WIL10 Willesden District Urban Council. THE 32nd ANNUAL REPORT OF THE MEDICAL OFFICER OF HEALTH, ON THE Vital Statistics and Sanitary Condition OF THE URBAN DISTRICT OF WILLESDEN, FOR THE YEAR 1907, BY WILLIAM BUTLER, M.B., C.M., D.P.H., Medical Officer of Health of Willesden, Lonbon: Morton & Burt, Ltd., Printers, Paddington and Willesden. 1908. CONTENTS. Page. Vital Statistics 11—33 Infantile Mortality and Birth Enquiries 35—52 Wards and particular areas Vital Statistics 54—63 Infectious Diseases 68—84 Health of Scholars in Public Elementary Schools 86—101 Sanitary Administration 106—118 Factory and Workshop Act 120—125 Local Government Board Tables 127—139 APPENDIX. 1. Hospital Report. 2. Report on Medical Inspection of Children attending Public Elementary Schools. 3. Report on Expenditure of Public Health Department. 4. Quarterly Reports. 3 INDEX. Page. Areas, Wards and other, Vital Statistics of 54—63 Bacteriological Examinations (Hospital Report) 17 Bakehouses 121, 122 Births and Birth Rates 23 — 25 „ Distributed into weeks, according to date of Birth 25 „ Illegitimate 26 Birth Inquiries 50—52 „ and Infantile Death Inquiries, 1906—7 42—44 Births in Wards 24 Cancer 30 & 32 „ Deaths in Wards, Age and Sex Distribution 33 Cerebro-Spinal Meningitis 79 Chart, Measles and Whooping Cough 92 ,, Weekly Deaths, 1906—7 10 Committee, Public Health 8 Common Lodging Houses 110 Complaints received 117 Customs and Inland Revenue Act 112 4 Page. Dairies and Milkshops 115 Deaths, at Age Periods 27 Deaths, Causes of 26, 27, 132—137 „ Cancer, Wards, Age and Sex Distribution. 33 „ Diarrhœa, Rates 1875—1907 36 „ Illegitimate 29 Death Rates, 1875—1907 28 Deaths, Uncertified 29 Diarrhœa, and Meteorological and Seasonal Conditions 14, 15 Diphtheria 77 „ Cases notified under 15 years of Age 81 „ Death Rates, 1875—1907 84 ,, Fatality Rates, 1888—1907 83 „ Incidence Rate, „ 83 „ Ward Incidence 82 Epidemic Diseases, Death Rate from seven principal 34 Erysipelas, Ward Incidence 82 Factory and Workshop Act, 1901 120—125 Factories 56 Health of Scholars in Public Elementary Schools 86—101 House Refuse, Collection of 106—109 Housing of Working Classes Act 114 Homeworkers 121, 124 Ice Cream 113 Illegitimate Births 26 „ Deaths 29 Infantile Deaths, Causes of 138, 139 5 Page. Infantile Mortality and Birth Inquiries 35—52 „ „ Bates, 1875—1907 36 „ „ Remarks on 37—39 Infectious Diseases 68—84 „ „ in Wards, Analysis of 69 „ „ Tables of, 1892—1907 80 Inquests 29 Inspection and Re-inspection of Premises, Summary of 117 Inspection of Manholes 78 Isolation Hospital (see Appendix) 79 Laundries 56, 121 Legal Proceedings 116 Local Government Board Tables 127—139 Marriage Rates 22 Measles 89 „ Death Rates, 1875—1907 84 Meteorological Tables 16, 17 „ Conditions and Death Returns 11—15 Milkshops and Dairies 115 Mortality, Cancer 32 „ Infantile Rates, 1875—1907 36 „ „ Remarks on 37—39 ,, Phthisis, Rates, 1875—1907 32 „ Zymotic, Rates, 1894—1907 34 Mortuary 29 Notification of Infectious Diseases 68, 69 Nuisances, Inspection of 117 6 Page. Offensive Trades 111 Persons per acre 9, 63 Phthisis 30, 32 Population estimated in Drainage Areas 21 „ „ Wards, Midsummer, 1907 20 „ Remarks on 18, 19 Public Health Committee 8 Re-adjustment of Ward Boundaries 64, 65 Rearing of Infants, Tables and Remarks on 42—52 Statistical Summary, 1907 9 Scarlet Fever 72 „ Cases notified under 15 years of age 81 „ Death Rates, 1875—1907 84 „ Fatality Rate, 1888—1907 83 „ Incidence „ „ „ 83 „ Infectiousness of 72—76 „ Map showing distribution of, 1903—7 63 „ Ward Incidence 82 Schools, Eyesight of Scholars in 97, 98 „ Health of Scholars in 86—101 Height and Weight of Scholars in 102, 103 ,, Inspection of 104 ,, Measles and Whooping Cough in 89 ” ” ” ” Diagrams 92 „ Non-Notifiable, Diseases in 88,99—101 Sewage Disposal 110 Typhoid Fever 78 7 Page Typhoid Fever Death Rates, 1875—1907 84 „ ,, Fatality Rates, 1887—1907 83 ,, ,, Incidence Rates 83 Uncertified Deaths 29 Vaccination Returns 71 Vital Statistics 10—34 ,, Wards and Areas 54—63 Ward Boundaries, Readjustment of 64, 65 Whooping Cough Death Rates, 1875—1907 84 Workshops 56, 57, 120 Zymotic Mortality Rates, 1901—1907 34 8 PUBLIC HEALTH COMMITTEE, 1907-8. Chairman : Councillor F. W. DOWNIE. Councillor H. T. ALFORD. Councillor J. ANDREWS. Councillor C. O. BIDDISCOMBE. Councillor W. R. DUNN. Councillor J. E. HILL, J.P., Chairman of Council (ex-officio) Councillor J. W. INGLEDEW. Councillor G. H. JOHNSON. Councillor W. RILEY. 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. Sanit. Insp. Exam. Board. „ Cook, Assistant, ” ” ” Stokes „ „ „ „ A. A. Gibb, Senior Clerk. J. Barker, Clerk. L. Louth, „ 9 STATISTICAL SUMMARY FOR 1907. Population estimated to middle of year 144,376 Area 4,383 acres Population per acre 33 „ Metropolitan District 1,081 „ „ „ 73 „ Brent District 3,302 „ „ „ 20 Soil—The London Clay. Altitude varies from 78 ft. to 242 ft. above Ordnance Datum. Rateable Value, £848,221. s. d. Metropolitan District 3 0 General District Rate Brent District 3 9 Poor Rate (Including Education Rate) 4 2 Rate per 1,000 Population. Marriage Rate 13.1 Birth Rate 29.4 Crude Death Rate 10.7 Recorded Death Rate 11.8 Corrected Death Rate 12.7 Infantile Mortality (per 1,000 births) 106 Zymotic Mortality 1.6 10 PUBLIC HEALTH REPORT For 1907. To the Chairman and Members of the Willesden Urban District Council. Gentlemen, I beg leave to submit the 32nd Annual Report on the Health and Sanitary Condition of Willesden. In the Appendix will be found the Quarterly Statistical Returns already submitted and reference to them will show such seasonal variations as the grouping of the vital and other statistics in each quarter of the year serves to exhibit. A.-VITAL STATISTICS. Chart showing number of Deaths registered each week during the years 1906-1907. 11 METEOROLOGICAL AND SEASONAL CONDITIONS AND THE DEATH RETURNS. The relationship between the prevalence and type of disease and the character of the weather and season of the year is intimate, and is commonly recognised. This may be observed by comparison of the death returns in each quarter of the year. During the last four years, as will be seen from the table below, the least fatal quarter of the year is the second, with a mean percentage of the total deaths of 21*1. The third quarter, with 23.2 per cent. of the total deaths, comes next, the fourth quarter with 25.9 per cent. and the first with 29.7 per cent. of the total, being much the more fatal seasons. Table No. 1. Table showing number of Deaths in each Quarter. Year 1st. Quarter. 2nd. Quarter. 3rd. Quarter. 4th. Quarter. 1904. 476 324 435 410 1905. 536 373 406 429 1906. 446 341 436 449 1907. 551 391 296 466 2,009 1,429 1,573 1,754 The year 1907 differs from the mean of the four and from each of the three preceding years in this, that the least fatal quarter is the third, and this is accounted for by the fact that the second quarter was more fatal than the corresponding quarters of the 3 preceding years, while the third quarter of 1907 was very markedly less fatal than its corresponding predecessors. If, instead of comparing the deaths at all ages in each quarter of the year, we take the deaths of children under 1 year of age and of persons over 55 years of age, the relationship between season and mortality will be still more apparent. 12 Persons at the extremes of life are most susceptible to adverse influences, and it is upon these that the effect of weather in producing mortality is most readily seen. Table No. 2. Showing in the respective years the deaths in each quarter at the earlier and later age periods of life. WILLESDEN. First Quarter Second Quarter. Third Quarter. Fourth Quarter. Under 1. Over 55. Under 1. Over 55. Under 1. Over 55. Under 1. Over 55. 1904 127 1S1 87 102 201 81 94 145 1905 131 192 90 107 171 93 98 134 1906 111 154 85 102 179 104 118 156 1907 149 159 98 123 84 101 120 136 Percentage of total deaths 518 656 360 434 635 379 430 571 26.6 32.1 18.5 21.2 32.6 18.5 22.1 28.0 SEVENTY-SIX GREAT TOWNS. First Quarter Second Quarter. Third Quarter. Fourth Quarter. Under 1. Over 60. Under 1. Over 60. Under 1. Over 60. Under 1. Over 60. 1904 16,373 21,134 13,464 15,205 25,288 13,082 15,763 18,513 1905 14,554 20,450 12,477 15,487 20,404 12,933 13,844 18,072 1906 14,508 19,734 12,008 17,142 23,065 13,426 14,425 18,441 1907 15,158 24,863 12,369 16,913 11,559 13,105 15,739 17,030 Percentage of total deaths 60,593 86,181 50,318 64,747 80,316 52,546 59,771 72,056 24.1 31.2 20.4 23.1 32.0 19.1 23.8 26.1 13 From the above table it will be observed that both in Willesden and in the 76 great towns the most favourable season as regards infantile mortality is the second quarter; while the third quarter is the least favourable, by far the greater proportion of deaths among infants occurring in this quarter. As regards the year 1907, however, it will be noted that both in Willesden and the 76 great towns the third quarter forms a most remarkable exception. Instead of being the most fatal quarter of the year for infants, it is the least fatal. So striking a departure from the usual course over so wide an area must be due to some widely operating and exceptional condition, and this is to be found in the unseasonable weather experienced during the summer months of the year. It may seem remarkable, however, that the season which is most fatal to infants is most favourable to the aged, who find the most inimical conditions in the first and last quarters of the year. Extremes of cold are most injurious to persons of advanced years, who, in consequence of exposure to these conditions, contract pulmonary affections which are most fatal. With infants, however, the relationship between season and mortality is not so direct. It is not so much extremes of cold, as of heat, which are fatal to young lives. If the number of deaths in the third quarter of 1907 be compared with the number of deaths in the second quarter of the 3 preceding years, the numerical resemblance is striking. It will be seen by reference to the Meteorological Tables that the temperatures of the third quarter approximated more to those of the second quarters of other years. The summer and early autumn of 1907, in fact, were cold, and the four-foot earth thermometer, which measures only the increments of heat slowly absorbed by the earth's surface with the advance of the season, never at any period registered a temperature higher than 55° F. This phenomenon is not only rare, but very important. 14 The normal high mortality among infants in the third quarter of the year is due to zymotic diarrhcea. If we compare the deaths from this disease in the third quarter of 1907 with the deaths in corresponding quarters of previous years we get the following results. Table No. 3. DEATHS FROM ZYMOTIC DIARRHCEA AND ENTERITIS IN THIRD QUARTER OF THE YEAR. Diarrhœa. Enteritis. 4ft. earth temperature 1904. 138 16 July. Aug. Sept. 58.75 59.25 58.75 1905. 88 10 58.50 58.75 58.25 1906. 134 16 57. 58.25 58.75 1907. 14 7 54. 55. 55. The low mortality from Zymotic Diarrhoea in 1907 is just what would be expected from the meteorological facts of the summer and autumn. Over 20 years ago Dr. Ballard arrived at the following conclusions concerning Zymotic Diarrhœa:— (a) " The summer rise of diarrhœal mortality does not commence until the mean temperature recorded by the four-foot earth thermometer has attained somewhere about 56° F., no matter what may have been the temperature previously attained by the atmosphere or recorded by the one-foot earth thermometer. (b) The maximum diarrhœal mortality of the year is usually observed in the week in which the temperature recorded by the fourfoot earth thermometer attains its mean weekly maximum. (c) The decline of the diarrhœal mortality is in this connection not less instructive, perhaps more so, than its rise. It coincides with the decline of the temperature recorded by the four-foot earth thermometer, which temperature declines very much more slowly than 15 the atmospheric temperature, or than that recorded by the one-foot earth thermometer ; so that the epidemic mortality may continue (although declining), long after the last-mentioned temperatures have fallen greatly, and may extend some way into the fourth quarter of the year." The records of the four-feet earth thermometer in Willesden and their association in 1907 with phenomenally low diarrhoeal mortality form a striking instance, almost within experimental limits, of the truth of these provisional conclusions of Dr. Ballard. It is to be noted that the reduction in infantile mortality during the 3rd quarter of 1907, was general throughout the 76 great towns, and was doubtless due to the same causes. In the case of no other disease has the relationship to meterological conditions been so definitely established, and this relationship sufficiently explains the anomalous seasonal distribution of deaths in the quarterly returns. 16 Table No. 4. METEOROLOGICAL OBSERVATIONS. 1907. Month. Highest by Day. Lowest by Night. Range in Month. Mean of all Highest. Mean of all Lowest. 4-foot Earth Thermometer. Mean degree of Humidity. Rainfall in inches. Number of days on which Rain was measured. Hours of bright Sunshine. Hours of bright Sunshine registered at Greenwich. Max. Min. January 51.00 21.00 30.00 42.81 33.49 47.25 45.25 89° .95 7 60.25 37.4 February 52.00 21.00 31.00 41.95 32.24 45.25 43.75 85° 1.08 9 76.75 57.8 March 69.00 22.00 47.00 53.23 33.20 44.75 43.75 82° .87 11 174.50 170.1 April 70.00 28.50 41.50 55.51 38.71 46.25 45.00 78° 3.10 13 126.99 124.0 May 79.50 32.00 47.50 61.01 44.34 49.00 46.25 71° 1.70 13 144.75 159.1 June 73.50 40.25 33.25 64.43 49.56 51.75 49.00 72° 2.41 18 155.00 167.6 July 77.50 40.00 37.50 67.20 50.43 54.00 52.00 72° 2.02 16 182.25 188.9 August 76.00 40.00 36.00 68.43 51.10 55.00 54.25 72O 2.51 13 167.00 173.0 September 76.00 32.50 43.50 68.47 47.91 55.00 55.00 76° .52 4 151.75 154.4 October 65.50 34.00 31.50 58.18 44.06 55.00 53.00 81° 3.65 20 75.25 90.0 November 61.50 27.00 34.50 51.54 39.63 53.00 50.00 89° 1.95 9 39.00 46.0 December 57.00 27.00 30.00 46.27 37.55 50.00 47.00 88° 3.43 13 35.25 47.3 Means 67.38 30.44 36.94 56.67 41.85 50.52 48.69 80° 24.19 146 1388.74 1415.6 Mean of last 5 years 72.35 18.58 39.47 56.37 39.70 51.38 48.74 79O Total Total Total Total 24.74 130 17 Table No. 5. meteorologigal OBSERVATIONS. 5 years 1902-1906 inclusive. Month, Highest in 5 Years. Lowest in 5 Years. Mean Annual Range. Mean Highest by Day. Mean Lowest by Night. 4 feet Earth Thermometer. Mean Mean Humidity 4 Years. Mean Rainfall in Inches. Mean No. of Days on which Rain was Measured (4 Years). Maximum in 5 Years, Minimum in 5 Years. January 60.5 1906 14.0 1906 35.2 45.1 32.6 45.85 43.65 87° 1.96 11. February 57.9 1903 10.7 1902 33.2 44.7 32.7 43.95 42.72 86° 1.03 9. March 66.9 1903 14.5 1906 39.3 47.25 34.0 44.1 42.65 80° 2. 14.5 April 70.0 1906 15.0 1906 41.5 54.16 33.5 45.95 43.85 75° 1.03 9. May 79.25 1905 17.0 1906 47.0 59.7 39.1 49.31 46. 71° 2.07 13. June 81.7 1905 24.0 1906 42.2 66.75 45.1 53.47 49.45 72° 3.29 12. July 86.5 1904 37.25 1905 41.6 74.6 51.1 57.95 53.2 68° 2.06 7.7 August 87.0 1904 25.5 1905 43.6 70.0 49.9 58.45 57.57 70° 2.58 11.2 September 92.0 1906 26.5 1905 44.0 64.25 47.3 58.45 56.60 76° 1.97 8.5 October 69.0 1906 10.0 1905 37.8 57.0 41.77 56.60 53.45 82° 2.67 12. November 60.5 1906 11.5 1905 34.5 48.67 35.65 53.35 49.45 88° 2.58 12.5 December 56.9 1902 17.0 1906 33.8 44.28 33.7 49.10 46.25 88° 1.50 10. Means 72.35 18.58 39.47 56.37 39.70 51.38 48.74 79° total 24.74 total 130.4 b 18 POPULATION. The estimated population to Midsummer, 1907, is 144,376. This is estimated on the assumption that the average number of persons per occupied house has remained constant for houses existing at the census (1901), the number of persons occupying houses built since 1901 being ascertained by means of a special census taken by the Council. There is some reason to believe that this method slightly under-estimates the population. In a new district such as Willesden the number of persons per house tends to increase with the age of the house. Thus in the houses recently built it is found that the average number of persons per house is fewer (6.57 per house as compared with 7.16 per house) than that found at the census for the whole district. It appears that recently-erected houses are preferred by nowly-married couples, and so it is that after a few years there is an increased number of persons in houses which have been thus occupied. Another fact tending to raise the average number of persons per house in older houses is the adaptation of houses originally built for one family to tenement dwellings accommodating two or more families. It is probable therefore that a more correct estimate of the population would be based on the assumption that the average number of persons per house remained constant for all houses—new and old together—with that ascertained at the census, since the census datum is an expression of the outcome of the two tendencies, namely of old houses to exceed the average, and of new houses to fall below the mean number of persons per house, ascertained at the end of an intercensal period. The population of Willesden on this assumption was 146,107 at Midsummer. For calculating rates, however, the lower estimate has 19 been adopted as was done in the 1906 Annual Report, and in the second and third Quarterly Reports of 1907. The rates of the quarterly reports for the first and fourth quarters of the year respectively are calculated on the estimated population at Christmas. It is to be noted that both these estimates fall well below that of the Registrar General (149,192) which assumes the rate of increase to have remained constant with that of the previous intercensal period. The rapid decline of building operations in Willesden during recent years necessarily leads to an overestimate by methods which cannot take cognizance of this fact. B 2 20 Table No. 6 POPULATION ESTIMATED TO CHRISTMAS 1906 AND MIDSUMMER, 1907. name of WARD. 1906.7. Population estimated on the number of houses in occupation in each Ward as ascertained by special enumeration and Council's Census. Houses in Occupation. Total Number of Empty Tenements. No. of Houses recently erected but unoccupied. No. of Houses in course of erection. Percentage of empties exclusive of houses recently erected. Percentage of empties exclusive of houses recently erected, Midsummer 1906. Percentage of empties inclusive of houses recently erected. Percentage of Houses empty at Census. No. of Houses in Ward. No. of Empty Houses. 1 Room. 2 Rooms. 3 Rooms. Over 3 Rooms. Church End Mids'r. 24215 3626 179 — — 187 28 13 10 4.9 4.5 5.3 5.96 Xmas. 24298 3604 144 5 1 181 70 12 13 4.0 4.3 Harlesden Mids'r. 22166 3649 223 — 4 122 61 39 26 6.1 6.8 7.2 3.88 Xmas. 21920 3594 220 7 5 143 84 51 48 6.1 7.5 Kensal Green Mids'r. 29162 4152 113 6 11 65 111 2 4 2.7 4.7 2.8 2.92 Xmas. 29124 4136 114 14 21 153 20 8 4 2.8 2.9 S. Kilburn Mids'r. 14738 1316 40 7 41 81 — — — 3.0 1.5 3.0 1.26 Xmas. 14645 1316 48 17 29 40 6 — — 3.6 3.6 Mid. Kilburn Mids'r. 12322 1898 88 6 18 49 11 — — 5.5 5.6 5.5 4.16 Xmas. 12354 1598 84 15 16 56 12 — — 5.3 5.3 N. Kilburn Mids'r. 9982 1683 96 6 11 36 17 1 7 5.7 3.9 5.8 2.62 Xmas. 10070 1683 82 5 3 27 32 1 1 4.9 4.9 Willesden Green .. Mids'r. 31174 5353 232 7 1 72 94 125 78 4.3 5.8 6.7 7.37 Xmas. 30581 5260 226 — 2 44 88 158 54 4.3 7.3 Willesden U.D. aggregate of the Wards Mids'r. 143759 21377 971 32 86 612 322 180 125 4.5 5.1 5.4 4.02 Xmas. 142992 21191 918 63 77 644 312 230 120 4.3 5.4 Population as estimated to Midsummer, 1907, by the Register-General, 149,192. Population estimated on the assumption that the average number of persons per house at census has remained constant for the whole of Willesden—146,107 Midsummer, 1907 ; 145,155 Christmas, 1906. 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 = 144v376 Midsummer, 1907; 143,830 Christmas, 1906 21 POPULATION IN THE BRENT AND METROPOLITAN DRAINAGE AREAS. Estimated to Midsummer, 1907. Table No. 7. Houses. Population. Brent Area— Church End 3,699 23,831 Harlesden 2,355 14,105 Kensal Green 5 37 Willesden Green 5,049 28,670 Total 11,108 66,643 Metropolitan Area— Harlesden 1,339 8,018 Kensal Green 4,167 30,095 South Kilburn 1,315 14,992 Mid Kilburn 1,621 12,681 North Kilburn 1,729 10,592 Willesden Green 444 2,519 Total 10,615 78,897 Willesden Urban District 21,723 145,540 22 MARRIAGES. In the following Tables are given the statistics relating to Marriages in Willesden. As will be seen the marriage rate is increasing in Willesden. This is in contrast to the rate for England and Wales, which is declining. TABLE. 8. —MARRIAGES. 1907. First Quarter. Second Quarter. Third Quarter. Fourth Quarter. Total. Church of England 98 134 251 150 633 Nonconformist Churches — — — — 99 Registrar's Office — — — — 217 Totals 98 134 251 150 949 The total of 949 marriages for the year gives a marriage rate of 13.1 per 1,000 persons living. Since 1900 the marriage rates per 1,000 have been as follows:— Marriage Rate per 1900 1901 1902 1908 1904 1905 1906 1907 1,000 persons 10.8 11.2 12.4 12.9 12.4 12.7 13.1 13.1 Percentage performed otherwise than in Church of England 26.8 28.4 26.1 25.1 29.1 32.9 33.1 33.3 Ditto, England and Wales — — — 34.9 35.8 34.6 36.8 — 23 BIRTHS. The Birth Rate for the year is the lowest recorded for Willesden, although in 1890 it fell to the same level. The rate, 29 4 per 1,000 persons living, is higher than the corresponding rate for England and Wales. When, however, the rate is calculated on the number of women between 15 and 45 years of age— approximately the procreative age period of women—it is found that the rate for Willesden falls considerably below that of England and Wales. It will be seen moreover from the table that the rate, thus calculated, has very rapidly declined during the last four years. So rapidly in fact has it fallen that if the age distribution of the female population has not varied from that of the census, Willesden has now a much lower birth rate in proportion to the number of women of procreative age than has 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 32.9 116.5 England and Wales, 1904 27.9 111.8 Willesden, 1905 29.8 107.4 England and Wales, 1905 27.2 108.9 Willesden, 1906 30.1 107.6 England and Wales, 1906 27.1 108.3 Willesden, 1907 29.4 105.8 Table No. 9. BIRTHS REGISTERED IN WILLESDEN. 1907. Boys. Girls. Totals. First Quarter 509 531 1,040 Second „ 560 546 1,106 Third „ 539 506 1,045 Fourth „ 519 460 979 *In Queen Charlotte's Hospital 27 50 77 Totals 2,154 2,093 4,247 * As heretofore these births are included in the birth returns for Willesden, the mothers having been removed from Willesden to Queen Charlotte's Hospital immediately prior to their confinement. 24 Table. No. 10. BIRTHS DISTRIBUTED INTO WARDS. WARDS. First Quarter. Second Quarter. Third Quarter. Fourth Quarter. Total. Rate per 1,000 of Population. Church End 237 232 223 201 893 36.9 Harlesden 156 187 170 146 659 29.7 Kensal Green 200 225 193 194 812 27.8 South Kilburn 107 124 102 113 446 30.3 Mid Kilburn 90 92 103 84 369 29.9 North Kilburn 61 48 55 48 212 21.2 Willesden Green 200 220 219 217 856 27.5 Totals 1,051 1,128 1,065 1,003 4,247 29.4 Table No. 11. Birth-Rate. 1875 1876 1877 1873 1879 1880 1881 1882 1883 1884 1885 Willesden 44.7 43.4 41.1 40.2 37.6 38.3 31.4 33.3 333 34.1 35.6 England and Wales 35.4 36.3 36.0 35.6 34.7 34.2 33.9 33.8 33.5 33.6 32.9 Birth-Rate 1886 1887 1888 1889 1890 1891 1892 1893 1894 1895 1896 Willesden 35.7 33.8 32.1 33.7 29.4 33.1 31.7 32.5 30.7 31.2 32.2 England and Wales 32.8 31.9 31.2 31.1 30.2 31.4 30.4 30.7 29.6 30.3 29.6 Birth-Rate. 1897 1898 1899 1900 1901 1902 1903 1904 1905 1906 1907 W illesden 31.0 31.5 31.5 31.2 33.1 31.3 31.6 32.9 29.8 30.1 29.4 England and Wales 29.6 29.3 29.1 28.7 28.5 28.5 28.4 27.9 27.2 27.0 26.3 25 Table No. 12. SHOWING THE NUMBER OF CHILDREN BORN IN EACH WEEK OF THE YEAR DURING 1905, 1906, AND 1907. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 1905. 67 68 75 81 78 84 88 85 74 88 79 103 81 69 81 65 96 69 80 73 96 67 99 85 82 78 1906. 92 87 79 76 80 81 82 83 94 84 92 78 70 85 84 83 80 76 60 85 80 91 88 91 78 84 1907. 55 73 10 93 73 68 85 77 105 90 90 84 69 89 67 86 88 74 80 85 79 72 82 74 80 80 Totals. 214 228 229 250 231 233 255 245 273 262 261 265 220 243 232 234 264 219 220 243 255 230 269 250 240 242 Means. 71.3 76.0 76.3 83.3 77.0 77.6 85.0 81.6 91.0 87.3 87.0 88.3 73.3 8I.0 77.3 78.0 88.0 73.0 73.3 81.0 85.0 76.6 89.6 83.3 80.0 80.6 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 1905. 89 86 71 86 74 67 78 66 64 76 86 71 81 76 73 66 95 70 79 75 76 85 87 78 78 86 1906. 85 80 83 81 67 63 89 76 73 90 83 69 84 83 77 56 77 67 66 65 85 95 78 79 87 88 1907. 93 79 95 94 77 71 73 63 83 65 80 72 81 76 81 76 79 69 75 61 77 88 68 105 91 85 Totals. 267 245 249 261 218 201 240 205 220 231 249 212 246 235 231 198 251 206 220 201 238 268 233 262 256 259 Means. 89.0 81.0 83.0 87.0 72.6 67.0 80.0 68.3 73.3 77.0 83.0 70.6 82.0 78.3 77.0 66.0 83.6 68.6 73.3 67.0 79.3 89.3 77.6 87.3 85.3 86.3 Note.—The above Table shows the births distributed according to the date of birth, differing from the usual birth returns which give the number of births registered in the respective weeks to which they relate. 26 ILLEGITIMATE BIRTHS. There were 98 illegitimate births in Willesden, as compared with 111 last year, but in addition to the 98, there were 27 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. DEATHS. The deaths registered in the District were 1,545: males, 767; females, 778. Those registered outside the District of persons belonging to it were 165, giving a total of 1,710. There were six deaths registered in the District of persons not belonging to it, making 1,704 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. The last five 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 1907 12.8 12.2 12.4 11.8 11.8 The death-rates for 1906 and 1907 are 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. 1907. Measles 84.. 44 51 25 45 Whooping cough 67 10 67 25 75 Pulmonary affections 291 261 268 235 330 Disease of nervous system 1166 126 147 134 161 Notwithstanding the low death-rate, which as already pointed out, is largely due to diminished mortality from Zymotic Diarrhoea, 27 there is a considerable increase in deaths from Measles, Whooping Cough, and Pulmonary Affections. Nevertheless the increase in deaths directly attributed to Measles and Whooping Cough has not been sufficient to compensate for the saving in deaths from Diarrhoea and the Zymotic death rate, 1.5 per 1,000, is the lowest hitherto recorded. The great increase in deaths from Pulmonary Affections, is, however, largely to be set down to the prevalence of Measles and Whooping Cough. As I have repeatedly pointed out when Measles and Whooping Cough prevail, many children dying of these affections have their deaths attributed to the pulmonary complications to which they give rise. Table No. 13. 1907. DEATHS FROM ALL CAUSES AT THE FOLLOWING AGE PERIODS. 0 to 1 1 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 76 75 to 85 85 and up. All Ages. 1st Quarter 149 100 7 7 5 13 33 30 48 45 56 45 13 551 2nd „ 98 58 9 5 8 3 24 33 33 42 44 28 9 391 3rd „ 84 28 3 2 1 10 17 18 32 32 39 28 2 296 4th „ 120 65 19 5 8 11 19 43 40 40 57 32 7 466 Males 262 131 16 6 11 24 41 56 86 73 78 50 12 846 Females 189 120 22 13 11 13 52 65 67 86 118 83 19 858 1907 451 251 38 19 22 37 93 121 153 159 196 133 31 1,704 28 Table No. 14. DEATH RATES. 1875 to 1907. Year. Number of Deaths. Rate per 1,000. Year. Number of . Deaths. Rate per 1,000. 1875 385 21.4 1892 945 14.4 1876 401 21.7 1893 1,070 15.5 1877 346 17.7 1894 917 13.2 1878 441 21.4 1895 1,143 14.5 1879 376 16.8 *1896 1,210 + 102 14.1 1880 471 18.7 1897 1,173 + 170 14.4 1881 490 17.6 1898 1,197 + 191 13.9 1882 587 18.1 1899 1,448 + 195 15.2 1883 538 15.4 1900 1,359 + 218 13.6 1884 530 14.7 1901 1,325 + 204 13.2 1885 632 16.2 1902 1,447 + 262 13.9 1886 685 15.5 1903 1,507 + 148 12.8 1887 701 14 .3 1904 1,479 + 180 12.2 1888 835 15.8 1905 1,562 + 182 12.4 1889 686 12.0 1906 1,501 + 171 11.8 1890 882 14.4 1907 1,539 + 165 11.8 1891 860 13.8 * Deaths outside District included for first time. 29 INQUESTS. Total number of Inquests held in Willesden on residents during 1907—89. On non-residents—3. The following is an abstract of the verdicts. Residents:— Cerebro Spinal Meningitis 1, Diarrhoea 1, Consumption 1, other Tubercular Diseases 1, Bronchitis 1, Pneumonia 15, Heart Disease 14, Accidents 27, Murder 2, Suicide 3, Congenital Defects 2, Diseases of Nervous System 11, Diseases of Digestive System 4, Urinary System 1, other causes 5. Total 89. Non-residents:—Accidents 1, Suicide 1, all other causes 1. Total 3. Table 15. RETURN OF INQUESTS, &c., HELD DURING THE YEAR ENDED 31st DECEMBER, 1907. Mortuary. Inquests. Infectious Cases. Removed for Accommodation. Total. No. of Post Morterns. Male. Female. Church End Kilburn 58 34 — 39 131 78 UNCERTIFIED DEATHS—8. Causes ascribed—Consumption 1, Senile Decay 2, Premature Birth 2, Cerebral Haemorrhage 1, Neuritis 1, Heart Disease 1. ILLEGITIMATE DEATHS, 1907. Illegitimate deaths in Willesden, excluding one belonging to another district, 32. Causes—Measles 1, Whooping Cough 3, Diarrhoea 1, Tubercular Disease 1, Pneumonia 6, Premature Birth 4, Marasmus 5, Diseases of Digestive System 7, all other causes 4. 30 PHTHISIS. The deaths from Phthisis number 138, and give a phthisical deathrate of 955 per million. This is considerably lower than the quinquennial average 1901—05 for both sexes in England and Wales, which equals 1214 per million. The phthisical death-rate for the corresponding period in Willesden is 934 per million, a rate slightly lower than that for 1907. The mean rate for Willesden during the last 27 years is 1,000 per million, so that the death-rate from phthisis is practically stationary in this district. This is far from satisfactory. Willesden being a new district which, for practical purposes, may be taken to have grown within the period used for comparison—the population in 1881 numbering only 27,000—we have the phenomenon of a low but practically stationary phthisical death-rate extending over a period during which a most marked decline has been observed in less favoured areas. Assuming that the conditions of modern housing have influenced this decline, the facts are suggestive that Willesden early attained the full advantages derivable from this condition, and that further reduction in the death-rate from phthisis is to be looked for as a result of other changes than those comprised in better housing. It would, however, be premature to conclude that this is so, for it must be borne in mind that in recent years there has been a marked increase in the number of houses of the industrial class, and these, though in many respects superior to older houses of the same class, still preserve some of their worst features. This is notably the case in respect of size of rooms, an extremely important fact in relation to phthisis. Reference to the small size of rooms in recently erected houses will also be found under the heading "Customs and Inland Revenue Acts." CANCER. There were 108 deaths ascribed to Cancer, giving a cancer death rate of 748 per million for the year. 31 The mean annual death-rate from cancer for the last 7 years is 791 per million; for the septennium immediately preceding, it was 501 per million. This material increase in the number of deaths from cancer corresponds to an increase which has been observable throughout the country, and the only satisfactory feature in the local rate is that it has during the last two years fallen below the septennial mean. 32 Table No. 16. PHTHISIS AND CANCER MORTALITY. 1875 to 1907. Year. Number of Deaths from Phthisis. Bate per 1,000 of Population. Number of Deaths from Cancer. Rate per 1,000 of Population 1875 37 2.03 7 .385 1876 24 1.30 11 596 1877 32 1.64 8 .410 1878 40 1.94 16 .727 1879 35 1.56 10 .447 1880 36 1.42 8 .317 1881 44 1.60 - 1882 27 0.83 14 .431 1883 56 1.60 10 .285 1884 35 0.96 20 .553 1885 55 1.42 21 .543 1886 35 0.79 18 .406 1887 47 0.95 12 .244 1888 47 0.87 36 .680 1889 55 0.96 25 .437 1890 73 1.18 29 .472 1891 67 1.07 36 .578 1892 65 0.98 35 .531 1893 73 1.05 87 .535 1894 72 0.98 32 .434 1895 96 1.08 44 .555 1896 88 1.02 51 .594 1897 86 0.92 30 .322 1898 100 1.00 46 .462 1899 135 1.25 55 .511 1900 103 0.89 73 .634 1901 96 0.81 85 .746 1902 111 0.909 97 .794 1903 113 0.873 107 .827 1904 141 1.04 111 .825 1905 146 1.037 115 .817 1906 139 .981 111 .783 1907 138 .955 108 .748 33 Table 17. CANCER DEATHS, 1907 (Distributed According to Age and Sex.) Wards. 15 to 20 20 to 25 25 to 35 35 to 45 45 to 55 55 to 65 65 to 76 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. Church End ... ... ... ... ... 1 ... 2 1 4 1 1 1 2 1 ... ... ... 4 10 14 Harlesden ... 1 ... ... ... 1 ... ... ... 1 ... 6 1 1 1 2 ... ... 2 12 14 Kensal Green ... ... ... 1 ... ... ... 1 3 2 6 4 1 2 ... 1 ... ... 10 11 21 South Kilburn ... ... ... ... ... ... ... 1 1 2 1 1 3 ... ... 1 ... 1 5 6 11 Mid Kilburn ... ... ... ... ... ... ... 2 2 6 ... 2 ... 4 ... 1 ... ... 2 15 17 North Kilburn ... ... ... ... ... ... ... ... ... ... ... 3 2 2 2 1 ... ... 4 6 10 Willesden Green ... ... ... ... ... l 1 2 ... ... 3 5 4 3 1 1 ... ... 9 12 21 Infirmary ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Willesden U. D. ... 1 ... 1 ... 3 l 8 7 15 11 22 12 14 5 7 ... 1 36 72 108 34 Table No. 18. ZYMOTIC MORTALITY DURING THE LAST 14 YEARS. RATE PER 1,000. 1884. 1895. 1896. 1897. 1898 1819. 1900. 1901. 1902. 1903. 1904. 1905. 1906. 1907. 1907. Rate for 76 Great Towns. Rate for Eng. and Wales less the 218 towns. Scarlet fever 0.09 0.21 0.19 0.11 0.09 0.14 0.10 0.10 0.08 0.08 0.01 0.03 0.07 0.13 0.12 0.06 Enteric fever 0.15 0.15 0.11 0.11 0.08 0.08 0.12 0.08 0.07 0.06 0.05 0.08 0.04 0.02 0.07 0.06 Diarrhœa 0.42 0.07 0.83 1.03 0.99 1.58 1.19 1.05 0.81 0.62 1.08 0.71 1.17 0.37 0.40 0.18 Diphtheria 0.21 0.42 0.32 0.68 0.65 0.42 0.24 0.45 0 .40 0.07 0.14 0.09 0 .11 0.12 0.17 0.15 * Zymotic death.rate 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 1.48 1.54 0.91 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 11.8 15.4 14.7 * Zymotic death-rate is the death-rate from the seven principal zymotic disease, viz., Small Pox, Measles, Scarlet Fever, Diarrhœa, Diphtheria, Whooping Cough, and Typhoid Fever. 35 INFANTILE MORTALITY. C 2 36 Table No. 19. INFANTILE MORTALITY AND DIARRHœA DEATHS. 1875 ro 1907. Year. Infantile Deaths. Infantile Mortality Hate per 1,000 Births. Deaths from Diairhœa. Rate per 1,000 of Population 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 873 150 56 0.70 I896 460 167 72 0.83 1897 444 155 122 1.31 1898 427 136 102 1.02 1899 537 159 169 1.57 1900 497 139 137 1.19 1901 495 131 123 1.14 1902 436 130 104 0.85 1903 509 123 81 0.61 1904 509 115 146 1.08 1905 490 117 100 0.71 1906 493 115 157 1.17 1907 451 106 54 0.47 37 INFANTILE MORTALITY. The Infantile Mortality Rate for the year is 106 per 1,000 births. This is the lowest rate hitherto experienced in Willesden. Although infantile mortality has shown a steady decrease during the last 30 years and has been exceptionally reduced during recent years owing to the special efforts directed to this end there can be no question that the low mortality of 1907 was materially influenced as already pointed out by the favourable meteorological features of the year. Although comparatively the infantile mortality rate is a low one, it is as a matter of fact still far in excess of what might be achieved under reasonable conditions of infant upbringing. That there should be great wastage of infant life is in accord with natural law. That is to say observed fact discloses this phenomenon throughout the animal world. It does not mean that there is necessarily any merit or advantage in this order of things. It is merely an observed fact that organisms at lower levels of development are subject to a high rate of destruction. This is sometimes referred to as a "provision" to secure continuity of the species and it is inferred that not infrequently exuberant reproduction and an accompanying excessive destruction leads to survival of the fittest. This means no more than that the fittest are the survivors and the truism has not led us one step towards saying whether these are desirable or not. This distinction is important, for many people think that in the fittest there has been secured some developmental advantage, whereas all that has been secured is the survivors under existing conditions. And these existing conditions may be altogether undesirable and the survivors even less so. Applied to the problem of infantile mortality it is simply the sheerest nonsense to suppose that a great destruction of infants every year is promoting the culture of the race, and that the bad conditions which permit of this are adding to the strength and physical vigour 38 of the unfortunate surviving victims of such an undesirable environment. It is necessary to say these things because such unfortunate and pernicious views prevail in consequence of the prevalent misunderstanding of what has become scientific jargon It is not to be expected, and probably it is undesirable, that every infant which may have the misfortune to be ushered into the world should continue an indefinite wretched mortality in despite of its inherent physical unfitness to live its life under reasonably controlled conditions. But that is no reason why normally constituted human babies, who constitute by far the greater majority of those who are born, should be destroyed by the inhuman conditions to which so vast a number are subjected. It is wretched bad economy to bring a baby into the world simply to give it the worst chance of surviving, for, should it die, as most probably it will, the lowest cost to the parent will not be less, on the most sordid estimate, than .£6 to £10, without counting the trouble, the loss of time and dislocation of affairs that such an experiment entails. Such unnatural, anti-social conduct might be thought to stand self-condemned; but whether of malice aforethought, from radically wrong ideas, from ignorance, or from an over-estimated force of circumstance, the fact remains that a large proportion of our population resorts, wittingly or unwittingly, to this barbarous practice. The following tabulation of facts, ascertained in the course of enquiries into the methods of rearing infants born in Willesden, tells its own tale Of course, the great majority of mothers wish to do the best they can for their infants, and it is pitiable that so many should lack the simple knowledge necessary to achieve their most primitively earnest desire. As a result of nearly 3,000 enquiries made during the last two years, I am able to give the following table, showing at each month of age the manner in which infants are fed, whether surviving the 3rear of their birth or not. Unfortunately, after 3 months of age the number of children about whom any knowledge has been acquired is too limited to be taken as an index of what generally occurs. 39 Table No. 20. Table showing at each month of age, manner of feeding, as ascertained upon enquiry into 2,831 births, Months. Number enquired into. 0-1 -2 -3 -4 -5 -6 Ove 6 612 1414 547 111 51 45 183 Bread Fed. Infants alive at end of year 369 993 330 47 4 1 2 Infants dead within year 97 33 23 7 9 14 49 Total 466 1026 353 54 13 18 51 Percentage 75 72 64 49 25 40 28 Breast and Hand Fed. Infants alive at end of Year 17 150 59 10 2 2 Infants dead within Year 9 10 22 6 5 4 25 Total 26 160 81 16 7 6 25 Percentage 4 11 14 14 13 13 13 Hand Fed. Infants alive at end of Year 36 151 56 10 5 1 1 Infants dead within Year 84 77 57 31 26 20 106 Total 120 228 113 41 31 21 107 Percentage 10 16 20 37 60 46 58 Generally, it may be said that the enquiries of 1907 confirm in their results those of 1906. The results of the two years' enquiries (litter only in negligeable proportions. The following table gives the results of the enquiries:— 41 TABLES 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. 42 Table No. 21—A. Table giving Summary of Results of Birth and Infantile Death Enquiries for the Years 1906 and 1907. Breast Fed. Breast and 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. Infant surviving at end of year. 1906 1126 217 179 200 124 824 1045 958 932 1064 1201 235 716 — — — — Mths — 1522 1907 600 72 43 54 44 400 477 401 428 444 567 137 281 — — — — — 715 Totals 1726 289 222 254 168 1224 1522 1359 1360 1508 1768 372 997 — — — — — 2237 Percentage 77 13 10 11 7 54 68 60 60 67 79 16 44 — — — — — — Infants dead within the year. 1906 84 52 195 110 58 161 184 165 139 222 210 85 118 — — — — — 331 1907 124 43 137 76 64 183 163 133 157 220 235 82 130 — — — — — 304 Totals 208 95 332 186 122 344 347 298 296 442 445 167 248 — — — — — 635 Percentage 33 15 52 29 19 54 54 47 46 70 70 26 39 — — — — — — Grand Total. 1906-7 1934 384 554 440 290 1568 1869 1657 1656 1950 2213 539 1245 — — — — — 2872 Percentage 67 13 19 15 10 54 65 57 57 67 77 18 43 — — — — — — 43 Table No. 21—B. Infants dead within the year. Diarrhoea and Enteritis. Breast Fed. Breast and 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 Inst:red. Mother attended by Doctor. Midwife. Promises to improve. Age of Mother. Mean age at death. Totals in each class. 1906 7 13 104 54 31 69 49 64 69 82 69 37 44 84 37 — — — 124 1907 3 5 38 17 11 33 15 14 34 34 39 12 16 27 18 — — — 46 Totals 10 18 142 71 42 102 64 78 103 116 108 49 60 111 55 — — — 170 Tuberculosis. 1906 3 1 14 4 2 10 9 8 7 10 12 7 8 9 8 — — — 18 1907 7 6 5 4 4 11 11 9 10 14 12 4 6 10 7 — — — 18 Totals 10 7 19 8 6 21 20 17 17 24 24 11 14 19 15 — — — 36 Marasmus 1906 8 9 32 16 6 22 26 20 12 35 34 8 9 31 15 — — — 49 1907 9 3 33 12 14 29 19 22 15 36 37 12 16 31 13 — — — 45 Totals 17 12 65 28 20 51 45 42 27 71 71 20 25 62 28 — — — 94 Pneumonia. 1906 14 11 11 18 4 15 26 23 16 20 22 7 16 25 11 — — — 36 1907 26 5 15 11 10 21 27 24 23 26 34 16 24 30 14 — — — 46 Totals 40 16 26 29 14 36 53 47 39 46 56 23 40 55 25 — — — 82 Bronchitis. 1906 13 2 8 4 3 10 15 12 6 18 18 5 11 12 9 — — — 23 1907 24 1 9 3 3 23 23 16 13 26 28 7 13 22 12 — — — 34 Totals 37 3 17 7 6 33 38 28 19 44 46 12 24 34 21 — — — 57 Whooping Cough. 1906 22 9 14 11 6 28 23 18 32 36 37 14 30 32 12 — — — 45 1907 8 6 6 6 4 8 15 7 10 13 14 3 8 12 7 — — — 20 Totals 30 15 20 17 10 36 38 25 42 49 51 17 38 44 19 — — — 65 44 TABLE NO. 21—C PERCENTAGES. Results of Enquiries during Two Years Breast Fed. Breast and 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 the year. All diseases. 33 15 52 29 19 54 55 47 47 70 70 26 39 — — — — Mths 4.5 — Diarrhoea and Enteritis. 6 10 84 42 25 60 38 46 60 68 63. 29 35 — — — — — — Tuberculosis. 28 19 53 22 16 58 55 47 47 67 67 30 39 — — — — — — Marasmus. 18 13 69 30 21 54 48 44 28 75 75 21 26 — — — — — — Pneumonia. 49 19 32 35 17 44 64 57 47 56 68 28 49 — — — — — — Bronchitis. 65 5 30 12 10 58 67 49 33 77 80 21 42 — — — — — — Measles and Whooping Cough. 46 23 31 26 15 55 58 38 64 75 78 26 58 — — — — — — 45 Table No. 22.—D. Table giving Summary of Results of Birth Enquiries for the Year 1907. Children alive at end of year. Breast Fed. Breast and 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 Dr. Midwife. Promises to Improve. Age of Mother. Mean Age at Death. Totals in each Class. All children in family surviving 1st child 115 83 17 15 16 16 74 68 66 87 81 101 25 43 — — — — — 115 2nd ,, 98 85 5 8 5 4 64 65 56 71 67 56 15 48 — — — — — 98 3rd „ 72 65 2 5 3 3 46 53 42 43 51 59 10 26 — — — — — 72 Nth „ 183 167 14 2 8 6 97 133 104 88 108 144 30 64 — — — — — 183 Other children in family dead. 1 dead 03 22 7 14 10 59 81 63 74 74 98 34 56 21 111 132 2 ,, 155 8 1 5 1 39 43 41 39 36 43 15 28 13 50 25 — — 64 Nth ,, 42 4 5 3 4 21 34 29 26 27 36 8 16 9 42 26 — — 51 All children in family surviving. Percentage. 1st child 72 15 13 14 14 64 59 57 76 70 88 22 37 — — 37 23.8 2nd „ 87 5 8 5 4 66 66 57 72 68 87 15 49 — — 34 25.5 3rd „ 90 3 7 4 4 64 73 58 60 71 82 14 36 — — 30 28.4 Nth „ 91 8 1 4 3 33 72 57 48 59 78 16 35 — — 37 32.6 Other children in family dead Percentage. 1 dead 78 16 5 10 7 45 61 47 56 56 74 25 42 — — 37 30.5 2 ,, 86 12 1 8 1 61 67 64 61 56 67 23 44 — — 39 32.7 Nth ,, 82 8 10 6 8 41 66 57 52 53 70 15 31 — — 52 36.4 46 Table No. 23.—E. Children During within the Year. Causes of death. Breast Fed. Breast and 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 Dr. Midwife. Total number of months lived. Number of Cases. Totals in each Class. Convulsions 9 3 9 6 6 11 11 9 9 17 14 7 8 13 8 68 21 21 Pneumonia 26 5 15 11 10 21 27 24 23 26 34 16 24 30 14 291 46 46 Bronchitis 24 1 9 3 3 23 23 16 13 26 28 7 13 22 12 124.5 34 34 Marasmas 9 3 33 12 14 29 19 22 15 36 37 12 16 31 13 106.5 45 45 Zymotic Euteritis 3 3 30 14 8 26 12 11 28 28 30 9 12 22 13 167.5 36 36 Gastro Enteritis — 2 8 3 3 7 3 3 6 6 9 3 4 5 5 38 10 10 Tuberculosis 7 6 5 4 4 11 11 9 10 14 12 4 6 10 7 90 18 18 Meningitis 12 6 7 5 5 13 16 12 15 18 17 6 9 16 7 145 25 25 Measles 3 2 2 1 2 4 4 4 5 5 7 2 4 3 4 53 7 7 Whooping Cough 19 7 12 10 4 24 19 14 27 31 30 12 26 29 8 267 38 38 Miscellaneous 12 5 7 7 5 14 18 9 6 13 17 4 8 17 7 62.5 24 24 Totals 124 43 137 76 64 183 163 133 157 220 235 82 130 198 98 1416 304 304 Percentage 41 14 45 25 21 60 53 43 81 77 27 42 65 32 Mean age at death. 4.7 Percentages — Deaths from particular causes. Convulsions 43 14 43 29 29 52 52 43 43 81 66 33 38 — — Mean age at death. 3.2 mths. Pneumonia 56 11 33 24 21 45 59 52 50 56 74 35 52 65 30 6.4 „ Bronchitis 70 3 26 9 9 67 67 47 38 76 83 20 38 64 35 3.7 „ Marasmus 20 7 73 27 31 65 42 49 33 80 82 27 36 — — 2.5 , Zymotic and Gastro Enteritis 6 11 83 37 24 74 32 30 74 74 85 26 35 — — 4.4 ,, Tuberculosis 38 33 28 22 22 61 61 50 55 77 66 22 33 55 38 5.8 ,, Whooping Cough 50 18 31 26 10 63 50 37 71 81 78 31 68 76 21 6.8 „ 47 In Tables D and E are shown in detail the results of enquiry during 1907. The beginning and the end of infant rearing is good mothering. From one reason or another, however, as will be seen from the above tables, this is denied to a large number of infants. Probably not more than half of the babies over throe months of age are nursed by their mother?. So long as this continues infantile mortality must necessarily be high. Artificial feeding of infants under the best of circumstances is a poor substitute for natural nurture, and is inevitably associated with the direst risks to the infant. The mere fact that only one-third of the infants dying within the year of their birth are breast fed, as compared with 77 per cent, of those surviving, is a striking commentary on the importance of mothers nursing their offspring. When it is remembered further that of those artificially fed nearly one-half are fed with improper food—i.e., with food that the infantile stomach is physiologically incapable of digesting—the evils of resorting to this method will be readily appreciated. Even were a pure and clean milk supply assured to those who resort to artificial feeding and proper protection and storage possible in the homes, the use of improper feeding bottles in the case of nearly one-third of the infants thus fed is calculated to undo all the good which the most elaborate precautions would otherwise secure Only a little over half the babies, whether naturally or artificially fed, are fed regularly, and this fact in itself is responsible for a lot of infantile illness and domestic discomfort. Two-thirds of the babies sleep in bed with their mothers, more than half sleep in the hot crowded kitchen during the day, only about the same proportion are taken out regularly into the open air. and nsarly a third are improperly clothed. These conditions are not compatible with healthy babyhcod. 48 It is not merely that a large number of infants succumb to this evil environment, it is that a large number of weakly children are produced by these defective domestic habits that makes the position so serious. They are to be remedied only by persistent education of the mothers by combatting their prejudices, instructing the ignorant and encouraging the well-intentioned to persevere in the simple rational methods of baby culture which are dictated alike by common sense and the results-of experience. The fact that certain mothers have to maintain their families wholly or in part by their own earnings cannot fail to act injuriously upon the babies who require their personal attention, yet it is encouraging to find that as a class employed mothers in Willesden do not compare so very unfavourably with others more fortunate in so far as their treatment of their babies is concerned. This will be seen by comparing the following table with those above. Table No. 24. Table giving results of enquiries made during 1907 into births where the mothers are employed. Breast Fed. Breast and Hand Fed. Hand Fed. Improper Food. Improper Bottles. Fed Regularly. 81ept with Mother. Slept in Kitchen. Taken out Regularly. Properly Clothed. Premises Clean. Mother Employed. Baby Insured. Mother attended by Dr. Midwife. Age of Mother. Age of Child. Totals. All Children in Family Surviving— lst Child 14 5 6 4 7 12 15 16 17 13 24 — 10 8 17 22.6 — 25 2nd „ 11 1 3 2 0 5 10 11 11 11 12 — 6 2 13 — — 15 3rd „ 10 — — — — 6 9 9 8 5 7 — 6 1 9 — — 10 Nth 25 5 — 3 2 16 24 13 17 12 21 — 7 4 26 31 — 30 Other Children Dead— 1 Child Dead 23 8 3 3 6 13 20 16 12 17 22 — 10 3 31 31 4 — 34 2 „ „ 14 — 1 1 — 6 10 10 11 9 9 — 7 4 11 34 9 — 15 N „ „ 8 — — — — 5 6 5 5 2 5 — 4 1 7 35.1 — 8 Children Alive at end of Year— Totals 105 19 13 13 15 62 94 80 81 70 100 — 50 23 114 — — 137 Percentage 76 14 9 9 11 45 68 58 59 51 72 — 36 — — — — — Children Dead within Year 20 17 43 29 30 36 42 45 39 53 54 — 39 44 33 28 5 5 80 Percentage 25 21 54 36 37 45 52 56 49 66 67 — 49 57 44 - — — Totals 125 36 56 42 45 98 136 125 120 123 154 - 89 67 147 — — 217 Percentage 58 17 25 19 20 45 62 58 55 56 57 — 41 30 67 — — — 49 50 Nevertheless the fact of employment does tell; the homes are less cleanly, artificial feeding is more readily resorted to, and in most respects the baby is not so well cared for; but it would seem that this lower standard of infant nurture is an enforced result of the mother's absence rather than an indifference to the claims of maternity. BIRTH ENQUIRIES, 1907. Report by Miss Gaul, Lady Health Visitor. There is little that has not already been said with regard to the conditions found in the homes in which birth enquiries have been made during the year 1907. The visits are generally well received and it is not unusual to be told by a mother, as if she considered it a real grievance, "You didn't come to see my baby," or to have the information volunteered" Mrs. Brown has had a baby, aren't you going to see her ?" The young mother with her second baby, particularly if she has lost the first, is usually most anxious to learn anything that may be for the baby's welfare. The mother with her first baby is frequently at the mercy of wellintentioned but sadly misguided grandmothers and neighbours, whose varied specifics for the treatment of the newly born are more interesting to the observer than beneficial to the baby. The need for providing adequate and suitable food for the mothers and so for the infants is perhaps greater than ever before. In times of stress when the husband is out of work the mother is usually the first to deny herself, regardless of the fact that two lives are more or less dependent on the nourishment she takes. Many of the mothers have suffered very acutely from hardships this winter and there is no agency for dealing with and providing food for these cases at a time when sufficient nourishment is so very necessary. Practical demonstrations in the washing and dressing of infants are another great want in the district. A large number of infants are improperly clothed, not entirely owing to inability to procure clothing, 51 but through ignorance of the kind of clothing suitable and indeed necessary for such delicate mortals. After the confinement of the mother it would appear that the question of clothing is left entirely to the nurse. At the Lying-in Hospitals the mothers are not instructed to use woollen material for the garment to be placed next the skin of the infants—hence the midwives trained in these hospitals do not impress upon their patients the necessity for providing woollen vests or soft flannel shirts. It needs but little consideration to understand that an infant must feel every variation of the surrounding atmosphere. The thin cotton shirt is responsible for much of the suffering the babies are made to endure, and is no doubt an important factor in causing the high mortality amongst infants during the first few weeks of life from diseases of the respiratory organs. More real good would probably accrue from practical demonstrations before a number of mothers gathered together than from the individual instruction, as it would encourage them to discuss the subject and doubtless to vie with one another to some extent as to who should do best for her baby. An honest competition in this direction would be most helpful. Visits to the homes would of course be essential, in addition to this. A considerable amount of opposition is met with when trying to convince the mothers of the advisability of putting the infant in a cradle or separate bed of some description. Here again the fact that in the Lying-in Hospital the babies are put in the mothers' beds is a difficulty not easily overcome. The visitor is frequently told that the mother could not love her baby if she put it away from her at night, and there may be some reason for believing that the children put in separate beds are not always the best cared for in other ways, although this would only apply to a certain class of mother, and certainly not to those who have the real welfare of their offspring at heart. Another reason given for keeping baby in the mother's bed is the difficulty experienced in keeping the infant warm, but this in D2 52 most cases is more fancied than real and may be easily overcome. When once a mother has been persuaded to put her baby in a suitable cot she never has one in her bed again. A very large percentage of infants are breast-fed during the first months of life, but it is very doubtful how many of these children get only the breast. Many of them get sugar, treacle, or condensed milk on the so-called " comforters," which are very doubtful blessings, and in many cases are certainly injurious owing to the dirty condition in which they are kept. There is still a fondness for "boiled bread," particularly amongst mothers of large families or the young mothers who are themselves survivors of large families fed in infancy in this manner. The long-tube bottle, although not entirely a thing of the past is not so much in evidence now, but it will continue in favour with the mother who objects to the trouble of feeding her infant. It is difficult in some cases to make the mothers understand that it is not kindness, but cruelty, to give the baby a bit of "anything that's going" as it is often expressed, indeed it is useless to hope for reform on this point in some instances. 53 VITAL STATISTICS of the WARDS AND OTHER DIVISIONAL AREAS OF THE DISTRICT. 54 WARD AND PARTICULAR AREAS VITAL STATISTICS. In the following tables are given the statistics relating to the Ward Divisions of the district. As I have previously pointed out, the Ward which is a Division for electoral purposes does not constitute a suitable unit as a statistical area. For this reason I have given on pages 59-63 the vital statistics o areas with grouped populations, arranged according to density of population upon area, and on page 57, similar statistics arranged according to such a crude classification of social status as is represented in differences of rental value of the houses occupied. WARD MORTALITY RATES. Table No. 25. wards. ean Death Hate 1902-6. 1907. Corrected. Death Hates 1907, per 1,000. Mean Kate of Infantile Mortality. 1902-1906. 1907. Rate of Infantile Mortality Per 1,000. Zymotic rate Per 1,000. Diarrhœa. Per 1,000. Phthisis per 1,000. Church End 14.2 13.5 12.9 137 122 20 .5 9 Harlesden 130 130 11..6 126 103 1.8 .2 9 Kensal Green 10.2 10.5 9.6 99 89 .9 .3 .11 South Kilburn 17.2 17.0 16.3 156 155 2.4 7 1.4 Mid Kilburn 15.7 180 17.4 148 119 19 .2 12 North Kilburn 10.9 10.4 9.4 102 66 .6 .2 .7 Willesden Green 10.2 108 9.5 101 86 11 5 7 Willesden 12.6 12.7 11.8 120 106 1.5 4 1.0 55 56 CLASS VITAL STATISTICS. As represented by Differences in Class Rentals. The table given in the reports of 1905 and 1906 showing the effect of social status upon vital statistics is repeated again for the year 1907. The figures compare very closely with those of previous years, thus confirming the results arrived at in the previous reports. 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. 26 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. 26. Table A. CLASS VITAL STATISTICS. Class. Notifications of Infectious Diseases. Births. Deaths. No. of houses. Population. Scarlet Fever. Diphtheria or Croup. Erysipelas. Enteric Fever. Puerperal Fever. Males. Females. At all ages. Infants' Deaths. Whooping Cough. Measles. Diarrhœa. Scarlet Fever. Diphtheria or Croup. All other Fevers. Cancer. Phthisis. Marasmus. Class 1 3,036 16,453 60 24 3 6 2 117 109 115 19 1 — 1 — — 1 19 5 3 2 10,575 62,598 304 109 39 15 6 849 836 663 144 21 6 22 6 8 2 50 63 14 3 7,766 64,708 277 121 35 7 5 1,193 1,143 913 288 53 39 31 13 10 1 39 70 31 Totals 21,377 143,759 641 254 77 28 13 2,159 2,088 1,696 451 75 45 54 19 18 4 108 138 48 4,247 + 8 1,704 [Died in Infirmary, address unknown.) Table B. —Mean Kates 1005, 1906, 1907. Mean No. of Houses. Mean Population. Mean Infectious Disease Notification rates per 1,000 population. Mean Birth Hates per 1,000. (3 years). Mean General Death Rates. Mean Infantile mortality per 1,000 births. Mean Death Rates. Class 1 2,927 15,864 2.40 1.43 .27 .27 .06 12.90 7.33 65 .04 — .08 — .04 .06 904 .420 .08 2 10,343 61,208 4.08 1.69 .65 .02 .09 27.38 10.60 97 .26 .08 .51 .06 .12 03 .784 .958 .27 3 7,717 64,081 4.23 2.23 .70 .31 .08 36.82 14.52 128 .62 .54 1.15 .12 .13 .07 .744 1.196 .51 Mean Rates 20.987 141,153 3.96 1.91 .63 .28 .08 30.04 12.09 113 .40 .28 .75 .08 .12 .05 .779 1.006 .36 Table A gives the figures for the year 1907. The corresponding figures for 1906 and 1906 are given respectively in the reports for those years. Table B. The rates given in Table B are the mean rates for the years 1905, 1906 and 1907. The larger number of figures thus dealt with eliminates many of the chance results of insufficient data. 57 58 VITAL STATISTICS OF GIVEN AREAS ARRANGED ACCORDING TO DENSITY OF POPULATION. In Table No. 27 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. Read in conjunction with the map they will show the local topographical distribution of vital statistics. The inequalities in the areal populations and in some instances their small size preclude comparison until a longer interval of observation has elapsed. Table No. 27. VITAL STATISTICS OF PARTICULAR AREAS ARRANGED IN ORDER OF INCREASE OF DENSITY OF POPULATION PER ACRE. Notifications of Infectious Diseases. Population, 1907. Births. Deaths. Scarlet Fever. Diphtheria or Croup. Erysipelas. Enteric Fever. Puerperal Fever. Population. Number of Houses. Male. Female. At all Ages Infant Deaths. Whooping Cough. Measles. Diarrhœa. Scarlet Fever Diphtheria or Croup. All other Fevers. Cancer. Phthisis. Marasmus. Area No. 1 16 4 1 1 - 2463 396 9 11 22 2 — — — — — — 3 1 1 2 39 19 .6 6 1 11202 2131 138 134 82 18 — — 4 — 1 1 6 6 1 3 38 15 7 2 1 9054 1429 102 92 79 18 2 1 1 1 1 1 6 2 1 4 16 6 8 — 1 5664 1058 55 64 48 9 1 — 2 — — — 3 3 — 5 61 15 6 8 1 11501 2086 121 116 110 18 1 1 1 — — 1 13 7 8 6 24 5 1 1 — 3035 477 42 53 23 7 — — 1 — — 1 3 1 1 7 31 17 6 1 1 14844 2449 180 179 179 34 2 5 4 1 4 — 12 19 3 8 113 23 4 1 2 10004 1434 200 193 144 48 9 14 3 8 2 — 3 11 7 9 77 18 10 1 — 11295 1556 172 146 91 27 5 1 1 — — — 7 13 1 10 29 9 l — 1 11483 1637 215 187 150 49 8 6 9 — 1 — 6 14 5 11 62 48 7 3 1 17630 2578 342 321 218 78 13 2 8 7 2 2 9 19 10 12 — 5 — — — 1145 157 32 21 26 10 1 2 — — 2 — — 1 2 13 35 19 6 2 6218 787 111 127 70 19 3 4 5 — 1 — 5 8 4 14 65 32 17 5 2 20639 1867 821 336 359 91 27 8 11 — 3 2 21 27 7 Total 596 234 74 26 11 136177 20042 2040 1979 1601 428 72 44 50 17 17 8 97 132 46 59 * MEAN ANNUAL RATES PER 1,000 POPULATION IN RESPECTIVE AREAS, For the Years 1906—1907. Notifications of Infectious Diseases. Population, 1907. Deaths. Scarlet Fever. Diptheria or Croup. Erysipelas. Enteric Fever. Puerperal Fever. Population. Number of Houses. Births. At all Ages. Infant Deaths. Whooping Cough. Measles. Diarrhoea. Scarlet Fever. Diptheria or Croup. All other Fevers. Cancer. Phthisis. Marasmus. Area No. 1 4.3 1.9 .4 .2 - 2430 396 9.7 8.85 43 - - - - - - 1.646 .206 .2 2 3.4 1.1 .5 .4 .1 10893 2088 23.36 7.25 63 - - .32 - .05 .05 .505 .551 .09 3 3.9 1.9 .6 .2 .06 8894 1413 23.22 8.21 90 .11 .06 .22 .06 .11 .06 .449 .394 .06 4 2.9 .9 .9 - .09 5631 1057 21.58 7.99 82 .09 - .36 - - - .533 .444 .09 5 3.3 1.5 .4 .4 .09 11409 2067 22.39 10.61 108 .04 .13 .48 .04 .04 .13 .920 .701 .26 6 fi.4 1.2 .3 .3 - 2954 476 34.69 7.62 49 — .17 .51 — — .17 .846 .508 .17 7 26 1.5 .5 .07 .07 14908 2448 23.75 11.87 97 .13 .27 .50 .03 .23 — 1.140 1.006 .20 8 7.2 1.9 .7 .7 .1 10007 1432 38.57 14.14 135 .75 .70 1.45 .40 .20 .10 .400 .799 .50 9 6.5 2.0 .7 .2 — 11174 1556 26.89 8.99 100 .26 .09 .26 .04 .09 — .537 1.208 .13 10 4.5 1.6 .4 .1 .1 11363 1624 34.67 12.50 115 .35 .26 1.10 .13 .04 .04 .484 1.320 .40 11 4.8 3.3 .7 .4 .06 17483 2566 37.80 13.04 134 .51 .06 1.23 .26 .14 .09 .629 .972 .80 12 1.8 2.2 1.3 - - 1135 155 50.63 24.66 174 .44 3.52 .88 — .88 — — 1.761 1.32 13 6.9 3.0 1.0 .2 .08 6201 787 37.98 11.29 83 .48 .48 .89 .08 .08 — .564 1.209 .40 14 4.0 1.4 .8 .19 .1 20754 1867 32.86 16.02 127 .87 .41 .89 .05 .12 .07 1.012 1.301 .22 4.44 1.85 .64 .27 .07 135241 19935 29.83 11.69 110 .36 .25 .73 .10 .11 .06 .721 .939 .31 * The figures on which these rates are calculated are those given above, together with those 111 the corresponding Table in the Annual Report for 1906 † Infantile Mortality per 1,000 Births. 60 G1 C'2 63 Table No. 28. VITAL STATISTICS OF AREAS. 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. 1 114.2 396 2463 3.5 21.6 2 272.4 2131 11202 7.8 41.1 3 130.3 1429 9054 11.0 69.5 4 79.0 1058 5664 13. 4 71.7 5 156.7 2086 11501 13.3 73.4 6 37.6 477 3035 12.7 80.7 7 181.4 2449 14844 13.5 81.8 8 111.8 1434 10004 12.8 89.5 9 108.5 1556 11295 14.3 104.1 10 102.0 1637 11483 16.0 112.6 11 153.2 2578 17630 16.8 115.1 12 9.4 157 1145 16.7 121.8 13 35.6 787 6218 22.1 174.7 14 107.2 1867 20639 17.4 192.5 1599.3 20042 136177 Mean 12.5 Mean 85.2 64 FORMATION OF NEW WARDS AND RE-ADJUSTMENT OF WARD BOUNDARIES. Owing to the continued growth of the district the old Ward divisions had become quite insufficient and the inequalities existing made it highly desirable to re-adjust the boundaries of the existing wards and create further ward areas. As a result of the labours of the Ward Representation Committee, the Council at their meeting held on the 26th February, 1907, adopted a scheme for the re-adjustments of the wards. In a report which I submitted to the Committee on the 18th February, a provisional scheme was set out dividing the district into areas of approximately equal population. Consideration was given to other than mere electoral requirements in preparing the re-distribution scheme and in submitting it in draft I reported as follows: — "In determining the sub-division of the District into the suggested new Wards the following considerations have been borne in mind:— "(1). That the population of the new Wards should be approximately equal. "The population of the District divided equally among 11 Wards yields approximately about 13,000 persons to each Ward, and this is so whether the Brent or Metropolitan areas be taken separately or together. " (2). That where there is a discrepancy in size of population, the lesser population should be in Wards where there is greater room and probability of expansion : and per contra where the area of a Ward is completely built upon a relatively larger population should be included. "(3). That so far as practicable the population of each Ward should be homogeneous as regards class. "(4). That the watershed boundary should be co-terminous with 65 the respective Ward boundaries of the two drainage areas so that no Ward is situated partly in one and partly in the other area. "(5). That consideration be had to the facilities of inter-communication within a Ward for polling purposes. "(6). That wherever practicable the Ward boundaries should run at the rear of the houses in a street, so that both sides of the road are situated in the same Ward." With slight modifications in respect of the older Kilburn Wards where it was deemed undesirable to make extensive alterations this scheme was adopted. Four new Wards were created and the necessary adjustments of the boundaries of the existing Wards made. The following table gives the number of houses and estimated population of the Wards under the re-distribution scheme as adopted by the Council at their meeting on February 26th. 1907. Table No. 29. Ward. No. of Houses. Estimated Population. No. 1. South Kilburn 1,316 14,969 „ 2. Mid Kilburn 1,748 13,320 „ 3. North Kilburn 2,098 12,587 „ 4. Brondesbury Park 1,281 8,736 „ 5. Kensal Rise 1,868 13,096 „ 6. Harlesden 2,026 12,620 „ 7. Stonebridge 1,944 13,080 „ 8. Round wood 2,123 13,174 „ 9. Church End 1,947 12,669 „ 10. Willesden Green 2,171 13,836 „ 11. Cricklewood 2,472 12,692 20,994 140,779 67 INFECTIOUS DISEASES. K 68 INFECTIOUS DISEASES. NOTIFICATIONS. There were notified during the year altogether 1,016 cases of Infectious Disease. This gives a notification rate of 7 per 1,000, as compared with 7.6 per 1,000 last year. The average number of cases per infected road, and the proportion of infected to non-infected roads were slightly less than last year. Table No. 30. ANALYSIS OF NOTIFICATIONS. Wards. Total No. of Roads. Total No. of Roads Infectted. Total No. of Roads not Infected. Average No. of Cases per Infected Road. Average No. of Case6 per Road. Infected Roads per cent. of whole. Notification Kate per 1,000 of Population. 1904 1905 1906 1907 1904 1905 1966 1907 1904 1905 1906 1907 1904 1905 1906 1907 Church End 85 53 32 4.7 3.8 46 3.8 3.0 2.5 3.0 2.4 65.0 63.9 65.4 62.4 11.7 8.8 10.7 8.3 Harlesden 73 34 29 4.1 3.1 3.6 5.9 2.2 1.7 1.9 2.8 53.5 54.2 53.4 46.6 7.8 5.8 6.5 9.1 Kensal Green 72 54 18 3.5 3.8 5.1 4.7 1.9 2.1 3.4 3.6 54.2 64.9 66.6 75.0 4.7 5.1 8.6 8.8 South Kilburn 39 19 20 2.3 3.4 4.6 4.8 1.1 1.6 2.8 2.4 48.7 48.7 61. 5 48.7 3.0 4.3 7.4 6.2 Mid Kilburn 34 18 16 4.5 2.8 3.9 2.9 1.6 1.9 2.2 1.6 35.3 67.6 55 .8 52.9 4.3 5.2 61 4.3 North Kilburn 38 20 18 2.2 1.7 2.9 1.9 .8 1.1 1.6 1.0 38.8 65.8 52.6 52.6 3.0 4.2 5.8 3.8 Willesden Green 107 56 51 3.1 3.1 3.6 3.1 1.3 1.6 1.9 1.6 42.2 5.24 51.9 52.3 4.9 6.0 6 7 5.6 Willesden 443 254 184 3.7 3.2 4.2 4.0 1.8 1.8 2.4 2.3 50.2 57. 3 58.3 56.7 5.9 5.8 7.6 7.0 69 E 2 70 SMALL POX. For the third consecutive year no cases of Small Pox were notified in the district. From the appended table of Vaccination returns, it will be seen, however, that this is in no way due to any lack of susceptible material in the population. An increasingly large percentage of surviving infants each year escape vaccination, so that we are accumulating a very large susceptible population unprotected by vaccination or previous attack of Small Pox. Experience has shown that where this happens it is followed sooner or later by disastrous epidemics which sweep away in vast numbers those who have had the misfortune to escape vaccination, and in consequence have failed to acquire the immunity to Small Pox which vaccination confers. I regret to say that I see in this unprotected state of Willesden's population a most serious menace to the public health. At such a time as the present when Small Pox is virtually non-existent in Great Britain, the danger appears remote and the sense of security which this breeds only increases the danger by fostering laxity in the observance of vaccination. But just as surely as the statutory and administrative insistance on vaccination has been relaxed and been followed by an increasing neglect of vaccination, so certainly will this neglect be paid for when the cycle of epidemic prevalence recurs and there are repeated the tragic consequences with which Small Pox has made us familiar. 71 Table No. 3. 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 24 345 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 1907 4,170 2,314 15 269 157 61 329 1.025 40 72 SCARLET FEVER. During the last two years Scarlet Fever has prevailed in much greater degree than during the years immediately preceding. There were notified altogether 641 cases during the year, actually the highest number hitherto notified, and giving a scarlet fever incidence rate of 4.4 per 1,000 as compared with a mean rate for the last 20 years of 4.0 per 1,000. Rut for the adequate provision of hospital isolation, it is certain that the prevalence would have assumed the proportions of an epidemic. On page 63 will be seen a map on which the cases of scarlet fever occurring during the last 5 years are spotted. The cases are distributed equally along the streets in which they occur. Upon comparison with a similar chart showing similarly the distribution of Diphtheria and published in my last Annual Report, a marked contrast will be observed. Whereas diphtheria shows a preference, so to speak, for certain areas where it appears to luxuriate, irrespective of the density of population of the area, scarlet fever is more uniformly distributed according to the density of population upon area. The map may be described as roughly indicating a distribution of scarlet fever in which the cases are numerous directly in proportion as the population is denser upon area. Whether this would hold true of a larger survey it would be unsafe to infer in the absence of more direct knowledge. THE PERIOD OF INFECTIOUSNESS IN SCARLET FEVER. The wider recognition of the occurrence of return cases of scarlet fever has raised the question of the duration of infectiousness in persons attacked to one of the first importance in connection with this disease. With a view to throwing some light upon this problem I have gone through the records of the past 8 years and abstracted and tabulated all the cases of houses in respect of which multiple cases of scarlet fever were notified as occurring at intervals of from a 73 month to five years. The intervals are counted from the date of receipt of one notification in a house to the date of the receipt of the next, no note being taken of cases occurring at shorter intervals than those respectively shown in the table. Table No 32. Showing the Number of Cases of Scarlet Fever in Houses Previously Infected, recurring at intervals of not less than 3 weeks, and not longer than 5 years. Intervals. Year. 3 Weeks to 3 Months. Months. 3-6 Months. 6—12 Years. 1—2 Years. 2—3 Years. 3—4 Years. 4-5 1900 8 6 5 1901 28 5 7 9 1902 14 5 4 6 6 1903 16 9 8 10 4 3 1904 22 4 1 6 5 3 1 1905 15 8 6 7 11 12 8 1906 23 11 7 14 14 9 12 1907 36 6 11 18 8 6 7 Totals 162 54 49 70 48 33 28 Taken merely as it stands the table would seem to indicate that the liability of a house to a recurrence of scarlet fever was much greater, the shorter the interval that has elapsed from the occurrence of a previous case. Within limits this is unquestionably true, but the figures do not warrant the inference which they appear to suggest, namely that this greater liability extends through a period of several years. 74 In comparing the instances of recurrence, those which are separated from their primary cases by the longer intervals can be compared with cases recurring at shorter intervals only if the respective primary cases of both classes fall within an identical period. The recurrent cases which are compared may be widely separated in time, and indeed where those with intervals of years are compared with cases separated from their primaries only by months, they necessarily will fall in different years. In the above table for instance, the cases recurring after an interval of 4-5 years only, in houses previously infected are all found in the years 1904-1907. But the primary cases in the respective houses re-invaded during these years must have occurred in the years 1900-1903. Each group of recurring cases therefore which is compared with the group 4-5 years must include those only which are recurrent to primary cases occurring in the period 1900-1903. Table No 33. Showing Recurrent Cases in Interval Groupings, in relation to which the respective houses were primarily invaded during an identical period. Primary Cases Occurring Interval Groupings of Recurrent Cases. 3 weeks to 3 months 3 to 6 mouths. 6 to 12 months. 1 to 2 years. 2 to 3 years. 3 to 4 years. 4 to 5 years. During 1900-1903. 66 25 24 31 26 27 28 „ 1900-1904. 88 29 25 38 40 33 — „ 1900-1905. 103 37 37 52 48 – – „ 1900-1906. 126 48 38 70 — — — „ 1900-1907. 162 54 49 — — – – Thus compared it is seen that the cases recurring at intervals respectively of 1-2, 2-3, 3-4, and 4 to 5 years do not exhibit any greater liability to be more numerous when separated from their 75 primaries by shorter intervals. This does not apply, however, to cases recurring in infected houses within 12 months of the primary infection of the house. It may be mentioned that the group of cases recurring at intervals 6-12 months, when subdivided into two groups 6-9 and 9-12 months, were found in an analysis of several years' returns to give equal numbers in each group, namely 12 and 12. The above data relate merely to notifications. The following table shows in each of the respective years the number of houses in which there occurred single cases, 2 cases, 3 cases, and 4 or more cases of scarlet fever, as judged from the notifications received. Table No. 34. Showing the number of houses in which single and grouped multiple cases of Scarlet Fever occurred during each year. 1 case. 2 cases. 3 cases. 4 cases or more. Total notified in year. 1904 179 31 14 10 326 1905 242 42 10 7 397 1906 392 81 20 5 637 1907 354 70 29 14 641 1,167 224 73 36 2,001 Percentage of total 58.3 12.2 3.7 1.8 — THE RELATIONSHIP OF SORE THROAT TO THE SPREAD OF SCARLET FEVER. A fact having an important bearing upon the spread of Scarlet Fever has been the subject of observation for several years. I was 76 struck some years ago by the frequency with which a history of recent sore throat was elicited in houses where cases of Scarlet Fever were notified as occurring. During the years 1905, 1906 and 1907, note has been kept of all cases where, in a house infected with Scarlet Fever, sore throat had been complained of prior to or at the time of the occurrence of recognised Scarlet Fever in the house. At the same time a control observation was made in respect of houses not infected with Scarlet Fever at which enquiry was made in connection with other diseases not themselves associated with sore throat as a symptom of the disease. The results of the observations are shown in the following table:— Table No. 35. Showing the number of houses in which persons had suffered from Sore Throat at, or within a month prior to, the time of enquiry. scarlet fever. other diseases. Year. No. of Infected Housos. No of houses where sore throat occurred. No. of houses where enquiry made. No. of houses where sore throats occurred. 1905 301 130 — – 1906 498 170 833 20 1907 467 133 811 27 Totals 1,266 433 *38 1,644 47 Nett 1,266 395 1,644 47 Percentage 3.12 2.8 * In these 38 instances the sore throat complained of at time of enquiry subsequently proved t to be cases of scarlet fever. 77 DIPHTHERIA. 251 cases of Diphtheria were notified during the year, giving an incidence rate of 17 per 1,000. On only three occasions since Diphtheria became notifiable has a lower rate than this been experienced. Having regard to the fact that many more cases are now discovered as a result of bacteriological examination than would have been possible before this aid to diagnosis was available, this low incidence of Diphtheria is very satisfactory. Where there is reason to suspect that the cases are school spread the throats of children in the affected classes are swabbed and those found to be harbouring the organism associated with Diphtheria are excluded from school and treated as cases in an infectious condition. In my last Annual Report I pointed out the distribution relationship between Diphtheria and a particular type of drainage. The Local Government Board, in response to the Council's request to be permitted to make drainage bye-laws which should not call for the intercepting trap, have been pursuing enquiries with regard to the defects which formed the basis of the Council's application, but have not yet reported whether they will be prepared to sanction the omission of the interceptor from new drainage. I append, therefore, a table showing the further results of continued inspection of this unscientific appliance. 78 Table No. 36. SHOWING RESULTS OF INSPECTION OF MANHOLES IN WILLESDEN, 1905—1907. Date. Total Inspections. Choked. Percentage. Stoppers Missing. Percentage. October, 1905 6,745 288 4.25 654 9.7 January, 1906 504 49 9 .7 41 8.1 November, 1906 5,322 204 3.8 266 5.0 Various dates, 1907 1,227 119 9.7 33 2.7 Total 13,798 660 4.8 994 7.2 Note— The inspections made during 1907 differ from those of previous years in that they included a considerable number inspected upon complaint, where choked drains manifested themselves to the complainants. The inspections of 1905 and 1906 were systematic and non-selective in character. The fewer number of missing stoppers found in the inspections made during 1907 is accounted for in large measure by the fact that a large number of the old loose stoppers have been replaced by stoppers with a locking arrangement, which prevents them from being blown out by any increase of pressure on the sewer side of the Interceptor. It is to be noted that this simple accident (displaced stoppers) in itself converts the intercepting trap into a most dangerous appliance. Practically, in all cases where the stopper is displaced the sewer ventilates directly beneath the windows of the houses through what is misnamed the Fresh Air Inlet. TYPHOID FEVER. 28 cases only of Typhoid Fever were notified during the year. This gives an incidence rate of 019 per 1,000, by far the lowest rate hitherto experienced in Willesden. The continued decline in incidence of this disease is probably to be attributed to the increasing care bestowed at seaside places upon the sources of shell fish used for human consumption. Most of the cases occurring for some years past, there has been 79 good reason to believe, derived either directly from eating contaminated shell fish or by contact with cases so originating. The incriminated shell fish has commonly been partaken of at seaside resorts. CEREBROSPINAL MENINGITIS. This disease was made notifiable for a period of 12 months dating from 5th August, 1907. Altogether 3 cases were notified during the year. There does not appear to be any immediate risk of the disease becoming epidemic, but it is certainly an advantage that the disease is notifiable, as the early intimation of the occurrence of cases is the surest way of protecting against its spread. ISOLATION HOSPITAL. All particulars relating to the Isolation Hospital will be found in the appended Report of the Medical Superintendent. 80 Table No. 37. NOTIFICATIONS. 1892. 1893. 1894. 1895. 1896 1897. 1898. 1869. 1900. 1901. 1902. 1903 1904. 1905. 1906. 1907. Small Pox 5 23 21 5 2 — 1 — — 10 88 7 12 — — — Scarlet Fever 366 589 268 392 475 510 361 414 335 553 466 502 326 397 637 641 Diphtheria 141 221 125 179 171 270 333 317 225 399 433 217 351 273 280 251 Croup (Memb.) 4 8 4 7 2 5 2 2 1 5 7 4 2 2 6 3 Typhus Fever – 1 — — — — — — — – — — – – – – Typhoid Fever 28 47 70 69 52 52 66 79 77 57 73 45 38 41 46 28 Continued Fever – – 2 — 1 1 – – – – – – – – 1 – Puerperal Fever 4 6 4 8 10 9 2 6 8 2 8 11 5 13 9 13 Cholera Nostras 1 1 1 — 1 2 – 1 – – – — – >— – — Erysipelas 85 139 63 81 101 107 70 82 89 79 104 76 73 86 103 77 Plague (Pestis minor) – – – – – – – – – 1 – – – – – – Cerebro-Spinal Meningitis – – – – – – – – – – – – – – – 3 Totals 634 1,025 558 741 815 956 835 901 735 1,106 1,170 862 807 812 1,082 1,016 Rate per 1,000 9.4 15.0 7.3 9.3 9.5 10.3 8.4 8.3 6.4 9.5 9.6 6.7 9.9 5.8 7.6 7.0 81 Table No. 38. CASES NOTIFIED UNDER 15 YEARS OF AGE DURING THE YEAR 1907. 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 16 years of age. Church End 90 9.5 63 6.6 Harlesden 128 18.1 26 3.7 Kensal Green 151 14.7 48 4.7 South Kilburn 46 8.4 21 3.8 Mid Kilburn 26 6.5 12 3.0 North Kilburn 18 7.6 8 3.4 Willesden Green 87 9.2 34 3.6 Willesden Urban District 546 113 212 4.4 Mean of years, 1903—7 436 9.4 220 4.8 82 Table No. 39. WARD INCIDENCE OF SCARLET FEVER, DIPHTHERIA AND ERYSIPELAS. Ward. SCARLET FEVER. diphtheria. ERYSIPELAS. Rate. Quinquennial Means. Decennial Means. Rate. Quinquennial Means. Decennial Means. Rate. Qainquennial Means. Decennial Means. 1907. 1867 to 1901. 1902 to 1906. 1897 to 1906. 1907. 1897 to 1901. 1902 to 1906. 1897 to 1906. 1907. 1897 to 1901. 1902 to 1906. 1897 to 1900. Church End 4.5 4.9 5.3 5.1 3.1 3.8 5.4 4.6 0.4 0.8 0.6 0.7 Harlesden 6.8 4.1 3.6 3.8 1.4 2.9 2.8 2.9 0.5 1.1 0.8 0.9 Kensal Green 5.7 4.4 3.5 3.9 1.9 3.4 1.6 2.5 0.9 0.9 0.5 0.7 South Kilburn 3.4 4.9 2.7 3.8 1.7 3.4 1.1 2.2 0.7 0.8 0.9 0.8 Mid Kilburn 2.4 4.1 2.3 3.2 1.2 3.3 1.3 2.3 0.6 0.7 0.9 0.8 North Kilburn 2.2 2.9 2.6 2.7 1.1 1.9 1.2 1.5 0.4 0.4 0.4 0.4 Willesdeu Green 3.7 3.4 3.2 3.3 1.2 1.6 1.8 1.7 0.3 0.6 0.5 0.6 83 Table No. 40. FATALITY AND INCIDENCE FROM SCARLET FEVER, DIPHTHERIA, AND TYPHOID FEVER, PER 1,000— 1888 TO 1907. Year. Fatality Rate. Scarlet Fever. Deaths per 1,000 cases. Incidence Hate. Scarlet Fever. Cases per 1,000 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 38 193 1.2 209 0.81 1889 13 26 69 1.8 71 0.49 1890 11 29 . 140 2.4 170 0.66 1891 15 21 78 1.2 121 0.53 1892 22 55 127 2.1 214 0.42 1893 25 8.5 199 31 191 066 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 21 211 0.66 1897 21 5.4 250 29 230 0.56 1898 28 36 204 33 136 0.66 1899 38 3.9 148 29 128 0.73 1900 35 2.9 124 1.9 181 0.68 1901 21 4.9 138 34 175 0.49 1902 27 3.8 122 35 205 0.60 1903 22 3.8 46 1.6 290 0.34 1904 6 2.4 54 2.6 211 0.27 1905 13 2.8 51 1.9 293 0.29 1906 17 45 57 2.0 152 0.32 Mean Rate. 26 40 135 2.3 187 0.59 1907 30 4.4 71 1.7 143 0.19 F 84 Table No. 41. DEATH RATES FROM SCARLET FEVER, DIPHTHERIA, TYPHOID FEVER, MEASLES AND WHOOPING COUGH per 100,000. 1875 TO 1907. 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 1907 13 12 2 31 51 mp a k 1875-1887 42 26.5 17 23.5 24 17 50 45.5 75 57.5 1888-1907 11 30 10 41 40 * Infectious Diseases Notification compulsory in Willeaden from this year. 85 HEALTH OF SCHOLARS IN PUBLIC ELEMENTARY SCHOOLS. F 2 86 HEALTH OF SCHOLARS IN PUBLIC ELEMENTARY SCHOOLS. It has for long been apparent that the next great advance in the improvement of the national health conditions would be made in respect of the children attending public elementary schools. The aggregating of large numbers of children in schools necessitated by the statutory elementary education has brought with it its own particular risks to the child as a direct result of the system. But apart from the school-imposed risks, for which the responsibility of the State cannot be unheeded, investigation has shown that large numbers of children were receiving at the public charge an education, the value of which was greatly or entirely negatived by the more urgent hygienic needs of the child. Disease in children, even of an advanced and serious character, may be entirely overlooked by parents and teachers intelligent and careful in the things with which they are acquainted, but lacking in the perception which comes from special training. Nevertheless, the exercise of common sense and careful though untrained observation on the part of teachers has brought to light large numbers of cases of serious illness among scholars which had quite escaped the attention of the parents. For some years past, advantage has been taken of this watchful care of the teachers of their little proteges, to discover cases of illness among school children and to deal with them by means of the existing public health administrative organisation. Much useful work has been done and I desire here again to tender to the teachers my thanks for their co operation and to express my appreciation of the valuable aid they have rendered in this work. The Education Administrative Provisions Act will place this work on a much more satisfactory footing and will supplement in inany important respects the work which since 1903 has been carried on with such beneficial results. 87 NON-NOTIFIABLE INFECTIOUS DISEASES INTIMATED FROM THE SCHOOLS. The following table shows the number of cases of non-notifiable infectious disease of which no knowledge would have been obtained and no public measures taken to control their spread, but for the notifications sent by the teachers. The attendance at school of these cases has been regulated in accordance with the nature of the ailments from which the scholars or their home-contacts suffered; as a result of visits paid to the homes the parents in many instances have been induced to call in medical aid where it was required, the hygienic steps necessary to protect others have been pointed out, and in many instances insisted upon. The treatment of a certain number of cases has been undertaken where circumstances have warranted it, and altogether a large amount of suffering and disability has been relieved and in considerable degree prevented. The administrative details of carrying out this work have occupied a large and prominent place in each day's duties. No change in procedure has taken place during the year, although in several directions it had become evident that improvements might be effected. The Education Committee, however, having regard to the wider changes that will be necessitated in carrying out the requirements of the Education (Administrative Provisions) Act deferred consideration of the purposed amendments of procedure until the Act should come into operation. 88 Table No. 42. NON-NOTIFIABLE INFECTIOUS DISEASES—INTIMATED FROM THE SCHOOLS. 1907. Disease. Vibited. Suffering. Contacts. Revisited. Suffering upon ro-visit. Doctor in attendance. Isolated. Total No. Suffering. Measles 1,128 1,078 2,911 465 369 777 284 1,442 Whooping Cough 540 868 1,322 173 91 529 61 986 Chicken Pox.. 152 181 — —. — 49 16 181 Mumps 76 77 — — — 26 3 77 Ringworm 338 378 — – — 109 107 378 Other Disease 624 627 — — — 196 54 627 Consumption 9 8 — — — 6 1 8 Coughs and Colds 179 175 — 47 27 4 — 175 Totals 3,046 3,387 4,233 685 487 1,696 526 3,874 89 MEASLES AND WHOOPING COUGH. No other diseases are so intimately associated with school life as measles and whooping cough. Both these diseases prevailed in considerable degree during the year, and together were responsible for a total of 120 deaths. The deaths from measles numbered 45, of which 40 occurred in children under 5 years of age. As a result of the notifications from the schools and of the enquiries made in connection with these, 1,442 cases of measles came to knowledge. It is probable that these constituted by far the greater proportion of all the cases occurring, as the number of deaths had they occurred only as a result of these 1,442 cases represent a fatality rate of little over 3 per cent. The fatality rate of measles is probably not much lower than this. It may, however, under particular circumstances rise to a very much higher rate, as is well seen in certain institution outbreaks. By the courtesy of the Medical Officer of the Willesden Infirmary I am able to give the fatality rate at that institution, and the result is striking, Altogether there occurred in the Infirmary during an outbreak not strictly limited to the year under review, 24 cases of measles, and of these no fewer than 11 died, giving the phenomenally high case fatality rate of 46 per cent. Measles under such circumstances assumes so formidable an aspect as to take rank among the more virulent pestilences, such as plague, small pox, and cholera. The reasons for this high measles fatality rate among infirmary children are probably complex. 90 1. Age incidence is a very important factor. Taking the age distribution of all the cases in Willesden coming to knowledge during the year, the following results are obtained:— Table No. 43. Showing Measles Fatality at different Age Periods. Age. Cases. Deaths. Fatality Rate. 0—1 84 6 7.1 1—5 670 34 5.0 5—15 687 5 0.7 0—15 1,441 45 3 1 The higher fatality at the lower age periods is well known, and in fact it may generally be stated that the lower the age of attack the more likely is a fatal issue to occur. Among the children dying from measles at the Infirmary the age distribution was as follows:— 0—1 1 case. 1—2 5 cases. 2—3 3 „ 3—4 2 „ It cannot therefore be stated that the excessive fatality is wholly accounted for by the low age period of those attacked. 2. The increased virulence of institution outbreaks is probably in some measure due to exaltation of virus due to rapid transference from person to person. This is a hypothetical explanation in harmony with certain laboratory experiments with organisms whose virulence has been purposely raised by inoculation from animal to animal. 91 3 Diminished resistence in the persons infected is a well recognised feature of certain selected classes, living in an unhygienic environment. The children living in the Infirmary are drawn from a class where bad feeding, bad housing, improper clothing, degraded heredity and other circumstances all tend to lower resistance. Notwithstanding the operation of all these influences, however, it is to be feared that the excessive fatality of Poor Law institutional measles points to the urgent need for amending the hygienic circumstances of the inmates. It is certain that a measles fatality rate of 46 per cent. calls urgently for drastic changes in the conditions which permit of it. 92 INFLUENCE OF SCHOOL ATTENDANCE UPON MEASLES AND WHOOPING COUGH. The accompanying diagrams (A. B. & C.) exhibit graphically some of the results of investigation into cases of measles and whooping cough intimated from the schools. The cases analysed did not all occur during the year 1907, and the cases occurring during the last half of 1907 are not included. They exhibit clearly the influence of public elementary schools upon the spread of measles and whooping cough. In Diagram A. is seen the influence of age upon school-spread measles and whooping cough. Children under 5 attending the infants' departments are attacked from both those diseases in much higher proportion than those at later age periods, and the same holds true of each year of age up to 8. By raising the minimum age at which children are admitted to school it is probable that the attack rate of scholars would be reduced to something like the proportion seen in the columns at the respective age periods. The effect of raising the age of admission to school would be to reduce the number of cases occurring in the infants' departments, and as will be seen from Diagram B, these with the cases to which they give rise at home constitute by fat the greater number of cases both of measles and of whooping cough. From Diagram C. it will be seen that previous attack confers a very large degree of immunity, but that mere exposure to infection in the homes, of children unprotected by previous attack, does not in a Diagram A. Diagram B. Diagrammatic Analysis of 2599 cases of Measles, and of 2377 cases of Whooping Cough. The primary cases were cases which, contracting the disease at school by contact with scholars attending whilst in an infectious condition, were the first to introduce the infection into their homes and there give rise to the cases indicated as secondary. Both the primary and secondary cases are properly to be credited to the departments of the schools which were the means of infecting the respective families. Diagram C. Tlie black columns represent the number of cases of Measles or Whooping Cough occurring in the respective classes of contacts. Among the contacts who were stated to have previously suffered, only a small proportion contracted disease upon definite exposure, while among the contacts stated not to have previously suffered, the number who failed after defiuite exposure was considerable. 93 large proportion of cases necessarily involve contracting the disease. This is a very significant and somewhat surprising result of the investigations. Measles and whooping cough are certainly very highly infectious diseases, hut more than half the children definitely and persistently exposed to infection, even when unprotected by a previous attack, fail to contract these maladies. These results are borne out it will be observed when the observations of 1907, exclusively, are considered. 94 95 TABLE NO. 44. MEASLES AND WHOOPING COUGH. Cases where Primary Case is ) attending Infant School. Primary Case, School Contact. Home Contact. Secondary Cases. Primary Case arising otherwise. Home Contact. Secondary Cases. 3 4 5 6 7 up Total. 13 p 0-1 1-2 2-3 3-4 4-5 5-10 10 15 15 up Total 3 4 5 6 7 Tota 1. 13 p 0-1 1-2 2-3 3-4 4-5 5 10 10 -15 15 up. Total. Measles, 1907 7 118 301 166 48 640 N.p s. 1090 55 80 110 118 66 69 12 3 513 ... 4 11 7 1 23 n.p.s. 32 4 2 3 2 ... 4 1 ... 16 p.s. 1062 ... ... ... 4 4 2 1 ... 11 p.s. 28 Measles, 1908 1 29 74 51 18 173 n.p.8. 231 33 38 56 84 58 36 6 1 311 to end of p.s. 292 ... ... ... ... 1 2 ... ... 3 Total 8 147 37S 217 66 813 N.P.S 1321 88 118 166 202 124 104 18 4 824 ... 4 11 7 1 23 N.P S 32 4 2 3 2 ... 4 1 ... 16 Total ... ... ... ... ... ... P.S. 1354 ... ... ... 4 5 4 1 ... 14 ... ... ... ... ... ... P.S 28 Whooping 4 40 121 99 43 307 n.p.s. 532 6 44 61 40 48 30 3 ... 289 1 3 11 10 2 27 n.p.s. 32 ... 3 5 2 4 2 ... ... 16 Cough p.s. 359 ... ... ... ... ... 3 ... ... 3 p.s. 28 No.of Seholats on Roll at Various Age Periods ... 851 2017 2589 1914 7371 • Cases where Primary Case is attending Mixed Department. Primary Case, School Contact. Home Contact. Secondary Cases. Primay Case arising otherwise. Home Contact. Secondary Cases. under 8 8-9 9-10 10 15 15 up Total. 13 p 0-1 1-2 2 3 3-4 4-5 5-10 10 15 15 up Total. 7 8 8-9 9-10 10-15 15 up. Total. 13 p 0-1 1-2 2-3- 3-4 4-5 5-10 10-15 15 up. Total 5 4 0 2 13 n.p.s. 20 ... 1 2 ... 1 6 ... ... 10 1 1 2 6 n.p.s. 9 ... 1 1 1 1 3 ... ... 7 p.s. 24 ... ... ... ... ... 1 ... ... 1 p.s. 2 1 5 1 1 8 n.p.s. 11 ... 2 ... 3 1 1 ... ... 7 ... ... 1 ... ... 1 n.p.s. — to end of p.8. 15 p.s. 12 Total 6 9 3 3 ... 21 N.P.S 31 ... 3 2 3 2 7 ... ... 17 1 1 3 2 7 N P.S 9 1 1 1 1 3 7 Total ... ... ... ... ... ... P.S. 39 ... ... ... ... ... 1 ... ... 1 P.S 14 Whooping 5 2 3 5 15 n.p.s. 24 1 4 3 3 3 5 ... ... 19 1 ... ... ... ... 1 n.p.s. 3 1 ... ... 1 ... 1 ... ... 3 Cough p.s. 11 p.s. No. of Scholars on roll at Various Age Periods 863 2324 •2376 8875 45 14483 Cases where Primary Case is attending School. Primary Cases. Home Contact. Secondary Cases. Measles Tota] No. of Cases 2045 Whooping Cough 969 0-1 1-2 •2-3 3-4 4-5 5 10 10 15 15 up. Total. p 0-1 1-2 2-3 3-4 4-5 5-10 10-15 15 up. Total. Home Contact means the number of children under 13 years of age in the home at the time of the occurrence of the primary case. n.p.s.—The number of these contacts who were stated not to have previously sutfered from measles or whooping cough. p.s.—The number of these contacts who were stated already to have sutfered. Secondary cases.—Are those which derived from the primary case in each class. They represent the number of Home Contacts who contracted the disease as a result of exposure to the primary case in the home. NoTK.—The cases of measles in the above table are given to the end of 1907, while in a separate line are also given the figures to the end of the epidemic in 190H. The reason for this is that at the end of the year measles was still eni- Measles, 1907 13 20 25 33 20 12 5 128 n.p.S. 250 12 20 10 7 9 14 1 1 74 p.s. 438 , Measles, 1908 to end of 4 11 11 12 7 5 ... ... 50 n.p.s. 48 9 5 10 7 8 9 1 1 50 p.h. 109 ... 1 1 2 Epidemic Total ... 17 31 36 45 27 17 5 178 N.P.S. P.S. 298 21 25 20 14 17 23 2 2 124 Total ... ... 547 1 1 2 Whooping Cough 27 24 20 27 23 11 1 133 n.p.s. p.s. 211 29 17 26 22 13 42 3 2 154 250 ... ... ... 1 1 ... ... ... 2 demic in the district. To make the return only to the end of 1907, would be to include for instance in the home contacts many cases which subsequently became secondary cases, but which would not appear as such at the end of 1907. The figures for the epidemic period therefore are alone valid in estimating the proportionate distribution of the cases. 96 DEATHS FROM MEASLES AND WHOOPING COUGH. Among 35 children dying from measles it was found that 21, or 60 per cent, had either contracted the disease at school or at home from other children who had themselves contracted disease at school. 13, or 37 per cent, of those dying from measles were insured, and 10, or 28 per cent, of the mothers were employed in earning a living. Out of 38 deaths from whooping cough it was ascertained that 20, or 52-6 per cent, of the children were insured, while 9, or 24 per cent, of the mothers who lost their children from this disease were employed in earning a livelihood. OTHER DISEASES INTIMATED FROM THE SCHOOLS. Particulars relating to other diseases are given in Table No. 42. A number of these cases came under the care of Dr. Stephens at the Hospital, either for treatment or for certification prior to re-admission to school. Dr. Stephens reports in respect of these as follows: — " During the year 243 children have been sent to the Isolation Hospital for treatment as out-patients. The skin condition of 30 of these children was lion-infectious, and the scholars were certified as fit for re-admission to their schools. The infectious diseases included 110 cases of Ringworm, 66 cases of Contagious Impetigo, 57 cases of Verminous Heads, 5 cases of Scabies, and 6 cases of Ophthalmia. On recovery from their disease 115 cases were certified as fit to return to school, and at the end of the year there were 20 children still under treatment at the Hospital. Only those cases in which the verminous condition of the head was extreme, and was the cause of the disease, usually impetigo, for which the child had been excluded from school, are included in the 97 above 57 cases. Children suffering from these diseases, which are due entirely to neglect, and quickly yield to a thorough cleaning of the head, are often kept at home in a filthy and infectious condition for several weeks before the parents can be persuaded that it is their duty to make any effort to clean the heads. In a large majority of the ringworm cases, however, the parents fully appreciate the facilities afforded for the treatment of their children at the Hospital, and thoroughly carry out all instructions, with the result that, although ringworm is a disease which tends to run a long Course, these children are usually fit to return to school after a comparatively short period of treatment." EYESIGHT OF CHILDREN ATTENDING PUBLIC ELEMENTARY SCHOOLS. The following table gives the results of vision testing in the Schools. Children with subnormal vision, who constitute so large a proportion of scholars, ought all to be re-examined by the school Medical Officer, and in those cases which he reports as urgently in need of glasses greater pressure should be placed upon the parents than is possible under the existing procedure. The practice will require considerable modification when the fresh arrangements necessary to carry out the provisions of the Education (Administrative Provisions) Act come into operation. 98 Table No. 45. SHOWING THE STATE OF VISION OF 10,860 SCHOLARS ATTENDING PUBLIC ELEMENTARY SCHOOLS. 1906-7. No. of Schools. No. of Scholars Examined Normal Vision. Slightly Defective Vision. No. of Scholars wearing glasses. Seriously Defective Vision. No. of Scholars wearing glasses. Percentage of total No. of Scholars wearing glasses. Equal 6 6 — & — 9 12 Unequal. 6 6 — & — 6 9-12 Left most defective. Unequal 6 6 — & — 9-12 6 Right most defective. Unequal. 6 6 — & — 9 1 Left most defective. Unequal. 6 6 — & — 12 9 Right most defective. Equal. 6 Below — 12 Unequal. 6 Below — 12 Left most defective. Unequal. 6 Below — 12 Right most defective. Bors 24 5,715 3,089 = 54 05% of total 1,114 378 307 129 112 90 = 4 4% of scholars with slightly defective 183 219 184 77 = 13-1% of scholars with seriously defective 167 = 292% 2,040 = 35.7% of Total. 586 = 10.25% of Total. Girls... 21 5,145 1,932 = 37.550/o of total 1,507 331 251 185 188 vision. 3.6% of scholars with slightly defective vision. 272 226 253 vision. 115 = 15 3% of scholars with seriously defective vision. 204=3 96% 2,462 =47 85% of Total. 751 = 14.6% of Total. 99 Table No. 46. NUMBER OF CASES OF NON-NOTIFIABLE INFECTIOUS DISEASES OCCURRING IN SCHOOLS during the Year ending December 31st, 1907. Name OF SCHOOL. .Measles. Whooping Cough. Mumps. Chicken Pox. Tuberculosis. Influenza. Ophthalmia. Ringworm. Other Diseases. Coughs. All Diseases. Not Suff. Not. Suff Not. Suff. Not. Suff. Not. Suff. Not. Suff. Not. Suff. Not. Suff. Not. Suff. Not. Suff Not. Suff. Not Suff. Acton Lane—Mixed 12 6 4 2 4 1 1 ... ... ... ... ... ... ... 6 8 6 4 ... ... 33 21 8 „ Infants 27 14 7 6 19 4 ... 3 ... ... ... ... ... ... 11 9 '/ 13 ... ... 71 49 10 Buller Road—Boys 4 ... 6 ... ... ... 1 ... ... ... ... ... 1 1 2 1 1 ... ... ... 15 2 8 Cambridge Road (Temp.) 14 1 4 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 18 1 16 Chamberlayne Wood Road— Boys and Girls 14 2 ... ... 1 9 12 1 2 1 ... ... 2 2 23 24 86 76 14 13 160 128 33 ,, ,, Infants 46 33 65 56 11 1 61 14 1 1 14 18 40 37 ... 1 238 161 39 Dudden Hill—B. and G. 54 3 2 ... ... ... 7 1 ... ... ... ... ... ... ... 1 1 1 ... ... 64 6 46 „ Infants 94 94 19 14 4 ... 17 3 ... ... ... ... ... 1 7 6 15 15 2 1 158 134 42 Granville Road ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... 1 ... 1 Gibbons Road—Mixed 24 3 25 5 16 9 10 4 1 1 ... ... 2 3 17 21 52 42 5 4 152 92 49 „ Infants 35 26 25 32 8 7 10 11 ... ... ... ... 3 2 5 12 35 42 2 3 123 135 10 Kensal Rise—B. and G. 1 ... 1 1 ... ... 4 1 ... ... ... ... ... ... 6 9 2 ... ... ... 14 11 3 „ Infants 21 14 48 45 ... ... 28 4 ... ... ... ... ... ... 16 16 32 11 11 22 156 113 11 Lower Place—B. and G. 10 3 4 4 17 16 4 ... 1 ... ... ... ... 1 19 17 9 8 1 2 65 51 13 Kilburn Lane—Infants ... ... 1 1 ... ... 3 ... ... ... ... ... ... ... 2 2 ... ... ... ... 6 3 ... Leopold Road—B. and G. 38 6 12 1 2 2 19 6 1 1 ... ... ... 2 11 10 10 11 ... ... 93 41 62 ,, Infants 57 88 18 22 2 ... 10 22 ... ... ... ... 1 1 13 14 19 21 15 9 135 177 12 Not. = Notified. Stiff. = Suffering. 100 NUMBER OF CASES OF NON-NOTIFIABLE INFECTIOUS DISEASES OCCURRING IN SCHOOLS—continued. NAME OF SCHOOL. Mcasles. Whooping Cough. Mumps. Chicken Pox. Tuberculosis. Influenza. Ophthalmia. Ringworm. Other Diseases. Coughs. All Diseasts. Not Suff. Not. Suff. Not Suff. Not. Suff. Not. Suff Not. Suff. Not. Suff. Not. Suff. Not. Suff. Not. Soff. Not. Suff. -Not Suff Disraeli Road—Infants 19 10 11 9 23 6 12 3 ... ... ... ... ... ... 13 17 10 6 ... ... 88 51 29 Old field Road—B. and G. 10 1 2 ... ... ... 2 1 ... ... ... ... ... ... 5 4 5 2 ... ... 24 8 13 „ Infants 2 2 1 2 ... ... 1 ... ... ... ... ... ... ... ... ... 1 2 ... ... 5 6 1 Pound Lane—Mixed 5 1 8 1 3 ... 10 1 ... ... ... ... ... ... 5 5 5 6 ... ... 36 14 15 ,, Infants 66 48 15 19 9 ... 27 9 ... ... ... ... ... 1 18 19 9 21 7 144 124 27 Salusbur y Road—Mixed 22 2 13 2 2 ... 1 ... ... ... ... ... ... ... 5 7 1 2 ... 44 13 28 ,, Infants 78 75 30 26 6 1 2 1 ... ... ... ... ... ... 3 2 3 ... 3 2 125 114 33 Mora Road—B. and G. ... ... ... ... ... ... 2 ... ... ... ... ... ... ... 3 2 ... ... ... ... 5 2 „ Infants ... ... ... ... ... ... 15 1 ... ... ... ... ... ... 2 2 1 ... ... ... 18 3 1 Stonebridge— B. and G 84 3 7 1 16 10 11 1 ... ... ... ... 8 8 24 24 35 28 ... ... 186 76 104 ,, Infants 78 84 4 6 3 2 14 9 ... ... ... ... 3 5 3 5 10 14 ... ... 115 125 14 Tubbs Road—Boys 2 2 1 4 ... 4 ... ... ... ... ... ... ... 7 3 ... 1 ... ... 18 6 9 NON-PROVIDED SCHO Christ Church—B. and G. OLS 4 2 3 1 3 ... 2 ... ... ... ... ... ... ... ... 2 ... 1 ... ... 12 6 5 „ Infants 12 10 37 14 5 1 5 2 ... ... ... ... ... ... 3 3 4 6 16 12 82 48 34 Gordon Memorial—B. and G. 7 1 1 1 ... 1 ... ... ... ... ... ... ... ... 1 11 8 ... ... 20 11 6 „ Infants.. 2 ... 2 ... ... ... ... ... ... ... ... 5 1 ... ... 3 15 1 Harlesden National — B & G 6 8 2 ... 4 ... ... ... ... ... ... ... 4 3 5 3 ... ... 29 12 10 „ Infants 7 6 12 11 6 5 17 4 ... ... ... ... ... ... 11 9 2 3 ... 1 55 39 7 Harlesden R.C.—Mixed 4 1 ... ... 4 1 4 3 ... ... ... ... ... ... 5 4 2 1 ... ... 19 8 6 ,, Infants ... ... ... ... 1 ... 2 ... ... ... ... ... ... ... ... ... 1 1 ... ... 4 1 ... NUMBER OK CASES OF NON-NOTIFIABLE INFECTIOUS DISEASES OCCURRING IN SCHOOLS-continued. NAME OF SCHOOL. Measle-. Whooping Couph. Mumps. Chicken Pox. Tuberculosis. Influenza. Ophthalmia. Ring worm. Other Disease 3. Coughs. AH Diseases. Not. Sutf. Not Suff Not. Stuff. Not. Suff. Not. Suff. Not. Suff. Not. Suff. Not. Suff. Not. Suff Not. Suff, Not. Suff. Not Suff. Holy Triuity—B. and G. 7 5 1 ... ... ... ... ... ... ... ... ... ... ... ... 3 ... ... ... 1 8 9 6 „ Infants 42 26 13 11 ... ... ... 1 ... ... ... ... ... ... 1 2 ... 8 9 ... ... 65 48 16 Keble Memorial—B. and G. 1 1 1 2 ... 1 ... ... ... ... ... 3 1 1 2 ... ... ... ... 8 6 1 „ Infants 22 24 47 36 27 ... 5 2 1 ... ... ... ... ... 5 9 2 4 ... ... 109 78 11 Kilburn Park Rd. Evangelical ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 6 4 ... ... 6 4 3 Neasden—Mixed ... ... ... ... ... ... ... ... ... ... ... ... ... 1 1 ... ... 6 8 ... 7 9 ... „ infants ... ... 21 13 ... ... ... ... ... ... ... ... 2 6 1 2 18 20 1 3 43 44 13 Princess Frederica— B. and G. 55 4 9 ... 12 3 5 5 3 ... ... ... 1 1 14 14 14 12 ... ... 113 42 67 „ Infants 36 50 16 13 6 1 3 3 ... ... ... ... ... ... 10 11 1 4 1 2 73 84 7 St. Andrew's—B. and G. 8 ... ... ... ... ... 8 ... ... ... ... ... ... ... 3 3 ... ... ... ... 19 3 19 „ Infants 61 41 3 9 ... ... 1 1 ... ... ... ... ... ... 1 1 4 3 ... ... 70 55 20 St. John—B. and G. 6 1 1 1 1 ... 1 ... ... ... ... ... ... ... 2 1 5 4 ... ... 16 7 9 „ Infants 14 18 ... 7 ... ... ... ... ... ... ... ... ... ... ... ... 1 1 3 ... ... 15 29 St. Mary's,Willesden - B.& G. 8 1 5 3 6 6 10 3 1 ... ... ... 1 1 14 17 12 13 ... ... 57 44 20 „ Infante 5 8 6 3 ... 1 10 4 1 ... ... ... ... 1 4 3 5 5 ... 1 31 27 6 St. Mary's R.C.—Mixed ... ... 3 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 3 ... 3 „ Infants 4 1U 24 16 ... ... ... ... ... ... ... ... ... ... ... 1 ... ... 1 2 29 29 9 Schools outside Willesden 60 60 27 22 ... 1 6 9 ... ... ... ... ... ... 5 6 5 10 ... ... 103 107 32 Totals ... 1186 792 575 429 226 89 375 133 12 9 ... 1 29 40 326 358 508 494 72 86 3309 2431 948 101 G 2 102 HEIGHT AND WEIGHT OF SCHOLARS. I am greatly indebted to the head teachers of the Kensal Rise Council School for their continued observations in respect of Weight and Height of scholars attending that school. I have classified and tabulated these returns as shown in the following table. The value of these results will be even more apparent when similar observations are carried out in all the schools as it is hoped will be done under the expanded scheme for the medical inspection of school children. 103 Table No. 47. SHOWING AVERAGE HEIGHTS AND WEIGHTS OF SCHOLARS ATTENDING KENSAL RISE SCHOOL. Girls. Boys. Age Year. No. of Scholars. Average Weight in Kilogrammes. Average Height in Centimetres. Age. Year. No. of Scholars. Average Weight in Kilogrammes. Average Height in Centimetres. 7 1904 20 22.48 122.50 122.22 122.20 7 1904 21 22.13 22.97 110.49 119.04 1905 17 22.5 122.17 1905 38 23.20 123.19 1906 4 22.62 122.25 1906.7 8 24.14 121.76 8 1904 63 23.64 24.11 124.25 125.39 8 1904 60 24 12 24.12 125.85 125.46 190S 62 24.3 125.98 1905 76 23.50 122.42 1906-7 38 24.6 126.36 1906-7 45 25.19 125.93 9 1904 53 24.62 25. 71 127 .3 129 75 9 1904 76 25.58 26.31 128.14 129.04 1905 58 26.5 131.06 1905 48 26.7 129.79 1906-7 61 25.91 129.61 19H6-7 61 26.9 129.59 10 1904 64 27.34 28.08 133.62 134.32 10 1904 48 27.87 28.70 132.23 1.134.01 1905 82 28 133.85 1905 54 28.6 134.11 1906-7 59 28.99 135.75 1906-7 91 29.2 134.89 11 1904 55 28.42 30.61 136.27 139.03 11 1904 42 30.30 31.18 136.06 138.63 1905 61 31.2 139.70 1905 47 31.1 138.43 1906-7 74 31.75 140.53 1906-7 84 31.88 140.03 12 1904 54 32.14 33.78 142.39 144.38 1-2 1904 54 33.12 34.20 140.94 143.44 1905 50 33.9 143.76 1905 41 35.2 145.28 1906-7 56 35.3 146.86 1906-7 46 34.58 144.75 13 1904 61 36.66 37.71 149.12 150.31 13 1904 45 36.2 36.87 144.55 146.15 1905 67 38.1 150.87 1905 61 35.3 144.01 1906-7 52 38.44 151. 1906-7 46 39.16 150.67 14 1904 12 19 31 38.23 42.05 151.91 154.40 14 1904 15 37.40 38.50 146.05 148.38 1905 41.8 155.19 1905 26 37.7 148.08 1906-7 43.68 154.89 1906-7 8 43.17 153.74 104 INSPECTION OF PUBLIC ELEMENTARY SCHOOLS. All the Public Elementary Schools in the District were inspected during the vacation. The drains of each school were flushed, and in two instances were found to be choked. Several minor defects were found and were duly remedied. 105 SANITARY ADMINISTRATION. 106 COLLECTION OF HOUSE REFUSE. The Tables give the chief data relating to Refuse Collection. There is little to add to what has been said in previous years with reference to this province of sanitary administration. The contract price is one which has been particularly favourable to the Council if it be compared with that charged a few years back. It is satisfactory to note that the saving in cost has not been at the expense of efficiency in the collection. Although the amount of refuse collected per house tends to fall, this is due to the fact that the distinction between trade and house refuse has been more strictly observed. On the whole this has led to an improved sanitary condition of the premises from which trade refuse was previously collected as house refuse. Provision for burning considerable quantities of decomposable trade refuse has been made by many of the tradesmen, and instead of a weekly accumulation having to be removed by the dust carts, a small quantity of ashes, the result of daily combustions, is all that it is now necessary to remove. The Tables have all been re-calculated from more accurate data. Instead of taking the number of houses in the district as that ascertained at Midsummer the number existing at Michaelmas has been taken as the basis of calculation. This is rendered necessary by the fact that the year for the collection of house refuse commences in March and not in January as is the case with the other periods for which statistical returns are given. The mid-yearly period for the year commencing March is of course Michaelmas and not Midsummer. 107 Table No. 48. DATA RELATING TO REMOVAL OF HOUSE REFUSE. Year. 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. Total No. of complaints. Percentage of complaints to total No. of houses. 1901-2 34 20 24 58 36 189 1.09 1902-3 38 21 24 69 38 167 0.91 1903-4 39 22 25 70 36 139 0.72 1904-5 37 24 27 70 43 104 0.51 1905-6 29 18 19 58 36 198 0.95 1906-7 27 18 20 54 36 220 1.04 1907-8 22 10 18 44 20 105 0.48 108 Table No. 49. REMOVAL OF HOUSE REFUSE. TABLE OF QUANTITIES. Year, Total No. of Loads collected of 3.75 cubic yds. No. of cubic yards collected. Standard Quantity in cubic yards. No. of Houses in District to Michaelmas. Population of district to Michaelmas. Amount of Refuse collected per house per annum. Amount of Refuse per head of population. 1901-2 22,290 83,587 77,661 17,258 117,619 Cubic yds. 4.8 Cubic yd .71 1902-3 24,312 91,170 81,846 18,188 123,987 5.0 .73 1903-4 26,603 99,761 86,274 19,172 130,621 5.2 . 76 1904-5 26,536 99,510 90,040 20,009 135,613 4.9 .73 1905-6 23,696 88,860 93,307 20,735 140,692 4.3 .63 1906-7 21,103 79,137 94,990 21,109 142,772 3.7 .55 1907-8 21,360 80,100 96,682 21,485 144,912 3.7 .55 Mean 4. 5 † Standard Quantity.—Theoretical No. of cubic yards of Refuse removed on the assumption that the mean number of cubic yards collected for each house during the last 7 years had remained constant for all the houses in the district. The mean amount per house for this period is 4.5 cubic yards. The quantity rises steadily and proportionately to the number of new houses added to the district. 10!) Table No. 50. REMOVAL OF HOUSE REFUSE. TABLE OF COST. Year. Total Cost of Collection. Standard Cost.+ Cost per Cubic Yard. Cost per Load of 3 76 Cubic Yards. Cost per House. Cost per Head of Population. Rate is the £. Districts. Total. 1 2 3 1901-2 £ 2,475 £ 1,895 £ 3,452 £7,822 £7,225 d 22.5 .s. d. 7 0¼ a. d. 9 6¾ d. 16.0 d. 3.45 1902-3 2,725 2,495 3,752 £8,972 £,7604 23.6 7 4¾ 9 104 17.4 3.69 1903-4 3,100 2,950 3,895 £9,945 £8,016 23.9 7 5¾ 10 4| 18.3 3.83 1904-5 3,445 3,489 3,995 £10,929 £8,366 26.4 8 2¾ 10 11 19.3 3.99 1905-6 2,500 2,150 2,800 £7,450 £8,669 20.1 6 3½ 7 12.8 2.60 1906-7 *1,930 *2,156 *2,258 £6,250 £8,826 19.0 5 11 5 11 10.5 2.10 1907-8 *2,300 *2,450 ... *2,260 £6,850 £8,983 20.5 Mean 22.3 6 5 6 41 ... 11.3 2.24 * Alternative to inclusive contract for the District. †Standard Cost.—Mean theoretical cost of Refuse Removal on the assumption that the mean No. of cubic yds. collected for each house during the last 7 years had remained constant—viz. 4.5 cubic yards per house, and that tbe cost of collection bad been uniformly at the mean rate, namely 22.3d. per cubic yard. The price rises steadily and proportionately to the number of new houses added to the district. 110 SEWAGE DISPOSAL. As stated in previous Reports, the Sewage of the Metropolitan area drains into the London County Council sewers, while that of the Brent area is treated at the sewage works situated in the extreme west of the district, north of the Harrow-road. It has for some years been obvious that sewage works dealing with the sewage of so large a population as that of the Brent area, situated in the midst of what is rapidly becoming a densely populated district, could not be continued indefinitely without grave menace to the public health. Apart, from the fact that large sums of money have from time to time had to be spent to equip the works for dealing with the increasing volume of sewage, it was clear that no final settlement of the problem was possible on the existing site. Negotiations with the London County Council have for some time been proceeding with a view to the Brent sewage being received into the County Council sewers. In July of 1907 the Clerk of the London County Council wrote that the County Council had decided to seek authority in the Session of Parliament, 1908, to enable them to receive into the Metropolitan drainage system the sewage and drainage from the Brent area of Willesden. In this decision there will without question be found a final settlement of one of the most difficult sanitary problems of the district. COMMON LODGING HOUSES. During the last two years two Common Lodging Houses have been registered in Willesden, although prior to 1906 no Common Lodging House had ever been registered in Willesden. During 1907 premises situated at 1 and 2, Malvern Gardens, were registered as a Common Lodging House. In addition to complying with the bye-laws of the Council the premises were adapted so as to meet the requirements of the Public Health Committee in 111 other respects. Thus a large sitting room for the men was provided, trees were planted in the large forecourt attached to the premises and seats for the men to sit outside ; bath-room accommodation with hot water supply was provided, and it is interesting to note in this connection that full advantage is taken of this provision by those inhabiting the lodging house. The following table gives the particulars relating to each of the Common Lodging Houses registered in the district:— Table No. 51. Locality. Total No. of rooms. No. with 2 beds in room. No. with 3 beds in room. No. with 4 beds in room. No. with 6 beds in room. Total accommodation 108, Villiers Road 14 — 9 4 1 49 1 & 2, Malvern Gardens 24 6 11 7 — 73 38 6 20 11 1 122 OFFENSIVE TRADES. As a result of inspection of a large piggery at Gravel Pit Farm, Neasden, it was ascertained that the trade of fat boiling was carried, on. The owner of the piggery was therefore called upon to make a (plication to the Council to be permitted to carry on this offensive trade. This he did, and all requirements having been complied with their formal consent was given. From 250 to 300 pigs arc kept on the premises, and it was necessary to reconstiuct the drainage and connect with the Council's sewer in Older to abate a nuisance from cesspool drainage, the overflow from which was found to discharge into the river Brent. 112 CUSTOMS AND INLAND REVENUE ACT. During the year 81 applications were made for certificates under section 26 and 11 of the Customs and Inland Revenue Acts. The following list shows the roads where the houses are situated, and the number of houses in respect of which certificate was granted or refused :— Table No. 52. Houses where certificate refused. Houses where certificate was granted. Colin Road - 4 College Road 3 — Greyhound Road 2 — Victor Road 2 — Queen's Road — 2 Carlyle Avenue 18 2 Holland Road — 4 Shakespeare Avenue 15 — Fortune Gate Road... — 2 Salusbury Road 13 14 53 28 It is no uncommon thing to find in recently-erected houses bedrooms of such tiny dimensions as are represented by a floor area of from 40 to 70 square feet. I have persistently refused to grant certificates of exemption under the Customs and Inland Revenue Acts for houses possessing rooms of such small size. They do not, in my opinion, provide suitable accommodation for the families dwelling in houses where such rooms have to be occupied. The task of refusing these certificates, however, is a thankless one. The houses are built in accordance, with the building bye-laws of the Council, and the owners not unnaturally feel a grievance when having complied with the Council's requirements, they find they are precluded from the benefits under the Customs and Inland Revenue Acts which would follow but for the withholding of the exemption certificates. 113 The responsibility for this anomalous state of affairs rests, however, in some measure with the Local Government Board. In promoting their Bill of 190.'$, the Council endeavoured to get powers to prevent the erection of houses with rooms having less than a given specified floor area, but in this they were successfully opposed by the Local Government Board. As the granting of the certificates under the Customs and Inland Revenue Acts is entirely within the discretion of the Medical Officer of Health he is bound to act according to his judgment, and it would he a travesty of all hygienic knowledge to certify that rooms with 40 square feet floor area constituted suitable accommodation for the unfortunate people who have to spend a third of their life in so confined a space. There is perhaps no fact in relation to the conditioning of phthisis on which medical men are more agreed than that living under such conditions is conducive to the development of tubercular affections. ICE CREAM VENDORS. During the summer months the premises where ice cream is manufactured were periodically inspected, the utensils examined, and the method of making and storing enquired into. A copy of the provisions of the Willesden Urban District Council Act 1903, relating to the manufacture and sale of ice cream was also served on all vendors, printed in both English and Italian. No serious insanitary conditions were discovered, the premises being found clean and the method of preparing and storing in all instances satisfactory. A few minor defects called for the service of notices. The fact that the custard has to be boiled before it is frozen, to my mind minimizes the risk of any infection or contagion. 114 Table No. 53. District. No. of premises visited. No. found satisfactory. No. of notices served. 2 9 9 — 3 24 22 2 4 13 11 2 5 17 16 1 6 21 20 1 84 78 6 SMOKE NUISANCES. Smoke nuisances, which were such a source of trouble a few years ago, have been the occasion of very few complaints during 1907. On no occasion in the course of the systematic observations kept by the Inspectors was any nuisance observed. A nuisance of another character, however, arose in connection with a Carpet Beating Works situated at Lower Place. Several complaints were received in respect of these Works, and observations made at the time resulted in considerable collections of gritty and floeculent deposits being secured. The nuisance was abated upon the representation of the Council without litigation being necessary. HOUSING OF THE WORKING CLASSES ACT, 1890. During the year three premises were dealt with under the above Act—Nos. 16 and 18, Dudding Hill Lane. On the 18th December, 1906, representation was made to the Council as to the untenantable condition of these premises, and in accordance with instructions notices were served upon the owners to put thein in a proper habitable condition. As the property was old, and the dilapidations extensive, the expense of so doing would have been more than the houses were worth, and the owners therefore decided to pull the premises down. Ultimately the houses were demolished. 115 In Cambridge Road a house was dealt with under the Housing Act but no proceedings were taken, as the owner carried out the notices of the Council. MILKSHOPS AND DAIRIES. All the Milkshops in the District are periodically inspected, each one being inspected not fewer than three times in the course of the year. . The following Table shows the defects discovered in the course of these inspections:— Table No. 54. District. Number in District. Total No. of Inspec. tions. No. found satisfactory. No. found defective. No. where other articles than Milk are sold. No. where steam is used for cleaning. No. 2 26 65 26 — 5 3 „ 3 25 95 25 — 12 2 „ 4 17 51 16 1 3 2 „ 5 •24 65 21 3 5 6 6 36 117 29 7 19 — Total 128 383 117 11 44 13 SLAUGHTER-HOUSES. The number of Slaughter-houses in the District is nine, five being licensed and four registered. No alterations have been made during the year. The cleansing is carried out twice yearly. In four of the slaughter houses only a few sheep are slaughtered each year. H 116 LEGAL PROCEEDINGS. Two applications were made to the Police Court, one for overcrowding of a workroom (Dressmaker), and the other for recovery of debt for the removal of trade refuse. In the overcrowding case an order to abate was made carrying with it a penalty of £1 and costs. The case of Willesden* District Council versus Lockharts, Ltd., raised a very important question as to the definition of Trade refuse, A notice was served upon the owners of a lock-up shop used as a restaurant under section 49 of the Public Health Act, 1875, to remove an offensive accumulation which the Council maintained was not house refuse. Owing to default of the defendant, the Council themselves removed the refuse and applied to the Court for the recovery of the expenses incurred. The defendants alleged that the accumulation consisted of house refuse aud relied on the judgment given in the Westminster Borough Council v. Gordon Hotels Limited. The magistrates, however, held that the refuse was trade refuse and gave judgment for the Council with costs. Leave of appeal was granted, but in the result the judgment of the magistrates was accepted. The following table summarises the work of the Inspectors and Health Visitors in carrying out the provisions of the Public Health Act. 117 Summary of Principal Items of Work for Year ending December 31st, 1907. Tablk No. 55. Description of Work Quarter. Tota 1907 1st. ■2nd 3rd. 4tb. Inspection of Houses- Number inspected on complaint 185 219 147 190 741 „ ,, for special inquiry 133 91 154 23 401 „ „ from house to house 140 197 55 72 464 (Housing of the Working Classes Act, 1890) 2 1 — — 3 Re-Inspection of Houses- Number re-inspected 112 94 149 119 474 Number of visits to premises wh«re works of amendment are in operation 2347 2625 1873 2121 8,966 Number of Birth Enquiries 340 292 230 179 1,041 Infantile Death Enquiries 172 110 58 110 450 Cases of Infectious disease visited 267 186 232 33'^ 1,017 „ „ re-visited .. 183 73 68 148 472 ,, ,, removed .. 213 124 169 244 750 Number of rooms disinfected 271 222 269 34:1 1,105 Cases of Non-notifiable diseases visited 1410 1583 562 1124 4,679 „ ,, „ re-visited 246 454 199 244 1.143 Miscellaneous Visits 7 — — 16 23 Number of rooms disinfected after | Consumption .. 17 19 21 14 71 Cancer — 2 9 4 15 [Other Disease . 7 6 3 8 24 Inspection of Mews, Stables, etc. 62 80 62 52 256 ,, of Dairies, Milkshops, etc... 69 8" 76 127 352 ,, of Canal Boats 17 12 19 — 48 ,, of Slaughterhouses 11 8 10 13 34 Visits re Miscellaneous subjects 292 146 74 130 642 Observations and Inspections re Smoke Nuisance .. — 0 32 3 40 Nuisances abated— Number of new drains constructed 22 19 21 25 87 ,, drains amended .. 47 62 28 33 170 ,, tested and examined 139 107 114 112 472 ,, nuisances of various descriptions abated 297 415 •297 344 1,353 Sanitary notices issued 269 301 328 355 1,253 Statutory „ ,, 46 115 53 81 295 „ „ „ under the Housing of the Working Classes Act, 1890 .. 2 1 3 Number of letters received 907 838 786 781 3,312 „ „ written 684 626 591 641 2,542 Number of Summonses issued 1 1 — 1 3 H 2 119 FACTORY AND WORKSHOP ACT, 1901. 120 FACTORY AND WORKSHOP ACT, 1901. The following Tables give particulars as to the number and nature of the Factories and Workshops in the District, and the defects found in the course of inspections:— Total number of Factory Laundries 49 ,, ,, ,, Workshop „ 100 „ „ „ Domestic „ 33 182 Total number of Laundries without defects 137 No. where defects were discovered 45 Total No. of revisits by Sanitary Inspectors 207 Total No. of rooms measured by Inspectors 120 No. of Laundries discontinued 17 No. newly started 21 Defects discovered by Lady Health Visitors and remedied under supervision of Sanitary Inspectors:— Cleansing of workrooms 63 instances Insufficient ventilation 5 ,, Insufficient water closet accommodation 2 „ Defective water closets 26 „ No separate closet accommodation for sexes 2 ,, Failure to affix abstract 30 ,, Minor sanitary defects 55 „ SANITARY CONDITION OF WORKSHOPS WHERE WOMEN ARE EMPLOYED. INSPECTIONS UNDER THE FACTORY AND WORKSHOP ACT. Workshops.—The workshops where women and girls are employed are inspected by the Lady Health Visitors, and during the year 1907 were found to be as a rule in very fair condition. A number of dressmakers had either removed to premises outside the district, or given up work altogteher. Complaints of slackness of trade were general. In one instance proceedings were taken for overcrowding of a dressmaker's workroom. Dressmakers frequently work up to their limit with regard to air space although actual overcrowding is unusual. The workrooms have often anything but adequate air space for the comfort of the workers. 121 Laundries.—A number of defects found during the inspection of Laundries have been referred to the District Inspectors. With the passing of the new Act dealing with workshop laundries it will be possible greatly to improve the condition under which the women and girls work, particularly in the ironing rooms, where it will now be compulsory for the occupier to screen the iron heating stoves. The need for this provision has been a very real one. The evil of overhead drying still remains. Homeworkers.—The conditions found in the homes of the outworkers are almost invariably satisfactory. This part of the work, however, is very unsatisfactory, owing to the frequent changes of tenancy to which outworkers' premises are subject. About 40 outworkers notified from other districts during the year 1907 had either removed from the district or given up work at the time of inspection. Names and addresses are repeatedly received of outworkers long since removed from the district, or who perhaps had a little work months prior to receipt of the notification and have no intention of taking any more. A considerable amount of unnecessary time is spent over this work in consequence. BAKEHOUSES. At the end of 1906 there were 64 bakehouses in the District. During 1907 three new ones were built. The bakehouses are kept under constant supervision, and the decided improvement effected some three or four years ago is fairly well maintained. In all instances where new ones are constructed the plans are brought to the notice of the Medical Officer of Health, so that due provision for the accommodation of the workpeople is now enforced prior to the erection of the bakery. Total number in District 67 „ „ Underground 25 Number requiring cleansing 30 Other defects 19 122 Table No. 56. Factories, workshops, laundries, workplaces, and homework. 1.—INSPECTION—Including Inspections made by Sanitary Inspectors or Inspectors of Nuisances. Premises. Number of Primary Inspections. Reinspected. Written Notices Prosecutions. (1) (2) (3) (4) Factories (including Factory laundries) 58 26 26 – Workshops (including Workshop laundries) 402 274 155 1 Workplaces (other than Outworkers' premises included in Part 3 of this Report) — — — — Total 455 300 181 1 2. -DEFECTS FOUND. Particulars. Number of Defects. Number of Prosecutions. Found. Remedied. Referred to h.m. Inspector. 1) (2) (3) (4) (5) Nuisances under the Public Health Acts:— Want of Cleanliness 136 136 — — Want of Ventilation 8 8 — — Overcrowding 2 2 — 1 Want of drainage of floors 14 14 — — Other Nuisances 109 109 — — Sanitary accommodation— Insufficient 3 3 — — Unsuitable or defective 35 35 — — Not separate for Sexes 11 11 — — Offences under the Factory and Workshop Act :— Illegal occupation of underground bakehouses (S. 101) Nil. — — — Breach of special sanitary requirements for bakehouses (SS. 97 to 100) 2 2 — — Other offences — — — — (Excluding offences relating to out work which are included in Part 3 of this Report.) Total 320 320 — 1 123 Table No 57. 4.—REGISTERED WORKSHOPS. Workshops on the Register (s. 131) at the end of the year. Number. (1) (2) Factories, Miscellaneous 4 ,, Laundries 49 Workshops, Laundries 100 Domestic Laundries 33 Bakehouses 67 Dressmakers 40 Outworkers 83 Tailors 11 Bootmakers 21 Masons 2 Motor and Cycle Makers 8 Metalworkers 7 Wood Workers 14 Upholsterers 5 Miscellaneous 11 Total number of Workshops on Register 455 5.—OTHER MATTERS. Class. Number. (1) (2) Matters notified to H.M. Inspector of Factories :—Failure to affix Abstract of the Factory and Workshop Act (s. 133) 23 Action taken in matters referred by H.M Inspector as remediable under the Public Health Acts, but not under the Factory and Workshop Act (s. 5)— Notified by H.M. Inspector 5 Reports (of action taken) sent to H.M Inspector 5 Other 2 Underground Bakehouses (s. 101) Certificates granted during the year Nil In use at the end of the year 67 TABLE NO. 58. 3.—HOME WORK. Nature of Work. Outworkers' Lists, Section 107. Inspection of Outworkers' Premises. Outwork in Unwholesome Premises, Section 109. Outwork in Infected Premises, Sections 109, 110. Lists received from Employers. Addresses of Outworkers. Twice in the Year. Once in the Year. Lists. Outworkers. List?. Outworker.. Received from other Councils. Forwarded to other Councils. Notices Served. Instances. (1) (2) Workmen. (4) (5) Workmen. (7) (8) (9) (12) (14) (16) Wearing Apparel— (1) making, &c. 23 30 14 22 100 33 127 8 2 ('2) cleaning and washing — — — — 6 — 8 — 4 Lace, lace curtains, and nets — — — — 2 — 2 — — Furniture and upholstery — — — — 3 — 8 1 — Paper bags and boxes — — — — 1 — 1 — — Total 23 30 14 22 112 33 146 9 6 124 Table No. 59. Description of Defects, etc. Factories Miscellaneous. Factory Laundries Workshop Laundries. Domestic Laundries. Dressmakers. Miscellaneous Workshop". Outworkers. Bakehouses. Total. Description of Work or Occupation carried on by— Miscellaneous Workshops Miscellaneous Outworkers. Total. No. Inspected 4 49 100 33 40 79 83 67 455 Tailors 11 25 36 Want of Cleanliness 1 20 43 7 10 21 4 30 136 Dressmakers — 6 6 Want of Ventilation — 1 4 1 1 1 — 8 Bootmakers 21 6 27 Overcrowding — — — 1 1 — — 2 Blousemakers — 9 9 Sanitary Insufficient — — 2 — — 1 — — 3 Woodworkers 14 — 14 Accoin- Unsuitable or Defective — 12 14 — – 9 — — 35 Seamstresses — 20 20 modation ) Not Separate for Sexes — 9 2 — — — — 11 Millinors — 1 1 Other Nuisances — 21 34 3 5 22 5 19 109 Upholsterers 5 5 10 Failure to Affix Abstract — 15 15 — 6 7 — — 43 Masons 2 — 2 No. of Males employed 38 103 96 21 — 214 38 205 745 Cycle Makers 8 — 8 No. of Females employed 52 51 765 67 333 83 88 — 2,030 Glove Cleaners — — — Total No. of Persons employed 90 654 861 88 363 297 126 205 2,784 Wearing Apparel No. of Workshops discontinued — 7— 17 6 45 10 63 2 143 Cleaners — 5 5 Workshops Re-visited — 4 200 3 6 20 7 90 330 Metal Workers 7 — 7 Miscellaneous 11 6 17 Totals 79 83 162 125 127 LOCAL GOVERNMENT BOARD TABLES. Table No. 1. Year. Population estimated to Middle of each Year. Births. Total Deaths Registered in the DIstrict. Deaths in Public Institutions in the District. Deaths of Nonresideuts registered in District. Deaths of residents registered beyond District. Deaths at all Ages. 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. 1897 92,605 2,887 31.1 444 150 4 1,173 12.5 – 2 182 1,343 14.4 1898 99,180 3,142 31.7 427 1306 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 31.1 463 130.1 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 110,758 4,201 29 8 463 110.2 1,572 11.2 223 10 182 1,744 12.4 1906 141,714 1 4,272 30.1 477 111.7 1,518 10.7 219 17 171 1,672 11.8 Averages for 1897—06. 119,836 3,749 31.3 473 126.4 1,402 11.7 — 10 198 1,591 13.3 1907 144,376 4,247 29.4 436 102.7 1,545 10.7 222 6 165 1,704 11.8 Rates calculated per 1,000 of estimated population. 128 Table No. 11. Names of Localities. CHURCH END. Harlesden. kensal green. south kilburn. Year. Population estimated to middle of each Year. Births Registered. Deaths at all Ages. Deaths under 1 year | Population esti Dated to middle of each Year. Births Registered. Deaths at all Ages. Deaths under 1 year. Population estimatod 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. 1897 11,907 391 154 63 15,194 413 172 57 14,157 538 205 96 13,492 452 224 97 1898 13,280 544 181 66 15,854 420 156 53 16,331 633 186 74 13.546 490 251 93 1899 15.144 655 238 106 16,499 477 196 68 19,199 680 242 111 13,644 463 239 82 1900 16,688 701 278 100 17,542 491 214 70 22,380 785 304 94 13,819 416 279 66 1901 19,367 754 278 125 17,115 508 226 59 23,541 817 261 78 14,625 431 278 66 1902 20,153 786 281 95 17,924 576 233 78 25,296 871 294 99 14,923 447 352 104 1903 20,927 801 339 114 19,145 672 256 73 27,208 893 264 85 14,923 454 256 77 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 11,991 455 228 65 1906 23,846 853 319 124 21,755 711 288 103 28,473 843 274 78 14,969 489 225 59 Averages for 1897 to 1906 18,612 722 269 103 18,182 570 226 72 23,474 785 262 89 14,387 457 257 76 1907 24,215 893* 312 109 22,166 659 258 68 29,162 812* 280 72 14,738 446* 240 69 * Including Children born in Queen Charlotte's Hospital, and Willesden Workhouse 129 Table No. 11 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 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. Deaths Registered. Deaths under 1 year. 1897 11,787 379 180 64 11,203 183 83 22 14,985 509 154 15 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 1906 12,305 390 171 44 10,165 205 114 16 29,366 781 267 68 14 1 Averages for 1897 to 1906 12,269 369 185 54 11,043 211 110 24 21,591 632 224 67 1907 12,322 369 215 44 9,982 212 94 14 31,174 856 297 74 8 1 * Including Children born in Queen Charlotte's Hospital, and Willesden Workhouse. 130 Table No. III. CASES OF INFECTIOUS DISEASE NOTIFIED DURING THE YEAR 1907. Notifiable Diseases. Cases notified in Whole District. Total Cases notified in each Locality. Wards. No. of Cases removed to Hospital from" each Locality. Wards. Total No. of Cases Removed to Hospital. At all Ages. Under 1 year. 1 and under 5. 5 and under 15. 15 and under 25. 25 and under 65. 65 and upwards. Church End. Harlesden. Kensal Green. South Kilburn. Mid Kilburn. North Kilburn. Willesden Green. Church End Harlesden. Kensnl Green. South Kilburn. Mid Kilburn. North Kilburn. Willesden Green. Small Pox .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Cholera .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Diphtheria and Membranous Croup 254 2 81 131 19 21 .. 75 32 57 25 15 11 39 54 20 48 20 12 7 25 186 Erysipelas 77 3 2 5 6 53 8 10 10 25 11 7 4 10 .. .. .. .. 1 .. .. 1 Scarlet Fever 641 10 152 384 62 33 .. 108 151 167 50 29 22 114 96 129 140 51 27 16 88 547 Typhus Fever .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Enteric Fever 28 .. 1 8 8 10 1 4 7 5 4 1 .. 7 1 5 3 3 .. .. 2 14 Relapsing Fever .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Continued Fever .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Puerperal Fever 13 .. .. .. 1 12 .. 3 1 2 2 1 1 3 1 .. .. .. .. .. .. 1 Plague .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Cerebro-Spinal Meningitis 3 1 1 1 .. .. .. .. .. .. .. .. .. 3 .. .. .. .. .. .. 1 1 Totals 1,016 16 237 529 96 129 9 200 201 256 92 53 38 176 152 154 191 74 40 23 116 750 131 132 Table IV. CAUSES OF, AND AGES AT, DEATH DURING YEAR 1907. (Inclusive of those dying outside the District.) CAUSES OF DEATH. DEATHS AT SUBJOINED AGES. DEATHS IN LOCALITIES, (At all Ages.) At all Ages 0 to 1 1 to 5 5 to 15 15 to 25 25 to 65 65 and Up. Church End. Hailesden. Kensal Green. S. Kilburn Mid-Kilburn. N. Kilburn. Willesden Green. Ward Unknown. Small Pox .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Measles 45 6 34 5 .. .. .. 11 10 6 5 7 1 5 .. Scarlet Fever 19 .. 14 3 .. 1 .. 10 7 1 .. .. 1 .. .. Whooping Cough 75 35 40 .. .. .. .. 12 14 10 20 8 1 10 .. Diph. and Memb. Croup 18 .. 10 8 .. .. .. 5 2 .. 1 5 1 2 .. Croup .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Typhus Fever .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Enteric Fever 4 .. .. .. .. 2 .. .. 3 .. .. .. .. 1 .. Other continued .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Epidemic Influenza 23 .. .. .. .. 12 .. 1 5 5 3 4 2 3 .. Cholera .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Cerebro Spinal Meningitis .. 1 .. .. .. .. .. .. .. 1 .. .. .. .. .. Diarrhœa . 54 49 .. .. .. .. .. 11 5 8 10 3 9 15 .. Enteritis 6 .. .. .. .. 1 4 2 2 .. .. .. .. 2 .. Puerperal Fever 9 .. .. .. .. 8 .. 1 1 2 2 1 2 .. .. Erysipelas 5 1 .. .. .. 3 1 .. 1 1 1 .. .. 2 .. Other Septic Diseases 12 3 .. .. 2 4 2 2 2 1 .. 2 2 3 .. Phthisis 138 .. 6 .. 26 94 6 22 21 31 20 15 7 22 .. Other Tubercular Diseases 50 22 14 .. 2 4 1 13 4 14 9 1 .. 9 .. Cancer 108 .. .. .. 2 67 39 14 14 21 11 17 10 21 .. Bronchitis 138 39 18 1 .. 23 57 23 20 23 24 17 4 26 1 Pneumonia 176 49 57 5 4 46 15 28 26 26 27 29 9 30 1 Pleurisy 5 1 .. .. .. 3 1 1 .. 1 2 .. .. 1 .. Other Diseases, Respiratory Organs 13 .. 4 .. 1 2 6 .. .. 3 4 2 3 1 .. Alcoholism (Acute) 1 .. .. .. .. 1 .. .. .. 1 .. .. .. .. .. Cirrhosis of Liver 19 .. .. .. .. 15 4 2 3 2 2 5 1 4 .. Venereal Disease 6 4 1 .. 1 .. .. 2 .. 1 .. 1 .. 2 .. Premature Birth 91 91 .. .. .. .. .. 22 13 16 13 9 5 13 .. Accidents and Diseases of Parturition 12 .. .. .. 1 11 .. 2 4 3 .. .. 1 2 .. Heart Disease 110 .. 2 5 6 60 37 16 19 15 9 20 11 20 .. Accidents 45 9 7 2 4 20 3 10 9 5 11 4 2 4 .. Suicide 5 .. .. .. 1 3 1 .. .. .. 1 2 1 1 .. Murder 2 2 .. .. .. .. .. 1 .. .. .. .. .. 1 .. Congenital Defects 34 31 1 1 .. 1 .. 10 8 3 6 2 2 2 1 Want of Breast Milk, Marasmus 48 46 2 .. .. .. .. 15 9 5 2 5 2 10 .. Diseases of Nervous System 163 34 13 6 1 48 61 26 26 27 18 20 10 35 1 Diseases of Digestive System 48 4 6 .. 2 25 11 10 4 13 3 5 4 9 .. Diseases of Urinary System 60 2 1 .. 1 34 22 10 8 10 10 9 3 10 .. All other causes 160 22 13 5 1 38 81 30 18 23 26 22 7 30 4 Totals 1704 451 251 57 59 526 360 312 258 280 240 215 94 297 8 Table IV. DEATHS OF WILLESDEN RESIDENTS DURING THE YEAR 1907 (Inclutive of those dying outside the District). Long Table. CAUSE OF DEATH. 0 to 1 1 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 & Up. At all Ages. Small Pox .. .. .. .. .. .. .. .. .. .. .. .. .. .. Measles 6 34 5 .. .. .. .. .. .. .. .. .. .. 45 Scarlet Fever .. 14 3 .. 1 .. 1 .. .. .. .. .. .. 19 Whooping Cough 35 40 .. .. .. .. .. .. .. .. .. .. .. 75 Diph. Membranous Croup .. 10 6 2 .. .. .. .. .. .. .. .. .. 18 Croup .. .. .. .. .. .. .. .. .. .. .. .. .. .. Typhus Fever .. .. .. .. .. .. .. .. .. .. .. .. .. .. Enteric Fever .. .. .. .. 1 1 .. 1 1 .. .. .. .. 4 Other continued .. .. .. .. .. .. .. .. .. .. .. .. .. .. Epidemic Influenza .. 2 1 .. .. .. 2 2 .. 8 5 3 .. 23 Cholera .. .. .. .. .. .. .. .. .. .. .. .. .. .. Cerebral Spinal Meningitis 1 .. .. 1 .. .. .. .. .. .. .. .. .. 2 Tetanus 1 .. .. .. .. .. .. .. .. .. .. .. .. 1 Diarrhoea & Dys Zym. or Epidemic Ent 49 5 .. .. .. .. .. .. .. .. .. .. .. 54 Enteritis (Enteritis and Gastro Enteritis) .. 1 .. .. .. .. .. .. 1 .. 3 1 .. 6 Glanders (Farcy) .. .. .. .. .. .. .. .. .. .. .. .. .. .. Anthrax (Splenic Fever) .. .. .. .. .. .. .. .. .. .. .. .. .. .. Cow Pox (Accidents of Vaccination) .. .. .. .. .. .. .. .. .. .. .. .. .. .. Syphilis.- 4 1 .. .. 1 .. .. .. .. .. .. .. .. 6 Gonorrhœa .. .. .. .. .. .. .. .. .. .. .. .. .. .. Phagædena .. .. .. .. .. .. .. .. .. .. .. .. .. .. Erysipelas 1 .. .. .. .. .. .. 2 .. 1 1 .. .. 5 Puerperal Fever .. .. .. .. .. 1 4 2 1 1 .. .. .. 9 Pyaemia Septicaemia 2 .. .. .. .. .. 1 .. 1 .. 1 .. .. 5 Infective Endocarditis .. .. .. 1 1 1 .. 1 .. .. .. .. .. 4 Other Septic Diseases 1 .. .. .. .. .. .. .. 1 .. 1 .. .. 3 Malarial Fever .. .. .. .. .. .. .. .. .. .. .. .. .. .. I 2 133 Table IV—DEATHS OF WILLESDEN RESIDENTS—continued. CAUSE OF DEATH. 0 to 1 1 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 & Up. At all Ages. Rheumatic Fever .. .. .. .. .. .. .. 1 3 1 1 .. .. 6 Rheumatism of the Heart .. .. .. 1 .. .. .. .. .. .. .. .. .. 1 Tuberc. of Brain or Meninges, acute Hydrocephalus 8 9 3 2 .. .. .. .. .. .. .. .. .. 22 Tuberculosis of Larynx .. .. .. .. .. .. .. .. .. .. .. .. .. .. Tuberculosis of Lungs .. 6 .. 6 10 16 35 19 30 10 6 1 .. 138 Tuberculosis of Intestines, Tabes Mesenterica 9 4 1 .. .. .. .. 1 .. 1 .. .. .. 16 General Tube'losis T'br'clr Dis. of undefined position 5 1 1 .. 1 1 1 1 .. .. .. .. .. 11 Other forms of Tuberculosis, Scrofula .. .. .. .. .. .. .. .. .. .. .. 1 .. 1 Other Infective Dis., Rubeola, Varicella, etc. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Thrush .. .. .. .. .. .. .. .. .. .. .. .. .. .. Actinomycosis .. .. .. .. .. .. .. .. .. .. .. .. .. .. Acute Alcoholism, Delirium Tremens .. .. .. .. .. .. .. .. 1 .. .. .. .. 1 Chronic Alcoholism, Cirrhosis of Liver .. .. .. .. .. .. 2 4 6 3 4 .. .. 19 Chronic Industrial Poisoning .. .. .. .. .. .. 1 1 .. .. .. .. .. 2 Osteo Arthritis Rheumatoid Arth.Chronic Rheu'ism. .. .. .. .. .. .. .. .. .. .. 2 1 .. 3 Gout .. .. .. .. .. .. .. .. .. .. .. 1 .. 1 Cancer Malignant Growth .. .. .. .. 1 1 3 9 22 33 26 12 1 108 Diabetes Mellitus .. .. .. .. .. .. .. .. 1 3 2 .. .. 6 Haemophilia 1 .. .. .. .. .. .. .. .. .. .. .. .. 1 Anaemia Leucocythemia .. 1 1 .. .. .. .. .. 2 3 1 1 .. 9 Premature Birth 91 .. .. .. .. .. .. .. .. .. .. .. .. 91 Injury at Birth 4 .. .. .. .. .. .. .. .. .. .. .. .. 4 Debility at Birth 14 .. .. .. .. .. .. .. .. .. .. .. .. 14 Atelectasis 1 1 Congenital Delects .. .. .. .. .. .. .. .. .. .. .. .. .. .. Malformation of Heart, Congenital Heart Disease 4 .. .. .. .. .. 1 .. .. .. .. .. 5 Spina Befida Hydrocephalus 3 1 1 .. .. .. .. .. .. .. .. .. .. 5 Ituperforate Anus & other Cong'l Rectal Malform'ns 2 .. .. .. .. .. .. .. .. .... .. .. 2 Other Cougenital Defects, Icterus Neonatorum 7 1 .. .. .. .. .. .. .. .. .. .. .. 8 134 Table IV.—DEATHS OF WILLESDEN RESIDENTS— continued. CAUSE OF DEATH. 0 to 1 1 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 & Up. At all Ages. Want of Breast Milk 1 .. .. .. .. .. .. .. .. .. .. .. .. 1 Atrophy Debility Marasmus Starvation 51 2 .. .. .. .. .. .. .. .. .. .. .. 53 Dentitiou 4 7 .. .. .. .. .. .. .. .. .. .. .. 11 Rickets .. 1 .. .. .. .. .. .. .. .. .. .. .. 1 Old Age, Senile Decay .. .. .. .. .. .. .. .. .. 1 14 25 22 62 Convulsions 27 3 .. .. .. .. .. .. .. 1 .. .. .. 31 Meningitis 7 7 2 .. .. .. .. .. 1 .. .. .. .. 17 Apoplexy 1 1 1 1 3 10 12 27 17 1 74 Softening of Brain .. .. .. .. .. .. .. .. .. 1 2 1 .. 4 Hemiplegia Brain, Paralysis .. .. .. .. .. .. .. .. .. 2 4 .. .. 6 Genera) Paralysis of Insane .. .. .. .. .. .. 1 2 3 1 .. .. .. 7 Other forms of Insanity .. .. .. .. .. .. .. 1 1 .. .. .. .. 2 Chorea 1 1 Cerebral Tumour .. .. .. .. .. .. 2 .. .. 1 .. .. .. 3 Epilepsy .. .. 1 .. .. .. 1 .. .. .. .. .. .. 2 Locomotor Ataxy .. .. .. .. .. .. .. .. .. .. 1 1 .. 2 Paraplegia, Diseases of Spinal Cord .. 1 .. .. .. .. .. 1 .. 2 2 .. .. 6 Other & ill defined dis. of Brain or Nervous System .. 1 1 .. .. 1 .. 1 .. .. 1 1 .. 6 Otitis Otorrhœa 2 1 1 1 .. .. .. 1 .. .. .. .. .. 6 Diseases of Nose, Epistaxis .. .. .. .. .. .. 1 .. .. .. .. .. .. 1 Pericarditis .. .. .. .. .. .. 1 .. .. .. .. .. .. 1 Endocarditis, Valvular Disease of Heart .. 2 1 4 4 2 6 15 14 18 21 12 .. 100 Hypt-rtrophy of Heart .. .. .. .. .. .. .. 1 1 1 .. .. .. 3 Angiua Pectoris .. .. .. .. .. .. .. .. 1 .. .. .. .. 1 Aueurism .. .. .. .. .. .. .. 1 1 1 2 1 .. 6 Senile Gaugrene .. .. .. .. .. .. .. .. .. .. 1 4 .. 5 Embolism Thrombosis .. .. .. .. .. .. .. 1 2 3 4 1 11 Other & ill-defined Dis. of Heart & Circulat'y Syst. .. .. .. .. .. .. .. 1 .. 2 1 1 1 6 * Return corrected to under 1 year, but correction received after Table in print. 135 Table IV. - DEATHS OF WILLESDEN RESIDENTS—continued. CAUSE OF DEATH. 0 to 1 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 & Up. At all Ages. Laryngitis .. 4 .. .. .. 1 .. .. .. .. .. 1 .. 6 Acute Bronchitis 37 18 1 .. .. .. 1 1 .. 4 3 2 1 68 Bronchitis and Chronic Bronchitis 2 .. .. .. .. .. 1 1 5 9 20 29 1 68 Lobar Croupous, Pneumonia 1 3 1 .. .. 1 2 1 1 .. 2 .. .. 12 Lobular Broncho Pneumonia 30 35 2 .. .. .. .. 1 2 3 5 2 .. 80 Pneumonia, Form not stated 18 19 2 .. 1 2 3 9 11 13 3 3 .. 84 Emphysema Asthma .. .. .. .. .. .. 1 1 1 .. 3 1 .. 7 Pleurisy and Empyema 1 .. .. .. .. .. 1 1 1 .. 1 .. .. 5 Other and ill-defined Dis. of Respiratory System .. .. .. .. .. .. .. .. .. .. 1 .. .. 1 Diseases of (Esophagus .. .. .. .. .. .. .. .. 1 .. .. .. .. 1 Ulcer of Stomach and Duodenum .. 1 .. .. .. 1 2 1 .. .. 3 .. .. 8 Other Diseases of Stomach 1 3 1 1 2 1 1 .. .. 12 Stricture of Duodenum 1 .. .. .. .. .. .. .. .. .. .. .. .. 1 Appendicitis .. .. .. .. .. .. 5 1 2 1 1 .. .. 10 Obstruction of Intestine 2 2 .. .. .. .. .. 1 .. 1 3 .. .. 9 Other diseases of Intestine .. .. .. .. .. .. .. 2 .. 1 1 .. .. 4 Disease of Liver (other than Cirrhosis) 1 .. .. .. .. .. .. 1 .. 1 1 .. .. 4 Peritonitis 1 .. .. .. .. 1 .. 1 .. .. .. .. .. 3 Acute Nephritis 2 .. .. .. .. 1 1 .. 1 .. 1 .. .. 6 Bright's Disease .. 1 .. .. .. .. 4 5 11 6 10 7 .. 44 Disease of Bladder and Prostate .. .. .. .. .. .. 1 .. 1 3 1 1 .. 9 Other and ill-defined disease Urinary System .. .. .. .. .. .. .. .. .. 1 .. .. .. 1 Disease of Ovaries .. .. .. .. .. .. .. .. 1 .. .. .. .. 1 Disease of Uterus and Appendages .. .. .. .. .. .. .. 1 1 .. .. .. .. 2 Disease of Vagina and External Genital Organs .. .. .. .. .. .. .. .. .. .. .. .. .. .. Abortion, Miscarriage .. .. .. .. .. .. 1 .. .. .. .. .. .. 1 Puerperal Mania .. .. .. .. .. .. .. 1 .. .. .. .. .. 1 Puerperal Convulsions .. .. .. .. .. 1 1 .. .. .. .. .. .. 2 Placenta Praevia, Flooding .. .. .. .. .. .. .. 5 .. .. .. .. .. 5 Puerperal Thrombosis or Embolism .. .. .. .. .. .. 1 .. .. .. .. .. .. 1 136 Table IV —DEATHS OF WILLESDEN RESIDENTS—continued. CAUSE OF DEATH. 0 to 1 1 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 & Up. At all Ages. Other & ill-def. accid'ts & dis. of Preg. & Childbirth .. .. .. .. .. .. 1 1 .. .. .. .. .. 2 Ulcer, Bedsore .. .. .. .. .. .. .. .. .. 2 .. .. .. 2 Pemphigus 2 .. .. .. .. .. .. .. .. .. .. .. .. 2 Deaths from external causes by accidentor negligence in Vehicular Traffic .. 1 .. .. .. 1 .. 2 .. .. .. .. .. 4 On Railways .. .. .. .. .. .. .. 2 .. .. .. .. .. 2 Burns and Scalds .. 2 .. .. .. 1 .. 1 .. 1 1 .. .. 7 Poisons, Poisonous Vapours .. .. .. .. .. .. .. 1 1 1 1 .. .. 4 Surgical Operations .. 1 .. .. .. .. .. .. .. .. .. .. .. 1 Corrosion by Chemical .. 1 .. .. .. .. .. .. .. .. .. .. .. 1 Drowning .. 1 .. .. .. .. .. .. .. .. .. .. .. 2 Suffocation, Overlaid in bed 6 .. .. .. .. .. .. .. .. .. .. .. .. 6 Suffocation otherwise 3 .. .. .. .. .. .. 2 .. .. .. .. .. 7 Falls—not specified .. .. .. .. .. .. .. 3 .. .. .. .. .. 8 By Falling bodies .. .. .. .. .. .. .. .. .. .. .. .. .. 2 Otherwise not stated .. .. .. .. .. .. .. 1 .. .. .. .. .. 2 Homicide .. .. .. .. .. .. .. .. .. .. .. .. .. 2 Suicides (all forms) .. .. .. .. .. .. .. .. .. .. .. .. .. .. By Poison .. .. .. .. .. .. .. .. 1 .. .. .. .. 1 By Asphyxia .. .. .. .. .. .. .. .. 1 .. .. .. .. 1 By Drowning .. .. .. .. .. .. .. .. 1 .. ..1 .. .. 2 By Crushing, Railway, etc. .. .. .. .. .. 1 .. .. .. .. .. .. .. 1 Other and ill-defined and not specified causes .. .. 1 .. .. 1 1 1 1 .. 1 .. .. 6 Totals 451 251 38 19 22 37 93 121 153 159 196 133 31 1704 137 Table V. INFANTILE MORTALITY DURING THE YEAR 1907. Deaths from stated Causes in Weeks and Mouths 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. 1 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. All Causes Certified 96 26 18 16 156 48 41 43 24 27 17 21 21 19 16 16 449 Uncertified 2 .. .. .. 2 .. .. .. .. .. .. .. .. .. .. .. 2 Common Infectious Diseases Small-pox .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Chicken-pox .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Measles .. .. .. .. .. .. 1 .. .. 1 1 .. .. 2 1 .. 6 Scarlet Fever .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Diphtheria (including Membrauous Croup .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Whooping Cough .. .. .. 1 1 3 2 4 1 6 6 3 6 1 2 35 Diarrhœa1 Diseases Diarrhoea, all forms .. .. 1 1 2 3 12 7 6 6 5 2 4 1 .. 1 49 Enteritis, Muco-enteritis, Gastro-enteritis .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Gastritis, Gastro- .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Wasting Diseases Premature Birth 65 8 5 5 83 4 4 .. .. .. .. .. .. .. .. .. 91 Congenital Defects 8 4 1 .. 13 2 .. .. 1 .. .. .. .. .. .. 1 17 Injury at Birth 3 1 .. .. 4 .. .. .. .. .. .. .. .. .. .. .. 4 Want of Breast-milk, Starvation .. .. .. .. .. .. .. .. .. 1 .. .. .. .. .. .. 1 Atrophy, Debility, Marasmus 9 4 6 3 21 11 4 13 1 5 .. 3 3 1 3 .. 65 138 Table V—continued. INFANTILE MORTALITY DURING THE YEAR 1907. 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. Totul under 1 Month. 1-2 Months. 2-3 Months 3-4 Months. 4-5 Months. 5-6 Months. 6-7 Month. 7-8 Months. 8-.9 Months. 9-10 Months. 10-11 Months. 11-12 Months. Total Deaths under One Year. Tuberculous Diseases Tuberculous Meningitis .. .. .. .. .. .. .. 1 9 1 .. .. 1 .. .. 1 8 Tuberculous Peritonitis: Tabes Mesenterica .. .. .. .. .. .. 3 1 .. 2 1 2 .. .. .. .. 9 Other Causes Other Tuberculous Diseases .. .. .. .. .. 1 .. 1 .. 2 1 .. .. .. .. .. 5 Erysipelas .. .. .. .. .. 1 .. .. .. .. .. .. .. .. .. .. 1 Syphilis .. .. 1 1 2 1 .. .. .. .. .. .. .. 1 . 4 Rickets .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Meningitis (not Tuberculous) .. .. .. .. .. .. .. 1 1 .. .. 1 .. .. ..2 1 7 Convulsions 6 4 .. .. 11 4 2 3 f. 1 .. 1 1 .. .. 2, 27 Bronchitis 2 1 i i 5 4 8 7 4 2 1 1 i i 4 1 39 Laryngitis .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Pneumonia .. 2 1 .. 3 10 3 3 4 3 1 2 6 5 2 1 49 Suffocation, overlying 2 .. .. 1 3 1 .. 1 .. •.. .. 1 .. .. .. .. 6 Other Causes 3 2 3 2 10 3 2 1 3 2 1 .. 1 2 3 .. 28 Totals 98 26 18 16 158 48 41 43 24 27 17 21 21 19 16 16 451 Percentage of total deaths 21'7 5-8 40 3 5 35 0 10-6 91 9 5 5 3 5 9 3 8 4 7 4-7 42 3 5 3 5 Births in the year legitimate 4,122 illegitimate 125 Deaths from all Causes at all Ages, 1,704 Deaths in the year of [legitimate infants 429 i illegitimate infants 22 Population, Estimated to middle of 1907 144,376 139 140 CONCLUSION. In the foregoing pages an attempt has been made to set out some main facts bearing upon life and health in Willesden. An annual review of these conditions enables a measure to be taken of the vital circumstances which most nearly are an index of the public health. For comparative purposes this is most valuable. The social organism is making for itself an environment adapted roughly to the hygienic requirements imposed by the time. How far is it succeeding in ameliorating the conditions of man's lot? Can health be sustained in a community forced to live under the artificial conditions which modern industrialism and commercialism have imposed 1 Since man i6 of more importance and concern than his vogues this question is first rate. The answer is not easy. The Annual Report of the Medical Officer of Health is for each district an attempt and a contribution to the answer. But it is not a complete answer. Were it so, it might emphatically be said that modern conditions are compatible not only with sustained but with improving general health. The death rate is reduced apace; zymotic diseases no longer claim the appalling tribute which in the past made them veritable human scourges. On every hand there are signs and even definite measure of improved health and vital prospects. Yet, withal, there is abounding scepticism as to the reality of health progress. It is indisputable that a child born today has a prospect of life measurably greater than it would have had a generation ago. It is unquestionable also that a child born in a new suburb such as Willesden has a prospect of life much greater than a child born in an older and more central part of London. But these improvements are the outcome merely of a better environment. So far, good. This is what the Local Health Authorities have properly 141 been aiming at. They have succeeded, and are succeeding, witness the comparative vital statistics. Better environment is a measure of human progress—desirable, necessary, and very properly a public concern. It and its results are all with which this Report is concerned. But the whole ground and circumstances of health are not covered. Actual racial deterioration is not incompatible with such achievement as is recorded in these and the pages of similar Reports. Eugenically, we may be making no headway; may even rapidly be losing ground. It is desirable that this point of view be kept in mind. It will not weaken present effort, but it will save from too sanguine a view of what has been accomplished, aud perhaps in time lead to more comprehensive endeavour than is at present contemplated. * * * * I cannot close this Report without acknowledgment of the efforts made by the Council, my Colleagues, and my Staff in the endeavour to promote the public health. To the Chairman and Members of your Public Health Committee I desire to tender my warmest thanks for their zealous support, and to the Members of my Staff I desire to express my sincere appreciation of their loyal and devoted service. I am, Gentlemen, Your obedient Servant, WILLIAM BUTLER. WILLESDEN Urban District Council. HOSPITAL REPORT FOR THE YEAR, 1907, BY WILLIAM J. J. STEWART, M.D. (Edin. , D.P.H. Camb.), MEDICAL SUPERINTENDENT. London: Printed by Martin & Son, The Brondesbury Press, 211 High Rd., Kilburn. 1908. Member of the hospital Vising Committee. Councillor F. W. DOWNIE, Chairman. „ H. T. ALFOED. „ J. ANDREWS. „ C. BIDDISCOMBE. „ W. B. DUNN. ,, J. E. HILL, Chairman of Council. [Ex- Officio.) „ J. W. INGLEDEW. „ G. H. JOHNSON. W. EILEY. HOSPITAL REPORT FOR 1907. To the Chairman and Councillors of the Willesden Urban District Council. Gentlemen, I have the honour to submit to you the Hospital Report for 1907. The number of patients admitted was 760, a falling off of 58, as compared with the previous year. Notwithstanding, it was necessary to open the hospital at Kingsbury in the autumn to accommodate the overflow of patients from this hospital. In 1906, although a greater number of cases was admitted, that hospital remained closed. The explanation of this is to be found in the fact that last year the cases were admitted iu large numbers within a short period, the result being that this hospital was soon filled. 4 The greatest number of admissions took place in the first and last quarters, the latter, as is usual, being the heavier. The most prevalent disease was scarlet fever, of which 504 cases were admitted, a relatively large number as compared with the 175 cases of diphtheria. As regards the latter disease it is several years since the diphtheria wards were for so long a time so lightly taxed. In 1903, another cold and wet year, there was also a very low number of diphtheria cases admitted. Kingsbury Hospital Avas opened on November 2nd and closed on January 11th of this year. The advantage of having Kingsbury to fall back upon has been felt more and more each year, but at no time so much as last November when both hospitals were full. Fortunately a decided fall in the number of admissions took place early in December, otherwise there would have been no alternative but to build temporary additions to this hospital for the accommodation of patients. I think it should be clearly understood that, in spite of the fact that there is this second hospital 5 at Ivingsbury, the accommodation at both hospitals together is sufficient for ordinary years only, and that it is very questionable if in years of epidemic prevalence it would prove to be anything short of being absolutely inadequate, especially in a district like Willesden with a large child population. Even now, that is in the busy season of nonepidemic years, it is only by means of frequent re-arrangement of the wards, which are set aside for the accommodation of one disease, and their conversion as occasion may require into wards for another disease, and by the temporary addition to the number of beds, that all the cases can be admitted. The Local Government Board suggests, as a standard of accommodation, that the number of beds provided in infectious hospitals should be at the rate of one bed for every thousand of the population, but it is not contended that this would be adequate provision in the event of an epidemic. In this hospital the accommodation, excluding 12 beds in a temporary building, amounts to 122 beds, which, if added to the 32 beds at Kingsbury, brings 6 the number up to 154 beds, or just the number, having regard to the population of Willesden, suggested by the Local Government Board. I draw the attention of the Council to this matter with the object of their recognising the possibility that may shortly arise of making further extensions to this hospital either of a permanent or temporary nature. It is generally acceded that if extensions are to be made to a hospital, they can be much more efficiently and less expensively built during nonepidemic periods than when undertaken during the stress and hurry of an outbreak. Table No. 1 shows the number of patients admitted and treated during the year. 7 TABLE No. 1. Disease. Remaining in Hospital, December 31st, 1906. Admitted during 1907. Total under Treatment during 1907. Discharged during 1907. Died during 1907 Mortality per cent. Remaining in Hospital, December 31st, 1907. Scarlet Fever 71 504 575 475 16 3.21 84 Diphtheria 23 175 198 171 14 7.7 13 Enteric Fever 1 9 10 6 3 33.3 1 Total 95 688 783 652 33 4.8 98 Other Diseases 3 72 75 70 3 .31 2 Grand Total 98 760 858 722 36 4.71 100 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 60 l 32 4 ... ... 8 2 100 7 February 30 2 15 ... 1 ... 3 1 49 3 March 48 1 12 1 02 ... 5 ... 65 2 April 16 ... 9 ... 2 ... 5 ... 32 ... May 31 ... 7 ... l ... 2 ... 41 ... June 32 ... 16 ... l l 5 ... 54 1 July 43 ... 9 1 l ... 5 ... 58 1 August 28 ... 22 ... ... ... 9 ... 59 ... September 37 2 15 1 l l 5 ... 58 4 October 78 2 15 2 l ... 16 ... 110 4 November 60 7 12 4 l l 4 ... 77 12 December 41 1 11 1 ... ... 5 ... 57 2 Total 504 16 175 14 9 3 72 3 760 36 9 TABLE No. 3. DIPHTHERIA. age. MALES. FEMALES. TOTAL. Admitted. Died. Admitted. Died. Admitted. Died. Under 1 l ... 2 ... 3 1 1 to 2 2 l 4 ... 6 ... 2 to 3 9 ... 10 ... 19 4 3 to 4 11 4 6 ... 17 3 4 to 5 10 2 7 l 17 4 5 to 10 42 3 37 l 79 1 10 to 15 6 ... 6 l 12 ... 15 to 20 2 ... 4 6 ... 20 to 25 4 ... 4 1 25 to 30 1 ... 6 l 7 ... 30 to 35 1 ... 3 4 ... 35 to 40 ... ... ... ... ... ... 40 and over ... ... 1 ... 1 ... Total 89 10 86 4 175 14 10 DIPHTHERIA. As compared with previous years, fewer cases of this disease were admitted. The type of attack was mild, although several cases of exceptional severity were admitted during the summer months. The number of patients treated was 198. The mortality of 7.7 per cent. is low. In the years immediately preceding the introduction of antitoxin the rate was usually about 30 per cent. A rather larger proportion than usual of the cases were laryngeal, 21 in all being admitted with this complication. Ten of these required tracheotomy, from which operation 9 recovered. In Table No. 4 the complications arising during the course of these attacks are shown. TABLE No. 4. complications of diphtheria. Complioations. Number of Cases. Paralysis 17 Albuminuria 21 Relapse 1 Broncho-Pneumonia 3 11 SCARLET FEVER. Exactly the same number of cases were admitted as in 1906. The total under treatment for the year was 575 cases. Seven deaths occurred in November out of a total of 16 for the year. All the seven cases died during the earliest days of the illness, the symptoms being of unusual severity. The mortality of 3.2 per cent. for the year is higher than it has been for some years. 12 TABLE No. 5. SCARLET FEVER. AGE. MALES. FEMALES. TOTAL. Admitted. Died. Admitted. Died. Admitted. Died. Under 1 2 ... 2 ... 4 ... 1 to 2 3 ... 11 l 14 l 2 to 3 14 3 16 l 30 4 3 to 4 20 2 18 2 38 4 4 to 5 22 ... 21 2 45 2 5 to 10 105 2 124 2 229 4 10 to 15 43 ... 39 ... 82 ... 15 to 20 8 ... 12 1 20 1 20 to 25 7 ... 14 ... 21 ... 25 to 30 4 ... 9 ... 13 ... 30 to 35 3 ... 3 ... 6 ... 35 to 40 2 ... 2 ... 4 ... Total 233 7 271 9 504 16 13 The incidence of albuminuria cases and nephritis is unusually high as compared with other years. Possibly the cold and wet year may account for this. TABLE No. 6. complications of scarlet fever. Complication. Number of Cases. Rheumatism 41 Albuminuria 37 Nephritis 16 Otorrhœa 58 Adenitis 41 Do. (suppurative) 1 Mastoid Abscess 1 Relapse 1 Retropharyngeal Abscess 1 Rhinitis 45 Endocarditis 1 Pericarditis 1 14 ENTERIC FEVER. Except that 9 cases only were admitted, nothing in respect to this disease calls specially for comment. TABLE No. 7. ENTERIC FEVER. AGE. MALES. FEMALES. TOTAL. Admitted. Died. Admitted. Died. Admitted. Died. Under 5 ... ... ... ... ... ... 5 to 10 ... ... ... ... ... 10 to 15 2 ... 1 ... 3 ... 15 to 20 1 l 1 1 2 2 20 to 25 1 l 1 ... 2 1 25 to 30 ... ... ... ... ... ... 30 to 35 1 ... 1 ... 2 ... Total 5 2 4 1 9 3 CO-EXISTENT DISEASE. Fortunately these were limited almost entirely to combined scarlet fever and diphtheria, there being only one case of scarlet fever and whooping cough, and one of diphtheria and measles. 15 Of the scarlet fever and diphtheria cases 8 suffered from the latter in a throat form, and in 45 the nose was affected. I have alluded in previous reports to these latter forms of attack as belonging to a type of case which retains its infectiousness in respect to both diseases, but, more especially so as regards scarlet fever, for a very protracted period, and it is mainly due to that fact that the average duration of stay in hospital of scarlet fever patients is so long. Moreover, these cases of scarlet fever, complicated with nasal diphtheria are, I believe, the cases above all others which give rise to " return cases " of scarlet fever on their discharge from hospital, although, in a small percentage of cases, attacks of diphtheria may result. OTHER DISEASES. These numbered six, and were as follows : — one case of pyaemia, one of cerebro-spinal fever, one of erysipelas, two of puerperal fever, and two of measles. With the exception of cerebro-spinal fever, patients suffering from these diseases are not customarily admitted, but as the conditions under which they would have been treated at home were, in 16 the opinion of the Medical Officer of Health, so unsuitable, it was deemed advisable to admit them. With regard to cases wrongly diagnosed 72 were admitted, or an average of a little under 10 per cent. of the total admissions. 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. 15 7 ... Tonsillitis 9 ... ... Erythema ... 1 ... Sarcoma of Larynx 2 ... ... Intertrigo 1 ... ... Septic Eruption 1 ... ... Rheumatism 11 ... 2 Gastric Catarrh 1 ... ... Burns ... 1 1 Pneumonia 1 ... ... Influenza 3 ... ... Morbilli 1 ... ... Gum Rash 1 ... ... Psoriasis ... ... 1 Colic 1 ... ... Phtheiriasis ... 1 ... Asthma ... 1 ... Tubercular Peritonitis 1 ... ... Purpura ... ... 1 Ovarian Cyst 2 ... ... Pertussis 50 11 5 17 RINGWORM. Two hundred and thirty-six fresh cases of this complaint, in addition to the balance left over from the previous year, were treated as out patients at the hospital. BACTERIOLOGY. Owing to the diminished number of diphtheria cases admitted to hospital the number of preparations examined was 1,267, or 326 less than in 1906. Amongst these are included 484 examinations made for practitioners in the neighbourhood. SICK STAFF. A rather high proportion of sickness occurred amongst the Staff, sixty-four members being off duty for periods exceeding 24 hours at a time. The total number of days they remained off duty amounted to 924, or an average of 14-2 days per sick person. The average number of staff employed during the year was seventy-five. Unfortunately nine members of the staff contracted complaints as a consequence of infection caught 18 whilst on duty in the wards. Four nurses and two ward maids contracted scarlet fever, two nurses enteric fever, and one nurse erysipelas. All recovered, except Nurse Gladys Gallier who, I greatly regret to say, died of a malignant attack of scarlet fever. Nurse Gallier, had only been on the staff some two months, but even in that time had shown great promise. Her death came as a great shock to us all. HOSPITAL BUILDINGS. No change has taken place in these, except that the lavatories and W.C.'s in Block " 0," the typhoid wards, have beeu enlarged and freshly equipped. The Steward was also provided with a separate office for his own special use. His old office being given up to the medical staff, who hitherto had used it jointly with him. HOSPITAL EXPENDITURE. As in previous years I submit a statement of expenses connected with the hospital for the year. The amount shown does not include the repayment of Sinking Fund and interest on loans on the hospital. 19 The total amounts to £8,644 16s. 7½d, and if this sum be divided up amongst the 858 patients treated, the cost per patient is £10 1s. 6d. The average stay in hospital of the patients treated was 46.3 days. In conclusion I would take this opportunity of thanking the principal officers and other members of the staff who have rendered me loyal assistance. No one appreciates more than I do, their zeal, thoroughness and the excellence of their work. I remain, Gentlemen, Your obedient servant, W. J. J. STEWART. March 31st, 1908. 20 CURRENT EXPENDITURE FOR THE YEAR 1907 (including Kingsbury). £ s. d. Staff Salaries (including Medical Staff) 3,130 7 6 Provisions 2,571 8 9 Furniture and House Linen 134 14 11 Clothing 127 11 11 Necessaries 255 2 5 Repairs 108 10 7 Coals, Coke and Oil 1,055 15 5 Gas 202 5 7 Water Supply 170 4 4 Electric Current 193 3 7 Drugs 107 2 74 Druggist's Sundries 119 4 0 Printing and Stationery 53 3 0 Disinfectants 6 3 3 Stable—Forage, Utensils, Repairs, etc. 251 3 1 Various and Sundry 158 15 7½ £8644 16 7½ Disinfecting (Cost of, included in above):— £ s. d. Forage, Utensils, Repairs, etc. 167 8 8½ Coachman and Assistant 67 12 0 Disinfecting Porter—Salary 59 16 0 Coals 376 16 10 £671 13 Ambulance Station (Cost of, included in above):— £ s. d. Forage, Utensils, Repairs, etc. 83 14 4i Coachman and Assistant 67 12 0 £151 6 4½ Cost of Maintenance, pee Head, per Week. s. d. Patients 4 5½ Staff 7 7 W1LLESDEN DISTRICT COUNCIL AND WILLESDEN EDUCATION COMMITTEE. Medical Inspection of Children Attending Public Elementary Schools. REPORT BY WILLIAM BUTLER, M.B., D.P.H., MEDICAL OFFICER OF HEALTH. London : Hanbury, Tomsett & Co., " Electric Press," Kensal Rise, N.W. 1908 Medical Inspection of Children Attending Public Elementary Schools. To the Chairman and Members of the Willesden Urban District Council, and of the Education Committee. Gentlemen, In accordance with the instructions of the Public Health Committee and the request of the School Management Sub-Committee I have the honour to submit the following report on Medical Inspection of School Children. The Education (Administrative Provisions) Act, 1907, is the outcome of a wide recognition of the need to attend to the physical condition of the children on whom such large sums are being spent annually in the endeavour to train and educate them into useful citizens The fact has been established to the satisfaction of Parliament that physical defects and disabling diseases among children are extremely prevalent, that there is ground to fe;ir that physical deterioration of our people is threatening the national welfare and efficiency, and that it has become imperative from a National standpoint not only to investigate the facts of physical deterioration, but to remedysuch vital evils. On the need for doing this, fortunately all shades of political opinion are united. There may be differences of opinion as to the kind or degree of 4 Education necessary to a child's equipment ; as to the rudimentary need of securing physically sound healthy lives, there can be none. The Chaiter securing for the future that due attention shall be given to the physical, as well as to the mental needs of the child is comprised in Sect. 13 of the Act. This enacts that the powers and duties of a Local Education Authority, shall J 7 include:— The duty to provide for the medical inspection of children immediately before or at the time of or as soon as possible after their admission to a public elementary school, and on such other occasions as the Board of Education direct, and the power to make such arrangements as may be sanctioned by the Board of Education for attending to the health and physical condition of the children educated in public elementary schools. The provision for Medical Inspection of children is thus a statutory duty, the power to make arrangements for attending to the health and physical condition of the children, an enabling authority conferred by the Act. 5 THE STATUTORY INSPECTION. The Memorandum issued by the Board of Education on the 22nd November, last, defines the minimum as to degree and frequency of Medical Inspection, " the effectiveness of which will in future be one of the elements to be considered in determining the efficiency of each school as a grantaided school." DEGREE OR CHARACTER OF INSPECTION. The Memorandum requires that account shall be taken of the following matters :— (1) Previous disease, including infectious diseases. (2) General condition and circumstances— (a) Height and weight. (b) Nutrition [good, medium, bad]. (c) Cleanliness [including vermin of head and body]. (d) Clothing [sufficiency, cleanliness, and gear]. (3) Throat, nose and articulation [mouth-breathing, snoring, stammering, tonsillar and glandular conconditions, adenoids]. (4) External eye disease and vision testing. (5) Ear disease and deafness. (6) Teeth and oral sepsis. 6 (7) Mental capacity [normal, backward, defective]. (8) Present disease or defect: [(a) Deformities or paralyses: (b) Rickets; (c) Tuberculosis (glandular, pulmonary, osseous, or other forms) ; (d) Diseases of skin and lymph glands; (e) Disease of heart or lungs; (f) Anaemia; (g) Epilepsy (/i) Chorea ; (i) Ruptures ; (;') Spinal disease ; (k) Any weakness or defect unfitting the child for ordinary school life or physical drill, or requiring either exemption from special branches of instruction or particular supervision.] It is needless to point out that this entails a thorough Medical Examination of each child inspected. It is not anticipating results unduly, to say that many of the conditions discovered will require :— (a) The temporary exclusion of the scholar, and its reference to the Medical Attendant of the family, pending its recovery and attainment of fitness to return to school. The necessary representations to the parents in these cases will best be made by the Health Visitors, acting under the directions of the Medical Inspectors. (b) The continued medical supervision of the scholar in the case of children with physical+ 7 defects not necessitating exclusion, but calling possibly to some modification of the school regime. This the Medical Inspector would direct in accord with the requirements of particular defects. (c) Amendment of the home conditions of the child. As the Memorandum very properly observes, " it is in the home that both the seed and the fruit of public health are to be found. The increased work undertaken by the State for the individual will mean that the parents will not have to do less for themselves and their children, but more." Administrative economy will unquestionably best be served by using to the utmost extent " the existing machinery of Medical and Sanitary Admin- J J stration, developing and supplementing it as required, rather than supplanting it by bringing into existence new agencies partially redundant and possibly competing." FREQUENCY OF MEDICAL INSPECTION. "12. The Board have decided under section 13 of the Act that not less than three inspections during the school life of the child will be necessary 8 to secure the results desired. The first inspection should take place at the time of, or as soon as possible after admission to school; the second at or about the' third year (say the seventh year of age) ; and the third at or about the sixth year of school life (say the tenth year of age). A further inspection immediately before the departure of the child into working life would be desirable where practicable, and in some areas it may be best for this to take the place ot the third inspection. But in the first year (1908) it may prove impracticable to attempt more than the inspection of the children newly admitted and those leaving school; and in the second year (1909) the Board will be satisfied with the inspection ot those newly admitted and those leaving, with the addition of children who have matured for their second inspection (which is perhaps the occasion of all others requiring the most thorough examination). Some such adjustment would tend to equalise the burden over successive years." Number of Children to be Medically Examined. In order to comply with these mimimum requirements as set out in the memorandum, it will be necessary during 1908 to inspect primarily not 9 Other Medical Inspectors. fewer than 6,000 children. Apart from continued growth in the number of children attending public elementary schools in Willesden, this number will be augmented each year until all the children already primarily inspected have matured for their second medical inspection when the number of medical inspections will have reached about 9,000 per annum In addition to this routine, it will be necessary for the Medical Officers engaged, to examine children for specific purposes quite apart from the systematised non-selective examinations. Thus the occurrence in schools of communicable diseases requires frequent special visits to particular schools, the medical inspection of all scholars in the affected classes, and the immediate exclusion of those found to be suffering or suspected of developing the disease in question. There is also the re-inspection from time to time of physically defective children already discovered. Medical Certificates. Again the re-admission of children to school after recovery from illness can only safely be permitted in many cases after medical examination. Where no medical practitioner is in attendance or where the parents are unwilling to pay for an 10 opinion on so responsible an issue, great difficulty is experienced in regulating attendance. The examination and certification of such cases will constitute an important part of the duties of the Education Committee's Medical Officers. Teachers again are constantly in need of advice with respect to scholars who are obviously in need of medical care. While the Medical Officer is in the Schools making the systematised inspections, he will be consulted about children whom the teacher has noted as abnormal or suffering from some obtrusive defect. In time these will necessarily come under medical observation in the ordinary course of inspection, but before the whole ground is covered systematically, advice will properly be sought from the visiting Medical Officer in respect of these cases. Faulty habits in the children, defective hygiene in the schools, gross cases of disease and physical neglect other than those discovered in the routine inspection, will necessarily receive the attention of the Medical Officer in the course of his school visits. 11 ORGANISATION AND ADMINISTRATION. In considering the question of organisation, the first matter to he decided is, as to who shall carry out the regular systematised medical inspections at the schools. In the Memorandum issued by the Board of Education, the general principles governing the selection of officers for this work, are laid down in paragraph 7. i Supervising ' Medical Officer. " The work of inspection should be supervised by the Medical Officer of Health of the Authority which appoints the Education Committee; and when the work is obviously more than he can undertake unaided, it should be entrusted to one or more medical officers working under his supervision. AY hen it is necessary to appoint officers for the purpose of the Act it is extremely important that persons of suitable qualifications and experience should be selected, even though they may not be called upon to give the whole of their time to these duties, and it should be noted that there are many cases in which women are likely to be specially suitable. In making such appointments preference should be given to medical men and women who (1) have had adequate training in State Medicine or 12 Qualifications of Medical Officers. hold a Diploma in Public Health, (2) have had some definite experience of school hygiene, and (3) have enjoyed special opportunities for the study of diseases in children. The particular needs and circumstances of the area or group of schools concerned should receive due consideration, and great care must be taken to see that school hygiene really forms an integral and fundamental part of the public health administration of the district, and is not subordinated to other less important sanitary questions." Question of Part time employment of General Practitioners In Willesden the work is obviously more than the Medical Officer of Health can undertake unaided, and the choice of assistants lies between the appointment of all-time Medical Officers, devoting themselves exclusively to the work, and the parttime employment of medical practitioners otherwise engaged in general practice in the district. The chief advantage of employing local general practitioners is that they are familiar in their practices with the diseases widely affecting the children attending public elementary schools, and they have a direct knowledge of the home conditions of these children and of the circumstances which lead to the prevalence of the morbid affections. 13 Objections. There are on the other hand many drawbacks to the part-time employment of several officers to do work which can be accomplished by the employment of a lesser number of all-time officials. This is especially so where each part-time officer is also engaged in private professional work in the same locality in which his public duties are discharged. Medical men have generally viewed with distrust any system under which their private patients were officially seen by practitioners also engaged in private general practice in the same locality. On public grounds this sentiment should be respected not only because there should be harmony and friendly relations between the medical practitioners of the district, and the Council's Medical Officials, but also because whatever is apt even as an indirect result of official action, to disturb private professional relations is also calculated to render unpopular the official action taken. And the success of any scheme is to be assured only by avoiding such sources of friction. Again it will be found difficult to find among the local general practitioners a sufficient number who, in addition to possessing the invaluable 14 fication which their special opportunities for the study of disease in children have afforded them, have had also an adequate training in state medicine and have had definite experience of school hygiene. Even should such be forthcoming, there remains the further difficulty of conflict between the official demands on their time and the uncertain exigencies of general practice which make the definite allocation of a portion of the day for systematically recurring work, a practical impossibility. The difficulties of co-ordinating the work, of securing uniformity of procedure and of results and of utilising to the full, the invaluable presence in the schools of the practitioner of medicine would all be greatly increased were this method of conducting the work decided upon. Special All-time Medical Officers. Should the appointment of special all-time Medical Officers receive the approval of the Committee, 1 estimate that the number necessary to perform the work will be as follows 1. A supervising medical officer of schools. 2. An assistant medical officer of schools. 3. A second assistant medical officer of schools. 15 I. The Supervising Medical Officer of Schools. In accordance with the requirements of the Board of Education, and in conformity with the principle already endorsed by the Council, and the Education Committee, the supervising medical officer of schools should be the Medical Officer of Health. Duties. " The work of medical inspection should be carried out in intimate conjunction with the Public Health Authorities and under the direct supervision of the Medical Officer of Health." On him should devolve the organization and supervision of the work of medical inspection, in addition to the responsibility for continuance of the work already authorised and carried out during the last four years. The character of the medical inspection as indicated in the Memorandum (par. 9) comprehends :— (a) " The medical inspection of school children at regular intervals. (b) The oversight of the sanitation of the school buildings. (c) The prevention as far as may be of the spread of infectious and contagious diseases. 16 (d) The bringing under systematic supervision of the personal and home life of the child." The first of these provinces of work will fall for the most part to the Assistant Medical Officers of Schools, but the second, third, and fourth divisions of the work can only properly be carried out by the Supervising Medical Officer of Schools if he is also Medical Officer of Health. The personnel of his department, the statutory powers which have been acquired in accordance with the needs of public health administration, the undesirability of dual control, and overlapping of duties, alike indicate the propriety and economy of this division of work. The notification to the parents as to the time and place at which the medical inspection of the child will take place will, most conveniently be issued from the office of the supervising Medical Officer of Schools. The records to be kept in accordance with the regulations under Article 13 of the Memorandum, should preserve the continuity of those which during the last four years have been kept, abstracted, and tabulated in my department. 17 These records at present consist of about 48,000 cards, each containing the detailed results of investigation into the various conditions affecting the scholars who have been the subject of enquiry. The analysis and tabulation of the facts recorded on these cards have furnished a mass of statistics which have, in part, been embodied in my annual reports, and the value of which will be enhanced by comparison with the results which the further records will disclose. The responsibility for keeping these records and for their analysis and tabulation should rest with the Supervising Medical Officer. The entries will be made if the existing conservation of clerical work is preserved, partly by the Teachers or Attendance Officers, partly by the Assistant Medical Officers of Schools, and partly by the Lady Health Visitors. It is perhaps unnecessary to say more here with regard to the card system which I designed four years ago as part of the scheme for the hygienic control of schools than that it aims at 18 avoiding all duplication of clerical work and preserves the original entries made by the respective persons responsible in an ever accessible and permanent record, ft can readily be adaptable to the new conditions without dislocation of existing organization. The Annual Report required under the regulations ( par 13 of Memorandum ) should be prepared and presented by the" Supervising Medical Officer of Schools. In accordance with the recommendation of the Local Government Board, intimated in a recently issued Memorandum, and in conformity with the sub-section (e) 13 of the Memorandum of the Board of Education, this report should be issued with the closely related report of the Medical Officer of Health. Duties of Assistant Medical Officers. The Assistant Medical Officer of Schools should be a registered Medical Practitioner, possessing the qualifications, set out in paragraph 7, above quoted, who should devote the whole of his time to the work. He should act under the immediate direction of the Supervising Medical Officer, and his duties should be those already indicated. 19 Advantages of Second Assistant Medical Officer being a Qualified Medical Woman. The Second Assistant Medical Officer of Schools should possess similar qualifications, and perform similar duties to those of the Assistant Officer, but' I suggest that it is desirable from many points of view, that this medical officer should be a qualified medical woman. The work is of a character which a properly trained medical woman may be relied upon to perform ; in the case of female scholars, she will prove more acceptable to many of the parents than would a medical man : in the case of female teachers, delicate communications will be the more readily conveyed when the barrier of sex is removed. It is unnecessary to approve, or disapprove, the basis on which these preferences rest, it is sufficient that they exist and have to be reckoned with. Other Staff necessary— Clerk. From what has been said it will be recognised that a good deal of clerical work will be entailed in carrying out the requirements of the Act, and I estimate that this will fully occupy a clerk devoting the whole of his time to the duties- The work of the Lady Health Visitors will be considerably augmented as a result of this 20 Additional Lady Health Visitors or School Nurses. ment of the medical supervision of school children, and I am of opinion that for the scheme to be of practical value, two additional Health Visitors should be appointed. The duties of the Health Visitors would include the visiting of certain of the scholars at their homes to see that the instructions of the Medical Officers were there carried out, more especially with regard to dirty, verminous and impetiginous children, and those affected with scabies, ringworm, and allied contagious skin diseases. One of the Health Visitors should usually be present at the Medical Inspections, especially of the children in the Infant Departments. She should prepare the child for examination, and generally aid in making entries of the results on the child's card, and in noting instructions where parents have to be communicated with, and the child visited at the home. Only by the provision of skilled assistance in this way will it be possible to embrace the work with the staff as at present estimated. A considerable portion of the time of the Medical Officer can be saved 21 in each case where the children are already prepared and only strictly medical work has to be attended to by the doctor. From the first it should be recognised that what is needed is a scheme which shall prove of practical utility, It is useless to note that a child is dirty or verminous if nothing is done to see that it is properly and effectively cleansed. To exclude a child from school because it is suffering from ringworm is a necessary measure of prevention so far as the other children in the school are concerned, but there is an obvious incompleteness in the system if the affected child is permitted tc suffer through years of protracted disablement, because of the incapacity or neglect of the parent to provide for the treatment of the condition. It is obvious that if good practical results are to follow upon medical inspection of the children, the cooperation of the parents on the one hand, and of the teachers and officers of the Education Authority on the other must be enlisted. The children discovered to be suffering from curable complaints must be visited at their homes, the parents must be informed of the nature of their 22 ailments, of the need for treatment and, where necessary, of the existing available provision for the medical care of the cases. During the last four years many thousands of cases have thus been visited at their homes, and it has been found that a certain proportion of cases require to be kept under continued supervision. From a variety of causes, the cases are neglected and allowed to go from bad to worse, when by prompt treatment, they might be quickly cured and school attendance resumed. SUMMARY. The suggestions I have to make as to steps necessary to carry out the provisions of Section 13 of the Education (Administrative Provisions) Act 1907, and of the Memorandum of the Board of Education issued in supplement thereof may be summarised as follows :— [. The appointment of a Supervising Medical Officer of Schools. 2. The appointment of an Assistant Medical Officer of Schools, who should be a 23 tered medical practioner, holding the Diploma in Public Health or other qualification in State Medicine and possessed ot a knowledge of diseases in children and ot School Hygiene. 3. The appointment of a second Assistant Medical Officer, similarly qualified, This officer should be a woman. 4. The appointment of two additional Lady Health Visitors or School Nurses. 5. The appointment of an additional clerk to act under the direction of the Supervising Medical Officer. 6. Such modifications of existing arrangements and regulations as are best suited to the new dispositions necessitated by the recent statutory requirements. These would be the subject of a brief report when the new officers are appointed. Estimated Cost. The total cost of carrying out this work of Medical Supervision of the children attending Public Elementary Schools in Willesden I estimate to be about £ 1,000 a year. 24 This is something under I/- a head per annum, and considering that each child now costs nearly £3 a year for educational purposes alone, the amount to be spent does not seem excessive having regard to the advantages to be gained. Elementary Education will then be placed upon a basis which hitherto it has lacked, one in which the child is looked upon as a growing organism, whose physiological needs and physical culture are elements of educational interest, not less important because they are basal and subservient to the higher culture, and not unworthy of the discriminating care the)' will receive with the advent of the medical adviser to the schools. William Butler, Medical Officer of Health. January 10th, 1908. Millesden Arban District Council. REPORT ON EXPENDITURE OF PUBLIC HEALTH DEPARTMENT. To the Chairman and Members of the Works and General Purposes Committee. Gentlemen, In accordance with your instructions I have the honour to submit a return of the cost of the Public Health Department during the last seven years. I am indebted to the Clerk and the Engineer for kindly furnishing me with an account of expenses relating to my department, which were entered in books of account kept by them. The return does not include the Sinking Fund and Interest on that portion of the public offices used by the department, nor the cost of heating and lighting the same. But apart from this I believe it to be a full and complete return. 2 TABLE No. I. Showing the expenditure of the Public Health Department, during the years 1901-1907. Year. Population. Amount produced by a Penny rate. Gross cost of Department. Amount recovered from Imperial Grant. Net cost of Department. Net cost per head of Population. Net cost in the £ to the Rates. £ s. d. £ s. d. £ s. d. £ s. d. d. d. 1901-2 116089 2351 11 0 2265 7 8 253 17 9 2011 9 11 4.1 0.87 1902-3 122211 2507 7 0 2523 9 8 327 10 0 2195 19 8 4.3 0.8o 1903-4 129315 2678 17 0 2639 19 3 296 14 11 2343 4 4 4.3 0.87 1904-5 134539 2787 7 0 3111 4 11½ 559 15 9 255' 9 2½ 4.5 0.91 1905-6 140758 2926 3 0 3257 0 11½ 680 14 3 2576 6 8½ 4.3 0.88 1906-7 141714 3005 6 0 34l8 8 7 733 19 4 2684 9 3 4.5 0.91 190-.8* 144376 3090 0 0 3569 2 10 813 10 0 2755 12 10 4.5 0.86 • All figures for this year are estimated for that portion of the year unexpired. 3 As will be seen from a glance at the last column of Table No. 1, the net cost to the rates during the seven years has remained practically constant, and has never reached in any one year the sum yielded by a rate equal to id. in the £. The population, it will be observed, has increased during this time by nearly 30,000, an addition equal to that of a considerable town, and this has, of course, necessitated an increase of staff, apart from the increase in duties from the assumption of work not previously undertaken. The cost per head of population has varied only within the limits of two-fifths of a penny. Although the cost of the department to the rates has not increased at all, the scope of the work has been enormously expanded. The Factory and Workshop Act of 1901 threw a great amount of additional work upon local authorities, and especially upon their Public Health Departments. The Willesden District Council Act still further augmented the work in this district, and the Education Act of 1902, by making the local authority the authority for education, created conditions under which the work of the Public Health Department necessarily assumed a much more comprehensive character. Almost every session of Parliament throws some additional duty upon local authorities, and as the most pressing social reforms are those relating to the health of the nation, it is in the health departments that the augmentation of work is chiefly noticeable in this connection. During the last four years there have been made, in connection with entirely new 4 TABLE No. 2. 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. Year. Population. Standard Death Rate. General Death Rate, Willesden. Annual Saving in rate per 1000 Pop. Annual Saving in Lives. Equal to a Monetary Value of Mean Death Rate 7 years 1893-1900. Annual Saving in rate per 1000 Pop. Annual Saving in Lives. Equal to a Monetary Value of £ S. d. £ S. d. 1901-2 116089 16.38 I3.2 3.18 369 58671 0 0 14.4 1.2 139 22101 0 0 1902-3 122211 16.38 13.9 2.48 303 48177 0 0 14.4 .5 61 9699 0 0 1903-4 I29315 '16.38 12.8 3.58 463 73617 0 0 14.4 1.6 207 32913 0 0 1904-5 134539 16.38 12.2 4.18 562 89358 0 0 14.4 2.2 296 47064 0 0 1905-6 140758 16.38 12.4 3.98 560 89040 0 0 14.4 20 282 44838 0 0 1906-7 141714 16.38 11.8 4.58 649 103191 0 0 14.4 2.6 368 58512 0 0 1907-8 144376 16.38 11.6 4.78 690 109710 0 0 14.4 2.8 404 64236 0 0 3596 571764 0 0 1757 £279363 0 0 5 duties assumed by the department, no fewer than 25,000 domiciliary visits chiefly having for their aim the reduction of infantile mortality and the prevention of non-notifiable infectious disease. It is very pleasing to be able to report that during this period of expanding activity there has been a substantial reduction of the death rate of the District. This is shown in the fourth column of Table No. 2 :— This reduced mortality of Willesden residents is an asset of which it is difficult to assess the value in terms of money, for apart from the direct gain in lives saved, there is the reflex enhancement of residential desirability, which, though an unknown, cannot be a negligible quantity. Diminished mortality, moreover, means diminished sickness, and diminished sickness means greater efficiency of the units of the population and greater earning capacity. But available data do not enable these assets to be estimated. On the other hand, just as domestic animals have their money value, and the average prices of horses and dogs, asses and cattle, can be ascertained, so also have human beings a value which may be represented in monetary terms, and it is possible to measure approximately the immediate economic gain in lives saved, by translating them into terms of their minimum value as productive moneyearning agents. This value, averaged for men, women and children in the United Kingdom was estimated by the late Dr. Farr as being £159 per head. 6 If therefore we can calcalate the gain in lives, that gain multiplied by the monetary value per head will represent the total minimum economic saving in terms of currency. In the third column of Table No. 2 is given the standard death rate for Willesden, which I calculated from the census data of 1901. It represents the death rate in Willesden, if each sex at each quinquennial age period died at the same rate as persons of the same age and sex died in England and Wales, during the preceding decennium. The difference between this standard rate and the actual death rate for the District represents the gain or loss due to favourable or adverse local conditions. In column No. 5 of Table 2 is shown the reduction in the death rate on this comparison, and in column No. 6 the number of lives saved each year in Willesden on the assumption that, but for the favourable local conditions, the people in Willesden would at each age period have died at the same rate as in England and Wales. The total saving during the seven years, on this assumption, amounts to 3,596 lives, representing at their minimum value the sum of ^571.764. Another comparison, more useful perhaps in assessing the value of the particular efforts of the past seven years, is the change in the death rate during this period as compared with that of the preceding seven years. The mean annual death rate for the seven years ending 1901 was 14.4 per 1000, and in columr 10 is given the actual lives saved as a result of the reduced mortality in Willesden during the last septennium. 7 This represents a minimum monetary value of £279,363. So large a public credit would justify a substantial expenditure in the effort to achieve a result so gratifying, and I do not doubt that in criticising the expenditure of the Public Health Department, the credit side of the balance sheet will be remembered as a set-off to the actual contributions from the rates to the maintenance of the efficiency of the department. WILLIAM BUTLER, Medical Officer of Health. Dec. 7th, 1907. ISOLATION HOSPITAL. Maintenance and Loan Charges. Amount. Rate in the £ required. £ s. d. d. Year ending 1901-2* 10451 10 10½ 4.44 „ „ 1902-3 9067 7 4 3.61 „ „ 1903-4 9662 13 0½ 3.60 „ „ 1904-5 00189 11 3 4.57 „ „ 1905-6 13922 9 6 4.80 „ „ 1906-7 14512 18 4½ 4.84 „ „ 19007-8(Estd). 14523 18 9 4.70 * Small Pox Epidemic. Millesden Arban District Council. PUBLIC HEALTH QUARTERLY STATISTICS. First Quarter, 1907. To the Chairman and Members of the Public Health Committee. Gentlemen, I have the honour to submit the Vital and other Statistics for the First Quarter of the year. In doing so I wish to call attention to certain changes I have made in the form of these returns. In place of the long table of the causes of death hitherto published I have, for the purposes of the Quarterly Report, included only those causes set out in the shorter table of the Local Government Board, reserving the more detailed list of the longer table for issue at the end of the year in my Annual Report. The shorter table is more compact, economises space in printing and time in preparation while it sufficiently indicates the main causes of death during the quarter. I have for the first time introduced a table showing the number of cases of non-notifiable infectious disease coming to 2 knowledge as a result of the system of notification by the teachers from the public elementary schools. This table shows the number of cases notified from the respective schools and the number of cases which upon enquiry were found to be suffering from the diseases in question. In yet another table the total number of such cases coming to knowledge is set out. From these tables a very fair idea of the prevalence of these diseases in the district will be obtained, while the extent to which particular schools are invaded can be seen. I regret to have to report a very considerable outbreak of Whooping Cough in the district. Knowledge was obtained of no fewer than 624 cases during the quarter but these do not represent nearly all the cases as many of them were first brought to light through the death returns. There were fifty deaths ascribed to this disease during the 13 weeks reported on and many of the deaths ascribed to Bronchitis and Pneumonia unquestionably were due primarily to Whooping Cough. As I have explained in previous reports this is accounted for by the fact that no medical man is called to see the patient until death is imminent from the complications to which the Whooping Cough gave rise. These complications are chiefly Bronchitis aad Pneumonia, and several deaths returned as due to these causes were known to me to be suffering from Whooping Cough, prior to the onset of the complications on account of which a doctor was called. 3 The formidable character of the outbreak may be judged when it is remembered that the large number of deaths ascribed to Bronchitis and Pneumonia is in large measure accounted for by the prevalence of Whooping cough. In the corresponding quarter of last year the deaths from Bronchitis numbered 32, those from Pneumonia 46, this quarter they are 77 and 79 respectively. It is the high mortality from Whooping cough and its complications which account for the comparatively high death rate for Willesden during the quarter and for the excessively high mortality in Mid and South Kilburn. The very high infantile mortality of South Kilburn is also accounted for on the same ground. Measles has prevailed in a lesser degree than Whooping Cough, but all the conditions for a widespread extension of this disease exist. By the prompt closure of classes in the schools in which it has made its appearance, it has so far been possible to limit its spread among scholars, but should cases be overlooked in any of the schools, Measles may be expected to assume the serious proportions unfortunately attained by Whooping Cough. I wish again in this connection to point out the serious effect of withdrawing 101* of the Code from the Board of Education's Regulations. The abolition of the Epidemic Grant in 1903 penalises the local authority for the precautions taken to prevent the spread of infectious diseases. Teachers and Attendance Officers properly desire to maintain a high record of attendance at the schools, and the temptation 4 always is to let this consideration weigh when what appears the very problematical benefit from exclusion threatens to thwart the object immediately desired. But the interests of health are too serious to be prejudiced by such disturbing considerations. The heavy death roll from Measles and Whooping Cough would, I am convinced, be reduced under the operation of the epidemic grant, and I would suggest that the Council represent to the Board of Education the desirability of reinstating this grant. METEOROLOGICAL OBSERVATIONS. 1907. Week ending. Highest by Day. Lowest by Night. Range in week. Mean of all—Highest. Mean of all—Lowest. 4-ft. Earth Thermometer. Mean Degree of Humidity. Rainfall in Inches. No. of Days on which Rain was measured. Total No. of Hours of Bright Sunshine. Hours of Bright Sunshine Registered at Greenwich. Max. Min. Jan. 5 51.00 25.00 26.00 42.50 33.25 48.00 46.00 deg. .55 3 11.5 10.8 89 „ 12 47.00 30.50 16.50 45.68 35.46 46.00 45.75 89 .20 1 11.0 6.3 „ 19 48.50 28.50. 20.00 45.03 38.36 45.50 45.50 84 .. .. 5.25 3.3 „ 26 45.00 22.50 22.50 36.96 27.50 45.50 45.50 97 .04 1 17.0 7.2 Feb. 2 49.50 21.00 28.50 39.86 29.71 45.50 45.25 83 .16 2 19.5 11.0 „ 9 39.50 25.00 14.50 35.93 29.64 45.25 44.50 88 .18 2 18.0 17.9 „ 16 49.75 28.00 21.75 44.11 34.00 44.25 43.75 88 .70 5 20.25 15.0 „ 23 52.00 25.00 27.00 45.75 35.18 43.75 43.50 80 .20 2 26.50 19.8 Mar. 2 53.00 21.00 32.00 45.82 30.11 43.75 43.75 88 .. .. 14.25 11.0 „ 9 52.00 27.50 24.50 48.46 33.71 44.00 43.75 83 .25 3 25.75 21.9 „ 16 57.00 22.00 35.00 49.68 36.32 44.00 44.00 84 .54 6 29.75 27.0 „ 23 59.00 26.75 32.25 54.25 36.25 44.25 44.00 80 .08 2 52.50 50.5 „ 30 65.75 26.00 39.75 59.54 28.21 44.75 44.25 83 .. 49.50 53.5 Means 51.46 25.29 26.17 45.66 32.90 44.96 44.50 86 Total 2'95 Ttl. 27 Total 30.75 Total 25.60 5 BIRTHS for First Quarter, 1907. WARDS. Total. Boys. Girls. Rate per 1000. Corresponding period last year. Illegitimate Births, 1. Church End 235 127 108 39.7 40.5 ... 2. Harlesden 156 75 81 29.2 36.1 ... 3. Kensal Green 197 96 101 27.8 28.4 ... 4. South Kilburn 105 49 56 29.4 35.9 ... 5. Mid Kilburn 89 46 43 29.5 34.4 ... 6. North Kilburn 59 31 28 24.0 21.8 ... 7. Willesden Grn. 199 85 114 26.7 26.8 ... Willesden U.D. 1040 509 531 29.7 31.6 23 Willesden U.D. 4th q'rter, 1906 970 468 502 26.5 27.0 23 DEATHS.—1st Quarter, ending March 30th, 1907. 6 WARDS Deaths of Willesden residents Hying within the district. Deaths of Willesden residents dying outside the district. Total. Willesden residents dying within the district. Deaths under 1 year, inclusive of infants dying outside district. Infantile Mortality Rate. Standaid Death Rate. Mean Annual Death Rate last five years corrected for age and sex distribution. Rate per 1,000 for 1st Quarter, 1907. Corresponding, Qtr.1906. Illegitimate. Not certified. Inquests. Recorded. Corrected. Corrected. I. Church End 94 7 101 2 1 3 36 169.8 16.91 14.9 17.0 17.8 14.4 2. Harlesden 83 6 89 1 1 3 23 136.1 15.74 14.6 16.7 18.8 15.9 3. Kensal Green 80 7 87 ... ... 5 17 83.3 16.22 11.1 12.3 13.4 11.7 4. South Kilburn 80 10 90 3 1 4 28 256.9 16.98 17.9 25.2 26.3 13.4 5. Mid Kilburn 68 8 76 5 ... 5 14 156.4 I7.I3 16.2 25.2 26.0 19.3 6. North Kilburn 23 4 27 1 ... ... 6 120.0 16.00 12.1 11.0 12.2 11.9 7. Willesden Green 73 6 79 3 ... 4 25 128.2 15.60 11.6 10.6 12.0 12.0 Ward unknown 2 ... 2 ... ... ... ... ... ... ... ... ... ... Willesden U. D. 503 48 551 15 3 24 149 144.9 16.38 13.5 15.7 16.8 13.5 1st Quarter, 1906 402 44 446 3 9 22 111 105.8 16.38 12.6 13.5 4th Quarter, 1906 401 48 449 4 4 19 118 112.6 16.38 12.3 13.2 7 DEATHS of WILLESDEN RESIDENTS during the FIRST QUARTER, ending March 30th, 1907. (Inclusive of those dying outside the District.) CAUSES OF DEATH. DEATHS AT SUBJOINED AGES. DEATHS IN LOCALITIES. (At all Ages.) At all Ages 0 to 1 1 to 5 S to 15 15 to 25 25 to 65 65 & Up. Church End. Harlesden. Kensal Green. S. Kilburn. Mid-Kilburn. N. Kilburn. willesden Green. Ward Unknown. Small Pox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Measles 5 2 3 ... ... ... ... ... 1 2 ... 2 ... ... ... Scarlet Fever 4 ... 2 1 1 ... ... 3 ... 1 ... ... ... ... ... Whooping Cough 50 18 32 ... ... ... ... 8 7 5 18 5 ... 7 ... Diph and Merab. Croup 8 ... 5 3 ... ... ... 3 ... 1 1 2 ... 1 ... Croup ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Typhus Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Enteric Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Other continued ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Epidemic Influenza 14 ... 2 ... ... 7 5 ... 4 3 2 3 1 1 ... Cholera ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Cerebro Spinal Meningitis 1 1 ... ... ... ... ... ... ... 1 ... ... ... ... ... Diarrhoea 1 1 ... ... ... ... ... 1 ... ... ... ... ... ... ... Enteritis 3 2 ... ... ... ... 1 ... 1 ... 1 ... 1 ... ... Puerperal Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Erysipelas 1 ... ... ... ... 1 ... ... ... 1 ... ... ... ... ... Other Septic Diseases 4 1 ... 1 ... 2 ... 2 ... ... ... 1 1 ... ... Phthisis 35 ... ... 1 5 29 ... 4 5 7 7 6 2 4 ... Other Tubercular Diseases 18 9 5 2 ... 2 ... 7 4 3 1 ... ... 3 ... Cancer 22 ... ... ... ... 13 9 5 ... 4 2 8 2 1 ... Bronchitis 77 21 12 1 ... 12 31 10 17 13 16 7 2 12 ... Pneumonia 79 28 23 1 1 22 4 11 11 12 14 14 3 14 ... Pleurisy 2 ... ... ... ... 1 1 ... ... ... 1 ... ... 1 ... Other Diseases, Respiratory Organs 5 ... 1 ... 1 2 1 ... ... 2 1 ... 2 ... ... Alcoholism (Acute) 1 ... ... ... ... 1 ... ... ... 1 ... ... ... ... ... Cirrhosis of Liver 6 ... ... ... ... 6 ... 1 1 1 1 1 1 ... ... Venereal Disease 1 1 ... ... ... ... ... 1 ... ... ... ... ... ... ... Premature Birth 22 22 ... ... ... ... ... 4 4 3 3 2 3 3 ... Accidents and Disease of Parturition 5 ... ... ... 1 4 ... 2 2 ... ... ... 1 ... ... Heart Disease 34 ... 1 2 3 17 11 7 8 6 3 5 2 3 ... Accidents 8 ... ... ... 2 2 2 2 3 ... 2 1 ... ... ... Suicide 2 ... ... ... 1 ... 1 ... ... ... ... 1 ... 1 ... Murder ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Congenital Defects 7 7 ... ... ... ... ... 2 ... 2 3 ... ... ... ... Want of Breast Milk, Marasmus 13 11 2 ... ... ... ... 5 1 1 ... ... 1 5 ... Diseases of Nervous System 45 13 2 1 1 13 15 5 9 4 5 8 3 10 1 Dis. of Digestive System 8 ... ... ... 2 5 1 2 ... 2 ... 1 ... 3 ... Diseases of Urinary System 15 ... 1 ... ... 9 5 2 3 6 1 2 1 ... All other causes 55 10 9 1 ... 8 27 14 8 6 8 7 2 9 1 Totals 55 149 100 14 18 156 114 101 89 87 90 76 27 79 2 NOTIFICATIONS—1st Quarter ending March 30th, 1907. 8 Wards. Small Pox. Scarlet Fever. Diphtheria. Typhoid Fever. Erysipelas. Membraneous Croup. Puerperal Fever. Total. Estimated Population. Xmas, '06. Rate per 1,000 Population. Scarlet Fever. Diphtheria. Notified under 15 years of age. Notification rate per 1,000 population under 15 years of age. Last Report. Notified under 15 years of age Notification rate per 1,000 population under 15 years of age. Last Report. Church End ... 34 24 1 4 1 1 65 24298 11.0 27 11.6 10.3 22 9.5 8.2 Harlesden ... 19 9 ... 4 ... ... 32 21920 6.0 14 8.3 7.4 7 4.1 7.4 Kensal Green ... 43 18 1 9 ... ... 71 29124 10.0 38 15.2 12.3 l6 6.4 7.3 South Kilburn ... 17 8 ... 2 ... ... 27 24645 7.6 15 11.2 17.2 6 4.5 2.9 Mid Kilburn ... 9 5 ... ... ... ... 14 12354 4.6 8 8.2 11.7 4 4.1 2.9 North Kilburn ... 4 1 ... 2 ... 1 8 10070 3.3 2 3.4 6.5 1 1.7 6.5 Willesden Green ... 42 14 ... 1 ... ... 57 30581 7.6 32 14.1 18.6 13 5.7 3.0 Willesden U. D. ... 168 79 2 22 1 2 274 143830 7.8 136 11.6 12.5 69 5.9 5.7 Do. 4th qtr. '06 ... 178 88 14 35 3 1 3i9 143830 8.7 154 12.5 70 5.7 Do. 1st qtr. '06 ... 146 74 14 30 1 5 270 142563 7.6 137 11.5 64 5.4 NON-NOTIFIABLE INFECTIOUS DISEASES.—Coming to knowledge from Schools and other sources of information. Number of Cases for Quarter ending March 30th, 1907. disease. Families Visited. Total Nos. Suffering. (FirstVisit). Contacts. Families Re-visited. Secondary Cases discovered upon Re-visit. Doctor in Attendance. Total Cases. Isolated. Total No. Suffering. Measles 103 92 202 37 29 70 23 121 Whooping Cough 332 551 841 100 52 330 22 603 + 21* Chicken Pox 43 41 ... ... ... 14 5 41 Mumps 58 60 ... ... ... 16 3 60 Ringworm 117 130 ... ... ... 42 21 130 Other Diseases 165 167 ... ... ... 48 8 167 Consumption 2 2 ... ... ... 1 ... 2 Coughs *119 117 ... 21 *21 35 ... 96 1160 1043 158 81 556 82 1241 These 21 cases were excluded from School in accordance with a request conveyed in a circular letter to the teachers of January 25th. At the time the scholars appeared to the teachers to be cases of simple cough, but within a fortnight 21 or over 18 per cent. of all the cases so excluded proved to be Whooping Cough. The other cases were re-admitted to school so soon as they were definitely known not to be cases of Whooping Cough. NUMBER OF CASES OF NON-NOTIFIABLE INFECTIOUS DISEASES OCCURING IN SCHOOLS. 10 Quarter ending March 30th, 1907. NAME OF SCHOOL Measles. Whooping Cough. Mumps. Chicken Pox. Tuberculosis. Influenza. Ophthalmia. Ringworm. Other Diseases. Coughs. All Diseases. Notd Sufg Not. Suff. Not. Suff. Not. Suff. Not. Suff. Not. Suff. Not. Suff. Not. Suff. Not. Suff Not. Suff. Not. Suff. Not Suff. Acton Lane—Mixed 2 ... 1 ... 4 1 1 ... ... ... ... ... ... ... 2 2 1 1 ... ... 11 4 3 Ditto Infants 5 2 4 5 17 4 ... ... ... ... ... ... ... ... 2 2 1 4 ... ... 29 17 2 Buller Road ... ... 3 ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... 3 ... 3 Cambridge Road 1 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... Chamberlayne Wood Road Mixed 4 ... 2 ... 1 9 1 ... ... ... ... ... 1 1 14 15 7 10 14 13 44 48 7 Ditto Infants 4 ... 33 26 2 1 26 7 ... ... ... ... ... ... 5 9 11 10 ... ... 9 54 15 Dudden Hill—Mixed 1 ... 2 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 3 ... 3 Ditto Infants ... ... 18 14 1 ... ... ... ... ... ... ... ... ... 1 2 1 1 2 1 23 18 9 Gibbons Road—Mixed ... ... 13 3 10 8 ... ... ... ... ... ... ... ... 5 8 7 8 5 4 44 31 10 Ditto Infants ... ... 8 10 7 6 1 ... ... ... ... ... ... 1 2 3 7 11 ... 1 27 32 3 Kensal Rise—Mixed ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 1 ... ... ... ... 3 1 2 Ditto Infants ... ... 25 27 ... ... 1 ... ... ... ... ... ... ... 3 2 22 3 9 21 60 53 4 Leopold Road—Mixed ... ... 9 0 1 2 ... ... ... ... ... ... ... 1 2 1 3 6 ... ... 19 10 10 Ditto Infants ... ... 17 20 1 ... ... 2 ... ... ... ... ... ... 4 5 2 2 5 4 29 33 2 Lower Place—Mixed ... ... 2 3 15 l6 1 ... 1 ... ... ... ... 1 5 7 2 ... 1 2 26 19 5 Disraeli Road—Infants ... ... 11 9 22 6 ... ... ... ... ... ... ... ... 7 10 1 2 ... ... 41 27 10 Not.=Notified Suff=Suffering. Number of Cases of Non-notifiable Infectious Diseases occurring in Schools—(Continued). n NAME OF SCHOOL. Measles. Whooping Cough. Mumps. Chicken Pox. Tuberculosis. Influenza. Ophthalmia. Ringworm. Other Diseases. Coughs. All Diseases- Notd Sufg Not. Suff. Not. Suff. Not. Suff. Not. Suff. Not. Suff. Not. Suff Not. Suff. Not. Suff. Not. Suff. Not. Suff. Not Suff. Pound Lane—Mixed ... ... 8 1 1 ... 2 ... ... ... ... ... ... ... 2 2 1 ... ... ... 14 3 8 Ditto Infants ... ... 11 18 4 ... 3 4 ... ... ... ... ... ... 3 4 2 3 ... ... 23 29 4 Salusbury Road—Mixed 18 2 10 2 1 ... ... ... ... ... ... ... ... ... 1 2 ... 2 ... ... 3° 8 22 Ditto Infants 48 53 23 25 4 1 1 1 ... ... ... ... ... ... ... ... 2 4 2 2 80 86 25 Stonebridge—Mixed 5 2 3 1 !3 9 2 ... ... ... ... ... 3 3 9 10 11 9 ... ... 46 34 15 Ditto Infants 1 1 2 3 3 2 5 6 ... ... ... ... ... ... 2 2 3 4 ... ... 16 18 2 Tubbs Road ... ... ... ... 1 ... ... ... ... ... ... ... ... ... 1 2 ... 1 ... ... 2 3 ... Non-Proyided Schools. ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Christ Church—Mixed 2 ... 2 1 ... ... 1 ... ... ... ... ... ... ... ... 2 ... 1 ... ... 5 4 3 Ditto Infants 2 2 30 12 ... ... 3 2 ... ... ... ... ... ... 1 1 1 3 12 11 49 31 22 Gordon Memorial—Mixed ... 1 ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 ... Ditto Infants ... ... ... 6 ... ... ... ... ... ... ... ... ... ... ... 4 ... ... ... ... ... 10 ... Harlesden National—Mixed ... ... 8 4 2 ... ... ... ... ... ... ... ... ... 2 1 1 1 ... ... 13 6 3 Ditto Infants ... ... 11 7 5 4 1 1 ... ... ... ... ... ... 6 5 2 2 ... 1 25 19 4 Harlesden Roman Catholic Mixed ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 1 ... ... ... ... 1 1 ... Holy Trinity—Mixed ... 4 1 ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... 1 1 6 1 Ditto Infants ... ... 2 4 ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... 2 5 1 Not.=Notified. Suff.=Suffering. Number of Cases of Non-notifiable Infectious Diseases occurring in Schools—(Continued). 12 NAME OF SCHOOL. Measles. Whooping Cough. Mumps. Chicken Pox. Tuberculosis. Influenza. Ophthalmia. Ringworm. Other Diseases. Coughs. All Diseases. Notd Sufg Not. Suff. Not. Suff. Not. Suff. Not. Suff. Not. Suff. Not. Suff. Not. Suff. Not. Suff. Not. Suff. Not. Suff. Not Su ff. Keeble Memorial—Infants ... ... 38 31 22 2 ... ... 1 1 ... ... ... ... ... 1 ... ... ... ... 61 35 8 Neasden—Mixed ... ... ... ... ... ... ... ... ... ... ... ... 1 1 ... ... 6 8 ... ... 7 9 ... Ditto Infants ... ... 3 ... ... ... ... ... ... ... ... ... 2 6 ... 2 18 20 ... ... 23 28 3 Princess Frederica—Mixed ... ... 3 ... 4 2 1 ... ... ... ... ... ... ... 4 6 4 1 ... ... 16 9 5 Ditto Infants ... ... 7 9 2 ... ... ... ... ... ... ... ... ... 4 4 1 1 ... ... 14 14 ... St. Andrew's—Infants ... ... 3 9 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 3 9 ... St. John's—Mixed 1 1 1 1 1 ... 1 ... ... ... ... ... ... ... 1 1 2 1 ... ... 6 ... ... Ditto Infants ... 1 ... 7 ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... 9 ... St. Mary's, Willesden— ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Mixed 1 ... 2 1 2 ... ... ... ... ... ... ... ... ... 7 10 5 5 ... ... 17 19 ... Infants ... ... 4 2 ... 1 ... ... ... ... ... ... ... 1 ... ... ... 1 ... ... 4 5 4 St. Mary's, Roman Catholic ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Mixed ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 3 ... ... Infants ... ... 24 16 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 25 18 8 Schools outside Willesden 4 4 4 9 ... ... ... 5 ... ... ... ... ... ... 1 2 ... 2 ... ... 9 22 10 Totals 108 72 351 287 146 67 59 28 2 1 ... ... 9 14 99 131 124 127 61 64 949 764 245 Not.=Notified. Suff.=Suffering. 13 Summary of principal items of Work for 1st Quarter, ending March 30th, 1907. Description of Work. Sanitary Districts. Lady Hlth. Vis. No. 2 No. 3 No. 4 No. 6 No. 6 Total Inspection of Houses— Number inspected on complaint 23 41 39 20 35 27 185 ,, ,, for special inquiry 6 12 52 22 41 133 ,, ,, from house to house „ „ (Housing of 20 29 30 61 140 the Working Classes Act, 1890) 2 2 Re-inspection of Houses— Number re-inspected 14 56 42 112 Number of visits to premises where works of amendment are in operation 625 730 255 200 537 2347 Number of Birth Enquiries 340 34° „ Infantile Death Enquiries 172 172 Cases of Infectious disease visited 267 267 „ ,, „ re-visited 183 183 „ ,, ,, removed 213 Number of rooms disinfected 271 271 Cases of Non-notifiable disease visited 1410 1410 ,, ,, re-visited 246 246 Miscellaneous Visits 7 7 Number of rooms disinfected after Consumption 17 17 Measles 2 2 Other diseases 5 5 Inspection of Mews, Stables, etc. 19 13 10 20 62 ,, of Dairies, Milkshops, etc. 9 23 6 31 69 „ of Canal Boats 17 17 ,, of Slaughterhouses 6 1 4 11 „ of Miscellaneous matters 26 121 11 134 292 Observations re Smoke Nuisance Nuisances abated— Number of new drains constructed 4 4 4 2 8 22 „ drains amended 27 7 1 4 8 47 ,, tested and examined 36 39 6 40 18 139 ,, nuisances of various descriptions abated 75 88 9 58 67 297 Sanitary notices issued 67 64 20 69 49 269 Statutory ,, „ 16 13 7 3 7 46 ,, under the Housing of the Working Classes Act, 1890 2 2 Number of letters received 907 written 684 Number of Summonses issued 1 1 14 Statement of principal items of work done under the Factory and Workshops Acts, 1901, during 1st Quarter ending March 30th, 1907. Description of Defects, &c. Factories— Miscellaneous. Factory Laundries. FactoriesDomestic. Workshop Laundries. Domestic Laundries. Dressmakers. Miscellaneous Workshops. Outworkers. Bakehouses. Total. Number inspected .. 4 .. 7 4 22 9 12 22 80 Want of cleanliness .. 1 .. .. 2 3 .. •• 8 14 Want of ventilation .. 1 .. .. 1 .. .. .. .. 2 Overcrowding .. .. .. .. .. 1 .. .. .. 1 Sanitary Accommodation:— Insufficient .. .. .. .. .. .. 1 1 .. 2 Unsuitable or defective .. .. .. 3 2 .. .. 1 .. 6 Not separate for sexes .. 1 .. .. .. .. .. .. .. 1 Other nuisances .. 9 .. 7 2 .. 1 .. 2 21 Failure to affix abstract .. .. .. .. .. 1 1 .. .. 2 Number of males employed .. 8 .. 5 1 1 26 7 51 99 Number of females employed .. 61 .. 58 9 61 1 9 .. 199 Total number of persons employed .. 69 .. 63 10 62 27 16 51 298 Number of Workshops discontinued .. .. .. .. .. .. .. .. .. .. Number of Workshops revisited .. .. .. .. 3 .. .. .. .. 3 Workrooms used for sleeping .. .. .. .. .. .. .. .. .. .. Rooms measured .. .. .. .. 7 .. .. 1 .. 8 Space notices .. .. .. .. .. .. .. .. .. .. WILLIAM BUTLER, Medical Officer of Health. April, 1907. 15 To The Public Health Committee. Gentlemen, The following table shows the number of patients treated in this hospital during the quarter ending the 31st of March. It is my intention in the future to submit to you a similar table at the end of each quarter, rather than at irregular intervals as has hitherto been my custom. In this way, no doubt, the value of the figures will be enhanced, especially for purposes of comparison, as they will be submitted along with Dr. Butler's quarterly returns. It will be seen that 214 patients were admitted during the quarter ; for the corresponding period of last year the number admitted amounted to 196. STATISTICS. Disease. Remaining in Hospital, Dec. 31, 1906. Admitted. Discharged. Died. Remaining in Hospital, Mar. 31,1907. Scarlet Fever 71 138 118 4 87 Diphtheria 23 59 62 5 15 Enteric Fever 1 1 1 ... 1 Other Diseases 3 l6 12 3 4 Total 98 214 193 12 107 The daily average number of patients in hospital was 104. The cost of maintenance of patients for the quarter was 4s. 4¾d., and for staff was 7s. 4d I remain, Your obedient servant, W. J. J. STEWART. . Willesden (Arban District Council. PUBLIC HEALTH QUARTERLY STATISTICS. Second Quarter, 1907. To the Chairman and Members of the Willesden Urban District Council. METEOROLOGICAL OBSERVATIONS. 1907. Week ending. Highest by Day. Lowest by Night. Range in week. Mean of all—Highest. Mean of all - Lowest. 4-ft. Earth Thermometer. Mean Degree of Humidity. Rainfall in Inches. No. of Days on which Rain was measured. Total No. of Hours of Bright Sunshine. of Bright Sunshine Registered at Greenwich. Max. Min. April 6 70.00 30.50 39.50 63.32 37.75 45.00 44.75 deg. .07 1 41.80 43.6 71 „ 13 56.50 31.50 25.00 52.00 38.36 45.50 45.25 79 1.29 4 20.25 18.8 ,, 20 57.50 28.50 29.00 52.50 35.82 46.00 45.50 82 .17 1 32.75 27.7 „ 27 71.50 34.50 37.00 57.53 42.75 46.00 46.00 78 1.37 4 30.00 31.4 May 4 55.00 33.50 21.50 53.07 39.50 46.50 46.00 71 .55 5 42.00 41.6 „ 11 73.00 33.50 39.50 64.82 45.53 47.00 46.50 67 .51 2 44.50 50.2 „ 18 79.50 37.00 42.50 63.89 46.75 48.00 47.00 69 .30 3 38.25 39.5 „ 25 66.50 32.00 34.50 57.29 40.21 48.50 48.00 72 .18 3 20.00 28.2 June 1 71.50 41.50 30.00 62.82 47.71 49.00 48.50 78 .38 3 14.75 r5.3 „ 8 67.50 45.00 22.50 61.96 49.71 49.50 49.00 74 .73 4 25.75 25.1 „ 15 73.50 48.50 25.00 67.71 52.32 50.00 49.50 71 .66 5 40.00 48.5 „ 22 69.00 40.25 28.75 63.46 47.14 51.00 50.50 66 .15 2 62.00 62.6 „ 29 68.50 41.00 27.50 64.28 49.14 51.50 51.00 71 .41 5 21.50 24.8 Means 67.65 36.71 30.94 60.36 44.05 47.96 47.50 73 Total Ttl. Total Total 6.77 42 433.55 457.3 2 POPULATION ESTIMATED TO CHRISTMAS 1906 AND MIDSUMMER, 1907. NAME OF WARD. 1906-7. Population estimated on the number of houses in occupation in each Ward as ascertained by special enumeration and Council's Census. Houses in Occupation. Total Number of Empty Tenements. No. of Houses recently erected but unoccu pied. No. of Houses in course of erection. Per centage of empties exclusive of houses recently erected. Per centage of empties exclusive of houses recently erected, Midsummer 1906. Fer centage of empties inclusive of houses recently erected. Per centage of Houses empty at Census. No. of Houses in Ward. No. of Empty Houses. 1 Room. 2 Rooms. 3 Rooms. Over 3 Rooms Church End Mids'r, 24215 3626 179 - - 187 28 13 10 4.9 4.5 5.3 5.96 Xmas. 24298 3604 144 5 1 181 70 12 13 4.0 4.3 Harlesden Mids'r. 22166 3649 223 - 4 122 61 39 26 6.1 6.8 7.2 3.88 Xmas. 21920 3594 220 7 5 143 84 51 48 6.1 7.5 Kensal Green Mids'r. 29162 4152 113 6 11 65 111 2 4 2.7 4.7 2.8 2.92 Xmas. 29124 4136 114 14 21 153 20 8 4 2.8 2.9 S. Kilburn Mids'r, 14738 1316 40 7 41 81 — — - 3.0 1.5 3.0 1.26 Xmas. 14645 1316 48 17 29 40 6 — — 3.6 3.6 Mid Kilburn Mids'r. 12322 1598 88 6 18 49 11 — — 5.5 5.6 5.5 4.16 Xmas. 12354 1598 84 15 16 56 12 — — 5.3 5.3 N. Kilburn Mids'r. 9982 1683 96 6 11 36 17 1 7 5.7 3.9 5.8 2.62 Xmas. 10070 1683 82 5 3 27 32 1 1 4.9 4.9 Willesden Green Mids'r. 31174 5353 232 7 1 72 94 125 78 4.3 5.8 6.7 7.37 Xmas. 30581 5260 226 - 2 44 88 158 54 4.3 7.3 Willesden U. D. aggregate of the Wards Mids'r. 143759 21377 971 32 86 612 322 180 125 4.5 5.1 5.4 4.02 Xmas. 142992 21191 918 63 77 644 312 230 120 4.3 5.4 Population as estimated to Midsummer, 1907, by the Registrar-General, 149,192. Population estimated on the assumption that the average number of persons per house at census has remained constant for the whole of Willesden—146,107 Midsummer, 1907 ; 145,155 Christmas, 1906. 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 = 144,376 Midsummer, 1907; 143,830 Christmas, 1906. 3 BIRTHS for Second Quarter, 1907. WARDS. Total. Boys. Girls. Rate per 1000. Corresponding period last year. Illegitimate Births. Church End 230 122 108 38.0 33.8 ... 2. Harlesden 187 87 100 33.9 33.0 ... 3. Kensal Green 221 114 107 30.4 31.6 ... 4. South Kilburn 115 54 61 31.4 27.1 ... 5. Mid Kilburn 89 45 44 29.0 32.3 ... 6. North Kilburn 48 22 26 19.3 21.3 ... 7. Willesden Grn. 216 116 100 27.8 25.5 ... Willesden U.D. 1106 560 546 30.7 29.6 19 Willesden U.D. 1st quarter '07 1040 509 531 297 31.6 23 DEATHS.—2nd Quarter, ending June 29th, 1907. 4 WARDS Deaths of Willesden residents dying within the district. Deaths of Willesden residents dying outside the district. Total. Willesden residents dying within the district. Deaths under 1 year, inclusive of infants dying outside district. Infantile Mortality Rate. Standaid Death Rate. Mean Annual Death Rate last five years corrected for age and sex distribution. Rate per i.ooo for 2nd Quarter, 1907. Corresponding Qtr.,1906. Illegitimate. Not certified. Inquests. Recorded. Corrected. Corrected. 1. Church End 63 9 72 1 2 6 23 105.0 16.91 14.9 11.9 12.4 9.5 2. Harlesden 49 5 54 ... ... 4 16 93.6 15.74 14.6 9.8 11.0 13.9 3. Kensal Green 60 9 69 ... ... 2 19 93.6 16.22 11.1 9.5 10.4 8.7 4. South Kilburn 49 6 55 ... ... 5 14 124.4 16.98 17.9 15.0 15.6 12.3 5. Mid Kilburn 47 6 53 3 ... 1 8 92.0 17.13 16.2 17.3 17.9 12.5 6. North Kilburn 27 2 29 1 ... 2 6 122.4 16.00 12.1 11.7 12.9 11.4 7. Willesden Green 52 6 58 1 ... 3 12 59.4 15.60 11.6 7.5 8.5 8.1 Ward unknown 1 ... 1 ... ... ... ... ... ... ... ... ... ... Willesden U. D. 348 43 391 6 2 23 98 94.0 16.38 13.5 10.9 11.7 10-4 1st Quarter, 1907 503 48 551 15 3 24 149 144.9 16.38 15.7 16.8 2nd Quarter, 1906 303 38 341 6 2 22 85 81.0 16.38 9.7 10.4 5 DEATHS of WILLESDEN RESIDENTS during the SECOND QUARTER, ending June 29th, 1907. (Inclusive of those dying outside the District.) CAUSES OF DEATH. DEATHS AT SUBJOINED AGES. DEATHS IN LOCALITIES. (At all Ages.) At all Ages 0 to 1 1 to 5 5 to 15 15 to 25 25 to 65 65 & Up. Church End. Harlesden. Kensal Green. S. Kilburn. Mid-Kilburn. N. Kilburn. Willesden Green. Ward Unknown. Small Pox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Measles 12 1 11 ... ... ... ... ... 1 2 3 5 1 ... ... Scarlet Fever 1 ... 1 ... ... ... ... 1 ... ... ... ... ... ... ... Whooping Cough 23 16 7 ... ... ... ... 4 7 3 2 3 1 3 ... Diph. and Merab. Croup 1 ... ... 1 ... ... ... ... ... ... ... 1 ... ... ... Croup ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Typhus Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Enteric Fever 2 ... ... ... ... 1 ... ... 2 ... ... ... ... ... Other continued ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Epidemic Influenza 3 ... ... 1 ... 1 1 ... ... 1 ... 1 ... ... ... Cholera ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Cerebro Spinal Meningitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Diarrhoea 4 3 1 ... ... ... ... 1 ... ... ... 1 ... 2 ... Enteritis 6 4 1 ... ... ... 1 2 1 ... 2 ... 1 ... ... Puerperal Fever 4 ... ... ... ... 4 ... 1 ... ... ... 1 ... ... ... Erysipelas 3 1 ... ... ... 2 ... ... ... ... 1 ... ... 2 ... Other Septic Diseases 2 2 ... ... ... ... ... ... 1 1 ... ... ... ... ... Phthisis 42 ... 3 2 5 27 5 8 7 6 5 3 4 9 ... Other Tubercular Diseases 11 4 2 2 1 1 1 2 ... 5 1 1 ... 2 ... Cancer 27 ... ... ... 1 17 9 4 4 7 2 3 4 3 ... Bronchitis 18 3 2 ... ... 4 9 5 ... 3 ... 3 ... 6 ... Pneumonia 39 10 16 ... ... 9 2 4 10 4 8 7 3 3 ... Pleurisy 2 1 ... ... ... 1 ... ... ... 1 1 ... ... ... ... Other Diseases, Respiratory Organs 2 ... ... ... ... ... 2 ... ... ... ... 1 ... 1 ... Alcoholism (Acute) ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Cirrhosis of Liver ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Venereal Disease 1 ... ... ... ... ... ... 1 ... ... ... ... ... ... ... Premature Birth 23 23 ... ... ... ... ... 5 4 6 4 1 ... 3 ... Accidents and Disease of Parturition 2 ... ... ... ... 2 ... ... 1 1 ... ... ... ... ... Heart Disease 24 ... 1 1 3 9 10 5 ... 4 4 5 3 3 ... Accidents 17 2 10 1 5 3 2 4 1 1 1 ... Suicide ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Murder ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Congenital Defects 9 8 1 ... ... ... ... 3 3 ... 1 ... 2 ... ... Want of Breast Milk, Marasmus 8 8 ... ... ... ... ... 3 ... 2 1 ... 1 1 ... Diseases of Nervous System 47 8 5 ... ... 15 16 7 6 12 5 6 3 8 ... Dis. of Digestive System 12 1 2 ... ... 5 4 3 1 2 1 2 1 2 ... Diseases of Urinary System 13 ... ... ... ... 9 4 1 1 2 4 2 1 2 ... All other causes 33 3 ... 2 ... 12 16 7 2 5 5 6 1 6 1 Totals 39i 98 58 14 11 129 81 72 54 69 55 53 29 58 1 NOTIFICATIONS.—2nd Quarter ending June 29th, 1907. 6 Wards. Small Pox. Scarlet Fever Diphtheria. Typhoid Fever. Erysipclas. 1 Membraneous Croup Puerperal Fever. Total. Estimated Population. Midsummer, '07. Rate per 1,000 Population. Scarlet Fryer. Diphtheria. Notified under 15 years of age. Notification rate per 1,000 population under 15 years of age Last Report. Notified under 15 1 years of age Notification rate per 1,000 population under 15 years of age. Last Report. Church End ... 18 15 3 1 ... 1 38 24215 6.3 15 6.3 11.6 14 5.9 9.5 Harlesden ... 15 9 3 2 ... ... 29 22166 5.2 9 5.1 8.3 7 4.0 4.i Kensal Green ... 26 12 1 1 ... ... 40 29162 5.5 23 9.0 15.2 10 3.9 6.4 South Kilburn ... 12 7 1 4 ... ... 24 17738 6.5 11 8.1 11.'2 7 5.1 4.5 Mid Kilburn ... ... 1 ... 3 ... 1 5 12322 1.6 ... ... 8.2 1 1.0 4.1 North Kilburn ... 4 2 ... 1 ... ... 7 9982 2.8 3 5.1 3.4 1 1.7 17 Willesden Green ... 31 5 1 5 ... 1 43 31174 5.5 24 10.1 14.1 4 1.7 5.7 Willesden U. D. ... 106 51 9 17 ... 3 186 144376 5.2 85 7.0 11.6 44 3.6 5.9 Do 1st qtr. '07 ... 168 79 2 22 1 2 274 143830 7.8 136 11.6 69 5.9 Do. 2nd qtr. '06 ... 147 63 8 19 1 1 239 141714 6.8 131 11.1 50 4.2 NON-NOTIFIABLE INFECTIOUS DISEASES.—Coming to knowledge from Schools and 7 other sources of information. Number of Cases for Second Quarter ending June 29th, 1907. disease. Families Visited. Total Nos. Suffering. (FirstVisit). Contacts. Families Re-visited. Secondary Oases di&covered upon Re-visit. Doctor in Attendance. Total Cases. Isolated. Total No. Suffering. Measles 464 445 1243 213 178 320 118 623 Whooping Cough 141 207 342 42 26 129 27 233+6* Chicken Pox 41 57 ... ... ... 12 4 57 Mumps 5 3 ... ... ... i ... 3 Ringworm 85 98 ... ... ... 34 41 98 Other Diseases 213 200 ... ... ... 55 26 200 Consumption 2 2 ... ... ... 1 ... 2 Coughs and Colds 37 35 ... 25 26 5 ... 35 Totals 988 1047 1585 280 210 557 216 1257 These 6 cases were excluded from School in accordance with a request conveyed in a circular letter to the teachers of January 25th. At the time the scholars appeared to the teachers to be cases of simple cough, but within a fortnight 6 or over 17 per cent, of all the cases so excluded proved to be Whooping Cough. The other cases were re-admitted to school so soon as they were definitely known not to be cases of Whooping Cough. NUMBER OF CASES OF NON-NOTIFIABLE INFECTIOUS DISEASES OCCURING IN SCHOOLS. 8 Second Quarter ending June 29th, 1907. NAME OF SCHOOL. Measles. Whooping Cough. Mumps. Chicken Pox. Tuberculosis. Influenza. Ophthalmia. Ringworm. Other Diseases. Coughs. All Diseases. Notd Sufg Not. Suff. Not. Suff. Not. Suff. Not. Suff. Not. Suff. Not. Suff. Not. Suit. Not. Suff. Not. Suff. Not. Suff. Not Suff. Acton Lane—Mixed 10 6 2 1 ... ... ... ... ... ... ... ... ... ... 2 3 4 2 ... ... 18 12 5 Ditto Infants 16 11 2 1 1 ... ... 3 ... ... ... ... ... ... 4 2 3 3 ... ... 26 20 4 Buller Road 4 ... 3 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 7 ... 5 Cambridge Road (Temp.) 9 ... 4 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 13 ... 12 Chamberlayne Wood Road Mixed 7 1 ... ... ... ... 6 1 1 ... ... ... 1 1 6 7 40 32 ... ... 61 42 17 Ditto Infants 13 8 15 10 2 ... 31 6 ... ... ... ... 1 1 6 6 23 23 ... ... 91 54 13 Dudden Hill—Mixed 12 ... ... ... ... ... 3 ... ... ... ... ... ... ... ... 1 ... ... ... ... 15 1 12 Ditto Infants 36 31 ... ... 3 ... 3 ... ... ... ... ... ... ... 1 1 3 7 ... ... 46 39 11 Gibbons Road—Mixed 1 ... 7 1 4 ... 1 1 1 1 ... ... ... ... 6 4 18 13 ... ... 38 21 12 Ditto Infants ... ... 11 15 ... ... 6 7 ... ... ... ... ... ... 1 5 14 9 ... ... 32 36 3 Kensal Rise—Mixed ... ... 1 1 ... ... ... ... ... ... ... ... ... ... 4 7 2 ... ... ... 7 8 1 Infants. 18 13 22 18 ... ... 2 ... ... ... ... ... ... ... 8 9 3 2 2 1 55 43 4 Leopold Road—Mixed 13 1 3 1 1 ... 3 2 ... ... ... ... ... 1 3 3 1 2 ... ... 24 10 18 Ditto Infants 34 40 ... 2 ... ... 3 2 ... ... ... ... 1 1 6 5 8 12 10 4 62 66 9 Lower Place—Mixed 3 2 2 1 2 ... ... ... ... ... ... ... ... ... 4 3 3 4 ... ... 14 10 3 Disraeli Road—Infants 7 2 ... ... ... ... 1 ... ... ... ... ... ... ... 2 2 1 1 ... ... 11 5 7 Not.=Notified Suff.=Suffering. 9 Number of Cases of Non-notifiable Infectious Diseases occurring in Schools—(Continued). NAME OF SCHOOL. Measles. Whooping Cough. Mumps. Chicken Pox. Tuberculosis. Influenza. Ophthalmia. Ringworm. Other Diseases. Coughs. All Diseases. Notd Sufg Not. Suff. Not. Suff. Not. Suff. Not. Suff. Not. Suff. Not. Suff. Not. Suff. Not. Suff. Not. Suff. Not. Suff. Not Suff. Pound Lane—Mixed 1 ... ... ... 1 ... 1 ... ... ... ... ... ... ... ... ... 1 2 ... ... 4 2 ... Ditto Infants 10 ... 3 1 2 ... 21 3 ... ... ... ... ... 1 1 1 2 4 ... 1 39 10 2 Salusbury Road—Mixed 3 ... 3 ... ... ... 1 ... ... ... ... ... ... ... 1 2 ... ... ... ... 8 2 5 Ditto Infants 26 19 3 ... 2 ... 1 ... ... ... ... ... ... ... 2 1 1 3 ... ... 35 23 7 Stonebridge—Mixed 26 ... 3 ... ... ... 3 ... ... ... ... ... 3 3 4 2 11 9 ... ... 50 14 31 Ditto Infants 17 19 ... 1 ... ... 6 2 ... ... ... ... ... ... ... ... ... 1 ... ... 23 23 3 Tubbs Road 1 ... 1 ... 2 ... ... ... ... ... ... ... ... ... 3 ... ... ... ... ... 7 2 4 Non-Provided Schools. Christ Church—Mixed 2 2 1 ... 3 ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... 7 2 2 Ditto Infants 10 8 7 2 4 1 1 ... ... ... ... ... ... ... ... ... ... ... 3 ... 25 11 12 Gordon Memorial—Mixed 5 ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... 3 ... ... ... 9 ... 4 Ditto Infants ... ... ... ... ... ... 2 ... ... ... ... ... ... ... ... ... ... ... ... ... 2 ... 1 Harlesden National—Mixed ... ... ... 2 ... ... 2 ... ... ... ... ... ... ... 2 1 4 2 ... ... 8 5 1 Ditto Infants 3 3 1 2 ... ... 1 ... ... ... ... ... ... ... 1 1 ... ... ... ... 6 6 ... Harlesden Roman Catholic Mixed ... ... ... ... 1 ... 3 ... ... ... ... ... ... ... 2 2 ... ... ... ... 6 2 1 Ditto Infants ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... 1 1 ... ... 2 1 ... Holy Trinity—Mixed 7 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 7 1 5 Ditto Infants 42 26 1 7 ... ... ... 1 ... ... ... ... ... ... ... ... 8 8 ... ... 61 42 15 Not.=Notified. Suff.=Suffering. 10 Number of Cases of Non-notifiable Infectious Diseases occurring in Schools—(Continued). NAME OF SCHOOL. Measles. Whooping Cough. Mumps. Chicken Pox. Tuberculosis. Influenza. Ophthalmia. Ringworm. Other Diseases. Coughs. All Diseases. Notd Sufg Not. Suff. Not. Suff. Not. Suff. Not. Suff. Not. Suff. Not. Suff. Not. Suff. Not. Suff. Not. Suff. Not. Suff. Not Suff. Keble Memorial—Mixed ... ... ... 1 2 ... ... ... ... ... ... ... 1 ... ... 1 ... ... ... ... 3 2 ... Infants 1 ... 2 4 3 ... 5 2 ... ... ... ... ... ... ... 1 2 3 ... ... 13 10 ... Neasden National—Mixed ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Ditto Infants ... ... 6 2 ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 2 7 4 7 Princess Frederica—Mixed 52 3 4 ... 3 ... ... ... 2 2 ... ... ... ... 4 5 4 2 ... ... 69 12 56 Ditto Infants 34 50 4 1 2 ... ... ... ... ... ... ... ... ... 3 4 ... 1 ... 1 43 56 5 St. Andrew's—Mixed 4 ... ... ... ... ... 8 ... ... ... ... ... ... ... 3 2 ... ... ... ... 15 2 5 Infants 10 11 ... ... ... ... ... ... ... ... ... ... ... ... 1 1 1 1 ... ... 12 13 2 St. John's—Mixed ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... 1 ... Ditto Infants 2 2 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 2 St. Mary's, Willesden— Mixed 3 1 3 1 2 ... 7 3 ... ... ... ... ... ... 5 4 3 4 ... ... 23 13 7 Infants. ... ... 1 1 ... ... 10 3 ... ... ... ... ... ... 2 1 3 4 ... 1 16 10 ... St Mary's, Roman Catholic Mixed ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Infants ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Schools outside Willesden 55 51 22 11 ... ... 6 2 ... ... ... ... ... ... 3 2 2 6 ... ... 88 72 20 Totals 497 311 147 87 41 2 139 38 4 3 ... ... 7 8 90 89 169 162 16 10 1110 710 331 Not.= Notified. Suff.=Suffering. II Summary of principal items of Work for 2nd Quarter, ending June 29th, 1907. Description of Work. Sanitary Districts. Lady Hlth. Vis. No. 2 No. 3 No. 4 No. 5 No. 6 Total Inspection of Houses— Number inspected on complaint 17 46 46 29 12 69 219 „ „ for special inquiry 16 6 40 25 4 91 „ „ from house to house 6 58 108 9 16 197 „ „ „ „ (Housing of the Working Classes Act, 1890) 1 1 Re-inspection of Houses— Number re-inspected 14 30 20 30 94 Number of visits to premises where works of amendment are in operation 660 783 230 172 780 2625 Number of Birth Enquiries 292 292 „ Infantile Death Enquiries 110 110 Cases of Infectious disease visited 186 186 „ „ „ re-visited 73 73 „ „ removed 124 124 Number of rooms disinfected 222 222 Cases of Non-notifiable diseases visited 1583 1583 ,, re-visited 454 454 Miscellaneous Visits Number of rooms disinfected after Consumption 19 19 Cancer 2 2 Other diseases 6 6 Inspection of Mews, Stables, etc. 20 30 7 23 80 ,, of Dairies, Milkshops, etc. 17 24 12 27 80 ,, of Canal Boats 12 12 ,, of Slaughterhouses 3 5 8 of Miscellaneous matters 10 129 7 146 Observations re Smoke Nuisance 1 4 5 Nuisances abated— Number of new drains constructed 5 6 2 3 3 19 ,, drains amended 29 18 5 5 5 62 tested and examined 23 21 23 20 20 107 nuisances of various descriptions abated 79 137 82 44 73 415 Sanitary notices issued 39 107 43 49 60 301 Statutory ,, ,, 1 12 8 3 2 89 115 „ „ „ under the Housing of the Working Classes Act, 1890 1 1 Number of letters received 838 written 626 Number of Summonses issued 1 1 12 Statement of principal items of work done under the Factory and Workshops Acts, 1901, during 2nd Quarter ending June 29th, 1907. Description of Defects, &c. Factories— Miscellaneous. Factory Laundries. Factories— Domestic. Workshop Laundries. Domestic Laundries. Dressmakers. Miscellaneous Workshops. Bakehouses. Outworkers. Total. Number inspected .. 3 .. 6 4 6 18 17 23 77 Want of cleanliness .. .. .. .. 1 2 6 7 1 17 Want of ventilation .. .. .. .. .. .. 1 .. .. 1 Overcrowding .. .. .. .. .. .. .. .. .. .. Sanitary Accommodation:— Insufficient .. .. .. .. .. .. .. .. .. .. Unsuitable or defective.. .. 1 .. 1 .. .. 2 1 2 7 Not separate for sexes .. .. .. .. .. .. .. .. .. Other nuisances .. .. .. 2 2 3 8 1 3 19 Failure to affix abstract .. 1 .. .. .. 2 1 .. .. 4 Number of males employed .. 2 4 3 1 29 25 37 2 103 Number of females employed .. 21 37 44 7 9 .. .. 27 145 Total number of persons employed .. 23 41 47 8 38 25 37 29 248 Number of Workshops discontinued .. .. .. .. 2 .. .. .. 2 4 Number of Workshops newly discovered .. .. .. 1 1 1 .. .. .. 3 Workrooms used for sleeping .. .. .. .. .. .. .. .. .. .. Rooms measured .. .. .. .. .. .. .. .. .. .. Space notices .. .. .. .. .. .. .. .. .. .. WILLIAM BUTLER, Medical Officer of Health. July, 1907. 13 To the Hospital Visiting Committee. Gentlemen, I beg to submit to you the Hospital Statistics for the quarter ending June 30th. As compared with the previous quarter there has been a marked fall in the number of admissions, a circumstance which it is usual to expect at this period of the year. STATISTICS. Disease. Remaining in Hospital, Mar. 31,1907. Admitted. Discharged. Died. Remaining in Hospital, June 30, 1907. Scarlet Fever 87 79 105 1 62 Diphtheria 15 32 24 ... 23 Enteric Fever 1 4 4 1 0 Measles ... 1 1 ... 0 Erysipelas ... 1 1 ... 0 Other Diseases ... 4 10 12 ... 2 Total 107 127 147 2 87 I would here acknowledge receipt of gifts of flowers and plants kindly sent by the local churches and others, which were greatly appreciated by the patients. I remain, Your obedient servant, W. J. J. STEWART. July 5th, 1907. Willesden Arban District Council. PUBLIC HEALTH QUARTERLY STATISTICS. Third Quarter, 1907. To the Chairman and Members of the Willesden Urban District Council. METEOROLOGICAL OBSERVATIONS. 1907. Week ending. Highest by Day. Lowest by Night. Range in week. I Mean of all—Highest. Mean of all—Lowest. 4ft. Earth Thermometer. Mean Degree of Humidity. Rainfall in Inchcs. No. of Days on which Rain was measured. Total No. of Hours of Bright Sunshine. Hours of Bright Sunshine Registered at Greenwich. Max. Min. deg. July 6 65.50 40.00 25.50 62.28 46.43 52.00 51.50 71 .41 5 21.5 24.8 „ 13 68.00 42.25 25.75 64.18 47.11 52.25 52.00 66 .27 3 39.5 36.6 „ 20 77.50 52.00 25.50 72.86 54.70 52.50 52.25 72 - - 605 577 „ 27 72.00 44.50 27.50 67.36 52.11 54.00 52.50 76 .88 4 21.7 24.7 Aug, 3 73.75 40.00 33.75 69.32 49.53 54.25 54.00 73 .56 5 43.5 43.7 ,, 10 76.00 48.00 28.00 69.71 54.36 54.75 54.25 70 .16 2 38.7 41.9 ,, 17 72.25 47.50 24.75 69.50 52.70 55. 00 54.75 69 .72 3 39.5 45.0 ,, 24 70.50 42.00 28.50 65.14 50.79 55.00 55.00 78 .64 5 25.0 24.9 ,, 31 76.00 41.00 35.00 69.64 49.00 55.00 55.00 72 .16 2 47.7 47.8 Sept. 7 71.25 43.50 27.75 65.46 50.39 55.oo 55.00 72 35 3 18.5 18.7 ,, 14 76.00 37.00 39.00 72.11 46.93 55.00 55.00 75 — — 50.0 41.9 ,, 21 71.50 40.00 31.50 67.43 44.57 55.00 55.00 73 — — 43.7 46.0 ,, 28 76.00 32.50 43.50 68.71 47.43 55.00 55.00 82 7 1 39.5 47.7 Means 72.79 42.33 30.46 67.98 49.69 54.21 53.94 73 Total 4.32 Ttl. 33 Total 489.3 Total 501.4 2 BIRTHS for Third Quarter, 1907. WARDS. Total. Boys. Girls. Rate per 1000. Corresponding period last year. Illegitimate Births. I. Church End 221 100 121 36.6 36.2 ... 2. Harlesden 169 84 85 30.6 31.9 ... 3. Kensal Green 189 104 85 26.0 28.9 ... 4. South Kilburn 98 51 47 26.7 33. 5 ... 5. Mid Kilburn 97 48 49 31.6 29.3 ... 6. North Kilburn 55 28 27 22.2 16.6 ... 7. Willesden Grn. 216 124 92 27.8 28.1 ... Willesden U.D. 1045 539 506 29.1 29.9 30 Willesden U.D. 2nd quarter '07 1106 560 546 30.7 29.6 19 1st „ '07 1040 509 531 29.7 31.6 23 3 DEATHS.—3rd Quarter, ending September 28th, 1907. WARDS Deaths of Willesden residents dying within the district. Deaths of Willesden residents dying outside the district. Total. Willesden residents dying within the district. Deaths under 1 year, inclusive of infants dying outside district. Infantile Mortality Rate. Standard Death Rate. Mean Annual Death Rate last five years corrected for age and sex distribution. Rate per 1,000 for 3rd Quarter, 1907. Corresponding Qtr.,1906. Illegitimate. Not certified. Inquests. Recorded. Corrected. Corrected. I. Church End 49 ... 49 1 ... 1 18 81.6 16.91 14.9 8.1 8.5 18.5 2. Harlesden 37 2 39 1 ... 1 11 64.7 15.74 14.6 7.1 8.0 15.5 3. Kensal Green 44 7 51 ... ... 2 17 85.4 16.22 11.1 7.0 7.6 8.2 4. South Kilburn 29 7 36 ... ... 2 11 103.8 16.98 17.9 9.8 10.2 19.6 5. Mid Kilburn 36 3 39 ... ... 4 11 123.6 17.13 16.2 12.7 13.1 12.8 6. North Kilburn 12 3 15 ... ... 4 1 19.2 16.00 12.1 6.0 6.6 11.8 7. Willesden Green 56 8 64 1 ... 1 15 73.3 15.60 11.6 8.2 9.3 10.1 Ward unknown 3 ... 3 ... ... ... ... ... ... ... ... ... ... Willesden U. D. 266 30 296 3 ... 15 84 80.8 16.38 13.5 8.2 8.8 13.2 2nd Quarter, 1907 348 43 391 6 2 23 98 94.0 16.38 10.9 11.7 1st Quarter, 1907 503 48 551 15 3 24 149 144.9 16.38 15.7 16.8 3rd Quarter, 1906 396 40 436 16 5 19 179 171.2 16.38 12.3 13.2 4 DEATHS of WILLESDEN RESIDENTS during the THIRD QUARTER, ending September 28th, 1907. CAUSES OF DEATH. DEATHS AT SUBJOINED AGES. DEATHS IN LOCALITIES. (At all Age9.) At all Ages 0 to 1 2 to 5 3 to 15 15 to 25 25 to 65 65 & Up. Church End. Harlesden. Kensal Green. S. Kilburn. Mid-Kilburn. N. Kilburn. Willesden Green. Ward Unknown. Small Pox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Measles 3 ... 3 ... ... ... ... ... 2 1 ... ... ... ... ... Scarlet Fever 2 ... 1 ... ... 1 ... 1 1 ... ... ... ... ... ... Whooping Cough 2 1 1 ... ... ... ... ... ... 2 ... ... ... ... ... Diph. and Memb. Croup 2 ... 2 ... ... ... ... 1 1 ... ... ... ... ... ... Croup ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Typhus Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Enteric Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Other continued ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Epidemic Influenza 2 ... ... ... ... 1 1 1 ... ... ... ... ... 1 ... Cholera ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Cerebro Spinal Meningitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Diarrhœa 14 14 ... ... ... ... ... 2 2 5 3 ... ... 2 ... Enteritis 7 5 ... ... ... 1 1 3 ... 1 ... ... ... 3 ... Puerperal Fever 2 ... ... ... 1 1 ... ... 1 1 ... ... ... ... ... Erysipelas ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Other Septic Diseases 1 ... ... ... ... 1 ... ... ... ... ... ... ... 1 ... Phthisis 26 ... 3 1 6 16 ... 7 3 6 3 2 ... 5 ... Other Tubercular Diseases 8 3 3 1 1 ... ... 1 ... 4 ... ... ... 3 ... Cancer 30 ... ... ... ... 20 10 2 6 5 4 4 1 8 ... Bronchitis 9 ... 1 ... ... 2 6 1 ... 2 3 1 ... 1 1 Pneumonia 17 2 4 ... 1 7 3 3 1 2 2 4 1 3 1 Pleurisy 1 ... ... ... ... 1 ... 1 ... ... ... ... ... ... ... Other Respiratory Organs 3 ... 1 ... ... ... 2 ... ... ... 1 1 1 ... ... Alcoholism (Acute) ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Cirrhosis of Liver 6 ... ... ... ... 3 3 1 1 ... ... 3 ... 1 ... Venereal Disease 3 2 ... ... 1 ... ... ... ... 1 ... 1 ... 1 ... Premature Birth 24 24 ... ... ... ... ... 6 3 4 3 5 1 2 ... Accidents and Diseases of Parturition 1 ... ... ... ... 1 ... ... ... ... ... ... ... 1 ... Heart Disease 18 ... ... ... ... 13 5 1 3 3 ... 2 2 7 ... Accidents 5 2 1 1 1 ... ... 1 ... 3 1 ... ... ... Suicide 2 ... ... ... ... 2 ... ... ... ... 1 ... 1 ... ... Murder 1 1 ... ... ... ... ... ... ... ... ... ... ... 1 ... Congenital Defects 5 5 ... ... ... ... ... 2 ... ... 1 ... ... 2 ... Want of Breast Milk, Marasmus 10 10 ... ... ... ... ... 2 3 ... ... 3 ... 2 ... Diseases of Nervous System 36 8 3 1 ... 9 15 8 7 7 2 4 1 7 ... Dis. of Digestive System 8 ... 2 ... ... 4 2 2 1 ... 1 1 2 1 ... Diseases of Urinary System 12 ... ... ... 1 7 4 2 1 1 1 2 2 3 ... All other causes 36 7 3 ... ... 8 17 2 2 6 8 5 3 9 1 Totals 296 84 28 5 11 99 69 49 39 51 36 39 15 64 3 5 NOTIFICATIONS.—3rd Quarter ending September 28th, 1907. 5 Wards. Small Pox. Scarlet Fever Diphtheria. Typhoid Fever. Erysipelas. Membraneous Croup. Puerperal Fever. Cerebro Spinal Meningitis. Total. Estimated Population. Midsummer, '07. Rate per 1,000 Population. Scarlet Fever. Diphtheria. Notified under 15 years of age. Notification rate per 1,000 population under 15 years] of age. Last Report. Notified under 15 years of age Notification rate per 1,000 population under 15 years of age. Last Report. Church End ... 25 17 ... 2 ... ... ... 44 24215 7.3 20 8.5 6.3 15 6.3 5.9 Harlesden ... 32 7 2 I ... 1 ... 43 22166 7.8 27 15.4 5.1 6 3.4 4.0 Kensal Green ... 38 12 2 6 ... 1 ... 59 29162 8.1 37 14.5 9.0 10 3.9 3.9 South Kilburn ... 7 8 1 1 ... ... ... 17 14738 4.6 7 5.1 8.1 6 4.4 5.1 Mid Kilburn ... 7 4 1 1 ... ... ... 13 12322 4.2 5 5.1 ... 2 2.0 1.0 North Kilburn ... 5 4 ... ... ... ... ... 9 9982 3.6 5 8.5 5.1 2 3.4 1.7 Willesden Green ... 20 8 4 1 ... ... 2 35 31174 4.5 14 5.9 10.1 6 2.5 1.7 Willesden U. D. ... 134 60 10 12 ... 2 2 220 144376 6.1 115 9.5 7.0 47 3.9 3.6 Do. 2nd qtr. '07 ... 106 51 9 17 ... 3 ... 186 144376 5.2 85 7.0 ... 44 3.6 ... Do. 1st qtr. '07 ... 168 79 2 22 1 2 ... 274 143830 7.8 136 11.6 ... 69 5.9 ... Do. 3rd qtr. '06 ... 166 55 11 19 1 2 ... 254 141714 7.2 142 12.0 ... 41 3.5 ... 6 NON-NOTIFIABLE INFECTIOUS DISEASES.—Coming to knowledge from Schools and other sources of information. Number of Cases for Third Quarter ending September 28th, 1907. DISEASE. Families Visited. Total Nos. Suffering. (First Visit). Contacts. Families Re-visited. Secondary Cases discovered upon Re-visit. Doctor in Attendance. Total Cases. Isolated. Total No. Suffering. Measles 126 110 259 110 81 86 42 191 Whooping Cough 55 91 112 26 9 57 12 100 Ringworm 64 78 ... ... ... 20 29 78 Chicken Pox 24 24 ... ... ... 5 3 24 Coughs and Colds 10 10 ... ... ... 2 ... 10 Mumps 2 1 ... ... ... ... ... 1 Other Diseases 93 90 ... ... ... 34 8 90 Consumption 4 3 ... ... ... 3 ... 3 Totals 378 407 371 136 90 207 94 497 7 NUMBER OF CASES OF NON-NOTIFIABLE INFECTIOUS DISEASES OCCURRING IN SCHOOLS. Third Quarter ending September 28th, 1907. NAME OF SCHOOL. Measles. Whooping Cough. Mumps. Chicken Pox. Tuberculosis. Influenza. Ophthalmia. Ringworm. Other Diseases. Coughs. All Diseases. Notd Suff. Not. Suff. Not. Suff. Not. Suff. Not. Suff. Not. Suff. Not. Suff. Not. Suff. Not. Suff. Not. Suff. Not. Suff. Not Suff. Acton Lane—Mixed ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 2 ... ... ... ... 1 2 ... Ditto Infants ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 2 2 ... ... ... 4 4 ... Buller Road ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Cambridge Road (Temp.) 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 Chamberlayne Wood Road Mixed 3 1 4 ... ... ... 1 ... 1 1 ... ... ... ... 1 1 3 2 ... ... 13 5 2 Ditto Infants 27 25 15 19 ... ... 4 1 ... ... ... ... ... ... 3 3 4 3 ... 1 53 52 9 Dudden Hill—Mixed ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... 1 1 ... Ditto Infants 1 ... 1 ... ... ... 3 ... ... ... ... ... ... ... 5 3 4 2 ... ... 14 5 5 Granville Road ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Gibbons Road—Mixed 5 ... 2 ... ... ... 2 1 ... ... ... ... 2 2 4 6 11 14 ... ... 27 23 8 Ditto Infants 2 2 5 6 ... ... 1 2 ... ... ... ... ... ... 1 3 10 10 ... ... 19 23 ... Kensal Rise—Mixed ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Ditto Infants 1 ... 1 ... ... ... 1 ... ... ... ... ... ... ... 4 4 5 4 ... ... 12 8 3 Kilburn Lane—Infants ... ... 1 1 ... ... ... ... ... ... ... ... ... ... 1 1 ... ... ... ... 2 2 ... Leopold Road—Mixed 2 1 ... ... ... ... 6 2 1 1 ... ... ... ... 3 3 1 3 ... ... 13 10 8 Ditto Infants 1 2 1 ... ... ... 1 6 ... ... ... ... ... ... ... 1 2 ... ... 1 5 10 ... Not.=Notified Suff.=Suffering. 8 Number of Cases of Non-notifiable Infectious Diseases occurring in Schools—(Continued). 8 NAME OF SCHOOL. Measles. Whooping Cough. Mumps. Chicken Pox. Tuberculosis. Influenza. Ophthalmia. Ringworm. Other Diseases. Coughs. All Diseases. Notd Suffgg Not. Suff. Not. Suff. Not. Suff. Not. Suff. Not. Suff. Not. Suff. Not. Suff. Not. Suff. Not. Suff. Not. Suff. Not Suff. Lower Place—Mixed 2 ... ... ... ... ... 1 ... ... ... ... ... ... ... ... 2 1 1 ... ... 4 3 1 Disraeli Road—Infants 3 ... ... ... ... ... 2 1 ... ... ... ... ... ... 2 2 ... ... ... ... 7 3 3 Mora Road—Mixed ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 2 ... ... ... ... 2 2 ... Ditto Infants ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Oldfield Road—Mixed ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... Ditto Infants ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... Pound Lane—Mixed 2 ... ... ... 1 ... 1 ... ... ... ... ... ... ... 1 1 ... 1 ... ... 5 2 1 Ditto Infants 2 4 1 ... 1 ... 3 1 ... ... ... ... ... ... 7 6 2 4 ... ... 16 15 ... Salusbury Road—Mixed 1 ... ... ... 1 ... ... ... ... ... ... ... ... ... 1 1 ... ... ... ... 3 1 1 Ditto Infants 4 3 4 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 9 4 1 Stonebridge—Mixed 11 ... ... ... ... ... 3 ... 1 1 ... ... ... ... 7 8 2 1 ... ... 24 10 12 Ditto Infants 7 7 ... ... ... ... 1 1 ... ... ... ... ... ... 1 2 2 2 ... ... 11 12 1 Tubbs Road 1 1 ... ... ... ... ... ... ... ... ... ... ... ... 1 1 ... ... ... ... 2 2 ... Non-Provided Schools. Christ Church—Mixed ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Ditto Infants ... ... ... ... 1 ... 1 ... ... ... ... ... ... ... 1 1 3 3 1 1 7 5 ... Gordon Memorial—Mixed ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... 4 4 ... ... 5 4 ... Ditto Infants ... 2 ... ... ... ... ... 2 ... ... ... ... ... ... ... ... ... ... ... ... ... 4 ... Harlesden National—Mixed ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Ditto Infants 1 1 ... ... ... ... ...3 ... ... ... ... ... ... ... 1 ... ... ... ... ... 5 1 1 ...Not.=Notified. Suff.=Suffering. 9 Number of Cases of Non-notifiable Infectious Diseases occurring in Schools—(Continued). 9 NAME OF SCHOOL. Measles. Whooping Cough. Mumps. Chicken Pox. Tuberculosis. Influenza. Ophthalmia. Ringworm. Other Diseases. Coughs. All Diseases. Notd Sufg Not. Suff. Not. Suff. Not. Suff. Not. Suff. Not. Suff. Not. Suff. Not. Suff. Not. Suff. Not. Suff. Not. Suff. Not Suff. Harlesden Roman Catholic ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... 1 ... 1 Holy Trinity—Mixed ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Ditto Infants ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... 1 ... Keble Memorial—Mixed ... 1 ... ... ... ... ... ... ... ... ... ... 1 ... 1 1 ... ... ... ... 2 2 1 Infants ... 2 5 1 2 ... ... ... ... ... ... ... ... ... 3 4 ... ... ... ... 100 7 2 Neasden National—Mixed ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Ditto Infants ... ... 12 11 ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... 1 13 12 3 Princess Frederica—Mixed 2 1 2 ... 1 ... 1 ... ... ... ... ... 1 1 3 1 4 1 ... ... 14 4 4 Ditto Infants 2 ... 4 3 2 1 1 ... ... ... ... ... ... ... 2 2 ... 1 1 ... 12 7 2 St. Andrew's—Mixed 4 ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... 4 1 4 Infants 46 26 ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... 47 26 17 St. John's—Mixed ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 2 ... ... 2 2 1 Ditto Infants ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... St. Mary's—Mixed ... ... ... 1 ... ... 2 ... 1 ... ... ... 1 1 1 3 ... 2 ... ... 4 7 2 Infants ... ... 1 ... ... ... ... 1 1 1 ... ... ... ... 1 1 2 ... ... ... 5 3 1 St. Mary's, R. C.—Mixed ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Infants 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... 1 1 ... Schools outside Willesden 1 5 1 2 ... ... ... ... ... ... ... ... ... ... 1 1 1 ... ... ... 4 8 1 Totals 133 84 61 45 10 1 40 18 5 4 ... ... 5 4 65 70 65 64 3 4 388 296 98 Not.=Notified. Suff.=Suffering. 10 Summary of principal items of Work for 3rd Quarter, ending Sept. 28th, 1907. Description of Work. Sanitary Districts. Lady Hlth. Vis. No. 2 No. 3 No. No. 6 No. 6 Total Inspection of Houses— Number inspected on complaint 27 42 20 14 44 147 ,, ,, for special inquiry 29 15 63 12 8 27 154 ,, ,, from house to house 45 5 5 55 „ „ „ „ Housing of the Working Classes Act, 1890) Re-inspection of Houses— Number re-inspected 25 72 20 12 20 149 Number of visits to premises where works of amendment are in operation 545 550 120 116 542 1873 Number of Birth Enquiries 230 230 ,, Infantile Death Enquiries 58 58 Cases of Infectious disease visited 232 232 „ ,, „ re-visited 68 68 „ „ ,, removed 169 Number of rooms disinfected 269 269 Cases of Non-notifiable diseases visited 562 562 ,, ,, ,, re-visited 199 199 Miscellaneous Visits Number of rooms disinfected after Consumption 21 21 Cancer 9 9 Vermin 3 3 Inspection of Mews, Stables, etc. 16 r7 7 9 13 62 „ of Dairies, Milkshops, etc. 15 21 17 23 76 ,, of Canal Boats 19 19 ,, of Slaughterhouses 3 3 1 3 10 ,, of Miscellaneous matters 12 27 25 10 74 Observations and Inspections re Smoke Nuisance 3 21 8 32 Nuisances abated— Number of new drains constructed 5 3 2 3 8 21 ,, drains amended .. 11 7 5 2 3 28 ,, tested and examined 26 3° 16 15 27 114 ,, nuisances of various descriptions abated 71 85 51 25 65 297 Sanitary notices issued 61 129 40 37 61 328 Statutory ,, „ 19 5 6 1 22 53 ,, ,, „ under the Housing of the Working Classes Act, 1890 Number of letters received 786 written 591 Number of Summonses issued II Statement of principal items of work done under the Factory and Workshops Acts, 1901, during 3rd Quarter ending September 28th, 1907. Description of Defects, &c. Factories— Miscellaneous. Factory Laundries. FactoriesDomestic. Workshop Laundries. Domestic Laundries. Dressmakers. Miscellaneous Workshops. Bakehouses. Outworkers. Total. Number inspected 1 36 .. 75 25 49 48 2 53 289 Want of cleanliness .. 17 .. 39 4 5 4 2 5 76 Want of ventilation .. .. .. 2 .. .. .. .. .. 2 Overcrowding .. .. .. .. .. .. .. .. .. .. Sanitary Accommodation:— Insufficient .. 2 .. .. .. .. .. .. .. 2 Unsuitable or defective .. 11 .. 34 6 2 5 4 63 Not separate for sexes .. 8 .. 2 .. .. .. .. .. 10 Other nuisances .. 26 .. 57 29 2 4 4 4 126 Failure to affix abstract .. 12 .. 14 .. 2 .. .. .. 28 Number of males employed 12 82 .. 81 19 .. 31 2 25 252 Number of females employed 30 511 .. 602 51 241 57 .. 50 1542 Total number of persons employed 42 593 .. 683 70 241 88 2 75 1794 Number of Workshops discontinued .. .. .. .. 4 7 14 .. 40 65 Number of Workshops newly .. .. .. .. .. .. .. .. .. .. Re-Inspection .. 4 .. 22 .. 2 2 .. 7 37 Rooms measured 2 4 .. 4 6 1 .. .. .. 17 Space notices issued 1 .. .. .. .. 1 .. .. .. 2 WILLIAM BUTLER, Medical Officer of Health. October 15th, 1907. 12 To the Hospital Committee. Gentlemen, I submit the usual Quarterly Statistics. As regards the table appended, there is nothing of note, except that the number of admissions shows a considerable increase on that of the previous quarter. STATISTICS. Disease. Remaining in Hospital, June 30, 1907. Admitted. Discharged. Died. Remaining in Hospital, Sep. 30, 1907. Scarlet Fever 62 108 100 1 69 Diphtheria 23 46 44 2 23 Enteric Fever ... 2 ... 1 1 Cerebro Spinal Fever ... 1 ... ... 1 Other Diseases 2 18 17 3 Total 87 175 161 4 97 All the wards in the hospital are now practically full, so that it is possible it may be necessary to open Kingsbury, very shortly, for convalescent patients. Seven-eighths of the patients in hospital at present, are suffering from scarlet fever. For the Quarter, the cost of maintenance is 4/5 per patient, and for Staff 7/9½. I remain, Your obedient servant, W. J. J. STEWART. October 18th, 1907. Willesden Arban District Council. PUBLIC HEALTH QUARTERLY STATISTICS. Fourth Quarter, 1907. To the Chairman and Members of the Willesden Urban District Council. METEOROLOGICAL OBSERVATIONS. 1907. Week ending. Highest by Day. Lowest by Night. Range in week. Mean of all—Highest. Mean of all—Lowest. 4-ft. Earth Thermometer. Mean Degree of Humidity. Rainfall in Inches. No. of Days on which Rain was measured. Total No. of Hours of Bright Sunshine. Hours of Bright Sunshine Registered at Greenwich. Max. Min. dee. Oct. 5 73.50 34.00 39.50 64.20 48.20 55.00 55.00 81 .35 4 19.0 22.7 „12 63.00 37.00 26.00 60.21 47.00 55.00 54 75 76 1.01 6 20.1 25.0 „ 19 62.50 34.50 28.00 57.64 45.43 54.75 54.00 80 1.46 4 17.0 19.1 „ 26 64.00 34.00 30.00 57.43 41.07 54.00 53.75 83 .42 4 13.0 22.5 Nov, 2 59.00 34.50 24.50 54.00 40.36 53.50 53.00 89 .41 2 8.0 1.02 „ 9 56.00 43.50 12.50 54.07 47.50 53.00 52.25 89 - — 8.5 8.1 „ 16 61.50 27.00 34.50 52.21 36.43 52.25 52.00 89 .10 2 13.5 11.0 „ 23 52.00 30.50 21.50 48.53 39.00 52.00 51.00 93 .81 3 .5 2.6 „ 30 54.50 30.50 24.00 49.93 35.71 51.00 50.00 86 1.04 4 14.75 14.9 Dec. 7 52.00 27.00 25.00 47.70 33.71 50.00 49.50 88 .46 3 1275 15.6 „14 57.00 33.00 24.00 50.79 39.00 49.50 48.50 88 2.41 6 11.75 16.7 „ 21 53.50 29.00 24.50 47.79 39.50 48.25 47.75 86 .05 1 7.25 10.2 „ 28 52.50 33.00 19.50 44.36 37.43 47.75 47.50 89 .51 3 1.50 4.8 Means 58.54 32.88 25.65 52.99 40.79 52.00 51.46 86 Total 9.03 Ttl. 42 Total 147.60 Total 183.4 2 POPULATION ESTIMATED TO MIDSUMMER AND CHRISTMAS, 1907. NAME OF WARD. 1907. Population estimated on the number of houses in occupation in each Ward as ascertained by special enumeration and Council's Census. Houses in Occupation. Total Number of Empty Tenements. No. of Houses recently erected but unoccupied. No. of Houses in course of erection. Percentage of empties exclusive of houses recently erected. Percentage of empties exclusive of houses recently erected, Xmas., 1906. Percentage of empties inclusive of houses recently erected. Percentage of Houses empty at Census. No. of Houses in Ward. No. of Empty Houses. 1 Room. 2 Rooms. 3 Rooms. Over 3 Rooms. Church End Xmas 24293 3651 193 2 - 224 37 11 8 5.3 4.0 5.6 5.96 Mids'r 24215 3626 179 - - 187 28 13 10 4.9 5.3 Harlesden Xmas 22016 3672 264 2 2 142 27 37 20 7.2 6.1 8.2 3.88 Mids'r 22166 3649 223 - 4 122 61 39 26 6.1 7.2 Kensal Green Xmas 29237 4159 106 6 14 119 40 3 2 2.5 2.8 2.6 2.92 Mids'r 29162 4152 113 6 11 65 111 2 4 2.7 2.8 S. Kilburn Xmas 14807 1316 34 25 73 95 7 - - 2.6 3.6 2.6 1.26 Mids'r 14738 1316 40 7 41 81 - - - 3.0 3.0 Mid Kilburn Xmas 12362 1598 83 12 48 48 5 - - 5.2 5.3 5.2 4.16 Mids'r 12322 1598 88 6 18 49 11 - - 5.5 5.5 N. Kilburn Xmas 10039 1684 88 4 22 40 6 2 7 5.2 4.9 5.3 2.62 Mids'r 9982 1683 96 6 11 36 17 1 7 5.7 5.8 Willesden Green Xmas 32031 5513 227 1 3 53 145 118 80 4.1 4.3 6.3 7.37 Mids'r 31174 5353 232 7 1 72 94 125 78 4.3 6.7 Willesden U. D. aggregate of the Wards Xmas 144785 21593 995 52 162 721 267 171 117 4.6 4.3 5.4 4.02 Mids'r 143759 21377 971 32 86 612 322 180 125 4.5 5.4 Population as estimated to Midsummer, 1908, by the Registrar-General, 154,792. Population estimated on the assumption that the average number of persons per house at census has remained constant for the whole of Willesden-147,482 Christmas, 1907; 146, 107 Midsummer, 1907. 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 =145,449 Christmas, 1907; 144,376 Midsummer, 1907. 3 BIRTHS for Fourth Quarter, 1907. WARDS. Total. Boys. Girls. Rate per 1000. Corresponding period last year. Illegitimate Births. I. Church End 198 104 94 31.6 31.7 ... 2. Harlesden 145 83 62 25.6 29.9 ... 3. Kensal Green 191 97 94 25.4 25.5 ... 4. South Kilburn 107 54 53 28.1 28.1 ... 5. Mid Kilburn 75 38 37 23.6 25.4 ... 6. North Kilburn 47 32 15 18.2 17.9 ... 7. Willesden Grn. 216 111 105 26.2 24. ... Willesden U.D. 4th quarter '07 979 519 460 26.1 26.5 26 3rd „ '07 1045 539 506 29.1 29.9 30 2nd „ '07 1106 560 546 30.7 29.6 19 1st „ '07 1040 509 531 29.7 31.6 23 4170 2127 2043 ... ... 98 No. of Willesden Infants born in Queen Charlotte's Hospital 77 27 50 ... ... Willesden U.D. Year 1907 4247 2154 2093 29.4 30.1 98 4 DEATHS.—4th Quarter, ending December 31st, 1907. WARDS Deaths of Willesden residents dying within the district. Deaths of Willesden residents dying outside the district. Total. Willesden residents dying within the district. Deaths under 1 year, inclusive of infantsdying outside district. Infantile Mortality Rate. Standard Death Rate. Mean Annual Death Rate last five years corrected for age and sex distribution. Rate per 1,000 for 4th Quarter, 1907. Corresponding Qtr.,1906 Illegitimate. | Not certified. Inquests. Recorded. Corrected. Corrected. 1. Church End 81 9 90 3 1 4 32 144.8 16.91 14.9 14.4 15.1 13.4 2. Harlesden 71 5 76 ... 1 4 18 109. 8 15.74 14.6 13.4 15. 1 15.0 3. Kensal Green 68 5 73 1 4 19 95.2 16.22 11.1 9.7 10.6 12.7 4. South Kilburn 54 5 59 1 1 5 16 150.9 16.98 17.9 15.5 16.2 17.6 5. Mid Kilburn 41 6 47 2 ... 1 11 125.7 17.13 16.2 14.8 15.3 12.5 6. North Kilburn 21 2 23 1 ... 3 1 19.2 16.00 12.1 8.9 9.8 14.7 7. Willesden Green 84 12 96 ... ... 6 22 103.8 15.60 11.6 11.6 13.2 10.4 Ward unknown 2 ... 2 ... ... ... 1 ... ... ... ... ... ... Willesden U. D. 422 44 466 8 3 27 120 115. 1 16.38 13.5 12.4 13.3 13.1 3rd Quarter, 1907 266 30 296 3 ... 15 84 8o.8 8.2 8.8 2nd Quarter, 1907 348 43 391 6 2 23 98 94.0 10.9 11.7 1st Quarter, 1907 503 48 551 15 3 24 149 144.9 15.7 16.8 Year 1907 1539 165 1704 32 8 89 451 106.2 16.38 11.8 12.7 5 DEATHS of WILLESDEN RESIDENTS during the FOURTH QUARTER, ending December 31st, 1907. (Inclusive of Residents Dying Outside the District.) CAUSES OF DEATH. DEATHS AT SUBJOINED AGES. DEATHS IN LOCALITIES. (At all Ages.) At all Ages 0 to 1 1 to 5 5 to 15 15 to 25 25 to 65 65 & Up. Church End. Harlesden. Kensal Green. S. Kilburn. Mid-Kilburn. N. Kilburn. Willesden Green. Ward Unknown. Small Pox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Measles 25 3 17 5 ... ... ... 11 6 1 2 ... ... ... ... Scarlet Fever 12 ... 10 2 ... ... ... 5 6 ... ... ... 1 ... ... Whooping Cough ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Diph. and Memb. Croup 7 ... 3 4 ... ... ... 1 1 1 ... ... 1 1 ... Croup ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Typhus Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Enteric Fever 2 ... ... ... 1 1 ... ... 1 ... ... ... ... ... ... Other continued ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Epidemic Influenza 4 ... ... ... ... 3 1 ... 1 1 1 ... 1 ... ... Cholera ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Cerebro Spinal Meningitis ... ... ... 1 ... ... ... ... ... ... ... ... ... 1 ... Diarrhœa 18 14 4 ... ... ... ... 2 3 2 3 1 ... 7 ... Enteritis 7 6 ... ... ... ... 1 2 ... ... 1 1 ... 3 ... Puerperal Fever 3 ... ... ... ... 3 ... ... ... 1 2 ... ... ... ... Erysipelas 1 ... ... ... ... ... 1 ... 1 ... ... ... ... ... ... Other Septic Diseases 5 ... ... ... 2 1 2 ... 1 ... ... 1 1 2 ... Phthisis 35 ... ... 2 10 22 1 3 6 12 5 4 1 4 ... Other Tubercular Diseases 13 6 4 2 ... 1 ... 3 ... 2 7 ... ... 1 ... Cancer 29 ... ... ... ... 17 11 3 4 5 3 2 3 9 ... Bronchitis 34 15 3 ... ... 5 11 7 3 5 4 6 2 7 ... Pneumonia 41 9 14 2 ... 8 6 10 4 8 3 4 2 10 ... Pleurisy ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Other Dis. Resp. Organs 3 ... 2 ... ... ... 1 ... ... 1 2 ... ... ... ... Alcoholism (Acute) ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Cirrhosis of Liver 7 ... ... ... ... 6 1 ... 1 1 1 1 ... 3 ... Venereal Disease 1 1 ... ... ... ... ... ... ... ... ... ... ... 1 ... Premature Birth 22 22 ... ... ... ... ... 7 2 3 3 1 1 5 ... Accidents and Diseases of Parturition 4 ... ... ... ... 4 ... ... 1 2 ... ... ... 1 ... Heart Disease 34 ... ... 2 ... 21 11 3 8 2 2 8 4 7 ... Accidents 15 3 2 1 2 7 ... 3 2 3 2 1 1 3 ... Suicide 1 ... ... ... ... 1 ... ... ... ... ... 1 ... ... ... Murder 1 1 ... ... ... ... ... 1 ... ... ... ... ... ... ... Congenital Defects 13 11 ... 1 ... 1 ... 3 5 1 1 2 ... ... 1 Want of Breast Milk, Marasmus 17 17 ... ... ... ... ... 5 5 2 1 2 ... 2 ... Diseases of Nervous System 35 5 3 1 ... 11 15 6 4 4 6 2 3 10 ... Dis. of Digestive System 20 3 2 ... ... 11 4 3 2 9 1 1 1 3 ... Diseases of Urinary System 20 2 ... ... ... 9 9 5 3 1 4 3 4 ... All other causes 36 2 1 1 1 10 21 7 6 6 5 4 1 6 1 Totals 466 120 65 24 19 142 96 90 76 73 59 47 23 96 2 6 NOTIFICATIONS.—Fourth Quarter ending December 31st, 1907. Wards. Small Pox. Scarlet Fever Diphtheria. Typhoid Fever. Erysipelas. Membranous Croup. Puerperal Fever. Cerebro Spinal Meningitis. Total. Estimated Population. Christmas, 1907. Rate per 1,000 Population. Scarlet Fever. Diphtheria. Notified under 15 years of age. Notification rate per 1,000 population under 15 years of age Last Report. Notified under 15 years of age Notification rate per 1,000 population under 15 years of age. Last Report. Church End ... 31 18 ... 3 ... 1 ... 53 24293 8.5 28 11.4 8.5 12 4.9 6.3 Harlesden ... 85 7 2 3 ... ... ... 97 22016 17.1 78 43.4 15.4 6 3.3 3.4 Kensal Green ... 60 14 1 9 1 1 ... 86 29237 11.4 53 20.0 14.5 12 4.5 3.9 South Kilburn ... 14 2 2 4 2 ... 24 14807 6.3 13 9.1 5.1 2 1.4 4.4 Mid Kilburn ... 13 5 ... 3 ... ... ... 21 12362 6.6 13 12.6 5.1 5 4.8 2.0 North Kilburn ... 9 4 ... 1 ... ... ... 14 10039 5.4 8 12.9 8.5 4 6.5 3.4 Willesden Green ... 21 11 2 3 1 2 1 41 32031 5.0 17 6.8 5.9 11 4.4 2.5 Willesden U. D. ... 233 61 7 26 2 6 1 336 145449 9.0 210 16.7 9.5 52 4.1 3.9 Do. 3rd qtr. '07 ... 134 60 10 12 ... 2 2 220 144376 6.1 115 9.5 ... 47 3.9 ... Do. 2nd qtr. '07 ... 106 51 9 17 ... 3 ... 186 144376 5.2 85 7.0 ... 44 3.6 ... Do. 1st qtr. '07 ... 168 79 2 22 1 2 ... 274 143830 7.8 136 11.6 ... 69 5.9 ... Do. Year 1907 ... 641 251 28 77 3 13 3 1016 144376 7.0 546 11.3 ... 212 4.4 ... Do. 4th qtr. '06 ... 178 88 14 35 3 1 ... 319 143830 8.7 154 12.5 ... 70 5.7 ... 7 NON-NOTIFIABLE INFECTIOUS DISEASES.-Coming to knowledge from Schools and other sources of information. Number of Cases for Fourth Quarter ending December 31st, 1907. DISEASE. Families Visited. Total Nos. Suffering. (First Visit). Contacts. Families Re-visited. Secondary Cases discovered upon Re-visit. Doctor in Attendance. Total Cases. Isolated. Total No. Suffering Measles 435 426 1207 105 81 30I 101 507 Whooping Cough 12 19 27 5 4 13 ... 23 Chicken Pox 44 59 ... ... ... 18 4 59 Mumps 11 13 ... ... ... 3 ... 13 Ringworm 72 72 ... ... ... 13 16 72 Other Diseases 153 170 ... ... ... 59 12 170 Consumption 1 1 ... ... ... 1 1 1 Coughs and Colds 13 13 ... 1 ... 4 ... 13 Totals 741 773 1234 111 85 412 134 858 8 NUMBER OF CASES OF NON-NOTIFIABLE INFECTIOUS DISEASES OCCURRING IN SCHOOLS. 8 Fourth Quarter ending December 31st, 1907. NAME OF SCHOOL. Measles. Whooping Cough. Mumps. Chicken Pox. Tuberculosis. Influenza. Ophthalmia. Ringworm. Other Diseases. Coughs. All Diseases. Notd Sufg Not. Suff. Not. Suff. Not. Suff. Not. Suff. Not. Suff. Not. Suff. Not. Suff. Not. Suff. Not. Suff. Not. Suff. Not Suff. Acton Lane—Mixed ... ... 1 1 ... ... ... ... ... ... ... ... ... ... 1 1 1 1 ... ... 3 3 ... Ditto Infants 6 ... 1 ... 1 ... ... ... ... ... ... ... ... ... 3 3 1 4 ... ... 12 8 4 Buller Road—Boys ... ... ... ... ... ... 1 ... ... ... ... ... 1 1 2 1 1 ... ... ... 5 2 ... Cambridge Road (Temp.) 3 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 3 ... 3 Chamberlayne Wood Road Mixed ... ... ... ... ... ... 4 ... ... ... ... ... ... ... 2 1 36 32 ... ... 42 33 7 Ditto Infants ... ... 2 ... 2 ... 7 ... ... ... ... ... ... ... ... ... 2 1 ... ... 13 2 2 Dudden Hill—Mixed 41 3 ... ... ... ... 4 1 ... ... ... ... ... ... ... ... I ... ... ... 46 4 31 Ditto Infants 57 63 ... ... ... ... 11 3 ... ... ... ... ... I ... ... 7 5 ... ... 75 72 17 Granville Road ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... 1 ... 1 Gibbons Road—Mixed 18 3 3 1 I ... 3 2 ... ... ... ... ... I 2 3 16 7 ... ... 43 17 l9 Ditto Infants 33 24 1 1 I ... 2 2 ... ... ... ... ... I 1 1 4 12 ... 2 45 44 4 Kensal Rise—Mixed ... ... ... ... ... ... 4 1 ... ... ... ... ... ... ... 1 ... ... ... ... 4 2 ... Ditto Infants 2 1 ... ... ... ... 24 4 ... ... ... ... ... 1 1 2 2 ... ... 29 9 ... Kilburn Lane—Infants ... ... ... ... ... ... 3 ... ... ... ... ... ... ... 1 1 ... ... ... ... 4 1 ... Leopold Road—Mixed 23 4 ... ... ... ... 6 2 ... ... ... ... ... ... 3 3 5 2 ... ... 37 11 26 Ditto Infants 22 46 ... ... I ... 6 12 ... ... ... ... ... ... 3 3 7 7 ... ... 39 68 1 Not.=Notined. Suff.==Suffering. 9 Number of Cases of Won-notifiable Infectious Diseases occurring in Schools—(Continued). g NAME OF SCHOOL. Measles. Whooping Cough. Mumps. Chicken Pox. Tuberculosis. Influenza. Ophthalmia. Ringworm. Other Diseases. Coughs. All Diseases. Notd Sufg Not. Suff. Not. Suff. Not. Suff. Not. Suff. Not. Suff. Not. Suff. Not. Suff. Not.j Suff. Not. Suff. Not. Suff. Not Suff Lower Place—Mixed 5 I ... ... ... ... 2 ... ... ... ... ... ... ... 10 5 3 3 ... ... 20 9 4 Disraeli Road—Infants 9 8 ... ... I ... 9 2... ... ... ... ... ... ... 2 3 8 3 ... ... 29 16 9 Mora Road—Mixed ... ... ... ... ... ... 2 ... ... ... ... ... ... ... I ... ... ... ... ... 3 ... ... Ditto Infants ... ... ... ... ... ... 15 I ... ... ... ... ... ... 2 2 1 ... ... ... 18 3 1 Oldfield Road—Mixed 10 I I ... ... 2 I ... ... ... ... ... ... 5 4 5 2 ... ... 23 8 13 Ditto Infants 2 2 I ... ... ...... ... ... ... ... ... ... ... ... ... ... 1 2 ... ... 4 6 1 Pound Lane—Mixed 2 I ... ... ... ... 6 I ... ... ... ... ... ... 2 2 3 3 ... ... 13 7 6 Ditto Infants 54 44 ... ... 2 ... ... I ... ... ... ... ... ... 7 8 3 10 ... ... 66 69 21 Salusbury Road—Mixed ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 2 1 ... ... ... 3 2 ... Ditto Infants ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 1 ... ... ... ... 1 1 ... Stonebridge—Mixed 42 1 I ... 3 I 3 I ... ... ... ... 2 2 4 4 11 9 ... ... 66 18 46 Ditto Infants 53 57 2 ... ... ... 2 ... ... ... ... ... 3 5 ... 1 5 7 ... ... 65 72 8 TubbsRoad ... 1 ... ... 1 ... 4 ... ... ... ... ... ... ... 2 ... ... ... ... ... 7 1 5 Non-Provided Schools. Christ Church—Mixed ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Ditto Infants ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 1 ... ... ... ... 1 1 ... Gordon Memorial—Mixed 2 ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 4 4 ... ... 6 5 2 Ditto Infants ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 1 ... ... ... 1 1 ... Harlesden National—Mixed 6 ... ... ... ... ... 2 ... ... ... ... ... ... ... ... 1 ... ... ... ... 8 1 6 Ditto Infants 3 2 ... 2 1 I 12 3 ... ... ... ... ... ... 3 3 ... I ... ... 19 12 2 Not.=Notified. Suff.=Suffering. IO Number of Cases of Non-notifiable Infectious Diseases occurring in Schools—(Continued). NAME OF SCHOOL. Measles. Whooping Cough. Mumps. Chicken Pox. Tuberculosis. Influenza. Ophthalmia. Ringworm. Other Diseases. Coughs. All Diseases. Notd Sufg Not. Suff. Not. Suff. Not. Suff. Not. Suff. Not. Suff. Not. Suff. Not. Suff. Not. Suff. Not. Suff. Not. Suff. No Sut Harlesden Roman Catholic Mixed 4 I ... ... 3 1 I 1 ... ... ... ... ... ... I I 2 I ... ... 11 5 4 Infants ... ... ... ... 1 ... I ... ... ... ... ... ... ... ... ... ... 2 ... ... Holy Trinity—Mixed ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 ... ... ... ... ... 2 ... Ditto Infants ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 ... ... ... ... ... 2 ... ... Keble Memorial—Mixed I ... ... ... ... ... I ... ... ... ... ... ... ... ... ... ... ... ... ... 3 1 ... Infants 21 22 ... ... ... ... ... ... ... ... ... ... ... ... 2 3 ... I ... ... 25 26 I Kilburn Park Evan.—Inf. ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 6 4 ... ... 6 4 3 Princess Frederica—Mixed I ... ... ... 1 3 5 ... ... ... ... 3 2 2 8 ... ... 14 17 2 Ditto Infants ... ... ... ... ... 2 3 ... ... ... ... ... ... I I ... 1 ... ... 4 5 ... St. Andrew's—Mixed ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Infants 5 4 ... ... ... ... 1 1 ... ... ... ... ... ... ... ... 2 2 ... ... 8 7 1 St. John's—Mixed 5 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 ... ... ... 7 ... 7 Ditto Infants 12 I5 ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 3 ... ... 13 18 ... St. Mary's—Mixed 4 ... ... ... 3 1 ... ... ... ... ... ... ... I ... 4 2 ... ... 12 5 8 Infants 5 8 ... ... ... ... ... ... ... ... ... ... ... ... I I ... ... ... ... 6 9 1 St. Mary's, R. C.—Mixed ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Infants 3 1O ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 3 10 1 Schools outside Willesden ... ... ... ... ... 1 ... 2 ... ... ... ... ... ... ... ... 2 2 ... ... 2 5 1 Totals 454 323 16 9 24 10 T44 49 1 I 1 8 12 73 68 150 141 2 8 872 622 267 Not.=Notined. Suff.=Suffering. II Summary of principal items of Work for 4th Quarter, ending Dec. 31st, 1907 Sanitary Districts. Description of Work. Lady Hlth. Vis. No. 2 No.3 No.4 No.5 No. 6 Total Inspection of Houses- Number inspected on complaint 14 31 41 33 29 42 190 „ ,, for special inquiry 1 5 1 16 23 „ „ from house to house 26 4° 6 72 „ „ „ (Housing of the Working Classes Act, 1890) Re-inspection of Houses— Number re-inspected 10 34 59 16 "9 Number of visits to premises where works of amendment are in operation 495 639 154 154 679 2121 Number of Birth Enquiries 179 179 ,, Infantile Death Enquiries no no Cases of Infectious disease visited 332 332 „ ,, „ re-visited 148 148 ,, ,, ,, removed 244 244 Number of rooms disinfected 343 343 Cases of Non-notifiable diseases visited 1124 1124 „ ,, „ re-visited Miscellaneous Visits 244 16 244 16 Number of rooms disinfected after Consumption 14 '4 Cancer 4 4 Other Disease 8 8 Inspection of Mews, Stables, etc. 14 8 ii 19 52 ,, of Dairies, Milkshops, etc. 24 27 16 24 36 127 ,, of Canal Boats ,, of Slaughterhouses 1 4 3 5 13 ,, of Miscellaneous subjects 5 74 3° 21 130 Observations and Inspections re Smoke Nuisance 3 3 Nuisances abated— Number of new drains constructed 5 4 1 4 11 25 ,, drains amended 15 9 2 3 4 33 ,, tested and examined 29 21 17 31 14 112 ,, nuisances of various descriptions abated 63 74 103 51 53 344 Sanitary notices issued 42 148 61 5° 54 355 Statutory ,, ,, 33 10 6 7 25 81 „ ,, „ under the Housing of the Working Classes Act, 1890 Number of letters received 781 written 64I Number of Summonses issued 1 I 12 Statement of principal items of work done under the Factory and Workshop Act, 1901, for the 4th Quarter ending December 31st, 1907. Description of Defects, &c. Factories— Miscellaneous. 1 Factory Laundries. FactoriesDomestic. Workshop Laundries. Domestic Laundries. Dressmakers. Miscellaneous Workshops. Bakehouses. Outworkers. Total. Number inspected 3 6 .. 12 8 52 60 5 146 Want of cleanliness 1 2 .. 4 •• .. 11 20 1 39 Want of ventilation .. .. .. 2 .. .. .. .. .. 2 Overcrowding .. .. .. .. .. .. i .. .. I Sanitary Accommodation:— .. .. .. .. .. .. .. .. Unsuitable or defective .. .. .. 2 .. .. 2 6 .. IO Not separate for sexes .. .. .. .. .. .. .. .. .. Other nuisances .. 6 .. 8 .. .. 9 10 .. 33 Failure to affix abstract .. 2 .. 1 .. i 5 .. .. 9 Number of males employed 26 11 .. 7 .. .. 132 4 295 Number of females employed 22 58 .. 61 .. 22 25 .. 2 190 Total number of persons employed 48 69 .. 68 .. 22 157 115 6 485 Number of Workshops discontinued .. .. .. .. .. 3 2 i .. 6 Number of Workshops newly discovered .. .. .. .. .. .. .. .. .. .. Re-Visited .. .. .. .. .. .. 2 .. .. 2 Rooms measured .. .. .. .. .. .. .. .. .. Space notices issued .. .. .. .. .. .. .. .. .. .. WILLIAM BUTLER, Medical Officer of Health. January 14th, 1908. !3 To the Members of the Public Health Committee. Gentlemen, I submit the Hospital Statistics for the quarter ending December 31st, 1907. They are as follows Disease. Remaining in Hospital, Sep. 30, 1907. Admitted. Discharged. Died. Remaining in Hospital, Dec. 30, 1907. Scarlet Fever 69 179 154 IO 84 Diphtheria 23 38 41 7 13 Enteric Fever 1 2 1 1 I Cerebro Spinal Fever 1 ... 1 ... ... Other Diseases 3 25 26 2 Total 97 2 44 223 18 100 For the quarter the cost of maintenance of patients amounted to 4s. 3½d., and for staff 7s. 7½d. Your obedient servant, W. J. J. STEWART. January 21st, 1908. ■