BUCKINGHAMSHIRE COUNTY COUNCIL ANNUAL REPORT Medical Officer of Health for the Year 195 3 C. T. DE FRAINE ft CO., LTD., AYLESBURY. TABLE OF CONTENTS. Section A.—Statistics and Social Conditions. General Statistics for the County Section B.—National Health Service Act, 1946. General Section 22—Care of Mothers and Young Children .. 23—Midwives’ Service » 24—Health Visiting ... » 25—Home Nursing ... „ 26—Vaccination and Immunisation .. 27—Ambulance Service „ 28—Prevention of Illness—Care and After-Care „ 29—Domestic Help Service » 51—Mental Health Service ... Section C.—National Assistance Act, 1948. Section 21 Provision of Residential and Temporary Accommodation „ 29 and 30—Welfare Services Section D.—Sanitary Circumstances of the Area. Water Supply Sewerage and Drainage Housing Section E.—Inspection and Supervision of Food. Food and Drugs Food and Drugs—Milk and Dairies Regulations Section F.—Prevalence of, and Control over. Infectious Disease PAGE 5 6 6 13 14 17 17 18 19 26 26 30 31 34 36 38 39 40 40 Section G.—General. Registration of Nursing Homes 40 Nurseries and Child Minders’ Regulation Act 40 Section H.—Statistical Tables, etc. (a) List of Sanitary Authorities 41 (b) Registered Nursing Homes 41 (c) Child Welfare Centres 42 (d) Populations, Birth and Mortality Rates, 1953 44 (e) Comparative Tables of Birth, Death and Infant Mortality Rates for Ten-Year Period, 1944-53 45 (f) Causes of Death at Different Periods of Life—1953 46 (g) Notification of Infectious Diseases in Urban and Rural Districts 47 (h) Care of Mothers and Young Children—Dental Treatment 48 (i) Ambulance Service 48 Mr. Chairman, Ladies and Gentlemen. I sometimes wonder if those of us who are heavily engaged in day to day administration of large departments ever get time to stand back from what we are doing and survey our work as a whole. Can we see the wood for the trees? This was forcibly brought home to( me during the preparation of this Annual Report for 1953. Owing to unusual circumstances some time elapsed between the, preparation of the sections of the report and their final assembly. When I read the report as a whole I was impresed by the change of content and the shift of emphasis as compared with one of my reports of say ten years ago. This annual report largely concerns itself with social and medico-social problems which were scarcely mentioned in the reports of those days. The care and after-care of all sorts of persons, the blind, the deaf, the crippled, the very young and the very old, the education of mothers (and fathers), the domiciliary care of the mentally backward and the mentally afflicted—we concern omselves with these and a great deal more. What perhaps is not so apparent from casual reading of the report is the enormous importance the whole department places on teaching: every section of the department is alive to the duty of teaching the p>eople and families with whom they are concerned to make the best of themselves. The best social medicine is to teach people to help themselves and to provide them the wherewithal to do it. I am glad to be able once again to thank everybody—members and officers alike—for the advice and assistance they have given me during the year. I am. Your obedient Servant, G. W. H. TOWNSEND, County Medical Officer. PUBLIC HEALTH OFFICERS OF THE AUTHORITY (a) Whole-time OflScers of the County Council as at 31st December, 1953. County Medical Officer of Health: G. W. H. Townsend, b.a„ m.b., b.ch., d.p.h. Deputy: C. D. CORMAC, M.A., B.M., B.CH., D.P.H. Senior Medical Officers; Hilda M. Davis, m.d., ch.b., d.p.h. A. W. Pringle, b.a., m.b., b.ch., b.a.o., D.pji. Assistants: M. A. CHAERETT, M.R.C.S., L.E.C.P., D.PJH, (Also Medical Officer of Health Borough ot Slough and Area Medical Officer). Patricia M. Elliott, m.d., b.s. (lon.), d.obst., e.c.o.g., d.p.h. T. P. Evans, m.r.c.s., l.r.c.p., d.p.h. (Also Medical (Officer of Health Urban Districts of Beaconsfield and Chesbam, and Rural District of Amersham). G. M. Hobbin, B.com., m.b., ch.b., d.p3. (Also Medical Officer of Health Urban District of Eton and Rural District of Eton). G. B. Hopkins, m.h., ch.b., d.p.h., b.pharm. Mary C. Im Thurn, m.r.c.s., l.e.c.p., d.p.h. A. J. Muir, m.b., ch.b., b.hy., d.p.h. (Also Medical Officer of Health Borough of High Wycombe, Urban District of Marlow and Rural District of Wycombe and Area Medical Officer). J. J. A. Reid, b.sc., m.b., ch.b., d.p.h. Janet C. RonaldsoN/ m.b.„ ch.b., d.p.h. A. E. R. Scott, m.r.c.s., l.r.c.p. J. T. C. Sims-Roberts, m.b^ ch.b., d.p.h. (bareister-at-law) (Also Medical Officer of Healffi Borough of Aylesbury and Rural Districts of Aylesbury and Winslow). Mary G. Tate, m.d., b.s., d.c.h. D. H. Waldron, m.d., b.ch., b.a.o., d.p.h. (Also Medical Officer of Health Borough of Buckingham, Urban Districts of Bletchley and Linslade, and Rural Districts of Buckingham and Wing and Area Medical Officer). County Assistance Officer: R. A. Hogarth. Senior Dental Surgeon: E. KeW, L.D.S. Superintendent Health Visitor: Miss F. E. Lillywhite. Senior Administrative Assistant^ E. L. Eyre. County Health Inspectort- F. Harding. Supervisor of Midwives and Home Nurses: Miss M. F. Webb. Senior County Almoner: Miss M. C. M. Bowikv. Senior Occupational Therapist: Miss F. B. Silk. Area Medical Officers: North Bucks Area Committee ... Dr. D. H. Waldron. Wycombe Area Committee ... Dr. A. J. Muir. South Bucks Area Committee Dr. M. A. Charrett. (b) Part-time Officers of the Authority and others discharging duties for the Authority. County Consultant (diseases of the chest)’ A. Stephen Hall, m.a., m.b., f.r.c.p. Physicians (diseases of the chest): Oxford R^onal Hospital Board ... W. T. Bermingham, b.a., m.b., b.ch. ... A. Stephen Hall, m.a., m.b., f.r.c.p. ... F. S. Hawkins, m.d., f.r.c.p. North West Metropolitan Regional Hospital Board ... Brian C. Thompson, m.a., m.d. Qonsultant Geriatrician : Philip Arnold, m.d., m.r.c.p. Chief Inspector: Public Analyst: W. A. Davenport, m.i.w.m.a. Eric Voelcker, f.i.c., a.r.c.s. SECTION A.—GENERAL STATISTICS FOR THE COUNTY. The area of the geographical and administrative County is 479,411 acres (approximately 749 square miles) and the number of inhabitated houses at the 1931 census was 68,994, including 73,013 fa miles or separate occupiers. The rateable value of the County at 1st April, 1954 was £3,119,897 as against £3,015,389 at 1st April, 1953, an increase of 3^ per cent. The estimated product of a penny rate for the financial year 1954/55 was £12,558 as compared with a figure for 1953/54 of £12,111. The estimate of the Registrar General for mid-1953 refers to the home population, including members of the armed forces stationed in the area, and amounts to 398,200 as compared with 394,700 for 1952. At the 1951 census the total population of the County was 386,164. Census populations, estimated populations, birth and mortality rates for individual County Districts are quoted in Table (d) of Section H. 1952 Births. M. F. Legitimate 2,962 2,758 Illegitimate 136 133 3,098 2,891 Birth-rate. Total. M. 1953 F. Total. 5,720 2,861 2,815 5,676 269 136 134 270 5,989 2,997 2,949 5,946 — —— 1951 1952 1953 Urban Districts (per 1,000 home population) ... Rural Districts (per 1,000 home population) ... County (per 1,000 home population) England and Wales (per 1,000 home population) Still-births (rate per 1,000 total births) 15.2 15.3 15.1 15.0 15.1 14.8 15.1 15.2 14.9 15.5 15.3 15.5 18.6 17.4 17.5 Deaths from all causes. Urban Districts (per 1,000 home population) ... Rural Districts (per 1,000 home population)... Total for County (per 1,000 home population)... England and Wales (per 1,000 home population) 10.3 9.9 9.4 11.3 9.9 9.9 10.8 9.9 9.7 12.5 11.3 11.4 Infant Mortality Rate. Urban Districts (per 1,000 births) Rural Districts (per 1,000 births) County (per 1,000 births) England and Wales (per 1,000 births) Infant Mortality Rate among Illegitimate children 26.4 26.7 18.8 22.8 23.4 21.2 24.6 25.0 20.0 29.6 27.6 26.8 43.5 26.0 37.0 No. of women dying in, or in consequence of, pregnancy, child birth or abortion 3 4 2 Deaths from— Measles 1 2 4 Whooping Cough 3 0 0 Diphtheria 0 0 0 Principal causes of death. Heart Disease 1,278 1,174 1,173 Cancer 725 709 662 Bronchitis 224 179 193 Pneumonia 201 178 188 Influenza 100 7 69 T uberculosis—Respiratory 56 50 35 —Other forms 16 8 2 Motor Vehicle Accidents 45 41 50 Other Accidents 89 82 89 Total deaths from all causes ... 4,216 3,907 3,844 Two maternal deaths were recorded in the County during the year, representing a rate of 0.33 per thousand total births, as compared with a rate of 0.76 for England and Wales. In one of the maternal deaths mentioned the interval between the maternal condition and death was stated to exceed twelve months. For the sixth year in succession and the seventh time in the last eight years, it is gratifying to report that no deaths from diphtheria occured in the Coimty. I SECTION B.—GENERAL PROVISION OF HEALTH SERVICES. NATIONAL HEALTH SERVICE ACT, 1946. Full details of the Council’s Schemes under this Act were given in the Report for the year 1949, and a special survey of the working of the Services over the foui^ years 1949-1952 was in- cluded last year. No very great changes, took place in 1953 and comments and statistics covering the various set^tions are given in the body of the report. SECTION 22.—CARE OF MOTHERS AND YOUNG CHILDREN. Child Welfare Centres. Child welfare centres show an increase in attendances during this year. The percentage of new babies under one year attending the centres, related to the total live births in 1953, was 74; this is the highest figure recorded in recent years. The average for 1949—1952 was 70, but in 1947 only 64% of babies attended. Attendances among children between the ages of one and two years is 67% of the 1952 births, but only 26% of children in the two to five year group come to the centres. It is in this latter group of pre-school children that more preventative work is needed and it is hoped that the number of special sessions where mothers can bring their older children by appoint- ment may be increased. At present these “ toddlers’ sessions ” are held at six centres in the County. During the year certain changes were made in the siting of welfare centres, due to shifts in population. One village centre was closed and another was replaced by a monthly visit from the mobile centre. In the Denham area two centres were combined in new premises. In order to provide adequate coverage by the child welfare centre service, transport is provided for mothers and children attending 10 of the rural centres. The mobile centre now visits 35 villages and is out for 12 sessions a mionth. The Voluntary Committees continue to take an active part in the work at all the centres; their interest and help is invaluable. During November and December, the first four of a series of one- day conferences for Voluntary Workers were held, at which talks and discussions on the past, present and future of child welfare centres aroused keen interest. The health education programme for the year at child welfare centres and mothers’ clubs is described in the section on Health Visiting. The following table gives particulars of the attendances at the Child Welfare Centres operating during the year: Permanent. Mobile. Voluntary. (1) Number of Centres operating at end of year 94 12* 2 (2) Number of times Centres opened 2,539 100 46 (3) Number of times Medical Officer attended 1,727 100 17 (4) Number of children presented for examination to the Medical Officer 22,008 1,351 292 (5) Number of children who first attended during the year and who at their first attendance were under one year of age 4,156 166 61 (6) Number of children who* attended during the year and who were bom in: (a) 1953 3,806 149 60 (b) 1952 3,848 131 68 (c) 1951-1948 4,843 271 68 (7) Total number of children who attended during the year ... 12,497 551 196 (8) Number of attendances during the year made by children who at the date of attendance were: (a) Under one year 54,339 926 587 (b) One but under two years 17,287 469 281 (c) Two but under five years 18,663 751 175 Total attendances during the year 90,289 2,146 1,043 * Twelve half-day sessions covering 36 villages. Table (c) of Section H of the report shows a current list of Child Welfare Centres. Maternity Accommodation. The County Health Department has continued to act as the clearing house for allocating patients to maternity beds available on social grounds. County Health Visitors investigate the home circumstances of applicants, including those referred by medical practitioners, ante-natal clinics, etc., and co-operation with Hospital Management Committees is maintained to ensure that the best possible use is made of available beds. Patients requiring maternity accommodation for medical reasons are usually referred direct to the hospital ante-natal clinics by the family doctors. An analysis of the births notified as occuring in the various maternity institutions accepting cases from this County reveals that 68 per cent of births occured in hospitals and maternity homes (including private nursing homes), the remaining 32 per cent being domiciliary confinements, a proportion similar to that of the previous year. Premature Births. The care of premature infants has continued, a premature birth being defined as one weighing 5| lbs. or less irrespective of the period of gestation. Arrangements are made for the required irformation relating to birth weights, including stillbirths, to be entered on the birth notification cards. The following is a summary of such notifications relating to mothers normally resident in this County:— Premature Live Births. (a) In hospital 244 (b) At home 74 (c) In private nursing homes 11 Premature Still-births. (a) In hospital 36 (b) At home 8 (c) In private nursing homes Nil. In domiciliary cases midwives are required to seek immediate advice and any necessary assistance from the County Supervisor, and special portable heated cots and an infant oxygen tent are available for use in nursing premature infants bom at home. The health visitors pay particular attention to the care of premature infants when the responsi- bility of the midwife ceases at the end of the lying-in-period, and also maintain close liaison with maternity departments of hospitals and with maternity homes, in order to obtain information of the discharge of premature infants and of any special care needed. Detailed information of survival related to birth weights is now compiled for all premature live births, including those occuring in hospitals, and the following table also includes details of the weights of all premature stillbirths:— ! Weight at Birth. 1 31bs. 4ozs. or less. Over 3Ibs. 4ozs. 1 up to and 1 including j 41bs. 6ozs. Over 41bs. 6ozs. up to and including 4lbs. ISozs. 3ver 41bs. ISozs. up to and including Slbs. 8ozs. TOTAL. Premature live births. Bom in hospital.— Total 28 41 47 128 244 Died within 24hrs. of birth ... 11 5 3 2 21 Survived 28 days 12 35 42 122 211 Born at home and nursed en- tirely at home— Total 3 6 7 48 64 Died within 24hrs. of birth ... 2 1 3 Survived 28 days 1 6 6 48 61 Born at home and transferred to hospital before 28th day— Total 2 6 2 10 Died within 24hrs. of birth ... — Survived 28 days 1 6 2 9 Bora in Nursing Home and nursed entirely there— Total - — 4 7 11 Died within 24hrs. of birth ... — — Survived 28 days - - 3 7 10 Premature Stillbirths. Born in hospital 19 3 4 10 36 Born at home 6 — - 2 8 Bom in Nursing Home - - - - - Nurseries. (a) Day Nurseries. At the beginning of the year a revised scheme of charges for day nursery accommodation was instituted, whereby a standard weekly charge, related to the latest ascertained cost per place, is made irrespective of the parents’ income for a child who does not belong to one of the categories which have priority of admission. A child is regarded as a priority case where the circumstances of the family fall within any one or more of the following categories:— (a) Mother sole wage earner; e.g. widowed, unmarried, separated or divorced, father disabled; (b) Widower;; (c) Mother ill and no one available to look after children; (d) Unavoidable bad home conditions as certified by Area Medical OflBcer; (e) In interest of child’s health, where certified by Area Medical Officer; (f) Acute financial need (i.e. where the net family income at date of application for admission to day nurseries is less than £2 per week). Where a child belongs to one or more of these priority classes, the standard charge may be reduced, subject to a minimum of 10/- per week, according to the financial circumstances of the family. In March it was decided to close the Slough Baylis Court Day Nursery. The children remain- ing in attendance at the time was transferred to the other nursery in Slough, the Manor Park Day Nursery and the number of places at that nursery was reduced from 48 to 35. A few priority cases remained in attendance at Temple End Day Nursery, High Wycombe, but it became possible to make alternative arrangements for these children, following the introduction of a scheme for providing daily minders and the nursery was closed in October. The position at the two day nurseries remaining open at the end of 1953 was as follows:— No. on Average Nursery. Accommodation. Register. Attendance. Walton Cottage, Aylesbury 30 14 15 Manor Park, Slough 35 22 20 (b) Residential Nurseries Medical care of the two residential nurseries at Brookside, Slough (28 children) and Larchmoor, Stoke Poges (34 children) is, by arrangement with the Children’s Committee, also undertaken by the medical officers of this Etepartment. Arrangements are made for medical officers to examine all children on admission and at suit- able intervals aftenviards, to arrange vaccination and immunisation in suitable cases and to co-operate with the general practitioner appointed to treat sickness among children and staff. They also advise on general hygiene in nurseries, supervise diet and feeding, arrange for medical examination of staff, including periodic X-ray examinations, and furnish medical reports on children about to be boarded out or adopted. (c) Training. The two day nurseries and both the residential nurseries are recognised as Training Schools for the National Nursery Examination Board Certificate and the medical and nursing staff of the health department are utilised for teaching the appropriate sections of the syllabus. During the year six students completed training and successfully passed the examination. Ante-natal and post-natal care. The bulk of the ante-natal and post-natal work continues toi be undertaken at the speciahst ante-natal clinics under the control of the Hospital Management Committees, but the two remaining County Council ante-natal clinics for domiciliary cases at High Wycombe and Slough still serve a useful purpose. During the year 419 expectant mothers made a total of 1,258 attendances at these two Clinics, and in addition 15 post-natal examinations were carried out. The training of expectant mothers in small groups in mothercraft, relaxation and correct breathing technique in preparation for confinement has continued to be undertaken by many domi- ciliary midwives and health visitors. The popularity of the classes may be judged by the fact that by the end of the year the number being held regularly in different parts of the Count had increased from thirteen to twenty. Letters of appreciation from mothers who have benefited from the training are constantly received and an endeavour is being made to asses the value of the work in statistical form. Winterton House. This Rest Home for mothers with young children is gradually proving its value as a centre for education and rehabihtation, as well as providing convalescent care. During 1953 there were 88 mothers in residence for an average period of 18 days, and they were accompanied by 63 babies and 26 children over one year of age. Of these 88 mothers, 28 were referred for admission from hospitals, 17 by general practitioners, 41 by health visitors and midwives, and two by Health Departments of other counties. A total of 12 mothers was sent from neighbouring counties, because this is the only home in the area where a mother can receive convalescent care accompanied by her young children. Reasons for admission can be summarised as follows;— Ante-natal care and rest 19 Post-natal rest and recuperation 26 Feeding difficulties with baby 10 Baby who had received B.C.G 2 Teaching and rehabilitation of mother 17 Convalescence after illness 5 Mild psychiatric disorders 9 Total ... 88 Of the 19 ante-natal mothers, eight would have required hospital treatment if this home had not been available; and of the mothers admitted for teaching and rehabilitation six came from “problem families”. Mothercraft trainmg is given by the Matron, who is a midwife and trained nursery nurse, and frequent visits are made to the Home by the County Health Education Organiser and other members of the staff of the Health Department, who hold discussions with the mothers and show, film strips on various aspects of child care and home management. The local midwife holds a weekly ante- natal class here for relaxation exercises and mothercraft talks for mothers booked for domiciliary confinement, which the ante-natal mothers in residence also attend. Care of Illegitimate Children. The agreement with the Oxford Diocesan Council for Moral Welfare for the care of illegiti- mate children, has been continued. All cases requiring help were referred to the appropriate area Diocesan Moral Welfare Worker, and financial assistance in approved cases, consisting of the ascertained cost of maintenance at selected institutions, less each girl’s contributions from insurance and other sources, for a period lof six weeks before and eight weeks after confinement was available on application to the County Medical Officer. In addition an annual grant is paid to the Diocesan Council towards the cost of case work undertaken by their Moral Welfare Workers. Close co-operation exists between Health Visitors and Moral Welfare Workers and the arrange- ments continue to work quite smoothly. Maintenance at suitable institutions was approved for 57 cases during 1953, 13 of whom were admitted to Putnam House, Aylesbury, the Maternity Home of the Mid-Bucks Association of the Oxford Diocesan Council for Moral Welfare. Report of the Senior Dental Officer. The number of Dental Officers employed in the County still remains much below establishment, and in consequence it has not been possible to increase the time allocated to the dental treatment of expectant and nursing mothers and children under five years of age. Table (h) of Section H of the report, which sets out the numbers treated during 1953, therefore shows no improvement on the previous year and does not call for further comment. INFANT DEATHS Part 1. 1953 Investigation. The total loss of infant life from stillbirth and infant death was 37.2 per 1,000 total births in 1953, which is the lowest figure yet recorded in the county. In 1943 this infant loss was 61.1 and 1948, 47.8 per 1,000 total births. The 1953 figure represents a stillbirth rate of 17.5 per 1,000 total births and an infant mortahty rate of 20.0 per 1,000 live births. The neo natal mortality rate (infants dying before the age of 4 weeks) was 12.4. During the year a detailed enquiry has been made into the circumstances of 105 stillbirths and 121 infant deaths occurring among the 6,052 births to residents of the county. The total number of stillbirths and infant deaths under the age of one year allocated to the county by the Registrar General was 106 and 119 respectively. The percentage of premature infants among the total births in the county was 6.2 and prematurity continued to figure largely among causes of death in early infancy. Prematurity was associated with 42.9% of stillbirths and 55.1% of neo-natal deaths, being nearly half of the peri- natal deaths. The main causes of stillbirth and neo-natal death are set out in Table 1 in percentage of total numbers under each heading. Table 1. Percentage distribution by cause: 1953. Cause. Stillbirths (105) Neo-natal Deaths (78) Total (183) Unknown or prematurity only 25% 17% 21.3% Congenital malformation 15% 15% 15.3% Hazards of birth 20% 35% 26.2% Maternal toxaemia and haemorrhage 30% 13% 23 0% Rhesus incompatability 6% 12% 8.2% Other maternal illness ... 4% 1% 2.7% Infection — 6% 2.7% Other causes — 1% 0.6% Of 43 deaths in infants between thet ages, of one month and 12 months, 19 or 44% were due to acute infection and 14 or 33% to congenital malformation. Only three or 7% were due to accidents. To summarise, out of 6,052 total births in 1953, 225 or 3.7% of infant lives were lost by stillbirth: or death before the age of one year. The comparative figure for 1952 was 4.2%. Part II. Review of Infant Deaths 1949-1953. Diuing the five years since 1949 the circumstances of stillbirths and infant deaths under the age of one year in the county have been investigated in an endeavour to ascertain the main causes of these deaths and find where it may be possible to obtain a further saving in this wastage of infant life. In this five year period there has been a reduction in the stillbirth rate from 19.1 to 17.5 per 1,000 total births and in the infant mortality rate from 22.5 to 20.0 per 1,000 live births. The saving of infant lives has occurred in the first month of life, as shown by the drop in the neonatal mortality rate from 15.6 to 12.4 per 1,000 live births. The death rate between one month and twelve months has remained fairly constant. Details of the above rates and of numbers of births and deaths over the five year period are set out in Table 2. Table 2. Statistics. 1949 1950 1951 1952 1953 Total births ... 6,476 6,086 6,007 6,095 6,052 Live births 6,352 5,968 5,895 5,989 5,946 Stillbirths 124 118 112 106 106 Infant deaths 143 148 145 150 119 Combined Stillbirth and Infant Mortality Rate 41.2 43.7 42.8 42.0 37.2 Infant Mortality Rate (1943; 36.2) 22.5 24.8 24.6 25.0 20.0 Stillbirth Rate (1943 : 24.9) 19.1 19.4 18.6 17.4 17.5 Neonatal Mortality Rate 15.6 17.4 18.2 17.5 12.4 1-12 Months Mortality Rate ... 6.9 7.4 6.4 7.5 7.6 Prematurity rate total births ... 5.3% 5.9% 5.1% 6.7% 6.2% Prematurity percentage neonatal deaths 58.0% 57.0% 59.0% 60.0% 55.0% Prematurity percentage still- births 52.5% 31.4% 40.4% 40.6% 42.9% 1. Stillbirths and Neonatal Deaths. (a) Causes of stillbirth and of infant death in the first four weeks after birth are considered together, since in the majority of cases the causal factors are similar, e.g. maternal toxaemia or birth injuries. In Table 3 these causes are set out as a percentage of the total deaths in each year. Table 3. Causes of stillbirth and neo-natal death. 1949 (224) 1950 (222) 1951 (215) 1952 (206) 1953 (183) Unknown or prematurity only 20.8% 16.2% 16.7% 25.7% 21.3% Congenital malformation 23.6% 12.6% 19.1% 17.5% 15.3% Hazards of birth (injury, as- phyxia, atelectasis) 26.4% 32.4% 22.3% 22.3% 26.2% Maternal toxaemia and haemor- rhage 15.7% 24.3% 24.7% 22.8% 23.0% Rhesus incompatability 5.1% 4.5% 7.9% 4.4% 8.2% Other maternal illness 3.7% 3.2% 2.3% 2.9% 2.7% Infection 2.5% 5.4% 5.1% 4.4% 2.7% Other causes 2.3% 1.4% 1.9% 0.0% 0.6% Although the total number of deaths and the death rates have declined, the only reduction under any specific cause is in deaths from congenital malformation, a reduction which is seen also in deaths from this cause in the one to twelve month age group. The most frequent causes of death are maternal complications of pregnancy, prematurity and other hazards of birth to the infant. (b) Parity of Mother. Approximately 40% of all stillbirths and neonatal deaths occur in first pregnancies. The incidence of stillbirth and neonatal death according to parity, for the years 1949 and 1953 are shown in Table 4. Table 4. Parity in stillbirths and neo-natal deaths. 1949 1953 1st pregnancy 2nd^—4th! pregnancy 5th or more pregnancies 40% 41% 51% 47% 9% 12% In 1953, 34% of mothers wiho lost a baby in the “ 2nd to 4th pregnancy ” group had a previous history of one or more pregnancies ending ip foetal or infant death; in the group “ fifth or more pregnancies ” this figure was 23%. . - These figures emphasise the need for adequate ante natal care, especially in primiparae and in those mothers with a history of previous foetal or early infant death. 2. Infant Deaths between One and Twelve Months. The infant death rate in this age group has not shown any reduction during the past five years (see Table 2), and remains at a little over seven per 1,000 live births. The main causes of death are set out below: Table 5. Deaths between one and twelve months. Cause. 1949 (37) 1950 (44) 1951 (38) 1952 (45) 1953 (43) Infections 46% 54% 63% 39% 44% Congenital Malformation 41% 34% 16% 33% 33% Accidents 5% 5% 8% 17% 7% Other Causes 8% 7% 13% 11% 16% Infection is the greatest single cause of death in this age group; these deaths are analysed in Table 6 for the years 1949 to 1953. Deaths from measles and whooping cough have been reduced to a low level (In 1943—six infants died from whooping cough and one from measles), but pneumonia and other respiratory diseases still present a problem requiring further efforts for pre- vention. Table 6. Deaths from infection one to twelve monlhs. Year Measles Whooping Cough Pneumonia & Bronchitis Gastro- Enteritis Other Infection Total 1949 1 1 7 4 4 17 1950 — 15 8 1 24 1951 _ 1 17 4 2 24 1952 1 — 13 — 4.. 18 1953 1 - 10 7 1 19 Accidental deaths, though a small group, are ones which should be preventable. During the five-year period under review, there were 17 deaths due to accidents to babies between the ages of one land twelve months. Of these 17, one was the result of burns and two were due to falls. The remaining 14 deaths were due to accidental suffocation, six from pillows or bedding and eight following vomiting and inhalation of stomach contents. Babies showing evidence of infection were excluded from the last dategory. 3. Coedusions. Although the number of stillbirths and infant deaths has decreased considerably in recent years, and these death rates in Bucks compare favourably with those for England and Wales, there! is still scope for improvement. Preventive measures, which could bring about further saving of infant lives, must be applied to the main causes of death. This review of stillbirths and infant deaths which have occured during the past five years reveals that 83% of the total deaths took place before or within four weeks of birth, and that 49.6%' of these were associated with premature birth. Hazards of birth and maternal complica- tions of pregnancy and delivery were directly responsible for 48% of stillbirths and neonatal deaths. This emphasises the need for adequate ante-natal care and skilled attention at the time of delivery and for the new born infant. Although there has been no reduction in the incidence of premature births during this five year period, the survival rate of new born infants show a significant improve- ment, which is gratifying for those undertaking their care. The death rate among older babies, between the ages of one and twelve months, has not shown any improvement Infections, particularly pneumonia and bronchitis, account for half the deaths in this age-group, and accidents in the home were responsible for 8.5%-. In both these fields, health education must be directed towards making the environment safer, by stressing the dangers of ex- posure to infection and other risks in the home. Although there has been some improvement spread over the past five years, stillbirths and deaths of infants under one year of age still represent almost 4% of the total (live and still) births, and efforts to improve this figure must not be allowed to relax. Section 23. MIDWIVES SERVICE. The number of mid wives who notified their intention to practise in the County during 1953 was 264. Of these, 120 were working in institutions and 144 were engaged in domiciliary work. The number of institutional deliveries during 1953 was 3,781 compared with 3,761 in 1952. Domiciliary Midwives employed by Local Health Authority. On the 31st December, 1953, the staffing position was as follows:— Two were engaged on full-time midwifery work. 107 undertook midwifery combined with nursing duties and 46 of these also worked as part- time health visitors. Domiciliary deliveries attended numbered 1,820 as compared with 1,834 in 1952. The follow- ing domiciliary visits were paid:— Ante-natal 22,278 Nursing visits 39,616 The nursing visits included 3,354 visits to 579 women confined in hospital but returned home before the fourteenth day of the puerperium. The following Central Midwives Board notifications were received from midwives during the year. These figures relate to the work of both institutional and domiciliary midwives. For the purpose of comparison the figures for the preceding year are also given:— 1952. 1953. Notice for sending for medical aid: Dom. Inst. Dom. Inst Mother 323 46 370 35 Infant 83 8 73 4 Stillbirths 28 67 18 69 Deaths of Mothers — 1 Deaths of Infants Artificial Feeding; 15 24 7 49 Partial 148 49 120 Complete 276 86 208 Premature Babies. 74 premature babies were delivered at home and of these survived over a period of 28 days. 10 were transferred to hospital. 70 Analgesia. All the midwives employed by the County Council were qualified to administer gas and air analgesia in accordance with the requirements of the Central Midwiives Board. An apparatus was available for use by every midwife and analgesia was administered during labour to 1,484 women (domiciliary confinements). Relaxation Classes. Facilities were available at 16 centres in the County for mothers to attend relaxation classes during pregnancy. In many districts the midwives gave individual instruction. Post-graduate work. A County post-graduate course was held during 1953 (see Section 25), during which several lectures were given on midwifery subjects. These were much appreciated by the staff. One midwife (attended a two weeks’ residential course for Midwife Teachers and four Mid wives attended a week’s course in relaxation exercises. Pupil Midwives. Arrangements were made for 33 Pupil Midwives to receive the requisite domiciliary experience during their Part II Training. This was mainly undertaken in conjunction with approved Part 11 schools within the County. SECTION 24. HEALTH VISITING. Over a considerable number of years, professional and public concern has been expressed over the shortage of health visitors and in 1953 the NuflBeld Provincial Hospitals Trust published a Report on a study of the Work of Public Health Nurses. Following this the Minister of Health, in October, appointed a Working Party to enquire into the proper field of work, recruitment and training of health visitors. Within this Department the number of health visitors employed still falls short of establish- ment but the staff position improved during the year. Three resignations were received (on account of marriage, disability due to accident and to take up appointment with another authority), and advertisement only replaced two, but four students completed their training course and joined the staff during the summer and autumn. The staff position on the 31st December, 1953. was as follows:— Superintendent Health Visitor 1 Deputy Superintendent Health Visitor ... 1 Area Superintendent Health Visitors ... 2 Health Education Organisers 2 Full-time Health Visitors ... 38 Part-time Health Visitors 1 Part-time District Nurse/Health Visitors ... 46 Tuberculosis Clinic Sisters 2 Student Health Visitors in training at approved training centres ... 6 Of the 46 District Nurse/Health Visitors, 26 hold the Health Visitor’s certificate. The Tuberculosis Clinic Sisters are engaged in techniaal nursing duties only. Staff Edocation. Eight health visitors attended post-certificate courses approved by the Ministries lof Health and Education. Such courses are invaluable not only for their study content, which helps to keep staff up-to-date in technical knowledge and medical science, but for the opportunity to mix with fellow workers from lall parts of England and Wales and to keep abreast of current professional thought and opinion. Full staff conferences have been held in Aylesbury from time to time and area conferences arranged more frequently to give health visitors the opportunity to report progress and changes in the scope of field work and to discuss domestic issues. Such conferences are stimulating and educative for both field workers and administrative members of the staff. The Care of Mothers and Young Children. (a) Home Visiting. It becomes increasingly apparent that the present health needs of the community are centred round emotional and social problems of the individual rather than questions of physical care. Home visiting therefore becomes of paramount importance in the health visiting service, with particular attention focussed on the mother of the family. She must be guided to develop an awareness of the changing emotional attitudes of her family as they grow up around her, and to make every endeavour to meet their needs. Frequency of visiting must depend on the health visitor’s assessment of the mother’s need for guidance, on her education, leisure, finan- cial status, self-confidence and maturity. Individual teaching on this plane requires skill and time, time to listen as well as time to explain. The major part of the health visitor’s work is carried out in the home and the value of this individual teaching cannot be overestimated. (b) Child Welfare Centres are complementary to home visiting and while remaining centres for special individual consultation and medical examination are expanding to include the group teaching to which modem mothers with young children respond. Both health visitors and medical officers take part in these teaching groups and a significant trend is the popularity and increasing demand for educational films, film-strips and other visual aids. Care of the Aged. Care of the aged remains a challenge and a matter of concern for health visitors who could well spend more time than is possible on the prevention of the mental and physical disabilities of old age. Handling old people and making the right contacts for them is very time consuming, though worthwhile. Since August the help of the geriatric almoner has been much appreciated and every effort is made to keep the home available for the return of those who require institutional care for a long or short period. Problem Families. Problem families demand a long-term policy of patience and teaching and a disproportionate amount of work and time in the hope that the rising generation will reap the benefit of slowly improving standards in the home and of family education. Regular case conferences, directed by the Area Medical Officers, endeavour to co-ordinate the efforts of 'all workers concerned with the varying problems presented and prevent the overlap- ping of work and home visits which can undermine family morale and responsibility. Tuberculosis Service. Health visitors incorporate home visiting to tuberculosis patients as part of the overall home visiting service and in these homes special attention is directed towards prevention of spread of infection, the attitude of mind of all members of the family and the particular care of susceptible age groups. A close co-operation with the chest consultant is essential to ensure that the family understands his instructions and to indicate to him any neighbourhood and family aspects which may be of value in assessing the patient’s needs. Equally close consultation is maintained with almoners and occupational therapists to prevent duplioation of visits and provide complementary moral support for the family. Research. A local enquiry into breast feeding, undertaken in collaboration with and on behalf of one of the maternity units of the Regional Hospital Board, was completed during the year. A full scale survey and tuberculin testing of all school children in Bletchley was carried out under the direction of the Chest Consultant. The National Tuberculosis Vaccine Clinical Trials and the Infant Morbidity Survey demanded sustained home visiting at intervals throughout the year. Co-operation. A happy relationship is well established between health visitors and all other social workers, both official and voluntary, who are/ serving the community, and general practitioners are becoming increasingly aware of the assistance that health visitors can offer to them and to the families in their charge and in consequence are making use of their services. Excellent liaison continues with almoners, nursing and medical staff of the Regional Hospital Boards. Arrangements have been made with two nurse training schools for a scheme to be put into effect in 1954 for senior public health nurses to take part in the teaching of student nurses and for demonstrations to student nurses of the domiciliary care of patients and of the preventive services of the Health Department. Practical training of student health visitors has been undertaken in association with London Training Centres. Health Visitors have attended school holiday camps organised by the Education Department and have offered a 24 hours’ service, much appreciated by their teacher colleagues. Publicity and International Visitors. Again during 1953 information and demonstration was sought regarding the health visiting service by journalists preparing material for articles on careers for women and for B.B.C. broad- casts. It was a pleasure to health visitors to assist in the study programmes of post-graduate students visiting this country from the Phillipines, Uganda, Iran, Thailand, Ceylon, Burma, India and Chile. Health Education. Activities in 1953 have been mainly directed towards consolidating the results of the past three years’ effort to stimulate interest in, and establish a foundation for a progressive health education programme. The following facts would appear to indicate that these aims have now been achieved. It can be fairly said that any measure of success is largely due to the Health Visitors in the field who have not only participated! in group talks (a total of 373) but have in many instances prepared talks in their leisure time and given valuable support to the mothers’ clubs. Future developments will primarily depend on their ability to sustain interest and their readiness to accept and adapt new teaching techniques to educate selected groups in healthy living. Experience in other fields has shown that it is easier to change the habits of individuals formed into groups than to change any one of them separately and, with this in mind, group talks and discussions have formed the major part of the health education programme. Over 700 discussions and demonstrations have been arranged this year and speakers have included senior members of the Health Department; Medical, Nursing and Almoner Hospital staff; Private Practitioners, Probation Officers, House- wifery experts. Marriage Guidance Counsellors, members of the Education Department and many others. An analysis of lecture titles shows that 50% relate to positive health as opposed to ill-health. Mothers’ Clubs. Four clubsi were inaugurated this year, making a total of 16. A Mothers’ Clubs Conference! was held in Aylesbury on June 27th and was an outsflanding success with over 300 mothers attending. The Conference was presided over by His Worship the Mayor of Aylesbury and the address was given by Mrs. McKellan-Wild, the retiring president of the Assocation of Inner Wheel Clubs. The study project for the year was “ Loyalty ” and the lecture title was “ Human Relationships and Loyalty.” Fathers’ Exhibition. This was held at the Pebble Lane Clinic. Aylesbury, on July 8th, and was well attended by mothers and fathers. The fathers made and exhibited a wide range of durable toys and a variety of home gadgets ranging from the necessary fireguard to the ingenious wool-winder. This exhibition ,wias organised by the Health Visitors and was in itself a demonstration of the interest shown in newer methods of Health Education. Teaching Groups. These continue to be established either within the framework of the child welfare centres or as an alternative session according to the needs of the area. Expectant Mothers’ Groups. The health education staff have inaugurated new groups through- out the County and details of classes conducted by the health visitors and domiciliary midwives are given elsewhere. Health Education in Schools. Two weekly classes have been undertaken throughout the year and a number of talks given to senior girls in other schools. Classes have also been commenced in Slough College of Further Education. Nursery Nurse Student Groups. The staff undertake responsibility for eight lectures weekly to those students who are qualifying for the examination of the Nursery Nurses Examination Board of the Royal Sanitary Institute. Lectures to Voluntary Organisations. These groups include Parent Teachers’ Associations, Women’s Institutes, Youth Clubs and many other voluntary organisations. In Service Training. A special course was arranged at Winterton House on “ Teaching Techniques ” with practical work carried out in schools with the co-operation of the Education Department. Fifteen health visitors attended the course and all but two passed the examination held at its conclusion. The Deputy Health Education Organiser attended a. Seminar and Summer School organised by the Central Council for Health Education which was h^:^. Englefield Green. Visual Aids. The department co-operated with Camera Talks, Ltd., and produced photogenic materials and scripts for three film strips. One is entitled “ The Work of the Health Visitor ” and the other two deal with aspects of “ Child Care ”. All three have had very good reviews and are now in wide circulation in other counties. One has been shown in America and to the World Health Organisation Group. They were made in the districts of High Wycombe, Long Crendon and Aylesbury. Flaimelgraphs and other teaching aids have been produced in the Department and a nucleus of teaching media is now in existence. This is intended to assist Health Visitors and Other speakers in the preparation of talks and will eventilaliy form part of a Visual Aid Library. A Bell & Howell sound film projector recently acquired is an extremely valuable addition. Statistics. The following statistics relate to work undertaken by health (a) Home visits. Expectant Mothers Children under one year of age Children between one and two years of age Children between two and five years of age Tuberculosis Care of the Aged Other Special Enquiries No. of children under five visited for first time No. of families or households visited for first time ... (b) Fixed Sessions. Ante-Natal Clinics Child Welfare Centres Diphtheria Immunisation Clinics Chest Clinics E.N.T. Clinics Group Teaching visitors during the year 1953:— First Total Visits. Visits. 3,042 3,898 6,216 33,644 15,955 28,393 3,537 1,533 1,074 23,736 22,047 39 2,601 121 1,008 21 840 SECTION 25. HOME NURSING. The total number of full-time domiciliary nursing staff employed at the 31st December, 1953, was 112. Five were employed wholly on nursing work (including one male nurse). 107 undertook combined nursing and midwifery work. 46 of these also worked as part time health visitors. In addition ten nurses undertook part-time duty. 16,646 new cases were attended during the year and the total number of nursing visits paid was 235,727. The following is a summary of these visits; Medical 168,190 Surgical 49,043 Infectious Diseases 3,851 Tuberculosis 7.402 Maternal Complications 2,300 Others 4,941 The care of old people continues to absorb a large part of the nurses’ time and 46% of the above visits were paid to patients over the age of 65. Good co-operation has been maintained with hospitals in the area but it is still felt that in some instances more use could be made of the district nursing service in place of treatment given in hospital out-patient departments. Training Courses. Five nurses were sent for an approved course of district training and one for Health Visitors’ Training. During the year arrangements were made for ten student district nurses from urban areas to be given three days’ experience of combined work in a rural area. Post-graduate Course. A post-graduate course was held during the year and a series of ten lectures was given by specialists on a variety of subjects relating to domiciliary nursing work in its widest aspect. The lectures were duplicated to enable all the staff to attend. The course was much appreciated and provided a valuable educational stimulus of which the staff took full advantage. SECTION 26. VACCINATION AND IMMUNISATION. Vaccination. Vaccination continues to be undertaken by medical practitioners, parents making the neces- sary appointments with their own family doctors, and it is not envisaged that it will be necessary for it to be done at child welfare centres except in the event of an epidemic of smallpox. The number of successful primary vaccinations during the year was 2,730, a decrease of 200 on the previous year, but this decrease was almost entirely in the adult group, following the intimation to doctors that records of vaccination or re-vaccination of persons proceeding abroad were no longer required. Details of vaccinations carried out during 1953, as submitted on the return to the Ministry of Health, were as follows: — Age- Under 1. 1. 2-4. 5.14. 15 or Over. Total. Number vaccinated ... 2,157 160 116 124 173 2,730 Number re-vaccinated , 2 6 32 133 599 772 Immunisation. The Council’s scheme for diphtheria immunisation continued in full operation during the year, and records were regularly received from medical practitioners in addition to immunisations carried out at Child Welfare Centres. Details of primary immimisations and re-immunisations, divided into the two six-monthly periods are given below; — Half-year ended 30.6.53 Half-year ended 31.12.53 Total Children under five years 2,235 2,244 4,479 Children five to fourteen years 90 231 321 Re-immunisations 2,175 4,028 6,203 Of the total of 4,800 primary immunisations, 3,970 received the combined immunisation against diphtheria and whooping cough and in addition 15 children were immunised against whooping cough only. The usual return of immunisation in relation to child population required by the Ministry of Health was amended this year to take into account the proportion of children of each age who have received a coiuse of immunisation as well as the age at which the coiuse was received. To achieve this a double classification of children who had completed a full course of immunisation at any time up to 31st December, 1953, was compiled by age at inoculation, as well as by age attained, to facilitate the calculation of the proportion of children who have been immunised during the last five years. This resulted as follows: — Age at 31.12.53 Under 1 1-4 5-9 10-14 Under 15 i.e., bom in year (1953) (1952-1949) (1948-1944) (1943-1939) Total. Last complete immunisation (primary or booster)— 1949-53 411 16,679 18,834 8,718 44,642 1948 or earlier — — 7,203 13,393 20,596 Estimated mid-year child population 5,980 24,320 58,900 89.200 SECTION 27.—AMBULANCE SERVICE. Radio Control was introduced into the ambulance service during the year, and became fully operative in June, 1953. All vehicles, ambulances and sitting-case cars, were equipped with transmitting and receiving sets and one central control was estabhshed in new headquarters situated in Buckingham Road, Aylesbury. The installation soon proved the advantages to be gained as a result of having vehicles under direct control at all times, and it is obvious from records kept of major diversions that there is a considerable material saving in man-hours and mileage. Vehicles were diverted on 1,113 occasions during the period 1st September to 31st December, as a result of which it is estimated that 7,924 miles were saved. Many of these diversions were made in response to emergency calls which were thus answered more promptly than could have been possible through normal methods. In addition to these major diversions, radio control enabled drivers to be instructed on numerous occasions to undertake additional journeys without returning to base. The mileage and drivers’ time saved as a result must have been very considerable, although it was not practicable to keep detailed records. With the advent of radio control the opportunity was taken to revise completely the central administration of the service. Premises in Aylesbury already belonging to the County Council were adapted to provide offices, control room and accommodation for the drivers and attendants. Early in the year steps were taken to co-ordinate the journeys undertaken by the Hospital Car Service with the whole-time vehicles of the Ambulance Service, by arranging for all requests for Hospital Car Service transport to be received first at the Ambulance Station instead of being sent direct to the local organisers. It was soon apparent that much overlapping was avoidable by com- bining journeys and using the larger whole-time sitting case vehicles, and by the end of the year the Hospital Car Service was practically absorbed into the Ambulance Service. The staffing of the main stations was reviewed and with the exception of High Wycombe, two Senior Drivers now undertake duties at each station formerly allocated to a Station Officer. A female clerk is also employed at each of the main stations. Plans were laid for new stations at Aylesbury and High Wycombe and it is hoped that a start will be made on the erection of these before the end of 1954. The provision of a new station at Slough was also approved in principle. During the year four new vehicles were purchased, two Bedford Light Transit Ambulances (Sitting-case cars) and two Morris Commercial Ambulances. The agreement with the Joint Committee of the Order of St. John and the British Red Cross Society was continued for a further year and volunteers from both bodies have again given con- siderable help during the year, both as drivers and attendants, mainly at week-ends and nights. The statistics which are given in Table (i) of Section H again show a considerable increase over those for the previous year. Details of the patients carried and mileage travelled each year since the inception of the National Health Service Act on the 5th July, 1948, are given below:— Year. Ambulances. Sitting Case Cars. Hospital Car Service. Total. Patients. Mileage. Patients. Mileage. Patients. Mileage. Patients. Mileage. 1948 10,195 184,686 8,582 202,560 18,777 387,246 1949 30,396 469,096 — — 33,941 597,832 64,337 1,066,928 1950 32,239 471,019 8,468 117,041 29,159 632,291 69,866 1,220,351 1951 39,656 485,508 18,489 228,879 30,452 607,019 88,.597 1,321,406 1952 47,988 530,373 26,952 301,405 28,685 547,189 103,625 1,378,967 1953 65,824 612,876 38,219 383,794 12,992 270,102 117,035 1,266,772 SECTION 28. PREVENTION OF ILLNESS—CARE AND AFTER-CARE Report of the County Chest Consultant. During the year 1953, fxuther progress was made in the control of tuberculosis as a serious public health problem. Deaths numbered 37, a decline from 58 in 1952 and from 148 in 1947. It is gratifying to record a fall in the number of deaths occurring in the southern part of the County where, for some years, there has been an excess compared with the remainder of the county. There were only two non-pulmonary deaths. The tuberculosis death rate per 1,000 population was .09, a figure which would hardly have been thought possible a few years ago. Notifications also showed a fall from 345 in 1952 to 310 in 1953, despite the activities of the mass-radiography units. It does appear that the peak of notifications has been passed and that the curve may be expected to fall although not to the same extent as the mortality curve. The notifica- tion regulations are adhered to much more closely than in times past. Some surgical cases, how- ever, still escape notification and thus remain unknown to the tuberculosis physicians. There is a heavy preponderance of men both in notifications and deaths. Owing to the high rate of notifications in the past few years, the decline in mortality and the disinclination of chest physicians to class their patients as recovered, the number on the register continues to increase and now stands at 2206. Treatment. There has been no change in the arrangements for the treatment of patients with tuberculosis. It continues at home, in the beds attached to general hospitals and at Peppard, Creaton and Harefield chest hospitals. A few patients have been sent to Switzerland under the scheme of the Ministry of Health. Although there is little or no delay in providing initial treat- ment, the arrangements for thoracic surgery are still not entirely satisfactory. Prevention. Every effort is made to examine the home contacts of cases of tuberculosis. On receiving a notification the Health Visitor visits the home where one of her duties is to arrange for the contacts to attend the clinic. There, all have an X-ray examination and adolescents and children have a tuberculin test. Those who are negative to the tests are offered B.C.G. vaccination which is very rarely refused. About four new contacts are examined each year for every new notification. In addition, a great number are re-examined at varying intervals, depending on the special circumstances of exposure to infection and other environmental influences. Vaccination has now been given for four years and so far no vaccinated person has developed tuberculosis. Copies of all death certiflcates containing mention of tuberculosis are sent to the offifce of the Chest Section and sometimes it is found that for one reason or another a person has died of tuberculosis who was not notified in life. Contacts of such persons are dealt with in the same way as ordinarily notified cases. During the year several epidemiological studies were made amongst school children. At Bletchley and the surrounding villages 1,978, or very nearly all the school children were tuberculin tested. The arrangements involved close co-operation between the departments of public health and education and they worked very smoothly. The children were aged 4 to 17 years and amongst them 486 or about 25 per cent, were foimd to give a positive tuberculin reaction. There was a rapid rise in positivity after the age of 15. There were extreme variations in the positivity in different villages. For instance, in Wavendon primary school 48 per cent, of the children reacted. Despite much X-raying, no source case was found and it seems likely that at some time in the last few years tuberculous milk was being distributed in the village. At Newton LongviUe on the other hand only 8 per cent, of the children were positive. Dr. W. T. Bermingham examined all these 486 positive children by X-ray, but found no other evidence of tuberculosis in them; he also examined a great number of the home contacts and apart from known cases found no source cases of infection. At Halton an open case of tuberculosis in a girl of twelve was found: it was thought that she had derived her infection from her uncle who was on the tuberculosis register in another part of the county. About the same time a boy from the same class at school came to light with a severe primary tuberculous lesion. At a later date a third chUd, a girl from the same class, was found to have a lesion requiring treatment. Meanwhile, the whole school and all grades of staff were examined by tuberculin test and Mass X-ray. Amongst the children the positivity rates were low except in the class from which came the original case. Class 2 of the Senior Group, as shown in the graph. Here 75 per cent, were positive in addition to the two children mentioned above who were away ill. It seems that close and repeated contact in class is more important than casual contact in corridors, lavatories, etc. The adult staff were all clear and there were only two other small radiological primary infections amongst the children. These were not sufficient to call for any treatment. At the request of the general practitioner a similar survey was undertaken at Quainton although no source case had arisen. Eighty-seven children aged 5-13 were tested and of these 20 were positive. No radiological abnormalities were found either amongst them or the staff, who were all X-rayed. Close enquiry of the parents of the positive children revealed how difficult epidemi- ological studies may be. Milk delivered by the same retailer may be derived from two or more sources while, in addition, a member of the family brings home odd bottles of milk either regularly or occasionally. Children were positive whose parents declared they had always drunk tuberculin tested milk and the members of whose households were radiologically clear. It seems, therefore. that although infection rates may be falling, yet even in village communities we are often not yet able to trace the source of infection. Similar surveys were performed in two private schools in the Wycombe area. Of 211 children tested, 62 were positive, but no active primary infection or source case was foimd radiologically. The employment of tuberculous patients presents a problem of peculiar difficulty. Part-time work is for the most part unobtainable except for nurses who, on their return to work, are usually given modified hours. Patients who are ready for full time work can nearly always find a job which suits them. Sometimes the chance of more money tempts a patient to work which is too hard and a relapse ensues. No case is known where a patient has returned to work and infected a fellow worker. Report of Chest Physician to the Windsor Group Hospital Management Committee. As forecast in my report of last year, the work at the Windsor Chest Clinic and the Slough Sub-Clinic has continued to be carried out under the strain of inadequate premises, while the new housing estates are going ahead and a heavy increase in the anti-tuberculosis pro^amme, both clinical and preventive, becomes more imminent. The North West Metropolitan Regional Hospital Board has acknowledged the need for enlarged facilities and a new chest clinic is to be built within the grounds of Upton Hospital in the very near future. This is being designed to meet the needs involved in modem techniques. It will have its own X-ray Department, including apparatus for both full-size and miniature radiography and will be capable of handling the large numbers of people who tend to come to “ open ” sessions for X-ray only, according to the system in practice at Windsor over the past 18 months. This is, of course, additional to the ordinary system of appointments, which will continue as heretofore. It will also be much easier to deal with the routine examination of contacts and B.C.G. inoculation of tuberculin non-reactors, which require a good deal of space in view of their large and increasing numbers. The tuberculosis picture in Slough seems at last to be improving. Provisional figures indicate that the death rate, which for the past two years has been double that for the rest of the Coimty, is this year not seriously in excess. Notifications also show a drop for the first time since a more intensive programme of case-finding has been in operation. The Mass X-ray Unit has paid another visit to Slough, with a reduced rate of case-detection, which is in itself a favourable index of tuberculosis control. Mass Radiography. During the year the Mass radiography units of the Regional Hospital Boards visited the County. The Oxford Regional Hospital Board units filmed 18,720 persons, bringing to light 30 new cases of tuberculosis, a rate of 1.6 per thousand. This is perhaps more than might be expected. In the Slough area 18,751 persons were filmed and of these 17 were found to have active tuberculosis. Mass Radiography. Unit. Number examined. New cases of active Tuberculosis found. Males. Females. Total. Males. Females. Total. Reading. Princes Risborough 792 879 1,671 4 2 6 Marlow 561 583 1,144 1 0 1 Quainton 131 167 298 — — — Northampton. Aylesbury 4,137 3,368 7,505 7 6 13 St. John’s Hospital 468 482 950 3 3 6 Marsworth 180 198 378 — — — Borstal Institution 13 205 218 — — — Halton 201 186 387 1 1 2 Westcott 680 249 929 — 1 1 Wolverton 3,377 1,863 5,240 1 — 1 North West Metropolitan. Slough 10,354 7,771 18,125 15 2 17 Pinewood Studios 507 119 626 — — — Totals 21,401 16,070 37,471 32 15 47 Notification and Mortality. Notifications of, and deaths from, tuberculosis during the twelve-year period 1942-53, together with death rates per thousand of the population, are given below: — Primary Notifications, Mortality. Year. Respiratory All forms (including Respiratory only. All forms (including respiratory). only. respiratory). No. Rate. No. Rate. 1942 165 236 112 0.30 138 0.37 1943 158 216 131 0.36 164 0.45 1944 183 248 119 0.33 144 0.40 1945 179 240 131 0.37 157 0.44 1946 176 245 114 0.32 132 0.37 1947 266 312 135 0.37 148 0.41 1948 318 376 114 0.31 126 0.34 1949 319 380 102 0.27 112 0.30 1950 314 383 62 0.16 70 0.18 1951 309 365 56 0.14 72 0.18 1952 292 345 50 0.13 58 0.15 1953 256 310 35 0.09 37 0.09 The following are the particulars of notifications and deaths during the year under review, set out in age groups:— ^ Primary Notifioatioiis. Age Grcraps. Respiratory. Non-Respiratory. Respiratory. Non-Respiratory. M. F. M. F. M. F. M. F. Under 1 1 - 1—5 2 1 1 — 5—15 13 11 6 7 — — - - 15—25 33 28 6 6 1 1 25—45 56 45 7 14 2 5 45—65 49 9 2 3 13 2 - - 65—75 5 3 1 9 — 1 75 and over — — 1 — 2 — — 1 Totals ... 158 98 24 30 27 8 1 1 Deaths. Halton County School. Graph showing percentage of Scholars in Individual Classes who gave a Tuberculin Positive Reaction. All children in the School were tested following the discovery of a Sputum Positive Case in Senior Class 2. Group Infants Juniors Seniors Class 1 2 3 4 1 2 3A 3B 4 1 2 3 100 90 80 ■ 70 60 50 40 30 20 10 0 BUCKINGHAMSHIRE. TUBERCULOSIS (ALL FORMS). Notification and Death Rates, 1942-1953. /\ / ^ / /' \ ' / ^ / / \ f \/ V \ \ \ \ \ \ \ \ \ \ \ \ — Notifications Deaths T 1943 1944 I I 1945 1946 —I r- 1947 1948 Year j I I j I 1949 1950 1951 1952 1953 RETURN RELATING TO THE WORK OF THE CHEST CLINICS during the year ended 31st December, 1953. RESPIRATORY. NON-RESPIRATORY. TOTAL. Adults Children Adults Children Adults Children . Grand Total M F M F M F A. (1) Register at beginning of year 955 724 142 91 85 99 1046 809 241 2096 (2) Transfers—in 51 37 4 1 1 1 52 38 5 95 (3) Transfers from child register 9 5 _ 7 2 16 7 23 (4) “ Lost sight of ” returned 2 1 — — — — 2 1 — 3 B. New / Minus 61 46 30 10 12 8 71 58 38 167 cases 1 added [ Plus 77 42 3 3 4 3 80 46 6 132 Totals A. & B 1155 855 179 112 104 111 1267 959 290 2516 C. Removals from Register (1) Recovered 35 35 11 11 6 9 46 41 20 107 (2) Pied 32 10 — 1 — — _33 10 — 43 (3) Transfers—out 51 42 1 4 5 2 ^ 47 3 105 (4) Child transferred to adult 14 9 — — 23 23 (5) Others 12 10 2 3 3 2 15 13 4 32 Totals of C 130 97 28 19 14 22 149 111 50 310 D. (1) Register at end of year 1025 758 151 93 90 89 1118 848 240 2206 (2) Number of positive sputums last six months 195 57 1 195 57 1 253 E. (a) Number of first exams. — — — — — — 891 866 663 2420 (b) New Contacts; (1) Tuberculous — . _ 3 5 9 17 (2) Non-Tuberculous — — — — — — 202 368 495 1065 (3) Not determined... — — — — i — — — — — — WELFARE SERVICES. As might be expected, the demand for care and after-care of disabled persons, other than those with Tuberculosis, increased and is likely to continue to increase for some years to come as those who deal with medical and social problems in this field obtain practical experience of the value of the service. During the course of the year, a Senior Medical Offioer was appointed to devote part of his time to the co-ordination of the work of care and aftercare. The Senior County Almoner retired at the end of July and it did not prove possible to replace her before the end of the year. This meant that the areas covered by the remaining County Almoners had to be extended with consequent increase in case work. Tuberculosis. Altogether 621 patients of whom 207 were new cases, received after-care. The number of new cases referred has tended to decrease each year since 1948, which is in keeping with the general trend of the morbidity rate for the County, but it is probable that the total of cases receiving after-care wiill continue to increase as a proportion of new cases become long-term, requiring advice and assistance over a number of years. The County Almoners continued to attend sessions at the Chest Clinics, where in co-operation with the Chest Physicians they interviewed cases and dealt with their social problems. Patients benefit more when case work can be started soon after the diagnosis has been confirmed, for at this time, when their problems are most acute, it is relatively easy to gain their confidence and essential to sustain their morale. Bringing the patient, the Physician and the Almoner together under one roof undoubtedly facilitates a team approach to problems. Only 15 patients occupied garden chalets, which may reflect a slight easing of the housing situation throughout the County. Other Illness. Care and after-care was required in 248 cases suffering from a wide range of disabilities, including epilepsy and cerebral palsy. Arrangements were made for 67 patients to go to convalescent homes through the Council’s recuperative holiday scheme. A total of 52 adult epileptics and 24 spastics were known to departments concerned with their welfare. Of these, 9 epileptics and 12 spastics received care and after-care, 20 and 12 were under voluntary or statutory supervision by the mental health section and 23 epileptics were in Colonies. In addition there were a number lof mentally defective epileptics in Mental Deficiency Hospitals under the Regional Hospital Boards. As cases are referred through a variety of channels, it is essential that as a preliminary to medico-social work there should be accurate medical assessment of the disabled person’s capabilities. In some cases all the required information was available, but in others it was necessary to make a fresh approach to the problem in co-operation with the general practitioner and hospital. There has been a willing response at all times to requests for information and specialist investigation. Close contact has been maintained with the local officers of the Ministry of Labour and the Youth Employment Service with a view to obtaining training and local employment for suitable cases and w’nere possible factory out wiork was arranged for home bound cases as a form of Occupational Therapy. Those who were found to suffer from physical disabilities combined with mental deficiency were placed in the care of the Mental Health Section. The presence of a disabled person in the home almost always gives rise to social problems for his family and thepatient’s natural anxiety about the future may well retard his recovery. Some of the most valuable work done by the Almoners and Occupational Therapists has been the assis- tance they have given towards the adjustment of the family to meet the altered circumstances and the improvement achieved in the patient’s general well-being by advice and realistic encouragement. Care Committees. The Care Committees met regularly during the year and considered appli- cations for financial help and other assistance to patients. In addition to the administration of funds provided by the County Council in connection with the Approved Scheme under Section 29 of the National Assistance Act 1948, the Committees were able to offer assistance to patients from voluntary funds derived from several charitable organisations. In this way it was possible to relieve temporary hardship and to provide small necessities in a number of cases which were outside the scope of assistance ordinarily available. Occupational Therapy. The total number of cases treated during the year was 330, which involved 6,374 home visits. Thirty-eight patients, who were previously employed, became fit enough to return to work at their former jobs or were re-employed at work modified to suit their capabilities. It is interesting to note that while the number of patients suffering from Tuberculosis who were referred for treatment declined, there was an increase in those referred with disabilities due to other diseases, notably the rheumatic group of diseases and hemiplegia. The Disabled Men’s Clubs started last year in Slough made good progress, membership in- creasing from 14 to 22. They continue to meet fortnightly with the exception of holiday periods and an occupational therapist attends each session. The craft instruction is much appreciated, as is demonsti’ated by the number of patients who took work home to continue between sessions and all derive considerable benefit from the cheerful atmosphere of the clubs. The Helping Hand Shop in High Wycombe also continued to be successful but in spite of considerable sales, it became obvious that an additional method of selling the increased volume of goods produced was necessary so that patients could afford materials for further treatment. Con- sequently it was decided to take a stall in the Aylesbury market as an experiment. The venture has proved to be very succesful and much of the credit for this belongs to the Women’s Voluntary Services, for the willing help which its members have given. It need hardly be added that the patients’ general health and morale has been improved by the knowledge that the goods which they produce in the course of treatment can be sold to the public. On 30th November, an exhibition and sale was held in the County Offices. Some £50 worth of goods werd sold. It is hoped that it will be possible for an exhibition of this kind to become an annual occurence. The distribution of factory outwork to patients who cannot leave their homes to go out to work but who are capable of undertaking industrial work is one of the most helpful forms of occupa- tional therapy. Many firms in the County have co-operated by providing this type of employment but there is still a need for more of it and further offers would be much appreciated. A total of 391 visits was paid to< the Old People’s Homes in the County. It was not always easy to create an interest in craft work previously unknown to the majorty of old people, some of whom have led inactive lives for a number of years. However, since group instruction has been started, the majority look forward to their weekly ‘ class ’ and some extremely well finished articles have been made. SECTION 29. DOMESTIC HELP SERVICE The Domestic Help Scheme has continued to function satisfactorily throughout the County with the co-operation of the Women’s Voluntary Services and other Voluntary Organisers. There is a full-time Organiser in Slough with a part-time assistant. The rest of the County has a Supervisor and three part-time paid Organisers. At the end of the year there were 282 part-time home helps employed by the County and one whole-time, as compared with 387 part-time and two whole-time at the end of 1952. The total number of cases served was 1,517 as compared with 1,322 the previous year. The maternity cases increased by 49 and the aged and chronic sick by 185, whilst there was a slight decrease in the number of acute sick and tuberculosis cases attended. Difficulty in recruiting home helps is increasing in the face of competition from the local labour market, as factories are employing part-time as well as whole-time female workers, and providing transport to and from villages. During the year an effort has been made in the rural areas to enrol home helps who can undertake more than one case, rather than recruit individually for each case as has been the tendency in the past. In view of this, whilst there was an increase in the number of cases served, the helps employed decreased by 106. There is close co-operation between the Organisers and the Hospital Almoners, General Practitioners, Health Visitors and District Nurses in the working of the Scheme. Conferences for home helps have been held during the year at Bletchley and High Wycombe. Attendance was limited as this was an experiment, but sixteen home helps attended each session, together with several organisers who were interested. There were two sessions in each area with lectures and demonstrations on health, hygiene and domestic matters. Those who attended much appreciated the opportunity afforded for discussing various aspects of their work. In common with all voluntary organisations today, the W.V.S. find it difficult to recruit personnel and in some instances W.V.S. part-time organisers have been replaced on their resigna- tion by other voluntary workers. Much is due to the untiring efforts of these volimtary and part- time helpers, whose work enables the Scheme to take its very useful place amongst the modem social services. The number of householders assisted during the year in the various districts in the County was as follows: — Area. Aylesbury Borough Aylesbury Rural Amersham Rural W. Beaconsfield Bourne End Bletchley Buckingham Chesham Eton Rural Gerrards Cross High Wycombe Marlow Newport Pagnell Olney Slough and District Stony Stratford Wing Winslow Wolverton Wycombe Rural Totals 1952 Acute Sick. Chronic Sick. Old Age. Tuber- culosis. Maternity* Total. 14 17 23 O 19 75 9 15 13 3 13 53 3 3 6 — 3 15 14 _ 2 — 7 23 2 3 5 2 10 22 35 25 44 2 23 129 7 9 22 — 9 47 36 41 49 4 27 157 1 6 — — 1 8 15 14 19 3 19 70 34 56 54 8 55 207 3 4 2 — 4 13 6 15 9 2 1 33 1 4 7 3 15 63 112 137 11 42 365 8 7 19 — 1 35 1 20 17 2 2 42 4 18 15 — 11 48 21 35 59 3 4 122 6 12 9 1 10 38 283 416 511 43 264 1,517 300 449 293 66 215 1,322 SECTION 51. MENTAL HEALTH SERVICE. Mental Health Section. (1) Administration. (a) Constitution and Meetings of Mental Health Sub-Committee. The Mental Health Sub-Committee of the County Health Committee, which is composed of members of the Council and persons with knowledge and interest in mental health who are coopted, continues to administer the Mental Health Services and meets four times a year. (b) Staff. The County Medical Officer is in charge of the general medical direction of the service with one of the Assistant County Medical Officers being given special responsibility for the administra- tion of the section. Thirteen medical officers employed in the Etepartment are available for duties throughout the County that may arise in connection with the service. Apart from the obvious advantages and economies in having a number of officers available throughout the County who may be called upon to undertake medical examinations of mental defectives, an important measure of continuity of care is possible as the majority of these officers are also approved for purposes of the Education Act for examination of educationally subnormal pupils. During the latter part of the period under review it was found necessary to appoint a further social worker who is centred on High Wycombe and available for work in the south of the County. The senior lay administrative officer in the section also carries out duties as a social worker and is assisted by another mental health social worker based on the central office. There are thus three petitioning officers under the Mental Deficiency Acts who also carry out duties in relation to the care and after-care of defectives and persons suffering from mental illness. The services of the Psychiatric Social Worker of St. John’s Hospital, Stone, have continued to be available for special cases and this co-operation by the Hospital, although only required occasion- ally, is most helpful. Nine officers, authorised to act under the Lunacy and Mental Treatment Acts, have provided a full service throughout the County. These officers are also welfare officers with duties under the National Assistance Act and, in the rural areas. Registrars of Births and Deaths. An officer on the central office staff is also available in case of emergency. The organization of the duly authorised officers has been reviewed and consideration has been given to the way in which the duties of the Council in respect of persons suffering from mental illness can best be carried out. It is necessary that an officer should be available throughout the twenty-four hours for an unpredictable number of cases and in view of the nature of the work it is not considered desirable to increase the area covered by each officer. The nature of the officers’ duties, however, permits other work to be carried out and it is considered desirable to continue the present arrangement of part-time authorised officers. Where appropriate the Duly Authorised Officers assist in the care and after-care of persons suffering from mental illness. The Council’s responsibility to provide training for defectives is met in a limited number of suitable cases by using the services of the Department’s five occupational therapists; by Occupation Centres at Slough and High Wycombe ancJ by the agency services of the Bucks Voluntary Associa- tion for Mental Welfare home tuition scheme. Twio supervisors and three assistants staff the two Occupation Centres and sixteen part- time teachers of the Voluntary Association carry out training of cases where there is no Centre. One of the assistant supervisors holds the approved Diploma for this work and the remaining staff have been recruited from persons having an interest in the training of defectives. (c) Co-ordination with Regional Hospital Boards and Hospital Management Committees. The Authority’s officers continue to supervise patients on licence from mental deficiency institutions and during the year have visited ninety-eight patients. Co-operation with the hospital in this way has been a valuable contribution in maintaining defectives in the commimity until they can be considered capable of maintaining themselves without the formal protection of institution detention order. Reports required by hospitals in connection with review of orders and holiday leave for their patients are furnished by the Authority’s social workers. (d) Duties Delegated to Voluntary Associations. The Bucks Voluntary Association for Mental Welfare has continued to provide a valuable organization of local visitors who are able to keep in touch with defectives in their homes. Of necessity, the Association’s work is Umited by the number of suitable voluntary workers who are willing to undertake this type of service but social problems frequently arise in the care of mental defectives within the community and where early information is received of these, or of their imminence, much important assistance is given to the social workers. The Association also undertakes the home tuition scheme for defectives unable to attend Occupation Centres. Voluntary efforts are closely co-ordinated with official action by the Authority as the Honorary Secretary is on the staff of the Council and members of the Association’s Executive Committee are co-opted to the Mental Health Sub-Committee. The Guardianship Society at Brighton continues to be responsible on behalf of the Authority for cases placed with guardians who are found and supervised by the Society. Holiday accommodation is also arranged for numerous defectives under supervision, guardianship and on licence in homes, under arrangements made by the Guardianship Society. (e) Training of Mental Health Workers. The size of the Authority does not permit ainy reserve of staff who could be seconded for training courses but lone of the staff of the Occupation Centre at Slough has recently returned after completion of the year’s training course. (2) Work Undertaken in the Community. (a) Prevention, Care and After-Care. The mental hospitals serving the area of this Authority provide psychiatric out-patient clinics for discharged patients and persons not previously admitted to hospital care and the social workers of the hospitals continue to keep in touch with patients on trial at home following a period of in- patient treatment. The development of the Local Health Authority’s powers in relation to the care and after-care of persons suffering from mental illness has been small due m an appreciable degee to the lack of trained psychiatric social workers and the need to preserve continuity between treat- ment and social care. During the year eleven persons were visited as “ after-care ” cases—six being referred as ex-service cases, two by mental hospitals and three from information received from other sources. None of these cases was under active supervision at the end of the year. Twelve persons suffering from mental illness who are in touch with psychiatric out-patient clinics are receiving visits from occupational therapists. In the field of prevention of mental illness a considerable number of cases come to the notice of the social workers and duly authorised officers in respect of which little positive action may be possible or necessary but the availability of the officers to assist with information and advice is of definite service. The services of the health visitor in this respect and of health education which is referred to in another section of the Report, are also of value. The Council’s scheme under Sections 28 and 51 of the Act was amended last year to empower the Authority to assist financially in the provision of short term care for defectives in cases of urgency and eight defectives received care in hospitals (without charge to the Authority) or parents were given financial assistance from the Council to enable them to go to a private home for a period not exceeding twio months. This service enables relatives of defectives to be assisted over limited periods when they would be unable to look after the defectives at home such as during confinement of mother or her illness. (b) The Lunacy and Mental Treatment Acts, 1890-1930. During the period under review the duly authorised officers dealt with the admission to hospital of 121 patients admitted on Summary Reception Orders, eleven as Temporary Patients and six under Section 20 of the Lunacy Act, 1890. In addition assistance was given to many of the 150 voluntary patients admitted. A survey of the patients admitted to mental hospitals under Summary Reception Orders during the year ending 31st March, 1953, showed the following age groupings:— Under 65 yrs. 65-69 yrs. 70-74 yrs. 75-79 yrs. 80 yrs. and over. Men 47 5 5 5 6 Women 51 9 7 11 10 As has been reported elsewhere the acute shortage of mental hospital beds would not exist if all senile patients and all defectives not requiring actual psychiatraic care could be discharged to more appropriate accommodation. (c) Mental Deficiency Acts 1913—1938. (i) Ascertainment and statistics. The main source of referral is by notification under the Education Act, 1944 but an increasing number of cases is being notified by the National Assistance Board under the Scheme for the Welfare of Handicapped Persons. A number of defectives of whom no previous record is held come to the notice of the Authority after getting into social difficulties and appearmg before the Courts When the Police request, medical evidence is given to the Courts in ord^ that persons who require care on account of mental deficiency rather than punishment for crime should be dealt with appropriately. The following table gives particulars of cases ascertained during 1953 as defectives who were subject to be dealt with under the Mental Deficiency Acts. Under age 16 Aged 16 and over Total M F M F Action taken on reports by:— (i) Local Education Authority on Children (1) While at school or liable to attend school 19 14 — — 33 (2) On leaving special schools ... — 5 1 1 7 (3) On leaving ordinary schools ... 10 1 — — 11 (ii) Police or by Courts — — 4 — 4 (iii) Other sources 5 7 11 22 45 Total ... 34 27 16 23 100 The total number of cases on the Authority’s registers on 31st December, 1953 was: — Under age 16 Aged 16 and over Total M F M F (i) Under statutory supervision 98 49 157 132 436 (ii) Under guardianship 1 — 17 11 29 (iii) In “ place of safety ” — — — 2 2 (iv) In institutions including those on licence 40 21 266 292 619 (v) Under voluntary supervision 1 1 91 90 183 Total ... 140 71 531 527 1269 Cases living in the community for whom institutional care is awaited as at 31st December, were:— i North West Metropolitan Regional Hospital Board Oxford Regional Hospital Board Under age 16 Aged 16 and over Under age 16 Aged 16 and over M 1 ] F M F M F M F (1) In urgent need of institutional care:— (i) “cot and chair” cases ... 2 5 2 (ii) ambulant low grade cases. — — — — 7 — 2 (iii) medium grade cases 1 1 3 — 2 2 — (iv) high grade cases 4 • — — 2 — — (2) Not in urgent need of insti- tutional care:— (i) “cot and chair” cases ... 3 6 2 2 (ii) ambulant low grade cases. — — — 2 2 — 2 (iii) medium grade cases 2 — — — 14 2 12 6 (iv) high grade cases 1 1 — 2 — 1 2 10 2 4 — 37 12 17 14 Total ... .6 80 (ii) Guardianship and Supervision. Twenty-nine cases remained under guardianship at the end of the year. This form of care provides a sort of protection within the community which can be extremely useful for stable defectives either as an aid to relatives or in cases where there is no other home care available. There is unfortunately considerable difficulty in obtaining suitable homes and persons willing to act as guardian and this shortage will become increasingly felt in future as the age of the existing guardians is in the majority of cases over 60 years and in some cases over 70 years. Defectives whose parent acts as guardian 12 Where another relative acts Placed under guardianship of an officer of the authority Under supervision of Guardianship Society, Brighton . Where guardian is not related 29 Three guardianship orders have been made by order of the Courts. ~ The local visitors of the Bucks Voluntary Association for Mental Welfare have continued to assist with the supervision of defectives in their homes and the Association has undertaken for defectives the functions of the Care Committees in other spheres, making grants from voluntarj' funds to necessitous cases. (3) Training. Occupation Centres continue to provide training for defectives from the Slough and High Wycombe areas. The Centre at Slough has now been transferred to premises occupied by the former day nursery and with minor structural alterations they provide good facilities. Twenty-nine defectives have been on! the register during the year. With the increased number of children attending and alteration in location of the Centre it is no longer possible to provide transport for all children attending, but the existing transport facilities have continued to be used, and priority is given to physically handicapped defectives and those unable to reach the Centre by pubhc transport. In High Wycombe, the Centre which opened during the last few weeks of 1952 has continued to make good progress and the work that had been done at this Centre during the year was favourably commented upon in the report of the Inspector of the Board of Control who visited in November. Fifteen children are now on the register of this Centre. The home tuition scheme organized by the Bucks Voluntary Association for Mental Welfare on behalf of the .Authority continues to provide group training centres at Chesham, Aylesbury, and Buckingham and in November a further group was commenced at Wolverton. Twenty-three children attend these groups and where defectives cannot do so efforts are made to provide a home teacher. Sixteen cases are visited at their homes by the home teachers and fourteen by occupational therapists. SECTION C. NATIONAL ASSISTANCE ACT, 1948. PROVISION OF RESIDENTIAL AN D TEMPORARY ACCOMMODATION. SECTION 21. REPORT OF THE COUNTY ASSISTANCE OFFICER, “ The general position during the year regarding the provision of residential accommodation for persons needing ‘ care and attention ’ has not varied to any appreciable extent; the Council have steadily increased their accommodation, but the demand always exceeded the supply. During the year the Council, in conjunction with the Oxford Regional Hospital Board appointed a Geriatrician and a Geriatric Almoner; the services of these officers has resulted in a more advantageous use of the available beds in hospitals and hostels. The fact remains, however, that during the period under review there were insufficient beds of all types available. Admissions to the Council’s accommodation was made in order of merit and not by the length of time on the waiting list. The services of the Council’s Physiotherapist proved very beneficial to the old people and the medical officers of the several hostels made full and continuous demands for her services. The following shows the number of persons resident in Part III accommodation at 31st December, 1953, and in brackets, the numbers at 31st December, 1952:— Males Females. Total. ‘ Serviced ’ accommodation 112 (108) 67 (65) 179 (173) Hostels (self-contained) 39 (29) 83 (72) 122 (101) Hostels (self-contained) (Bucks Old People’s Welfare Committee, W.V.S. and the Council) 37 (39) 51 (44) 88 (83) Katherine Knapp Home (Blind Persons 7 (6) 11 (13) 18 (19) In various voluntary or other local authorities 29 (27) 47 (35) 76 (62) 224 (209) 259 (229) 483 (438) Temporary Accommodation Some difficulty wias experienced with homeless families, including those evicted under Court Orders. The arrangements made by the Council with Housing Authorities in the more populous areas have gone a long way in meeting this problem, but generally speaking, no satisfactory solution has been found to cover the needs of the problem as a whole. The Council’s accommodation for two families has been continuously occupied, but not by the same persons. At the 31st December, 1953, the two families consisted of two males, two females and eight children. Voluntary Organisations. The County Assistance Officer continues to act as Honorary Secretary to the Bucks Old People’s Welfare Committee and to the two hostels administered jointly by them and the County Council; these arrangements continue to work satisfactorily and have resulted in a large voluntary effort being co-ordinated with the Council’s work for the betterment of old people. The ‘ meals on wheels ’ service, operated by the Women’s Voluntary Services on behalf of the Council, continued to provide hot meals to old persons; during the year, the number of hot meals supplied was approximately 12,000. General Remarks. It is becoming apparent that the family unit is not as strong as it used to be; on the whole, in my opinion, children are not exerting themselves to look after their parents to the same extent they did a few years ago. As to the future, the population are living longer and in consequence, residential accommodation of all types for old pople of all classes, houses, hospitals and hostels should be increased to keep pace with the demand. ” SECTIONS 29 and 30. WELFARE SERVICES. A. WELFARE OF THE BLIND. Registration. The number of registered blind persons at 31st December 1953 was 593, as compared with 580 on 31st December, 1952. Of the 593 cases registered, 320 were females and 273 were males. During the year under review 69 new cases were registered and there were 19 inward transfers. Removals from the register for various reasons, e.g. death, left county, etc., totalled 75. Blind Population. The ages of the blind population in the County at 31st December, 1953, are shown in the following table which is in accordance with the revised age distribution now required by the Ministry of Health. The figures in brackets relate to the previous year and are quoted for reference:— 0 1 2 3 4 5-10 11—15 16 -20 21-30 31-39 40-49 50—59 60-64 65—69. 70 and over. Age N.K. Total. (1) 1 (1) 1 (2) 3 (1) 1 (3) 11 (6) 5 (7) 8 (10) 18 (17) 36 (34) 46 (46) 57 (59) 49 (49) 83 (76) 27 4 (268) (-) 593 (580) Register of Partially Sighted Cases. The County Council’s Scheme approved by the Minister of Health provides that a register shall be kept of partially sighted cases, i.e. persons who are substantially and permanently handicapped by congenitally defective vision or in whose case illness or injury has caused defective vision of a substantial and permanently handicapping character. The number of partially sighted cases on the register at 31st Etecember, 1953, was 130 (71 females, 59 males), the age classification, in the form required by the Ministry, being as follows;— 0—1 2— 4 5—15 16—20 21—49 50—64 65 and over Total — 1 22 6 26 21 54 130 The number on the register at 31st December, 1952, was 101 (52 females, 49, males). Observation Register. There were 124 cases under observation with a view to maintaining contact in the event of subsequent certification as blind or partially sighted. During the year under review two of these cases were! certified as partially sighted and seven as blind, two transferred out and four died. Incidence of Blindness and Partial Sight. The following table gives particulars of the 69 blind and 30 partially sighted (P/S) cases, certified on form B.D. 8 in the County during 1953. The Table is in the form suggested by the Ministry of Health. TABLE A. Cause of Disability Cataract Glaucoma Retrolental Fibroplasia Others Blind P/S Blind P/S Blind P/S Blind P/S (i) Number of cases registered during the year 29 12 10 1 1 29 17 (ii) Number of cases where treat- ment was recommended ... 10 3 2 — 10 8 (lii) Number of cases at (ii) above which on follow up received treatment 2 1 2 — — — 5 4 Of the 29 cases of cataract registered as blind, 24 were over 70 years of age, and of the 10 registered cases of glaucoma, five were over 70. In the case of the partially sighted; seven of the 12 cataract cases and the one case of glaucoma were over 70 years of age. The reports on the follow up visits indicate that the refusals for treatment for cataract were mainly on account of age, three of the registered blind cases being over 80. Of the three cataract cases registered as partially sighted, two are still under treatment. The case refusing treatment was over 80 years of age. The history of the one case of retrolental fibroplasia revealed that it was a premature baby weighing 31bs. 3ozs. at birth. The case is being regularly followed up and it is hoped to obtain its admission into an appropriate school in due course. The last case of retrolental fibroplasia was registered in 1951. There is close co-operation with the hospital and home teaching services in connection with blind and partially sighted cases. In those instances where notification is received from the hospital, arrangements are made for thq follow up of cases which have failed to keep appointments. Opthalmia Neonatorum. The following table is included at the request of the Ministry of Health. Both the cases notified made a good recovery. There were five ophthalmia neonatorum cases notified in 1952. TABLE B. (i) Total number of cases notified during the year 2 (ii) Number of cases in which: (a) Vision lost - (b) Vision impaired — (c) Treatment continuing at end of year — Employment. (i) Homeworkers. The Royal London Society for the Blind (formerly known as The Royal London Society for Teaching and Training the Blind) operate the Homeworkers’ Scheme in the County and at 31st December, 1953, there were 15 blind persons m Class A and three in Class B. The scheme has functioned quite well during the year. The following table shows the numbers and the occupations of the homeworkers in the respective classes:— Class A Basket Workers Machine Knitters Music Teacher Piano Tuners Class B. 6 Basketry and Seating 1 4 Machine Knitters 1 1 Piano Tuners 1 4 There was also one blind physiotherapist included by arrangement in the scheme operated by the Royal National Institute for the Blind. (ii) Workshop Employees. There has been no addition during the year unde review to the one female blind machine knitter from this County in the London Workshops operated by tho Royal London Society for the Blind. (iii) Other Employment. The Placement Service! of the National Institute for the Blind has been utilised in those instances where rehabilitation and/or training was considered necessary. Unfortimately there have been very few vacancies arising in the employment field which were con- sidered suitable for blind persons and it has proved diflicult to obtain placement in two or three instances. At the end of December 1953, there were 78 blind persons usefully employed and seven were in training. The following table gives details of employment of blind persons:— Agricultural Worker 1 Legal Profession 1 Basket Worker 1 Massage and Physiotherapy 2 Upholsterers 2 Mat Makers 3 Boot Repairers 1 Office Executive 1 Carpenters and Woodworkers 1 Piano Tuners 2 Clerks and Typists 6 Porters, packers and cleaners 4 Craft Instructors 2 Poultry Keepers 2 Dealers and Shopkeepers ... 6 School Teachers 1 Domestic Workers 1 Telephone Operators 7 Factory Operatives ... 23 Open Employment other than Firewood Workers 1 already catalogued 6 Gardeners 2 Miscellaneous 2 Home Teaching Service. The following is a summary of work carried out through the home teaching service during the period 1st January to 31st December, 1953. Total Number of Visits paid ... ... 6,261 Total Number of Lessons given:- Braille .. 169 Stringbag 30 Moon ... 82 Typewriting 3 Rug Making 1 Handwriting 5 Leatherwork 3 Stool Seating 5 Cane and Basket Work ... 37 Knitting 2 Social Centres. There has not been any addition dujring the year to the number of centres already established in the County. Great interest in the various activities is being shown by the blind persons, helpers and friends attending the respective centres. The following are particulars of the centres operating in the County:— Place. Type. Centre Days. Average Attendance, Aylesbury. Social. Alternate Tuesdays 30 Chesham. Social. Alternate Mondays 80 Wolverton. Social. Alternate Tuesdays 45 Wycombe. Social. 1st and 3rd Tuesdays 20 Slough. Social. 3rd Tuesdays 35 General Social Welfare. The respective Divisional Committees, in conjunction with the County Executive Committee of the Bucks Association for the Blind have maintained their activities in connection with the general social welfare for blind persons in the County. Outings and social gatherings have been arranged and there continues to be a good demand for handicraft materials which are supplied at cost price. Blind aids of many types have also been provided free or at reduced charges by the Association. Katharine Knapp Home for the Blind. During the year under review the accommodation has been well utilised. At the 31st December, there were 18 permanent residents and 1 holiday case in the Home. One resident was in hospital. Twenty-four blind persons from various parts of the County spent holiday periods in the Home during 195T During the year the residents have continued to receive visits from local organizations who have provided varied programmes of entertainment. For the annual outing the residents, staff and friends paid a visit to Whipsnade Zoo. The Management Committee have approved a proposal to make adjustments at the Home which would provide accommodation on the ground floor for three additional female patients. The work is well in hand and the expenditure in connection with the necessary structural alterations is being defrayed by the Bucks Association for the Blind. B DEAF AND DUMB. Welfare Services for the Deaf and Dumb are provided by the County Council through the agency of the Oxford Diocesan Council for the Deaf and Dumb. A whole-time Missioner and Welfare Officer is employed by the Diocesan Council for wiork mainly in this County. The number of cases on the register at the 31st December, 1953, together with corresponding figures for the previous year are shown in the following Table:— Deaf and Dumb. Number of Cases on Register at 31st December. Under 5 5- -15 Over 15 Total Year hi F M F M F M F Grand Total 1953 — 23 14 86 78 109 92 201 1952 1 3 24 12 83 81 108 96 204 From the reports received from the Missioner it is evident that the social clubs operating in the County are providing a useful medium for assisting the deaf and dumb. The following is an indication' of the scope of activities at the various centres:— Slough. Meetings are held weekly on Wednesdays and Saturdays. Coach outings to deaf centres in other Counties and return visits are arranged. In addition to the many activities of a social nature, the religious side is catered for by holding special services every month. High Wycombe. The club is held monthly and the activities include outings iit conjunction with the Slough Club. Visits to film shows and periodical parties are also arranged. On the religious side monthly evening services are held. Aylesbury. The club is held monthly and activities include visits to film shows, coach Outings, parties, etc. Religious services are held monthly. Every encouragement is given to the deaf and dumb to take part in all activities both in the social and rehgious fields and the response appears to fce most encouraging. Consideration is being given to the possibility of providing social activities for deaf and dumb persons in the north of the County. The following table gives an indication of the services carried out during the year by the Mis- ioner and Welfare Officer on behalf of deaf and dumb cases in the County. No. of Religious services conducted 61 No. of socials attended 66 No. of visits to Hospital cases ... 34 No. of visits to Mental Hospital cases 10 No. of Home Visits paid 321 No. of visits to deaf/ blind 2 Interpretations at doctors’ consulta- tions 4 No. of personal interviews ... 80 Visits paid in connection with employ- ment 37 Employment obtained for 3 Men 4 Women No. of attendances at Meetings ... 24 Miscellaneous visits 63 SECTION D. SANITARY CIRCUMSTANCES OF THE AREA. (1) Water Supply. The Water Undertakers in the County fall into three classes, (1) The Bucks Water Board, (2) Local Authorities, (3) Water Companies. Over half the County area is now supplied by the Bucks Water Board which has five consti- tuent authorities—the Bucks County Council and the Rural District Councils of Aylesbury, Buckingham, Wing and Winslowi. The Board’s area of supply also includes the Borough of Aylesbury, the Urban District of Tring and small parts of the Rural Districts of Amersham, Berkhamsted and Wycombe. The statutory area of the Board covers 405 square miles with a population of approximately 96,000. The Engineer of the Bucks Water Board has kindly supplied the following iffiormatiOn:— “ The Board’s main sources of supply are situated at Wendover, New Ground, Hawridge and Battlesden. The Wendover source lies between Wendover and Great Missenden, New Ground between Tring and Berkhamsted, while Hawridge lies just north of Chesham. These are all chalk sources and at Wendover no treatment beyond simple aeration and routine chlorination is required. The Battlesden source, which lies in Bedfordshire, supplies water from greensand bore- holes; here aeration, sedimentation and rapid gravity filtration is the order of treatment. In addition to the above the Board also operates several sources which formerly belonged to the Rural Districts Water Company—the chief of these is that at Hampden Bottom. A new bore- hole was sunk here during the year and early in 1954 a new main wiill be laid to convey an increased quantity of water from this site. The newest of the Board’s sources is that at Foxcote, near Buckingham, where water is abstracted from the River Great Ouse and which came into operation during the year. From the 1st October, 1953 regular supplies were commenced to the Wolverton and Newport Pagnell Urban Districts and to the Rural District of Brackley. With effect from 1st January, 1954, a regular supply is being made available to the Towcester Rural District. The Foxcote works include a fully equipped laboratory and the Board has now commenced to collect and analyse their own samples of water throughout their district. This represents a very important stage in the rapid growth and development of the Board. During the year regular samples of water have been taken both from consumers’ taps and from various sources. Thd results of these samples indicate that the water supplied by the Board conforms to the high standard of that required from any public supply authority.” In view of the predominance of the Bucks Water Board in Mid and North Bucks only a few Local Authorities in the North have their own W ater Undertaking, while in the South of the County Water Companies predominate. The Local Authorities in the County are served by the Water Undertakers shown below:— Local Authority. Boroughs. Aylesbury Buckingham Slough Wycombe ... Water Undertakers. The Bucks Water Board. Buckingham Borough Council. Slough Borough Council. The Burnham Water Company. The Slough Estates, Ltd. Wycombe Borough Council. Urban Districts. Beaconsfield Bletchley Chesham Eton Linslade Marlow Newport Pagnell Wolverton Rickmansworth and Uxbridge Valley Water Company. The Marlow Water Company. Bletchley Urban District Council. Chesham Urban District Council. Rickmansworth and Uxbridge Valley Water Company. Borough of New Windsor. Linslade Urban District Council. The Marlow Water Company. Newport Pagnell Urban District Council. Wolverton Urban District Council. Rural Districts. Amersham Aylesbuiy ... . Buckingham Eton Newport Pagnell Wing Winslow Wycombe ... ... The Bucks Water Board. Rickmansworth and Uxbridge Valley Water Company. The Bucks Water Board. The Bucks Water Board. Rickmansworth and Uxbridge Valley Water Company. Slough Borough Council. The Burnham Water Company. The South-West Suburban Water Company. Newport Pagnell Rural District Council. Stoke Goldington Water Company. The Bucks Water Board. The Bucks Water Board. Wycombe Rural District Council. Wycombe Borough Council. Rickmansworth and Uxbridge Valley Water Companv. The Bucks Water Board. The Marlow Water Company. A total of 24 schemes of Water Supply submitted by Rural Disrict Councils received County Council approval for the purposes of the Rural Water Supplies and Sewerage Act, 1944 and at 31st December, 1953 had reached the stage shown below:— SCHEMES OF WATER SUPPLY. PROGRESS REPORT TO 31st DECEMBER. 1953. Percentage of Local Authority. Parish Total Est. Cost. Scheme completed. Amersham R.D.C Ashley Green £ Chartridge Cholesbury 1,667 100% Coleshill (Amended) 100 100% Chalfont St. Giles 570 100% Latimer 460 100% Gt. and Lt. Missenden 2,785 100% Penn ... - 370 100% Aylesbury R.D.C Oakley 1,300 — Wellwick 650 100% Birchmoor Joint Committee ... Woburn Sands 72,250 70% Buckingham R.D.C Buffler’s Holt 650 100% East Claydon Middle Claydon 1 1,902 100% Eton R.D.C ... Burnham (Littleworth Common) 439 100% Dorney (Boveney) .... 1,760 100% Dorney (Lake End) 198 100% Taplow .... 10,066 100% Wraysbury (Nursery Lane) ... 360 100% Newport Pagnell R.D.C Cold Brayfield 2,400 — East End, North Crawley 3,000 — Great Linford 6,700 33% Loughton 2,200 — Moulsoe Link Main 4,000 100% Olney ) d , , Olney Park 1 Warrington i ^ 3,239 3,200 100% 100% Regional Water Supply Scheme 129,700 _ TOTAL ... £249,966 (ii) Sewerage and Drainage. The Rural Water Supplies and Sewerage Act, 1944, enables the Ministry of Housing and Local Government and the County Council to make financial contributions towards schemes of water supply, sewerage and sewage disposal in rural localities. The Act requires Local Authorities to consult the County Council before submitting schemes to the Minister and to report to the Minister the observations, if any, of the County Council. This arrangement enables the County Council to express their views on the scope of schemes in their area and to encourage and assist local auth- orities in considering and determining the scope of comprehensive schemes when circumstances indicate that such schemes are preferable to a more local solution. The Rural District Councils have made a good response to the facilities provided by the Act and in many cases have employed consulting engineers for the preparation of suitable schemes. The following list shows the schemes submitted to the County Council since the Act came into operation and which have received conditional approval for the purposes of Section 2(2) of the Rural Water Supplies and Sewerage Act, 1944. List of Schemes submitted under the Act to 31st December, 1953. (1) (2) (3) (4) Population Total for Local Authority. Parish. provided each for. Authority. Aspley Guise Joint Committee .. Wavendon . • . ' . • 600 Wobum Sands 1,600 2,200 Aylesbury R.D.C Dinton 485 Hardwick and Weedon ... 682 Kingswood and Grendon Underwood ... 400 Long Crendon 1,400 Ludgershall 300 Oakley 450 Oving ... 345 Quainton 1,200 Stoke Mandeville 815 Stone 630 Upper Winchendon ... ... 160 Worminghall and Ickford 800 7,667 Buckingham R.D.C Adstock 300 Akeley ... 350 Charndon 700 Marsh Gibbon 600 Padbury 500 Thornborough 550 Tingewick 800 Tw^ord 450 4,250 Eton R.D.C . Farnham Royal Hedgerley Stoke Poges Stoke Common Wexham Fulmer • •• ' . 14,240 Denham 8,000 Domey Taplow Datchet 3,620 Wraysbury Horton • ••. • 9,000 34,860 Newport Pagnell R.D.C Bow Brickhill 450 Bradwell 600 Castlethorpe ... Emberton 700 470 ' Revised Schemes. Hanslope 1,300 Lavendon 630 4,150 Wing R.D.C . Cheddington and Marsworth 856 I>agnall 375 Horton ... „ ,, 60 Ivinghoe Aston 195 Ivinghoe (Great Gap) 42 Littleworth and Burcott ... 352 Noithall 245 Pitstone 436 Rowsham ... 133 Slapton 175 Soulbury 675 Stoke Hammond 350 Revised Scheme. Wingrave 400 — 4,294 Winslow R.D.C Drasdon Parslow 450 Granborough 500 Great and Little Horwood 1,000 North Marston 500 Stewkley 1,300 Swanboume and Mursley 1,100 Winslow ... 2,000 6,850 Wycombe R.D.C . Princes Risborough 6,000 Woobum Valley Scheme 16,000 22,000 Total 86,271 86.271 Of the 54 schemes of main drainage submitted by Rural District Councils under the Rural Water Supplies and Sewerage Act, 1944, the following 20 schemes had at 31st December. 1953, reached the stage shown below:— SCHEMES OF SEWERAGE AND SEWAGE DISPOSAL. Progress Report to> 31st December, 1953. Local Authority. Scheme. Total Est. Cost. Percentage of Scheme Completed. Aylesbury R.D.C Stone £ 15,400 100% Stoke Mandeville 36,500 100% Worminghall and Ickford 42,903 70% Buckingham R.D.C Tingewick 20,900 100% Eton R.D.C. Thomborough Denham (Aproximately 50% of 35,500 100% Scheme) 202,154 90% Wing R.D.C Great Gap, Ivinghoe 2,320 100% Ivinghoe Aston 9,650 95% Littleworth & Burcott ... 31,000 100% Marsworth 17,250 100% Pitstone 24,150 100% Slapton (Church Road) 5,550 100% Soulbury 30,850 100% Wingrave (50% of village) 23,450 75% Winslow R.D.C Drayton Parslow 15,800 100% North Marston 20,000 100% Stewkley 35,000 100% Winslow 22,200 100% Great & Little Horwood 29,500 100% Birchmoor Joint Committee Wavendon 61,000 30% Woburn Sands 9,400 (First instalment) 100% TOTAL ... £690,477 There remain therefore 34 approved Main Drainage schemes yet to be commenced. (iii) Housing. The progress report showing the position of the Bucks Rural Housing Survey as at 31st Dec- ember, 1953, in each of the rural districts of the County is set out below. HOUSING SURVEY Progress Report to 31st December, 1953. Amer. Ayles. U’ham. Eton. N. Pag. Wing. W’nslow. Wyc. Total. Estimated total number of houses to be surveyed 3,313 4,400 2,181 5,768 4,780 2,745 1,650 7,749 32,586 Houses inspected and classi- fied in accordance with the Hobhouse Report:— Category Classification. 1. Satisfactory in all respects 392 423 81 2,938 2,497 1,432 509 2,836 11,108 2. Minor defects only ... 691 246 265 1,724 873 836 345 2,772 7,752 3. Requiring structural alteration or repair ... 984 1,700 323 638 375 194 407 1,071 5,692 4. Suitable for recon- ditioning 347 624 141 348 126 98 57 134 1,875 5. Unfit for habitation and requiring demolition ... 381 587 241 120 126 185 46 936 2,622 Number of Houses remain- ing to be surveyed 518 820 1,130 — 783 — 286 — 3,537 3,313 4,400 2,181 5,768 4,780 2,745 1,650 7,749 32,586 With reference to new housing, the Ministry of Health commenced publication of Housing Progress Reports in January, 1946. The following table shows the progress made by the Local Authorities in Bucks to 31st December, 1953. New Housing—Summary of Progress to 31st December, 1953. Local Authorities. Boroughs. Aylesbury Buckingham High Wycombe Slough ... ... Urban Districts. Beaconsheld Bletchley Chesham Eton Linslade Marlow Newport Pagnell Wolverton Rural Districts. Amersham Aylesbury Buckingham Eton Newport Pagnell Wing Winslow Wycombe Totals i Permanent Housing Total Permanent Houses Completed. War Destroyed Houses Rebuilt. Temporary Houses Completed. Local Authorities. Private Builders. Under Con- struction. Completed. Under Con- struction. Completed. 147 144 1,271 42 191 1,462 *15 20 162 2 42 204 — 50 187 1,753 97 354 2,107 — 400 78 1,375 79 207 1,582 16 49 294 45 165 459 — 72 1,068 13 89 1.157 — 35 171 350 51 124 474 — 12 28 183 8 44 1 8 158 15 52 210 — 34 231 23 88 319 1 4 124 — 16 140 — 90 30 254 2 48 302 90 89 1,242 252 769 2,011 12 195 899 74 226 1,125 — 49 8 258 5 74 332 125 1,072 90 556 1,628 20 _ 56 386 16 149 535 — — 43 420 9 96 516 1 — 39 261 20 65 326 — 80 276 1,639 177 357 1,996 — 968 1,456 13,400 1,020 3,712 17,112 51 SECTION E. INSPECTION AND SUPERVISION OF FOOD. The Chief Inspector submits the following report for 1953. (i) Food and Drugs (Compositional Quality). 1,383 samples of food and drugs were procured. The bulk of them were of milk and the general samples included:— Spirits, Beer, Wines, Cocktails, Tea, Cocoa, Coffee, Coffee Mixtures, Pickles, Sauces, Butter, Cheese, Lard, Suet, Cooking Fats, Chocolate and Sugar Confectionery, Jam and other Preserves, Seasoning, Stuffing, Cereals, Flour, Flour Confectionery, Cake, Pudding Mixtures, Minerals, Soft Drinks, Sausages, Tinned Meats, Jellies, Blanc-mange and Dessert Powders, Ice Cream, Colouring and Flavouring Materials, and Drugs and Medicines. 422 samples wiere submitted to the Public Analyst who reported adversely upon 21 of them. The remaining 961 wiere miUc samples tested by the Inspectors in the Department’s laboratory and found to be genuine or to vary but slightly from the standard laid down by the Sale of Milk Regu- lations. The 422 samples sent to the Public Analyst included 34 samples of milk, comprising 21 suspected of adulteration and 13 consequential “ follow-up ” samples, i.e., taken on “ appeal to cow ” or in course of delivery. In accordance with the arrangements for the supervision of the milk supplies under tlie Milk in Schools Scheme, 418 informal samples were procured from the milk delivered to schools. Three were slightly deficient in fat. In addition, samples of milk were taken at the various insti- tutions in the county, and on behalf of Hospital Management Committees, Educational Establish- ments, Residential Nurseries, School Canteens and Children’s Homes. The proportion of samples adversely reported upon by the Public Analyst rose from 8.24 per cent in 1950, to 10.19 per cent in 1951 and to 12.43 per cent in 1952 and fell to 4.97 per cent in the present year. There were three cases before the Courts during the year and the fines and costs amounted to £10 6s. Od. They were in respect of adulterated milk. (ii) Food and Drugs Acts and Milk and Dairies Regulations. (Bacteriological Quality). 1,462 samples of milk, involving 17,936 cows were taken from farms for biological examination to detect the presence of tubercle infection; the same samples were also tested biologically for brucella abortus or brucella raelitensis. 172 were infected (31 with tubercule bacilli and 141 with brucella). The appropriate District Medical Officers were informed of the infections immediately they were discovered so that human consumption of the infected milk in its raw state could be prevented. A further 61 samples were procured from th raw milk delivered to schools in connection with the supervision of milk under the Milk in Schools Scheme. None of these were found tuberculous nor brucella infected. In addition, 368 samples of “ Pasteurised ” milk delivered to schools were checked; 14 were unsatisfactory in varying degrees due to under heat treatment lor careless handling on the part of the distributors. The causes were brought to the notice of the processors and were promptly rectified. The Ministry of Agriculture and Fisheries reported that following upon reports made to them by the Chief Inspector’s staff, 33 cows were slaughtered during the year. The milk of three cows suffering from other diseases affecting the milk was prohibited from sale by the Chief Inspector. 287 check-samples of “ Pasteurised ” milk were procured from 11 pasteurising plants licensed by the County Council where approximately 14,000 gallons of milk are pasteurised daily. Of these, only 17 samples were found to be unsatisfactory, due to temporary faults which were promptly corrected. SECTION F. PREVALENCE OF, AND CONTROL OVER, INFECTIOUS DISEASE. 1. Poliomyelitis. The number of confirmed cases of poliomyelitis notified during the year showed a considerable decrease, being 56 compared with 104 the previous year. Of the 56 cases, 28 were paralytic and 28 non-paralytic. The cases notified were distributed throughout the County, 21 from Urban and 35 from Rural Districts. 2. Diphtheria. As mentioned earlier in the Report, no death from diphtheria occurred for the sixth year in succession, and in fact there was not a single confirmed case of diphtheria notified during the year. 3. General. Details of all cases of infectious diseases notified during the year are set out in Table (g) of Section H. SECTION G. GENERAL. 1. Public Health Act, 1936. Registration of Nursing Homes. One Nursing Home was registered for the first time during the year and three closed volun- tarily, leaving a total of 23 on the register at the end of 1953. These 23 Nursing Homes provided for 68 maternity beds and 223 others, making a total of 291. A complete list of registered Nursing Homes is contained in Tablei (b) of Section H. 2. Nurseries and Child-Minders Regulation Act, 1948. This Act, which came into force in 1948, provides for the registration and inspection of places such as private day nurseries, in which children are cared for by the day, and the registration in certain cases of persons known as daily minders, who look after other peoples’ young children in their own homes. During the year 1953 there was one new registration of premises, providing for twenty children. Three daily minders, allowed to care for fifteen, eight and six children respectively, were also regis- tered, and one registration providing for eight children was cancelled on removal from the County of the person registered. The number registered at the end of 1953 w as follows: Number Number of Registered. Children provided for. 6 102 8 73 Premises Daily Minders SECTION H —TABLES, ETC. (o) UST OF SANITARY AUTHORITIES. District. Medical Officer of Health. URBAN DISTRICTS. Aylesbury, Borough of J- T. C. Sims-Roberts, m.b., ch.B., d.p.h., Barrister-at-Law. Beaconsfield TP. Evans, m.r c.s., l.r.c.p., d.pa Bletchley D. H. Waldron, m.d,. B.ch., b.a.o., d.p.h. Buckingham, Borough of ... Waldron, m.d,. B.ch., b.a.o., d.p.h. Chesham T. P. Evans, m.r.c.s., l.r.c.p., d.p^. Eton Hobbin, M.B., ch.B., d.p.h. Linslade H. Waldron, m.d., B.ch., b.a.o., d.p.h. Marlow A. j. MriH, m.b., ch.b., b.hy., d.p.h. Newport Pa^dl C. H. F. Bailey, m.r.c.s., l.r.c.p. Slough, Borough of M. A. Charrett, m.r.c.s., l.r.c.p., d.p.h. W'olverton D. W. A. Bull, m.d., m.r.c.s., l.r.c.p. Vvycombe, Borough of A. J. Muir, m.b., ch.B., B.Hy., d.p.h. RURAL DISTRICTS. Amersham T. P. Evans, m.r.c.s., l.r.c.p., d.p^l Aylesbury J. T. C. Sims-Roberts, m.b., ch.B., d.p.h., Barrister-at-Law. Buckingham D. H. Waldron, m.d,. B.ch., b.a.o., d.p.h. Eton O. M. Hobbin, m.b., ch.B., d.p.h. Newport Pa^^ C. H. F. Bailey, m.r.c.s., l.r.c.p. Wing D. H. W aldron, m.d., B.ch., b.a.o., d.p.h. Winslow J. T. C. Sims-Roberts, m.b., ch.B., d.p.h., Barrister-at-Law. Wycombe J. Mi iR, m.b., ch.b., b.hy., d.p.h (b) REGISTERED NURSING HOMES. District. Name and Address. Description. Adstock 1 Rose Villa, Adstock Aged, Infirm. Aylesbury The Gables, 123, Wendover Road Maternity, Medical, Aged, Infirm. Aylesbury Beaconsfield Kinellan Nursing Home, Penn Road, Maternity, Medical, Minor Surgical, Beaconsfield Aged, Infirm. Beaconsfield St Joseph’s, Candlemas Lane, Maternity, Medical, Convalescent, Aged, Beaconsfield Infirm Beaconsfield Bryn Glyn, Penn Road, Beaconsfield Medical, Convalescent, Aged, Infirm. Beaconsfield Rcsslyn, Ledborough Lane, Beacons- Acute and Minor Surgical, Medical, field Convalescent, Aged, Infinn. Bi.£TCHLEY Red House Bungalow, High Street, Maternity. Bletchley ♦Bourne End Fieldhead, Bourne End Aged, Infirm. Hitcham Place, Burnham x'oluntary, temporary, and certified patients under the Mental Treat- ment Act, 1930. Farnham Common Withyfield, Green Lane, Farnham Maternity, Medical, Convalescent, Common. Aged, Infirm. Gerraeds Cross Chalfonts Nursing Home, Packhorse Maternity, Acute and Minor Surgical, Road, Gerrards Cross Medical, Aged, Infirm. Gerrards Cross White House (Annexe to Chalfonts), Maternity. Medical, Convalescent, North Park, Gerrards Cross Aged, Infirm. Gerrards Cross Dawn House, South Park, Gerrards Cross ... Medical, Convalescent, Aged, Infirm. Great Linford The Rectory, Great Linford Convalescent, Aged, Infirm. Great Missenden V\ oodlauds Park, Aylesljiiry l-load, tireat Missenden Convalescent, Aged, Infirm. High Wycombe 749, London Road, High Wycombe ... Convalescent, Aged, Infirm. Newport Pagnell Highfield, Tickford Street, Newport Pagnell ... ... Coinalescent, Aged, Infirm, Olney 90, High Street, Olney Maternity. Olney Gresham House, Weston Road, Olney . .. Aged, Infirm. Slough Parkside Nursing Home, Upton Court Road, Slough ... Convalescent, Aged, Infirm. Slough Heathfield Nursing Home, 10, Uxbridge Road, Slough Aged, Infirm. Stoke Poges Fulmer Grange, Stoke Poges Medical, Minor Surgical, Aged, Infirm. Taplow Old Court, Bath Road, Taplow Maternity, Acute and Minor Surgical, Mejlical, Convalescent, Aged, Infirm. Tingewick Tingewick Nursing Home, Tingewick Maternity, Convalescent, Aged, Infirm. ♦Reserved for Chronic Sick from W.V.S. Residential Clubs for elderly people. (c) CHILD WELFARE CENTRES. Name of Centre. Amersham (New Town) Amersham (Old Town) Aston Clinton Aylesbury Aylesbury—Quarrendon „ Southcourt Beaconsfield Bledlow Ridge Bletchley Bourne End Bradwell Brill Buckingham Burnham Castlethorpe Chalfont St. Giles Chalfont St. Peter Chartridge Chenies Chesham Cippenham Datchet Denham Dinton Downley Edlesborough Ei-LPSBOROUGH Eton Eton Wick Farnham Royal Flackwell Heath ... Gerrards Cross Great Hampden Great Horwood Great Kingshill ... Great Missenden ... Haddenham Halton (Voluntary) Hanslope Hazlemere Hedgerley High Wycombe „ Booker Situate. Hodgmoor Holmer Green Horton Tver IvER Heath Ivinghoe Kimble Lane End Langley Lee Common Linslade Little Chalfont Long Crendon Loudwater Marlow Medmenham (Voluntary) Naphill Newport Pagnell ... Olney Prestwood Princes Risborough Quainton Richings Park, Iver Sands Totteridge West Wycombe Wycombe Marsh Red Cross Hut, Chiltern Avenue, Woodside Road i British Legion Hall, Whielden Street Baptist Church Hall The Clinic, Pebble Lane Quarrendon Community Centre, Bicester Road Baptist Church Hall, Penn Road, Southcourt The Old Rectory Village Hall, Bledlow Ridge School Clinic, Bletchley Road Red Cross Hut, New Road Labour Hall, New Bradwell The Institute Congregational School Room ... Village Hall, Gore Road Carrington Hall Memorial Hall Tythe Barn, Swan Farm Reading Room Florence Brown Memorial Hall, Chorley Wood The School Clinic, Germain Street Central Hall, Bower Way Working Men’s Club Health Centre, Oxford Road Village Hall ’ Village Hall Memorial Hall ... Butler’s Cross Parish Hall College Arms, High Street Village Hall Village Hall Temperance Hall British Legion Hall Parish Room Memorial Hall Village Hall Memorial Hall Community Centre R.A.F. Camp, Halton Church Institute Penn Road Methodist School Room Memorial Hall Municipal Health Centre Castlefields Methodist Church Hall Methodist School Room Turner’s Sports Pavilion Methodist Schoolroom St. Anne’s Church Room Theatre Hall, Hodgmoor Camp Wesleyan Chapel School Room ... ... ... Champneys Hall Church Institute, Thomey Lane Village Hall ... Town Hall Stewart Hall ... Memorial Hall Women’s Institute Hall Youth Club Hall Forster Institute Little Chalfont Hall Old Court House Recreation Hall Public Library, Chapel Street R.A.F. (tamp, Medmenham Memorial Hall 73, High Street Church Hall, High Street Village Hall Baptist Church Room, Bell Street Memorial Hall St. Leonard’s Church Hall Doctor Attends Twice monthly Monthly Do. Weekly Monthly Twice monthly Twice monthly Monthly Thrice monthly Monthly Twice monthly Monthly Do. Twice monthly Monthly. Do. Twice monthly See Lee Common Monthly Weekly Do. Twice monthly Thrice monthly Monthly Do. Do. Do. Do. Do. Thrice monthly Monthly Do. Do. Do. Do. Twice monthly Monthly Tivice monthly Monthly Monthly Monthly Twice weekly Twice monthly Monthly Monthly Monthly Twice monthly. Monthly Do. Do. Do. Do. Twice monthly Monthly Do. Do. Do. Do. Do Do. Do. Weekly Monthly Monthly Twice monthly Twice monthly Monthly Twice monthly Monthly Do. CHILD WELFARE CENTRES—continued. Name of Centre. Situate. Doctor Attends St. Leonards-cum-Cholesbury ... Village Hall, Cholesbury Monthly. Seer Green and Jordans Baptist School Room, Seer Green Do. Slough Health Centre, Burlington Road Weekly Slough, St. Michael's Slough Social Centre Do. Slough, Wexham Road Wexham Road Community Centre Do. Steeple Claydon Library Hall Monthly Stewkley Methodist Church School Room Do. Stokenchurch Memorial Hall ... Do. Stoke Poges Village Hall Do. Stone Village Hall Do. Stony Stratford Scout Hut Twice monthly Tbornborough Church Hall Monthly Twyford Village Hall Do. Tylers Green Parish Room Do. Waddesdon Village Hall Do. Wendover Public Hall Twice monthly Whitchurch Methodist Hall Monthly Wing Village Hall Do. Wingrave ... Temperance Hall Do. Winslow ... St. Lawrence Church Hall Do, Woburn Sands Social Club Do. Wolverton Scouts Hall Thrice monthly WooBURN Green St. Mary’s Church Hall Monthly Worminghall Social Hut, Ex-R.A.F. Camp Do. Wraysbury Village Hall Do. Monthly Session. First Monday Second Monday Fourth Monday First Thursday Second Thursday Third Thursday Fourth Thursday First Friday Second Friday Third Friday Fourth Friday MOBILE WELFARE CENTRE (Doctor attends each session). Villages Visited. Stoke Goldingtoii, Ravenstone, Filgrave. ... Willen, Woolstone, Woughton, Simpson, Milton Keynes. Swanboume, Drayton Parslow, Mursley. ... Preston Bissett, Charndon, Calvert. Stoke Hammond, Little Brickhill, Soulbury, Great Brickhill. ... Grendon Underwood, Westcott, Cuddington. ... Far Bletchley. Sherington, Lavendon, Newton Blossomville, Astwood, North Crawley. Beachampton, Nash, Whaddon, Shenley Brook End, Shenley Church End, Loughton. ... Leckhampstead, Li.llingstone Dayrell, Akeley. ... Tingewick, Dadford, Chackmore, Maids Moretcn. (d) POPULATIONS, BIRTH AND MORTALITY RATES FOR THE YEAR 1953. O rt yj 2 ^ tS rt O • II I I 1 I c I I I ! I I I I I ! i I 1,1 11- I 1 I I 1 I I d tjo 83o SS-o Su I ^ (N m vq Tt so (S 00 a\ m ^ (N ^ 1 cn m fn so 1 -a- CT\ ^£3 rn d 1 Tf v-i 0^ o ^ m ro <s m so rn f-i rq (S m 00 <N 00 od ^ '«0 rvj r-* - rn uS r4 ^ (N n-) ^ rn O On r- 1 (N ‘ O <s tn a ^ • "■S'^3 ■§ S U o HQ “■Q ,^l I r4 d ^ 1 ON m I O d d -H m Tf 1—< ‘ r^mo^oo*-* p ^ (N ^ fN| ^ d d d d d d ^ o d U TS 3 U cd Jf. o« 4> $> O N^r*^o6d^ddosdr^rsi ON<SON^mONf^<^ OTj-\0»-M^0Nf^00 'W^CO osOsooNd’—<r^ON ^a> a V «2.2 •Sw®. g m “•£ ’S.iS M a gjST ■&.? B 3'a «i w ‘O « w(2^ ••5 « •S 0.S2 P4 G f^G^o fr o i'^-H^so»r>t^'o^r^sovNso fn»—l<s^^^’^so'*^^'^0^^ poois"^. NOO''^^'^P<^. o ooooooasmOf<N ON^rJ-ONOOV-)^^ V-J'^^SO^.—(»-HVO ON p vO p 'n On '^/'O Ooor-*OmOON<^ooOO Orj*^^sO<SON*'^f^sO'^'^ ’^fS’^o^r^oo^p^'q.C'J^ON*'^^ 00 ^ ^ «-4 fn so Tf G m ^ Tt so opoooooo ONr^oor^u-icn^oi—( 0^ ^ p 0^ ^ rn-^"'0'^’^ONl>^ rt ^ Tj* 1—I Tt •^ONSO’^OOOtSONOsOON^ »no»-‘rt'r4»/-»ONSOoosofnra O ON On o^ <N so^ <S r<N ^r^dco»-Hfoof^GGGro fS *-H Tt so &cS p ‘ x> ^ 0) oc c S!c c $3 o .c *•0 . S • o • o >> . o a CD • a :a. ^ oj: Z_0«'PG« I Sfl-S a.C'2.2 a|| CQ U iJ 3 .a 2 K .5 ^ JJ > S <cQa5muw3:i-i!SZ(«^ <Nf^(MOr^r4oo<Ni r^N^r^fS^Tj-vovN Ttsn'<t^ooo<NfO oi § D < B P OD Xi a a tQ • a :0l, 2 ® £ oi ^ G > 5? fi? o ^ o ^ 5^ Q G ^ >» P 2 ^ iC '►C! kC <P3WZ^^^ 0!! I -In view of the small numbers on which some of the rates quoted are based, the actual numbers are given in parenthesis for the purpose of clearer comparison. (e) COMPARATIVE TABLE OF BIRTH. DEATH AND INFANT MORTALITY RATES FOR TEN YEAR PERIOD, 1944-53 (f) CAUSES OF DEATH AT DIFFERENT PERIODS OF LIFE IN THE ADMINISTRATIVE COUNTY OF BUCKINGHAM. 1953. Aggr^ate of Urban Districts. Aggregate of Rural Districts. CAUSES OF DEATH. Sex 0-1 1 1— 5— 15- 25- 45— 65— 75- Total 0-1 1— 5- 15— 25- 45— 65- 75- Total M 35 11 6 6 47 256 270 329 960 34 4 7 23 52 230 294 404 1048 All Causes F 21 2 8 6 42 149 212 452 892 29 6 10 3 41 142 220 493 944 1—Tuberculosis, Respiratory ... M — 1 2 9 2 1 15 — — — — 4 7 1 12 F — 1 2 2 — — 5 — — — — 3 — — — 3 2—Tuberculosis, Other M — — — — — — — — — — — — — — — 1 — 1 F 1 1 3—Syphilitic Disease M — — — — — 2 2 7 ► — — — — 1 1 2 4 F — — 1 4—Diphtheria M F — 5—Whooping Cough M — F 1 — 6—Meningococcal infections ... M — 1 — — — — — — F — — — 7—Acute Poliomyelitis M — — 1 1 — — — 3 F 2 1 — 3 8—Measles M -- 1 — 1 1 — — — 1 F — — — — I 1 — — — 2 9—Other infective and parasitic M — — 2 — 2 — 1 1 diseases F — — — — 1 1 2 1 — — — 1 1 3 10—Malignant neoplasm, stomach M F — — — 1 1 10 5 7 4 7 9 25 19 — — — 1 14 5 11 7 4 16 29 29 11— „ „ lung, bronchus M — — — — 1 22 18 3 44 — — — — — 14 20 7 41 F — — — — — 3 3 — 6 — — — — 1 3 4 — 8 12— „ „ breast ■ M — — — — — 1 — — 1 — — — — — — 1 1 2 F — — — — 5 18 5 5 33 — — — — 4 13 9 11 37 13— „ „ uterus . M 17 F — — — — 4 4 4 5 — — — — 1 6 4 5 16 14—Other Malignant and Lym- M — — — 2 6 28 25 32 93 — 2 2 11 30 32 41 118 phatic Neoplasms F — — 1 — 7 24 13 27 72 — — — 2 4 25 23 18 72 15—Leukaemia, Aletdcaemia M — 1 — — 1 3 — — 5 — — — — 1 4 1 1 7 F 1 — 2 — — 2 3 — 8 — — — — 3 — 1 4 16—Diabetes M — — —■ — 1 — 1 3 — 1 — — 1 2 1 5 F — — — — 3 1 4 8 — — — — — 1 3 4 17—^Vascular lesions of nervous M — — — 2 21 31 53 107 — — — — 17 28 57 102 system F — — — — 1 24 39 98 162 — — 1 — 3 23 39 83 149 18—Coronary disease, Angina ... M — — — — 6 49 59 41 155 — — — — 5 50 48 60 163 F — — — — 1 12 41 38 92 — — — 12 35 31 98 19—Hypertension with Heart M — — 5 7 3 15 — — — 1 1 5 5 12 disease F — — 7 8 13 28 — — — 5 5 11 21 20—Other heart disease M 1 1 1 12 31 77 123 1 — — — 2 14 38 70 125 21—Other circulatory disease ... F — — 6 16 28 122 172 — — — — 4 14 33 118 169 M — — — 1 7 8 14 30 — — — — 1 5 14 28 48 F — — — 1 2 9 20 32 — — — — 1 4 7 30 42 22—Influenza M — — — — — 2 6 5 13 — — — — 2 6 3 5 16 F 1 — — 1 2 3 — 10 17 — — — — 2 — 5 16 23 23—Pneun.onia M 2 4 1 — 1 6 12 22 48 4 1 — 1 1 10 10 20 47 F 3 1 — — 2 11 24 41 2 — — — 2 6 13 29 52 24—Bronchitis M 1 1 1 — 1 21 21 23 69 1 — — — — 13 25 26 65 F — 1 2 11 20 34 — — — — — 3 3 19 25 25—Other diseases of respiratory M 1 — — 1 6 4 6 18 — — — 1 — 4 4 3 12 system F — 1 — — — — 1 2 — — — — 1 — 1 5 7 26—Ulcer of Stomach and Duo- M — — — — 11 9 4 24 — — — — — 6 6 8 20 denum F — — 1 2 3 6 — — — — — 1 1 2 4 27—Gastritis, Enteritis. Diarrhoea M 2 — — — 1 — 1 1 5 2 — — — 1 2 3 — 8 F — — — 1 2 2 4 9 2 — — 1 1 1 2 7 28—Nephritis and Nephrosis ... M — — — — 2 5 3 5 15 — — 1 — 1 6 3 1 12 F — — 1 1 2 — 2 5 11 — — 1 — 2 1 1 6 11 29—Hyperplasia of prostate ... M 3 7 10 — — — — — 3 7 24 34 30—Pregnancy, Childbirth. Abor- t M tion F — 1 1 — 1 1 31—Congenital Malformations ... M 6 — — — — 2 — — 8 3 1 — — 1 — — — 5 32—Other defined and ill-defined F 7 — — 1 — 1 9 3 1 2 1 2 2 — — 11 M 21 — — — 4 15 13 15 68 23 — 2 3 — 19 16 27 90 diseases F 9 — 2 3 5 11 22 27 79 18 — 2 — 5 11 23 45 104 33—Motor vehicle accidents M 1 3 1 7 4 1 1 18 — — — 6 14 — 3 3 26 F — 1 — — — 1 1 3 — 1 1 — 1 — — — 3 34—All other accidents M 3 1 — — 3 5 4 4 20 — — 1 8 5 2 1 9 26 35—Suicide F — 1 1 14 16 2 2 1 1 3 18 27 M — 1 5 7 2 2 17 — — 1 4 4 4 13 36—Homicide and operations of F — 2 4 1 1 8 — — 2 2 1 2 7 M war F (g) SUMMARY OF NOTIFICATIONS OF INFECTIOUS DISEASES RECEIVED DURING THE YEAR 1953. Tuber- culosis .5 '2 o s O Acute Poliomye litis Acute Encepha { litis Ophthalmia neonatorum '>< u V > V Oh DISTRICT. Respiratory Other 1 1 Scarlet Fever i O U bo _c ‘S, o o -C Diphtheria Measles 2 D (U a 3 u < 1 Meningococca 1 lufec: o ’^3 u. rt Non- i paralytic i 1 Infective 1 Fost infectious G a "2 O. ti (U 3 04 Smallpox rs 'o O. nj u cfl O. Typhoid Feve Food poisonin Erysipelas Malaria Infective Hepatitis. URBAN. 1 1. Aylesbury 21 4 27 13 435 6 1 2 4 1 18 3 2. Beaconsfield .... 3 1 30 2 263 5 1 1 3 3. Bletchley 2 1 31 7 512 17 1 7 1 4. Buckingham .... 4 1 11 38 S. Chesham 7 3 3 1 124 1 6. Eton 3 7 39 61 1 1 3 1 7. High Wycombe 26 6 68 14 304 18 3 4 9 1 1 5 8. Linslade 1 21 20 24 18 1 9. Marlow 4 7 11 18 1 1 1 1 0. Newport Pagnell 3 3 1 96 1 1 11 3 1. Slough 57 4 206 139 505 67 1 5 2 6 1 25 12 17 1 2. Wolverton 6 2 50 3 I 160 15 3 2 Total Urban ... 136 22 454 261 2540 148 4 11 10 1 41 2 49 17 31 1 RURAL. 1. Amersham 22 9 56 77 857 15 3 2 1 2 14 2 6 2. Aylesbury 25 7 30 5 349 27 2 1 8 2 3 3 4 3. Buckingham .... 2 1 25 2 225 4 1 3 1 2 4 Eton 39 5 150 73 627 47 6 2 3 39 5 7 1 S. Newport Pagnell 4 2 25 5 226 5 5 1 6. Wing 6 2 9 11 96 18 3 1 7. Winslow 30 12 204 2 8. Wycombe 25 6 56 50 432 29 1 5 7 3 1 2 Total Rural .... 123 32 381 235 3016 147 1 17 18 1 22 56 10 22 1 4 Total for County ... 259 54 835 496 5556 295 5 28 28 2 63 2 105 27 53 2 4 (h) CARE OF MOTHERS AND YOUNG CHILDREN, SUMMARY OF DENTAL TREATMENT, 1953. Examined. Needing treatment. Treated. Made Dentally Fit Expectant and Nursing Mothers 22 9 9 7 Children under five years of age ... 39 36 35 18 Forms of dental treatment provided:— Extrac- tions. General Anaes- thetics. Fillings. Scalings or Scaling and gum treatment Silver Nitrate treatment Radio- graphs. Dentures provided. Inlays and Crowns. Complete. Partial. Expectant and Nursing mothers 31 7 4 2 — — 3 1 — Children under five years of age 38 7 14 — 25 1 — — — (i) AMBULANCE SERVICE. Statistics for year ending 31st December, 1953. Whole-time Vehicles. Hospital Car Service. Ambulances. Sitting-Case Cars. Total. Sitting-Case C^s. No. of patients carried 65,824 38,219 104,043 12,992 No. of Journeys 23,755 10,057 33,812 9,531 Total Mileage 612,876 383,794 996,670 270,102 No. of Vehicles 31 15* 46 — No. of whole-time operational staff — — 63 — No. of patients carried per 1,000 population 165 96 261 33 No. of journeys per 1,000 population 60 25 85 24 *lDcludes two coaches.