WIL 59 Borough of Millesden 1963 THE 88th 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 13 Old People's Welfare Committee 14 Voluntary services 14 Bacteriological examinations 4 Basement bakehouses 12 Bronchitis Morbidity and mortality 7 Cancer of the lung Morbidity and mortality 7 Prevention and diagnosis 7 Treatment 7 Census—household arrangements 8 Child guidance 20 Chiropody 20 Clean air 10 Common lodging houses 16 Convalescence 19 Coroner's court 15 Day nurseries 19 Dental service 20 Disinfestation 11 Factories 12 Food Contaminated food 12 Education in food hygiene 11 Food poisoning 11 Improvements in premises 11 Prosecutions 12 Registration of premises 11 Sampling 12 Unsound food 12 Hawkers—licensing of 16 Health education 5 Health visiting 17 Home safety 21 Home help service 19 Home nursing 18 Hospitals Facilities 16 Liaison 16 Household arrangements 8 Housing Demolition and closing orders 9 Multiple Occupation 9 New dwellings 10 Notices served 10 Nuisances abated 10 Overcrowding 10 Rent Act, 1957 10 Slum clearance and re-development 9 Ice cream 4 & 11 Immunisation 19 Infant mortality 4 Infectious diseases Page Diphtheria 6 Dysentery 6 Food poisoning 6&11 Measles 6 Meningococcal infection 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 16 Clinics 17 Problem families 17 Medical examination of staff 16 Midwifery service 17 Milk and dairies 12 Mortuary 15 National Assistance Act, 1948 Burials 15 Removal to hospitals 13 Noise 13 Outworkers and homeworkers 12 Pet Animals Act, 1951 16 Poliomyelitis inoculation 19 Prematurity 4 Problem families 17 Public Health Laboratory Service 4 Rag, Flock and Other Filling Materials Act, 1951 16 Refuse disposal 8 Rodent control 11 Sanitary circumstances 8 Scabies 5 School health service 20 Sewage and drainage 8 Slaughterhouses 16 Smallpox vaccination 19 Staff Medical examinations 16 Sanitary section 9 Swimming baths 8 Tuberculosis B.C.G. Vaccination 8 Co-operation 8 Factories and workshops 8 Morbidity and mortality 7 Prevention and diagnosis 7 Vermin 11 Vital statistics Births 4 Deaths 4 Population 3 Water 8 BOROUGH OF WILLESDEN Health Department, 54 Winchester Avenue, Kilburn, N.W.6. July, 1964. To the Mayor, Aldermen and Councillors of the Borough of Willesden. Madam Mayor, Ladies and Gentlemen, The year 1963 was spent under the shadow of the impending disappearance of Willesden and Wembley and the birth of a new borough combining the two. It has not been a comfortable period; uncertainty is not an easy companion; but it would be true to say that the work of the Health Department has continued uninterrupted, developing projects already begun and planning for the future. One problem from which Wembley is fortunate to be relatively free is the legacy of bad housing, which continues to be a source of considerable anxiety in Willesden. Resources and staff are unfortunately insufficient to alleviate it fully, and rehousing is perforce a long-term remedy. Much has been done to cope with the worst aspects, so that living conditions are at least tolerable for many; but it is to be regretted that the Housing Act, 1961, with its measures against multi-occupation, has not overcome the wiles of the worst type of landlord. Further legislation is essential to control this exploitation of tenants. Smoke control, however, had made further progress. By the end of 1962, there was a band of smoke control areas stretching from the northern to the southern boundaries of the borough. In 1963, the advance began into the crowded south-eastern districts where some of the poorer housing conditions are found. It seemed for a while, however, that our expectations for clean air were due for a setback, when it was revealed that a new method of gas manufacture had proved so efficient that the by-product, gas coke, would not be so readily available in the future. With the prospect of shortage of a hitherto common source of solid fuel, the national programme of smoke control has had to be redirected so that other fuels could replace it. This has meant greater cost, but the government has increased its financial support, and it is probable that in the future we will be glad that cleaner and more convenient fuels are being so extensively introduced. In overcoming air pollution we are helping in the fight against bronchitis. It is sometimes hard for us to realise that this condition is almost unique to our country, and is known abroad as the English Disease. This is one national distinction we could well do without. It is such a slow-acting, insidious disease that we cannot expect to see the results of smoke control for a long time; but they would come all the sooner if that personal source of air pollution, cigarette smoking, were abandoned. It is probable that for many addicts this can only be a pious hope, but the prospect of mounting mortality due to this cause from a much deadlier disease, lung cancer, creates a challenge for the future. I am increasingly inclined to wonder if the propaganda directed at the adult smoker by health organisations has been of any real value. Whatever fresh piece of evidence appears, or even if the cost of a packet of cigarettes goes up, the sales falter only temporarily and then continue to rise. There is a curious blind spot in most smokers; they cling to their addiction, lament their lack of will, and relieved by confession, resume the habit. The fact that during the next year several thousand of them will come to a horrible awakening does not bother them at all. It is strange that no wonder what prodigies they can achieve in other directions, in this they are frequently incapable. I would not go so far as to say that the adult smoker should be abandoned to his fate, but the time is coming when there must be a drastic change in the balance of forces. Health propaganda in this field has struggled with inadequate resources for years against the millionaire advertising of the cigarette manufacturers. Since people cannot be forbidden to smoke the only resource left is that the Government should stop all advertising of cigarettes, so that young people at least would be protected against its seductive cunning. In spite of its small membership, the Willesden Home Safety Committee continues to do useful work in the prevention of accidents in the home. There is need for more public support for its activities, but perhaps this will not come until it is more generally realised that it is in the home—not on the roads or in the factories—that most deaths from accidents occur. The year saw a satisfactory increase in chiropody staff and there are good prospects of improving the service still further. One cannot help feeling regret, however, that skilled personnel have to devote their time to the treatment of foot conditions which could so easily have been prevented. Many of the older patients are suffering from fashions in footwear going back more than half a century, and most modern women's shoes are no better in this respect. When one hears the claims of the makers that they are unable to change the fashion, one can only wonder what is wrong with the designers that they cannot produce a shoe which is comfortable, efficient and attractive to the customer. This is being written during the aftermath of the Aberdeen typhoid epidemic, a chastening reminder that even while we advance into the modern, more hygienic world of the personal health services, the old enemies are still not far behind. While there is no denying that hygienic standards have risen, the improvement has often been counteracted bv increased mass production of food and the greater popularitv of eating out, so that a slip by one careless individual can have far-reaching and even disastrous consequences. It is the policy of the Public Health Department to visit as many food establishments as possible, educating the proprietors and staff in hygiene matters, and prosecuting onlv when all else has failed. Only by such cooperation can the best results be achieved, and the general public can improve the protection thus given to them by complaining when they find unsatisfactory standards. Typhoid itself is fortunatelv rare, and the one or two cases which occur annually have been successfully limited by routine measures. The main problem in this kind of situation is to maintain a balance between strict control and the avoidance of public alarm. An instance of the latter occurred during the year in which a case, which was being investigated in Willesden, was publicised in another area. It was reported in the press and there were many anxious enquiries until we were in a position to show that it had been a false alarm. Much of the work of the department, however, has to be concentrated on a steady trickle of milder, though not necessarily innocuous, infections of various dysentery and food-poisoning germs. These cause suffering and inconvenience, and now and then death; and the effectiveness of the department would be further improved if members of the public would inform their doctors about their "tummy upsets" as soon as possible and save a portion of the suspected food for testing. The Old People's Clinic has continued its work at Neasden Clinic. One of its most valuable functions is to act as a centre to which the elderly can come, not only to discuss their problems, but perhaps just to say that everything has been going well. This affords an excellent opportunity to give guidance on the prevention of future difficulties, or the detection of early ones which can be nipped in the bud. The most significant advance has been in the provision of a food supplement, Complan, which is also available at Old People's Clubs. This was made possible after fruitless attempts had been made to persuade the Ministry of Health to authorise its provision on the same terms as welfare foods for mothers and children. The Complan is purchased by the Borough Health Department and sold to the elderly at a fraction above cost price. It has become very popular, and an important factor for health in many whose normal diets place them on or below the margin of malnutrition. The Old People's Welfare Committee itself has continued to broaden its services, and in its clubs and outings and its concern for individuals has added a new dimension to the lives of many lonely old folk. Perhaps the subject of malnutrition should not be left without a mention of its wider implications, for no group of the community is without its problems in this respect. It can mean either not enough of the right kind of food or too much of the wrong kind. The fat schoolboy is as much involved as the thin, apathetic old man. We all need sufficient quantities of body-building foods such as meat, fish, cheese, eggs and milk, plus fruit and vegetables; but we store up trouble if we stuff ourselves with too much of the sugary, starchy and fatty foods. Vitamin deficiencies are not as important as they used to be in this country, although rickets, associated with shortage of vitamin D, has recently appeared sporadically in immigrants. Mineral deficiencies could well be more important. Anaemia caused by a lack of iron in the diet is quite common, especially in the immigrant population, and here the balance of the diet should be altered to include foods like lentils, egg-yolk, liver, beans, black treacle, oatmeat, whole wheat, turnip tops, spinnach, prunes, dates and raisins. It is possible that lack of calcium may make the bones of the elderly more brittle, and they would be well advised to take at least a pint of milk a day. Increasing attention is being given nowadays to the socalled trace elements. It has been known for some time that lack of iodine in certain districts can cause goitre and cretinism, but more recent work suggests that, for example, in remote parts of the world zinc deficiency can result in dwarfed, anaemic males, and lack of cobalt may be responsible for a form of debility which has been observed in children and animals. Another element about which there is stronger evidence is fluorine, and few of those who oppose it, I think, would question its value in strengthening the resistance of the teeth of children to decay. It has recently been shown, moreover, to have a place in the chemical structure of normal teeth. Now whereas the addition of iodine to table salt succeeded in eliminating goitre and cretinism in the places mentioned above, effective reduction of dental decay is only possible by adding fluoride to the water supplies. Other methods such as fluoride pills or local application of fluoride are tedious and less efficient. The National Pure Water Association has, however, strongly opposed fluoridation, claiming that it is harmful and that the liberty of the subject would be undermined. Eminent authorities have denied these, and lengthy arguments have been held. Only recently I received a paper from the National Pure Water Association claiming that fluoridation caused mongolism in babies. It was rapidly followed by another from the Ministry of Health pointing out statistical errors which invalidated it. It is hardly surprising, therefore, that the general public has been perplexed and that many local authorities have hesitated to put this controversial measure into effect. The trend throughout the country is that a few have accepted it, but most have not. I am in the peculiar position of being Medical Officer of Health to one borough, Wembley, which has approved it, and another, Willesden, which has rejected it. One thing at any rate is clear: that the controversy will continue for a long time. It may be that new evidence will appear, for example, confirmation or denial of the theory that in fluoridated areas fractures of the bones in the elderly are less likely than elsewhere. It will be the responsibility of every citizen to weigh all the facts carefully and decide in the light of conscience and what he considers to be the needs of the community. An important milestone in 1963 was the formation of the Willesden Association for Mental Health. Far from being just another local organisation, this signified an important advance. Mental health can no longer be regarded as the prerogative of the psychiatrically trained: it has become the concern of all. One of the first actions of the committee was to set about the formation of a local group of the Samaritans, the members of which would undertake to befriend people who are depressed or feel suicidal. No special knowledge would be required of them, nor would they have to undergo intensive training. After instruction the chosen workers would, under suitable direction, not only support unhappy people through their emotional crises, but also by their example spread the understanding of mental health throughout the community. The association has succeeded in bringing together a group of local clergymen who have undertaken to form the group from members of their own congregations and others who are interested. From this humble beginning may emerge a force for good which would profoundly affect this and future generations. Work in the public health field is increasing in size and complexity. I would like to express my thanks to all the members of the staff for their loyalty and hard work throughout this difficult year, and also my appreciation for the encouragement and support I have received from all members of the Council, particularly the members of the Public Health Committee. I have the honour to be. Madam Mayor, Ladies and Gentlemen. Your obedient servant, E. GRUNDY, Medical Officer of Health. 3 STATISTICS AND SOCIAL CONDITIONS OF AREA Population estimated, 1963 (30th June) 172,130 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) 45,405 Rateable value (1st April, 1963) £9,733,729 General rate in the pound for the year 1963/64 7s.10d. Product of a penny rate £39,500 VITAL STATISTICS Registered live births: Male Female Total Legitimate 1,940 1,797 3,737 Birth rate per 1,000 estimated resident population Illegitimate 399 404 803 Crude 26.4 Total 2,339 2,201 4,540 Adjusted 21.9 Registered stillbirths: 55 40 95 Rate per 1,000 Give and still) births 20.5 Deaths: 940 875 1,815 Death rate per 1,000 estimated resident population Crude 10.5 Adjusted 12.3 4 Births There was an increase in the birth rate for 1963 above that of England and Wales, which was 18-2 per 1,000. Deaths There was a slight decrease in the death rate for 1963, and it was a little below that of England and Wales, which was 12-2 per 1,000. The causes of deaths are shown in Table 1. Infant mortality In 1963, 96 children died in the first year of life—57 in the first week and another 8 in the first month. There was a small increase in the infant mortality rate from 20 to 21, which is the figure for England and Wales. During 1963 there were 285 births more than in the preceding year and this probably contributed to the rise in the total number of deaths. The still-birth rate dropped from 21 to 20 but this is still above the national figure of 17. The slight changes in these rates are unlikely to be significant in view of the comparatively small population involved (Table 2). The perinatal mortality was 34, the same figure as in the preceding year. 'a) By wards (Table 3) Cricklewood has taken the place of Brentwater as the best ward. The rate for Carlton has increased from 15 to 18 but this is probably not significant in view of the small number involved. Carlton maintains the overall improvement from the period 1958-1960 when its infant mortality rate was 29. A major factor in this reduction is probably the extensive redevelopment being carried out by the Council in this area. The five wards with the highest mortality rates were Kensal Rise (24), Brondesbury Park (23), Harlesden (23), Willesden Green (22) and Gladstone (22). (b) By Social Class (Table 4) Only 3 deaths occurred in social classes I and II, whilst 85 deaths occurred in the lower three classes, illustrating the effect of environment on infant mortality. (c) Causes of death (Tables 5, 6, 7 and 8) Prematurity accounted for one-third of deaths, Eleven of these babies were illegitimate and information about them was difficult to obtain, but it is likely that six of these mothers did not have adequate ante-natal care. Thirteen of the deaths occurred in families that lived in a single room. A set of premature triplets, had they survived, would have had to share a single room with their parents and 3 other children. Respiratory infections caused the second largest number of deaths. Antibiotics and improved environmental conditions have halved the rate in the last 20 years but there is still room for improvement. Five of these deaths, in infants over a month old, occurred in families living in one room. Congenital deformities caused one-fifth of the deaths. The majority of the abnormalities were cardiac defects. None of the known causes of congenital deformities was found to be operative in this group, which indicates a need for more research in this field. Diarrhoea and enteritis caused only 1 death. The steady improvement in infant care and the availability of antibiotics have brought this death rate down from 10.0 in the 1936-39 period to the low rate of 0.2 in 1963. Other infections. In this group the death rate was low, probably due to antibiotics. On occasions, however, the infection spread in spite of treatment, as in the case of an infant who died in hospital from an ascending umbilical infection. Birth injury. In spite of continued improvements in obstetrics the death rate to this cause (1.1) has not shown much improvement on the 1936-1939 figure of 1.6. One infant died due to an injury at birth and his body was found abandoned in the Willesden railway sidings. He may have been saved if skilled obstetric help was available at the time of his birth. Others. One death at 2 months was due to a malignant tumour (lymphosarcoma) and another at 11 months was due to a subdural haemotoma caused by an accident of unspecified nature. General. Prematurity is still responsible for the largest number of infant deaths. More research is necessary regarding its causation but a reduction in the contributing factors of illegitimacy, lack of ante-natal care and poor environmental conditions, could 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. 5 There was a slight increase in the number of samples of ice cream graded 2, 3 or 4, which was anticipated when the sale of soft ice cream, particularly by itinerant vendors, increased. The bacterial cleanliness of ice cream is still determined by the methylene blue reduction test, but this is only one of several combined methods of investigation. Grades 1 and 2 are considered satisfactory unless repeated grade 2 samples are taken from the same vendor, when cultures are made to indentify the organism in case it is a type resistant to pasteurisation. These organisms are, however, seldom responsible for grade 3 or 4 results. Faulty practice during production and/or distribution is the cause of unsatisfactory samples. Many producers accept responsibility for the sterilisation of the itinerant vendor's equipment. The van is returned to the depot each night and trained personnel do the work. Many vendors, however, cleanse their apparatus themselves, and unless sufficient supplies of hot and cold water are available, sterilisation may be incomplete and grade 3 or 4 samples result. Such traders are known to the department, and samples are taken whenever they are found in the borough. Four of the unsatisfactory samples of water from domestic supplies came from two flats in the same block. On investigation, it was found that the tank supplying both flats had been left uncovered. The owners had the tank cleansed and covered, and a subsequent sample was completely satisfactory. The other unsatisfactory sample came from the supply to a sink. The owners disconnected the supply from a tank in the roof space and connected it direct to the main. The two unsatisfactory paddling pool samples came from King Edward VII Park and 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, and since April, 1962 at the Chichester Terrace Clinic. The nurse who carried out treatment at Chichester Terrace Clinic resigned in November and as it was not possible to obtain a replacement, treatment had to be discontinued. As compared with 1962 there has been a considerable decrease in the number of adults and children, particularly school children, treated for lice and nits. There has been a very slight increase in the number of children under five and adults treated for scabies, but the numbers treated are still small and there is no evidence of a significant increase in the prevalence of this condition among the population. Establishments for Massage and Special Treatment The registration of establishments for massage and special treatment is delegated to the Borough Council under Part XII of the Middlesex County Council Act, 1944. During the year 20 licences 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. The Council refused to grant a new licence in one case because the person who would have administered the treatment did not possess a technical qualification. 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's staff, the Chief Public Health Inspector's 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 clinic mothercraft classes were held, and doctors, mid wives 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. It is pleasing to report that there was an increase in the number of lectures given to social, religious and political organisations. 18 were given this year compared with 8 last year. Unfortunately there was a decrease in the number of talks given to factory employees during lunchhour breaks. This was due to two factors. Firstly, the attitude of many factory managements to talks has changed during the last two or three years. Although they welcome a talk about subjects on which public interest has been stimulated by press, radio and television, e.g. smallpox, smoking and lung cancer, they are becoming reluctant to agree to talks on other subjects. Secondly, with re-arrangements of duties and increase in work, it has not been possible to spare the staff for the intensive visiting and persuasion necessary to keep the talks going. The Chairman and members of the Home Safety Committee gave talks on accidents in the home to religious and social organisations. 6 Posters on smoking and lung cancer were exhibited on the Council's 53 poster sites, in the four health clinics and the six libraries on three occasions during the year. 5,000 bookmarks were also distributed from the libraries. The Middlesex Executive Council kindly circulated a poster, six copies of each of four different leaflets and 20 bookmarks on the same subject to all general practitioners in the borough for display in their waiting rooms. Altogether one can look back on the year with the satisfaction of knowing that 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 in the past 50 years is a reflection mainly of improved living conditions. Better housing and 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 of various diseases for 1962 and 1963 is shown in Table 13. Diphtheria For the ninth year running there were no cases of diphtheria. Dysentery There were no localised outbreaks of dysentery. The number of cases confirmed (72) decreased compared with 1962 (109). Unfortunately a child of four months died from the disease a few hours after being admitted to hospital. Food poisoning There were no outbreaks of food poisoning. The number of cases confirmed (17) was the lowest figure since 1956 when there were 15 confirmed cases. Measles In common with the remainder of the country, measles reached epidemic proportions during the year. 1,948 cases were notified compared with 520 in 1962. There were no deaths from the disease. Meningococcal infection Three cases were confirmed. A child of one month died from meningococcal meningitis. The disease was certified by the Coroner after post-mortem examination. Ophthalmia neonatorum There was no impairment of the vision in the five cases of ophthalmia neonatorum. Poliomyelitis It is pleasing to report that there were no cases of poliomyelitis, which is probably the result of the steady increase in the number of people protected against the disease. One case was notified but re-diagnosed mumps, meningitis and encephalitis. Puerperal pyrexia Since 1st August, 1961, puerperal pyrexia applies to any 'febrile condition occurring in a woman in whom a temperature of 100 -4 degrees Fahrenheit has occurred within 14 days after childbirth or miscarriage'. The number of cases notified (134) was slightly less than last year (157). Smallpox There were no notified cases of smallpox. Nineteen 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 2,496 certificates of vaccination were authenticated by the department. Typhoid fever Four cases of typhoid fever were notified but only three were confirmed. An infection in a child was traced to a grandmother recently come from abroad, who was a carrier. In spite of extensive enquiries it was not possible to trace the source of infection in one case. Whooping cough The incidence of whooping cough increased in 1963 compared with the previous year. The case rate per 1,000 population (1.47) was a little above that of England and Wales (.74) (Table 14). 7 BRONCHITIS, CANCER OF THE LUNG AND TUBERCULOSIS The causes of many respiratory diseases are interlinked; for example, bronchitis and cancer of the lung sometimes occur together in a cigarette smoker; so it is advisable to consider these conditions together. Other causes, though often less important, are smoky atmosphere, dust and fumes. Smoking may also contribute to the development of pulmonary tuberculosis, especially in middle-aged and elderly people. The risk may well extend beyond the lungs and be a factor in coronary thrombosis and delayed healing of peptic ulcers. Over the last sixteen years, bronchitis and lung cancer have displaced tuberculosis as an important cause of invalidity and death. In Willesden the death rate from cancer of the lung in 1963 was almost eight times that from pulmonary tuberculosis, and from bronchitis nearly eleven times (Tables 16, 17 and 18). The campaign against tuberculosis has been successful because of the wide use of highly effective drugs. Cancer, however, presents a sombre picture because smoking is still widespread, and treatment, except in the early stages, 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 reform can also help; school children and members of social, religious and political organisations have been given talks on chest diseases, and in particular on the dangers to health from smoking cigarettes. Mortality and morbidity There were nine deaths from pulmonary tuberculosis among men and five among women with the now usual shift to the older age groups. There was a slight decrease in notifications of tuberculosis (113) as compared with the previous year (131). Although there was only a very slight decrease in the number of cases on the register, the downward trend which began in 1958 continued. This is encouraging, but complacency must be avoided. Bronchitis remains a serious problem. 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 more than trebled between 1924 and 1962, and there was a marked sex difference; for every woman who died there were six men. In 1963, 96 per cent, of the deaths occurred in men over 45 years of age. The death rate for cancer of the lung fell from 78 per 100,000 in 1962, to 63 in 1963. This, however, runs contrary to current trends and is probably just a transient local phenomenon. Prevention and diagnosis To prevent chest diseases we must deal with smoke from cigarettes and the atmosphere. Measurement of smoke and other impurities in the air continues and small improvements have been noted. It is hoped that the establishment of smoke control areas under the Clean Air Act will lead to further improvements. Some 15 to 20 years of smoking is normally required before a cancer develops, but it is better to take no risk at all. Talks have therefore been given to school children in their early teens when temptation backed by the enormous resources of the tobacco industry is at its strongest. Visual aids have also been used to explain clearly the relationship between smoking and respiratory diseases. It is hoped to stimulate a more active opposition to smoking among these children, like the Junior Anti-smoking League which has been formed in Camberwell in south London. Talks have also been given to political, religious and social organisations, endeavouring to persuade adults to give up smoking, not only for the sake of their own health but for the children who might follow their example. Bronchitis cannot be diagnosed easily by radiography, but X-ray surveys continue to play a very 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 fourth winter the Group Clinic for the prevention of bronchitis, started by Dr. C. H. Wood, Department of Occupational Health, London School of Hygiene and Tropical Medicine, has been continued under 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, 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 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. T uberculosis Tuberculosis creates a special problem beca'ise of its infectious nature: 14% of the deaths occurred in elderly men and women previously unknown to the health authorities (Table 24). This indicates that, in spite of the improvement in case-finding methods, there is still a reservoir of infection among older people in the community, which holds special hazards for the young and unprotected. 8 In view of this 'hard core' of tuberculous infection, B.C.G. vaccination is an important preventive measure offered to all school leavers to raise their resistance to the disease. This is very necessary during adolescence when the risk of infection is higher and many new stresses have to be faced. 81% of school leavers were found to need B.C.G. and 95% of these were vaccinated (Table 23). The proportion of younger children reacting to the tuberculin test was little changed, but over the years there has been a marked decline in school children, particularly entrants, reflecting the general reduction in the community. Compared with 1954, when children generally came into contact with infection before they entered school, today most of those affected do so during their school life. Factories and workshops One workplace was visited by the Medical Officer of Health and 19 contacts were encouraged to attend for X-ray examination 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 lung 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 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 is carried out by the Metropoliton 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. Three schemes have been approved and works are in progress. Refuse disposal The Borough Engineer's Department deals with the provision of dustbins. Refuse is disposed of by controlled tipping at Yiewsley; house refuse is collected weekly and trade refuse as often as required at an agreed charge. Household arrangements The census report for the County of Middlesex, 1961, showed clearly Willesden's housing problems as compared with the remainder of the County and London (Tables 25 and 26). (a) Persons per acre and density of occupation With the exception of Tottenham (37.6) Willesden has more persons per acre (36.9) than any district in the County, but slightly less than the average for London (42.7). The percentages of persons at more than 1^ per room (15.2) and of households at more than persons per room (10.1) are the highest in the County and higher than the averages for London (11.5 and 7.2 respectively). (b) Private households by availability of certain household arrangements (1) Cold water tap, hot water tap, fixed bath The percentage of households either sharing or without a cold water tap (8.9), hot water tap (42.4) and fixed bath (51.6) is more than double that of the average for the County and slightly above that of London. (2) Water closets The percentage of households either sharing or without a water closet (27.1) is more than double that of the County but slightly below that of London (30.9). 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. 9 9 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 392 samples were taken, and all were satisfactory. Swimming bath Samples taken Granville Road 255 Gladstone Park 84 King Edward's Park 53 SANITARY SECTION Staff The establishment of Public Health Inspectors includes the Chief Public Health Inspector, the Deputy Chief Public Health Inspector, eighteen district inspectors and five pupils. At the beginning of the year there were 6 vacancies for district inspectors and the Council were considering what action to take to fill the establishment. 12 of the 18 posts were graded APT. IV; the holders had to have at least ten years' experience and the Smoke Inspectors' Certificate in addition to the statutory qualification and Meat and Other Foods Certificate. The remaining posts were graded APT. II for those with only the statutory qualification, and APT. Ill for those who had the Meat and Other Foods Certificate as well. The Council decided that, with effect from the 1st April, Inspectors with the three certificates and ten years' experience should be graded APT. V (now Scale A); those with the statutory qualification and Meat and Other Foods Certificate should be graded APT. IV; and those with the statutory qualification only should be graded APT. III. It is pleasing to note that there were no further resignations during the year as a result of these improved gradings, but it has not been easy to recruit additional staff. Three appointments were made in February, one in April, and one of the other two vacancies was filled when a pupil qualified and was appointed by the Council. Two pupil Public Health Inspectors were on the staff at the beginning of the year, one of whom qualified in November, leaving four 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 Details of inspections carried out are shown in Tables 31 and 32. Five inspectors were engaged on special surveys: two on the south part of Carlton Ward, two on the smoke control areas, and one on 'Rachman' type problems. Demolition and Closing Orders (Table 27) Two closing orders were made during the year, but no demolition orders were made. Slum Clearance and Area Redevelopment During the year the survey of Carlton Ward south of Carlton Vale was completed. It involved 681 properties and some 1,576 families. Two other areas, Winchester Avenue (10 houses) and Kilburn Square (26 properties) were also surveyed. The conditions found were officially reported to the Council by the Chief Public Health Inspector and slum clearance action was initiated in both areas. A further survey of Willesden Green Proposed Comprehensive Development Area was carried out. It comprises 274 properties and 521 families. The Council is considering its policy in respect of the area. Other surveys included blocks of houses in Christchurch Avenue and Cavendish Road. House-to-house inspection and multiple occupation Towards the end of the year house-to-house inspection was resumed in every ward in the borough. Although hampered by shortage of staff a great deal of work was done in combating multiple occupation, to secure the provision of amenities, and general repair. This is proving to be a most time-consuming project and many additional public health inspectors must be recruited before any appreciable inroads into the problems can be made. 94 notices under section 15, Housing Act, 1961, requiring the provision of additional amenities, and 28 directions under section 19 of the Act to prevent overcrowding in houses in multiple occupation were served (Table 30). Two appeals against notices served under section 15 were dismissed. 10 overcrowding There has been little change in the extent of overcrowding which still remains acute. No licence; under section 80 of the Housing Act, 1957, were issued to permit temporary overcrowding (Table 28). 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 28), and also details of new dwellings constructed during the year (Table 29). Notices served under the Public Health Acts, 1936 and 1961, and Housing Acts, 1957 and 1961 There was an appreciable increase in the number of statutory notices served during the year, compared with 1962 (Table 30), due to the housing survey. No management orders under section 12, Housing Act, 1961, were served during the year. Rent Act, 1957 Details of the applications received and the certificates issued up to the end of the year are showr in Table 33. Nuisances abated and improvements made A summary of nuisances abated and improvements made is shown in Table 34. Inspection of factories, outworkers' premises and food premises A summary of inspections of the above premises is shown in Table 32. 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. 5 (Manor) Smoke Control Area, covering 355 acres with 4,192 dwellings, 105 commercial and 16 other premises, was confirmed by the Minister of Housing and Local Government in April, and came into operation on 1st November, 1963. 23 properties in the area which are due to be demolished during the next few years were exempted from the Order. 114 prefabricated Council dwellings were given exemption from having means of smokeless ignition and the occupiers allowed to use sticks and paper for lighting fires. The 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 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 5 1.11.63 355.0 4,192 121 1,265.3 15,894 1,199 The No. 6 (Kensal Rise) Smoke Control Order, covering 144 acres with 3,496 dwellings, 178 commercial and 35 other premises, was confirmed by the Council in November and submitted to the Minister of Housing and Local Government. The proposed date of operation is 1st November, 1964. In December, 1963, the Minister of Power presented a report to Parliament entitled "Domestic Fuel Supplies and the Clean Air Policy". This report set out the conclusions of a "comprehensive re-assessment of the probable availability of the different smokeless fuels in Great Britain during the coming decade or so and of the probable demand for smokeless fuels in the same period". As a result of the report the Ministry of Housing and Local Government issued Circular No. 69/63, on the 17th December, setting out certain changes desirable in the introduction of further smoke control areas. In the past gas coke has been the fuel mainly used to replace coal in smoke control areas, but due to technological changes in the gas industry less gas coke will be available, and the introduction of further areas will depend more on the use of hard coke, gas, oil, and 'off-peak' electricity. To encourage the installation of appliances which use these fuels, higher grants can now be paid towards the installation of openable stoves, under-floor draught open fires, or fixed gas, electric storage, or oil heaters. The volumetric analysis of sulphur dioxide in the air has continued at the Public Health Department. The results were sent to the Department of Scientific and Industrial Research each month. Unfortunately a similar analysis at the Willesden County Grammar School had to be discontinued at the end of July because of impending building operations and the demolition of the laboratory where the apparatus was housed. When the new science block is complete it may be possible to continue measurements. 11 Twenty-eight 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. DISINFEST ATION The Public Health Inspectors inspect verminous premises and supervise the work of disinfestors employed by the Council (section 83 of the Public Health Act, 1936) (Table 35). 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 196 Borough Council properties 7 Private dwellings 877 1,080 at the following cost:— Business premises £1,271 13 11 Private dwellings £1,599 9 0 £2,871 2 11 The cost of disinfestation at business premises is recovered from the occupiers; 109 had an annual agreement with the Council for regular inspection and disinfestation. Three were new agreements and 106 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 hvgiene in the production and sale of food since the first regulations (the Food Hygiene Regulations, 1955) came into force on 1st January, 1956. 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 37 and 38). The proprietors of a self-service store were prosecuted for ten contraventions of the Food Hygiene Regulations and were fined £50 with £5 5s. 0d. costs. An assistant in a greengrocer's and fruiterer's store was prosecuted for smoking while handling open food and was fined £5 with £2 2s. 0d. 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 39). 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. In addition, there was a decrease in the number of individual cases of food poisoning notified. 12 Food unfit for human consumption One ton, 11 cwt., 2,034 tins, 1,388 packets of food inspected by the Public Health Inspectors were found to be unfit for human consumption (Table 40). All the food was dealt with as trade refuse by the Borough Engineer's Department and deposited on the controlled refuse tip. The proprietors of a grocery shop were prosecuted under section 8 of the Food and Drugs Act, 1955, and fined £10 with £5 5s. 0d. costs for exposing for sale chocolate cakes which were unfit for human consumption. Contaminated food 18 specimens of contaminated food were dealt with by the department. They included mould in a cream cake, a piece of egg and pork pie, and chocolate cakes; a piece of cloth in a sausage; maggots in chocolate covered cakes; a nail in a loaf of bread ; and foreign matter in a loaf of bread and milk bottles. No action was taken in 7 cases because of insufficient evidence; of the remaining 11, 9 firms were cautioned and the Council decided to prosecute the other two. In one case, however, proceedings were not taken because the complainant was uncertain of the date when the offence occurred. In the other case the firm was fined £10 with £5 5s. 0d. costs for selling mouldy chocolate cakes. Clean food sampling The Middlesex County Council is responsible for taking samples and for supervising the control of food adulteration in accordance with the provisions of the Food and Drugs Act, 1955; the administration of the Emulsifiers and Stabilisers in Food Regulations, 1962; the Preservatives in Food Regulations, 1962; the Merchandise Marks Acts, 1887-1953; and the Labelling of Food Order, 1953. The Chief Officer of the Public Control Department has supplied details of his Department's work in previous years, but asked to be excused from doing so on this occasion because of pressure of administrative work due to the Weights and Measures Act, 1963, and the transfer of functions under the London Government Act. Milk and Dairies Regulations Milk sales are regulated by the Food and Drugs Act, 1955, the Milk and Dairies (General) Regulations, 1959, and the Milk (Special Designation) Regulations, 1960. Willesden has been a specified area since October, 1951: all milk sold by retail is sterilised, pasteurised, or tuberculin tested; the sale of raw milk is prohibited. The provisions of paragraph 6 of Part II of the Second Schedule to the Milk (Special Designation) Regulations, 1960, restricted the bottling of milk to the three premises in the borough where the milk is pasteurised. These Regulations transferred the issue of dealers' licences from the Borough Council to the food and drugs authority for the area, the Middlesex County Council. 109 persons are registered by the Council to trade as distributors and three premises are registered as dairies. Fifteen inspections were made of the three dairies; no defects were found. Ill samples of milk were submitted for bacteriological examination (see Table 9). One dirty milk bottle was reported by a member of the public, and one by another local authority. The Council issued an official caution in respect of one and referred the other to the local authority in whose district the milk was bottled. FACTORY INSPECTION There was a decrease of 27 in the total number of factories in the borough compared with the previous year (Table 41). 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 41 and 42. One firm was prosecuted for failing to maintain sufficient and suitable sanitary conveniences as required by section 7 of the Factories Act, 1961. They were fined £5 with £2 2s. 0d. 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. 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. 6 certificates were renewed in 1958. Since then one bakehouse has been demolished and four are no longer used. The Council agreed to the renewal of the certificate in respect of the remaining bakehouse. 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. 136 were employed during the year, the largest number, 88, altering and making clothing. Public Health Inspectors inspected these workers' homes, which were all found to be satisfactory (Table 43). 13 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 made day and night observations to determine whether complaints of noise nuisance were justified or not. Thirty-eight complaints were received during the year, of which 9 were repeated complaints and 21 did not constitute a nuisance within the meaning of the Act. Five of eight complaints found to be a nuisance were remedied after consultation with the firms concerned but the other three were still being dealt with at the end of the year. The Council authorised the employment of a noise consultant to advise on a difficult case of noise and vibration from machinery. The noises objected to by complainants were wide and varied and included those from a public chiming clock, ice-cream vendors' chimes, factory processes, shunting of coal wagons, power sewing machine in a domestic dwelling, unloading of milk churns, coin-operated laundry, loudspeakers, and inconsiderate neighbours. 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 was held at the same time as a chiropody clinic. The clinic was established to give advice to the elderly on physical and mental health. It can now be said to have passed the experimental stage and become firmly established. Knowledge built up over two to three years of experience is being used with increasing effectiveness in improving the health and well-being of those who attend. 49 sessions were held throughout 1963. Total attendances were 184, and 51 of the patients were new. A large variety of problems was dealt with, the social ones being at least as common as the medical. Sad to say, there is a kind of quiet despair which is common among the old, tending to lead to withdrawal from life and submission to disability. The clinic tries to overcome this by means of advice and gentle encouragement. Often they are referred to other agencies, which otherwise they might never have approached. Financial problems have been solved; illness has been cured or at least made more bearable and many have found new opportunities for social life and fresh interests. Friendly co-operation has been maintained with family doctors and numerous statutory and voluntary bodies. The most significant advance during the year was in the field of nutrition. Chronic undernourishment is unfortunately common among the elderly, among whom poverty and apathy are liable to result in poor and ill-chosen diets. There has been a long-felt need for a complete food supplement, such as Complan, which requires the minimum of preparation and is easy to take. Application was made to have it supplied at the clinic at reduced price, like welfare foods for mothers and children, but this was refused. Eventually it was decided to adopt a scheme used in Wembley, and the Complan was bought by the Willesden Borough Health Department, and sold in clubs and at the clinic at a fraction above cost price. This has proved very popular and demand has tripled over a period of three months. 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. The provisions of the National Assistance Act, 1948, and the National Assistance (Amendment) Act, 1951, were outlined in previous annual reports. Ten cases were investigated during the year, and although they all required further action it was not necessary to use compulsion. Three agreed to be removed to hospital voluntarily; two agreed to go into welfare homes: and 5 were made comfortable in their own homes by the provision of additional services, such as home help, home nurse, meals on wheels. Laundry service 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. 14 In April, 1952, the Council organised a laundry service for incontinent old people free of charge under section 84 of the Public Health Act, 1936. The articles are laundered and ironed at a cost of 5d. per lb. at the Neasden Hospital, by arrangement with the Central Middlesex Group Hospital Management Committee. Transport is provided by the Borough Council. 5 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 1.1.63 New cases Died Admitted to hospital Discontinued On register 31.12.63 37 58 26 13 12 44 Voluntary Services for the Aged The '49' Club organised by the Willesden Old Folks' Association celebrated its eleventh anniversary in February. The Club still has a good membership and is open daily from 1.30 to 10.0 p.m. Several firms gave donations to the Association's funds. Eighty members and helpers went for a day trip to Clacton in July. The visiting service which the Association provided for lonely housebound old people was transferred to the Old People's Welfare Committee in July, 1963. This transfer was necessary when Miss M. E. Piatt, Non-medical Supervisor of Midwives, Superintendent of Home Nursing Service and Superintendent Health Visitor, who recruited the visitors and arranged their visits on behalf of the Association, retired from the Middlesex County Council's service. Miss Piatt's enthusiasm, hard work and devotion will be sadly missed. 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, 1946. The Willesden Old Folks' Association acts as an agent for the County and arranges for the old people to have treatment. The five private chiropodists who have worked for the Association for a number of years still carry out treatments in their own surgeries. In addition treatments are carried out at the Neasden Clinic by a full-time chiropodist employed by the County Council. When sufficient chiropodists are recruited all treatments will be carried out at the clinics. The service is still in great demand, and 4,479 treatments were given by the five chiropodists. New applications receive initial treatment and are then placed on a register for periodic visits. In addition, 243 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 £1,958 in 1963. A grant of £1,706 was recovered from the Middlesex County Council. 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 t'ie 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 wellequipped kitchen, was opened. 16,529 meals were prepared and delivered, compared with 11,989 meals in 1962. 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. 88 frozen dinners were delivered at Christmas and 150 of the o'd 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 Deputv and an assistant work together with statutory bodies and voluntary associations and organise services for the aged. The two full-time centres operated by the Committee are now in their third year and are firmly established. 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. A garden layout at the rear of the Club was completed and opened in 1963. At this ceremony, a tree was planted by Mrs. Leff in memory of her husband, the late Medical Officer of Health of Willesden, who was greatly interested in the welfare of the elderly. 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. 15 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 off-peak 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. 430 old people had holidays in April, May, June and September, including a number who received assistance from the Women's Holiday Fund. A holiday for sixteen lonely old people was also arranged at the holiday homes at Christmas. The seven 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; Anson Hall, Cricklewood; and the Willesden Green and Kensal Rise Senior Clubs, all had a successful year's work during 1963. 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 28,334 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. During 1963, 16,154 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 15 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. Close on 100 parcels of produce were distributed by the Co nmittee and several more by private donors. At Christmas 1,300 food parcels were distributed to the over 70's who were in need. A further 200 names were provided to local concerns and individuals to receive parcels and 600 parcels were distributed by Luke Old Folks Fund. During 1963, "Operation Greenfield", under which housebound old people are taken into the country for the day, was carried out on 3 days in August when 100 old people were taken by car and special coach to Maidenhead and Bray where they were provided with refreshments. The problems which are brought to the office are varied and numerous and a large number of cases are referred by hospitals when an old person is about to be sent home. Much visiting and case-work is carried out and although statistics tell little of this part of the Committee's work it is worth recording that in 1963, 2,349 office interviews were held and 1,059 home visits made. On the recommendation of the Welfare Organiser a number of wireless sets were supplied to the bed-ridden by the Wireless for the Bedridden Society, the total number on loan from that source being close on 50. Ten old people were provided with new free television sets through the generosity of an anonymous donor. A number of reconditioned television receivers and radios 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 £17,235 which the Council set aside for the Committee's use in 1963/64. Financial assistance from the Middlesex County Council towards administration and visiting costs amounted to £1,490. A Flag Day and House Collection in September raised a net sum of £527 towards the cost of Christmas parcels and further donations for that purpose totalled £110. Close on £100 was also donated for outings for the housebound. In November the Committee initiated a scheme for the distribution of welfare foods among old people through the clubs, clinics and domiciliary services. BURIAL OF THE DEAD In accordance with the provisions of section 50 of the National Assistance Act, 1948, arrangements were made for the burial of eleven persons during the year, at a cost of £137 2s. 0d., £114 0s. Od. being recovered from the relatives. PUBLIC MORTUARY Post-mortems were performed on 643 bodies, followed by an inquest in 113 cases. Sixty-eight inquests were held on Willesden residents, but only one of these was held in the Coroner's Court attached to the mortuary. The remainder were held at Ealing. Inquests held on Willesden residents 1958 1959 1960 1961 1962 1963 Kilburn 17 24 16 10 2 1 Ealing 61 38 53 61 53 67 Total 78 62 69 71 55 68 16 In November the Council expressed concern that the Court was not used more often and at the end of the year an approach had been made to the Coroner to see if more inquests could be held there. 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 1963. COMMON LODGING HOUSES There are now no common lodging houses in the district registered under section 237 of the Public Health Act, 1936. SLAUGHTERHOUSE LICENCES There are now no slaughterhouses in the district under section 62 of the Food and Drugs Act, 1955. Slaughtering was last carried out in the borough in 1939; one licence was, however, renewed until 1955. RAG FLOCK AND OTHER FILLING MATERIALS ACT, 1951 The Rag Flock and Other Filling Materials Act, 1951, and Regulations, 1961, specify the standards of cleanliness for the filling materials. The premises of manufacturers of rag flock and those used for storing rag flock must be licensed. One manufacturer of soft toys who employs outworkers only, uses premises for the storage of rag flock. The premises of persons carrying on business of upholstering, stuffing or lining of bedding, toys and baby carriages, and others using materials specified in the Act, must be registered; a fee of £1 0s. 0d. is paid. There were no new registrations during the year. One registered business was discontinued leaving 13 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. Three 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 1963, 11 pet shops were licensed. STAFF MEDICAL EXAMINATIONS Sixty-nine 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, twenty-three special reports were made to the Council on staff who had prolonged periods of sickness and whose sick pay had expired, and four special enquiries were made for Chief Officers. 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 Services The remainder of the report provides detailed information on the personal health services in the area. CARE OF MOTHERS AND YOUNG CHILDREN Care of the Expectant Mother (Tables 44-47) During 1963 the average attendance per session at local ante-natal clinics was 15.0. This was a slight decrease over the previous year, but this is probably due to the fact that more general practitioners are conducting ante-natal clinics in their own surgeries. Close co-operation continued between general practitioners, assistant medical officers, health visitors, midwives and hospital staff to provide expectant mothers with adequate ante-natal care throughout pregnancy. The co-operation card is now being more widely brought into use for attendances between local clinics and hospitals. This card, which is retained by the patient ensures that a record of her ante-natal care is immediately available wherever she attends. 17 Towards the end of the year the North-West Metropolitan Regional Hospital Board made a monthly allocation to this area of a certain number of beds at St. Andrew's Hospital. These were to be made available to expectant mothers only if home conditions were unsuitable for domiciliary confinement. This was intended to relieve pressure on the emergency bed service, and from the commencement in November to the end of the year 39 beds have been allocated and taken up. Health visitors continue to follow-up expectant mothers who have failed to keep their appointments at local and hospital clinics. CHILD WELFARE CLINICS (Table 48) Child welfare sessions are held in the seven clinics staffed by assistant medical officers, health visitors and clinic nurses. Mothers are able to discuss the general management and feeding of the baby or toddler. Weight can be checked, and initial examination given and routine medical check-ups are available. More general practitioners are conducting their own child welfare sessions and some have asked for a health visitor to assist them at these sessions. Immunisation continues to be carried out against whooping cough, diphtheria, tetanus and poliomyelitis, also vaccination against smallpox. A nursing assistant continues to be employed at Pound Lane Clinic for three sessions a week to care for children when their mothers are attending at clinic sessions. 103 sessions were held and 437 attendances were made. PREVENTION OF BREAK-UPS OF FAMILIES IN WILLESDEN The Family Service Unit continues its work in this area. During the year a further 3 cases were opened making a total of 25 families. The total number of contacts with families numbered 1,194 whilst contacts on behalf of families numbered 753 making a total of 1,947 contacts. Co-operation continued between all workers concerned. MIDWIFERY SERVICE (Tables 49 and 50) At the beginning of the year the Middlesex County Council employed seven midwives in Willesden. During the year four midwives left, and three midwives were appointed making a total of six at the end of the year. Sixteen pupil midwives completed their three months domiciliary training during the year. Midwives continue to work in close liaison with general practitioner obstetricians and use a personal maternity record card. The number of deliveries attended during the year shows an increase over the number of deliveries in 1962. More ante-natal sessions have been held with a greater number of ante-natal visits to the patients' homes. Institutional discharges were higher this year, although the nursing visits to these patients were fewer, because the patients being discharged from hospital were coming home later in the "lying-in' period. The Maternity Record Card based on the Enfield Chase pattern is being used by the general practitioners and the midwives. 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 analgesia. Midwives work very closely with general practitioners who were present in approximately one-half of the deliveries. 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. The emergency obstetric squad was called 8 times during the year for the following emergencies: 2 retained placenta, 4 post-partum haemorrhage. 1 retained placenta with post-partum haemorrhage and 1 severely shocked baby. The Hammersmith Hospital premature baby unit provides a special ambulance for premature babies who require treatment in this unit. The ambulance with two qualified nurses trained in the care of premature babies carries special equipment, including a fitted cot and apparatus for administering oxygen. The ambulance is sent for by the doctor who may be present at the confinement or 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 it is sent out by ambulance with 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 hospital. In addition the midwives have assisted in the obstetric survey which is being carried out by the North-West Metropolitan Regional Hospital Board, by completing questionnaires on certain groups of cases. The midwives visited mothers and babies discharged early from hospitals and 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 51 and 52) The health visitor's function is primarily that of teaching the principles of health—physical and mental. In her visits to families in the home the health visitor becomes aware of early stress or tension, and can, with their permission, seek the help of the other social workers in the team. Visits are also paid to advise on the care of those suffering from infectious illness at home. 18 The general care of the elderly, either living within the family circle or alone, is making increasing demands on the health visitor's time. This is a sphere in which they are working closely in co-operation with general practitioners and other members of the health team. Circular No. 26/59 of the Ministry of Health states:— "The health visitors' work should be broadly based and should extend to the whole family." Health Education Talks have been given in clinics and schools. Poster displays have been set up in clinics to illustrate current topical points of health education, and suitable films have been shown to a variety of audiences. Sponsored students Three sponsored student health visitors commenced the course at Chiswick Polytechnic in September. Health visitors assist in their practical training, and also with student nurses and other students who come to see the work in the public health field. In-service training Three health visitors attended the two-day course in screening tests of the hearing of children. One health visitor undertook the part-time training course in teaching techniques, organised by the Health Visitors Association. One health visitor is continuing to attend the second year of the course on "Human Relations"; attendance is at weekly sessions over the year. A series of classes of instruction in the teaching of relaxation were held at one of the local clinics, and several health visitors attended. These classes were found to be both stimulating and instructive. Refresher Courses Three health visitors attended different courses on various aspects of their work. There have also been various lectures over the year for all social workers, at which health 1 isitc s have been fortunate enough to attend. HOME NURSING (Tables 53 and 54) 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. Home nurses carry out treatment such as the general care of the acute and chronic sick, blanket baths and injections for patients including children under 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. There has been an increase in the number of new cases referred, and more cases were carried forward at the beginning of the year, resulting in a higher total of visits as shown:— Number of cases brought forward 639 Number of new cases 2,193 Total: 2,832 Number of patients recovered 1,559 Number of patients admitted to hospital 398 Number of patients died 222 Number of patients remaining on register 653 Total: 2,832 Total number of visits paid 90,325 The "Pilot Scheme" of a home nurse attached to a group of four general practitioners, which was started in 1962, has continued to work well, to the satisfaction of the doctors and the home nurse concerned. Pilot Scheme cases: Number of cases brought forward 26 Number of new cases 78 Total: 104 Total number of visits paid 4,022 The Marie Curie Memorial Foundation has provided facilities whereby a nurse may be provided to assist with the care of terminal cases of carcinoma, enabling the relatives who are caring for these patients to have some rest; this greatly supplements the care which is given by the home nurse. One person has been employed in this capacity since 16.9.63, and she has attended 7 cases. The district nurse training course for state registered nurses has continued with a further 3 courses. Two home nurses attended these courses and were successful in obtaining the National Certificate. 19 SMALLPOX VACCINATION Vaccinations are done by the staff at the clinics and by general practitioners. The number of children under one year of age vaccinated represents 7.2% of the total live births for the year (Table 55). This is a fall of almost 28% and is due to a change in policy recommended by the Ministry of Health, in which primary vaccination of infants is postponed from the age of 5 months to 19-24 months, because reactions are less likely when the child is older. Since the change took place in April, 1963, there has not yet been time for the full results to appear in the figures. 1962 was an abnormal year for vaccinations due to epidemics of smallpox elsewhere in the country, resulting in great increases in the number performed by general practitioners, especially in the older children and adult groups. The 1963 figures could more properly be compared with the 1961 equivalents: the totals being 1,233 and 1,789 respectively. The inference would seem to be that although the public's alarm about smallpox may be great, its memory tends to be short. 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. 1,998 children completed a full course of primary immunisation, and 1,130 received a full reinforcing injection. INOCULATION AGAINST POLIOMYELITIS Inoculation of persons in the priority groups continued. 914 completed a course of Salk vaccine and 3,343 had a complete course of oral vaccine. The Minister announced in April that in the light of experience after one year, it was now recommended that children who had a course of oral vaccine in infancy should receive a reinforcing dose on entry to school, normally at the age of 5 years. During the year 4,068 persons received reinforcing doses. HOME HELP SERVICE (Tables 56 and 57) There were 665 applications for the service, and there was a slight increase in the number of cases still receiving help at the end of the year. Nine tuberculosis cases were helped, and help was provided free of charge to five mothers suffering from toxaemia of pregnancy. Fifty-two bookings were taken for home confinements, but only 37 mothers were helped, the remainder making alternative arrangements. There were 79 home helps employed at the end of the year. Their rate of pay was increased to 4s. 1d. per hour, and the charge to the public increased to 4s. 9d. per hour. Seven persons were enrolled to act as neighbourly helps but 3 only were still employed at the end of the year. The number of home visits made by the organisers was 4,687. DAY NURSERIES (Tables 58-61) All the approved places in the 8 nurseries, together with 30 places in York Park Nursery, Hendon, have been occupied throughout the year with a high general daily attendance. The waiting list has increased by 17%. The maximum daily charge was increased from 15s. 6d. to 17s. 6d. from 9th June. Applicants unable to pay the assessed charges can appeal at a meeting of the Appeals Sub-Committee. The William Dunbar Day Nursery was approved as a training nursery for the N.N.E.B. Course. There are now 6 training nurseries in Willesden. Thirteen students completed the 2 years period of training for the N.N.E.B. Course. 11 passed the examination and obtained the certificate. Recruitment of suitable trained nursery staff remains difficult. The establishment for students was increased by 16 to a total of 36 from September. It is hoped this may provide additional trained staff in 1965 when these students obtain N.N.E.B. qualification. 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. 20 Patients who ask for a reduction in the standard charge of £7 7s. 0d., must complete an economic circumstances form and they are assessed by the finance officer. They may also ask for payment of travelling expenses. Number of recommendations: — 1963 1962 Adults 60 98 Children 13 6 73 104 SCHOOL HEALTH SERVICE (Tables 62-73) Medical Inspection Routine medical inspection in schools continued, and the high percentage of children in a satisfactory physical condition was maintained. Handicapped Pupils In October the Audiology Unit or Hearing Clinic at Neasden opened, under the direction of Dr. L. Fisch. Previously children with hearing defects had to be referred for further investigation to one of the County's Units at Heston, or Tottenham, or to the Royal National Throat, Nose and Ear Hospital at Gray's Inn Road. After only two months, it is quite obvious from the number of cases referred and attendances made that this new service is a great boon both to medical staff and parents in the assessment and supervision of the partially hearing and deaf child. There is no delay in the admission of physically handicapped children to Lower Place Day Special School, but there is a considerable waiting period between a child being recommended and its actual date of admission to Woodfield Day School for Educationally Sub-normal Pupils. CHILD GUIDANCE (Tables 74 and 75) This year the clinic has had the uninterrupted services of a part-time consultant psychiatrist and two full-time educational psychologists, but the establishment of two and a half psychiatric social workers has been occupied by six different persons. The establishment of one and a half psychotherapists is made of part-time workers of different psychological schools and the centre is proud of the fact that the professional staff has a most varied outlook on the work of helping the emotionally disturbed. The team continues to investigate and treat the problems of children referred from any source; about half of whom were from medical sources and 16% from the parents themselves. There are about twice as many boys as girls referred. Table 75 shows the diagnoses made by the psychiatrist, and by far the largest number have behaviour problems occasioned by environmental factors. A growing problem is that of school phobia ; this usually has little connection with the school itself but springs from home difficulties. The waiting list at the end of the year was 23 compared with 17 last year. This is not great when compared with other areas. There is a need for day classes for maladjusted children. At the moment such children are placed at residential schools and certainly it is frequently desirable for the child to be away from home. However, there are many children who do not fit into a normal school but do not require a residential place. Many school phobics could attend a small class with a sympathetic teacher, even though they do not attend ordinary school. The work of the school psychological service continues; on an average each psychologist visits a school a day during the school year. Close liaison with the school medical officers has been maintained through monthly conferences and weekly visits of the psychiatrist and psychiatric social workers to school clinics. SCHOOL DENTAL SERVICE AND PRIORITY DENTAL SERVICE (Tables 76 and 77) The staff situation is still satisfactory insofar that it is possible to offer complete treatment to all school children and priority patients willing to accept it. The availability of part-time dental officers is now such that a fair degree of selection is possible in making appointments, but the recruitment of full-time officers remains difficult. As the benefits of dental treatment are becoming more appreciated, an increasing number of patients is requesting and receiving more frequent inspection and treatment with a resulting improvement in the proportion of teeth which can be conserved. There is also a considerable increase in the amount of work done which is not revealed by the actual figures. The greater use of new equipment and techniques encourages more ambitious and complicated conservations and restorations which, although more time-consuming, result in the saving of many teeth which, a few years ago, would undoubtedly have been lost. CHIROPODY (Table 78) A full-time chiropodist was working all through the year, and the number of patients seen was greater than in the previous year, with prospects of further improvement in the future as more chiropodists become available. 21 Much of the work has been done for old people, some of whom were seriously incapacitated by their feet and benefited greatly by the treatment. The preventive aspect has not been neglected, and talks illustrated by film strips have been given at schools. Mothers have been advised on the choice of suitable shoes for their children, and many of them take considerable care regarding these. Unfortunately, education has so far had little effect on trends in fashion in adolescent footwear and beyond, and there is every indication that today's young people will be as much in need of chiropody in the years to come as their parents and grandparents are today. 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 1963/64. 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 six meetings of sub-committees were held during the year. Sub-committees considered a photographic competition, a song competition, and the Willesden Show. It was agreed that a fourth edition of the Committee's Home Safety Handbook should be published, and preliminary work commenced. It is hoped that it will be available in June, 1964. Five thousand leaflets "How to Prevent Home and Everyday Accidents" were provided for the Willesden Old People's Welfare Committee for insertion in their handbook 'Services Available to Old People'; and 5,500 leaflets "Safety in the Home" were distributed by the Housing and Estates Manager to Council tenants. During the week preceding 5th November and at Christmas, posters were displayed on Council notice boards, in public libraries and in clinics. Literature was also distributed throughout the Borough. At the request of the Area Welfare Officer, a special demonstration and lecture were arranged at the London Electricity Board's Showrooms in Willesden Lane for a group of blind and partially sighted persons. The theme was "Safety with Ease", and the 60 handicapped people who attended were very appreciative of the arrangements made. A display, exhibited at the Willesden Show in September, was very successful. The theme was 'Oil Heaters' in support of the national campaign on the prevention of oil heater fires. Two very old unsafe oil heaters were featured against a 'flaming' background. The Chairman and members attended to answer questions and distribute pamphlets on the prevention of oil heater fires. A great deal of work was done preparing and arranging a photographic competition related to home safety. 2,000 entry forms were distributed from libraries, clinics, public offices and at the Willesden Show, and two firms donated photographic equipment as prizes. Unfortunately there were no entries for the competition. Preparations for a song competition have continued and this will probably be held at the Willesden Show in September, 1964. The Chairman wrote an article on 'Home Safety' which was published in the "West Indian Gazette"; and the Vice-Chairman wrote a children's play which it is hoped will be acted by a school or children's organisation. A copy of the play was sent to the Royal Society for the Prevention of Accidents who have asked for a note of reactions to it after its first performance. An article on the Committee's activities by their press representative was published in 'Safety News'. Members of the Committee gave six talks to local organisations, and approximately 190 people attended. Three members attended the National Home Safety Conference held at the Central Hall, Westminster, in October; one member attended several meetings of the Area 10 Home Safety Committee, which has representatives from all Home Safety Committees in Greater London and Middlesex ; and three members attended the Willesden Borough Council's Civic Forum in February. 22 TABLES Table 1 DEATHS Causes: Males Females Total 1. Tuberculosis (respiratory) 9 5 14 2. Tuberculosis (other) 1 1 2 3. Syphilitic disease 1 4 5 4. Diphtheria — — — 5. Whooping cough — — — 6. Meningococcal infections — 1 1 7. Acute poliomyelitis — — — 8. Measles - — — 9. Other infective and parasitic diseases 1 3 4 10. Malignant neoplasm, stomach 12 13 25 11. Malignant neoplasm, lung bronchus 93 16 109 12. Malignant neoplasm, breast — 34 34 13. Malignant neoplasm, uterus — 12 12 14. Other malignant and lymphatic neoplasms 82 72 154 15. Leukaemia, aleukaemia 4 3 7 16. Diabetes 3 8 11 17. Vascular lesions of nervous system 77 116 193 18. Coronary disease, angina 218 125 343 19. Hypertension, with heart disease 5 21 26 20. Other heart disease 48 95 143 21. Other circulatory disease 50 67 117 22. Influenza 3 5 8 23. Pneumonia 58 71 129 24. Bronchitis 104 44 148 25. Other diseases of respiratory system 8 5 13 26. Ulcer of stomach and duodenum 10 7 17 27. Gastritis, enteritis and diarrhoea 6 9 15 28. Nephritis and nephrosis 2 5 7 29. Hyperplasia of prostate 5 — 5 30. Pregnancy, childbirth, abortion — 3 3 31. Congenital malformations 5 13 18 32. Other defined and ill-defined diseases 77 78 155 33. Motor vehicle accidents 14 10 24 34. All other accidents 25 18 43 35. Suicide 18 10 28 36. Homicide and operations of war 1 1 2 TOTAL 940 875 1,815 23 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 1963 172,130 4,540 96 21 21 95 20 17 Perinatal mortality 1955 35 per 1,000 live and still births ,, ,, 1 95 6 3 5 ,, ,, ,, ,, ,, ,, ,, ,, 1957 32 „ „ „ „ ,, ,, ,, ,, ,, 1958 31 ,, ,, ,, ,, ,, ,, ,, ,,1959 27 ,, ,, ,, ,, ,, ,, ,, ,, 1960 30 ,, ,, ,, ,, ,, ,, ,, ,, 1961 29 ,, ,, ,, ,, ,, ,, ,, ,, 1962 34 ,, ,, ,, ,, ,, ,, ,, ,, 1963 34 ,, ,, ,, ,, ,, ,, Table 3 Infant Mortalit: —by Wards Ward Number of deaths Total 1961-63 Rate 1961-63 1961 1962 1963 Carlton 5 3 8 16 18 Kilburn 7 11 6 24 21 Brondesbury Park 8 9 3 20 23 Kensal Rise 3 8 8 19 24 Manor 2 7 10 19 20 Harlesden 10 9 13 32 23 Stonebridge 4 5 5 14 18 Roundwood 6 8 6 20 18 Church End 3 1 5 9 15 Willesden Green 6 11 8 25 22 Mapesbury 6 9 7 22 18 Gladstone 5 4 6 15 22 Cricklewood 2 2 7 11 17 Brentwater 1 — 4 5 10 68 87 96 251 20 24 Table 4 Deaths by Social Class I — II 3 III 39 IV 18 V 28 Not known 6 Not classified 2 Total 96 Table 5 Infant Mortality—Causes (Based on Registrar General's Figures) 1936-1939 1940-1945 1946-1950 1956-1960 Deaths 1963 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 14 22 4.8 Diarrhoea and enteritis 131 100 108 6.8 37 2.3 3 •2 - 1 1 •2 Other infections 34 2.6 40 2.5 15 •9 5 •3 1 2 3 •7 Congenital malformations 83 6.3 89 5.6 72 4.4 55 3.5 8 9 17 3.7 Prematurity 170 130 179 11.3 99 61 72 4.6 39 — 39 8.6 Injury at birth 21 1.6 33 2.1 43 2.7 18 1.1 5 - 5 11 Other causes 134 10.3 149 9.4 96 5.9 88 5.6 4 5 9 2.0 All causes 679 51.9 738 46.5 430 26.5 298 18.9 65 31 96 21.1 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) 1963 19 (1) 276 (38) 1 (1) 285 (39) 25 Table 7 Premature births by wards Ward Premature births notified Percentage of live births in brackets Carlton 22 (7.6) Kilburn 21 (4.8) Brondesbury Park 9 (3.1) Kensal Rise 28 (8 .9) Manor 33 (8.8) Harlesden 27 (5.8) Stonebridge 22 (8.5) Roundwood 24 (5.9) Church End 15 (7.2) Willesden Green 27 (6.5) Mapesbury 14 (3.2) Gladstone 10 (4.0) Cricklewood 13 (5.8) Brentwater 20 (8.4) Total 285 (6.2) Table 8 Infant Mortality: Congenital Malformations Anencephaly 1 Congenital heart defects 10 Congenital diaphragmatic hernia 1 Congenital thrombocytopenia 1 Congenital atelectasis 1 Duodenal atresia 1 Hydrocephalus and myelocele 1 Total amomalous venous drainage 1 Total 17 26 GENERAL PROVISION OF HEALTH SERVICES Table 9 Bacteriological examination of milk, ice cream and water Milk examinations—111 Schools (pasteurised) Dealers' premises Total Pasteurised T.T. pasteurised Sterilised Samples 52 33 18 8 111 Satisfactory 52 33 18 8 111 Unsatisfactory — — — Ice cream examinations—30 Grade 1 Grade 2 Grade 3 Grade 4 Total 18 9 2 1 30 Water examinations—443 Domestic supplies Swimming pools Paddling pool Total Samples Satisfactory Unsatisfactory 6 1 5 392 392 22 20 2 420 413 7 Table 10 Uncleanliness and Scabies New cases treated Attendances Scabies Lice and nits Total Scabies Lice and nits Total Children under 5 years 6 9 15 6 11 17 Children 5-15 years 2 50 52 4 65 69 Adults Men 8 2 10 11 2 13 Women 11 6 17 12 7 19 Total 27 67 94 33 85 118 HEALTH EDUCATION Table 11 Talks No. visited Total No. of talks Subjects Total attendances No. of attendances Schools 29 253 53 1,649 30—250 Factories 6 6 4 660 30—200 Religious, social and political organisations 13 18 10 850 10—120 Table 12 Mothercraft No. of clinics Total No. of classes Visits by health visitors 6 184 11,581 27 PREVALENCE AND CONTROL OF INFECTIOUS AND OTHER DISEASES Table 13 Infectious diseases 1963 (1962 in brackets) Notified Confirmed Diphtheria - (-) - (-) Dysentery 86 (112) 72 (109) Erysipelas 15 (8) 15 (8) Encephalitis, acute — (2) — (2) Food poisoning 19 (22) 17 (21) Malaria — (5) — (5) Measles 1,948 (520) 1,948 (520) Meningococcal infection 4 (4) 3 (4) Ophthalmia neonatorum 5 (4) 5 (4) Paratyphoid fever - (-) - (-) Pneumonia 52 (40) 51 (39) Poliomyelitis and polioencephalitis 1 (5) - (5) Puerperal pyrexia 134 (157) 134 (157) Scarlet fever 59 (65) 59 (62) Smallpox (-) — (—) Typhoid fever 4 (2) 3 (2) Whooping cough 254 (37) 254 (37) Table 14 Whooping Cough Cases: Willesden and England and Wales Year Cases confirmed Case rate per 1,000 population Children vaccinated in Willesden Willesden England & Wales Willesden England & Wales 1948 423 146,410 2.35 3.42 — 1949 205 102,816 113 2.39 1,615 1950 648 157,781 3.57 3.60 822 1951 543 169,441 3.02 3.87 1,163 1952 328 114,869 182 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 24,469 •54 •53 2,694 1962 37 8,347 •22 •18 3,057 1963 254 34,733 1.47 •74 3,349 28 BRONCHITIS, CANCER OF LUNG AND TUBERCULOSIS Table 15 Tuberculosis: Notified cases and deaths Year Population New cases Deaths Cases on register Pulmonary pulmonary All forms Pulmonary Nonpulmonary All forms Pulmonary pulmonary 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 1963 172,130 101 13 114 14 2 16 1,584 286 1,870 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 1963 172,130 59 7 66 8 1 9 29 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 1963 104 44 148 86 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 1963 93 16 109 63 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 2 (-) 1 (-) -(-) - (-) 1 to 4 2 (-) 3 (-) 1 (—) - (-) 5 to 9 1 (-) 3 (-) - (-) 1 (—) 10 to 14 1 (-) - (-) - (-) — (—) 15 to 19 2 (-) 3 (-) 1 (—) 20 to 24 10 (-) 6 (-) 1 (—) 1 (—) 25 to 34 16 (-) 10 (1) 3 (—) 1 (—) 35 to 44 10 (1) 2 (-) 2 (1) - (-) 45 to 54 11 (1) 4 (1) - (-) - (-) 55 to 64 6 (6) - (-) - (-) 1 (—) 65 and upwards 5 (1) 3 (3) - (-) 1 (1) Totals 66 (9) 35 (5) 7 (1) 6 (1) 30 Table 20 Tuberculosis 1963: Cases by Wards Ward Pulmonary cases Nonpulmonary cases Pulmonary rate per 100,000 Combined rate per 100,000 Carlton 5 47 47 Kilburn 12 4 93 124 Brondesbury Park 9 - 73 57 Kensal Rise 9 1 80 89 Manor 7 4 53 83 Harlesden 10 1 72 79 Stonebridge 6 — 50 50 Roundwood 8 - 66 66 Church End 7 - 56 56 Willesden Green 10 1 74 81 Mapesbury 9 1 65 72 Gladstone 3 1 26 35 Cricklewood 2 — 17 17 Brentwater 4 — 36 36 Whole Borough 101 13 59 66 Table 21 Tuberculosis 1961-63: Cases by Wards Ward Pulmonary cases Nonpulmonary cases Pulmonary rate per 100,000 Combined rate per 100,000 Carlton 17 2 52 58 Kilburn 32 7 83 101 Brondesbury Park 21 2 57 63 Kensal Rise 17 3 51 59 Manor 22 5 56 68 Harlesden 27 3 65 72 Stonebridge 17 2 47 53 Roundwood 34 2 94 100 Church End 13 — 35 35 Willesden Green 31 4 77 87 Mapesbury 31 2 76 81 Gladstone 17 1 50 53 Cricklewood 19 1 55 58 Brentwater 9 — 27 27 Whole Borough 307 34 60 66 Table 22 Tuberculin Tested, 1954-1963 Children under 5 years School children (5 years) School leavers Tested Positive % Positive Tested Positive % Positive Tested Positive % Positive 1954 1,526 43 2.8 938 169 180 1,868 1,116 59.7 1955 1,308 13 10 1,537 32 2.1 2,041 387 190 1956 1,333 14 1.0 1,473 56 40 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 11 1,573 63 4.0 1,855 328 17.7 1960 234 5 21 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 1963 242 4 1.7 2,101 122 6.0 1,620 282 17.4 31 Table 23 Tuberculosis: B.C.G. vaccination of school leavers, 1954-1963 No. tested and found negative No. vaccinated 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) 1963 1,314 (81) 1,254 (95) * Percentage of total tested, t Percentage of negatives vaccinated. Table 24 Tuberculosis: Notification of deaths 1958 1959 1960 1961 1962 1963 1958-63 Deaths 16 5 11 14 10 14 70 Percentage not notified 12 20 36 43 20 14 24 Percentage notified before death: 0—12 months 25 — 19 — 10 14 13 1—5 years 13 40 9 — 20 7 12 Over 5 years 50 40 36 57 50 65 51 SANITARY CIRCUMSTANCES OF THE AREA Table 25 Census 1961 Private Households by availability of certain household arrangements (Percentages in brackets) Number of households Cold water tap Hot water tap Fixed bath Water closet Exclusive use of all four arrangements Sharing Without Sharing Without Sharing Without Sharing Without Willesden 56,803 4,921 (8.7) 120 (0.2) 5,459 (9.6) 18,627 (32.8) 17,247 (30.4) 12,020 (21.2) 15,086 (26.6) 310 (0.5) 24,614 (43.3) Middlesex 725,754 27,397 (3.8) 1,796 (0.2) 32,291 (4.4) 105,381 (14.5) 94,818 (13.1) 76,418 (10.5) 87,183 (12.0) 4,185 (0.6) 530,212 (73.1) London 1,134,747 80,295 (7.3) 2,458 (0.2) 52,519 (4.7) 405,714 (36.6) 206,002 (18.6) 338,128 (30.5) 334,089 (30.2) 7,220 (0.7) 500,217 (45.2) 32 33 Table 26 Census 1961 Persons per acre and density of occupation Area Acreage Persons per acre Density of occupation Persons per room Percentage of persons at more than 1£ per room Percentage of households at more than 1£ persons per room WILLESDEN 4,633 36.9 0.80 15.2 10.1 Carlton 125 91.2 0.97 26.1 (Figures not available by wards) Kilburn 196 65.1 0.86 21.0 Mapesbury 285 47.8 0.82 17.4 Gladstone 346 32.7 0.74 13.1 Cricklewood 355 32.1 0.71 91 Brentwater 475 21.5 0.68 3.6 Church End 612 19.3 0.75 8.5 Stonebridge 780 16 2 0.87 18.4 Harlesden 210 67.7 0.90 20.9 Roundwood 190 64.9 0.90 21.4 Willesden Green 206 64.0 0.79 14.5 Manor 334 380 0.71 10.4 Kensal Rise 140 77.3 0.79 15.2 Brondesbury Park 379 33-2 0-72 10-4 MIDDLESEX 148,687 150 0.67 5.0 30 LONDON 74,898 42.7 0.77 11.5 7.2 Table 29 New Dwellings, 1963 Houses Flats Rebuilds Dwellings built by private builders (excluding those built by the police authorities) Nil 23 50 Built by local authority Nil (bv conversion) 308 Nil Applicants on Council's waiting list at 31.12.63 5,656 Table 28 Overcrowding (a) Dwellings overcrowded at end of year 721 (b) Overcrowding reported during the year 172 (c) (i) Overcrowding relieved during the year 56 (ii) Persons 224 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 18 (ii) Families 20 (iii) Persons 90 (f) Overcrowding in Council houses relieved during the year 6 (g) Section 80, Housing Act, 1957—licences issued Nil SANITARY INSPECTION OF THE AREA Table 27 Demolition and Closing Orders Housing Act, 1957 (Sections 16, 17 and 18) Demolition Orders, section 16, Housing Act, 1957 Nil Closing Orders, sections 17 and 18, Housing Act, 1957 108 Carlton Vale (basement) 16a Victoria Villas (basement) 2 34 Table 30 Notices served (including Housing Survey) 1963 Intimation notices served 482 Intimation notices complied with 449 Statutory notices served (Public Health Act. 1936) 1,392 Statutory notices complied with (Public Health Act, 1936) 1,308 Statutory notices served (Public Health Act, 1961) 96 Statutory notices complied with (Public Health Act, 1961) 104 Statutory notices served (Shops Act, 1950) 16 Statutory notices complied with (Shops Act, 1950) 16 Statutory notices served (Prevention of Damage by Pests Act, 1949) 5 Statutory notices complied with (Prevention of Damage by Pests Act, 1949) 6 Statutory notices served (Middlesex County Council Act, 1956) 85 Statutory notices complied with (Middlesex County Council Act, 1956) 85 Statutory notices served (Housing Act, 1957 98 Statutory notices complied with (Housing Act, 1957) 48 Statutory notices served Housing Act. 1961 (Section 15) 94 Statutory notices complied with Housing Act, 1961 (Section 15) 17 Non-compliance with statutory notices referred to Town Clerk (Public Health Act, 1936 section 93) 279 Referred to Borough Engineer for work to be carried out in default of owners (164 work done by Borough Engineer) 363 Table 31 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 1963 Dwelling houses inspected 3,646 Dwelling houses re-inspected 8,101 Other visits 1,170 Housing Act Dwelling houses wholly inspected 1,196 Dwelling houses partly inspected 421 Dwelling houses re-inspected 1,191 Underground rooms inspected 32 Overcrowding visits 449 Improvement grant inspections 83 Other visits 1,291 Rent Act Dwelling houses inspected 12 Dwelling houses re-inspected 17 Other visits 22 Clean Air Act Boiler plant inspections 7 Boiler plant re-inspections 4 Premises inspected (S.C.A.) 5,671 Premises re-inspected (S.C.A.) 94 Smoke observations 97 Rag Flock and Other Filling Materials Act Premises inspected 7 Visits re samples 3 Infectious diseases Infectious disease enquiries 493 Food poisoning enquiries 19 Polio virus survey visits Nil Miscellaneous Massage establishments inspections 22 Cinemas, dance halls, schools, etc. inspected 36 Noise nuisance investigations 115 Visits re unsound food 99 All other visits 1,479 25,777 35 Table 32 Inspection of Factories, Outworkers Premises and Food Premises 1963 No. inspected Inspections made Power factories 659 659 Non-power factories 21 21 Homeworkers and outworkers 62 62 fnspections of food premises (including revisits) Baker 21 135 Bread and confectionery 38 77 Dairy 3 15 Butcher 104 373 Grocer and general store 298 622 Fishmonger and fish-fryer 42 101 Cafe and restaurant 140 543 Greengrocer and fruiterer 126 235 Ice cream and sweet shop 214 321 Food stall 19 83 Public House Works canteen 43 122 106 179 School canteen 39 45 Food factory 4 33 Any other food premises 59 70 Total periodic inspections 2,014 3,680 Total all inspections 1963 29,457 Table 33 Rent Act, 1957 Certificates of Disrepair Applications (Form D received and investigated 12 Agreed and proposal to issue Certificate of Disrepair (Form J) served 11 Refused 1 Undertakings (Form K) received from landlords 5 Accepted 5 Refused Nil Certificate of Disrepair (Form L) issued Applications received for cancellation of Certificates of Disrepair (Form M) 4 5 Granted 5 Refused Nil Table 34 Summary of Nuisances abated and of Improvements Effected Water Supply and Water Service 1963 New cisterns provided 8 Cisterns cleansed, repaired, covered, etc. 23 Draw taps placed on mains 3 Drainage and Sewerage Water Closets: Repaired, supplied with water or otherwise improved 259 New closets built 7 Provided with better ventilation 2 Drains: Examined, tested, exposed, et 357 Unstopped, repaired, trapped, etc. 335 New soilpipes or vent shafts fixed 25 Disconnecting traps or chambers inserted 21 Reconstructed 30 New manhole covers 38 Soilpipes or vent shafts repaired 68 Other Defects Smoke nuisances 7 Accumulation of refuse 127 Fowls, pigs, etc., kept in an insanitary condition 6 Dampness 330 Yards and forecourts paved, repaved or repaired 80 Walls and ceilings cleansed 180 Verminous rooms disinfested 136 Leaky roofs made watertight 456 36 Additional ventilation provided under floors 8 Dilapidated plaster repaired 515 Flooring and other woodwork repaired 317 Damp proof courses inserted 10 Water supply reinstated 117 Wash house floors repaired or repaved 12 Fireplaces and stoves repaired 52 Decayed brickwork repaired and repointed 216 Sinks provided or replaced 56 Additional light and ventilation to staircase 3 Gutters and/or rainwater pipes repaired or renewed 474 Larders or food cupboards ventilated or provided 3 New sashcords and glass provided to doors and windows 557 Miscellaneous 284 Total nuisanccs abated 5,122 DISINFESTATION Table 35 (a) Verminous premises: Council properties 19 Private properties 40 Total 59 (b) Verminous rooms:* Council properties 44 Private properties 92 Total 136 *Some rooms are treated more than once. (c) Clothing and bedding materials: (i) disinfested 10 (ii) disinfected 4 (d) Miscellaneous: Ants 5 Earwigs 1 Table 37 Premises unsatisfactory on 31.12.62 28 Unsatisfactory during the year 169 Premises made satisfactory during the year 164 Unsatisfactory on 31.12.63 33 INSPECTION AND SUPERVISION OF FOOD AND FOOD PREMISES Table 36 Types of food premises Baker 21 Bread and confectionery 38 Dairy 3 Butcher 104 Grocer and general store 298 Fishmonger and fish fryer 42 Cafe and restaurant 140 Greengrocer and fruiterer 126 Ice cream and sweet shop 214 Food stall 19 Public house 43 Works canteen 122 School canteen 39 Food factory 4 Other food premises 59 Total 1,272 Inspections and revisits: Inspections ... 2,340 Revisits 598 Total 2,938 37 Table 38 Food premises: Defects remedied Defects Outstanding at 31.12.62 Found during the year Total Remedied during year Outstanding at 31.12.63 Inadequate lighting and ventilation 2 3 5 4 1 Inadequate washing facilities 7 35 42 34 8 Inadequate refuse storage 4 22 26 20 6 Unsatisfactory or insufficient sanitary accommodation 5 36 41 31 10 Inadequate storage accommodation 1 6 7 6 1 Defective walls, ceilings or floors 20 56 76 65 11 Dirty walls, ceilings or floors 18 100 118 103 15 Inadequate first aid materials 2 14 16 12 4 Unsatisfactory conditions 1 18 19 18 1 Any other defects 10 72 82 65 17 Totals 70 362 432 358 74 Table 39 Food premises: Registration Premises on register 31.12.62 Applications received Applications granted Applications refused Premises removed from register during 1963 Total on register at 31.12.63 1. Sale and storage of ice cream 348 4 4 - - 352 359 2. Manufacture of ice cream 7 - - - - 7 3. Manufacture of preserved food 131 - - - - 131 4. Fish curing 1 - - - - 1 Table 40 Food unfit for human consumption Meat and meat products Miscellaneous Cooked 94¼ lbs. Apricot pulp 5 cwt. Tinned 953 ¾ lbs. Fresh 1,534 lbs. Chickens 14 lbs. tish Cream 3 tins Tinned 121 tins Frozen food (various) 1,086 pkts. Fresh 266 lbs. Fruit juice 2 tins Packets 177 pkts. Horseradish sauce 1 iar v egetables Milk 66 tins Tinned 985 tins Mouse 1 Fresh 58¼ lbs. Onions Packets 118 pkts. Preserves 1 jar Fruit Soup 1½1bs. Tinned 808 tins Soup 49 tins Fresh 22½ lbs. Steak and kidney pies 6 38 FACTORIES Table 41 On register and inspections No. on register Inspections Written notices Occupiers prosecuted Factories in which sections 1, 2, 3, 4, and 6 are to be enforced by local authority 60 21 - - Factories not included above in which section 7 is enforced by the local authority 715 659 29 1 Other premises in which section 7 is enforced by the local authority (excluding outworkers premises) 10 15 — — Total 785 695 29 1 Table 42 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) _ Overcrowding (sec. 2) — — — — Unreasonable temperature (sec. 3) — — — — Inadequate ventilation (sec. 4) — — — — Ineffective drainage of floors (sec. 6) — — — — - Sanitary conveniences (sec. 7) — — — - - (a) Insufficient 3 5* — - - (b) Unsuitable or defective 27 18 — 6 1 (c) Not separate for sexes 2 1 — — - Other offences against the Act (not including offences relating to outworkers) — — — — — Total 32 24 — 6 1 * Two defects outstanding from previous year. Table 43 Outworkers Nature of work No. of outworkers in August list No. of instances of work in unwholesome premises Notices served Wearing apparel (making, etc.) 88 - - Household linen 1 - - Curtains and furniture hangings 2 - - Plastic bags 2 - — Handbags 5 - — Making of boxes or other receptacles or parts thereof made wholly or partially of paper 13 - — Carding, etc. of buttons, etc. 13 - - Stuffed toys 7 - - Cosaques, Christmas stockings, etc. 1 - - Imitation jewellery and jewellery pads 4 - — Total 136 - — There were no cases of default in sending lists to the Council, and there were no prosecutions. 39 CARE OF MOTHERS AND YOUNG CHILDREN Table 44 Ante-natal Clinics Clinic Sessions Attendances Average attendance per session Antenatal Postnatal Kilburn 103 1,689 9 16.5 Pound Lane 100 1,298 5 13.0 Stonebridge 157 2,288 8 8.3 Neasden 51 580 6 11.5 Cricklewood (Sneyd Road) 53 738 10 141 Kensal Rise (St. Martin's) 104 1,673 3 161 South Kilburn (Chichester Terrace) 51 959 — 18.8 Totals: 1963 619 9,225 41 15.0 1962 609 9,714 46 16-0 Table 45 Births Hospital and domiciliary 1963 1962 Total notified live births 4,423 4,143 Born in institutions 3,913 3,641 Born at home 510 502 Percentage born in institutions 88.5 87.8 Institutions Central Middlesex Hospital 1,531 1,503 Kingsbury Maternity Hospital 570 463 St. Andrew's Hospital 42 — Larger hospitals outside Willesden 1,633 1,539 Smaller hospitals outside Willesden 124 118 Nursing homes, etc. 13 18 3,913 3,641 Home County Midwives 507 498 Others 1 2 Private Doctors 2 2 510 502 Table 46 Mothercraft Clinic Sessions Total attendances Average attendance per session Kilburn 34 194 5.7 Pound Lane 45 147 3.2 Stonebridge 51 304 6.0 Neasden 37 154 4.2 South Kilburn (Chichester Terrace) 17 72 4.3 Totals: 1963 184 871 4.7 1962 210 1,070 5.1 40 Table 47 Relaxation Classes Clinic Sessions Total attendances Average attendance per session Kilburn 46 272 5.9 Pound Lane 48 226 4.7 Stonebridge 50 235 4.7 Neasden 42 140 3.3 Totals: 1963 186 873 4.7 1962 159 818 5-1 Table 48 Child Welfare Clinics Clinic Sessions Total attendances Seen by doctor Referred elsewhere Average attendance per session Kilburn 264 8,628 3,935 29 32-7 Pound Lane 255 9,355 3,674 138 36-7 Stonebridge 255 7,593 2,795 49 29-8 Neasden 253 7,248 2,538 17 28-7 Cricklewood (Sneyd Road) 103 4,324 1,623 10 42-0 Kensal Rise (St. Martin's) 154 7,456 1,614 48-4 South Kilburn (Chichester Terrace) 127 3,572 1,157 121 28-1 Totals: 1963 1,411 48.176 17,336 364 34-1 1962 1,384 53,704 20,007 Not received 38-8 MIDWIFERY SERVICE Table 49 Midwives' Clinics Sessions Total attendances Average attendance 1963 305 4,609 151 1962 275 5,936 21-6 Table 50 Deliveries attended:— 1963 Doctor not booked, doctor present 4 Doctor not booked, doctor not present 4 Doctor booked, doctor present 229 Doctor booked, doctor not present 278 Cases attended which have been discharged before 10th day Cases in which:— 204 (a) gas and air only administered, doctor present gas and air only administered, doctor not present 134 115 (b) trilene only administered, doctor present trilene only administered, doctor not present 42 96 (c) gas and air followed by trilene administered, doctor present gas and air followed by trilene administered, doctor not present 1 11 (d) trilene followed by gas and air administered, doctor present trilene followed by gas and air administered, doctor not present (e) pethidine administered, doctor present pethidine administered, doctor not present 96 157 Visits paid:— (a) ante-natal 3,471 (b) during labour 1,021 (c) nursing, domiciliary confinements nursing institutional discharges 7,667 730 (d) others 800 41 Clinic sessions attended (local authority clinics):— (a) ante-natal, doctor present 7 (b) ante-natal, midwife only 305 (c) relaxation 7 (d) mothercraft Clinic sessions attended (general practitioner clinics):— (a) ante-natal Medical aid:— (a) doctor booked 79 (b) doctor not booked 1 Medical Aid For Mother For Child Pre-Eclamptic Toxaemia 7 Sticky eyes 4 Breech presentation 1 Cyanosis of face 1 Post-partum haemorrhage 2 Prematurity 2 Ruptured perineum 24 Jaundice 1 Early rupture of membranes 3 Abnormality of eye 1 High head 1 Vomiting 1 Stillbirth 1 Septic spot 1 Asthma and bronchitis 1 Asphyxia 1 Premature labour 3 Ante-partum haemorrhage 6 Doctor not booked 1 Foetal distress 6 2nd stage delay 6 Hyperpyrexia 2 Uterine inertia 2 Multiple pregnancy 1 Retained placenta 1 Totals 68 12 Table 51 Establishment: Health Visitors Whole-time equivalent as at: 31.12.62 31.12.63 Health Visitors (Whole-time) 23 22 ,, ,, (Part-time) 10/11 10/11 ,, ,, (Sponsored) — 1 1/11 Clinic Nurses (Whole-time) 5 5 Nursing Assistants (Part-time) 3/11 3/11 Health Assistant (Part-time) 2/11 2/11 Totals 29 4/11 29 5/11 42 Table 52 Visits made by Health Visitors First Effective Total Effective Total No Access 1963 1962 1963 1962 1963 1962 Expectant Mothers 1,662 1,788 2,307 2,538 584 Not recorded Children born 1963 4,545 4,431 8,602 12,276 2,061 Children born 1962 3,768 Not recorded 6,893 5,347 1,515 Children born 1958/61 6,801 11,582 9,486 2,453 Persons aged 65 or over 386 723 Not recorded 125 Mentally disordered 35 56 11 Discharged from hospital 23 31 2 Households—tuberculous 5 5 31 Households—other infectious disease 135 141 Not recorded 4 Other visits as health visitor 127 185 1,453 49 Total visits as health visitor 17,487 30,525 31,131 6,804 Total cases seen as school nurse 883 897 146 Table 53 Work: Home Nurses New Cases Total Visits Visits of over 1 hour duration Cases on register at end of year Totals 1963 1962 2,193 2,134 90,325 89,883 502 Not Recorded 653 639 Table 54 Establishment: Home Nurses Nurses 1.1.63 31.12.63 Whole-time 22 25 Part-time 3 2 Candidates SMALLPOX Table 55 Vaccination Under 1 1 year year 2-4 years 5-14 years 15 years and over Total Primary Vaccinations 319 235 68 40 73 735 Re-vaccinations — 2 19 111 366 498 Totals 1963 319 237 87 151 439 1,233 1962 1,460 1,173 1,658 8,104 18,120 30,515 Approximate number of children (end of 1963) 0— 5 18,285 5—15 20,468 38,753 43 HOME HELPS Table 56 Cases: Home Helps Cases receiving help at No. of new cases helped during No. of cases receiving help at 1.1.63 1.1.62 1963 1962 31.12.63 31.12.62 Aged 65 or over at first visit Under 65: chronic sick or tuberculosis 515 | 538 300 47 269 585 61 515 Mentally disordered Not Recorded i Not J Recorded 3 Not Recorded 2 Not Recorded Maternity — 2 37 60 — — Others 138 154 88 189 19 138 Totals 653 694 475 518 667 653 Table 57 Staff: Home and Neighbourly Helps Position at: 1.1.63 31.12.63 Home Helps: Whole time 3 4 Part time 77 75 Neighbourly Helps 3 3 DAY NURSERIES Table 58 Day Nurseries: Attendances Nursery Approved places Children on register at 31.12.63 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 Essex Road 25 25 27 28 5,637 6,256 22 25 Evefield 25 25 25 24 4,969 5,057 20 20 Gladstone Park 25 25 29 29 4,663 6,180 18 24 Longstone Avenue 25 25 26 27 5,139 5,890 20 23 Mortimer Road 25 25 26 28 5,645 5,879 22 23 Villiers Road 25 25 30 30 4,300 4,754 17 19 Wesley Road 15 25 17 28 2,765 4,725 11 19 William Dunbar 25 25 27 29 5,312 5,990 21 23 Totals: 1963 190 200 207 223 38,430 44,731 151 176 1962 183 207 180 224 38,390 46,417 150 182 44 Table 59 Day Nurseries: Waiting List Position at: — Nursery 1.1.63 31.12.63 Essex Road 6 14 Evefield 1 1 Gladstone Park 29 24 Longstone Avenue 5 6 Mortimer Road 41 35 Villiers Road 30 25 Wesley Road 10 2 William Dunbar 29 69 Totals 151 176 Table 60 Day Nurseries: Priorities Nursery Unsupported Mothers Medical reasons Bad Housing Low Income Total on Register Essex Road 31 7 6 6 50 Evefield 22 2 12 4 40 Gladstone Park 20 13 10 6 49 Longstone Avenue 32 6 8 5 51 Mortimer Road 41 8 4 3 56 Villiers Road 28 1 7 2 38 Wesley Road 24 — 5 4 33 William Dunbar 42 7 6 5 60 York Park (Area No. 4) 12 2 4 5 23 Totals 252 46 62 40 400 Table 61 Day Nurseries: Staff Establishment Position at: 31.12.63 31.12.62 Supervisory Matron 1 1 1 Matrons 8 8 8 Deputy Matrons 8 8 8 Wardens 8 5 7 Nursing Staff 44 34 36 Students 36 36 20 45 SCHOOL HEALTH SERVICE Table 62 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) 1959 and later 192 192 100.0 1958 1,403 1,387 98.8 16 1.2 1957 643 634 98.6 9 1.4 1956 180 178 990 2 1.0 1955 1,213 1,199 98.8 14 1.2 1954 236 236 100.0 — — 1953 1,090 1,084 99.5 6 0.5 1952 558 552 98.9 6 1.1 1951 163 158 97.0 5 3.0 1950 139 138 99..3 1 0.7 1949 443 441 99.5 2 0.5 1948 and earlier 1,346 1,336 99.2 10 0.8 Totals: 1963 7,606 7,535 99.1 71 0.9 1962 8,579 8,516 99.3 63 0.7 Table 63 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 1959 and later 2 9 11 1958 7 121 126 1957 3 57 59 1956 5 11 16 1955 82 72 148 1954 24 18 38 1953 54 74 116 1952 32 41 68 1951 23 24 43 1950 15 26 38 1949 26 56 73 1948 and earlier 89 196 246 Totals: 1963 362 705 982 1962 427 695 1,031 46 Table 64 Defects Found by Medical Inspection * Periodic inspections Special inspections Entrants Leavers Others Total (a) (b) (a) (b) (a) (b) (a) (b) (a) (b) Skin 15 73 56 76 53 109 124 258 5 156 Eyes (a) Vision 12 20 110 168 240 341 362 529 20 21 (b) Squint (c) Other 10 32 2 13 11 44 23 89 3 1 24 2 15 8 28 11 67 — 27 Ears (a) Hearing 15 96 42 38 55 84 112 218 9 31 (b) Otitis media 8 73 — 11 1 40 9 124 — 1 (c) Other 8 27 4 12 11 26 23 65 1 18 Nose and throat 34 409 8 41 22 245 64 695 8 20 Speech 46 50 4 7 20 31 70 88 14 39 Lymphatic glands 9 247 1 5 1 125 11 377 — 8 Heart — 47 — 17 1 32 1 96 — 4 Lungs 8 110 — 22 2 57 10 189 — 22 Developmental (a) Hernia 5 24 — 4 6 21 11 49 — 5 (b) Other 2 100 1 10 4 135 7 245 — 5 Orthopaedic (a) Posture 12 35 31 60 32 69 75 164 1 14 (b) Feet 30 76 55 36 47 103 132 215 2 15 (c) Other 8 57 9 62 19 73 36 192 1 29 Nervous system (a) Epilepsy — 5 2 7 1 15 3 27 1 5 (b) Other — 5 — 6 — 10 — 21 — 4 Psychological (a) Development 6 38 — 12 2 66 8 116 8 33 (b) Stability 2 283 1 118 8 397 11 798 8 39 Abdomen Other - 20 13 27 60 4 18 294 33 60 35 294 169 648 237 51 68 Totals 1963 525 1,884 388 788 838 2,247 1,751 4,919 136 582 1962 436 1,887 362 1,050 815 2,089 1,613 5,026 162 643 * (a) Requiring treatment (b) Requiring observation. 47 Table 65 Treatments : School Health Service Number of cases known to have been dealt with (i) Eye Diseases, Defective Vision and Squint (a) External and other, excluding errors of refraction and squint 42 (b) Errors of refraction (including squint) Totals 1963 1,498 1,540 1962 1,500 (c) Number of pupils for whom spectacles were scribed Totals 1963 437 1962 456 (ii) Diseases and Defects of Ear, Nose and Throat Received operative treatment for : (a) diseases of the ear — (b) adenoids and chronic tonsillitis 46 (c) other nose and throat conditions 5 Received other forms of treatment 109 Totals 1963 160 1962 217 Total number of pupils in schools who are known to have been provided with hearing aids : 8 (a) during the current year (b) in previous years (excluding any pupils shown at (a) above who were provided with an aid in the previous year) 2 (iii) Orthopaedic and Postural Defects Number of pupils known to have been treated at clinics or at outpatients departments 1963 600 1962 655 (iv) Diseases of the Skin (Excluding Uncleanliness) Ringworm (i) Scalp 1 (ii) Body 1 Scabies 15 Impetigo 13 Other skin diseases 139 Totals 1963 169 1962 170 (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 612 County Council) 1963 1962 173 (vi) Speech Therapy Number of pupils treated by speech therapists under arrangements made by the authority 1963 278 1962 340 (vii) Other Treatment Given (a) Number of miscellaneous minor ailments treated by the County Council 622 (b) Treatment other than (a) above and excluding convalescent treatment: 1. Lymphatic glands - 2. Heart 3. Lungs 67 4. Developmental (a) Hernia - (b) Other 5. Nervous system (a) Epilepsy - (b) Other 9 6. Psychological (a) Development 11 (b) Stability 52 7. Abdomen 1 8. Other 60 Totals 1963 1962 822 737 48 Table 66 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 97 20 9 11 5 15 Table 67 Audiometry : Children Tested Routine Failures Age group 1st Tests Re-tests Both ears One ear Totals Right Left Up to 7 years 1,681 133 8 10 27 45 Intermediate 1,359 52 10 10 12 32 Leavers 1,719 52 5 8 15 28 Totals 1963 4,759 237 23 28 54 105 1962 4,978 247 20 49 44 113 Specials All ages 1st Tests Re-tests Failures Totals Both ears One ear Right Left Totals 1963 928 271 52 77 85 214 1962 761 259 54 58 84 196 Table 68 Summary of Failures to pass Audiometer Test Passed at second test 150 Referred to Assistant Medical Officers 173 Normal Hearing after removal of wax 21 Under observation by hospital or private doctor 9 No action—further test recommended after given period 47 Referred for Tonsils and Adenoids operation 18 Appointments not accepted 9 Referred by A.M.O.'s to Ear, Nose and Throat Specialist 99 Treatment considered of little value 11 Referred to hospital 10 Hearing improved after treatment 29 Recommended for Hearing Aid 2 Awaiting appointments 9 Failed to attend appointments 23 49 Table 70 Infestation with Vermin 1963 1962 Total no. of examinations 25,448 23,737 Total no. of individual pupils found to be infested for the first time during the current year 448 363 Number of individual pupils in respect of whom cleansing notices were issued under section 146 54/2 Education Act, 1944 158 Number of individual pupils in respect of whom cleansing notices were issued under section 54/3 Education Act, 1944 Table 71 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 31.12.63 Lower Place Special School for Physically Handicapped Pupils Willesden 12 12 Wembley 2 2 — Harrow 2 2 — Acton 2 2 — Hendon 2 2 — Totals 20 20 — Table 72 The Educational Sub-Normal Education Act, 1944—Section 57 1963 1962 Cases dealt with under section 57, Education Act, 1944 : — 5 13 Cases de-notified under section 8, Education (Miscellaneous Provisions) Act, 1948 — — Table 69 Speech Therapy Clinic or School f cases dealt with during the year Kilburn clinic 67 Pound Lane clinic 58 Stonebridge clinic 72 Lower Place special school for physically handicapped pupil 20 Neasden clinic Woodfield Special School for E. S.N 18 Totals 1963 278 1962 340 Table 73 Return of Handicapped Pupils (Year Ended 31st December, 1963) Ascertainment Distribution (as at last day of Year) Category No. of ascertained Cases known 1st day of Year No. of New Cases ascertained during year No. of ascertained Cases known last day of Year In Special Day Schools In Special Residential Schools In Maintained Primary and Secy. Schools In Independent Schools Not at School Totals B. G. B. G. B. G. B. G. B. G. B. G. B. G. B. G. B. G. Blind Pupils __ __ Partially-Sighted Pupils 9 7 - - 7 7 6 5 1 2 7 7 Deaf Pupils 5 1 1 1 5 2 4 2 1 - - - - 5 2 Partially Deaf Pupils 7 2 — 2 7 4 7 4 7 4 Delicate Pupils Diabetic Pupils 28 15 17 12 27 22 5 3 19 18 3 1 27 22 Educ. Sub-normal Pupils 97 65 20 18 102 68 84 58 8 1 10 9 102 68 Epileptic Pupils 2 — 1 — 1 — — — 1 — - - - - 1 Maladjusted Pupils 51 10 4 1 44 9 1 — 15 1 6 1 21 7 1* 44 9 Physically Handicapped Pupils 28 23 7 1 30 15 26 13 3 1 — — — 1* 1 30 15 Pupils with Speech Defects 383 155 85 32 403 165 — — — 383 141 — — 20 24 403 165 Pupils with Multiple Defects 32 22 6 4 37 25 33 24 3 1 — — — — 1 — 37 25 Totals 642 300 141 71 663 317 166 109 51 24 402 152 21 7 23 25 663 317 Grand Totals: 1963 942 212 980 275 75 554 28 48 980 1962 923 188 942 264 76 534 33 35 942 *Receiving home tuition. Boys Girls Children not ascertained as handicapped pupils, but recommended for convalescence in a holiday home or camp school 21 20 51 CHILD GUIDANCE Table 74 Waiting list at 1.1.1963 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 31.12.1963 17 454 112 342 135 17 23 Table 75 Reasons for Referral 1. Behaviour Problems (52%) (a) Mainly due to constitutional factors (including parental problems) 41 (b) Mainly due to constitutional factors 14 (c) Mainly due to mental retardation 2 (d) Mainly due to brain damage 1 2. Problems of Habit and Maturation (16%) (a) Emotional crisis of adolescence and sex development 9 (b) Enuresis and encopresis (wetting and soiling) 5 (c) Sleep disturbance 3 (d) Speech disturbance 1 Psychoneurotic disturbances (27%) (a) Chronic anxiety state 6 (b) School phobia 12 (c) Psychosomatic disorders, e.g. asthma 4 (d) Hysteria 4 (e) Acute anxiety state 5 4. Psychotic disturbance (4%) 4 5. No Evidence of Psychiatric disturbance (1%) 1 112 SCHOOL DENTAL SERVICE Table 76 Inspection and Treatment (a) Inspections Inspected Required Treatment Referred for Treatment 1963 1962 1963 1962 1963 1962 Periodic 14,676 15,290 7,815 8,720 | 8,456 7,835 Special 1,688 1,344 1,447 1,155 Totals 16.344 16,634 9,262 9,875 8,456 7,835 52 (b) Treatment 1963 1962 No. of pupils actually treated 4,271 3,957 No. of attendances 13,928 13,779 No. of half-days of Inspection 208 224 Treatment 2,816 2,953 No. of fillings: 8,738 (a) Permanent teeth 7,823 (b) Temporary teeth 5,560 4,109 No. of extractions of : (a) Permanent teeth 353 391 (b) Teeth for orthodontia 206 200 (c) Temporary teeth 2,342 2,638 No. of general anaesthetics 1,182 1,203 No. of other operations 3,664 4,709 PRIORITY DENTAL SERVICE Table 77 Expectant and Nursing Mothers Children under 5 1963 1962 1963 1962 Number examined 304 346 671 614 Number required treatment 275 310 475 457 Number of new cases commenced treatment 300 329 424 396 Dentally fit 132 126 245 265 Extractions 306 201 202 227 Fillings 941 792 984 790 Scaling and gum treatment 145 135 — — Silver nitrate dressings — — 215 500 Dentures 61 72 — — Number of attendances 1,291 1,273 1,143 1,036 Number of appointments not kept 426 376 296 219 CHIROPODY Table 78 New cases First attendance of old cases Total cases attendances Elderly 83 33 116 716 Physically Handicapped - — Expectant and Nursing Mothers 31 3 34 62 Others 7 1 8 31 School Children 250 180 430 1,951 Totals 371 217 588 2,760 Deaner Printers Ltd. (T.U.), London.