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Willesden, was publicised in another area. It was reported in the press and there were many anxious enquiries
until we were in a position to show that it had been a false alarm. Much of the work of the department, however,
has to be concentrated on a steady trickle of milder, though not necessarily innocuous, infections of
various dysentery and food-poisoning germs. These cause suffering and inconvenience, and now and then
death; and the effectiveness of the department would be further improved if members of the public would
inform their doctors about their "tummy upsets" as soon as possible and save a portion of the suspected food
for testing.
The Old People's Clinic has continued its work at Neasden Clinic. One of its most valuable functions
is to act as a centre to which the elderly can come, not only to discuss their problems, but perhaps just to
say that everything has been going well. This affords an excellent opportunity to give guidance on the prevention
of future difficulties, or the detection of early ones which can be nipped in the bud. The most significant
advance has been in the provision of a food supplement, Complan, which is also available at Old People's
Clubs. This was made possible after fruitless attempts had been made to persuade the Ministry of Health
to authorise its provision on the same terms as welfare foods for mothers and children. The Complan is
purchased by the Borough Health Department and sold to the elderly at a fraction above cost price. It has
become very popular, and an important factor for health in many whose normal diets place them on or below
the margin of malnutrition. The Old People's Welfare Committee itself has continued to broaden its services,
and in its clubs and outings and its concern for individuals has added a new dimension to the lives of
many lonely old folk.
Perhaps the subject of malnutrition should not be left without a mention of its wider implications,
for no group of the community is without its problems in this respect. It can mean either not enough of the
right kind of food or too much of the wrong kind. The fat schoolboy is as much involved as the thin,
apathetic old man. We all need sufficient quantities of body-building foods such as meat, fish, cheese, eggs
and milk, plus fruit and vegetables; but we store up trouble if we stuff ourselves with too much of the sugary,
starchy and fatty foods. Vitamin deficiencies are not as important as they used to be in this country, although
rickets, associated with shortage of vitamin D, has recently appeared sporadically in immigrants. Mineral
deficiencies could well be more important. Anaemia caused by a lack of iron in the diet is quite common,
especially in the immigrant population, and here the balance of the diet should be altered to include foods like
lentils, egg-yolk, liver, beans, black treacle, oatmeat, whole wheat, turnip tops, spinnach, prunes, dates and
raisins. It is possible that lack of calcium may make the bones of the elderly more brittle, and they would
be well advised to take at least a pint of milk a day. Increasing attention is being given nowadays to the socalled
trace elements. It has been known for some time that lack of iodine in certain districts can cause
goitre and cretinism, but more recent work suggests that, for example, in remote parts of the world zinc deficiency
can result in dwarfed, anaemic males, and lack of cobalt may be responsible for a form of debility
which has been observed in children and animals. Another element about which there is stronger evidence
is fluorine, and few of those who oppose it, I think, would question its value in strengthening the resistance
of the teeth of children to decay. It has recently been shown, moreover, to have a place in the chemical
structure of normal teeth. Now whereas the addition of iodine to table salt succeeded in eliminating goitre
and cretinism in the places mentioned above, effective reduction of dental decay is only possible by adding
fluoride to the water supplies. Other methods such as fluoride pills or local application of fluoride are tedious
and less efficient. The National Pure Water Association has, however, strongly opposed fluoridation, claiming
that it is harmful and that the liberty of the subject would be undermined. Eminent authorities have
denied these, and lengthy arguments have been held. Only recently I received a paper from the National
Pure Water Association claiming that fluoridation caused mongolism in babies. It was rapidly followed by
another from the Ministry of Health pointing out statistical errors which invalidated it. It is hardly surprising,
therefore, that the general public has been perplexed and that many local authorities have hesitated to
put this controversial measure into effect. The trend throughout the country is that a few have accepted it,
but most have not. I am in the peculiar position of being Medical Officer of Health to one borough, Wembley,
which has approved it, and another, Willesden, which has rejected it. One thing at any rate is clear: that
the controversy will continue for a long time. It may be that new evidence will appear, for example, confirmation
or denial of the theory that in fluoridated areas fractures of the bones in the elderly are less likely
than elsewhere. It will be the responsibility of every citizen to weigh all the facts carefully and decide in
the light of conscience and what he considers to be the needs of the community.
An important milestone in 1963 was the formation of the Willesden Association for Mental Health.
Far from being just another local organisation, this signified an important advance. Mental health can no
longer be regarded as the prerogative of the psychiatrically trained: it has become the concern of all. One
of the first actions of the committee was to set about the formation of a local group of the Samaritans, the
members of which would undertake to befriend people who are depressed or feel suicidal. No special knowledge
would be required of them, nor would they have to undergo intensive training. After instruction the
chosen workers would, under suitable direction, not only support unhappy people through their emotional
crises, but also by their example spread the understanding of mental health throughout the community. The
association has succeeded in bringing together a group of local clergymen who have undertaken to form the
group from members of their own congregations and others who are interested. From this humble beginning
may emerge a force for good which would profoundly affect this and future generations.
Work in the public health field is increasing in size and complexity. I would like to express my
thanks to all the members of the staff for their loyalty and hard work throughout this difficult year, and also
my appreciation for the encouragement and support I have received from all members of the Council, particularly
the members of the Public Health Committee.
I have the honour to be. Madam Mayor, Ladies and Gentlemen.
Your obedient servant,
E. GRUNDY,
Medical Officer of Health.