WIL 8 Willesden Urban District Council. THE 29th ANNUAL REPORT ON THE Vital Statistics and Sanitary Condition OF THE URBAN DISTRICT OF WILLESDEN, FOR THE YEAR 1904. BY WILLIAM BUTLER, M.B., CM., D.P.H., Medical Officer of Health for Willesden. Fellow of the Royal Sanitary Institute, and of the Society of Medical Officers of Health. London: Chas. Striker & Sons, Ltd., Bishopsgate Avenue, London. E.C. 1905. INDEX. Page. Members of Committees 5 Staff of Public Health Department 6 Statistical Summary for 1904 6 Report 7 Topographical Features 8 Meteorology 9 Do. Table 1 10 Estimated Population to Midsummer, 1904—Table 2 11 Do. do. December 31st, 1904—Table 3 12 Population 13 Marriages—Table 4 13 Births—Tables 5—6 14 Birth-rate—Table 7 15 Rateable Value per House and Head of Population—Table 8 16 Illegitimate Births 18 Deaths—Tables 9—13 19 Causes of Death 28 Zymotic Mortality during last ten years—Table 14 30 Do. and Phthisis 31 Phthisis and Cancer Mortality—Table 15 32 Cancer 33 Infantile Mortality 34 Birth Enquiries, 1904 40 Deaths of Illegitimate Children 42 Uncertified Deaths 43 Inquests 44 Estimated Population, Births and Deaths—Table 16 45 Infantile Mortality and Diarrhoea Deaths—Table 17 47 Ward Distribution of Deaths 48 Ward Mortality Rates—Table 18 49 Infectious Disease Notified during 1904—Table 19 50 Notifications of Infectious Disease 51 Do, do. —Table 20 52 Analysis of Notifications—Table 21 53 Small Pox 54 Vaccination Returns 56 Cases Notified under 15 years during 1904—Table 22 57 Diphtheria 58 Fatality and Incidence from Scarlet Fever, Diphtheria and Typhoid Fever—Table 23 59 4 Index.— continued. Page. Ward Incidence of Scarlet Fever—Table 24 60 Do. Diphtheria—Table 26 61 Do. Erysipelas—Table 26 62 Death Rates from Scarlet Fever, Diphtheria, Typhoid Fever, Measles and Whooping Cough—Table 27 64 Enteric Fever—Isolation Hospital—Disinfection 65 Non-notifiable Infectious Diseases—Table 28 66 Vision of Scholars attending Public Elementary Schools 67 State of Vision of Scholars attending Public Elementary Schools —Table 29 70 Weights and Heights of Scholars 72 Do. do. —Tables 30—34 74 Chart 76 Water Supply—Sewage Treatment 78 Collection of House Refuse 79 Data relating to Dust Collection—Table 35 80 Do. do. —Table 36 81 Do. do. —Table 37 82 Do. do. —Table 38 84 Gipsies and Unfenced Plots of Land 86 Canal Boats Acts 86 Dairies, Cowsheds and Milkshops—Table 39 87 Slaughter Houses—Legal Proceedings — Customs and Inland Revenue Act 88 Sanitary Condition of School Buildings—Adoption of Card System 89 Summary of Principal Items of Work—Table 40 90 Factories, Workshops, Laundries, &c.—Table 41 91 Do. do. —Table 42 93 Factory and Workshop Act 94 Workshops and Workplaces—Bakehouses 96 Above-Ground Bakehouses—Table 43 97 Chief Sanitary Inspector Reports on Petroleum Acts 98 Housing of the Working Classes Acts 99 MEMBERS OF THE PUBLIC HEALTH COMMITTEE. Councillor ADAMS (Chairman). „ BIDDISCOMBE. COOMBES. „ DUNN. „ JOHNSON. „ KIDGELL. „ EILEY. „ SEXTON, Chairman of Council (ex-officio). MEMBERS OF BAKEHOUSE COMMITTEE. Councillor F. HILBORN, Chairman. „ C. PINKHAM. „ J. A. ADAMS. „ W. RILEY. HOUSING OF THE WORKING CLASSES COMMITTEE. Councillor BARRETT (Chairman). „ BATE. „ GRIFFIN. „ HODNETT. „ JONES. „ KIDGELL. „ PINCOMBE. „ RILEY. „ SEXTON, Chairman of Council (ex-officio). 6 STAFF OF PUBLIC HEALTH DEPARTMENT. WILLIAM BUTLEB, M.B., D.P.H., Medical Officer of Health. H. de Lima Woods, Chief Sanitary Inspector, Cert, of Royal Sanil. Inst. J. H. Smith, „ „ „ „ A. W. Locghlin, „ „ „ „ G. W. Wilson, „ „ „ „ F. Sheriff, „ „ „ „ T. L. Morley, „ „ „ „ Miss K. Gaul, Lady Health Visitor, Cert Sanit. Insp. Exam. Board. „ K. Walton, Probationer, „ „ „ A. A. Gibb, Senior Clerk. J. Barker, Junior Cleric. STATISTICAL SUMMARY FOR 1904. Population estimated to middle of year 134,539 Area 4,383 acres. Population per acre 30 „ Metropolitan District 1,081 „ „ „ 69 „ Brent District 3,302 „ „ „ 18 Altitude varies from 78 ft. to 242 ft. above Ordnance Datum. Rateable Value, £746,682. s. d. General District Rate Metropolitan District 3 2 Brent District 3 11 Poor Rate (Including Education Rate) 3 8 Rate per 1,000 Population. Marriage Rate 12.4 Birth Rate 32.9 Crude Death Rate 11.0 Recorded Death Rate 12.2 Corrected Death Rate 13.1 Infantile Martality 115.0 Zymotic Mortality 1.7 PUBLIC HEALTH REPORT For 1904. To the Chairman and Members of the Willesden Urban District Council. Gentlemen, I have the honour to present to you the 29th Annual Report on the Health and Sanitary Conditions of Willesden. The Report embraces a somewhat wider field than that surveyed in previous reports. The rapid growth of the district, and the changed conditions under which modern houses are erected, are together, shifting the incidence of the factors which in the main determine the public health in Willesden. With the greater part of the district a modern town, erected in accordance with the latest legislative pronouncements as to sanitary housing, the relative importance of housing conditions upon the health of Willesden must necessarily decline. Comparatively speaking, and leaving out of account the older portions of the district, it must be admitted that the problems of preventive medicine in Willesden are now less concerned with the dwellings and more with their inmates than ever before. Not that anything approaching a sanitary house has yet been attained for the majority of people, even in brand new districts. Drainage for the most part is satisfactory; water supply is practically pure; ground air 8 and damp, and the noxious effluvia that come from defective scavenging, are excluded from the modern house. On the other hand, small rooms, wretchedly lighted and abominably ventilated under occupied conditions, are a widespread monument of legislative incapacity to secure the rudiments of sanitary conditions in houses. But broadly speaking, notwithstanding these and other manifest defects in housing, the part they play in the production of disease and death is insignificant when compared with that produced by the colossal ignorance and incapacity of a large section of the people. Devoid of the rudiments of hygienic knowledge, deprived by the social conditions of the time of even a traditional domestic economy such as secured to their ancestors a bucolic content and health, the new urban population makes, by its ineptitude and inexperience, new dangers and detriments to health, and creates fresh menaces to the physical and social well-being of the community. The gravity of the problems arising in this connection is increasingly receiving attention, and if the venue of sanitary administration is not shifting, its basis is being broadened so as to include those educative measures which are the hope of the sanitary reformer. TOPOGRAPHICAL FEATURES. Situation.—The chief fact bearing upon health in relation to the situation of Willesden is its proximity to London. Willesden consists of a triangular area of 4,384 acres, one of the basal angles of which is wedged deep into the metropolis. The influences affecting the health of the district of Willesden are the influences operative in London. There is no greater menace to the health of Willesden than is to be found in the contiguity of its great neighbour; and, in its turn, Willesden may threaten, in this respect, the huge metropolis in whose shadow it lies. 9 Soil.—The soil consists of a thin stratum of loam overlaying the London clay. The clay extends to a depth known to vary from 70 ft. to 260 ft. Along the course of the River Brent, which forms the north-western limb of the triangle, there is a strip of gravel extending in places to a considerable distance from the present bed of the river. On the farm lands of Dollis Hill there is a capping of Bagshot sand, similar to that occurring on Hampstead Heath. Over the rest of the district the clay holds undisputed possession. An unfortunate topographical feature is the ridge running athwart the district from S.W. to N.E., which divides the watershed of the Brent from that of the metropolis. By creating two drainage areas it has raised a sewage problem in the Brent district which, while a vital concern to the whole of Willesden, is but part of a problem of wider significance since the interests of London in matters so deeply concerning health are inseparable from those of its immediate neighbours. METEOROLOGY. The following meteorological table has been computed upon data of observations made at the Council's stations. A comparison with the table in last year's report shows that the year was warmer, dryer and more equable than 1903, the rainfall being little more than half of that recorded during that year. 10 Table No. 1. METEOROLOGICAL TABLE. 1904. Month. 1904. Highest by Day. Lowest by Night. Range in Month. Mean of all Highest. Mean of all Lowest. 4 Earth Thermometer. Rainfall in Inches. No. of Days on which Rainfall was Measured. Maximum. Minimum. January 54.50 25.00 29.50 43.33 33.13 45.75 43.00 2.40 17 February 52.50 29.00 23.50 40.42 34.45 43.00 42.50 .36 2 March 58.75 27.00 31.75 43.26 33.44 43.00 42.00 1.77 14 April 65.50 30.50 35.00 56.54 37.70 46.00 43.00 1.12 8 May 73.00 33.00 40.00 60.80 44.81 49.30 46.25 2.23 14 June 72.75 41.50 31.25 65.86 48.17 53.75 49.75 1.14 8 July 86.50 48.00 38.50 77.43 56.09 58.75 53.00 2.27 9 August 87.00 43.75 43.25 69.60 51.15 59.25 58.75 1.06 9 September 71.75 40.00 31.75 63.75 50.39 58.75 56.50 2.05 11 October 67.00 34.75 22.25. 58.55 47.24 56.25 53.75 1.70 11 November 56.25 23.50 32.75 45.39 36.91 53.75 49.00 1.81 7 December 55.75 27.25 28.50 46.66 39.10 48.75 45.00 1.91 14 Means 66.77 33.60 32.33 55.96 42.71 51.36 48.54 19.82 1903 66.2 28.2 37.3 55.2 41.3 51.75 49.00 Total 37.66 11 ESTIMATED POPULATION TO MIDSUMMER, 1904 Table No. 2. Houses. Population. Harlesden, Met. 1,175 7,034 „ Brent 2,182 13,064 3,357 20,098 Kensal Green, Met. 3,946 28,503 „ Brent 5 37 3,951 28,540 Willesden Green, Met 284 1,657 „ Brent 4,217 24,608 4,501 26,265 South Kilburn, Met 1,309 14,934 Mid „ „ 1,606 12,558 North „ „ 1,701 10,416 Church End, Brent 3,373 21,728 7,989 59,636 Totals, Met 10,021 75,102 „ Brent 9,777 59,437 19,798 134,539 Population as estimated to Midsummer by the Registrar- General 132,566 Population estimated to Midsummer according to the Birth Rate 135,590 12 Table No. 3. ESTIMATED POPULATION to DECEMBER 31sr, 1904. NAME OP WARD. Population estimated to Dec. 31,1904, on the number of houses at Census, with the addition of houses put In rating since 1901. Population estimated to Dec. 31,1904, on the number of houses in occupation in each Ward as ascertained by special enumeration. Total No. of Houses in Ward. Total No. of Empty Houses. Total Number of Empty Tenements. Total No. of Houses recently erected but unoccupied. Total No. of Houses in course of erection. Percentage of Homes empty. Per centage of Houses empty, Michaelmas Quarter Percentage of Houses empty at Census. 1 Room. 2 Rooms. 3 Rooms. Over 3 Rooms. Church End 22,331 22,783 3,464 138 7 9 69 140 80 15 3.98 4.01 5.96 Harlesden 20,783 20,765 3,504 171 2 7 126 71 63 34 4.88 5.12 3.88 Kensal Green 29,046 28,964 3,999 106 4 32 56 77 36 17 2.65 2.21 2.92 South Kilburn 14,934 14,900 1,322 32 4 34 28 4 4 — 2.42 3.47 1.26 Mid Kilburn 12,575 12,264 1,587 84 5 18 44 — 7 — 5.29 5.41 4.16 North Kilburn 10,441 10,045 1,682 85 2 1 9 38 4 4 5.05 4.94 2.62 Willesden Green 27,317 27,544 4,570 198 4 10 79 139 251 66 4.33 4.61 7.37 Willesden U.D. 137,427 137,265 20,128 814 28 111 411 469 445 136 4.04 4.13 4.02 13 POPULATION. The tables give the population estimated according to the methods indicated. The Registrar-General's estimate, it will be observed, is of a smaller population than that yielded by my own. The method to which his available data limit him is one most liable to error in a district such as Willesden, subject as it is to such wide fluctuations in its rate of increase as are reflected in the varying local activities of the building trade. In the third and fourth quarterly estimates I introduced a new method of estimating the population, which, I venture to think, will be found an improvement in accuracy on older methods. It consists in an actual enumeration of the houses in (he district occupied and unoccupied, and from the known number of occupied houses in each ward estimating the population on the assumption that the number of persons per house has remained constant in each ward with that found at the census. It will be observed that in the fourth quarterly estimate—which I reproduce—there is but little difference in the result from that yielded by the older method. TABLE NO. 4.—MARRIAGES. 1904. First Quarter. Second Quarter. Third Quarter. Fourth Quarter. Total. Church of England 96 167 174 158 595 Nonconformist Churches — — — — 80 Registrar's Office — — — — 165 Totals 96 167 174 158 840 The total of 840 marriages for the year gives a mairiage rate of 12.4 per 1,000 persons living. of 12*4 per 1,000 persons living. Since 1900 the marriage rates per 1,000 have been as follows:— ] 1900 1901 1902 1903 1904 Marriage Rate per 1,000 persons 10.8 11.2 12.4 12.9 12.4 Percentage performed otherwise than in Ch. of England 26.8 28.4 26.1 25.1 29.1 Ditto, England and Wales — — — 34.9 — 14 For purposes of comparison the following rates are abstracted from 66th Annual Report of the Registrar-General. Marriage Rates per 1,000 Population, 1903. England and Wales 15.6 London 17.5 Middlesex 14.1 Table No. 5. BIRTHS. 1904. Boys. Girls. Totals. First Quarter 595 498 1,093 Second „ 533 557 1,090 Third „ 537 538 1,075 Fourth „ 571 528 1,099 In Queen Charlotte's Hospital 39 25 64 Totals 2,275 2,146 4,421 Table No. 6. BIRTHS DISTRIBUTED INTO WARDS. WARDS. First Quarter. Second Quarter. Third Quarter. Fourth Quarter. Total. Kate per 1,000 of Population. Church End 214 222 211 219 866 39.85 Harlesden 209 171 171 179 730 36.32 Kensal Green 226 253 227 216 922 32.30 South Kilburn 123 120 94 114 451 30.19 Mid Kilburn 81 92 98 89 360 28.66 North Kilburn 62 52 51 60 225 21.60 Willesden Green 178 180 223 222 803 30.57 Queen Charlotte's Hospital 10 17 16 21 64 — Totals 1,103 1,107 1,091 1,120 4,421 32.86 15 The birth-rate (32-86) maintains the level which has characterised it during recent years. In this respect the birthrate of Willesden contrasts with the downward tendency of the birth-rate of the country generally, where, for many years, the birth-rate has been declining. Table No. 7. 1875 1876 1877 1878 1879 1880 1881 1882 1883 1884 1885 1886 1887 1888 1889 Willesden birthrate 44.7 43.4 41.1 40.2 37.6 38.3 34.4 33.3 33.3 34.1 35.6 35.7 33.8 32.1 33.7 England and Wales birth-rate 35.4 36.3 36.0 35.6 34.7 34.2 33.9 33.8 33.5 33.6 32.9 32.8 31.9 31.2 31.1 1890 1891 1892 1893 1894 1895 1896 1897 1898 1899 1900 1901 1902 1903 1904 Willesden birthrate 29.4 33.1 31.7 32.5 30.7 31.2 32.2 31.0 31.5 31.5 31.2 33.1 31.3 31.9 32.9 England and Wales birth-rate 30.2 31.4 30.4 30.7 29.6 30.3 29.6 29.6 29.3 29.1 28.7 28.5 28.5 28.4 — A high birth-rate, other things equal, is a good. It is true that if fecundity in an especial degree be a feature of an undesirable element in the community—the reckless, the indigent, the criminal — such contribution to the birth-rate is to be deplored; but, per contra, if we find that the desirable section of the population—the able, industrious and gifted—is disproportionate!}' contributing to the birth-rate it is matter for congratulation. For it is obvious that the type of people will vary largely according as it is recruited predominantly from one or other of these classes. I shall not attempt to decide whether in Willesden fecundity is a character of the most desirable element in our population or of the reverse, but I will point out, as in previous reports, that high birth-rates are a feature of those wards distinguished by a class of house of comparatively lower average rateable value. 16 Table No. 8. * STATISTICS RELATING TO RATEABLE VALUE PER HOUSE, AND PER HEAD OF POPULATION. Ward. Total No. of Houses October, 1903. Total Population. Rateable Value October, 1903. Rateable Value per House not Including Factories. Rateable Value per House lncluding Factories. Rateable Value per Head. Rateable Value per Head Including Factories. £ £ £ South Kilburn 1,308 14,923 42,061 32.15 32.62 2.81 2.85 Mid Kilburn 1,604 12,542 58,381 36.39 37.26 4.65 4.76 North Kilburn 1,690 13,353 81,243 48.07 51.00 7.84 8.32 Willesden Green 4,149 24,217 152.641 36.78 38.06 6.30 6.52 Kensal Green 3,767 27,208 114,056 30.27 31.70 4.19 4.38 Church End 3,249 20,927 73,624 22.86 24.52 3.51 3.80 Harlesden 3,197 19,145 94,272 29.48 35.75 4.92 5.97 18,964 129,315 616,278 32.49 34.80 4.76 5.10 Factories, etc. 43,694 Railways. 53,659 18,964 129,315 713,631 37.51 37.51 5.51 5.51 * I am indebted to Mr. Ball, tho Clerk to the Council, by whose courtesy I am able to give this table. 17 In the main it is the poorer districts that have the higher birth-rates, and if economic conditions were such that the distribution of personal wealth was directly as the distribution of the true worth of each person to the community, the facts revealed by our birth-rate would be far from satisfactory. But, of course, everybody knows that it would be impossible to formulate the relationship between a man's worldly possessions and his personal value to the community. And so we must fain, in our ignorance, be content to rejoice in our improving birth-rate of presumably desirables. The increasing birth-rate in Willesden may, however, be due to the changing distribution of the age and sex of our population. The method of taking the whole population as the standard in estimating the birth-rate is very faulty, on account of the varying age and sex distribution of any given population as compared with any other. A much more reliable rate would be that in which the female population at the procreative age period (15 to 45) is the standard. At the census year the birth-rate in Willesden was 115 per 1,000 females at the age period 15 to 45. Assuming the proportion of females at this age period to have remained constant, the birth-rate for the year now reported on is 116.5 per 1,000 females at the age period 15 to 45. This is in excess of the rate for England and Wales estimated on the same basis. The Registrar-General, in his 66th Annual Report, has shown that on this more reliable method the birth-rate of England and Wales is a rapidly declining one. Table showing the Proportion of Total Births per 1,000 Women aged 15-45. Three-Year Periods. Year. 1870-2 1880-2 1890-2 1900-2 1903. 153.7 147.7 129.7 114.8 113.8 B 18 Births are a prime factor in the national well-being, and this rapid decline in our national birth-rate cannot be viewed without concern. A large part of the decline is undoubtedly due, however, to the later age at which women marry. The proportion of childbearing married women between 15 and 25 to those between 25 and 45 must now be very much less than it was 30 years ago, and on this account the decline in the birth-rate, thus estimated, is less serious than it appears. ILLEGITIMATE BIRTHS. The illegitimate births, which last year had risen from 12 per 1,000 births in 1902 to 21 per 1,000, show a still further increase this year, namely, to 24 per 1,000. This is rather a sad index of the changing character of Willesden, for although the rate is well below that of England and Wales, it is a rate which is increasing, whereas the rate for England and Wales is diminishing, as is shown in the following table:— England and Wales—Illegitimate Births in 1,000 Births, in Groups of Years 1851—1900. Period. Illegitimate births in 1,000 births. 1851-1860 65 1861-1870 61 1871-1880 50 1881-1890 47 1891-1900 42 19 Table No. 9. Year. Population estimated to Middle of each Year. Births. Total Deaths Registered in the District. Deaths in Public Institutions in the District Deaths of Nonresidents registered in District. Deaths of residents registered beyond. District. Deaths Ages. at all Nett. Deaths under One Year of Age. Deaths at all Ages. Total. Number. Rate.* Number. Hate per 1,000 Births registered. Number. Rate.* Number. Rate.* 1895 79,260 2,469 31.1 373 150 1,084 13.6 — — — — — 1896 85,421 2,749 32.2 460 167.3 1,210 14.16 — 9 111 1,312 15.29 1897 92,605 2,887 31.05 444 150.4 1,173 12.5 — 12 182 1,343 14.4 1898 99,180 3,142 31.68 427 130.6 1,197 12.06 — 9 200 1,388 13.93 1899 107,044 3,375 31.5 537 150.9 1,448 13.5 — 4 199 1,643 15.2 1900 114,905 3,559 31.1 463 130.09 1,359 11.8 — 7 225 1,577 13.68 1901 116,089 3,670 31.7 456 124.2 1,325 11.4 51 9 213 1,529 13.17 1902 122,211 3,835 31.38 498 129.8 1,417 11.8 55 6 268 1,715 13.9 1903 129,315 4,132 31.95 483 116.8 1,507 11.5 168 11 159 1,655 12.8 Averages for 1895.03. 105,114 3,313 31.52 460 138.89 1,306 12.48 91 8 191 1,520 14.04 1904 134,539 4,421 32.86 487 110.1 1,479 10.99 193 14 180 1,645 12.22 * Rates calculated per 1,000 of estimated population. b 2 Table No. 10. DEATH RATES. 1875 to 1904. Year. Number of Deaths. Rate per 1,000. Year. Number of Deaths. Rate per 1,000. 1875 385 21.4 1890 882 14.4 1876 401 21.7 1891 860 13.8 1877 346 17.7 1892 945 14.4 1878 441 21.4 1893 1,070 15.5 1879 376 16.8 1894 917 13.2 1880 471 18.7 1895 1,143 14.5 1881 490 17.6 *1896 1,210+102 14.1 1882 587 18.1 1897 1,173+170 14.4 1883 538 15.4 1898 1,197+191 13.9 1884 530 14.7 1899 1,448+195 15.2 1885 632 16.2 1900 1,359+218 13.6 1886 685 15.5 1901 1,325+204 13.2 1887 701 14.3 1902 1,447+262 13.9 1888 835 15.8 1903 1,507+148 12.8 1889 686 12.0 1904 1,479+180 12.2 * Deaths outside District included for first time. 20 21 Table No. 11.—Short Table. CAUSES OF, AND AGES AT, DEATH DURING YEAR 1904. 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 65. 65 and upwards. Church End. Harlesden. Kensal Green. South Kilburn. Mid Kilbuin. North Kilburn. Willesd.n Green. Small pox .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Measles 44 9 31 3 .. 1 .. 2 18 11 4 4 1 4 .. Scarlet fever 2 .. 1 1 .. .. .. 1 1 .. .. .. .. .. .. Whoaping-cough 10 4 6 .. .. .. .. 2 .. 5 1 1 1 .. .. Diphtheria and membranous croup 19 .. 11 8 .. .. .. 6 3 7 .. .. .. 3 .. Croup 1 .. 1 .. .. .. .. .. .. .. .. .. .. 1 .. Fever Typhus .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Enteric 8 .. .. 2 1 5 .. .. 3 1 1 1 1 1 .. Other continued .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Epidemic influenza 14 .. 1 .. 1 4 8 1 3 4 1 2 2 1 .. Cholera .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Plague .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Diarrhœa 146 114 29 .. .. 1 2 40 27 20 19 10 3 27 .. Enteritis 31 21 3 .. .. 6 1 10 2 3 5 5 2 4 .. Puerperal fever 5 .. .. .. 2 3 ,. .. 1 3 .. 1 .. .. .. Erysipelas 6 3 .. .. .. 2 1 2 .. 1 .. 2 .. 1 .. Other septic diseases 11 1 2 .. 1 7 .. 1 2 1 3 1 .. 3 .. Phthisis 141 2 4 8 15 107 5 27 14 24 16 28 5 27 .. 22 Table No. 11—continued. CAUSES OF. AND AGES AT, DEATH DURING YEAR 1904. 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. 1 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. Other tubercular diseases 47 17 16 8 1 4 1 8 9 4 7 9 3 7 .. Cancer, malignant disease 111 .. .. .. 3 73 35 16 19 20 14 15 10 17 .. Bronchitis 120 39 14 1 1 16 49 17 21 18 19 13 6 26 .. Pneumonia 128 44 29 2 1 34 15 16 18 17 20 16 7 34 .. Pleurisy 1 .. .. .. .. .. 1 .. .. 1 .. .. .. .. .. Other diseases of respiratory organs 12 4 3 1 1 2 1 2 2 4 2 1 1 .. .. Alcoholism and cirrhosis of liver 26 .. .. .. .. 22 4 4 6 1 5 6 2 2 .. Venereal diseases 5 3 .. .. .. 2 .. 1 2 1 1 .. .. .. .. Premature birth 78 78 .. .. .. .. .. 11 16 16 8 10 8 9 .. Diseases and accidents of parturition 10 .. .. .. .. 10 .. 3 2 .. 1 .. 2 2 .. Heart diseases 118 3 2 3 4 71 35 15 20 28 17 11 6 21 .. Accidents 53 16 7 4 3 22 1 7 12 5 9 7 6 7 .. Suicides 13 .. .. .. 3 10 .. .. 2 1 1 5 1 3 .. Diseases of nervous system 126 17 11 6 6 37 49 15 19 28 19 13 9 23 .. Diseases of urinary system 56 3 .. .. 1 30 22 8 9 11 12 10 4 2 .. Murder 1 .. .. .. .. 1 .. .. .. .. .. .. .. 1 .. All other causes 302 131 16 19 11 52 73 58 36 52 54 42 16 44 .. All causes 1,645 509 187 66 58 522 303 273 267 287 239 213 96 270 193 23 Table No. 12.—Long Table. CAUSES OF DEATH. Diseases. Year 1904. 1st Quarter. 2nd Quarter. 3rd Quarter. 4th Quarter. Small Pox .. .. .. .. .. Measles 44 38 6 .. .. Scarlet Fever 2 2 .. .. .. Whooping Cough.. 10 .. 4 2 4 Diph. Membraneous Croup 19 10 4 2 3 Croup 1 1 .. .. .. Typhus Fever .. .. .. .. .. Enteric Fever 8 1 .. 2 5 Other continued .. .. .. .. .. Epidemic Influenza 14 2 .. 1 11 Cholera .. .. .. .. .. Plague .. .. .. .. .. Diarrhœa and Dysentery .. .. .. .. Zymotic or Epidemic Enteritis 140 3 2 138 3 Enteritis (Enteritis and Gastro Enteritis) 31 5 5 16 5 Glanders (Farcy) .. .. .. .. .. Anthrax (Splenic Fever) .. .. .. .. .. Cow Pox (Effects of Vaccination) .. .. .. .. .. Syphilis 5 .. .. 2 3 Gonorrhœa .. .. .. .. .. Phagædena .. .. .. .. .. Erysipelas 6 1 .. 2 1 Pyæmia 4 1 .. 1 2 Puerperal Fever 5 2 .. 1 2 Infective Endocarditis 3 .. 2 1 .. Other Septic Diseases 5 3 .. 1 1 Malarial Fever .. .. .. .. .. Rheumatic Fever 9 1 2 1 5 Tetanus .. .. .. .. .. Tuberculosis— (a) Tubercular Disease of Brain, or Meninges Acute Hydrocephalus 19 9 5 3 2 (b) Laryngeal and Pulmonary Phthisis 141 28 41 28 44 (c) Tabes Mesenterica Tubercular Disease of Intestine 14 5 1 6 2 (d) General Tuberculosis, Tubercular Disease of undefined position 11 2 3 5 1 (e) Other forms of 2 .. 2 .. .. Other Infective Diseases 2 .. 1 1 .. Thrush .. .. .. .. .. Actinomycosis 1 .. 1 .. .. Hydatid Disease 1 .. .. 1 .. 24 Table No. 12—continued. CAUSES OF DEATH. Diseases. Year lv04. 1st Quarter. 2nd Quarter. 3rd Quarter. 4th Quarter. Atrophy, Marasmus Starvation, Want of Breast Milk 75 13 17 26 19 Rickets 4 1 .. 1 2 Scurvy .. .. .. .. .. Chronic Alcoholism (Cirrhosis of Liver) 26 6 2 10 8 Acute Alcoholism, D.T. .. .. .. .. .. Chronic Industrial Poisoning 1 .. .. .. 1 Osteo-Arthritis Rheumatoid Arthritis (Chronic Rheumatism) 2 1 .. .. 1 Gout 2 .. 1 1 .. Cancer (Malignant Growth) 111 19 34 31 27 Diabetes Mellitus 5 2 2 .. 1 Purpura Hæmorrhagica .. .. .. .. .. Hæmophilia 1 1 .. .. .. Anæmia Leucocythæmia 6 3 .. .. 3 Lymphadenoma .. .. .. .. .. Hodgkin's Disease .. .. .. .. . . Premature Birth 78 23 16 25 11 Debility at Birth 22 7 4 4 7 Injury at Birth 6 2 2 1 1 Atelectasis 10 4 .. 4 .. Malformation of Heart 6 3 2 .. 1 Spina Bifida, Hydrocephalus 4 .. 1 2 1 Imperforate Anus, and other congenital rectal malformations 2 2 .. .. .. Cleft Palate (Hare Lip) .. .. .. .. .. Icterus Neonatorum and other congenital defects 1 1 .. .. .. Old Age, Senile Decay 58 19 12 10 17 Inflammation of Brain or Membranes 16 3 6 2 5 Convulsions 18 10 3 2 3 Apoplexy (Cerebral Hæmorrhage) 43 13 13 7 10 Softening of Brain 5 2 1 2 .. Hemiplegia (Brain Paralysis) 7 2 1 2 2 Paralysis Agitans 2 .. 1 .. 1 Insanity (General Paralysis of Insane) 8 3 1 1 3 Chorea 1 1 .. .. .. Epilepsy 3 1 2 .. .. Laryngismus Stridulus .. .. .. .. .. Locomotor Ataxy Parahlegia (Diseases of Spinal Cord) 9 4 1 2 2 Other and Undefined Diseases of Brain or Nervous System 14 3 3 7 1 25 Table No. 12—continued. CAUSES OF DEATH. Diseases. Year 1904. 1st Quarter. 2nd Quarter. 3rd Quarter. 4th Quarter. Otitis, Otorrhœa 3 .. 3 .. .. Epistaxis (Diseases of Nose) .. .. .. .. .. Ophthalmia (Diseases of Eye) .. .. .. .. .. Endocarditis Valvular Diseases of Heart (Morbus Cordis : fatty heart) 103 23 25 18 37 Pericarditis 2 .. .. 1 1 Hypertrophy of Heart 2 1 .. .. 1 Angina Pectoris 1 1 .. .. .. Aneurism 5 .. 1 3 1 Senile Gangrene 1 .. 1 .. .. Embolism (Thrombosis; 6 3 .. .. 3 Phlebitis .. .. .. .. .. Varicose Veins .. .. .. .. .. Other and Undefined Diseases of Heart and Circulatory System 7 4 .. 2 1 Laryngitis .. .. .. .. .. 3 1 1 1 .. Other Diseases of Larnyx and Trachea 1 .. .. .. 1 Bronchitis 120 52 18 5 45 Lobar, Croupous Pneumonia 9 3 2 1 3 Lobular, Broncho-Pneumonia 63 29 15 3 16 Pneumonia (form not stated) 56 27 .. 7 17 Emphysema (Asthma) .. .. .. .. .. Pleurisy 2 1 1 .. .. Other and Undefined Diseases of Respiratory System 7 1 3 2 1 Sore Throat (Quinsy) 1 .. .. .. 1 Dentition 6 .. 4 .. .. Ulcer of Stomach 9 1 2 2 4 Other Diseases of Stomach 2 2 .. .. .. Obstruction of Bowels (Strangulated Hernia) 13 3 5 .. 5 Peritonitis and Appendicitis 18 7 1 4 6 Other Diseases of Digestive System 8 2 2 2 2 Diseases of Lymphatic System .. .. .. .. .. Acute Nephritis 6 1 2 .. 3 Bright's Disease (Albuminuria Uraemia. Pyo-Nephrosis) 37 11 3 9 14 Calculus Diseases of Bladder and of Prostrate 11 4 2 2 3 Other and Undefined Diseases of Urinary System 3 3 .. .. .. Male:—(a) Diseases of Testicles .. .. .. .. .. (b) Diseases of Penis .. .. .. .. .. 26 Table No. 12—continued. CAUSES OF DEATH. Diseases. Year 1904. 1st Quarter. 2nd Quarter. 3rd Quarter. 4th Quarter. Female:— (a) Diseases of Ovaries 1 l .. .. .. (b) Diseases of Uterusand Appendages 2 1 1 .. .. (c) Diseases of Vagina and External Genital Organs .. .. .. .. .. Abortion (Miscarriage) 3 1 1 1 .. Puerperal Mania .. .. .. .. .. Puerperal Convulsions .. .. .. .. .. Placenta Prævia, Flooding 2 1 .. 1 .. Puerperal Thrombosis 3 .. .. 2 1 Other & Undefined Accidents of Child Birth 2 .. 1 1 .. Arthritis, Ostitis, Periostitis, Osteo Myelitis 5 .. 3 .. .. Other and Undefined Diseases of Organs of Locomotion .. .. .. .. .. Ulcer, Bedsore 1 .. 1 .. .. Eczema 1 .. 1 .. .. Pemphigus 1 .. 1 .. .. Other and Undefined Diseases of Integumentary System .. .. .. .. .. .. .. Deaths from Accident or Negligence:— (a) In Mines and Quarries .. .. .. .. .. (b) By Vehicles and Horses 10 3 2 1 4 (c) On Railways 5 3 .. 1 1 (d) On Ships, Boats and Docks, other than Drowning 1 .. .. .. 1 (e) In Building Operations .. .. .. .. .. (f) By Machinery .. .. .. .. .. (g) By Weapons and Implements .. .. .. .. .. (h) Burns and Scalds 3 2 1 .. .. (i) Poisons, Poisonous Vapours 3 1 1 .. 1 (j) Drowning 3 1 1 .. 1 (k) Suffocation, overlaid in bed 14 4 3 3 4 Suffocation, otherwise 1 .. .. 1 .. (l) Palls and falling bodies 10 2 3 4 1 (m) Weather Agencies 1 .. .. 1 .. (n) Otherwise not stated 2 1 .. .. 1 Homicide 2 2 .. .. .. Suicide 13 5 2 2 4 Execution .. .. .. .. Sudden Death .. .. .. .. .. Other ill-defined and not specified causes 1 .. .. .. .. Totals 1,645 476 324 435 410 27 Table No. 13. 1904. DEATHS FROM ALL CAUSES AT THE FOLLOWING AGE PERIODS. 0 to 1 l to 5 5 to 10 10 to 15 15 to 20 20 to 25 25 to 35 35 to 45 45 to 55 55 to 65 65 to 75 75 to 85 85 and up. All Ages. 1st Quarter 127 78 17 6 4 8 35 22 28 52 49 39 11 476 2nd „ 87 30 12 5 6 4 22 26 30 40 28 25 9 324 3rd „ 201 51 5 8 7 4 18 28 32 32 32 10 7 435 4th „ 94 28 9 4 9 16 27 44 34 52 39 47 7 410 509 187 43 23 26 32 102 120 124 176 148 121 34 1,645 DEATHS. The deaths registered in the District were 1,479: males, 745; females, 734. Those registered outside the District of persons belonging to it were 180, giving a total of 1,659. There were 14 deaths registered in the District of persons not belonging to it, making 1,645 deaths. The crude death-rate for the year is 10.99 per 1,000. Corrected for deaths of residents dying outside the District and of non-residents dying within, it is 12.2 per 1,000. Corrected for the age and sex distribution of Willesden's population it is 13.1. This is the lowest death-rate on record in Willesden since the passing of the Public Health Act, 1875. 28 Last year I was able to record a similar low-water mark in our death-rate, which was then the lowest hitherto recorded. I was disposed to ascribe it largely to the exceptionally wet weather which characterised the year 1903. This year being an exceptionally dry year, a different explanation must be sought. A comparison of the deaths from particular causes confirms the view expressed last year. Whereas the deaths from diarrhoea then amounted only to 84, this year they reached a total of 146, and this, although furnishing a rate well below what has been experienced in previous years, is a characteristic index of the type of season thus reflected in a particular death-rate. Diarrhoea is a disease of hot, dry seasons. CAUSES OF DEATH. The chief saving of life has been in respect of the deaths ascribed to measles, whooping cough, pulmonary affections and diseases of the nervous system, as shewn in the following table:— Table shewing Deaths in 1903 and in 1904 from certain Specified Diseases. 1903. 1904. Measles 84 44 Whooping cough 67 10 Pulmonary affections 291 261 Disease of nervous system 166 126 The deaths from pulmonary affections bear a distinct relation to those from measles and whooping cough. Whenever either measles or whooping cough is rife the deaths from bronchitis and from pneumonia increase. This is due to the fact that medical aid is sought only when the complications of these infectious 29 diseases has set in, and when it may be the evidence that they are complications and not primary diseases has disappeared. It must be concluded, then, that the main reduction in deaths is due to a reduction in the number of deaths from measles and whooping cough and their complications. The death-rate from measles amounts to 32 per 100,000, that from whooping cough to 7 per 100,000. The sum of these rates is the lowest recorded in Willesden since 1895, It would be premature to credit this reduction to the fact that for the first time it has been practicable, owing to the notifications from schools, to enquire into the cases of measles and whooping cough, and to issue instructions and tender advice as to the steps to be taken to prevent their spread. But there can be no question that the work of the Lady Health Visitors has borne some fruit in this satisfactory result. Altogether some 730 cases of measles and 90 cases of whooping cough came to my knowledge during the year, and these were all visited by the Lady Health Visitors with such beneficial results as can find only a partial expression in mortality statistics. 30 Table No. 14. ZYMOTIC MORTALITY DURING THE LAST TEN YEARS. RATE PER 1,000. 189-1. 1895. 1896. 1897. 1898. 1899. 1900 1901. 1902. 193. 1904. Rate for the Country generally. Scarlet fever 0.09 0.21 0.19 0.11 0.09 0.14 0.10 0.10 0.08 0.08 0.01 0.17 Enteric fever 0.15 0.15 0.11 0.11 0.08 0.08 0.12 0.08 0.07 0.06 0.05 0.09 Diarrhœa 0.42 0.7 0.83 1.3 0.99 1.58 1.19 1.05 0.81 0.62 1.08 0.86 Diphtheria 0.21 0.42 0.32 0.68 0.65 0.42 0.24 0.45 0.40 0.07 0.14 0.17 Seven principal zymotic diseases 1.94 1.66 3.40 2.86 2.54 2.75 2.38 2.26 2.16 2.02 1.70 1.94 General rate from all causes 13.25 13.67 15.40 14.44 12.06 13.5 13.72 13.17 13.9 12.8 12.22 16.2 31 ZYMOTIC MORTALITY. Notwithstanding the considerable increase in mortality from zymotic diarrhoea, the death-rate from the seven principal zymotic diseases is the lowest but one during the last ten years. It is 1.7 per 1,000 as compared with the lowest, viz., 1.66 per 1,000 in 1895. The death-rate from scarlet fever, namely, 1.4 per 100,000, is the lowest on record; that from diphtheria, viz., 14 per 100,000, is double that of last year, but about half of the mean for the last 30 years. The death-rate from typhoid fever is 6 per 100,000, or about one-third of the mean for the same period. PHTHISIS. The deaths from phthisis, 141, give a rate of 104 per 100,000, the highest during the last five years. At a time when so much attention is devoted to diminishing the death-rate from this cause, this is far from satisfactory. It is probable, however, that the increase is accidental. Phthisis is a disease usually of some years duration, and last year the deathrate from this cause in Willesden was one of the lowest recorded. It may be that the year is unfavoured in the balance which more truly represents the mortality from such chronic affections. It will be seen from the table that Willesden compares not unfavourably in its phthisis mortality either with rural or urban England. Mortality Rate per 100,000 from Phthisis. Period 5 years. Rate. England and Wales 1898-1902 129 Urban Counties 1898-1902 140 Rural Counties 1898-1902 114 Willesden 1900-1904 90 32 Table No. 15. PHTHISIS AND CANCER MORTALITY. 1875 to 1904. Year. Number of Deaths from Phthisis. Rate per 1,000 of Population. Number of Deaths from Cancer. Rate per 1,000 of Population. 1875 37 2.03 7 .385 1876 24 1.30 11 .596 1877 32 1.64 8 .410 1878 40 1.94 16 .727 1879 35 1.56 10 .447 1880 36 1.42 8 .317 1881 44 1.60 — — 1882 27 0.83 14 .431 1883 56 1.60 10 .285 1884 35 0.96 20 .553 1885 55 1.42 21 .543 1886 35 0.79 18 .406 1887 47 0.95 12 .244 1888 47 0.87 36 .680 1889 55 0.96 25 .437 1890 73 1.18 29 .472 1891 67 1.07 36 .578 1892 65 0.98 35 .531 1893 73 1.05 37 .535 1894 72 0.98 32 .434 1895 96 1.08 44 .555 1896 80+8 1.02 51 .594 1897 74+12 0.92 30 .322 1898 78+22 1.00 46 .462 1899 121+14 1.25 55 .511 1900 103 0.89 73 .634 1901 96 0.81 85 .746 1902 111 0.909 97 .794 1903 113 0.873 107 .827 1904 141 1.04 111 .825 33 CANCER. The total number of deaths from cancer was 111. In the following table the deaths from cancer are distributed according to age and sex in each Ward of the District. The death-rate from cancer is nearly identical with that of last year, namely .825 as compared with .827 per 1,000. 8.5 per cent of the deaths from cancer among females occurred in Hospital, but of males the proportion dying in Hospital rose to 34'8 per cent. The total number of deaths among females was 68, among males 43. CANCER DEATHS, 1904 (Distributed According to Age and Sex.) Wards. 20 to 25. 25 to 35. 35 to 45. 45 to 55. 55 to 65. 65 to 75. 75 to 85 85 and upwards Total. M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. Church End .. .. .. .. .. .. .. 3 3 5 1 2 1 1 — — 16 Harlesden .. .. .. .. 1 1 3 2 2 1 1 4 2 1 — 1 19 Kensal Green 2 — — 1 — 3 — 1 2 4 2 5 — — — — 20 South Kilburn .. .. 1 — 1 1 2 3 2 2 2 — — — — — 14 Mid Kilburn .. .. .. .. 1 — 3 1 2 4 1 1 — 2 — — 15 North Kilburn .. .. .. .. .. .. .. 3 2 3 — 1 — 1 — 10 Willesden Green 1 — — — — 2 — 2 2 4 — 3 2 1 — — 17 Willesden U. D. 3 — 1 1 3 7 8 15 15 23 7 16 5 6 .. 1 111 c 34 INFANTILE MORTALITY. The rate of infantile mortality which last year was considerably the lowest on record shows a still further reduction, namely, from 123 per 1,000 in 1903 to 115 per 1,000 in 1904. There were altogether 509 deaths of infants under one year of age, and of these no fewer than 135 were contributed by diarrhoea and enteritis, while atrophy, marasmus, starvation or want of breast milk accounted for 73. All of these are preventable diseases, so that 2/5ths at least of the deaths of infants under one year should not have occurred, and this in a year of exceptionally low mortality. There were 78 premature births and 87 deaths from diseases of the respiratory system. The greater proportion of deaths occurred during the 3rd quarter of the year when zymotic diarrhoea was prevalent. With a view to removing some of the main causes of infantile deaths, the lady health visitors during the year systematically visited at houses in which, according to the registration returns, births had recently occurred. Over 1,000 houses were thus visited and details as to the methods of infant rearing were recorded in respect of some 872 births. At all houses where visits were paid, advice was tendered where faulty methods were found and leaflets of instruction left with the mothers or foster-mothers. A point was made of visiting also at all houses where deaths of infants ascribed to zymotic diarrhoea occurred. Altogether there were 651 birth enquiries where at the end of the year the infants were alive, and 221 where deaths had occurred within the year. 35 INFANTILE DEATHS FROM ZYMOTIC DIARRHŒA. Of the 651 births of children believed to be alive at the end of the year, the methods of feeding were found to be as follows:— Breast fed. Hand fed. Breast fed supplemented by Hand feeding. Breast fed for short period followed by Hand feeding. 463 76 105 7 71.1% 11.6% 16.1% 1.0% Of the 221 infantile deaths from all causes enquired into the methods of feeding were found to be as follows:— Breast fed. Hand fed. Breast fed. supplemented by Hand feeding. Breast fed for short period followed by Hand feeding. 44 124 26 22 19.9% 56.1% 11.7% 9.9% Five due to premature birth were not fed. Of the 114 of these deaths which were ascribed to zymotic diarrhœa, the methods of feeding were found to be as follows:— Breast fed. Hand fed. Breast fed supplemented by Hand feeding. Breast fed for short period followed by Hand feeding. 13 75 13 13 11.4% 65.8% 11.4% 114% The bearing of the method of feeding upon the chances of survival is well seen in the following table giving the percentage of each method for each class investigated. Breast fed. Per cent. Hand fed entirely or in part. Per cent. Infants alive at end of year 71.1 28.9 Infants dead from other causes than diarrhoea 30.4 69.6 Infants dead from diarrhœa 11.4 88.6 c 2 36 The risks to infant life from artificial feeding under the most careful and skilled supervision are very considerable; under the conditions practicable to the bulk of our population they are appalling. Given a conscientious and intelligent mother, scrupulous in her attention to the quality, quantity, method and regularity of administering the food selected as most suitable to infantile digestion, there yet remain the grave risks which are inseparable from the conditions of the urban milk supply. How great these are is so little appreciated by the public that it is not too much to say that a more general knowledge of them would lead to as drastic legislative and administrative changes in the control of the milk supply as have occurred in the water supply of this country during the last 30 or 40 years. The great mortality among infants is due for the greater part to poisoned milk. Year after year thousands of infants in England and Wales die owing to the filthy pollutions which gain admission to the milk of the town consumer. At the dairy farm, during transit, in the milk shop, in the home, it runs the gauntlet of a thousand dangers and it says much for the natural resistance of the hand-fed infant that it succumbs in no greater degree than is shown in our high infantile mortality tables. The greatest specific risk, undoubtedly, is to summer diarrhoea, but, as is well shown in the table, it does not stop here. There is, it will be observed, among infants dying from causes other than diarrhoea a much higher percentage of artificial feeding than is found among those who survive the year of their birth, although it is lower than among those dying from zymotic diarrhœa. It was found that out of the total of 872 births investigated, 325 were hand-fed, wholly or in part. Of these 325 no fewer than 147 were found to be fed with improper food. With 45 per cent. 37 of the artificially-fed infants fed with improper food it is not wonderful that their mortality is high. Things are no more satisfactory when we consider the methods of feeding as contrasted with the quality of food. Out of the 325 artificially-fed infants 105, or 32 per cent., were fed by means of feeding-bottles fitted with an india-rubber tube. Not only is it impossible to keep these bottles clean—the tube defying the most scrupulous efforts at cleanliness—but the facility with which these bottles can be placed in bed with the babies is provocative of the most serious irregularity in feeding. The bottle is the constant companion of infants thus fed, and the baby's life consists of a perpetual disagreement with food which is just as perpetually being fed to it by this ingenious instrument of irresponsible motherhood. With facts like these before us the 75 deaths ascribed to marasmus, atrophy or starvation are not to be wondered at. 73 of these deaths occurred in infants under one year of age and 30 were investigated. As might be expected, nearly 80 per cent. of the infants dying from this condition were found to be artificially fed. It was found that 56 per cent. of all the infants investigated were taken out daily, and 40 per cent. occasionally, but of those who died, the 4 per cent. never taken out rose to 21 per cent after excluding infants who died within so short a time of their birth as to justify their being kept indoors. OVERLAYING. There is one respect in which the hand fed infant is more favoured than the nursling. It is in its improved chance of 38 sleeping separate from its mother. 614 infants surviving at the end of the year were investigated as to this condition, and the results are given in the following table:— Number Investigated in respect of Sleeping. Sleeping With Mother. Percentage Sleeping wiih Mother. Breast Fed 436 353 81 Hand Fed 68 30 44 Partly Hand Fed 110 79 72 Partly Breast Fed Total 614 462 75 It is to be feared that the disparity in the percentage of breast fed infants sleeping with their mother, as compared with the percentage of the hand fed is to be explained on grounds of maternal convenience. Where a baby is nursed, it is certainly more convenient for the mother to have her infant in bed with her than to be put to the trouble of reaching it from its cot when it is fed. But mothers should know that they purchase this slight gain in personal comfort at the cost of their infants' rest and comfort and health, and above all at serious menace to its life from suffocation. No fewer than 14 deaths were caused during the year by suffocation in bed, due to this most indefensible practice. Accidents from all causes at all ages were accountable for a total of 52 deaths during the year, and 14, more than a fourth of this total, were due to overlaying. Consider the elaborate legislative and administrative measures which have been concerted with a view to diminish the risk of injury and death from accident—the Factory Acts, the Employers Liability Act, the Board of Trade Regulations, the army of inspectors, and the inventive and administrative ingenuity devoted 39 to this end, and consider that one-fourth of the accidents from all causes at all ages are caused in a semi-industrial centre like Willesden to suffocation of infants from overlaying in bed. There needs an awakening of the public conscience upon the enormity of this offence; there needs a drastic reform in the education of women such as shall fit them for their primal, most noble and most important function of child rearing. INFANT LIFE INSURANCE AS A FACTOR IN INFANTILE MORTALITY. It has been alleged that infant life insurance has been a malign factor in the causation of infant mortality. It may be that in some localities this is the case; it is possible that in Willesden, here and there, where maternal instinct and sense of parental responsibility are utterly degraded, it may stimulate a low cupidity so that it weighs in the balance against the welfare of offspring. But in the main I am convinced, as a result of my investigations, that it is quite inoperative upon the chances of survival of the infant. On the whole it is the better cared for child of the working classes that is insured. Its insurance is an expression of that forethought, providence and care which are among the first virtues of good citizenship. And I have found that the worst class of parents do not as a rule insure their infants. In respect of the primal conditions of healthy upbringing, the uninsured infants compare unfavourably with the insured—not that these factors stand in relation of cause and effect, but because the uninsured babies are more frequently found among the improvident and indigent classes. 40 An analysis of the enquiries into births and infantile deaths reveals the following results :— Insured. Not Insured. No. Percentage. No. Percentage. Infants surviving 342 45.5 409 54.5 Infants dead within the year 80 36.2 141 63.8 Total 422 48.4 450 51.6 From this table it will be observed that although of the 872 births investigated, the number of insured and uninsured was almost equal, the proportion of uninsured infants who died was greater than among the insured. This is exactly what I should have expected, judging from the increased care with which the insured are treated. Infant life insurance may or may not be a good thing. It certainly will not tend to improve the prospects of living in the case of any infant insured. But it is not evident that in any measurable degree, it tends in this district to militate against the infants' welfare. I have the greatest pleasure in inserting here the report of Miss Gaul on the general results of her inquiries into the conditions of infant rearing. BIRTH ENQUIRIES, 1904. Report by Miss Gaul, Lady Health Visitor. "In making birth enquiries I have found, as a rule, the parents welcome, rather than resent, any advice offered; and, even in those cases where at the outset the enquiries have been looked upon 41 with suspicion, after a iitfle conversation the mothers become interested. "The most difficult mother to deal with is of the type who, while treating her child in the worst possible manner with regard to diet, bathing and sleeping arrangements, admits the instructions given are the proper manner in which to treat a child, but also says she "has heard tell of it before," and insinuates that she has quite determined not to alter her old régime in the least; but much may be done with these mothers in time. "A certain class of parents appear to consider it a natural and desirable thing to lose their children in early infancy. One mother, having had 11 children and only five surviving, remarked, "Well, it's a blessing they do die; how could we keep them if they lived ?" "There is a decided prejudice against taking the babies out in all weathers, and it is hard to convince the parents of the great necessity for fresh air for infants as well as adults, especially in sleeping apartments. So many people seem to consider it necessary to treat babies like hot-house plants. "It is very difficult to dissuade the mothers from having baby to sleep in their beds. Many mothers make the cold weather an excuse, and say it is impossible to keep the child warm in a cradle. Even the danger of over-laying will not induce some mothers to part with their infants at night. "Very few of the babies visited are properly clothed. There is a great tendency to use too many garments of an unsuitable kind. Long cotton robes and petticoats are dearly loved by many mothers, and the necessity for woollen clothing is ignored. It is quite the exception to find a child with woollen garments to the wrist and below the knees, even in the coldest weather. Flannelette has largely taken the place of wool or flannel for infants' clothing. In many cases this is due to the fact that flannel is so much more expensive, and also more difficult to wash and dry. 12 "The mothers of the "rather better-class" are usually much interested in everything connected with baby's welfare, and listen most attentively to all instructions. A second visit shows that many of the suggestions have been adopted. "The idea of a cold bath is usually received with consternation, but in those cases where it has been tried the mothers are very pleased with the result. "Tube bottles are one of the greatest stumbling-blocks, the excuse given for their use as a rule being the extra expense incurred by using the others; but the real reason is the fact that the child can feed from them without assistance. In some cases boat-bottles are used in the daytime and the tube at night, as the mothers object to sitting up long enough to feed the child from a boat-bottle. With regard to the extra cost of boat-bottles, I have suggested the use of a soda water bottle with a large teat in preference to a tube, as being more readily cleansed, easily procured and generally less objectionable. These in some cases have been adopted. "Many mothers who could feed their children naturally do not, either on account of going out to work or because breast-feeding the infant would tie them down too much. "Hand-feeding is often adopted as the breast does not appear to satisfy the infant." DEATHS OF ILLEGITIMATE CHILDREN. These numbered 53, 51 of which were certified, and two inquests were held. The causes of death were:— Marasmus 7 Pneumonia 6 Tubercle 4 Bronchitis 6 Epidemic Diarrhœa 10 Suffocation in bed 2 Enteritis 8 Venereal Disease 1 Diphtheria 1 Other Causes 7 Measles 2 13 Of the 53 deaths three occurred in children over one year of age (leaving 50 deaths of illegitimate infants). There were 108 illegitimate births during the year, so that the rate of infantile mortality among illegitimate children amounts to 463 per 1,000, as compared with a rate of 106 per 1,000 among legitimate infants. This high rate of mortality among illegitimate children is a sad reflex of the fact that unwanted children can. under cover of the law, be naturally eliminated—to use an euphemism which shall decently cover the varied terms which label the manner of their exits. UNCERTIFIED DEATHS. These numbered for the year nine. As I have repeatedly pointed out, uncertified deaths offer the readiest loophole for undetected homicide. The high mortality among illegitimate children shows to what an extent undesired lives can be got rid of. Unless a medical certificate of the cause of death is forthcoming, I am strongly of opinion that an inquest should be held. Whatever discretion may be left to a coroner in rural districts where medical attendance is not always procurable within short notice, such discretion should not be exercised in, or in the suburbs of a large city. In this the Middlesex Coroner frankly disagrees with me, and a somewhat lengthy correspondence has failed to bring us to see the question eye to eye. The nine uncertified deaths, however, compare favourably with the 14 of last year, though they still leave us to share with Lej'ton the distinction of possessing the highest number of uncertified deaths of any of the large urban communities in the outer circle of London. 44 The following number of uncertified deaths have been returned for Willesden during the last seven years:— 1898. 1899. 1900. 1901. 1902. 1903. 1904. 26 19 11 8 20 14 9 During the year there were no uncertified deaths returned for Croydon and Hornsey, only one for Tottenham, and three for Walthamstow. The causes to which the nine uncertified deaths in Willesden were ascribed are as follows:—Phthisis, one; influenza, one; bronchial catarrh, one; convulsions, two; syncope, one; heart disease, one; premature birth, one; and insufficient vitality at birth, one. No firm employing a large number of hands would accept the assurance of a layman that the alleged illness of an employe was sufficient excuse for abstention from work; but the State is content upon such evidence to register the cause of death, and to grant a certificate of burial where no medical man has seen the deceased whether alive or dead. INQUESTS. There were 94 inquests held in the District during the year, as compared with 101 last year. In 4G the deaths were ascribed to natural causes, 10 to suicide, 28 to accidents, one to murder, and nine to other causes. Of those dying by suicide, five were returned as due to taking poison (three oxalic acid, one chloroform, one spirits of salts), one to cut throat, one to hanging, one felo de se, one on the railway, and one to fractured skull. It is nowhere truer than of suicide that the sight of means to do ill deeds makes ill deeds done—hence the preponderence of suicides by poisons most easily procurable. 45 TABLE NO. 16. Names of Localities. CHURCH END. HARLESDEN. KENSAL GREEN. SOUTH KILBURN. 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. Population estimated to middle of each Year. Births Registered. Deaths at all Ages. Deaths under 1 year. 1895 9,572 350 148 41 12,784 346 144 40 10,239 418 160 83 13,387 473 240 93 1896 10,589 440 181 83 13,523 383 146 46 11,757 510 190 83 13,441 449 253 101 1897 11,907 391 154 63 15,194 413 172 57 14,157 538 205 96 13,492 452 224 97 1898 13,280 544 181 66 15,854 420 156 53 16,331 633 186 74 13,546 490 251 93 1899 15,144 655 238 106 16,499 477 196 68 19,199 680 242 111 13,644 463 239 82 1900 16,688 701 278 100 17,542 491 214 70 22,380 785 304 94 13,819 416 279 66 1901 19,367 754 278 125 17,115 508 226 59 23,541 817 261 78 14,625 431 278 66 1902 20,153 786 281 95 17,924 576 233 78 25,296 871 294 99 14,923 447 352 104 1903 20,927 801 339 114 19,145 672 256 73 27,208 893 264 85 14.923 454 256 77 Averages for 1895 to 1903 15,291 602 231 88 16,175 476 193 60 18,912 682 234 89 13,978 453 262 87 1904 21,728 871* 273 117 20,098 735* 267 80 28,510 931* 287 91 14,934 473* 239 64 * Including Children born in Queen Charlotte's Hospital. 46 Table No. 16—continued. Names of Localities. mid kilburn. north kilburn. willesden green. 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 11,339 381 184 64 9,178 197 107 23 12,661 304 101 27 1896 11,527 355 177 65 9,554 205 105 25 14,499 407 156 57 1897 11,787 379 180 64 11,203 183 83 22 14,985 509 154 45 1898 11,968 377 173 62 12,384 169 84 13 15,678 492 164 62 1899 12,201 380 179 56 12,602 208 138 33 17,695 512 213 79 1900 12,298 380 185 49 13,002 224 118 23 19,176 562 199 61 1901 12,290 370 160 44 9,913 201 123 29 19,238 589 203 59 1902 12,477 344 213 65 10,259 249 134 31 21,179 622 218 64 1903 12,542 349 186 54 10,353 228 105 25 24,217 673 260 79 Averages for 1895 to 1903 12,048 368 181 58 10,945 207 111 25 17,703 519 189 59 1904 12,558 373* 213 55 10,416 230* 96 21 26,265 808* 270 81 * Including Children born in Queen Charlotte's Hospital. 47 Table No. 17. INFANTILE MORTALITY AND DIARRHCEA DEATHS. 1875 to 1904. Year. Infantile Deaths. Infantile Mortality Rate per 1,00 Births. Deaths from Diarrhoea. Rate per 1,000 of Pupulaton. 1875 131 162 28 1.54 1876 120 149 28 1.52 1877 113 140 8 0.41 1878 167 201 23 1.11 1879 118 130 12 0.54 1880 168 173 29 1.11 1881 — — 37 1.35 1882 202 186 31 0.95 1883 196 167 28 0 80 1884 203 164 42 1.16 1885 235 172 33 0.85 1886 265 164 37 0.83 1887 264 159 45 0.92 1888 290 170 36 0.68 1889 276 143 43 0.75 1890 287 158 38 0.62 1891 273 132 32 0.51 1892 333 159 36 0.54 1893 345 153 52 0.78 1894 299 132 31 0.42 1895 373 150 56 0.70 1896 460 167 72 0.83 1897 444 155 121+1 1.31 1898 427 136 100+2 1.02 1899 537 159 168+1 1.57 1900 497 139 137 1.19 1901 495 131 123 1.14 1902 498+38 130 104 0.85 1903 483+26 123 81 0.61 1904 487+22 115 146 1.08 48 WARD DISTRIBUTION OF DEATHS. It will be seen from Table No. 18 that the death rates in the different wards vary within considerable limits. The North Kilburn Ward in all respects exhibits the most satisfactory vital statistics, but Kensal and Willesden Green are not far behind, and all may be described as eminently satisfactory. Harlesden and Church End form an intermediate group between the wards with very low and the wards with unsatisfactorily high mortality figures. Mid and South Kilburn run each other hard for the lowest place. These two wards largely constitute the older part of the district, and much insanitary property exists in each of these wards. It is hoped gradually to bring them more into line with modern sanitary requirements, and with this there is considerable prospect of reducing their high mortality. Nothing could better illustrate the effect of modern sanitation upon the lives and health of people than this contrast in the mortality figures persistently maintained in wards which vary almost in direct proportion in respect of their comparative insanitariness. Arrayed against sanitary reform, and opposed to every effort made to secure the rudimentary conditions of a healthy home are the threatened interests of property. Less strenuous it is certain would be this opposition were it not that monetary interest or ignorance too often blinds to the evils—the cost in human life which the continuance of the insanitary conditions entails. The social, the educative, the economic conditions of the people count largely without doubt. Sunk in an abyss of brutality, ignorance, dirt, squalor and incompetence a submerged considerable fraction of our population will be helped but little by the mere provision of sanitary dwellings. But the ward statistics show that insanitary houses still bulk largely as factors in the production of high mortality rates. 49 WARD MORTALITY RATES. Table No. 18. wards. 1904. Corrected. Death Kates 1904. Per 1,000. 1900-1904. Rate of Infantile Mortality. 1904. Rate of Infantile Mortality. Per 1,000. Zymotic rate. Per 1,000. Diarrhœa. Per 1,000. Phthisis. Per 1,000. Church End 13.14 12.56 140 134.3 2.3 1.8 1.24 Harlesden 14.93 13.28 120 108.8 2.5 1.3 0.69 Kensal Green 10.96 10.05 104 97.7 1.5 0.7 0.84 South Kilburn 16.67 16.00 169 135.3 1.6 1.2 1.07 Mid Kilburn 17.52 16.96 147 147.4 1.2 0.7 2.22 North Kilburn 10.18 9.21 113 91.3 0.5 0.2 0.48 Willesden Green 11.65 10.27 105 100.2 1.3 1.02 1.02 Willesden 13.1 12.22 121 115 1.7 1.08 1.04 D TABLE NO. 19. CASES OF INFECTIOUS DISEASE NOTIFIED DURING THE YEAR 1904. Notifiable Diseases. Cases notified in Whole District. Total Cases notified in each Locality. Wards. No. of Cases removed to Hospital from each Locality. Wards. 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 12 2 .. .. 4 6 .. 1 .. .. .. .. .. 11 1 .. .. .. .. .. 11 Cholera .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Diphtheria 351 2 100 183 34 32 .. 154 49 48 14 20 6 60 130 42 43 13 15 2 45 Membranous croup 2 .. 2 .. .. .. .. .. .. 1 .. .. .. 1 .. .. .. .. .. .. .. Erysipelas 73 5 1 6 3 52 6 10 15 14 11 10 5 8 .. 1 1 2 1 .. 1 Scarlet Fever 326 3 88 191 25 18 1 86 87 61 16 17 16 43 67 60 50 16 13 7 29 Typhus Fever .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Enteric Fever 38 .. 1 4 9 22 2 4 6 8 4 6 5 5 1 3 2 2 1 1 2 Relapsing Fever .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Continued Fever .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Puerperal Fever 5 .. .. .. 2 3 .. .. .. 3 .. 1 .. 1 .. .. .. .. .. .. .. Plague .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Totals 807 12 192 381 77 133 9 255 157 135 45 54 32 129 199 106 96 33 30 10 88 51 NOTIFICATIONS OF INFECTIOUS DISEASE. The year has been characterised by an exceptionally low incidence of notifiable infectious diseases. The rate from all the notifiable diseases together, 5.9 per 1,000, is the lowest recorded, as will be seen from the table No. 20. The percentage of roads infected is lower than was the case either last year or the year before. And this is uniformly the case in each of the wards. - See table No. 21. There is, however, a slight increase in the number of cases per infected road in Church End, Harlesden, Mid Kilburn and Willesden Green. In Church End, Harlesden and Mid Kilburn, also, there is a slight increase in the notification rate, but in the other wards a reduction in each of these respects. D 2 52 Table No. 20. NOTIFICATIONS. 1892 1893. 1894. 1895. 1896. 1897. 1898. 1899. 1900. 1901. 1903. 1903. 1901. Small pox 5 23 21 5 2 — 1 — — 10 88 7 12 Scarlet fever 366 589 268 392 475 510 361 414 335 653 466 502 326 Diphtheria 141 221 125 179 171 270 333 317 225 399 433 217 351 Croup 4 8 4 7 2 5 2 2 1 5 7 4 2 Typhus fever — 1 — — — — — — — — —— — — Typhoid fever 28 47 70 69 52 52 66 79 77 57 73 45 38 Continued fever — — 2 — 1 1 — — — — — — — Puerperal fever 4 6 4 8 10 9 2 6 8 2 8 11 5 Cholera nostras 1 1 1 — 1 2 — 1 — — — — — Erysipelas 85 139 63 81 101 107 70 82 89 79 104 76 73 Plague (Pestis minor) — — — — — — — — — 1 — — — Totals 634 1,035 558 741 815 956 835 901 357 1,106 1,179 862 807 Rate per 1,000 9.4 15.0 7.5 9.3 9.5 10.3 8.4 8.3 6.4 9.5 9.6 6.7 5.9 53 Table No. 21. ANALYSIS OF NOTIFICATIONS. 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 Roads per cent, of whole. Notification Rate per 1 ,000 of Population. 1903 1903 1904 1902 1903 1904 1902 1903 1901 1902 1903 1904 Church End 83 54 29 7.6 3.7 4.7 61 2.5 3.0 79.7 68.9 65.0 20.8 9.1 11.7 Harlesden 71 38 33 5.6 3.1 41 3.9 2.3 2.2 69.6 74.6 53.5 12.2 7.6 7.8 Kensal Green 70 38 32 4.0 4.1 3.5 2.6 2.4 1.9 65.6 60.0 54.2 6.6 5.9 4.7 South Kilburn 39 19 20 4.0 3.5 2.3 2.8 2.2 1.1 51.4 62.8 48.7 5.9 5.1 3.0 Mid Kilburn 34 12 22 4.0 2.3 4.5 2.3 1.6 1.6 57.5 57.5 35.3 6.0 4.2 4.3 North Kilburn 36 14 22 3.3 4.5 2.2 1.3 1.2 .8 55.8 70.5 38.8 6.2 4.2 3.0 Willesden Green 97 41 56 3.2 2.2 3.1 1.9 2.4 1.3 58.9 56.5 42.2 6.5 7.7 4.9 Willesden 430 216 214 5.0 3.1 3.7 3.2 2 2 1.8 64.5 64.5 50.2 9.6 6.7 5.9 54 SMALL POX. Twelve eases of small pox were notified during the year. The history of these is interesting, and well illustrates the advantage of the system of inter-communication between Medical Officers of Health. It is as follows:— On October 18th, I received a telegram from the Medical Officer of Health of Horbury, Yorks, stating that a small pox contact was residing at Villiers Road, Willesden. The contact, a Salvation Army " Captain," was discovered there, and a history of influenza from which he was alleged to have suffered did not lessen the suspicion with which he was necessarily regarded owing to his contact with small pox in Yorkshire 19 days previously. Subsequent investigation after communicating with the medical attendant elicited the following facts. -D-, the contact, came to Yilliers Road with his wife from Horbury, Yorkshire, on September 29th. Prior to leaving Horbury he had visited a patient whose illness subsequently proved to be small pox. On October 2nd he was seized with symptons of influenza, which confined him to his home until October 16th. On October 7th his wife returned to Horbury, and on October 18th she was admitted to the small pox hospital there suffering from small pox. As the rash was stated to have appeared on this date, it was certain that she had contracted the disease in Willesden, probably on October 4th. If she had contracted the 55 disease in Willesden, it was tolerably certain she had contracted it from her husband, as he was ill at that time with symptoms indistinguishable from those of small pox. There could, in the light of the nature of his wife's illness, be no doubt that the nature of his attack was also small pox. On October 19th, no fewer than seven persons living at Yilliers Road developed symptons of influenza which were looked upon by the attending practitioners as gravely suspicious of smallpox. On the 21st I was asked to see one of the patients, a baby, who had just developed a few spots sufficient to make the diagnosis of small pox almost a certainty. On the morning of the 22nd I again saw the patients with one of the attending practitioners, when the diagnosis of small pox was practically certain in the case of all the patients, although the eruption was only just beginning to appear in some, while in others it was still invisible. 14 persons were known to have been in contact with one or other of these cases, and of these, five subsequently developed the disease while under observation. The early intimation, prompt isolation of the patients, and vaccination or re-vaccination and segregation of the contacts were successful in checking the further spread of the disease. 56 VACCINATION RETURNS. YEARS No. of Births. Successfully Vaccinated. Insusceptible Dead. Conscientious Objectors. Postponed by Doctor. Gone Away. Un-vaccinated. Percentage of Survivors unprotected by Vaccination. 1898 3,125 1,474 13 257 37 117 259 968 48 1899 3,375 1,615 21 345 63 76 91 1,161 46 1900 3,560 1,704 8 253 106 56 268 1,165 48 1901 3,670 2,351 12 304 120 40 280 563 30 1902 3,835 2.548 28 353 84 39 352 430 27 1903 4,070 2,687 27 346 84 52 322 552 27 1904 4,357 2,697 19 308 100 56 355 852 31 Out of 552 patients admitted to Dog Lane Hospital whose arms were examined, 119 were found to be un-vaccinated = 21.7 per cent. Should small pox ever gain a firm footing, the unprotected condition of so large a section of our population due to neglect of vaccination would make a formidable epidemic of costly proportions, not only possible but extremely probable. SCARLET FEVER. 326 cases of scarlet fever were notified during the year. This gives the lowest rate but one, since scarlet fever became notifiable in Willesden, viz.:—2.4 per 1,000 of population, the lowest being 2.1 per 1,000 in 1891. The rate was considerably reduced on the rate of last year in each of the Wards. Harlesden and Church End suffered most, and South Kilburn least. Only two deaths were returned as due to this disease, giving the lowest fatality rate recorded in the district. The disease was, therefore, neither prevalent nor of a severe type. 57 Table No. 22. CASES NOTIFIED UNDER 15 YEARS OF AGE DURING THE YEAR 1904. wards. scarlet fever. diphtheria. Notified under 15 years of age. Notification rate per 1,000 population under 15 years of age. Notified under 15 years of age. Notification rate per 1,000 population under 15 years of age. Church End 76 8.89 120 14.04 Harlesden 71 11.12 42 6.57 Kensal Green 53 5.28 39 3.89 South Kilburn 13 2.33 14 2.51 Mid Kilburn 16 3.93 15 3.69 North Kilburn 14 5.67 3 1.21 Willesden Green 35 4.37 46 5.75 Totals 278 6.17 279 6.19 Mean of years, 1902-3 — 9.9 — 3.6 „ 1903-4 — 8.16 — 5.03 58 DIPHTHERIA. 351 cases of diphtheria were notified during the year. This gives an incidence rate of 2.6 per 1,000, which is just above the mean rate for the whole period since diphtheria became notifiable. With the exception of Willesden Green and South and North Kilburn, the incidence rate was increased in each of the Wards Church End suffered most, and Harlesden and Willesden Green next. North Kilburn was least affected. It is a notable fact, and one for which I cannot wholly account, that the newer part of the District, and especially that situated in the Brent area, persistently suffers more from diphtheria than the metropolitan area. The difference in the age distribution of the respective populations is not a sufficient explanation, for in the Table (No. 22) the rates are estimated on the population under 15 years of age. South and Mid Kilburn usually suffer in a greater degree from erysipelas than do the other Wards, while Church End, Harlesden and Willesden Green show a preference for diphtheria. I will not hazard a guess at the explanation of these phenomena but they are interesting epidemiological facts not to be lost sight of in considering the relation of certain zymotic diseases to the prevailing sanitary conditions. 59 Table No. 23. FATALITY AND INCIDENCE FROM SCARLET FEVER, DIPHTHERIA, AND TYPHOID FEVER, PER 1,000— 1888 TO 1901. Year. Fatality Rate. Scarlet Fever. Deaths per 1,000 cases. Incidence Rate. Scarlet Fever. Cases per 1,000 population. Fatality Fate. Diphtheria, Deaths per 1,000 cases. Incidence Rate. Diphtheria. Cases per 1.000 population. Fatality Rate. Typhoid Fever. Deaths per 1,000 cases. Incidence Rate. Typhoid Fever. Cases per 1,000 population. 1888 60 3.8 193 1.2 209 0.81 1889 13 2.6 69 1.8 71 0.49 1890 11 2.9 140 2.4 170 0.66 1891 15 2.1 78 1.2 121 0.53 1892 22 5.5 127 2.1 214 0.42 1893 25 8.5 199 3.1 191 0.66 1894 26 3.6 126 1.7 157 0.96 1895 43 4.9 190 2.2 174 0.87 1896 35 5.5 169 2.1 211 0.66 1897 21 5.4 250 2.9 230 0.56 1898 28 3.6 204 3.3 136 0.66 1899 38 3.9 148 2.9 128 0.73 1900 35 2.9 124 1.9 181 / 0.68 1901 21 4.9 138 3.4 175 0.49 1902 27 3.8 122 3.5 205 0.60 1903 22 3.8 46 1.6 290 0.34 Mean Rate 28 4.2 145 2.3 179 0.63 1904 6 2.4 54 2.6 211 0.27 60 Table No. 24. WARD INCIDENCE OF SCARLET FEVER DURING THE LAST TEN YEARS. RATE PER 1,000 POPULATION, Ward. Rates. Quinquennial Means. Decennial Mean. 1895 1896 1897 1898 1899 1900 1901 1902 1903 1904 1895 to 1899 1900 to 1904 1895 to 1904 Church End 2.1 7.7 5.0 3.9 5.9 4.3 5.6 7.5 5.5 4.0 4.9 5.4 5.15 Harlesden 3.7 3.1 4.2 2.2 3.8 2.3 8.2 4.2 4.0 4.3 3.4 4.6 4.00 Kensal Green 6.8 3.9 6.5 3.9 4.0 2.8 4.7 3.0 3.7 2.1 5.0 3.3 4.14 South Kilburn 6.6 7.9 9.1 4.8 4.7 2.3 3.7 1.9 2.9 1.0 6.6 2.4 4.49 Mid Kilburn 5.9 4.0 6.2 4.0 3.1 2.9 4.1 2.0 2.4 1.3 4.6 2.5 3.59 North Kilburn 5.0 4.1 3.3 3.4 1.5 3.0 3.3 3.6 2.4 1.5 3.4 2.8 3.41 Willesden Green 3.9 7.6 3.9 3.3 3.6 3.7 2.7 3.2 4.1 1.6 4.5 3.1 3.76 61 Table No 25. WARD INCIDENCE OF DIPHTHERIA DURING THE LAST TEN YEARS. RATE PER 1,000 POPULATION. ward. Rates. Quinquennial Means. Decennial Mean. 1895 1896 1897 1898 1899 1900 1901 1902 1903 1904 1895 to 1899 1900 to 1904 1895 to 1904 Church End 2.3 4.4 1.5 2.6 5.0 2.8 7.1 9.9 2.7 7.0 3.0 5.9 4.53 Harlesden 2.3 1.9 1.9 3.6 3.4 2.3 3.5 6.1 1.7 2.4 2.6 3.2 3.2 Kensal Green 2 .2 1.7 4.5 3.4 2.8 2.7 3.5 1.7 1.2 1.7 2.9 2.2 2.54 South Kilburn 3.0 1.4 43 4.7 3.0 2.3 2.6 1.4 0.9 0.9 3.3 1.6 2.45 Mid Kilburn 3.1 2.0 5.2 6.4 2.8 1.0 1.3 1.8 0.6 1.6 3.9 1.3 2.58 North Kilburn 1.3 2.1 2.7 24 0.9 06 31 1.2 0.8 0.5 1.9 1.2 1.56 Willesden Green 1.7 11 1.0 1.7 2.5 1.2 1.4 1.0 24 2.2 1.6 1.6 1.62 62 Table No. 26. WARD INCIDENCE OF ERYSIPELAS DURING THE LAST TEN YEARS. RATE PER1,000 POPULATION. Ward. Rates. Quinquennial Means. Decennial Mean. 1895 1896 1897 1898 1899 1900 190l 1902 1903 1901 1895 to 1899 1900 to 1904 1895 to 190.1 Church End 1.3 1.2 1.6 0.5 0.8 0.7 0.5 0.7 0.4 0.4 1.1 0.5 0.81 Harlesden 0.8 .2 1.3 1.2 0.9 1.1 1.0 0.9 0.6 0.7 1.1 0.9 0.97 Kensal Green 0.9 1.2 1.6 0.7 0.7 0.6 0.7 0.4 0.6 0.5 1.0 0.6 0.79 South Kilburn 0.9 1.1 1.3 0.9 1.0 0.5 .1 1.7 0.9 0.7 1.0 1.0 1.01 Mid Kilburn 0.8 0.5 0.6 0.7 0.8 1.0 0.5 1.3 0.8 0.8 0.7 0.9 0.78 North Kilburn 1.2 1.8 0.6 0.4 — 0.5 0.3 0.1 0.4 0.4 0.8 0.3 0.57 Willesden Green 1.0 1.1 0.8 0.4 0.8 0.6 0.3 0.7 0.4 0.3 0.8 0.5 0.64 63 I have thought it worth while to calculate the scarlet fever, diphtheria and erysipelas rates respectively for each of the wards for the last ten years. They are given in the tables, and exhibit a curious change in the incidence of these diseases upon the wards. Erysipelas has declined markedly in all the wards, except Mid and South Kilburn. This is obvious when the two quinquennial mean rates are compared. Diphtheria on the other hand has markedly increased in Church End and Harlesden, while in all the other wards except North Kilburn, which has a very low rate, it has declined. In Mid and South Kilburn this decline is most marked. The incidence of scarlet fever has followed the same rule. In Church End and Harlesden there is a considerably increased incidence in the later quinquennium. In all the other wards there is a remarkable decline. Nineteen deaths altogether were registered as due to diphtheria, which gives a fatality rate of 5.4 per cent.—a rate so low as to indicate a mild type of the disease, though doubtless this result is contributed to by the increased use of diphtheria antitoxin. This is the first year since they become notifiable in which the number of cases of diphtheria has been in excess of the number of cases of scarlet fever. 64 Table No. 27. DEATH RATES FROM SCARLET FEVER, DIPHTHERIA, TYPHOID FEVER, MEASLES AND WHOOPING COUGH per 100,000. 1875 TO 1904. Year. Scarlet Fever. Diphtheria. Typhoid Fever. Measles. Whooping Cough. 1875 66 33 71 0 38 1876 59 27 48 78 238 1877 128 10 41 87 30 1878 19 14 29 29 174 1879 35 35 9 13 27 1880 99 8 15 75 99 1881 47 3 22 25 47 1882 24 3 15 141 86 1883 20 11 17 14 34 1884 13 16 11 11 58 1885 13 36 23 52 44 1886 2 15 4 67 79 1887 28 12 16 59 22 *1888 22 22 17 66 77 1889 4 12 3 14 17 1890 3 31 11 55 70 1891 3 11 6 8 67 1892 12 27 9 73 55 1893 21 63 13 15 49 1894 9 21 15 60 42 1895 21 42 15 6 10 1896 20 34 12 144 47 1897 12 69 13 14 48 1898 9 65 8 49 24 1899 15 42 10 23 30 1900 10 24 12 45 26 1901 10 45 9 7 49 1902 10 43 12 54 20 1903 8 7 7 65 52 1904 1 14 6 33 7 mean. 1875-1887 42 26.5 17 25.5 24.7 17.5 54 48.5 75 58 1888-1904 11 34 10.4 43 41 * Infectious Diseases Notification compulsory in Willesden from this year. 65 ENTERIC FEVER. Thirty-eight cases of typhoid fever were notified during the year. This gives an incidence rate lower than any hitherto recorded from this disease. Eight deaths were ascribed to this cause, giving a fatality rate in excess of the mean. ISOLATION HOSPITAL. . All particulars relating to the Isolation Hospital will be found in the report of the Medical Superintendent appended. DISINFECTION. During the year 1,115 rooms were disinfected after infectious disease, bedding and other articles likely to retain infection being removed to the Public Disinfecting Station at the Hospital and there subjected to disinfection by high pressure steam. A new disinfecting station has been erected and equipped, and was opened with the new sections of the hospital on the 20th October. At the beginning of the year the methods of disinfection were reconsidered and reorganised. The rooms instead of being fumigated by sulphurous acid are now disinfected by spraying with formic aldehyde. The Lady Health Visitor in each case personally decides specifically what articles of clothing, bedding, etc., shall be removed for steam disinfection. These and other minor changes have effected great improvement in the conduct of disinfection after infectious disease. E 66 NON-NOTIFIABLE INFECTIOUS DISEASES. Owing to the system instituted by which notifications were received from the public elementary schools, it has this year been possible to gain some notion of the nature and prevalence of a large number of cases of infectious disease of which hitherto no knowledge was attained. The details of these are set our, in the following table:- Table 28. NON-NOTIFIABLE INFECTIOUS DISEASES 1904 INTIMATED FROM THE SCHOOLS. DISEASE. Number of Casks. Percentage Incidence. Visited. Suffering. Contacts. Doctor in Attendance. Isolated. Under 5 Years. 5 Years and upwards. Cases not Attending School. Cases Attending School. Percentage Incidence. Cases Attending School. Percentage Incidence. Measles 1,323 730 593 274 378 260 110 7.4 360 1.7 Whooping Cough 119 90 29 35 11 27 17 1.1 46 .22 Chicken Pox 364 108 256 102 60 4 35 2.3 69 .3 Mumps 105 62 43 18 17 11 5 .3 46 .22 Tuberculosis 6 6 — 6 — — — — 6 .02 Influenza 27 13 14 4 3 3 — — 10 .04 Ringworm 262 262 — 103 79 11 28 1.9 223 1.08 Ophthalmia 45 45 — 9 6 4 5 .3 36 .17 Other Diseases 212 212 — 74 16 35 17 1.1 160 .77 Verminous Heads 26 26 — 2 — 2 — — 24 .11 Perhaps the most striking fact in connection with these returns is the greatly increased incidence upon children under five years of age of nearly all the infectious diseases notified from the schools. This is shewn in the above table. 67 It will be observed that the higher incidence upon children under five years is not confined to those attending school. The attack rate, however, upon the children under five attending school is so disproportionate to that upon children above five as to exhibit the extreme risk of aggregating large numbers of children of tender years in the infant departments of public elementary schools. Susceptibility to zymotic disease is in the main a question of age. If young children can be shielded from infection, their chance of contracting zymotic diseases when they grow older is greatly reduced, while the risk to life should they do so is immensely lessened. Especially is this the case with measles and whooping cough. All the deaths from whooping cough during the year occurred in children under five years of age. Forty out of the 44 deaths from measles occurred in children under five. It is difficult to conceive stronger argument for protecting to the uttermost the younger children from risk of infection. Aggregating large numbers of highly susceptible children in class-rooms where the risk of exposure to infection is extreme is courting disaster. Whatever advantages there are in very young children attending the infant departments they are purchased at a price set out in our sickness and mortality bills, and there can be no question that to send a child to school under five years of age is seriously to imperil its health and its life. VISION OF SCHOLARS ATTENDING PUBLIC ELEMENTARY SCHOOLS. In my report of last year on the hygienic control of schools, I prepared a scheme whereby it was arranged to test the vision of all scholars attending the schools controlled by the Council. I prepared detailed instructions for the guidance of the teachers, which were incorporated in the regulations of the Education Committee, and are here produced. E 2 68 Instructions to School Teachers as to Testing the Eyesight of School Children. Each department will be supplied with sets of test types for testing the vision of scholars, and with cards for entering the results of such tests thereon. When not in use, it is of the first importance, in order that the scholars may not be familiarised with the letters, that the types be not exposed to view. It is desirable, where practicable, for the same reason, in testing a scholar's vision, to keep the test card out of view of the class. The cards should be placed in a good light, coming from the side of the card, and so placed that when the scholar whose vision is being tested is looking at the card he or she shall not be facing the light itself. After placing the card in a good light, a distance of 20 feet (6 metres) in a straight line should be measured off and all scholars should stand at this distance when having their vision tested. Each eye should be examined separately, but the scholar must not be asked to close the eye not under immediate examination, nor be permitted to obstruct its vision by pressing the hand or fingers over the lid. A card held close to the nose should be used to obstruct the vision of each eye alternately. By this means will be avoided that temporary disturbance of vision which arises from pressure on the eyeball. After standing the scholar at 20 feet from the test type, he or she should be asked to read the letters in their order from above downwards, first with the right eye and then with the left. The letters should be read easily without facial distortion or stressful efforts at advancement of the head. No suggestion should be made by the teacher to help the scholar read any letter in the recognition of which difficulty is experienced. 69 The Object is to test the Vision, not to Read the Letters. Where the letters cannot be read, that is the fact to be observed. Each scholar should, if the vision be normal, be able to read the line under D 6, with each eye separately. Where this can be done, the vision is stated to be or as "D"=6 meters, 6/6ths, similarly with the letters under the line If they be the last which the scholar can read, the vision is stated to be 6/9 ths. The results of the test are to be entered on the " scholar's card." The vision of the right eye "R.V." will then be expressed as a fraction —6/60ths, 6/36ths 6/24ths, 3/18ths, 6/12ths, 6/9ths or 6/6ths, according to the line which the scholar can read with his or her right eye, while the vision of the left eye is obstructed by a card as above described. The vision of the left eye "L.V." will be similarly expressed. These results, together with the other entries relative to vision and hearing, are to be entered on the "scholar's card " at the time the vision is tested. The vision of every child should be tested once in the course of each year, and all new scholars should have their vision tested and recorded on their admission to the school. Where the vision of either eye falls short of 6/6ths, the parents of the child should be informed by means of form, I have analysed and tabulated the results of these tests in the following table 70 Table No. 29. SHOWING THE STATE OF VISION OF 10,771 SCHOLARS ATTENDING PUBLIC ELEMENTARY SCHOOLS. No. of Schools. Total No. of Scholars. Normal Vision Percentage with Normal Vision. Vision = 6/9 (slightly defective.) Percentage with Vision =6/9 Below 6/9 (markedly detective.) Percentage with Vision less than Below Vision different in each eye. Percentage. No. of children with Squints. State of Vision of scho'ars complaining of Headache. Normal Vision. Percentage. Abnormal Vision. Percentage. Boys 20 5,690 3,262 57.15 963 16.92 545 9.57 806 34.16 96 256 7.8 336 14.5 Girls 19 5,081 2,414 475 1,143 22.49 558 10.98 920 18.10 77 147 6.6 337 14.1 Boys: Below 6/9, 24 per cent. „ „ 6/9 ,41 „ Girls: Below 6/9, 29 per cent, „ „ 6/9, 51 „ 71 The vision of over 10,000 children was tested under the scheme. On the whole, the teachers have done the work satisfactorily, and the resulting advantage to scholars with defective vision is very great. In some of the schools, however, the regulations of the Education Committee have been wholly disregarded, no attempt having been made to test the vision of any of the scholars. In others the instructions have been followed so carelessly that the results are quite unreliable, and children reported with seriously defective vision have been found to possess quite normal sight. The inadequate lighting of some of the older schools is in some measure responsible for the errors in testing, while in still larger measure it is responsible for many of the visual defects themselves. The vision of 41 per cent. of the boys and 51 per cent. of the girls was found to fall short of the normal, while 24 per cent. of the boys and 29 per cent. of the girls tested exhibited, according to the returns, serious visual defects. Headache is a common symptom of defective vision, and of the scholars reported subject to this affection 14.5 per cent. of the boys and 14.1 per cent. of the girls were found to have defective sight; 7.8 per cent. of the boys and 6.6 per cent. of the girls reported as so suffering had normal visual acuity. Considerable difficulty is experienced in many cases in getting the parents to have the eyesight of their children attended to when the existence of error is pointed out to them. Even of the gratuitous attention they can receive at the hospitals they will not avail themselves, and one is tempted to think, in many cases, that everyone is more careful of the welfare of the children than the parents themselves. Neglect to relieve the remediable defects of vision is a grave offence against the. child and against the community. Defective 72 sight is responsible for serious mental and physical incapacity, and the state loses incalculably in the efficiency of its members through these remediable defects. WEIGHTS AND HEIGHTS OF SCHOLARS. It will be within the recollection of the Council that in my Report in 1903 on "The Hygienic Control of Schools," I recommended the systematic weighing and measuring of scholars attending the public elementary schools in the district. My recommendation was adopted in respect of two schools, namely, Kensal Rise and Lower Place Council Schools, for one year as an experiment. These schools were selected, the one, Kensal Rise, because it probably represented the better class of scholars, physically-speaking, in t he district; the other, Lower Place, because it was representative of a class of scholars whose conditions of life were, in the main, distinctly adverse to good physical development. In accordance with the instructions of the Education Committee, the teachers at the above-mentioned schools took the height and weight of scholars in each of the classes and entered the results on cards, which I collected at the end of the year. These results I have classified and tabulated, and now submit for your consideration. The teachers have shown great care and accuracy in the manner in which they have carried out this work, though in one or two of the classes the returns are not nearly so complete as they might have been. On the whole, however, great credit is due to the teachers for the manner in which they have discharged 73 an arduous bit of pioneer work, the importance of which, I venture to think, will be more and more appreciated with the growing sense of the supreme value of health and physique. The tables exhibit the results of the observations made in respect of 551 boys and 523 girls. As was anticipated, the scholars attending Kensal Rise school compare very favourably with those attending Lower Place. In the case of Kensal Rise scholars the average weight of the boys is greater at each age except that of twelve when the scholars at both schools are equal; while the average height is greater at each age except at seven, when Lower Place boys show a slight increase over those of Kensal Rise. The average weight of Kensal Rise girls is greater at each age except at 11 and 12, when Lower Place girls are slightly heavier. The average height of Lower Place girls is, without exception, less than that of Kensal Rise girls at the same ages. For purposes of comparison I have compiled a series of tables in which the weights and heights of boys and girls attending Kensal Rise and Lower Place Schools are set out with those of reliable authorities relating to British and American children at the same respective ages. 74 Table No. 30. TABLE SHOWING THE WEIGHT AND HEIGHT OF BOYS AND GIRLS ATTENDING KENSAL RISE AND LOWER PLACE SCHOOLS. Distributed according to Age. SCHOOL. BOYS. GIRLS. Age. Average Weight. Average Height. Average Weight. Average Height. No.of Scholars. Kilogr. No.of Scholars. Inches. No.of Scholars. Kilogr. No.of Scholars. Inches. Lower Place 7 39 21.46 39 45.52 10 20.87 10 45.15 Kensal Rise 7 21 22.13 21 43.50 20 22.48 19 48.12 Lower Place 8 23 23.48 23 47.64 26 22.04 26 47.01 Kensal Rise 8 60 24.12 60 49.55 63 23.64 63 48.92 Lower Place 9 22 25.39 22 49.06 35 23.68 35 47.97 Kensal Rise 9 76 25.58 75 50.45 53 24.62 53 50.12 Lower Place 10 40 27.07 40 52.42 22 24.85 22 49.38 Kensal Rise 10 48 27.87 48 52.06 64 27.34 64 52.61 Lower Place 11 24 29.99 24 53.4 20 29.51 20 53.05 Kensal Rise 11 42 30.3 42 53.57 55 28.42 54 53.65 Lower Place 12 23 33.15 23 54.80 8 33. 8 55.16 Kensal Rise 12 54 33.12 54 55.49 54 32.14 54 56.06 Lower Place 13 12 35.4 12 56.35 20 34.86 20 55.97 Kensal Rise 13 45 36.2 45 56.91 61 36.66 61 58.71 Lower Place 14 Kensal Rise 14 15 37.4 15 57.50 12 38.23 12 59.81 75 Table 31. TABLE SHOWING AVERAGE WEIGHTS OF BOYS IN KENSAL RISE AND LOWER PLACE SCHOOLS. Compared with the average weights of Boys at the same ages as ascertained by other observers. AGES. Kensal Rise School. Lower Place School. Averages from totals of British and American (statistics. Averages of American Boys (Bowditch). Averages of Anthropometric Committee. (British.) Averages of Artisan Class in Towns. Kilogram. Kilogram, Kilogram, Kilogram. Kilogram. Kilogram. 7 22.1 21.o 22.4 22.4 22.5 — 8 24.1 23.5 24.6 24.7 25.8 - 9 25.6 25.4 27.1 26.6 27.4 - 10 27.9 27.1 30.1 30.2 30.6 30.0 11 30.3 30.0 32.2 32.8 32.6 31.5 12 33.1 33.1 34.8 36.2 34.8 33.4 13 36.2 35.4 37.9 40.0 37.4 35.5 14 37.4 — 42.4 45.0 41.7 38.3 Table No. 32. TABLE SHOWING THE AVERAGE WEIGHTS OF GIRLS ATTENDING KENSAL RISE AND LOWER PLACE SCHOOLS. Compared with the average weights of Girls at the same ages as ascertained by other observers. ages. Kensal Rise School. Lower Place School. Averages from totals of British and American Statistics. Averages of American Girls (Bowditch). Averages of Anthropometric Committee (British). Kilogram. Kilogram. Kilogram. Kilogram. Kilogram. 7 22.5 20.9 21.3 21.8 21.5 8 23.6 22.4 23.6 24.0 23.5 9 24.6 23.7 25.5 26.1 25.1 10 27.3 24.8 28.2 29.1 28.1 11 28.4 29.5 31.0 31.9 30.8 12 32.1 33.0 35.0 36.9 34.7 13 36.7 34.9 39.8 41.4 39.4 14 38.2 — 44.2 45.5 43.8 76 Table No. 33. TABLE SHOWING THE AVERAGE HEIGHTS OF BOYS ATTENDING KENSAL RISE AND LOWER PLACE SCHOOLS. Compared with the average heights of Boys at the same ages as ascertained by other observers. ages. Kensal Rise School. Lower Place School. Averages from Totals of British and American Statistics. Averages of American Bnys (Bowditch). Averages of Anthropometric Committee (British). Inches. Inches. Inches. Inches. Inches. 7 43.5 44.8 45.9 46.2 46.0 8 49.5 45.5 47.4 48.2 47.0 9 50.4 47.6 49.7 50.1 49.7 10 52.1 49.1 51.8 52.2 51.7 11 53.6 52. 4 53.5 54.0 53.5 12 55.5 63.4 55.0 55.8 55.0 13 56.9 54.8 57.1 58.2 57.0 14 57.5 50.4 59.6 61.0 59.2 Table No. 34. TABLE SHOWING THE AVERAGE HEIGHTS OF GIRLS ATTENDING KENSAL RISE AND LOWER PLACE SCHOOLS. Compared with the average heights of Girls at the same ages as ascertained by other observers. ages. Kensal Rise Schools. Lower Place Schools. Averages from Totals of British and American Statistics. Averages of American Girls (Bowditch). Averages of Anthropometric Committee (British). 7 Inches. 48.1 Inches. 45.1 Inches. 45.0 Inches. 45.9 Inches. 44.0 8 48.9 47.0 47.1 48.0 46.5 9 50.1 48.0 49.0 49.6 48.7 10 52.6 49.4 51.2 51.8 51.0 11 53.6 53.0 53.3 53.8 53.0 12 56.1 55.2 55.8 57.1 55.5 13 58.7 56.0 58.0 58.7 57.7 14 59.8 — 60.0 60.3 59.7 77 These tables exhibit a less satisfactory state of affairs in respect of the physique of Willesden children than one could wish. To exhibit still further the differences, I have charted the curve of deviation for Willesden scholars from the mean weights and heights at each age and for each sex, as calculated by Dr. W. Stevenson, from the tables of British and American statistics. These mean weights and heights are represented in the charts by the straight line. The deviations of the averages of Willesden scholars above and below this mean are so represented in the curves. It will be observed in respect of weight that at the age of seven Kensal Rise girls start well above the average; at eight their average is the same; while at each age after that they steadily lose ground, at 14 having fallen farthest below the mean. Kensal Rise boys at seven have an average weight just below the mean, and they lose ground less steadily, yet in the end to a greater degree than the girls. Lower Place scholars exhibit a deviation below the mean even more marked, and with the same downward tendency of theaverage weight curve at the higher ages. The height curves similarly charted are, on the whole, more satisfactory, though the converse of this holds when taken in conjunction with the weight. For subnormal weight averages are found to be associated with height averages for the most part in excess of the mean. How far these observations justify a pessimistic view of the physique ot the rising generation in Willesden it would be premature to conclude. The data are too few to warrant the startling conclusions to which they point; yet they cannot be viewed with complacency. For it must be remembered that Kensal Rise is a picked school, where the most satisfactory results were anticipated. Compared with other schools in the district this would doubtless hold good, but this makes the comparison with the mean weights and heights 78 for the English-speaking race of all classes the less pleasant to contemplate. The rapid urbanisation of our population makes it increasingly important to measure by every means at our command the effect of the changed conditions upon the health and physique of the people; and there is no more promising field of enquiry to this end than that which has been opened by the observations now reported. WATER SUPPLY. The principal fact calling for comment in connection with the water supply of the district is the transfer of authority from the West Middlesex Water Company to the Metropolitan Water Board. It is to be hoped that now that the control of the water supply has been transferred to a public representative body, the iniquitous system of cutting off the water supply of the rate defaulters will be abolished. No grosser menace to the public health can be conceived than this atrocious custom. Were the Council to sever the drainage system of a house from its sewers as a means of putting pressure on defaulting ratepayers, they would be guilty of a less dangerous practice than is entailed in depriving a modern house of its water supply. SEWAGE TREATMENT. No change in the treatment of the sewage in the Brent area has occurred during the year. As before, the treatment consists of chemical precipitation and sedimentation in tanks, filtration 79 through filter beds and on the land. For the latter purpose an additional 14 acres have been brought into use, the total area of land subject to sewage treatment now amounting to 75 acres. During the year the London County Council have been approached, with a view to their taking the whole of the sewage of Willesden into their sewers. There appears to be a reasonable prospect of a scheme with this object being adopted, and no more satisfactory solution of the sewage problem of the Brent area could be hoped for. The sewage of the whole district would then be taken into the metropolitan sewers. COLLECTION OF HOUSE REFUSE. In the accompanying tables are given the data relating to refuse removal. This is an item of Public Health administration which is at once one of the most costly, and, since it touches every household in the district, one of the most important of the Council's responsibilities. House refuse is removed by contract, the terms of the contract requiring the collection of domestic refuse from each house in the district at least once in each week. The tables are compiled from returns made to the Chief Sanitary Inspector each morning by the Dust Inspectors, under whose immediate supervision the house refuse is collected. The data in my posession have enabled me to give the figures relating to the removal of refuse as far back as 1896. 80 Table No. 3d. DATA RELATING TO DUST COLLECTION. Year. Total Cost of Collection. Total No. of Loads Collected. No. of Cubic Yards Represented. Rate in the £. Maximum No. of Carts Employed. Minimum No. of Carts Employed. Average No. of Carts Employed. Maximum No. of Men Employed. Minimum No. of Men Employed. Yearly Increase in Cubic Yards. No. of Houses in District. Yearly Increase of Houses. Total No. of Complaints. Percentage of Complaints to Total No. of Houses. Districts. 1 2 3 Total. 1899) £ £ £ £ d. 2,095 1,500 3,127 6,722 18,363 68,861 3.35 29 18 23 50 35 7,386 15,232 — 134 0.87 1900) 1900-1 2,095 1,600 3,127 6,822 21,300 79,875 3.13 32 19 24 54 36 11,014 16,806 1,574 156 0.92 1901-2 2,475 1,895 3,452 7,822 22,290 83,587 3.32 34 20 24 58 36 3,712 17,673 867 189 1.07 1902-3 2,725 2,495 3,752 8,972 24,312 91,170 3.57 38 21 24.6 69 38 7,583 18,655 982 167 0.89 1903-4 3,100 2,950 3,895 9,945 26,603 99,761 3.71 39 22 25.5 70 36 8,591 19,588 933 139 0.70 1904-5 3,445 3,489 3,995 10,929 26,536 99,510 — 37 24 27.4 70 43 — 20,247 659 104 0.51 81 Table No. 36. Year. Cost per Load. Cost per Cubic Yard. Cost per House. Cost per Head of Population. s. d. d. S. d. d. 1896 8 0 25.6 8 3 14.53 1897 7 4¾ 23.6 8 2 14.12 1898 7 4¼ 23.5 8 4¾ 14.56 1899 7 3¾ 234 8 9¾ 15.07 1900 6 4¾ 20 5 8 1½ 14.25 1901 7 0 22.4 8 10½ 16.17 1902 7 4½ 23.6 9 7½ 17.61 1903 7 5¾ 23.9 10 1¾ 18.45 1904 8 2¾ 26.3 10 9½ 19.44 Perhaps the most striking fact elicited in the comparative tables is the steady increase in the cost of refuse removal, whether it be estimated as cost per load, per cubic yard, per house, or per head of population. The cost per load and per cubic yard of " rough dust," as it is called, fluctuates from year to year within much wider limits than the cost per head and per house. The cost per house and per person has been almost continuously increasing during the nine years, and this is the more remarkable in that there has been during this time an enormous increase in the number of houses in the district. Looking at these figures alone it would appear as though, with increase in the total amount of refuse collected, there was F 82 an increase in the cost per unit of refuse removed ; and, indeed, during the last five years this has been literally the case. This means either that the cost to the contractors of refuse removal has increased proportionately, or that with increase in the amount of the contract there has been a considerable increase of profit on each house from which the refuse was collected. It will be seen from Table No. 37 that there has, probably, been some slight increase in the cost of removal from each house, since until 1904 there had been a steady increase in the amount of refuse collected per house and per person. Table No. 37. Year. Amount of Refuse Collected per house per annum. Amount of Refuse per head of population. Cubic Yards. Cubic Yards. 1896 3.9 .56 1897 4.1 .59 1898 4.2 .61 1899 45 .64 1900 4.7 .68 1901 4.7 .72 1902 4.7 .74 1903 4.9 .77 1904 4.1 .74 Mean 4.4 — It is not easy to understand why there should be this increase in quantity per head and per house. The increase in quantity per house has not kept pace with the increased quantity per head, for while per house the increase in the eight years ending 1903 amounts to 25.6 per cent. that per head has gone up by 37.5 per cent. 83 Now this could not be possible were the apparent increase per head actually contributed by each head of population unless the population per house had been steadily and rapidly diminishing. And this we know to be not the case. It follows, then, that the increase has occurred in that class of house where the population (number of persons) per house is less than the average. If, in fact, there be any houses increasingly contributing to what is removed as domestic refuse where the number of persons per house has not increased, and where the number of persons is disproportionate to the amount of refuse contributed, such cases would explain the phenomenal increase. This is readily seen if it be imagined that half-a-dozen warehouses at one time contributed, say, one-sixth of the total refuse of the district, and at a subsequent period the same number of warehouses contributed, say, one-fourth of the total, although the total number of houses of all classes had increased. Warehouses having a small population per house, we should here have a case in which the amount of refuse per head had increased in excess of the amount per house, due to the fact that the warehouses had increased their proportion of refuse contribution. With these facts and considerations before me, I directed that a return should be made to me by the Dust Inspectors of the amount of refuse contributed by business premises as compared with that of private dwellings. f 2 84 Table No. 38. TRADING PREMISES. District No. I. District No. II District No. III. Total No. of Business Premises. Cube Yards Represented. Average Amount per Business House in Cubic Yards per Week. Estimated Average Amount per Home in Cubic Yards per Year. No. of Shops. Bushels Represented. No. of Shops. Bushels Represented. No. of Shops. Bushels Represented. Public Houses 8 103½ 5 77 20 253¾ 33 20.66 .63 32.7 Butcher and Fishmonger 9 64¾ 21 166¼ 19 148¾ 49 18.08 .37 18.2 Draper 7 77 7 64¾ 7 59½ 21 9.58 .45 23.4 Grocery and Provisions 19 196 18 192½ 24 201½ 61 28.08 .46 23.9 Greengrocery 9 99¾ 8 108½ 10 101½ 27 14.75 .55 28.6 Laundry 1 7 1 5¼ 2 12¼ 4 1.16 .29 15.08 General 26 192½ 46 348¼ 67 460¼ 139 47.68 .34 17.7 79 740¼ 106 962½ 149 1,237¼ 334 140.01 42 21.48 85 From this return it will be seen that the contribution of refuse by business premises is very largely in excess of that contributed by private houses, the average amount per annum collected from houses of all classes being equal to 4.4 cubic yards, while from business premises of all classes it amounts, according to the estimate to 218 cubic yards per annum. It is probable, therefore, that the disproportionate increase in the amount of refuse collected per person, as well as the increase in the amount collected per house, is due either to an increased proportion of business premises in the district, or to an increased contribution from them of what is termed domestic refuse. It is true that the terms of the contract do not require the removal by the contractors of " trade refuse," but a definition of this term is difficult to formulate, and the facts show that business premises do contribute disproportionately to the refuse of the district. When it is remembered that the cost during the year amounted to 10s. 9½d. for every house in the district for refuse removal, this increased contribution of refuse from business premises becomes a matter for serious consideration. All the facts point to the possibility of effecting considerable economies by the Council themselves undertaking the removal of domestic refuse in the district. But in order to do so economically it would first be necessary to provide the much needed destructor. The difficulty of disposing of the refuse increases from year to year. Considerable sums are already paid by the Contractors for leave to deposit it on lands in, or in the vicinity of, Willesden, and these sums are of course ultimately paid for by the public. In one of the three divisions into which for purposes of dust removal the district is divided, the refuse is transported to canal boats and thence carried to outlying districts in Middlesex. 86 These irrational, costly, and insanitary expedients of improperly disposing of the district's refuse could without question be economically supplanted were the Council to provide a destructor and carry out its own dustiDg. GIPSIES AND UNFENCED PLOTS OF LAND. In the early months of the year frequent complaints were received of the nuisance caused by the location of gipsies with their caravans on the vacant and unfenced land in the district. Proceedings were taken at the Harlesden Police Court on several occasions, resulting in penalties being imposed. This, however, is a very unsatisfactory way of proceeding as by the time the cases are heard the gipsies have decamped, and the penalties in consequence are not recovered. The Council by their Act of .1903 obtained powers to call upon owners of vacant land to erect and maintain an adequate fence. These powers have been put into operation during the year, and have to a very great extent abated the nuisance caused bv gipsy caravans. CANAL BOATS ACTS. The following is a summary of the contraventions observed: Total number of boats inspected 83 ,, ,, contravening Acts and Regulations 12 ,, ,, infringements 15 ,, ,, remedied 3 ,, ,, complaint notes issued 6 ,, ,, complied 3 Absence of certificate 2 Certificate not identifying owner with boat 2 Marking, &c 3 Overcrowding 1. Painting 1 Dilapidation 4 Boats without double bulkheads 1 Assistance to board refused 1 Boats occupied by 106 adults and 56 children. 87 DAIRIES, COWSHEDS AND MILKSHOPS. The number of milkshops now on the register is 113. Several new milkshops were opened during the year, and were registered under the order. In a number of instances the businesses were discontinued, the premises no longer being used as milkshops. In the case of some of the small general shops, on account of the unsuitability of the premises, the owners were induced to discontinue the sale of milk. During the year each of the milkshops in the district were visited twice. and oftener where found necessary. In all 227 inspections and 37 re-inspections were made. 20 notices were served and complied with. The following table gives details of the results of inspection : Table No. 39. Inspector's Districts. No. of Milkshops in District. No. found Registered. No. found not .Registered. No. of Visits Paid. No. found in good Condition. No. found in Unsatisfactory Condition. No. of Notices Served. No. of Re-inspect ions made where Notices Served. No. of Nuisances Abated. l 24 11 13 58 21 3 2 3 4 2 22 12 10 49 20 2 4 9 4 3 15 7 8 36 12 3 5 8 4 4 17 6 12 39 14 3 2 4 3 5 35 19 16 82 32 3 7 13 8 Totals 113 55 59 264 99 14 20 37 23 88 SLAUGHTER HOUSES. All the slaughter houses in the district, ten in number, were visited during the year. Amendments involving considerable alterations were made in respect of four of the slaughter houses, but the general condition of the private slaughter houses leaves much to be desired. LEGAL PROCEEDINGS. Legal proceedings were taken in the following cases, the Council being uniformally successful in securing judgment in their favour :— Description of Nuisance. No. of Cases. Resuit. Smoke nuisance 1 Appeal to Quarter Sessions against the Magistrate's decision in favour of the Council (imposing a penalty and abatement order) dismissed with costs. Insanitary condition of gipsy caravans 10 Penalties imposed and orders to abate made in each case. Houses unfit for human habitation 5 Closing orders obtained in each case. Houses without water supply 3 Penalties imposed. Refusal to disinfect after infectious disease 1 Penalty imposed. CUSTOMS AND INLAND REVENUE ACT. 164 premises were inspected at the request of the owners with a view to granting the necessary certificate claiming exemption from inhabited house duty in accordance with the terms of Section 26 of the above Act. Such certificate was granted where the sanitary conditions of the premises warranted, but a large proportion of the applications was in respect of properties where I found it necessary to withold the certificate. 89 SANITARY CONDITION OF SCHOOL BUILDINGS. All the public elementary schools were inspected during the summer vacation. Tne defects found for the most part have been remedied. A few outstanding are the subject of correspondence, or are of such a nature that they have been deferred pending a decision to close the schools. The following is a list of the defects found:— Schools Examined. Drains found Defective. Insufficient W.C. Accommodation. Insufficient Urinal Accommodation. Defective Light. Other Sanitary Defects. 24 7 6 4 4 11 ADOPTION OF THE CARD SYSTEM. All the records of the department are now kept on Cards. The clerical work entailed in the old system of keeping books with its duplication in the office of notes made on the spot was seriously interfering with the work of the department. I therefore reorganised the work, designed or adopted cards, and instituted a complete card system for all branches of the work. After a year's experience with the cards, I can speak confidently of the great improvement effected in the record making and keeping which has resulted. The supervision of the work of my staff is greatly facilitated, the work of inspection and enquiry is systematised, the most complete records of first-hand observations are preserved, and are ever ready and easy of reference, while a great economy has been effected in needless transcriptions of scrappy notes made to be copied and then destroyed. 90 Table No. 40. SUMMARY OF PRINCIPAL ITEMS OF WORK FOR YEAR ENDING DECEMBER 31st, 1904. DESCRIPTION OF WORK. Quarter. Total. 1st. 2ll(l. ;?rd. 4th. Inspection of House3— Gipsy caravans 12 17 18 — 17 Number inspected on complaint or in course of special inquiry 511 489 535 389 1,924 Number inspected from house to house 552 367 200 245 1,364 Visits re inspection of above-ground bakehouses - - - 24 24 He-inspection of houses— Number re-iDspected during the Year 267 335 169 110 881 Number of visits to premises where works of amendment were in operation 1,994 2,773 2,479 2,623 9,869 Cases of Infectious disease visited 180 201 221 207 809 „ ,, „ re-visited 131 90 75 134 430 ,, ,, ,, removed 134 135 150 134 553 ,, Non-infectious disease visited 1,286 421 266 513 2,489 ,, ,, re-visited 25 79 44 58 206 Number of rooms disinfected 197 309 302 307 1,115 ,, Birth inquiries — — 642 517 1,159 ,, Death inquiries — — 204 93 297 Inspection of dairies, milkshops, &c. 80 75 27 82 264 ,, slaughter-houses, mews, &c. 173 615 532 182 1,502 ,, re Petroleum licences 7 19 21 12 59 Observations re smoke, and inspections re deposits of coal dust — — 37 59 96 Nuisances abated during the year— Number of new drains constructed 32 34 27 41 134 ,, Drains amended 29 35 76 55 195 ,, Tested and examined 181 192 265 215 853 ,, Nuisances of various descriptions abated 280 435 340 280 1,345 Sanitary notices issued 443 513 262 239 1,457 Statutory ,, ,, 142 58 35 108 343 Number of letters received 721 838 827 639 3,025 ,, ,, written 491 749 564 559 2,363 91 Table No. 41. FACTORIES, WORKSHOPS, LAUNDRIES, WORKPLACES AND HOMEWORK. 1. INSPECTION.—Including Inspections made by Sanitary Inspectors or Inspectors of Nuisances. Premises. Number of. Inspections. Reinspections. Written Notices. Prosecutions. Factories (including factory laundries) 23 31 4 - Workshops (including Workshop laundries) 280 666 70 - Workplaces 55 110 2 - Homeworkers premises 52 52 1 - Total 410 859 77 - 2. DEFECTS FOUND. Particulars. Number of Defects. Number of Prosecutions. Found. Remedied. Referred to H.M. Inspector. Nuisances under Public Health Acts:– Want of cleanliness 67 07 - - Want of ventilation 6 6 1 - Overcrowding 4 4 - - Want of drainage of floors 30 30 - - Other nuisances 42 42 — — Sanitary accommoda tions insufficient — — — — unsuitable or defective 17 17 — - not separate for sexes 1 1 — - Offences under the Factory and Workshops Act:— Illegal occupation of underground bakehouses (S. 101) - - - - Breach of special sanitary requirements for bakehouses (SS. 97 to 100 49 - - - Failure as regards lists of outworkers (S. 107) - - - - Giving out work to be done in premises which are unwholesome (S 108) - - - - infected (S. 110) - - - - Allowing wearing apparel to be made in premises infected by scarlet fever or smallpox (S. 109) - - - - Other offences - - - - Total 216 167 1 — 92 Table No. 41—continued. 3. OTHER MATTERS. Class. Number. Matters notified to H.M. Inspectors of Factories:— 17 Failure to affix Abstract of the Factory and Workshop Act (S. 133) 19 Ac tion taken in matters referred by H.M. Inspectors as remediable under the Public Health Acts, but not under the Factory Act (S. 5) , Notified by H.M. Inspector 4 Reports (of action taken) sent to H.M. Inspectors 4 Other — Underground Bakehouses (S. 101):In use during: 1903 27 Certificates granted in 1903 25 in 1904 — In use at the end of 1904 25 Homework :— Lists of Outworkers (S. 107):— Lists received Number of. Lists. Outworkers. 15 29 Addresses of outworkers forwarded to other Authorities 19 27 received from other Authorities 49 81 Homework in unwholsome or infected premises:— Notices prohibiting homework in unwholesome Wearing Apparel. Other. premises (S. 108) — — Cases of infectious disease notified in homeworkers' premises - - Orders prohibiting homework in infected premises (S. 110) - - Workshops on the Register (S. 131) at the end of 19C4. Important classes of workshops, such as workshop bakehouses, may be enu- merated here. 'Laundries (Factory) 23 ,, (Workshop).. 96 ,, (Domestic 34 Bakehouses 59 Dressmakers 91 Tailors 12 Bootmakers 13 Builders 4 Milliners 9 Stone Masons 3 Cycle Makers 4 Miscellaneous 10 Homeworkers 52 Total number of workshops on Register 410 93 Table No. 42. Description of Defects, &c. Factory Laundries. Workshop Laundries. Domestic Laundries. Dress-makers. Miscellaneous Workshops. Out-workers. Total. Description of Work or Occupation carried on by— Miscellaneous Workshops. Outworkers. Total. No. Inspected 23 96 34 91 55 52 351 Tailors 12 20 32 Want of Cleanliness 5 33 18 5 6 .. 67 Dressmakers .. 13 13 Want of Ventilation 1 3 1 , , 1 .. 6 Bootmakers 13 2 15 Overcrowding .. 1 .. 3 .. .. 4 Blousemakers .. 6 6 Sanitary Accommodation Insufficient .. .. .. .. .. .. .. Cabinet-makers 4 .. 4 Unsuitable or Defective .. 10 2 .. 4 1 17 Seamstresses .. 4 4 Not separate for Sexes 1 .. .. .. .. .. 1 Milliners 9 .. 9 Other Nuisances 2 19 9 9 3 .. 42 Upholsterers .. 2 2 Failure to affix Abstract .. 15 .. .. 4 .. 19 Masons 3 .. 3 No. of Males employed 32 48 .. .. 171 .. 251 Cycle-makers 4 .. 4 No. of Females employed 302 758 22 402 51 63 1,598 Glove Cleaners .. 2 2 Total No. of Persons employed 334 806 22 402 222 63 1,849 Various 10 3 13 No. of Workshops discontinued.. .. 16 .. .. 7 .. 23 Total 55 52 107 94 FACTORY AND WORKSHOP ACT. The above tables summarise the inspections made under the Act during the year. It will be observed that by far the greatest class of workshops is comprised under the head of laundries. Of the different classes of laundries, the factory laundries are found to maintain a far higher standard of sanitation than is the case in workshop laundries. This is largely accounted for by the fact, that the owners of laundries using steam power have the premises specially erected or adapted for the purpose of their business, and such matters as lighting and ventilation are duly considered when the plans are prepared. In one instance a power laundry was found to be structurally so unsuitable as to render it on sanitary grounds unfit for the Purposes of a laundry. In order to avoid the proceedings which the Council authorised in respect of this laundry, the proprietor discontinued its use and obtained other and more suitable premises in another part of the district. I append here Miss Gaul's report on the results of her inspections of workshops where women are employed. “Laundries.—The laundry work in by far the greater number of laundries in Willesden is carried on in ordinary dwelling houses, which are necessarily unsatisfactory workplaces. "The premises are as a rule fairly well kept, the greatest number of nuisances found arising from defective wash-house or ironing-room floors. " Many of the wash-houses are unsuitably situated, interfering generally with the light and ventilation of the lower portion of the premises. 95 “ The ventilation of the wash-houses would be much improved if hoods for carrying off the steam from the coppers were provided. " There appears to be no provision in the Factory and Workshop Act dealing with the drying of clothes in hand laundries. The general practice is to utilize the heat of the ironing rooms by drying the clothes overhead. This, if not strictly injurious, must cause great discomfort to the workers. " Another point difficult to deal with in connection with hand laundries is the screening of stoves. There is no obligation to provide screens for the stoves used for heating irons. In the majority of cases the stoves are situated in the ironing rooms without screens to protect the workers from the direct heat. In a few instances screens have recently been provided, but as a rule clothes are dried round the stoves, or they are left quite unscreened. " Workshops.—The workshops which I have visited,principally dressmakers and milliners, are generally satisfactory. Very few defects were found. The methods of ventilation are as a rule good, but there is the usual difficulty in getting the workers to use the means at their command. “Very few outworkers are employed in connection with the workshops situated in Willesden. “ Outworkers. -The outworkers residing in "Willesden appear to work under particularly good conditions. Only one sanitary defect has been discovered during the year. “ The workrooms are as a rule well ventilated and very clean. In only eight instances were people found to be using the workrooms for sleeping purposes. “ The children of outworkers are usually clean and well cared for, and the families generally live under much better conditions 96 than those from which the mothers go out to work. This should naturally follow, as the mothers can at any rate have more influence over their households generally if they are constantly at home, although they may have to work even longer hours than if they are employed away from home.'' Employers of labour do not fully understand the obligations placed upon them by the Factory and Workshop Act with regard to persons employed by them as outworkers. Out of the large number of lists received 19 only referred strictly to outworkers. Others gave the names and addresses of the persons they employed upon the premises. Forty-nine lists were received from other Local Authorities, but it was found in many instances that the addresses notified were those long since changed. Fifty-two premises were inspected, and with one exception found to be satisfactory. WORKSHOPS AND WORKPLACES. The workshops and workplaces were found generally to be in a fairly satisfactory condition. In three instances the workrooms were found to be overcrowded. A workroom where nine females were employed was found unsuitable on sanitary grounds, and after notice served upon the owner the business was transferred to more suitable premises. BAKEHOUSES. The bakehouses in the district number 59, there being 25 underground and 34 above ground. The underground bakehouses were dealt with during the preceding year, and with the exception of two, which were closed, carried out the requirements of the Council, necessitating in most 97 instances considerable structural alterations. These were duly certified in accordance with the provisions cf the Act. So great an improvement having been effected in the underground bakehouses, the Council decided that those above ground should if possible be brought up to a similar sanitary standard. Of the 34 bakehouses, eight were found to be in a far from satisfactory condition, and it was decided to deal with these first. The requirements of the Council were accordingly intimated to the owners, and as a result one bakehouse has been closed and more suitable premises secured in its place. Plans for a bakehouse have been submitted in another instance, and when completed the present bakehouse will be closed. One most unsatisfactory bakehouse will be abolished by reason of the premises being required by the Middlesex County Council for widening purposes. Two have completed alterations in accordance with the requirements, and the remaining three have submitted plans showing extensive alterations and improvements. In a number of instances the bakehouses were found to be in a satisfactory condition. In others, alterations of a minor character still remain to be carried out. Table No. 43 gives in detail the defects found on inspection. Table No. 43. ABOVE-GROUND BAKEHOUSES, Number of above Bakehouses in District. Bakehouses with capacity less than 1,500 cubic ft. Inefficiently lighted. Defective ventilation. Absence of lavatory accommodation Absence of separate w.c. accommodation Defective walls and ce lings Defective floors. Want of cleanliness. 34 11 7 7 30 6 11 9 12 G 98 THE CHIEF SANITARY INSPECTOR REPORTS AS FOLLOWS ON THE ADMINISTRATION OF THE PETROLEUM ACTS: "Petroleum, as defined by the Petroleum Act of 1871, includes any oil or product of petroleum which when tested gives off inflammable vapour at a temperature of less than 73° F. "Persons desiring to store for the purposes of sale any oil or spirit as above defined, are required to obtain from the local authority a licence as provided by Section 9 of the Act of 1871. In addition to petroleum licenses are required from the Council to store benzine, naphtha, petrol and carbide of calcium. "The number of persons licensed under the Act is 36, an addition of eight from last year. “Benzine.—16 licences were granted for the storage of benzine, the largest quantities being 1,200, 500, and 200 gallons respectively, the remainder being for quantities varying from 10 to 40 gallons. “ Licences for the larger quantities are granted to persons carrying on the business of dyers and cleaners. “ In each instance the spirit is stored in tanks below ground and well protected from the solar heat. It is pumped up as required into the washing machine. “ The smaller amounts are stored by persons carrying on the business of oilmen and retailed in small quantities. “ Naphtha.—Licences were renewed in four instances for the storage of naphtha. The nahptha is stored in brick-built chambers in isolated positions. 99 "The Metropolitan Railway Co. are also licensed for the storage of 1,780 gallons of crude oil, from which is manufactured gas for use in the railway carriages. "Petrol.—14 licences were granted for the sale of petrol, chiefly to persons in the motor car industry. In one instance the licence granted is for 150 gallons, the remainder being for quantities of 60 gallons or less. " Petrol is a doubly distilled spirit derived from petroleum, having a specific gravity of .700, and a flash point much below the ordinary temperature. " A sample tested by Abel's close test, flashed at a temperature of 45° F. " Carbide of Calcium.—Two licences were renewed for the storage of carbide of calcium. In one instance 1½ tons are stored under such special regulations as are laid down by the Order in Council, dated February 26th, 1897. " During the year all licensed premises have been visited to see that the regulations of the Council are strictly enforced, and in all instances these were found to be duly observed." HOUSING OF THE WORKING CLASSES ACTS. The proceedings taken under these Acts were more numerous than has hitherto been the case. During the year representations were made in respect of 31 houses under Part II. of the Act of 1890, and in respect of four under the Act of 1903. These do not include the representations made concerning Alpha Place, Alpha Place North, Alpha Place West, and Alpha Mews; nor the houses in Church Road, which at the end of the year were still 100 subject to consideration. The following is a detailed list of the houses in respect of which proceedings were authorised. Location of No. of Acts and Result. Premises. Houses. Section. Station Road 2 H.W.C.Act 1890, Sec. 32 Premises closed. Hampton Road 1 ,, 1903, Sec. 8 ,, Newton Place 2 ,, ,, ,, Chippenham Gds. 1 ,, 1890, Sec. 32 Notices complied with. Dudden Hill Lane 2 ,, ,, „ Market Place Yard 3 „ ,, Work in progress. Church Lane 20 „ ,, ,, Victoria Place 4 ,, 1903, Sec. 8 Proceedings authorised. Further particulars relating to the housing of the working classes in Willesden will be found in the special report on this question, and in the report on Alpha Place and its environment in the Appendix. My thanks are due to the Chairman and Members of the Public Health Committee for the manner in which they have ever aided and supported me in my efforts to improve the conditions of the public health. To the members of my staff I am indebted for loyal service ungrudgingly and ably rendered alike in the routine of sustained effort, and in the stress and pressure of exacting times. To all I tender my sincerest thanks for their invaluable help. I have, Gentlemen, the honour to be Your obedient Servant, WILLIAM BUTLER. WILLESDEN Urban District Council. HOSPITAL REPORT FOR THE YEAR 1904, by WILLIAM J. J. STEWART, M.D., C.M. (Edin.), D.P.H. (Cam.), MEDICAL SUPERINTENDENT. London: Martin & Son, Printers, 211 High Road, Kilburn, and Marylebone. 1905. Members of the Hospital Visiting Committee. Councillor J. A. ADAMS, Chairman. „ C. BIDDISCOMBE. „ M. COOMBES. „ W. R. DUNN. „ G. H. JOHNSON. HOSPITAL REPORT for 1904 To the Chairman and Members of the Willesden Urban District Council. Gentlemen, I have the honour to submit to you the Hospital Report for the year 1904. The year just completed has been possibly a more arduous one than any of its predecessors, and this I think will be allowed, if it is remembered that with the somewhat inadequate accommodation which has existed here of recent years, an even larger number of patients were dealt with than was the case on any previous occasion. The work entailed in consequence of this increased number of patients was moreover greatly added to by reason of the fact that the accommodation referred to was still further diminished on account of the Nursing and Domestic Staff having to be housed in certain of the wards for several months, during the time their own quarters in the Adminstration Block 4 were undergoing structural alterations. If it is borne in mind too, that during the last quarter of the year the hospital at Kingsbury was no longer available for Scarlet Fever patients, some idea of the strain put upon this hospital may be arrived at. Two of the new wards, it is true, were opened during the last week in October, but, owing to the fact that the hospital at Kingsbury was being got ready at that very time for Small Pox, accommodation had to be provided for the Scarlet Fever patients (23) displaced therefrom, so that the opening of these new wards in no way relieved the pressure. It is satisfactory to note, however, that in spite of the many disadvantages, the comfort and progress of the patients was not affected. During the year 552 patients were admitted to hospital from outside alone, a number exactly corresponding to the total number of patients, including sick staff, admitted last year. The total number of patients treated, that is, the number admitted during the year added to those remaining over from the previous year, was 627, an appreciable increase on the 611 of 1903, 5 TABLE No. 1. Disease. Remaining in Hospital, December 31st, 1903. Admitted during 1904. Total under Treatment during 1904. Discharged during 1904. Died during 1904. Mortality per cent. Remaining in Hospital, December 31st, 1904. Scarlet Fever 47 227 274 225 l .44 48 Diphtheria 22 276 298 263 17 6.11 18 Enteric Fever 3 11 14 9 2 18.18 3 Total 72 514 586 497 20 3.87 69 Other Diseases 3 38 41 36 2 5.26 3 Grand Total 75 552 627 533 22 72 Average daily number of Patients in Hospital 69.2. 6 On comparing the admissions of all diseases for the year with those of 1903, it is seen that although the aggregate number is practically the same for both, yet there is a marked diversity as regards the number admitted in respect to the individual diseases themselves, more especially Scarlet Fever and Diphtheria. Thus in 1903, no less than 393 cases of Scarlet Fever were admitted, whereas this year the admissions were only 227. Again in 1903, 122 cases of Diphtheria were admitted but this year the number reached 276. In other words a fall has taken place this year in the Scarlet Fever admissions to the extent of 166, whilst in Diphtheria there has been an increase of 154 cases as compared with the admissions of those diseases in 1903. In respect to Enteric Fever a somewhat lower figure was reached, but "Other Diseases" show a slight increase. A larger number of Enteric Fever cases would have been admitted had the accommodation throughout the year been equal to dealing with all the cases requiring admission. From February to the end of July no cases of this disease were admitted, the reason 7 being that during that time the wards ordinarily set aside for that disease were given up to Diphtheria. To explain the fall in the admissions of Scarlet Fever, and the corresponding rise in those of Diphtheria is hardly possible, but the fact that the sum total of all admissions exceeds that of any previous years, demonstrates the wisdom of the Council's action in increasing the accommodation of this hospital. As will be seen from the footnote to Table No. 1, the average daily number of patients in hospital was 69.2, a fall of 11 as compared with the figure of the preceding year. When it is remembered that a greater number of patients was treated than on any previous occasion, the lowness of this figure must be considered very satisfactory, meaning as it does a proportionate diminution in the cost of maintenance. The following table shows the monthly admissions and deaths from all diseases:— 8 TABLE No. 2. Month. Scarlet Fever. Diphtheria. Enteric Fever. Other Diseases. Total Admissions. Total Deaths Admissions. Deaths. Admissions. Deaths. Admissions. Deaths. Admissions. Deaths. January 28 ... 16 3 l ... 5 ... 50 3 February 14 1 22 5 ... ... 5 ... 41 6 March 13 ... 23 2 ... ... 5 ... 41 2 April 10 ... 21 1 ... ... 4 1 35 2 May 14 ... 32 2 ... ... 6 ... 52 2 June 14 ... 37 1 ... ... 3 ... 54 1 July 20 ... 30 1 ... ... 1 ... 51 1 August 17 ... 21 1 1 ... 1 ... 40 1 September 16 ... 31 ... 1 1 ... ... 48 1 October 37 ... 22 ... 4 ... 2 ... 65 ... November 21 ... 11 1 2 ... 2 ... 36 1 December 23 ... 10 ... 2 l 4 1 39 2 Total 227 l 276 17 11 2 38 2 552 22 9 DIPHTHERIA. As already pointed out an increase took place in the number of admissions of this disease as compared with those of 1903. The number admitted during the year was 276, which added to the 22 cases remaining in hospital at the end of 1903, brings the total number treated up to 298. The type of attack was of average severity, but, thanks to the continued efficacy of anti-toxin treatment, the mortality did not exceed the low figure of 6.11 per cent. As compared with last year this shows an increase of 5.4 per cent., but, as mentioned in my report then, the lowness of that fatality rate was mainly attributable to the mild type of disease then prevalent and could hardly be relied upon as a figure which would be maintained in the future. 10 TABLE No. 3. DIPHTHERIA. AGE. MALES. FEMALES. TOTAL. Admitted. Died. Admitted. Died. Admitted. Died. Under 1 2 ... l ... 3 ... 1 to 2 8 ... 3 ... 11 ... 2 to 3 8 l 7 ... 15 1 3 to 4 12 l 18 2 30 3 4 to 5 16 5 24 1 40 6 5 to 10 45 2 58 4 103 6 10 to 15 16 ... 17 1 33 1 15 to 20 3 ... 13 ... 16 ... 20 to 25 4 ... 1 ... 5 ... 25 to 30 4 ... 6 ... 10 ... 30 and over 3 ... 7 ... 10 ... Total 121 9 155 8 276 17 11 Amongst the 298 cases, 17 showed evidence of laryngeal implication or Croup, and, of these six required tracheotomy. Of the six cases operated upon, four recovered, the other two dying from complications which they suffered from on admission to hospital. TABLE No. 4. complications of diphtheria. Complications. Number of Cases. Per Cent. Paralysis 33 12.5 Albuminuria 12 4.5 Relapse 5 1.9 Broncho-Pneumonia 3 1.1 With regard to antitoxin this was administered to 267 out of the 298 under treatment. The dosage was practically the same as detailed in last year's report. 12 Amongst the 267 patients treated no less than 1,964,000 units* were given, or an average of slightly over 7,000 units per patient. Taking the average cost of antitoxin to be at the rate of 2/6, per 2,000 units, the total amount expended upon antitoxin during the year was £122 approximately, or an average of 9/2 per patient. When it is remembered that the adoption of the antitoxin treatment has led to the saving on an average of about 20 lives in every 100 cases of diphtheria so treated, which in these 267 cases means that possibly some 53 patients were saved, this sum is a trivial amount. Subsequently to the injection of antitoxin, eruptions of a nettle rash character appeared in 82 cases. Similarly, 12 cases developed joint pains. In no instance was either of these conditions of a serious nature. SCARLET FEVER. During the year 274 cases were treated. The type of attack was extremely mild, as may be gathered from the fact that only one patient died, a death rate of .44 per cent. *A unit being a measure of strength or quality, 2,000 of which are contained usually in less than a teaspoonful of antitoxin. 13 TABLE No. 5. SCARLET FEVER. AGE. MALES. FEMALES. TOTAL. Admitted. Died. Admitted. Died. Admitted. Died. Under 1 3 ... ... ... 3 ... 1 to 2 3 3 1 6 1 2 to 3 7 ... 5 ... 12 ... 3 to 4 13 9 ... 22 ... 4 to 5 10 ... 13 ... 23 ... 5 to 10 42 56 ... 98 ... 10 to 15 19 ... 15 ... 34 ... 15 to 20 7 3 ... 10 ... 20 to 25 2 ... 3 ... 5 ... 25 to 30 2 6 ... 8 ... 30 and over 1 ... 5 ... 6 ... Total 109 ... 118 1 227 1 14 Table No. 6 deals with the nature and incidence of the more important complications arising during the course of the attacks. TABLE No 6. complications of scarlet fever. Complication. Number of Cases. Rate per cent. 1903. 1904. 1903. 1904. Rheumatism 20 18 5.06 8 Albuminuria 17 14 4.3 6.2 Nephritis ( Inflamation of Kidneys) 4 4 1.01 1.7 Otorrhœa (Ear discharge) 34 22 8.6 9.7 Adenitis (smaller glands) 31 9 7.8 4 Do. (suppurative) 6 4 1.5 1.7 Mastoid Abscess 4 4 1.01 1.7 Relapse 2 3 .50 1.3 16 ENTERIC FEVER. For want of accommodation 11 cases only of this disease were admitted, but three cases remained over from the previous year, making a total of 14 cases treated. The following table shows the age distribution of the patients admitted, and the ages of those who died. TABLE No. 7. ENTERIC FEVER. age. males. FEMALES. TOTAL. Admitted. Died. Admitted. Died. Admitted. Died. Under 5 ... ... ... ... ... ... 5 to 10 1 ... 2 ... 3 ... 10 to 15 1 1 ... ... 1 1 15 to 20 1 ... 1 ... 2 ... 20 to 25 1 ... ... ... 1 ... 25 to 30 ... ... 1 ... 1 ... 30 to 35 ... ... 1 ... 1 ... 35 to 40 ... ... 2 1 2 1 Total 4 1 7 1 11 2 16 CO-EXISTENT DISEASES. Co-existence of more than one disease in the same patient at the time of admission to hospital was observed frequently throughout the year. Thus there were 12 patients who suffered from combined Scarlet Fever and Diphtheria ; 2 from Scarlet Fever and Chicken Pox, and 1 from Diphtheria and Measles. Amongst these 15 cases there was 1 death, a case of Scarlet Fever and Diphtheria. OTHER DISEASES. Under this heading I refer to the 32 cases out of the 36 as shown in table No. 8 (the balance of 4 being Scarlet Fever), to 4 cases of Erysipelas admitted as such, and to 2 other cases, 1 a Small Pox suspect, and 1 a possible case of Scarlet Fever, which were also admitted. Amongst the 38 cases 2 died, 1 from Senile Gangrene and 1 from BronchoPneumonia. TABLE No. 8. Table showing cases wrongly certified and the disease for which they were mistaken. Certified as suffering from Diagnosed in Hospital as suffering from Diphtheria. Scarlet Fever. Erysipelas. 4 ... ... Scarlet Fever. 8 6 ... Tonsillitis. ... 2 ... Rotheln. ... 1 ... Urticaria. ... 1 ... Gum Rash. 1 ... ... Septic Sore Throat. ... 4 ... Erythema. ... 1 ... Influenza. 1 ... ... Broncho-Pneumonia. ... 1 ... Gastric Catarrh. ... ... 1 Lymphadenitis. ... ... 1 Senile Gangrene. ... 4 ... Nil. 14 20 2 18 BACTERIOLOGY. No less then 1,084 bacteriological examinations were made during the year, an increase of 600 as compared with 1903. This increase was mainly attributable to the increased prevalence of Diphtheria in the district during the year, and to the increased number of patients admitted to hospital as a consequence. TABLE No. 9. Microscopical Examinations of Swabs from Throats suspected of harbouring Diphtheria Bacilli. From Patients of outside Practitioners. From Patients in Hospital. + - + - 58 113 420 493 + Diphtheria Bacilli present 478 - „ „ not present 606 Total 1084 19 SMALL POX. Ten cases of this disease were admitted. The first case occurred on October 20th, and on that day 8 patients were admitted to the Stonebridge Shelters, where they remained until the 22nd when they were transferred to the hospital at Kingsbury. On the 25th 2 cases were admitted, and these proved to be the last. I append a table showing the age of those attacked, their state as to vaccination, the type of attack, and the result. From that table it will be seen that although all recovered, severe or confluent attacks occurred only in those who were unvaccinated, and that those who had been vaccinated escaped with mild attacks. Small figures such as these, it may be said, carry little weight, but as far as they go they point very forcibly to the efficacy of vaccination and to the certainty with which Small Pox in its worst forms appears amongst the unprotected. 20 TABLE No. 10. Age. Number attacked. Vaccinated. Un-vaccinated. Type of Attacks. Result. Under 5 2 ... 2 Confluent. Recovered. 5 to 10 ... ... ... ... ... 10 to 15 ... ... ... ... ... 15 to 20 2 2 ... Mild Discrete. Recovered. 20 to 25 2 2 ... Mild Discrete. Recovered. 25 to 30 ... ... ... ... ... 30 to 35 1 1 ... Mild Discrete. Recovered. 35 to 40 1 1 ... Mild Discrete. Recovered. 40 to 45 ... ... ... ... ... 45 to 50 1 1 ... Mild Discrete. Recovered. 50 to 55 1 ... 1 Confluent. Recovered. 21 SICK STAFF. During the year 37 members of the staff were off duty through illness for periods longer than 24 hours. Four nurses contracted Diphtheria, whilst two nurses, one wardmaid, and one porter contracted Scarlet Fever. The remainder suffered from non-infectious complaints, chiefly of the nature of sore throat, a not uncommon occurrence in hospitals of all kinds. HOSPITAL BUILDINGS. Now that the extensions to the Hospital are finished and in use, it is, perhaps, desirable that I should lay before you a short description of the Hospital in its completed state. As you are aware it was originally intended that these extensions should be completed early in 1903, but, for unforeseen reasons, it was not until October of this year (1904) that the contractor finally handed them over. The Hospital consists now of ten blocks of buildings, not including, however, the two iron 22 buildings, the original Hospital in fact, which although they are still available for patients, cannot be looked upon as permanent. The ten blocks comprises the following:— 1. " A."-—The Administration Block. 2. " B."—Four Ward Block. 3. " C."—Two ,, „ 4. " D."—Two ,, „ New Single Storey Block. 5. " E."—Two „ 6. " F " & "G."—Two Ward Block. New Double Storey Block. 7. "H" & "H"—Four „ „ New Observation Block. 8.—The Male Staff Quarters. 9.—The Laundry Block. 10.—The Ambulance Station. In the Administration Block, in addition to the Medical Staff Quarters, the Matron's Quarters, the Steward's Office, there are the Nurses' Sitting Boom, the Kitchen and other offices, Provision Stores, and Needleroom, as well as Bedroom Accommodation for 21 members of the Domestic Staff. In the newly-built west wing of the Administration Block—the "Annexe" as it is called—there are 24 bedrooms, etc., for nurses. Before these rooms 23 were available the Nursing Staff were accommodated in various parts of the Administration Block itself, and in the house at Bruce Road, an arrangement which had many disadvantages. Coming next to the ward blocks, which are situated for the most part to the east and south side of the Administration Block, accommodation is here provided for some 122 patients, thus:— In " B " Block there are 10 beds for Enteric Fever. In " C " Block there are 16 beds for Diphtheria. In " D " Block there are 28 beds for Diphtheria. In " E " Block there are 16 beds for Scarlet Fever. In " F " & " G " Block there are 40 beds for Scarlet Fever. In "H" & "H," Block there are 12 beds for Observation Purposes. Assuming that there is no epidemic increase in the number of cases requiring admission, these 122 beds should prove equal to the demands of the district, should they not do so there will still remain at least 12 beds in one of the iron buildings beforementioned, us well as 32 beds in the hospital at Kingsbury. 24 Immediately behind the Administration Block and between it and the Wards, but quite separate from the latter, the Discharge Block is situated. This consists of three rooms leading into one another. It is through these rooms that patients pass during their final disinfection, preparatory to being discharged from hospital. The patient invariably enters at one end of the series and leaves by the other. In the entrance room he removes all his infected clothing, having done this he passes into the second room, the bath room, where he is disinfected, he then passes on to the third room, where he puts on his outdoor garments, finally passing into the open air by a second door in this particular room. The Male Staff Quarters which shortly will be ready for occupation is really the old laundry rearranged and structurally altered. The accommodation provided here is for 5 staff, and consists of 1 large dormitory, 1 smaller sleeping room, 1 mess room, scullery, bathroom, etc. On the southern aspect of this block, but entirely shut off from the rest of the building, are the mortuary and post-mortem rooms. 25 In the Laundry Block there is a Patients' and Staff Laundry partially separated from one another. All the machinery here is of modern pattern and steam driven. On the north-east of this block the new disinfector has been erected, whilst on the southern side are the boilers, engines, etc., for driving the laundry machinery and supplying the steam heating to the hospital generally. The Ambulance Station consists of three 2-stalled stables, coachhouses, etc., and a 3-roomed house over the stables, in which the head coachman lives. In conclusion I would again express my appreciation of the assistance I have received throughout the year from the Principal Officers and Members of the Staff. I remain, Gentlemen, Your obedient servant, W. J. J. STEWART. April 3rd, 1905. 26 EXPENSES FOR THE YEAR 1904. Including Maintenance of Hospital at Kingsbury. £ s. d. Staff (Salaries, etc.) 1,882 19 11 Provisions 1,889 13 10 Furniture (including House linen) 140 19 7 Clothing 46 8 11½ Necessaries 201 4 8 Repairs 10 2 4 Coals and Coke 490 8 0 Gas 137 4 7 Electric Lighting 51 7 5 Drugs 157 9 11 Druggists' Sundries 77 15 9 Printing and Stationery 46 6 8 Disinfectants 15 3 4 Various 69 5 6 £25,216 10 5½ Disinfecting:— £ s. d. Forage, Shoeing, Utensils, Repairs, &c 117 9 0 Coachman and Assistant 64 0 0 Disinfecting Porter 54 12 0 Coals 50 0 0 £286 1 0 27 Ambulance:— £ s. d. Forage, Shoeing, Utensils, Repairs, &c 58 14 6 Coachman and Assistant 64 0 0 £122 14 6 Cost of Maintenance per head per week:— s. d. Staff 7 93/4 Patients 4 8½ APPENDIX. TABLE SETTING OUT DETAILED SUMMARY OF STREET INSPECTION. Ref. No. Name of Street. Houses. Population. No. of Rooms per Tenement. No. of Persons per Room. Weekly Rental for Tenement. Weekly Rental per Room. Total. Average No. of Persons per Tenement. No. of Tenements found Clean. No. of Tenements found fairly Clean. No. of Tenements found Dirty. No. of Houses where Lodgers are taken. Total No. of Lodgers in Street. Maximum No. of Lodgers in any one House. Mean No. Lodgers per House. Percentage of Tenements where Lodgers are taken. Supplemental Earners. Average Cubic Capacity of 1, 2, & 3 Roomed Tenements. Carmen, Coachmen, Ac. Builder & Contractor. Bootmaker, Saddler, &c. Factory & Laundry Hands. Smith and Farrier. Bricklayer, Mason, & c. Coachbuilder Wheelwright &c. Police Officer. Shopkeeper. Labourer. Sign Writer. Plumber. Post Office Official. Watchmaker and Jeweller. Engineer, Fitter, &c. Railway Worker. Clerk, Traveller, &c. Sailor or Soldier. Painter, Polisher, &c Journeymen, Tradesmen. Warehouseman. Carpenter, Joiner,&c. Upholsterer. Cab, 'Bus and Tram Driver. Tailor, Dressmaker, &c. Printer, &c. Coster and Hawker. Dealers. Ref. No. Total Number Number Empty. Percentage of Empties. Total Stated. Male. female. Total as per Census. Mas. Min. Mean. Max. Min. Mean. Max Min. Max Min. Mean. Rooms Tenements Persons. Male. Female. No. of Tenements Mean Cub. Cap. per Tenement. Mean Cub. Cap. per Room. No. of Tenements Mean Cub. Cap. per Tenement. Mean Cub. Cap. per Room. No. of Tenements Mean Cub. Cap. pel Tenement. Mean Cub. Cap. per Room. s. d s d. s. d s. d. S. d. 1 ROOM 2ROOM 3 ROOM 1 Acton Lane (part of) 40 2 5. 288 153 135 (Whole St.) 751 6 2 3.25 3.66 .4 1.42 17 0 6 6 3 5 2 2 2 8¼ 202 62 288 4.64 29 6 3 7 9 2 .22 11.29 11 5 — — — 3 2555 1277 42 2840 947 — — 1 — — — — — 12 16 — — — — 3 6 1 — 1 — — 1 — — 3 — — — 1 2 Albert Gardens 18 — — 184 98 86 229 6 1 3.20 3.50 .33 1.27 16 0 2 6 2 6 1 10½ 1 113/4 144 45 184 4.08 16 2 — — — — — — 11 6 4 1620 1620 15 2492 1246 13 3336 1112 4 — — 2 — 5 — — — 4 — — — — — 5 1 — 1 — 1 4 — — 1 4 — — 2 3 Albert Road 110 5 4.45 1240 621 619 1539 8 1 2.68 3. .5 1.4 18 0 2 6 2 93/4 2 1½ 2 2 880 328 1240 3.78 113 99 22 — — — — — 34 24 50 2477 2477 111 3298 1649 117 3816 1272 42 1 4 14 10 15 — — 14 31 — 3 4 — 5 9 2 — 4 14 14 9 — — 5 16 — — 3 4 Allington Road 36 4½ 12.50 284 138 146 307 4 3 3.5 2.66 .5 1.27 8 0 7 6 2 6 2 0 2 2½ 223 63 284 4.50 60 3 — — — — — — 14 10 — — — — — — 29 3728 1242 9 — — — 4 3 — 1 — 5 — — 4 — — 4 1 — 6 — 4 15 — — — 2 — — 4 5 Alpha Place, N 28 — — 249 129 120 288 5 1 2.91 5. 1. 1.8 11 0 3 0 4 6 1 9 2 5½ 138 61 249 4.08 18 7 3 — — — — — 15 2 16 1113 1113 27 1998 999 10 2337 779 — — — — — — — — — — — — — — — — — — — — — — — — — — — — 5 6 Avenue Road 7 — — 28 14 14 42 6 3 4. 1.75 .33 1. 7 0 6 0 2 0 1 2 1 8 28 7 28 4. 6 1 — — — — — — 2 1 — — — — — — — — — 5 — — — — — — — — — — — — — — — — — — — — — — — — — — — 6 7 Bourke Road 38 4 10.52 200 106 94 232 7 2 3.40 2.6 .25 .97 13 6 6 6 2 2 1 6 2 03/4 204 63 200 3.17 50 13 — 4 6 2 .09 6.34 9 — — — — 4 2570 1285 35 2950 983 — 1 2 4 11 7 — 2 — 5 — 1 — — 4 10 2 — 2 1 — 2 — — 1 1 — — 7 8 Boyer Road 20 — 329 162 167 378 3 2 2.66 4. 1. 2.09 7 6 5 0 2 6 2 6 2 6 157 59 329 5.57 12 18 30 1 1 1 .01 1.69 14 9 — — — 20 2334 1167 36 3227 1076 11 — 2 2 4 3 — — — 18 — — — — 1 6 — — 9 1 — 2 — — 2 — — — 8 9 Bridge Road 40 6 15. 251 124 127 289 5 2 4.34 2.4 .6 1.25 10 0 6 6 2 8 1 93/4 1 10 200 46 251 5.45 27 7 6 5 7 2 .17 10.86 8 12 — — — 3 1817 908 23 2398 799 3 — — — — 1 — — 1 23 — 2 ■ — — 3 2 2 — 4 1 — — — — — — — 9 10 Bridge Street 37 2 5.40 255 135 120 273 5 1 2.63 3.33 .6 1.74 20 0 2 6 4 0 2 0 1 11 146 55 255 4.61 24 20 11 2 5 3 .13 3.63 2 1 5 1270 1270 19 2303 1151 9 2967 989 16 — — 2 — 1 — — 1 9 — — — — 2 1 1 — — 3 10 1 — 4 — — — — 10 11 Cambridge Road 151 — — 2040 1044 996 2283 9 1 2.57 5. .57 1.65 20 0 2 0 5 6 2 0 2 9½ 1229 478 2040 4.26 83 55 8 17 27 5 1.58 11.25 134 75 62 1397 1397 140 2317 1158 107 3397 1132 43 2 8 16 3 19 1 2 62 107 1 10 1 2 1 12 8 3 35 13 15 20 2 22 19 5 — — 11 12 Canterbury Terrace 17 — — 179 94 85 165 8 1 2.72 2.5 .5 1.31 9 6 5 6 3 3 2 0 2 2¼ 136 50 179 3.58 17 — — — — — — — 1 2 4 1581 1581 18 2516 1258 24 3384 1128 6 — — — 7 3 — — — 1 — — — — 6 3 — — 3 3 1 2 — — — 7 — — 12 13 Churchill Road 131 16 12.21 629 314 315 683 7 3 5.40 1.7 .25 .78 13 11 8 6 2 1½ 1 9 1 11 805 149 629 4.22 147 2 — 6 11 3 .08 4.02 29 12 — — — — — — 39 3064 1021 — 11 6 — — 5 — 3 — 8 — 3 — — 7 — 17 — 7 10 5 10 2 — 18 6 — 13 13 14 College Road 65 4 6.15 495 249 246 510 7 2 3.86 3.3 .3 1.15 15 0 5 6 2 10 1 10½ 2 1 427 108 495 4.58 86 26 — — — — — — 22 12 — — — 18 2524 1262 65 3592 1197 2 — 3 3 — 10 — — 6 15 — 10 3 — 2 15 9 — 4 7 — 9 — 3 — 2 — — 14 15 Conley Road 36 1 2.77 163 87 76 196 5 5 5. 1.6 .4 .9 10 0 7 0 2 0 0 11¼ 1 1½ 180 36 163 4.52 33 2 1 5 6 2 .16 13.88 14 12 — — — — — — — —— — — — — — — 2 — 2 — 2 — — — — 10 3 1 — 4 1 — 2 — — — — — — 15 16 Cooper Road 44 2 4.54 259 139 120 343 6 3 4.15 2.33 .66 1.05 14 0 7 0 3 4 2 4 2 1 245 59 259 4.38 30 14 — 10 11 2 .26 16.94 8 8 — — — — — — 27 3048 1016 2 1 1 — — 9 1 1 — 13 — 1 — — — 5 4 — 3 — — 8 — — 3 — — — 16 17 Deacon Road 133 7 5.26 1312 662 650 505 5 3 4.30 2.25 .4 1.20 11 0 9 0 3 8 2 3 2 0½ 1073 249 1312 5.31 70 11 2 22 32 2 .24 8.90 27 15 — — — — — — 24 3270 1090 13 2 7 3 6 21 — 5 1 29 — 5 2 5 19 9 17 — 16 16 3 44 — 2 10 10 — 2 17 18 Denbigh Road 60 6 10. 455 233 222 537 6 3 3. 3. 1.5 1.40 14 0 7 0 2 4 2 4 2 4 324 106 455 4.29 39 15 — 4 6 2 .10 3.77 15 11 — — — — — — 105 3961 1320 3 — 1 1 3 2 — 1 1 35 — 1 1 — 7 19 2 — 2 2 1 8 — — — 1 — 1 18 19 Denton Road 28 1 3.57 280 148 132 298 3 3 3. 3. .33 1.7 6 6 6 6 2 2 2 2 2 2 165 55 280 3. 11 15 2 7 9 2 .32 12.54 17 9 — — — — — — 55 2464 821 1 — 2 3 2 1 — — — 28 — 1 — — 1 5 1 — 3 — 1 1 — — 1 — — — 19 20 Earlsmead Road 68 1 1.47 597 307 290 635 6 2 3.26 2.50 1.3 1.48 14 0 4 0 3 0 2 0 2 2½ 402 123 597 4.85 68 25 25 1 1 1 .01 .81 41 24 — — — 18 2173 1086 73 2865 955 5 — 3 — 3 2 — — — 17 — — — — 2 4 6 — 6 2 — 5 — 3 — 1 — — 20 21 Felixstowe Road 56 4 7.14 407 201 206 480 6 2 3.17 2.66 .66 1.71 13 6 5 6 2 9 2 0 2 3¼ 238 75 407 5.42 37 17 2 13 17 4 .30 17.33 22 12 — — — 3 2042 1021 67 3080 1026 4 2 2 7 — 7 — 2 1 12 — 1 2 1 5 15 1 — 1 9 2 6 1 3 1 — — — 21 22 Gordon Road 11 — — 203 98 105 188 5 1 2.5 4. 1. 2.30 11 0 5 6 3 3 2 2 2 6¼ 86 34 203 5.97 12 8 14 — — — — — 8 1 1 1443 1443 15 1906 953 8 3220 1073 3 — 1 — 1 4 — — — 5 — 1 — — — 4 — — 4 1 3 2 — 1 — 1 — — 22 23 Granville Road 95 3 3.15 1486 722 764 1517 8 1 1.96 4.50 .66 2.01 2; 0 3 0 5 6 2 9 2 10½ 736 374 1486 3.97 170 163 41 — — — — — 18 11 31 1569 1569 216 3004 1502 28 3736 1225 54 2 — 7 8 19 — 1 4 103 — 4 2 — 3 — — — 12 5 32 18 3 1 1 1 2 1 23 24 Greyhound Road 65 1 1.53 585 301 284 661 6 2 3.03 3.6 .6 1.80 15 8 5 6 2 7 1 11 2 2 325 107 585 5.46 41 21 3 2 3 2 .04 1.86 28 11 — — — 3 1944 972 99 3333 1111 9 2 2 2 3 11 — — 5 37 — 1 — 1 2 9 2 — 3 5 — 7 1 5 3 — — — 24 25 Guilsborough Road 49 10 20.40 335 167 168 424 3 3 3. 2.3 .66 1.22 7 0 7 0 2 4 2 4 2 4 273 89 335 3.76 39 — — — — — — — 2 2 — — — — — — 84 3231 1077 3 — — 2 — 2 2 5 — 7 — 2 3 — 8 13 3 — 4 7 1 3 2 — 2 1 — — 25 26 Heron Road 50 1 2. 395 213 182 394 6 2 3.2 2.33 .57 1.5 15 0 5 6 2 6 1 10 2 5 256 78 395 5.06 41 10 2 4 5 2 .10 5.12 17 10 — — — 4 2000 1000 62 3524 1174 1 — — 2 1 7 1 — — 22 — 1 — 2 3 13 2 — 7 2 3 6 — — — 1 — — 26 27 High Street 19 10 52.63 59 26 33 whole St. 1207 8 3 3.27 1.33 .5 1. 20 0 7 6 2 6 2 6 2 6 59 18 59 3.27 9 — — 2 5 4 .55 22.22 2 1 — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — 27 28 Hiley Road 68 3 4.41 522 266 256 568 6 1 3. 2.66 .33 1.51 12 0 5 0 4 0 2 2 2 5 345 115 522 4.53 60 38 17 — — — — — 22 10 2 1259 1259 20 2132 1066 50 3095 1032 7 — 1 2 — 6 — 1 — 13 1 3 — — 3 3 1 — 7 3 — 1 — 1 1 — — — 28 29 Holly Lane 29 1 3.44 310 153 157 266 6 3 3.60 3.75 .75 1.6 20 0 6 0 2 6 2 0 2 13/4 184 51 310 6.07 3 26 — 3 5 2 .17 5.88 2 6 — — — — — — — — — 6 — 1 2 — 6 — — — 22 — — — — 2 4 — — 2 4 — 3 1 — — — 2 — 29 30 Honey wood Road 14 — — 119 67 52 125 7 2 3.92 2.6 1. 1.21 16 0 5 6 3 3 2 1 2 23/4 98 25 119 4.76 11 2 1 8 17 4 1.21 32. 5 6 — — — — — — 11 3718 1239 3 — — — — 1 — — — 5 — — — — 1 6 — — — 1 — 1 — 4 — — — — 30 31 Mayo Road 108 7 6.48 771 404 367 862 7 1 3.33 2.5 .5 1.25 13 0 3 0 3 0 1 4½ 1 8¼ 614 184 771 4.19 174 10 — — — — —— 46 18 5 1450 1450 — — — 89 3502 1167 5 — — 6 7 11 — 4 — 47 — 3 1 1 14 24 3 — 9 12 5 11 3 1 4 1 — — 31 32 Melville Road 63 9 14.28 452 231 221 512 6 2 4.39 2.66 .66 .9 14 0 5 6 2 4 1 5 1 7½ 378 86 452 5.25 22 19 3 5 5 1 .07 5.81 20 13 — — — — — — 80 2874 958 6 — — 6 2 3 — 1 — 48 — — — — 1 8 2 — 3 — 1 5 — 1 1 — — — 32 33 Mordaunt Road 67 3 4.47 527 284 243 601 6 3 3.49 3.33 .66 1.31 15 0 6 0 2 6 2 0 2 4 402 115 527 4.58 39 25 3 20 31 3 .46 17.39 17 9 — — — — — — 103 3412 1137 3 — — 1 2 7 — — 5 37 — 2 2 — 8 22 5 — 8 2 — 3 — — — — — — 33 34 Napier Road 44 4 9.09 269 136 133 328 6 3 3.33 3. .16 1.12 15 0 7 6 2 6 2 0 2 4½ 240 72 269 3.73 30 — 10 5 5 1 .12 6.94 16 7 — — — — — — 48 3127 1042 4 — 1 — 1 1 — — 2 6 — — — — 1 19 6 — 5 4 — 4 1 1 1 — — — 34 35 Neville Road 4 — . — 31 17 14 26 4 1 3. 4. 1. 1.72 10 0 3 6 3 6 2 03/4 3 4½ 18 6 31 5.16 2 2 — — — — — — 1 1 1 1450 1450 — — — 1 2799 933 3 — — 1 — — — — 1 — — — — — — — — — — — .— — — — — — — — 35 36 Oak Road 17 6 29.41 76 35 41 104 4 3 3.1 2.75 .5 1.7 8 0 8 0 2 0 2 0 2 0 44 14 76 5.42 10 2 — — — —- — — — 1 — — — — — — — — — — — — — — — 1 5 — — — — — 5 — — 1 — — — — — — — — — 36 37 Park Road Mews 10 3 30. 32 14 18 41 3 3 3. 1.66 .66 1.52 6 6 6 6 2 2 2 2 2 2 21 7 32 4.57 6 1 — — — — — — — — — — — — — — — — — — — — — — — — — —— — — — — — — — — — — — — — — — — — — — 37 38 Pembroke Place 14 — — 97 47 50 96 5 3 3.57 2.6 .6 1.94 11 0 8 6 3 8 2 0 2 9½ 50 14 97 6.92 — 5 9 1 1 1 .07 7.14 12 5 7 2630 877 2 — — — — 1 1 — — 1 — — 1 — — 1 — — — 5 — — — 1 — — — — 38 39 Queen's Road 98 11 11.22 807 422 385 808 6 3 3.6 3.6 .6 1.54 14 0 5 0 2 6 1 8 2 0¼ 522 145 807 5.56 23 29 35 21 47 5 .54 14.48 41 25 — — — — — — 111 3199 1066 1 — 2 2 2 5 1 — 2 31 — 1 — — 2 10 1 — 6 3 — 4 — 2 1 1 — — 39 40 Ravensworth Road 52 1 1.92 357 182 175 397 6 3 3.8 3. .3 1.11 15 0 6 6 2 6 2 2 2 3¼ 312 82 357 4.35 45 4 3 4 5 2 .09 4.87 23 5 — — — — — — 72 2857 952 7 — — 2 2 3 2 — — 16 — 3 — 1 6 8 4 —. 3 3 2 6 2 1 1 2 — — 40 41 Rupert Road 8 — — 84 37 47 94 9 1 3.93 4. .57 1 .42 20 0 2 6 4 0 2 6 2 7¼ 59 15 84 5.60 5 3 — — — — — — 2 3 — — — — — — — — — — — — 6 1 — — — — 2 — — — — — — — — — — — — — — — — — — 41 42 St. Margaret's Road 68 1 1.44 598 310 288 637 6 3 3.26 3. .3 1.46 15 0 6 6 2 6 2 2 2 3¼ 408 125 598 4.78 98 23 4 13 16 3 .23 10.40 19 4 — — — — — — 117 2715 905 8 — 2 1 1 10 1 — — 34 — 2 — — 4 13 3 — 7 5 3 8 — 4 2 1 — — 42 43 Sandringham Road 176 13 7.38 858 434 424 943 6 1 3.36 2.5 .33 1.26 20 0 5 0 5 0 1 8 2 5 677 201 858 4.26 151 10 2 16 25 3 .15 7.96 7 7 3 1320 1320 2 2013 1006 77 2628 876 14 2 4 3 3 14 2 1 1 26 — 3 1 3 7 7 7 — 15 17 4 26 — 3 5 4 — — 43 44 Shakespeare Avenue 130 7 5.38 965 502 463 315 7 2 3.97 2.66 .5 1.08 15 0 6 6 2 6 1 10¼ 2 0 891 224 965 4.30 99 19 3 21 36 4 .29 9.37 11 10 — — — 10 2203 1101 70 3143 1048 9 2 — — 2 9 1 1 — 66 — 1 2 — 16 49 4 — 11 2 1 8 — 2 — 1 — — 44 45 Shelley Road 41 1 2.43 331 178 153 321 6 3 3.47 4. .8 1.37 15 0 6 0 3 0 2 0 2 5 240 69 331 4.79 32 8 — 8 11 3 .15 11.59 12 7 — — — — — — 67 3345 1115 2 1 — — 3 4 — — 4 23 — — — — 7 14 — — 2 2 — 1 1 — — 2 — — 45 46 Stafford Mews 26 2 7.69 132 72 60 151 6 2 3.24 2.66 1. 1.76 8 0 5 6 4 0 1 8 2 10 81 25 132 5.28 5 17 2 1 1 1 .04 4. 4 — — — — 1 2396 1198 — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — 46 47 Taylor's Lane 21 3 14.28 108 55 53 146 6 2 3.60 2.3 .3 1.20 1(> 0 4 6 2 8 1 9¼ 2 1 90 25 108 4.32 18 3 — 3 5 2 .27 12. 1 — — — — — — — 11 3454 1151 1 — — 1 — — — — 6 4 — — — — 1 2 — — — — — — — — — — — — 47 48 Victoria Place 27 3 11.11 139 71 68 141 6 2 3.70 3.3 .4 1.47 12 0 5 0 3 0 2 0 2 1¼ 89 24 139 5.79 15 5 4 — — — — — 18 11 — — — 6 1653 827 5 2493 831 3 — 2 — — 2 — — 1 11 — — — — — 1 — — 1 1 — — — — — — — — 48 49 Victor Road 82 5 6 .09 557 291 266 602 6 2 3.60 3.33 .5 1.20 15 0 5 6 2 1½ 2 0 2 1 462 128 557 4.35 43 1 3 14 19 3 .24 10.93 41 5 — — — 6 2097 1048 86 3235 1078 7 — 1 4 7 4 — 1 2 13 — 4 4 — 6 32 4 — 11 3 — 7 — 6 1 — — — 49 50 Villiers Road 166 20 12.04 1029 512 517 1264 6 1 4.13 2.13 1. 1.03 15 0 2 0 3 0 2 0 2 2¼ 996 241 1029 5.26 133 11 2 32 56 4 .33 13.27 28 48 9 2253 2253 12 2910 1455 122 4494 1498 19 4 4 8 1 19 6 4 5 44 3 6 3 6 3 8 8 2 14 6 12 21 1 2 3 14 — — 50 51 Westbury Road 36 5 13.88 241 133 108 213 6 3 3.87 2.66 .66 1.29 14 0 6 0 2 6 2 0 2 1¼ 186 48 241 5.02 16 14 1 1 3 3 .09 12.08 11 5 — — — — — — 32 2754 918 3 2 — — — — — — — 25 — 2 1 — 2 — 1 — 4 2 — 5 — — — — — — 51 52 Winchelsea Road 52 2 3.84 380 191 189 364 7 2 3.89 2.6 .5 1.14 15 0 7 0 2 6 1 9 2 03/4 331 85 380 4.47 43 7 — 12 19 4 .38 14.11 9 11 — — — — — — 71 3338 1112 — — — — 2 4 — — — 18 — — 1 — 6 35 1 — 1 1 3 3 — — — 1 — — 52 53 Woodhays Road 83 21 25.30 300 161 138 338 5 5 5. 2.4 .4 .96 10 6 8 6 2 1¼ 1 8½ 1 90¼ 310 63 300 4.76 63 — — 9 12 2 .19 14.28 11 5 — — — — — — — — — 1 — — 1 — — — — — 1 — — — — 24 18 12 — 3 — — — — 3 — — — — 55 2956 220½ Mean Avg. of Empty Hous's 7.75 % 23279 11891 11388 25619 Max. 9 Min 1 Mean Avg. Room, per Ten't 3.47 per Ten't. 3-47 Max. 5. Min. .16 Mean Avg. No. of Pers'ns per Room 1.38 Max. 22/- Min. 2/- Max. 5/6 Min. 1/2 Mean Avg. W'kly Rental per Room 2/22/3 17329 5164 23279 Mean Avg. No. of Pers'ns per Ten't. 4.67 2434 844 277 309 408 Max. 5 — Mean Avg. of Ten'ts where Lodg's are taken 5.84 % 904 520 Total No. of 1 Room Tenements, 193. Mean Avg. Capacity of each Room, = 1692 Cubic Feet. Total No. of 2 Room Tenements, 694. Mean Avg. Capacity of each Room, 1277 Cubic Feet. Total No. of 3 Room Tenements, 2401 Mean Avg. Capacity of each Room, 1098 Cubic Feet. 353 35 63 116 102 269 19 38 138 1050 5 77 38 22 208 461 145 5 254 179 127 302 20 76 90 86 4 17 Willesden District Council. Report BY THE MEDICAL OFFICER OF HEALTH on Tenement Dwellings in Willesden: Details of Investigation into 5,164 Tenements Housing 23,279 People. London : MORTON & BURT, Printers, 187, Edgware Road, Paddington, W. PUBLIC HEALTH DEPARTMENT. Public Offices, Dyne Road, Kilburn, N.W. To the Chairman and Members of the Housing of the Working Classes Committee. Gentlemen, I have the honour to submit to you some of the data relating to housing, which I have tabulated from the records under my care. During the last two years the Officers of your Public Health Department in the course of their systematic inspection by house-to-house visitation, have enquired into the conditions of housing of over 23,000 people, living in some 5,164 tenements, chiefly of the working classes. Before passing to the consideration of these results, however, I should like to call attention to some facts which I am able to lay before you relative to the distribution of the whole of that section of 4 the population of Willesden living in tenements of less than five rooms. The working classes are almost wholly housed in such tenements, although the tenements are not exclusively occupied by the labouring classes. I have calculated from data furnished in the census returns, the population in Willesden living in tenements of less than five rooms. This population, distributed in 1,2, 3, and 4 roomed tenements, is exhibited as it existed at the census of 1891 and at the census of 1901. The proportion of this population in each class living in rooms where the number of persons exceeds 2 per room is also shown. From the table (No. 1) it will be seen that about half the population of Willesden is housed in tenements of less than 5 rooms, while the other half occupies houses of 5 rooms and over. The tendency, judging from the changes that have occurred in the intercensal period, is for the tenement class to increase, it having risen during the ten years from 48 to 50 per cent. of the whole population. But proportionate increase is confined in the case of tenements of less than 5 rooms to that section housed in 3 and 4 roomed tenements. 5 Table No. 1. No. of Rooms per Tenement. Population living in Tenements of less than 5 Rooms. Percentage of total Population in each class of Tenement. Actual population living in Rooms occupied by more than 2 Persons per Room. Percentage of each Class Overcrowded. Mean Annual crude Death Rate for the Decennium ending. Census 1891. Census 1901. 1891. 1901. London. 1901. 1891. 1901. 1891. 1901. 1891. 1901. 1 3285 2972 5.3 2.6 6.6 1981 1325 60 44 ... ... 2 8204 11140 13.3 9.7 15.4 4293 4485 52 40 ... ... 3 10854 23902 17.7 20.8 16.5 3483 5657 32 23 ... ... 4 7548 20192 12.3 17.6 15.2 1010 1845 13 9 ... ... Totals 29891 58206 48.6 50.7 53.7 10767 13312 36 23 15.38 13.54 6 The class housed in 1 roomed tenements is absolutely diminishing, that in 2 roomed tenements becoming only proportionately smaller. This is so far satisfactory, in that 1 and 2 roomed tenements must be looked upon as injurious to the health of their inmates. This has been shown statistically, repeatedly, and is well exhibited in the following tables:— Table No. 2. * Showing the relation of the Death-rate to the proportion of Population living in Tenements of less than 5 Rooms, in the Eight Principal Towns of Scotland. Locality. Death Rate, 18711880. Percentage of Population living in dwellings of One Room. Two Rooms. Three Rooms. Four Rooms. Five or more Rooms. Aberdeen 21.17 13.6 38.3 20.3 9.1 18.7 Leith 22.5 14.2 43.3 18.3 9.0 15.2 Perth 22.6 100 34.3 19.3 10.7 25.7 Edinburgh 23.2 16.8 31.6 15.4 8.9 27.3 Dundee 25.7 16.9 48.1 14.7 10.2 14.1 Greenock 27.4 15.4 47.3 19.7 5.7 12.0 Paisley 27.8 23.0 441 14.7 6.8 11.4 Glasgow 28.6 24.7 41.7 16.0 6.1 8.5 * Table prepared by the late Dr. J. B. Russell while Medical Officer of Health for Glasgow. 7 Table No. 3 * Death-rates from various causes in various sized Dwellings in Glasgow in 1885. Causes of Death. Dwellings of 1 and 2 Rooms. Dwellings of 3 and 4 Rooms. Dwellings of 5 Rooms and upwards. Zymotic Diseases (including Diarrhœa) 4-78 2-46 1-14 Acute Diseases of the Lungs (including Consumption) 9.85 6.89 3.28 Nervous Diseases and Diseases of Nutrition of Children 4.80 2.35 0.91 Accidents and Syphilis in Children 0.32 0.11 ... Miscellaneous unclassified Diseases 7.99 7.64 5.90 Total (all Causes) 27.74 19.45 11.23 * Table prepared by the late Dr. J. B. Russell while Medical Officer of Health for Glasgow. There is another ground for satisfaction to be found in the table which I have prepared (Table No. 1) from data in the census returns. It is in the 8 substantial reduction of overcrowding in each class of tenement. Anything over 2 persons per room is rightly looked upon as overcrowding in cubic area, and adopting this standard it is found that between the two censi the reduction of overcrowding has been most marked, and further, has been greatest directly as the overcrowding. Thus 1 roomed tenements have had their overcrowding reduced by 16 per cent., 2 roomed tenements by 12 per cent., 3 roomed by 9 per cent., and 4 roomed by 4 per cent. That 23 per cent. of the population living in tenements of less than 5 rooms should still be housed in dwellings with more than 2 persons to each room, must be regarded, however, as very far from satisfactory. I have calculated the distribution of the population at each census according to the number of persons per room. From the table (No. 4) the same tendency to amelioration may be observed as is shown in table No. 1, where the population is distributed according to the class of tenement. 9 Table No. 4. Table shewing distribution of Population in Willesden living in Tenements of less than 5 Rooms. No. of Persons per Room. Census, 1891. Census, 1901. Total No. of Persons. Percentage to total persons living in tenements of less than 5 Rooms. Total No. of Persons. Percentage to total persons living in tenements of less than 5 Rooms. Less than 1 person 2110 70 6615 11.3 1 per room 3859 12.9 9941 17.8 Over 1, less than 2 8339 27.9 20186 34.7 2 per room 4816 16.1 8152 14.0 Over 2, less than 3 4944 16.5 7805 13.4 3 per room 2526 8.4 2973 5.1 Over 3, less than 4 1267 4.2 1349 2.3 4 per room 1112 3.7 840 1.4 Over 4 to 5 680 2 3 272 0.5 Over 5 238 0.8 73 0.1 Less than 1 to over 5 29891 100 58206 100 The effect of increasing density of population in rooms is generally a directly increasing degree of 10 insanitariness, and the result of this on mortality is well exhibited in the accompanying table, No. 5. Table No. 5. Town of Leipsic. Streets with a mean Population of— of 100 died yearly. All ages. Under one year. Over five years. Per cent. 0—1.0 Inmates in each Room 11 1.0 1.1 1—1.5 „ „ „ 25 1.1 1.8 1.5—2.0 „ „ „ 26 1.1 2.0 2—2.5 „ „ „ 34 1.4 2.6 2.5—3.0 „ „ „ 33 1.3 2.7 Over 3 „ „ „ 42 1.8 3.4 It is not wonderful when all these facts are considered, that a very material improvement in the mortality rate of Willesden should have accompanied changes in housing known to make for this result. The reduction in the mean annual crude death rate from 15.4 per 1,000 for the deceunium ending 1891 11 to 13.5 per 1,000 for the decennium ending 1901, means a saving practically of 2 lives for every 1,000 of population each year, and this, on the present population of Willesden, means a saving of 270 persons a year, or roughly 5 a week. It is to be noted then— (1) That the trend of growth of the population in Willesden is to an augmentation of the class living in tenements of less than 5 rooms. (2) That the greatest increase in the tenement class during the last decennium of which we have statistical evidence has occurred in tenements of 4 rooms. (3) That the increase next in proportion has occurred in 3 roomed tenements, and that this constitutes the largest class of tenements of less than 5 rooms. (4) That the population housed in 2 roomed tenements is actually increasing, though proportionately to the whole population it is diminishing. 12 (5) That the population housed in 1 roomed tenements is now actually and proportionately diminishing, and has sunk to 2.6 per cent. of the whole population. (6) That the proportion of overcrowding in each class of tenement is undergoing marked and substantial reduction. The significance of these results receives reinforcement when we come to consider the bearing of the facts elucidated in the course of systematic inspection. In analysing and tabulating the results of the Inspectors' enquiries into the sanitary condition of Willesden tenements, I have endeavoured to discover whether any relationship exists between rental and the number of rooms per tenement, between the number of rooms per tenement and the number of persons per room, between the rental per room and the number of persons per room, between the rental per room and the cubic capacity of the room, between the cubic capacity of rooms and the number of rooms per tenement, between the rental per 13 son and any and all of these factors which go to the constitution of a tenement dwelling. For this purpose I have taken the room as the unit whether occupied separately, or fractionally as part of a tenement. I have reduced the expression with regard to each class of tenement to a mean of all the units in the class. The results can only be taken as approximately correct for the whole of Willesden, on account of the comparatively small number of tenements with which I have been able to deal. It is right to say, however, that the results are based upon an analysis of returns made in respect of a systematic inspection, and not of inspections instituted with a special object. They are on this account the more likely to be characteristic. I am indebted to the Clerk to the Council for the following table (No. 6), the data for compiling which was furnished by him to the Housing of the Working Classes Committee of the London County Council. It will be observed that the average rent per room for houses of all classes brought into assessment during 1902 was 2s. 53/4d. During 1903 it was 2s. 5d. 14 Table No. 6, Year. District. Population per acre, 1901, on the basis of the total area of land and water. Labouring class Dwellings built (brought into Assessment during 1902-3.) Houses. Number of Tenements of— No. of Rooms. Average weekly rental per Room. 1 Room. 2 Rooms. 3 Rooms. 4 Rooms. 5 Rooms and over. Total. 1902 Willesden 26.2 135 ... ... 74 176 40 290 1126 2/53/4 1903 " 26.2 181 ... 1 168 173 24 366 1318 2/5 15 My own results yield for tenements and houses of less than 7 rooms an average of 2s. 4½d. Table No. 7.—* Summary of 1-room Tenements. No. of Persons. No. of Tenements Total Weekly Rental. Mean No. of Persons per Room. Mean Rental per Person. Rental per Room. Average Capacity per Room. Maximum Capacity per Room. Minimum Capacity per Room. £ s. d. 6 4 0 8 0 1.5 1/4 2/- 1(583 2511 1320 83 49 6 2 6 1.7 1/53/4 2/6 2300 2592 1330 118 56 8 8 0 2.1 1/5 3/- 1694 2592 787 18 8 1 8 0 2.2 1/6½ 3/6 1110 2520 1049 21 9 1 16 0 2.3 1/83/4 4/- 1958 2240 1259 12 5 1 2 6 2.4 1/10½ 4/6 1674 2240 1166 4 1 0 5 0 4.0 ... 5/- 1320 ... ... 2 1 0 5 6 2.0 ... 5/6 1866 ... ... 264 133 19 15 6 2.0 1/6 2/11 1832 ... ... Table No. 8.—* Summary of 2-room Tenements. 27 11 2 4 0 1.2 1/7½ 2/- 1038 1880 826 30 12 2 14 0 1.2 1/9½ 2/3 1269 1380 977 559 128 32 0 0 2.2 1/33/4 2/6 1186 1824 774 615 167 45 9 0 1.8 1/6 2/9 1425 1824 872 816 204 61 4 0 2.0 2/2 3/- 1421 1824 774 176 37 12 0 6 2.4 1/113/4 3/3 1412 1824 848 40 11 3 17 0 1.8 1/9 3/6 1546 1785 1262 3 1 0 7 6 1.5 2/6 3/9 1086 ... ... 3 1 0 9 0 1.5 3/- 4/6 1081 ... ... 2269 572 160 5 0 1.9 1/5 2/10¼ 1307 ... ... * Since preparing the Summary the detailed table has been augmented so as to include a total population of 23,279 and an aggregate of occupied tenements of 5,164. 16 Table No. 9.—*Summary of 3-room Tenements. No. of Persons. No. of Tenements. Total Weekly Rental. Mean No. of Persons per Room. Mean Rental per Person. Rental per Room. Average Capacity per Room. Maximum Capacity per Room. Mini mum Capacity per Room. £ s. d. 1060 215 58 8 0 1.64 1/1½ up to 2/- 1134 1760 877 1880 390 126 15 0 1.60 1/4 2/2 1052 1760 682 3146 751 262 17 0 1.39 1/8 2/4 1109 1760 799 3059 693 259 17 0 1.47 1/8¼ 2/6 1071 1760 799 597 149 59 12 0 1.33 2/- 2/8 1187 1760 799 280 68 28 18 0 1 37 2/03/4 2/10 1076 1760 826 72 17 7 13 0 1.41 2/1½ 3/- 1020 1760 824 10094 2283 904 0 0 1.47 1/9¼ 2/7½ 1095 ... ... Table No. 10.—'Summary of 4-room Tenements. No. of Persons. No. of Tenements. Total Weekly Rental. Mean No. of Persons per Room. Mean Rental per Person. Rental per Room. £ S. d. 517 108 36 14 8 1.2 1/48/4 under 2/- 735 147 60 7 4 1.25 1/7½ 2/- — 2/2 463 89 20 5 8 1.3 1/83/4 2/3 — 2/5 497 102 51 0 0 1.2 2/0½ 2/6 66 10 5 14 4 1.6 1/83/4 over 2/6 2278 456 174 2 0 1.3 1/6¼ 1/103/4 * Since preparing the Summary the detailed table has been augmented so as to include a total population of 23,279 and an aggregate of occupied tenements of 5,164. 17 Table No. 11.—* Summary of 5-room Tenements & Houses. No. of Persons. No. of Tenements. Total Weekly Rental. Mean No. of Persons per Room. Mean Rental per Person. Rental per Room. £ s. d. 1430 275 122 4 5 1.0 1 8½ less than 2/- mean 1/9½ 420 73 37 7 6 1.15 1/9¼ 2/- — 2/2 167 32 20 2 1 1.04 2/4f 2/4-3/- 2017 380 179 14 0 1.0 1/9½ 1/10 Table No. 12.—* Summary of 6-room Tenements & Houses. 257 46 24 0 6 0.93 1/10¼ less than 2/- mean l/8¾ 885 136 83 5 0 1.05 1/10½ 2/-2/2 880 148 109 4 0 1.03 2/5¾ 2/4— 2/8 2022 330 216 9 6 1.0 2/1½ 2/2} Table No. 13.—* Summary of Tenements 1 to 6 Rooms. No. of Person*. No. of Tenements. Total Weekly Rental. Mean No. of Persons per Room. Mean Rental per Person. Rental per Room. Average Capacity per Room. No. of Rooms in Tenements. £ s. d. 264 133 19 15 6 2.0 1/6 2/11½ 1832 1 2269 572 160 5 0 1.9 1/5 2/9½ 1307 2 10091 2283 904 0 0 1.5 1/9¼ 2/7½ 1095 3 2278 456 174 2 0 1.3 1/6¼ 1/10¾ 4 2017 380 179 14 0 1.0 1/9¼ 1/10½ 5 2022 330 216 9 6 1.0 2/1½ 2/2 6 18944 4154 1654 6 0 1.36 1/8¾ 2/4½ * Since preparing the Summary the detailed table has been augmented so as to include a total population of 23,279 and an aggregate of occupied tenements of 5,164. 18 Consideration of the above summary of tenements yields the following conclusions:— For tenements of 5 rooms and less, the mean number of persons per room increases inversely as the number of rooms per tenement, and directly as the mean rental per room. Less constant is the relationship between rental per person and rental per room, but approximately it may be stated that the mean rental per person increases directly as the mean rental per room. It is generally true of all except tenements of 3 rooms that with each successive increment of rent there is a corresponding rise in the mean number of persons per room. The exception is not improbably due to the fact that a large number of families are forced by their numbers into such of the 3 roomed tenements as can be secured at a tenement rental not exceeding that charged for tenements of 2 rooms. The cheaper of the 3 roomed tenements thus become disproportionately crowded, in contrast to the rule that crowding tends to increase in each class of tenement with the increase of room rental. Increased rental per room, as I have pointed out, is accompanied by increased rental per head, 19 and we thus have the anomaly produced of each inmate in a room paying more, the more that room is shared by others. This is especially the case with 1 and 2 roomed tenements. In these two classes of tenements the more persons there are to a room the more each of them has to pay. It is satisfactory, on the other hand, to notice that the mean cubic area of one-roomed tenements is greater by 500 cubic feet than that of two-roomed tenements, and that two-roomed tenements have a greater mean capacity per room than tenements of three rooms. Density of population in cubic area in tenements of less than four rooms, is greatest in two-roomed tenements, and least in tenements of one room. The mean cubic area per head is as follows:— For tenements of 1 room 916 ft. Do. do. 2 rooms 689 „ Do. do. 3 rooms 745 „ And the mean rate of rental per head for each 1000 cubic feet in Tenements of 1 room 1/7½ a week. Do. do. 2 rooms 2/0½ „ Do. do. 3 rooms 2/4½ „ 20 The cost of cubic space is thus progressively increased for each person the greater the number of rooms in which it is available. Thus it is cheaper for two persons to live in one room, say of 2000 cubic feet, than for the same persons to live in two rooms of 1000 cubic feet each, the weekly rental in one case would amount to 3/3, in the other to 4/1, though the rental per room in such a case would be for the one-roomed tenement 3/3, and for the two-roomed tenement 2/0½. It is this fact, presumably, which causes the larger rooms to be let off as single-roomed tenements, thus creating the anomaly already referred to. It must be remembered that these results relate to averages which only show broadly the trend or principle of the relations established. In actual fact there are wide divergencies from this principle. For instance, a mean of the minimum cubic space of one class of one-roomed tenements in the different streets in which they occur, yields only 787 cubic feet per room, a diminutive class of rooms which occupied separately must produce the most disastrous results. But a single room occupied by a family as a tenement, no matter what its size, can rarely be a 21 sanitary dwelling. Such a room is constantly occupied day and night; is used for sleeping and living, the storage, preparation, and eating of food; the cleansing of the person and washing and drying of clothes; it is the one little space where children are born and live, are sick and die, and where decency is as impossible of attainment as healthy living. The real difficulty is the remedy. I have shown that the newer Willesden of the last decennium is automatically reducing the proportion of tenements of one and two rooms. Those that remain are not the outcome of house famine operating in Willesden as a whole. Improvement of transit within the borders of Willesden itself will remove the local causes of congested areas, and we may well hope that the improvement now manifest will then be accelerated. There will remain, however, even if unhealthy crowding should disappear, many insanitary and unsuitable houses. There are, especially in South and Mid. Kilburn, houses into which a ray of sunlight never penetrates, on which the winds of heaven never blow. Situated in squalid courts reeking with the filth of animals, walled around by houses more than twice their height, incapable of 22 ment, they should be swept away. This is costly work and for the capital expended there is nothing to show but the demolition of insanitary houses. It will, however, not be in worse case than that of erecting municipal models in which the rental minus the rates fails to balance the interest paid on the capital expended. In either case there is loss. This may not be the alternative, however, and it is for the Council to decide whether they can erect municipal dwellings at a cost that will enable them, without loss, to charge rentals the same or lower than those exhibited in the tables. I have pointed out that there is an accumulation of persons in the cheaper of the three-roomed tenements contrary to the rule in which it is found that the cheaper of each class of tenements are the least crowded. The reason is that the tenement rental for three rooms is, in these cases, not higher than the tenement rental for two rooms. It is the tenement rental which is determinant of the number of the rooms rented, and if municipal dwellings are to secure the provision of suitable accommodation for all classes they must do so by being provided at a rental that shall attract from the inferior and inadequate class of tenement dwellings. 23 But the problem as to what to do with the vacated inferior tenements would still remain. Vacated by their present occupants, it is not to be supposed they would remain untenanted. A lower social stratum would replace that removed by the attraction of the better and cheaper houses, and the old evil would go on in the insanitary dwellings at a still lower social level. What is primarily needed is an equitable arrangement by which irremediable insanitary property can be demolished. Such property is the sore at the heart of the housing problem in Willesden. It will not be healed by indirect measures. I have, Gentlemen, the honour to be Your obedient Servant, WILLIAM BUTLER. 10th November, 1904. Willesden Urban District Council. REPORT on the Vital Statistics and Sanitary Condition of Alpha Place and its Environment. To the Chairman and Members of the Public Health Committee. Gentlemen, I beg leave to submit the following report on the vital and sanitary conditions of Alpha Place and its immediate environment. Perhaps the most reliable evidence of the healthiness of a locality is its general death rate. In the following table are set out the mean annual death rates of each of the localities named during the last decennium. 2 TABLE No. 1. Locality. Years. Mean Annual Death Rate per 1,000. Alpha Place 1894-1903 34.6 Alpha Place North „ „ 23.0 Alpha Mews „ „ 27.2 Alpha Place West „ „ 16.8 Willesden „ „ 13.9 From this it will be observed that ??? Alpha Place North, and Alpha Mews ???ve a death rate very greatly in excess of that for the whole of Willesden. There is thus established a prima facie ground for believing that the conditions under which their respective populations reside, are detrimental to health. Such a view, it will be seen, is strengthened by further enquiry into their vital statistics. Tables showing the number of deaths which have occurred at each house during the decennium 18941903. 3 DEATHS, Etc. No. of House. Alpha Place. Average No. of Persons per House, 8.4 Alpha Place North. Average No. of Persons per House, 9.4 Alpha Place West. Average No. of Persons per House, 9.1 Alpha Mews, Average No. of Persons per House, 4.1 No. of Deaths. No. of Deaths. No. of Deaths. No. of Deaths. 1 5 5 3 0 2 1 3 1 0 3 7 2 1 1 4 5 0 2 2 5 4 3 2 1 6 2 3 3 3 7 2 1 2 0 8 3 2 1 0 9 4 1 2 0 10 5 4 0 4 Alpha 2 4 0 2 0 1 — 1 13 0 17 0 14 1 0 Average No. of Deaths per House, 0 15 No House 3 2 16 1 3 1.5 2 Alpha House. 1 No House — 18 17 - 2 Average No. of Deaths per House, 18 45 1 19 Average No. of Deaths per House— 5 1.1 20 1 21 2.8 1 22 4 23 2 24 1 25 4 26 2 27 3 28 2 63 Average No. of Deaths per House, 2.2 4 It will be seen that in Alpha Place only 1 house, and in Alpha Place North only 3 have escaped the visits of death during the 10 years, while in many houses 4 and 5 deaths have occurred, and in 1 no fewer than 7 deaths. For Willesden, the average number of deaths per house is less than 1 in 10 years. The average population per house, however, is lower, being 7.16, as compared with 8.4 in Alpha Place, and 9.4 in Alpha Place North. In Alpha Mews, the average population per house is necessarily, from the character of the houses, low, being in fact 4.1. This accounts for the fact that despite its high death rate, the house incidence of death is low. The Tables justify the observation that the conditions of life are not only injurious to the resideots, but are so widely distributed as to tell upon the whole local population. Perhaps the actual loss entailed as a result of these injurious conditions is best appreciated when stated in terms of comparative deaths. Had the people in Alpha Place died at the same mean rates as the rest of Willesden in the 10 years 1894-1903, only 18 persons would have died. As a matter of 5 fact, no fewer than 45 have died during this period. In Alpha Place North instead of 63 persons dying only 38 would have died, and in Alpha Mews instead of 18 only 9. If the increased incidence of death on the population in and around Alpha Place be due to defective sanitary conditions, it is to be anticipated that these will find specific expression in an increase of those deaths due to diseases which are known to follow upon these conditions. I have set out in the following Table the death rates per 100,000 of population from Diarrhoea, Typhoid Fever, Diphtheria and Phthisis, diseases which are generally recognised as being intimately associated with insanitary conditions. MEAN ANNUAL DEATH RATE PER 100,000 FOR THE DECENNIUM, 1894-1903. Alpha Place, etc. Willesden. Diarrhœa 263 96 Typhoid Fever 70 11 Diphtheria 140 37 Phthisis 140 97 The comparison instituted in the table is sufficiently striking to make comment superfluous. During the decennium no fewer than 12 coroner's inquests were held, and 2 deaths were 6 uncertified. These elicited the fact that 7 persons died a violent death, 4 of them from suffocation in bed. Alpha Mews heads the list, 22 per cent. of the deaths occurring there being the occasion of an inquest and 75 per cent. of the inquests there yielding a verdict of death from violence. It is a legitimate inference from the above facts that the conditions of life in and around Alpha Place are conducive to disease and death, and such a low social morale as is evidenced in a high rate of violent deaths. SANITARY CONDITION GENERALLY. The most striking feature in the area known as Alpha Place, Alpha Place North, Alpha Place West, and Alpha Mews is the bad arrangement of the houses. The circulation of air in and around the houses is most seriously obstructed, the lighting is defective. The rear space such as it is, and where there is any, is largely covered in by obstructive buildings. The badly arranged streets and houses and crowding of buildings upon area make the task of remedying the other sanitary defects which abound, a process of sanitary 7 interference which is irritating because of its inefficiency to secure wholesome conditions of housing. To arrange for a proper circulation of air around, and through ventilation within the houses without a re-arrangement seems impossible. It is certain that the most satisfactory way of dealing with the area is to deal with it as a whole. Part I. of the Housing of the Working Classes Act provides specifically for dealing with unhealthy areas, but the procedure is cumbrous and excessively costly, and is not one I should recommend. Under Part II. of the Act small areas such as this can be dealt with, but the question of cost again is a serious objection. It is possible that satisfactory results would be secured at less cost by private negotiation with the owners and freeholders, together with the judicious exercise of the powers conferred in the Public Health and Local Acts. Should the Committee decide to adopt this course, I would ask for authority to serve the requisite notices. I am, Gentlemen, Your obedient servant, WILLIAM BUTLER October 25th, 1904. MARTIN & SON, 211 High Road, Kilburn, N.W. and at Marylebone. Willesden Urban District Council. PUBLIC HEALTH DEPARTMENT. The Care of Infants and Children. The chief concern of every right-minded mother is to do her duty by her children. On the faithful discharge of this duty depends the future well-being of her offspring—health, a sound constitution, and the joy of physical fitness for the combat of life. Wbong Notions as to what to do and not do, in the bringing up of children, are just as evil in their effects upon the child as culpable neglect or cruel and cowardly forsaking of the little ones trusted to your care. THE BATH. Babies should be bathed regularly twice a day from their birth. In this, as in all else that is done for the baby, an effort should be made to teach it habits. Let the bath be given at the same hour every morning and every evening. The warm bath at night is most soothing to children, and they will sleep soundly after it, even when they are most fretful. The morning bath should be tepid, and, in the case of healthy children over six months of age, cold. The tepid or cold bath is bracing, and, together with fresh air, one of the best preventives against catching cold. There are few babies over six months of age who have been properly cared for, who do not soon learn to enjoy their rapid dip in cold water. Remember that a baby not kept clean cannot be healthy. 2 ATTENTION TO THE BOWELS. But not only must a baby be kept clean, it must be kept dry, or there will be "scalding" or chafing. On no account should clothing (napkins in particular) which has been wetted by baby be dried and used a second time without having been thoroughly washed. This practice, too often followed by mothers, will very quickly cause chafing. Soda should never be used in the washing of napkins as it irritates the skin. A little common starch powder may be used with advantage to powder baby after bathing and when changing, as it absorbs moisture and helps to prevent chafing. Nothing adds more to the mother's or the baby's comfort than regular attention to the natural functions. Baby should be held out at regular intervals each day. Habits are sometimes established within a week of birth that persist through babyhood. Not only is constipation by this means avoided, but also a good deal of the insanitariness arising from soiled or wetted linen. It will be found that the habit is most quickly formed if the baby is held out after the first meal in the morning and again after the bath. SLEEP. Healthy infants sleep the greater part of their time. To secure this, they should be put to bed at regular hours. On no occasion should babies ever sleep with their mothers. So important is this that, in some countries, it is recognised as a criminal offence for the mother to sleep in the same bed with the baby. It is more dangerous to the life of the child than all the other causes of accident put together. It is most unhealthy for the child, and cannot be condemned too strongly. Poverty is no excuse for it, for an orange box will make a healthier cot than the best appointed bed shared by the mother. The infant should be put to its cot in the bedroom at an early hour, and left there—not nursed to sleep. This is one of the secrets of having good as well as healthy children. A little crying is good for the baby's lungs. Much crying comes of encouraging baby to cry by giving it what it very soon learns to know it gets by crying for. If a baby is not taught to have someone by its cot to keep it awake when it is sleepy, it will never learn to expect or cry for the luxury, and will go to sleep as a good child should. 3 FRESH AIR. Babies are more susceptible to the evils of foul or tainted air than grown-ups. If you are a mother of the working class, you have one other room besides the kitchen. Keep baby's cot there. Do not let it sleep in the kitchen, the one little room where it is a pity you should all have to live, and where the air is so hot and so foul. And let the sunlight into the room. Do not let your little one grow up in a dingy twilight. This would sadden the brightest life. The window of the room in which baby sleeps should always be kept open, care being taken that the cot is placed in such a position as to be free from draughts. No matter how young the baby may be, when you are able to take it out, take it out every day ever after, whether it be winter or summer, and whatever the weather may be. It is the babies who are kept indoors who are always taking cold and having bronchitis. It would be better for baby if you could keep it out all dav long, but if you have not time for that, you must make time to take it out once every day at least, if you would have your little one strong and healthy. FOOD. Nature provided that children should be nursed by their mothers, and not the cunningest artifice can compete with nature's method. But nature's provision can be abused. The newly-born infant has to acquire habit and the habits it so quickly acquires are good or bad according as the mother is intelligent and wilful or stupid and weak. Motherhood imposes from the first the need for restraint and guidance. Natural affection and maternal impulse must not run riot but be educated for the infant's welfare. Babies do not cry only because they are hungry, and the cure for crying is not an incontinent application of the infant to the breast. Least of all is this method the way to feed the child. Babies are frequently starved to death by too frequent and irregular feeding. The food put into the stomach in these circumstances is not digested. The digestion of one meal is interrupted by fresh food introduced too soon after the first meal, and neither meal agrees—that is to say, neither is digested. The undigested milk ferments in the stomach and gives rise to wind, colic and diarrhoea, with their attendant discomfort and inevitable crying. Children thus mis-fed are truly stated to be ravenous and never 4 satisfied. But the remedy lies not in putting more food into the stomach, but in less frequent feeding. The following table shows the frequency of nursing according to the age of the child:— Age. No. of Nursings in 24 hours. Interval during the Day. Hours. No. of Night Nursings between 9 p.m. and 7 a.m. First day 4 6 l Second day 6 4 l Third to twenth- eighth day 10 2 2 Fourth to thirteenth week 8 2½ 1 Third to fifth month 7 3 1 Fifth to twelfth month 6 3 0 At first, and when a change in the time of feeding is made, so important is it that regularity be established that during the day at least baby should be awakened if necessary in order to be fed. Only by placing baby in the cot between nursings can regular nursing be established. Where baby is kept in bed with its mother it is restless and disturbs the mother frequently in order to be fed and the harm to both resulting from this would in itself be sufficient reason for sleeping separate. During the First Six Months nothing but breast milk should be given. After that, bread and milk, milk pudding, biscuits or rusks soaked in milk may be added. During the second year eggs slightly boiled, gravy, broth, and as the teeth develop fresh meat and vegetables may be given. William Buleer Medical Officer of Health. Printed at the Brondesbury Press, Kilburn, N.W. Willesden Urban District Council. PUBLIC HEALTH DEPARTMENT. Artificial Feeding of Infants AND Summer Diarrhoea. THE DANGER OF INFANTILE OR SUMMER DIARRHCEA. In the hot summer months of every year a disease breaks out among the babies, especially of the working classes, which kills an incredible number of them. It is called diarrhoea, and during hot dry summers it is so dangerous to infants under one year of age that it is safer to be a soldier on a field of battle than to be a baby of tender months and run the gauntlet of this terrible infantile pestilence. None of the epidemics of later years, however deadly they may appear, are to be compared in deadliness to the summer diarrhoea of infants, and if you can guard your baby from this disease you will have shielded it from the greatest particular danger of its life. HOW TO PREVENT IT. (1) Nursing at the Breast versus Hand Feeding. If your baby is nursed at the breast, it has an enormously increased chance of escaping this disease. The death rate among infants from diarrhoea is nearly half as much again among those who are hand fed as among those who are nursed. There is no doubt that bottle-feeding is the greatest cause of all of this disease. (2) But Breast-Fed Infants do die of this Disease, and Why? (a) Because of dirty surroundings. Quite as important as keeping your house fresh and clean indoors is the need for keeping the outside clean,also. Dirty yards are probably more dangerous to infants than malarial swamps are to adults. Where the yard is paved, as it always should be in tenement houses, it should be swilled at least once a week. The gullies should be kept clean and free from the slimy abominations which tend naturally to accumulate. Accumulations of dung near houses in the neighbourhood of stables are particularly dangerous. No refuse of any kind should be permitted to lie either on the ground or on the paved yard. Vegetable and animal matter should be burned. All else should be put in the dustbin. Dustbins should always be kept covered and placed as far as possible out of the sun. Moisture of any description in the dustbin should be avoided. Where the back area is not paved it should be cultivated. Even if things won't grow the ground can be made tidy and sanitary by digging. It should be watered frequently during hot dry weather. The domestic dust of foul yards and houses is more dangerous than sewer gas. Remember, if these things are neglected that properly constructed drains do not safeguard you and your little ones from the evils of bad sanitation. (b) Next to cleanliness inside and outside the house and cleanliness of the body is the need for clean air. Over-crowded and illventilated rooms not only injure permanently the health of all the inmates, but specially endanger the infant to diarrhoea. It is particularly important that slops and refuse should not be allowed in the house a moment longer than is necessary. Windows should never be closed. ARTIFICAL FEEDING OF INFANTS. Where baby is hand-fed the above precautions are of even greater importance. The poison of diarrhoea is mostly conveyed in the milk. But it is destroyed by boiling, Therefore all milk should be boiled. The milk should be kept in a clean cool place, and the jug in which it is kept covered with fine muslin to keep out the flies and dust. Flies undoubtedly carry the infection both of diarrhoea and of other diseases. Baby's bottle should be thoroughly cleansed and scalded in boiling water before each feed. After use it should be washed and placed in clean water with a little Condy's fluid in it. Never leave the bottle in baby's cot for it to suck or leave as it likes. The mother should hand-feed the baby just as she would if she were nursing it. Give baby the bottle and then let nothing enter it's stomach for at least two hours, or longer, according to its age. Mothers who leave the bottle in the cot under the idea of pacifying the child are injuring it most seriously. Such conduct is selfish, foolish and unpardonable. Bottles with long india rubber tubes are an abomination. They cannot be kept clean, and have poisoned more children than all the scheduled poisons of the chemist put together. Baby's bottle should be a plain glass boat-shaped bottle fitted directly with an india-rubber teat. The teat should be frequently changed and cleaned daily, the teat being turned inside out for this purpose. During the first six months of life nothing but milk should be given. The milk should be fresh cows' milk, diluted with barley water and sweetened. Tinned condensed milk and patent foods should be strictly shunned, certainly during the first six months. In the very few cases where condensed milk is necessary it should be given only under medical advice and the brand should be carefully selected. The selection of the proper strength of milk to give is most difficult, as children differ so much, that what is right for one is altogether wrong for another. The following rules are only a rough guide which will require intelligent modifications generally under medical advice in all cases where the baby does not thrive. The fresh cows' milk should be boiled by placing it in a basin or other clean vessel, and putting the basin in a saucepan of water, which is then set to boil. Enough milk should be thus boiled to last twenty-four hours. The milk should then be rapidly cooled by placing the basin with the milk in it in cold water which is frequently changed. It should then be covered up with muslin and put in a cool clean cupboard, and used as required. To make Barley Water. Take two tablespoonsful of pearl barley, wash it well in two changes of cold water, and place in a clean jug. Pour on one pint of boiling water, leave it to soak for twenty minutes, strain off and set the liquid aside for use as required, keeping the jug covered with a piece of clean muslin. Fresh barley water should be made each day, or twice a day during hot weather. The same barley should never be used twice. As a general rule:— During the first two months, one part of this milk to two of water or barley water should be given. From two or three months one part of milk to one of water. From three to six months, two of milk to one of water. Each bottle should be sweetened with a little sugar. As the baby gets older the addition of a little cream or a few drops of Cod Liver Oil to each bottle will be found to be a great advantage. The following Table shows the amount and frequency of feeding to be adopted generally according to the age of the child:— Age. Interval between meals by day. hours. Night Feedings 10 p.m. to 7 a.m. No. of Feedings 24 hours. Quantity for one Feeding. ounces. Quantity for 24 hours. ounces. 2nd to 7th day 2 2 10 1-1½ 10—15 2nd and 3rd weeks . . 2 2 10 1½-3½ 15—35 4th and 5th weeks ... 2 1 10 2½-3½ 25—35 6th week to 3rd month 2½ 1 8 3 —5 24—40 3rd to 5th month 3 1 7 4 —6 28—42 5th to 9th month 3 0 6 5 —7½ 30—45 9th to 12th month ... 4 0 5 7 — 9 35—45 One Ounce = Two Tablespoonsful. The food should be given warm. A rough test is for the mother to pour a few drops on the front of her wrist, when it should feel warm but not hot. It is wrong for the mother to put the teat in her own mouth in order to test whether the food is of the right temperature. Baby should be held in the arms while being fed, and should never be fed for longer than twenty minutes at a time. The bottle should be so held that the neck is kept filled with the milk in order that no air be sucked by the infant. These are general elementary instructions. In many cases they will require modification, but the reasons which call for this call also for the skilled and particular advice of the medical practitioner. William Buffer Medical Officer of Health. Morton & Burt, Printers (L.S.C.), 187, Edgware Road, W. Willesden Urban District Council. PUBLIC HEALTH DEPARTMENT. PRECAUTIONS TO BE OBSERVED IN CASES OF INFECTIOUS DISEASE. WILLIAM BUTLER, M.B., D.P.H., Medical Officer of Health. Printed at the Brondesbury Press, Kilburn, N.W. 2 Precautions to be observed in cases of Infectious Disease. On the occurrence in a household of a case of Infectious Disease, the patient must first be isolated from all other members of the household. If the patient is to be removed to the Isolation Hospital, he or she should be kept in the room which was occupied at the commencement of the illness until removed in the Hospital Ambulance, and until then none but the person in charge should be permitted to enter the room. If the patient is to be isolated at home, this should be done in a well-lighted and ventilated room at the top of the house. If the patient does not occupy this room at the commencement of the illness, it should, previously to being occupied, be prepared by removing all bed hangings, curtains carpets, or other articles likely to retain infection. If, on the other hand, it is decided to isolate the patient in the room which he occupies, nothing should be removed from the room until after the illness is over, when everything in it will be disinfected by the Officers of the Council. Similarly, where a patient is removed to Hospital, nothing should be removed from the room until it has been disinfected. In a word, no articles whatever which have been exposed to infection must be used, removed or put away until they have been disinfected. Breach of this rule is a penal offence, and may have the effect of stultifying all other efforts at stopping the spread of infection. ISOLATION AT HOME. The room in which the patient is isolated must be as far away as possible from any room occupied as a living or sleeping room. A sheet kept wet by means of disinfectant solution should be hung outside the door. The attendant upon the patient should have a clean washable wrapper, fitting tight round the neck and extending to the feet. This should be worn immediately upon entering, and all the time she is in the sick room, and taken off and hung upon the door immediately before leaving the room. The hands and face should be washed with soap and water prior to leaving the 3 room on all occasions. The windows of the sick room should always be open at the top. An open fire should always be kept burning. All discharges from the patient should be received into disinfectant solution. Handkerchiefs should not be permitted, but rag or absorbent cotton wool may be used and immediately burned. Nothing should leave the sick room unless it has been previously disinfected, either in strong disinfectant solution or boiling water. This applies alike to linen, clothing, and the utensils of food. Unused or left food should be burned. At the termination of the period of infectiousness, the patient should have a warm bath, and leaving all wearing apparel in the sick room, dress in clean clothes that have not been exposed to infection. The room should be then closed up, and intimation sent to the Medical Officer of Health by the Medical Attendant, that the room is ready for disinfection. For some time after release from isolation or return from the Hospital, the patient should not sleep, kiss, or come into immediate contact with other persons. Should a cold be contracted, a further period of isolation is necessary until all nasal or other discharges have ceased, as infectiousness recurs with the occurrence of catarrh. It is particularly important that a patient released from isolation should not enter a crowded or ill-ventilated room for some time after recovery. The more time spent in the open air the better, and the better the sanitary condition of the house and its inmates, the less likelihood of the recurrence of infection. Section 126 of the Public Health Act, 1875, provides that " Any person who, while suffering from any dangerous infectious disorder, wilfully exposes himself without proper precautions against spreading the said disorder in any street, public place, shop, inn, or public conveyance, or enters any public conveyance without previously notifying to the owner, conductor, or driver thereof that he is so suffering; or being in charge of any person so suffering so exposes such sufferer; or gives, lends, sells, transmits, or exposes without previous disinfection any bedding, clothing, rags, or other things which have been exposed to infection from such disorder, shall be liable to a penalty not exceeding £5." 4 The following are some of the more common dangerous infectious diseases, and are given along with their periods of incubation, quarantine, and infectiousness :— Incubation Period Period of quarantine required after the latest exposure to infection. Period of Infection ceases. *Diphtheria 2 to 10 days 12 days In not less than 4 weeks if no discharges, and if bacteriological examination of nose and throat be negative. *Scarlet Fever 1 to 8 days— usually 3 to 5 days 10 days When desquamation and sore throat and albuminuria disappear, but never in less than 6 weeks. *Small Pox 12 to 14 days 16 days When every scab has disappeared. *Typhoid Fever 7 to 21 days— usually to 14 23 day8 •Typhus 5 to 14—very variable 14 days After 4 weeks. Whooping Cough 7 to 14 days 21 days In 5 weeks from the commencement, provided all characteristic spasmodic cough and whooping have ceased for at least 2 weeks. Measles 10 to 14 days 16 days In not less than 2 weeks from appearance of rash. * Notifiable Diseases. The period of infectiousness usually extends beyond the minimum given, and in all cases should be decided by the medical attendant. The period of incubation means the interval between the time of exposure to infection and the development of symptoms in the person infected. The period of quarantine is the time after the last exposure to infection during which contacts of the patient who have not previously suffered from the disease, usually other children in the family, should refrain from mixing with other susceptible persons. During this time they should attend neither day nor Sunday schools. Medical Officer of Health. Willesden Urban district Council. DIRECTIONS for PREVENTING THE SPREAD of MEASLES. WILLIAM BUTLER, M.B., D.P.H., Medical Officer of Health. Printed at the Brondesbury Tress. Kilburn, N.W. 2123/l2/03. 2 MEASLES. Measles is not the slight ailment it is usually supposed to be. It kills every year three or four times as many persons as does Scarlet Fever. From 10,000 to 17,000 persons are killed by this disease in England and Wales every year, and it is quite safe to say that by far the majority of these deaths are due to the manner in which people look at this disease. Were they to look at it as the serious disease which it is, there would be a saving every year of many thousands of lives. It is very frequently the case that when a child dies from Measles, it does so because its parents have said when it was attacked, " Oh, it is only Measles," and neglected the simple precautions which would have saved the child's life. Of course, there are cases so severe tha.t in spite of all precautions there is little hope of recovery, but these are few. It is most dangerous in the case of very young children. There is no greater or more pernicious superstition than that which is so widely held, namely, that a child must have Measles. Rather the contrary view should be held, that it is a disgrace to the community that a child should suffer from thi 3 disease. No condemnation can be too strong for the practice of wilfully exposing other members of a family to this infection, which it is to be feared is too frequently done. PRECAUTIONS. As Measles is highly infectious the first thing to do when a child is attacked is to isolate it. It should be placed in a room by itself and kept in bed. The room should be kept warm but well ventilated. Except in the hottest weather a fire should be kept burning in an open grate. On no account should the room be kept warm by burning oil lamps or stoves. Bedroom windows should be kept open and the bed so placed that the child is not exposed to draught. Catching cold is most fatal to patients suffering from Measles. Unless the mother or other attendant can be constantly with the child, its clothing should be sufficiently 3 warm to protect it from cold should it throw the bed-clothes off. The patient is infectious for at least three weeks, and during this time no other child should be permitted to enter the bedroom in which the patient is isolated. Isolation should continue beyond the three weeks if there be any cough, or discharge from the nose, ears or eyes. These discharges are most infectious. They should be received on bits of old linen or cotton wool and burnt. A sheet wetted with disinfectant should be hung outside the door of the sick room. Other children in the house should not attend school or Sunday school unless they are certified by a Medical man as free to do so, for at least 17 days after the last occasion on which they came in contact with the patient, and in no case during the period of isolation. At the end of the illness all clothing and bed linen should be boiled or otherwise disinfected. The walls should he cleansed and the floors scrubbed. The windows and door should then be left wide open for several hours. It is important to remember that the first symptoms of Measles are those of a common cold, and that the rash does not usually appear until the fourth day after the onset of these symptoms. The disease is highly infectious during these three days before the rash appears. Should these symptoms appear among children in a household where anyone is suffering from Measles, the children so affected should be kept away from the others until the nature of the cold has been made clear. WILLIAM BUTLER, Medical Officer of Health. Willesden Urban District Council. PUBLIC HEALTH DEPARTMENT. SCHOLARS ATTENDING PUBLIC ELEMENTARY SCHOOLS. NOTICE of DEFECTIVE EYESIGHT. Martin & Son, Brondesbury Press, Kilburn, N.W. Willesden District Council. PUBLIC HEALTH DEPARTMENT. NOTICE TO PARENTS. Dear Sir or Madam, It is reported to me that upon examination your child has been found to be suffering from defective vision. It is of the greatest importance, therefore, that with a view to prevent the eyesight from becoming worse, an oculist be consulted without delay. Should glasses be prescribed by the oculist, they should be procured at once. Do not let the most precious sense your child possesses be injured either by prejudice or by negligence. Yours faithfully, Medical Officer of Health. It is more important that your child should see well than look well if the choice lies between the two. The most harmful superstitions are prevalent with regard to wearing glasses. Children with defective vision require glasses to correct their errors of sight, that is to make their eyes normal. Glasses so worn do not weaken but strengthen the eyes. Neglect to wear the proper glasses where they are required often leads to complete loss of sight in one or both eyes. The great majority of headaches and so-called bilious attacks arise from defective eyes, and would be entirely prevented by wearing proper glasses. Many dull and stupid children would be found to be intelligent, if their eyes were attended to, and their eye strain relieved by the use of proper glasses. Most squints would be prevented and are often cured without operation by wearing spectacles. But glasses are worse than useless if not of the proper strength. Therefore only a Surgeon trained in ophthalmic work should be consulted, and you are cautioned against the dangers of wearing glasses prescribed by the various sight-testing establishments. Opticians, watchmakers, chemists, and others are not qualified to interfere with so delicate an organ as the eye. The optician's work is to supply the glasses to the surgeon's prescription. Ophthalmic Surgeons can be consulted at the following Hospitals :— Name and Address of Hospital. Attendance of Ophthalmic Surgeons. Mon. Tues. Wed. Thurs. Fri. Sat. St Bartholomew's Hospital, West Smithfield a.m. 9—10 a.m. 9—10 a.m. 9—10 a m. 9—10 a.m. 9—10 a.m. 9—10 King's College Hospital. Portugal Street, Lincoln's Inn, W.C. 2p.m. - - 2 p.m. - - St.Thomas's Hospital, Albert Embankment, Westminster Bridge 1pm. 1p.m. 1 p.m 1p.m. 1p.m. - University College Hospital, Gower Street, W.C - - p.m. 1.30 p.m. 1.30 - p.m. 1.30 Central London Ophthalmic Hospital, Gray's Inn Road, W.C. p.m. 1—3 p.m. 1—3 p.m 1—3 p m 1—3 p.m. 1—3 p.m 1-3 Royal London Ophthalmic Hospital, Moorfield's Eye Hospital, CityRoad, E.C. a.m. 8-10 a.m. 8—10 a.m. 8—10 a.m. 8-10 a.m. 8-10 a.m 8—10 Royal Westminster Ophthalmic Hospital, King William Street, Strand 12 — 1.30 12— 1.30 12 — 1.30 12 1.30 12 1.30 12 - 1.30 Western Ophthalmic Hospital, 153 and 155 Marylebone Road p.m. 1.30-3 p.m. 1.30-3 p.m. 1.30-3 p.m. 1.30-3 p.m 1.30-3 6-8 p.m 1.30-3 Middlesex Hospital, Berners Street, W. - 9 a m. - - 9 a.m. - St. Mary's Hospital, Cambridge Place, Paddington - 9a.m - - 9 a.m. - Westminster Hospital, opposite Westminster Abbev - 9 a.m. - - 9 a.m. - New Hospital for Women, 144 Euston Road - - a.m 9.30-10 - - am. 3.30-10 St. George's Hospital, Hyde Park Corner, S.W. — — p.m. 1.30 - - p.m. 1.30 To the Parents of