Ac. 439(1) WIL 57 Borough of Willesden 1961 THE 86th 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 15 Voluntary services 15 Bacteriological examinations 5 Basement bakehouses 13 Bombed sites 11 Bronchitis Morbidity and mortality 7 & 8 Cancer of the lung Morbidity and mortality 7 Prevention and diagnosis 8 Treatment 8 Census—household arrangements 9 Child guidance 22 Chiropody 23 Clean air 10 Common lodging houses 17 Convalescence 22 Coroner's court 17 Day nurseries 21 Dental service 22 Disinfestation 11 Factories 13 Food Contaminated food 12 Education in food hygiene 12 Food poisoning 7 & 12 Improvements in premises 11 Registration of premises 12 Sampling 12 Unsound food 12 Hawkers—licensing of 17 Health education 6 Health visiting 20 Home safety 23 Home help service 21 Home nursing 20 Hospitals Facilities 17 Liaison 17 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 and re-development 10 Icecream 5&12 Immunisation 21 Infant mortality 5 Infectious diseases Page Dysentery 6 Food poisoning 7 & 12 Malaria 7 Measles 7 Poliomyelitis 6 Puerperal pyrexia 7 Typhoid 7 Whooping cough 6 Laboratory service 5 Massage and special treatment establishments 5 Maternity and child welfare Ante-natal care 18 Clinics 18 Medical examination of staff 17 Midwifery service 19 Milk and dairies 13 Mortuary 16 National Assistance Act, 1948 Burials 16 Removal to hospitals 14 Noise 14 Outworkers and homeworkers 10 & 13 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 8 Scabies 5 School health service Handicapped pupils 22 Medical inspections 22 School clinics 22 Sewage and drainage 8 Slaughterhouses 17 Smallpox vaccination 21 Staff Medical examinations 17 Sanitary section 9 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 Births4 Deaths 4 Population 4 Water 8 BOROUGH OF WILLESDEN Hfalth Department, 54 Winchester Avenue, Kilburn, London, N.W.6. July, 1962. To the Mayor, Aldermen and Councillors of the Borough of Willesden. Mr. Mayor, Ladies and Gentlemen. I beg to submit the annual report of the health and circumstances of the borough for the year 1961. Public health measures were extended to protect people against the common disorders of our modern age: the ills and discomforts of old age, the mental disturbances, the respiratory diseases, and mental and physical crippling by accidents. There is no doubt that the disturbances of old age and the mental disorders form our major future public health problems. Only a strengthening and extension of the community services can help to deal with them adequately. All the hospital beds in the world and all the specialists who look after them cannot cope with these problems unaided. It is certain that the new type of hospitals that are being planned cannot deal with most old people who suffer from many illnesses, some of them minor, but disabling. Old people need a range of treatment from effective home care and day treatment to full hospital facilities. It is becoming more and more necessary to integrate the community, domiciliary and hospital services if only to obtain more effective treatment of the aged. The Council and the Willesden Old People's Welfare Committee have adopted a true pioneering spirit in their help for the aged. They are making every effort to help the aged feel that they are still wanted in the community and they are providing them with services to keep them up and about. Two senior clubs were opened during the year, the Willesden Green in August and Kensal Rise in September. Here they can find companionship and enjoy the amenities, which include billiards, television, hobbies, cheap good meals, whist drives and concerts. A survey in the borough revealed that the elderly had little or no hobbies, and few had prepared themselves for retirement by cultivating outside interests other than work; both men and women listened to the radio and read a newspaper; women, in addition, enjoyed their leisure by knitting or sewing. The senior clubs are very successful: within an hour of the Kensal Rise club opening, 110 members signed on, and the maximum of 250 were enrolled by the end of the afternoon. The old people's clinic, opened in September, 1961 concentrated mainly on providing social and welfare services. It fills a need in helping the elderly to live happy and independent lives. The friendly, leisurely atmosphere of the clinic makes them very willing to accept help on health and welfare problems. In the future people may well be prepared for retirement at an even earlier age, say 50, to help them face ageing with more confidence. Malnutrition was found to be a common disorder among the aged, because of their low incomes and their inability to do their shopping and prepare their meals. The Willesden survey showed that their diet was monotonous and stodgy, with starch making up its bulk. Their breakfast was rarely cooked, their dinner comprised one main dish—meat and vegetable, and their tea was invariably bread, butter and tea. Some of them took a high tea as the main meal, with only a meagre snack eaten at mid-day. They rarely bought fruit. A welcome relief for many of them is the opening of luncheon clubs (three more during the year, making a total of six) where they can enjoy a cheap, hot, well-cooked meal and the opportunity of meeting friends. Old people have welcomed the chance the Committee gave them of a good cheap holiday by the seaside. In particular the Council is helping the aged by building many flats and bungalows for them. With the battle against tuberculosis succeeding on all fronts, more attention has been paid to cancer of the lung and bronchitis. Over the last fifteen years, bronchitis and cancer have displaced tuberculosis as an important cause of invalidity and death. The death rate from cancer of the lung in Willesden has more than doubled in the last fifteen years; in 1961 it was eight times that from tuberculosis and ten times that from bronchitis. For every woman eight men die from lung cancer, the majority over 45 years of age when they had already smoked enough cigarettes to produce the cancer. The first essential in tackling bronchitis is to give the patient an understanding of his disorder, telling him what to do and what to avoid to prevent deterioration. The group clinic for the prevention of bronchitis entered its second year at Pound Lane Clinic. It received patients with early evidence of chest trouble, such as chronic cough or those who have been absent from work on account of chest colds, referred to the clinic by general practitioners, industrial medical officers or mass X-ray units. The patients are helped to understand the disease and are taught breathing exercises and the use of antibiotics. They are inoculated against influenza, helped to stop smoking and given an airwick bottle containing ammonia for use at home during fog. The national press published reports of the activities of this clinic, a short film for showing overseas was made, and some of the patients appeared on a B.B.C. television programme concerned with smoking. The report of the Royal College of Physicians published early in 1962 on Smoking and Health came to the conclusion that 'cigarette smoking is a cause of lung cancer and bronchitis and probably contributes to the development of coronary heart disease.' Talks have been given to school children in the early 'teens, factory workers during lunch-hour breaks, and to political, religious and social organisations on chest diseases and the evidence of this report. The Council's campaign for clean air has continued, and the No. 4 (Harlesden) Smoke Control Area was confirmed by the Council in September. We look forward to the day when the whole of Willesden will be a smokeless zone. Tuberculosis is certainly on the decline but is not yet defeated. As it is an infectious disease, special precautions have to be taken. The campaign for B.C.G. vaccination of school children is progressing well. There is also an improvement in all the wards of the borough following the more effective treatment of this disease by the new drugs and by improvements in housing and nutrition, but the rate in the worst wards is still more than three times as high as that in the best wards, which indicates that a further improvement in housing conditions, particularly in reducing overcrowding, will help in the battle against this disease. Housing has recently been accepted as an important basis for some mental illnesses. An unsatisfactory home environment, provoking constant irritations and upheavals, can easily cause a mental disturbance. Certainly some forms of neurosis accompany lack of privacy and other frustrations. Lack of sleep is a common complaint where there is overcrowding and conflict between the different activities of adults and children. There must be many children who are backward at school because of lack of sleep and because they have had few opportunities for developing their interests in the home. The social services can do much to prevent mental illnesses. As one medical officer has pointed out, most mental illnesses can he dealt with in their early stages by solving social problems or easing personal relations, or even providing more or better services like home helps. Many, particularly mothers with large families, do not require lengthy psychiatric treatment so much as specialised help in coping with the stresses of daily life. The extent of the social services provided will also determine how far the family and society will tolerate eccentrics and the mentally disturbed. The number of suicides is reaching epidemic proportions in the country, far exceeding the number of deaths from tuberculosis and almost equalling the number of deaths from motor vehicle accidents. There were fewer suicides in Willesden in 1961 than in the three previous years, but it still meant that at least one person committed suicide each month. To prevent depression among the elderly, often caused by loneliness and the increasing awareness of waning powers may provoke them to suicide.^ dfBe arrange for a visit when they suffer a bereavement involving their elderly partner. However, to take effective action against suicides we need to know more about the effects of bereavement, loneliness, poverty, decreasing vitality and impairment of physical health. Through the Willesden International Friendship Committee the Council has done sterling work in overcoming racial prejudice, now a common cause of mental disturbance. Prejudice is really, a medical problem because it usually results from a failure of mental attitudes. It has been responsible for the death of about six million people in Germany a few years ago and it was still killing people today. No child was born prejudiced; it became infected when it was aged between 3 and 6 years. Parents and teachers could adopt a positive approach so that children would grow up pleased to belong to a particular sect and race but without harmful prejudice against other people's sects, races and colour. The Friendship League has appointed a liason officer to deal with the problem of the coloured immigrants, particularly those associated with overcrowding and housing. A conference has been organised to help immigrants to understand their rights and obligations in another society. The joint social activities of coloureds and whites has been organised to bring them together for concerts, drama groups, dinner evenings and dances, so that friendship could be fostered. By integrating the coloured into the community we could also prevent promiscuity and so reduce the spread of venereal diseases. Now that infectious diseases are no longer producing the invalidism so common in the past, more attention has been paid to the results of accidents. The Willesden Home Safety Committee has done very useful work during the year to bring to the notice of the public the various dangers in the environment and in the home that can so easily lead to accidents, possibly resulting in physical and mental crippling. With the increase in the birth rate we face another crisis in the midwifery services. Although there was a slight reduction in the percentage born in institutions the actual numbers were increased by over 300. The hospitals and nursing homes outside Willesden actually delivered a few more babies than in the Central Middlesex Hospital. Overworked staff cannot give enough time to deal with the emotional problems, hopes, fears and difficulties of mothers. The mother's mental health can also be damaged if she is uncertain where she is going to be delivered. It is becoming increasingly difficult to book beds for women needing hospital confinement on social rather than on medical grounds, and there has been a marked increase in the number of requests for admissions under the Emergency Bed Service. Occasionally, because of the delay, the mother has to have the baby in unsuitable surroundings. Fortunately in Willesden no medical complications have arisen as a result of this, but it is difficult to gauge what effect the anxiety and distress has had on the mother's mind. Although there was a slight rise in the infant mortality rate, it still compares favourably with that of England and Wales. Each death is thoroughly investigated and some are undoubtedly due to poor social conditions, but until we learn more about prematurity and the causes of congenital abnormalities we shall not be able to make an appreciable reduction in the infant mortality and stillbirth rates. There was no reduction in the waiting list of the day nurseries. Indeed, during the year the number on the waiting list reached a new record height. The borough maintained its good record in having no cases of diphtheria and has started a new one with no cases of poliomyelitis. This is probably due to the increase in the number of children and adults inoculated against the disease. Many children had a fourth reinforcing dose during the year and many adults were vaccinated at their place of work. However, the largest recorded outbreak of measles in the borough took place in 1961, but although there were over 3,000 cases there was only one death. Now that measles vaccine is becoming a feasible proposition it will be interesting to note how many of these cases actually had complications, so that we could determine how far the vaccine should be used. The typhoid fever outbreak was confined to the members of one family, but despite investigations in the borough and in the Isle of Wight, where they had eaten a meal in a restaurant, it was impossible to trace the source of the infection. Last year we were worried about the increase in the number of whooping cough cases, but in 1961 there was a marked decline in the incidence. There was no outbreak of food poisoning during the year, which is probably a reflection of the general improvement in handling, preparation, storage and sale of food. In general, attempts are made to improve standards in food premises by talks, lectures and persuasion. However, some owners had to be prosecuted before they were prepared to improve their premises and methods of food handling. The public are co-operating in bringing specimens of contaminated food to the department. Most firms are officially cautioned, but a minority are prosecuted. There were no outbreaks of dysentery for the first time since 1951, and the number of cases confirmed was also the lowest since 1951 except for 1957. The improvement of housing conditions still remains a very important function of the health department. The survey of the proposed Church Road Comprehensive Redevelopment Area has now been completed together with a further survey of Carlton Ward not at present included in the South Kilburn Redevelopment Area. The Minister of Housing and Local Government has confirmed, with modifications, the Middlesex County Council scheme for the Stonebridge Proposed Redevelopment Area. Two owners were prosecuted for allowing occupation of basements where closing orders had been made, and one owner was prosecuted twice for contravening the overcrowding provisions of the Housing Act. Much work has been done informally to reduce overcrowding in houses, particularly those let for multiple occupation. The Neasden Clinic, replacing the one formally held at St. Catherine's Church Hall, was officially opened in July. Plans are already available for the replacement of the Kilburn Clinic, the oldest in the district, and of St. Martin's Church Hall. The County Valuer has also been asked to find another site for the Sneyd Road Church Hall Clinic. When this has been done all the church hall clinics in the area will be replaced by purpose-built clinics. Liaison between the general practitioners and the public health staff is further encouraged by meetings at the clinics where points of interest can be discussed over a cup of tea. Already one health visitor is attached to a doctor's infant welfare clinic, one family doctor attends the micMives' clinic, and an experiment is being carried out in attaching a home nurse to a partnership of doctors. There is an urgent need for closer working together of the family doctor and public health staff. Once again, this has been a most interesting year for public health in Willesden, and my sincere thanks go to councillors, members of the staff and public health inspectors who have played such an important part in the health and welfare of the people of the borough. I have the honour to be, Your obedient servant, S. LEFF, Medical Officer of Health. 4 STATISTICS AND SOCIAL CONDITIONS OF AREA Population estimated, 1961 (30th June) 170,030 Population census, 1961 170,835 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) 44,295 Rateable value (1st April, 1961) £3,195,359 General rate in the pound for the year 1961/62 20s. 8d. Product of a penny rate (estimated) £13,000 VITAL STATISTICS Registered live births: Male Female Total Legitimate 1,769 1,567 3,336 Birth rate per 1,000 estimated resident population Illegitimate 299 308 607 Crude 23.2 Total 2,068 1,875 3,943 Adjusted 21.8 Registered stillbirths: 27 47 74 Rate per 1.000 (live and still) births 18.4 Deaths: 955 877 1.832 Death rate per 1,000 estimated resident population Crude 10.8 Adjusted 11.8 Death rate of infants under one year of age: All infants per 1,000 live births 17.2 Legitimate infants per 1,000 legitimate live births 18.3 Illegitimate infants per 1.000 illegitimate live births 11.5 Death rate of infants under four weeks of age: All infants per 1,000 live births 12.4 Legitimate infants per 1.000 legitimate live births 12.6 Illegitimate infants per 1.000 illegitimate live births 11.5 Maternal mortality: Deaths from puerperal causes— Puerperal sepsis Nil Other puerperal causes Other maternal causes 3 Maternal mortality rate .75 per 1,000 live and still births Deaths from: Males Females Total Cancer (all ages) 220 178 398 Measles (all ages) 1 — 1 Whooping cough (all ages) — — — Diarrhoea (under 2 years of age) — — — 5 Births There was an increase in the birth rate for 1961, and it is now above that of England and Wales. Deaths There was a slight increase in the death rate for 1961, 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 In 1961, 68 children died in the first year of life (41 in the first week and another 8 in the first month). There was a slight rise in the infant mortality rate, as compared with last year's record low figure, but both the infant mortality rate (17) and the stillbirth rate (18) were below those for England and Wales (21, and 19 respectively). (Table 2) (a) By wards (Table 3) The infant deaths were more evenly distributed through the wards than was the case a few years ago. Brentwater kept its place as the best ward; the rates in the worst wards were all reduced. Housing conditions are improving through the building of many houses and flats by the local authority. However, the old houses which were adequate for one family become overcrowded when let for multiple occupancy. (b) By social class (Table 4) A greater number (57) of deaths occurred in the three lower social classes compared with only 3 in the two upper classes. (c) Causes of death (Tables 5, 6, 7 and 8) Prematurity accounted for almost one-half of the infant deaths. Congenital malformations accounted for thirteen of the deaths but no specific cause was indicated in any case. All the six deaths from birth injuries occurred in the neonatal period. The babies whose birth weights are recorded had reached a satisfactory maturity and their mothers had good antenatal care. Obstetric difficulties are diagnosable and present a field where some saving of life might yet be effected. There is a possibility that the eight deaths from pneumonia developing from an upper respiratory tract infection in children of more than one month might have been prevented. A baby of eleven weeks who died after the inhalation of food might also have been saved. Other causes include one case of blood incompatibility which was treated by three exchange transfusions but without effect. General. No specific physical cause amongst the mothers can be said to contribute to the infant deaths. Poor social conditions certainly seem to play a part, for example where a mother aged 20 years was having her fourth illegitimate child, where a girl of 16 years who had just left grammar school had a premature baby, and where the father deserted the mother during pregnancy. These are examples of cases in which improvement in social education and responsibility might help to save infant lives. 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. Eight of the unsatisfactory samples of water came from the Granville Road Baths. It was not possible to give a reason for these results as there was no breakdown or temporary difficulties with the plant, but the amount of chlorine was increased and the plant kept working overnight. Subsequent samples were satisfactory. The other two unsatisfactory samples came from the Paddling Pool at the King Edward VII Park These were probably due to children contaminating the water by running on the grass verges, surrounds and sandpit adjoining the pool. The three unsatisfactory samples of milk were bottled outside the borough and the local authorities in whose areas the bottlers were situated were informed. No reason could be given for the unsatisfactory results and subsequent samples proved to be satisfactory. Uncleanliness and scabies (Table 10) As compared with 1960, there has been an increase in the number of adults and children treated for scabies, lice and nits. However, the numbers treated are still small, and there is no evidence of an increase in the prevalence of these conditions among the population. Establishments for Massage and Special Treatment The registration of establishments for massage and special treatment is delegated to the Borough Council under Part XII of the Middlesex County Council Act, 1944. 6 During the year four new licences were issued and 21 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, the Chief Public Health Inspector and his staff and the Public Relations Officer 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. 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 many occasions over a period of five 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 arranged for 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 deaths from various diseases for 1960 and 1961 is shown in Table 13. Whooping cough The incidence of whooping cough decreased in 1961 compared with the previous year; the case rate per 1,000 population (.54) was only a little above that of England and Wales (.53) (Table 14). The number of confirmed cases was less than recorded during any of the fourteen years 1948—1961 with one exception. Dysentery There were no outbreaks of the disease for the first time since 1951. Only 25 individual cases were confirmed and this is the lowest figure since 1951 except for 1957 when there were 13 confirmed cases. Poliomyelitis There were no notified cases of poliomyelitis. This was the best year since 1951, when there were 5 notified cases but none confirmed. 7 Food poisoning There were no outbreaks of food poisoning (see page 12). Measles At the beginning of December, 1960, the largest outbreak of measles for many years commenced in Willesden and continued until the end of June, 1961. 3,468 cases were notified during this period, of which 3,463 were confirmed. There was one death in a boy of 11 years with broncho-pneumonia as a complication. Malaria Two cases of malaria in the same family were notified and confirmed, but in each case the disease was contracted while the patient was abroad. Typhoid fever There was an outbreak of typhoid fever confined to the members of one family. The first patient, a child of 9£ years, was admitted to Paddington Hospital and three days later transferred to Neasden Hospital. The mother and a sister aged 4\ years, were admitted to Neasden Hospital on the same day. Another sister aged 8J years, the father, and a brother aged 6 years were also admitted five days later. An examination of specimens of faeces and blood revealed that the four females in the family were suffering from typhoid, but the two males were found to have no signs of disease. A week before the onset of the illness, the family visited the Isle of Wight and had a meal in a restaurant. Specimens were submitted by the staff of this restaurant but they proved to be negative. Other enquiries were made but it was not possible to trace the source of the infection. 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 decrease in the number of cases in 1961. BRONCHITIS, CANCER OF THE LUNG AND TUBERCULOSIS (Tables 15-24) Today serious respiratory diseases should be considered together, because of their common causes ; lungs already damaged may have a lowered resistance to infection or cancer. The major common cause is smoke from cigarettes and to a lesser degree, dirty air, dust and fumes. Over the last few years much evidence of this has been produced for bronchitis, tuberculosis, and particularly for cancer of the lung. The report of the Royal College of Physicians published early in 1962 on 'Smoking and Health' summarised all the evidence available, discussed its interpretation and came to the conclusion that "cigarette smoking is a cause of lung cancer and bronchitis, and probably contributes to the development of coronary heart disease and various other less common diseases. It delays healing of gastric and duodenal ulcers". The report also stated that "smoking may possibly contribute to the development of pulmonary tuberculosis, especially in the middle-aged and elderly". A separate report will be published by the College dealing with the important effects of atmospheric pollution on health. Over the last fifteen years, bronchitis and cancer have displaced tuberculosis as an important cause of invalidity and death. In Willesden, the death rate from cancer of the lung in 1961 was eight times that from tuberculosis and from bronchitis, ten times (Tables 16, 17, 18). The attacks on tuberculosis have been successful because of the wide use of effective drugs. Cancer, however, presents a different picture because smoking is still widespread, and treatment, except in the early stages of the disease, is rarely successful. 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; school children, factory workers and members of social, religious and political organisations 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 eight deaths from pulmonary tuberculosis among men and five deaths among women with the now usual shift to the older age groups. There has been a substantial fall in notifications of tuberculosis (Table 15) compared with last year and for the first time since 1951 the total number of cases on the register was below 2,000. However, there is no cause for complacency; tuberculosis has not yet been defeated. 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 17). The most startling and tragic figures of all are found for deaths from cancer of the lung (Table 18). The death rate has more than doubled in the last fifteen years, and there is a more marked sex difference; for every woman, eight men died from lung cancer. Ninety-eight per cent, of these cancers occurred in men over 45 years of age when they had already smoked enough cigarettes to produce the cancer. 8 Prevention and diagnosis To prevent chest diseases 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, ft is hoped that the establishment of smoke control areas under the Clean Air Act (see page 10) 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 were also used to explain clearly the relationship between smoking and respiratory diseases. By these measures it is hoped to prevent young people smoking before the habit becomes difficult to break. Talks have also been given to factory workers during lunch-hour breaks and to political, religious and social organisations. It is hoped that these talks will encourage adults to give up smoking. 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 reports of doctors at the Chest Clinic, mass X-ray units, the public health department and general practitioners ensure that many suspected cases are X-rayed early. For the second winter, the Group clinic for the prevention of bronchitis has been organised one evening a week at Pound Lane Clinic. The clinic has been run by Dr. C. H. Wood from the Department of Occupational Health, London School of Hygiene and Tropical Medicine, working with a research grant from the North-West Metropolitan Regional Hospital Board. In the winter of 1962, the clinic will be run by the Willesden Chest Clinic. Patients with early evidence of chest trouble such as chronic cough, or who have been absent from work on account of chest colds, are referred to the clinic by general practitioners, industrial medical officers at their place of work, or mass X-ray units. They attend for two hours a week for four to six weeks, and are helped to understand the disease by talks, films, records, individual and group discussions. They are taught breathing exercises, and the use of antibiotics, innoculated against influenza, helped to stop smoking and given an 'Airwick' bottle containing ammonia for use at home during fog. During the winter, the Medical Superintendent of the Central Middlesex Hospital, the Consultant Physician in Cardiology and General Medicine, the Medical Officer of Health of Salford. the Medical Director of Clare Hall Hospital, the Chest Physician and the Medical Officer of Health have taken part in discussions at the clinic. The national press published reports of the activities, a short film for showing overseas was made, and some of the patients appeared on a BBC. television programme concerned with smoking. 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: nearly 50% of the deaths occurred in elderly men and women previously unknown to the health authorities (Table 24). 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 theirresistance 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 (98%) were vaccinated (Table 23). The proportion of younger children reacting to the tuberculin test remained about the same (Table 22) but over the years there has been a marked decline 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 Three factories were visited by the Medical Officer of Health and thirty-four 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 old healed tuberculosis was found but no further action was necessary. 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. 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 examination of the water are carried out by the: Metropolitan Water Board and 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. 9 The arrangements for sewage disposal are adequate and also those for sewerage with minor exceptions due to local flooding. Remedial works are under consideration. Refuse disposal The Borough Engineer's Department deals with the provisions 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 Country (see report for 1956). (a) Shared dwellings and overcrowding About six out of ten households in Willesden share a dwelling. This is higher than the average for the county and for Greater London (about three out of ten) and much higher than England and Wales (less than two out of ten). The number of persons per room is higher than that of Greater London, England and Wales, and any district in the county, and the percentage of population and of households at densities over 1½ and 2 persons per room is the highest in the county, in some instances the percentage is more than double. (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 that 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 6½ 403 samples were taken, 8 of which were unsatisfactory (see Public Health Laboratory Service, page 5). Swimming bath Samples taken Satisfactory Unsatisfactory Granville Road 241 233 8 Gladstone Park 83 83 — King Edward's Park 79 79 — 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. Twelve of the posts of district Inspector are graded APT. IV; the holders must have had at least ten years' experience and the Smoke Inspectors' Certificate in addition to the statutory qualification and the Meat and Other Foods Certificate. The remaining posts are graded APT. II for those with only the statutory qualification, and APT. Ill for those who have the Meat and Other Foods Certificate as well. At the beginning of the year there was one vacancy on APT. II or III, and during the year two Inspectors on APT. Ill and one on APT. IV resigned. The vacancy on APT. IV was quickly filled but it was only possible to fill one of the other three vacancies. 10 Four pupil public health inspectors were on the staff at the beginning of the year. One resigned during the year leaving two vacancies. The Rodent Officer and four operatives are employed in the destruction of rats and mice, and two labourers on vermin disinfestation. drain testing and general duties. SANITARY INSPECTION OF THE AREA The majority of houses inspected during the year followed complaints from tenants; there was no systematic house-to-house inspection. Unfortunately many tenants approach the Public Health Department only when the defects are serious and costly to remedy. Demolition and Closing Orders (Table 25) One demolition order and eight closing ord ers were made during the year. The owners of two houses were prosecuted during the year for allowing occupation of basements where closing orders had been made. One was fined £20 with £10 10s. costs, and the other £5 with £3 3s. Od. costs. Slum Clearance and Area Redevelopment During the year three houses in Stonebridge Park were represented as a 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 continued. A survey was commenced of the remainder of Carlton Ward not at present included in the South Kilburn Redevelopment Area. The Minister of Housing and Local Government confirmed, with modifications, the Middlesex County Council scheme of the Stonebridge Proposed Redevelopment Area comprising 1,291 houses, which had formed the subject of a public inquiry on 8th June, 1960. Overcrowding There has been little change in the extent of overcrowding which still remains acute. Very few licences under section 80 of the Housing Act, 1957, were issued to permit temporary overcrowding (Table 26). 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 26), and also details of new dwellings constructed during the year (Table 27). A house owner was prosecuted twice for contravening the overcrowding provisions of the Act. He was fined £5 with £5 5s. Od. costs on the first occasion for permitting overcrowding, and subseqeuntly £20 with £3 3s. Od. for allowing the overcrowding to continue. Notices served under the Public Health Acts, 1936 and 1961, and Housing Acts, 1957 There was a slight decrease in the number of statutory notices served during the year compared with 1960 (Table 28). Details of the inspections carried out during the year are shown in Tables 29 and 30. Four inspectors were engaged on special surveys—one 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 31. Nuisances abated and improvements made A summary of nuisances abated and improvements made is shown in Table 32. Inspection of factories, outworkers' premises and food premises A summary of inspections of the above premises is shown in Table 30. 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. Steady progress continues to be made in the establishment of such areas. The No. 3 (Church End/Roundwood) Smoke Control Area, covering 380 acres, with 5,057 dwellings. 378 commercial, 52 industrial and 20 other premises, was confirmed by the Minister of Housing and Local Government in April and came into operation on 1st November, 1961. The Orders now in operation are as follows:— Area No. Date of operation Acreage No. of dwellings No. of other premises 1 1. 6.59 48-5 627 73 2 1.10.60 271.0 2,351 143 3 1.11.61 380.0 5,057 450 Total 699.5 8,035 666 11 The No. 4 (Harlesden) Smoke Control Area covering 210-8 acres with 3,959 dwellings, 399 commercial, 18 industrial and 20 other premises was confirmed by the Council in September and was submitted to the Minister of Housing and Local Government. One of the industrial premises burns coal, and the Council decided that it should not be granted exemption from the Order. The proposed date of operation is 1st October, 1962. Fifty-eight notifications of the installation of new boiler plant were received in accordance with the provisions of section 3 of the Clean Air Act. In accordance with the policy of the Department of Scientific and Industrial Research the use of deposit gauges and lead peroxide candles on six sites in the borough was discontinued at the end of March. Apparatus for the volumetric analysis of sulphur dioxide in the air was installed at the Willesden County School, and is operated by science students and masters. The results, together with those obtained from similar apparatus in the Public Health Department, are sent to the appropriate section of the Department of Scientific and Industrial Research each month. The Council is represented on an Inter-borough Smoke Control Liaison Committee, which includes delegates form Hammersmith, Fulham, Brentford and Chiswick. Acton. Barnes and Richmond Councils, and meets 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. DISINFESTATION The Public Health Inspectors inspect verminous premises and supervise the work of disinfestors employed by the Council (section 93 of the Public Health Act, 1936) (Table 33). 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 233 Borough Council properties 11 Private dwellings 820 Total 1,064 at the following cost: Business premises £1,704 6 9d. Private dwellings £2,203 13 9d. Total £3,908 0 6d. The cost of disinfestation at business premises is recovered from the occupiers; 122 had an annual agreement with the Council for regular inspection and disinfestation, 7 were new agreements and 115 renewals. The service is free to occupiers of private dwellings. Rodent control in the Council's sewers is carried out by the Borough Engineer's Department. Where surface rat infestation is due to faults in the connections of the house drains with the sewer, the Borough Engineer's Department arranges for opening the pavement. INSPECTION AND SUPERVISION OF FOOD AND FOOD PREMISES The food premises in the borough are inspected regularly by the Public Health Inspectors (Table 34). The Food Hygiene (General) Regulations, 1960, which came into operation on the 1st October of that year 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 since the first regulations (The Food Hygiene Regulations, 1955) came into force on 1st January, 1955. Public Health Inspectors visit food premises frequently and serve verbal or written notice to improve the standards of food hygiene. Improvements in some premises are still either in progress or arrangements are being made for them to be carried out (Tables 35, 36). 12 Four cafe proprietors were prosecuted for contraventions of the Food Hygiene Regulations, with the following results:— (a) 5 contraventions—convicted on 3 with a total fine of £15 with £5 5s. Od. costs; granted an absolute charge on 1, and 1 dismissed; (b) 11 contraventions—convicted on 10 with a total fine of £36 with £2 2s. Od. costs, and 1 dismissed; (c) 7 contraventions—convicted on 6 with a total fine of £24 with £2 2s. Od. costs, 1 dismissed; (d) 6 contraventions—convicted on 5 with a total fine of £15 with £5 5s. Od. costs, and granted a conditional discharge on 1. 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 37). Premises where ice-cream is manufactured are kept under constant supervision. Most of the icecream sold in the borough is manufactured outside the district, and is usually pre-packed. The ice-cream reaches a high standard of purity (Table 9). Education in food hygiene Lectures and talks illustrated with film shows, filmstrips and bacteriological cultures were given to social and political organisations and school leavers. Food poisoning It is pleasing to report that there was no outbreak of food poisoning in the borough. This is probably a reflection of the general improvement in handling, preparation, storage and sale of food. Food unfit for human consumption Nearly 1| tons, 2,355 tins and 1,335 packets of food inspected by the Public Health Inspectors were found to be unfit for human consumption (Table 38). All the food was dealt with as trade refuse by the Borough Engineer's Department and deposited on the controlled refuse tip. Two butchers were prosecuted for offences under section 8 of the Food and Drugs Act, 1955, with the following results:— (a) fined £5 0s. Od. with £5 5s. Od. costs for having in his possession for the purpose of sale 13 chickens and 1 duck unfit for human consumption; (b) fined £10 0s. Od. with £5 5s. Od. costs for selling liver unfit for human consumption. Contaminated food 17 specimens of contaminated food were dealt with by the department. They included foreign matter in a bottle of milk, in a steak and kidney pie and in loaves of bread; mouldy growth in cakes, and in a steak and kidney pie; a bottle of beer with an offensive smell; beetles in a tin of strawberries and a loaf of bread; a drinking straw in a carton of soft drink; and larvae in a packet of puff pastry mix. No action was taken in five of them because of insufficient evidence; of the remaining 12, 9 firms were cautioned and the Council decided to prosecute the other 3. The results of the prosecutions were as follows: — 1. Fined £5 0s. Od. with £8 8s. Od. costs for selling a steak and kidney pie containing mould ; 2. Fined £20 0s. Od. with £5 5s. Od. costs for selling a loaf of bread containing a beetle ; 3. Fined £15 0s. Od. with £5 5s. Od. costs for selling cakes containing mould. Clean Food Sampling The Middlesex County Council is responsible for taking samples and for supervising the control of food adulteration (Table 39). The Chief Officer of the Public Control Department has kindly supplied the following information. Of the four firms concerned in the nine samples found to be unsatisfactory, 3 were prosecuted and 1 was officially cautioned. A cafe proprietor was prosecuted and fined £10 with £8 10s. Od. costs for selling 3 samples of hot milk containing 11.8% of added water; a butcher was fined £15 with £5 7s. Od. costs in respect of 3 samples of minced beef containing sulphur dioxide, a preservative which is not permitted in meat; and a manufacturing baker was fined £15 with £5 5s. Od. costs for supplying a loaf of bread containing a rusty nail head. An official caution was issued to a firm of sausage manufacturers because they failed to supply labels declaring the presence of preservative in sausages, although the quantity of preservative was within the limits prescribed by the Public Health (Preservatives, etc. in Food) Regulations, 1925. Merchandise Marks Acts, 1887-1933 646 displays of articles of food were examined under the Merchandise Marks Acts, 1887-1953. Minor infringements were dealt with by verbal warnings, but official cautions were given to 2 greengrocers who described Seville oranges as 'Jaffa', and South African and Israeli grapefruit as 'Jaffa'. Labelling of Food Order, 1953 935 articles of pre-packed food were examined under the Labelling of Food Order. A caution was sent to the manufacturers of pickled cucumber where the label indicated the use of preservative but not its nature; and to the packers of lamb chops where the label did not give a sufficient address. 13 Labelling and Advertising Infringements The Public Control Department also carried out a considerable amount of work in the County, which indirectly protected the residents of Willesden, by challenging labelling and advertising claims made in respect of nationally retailed articles of food. Several manufacturers of instant coffee were required to designate the ingredients on the labels. The manufacturers of 'non-alcoholic wine' amended the label on his product to 'non-alcoholic beverage'. An importer corrected claims in his advertising literature on the 'vitamin concentration' of a slimming food. A manufacturer who claimed 'slimming properties' for a reducing product subsequently withdrew it. A manufacturer who made slimming claims for lemon juice modified a television advertisement. A manufacturer made modifications to the labels of several brands of canned chicken where they did not indicate that the contents were chicken in jelly or broth. As a result of a complaint, the manufacturer of a soft drink modified the ingredients to prevent phenolic contamination arising from chemical reaction between chlorinated water and the phenol formaldehyde stopper. Milk and Dairies Regulations—Issue of Licences The Milk (Special Designation) Regulations, 1960, which transferred the issue of dealers licences from the borough council to the Middlesex County Council as from the 1st January, 1961, extended the period for which these licences are granted from one year to five years. 141 licences were issued to distributors of pasteurised, tuberculin tested and sterilised milk during the year. Ill samples of milk were obtained to ensure that heat treatment and storage were properly carried out; all were satisfactory. The County Council continue to licence the three premises within the borough where milk is processed. 88 inspections of premises were made to ensure compliance with the Regulations. Milk and Dairies Regulations—Other Provisions 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 food and drugs authority for the area, the Middlesex County Council. 104 persons are registered by the Council to trade as distributors and three premises are registered as dairies. Illirty-seven inspections were made of the three dairies; the seven defects found were quickly remedied. 228 samples of milk were submitted for bacteriological examination (see Table 9). Three dirty milk bottles were reported by the public and one by another local authority. The Council issued official cautions in respect of 3 and referred the fourth to the local authority in whose district the milk was bottled. FACTORY INSPECTION There was a slight increase in the total number of factories in the borough compared with the previous year (Table 40). 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 40, 41. 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, 1947, 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 one bakehouse has now been demolished and another is no longer used. 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. 256 were employed during the year, the largest number, 168, altering and making clothing. Public health inspectors inspect these workers' homes and notices were served in respect of two found to be unsatisfactory (Table 42). 14 Noise nuisance The Borough Council deal with noise nuisances under the Noise Abatement Act, 1960, which repealed 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. Public health inspectors carried out observations at all times of the day and night to determine whether complaints of noise nuisances were justified or not. 29 complaints were received during the year, of which 14 did not constitute a nuisance within the meaning of the Act. Ten were repeated complaints and five were found to be nuisances. These were the subject of informal action and after consultation with the firms concerned the nuisances were abated. The noises objected to by complainants were wide and varied and included those from boiler chimneys, lorry engines, factory processes, panel-beating, steam-crane, power-sewing machines in domestic dwellings, unloading of milk churns and crates, inconsiderate neighbours and loud-speakers. CARE OF THE AGED As the proportion of old people in the community increases it becomes more urgent and necessary to extend our medical and welfare services to care adequately for them. Most old people are living alone but they can manage to look after themselves in spite of their deficiencies in money, suitable living accommodation and general amenities. Some require help to keep them comfortable and happy in their own homes, while a small minority cannot be adequately cared for except in a hospital or old people's home. The local health authority provides home nurses, home helps, and health visitors, who investigate the needs of the old people and arrange for the necessary services to be given. An experimental old people's clinic was opened at Pound Lane in February, 1961 and moved to Neasden Clinic in June, 1961, when it was held at the same time as a chiropody clinic. This clinic was established to give advice to old people on problems of physical and mental health. 47 sessions were held during the year; 76 old people were seen, making 175 attendances. The majority are referred by health visitors or the Old People's Welfare Organiser. Advice is mainly given on social matters and a report is sent to the family doctor. Defects including arthritis, bronchitis, varicose veins, hernia, obesity and unsuitable false teeth or glasses are usually referred to the family doctor for treatment. Good relationships have been maintained with family doctors who referred 2 old people for the advice of a geriatrician. Old people who fail to keep an appointment are visited to see if there has been any deterioration in their condition. Occupational therapy has also been arranged for 3 old people at home and 5 appliances have been provided for the handicapped. 7 old people have been referred to the National Assistance Board for special allowances and free transport to and from the clinic was arranged for 17. Advice is given on diet and where necessary a Luncheon Club or 'Meals-on-Wheels' are arranged. Malnutrition is a serious problem and 20 persons could have benefited from the supply of protein concentrates and vitamin supplements, free or at reduced prices. Unsuitable accommodation is a common cause of complaint. 30 old people were suffering from emotional difficulties and were referred to clubs and other organisations. The Old People's Clinic fills a need in helping the elderly to live happy and independent lives. The friendly, leisurely atmosphere of the clinic makes them very willing to accept help on health and welfare problems. Generally speaking, it is now easier to obtain admission for an aged patient, and the Geriartric 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. Two cases were removed under the National Assistance Acts, 1948 and 1951. Miss E.B., aged 77 years, was bed-ridden, doubly incontinent and suffering from chronic arthritis, myocarditis, general atrophic condition of the muscles and bed sores. She was being looked after by her sister, Miss R.B., who was feeble minded and deaf. They occupied three dingy rooms. The condition of both sisters had been slowly deteriorating and finally Miss R.B. was unable to give adequate care to her sister who was sometimes left lying in a soiled bed without food and drink. Because Miss R.B. frequently refused to open the door, the home help and home nurse were unable to make regular visits, and the soiled bed linen could not be collected regularly. An order under the National Assistance (Amendment) Act, 1951, was obtained from a Justice of the Peace on the 30th October, and Miss E.B. was removed to the Central Middlesex Hospital the same day. At the same time her sister was removed to Shenley Hospital by the Duly Authorised Officer. Mrs. J.Y., aged 80 years, was bed-ridden and suffering from chronic polyarthritis and senility. She lived alone in one room of a very large house. Her only visitor was a home help who visited for two hours daily and prepared sandwiches and a hot drink. Her condition had been slowly deteriorating and she refused to have medical attention, meals-on-wheels and other services. Her clothing and bedding were filthy and she refused to have them changed. An order under the National Assistance (Amendment) Act, 1951 was obtained from a Justice of the Peace on the 6th November and she was removed to the Central Middlesex Hospital the next day. 15 Laundry for the Aged The care of incontinent old people places a heavy burden on their relatives. The washing of soiled bed linen and night clothes, particularly in cramped accommodation in winter, with inadequate facilities for drying, adds another intolerable strain on relatives which finally convinces them that the only place where the old people can receive reasonable care is in an institution. One way of postponing this unpopular event is to do their laundry. In April, 1952, the Council organised a laundry service for incontinent old people free of charge under section 84 of the Public Health Act, 1936. The articles are laundered and ironed at a cost of 4Jd. per lb. at the Neasden Hospital by arrangement with the Central Middlesex Group Hospital Management Committee, and transport is provided by the Borough Council. 6 tons 15^ cwt. of laundry was dealt with. The service has continued to be greatly appreciated by old people and their relatives. No. of old people using the laundry service On register 1.1.61 New cases Died Admitted to hospital Recommenced after discharge from hospital Discontinued On register 31.12.61 50 36 29 17 5 11 34 Voluntary Services for the Aged The '49' Club organised by the Willesden Old Folks' Association celebrated its ninth anniversary in February. The Club still has a substantial membership and is open daily from 1.30—10.0 p.m. Severa' firms gave donations to the Association's funds. 150 members and helpers went for a day trip to Folkestone in July. Voluntary visitors visited 20 old people weekly or fortnightly. Lonely housebound old people greatly appreciate the services, which include shopping, reading, general conversation and tidying the room. The usual distribution to the housebound of Christmas dinners and 5/- food parcels was taken over by the Willesden Old People's Welfare Committee. 46 parcels of imperishable foods were made up and distributed to the housebound by Middlesex County Council nurses from 230 articles of food given by the children of Malorees School after Harvest Thanksgiving. Two hand-knitted woollen shawls were given to two housebound old ladies. A very successful Christmas Party was held at Anson Hall. Cricklewood; 240 people attended and were given high tea, entertainment and 2/-. 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. Treatment will be carried out at the clinics when the County Council appoint their own chiropodists. The service is still in great demand. 2,950 treatments were given by the four chiropodists in Kilburn, Harlesden, Kensal Rise and Willesden Green areas. New applications receive initial treatment and are then placed on the register for periodic visits. In addition 240 treatments were given to the housebound. 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 a married couple. 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 £1,204 in the financial year ending 31st March. 1962. A grant of £1,125 is expected from the Middlesex County Council. On the recommendation of health visitors, free coal was supplied to old people who could not afford it. The branch club which met at St. Martin's Church Hall, was closed at the end of August when the Willesden Old People's Welfare Committee opened the Kensal Rise Senior Club. 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 Women's Voluntary Services is probably the most important service for old people. The Willesden Old People's Welfare Committee took over the cooking of meals from the W.V.S. on the 21st November, 1961, when the Kensal Rise Senior Club, with its spacious and well-equipped kitchen, was opened. 11,346 meals were prepared and delivered compared with 10,793 in 1960. 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. 72 frozen dinners were delivered at Christmas, 21 by Middlesex County Council nurses. In the summer a coach party of housebound were taken for a day's outing to Potters Bar. They were entertained by local school children, tea was provided by the local branch of the Women's Institute, and they were all given flowers, eggs and cakes to take home. 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. 16 The building of two centres was completed during the year. The Willesden Green Senior Club was opened to old people in August. It was formerly a health clinic and the extensive adaptations, planned and carried out by the Council, cost some £8,000. The Kensal Rise Senior Club was opened in September. The building was designed by the Council and built by private contractors. It cost the Council £18,000. The Clubs are open every day, except Sunday, from 10 a.m. to 9 p.m. The 300 members of each club pay 1/a year and the amenities include rooms for billiards, television, hobbies, reading and spacious main club rooms for meals, whist drives and concerts. Light refreshments are available at certain hours during the day. The legal ownership of the building remains with the Council, the management is in the hands of the Old People's Welfare Committee. One of the important services which the Committee organise 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. 351 old people had holidays from June to September. A holiday for several 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 more luncheon clubs, which open on Tuesday and Thursday, were started during the year: at Harlesden Congregational Church, Church Road, N.W. 10 in January ; Neasden Methodist Church, Neasden Lane, N.W.10 in May; and the new Willesden Green Senior Club, High Road, N.W.10 in August. There are now six clubs operating and it is proposed to open two more in 1962. When the Kensal Rise Senior Club, Mortimer Road, was opened in September, the club at St. Martin's Church Hall, Mortimer Road, was transferred to the new premises. 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 clubs in insulated containers. The meal, including sweet, costs the old people Is. 3d. and a total of 22,496 were served during the year. The old people enjoy a good, hot, well-cooked meal and the opportunity of meeting friends. With the opening of the Kensal Rise Senior Club with its spacious and well-equipped kitchen it was possible for the committee to take over from the W.V.S. the cooking of meals for the meals-on-wheels service on 21st November. The W.V.S. still arrange the distribution. 1,438 meals were prepared to the end of the year. For those who can get out there are many clubs where they can find companionship. To assist some of these clubs and attract more members the Committee arranged for professional entertainers to visit fourteen of them one afternoon each month during the winter. This service is greatly appreciated by the members, and supplements the summer entertainment in the parks. After Harvest Thanksgiving, gifts of food were received from a few schools and churches, in particular from the Wykeham Junior School. Perishable items were distributed immediately, but a quantity of dry goods were kept back and were distributed from time to time when help was needed quickly. At Christmas nearly 1,500 food parcels or vouchers were distributed to the over 70's who were in need The Committee spent £750 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 1960 1961 Office interviews 715 1,139 1,724 Home visits 826 1,043 1,395 In addition, 491 visits were paid to elderly persons where on the basis of the Registrar's returns they had suffered the loss of a partner. On the recommendation of the Welfare Organiser 36 wireless sets were supplied to the bed-ridden by the Wireless for the bed-ridden Society. The Shenley Group Hospital Management Committee made a gift of eighteen television sets which were overhauled and repaired and distributed to the housebound. The Welfare Organiser acts as a referee to various charitable organisations and distributes monetary payments on their behalf. All the above services are financed from a grant of £8,605 which the Council set aside for the Committee's use in 1961/62. 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 twelve persons during the year, at a cost of £138 15s. 0d., £70 15s. Od. being recovered from the relatives. PUBLIC MORTUARY Post-mortems were performed on 616 bodies, followed by an inquest in 111. 71 inquests were held on Willesden residents but only 10 of these were held in the Coroner's Court attached to the mortuary. The remainder were held at Ealing. 17 Inquests held on Willesden residents AT 1951 1952 1953 1954 1955 1956 1957 1958 1959 1960 1961 Kilburn 49 25 12 13 12 10 20 17 24 16 10 Ealing — 26 21 37 24 62 40 61 38 53 61 Total 49 51 33 50 36 72 60 78 62 69 71 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). 16 licences have been issued to hawkers (14 selling fruit and vegetables, 2 selling fish). There were four new licences issued in 1961. 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 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. 1951 and Regulations, 1961, 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 no new registrations during the year and the number of registered premises remains at 15. The Act does not cover the re-making of an article, and dirty materials may be used in upholstering articles being repaired. Six samples of filling materials were taken during the year. Five were satisfactory and one was unsatisfactory with a dust index figure of 2.4 as compared with the permitted maximum of 1.8 laid down in the Regulations. The firm concerned was cautioned. PET ANIMALS ACT, 1951 The owners of pet shops must obtain an annual licence costing 10/-. The shops are inspected by both Public Health Inspectors and Shops Act Inspectors; Public Health Inspectors inspect premises for size, lighting, ventilation and cleanliness, and for the precautions taken for preventing spread of infectious diseases. During 1961, 16 pet shops were licensed. STAFF MEDICAL EXAMINATIONS 54 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 Paediatric Out-Patients Department at the Central Middlesex Hospital and the local health authority continued. This scheme has been working very satisfactory and has brought the work of the two departments more closely together. 18 Personal Health Service 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 1961 60% of all expectant mothers attended the local ante-natal clinics staffed by assistant medical officers (Table 43). 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. The maternity record card based on the Chase Farm one is also being used for those mothers who attend at both the Paddington or Kingsbury Maternity Hospital and at the Willesden clinics. Health visitors make the initial arrangements for hospital and domicilary cofinements at the local clinics (Table 44). 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 midwives. Mothers are encouraged to ask questions and interesting discussions follow over a cup of tea (Table 45). Short talks are also given at one of the sub-clinics during the ante-natal sessions. 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; and Neasden clinic; a health visitor conducts the classes at Kilburn clinic on one morning (Table 46). 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 taks 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; due to Neasden clinic being opened during the year, four are main clinics and three are subsidiary ones. Two of the subsidiary clinics are held in church halls and one in a converted house. Assistant medical officers and health visitors give advice on the feeding, hygiene and general management of infants and young children. The doctors give advice and immunise children against diphtheria, whooping cough and tetanus and subsequently against poliomyelitis. Compared with the previous year the proportion of children vaccinated against smallpox (Table 57) and the number immunised against diphtheria (Table 58) was maintained. 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. 122 sessions were held and 592 attendances were made. The Stonebridge Clinic Mothers' Club formed seven years ago has become firmly established with a membership of 50. The mothers meet once a week and run the club and committee themselves with the help of the nursing staff; an average attendance at meetings is 35. The club is self-supporting and its assets amount to about £25. A number of old members have left and acquired new homes out of Willesden; these mothers have been replaced by other mothers living in the Stonebridge area. Medical officers, health visitors and outside speakers have given lectures, talks and demonstrations on health and homecraft, many illustrated with films. Mothers have visited places of interest including the new Birds Eye demonstration kitchen in the city and the De-La-Rue House in Regent Street, where they were entertained, shown a film on the uses of Formica in the home, and shown over the new demonstration kitchens. They have also been to theatres, to Southend to see the lights, to an evening mystery bus tour and with their children to a pantomime, and a day's outing to Maiden in Essex. A children's Christmas party and a seventh anniversary dinner were held at Stonebridge Clinic. An annual donation of £1 is sent to the Willesden Old Folks' Association. A door-todoor collection was arranged in aid of the National Society for the Prevention of Cruelty to Children and the proceeds which amounted to £20 were given to the Society's funds. Neasden Clinic Neasden Clinic was officially opened on Friday, 21st July, 1961, by County Alderman Colonel Sir Joseph Maygarth, C.B.E., J.P., Chairman of the County Council. The clinic replaces one formerly held at St. Catherine's Church Hall, Neasden which the County Council used only part-time. 19 The clinic is designed so that advice and treatment can be given to mothers, young children and school children in the neighbouring community at mother and baby sessions (ante-natal, post-natal, and child welfare) and at dental, immunisation, minor ailments, speech therapy, physiotherapy and chiropody clinics. Mothercraft classes are organised. Specialist services including ophthalmic and ear, nose and throat sessions will be added later. The clinic, which is on two floors, has its main entrance in Balnacraig Avenue. It has been designed so that, in general, expectant and nursing mothers and children under five are dealt with on the ground floor. There is a waiting hall on each floor. The general office and food sales room adjoin the main waiting hall on the ground floor. The weighing and ante-natal suite lead directly off the waiting hall. A large physiotherapy room on this floor can also be used for mothercraft classes and lectures. On the first floor is the dental suite, comprising two surgeries with a recovery room between, together with the minor ailments, chiropody and ophthalmic surgeries, a home nurses' room where they can sterilise their equipment, and an office for the health visitors. The building is centrally heated by oil-fired boilers in the basement. 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. In I960 an additional trained worker, half-time was employed and this assistance is still being given. Altogether 46 families have been referred; 26 were found to be suitable for dealing with by the Family Service Units, 17 were found to be unsuitable and 3 families refused help. Of the 26 families, 1 family has removed out of Willesden and 3 families have been referred to the care of the National Society for the Prevention of Cruelty to Children. At the end of the year the Family Service Units were dealing with 22 families. During the year 1,722 contacts with these families and 788 contacts on behalf of these families were made by the staff of the Family Service Units. 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 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 seven midwives in Willesden. During the year one midwife left making a total of six at the end of the year. There 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 48), 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 liaison between the general practitioners and the midwives is good. Several doctors attend at the midwives' ante-natal clinics to see the expectant mothers booked with them. The Maternity Record Card, based on the Enfield Chase one, is now being used by the general practitioners and the midwives. The general practitioners and the midwives also meet together at Pound Lane Clinic from time to time to discuss points of interest over a cup of tea. The assistant medical officers take blood specimens from 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 49). Midwives work very closely with general practitioners who were present in about one in four deliveries (Table 50). 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 51). 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 six mothers during the year for the following conditions: one ante-partum haemorrhage, two retained placenta with haemorrhage, one adherent placenta and two post-partum haemorrhage. 20 The Hammersmith Hospital premature baby unit provides a special ambulance for premature babies who require treatment in their unit. TTie 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. Three babies were admitted to the unit during the year. The number of visits made by midwives to mothers and babies discharged early from hospitals was 871. 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 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 52). Health visitors work in close co-operation with general practitioners (Table 53), staffs of hospitals, children's officers, welfare officers, public health inspectors and other social workers. Some patients who attend Diabetic Clinics require advice to be given in their homes on their treatment, diet and after-care. Health visitors who attend the Diabetic Clinics at the Central Middlesex Hospital and Willesden General Hospitals give this advice under the supervision of the physician-in-charge. 37 visits were made during the year to the 20 patients selected by the physician-in-charge for these health visitors. The number of health visitors increased for the Willesden part of the area (Table 54) and 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. One student who was sponsored for Willesden commenced her training in 1961 and will take her final examination in 1962. 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 week-ends and bank holidays, when the Area Health Office is closed. Home nurses carry out treatment 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 cases referred during the year, but an increase in the number of visits made (Table 55). The total number of cases nursed during the year was 2,909. Number of cases brought forward from 1960 642 Number of new cases 2,267 Total : 2,909 Number of patients recovered 1,644 Number of patients died 226 Number of patients admitted to hospital 431 Number of patients remaining on register at the end of the year 608 Total: 2,909 The 2,909 cases were nursed for the following reasons: Abscesses (including boils) 184 Amputation of leg 4 Anaemia 188 Arthritis 135 Bronchitis (including pleurisy and influenza) 472 Burns 17 21 Cancer 209 Cardiac 397 Circumcisions (10 operations at home) 21 Complication of maternity 26 Cataract 9 Diabetics 71 Disseminated Sclerosis 51 Hemiplegia 134 Jaundice 5 Leukaemia 2 Otitis Media 55 Pneumonia 49 Post Abdominal Operation 55 Senility 157 Slipped Disc 25 Tonsillitis 79 Tuberculosis 66 Uterine conditions 19 Varicose Ulcers 80 Others (including impetigo, dermatitis, cuts, shingles and supervision of Foley's Catheters) 399 Total : 2,909 SMALLPOX VACCINATION Vaccinations are done by the staff at the health clinics and by general practioners. The number of children under one year of age vaccinated, represents 45% of the total live births for the year (Table 57). IMMUNISATION All children under one year are offered protection against diphtheria, whooping cough and tetanus and private doctors and assistant medical officers of health immunise them. Children usually receive reinforcing doses just before they start school. Table 58 shows the total number of children who completed a full course of primary immunisation or who received a reinforcing injection. INOCULATION AGAINST POLIOMYELITIS In April, 1961 the Minister of Health announced that in view of the greater risk of infection to which children in school are exposed, a fourth reinforcing dose should be offered to children on entering school (normally at the age of five years),and to children already at school between the ages of five and twelve. 5,454 children were given the fourth vaccination at the clinics and by general practitioners until October, when the scheme was suspended due to shortage of Salk vaccine. At this time the Minister indicated that he was in favour of the use of an oral vaccine, details of which would be available early in the new year. Vaccination of persons in the priority groups continued ; 5,231 completed a course of two injections and 4,307 three injections, either at a clinic or by a general practitioner. Vaccination of factory employees continued. 71 factories were visited—707 employees received two injections and 2,796 had their third. HOME HELP SERVICE (Tables 59 and 60) 41 more applications were received for the service in 1961 as compared with 1960 ; 43 more cases were being helped at the end of the year. The number of cases suffering from tuberculosis receiving help dropped to a new low figure of 10. 111 bookings were originally taken for maternity cases but only 66 were helped ; the remainder preferred to make alternative arrangements. Help was provided free of charge for 3 mothers with toxaemia of pregnancy. There were 79 home helps at the end of the year; their rate of pay remained at 3/10d. per hour. The charge to the public in 1961 remained at 4/6d. per hour. The number of home visits made by the organisers was 4,321. DAY NURSERIES (Tables 61-65) All the approved places in the 8 nurseries, together with 30 places in York Park Nursery, Hendon, have been occupied throughout the year with a high general daily attendance. There is still a considerable waiting list. 22 The maximum daily charge was increased from 13s. Od. to 15s. 6d. from July 3rd. Applicants unable to pay the assessed charges can appeal at a meeting of the Appeals Sub-Committee. The nurseries have remained under-staffed because it has been difficult to recruit qualified nursery nurses. Five nurseries are approved as training schools for the N.N.E.B. Course. Nine students completed their 2 years period of training, 7 passed the examination and obtained the N.N.E.B. certificate. Three deputy matrons and 5 staff nursery nurses attended refresher courses held in January and April at Chiswick Polytechnic. 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 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.0d. must complete an economic circumstances form and they are assessed by the finance officer. They may also ask for payment of travelling expenses. Number of recommendations:— 1961 1960 Adults 106 96 Children 18 21 124 117 SCHOOL HEALTH SERVICE (Tables 66—77) Medical Inspection Routine medical inspections in schools continued and fewer children were found to be in an unsatisfactory physical condition. Hatrdicapped Pupils The Day Special School for Physically Handicapped Pupils at Lower Place still has no waiting list and pupils can be admitted immediately. The accommodation at Woodfield School, Wembley, was increased in September, 1961 from 170 to 190, with the result that no child ascertained as educationally subnormal now has to wait more than a term for a place. School Clinics The opening of Neasden Clinic in June made treatment facilities more easily accessible for children attending John Kelly, Braintcroft, Wykeham and Gladstone Park Schools. CHILD GUIDANCE (Tables 78 - 79) Once again work was hindered by staff changes. The clinic was covered by a locum psychiatrist doing five sessions per week from January to February and during March no one was in attendance. Dr. Graf, the first permanent psychiatrist for over a year, commenced duty in April and has brought about a welcome reduction of the waiting list. 115 children were referred to the clinic for investigation (16 more than 1960) and 72 attended regularly for psychotherapy. At the end of the year there were 16 cases awaiting full investigation, less than half of those remaining last year. The Educational Psychologist examined 451 children. Much of the work is concerned with backward children. The large immigrant population presents the schools with a considerable educational problem, as many of these children have low educational attainments compared with their age. There continues to be a large demand for the language class; 45 children attended during the year. The monthly visits of school medical officers continue when cases known to both teams are discussed. SCHOOL DENTAL SERVICE AND PRIORITY DENTAL SERVICE (Tables 80 and 81) During the year the pattern of dental inspection and treatment has been similar to that of the past few years but the total amount of work completed has decreased due to staff shortages. However, the staffing situation improved towards the end of the year; if it remains the same, there will be a greater volume of work and more frequent routine inspections during the coming year. More time than in previous years has been given to dental health education both in schools and to smaller groups of children and nursing and expectant mothers. 23 CHIROPODY (Table 82) There has been a great demand for chiropody treatment again this year. The geriatric clinic was opened this year and there was soon a long waiting list of patients requiring treatment. Old people require to be treated with considerable caution because the senile tissue is very fragile. Most of them also suffer from a systemic disease which has a direct effect on their feet; for example, some patients suffering from arthritis can be made comfortable by means of padding which relieves pressure on the painful areas. Apart from the usual corns and callouses, malformation of the nails is very common and can have a crippling effect on the patient. Children continue to attend in large numbers for chiropody treatment. The number of children with foot infections increased but they are quickly remedied. Conditions caused by ill-fitting footwear are the most difficult to treat, because most children are reluctant to change to more suitable shoes. A high percentage of children were not present at the shops when their shoes were bought. The necessity of having both feet fitted when shoes are purchased must be stressed. HOME SAFETY The Willesden Home Safety Committee which was formed in November, 1956, has done valuable work during the year. It is a voluntary committee which has the support of both the Willesden Borough and Middlesex County Councils. The Borough Council made a further grant of £100 to the committee's funds in the financial year 1961/62. 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 twenty-four local organisations are represented on the Committee, which is affiliated to the Royal Society for the Prevention of Accidents and the National Home Safety Committee. The Committee is also a member of the British Standards Institution and the Consumers' Association Limited. Five committee meetings and three meetings of the 'Willesden Show' Sub-committee were held during the year. The Committee participated in the National 'Water Safety' Campaign held in the summer. Posters were displayed on Council notice boards and in the public libraries and booklets and bookmarks were distributed from clinics, libraries, schools, swimming pools and from doctors' surgeries. The Committee also participated in the National 'Fire Prevention' Campaign, held in the winter. Posters were displayed on Council notice boards and in the public libraries, and leaflets were distributed at Christmas time. In addition, the Committee also played an active part during the National'Fire Prevention Week' which was held from 30th October to 5th November. Exhibitions were held in the clinics, in a large department store and in the foyers of five cinemas. In two of the cinemas a fire prevention film was shown. On 4th October, Alderman Mrs. Louise Dunbar, Mayor of Willesden and Vice-Chairman of the Committee, held a Reception at the Anson Hall for people engaged in home safety work and representatives from interested organisations. Approximately 200 guests attended. Dr. Johnson, M.P., Chairman of the Parliamentary Home Safety Committee, gave a short talk and members of the Committee acted as hosts. The reception was very successful and much interest was shown in the Committees' work. 2,000 copies of the second edition of the Home Safety Handbook were distributed and a third edition will be published in 1962. 6,000 copies of a leaflet 'Home and Everyday Accidents' were distributed by the Housing and Estates Manager to Council tenants. Members of the Committee and the Divisional Officer of the Fire Service gave seven talks to local organisations, and approximately 300 people attended. 200 copies of the Readers' Digest Handbook of First Aid were purchased and distributed at the talks when appropriate. A display was exhibited at the Willesden Show in September with the theme of 'Protect your Child'. The Chairman and Members attended to answer questions and distribute literature. Last 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; two of these girls were successful in passing at the Silver Standard this year. The Chairman attended a conference on 'Accident Prevention' and the National 'Water Safety Campaign' held at the Croydon Technical College in June; two members attended the National Home Safety Conference held at Church House, Westminster, in November; and one member attended several meetings of the Area 10 Home Safety Committee, which has representatives from all the Home Safety Committees in Greater London and Middlesex. 24 TABLES Table 1 DEATHS Causes: Males Females Total 1. Tuberculosis (respiratory) 8 5 13 2. Tuberculosis (other) 1 — 1 3. Syphilitic disease 5 1 6 4. Diphtheria — — — 5. Whooping cough — — — 6. Meningococcal infections — — — 7. Acute poliomyelitis — — — 8. Measles 1 — 1 9. Other infective and parasytic diseases 1 4 5 10. Malignant neoplasm, stomach 24 14 38 11. Malignant neoplasm, lung, bronchus 95 11 106 12. Malignant neoplasm, breast — 46 46 13. Malignant neoplasm, uterus — 16 16 14. Other malignant and lymphatic neoplasms 101 91 192 15. Leukaemia, aleukaemia 9 6 15 16. Diabetes 5 7 12 17. Vascular lesions of nervous system 87 119 206 18. Coronary disease, angina 206 125 331 19. Hypertension, with heart disease 17 22 39 20. Other heart disease 47 110 157 21. Other circulatory disease 38 51 89 22. Influenza 9 11 20 23. Pneumonia 31 47 78 24. Bronchitis 90 41 131 25. Other diseases of respiratory system 12 9 21 26. Ulcer of stomach and duodenum 11 4 15 27. Gastritis, enteritis and diarrhœa 7 5 12 28. Nephritis and nephrosis 2 3 5 29. Hyperplasia of prostate 11 — 11 30. Pregnancy, childbirth, abortion — 3 3 31. Congenital malformations 7 10 17 32. Other defined and ill-defined diseases 80 79 159 33. Motor vehicle accidents 14 4 18 34. All other accidents 23 26 49 35. Suicide 11 5 16 36. Homicide and operations of war 2 2 4 TOTAL 955 877 1,832 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 1961 170,030 3,943 68 17 21 74 18 19 Perinatal mortality 1955 35 „ „ 1956 35 „ „ 1957 32 „ „ 1958 31 „ „ 1959 27 „ „ 1960 30 „ „ 1961 29 Table 3 Infant Mortality:—by Wards Ward Number of deaths Total 1959-61 Rate 1959-61 1959 1960 1961 Carlton 8 5 5 18 20 Kilburn 7 7 7 21 21 Brondesbury Park 5 1 8 14 17 Kensal Rise 6 5 3 14 23 Manor 6 1 2 9 12 Harlesden 3 11 10 24 22 Stonebridge 9 4 4 17 22 Roundwood 7 5 6 18 18 Church End 4 2 3 9 17 Willesden Green 2 3 6 11 13 Mapesbury 6 3 6 15 14 Gladstone 1 1 5 7 12 Cricklewood 1 4 2 7 13 Brentwater 1 2 1 4 9 66 54 68 188 17 26 Table 4 Deaths by Social Class I Nil II 3 III 35 IV 8 V 15 Not known 3 Not classified 4 Total 68 Table 5 Infant Mortality—Causes (Based on Registrar General's Figures) 1936-1939 1940-1945 1946-1950 1956-1960 1961 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 2 9 11 2.8 Diarrhoea and enteritis 131 10.0 108 6.8 37 2.3 3 .2 - - - - Other infections 34 2.6 40 2.5 15 .9 5 .3 - 1 1 .3 Congenital malformations 83 6.3 89 5.6 72 4.4 55 3.5 6 7 13 3.3 Prematurity 170 13.0 179 11.3 99 6.1 72 4.6 31 1 32 8.1 Injury at birth 21 1.6 33 2.1 43 2.7 18 1.1 6 6 1.5 Other causes 134 10.3 149 9.4 96 5.9 88 5.6 4 1 5 1.2 All causes 679 51.9 738 46.5 430 26.5 298 18.9 49 19 68 17.2 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) 1961 30 (1) 221 (24) 2 (0) 251 (25) 27 Table 7 Premature births by wards Ward Premature births notified Percentage of live births in brackets Carlton 25 (8.6) Kilburn 25 (7.2) Brondesbury Park 16 (5.2) Kensal Rise 7 (3.1) Manor 24 (8.7) Harlesden 24 (5.5) Stonebridge 15 (5.8) Roundwood 26 (7.2) Church End 10 (5.1) Willesden Green 17 (5.3) Mapesbury 31 (7.7) Gladstone 15 (7.4) Cricklewood 7 (3.5) Brentwater 9 (7.5) Total 251 (6.4) Table 8 Infant Mortality : Congenital Malformations Heart disease 3 Multiple deformities 1 Epidermylosis cullosa 1 Spina bifida 1 Myelomeningocele 1 Intussesception of small intestine 1 Multiple anus and atresia of small intestine 1 Internal hydrocephalus 1 Intestinal obstruction 1 Microcephaly 1 Haemorrhage diathesis 1 Total 13 28 GENERAL PROVISION OF HEALTH SERVICES Table 9 Bacteriological examination of milk, ice cream and water Milk examinations—228 Schools (pasteurised) Dealers' premises Total Pasteurised T.T. pasteurised Sterilised Samples 107 99 11 11 228 Satisfactory 105 98 11 11 225 Unsatisfactory 2 1 — — 3 Ice cream examinations—12 Grade 1 Grade 2 Grade 3 Grade 4 Total 8 3 1 - 12 Water examinations—415 Domestic supplies Swimming pools Paddling pool Total Samples - 403 12 415 Satisfactory - 395 10 405 Unsatisfactory - 8 2 10 Table 10 Uncleanliness and Scabies New cases treated Attendances Scabies Lice and nits Total Scabies Lice and nits Total Children under 5 years 11 10 21 15 10 25 Children 5-15 years 13 62 75 25 63 88 Adults Men 12 5 17 17 5 22 Women 13 16 29 16 16 32 Total 49 93 142 73 94 167 HEALTH EDUCATION Table 11 Talks No. visited Total No. of talks Subjects Total attendances No. of attendances Schools 26 341 41 1,200 25—180 Factories 58 64 19 7,120 13—800 Religious, social and political organisations 20 24 17 860 10— 70 Table 12 Mothercraft No. of clinics Total No. of classes Visits by health visitors 3 126 8,103 29 PREVALENCE AND CONTROL OF INFECTIOUS AND OTHER DISEASES Table 13 Infectious diseases 1961 (1960 in brackets) Notified Confirmed Deaths Diphtheria - (-) - (-) - (—) Dysentery 29 (58) 25 (40) - (—) Erysipelas 22 (12) 21 (11) - (—) Encephalitis, acute — (-) — (-) - (—) Food poisoning 35 (44) 28 (23) - (1) Malaria 2 (-) 2 (—) - (—) Measles 3,187 (478) 3,182 (476) 1 (—) Meningococcal infection 4 (1) 3 (-) - (—) Ophthalmia neonatorum 3 (1) 2 (1) - (—) Paratyphoid fever — (-) — (-) - (—) Pneumonia 71 (68) 70 (65) - (65) Poliomyelitis and polioencephalitis - (3) (3) - (—) Puerperal pyrexia 158 (166) 158 (166) - (—) Scarlet fever 68 (86) 66 (82) - (—) Smallpox — (-) — (-) - (—) Tvphoid fever 7 (-) 4 (—) - (—) Whooping cough 92 (289) 92 (287) - (—) 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 1961 92 24,667 .54 .53 2,694 30 BRONCHITIS, CANCER OF LUNG AND TUBERCULOSIS Table 15 Tuberculosis: Notified cases and deaths Year Population New cases Deaths Cases on register Pulmonary Nonpulmonary 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 1961 170,030 97 18 115 13 1 14 1,678 288 1,966 Table 16 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 57 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 1961 170,030 57 11 68 7 1 8 31 Table 17 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 1961 90 41 131 77 Table 18 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 1961 95 11 106 62 Table 19 Tuberculosis: New cases and deaths by age groups (Deaths in brackets) Age groups New cases Respiratory Non-respiratory Male Female Male Female Under 1 - (-) 1 (-) - (-) - (-) 1 to 5 1 (-) 4 (-) - (-) - (-) 5 to 10 1 (-) - (-) - (-) - (-) 10 to 15 - (-) - (-) - (-) - (-) 15 to 20 2 (-) - (-) - (-) - (-) 20 to 25 5 (-) 12 (-) 1 (-) 1 (—) 25 to 35 14 (1) 15 (-) 3 (1) 5 (—) 35 to 45 4 (1) 5 (-) - (—) 5 (—) 45 to 55 9 (2) 3 (1) 1 (-) — (—) 55 to 65 11 (2) 2 (2) 1 (—) — (—) 65 and upwards 5 (2) 3 (2) — (—) 1 (—) Totals 52 (8) 45 (5) 6 (1) 12 (-) 32 Table 20 Tuberculosis 1961: Cases by Wards Ward Pulmonary cases Nonpulmonary cases Pulmonary rate per 100,000 Combined rate per 100,000 Carlton 6 2 54 72 Kilburn 10 2 78 94 Brondesbury Park 6 — 50 50 Kensal Rise 5 — 45 45 Manor 8 — 62 62 Harlesden 7 1 51 58 Stonebridge 4 1 33 42 Roundwood 10 3 84 110 Church End 1 3 8 24 Willesden Green 10 — 76 76 Mapesbury 12 3 91 114 Gladstone 6 — 54 54 Cricklewood 10 — 88 88 Brentwater 2 3 18 45 Whole Borough 97 18 57 68 Table 21 Tuberculosis 1959—1961: Cases by Wards Ward Pulmonary cases Nonpulmonary cases Pulmonary rate per 100,000 Combined rate per 100,000 Carlton 43 4 125 136 Kilburn 33 7 85 103 Brondesbury Park 20 3 56 64 Kensal Rise 19 2 56 62 Manor 26 2 68 73 Harlesden 29 4 71 80 Stonebridge 26 8 71 93 Roundwood 29 6 81 98 Church End 15 3 40 48 Willesden Green 43 6 108 123 Mapesbury 42 8 122 145 Gladstone 26 2 77 83 Cricklewood 26 1 76 78 Brentwater 12 3 34 43 Whole Borough 389 59 76 87 Table 22 Tuberculin Testing, 1953-1961 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 1961 388 6 1.5 1,690 95 5.6 2,228 343 15.4 33 Table 23 Tuberculosis: B.C.G. vaccination of school leavers, 1953-1961 No. tested and found negative No. vaccinated 1953 587 *(32) 456 †(78) 1954 447 (24) 391 (87) 1955 1,535 (75) 1,279 (83) 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) 1961 1,840 (82) 1,807 (98) *Percentage of total tested, †Percentage of negatives vaccinated. Table 24 Tuberculosis: Notification of deaths 1956 1957 1958 1959 1960 1961 1956-61 Deaths 25 13 16 5 11 14 84 Percentage not notified 24 15 12 20 36 43 25 Percentage notified before death: 0—12 months 20 15 25 - 19 — 15 1—5 years 4 23 13 40 9 — 11 Over 5 years 52 47 50 40 36 57 49 SANITARY INSPECTION OF THE AREA Table 25 Demolition and Closing Orders Housing Act, 1957 (Sections 16, 17 and 18) Demolition Orders, section 16, Housing Act, 1957 1 3 Denzil Road Closing Orders, sections 17 and 18, Housing Act, 1957 8 9 Pound Lane (whole house); demolition order substituted by closing order 46 Cavendish Road (basement) 46 Cavendish Road (attic rooms) 125 Malvern Road (basement) 98 Cambridge Road (basement) 180 Cambridge Road (basement) 4a The Avenue (basement) 61 Carlton Vale (basement) Table 26 Overcrowding (a) Dwellings overcrowded at end of year 579 (b) Overcrowding reported during the year 103 (c) (i) Overcrowding relieved during the year 29 (ii) Persons 116approx. (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 25 (ii) Families 31 (iii) Persons 186 (f) Overcrowding in Council houses relieved during the year 14 (g) Section 80, Housing Act, 1957—licences issued 3 34 Table 27 New Dwellings, 1961 Houses Flats Rebuilds Dwellings built by private builders (excluding those built by the police authorities) 63 Nil Nil Built by local authority Nil 26 Nil Applicants on Council's waiting list at 31.12.61 3,019 Table 28 Notices served under Public Health Acts, 1936 and 1961 and Housing Act, 1957 1961 1960 Intimation notices served 703 745 Intimation notices complied with 688 668 Statutory notices served (Public Health Act, 1936) 1,026 1,116 Statutory notices complied with (Public Health Act, 1936) 1,024 1,180 Statutory notices served (Public Health Act, 1961) 2 — Statutory notices complied with (Public Health Act, 1961) — — Statutory notices served (Housing Act. 1957) 8 12 Statutory notices complied with (Housing Act, 1957) 3 11 Non-compliance with statutory notices referred to Town Clerk (Public Health Act. 1936, sec. 93) †134 199 Referred to the Borough Engineer for work to be carried out in default of owners *137 182 *81 work done by Borough Engineer. fDetails of cases referred to the Town Clerk during the year:— Work carried out 93 111 Work in hand — — Court orders obtained 15 45 Summons withdrawn—notices complied with 23 38 Notices withdrawn 3 5 Proceedings pending — — Total 134 199 Table 29 Inspections carried out under Public Health Acts, 1936 and 1961, Housing Act, 1957, Rent Act, 1957, Clean Air Act, 1956, Infectious Diseases and Miscellaneous Inspections Public Health Acts 1961 1960 Dwelling houses inspected 2,972 2,876 Dwelling houses re-inspected 9,130 10,089 Other visits 1,610 1.331 Housing Act Dwelling houses wholly inspected 718 514 Dwelling houses partly inspected 163 57 Dwelling houses re-inspected 132 103 Underground rooms inspected 52 77 Overcrowding visits 48 99 Improvement grant inspections 148 165 Other visits 1,178 326 Rent Act Dwelling houses inspected 23 54 Dwelling houses re-inspected 30 56 Other visits 6 21 Clean Air Act Boiler plant inspections 64 71 Boiler plant re-inspections 2 14 Premises inspected (S.C.A.) 2,903 11,325 Premises re-inspected (S.C.A.) 1.729 1.500 Smoke observations 369 349 Rag Flock and Other Filling Materials Act Premises inspected 3 8 Visits re samples 8 8 Infectious diseases Infectious disease enquiries 324 418 Food poisoning enquiries 109 66 Polio virus survey visits 300 7 Miscellaneous Massage establishments inspections 24 40 Cinemas, dance halls, schools, etc. inspected 41 41 Noise nuisance investigations 197 71 Visits re unsound food 126 137 All other visits 1,178 5,453 23,587 35,276 35 Table 30 Inspection of Factories, Outworkers Premises and Food Premises 1961 1960 No. inspected Inspections made No. inspected Inspections made Offensive trades — — — — Power factories 748 821 774 1,121 Non-power factories 62 94 61 84 Homeworkers and outworkers 203 220 213 172 Inspections of food premises (including revisits) Baker 27 169 26 129 Bread and confectionery 40 120 40 150 Dairy 3 37 3 44 Butcher 109 353 115 414 Grocer and general store 315 778 324 934 Fishmonger and fish-fryer 45 180 45 148 Cafe and restaurant 140 598 137 655 Greengrocer and fruiterer 128 304 126 378 Ice cream and sweet shop 224 399 227 586 Food stall 19 68 18 22 Public House 44 71 44 101 Works canteen 118 324 118 258 School canteen 40 48 39 43 Food factory 6 39 4 32 Anv other food premises 41 46 36 36 Total periodic inspections 2,312 4,669 2,350 5,307 Total all inspections 1961 1960 28,256 40,583 Table 31 Rent Act, 1957 Certificates of Disrepair Applications (Form I) received an investigated 16 Agreed and proposal to issue Certificate of Disrepair (Form J) served 16 Refused Nil Undertakings (Form K) received from landlords 4 Accepted 3 Refused 1 Certificates of Disrepair (Form L) issued 9 Applications received for cancellation of Certificates of Disrepair (Form M) 14 Granted 10 Refused 4 36 Table 32 Summary of nuisances abated and of improvements effected Water supply and water service 1961 1960 New cisterns provided 7 7 Cisterns cleansed, repaired, covered, etc. 12 26 Draw taps placed on mains 3 2 Drainage and Sewerage Water closets: Repaired, supplied with water or otherwise improved 169 205 New closets built 8 2 Provided with better ventilation 5 2 Drains: Examined, tested, exposed, etc. 386 95 Unstopped, repaired, trapped, etc. 275 233 New soilpipes or vent shafts fixed 13 12 Disconnecting traps or chambers inserted 23 16 Reconstructed 33 19 New manhole covers 34 34 Soilpipes or vent shafts repaired 52 45 Other Defects Smoke nuisances 5 7 Accumulation of refuse 142 87 Fowls, pigs, etc., kept in an insanitary condition 2 2 Dampness 345 373 Yards and forecourts paved, repaved or repaired 61 111 Walls and ceilings cleansed 69 100 Verminous rooms disinfested 218 301 Leaky roofs made watertight 464 496 Additional ventilation provided under floors 12 13 Dilapidated plaster repaired 499 540 Flooring and other woodwork repaired 219 306 Damp proof courses inserted 14 34 Water supply reinstated 24 31 Wash house floors repaired or repaved 24 19 Fireplaces and stoves repaired 59 80 Decayed brickwork repaired and repointed 148 207 Sinks provided or replaced 52 43 Additional light and ventilation to staircase 2 - Gutters and/or rainwater pipes repaired or renewed 315 386 Larders or food cupboards ventilated or provided — 3 New sashcords and glass provided to doors and windows 461 597 Miscellaneous 165 170 Total nuisances abated 4,320 4,604 DISINFESTATION Table 33 (a) Verminous premises: Council properties 29 County Council properties — Private properties 73 Total 102 (b) Verminous rooms:* Council properties 73 County Council properties — Private properties 145 Total 218 *Some rooms are treated more than once. (c) Clothing and bedding materials: (i) disinfested 2 (ii) disinfected 11 (d) Miscellaneous: Ants 2 Beetles 6 37 INSPECTION AND SUPERVISION OF FOOD AND POOD PREMISES Table 34 Types of food premises Baker 27 Bread and confectionery 40 Dairy 3 Butcher 109 Grocer and general store 315 Fishmonger and fish fryer 45 Cafe and restaurant 140 Greengrocer and fruiterer 128 Ice cream and sweet shop 224 Food stall 19 Public house 44 Works canteen 118 School canteen 40 Food factory 6 Other food premises 41 Total 1,299 Inspections and revisits: Inspections 2,581 Revisits 953 Total 3,534 Table 35 Premises unsatisfactory on 31.12.60 97 Unsatisfactory during the year 310 Premises made satisfactory during the year 348 Unsatisfactory on 31.12.61 59 Table 36 Food premises: Defects remedied Defects Outstanding at 31.12.60 Found during the year Total Remedied during year Outstanding at 31.12.61 Inadequate lighting and ventilation 6 20 26 23 3 Inadequate washing facilities 36 73 109 91 18 Inadequate refuse storage 18 14 32 29 3 Unsatisfactory or insufficient sanitary accommodation 13 54 67 60 7 Inadequate storage accommodation 1 22 23 17 6 Defective walls, ceilings or floors 40 91 131 110 21 Dirty walls, ceilings or floors 34 240 274 236 38 Inadequate first aid materials 8 9 17 17 — Unsatisfactory conditions 5 27 32 25 7 Any other defects 41 147 188 163 25 Totals 202 697 899 771 128 Table 37 Food premises: Registration Premises on register 31.12.60 Applications received Applications granted Applications refused Premises removed from register during 1961 Total on register at 31.12.61 1. Sale and storage of ice cream 317 14 14 - - 331 338 2. Manufacture of ice cream 7 - - - - 7 3. Manufacture of preserved food 128 3 3 - - 131 4. Fish curing 1 — — - - 1 38 Table 38 Food unfit for human consumption Meat Bread, flour, cereals, etc. 4 lbs. Bacon 39 lbs. Preserves 81 lbs. Cooked 74 lbs. Tinned milk 73 tins Tinned 1,804 lbs. Butter and fats 2 lbs. Raw 627 lbs. Soups 36 tins Fish Miscellaneous Tinned 229 tins Biscuits 28 lbs. Coconut 48 lbs. Poultry Frozen food (miscellaneous) 1,335 packets Raw 1,014 lbs. Fruit juice 95 tins Vegetables Horseradish relish 5 jars Mustard 20 tins Tinned 633 tins Rice, creamed 3 tins Fruit Sugar 36 lbs. Tomato juice 10 tins Tinned 1,255 tins Shelled nuts 55 lbs. Table 39 Food: Samples taken Article No. of samples Unsatisfactory Milk (various) 126 3 Butter 36 - Cakes and biscuits 6 - Cream 19 - Drugs 42 - Fish and fish products 9 - Fruit (fresh, canned and dried) 16 - Herbs 6 - Ice cream 32 - Liver 4 - Margarine 24 - Meat and meat products 95 3 Preserves 5 - Sausages 7 2 Soft drinks and fruit juices 4 — Sweets 7 — Vinegar and non-brewed condimt jnts 27 — Miscellaneous 17 1 (bread) Total 482 9 FACTORIES Table 40 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 94 3 Factories not included above in which section 7 is enforced by the local authority 748 821 41 Other premises in which section 7 is enforced by the local authority (excluding outworkers premises) 10 15 — Total 820 930 44 No occupiers were prosecuted during the year. 39 Table 41 Defects found Found Remedied Referred To H.M. Inspector By H.M. Inspector Want of cleanliness (sec. 1) 3 3 — — Overcrowding (sec. 2) — — — — Unreasonable temperature (sec. 3) — — — — Inadequate ventilation (sec. 4) 2 2 — — Ineffective drainage of floors (sec. 6) 1 1 — — Sanitary conveniences (sec. 7) (a) Insufficient 4 3 — 1 (b) Unsuitable or defective 35 47* — — (c) Not separate for sexes — — — 1 Other offences against the Act (not including offences relating to outworkers) 4 4 6 — Total 49 60* 6 2 * Twelve defects outstanding from previous year. No prosecutions were instituted during the year. Table 42 Outworkers Nature of work No. of outworkers in August list No. of instances of work in unwholesome premises Notices served Wearing apparel (making, etc.) 168 — — Household linen — — — Curtains and furniture hangings 1 — — Furniture and upholstery 1 — — Artificial flowers — — — Paper bags — — — Making of boxes or other receptacles or parts thereof made wholly or partiallv of paper — — — Carding, etc. of buttons, etc 17 — — Stuffed toys 46 2 2 Cosaques, Christmas stockings, etc. 6 — — Imitation jewellery and jewellerv pads 10 — — Lampshades 7 — — Total 256 2 2 There were no cases of default in sending lists to the Council, and there were no prosecutions. CARE OF MOTHERS AND YOUNG CHILDREN Table 43 Ante-natal Clinics Clinic Sessions New cases Attendances Average attendance per session Antenatal Postnatal Antenatal Postnatal Kilburn 102 459 17 1,958 17 19.4 Pound Lane 102 398 4 1,798 4 17.7 Stonebridge 151 673 11 3,058 12 20.3 Neasden 52 96 4 324 4 6.3 Cricklewood (Sneyd Road) 51 308 5 872 6 17.2 Kensal Rise (St. Martin's) South Kilburn 50 274 — 1,199 — 24.0 (Chichester Terrace) 51 198 7 817 7 16.1 Totals: 1961 559 2,406 48 10,026 50 17.9 1960 556 2,036 43 8,474 43 15.3 40 Table 44 Births Hospital and domiciliary 1961 1960 Total notified live births 3,937 3,544 Born in institutions 3,394 3,069 Born at home 543 475 Percentage born in institutions 86.2 86.6 Institutions Central Middlesex Hospital 1,470 1,221 Kingsbury Maternity Hospital 441 429 Larger hospitals outside Willesden 1,311 1,159 Smaller hospitals outside Willesden 156 244 Nursing homes, etc. 16 16 3,394 3,069 Home County Midwives 536 471 Others 6 1 Private Doctors 1 3 543 475 Table 45 Mothercraft Clinic Sessions New cases Total attendances Average attendance per session Kilburn 36 71 247 6.9 Pound Lane 33 54 143 4.3 Stonebridge 51 96 331 6.5 Neasden 6 4 7 1.2 Totals: 1961 126 225 728 5.8 1960 120 206 806 6.5 Table 47 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 297 612 6,278 860 575 7,713 4,024 25.9 Pound Lane 254 637 7,360 735 540 8,635 3,247 33.1 Stonebridge 254 739 6,800 746 474 8,020 2,804 30.8 Neasden 186 285 5,460 788 481 6,729 1,965 36.2 Cricklewood (Sneyd Road) 102 381 3,486 492 245 4,223 1,748 41.4 Kensal Rise (St. Martin's) 154 390 4,860 554 242 5,656 1,958 36.7 South Kilburn (Chichester Terrace) 100 261 3,777 429 251 4,457 1,158 44.6 Totals: 1961 1,347 3,305 38,021 4,604 2,808 45,433 16,904 33.7 1960 1,250 3,046 35,699 4,875 2,405 42,979 14,347 34.4 Table 46 Relaxation Classes Clinic Sessions New cases Total attendances Average attendance per session Kilburn 41 84 247 6.0 Pound Lane 47 58 219 4.6 Stonebridge 49 85 280 5.7 Neasden 2 3 4 2.0 Totals: 1961 139 230 750 5.4 1960 134 200 897 5.2 41 MIDWIFERY SERVICE Table 48 Midwives' Clinics Sessions New Cases Total attendances Average attendance 1961 253 1,051 6,565 23.9 1960 353 767 5,580 15.8 Table 49 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 285 (b) When doctor was present at delivery 125 Number of cases in which pethidine was administered in domiciliary practice during the year: (a) When doctor was not present at delivery 126 (b) When doctor was present at delivery 48 Number of cases in which trichloroethylene was administered in domiciliary practice during the year: (a) When doctor was not present at delivery 52 (b) When doctor was present at delivery 16 Totals: 1961 785 1960 665 Table 50 Domiciliary Births Attended by midwives Visits 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 6 - 158 374 16,464 381 Totals: 1961 532 16,464 381 1960 476 16,461 439 Table 51 Medical Aid 1961 1960 (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 66 68 (ii) Others - - Totals 66 68 42 Medical Aid For Mother For Child Ruptured perineum 7 Vomiting 4 Foetal distress 5 Prematurity 2 Phlebitis 2 White Asphyxia 3 Ante-partum haemorrhage 8 Sticky eyes 1 Post-partum haemorrhage 4 Blue Asphyxia 1 Early rupture of membranes 3 Premature labour 5 Uterine Inertia 1 Toxaemia of pregnancy 3 Raised temperature 3 Retained placenta 4 Abdominal Pain 1 Breech presentation 2 Inflamed Vein 2 Delayed 1st stage 1 Albuminuria ? Twins 1 Delayed second stage 1 High head 3 Totals 55 11 HEALTH VISITING Table 52 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 1961 1,799 2,681 4,108 12,963 5,918 10,685 4 1,825 1,200 1960 1,746 2,596 3,761 12,423 5,786 9,318 37 1,476 1,000 Table 53 Special cases referred by General Practitioners for:- Care of children Care of elderly persons Ante-Natal care Home help Family care Housing 4 16 9 2 4 1 43 44 HOME NURSING Table 55 Work: Home Nurses New Cases Visits Cases on register at end of year Male Female Male Female Medical 733 1,329 80,734 152 428 Surgical 79 47 5,469 13 5 Infectious 3 9 154 - 2 Tuberculosis 23 18 3,003 5 3 Maternal complications - 26 214 - - Total 838 1,429 170 438 Totals: 1961 2,267 89,574 608 1960 2,363 85,410 642 SMALLPOX Table 57 Vaccination Under 1 year 1 year 2-4 years 5-14 years 15 years and over Total Primary Vaccination 1,088 283 177 46 36 1,630 Re-vaccinations 4 - 7 15 133 159 Totals 1961 1,092 283 184 61 169 1,789 1960 1,488 206 108 107 365 2,274 Approximate number of children (end of 1961) 0- 5 16,908 5- 15 20,072 36,980 Table 54 Establishment: Health Visitors Whole-time equivalent as at: 31.12.60 31.12.61 Health Visitors (Whole-time) 21 25 (Part-time) 1 4/11 1 2/11 (Sponsored) 2 1 Clinic Nurses (Whole-time) 4 4 Nursing Assistant (Part-time) 2/11 2/11 Totals 28 6/11 31 4/11 Table 56 Establishment: Home Nurses Nurses 1.1.61 31.12.61 Whole-time 24 22 Part-time 5 3 Candidates - - Total whole-time equivalent 21½ 24 IMMUNISATION Table 58 Year of birth Number of children who completed a full course of primary immunisation. Number of children who received a secondary (reinforcing) injection. Diphtheria only Whooping cough only Tetanus only Combined diphtheria and whooping cough Combined diphtheria and tetanus Combined diphtheria, tetanus and whooping cough Diphtheria only Whooping cough only Tetanus only Combined diphtheria and whooping cough Combined diphtheria and tetanus Combined diphtheria, tetanus and whooping cough 1961 - - - 4 7 995 - - - - - 1 1960 44 19 - - 16 1,118 7 - - - - 133 1959 24 9 1 1 22 175 2 - - 1 2 96 1958 14 3 2 - 19 79 11 - - - 3 7 1957 11 1 3 1 15 51 94 - - 2 14 30 1952-1956 159 6 15 18 92 138 657 32 3 13 66 200 1947-1951 90 - 6 3 35 73 191 30 - 4 9 69 Totals 342 38 27 27 206 2,629 962 62 3 20 94 536 Approximate number of children (end of 1961) 0- 5 16,908 5-15 20,072 36,980 45 46 HOME HELPS Table 59 Cases: Home Helps Cases receiving help at No. of new cases helped during No. of cases receiving help at 1.1.61 1.1.60 1961 1960 31.12.61 31.12.60 Maternity - 61 51 2 - Tuberculosis 13 18 2 3 10 13 Chronic sick and aged 516 491 269 214 528 516 Others 122 95 178 164 154 122 Totals 651 604 510 432 694 651 Table 60 Staff: Home Helps Position at Appointments during Resignations during Position at 1.1.61 1.1.60 1961 1960 1961 1960 31.12.61 31.12.60 Whole time 2 2 3 2 3 2 2 2 Part time 84 84 18 14 25 14 77 84 Totals 86 86 21 16 28 16 79 86 DAY NURSERIES Table 61 Day Nurseries: Attendances Nursery Approved places Children on register at 31.12.61 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 17 29 3,698 6,494 14 26 Essex Road 25 25 27 29 5,795 6,209 23 24 Evefield 25 25 25 24 4,850 5,226 19 21 Gladstone Park 25 25 24 27 5,118 5,604 20 22 Longstone Avenue 25 25 22 28 4,545 5,356 18 21 Mortimer Road 25 25 22 24 4,912 5,660 19 22 Villiers Road 25 25 25 26 5,046 5,713 20 23 Wesley Road 15 25 17 22 2,963 5,042 12 20 Totals: 1961 183 207 179 209 36,927 45,304 145 179 1960 183 207 202 232 39,910 47,700 156 187 47 Table 62 Day Nurseries: Infectious Diseases Number of Cases Nursery Measles Chicken Pox German Measles Chichester Road 22 12 1 Essex Road 23 8 7 Evefield 21 - - Gladstone Park - - - Longstone Avenue 1 - - Mortimer 6 - 1 Villiers Road 2 - 2 Wesley Road 22 2 4 Totals 97 22 15 Table 63 Day Nurseries: Waiting List Position at:- Nursery 1.1.61 31.12.61 Chichester Road 30 33 Essex Road 5 10 Evefield 4 2 Longstone Avenue 3 12 Gladstone Park 20 21 Mortimer Road 45 16 Villiers Road 31 27 Wesley Road 23 41 Totals 161 162 Table 64 Day Nurseries: Priorities Nursery Unsupported Mothers Medical reasons Bad Housing Total on Register Chichester Road 37 5 6 48 Essex Road 30 18 5 53 Evefield 21 11 14 46 Gladstone Park 21 4 13 38 Longstone Avenue 25 7 6 38 Mortimer Road 24 5 9 38 Villiers Road 32 3 9 44 Wesley Road 19 6 11 36 York Park 13 3 13 29 Totals 222 62 86 370 48 Table 65 Day Nurseries: Staff Establishment Position at: 31.12.61 31.12.60 Supervisory Matron 1 1 1 Matrons 8 8 8 Deputy Matrons 8 8 8 Wardens 8 6 6 Nursing Staff 44 42 40 Students 20 19 19 SCHOOL HEALTH SERVICE Table 66 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) 1957 and later 209 208 99.5 1 0.5 1956 1,093 1,079 98.7 14 1.3 1955 653 643 98.5 10 1.5 1954 308 306 99.3 2 0.7 1953 1,301 1,285 98.8 16 1.2 1952 286 279 97.5 7 2.5 1951 1,036 1,028 99.2 8 0.8 1950 502 499 99.4 3 0.6 1949 127 124 97.6 3 2.4 1948 274 270 98.9 4 1.1 1947 764 759 99.3 5 0.7 1946 and earlier 1,976 1,952 98.8 24 1.2 Totals: 1961 8,529 8,432 98.9 97 1.1 1960 7,791 7.660 98.3 131 1.7 49 Table 67 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) 1957 and later 3 20 23 1956 14 98 103 1955 8 77 85 1954 15 35 50 1953 75 87 155 1952 12 31 41 1951 68 98 158 1950 34 45 78 1949 21 15 35 1948 26 41 64 1947 34 45 75 1946 and earlier 104 213 300 Totals: 1961 414 805 1,167 1960 300 520 807 Table 68 Defects Found by Medical Inspection Periodic inspections Special inspections Entrants Leavers Others Total (a) (b) (a) (b) (a) (b) (a) (b) (a) (b) Skin 16 70 58 103 36 114 110 287 62 60 Eyes (a) Vision 29 46 142 232 243 314 414 592 36 38 (b) Squint 16 26 5 24 14 55 35 105 - 3 (c) Other 5 14 3 20 14 35 22 69 5 14 Ears (a) Hearing 12 70 8 30 29 82 49 183 46 54 (b) Otitis media 10 50 9 9 33 19 92 4 5 (c) Other 7 19 9 2 46 16 62 37 - 15 Nose and throat 38 296 13 45 26 211 77 552 7 34 Speech 37 46 - 6 19 61 56 115 24 29 Lymphatic glands 2 116 - 7 3 94 5 217 - - Heart 2 38 - 21 2 41 4 100 - 4 Lungs 6 89 1 23 2 70 9 182 2 18 Developmental (a) Hernia 4 17 - 5 3 16 7 38 - 7 (b) Other 1 56 5 14 4 101 10 171 1 11 Orthopaedic (a) Posture 15 41 47 43 57 109 119 193 - 8 (b) Feet 29 50 59 55 81 127 169 232 7 17 (c) Other 3 52 18 66 23 90 44 208 2 23 Nervous system (a) Epilepsy 1 11 1 3 - 3 2 17 - - (b) Other - 5 3 7 - 15 3 27 - 9 Psychological (a) Development 1 23 1 5 4 48 6 76 - 30 (b) Stability - 203 - 122 3 302 3 627 - 22 Abdomen 22 1 11 1 32 2 65 1 2 Other 132 36 50 34 251 85 433 155 65 90 Totals 1961 366 1,399 424 887 870 2,054 1,660 4,340 262 493 1960 323 1,167 297 570 760 1,938 1,380 3,675 703 160 * (a) Requiring treatment (b) Requiring observation. 50 Table 69 Treatments: School Health Service Number of cases known to have been dealt with (i) Eye Diseases, Defective Vision and Squint 49 (a) External and other, excluding errors of refraction and squint (b) Errors of refraction (including squint) 1,463 Totals 1961 1,512 1960 1,039 (c) Number of pupils for whom spectacles were prescribed Totals 1961 518 1960 437 (ii) Diseases and Defects of Ear, Nose and Throat Received operative treatment for: (a) diseases of the ear 3 (b) adenoids and chronic tonsillitis 67 (c) other nose and throat conditions 7 Received other forms of treatment 81 Totals 1961 158 1960 136 Total number of pupils in schools who are known to have been provided with hearing aids: (a) during the current year (b) in previous years (excluding any pupils shown at (a) above who were provided with an aid in the previous year) 20 (iii) Orthopaedic and Postural Defects 621 Number of pupils known to have been treated at clinics or at out-patients departments 1961 1960 640 (iv) Diseases of the Skin (Excluding Uncleanliness) Ringworm (i) Scalp (ii) Body - Scabies 16 Impetigo 9 Other skin diseases 262 Totals 1961 287 1960 247 (v) Child Guidance Treatment 235 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) (vi) Speech Therapy 547 Number of pupils treated by speech therapists under arrangements made by the authority 1961 1960 271 (vii) Other Treatment Given 630 (a) Number of miscellaneous minor ailments treated by the County Council (b) Treatment other than (a) above and excluding convalescent treatment: 1. Lymphatic glands 2. Heart - 3. Lungs 148 4. Developmental (a) Hernia - (b) Other - 5. Nervous system (a) Epilepsy - (b) Other 2 6. Psychological (a) Development 14 (b) Stability 36 7. Abdomen 1 8. Other 10 Totals 1961 841 1960 854 51 Table 70 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 99 35 7 9 2 17 Table 71 Audiometry: Children Tested Routine Age group 1st Tests Re-tests Failures Total Both ears One ear Right Left Up to 7 years 3,315 254 39 48 36 123 Intermediate 1,683 71 9 13 12 34 Leavers 2,490 82 21 12 21 54 Totals 1961 7,488 407 69 73 69 211 1960 5,045 179 38 45 54 137 Specials All ages 1st Tests Re-tests Failures Total Both ears One ear Right Left Totals 1961 633 316 70 65 81 216 1960 433 180 54 63 62 179 Table 72 Summary of Failures to pass Audiometer Test Passed at second test 184 Referred to Assistant Medical Officers 178 Normal Hearing after removal of wax 36 Under observation by hospital or private doctor 9 No action-further test recommended after given period 27 Referred for Tonsils and Adenoids operation 19 Appointments not accepted 7 Referred by A.M.O.'s to Ear, Nose and Throat Specialist 93 Treatment considered of little value 9 Referred to hospital 8 Hearing improved after treatment 25 Recommended for Hearing Aid 2 Awaiting appointments 15 Failed to attend appointments 17 52 Table 73 Speech Therapy Clinic or School No. of cases dealt with during the year Kilburn clinic 106 Pound Lane clinic 100 Stonebridge clinic 72 Lower Place special school for physically handicapped pupils 25 Neasden clinic 20 Totals 1961 323 1960 267 Table 74 Infestation with Vermin 1961 1960 Total no. of examinations 31,010 26,764 Total no. of individual pupils found to be infested for the first time during the current year 399 438 Number of individual pupils in respect of whom cleansing notices were issued under section 54/2 Education Act, 1944 134 194 Number of individual pupils in respect of whom cleansing notices were issued under section 54/3 Education Act, 1944 Table 76 The Educational Sub-Normal Education Act, 1944-Section 57 1961 1960 Cases dealt with under section 57, Education Act, 1944:- 12 5 Cases de-notified under section 8, Education (Miscellaneous Provisions) Act, 1948 - - Table 75 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 31.12.61 Lower Place Special School for Physically Handicapped Pupils Willesden 8 8 2 Wembley 2 2 Ealing 1 1 - Acton 1 1 1 Hendon 4 2 2 Brentford and Chiswick 1 1 - Harrow 1 1 - Totals 18 16 5 Table 77 Return of Handicapped Pupils (Year Ended 31st December, 1961) Ascertainment Distribution (as at last day of Year) Category No. of ascertained Cases known 1st day of Year No. of New Cases ascertained during year No. of ascertained Cases known last day of Year In Special Day Schools In Special Residential Schools In Maintained Primary and Secy. Schools In Independent Schools Not at School Total B. G. B. G. B. G. B. G. B. G. B. G. B. G. B. G. B. G. Blind Pupils - 1 - - - - - - - - - - - - - - - - Partially-Sighted Pupils 10 11 1 1 11 7 10 4 1 3 - - - - - - 11 7 Deaf Pupils 9 3 - - 7 1 5 1 2 - - - - - - - 7 1 Partially Deaf Pupils 7 - - 2 6 2 6 2 - - - - - - - - 6 2 Delicate Pupils 31 11 9 15 23 15 2 1 21 13 - 1 - - - - 23 15 Diabetic Pupils Educ. Sub-normal Pupils 74 61 17 17 80 68 64 57 9 4 7 7 - - - - 80 68 Epileptic Pupils 1 - - - 1 - - - 1 - - - - - - - 1 - Maladjusted Pupils 42 14 13 4 41 11 - - 13 2 6 - 21 9 1* - 41 11 Physically Handicapped Pupils 30 18 2 3 27 19 24 18 1 1 - - - - 2* - 27 19 Pupils with Speech Defects Pupils with Multiple 377 153 102 56 389 158 - - - - 385 148 - 4 10 389 158 Defects 37 22 2 3 34 23 31 23 3 - - - - - - - 34 23 Total 618 294 146 101 619 304 142 106 51 23 398 156 21 9 7 10 619 304 Grand Totals: 1961 912 247 923 248 74 554 30 17 923 1960 871 166 912 260 76 535 34 7 912 53 *Receiving home tuition. Boys Girls Children not ascertained as handicapped pupils, but recommended for convalescence in a holiday home or camp school 52 56 54 CHILD GUIDANCE Table 78 Waiting list at 1.1.1961 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 31.12.1961 40 168 138 30 115 31 16 Table 79 Main Symptoms Cases Nervous Disorders 10 Fears and anxieties Inhibited behaviour 5 Behaviour Disorders 19 At Home At School 5 Predominantly aggressive 17 Habit Disorders 5 Enuresis (wetting) Encropesis (soiling) 8 Involuntary movements 5 Sleep disturbances 3 Speech disorders 5 Psychosomatic 5 Asthma, Eczema, etc Anti-Social Behaviour Stealing 10 Non-attendance at school 12 Educational Difficulties 6 Backwardness and retardation in school work Total number referred in 1961 115 SCHOOL DENTAL SERVICE % Table 80 Inspection and Treatment (a) Inspections Inspected Required Treatment Referred for Treatment 1961 1960 1961 1960 1961 1960 Periodic 13,065 16,608 6,927 9,901 7,267 10,129 Special 1,564 1,258 1,435 1,186 Totals 14,629 17,866 8,362 11,087 7,267 10,129 55 (b) Treatment 1961 1960 No. of pupils actually treated: 3,780 4,715 No. of attendances 12,076 13,919 No. of half-days of Inspection 129 225 Treatment 2,083 2,270 No. of fillings: 7,365 8,912 (a) Permanent teeth (b) Temporary teeth 3,009 3,592 No. of extractions of: 495 416 (a) Permanent teeth (b) Teeth for orthodontia 252 228 (c) Temporary teeth 2,184 2,781 No. of general anaesthetics 1,174 1,398 No. of other operations 4,729 5,682 PRIORITY DENTAL SERVICE Table 81 Expectant and Nursing Mothers Children under 5 1961 1960 1961 1960 Number examined 301 316 616 562 Number required treatment 292 306 448 452 Number of new cases commenced treatment 292 336 393 486 Dentally fit 100 144 260 378 Extractions 376 391 185 244 Fillings 540 781 693 788 Scaling and gum treatment 129 193 - - Silver nitrate dressings - - 636 745 Dentures 54 82 2 - Number of attendances 1,159 1,353 961 1,050 Number of appointments not kept 157 311 157 203 56 Table 82 Chiropody-Defects Condition Expectant and Nursing Mothers Boys Girls Total 0-5 yrs. School 0-5 yrs. School Verrucae 1 - 47 1 65 114 Corns 31 - 28 - 40 99 Callosities 2 - - - 3 5 Nail conditions 4 2 8 3 1 18 Warts 1 2 6 - 10 19 Advice - - 1 - - 1 Hallux Valgus - - 9 - 33 42 Epidermophytosis - - 10 - 2 12 Claw toes - 1 4 1 15 21 Chilblains - - 1 - 2 3 Totals 1961 39 5 114 5 171 334 1960 32 26 103 9 174 344 DEANER PRINTERS LTD. (T.U.) LONDON