439(1) WIL 58 Borough of Willsden 1962 THE 87th ANNUAL HEALTH REPORT E. GRUNDY, M.D., D.P.H., Medical Officer of Health CONTENTS Aged—care of Page Chiropody 14 Clinic 13 Laundry service 14 Old People's Welfare Committee 15 Voluntary services 14 Bacteriological examinations 4 Basement bakehouses 13 Bronchitis Morbidity and mortality 6 Cancer of the lung Morbidity and mortality 6 Prevention and diagnosis Treatment 7 Census—household arrangements 8 Child guidance 22 Chiropody 22 Clean air 10 Common lodging houses 16 Convalescence 22 Coroner's court 16 Day nurseries 21 Dental service 22 Disinfestation 10 Factories 13 Food Contaminated food 11 Education in food hygiene 11 Food poisoning 11 Improvements in premises 11 Prosecutions 11 Registration of premises 11 Sampling 12 Unsound food 11 Hawkers—licensing of 16 Health education 5 Health visiting 19 Home safety 23 Home help service 21 Home nursing 19&20 Hospitals Facilities 17 Liaison 17 Household arrangements 8 Housing Demolition and closing orders 9 Nuisances abated 9 Rent Act, 1957 9 New dwellings 9 Notices served 9 Overcrowding 9 Slum clearance and re-development 9 Icecream 4&11 Immunisation 21 Infant mortality 4 Infectious diseases Page Dysentery 5 Food poisoning 6 & 11 Malaria 6 Ophthalmia neonatorum 6 Poliomyelitis 6 Puerperal pyrexia 6 Smallpox 6 Typhoid 6 Whooping cough 6 Laboratory service 4 Massage and special treatment establishments 5 Maternity and child welfare Ante-natal care 17 Clinics 17 Problem families 18 Medical examination of staff 17 Midwifery service 18 & 19 Milk and dairies 12 & 13 Mortuary 16 National Assistance Act, 1948 Burials 16 Removal to hospitals 14 Noise 13 Outworkers and homeworkers 13 Pet Animals Act, 1951 17 Poliomyelitis inoculation 21 Prematurity 4 Problem families 18 Public Health Laboratory Service 4 Rag, Flock and Other Filling Materials Act, 1951 16 & 17 Refuse disposal 8 Rodent control 10 Sanitary circumstances 7 & 8 Scabies 4 School health service 22 Sewage and drainage 8 Slaughterhouses 6 Smallpox vaccination 21 Staff Medical examinations 17 Sanitary section 9 Swimming baths 8 Tuberculosis B.C.G. Vaccination 7 Co-operation 7 Factories and workshops 7 Morbidity and mortality 6 Prevention and diagnosis 7 Vermin 10 Vital statistics Births 4 Deaths 4 Population 3 Water 7 & 8 W1LLESDEN With the Compliments of the Medical Officer of Health BOROUGH OF WILLESDEN, HEALTH DEPARTMENT, 54 WINCHESTER AVENUE, KILBURN, N.W.6 BOROUGH OF WILLESDEN Health Department, 54 Winchester Avenue, Kilburn, N.W.6. July, 1963. To the Mayor, Aldermen and Councillors of the Borough of Willesden. Mr. Mayor, Ladies and Gentlemen, The end of 1962 marked the onset of the grave illness which terminated with the death, early in January, of Dr. Leff, who had been Medical Officer of Health of the borough since 1947. He was a man of remarkable ability and vision, with a drive and enthusiasm which gave Willesden a high reputation throughout the country in the field of public health. He was a prolific writer and his books and articles were read throughout the world. His passing was a great loss to the borough. It falls to me, therefore, to submit the annual report of the health and sanitary circumstances of the borough for 1962, which has been a year of consolidation and expansion, of improvement of the services and the environment, of the spread of knowledge of hygiene and positive health among the general population. During the first five months there was an outbreak of smallpox in England and Wales which resulted in sixty-two cases. The department was kept busy visiting and following up suspected cases and contacts, but fortunately the disease did not occur in the borough. The Ministry of Health policy of discouraging mass vaccination was followed, and statements to the press and talks on the subject in factories did much to allay public anxiety. The incidence of measles dropped considerably from the record figure of 1961, which was in accordance with the biennial pattern of the disease. Dysentery increased, as in other parts of the country, in spite of the work done in raising hygiene standards. A considerable amount of work was done in promoting clean food. Most proprietors of food premises remedy contraventions of the Food Hygiene Regulations as soon as their attention is drawn to them, but five who would not co-operate and one who obstructed a public health inspector were prosecuted. The No. 4 (Harlesden) Smoke Control Order came into operation in October, continuing the Council's phased programme of clearing the atmosphere of smoke pollution. Doubts have been raised about the effectiveness of this approach in removing the causes of bronchitis from the air, and it is encouraging to note that the results of a survey carried out in London during a smog episode strongly suggest that the reduction of the solid matter had a beneficial effect, even though the sulphur dioxide content was little changed. It is disturbing to note a further increase in the number of deaths from cancer of the lung and bronchus. The Report of the Royal College of Physicians on this subject, and vigorous propaganda with small financial backing, has obviously made little headway against the eleven million pounds spent by the tobacco industry on propaganda, combined with the apathy of smokers. The Willesden Old People's Welfare Committee has further extended its services for the aged, and is doing invaluable work towards achieving the goal in which old age is a time of fulfilment and not of despair. Malnutrition is a common problem in the aged, and it is pleasing to note the increase in the number of meals served in luncheon clubs and by the Meals on Wheels Service. This is a problem which has caused some anxiety to those in charge of the old people's clinic at Neasden Clinic, and though many patients have been referred to these services, there is a proportion who are unwilling to take advantage of them. There is a need for a change in the Regulations so that welfare foods and vitamin supplements are available to them on the same terms as to mothers and young children. The clinic itself continues its useful functions of discovering the problems and disabilities of the aged, which they so often tend to keep to themselves, and arranging help so that they can continue to lead independent lives. Housing remains one of our most serious problems. It is impossible to assess in full the mental and physical harm stemming from this cause, but it is certain to be considerable. It is too early to say to what extent the Housing Act, 1961, will help in improving housing conditions and in controlling overcrowding. Living in overcrowded conditions is frequently the lot of the coloured immigrants to Willesden. This and the problem of race prejudice has occupied the attention of the Willesden International Friendship Committee, which is doing invaluable work towards racial integration. The problem of tuberculosis is still with us. It is perhaps a good thing that we should keep reminding ourselves of this since the effectiveness of chemotherapy, B.C.G. vaccination, pasteurisation and so on tend to make us think that the battle has been won. Much work lies ahead before this scourge is finally defeated. There were twenty-four suicides in Willesden in 1962, a tragic waste of life which so far we have not had much capacity to prevent. It is encouraging to learn, therefore, that the Willesden Council of Social Service, among its many useful activities, is working towards the setting up of a branch of the Samaritans in the borough. This organisation already exists in other parts of the country and in Europe and Asia, and is a useful field in which the churches can work together. The "Nursing Times" of 3rd May, 1963, mentions a drop in attempted suicides in Bournemouth by 50% the year after the Samaritans started there, and in West Berlin an average of thirty-three on New Year's night dropped to four. The Samaritans' policy of offering friendship to people going through a period of depression, referring more difficult cases to other agencies, has proved helpful to many, and has not shown the disadvantages that some might have expected where comparatively untrained workers deal with emotional problems. It is important to remember that, for the most part, unhappiness arises not from mental disease, but from an inability to cope with the difficulties of everyday life; and here friendship is usually all that is needed until the crisis is past. The improvement in the dental service is reassuring, but it is depressing to see the amount of avoidable suffering caused by dental caries. Fluoridation of water supplies would reduce this by a third to a half. The Willesden Home Safety Committee has further developed and expanded its work. Its members, who come from different walks of life, have combined their experience and skills to bring to the notice of the public the many dangers which surround them in everyday life, and the ways in which these might be avoided. The increasing success of their efforts tends to conceal, however, how few people there are to do the essential work, and the Committee has now reached the stage when it will be unable to expand its work unless there are more members. A large number of local organisations have undertaken to send representatives to its meetings, but only a small proportion actually do so. It is to be hoped that they will remedy this situation, and that many other organisations will also participate in this interesting and useful work. Finally, appreciation is due to the staff for their loyal and enthusiastic endeavours during the year, and sincere thanks and gratitude to all members of the Council, particularly the members of the Health Committee, who have played such an important part in the health and welfare of the people of the borough. I have the honour to be Mr. Mayor, Ladies and Gentlemen, Your obedient servant, E. GRUNDY, Medical Officer of Health. 3 STATISTICS AND SOCIAL CONDITIONS OF AREA Population estimated, 1962 (30th June) 171,230 Population census, 1961 171,001 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) 44,240 Rateable value (1st April, 1962) £3,212,716 General rate in the pound for the year 1962/63 22s. 6d. Product of a penny rate £13,089 VITAL STATISTICS Registered live births: Male Female Total Legitimate 1,764 1,756 3,520 Birth rate per 1,000 estimated resident population Illegitimate 379 356 735 Crude 24.8 Total 2,143 2,112 4,255 Adjusted 23.3 Registered stillbirths: 51 42 93 Rate per 1,000 (live and still) births 21.4 Deaths: 985 914 1,899 Death rate per 1,000 estimated resident population Crude 11.1 Adjusted 12.1 Death rate of infants under one year of age: All infants per 1,000 live births 20.4 Legitimate infants per 1,000 legitimate live births 19.9 Illegitimate infants per 1,000 illegitimate live births 23.1 Death rate of infants under four weeks of age: All infants per 1,000 live births 15.3 Legitimate infants per 1,000 legitimate live births 14.2 Illegitimate infants per 1,000 illegitimate live births 20.4 Maternal mortality: Deaths from puerperal causes— Puerperal sepsis Nil Other puerperal causes Other maternal causes 3 Maternal mortality rate .9 per 1,000 live and still births Deaths from: Males Females Total Cancer (all ages) 242 169 411 Measles (all ages) - - - Whooping cough (all ages) - - - Diarrhoea (under 2 years of age) 1 - 1 4 Births There was an increase in the birth rate for 1962 above that of England and Wales, which was 18.0 per 1,000. Deaths There was a slight increase in the death rate for 1962, and it was a little below that of England and Wales, which was 11.9 per 1,000. The causes of death are shown in Table 1. Infant mortality In 1962, 87 children died in the first year of life (57 in the first week and another 8 in the first month). There was a rise in the infant mortality rate, as compared with last year's figure (from 17 to 20), but this was lower than the rate for England and Wales (21). Stillbirths, however, also rose from 18 to 21, which is higher than the figure for the country at large (18). However, in view of the comparatively small population involved, these changes are not likely to be significant. (Table 2). (a) By wards (Table 3) Brentwater has kept its place as the best ward and has even improved its rate. Carlton, which used to be the worst (29 per 1,000 in 1958-60) has steadily improved its figures to 15. It is possible that this is a result of the Council's extensive redevelopment scheme, and since it is not yet complete it will be interesting to see if the trend continues. There have been some variations in the rates for the other wards, but no definite conclusions can be drawn from them. Housing conditions are improving, but, on the other hand, old houses which were adequate for one family tend to become overcrowded when let for multiple occupancy. It is to be hoped that the new powers conferred on the local authority by recent legislation will help to control this problem. (b) By social class (Table 4) A greater number of deaths (76) occurred in the three lower social classes compared with only four in the two upper classes. (c) Causes of death (Tables 5, 6, 7 and 8) Prematurity accounted for over one-third of the infant deaths. Congenital malformations accounted for 19 of the deaths. Seven of these were due to congenital heart defects and a number had unspecified congenital lesions. Six deaths occurred from birth injuries, five of them in the neo-natal period. It is possible that the 12 deaths from respiratory conditions in children of more than one month might have been prevented. A two-weeks-old baby died from pneumococcal meningitis, and a seven-weeks-old boy died of cerebral contusion and was found to have multiple injuries, though there was no indication as to how he came by them. General. There are many causes of infant mortality, and it is not always possible to cite a particular factor as being responsible, but there is a strong probability in the case of a mother suffering from toxaemia of pregnancy who refused to go into hospital until an emergency developed. A premature baby was delivered by caesarean section who died aged two days. Avoidable factors were present in the cases of three mothers who did not attend for ante-natal care, one of them producing a baby who died of icterus gravis neonatorum. Social conditions also seemed to play a part where two unmarried mothers aged 16 were concerned. These are examples of cases in which improvement in social education and responsibility might 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 to the Health Department and the Health Clinics are collected and taken to the laboratory in Neasden Hospital. A report by telephone is given to the doctor as soon as possible, followed by a written report. Samples of milk, ice cream, and water are sent by Public Health Inspectors. Four of the unsatisfactory samples of water came from the Granville Road Baths, three from Gladstone Park Baths, and two from King Edward VII Baths. Two of the unsatisfactory results were traced to faecal contamination of water by persons using the baths, but it was not possible to give a reason for the remainder as there was no breakdown or temporary difficulty with the plant. The other two unsatisfactory samples came from the Paddling Pool at 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 Uncleanliness and scabies (Table 10) Since September, 1952, treatment for scabies, lice and nits has been carried out by arrangement with the Middlesex County Council at the Stonebridge Health Clinic. From April this year cases have also been treated at the Chichester Terrace Clinic. As compared with 1961 there has been an increase in the number of children treated for lice and nits. However, the numbers treated are still small, and there is no evidence of a significant increase in the prevalence of these conditions among the population. 5 Establishment for Massage and Special Treatment The registration of establishments for massage and special treatment is delegated to the Borough Council under Part XII of the Middlesex County Council Act, 1944. During the year four new licences were issued and 22 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, gave talks in schools (table 11). Brains trusts were held at the end of each term, which enabled the children to ask questions which it had not been possible to answer adequately during the lectures. The questions which they put to the panel at these brains trusts showed quite clearly that the children were interested in the subject and that they had gained much useful knowledge of health matters. At the health clinics mothercraft classes were held, and doctors, midwives and nurses gave many talks, some illustrated with filmstrips. These talks were most useful in helping mothers to care for themselves and their babies. Health visitors also gave more specific individual health education in the mothers' homes during their routine visits (table 12). The Mothers' Club held at Stonebridge Health Clinic has been successful and much appreciated. Health workers themselves need post-graduate education. Films were 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 were held regularly, and the interesting discussions that followed many of them have been most valuable in keeping staff abreast with recent advances in technique in their special subjects. Students studying at the University of London Institute of Education for the Diploma in Health Education visited Willesden on 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 this year the number of requests received by the department decreased considerably. Television and "bingo" probably contributed to this decrease, but nevertheless eight talks were given and these were fairly well attended and greatly appreciated. To compensate the decrease in the number of lectures given to social, religious and political organisations, the department arranged more talks to factory employees. The Medical Officer of Health and his deputy gave these talks during lunch-hour breaks and they were well attended and very useful (Table 11). 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 1961 and 1962 is shown in Table 13. Dysentery In common with the remainder of the country, there was an increase in the number of cases of sonne dysentery during the year. Generally the disease is much more prevalent than before the war, but it is usually a mild disease causing no deaths although it can produce some disruption and discomfort in the life of the community. There were two small outbreaks:— (1) The first occurred at Mortimer Road Day Nursery on the 11th May. Altogether 19 children and one member of the staff were affected. They were all excluded and one child was admitted to isolation hospital for treatment. The infection was quickly cleared up and all the children were re-admitted by the middle of June. (2) The second outbreak occurred at the Longstone Avenue Day Nursery on the 4th June. Altogether, 25 children and one member of the staff were affected. They were all excluded and two children were admitted to hospital for treatment. The infection took a long time to clear up and it was the end of August before all the children were re-admitted. 6 Food poisoning There were no outbreaks of food poisoning. The number of cases confirmed (21) was the lowest figure since 1957, when there were 20 confirmed cases. Malaria Five cases of malaria were notified and confirmed but in each case the disease was contracted while the patient was abroad. Ophthalmia neonatorum There was no impairment of the vision in the four cases of ophthalmia neonatorum. Poliomyelitis There were five confirmed cases of poliomyelitis (four females, one male), all paralytic. The four females were aged 5, 7, 10 and 27 years. The man. aged 40 years, was unfortunately a fatal case, the cause of death being respiratory paralysis. Typhoid fever Two cases of typhoid fever were notified and confirmed. In each case the disease was contracted while the patient was abroad on holiday. Whooping cough The incidence of whooping cough decreased in 1962 compared with the previous year. The case rate per 1,000 population (.22) was a little above that of England and Wales (T8) (Table 14). The number of confirmed cases was the lowest recorded since the disease became notifiable on 1st October, 1917. 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 for 38 degrees Centigrade) has occurred within 14 days after childbirth or miscarriage". The number of cases notified (157) was almost the same as last year (158). Smallpox There were no notified cases of smallpox. Forty-eight contacts of the disease were kept under surveillance for 21 days from the last date of contact. In accordance with the International Sanitary Regulations the signatures of doctors on 9,095 certificates of vaccination were authenticated by the department. 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 of 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". Over the last 15 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 1962 was 13 times that from tuberculosis, and from bronchitis 14 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 six deaths from pulmonary tuberculosis among men and four deaths among women with the now usual shift to the older age groups. There has been a slight increase in notifications of tuberculosis (Table 15) compared with last year, but the total number of cases on the register fell to 1,876. There is still no cause for complacency; tuberculosis has not yet been defeated, 7 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 trebled in the last 15 years, and there is a marked sex difference; for every woman, six 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. 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. It is hoped that the establishment of smoke control areas under the Clean Air Act (see page 10) will lead to further improvements. Some 15 to 20 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 third winter the Group Clinic for the prevention of bronchitis, started in 1960 by Dr. C. H. Wood, Department of Occupational Health, London School of Hygiene and Tropical Medicine, has been continued under the auspices of the Willesden Chest Clinic. By arrangement with the Middlesex County Council the Clinic is held one evening a week at Pound Lane 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, inoculated against influenza, helped to stop smoking and given an "Airwick" bottle containing ammonia for use at home during fog. The clinic has had a number of visitors who are considering starting similar activities in other areas. 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: 20% 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 their resistance to infection, very necessary during adolescence when the risk of infection is higher and many new stresses have to be faced. About 80% of school leavers were found to need B.C.G. and practically all of them (94%) 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 Five workplaces were visited by the Medical Officer of Health and 36 immediate contacts of active cases were encouraged to attend for examination by the Mass X-ray Unit at the Central Middlesex Hospital. They were all found to be free from infection. 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 cooperation 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 8 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. The arrangements for sewage disposal are adequate and also those for sewerage with minor exceptions due to local flooding associated with severe storms. Remedial works are under consideration. Refuse disposal The Borough Engineer's Department deals with the provision of dustbins. Refuse is disposed of by controlled tipping at Yiewsley; house refuse is collected weekly and trade refuse as often as required at an agreed charge. Household arrangements The decennial census was taken on the 24th April, 1961, and when the results are published much useful information on Willesden's housing problems will be available to the Council. The census report for the County of Middlesex published in 1951 and the housing report for England and Wales clearly showed Willesden's problem as compared with the rest of the 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 and 2 persons per room is the highest in the county, in some instances the percentage is more than double. (b) Bathrooms The proportion of households either sharing or without a fixed bath (six out of ten) is almost double that of the average of the county, and is much higher than that of Greater London and England and Wales (about four out of ten). The proportion sharing or without a water closet, cooking stove or a kitchen sink is higher than the average for the County of Middlesex. Gardens Willesden is poorly equipped with public open spaces; 242 acres compared with an estimated need of 1,313 acres; yet one in four families have no garden at all, and a large number have to share a garden. Swimming baths The Borough Engineer has kindly supplied the following information in respect of the three swimming baths in the borough. The water for filling the baths is obtained from the mains supply. It is regularly chlorinated and plant of sufficient capacity to insure breakdown conditions is installed at each bath. The capacity of each bath and the time taken for the whole of the water to pass through the filters and treatment plant is as follows:— Capacity (gallons) Time taken for water to pass through filters, etc. (hours) Granville Road Baths 145,000 3½ Gladstone Park Swimming Pool 500,000 11 King Edward's Recreation Ground Swimming Pool 350,000 6½ 429 samples were taken, 10 of which were unsatisfactory (See Public Health Laboratory Service, page Swimming bath Samples taken Satisfactory Unsatisfactory Granville Road 260 256 4 Gladstone Park 80 77 3 King Edward's Park 89 87 2 9 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. III for those who have the Meat and Other Foods Certificate as well. At the beginning of the year there were two vacancies on APT. II or APT. III and during the year one Inspector on APT. III and three on APT. IV resigned. In spite of several advertisements, no applications for the vacancies were received and at the end of the year the Council were considering what action to take to rectify the position. Three pupil public health inspectors were on the staff at the beginning of the year, One qualified, received his certificate and took up an appointment with another authority, leaving three vacancies. The Rodent Officer and three operatives are employed in the destruction of rats and mice and two labourers on disinfestation, disinfection, drain testing and general duties. SANITARY INSPECTION OF THE AREA The majority of houses inspected during the year followed complaints from tenants; there was no systematic house-to-house inspection. Unfortunately many tenants approach the Public Health Department only when the defects are serious and costly to remedy. Details of inspections carried out are shown in Tables 29 and 30. Four Inspectors were engaged on special surveys, one on the Church Road Comprehensive Redevelopment Area until it was completed, one on the south part of Carlton Ward and two on the smoke control areas. Demolition and Closing Orders (Table 25) One demolition and two closing orders were made during the year. Slum Clearance and Area Redevelopment During the year the survey of the Church Road Comprehensive Redevelopment Area, bounded by Craven Park, Church Road, Neasden Lane and the L.M.S. Railway, was completed. The survey of the remainder of Carlton Ward south of Carlton Vale continued, but was brought almost to a standstill in the latter part of the year owing to shortage of staff. Overcrowding There has been little change in the extent of overcrowding which still remains acute. Only one licence under section 80 of the Housing Act, 1957, was 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). Four notices under section 90 of the Housing Act, 1957, were served on the owners of 28 St. Paul's Avenue, 230, 232 and 234 Willesden Lane, requiring them to abate overcrowding. Notices served under the Public Health Acts, 1936 and 1961, and Housing Acts, 1957 and 1961 There was a slight increase in the number of statutory notices served during the year compared with 1961 (Table 28). One management order under section 12, Housing Act, 1961, was served during the year, and the Housing (Management of Houses in Multiple Occupation) Regulations, prescribing the standards of management to be maintained by the manager of the house, were applied. 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. 10 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. 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 Minister of Housing and Local Government in February, and came into operation on 1st October, 1962. In April, the Middlesex County Council stated that the proposed Harrow Road Diversion Scheme had been included in the 1965/66 programme of major road works submitted to the Ministry of Transport. This scheme will involve the demolition of 196 properties in the No. 4 Area, affecting 292 dwellings, 24 commercial and one other premises. The Council therefore decided that these premises should be exempted from the Order and a Variation Order was submitted to the Minister on 12th November, 1962. 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 4 1.10.62 210.8 3,667 412 910.3 11,702 1,078 The No. 5 (Manor) Smoke Control Area, covering 355 acres, with 4,192 dwellings, 105 commercial and 16 other premises, was confirmed by the Council in October and was submitted to the Minister of Housing and Local Government. The proposed date of operation is 1st November, 1963. The Council decided that 23 properties which are due to be demolished during the next few years should be exempted from the Order, and also 114 prefabricated Council dwellings should be given exemption from having means of smokeless ignition and the occupiers be allowed to use sticks and paper for lighting fires. These dwellings, which are due to be demolished during the next few years, are all fitted with fireplaces which can burn solid smokeless fuel, but not fitted with gas ignition. The volumetric analysis of sulphur dioxide in the air has continued at the Willesden County Grammar School and in the Public Health Department. The results are sent to the appropriate section of the Department of Scientific and Industrial Research each month. Thirty-six notifications of the installation of new boiler plant were received in accordance with the provisions of section 3 of the Clean Air Act. The Council is represented on an Inter-borough Smoke Control Liaison Committee, which includes delegates from Hammersmith, Fulham, Brentford and Chiswick, Acton, Barnes and Richmond Councils, and meets at Hammersmith Town Hall. 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 202 Borough Council properties 9 Private dwellings 828 Total 1,039 at the following cost:— Business premises £1,600 11 6 Private dwellings £2,159 1 9 Total £3,759 13 3 11 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. Ten were new agreements and 112 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 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 inspect food premises regularly 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 and 36). The proprietors of five food premises were prosecuted for contraventions of the Food Hygiene Regulations, with the following results:— (a) 5 contraventions: 2 dismissed, 3 proved—fined £20 with £3 3s. Od. costs; (b) 7 contraventions; all proved—fined £84 with £5 5s. Od. costs; (c) 22 contraventions: all proved—fined £44 with £5 5s. Od. costs; (d) 10 contraventions: all proved—granted absolute discharge in 1 and two defendants each fined £27 with £2 12s. 6d. costs; (e) 10 contraventions: 1 dismissed, 9 proved—granted absolute discharge in 2 and fined £17 with £5 5s. Od. costs. Proceedings were commenced to have the occupier of a cafe disqualified from using the premises, in accordance with the provisions of section 14 of the Food and Drugs Act, 1955. Before the proceedings could be heard, however, the occupier ceased to use them and no further action was taken. The proprietor of a self-service store was summoned under section 105(1) of the Food and Drugs Act, 1955, for wilfully obstructing a Public Health Inspector in the execution of his duties. He was fined £5 with £3 3s. Od. costs. Premises where food is prepared Premises which manufacture or sell ice-cream or prepare or manufacture sausages, potted, pressed, pickled or preserved foods, including cooked meat or fish intended for sale, must be registered by the Council. If the Council refuses or cancels a registration, the owner can appeal first to them and if unsuccessful to a court of summary jurisdiction (Table 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 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 ton, 18 cwt., 1,623 tins and 1,026 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. The proprietor of a self-service store was prosecuted under section 8 of the Food and Drugs Act, 1955, and given an absolute discharge, for exposing for sale nine pork and three mutton chops which were unfit for human consumption. Contaminated food Fifteen specimens of contaminated food were dealt with by the department. They included foreign matter in a bottle of milk, in a jar of beverage, and in a bread roll; cigarette end in a chocolate drink, and in a packet of chips; mouldy growth on a malt loaf, and in a meat pie; maggots in a box of dates; paper in baby food; glass in Frankfurter sausage; rag in corned beef; insects in egg mandles; larva in raisins; mites in cheese; and unwholesome tripe in sauce. No action was taken in two cases because of insufficient evidence; of the remaining 13, 10 firms were cautioned and the Council decided to prosecute the other three. In one case, however, proceedings were not taken because the complainant refused to give evidence. The results of the two prosecutions were as follows:— 1. Fined £10 0s. Od. with £5 5s. Od. costs for selling chips containing cigarette end; 2. Fined £20 0s. Od. with £6 6s. Od. costs for selling a meat pie containing mould. 12 Clean food sampling Food and Drugs Act, 1955 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 12 firms concerned in the 17 samples found to be unsatisfactory, three were prosecuted and no action was taken against the other nine. Six of the unsatisfactory samples of meat were minced beef containing a preservative, which is not permitted. Two butchers were involved and both were prosecuted. One was fined £10 with £7 7s. Od. costs, and the other was fined £28 with £8 10s. Od. costs. Another butcher who sold best end of neck of lamb as loin of lamb was prosecuted and given a conditional discharge on payment of £3 3s. Od. costs. A sample of whole lemon drink contained sugar and saccharine but the label suggested that the only sweetening matter present was pure cane sugar. The reference to sugar on the label is now omitted. No action was taken in the case of a sample of whisky found to be below 65° proof spirit as subsequent samples from the licensed premises were found to be correct. The four samples of vinegar and non-brewed condiment were deficient in acetic acid due to prolonged storage causing loss of strength. Advice was given as to precautions to be taken to prevent such losses. A sample of cheese spread made from cheese and butter was labelled "Cream and Cheese Spread" and the importer agreed to correct the label. Two samples of raspberry juice were found to be artificially flavoured and to contain no fruit juice. The syrup was produced in a private dwelling by an immigrant who was unaware of the requirements of the Food and Drugs Act and Labelling of Food Order. Production was stopped. A sample of vegetarian mincemeat was deficient in soluble solids. The retailer, who made the mincemeat on his premises was advised as to the revision of his recipe. Emulsifiers and Stabilisers in Food Regulations, 1962; Preservatives in Food Regulations, 1962 The effect of these Regulations is to define and limit the additives which are permitted and (in the case of preservatives) to extend the range of food and the type of preservatives allowed, but nevertheless closely controlling the quantity of such preservatives. No infringements were reported. The Merchandise Marks Acts, 1887-1953 355 premises were inspected and 1,025 displays of articles of food were examined. Minor infringements were dealt with by verbal warnings but official cautions were given to a retailer who marked Yugoslav bacon as "Danish," and to the packers of two samples of imported potatoes for failing to indicate the country of origin. Labelling of Food Order, 1953 441 premises were visited and 1,646 articles of pre-packed food were examined. A caution was sent to the packers of rice found to be on sale in plain bags bearing none of the information required by the Order. 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 and importers were reminded that the name and address of the packer or labeller and a declaration of ingredients must appear on labels. An ice-cream manufacturer who put the statutory declaration on the base of the carton was reminded that it must be conspicuous and prominent. Two advertisers of honey were required to declare that it was of foreign origin. The packers of lamb chops were required to declare in half-inch letters that the chops were of foreign origin. The manufacturers of five cake mixes amended their labels to indicate that egg or milk must be added before the mixes could be used. A manufacturer who claimed "slimming properties" for lemon juice deleted the claim from his labels. Corrective action was secured for the description applied to cream cheese, tinned rice, tinned cream, canned meat, breakfast cereals, ice lollies, chopped pork and butter mintoes. Cautions were given to the manufacturers of sodium fluoride tablets deficient in the stated amount of the chemical, although this did not impair the efficiency of the tablets; to the manufacturers and importers of instant coffee because it contained sulphur dioxide, a preservative not permitted at the time; and to the manufacturers of dried apricots containing an authorised preservative which was not declared. Milk and Dairies Regulations and Milk (Special Designation) Regulations 131 samples of milk were obtained to ensure that heat treatment was properly carried out; all were satisfactory. 141 inspections were made of premises where milk was processed to ensure compliance with the Regulations. 48 milk bottles from a processing dairy were tested to ensure the efficient operation of the bottle-washing plant; they were found to be satisfactory. A sample of pasteurised milk was found to be sour on testing but no action was taken as there was no evidence whether the milk was sour when sold or subsequently became sour. Subsequent samples were satisfactory. Cautions were issued to a dairyman who supplied milk to a school with fly puperia adhering to the inside of a bottle, and to another who also supplied milk to a school with a stain on the inside of a bottle similar to that made by wax crayons. 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. 13 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. 105 persons are registered by the Council to trade as distributors and three premises are registered as dairies. Twenty-eight inspections were made of the three dairies; the two defects found were quickly remedied. 186 samples of milk were submitted for bacteriological examination (see Table 9). Three dirty milk bottles were reported by the public and three by other local authorities. The Council issued official cautions in respect of four and referred two to the local authority in whose district the milk was bottled. FACTORY INSPECTION There was a decrease of eight 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 and 41. One firm was prosecuted for contravening section 7 of the Factories Act, 1961, and Regulations 5 and 6 of the Sanitary Accommodation Regulations, 1938. They were granted an absolute discharge and the Council were awarded £3 3s. Od. costs. Basement bakehouses The local authority is responsible for the supervision of basement bakehouses under the Factories Act, 1961. 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 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. 180 were employed during the year, the largest number, 106, altering and making clothing. Public Health Inspectors inspect these workers' homes, which were all found to be satisfactory (Table 42). Noise nuisance The Borough Council deals 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 nuisances 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 have carried out observations at all times of the day and night to determine whether complaints of noise nuisance were justified or not. 53 complaints were received during the year, of which 29 did not constitute a nuisance within the meaning of the Act. 13 were repeated complaints and 11 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, locomotive shunting, truck unloading, power saws, coin-operated laundry, steam crane, power sewing machines in domestic dwellings, inconsiderate neighbours and loudspeakers. CARE OF THE AGED The proportion of old people in the community is increasing and it becomes more urgent and necessary for the medical and welfare services to be extended to care adequately for them. The majority of old people are living alone, but they can manage to look after themselves in spite of 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 old people and arrange for the necessary services to be given. Old People's Clinic An experimental old people's clinic was opened at Pound Lane Clinic in February, 1961. It was transferred to Neasden Clinic in June, 1961, and held at the same time as a chiropody clinic. The clinic was established to give advice to old people on problems of physical and mental health. Thirty-nine sessions were held during the year and 57 old people were seen, making 128 attendances. Thirty-one cases were referred by health visitors, nine by the Old People's Welfare Organiser, two by general practitioners, two by relatives, and 13 attended of their own accord. Old people who failed to keep an appointment were visited to see if there had been any deterioration in their condition. 14 Good relationships have been maintained with family doctors. A report on the action taken in each case was sent to them and 13 cases who had defects, including bilateral cataract, arthritis, cardiac failure, hernia, dysuria, bronchitis, varicose ulcers, erysipelas, hallux valgus and septic bunions, were referred for treatment. Chiropody treatment was arranged for 45 cases; five were referred to the Old People's Welfare Committee for a holiday; three to opticians for eye test and new glasses; three to the local health authority (two for home help and one for home nursing); two to the Welfare Department for appliances; one to the National Assistance Board for a supplementary allowance; one to the W.V.S. for additional clothing; one to hospital for hearing aid; and one for dental treatment. Advice was given on housing and diet; a few grossly obese rejected the idea of dieting and tended to stay away from the next appointment. A few suffered from deficiencies in their diet and would have benefited by the addition of "Complan," iron and B Group vitamins. On the whole, the old people attending were depressed, either from living alone or in unsuitable accommodation, and therefore rather introspective regarding their minor disabilities. The clinic fills a need in helping the elderly to live happy and independent lives. The friendly, leisurely atmosphere makes them very willing to accept help on health and welfare problems. Hospital treatment Generally speaking, it is now easier to obtain admission for an aged patient, and the geriatric physician and his almoner work in close co-operation with the local health and district authorities. However, there is still a great need for more hospital accommodation. Compulsory powers for removing old people to a hospital or hostel are only used when absolutely necessary, and then only after all other possibilities have been fully explored. Seven cases were investigated during the year and six required further action. Four of them were made comfortable in their own homes by the provision of additional services, such as Home Help, Home Nurse, Laundry Service and Meals on Wheels. Two needed hospital treatment but it was only necessary for one to be removed compulsorily under the National Assistance Acts, 1948 and 1951, as the other agreed to go into hospital voluntarily. Miss A. B., aged 78 years, was housebound, suffering from cardiac failure, secondary to ischaemic heart disease, senile dementia, cerebral arterio-sclerosis and malnutrition. She was being looked after by an aged friend, who was unable to give her the care and attention she required. The two old ladies had been kept under observation for two years and a great deal had been done to help them. New bedding and clothing had been provided, cleaning materials, a home help had been sent, and the Meals on Wheels service provided meals, but Miss A. B.'s condition had been slowly deteriorating. They refused to have the laundry service and eventually the home help. The accommodation became insanitary and finally an order under the National Assistance (Amendment) Act, 1951, was obtained from a Justice of the Peace on the 31st January, and Miss A. B. was removed to the Central Middlesex Hospital the same day. 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 is to do their laundry. In April, 1952, the Counoil 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 the Neasden Hospital by arrangement with the Central Middlesex Group Hospital Management Committee, and transport is provided by the Borough Council. Due to increased costs, the Management Committee increased the charge for laundering and ironing from 4¼d. to 5d. per lb. from 1st April, 1961. 6 tons 16 cwt. of laundry were 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 1.1.62 New cases Died Admitted to hospital Recommenced after discharge from hospital Discontinued On register 31.12.62 34 40 19 19 4 3 37 Voluntary Services for the Aged The "49" Club organised by the Willesden Old Folks' Association celebrated its tenth anniversary in February. The Club still has a substantial membership and is open daily from 1.30—10 p.m. Several firms gave donations to the Association's funds. One hundred members and helpers went for a day trip to Clacton in July. Voluntary visitors visited 12 old people weekly or fortnightly. Lonely housebound old people greatly appreciate the services, which include shopping, reading, general conversation, and tidying the room. Forty-four parcels of imperishable food were made up and distributed to the housebound by Middlesex County Council nurses and health visitors from 232 articles of food given by the children of Malorees School after Harvest Thanksgiving. From the 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 treatments in their own surgeries. An additional chiropodist in the Neasden area commenced working for the Association during the year. Treatment will be carried out at the clinics when the County Council appoint their own chiropodists. 15 The service is still in great demand, and 3,614 treatments were given by the five chiropodists. New applications receive initial treatment and are then placed on a register for periodic visits. In addition, 263 treatments were given to the housebound, and much credit is due to the Kilburn chiropodist who carries out this work. 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 £1,511 in the financial year ending 31st March, 1963. A grant of £1,411 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 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 Service, is one of the most important services for old people. The Willesden Old People's Welfare Committee took over the cooking of meals from the W.V.S. in November, 1961, when the Kensal Rise Senior Club, with its spacious and well-equipped kitchen was opened. 11,989 meals were prepared and delivered, compared with 11,346 in 1961. 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 and 140 of the old people had money or a parcel for Christmas. Willesden Old People's Welfare Committee The Willesden Old People's Welfare Committee was formed in April, 1958. The Committee has a membership of 19, ten representing the Willesden Borough Council, two the Middlesex County Council, and seven representing Willesden organisations concerned with the welfare of old people. A full-time Welfare Organiser, a Deputy and an assistant work together with statutory bodies and voluntary associations and organise services for the aged. The two centres operated by the Committee had their first full years working and have proved a great success. The Willesden Green Senior Club was opened to old people in August, 1961. 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, 1961. 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 500 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 buildings remains with the Council, the management being 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. 404 old people had holidays from June to September, including a number who received assistance from the Women's Holiday Fund. A holiday for several lonely old people was also arranged at the holiday homes at Christmas. The six luncheon clubs operating in the Borough at Granville Road Community Centre, Harley Road Gospel Hall, St. Michael's Church Hall, Knatchbull Road, Neasden Methodist Church Hall, Neasden Lane, and the Willesden Green and Kensal Rise Senior Clubs all had a successful year's work during 1962. 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 1/3d and 30,218 were served during the year. The old people enjoy a good hot, well-cooked meal and the opportunity of meeting friends. Investigations were carried out during the year into the establishment of further lunch clubs to serve those areas of the Borough not at present adequately covered. The Meals on Wheels service continued to be operated, in conjunction with the Women's Voluntary Service, from the kitchen at the Kensal Rise Senior Club. To meet demands on the service, it became necessary to introduce a third van into commission in 1962, and this was made available by the Borough Council. During 1962, 11,236 meals were delivered to housebound old people at a charge of 1/3d per meal to the recipient. 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 14 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 some 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. 101 parcels of produce were distributed by the Committee and 33 by private donor. 16 At Christmas nearly 1,500 Postal Orders to the value of 10/- were distributed to the over 70's who were in need. During 1962, "Operation Greenfield", under which housebound old people are taken into the country for the day, was initiated. In May and September, 83 old people were taken by car to Chertsey and Cuffley and Potters Bar where they were provided with refreshments. The problems which are brought to the office are varied and numerous and a large lumber 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 1962 Office interviews 715 1,139 1,724 1,905 Home visits 826 1,043 1,395 1,578 In addition 571 visits were paid to elderly persons who, it was revealed from the Registrar's returns, had suffered the loss of a partner. On the recommendation of the Welfare Organiser a number of wireless sets were supplied to the bed-ridden by the Wireless for the Bed-ridden Society. A number of reconditioned television receivers were also made available to housebound old people by the Committee. The Welfare Organiser acts as a referee to various charitable organisations and distributes monetary payments on their behalf. All the above services except "Operation Greenfield" are financed from a grant of £13,925 which the Council set aside for the Committee's use in 1962/63. Financial assistance from the Middlesex County Council towards administration and visiting costs amounted to approximately £1,000. BURIAL OF THE DEAD In accordance with the provisions of section 50 of the National Assistance Act, 1948, arrangements were made for the burial of eight persons during the year, at a cost of £91 12s. 0d., £48 16s. Od. being recovered from the relatives. PUBLIC MORTUARY Post-mortems were performed on 556 bodies, followed by an inquest in 97 cases. Fifty-five inquests were held on Willesden residents, but only two of these were held in the Coroner's Court attached to the mortuary. The remainder were held at Ealing. Inquests held on Willesden Residents At 1958 1959 1960 1961 1962 Kilburn 17 24 16 10 2 Ealing 61 38 53 61 53 Total 78 62 69 71 55 One of the two post-mortem tables became unserviceable and was replaced in November at a cost of £247 10s. 0d. 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). Sixteen licences have been issued to hawkers (14 selling fruit and vegetables, two selling fish). There were no new licences issued in 1962. 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. 17 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. 0d. is paid. There were no new registrations during the year. One registered business was discontinued leaving 14 premises on the register. The Act does not cover the re-making of an article, and dirty materials may be used in upholstering articles being repaired. Four samples of filling materials were taken during the year and they proved to be satisfactory. PET ANIMALS ACT, 1951 The owners of pet shops must obtain an annual licence costing 10/-. The shops are inspected by both Public Health Inspectors and Shops Act Inspectors: Public Health Inspectors inspect premises for size, lighting, ventilation and cleanliness, and for the precautions taken for preventing spread of infectious diseases. During 1962, 14 pet shops were licenced. STAFF MEDICAL EXAMINATIONS Seventy-five medical examinations were carried out by the Medical Officer of Health and Deputy Medical Officer in connection with the admission of staff to the superannuation scheme. In addition, six speoial reports were made to the Council on manual staff who had prolonged periods of sickness. Three were retired on the grounds of permanent disability; the services of two, who were temporary employees, were terminated; and one was transferred to light work. 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 satisfactorily and has brought the work of the two departments more closely together. 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 1962 55% 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 domiciliary confinements 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 Wass2rman 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 four main clinics and at Chichester Terrace Clinic) 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 one afternoon a week at Pound Lane clinic, Stonebridge clinic and Neasden clinic; a health visitor conducts the classes at Kilburn clinic on one morning a week and at Chichester Terrace clinic on one afternoon a week (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 take up during labour and, therefore, gains further confidence. 18 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 hospitals or clinics. Child Welfare Clinics Child welfare sessions are held in seven clinics; 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 (Table 47). 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, tetanus and poliomyelitis. 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. 133 sessions were held and 715 attendances were made. The Stonebridge Clinic Mothers' Club formed eight 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 £35. The club continues to function with as much enthusiasm as ever. 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 a demonstration at T. Wall & Sons, food and cookery centre, and a branch of the United Dairies Ltd. at Blackfriars when the children were invited and tea was served. They have also been to a theatre, for an evening bus tour and with their children to a pantomime and a day's outing to Westcliff. A children's Christmas party was held, which was a great success. His Worship the Mayor and the Mayoress attended and they donated £5 5s. Od. to the club's funds. The eighth anniversary dinner held at Stonebridge was attended by 40 mothers who made the occasion most delightful by wearing a wonderful collection of hats designed and made by the wearers. An annual donation of £1 is sent to the Willesden Old Folks' Association. A door-to-door collection was arranged in aid of the National Society for the Prevention of Cruelty to Children and the proceeds, which amounted to £24, were given to the Society's funds and £1 1s. Od. was sent to the Oxford Famine Relief Fund out of the club's funds. The mothers feel that this club continues to fulfil a great need in the Stonebridge area, as there does not appear to be a similar sort of club where education and social welfare flourishes side by side in such a congenial and friendly atmosphere. 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 1960 an additional trained worker, half-time, was employed and this assistance is still being given. Altogether 50 families have been referred; 29 were found suitable for dealing with by the Family Service Units, 17 were found to be unsuitable, three refused help, and one was referred to the Child Guidance Clinic. Of the 29 families, two removed out of Willesden, three have been referred to the care of the National Society for the Prevention of Cruelty to Children, one was in a position to carry on without further support and one was rehoused, and as this had been the major problem, it was considered help was no longer needed. At the end of the year the Family Service Units were dealing with 22 families. During the year, 1,431 contacts with these families and 860 contacts on behalf of these families were made by the staff of the Family Service Units. The families receiving help are long term, but of these two have now been closed. 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 have been held during the year by the workers from the Family Service Units, the N.S.P.C.C. Inspector, other social workers, assistant medical officers and health visitors. Reports are exchanged, the families are discussed and suggestions for helping them are made. MIDWIFERY SERVICE At the beginning of the year the Middlesex County Council employed six midwives in Willesden. During the year two midwives left and three midwives were appointed, making a total of seven at the end of the year. Three or four pupil midwives work for three months at a time in Willesden under the supervision of approved midwife teachers as part of their second period training for the Central Midwives' Board Examination. 19 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 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 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 approximately one-half of the deliveries (Table 49). 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 49). When labour tends to be long, pethidine or pethilorfan is given. This assists with relaxation and shortens the labour. Trichloroethylene is also 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 12 mothers during the year for the following conditions: six ante-partum haemorrhage, three retained placenta with haemorrhage, and three post-partum haemorrhage. The Hammersmith Hospital premature baby unit provides a special ambulance for premature babies who require treatment in this u nit. The ambulance with two qualified nurses trained in the care of premature babies carries special equipment, including a fitted cot and apparatus for administering oxygen. The ambulance is sent for by the doctor who may be present at the confinement who has been called for medical aid by a midwife. Two babies were admitted to the unit during the year. The Middlesex County Council also provides similar equipment which is kept at the Willesden Ambulance Station and is sent out by ambulance and two ambulance drivers when it is required to take a premature baby into a hospital other than Hammersmith Hospital. The midwife in attendance at the confinement accompanies the baby to the hospital. Four premature babies were admitted to hospital during the year under these arrangements. In addition the midwives have assisted in the obstetric survey which is being carried out by the North West Metropolitan Regional Board, by completing questionnaires on certain groups of cases. The number of visits made by midwives to mothers and babies discharged early from hospitals was 900. They also answered calls made to them by general practitioners or the ambulance station to attend mothers booked under the Emergency Bed Service. HEALTH VISITING (Tables 50-52) The health visitor is the most important social worker for the care of expectant 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 College of Technology who are in training during the year. Health visitors work in close co-operation with general practitioners (Table 52), 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 Hospital give this advice under the supervision of the physician-in-charge. Twentyseven visits were made during the year to the 16 patients selected by the physician-in-charge for these health visitors. A number of health visitors 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. No students were sponsored for Willesden 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, four alternative telephone numbers are set out on the list which can be used for emergency calls at weekends and bank holidays, when the Area Health Office is closed. 20 Home nurses carry out treatment such as the general care of the acute and chronic sick, blanket baiths and injections for patients including children under five 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 make 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. A "Pilot Scheme" in which a home nurse worked directly with a group of general practitioners in Willesden was carried out during the year commencing on 1st February, 1962. The following report is on 11 months working of the Scheme. It was agreed that the experiment should be carried out in a group practice of four doctors with one home nurse to commence the scheme. The first meeting to discuss the working of the scheme was held on 8th January, 1962. The general practitioners said they would welcome such an experiment. The second meeting to discuss the progress of the scheme was held in May, 1962. It was agreed to extend the trial period for a further three months. One home nurse carried out the duties of the scheme for the first seven months, when they were taken over by another. Total number of cases attended by the nurses during the 11 months 1st February to 31st December, 1962 Brought forward 16 New cases 94 Total: 110 Total number of visits made 2,898 The type of cases attended were in most respects similar to those on any other home nurses' district, with a larger proportion of patients requiring general nursing care and supervision. Travelling time: The average mileage for a month compared favourably with other home nurses' mileage, who worked in groups of four and did relief duties within their group. Transport: The first nurse used a "Moped Scooter", the other used a car and was, therefore, better equipped for the scheme. Advantages of the Scheme (a) Closer working between the general practitioners and the home nurse brought about a better understanding of each patient. The nurse met the doctors at their surgery to receive her instructions and to discuss the work. (b) The scheme was liked by the group of general practitioners. Any extension of the scheme would be limited on account of the few practitioners who at present work group practices. However, it has revealed that it is necessary to have a closer liaison between general practitioners and home nurses. (c) The group of general practitioners were keen for this scheme to continue and the home nurse was willing to carrv on with this work and it accordingly remained in operation. 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 53). The total number of cases nursed during the year was 2,742. Number of cases brought forward from 1961 608 Number of new cases 2,134 Total: 2,742 Number of patients recovered 1,388 Number of patients died 288 Number of patients admitted to hospital 427 Number of patients remaining on register at end of year 639 Total: 2,742 The 2,742 cases were nursed for the following reasons: Abscesses (including boils) 134 Amputation of leg 5 Anaemia 202 Arthritis 189 Bronchitis (including pleurisy and influenza) 288 Burns 14 Cancer 286 Cardiac 344 Circumcisions 24 Complication of maternity 19 Cataract 7 Diabetics 101 Disseminated Sclerosis 37 21 Hemiplegia 208 Jaundice 3 Leukaemia 4 Otitis Media 46 Pneumonia 44 Post Abdominal Operation 51 Senility 125 Slipped Disc 12 Tonsilitis 70 Tuberculosis 52 Uterine conditions 13 Varicose Ulcers 83 Others (including impetigo, dermatitis, cuts, shingles and supervision of Foley's Catheters) 381 Total: 2,742 During the year the County Council approved the setting up of a scheme for training district nurses, to be based at Chiswick Polytechnic. The first course commenced on Monday, 17th September, 1962. Two home nurses working in Willesden attended the course. They were subsequently successful in the examination and qualified for the Ministry of Health's National Certificate in District Nursing. SMALLPOX VACCINATION Vaccinations are done by the staff at the health clinics and by general practitioners. The number of children under one year of age vaccinated, represents 35% of the total live births for the year (Table 55). 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. 2,983 children completed a full course of primary immunisation, and 1,079 received a full reinforcing injection. INOCULATION AGAINST POLIOMYELITIS In February, 1962, the Minister of Health announced the anticipated introduction of oral vaccine for routine inoculation. The recommended course of this vaccine consisting of three doses of three drops each, there being no reinforcing dose, was available at the clinics from 1st April. The reinforcing fourth injections of Salk vaccine for children between five and 12 years, suspended in October, 1961, due to shortage of vaccine, were resumed in April, 1962. One dose of oral vaccine could be used as an alternative to a fourth injection of Salk and 1,459 persons received such doses. Vaccination of persons in the priority groups continued. 8,236 completed a course of Salk vaccine and 2,118 had a complete course of oral vaccine. The demand from new cases was confined mainly to young babies, the inference being that the majority of people within the priority groups had already been vaccinated against poliomyelitis. HOME HELP SERVICE (Tables 56 and 57) Applications for the service again increased in 1962, although the number of cases being helped at the end of the year showed a slight drop. Eleven tuberculosis cases were assisted and help was provided free of charge to five mothers suffering from toxaemia of pregnancy. Ninety-one bookings were taken for home confinements, but only 55 were helped, the remainder making alternative arrangements. There were 78 home helps at the end of the year; their rate of pay was increased to 3s. ll|d. per hour. The charge to the public remained at 4s. 6d. per hour. Three persons were enrolled as neighbourly helps under the County Council's new scheme. Two of them were paid 15s. Od. weekly, and the third the maximum of £2 for assisting neighbours in small household tasks. The number of home visits made by the organisers was 4,484. DAY NURSERIES (Tables 58-62) The 390 approved places in the eight day nurseries, together with 30 places in York Park Day Nursery, Hendon, have been filled throughout the year. There is still a considerable waiting list. From 29th October, Chichester Road Day Nursery was closed and the children and staff transferred to the William Dunbar Day Nursery, Albert Road, N.W.6, a new nursery incorporated in a block of flats forming part of the South Kilburn Re-development Scheme. Twelve students completed the 2 years' period of training for the N.N.E.B. Course; 10 passed the examination and obtained the certificate. Two staff nursery nurses attended a course at Chiswick Polytechnic in March and obtained the Warden's Certificate. Recruitment of suitable trained nursery staff remains difficult. 22 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. Od. 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:— 1962 1961 Adults 98 106 Children 6 18 104 124 SCHOOL HEALTH SERVICE (Tables 63-74) Medical Inspection Routine medioal inspection in schools continued and it is pleasing to note that still fewer children were found to be in an unsatisfactory physical condition. Treatment for defects found at these inspections is available up to consultant level at the four school clinics. Handicapped Pupils Pupils continue to be admitted to the Lower Place Day Special School for the Physically Handicapped on application. Some pupils are admitted on a temporary basis following long periods of hospitalization prior to readmission to ordinary schools. The large immigrant population, many of whom have low educational attainments, has caused the demand for places at the Woodfield Day Special School for the Educationally Subnormal to increase. If no further accommodation is made available, long waiting lists are bound to arise. CHILD GUIDANCE (Tables 75 and 76) This is the first year the clinic has had the uninterrupted service of a Consultant Psychiatrist, which has meant the avoidance of long waiting lists for diagnostic procedure. Like many other child guidance centres there is a shortage of Psychiatric Social Workers. One hundred and thirty-four children were referred to the clinic for investigation, of which 41% were from medical sources, and it should be noted that 15% came from parents themselves. The distribution of problems is similar to that of last year. It is perhaps significant that about 30% of cases referred have problems primarily due to environmental factors. The waiting list of cases at the end of the year is not unduly long and compares favourably with the long waiting lists for which most child guidance clinics are notorious. Some concern is occasioned by the long wait for suitable residential placement. Although less than 10% are recommended the need is urgent in many of these cases. Placement is undertaken by the County Education Officer. The work of the School Psychological Service was enhanced by the appointment in September of an additional Educational Psychologist. 503 cases were seen, the largest number ever. Monthly conferences with school medical officers have continued when cases known to both teams are discussed. SCHOOL DENTAL SERVICE AND PRIORITY DENTAL SERVICE (Tables 77 and 78) There has been little change in the Dental Service during the year. It is, however, noteworthy that the ratio of fillings and extractions continues to improve, particularly with reference to permanent teeth. The staffing problem has been largely resolved, albeit with part time dental officers, and it is now possible to offer complete dental treatment to all school children and priority patients willing to accept it. CHIROPODY There has been a considerable back-log of patients, owing to an interval of 5 months when there was no full-time chiropodist. This has since been largely overcome. A great deal of work has been done for the 'Senior Citizens' and each clinic has been entirely booked and well attended Ln spite of bad weather. At the other end of the scale, a number of schools in the district have been visited and lectures with film strips given. Mothers in particular have been advised as to the most suitable type of footwear for their children if they are to avoid in future the foot malformations and discomfort from which the present generation suffers in large numbers. The present tendency towards sharp pointed shoes is to be particularly deplored. It is felt that there is great scope for preventive treatment of children in the case of chiropody. 23 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 1962/63. 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 annual 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. Four committee meetings and twelve meetings of sub-committees were held during the year. Subcommittees considered the future work of the committee: a song competition; the third edition of the Safety handbook; the Willesden Show; and the national and local campaign for 1963 on oil heaters. The third edition of the Committee's Home Safety Handbook was published in September, and by the end of the year more than 1,000 copies of the 3,000 printed had been distributed. Publication of a fourth edition is now being considered. Six thousand copies of a leaflet on "Safety in the Home" were distributed by the Housing and Estates Manager to Council tenants. At the Willesden Regatta held at the Welsh Harp in June copies were available of "Water Safety Code" and "Safety Afloat" published by the Royal Society for the Prevention of Accidents. During autumn and winter appropriate posters were displayed on Council notice boards in public libraries and in clinics. A children's poster competition was arranged with the co-operation of the Borough Education Officer. There was an excellent response and some remarkable posters were produced. Four prizes of engraved plaques were presented to the winners at the Willesden Carnival. The plaques were a gift from an anonymous donor. A display was exhibited at the Willesden Show in September which aroused tremendous interest. It depicted in a unique way "Safety in the Home", the main feature being a life-size model of a Spaceman. Several pairs of earphones were provided and the public were invited to listen to a broadcast from the commander of a space ship to the people of Willesden on home safety. A special leaflet was produced on "How to become a Spaceman", emphasising that safety and adventure must go together, to fit in with the theme of the stall. Considerable interest was also shown in the "Burns and Scalds" quiz board, and the winning posters from the schools poster competition. The Chairman and members attended to answer questions and distribute literature. Members of the Committee gave six talks to local organisations, and approximately 210 people attended. During the year a great deal of thought was given to the hazards caused in homes by oil heaters. There will be a special national campaign on the subject in 1963, and the Royal Society for the Prevention of Accidents invited the Committee to submit suggestions for the campaign and send specimen posters. As a result, a sub-committee was set up to consider suggestions for this campaign and also a local one. The Vice-Chairman and a member attended the Willesden Borough Council's Sixth Civic Forum in February; two members attended the National Home Safety Conference held at Central Hall, Westminster, in October; 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) 6 4 10 2. Tuberculosis (other) — — — 3. Syphilitic disease 1 1 2 4. Diphtheria — — - 5. Whooping cough — — - 6. Meningococcal infections 1 — 1 7. Acute poliomyelitis 1 — 1 8. Measles — — - 9. Other infective and parasitic diseases 2 4 6 10. Malignant neoplasm, stomach 34 21 55 11. Malignant neoplasm, lung, bronchus 116 18 134 12. Malignant neoplasm, breast — 43 43 13. Malignant neoplasm, uterus — 13 13 14. Other malignant and lvmphatic neoplasms 92 74 166 15. Leukaemia, aleuksemia 9 3 12 16. Diabetes 7 11 18 17. Vascular lesions of nervous system 71 107 178 18. Coronary disease, angina 224 134 358 19. Hypertension, with heart disease 17 24 41 20. Other heart disease 64 106 170 21. Other circulatory disease 28 62 90 22. Influenza 3 3 6 23. Pneumonia 47 80 127 24. Bronchitis 100 46 146 25. Other diseases of respiratory system 4 9 13 26. Ulcer of stomach and duodenum 12 7 19 27. Gastritis, enteritis and diarrhoea 1 2 3 28. Nephritis and nephrosis 5 5 10 29. Hyperplasia of prostate 6 — 6 30. Pregnancy, childbirth, abortion — 3 3 31. Congenital malformations 18 9 27 32. Other defined and ill-defined diseases 70 87 157 33. Motor vehicle accidents 14 3 17 34. All other accidents 19 21 40 35. Suicide 12 12 24 36. Homicide and operations of war 1 2 3 TOTAL 985 914 1,899 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 1962 171,230 4,255 87 20 21 93 21 18 Perinatal mortality 1955 35 per 1,000 live and still births „ „ 1956 35 „ „ „ „ „ ,, „ „ 1957 32 „ „ „ ,, „ ,, „ „ 1958 31 „ „ „ „ „ „ „ „ 1959 27 „ „ „ „ „ „ „ „ 1960 30 „ „ „ „ „ „ „ „ 1961 29 „ „ „ „ „ „ „ „ 1962 34 „ „ „ „ „ „ Table 3 Infant Mortality:—by Wards Ward Number of deaths Total 1960-62 Rate 1960-62 1960 1961 1962 Carlton 5 5 3 13 15 Kilburn 7 7 11 25 23 Brondesbury Park 1 8 9 18 20 Kensal Rise 5 3 8 16 23 Manor 1 2 7 10 12 Harlesden 11 10 9 30 23 Stonebridge 4 4 5 13 16 Roundwood 5 6 8 19 17 Church End 2 3 1 6 11 Willesden Green 3 6 11 20 20 Mapesbury 3 6 9 18 14 Gladstone 1 5 4 10 16 Cricklewood 4 2 2 8 13 Brentwater 2 1 — 3 6 54 68 87 209 17 26 Table 4 Deaths by Social Class I 2 II 2 III 38 IV 15 V 23 Not known 2 Not classified 5 Total 87 Table 5 Infant Mortality—Causes (Based on Registrar General's Figures) 1936-1939 1940-1945 1946-1950 1956-1960 1962 Deaths Rate Deaths Rate Deaths Rate Deaths Rate Deaths Rate Neonatal 1-12 months Total Respiratory 106 81 140 8.8 68 4.2 57 3.6 8 12 20 4.7 Diarrhoea and enteritis 131 10.0 108 6.8 37 2.3 3 .2 - 1 1 .2 Other infections 34 2.6 40 2.5 15 .9 5 .3 1 - 1 .2 Congenital malformations 83 6.3 89 5.6 72 4.4 55 3.5 13 6 19 4.5 Prematurity 170 13.0 179 11.3 99 6.1 72 4.6 30 - 30 7.1 Injury at birth 21 1.6 33 2.1 43 2.7 18 1.1 5 1 6 1.4 Other causes | 134 10.3 149 9.4 96 5.9 88 5.6 7 3 10 2.3 All causes 679 51.9 738 46.5 430 26.5 298 18.9 64 23 87 20.4 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 (32) 2 (0) 251 (25) 1962 19 (1) 298 (34) 3 (0) 317 (35) 27 Table 7 Premature births by wards Ward Premature births notified Percentage of live births in brackets Carlton 22 (7.6) Kilburn 29 (7.6) Brondesbury Park 21 (7.2) Kensal Rise 31 (1.1) Manor 22 (7.7) Harlesden 31 (6.2) Stonebridge 17 (6.1) Roundwood 34 (8.9) Church End 11 (5.9) Willesden Green 33 (8.6) Mapesbury 23 (5.3) Gladstone 18 (7.7) Cricklewood 15 (7.2) Brentwater 10 (5.8) Total 317 (7.4) Table 8 Infant Mortality : Congenital Malformations Band in jejunum 1 Heart disease 7 Multiple jejunal atresia 1 Anencephaly 1 Hydrocephalus 1 Encephalocele 1 Multiple deformities 2 Bilateral polycystic kidney 1 Congenital thrombocytopenia 2 Congenital bulbar palsy 1 Exomphalos 1 Total 19 28 GENERAL PROVISION OF HEALTH SERVICES Table 9 Bacteriological examination of milk, ice cream and water Milk examinations—186 Schools (pasteurised) Dealers' premises Total Pasteurised T.T. pasteurised Sterilised Samples 62 77 35 12 186 Satisfactory 62 77 35 12 186 Unsatisfactory — — - - - Ice cream examinations—10 Grade 1 Grade 2 Grade 3 Grade 4 Total 9 1 — — 10 Water examinations—443 Domestic supplies Swimming pools Paddling pool Total Samples 2 429 12 443 Satisfactory 2 420 10 432 Unsatisfactory - 9 2 11 Table 10 Uncleanliness and Scabies New cases treated Attendances Scabies Lice and nits Total Scabies Lice and nits Total Children under 5 years 4 11 15 7 11 18 Children 5-15 years 14 127 141 24 129 153 Adults Men 6 6 12 8 7 15 Women 7 13 20 8 13 21 Total 31 157 188 47 160 207 HEALTH EDUCATION Table 11 Talks No. visited Total No. of talks Subjects Total attendances No. of attendances Schools 24 247 44 1,420 25—480 Factories 69 78 14 9,900 10—800 Religious, social and political organisations 7 8 8 260 10— 60 Table 12 Mothercraft No. of clinics Total No. of classes Visits by health visitors 6 207 8.956 29 PREVALENCE AND CONTROL OF INFECTIOUS AND OTHER DISEASES Table 13 Infectious diseases 1962 (1961 in brackets) Notified Confirmed Diphtheria - (—) - (-) Dysentery 112 (29) 109 (25) Erysipelas 8 (22) 8 (21) Encephalitis, acute 2 (-) 2 (-) Food poisoning 22 (35) 21 (28) Malaria 5 (2) 5 (2) Measles 520 (3,187) 520 (3,182) Meningococcal infection 4 (4) 4 (3) Ophthalmia neonatorum 4 (3) 4 (2) Paratyphoid fever - (-) - (-) Pneumonia 40 (71) 39 (70) Poliomyelitis and polioencephalitis 5 (-) 5 (-) Puerperal pyrexia 157 (158) 157 (158) Scarlet fever 65 (68) 62 (66) Smallpox - (-) - (-) Typhoid fever 2 (7) 2 (4) Whooping cough 37 (92) 37 (92) 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 33,252 1.10 .73 1,978 1960 287 58,029 1.66 1.27 2,798 1961 92 24,436 .54 .53 2,694 1962 37 8,343 .22 .18 3,057 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 1962 171,230 109 22 131 10 — 10 1,595 281 1,876 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 1962 171,230 64 13 77 6 — 6 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 1962 100 46 146 85 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 1962 116 18 134 78 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 (—) 1 to 4 1 (—) 5 (—) - (-) - (-) 5 to 9 1 (—) 3 (-) - (-) 1 (—) 10 to 14 1 (—) 3 (—) - (-) 1 (—) 15 to 19 6 (—) 5 (—) 2 (—) - (-) 20 to 24 8 (—) 11 (—) 2 (—) — (—) 25 to 34 18 (—) 9 (—) 3 (—) 5 (—) 35 to 44 8 (1) 2 (—) 1 (—) - (-) 45 to 54 8 (—) 1 (—') - (-) 1 (—) 55 to 64 13 (2) — (2) 2 (—) 4 (—) 65 and upwards 4 (3) - (2) - (-) - (-) Totals 69 (6) 40 (4) 10 (-) 12 (—) 32 Table 20 Tuberculosis 1962: Cases by Wards Ward Pulmonary cases Nonpulmonary cases Pulmonary rate per 100,000 Combined rate per 100,000 Carlton 6 1 56 66 Kilburn 10 - 78 78 Brondesbury Park 6 1 49 57 Kensal Rise 3 2 27 45 Manor 7 2 53 68 Harlesden 10 4 72 100 Stonebridge 7 2 59 75 Roundwood 16 - 133 133 Church End 5 - 41 41 Willesden Green 11 1 82 89 Mapesbury 10 4 73 102 Gladstone 8 - 71 71 Cricklewood 7 3 61 87 Brentwater 3 2 27 46 Whole Borough 109 22 64 77 Table 21 Tuberculosis 1960—1962: Cases by Wards Ward Pulmonary cases Nonpulmonary cases Pulmonary rate per 100,000 Combined rate per 100,000 Carlton 29 5 88 103 Kilburn 27 5 70 83 Brondesbury Park 16 3 44 52 Kensal Rise 19 4 56 68 Manor 27 3 69 76 Harlesden 26 7 63 80 Stonebridge 25 5 69 83 Roundwood 35 5 97 111 Church End 12 3 32 40 Willesden Green 34 4 85 95 Mapesbury 37 8 92 112 Gladstone 23 — 68 68 Cricklewood 26 4 75 87 Brentwater 10 5 30 45 Whole Borough 346 61 67 79 Table 22 Tuberculin Tested, 1953-1962 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 1962 322 3 0.9 2,264 153 7.0 2,219 374 17.0 33 Table 23 Tuberculosis: B.C.G. vaccination of school leavers, 1953-1962 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) 1962 1,758 (80) 1,667 (94) *Percentage of total tested, †Percentage of negatives vaccinated. Table 24 Tuberculosis: Notification of deaths 1957 1958 1959 1960 1961 1962 1957-62 Deaths 13 16 5 11 14 10 69 Percentage not notified 15 12 20 36 43 20 25 Percentage notified before death: 0—12 months 15 25 — 19 — 10 13 1 —5 years 23 13 40 9 — 20 14 Over 5 years 47 50 40 36 57 50 48 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 27 Connaught Road—appeal pending Closing Orders, sections 17 and 18, Housing Act, 1957 2 7A Rucklidge Avenue (basement) 23A Winchester Avenue (basement) Table 26 Overcrowding (a) Dwellings overcrowded at end of year 721 (b) Overcrowding reported during the year 181 (c) (i) Overcrowding relieved during the year 39 (ii) Persons 156 approx. (d) Dwelling houses which have again become overcrowded after the local authority have taken steps for the abatement of overcrowding No information (e) (i) Council houses found to be overcrowded at end of year 21 (ii) Families 25 (iii) Persons 130 (f) Overcrowding in Council houses relieved during the year 10 (g) Section 80, Housing Act, 1957—licences issued 1 34 Table 27 New Dwellings, 1962 Houses Flats Rebuilds Dwellings built by private builders (excluding those built by the police authorities Nil 24 38 (by conversion) Built by local authority Nil 137 Nil Applicants on Council's waiting list at 31.12.62 3,997 Table 28 Notices served 1962 1961 Intimation notices served 456 703 Intimation notices complied with 606 688 Statutory notices served (Public Health Act, 1936) 986 1,026 Statutory notices complied with (Public Health Act. 1936) 1,029 1,024 Statutory notices served (Public Health Act, 1961) 114 2 Statutory notices complied with (Public Health Act. 1961) 107 — Statutory notices served (Shops Act, 1950) 4 — Statutory notices complied with (Shops Act. 1950) 1 — Statutory notices served (Prevention of Damage by Pests Act, 1949) 1 — Statutory notices complied with (Prevention of Damage by Pests Act, 1949) 1 — Statutory notices served (Housing Act, 1957) 7 8 Statutory notices complied with (Housing Act. 1957) 6 3 Non-compliance with statutory notices referred to Town Clerk (Public Health Act, 1936, sec. 93) 179 134 Referred to Borough Engineer for work to be carried out in default of owners *133 work done by Borough Engineer. *210 137 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 1962 1961 Dwelling houses inspected 3,099 2,972 Dwelling houses re-inspected 8,567 9,130 Other visits 1,336 1,610 Housing Act Dwelling houses wholly inspected 209 718 Dwelling houses partly inspected 93 163 Dwelling houses re-inspected 418 132 Underground rooms inspected 21 52 Overcrowding visits 86 48 Improvement grant inspections 112 148 Other visits 255 1,178 Rent Act Dwelling houses inspected 25 23 Dwelling houses re-inspected 24 30 Other visits 8 6 Clean Air Act Boiler plant inspections 15 64 Boiler plant re-inspections 1 2 Premises inspected (S.C.A.) 3,346 2,903 Premises reinspected (S.C.A.) 1.773 1,729 Smoke observations 53 369 Rag Flock and Other Filling Materials Act Premises inspected 7 3 Visits re samples 7 8 Infectious diseases Infectious disease enquiries 603 324 Food poisoning enquiries 28 109 Polio virus survey visits 283 300 Miscellaneous Massage establishments inspections 29 24 Cinemas, dance halls, schools, etc. inspected 26 41 Noise nuisance investigations 136 197 Visits re unsound food 111 126 All other visits 1,321 1,178 21,992 23,587 35 Table 30 Inspection of Factories, Outworkers Premises and Food Premises 1962 1961 No. inspected Inspections made No. inspected Inspections made Offensive trades — — — — Power factories 737 709 748 821 Non-power factories 63 69 62 94 Homeworkers and outworkers 180 266 203 220 Inspections of food premises (including revisits) Baker 26 156 27 169 Bread and confectionery 40 108 40 120 Dairy 3 28 3 37 Butcher 107 341 109 353 Grocer and general store 305 632 315 778 Fishmonger and fish-fryer 44 164 45 180 Cafe and restaurant 135 539 140 598 Greengrocer and fruiterer 126 254 128 304 Ice cream and sweet shop 219 381 224 399 Food stall 19 97 19 68 Public House 43 130 44 71 Works canteen 122 210 118 324 School canteen 39 44 40 48 Food factory 6 39 6 39 Any other food premises 46 50 41 46 Total periodic inspections 2,260 4,217 2,312 4,669 Total all inspections 1962 1961 26,209 28,256 Table 31 Rent Act, 1957 Certificates of Disrepair Applications (Form I) received and investigated 16 Agreed and proposal to issue Certificate of Disrepair (Form J) served 16 Refused Nil Undertakings (Form K) received from landlords 4 Acceptcd 4 Refused Nil Certificates of Disrepair (Form L) issued 10 Applications received for cancellation of Certificates of Disrepair (Form M) 8 Granted 8 Refused Nil 36 Table 32 Summary of nuisances abated and of Improvements Effected Water supply and water service 1962 1961 New cisterns provided 4 7 Cisterns cleansed, repaired, covered, etc. 18 12 Draw taps placed on mains 2 3 Drainage and Sewerage Water closets: Repaired, supplied with water or otherwise improved 176 169 New closets built — 8 Provided with better ventilation 10 5 Drains: Examined, tested, ex nosed, etc. 339 386 Unstopped, repaired, trapped, etc. 271 275 New soilpipes or vent shafts fixed 18 13 Disconnecting traps or chambers inserted 28 23 Reconstructed 21 33 New manhole covers 34 34 Soilpipes or vent shaftes repaired 43 52 Other Defects Smoke nuisances 8 5 Accumulation of refuse 142 142 Fowls, pigs, etc., kept in an insanitary condition 5 2 Dampness 357 345 Yards and forecourts paved, repaved or repaired 57 61 Walls and ceilings cleansed 79 69 Verminous rooms disinfested 145 218 Leaky roofs made watertight 477 464 Additional ventilation provided under floors 15 12 Dilapidated plaster repaired 472 499 Flooring and other woodwork repaired 215 219 Damp proof courses inserted 7 14 Water supply reinstated 24 24 Wash house floors repaired or repaved 12 24 Fireplaces and stoves repaired 40 59 Decayed brickwork repaired and repointed 146 148 Sinks provided or replaced 43 52 Additional light and ventilation to staircase — 2 Gutters and /or rainwater pipes repaired or renewed 388 315 Larders or food cupboards ventilated or provided 4 — New sashcords and glass provided to doors and windows 462 461 Miscellaneous 200 165 Total nuisances abated 4,262 4.320 DISINFESTATION Table 33 (a) Verminous premises:* Council properties 20 Private properties 53 Total 73 (b) Verminous rooms:* Council properties 42 Private properties 103 Total 145 *Some rooms are treated more than once. (c) Clothing and bedding materials: (i) disinfested 16 (ii) disinfected 3 (d) Miscellaneous: Ants 6 Earwigs 2 Bluebottles 1 37 INSPECTION AND SUPERVISION OF FOOD AND FOOD PREMISES Table 34 Types of food premises Baker 26 Bread and confectionery 40 Dairy 3 Butcher 107 Grocer and general store 305 Fishmonger and fish fryer 44 Cafe and restaurant 135 Greengrocer and fruiterer 126 Ice cream and sweet shop 219 Food stall 19 Public house 43 Works canteen 122 School canteen 39 Food factory 6 Other food premises 46 Total 1,280 Inspections and revisits: Inspections 2.392 Revisits 781 Total 3,173 Table 35 Premises unsatisfactory on 31.12.61 59 Unsatisfactory during the year 200 Premises made satisfactory during the year 231 Unsatisfactory on 31.12.62 28 Food premises: Defects remedied Defects Outstanding at 31.12.61 Found during the year Total Remedied during year Outstanding at 31.12.62 Inadequate lighting and ventilation 3 8 11 9 2 Inadequate washing facilities 18 51 69 62 7 Inadequate refuse storage 3 24 27 23 4 Uns 7 24 - 26 5 Inadequate storage accommodation 6 19 25 24 1 Defective walls, ceilings or floors 21 61 82 62 20 Dirty walls, ceilings or floors 38 141 179 161 18 Inadequate first aid materials — 18 18 16 2 Unsatisfactory conditions 7 6 13 12 1 Any other defects 25 114 139 129 10 Totals 128 466 594 524 70 Table 37 Food premises: Registration Premises on register 31.12.61 Applications received Applications granted Applications refused Premises removed from register during 1962 Total on register at 31.12.62 1. Sale and storage of ice cream 331 17 17 - - 348 355 2. Manufacture of ice cream 7 - - - - 7 3. Manufacture of preserved food 131 - - - - 131 4. Fish curing 1 - — — — 1 38 Table 38 Food unfit for human consumption Meat and meat products Bread, flour, cereals, etc. 187i lbs. Bread, flour, cereals, etc. 192 pkts. bacon 20 lbs. Preserves 31 lbs. Cooked 61 lbs. Cheese 37 lbs. Tinned 1,110½ lbs. Butter 122 lbs. Raw 1,396 lbs. Eggs 42 Meat pies 33 lbs. Frankfurtrs 29 tins Miscellaneous Poultry Beef cubes 1,559 singles Biscuits 43li lbs. Raw 362 lbs. Coconut 120 lbs. Goose fillets 1 tin Crisps 44 pkts. Fish Fish balls 1 tin Tinned 133 tins Frozen food (miscellaneous) 119 pkts. Raw 6 lbs. Fruit juice 74 tins Vegetables Goulash 1 tin Jelly piping 6J lbs. Tinned 283 tins Marmalade 3 jars Dried 142 nkts Milk pudding 6 tins Fruit Mincemeat 1 jar Pastries 261 singles Tinned 1,026 tins Pudding, cake, pudding mixture, cake ingredients 197 pkts. Fresh 11 lbs. Dried 112 okts. Pudding, cake, pudding mixture. cake ingredients 621 lbs. Milk Ravioli 19 tins Bottled 47 pints Salt 17 lbs. Tinned 29 tins Spaghetti 2 lbs. Soups Spaghetti dinners 2 tins Sugar 132 lbs. I Tinned 19 tins Tea 191 lbs. Packets 90pkts. Walnuts (shelled) 4f lbs. Table 39 Food: Samples taken Article No. of samples Unsatisfactory Milk (various) 30 — Butter 60 — Cakes and biscuits 4 — Cream 27 — Drugs 56 — Fish and fish products 13 — Fruit (fresh, canned and dried) 17 — Ice cream 27 — Liver 24 — Margarine 30 — Meat and meat products 113 7 Preserves 10 — Soft drinks and fruit juices 5 1 Spirits 21 1 Sweets 7 — Vinegar and non-brewed condiments 50 4 Vegetables 6 — Miscellaneous 23 4 Total 523 17 39 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 63 69 5 Factories not included above in which section 7 is enforced by the local authority 737 709 19 Other premises in which section 7 is enforced by the local authority (excluding outworkers premises) 12 18 — Total 812 796 24 No occupiers were prosecuted during the year. Table 41 Defects found Found Remedied Referred No. of cases in which prosecutions were instituted To H.M. Inspector By H.M. Inspector Want of cleanliness (sec. 1) - 1 - - - Overcrowding (sec. 2) — — — — — Unreasonable temperature (sec. 3) 1 1 — — — Inadequate ventilation (sec. 4) 1 1 — — — Ineffective drainage of floors (sec. 6) — — — — — Sanitary conveniences (sec. 7) (a) Insufficient 3 3 — 1 — (b) Unsuitable or defective 21 30* — 1 1 (c) Not separate for sexes — — — — — Other offences against the Act (not including offences relating to outworkers) 1 1 2 1 — Total 27 37* 2 3 1 *Twelve defects outstanding from previous 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.) 106 - - Household linen 1 - — Curtains and furniture hangings 2 - — Furniture and upholstery 1 - - Artificial flowers - - Paper bags 12 - — Making of boxes or other receptacles or parts thereof made wholly or partially of paper 19 - - Carding, etc. of buttons, etc. 22 - — Stuffed toys 9 - — Cosaques, Christmas stockings, etc. 2 - — Imitation jewellery and jewellery pads 3 - — Lampshades 3 - — Total 180 - — There were no cases of default in sending lists to the Council, and there were no prosecutions. 40 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 102 376 23 1,611 23 16.0 Pound Lane 100 434 6 1,907 6 19.1 Stonebridge 151 488 4 2,436 4 16.2 Neasden 52 112 4 444 4 8.6 Cricklewood (Sneyd Road) 51 254 5 946 5 18.6 Kensal Rise (St. Martin's) 102 351 2 1,557 2 15.5 South Kilburn (Chichester Terrace) 51 280 2 793 2 15.6 Totals: 1962 609 2,295 46 9,714 46 16.0 1961 559 2,406 48 10,026 50 17.9 Table 44 Births Hospital and domiciliary 1962 1961 Total notified live births 4,143 3,937 Born in institutions 3,641 3,394 Born at home 502 543 Percentage born in institutions 87.8 86.2 Institutions Central Middlesex Hospital 1,503 1,470 Kingsbury Maternity Hospital 463 441 Larger hospitals outside Willesden 1,539 1,311 Smaller hospitals outside Willesden 118 156 Nursing homes, etc. 18 16 3,641 3,394 Home County Midwives 498 536 Others 2 6 Private Doctors 2 1 502 543 Table 45 Mothercraft Clinic Sessions New cases Total attendances Average attendance per session Kilburn 33 72 291 8.8 Pound Lane 48 57 183 3.8 Stonebridge 51 110 429 8.4 Neasden 49 26 97 2.0 South Kilburn (Chichester Terrace) 29 37 70 2.4 Kensal Rise (St. Martin's) 7 48 72 10.3 Totals: 1962 217 350 1,142 5.3 1961 139 230 750 5.4 41 Table 46 Relaxation Classes Clinic Sessions New cases Total attendances Average attendance per session Kilburn 39 87 278 7.1 Pound Lane 44 68 189 4.3 Stonebridge 46 109 290 6.3 Neasden 30 19 61 2.0 Totals: 1962 159 283 818 5.1 1961 139 230 750 5.4 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 259 565 7,986 682 389 9,057 4,554 35.0 Pound Lane 254 664 9,042 936 420 10,398 3,615 40.9 Stonebridge 254 855 7,475 673 485 8,633 3,518 34.0 Neasden 254 339 6,502 1,254 1,030 8,786 2,514 34.5 Cricklewood (Sneyd Road) 102 366 3,690 432 258 4,380 1,686 43.0 Kensal Rise (St. Martin's) 154 484 5,716 402 194 6,312 2,114 40.0 South Kilburn (Chichester Terrace) 107 620 5,534 496 108 6,138 2,006 57.4 Totals: 1962 1.384 3.893 45,945 4,875 2,884 53,704 20.007 38.8 1961 1,347 3,305 38,021 4,604 2,808 45,433 16,904 33.7 MIDWIFERY SERVICE Table 48 Midwives' Clinics Sessions New Cases Total attendances Average attendance 1962 275 982 5,936 21.6 1961 253 1,051 6,565 23.9 Table 49 Deliveries attended:— Doctor not booked, doctor present 16 Doctor not booked, doctor not present 6 Doctor booked, doctor present 200 Doctor booked, doctor not present 277 Cases attended which have been discharged before 10th day 150 Cases in which:— (a) gas and air only administered, doctor present 127 gas and air only administered, doctor not present 176 (b) trilene only administered, doctor present 36 trilene only administered, doctor not present 55 (c) gas and air followed by trilene administered, doctor present 1 gas and air followed by trilene administered, doctor not present — (d) trilene followed by gas and air administered, doctor present 2 trilene followed by gas and air administered, doctor not present 1 (e) pethidine administered, doctor present 94 pethidine administered, doctor not present 127 Visits paid:— (a) ante.natal 2,956 (b) during labour 952 (c) nursing, domiciliary confinements 6,734 nursing institutional discharges 749 (d) others 626 42 Clinic sessions attended (loccd authority clinics):— (a) ante-natal, doctor present 1 (b) ante-natal, midwife only 275 (c) relaxation 4 (d) mothercraft — Clinic sessions attended (general practitioner clinics:)— (a) ante-natal — Medical aid:— (a) doctor booked 84 (b) doctor not booked 8 Medical Aid For Mother For Child Toxaemia of pregnancy 9 Sticky eye 2 Breech presentation 2 Cyst 1 Post-partum haemorrhage 4 Prematurity 1 Ruptured perineum 15 Poorly 1 Early rupture of membranes 7 Snuffly cold 1 High head 1 Cleft palate 1 Blushed breast 1 Grunting respiration 1 1st stage delay 1 Projectile vomiting 1 Premature labour 9 White asphyxia 4 Ante-partum haemorrhage 5 Raised blood pressure 2 Raised temperature 4 Foetal distress 1 2nd stage delay 2 Low blood pressure 1 Postmaturity 2 Puerperal pyrexia 2 Puerperal mania 1 Urinary condition 1 Uterine inertia 2 Multiple pregnancy 3 Retained placenta 2 Malpresentation 2 Totals 79 13 Table 50 Establishment: Health Visitors Whole-time equivalent as at: 31.12.61 31.12.62 Health Visitors (Whole-time) 25 23 (Part-time) 1 2/11 10/11 (Sponsored) 1 - Clinic Nurses (Whole-time) 4 5 Nursing Assistants (Part-time) 2/11 3/11 Health Assistant (Part-time) - 2/11 Totals 31 4/11 29 4/11 43 HEALTH VISITING Table 51 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 1962 1,788 2,538 4.431 12,276 5,347 9,486 31 1,453 897 1961 1.799 2,681 4,108 12,963 5,918 10.685 4 1,825 1,200 Table 52 Special cases referred by General Practitioners for:— Care of elderly persons Ante-Natal care Home help Living Conditions Housing 14 1 3 2 2 44 Table 53 Work: Home Nurses New Cases Visits Cases on register at end of year Male Female Male e Medical 683 1,245 83,127 150 453 Surgical 74 41 3,848 7 9 Infectious 9 10 239 2 3 Tuberculosis 18 24 2,337 6 9 Maternal complications - 30 332 — — Total 784 1,350 165 474 Totals 1962 2,134 89,883 639 1961 2,267 89,574 608 Table 54 Establishment: Home Nurses Nurses 1.1.62 31.12.62 Whole-time 22 22 Part-time 3 3 Candidates — — Total whole-time equivalent 24 24 SMALLPOX Table 55 Vaccination Under 1 year 1 year 2-4 years 5-14 years 15 years and over Total Primary Vaccinations 1,452 1,160 1,402 5,241 6,086 15,341 Re-vaccinations 8 13 256 2,863 12,034 15,174 Totals 1962 1,460 1,173 1,658 8,104 18,120 30,515 1961 1,092 283 184 61 169 1,789 Approximate number of children (end of 1962) 0— 5 18,166 5—15 20,555 38,721 HOME HELPS Table 56 Cases: Home Helps Cases receiving help at No. of new cases helped during No. of cases receiving help at 1.1.62 1.1.61 1962 1961 31.12.62 31.12.61 Maternity 2 - 60 61 - 2 Tuberculosis 10 13 3 2 11 10 Chronic sick and aged 528 516 266 269 504 528 Others 154 122 189 178 138 154 Totals 694 651 518 510 653 694 45 Table 57 Staff: Home Helps Position at Appointments during Resignations during Position at 1.1.62 1.1.61 1962 1961 1962 1961 31.12.62 31.12.61 Whole time 2 2 1 3 — 3 3 2 Part time 77 84 24 18 24 25 77 77 Totals 79 86 25 21 24 28 80 79 DAY NURSERIES Table 58 Day Nurseries: Attendances Nursery Approved places Children on register at 31.12.62 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/ William Dunbar 18 32 23 30 4,191 6,558 16 26 Essex Road 25 25 24 30 5,724 6,264 22 24 Evefield 25 25 21 29 5,065 5,807 20 23 Gladstone Park 25 25 22 30 4,572 5,695 18 22 Longstone Avenue 25 25 27 26 4,737 5,301 19 21 Mortimer Road 25 25 24 28 5,587 5,815 22 23 Villiers Road 25 25 27 25 5,389 5,842 21 23 Wesley Road 15 25 12 26 3,125 5,135 12 20 Totals: 1962 183 207 180 224 38,390 46,417 150 182 1961 183 207 179 209 36,927 45,304 145 179 Table 59 Day Nurseries: Infectious Diseases Number of Cases Nursery Measles Chicken Pox German Measles Scarlet Fever Chichester Road/ William Dunbar 1 2 - - Essex Road — 7 — 1 Evefield — 2 2 — Gladstone Park — 1 — - Longstone Avenue 2 — 1 - Mortimer Road — 2 — - Villiers Road — — — - Wesley Road — 3 13 - Totals 3 17 16 1 46 Table 60 Day Nurseries: Waiting List Position at:— Nursery 1.1.62 31.12.62 Chichester Road/ William Dunbar 33 29 Essex Road 10 6 Evefield 2 1 Longstone Avenue 12 5 Gladstone Park 21 29 Mortimer Road 16 41 Villiers Road 27 30 Wesley Road 41 10 Totals 162 151 Table 61 Day Nurseries: Priorities Nursery Unsupported Mothers Medical reasons Bad Housing Total on Register William Dunbar 33 7 3 43 Essex Road 32 9 7 48 Evefield 31 3 11 45 Gladstone Park 24 6 21 51 Longstone Avenue 35 6 9 50 Mortimer Road 38 4 3 45 Villiers Road 34 — 13 47 Wesley Road 19 3 10 32 York Park 14 — 8 22 Totals 260 38 85 383 Table 62 Day Nurseries: Staff Establishment Position at: 31.12.62 31.12.61 Supervisory Matron 1 1 1 Matrons 8 8 8 Deputy Matrons 8 8 8 Wardens 8 7 6 Nursing Staff 44 36 42 Students 20 20 19 47 SCHOOL HEALTH SERVICE Table 63 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) 1958 and later 264 261 98.8 3 1.2 1957 1,363 1,350 99.0 13 1.0 1956 738 727 98.5 11 1.5 1955 238 234 98.0 4 2.0 1954 1,294 1,287 99.5 7 0.5 1953 252 250 99.2 2 0.8 1952 1,007 1,003 99.6 4 0.4 1951 466 463 99.4 3 0.6 1950 229 227 99.1 2 0.9 1949 289 286 98.9 3 1.1 1948 640 633 98.9 7 1.1 1947 and earlier 1,799 1,795 99.8 4 0.2 Totals: 1962 8,579 8,516 99.3 63 0.7 1961 8,529 8,432 98.9 97 1.1 Table 64 Individual Pupils found at periodical Medical Inspections to require treatment (excluding dental diseases and infestation with vermin) Year of birth For defective vision (Excluding squint) For any of the other conditions in table Total individual pupils 1958 and later 3 16 18 1957 15 116 121 1956 11 65 71 1955 8 18 22 1954 84 75 147 1953 25 20 40 1952 69 82 128 1951 35 38 71 1950 17 20 34 1949 28 46 67 1948 34 44 73 1967 and earlier 98 155 239 Totals: 1962 427 695 1,031 1961 414 805 1,167 48 Table 65 Defects Found by Medical Inspection * Periodic inspections Entrants Leavers Others Total Special inspections (a) (b) (a) (b) (a) (b) (a) (b) (a) (b) Skin 9 96 46 138 47 154 102 388 11 129 Eyes (a) Vision 31 36 133 215 263 344 427 595 19 30 (b) Squint 20 32 2 11 14 43 36 86 - 7 (c) Other 4 28 3 17 5 36 12 81 3 21 Ears (a) Hearing 14 102 17 46 31 94 62 242 21 55 (b) Otitis media 6 73 1 20 3 40 10 133 - 2 (c) Other 15 48 15 2 18 30 48 80 - 11 Nose and throat 32 374 10 35 19 206 61 615 12 34 Speech 46 49 5 11 27 37 78 97 14 38 Lymphatic glands — 181 - 10 1 77 1 268 - 2 Heart 6 59 - 26 1 35 7 120 1 4 Lungs 4 120 1 30 6 80 11 230 1 16 Developmental (a) Hernia 8 25 1 5 3 16 12 46 - - (b) Other 4 84 1 23 6 115 11 222 - 14 Orthopaedic (a) Posture 8 31 43 55 54 59 105 145 1 15 (b) Feet 16 68 26 57 34 85 76 210 4 21 (c) Other 10 67 12 81 19 92 41 240 1 19 Nervous system (a) Epilepsy — 10 1 10 3 9 4 29 - - (b) Other - 13 - 10 1 11 1 34 1 25 Psychological (a) Development 2 35 1 16 2 58 5 109 - 26 (b) Stability 4 279 1 178 - 337 5 794 9 35 Abdomen — 20 - 16 1 34 1 70 - - Other 197 57 43 38 257 97 497 192 04 139 Totals 1962 436 1,887 362 1,050 815 2,089 1,613 5,026 162 643 1961 366 1,399 424 887 870 2,054 1,660 4,340 262 493 *(a) Requiring treatment (b) Requiring observation. 49 Table 66 Treatments : School Health Service r of cases known to have been dealt with (i) Eye Diseases, Defective Vision and Squint (a) External and other, excluding errors of refraction and squint 55 (b) Errors of refraction (including squint) 1,445 Totals 1962 1,500 1961 1,512 (c) Number of pupils for whom spectacles were prescribed Totals 1962 456 1961 518 (ii) Diseases and Defects of Ear, Nose and Throat Received operative treatment for: (a) diseases of the ear — (b) adenoids and chronic tonsillitis 51 (c) other nose and throat conditions — Received other forms of treatment 166 Totals 1962 217 1961 158 Total number of pupils in schools who are known to have been provided with hearing aids: (a) during the current year 4 (b) in previous years (excluding any pupils shown at (a) above who were provided with an aid in the previous year). 24 (iii) Orthopaedic and Postural Defects Number of pupils known to have been treated at clinics or at outpatients departments 1962 655 1961 621 (iv) Diseases of the Skin (Excluding Uncleanliness) Ringworm (i) Scalp — (ii) Body — Scabies 18 Impetigo 8 Other skin diseases 144 Totals 1962 170 1961 287 (v) Child Guidance Treatment Number of pupils treated at child guidance clinics under arrangements made by the County Council (including children sent to the Tavistock and other hospital clinics under arrangements made by the County Council) 173 (vi) Speech Therapy Number of pupils treated by speech therapists under arrangements made by the authority 1962 340 1961 547 (vii) Other Treatment Given (a) Number of miscellaneous minor ailments treated by the County Council 596 (b) Treatment other than (a) above and excluding convalescent treatment: 1. Lymphatic glands - 2. Heart - 3. Lungs 19 4. Developmental (a) Hernia - (b) Other 1 5. Nervous system (a) Epilepsy 1 (b) Other 10 6. Psychological (a) Development 12 (b) Stability 43 7. Abdomen - 8. Other 55 Totals 1962 737 1961 841 50 Table 67 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 101 35 8 10 4 20 Table 68 Audiometry: Children Tested Routine Age group 1st Tests Re-tests Failures Total Both ears One ear Right Left Up to 7 years 1,676 147 10 25 20 55 Intermediate 1,470 60 4 10 15 29 Leavers 1,832 40 6 14 9 29 Totals 1962 4,978 247 20 49 44 113 1961 Specials 7,488 407 69 73 69 211 All ages 1st Tests Re-tests Failures Total Both ears One ear Right Left Totals 1962 761 259 54 58 84 196 1961 633 316 70 65 81 216 Table 69 Summary of Failures to pass Audiometer Test Passed at second test 174 Referred to Assistant Medical Officers 159 Normal Hearing after removal of wax 17 Under observation by hospital or private doctor 12 No action—further test recommended after given period 21 Referred for Tonsils and Adenoids operation 16 Appointments not accepted 5 Referred by A.M.O.'s to Ear, Nose and Throat Specialist 103 Treatment considered of little value 7 Referred to hospital 9 Hearing improved after treatment 21 Recommended for Hearing Aid 2 Awaiting appointments 7 Failed to attend appointments 13 51 Table 70 Speech Therapy Clinic or School No. of cases dealt with during the year Kilburn clinic 110 Pound Lane clinic 104 Stonebridge clinic 76 Lower Place special school for physically handicapped pupils 26 Neasden clinic 24 Totals 1962 340 1961 323 Table 71 Infestation with Vermin 1962 1961 Total no. of examinations 23,737 31,010 Total no. of individual pupils found to be infested for the first time during the current year 363 399 Number of individual pupils in respect of whom cleansing notices were issued under section 54/2 Education Act, 1944 146 134 Number of individual pupils in respect of whom cleansing notices were issued under section 54/3 Education Act, 1944 — - Table 72 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 31.12.62 Lower Place Special School for Physically Handicapped Pupils Willesden 11 10 - Wembley 3 3 — Ealing 2 2 — Acton 1 1 — Hendon 3 3 — Totals 20 19 — Table 73 The Educational Sub-Normal Education Act, 1944—Section 57 1962 1961 Cases dealt with under section 57, Education Act, 1944:— 13 12 Cases de-notified under section 8, Education (Miscellaneous Provisions) Act, 1948 — — 52 Table 74 Return of Handicapped Pupils (Year Ended 31st December, 1962) Category Ascertainment Distribution (as at last day of Year) 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 - - - - - - - - - - - - - - - - - - Partially-Sighted Pupils 11 7 - 2 9 7 8 4 1 2 - 1 - - - - 9 7 Deaf Pupils 7 1 1 — 5 1 4 1 1 - - - - - - 5 1 Partially Deaf Pupils 6 2 — — 7 2 7 2 - - - - - - - - 7 2 Delicate Pupils Diabetic Pupils 23 15 12 12 28 15 2 — 25 14 1 1 - - - - 28 15 Educ. Sub-normal Pupils 80 68 22 11 97 65 79 58 10 3 8 4 - - - - 97 65 Epileptic Pupils 1 — 1 — 2 — — - 2 — — — - - - - 2 - Maladjusted Pupils 41 11 17 3 51 10 — — 12 1 13 2 25 7 1* - 51 10 Physically Handicapped Pupils 27 19 4 7 28 23 25 22 2 1 - - - - 1* - 28 23 Pupils with Speech Defects 389 158 64 26 383 155 — — — — 368 136 - 1 15 18 383 155 Pupils with Multiple Defects 34 23 4 2 32 22 30 22 2 - - - - - - - 32 22 Total 619 304 125 63 642 300 155 109 55 21 390 144 25 8 17 18 642 300 Grand Totals: 1962 923 188 942 264 76 534 33 35 942 1961 912 247 923 248 74 554 30 17 923 *Receiving home tuition. Boys Girls Children not ascertained as handicapped pupils, but recommended for convalescence in a holiday home or camp school 40 28 53 CHILD GUIDANCE Table 75 Waiting list at 1.1.1962 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 31.12.1962 16 207 113 94 134 20 17 Table 76 REASONS FOR REFERRAL 1. Behaviour Problems (52%) (a) Mainly due to environmental factors (including parental problems) 40 (b) Mainly due to constitutional factors 16 (c) Mainly due to mental retardation 10 (d) Mainly due to physical ill-health 2 2. Problems of Habit and Maturation (20%) (a) Emotional crisis of adolescence and sex ment 12 (b) Enuresis and encopresis (wetting and soiling) 9 (c) Sleep disturbance 4 (d) Speech disturbance 2 3. Psychoneurotic disturbances (22%) (a) Chronic anxiety state 13 (b) School phobia 7 (c) Psychosomatic disorders, e.g. asthma 5 (d) Hysteria 3 (e) Acute anxiety state 1 (f) Obsessive compulsive neurosis 1 4. Psychotic disturbance (1%) 1 5. Epileptic Behaviour Disturbance (1%) 2 6. No Evidence of Psychiatric Disturbance (4%) 6 134 SCHOOL DENTAL SERVICE Table 77 Inspection and Treatment (a) Inspections Inspected Required Treatment Referred for Treatment 1962 1961 1962 1961 1962 1961 Periodic 15.290 13,065 8,720 6,927 7,835 7,267 Special 1,344 1,564 1,155 1,435 Totals 16,634 14,629 9,875 8,362 7,835 7,267 54 (b) Treatment 1962 1961 No. of pupils actually treated: 3,957 3,780 No. of attendances 13,779 12,076 No. of half-days of Inspection 224 129 Treatment 2,953 2,083 No. of fillings: (a) Permanent teeth 8,738 7,365 (b) Temporary teeth 4,109 3,009 No. of extractions of: (a) Permanent teeth 391 495 (b) Teeth for orthodontia 200 252 (c) Temporary teeth 2,638 2,184 No. of general anaesthetics 1,203 1,174 No. of other operations 4,709 4,729 PRIORITY DENTAL SERVICE Table 78 Expectant and Nursing Mothers Children under 5 1962 1961 1962 1961 Number examined 346 301 614 616 Number required treatment 310 292 457 448 Number of new cases commenced treatment 329 292 396 393 Dentally fit 126 100 265 260 Extractions 201 376 227 185 Fillings 792 540 790 693 Scaling and gum treatment 135 129 — — Silver nitrate dressings — — 500 636 Dentures 72 54 — 2 Number of attendances 1,273 1,159 1,036 961 Number of appointments not kept 37 157 219 157 DEANER PRINTERS LTD. (T.U.). LONDON