WIL 9 Willesden Urban District Council. THE 31st ANNUAL REPORT ON THE Vital Statistics and Sanitary Condition OF THE URBAN DISTRICT OF WILLESDEN, FOR THE YEAR 1906, BY WILLIAM BUTLER, M.B., C.M., D.P.H., Medical Officer of Health for Willesden. Lonbon: Chas. Strakeh & Sons, Ltd., Bishopsgate Avenue, London, E C. 1907. INDEX. Page. Birth# and Birth Rates 11-12 ,, Illegitimate 13 Breast Feeding 37-39 Birth Enquiries 41-44 Bakehouses 90 Cancer Mortality, 1875-1906 24 „ Deaths, Age and Sex Table 25 26 Chart (Infant Investigation) 32-35 Class Vital Statistics 50-54 Chart (Distribution of Diphtheria in given areas) 56 Customs and Inland Revenue Act 83-84 Common Lodging House 91 Death Rate Tables, 1875-1906 15 ,, Causes of, Table IV. Local Government Board 16-17 ,, ,, Long Table 18-20 ,, at Age Periods 21 „ Diarrhoea, 1875-1906 29 ,, Uncertified 46 ,, Illegitimate 46 ,, Distribution in Wards 46 Diphtheria Chart 56 „ under 15 years, Table 63 „ 64-65 ,, Fatality Rates. 1888-1906 66 ,, Ward Incidence . 67 ,, Death Rates, 1875-1906 69 Erysipelas Ward Incidence 67 Eyesight of School Children 77 House Refuse, Collection of 79-81 Infantile Mortality 29-41 „ ,, Table V. of Local Government Board 27-28 ,, „ Rates, 1875-1906 29 Infants, Rearing of 30-31 ,, ,, Charts 32-35 Inquests 44-45 Infectious Disease Notification, Table III. of Local Government Board 57 3 Index—continued. Page. Infectious Disease Notification, 1892-1906 58 Inspection of Manholes 65 Isolation Hospital *>8 Illegitimate Births 13 ,, Deaths 46 Infectious Diseases in Schools 70-77 Table 72 Local Government Board, Table I. 14 „ „ „ „ ii .47-48 „ „ „ „ III. 57 „ „ „ „ IV. 16-17 „ „ „ „ V. 27-28 „ „ „ „Factory and Workshops Act 86-87 Laundries 89 Members of Public Health Committee 5 Meteorological Table 8 Marriages 1' Measles, Death Rates 1875-1906 69 „ in Schools 73-75 Milkshops, Inspection of ., 82-83 Notification of Infectious Disease. 57-60 „ ,, Table III. of Local Government Board 57 Notifications, 1892-1906 58 ,, Analysis of 59 ,, of Ptomaine Poisoning 60 Nuisances 92 Outworkers 89 Population Estimated in Drainage Areas 10 ,, ,, in Wards 9 Phthisis, Mortality, 1875-1906 24 ,, 26 Ptomaine Poisoning 60 Ringworm in Schools 76-77 Staff of Public Health Department 5 Statistical Summary 6 Small Pox 60 4 Index—continued. Page. Scarlet Fever 62 „ „ under 15 years 63 ,, ,, Fatality Rates, 1888-1906 66 „ ,, Ward Incidence 67 „ Death Rates 1875-1906 69 Scholars, Health of in Public Elementary Schools 70-78 Scabies in Schools 76 Sanitation of Schools 77 Slaughterhouses 83 Smoke Nuisances 92 Typhoid Fever Fatality Rates, 1888-1906 66 68 Death Rates, 1875-1906 69 Table 1, of Local Government Board 14 Table 37, Factory and Workshops Act 86-87 Uncertified Deaths 46 Vital Statistics 47 „ ,, Separate Localities 56 Class 50-51 ,, ,, Areas 52-56 Vaccination, Return of 61 Ward Vital Statistics 47-48 ,, Mortality Rates ,. 49 ,, Incidence, Scarlet Fever, Diphtheria and Erysipelas 57 Whooping Cough, Death Rates, 1875-1906 69 ,, ,, in Schools 75 Workshops, Sanitary condition of 88 Work, Summary of 93-94 Zymotic Mortality 22 „ „ Table 23 STAFF OF PUBLIC HEALTH DEPARTMENT. WILLIAM BUTLER, M.B., D.P.H., Medical Officer of Health. H. de Lima Woods, Chief Sanitary Inspector, Cert, of Royal Sanit. Inst. J. H. Smith, „ „ „ ,, A. W. Loughlin, „ ,, „ ,, G. W. Wilson, „ „ „ „ F. Sheriff, „ „ „ „ T. L. Morley, „ „ „ ,, Miss K. Gaul, Lady Health Visitor, Cert. Savit. lnxp. Exam. Board. ,, Cook, Assistant, ,, ,, „ ,, Stokes ,, ,, ,, ,, A. A. Gibb, Senior Clerk. J. Barker, Clerk. L. Louth, ,, 5 MEMBERS OF THE PUBLIC HEALTH COMMITTEE. Councillor EVERSHED (Chairman). * ,, COOMBES (Chairman), † ADAMS. BIDDISCOMBE. ,, GALE, Chairman of Council (er-officio). JOHNSON. KIDGELL. „ PINKHAM. „ RILEY. EDWARDS,† * Resigned July, 1906. †Elected July, 1906. 6 STATISTICAL SUMMARY FOR 1906. Population estimated to middle of year 141,714 Area 4,383 acres Population per acre 32 ,, Metropolitan District 1,081 „ „ „ 72 „ Brent District 3,302 „ ,, ,, 20 Soil—The London Clay. Altitude varies from 78 ft. to 242 ft. above Ordnance Datum. Rateable Value, £811,861 s. d. Metropolitan District 3 1 General District Rate (Brent District 3 11 Poor Rate (Including Education Rate) 4 0 Rate per 1,000 Population. Marriage Rate . 13.1 Birth Rate . . 30 1 Crude Death Rate 10.7 Recorded Death Rate 11.8 Corrected Death Rate 12.7 Infantile Mortality 115 0 Zymotic Mortality 1.7 PUBLIC HEALTH REPORT For 1906. To the Chairman and Members of the Willesden Urban District Council. Gentlemen, I have the honour to present to you the 31st Annual Report on the Health and Sanitary Conditions of Willesden. I wish again first to acknowledge the help and support which have been accorded me by the Chairman and Members of the Public Health Committee, and I wish also to tender my thanks to the members of my Staff for their assistance and support during the year. Whatever of value there is to record is due to the thoroughness and efficiency with which their duties have been discharged, and to the zeal with which they have aided every effort to improve the health conditions of the district. 8 Table No. 1. METEOROLOGICAL TABLE. 1906. Month. 1906. Highest by Day. Lowest by Night. Range in Month. Mean of all Highest. Mean of all Lowest. 4ft. Earth Thermometer. Mean Degree of Humidity. Rainfall in Inches. No. of Days on which Rainfall was Measured. Total No. of Hours of Bright Sunshine. Hours of Bright Sunshine recorded at Gr'nwich. Maximum. Minimum. January 80.50 14.00 46.50 48.21 27.14 45.00 43.50 87° 3.56 17 54.9 February 51.00 1200 39 00 46.75 24.47 43.50 42 .00 88° 1.75 .17 63.2 March 63.75 14.50 49.25 48.79 25.79 43.50 42. 00 80° 1 36 15 101.4 April 70 00 15.00 55.00 54.78 24.69 45.50 43.00 75° 0.45 4 218.5 May 67.75 17.00 50.75 58.77 35 70 49 00 45.50 77° 1.39 13 1530 June 78 00 24 00 54.00 69.72 39.35 53.50 49.25 71° 2.86 8 230.75 229.6 July 79.50 43 00 36.50 76.68 51.00 57 00 54.00 70° 0.50 5 249.75 262.6 August 85.75 40.50 45.25 74.41 53.28 58.25 57.00 64° 1.00 8 244.75 248.6 September 92.00 33.50 58.50 71.94 48.21 58.75 57.50 72° 1 97 7 164.50 185.7 October 69 00 20.00 49 00 60.23 4547 57.50 55.00 85° 3.45 16 86.13 141.6 November 60.50 2750 33 00 51.65 40.74 55.00 51.50 90° 4.24 15 43.25 45.1 December 54.50 17.00 37.50 44.02 32.90 50.75 48 00 86° 1.42 11 50.50 32.6 Means 69.35 2317 4619 58.83 37.39 51.44 4902 79° Total Total Total Total 23.95 136 10696 for 7 months. 1736.8 1905 65050 23.27 42.23 5«.09 34.57 50.96 48.10 76° 20.59 139 9 Table No. 2. ESTIMATED POPULATION—MIDSUMMER, 1906. name OP ward. Population esti mated to Midsummer,.06, on the number of houses in occupation in each Ward as ascertained by special enumeration ACouncil.s Census. Houses in Occupation. Total Number of Empty Tenements No. of Houses recently erected but unoccupied. No. of Houses in course of erection. Per centage of empties exclusive of houses recently erected. Percentage of empties .Xmas Quarter 1905. Percentage of empties inclusive of houses recently erected. Per. centage of Houses empty at Census. No. of Houses iu Ward. No. of Empty Houses. 1 Room. 2 Rooms. 3 Rooms. Over 3 Rooms. Church End 23,846 3,590 161 6 2 219 20 10 12 4.5 4.4 4.8 5.96 Harlesden 21,755 3,592 244 1 3 95 48 49 20 6.8 6.8 80 3.88 Kensal Green 28,473 4,126 195 2 22 166 20 9 7 4.7 4.1 49 2.92 South Kilburn 14,969 1,316 20 — 63 23 2 — — 1.5 2.1 - 1.26 Mid Kilburn 12,305 1,598 90 3 25 31 5 — — 5.6 5.9 — 4.16 North Kilburn 10,165 1,681 65 — 1 20 15 1 2 3.9 4.3 3.9 2.62 Willesden Green .. 29,366 5,125 299 3 6 91 64 163 93 5.8 4.7 8.7 7.37 Willesden U.D. aggregate of the Wards ) 140,879 21,028 1,074 15 122 555 174 232 134 5.1 4.8 6.1 4.02 Population as estimated to Midsummer, 1906, by the Registrar.General, 143,622. Population estimated on the assumption that the average number of persons per house at census has remained constant for the whole of Willesden, 142,871. Population estimated on the assumption that the average number of persons per occupied house at the last census (1901), remains constant for the houses existing at the census, the number of persons occupying houses built since 1901, being ascertained by Council.s census=141,714. 10 POPULATION IN THE BRENT AND METROPOLITAN DRAINAGE AREAS. Estimated to Midsummer, 1906. Table No. 3. Brent Area — Houses. Population. Church End 3,650 23,509 Harlesden 2,331 13,961 Kensal Green 5 37 Willesden Green 4,799 27,248 •• 10,785 64,755 Metropolitan Area— Harlesden 1,293 7,744 Kensal Green 4,127 29,805 South Kilburn 1,315 14,992 Mid Kilburn 1,620 12,672 North Kilburn 1,722 10,548 Willesden Green 403 2,286 Total 10,480 78,047 Willesden Urban District 21,265 142,802 11 Table No. 4.—MARRIAGES. 1906. First Quarter. Second Quarter. Third Quarter. Fourth Quarter. Total. Church of England 82 175 196 166 619 Nonconformist Churches — — — — 88 Registrar.s Office — — — — 219 Totals 8.2 175 196 166 926 The total of 926 marriages for the year gives a mairiage rate of 13.1 per 1,000 persons living. Since 1900 the marriage rates per 1,000 have been as follows:— Marriage Rate per 1,000 persons 1900 1901 1902 1903 1904 1905 1906 10.8 11.2 12.4 129 12.4 12.7 13.1 Percentage performed otherwise than in Church of England 26.8 28.4 26.1 25.1 29.1 32.9 33.1 Ditto, England and Wales — — — 34.9 35.8 34.6 — Table No. 5. BIRTHS. 1906. Boys. Girls. Totals. First Quarter 577 544 1,121 Second ,, 535 510 1,045 Third ,, 500 556 1,056 Fourth ,, 468 502 970 In Queen Charlotte.s Hospital 42 38 80 Totals 2,122 2,150 4,272 12 Table No. 6. BIRTHS DISTRIBUTED INTO WARDS. WARDS. First Quarter. Second Quarter. Third Quarter. Fourth Quarter. Total. Rate per 1,000 of Population. Church End 236 201 219 197 853 35.8 Harlesden 188 180 175 168 711 32.7 Kensal Green 215 227 209 192 843 296 South Kilburn 139 108 129 113 489 32.7 Mid Kilburn 107 105 94 84 390 31.7 North Kilburn 57 55 45 48 205 20.2 Willesden Green 199 187 207 188 781 266 Totals 1,141 1,063 1,078 990 4,272 30.1 Table No. 7. Birth.Kate. 1876 1876 1877 1878 1879 1880 1881 1882 1883 1884 1886 1886 1887 1888 1889 1890 Willesden .. 447 434 411 40.2 376 38.3 34.4 33.3 33.3 34.1 35.6 35.7 33.8 321 33.7 29.4 England and Wales 35.4 36.3 360 35.6 34.7 34.2 33.9 33.8 33.5 33.6 32.9 32.8 31.9 31.2 31.1 30.2 Birth.Kate. 1891 1892 1893 1894 1895 1896 1897 1898 1899 1900 1901 1902 1903 1904 1905 1906 Willesden .. 33.1 31.7 32.5 30.7 31.2 32.2 31.0 316 31.5 31.2 331 31.3 31.9 32.9 29.8 30.1 England and Wales 314 30.4 30.7 29.6 30.3 29.6 29.6 29.3 291 28.7 28.5 28.5 28.4 27.9 27.2 27.0 13 The birth.rate for the year is slightly increased on that of 1905, viz.: 30' 1 per 1,000 as compared with 29.8 of last year, but it represents a considerable reduction on the rates of previous years. The birth.rate of Willesden is in excess of that of England and Wales, but this is due less to an actual increased fertility of women of child bearing age, than to an accumulation of women of the procreative age period in Willesden, in excess of the proportion found in the country generally. ILLEGITIMATE BIRTHS. There were 111 illegitimate births in Willesden, as compared with 107 last year, but in addition to the 111, there were 14 illegitimate births in Queen Charlotte's Hospital of Children whose mothers were removed there from Willesden, so that the total number of illegitimate births is 125 and the rate per 1,000 births, 29. For when the birth.rate is calculated, not upon the total population, but upon the number of women between 15 and 45 years of age, in Willesden it is found that the birth.rate is now really lower than that for England and Wales. Birth.rate on Total population, All ages. Rate per 1,000. Birth.rate on Female population, 15.45 years. Rate per 1,000 Willesden, 1904 32.9 + 17 % 116 5 + 4 1 England and Wales, 1904 27.9 111.8 Willesden, 1905 29.8 + 7.3 % 107.4 . 1*3 1 England and Wales, 1905 27.2 108.9 Willesden, 1906 301 107.6 14 Table No. 8. Year. Population estimated to Middle of each Year. Births. Total Deaths Registered in the District. Deaths in Pl.blic 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. Rate per 1,000 Births registered. Number. Rate.. Number. Rate.. 1895 79,260 2,469 31.2 373 150.0 1,084 13.6 — — — — — 1896 85,421 2,749 32.2 460 167.3 1,210 14.2 . 9 in 1,312 15.3 1897 92,605 2,887 311 444 150.4 1,173 12.5 — 12 182 1,343 14.4 1898 99,180 3,142 31.7 427 130.6 1,197 12.1 — 9 200 1,388 13.9 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 1301 1,359 11.8 — 7 225 1,577 13.7 1901 116,089 3,670 31.7 456 124.2 1,325 11.4 51 9 213 1,529 13.2 1902 122,211 3,835 31.4 498 129.8 1,447 11.8 55 6 268 1,715 13.9 1903 129,315 4,132 32.0 483 116.8 1,507 11.5 168 11 159 1,655 12.8 1904 134,539 4,421 329 487 110.1 1,479 11.0 193 14 180 1,645 12.2 1905 140,758 4,201 29.8 463 110.2 1,572 11.2 223 10 _ 182 1,744 12.4 Averages for 1895.05. 111,030 3,495 31.5 463 133.7 1,346 12 2 138 9 192 1,555 13.7 1906 141,714 4,272 301 477 111.7 1,518 10.7 219 17 171 1,672 11.8 . Kates calculated per 1,000 of estimated population. 15 Table No. 9. DEATH RATES. 1875 TO 1906. Year. Number of Deaths. Rate per 1.000. Year. Number of Deaths. Rate per 1,000. 1875 385 21.4 1891 860 13.8 1876 401 21.7 1892 945 14.4 1877 346 17.7 1893 1,070 15.5 1878 441 21.4 1894 917 13.2 1879 376 16.8 1895 1,143 14.5 1880 471 18.7 .1896 1,210+102 14.1 1881 490 17.6 1897 1,173+170 14.4 1882 587 181 1898 1,197 + 191 13.9 1883 538 15.4 1899 1,448 + 195 15.2 1884 530 14.7 1900 1,359+218 136 1885 632 16.2 1901 1,325 + 204 13.2 1886 685 15.5 1902 1,447+262 139 1887 701 14.3 1903 1,507 + 148 12.8 1888 835 15.8 1904 1,479+180 12.2 1889 686 12.0 1905 1,562+182 12.4 1890 882 14.4 1906 1,501 + 171 11. 8 *Deaths outside District included for first time. 16 Table No. 10. CAUSES OF, AND AGES AT, DEATH DURING YEAH 1906. CAUSES OF DEATH. Deaths in whole District at subjoined Ages. Deaths in Localities (at all Ages). Deaths in Public Institutions. (Wabd l \known) Deaths in Public Institutions in the District. All ages. Under 1. | 1 and under 5. 5 and under 16. 15 and under 25. 25 and under 65. 65 and upwards. Church End. Harlesden. Kensal Green. South Kilburn. Mid Kilbuin. North Kilburn. i Willesden Green. Small pox .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Measles 25 6 18 1 .. .. .. .. 10 4 4 6 l .. .. .. Scarlet fever 11 .. 6 4 .. l .. 4 l 1 1 1 l 2 .. .. Whooping-cough 25 11 13 1 .. .. .. 7 4 5 5 4 .. .. .. .. Diphtheria and membranous croup 16 1 7 7 .. 1 .. 5 2 4 1 1 2 1 .. .. Croup 2 .. 2 .. .. .. .. .. 1 .. .. .. 1 .. .. .. Fever Typhus .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Enteric 7 .. .. 3 1 3 .. 3 2 .. 1 .. .. 1 .. .. Other continued .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Epidemic influenza 24 .. 3 .. .. 15 6 3 4 4 2 3 1 .. .. Cholera .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Plague .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Diarrhoea 157 133 19 .. 1 .. 4 46 36 19 19 12 21 .. .. Enteritis 10 .. 6 .. .. 3 1 3 .. 1 3 1 .. 2 .. .. Puerperal fever 5 .. .. .. 1 4 .. 1 1 .. .. .. .. 3 .. .. Erysipolas 2 .. .. .. .. .. 2 .. .. .. .. .. 1 1 .. Other septic diseases .. 18 4 2 .. 3 5 4 .. 4 2 4 2 .. 5 1 .. Phthisis 139 1 4 5 32 95 2 24 22 27 22 9 7 25 3 .. 17 Table No. 10—continued. CAUSES OF, AND AGES AT, DEATH DURING YEAR 1906. CAUSES OF DEATH. Deaths in whole District at Subjoined Ages. ; Deaths in Localities (at all Ages). Deaths in Public Institutions. (Ward Unknown). Deaths in Public Insti tutions in the District All ages. | _ Under 1. 1 and under 5. 5 and | under 15. 1") and 1 under 25. 25 and under 65. 65 and upward 9. Church | End. Harlesden Kensal Green. 1 South Kilburn. Mid Kilburn. North Kilburn. Willesden Green. Other tubercular diseases 49 21 15 8 3 2 9 10 6 7 2 4 10 1 .. Cancer,malignant disease 111 .. .. 1 1 73 36 17 15 13 15 15 18 18 .. .. Bronchitis 79 22 9 1 .. 12 35 18 14 10 12 8 3 12 2 .. Pneumonia 130 38 38 3 33 12 27 21 23 20 10 2 27 , . .. Pleurisy 9 .. 2 .. .. 4 3 1 4 1 1 . . .. 2 .. Other diseasesofrespiratory organs 17 2 3 .. .. 7 5 1 3 3 3 1 3 3 .. .. Alcoholism and cirrhosis of liver 30 .. .. .. 28 2 9 4 3 3 4 3 3 1 .. Venereal diseases 6 3 .. 1 1 3 2 1 .. • . .. .. Premature birth 87 87 .. .. .. .. 10 16 19 11 12 5 14 .. Diseases and accidents of parturition 6 .. 2 4 1 2 1 2 .. Heart diseases 132 9 2 8 3 61 49 20 28 26 17 12 6 21 2 .. Accidents 43 10 9 5 2 14 3 12 8 6 8 3 2 3 1 .. Suicides 14 .. .. 1 13 .. 3 .. 1 3 2 .. 5 a . .. Diseases of nervous system 134 31 20 1 47 35 20 20 22 13 17 9 32 1 .. Diseases of urinary system 70 2 2 1 2 34 29 7 8 18 14 6 8 9 .. Murder 3 1 .. 2 , . 1 . , , . .. 2 .. .. All other causes 311 111 9 7 8 58 118 65 45 55 36 40 26 42 2 .. All causes 1,672 493 189 59 67 518 346 319 288 274 225 171 114 267 14 219 B 18 Table No. 11.—Long Table. CAUSES OF DEATH. DISEASES. Year 1906. 1st Quarter. 2nd Quarter. 3rd Quarter. 4th Quarter. Measles 25 12 9 2 2 Scarlet Fever 11 4 2 4 1 Whooping Cough 25 6 3 6 10 Diph. Membranous Croup 16 6 2 5 3 Croup 2 .. .. .. 2 Enteric Fever 7 1 .. 2 4 Epidemic Influenza 24 2 6 .. 16 Diarrhoea and Dysentery 157 2 5 134 16 Zymotic or Epidemic Enteritis Enteritis (Enteritis and Gastro Enteritis) 10 1 3 5 1 Syphilis 6 3 .. 3 Erysipelas 2 1 .. 1 Pyaemia 1 .. 1 .. .. Puerperal Fever 5 2 .. 1 2 Infective Endocarditis 3 2 .. 1 .. Other Septic Diseases 10 2 1 2 5 Rheumatic Fever 11 8 2 1 .. Tuberculosis— (a) Tubercular Disease of Brain, or Meninges Acute Hydrocephalus 22 5 5 8 4 (b) LaryngealandPulmonaryPhthisis 139 41 30 33 25 (c) Tabes Mesenterica Tubercular Disease of Intestine 11 1 2 5 3 (d) General Tuberculosis, Tubercular Disease of undefined portion 16 3 8 4 1 Atrophy, Marasmus Starvation, Want of Breast Milk 51 16 13 7 15 Rickets 3 2 .. .. 1 Chronic Alcoholism (Cirrhosis of Liver) 28 8 12 4 4 Acute Alcoholism D.T. 2 .. .. 1 1 Chronic Industrial Poisoning 1 .. .. .. 1 OsteoArthritis Rheumatoid Arthritis (Chronic Rheumatis) 5 .. 1 2 2 Gout 2 .. .. 2 .. Cancer (Malignant Growth) 111 34 20 28 29 Diabetes Meflitus 14 .. 3 4 3 Anaemia Leucocythaemia 3 .. .. 3 .. Lymphadenoma 1 1 .. .. .. Premature Birth 87 20 24 15 28 Debility at Birth 23 6 4 3 10 Injury at Birth 6 1 3 2 Atelectasis 4 1 1 2 19 Table No. 11—continued. CAUSES OF DEATH. diseases. Year 1906. 1st Quarter. 2nd Quarter. 3rd Quarter. 4th Quarter. Malformation of Heart 8 5 2 .. 1 Spina Bifida, Hydrocephalus 6 2 1 2 1 Imperforate Anus, and other congenital rectal malformations 1 .. 1 .. .. Cleft Palate—Hare Lip 1 1 .. .. .. Icterus Neonatorum and other congenital defects 8 2 .. 2 4 Old Age, Senile Decay 94 26 18 16 34 Inflammation of Brain or Membranes Convulsions 24 27 5 11 6 6 8 4 5 6 Apoplexy (Cerebral Hemorrhage) 48 8 13 8 19 Softening of Brain 1 1 .. .. .. Hemiplegia (Brain Paralysis) 8 4 2 1 1 Insanity (General Paralysis of Insane).. 11 1 1 .. 5 Epilepsy 6 1 .. .. 3 Laryngismus Stridulus 2 1 .. .. 1 Locomotor Ataxy Paraphlegia (Diseases of Spinal Cord) 5 3 .. .. 2 Other and Undefined Diseases of Brain or Nervous System 3 .. 1 .. 2 Otitis, Otorrhoea 5 4 .. .. 1 Endocarditis Valvular Diseases of Heart (Morbus Cordis : fatty heart) 113 33 28 28 24 Pericarditis 4 .. .. 1 3 Hypertrophy of Heart 4 .. 3 .. 1 Angina Pectoris 4 .. 2 .. 2 Aneurism 6 1 1 1 3 Senile Gangrene 1 .. .. .. 1 Embolism (Thrombosis) 5 2 2 1 .. Other and Undefined Diseases of Heart and Circulatory System 1 1 .. .. .. Laryngitis 3 .. 2 .. 1 Other Diseases of Larynx and Trathoea 1 .. 1 .. .. Bronchitis 79 32 15 .. 27 Lobar, Croupous Pneumonia 8 1 2 .. 4 Lobular, Broncho-Pneumonia 62 24 8 12 18 Pneumonia (form not stated) 60 21 13 9 17 Emphysema (Asthma) 10 7 .. .. 3 Pleurisy 10 3 2 2 3 Other and Undefined Diseases of Respiratory System 2 .. 2 .. .. Dentition 4 .. 1 .. 1 B2 20 Table No. 11—continued. CAUSES OF DEATH. diseases. Year 1906. 1st Quarter. 2nd Quarter. 3rd Quarter. 4th Quarter. Ulcer of Stomach 7 4 1 1 l Other Diseases of Stomach 4 .. 4 .. .. Obstruction of Bowels (Strangulated Hernia) 11 2 2 I 6 Peritonitis and Appendicitis 13 3 4 2 4 Other Diseases of Digestive System 8 2 3 1 2 Diseases of Lymphatic System—Spleen, Thryroid, and Supra Renal Capules 3 1 2 .. .. Acute Nephritis 8 2 1 4 1 Bright's Disease (Albuminuria Urasmia. Pyo-Nephrosis) 54 17 17 12 8 Calculus 1 .. .. 1 .. Diseases of Bladder and of Prostate .. 6 3 .. 2 1 Other and Undefined Diseases of Urinary System .. .. .. .. .. Female :— (a) Diseases of Ovaries .. .. .. .. .. (b) Diseases of Uterus and Appendages 4 1 . . .. 3 (c) Abortion, Miscarriage 1 .. .. .. 1 Puerperal Convulsions 2 1 1 .. Placenta Prsevia, Flooding 1 .. .. 1 .. Other & Undefined Accidentsof Child Birth 2 .. .. .. 2 Arthritis, Ostitis, Periostitis, Osteo Myelitis 2 1 .. .. 1 Pemphigus 3 1 1 1 .. Deaths from Accident or Negligence :— (a) By Vehicles and Horses 7 3 1 2 1 (b) On Eailways 3 .. .. .. 3 (c) Burns and Scalds 7 1 2 1 3 (d) Poisons, Poisonous Vapours 4 1 2 1 . . (e) Drowning .. .. .. . . . . (f) Suffocation, overlaid in bed 9 2 3 1 3 (g) Suffocation, otherwise 3 2 .. .. 1 (h) Falls and falling bodies .. 4 .. 1 2 1 (i) Weather Agencies . . 3 1 .. 2 .. (j) Otherwise not stated 1 .. 1 .. (k) At Birth 1 .. 1 .. .. Surgical Operation 1 .. .. 1 Homicide 3 1 .. .. 2 Suicide 14 1 5 4 4 Other ill-defined and not specified causes 3 1 .. .. 2 Totals 1,672 446 341 436 449 21 Table No. 12. 1906. 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 Agas. 1st Quarter 111 58 7 6 13 11 24 31 31 42 56 46 10 446 2nd „ 85 39 9 4 10 9 22 33 28 38 35 22 7 341 3rd „ 179 51 9 4 6 5 14 32 32 41 31 28 4 436 4 th „ 118 41 8 12 5 8 26 36 39 49 52 45 10 449 Males 271 97 17 15 21 17 35 74 68 86 82 50 15 848 Females 222 92 16 11 13 16 51 58 62 84 92 91 16 824 1906 493 189 33 26 34 33 86 132 130 170 174 141 31 1,672 DEATHS. The deaths registered in the District were 1,518 : males, 752 ; females, 766. Those registered outside the District of persons belonging to it were 171, giving a total of 1,689. There were 17 deaths registered in the District of persons not belonging to it, making 1,672 deaths properly accredited to the district. The crude death.rate for the year is 10.7 per 1,000. Corrected for deaths of residents dying outside the District and of non.residents dying within, it is 11.8 per 1,000. Corrected for the age and sex distribution of Willesden's population it is 12.7. 22 The last four years have seen the lowest death-rates hitherto recorded. Corrected for residents dying outside the district, and for non-residents dying within, they have been respectively for:— 1903 1904 1905 1906 12.8 12.2 12.4 11.8 The death-rate for 1906 is therefore the lowest on record for Willesden. CAUSES OF DEATH. Table shewing Deaths in 1903, 1904, 1905 and 1906 from certain Specified Diseases. 1903. 1904. 1905. 1906. Measles 84 44 51 25 Whooping cough 67 10 67 25 Pulmonary affections 291 261 268 235 Disease of nervous system 160 126 147 134 Measles, Whooping Cough, Pulmonary affections and diseases of the Nervous System, each yield considerably lower contributions to the death-rate than was the case last year, and it is chiefly to the reduction in the number of deaths from these causes that the low death-rate for the year is to be ascribed. Deaths from Zymotic Diarrhoea have considerably increased as was to be expected from a hot dry summer, such as was experienced last year. ZYMOTIC MORTALITY. The death-rate from the seven principal Zymotic diseases on the other hand is among the lowest recorded. The death-rates from Scarlet Fever and from Diphtheria have each slightly increased on the rates of 1905, while the rate from Enteric Fever is the lowest hitherto experienced. 23 Table No. 13. ZYMOTIC MORTALITY DURING THE LAST 13 YEARS. RATE PER 1,000. 1894. 1895. 1896. 1897. 1898. 1899. 1900 1901. 1902. 1903. 1904. 1905. 1906. 1906. Kate for 76 Great Towns. Rate for the Country generally. Scarlet fever 0.09 0.21 0.19 0.11 009 0.14 0.10 0.10 0.08 0.08 0.01 0.03 0.07 0 .12 0.10 Enteric fever 0.15 015 0.11 0.11 0.08 0.08 0.12 0.08 0.07 0.06 0.05 0.08 0.04 0.09 0.09 Diarrhoea 0.42 0.07 0.83 1 03 0.99 1.58 119 1.05 0.81 0.62 1.08 0.71 1 17 1.16 0.87 Diphtheria 0.21 0.42 0.32 0.68 0.65 0.42 0.21 0.45 0.40 0.07 0.14 009 0 11 0.19 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 1.76 1.70 2.24 1.73 Rate from all causes 13.25 13.67 15.40 14.44 12.06 13.05 13.72 13.17 13.9 12.8 12.2 12.4 11 8 15.9 15.4 24 Table No. 14. PHTHISIS AND CANCER MORTALITY. 1875 TO 1906. Year. Number of Deaths from Phthisis. Rate per 1,000 of Population. Number of Deaths from Cancer. Rate per 1,000 of Population. 1875 37 203 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 73 118 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 96 108 44 .555 1896 80 + 8 1.02 51 .594 1897 74+12 0.92 30 .322 1898 78 + 22 100 46 .462 1899 121 + 14 1.25 55 .511 1900 103 089 73 .634 1901 96 081 85 .746 1902 111 0 909 97 .794 1903 113 0.873 107 .827 1904 141 1 04 111 .825 1905 146 1.037 115 .817 1906 139 .981 111 .783 25 Table No. 15. CANCER DEATHS, 1906 (Distributed According to Age and Sex.) Wards. 10 to 15. 15 to 20. 25 to 35. 35 to 45. 45 to 55. 55 to 65. 65 to 75. 75 to 85. 85 up. total. m. F. M. f. m. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. Churoh End .. .. 1 .. .. 1 .. 2 1 3 3 1 2 2 .. 1 .. .. 7 10 17 Harlesden .. .. .. .. .. .. 1 1 .. 2 3 3 2 1 1 1 .. .. 7 8 15 Kensal Green .. .. .. .. .. .. .. 1 .. 4 2 .. 1 3 .. 2 .. .. 3 10 13 South Kilburn .. .. .. .. .. 1 i .. 1 1 6 1 .. .. 1 1 .. 9 6 15 Mid Kilburn 1 .. .. .. .. .. .. .. .. 2 1 3 2 3 .. 1 .. .. 6 9 15 North Kilburn .. .. .. .. .. .. 3 1 3 5 2 1 2 .. 1 .. .. 7 11 18 WillesdenGreen .. .. .. .. .. 1 1 2 .. 1 3 4 2 1 1 2 .. .. 7 11 18 Infirmary .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Willesden U. D 1 .. 1 .. .. 3 3 9 5 16 23 14 10 14 2 9 1 .. 46 65 111 26 PHTHISIS. The deaths from Phthisis number 139, and give a phthisical death-rate equal to 0.98 per 1,000. Both the number of deaths and the rate are slightly lower than in the previous two years, but the rate, although a low one, shows little tendency to diminution during recent years. For the most part phthisical deaths are deaths of persons in middle life. They have a pre-eminent claim to public concern, if for no other reason than because a large number of those who die from this disease, in its later stages become a public charge and not infrequently leave young families, who necessarily also must be assisted out of the public purse. The general raising of the hygienic standard of life, better food, better housing, better air and light, and more of these in the homes, are the most hopeful means of further reducing the incidence of this disease. CANCER. There were 111 deaths from Cancer during the year, giving a Cancer death-rate of .783 per 1,000 for the year. There has been a rapid increase in the number of deaths from Cancer during the last 12 years, but the increase has ceased to be progressive during more recent years. Females die of this disease to a much greater extent than males, but male deaths have increased from 41 last year to 46, while female deaths have been reduced from 74 to 65. 27 Table No. 16. INFANTILE MORTALITY DURING THE YEAR 1906. Deaths from stated Causes in Weeks and Months under One Year of Age. cause of death. Under 1 Week. 1-2 Weeks. 2-3 Weeks. 3-4 Weeks. Total under 1 Month. 1-2 Months. 2-3 Months. 3-4 Months. 4-5 Months. 5-6 Months. 6-7 Months. 7-8 Month*. 8-9 Months. 9-10 Months. 10-11 Months. 11-12 Months. Total Deaths under One Year. All Causes. Certified 95 23 21 19 158 64 38 44 31 25 31 23 21 18 18 14 485 Uncertified 5 •• •• .. 5 •• 2 .. .. .. .. .. 1 .. .. 8 Common Infectious Diseases. Small-pox .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Chicken-pox .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. • • Measles .. .. .. .. .. 1 .. .. .. .. .. 3 .. 1 .. 1 6 Scarlet Fever .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. • • Diphtheria: Croup .. .. .. .. .. .. .. .. .. .. 1 .. .. .. .. .. 1 Whooping Cough.. .. .. .. .. .. .. .. 5 .. 1 2 1 .. .. 2 .. 11 Diarrhœal Diseases. Diarrhoea (Total) .. 7 .. 3 4 15 13 17 18 13 15 10 10 7 b 6 133 Zymotic Enteritis (not Tubtreulous) .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. •• Gastritis, Castrointestinal Catarrh .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. •• Wasting Diseases. Premature Birth 60 7 5 2 74 10 3 .. .. .. .. .. .. .. .. .. 87 Congenital Defects 6 4 3 2 15 3 .. 4 .. 1 .. .. .. .. 1 .. 24 Injury at Birth 4 .. .. .. 4 .. .. .. 1 .. .. .. .. .. .. .. 5 Want of Breast-milk Atrophy, Debility, Marasmus 2 2 6 5 15 15 5 5 2 3 1 2 .. .. 2 •• 50 28 Table No. 16.—continued. INFANTILE MORTALITY DURING THE YEAR 1906. Deaths from stated Causes in Weeks and Months under One Year of Age. cause of death. Under 1 Week. 1-2 Weeks. 2-3 Weeks. 3-4 Weeks. Total under 1 Month. 1-2 Months. 2-3 Months. 3-4 Months. 4-5 Months. 5-6 Months. 6-7 Months. 7-8 Months. 8-9 Months. 9-10 Months. 10-11 Months. 11-12 Months. Total Deaths under One Year. Tuberculous Diseases. Tuberculous Meningitis .. .. .. .. .. .. .. 3 1 .. 1 .. .. 1 1 .. 7 Tuberculous Peritonitis: Tabes Mesenterica .. 1 •• .. 1 1 1 1 1 2 .. .. .. 1 •• .. 8 Other Tuberculous Diseases .. .. .. .. .. .. .. .. 1 1 1 1 1 1 1 •• 7 Erysipelas .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Syphilis .. 1 .. .. 1 .. 2 .. .. .. .. .. .. .. .. .. 3 Rickets .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Meningitis (not Tuberculous) .. .. .. .. .. .. 1 .. 1 .. .. 1 1 .. 1 2 7 Convulsions 5 3 1 2 11 4 1 3 .. 1 2 • • 1 .. • • •• 23 Bronchitis 1 • • 1 .. 2 3 4 2 2 .. 3 2 .. 1 2 1 22 Laryngitis .. .. .. .. .. .. .. .. .. 1 .. .. .. .. .. .. 1 Pneumonia .. .. 2 .. 2 5 4 4 2 1 2 2 6 5 3 2 38 Suffocation, overlaying 2 .. 1 1 4 3 1 .. .. .. .. .. .. .. .. .. 8 Other Causes 20 4 2 4 30 4 3 2 2 1 3 1 2 2 •• 2 52 Totals 100 23 21 19 163 64 38 46 31 25 31 23 21 19 18 14 493 Percentage of total deaths 20.3 4.7 4.3 3.9 33.1 13.0 7.7 9.3 6.3 5.1 6.3 4.7 4.3 3.9 3.7 2.8 •• Births in the year legitimate, 4147 4272. Deaths in the year legitimate, 471 493. illegitimate, 125 illegitimate, 22 Deaths from all Causes at all Ages 1672. Population. Estimated to middle of 1906 141,714. 29 Table No. 17. INFANTILE MORTALITY AND DIARRHŒA DEATHS. 1875 TO 1906. Year. Infantile Deaths. Infantile Mortality Rate per 1,000 Births. Deaths from Diarrhœa. Rate per 1,000 of Populaton. 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 1905 463+27 117 100 0.71 1906 477 + 16 115 157 1.17 INFANTILE MORTALITY. The last three years have witnessed the lowest rates of infantile mortality recorded in Willesden. The rates for 1904, 1905, and 1906 are respectively 115, 117 and 115 per 1,000 births. Fuller particulars bearing on this question will be found under the heading "Infantile Mortality and Birth Inquiries." 30 Table No. 18. SHOWING THE NUMBER OF CASES AND THE PROPORTION OF CASES IN EACH CLASS IN RELATION TO THE FACTS OBSERVED WITH REGARD TO THE REARING OF THE INFANTS. Breast Fed. Breast & Hand Fed. Hand Fed. Improper Food. Improper Bottles. Fed Regularly. Slept with Mother. Slept in Kitchen Taken out Regularly Properly Clothed. Premises Clean. Mother Employed. Baby Insured. Mother attended by Doctor. Midwife. Promises to Improve. Age of Mother. Mean Age at Death. Totals in each Class. Infants Dead within Year— All Diseases No. 84 52 195 110 58 160 184 165 139 222 210 85 118 211 109 .. .. 4.3 331 Per cent. 25 15 60 33 17 48 55 50 42 67 63 25 35 63 33 .. .. .. .. Diarrhœa No. 4 8 90 46 26 53 41 51 55 65 54 33 36 68 32 .. .. 5.0 102 Per cent. 4 8 88 45 25 52 40 50 54 64 53 32 35 67 31 .. .. .. .. Tuberculosis No. 3 1 14 4 2 10 9 8 7 10 12 7 8 9 8 .. .. 5.2 18 Per cent. 17 6 78 22 11 55 50 44 38 55 66 38 44 50 44 .. .. .. .. Enteritis No. 3 5 14 8 5 16 8 13 14 17 15 4 8 16 5 .. .. 5.2 22 Per cent. 14 23 63 36 23 73 36 59 63 77 67 18 36 73 23 .. .. .. .. Marasmus No 8 9 32 16 6 22 26 20 12 35 34 8 9 31 15 .. .. 2.3 49 Per cent. 16 18 66 33 12 45 53 41 25 73 70 16 18 65 31 .. .. .. .. Pneumonia No. 14 11 11 18 4 15 26 23 16 20 22 7 16 25 11 .. .. 6.0 36 Per cent. 39 30 30 50 11 42 72 64 44 55 61 21 44 70 30 .. .. .. .. Measles & Whooping Cough .. No. 8 6 6 6 4 8 15 7 10 13 14 3 8 12 7 . . .. 6.0 20 Per cent. 40 30 30 30 20 40 75 35 50 65 70 15 40 60 35 .. .. .. .. Bronchitis No. 13 2 8 4 3 10 15 12 6 18 18 5 11 12 9 .. .. 4.4 23 Per cent. 56 8 34 17 13 43 65 52 26 78 78 21 47 52 39 .. .. .. .. All children in family surviving— First. Child No. 206 37 58 42 35 182 177 203 227 239 267 52 130 235 60 143 24.4 .. 301 Per cent. 68 12 19 14 12 60 59 67 75 80 89 17 43 78 20 47 .. .. .. Second Child No. 206 29 29 30 19 162 188 178 175 193 216 31 138 183 78 134 26.6 .. 264 Per cent. 78 11 11 11 7 61 71 67 66 73 82 11 52 69 29 50 .. .. .. 31 Table No. 18—continued. SHOWING THE NUMBER OF CASES AND THE PROPORTION OF CASES IN EACH CLASS IN RELATION TO THE FACTS OBSERVED WITH REGARD TO THE REARING OF THE INFANTS. Breast Fed. Breast & Hand Fed. Hand Fed. Improper Food. Improper Bottles. Fed Regularly. Slept with Mother. Slept in Kitchen Taken out Regularly. Properly Clothed. Premises Clean Mother Employed. Baby Insured. Mother attended by Doctor. Midwife. Promises to Improve. Age of Mother. Mean Age at Death. Totals in each Class. All children in family surviving—eontd. Third Child No. 157 30 19 21 15 112 134 127 124 155 172 22 94 135 70 98 28.7 .. 206 Per cent. 76 14 9 10 7 54 65 61 60 75 83 11 45 65 34 47 .. . . .. Nth Child No. 229 47 25 37 22 145 225 172 156 193 221 47 117 162 134 161 33.2 .. 301 Per cent. 76 15 8 12 7 48 74 57 51 64 73 15 39 54 44 53 .. .. .. Other children in family dead— One dead No. 186 42 29 37 16 132 188 163 144 157 199 44 132 155 101 143 32 .. 257 Per cent. 72 16 11 14 6 51 73 63 56 61 77 17 51 60 39 56 .. .. .. Two dead No. 85 20 10 18 10 54 77 70 66 76 79 24 58 65 48 65 33 .. 115 Per cent. 74 17 9 16 9 47 67 60 57 66 68 21 50 56 41 56 .. .. .. Three or more dead No. 57 12 9 15 7 37 56 45 40 51 47 15 47 38 39 53 35 .. 78 Per cent. 73 15 12 19 9 47 72 57 51 65 60 19 60 48 50 68 .. .. .. Total surviving at end of Year No. 1126 217 179 200 124 824 1045 958 932 1064 1201 235 716 973 530 797 29.4 .. 1522 Per cent. 74 14 12 13 8 54 69 63 61 70 79 15 47 63 35 52 .. .. .. Total dead within Year No 84 52 195 110 58 161 184 165 139 222 210 85 118 211 109 .. .. 4.3 331 Per cent. 25 15 60 33 17 48 55 50 42 67 63 25 35 63 32 .. .. .. .. Grand Total all cases 1210 269 374 310 182 984 1229 1123 1071 1286 1411 320 834 1184 639 797 .. .. 1853 Per cent. 65 14 20 16 10 53 66 60 57 69 76 17 45 63 34 .. .. .. .. 32 INFANTS SURVIVING and INFANTS DEAD WITHIN THE YEAR. 33 IN FAINTS DEAD WITHIN THE YEAR. 34 INFANTS DEAD WITHIN THE YEAR. 35 INFANTS ALIVE AT END OF YEAR. 37 INFANT MORTALITY AND BIRTH ENQUIRIES. During the year the Lady Health Visitors have enquired into the conditions of upbringing of infants in nearly 2,000 cases, or into about half of the children born during the year. At the registration of the births the mothers are supplied with handbills setting forth the rudimentary conditions for the healthy rearing of children. The enquiry of the Health Visitors is directed to ascertain how far these conditions are observed, and, at the same time, they advise in what directions the methods should be modified where they are faulty. From the returns made to me I have abstracted some 30,000 facts ascertained in the course of these enquiries and classified them as shown in the preceding Tables. They throw an interesting light on the conditions affecting infantile mortality, and a study of the results convinces that the chief factor in the excessive mortality of infants is what may be described as defective mothering. Whether this results from ignorance or indifference, from physical, economic or imbecile inability to mother their offspring, the facts show conclusively that the infants who die are the children of mothers who, for the most part, have failed to afford their young the mere animal opportunities of survival. BREAST FEEDING. Unquestionably the most important fact bearing upon the prospects of survival of the infant is the manner of feeding. Out of 331 infants investigated dying within the year, no fewer than 60 per cent. were solely hand fed, while of 1,522 surviving to the end of the year under 12 per cent. were so fed. The lowest percentage of exclusively hand-fed infants occurs in those families where of four or more other children all have survived. Among this class only 8 per cent. are hand-fed. In the same group of cases, that is, in families where none of the children have died, it c 38 is found that where there are three surviving only 9 per cent. of the last born are exclusively hand-fed; where there are two surviving only 11 per cent., and where the infant is the first baby just over 19 per cent. are exclusively fed by artificial means. In the group where other children in the family have died, exclusive breast-feeding occurs in a smaller percentage of the infants investigated than is the case where all the children in the family have survived. Among the infants dying within the year in which they were born, no matter from what disease they die, breast-feeding occurs in a considerably lower percentage of cases than among survivors. This is extremely significant, for it shows that, quite apart from the direct injury to the baby resulting from the deprivation of its natural food, these babies succumb in greater degree to all diseases by which they are attacked. In other words, artificially fed infants have a lowered vitality even when they survive, as is shown by their greater mortality from such diseases as bronchitis, pneumonia, measles and whooping cough—diseases which apparently bear no direct relation to the method of feeding. But when we consider that 88 per cent. of the children dying from zymotic diarrhcea are exclusively hand-fed, and that only 4 per cent. were alleged to be solely breast-fed, that 78 per cent. of those dying from tuberculosis, 66 per cent. of those dying from marasmus, and 63 per cent. of those dying from enteritis were exclusively hand-fed, it is impossible to avoid the conclusion that in this fact alone we have the chief factor in the production of these diseases. It is impossible to insist too strongly on the importance of breast-feeding infants. It is certainly important that a pure supply of cows' milk should be available, but first and last it must 39 be insisted that the natural food of the human infant is its mother's milk, and that to deprive it of this is to court disease, physical decay and death. I am convinced that the most important step in checking the disgraceful waste of infant life is to insist on mothers mothering their young, and that before all other measures it should be imperative that all mothers, physically capable, should, if need be under penalty, suckle their own. OTHER CONDITIONS AFFECTING THE HEALTH OF THE INFANT. Many other facts of considerable interest come out as a result of the enquiry, and these are all exhibited in the diagrams, which represent graphically the proportion of cases in each class in respect of the particular conditions enquired into. In respect of improper food, improper feeding bottles and irregularity of feeding, infants dying within the year are much worse than those surviving. Among those surviving, that class is best in which all the others of the family of four or more survive, while the worst occur in the group in which three or more of the family have died. First-born infants are taken out of doors more than second, second more than third, and third more than nth in the group where all survive; while the greater the number of children a mother has lost the less frequently is the last child taken out. The more children a mother has the less likelihood there appears of the later children being properly clothed, or of living in clean premises, or sleeping separate from their mothers. The mothers of infants who die within the year are employed in earning a living in much greater proportion than the mothers whose babies survive. C 2 40 The class where mothers are least employed is that where all the children survive, and the family consists of two or three children. Where two or more children in a family have died, there a greater proportion of mothers are employed. The mothers of first-born children are employed to a greater extent than any of the mothers the whole of whose family are living. I have pointed out in a previous report that insured babies die in lesser proportion than those uninsured, and this holds good of the cases investigated during the year. But it will now be observed that the greatest proportion of insured babies occurs in that class where three or more children in a family have died, while it is least in families of four or more children all of whom survive. Whether the mother is attended by a doctor or a midwife at her confinement appears to have no influence upon the prospects of the infant's surviving, but it is interesting to note that the proportion of mothers attended by midwives increases with the number of children they have previously born. It is also interesting to note that the more children a mother has lost the more ready is she to promise to improve her methods in the care of the infant, and that the mothers of first born children are the least disposed to amend their ways or, at any rate, to admit that they will. The mothers of first born infants in fact show up considerably worse than those who having had two or three children had succeeded in keeping them alive. This is partly to be accounted for by the fact that the class of mothers of first children is composed partly of those the whole of whose children survive and partly of those who subsequently lose their children. The mothers, moreover, are the youngest of all the mothers in the different groups. On the whole the facts approximate to what one familiar with the conditions of the working and lower middle classes would expect. 41 Amendment of their vital conditions, especially as regards infant mortality, is very much a question of improving the mothers. This is the greatest and most pressing sanitary problem of the day. The further improvement, not of drainage, nor housing, nor water supply, nor even of all that is comprehended under sanitary engineering is of first importance in a modern town. A proper perspective of the factors which chiefly under modern conditions determine disease and mortality cannot fail to give prominence, nay pre-eminence, to the influence of ignorance and inaptitude the more fatal where domestic and so rudimentary and primordially cogent. Even more important than the elementary education of girls is the secondary training of young women in the first principles and practice of domestic hygiene and in the management of the home and of the young family. BIRTH ENQUIRIES, 1906. Report by Miss Gaul, Lady Health Visitor. Enquiries into the care and feeding of infants have been continued during the year 1906. This perhaps is the most disheartening portion of the Health Visitor's work. There is so very much which needs doing, and so little improvement to be noticed for the energy expended. It must, however, be remembered that the class of mother most in need of advice, and who should benefit to the greatest extent by the instruction given, is also the mother who has least encouragement to make the effort necessary for any appreciable alteration in her present regime. It can hardly be surprising that women whose husbands are so irregularly employed, that oftimes it is a matter of 42 bility to provide sufficient food for their children and themselves, should be lacking in those qualities of energy and thrift so essential to the comfort of the home and the welfare of the children. The most pressing need in connection with the question of Infant rearing is that of insuring a sufficient supply of good nourishing food for the mothers during pregnancy, and the six, or if possible nine months immediately following child-birth. The lack of good food for the mother is one of the principle causes of the ever increasing prevalence of artificial feeding of infants, which is perhaps the most important factor in the very heavy death-rate from Infantile Diarrhcea and Enteritis during the summer months. Occupation of Mothers.—It is very noticeable that families living to all intents and purposes under exactly similar conditions with regard to housing and income, differ very widely as to the comfort and cleanliness of their homes and the success with which they rear their children. Although one would expect that the cleanest homes and best cared for babies would be found amongst that class where the mother is wholly occupied by her household duties, and not as a wage earner, this is by no means always the case. There is a certain class of mother who fails from sheer inability to make "both ends meet" on a very limited income. Each day brings its same monotonous round of duties never done, there seems to be no brightness, no hope, she sits down to her fate and lets everything go. Here again probably the lack of proper nourishment has much to do with the failure. This particular class of mother seems to be 43 less capable of making an effort than the woman who goes out to work, and probably by so doing broadens her view of life if only to a small extent. Where the mother is a wage earner, the most satisfactory conditions prevail amongst the "Homeworkers." In this district the general condition of the homes in which the mothers take in work is good. The infants are as a rule well cared for. The homeworker has a tendency to bring up her children and look after her home in a more methodical and regular manner than many unoccupied women. The mothers who go out to work daily have inevitably unsatisfactory homes. The babies are as a rule left to the care of incompetent people, and the homes are usually neglected. It is not possible for any woman to work twelve hours a day at laundry work, and still keep her home clean. Instead a woman returning after a hard day's work to a dirty house loses all heart, and spends the short remaining time between work and sleep anywhere rather than at home. The extra amount gained by the mother going to work is squandered in other ways, and indeed when the expense of bottle feeding and the cost of having baby "minded" is deducted, the remainder is very little. Where the mother goes out to work, charing, &c., during a portion of the week the general conditions are usually better. The better food which the woman gets on the days she goes out is a distinct advantage. In many cases the child is still entirely breast fed, the mother often being allowed by her employer to take the child with her to work. Previous Life of the Mother.—The life of the girl after leaving school and before marriage, appears to be of great importance in 44 determining what kind of housewife and mother she will be. The domestic servant does not always make the most satisfactory mother, although, undoubtedly some of the best mothers are to be found amongst this class. I should again like to point out the great necessity for better training for the girls during the last year of, or subsequent to their school lives. The ignorance of the young girls and mothers of the most elementary principles of domestic hygiene is appalling. There is also a great need for the girls to be taught how to utilise the means and materials at their command for the preparing of good plain food. Many of the girls who are taught cooking at school, are quite unable to use the knowledge thus gained for the benefit of the home, as they have not the proper utensils in their homes, while those they have are not of a type provided at the schools, and the ability to improvise seems to be utterly lacking. Where girls, immediately upon leaving school, begin work in a Laundry or Workroom, they have little or no time to gain knowledge of domestic duties. And unless they are blessed with a taste for such things their leisure time will certainly be spent in some other way. INQUESTS. Total number of Inquests held in Willesden on residents during 1906—82. On non-residents—6. The following is an abstract of the verdicts. Residents:— Suicides 9, Accidents or Negligence 26, Murder 3, Other causes 44—Total 82. Non-residents:-Suicides 1, Accidents 4, other causes 1. Total 88. 45 RETURN OF INQUESTS, &c., HELD DURING THE YEAR ENDED 31ST DECEMBER, 1906. Mortuary. Inquests. Infectious Cases. Removed for Accommodation. Total. No. of Post Mortems. Male. Female. Church End 27 16 Nil l 44 28 Kilburn 20 25 Nil 33 78 30 I have to report that in October of this year the Council decided to discontinue the use of the post mortem chamber at Church End, acting upon my advice that the premises were totally unsuitable for post mortem examinations. So long ago as December, 1904, the Council applied to the Local Government Board for a loan of £385, estimated by the Engineer as necessary to provide a proper post mortem chamber at Church End. The Board, however, were of opinion that one post mortem chamber should prove sufficient for the needs of the district, and in this view I concur. The mortuary, post mortem chamber and Coroner's Court situated at Salusbury Road, are really most suitable buildings for their purpose, and although there may be some slight inconvenience to those living at a distance from the mortuary, the occasions in one's life when attendance at an inquest is necessary are so rare that the provision of a duplicate court, mortuary and post mortem chamber in the same district seems unnecessary. 46 UNCERTIFIED DEATHS—20. Causes ascribed—Premature Birth 4, Heart Failure and Heart Disease 5, Bronchitis 3, Asthma 1, Nephritis 1, Deficient Vitality at Birth 1, Renal Disease 1, Castro Enteritis 3, Surgical Operation 1. ILLEGITIMATE DEATHS, 1906. Illegitimate deaths in Willesden, excluding one belonging to another district, 29. Causes—Convulsions 2, Premature 2, Diarrhcea, Epidemic and Zymotic Enteritis 16, Pneumonia 1, Tuberculosis 1, Marasmus 3, Bronchitis 1, Broncho Pneumonia 1, other causes 2—29. DISTRIBUTION OF DEATHS IN WARDS. The ward distribution of deaths is set out in the tables as hitherto. They differ but little from the general features exhibited by the wards in previous years. 47 Table No. 19. Names or 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 l 4,157 538 205 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 1902 20,927 801 339 114 19,145 672 256 73 27,208 893 264 85 14,923 454 256 77 1904 21,728 871 273 117 20,098 735 267 80 28,540 931 287 91 14,934 473 239 64 1905 23,077 860 346 123 20,696 697 256 82 29,611 856 299 81 14,991 455 228 55 Averages for 1895 to 1905 16,585 650 245 94 16,943 520 206 64 20,760 721 245 89 14,157 455 258 82 1906 23,846 853 319 124 21,755 711 288 103 28,473 843 274 78 14,969 489 225 59 * Including Children born in Queen Charlotte's Hospital, and Willesden Workhouse. 48 Table No. 19—continued. Names of Localities. mid kilburn. north kilburn. willesden green. infirmary. Ward Unknown. Year. Population estimated to middle of each Year. Births Registered. Deaths at all Ages. Deaths under 1 year. Population estimated to middle of each Tear. 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. Deaths Registered. 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 12,662 208 138 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 12,477 344 203 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 1904 12,558 373 213 55 10,416 230 96 21 26,265 808 270 81 1905 12,264 345 196 47 10,070 218 109 23 28,112 770 297 75 13 4 Averages for 1895 to 1905 12.114 367 185 57 10,818 210 109 24 19,428 568 203 63 1906 .. 12,305 390 171 44 10,165 205 114 16 29,366 781 267 68 14 1 * Including Children born in Queen Charlotte's Hospital, and Willesden Workhouse. 49 WARD MORTALITY RATES. Table No. 20. WARDS. 1906. Corrected. Death Kates 1906. Per 1,000. 1902-1906. Rate of Infantile Mortality. 1906. Rate of infantile Mortality. Per 1,000. Zymotic rate. Per 1,000. Diarrhoea. Per 1,000. Phthisis. Per 1,000. Church End 14.0 13.4 137 145 2.7 1.9 1.0 Harlesden 14.3 13.2 126 145 2.5 1.7 1.0 Kensal Green 10.5 9.6 99 93 1.2 0.7 0.9 South Kilburn 15.6 15.0 156 121 2.1 1.3 1.5 Mid Kilburn 14.4 13.9 148 113 2.0 1.0 0.7 North Kilburn 12.4 11.2 102 78 0.8 0.4 0.7 Willesden Green 10.3 91 101 87 0.9 0.7 0.9 Willesden 12.7 11.8 120 115 1.7 1.1 0.98 50 CLASS VITAL STATISTICS. The table given in last year's report showing the effect of social status upon vital statistics is repeated again for the year 1906. The figures compare very closely with those of last year, thus confirming the results arrived at in the previous report. The basis of classification was the same, viz.:— Class I.—Streets in which the houses generally were occupied separately by one family, and where the rental exceeded £50 a year. Broadly it may be described as the better residential class. Class II.—Streets in which the houses generally were of the better tenement class, consisting of houses occupied mostly by not more than two families, and where the rentals paid were between £30 and £50 a year. Class III.—Streets in which the prevailing type of house consisted of one, two, three or four roomed tenements, and where the rental was less than £30 a year. Of course there has been an overflow in each class from the others, for though streets are generally uniform as regards any one of these classes of houses there are necessarily occasional exceptions. Nevertheless, each class is representative of its kind, and I am of opinion that the statistical results shown in Table No. 21 may be taken as typical of their class. Class I., which constitutes about 11 per cent, of the population of Willesden, in round figures averages about 5 persons per house. Class II., constituting about 43 per cent., averages about 6 persons per house, while Class III., constituting about 45 per cent., averages about 8 persons per house. Table No. 21. TOTALS—CLASS STATISTICS SUMMARY. Notifications of Infectious Diseases. Births. Deaths. Houses. Scarlet Fever. Diphtheria or Croup. Erysipelas. Enteric Fever. Puerperal Fever. Population. Male. Female. At all Ages. Infant Deaths. Whooping cough. Measles. Diarrhoea. Scarlet Fever. Diphtheria or Croup. All other Fevers. Cancer. Phthisis. Marasmus. 2,940 31 21 7 1 — 14,819 96 105 113 7 — — — — — — 13 10 — Class I. 1.96 1.33 044 0.06 — — 201 = 12.71 7.14 34 — — — — — — 0 822 0 632 — 10.363 272 114 43 15 3 60,611 882 843 617 174 2 5 45 2 9 1 42 55 22 Class II. 4.48 1.88 .71 .24 0.4 — 1,725 = 28.46 10.50 100 .03 .08 .74 .03 .14 .016 .693 .907 36 7,725 334 145 53 31 6 64,449 1,144 1,202 909 312 23 20 112 9 7 6 56 74 29 Class III. 5i8 2.25 .82 .48 0.9 — 2,346 = 36 40 13.1 133 .35 .31 1.73 .13 .10 .09 .869 1.147 .44 21,028 637 280 103 47 9 140,879 2,122 2,150 1,659 14* 493 25 25 157 11 16 7 1ll 139 51 Totals. 4.5 2.0 .73 .32 .06 — 4,272= 30.1 1,673 115 0.17 0.17 1.11 .07 .11 .04 .783 .981 .36 118 * Persons dying in Infirmary, address unknown. 51 52 VITAL STATISTICS OF GIVEN AREAS ARRANGED ACCORDING TO DENSITY OF POPULATION. In Table No. 22 are given the Vital Statistics of certain areas in the district, each of which while fairly homogeneous in class and density of population upon area, is different in these respects from those with which it is compared. In the table these areas are arranged in order of increase in density of population. Although, as will be seen, birth.rates, infectious disease rates, death.rates and infantile mortality rates tend to increase with increased density of population, this is by no means uniformly so. The areas are too small to base reliable inferences upon on the returns of one year, but it may be said that generally where there is any breach in the regularity of increase in the rates concurrently with increasing density of population, there is a more rapid decrease in the social level of the population. This will be obvious by a glance at the skeleton reference map accompanying the table. Table No. 22. NOTIFICATIONS OK INKEOTIOU8 DISEASES. POP'N,&C, 1906. BIRTHS. DEATHS. Scarlet Fever theria or 1 Croup. las. Enteric fever Purrperal fever. Popula- tion. No. of House Male. Female. At all Age. Infant deaths. Whooping Measles. Diarrhœa Scarlet Fever. Diphtheria or Croup. All other Fevers. Cancer. Phthisis Marasmus. Area No. 1 5 5 1 .. .. 2,897 396 13 14 21 .. .. .. .. .. .. .. 5 .. .. Rate per 1,000 2.1 2.1 .4 .. .. .. .. 27=11.26 8.76 .. .. .. .. .. .. .. 2.086 .. .. Area No. 2 M 6 6 3 1 10,585 2,046 125 112 76 14 .. .. 3 .. .. .. 5 6 1 Rato per 1,000 32 .6 6 3 1 .. .. 237=22-39 7.17 59 .. .. .28 .. .. .. 472 .567 .09 Area No. 3 32 19 4 2 8,736 1,398 113 106 67 19 .. .. 3 .. 1 .. 2 5 .. ltate per 1,000 3 7 22 .4 2 •• 219=2507 7.67 87 .. .. .34 .. .11 .. .229 572 .. Area No. 4 17 5 7 5,599 1,057 70 54 42 11 .. .. 2 .. .. .. 3 2 1 Kate per 1,000 3.0 .9 1.2 •• • • .. • • 124=2214 7.50 89 .. .. 35 .. .. .. .536 .357 .17 Area No. 5 24 2o 4 6 1 11,318 2,049 138 136 132 37 .. 2 10 1 1 2 8 9 3 Rate per 1,000 2.1 1.8 .3 .5 .1 .. .. 274=2421 11.66 135 .. .17 .88 .08 .08 .17 .707 .795 .26 Area No. 6 14 2 1 1 .. 2,874 476 57 53 22 3 .. 1 2 .. .. .. 2 2 .. Rate per 1,000 4.9 .7 .3 .3 • • .. •• 110=3827 7.65 27 .. .34 .69 .. .. •• .696 .696 •• Area No. 7 46 28 9 1 1 14,972 2,418 166 183 175 35 2 3 11 .. 3 22 11 3 Rate per 1,000 3.1 1.9 .6 .1 .1 .. .. 349=2331 11.68 100 .13 .20 .73 .. .20 •• 1.469 .734 .20 Area No. 8 32 16 10 13 .. 10,011 1,430 187 192 139 56 6 2 6 .. 2 2 5 5 3 Rate per 1,000 3.2 1.6 1.0 1.3 •• .. .. 379=37.85 13.83 148 .6 2.59 .. .20 .20 .499 .499 .29 Area No. 9 68 27 5 3 .. 11,054 1,556 137 146 110 33 1 1 5 1 2 .. 5 14 2 Rate per 1,000 6.1 2.4 .4 .3 .. .. .. 283=25.60 9.95 117 .09 .09 .45 .09 .18 .. .452 1.267 .18 Area No. 10 73 27 7 3 2 11,244 1,611 201 185 134 42 .. .. 16 3 .. 1 5 16 4 Rate per 1,000 6.5 2.4 .6 .3 .2 .. .. 386=34.32 11.91 109 .. .. 1.42 .26 .. .08 445 1.423 .35 Area No. 11 105 66 17 11 1 17,336 2,554 833 326 238 99 5 35 2 3 1 13 15 18 Rate per 1,000 60 3 8 1. 6 05 •• .. 659=3801 13.72 150 29 2 02 .11 .16 .05 .750 .865 1.03 Area No. 12 4 .. 3 .. .. 1,126 154 28 34 30 10 .. 6 2 .. .. .. .. 3 1 Rate per 1,000 3.5 .. 2.7 .. .. .. .. 62=55.06 26.6 161 .. 5.32 1.77 .. .. .. .. 2.664 .88 Area No. 13 50 18 7 1 1 6,184 787 105 128 7o 20 3 2 6 1 .. .. 2 7 1 Rate per 1,000 8.1 2.9 1.1 .2 .2 .. .. 233=37.67 11.31 86 .48 .32 .97 .16 .. .. .323 1.132 .16 Area No. 14 102 27 18 8 2 20,870 1,867 343 365 306 82 9 9 26 2 2 1 21 27 2 Rate per 1,000 4.9 1.3 .9 .1 .1 .. .. 708=33.92 14.66 116 .43 .43 1.24 .09 .09 .04 1.006 1.294 .09 Total 606 266 99 47 9 134305 19,829 2016 2034 1,562 461 26 24 147 10 14 7 98 122 39 Rate per 1,000 4.51 1.98 .74 .35 .07 4050= 30.16 11.63 114 .19 .18 1.09 .07 .10 .05 730 .908 .29 REFERENCE. No of Area on Map. Area In Acres. No of Houses in Area. Population in Area. No of Houses per Acre. Population per Acre. No of Area on Map. Area In Acres. No of Houses in Area. Population in Area. No of Houses per Acre. Population per Acre. No. 1 114.2 351 2111 3.1 18.5 8 111.8 1413 9232 12.6 82.6 2 272.4 1841 8935 6.7 32.7 9 108.5 1628 11772 15.0 108.5 3 130 .3 1386 8693 10.6 66.7 10 102.0 1592 11224 15.6 110.0 4 79.0 1049 5558 13.3 70.3 11 153.2 2516 17132 16.4 111.8 5 156.7 2054 11301 13.1 72.1 12 9.4 154 1127 16.4 119.9 6 37.6 473 2905 12.6 773 13 35.6 787 6264 22.1 175.9 7 181.4 2412 14547 13.3 80.2 14 107.2 1855 20658 17.3 192.9 1599.3 19511 131459 Mean 13.4 Mean 94.2 Map showing distribution of Diphtheria in Willesden during the five years 1901-5, and Areas of varying densities of Population per Acre. See reference. 57 TABLE NO. 23. CASES OF INFECTIOUS DISEASE NOTIFIED DURING THE YEAR 1906. 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 aud 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. Nirth Kilburn. Willesden Green. Small Pox .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Cholera .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Diphtheria 280 2 71 152 22 33 .. 81 39 62 20 15 20 43 74 31 49 19 10 12 27 Membranous Croup 6 1 4 1 .. .. .. 2 1 .. 1 1 .. 1 .. .. .. .. .. .. .. Erysipelas 103 5 2 7 8 67 14 19 20 16 12 13 5 18 1 1 .. .. .. .. .. Scarlet Fever 637 2 146 416 47 26 134 67 158 75 44 33 126 109 54 139 71 43 19 108 Typhus Fever .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Enteric Fever 46 .. 5 14 9 18 .. 16 13 8 2 1 .. 6 16 7 7 1 1 .. 1 Relapsing Fever .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Continued Fever . 1 .. .. .. .. 1 .. .. .. .. .. 1 .. .. .. .. .. .. .. .. .. Puerperal Fever 9 .. .. .. 2 7 .. 2 1 1 1 .. 1 3 .. .. .. 1 .. .. 1 Plague .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Totals 1082 10 228 590 88 152 14 254 141 245 111 75 59 197 200 93 195 92 54 31 137 58 Table No. 24. NOTIFICATIONS. 1892. 1893. 1894. 1895. 18%. 1897. 1898. 1899. 1900. 1901. 1902. 1903. 1904. 1905. 1906. Small pox 5 23 21 5 2 — 1 — — 10 88 7 12 — — Scarlet fever 366 589 268 392 475 510 361 414 335 553 466 502 326 397 637 Diphtheria 141 221 125 179 171 270 333 317 225 399 433 217 351 273 280 Croup (Memb.) 4 8 4 7 2 5 2 2 1 5 7 4 2 2 6 Typhus fever — 1 — — — — — — — — — — — — Typhoid fever 28 47 70 69 52 52 66 79 77 57 73 45 38 41 46 Continued fever. — — 2 — 1 1 — — — — — — — — 1 Puerperal fever 4 6 4 8 10 9 2 6 8 2 8 11 5 13 9 Cholera nostras 1 1 1 — 1 2 — 1 — — — — — — Erysipelas 85 139 63 81 101 107 70 82 89 79 104 76 73 86 103 Plague (Pestis minor) — — — — — — — — — — — — — — — Totals 634 1,035 558 741 815 956 835 901 735 1,106 1,179 862 807 812 1,082 Bate 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 5.8 7.6 59 Table No. 25. ANALYSIS OF NOTIFICATIONS. Wards. Totat 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 1904 1905 1906 1903 1904 1905 1906 1903 1904 1905 1906 1903 1904 1905 1906 Church End 84 55 29 3.7 4.7 3.8 4.6 2.5 3.0 2.5 3.0 68.9 65.0 63.9 65.4 9.1 11.7 8.8 10.7 Harlesden 73 39 34 3.1 4.1 3.1 3.6 2.3 2.2 1.7 1.9 74.6 53.5 54.2 53.4 7.6 7.8 5.8 6.5 Kensal Green 72 48 24 4.1 3.5 3.8 5.1 2.4 1.9 2.1 3.4 60.0 54.2 54.9 66.6 5.9 4.7 5.1 8.6 South Kilburn 39 24 15 3.5 2.3 3.4 4.6 2.2 1.1 1.6 2.8 62.8 48.7 48.7 61.5 5.1 3.0 4.3 7.4 Mid Kilburn 34 19 15 2.3 4.5 2.8 3.9 1.6 1.6 1.9 2.2 57.5 35.3 67.6 55.8 4.2 4.3 5.2 6.1 North Kilburn 38 20 18 4.5 2.2 1.7 2.9 1.2 .8 1.1 1.6 70.5 38.8 65.8 52.6 4.2 3.0 4.2 5.8 Willesden Green 104 54 50 2.2 3.1 3.1 3.6 2.1 1.3 1.6 1.9 56.5 42.2 52.4 51.9 7.7 4.9 6.0 6.7 Willesden 444 259 185 3.1 3.7 3.2 4.2 2.2 1.8 1.8 2.4 64.5 50.2 57.3 58.3 6.7 5.9 5.8 7.6 60 NOTIFICATIONS OF INFECTIOUS DISEASES. The total number of notifications received last year amounted to 1,082. This gave a notification rate of 7.6 per 1,000, the highest rate since 1902, when the rate was 9.6 per 1,000. This was due chiefly to an increase in the notifications of Scarlet Fever. VOLUNTARY NOTIFICATION OF PTOMAINE POISONING. Owing to the occurrence from time to time of cases of Ptomaine poisoning, knowledge of which was received for the first time through the death certificates, it was decided to make this disease voluntarily notifiable. In consequence of this decision of the Council there were notified during the year 7 cases of Ptomaine poisoning. Very little expense has been incurred as a result of this decision, and there can be no question that, although fortunately cases of ptomaine poisoning are comparatively rare, it is of the utmost importance that early intimation of such cases should be made to the Medical Officer of Health. It would be premature to report on the value of the experiment after so short a trial—no case of first.rate importance having as yet been reported. SMALL POX. There were no cases of Small Pox reported during the year. 61 VACCINATION RETURNS. Years. No. of Births. Successfully Vaccinated. Insusceptible. Dead. Conscientious Objectors. Postponed by Doctor. Gone Away. Unvaccinated. 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 35 1905 4,135 2,448 15 286 75 64 297 950 36 1906 .. 4,190 2 325 19 290 102 68 348 1,038 40 It is to he noted that the Vaccination Returns show an increasing proportion of babies unvaccinated as we get further removed from the years in which Small Pox prevails. 62 SCARLET FEVER. Scarlet Fever has prevailed considerably in excess of what has been experienced in recent years. There were reported altogether 637 cases during the year, yielding a notification rate of 4.5 per 1,000 persons living in Willesden, a rate slightly in excess of the mean for the whole period since it was made notifiable. At no time could it be said that the disease assumed the proportions of an epidemic, but throughout the year and in all parts of the district it prevailed in greater degree than usual. What Sydenham described as the " epidemic constitution of the year," may for lack of more precise knowledge of the conditions be said to have favoured the spread of Scarlet Fever, and but for the prompt and extensive hospital isolation of the cases, I have no doubt we should have experienced a sharp epidemic of the disease. 63 Table No. 26. CASES NOTIFIED UNDER 15 YEARS OF AGE DURING THE YEAR 1906. 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 115 12.3 67 7.1 Harlesden 55 8.0 30 4.3 Kensal Green 144 14.4 54 5.4 South Kilburn 70 12.5 12 2.2 Mid Kilburn 41 10.3 11 2.8 North Kilburn 30 12.5 15 6.2 Willesden Green 109 12.2 36 4.0 Willesden Urban District .. 564 11.9 225 4.7 Mean of years, 1903–6 – 8.9 — 4.8 64 DIPHTHERIA. 280 cases of diphtheria were notified during the year, giving an incidence.rate of just under 2 per 1,000, a rate practically identical with the rate of last year, and below the mean for the period during which the disease has been notifiable. Up to 1902 the incidence of diphtheria in Willesden was progressive, but since then there has been a marked fall in the number of cases notified. The greatest incidence is still in the western part of the district, and more particularly in the Church End Ward. In the chart on page 56 are spotted the cases of diphtheria occurring in Willesden during the five years 1901-1905. They have been distributed equally among the houses in the streets in which they have occurred. The chart very clearly shows how heavy is the incidence of this disease in the lower lying parts of the Brent area. In my evidence at a Local Government Board enquiry into the value of the intercepting trap, I pointed out how this incidence was much greater on houses provided with interceptors than on the older houses where the drains were not disconnected from the sewers. I also showed that in the lower lying parts of the district drains with interceptors were more liable to blockage or to provide ventilation to the sewers beneath the windows of the houses where the cap of the raking arm had been displaced. The frequency with which this is found to happen is shown in Table No. 27, based on special systematic inspections of manholes throughout the district. I suggested, and I still think, that a causal relationship exists between exposure of young children to the emanations of sewage and the incidence of diphtheria; and I state as a fact that the intercepting trap and the drain 65 ventilator, wrongly known as an inlet, is a device that effects this exposure to an infinitely greater degree than even faulty drainage of an older type. In a word, I am of opinion that the phenomena of the differential incidence of diphtheria displayed in the chart is in some measure accounted for by the defective type of drainage compulsorily adopted in new districts. I wish not to be misunderstood in saying this. I am convinced that there is great misapprehension as to the cause of diphtheria, and much needless alarm as to the condition of the drainage when a case of diphtheria occurs in a house. Diphtheria is not caused by "bad drains," and probably in every case where a child develops the disease it has caught it by exposure to infection from another child suffering from the same disease. But exposure to sewage emanations does, in my opinion, as is traditionally believed, predispose to throat infections. To live in an atmosphere polluted with sewer gas is, other things equal, to be predisposed to diphtheritic infection. It is on this ground and in this way that I account for the remarkable endemicity of diphtheria in the lower lying areas of West Willesden. Table No. 27. SHOWING RESULTS OF THREE SPECIAL INSPECTIONS OF MANHOLES IN WILLESDEN. Date. Total Inspections. Choked. Percentage. stoppers Missing. Percent age October, 1905 6,715 288 4.25 654 9.7 January, 1906 504 49 9.7 41 8.1 November, 1906 5,322 204 3.8 266 5.0 Total 12,571 541 4.3 961 7.6 66 Table No. 28. FATALITY AND INCIDENCE FROM SCARLET FEVER, DIPHTHERIA, AND TYPHOID FEVER, PER 1,000— 1888 TO 1906. Year. Fatality Rate. Scarlet Fever. Deaths per 1,000 cases. Incidence Rate. Scarlet Fever. Cases per l,000 population. Fatality Rate. 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 1904 6 2.4 54 2.6 211 0.27 1905 18 2.8 51 1.9 293 0.29 Mean Rate 26 4.0 135 2.3 187 0.59 1906 17 4.5 67 2.0 152 0.32 67 Table No. 29. WARD INCIDENCE OF SCARLET FEVER, DIPHTHERIA AND ERYSIPELAS. Ward. SCARLET FEVER. DIPHTHERIA. ERYSIPELAS. Kate. Quinquennial Means. Decennial Means. Kate. Quinquennial Means. Decennial Means. Rate. Quinquennial Means. Decennial Means. 1906. 1896 to 1900 1901 to 1905 1896 to 1905 1906. 1896 to 1900 1901 to 1905 1896 to 1905 1906. 1896 to 1900 1901 to 1905 1896 to 1905 Church End 5.6 5.4 5.3 5.3 3.4 3.3 6.2 4.7 0.8 1.0 0.5 0.7 Harlesden 3.1 3.1 4.6 3.8 1.8 2.6 3.2 2.9 0.9 1.1 0.8 1.0 Kensal Green 5.5 4.2 3.3 3.8 2.2 3.0 1.8 2.4 0.6 1.0 0.5 0.7 South Kilburn 5.0 5.8 2.4 4.1 1.3 3.1 1.3 2.2 0.8 1.0 0 8 0.9 Mid Kilhurn 3.6 4.0 2.4 3.2 1.2 3.5 1.3 2.4 1.1 0 7 0.8 0.8 North Kilburn 3.2 3.1 2.6 2.8 2.0 1.7 1.4 1.6 0.5 0.7 0.3 0.5 Willesden Green 4.3 4.4 2.9 3.7 1.5 1.5 1.8 1.6 0.6 0.7 0.5 0.6 68 ENTERIC FEVER. 46 cases of typhoid fever, as compared with 41 last year, were notified. Particulars of the principal outbreak are given in the Third Quarterly Report of the year. ISOLATION HOSPITAL. All particulars relating to the Isolation Hospital will be found in the report of the Medical Superintendent appended. 69 Table No. 30. DEATH RATES FROM SCARLET FEVER, DIPHTHERIA, TYPHOID FEVER, MEASLES AND WHOOPING COUGH per 100,000. 1875 to 1906. 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 1905 3 9 8 36 47 1906 7 11 4 17 17 MEAN. 1875-1887 42 265 17 24 24 17 50 45 75 57 1888-1906 11 31 10 41 39 * Infectious Diseases Notification compulsory in Willesden from this year. E 70 HEALTH OF SCHOLARS IN PUBLIC ELEMENTARY SCHOOLS. Non-Notifiable Infectious Diseases Intimated from the Schools. The only knowledge possessed of the cases of non-notifiable infectious diseases is that derived from the intimations of the School Teachers and Attendance Officers, and from the enquiries made upon receipt of these intimations. The system instituted under the scheme for the Hygienic Control of Schools in 1903, and appended to my Annual Report for that year, has yielded the most useful results. As the benefits resulting from the system are more intelligently appreciated by the teachers, there is greater promptitude in excluding and notifying scholars suspected of suffering from infectious conditions. The suspicion entertained that the apparently drastic method of exclusion would encroach seriously upon the level of school attendance, has yielded before the striking improvement which has resulted in this respect during the operation of the scheme. A large number of notifications are received each morning from the schools. These are investigated, instructions to prevent further spread are issued to the parents, exclusion or re-admission notices are sent to the schools, the origin and spread of an outbreak among classes or schools are traced, and the timely closure of a class or department rendered possible. There are many indications of the growth of a "health conscience " among 71 parents. Measles, for instance, hitherto treated slightingly with the most disastrous results, is increasingly respected, and medical men are consulted with much greater frequency with regard to ailments requiring skilled care, which, in the past, were greatly neglected. This is well illustrated if the proportion of cases of measles and whooping cough treated by a doctor in each of the three years is compared. Percentage of cases attended by medical men : 1904. 1905. 1906. Measles 37 per cent. 56 per cent. 58 per cent. Whooping cough 38 54 „ 47 „ It is hoped during the ensuing year further to improve in the details of the scheme for the hygienic control of schools. The supervision of the health conditions of nearly 25,000 children is an undertaking of great magnitude. Health is of primary importance to education, yet how disproportionately it is regarded may be judged by the relative cost of these two interests. The whole of the work relating to the health of scholars is undertaken as a part of the work of the relatively small staff of the Public Health Department. While I am of opinion that it should always remain a branch of public health administration, I think also that the great advantages to education resulting from this province of work deserve some recognition and assistance at the hands of the Education Authority. £ 2 72 Table No. 31. NON-NOTIFIABLE INFECTIOUS DISEASES INTIMATED FROM THE SCHOOLS. 1904. 1905. 1906. Suffering. Attended by Doctor. Suffering. Attended by Doctor. Notified. Suffering as Notified. Secondary and Additional Gases Discovered. Total 1906. Attended by Doctor. Measles 730 274 1,636 930 379 169 199 368 213 Whooping Cough 90 35 1,095 592 319 220 235 455 214 Chicken Pox 108 102 281 122 337 209 134 343 135 Mumps 62 18 126 32 797 500 160 660 192 Tuberculosis 6 6 11 9 16 15 15 13 Influenza 13 4 15 9 6 5 18 23 10 Ringworm & Scabies 262 103 341 142 296 278 78 356 119 Ophthalmia 45 9 50 21 30 26 19 45 8 Other Diseases 212 74 584 132 347 279 228 507 169 Verminous Heads 26 2 17 12 10 2 12 .. Totals 1,554 627 4,156 1,989 2,539 1,711 1,073 2,784 1,073 73 MEASLES AND WHOOPING COUGH. The district has remained comparatively free from measles and whooping cough during the year. Only 368 cases of measles and 455 of whooping cough came to knowledge, as compared respectively with 1,636 and 1,095 cases in 1905. Measles. Measles accounted for 25 deaths, compared with 51 during 1905, but 28 of the 51 deaths of 1905 occurred during the fourth quarter of 1905, and 12 of the 25 deaths of 1906 during the first quarter of 1906. All of these deaths are, therefore, to be credited to the epidemic which prevailed towards the end of last year. At the re-assembling of the schools at the beginning of the year a few cases of measles were reported, for the most part residua of the 1905 outbreak, but until the end of April there was no considerable outbreak of measles in any of the schools throughout the district. From the end of April until the end of July measles prevailed in moderate degree without intermission, but alter the summer holidays the schools remained practically free of the disease until the end of the year. There was one exception to this, namely, Kensal Kise School. An outbreak occurred in one of the classes in the infant department of this school towards the end of October. As the outbreak was limited to one class, the class alone was closed ; but on the expiry of the incubative period of the disease another class in the same department became extensively affected, and I deemed it advisable to recommend the closure of the department. This was done, with the result that not another case of measles occurred in that school up to the end of the year. 74 But for the promptitude of the head teacher in notifying before the disease had obtained an extensive hold of the school, it is probable that a much more serious outbreak would have had to have been dealt with. One incident of the school closure is instructive. The parent of a scholar, excluded as a result of the closure sent the child to school in the neighbouring borough of Paddington. While attending this school the child developed measles, and as a result a considerable outbreak occurred in the school in question. It is often urged that school closure is futile, because the children play together in the streets, and there infect one another. It is doubtless a fact that street infection does occur under these conditions, but it is none the less a fact that school closure, whether specifically with this object or for the purpose of holidays, does result in checking the spread of such diseases as measles and whooping cough; and especially is this so in regard to the infant departments. Generally speaking, the younger the child the more liable is it to contract and die from these diseases if exposed to infection. Of all the cases coming to knowledge during the year, no fewer than 33 per cent, were primary cases occurring in the infants' departments, whom there was reason to believe had contracted the disease by school contact. To these have to be added 11.7 per cent, of primary cases occurring among infants attending public elementary schools who were believed to have contracted the disease otherwise than by school contact. In the boys', girls' and mixed departments, on the other hand, the primary cases occurring in infected households and 75 traceable to school contact constituted only 1.6 per cent, of all the cases. It is noticeable this year that a larger percentage than last, namely, 22.2 per cent., as compared with 10.7 per cent, of primary ases, have occurred among young children not attending school. This is to be expected in a non-epidemic year. The cause of the constantly-recurring epidemics of measles is the aggregation of susceptible children in the infants' departments. When it does not spread by this means there is a greater relative primary incidence upon children not attending school, but the proportions of the epidemic are greatly reduced. Whooping Cough. Whooping cough accounted for precisely the same number of deaths as measles, namely, 25. With the exception of a little outbreak in June, a few cases only of whooping cough were regularly notified from the schools each week until November. From November until the end of the year a considerable accession of cases occurred. 34.7 per cent. of all the cases were primary cases contracted by school contact in the Infants' Departments. 11.4 per cent. were primary cases attending the Infants' Departments, believed to have contracted the disease otherwise than by school contact. Primary cases in the Boys', Girls' and Mixed Departments contracting the disease by school contact accounted for only 1.7 per cent, of all the cases, while primary cases occurred in 13.6 per cent, of the total, among children not attending school at all. 76 RINGWORM AND SCABIES. As a result of the notifications from the schools, 282 cases of Ringworm and 74 cases of scabies came to knowledge, and were investigated by the Officers of the Public Health Department. 123 or 436 per cent, of the ringworm cases, and 39 or 51.3 per cent. of the cases of scabies were found to be or were persuaded to place themselves under the treatment of a hospital or medical practitioner. Of the cases remaining untreated, 94 cases of ringworm and 9 of scabies were treated at the Isolation Hospital as out-patients. At the Isolntion Hospital there were also treated 40 cases of impetigo, an infectious skin disease, 4 cases of ophthalmia, and 29 cases of other diseases, while 52 cases recovered from infectious skin diseases were also certified by Dr. Stephens, the Assistant Medical Officer at the hospital as fit to return to School. The problem of dealing with infectious skin and other allied affections in school children is beset with difficulties. Ringworm, impetigo, scabies, verminous heads, ophthalmia, are highly infectious conditions necessitating the exclusion of the scholar in the interests of the other children. They form a group of diseases showing little tendency to natural cure, and some of them require careful, painstaking, and even tedious treatment if they are not to drag themselves out t hrough years of disfiguring misery. Impetigo, lousiness, and scabies are easily cured if properly and vigorously attacked, but the indolent filthiness of the parents, who will in many of these cases neither seek nor follow advice, leaves the little sufferers to linger on a danger to others and a semi-tolerated misery to themselves. It is no uncommon thing to find children excluded from School because of these ailments employed in earning a pittance instead of in getting themselves cured. In one such case—a case of scabies—the child was employed in a butcher's shop. In a 77 bye-law submitted under the Employment of Children's Act this would be a punishable offence, and it is hoped that these bye-laws, recommended by the Public Health Committee, will soon receive the consideration of the Council with a view to their being formally adopted. EYESIGHT OF SCHOOL CHILDREN. In order to meet the convenience of the teachers, I have arranged to receive the returns relating to the eyesight of scholars at the end of the school year in July. The returns for 1900 cannot therefore appear in the report, but I hope to publish them next year. SANITATION OF SCHOOLS. All the public elementary schools were inspected during the summer vacation and with a few exceptions were found to be in a satisfactory condition. The drains in every instance were tested by smoke, and where found necessary, were efficiently flushed by the Council's flushing apparatus. Table No. 32. MEASLES AND WHOOPING COUGH. Cases where Primary Case is attending Infant School. Primary Case, School Contact. Secondary Case, Primary Case, arising otherwise. Secondary Case. Age Periods. Total. Percent age of Total Cases. Age Periods. Total. Percent age of Total Cases. Age Periods. Total. Percent age of Total Cases. Age Periods. Total. Percent age of Total Cases. 3 4 5 6 7 0-1 1-5 5-10 10-15 15 up 3 4 5 6 7 0-1 1-5 5-10 10-15 ... 15up Measles 9 33 51 24 6 123 33.4 14 45 13 1 ... 73 19.8 ... 9 21 8 5 43 11.7 1 11 3 ... 15 4 .1 Whooping Cough 2 38 75 30 13 158 34-7 21 60 13 94 20.7 12 15 21 4 52 11.4 8 21 2 1 32 7.0 Total No. of Scholars on Roll at various ... 656 1958 2153 1767 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Age Periods Cases where Primary Case is attending Boys', Girls, or Mixed Departments. Primary Case, School Contact. Secondary Case. Primary Case, arising otherwise. Secondary Case. Age Periods. Total. Per centage of Total Cases Age Periods. Total. Percent age of Total Cases. Age Periods Total. Percent age of Total Cases. Age Periods. Total. Percent age ot Total Cases. 7-10 10-15 15 up 0-1 1-5 5-10 10-15 15 up 7-10 10-15 15 up 0-1 1-5 5-10 10-15 15 up Measles 4 2 ... 6 1.6 1 1 1 ... ... 3 0.8 4 2 ... 6 1.6 ... ... ... ... ... ... ... Whooping Cough 6 2 ... 8 1.7 2 3 3 ... ... 8 1.7 2 1 ... 3 0.7 ... 1 ... ... ... 1 0.2 Total No. of Scholars on Roll at various 5405 7926 36 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Age Periods Cases where Primary Case is not attending School. Primary. Secondary. Measles Total No. of Cases, 368. Age Periods. Total Per cent. age of Total Cases Age Periods. Total Per cent. age of Total Cases 0-1 1-5 5-10 0-15 15 up 0-1 1-5 5-10 10-15 15 up Whooping Cough 455. Measles 18 62 1 1 ... 82 222 4 10 2 1 17 4.6 Note.—Primary Case means primary in a household. Whooping Cough 9 50 3 ... ... 62 13 6 13 17 6 1 37 8.1 79 COLLECTION OF HOUSE REFUSE. The collection of house refuse is still carried out by contract. The contract for the year 1906 instead of being let to two or three contractors, as in previous years, was secured by one firm for the whole of the district. There has been a still further reduction of the cost of the collection for the year. For several years prior to 1905 the cost of collection had been steadily increasing, having reached as high as the yield of 3.92d. in the pound of rateable value, but this was reduced to a sum equal to a rate of 2.54d. for the year 1905 and of 2.09d. for this year. During the year 1905 a lesser quantity of refuse to the extent of 10,650 cubic yards was collected, and for the year 1906 a still further reduction of 9,723 cubic yards was made. This reduction is due to a stricter adherence to the terms of the contract, which provide exclusively for the removal of house refuse. The annual saving of over £4,500 is to be ascribed very largely to the contractor observing the distinction between house and trade refuse. The work generally has been discharged in a most satisfactory manner, and, with the exception of a few disputes as to the determination of what is and what is not trade refuse, very few complaints have been received. The total number of complaints is 220, representing 1.03 per cent, of the total number of houses. 80 Table NO. 33. DATA RELATING TO DUST COLLECTION. Year Total Cost of Collection. Total No. of Loads Collected. No. of Cubic Yards Represented. Kate 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 or Decrease 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. £ £ £ £ d.. 1899 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 69 38 7,583 18,655 982 167 0.89 1905-4 3,100 2,950 3,895 9,945 26,603 99,761 3.71 39 22 25 70 36 8,591 19,588 933 139 0.70 1904-5 3,445 3,489 3,995 10,929 26,536 99,510 3.92 37 24 27 70 43 † 251 20,247 659 104 0.51 1905-6 2,500 2,150 2,800 7,450 23,696 88,860 2.54 29 18 19 58 36 †10650 21,087 840 198 0.93 1906-7 *1,930 *2,156 *2,258 6,250 21,103 79,137 2.09 27 18 20 54 36 †9,723 21,272 185 220 1.03 * Alternative to inclusive contract for the district. † Decrease. 81 Table No. 34. 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 4.3 .61 1899 4.5 .64 1900 4.8 .69 1901 4.9 .72 1902 5.1 .74 1903 5.3 .77 1904 5.0 .73 1905 4.3 .63 1906 3.8 .55 Mean 4.5 .65 Table No. 35. Year. Cost per Load. Cost per Cubic Yard. Cost per House. Cost per Head of Population. 8. d. d. 8. d. d. 1896 8 0 256 8 3 14.53 1897 7 4¾ 236 8 2 14.12 1898 7 4¼ 235 8 4¾ 14.56 1899 7 3¾ 234 8 9¾ 15.07 1900 6 4¾ 20 5 8 1¼ 14.25 1901 7 0 224 8 10¼ 16.17 1902 7 4½ 23.6 9 7¼ 17.61 1903 7 5¾ 28.9 10 1¾ 18.45 1904 8 2¾ 263 10 9½ 19.44 1905 6 3½ 20.1 7 0¾ 12.70 1906 5 11 18.9 5 11¾ 10.58 82 MILKSHOP INSPECTION. In the inspection of Milkshops special attention has been given during the year as to the steps taken or failing to be taken to prevent contamination of the milk from dirt, dust or flies. It is not generally recognised by milk sellers that during the hot weather milk exposed for sale is liable to be contaminated from its exposure to the dust and dirt of the shop, and great surprise is often expressed when their attention is called to this fact. This applies also to the milk which stands in the churns in the dairy previous to its being strained prior to delivery to customers. The milkman generally deems that his duty has been discharged if he strains the milk through a muslin strainer. By this means he intercepts the grosser impurities, but utterly fails to free the milk from the more dangerous contaminations, such as germs, which he invites by his careless exposure of the milk. Out of a total of 368 visits, in 232 cases attempts were made to protect the milk in the storage vessels, the usual practice being to strain a muslin cloth over a frame. The only attempt in many cases was to improvise a cover of an ordinary newspaper, and in 136 cases no protection of any kind was attempted. The provision made for the cleansing of milk vessels and utensils was also dealt with. In 13 instances either a steam apparatus or a special boiler is used for heating water for cleansing or sterilizing purposes. In 25 instances a special copper is used for boiling water. In 43 instances the ordinary domestic copper is used, this also doing duty for the washing of clothes, and in 40 instances the ordinary kettle is brought into use. Many of these dairies are general shops where only a small quantity of milk is sold, and where it is not infrequently the case that other articles, such as paraffin oil, soap, chandlery, 83 potatoes, etc., are stored alongside the milk. Daring the year 10 persons have given up the sale of milk stored under these conditions. In six instances new businesses have been established. In all new businesses established the provision of proper means for the cleansing of utensils and the storage of milk is insisted upon. During the year 18 notices were served to amend insanitary conditions found as a result of inspection, and of these 16 have been duly complied with. The total number of milk shops in the district is 121. Each milk shop has been inspected at least three times during the year. SLAUGHTER-HOUSES. There are four registered and five licensed slaughter-houses in the district. These are systematically inspected, and are kept in accordance with the provisions of the Acts and Byelaws relating to slaughter-houses. I am of opinion, however, that the slaughtering of animals for human food should always be carried out under conditions of adequate inspection which is only possible in a central abattoir, and I trust that future legislation will provide for the abolition of the private slaughter-house. CUSTOMS AND INLAND REVENUE ACT. Ninety-six premises have been inspected under the provisions of the above Act in order to ascertain whether the premises afforded suitable accommodation for each of the families or persons dwelling therein, and that due provision was made for their sanitary requirements. In only 36 instances was I able to grant the certificate required, the remaining 60 not having 84 "suitable accommodation" for the persons dwelling therein, the chief ground of refusal being that the floor area of certain of the rooms was very considerably below the 96 square feet which I have adopted as the minimum which could reasonably be described as " suitable." The following table gives the details with regard to the applications and the certificates granted or refused. Number Inspected. Certificate Granted. Certificate Not Granted. Shakespeare Avenue 21 — 21 Chevening Road 1 1 — College Road 5 2 3 Lushington Road 3 3 — Holland Road 3 3 — Victor Road 2 — 2 Greyhound Road 2 — 2 Oldfield Road 6 — 6 Queens Road 4 4 — Roundwood Road 6 — 6 Church Road 10 — 10 Burton Road 3 3 — Streatley Road 12 12 — Villiers Road 2 — 2 Sandringham Road 14 6 8 Chapter Road 2 2 — 96 36 60 81 Table No. 36. Description of Defects, &c. Factories Miscellaneous. Factory Laundries. Factories Domestic. Workshop Laundries. Domestic Laundries. Dress-makers. Miscellaneous Workshops. Out-workers. Total. Description of Work or Occupation carried on by— Miscellaneous Workshop. Outworks. Total. No. Inspected 14 35 .. 105 38 63 108 100 463 Tailors 17 29 46 Want of Cleanliness 6 5 .. 39 12 14 18 7 101 Dressmakers .. 15 15 Want of Ventilation .. 2 .. 3 .. .. 5 .. 10 Bootmakers 31 9 40 Overcrowding .. .. .. .. .. .. 1 1 Blouse makers 13 13 Sanitary Accommodation Insufficient .. 3 .. 1 .. .. 2 .. 6 Cabinet Makers 1 .. 1 Unsuitable or Defective 3 3 .. 15 5 6 7 .. 40 Seamstresses 1 21 22 Not Separate for Sexes .. 2 .. 2 .. .. 1 .. 5 Milliners 2 .. 2 Other Nuisances 10 28 .. 54 10 2 3 .. 107 Upholsterers 4 4 Failure to affix Abstract 2 3 .. 10 .. 1 12 1 29 Masons 4 .. 4 No. of Males employed 108 51 .. 76 9 .. 197 25 .. Cycle Makers 6 .. 5 No. of Females employed 146 384 .. 604 66 239 77 74 .. Wearing Apparel Cleaners 1 4 6 Total No. of Persons employed 254 435 .. 680 75 239 274 99 .. No. of Workshops discontinued .. .. .. 10 .. 10 3 15 .. Saddlers 2 .. 2 No. Re-visited .. 12 .. 27 15 12 15 8 .. Printers 3 .. 3 Workroom used as Sleeping Room .. .. .. .. .. .. .. 1 .. Metal Workers (Art) 3 .. 3 Workrooms Measured .. 12 .. 12 1 6 8 6 .. Builders Engineers Miscellaneous 9 6 23 .. .. 5 9 6 28 Total 108 100 208 86 Table No. 37. FACTORIES, WORKSHOPS, LAUNDRIES, WORKPLACES AND HOMEWORK. 1. INSPECTION.— Including Inspections made by Sanitary Inspectors or Inspectors of Nuisances. Premises. Number of. Inspections. Reinspec tions. Written Notices. Prosecutions. Factories (including factory laundries) 49 20 9 — Workshops (including Workshop laundries) .378 96 87 — Workplaces — — — — Home workers premises 100 8 10 — Total 527 124 106 — 2. DEFECTS FOUND. Particulars. Number of Defects. Number of Prosecutions. Found. Remedied. lief erred to h.M. Inspector. Nuisances under Public Health Acts:- Want of cleanliness 101 101 — — Want of ventilation 10 10 — — Overcrowding l l — — Want of drainage of floors 15 15 — — Other nuisances 107 107 — — Sanitary accommoda tions insufficient 6 6 — — unsuitable or defective 39 39 — — not separate for sexes. 5 5 — — Offences under the Factory and Workshop Act:— Illegal occupation of underground bakehouses (S. 101) — — — — Breach of special sanitary requirements for bakehouses (SS. 97 to 100; 3 3 — — 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 287 287 — — 87 Table No. 37—continued. 3. OTHER MATTERS. Class. Number. Matters notified to H.M. Inspectors of Factories : — Failure to affix Abstract of the Factory and Workshop Act (S. 133) Action taken in matters referred by H.M. Inspectors as remediable under the Public Health Acts, bul not under the Factory Act (S. 5):— 19 Notified by H.M. Inspectors — Reports (of action taken) sent to H.M. Inspectors.. — Other — Underground Bakehouses (S. 101):— Certificates granted during the year — In use at the end of the year 25 Number of. Homework :— Lists. Outworkers. Lists of Outworkers (S. 107):— 18 28 Lists received Addresses of outworkers forwarded to other Authorities 18 18 received from other Authorities 79 100 Homework in unwholesome or infected premises: Wearing Apparel. Other. Notices prohibiting homework in unwholesome premises (S. 108) — — Cases of infectious disease notified in homeworkers' premises 6 — Orders prohibiting homework in infected premises (S. 110) — Workshops on the Register (S. 131) at the end of 1905. Important classes of workshops, such as workshop bakehouses, may be enumerated here. Factories (Miscellaneous) 14 Laundries (Factory) 35 ,, (Workshop) 105 ,, (Domestic) 38 Bakehouses 64 Dressmakers 63 Tailors 17 Bootmakers 31 Outworkers 100 Cabinet Makers — Saddlers 2 Builders 9 Engineers 6 Masons 4 Motor Car and Cycle Makers 5 Art Metal Workers 3 Miscellaneous 31 Total number of workshops on Register 527 88 SANITARY CONDITION OF WORKSHOPS WHERE WOMEN ARE EMPLOYED. The workshops where women are employed are on the whole satisfactory. The majority of these workshops are occupied by milliners, dressmakers, and tailors. They are systematically inspected by the Lady Health Visitors. (a) Cleanliness.—The premises are as a rule clean, including the sanitary conveniences which are suitable and sufficient. (b) Air Space.—There is a tendency, especially amongst dressmakers, to use the air space quite up to the limit of persons allowed. 250 cubic feet is altogether an insufficient amount of air space for a woman sitting closely at work often for 12 hours with only one hour's interval for dinner and 20 minutes or half an hour for tea. Yet this is often grudgingly given, as it is inconvenient to separate the workers who cannot then be constantly under the immediate supervision of the employer. The average dwelling room will allow 250 cubic feet of air space for four or five persons only, and it is in the dwelling houses that dressmaking is for the most part carried out in Willesden. It is not unusual to find the workers all together in one room when they might well be distributed over two rooms. (c) Ventilation.—The means of ventilation are usually adequate, but there is little desire on the part of the workers to use those means, and it is no easy matter to compel their use. Workrooms with French windows are unsatisfactory as it is only in the very hot weather these are found open. 89 LAUNDRIES. "With the exception of the large power laundries the conditions are not satisfactory. The ordinary dwelling house is of necessity unsuitable for laundry work even where specially built ironing rooms arid wash-houses have been added. (a) Defects.—The defects most frequently found are defective ironing room and wash-house floors and defective yard paving, also want of cleanliness. (b) Air Space.—The air space is generally ample, the full number of people allowed seldom being employed. (c) Ventilation.—The ventilation of the ironing rooms in the hand laundries will not be satisfactory so long as ''overhead" drying and the drying of clothes around the stoves are permitted. (d) Sanitary Conveniences.—In the matter of cleanliness these do not compare favourably with those of the workshops. The accommodation is usually sufficient, but in some cases has not been separate for the sexes. In all such cases further accommodation has been provided. OUTWORKERS. The outworkers in Willesden are comparatively few in number, and the work for the most part is done at irregular intervals to supplement the income, not as the sole means of support. In many cases the outworker has also a workshop and so is dealt with under that heading. The conditions are generally quite satisfactory. Not infrequently the outworkers resent inspection as they work only occasionally and " employ no one." 90 BAKEHOUSES. Prior to the year 1901 the conditions under which bakers worked were far from satisfactory, and in many cases gross evils existed. The powers conferred upon Local Authorities by the provisions of the Factory and Workshop Act, 1901, enabled them to improve the sanitary conditions of bakehouses, and a great deal of work has been done to premises of this character since that date. It was the rule in most bakehouses that the bakers washed in the bakehouse itself, a pail of water serving as a lavatory basin, while the bakehouse also served as a dressing room in which he changed his working clothes. These conditions, without exception, have been altered during the last few years, and the employees of the baker are now provided with a room where they can change their clothes, and a lavatory basin for washing purposes. In the course of my visits of inspection to bakehouses in the district 1 have been struck with the general improvement in their sanitary condition. A great difficulty, however, exists in breaking down the prejudice of the baker as to the necessity for the efficient ventilation of his bakehouse, and whenever attention is drawn to the fact one is met with the reply " Oh, I must have the place shut up otherwise my bread will not rise." This plea is put forward on all occasions irrespective of whether the dough is rising or being withdrawn from the oven. Another great difficulty that has to be contended with is the loading of the bakehouse with sacks of Hour, a practice which is most undesirable as the cubic area of the bakehouse is thereby restricted, and the dirt and dust from the sacks makes anything but a desirable admixture in the bread with which it is baked. 91 Before new bakehouses are constructed the plans presented to the Council are, by the courtesy of the Engineer, brought under my notice in order to ascertain whether they comply with the regulations as regards sanitary conditions and provision of accommodation for workmen. The total number of bakehouses in the district is 64. During the year one was discontinued and two others have been newly constructed. 33 notices were served upon the owners, principally for cleansing of the premises. COMMON LODGING HOUSE. Early in the year application was received for the registration of a house in Villiers Road, under section 77 of the Public Health Act, 1875, as a common lodging house. The premises consisted of a double fronted house which had previously been let out in separate tenements, the house being inhabited by"an undesirable class. The premises were continually found to be in a most insanitary condition, principally due to the habits of the tenants. Upon receipt of the application, I visited the premises and formed the opinion that they could be altered and made suitable for the purposes of a common lodging house by the addition of a large kitchen fitted with cooking range, and the provision of a supply of hot water. The applicant complied with the suggestions, and after the completion of the work the premises were registered by the Council for the accommodation of 49 male adults. The cubic area allowed for each person was 300 cubic feet net. Two baths were fitted and adequate provision was made by means of hand basins for washing. I have visited the premises on several occasions and they have been frequently inspected by the Inspector, and on every 92 occasion the common living room, the kitchen and bedrooms were found to be kept in a cleanly and orderly condition. Although the premises are registered for 49 persons it is found that the rooms are seldom fully occupied, and the average number of persons using the premises at night is 25. SMOKE NUISANCES. I have for several years had to report frequent and serious nuisance from the emission of black smoke by the chimney shafts of factories in the district. Proceedings taken by the Council against the offenders have had the effect of reducing this nuisance to a minimum, and it is gratifying to note that during the past year very few complaints have been received, and on no occasion was it. found necessary to institute proceedings. I should like further to state that the owners of factories have shown every desire and have willingly done whatever was possible to prevent the occurrence of this nuisance. NUISANCES. The work of the Department so far as relates to the abatement of nuisances and sanitary work generally is summarised in the appended table. It will be observed that 1,027 premises were inspected by reason of complaint, 1,253 for purposes of special enquiry and 2,695 for various purposes. 614 drains were examined, and of these 116 were found to be so defective as to require entire reconstruction, in 132 instances the conditions were amended, the remaining 366 being found in a satisfactory state. In all instances after inspection has been made notices are served upon the owners to remedy the defects. Altogether 2,149 intimation notices and 464 statutory notices were served. In order to keep the work required by these notices nnder supervision 11,591 visits were paid by the inspectors. The table shows the number of visits paid for various purposes. 93 Table No. 38. SUMMARY OF PRINCIPAL ITEMS OF WORE FOR YEAR ENDING DECEMBER 31st, 1906. description of work. Quarter. Total 1906. 1st. 2nd. 3rd. 4th. Inspection of Houses— Number inspected on complaint 237 233 329 228 1.027 ,, ,, for special inquiry .. 66 167 127 899 1,253 ,, ,, under Customs and Inland Revenue Act 96 — — — 96 ,, ,, from house to house 180 214 91 40 525 ,, ,, from house to house under Housing of Working Classes Act, 1890 2 1 — 4 7 Number of canal boats inspected 22 7 33 12 74 ,, found contravening Regulations 2 13 4 19 Re-inspection of houses— Number re-inspected 127 185 155 70 537 ,, of visits to premises where works of amendment are in operation 2,956 3,112 2,910 2,613 11,591 Number of birth inquiries 883 528 564 420 2,395 ,, infantile death inquiries 120 50 236 86 492 Cases of infectious disease visited 256 239 254 308 1,057 ,, ,, ,, re-visited 135 104 95 113 447 ,, ,, ,, removed 196 182 208 232 818 Number of rooms disinfected 290 267 332 351 1,240 Cases of non-notifiable disease visited 714 1,106 508 1,102 3,430 ,, ,, ,, re-visited 100 157 129 173 559 Miscellaneous visits - - 69 41 110 Number of rooms disinfected after— Consumption 22 15 10 26 73 Cancer 1 3 4 1 9 Ringworm - - - - - Other diseases 2 3 8 1 14 94 Table No. 38—continued. SUMMARY OF PRINCIPAL ITEMS OF WORK FOR YEAR ENDING DECEMBER 31st, 1906. description of wohk. QUARTER. Total 1906. 1st. 2nd. 3rd. 4th. Inspection of mews, stables, etc. 79 127 91 56 353 ,, dairies, cowsheds, milkshops, etc. 63 57 107 141 368 „ of slaughter-houses 3 2 7 5 17 ,, re miscellaneous subjects 95 117 44 356 612 Observations re smoke nuisance 2 31 6 11 49 Inspections re grit and dust nuisance. — — — — — Number of bakehouses visited 39 31 25 9 104 Inspection of Gipsy caravans 10 17 — — 27 Nuisances abated— Number of new drains constructed 17 18 42 39 116 ,, drains amended .. 26 33 37 36 132 ,, drains tested and examined 112 166 170 166 614 ,, nuisances of various descriptions abated 369 248 301 347 1,265 Sanitary notices issued 519 413 352 865 2,149 Statutory ,, ,, 104 169 88 103 464 „ „ ,, under Housing of Working Classes Act, 1890 1 1 4 6 Number of letters received 786 1,245 1,676 1,140 4,847 ,, ,, written 609 731 832 729 2,901 ,, Summonses issued — — — — — I am, Gentlemen, Your obedient Servant, WILLIAM BUTLER. Medical Officer of Health. May, 1907. WILLESDEN Urban District Council. HOSPITAL REPORT FOR THE YEAR 1906, BY WILLIAM J. J. STEWART, M.D. (Edln.), D.P.H .(Camb.). medical superintendent. Printed by M auxin & Son, The Brondesbury Press, 211 High Rd., Kilbiirn. 1907. Members of the Hospital Visiting Committee Councillor W. J. EVERSHED, Chairman. „ J. A. ADAMS. „ C. BIDDISCOMBE. „ M. COOMBES. „ G. H. JOHNSON. „ W. RILEY. HOSPITAL REPORT FOR 1906. To the Chairman and Councillors of the Willesden Urban District Council. Gentlemen, I have the honour to submit to you the annual Hospital Report, the fifteenth of its series. It has again to be recorded that the number of patients treated has exceeded that of any previous year. The possibility of this I drew your attention to in my report a year ago, and I suggested then that it was advisable you should consider the question of permanently increasing the nursing staff, whereby the patients might be more expeditiously dealt with, and their stay in hospital reduced to the minimum period, for it would only be by such means that a hospital of this dimensions could cope with the number of patients to be treated. Your sanction to this increase of staff having been given, the necessary number of nurses were 4 engaged. The effect of this was as surmised, for although the daily average number of patients was greater than ever previously, this hospital alone proved adequate, and that without incurring the expense of opening the hospital at Kingsbury. The saving thus effected, in some measure counterbalanced the extra outlay in respect to the increase in staff. Owing to the great pressure of patients in the wards throughout the year, it was impossible to close any of them temporarily for cleaning purposes, as has hitherto been the custom. This was much to be re arretted, for there can be no doubt but that wards such O i as these, when constantly in use, accumulate infection to such a degree that a periodic disinfection is absolutely essential. I have drawn the attention of the Hospital Committee to this matter, and have pointed out to them that failing a diminution in the daily number of cases under treatment during the current year so as to admit of the emptying of at least one ward at a time for disinfection purposes, there will be no alternative but to open Kingsbury Hospital temporarily for the reception of such patients as will be displaced during the cleansing of the wards they would occupy here. TABLE No. 1. Disease Remaining in Hospital, December 31st, 1905. Admitted during 1906. Total under Treatment during 1906. Discharged during 1906. Died during 1906. Mortality per cent. Remaining in Hospital, December 31st, 1906. Scarlet Fever 69 504 573 492 10 1.90 71 Diphtheria 24 202 226 190 13 6.41 23 Enteric Fever 1 27 28 22 5 18.51 1 Total 94 733 827 704 28 ... ... Other Diseases ... ••• 85 85 75 7 8.38 3 Grand Total ... 94 818 912 779 35 4.28 98 Mortality Rate is calculated according to the registrar-general's formula. Average daily number of Patients in Hospital for the year was 1035. 5 6 As will be seen from Table No. 1, the total number of patients admitted amounted to 818, which is 205 more than in the preceding year. This number is greater than any previous year. From the following list it will be seen how steadily the increase in the number of admissions has taken place year after year. Since 1901 the annual admissions have been :— 1901 466 1904 552 1902 518 1905 613 1903 543 1906 818 In Table No. 2, which gives the admissions each month, it will be noticed that from May onwards a high number is maintained, and that in the earlier months of the year the number of admissions does not show that diminution it is customary to expect at that period. It is fortunate, perhaps, that the admissions are so evenly distributed over the year, and that they did not take place within a shorter interval. In consequence of the increased admissions there was a proportionate rise in the daily number of 7 patients under treatment, the average for the year being 103, or 30 patients more than in 1905. On comparing the figures in Table No. 1, representing the admissions, with those in the corresponding table of the previous year, it will be seen that the greatest increase took place in Scarlet Fever, of which disease there were 504 as against 309 cases. The other diseases tabulated do not show any marked divergence from the figures of the previous year. 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 48 2 22 3 7 ... 7 2 84 7 February 30 19 1 2 ... 6 2 57 3 March 38 2 13 ... I 1 3 2 55 5 April 31 ... 13 1 0 ... 1 ... 45 1 May 43 1 20 ... 1 ... 12 ... 76 1 June 37 2 14 2 2 1 8 ... 61 5 July 54 1 12 1 0 ... 6 ... 72 2 August 54 1 12 2 1 ... 5 ... 72 3 September 40 ... 15 1 5 l 4 ... 64 2 October 48 ... 21 1 6 l 16 ... 91 2 November 42 ... 19 1 1 l 11 1 73 3 December 39 1 22 ... 1 ... 6 ... 68 1 Total 504 10 202 13 27 5 85 7 818 35 9 TABLE No. 3. DIPHTHERIA. AGE. MALES. FEMALES. TOTAL. Admitted. Died. Admitted. Died. Admitted. Died. Under 1 ... l 2 ... 2 l 1 to 2 5 l 5 l 10 2 2 to 3 4 ... 3 ... 7 ... 3 to 4 5 ... 8 ... 13 ... 4 to 5 10 l 12 l 22 2 5 to 10 40 1 40 4 80 5 10 to 15 14 2 17 ... 31 2 15 to 20 2 ... 6 ... 8 ... 20 to 25 1 ... 6 ... 7 ... 25 to 30 6 ... 4 ... 10 ... 30 to 35 3 ... 2 ... 5 ... 35 to 40 ... ... 2 ... 2 ... 40 to 45 1 ... 1 ... 2 ... 45 to 50 ... ... 1 ... 1 ... 50 and over 2 1 ... ... 2 1 Total 93 7 109 6 202 13 10 DIPHTHERIA. The number of cases treated during the year was 236, a slightly smaller number than in 1905. The case mortality of 6.41 per cent, is very satisfactory. In the subjoined list the fatality rate for the last 12 years, that is, since the introduction of the antitoxin treatment, is shown. 1895 28 .8 per cent. 1901 11.9 per cent. 1896 22.6 „ 1902 10.7 „ 1897 24.8 1903 1.7 „ 1898 19.3 „ 1904 6.41 „ 1899 14.3 „ 1905 4.91 „ 1900 14.2 „ 1906 6.41 „ Twenty-five of the cases admitted during the year showed symptoms of laryngeal implication, and of that number 9 were tracheotomied, all except 3 recovering from that operation. The following table shows the number of cases which developed complication during the course of their attack: — 11 TABLE No. 4. complications of diphtheria. Complications. Number of Cases. Per Cent. Paralysis 14 6.9 Albuminuria 10 4.4 Relapse 2 .8 Broncho-Pneumonia 4 1.7 Antitoxin treatment was withheld only in those cases suffering from the mildest attacks, which amounted to 36 in number. It is worthy of note that the skin eruption and joint pains which, in previous years, somewhat frequently followed the injection, now rarely make an appearance. Out of the 190 cases treated with antitoxin, only 16 developed eruptions and 8 joint affection. SCARLET FEVER. During the year 573 cases were treated ; this is a very much larger number than in 1905, when there were 357 cases. In spite of the increased numbers, there was no rise in the mortality rate. 12 TABLE No. 5. SCARLET FEVER. age. amales. FEMALES. total. Admitted. Died. Admitted. Died. Admitted. Died. Under 1 2 1 1 ... 3 1 1 to 2 4 ... 6 ... 10 ... 2 to 3 13 ... 11 ... 24 ... 3 to 4 15 1 21 l 36 2 4 to 5 15 2 31 l 46 3 5 to 10 111 ... 118 2 229 2 10 to 15 38 1 68 ... 106 1 15 to 20 10 ... 13 ... 23 ... 20 to 25 5 ... 3 ... 8 ... 25 to 30 4 1 5 ... 9 1 30 to 35 2 ... 1 ... 3 ... 35 to 40 1 ... 4 ... 5 ... 40 to 45 ... ... 1 ... 1 ... 45 to 50 ... ... ... ... ... ... 50 and over 1 ... ... ... 1 ... Total 221 6 283 4 504 10 13 I append Table No. 6, which shows the more common complications which made their appearance during the course of the attacks. TABLE No. 6. complications of scarlet fever. Complication. Number of Cases. Rheumatism 33 Albuminuria 13 Nephritis 12 Otorrhoea 39 Adenitis 30 Do. (suppurative) 9 Mastoid Abscess 6 Relapse 1 Retropharyngeal Abscess 1 ENTERIC FEVER. Thirty-five cases were admitted to hospital certified as suffering from this disease, but eight of these proved to be suffering from some other complaint. The balance of 27, therefore, represents the number of enteric fever cases actually admitted. 14 The mortality rate of 18.51 per cent, is of average severity. TABLE No. 8. enteric fever. AGE. MALES. FEMALES. TOTAL. Admitted. Died. Admitted. Died. Admitted. Died. Under 5 2 ... 2 ... 4 ... 5 to 10 2 ... 3 ... 5 ... 10 to 15 3 2 1 ... 4 2 15 to 20 1 ... ... ... 1 ... 20 to 25 2 ... 1 ... 3 ... 25 to 30 2 ... 1 ... 3 ... 30 to 35 2 ... 1 ... 3 ... 35 to 40 1 1 1 ... 2 1 40 to 45 ... ... ... ... 45 to 50 ... ... ... ... ... ... 50 and over ... ... 2 2 2 2 total 15 3 12 2 27 5 CO-EXISTENT DISEASES. Amongst these diseases, as in previous years, combined attacks of scarlet fever and diphtheria were 15 by far the most common. Thus, I find that no less than 105 of the 504 cases of scarlet fever admitted showed evidence at one or other time during their stay in hospital of this mixed infection. Seventythree out of this number suffered from scarlet fever and nasal diphtheria, whilst the remainder suffered from scarlet fever and faucial or throat diphtheria. I am of opinion that a thorough bacteriological examination should be made of the throats and noses of all patients suffering from scarlet fever, on admission. If such a practice were in force, and the cases showing a double infection isolated in a separate ward, there is no doubt that outbreaks of diphtheria in the scarlet fever wards would be of much rarer occurrence, and, consequently, the incidence of combined attacks would hardly reach the somewhat high proportion as above stated. The necessity for a bacteriological examination of the throats and noses of all patients suffering from scarlet fever at the time of their admission, will be explained if it is understood that such patients very frequently harbour diphtheria organisms, and yet at 16 the same time may show no clinical evidence of such an infection. The increase in work that this bacteriological examination would entail, however, precludes its adoption here at present, for the routine hospital work is in itself now assuming such proportions that your Medical Officers are fully occupied, and quite unable to give up the time that such an undertaking would require. In this connection I would point out that the duration of stay in hospital of those cases who suffer from scarlet fever and nasal attacks of diphtheria is practically double of those suffering from combined scarlet fever and faucial diphtheria, or from scarlet fever only. The importance of this will be obvious when it is bome in mind that each patient costs the district the sum of £1 4s. 2½d. for every week they remain under treatment. OTHER DISEASES. The number of diseases other than those ordinarily isolated, amounted to three. Of these, two were cases of Puerperal Fever, the third being one of Erysipelas. 17 In Table No. 8 a list of cases wrongly diagnosed, and the diseases for which they were mistaken is given. TABLE No. 8. Table showing the cases wrongly diagnosed on admission, and the diseases for which they were mistaken. Certified as suffering from Diagnosed in Hospital as suffering from Scarlet Fever. Diphtheria. Enteric Fever. Erysipelas. 1 ... ... ... Rotheln 1 ... ... ... Morbilli 1 ... ... ... Drug Rash 3 ... ... ... Septic Eash 16 ... ... ... Erythema 13 15 ... ... Tonsillitis 2 ... l ... Gastritis ... ... l ... Appendicitis 1 ... ... ... Infective Eudocarditis 1 ... ... ... Urticaria 1 ... ... ... Peliosis Rheumatica ... ... ... ... Osteomyelitis ... ... 2 ... Cerebral Abscess 1 ... ... ... Puerperal Fever ... ... 1 ... Pulmonary Tuberculosis 1 ... ... ... Influenzal Eruption 3 ... ... ... Acute Bronchitis ... 2 1 ... Pneumonia ... ... 1 ... Constipation ... ... ... ... Laryngitis 9 ... 1 ... Nil ... 54 18 8 1 18 RINGWORM. It will be within the recollection of the Council that just over 18 months ago it was resolved that schoolchildren suffering from Ringworm and allied skin diseases, but who were unable to afford ordinary medical attendance, should be treated as out-patients at this hospital. In the year just completed approximately 250 children were under treatment. BACTERIOLOGY. A great increase in the work of this department took place during the year. No less than 1593 bacteriological examinations of specimens were made, and out of that number 380 were for medical practitioners in the district. In 1905 the aggregate number examined was 1141, and that included 238 specimens from sources outside the hospital. SICK STAFF. Fifty-four members of the staff were off duty through illness for periods exceeding 24 hours at one time. Except in the cases of three wardniaids and one porter, who contracted scarlet fever, the ailments were of minor importance. In the case of the members of the staff mentioned, I am glad to say they all made a complete recovery. 19 The total number of days the fifty-four members of the staff were off duty was 726, or an average of 13.4 days per person. HOSPITAL BUILDINGS. It will be remembered that the Council sanctioned on July 3rd the erection of a corrugated iron building, for the accommodation of extra female staff. This building was completed in October, and first occupied on the 27th of that month. With the exception of this building, which has been built as an extension to " S" Block, the hospital blocks are the same as detailed in my report two years ago. HOSPITAL EXPENDITURE. I submit a statement showing the hospital expenditure for the year, which amounts to £7,913 16s. 9d. This figure is a very satisfactory one, having regard to the fact that there was an excess of 205 patients over the number treated in the previous year when the total expenditure amounted to £7,640 2s. I find that the average stay in hospital of the 912 patients treated was 50.1 days, so that the 20 expenses incurred in connection with each patient was £8 13s. 6½d., or at the rate of 3s. 5½d. per day. In 1905, the cost per diem was 5s. 3¾d. Finally, I tender my thanks to the principal officers, and to all the members of the staff for their loyal assistance throughout a year of exceptionally hard work. I remain, Gentlemen, Your obedient servant, W. J. J. STEWART. April 30th, 1907. 21 CURRENT EXPENDITURE FOR THE YEAR 1906 (including Kingsbury). £ s. d. Staff Salaries (including Medical Staff 2,974 0 5 Provisions 2,527 14 6 Furniture and House Linen 187 1 4 Clothing 115 5 11 Necessaries 226 10 9 Repairs 53 3 11 Coals, Coke and Oil 603 12 1 Gas 166 2 5 Water Supply 163 9 11 Electric Current 154 7 11 Drugs 105 5 2 Druggists' Sundries 113 3 11 Printing and Stationery 43 2 11 Disinfectants 9 9 0 Stable—Forage Utensils, Repairs, etc. 219 2 4 Various 159 12 4 Cost of Furniture for Extension to Staff Quarters 92 18 11 £7,913 16 9 Disinfecting (Cost of, included in above):— £ s. d. Forage, Utensils, Repairs, etc. 146 1 6 Coachman and Assistant 66 6 0 Disinfecting Porter 57 4 0 Coals 317 5 10 £586 17 4 22 Ambulance (Cost of, included in above):— £ s. d. Forage, Utensils, Repairs, etc. 73 0 9 Coachman and Assistant 66 6 0 £139 6 9 Cost of Maintenance pee Head pee Week. s. d. Patients 4 6½ Staff 7 5 REPORT OF THE INSPECTOR OF CANAL BOATS. To the Chairman and Members of the Willesden Urban District Council. Gentlemen, I beg to present my Annual Report on the work performed under the Canal Boats Acts and the Regulations relating to Canal Boats issued by the Local Government Board. During the year ending December 31st, 1906, the canal at Lower Place has been visited on numerous occasions and every opportunity has been taken to inspect the boats moored alongside the banks of the canal. In previous reports I have drawn attention to the difficulties that exist in Willesden in performing the duties prescribed by the above Acts. In consequence of the fewer number of boats which now discharge their cargoes in the Willesden area the time occupied in seeking opportunities of inspection exceeds that occupied in the inspection itself. Attempts on various occasions have been made to board the boats whilst in motion for the purpose of inspection, but this is not only a dangerous practice but is one generally resented by the occupants. 2 Seventy-four canal boats were inspected, 19 of which were found to contravene the Acts and Regulations, the remaining 55 being found structurally in good condition and with but few exceptions kept in a cleanly state. In no instance was overcrowding observed, but in several cases where the same family worked two boats the arrangements for sleeping were such that overcrowding at night time was likely to occur. No illness of an infectious character was notified during the year as occurring on the boats. Where defects were found to exist, notices were served upon the owners, and in all instances have been complied with. At the end of the year 1905 there were a few notices outstanding which have since been complied with. The following table is a summary of the work done and also shows in detail the contraventions observed during the year:— Total number of boats inspected ... ... ... 74 „ contravening Acts and Regulations 19 „ of infringements ... ... ... 20 „ of infringements remedied ... 20 „ of complaint notes issued ... 13 „ of complaint notes complied with 13 Infringements and nature of same. Absence of certificate—Act 1877 (Sect. 3) ... 4 Marking—Act 1884 (Reg. 7) ... ... ... 2 Painting (Reg. 9) 3 Absence of proper receptacle for water (Reg. 3, i.) 8 Cabins in dirty condition (Reg. 11) ... ... 2 Dilapidations (Reg. 11) ... ... ... ... 1 3 No. of persons occupying boats. 64 men. 58 women. 67 children. I take this opportunity of submitting the following suggestions which would, I feel sure, be of great assistance to Inspectors generally in carrying out the work of inspection, and I would respectfully ask that a recommendation be made to ascertain if it be possible for the Local Government Board to frame a regulation making it compulsory for the master of the canal boat to keep a register on board :— (a) Giving the Christian and surname and the age of each occupant. (b) Giving the date of last painting. (c) Giving the dates and particulars of each complaint note served with respect to the boat. (d) Giving the Captain's name and address. (e) Showing the signature of Inspector at each visit of inspection. I have to report further that on the 12th December, 1906, Mr. Llewellyn, H.M. Inspector of Canal Boats, visited these offices and expressed his satisfaction with the manner in which the duties of Canal Boat Inspector had been discharged in Willesden. I am, Gentlemen, Your obedient servant, H. D. WOODS, Inspector of Canal Boats. Feb. 12th, 1907.