AC. 439(1) WIL 55 Borough of Willesden 1959 THE S. LEFF, M.D., D.P.H., Barrister-at-Law, Medical Officer of Health CONTENTS Aged—care of Page Laundry service 15 Old People's Welfare Committee 16 Voluntary services 15 Bacteriological examinations 5 Basement bakehouses 14 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 17 Convalescence 21 Coroner's court 16 Day nurseries 21 Dental service 22 Disinfestation 11 Diphtheria immunisation 20 Factories 13 Food Contaminated food 12 Education in food hygiene 11 Food poisoning 7 & 12 Improvements in premises 11 Registration of premises 11 Sampling 12 Unsound food 12 Hawkers—licensing of 17 Health education 6 Health visiting 19 Home safety 22 Home help service 20 Home nursing 20 Hospitals Facilities 17 Liaison 17 Household arrangements 8 Housing Demolition and closing orders 9 Nuisances abated 10 Rent Act, 1957 10 New dwellings 10 Notices served 10 Overcrowding 10 Slum clearance 10 Ice cream 5 Infant mortality 5 Infectious diseases Page Dysentery 7 Food poisoning 7 & 12 Poliomyelitis 7 Puerperal pyrexia 7 Whooping cough 7 Laboratory service 5 Massage and special treatment establishments 6 Maternity and child welfare Ante-natal care 18 Clinics 18 Medical examination of staff 17 Midwifery service 19 Milk and dairies 13 Mortuary 16 National Assistance Act, 1948 Burials 16 Removal to hospitals 15 Noise 14 Occupational health service 14 Outworkers and homeworkers 14 Pet Animals Act, 1951 17 Poliomyelitis inoculation 20 Prematurity 5 Problem families 19 Public Health Laboratory Service Rag, Flock and Other Filling Materials Act, 1951 17 Refuse disposal 8 Rodent control 11 Sanitary circumstances 8 Scabies 6 School health service Handicapped pupils Medical inspections 21 Survey of schools 21 Sewage and drainage 8 Slaughterhouses 17 Smallpox vaccination 20 Staff Medical examinations 17 Sanitary section 9 Swimming baths 9 Tuberculosis B.C.G. Vaccination Co-operation 8 Factories and workshops 8 Morbidity and mortality 7 Prevention and diagnosis 7 Vermin 11 Vital statistics Births 4 Deaths 4 Population 4 Water 8 Welfare foods 20 BOROUGH OF WILLESDEN Health Department, 54, Winchester Avenue, Kilburn, London, N.W.6. July, 1960. To the Mayor, Aldermen and Councillors of the Borough of Willesden. Mr. Mayor, Ladies and Gentlemen, I beg to submit the annual report of the health and circumstances of the borough for the year 1959. There was a further slight decrease in the population, but this does not seem to have relieved the overcrowding in the borough very much. Housing still remains the main problem in the area, and although the Council is carrying out large schemes for rehousing, many cases of serious overcrowding are reported to the Health Department; often very little can be done for them. Overcrowding and bad housing remain the most serious threats to health in the borough. During the year public inquiries were held on two clearance areas in South Kilburn and another area was confirmed by the Minister. Large surveys have been made of houses in both Stonebridge and Willesden Green for schemes of redevelopment and improvement. Also many tenants living in very poor conditions in the basements of Granville Road were rehoused. There was a further rise in the birth rate and despite an increase in the proportion delivered at hospital and a fall in the numbers delivered at home, the midwives were often overburdened with work because of shortage of staff. About nine out of ten mothers are now delivered in hospitals or nursing homes. Owing to the pressure on hospital beds some mothers have to be admitted as an emergency because no bed has been available for them at the time of booking. This often leads to misunderstanding and ill-feeling among the medical personnel involved, and sometimes to complications. It is pleasing to report that no mothers died during the year as a result of childbirth, but it is difficult to assess how many mothers suffered disability because of the inadequacy of the services. There was a further fall in the infant mortality rate and also of that of infants under four weeks of age. There was, however, a slight rise in the number of deaths of illegitimate infants under four weeks and under 1 year old. There was also a rise in the total number of illegitimate babies. There was a fall in the stillbirth rate, which must now be considered together with deaths of very young babies. It is significant that over three-quarters of the babies who died in the first year failed to survive the first two days. Clearly the causes for these deaths must be similar to those of stillbirths. Prematurity is again the most important single factor in infant mortality, accounting for over onethird of the deaths. Social conditions play an important role in this, and the number of premature births in the poorer wards is at least twice as high as those in the more properous ones. Carlton ward, as usual, shows the highest infant mortality rate, being four times as high as the more prosperous wards. There were no deaths from gastro-enteritis but twelve babies died from broncho-pneumonia; their home conditions were generally unsatisfactory with overcrowding as a prominent feature. A special study was made of congenital malformations, responsible for thirteen deaths, but all the pregnancies were normal and there was no history of virus infection or ill effects of pelvic radiation. With the improvement of health in our children there is a more rapid maturing which clearly increases the risks of having illegitimate babies. There is a need in the borough for more education on these matters so that school children can go out into the world of industry and commerce more prepared to deal with the various hazards they might meet. The common infectious diseases no longer kill or cripple children as they did in the past. However, the satisfaction expressed in the last report on the lowest recorded number of whooping cough cases since 1919 was premature: in 1959 the numbers were almost trebled. However, this is not very significant because apart from last year there was only one other year in which numbers were lower. The number of cases of poliomyelitis was only one more than in 1958, a record year. There is no doubt that vaccination is having an effect and its extension to the age group up to 40 years will certainly play an important part in eliminating this disease. Many talks were given in factories on poliomyelitis vaccination and a doctor and nurse from the health department went into many of them and vaccinated the workers there in the management's time. As a result of these facilities many more were done who might otherwise have been neglected. During the last week in May an extensive publicity campaign was carried out which included posters, films at local cinemas and a recorded broadcast at a local dance studio during dancing sessions and classes. A striking exhibit was also shown at the Willesden Show in September. There was a further increase in the number of cases of dysentery and there were two outbreaks at day nurseries and one in the hostel at 91 Dartmouth Road. There is no doubt that unless toilet facilities are adequate and scrupulous cleanliness is maintained, dysentery is likely to spread. There were four outbreaks of food poisoning during the year, and in three of these the cause was the same: meat was left to cool slowly so allowing germs to flourish. Meat must be cooled rapidly and placed in a refrigerator if this variety of food poisoning is to be avoided. Despite these four outbreaks, the actual number of cases of food poisoning was less than last year. Bronchitis and cancer of the lung have increased in importance. There was a new high record of deaths from cancer of the lung, and there were eight deaths in men for every one in women, probably because of the heavier smoking habits of middle-aged and elderly men. Cancer generally has now become a very important disease and much work could be done by educating people on how to prevent it and also how to obtain early treatment. This was recognised by the authorities over five years ago when they suggested there should be a special scheme for health education on cancer in Willesden. The appointment of an officer to help carry out this scheme was made in May, 1957, but the scheme has not been started in Willesden yet. Bronchitis placed a very heavy burden on the hospitals during the year and at one time only emergencies could be treated. A special committee has been formed representing various branches of the service, including research, to make studies of bronchitis. Already much useful work has been done in investigating deaths from this disease and methods of treatment and prevention. A plan which will be carried out in the immediate future includes organising a therapeutic group for early chronic bronchitics in a local authority centre, and a further study of drugs which may be used in prevention. Dirty air undoubtedy has some effect, both in cancer of the lung and in bronchitis, and the Council has plans to make the whole of Willesden a smokeless zone within a period of ten years. Already the first two areas have been dealt with and the third one has been surveyed. The Council is co-operating with the neighbouring borough councils in their plans for clear air. There have been the usual complaints about factory chimneys and there have been meetings with the railway authorities on the nuisances of railway smoke from the Willesden, Neasden and Cricklewood Locomotive Depots. The plan is to electrify completely the main line from Euston to Liverpool and Manchester, but until this has been done we can still expect smoke nuisance from railway engines. The power stations are not creating as big a nuisance as they did in the past, firstly because of the transfer and modernisation of the Acton Lane Power Station, and secondly the reduction in the generating power at Taylors Lane. The first clean air exhibition in Willesden was held at the beginning of the year, and was very successful. Exhibitors included the gas and electric companies, the Health Department and the Coal Utilisation Council. The other danger from air is radiation, and the Council has been seriously concerned about this, together with the dangers from other sources, such as radioactive waste and materials. The Council has made many applications to the Minister and various other bodies for a more efficient monitoring service. There has been an extension of the health education on the dangers of cigarette smoking to both school children and workers in factories. There is no doubt that many school children start to smoke at an early age and it is at this time that their future can be determined by discouraging them from smoking cigarettes, because once the habit is formed it is difficut to break. Adults, teachers and doctors must not only preach to school children but set a good example themselves. We are winning the battle against tuberculosis, but we still have to deal with the problem that at least one-fifth of the deaths over the past six years have occurred in elderly men previously unknown to the health authorities. Although the numbers are small this group can be quite dangerous because they are difficult to discover before they have infected others. The proportion of children who react to tuberculin testing has fallen following the general reduction in infection in the area. The proportion of children who have B.C.G. vaccination is fortunately still high. The Chest Clinic has made a special study of children who react to tuberculin testing and as a result they have found a number of cases who have been responsible for the infection of these children. The study has shown that the most fruitful source of detecting unknown cases is tracing the route of infection from young children who react to the tuberculin test. There has been a considerable extension in the work for old people, particularly since the appointment of an Old People's Welfare Organiser. Voluntary organisations have been doing much work for old people in the area, but since the appointment of the Organiser there has been an extension of the meals service and an increase in the number of old people who have been assisted to take holidays and of those receiving free wireless sets. The Home Safety Committee has been active throughout the year and has co-operated with national campaigns. The first public meeting was held with prominent speakers and was a great success. The provision of day nurseries still remains a problem in the area, and although one was closed on 30th August, 1957, the numbers of children waiting to go into day nurseries in Willesden could now fill at least four day nurseries. A scheme was started in clinics to look after infants while the mother was seeing the doctor or health visitor. This was not successful at first, but it is being used much more now. Some difficulty was experienced during the year because the regional hospital board could not provide consultants for the various specialist clinics, and suggestions were made that these children should be dealt with at the local hospital, and that the clinic should be manned either by assistant medical officers of health or general practitioners. Fortunately this scheme did not come into operation, and the regional hospital board found it possible to provide, at least for the time being, consultants to the clinics sessions. It would be disastrous if after fifty years of the school health service the preventive aspects of these clinics were minimised by their transfer to the curative atmosphere of a hospital. The local council have protested to the regional hospital board because although they have nominated people for membership on the management committee over a period of years, none of them has been accepted. The new Mental Health Act should lead to an extension of the work in the area for comprehensive mental health and for preventing relapses in those who have been discharged from hospital or otherwise have had treatment. There is no doubt that much work can be done in the community to adapt the mentally disturbed for their working and living there. Already much preventive work is done in the area in the child guidance clinic and in the maternal and child welfare clinics where the psychiatrist attends regularly and gives advice to doctors and health visitors. Clearly the psychiatrists cannot solve the problems of the mentally disordered by themselves. With the support of doctors and health visitors in the area, together with a more sympathetic approach of the public, we can help overcome many of the troubles of these 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 peopie of the borough. I have the honour to be, Your obedient servant, S. LEFF, Medical Officer of Health. 4 STATISTICS AND SOCIAL CONDITIONS OF AREA Population estimated, 1959 172,800 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) 43,810 Rateable value (1st April, 1959) £3,184,000 General rate in the pound for the year 1959/60 18s. Od. Product of a penny rate (estimated) £12,900 VITAL STATISTICS Registered Live Births: Male Female Total Legitimate 1,537 1,463 3,000 Birth rate per 1,000 estimated resident population Illegitimate 197 187 384 Crude 19.6 Total 1,734 1,650 3,384 Adjusted 18.2 Registered Stillbirths: 26 27 53 Rate per 1,000 (live and still) births 15.4 Death rate per 1,000 estimated resident population Deaths: 975 839 1,814 Crude 10.5 Adjusted 11.9 Death rate of infants under one year of age: All infants per 1,000 live births 19.5 Legitimate infants per 1,000 legitimate live births 17.7 Illegitimate infants per 1,000 illegitimate live births 33.8 Death rate of infants under four weeks of age: All infants per 1,000 live births 14.5 Legitimate infants per 1,000 legitimate live births 12.7 Illegitimate infants per 1,000 illegitimate live births 28.4 Maternal mortality: Deaths from puerperal causes- Puerperal sepsis Nil Other puerperal causes Other maternal causes Nil Deaths from: Males Females Total Cancer (all ages) 218 202 420 Measles (all ages) - — - Whooping cough (all ages) - - - Diarrhoea (under 2 years of age) - — - 5 Births There was an increase in the birth rate for 1959, and it is now above that of England and Wales. Deaths There was a slight increase in the death rate for 1959, and it appears to be becoming stabilised at about 10 per 1,000, a little below that of England and Wales, which is about 12 per 1,000. The causes of deaths are shown in Table 1. Infant mortality The infant mortality rate fell from 22 to 19 per thousand, which is below that for England and Wales (22 per thousand). The stillbirth rate has also been reduced from 17 to 15 per thousand and the perinatal mortality rate from 31 to 27 (Table 2). 66 infants under one year died in Willesden in 1959, 49 in the first two days. By wards and social class (Tables 3 and 4) Carlton ward again showed the highest infant mortality rate of 33 and Kensal Rise and Roundwood had mortality rates above the national rate. The best wards, Brentwater and Willesden Green, had rates of 8 and 9 respectively, which is a quarter of the Carlton rate. The figures speak for themselves: bad social conditions play a part in producing infant deaths. Causes of death (Table 5) Prematurity is again the most important single factor in infant mortality: 25 premature babies died (37 per cent, of total infant deaths); 2 suffered a birth injury. 7 (one illegitimate) were twin pregnancies; 5 others were also illegitimate. Illness in the mother did not seem to play an important part in prematurity except in 4 where the mother suffered from toxaemia. However, social conditions appear to play an important role in prematurity: in Carlton, Roundwood and Manor wards the percentage of premature births is twice as high as Brentwater, Gladstone, Mapesbury and surprisingly Kilburn (table 7). Congenital malformations caused 13 deaths: 7 due to congenital heart disease and 5 to involvement of the central nervous system (Table 8). All the pregnancies were normal, with no history of virus infection or pelvic radiation. More research is needed to solve this problem. Gastro enteritis and respiratory and other infections. There were no deaths from gastro enteritis but 12 babies died from bronchopneumonia. 10 of them died suddenly with no or only a short history of illness. Only one of these babies who died at the age of six weeks was breast fed at the time of death. The home conditions generally were unsatisfactory; overcrowding was a prominent feature, but there was no evidence of neglect. Improvement in social conditions would help in preventing respiratory infections. Other causes. All the other deaths occurred in the neonatal period. One boy was killed in an accident when the house caught fire. 2 babies died of blood incompatability though the mothers had antenatal supervision. 5 babies died from atelectasis, 4 of whom were delivered by Cæsarian section because of fcetal distress; otherwise the pregnancies were normal. Conclusions Considering Willesden's large immigrant and floating population it is satisfactory to report that the infant mortality has fallen once again. However, there is still room for improvement; general raising of the standard of living, especially reduction of overcrowding would reduce the mortality due to respiratory illness and the premature birth rate. But further research is necessary into the causes of atelectasis, congenital malformations, stillbirths and prematurity. GENERAL PROVISION OF HEALTH SERVICES Public Health Laboratory Service (Table 9) Bacteriological specimens (swabs from sore throats, fasces from intestinal infections, cough plates and post-nasal swabs from whooping cough cases, etc.) are examined by the Public Health Laboratory Service at the Central Public Health Laboratory, Colindale, and at the branch laboratory in Neasden Hospital. 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. Of the 33 unsatisfactory samples of water 22 came from the paddling pool and swimming baths at King Edward VII Park. New break-point chlorination plant was installed in September and subsequent samples of water were found satisfactory. 8 came from Gladstone Park Baths, 2 because of breakdown in the chlorinator and 6 because of the heavy demands made on the plant during the exceptionally hot summer. 3 came from Granville Road Baths and were due to temporary difficulties with the plant. 6 Uncleanliness and scabies (Table 10) As compared with 1958 there has been an increase in the number of children and adults treated for scabies, lice and nits. However, the numbers treated are still small and there is no evidence of an increase in the prevalence of these conditions in the community. Establishments for massage and special treatment The registration of establishment for massage and special treatment is delegated to the Borough Council under Part XII of the Middlesex County Council Act, 1944. During the year two new licences were issued and 25 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 practise the simple rules of hygiene. This knowledge helps many people to avoid mental and physical disorders and relieves general practitioners and hospitals of some of their heavy burdens in dealing with the sick. The department's health education programme is based mainly on lectures illustrated by filmstrips and films. To ensure that the rising generation gets the best possible training in health, special attention is paid to health education in schools, linked, as far as possible, with a hygiene or biology syllabus. The Area Medical Officer, and members of his staff, and the Chief Public Health Inspector and his staff give the talks in schools (Table 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, mid wives 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. Students studying at the University of London Institute of Education for the Diploma in Health Education visited Willesden on numerous occasions over a period of three months 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. 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, 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 and members of the Home Safety Committee and health visitors gave talks on Accidents in the Home to religious and social organisations (see page 22). During the last week in May an extensive publicity campaign was carried out to publicise vaccination against poliomyelitis. Posters were shown at shops, railway stations, clinics, libraries, police stations, public baths, gas and electricity showrooms, churches, doctors' waiting rooms and sites in the area; notices were published in the local press; films lasting eleven seconds were shown at cinemas; and a recorded message was broadcast at a local dance studio during dancing sessions and classes. An exhibit was also shown at the Willesden Show in September. 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 1958 and 1959 is shown in Table 13. 7 Whooping cough (Table 14) The incidence of whooping cough rose in 1958 compared with the previous year when the number of cases confirmed was the lowest recorded since 1919. However, the number of confirmed cases was less than recorded during any of the ten years 1948-1957, with one exception. Dysentery In common with the remainder of the country, there was a slight decrease in the number of cases of sonne dysentery during the year. However, in the country generally the disease is much more prevalent than before the war. It is usually a mild disease causing no deaths but it can produce some disruption and discomfort in the life of the community. There were three outbreaks:— (1) The first occurred at the Wesley Road Day Nursery on the 22nd February. Altogether 26 children and 1 member of the staff were affected; 12 children and one member of the staff had symptoms, and 14 children were found to be carriers. Four cases were admitted to the isolation hospital. The infection took three months to clear up and new admissions were not accepted until 4th April. (2) The second outbreak occurred at the Mortimer Road Day Nursery on the 22nd March. Altogether 17 children were affected, 7 had symptoms and 10 were found to be carriers. Four cases were admitted to the isolation hospital. The infection took some time to clear up and new admissions were not accepted until 10th May. (3) The third outbreak occurred at 91 Dartmouth Road on the 26th April. Altogether 19 mothers and children were affected, 6 had symptoms and 13 were found to be carriers. The infection took three months to clear up. Poliomyelitis There were nine notified cases of poliomyelitis, but only five confirmed (four paralytic). There was one death (Table 15). This was another good year and with the exception of 1958 when there were only four confirmed cases it was the best year since 1951. Food poisoning There were four outbreaks of food poisoning (see page 12). 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 Farenheit (or 38 degrees Centigrade) has occurred within fourteen days after childbirth or miscarriage'. There was a slight decrease in the number of cases in 1958. BRONCHITIS, CANCER OF THE LUNG AND TUBERCULOSIS (Tables 16-25) Long term irritation of the lungs by exposure to smoke, both from cigarettes and air pollution, is a major factor in the causation of lung cancer, chronic bronchitis, and tuberculosis in middle-aged men. The attack on tuberculosis has been very successful because of improved diet and standards of living and medical advances in prevention, detection and treatment. Chronic bronchitis and lung cancer, present a different picture; in Willesden in 1959, the death rates of bronchitis and lung cancer were each more than twenty times that of tuberculosis. Early diagnosis of chest disease is essential for treatment to be effective, but a marked and urgent change in social habits is needed before these killing diseases can be eliminated or even reduced. Health education is therefore an important weapon. Mortality and morbidity During 1959, 5 men over the age of 25 and no women died of tuberculosis (Table 20). More people died from bronchitis (Table 18); however, the number of deaths from bronchitis fluctuates widely over the years. The sex differences probably result from the heavier smoking habits of middle-aged and elderly men. Also, smoke has probably played an important part and was certainly responsible for the larger number of deaths in 1952 and 1953 following a severe fog. In 1959 a few more people died from cancer of the lung (Table 19). The death rate has more than doubled in the last 12 years, and there is a more marked sex difference: at present for every woman, six men die of lung cancer, most of them over 45 years of age when they have already smoked enough cigarettes to produce a cancer. Prevention and diagnosis To prevent chest disease, it is clear we must deal with smoke from cigarettes and the atmosphere. It is hoped that the Clean Air Act will help to improve the air. 8 It is usually only after some fifteen to twenty years of smoking that a cancer develops, but it is advisable to take no risk at all; talks are therefore given to school children in their early teens, when the environment to start smoking is favourable and the temptation strong. Visual aids are also used to explain clearly how smoking causes respiratory disease. It is hoped by these means to prevent young people smoking and so develop a habit which is difficult to break. X-ray examinations are effective in discovering early cases of tuberculosis and cancer, but not of bronchitis. Following a report from the Chest Physician that 12 cases of tuberculosis had been notified in Mitchell Way, Stonebridge, over the past five years, the Mass X-ray Unit carried out a survey of the residents, after they had been visited by a health visitor and invited to co-operate and a small leaflet had been left in every house advertising when the Unit would come to the street. 112 people were X-rayed but no active cases of chest disease were found. Treatment The treatment of cancer of the lung is still in its infancy. There is no shortage of hospital beds at present despite 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. T uberculosis Tuberculosis creates a special problem because of its infectious nature; nearly a fifth of the deaths over the past 6 years 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 they have infected others. Because of the presence of this infection, B.C.G. vaccination of school leavers is an important preventive measure for raising their resistance to infection at a time when the risk of infection is higher and many new stresses have to be faced. Fewer children (Table 24) were tuberculin tested in 1959; about 80 per cent. were found to need B.C.G., and of these 91 per cent. accepted vaccination. Tuberculin testing of the younger children also continued and the results appear in Table 23. There was a slight decline in the proportion reacting but over the years there has been a marked decline in school children, particularly entrants, reflecting the general reduction of tuberculosis in the community. In 1953 children usually came in contact with infection before they entered school but today most of them do so during their school life. Factories and workshops Six factories were visited by the Medical Officer and 37 immediate contacts of active cases were encouraged to attend for examination by the Mass X-ray Unit at the Central Middlesex Hospital. One case with tuberculous scarring in the left upper zone was discovered and referred to her private medical practitioner for treatment. Ten factories were revisited at six-monthly intervals to encourage contacts of old cases to re-attend for examination; 202 workers went to the Central Middlesex Hospital. Three cases with slight abnormalities were found but the lung fields were clear and the heart normal and no further action was necessary. Co-operation With diseases of wide social implications, such as tuberculosis, bronchitis and cancer, it is essential for all concerned—Chest Physician, Medical Officer of Health, Welfare Officers, Disablement Resettlement Officer and Health Visitors—to work as a team. 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 dustbins. Refuse is disposed of by controlled tipping at Yiewsley; 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 county (see report for 1956). (a) Shared dwellings and overcrowding About six out of ten households in Willesden share a dwelling. This is higher than the average for the county and for Greater London (about three out of ten) and much higher than England and Wales (less than two out of ten). The number of persons per room is higher than that of Greater London, England and Wales, and any district in the county, and the percentage of population and of households at densities over 1½ and 2 persons per room is the highest in the county, in some instances the percentage is more than double. 9 (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 The Borough Engineer has kindly supplied the following information in respect of the three swimming baths in the borough. The water for filling the baths is obtained from the mains supply. It is regularly chlorinated and plant of sufficient capacity to insure breakdown conditions is installed at each bath. The capacity of each bath and the time taken for the whole of the water to pass through the filters and treatment plant is as follows:— Capacity (gallons) Time taken for water to pass through filters, etc. (hours) Granville Road Baths 145,000 3½ Gladstone Park Swimming Pool 500,000 11 King Edward's Recreation Ground Swimming Pool 350,000 6½ 256 samples were taken, 22 of which were unsatisfactory (see Public Health Laboratory Service, page 5). Swimming bath Samples taken Satisfactory Unsatisfactory Granville Road 161 158 3 Gladstone Park 50 42 8 King Edward's Park 45 34 11 SANITARY SECTION Staff The establishment of Public Health Inspectors includes the Chief Public Health Inspector, the Deputy Chief Public Health Inspector, 18 district Inspectors and 5 pupils. At the beginning of the year there were three vacancies for district Inspectors and this shortage seriously affected the work of the department. The Council had decided that inspections in the proposed Stonebridge Redevelopment area should be stopped, inspections in the No. 2 Smoke Control area should not be commenced, and they determined priorities for other urgent schemes. Advertisements offering grades APT. II and III produced no applicants. In March, the Council decided to advertise vacancies on APT. IV in order to attract well-qualified and experienced officers (with at least ten years' experience and the Smoke Inspectors Certificate in addition to the statutory qualification and the Meat and Other Foods Certificate). In April the vacancies increased to four; two were filled and four existing staff were regraded APT. IV. The remaining two vacancies, together with another which had arisen were re-advertised and two appointments were made. The remaining vacancy was filled on grade APT. II by a pupil who had recently qualified. Four pupil public health inspectors were on the staff at the beginning of the year. One qualified, received his certificate and was appointed to Willesden, one new pupil was appointed, leaving one vacancy. The Rodent Officer and four operatives are employed in the destruction of rats and mice in the • borough, and two labourers on vermin disinfestation, disinfection, 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 Clos ing Orders (Table 26) There were no demolition orders made during the year. 10 Slum Clearance The Minister of Housing and Local Government held a public inquiry into the Granville Road (north side) Compulsory Purchase Order (48 houses) which he confirmed and a further public inquiry into the Granville Road (north side)/Carlton Vale/Kilburn Park/Percy/Cambridge Roads Compulsory Purchase Order (66 houses), the result of which is awaited. He also confirmed the Carlton Vale/Canterbury/Peel Roads Compulsory Purchase Order (35 houses) which had been the subject of a public inquiry in the previous year. In addition, a survey was carried out of 550 houses in the No. 3 and No. 4 phased zones of the Stonebridge Proposed Development Area. A start was also made on the survey of 732 houses in the Willesden Green Proposed Improvement Area. Overcrowding There has been little change in the extent of overcrowding which still remains acute. Very few licences under section 80 of the Housing Act, 1957, were issued to permit temporary overcrowding (Table 27). Landlords do not 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 Act, 1936 and Housing Act, 1957 There was a slight decrease in the number of statutory notices served during the year compared with 1958 (Table 29). In spite of the continued shortage of Public Health Inspectors more inspections were carried out (Tables 30-31). There were three vacancies at the beginning, but these were filled towards the end of the year. Five Inspectors were engaged on special surveys—two on the proposed redevelopment area, one on the proposed improvement area, and two on the smoke control areas. Rent Act, 1957 Details of the applications received and the certificates issued up to the end of the year are shown in Table 32. Nuisances abated and improvements effected A summary of nuisances abated and improvements effected is shown in Table 33. Inspection of factories, outworkers' premises and food premises A summary of inspections of the above premises is shown in Table 31. CLEAN AIR The Clean Air Act, 1956, came into full operation on the 1st June, 1958. With certain temporary exemptions the Act prohibits the emission of 'dark smoke' from chimneys of all kinds and provides for the establishment of smoke control areas. The No. 1 (Neasden) Smoke Control Order covering 48 -5 acres came into operation on the 1st June. 1959. It includes 627 dwellings, 69 commercial premises and 4 industrial premises. 222 open fires, 9 open fires with boilers, 2 gas fires and 10 electric fires were installed; 69 existing appliances were adapted; and 16 gas and 11 electric points were installed. Grants of 70% or 100% were paid to 204 owners and tenants amounting to £1,441; the Council will recover £788 from the Exchequer. The No. 2 (Neasden) Smoke Control Order covering 271.24 acres was confirmed by the Minister of Housing and Local Government on the 18th December, 1959, and will come into operation on 1st October, 1960. It includes 2,351 dwellings, 112 commercial premises, 24 industrial premises and 7 other premises. Two of the industrial premises burn coal but the Council decided they should not be granted exemption from the Order. A preliminary survey of the third area of 658 acres was completed at the end of the year and a detailed survey will commence in 1960. It contains approximately 11,280 dwellings, 966 commercial premises, 34 industrial premises and 55 other premises. The usual measurement of grit and sulphur have been made, and the results in the areas surrounding the three power stations show improvement. In the case of Taylors Lane Power Station, however, the improvement was probably due to the fact that there was a reduction in output because it is now mainly used as a stand-by station (Tables 34 and 35). Compared with 1956 the reduction in coal burnt in 1959 was 54% and in units generated 59%. A clean air exhibition was staged at Neasden Special Training School at the beginning of the year. It was very successful and about 400 people attended. The Council is represented at an Inter-borough Smoke Control Liaison Committee, which also includes delegates from the Hammersmith, Fulham, Brentford and Chiswick, Acton and Barnes Councils. Meetings designed to co-ordinate smoke control area planning are regularly held at Hammersmith Town Hall. 11 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 36). There was a considerable increase 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. 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 239 Borough Council properties 7 Private dwellings 769 Total 1,015 at the following cost: Business premises £1,464 11 4 Private dwellings £2,032 10 4 Total £3,497 1 8 The cost of disinfestation at business premises is recovered from the occupiers; 124 had an annual agreement with the Council for regular inspection and disinfestation, 12 were new agreements and 112 were renewals. The service is free to occupiers of private dwellings. 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 37). Improvements in premises The Food Hygiene Regulations, 1955, which came into operation on the 1st January, 1956, prescribe 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 serve verbal or written notices to improve their standard. Works in some premises are still either in progress or arrangements are being made for them to be carried out (Tables 38 and 39). Three persons were prosecuted for smoking while handling open food. One was fined £10 with £2.2.0 costs; the second was fined £10 with £3.3.0 costs and the third was fined £5 with £2.2.0 costs. A greengrocer was prosecuted for 17 contraventions of the Food Hygiene Regulations; he was granted an absolute discharge on 5, 3 were dismissed and he was convicted on 9 with fines totalling £33 and £10.10.0 costs. A baker was prosecuted for four contra vent ions of the Regulations; he was granted an absolute discharge on 1, one was withdrawn and he was convicted on 2 with fines totalling £20 with £10.10.0 costs. Premises where food is prepared Premises which manufacture 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 40) Premises where ice-cream is manufactured are kept under constant supervision. Most of the icecream 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). Education in food hygiene Lectures and talks, illustrated with film shows, filmstrips, and bacteriological cultures, were given to social and political organisations, and school-leavers. At the end of the year posters were issued to food shops asking the public not to take their dogs into the shop and to refrain from smoking while shopping. 12 Food poisoning There were four outbreaks of food poisoning during the year:— (a) The first occurred in a work's canteen and affected 32 workers. The illness was mild and they speedily recovered. The causative organism was not identified. All those affected had eaten roast beef but none was available for bacteriological examination. The beef was cooked on a Saturday, left to cool slowly, placed in a refrigerator over the weekend and served warm on Monday. It was probable that it was contaminated after cooking as it was not cooled rapidly before being placed in the refrigerator and when re-cooked two days later the contamination survived because it was only warmed and not well heated. (b) The second occurred in a private school and 6 teachers and 20 children were affected, but they recovered quickly. The food causing the outbreak was prepared at a Kosher meals centre in Kensington and delivered to the school in sealed containers. Notification of the outbreak was not received until four days after it occurred, and it was not possible, therefore, to identify the causative organism or the food responsible. (c) The third occurred in the nurses dining room at a hospital and affected 30 nurses, who speedily recovered. The causative organism was Clostridium Welchii, which was found in a specimen of boiled beef eaten by all those affected. The beef was boiled, placed in two large pans and left to cool with the lids ajar for seventeen hours, re-cooked and served. It should have been cooled rapidly (within 1½ hours) and placed in a refrigerator, but this was impossible as the refrigerator in the kitchen was unable to accommodate the meat, being already filled with other perishables. It was inadequate in size for the kitchen, which catered for 300 staff. In addition, the general poor condition of the walls and ceilings and the absence of proper hand washing arrangements were an added handicap to the staff in their efforts to keep the food handled free from contamination. The Hospital Secretary and the Medical Director were advised of these deficiencies. (d) The fourth occurred in a factory canteen and affected 20 workers. The causative organism was Clostridium Welchii Type 1, which was found in a specimen of steak and kidney pie eaten by all those affected, and also in specimens of fæces submitted by four of them. The fresh meat for the steak and kidney pie was cooked and left to cool in a pan for 5½ hours, then placed in a refrigerator. It was made into a pie the following day, cooked for half and hour and left in an oven until served. It was probable that the meat was contaminated after cooking as it was not cooled rapidly before being placed in the refrigerator, and when re-cooked the following day the contamination survived a further cooking. Food unfit for human consumption More than 3¼ tons and 9,250 tins of food inspected by the Public Health Inspectors were found to be unfit for human consumption (Table 41). All the food was dealt with as trade refuse by the Borough Engineer's Department, and deposited on the controlled refuse tip. A complaint was received in July that a shopkeeper was selling cooked pork which was unsound. An inspection revealed that the pork was contaminated with maggots. Two pounds of pork were seized, taken before a Justice and condemned. Legal proceedings were taken under the Food and Drugs Act, 1955, and the shopkeeper was fined £75 with £3.3.0 costs. Contaminated food 22 specimens of contaminated food were dealt with by the department. They included larvae in chocolate biscuits, currants, egg rusks and prunes; a caterpillar in a tin of peas mouldy growth in a pork pie and an apple pie; dirt in a bottle of cream; splinters of glass in a milk bottle; disinfectant in currant buns; a fly in a bottle of mineral water; and paper, dirt, a button, grease from vegetable oil, mould and a cigarette end in loaves of bread. No action was taken in four of them because of insufficient evidence. Of the remaining 18, 12 firms were cautioned and the Council decided to prosecute the other 6. The results of 5 prosecutions were as follows:— 1. £5 with 5 guineas costs for selling bread containing paper; 2. £5 with 2 guineas costs for selling bread containing oil; 3. £5 with 5 guineas costs for selling bread containing mould; 4. £5 with 5 guineas costs for selling rusks containing larvae; 5. Absolute discharge on payment of 3 guineas costs for selling currants containing larvae. The defendant in the sixth case died before a summons was issued. One dirty milk bottle was reported but this was referred to another local authority for action because the milk was bottled in their area. Clean food sampling The Middlesex County Council is responsible for taking samples and for supervising the control of food adulteration (Table 42). The Chief Officer of the Public Control Department has kindly supplied the following information:— Of the twelve firms who were concerned in the 19 samples found to be unsatisfactory, 2 were prosecuted, 4 were officially cautioned, 3 were warned and no action was taken against the other 3. A sample of milk was found to be low in solids not fat; a subsequent sample was satisfactory and no further action was taken. No action was taken in the case of two samples of iodine solution of a strength in excess of the British Pharmacopoeia's prescribed standard; in one case a further sample was of the correct strength, and no further supply of the other brand was available. 13 Official cautions were issued to the importers of biscuits called 'Cheese-filled Krisps' because the soft filling was flavoured with cheese; and to the manufacturers of a drink labelled 'Raspberry juice" because on analysis it was found to be a compound of raspberry juice and sugar. Warnings were given to the importers of tinned smoked Saithe found to contain prohibitive preservative, to the retailer of sausages where the preservative was undeclared, and to the importers of 'Cream of Mushroom' dried soup mix found to be deficient in fat content. In the case of ten samples of fresh meat preserved with sulphur dioxide, one retailer was officially cautioned in respect of three joints, another trader was prosecuted in respect of minced beef and joints of beef and fined £25 on each of two counts with costs of £10.10.0, and a third firm of butchers was fined £25 with £10.10.0 costs for adding preservative to steak and kidney. The packers of pre-packed 'Beef fingers" were cautioned because the food consisted of beef and 31% carbohydrate filler. Merchandise Marks Act, 1887-1953 1,007 displays of articles of food were examined under the Merchandise Marks Act, 1887-1953. Minor infringements detected were dealt with by verbal warnings, but one firm who described blended tea as Ceylon was prosecuted and fined £20 with £5.5.0 costs. Labelling of Food Order, 1953 1,147 articles of pre-packed food were examined under the Labelling of Food Order, 1953. No serious infringements were detected. False and misleading descriptions Scrutiny of food advertisements and labels for false and misleading descriptions is usually combined with inspections under the Merchandise Marks Acts and Labelling of Food Order. No serious infringements were disclosed, but action was taken for descriptions applied to fruit 'juices' and a 'seedless' fig bar, and for slimming claims for lemon juice drinks. Extravagant claims for medical remedies were also challenged and the advertisements withdrawn. Milk and Dairies (Table 43) Milk sales are regulated by the Food and Drugs Act, 1955, the Milk and Dairies (General) Regulations, 1959, 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. 12 inspections were made of the dairies; 3 defects were found and soon remedied. FACTORY INSPECTION The Factories Acts 1937-48 have three main weaknesses. Firstly they do not cover all factories. There are eleven million persons who are not protected by the Acts—domestic workers, transport workers, office workers, electricians, painters, employees at cinemas and theatres, etc. Secondly there are not enough factory inspectors to supervise the factories adequately: the Ministry of Labour employs just over 400 factory inspectors, to supervise over a quarter of a million factories. Willesden shares a staff of three factory inspectors with Harrow, Kensington, Paddington and Wembley. Lastly the local authorites, with the specialised staff of Public Health Inspectors, have very few duties in respect of factories. The Willesden Borough Council has duties in the supervision of outworkers and basement bakehouses, the provision of sanitary conveniences in the case of all factories and the supervision of cleanliness, overcrowding, temperature, ventilation and drainage of floors in the case of factories in which mechanical power is not used. The local authority is also responsible for certifying that the provisions for escape in the case of fire are suitable. In brief, apart from the elementary duties of supervising the lavatory accommodation, the local authority has little power in the supervision of the large majority of factories, i.e. where mechanical power is used. Supervision of sanitary accommodation The Council must see that suitable and sufficient sanitary conveniences, well-lit and separate for the sexes, are provided in all factories and that they are maintained and kept clean. The Sanitary Accommodation Regulations, 1938, also laid down rules of ventilation, privacy, screening, positioning, proper doors and fastenings for the lavatories. There are 835 factories in the Borough of Willesden, 774 using mechanical power and 61 nonmechanical. The greater number of factories are in engineering (186), motor and cycle repair (98), dressmaking (47) and food manufacture (45) (Table 44). The factories vary in size from the employment of less than 5 persons to more than 2,000, the larger factories being in engineering, food manufacture and printing; the majority of the factories are medium to small in size (Tables 45 and 46). More than half employ less than 10 workers and less than 1 in 10 (75) employ more than a 100 workers. Some of the factories, especially in the Willesden Green area, are in converted houses or backyards. There are three main industrial areas in Willesden:— 1. The north-east end of the North Circular Road area; 2. The Park Royal area in the Stonebridge ward area; and 3. The Church End area, where the main factories are British Thomson-Houston and Associated Automation Ltd. 14 Factory owners have criticised the procedure where two sets of officials, factory and Public Flealth Inspectors, visit the same premises. The Public Health Inspector is restricted to the supervision of sanitary accommodation in mechanical factories and cannot maintain a keen interest in this work. The Public Health Inspector is as well qualified to supervise the various requirements in a mechanical factory and could have technical assistance in the more difficult cases. The numbers of Public Health Inspectors would also make it possible to have better and more frequent supervision of factory premises. The fact that the local authority would be responsible for the supervision of factory premises would lead to better control of the safeguards for preserving the health and welfare of the workers in the factories. There was a slight decrease in the total number of factories on the register compared with the previous year. Details of inspections, defects found and action taken, are given in Tables 47 and 48. Most notices were served for minor defects and were complied with without legal action. Section 1 of the Factories Act requires internal walls, ceilings, etc. in all rooms, passages and staircases in factories to be washed and repainted periodically, but provides for exemption in certain cases. The Factories (Cleanliness of Wall and Ceilings) Order, 1957, which came into operation on the 16th June, 1958, grants such exemptions where walls and ceilings have been painted with two or more coats of emulsion paint and which are repainted with at least one coat of such paint once every five years and are washed every fourteen months. The makers certificate of quality of the paint and the dates of painting and washing must be recorded in the general register of the factory. Basement bakehouses The local authority is responsible for the supervision of basement bakehouses under section 54 of the Factories Act, 1937. 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. Any basement bakehouse which is not used for twelve months cannot be used again. Under section 54 certificates of suitability issued to the occupiers of basement bakehouses when the Factories Act came into operation, that is 1st July, 1938, have to be reconsidered by the Council every five years. Provided the bakehouse is still suitable as regards construction, height, light, ventilation and any hygienic respect, the certificate must be renewed. In 1958 six certificates were renewed but since then one bakehouse has ceased to be used as it was demolished. 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. 213 were employed during the year, the greatest number (108) making clothes (Table 49). Inspection of these workers' homes was made by the Public Health Inspectors and a notice was served in respect of one found to be unsatisfactory. Noise nuisance The Borough Council deal with noise nuisances under section 313 of the Middlesex County Council Act, 1944. Complaints about 20 alleged noise nuisances were received, but only 12 could be dealt with under this section. Four were caused by various types of woodworking machinery and others by concrete drilling, steam raising, engine testing, oil firing jets, compressors, moulding presses, power fans and steam safety valves. All except two were remedied after consultation with the management by such means as fixing suppressors and sound insulators. A noise consultant has been called in to advise the Council on the two firms who have failed to remedy their noise nuisance. OCCUPATIONAL HEALTH SERVICE The Council introduced an occupational health service for their employees in April, 1954. Public Health Inspectors visit all offices and workplaces to inspect 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 first-aid equipment, are brought to the notice of the chief officer concerned. First-aid boxes are provided for the use of the departments, libraries, workshops and depots. Regular inspection of the boxes and equipment are made to ensure that the boxes are fully stocked and that the notice bearing the name and address of the nearest medical practitioner is correct. Five employees who had been regularly absent from work on account of sickness were 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. 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, home helps, and health visitors, who 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. However, there is still a great need for more hospital accommodation. 15 Compulsory powers for removing old people to a hospital or hostel are only used when absolutely necessary and then only after all other possibilities have been fully explored. Two cases were removed under the National Assistance Acts, 1948 and 1951. Mr. E.M., aged 83 years lived in a flat with his landlady Mrs. B., also aged 83 years. Mrs. B. was ill in bed and was awaiting admission to hospital. Mr. E.M. was sitting in a chair wrapped in a blanket and was suffering from bronchitis and gangrene of the leg. He was incontinent, and in a filthy condition and refused to go to hospital. There was a foul odour in the room which was in a filthy condition. Mrs. B.'s sister, aged 70, lived in Hampstead and was looking after her until she could be admitted to hospital, but she was unable to look after Mr. E.M. because she was also unwell. An order under the National Assistance (Amendment) Act, 1951, was obtained from a Justice of the Peace on the 23rd February and Mr. E.M. was removed to Neasden Hospital the same day. He died four days later. Mr. S.S. aged 51 years, lived alone in a small cottage. He was blind and had tuberculous disease of the hip. In February, 1959 Mr. S.S., a chain smoker, set fire to his cottage causing severe damage and rendering it unfit for human habitation. He was persuaded to enter Percy House, Isleworth, as a voluntary patient. In July he returned and entered by breaking a staple on the door. The windows were boarded up, and there was no gas or electricity, furniture or other amenities. He refused to leave and an order under the National Assistance (Amendment) Act, 1951, was obtained from a Justice of the Peace and he was removed to Redhill House. An application for an extension of the Order was made in August and this was granted for three months. Mr. S.S. returned to his cottage when the order expired; repairs had commenced but could not be continued whilst he was in occupation. He was fit after his detention at Redhill House and had his meals at local cafes, refusing any kind of assistance. His condition slowly deteriorated and on the 24th December a further order under the National Assistance (Amendment) Act, 1951, was obtained and he was again removed to Redhill House. On the 7th January he was transferred to Shenley Hospital by the Duly Authorised Officer in accordance with an order made under section 16 of the Lunacy Act, 1890. Laundry for the Aged The care of incontinent old people places a heavy burden on their relatives. The washing of soiled bed linen and night clothes, particularly in cramped accommodation in winter, with inadequate facilities for drying, adds another intolerable strain on relatives which finally convinces them that the only place where the old people can receive reasonable care is in an institution. One way of postponing this unpopular event is to do their laundry. In April, 1952, the Council organised a laundry service for incontinent old people free of charge under section 84 of the Public Health Act, 1936. The articles are laundered and ironed at a cost of 4£d. per lb. at the Neasden Hospital by arrangement with the Central Middlesex Group Hospital Management Committee, and transport is provided by the Borough Council. The service has continued to be greatly appreciated by old people and their relatives. No. of old people using the laundry service On register 1.1.59 New Cases Died Admitted to hospital Recommenced after discharge from hospital On register 31.12.59 41 36 21 12 2 46 Voluntary services for the aged The '49' Club organised by the Willesden Old Folks' Association celebrated its seventh anniversary in February. The Club has a membership of more than 450 and is open daily from 1.30 to 10 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. 200 members and helpers went for a day trip to Southend in July. Voluntary visitors visited 40 old people weekly or fortnightly. Lonely housebound old people greatly appreciate the services which include shopping, reading, general conversation, and tidying the room. At Christmas the visitors took 5/- each to 65 old people and a Christmas dinner from the Association to 64. The Willesden Youth Committee, the Stonebridge Mothers' Club and pupils of the Kensal Rise Boys' School contributed towards the cost of the dinners. A Christmas party was held at Anson Hall, Cricklewood, and was very successful. 315 people attended and were given a high tea, an entertainment, and 2/-. Grants were also made to other organisations to help them arrange their own parties. 31 parcels of food for distribution to the housebound were given by Malorees School after Harvest Thanksgiving. The chiropody service is in greater demand. 346 people attended the four chiropodists in Kilburn, Harlesden, Kensal Rise and Willesden Green areas for periodic treatment during the year. New applicants receive initial treatment and are then placed on the register for periodic visits. 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 Willesden Old People's Welfare Committee made a grant of £250 towards the cost of treatment, which in 1959 cost the Association more than £350. On the recommendation of the Welfare Officer, free coal was supplied to old people who could not afford it, and financial assistance was given to several of the housebound for their wireless licences. 16 The branch club opened at St. Martin's Church Hall, Kensal Rise, in January, 1955, meets every Wednesday afternoon from 2—4 p.m. An average of 50 old people attend each week. The club is selfsupporting, but the Association pays the rent of the hall. Members went for a day trip in the summer to Felixtowe. The club has a very good selection of books given by the Borough Librarian. Many high teas and birthday parties were held. The Willesden Division of the British Red Cross Society, the Women's Voluntary Services, religious and other organisations in the area run clubs for the old folk, arrange outings and their members visit them in their own homes. The meals-on-wheels service organised by the Women's Voluntary Services, is probably the most important service for old people. The additional equipment provided by the Borough Council and the additional transport provided by the Willesden Old People's Welfare Committee enabled the service to be extended in 1959. 10,000 meals were prepared and delivered compared with 8,100 in 1958. 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. 25 housebound were taken to Potters Bar in the summer and entertained by local school children. Afterwards they had tea and were given flowers, cakes and eggs to take home with them. 120 old people who were being helped by the meals-on-wheels service received a free Christmas dinner, and another 140 received Christmas parcels. Willesden Old People's Welfare Committee The Willesden Old People's Welfare Committee was formed in April, 1958. The Committee has a membership of 19, ten representing the Willesden Borough Council, 2 the Middlesex County Council and 7 representing Willesden organisations concerned with the welfare of old people. A full-time Welfare Officer was appointed who co-operates and acts in liaison between the statutory bodies and voluntary associations, and who organise from time to time such services as may be considered necessary to assist the aged. One of these is the Assisted Holiday Scheme whereby old people can benefit by a fortnight by the sea during the summer months at a cost of £2 per week (including fare). Accommodation and travel to Holiday Homes or Private Guest Houses is arranged with a choice of the most popular coastal resorts and from June to September 149 old people took advantage of the scheme. A limited number of places were available at the Holiday Homes at Christmas and several lonely ones spent a very enjoyable ten days, whilst others who were alone received invitations from families willing to have them during the festive season. Plans are in progress to start Luncheon Clubs at various points in the borough within reach of most old people where cheap mid-day meals will be served and the first of these was opened in May, 1960. For those who can get out there are many Clubs where companionship may be found, and with a view to assisting these Clubs and attracting more members the Old People's Welfare Committee are arranging entertainment and competitions during the winter months. Plans for the building of two Centres for the aged have been approved and it is hoped that the coming year will see the completion of these. Once these are opened an extension of the meals and other services will be possible. The problems which are brought to the office are varied and numerous, and a large number of cases are referred by hospitals, when an old person is about to be sent home. Much visiting and case work is carried out and some idea of the growth of the work will be noted by the following figures: Old people interviewed at office 715 Old people visited at home 826 All the above services are financed from the grant of £3,000 which the Council set aside for the Committee's use in 1959/60. 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 eight persons during the year, at a cost of £94.18.0, £77.3.7 being recovered from the relatives. PUBLIC MORTUARY Post-mortems were performed on 580 bodies, followed by an inquest in 110. 62 inquests were held on Willesden residents but only 24 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 1958 1959 At Kilburn 49 25 12 13 12 10 20 17 24 At Ealing — 26 21 37 24 62 40 61 38 Total 49 51 33 50 36 72 60 78 62 17 In December, the Council approved an estimate of £2,270 for improvements to the Mortuary, including the extension of the post-mortem room, providing another table, a new concrete runway from the post-mortem room to the refrigerator room, with a glazed metal screen, improved heating and lighting, decorations and modernising the viewing room. 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 1959. COMMON LODGING HOUSES There are now no common lodging houses in the district registered under section 237 of the Public Health Act, 1936. SLAUGHTERHOUSE LICENCES There are now no slaughterhouses in the district licensed under section 62 of the Food and Drugs Act, 1955. Slaughtering was last carried out in the borough in 1939; one licence was, however, renewed until 1955. RAG FLOCK AND OTHER FILLING MATERIALS ACT, 1951 The Rag Flock and Other Filling Materials Act and Regulations, 1951, came into operation on the 1st November, 1951. The Regulations specify the standards of cleanliness for the filling materials, the analysis for the tests, the fees which may be charged by the analyst, and the form of records to be kept by the occupiers of the premises registered and licensed under the Act. The premises of manufacturers of rag flock and those used for storing rag flock must be licensed by the local authority; the fee and the renewal fee is £1.0.0 for a period not exceeding twelve months. There are no premises in Willesden used for manufacturing or storing rag flock. 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 were five new registrations during the year. The number of registered premises is now fifteen. 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. Six 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 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 1959, 20 pet shops were licenced. STAFF MEDICAL EXAMINATIONS. 56 staff medical examinations were carried out by the Medical Officer of Health and Deputy Medical Officer of Health in 1959. 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, 1953, 1957 and 1958 reports. The Department of Gastro-enterology which was opened in 1957 at the Central Middlesex Hospital was completed by the provision of a new diet kitchen. 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. 18 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 1959 a little over half of all expectant mothers attended the local ante-natal clinics staffed by assistant medical officers (Table 50). 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 51). Mothers are booked for confinement at home or in Paddington Hospital, and have specimens of blood taken by assistant medical officers for Wasserman reaction, blood grouping, and Rhesus factor; tests for Haemoglobin estimation are also carried out. All expectant mothers are invited to attend the Mass X-Ray Unit at Central Middlesex Hospital. 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 52). The physiotherapist conducts ante-natal relaxation classes on two afternoons a week in the orthopaedic department at Stonebridge Clinic and on one afternoon a week at Pound Lane Clinic and a health visitor conducts similar classes at Kilburn Clinic on one morning (Table 53). 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 practise 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 the 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 54). Assistant medical officers and health visitors give advice on the feeding, hygiene and general management of infants and young children. The doctors immunise children against diphtheria, whooping cough and poliomyelitis. The number of children vaccinated against poliomyelitis continued to increase and adequate supplies of vaccine were available (page 20). The number of children vaccinated against smallpox (Table 64) increased by approximately 20% from 1958 while the number immunised against diphtheria (Table 65) was almost the same as in 1958. Health visitors advise mothers of young babies on immunisation against poliomyelitis as well as against diphtheria, whooping cough and smallpox. Greeting cards are sent to children on their first and second birthdays, inviting mothers to bring them to the clinic for routine yearly examinations; many mothers respond to these invitations. A Mothers' Club is held in Kilburn Clinic once a fortnight, 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. The Stonebridge Clinic Mothers' Club was formed five years ago and has become firmly established. The total membership is 39 and the average attendance at meetings is 25. The club is self-supporting and its assets amount to just over £12. During the year lectures, talks and demonstrations on health and home crafts, many illustrated with films, have been given by medical officers, health visitors and outside speakers. Outside activities have included visits to theatres, cooking centres, places of interest (a farm and a printing works), a day trip to Heme Bay and a visit by mothers and children to a pantomime. The highlight of the year was a very successful children's Christmas party attended by Her Worship the Mayor, Councillor Mrs. N. Clark, J.P. Bring-and-buy sales and raffles were held to pay for the activities arranged for the children. An annual donation of £1 is sent to the Willesden Old Folks' Association. A door-to-door collection was arranged in aid of the National Society for the Prevention of Cruelty to Children and was donated to the society's funds. The members are most enthusiastic and look forward to the weekly evening meeting. They all feel that they have gained much useful knowledge from the visits of the many people who have addressed them on widely differing subjects, and from friendliness with each other. 19 Pound lane clinic This clinic has been open two years. The mothers find the bungalow type building more convenient. The clinic is designed to afford facilities for giving advice and treatment to mothers, young children and school children in the neighbouring community. These facilities include mother and baby sessions (antenatal, post-natal and infant welfare), dental treatment and sessions for immunisation, vaccination, treatment of minor ailments, speech therapy, physiotherapy, orthoptics and chiropody. Specialists' services include orthopaedic, opthalmic and ear, nose and throat sessions. Mothercraft classes and ante-natal relaxation classes are also provided. The additional facilities of physiotherapy and ante-natal relaxation classes which were unable to be provided at the former clinic are appreciated. In May, 1959 the County Council approved the provision of facilities at this clinic for the care of children when their mothers were attending at the clinic. It was agreed to hold three sessions a week and the first session was held on 28th July, 1959 and to the end of the year 43 sessions were held and 115 attendances were made. Prevention of break-up of families in willesden In October, 1958 the Middlesex County Council entered into an agreement with the Family Service Units for the equivalent of one whole-time trained social worker to be employed to assist in the prevention of break-up of families in Willesden. The families are mainly referred by the health visitors, who already have them under supervision. Since the inception of the scheme 26 families have been referred of which 12 were found to be suitable by the Family Service Units and with whom they could work. 12 were found to be unsuitable and 2 families refused help. The families receiving help are long term cases and it is, therefore, too early to give a report an any permanent results. The assistance given by the Family Service Units has relieved the health visitors of their concentrated work with these families. Joint quarterly meetings are held and are attended by the workers from the Family Service Units, the N.S.P.C.C. Inspector, other social workers, assistant medical officers, and health visitors. The families are discussed, various suggestions are made and reports are co-ordinated. MIDWIFERY SERVICE At the beginning of the year the Middlesex County Council employed six midwives in Willesden. During the year one midwife left and was replaced, making a total of six midwives at the end of the year. As part of their second period training for the Central Midwives Board Examination three or four pupil midwives work for three months in Willesden under the supervision of approved midwife teachers. 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 a blood specimen and a routine chest X-ray to be taken. The midwife examines the mother at her special clinic (Table 55), 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 confinements. 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 Midwives' Clinic regularly throughout the 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 medical fitness for gas and air analgesia. Mothers who had gas and air analgesia during labour had substantial relief from pain (Table 56). Midwives work very closely with general practitioners who were present in about one in four deliveries of their booked cases (Table 57). 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 58). In addition, pethidine is given to some mothers when labour is established; this assists with relaxation and tends to shorten the labour. Trichloroethylene is now being used, but experience has been too little to estimate its effectiveness. 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 a blood transfusion apparatus. The "flying squad" was called out seven times during the year for the following conditions:— ante-partum haemorrhage (2), post-partum haemorrhage (1), retained placenta with post-partum hæmorrhage (3), and a still-born infant (1). The Hammersmith Hospital premature baby unit provides a special ambulance for transporting premature babies who require treatment in their unit. The ambulance with two qualified nurses trained in the care of premature babies, 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. Five babies were admitted to the unit during the year. HEALTH VISITING The health visitor is the most important social worker for the care of expectant and nursing mothers and young children. Under the National Health Service Act, 1946, her work has been extended to the whole family for their health education and for the prevention, care and after-care of illness. 20 Health visitors attend with the assistant medical officers at maternity and child welfare clinics and at schools for medical inspections and routines hygiene inspections. During the year they gave 47 school talks to senior girls on mothercraft. These talks were much appreciated by the girls, who showed interest and asked many intelligent questions. Health visitors make enquiries for the National Surveys, and help in the practical training of hospital student nurses, and student health visitors from Middlesex and Battersea Polytechnic, who are in training during the year (Table 59). Health visitors work in close co-operation with general practitioners (Table 60), staffs of hospitals, children's officers, welfare officers, public health inspectors, and other social workers. Some patients who attend Diabetic Clinics require advice to be given in their homes on their treatment, diet and after-care. Health visitors who attend the Diabetic Clinics at the Central Middlesex and Willesden General Hospitals, give this advice under the supervision of the physician-in-charge. The physician selected 26 patients during the year for these health visitors. The number of health visitors has increased for the Willesden part of the Area (Table 61). However, some temporary clinic nurses have 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 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. Two students who were sponsored for Willesden commenced their training in 1959 and will take their final examinations in 1960. Four other students had their practical training in Willesden. MINISTRY OF FOOD—WELFARE FOODS National dried milk, orange juice, cod liver oil and vitamin 'A' and 'D' tablets continued to be distributed from centres and clinics in the Borough. 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. Home nurses give injections and other treatments to patients who include children under 5 years of age and the aged and infirm (Table 62). The home nurses have helped a number of aged and infirm people to get up and about again. 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 one year of age vaccinated, represents 38.2% of the total live births for the year (Table 64). 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 65 shows the total number of children who have received protection against diphtheria during the last 15 years (1945—1959). The estimated percentage of children who have received an injection during their school life is 75.1. INOCULATION AGAINST POLIOMYELITIS During the year 22,246 expectant mothers and children born between 1943 and 1958 received third doses, and 4,000 received two doses. Inoculation of factory employees continued, and 3,665 received two doses. After an interval of 7 months, third injections were given to 2,185 employees. Large numbers of employees who had left the factories before their third injection was due, were advised to obtain the injection either through their own doctor or at a local clinic. HOME HELP (Tables 66 and 67) There were 68 more applications for home help received in 1959 than in 1958 but the number of cases receiving help at the end of 1959 remained at just over 600. There were 86 home helps employed at the end of 1959, and their rate of pay remained at 3 s. 5d. per hour. 78 bookings were taken for maternity cases, but only 37 were helped, the remainder making other arrangements. The maximum charge for the service remained at 4s. Od. per hour. The number of home visits made by the Organisers increased to 4,648. 21 DAY NURSERIES 8 day nurseries with 370 approved places are maintained by the local authority. From June 1st an additional 30 places in York Park Day Nursery, Hendon, were made available for children living in the Willesden Area. Free transport in special vehicles with escorts is provided because of the distance from their homes. All approved places available have been filled throughout the year. The number of children on the waiting list for admission has increased 100% in spite of the additional places provided at York Park Day Nursery (Table 70). The general attendance has been good apart from a few periods when nurseries had cases of infectious disease (Tables 68 and 69) with 99% of the children in the priority groups (Table 71). Recruitment of suitable qualified staff nursery nurses and wardens has again proved difficult and 8 vacancies remained at the end of the year (Table 72). The establishment of 20 student nursery nurses was filled throughout the year. Six students completed their training and all successfully obtained the N.N.E.B. certificate. CONVALESCENCE Under Section 28 of the National Health Service Act, patients may be recommended for a short term stay in a convalescent 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 general 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 £5.5.0d. 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:— 1959 1958 Adults 110 106 Children 35 20 145 126 SCHOOL HEALTH SERVICE (Tables 73-85) Medical Inspection The routine medical inspections in schools continued. Defects were followed up and treatment offered at one of the specialist clinics. In addition to these routine inspections special school visits were made by the Medical Officers to deal with problems of children referred by the Head Teacher. This scheme may make it possible to reduce the number of routine inspections by concentrating more on the children who require attention. School Survey A comprehensive survey of all schools in the Borough was made during the year by teams of medical officers, public health inspectors and health visitors. Defects and deficiencies included such things as inadequate toilet accommodation, washing facilities, inadequate heating and lighting, dampness, and unsatisfactory medical inspection rooms. Summaries of the team's comments and recommendations have been brought to the notice of the Borough Education Officer. Handicapped Pupils In September the Day Special School for Educationally Subnormal Children was transferred from College Road to the Glenwood School, Kingsbury, N.W.9. The additional accommodation available will greatly reduce the waiting for admission. CHILD GUIDANCE (Tables 86 and 87) The clinic has been hampered by various staff shortages during the year. A Psychiatrist was appointed in January, but it was not until May that the vacancy for an Educational Psychologist was filled. In September, a further part-time psychotherapist was appointed. There was also a shortage of clerical staff. 136 children were referred to the Centre for investigation. This is the largest number since its inception in 1954. In addition the School Psychological Service has had a very busy year. The Child Guidance Centre has a long waiting list of six months and the School Psychological Service of nine months. Treatment is mainly carried out by the psychiatrist and three part-time psychotherapists with regular sessions for the children, assisted by the two full-time psychiatric social workers, who have regular meetings with the parents. Regular monthly meetings of the assistant medical officers and clinic staff have continued, and the psychiatrist has made weekly visits to the maternity and child welfare centres. At these meetings the medical officers have brought forward their own cases for discussion and emphasis has been on the prevention. Joint conferences have been arranged with probation officers, speech therapists and child care officers, and group meetings have also been held for health visitors, psychologists and nurses. In addition, psychological and social casework students have spent periods at the Centre as part of their training. 22 SCHOOL DENTAL SERVICE (Table 88) The number of dental officers remains at 6½, which is very satisfactory. The equivalent of 4/11 orthodontist at the beginning of the year, dropped to 3/11 towards the end, compared with 5/11 in 1958. In 1952 because of the shortage of staff and accommodation, a restricted scheme was introduced. This was modified in 1956, and terminated in February, 1958. Thus 1959 was the first full year in which all children on the school roll were eligible for routine inspection and treatment. As a result of the shortage of orthodontists, there is a long waiting list for treatment, and cases have had to be selected for reasons of age or urgency. PRIORITY DENTAL SERVICE (Table 89) In 1959 11% of the Dental Officers' time was spent in the inspection and treatment of the priority groups. The number of expectant and nursing mothers who were examined was 341 compared with 289 in 1958. The average over the previous five years, 1953-57, was 338. 97% of those seen in 1959 required treatment, 99% started, but only 45% completed their treatment and were made dentally fit. The ratio of fillings to extractions remains constant at 2.2:1. There has been a steady annual decline in the demand for treatment for the children under five, from 849 examinations in 1956, to 600 in 1959. Arrangements were made in 1958 to provide a routine inspection, but the numbers have continued to fall. The average number of conservations (fillings and silver nitrate dressings) per child treated was 3.3, and the ratio of fillings to extractions was 2.4:1. The need for advice on matters of oral hygiene and diet is great, and emphasis is laid on the care and value of the first or "foundation" teeth. CHIROPODY SERVICE (Table 90) The number of patients treated at the chiropody clinics in 1959 increased. Foot inspections of school children were made to discover defects and the possibility of their developing in the future. Four out of ten children needed treatment and many will be kept under review because they are likely to develop defects; hallux valgus and deformities of the lesser toes with associated pressure lesions were the commonest forms of defects. Health education talks were given to school children and the co-operation from the school staff was greatly appreciated. Talks were also given to expectant mothers on foot care during pregnancy and foot care of the infant beginning in the cradle. The foot and shoe fitting was particularly discussed at these meetings. The number of patients treated for foot infections increased; the need for foot hygiene is continually stressed. The major cause of foot disorders is unsuitable footwear, which includes socks as well as shoes; and with better designed shoes, and trained shoe fitters much foot suffering could be avoided. 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 Middlesex County Councils. The Borough Council made a further grant of £100 to the committee's funds in the financial year 1959/60. 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. The Willesden Borough Council and twenty-four local organisations are represented on the committee, which is affiliated to the Royal Society for the Prevention of Accidents and the National Home Safety Committee. Four committee meetings and two sub-committee meetings were held during the year. The committee participated in the National 'Guard the Fire' campaign. 4,000 copies of a pamphlet on fire prevention were distributed by the Housing Manager with a new rent book issue, and posters were displayed on the Council's notice boards. The Chief Officer of the Middlesex Fire and Ambulance Service wrote a second report on the causes of fires in houses and flats in Willesden. The report will be incorporated in the second edition of the home safety handbook. A sub-committee was set up to draft the new edition. Some propaganda and publicity was given on the use of flame-resistance materials. During the national 'Check that Fall' compaign, posters were displayed on the Council's notice boards and in the health clinics. Talks were given to local organisations by the Chairman and members of the committee and health visitors. Displays were exhibited at the Willesden Show and the Chairman and members attended to answer questions. Copies of the handbook and leaflets were distributed. A successful public meeting was held at Anson Hall on the 29th October, attended by 80 people. Her Worship the Mayor was chairman and opened the meeting. The Medical Officer of Health, the Consultant Physician to the Geriatric Department, Central Middlesex Hospital Group, the Manager of the Home Safety Department of the Royal Society for the Prevention of Accidents, and the Assistant Divisional Officer, Middlesex Fire and Ambulance Service, spoke on home safety. Three films were shown and home safety material was displayed by the London Electricity Board and the North Thames Gas Board. Handbills and copies of the home safety handbook were distributed. A children's poster competition was arranged with the co-operation of the Borough Education Officer. 266 entries were received and were divided into two groups; primary and secondary schools. Three prizes of savings stamps were awarded in each group, and twenty-two children were highly commended. The awards were presented by Her Worship the Mayor and the posters exhibited at the Willesden Borough Council meeting in December. There has been close association during the year with the Youth Officer for Willesden and the Youth Advisory Committee which will result in young people becoming more interested in home safety. 23 TABLES Table 1 DEATHS Causes: Males Females Total 1. Tuberculosis (respiratory) 5 — 5 2. Tuberculosis (other) — — — 3. Syphilitic disease 3 5 8 4. Diphtheria — — — 5. Whooping cough — — — 6. Meningococcal infections — — — 7. Acute poliomyelitis 1 — 1 8. Measles — — — 9. Other infective and parasytic diseases 2 1 3 10. Malignant neoplasm, stomach 20 26 46 11. Malignant neoplasm, lung, bronchus 94 12 106 12. Malignant neoplasm, breast — 44 44 13. Malignant neoplasm, uterus — 19 19 14. Other malignant and lymphatic neoplasms 104 101 205 15. Leukemia, aleukemia 5 7 12 16. Diabetes 4 12 16 17. Vascular lesions of nervous system 74 113 187 18. Coronary disease, angina 197 106 303 19. Hypertension, with heart disease 23 24 47 20. Other heart disease 50 98 148 21. Other circulatory disease 40 41 81 22. Influenza 11 17 28 23. Pneumonia 59 50 109 24. Bronchitis 106 27 133 25. Other diseases of respiratory system 12 3 15 26. Ulcer of stomach and duodenum 13 13 26 27. Gastritis, enteritis and diarrhœa — 3 3 28. Nephritis and nephrosis 7 3 10 29. Hyperplasia of prostate 16 — 16 30. Pregnancy, childbirth, abortion — — — 31. Congenital malformations 9 8 17 32. Other defined and ill-defined diseases 56 74 130 33. Motor vehicle accidents 19 4 23 34. All other accidents 31 19 50 35. Suicide 14 6 20 36. Homicide and operations of war — 3 3 TOTAL 975 839 1,814 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 1958 173,100 3,216 69 22 23 55 17 22 1959 172,800 3,384 66 19 22 53 15 21 Perinatal mortality 1955 35 „ „ 1956 35 „ „ 1957 32 „ „ 1958 31 „ „ 1959 27 Table 3 Infant Mortality: —by Wards Ward Number of deaths Total 1957-59 Rate 1957-59 1957 1958 1959 Carlton 9 13 8 30 33 Kilburn 4 7 7 18 22 Brondesbury Park — 3 5 8 12 Kensal Rise 3 3 6 12 24 Manor 4 4 6 14 22 Harlesden 3 6 3 12 14 Stonebridge 2 4 9 15 21 Roundwood 6 8 7 21 25 Church End 2 4 4 10 19 Willesden Green 2 3 2 7 9 Mapesbury 4 7 6 17 19 Gladstone 5 2 1 8 16 Cricklewood 3 4 1 8 18 Brentwater 1 1 1 3 8 48 69 66 183 19 25 Table 4 Deaths by Social Class I 1 II 2 Ill 39 IV 10 V 12 Not known 2 Total 66 Table 5 Infant Mortality—Causes (Based on Registrar General's Figures) 1936-1939 1940-1945 1946-1950 1951-1955 1959 Deaths Rate Deaths Rate Deaths Rate Deaths Rate Deaths Rate Neonatal 1-12 months Total Respiratory 106 81 140 8.8 68 4.2 53 4.1 2 12 14 41 Diarrhoea and enteritis 131 10.0 108 6.8 37 2.3 12 1.0 - - - - Other infections 34 2.6 40 2.5 15 0.9 12 1.0 - 2 2 0.6 Congenital malformations 83 6.3 89 5.6 72 4.4 53 4.1 10 3 13 3.8 Prematurity 170 13.0 179 11.3 99 6.1 110 8.4 23 — 23 6.8 Injury at birth 21 1.6 33 2.1 43 2.7 27 2.0 4 — 4 1.2 Other causes 134 10.3 149 9.4 96 5.9 31 2.2 10 — 10 3.0 All causes 679 51.9 738 46.5 430 26.5 298 22.8 49 17 66 19.5 Table 6 Premature births and deaths (deaths in brackets) Year Births in home Births in hospital Home births transferred to hospital Total 1946 47 (1) 128 (18) 12 (10) 175 (29) 1952 38 (3) 137 (23) 8 (3) 175 (26) 1953 31 (3) 143 (18) 7 (0) 174 (21) 1954 31 (2) 131 (10) 9 (0) 162 (12) 1955 31 (0) 139 (20) 7 (0) 170 (20) 1956 19 (0) 146 (12) 3 (0) 165 (12) 1957 25 (1) 169 (4) 6 (1) 194 (5) 1958 31 (1) 215 (17) 5 (1) 246 (18) 1959 24 (0) 201 (23) 3 (0) 225 (23) 26 Table 7 Premature births by wards Ward Premature births notified Percentage of live births in brackets Carlton 29 (9.4) Kilburn 13 (4.3) Brondesbury Park 12 (5.0) Kensal Rise 12 (6.5) Manor 23 (9.8) Harlesden 27 (8.4) Stonebridge 19 (7.6) Roundwood 27 (9.4) Church End 10 (5.8) Willesden Green 14 (5.3) Mapesbury 15 (4.3) Gladstone 8 (4.5) Cricklewood 10 (6.2) Brentwater 6 (4.4) Total 225 (6.6) Table 8 Infant Mortality : Congenital Malformations Anencephaly 1 Cyanotic congenital heart disease 1 Congenital heart disease. Transposition of great vessels and patent ductus arteriosus 1 Multiple congenital abnormalities 3 Dextra-cardia 1 Congenital heart disease 2 Hydrocephalus and sub-dural hæmatoma 1 Congenital internal hydrocephalus 1 Congenital tumour of right ventricle 1 Congenital cardiac malformation 1 Total 13 27 GENERAL PROVISION OF HEALTH SERVICES Table 9 Bacteriological examination of milk, ice cream and water Milk examinations—260 Schools (pasteurised) Dealers' premises Total Pasteurised T.T. pasteurised Sterilised Samples 68 141 18 33 260 Satisfactory 68 141 18 33 260 Unsatisfactory — — — — — Ice cream examinations—25 Grade 1 Grade 2 Grade 3 Grade 4 Total 22 — 3 — 25 Water examinations—278 Domestic supplies Swimming pools Paddling pool Total Samples 2 256 20 278 Satisfactory 2 234 9 245 Unsatisfactory — 22 11 33 Table 10 Uncleanliness and Scabies New cases treated Attendances Scabies Lice and nits Total Scabies Lice and nits Total Children under 5 years - 1 1 - 1 1 Children 5-15 years 23 56 79 27 61 88 Adults Men 4 6 10 5 6 11 Women 8 16 24 10 17 27 Total 35 79 114 42 85 127 HEALTH EDUCATION Table 11 Talks No. visited Total No. of talks Subjects Total attendances No. of attendances Schools 26 367 41 1,117 25—70 Factories 67 87 15 8,080 10—1,000 Religious, social and political organisations 14 15 13 460 12—70 Table 12 Mothercraft No. of clinics Total No. of classes Visits by health visitors 3 125 15,592 28 PREVALENCE AND CONTROL OF INFECTIOUS AND OTHER DISEASES Table 13 Infectious diseases 1959 (1958 in brackets) Notified Confirmed Deaths Diphtheria -(-) -(-) -(-) Dysentery 140 (108) 91 (93) — (—) Erysipelas 7 (13) 7 (11) — (—) Encephalitis, acute -(1) -(-) — (—) Food poisoning 40 (68) 24 (38) — (—) Malaria — (—) -(-) — (—) Measles 822 (1,939) 821 (1,939) — (—) Meningococcal infection 2 (4) 2 (4) — (—) Ophthalmia neonatorum -(1) - (1) — (—) Paratyphoid fever -(-) (-) — (—) Pneumonia 96 (98) 92 (97) 109 (80) Poliomyelitis and polioencephalitis 9 (7) 5 (4) 1 (—) Puerperal pyrexia 161 (120) 161 (120) — (—) Scarlet fever 143 (124) 142 (122) — (—) Smallpox - (-) (-) — (—) Typhoid fever 1 (-) 1 (-) — (—) Whooping cough 194 (71) 191 (70) -(-) Table 14 Whooping Cough Cases : Willesden and England and Wales Year Cases confirmed Case rate per 1,000 population Children vaccinated in Willesden Willesden England & Wales Willesden England & Wales 1948 423 146,410 2.35 3.42 - 1949 205 102,816 113 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 295 105,912 1.66 2.39 1,198 1955 171 79,133 .97 1.80 1,020 1956 226 92,410 1.21 2.06 1,814 1957 287 85,018 1.59 1.89 3,073 1958 70 33,404 .40 .74 1,849 1959 191 33,208 1.10 .73 1,978 Table 15 Poliomyelitis 0—15 years 15 years and over Total Notified 5 4 9 Confirmed 1 4 5 Non-paralytic — 1 1 Paralytic 1 3 4 Fatal - 1 1 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 1958 173,100 124 17 141 14 2 16 1,990 291 2,281 1959 172,800 152 20 172 5 — 5 1,910 288 2,198 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 1958 173,100 71 10 81 8 1 9 1959 172,800 88 12 100 3 3 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 1958 89 41 130 75 1959 106 27 133 78 Table 19 Cancer of the 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 1958 81 21 102 59 1959 94 12 106 62 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 to 5 6 (—) 3 (—) 1 (—) -(-) 5 to 10 1 (—) — (—) 1 (—) -(-) 10 to 15 — (—) 1 (—) — (—) -(-) 15 to 20 3 (—) 3 (—) — (—) -(-) 20 to 25 15 (—) 9 (—) 3 (—) 3 (—) 25 to 35 14 (1) 16 (—) 1 (—) 3 (—) 35 to 45 18 (—) 11 (—) — (—) 1 (—) 45 to 55 19 (—) 8 (—) 1 (—) 3 (—) 55 to 65 17 (2) ( ) ( ) — (—) 65 and upwards 6 (2) 2 (-) 2 (-) 1 (-) Totals 99 (5) 53 (-) 9 (-) 11 (-) Table 21 Tuberculosis 1959: Cases by wards Ward Pulmonary cases Nonpulmonary cases Pulmonary rate per 100,000 Combined rate per 100,000 Carlton 20 - 166 166 Kilburn 16 2 121 136 Brondesbury Park 10 1 86 95 Kensal Rise 3 - 26 26 Manor 6 1 48 56 Harlesden 13 1 94 101 Stonebridge 8 5 65 105 Roundwood 10 1 84 93 Church End 8 - 63 63 Willesden Green 20 3 152 175 Mapesbury 15 4 117 148 Gladstone 11 2 97 115 Cricklewood 7 — 61 61 Brentwater 5 — 40 40 Whole Borough 152 20 88 100 31 Table 22 Tuberculosis 1957—1959: Cases by wards Ward Pulmonary cases Nonpulmonary cases Pulmonary rate per 100,000 Combined rate per 100,000 Carlton 49 7 135 154 Kilburn 40 6 100 115 Brondesbury Park 20 5 55 69 Kensal Rise 14 2 41 47 Manor 29 2 74 80 Harlesden 40 4 96 106 Stonebridge 26 7 70 89 Roundwood 32 3 90 99 Church End 26 — 68 68 Willesden Green 44 5 111 123 Mapesbury 40 10 105 131 Gladstone 31 4 91 103 Cricklewood 22 2 64 70 Brentwater 22 5 62 76 Whole Borough 435 62 83 95 Table 23 Tuberculin Testing, 1953-1959 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 2.8 938 169 180 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 1958 989 26 2.6 1,613 81 5.0 2,069 403 19.0 1959 273 3 1.1 1,573 63 4.0 1,855 328 17.7 Table 24 Tuberculosis: B.C.G. vaccination of school leavers, 1953-1959 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) 1958 1,645 (80) 1,527 (93) 1959 1,506 (81) 1,373 (91) * Percentage of total tested. † Percentage of negatives vaccinated. 32 Table 25 Tuberculosis: Notification of deaths 1954 1955 1956 1957 1958 1959 1954-59 Deaths 37 27 25 13 16 5 123 Percentage not notified 19 15 24 15 12 20 18 Percentage notified before death: 0—12 months 11 15 20 15 25 - 14 1—5 years 30 26 4 23 13 40 23 Over 5 years 40 44 52 47 50 40 45 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 Nil Closing Orders, section 18, Housing Act, 1957 4 32a, Oxford Road (basement) 28, Granville Road (basement) 56, Teignmouth Road (three attic rooms) 862, Harrow Road (hall floor, small back addition room) Table 27 Overcrowding (a) Dwellings overcrowded at end of year 1,723 (b) Overcrowding reported during the year 95 (c) (i) Overcrowding relieved during the year 36 (ii) Persons 144 (approx.) (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 46 (ii) Families 68 (iii) Persons 408 (f) Overcrowding in Council houses relieved during the year 9 (g) Section 80, Housing Act, 1957—licences issued 4 Table 28 New Dwellings, 1959 Houses Flats Rebuilds Dwellings built by private builders (excluding those built by the police authorities 1 20 Nil Built by local authority 8 110 Nil Applicants on Council's waiting list at 31.12.59 10,120 33 Table 29 Notices served under Public Health Act, 1936 and Housing Act, 1957 1959 1958 Intimation notices served 900 1,140 Intimation notices complied with 886 1,179 Statutory notices served (Public Health Act, 1936) 1,050 1,062 Statutory notices complied with (Public Health Act, 1936) 902 1,041 Statutory notices served (Housing Act, 1957) 5 10 Statutory notices complied with (Housing Act, 1957) 6 17 Non-compliance with statutory notices referred to Town Clerk (Public Health Act, 1936, Sec. 93) 1 †165 Referred to the Borough Engineer for work to be carried out in default of owners 151 *219 *82 work done by Borough Engineer. †Details of cases referred to the Town Clerk during year: — Work carried out 93 72 Work in hand — 1 Court orders obtained 13 39 Summons withdrawn—notices complied with 22 36 Notices withdrawn 7 9 Proceedings pending — 8 Total 135 165 Table 30 Inspections carried out under Public Health Act, 1936, Housing Act, 1957, Rent Act, 1957, Clean Air Act, 1956, Infectious Diseases and Miscellaneous Inspections Public Health Act Dwelling houses inspected 2,733 Dwelling houses re-inspected 8,184 Other visits 1,254 Housing Act Dwelling houses wholly inspected 1,582 Dwelling houses partly inspected 191 Dwelling houses re-inspected 216 Underground rooms inspected 4 Overcrowding visits 33 Improvement grant inspections 73 Other visits 1,471 Rent Act Dwelling houses inspected 80 Dwelling houses re-inspeoted 199 Other visits 91 Clean Air Act Boiler plant inspections 55 Boiler plant re-inspections 63 Premises inspected (S.C.A.) 3,462 Premises re-inspected (S.C.A.) 489 Smoke observations 360 Rag, Flock and Other filling materials Act Premises inspected 5 Visits re samples 10 Infectious diseases Infectious disease enquiries 778 Food poisoning enquiries 115 Polio virus survey visits 277 Miscellaneous Massage establishments inspections 26 Cinemas, dance halls, schools, etc., inspected 65 Noise nuisance investigations 166 Visits re unsound food 139 AH other visits 1,461 23,582 34 Table 31 Inspection of Factories, Outworkers Premises and Food Premises 1959 1958 No. inspected Inspections made No. inspected Inspections made Offensive trades — — — — Power factories 774 1,050 782 1,213 Non-power factories 61 117 61 61 Homeworkers and outworkers 213 320 330 330 Inspections of food premises (including revisits) Baker 27 172 29 75 Bread and confectionery 39 133 38 90 Dairy 3 12 3 20 Butcher 117 405 116 311 Grocer and general store 329 910 335 777 Fishmonger and fish-fryer 49 150 49 131 Cafe and restaurant 136 632 144 388 Greengrocer and fruiterer 124 347 125 253 Ice cream and sweet shop 222 579 223 501 Food stall 15 41 15 23 Public House 43 72 43 70 Works canteen 120 298 122 250 School canteen 35 39 24 29 Food factory 5 34 5 20 Any other food premises 34 62 37 37 Total periodic inspections 2,346 5,373 2,481 4,579 Total all inspections 1959 1958 28,955 20,557 Table 32 Rent Act, 1957 Certificates of Disrepair Applications (Form I) received and investigated 59 Agreed and proposal to issue Certificate of Disrepair (Form J) served 58 Refused 1 Undertakings (Form K) received from landlords 29 Accepted 28 Refused 1 Certificates of Disrepair (Form L) issued 23 Applications received for cancellation of Certificates of Disrepair (Form M) 29 Granted 19 Refused 10 35 Table 33 Summary of nuisances abated and of improvements effected Water supply and water service 1959 1958 New cisterns provided 3 9 Cisterns cleansed, repaired, covered, etc. 19 43 Draw taps placed on mains 8 2 Drainage and sewerage Water closets: Repaired, supplied with water or otherwise improved 251 214 New closets built 5 3 Provided with better ventilation — — Drains: Examined, tested, exposed, etc. 77 104 Unstopped, repaired, trapped, etc. 204 203 New soilpipes or vent shafts fixed 15 11 Disconnecting traps or chambers inserted 16 17 Reconstructed 13 31 New manhole covers 36 19 Soilpipes or vent shafts repaired 61 53 Other defects Smoke nuisances 8 9 Accumulation of refuse 86 77 Fowls, pigs, etc., kept in an insanitary condition 3 9 Dampness 403 361 Yards and forecourts paved, repaved or repaired 66 68 Walls and ceilings cleansed 476 466 Verminous rooms disinfested 489 294 Leaky roofs made watertight 359 648 Additional ventilation provided under floors 11 18 Dilapidated plaster repaired 604 846 Flooring and other woodwork repaired 356 472 Damp proof courses inserted 28 68 Water supply reinstated 28 34 Wash house floors repaired or repaved 21 29 Fireplaces and stoves repaired 96 186 Decayed brickwork repaired and repointed 174 310 Sinks provided or replaced 58 44 Additional light and ventilation to staircase 4 — Gutters and /or rainwater pipes repaired or renewed 358 544 Larders or food cupboards ventilated or provided — 1 New sashcords and glass provided to doors and windows 637 959 Miscellaneous 247 270 Total nuisances abated 5,220 6,422 36 CLEANAIR Table 34 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 30.39 30.35 18.34 29.75 25.31 -(a) 21.96 February 22.24 21.33 13.66 19.88 11.73 11.92 10.70 March 25.91 37.74 24.81 26.91 19.88 22.88 21.96 April 26.77 45.07 20.24 23.32 9.48 (b) 16.49 18.80 May 17.40 15.24 12.54 13.45 12.46 9.84 11.39 June 25.91 24.55 19.57 (c) 20.28 46.59 (c) 17.78 20.54 July 21.34 15.01 17.54 14.71 15.24 16.10 14.15 August 26.84 23.06 18.17 17.59 18.92 23.31 (c) 18.27 September 17.56 12.46 14.27 13.95 11.36 12.84 11.32 October 29.23 24.35 18.41 21.08 40.69 (c) 21.14 22.26 November 24.59 42.68 24.44 24.98 18.52 24.03 21.07 December 36.62 47.39 31.02 30.26 29.49 22.88 25.06 Totals 304.80 339.23 233.01 256.16 259.67 199.21 217.48 (a) Collecting bottle blown over during gale. (b) Collecting bottle tampered with. (c) Contaminated with extraneous matter. Table 35 Examination of sulphur by lead peroxide method (milligrams of SO3 year day per 100 square centimetres) Site January February March April May June July August September October November December Minet Gardens 4.67 3.93 2.93 2.45 0.89 0.96 0.87 1.26 0.90 2.30 3.67 2.91 Town Hall 4.34 3.90 2.36 2.13 1.14 0.89 0.78 1.33 1.21 2.21 2.71 2.52 37 DISINFESTATTON Table 36 (a) Verminous premises: Council properties 37 County Council properties 2 Private properties 129 Total 168 (b) Verminous rooms*: Council properties 147 County Council properties 4 Private properties 338 Total 489 *Some rooms are treated more than once. (c) Bedding materials (i) disinfested 8 (ii) disinfected 24 (d) Miscellaneous: Beetles 2 Ants 3 INSPECTION AND SUPERVISION OF FOOD AND FOOD PREMISES Table 37 Types of food premises Baker 27 Bread and confectionery 39 Dairy 3 Butcher 117 Grocer and general store 329 Fishmonger and fish fryer 49 Cafe and restaurant 136 Greengrocer and fruiterer 124 Ice cream and sweet shop 222 Food stall 15 Public house 43 Works canteen 120 School canteen 35 Food factory 5 Other food premises 34 Total 1,298 Inspections and revisits: Inspections 3,080 Revisits 959 Total 4,039 Table 38 Premises unsatisfactory on 31.12.58 54 Unsatisfactory during the year 325 Premises made satisfactory during the year 331 Unsatisfactory on 31.12.59 48 38 Table 39 Food premises: Defects remedied Defects Outstanding at 31.12.58 Found during the year Total Remedied during year Outstanding at 31.12.59 Inadequate lighting and ventilation 1 13 14 9 5 Inadequate washing facilities 8 32 40 36 4 Inadequate refuse storage 2 26 28 22 6 Unsatisfactory or insufficient sanitary accommodation 12 39 51 43 8 Inadequate storage accommodation 5 7 12 11 1 Defective walls, ceilings or floors 19 104 123 96 27 Dirty walls, ceilings or floors 35 247 282 246 36 Inadequate first aid materials 1 6 7 6 1 Unsatisfactory conditions 3 32 35 35 — Any other defects 28 176 204 174 30 Totals 114 682 796 678 118 Table 40 Food premises: Registration Premises on register 31.12.58 Applications received Applications granted Applications refused Premises removed from register during 1959 Total on register at 31.12.59 1. Sale and storage of ice cream 360 26 25 1 45 340 348 2. Manufacture of ice cream 11 3 8 3. Manufacture of preserved food 135 2 2 - - 137 4. Fish curing 2 — — — 1 1 Table 41 Food unfit for human consumption Meat Tinned milk 381 tins Bacon 2,381 lbs. Butter and fats 1 lb. Cooked 21¼ lbs. Whole egg (powdered) 154 lbs. Tinned 2,919½ lbs. Raw 1,096¼ lbs. Fish Miscellaneous Tinned 361 tins Cornflakes 4 pkts. Raw 140 lbs. Dried fruit 183¾ lbs. Vegetables Frozen food (miscellaneous) 347 pkts. Fruit juice 108 tins Tinned 3,030 tins Liver and kidney pudding 17 tins Raw - - Meat pie 18 Fruit Rice pudding 6 tins Tinned 5,041 tins Salad cream 4 jars Raw 237 lbs. Sausages 5½ lbs. Bread, flour, cereals, etc. 53 lbs. Sauce 11 bottles Preserves 145 lbs. Soup 223 tins Cheese 63 pkts. Treacle 2 lbs. 39 Table 42 Food: Samples taken Article No. of samples Unsatisfactory Milk (various) 231 1 Bread, cakes and biscuits 6 1 Butter 38 — Cheese 17 — Cream 48 — Drugs 48 2 Fish and fish products 30 1 Fruit (fresh canned, etc.) 12 — Fruit juice, squash, etc. 14 1 Ice cream 44 — Liver 4 — Meat and meat products 95 11 Margarine 24 — Preserves 4 — Sauce and Pickles 7 — Sausages, etc. 5 1 Spirits 7 — Sweets 10 — Vinegar 30 — Miscellaneous 14 1 Total 688 19 Table 43 Dairies—Registrations and Licences Premises in Willesden 131 Dairymen 106 Licences issued Pasteurised milk 114 Sterilised milk 117 Tuberculin tested milk 88 Premises outside Willesden 12 Dairymen 6 Licences issued Pasteurised milk 12 Sterilised milk 12 Tuberculin tested milk 12 40 FACTORIES Table 44 Classification of Factories (Figures for 1949 in brackets) Power Factories Non-Power Factories Total Builders 11 (7) 3 (5) 14 (12) Basket Makers 0 (1) 0 (1) 0 (2) Body and Coach Builders 13 (17) — 13 (17) Bottle Washing 1 (2) — 1 (2) Boot and Shoe Repairs 21 (47) - (8) 21 (55) Brewers and Bottling of Beer, etc. 2 (3) — 2 (3) Brush Makers 1 (2) — 1 (2) Bedding and Mattresses, etc. 3 (9) — 3 (9) Brass and other Metal Foundries 4 (7) — 4 (7) Cameras and Optical Instruments 1 (5) — 1 (5) Cosmetics and Perfumes Manufacturers 1 (6) — 1 (6) Chocolate and Sweet Makers 0 (2) — 0 (2) Coffin Makers 4 (3) - (1) 4 (4) Cleaners and Dyers 12 (8) - (2) 12 (10) Cardboard Box and Paper Bag Makers 5 (2) — 5 (2) Denture and Dentist Requisites 3 (5) — 3 (5) Dressmakers, Tailors, etc. 47 (58) - (2) 47 (60) Detergents Manufacturer 1 (0) — 1 (0) Dolls, Toys and Fancy Goods 10 (21) 16 (2) 26 (23) Display Works 7 (2) — 7 (2) Engineering (Light) 33 (0) — 33 (0) Engineers—Mechanical 95 (89) — 95 (89) Engineers—Electrical 55 (34) 3 (2) 58 (36) Enamel Plate Manufacture 1 (1) — 1 (1) Furniture and Upholstery 18 (10) - (2) 18 (12) Food Factories (Bakehouses, etc.) 45 (49) — 45 (49) Florists — 1 (7) 1 (7) Film Processing and Equipment 5 (0) — 5 (0) Furriers 2 (3) - (1) 2 (4) Glassworkers, Glazing, etc. 9 (9) - (1) 9 (10) Gas Manufacturers, Sales, Workshops, etc. 3 (1) 1 (3) 4 (4) Kitchen Equipment and Household Goods 4 (7) 2 (0) 6 (7) Laundries 23 (24) - (2) 23 (26) Leather Goods (Handbags, Belts, etc.) 8 (12) 1 (0) 9 (12) Medical and Surgical Requisites 6 (0) 1 (0) 7 (0) Motor and Cycle Repairs 84 (60) 14 (11) 98 (71) Motor Accessories, etc. 12 (12) 1 (0) 13 (12) Motor Tyre Repairs and Retreading 6 (7) — 6 (7) Meters and Instruments 8 (10) — 8 (10) Plating, Polishing and Die Casting 12 (9) — 12 (9) Plastic Goods 9 (5) — (3) 9 (8) Paint, Polish and Varnish Makers 4 (4) - (1) 4 (5) Paint and Cellulose Spraying 11 (6) — 11 (6) Pen, Pencil and Stationery Makers 10 (5) — 10 (5) Printing, Bookbinding, etc. 38 (36) — (4) 38 (40) Photographic Materials, etc. 3 (9) 2 (2) 5 (11) Packers and Warehouse - (5) 10 (5) 10 (10) Opticians and Lens Grinding 3 (9) — 3 (9) Removals and Haulage Contractors 4 (0) 1 (0) 5 (0) Roof and Sealing Compounds 3 (2) — 3 (2) Rubber Goods Manufacturers 2 (0) — 2 (0) Scrap Metal Dealers, etc. 5 (2) 5 (0) 10 (2) Shop Fitters 4 (2) — 4 (2) Silversmiths and Goldsmiths 3 (2) — 3 (2) Sheet Metal Workers, etc. 21 (15) — 21 (15) Stonemasons 7 (5) - (2) 7 (7) Sports Goods, etc. 3 (4) — 3 (4) Spring Makers and Wire Workers 10 (7) — 10 (7) Tool Makers 15 (4) — 15 (4) Tiled Fireplaces, etc. 2 (5) - (1) 2 (6) Waste Paper Baling 3 (0) — 3 (0) Watch and Clock Manufacturers, Repairers, etc. 3 (4) - (4) 3 (8) Woodworkers and Joinery 32 (20) - (1) 32 (21) Gun and Rifle Manufacturers 1 (0) — 1 (0) Industrial Chemical Manufacturers 1 (0) — 1 (0) Manufacturers of Cigarette Paper Tubes 1 (0) — 1 (0) TOTAL 774 (695) 61 (73) 835 (768) 41 Table 45 Grouping of Factories Firms employing: 1 to 5 332 6 to 10 149 11 to 25 152 26 to 50 70 51 to 100 57 101 to 200 43 201 to 300 10 301 to 400 4 401 to 500 5 501 to 750 3 751 to 1,000 5 1,001 to 2,000 2 2,001 to 3,000 3 Total 835 Table 46 Names of Firms employing 200 to 300: 10— Smith's Crisps, 717, North Circular Road, N.W.2 230 North Thames Gas (Meter Repairs), Pound Lane, N.W.10 200 Aron Electricity Meters Ltd., 8, 17, 20, 34, Lonsdale Road, N.W.6 208 Luxfer Ltd.. Metal Window Frames, Waxlow Road, N.W.10 206 Normand Garages Ltd., Cumberland Avenue, N.W.10 300 J. Lyons, Abbey Road, N.W.10 270 Harvey Bradfield & Toyer, Coombe Road, N.W.10 219 Rolls Razor Ltd., Cricklewood, N.W.2 275 Mono Containers Ltd., Cumberland Avenue, N.W.10 250 London Electricity Board, Taylor's Lane, N.W.10 218 301 to 400:4— Biro Swan, Whitby Avenue, N.W.10 350 Smiths Motor Accessories, Oxgate Lane, N.W.2 346 Delaney Gallay—Vulcan Works, Edgware Road, N.W.2 380 G. & E. Bradley Ltd., Electronic Research Engineering, 58, Neasden Lane 330 401 to 500: 5— Aron Electricity Meters, 72-82, Salusbury Road 440 Neasden Motive Power Depot, North Circular Road 450 Electroflo Meters, Abbey Road. N.W.10 500 Coach Builders, Park Ward, 473, High Road, N.W.10 485 Thrupp & Maberley, Humber Road, N.W. 463 501 to 750: 3— Ascots Ltd., North Circular Road, N.W.10 540 L.T.E. Neasden Railway Depot, North Circular Road 540 Lancashire Dynamo & Crypto, Acton Lane, N.W.10 540 751 to 1,000: 5— Waterlow & Sons Ltd., Twyford Abbey Road, N.W.10 812 Scribbans Kemp Bakeries Ltd., North Circular Road, N.W.2 930 Park Royal Vehicles Ltd., Abbey Road, N.W.10 816 Guinness Brewery—Cumberland Avenue, N.W.10 800 Associated Automation Ltd., Dudden Hill Lane, N.W.10 880 1,001 to 2,000: 2— S. Smith & Sons (England) Ltd., Waterloo Road, N.W.2 1,164 McVitie & Price, Waxlow Road, N.W.10 1,161 2,001 to 3,000: 3— H. J. Heinz & Co., Waxlow Road, N.W.10 2,229 British Thomson-Houston, Ltd. Neasden Lane, N.W.10 2,251 S. Smith & Sons (England) Ltd., Cricklewood, N.W.2 2,759 42 Table 47 On register and inspections No. on register Inspections Written notices Factories in which sections 1, 2, 3, 4, and 6 are to be enforced by local authority 61 117 4 Factories not included above in which section 7 is enforced by the local authority 774 1,050 59 Other premises in which section 7 is enforced by the local authority (excluding outworkers premises) 8 12 — Total 843 1,179 63 No occupiers were prosecuted during the year. Table 48 Defects found Found Remedied Referred To H.M. Inspector By H.M. Inspector Want of cleanliness (sec. 1) 6 9 - - Overcrowding (sec. 2) — — — — Unreasonable temperature (sec. 3) — — — — Inadequate ventilation (sec. 4) 1 1 — — Ineffective drainage of floors (sec. 6) — — —' — Sanitary conveniences (sec. 7) (a) Insufficient 5 7 — — (b) Unsuitable or defective 48 72 — 8 (c) Not separate for sexes — I — — Other offences against the Act (not including offences relating to outworkers) 1 1 — — Total 61 91* — 8 *Includes defects outstanding from previous year. No prosecutions were instituted during the year. Table 49 Outworkers Nature of work No. of outworkers in August list No. of instances of work in unwholesome premises Notices served Wearing apparel (making, etc.) 108 1 1 Household linen 3 - - Curtains and furniture hangings 1 - - Furniture and upholstery 1 - - Artificial flowers 1 - - Paper bags 3 - - Making of boxes or other receptacles or parts thereof made wholly or partially of paper 8 - - Carding, etc. of buttons, etc. 10 - - Stuffed toys 43 - - Cosaques, Christmas stockings, etc. 7 - - Imitation jewellery and jewellery pads 27 - - Lampshades 1 - - Total 213 1 1 There were no cases of default in sending lists to the Council, and there were no prosecutions. 43 CARE OF MOTHERS AND YOUNG CHILDREN Table 50 Ante-natal Clinics Clinic Sessions New cases Attendances Average attendance per session Antenatal Postnatal Antenatal Postnatal Kilburn 102 343 30 1,452 30 14.5 Pound Lane 100 391 8 1,703 8 17.1 Stonebridge 151 601 13 3,825 13 25.4 Cricklewood (Sneyd Road) 52 210 15 434 15 8.6 Neasden (St. Catherine's) 53 52 — 154 — 2.9 Kensal Rise (St. Martin's) 52 188 1 795 1 15.3 South Kilburn (St. Luke's) 52 109 3 852 4 16.5 Totals : 1959 562 1,894 70 9,215 71 16.5 1958 562 1,845 44 9,285 45 16.5 Table 51 Births Hospital and domiciliary 1959 1958 Total notified live births 3,332 3,210 Born in institutions 2,891 2,728 Born at home 441 482 Percentage born in institutions 86.9 85.0 Institutions Central Middlesex Hospital 1,174 1,169 Kingsbury Maternity Hospital 498 441 Larger hospitals outside Willesden 1,092 1,029 Smaller hospitals outside Willesden 113 66 Nursing homes, etc. 14 23 2,891 2,728 Home County Midwives 436 482 Others 5 — 441 482 Table 52 Mothercraft Clinic Sessions New cases Total attendances Average attendance per session Kilburn 35 57 294 8.4 Pound Lane 36 50 177 4.9 Stonebridge 54 102 335 6.2 Totals : 1959 125 209 806 6.4 1958 123 168 790 6.4 Table 53 Relaxation Classes Clinic Sessions New cases Total attendances Average attendance per session Kilburn 43 74 333 7.8 Pound Lane 43 52 187 4.3 Stonebridge 58 105 377 6.5 Totals: 1959 144 231 897 6.2 1958 141 232 721 5.1 44 Table 54 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 283 531 5,556 803 390 6,749 2,745 23.9 Pound Lane 256 658 6.908 868 421 8,197 3,405 32.0 Stonebridge 265 720 7,434 959 557 8,950 2,827 33.7 Cricklewood (Sneyd Road) 102 359 3,758 542 338 4,638 1,613 45.5 Neasden (St. Catherine's) 101 279 4,545 866 455 5,866 1,050 58.1 Kensal Rise (St. Martin's) 154 364 5,877 751 343 6,971 1,775 45.3 South Kilburn (St. Luke's) 101 233 3,371 473 193 4,037 1,199 40.0 Totals: 1959 1,262 3,144 37,449 5,262 2,697 45,408 14,614 36.0 1958 1,326 2,984 34,726 5,919 3,176 43,821 15,433 33.0 MIDWIFERY SERVICE Table 55 Midwives' Clinics Sessions New Cases Total attendances Average attendance 1959 405 948 5,868 14.5 1958 309 732 4,877 15.8 Table 56 Midwives—Administration of analgesics 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 313 (b) When doctor was present at delivery 65 Number of cases in which pethidine was administered in domiciliary practice during the year: (a) When doctor was not present at delivery 127 (b) When doctor was present at delivery 33 Number of cases in which trichloroethylene was administered in domiciliary practice during the year: (a) When doctor was not present at delivery 1 (b) When doctor was present at delivery 1 Totals: 1959 540 1958 468 Table 57 Domiciliary Births Attended by midwives Visits Visits made to mothers discharged from hospitals before 14th day Domiciliary cases where infant wholly breast fed at 14th day Dr. not booked Dr. booked Dr. present at delivery Dr. not present at delivery Dr. present at delivery Dr. not present at delivery Mothers Visits 1 — 91 343 15,493 51 347 378 Totals: 1959 435 15,493 51 347 378 1958 424 15,110 25 151 397 45 Table 58 Medical Aid 1959 1958 (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 69 67 (ii) Others - 8 Totals 69 75 Medical Aid For Mother For Child Early rupture of membranes 1 Sticky eyes 1 Post-partum haemorrhage 4 Symptom of a cold 1 Ruptured perineum 37 Delayed 2nd stage 2 Raised temperature 1 Foetal distress 4 Ante-partum haemorrhage 2 Prolapsed cord 1 Delayed 1st stage 3 Twin pregnancy 3 Disproportion 2 Prematurity 3 Hæmatoma, vaginal wall 1 Breech delivery 1 Toxaemia of pregnancy 1 Maternal distress 1 Totals 67 2 HEALTH VISITING Table 59 Visits made by Health Visitors Year Expectant Mothers Children under 1 year Children 1—2 years Children 2—5 years Tuberculosis Households General First Total First Total Total Total Total Total as health visitor Total as school nurse 1959 2,043 2,916 3,681 12,676 6,049 9,576 10 1,895 824 1958 1,937 2,758 3,392 11,869 5,656 9,518 6 2,078 1,162 Table 60 Special cases referred by General Practitioners for:— Care of children Care of elderly persons Family problems General advice Home help Laundry service w.v.s. 6 8 5 6 4 1 7 47 Table 61 Establishment: Health Visitors Whole time equivalent as at: 31.12.58 31.12.59 Health Visitors (Whole time) 19 23 „ „ (Part time) 1 1/11 3/11 „ „ (Sponsored) - 2 Clinic Nurses (Whole time) 7 4 Nursing Assistant (Part time) - 2/11 Totals 27 1/11 29 5/11 HOME NURSING Table 62 Work: Home Nurses New Cases Visits Cases on register at end of year Male Female Male Female Medical 699 1,275 71,576 146 397 Surgical 148 159 11,487 16 37 Infectious 20 16 343 1 1 Tuberculosis 26 29 4,013 7 9 Maternal complications — 51 404 — - Others — — — — — Total 893 1,530 170 444 Totals: 1959 2,423 87,823 614 1958 2,753 93,783 666 Table 63 Establishment: Home Nurses Nurses 1.1.59 31.12.59 Whole time 21 24 Part time 6 5 Candidates - - Total whole time equivalent 25½ 27 SMALLPOX Table 64 Vaccination Under 1 year 1 year 2—4 years 5—14 years 15 years and over Total Primary Vaccinations 1,274 238 91 47 93 1,743 Re-vaccinations — — 5 26 235 266 Totals: 1959 1,274 238 96 73 328 2,009 1958 972 166 65 81 378 1,662 Approximate number of children (end of 1959) 0— 5 14,502 5—15 19,928 34,430 48 DIPHTHERIA Table 65 Immunisation Age at 31.12.59 Under 1 1 2 3 4 5—9 10—14 Totals Courses completed (primary or boosting) during last 5 years 1955-59 360 1,571 1,502 1,391 1,189 3,898 480 10,391 Courses completed (primary or boosting) during the period 1945-54 — — — — — 4,180 11,276 15,456 Approximate number of children (end of 1959) 0— 5 14,502 5—15 19,928 34,430 HOME HELPS Table 66 Cases: Home Helps Cases receiving help at No. of new cases helped during No. of cases receiving help at 1.1.59 1.1.58 1959 1958 31.12.59 31.12.58 Maternity 9 1 48 63 - 9 Tuberculosis 11 12 10 7 18 11 Chronic sick and aged 520 488 222 216 491 520 Others 65 45 175 110 95 65 Totals 605 546 455 396 604 605 Table 67 Staff: Home Helps Position at Appointments during Resignations during Position at 1.1.59 1.1.58 1959 1958 1959 1958 31.12.59 31.12.58 Whole time 2 1 1 1 1 — 2 2 Part time 83 83 25 25 24 25 84 83 Totals 85 84 26 26 25 25 86 85 49 DAY NURSERIES Table 68 Day Nurseries: Attendances Day Nursery Approved places Children on register at 31.12.59 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 23 33 4,121 6,985 16 27 Essex Road 25 25 27 30 6,120 6,227 24 25 Evefield 25 25 27 27 5,354 5,367 21 21 Gladstone Park 25 25 28 30 5,357 5,846 21 23 Longstone Avenue 25 25 24 31 4,574 6,272 18 25 Mortimer Road 25 25 22 27 4,804 5,013 19 20 Villiers Road 25 25 26 31 5,186 5,923 20 23 Wesley Road 15 25 17 28 2,209 4,459 9 17 Totals: 1959 183 207 194 237 37,725 46,092 148 181 1958 183 207 196 221 40,200 45,637 157 178 Table 69 Day Nurseries: Infectious Diseases Number of Cases Nursery Measles Scarlet Fever Chicken Pox Dysentery Mumps German Measles Whooping Cough Chichester Road - - - 1 14 - 1 Essex Road - - 1 - - - - Evefield - - - - 5 1 2 Gladstone Park 6 - - - 1 - 3 Longstone Avenue 3 - - - 11 - - Mortimer Road 1 - - 7 - 2 - Villiers Road - - 1 - - - 6 Wesley Road 24 1 - 12 4 1 - Totals 34 1 2 20 35 4 12 Table 70 Day Nurseries Waiting List Position at: — Nursery 31.12.58 30.6.59 31.12.59 Chichester Road 16 17 11 Essex Road 5 16 16 Evefield 4 Longstone Avenue 4 8 6 Gladstone Park 15 12 31 Mortimer Road 2 11 17 Villiers Road 4 16 27 Weslev Road 14 2 9 Totals 60 87 123 50 Table 71 Day Nurseries: Priorities Nursery Unsupported Mothers Medical reasons Bad Housing Total on Register Chichester Road 34 8 12 54 Essex Road 26 16 13 55 Evefield 18 5 23 48 Gladstone Park 25 9 15 51 Longstone Avenue 22 16 13 51 Mortimer Road 32 1 16 49 Villiers Road 26 5 22 53 Wesley Road 10 6 17 33 York Park 2 4 24 30 Totals 195 70 155 424 Table 72 Day Nursery Staff Establishment Establishment Position as at: 31.12.59 31.12.58 Supervisory Matron 1 1 1 Matrons 8 8 8 Deputy Matrons 8 8 8 Wardens 8 5 5 Nursing Staff 44 39 35 Students 20 20 20 SCHOOL HEALTH SERVICE Table 73 Medical Inspection of Pupils attending Maintained Primary Schools and Secondary Schools (including Nursery and Special Schools) Year of birth (1) Number of pupils inspected (2) Physical condition of pupils inspected Satisfactory Unsatisfactory Number (3) % of column 2 (4) Number (5) % of column 2 (6) 1955 and later 97 93 95.9 4 4.1 1954 1,319 1,287 97.6 32 2.4 1953 456 448 98.2 8 1.8 1952 433 426 98.4 7 1.6 1951 1,092 1,067 97.7 25 2.3 1950 172 164 95.3 8 4.7 1949 1,338 1,325 99.0 13 1.0 1948 131 131 100.0 — — 1947 165 164 99.4 1 0.6 1946 174 170 97.7 4 2.3 1945 657 644 98.0 13 2.0 1944 and earlier 1,479 1,463 98.9 16 11 Totals 7,513 7,382 98.3 131 1.7 51 Table 74 Individual Pupils found at periodical Medical Inspections to require treatment (excluding dental diseases and infestation with vermin) Year of birth (1) For defective vision (Excluding squint) (2) For any of the other conditions in table (3) Total individual pupils (4) 1955 and later - 3 3 1954 19 80 95 1953 8 40 46 1952 27 31 56 1951 66 90 152 1950 12 13 25 1949 81 63 142 1948 13 13 25 1947 9 16 24 1946 9 13 20 1945 34 60 91 1944 and earlier 69 111 178 Totals 347 533 857 Table 75 Defects Found by Medical Inspection * Periodic inspections Special inspections Entrants Leavers Others Total (a) (b) (a) (b) (a) (b) (a) (b) (a) (b) Skin 4 51 49 60 14 91 67 202 254 52 Eyes (a) Vision 33 37 100 128 214 323 347 488 37 12 (b) Squint 3 23 3 14 10 49 16 86 7 2 (c) Other 7 9 1 11 4 33 12 53 52 36 Ears (a) Hearing 3 39 1 16 12 58 16 113 60 21 (b) Otitis media 3 38 2 7 3 44 8 89 4 3 (c) Other - 12 1 1 1 10 2 23 22 22 Nose and throat 39 221 8 43 53 239 100 503 54 68 Speech 24 32 5 9 18 34 47 75 83 22 Lymphatic glands 6 88 — 4 5 49 11 141 1 1 Heart - 30 — 15 — 41 — 86 — 1 Lungs 2 51 — 34 4 60 6 145 8 29 Developmental (a) Hernia 1 16 — 10 1 15 2 41 — — (b) Other 1 53 3 21 2 125 6 199 — 15 Orthopaedic (a) Posture 4 27 37 44 36 98 77 169 4 14 (b) Feet 11 30 47 49 46 116 104 195 1 29 (c) Other 6 58 11 41 20 70 37 169 22 20 Nervous system (a) Epilepsy — 5 — 3 — 8 — 16 1 1 (b) Other — 18 — 11 3 21 3 50 2 8 Psychological (a) Development 2 20 2 12 3 20 7 52 6 14 (b) Stability 2 120 — 72 16 155 18 347 3 10 Abdomen — 18 1 12 — 26 1 56 — 7 Other 176 44 82 49 196 117 454 210 344 75 Totals 327 1,040 353 666 661 1,802 1,341 3,508 965 462 * (a) Requiring treatment (b) Requiring observation. 52 Table 76 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 102 (b) Errors of refraction (including squint) 1,234 Totals 1959 1,336 1958 1,023 (c) Number of pupils for whom spectacles were prescribed Totals 1959 586 1958 570 (ii) Diseases and Defects of Ear, Nose and Throat Received operative treatment for: (a) diseases of the ear 8 (b) adenoids and chronic tonsillitis 54 (c) other nose and throat conditions 10 Received other forms of treatment 92 Totals 1959 164 1958 340 Total number of pupils in schools who are known to have been provided with hearing aids: (a) during the current year 2 (b) in previous years (excluding any pupils shown at (a) above who were provided with an aid in the previous year). 11 (iii) Orthopaedic and Postural Defects Number of pupils known to have been treated at clinics or at out-patients departments 1959 678 1958 707 (iv) Diseases of the Skin (Excluding Uncleanliness) Ringworm (i) Scalp — (ii) Body — Scabies 3 Impetigo 33 Other skin diseases 258 Totals 1959 294 1958 252 (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) 163 (vi) Speech Therapy Number of pupils treated by speech therapists under arrangements made by the authority 1959 205 1958 300 (vii) Other Treatment Given (a) Number of miscellaneous minor ailments treated by the County Council 655 (b) Treatment other than (a) above and excluding convalescent treatment: 1. Lymphatic glands 1 2. Heart 1 3. Lungs 126 4. Developmental (a) Hernia - (b) Other 21 5. Nervous system (a) Epilepsy - (b) Other 4 6. Psychological (a) Development 8 (b) Stability 15 7. Abdomen 4 8. Other 5 Totals 1959 840 1958 1,105 53 Table 77 Orthoptics—Cases seen at Pound Lane Clinic Total No. of cases seen No. of new cases Placed on operation waiting list Discharged cured Failed to attend Orthoptic Cosmetic 66 31 2 6 — 10 Table 78 Audiometry : Children Tested Routine Age group 1st Tests Re-tests Failures Total Both ears One ear Right Left Up to 7 years 1,546 57 13 27 16 56 Intermediate 1,658 39 18 12 11 41 Leavers 2,065 52 16 23 11 50 Totals 5,269 148 47 62 38 147 Specials All ages 1st Tests Re-tests Failures Total Both ears One ear Right Left Totals 424 156 63 37 55 155 Table 79 Summary of Failures to pass Audiometer Test Passed at second test 85 Referred to Assistant Medical Officers 169 Normal Hearing after removal of wax 19 Under observation by hospital or private doctor 13 No action—further test recommended after given period 7 Referred for Tonsils and Adenoids operation 8 Appointments not accepted 6 Referred by A.M.O.'s to Ear, Nose and Throat Specialist 21 Treatment considered of little value 9 Referred to hospital 4 Hearing improved after treatm 21 Recommended for Hearing Aid 8 Awaiting appointments — Failed to attend appointments — 54 Table 80 Speech Therapy Clinic or School No. of cases dealt with during the year Kilburn clinic 150 Pound Lane clinic 81 Stonebridge clinic 57 Lower Place special school for physically handicapped pupils 25 Leinster special school for educationally subnormal pupils 8 Totals: 1959 321 1958 355 Table 81 Infestation with Vermin 1959 1958 Total no. of examinations 31,235 22,737 Total no. of individual pupils found to be infested for the first time during the current year 465 261 Number of individual pupils in respect of whom cleansing notices were issued under section 54/2 Education Act, 1944 189 32 Number of individual pupils in respect of whom cleansing notices were issued under section 54/3 Education Act, 1944 1 5 Table 82 Medical Examination of Teachers 1959 1958 No. of teachers examined as to fitness for appointment - 1 No. of students examined as to fitness for first appointment 72 65 No. of students examined as to fitness to undertake training course 81 45 55 Table 83 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 31.12.59 Leinster Special School for Educationally Sub-Normal Pupils Willesden 16 14 School transferred to Ealing 5 Wembley on 3.9.59 Totals 21 14 Lower Place Special School for Physically Handicapped Pupils Willesden 3 4 - Wembley 2 3 - Ealing 3 3 - Acton 2 3 - Hendon 4 4 - Hayes/Harlington 2 2 - Totals 16 19 - Table 84 The Educational Sub-Normal Education Act, 1944 — Sections 57 (3), 57 (4) and 57 (5) 1959 1958 Cases dealt with under section 57, Education Act, 1944 : — Sub-Section 3 6 10 Sub-Section 4 - - Sub-Section 5 22 18 Cases de-notified under section 8, Education (Miscellaneous Provisions) Act, 1948 1 — 56 Table 85 Return of Handicapped Pupils (Year Ended 31st December, 1959) 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 2 13 11 12 8 1 1 - 1 - - - 1 13 11 Deaf Pupils 10 3 - - 9 2 6 2 3 - - - - - - - 9 2 Partially Deaf Pupils 4 - - - 4 - - - - - -- - - - - - 4 - Delicate Pupils Diabetic Pupils 30 16 33 11 34 10 6 1 3 6 3 2 2 1 - - 34 10 Educ. Sub-normal Pupils 74 60 17 16 75 63 64 55 8 6 2 2 - - 1 - 75 63 Epileptic Pupils 4 1 1 — 2 — — — 2 — — — - - — - 2 - Maladjusted Pupils 42 13 11 6 43 15 — — 14 — 10 4 19 11 — - 43 15 Physically Handicapped Pupils 27 18 2 6 23 17 18 17 3 - - - - - 2* - 23 17 Pupils with Speech Defects 339 114 67 32 357 131 — — — — 357 131 - - - - 357 131 Pupils with Multiple Defects 38 20 6 2 38 22 36 22 2 - - - - - - - 38 22 Total 581 256 138 75 598 273 146 105 56 15 372 140 21 12 3 1 598 273 Grand Totals: 1959 837 213 871 251 71 512 33 4 871 1958 837 207 837 246 74 453 28 36 837 *Receiving home tuition. 57 CHILD GUIDANCE Table 86 Waiting list at 1.1.1959 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 31.12.59 13 163 86 77 136 19 44 Table 87 Main Symptoms Cases Behaviour problems (aggressiveness, etc.) 72 Stealing 17 Enuresis 12 Psychomatic disorders 9 Truancy 13 Anxiety (including night terrors) 5 Failure to progress at school 8 Total number referred in 1959 136 SCHOOL DENTAL SERVICE Table 88 Inspection and Treatment (a) Inspection Age Groups Inspected Required Treatment Referred for Treatment 1959 1958 1959 1958 1959 1958 Under 5 121 81 83 48 80 32 5—16 16,525 16,953 10,675 11,503 9,722 10,203 Specials 1,417 1,457 1,318 1,329 1,299 1,278 Totals 18,063 18,491 12,076 12,880 11,001 11,613 58 (b) Treatment 1959 1958 No. of pupils actually treated: 5,401 5,458 No. of attendances 15,635 15,479 No. of half-days of Inspection 228 220 Treatment 2,513 2,426 No. of fillings: (a) Permanent teeth 10,154 10,571 (b) Temporary teeth 3,621 3,347 No. of extractions of: (a) Permanent teeth 522 550 (b) Teeth for orthodontia 267 338 (c) Temporary teeth 3,201 2,883 No. of anaesthetics: (a) General 1,654 1,611 (b) Local 755 794 No. of other operations 6,093 6,156 PRIORITY DENTAL SERVICE Table 89 Expectant Mothers Nursing Mothers Children under 5 1959 1958 1959 1958 1959 1958 Number examined 241 220 100 69 600* 679* Number required treatment 232 218 99 68 437 505 Number of new cases commenced treatment 212 207 115 97 410 462 Dentally fit 82 71 65 53 336 328 Extractions 274 252 126 152 280 304 Fillings 654 571 222 279 671 882 Scaling and gum treatment 135 117 96 62 — — Silver nitrate dressings — — — — 686 642 Dentures 14 21 50 43 — — Number of attendances 841 752 537 490 976 1,135 Number of appointments not kept 225 174 94 62 155 158 *Including 126 at day nurseries. 59 Table 90 Chiropody—Defects Condition Expectant and Nursing Mothers Boys Girls Total 0—5 yrs. School 0—5 yrs. School Verrucae — - 63 - 110 173 Corns 43 2 34 3 55 137 Callosities 13 — 16 2 9 40 Nail conditions 10 21 15 12 6 64 Warts 2 — 16 1 35 54 Hallux Rigidus — — 4 — 8 12 Advice 3 1 5 — 3 12 Bursitis — — 5 — 8 13 Hallux Valgus 1 — 10 1 67 79 Epidermophytosis 5 1 31 — 11 48 Claw toes — 6 16 11 23 56 Ingrowing Toenail 1 1 8 — — 10 Ganglion — — 2 — — 2 Totals 78 32 225 30 335 700 DEANER PRINTERS LTD. (T.U.) LONDON