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 70 53 (ii) Others 7 11 Totals 77 64 43 Medical Aid For Mother For Child Retained Placenta 1 Sticky eyes 4 Repair of Perineum (Scar Tissue) 3 Septic spots 3 Poor condition before delivery 1 Blue asphyxia 2 Early rupture of membranes 2 Premature baby 3 Post-partum haemorrhage 6 Suppression of lactation 2 Ruptured perineum 33 Raised blood pressure 1 Vaginal bleeding 1 Delayed 2nd stage 4 Vomiting and restlessness 1 Mentally disturbed 1 Raised temperature 3 Foetal distress 2 Ante-partum haemorrhage 3 Pain in leg 1 Totals: 65 12 44 HEALTH VISITING Table 57 Visits made by Health Visitors Year Expectant Mothers Children under 1 year Children 1—2 years Children 2—5 years Tuberculous Households General First Total First Total Total Total Total Total as health visitor Total as school nurse 1957 1,600 2,193 3,000 11,062 4,403 8,661 13 1,779 914 1956 1,282 1,767 2,649 8,754 3,584 7,388 13 1,152 665 Table 58 Cases referred by General Practitioners for:— Care of children Elderly persons General advice Hospital admission Home help Welfare foods Others Total 3 20 — 3 — — 2 28 45 Table 59 Establishment:Health Visitors Whole time equivalent as at: 31.12.56 31.12.57 Health Visitors (Whole time) 14 19 (Part time) 1 4/11 4/11 (Sponsored) 1 1/11 1 4/11 Clinic Nurses (Whole time) 10 8 Health Assistant (Part time) 2/11 — Totals 26 7/11 28 8/11 HOME NURSING Table 60 Work: Home Nurses New Cases Visits Cases on register at end of year Male Female Male Female Medical 1,076 1,780 92,466 268 558 Surgical 169 265 14,242 30 55 Infectious 6 4 70 1 — Tuberculosis 61 35 4,948 22 6 Maternal complications — 23 303 — 2 Others — — — — — Total 1,312 2,107 321 621 Totals: 1957 3,419 112,029 942 1956 3,749 115,478 1,037 Table 61 Establishment:Home Nurses Nurses 1.1.57 31.12.57 Whole time 20 21 Part time 5 5 Candidates 8 5 Total whole time equivalent 27 26½ SMALLPOX Table 62 Vaccination Under 1 year 1 year 2—4 years 5—14 years 15 years and over Total Primary Vaccinations 1,212 141 105 177 163 1,798 Re-vaccinations + + 7 94 588 689 Totals: 1957 1,212 141 112 271 751 2,487 1956 858 102 36 78 409 1,483 Approximate number of children (end of 1957) 0— 5 13,337 5—15 21,646 34,983 46 DIPHTHERIA Table 63 Immunisation Age at 31.12.57 Under 1 1 2 3 4 5—9 10—14 Totals Courses completed (primary or boosting) during last 5 years 1953-57 222 1,192 1,094 1,321 1,207 4,223 617 9,876 Courses completed (primary or boosting) during the period 1943-52 — — — — — 5,094 11,921 17,015 Approximate number of children (end of 1957) 0— 5 13,337 5—15 21,646 34,983 POLIOMYELITIS VACCINATION Table 64 Year of Birth No. registered at 31.12.57 No. received two injections at 31.12.57 1943 4 — 1944 12 — 1945 19 — 1946 54 — 1947 1,021 582 1948 1,079 713 1949 1,044 704 1950 1,095 669 1951 847 392 1952 820 209 1953 808 161 1954 806 150 1955 436 119 1956 371 14 1957 64 — Totals: 8,480 3,713 47 Table 65 Cases:Home Helps Cases receiving help at No. of new cases helped during No. of cases receiving help at 1.1.57 1.1.56 1957 1956 31.12.57 31.12.56 Maternity 2 2 86 77 5 3 Tuberculosis 27 36 5 14 15 25 Chronic sick and aged 522 494 253 253 513 511 Others 45 64 86 84 50 45 Totals 596 596 430 428 583 584 Table 66 Staff: Home Helps Position at Appointments during Resignations during Position at Whole time 1.1.57 1.1.56 1957 1956 1957 1956 31.12.57 31.12.56 2 2 — 1 1 1 1 2 Part time 84 93 27 22 28 31 83 84 Total 86 95 27 23 29 32 84 86 DAY NURSERIES Table 67 Day Nurseries: Attendances Day Nursery Approved places Children on register at 31.12.57 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 22 36 4,538 7,491 18 29 Crest Road 25 25 — — 3,058 2,926 18 17 Essex Road 25 25 25 30 5,276 6,165 21 24 Evefield 25 25 20 22 4,045 4,215 16 17 Gladstone Park 25 25 25 20 4,908 4,478 19 18 Longstone Avenue 25 25 24 19 5,284 3,925 21 16 Mortimer Road 25 25 25 24 5,145 5,829 20 23 Villiers Road 25 25 31 24 6,091 5,464 24 21 Wesley Road 15 25 18 16 2,782 4,092 11 16 Totals: 1957 208 232 190 191 41,127 44,585 168 181 1956 208 232 202 210 37,805 44,708 149 175 48 Table 68 Day Nurseries:Applications Nursery Applications received Children admitted Children left Chichester Road 89 51 47 Crest Road 33 33 28 Essex Road 88 53 55 Evefield 39 35 41 Gladstone Park 100 48 52 Longstone Avenue 74 53 37 Mortimer Road 95 77 72 Villiers Road 103 63 50 Wesley Road 61 41 41 Totals 682 454 423 Table 69 Day Nursery Applicants Not Admitted Reason Number of applications Percentage Moved away 57 25% Domestic circumstances changed 57 25% Private minder 46 20% Fees to high 34 15% Admission refused—no grounds under County Council Regulations 14 6% Reason unknown 14 6% Placed on waiting list 6 3% 228 100% Table 70 Day Nurseries: Priorities Nursery Unsupported Mothers Medical reasons Bad Housing Total on Register Priorities as percentage of total Chichester Road 36 12 7 55 100 Crest Road 13 8 15 38 95 Essex Road 28 11 20 60 98 Evefield 14 6 16 37 97 Gladstone Park 19 4 22 46 97 Longstone Avenue 20 19 7 46 100 Mortimer Road 30 12 7 51 96 Villiers Road 20 7 21 48 100 Wesley Road 14 2 17 34 96 Totals 194 81 132 415 98 49 Table 71 Day Nurseries:Infectious Diseases Number of Cases Nursery Measles Scarlet Fever Chicken Pox Gastroenteritis Mumps German Measles Whooping Cough Chichester Road — — 21 — — Crest Road — — 5 — 1 1 — Essex Road — — 19 — 1 — — Evefield 1 — 1 — — 1 — Gladstone Park 13 1 1 — 1 1 — Longstone Avenue 1 — 2 — — — 1 Mortimer Road 2 — — 1 — — — Villiers Road 1 — — — — — 1 Wesley Road 7 — — — — — 1 Totals 25 1 49 1 3 3 3 Table 72 Day Nursery Staff Establishment Establishment Position as at: 31.12.56 31.12.57 Supervisory Matron 1 1 1 Matrons 8 9 8 Deputy Matrons 8 9 8 Wardens 8 6 5 Nursing Staff 44 45 44 Students 20 11 14 Domestic Staff (part time) 34 36 34 SCHOOL HEALTH SERVICE Table 73 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 1957 2,080 2,344 2,114 6,538 1,532 6,281 2,703 1956 2,108 2,082 2,135 6,325 2,418 6,926 1,936 Table 74 Pupils Found to Require Treatment Periodic age groups inspected For defective vision (excluding squint) For any of the other conditions in Table 76 Total individual pupils Entrants 32 186 212 Age 10 and 11 years 135 173 303 Leavers 126 157 275 Total 293 516 790 Additional periodic inspections 89 122 205 Grand Total 382 638 995 50 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 2,080 2,011 96.7 69 3.3 Age 10 & 11 years 2,344 2,294 97.9 50 2.1 Leavers 2,114 2,090 98.8 24 1.2 Additional periodic inspections 1,532 1,514 98.8 18 1.2 Total 8,070 7,909 98.1 161 1.9 Table 76 Defects Found by Medical Inspection Defect or disease * Periodic inspections Special inspections Entrants Leavers Total —including all other age groups inspected (a) (b) (a) (b) (a) (b) (a) (b) Skin 11 71 47 64 76 254 237 54 Eyes (a) Vision 32 36 126 116 382 439 26 32 (b) Squint 18 40 9 17 39 124 7 1 (c) Other 12 5 6 11 30 59 88 38 Ears (a) Hearing 7 15 5 4 23 58 54 26 (b) Otitis media 5 59 8 11 16 112 2 7 (c) Other — 2 2 1 4 15 2 27 Nose and throat 53 259 8 23 124 448 71 34 Speech 26 50 1 2 37 107 12 17 Lymphatic glands 5 95 — 12 6 153 2 — Heart — 26 1 18 1 79 — — Lungs 5 87 — 31 9 203 16 16 Developmental (a) Hernia 3 4 — 2 4 10 — — (b) Other 1 72 3 6 17 181 3 2 Orthopaedic (a) Posture 7 36 23 47 60 189 1 10 (b) Feet 21 81 27 47 103 258 15 2 (c) Other 6 54 7 24 38 162 22 36 Nervous system (a) Epilepsy — 3 — 9 — 21 1 — (b) Other — 29 — 2 — 52 2 4 Psychological (a) Development 2 27 — 10 3 95 21 9 (b) Stability 2 117 2 51 13 350 12 38 Abdomen 1 26 — 5 3 68 1 — Other 195 34 95 51 494 194 536 73 Totals 412 1,228 370 564 1,482 3,631 1,131 426 *(a) Requiring treatment (b) Requiring observation. 51 Table 77 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 by the County Council Otherwise 87 12 (b) Errors of refraction (including squint) 75 1,312 Totals 1957 162 1,324 1956 1,405 (c) Number of pupils for whom spectacles were prescribed 1957 — 550 1956 589 (ii) Diseases and Defects of Ear, Nose and Throat Received operative treatment for: (a) diseases of the ear — 14 (b) adenoids and chronic tonsilitis — 103 (c) other nose and throat conditions — 11 Received other forms of treatment 146 — Totals 1957 146 128 1956 358 Total number of pupils in schools who are known to have been provided with hearing aids: (a) during the current year — 3 (b) in previous years (excluding any pupils shown at (a) above who were provided with an aid in the previous year). — 28 (iii) Orthopaedic and Postural Defects Number of pupils known to have been treated at clinics or at out-patient departments 1957 372 441 1956 918 (iv) Diseases of the Skin (Excluding Uncleanliness) Ringworm (i) Scalp — — (ii) Body — — Scabies — — Impetigo 56 — Other skin diseases 274 — Totals 1957 330 — 1956 460 (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) 233 — (vi) Speech Therapy Number of pupils treated by speech therapists under arrangements made by the authority 1957 380 — 1956 361 (vii) Other Treatment Given (a) Number of miscellaneous minor ailments treated by the County Council 880 — (b) Treatment other than (a) above and excluding convalescent treatment: 1. Lymphatic glands 3 — 2. Heart — — 3. Lungs 67 — 4. Developmental (a) Hernia — — (b) Other — — 5. Nervous system (a) Epilepsy 1 — (b) Other 5 — 6. Psychological (a) Development 12 — (b) Stability 16 — 7. Abdomen — — 8. Other 10 — Totals 1957 994 — 1956 1,184 52 Table 78 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 1,077 1,003 128 82 11.9 8.2 Age 10 and 11 years 1,186 1,158 279 240 23.5 20.7 Leavers 1,014 1,100 160 225 15.8 20.4 Other periodic inspections (by age group) 7—8 611 626 119 111 19.5 17.7 12—13 37 258 18 58 48.6 22.5 Totals 3,925 4,145 704 716 17.9 17.3 Table 79 Orthoptics—Cases seen at Willesden Health Clinic (a) Cases seen No. treated Placed on operation waiting list No treatment required Failed to attend Total 24 10 — — 34 (b) Cases treated Discharged cured Operation waiting list Observation Ceased to attend 18 (orthoptic) 11 16 2 Table 80 Audiometry:Children Tested Total tested Absentees Failure Total Both ears One ear 63 L. R. 8,165 859 56 43 162 4,684 537 37 37 32 106 Table 81 Summary of Failures to pass Audiometer Test Passed at second test 24 Referred to Assistant Medical Officers 47 Normal Hearing after removal of wax 22 Under observation by hospital or private doctor 16 No action—further test recommended after given period 23 Referred for Tonsils and Adenoids operation 7 Appointments not accepted 4 Referred by A.M.O.'s to Ear, Nose and Throat Specialist 19 Treatment considered of little value 17 Referred to hospital 8 Hearing improved after treatment 11 Recommended for Hearing Aid 3 Awaiting appointments 24 Failed to attend appointments wearing Hearing Aid 9 53 Table 82 Speech Therapy Clinic or School No. of cases dealt with during the year Kilburn clinic 156 Willesden clinic 65 Stonebridge clinic 112 Lower Place special school for physically handicapped pupils 32 Leinster special school for educationally subnormal pupils 15 Totals 1957 380 1956 365 Table 83 Infestation with Vermin 1957 1956 Total no. of examinations 34,874 34,611 Total no. of individual pupils found to be infested for the first time during the current year 713 701 Number of individual pupils in respect of whom cleansing notices were issued under section 54/2 Education Act, 1944 136 149 Number of individual pupils in respect of whom cleansing notices were issued under section 54/3 Education Act, 1944 10 21 Table 84 Employment of Children and Young Persons 1957 1956 No. of children medically examined in order to ascertain whether they were physically fit to undertake employment of a light nature outside school hours 205 193 No. of instances in which the state of health was found to be such that certificates were withheld — — No. of children examined as to fitness to take part in entertainments 5 10 No. of cases in which certificates to take part in entertainments were withheld 1 1 Table 85 Medical Examination of Teachers 1957 1956 No. of teachers examined as to fitness for appointment 3 2 No. of students examined as to fitness for first appointment 88 43 No. of students examined as to fitness to undertake training course 41 46 54 Table 86 Return of Handicapped Pupils (Year Ended 31st December, 1957) 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 — 2 — — — 2 — — — 2 — — — — — — — 2 Partially-Sighted Pupils 13 9 1 — 12 10 10 8 1 2 — — — — 1 — 12 10 Deaf Pupils 10 6 1 — 13 7 7 3 5 3 — — — 1 1 — 13 7 Partially Deaf Pupils 2 3 — — 2 2 2 — — 2 — — — — — — 2 2 Delicate Pupils Diabetic Pupils 45 25 20 12 37 15 7 3 26 9 2 3 1 — 1 — 37 15 Educ. Sub-normal Pupils 74 56 13 11 80 66 59 50 11 10 8 5 1 1 1 — 80 66 Epileptic Pupils 3 1 1 — 4 1 — — 4 1 — — — — — — 4 1 Maladjusted Pupils 50 12 11 8 42 16 — — 10 2 9 1 21 11 2 2 42 16 Physically Handicapped Pupils 30 24 7 5 31 19 26 17 2 1 — — — — 3 1 31 19 Pupils with Speech Defects Pupils with Multiple 307 97 48 31 317 106 — — — — 294 100 — — 23 6 317 106 Defects 31 21 7 4 35 20 35 19 — — — — — — — 1 35 20 Total 565 256 109 71 573 264 146 100 59 32 313 109 23 13 32 10 573 264 Grand Totals 1957 821 180 837 246 91 422 36 42 837 1956 807 231 821 232 157 402 — 30 821 55 Table 87 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 31.12.57 Leinster Special School for Educationally Sub-Normal Pupils Willesden 22 20 13 Ealing 2 1 7 Totals 24 21 20 Lower Place Special School for Physically Handicapped Pupils Willesden 11 10 — Wembley 3 4 — Ealing 5 5 — Acton 3 3 — Hendon 2 2 — Totals 24 24 — Table 88 The Educational Sub-Normal Education Act, 1944 — Sections 57 (3), 57 (4) and 57 (5) 1957 1956 Cases dealt with under section 57, Education Act, 1944:— Sub-Section 3 8 10 Sub-Section 4 — — Sub-Section 5 20 20 Cases de-notified under section 8, Education (Miscellaneous Provisions) Act, 1948 — 1 CHILD GUIDANCE Child Guidance (Table 89) Waiting list at 1.1.57 Total cases seen by Psychiatrist New cases seen by Psychiatrist Other cases seen by Psychiatrist New cases referred Cases not requiring to be seen by Psychiatrist Waiting list at 31.12.57 81 116 72 44 71 70 10 56 Table 89a Main Symptoms Cases Behaviour difficulties (aggressiveness, etc.) 26 Anxiety (including night terrors) 2 Enuresis 10 Failure to progress at school 6 Habits (Tics, thumb-sucking, nail-biting, etc.) 4 Psychosomatic disorders 1 Soiling 1 Speech difficulties 2 Stealing 8 Truancy and wandering 9 Others 3 72 RHEUMATISM Table 90 Clinic—Attendances (Figures in backets are those found to be suffering from Rheumatism) Total attendances History of rheumatism Dampness in home Social Groups IV and V 13 (15) 7 (4) 12 (7) 21 (11) Table 91 Rheumatism Treatment Sent for convalescence 6 Sent to special school for physically handicapped 1 Referred to orthopaedic clinic 4 Referred to chiropodist 1 Referred to specialist 4 Reports requested from hospital 4 Medicaments and vitamins given 3 Referred to Medical Officer of Health 12 SCHOOL DENTAL SERVICE Table 92 Inspection and Treatment (a) Inspection Age Groups Inspected Required Treatment Referred for Treatment 1957 1956 1957 1956 1957 1956 Under 5 71 70 49 32 45 32 5—16 17,479 17,619 12,166 12,276 11,737 10,103 Specials 1,594 1,607 1,421 1,491 1,411 1,460 Totals: 19,144 19,296 13,636 13,799 13,193 11,595 57 (b) Treatment 1957 1956 No. of pupils actually treated: 6,139 5,898 No. of attendances 19,176 16,577 No. of half-days of Inspection 217½ 207½ Treatment 2,612½ 2,279½ No. of fillings: (a) Permanent teeth 11,563 9,887 (b) Temporary teeth 3,996 4,582 No. of extractions of: (a) Permanent teeth 673 706 (b) Teeth for orthodontia 319 306 (c) Temporary teeth 3,679 4,058 No. of anaesthetics: (a) General 1,943 2,110 (b) Local 953 946 No. of other operations 9,737 9,037 PRIORITY DENTAL SERVICE Table 93 Expectant Mothers Nursing Mothers Children under 5 1957 1956 1957 1956 1957 1956 Number examined 256 220 102 78 760* 849 Number required treatment 248 212 102 76 528 574 Number of new cases commenced treatment 251 215 139 106 475 523 Dentally fit 78 68 79 52 361 365 Extractions 271 262 144 171 316 342 Fillings 632 647 345 264 863 874 Scaling and gum treatment 157 132 108 52 — — Silver nitrate dressings — — — — 745 681 Dentures 28 23 56 52 — — Number of attendances 891 819 684 475 1,138 1,161 Number of appointments not kept 225 167 115 58 190 165 *including 275 at day nurseries. 58 Table 94 Chiropody—Defects Condition Expectant and Nursing Mothers Boys Girls Total 0—5 yrs. School 0—5 yrs. School Varrucae 2 1 50 — 104 157 Warts 3 — 13 2 16 34 Corns 63 9 31 2 67 172 Hallux Valgus — — 1 — 22 23 Callosities 9 — 2 7 2 20 Nail conditions 8 3 5 4 10 30 Claw toes — — 2 1 8 11 No treatment required 1 1 5 1 15 23 Hallux Rigidus 1 — 2 — 2 5 Bursitis 1 — 2 — 5 8 Epidermophytosis 2 — 7 — 9 18 Chilblains — — — — 4 4 Metatarsalgia 7 — — — 2 9 Totals 97 14 120 17 266 514 DEANER PRINTERS LTD. (T.U.). LONDON