WI L 6 Willesden Urban District Council. PUBLIC HEALTH REPORT FOR THE YEAR 1902, BY WILLIAM BUTLER, MB., D.P.H., Fellow of the Society of Medical Officers of Health; Member of Sanitary Institute, Epidemiological Society, &c. Assistant Medical Officer of Health for Willesden London: Feinted by Mabtin & Son, 211 High Road, Kilbuen, N.W. 1903. MEMBERS OF THE SANITARY COMMITTEE. Councillor G. H. JOHNSON, Chairman. Dr. J. S. CRONE, J.P., Chairman of the Council (ex-officio). „ G. A. SEXTON, Vice-Chairman of the Council (ex-officio). J. J. BATE. „ C. BIDDISCOMBE. „ A. C. COCKBURN. „ C. COWLEY. „ O. H. DAVIES. „ W. J. EVERSHED. „ J. F. HILL. „ F. HILBORN. „ Dr. W. H. KNOX. „ J. McKENZIE. „ J. PICKWORTH. „ C. PINKHAM, J.P. „ G. R. R. STRINGER. PUBLIC HEALTH REPORT For 1902. To the Chairman and Members of the Willesden Urban District Council. Gentlemen, I beg leave to present, on behalf of the Medical Officer of Health, the Annual Report of the Public Health Department for the year 1902. The regretable illness of Dr. Skinner, unfortunately, prevents him from reviewing the work of his department, and presenting to you the results of his investigations into the conditions affecting health as they exist in Willesden. Dr. Skinner alone has been in complete touch with the work during the greater part of the year, and it is, therefore, impossible for me to do justice to work the magnitude of which I can appreciate, but with which my acquaintanceship has been intimate during only a fractional part of the year. But for the excellent records kept by Dr. Skinner, it would have been impossible to have maintained the continuity of his Reports. His absence is a loss regretted by all, and the universal sympathy with him in his illness is an assurance of the warm and kindly feelings in which he is everywhere held. (2) TABLE No. 1. ESTIMATED POPULATION TO MIDSUMMEE 1902. Houses. Population Harlesden, Metrop 1126 6741 „ Brent 1867 11183 2993 17924 Kensal Green, Metrop. 3497 25259 „ Brent 5 37 3502 25296 Willesden Green, Metrop. 133 754 „ Brent 3596 20425 3729 21179 South Kilburn, Metrop. 1307 14923 Mid 1595 12477 North ,, „ 1675 10259 Church End, Brent 3128 20153 7705 57812 Totals—Metrop. 9333 70413 „ Brent 8596 51798 17929 122211 (3) POPULATION. Before any judgment can be passed upon statistical returns of births or deaths or marriages, it is imperative that the fullest details of population shall be available. Thus a population of children under school age will have a very high death rate, a very high sick rate, a high incidence of infectious diseases, no marriage rate and no birth rate, and thus it is evident that the age constitution or distribution of any given population will very materially affect its rates in these and in other respects. That Ward A has a high birth rate, while Ward B has a low one, and that Ward A always has a high rate of infectious disease, while Ward B's is inappreciable may be due almost entirely to the fact that Ward A consists of children and young adults, while Ward B is the chosen locality of adults on the declining side of the period of fecundity. On the other hand differences of birth and death and infectious rates may be very marked in the districts compared, and a knowledge of the age distribution of the population may show that these differences can not be accounted for on this ground, (4) and that other and possibly preventable conditions are responsible for the excess which one district exhibits over another. The returns of the recent census have furnished the material for an enquiry into the age and sex distribution of the population of Willesden and are sufficiently recent to justify some attempt at presenting them so that their significance shall be understood. Chart No. I. shows the distribution in quinquennia of males and females for the whole of Willesden. It will be observed that while in the first quinquennium males are slightly in excess of females, in every succeeding age period females are numerically predominant. This is notably the case between the ages of 15 and 35, and consideration of the corresponding charts for the different wards suggests that this is very largely due to the influx of domestic servants. The rise in the excess of females at the age periods over 50 is probably due in great measure to their lower death rate, for although boys start with a numerical lead, they quickly lose it owing to their increased rate of mortality which is greater than that of females at almost every age period of life. (5) Church End, Kvensal Green, and South Kilburn (Chart No. II.) ate The Wards in which the male and female populations are most nearly equal; Harlesden and Mid Kilburn coming next; while North Kilburn and Willesden Green exhibit a great disproportion due largely to excess of females in early adult and middle life. As I have already suggested differences in the social conditions of the Wards are probably accountable for these variations. The Wards possessing the greatest excess of females over males, especially at the age periods of lowest mortality, should cceteris paribus have the lowest death rates, since in these Wards there is an accumulation of persons of an age and sex when they are least prone to illness and death. But more important than differences of sex distribution are those of the age constitution of the districts compared, and in Chart III. is seen the distribution of the population living at each decennium in the different wards of the Districts. The varied character of the age constitution of each of the wards becomes apparent when the relative length of the columns showing the number of persons living at the age period which each column represents, is compared. (6) It will be observed that Church End and Kensal Green have a much greater proportion of their population living at the age period 0-10 than at any of the succeeding decennia. To a lesser extent, this applies to Harlesden, South Kilburn, and Mid-Kilburn, while in North Kilburn and Willesden Greeu it is not until the third decennium is reached that the maximum population living in a 10-year age group is reached. As the death rates at the different age periods materially differ, it follows that the diverse age constitution of the Ward populations will profoundly modify their different death rates, and, indeed, their sick rates, birth rates, and other rates, based on the proportion of cases per thousand of population. (7) Grouped occupations of Males aged 10 years and upwards in the Urban District of Willesden; also proportion of children of 10 and under 14 years of age engaged in occupations according to the Census of 1901. Males aged 10 and under 14 years Engaged in occupations 112 Proportion per cent. engaged in occupations to total 2.6 Total occupied and unoccupied 39,991 Retired or unoccupied 6,512 Engaged in occupations 33,479 Commercial or Business Clerks 2,374 Conveyance of Men, Goods and Messages 6,362 Agriculture on Farms, Woods and Gardens 394 Engineering and Machine Making 1,243 Tools, Dies, etc., Arms, Miscellaneous Metal Trades 381 Building and Works of Construction 6,040 Wood, Furniture, Fittings and Decorations 1,153 Brick, Cement, Pottery and Glass 179 Chemicals, Oil, Grease, Soap, etc 352 Skins, Leather, Hair, Feathers 200 Paper, Print, Books and Stationery 926 Dress 1,425 Food, Tobacco, Drink and Lodging 2,858 All other occupations 9,592 (8) Grouped occupations of Females aged 10 years and upwards in the Urban District of Willesden: also proportion of children of 10 and under 14 years of age, and of Married and Widoived Women engaged in occupations, and proportion of female Domestic Servants to separate occupiers or families according to the Census of 1901. Females aged 10 and under 14 years of age Engaged in occupations Proportion per cent. 33 gaged in occupations to total 0.7 Total occupied and unoccupied 47,277 Retired or unoccupied 32,956 Engaged in occupations— (a) Unmarried 11,400 (b) Married or Widowed 2,921 Teaching 805 Domestic In-door Servants (not in Hotels, etc.) 5,646 Charwomen 358 Laundry and Washing Service 2,046 Commercial or Business Clerks 425 Chemicals, Oil, Grease, Soap, etc. 39 Paper, Print, Books and Stationery 149 Tailoresses, Milliners, Dressmakers, Shirtmakers, Seamtresses 2,298 Pood, Tobacco, Drink and Lodging 539 All other occupations 2,016 Proportion per cent. of Married or Widowed engaged in occupations 11.5 Proportion per cent. of Domestic Servants to total number of separate occupiers or families 220 (9) TABLE No. 2. MARRIAGES. 1902. First Quarter. Second Quarter. Third Quaiter. Fourth Quarter. Total. Church of England— 92 132 182 156 562 Noneotn. Churches — — — — 58 Registrar's Office — — — — 140 Totals 92 132 182 166 760 The total of 760 marriages for the year gives a marriage rate of 6.2 per 1000 persoDs living. This is an increase on last year when the rate was 5.6 per 1000. The rate for England and Wales was 15.9 per 1000. Usually the marriage rate is about half the birth rate, and the very low marriage rate in Willesden, amounting ouly to one-fifth of the birth rate, is an evidence of the large immigration there is into the district of people recently married. (10) TABLE No. 3. BIRTHS. 1902. Boys. Girls. Totals. First Quarter 475 465 940 Second ,, 497 493 930 Third ,, 482 486 968 Fourth ,, 425 512 937 In Workhouse 18 17 35 In Queen Charlotte's Hospital 20 26 46 Totals 1,917 1,999 3,916 TABLE No. 4. Births distributed into Wards as follows : — wards. First Quarter. Second Quarter. Third Quarter. Fourth Quarter. Total. Rate per 1000 of Population. Church End 208 198 198 182 786 39.00 Harlesden 121 118 137 140 516 28.77 Keusal Green 222 233 217 199 871 34.42 South Kilburn. 109 121 113 104 447 29.95 Mid Kilburn 88 82 79 95 344 27.65 North Kilburn 54 73 59 63 249 24.27 Willesden Green 138 165 165 154 622 29.36 Workhouse 10 10 8 7 35 Queen Charlotte's 11 12 9 14 46 — Totals 961 1012 985 958 3916 31.38 (11) BIRTHS. The births registered in the District were 3,916. The birth rate per thousand of population is 31.38, a reduction on last year and that of the year preceding. This is in accord with what is happening throughout the country, where since 1895 the rate has steadily decreased year by year. Comparing different Wards, Church End, with a birth rate of 39 per thousand, is higher than in 1901, when its rate was 38.9. In 1900 it was 42 per thousand. Kensal Green, with a rate of 34.42 per thousand, comes next. In 1901 its rate was 34.7, and in 1900 35.07. South Kilburn and Willesden Green have a rate respectively of 29.95 and 29.36, while Harlesden and Mid Kilburn have respectively a rate of 28.77 and 27.65. North Kilburn has the lowest rate, 24.27, but this is an increase on last year, when it stood at 20 27, while in 1900 it was 17.22 only. For the purpose of comparison I have abstracted from the total population in each of the Wards the number of persons living between the ages of 0-20 and between 20 and 45, the latter age period virtually synchronising with the procreative period of life. In Chart No. IV. the respective populations of the different Wards at the census year at (12) these age periods is represented diagramatically. It will be seen that Church End and South Kilburn have a population under 20 considerably exceeding that between 20 and 45. In Kensal Green and Mid Kilburn the columns are almost equal, while in Harlesden, North Kilburn and Willesden Green, the population under 20 is less, and in the case of Willesden Green considerably less than that between 20 and 45. Taking the figures of the census year 1901 to which my data limit me, I find that the birth rate per thousand estimated on the population living at the procreative period, 20-45, is as follows:— WARDS. Birth Rates per 1,000, 20-45. 1901. Rate per 1,000 of Population. Church End 100 38.9 South Kilburn 82.3 29.4 Kensal Green 80.4 34.7 Mid-Kilburn 74.0 30.0 Harlesden 69.3 29.6 Willesden Green 69.1 30.6 North Kilburn 54.0 20.2 Estimated on this basis, the relative fecundity of the different Wards works out differently, but (13) probably much more correctly than on the usual basis of rate per thousand living. The rate per thousand living at the procreative age period gives the order of relative fecundity as above stated, whereas, worked on the ordinary basis, the order is Church End, Kensal Green, Willesden Green, Mid-Kilburn, Harlesden, South Kilburn, and North Kilburn. South Kilburn on the latter basis comes second lowest, whereas on the basis of people living at the procreative period it is second highest. It must be borne in mind, however, that in the Wards where the servant-keeping class predominate such as Willesden Green and North Kilburn, there is a large population living at this age period which is unmarried. BIRTHS OF ILLEGITIMATE CHILDREN. The illegitimate births registered in the District were 48: boys, 27 ; girls, 21; equal to 1*2 per cent, of the births, the figures apart from the rate corresponding exactly with those of last year. DEATHS. The deaths registered in the District were 1,447; males, 703; females, 744. Those registered outside the District but belonging to it were 268, giving a (14) grand total of 1,715. There were six deaths registered in the District of persons not belonging to it, making a corrected total of 1,709. The death rate for the year after making these corrections is 13.9. Last year it was 13.7. From the remarks made under the heading of population it will be seen that the death rate thus corrected is not quite comparable with the death rates similarly corrected for other districts, for the reason that the age and sex distribution of the populations whose rates are compared may be totally different, and in itself this would favour or discredit as the case might be the Districts between which a comparison was instituted. If, therefore, the death rate in Willesden is to be compared with the death rate in other Districts, it is evident that difference in age and sex distribution niust be allowed for, and in order to do this I have calculated the standard mortality for Willesden, its population being distributed as at the census. The comparison, of course, must be made between such a corrected death rate and a death rate similarly corrected for the district compared. (15) TABLE No. 5. (15) Mean Annual Death Rate for England and Wait, I896-1900. Population of Willesden, 1901. Calcu'ated number of Deaths. Ages. Males. Females. Males. Females. Males. Females. Persons. Under 5 59.6 49.9 7,540 7,486 449 372 821 5—10 3.8 3.9 6,183 6,334 23 25 48 10—15 2.2 2.3 5,386 5,588 12 13 25 15—20 3.5 3.3 4,814 5,667 17 19 36 20—25 5.1 4.3 4,911 6,202 25 27 52 25—35 6.7 5.9 9,942 12,072 67 71 138 35—45 11.7 9.6 7,413 7,961 87 76 163 45—55 19.0 14.5 4,116 4,771 78 69 147 55—65 35.3 28.1 2,206 2,858 78 80 158 65—75 66.2 57.4 892 1,522 59 87 146 75—85 144.3 131.2 276 538 40 71 111 85 & upwards 280.2 255.9 35 98 10 25 35 All Ages 18.8 16.6 53,714 61,097 945 935 1880 114,811 (16) In the above table the figures representing the calculated number of deaths are the theoretical deaths that would have occurred in Willesden during 1901 had the death rate at each of the twelve age periods been the same as in England and Wales during the period 1896-1900. The standard death rate on the same supposition is 16.38 per 1,000. From this is calculated the factor for correction, which is 1 08. By multiplying the recorded death rate by the factor for correction we get the death rate corrected for age and sex distribution. The corrected death rate for Willesden thus becomes 15.0 per 1,000 instead of 13.9, the recorded death rate. WThen all corrections are made it will be seen that the death rate of Willesden is well below 17*7, the mean death rate for England and Wales for the years 1896-1900. The best statistical evidence of the healthiness of a district consists in — (1) The corrected death rate. (2) The zymotic death rate. (3) The rate of infantile mortality. (4) The phthisical death rate. (17) For Willesden these rates are as follows for the year:—Corrected death rate 15.0 per 1000; Zymotic death rate 2.3 per 1000. Infantile mortality rate 129.8 per 1000, phthisical death rate 909 per million. For the different wards these rates are as follows :— TABLE No. 6. WARDS. Death Rates 1902. Per 1000. 1898-1902. Rate of Infantile Mortality. 1902. Rate of Infantile Mortality. Per 1000 Zymotic rate. Per 1000. Diarrhoea. Per 1000. Phthisis. Per 1000. Church End... 13.8 143 120.8 2.6 .7 .8 Harlesden ... 13.0 134 151.0 1.6 .8 .5 Kensal Green 11.6 124 113.6 1.9 .6 .9 South Kilburn 22.8 182 232.8 4.4 1.0 1.5 Mid Kilburn... 16.6 149 188.9 2.9 1.9 1.1 North Kilburn 13.0 122 124.5 1.7 .6 1.6 Willesden Green 10.2 113 102.8 1.2 .5 .6 (18) On the statistical evidence South Kilburn shows much the worst as regard unhealthiness, Mid Kilburn and Church End coming next, both being above the average for the whole District. Willesden Green shows best and is followed closely by North Kilburn, and Kensal Green, Harlesden being intermediate between the two classes. The rates of infantile mortality are the only ones of those above given which are strictly comparable since in the different Wards the age and sex distribution varies extensively, as will be seen from the charts. Zymotic deaths are contributed to, for the most part, by persons in the first decennium of life, and this applies largely also to diarrhoea deaths. The deaths from phthisis 011 the other hand occur almost exclusively between the ages of 15 and 55, deaths at this age period constituting 81'0 per cent, of the whole of those from this disease. A glance at Chart No. III. will show how the population at these age periods is distributed in the different Wards, but disturbance arising from difference of age constitution does not apply to the rate of infantile mortality. It is calculated on the number of deaths (19) occuring under one year of age in proportion to the number of births for the year in the Ward under consideration. It is noticeable that the rate of infantile mortality places the Wards in almost the same order of healthiness or unhealthiness, as they would be when judged by the other rates. ILLEGITIMATE DEATHS. These deaths numbered 36; of these, 32 were certified, and 2 uncertified, and 2 inquests were held. Of the certified deaths, the causes were:—Marasmus 5, Diarrhoea 5, Pneumonia 5, Diphtheria 4, Premature Birth 3, Measles 2, Food Atrophy 2, Dentition 2, Debility from birth 2, Gastro Enteritis 2, Asthenia, Convulsions, Tabes Mesenterica, and Double Hare-Lip, 1 each. UNCERTIFIED DEATHS. Total 26. This is a great increase on last year, when they numbered 8. Up to last year they had been diminishing rapidly. The figures for the last four years are 28, 19, 11 and 8. Croydon, with an estimated population of 137,917, and Hornsey, with an estimated population of 75,765, have no uncertified deaths for the year to be contrasted with Willesden's (20) 26. Since 1878, the proportion of uncertified deaths to certified has steadily decreased for England and Wales, and it is a matter for regret, if not for appprehension, that in so large a population as Willesden's, virtually an integral part of the Metropolis, no fewer than 26 people should die in one year, and be unattended by a medical man, and the cause of death remain uncertified. It is ground for apprehension since the occurrence of such a large number of cases cannot but open the door to crime, which shall remain undetected. That Hornsey and Croydon for the same period have no uncertified deaths to set against Willesden's 26 cases is a contrast very unfavourable to us, and it is a question whether an inquiry should not be held by a duly qualified and appointed medical man into all deaths not properly certified by a medical practitioner where it is thought unnecessary to hold a coroner's inquest. Of these 26 deaths, 14 died under the age of one year, 8 between one and sixty, and 4 over sixty. The ascribed causes of death were:—Premature Birth 4, Convulsions 5, Syncope 8, Marasmus 1, Measles 2, Diarrhoea 2, Smallpox 1, Debility from birth 1, Apoplexy 1, Influenza 1. It is disquieting (21) that on the confines of London anyone should die from alleged Influenza, Smallpox, Diarrhoea or Measles, and be buried without a medical certificate of the cause of death being given, or a public inquiry into the death being held. DEATHS OUTSIDE THE DISTRICT. Of persons belonging to it, have been 103 in the Metropolis, and 105 in the Workhouse. Of those in the Metropolis there have occurred in the thirty Hospitals and Infirmaries, 115; in lunatic asylums, 23; and in other places, 25. Twenty-five inquests were held. There have been 17 deaths from Consumption, and 7 from other tubercular diseases. INQUESTS. The number of inquests held in the District was 90, of which 45 were ascribed to natural causes, 25 to accident, 2 to negligence, 12 to suicide, 1 to misadventure, 2 found drowned, 1 convulsions from improper feeding, 1 alcoholic poisoning and 1 murder. Of those dying by suicide 2 were returned as shot by revolver, 2 by cut throat, 1 by throwing herself in front of train, and 7 by poisoning. Of those dying from taking poison, oxalic acid caused 1 death, prussic (22) acid 1, corrosive sublimate 1, carbolic acid 2, poison not specified 2. Of the inquests into the causes of death from accidents, 10 were due to suffocation in bed. This "accident" means nothing less than culpable negligence, and it is regretable that in this country, as in others, it is not a penal offence for mothers to have their infants sleeping in the same bed with them. Of the other accidents 5 were ascribed to falls, 2 to poisoning by gas, 1 to drowning, 3 to being run over by passing train, and 4 otherwise. 23 TABLE No. 7. Year. Population estimated to Middle of each Year. Births. Deaths under One Year of Age. Deaths at all Ages. Total. Deaths in Public Institutions. Deaths of Nonresidents registered in District. Deaths of residents registered beyond District. Deaths at all Aoe8. Nett. Number. Rate* Number. Rate per 1,000 Births registered. Number. Rate* Number. Rate* 1895. 79260 2469 31.2 373 150 1084 13.6 1896. 85421 2749 32.2 460 167.3 1210 14.16 9 111 1312 15.29 1897. 92605 2887 31.05 444 l50.4 1173 12.5 12 182 1343 14.4 1838. 99180 3142 31.68 427 130.6 1197 1206 9 200 1388 13.93 1899. 107044 3375 31.5 537 150.9 1448 13.5 4 199 1643 15.2 1900. 114905 3559 31.1 463 130.09 1359 11.8 7 225 1577 13.68 1901. 116089 3670 31.7 456 124.2 1325 11.4 51 9 213 1529 13.17 Averages for 99215 3121 3149 451 143 35 1256 12.71 8.3 188.3 1466 14.27 1895-1901 1902. 122211 3835 31-38 498 129 8 1447 11-8 55 6 268 1715 13-9 *Rates calculated per 1,000 of estimated population. (24) TABLE No. 8. Names of Localities. CHURCH END. HARLESDEN. KENSAL OREEN. SOUTH KILBURN. yeab. Population estimated to middle of each Year. Births Registered. Deaths at all Ages Deaths under 1 year Population estimated to middle of each Year. Births Registered. Deaths at all Ages. Deaths under 1 year. Population estimated to middle of each Year. Births Registered. Deaths at all Ages. Deaths under 1 year. Population estimated to middle of each Year. Births Registered. Deaths at all Ages. Deaths under 1 year. 1895 9572 350 148 41 12784 346 144 40 10339 418 160 83 13387 473 240 93 1896 10589 440 181 83 13523 383 146 46 11757 510 190 83 13441 449 253 101 1897 11907 391 154 63 15194 413 172 57 14157 538 205 96 13492 452 224 97 1898 13280 544 181 66 15854 420 156 53 16331 633 186 74 13546 490 251 93 1899 15144 655 238 106 16499 477 196 68 19199 680 242 111 13644 463 239 82 1900 16688 701 278 100 17542 491 214 70 22380 785 304 94 13819 416 279 66 1901 19367 754 278 125 17115 508 226 59 23541 817 261 78 14625 431 278 66 Averages of Years 1895 13792.4 548 208.2 83.4 15501.5 434 179.1 56.1 16815 626 219.7 88.4 13707.7 453.4 252 87 to 1901. 1902 20153 786 281 95 17924 576 233 78 25296 871 294 99 14923 447 352 104 (25) TABLE No. 8.— Continued. Names of Localities. MID KILBURN. NORTH KILBURN. WILLESDEN GREEN. Yeab. Population estimated to middle of each Year. Births Registered. Deaths at all Ages. Deaths under 1 year. Population estimated to middle of each Year. Biiths Registered. Deaths at all A get*. Deaths under 1 year. Population estimated to middle of each Year. Births Registered. Deaths at all Ages. Deaths under 1 year. 1895 11339 381 184 64 9178 197 107 23 12661 304 101 27 1896 11527 355 177 65 9554 205 105 25 14499 407 156 57 1897 11787 379 180 64 11203 183 83 22 14985 509 154 45 1898 11968 377 173 62 12384 169 84 13 15678 492 164 62 1899 12201 380 179 56 12662 208 138 33 17695 512 213 79 1900 12298 380 185 49 13002 224 118 23 19176 562 199 61 1901 12290 370 160 44 9913 201 123 29 19238 589 203 59 Averages of Years 1895 to 1901. 11915.7 374.5 176.8 57.7 111.28 198.1 108.2 24 16276 482.1 170 55 .7 1902 12477 344 203 65 10259 249 134 31 21179 622 218 64 (26) TABLE No. 9. CASES OF INFECTIOUS DISEASE NOTIFIED DURING THE YEAR 1902. Cases notified in Whole District. Total Cases notified in each Locality. Wards. No. of Cases removed to Hospital from each Locality. Wards. Notifiable Diseases. At all Ages. Under 1 year. 1 and under 5. 5 and under 15. 15 and under 25. 25 and under 65. 65 and upwards. Church End. Harlesden. Kensal Green. South Kilburn. Mid Kilburn. North Kilburn. Willesden Green. Church End. Harlesden. Kensal Green. South Kilburn. Mid Kilburn. North Kilburn. Willesden Green. Small Pox 88 3 12 12 15 14 2 38 10 13 4 2 3 18 35 8 11 3 2 2 11 Cholera ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Diphtheria 433 14 115 208 49 46 200 110 44 21 23 13 22 108 56 20 13 10 4 11 Membranous croup 7 ... 4 3 ... ... ... 2 1 ... 2 ... ... 2 ... ... ... ... ... ... ... Erysipelas 104 6 9 7 10 61 11 15 16 12 26 17 2 16 ... ... ... ... ... ... ... Scarlet Fever 466 5 120 271 47 23 ... 153 75 78 29 26 37 68 101 37 44 28 18 21 33 Typhus Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Enteric Fever 73 ... ... 20 17 35 11 8 22 5 8 7 12 5 1 34 1 1 1 2 Relapsing Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Continued Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Puerperal Fever 8 ... ... ... 1 7 ... 2 1 ... 2 ... 2 1 ... ... ... ... ... ... ... Plague ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Totals 1179 28 260 521 139 216 15 421 221 169 89 76 64 139 249 102 78 45 31 28 57 (27) TABLE No. 10.—Causes of, and Ages at, Death during Year 1902. Causes of Death. Deaths in whole District at subjoined Ages. Deaths in Localities (at all Ages). Deaths in Public Institutions. All ages Under 1. 1 and under 5. 5 and under 1. 15 and under 25. 25 and under C5. 65 and upwards. Church End. Harlesden. Kensal Green. South Kilburn. Mid Kilburn. North Kilburn. Willesden Oreen. Small-pox 7 .. 2 .. l 4 .. .. .. 4 1 .. .. 2 .. Measles 66 18 38 10 .. .. .. 4 .. 9 36 11 4 2 .. Scarlet fever 12 , . 4 6 l i .. 7 .. i 1 .. .. 3 .. Whooping-cough 25 13 11 1 .. .. .. 4 4 7 5 .. 3 2 .. Diphtheria and membranous croup 53 9 28 14 l l .. 22 10 8 4 l 3 5 .. Croup . 5 2 .. .. .. .. .. .. 1 2 1 .. .. 1 .. Fever Typhus .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Enteric 15 .. .. .. .. 9 .. 1 .. 4 4 3 2 1 .. Other continued .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Epidemic influenza 30 5 .. .. .. 14 8 4 6 5 4 6 3 2 .. Choler .. .. .. .. .. .. .. .. . . .. .. .. .. .. .. Plague . . .. .. .. .. . . .. .. .. .. .. .. .. .. Diarrhoea 104 91 .. 1 .. 1 3 16 16 17 16 21 6 12 .. Enteritis 11 9 .. 1 .. .. 1 .. 2 .. 3 2 1 3 .. Puerperal fever 4 .. .. .. .. 4 . . 2 .. 1 1 .. .. 2 .. Erysipelas 5 1 .. .. .. 3 1 .. .. 2 3 3 .. .. .. Other septic diseases 10 2 .. 1 i 3 3 1 .. .. 3 1 2 3 .. Phthisis 111 2 3 7 20 75 4 18 10 25 23 14 7 14 .. (28) TABLE No. 10.—Causes of, and Ages at, Death during Year 1902.—(Continued). Causes of Death. Deaths in whole District at subjoined Ages. Deaths in Localities (at all Ages). Deaths in Public Institutions, All ages. Under 1. 1 and under 5. 5 and under 15. 15 and under 25. 25 and under G5. 65 and upwards. Church End. Harlesden. Kensal Oreen. South Kilburn. Mid Kilburn. North Kilburn. Willesden Green. Other tubercular diseases 49 17 19 7 .. 6 .. 9 I 15 8 6 6 4 .. Cancer, malignant disease 97 .. .. 1 3 59 34 15 12 12 20 13 11 14 .. Bronchitis 147 42 13 .. .. 22 70 38 16 24 25 19 8 17 .. Pneumonia 144 52 33 4 i 37 17 17 25 24 39 12 9 18 .. Pleurisy Other diseases of 7 1 1 .. .. 2 3 .. 1 2 1 .. .. 3 .. piratory organs Alcoholism and 19 4 1 1 2 5 6 4 3 0 1 2 2 2 .. Cirrhosis of liver 22 .. .. .. . . 17 5 3 4 3 2 7 2 1 .. Venereal diseases 8 7 .. .. .. 1 .. .. 1 .. 2 3 1 1 .. Premature birth 18 88 .. .. .. .. .. 13 10 19 18 6 9 13 .. Diseases and accidents of parturition 3 .. .. .. .. 3 .. .. .. 1 1 .. .. 1 .. Heart diseases 118 3 2 2 5 66 40 26 15 20 20 15 7 15 .. Accidents 49 9 3 7 7 21 2 7 11 8 7 7 2 7 .. Suicides 12 .. .. .. .. 12 .. 2 3 1 1 2 1 2 .. Murder 1 1 .. .. .. .. .. .. .. .. .. .. .. .. .. All other causes 493 160 28 9 10 135 151 68 82 75 103 52 45 68 .. All causes 1715 536 200 72 58 501 348 281 233 294 342 203 134 218 55 (29) TABLE No. 11. (29 ZYMOTIC MORTALITY DURING THE LAST TEN YEARS. EATE PEE 1,000. 1893. 1894. 1895. 1896. 1897. 1898. 1899. 1900. 1901. Rate for the Country Generally. 1902. Rate for the Country Generally. Scarlet Eever 0.21 0.09 021 0.19 0.11 0.09 0.14 0.10 0.10 0.13 0 08 0.14 Enteric Eever 0.13 015 015 0.1l o.ll 008 0.08 0.12 0.08 0.16 0.07 0.13 Diarrhoea 0.75 0.42 0.7 0.83 1.3 099 1.58 1.19 1.05 0 91 0.81 0.37 Diphtheria 0.63 0.21 0.42 0.32 0.68 0.65 0.42 0.24 045 0.27 0.40 0.23 Seven principal Zymotic Diseases 2.18 1.94 1.66 3.40 2.86 2.54 2.75 2.38 2.26 2.05 2.16 1.62 General Rate from All Causes 15.46 13.25 13.67 15.40 14.44 12.06 13.5 13.72 1317 16.9 13.9 16.3 (30) TABLE No. 12. NOTIFICATIONS. 1892. 1893. 1891. 1895. 1696. 1897. 1898. 1899. 1900. 1901. 1902. Small Pox 5 23 21 5 2 — 1 - - 10 88 Scarlet Fever 366 * 589 * 268 * 392 475 * 510 361 * 414 335 553 466 * Diphtheria 141 (1.4) 221 (3.1) 125 (2.6) 179 171 (2.1) 270 333 (3.3) 317 225 399 433 (3.5) Croup 4 8 4 7 2 5 2 2 1 5 7 Typhus Fever — 1 — - - - - - - - - Tyhoid Fever 28 47 70 69 52 52 66 79 77 57 73 Continued Fever - — 2 — 1 1 — — — — — Puerperal Fever 4 6 4 8 10 9 2 6 8 2 8 Cholera Nostras 1 1 1 — 1 2 — 1 — — — Erysipelas 85 139 63 81 101 107 70 82 89 79 104 Plague (Pestis minor) - - - - - - - - - 1 — Totals 634 1035 558 741 815 956 835 901 735 1106 1179 Rate per 1000 9.64 14.96 7.5 9.3 9.5 10.28 8.42 8.3 6.39 9.52 9.65 * Notification rate per 1000 population. 31 NOTIFICATIONS DISTRIBUTED IN WARDS. TABLE No. 13. WARDS. Plague. Small Pox. Scarlet Fever. Diphtheria Typhoid Fever. Erysipelas. Croup. Puerperal Fever. TOTAL. Church End .. 38 153 200 11 15 2 2 421 Harlesden • • 10 75 110 8 16 1 1 221 Ken sal Green .. 13 78 44 22 12 .. .. 169 South Kilburn • • 4 29 21 5 26 2 2 89 Mid Kilburn .. 2 26 23 8 17 .. .. 76 North Kilburn .. 3 37 13 7 2 .. 2 64 Willesden Green .. .. 18 68 22 12 16 2 1 139 Totals .. 88 466 433 73 104 7 8 1179 32 ANALYSIS OF NOTIFICATIONS. TABLE No. 14. WARDS. Total No. of Roads. Total No. of Roads infected. Total No. of Roads not infected. Average No. of cases per Infected Road. Average No. of cases per Road. Infected Road3. Per cent, of whole. Notification Rate per 1,000 of Population. Church End 69 55 14 7.6 6.1 79.7 20.8 Harlesden 56 39 17 5.6 3.9 69.6 12.2 Kensal Green 64 42 22 4.02 2.6 65.6 6.6 South Kilburn 35 18 17 4.9 2.8 51.4 5.9 Mid Kilburn 33 19 14 4.0 2.3 57.5 6.0 North Kilburn 34 19 15 3.3 1.3 55.8 6.2 Willesden Green 73 43 30 3.2 1.9 58.9 6.5 (33) Children admitted to Dog Lane Hospital, February to December, unvaccinated— 26.3 per cent. VACCINATION RETURNS. Years. No. of Births. Successfully Vaccinated. Insusceptible. Dead. Conscientious Objectors. Postponed by Doctor. Gone Away. Unvaccinated. 1898 3125 1474 13 257 37 117 259 968 1899 3375 1615 24 345 63 76 91 1161 1900 3560 1704 8 253 106 56 268 1165 1901 3670 2351 12 304 120 40 280 563 1902 3835 2548 28 353 84 39 352 430 The total number of successful vaccinations of children of all ages up to 14 years in 1902, including the above, was 3967. R. HAYLOR, Vaccination Officer. ( 34 ) NOTIFICATIONS OF INFECTIOUS DISEASES. From the above table, No. 14, it will be noticed that several roads in each of the wards were infected with one or more of the notifiable diseases. Church End had by far the highest incidence, Harlesden and Kensal Green coming next, the subsequent order being:—Willesden Green, North Kilburn, Mid Kilburn, and South Kilburn. The average number of cases per infected road gives a somewhat different order, Church End and Harlesden still coming first, and South Kilburn, which had the least per centage of infected roads and the lowest rate per 1,000 of population, is third in order as regards the number and per centage of cases per road and per infected road. This is to be accounted for on the ground of lessened facilities for temporary isolation which exists in this Ward as compared with those having a higher per centage of infected roads. SMALL POX. During the year, 88 cases of Small Pox were notified, of which 38 occurred in Church End, 18 in Willesden Green, 13 in Kensal Green, 10 in Harlesden, ( 35) while Mid Kilburn, North Kilburn, and South Kilburn, had 2, 3 and 4, respectively. These 88 cases represented a succession of outbreaks quite independent of each other, the primary case in each outbreak being traceable in its origin to cases occurring outside the District, for the most part within the. administrative County of London. Each of these outbreaks was stamped out completely and effectually, but the occurrence of fresh foci of infection maintained an almost uninterrupted succession of cases. It is ground for gratification that in a year manifestly favourable to the epidemicity of Small Pox it has been possible to have saved the District from a serious epidemic of this disease, to which, from its proximity to London, Willesden was so continuously threatened. There can be no question that the prompt action of the Council in erecting with remarkable expedition an Isolation Hospital for Small Pox has been the means of saving the District from a disastrous epidemic. Without doubt, the extensive advantage which was taken of the facilities offered for vaccination did much to prevent the spread of Small Pox, but, (36) notwithstanding the extent to which the public availed themselves of this, it must be admitted that a large population was always with us wholly unprotected from the infection of this disease. I have kept at the Isolation Hospital, Hog Lane, a record as to the condition of children as regards successful vaccination, and I find that notwithstanding the large amount of vaccination and re-vaccination which was practised in the early part of the year, no fewer than 26.3 per cent. of the children admitted to the Hospital suffering from Scarlet Fever and Diphtheria were unvaccinated. These figures probably represent approximately the proportion of the child population still unprotected from Small Pox by means of vaccination. The value of vaccination where Small Pox is prevalent can best be judged from the analysis of cases admitted to the Small Pox Hospital during the year, and furnished in my Hospital Report. SCARLET FEVER. Four hundred and sixty-six cases of Scarlet Fever were notified during the year, as compared with 533 in 1901. The mean number of cases of this disease notified during the last ten years is 426, but during (37) this time the population has doubled, so that the incidence of Scarlet Fever cannot be considered excessive, as compared with past years. RETURN CASES OF SCARLET FEVER. The occurrence of what are known as return cases has led in certain quarters to a questioning of the utility of Isolation Hospitals as a means of preventing the spread of infection. Return cases are cases understood to arise from infection by exposure to cases discharged from Hospital as well, and presumably free from infection. It is alleged that in the case of Scarlet Fever the number of return cases is so great as fully to compensate for any gain that might arise from isolation in Hospitals. It is insisted upon that the aggregation of a great number of infectious cases in one building makes it practically impossible for the Scarlet Fever patient to get rid of his infectiousness, and it is urged that not the aggregation which the present Hospitals provide, but isolation, in the strict sense of the term, is necessary in order to stamp out the infection arising from an attack of this disease. The question is a serious one, because the fact of the occurrence of return cases cannot be gainsaid, and the (38) fact that Hospitals for preventing the spread of infection are costly no one will deny, and their costliness can be justified only on the grounds of their etficiency, not only as regards the improved chances of recovery given to a patient, but also upon the ground of guarding the public from infection, which is the theoretical basis upon which they are provided. It is asserted also that return cases were not known, and still do not occur, when the case is isolated at home. To test the accuracy of these statements as applied to Willesden, I have been at some pains in tabulating the number of cases where more than one member of a household has been attacked with Scarlet Fever during the past year, and the results of this investigation are given in the following tables : (39) TABLE No. 15. SCARLET FEVER. Total No. of cases in which the notifications were consecutivc, but where the secondary cases occurred within the incubative period of the primary. WARD. No. of Cases. No. of Houes. No. of Cases per House. Church End 14 11 Harlesden 4 3 Kensal Green 2 2 South Kilburn 2 2 Mid Kilburn - - North Kilburn 2 2 Willesden Green 2 2 Totals 26 22 2.4 TABLE No. 16. Cases nursed at home with secondary notifications beyond the incubative period. ward. No. of Secor dary Cases. No. of Houses. Interval between Notification of Primary and Not fication of Secondary Cases. Church End 3 3 53 Days. 14 15 Harlesden 5 4 73 20 135 83 Kensal Green 1 1 36 — — — South Kilburn — — — — — — Mid Kilburn — — — — — — North Kilburn 2 2 10 9 — — Willesden Green 2 2 18 10 — — Totals 13 12 (40) TABLE No. 17. Total No. of cases occurring where primary case had been discharged from Hospital within one month of notification of secondary. \ward. No. of Infecting Cases. No. of Returns. No. Of Houses. Interval in davs from date of discharge to occurrencf of return. Church End 2 3 2 5 5 5 Harlesden — — — — — — Kensal Green 1 1 1 11 — — South Kilburn 1 1 1 16 — — Mid Kilburn — — — — — — North Kilburn 1 1 1 25 — — Willesden Green 1 1 1 8 — — Totals 6 7 6 TABLE No. 18. Total No. of cases occurring where primary case had been discharged from Hospital after one month of notification of secondary. Church End.—Two cases were followed respectively three months and seven months later by secondary cases occurring in the same houses as the primary cases were discharged to. They are not included in the above list of return cases. (41 ) TABLE No. 19. Total No. of Cases in which the secondary case exceeds the incubative period, but occurring Whilc the primary case was still in Hospital. WARD. No of Secondary Cases No. of Houses. Interval between Primary and Secondary. Interval between date of Disinfection and Secondary. Church End 4 4 31, 14, 48, 49a 30, 13, 47 Harlesden 1 1 9 9 Kensal Green 1 1 18 South Kilburn — — Mid Kilburn 1 1 16 — North Kilburn 4 1 13,34, 356,60c — Willesden Green 2 1 11, 11 Totals 13 9 (a).—Primary case discharged from Hospital 18 days before notification of secondary, which was desquamating, and with definite history of onset, 2 days prior to date of discharge from Hospital of primary case. (b).—Infecting case. Undiscovered until after occurrence of second case of which it was the source. (c).—Onset of illness the same day, but a few hours prior, to return from Hospital of first case. ( 42) It is certain that so far as Willesden is concerned, our experience does not bear out the statements made that return cases are so numerous as to invalidate the usefulness of Isolation Hospitals. During the year, 277 patients were discharged from Hospital as having recovered from Scarlet Fever, and as presenting at the date of their discharge no evidence of infectiousness. The event has proved that six of these cases, or 2.1 per cent., were at the time of their discharge, or within one month subsequent to this, apparently capable of giving rise to Scarlet Fever in other persons with whom they came into contact, since in the households to which they were discharged return cases have occurred. It would be a mistake, however, to conclude that every case classed as a return inevitably received its infection from the case discharged from Hospital. Twice within the last few months it has been my experience to receive notifications from households to which cases discharged from Hospital had returned prior to the receipt of the notification. On investigation, however, it was found in one case that the notification was of a case which (43) definitely and unmistakably sickened with Scarlet fever two days prior to the return home of the patient discharged from Hospital. In the other, an equally definite history of the existence of unmistakable Scarlet Fever symptoms, a few hours prior to the return of the case discharged from Hospital was equally definitely established. These coincidences servo to show how careful it is necessary to be before concluding that the relationsbip between the return home from Hospital of a discharged case and the occurrence of a fresh one of the same disease, is in that of cause and effect. But if it be granted that the seven cases above referred to did actually derive their infection from the six supposed infecting cases discharged from Hospital, it must be confessed the evil is very small compared with what would result had the 277 cases been nursed at home under conditions in which any kind of isolation, during at least six weeks of infectiousness, would have been virtually impossible, for when we turn to the evidence to be derived from a review of the cases isolated at home under unmistakably better conditions than would have been possible for the 277 cases aggregated in and (44 ) discharged frum the Hospital, we find anything but a satisfactory state of affairs revealed. Out of 466 cases of Scarlet Eever notified, all but 184 were removed to Hospital. In 12 of the houses out of the total in which these 184 cases occurred, secondary cases, amounting in all to 13, occurred at an interval later than the incubative period of the disease dating from the receipt of the notification. Of course, here again it would be wrong to assume that the secondary cases were derived from the primary case, simply and solely because they occurred in the same house within, in most cases, a reasonable interval after the occurrence of the primary case. There is another class of case shown in the above tables, calling for attention and comment. It is that of secondary cases arising in houses from which the primary case had been removed to Hospital after the incubative period had expired, and while the primary was still in Hospital. During the year 13 such cases occurred in nine houses. This must not be set against the value of an Isolation Hospital, since it is certain that they did not derive their infection from the case in Hospital, but contracted it either by means of some article escaping disinfection or, as was demonstrated in one succession (45 ) of cases at least, from a case, or cases, escaping recognition until several members of the family had been infected. Scarlet Fever is often of so mild a type that this is liable to occur in some cases. Altogether, the above analysis, though in many respects unsatisfactory, cannot be wholly so regarded. DIPHTHERIA. Four hundred and thirty-three cases of Diphtheria were notified during the year. This is the largest number of cases notified during the last ten years, and therefore the largest number yet notified in Willesden. The mean for the last ten years is 238. The rate of notifications of Diphtheria per 1,000 of the population is 3 5; in 1901 it was 3.4, in 1898 it was 3.3, in 1893 it was 3.2, so, although the rate is the highest yet recorded, it is only slightly in excess of what has occurred in previous years, even so far back as 1893. The least recorded rates for Diphtheria are 1.4, 1.6, and 2.1 for the years 1891, 1894, and 1896 respectively. The incidence of Diphtheria on Urban populations throughout the country is an increasing one. Its (46) cycles of recurrence after intervals of comparative freedom have been frequently noted, and these considerations are ground for not viewing with too great an apprehension the outbreak which excited such misgiving on the part of the public. The agitation which the outbreak aroused is a satisfactory indication of the increased interest in questions of sanitation and hygiene and contrasts favourably with the complete indifference which in the past has marked the public attitude towards matters affecting the public health. TYPHOID FEVER. Seventy-three cases of this disease were notified, as compared with 57 in 1901, and 79 and 77 in 1899 and 1901 respectively. Fourteen of these cases were treated at the Council's Isolation Hospital, others being removed to the Cottage Hospital or the London Hospitals. In most of the cases the origin of this disease was to be traced to sources outside the district. (47) The consumption of shell fish at a date from the onset of illness coinciding with the incubative period of the disease was noted in a considerable number of cases notified. The cases nursed at home were followed by the occurence of secondary cases in a considerable proportion of the whole. MEASLES & WHOOPING COUGH. These diseases are now responsible each of them for many more deaths each year than any of the other notifiable diseases. During the year there were recorded no fewer than 66 deaths from Measles and 25 from Whooping Cough compared with 50 from Diphtheria. The 66 deaths from Measles represent not only directly a greater number of cases, but relatively also, since the fatality rate from Measles is lower than that from Diphtheria. These 66 deaths represent a volume of sickness many times greater than that represented by the 50 deaths from Diphtheria, yet the district passed through this visitation of Measles without any anxiety being manifested, while the slightly increased incidence of Diphtheria caused an outcry. This (48) apprehension of Diphtheria on the one hand, and indifference to Measles on the other, is in large measure to be accounted for by the fact that the one disease is compulsorily notifiable while the other is not. If, for no other reason than the removal of the "only Measles" attitude, the compulsory notification of Measles would justify the expense. What I have stated with regard to Measles applies equally to Whooping Cough, for although this year only 25 deaths have occurred last year there were no fewer than 57. To make these diseases notifiable is greatly to increase the cost of Public Health administration, since if their incidence is to be diminished the same or similar means for prevention will be required to be taken, but there can be no doubt that if these measures were taken there would be, as in the other notifiable diseases, a lessened incidence and a lessened mortality, and the economic gain to the community would far outweigh the cost. TUBERCULAR DISEASES AND CANCER. One hundred and eleven deaths from Phthisis, and 49 from other Tubercular diseases were recorded 49 as compared with 96 and 47 last year. The rates in the different wards are given in Table No. 6. The 97 deaths ascribed to Cancer run the 111 from Phthsis very closely. It is doubtful, however, how far the increase of the deaths ascribed to Cancer is real, as there can be no doubt that much of it is due to improved diagnosis. METEOROLOGY. The following table and diagrams give the chief data for the year. They are an abstract from the records of observations made at the Council's Meteorological Stations situated at the Hospital and the Sewage Farm. 50 TABLE No. 20. 1903. Highest by day. Lowest by Night. Ringe in mouth. Mean of all highest. Mean of all lowest. Four-foot earth Thermometer. Meandepree of humidity. Rainfall in inches. Number of riavs on which rain fell. Maximum. Minimum. January 56 20.0 36.0 47.2 36.8 46.00 45.25 88 0.66 6 February 52.5 10.7 41.7 41.6 30'4 45.00 43.00 90 1.23 8 March 61 25.5 35.5 41.0 360 44.50 43.00 89 1.84 12 April 67 260 41.0 55.3 36.9 46.25 43.75 78 0.54 9 May 68 27.0 41.2 57.0 38.4 48.25 46.25 69 2.74 18 June 81.5 36.0 36.0 64.6 48.7 53.00 48.25 70 3.69 16 July 82 390 43.2 71.8 50.9 57.75 53.00 65 1.70 10 August 77 41.0 36.2 68.6 52.0 58.25 57.00 75 3.74 13 September 70.7 33.2 37.5 65.5 47.2 58.75 57.00 80 110 5 October 63.9 31.0 32.9 56.3 42.9 57.00 54.00 81 1.36 10 November 58.5 25.5 330 49.1 38.5 5400 50.50 87 1.80 11 December 56.9 23.5 33.4 44.6 36.8 50.25 47.50 87 1.38 7 Means 66.2 28.2 37.3 55.2 41.3 51.75 49.00 79.9 21.78 125 (Total.) (Total.) (51 ) GEOLOGICAL CHARACTER OF DISTRICT. I am indebted to Messrs. McVitie & Price for their kindness in furnishing me with the following new facts concerning the underlying Strata, as discovered by a boring at their works in Willesden. Details of Strata discovered during boring of Artesian Well at Messrs. McVitie & Price's, Lower Place. Total depth 837 feet. Boring commenced the middle of June, 1902, finished the end of August, 1902. Depth, feet. Thick ness. Depth. feet. Thick ness. 52 52 Yellow Clay 359 30 Hard chalk 62 10 Blue Grey Clay streaked 366 7 Flint 368 2 Chalk & small flint 80 18 Blue Grey Clay 438 70 Chalk and flint 123 Water level 513 75 Chalk 126 46 Brown clay 524 11 Chalk and sand 236 110 „ „ Boulders 525 1 Flint 240 4 Clay 544 19 Flint and chalk 250 10 Quicksand 545 1 Flint 259 9 Clay and pebbles 551 6 Chalk 279 20 Clayey sand 555 4 Chalk and flint 288 9 Sandstone 566 11 Hard chalk 290 2 Flint 651 85 Light grey chalk 302 12 Sand 691 40 Sand and chalk 305 3 Flint pebbles 716 25 Chalk 309 4 Sand 726 10 Chalk & small flint 311 2 Flint 750 24 Grey chalk & marl 313½ 2½ Lime 752 2 Sand 315 1½ Flint 758 6 Chalk 318 3 Hard rock 320 2 Flint 762 4 Micaceous streaks 328 8 Chalk and flint 826 64 Grey chalk & marl 329 1 Flint 837 11 Hard chalk ( 52 ) I have to thank Mr. Robson for kindly supplying me with the following information concerning the underlying Strata, as discovered by a boring at the Metropolitan Railway works, Neasden. Details of Strata discovered during Boring of an Artesian Will, at the Metropolitan Railway Works, Neasden. Total depth 400 feet. Depth. Thickness 3 teet ... Made Ground 8 „ 5 feet Ballast. 37 „ 29 „ London Clay. 78 „ 41 „ Coloured Clay. 95 „ 17 „ Black Pebbles and Sand, (very hard) 95½ „ ½ „ Green Flints. 400 „ 304½ „ Chalk. Height of water when not pumping 40 feet. UNDERGROUND BAKEHOUSES. A preliminary inspection of the underground bakehouses in the District, numbering 27, has been made and with few exceptions considerable alterations will be necessary in order to render the bakehouses suitable, from a sanitary point of view, for their purpose. The table at the end of the report shows the chief facts concerning the existing bakehouses as regards construction, light, ventilation, and other respects. ( 53 ) DUST COLLECTION. For the purpose of the collection of house refuse the district is divided into three. The collection is a weekly one and under the supervision of the Public Health Department, is done by contract. The dust collected in No. 1 District is removed in van to Paddington and discharged into barges and taken to other parts of Middlesex. The Contractors for the other two districts depend for the disposal of their refuse on brickfields in the neighbourhood and outlying parts. With the exception of about two months the whole of the refuse during the year from these two districts has been deposited at the Brent brickfields, Acton Lane, and for the other two months it was deposited at the Grange brickfields, Chambers Lane. Complaints of nuisance arising from the deposit and combustion of the refuse have on several occasions been received, and without doubt, the need for a dust destructor is an immediate one, and will become increasingly so with the rapid increase of population in and around the district. ( 54 ) Two Dust Inspectors in the employ of the Council supervise the collection, reporting each morning to the chief Sanitary Inspector and investigating the ground of such complaints as are received. These, considering the extent of the work involved, are very few, amounting only to 0.93 per cent. of the houses from which refuse is collected. In the appended table will be found the chief data in connection with the refuse disposal of the district. Total number of carts or vans 7,577. Average number of carts or vans daily 2 1.6. Average number of men daily 43.4. Total number of loads collected 23,933. Representing cubic capacity of 89,751 yds. Total number of houses 17,929. Average amount collected per house 1.3 loads. Number of loads removed per month Jan. 2,128 May 2,042 Sept. 1,929 Feb 1,846 June 1,910 Oct 2,071 March 1,907 July 2,154 Nov 1,840 April 2,161 Aug. 1,835 Dec. 2,110 ( 55 ) Number of working days per month:— Jan. 27 May 26 Sept. 26 Feb. 24 June 25 Oct. 27 March 24 July 28 Nov. 25 April 26 Aug. 25 Dec. 25 Total number of complaints, 167. HOUSES OF THE WORKING CLASSES ACT 1890. On the 25th March, Dr. Skinner represented to the District Council that certain houses in Dudden Hill Lane were in a condition such as to render them unfit for human habitation. Authority was then given to serve Notices under Section 94 of the Public Health Act, 1875, and Section 32 of the Housing of the Working Classes Act, 1890, with power to enforce if necessary. Certain works of amendment were at that time made to the drains, the owner stating that he proposed to convert the premises into shops, and desired what he described as the "decorative part" of the work to be left over until such time as the alterations were made, but in the meantime no attempt was made to carry out the requirements of the Council. Other (56) complaints having been received, I visited the premises on the 22nd October, and was so impressed with the state of indescribable filth and dilapidation which I found that I gave instructions for immediate action to be taken. Summonses were accordingly issued by the Clerk of the Council, which were heard at the Harlesden Police Court on the 30th October. The evidence of myself and the Sanitary Inspector having been heard, the case was adjourned at the request of the Clerk of the Council, to enable the Magistrates to view the premises. At the adjourned hearing the Magistrates made an order for the closing of one of the houses and the payment by the defendant of the costs of the tenants' removal. The summonses with regard to the three remaining houses were adjourned until the 20th November to enable the defendant to comply with the requirements of the Council. At the hearing of the adjourned proceedings, the Bench on November 20th made an order to close the remaining houses, and imposed a penalty of 20s. and costs for each of the houses. An allowance of 5s. to each tenant towards defraying the cost of removal was also made. (57) COWSHEDS AND MILKSHOPS. The number of cowsheds are gradually diminishing as the district expands. At the present time there are seven existing. During the past year Goddard's Farm at Lower Place has been closed. The Royal Agricultural Society having taken the land at the extreme end of the district bordering on Acton has practically absorbed another, one of the largest dairy farms in the Willesden area. Of those remaining one is situated in the South Kilburn Ward, two in Kensal Green Ward, three in Willesden Green Ward, and one in Llarlesden. The cow sheds are inspected annually and as occasions arise. The cleansing and limewashing of the sheds occurs during the time the cows are out at pasture. (58) TABLE No. 21. Showing Result of Inspections of Milk Shops in respect of the following items:— District. Number of Milkshops. Number found registered. Number found unregistered Condition of milk storage. Cleansing of milk vessels. Special provision made for beating of water. Number of Customers. Number of Vendors supplied by Distributing Agent. Number supplied direct by farmer. Satisfactory. Unsatisfactory. Satisfactory. Unsatisfactory. 1 42 32 10 42 — 42 — 21 12240 31 n 2 22 20 2 22 — 22 — In 10 cases only. 4627 15 7 3 19 6 13 18 l 19 — In 7 cases only. 2820 15 4 4 26 18 8 20 6 17 9 In 5 cases only. 4530 15 11 109 76 33 102 7 100 9 43 24217 76 35 (59) FOOD INSPECTION ON SATURDAY NIGHTS AND SUNDAY MORNINGS. Food offered for sale is periodically inspected on Saturday nights and Sunday mornings. Instituted some three years ago these inspections are still maintained and carried out by the Chief Sanitary Inspector, and the assistant Inspectors who take their turn alternately. During the twelve months 39 visits were made on Saturday nights, and 32 on Sunday mornings. The former require that the whole of the main thoroughfares where shops or stalls exist should be visited, while on. Sunday morning South Kilburn is the part of the District where shops are chiefly open. On no occasion during these visits was there any necessity to seize any articles exposed for sale as unfit for food. It frequently happens that complaint has to be made to the salesman that the articles are not very fresh. On all such occasions the proprietors have willingly withdrawn from sale such articles taken exception to. The vicinity of this District to the London Markets undoubtedly safeguards the food supply of Willesden, owing to the vigilance of the Inspectors of those markets. (60) FACTORY AND WORKSHOPS' ACT, 1901. The above Act, which became operative in January, 1902, made considerable alterations and additions to the duties of District Councils, with regard to factories, workshops, and work places, and it was deemed necessary to appoint an Inspector, principally to carry out the provisions of the Act. During the nine months since the appointment was made 205 workshops, 137 laundries, and 61 bakehouses have been inspected and placed on the register, besides 89 premises where work is carried on (principally in the making of wearing apparel, for firms in and outside the District), and known as outworkers. These have all been inspected and in many cases re-inspected, there having been 521 primary inspections and 387 re-inspections. Overcrowding was found to exist in 12 instances, 10 of these being dressmakers'establishments, and in 106 instances the premises were found to be in a very dirty condition, requiring whitewashing and cleansing. The appended table gives a summary of the visits and the work done during the nine months. (61 ) TABLE No. 22. Details of Inspections. Dress makers and other wearing apparel. Laundries. Miscellaneous. Total. Newly discovered and registered 74 8 20 102 Measured 29 7 27 63 Inspections 147 175 203 525 Re-inspections 27 252 88 367 Overcrowded 10 1 1 12 Insufficiently ventilated 2 2 Dirty condition 9 71 26 106 Space notices distributed 29 17 33 79 Houses visited for inquiry 141 Statutory and information notices sent 167 Bakehouses inspected and re-inspected 114 Do. contravening regulations 49 Visits to homes of outworkers 89 ( 62 ) CANAL BOATS. The following measures were taken in this district to carry out the provisions of the Canal Boats Acts, 1877-1884. During the year ending December, 1902, 125 boats were inspected, of which number 33 were found contravening the Acts and Regulations, and requiring the service of 35 complaint notes. The total number of infringements observed was 48, of which 26 have been remedied, leaving 22 to be dealt with in relation to which correspondence is still proceeding. There has been no notification of any infectious disease nor were any cases of sickness of an infectious nature discovered. Forty visits were paid to the canal for the purpose of inspecting boats. H. M. Inspector of Canal Boats visited these Offices on the 31st May, 1902, to inspect the books kept under the Acts, and expressed his satisfaction with the results of the boat inspections. Below will be found particulars of inspections and infringements. (63) Total number of Boats inspected 125 Total number of Boats contravening Acts and Regulations 33 Total number of Infringements met with 48 Total number of Infringements remedied 26 Total number of Complaint Notes issued 35 Total number of Complaint Notes complied with 18 Infringements and Nature of Same. Absence of Certificate, Act 1877, Section 3 12 Certificate not identifying Owner with Boat, Act 1877, Section 3 4 Marking, Act 1877, Section 3; Act 1884, Section 7; Regulation 7 5 Males over 14 years improperly occupying cabin, Regulation 8b 2 Overcrowding, Regulation, 8 2 Painting, „ 9 12 Ventilation, ,, 3c 1 Dilapidation, ,, 11 10 48 Number of Persons Occupying Boats Inspected. Men. Women. Children. Total 123 70 113 306 (64) EXPANSION OF WORK IN THE PUBLIC HEALTH DEPARTMENT. The pressure of work in the Public Health Department during the year has been very great. The rapid growth of the district, the industrial development within and around its boundaries, the prevalence of Small Pox, Scarlet Fever, and Diphtheria, the augmentation of work from recent legislation, have all contributed to make the year a heavy one. One additional Sanitary Inspector has been appointed, and two others in place of two resigned, but the department is still understaffed, and to cope with the work it will be necessary in the near future further to increase it. The turning over to the Council of the public Elementary Schools, and the assumption of responsibility for Elementary Education will doubtless entail additional work on the Executive responsible for carrying out measures affecting the public health. The Incorporated Society of Medical Officers of Health, alive to the importance of the conditions which the new Education Act has imposed, have passed the following resolutions:— (65) 1. That the hygienic control of public elementary and of other public schools should devolve on the Medical Officer of Health of the District. 2. That the Medical Officer of Health, or a Medical Practitioner acting under him, should be given entry and power to examine scholars on the same lines as laid down in the Eccles Corporation Act. 3. That the standard of cubic space in all schools should be raised to the maximum at present existing. 4. That a standard of purity of air in schools would be of great assistance. 5. That schools claiming grants should be required to produce a detailed report from the Medical Officer of Health, as to their sanitary condition on a form approved, showing that they are in a sanitary condition. 6. That the Medical Officer of Health should be required to record the action taken by his department in regard to schools, and to forward annually to the Board of Education such portions of his Report as relate to this subject. 7. That the Board of Education should secure a skilled medical adviser to co-ordinate the sanitary regulation of schools, and to organise a code of preventive measures applicable to schools. (66) 8. That school teachers should be instructed to notify to the Medical Officer of Health the occurrence of cases of alleged or of suspected infectious disease, and to furnish such other information as may reasonably be required by the sanitary authority. That it should further be obligatory on school teachers to carry out the requirements of the Medical Officer of Health as to the exclusion of suspected cases of infectious illness, subject to an appeal to the Board of Education. In view of the transference of schools to the District Council under the new Education Act, I beg leave to submit for your consideration the above resolutions in reference to schools, passed by the Incorporated Society of Medical Officers of Health. Some of these powers you are already seeking in the Bill now being promoted for the improvement of Willesden. Summary of the work done by the Sanitary Inspectors during the year 1902. ( 67 ) TABLE A. INSPECTIONS:— Complaints received 942 Cases of infectious disease notified 1179 Houses inspected from house to house 4219 Number of premises periodically inspected 525 Total number of houses, premises, &c. inspected 6865 Total number of re-inspections after notice or order 2940 Total number of inspections and reinspections 9805 NOTICES:— Letters written 2384 Letters received 2780 Cautionary notices given 2893 Statutory notices given 287 Summonses served 22 Abatement orders obtained 21 DWELLING HOUSES Closed as unfit for habitation 4 Demolished ... 0 Illegal underground dwellings vacated 0 CANAL BOATS Frequency or number of inspections Weekly Number of contraventions of regulations 48 ( 68 ) TABLE 13. SCHOOLS :— Number in District 29 Frequency or number of inspections, As required. Number amended 0 WORKSHOPS AND WORKPLACES Number in District 205 Frequency or number of inspections, Periodically. Contravention of Factory and Workshops Act 46 LAUNDRIES Number in District 137 Frequency or number of inspections, Periodically. Contravention of Factory and Workshops Act 74 BAKEHOUSES Number in District 61 Frequency or number of inspections, Periodically. Contravention of Factory and Workshops Act 49 SLAUGHTERHOUSES Number on Register 10 Frequency or number of inspections Quarterly. Contravention of Bye-Laws ... ... 0 COWSHEDS :— Number on Register 7 Frequency or number of inspections Yearly. Contravention of Bye-Laws 3 ( 69 ) DAIRIES AND MILKSHOPS Number on Register 109 Frequency or number of ins pections, Periodically Contravention of Bye-Laws 40 UNSOUND FOOD:— Animals seized 0 Articles and parcels condemned 0 TABLE C. DISINFECTION Rooms fumigated by Council's employees 1486 Cost of articles disinfected £ s. d.j £476 10 9 or destroyed 280 13 8 j- Cost of disinfecting rooms 185 17 11 DUST :— Dust bins repaired ... 26 New bins provided ... 87 Movable receptacles substituted for fixed 21 Periodical frequency of dust removals— House to house weekly. No. of complaints of non-removal received 167 SUNDRY NUISANCES ABATED Overcrowding 19 Smoke 1 Accumulation of refuse 28 Foul ditches, ponds, &c. and stagnant water 9 (70) I have in conclusion to express my thanks to the Sanitary Staff. A difficult position has been greatly relieved by their loyal support. The work of the Department during the prolonged and regretable absence of its chief has suffered no disorganisation, and I need add nothing to the statement of this fact, as an expression of my appreciation of the assistance which has been given me. I am, Gentlemen, Your obedient servant, WILLIAM BUTLER, Assist. Medical Officer of Health. INDEX. Page. Population—Table 1 2 Marriages—Table 2 9 Births—Tables 3—4 10 Do. —Illegitimate 13 Deaths 13 Do. —Table 5 15 Do. —Table 6 17 Do. —Illegitimate 19 Do. —Uncertified 19 Do. —Outside the District 21 Inquests 21 Notifications—Table 7 23 Do. —Table 8 24 Infectious Diseases—Table 9 26 Causes of Death—Table 10 27 Zymotic Mortality during the last 10 years— Table 11 29 Notifications—Table 12 30 Do. —Table 13 31 Analysis of Notifications—Table 14 32 Vaccination Returns 33 Notifications of Infectious Diseases 34 Small Pox 34 Scarlet Fever 36 Return Cases of Scarlet Fever 37 (72) Index—Continued. Page. Scarlet Fever—Table 15 39 Do. —Table 16 39 Do. —Table 17 40 Do. —Table 18 40 Do. —Table 19 41 Diphtheria 45 Typhoid Fever 46 Measles and Whooping Cough 47 Tubercular Diseases and Cancer 48 Meteorology 49 Do. —Table 20 50 Geological Character of District 51 Underground Bakehouses 52 Dust Collection 53 Housing of the Working Classes Act, 1890 55 Cowsheds and Milkshops 57 Do. —Table 21 58 Food Inspection on Saturday nights and Sunday mornings 59 Factory and Workshops Act, 1901 60 Do. —Table 22 61 Canal Boats 62 Expansion of work in Public Health Department 64 Summary of work done by Sanitary Inspectors 67 Charts I., II., III., IV At end of Report Rainfall Diagram „ Census Table ,, Underground Bakehouse Inspections ,, Systematic Inspections „ * CENSUS 1901. Ages of Persons, Males and Females, in the Urban District of Willesden and its Constituent Wards, 1901. All Ages. Under 1 Year. 1 2- 3— 4— Under 5 Years. 5— IO 13— 14— IO Years and under 15 Years. 15— 16— 17- 18- 19— 15 Years and under 20 Years. 20- 21 — 20 Years and under 25 Years. 25— 30- 35— 40— 45— 50 - 55— 6O— 65 70— 75— 80— 85— 90— 95— 1OO and upwards. p- 114,811 3,284 2,944 3,060 2,922 2,816 15,026 12,517 6,735 2,058 2,181 10,974 2,177 2,119 2,045 2,094 2,046 10,481 2,129 8,984 11,113 11,679 10,335 8,509 6,865 5,174 3,713 2,901 2,163 1,428 986 550 264 107 22 4 ... WILLESDEN, U. D. M. 53,714 1,664 1,518 1,505 1,408 1,445 7,540 6,183 3,324 997 1,065 5,386 1,082 988 928 898 918 4,814 940 3,971 4,911 5,239 4,703 4,103 3,310 2,436 1,680 1,318 888 547 345 188 88 33 2 ... ... F. 61,097 1,620 1,426 1,555 1,514 1,371 7,486 6,334 3,411 1,061 1,116 5,588 1,095 1,131 1,117 1,196 1,128 5,667 1,189 5,013 6,202 6,440 5,632 4,406 3,555 2,738 2,033 1,583 1,275 881 641 362 176 74 20 4 ... Wards:— CHURCH END | p- 19,185 624 630 631 591 606 3,082 2,449 1,265 373 373 2,011 373 325 313 285 326 1,622 313 1,336 1,649 1,805 1,698 1,385 1,001 821 578 389 266 196 120 58 39 13 2 1 ... M. 9,538 323 341 323 280 311 1,578 1,222 646 180 188 1,014 192 164 162 136 185 839 164 654 818 854 840 702 516 403 284 191 120 77 40 19 16 5 ... ... F. 9,647 301 289 308 311 295 1,504 1,227 619 193 185 997 181 161 151 149 141 783 149 682 831 951 858 683 485 418 294 198 146 119 80 39 23 8 2 1 ... HARLESDEN P. 16,940 448 379 424 385 379 2,015 1,776 940 312 337 1,589 310 320 323 357 332 1,642 339 1,463 1,802 1,702 1,457 1,308 1,059 777 589 403 338 195 155 71 42 17 3 ... ... M. 7,913 224 217 198 173 176 988 897 496 141 164 801 147 142 125 146 159 719 134 703 837 773 662 621 517 349 263 184 135 65 53 26 13 10 ... ... F. 9,027 224 162 226 212 203 1,027 879 444 171 173 788 163 178 198 211 173 923 205 760 965 929 795 687 542 428 326 219 203 130 102 45 29 7 3 ... ... KENSAL GREEN P. 23,168 759 664 672 642 594 3,331 2,627 1,331 416 431 2,178 420 399 338 341 343 1,841 369 1,632 2,001 2,676 2,386 1,754 1,350 981 659 509 359 224 155 91 30 14 2 ... ... M. 11,300 391 329 305 319 335 1,679 1,295 641 219 205 1,065 205 213 180 156 182 936 193 793 986 1,296 1,159 871 670 486 306 232 144 86 51 22 13 3 ... ... F. 11,868 368 335 367 323 259 1,652 1,332 690 197 226 1,113 215 186 158 185 161 905 176 839 1,015 1,380 1,227 883 680 495 353 277 215 138 104 69 17 11 2 ... ... MID. KILBURN P. 12,222 320 304 310 298 299 1,531 1,205 768 217 234 1,219 216 230 226 246 227 1,145 219 967 1,186 1,200 1,058 830 721 522 436 382 290 210 158 71 43 11 4 ... ... M. 5,578 162 144 155 147 149 757 574 378 110 123 611 116 109 106 110 97 538 94 399 493 533 456 387 352 239 179 164 112 83 58 28 11 2 1 ... ... F. 6,644 158 160 155 151 150 774 631 390 107 111 608 100 121 120 136 130 607 125 568 693 667 602 443 369 283 257 218 178 127 100 43 32 9 3 ... ... NORTH KILBURN P- 9,872 209 170 174 169 151 873 741 451 132 142 725 174 161 209 216 219 979 227 977 1,204 1,121 930 811 655 516 350 316 225 184 113 72 38 15 3 1 ... M. 4,147 115 86 80 81 66 428 376 217 67 65 349 78 58 85 76 73 370 79 341 420 447 358 359 289 239 152 121 87 76 42 22 9 3 ... ... F. 5,725 94 84 94 88 85 445 365 234 65 77 376 96 103 124 140 146 609 148 636 784 674 572 452 366 277 198 195 138 108 71 50 29 12 3 1 ... SOUTH KILBURN : P. 14,476 411 360 398 388 366 1,923 1,824 1,001 323 324 1,648 336 306 279 268 239 1,428 258 943 1,201 1,127 1,031 973 903 710 502 417 309 206 132 82 36 17 6 1 ... M. 6,820 191 187 209 199 191 977 873 481 130 163 774 188 159 134 140 105 726 131 429 560 499 451 501 409 325 234 193 134 77 47 26 13 1 ... ... F. 7,656 220 173 189 189 175 946 951 520 193 161 874 148 147 145 128 134 702 127 514 641 628 580 472 494 385 268 224 175 129 85 56 23 16 6 1 ... WILLESDEN GREEN P. 18,948 513 437 451 449 421 2,271 1,895 979 285 340 1,604 348 378 357 381 360 1,824 404 1,666 2,070 2,048 1,775 1,448 1,176 847 599 485 376 213 153 105 36 20 2 1 ... M. 8,418 258 214 235 209 217 1,133 946 465 150 157 772 156 143 136 134 117 686 145 652 797 837 777 662 557 395 262 233 156 83 54 45 13 9 1 ... ... F. 10,530 255 223 216 240 204 1,138 949 514 135 183 832 192 235 221 247 243 1,138 259 1,014 1,273 1,211 998 786 619 452 337 252 220 130 99 60 23 11 1 1 ... UNDERGROUND BAKEHOUSE INSPECTION, 1902. Reference No. Height of Bakehouse. Cubic Capacity. c. ft. Floor Area. Over 300 square ft. Condition of Walls. Provision for Storage of Flour. Opening into Bakehouse from Street Level. If Bakehouse adequately Lighted by Daylight. Ventilation. Communication with Area, etc., containing objectionable Materials. 1 6' 6" 1457 Slightly damp Yes TwoOne, 2' 3" x 11" One, 2' 3" x 1' No Poorly ventilated Manhole in bakehouse 2 9' 0" 2701 300 square feet Walls continually damp Damp An area— 2' 6" x 2' 3" x 4' deep, covered with iron grate No Very badly lighted and ventilated Gulley in bakehouse, and channelling to take water oozing through walls 3 7' 6" 3786 509 square feet Good Stored inside baking room One, 5' 6" x 1' 3" No Opening from street and through current No 4 Lowest 6- 7'' Highest 9' 10" 1946 Good Yes No direct opening. Opening in flour store-room from street level No Two windows in bakehouse open No 5 7' 10" 1120 Damp at one side Damp in one part Two— One, 2' 6" x 3' One, 1' 6" x 3' Yes Three windows open No 6 7 7' 10" 9' 2" 4008 2758 511 ] square feet ] 302 square feet 3riek walls imewashed Good Stored inside baking room Stored inside baking room and passage outside Three— One, 3' 9" x 5' One, 5' x 1' 9" One, 5' x 1' One, 4' 9" x 1' 8" ? Yes Three windows open Opening from street Yes No 8 8' 7" 3761 452 square feet 3rick walls imewashed Stored inside baking room TwoOne, 3' 6" x 1' 8" One, 6' x 1' 10" ? Two openings No 9 Lowest 8' 3" Highest 8' 6" 2175 3rick walls fair condition Yes One, 4' 9" x 10" Yes One opening No. W.C. improperly situated 10 7' 8" 1836 — Good Yes One, 5' 6" x 1' 9" ? One opening No 11 7' 5" 1472 Good Yes One, 4' 5" x 1' 10" Yes One opening and borrowed light from flour store No 12 6' 5" 995 — Slightly damp Yes One, 5' x 2' No One opening Not direct 13 6' 3" 1448 — Good but damp Stored inside baking room One, 3' 8" x 1' 10" Badly lighted One opening Room next baking room very damp 14 7' 2" 1852 — Good Stored inside baking room One, 3' 9" X 1' 1" No Badly lighted and ventilated No 15 7' 10" 1352 Good Stored inside baking room One, 4' x 2' Yes Opening (street) and through ventilation No 16 6' 9" 1461 Fail- Not very good One, 5' x 2' Yes Opening from street No. Brick drain under floor has opening covered by stone 17 6' 6" 1229 — Damp at one side Damp One, 5' 6" x 1' 6" No Street opening No 18 9' 4" 4123 449 square feet Good Stored inside baking room Three— Two, 6' 6" x 1' 8" One, 6' x 1' 8" 1 Three openings and through ventilation No 19 Varies 7' 9" 8' 0" 10' 10" 2027 Damp at one side Walls dilapidated One— (yard level) 2' x 1' 2" ? Opening and skylight, 2' 4" x 1' 3" Yes. Soil pipe runs through one part of bakehouse 20 8' 0" 1746 Good Two store-rooms. Walls of one are damp and ceiling dilapidated One, 5' 6" x 1' 9" Yes Opening and through ventilation No 21 7' 1" 2025 Good Yes Two— One, 2' 3" x 1' 6" One, 5' 3" x 1' 6" Yes Two openings anc through ventilation; well ventilated No 22 8' 4" 2264 Good Yes Two— 3' 6" x 1' 6" each Yes Two openings (street), opening over ovens 3' 2" x 2' 10' through ventilation No 23 9' 8" and 10' 0" 3683 369 square feet Bricks limewashec Plaster in one slightlY dilapidatec Stored inside baking room Two— 3' 6" x 8" each ? Openings from street and through ventilation No 24 7' 8" 2238 - Good Yes Two— (yard level) 1' 11" x 2' 6" each ? Openings (yard) No. Gulley in bakehouse 25 7' 8" and 8' 2" 2652 339 square feet Good Yes No Yes Three openings into yard 6' X 2' 4" 2' 6" x 8' 2' x 9" Fairly well ventilated No 26 7' 4" and 8' 9" 5155 745 square feet Good Stored inside baking room Two— One, 2' 3" x 1' 4" One, V 10" x 1' 4' Well lighted at both ends rather dark in middle of bakehouse Through ventilation Two openingS from street, Three openings at rear; atmosphere very sulphurous No. Gulley and grease trap in bakehous 27 9' 0" 3353 372 square feet Good Stored inside baking room There are twO baking rooms No Yes Two skylights 2' 8" x 2' 8' each No SUMMARY OF SYSTEMATIC INSPECTIONS, 1902. locality. Cisterns uncovered. Cisterns found dirty. Rooms or Premises Dirty. Roofs Defective. Drains Defective. Drains Choked. Rain Water Pipes and Guttering Defective. Soil and Vent. Pipes Defective. Absence of or insufficient supply of Water to W.C. Dilapidated Dust Bins. Dilapidated Yard Paving. Overcrowding. Defective W.C.'s Defective Waste Pipes. Total number of Houses. Winchelsea Road ... ... ... ... ... 1 ... 2 3 ... 2 ... 1 2 52 Bridge Road ... ... 10 ... ... 2 ... 2 7 ... 4 ... ... 2 38 Villiers Road 4 ... 2 2 ... 2 2 3 5 ... 5 ... 6 4 42 Stafford Mews 2 4 8 1 ... ... ... ... ... 3 ... ... 3 2 25 Ravensworth Road 1 2 3 ... ... ... 2 ... 2 4 ... ... ... 1 54 Chapman's Park ... ... ... ... ... 1 ... ... 3 2 3 ... ... ... 13 Pembroke Place ... ... 2 3 ... ... 3 ... ... ... ... ... ... 14 Meyrick Road ... 2 ... 2 2 1 ... ... 3 ... 2 ... 5 3 14 Conley Road 20 ... 10 ... ... ... 15 ... ... ... 3 ... 6 ... 36 Salusbury Road 2 4 9 3 ... ... ... 1 3 5 2 ... 3 ... 31 Park Mews 3 7 5 2 ... ... ... 8 ... ... ... ... ... ... 36 Carlton Vale 3 9 12 5 3 ... ... ... 4 6 ... 1 ... ... 123 College Road 6 14 6 ... ... ... 3 1 3 7 2 ... ... ... 65 Canterbury Road 1 4 45 15 4 3 6 ... 2 15 ... ... 15 6 141 Strode Road 1 4 2 ... ... ... ... ... 5 ... ... ... 3 62 Hawthorne Road 1 2 1 ... 1 1 ... ... 1 ... 2 ... ... ... 62 Parkfeld Road ... ... ... ... ... ... ... ... 3 ... 3 ... 4 ... 38 Pound Lane ... ... 1 ... ... ... ... ... 1 2 3 ... 1 ... 11 Church Road 3 6 19 8 ... 1 1 ... 12 1 ... ... 8 1 164 Denbigh Road 29 59 15 ... ... ... ... 3 2 ... 1 ... 1 ... 110 Church Lane ... ... 2 ... ... ... ... ... ... ... ... ... ... ... 20 Westbury Road 2 4 13 ... ... ... ... ... ... ... 6 1 2 ... 30 Guilsboro Road 13 28 ... ... ... ... ... ... ... ... ... ... ... ... 47 Cobbold Road 7 14 15 ... ... ... ... 4 ... ... 2 ... 5 1 48 Holly Lane ... ... ... ... ... ... ... ... ... ... ... ... ... ... 20 Wendover Road 11 22 5 ... ... 1 ... ... 12 1 4 ... 8 1 76 Queen's Road 22 37 ... ... 23 10 38 ... 3 2 13 ... ... ... 98 Steele Road 6 14 19 3 ... ... ... ... 6 4 2 ... 6 ... 45 Acton Lane 2 5 6 ... ... ... ... ... ... ... ... ... 5 ... 40 Corby Road ... ... 5 ... ... ... ... ... ... ... ... ... 1 ... 16 Disraeli Road 3 5 17 2 ... ... ... ... ... 2 ... ... 11 ... 35 Cobbold Road 6 5 2 ... ... ... ... 1 ... ... ... ... 1 ... 23 Essex Road 9 3 3 1 2 1 ... ... 2 1 4 ... ... ... 49 Roundwood Road 62 58 11 1 ... 1 5 ... 4 ... 4 1 2 ... 72 Honeywood Road 5 13 4 ... 1 ... 3 ... ... 3 2 ... 2 2 14 Ranelagh Road 4 26 10 ... ... ... 1 ... ... 5 2 ... 5 1 33 Talbot Road 19 19 2 ... ... ... ... ... 1 ... ... ... ... ... 38 Denzil Road 1 ... 2 ... 1 2 3 ... 3 1 7 ... ... ... 49 Beaconsfield Road ... ... 8 2 1 ... 3 ... 4 1 8 ... ... ... 45 Tubbs Road 39 57 ... 2 3 2 6 2 16 4 3 ... 11 ... 91 Clifton Road 9 9 2 1 ... ... 4 ... 2 1 1 ... 5 ... 9 Cooper Road ... 2 4 ... ... ... ... ... 3 1 3 ... 5 ... 46 Belton Road 2 2 4 1 ... ... ... 1 1 1 2 ... 3 ... 38 Dudden Hill Lane 3 1 4 ... ... 2 ... 3 1 1 ... 3 ... 34 Chippenham Gardens 1 6 2 1 ... ... 2 3 ... 6 2 ... ... ... 16 Shirland Road 1 ... 1 ... ... ... 1 1 1 ... ... ... ... 4 Malvern Terrace ... 1 5 1 ... ... ... ... 2 ... ... ... ... ... 6 Greyhound Road 16 24 16 6 ... ... 9 5 6 8 2 ... ... ... 65 Fortune Gate Road 76 60 1 5 1 3 2 12 5 ... 3 ... 3 ... 113 Brownlow Road 17 8 3 ... 1 ... ... 7 6 ... 2 ... 1 ... 73 Buckingham Road 9 21 4 ... 1 3 29 6 14 ... 5 ... 5 ... 84 Nightingale Road 16 9 8 2 2 2 3 18 11 3 ... ... 2 ... 63 Rucklidge Avenue 41 82 46 1 5 6 34 17 26 4 7 1 8 ... 169 Victoria Road 26 18 11 3 6 3 2 7 1 3 1 ... 5 ... 65 Kilburn Lane 18 49 30 ... 2 3 10 7 13 5 8 ... 5 ... 91 Charlton Road 34 33 14 1 4 1 9 2 6 ... 7 ... 11 ... 68 Glen gall Road 44 45 20 6 ... 1 4 9 12 7 1 ... 3 ... 109 Chaplin Road 23 19 4 1 ... ... 1 2 2 3 1 ... 3 ... 91 Redfern Road 33 5 1 8 ... 1 ... ... 12 2 ... ... 2 ... 64 Glynfield Road 10 12 ... 1 ... ... 1 ... 2 ... ... ... ... ... 37 Leopold Road 30 21 7 2 ... ... 2 ... 3 ... 1 ... ... ... 50 Northcote Road ... 6 2 ... ... ... ... ... ... ... ... ... ... ... 7 Goodson Road 10 7 2 ... ... ... 2 ... ... 1 1 ... 2 ... 11 Norfolk Road ... 2 ... ... ... ... ... ... ... ... ... ... ... ... 7 Preston Gardens 18 19 1 ... ... ... ... ... ... ... ... ... 1 ... 23 Eric Road 7 2 ... ... ... ... ... ... 1 ... ... ... ... ... 17 Vicarage Road 25 12 5 2 ... 1 2 ... 3 ... 1 ... ... ... 63 Princess Road 31 36 9 2 3 ... 20 35 10 4 ... ... 8 ... 76 High Street, Harlesden 27 34 10 5 5 11 20 14 19 17 8 ... 32 ... 153 Neasden Lane 12 14 2 2 ... ... ... ... 8 ... ... ... 1 ... 47 A Street ... ... 17 ... ... ... 1 ... 9 ... ... ... 2 ... 62 B Street ... ... 8 ... ... ... ... ... 11 ... ... ... 3 ... 40 Kingsbury Road ... ... 2 1 ... ... ... ... 4 ... ... ... ... ... 10 Osborne Road 17 16 1 ... ... 1 1 8 1 ... 5 ... ... ... 41 Preston Place ... ... 4 ... 1 ... 9 ... ... ... 5 ... ... ... 11 Chichester Road 25 21 8 1 ... ... ... ... 5 11 ... ... 1 ... 58 Denmark Road 12 7 ... ... ... 7 ... 3 22 2 ... 6 ... 71 Oldfield Road 35 61 ... 1 ... ... 1 ... 4 ... ... ... 2 ... 80 West Ella Road 14 11 ... ... ... 1 ... 5 3 ... ... ... 3 ... 57 Total 4219 WILLESDEN Urhan District Cauncil HOSPITAL REPORT FOR THE YEAR 1902, by WILLIAM BUTLER, M.B., C.M., D.P.H., • ■: ft MEDICAL SUPERINTENDENT. Councl Martin & Son, Printers, 211 High Koad, Kilburn, and Marylebone. 1903. Mimbers of the Hospital Uisiting Committee. Councillor G. H. JOHNSON, Chairman. J. S. CRONE, L.R.C.P., etc., J.P. C. BIDDISCOMBE. „ 0. H. DAVIES. „ W. H. KNOX., L.B.C.P., etc. „ J. PICKWORTH. W. J. EYERSHED. HOSPITAL REPORT for 1902. To the Chairman and Members of the Willesden Urban District Council. Gentlemen, I have the honour to present the Hospital Report for the year 1902. The year has been a strenuous one, a greater number of cases having been admitted to the Hospital at Dog Lane than in any previous year. In addition to this the equipment and administration of the Small-Pox Hospital at Kingsbury has devolved upon the Hospital staff. At the same time the work of permanent enlargement of the Hospital has been proceeding, and this has necessarily absorbed time and attention. The greatest difficulties have lain in having to cope with a volume of work far in excess of what the (4) administrative resources of the Hospital were calculated to deal with. This contingency will be obviated in the near future by the completion of the extensive additions both to the administrative and accommodative structures which are now in process. Cases treated in Hospital for the year ending December 31st, 1902. TABLE No. 1a. Scarlet Fever. Diphtheria. Enteric Fever. Other Diseases Total. Remaining on Dec. 31st, 1901 53 27 .. .. 80 Admitted 282 222 14 .. 518 Staff 2 3 •• 5 10 Total 337 252 14 5 608 Discharged 277 220 9 5 511 540 Died 4 24 1 .. 29 Remaining on Dec. 31st, 1902 56 8 4 .. 68 Average daily number 66.5. (5) TABLE No. 1b. Ages of those admitted. Under 1 year. From 1 to 2 yrs. Two to 5 years. Five to 10 yeais. Over 10 years. Total of Total m. F. m. F. m. F. m. F. m. F. Mis. Fins. Scarlet Fever 2 .. 4 7 32 40 59 64 28 48 125 159 284 Diphtheria 1 2 4 1 31 33 40 42 33 38 109 116 225 Enteric Fever .. .. .. .. .. .. 2 2 6 4 8 6 14 Other Diseases .. .. .. .. .. .. .. .. .. 5 .. 5 5 Total 3 2 8 8 63 73 101 108 67 95 242 286 528 TABLE No. lc. Deaths. Under 1 year. From 1 to 2 yrs. Two to 5 years. Five to 10 years Over 10 years. Total of Total M. Jr. M. F M. F. M. F. M. F. Mis Fms. Scarlet Fever .. .. .. .. 1 1 1 .. 1 .. 3 1 4 Diphtheria 1 2 • • , , 4 7 5 4 .. 1 10 14 24 Enteric Fever • • .. .. .. .. .. .. .. 1 .. 1 .. 1 Other Diseases .. .. .. .. .. .. .. .. .. .. .. .. .. Total 1 2 •• .. 5 8 6 4 2 1 14 15 29 (6) Fatality Rate per cent, for each age period. Scarlet Fever. Diphtheria. Under 1 year 0 100 From l to 2 years 0 0 2 5 2-7 .. 17-1 Under 5 years 2.3 .. 19.4 From 5 to 10 years 0.8 .. 10.9 Over 10 years 1.3 .. 1.4 DIPHTHERIA. An outbreak of Diphtheria in the autumn of 1901 continued to keep the admissions from this disease above the normal in the early months of the year. The latter part of the year, however, saw the district freer than it has been for some years. It is pleasing to be able to record a continued decrease in the fatality rate from this disease. This is solely due, in my opinion, to the wider and more expeditious use of Antitoxin. (7) TABLE No. 2. Fatality rate calculated according to the Registrar-General's formula of dividing the deaths multiplied by .100 by half the sum of the admissions, discharges, and deaths for the year. 1895 28.8 per cent. 1896 22.6 „ 1897 24.8 „ 1898 19.3 „ 1899 14.8 „ 1900 14.2 „ 1901 11.9 „ 1902 10.7 „ The tentative conclusions expressed in my last report are generally confirmed by a wider experience of the use of Antitoxin. Early injection is of the first importance. After the onset of the disease the interval to the time of injection is pregnant with fate for the victim of Diphtheria. Of 20 cases injected on the first day of disease none died. Of 60 injected on the second day, only 2 died. Early injection lessens the spread and duration of the membrane, and the shorter the duration and lesser the extent of membrane, the greater is the prospect of recovery. (8) The following tables well illustrate the truth of this statement:— TABLE No. 3. Mean duration of Membrane. Fatality Rate per cent. 1901. 1902. 1901. 1902. Cases injected on 1st day 3 days. 3.6 days Nil. Nil. „ „ 2nd „ 4 „ 4 3.7 3.3 „ „ 3rd „ 5.6 „ 4.7 „ ? 10.3 „ after 3rd ,, 7.3 „ 59 „ ? 15.3 TABLE No. 4. Duration of Membrane. Fatality Rate per cent. 1901. 1902. All cases up to 5 days 2.7 3.7 6 3.8 60 Cases in which it lasted 6 days 7.1 16.6 „ „ „ 7 days and over 211 22.9 Where the site of the membrane was faucial only, the fatality rate was 3.7 per cent.; where it was faucial and nasal, the rate was 21.1 per cent.; where faucial, nasal, and laryngeal, 30 per cent. (9) TRACHEOTOMY. This operation was performed during the year 9 times with 2 deaths, last year 10 times with 3 deaths. POST DIPHTHERITIC PARALYSIS. The relationship of the duration of membrane to the incidence of paralysis following Diphtheria has been quite as marked in this year's experience as in last. Where the duration of membrane did not exceed 0 days paralysis occurred in 19 per cent. of the cases, last year in 14 per cent. Where the duration exceeded six days the incidence this year was on 53.7 per cent. of the cases as compared with 44.2 per cent. last. The inference is forced upon one that early use of Antitoxin lessens the fatality rate, shortens the duration of membrane, and by so doing minimises the risk of succeeding paralysis. The facilities afforded by the Council for securing at once a gratuitous supply of Antitoxin for the use of any residents in the district have therefore again been justified in the substantial saving of life and lessened duration of illness of those attacked by Diphtheria. (10) In the following table is shown the dosage of Antitoxin used and the frequency with which the different doses have been used. TABLE No. 5. *Units of No. of Antitoxin injected. Cases. None used in 8 2,000 „ 23 4,000 „ 61 6,000 „ 48 8,000 „ 39 8,500 „ 1 10,000 „ 11 12,000 „ 22 14,000 „ 10 16,000 „ 12 18,000 „ 5 20,000 „ 2 24,000 „ 1 28,000 „ 1 * Including cases and amounts injected prior to admission. No untoward effects have ever been noted to follow its use, but a considerable proportion of the cases have been followed by what are known as Antitoxin rashes. These for the most part consists of an urticaria lasting two or three days as a rule and associated in a few of the cases with joint pains and occasionally a transient rise of temperature. (11) The following table is aa analysis of all the cases in which it was observed : TABLE No. 6. Showing the incidence of antitoxin rashes. Time of appearance from date of injection. No. of Cases. 5 days 1 6 ,, 1 7 ,, 3 8 „ 11 9 ,, 13 10 ,, 9 11 „ 9 12 ,, 5 13 „ 3 14 ,, 1 15 ,, 3 16 ,, 4 Total 63 Percentage of rashes to cases injected 26.7. 85 per cent, occurred during second week from date of injection. Abscesses followed injection in 3 cases. (12) BACTERIOLOGY. Examination of Swabs from Throats suspected of harbouring the Diphtheria Bacillus. TABLE No. 7. From Patients of outside Practitioners. From Patients on admission to Hospital. From Patients on discbarge from Hospital. From Patients in Hospital. + — + — + — + — 34 75 142 81 11 242 13 63 2nd Examination. 4 3 23 63 0 0 1 15 + = Found in 228 Patients. — = Not found in 461 „ 689 Total number of Primary Examinations in which D.B. was found 200 Do. do. do. was not found 461 661 Total number of Second Examinations in which D.B. was found 28 Do. do. do. was not found 81 109 Doubtful Cases 2 Total number of Examinations 772 (13) SCARLET FEVER. The following table shows the annual fatality rate of Scarlet Fever cases admitted to the Hospital since 1896. TABLE No. 8. 1896 1897 1898 1899 1900 1901 1902 4.0 2.7 3.3 4.0 4.1 3.5 1.4 The rate for 1892, it will be observed, is the lowest recorded. For some years Scarlet Fever has been of a much milder type than used to characterise it, and this year the cases admitted to Hospital show not only a reduction in the fatality rate, but also in the incidence of the complications which lend to it so much more formidable a character than it would otherwise possess. The following comparative table exhibits the number of cases in which the chief complications occurred, and the rate per cent, of the cases which yielded them:— (14) TABLE No. 9. Complications of Scarlet Fevkr. Nature of Complication. No. of Cases Rate per cent, of cases for the year. 1901. 1902. 1901. 1902. Albuminuria 40 25 16.1 8.9 Otorrhcea (Ear discharge) 37 35 14.9 12.0 Rhinorrhoea (Nose discharge) 33 26 13.3 9.2 Otorrhcea and Rhinorrhoea together 14 13 5.6 4.6 Otorrhcea or Rhinorrhoea—Total 56 48 22.5 17.0 Adenitis (inflamed glands) 49 85 19.7 30.2 Abscesses Not recorded 12 ... 4.2 Relapses associated with recurrence of rash 4 4 1.6 1.4 Albuminuria is by far the most serious of the complications above dealt with, and the substantial reduction in the incidence rate of this complication is in some measure accountable for the low fatality rate from Scarlet Fever. Last year 5, or 12.5 per cent, of the cases complicated by Albuminuria died. This year 1, or 4 per cent., succumbed. (15) ENTERIC FEVER. But few cases of this disease could be admitted to the Hospital owing to lack of accommodation. Altogether 14 were admitted during the year of whom one died. With the exception of Small-pox none of the infectious diseases have greater claims to hospital isolation than Typhoid Fever. The home conditions of the majority of cases are such as to make nursing at home highly imprudent from the standpoint of the interests either of the patient or the public health. Fortunately the district has not been visited with any considerable outbreak of this disease. SMALL POX. There were altogether 78 admissions to the Small Pox Hospital during the year. Nine of these were diagnosed as not suffering from Small Pox, of whom two subsequently contracted the disease. This leaves a total of 71 cases of Small Pox treated in the Hospital during the year. (16) TABLE No. 10. Weekly Return from the opening of the Small Pox Hospital at Honeypot Lane. Week ending. Feb. 22. Mar. 1. Mar. 8. Mar. 15. Mar. 22. Mar. 29. April 6. Admitted 14 14 10 4 1 Discharged 2 1 3 1 2 6 5 Died ... 1 3 2 ... ... ... Remaining 12 24 28 29 27 27 17 Average daily number 12.2 18.5 25.8 28.5 28.7 23.5 20 Week ending. April 12. April 19. April 23. May 3. May 10. May 17. May 24. Admitted 8 2 5 1 2 3 4 Discharged 8 2 ... 8 1 3 Died ... 1 ... 1 1 ... Remaining 17 16 21 13 13 13 17 Average daily number 18 16.2 18.8 18.2 13.4 14.7 13.8 (17) TABLE No. 10—continued. Week onding. May SI. June 7. June 14. June 21. June 28. July 5. July 12. Admitted 3 3 2 ... ... ... ... Discharged 3 6 2 2 2 l 1 Died 2 ... ... ... ... ... ... Remaining 15 12 12 10 8 7 6 Average daily number 16 14.1 12.5 11.4 9.1 7.5 6.4 Week ending. July 19. July 26. Aug. 2. Aug. 9. Aug. 16. Aug. 20. Total. Admitted ... ... ... ... ... ... 76 Discharged 1 2 1 ... ... 2 65 Died ... ... ... ... ... ... 11 Remaining 5 3 2 2 2 ... ... Average daily number 5.5 4 2.7 2 2 ... ... The following table shows the number of cases occurring among the vaccinated and the unvaccinated and their respective deaths and fatality rates. (18) TABLE No. 11. Cases. Deaths. Fataliiy Rate per 100. Vaccinated 49 5 10.2 Unvaccinated 19 5 26.3 Stated to be vaccinated but showing no evidence 3 2 Total 71 12 16.9 The efficiency of vaccination in protecting against Small Pox was admirably illustrated by the cases admitted to the Hospital. Efficient vaccination recently performed is the most certain preventive against attack by Small Pox. The vaccination returns show that the number of unvaccinated children in Willesden is very much smaller than the number who have undergone vaccination, yet of the relatively small number of unvaccinated children under 5 no fewer than 12 were attacked by Small Pox, while of the much larger number who were vaccinated not one became infected. As stated in my interim report, " During the whole course of the outbreak, not one of the many people (19) who had recently undergone vaccination or re-vaccination had been admitted suffering from Small Pox." The contrast between the age incidence of Small Pox upon the vaccinated and upon the unvaccinated is very striking. Twelve out of the total of 19 unvaccinated cases occurred in the first quinquennium of life, whereas among the vaccinated none occurred at that period, and it is not until the quinquennium 25 to 30 is reached that the maximum incidence amongst the vaccinated is attained. All the unvaccinated cases occurred in persons under 25 years of age, and out of 19 such cases 5, or more than a fourth of those attacked, died. Among the 49 vaccinated cases 12 occurred in persons under 25 years of age, and none died. Although among the vaccinated none were admitted who had been recently vaccinated, and so none who could be said to be completely protected by vaccination, the influence of vaccination in modifying (20) the attack was still traceable. Among those attacked who showed four or more marks not one died. Among those with three marks, only one. Among those with two or one, four. This is shown in the following table : — TABLE No. 12. No. of Marks. Cases. Deaths. Fatality Rate per cent. 1 or 2 18 4 22.2 3 15 1 6.6 4 or more 16 0 0 Total 49 5 10.2 The data from which these results are abstracted are set out in detail in the following table :— (21) TABLE No. 13. Table showing the number of unvaccinated cases at each quinquenium, nature of attack and result. Age Period. No. Attacked. Nature of Attack. Result. 0-5 12 Confluent, 9; Moderate, 1; Mild, 2 5 died. 5-10 3 Confluent, 3 All recovered. 10-15 2 Discrete, 1; Moderate, 1 ,, 15-20 1 Confluent ,, 20-25 1 Mild ,, 25 and over. None. ... Total 19 TABLE No. 14. Table shoiving the number of cases stated to have been vaccinated but presenting no evidence in the shape of vaccine marks. Age Period. No. Attacked. Nature of Attack. Result. 30-35 1 Confluent and Hærrhagic Died. 35-40 1 Confluent Recovered. 45-50 1 Confluent Died. Total 3 (22) TABLE No. 15. Tabic shoiving number of vaccinated cases at each quinquenium, the number of vaccine marks, nature of attack and result. Age Period. Vaccine Marks. No. Attacked. Nature of Attack Result. 0-5 ... ... ... ... 5-10 lgood 1 Very Mild Recovered. 10-15 2 „ 3 All Mild ,, 15-20 1 „ 2 Confluent, 1; Mild, 1 ,, 2 „ 1 Very Mild ,, 3 „ 1 ,, ,, 4 „ 2 Very Mild, 1; Moderate, 1 ,, 6 „ 1 Discrete, but severe ,, Total 7 20-25 3 good 2 Both Mild ,, 4 „ 2 ,, ,, 5 „ 1 Mild ,, Total 5 25-30 1 bad 2 Moderate, 1; Confluent 2 good 3 and Haemorrhagic, 1 Mild, 1; Confluent, 2 1 died. 1 died, 2 3 „ 3 Mild, 1; Moderate, 1; covered. 4 „ 5 Confluent, 1 Mild, 4; Moderate, 1 All recovered. ,, Total 13 (23) TABLE No. 15.—(Continued). Age Period. Vaccine Marks No. Attacked. Nature of Attack. Result. 30-35 lgood 1 Mild Recovered. 2 „ 2 Confluent, 1; Moderate, 1 1 ,, 1 died. 3 „ 2 Mild, 1; Moderate, 1 Recovered. 4 „ 3 Mild, 1; Moderate, 1; Confluent, 1 Total 8 35-40 2 good 1 Haemorrhagic Died. 3 „ 3 Mild, 2; Moderate, 1 Recovered. Total 4 40-45 3 good 1 Moderate ,, 4 small 1 ,, ,, Total 2 45-50 3 good 1 Mild „ 6 „ 1 ,, ,, Total 2 50-55 ... None. ... 55-60 3 (at 14 ys.age) 1 Mild Recovered. 60-65 3 good 1 Confluent Died. 65-70 1 „ 1 (Re-vaccinated in Middle Life) Moderate Recovered. 70-75 2 „ 1 Confluent ,, All ages, Total, 49. Mild, 28; Moderate and Severe, 11; Conliuent and Haemorrhagic, 10. Died, 5. (24) So far, the figures exhibit the protecting influence of vaccination against attack and against death by Small Pox. The influence of vaccination is quite as striking when we consider its effect upon the type of attack. Confluent Small Pox is incomparably more severe, horrible, and permanently damaging than discrete. The table shows how its incidence is modified by vaccination. TABLE No. 16. Cases. Confluent or haemorrhagic Rate per 100. Unvaccinated 19 13 68.4 Vaccinated 49 10 20.4 No Evidence 3 3 — Total 71 26 36.6 The value of efficient vaccination in preventing the occurrence of confluent Small Pox where time has weakened its protecting influence, is illustrated when the relationship between the number of vaccination marks and the incidence of confluent variola is considered. (25) TABLE No. 17. No. of Marks. Cases. Hæmorrhagic or confluent. Rate per cent. 1 or 2 18 7 38.8 3 15 2 13.3 4 or more 16 1 6.2 Total 49 10 20.4 Only one case of confluent Small Pox occurred under the age of 25 among the vaccinated, and that in a young man of 20, who presented only one vaccination mark. It only remains to add that out of 48 persons not suffering from Small Pox admitted to the Hospital wards, doctors, nurses, attendants, etc., all but three had undergone recent successful vaccination. Of the three who were unvaccinated, one died from Syphilis a few days after admission. The other two both contracted Small Pox. None of the 45 vaccinated took the disease, although many of them, as for instance the nurses, were more directly exposed to infection than any other persons in the community. ( 26 ) Among those who escaped infection was a well vaccinated child of 2 years, suffering from Gangrenous Chicken Pox, so seriously ill that for weeks its life was despaired of. For about 3 months it was daily exposed to an atmosphere of concentrated Small Pox infection, yet neither its tender years nor serious illness could undo the protection afforded by efficient and recent vaccination. Although the figures dealt with in this Report are small, they are thoroughly in conformity with what has been observed where the cases dealt with have been on a much larger scale, and this is a further tribute to the well-founded nature of the protection afforded by vaccination against Small Pox. There may be small personal comfort in consideration of massive results which have no personal bearing. The perfectly true assurance of the expectation of life at any age which has no bearing on the prospect of life of any particular person is cold comfort, but it is distinctly consoling to know that whether few or many, whether a single instance or a community of people be observed, the facts of vaccination in relation to Small Pox are uniform and telling. (27) DIAGRAM showing the incidence of Small Pox at different age periods upon the Vaccinated and upon the Unvaccinated. (28) INFECTIOUS COMPLICATIONS. ♦ These have been fewer than they were last year, but are still in excess of what might reasonably be anticipated. With the completion of the observation block now in course of construction, the Hospital will be in a much better position to deal with these unfortunate occurrences. The following tables show the number and character of these complications : — TABLE No. 18. Diseases complicating Diphtheria. Nature of Disease. No. of Cases No. of Deaths. 1901. 1902. 1901. 1902. Scarlet Fever 19 6 1 0 Measles 9 6 1 2 German Measles 1 0 0 0 Chicken Pox 2 0 1 0 Measles and Whooping Cough 1 0 0 0 Total 32 12 3 2 (29) TABLE No. 19. Diseases complicating Scarlet Fever. Nature of Disease. No. of Cases. Deaths. 1901. 1902. 1901. 1902. Diphtheria 28 19 1 0 German Measles 6 0 0 0 Measles 5 0 0 0 Erysipelas 2 0 0 0 Enteric Fever 1 0 0 0 Whooping Cough 3 0 1 0 Chicken Pox 0 8 0 0 Small Pox 0 2 0 0 Total 45 29 2 0 Thus one in every 20.3 patients admitted for Diphtheria, and one in every 9.6 admitted for Scarlet Fever suffered in addition from some other infectious disease contracted either before or during their stay in Hospital. (30) CASES WRONGLY DIAGNOSED. TABLE No. 20. Cases wrongly diagnoped. Admitted with mother or without illness. Admitted as suffering from Diphtheria 13 — „ „ „ Scarlet Fever 5 l „ ,, ,, Small Pox 5 4 Totals 23 5 Total 28 These errors of diagnosis arose in connection with the following cases, and are distributed as shown in the table:— (31) TABLE No. 21. Table showing cases admitted wrongly diagnosed and the diseases for which they were mistaken. Admitted foe Suffering fbom Diphtheria. Scarlet Fever. Small Pox. 1 1 1 Measles 1 ... ... Scarlet Fever ... 1 1 Chicken Pox ... 3 1 Febricula 1 ... ... Pneumonia 2 ... ... Bronchitis 8 ... ... Tonsillitis, Sore Throat ... ... 1 Pemphigus ... ... 1 Syphilis 13 5 5 It must not be supposed that the errors above recorded are evidence of carelessness or incompetence on the part of the certifying medical attendant. In many cases the notifications asking for removal were accompanied by notes pointing out the doubtful nature (32) of the cases and requesting temporary isolation until the nature of the case declared itself. This is the correct way of dealing with such cases. Doubt with regard to a certain number of cases can only be removed by their subsequent history, or may never be removed at all. Yet considerations of public safety require their isolation, while the patients' interests demand that they be isolated in an observation ward free from risk of infection from other inmates of the Hospital. The most fruitful sources of trouble are those cases which are admitted incubating some other infectious disease, which they thus introduce into a ward in a manner so insidious as to escape detection. I have already requested the local medical men to communicate to me any fact within their knowledge which should be ground for anticipating such an occurrence when they notify a case requiring removal. RATIO OF EEMOYALS TO NOTIFICATION. Fifty-three per cent, of the Diphtheria cases notified and 60 per cent, of the Scarlet Fever cases notified were removed to Hospital. The following tables give numbers and ratios for each ward. (33) TABLE No. 22. Table showing the number of cases of Diphtheria notified in each Ward, the number removed to Hospital, and the ratio of removals to notifications. Notifications. Cases removed to Hospital. Ratio of removals to Notifications. Church End 200 108 1 in 1.8 Harlesden 110 56 1 ,, 1.9 Kensal Green 44 20 1 „ 2.2 South Kilburn 21 13 1 „ 1.6 Mid Kilburn 23 10 1 „ 2.3 North Kilburn 13 4 1 „ 3.2 Willesden Green 22 11 1 „ 2.0 TABLE No. 23. Table shoiving the number of cases of Scarlet Fever notified in each Ward, tJie number removed to Hospital, and the ratio of removals to notifications. Notifications. Cases removed to Hospital. Ratio of removals to Notifications Mean. Church End 153 101 1 in 1.5 1 „ 1.6 Harlesden 75 37 1 ,, 2.0 1 „ 1.9 Kensal Green 78 44 1 „ 1.7 1 „ 1.9 South Kilburn 29 28 1 „ 1.0 1 „ 1.3 Mid Kilburn 26 18 1 „ 1.4 1 „ 1.8 North Kilburn 37 21 1 „ 1.7 1 „ 2.4 Willesden Green 68 33 1 „ 2.0 1 „ 2.0 (34) TABLE No. 24. Table shoiving the number of cases of Enteric Fever notified in each ward, the number removed to Hospital, and the ratio oj removals to notifications. Notifications. Cases removed to Hospital. Ratio of removals of Notifications. Church End 11 5 1 in 2.2 Harlesden 8 1 1 „ 8 Kensal Green 22 3 1 „ 7.3 South Kilburn 5 1 1 „ 5 Mid Kilburn 8 1 1 „ 8 North Kilburn 7 1 1 „ 7 Willesden Green 12 2 1 „ 6 The following table gives the ratio of removals to the total population, for each year since 1897. TABLE No. 25. 1897. 1898. 1899. 190p. 1901. 1902. All causes 50 4.7 4.1 3.0 4.0 4.9 Scarlet Fever 3.5 2.2 2.1 1.6 2.2 2.3 Diphtheria 1.4 2.2 1.7 1.0 1.6 1.8 Small Pox ... ... ... 0.63 (35) AMBULANCE STATION. Prior to the opening of the Small Pox Hospital, at Kingsbury, the work thrown upon this department was in excess of the facilities for dealing with it. The purchase of a new brougham ambulance, a new delivery van, two horses, renovating the old ambulance and vans, enlarging of the stable and coach-house accommodation, etc., have brought the station into a state of efficiency. DISINFECTING STATION. As reported on former occasions, this station is still far too small for the work falling to be dealt with. A new disinfector is now in course of construction, and it is hoped that this will place the department on a footing equally satisfactory with that of the ambulance station. The present Washington Lyon disinfector if reerected on a suitable site can be reserved for Small Pox disinfection. It is economical and there are 110 objections to disinfecting for the whole district at the Hospital station, but it is undesirable that articles infected with Small Pox should be introduced into the precincts of the Hospital. (36) Should this suggestion be adopted there will always be a reserve disinfecting station to be used only for exceptional outbreaks of such diseases as Small Pox, while in ordinary times there will be a great economy in continuing to use for the district the Hospital Station and Staff. I have in conclusion to express my appreciation of the support afforded me by the Hospital Staff. In a year of extreme pressure there has been an ungrudging response to claims for greater effort and strenuous and unremitting exertion. It would be invidious to make distinctions where all have shown themselves so willing. I cannot let pass without comment, however, the devotion to duty which the outbreak of Small Pox served to make manifest. Fortunately in these times Small Pox is a rate disease. It is so awesome that familiarity fails to breed for it contempt. Yet in no single instance did I fail to discover either among the nursing, the domestic, or the male staff anything else than a keen desire to participate in the work which the dread scourge brought with it. (37) Nor in this connection must I fail to mention the volunteered services of the Rev. A. G. Locke, Vicar of Kingsbury, who throughout the epidemic regularly ministered to the inmates of the Small Pox Hospital. I have, Gentlemen, the honour to be, Your obedient servant, WILLIAM BUTLER. (39) APPENDIX. EXPENSES FOR THE YEAR 1902. Including Maintenance of Hospital at Kingsbury. £ s. d Staff 1,076 4 9 Provisions 1,687 18 0 Furniture (including House Linen) 813 5 8 Clothing 151 13 4 Necessaries 203 4 3 Repairs 73 2 5 Coals and Coke 424 18 7 Gas 158 18 1 Drugs 26 19 7 „ Antitoxin 104 13 4 Druggist's Sundries 103 10 5 Printing and Stationery 48 1 7 Disinfectants 15 9 5 Various 87 18 7 £4,975 18 0 (40) Disinfecting:— £ s. d. Forage, Shoeing, Utensils, etc. 136 5 6 Coachman and Assistant 77 15 4 Engineer 27 6 0 Coals 39 6 10 £280 13 8 Ambulance:— Forage, Utensils, &c. 68 2 9 Coachman and Assistant 38 17 8 Van 45 0 0 Harness 26 14 9 Repairs to Ambulance, Vans, etc— 65 7 0 £244 2 2 (41) Statement of Expenditure out of Hospital Account during 1902, other than Accounts direct from Hospital. £ s. d. Wages—Surveyor's Department 117 17 1 Sundries— „ „ 1 14 10 Water 128 18 6 Insurance 10 2 1 Rates and Taxes 132 11 4 Maintenance of Telephones 23 5 0 Rent of No. 32 Bruce Road 41 1 4 Conversion of Stonebridge Farm Cottages 40 2 4 Wages in connection with same 10 17 10 Stable Extensions and Paving 151 17 5 Wages in connection with same 35 9 8 Sundries—Ironmongery, &c. 48 16 11 Flush Tank 12 10 0 Medical Superintendent 400 0 0 Consulting Physician 50 0 0 Locum Tenens 9 9 0 £1,214 13 4 (42) Statement of Expenditure in respect of Small Pox Hospital during 1902, other than Accounts received direct from Hospital. £ s. d. Wages and Sundries—Surveyor's Department 255 10 2 Erection and fitting-up of Hospital 2,380 11 9 Water Van 39 6 0 Horse 45 0 0 Horse Hire (Ambulance Horse) 2 2 0 Water 7 8 5 Rates and Taxes 50 7 6 Rent of Site 30 0 0 Insurance 3 10 2 Extra Remuneration to Mr. Annal and Miss Stripp 20 0 0 Dr. Butler—Salary (11 months) 91 13 4 Preparation of Small Pox Hospital for Convalescent Home 181 5 2 £3,106 14 6 (43) Statement of Amount paid during year 1902, for Instalments and Interest on Hospital Loans. Instalments. Interest. Totals. £ s. d. £ s. d. £ s. d. Loan No. 28. Hospital Site 42 0 0 56 16 10 98 16 10 „ 32. Erection of Hospital 528 16 8 389 1 5 917 18 1 „ 32a. Erection of Hospital 133 6 8 97 10 0 230 16 8 „ 38. Hospital Furniture 109 2 0 9 17 2 118 19 2 „ 57. Land for Extension 35 0 0 45 12 7 80 12 7 „ 104. Hospital Extensions 55 6 8 84 19 4 140 6 0 £903 12 0 £683 17 4 £1587 9 4