AC 439(1) 15-16-19 WIL 56 Borough of Willesden 1960 THE 85th ANNUAL HEALTH REPORT 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 8 Treatment 8 Census 1951—household arrangements 9 Child guidance 22 Chiropody 22 Clean air 11 Common lodging houses 17 Convalescence 21 Coroner's court 17 Day nurseries 21 Dental service 22 Disinfestation 11 Diphtheria immunisation 20 Factories 14 Food Contaminated food 12 Education in food hygiene 12 Food poisoning 7 & 12 Improvements in premises 12 Registration of premises 12 Sampling 13 Unsound food 12 Hawkers—licensing of 17 Health education 6 Health visiting 19 Home safety 22 Home help service 21 Home nursing 20 Hospitals Facilities 18 Liaison 18 Household arrangements 9 Housing Demolition and closing orders 10 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 18 Midwifery service 19 Milk and dairies 13 Mortuary 17 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 21 Prematurity 5 Problem families 19 Public Health Laboratory Service 5 Rag, Flock and Other Filling Materials Act, 1951 17 Refuse disposal 9 Rodent control 11 Sanitary circumstances 9 Scabies 6 School health service Handicapped pupils 22 Medical inspections 21 Orthoptics 21 Sewage and drainage 9 Slaughterhouses 17 Smallpox vaccination 20 Staff Medical examinations 18 Sanitary section 10 Swimming baths 9 Tuberculosis B.C.G. Vaccination 8 Co-operation 8 Factories and workshops 8 Morbidity and mortality 7 Prevention and diagnosis 8 Vermin 11 Vital statistics Births 4 Deaths 4 Population 4 Water 9 Welfare foods 20 BOROUGH OF WILLESDEN Health Department, 54, Winchester Avenue, Kilburn, London, N.W.6. July, 1961. To the Mayor, Aldermen and Councillors of the Borough of Willesden. Mr. Mayor, Ladies and Gentlemen, I am often asked by my colleagues in the medical profession, and by many other people, what there is left for public health to do today, now that infectious diseases have largely been conquered, and maternal and infant mortality reduced to the lowest known figures. The answer is clear. Public health still has an important part to play in its traditional fields of work: in the care of mothers and infants, in preventing infectious diseases by immunisation, and by improving the environment. But, in addition, there are new battles where public health measures are called on to protect people: the respiratory diseases, mental disorders, mental and physical crippling by accidents, and the disturbances which affect old people. Also, successful work in the traditional fields will often prevent illness and disorder in later years. There may be criticism that the battle against these conditions should be a combined operation, with others taking the lead. It is true that the hospital and general medical services have great interests in these aspects of ill health and do much useful work, but there is also no doubt that the community health services are indispensable allies in the medical struggles against disease. It is important that the various sections of the health services should understand more clearly how they can help each other. If we survey the battle against respiratory diseases we can see immediately how public health extends its influence. Over the past fifteen years, bronchitis and cancer of the lung have displaced tuberculosis as a main cause of illness, disablement and death. Public health has already had many years of useful experience in dealing with tuberculosis, and recently, even more effective ways have been introduced. When public health teaches mothers how to feed themselves and their babies properly, when public health helps to improve the diet of children in day nurseries, school children and old people, tuberculosis receives a serious blow. This is reinforced with better housing and the reduction of overcrowding. Vaccination of school children and of special contacts is also a useful weapon in the fight. And the final steps towards victory are the tracing of contacts, and the education of school children and factory workers in ways of preventing the spread of the disease. Bronchitis has only recently come into prominence, although it is one of the main causes of disablement, absence from work, and death. Once again prevention starts in the early years. Mothers who learn how to avoid respiratory infection in their babies can prevent chronic diseases. Better feeding and housing helps to raise resistance. Immunisation against infectious diseases and the control of their spread can lower the numbers who have respiratory complications. Breathing purer air can help to keep the lungs clear, and smokeless zones can play a part in overcoming chronic bronchitis and cancer of the lung. But trouble is caused not only by smoke in the air but by smoke in the cigarettes. Health education in the schools and factories can help in the battle against bronchitis and cancer of the lung. It is significant that not only factory workers but school children are asking for talks on how to stop smoking. There is no doubt about the need of a combined operation against bronchitis. In Willesden, there is close liaison with a research unit and through them with the hospital and general medical services. At the Pound Lane Clinic the research unit started an experiment to help people with bronchitis to understand their disease by talks, films, records, and individual and group discussions. To help them recover good health after influenza they receive special inoculations against this disease. They are also treated with antibiotics to try and cut short infections, and they are given an Airwick bottle containing ammonia to use at home during fog. Smokers are encouraged to stop smoking by group discussions. If these methods prove successful, they will encourage many others to promote similar measures against bronchitis. Public health has also a very positive function in helping people towards good mental health. Much work in their early years is needed to enable people to maintain a well-balanced personality, sufficiently integrated to be able to withstand the stresses and strains of modern life. The fears of the expectant mother, if not dealt with, may do untold harm to the security of the child. Children require to be managed with understanding if they are to grow to maturity with both mental and physical strength. This is achieved by the individual and group talks to mothers in the clinics, the education of mothers in the home by health visitors, and, more recently, with the active support of the child guidance clinic with members of their staff, including the psychiatrist who attends the clinics. Special attention paid to school children, by enlisting the help of parents and teachers, and by concentrating on their difficulties at an early stage, can prevent many of them from becoming mental wrecks or delinquents. The environment plays an important part in preserving mental as well as physical health. A noisy, overcrowded house, with the smells of different forms of cooking pervading the whole atmosphere, and the need to leave home to obtain any peace and quiet, do not help to maintain mental stability. Much work has been done in trying to reduce the tensions between tenants and owner-occupiers sharing houses, particularly where there has been colour prejudice. These troubles are not compatible with a sane and well-balanced attitude to one's fellowmen. Few today can say that they are absolutely immune from a mental illness. At least one in twenty will eventually spend some part of their lives in a mental hospital. This makes it essential that we all take an interest in the measures for treating the mentally ill. Modern methods of treatment in hospital have enabled people to be made fit to return to the community, much more so than in the past. They will relapse again if the conditions in the community do not help them in their recovery. This means that the community must be willing to accept them and provide special facilities to help them. Unless the organisation is based on areas with an old-established community spirit and where sufficient local interest can be aroused, schemes for helping the mentally ill cannot be entirely successful. It is essential to draw into this work as many interested people as possible, and this can be done only on a local basis. Then, and only then, will hostels and clubs for the mentally disordered not only be accepted by other members of the public, but they will also actively support them. An example of how local interest can be stimulated is given by the services for old people. Unlike the new towns, the older towns and communities have many old people who not only have their own problems but present many to others. As they grow older, gradually becoming separated from or losing their friends and relatives, it is easy for them to feel lonely, sad and neglected. This is usually the start for a gradual or rapid deterioration in their mental and physical health. To make them feel welcome and wanted we must provide them with essential services while they retain their independence and pride, with more respect for themselves and us. It is important to provide them with adequate meals in dining clubs and in their homes (meals on wheels), and to encourage the voluntary organisations to establish clubs and provide parties and entertainments. Old people can then be given a sense of belonging to the community and they are then able to communicate with others on an equal footing. Many other services, some of which appear minor, are essential to preserve their health. The local authority, together with voluntary organisations are doing sterling work in increasing and extending the services for the aged. But what is perhaps most important, they are treating them as individuals that merit attention and respect. Finally, in the advance in new territories, public health is doing much to prevent accidents, particularly in the home. A stream of propaganda has been directed to mothers in the home, to school children and to workers in the factory. Time and time again children are scalded by the contents of a kettle pr pan, or burned by a fire. They take poisons accidentally or they may drown even in shallow water. With the old, they share the risks of falls in the home, with the breaking of an arm or a leg. Most of these accidents are preventable by simple measures and a little foresight. All the timehonoured methods of publicity are devoted to this purpose. We try and sell safety to the public through posters, talks, films and even children's paintings. I started to answer the question of what public health can do to-day, and as yet I have only been able to deal briefly with the new fields of activity. We should not under-estimate the importance of continuing the battle for health in the usual fields. The day-to-day events in the clinics, in the homes, and in the schools may appear to be minor in preserving the health of the population, but together they add up to an eventful year. Here 1 must pay tribute to the excellent work that is being done by the midwives under very difficult conditions, with inadequate staff and not enough hospital beds. Health visitors also deserve a special mention, for in their day-to-day work they are building in the family the health of the future. Finally, I am particularly happy to mention the public health inspectors. There has been an extension of their work since more experienced public health inspectors have been engaged. This has applied particularly to improvements in restaurants, food shops and factory canteens, to housing conditions and to the air we breathe. Other members of the staff have also shown a keen interest in the developments in public health, and have contributed their share to it. My sincere thanks also go to the councillors, who have always shown an interest in the health and welfare of the people of the borough, and have played an important part in guiding the work of public health. I have the honour to be, Your obedient servant, S. LEFF, Medical Officer of Health. 4 STATISTICS AND SOCIAL CONDITIONS OF AREA Population estimated, 1960 172,430 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) 44,023 Rateable value (1st April, 1960) £3,158,771 General rate in the pound for the year 1960/61 19s. 6d. Product of a penny rate (estimated) £12,900 VITAL STATISTICS Registered Live Births: Male Female Total Legitimate 1,627 1,551 3,178 Birth rate per 1,000 estimated resident population Illegitimate 210 216 426 Crude 20.9 Total 1,837 1,767 3,604 Adjusted 19.4 Registered Stillbirths: 36 38 74 Rate per 1,000 (live and still) births 20.1 Death rate per 1,000 estimated resident population Deaths: 851 818 1,669 Crude 9.7 Adjusted 10.8 Death rate of infants under one year of age: All infants per 1,000 live births 15.0 Legitimate infants per 1,000 legitimate live births 15.1 Illegitimate infants per 1,000 illegitimate live births 14.1 Death rate of infants under four weeks of age: All infants per 1,000 live births 11.1 Legitimate infants per 1,000 legitimate live births 10-7 Illegitimate infants per 1,000 illegitimate live births 14.1 Maternal mortality: Deaths from puerperal causes Puerperal sepsis Nil Other puerperal causes Other maternal causes 1 Maternal mortality rate .27 per 1,000 live and still births Deaths from: Males Females Total Cancer (all ages) 210 176 386 Measles (all ages) — — — Whooping cough (all ages) — — — Diarrhoea (under 2 years of age) 1 1 2 5 Births There was an increase in the birth rate for 1960, and it is now above that of England and Wales. Deaths There was a slight decrease in the death rate for 1960, 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 to a record low figure of 15 per 1,000, which is well below that for England and Wales (22 per 1,000) (Table 2). There was a slight rise in the stillbirth rate to 20 per 1,000, which is the same as that for England and Wales. In 1960, 54 infants died, 38 in the first week of life and another three in the first month. (a) By wards (Table 3) For the three years 1958-60, the infant mortality was highest in Carlton (29 per 1,000) more than three times that of Gladstone (8 per 1,000) and Brent water (9 per 1,000), the best wards. Kensal Rise, Kilburn, Stonebridge and Roundwood all had high rates of 22 or more per 1,000. The rates in these five wards have been consistently high, and it is clear that an improvement in the social conditions of these wards would help to reduce the mortality. It will be interesting to see how far infant mortality will fall in the Carlton ward as a result of the improvements in housing following the Council's extensive redevelopment scheme. (b) By social class (Table 4) The number of deaths by social class gives a further illustration of the effects of environment on infant mortality; 49 were in the lower social groups, none in social class I, and only 4 in social class II. (c) Causes of death (Tables 5, 6, 7 and 8). (i) Prematurity. There were 239 premature births with 14 deaths in the first week of life. Prematurity was the most important cause of all infant deaths (26% of the total). Generally speaking, there were more premature births in those wards where overcrowding and bad housing conditions exist. (ii) Respiratory, diarrhoea and enteritis, and other infections. There were fifteen deaths from these causes; twelve from respiratory infection, two from gastro-enteritis and one from virus encephalitis. Thirteen came from the lower social classes and some of them were preventable. One child aged 4 months had at various times been in the care of five child minders, all with different methods of infant welfare. Overcrowding is responsible for many infant deaths from respiratory infection. (iii) Congenital malformations. Most of the deaths from this cause occurred in the neonatal period. There were 9 deaths, contributing 17% of the total infant deaths. Radioactivity in the form of ingestion of radioactive dust or exposure to excessive X-rays are thought to contribute to the development of malformations. Preventive measures are taken to remove another cause of congenital malformation: arrangements are made to reduce the contact made by expectant mothers in the first three months of pregnancy with cases of German measles and other virus infections. One mother was in contact with a case of measles in the first month of pregnancy. She had not had measles before and did not contract the illness. However, the child died of meningococcal and bilateral talipes equino-varus at three weeks. (iv) Birth injury. The birth injury rate has remained practically the same, and it is possible some of the deaths may have been avoided. There is no record of the number of infants who suffered birth injury and survived. (v) Other causes. All the deaths classified under other causes occurred in the neonatal period. Sixty-six per cent. were associated with prematurity (atelectasis and prematurity 4 ; pulmonary syndrome and prematurity 2; hyaline membrane and prematurity 2). One baby died of blood incompatability : the mother had no antenatal supervision. Of the other three deaths, two were due to pulmonary syndrome and one to meconium obstruction. (d) General. None of the mothers suffered any severe illness but five had anaemia, one had treatment for venereal disease, two were exposed to virus infection and two had toxaemia. It is possible that these conditions contributed to the deaths of the children. Four of the children who died were from twin pregnancies. (e) Conclusions. No particular factor emerges as a significant cause of infant deaths in the year, but there is no doubt that a general improvement in living standards and better maternal care would help to reduce infant mortality still further, but more research is still required into the causes of congenital malformations and prematurity. GENERAL PROVISION OF HEALTH SERVICES Public Health Laboratory Service (Table 9) Bacteriological specimens (swabs from sore throats, faeces from intestinal infections, cough plates and post-nasal swabs from whooping cough cases, etc.) are examined by the Public Health Laboratory 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. 6 Of the eight unsatisfactory samples of water, six came from the Granville Road Baths and one from the Gladstone Park Baths. It was not possible to give a reason for these results as there was no breakdown or temporary difficulties with the plant in either bath, and the demand made on the plant was average. The remaining sample came from the paddling pool at King Edward VII Park and was due to a breakdown in the chlorinator which was repaired by the manufacturers the following day. Uncleanliness and scathes (Table 10) As compared with 1959 there has been a decrease in the number of adults treated for scabies, lice and nits, but a slight increase in the number of children treated for these conditions. However, the numbers treated are still small, and there is no evidence of an increase in the prevalence of these conditions among children. Establishments eor Massage and Special Treatment The registration of establishments for massage and special treatment is delegated to the Borough Council under Part XII of the Middlesex County Council Act, 1944. During the year two new licences were issued and 24 were renewed. An exemption from licensing was claimed 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, midwives and nurses give many talks, some illustrated with filmstrips. These talks are most useful in helping mothers to care for themselves and their babies. Health visitors also give more specific individual health education in the mothers' homes during their routine visits (Table 12). The Mothers' Club held at the Stonebridge Health Clinic has been successful and much appreciated. The varied programme has included talks, lectures, films, discussion groups, sewing, socials, outings, and visits to places of interest. 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 Health 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 in 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 23). 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 death; from various diseases for 1959 and 1960 is shown in Table 13. 7 Whooping cough The incidence of whooping cough rose in 1960 compared with the previous year, but the case rate per 1,000 population (1-7) was only a little above that of England and Wales (1-3) (Table 14). Dysentery There was a marked decrease in the number of cases of dysentery compared with the previous year, although in England and Wales there was an increase. With the exception of 1957, when there were only 13 confirmed cases, it was the best year since 1951. Generally, however, 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 two small outbreaks:— (1) The first occurred at Essex Road Day Nursery on the 26th April. Altogether 10 children were affected. They were all excluded and two were admitted to Isolation Hospital for treatment. The infection was quickly cleared up and all the children were re-admitted by the end of May. (2) The second outbreak occurred at the Gladstone Park Day Nursery on the 16th May. Altogether three children and one member of the staff were affected. They were all excluded from the nursery and one child was admitted to Isolation Hospital for treatment. The infection was quickly cleared up and they were re-admitted by the end of June. In 1951, as a result of a study made in schools, investigations to discover carriers were discontinued in order not to disturb the children's schooling. Because day nurseries are relatively closed communities, the stools of all children were still examined and carriers were excluded until they had three consecutive negative stools taken at two-day intervals. This upset the work of mothers and staff and placed a heavy burden on the Public Health Laboratory Service. Also matrons and staff tended to rely on these examinations for safety, but now when only suspected cases are excluded they appreciate more fully the need to supervise personal and general hygiene. As an experiment the same procedure in schools was adopted in these two outbreaks: carriers were not searched for, and only children with symptoms were excluded until bacteriological examinations showed them to be non-infective. It is unlikely that the exclusion of carriers would have made any great difference to the extent and length of the outbreaks, and it certainly would have disrupted the work of the day nurseries and of factories where the mothers work. Poliomyelitis There were 3 notified cases of poliomyelitis, all of which were confirmed (3 paralytic) (Table 15). This was the best year since 1951, when 5 cases were notified but none was confirmed. Food poisoning There was one outbreak 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 Fahrenheit (or 38 degrees Centigrade) has occurred within fourteen days after childbirth or miscarriage'. There was a slight increase in the number of cases in 1960. BRONCHITIS, CANCER OF THE LUNG AND TUBERCULOSIS (Tables 16-25) Today serious respiratory diseases should be considered together, because of their common causes ; lungs already damaged may have a lowered resistance to infection or worse still cancer. The major common cause is smoke—from cigarettes and the atmosphere; over the last few years much evidence has been produced for bronchitis, tuberculosis, and particularly for cancer of the lungs. We have been successful in the attack on tuberculosis because of the wide use of effective drugs. Cancer, however, presents a different picture because cigarette smoking is still widespread, and treatment, except in the early stages of the disease, is rarely satisfactory. Over the last fourteen years, bronchitis and cancer have displaced tuberculosis as an important cause of invalidity and death. In Willesden the death rates from cancer of the lung and bronchitis in 1960 were nine times that from tuberculosis (Tables 17, 18 and 19). Early diagnosis of chest diseases is essential if treatment is to be effective, but a change in social habits is necessary if we are to eliminate them. Health education and social reform can also help: young people have been given talks on chest diseases, and in particular on the dangers to health and life from smoking cigarettes. Mortality and morbidity There were six deaths from tuberculosis among men and five deaths among women, with the now usual shift to the older age groups. For the second successive year there were no deaths from non-pulmonary tuberculosis. There has been a slight fall in notifications of tuberculosis (Table 16) compared with last year and a decrease in the total number of cases on the register at the end of the year. However, the figures are small and cannot indicate that tuberculosis has been defeated. 8 A wide fluctuation in the deaths from bronchitis over the years shows no apparent trend. Smoke has probably played an important part and was certainly responsible for the high peaks in 1952 and 1953 following the severe fog which caused 4,000 deaths in London during the winter. The sex difference in numbers of deaths probably relates to the heavier smoking habits of middle-aged and elderly men and to a lesser extent to conditions of dust and smoke at work (Table 18). The most startling and tragic figures of all are found for deaths from cancer of the lung (Table 19). The death rate has doubled in the last 14 years, and there is a more marked sex difference: for every woman, five men died from lung cancer. Most of these cancers occurred in men over 45 years of age when they had already smoked enough cigarettes to produce the cancer Prevention and diagnosis To prevent chest disease it is clear we must deal with smoke from cigarettes and the atmosphere. Measurements of smoke and other impurities in the air continues, and small improvements have been noted around power stations. It is hoped that the establishment of smoke control areas under the Clean Air Act will lead to further improvements. Some fifteen to twenty years of smoking is normally required before a cancer develops, but it is advisable to take no risk at all. Talks have therefore been 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 the relationship between smoking and respiratory disease. By these means it is hoped to prevent young people smoking before the habit becomes difficult to break. Bronchitis cannot be diagnosed radiographically but X-ray surveys continue to play the important role in discovering early cases of tuberculosis and cancer. The combined efforts of doctors at the Chest Clinic, Static X-ray units, the public health department and general practitioners ensure that many suspected cases are X-rayed early. Tn 1959, plans were made for the study and treatment of chronic bronchitis, with the help of a research grant of £750 from the North West Metropolitan Regional Board. A special clinic is held at the Central Middlesex Hospital one evening a week, with day-time sessions at neighbouring factories where managements are willing to release employees during working hours. An analysis of the detailed records of 50 patients suggests that the prophylactic use of drugs (tetracycline 05 grams daily throughout the winter) has not been very effective in preventing spells of illness. It is possible that after further analysis the regime will be modified but the group will be followed up for the information which is being obtained on the natural history of the disease. In October, 1960, an experimental clinic was started at Pound Lane Clinic for a therapeutic group for chronic bronchitis. Patients attend for two hours one night a week for four to eight weeks. They are helped to understand the disease by talks, films, records, individual and group discussions. An attempt is made to prevent exacerbations by inoculating them against influenza, giving them antibiotics for use early in chest infections, and by giving then ah 'Airwick' bottle containing ammonia for use at home during fog. Smokers are encouraged to stop smoking by group discussions. Part of each session is devoted to breathing exercises, and they are encouraged to do exercises at home. Postural drainage is included for some patients. Measurement of forced expiratory volume, chest expansion and early morning sputum volume, is made at each attendance. Tt is hoped to extend the clinic in 1961. Treatment The treatment of cancer of the lung is still in its infancy, and hospital admission is therefore usually needed. There is no shortage of hospital beds at present notwithstanding the increasing number of cases, because fewer beds are now needed for tuberculosis. Beds for bronchitis sufferers are now also being provided at the sanatoria. Tuberculosis Tuberculosis creates a special problem because of its infectious nature: a third of the deaths occurred in elderly men and women previously unknown to the health authorities (Table 25). They obviously form a small but significant minority of the population difficult to discover before others have been infected. In view of this 'hard core' of tuberculosis infection, B.C.G. vaccination remains an important preventive measure offered to all school leavers to raise their resistance to infection, very necessary during adolescence when the risk of infection is higher and many new stresses have to be faced. About 80% of school leavers were found to need B.C.G., and practically all of them (96%) were vaccinated. The proportion of younger children reacting to the tuberculin test remained about the same (Table 23), but over the years there has been a marked deciine in school children, particularly entrants, reflecting the general reduction of tuberculosis in the community. Compared with 1953, when children generally came in contact with infection before they entered school, today most of them do so during their school life. Factories and workshops Four factories were visited by the Medical Officer of Health and eighteen 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 dilatation of the aorta was referred to his private medical practitioner; no action was taken in four other cases with slight abnormalities as the lung fields were clear and the heart normal. Eight factories were re-visited at six-monthly intervals to encourage contacts of old cases to re-attend for reexamination; 107 workers went to the Central Middlesex Hospital. One case with elevation of the left diaphragm with gas distended bowel beneath was referred to her general practitioner. Co-operation The need for integration of all services provided by the Chest Physician, Medical Officer of Health, Welfare Officers, Disablement Resettlement Officer and Home Visitors is self-evident when dealing with diseases having such wide social implications as tuberculosis, bronchitis and cancer. The closest co-operation between all services for the patients and their families has continued throughout the year. 9 SANITARY CIRCUMSTANCES OF THE AREA Water The Metropolitan Water Board and the Colne Valley Water Company supply Willesden with water. These supplies are not subject to plumbo-solvent action and have been satisfactory both in quantity and quality. All dwelling houses and flats have a piped supply direct from the mains and there were no complaints of any contamination during the year. Frequent bacteriological and chemical examinations of the water are carried out by the Metropolitan Water Board and the Colne Valley Water Company. 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 decennial census was taken on the 24th April, 1961, and when the results are published much useful information on Willesden's housing problems will be available to the Council. The census report for the County of Middlesex published in 1951 and the housing report for England and Wales clearly showed Willesden's problem 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 1 and 2 persons per room is the highest in the county, in some instances the percentage is more than double. (b) Bathrooms The proportion of households either sharing or without a fixed bath (six out of ten) is almost double that of the average of the county, and is much higher than that of Greater London and England and Wales (about four out of ten). The proportion sharing or without a water closet, cooking stove or a kitchen sink is higher than the average for the County of Middlesex. Gardens Willesden is poorly equipped with public open spaces; 242 acres compared with an estimated need of 1,313 acres; yet one in four families have no garden at all, and a large number have to share a garden. Swimming baths 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:— Time taken for water to pass Capacity through filters, etc. (gallons) (hours) Granville Road Baths 145,000 3½ Gladstone Park Swimming Pool 500,000 11 King Edward's Recreation Ground Swimming Pool 350,000 435 samples were taken, 22 of which were unsatisfactory (see Public Health Laboratory Service, page 6). Swimming bath Samples taken Satisfactory Unsatisfactory Granville Road 269 263 6 Gladstone Park 80 79 1 King Edward's Park 86 86 - 10 SANITARY SECTION Staff The establishment of Public Health Inspectors includes the Chief Public Health Inspector, the Deputy Chief Public Health Inspector, eighteen district Inspectors and five pupils. At the beginning of the year there were no vacancies for Public Health Inspectors. Eight were graded APT. IV; they had at least ten years' experience and the Smoke Inspector's Certificate in addition to the statutory qualification and the Meat and Other Foods Certificate. The remainder were graded APT. II and III, depending on whether they had the statutory qualification only, or the Meat and Other Foods Certificate in addition. During the year there were four resignations of Inspectors on grades 11 and 111. Following the first two in the early part of the year advertisements were issued, but no applications were received. The Council therefore decided to revise the establishment, increasing the number on APT. IV to twelve and leaving six on APT. II or III. With the exception of one grade APT. II or III post, all vacancies were filled by the end of the year. Four pupil Public Health Inspectors were on the staff at the beginning of the year. One qualified during the year, and one new pupil was appointed, leaving one vacancy. The Rodent Officer and four operatives are employed in the destruction of rats and mice 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 approach the Public Health Department only when the defects are serious and costly to remedy. Demolition and Closing Orders (Table 26) There were three demolition orders made during the year. Slum clearance and area redevelopment During the year the Minister of Housing and Local Government confirmed the Granville Road (south side)/Carlton Vale/Kilburn Park/Percy/Cambridge Roads Compulsory Purchase Order, which had been the subject of a public inquiry in the previous year. Surveys were completed of the 1,291 houses in the Stonebridge Proposed Redevelopment Area, the 732 in the Willesden Green Proposed Improvement Area, and 13 houses in the Victoria Mews Slum Clearance Area. The survey of the Church Road Comprehensive Redevelopment Area, bounded by Craven Park, Church Road. Neasden Lane and the L.M.S. Railway line was continued during the year. 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 perm'it temporary overcrowding (Table 27). 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). The waiting list was reviewed in January, 1961. Letters were sent to the 9,665 applicants asking if they wished to remain on the list; 2,260 replied that they wished to do so and 188 said they wanted their names removed ; 2,579 letters were returned marked "gone away" or "not known", and 4,638 failed to reply. Of the total number now on the list (2,260), 443 are recorded as overcrowded. This does not necessarily mean that the overcrowding position in the borough has improved. The present proportion of applicants overcrowded is 19%, as compared with 17% before the review. It is probable that some of those still overcrowded did not reply because of apathy or because they thought they could not be rehoused for many years. Notices served under the Public Health Act, 1936 and Housing Act, 1957 There was a slight increase in the number of statutory notices served during the vear compared with 1959 (Table 29). Details of the inspections carried out during the year are shown in Tables 30 and 31. 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 made A summary of nuisances abated and improvements made 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. 11 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 all chimneys and provides for the establishment of smoke control areas. The No. 2 (Neasden) Smoke Control Order, covering 271 acres, with 2,351 dwellings, 112 commercial. 24 industrial and 7 other premises, came into operation on 1st October, 1960. The undermentioned appliances were installed by owners and tenants:— Open fires 628 Open fires with boilers 33 Gas fires 22 Electric fires 12 Immersion heaters 4 Free standing convectors 2 Gas cookers 2 Independent boilers 1 In addition, 140 appliances were adapted and 102 gas and 68 electric points were provided. 97 open fires were installed in property owned by the Council, and 23 appliances were adapted for gas ignition. The No. 3 (Church End/Roundwood) Smoke Control Area, of 380 acres, with 5,057 dwellings, 378 commercial, 52 industrial and 20 other premises, was confirmed by the Council in November and was submitted to the Minister of Housing and Local Government. 4 of the industrial premises burn coal but the Council decided that only 2 should be granted exemption from the Order. The proposed date of operation is 1st November, 1961. The usual measurements of grit and sulphur have been made and the results in the areas surrounding the three power stations show little change as compared with the previous year when the figures were relatively low (Tables 34. 35). The Council is represented at an Inter-borough Smoke Control Liaison Committee, which includes delegates from the Hammersmith, Fulham, Brentford and Chiswick, Acton and Barnes Councils. Meetings to co-ordinate smoke-control area planning are regularly held at Hammersmith Town Hall. BOMBED SITES The Health Department continues to deal with nuisances such as rats or refuse on the few remaining bombed sites in the borough. DISINFESTATTON 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 decrease in the work compared with the previous year. 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 230 Borough Council properties 12 Private dwellings 810 Total 1,052 at the following cost: Business premises £1,450 19 8d. Private dwellings £2,745 8 8d. Total £4,196 8 4d. The cost of disinfestation at business premises is recovered from the occupiers; 123 had an annual agreement with the Council for regular inspection and disinfestation, 8 were new agreements and 115 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. 12 INSPECTION AND SUPERVISION OF FOOD AND FOOD PREMISES The food premises in the borough are regularly inspected by the Public Health Inspectors (Table 37). The Food Hygiene Regulations, 1955, which came into operation on the 1st January, 1956, prescribed standards for the preparation, storage and sale of clean food. There has been a marked improvement in hygiene in the production and sale of food. Public Health Inspectors visited food premises frequently and served verbal or written notices to improve their standard. Works in some premises are still either in progress or arrangements are being made for them to be carried out (Tables 38, 39). One person was prosecuted for smoking while handling open food and was fined £5 with one guinea costs. A greengrocer was prosecuted for six contraventions of the Food Hygiene Regulations, and fined £30 with two guineas costs. A food hawker was prosecuted under section 105 of the Food and Drugs Act, 1955, and for one contravention of the Food Hygiene Regulations. He was fined £10 for the offence under the Food and Drugs Act and £3 for the offence under the Food Hygiene Regulations, with five guineas costs. The proprietors of a grocers' shop were prosecuted for three contraventions of the Food Hygiene Regulations ; they were granted an absolute discharge on two, convicted on the third and fined £2 with five guineas costs each. 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 Public Health Inspectors gave talks on food hygiene, illustrated with filmstrips, to the staff from 11 factory canteens and to the catering staff of 6 school meal kitchens and 38 schools. Lectures and talks illustrated with filmstrips and bacteriological cultures were also given to social and political organisations and school leavers. The Metropolitan Dairymen's Society and the department co-operated in exhibiting a display stand at the Willesden Show in connection with the Society's clean milk bottle campaign. Food poisoning There was one outbreak of food poisoning during the year. The first patient, a woman aged 80, was admitted to hospital suffering from salmonella Heidelberg infection and died a week later. The day after her admission four other patients became ill and salmonella Heidelberg was isolated from their specimens of faeces. Subsequently two more patients, a nurse and a ward maid contracted the illness. An examination of specimens of faeces submitted by the remaining patients and staff working in the ward revealed that two patients and three nurses were carriers of the infection. The illness was mild and those affected speedily recovered. Strict isolation prevented the infection from spreading to other parts of the hospital. One of the nurses affected lived out and on investigation it was found that four members of the family living at the same address were carriers of the infection. It was not possible to determine whether they were infected by the nurse or by food. Three members of another family living in the same area, who had no connection with the Neasden Hospital, developed symptoms and salmonella Heidelberg was isolated from their specimens of faeces. It was not possible to trace the food responsible for the outbreak. There were several outbreaks of salmonella Heidelberg infection in the London area, eight of which were connected with ham bought from various branches of a firm of grocers. The last family affected in Willesden had eaten ham recently, and occasionally bought groceries from this firm, but could not remember where they had bought the ham. There was no evidence to link the first case with ham or this family. Seven specimens of ham were taken from the firm's branch and three other shops in the area, and submitted for bacteriological examination, but the results were negative. Food unfit for human consumption Nearly 4 tons and 5,700 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 Engineers' Department, and deposited on the controlled refuse tip. Contaminated food 20 specimens of contaminated food were dealt with by the department. They included foreign matter in a bottle of milk, sausages, a cheesecake, and a loaf of bread; maggots in bacon and roast pork; mouldy growth in meat pies and a loaf; a bottle of mineral water with an offensive smell; a bolt in a bread roll: mice dirt and a beetle in loaves of bread; a cigarette end in a jar of jam; metal discs in a tin of tomatoes; an insect in a sausage roll, and pieces of glass in a milk bottle. 13 No action was taken in four of them because of insufficient evidence ; of the remaining 16, 11 firms were cautioned and the Council decided to prosecute the other five. The results of the prosecutions were as follows:— 1. Case dismissed for selling bacon infested with maggots. The complainant bought the bacon on Saturday and first noticed the maggots on Sunday morning. She brought the bacon to the Public Health Department on the following Tuesday, and it was examined by a Public Health Inspector the next day. The Justices considered that the evidence did not establish beyond reasonable doubt that the maggots were present in the bacon at the time of sale. 2. Absolute discharge on payment of five guineas costs for selling a pork pie containing a mouldy growth. The wholesalers were not brought in by the defendants in this case and so the extent of their responsibility could not be determined. 3. £25 with five guineas costs for selling bacon infested with maggots. 4. Absolute discharge on payment of five guineas costs for selling a bottle of mineral water with an offensive smell. The bottlers were not brought in by the defendants in this case and so the extent of their responsibility could not be determined. 5. Case dismissed, for selling a bottle of milk containing pieces of glass, There was doubt when the glass entered the bottle. 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. There were no prosecutions of the 8 firms responsible for the 16 samples found to be unsatisfactory; 5 firms were officially cautioned and no action was taken against the other 3. A sample of cheese advertised as cream cheese contained insufficient milk fat; the manufacturers agreed to amend their advertisement. No action was taken against the manufacturers of two samples of cream slightly deficient in fat; one sample was old stock and another one was not available; a second sample proved satisfactory in the other one. Official cautions were issued to two manufacturers of vinegar where two samples from each showed where advertisements suggested a fruit content (the advertisements were amended); to the manufacturers of only very slightly deficient. Official cautions were also issued to the manufacturer of 5 samples of artifically flavoured sweets where advertisements suggested a fruit content—the advertisements were amended; to the manufacturers of codeine tablets which were old stock and contained an excessive amount of free salicylic acid; and to the fishmonger who sold smoked cod as smoked haddock. Merchandise Marks Acts, 1887-1953 1,075 displays of articles of food were examined under the Merchandise Marks Acts, 1887-1953. Minor infringements were dealt with by verbal warnings, but one grocery company which gave a false weight on swedes and carrots was fined £20 with £5.5.0 costs, and another which labelled Irish bacon as "Danish" was fined £15 with £5.5.0 costs. Two butchers in partnership were sued on 54 counts, including failing to indicate, and falsely describing, the origin of imported meats ; they were fined a total of £108, with £10.10.0 costs each on 54 summonses, and their manager who aided and abetted them and removed brand marks indicating the origin of meat was fined £67 and £10.10.0 costs. All the fines were originally double these amounts, but were halved on appeal to Quarter Sessions. Labelling of Food Order, 1953 818 articles of pre-packed food were examined under the Labelling of Food Order. 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 "seedless" oranges, tangerines and grapefruit, and "cream" doughnuts and sponges. Milk and Dairies Milk sales are regulated by the Food and Drugs Act, 1955, the Milk and Dairies (General) Regulations, 1959, and the Milk (Special Designation) Regulations, 1960. 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. The provisions of paragraph 6 of Part II of the Second Schedule to the Milk (Special Designation) Regulations, 1960, restricted the bottling of milk to the three premises in the borough where the milk is pasteurised. These Regulations transferred the issue of dealers licences from the borough council to the Middlesex County Council, who are the food and drugs authority for the area. 105 persons are registered by the Council to trade as distributors and three premises are registered as dairies. Five inspections were made of the three dairies; one defect was found and soon remedied. 239 samples of milk were submitted for bacteriological examination (see Table 9). 14 Four dirty milk bottles were reported by the public and the Council issued official cautions. One was reported by another local authority and legal proceedings were taken against the bottlers, who were fined £10 with five guineas costs. The Metropolitan Dairymen's Society and the department co-operated in exhibiting a display stand at the Willesden Show in connection with the Society's clean milk bottle campaign. FACTORY INSPECTION There was a decrease in the total number of factories in the borough compared with the previous year (Table 43). The Council supervise sanitary conveniences in all factories and in addition cleanliness, overcrowding, temperature, ventilation and drainage of floors in non-power factories. Details of inspections and notices served, defects found and remedied, are given in Tables 43, 44. Most of the notices were served for minor defects and were complied with without legal action. Basement bakehouses The local authority is responsible for the supervision of basement bakehouses under 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. Certificates of suitability are issued under section 54 of the Factories Act, 1937, to the occupiers of basement bakehouses, and 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 have worked at home for them during the previous six months on certain jobs. 213 were employed during the year, the largest number, 123, altering and making clothing. Public Health Inspectors inspect these workers' homes and a notice was served in respect of one found to be unsatisfactory. (Table 45). Noise nuisance The Borough Council deal with noise nuisances under the Noise Abatement Act, 1960, which superseded the noise nuisance sections of the Middlesex County Council Act, 1944. It provides that noise and vibration which are a nuisance are offences under the Act. It is no longer necessary for a doctor to have to decide whether there is danger or injury to health. Fifteen complaints were received during the year, but only ten came within the scope of the Acts. These included noise from pneumatic drills, extractor fans, panel beating, boiler plant, planing and doughmaking machines, refrigerator motors and lorry engine; some of these nuisances occurred at night. All were remedied by re-siting machinery, by the use of insulating material, or by the rearrangement of working hours. The Council's noise consultant is giving advice on the abatement of noise nuisances in two factories. 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 officers. First-aid boxes are provided for the use of the departments, libraries, workshops and depots. Regular inspections 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. In March, the contents of all boxes were reviewed and revised lists were issued to chief officers. Nine 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. 15 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. 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. One case was removed under the National Assistance Acts, 1948 and 1951. Mr. E. J. L., aged 77 years and partially-sighted, lived alone in a dingy first floor flat. He was suffering from hypertension, uraemia, varicose ulcers, oedema of the legs and delusions. On the day of his removal, he was found lying on the floor of the bedroom and refused to be helped into bed. He was incapable of looking after himself, and was not receiving proper care and attention. He also refused to go into hospital and an Order under the National Assistance (Amendment) Act, 1951, was obtained from a Justice of the Peace on the 1st December. Mr. L. was admitted to Neasden Hospital the same day. It was not necessary to apply for an extension of the Order as he was too ill to discharge himself at the end of 21 days. 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 4¼d. 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 . 60 New cases Died Admitted to hospital Recommenced after discharge from hospital Discontinued On register 31 .12.60 46 60 34 18 1 5 50 Voluntary Services for the Aged The '49' Club organised by the Willesden Old Folks Association celebrated its eighth anniversary in February. The Club has a membership of more than 450, and is open daily from 1.30 to 10.0 p.m. Several firms gave donations to the Association's funds and additional money was raised by a flag day. Two hundred members and helpers went for a day trip to Clacton in July. Voluntary visitors visited 25 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 64 old people and a Christmas dinner from the Association to 44; the Willesden Youth Committee and the Stonebridge Mothers' Club contributed towards the cost of the dinners. Forty-two parcels of imperishable foods were made up from 252 articles of food given by the children of Malorees School after Harvest Thanksgiving and distributed to the housebound. Woollen socks and a bed-jacket were bought with a gift of 30/- from the children of one of the classes of Salusbury Road School, and given to a housebound old lady aged 102 years. A very successful Christmas party was held at Anson Hall, Cricklewood; 262 people attended and were given a high tea, an entertainment, and 2/-. The chiropody service is in great demand. 462 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, 300 housebound people had treatment in their own homes. Until 1st April, 1960, a charge of 2/- was made for treatment and the Association paid 4/6d., the balance of the charge. From 1st April, 1960, the Middlesex County Council have been responsible for the chiropody service for the aged, under section 28 of the National Health Service Act, 1947. The Willesden Old Folks' Association acts as an agent for the County and arranges for the old people to have treatment. The four private chiropodists who have worked for the Association for a number of years still carry out treatment in their own surgeries. When the County Council appoint their own chiropodists, treatment will be carried out at the clinics. 16 The standard charge for the service is 4/- if one foot is treated, or 8/- for treatment of both feet. The treatment is free to old people in receipt of national assistance and those whose weekly income does not exceed £5 per week for a single person or £8 per week for husband and wife. One half of the standard charge is made to all other old people in receipt of retirement pensions, but if they feel they cannot afford to pay, they may apply for the charge to be reduced or waived. The Association still pays for treatments which cost £758 in the financial year ending 31st March, 1961. The Willesden Old People's Welfare Committee gave a grant of £250 towards the cost and a substantial grant is expected from the County Council. 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. The branch club at St. Martin's Church Hall, Kensal Rise, opened 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 day trips in the summer to Bognor and Southend. 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, Women's Voluntary Service, 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 W.V.S. is probably the most important service for old people. The service was extended in 1960 with the additional equipment provided by the Borough Council and transport provided by the Willesden Old People's Welfare Committee. 10,793 meals were prepared and delivered compared with 10,000 in 1959. 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. 140 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, 10 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 and an assistant work together with statutory bodies and voluntary associations and organise services for the aged. One of these is the assisted holiday scheme for old people to go for a fortnight to the seaside 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 the choice of the most popular resorts; 235 old people had holidays from June to September. A holiday for five lonely old people was also arranged at the holiday homes at Christmas and several other lonely ones received invitations from families willing to have them during the festive season. Three luncheon clubs which open on Tuesdays and Thursdays were started during the year: at Granville Hall, Granville Road. N.W.6, on 26th April, Harley Hall, Harley Road, N.W.10, on 8th September, and St. Martin's Church Hall, Mortimer Road, N.W.10, on 8th November. By arrangement with the Middlesex County Council the meals are cooked at a school-meals centre and delivered by transport provided by the committee to the three clubs in insulated containers. The meal, including sweet, costs the old people 1s. 3d. and a total of 4,480 were served by the end of the year. The old people enjoy a good, hot, well-cooked meal and the opportunity of meeting friends. For those who can get out, there are many clubs where they can find companionship and, to assist some of these clubs and attract more members, the committee arranged for professional entertainers to visit eleven of them one afternoon each month during the winter. This service is greatly appreciated by the members, and supplements the summer entertainment provided in the parks. At Christmas nearly 1,000 food parcels or vouchers were distributed to the over 70's who were in need. The committee spent £500 on this service. 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 the following figures show the growth of the work:— 1959 I960 Office interviews 715 1,139 Home visits 826 1,043 In addition, 350 visits were paid to elderly persons where, on the basis of the registrar's returns, they had suffered the loss of a partner. The building of two centres has commenced and will be completed in the coming year. Once these are open an extension of the meals and other services will be possible. On the recommendation of the Welfare Organiser. 29 wireless sets were supplied to the bedridden by wireless for the Bedridden Society. All the above services are financed from a grant of £5,495 which the Council set aside for the committee's use in 1960/61. 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 £98 15s. 7d., £56 1s. 6d. being recovered from the relatives. 17 PUBLIC MORTUARY Post-mortems were performed on 600 bodies, followed by an inquest in 103. 69 inquests were held on Willesden residents but only 16 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 1960 At Kilburn 49 25 12 13 12 10 20 17 24 16 At Ealing — 26 21 37 24 62 40 61 38 53 Total 49 51 33 50 36 72 60 78 62 69 The mortuary and viewing room were adequate when built many years ago, but now fall short of modern requirements. The Public Health Committee gave much consideration to the improvements required, and work was started in September and completed early in 1961. The improvements to the post-mortem room included its extension, another table, a new covered-in concrete runway to the refrigerator room with a glazed metal screen, redecorations and improved heating and lighting. The viewing room was made more decorous and comfortable for relatives by bricking up three external and two internal windows, removing a fanlight and providing a false ceiling, stripping out the redundant gas pipes, hacking off wall tiles and replastering the walls, altering the door, providing curtains to the observation window and a skirting and linoleum to the floor, and altering the lighting and redecorating. 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). 12 licences have been issued to hawkers (10 selling fruit and vegetables, 2 selling fish) There was one new licence issued in 1960. 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, specify the standards of cleanliness for the filling materials. The premises of manufacturers of rag flock and those used for storing rag flock must be licensed. One manufacturer of soft toys who employs outworkers only, uses premises for the storage of rag flock. The premises of persons carrying on business of upholstering, stuffing, or lining of bedding, toys and baby carriages, and others using materials specified in the Act, must be registered; a fee of £1 0s. Od. is paid. There were two new registrations during the year and two premises were removed from the register. The number of registered premises is now fifteen. The Act does not cover the re-making of an article, and dirty materials may be used in upholstering articles being repaired. Five samples of filling material were taken during the year and they proved to be satisfactory. PET ANIMALS ACT, 1961 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 diseases. During 1960, 18 pet shops were licensed. 18 STAFF MEDICAL EXAMINATIONS 47 staff medical examinations were carried out by the Medical Officer of Health and Deputy Medical Officer of Health. 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. Liaison with hospitals The exchange of medical officers between the Pediatric 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. Personal health services The remainder of the report provides detailed information on the personal health services in the area. CARE OF MOTHERS AND YOUNG CHILDREN Care of the Expectant Mother During 1960, 61% of all expectant mothers attended the local ante-natal clinics staffed by assistant medical officers (Table 46). Close co-operation exists between general practitioners, staffs of hospitals, assistant medical officers, midwives and health visitors to provide expectant mothers with adequate ante-natal care throughout pregnancy. Health visitors make the initial arrangements for hospital and domiciliary confinements at the local clinics (Table 47). Mothers booked for confinement at home or in Paddington Hospital have specimens of blood taken by assistant medical officers for the Wasserman reaction, blood grouping, blood haemoglobin and the Rhesus factor. 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 widwives. Mothers are encouraged to ask questions and interesting discussions follow over a cup of tea (Table 48). The physiotherapist conducts ante-natal relaxation classes on two afternoons a week at Stonebridge Clinic and on one afternoon a week at Pound Lane Clinic; a health visitor conducts the classes at Kilburn Clinic on one morning (Table 49). The mothers enjoy these classes and their association with other expectant mothers has a good psychological effect. There is no doubt that the exercises help the mother at the time of the confinement. She is taught how to breathe correctly and how to relax, which is of great value, especially when an analgesic is administered. She also learns the various positions she will require to take up during labour and, therefore, gains further confidence. 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 examination six weeks after the confinement, at the hospital, clinic or general practitioner's surgery. Health visitors visit mothers who fail to keep appointments at the hospital or clinics. Child Welfare Clinics Child welfare sessions are held in seven clinics; three are main ones and four are subsidiary ones. The subsidiary clinics were all held in church halls but one of them was transferred in May, 1960, to a converted house at 5 Chichester Terrace, Kilburn, N.W.6. 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 and recently against tetanus as well. Compared with the previous year, the proportion of children vaccinated against smallpox (Table 60) increased by approximately 12% while the number immunised against diphtheria (Table 61) increased by 27%. At Pound Lane Clinic an experienced woman is employed for three sessions a week to care for children when their mothers are attending at clinic sessions. 138 sessions were held and 545 attendances were made. The Mothers' Club which was held in Kilburn Clinic, was discontinued during the year, because very few mothers supported it. The Stonebridge Clinic Mothers' Club formed six years ago has become firmly established with a membership of 50. The mothers meet once a week and run the club and committees themselves with the help of the nursing staff; an average attendance at meetings is 30. The club is selfsupporting and its assets amount to about £16. 19 Medical officers, health visitors and outside speakers have given lectures, talks and demonstrations on health and homecrafts, many illustrated with films. Mothers have visited the Houses of Parliament, theatres, Southend, and, with their children, a pantomime. A children's Christmas party and a sixth anniversary dinner were held at Stonebridge Clinic. 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 the proceeds were given to the Society's funds. 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 assist in the prevention of the break-up of families, referred by the health visitors. During the year an additional worker, half-time, was employed. Altogether 43 families have been referred; 23 were found to be suitable for dealing with by the Family Service Units, 17 were found to be unsuitable, and 3 families refused help. The families receiving help are long-term, and none have yet been discharged. The Family Service Units has relieved the health visitors of the heavy burden of work with these families; there has been good co-operation between all workers concerned. Joint quarterly meetings are held, 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. Reports are exchanged, the families are discussed, and suggestions for helping them are made. MIDWIFERY SERVICE At the beginning of the year the Middlesex County Council employed six midwives in Willesden. An additional midwife was appointed during the year making a total of seven at the end of the year. Three or four pupil midwives work for three months at a time in Willesden under the supervision of approved midwife teachers as part of their second period training for the Central Midwives' Board Examination. General practitioners and midwives together supervise the care of expectant mothers. The doctor supervises the care of the expectant mother, and arranges for a blood specimen, chest X-ray and for a certificate of medical fitness for gas and air analgesia. The midwife examines the mother at her special clinic (Table 51), visits her at home and ensures that everything is prepared for the confinement. Every mother has a general practitioner and a midwife booked for her confinement. The assistant medical officers take blood specimens for expectant mothers referred by general practitioners. Midwives instruct expectant mothers on the use of the apparatus for gas and air analgesia. Mothers who have gas and air analgesia during labour have substantial relief from pain (Table 52). Midwives work very closely with general practitioners who were present in about one in five deliveries (Table 53). 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 54). When labour tends to be long Pethidine or Pethilorfan is given. This assists with relaxation and shortens the labour. In some cases Trichloroethylene is administered with good results. 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 to two mothers during the year for the following condition: retained placenta with post-partum haemorrhage. The Hammersmith Hospital premature baby unit provides a special ambulance for 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 by the doctor who has been called for medical aid by a midwife. Four babies were admitted to the unit during the year and one to University College Hospital premature baby unit at a time when Hammersmith Hospital was under repair. The number of visits made by midwives to mothers and babies discharged early from hospitals has increased during the year (Table 53). 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. Health visitors attend with the assistant medical officers at maternity and child welfare clinics, and at schools for medical inspections and routine hygiene inspections. During the year they gave 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 55). Health visitors work in close co-operation with general practitioners (Table 56), staffs of hospitals, children's officers, welfare officers, public health inspectors and other social workers. 20 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. 27 visits were made during the year to the 71 patients selected by the physician in charge for these health visitors. The number of health visitors has decreased slightly for the Willesden part of the area (Table 57). However, 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 1960 and will take their final examinations in 1961. Two 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 the local medical practitioners and hospitals receive, from time to time, an up-to-date list of their names, addresses and telephone numbers, so that direct contact with the nurses can be made. In addition, three alternative telephone numbers are set out on the list which can be used for emergency calls at weekends and bank holidays, when the Area Health Office is closed. Home nurses carry out treatments such as the general care of the acute and chronic sick, blanket baths and injections for patients including children under 5 years of age and the aged and infirm. They also help to train handicapped and disabled patients to get up and about again; and they advise relatives on the care of the aged in their families. Home nurses made visits to their patients by arrangement with the family doctors. Some patients are visited morning and evening, some once a day and others less frequently. There has been a slight decrease in the number of new patients referred during the year and the number of visits made (Table 58), mainly because of a reduction in the number of injections ordered by doctors, particularly of penicillin. The following cases were being nursed at the end of the year:— Abscess of leg 10 Arthritis 61 Anaemia 96 Bronchitis 26 Cancer 38 Cardiac 120 Constipation 2 Diabetic 42 Disseminated sclerosis 21 Discharge of ear 3 Diseases of eye 6 Gastric conditions 3 Hemiplegia 43 Post operative 7 Pneumonia 3 Rheumatism 4 Senility 91 Tuberculosis 22 Uterine conditions 4 Varicose ulcers 40 642 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 42% of the total live births for the year (Table 60). 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 61 shows the total number of children who have received protection against diphtheria during the last 15 years (1946-1960). The estimated percentage of children who have received an injection during their school life is 73.6. 21 INOCULATION AGAINST POLIOMYELITIS In February, 1960, persons in the 26-40 year age groups were included. General practitioners and assistant medical officers of health gave two injections to 2,084 persons in the new group and three injections to 837. Factory managements were urged to encourage employees in this group to be vaccinated and 71 agreed to sessions being held on their premises where 2,570 employees received two injections and 42 had their third. Vaccination of persons in the earlier priority groups continued; 4,073 completed a course of two injections and 8,835 three injections either at a clinic or by a general practitioner. HOME HELP SERVICE There were 40 more applications for the service received during the year than in 1959, and the number receiving help at the end of the year increased by 10% (see Table 62). The number of Home Helps (86) remained the same. There were two increases in the rate of pay for Home Helps during 1960, bringing the rate up to 3s. lOd. per hour, and 10 helpers qualified for the extra 3 days' annual leave now granted after 10 years' service. The charge to the public in I960 remained the same at 4s. per hour, but it has now been increased to 4s. 6d. per hour. 87 bookings were taken for maternity cases but only 52 were helped, the remainder making alternative arrangements. The number of home visits made by the organisers was 4,659. DAY NURSERIES (Tables 64 - 68) All the approved places in the 8 nurseries, together with 30 places in York Park Nursery, Hendon, have been filled throughout the year with a good general daily attendance. The waiting list has increased. The nurseries have remained under-staffed because of the difficulty in recruiting qualified nursery nurses. Two nursery nurses attended a wardens' training course at Chiswick Polytechnic in January and were later appointed as wardens. Three matrons attended the Refresher Course held at Chiswick Polytechnic in July. Eight students completed their 2 years period of training and all successfully obtained the N.N.E.B Certificate. CONVALESCENCE Under Section 28 of the National Health Service Act, patients recovering from a serious illness or operation and requiring only rest, fresh air and good food to complete treatment, may be recommended for a short term stay in a convalescent home. General practitioners, hospitals and clinics, make the recommendations, which are sent to the county medical officer who arranges suitable homes. Patients who ask for a reduction in the standard charge of £5 5s. Od. must complete an economic circumstances form and they are assessed by the divisional finance officer. They may also ask for payment of travelling expenses. Number of recommendations:— 1960 1959 Adults 96 110 Children 21 35 117 145 SCHOOL HEALTH SERVICE (Tables 69 - 80) Medical Inspection Routine medical inspections in schools continued. Defects found were followed up and treatment offered at one of the specialist clinics. Orthoptics Since more children are being brought to the clinic soon after they begin to squint, we can assume that more parents now realise that squints can be treated at an early age. The Orthoptist can therefore assess early changes in the squint and give treatment to produce a quicker cure. 22 Handicapped Pupils Because the Day Special School for Physically Handicapped Pupils at Lower Place is not filled to capacity, there is no waiting list and suitable pupils can be admitted straightaway. Some children are admitted after they have been in hospital for short periods to help them become fit to return to an ordinary school. CHILD GUIDANCE (Tables 81-82) The efficiency of the service has been affected by staff changes. Dr. Tait resigned at the end of April. Two locum psychiatrists covered the clinic from May to December, but each was able to offer only five sessions per week. The post has now been upgraded to consultant status and it is hoped to have better continuity in the future. 99 children were referred to the centre for investigation (37 fewer than in 1959). At the end of the year there were 40 cases awaiting full investigation, which is about the same as last year, which again means a six months waiting list. The school phychological service continues to be hard pressed: 354 children were seen during the year, and the nine month waiting list remains. School medical officers still make regular monthly visits when cases known to both teams are discussed. A psychotherapist still attends the maternity and child welfare clinics. SCHOOL DENTAL SERVICE (Table 83) The number of dental officers at the end of the year was five, a reduction of 1| compared with 1959. The equivalent of 7/11 orthodontist is an improvement on the figure of 3/11 at the end of 1959 and as a result the delay in orthodontic treatment has been reduced. The percentage of children inspected who were found to require treatment shows a very slight increase over the figure for 1959. (1960: 61%, 1959: 60%) Acceptance rate is approximately 2.5% less than in 1959 (1960: 46%, 1959: 49%). This is probably accounted for by larger numbers making private arrangements for treatment. Because of staff shortages intervals between routine inspections are still much too long. PRIORITY DENTAL SERVICE (Table 84) There has been little change during the year in the extent and type of treatment required and approximately the same proportion of the Dental Officers' time, 11%, has been spent in the inspection and treatment of the priority groups. Every opportunity is taken to emphasise the importance of diet, oral hygiene and dental care generally, particularly to expectant and nursing mothers. CHIROPODY SERVICE (Table 85) A number of conditions were due to incorrect treatment by the patient—for example, painful toe nails due to bad cutting. Cotton socks which allow perspiration to evaporate and which can be boiled are preferable to those of other non-absorbent fabrics which can promote reinfection. Foot deformities are caused by badly shaped shoes which seem to be worn by many children today. In order that feet may function properly the shoes must be the same shape as the feet and well fitted. Socks, too, must not cramp the toes and can be just as damaging as shoes if too small. Many talks on "The Foot and its Relation to the Shoe" were given to the school children, but cooperation from the parents would do more to reduce the number of children requiring chiropody treatment. Advice on foot care is readily available in the clinics, because prevention is as important as cure. 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 fund? in the financial year 1960/61. The committee's aim is to reduce the number of accidents which occur in homes in Willesden, 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 24 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, three meetings of the 'Handbook' Sub-committee, three meetings of the ' Willesden Show' Sub-committee and an emergency committee meeting to discuss the water-safety campaign were held during the year. 23 Twenty-eight of the 266 posters submitted for the children's poster competition held in 1959 were exhibited at three local cinemas for a week at a time. Four of the posters have been incorporated in the second edition of the safety handbook which was published at the end of the year. At the request of the Willesden Youth Organiser, a course of seven lectures and examination was arranged for the Girls Guildry in connection with the Duke of Edinburgh's Award Scheme. Six girls passed the examination at the Bronze Standard and hope to proceed to the Silver Standard. This includes a section on publicity and the committee agreed to support the girls and for any articles they wished to submit to the local press to be vetted by the Chairman and Secretary. Five thousand copies of a pamphlet on fire guards were distributed by the Housing Manager, with a new rent book issue. The committee participated in the national "Water-Safety" campaign held in the summer, in the "Poisons" campaign held in the winter and the general "Safety" campaign at Christmas. Posters were displayed on the Council's notice boards, in clinics, libraries and other public buildings. Posters about "Water Safety" were also displayed and leaflets distributed at the Welsh Harp during the Women's European Rowing Championships. Posters were also displayed at the schools and leaflets distributed. Several members of the committee attended the National Safety Congress held at the Central Hall, Westminster. The theme was "The Prevention of Poisonous Accidents in the Home." A display was exhibited at the Willesden Show in September and several members attended to answer questions. Three thousand leaflets were distributed. Circular letters were sent to 107 local organisations offering a talk on home safety to their members. Thirteen accepted the offer and eleven talks were given by the end of the year by members of the committee and the Assistant Divisional Officer of the Fire Service. Approximately 420 people attended. The Royal Society for the Prevention of Accidents is considering the establishment of a Greater London Area Committee and Willesden nominated a delegate to attend the preliminary meetings called to discuss the formation of such a committee 24 TABLES Table 1 DEATHS Causes: Males Females Total 1. Tuberculosis (respiratory) 6 5 11 2. Tuberculosis (other) — — — 3. Syphilitic disease 4 1 5 4. Diphtheria — — — 5. Whooping cough — — — 6. Meningococcal infections — — — 7. Acute poliomyelitis — — — 8. Measles — — — 9. Other infective and parasytic diseases 2 2 4 10. Malignant neoplasm, stomach 35 24 59 11. Malignant neoplasm, lung, bronchus 83 16 99 12. Malignant neoplasm, breast — 34 34 13. Malignant neoplasm, uterus — 12 12 14. Other malignant and lymphatic neoplasms 92 90 182 15. Leukemia, aleukemia 2 5 7 16. Diabetes 5 8 13 17. Vascular lesions of nervous system 64 117 181 18. Coronary disease, angina 213 116 329 19. Hypertension, with heart disease 13 26 39 20. Other heart disease 48 80 128 21. Other circulatory disease 32 44 76 22. Influenza 1 4 5 23. Pneumonia 25 40 65 24. Bronchitis 67 26 93 25. Other diseases of respiratory system 16 7 23 26. Ulcer of stomach and duodenum 15 7 22 27. Gastritis, enteritis and diarrhœa 2 9 11 28. Nephritis and nephrosis 5 6 11 29. Hyperplasia of prostate 15 — 15 30. Pregnancy, childbirth, abortion — 1 1 31. Congenital malformations 9 10 19 32. Other defined and ill-defined diseases 50 88 138 33. Motor vehicle accidents 15 10 25 34. All other accidents 18 21 39 35. Suicide 13 8 21 36. Homicide and operations of war 1 1 2 Total 851 818 1,669 25 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 1960 172.430 3,604 54 15 22 74 20 20 Perinatal mortality 1955 35 ,, ,,1956 35 ,, ,,1957 32 ,, ,,1958 31 ,, ,,1959 27 ,, ,, 1960 30 Table 3 Infant Mortality:—by Wards Ward Number of deaths Total 1958-60 Rate 1958-60 1958 1959 1960 Carlton 13 8 5 26 29 Kilburn 7 7 7 21 23 Brondesbury Park 3 5 1 9 12 Kensal Rise 3 6 5 14 25 Manor 4 6 1 11 16 Harlesden 6 3 11 20 20 Stonebridge 4 9 4 17 23 Roundwood 8 7 5 20 22 Church End 4 4 2 10 19 Willesden Green 3 2 3 8 10 Mapesbury 7 6 3 16 16 Gladstone 2 1 1 4 8 Cricklewood 4 1 4 9 19 Brentwater 1 1 2 4 9 69 66 54 189 19 26 Table 4 Deaths by Social Class I Nil II 4 III 31 IV 10 V 8 Not known 1 Total 54 Table 5 Infant Mortality—Causes (Based on Registrar General's Figures) 1936-1939 1940-1945 1946-1950 1956-1960 1960 Deaths Rate Deaths Rate Deaths Rate Deaths Rate Deaths Rate Neonatal 1-12 months Total Respiratory 106 8.1 140 8.8 68 4.2 57 3.6 4 8 12 3.3 Diarrhoea and enteritis 131 10.0 108 6.8 37 2.3 3 .2 - 2 2 .6 Other infections 34 2.6 40 2.5 15 0.9 5 .3 - 1 1 .3 Congenital malformations 83 6.3 89 5.6 72 4.4 55 3.5 7 2 9 2.5 Prematurity 170 13.0 179 11.3 99 6.1 72 4.6 14 - 14 3.9 Injury at birth 21 1.6 33 2.1 43 2.7 18 1.1 4 - 4 1.1 Other causes 134 10.3 149 9.4 96 5.9 88 5.6 12 - 12 3.3 All causes 679 51.9 738 46.5 430 26.5 298 18.9 41 13 54 15.0 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) 1960 22 (0) 217 (14) 3 (0) 239 (14) 27 Table 7 Premature births by wards Ward Premature births notified Percentage of live births in brackets Carlton 24 (8.5) Kilburn 27 (8.0) Brondesbury Park 21 (7.8) Kensal Rise 10 (5.0) Manor 19 (7.7) Harlesden 17 (4.8) Stonebridge 15 (5.9) Roundwood 23 (7.1) Church End 8 (5.1) Willesden Green 20 (7.4) Mapesbury 25 (6.4) Gladstone 10 (5.3) Cricklewood 12 (6.8) Brentwater 8 (5.1) Total 239 (6.6) Table 8 Infant Mortality: Congenital Malformations Heart defects 4 Meningomyelocele 1 Hydrocephalus and spina bifida 1 Multiple defects 1 Hypoplasia of lungs, kidney and gall bladder 1 Urethral valves 1 Total 9 28 GENERAL PROVISION OF HEALTH SERVICES Table 9 Bacteriological examination of milk, ice cream and water Milk examinations—239 Schools (pasteurised) Dealers' premises Total Pasteurised T.T. pasteurised Sterilised Samples 85 129 7 18 239 Satisfactory 85 129 7 18 239 Unsatisfactory — — — — — Ice cream examinations—20 Grade 1 Grade 2 Grade 3 Grade 4 Total 16 4 — — 20 Water examinations—278 Domestic supplies Swimming pools Paddling pool Total Samples 3 435 17 455 Satisfactory 3 428 16 447 Unsatisfactory — 7 1 8 Table 10 Uncleanliness and Scabies New cases treated Attendances Scabies Lice and nits Total Scabies Lice and nits Total Children under 5 years 5 4 9 6 4 10 Children 5-15 years 17 62 79 21 63 84 Adults Men 5 — 5 11 — 11 Women 5 9 14 9 9 18 Total 32 75 107 47 76 123 HEALTH EDUCATION Table 11 Talks No. visited Total No. of talks Subjects Total attendances No. of attendances Schools 23 385 38 1,004 25—70 Factories 68 74 15 8,470 12—800 Religious, social and political organisations 12 14 12 580 12—100 Table 12 Mothercraft No. of clinics Total No. of classes Visits by health visitors 3 120 7,422 29 PREVALENCE AND CONTROL OF INFECTIOUS AND OTHER DISEASES Table 13 Infectious diseases 1960 (1959 in brackets) Notified Confirmed Deaths Diphtheria - (-) - (-) - (-) Dysentery 58 (140) 40 (91) - (-) Erysipelas 12 (7) 11 (7) - (-) Encephalitis, acute - (-) - (-) - (-) Food poisoning 44 (40) 23 (24) 1 (-) Malaria - (-) - (-) - (-) Measles 478 (822) 476 (821) - (-) Meningococcal infection 1 (2) (2) - (-) Ophthalmia neonatorum 1 (-) 1 (-) - (-) Paratyphoid fever - (-) - (-) - (-) Pneumonia 68 (96) 65 (92) 65 (109) Poliomyelitis and polioencephalitis 3 (9) 3 (5) - (1) Puerperal pyrexia 166 (161) 166 (161) - (-) Scarlet fever 86 (143) 82 (142) - (-) Smallpox - (-) - (-) - (-) Typhoid fever - (1) - (1) - (-) Whooping cough 289 (194) 287 (191) - (-) 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 1.13 2.39 1,615 1950 648 157,781 3.57 3.60 822 1951 543 169,441 3.02 3.87 1,163 1952 328 114,869 1.82 2.61 946 1953 450 157,842 2.52 3.58 1,333 1954 295 105,912 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 1960 287 58,029 1.66 1.27 2,798 Table 15 Poliomyelitis 0—15 years 15 years and over Total Notified 2 1 3 Confirmed 2 1 3 Non-paralytic — — — Paralytic 2 1 3 Fatal — — — 30 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 1960 172,430 140 21 161 11 — 11 1,819 284 2,103 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 1960 172,430 81 12 93 6 — 6 31 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 1960 67 26 93 54 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 1960 83 16 99 57 Table 20 Tuberculosis: New cases and deaths by age groups (Deaths in brackets) Age groups New cases Respiratory Non-respiratory Male Female Male Female Under 1 1 (-) 1 (-) - (-) - (-) 1 to 5 4 (-) - (-) - (-) - (-) 5 to 10 4 (-) 3 (-) 1 (-) - (-) 10 to 15 - (-) - (-) - (-) - (-) 15 to 20 3 (-) 2 (-) 1 (-) 1 (-) 20 to 25 14 (-) 15 (-) 2 (-) 4 (-) 25 to 35 18 (-) 14 (1) 1 (-) 2 (-) 35 to 45 11 (2) 6 (-) 2 (-) 4 (-) 45 to 55 15 (-) 7 (2) 1 (-) - (-) 55 to 65 7 (1) 4 (-) - (-) 1 (-) 65 and upwards 7 (3) 4 (2) - (-) 1 (-) Totals 84 (6) 56 (5) 8 (-) 13 (-) 32 Tuberculosis 1960: Cases by wards Table 21 Ward Pulmonary cases Nonpulmonary cases Pulmonary rate per 100,000 Combined rate per 100,000 Carlton 17 2 150 168 Kilburn 7 3 54 77 Brondesbury Park 4 2 33 49 Kensal Rise 11 2 97 115 Manor 12 1 91 99 Harlesden 9 2 65 79 Stonebridge 14 2 115 131 Roundwood 9 2 75 91 Church End 6 — 48 48 Willesden Green 13 3 93 120 Mapesbury 15 1 112 119 Gladstone 9 — 79 79 Cricklewood 9 1 78 86 Brentwater 5 — 44 44 Whole Borough 140 21 81 93 Table 22 Tuberculosis 1958—1960: Cases by yards Ward Pulmonary cases Nonpulmonary cases Pulmonary rate per 100,000 Combined rate per 100,000 Carlton 52 8 147 170 Kilburn 33 6 71 84 Brondesbury Park 17 5 47 61 Kensal Rise 20 3 59 68 Manor 26 2 67 72 Harlesden 36 5 87 99 Stonebridge 25 8 68 89 Roundwood 29 3 81 89 Church End 20 — 53 53 Willesden Green 46 7 116 133 Mapesbury 41 6 105 120 Gladstone 31 2 92 97 Cricklewood 22 1 64 67 Brentwater 18 2 51 57 Whole Borough 416 58 80 91 Table 23 Tuberculin Testing, 1953-1960 Children under 5 years School children (5 years) School leavers Tested Positive % Positive Tested Positive % Positive Tested Positive % Positive 1953 1,416 56 4.0 1,018 384 38.0 1,804 885 49.1 1954 1,526 43 2.8 938 169 18.0 1,868 1,116 59.7 1955 1,308 13 1.0 1,537 32 2.1 2,041 387 19.0 1956 1,333 14 1.0 1,473 56 4.0 1,759 391 22.2 1957 1,295 31 2.4 1,496 44 2.9 1,753 348 20.0 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 1960 234 5 2.1 1,592 91 5.7 1,601 321 20.0 33 Table 24 Tuberculosis: B.C.G. vaccination of school leavers, 1953-1960 No. tested and found negative No. vaccinated 1953 587 *(32.5) 456 t(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) 1960 1,262 (79) 1,215 (96) *Percentage of total tested. †Percentage of negatives vaccinated. Table 25 Tuberculosis: Notification of deaths 1955 1956 1957 1958 1959 1960 1955-60 Deaths 27 25 13 16 5 11 97 Percentage not notified 15 24 15 12 20 36 35 Percentage notified before death: 0—12 months 15 20 15 25 — 19 22 1—5 years 26 4 23 13 40 9 2 Over 5 years 44 52 47 50 40 36 41 SANITARY INSPECTION OF THE AREA Table 26 Demolition and Closing Orders Housing Act, 1957 (Sections 16, 17 and 18) Demolition Orders, section 16, Housing Act, 1957 3 9, Pound Lane 376, High Road, Willesden 378, High Road, Willesden Closing Orders, sections 17 and 18, Housing Act, 1957 10 107, High Street, Harlesden (basement) 26, Granville Road (basement) 39, Granville Road (basement) 79, Granville Road, (basement) 129, Granville Road, (basement) 83, Albert Road (whole house) 91, Albert Road (whole house) 97, Albert Road (whole house) 99, Albert Road (whole house) 105, Albert Road (whole house) Table 27 Overcrowding (a) Dwellings overcrowded at end of year 1,652 (b) Overcrowding reported during the year 24 (c) (i) Overcrowding relieved during the year 73 (ii) Persons 292 (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 31 (ii) Families 40 (iii) Persons 240 (f) Overcrowding in Council houses relieved during the year 12 (g) Section 80, Housing Act, 1957—licences issued 5 34 Table 28 New dwellings, 1960 Houses Flats Rebuilds Dwellings built by private builders (excluding those built by the police authorities 3 76 Nil Built by local authority 10 186 Nil Applicants on Council's waiting list at 31.12.60 9,665 Table 29 Notices served under Public Health Act, 1936 and Housing Act, 1957 1960 1959 Intimation notices served 745 900 Intimation notices complied with 668 886 Statutory notices served (Public Health Act, 1936) 1,116 1,050 Statutory notices complied with (Public Health Act, 1936) 1,180 902 Statutory notices served (Housing Act, 1957) 12 5 Statutory notices complied with (Housing Act, 1957) 11 6 Non-compliance with statutory notices referred to Town Clerk (Public Health Act, 1936, Sec. 93) 1199 135 Referred to the Borough Engineer for work to be carried out in default of owners *182 151 *90 work done by Borough Engineer. †Details of cases referred to the Town Clerk during the year:— Work carried out 93 Work in hand — Court orders obtained 13 Summons withdrawn—notices complied with 22 Notices withdrawn 7 Proceedings pending — Total 135 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 1960 1959 Dwelling houses inspected 2,876 2,733 Dwelling houses re-inspected 10,089 8,184 Other visits 1,331 1,254 Housing Act Dwelling houses wholly inspected 514 1,582 Dwelling houses partly inspected 57 191 Dwelling houses re-inspected 103 216 Underground rooms inspected 77 4 Overcrowding visits 99 33 Improvement grant inspections 165 73 Other visits 326 1,471 Rent Act Dwelling houses inspected 54 80 Dwelling houses re-inspected 56 199 Other visits 21 91 Clean Air Act Boiler plant inspections 71 55 Boiler plant re-inspections 14 63 Premises inspected (S.C.A.) 11,325 3,462 Premises re-inspected (S.C.A.) 1,500 489 Smoke observations 349 360 Rag Flock and Other Filling Materials Act Premises inspected 8 5 Visits re samples 8 10 Infectious diseases Infectious disease enquiries 418 778 Food poisoning enquiries 66 115 Polio virus survey visits 7 277 Miscellaneous Massage establishments inspections 40 26 Cinemas, dance halls, schools, etc.. inspected 41 65 Noise nuisance investigations 71 166 Visits re unsound food 137 139 All other visits 5,453 1,461 35,276 23,582 35 Table 31 Inspection of Factories, Outworkers Premises and Food Premises 1960 1959 No. inspected Inspections made No. inspected Inspections made Offensive trades — — — — Power factories 774 1,121 774 1,050 Non-power factories 61 84 61 117 Homeworkers and outworkers 213 172 213 320 Inspections of food premises (including revisits) Baker 26 129 27 172 Bread and confectionery 40 150 39 133 Dairy 3 44 3 12 Butcher 115 414 117 405 Grocer and general store 324 934 329 910 Fishmonger and fish-fryer 45 148 49 150 Cafe and restaurant 137 655 136 632 Greengrocer and fruiterer 126 378 124 347 Ice cream and sweet shop 227 586 222 579 Food stall 18 22 15 41 Public House 44 101 43 72 Works canteen 118 258 120 298 School canteen 39 43 35 39 Food factory 4 32 5 34 Any other food premises 36 36 34 62 Total periodic inspections 2,350 5,307 2,346 5,373 1960 1959 Total all inspections 40,583 28,955 Table 32 Rent Act, 1957 Certificates of Disrepair Applications (Form I) received and investigated 35 Agreed and proposal to issue Certificate of Disrepair (Form J) served 34 Refused 1 Undertakings (Form K) received from landlords 25 Accepted 23 Refused 2 Certificates of Disrepair (Form L) issued 11 Applications received for cancellation of Certificates of Disrepair (Form M) 8 Granted 7 36 Table 33 Summary of nuisances abated and of improvements effected Water supply and water service 1960 1959 New cisterns provided 7 3 Cisterns cleansed, repaired, covered, etc. 26 19 Draw taps placed on mains 2 8 Drainage and sewerage Water closets: Repaired, supplied with water or otherwise improved 205 251 New closets built 2 5 Provided with better ventilation 2 — Drains: Examined, tested, exposed, etc 95 77 Unstopped, repaired, trapped, etc 233 204 New soilpipes or vent shafts fixed 12 15 Disconnecting traps or chambers inserted 16 16 Reconstructed 19 13 New manhole covers 34 36 Soilpipes or vent shafts repaired 45 61 Other defects Smoke nuisances 7 8 Accumulation of refuse 87 86 Fowls, pigs, etc., kept in an insanitary condition 2 3 Dampness 373 403 Yards and forecourts paved, repaved or repaired 111 66 Walls and ceilings cleansed 100 476 Verminous rooms disinfested 301 489 Leaky roofs made watertight 496 359 Additional ventilation provided under floors 13 11 Dilapidated plaster repaired 540 604 Flooring and other woodwork repaired 306 356 Damp proof courses inserted 34 28 Water supply reinstated 31 28 Wash house floors repaired or repaved 19 21 Fireplaces and stoves repaired 80 96 Decayed brickwork repaired and repointed 207 174 Sinks provided or replaced 43 58 Additional light and ventilation to staircase — 4 Gutters and/or rainwater pipes repaired or renewed 386 358 Larders or food cupboards ventilated or provided 3 — New sashcords and glass provided to doors and windows 597 637 Miscellaneous 170 247 Total nuisances abated 4,604 5,220 37 CLEAN AIR 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/ Aylesbury Street Wembley Trading Estate Town Hall January 24.22 34.70 19.81 28.76 (a) - 20.51 23.61 February 32.34 32.84 27.54 31.02 (b) 36.22 24.96 28.58 March 34.00 25.55 40.25 36.32 17.40 17.38 32.93 April 19.32 (c) - 16.11 (c) - 16.76 (c) - 26.31 May 26.37 31.34 25.95 33.83 31.81 21.07 24.24 June 18.32 22.33 18.34 20.02 20.24 14.71 20.35 July 20.21 24.55 20.94 20.11 22.90 20.48 18.96 August 20.05 27.14 20.61 25.55 26.57 16.79 19.95 September 52.03 32.41 17.17 20.51 19.38 12.12 16.30 October 33.60 30.82 22.71 28.03 22.67 16.79 19.00 November 18.65 42.15 16.47 21.97 18.79 13.37 23.35 December 21.60 33.00 19.27 20.21 29.56 18 00 19.59 Totals 320.71 336.83 265.17 286.33 262.30 196.18 273.17 **Sited at Press Road during January and February; at Aylesbury Street March to December. (a) Grossly contaminated with extraneous matter. (b) Slightly contaminated with extraneous matter. (c) Collecting bottle blown over during gale Table 35 Examination of sulphur by lead peroxide method (milligrams of S03 per day per 100 square centimetres) Site January February March April May June July August September October November December Minet Gardens 3.12 3.00 2.57 1.97 1.58 1.29 1.05 0.95 1.36 2.24 2.57 2.78 Town Hall 2.62 2.62 2.92 1.49 1.22 1.31 1.22 0.86 1 29 2.28 2.29 2.16 38 DISINFESTATION Table 36 (a) Verminous premises: Council properties 39 County Council properties 1 Private properties 94 Total 134 (b) Verminous rooms:* Council properties 105 County Council properties 1 Private properties 195 Total 301 *Some rooms are treated more than once. (c) Bedding materials (i) disinfested 2 (ii) disinfected 12 (d) Miscellaneous: Cockroaches 1 Fleas 5 Lice 2 Ants 6 INSPECTION AND SUPERVISION OF FOOD AND FOOD PREMISES Table 37 Types of food premises Baker 26 Bread and confectionery 40 Dairy 3 Butcher 115 Grocer and general store 324 Fishmonger and fish fryer 45 Caf6 and restaurant 137 Greengrocer and fruiterer 126 Ice cream and sweet shop 227 Food stall 18 Public house 44 Works canteen 118 School canteen 39 Food factory 4 Other food premises 36 Total 1.302 Inspections and revisits: Inspections 3,294 Revisits 643 Total 3,937 Table 38 Premises unsatisfactory on 31.12.59 48 Unsatisfactory during the year 367 Premises made satisfactory during the year 316 Unsatisfactory on 31.12.60 97 39 Table 39 Food premises: Defects remedied Defects Outstanding at 31.12.59 Found during the year Total Remedied during year Outstanding at 31.12.60 Inadequate lighting and ventilation 5 13 18 12 6 Inadequate washing facilities 4 58 62 26 36 Inadequate refuse storage 6 34 40 22 18 Unsatisfactory or insufficient sanitary accommodation 8 58 66 53 13 Inadequate storage accommodation 1 5 6 5 1 Defective walls, ceilings or floors 27 108 135 95 40 Dirty walls, ceilings or floors 36 266 302 268 34 Inadequate first aid materials 1 16 16 9 8 Unsatisfactory conditions — 28 28 23 5 Any other defects 30 148 178 137 41 Totals 118 734 852 650 202 Table 40 Food premises: Registration Premises on register 31.12.59 Applications received Applications granted Applications refused Premises removed from register during 1960 Total on register at 31.12.60 1. Sale and storage of ice cream 340 31 31 - 54 317 324 2. Manufacture of ice cream 8 - - - 1 7 3. Manufacture of preserved food 137 6 6 - 15 128 4. Fish curing 1 - - - - 1 Table 41 Food unit for human consumption Meat Bread, flour, cereals, etc. 80 lbs. Bacon 207 lbs. Preserves 38½ lbs. Cooked 13½ lbs. Cheese 237 lbs. Tinned 2,002¼ lbs. Tinned milk 404 tins Raw 1,020¼ lbs. Butter and fats 32½ lbs. Fish Miscellaneous Tinned 283 tins Dried fruit 54 lbs. Raw 23 lbs. Dried vegetables 27½ lbs. Fish paste 28 jars Poultry Frankfurter sausages 27 tins Frozen 86 lbs. Frozen food (miscellaneous) 44 lbs. Vegetables Grapefruit juice 2 tins Jelly 19 pkts. Tinned 877 tins Milk powder 280 lbs. Raw 4,634 lbs. Minerals 812 bottles Fruit Salad cream 56 jars Salt 3 lbs. Tinned 2,712 tins Sauce 12 bottles Raw 47 3/4lbs. Shelled nuts 2½ lbs. 40 Table 42 Food: Samples taken Article No. of samples Unsatisfactory Milk (various) 220 — Butter and margarine 86 — Cakes and biscuits 5 — Coffee 5 — Cream 39 2 Drugs 34 1 Fish and fish products 36 1 Fruit—fresh and dried 13 — Ice cream 39 — Liver 11 — Meat and meat products 92 — Preserves 5 — Soft drinks 12 — Spirits 22 — Sweets 15 5 Vinegar and non-brewed condiments 65 6 Miscellaneous 21 1 (cheese) Total 720 16 FACTORIES Table 43 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 62 84 8 Factories not included above in which section 7 is enforced by the local authority 738 1,121 66 Other premises in which section 7 is enforced by the local authority (excluding outworkers premises) 12 18 — Total 812 1,223 74 No occupiers were prosecuted during the year. Table 44 Defects found Found Remedied Referred To H.M. Inspector By H.M. Inspector Want of cleanliness (sec. 1) 8 7 — Overcrowding (sec. 2) — — — — Unreasonable temperature (sec. 3) — — — — Inadequate ventilation (sec. 4) — — — — Ineffective drainage of floors (sec. 6) — — — — Sanitary conveniences (sec. 7) (a) Insufficient 1 2* — 1 (b) Unsuitable or defective 67 58 — 3 (c) Not separate for sexes 1 1 — — Other offences against the Act (not including offences relating to outworkers) 1 — — — Total 78 68* — 4 *One defect outstanding from previous year. No prosecutions were instituted during the year. 41 Table 45 Outworkers Nature of work No. of outworkers in August list No. of instances of work in unwholesome premises Notices served Wearing apparel (making, etc.) 123 1 1 Household linen 7 — — Curtains and furniture hangings 5 — — Furniture and upholstery 2 — — Artificial flowers 1 — — Paper bags 7 — — Making of boxes or other receptacles or parts thereof made wholly or partially of paper 3 — — Carding, etc. of buttons, etc. 15 — — Stuffed toys 35 — — Cosaques, Christmas stockings, etc. 5 — — Imitation jewellery and jewellery pads 7 — — Lampshades 3 — — Total 213 1 1 There were no cases of default in sending lists to the Council, and there were no prosecutions. CARE OF MOTHERS AND YOUNG CHILDREN Table 46 Ante-natal Clinics Clinic Sessions New cases Attendances Average attendance per session Antenatal Postnatal Antenatal Postnatal Kilburn 103 347 20 1,503 20 14.8 Pound Lane 100 365 10 1.566 10 15.8 Stonebridge 150 660 4 2,777 4 18.5 Cricklewood (Sneyd Road) 50 219 2 791 2 15.9 Neasden (St. Catherine's) 52 69 2 184 2 3.6 Kensal Rise (St. Martin's) 51 231 — 971 — 19.0 South Kilburn (St. Luke's) 50 145 5 682 5 13.7 Totals: 1960 556 2,036 43 8,474 43 15.3 1959 562 1,894 70 9,215 71 16.5 Table 47 Births Hospital and domiciliary 1960 1959 Total notified live births 3,544 3,332 Born in institutions 3,069 2,891 Born at home 475 441 Percentage born in institutions 86.6 86.9 Institutions Central Middlesex Hospital 1,221 1,174 Kingsbury Maternity Hospital 429 498 Larger hospitals outside Willesden 1,159 1,092 Smaller hospitals outside Willesden 244 113 Nursing homes, etc. 16 14 3,069 2,891 Home County Midwives 471 436 Others 1 5 Private Doctors 3 — 475 441 42 Table 48 Mothercraft Clinic Sessions New cases Total attendances Average attendance per session Kilburn 36 81 347 9.6 Pound Lane 36 45 168 4.6 Stonebridge 48 80 265 5.5 Totals: 1960 120 206 806 6.5 1959 125 209 780 6.4 Table 49 Relaxation Classes Clinic Sessions New cases Total attendances Average attendance per session Kilburn 38 78 291 7.6 Pound Lane 48 55 152 2.8 Stonebridge 48 67 260 4.0 Totals: 1960 134 200 897 5.2 1959 144 231 703 6.2 Table 50 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 282 575 5,782 820 422 7,024 3,325 24.9 Pound Lane 254 535 5,662 881 487 7,030 3,109 27.7 Stonebridge 257 718 7,073 850 535 8,458 2,429 32.9 Cricklewood (Sneyd Road) 102 399 3,843 494 272 4,609 1,794 45.2 Neasden (St. Catherine's) 100 259 5,258 758 306 6,322 1,175 63.2 Kensal Rise (St. Martin's) 155 335 5,102 632 181 5,915 1,456 38.1 South Kilburn (St. Luke's) 100 225 2,979 440 202 3,621 1,059 36.2 Totals: 1960 1,250 3,046 35,699 4,875 2,405 42,979 14,347 34.4 1959 1,262 3,144 37,449 5,262 2,697 45,408 14,614 36.0 MIDWIFERY SERVICE Table 51 Midwives' Clinics Sessions New Cases Total attendances Average attendance 1960 353 767 5,580 15.8 1959 405 948 5,868 14.5 43 Table 52 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 333 (b) When doctor was present at delivery Number of cases in which pethidine was administered in domiciliary practice during the year: 74 (a) When doctor was not present at delivery 173 (b) When doctor was present at delivery 62 Number of cases in which trichloroethylene was administered in domiciliary practice during the year: (a) When doctor was not present at delivery 18 (b) When doctor was present at delivery 5 Totals: 1960 665 1959 540 Table 53 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 — — 93 383 16,461 70 502 439 Totals: 1960 476 16,461 70 502 439 1959 435 15,493 51 347 378 Table 54 Medical Aid 1960 1959 (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 68 69 (ii) Others — — Totals 68 69 44 Medical Aid For Mother For Child Ruptured perineum 9 Talipes 2 Foetal distress 4 Prematurity 2 Puerperal pyrexia 1 White Asphyxia 1 Ante-partum haemorrhage 3 Sticky eyes 5 Post-partum haemorrhage 3 Rash 1 Early rupture of membranes 5 Cleft palate 1 Premature labour 5 Jaundice 1 Bulky uterus 1 Chest condition 2 Toxaemia of pregnancy 4 Raised temperature 4 Retained placenta 2 Presentation of cord 1 Breech presentation 1 Flushed breast 1 Transversal lie 1 Oedema of hands, face and feet 1 Raised blood pressure 2 Delayed second stage 2 Low Haemoglobin count 2 Insomnia 1 Totals 53 15 45 HEALTH VISITING Table 55 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 1960 1,746 2,596 3,761 12,423 5,786 9,318 37 1,476 1,000 1959 2,043 2,916 3,681 12,676 6,049 9,576 10 1,895 824 Table 56 Special cases referred by General Practitioners for:— Care of children Care of elderly persons Hospital admission Home help Home confinement 4 7 5 5 3 46 Table 57 Establishment: Health Visitors Whole time equivalent as at: 31.12.59 31.12.60 Health Visitors (Whole time) 23 21 (Part time) 3/11 1 4/11 (Sponsored) 2 2 Clinic Nurses (Whole time) 4 4 Nursing Assistant (Part time) 2/11 2/11 Totals 29 5/11 28 6/11 HOME NURSING Table 58 Work: Home Nurses New Cases Visits Cases on register at end of year Male Female Male Female Medical 736 1,272 73,462 141 454 Surgical 108 120 6,762 14 14 Infectious 13 10 292 — 2 Tuberculosis 34 38 4,607 11 6 Maternal complications — 32 287 — — Others — — — — — Total 891 1,472 166 476 Totals: 1960 2,363 85,410 642 1959 2,423 87,823 614 Table 59 Establishment: Home Nurses Nurses 1.1.60 31.12.60 Whole time 24 24 Part time 5 5 Candidates — — Total whole time equivalent 27 27½ SMALLPOX Table 60 Vaccination Under 1 year 1 year 2—4 years 5—14 years 15 years and over Total Primary Vaccinations 1,488 206 102 71 98 1,965 Re-vaccinations — — 6 36 267 309 Totals: I960 1,488 206 108 107 365 2,274 1959 1,274 238 96 73 328 2,009 Approximate number of children (end of 1960) 0— 5 15,522 5—15 20,701 36,223 47 DIPHTHERIA Table 61 Immunisation Age at 31.12.60 Under 1 1 2 3 4 5—9 10—14 Totals Courses completed (primary or boosting) during last 5 years 1956-60 910 1,855 1,823 1,570 1,494 4,079 456 12,187 Courses completed (primary or boosting) during the period 1946-55 — — — — — 3,612 10,870 14,482 Approximate number of children (end of 1960) 0— 5 15,522 5—15 20,701 36,223 HOME HELPS Table 62 Cases: Home Helps Cases receiving help at No. of new cases helped during No. of cases receiving help at 1.1.60 1.1.59 1960 1959 31.12.60 31.12.59 Maternity 9 51 48 _ Tuberculosis 18 11 3 10 13 18 Chronic sick and aged 491 520 214 222 516 491 Others 95 65 164 175 122 95 Totals 604 605 432 455 651 604 Table 63 Staff: Home Helps Position at Appointments during Resignations during Position at 1.1.60 1.1.59 1960 1959 1960 1959 31.12.60 31.12.59 Whole time 2 2 2 1 2 1 2 2 Part time 84 83 14 25 14 24 84 84 Totals 86 85 16 26 16 25 86 86 48 DAY NURSERIES Table 64 Day Nurseries: Attendances Nursery Approved places Children on register at 31.12.60 Attendances for the year Average daily attendances 0-2 years 2-5 years 0-2 years 2-5 years 0-2 years 2-5 years 0-2 years 2-5 years Chichester Road 18 32 21 34 4,025 7,401 16 29 Essex Road 25 25 29 31 5,948 5,809 23 23 Evefield 25 25 28 30 5,781 6,020 23 23 Gladstone Park 25 25 26 29 5,540 5,795 21 23 Longstone Avenue 25 25 34 29 5,234 5,822 21 23 Mortimer Road 25 25 22 24 5,430 5,751 21 23 Villiers Road 25 25 27 27 4,927 5,694 19 22 Wesley Road 15 25 15 28 3,025 5,408 12 21 Totals: 1960 183 207 202 232 39,910 47,700 156 187 1959 183 207 194 237 37,725 46,092 148 181 Table 65 Day Nurseries: Infectious Diseases Number of Cases Nursery Measles Scarlet Fever Chicken Pox Dysentery Mumps German Measles Whooping Cough Essex Road - - 17 10 - - - Evefield - - 13 - - - - Gladstone Park - 1 - 3 - - - Longstone Avenue - - 24 2 - - 6 Mortimer Road 10 - - - 1 - 3 Villiers Road 14 - 1 - 1 1 8 Wesley Road - - - - - - 1 Totals 24 1 55 15 2 1 18 Table 66 Day Nurseries Waiting List Position at:— Nursery 1.1.60 31.12.60 Chichester Road 11 30 Essex Road 16 5 Evefield - 4 Longstone Avenue 6 3 Gladstone Park 31 20 Mortimer Road 17 45 Villiers Road 27 31 Wesley Road 9 23 49 Table 67 Day Nurseries: Priorities Nursery Unsupported Mothers Medical reasons Bad Housing Total on Register Chichester Road 35 9 10 54 Essex Road 28 12 10 50 Evefield 18 8 16 42 Gladstone Park 22 7 13 42 Longstone Avenue 20 9 15 44 Mortimer Road 28 7 11 46 Villiers Road 24 4 14 42 Wesley Road 18 8 12 38 York Park 9 1 13 23 Totals 202 65 114 381 Table 68 Day Nursery Staff Establishment Establishment Position as at: 31.12.60 31.12.59 Supervisory Matron 1 1 1 Matrons 8 8 8 Deputy Matrons 8 8 8 Wardens 8 6 5 Nursing Staff 44 40 39 Students 20 19 20 SCHOOL HEALTH SERVICE Table 69 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) 1956 and later 80 79 98.7 1 1.3 1955 1,300 1,276 98.2 24 1.8 1954 665 645 97.0 20 3.0 1953 247 242 98.0 5 2.0 1952 1,150 1,121 97.5 29 2.5 1951 248 246 99.2 2 0.8 1950 1,293 1,276 98.7 17 1.3 1949 446 443 99.3 3 0.7 1948 147 144 98.0 3 2.0 1947 292 288 98.6 4 1.4 1946 711 696 97.9 15 2.1 1945 and earlier 1,218 1,204 99.3 8 0.7 Totals: 1960 7,791 7,660 98.3 131 1.7 1959 7,513 7,382 98.3 131 1.7 50 Table 70 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) 1956 and later - - - 1955 11 60 71 1954 7 50 57 1953 9 13 22 1952 59 77 135 1951 13 14 27 1950 54 77 127 1949 27 40 67 1948 6 17 23 1947 19 25 40 1946 37 57 91 1945 and earlier 58 90 147 Totals 1960 300 520 807 1959 347 533 857 Table 71 Defects Found by Medical Inspection * Periodic inspections Special inspections Entrants Leavers Others Total (a) (b) (a) (b) (a) (b) (a) (b) (a) (b) Skin 7 46 41 66 20 104 68 216 209 23 Eyes (a) Vision 28 33 92 117 190 303 310 453 34 6 (b) Squint 11 24 — 8 18 44 29 76 — 1 (c) Other 4 20 16 16 24 48 44 84 43 8 Ears (a) Hearing 4 44 6 12 15 60 25 116 56 21 (b) Otitis media 4 56 2 9 — 39 6 104 4 2 (c) Other — 10 5 10 5 17 10 37 9 4 Nose and throat 16 277 3 32 21 200 40 509 35 8 Speech 24 42 4 7 24 40 52 89 64 5 Lymphatic glands 4 93 — 5 1 96 5 194 — — Heart 2 31 — 7 7 38 9 76 8 5 Lungs 4 60 — 14 6 71 10 145 18 9 Developmental (a) Hernia 1 19 — 6 2 13 3 38 1 — (b) Other 1 55 2 7 8 95 11 157 6 17 Orthopaedic (a) Posture 6 29 20 41 48 103 74 173 1 7 (b) Feet 10 36 36 40 60 93 106 169 2 9 (c) Other 6 66 17 33 20 73 43 172 25 7 Nervous system (a) Epilepsy 1 7 — 1 2 2 3 10 1 3 (b) Other 1 8 — 7 — 14 1 29 3 2 Psychological (a) Development — 11 — 8 1 67 1 86 10 3 (b) Stability 2 130 3 74 15 255 20 459 7 8 Abdomen — 14 — 10 2 32 2 56 — 1 Other 187 56 50 40 271 131 508 227 167 11 Totals 1960 323 1,167 297 570 760 1,938 1,380 3,675 703 160 1959 327 1,040 353 666 661 1,802 1,341 3,508 965 462 * (a) Requiring treatment (b) Requiring observation. 51 Table 72 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 36 (b) Errors of refraction (including squint) 934 Totals 1960 1,039 1959 1,336 (c) Number of pupils for whom spectacles were prescribed Totals 1960 437 1959 586 (ii) Diseases and Defects of Ear, Nose and Throat Received operative treatment for: (a) diseases of the ear - (b) adenoids and chronic tonsillitis 51 (c) other nose and throat conditions 8 Received other forms of treatment 77 Totals 1960 136 1959 164 Total number of pupils in schools who are known to have been provided with hearing aids: (a) during the current year 1 (b) in previous years (excluding any pupils shown at (a) above who were provided with an aid in the previous year). 29 (iii) Orthopaedic and Postural Defects Number of pupils known to have been treated at clinics or at out-patients departments 1960 640 1959 678 (iv) Diseases of the Skin (Excluding Uncleanliness) Ringworm (i) Scalp — (ii) Body — Scabies 1 Impetigo 14 Other skin diseases 232 Totals 1960 247 1959 294 (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) 497 (vi) Speech Therapy Number of pupils treated by speech therapists under arrangements made by the authority 1960 271 1959 205 (vii) Other Treatment Given (a) Number of miscellaneous minor ailments treated by the County Council 660 (b) Treatment other than (a) above and excluding convalescent treatment: 1. Lymphatic glands — 2. Heart — 3. Lungs 143 4. Developmental (a) Hernia — (b) Other 10 5. Nervous system (a) Epilepsy — (b) Other 6. Psychological (a) Development 2 (b) Stability 25 7 Abdomen 2 8. Other 12 Totals 1960 854 1959 840 52 Table 73 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 74 36 5 6 2 18 Table 74 Audiometry: Children Tested Routine Age group 1st Tests Re-tests Failures Total Both ears One ear Right Left Up to 7 years 1,393 59 13 15 19 47 Intermediate 1,700 53 8 13 19 40 Leavers 1,952 67 17 17 16 50 Totals 1960 5,045 179 38 45 54 137 1959 5,269 148 47 62 38 147 Specials All ages 1st Tests Re-tests Failures Total Both ears One ear Right Left Totals 1960 433 180 54 63 62 179 1959 424 156 63 37 55 155 Table 75 Summary of Failures to pass Audiometer Test Passed at second test 107 Referred to Assistant Medical Officers 153 Normal Hearing after removal of wax 27 Under observation by hospital or private doctor 11 No action—further test recommended after given period 32 Referred for Tonsils and Adenoids operation 15 Appointments not accepted 8 Referred by A.M.O.'s to Ear, Nose and Throat Specialist 114 Treatment considered of little value 7 Referred to hospital 11 Hearing improved after treatment 31 Recommended for Hearing Aid 2 Awaiting appointments 9 Failed to attend appointments 21 53 Table 76 Speech Therapy Clinic or School No. of cases dealt with during the year Kilburn clinic 133 Pound Lane clinic 77 Stonebridge clinic 30 Lower Place special school for physically handicapped pupils 27 Leinster special school for educationally subnormal pupils — Totals 1960 267 1959 321 Table 77 Infestation with Vermin 1960 1959 Total no. of examinations 26,764 31,235 Total no. of individual pupils found to be infested for the first time during the current year 438 465 Number of individual pupils in respect of whom cleansing notices were issued under section 54/2 Education Act, 1944 194 189 Number of individual pupils in respect of whom cleansing notices were issued under section 54/3 Education Act, 1944 — 1 Table 78 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 31.12.60 Lower Place Special School for Physically Handicapped Pupils Willesden 15 13 2 Wembley 5 4 1 Ealing 1 1 - Acton 2 2 - Hendon 5 4 1 Totals 28 24 4 Table 79 The Educational Sub-Normal Education Act, 1944 — Sections 57 (3), 57 (4) and 57 (5) 1960 1959 Cases dealt with under section 57, Education Act, 1944:— Sub-Section 3 5 6 Sub-Section 4 - - Sub-Section 5 14 22 Cases de-notitied under section 8, Education (Miscellaneous Provisions) Act, 1948 — 1 54 Table 80 Return of Handicapped Pupils (Year Ended 31st December, 1960) 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 - - - 1 - - - 1 - - - - - - - 1 Partially-Sighted Pupils 13 11 1 10 11 9 9 1 2 - - - - - - 10 11 Deaf Pupils 9 2 — 1 9 3 6 2 3 1 - - - - - - 9 3 Partially Deaf Pupils 4 — 3 - 7 - 6 - 1 - - - - - - - 7 - Delicate Pupils Diabetic Pupils 34 10 9 9 31 11 4 1 25 8 1 1 1 1 - - 31 11 Educ. Sub-normal Pupils 75 63 14 10 74 61 64 57 10 4 - - - - - - 74 61 Epileptic Pupils 2 — — — 1 — - — 1 — - - - - - - 1 — Maladjusted Pupils 43 15 13 5 42 14 - — 13 2 8 1 21 11 - - 42 14 Physically Handicapped Pupils 23 17 12 4 30 18 28 18 1 1* - 30 18 Pupils with Speech Defects 357 131 48 35 377 153 - — - - 374 150 - - 3 3 377 153 Pupils with Multiple Defects 38 22 1 1 37 22 34 22 3 - - - - - - - 37 22 Total 598 273 101 65 618 294 151 109 58 18 383 152 22 12 4 3 618 204 Grand Totals: 1960 871 166 912 260 76 535 34 7 912 1959 837 213 871 251 71 512 33 4 871 *Receiving home tuition. Boys Girls Children not ascertained as handicapped pupils, but recommended for convalescence in a holiday home or camp school 60 47 55 CHILD GUIDANCE Table 81 Waiting list at 1.1.1960 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 31.12.1960 44 98 76 22 99 9 40 Table 82 Main Symptoms Cases Nervous Disorders Fears and anxieties 1 Inhibited behaviour 3 Behaviour Disorders At Home 15 At School 10 Predominantly aggressive 10 Habit Disorders Enuresis (wetting) 9 Encropesis (soiling) 1 Involuntary movements 2 Sleep disturbances 7 Speech disorders 4 Psychosomatic Asthma, Eczema, etc. 1 Anti-Social Behaviour Stealing 9 Non-attendance at school 15 Educational Difficulties Backwardness and retardation in school work 12 Total number deferred in 1960 99 SCHOOL DENTAL SERVICE Table 83 Inspection and Treatment (a) Inspection Age Groups Inspected Required Treatment Referred for Treatment 1960 1959 1960 1959 1960 1959 Under 5 121 83 10,129 80 5—16 16,608 16,525 9,801 10,675 9,722 Specials 1,258 1.417 1,186 1,318 1,299 Totals 17,866 18,063 10,987 12,076 10,129 11,001 56 (b) Treatment 1960 1959 No. of pupils actually treated: 4,715 5,401 No. of attendances 13,919 15,635 No. of half-days of Inspection 225 228 Treatment 2,270 2,513 No. of fillings: (a) Permanent teeth 8,912 10,154 (b) Temporary teeth 3,592 3,621 No. of extractions of: (a) Permanent teeth 416 522 (b) Teeth for orthodontia 228 267 (c) Temporary teeth 2,781 3,201 No. of anaesthetics: (a) General 1,398 1,654 (b) Local N/A 755 No. of other operations 5,682 6,093 PRIORITY DENTAL SERVICE Table 84 Expectant and Nursing Mothers Children under 5 1960 1959 1960 1959 Number examined 316 341 562 600* Number required treatment 306 331 452 437 Number of new cases commenced treatment 336 327 486 410 Dentally fit 144 147 378 336 Extractions 391 400 244 280 Fillings 781 876 788 671 Scaling and gum treatment 193 231 — — Silver nitrate dressings — — 745 686 Dentures 82 64 — — Number of attendances 1,353 1,378 1,050 976 Number of appointments not kept 311 319 203 155 * including 126 at day nurseries. 57 Table 85 Chiropody—Defects Condition Expectant and Nursing Mothers Boys Girls Total 0—5 yrs. School 0—5 yrs. School Verrucae 3 1 53 2 82 141 Corns 18 1 12 — 24 55 Callosities 1 — — — 3 4 Nail conditions 4 5 3 3 4 19 Warts 5 9 13 2 11 40 Hallux Rigidus — — 2 — 6 8 Advice — 1 — — 1 2 Bursitis 1 — 2 — 6 9 Hallux Valgus — — 6 — 27 33 Epidermophytosis — — 8 — 1 9 Claw toes — 9 4 2 9 24 Ingrowing Toenail — — — — — — Ganglion — — — — — — Totals: 1960 32 26 103 9 174 344 1959 78 32 225 30 335 700 DEANER PRINTERS LTD. (T.U.) LONDON