439 (1) WIL 60 Borough of Willesden 1964 THE 89th ANNUAL HEALTH REPORT E. GRUNDY, M.D., D.P.H., Medical Officer of Health CONTENTS Aged—care of Page Chiropody 13 Clinic 12 Laundry service 13 Old People's Welfare Committee 14 Voluntary services 13 Bacteriological examinations 4 Basement bakehouses 11 Bronchitis Morbidity and mortality 6 Cancer of the lung Morbidity and mortality 6 Prevention and diagnosis 6 Treatment 7 Census—household arrangements Child guidance 18 Chiropody 19 Clean air 9 Convalescence 18 Coroner's court 15 Day nurseries 18 Dental service 18 Disinfestation 10 Factories 11 Food Contaminated food 11 Education in food hygiene 10 Food poisoning 5, 10 Improvements in premises 10 Prosecutions 10 Registration of premises 10 Sampling 11 Unsound food 10 Hawkers—licensing of 15 Health education 5 Health visiting 17 Home safety 19 Home help service 17 Home nursing 17 Hospitals Facilities 16 Liaison 16 Household arrangements 7 Housing Demolition and closing orders 8 Multiple Occupation 8 New dwellings 9 Notices served 9 Nuisances abated 9 Overcrowding 9 Rent Act, 1957 9 Slum clearance and re-development 8 Ice cream 4 Immunisation 17 Infant mortality 4 Infectious diseases Page Diphtheria 5 Dysentery 5 Food poisoning 5, 10 Measles 5 Meningococcal infection 5 Ophthalmia neonatorum 5 Poliomyelitis 5 Puerperal pyrexia 6 Smallpox 6 Typhoid 6 Whooping cough 6 Laboratory service 4 Massage and special treatment establishments 51 Maternity and child welfare Ante-natal care 16 Clinics 16 Problem families 16 Medical examination of staff 16 Midwifery service 16 | Milk and dairies 11 Mortuary 15 National Assistance Act, 1948 Burials 15 Removal to hospitals 13 Noise 12 Offices, Shops and Railwav Premises Act, 1963 12 Outworkers and home workers 11 Pet Animals Act, 1951 15 Poliomyelitis inoculation 17 Prematurity 4 Problem families 16 Public Health Laboratory Service 4 Rag, Flock and Other Filling Materials Act, 1951 15 Refuse disposal 7 Rodent control 10 Sanitary circumstances 7 Scabies 4 School health service 18 Sewage and drainage Smallpox vaccination 17 Staff Medical examinations 16 Sanitary section 8 Swimming baths T uberculosis B.C.G. Vaccination Co-operation Morbidity and mortality 6 Prevention and diagnosis 6 Vermin 10 Vital statistics Births 3 Deaths 3 Population 3 Water 7 BOROUGH OF WILLESDEN Health Department, 54, Winchester Avenue, Kilburn, N.W.6. August, 1964. To the Mayor, Aldermen and Councillors of the Borough of Willesden. Madam Mayor, Ladies and Gentlemen, During the year 1964 the outlook of the Health Department was naturally coloured by the impending and almost inevitable merger with Wembley to form the new London Borough, which at this time had not yet received a name. Our intention was to advance as we had done in previous years, but at the same time, as far as possible, to avoid action which would complicate the eventual merger of the two boroughs into one. Staff also within the Department were concerned with, and perhaps apprehensive, of their future in the new London Borough, and although working to capacity, nevertheless per force were compelled to accept this added burden. The environmental inspections continued at the same tempo as in previous years and a monumental volume of work was undertaken in redevelopment areas and in an endeavour to improve the environmental conditions of those in Willesden, subjected to adverse influences. Fortunately, during the year the Borough was spared any incidence of serious infection and, whilst the Inspectorate were concerned in visiting and advising those who unfortunately suffered from an infectious disease and those who were in contact with such cases, the incidence did not call for additional staff to be allocated to this work. The old persons' welfare activities continued in the Borough and the Old Persons' Clinic was a nucleus around which our senior citizens could make application for medical examination and supplementary foodstuffs if need be. There is no doubt that the issue of accessory foods similar to Complan, improve the nutrition of many aged who are on marginal diets, either through disinterest or inattention to their food intake. The clubs and outings organised by the Old People's Welfare Committee were therapeutic and helpful to many in need. Chiropody provisions by the local health authority and the Old Folks' Association extended in scope as far as professional personnel could be engaged to cope with this service. The personal health services were closely associated with the Borough Department during the year and opportunities were taken to acquaint various members of the staff with colleagues with whom they would be working in the new Borough, in order to facilitate exchange of information in the future. The School Health Service continued under the direction of the Divisional Executive and health education in schools became an increasingly important feature of the activities. The tripartite nature of the service where function is spread between the hospital, the practitioner and the health authority, necessitated continuous co-operation and continuous "give and take" in administration to ensure that the services operated to the best advantage of the consumer. This is the last Report which a Medical Officer of Health will make to the Council of the Borough of Willesden and I take the opportunity to express to all members my deep appreciation of their encouragement and support which have been helpful to all staff of the Department during the year. As the Report is a final one I also take the opportunity of expressing thanks of my predecessors in office, both with the Urban District Council and with the Borough. 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, 1964 (30th June) 172,250 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) 45,252 Rateable value (1st April, 1964) £9,929,995 General rate in the pound for the year 1964/65 8/8d. Product of a penny rate £39,500 VITAL STATISTICS Registered live births: Male Female Total Legitimate 1,929 1,930 3,859 Birth rate per 1,000 estimated resident population Illegitimate 428 390 818 Crude 27.2 Total 2,357 2,320 4,677 Adjusted 22.5 Registered stillbirths: 42 45 87 Rate per 1,000 (live and still) births 18.3 Deaths: 910 774 1,684 Death rate per 1,000 estimated resident population Crude 9.8 Adjusted 11.4 Death rate of infants under one year of age: All infants per 1,000 live births 22.0 Legitimate infants per 1,000 legitimate live births 21.0 Illegitimate infants per 1,000 illegitimate live births 26.9 Death rate of infants under four weeks of age: All infants per 1,000 live births 15.2 Legitimate infants per 1,000 legitimate live births 13.5 Illegitimate infants per 1,000 illegitimate live births 23.2 Maternal mortality: Deaths from pregnancy, childbirth, abortion 1 Maternal mortality rate per 1,000 live and still births 0.21 Deaths from: Males Females Total Cancer (all ages) 207 167 374 Measles (all ages) — — — Whooping cough (all ages) — — — Diarrhoea (under 2 years of age) 3 1 4 4 Births There was an increase in the birth rate for 1964 above that of England and Wales, which was 18 4 per 1,000. Deaths There was a slight decrease in the death rate for 1964, and it was a little below that of England and Wales, which was 11.3 per 1,000. The causes of deaths are shown in Table 1. Infant mortality In 1964, 103 children died in the first year of life—60 in the first week and another 11 in the first month. There was a slight increase in the infant mortality rate from 21 to 22 which was a little above the figure for England and Wales (20). The still-birth rate dropped from 20 to 18, but this was still above the national figure of 16. The perinatal mortality rate dropped from 34 to 31 (Table 2). (a) By wards and social class (Tables 3 and 4) The worst wards were St. Raphael's and Carlton which had rates twice as high as the whole Borough but too much significance should not be placed on these figures in view of the small number involved. However, it is clear that an improvement in social conditions in some wards would certainly reduce the mortality. The number of deaths by social class illustrates in the same way the influence of environment onmortality. There were only nine deaths recorded in classes I and II. (b) Causes of death (Tables 5, 6, 7 and 8) Prematurity is again the most important single factor in infant mortality; 37 premature babies died (36 per cent of total infant deaths). Twelve of the babies were illegitimate and information about some of them was difficult to obtain. As far as could be ascertained, eight of the mothers did not have adequate antenatal care. Respiratory Infections caused the second largest number of deaths (23). Antibiotics and improved environmental conditions have halved the rate in the last 20 years, but there is still room for improvement. Congenital malformations caused 15 per cent of the deaths. In those cases investigated, the pregnancies were normal, with no history of virus infection or pelvic radiation. Diarrhoea and enteritis caused three deaths. The steady improvement in infant care and the availability of antibiotics have brought this death rate down from 10 in the period 1936-1939 to the low rate of 0 6 this year. Other infections caused only one death. A child of one week died of meningitis with pneumonia as a secondary cause. Birth injury. In spite of continued improvements in obstetrics, the death rate due to this cause (2.4) has remained almost unchanged for many years. In the periods 1940/45, 1946/50 and 1956/60, it was 2.1, 2.7 and 11 respectively. Other causes. Three deaths in this group could have been avoided. A girl of six months died of carbon monoxide poisoning and inhalation of fire fumes, when an oil stove overturned; a boy of seven weeks died of asphyxia due to carbon monoxide inhaled when gas escaped from a defective gas pipe; and a boy of five months died of asphyxia due to inhalation of vomit. One baby died of blood incompatability, despite good ante-natal supervision; one died of acute myeloid leukemia; and another died of sickle cell anaemia. An illegitimate child of 10 months was suffocated by a towel and then placed in a polythene bag. The mother was convicted of infanticide. (c) Conclusions More research is necessary into the causes of prematurity and congential malformations, 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. The percentage of ice cream samples graded 2, 3 or 4 was almost the same as last year. There were no unsatisfactory samples of water or milk. 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. As compared with 1963, there has been a considerable decrease in the number of children, particularly school children, treated for lice and nits. There has been a very slight increase in the number of children over five 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. 5 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. All the applicants are suitable persons to hold licences, and their premises were found satisfactory. Health education In the modern community it is essential that all citizens have a knowledge of the principles of health and are able to practise the simple rules of hygiene. This knowledge helps many people to avoid mental and physical disorders and relieves general practitioners and hospitals of some of their heavy burdens in dealing with the sick. The department's health education programme is based mainly on lectures illustrated by filmstrips and films. To ensure that the rising generation gets the best possible training in health, special attention is paid to health education in schools, linked as far as possible, with a hygiene or biology syllabus. The Area Medical Officer's staff, the Chief Public Health Inspector's staff, and the Public Relations Officer, gave talks in schools (Table 11). In some schools "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, midwives and nurses gave many talks, some illustrated with filmstrips. These talks were most useful in helping mothers to care for themselves and their babies. Health visitors also gave more specific individual health education in the mothers' homes during their routine visits (Table 12). The Mothers' Club held at Stonebridge Health Clinic has been successful and much appreciated. Twelve talks were given to five religious and social organisations and the staff of a local hospital and keen interest was shown in the five subjects chosen for discussion. The Chairman and a member of the Home Safety Committee gave two talks on accidents in the home to religious and social organisations. During the year posters entitled "Lung cancer deaths up again," "Wash your hands" and "For health's sake keep the lid on" were exhibited on the Council's 53 poster sites, in the four health clinics and six libraries. Leaflets and bookmarks on various subjects were displayed in the Health Department and were available to members of the public. 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 1963 and 1964 is shown in Table 13. Diphtheria For the tenth year running there were no cases of diphtheria. Dysentery The number of cases confirmed (104) increased compared with 1963 (72). This was due to an outbreak which occurred at the Evefield Day Nursery. Forty-five children and staff were affected, although only 15 had symptoms. The Nursery was closed to new entrants on the 19th November until the outbreak was cleared up just before Christmas. Food poisoning There were no outbreaks of food poisoning. There was an increase in the number of cases confirmed (41) compared with 1963 (17). Measles Nine hundred and fifty-one cases were notified compared with 1,948 in 1963. During the first nine months of the year the number of cases notified (395) fell sharply following the epidemic in 1963, but during the last quarter the disease again reached epidemic proportions when 556 cases occurred. There were no deaths from the disease. Meningococcal infection One case was notified but re-diagnosed meningitis. Ophthalmia neonatorum There was no impairment of vision in the case of ophthalmia neonatorum. Poliomyelitis It is pleasing to report that for the second year running there were no cases of poliomyelitis, which is probably the result of the steady increase in the number of people protected against the disease. 6 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 (129) was slightly less than last year (134). Smallpox There were no notified cases of smallpox. Eighty-four 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 3,150 certificates of vaccination were authenticated by the department. Typhoid fever There were no cases in Willesden, but a Willesden resident who was a patient in a mental hospital in Hertfordshire died of the disease which she contracted in the hospital. The organism isolated was salmonella typhi Type N which is rare in Britain, though it was found in a previous case at the hospital in 1952. Whooping cough The incidence of whooping cough decreased in 1964 compared with the previous year. The case rate per 1,000 population( -74) was a little below that of England and Wales. 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 17 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 1964 was almost 25 times that from pulmonary tuberculosis, and from bronchitis 21 times (Tables 15, 16 and 17). 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 have been given talks on chest diseases, and in particular on the dangers to health from smoking cigarettes. Mortality and morbidity There were four deaths from pulmonary tuberculosis among men and one among women with the now usual shift to the older age groups. There was a slight decrease in notifications of tuberculosis (98) as compared with the previous year (114). 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. 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 16). The most startling and tragic figures of all are found for deaths from cancer of the lung (Table 17). The death rate more than trebled between 1924 and 1964, and there was a marked sex difference; for every woman who died there were four men. In 1964, 99 per cent of the deaths occurred in men over 45 years of age. The death rate for cancer of the lung increased from 63 per 100,000 in 1963 to 73 in 1964. 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. 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 fifth 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 the auspices of the Willesden Chest Clinic. By arrangement with the Middlesex County Council, the Clinic is held one evening a week at Pound Lane Clinic. Patients with early evidence of chest trouble such as chronic cough, or who have been absent from work on account of chest colds, are referred to the Clinic by general practitioners, industrial medical officers, 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. 7 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. Tuberculosis Tuberculosis creates a special problem because of its infectious nature; during the past six years, 26 per cent of the deaths occurred in elderly men and women previously unknown to the health authorities (Table 22). 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. 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. Eighty per cent of school leavers were found to need B.C.G. and 99 per cent of these were vaccinated (Tables 20 and 21). 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. 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 Metropolitan Water Board and Colne Valley Water Company. Sewage and drainage Most of the sewage of the borough is discharged into the London County Council main sewers, but a small amount from the Park Royal area is discharged into the West Middlesex Main Drainage system. The arrangements for sewage disposal are adequate and also those for sewerage with minor exceptions due to local flooding associated with severe storms. Three schemes which were approved in 1963 were completed during the year. 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 23 and 24). (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 slighdy less than the average for London (42.7). The percentages of persons at more than 1½ per room (15.2) and of households at more than 1½ 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. 8 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 4 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 247 Gladstone Park 85 King Edward's Park 76 SANITARY SECTION Staff At the beginning of the year the establishment of the Public Health Inspectors' section included a Chief Public Health Inspector, a Deputy, 18 district inspectors and five pupils. District inspectors with 10 years' experience and the Smoke Inspectors' Certificate in addition to the statutory qualification and Meat and Other Foods Certificate were graded Scale A; those with the statutory qualification and Meat and Other Foods Certificate or the Diploma of the Public Health Inspectors' Education Board were graded APT IV; and those with the statutory qualification only were graded APT III. In April the Council increased the establishment of district inspectors from 18 to 22 to deal with the problem of multi-occupation. They also introduced casual user car allowance for any inspector who used his car on official business. These four new posts together with a vacancy which existed at the beginning of the year were advertised, but no applications were received. In July one of the existing inspectors resigned and by October there were eight vacancies with another resignation pending. Further advertisements met with no response. In November, the Council considered the serious position which had arisen and decided that inspectors with three certificates and seven years' experience should be graded Scale B; those with the statutory qualification and Meat and Other Foods Certificate, or the Diploma of the Public Health Inspectors' Education Board should be graded Scale A; and those with the statutory qualification only should be graded APT IV. It was also decided that all inspectors should be granted an essential user car allowance. Advertisements were issued in December and five of the nine vacancies were filled in January. It is still difficult to recruit suitable staff, but further advertisements will be issued in 1965 in an endeavour to fill the establishment. One pupil was on the staff at the beginning of the year. He qualified in November and was appointed. Three appointments were made in September leaving two 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 Table 29 and four inspectors were engaged on special surveys: one on the south part of Carlton Ward, two on the smoke control areas, and one on Rachmantype problems. Demolition and Closing Orders (Table 25) Two closing orders and one demolition order were made during the year. Slum Clearance and Area Redevelopment During the year one area, Rudolph Road and Cambridge Road (17 houses) was surveyed. The conditions found were officially reported to the Council by the Chief Public Health Inspector and slum clearance action was initiated. A public inquiry into the Winchester Avenue Compulsory Purchase Order was held in March and duly confirmed by the Minister of Housing and Local Government. House-to-house inspection and multiple occupation House-to-house inspection was carried out during the year in every ward in the borough. Although hampered by acute 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 problem can be made. 201 notices under section 15, Housing Act, 1961, requiring the provision of additional amenities, and 387 directions under section 19 of the Act to overcome overcrowding in houses in multiple occupation were served. Control Orders under section 73 of the Housing Act, 1964, were served on the owners of 12 houses. 9 Overcrowding There has been little change in the extent of overcrowding which still remains acute. One licence under section 80 of the Housing Act, 1957, was issued to permit temporary overcrowding. The Housing and Estates Manager has kindly supplied the details of overcrowding in the area, which have been based mainly on statements of housing applicants (Table 26), and also details of new dwellings constructed during the year (Table 27). Notices served under the Public Health Acts, 1936 and 1961, and Housing Acts, 1957 and 1961 There was a decrease in the number of statutory notices served during the year, compared with 1963 (Table 28). 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 shown in Table 30. Nuisances abated and improvements effected A summary of nuisances abated and improvements effected in dwelling houses is shown in Table 31. CLEAN AIR The Clean Air Act, 1956, came into full operation on the 1st June, 1958. With certain temporary exemptions the Aot 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. 6 (Kensal Rise) Smoke Control Area, covering 144 acres with 3,496 dwellings, 178 commercial and 25 other premises, was confirmed by the Minister of Housing and Local Government in March, and came into operation on 1st November,1964. 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 3,667 421 5 1.11.63 355.0 4,192 121 6 1.11.64 144.0 3,496 213 1,409.3 19,390 1,412 The No. 7 (Brondesbury Park) Smoke Control Order covering 409 acres with 5,042 dwellings, 170 commercial and 44 other premises was confirmed by the Council in December and submitted to the Minister of Housing and Local Government. The proposed date of operation is 1st November, 1965. 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. On the 3rd November a second recording apparatus was installed at the G.P.O. Research Station, Dollis Hill. The analysis is carried out by officers of the Research Station and the Council is very grateful for their help. This apparatus took the place of that previously installed in the Willesden County Grammar School, which was removed in July, 1963, because of impending building operations and the demolition of the laboratory where the apparatus was housed. In October the Chairman of the Public Health Committee and the Chief Public Health Inspector met the Alkali Inspector by appointment in Chesham Street to discuss and investigate the cause of the increase of deposits of grit and dust in the vicinity of the Neasden Power Station. The Alkali Inspector had previously inspected the boiler-plant at the Power Station and had arranged with the Superintendent to overhaul the grit arresting apparatus. Further complaints were received in November, which were reported to the Inspector, and he again visited the Power Station. It was arranged that access points should be provided in the flues and chimneys for the purpose of sampling suspended grit and the possibility was discussed of using the vacuum system to overcome build-up at the chimney bases. The nuisance was reported to the Council and a strong letter of protest was sent to the London Transport Board. Twenty-three notifications of the installation of new boiler plant were received in accordance with the provisions of section 3 of the Clean Air Act. All were inspected and found to be satisfactory. 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. 10 DISINFESTATION The Public Health Inspectors inspect verminous premises and supervise the work of disinfectors employed by the Council (section 83 of the Public Health Act, 1936) (Table 32). There was an increase 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 119 Borough Council properties 9 Private dwellings 1,118 1,246 at the following cost:— Business premises £1,389 1 7 Private dwellings 926 1 11 £2,315 3 6 The cost of disinfestation at business premises is recovered from the occupiers; 114 had an annual agreement with the Council for regular inspection and disinfestation. Fourteen were new agreements and 100 renewals. The service is free to occupiers of private dwellings. Rodent control in the Council's sewers is carried out by the Borough Engineer's Department. Where surface rat infestation is due to faults in the connections of the house drains with the sewer, the Borough Engineer's Department arranges for opening the pavement. INSPECTION AND SUPERVISION OF FOOD AND FOOD PREMISES The Food Hygiene (General) Regulations, 1960, which came into operation on the 1st October of that year prescribed standards for the preparation, storage and sale of clean food. There has been a marked improvement in hygiene in the production and sale of food since the first regulations (the Food Hygiene Regulations, 1955) came into force on 1st January, 1956. Public Health Inspectors inspect food premises (Table 33) 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 34 and 35). The proprietors of three food premises were prosecuted for contraventions of the Food Hygiene Regulations, with the following results:— (a) Six contraventions: All proved—fined £18 0s. 0d. with £5 5s. 0d. costs. (b) Ten contraventions: one dismissed, nine proved—fined £9 0s. 0d. with £5 5s. 0d. costs. (c) Twenty-two contraventions: All proved—fined £22 0s. 0d. with £5 5s. 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. One application for the manufacture, storage and sale of soft ice-cream was refused as facilities for the sterilisation of equipment were inadequate. The applicant did not appeal (Table 36). Premises where ice-cream is manufactured are kept under close supervision. Most of the ice-cream 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 illustrated with film shows, filmstrips and bacteriological cultures were given to 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 great improvement in handling, preparation, storage and sale of food. There was a slight increase in the number of individual cases of food poisoning notified. Food unfit for human consumption One cwt., 4 stone of meat, and 2 stone of fish inspected by the Public Health Inspectors was found tc be unfit for human consumption. All the food was dealt with as trade refuse by the Borough Engineer's Department and deposited on the controlled refuse tip. 11 Contaminated food Twenty-nine specimens of contaminated food were dealt with by the department. They included foreign matter in a pork pie, loaves of bread and bottles of milk; a fly in a bread roll and a bottle of milk; honey bee in a tin of apricots; mould in a coconut wafer, a meat pie, pork sausages, oakes and loaves of bread; unsound steak and kidney pie, crab meat, sausage rolls, tapioca, rice, and corned beef; and bottles of sour milk. No action was taken in 16 cases because of insufficient evidence; of the remaining 13, the Council Decided to caution seven firms and to prosecute the other six. The results of the prosecutions were as follows:— (a) Fined £25 0s. 0d. with £10 10s. 0d. costs for selling a bottle of milk containing foreign matter; (b) Fined £25 0s. 0d. with £5 5s. 0d. costs for selling an unsound steak and kidney pie; (c) Fined £12 0s. 0d. with £6 6s. 0d. costs for selling four unsound sausage rolls; (d) Fined £20 0s. 0d. with £10 10s 0d. costs for selling a wrapped loaf containing mould; (e) Fined £10 0s. 0d. with £5 5s. 0d. costs for selling a mouldy Swiss roll; (f) Fined £10 0s. 0d. with £10 10s. 0d. costs for selling a bottle of milk containing foreign matter. 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 is unable to supply details of his Department's work this year because shortage of staff made it impossible to complete statistical tables and extract the information required before the reorganisation of London Government on 1st April, 1965. 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. 110 persons are registered by the Council to trade as distributors and three premises are registered as dairies. Thirteen inspections were made of the three dairies; no defects were found. 10 samples of milk were submitted for bacteriological examination (see Table 9). One dirty milk bottle was reported by a head teacher of a school, and one by another local authority. The Council issued an official caution in each case. FACTORY INSPECTION There was a decrease of 37 in the total number of factories in the borough compared with the previous year (Table 37). 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 37 and 38. One firm was prosecuted for failing to maintain suitable sanitary conveniences. The ventilation in one convenience was insufficient and the lighting inadequate; and there was no intervening ventilated lobby to the other convenience and the door fastener was missing. The defendants were fined £5 on each count plus £10 10s. Od. costs. Basement bakehouses The local authority is responsible for the supervision of basement bakehouses under the Factories Act, 1961. Basement bakehouse is defined as a bakehouse any baking room of which is so situated that the surface of the floor is more than three feet below the surface of the footway of the adjoining street or of the ground adjoining or nearest to the room. Any basement bakehouse which is not used for 12 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 y ears. Provided the bakehouse is still suitable as regards construction, height, light, ventilation and any hygienic respect, the certificate must be renewed. Six 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. 187 were employed during the year, the largest number, 117, altering and making clothing. Public Health Inspectors inspected these workers' homes, which were all found to be satisfactory (Table 39). 12 OFFICES, SHOPS AND RAILWAY PREMISES ACT, 1963 The Act virtually came into full force on the 1st August, 1964, and with certain exceptions applies, to retail shops, offices, wholesale premises and most warehouses, catering establishments and canteens, fuel storage premises and certain railway premises. These exceptions are premises where only self-employed persons work, businesses in which only immediate relatives of the employer are employed, and other premises where not more than 21 man-hours weekly are normally worked. Employers are required to register their premises and the number registered during the year together with the number of persons employed is shown in Table 40. The general requirements of the Act deal with matters affecting the safety, health and welfare of employees, and covers cleanliness; overcrowding; temperature; ventilation; lighting; sanitary conveniences; washing facilities; drinking water; accommodation for clothing; seating arrangements; eating facilities in shops; cleaning machinery and fencing exposed parts; training and supervision of persons working at dangerous machines; prohibition of heavy work; first aid; penalisation of dangerous acts and interference with equipment; dangerous conditions and practices; and construction and maintenance of floors, passages and stairs. H.M. Factory Inspectorate is responsible for enforcing the general provisions of the Act in offices and shops in factories; railway premises and offices; premises owned or occupied by the Crown; and premises occupied by County Councils, local fire and police authorities, and probation committees. The responsibility for the remainder of premises falls to the Council, and in Willesden this responsibiity has been delegated to shops inspectors and public health inspectors. Broadly speaking, public health inspectors inspect offices, food shops, wholesale premises, warehouses and catering establishments open to the public, and canteens, and shops inspectors inspect the remainder. The total number of general inspections made is shown in Table 41, and the defects found and remedied in Table 42. Under section 46 of the Act the Council have power to grant an exemption in respect of the requirements regarding room space for employees, temperature, provision of sanitary conveniences and provision of running water for washing facilities. Exemption from the requirements to supply running water may be given either for a specified period or indefinitely; exemption from any other requirements must be for a period only, not exceeding two years. To obtain an exemption certificate it is necessary to satisfy the enforcing authority that it is not reasonably practicable to comply with the statutory requirement or requirements from which exemption is sought. The Council need to know precisely what trouble and cost would be involved in meeting the requirements and what other practical difficulties exist. An appeal against an authority's refusal to grant an exemption can be made to a magistrates' court. One application for exemption from the requirements of providing running water for washing facilities was received, but this was refused on the grounds that it was practicable to install the necessary facilities. The applicant did not appeal. Employers are required to notify accidents to employees which cause the death of the injured person or disables him for more than three days from doing his usual work. Three accidents were notified all resulting from falls and all non-fatal. Enforcing authorities have power to prosecute in any case of infringement of the Act or Regulations. However, during the first year or two of the operation of the Act it is best to proceed by way of advice and warning and no prosecutions have yet been instituted by the Council. NOISE NUISANCE The Borough Council deals with noise nuisances under the Noise Abatement Act, 1960, which repealed the noise nuisance section 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. 82 complaints were received during the year, of which 17 were repeated complaints and 41 did not constitute a nuisance within the meaning of the Act. Twenty-one of 24 complaints found to be a nuisance were remedied after consultation with the firms concerned, but three were still being dealt with at the end of the year. The Council authorised the employment of a noise consultant to advise on two difficult cases of noise and vibration from machinery and from car repairs. The noises objected to by complainants were wide and varied, and included those from factory processes, ice cream vendors chimes, car delivery and repairs, shunting of coal wagons, unloading of milk chums, loudspeakers, jazz bands 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 three to four years of experience is being used with increasing effectiveness in improving the health and well-being of those who attend. 13 Forty-nine sessions were held throughout 1964. Total attendances were 218, an increase of 10 per cent. on the previous year, and 52 of the patients were new. Although the number of new cases was about the same, the proportion of male attendances increased from 18 per cent. to 25 per cent. It is encouraging to note that patients have begun to appreciate the value of repeated visits. 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. Chronic undernourishment is unfortunately common among the elderly, among whom poverty and apathy are liable to result in poor and ill-chosen diets. The introduction of Complan, a complete food supplement in 1963, at reduced price, has proved highly popular. It was necessary, however, to keep a close check on intake, since many patients were taking insufficient amounts. The National Assistance Board has been informed of the need for this preparation in a number of cases, and has made extra grants. 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. Three cases were investigated during the year. It was possible to make them comfortable in their own homes by the provision of additional services, such as home help, home nurse, meals on wheels and no further action was necessary. 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 places where the old people can receive reasonable care is in an institution. One way of postponing this is to do their laundry. In April, 1952, the 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 Neasden Hospital, by arrangement with the Central Middlesex Group Hospital Management Committee. Transport is provided by the Borough Council. 7 tons 8 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 1.1.64 New Cases Died Admitted to hospital Discontinued On register 31.12.64 44 42 19 25 7 35 Voluntary Services for the Aged The '49' Club organised by the Willesden Old Folks' Association celebrated its twelfth anniversary in February. The Club still has a good membership and is open daily from 1.30 to 10 p.m. Several firms gave donations to the Association's funds. Fifty members and helpers went for a day trip to Southsea in June. From the 1st April, 1960, the Middlesex County Council have been responsible for the chiropody service for the aged under section 28 v>f 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, Kilburn Square, Mortimer Road, Stonebridge and Pound Lane Clinics by two full-time and one part-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 5,414 treatments were given by the five chiropodists. New applications receive initial treatment and are then placed on a register for periodic visits. In addition, 302 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 4/6d. it one foot is treated, or 9/- 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 £2,507 in 1964. A grant of £1,936 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. 14 The meals on wheels service, organised by the Women's Voluntary Service, is one of the most important services for old people. The Willesden Old People's Welfare Committee took over the cooking of meals from the W.V.S. in November, 1961, when the Kensal Rise Senior Club, with its spacious and well-equipped kitchen, was opened. 16,303 meals were prepared and delivered, compared with 16,529 meals in 1963. 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. 75 frozen dinners were delivered at Christmas and 125 of the old people had money or a parcel for Christmas. Willesden Old People's Welfare Committee The Willesden Old People's Welfare Committee was formed in April, 1958. The Committee has a membership of 19, 10 representmg the Willesden Borough Council, two the Middlesex County Council and seven representing Willesden organisations concerned with the welfare of old people. A full-time Welfare Organiser, a Deputy and an assistant work together with statutory bodies and voluntary associations and orgamse services for the aged. The two full-time centres operated by the Committee are now in their fourth 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 was completed and opened in 1963. 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 a nominal membership fee of 1/- a year and the amenities include rooms for billiards, television, hobbies, reading and spacious main club rooms for meals, whist drives and concerts. Light refreshments are available at certain hours during the day. The legal ownership of the buildings remains with the Council, the management being in the hands of the Old People's Welfare Committee. One of the important services which the Committee organise is the assisted holiday scheme for old people to go for a fortnight to the seaside during the 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. 450 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 12 lonely old people was also arranged at the holiday homes at Christmas. The eight luncheon clubs operated 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; The Scout Hall, Streatley Road (opened September, 1964), and the Willesden Green and Kensal Rise Senior Clubs, all had a successful year's work during 1964. 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 l/3d., and 30,093 were served during the year. The old people enjoy a good hot, well-cooked meal and the opportunity of meeting friends. 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 1964, 17,007 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 16 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 Primary School, and St. Helen's Preparatory 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 Committee. At Christmas 1,340 gifts of 10/- were distributed to the over 70's who were in need. A further 150 names were provided to local concerns and individuals to receive parcels and 540 parcels were distributed by Luke Old Folks' Fund, in Carlton and Kilburn Wards. During 1964 "Operation Greenfield" under which housebound old people are taken into the country for the day, was carried out on three days in May and September when 120 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 1964, 2,124 office interviews were held and 1,155 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 over 50. 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 £17,240 which the Council set aside for the Committee's use in 1964/65. Financial assistance from the Middlesex County Council towards administration and visiting costs amounted to £2,000. A Flag Day and House Collection in September raised a net sum of £509 towards the cost of Christmas gifts and further donations for that purpose totalled £60. Close on £60 was also donated for outings for the housebound. 15 The distribution of welfare foods among old people through the clubs, clinics and domiciliary services, continued in good demand during 1964. At the end of the year the Committee had appointed two Bathing Attendants to attend to the elderly frail in their own homes. The Committee laid in stocks of fuel for emergency use against a repetition of the severe winter conditions of 1962/63. A good deal of attention has been devoted during the year to the future of old people's welfare in the Borough in the light of the pending reorganisation of London Government. 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 nine persons during the year, at a cost of £109 18s. 6d., £13 14s. Od. being recovered from the relatives. PUBLIC MORTUARY Post-mortems were performed on 588 bodies, followed by an inquest in 108 cases. There were 55 inquests on Willesden residents, but only two of these were held in the Coroner's Court attached to the mortuary. The remainder were held at Ealing and Twickenham. Inquests held on Willesden residents 1959 1960 1961 1962 1963 1964 Kilburn 24 16 10 2 1 2 Ealing and Twickenham 38 53 61 53 67 53 Total 62 69 71 55 68 55 In June a deputation of three members and the Medical Officer of Health met the Coroner to discuss the use of the Court. The Council felt that the Court could be used more often and more inquests on Willesden residents could be held there. In spite of the representations made by the members the Coroner could hold out no hope of an improvement in the position and following the deputation's report the Council decided to defer the matter for the time being having regard to the possibility of a review of coroners' areas taking place as a result of local government reorganisation, particularly in the Borough of Brent which at present is in two coroners' areas. 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). Eighteen licences have been issued to hawkers (14 selling fruit and vegetables, two selling fish, one selling meat, one selling bread and confectionery). There were two new licences issued in 1964. 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 for storing rag flock must be licensed. One manufacturer of soft toys who employs out-workers 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 is paid. There were no new registrations during the year. One registered business ceased to use rag flock, using only foam fillings instead, leaving 12 premises on the register. The Act does not cover the re-making of an article, and dirty materials may be used in upholstering articles being repaired. Four samples of filling materials were taken during the year and they proved to be satisfactory. PET ANIMALS ACT, 1951 The owners of pet shops must obtain an annual licence costing 10/-. The shops are inspected by boih 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 1964, 10 pet shops were licenced. 16 STAFF MEDICAL EXAMINATIONS Thirty-six 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, five special reports were made to the Council on staff who had prolonged periods of sickness and whose sick pay had expired, and one special enquiry was made for a Chief Officer. 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 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. The allocation of maternity beds at St. Andrew's Hospital was discontinued in May, when the hospitals were made responsible for patients who had grounds for hospital confinement living within their catchment area. Health visitors continue to follow-up expectant mothers who have failed to keep their appointments at local and hospital clinics. CHILD WELFARE CLINICS Child welfare sessions are held in the seven clinics staffed by assistant medical officers, health visitors and clinic nurses. Two new clinics were opened during the year, Kilburn Square on the 13th January, which replaced the Willesden Lane Clinic, and Mortimer Road on the 12th May, which replaced St. Martin's Church Hall Clinic. 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 number of children born in 1963 have taken part in the Medical Research Council's measles vaccine trial. When the results are made known it is hoped that a measles vaccine will be included in the immunisation programme. 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. PREVENTION OF BREAK-UPS OF FAMILIES IN WILLESDEN The Family Service Unit continues its work in this area. Several new families were referred to the Unit for help and advice. One family was sent to Frimhurst for a period of rehabilitation. MIDWIFERY SERVICE Looking back this has been a very productive year! For the first time in many years, the midwifery staff have been up to establishment—and an off-duty rota was started which has been most successful. Midwives hold their own ante-natal sessions, but work in close liaison with general practitioners and hospitals. Three part-time midwives have been appointed for early discharge schemes; difficulty was experienced early on, because the hospital was unable to participate in the plan, due to lack of staff. 17 HEALTH VISITING 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. 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 visitor's 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 Five sponsored student health visitors successfully completed a course at the Chiswick Polytechnic and joined the staff in September. Health visitors assist them 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 Two health visitors attended a day release course on "Human Relations." A second series of classes of instruction in the teaching of relaxation during childbirth, were held at one of the local clinics and were attended by health visitors and midwives. The classes were found to be both stimulating and instructive. Most health visitors have attended lectures given by the Paediatrician at the Kingsbury Maternity Hospital. Refresher Courses Three health visitors attended courses on various aspects of their work. Five also attended a half-day conference organised by the British Diabetic Association. HOME NURSING There has been an increase again this year in the number of cases referred for nursing at home. This is a service which must and does work in close liaison with the hospital and general practitioner, to give nursing care within the patient's own home. There is a wide range of work, covering the young, the old, the acute, the chronic; these cases may necessitate daily or twice-daily visits. In 1962 a pilot scheme was started whereby a district Nursing Sister was attached to a group of general practitioners. This scheme worked well to the benefit of the patient and the satisfaction of the doctors and nurse, and two further schemes were introduced during the year, which are progressing well. SMALLPOX VACCINATION Of the 1,210 primary vaccinations reported during the year 69.5 per cent were given to children aged one year and 17.3 per cent to children aged between two and four years. This indicates that the postponement of primary vaccination till the second year of life, advocated by the Ministry of Health in the previous year, has been adopted generally. Only 67 records of revaccination were received due to the fact that the Ministry has now decided that only records in respect of persons under the age of 16 years need be obtained by Local Authorities. 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. 3,667 children completed a full course of primary immunisation, and 2,154 received a full reinforcing injection. INOCULATION AGAINST POLIOMYELITIS During the year 3,670 persons received a primary course inoculation, the majority of whom were aged between six months and one year, indicating that people in the priority groups were now protected against poliomyelitis. 1,027 reinforcing doses were given to children prior to admission to school. HOME HELP SERVICE Three health visitors attended courses on variond a further slight increase in the number of cases still receiving help at the end of the year (690). Two tuberculosis cases were helped, and help was provided free to three mothers suffering from toxaemia of pregnancy. Sixty-eight bookings were taken for home confinements but only 34 mothers were helped, the others either going into hospital or making other arrangements. 18 There were 74 Home Helps employed at the end of the year. Their rate of pay was increased to 4/4 7/8d. per hour during the year. The charge to the public remained at 4/9d. Six persons were enrolled to act as Neighbourly Helps, but only three were still employed at the end of the year. The number of home visits made by the organisers was 4,603. DAY NURSERIES Kilburn Day Nursery, built in connection with the Kilburn Square redevelopment project, admitted children from 29th July. This new nursery provides 50 additional places bringing the total approved places in nine day nurseries to 440. All these places have been occupied throughout the year with a high general daily attendance. The waiting list has increased by 73 per cent. Eleven students completed the two years' period of training for the N.N.E.B. Course and all passed the examination and obtained the certificate. Recruitment of suitable trained nursery staff remains difficult. 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 Medical Officer of Health who arranges suitable homes. Patients who ask for a reduction in the standard charge of £7 7s. Od. in ordinary homes and £8 8s. Od. in respect of special category homes, must complete an economic circumstances form and they are assessed by the Finance Officer. They may also ask for payment, of travelling expenses. 106 adults and nine children were recommended in 1964. SCHOOL HEALTH SERVICE Medical Inspection Routine medical inspection in schools continued, with the entrants, 7-8 years, 10-11 years, and leavers age groups again showing a high percentage of children in a satisfactory physical condition. The question of selective medical inspection has been raised by the Department of Education and Science and pilot schemes will be operated during the coming year. The object of the scheme is to give medical staff more time to deal with the child in need rather than examine fit children. Handicapped Pupils The Hearing Clinic at Neasden has now been open just over a year and due to the number of cases referred it has been necessary to apply to the North-West Regional Hospital Board for an additional specialist session. The facilities of the clinic are also available to children residing in the boroughs of Harrow, Hendon and Wembley. It is hoped that in the not too distant future classes for partially hearing children will be established in the district. At present deaf or partially hearing children requiring special educational treatment attend schools at Heston, Tottenham or in the London County Council area. CHILD GUIDANCE This year the establishment of staff has been complete except for psychotherapists where only three of the 17 sessions are able to be filled. This means that children's difficulties are diagnosed by the team but the more serious cases are kept waiting for treatment. By the end of last year three rooms previously used as a dental clinic were ready for use, enabling all personnel to have separate rooms. More children (164) were referred in 1964 than ever before, about half being from medical sources and there were about twice as many boys as girls. The proportion of children referred from the Children's Department has more than doubled. A disquieting feature is that in over 20 per cent of the cases investigations were incomplete through non-co-operation of parents who withdrew the case. Unless parents realise that the child's problems are those of the family, the Child Guidance staff can do little. The waiting list of 26 at the end of the year is slightly more than last year but not great when compared with other areas. Close co-operation with the School Health Service was maintained through monthly conferences and the psychiatrist's visits to school clinics. SCHOOL AND PRIORITY DENTAL SERVICE During the year the incidence of dental disease in the population for whose dental care the Local Authority is responsible, has not diminished. Of those inspected and found to require treatment a slightly higher percentage has opted to receive treatment by the Local Authority notwithstanding the fact that the number of practitioners in the General Dental Service in the area has increased. 19 Although the recruitment of full-time staff is still a problem, the tendency of part-time dental officers to transfer to more lucrative posts in the General Dental Service has virtually ceased as the number of practitioners in that service in this area is more than adequate for the demands made upon it. Indeed the reverse is now the case, part-time dental officers requesting additional sessions with the Local Authority. This is, of course, appreciated by the patients and parents who now enjoy continuity of treatment not previously possible with ever-changing staff. Full and immediate treatment is available to all entitled and willing to accept it. CHIROPODY The number of patients attending the Chiropody Clinic has increased, especially retirement pensioners and large numbers of housebound, both elderly and handicapped, are being given domiciliary chiropody treatment. The chiropodist is often able, when visiting these old people, to help in other ways; for instance, by reporting to the Health Visitors of a patient's needs in matters which come within the scope of their activities. Most parents who come to the clinic with their children for foot treatment are often anxious for advice on suitable shoes, etc., and this is freely given. Most patients receive a monthly treatment and a common expression when they leave is that they are "walking on air" and often say how much they appreciate this service provided by the Council. 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 their annual grant of £100 to the committee's funds in the financial year 1964/65, but in July it was necessary to ask for an additional grant of £25 for the purchase of 1,000 extra copies of the fourth edition of the "Home Safety Handbook." In October, after an extraordinary meeting held to discuss the committee's financial commitments until 31st March, 1965, an approach was made to the Council for a further grant of £50 so that these could be met. The Committee were most grateful to the Council for making these additional grants. 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 24 local organisations are represented on the Committee, which is affiliated to the Royal Society for the Prevention of Accidents and the National Home Safety Committee. The Committee is also a member of the British Standards Institution and the Consumers' Association Limited. Three committee meetings and six meetings of sub-committees were held during the year. Subcommittees considered the safety handbook, the song competition, the Willesden Show, and finance. An informal meeting was held in conjunction with the Home Safety Sub-committee of Wembley Accident Prevention Council to consider the future in view of the proposed merger of Wembley and Willesden under the London Government Act. The fourth edition of the Committee's Home Safety Handbook was completed; the publishers made 2,000 copies available free of charge and an additional 1,000 were purchased. Copies were widely distributed throughout the borough, and distribution will continue. During the week preceding 5th November, posters were displayed on borough sites, in libraries and clinics, and at Christmas posters were displayed on advertising sites. Literature was also distributed at the Willesden Show, and when talks were given to organisations. A display at the Willesden Show in September was very successful. The theme was 'Accidents in the Home'. 'Careless Lodge', an exhibit illustrating hazards in the home, was hired from Hertfordshire County Council, and proved a very great attraction to adults and children. The chairman and members attended to answer questions and distribute literature. The Committee invited entries for a song competition, with prizes of £20, £10 and £5, the lyric to be written to one of six tunes and to incorporate at least one aspect of home safety. 3,000 entry forms were distributed but only 14 entries were received. Five songs were selected by a panel of teenagers and sung in the Summer Theatre at the Willesden Show on 12th September; the prizes for the three winning songs were presented by Her Worship the Mayor. It was felt that the winning song should receive as much publicity as possible, and it has now been published in the December issue of the Home Safety Bulletin. The Committee's resolution 'To reduce the risk of fires through oil heaters', submitted to the National Home Safety Committee for consideration, was referred to the House of Lords asking that it should be included in the appropriate clauses of the Housing Bill. Articles on the Committee's activities have appeared in the local press and in 'Safety News'. Early in the year organisations were reminded that members would give talks on home safety, but the response was poor and only two talks were given to 71 people. Two members attended the National Home Safety Conference held at Friends House, Euston Road, 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; one member attended a oneday conference organised by the Women's Advisory Committee of the British Standards Institution on 'Safety for the Under-Fives'; and two members attended the Willesden Borough Council's Civic Forum in January. An invitation to attend the Forum was also extended to the Honorary Accident Prevention Officer for Wembley. 20 TABLES Table 1 DEATHS Causes: Males Females Total 1. Tuberculosis (respiratory) 4 1 5 2. Tuberculosis (other) 2 — 2 3. Syphilitic disease 1 1 2 4. Diphtheria — — — 5. Whooping Cough — — — 6. Meningococcal infections 1 — 1 7. Acute poliomyelitis — — — 8. Measles — — — 9. Other infective and parasitic diseases 2 3 5 10. Malignant neoplasm, stomach 29 15 44 11. Malignant neoplasm, lung bronchus 99 26 125 12. Malignant neoplasm, breast — 34 34 13. Malignant neoplasm, uterus — 15 15 14. Other malignant and lymphatic neoplasms 79 77 156 15. Leukaemia, aleukaemia 4 4 8 16. Diabetes 7 4 11 17. Vascular lesions of nervous system 60 96 156 18. Coronary disease, angina 241 130 371 19. Hypertension, with heart disease 6 12 18 20. Other heart disease 50 69 119 21. Other circulatory disease 35 56 91 22. Influenza — — — 23. Pneumonia 54 51 105 24. Bronchitis 80 29 109 25. Other diseases of respiratory system 12 5 17 26. Ulcer of stomach and duodenum 5 1 6 27. Gastritis, enteritis and diarrhoea 7 5 12 28. Nephritis and nephrosis 5 6 11 29. Hyperplasia of prostate 8 — 8 30. Pregnancy, childbirth, abortion — 1 1 31. Congenital malformations 8 10 18 32. Other defined and ill-defined diseases 63 84 147 33. Motor vehicle accidents 12 8 20 34. All other accidents 21 17 38 35. Suicide 15 12 27 36. Homicide and operations of war - 2 2 TOTAL 910 774 1,684 21 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 1964 172,250 4,677 103 22 20 87 18 16 Perinatal mortality 1955 35 per 1,000 live and still births 1956 35 „ „ „ „ „ „ 1957 32 „ „ „ „ „ 1958 31 „ „ „ „ „ 1959 27 „ „ 1960 30 „ 1961 29 „ 1962 34 „ „ „ „ „ ,, „ 1963 34 ,, ,, „ ,, ,, ,, 1964 31 „ „ Table 3 Infant Mortality:—by Wards Ward Number of deaths Rate Carlton 13 42 Kilburn 8 20 Queens Park 6 22 Brondesbury Park 4 15 Mapesbury 4 13 Cricklewood 7 29 Brentwater 4 25 Gladstone 4 27 Chamberlayne 4 22 Kensal Rise 6 18 Manor 3 10 Willesden Green 8 22 Church End 7 34 St. Raphael's 8 45 Stonebridge 8 26 Roundwood 7 19 Harlesden 2 6 103 22 22 Table 4 Deaths by Social Class I 1 II 8 III 35 IV 17 V 25 Not known 13 Not classified 3 Total 103 Table 5 Infant Mortality—Causes (Based on Registrar General's Figures) 1936-1939 1940-1945 1946-1950 1956-1960 1964 Deaths Deaths Rate Deaths Rate Deaths Rate Deaths Rate Neonatal 1-12 months Total Rate Respiratory 106 8.1 140 8.8 68 4.2 57 3.6 6 17 23 4.9 Diarrhoea and enteritis 131 10.0 108 6.8 37 2.3 3 .2 2 1 3 .6 Other infections 34 2.6 40 2.5 15 .9 5 .3 1 - 1 .2 Congenital malformations 83 6.3 89 5.6 72 4.4 55 3.5 8 8 16 3.4 Prematurity 170 13.0 179 11.3 99 6.1 72 4.6 37 - 37 7.9 Injury at birth 21 1.6 33 2.1 43 2.7 18 1.1 11 - 11 2.4 Other causes 134 103 149 9.4 96 5.9 88 5.6 5 7 12 2.6 All causes 679 51.9 738 46.5 430 26.5 298 18.9 70 33 103 22.0 Table 6 Premature births and deaths (deaths in brackets) Year Births in home Births in hospital Home births transferred to hospital Total 1946 47 (1) 128 (18) 12 (10) 175 (29) 1952 38 (3) 137 (23) 8 (3) 175 (26) 1953 31 (3) 143 (18) 7 (0) 174 (21) 1954 31 (2) 131 (10) 9 (0) 162 (12) 1955 31 (0) 139 (20) 7 (0) 170 (20) 1956 19 (0) 146 (12) 3 (0) 165 (12) 1957 25 (1) 169 (4) 6 (1) 194 (5) 1958 31 (1) 215 (17) 5 (1) 246 (18) 1959 24 (0) 201 (23) 3 (0) 225 (23) 1960 22 (0) 217 (14) 3 (0) 239 (14) 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) 1964 11 (0) 313 (37) 2 (0) 324 (37) 23 Table 7 Premature births by wards Ward Premature births notified Percentage of live births in brackets Carlton 29 (9.4) Kilburn 26 (6.3) Queens Park 23 (8.3) Brondesbury Park 11 (4.2) Mapesbury 24 (7.9) Cricklewood 21 (8.6) Brentwater 10 (6.3) Gladstone 10 (6.7) Chamberlayne 11 (6.0) Kensal Rise 18 (5.3) Manor 27 (9.0) Willesden Green 18 (4.9) Church End 11 (5.3) St. Raphael's 12 (6.7) Stonebridge 28 (8.9) Roundwood 27 (7.3) Harlesden 16 (5.1) Total 322 (6.9) Table 8 Infant Mortality : Congenital Malformations Achondraplasia 1 Arnold Chiari malformation 1 Biliary atresia 1 Diaphragmatic hernia 1 Fibro-elastosis of heart 1 Heart disease 4 Hydrocephaly 1 Hydrocephalus and meningo-myelocele 2 Meningo-myelocele with cerebral abnormalities 1 Multiple deformities 1 Pyloric stenosis 1 Valvular malformation 1 Total 16 24 GENERAL PROVISION OF HEALTH SERVICES Table 9 BACTERIOLOGICAL EXAMINATION OF MILK, ICE CREAM AND WATER Milk examination-10 Schools (pasteurised) Dealers' premises Total Pasteurised T.T. pasteurised Sterilised Samples 10 - - - 10 Satisfactory 10 - — — 10 Unsatisfactory — - — — — Ice cream examinations—76 Grade 1 Grade 2 Grade 3 Grade 4 Total 44 7 8 17 76 Water examinations—424 Domestic supplies Swimming pools Paddling pool Total Samples 3 408 13 424 Satisfactory 3 408 13 424 Unsatisfactory — — — — Table 10 Uncleanliness and Scabies New cases treated Attendances Scabies Lice and nits Total Scabies Lice and nits Total Children under 5 years 5 1 6 5 1 6 Children 5-15 years 9 6 15 9 8 17 Adults Men 7 4 11 8 4 12 Women 3 6 9 3 6 9 Total 24 17 41 25 19 44 HEALTH EDUCATION Table 11 Talks No. visited Total No. of talks Subjects Total attendances No. of attendances Schools 33 204 61 9,586 4—200 Religious, social and political organisations 5 12 5 570 40—90 25 Table 12 Mothercraft No. of clinics Total No. of classes Visits by health visitors 4 169 10,776 PREVALENCE AND CONTROL OF INFECTIOUS AND OTHER DISEASES Table 13 Infectious diseases 1964 (1963 in brackets) Notified Confirmed Diphtheria - (-) - (-) Dysentery 117 (86) 104 (72) Erysipelas 8 (15) 8 (15) Encephalitis, acute 1 (-) 1 (-) Food poisoning 43 (19) 41 (17) Malaria — (-) — (-) Measles 951 (1,948) 951 (1,948) Meningococcal infection 1 (4) — (3) Ophthalmia neonatorum 1 (5) 1 (5) Paratyphoid fever 1 (-) 1 (-) Pneumonia 49 (52) 49 (51) Poliomyelitis and polioencephalitis - (1) - (-) Puerperal pyrexia 129 (134) 129 (134) Scarlet fever 110 (59) 110 (59) Smallpox — (-) — (-) Tvphoid fever — (4) — (3) Whooping cough 128 (254) 128 (254) 26 BRONCHITIS. CANCER OF LUNG AND TUBERCULOSIS Table 14 Tuberculosis: Notified cases and deaths Year Population New cases Deaths Cases on register Pulmonary Nonpulmonary All forms Pulmonary Nonpulmonary All forms Pulmonary Nonpulmonary All forms 1938 187,600 210 56 266 117 11 128 691 172 863 1946 170,550 255 34 289 81 15 96 1,067 180 1,247 1952 180,400 229 27 256 29 4 33 1,803 250 2,053 1953 178,500 216 29 245 24 1 25 1,854 249 2,103 1954 177,300 229 33 262 33 4 37 1,917 267 2,184 1955 176,000 152 23 175 25 2 27 1,966 277 2,243 1956 174,900 140 23 163 25 — 25 1,993 291 2,284 1957 174,100 159 25 184 13 — 13 2,027 295 2,322 1958 173,100 124 17 141 14 2 16 1,990 291 2,281 1959 172,800 152 20 172 5 — 5 1,910 288 2,198 1960 172,430 140 21 161 11 — 11 1,819 284 2,103 1961 170,030 97 18 115 13 1 14 1,678 288 1,966 1962 171,230 109 22 131 10 — 10 1,595 281 1.876 1963 172,130 101 13 114 14 2 16 1,584 286 1,870 1964 172,250 83 15 98 5 2 7 1,558 294 1,852 Table 15 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 1964 172,250 48 9 57 3 1 4 27 Table 16 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 1964 80 29 109 63 Table 17 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 1964 99 26 125 73 Table 18 Tuberculosis: New cases and deaths by age groups (Deaths in brackets) Age groups New cases Respiratory Non-respiratory Male Female Male Female Under 1 - (-) - (-) - (-) - (-) 1 to 4 1 (-) 1 (—) — (—) 1 (—) 5 to 9 2 (-) 2 (—) — (—) - (-) 10 to 14 - (-) — (—) 1 (—) — (—) 15 to 19 2 (-) 2 (—) — (—) — (—) 20 to 24 10 (-) 5 (—) — (—) 2 (—) 25 to 34 11 (-) 7 (—) 4 (—) 2 (—) 35 to 44 7 (-) 8 (—) — (—) 2 (—) 45 to 54 9 (3) 4 (1) - (1) 1 (—) 55 to 64 8 (1) — (—) - (-) 1 (—) 65 and upwards 2 (-) 2 (—) - (1) 1 (—) Totals 52 (4) 31 (1) 5 (2) 10 (-) 28 Table 19 Tuberculosis 1964: Cases by Wards Ward Pulmonary cases Nonpulmonary cases Pulmonary rate per 100,000 Combined rate per 100,000 Carlton 6 - 58 58 Kilburn 7 1 57 65 Queen's Park 5 — 55 55 Brondesbury Park 7 — 66 66 Mapesbury 12 — 118 118 Cricklewood 4 2 41 61 Brentwater 2 3 20 50 Gladstone 6 1 66 77 Chamberlayne 6 2 56 75 Kensal Rise 5 1 51 61 Manor 3 — 29 29 Willesden Green 3 2 27 45 Church End 5 1 54 65 St. Raphael's 6 1 69 81 Stonebridge 1 1 10 19 Roundvvood 2 — 19 19 Harlesden 3 — 29 29 Whole Borough 83 15 48 57 Table 20 Tuberculin Testing, 1955-1964 Children under 5 years School children (5 years) School leavers Tested Positive % Positive Tested Positive % Positive Tested Positive % Positive 1955 1,308 13 10 1,537 32 2.1 2,041 387 19.0 1956 1,333 14 10 1,473 56 4.0 1,759 391 22.2 1957 1,295 31 2.4 1,496 44 2.9 1,753 348 20.0 1958 989 26 2.6 1,613 81 5.0 2.069 403 19.0 1959 273 3 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 15.4 1961 388 6 1.5 1,690 95 5.6 2,228 343 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 1964 258 4 1.6 2,376 166 7.0 1,851 348 19.0 29 Table 21 Tuberculosis: B.C.G. vaccination of school leavers, 1955-1964 No. tested and found negative No. vaccinated 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) 1964 1,462 (80) 1,447 (99) * Percentage of total tested, t Percentage of negatives vaccinated. Table 22 Tuberculosis: Notification of deaths 1959 1960 1961 1962 1963 1964 1959-64 Deaths 5 11 13 10 14 5 58 Percentage not notified 20 36 46 20 14 - 26 Percentage notified before death: 0—12 months — 19 — 10 14 20 10 1—5 years 40 9 — 20 7 60 15 Over 5 years 40 36 54 50 65 20 49 SANITARY CIRCUMSTANCES OF THE AREA Table 23 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) 31 Table 24 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 1½ per room Percentage of households at more than 1½ persons per room WILLESDEN 4,634 36.9 0.80 15.2 10.1 MIDDLESEX 148,687 15.0 0.67 5.0 3.0 LONDON 74,898 42.7 0.77 11.5 7.2 SANITARY INSPECTION OF THE AREA Table 25 Demolition and Closing Orders Housing Act, 1957 (Sections 16, 17 and 18) Demolition Orders, section 16, Housing Act, 1957 29 Neasden Lane Closing Orders, sections 17 and 18, Housing Act, 1957 5 Greenhill Road (ground floor back room (left) and side addition rear room) 9 Brondesbury Villas (basement) Table 26 Overcrowding (a) Dwellings overcrowded at end of year 782 (b) Overcrowding reported during the year 267 (c) (i) Overcrowding relieved during the year 69 (ii) Persons 276 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 23 (ii) Families 27 (iii) Persons 96 (f) Overcrowding in Council houses relieved during the year 27 (g) Section 80, Housing Act, 1957—licences issued 1 Table 27 New Dwellings, 1964 Houses Flats Rebuilds Dwellings built by private builders (excluding those built by the police authorities) Nil 88 Nil Built by local authority Nil 241 Nil Applicants on Council's waiting list at 31.12.64 5,582 32 Table 28 Notices served (including Housing Survey) Intimation notices served 357 Intimation notices complied with 378 Statutory notices served (Public Health Act, 1936) 1,212 Statutory notices complied with (Public Health Act. 1936) 1,299 Statutory notices served (Public Health Act, 1961) 30 Statutory notices complied with (Public Health Act, 1961) 22 Statutory notices served (Shops Act, 1950) 4 Statutory notices complied with (Shops Act, 1950) 5 Statutory notices served (Prevention of Damage by Pests Act, 1949) 22 Statutory notices complied with (Prevention of Damage bv Pests Act, 1949) 19 Statutory notices served (Middlesex County Council Act, 1956) 51 Statutory notices complied with (Middlesex County Council Act, 1956) 48 Statutory notices served (Housing Act, 1957) 194 Statutory notices complied with (Housing Act, 1957) 172 Statutory notices served Housing Act, 1961 (Section 15) 201 Statutory notices complied with Housing Act, 1961 (Section 15) 159 Non-compliance with statutory notices referred to Town Clerk (Public Health Act, 1936 section 93) 212 Referred to Borough Engineer for work to be carried out in refault of owners (203 work done by Borough Engineer) 360 Table 29 Inspections carried out Public Health Act Dwellings—inspected 1,472 Dwellings—re-inspected 4,622 Visits re accumulations 457 Visits re Vermin 135 Visits re improper keeping of animals 59 Other nuisances including rats 1,538 Other Visits 721 Housing Acts House-to-house-—inspections 604 House-to-house—re-inspections 1,675 Individual houses—inspected 82 Individual houses—re-inspected 133 Houses in multiple occ.—inspected 310 Houses in multiple occ.—re-inspected 933 Basement rooms inspected 21 Overcrowding visits 2,110 Imp. and standard grant inspections 73 Houses inspected—special surveys 28 Other visits 1,263 Rent Act Dwellings—inspected 11 Dwellings—re-inspected 11 Other Visits 12 Factories Act Power factories—inspected 559 Power factories—re-inspected 144 Non-power factories—inspected 40 Non-power factories—re-inspected - Outworkers rooms inspected 53 Other visits—building sites, basement bakehouses, etc. 30 Food and Drugs Premises—inspected 1,926 Premises—re-inspected 721 Visits re unsound food 459 Visits re contaminated food 248 Clean Air Act Boiler plant inspected 19 Premises inspected in SCAs. 5,697 Other visits in SCAs. 91 Visits re nuisance from smoke etc. 113 Smoke observations 72 33 Offices and Shops Act General Inspection Office 235 General Inspection Retail Shop 61 General Inspection Wholesale/Warehouse 14 General Inspection Catering Estab. 8 General Inspection Fuel Storage Depot — Re-Inspections 306 Other Visits 165 Infectious Disease Cases investigated 338 Contacts followed up 273 Food poisoning enquiries 64 Other Visits 124 Miscellaneous Aged persons 33 Attendance at Court 110 Drainage inspections 740 Massage, etc. establishments inspected 24 Noise nuisance investigations 281 Places of entertainment inspected 42 Rag Flock, etc. premises inspected 13 Unsuccessful visits 3,863 All other visits 828 Total 33,962 Table 30 Rent Act, 1957 Certificates of Disrepair Applications (Form I) received and investigated 10 Agreed and proposal to issue Certificate of Disrepair (Form J) served 10 Refused Nil Undertakings (Form K) received from landlords 7 Accepted 7 Refused Nil Certificate of Disrepair (Form L) issued 3 Applications received for cancellation of Certificates of Disrepair (Form M) 1 Granted Nil Refused 1 Table 31 Summary of Nuisances abated and Improvements Effected Dwelling Houses Water Supply and Service: New cisterns provided 3 Cisterns repaired/renewed 77 Cisterns cleansed/covered 2 Draw taps placed on mains 3 Water supply re-instated 45 Hot water provided 281 Drainage and Sewerage W.C.'s—pans and taps renewed 58 W.C.'s—cleansed/repaired 103 W.C.'s—add. accom. provided 5 W.C.'s—ventilation improved 4 Drains—reconstructed 5 Drains—examined, tested, exposed 44 Drains—cleared, repaired 296 Soil pipes or vent shafts repaired 82 New soil pipes or vent shafts fixed 24 Disconnecting traps or chambers inserted 2 New manhole covers 25 34 Other Defects: Baths provided 5 Brickwork repaired /repointed 352 Cookers provided 46 Dampness remedied—D.P. course 1 Dampness remedied—others 485 Exterior paintwork repainted 76 Fireplaces/ranges repaired or renewed 45 Flooring and other woodwork repaired/renewed 371 Floors (solid) repaired 15 Floors—additional ventilation provided 14 Food store provided 39 Food stores—ventilation provided — Gutters, R.W.P.'s waste pipes repaired 478 Overcrowding abated 1 Plastering repaired/renewed (rooms) 626 Refuse accumulations removed 40 Roofs repaired/renewed 514 Sinks—additional provided 85 Sinks—repaired/renewed 42 Flues repaired 6 Staircases, passages—cleansed 1 Staircases, passages—repaired 4 Walls and ceilings—cleansed 100 Walls and ceilings—repaired 63 Windows repaired 972 Other defects 316 Courts, Forecourts, Yards Nuisances abated 1 Paving repaired/relaid 141 Accumulations removed 141 Verminous Articles and Premises: Premises disinfested 74 Articles disinfested/destroyed 1 Animals: Nuisances abated 3 Miscellaneous: Nuisances abated 13 Smoke nuisances abated 3 Noise 3 Total 6,138 D1S1NFESTATION Table 32 (a) Verminous premises: Council properties 19 Private properties 55 Total 74 (b) Verminous rooms:* Council properties 47 Private properties 102 Total 149 *Some rooms are treated more than once. (c) Clothing and bedding materials: (i) disinfested 2 (ii) disinfected 4 (d) Miscellaneous: Ants 4 35 INSPECTION AND SUPERVISION OF FOOD AND FOOD PREMISES Table 33 Types of food premises Baker 19 Bread and confectionery 38 Dairy 3 Butcher 100 Grocer and general store 289 Fishmonger and fish fryer 43 Cafe and restaurant 137 Greengrocer and fruiterer 121 Ice cream and sweet shop 211 Food stall 19 Public house 43 Works canteen 116 School canteen 39 Food factory 4 Other food premises 60 Total 1,240 Inspections and revisits: Inspections 1,926 Revisits 721 Total 2,647 Table 34 Premises unsatisfactory on 31.12.63 33 Unsatisfactory during the year 141 Premises made satisfactory during the year 139 Unsatisfactory on 31.12.64 35 Table 35 Food premises: Defects remedied Defects Outstanding at 31.12.63 Found during the year Total Remedied during year Outstanding at 31.12.64 Inadequate lighting and ventilation 1 4 5 5 0 Inadequate washing facilities 8 36 44 36 8 Inadequate refuse storage 6 19 25 22 3 Unsatisfactory or insufficient sanitary accommodation 10 27 37 28 9 Inadequate storage accommodation 1 13 14 9 5 Defective walls, ceilings or floors 11 69 80 65 15 Dirty walls, ceilings or floors 15 85 100 84 16 Inadequate first aid materials 4 10 14 13 1 Unsatisfactory conditions 1 4 5 3 2 Any other defects 17 59 76 52 24 Totals 74 326 400 317 83 Table 36 Food premises: Registration Premises on register 31.12.63 Applications received Applications granted Applications refused Premises removed from register during 1964 Total on register at 31.12.64 1. Sale and storage of ice cream 348 3 2 1 2 352 360 2. Manufacture of ice cream 8 - - - - 8 3. Manufacture of preserved food 131 3 3 - - 134 4. Fish curing 1 — — - - 1 36 FACTORIES Table 37 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 61 40 1 Factories not included above in which section 7 is enforced by the local authority 677 559 32 1 Other premises in which section 7 is enforced by the local authority (excluding outworkers premises) 8 30 — — Total 746 629 33 1 Table 38 Defects found Found Remedied Referred No. of cases in which prosecutions were instituted To H.M. Inspector By H.M. Inspector Want of cleanliness (sec. 1) 1 1 1 - Overcrowding (sec. 2) — — — — — Unreasonable temperature (sec. 3) — — — — — Inadequate ventilation (sec. 4) — — — — — Ineffective drainage of floors (sec. 6) — — — — — Sanitary conveniences (sec. 7) (a) Insufficient 6 2 — 1 — (b) Unsuitable or defective 27 27 — 4 1 (c) Not separate for sexes 1 2* — — — Other offences against the Act (not including offences relating to outworkers) — — 4 — — Total 35 32 4 6 1 *One defect outstanding from previous year. Table 39 Outworkers Nature of work No. of outworkers in August list No. of instances of work in unwholesome premises Notices served Wearing apparel (making, etc.) 117 - - Household linen 1 - - Curtains and furniture hangings 1 - - Plastic and paper bags 12 - - Handbags 11 - - Making of boxes or other receptacles or parts thereof made wholly or partially of paper 19 - - Carding, etc. of buttons, etc 6 - - Stuffed toys 7 - - Imitation Jewellery and jewellery pads 9 - - Lampshades 2 - - Brush making 1 . Lace making 1 — — Total 187 - — There were no cases of default in sending lists to the Council, and there were no prosecutions. 37 Table 40 OFFICES, SHOPS AND RAILWAY PREMISES ACT, 1963 Registration of Premises and Analysis of Persons Employed (Figures in brackets relate to premises registered with Shops Inspectors) Class No. of premises registered during the year Total No. of registered premises at end of year No. of persons employed Offices 241 (33) 238 (32) 3040 (154) Retail Shops 300 (482) 299 (482) 1769 (1756) Wholesale shops, warehouses 29 (-) 29 (-) 845 (-) Catering estabs. open to the public, canteens 62 (-) 62 (-) 804 (—) Totals 632 (515) 628 (514) 6458 (1910) Males 3080 (831) Females 3378 (1079) Table 41 Inspections and Visits Class No. of registered premises receiving general inspection during the year Number of visits of all kinds Offices 235 789 Retail Shops 61 Wholesale shops, warehouses 14 Catering estabs. open to the public, canteens 8 Total 318 Table 42 Defects and Unsatisfactory Conditions Found and Remedied Section Unsatisfactory Condition or Defect Found Remedied during the year 4 Premises in a dirty state 6 3 5 Overcrowding 3 (a) 0 6 Temperature: Unreasonable 2 1 Lack of room thermometer 86 72 9 Sanitary Conveniences: Unsuitable or insufficient 13 (b) 2 Lack of artificial lighting 4 2 10 Washing facilities insufficient or unsuitable 42 (c) 24 11 Adequate supply of drinking water not provided 1 1 16 Floors, passages and stairs not soundly constructed, properly maintained or kept free from obstruction or slippery substances 3 2 17 Dangerous parts of machines not properly fenced 2 0 25 Lack of First Aid box 60 49 (a) The overcrowding was found in premises in use on 31st July, 1964, and therefore the space standards do not apply until 1st August, 1967. (b) 8 defects not required to be remedied until the Sanitary Conveniences Regulations, 1964, come into force on the 1st January, 1966. (c) 7 defects not required to be remedied until the Washing Facilities Regulations, 1964, come into force on the 1st January, 1966. 33 DEANER PRINTERS LTD. (T.U.), LONDON VR 1/67