wil 14 WILLESDEN URBAN DISTRICT COUNCIL. THE 38th ANNUAL REPORT on the HEALTH AND SANITARY CONDITION of the URBAN DISTRICT OF WILLESDEN, FOR THE YEAR 1913. by GEORGE F. BUCHAN, m.d., d.p.h. Medical Officer. IN DEX. Page Accommodation—Schools 129 Acts in Force—Willesden 36 Assistant School Medical Officers 133 Babies' Welcome 113 Bakehouses 39, 53 Births and Birth Rates 117 ,, Legitimate and Illegitimate 110, 119 ,, Notification of Births Act, 1907 113 Blind Children 153 Body, Cleanliness of 138 Bye-laws as to Cisterns, etc., Power to make 31 ,, in force 37 Canal Boats Acts, 1877 and 1884 45 Cancer, Deaths from 104 ,, ,, and Age Distribution of 105, 106 ,, ,, and Ward Distribution of 106 Cerebro-spinal Meningitis 76 Cesspools 41 Clothing 135 Closet Accommodation 32 Common Lodging Houses 39, 47 Councillors, 1913-14 8 Cowsheds 40, 48 Cows, Veterinary Inspection of 48 Dairies and Milkshops 40 Deaths, Age Periods of 121 Death Rates 120 ,, ,, per 100,000, Scarlet Fever, Diphtheria, Enteric Fever, Measles, Whooping Cough 99 Death Rates at Age Periods 123 iv. Page Deaf Children 154 Deformities 146 Diphtheria and Membranous Croup 74 ,, Removal of Cases 74 ,, Incidence and Fatality Rates 74 Disinfection 42 Drainage and Sewerage 32 „ ,, of Existing Buildings 41 Dust, Removal of 32-36, 42 Ear, Diseases of 143 Education Committee, Members of 126 Enteric Fever 75 ,, ,, Incidence and Fatality Rates 75 ,, ,, Removal of 75 ,, ,, Death Rate per 100,000 99 Epileptic Children 157 Eye Diseases (External) 141 Eyes, Medical Treatment, Report on (Appendix E) 215 Factory and Workshop Act, 1901 61 ,, ,, ,, Inspections under 62,63,64 Food, Unsound 40 ,, Adulterated 40 ,, Inspection 52 Footgear 135 Health Visitors, Action of, in Obtaining Treatment 144 Heights and Weights 136 ,, ,, Average for 4 years 93 Heart and Circulation, Diseases of 146 Hospital Report 232 House Refuse, Removal of 32-36, 40 Houses Let in Lodgings 39,47 ,, Unfit for Human Habitation 55,56 Housing, Town Planning &c., Act, 1909, Action taken under 38 V. Page Housing Inspection 54 ,, (Inspection of District) Regulations 57 Infant Care—Feeding (Appendix B) 186 Infantile Death Inquiries 115 Infant Mortality 108 Infantile Mortality—Medical Treatment, Want of 108 ,, ,, Wards 109 ,, ,, Legitimate 110 ,, ,, Illegitimate 110 ,, ,, Causes and Prevention of Ill Infectious Diseases, Prevalance of 66 ,, ,, Notifications, Table of 67 ,, ,, ,, ,, (inWards) 68 ,, ,, Administrative Action 77 ,, ,, in Willesden Schools 146 ,, ,, Regulations for the Control of 150 Inhabited House Duty, Exemption from 43 Introduction 9 Local Government Board Tables (Appendix A) 165 Table I—Population, Births and Deaths since 1908—District 165 ,, la—Population, Births and Deaths, Wards, 1913 166 ,, II—Infectious Diseases 168 ,, III—Causes of Deaths (Short Classification Table) 169 ,, Ilia—Causes of Deaths—in Wards 171 ,, III!)—Death Rates from Various Causes 172 ,, I lie—Causes of Deaths (Long Classification Table) 173 ,, IV—Infantile Mortality under 1 year of age—Causes of Deaths 183 ,, IVa—Infantile Mortality under 1 year of age—Causes of Deaths—in Wards 184 vi. Page Lungs, Diseases of the (excluding Tuberculosis) 146 Manholes, Inspection of 43 Marriages 116 Measles 78 ,, Death Rate per 100,000 99 ,, Table of Known Cases since 1907 80 ,, Table of Known Cases showing Age Periods 81,82 Meals, Provision of 163 Medical Inspection, Extent and Scope of 131 ,, ,, Organisation and Supervision of 129 ,, ,, Children Selected for 134 ,, ,, Number Inspected 134 ,, ,, Notice to Parents 130 ,, ,, Attendance of Parents at 130 Medical Treatment—Eyes and Teeth (Appendix E) 215 Mentally Defective Children 155 Meteorological Observations, Table of 93, 94 Midwives' Act 107 Milkshops 40, 53 Milk Samples 51,52 Mother-Craft 161 Natural and Social Conditions of the District 13 Neck Glands Enlarged 141 Nervous Diseases 104,146 Nose and Throat, Diseases of 140 Notification of Births Act, 1907 113 Nutrition 137 Offensive Trades 40,47 Overcrowding 42 Physically Defective Children 156 Poliomyelitis 76 Population—Census Returns, 1911 17 ,, to Midsummer, 1913 (in Wards) 16 ,, Midsummer, 1913, Estimated 16 vii. Page Population—Census 14 „ Rate of Increase of 17 ,, Rate of Increase—Table comparing Various Districts 17 ,, Age and Sex, Distribution in Wards —Census, 1911 18 ,, Rate of Increase in Age Periods 19 ,, Age and Sex, Constitution of 20 ,, Sex Distribution, Proportion of Females to Males—Wards 21 ,, Conjugal Conditions 22 ,, Density of—Wards 23, 24 ,, Families — Proportion in Various Sized Tenements or Houses 25 ,, Living in Various Sized Tenements or Houses 26 ,, Average Number of Occupants per Room in Various Sized Tenements 27 ,, Occupation of 28, 29, 30 Prevalence of and Control over Tuberculosis 83 ,, ,, ,, Acute Infectious Diseases 66 Public Health Committee 8 Respiratory Diseases, Table of 63, 64 ,, ,, Death Rates 63,64 Regulations made by Local Authority in force in Willesden 37 Rickets 146 Ringworm, Clinic and Treatment, Report on (Appendix D) 209 Ringworm and other Skin Diseases 139 Rivers and Streams 31 Sale of Food and Drugs Acts 53 Sanitary Circumstances of the District 31 viii. Page Sanitary Inspection 38 Sanitary Work 36 Scalp, Cleanliness of 138 Scarlet Fever, Removal of Cases of 69 ,, ,, Incidence and Fatality Rates in 69 ,, ,, Retarn Cases of 69, 70 ,, ,, Maltiple Cases 72 Scavenging, Removal of House Refuse—Statistics relating to 32-36 School Accommodation 129 School Medical Service, including the Re-organisation of the School Attendance Department, Report on (Appendix C) 191 School Arrangements, Disturbance of, by Medical Inspection 130 School Medical and Public Health Services, Co-relation of 129 Sewerage and Drainage 32 Slaughterhouses 39, 52 Small Pox, Cases Notified and Removed to Hospital 76 Speech Summer Diarrhœa 114 Summonses Served 38 Staff 37 Statutory Notices, Number of 38 Streams and Rivers 31 Teeth 139 ,, Medical Treatment of, Report on (Appendix E) 215 Tuberculosis 83 ,, Detection of, in Milk 48 ,, Prevalence of, and Control Over 83 ,, Table of Notifications Received 84 ix. Page Tuberculosis, Age Group of Cases Notified 85 ,, Occupation of Persons Notified as Suffering 86 ,, Ward Distribution of 87 ,, Localisation of Disease, Age and Sex Groups 85 ,, Administrative Action 88 ,, Family History of Patients 89 ,, Sleeping Accommodation of Patients 89 ,, Housing Accommodation of Patients 90 ,, Contacts 90 ,, Disinfection 91 ,, Treatment 91 Death Rate from 1875-1913 100 ,, Deaths from and Age Distribution of 101, 102 ,, In Children Medically Inspected 146 Throat, Diseases of 140 Treatment—Action of Health Visitors 88 Underground Rooms, Regulations for 57 Vaccination Statistics 78 Verminous Conditions 138 Vision 142 Vital Statistics of the District 116 Water Supply 31, 40 Whooping Cough 78 ,, ,, Death Rate per 100,000 99 8 WILLESDEN URBAN DISTRICT COUNCIL, 1913-1914. Mr. Councillor J. ANDREWS. Mr. Councillor J. E. BALL. *Mr. Councillor J. J. BATE. *Mr. Councillor W. BLACKLOCK. Mr. Councillor C. H. BOLTON, M.A. *Mr. Councillor W. M. BOLTON. *Mr. Councillor P. BOND. *Mr. Councillor S. BOWN. Mr. Councillor H. C. BROWN. Mr. Councillor S. D. BUMSTEAD. Mr. Councillor E. T. BUTTERISS Mr. Councillor J. COMBER. *Mr. Councillor J. E. CONLON. Mr. Councillor W. H. DOBBS. Mr. Councillor A. E. DORAN. Mr. Councillor H. H. GRIMWOOD. *Mr. Councillor J. E. HILL. Mr. Councillor W. A. HILL. Mr. Councillor G. H. HISCOCKS. Mr. Councillor C. H. HOGG. Mr. Councillor E. LANE. Mr. Councillor T. G. MATTHEWS. Mr. Councillor C. PINKHAM, j.p. (Chairman). Mr. Councillor H. B. PRATT. *Mr. Councillor W. C. RAPKIN. *Mr. Councillor W. RILEY, J.P. (Chairman of the Health Committee). *Mr. Councillor H. ROGERS. Mr. Councillor W. A. SAVILLE. Mr. Councillor The Rev. R. SILBY. Mr. Councillor A SMITH. *Mr. Councillor C. E. P. TAYLOR. Mr. Councillor H. D. TURNER (Vice-Chairman). Mr. Councillor W. WAY. * Member of the Health Committee. GEORGE F. BUCHAN, M.D., D.P.H. Medical Officer. Municipal Offices, Dyne Road, Kilburn, N.W. 3rd June, 1914. To the Chairman and Members of the Willcsden Urban District Council. Gentlemen, I beg to submit the 38th Annual Report on the health and sanitary condition of the district. The population which at the Census of 1911 was 154,214 was estimated at the middle of 1913 to be 163,644. It will accordingly be observed that the high rate of increase in the population is maintained. 4,037 births occurred in the district during the year, giving a birth-rate of 24.7 per 1,000. 1,677 deaths occurred in the district during the year, giving a death-rate of 10.24 per 1,000, which is approximately the average death rate during the past 5 years. The 'death-rate varies in the different wards, in South Kilburn it is 15.87 per 1,000 and in Cricklewood 7.22. 325 deaths of infants occurred during the year. Many of these are preventable deaths. Deaths of infants are most commonly caused by want of maternal nursing, want of knowledge of infant care, improper feeding, and want of medical treatment. For some time past the Council has conducted a Babies' Welcome on somewhat unconventional lines, but it is now desirable that a broader outlook should be taken of the functions of this clinic. The treatment of diseases occurring amongst children is at present a necessity, and school clinics are being established to supply the want. But it should be the business of the B 10 health authority to take steps to prevent such disease occurring in the future, and the child, when it arrives at school age, should be in a sound and healthy condition, ready and able to profit by the education provided. This means actually that the child has to be cared for from birth up to the age of five years before it enters school, and, in addition, regard has to be had as well to pre-natal conditions likely to affect the health of the offspring. During the year under review 128 children died before they reached the age of 4 weeks While, therefore, treatment is not to be disregarded, it should be considered in relation to the steps which should be taken to obviate the necessity for treatment in the future. These are the principles on which any system of state medicine should be based and would, I am certain, lead to much diminution in suffering as well as to the development of healthy habits and a healthy race. During the year considerable activity has been displayed in the matter of housing inspection. Three additional Inspectors of Nuisances were added to the staff and an organised system of housing inspection is now in vogue. It will, however, take some years before all the houses requiring inspection have been dealt with. 1,379 notifications were received during the year of diseases compulsorily notifiable. Of these, 504 referred to Scarlet Fever, which is the greatest number since 1909, when 638 were notified. Similarly, there has been a rise in the number of notifications of Diphtheria. Last year the number of notifications was 233, which is the highest number recorded since 1907, when 254 cases were notified. These coincident increases during the year have considerably taxed the hospital accommodation. In connection with infectious diseases generally, it should be observed that Scarlet Fever and Diphtheria no 11 longer produce the large number of deaths formerly attributable to them, there having been only 7 deaths from Scarlet Fever and 8 from Diphtheria during the year. On the other hand, the number of deaths from Measles and Whooping Cough is always considerable, and during last year there were 69 deaths from Measles and 23 from Whooping Cough. This is a subject of increasing importance and indicates that steps should be taken to provide hospital treatment for the worst forms of these two diseases, in respect of which 2,176 voluntary notifications were received during the year. 874 notifications of Tuberculosis, referring to 514 cases, were received during the year. Since the notification of Tuberculosis in one form or another became operative in 1909, 2,121 notifications have been received, referring to 1,399 cases, 720 of which were still in Williesden under observation at the end of the year 1913. I am, Gentleman, Your obediient Servant, GEORGE F. BUCHAN, Medical Officer. 13 A.—NATURAL & SOCIAL CONDITIONS OF THE DISTRICT. Physical Features.—Willesden is an Urban District in the County of Middlesex immediately adjacent to the County of London on its North-West borders. It is bounded on the North-East and North by the Borough of Hampstead and the Urban District of Hendon; on the North-West and West by the Urban Districts of Kingsbury, Wembley and Greenford; and on the South and East by the Urban District of Acton, and the Boroughs of Hammersmith, Kensington and Paddington. It covers an area of 4,384 acres, and is situated on the London clay, which is generally bare throughout the district. The lowest point of Willesden is near the spot where the boundary line between Willesden and Wembley crosses Harrow Road, and is 78 feet above O.D., and the highest point is at Dollis Hill, 242 feet above O.D., the usual average variation within the district being from 100 to 170 O.D. A ridge dividing the district into two unequal areas crosses it in a south-westerly direction, thus creating two distinct drainage areas. The smaller area to the south of the ridge draining to the Thames contains 1,154 acres, the larger area north of the ridge draining to the Brent consists of 3,230 acres. The crest of the ridge has an elevation of about 200 O.D. in the North-East, falling to about 150 O.D. in the South-West. 14 Census Populations since 1851.—The followingTable, No. 1, gives the population of Willesden at each census since 1851 :— Table No. 1. Census. Population. 1851 2,960 1861 3,879 1871 15,869 1881 27,453 1891 61,265 1901 114,811 1911 154,344 Method of Estimating Population in Willesden.— Room Factor.—These were explained in detail in my Annual Report for 1912, pp. 12 and 13. Estimated Midsummer Populations.—The following Table, No. 2, shews the population estimated by the method in vogue in< Willesden, at Midsummer of each year since 1901, together with the estimated annual increase and the natural increase as indicated by the excess of births over deaths:— Table No. 2. Year. Estimated Midsummer population. Estimated annual increase of population. Natural increase of population i. e. excess of births over deaths. 1901 116,089 — 2,141 1902 122,211 6,122 2,120 1903 129,315 7,104 2,477 1904 134,539 5,224 2,776 1905 140,758 6,219 2,457 1906 142,871 2,113 2,600 1907 146,107 3,236 2,543 1908 149,035 2,928 2,472 1909 150,145 1,110 2,494 1910 153,253 3,108 2,417 1911 156,572 3,319 2,151 1912 159,868 3,296 2,472 1913 163,644 3,776 2,360 15 163,644, the number appearing opposite 1913 above, is the figure which has been used throughout this Report as the Midsummer population for the calculation of the 1913 rates. The following Table, No. 3, gives certain particulars as to the estimated population of 163,644 at Midsummer. 1913:— Table No. 3.—POPULATION ESTIMATED TO MIDSUMMER, 1913. WARD. Population estimated on the number of rooms in occupation in each Ward as ascertained by enumeration. Mids'r, Occupiable Houses, including houses recently erected but not yet occupied. Occupiable rooms, including those of houses recently erected. Houses recently erected but unoccupied. Houses in course of erection. Houses demolished. Percentage of empty houses exclusive of houses recently erected Percentage of empty rooms inclusive of those in houses recently erected. total Empty Houses. Wholly funoccupied. No. having one or more empty tenements. Partly empty. Empty tenements, exclusive of those houses wholly unoccupied. 1 room 2 rooms 3 rooms over 3 rooms total. No. occupied. No. empty. (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) (13) (14) ('0 (16) (17) met. drain area. i. South Kilburn i417o 1304 45 122 3 40 93 ... 10259 9620 639 ... 1 ... 3.5 6.2 2. Mid Kilburn 14595 1811 80 112 6 21 89 4 14029 13090 939 ... ... 21 4.4 6.7 3. North Kilburn 12378 2046 82 46 1 i 29 19 17055 16202 853 ... ... ... 4.0 5.0 4. Brondesbury Park 9683 1392 18 38 ... 6 30 3 11269 11029 24o 4 4 ... 10 2.1 5. Kensal Rise 13961 1862 24 24 ... 2 21 1 12344 12098 240 4 4 ... 1.1 2.0 6. Harlesden 16599 2492 55 32 2 ... 32 ... 17526 17060 446 17 14 ... 1.5 2.7 Total Met. Drain. Area 81386 10907 304 374 12 7o 294 27 82482 79099 3383 25 21 21 26 4.1 brent drain area. 7. Stonebridge 17475 2057 23 35 ... ... 35 ... 13702 13432 270 4 1 ... 0.9 2. 8. Roundwood 15568 2195 37 17 1 10 6 15595 15263 332 1 ... ... 1.6 2.1 9. Church End 13986 1935 17 35 1 ... 25 8 12152 11974 178 1 1 3 0.8 1.5 10. Willesden Green 16402 2411 35 31 1 ... 14 17 16135 15786 349 7 14 ... 1.2 2.2 11. Cricklewood 18827 3679 140 41 ... 2 23 20 28634 27405 1229 47 7 2 2.6 4.3 T otal Brent Drain area 82258 12277 252 159 3 2 107 51 86218 83860 2358 60 23 5 1.6 2.7 Willesden U.D. *163644 23184 556 533 15 72 401 78 168700 162959 5741 85 44 26 2.0 3.4 Do. Xmas, 1912 *162508 23113 614 578 9 98 355 152 168197 161878 6319 120 40 10 2.1 3.8 * Aggregate of \\ ards. 17 Census Returns, 1911.—Certain information in regard to the results disclosed by the Census figures for 1911 is now available. In addition to the ordinary return of the Census Office, information has been obtained showing the age and sex distribution in each street in Willesden. Rate of Increase of Population.—The population of Willesden at the Census, 1911, numbered 154,344; in 1901, 114,811, and in 1891, 61,265. The provisional return of the Census placed the population as 154,21,4, but the revision showed that the true figure was as stated above. The percentage increase during the decennium 1901-1911 was 34.3 as compared with 87 :4 during the preceding decennium 1891-1901. The rates of increase for the various districts in the Outer Ring are shown below in Table No. 5. Table No. 5. Population Per Cent. Increase 1911 1901 1891-1901 1901-1911 11ford 78,188 41,244 277.6 89.6 Ealing 61,222 33,031 37.7 85.3 Acton 57,497 37,744 55.9 52.3 East Ham 133.487 96,008 193.6 39.0 Edmonton 64,797 46,899 84.8 38.2 Willesden 154.214 114,811 87.4 34.3 Tottenham 137.418 102,703 43.3 33..8 Wimbledon 54,966 41,652 61.6 32.0 Enfield 56,338 42,738 35.5 31.8 Walthamstow 124,580 95,131 105.3 30.9 Croydon 169,551 133,895 30.4 26.6 Leyton 124,735 98,912 56.7 26.1 Hornsey 84,592 72,056 61.8 17.4 West Ham 289,030 267,358 30.5 8.1 Age and Sex Distribution in Wards.— The following Table, No. 6, shows the age and sex distribution in the various Wards in Willesden at the Census, 1911, as compiled from the special return obtained from the RegistrarGeneral. 18 Table No. 6. Ages as per Census Return South Kilburn. Mid Kilburn. North Kilburn. Brondesbury Park. Kensal Rise. Harlesden. Stonebridge. Roundwood. Church End. Willesden Green. Cricklewood. Totals. M.&F Population. Under 1 year M 188 12 88 94 146 13 202 210 167 206 135 1771 3362 F 158 161 83 90 15 198 198 209 191 176 152 191 1—2 M 171 160 87 82 153 176 231 176 180 184 136 1736 3424 F 167 175 83 90 164 154 204 167 157 191 136 1688 2—3 M 162 180 79 100 175 175 255 221 187 161 159 1854 3589 F 187 150 93 81 168 178 201 174 175 188 140 1735 3—4 M 203 171 75 93 162 156 239 188 174 191 148 1800 3695 F 175 185 91 106 158 183 236 223 175 220 143 1895 4—5 M 176 144 95 67 157 157 222 190 133 183 136 1711 3514 F 190 157 93 84 171 164 214 211 156 214 149 1803 Under 5 years M 900 827 425 436 793 827 1149 985 891 925 714 8872 17784 F 877 828 443 451 836 877 1053 984 854 989 720 8912 5—10 M 842 736 441 488 763 756 1100 853 843 872 682 8376 16692 F 852 733 481 434 779 706 1110 887 823 840 671 8316 10—13 M 480 382 243 224 411 356 591 475 475 423 332 4392 8926 F 477 407 235 245 438 387 580 487 415 511 352 4534 13—14 M 151 132 71 81 133 107 172 125 145 156 96 1369 2844 F 159 128 92 66 148 133 194 152 120 164 119 1475 14—15 M 158 105 64 62 160 110 166 114 139 135 99 1312 2711 F 151 136 87 67 95 125 147 151 137 163 140 13991 15—16 M 143 125 74 66 119 91 135 136 122 139 102 1252 2572 F 119 109 99 91 122 104 149 134 104 159 130 1320 16—17 M 136 101 91 55 116 120 152 125 102 143 123 1264 2617 F 142 130 107 73 95 115 152 133 113 110 183 1353 17—18 M 142 119 81 50 101 123 144 110 102 136 96 1204 2593 F 103 107 117 83 125 122 147 147 110 129 199 1389 18—19 M 124 113 68 64 128 129 150 106 119 117 99 1217 2644 F 105 122 149 84 108 125 126 139 97 129 243 1427 19—20 M F 104 117 106 145 94 143 53 78 104 86 112 127 109 111 104 119 93 103 106 117 113 209 1098 155 2453 20—21 M 117 117 74 51 109 109 121 97 116 113 112 1136 2533 F 122 120 149 75 118 123 117 133 81 105 254 1397 21—22 M 446 404 374 211 403 550 440 424 413 444 474 4663 10752 F 458 582 644 358 451 500 463 525 455 508 1085 6089 25—30 M 525 565 475 392 576 832 601 644 567 714 648 6539 14447 F 552 697 744 530 663 891 661 708 577 726 1159 7908 30—35 M 494 523 440 481 654 743 665 641 562 666 716 6585 14188 F 518 649 694 585 656 817 676 716 525 706 1061 7603 [ 35—40 M 437 490 413 409 534 625 601 524 499 580 648 5760 12215 F 501 576 541 507 544 628 589 601 501 595 872 6455 40—45 M 380 406 336 327 443 473 483 422 403 503 571 4747 10030 F 475 456 475 345 432 519 478 499 386 506 712 5283 45—50 M 352 309 330 232 333 406 347 355 307 339 489 3799 8073 F 379 402 446 272 353 420 369 365 281 384 603 4274 I 50—55 M 308 292 266 173 243 343 281 268 241 307 353 3075 6402 F 310 359 336 196 265 351 255 273 245 327 410 3327 55—60 M 201 220 187 127 182 210 190 182 156 178 242 2075 4611 F 216 261 267 167 218 286 200 207 179 233 302 2536 60—65 M 143 160 105 100 130 135 157 111 103 133 163 1440 3379 F 192 212 194 139 158 190 145 159 137 174 239 1939 65—70 M 118 110 87 62 95 111 95 70 75 103 110 1036 2541 F 137 180 150 104 121 146 129 123 94 132 189 1505 70—75 M 45 02 54 34 47 51 49 44 44 51 86 567 1713 F 101 134 126 86 98 109 110 88 66 95 133 11461 75—80 M 30 34 42 26 20 27 43 39 15 31 28 351 994 F 72 74 72 49 56 56 81 57 35 31 76 659 80—85 M 13 16 15 8 9 10 10 8 6 3 l6 114 425 F 23 36 33 22 29 13 37 26 13 22 39 311 85—90 M 4 3 7 1 2 7 9 1 2 3 10 49 156 F 10 13 19 5 2 7 12 13 2 8 16 107 90—95 M 2 1 2 1 2 2 2 12 42 F 2 2 5 2 1 6 5 1 1 3 2 30 95—100 M .. .. .. .. 1 .. .. .. 1 .. .. 2 6 F 1 .. .. 1 .. .. .. 1 .. 1 .. 4 100 & upwards M .. .. .. .. .. .. .. .. .. .. .. .. 1 F .. .. .. .. .. .. .. .. .. .. 1 1 Totals P 13966 14136 11707 9328 13607 15324 16058 14791 12997 15187 17243 M 6795 6538 4859 4213 6610 7363 7962 6963 6543 7320 7124 72290 154344 F 7171 7598 6848 5ii5 6997 7961 8096 7828 6454 7867 10119 82054 j 19 Rate of Increase of Population for Age Periods.— The following Table, No. 7, shews the increase per cent, of the population for the various age-periods at the Census, 1911 as compared with 1901. Table No. 7. Age period. Increase per cent, during decenniuin 1901-1911. Age period. Increase percent. during decennium 1901-1911. 0-1 8.4 25-30 23.7 1—2 16.3 30—35 37.2 2—3 17.2 35—40 43.5 3—4 26. 4 40—45 46.1 4—5 24.7 45—50 56.0 0—5 18.3 50—55 72.4 5— 10 33.3 55-6o 58.9 10-15 31.9 60—65 56.2 15—20 22.8 65—70 77.9 20-25 19.5 70—75 73.7 75 & over 71.4 It may be inferred from the above Table No. 7 that the population as a whole is becoming older, i.e., the average age of the population has increased since the Census of 1901. 20 Age and Sex Constitution of Population compared with England and Wales.—The following Table, No. 8, shows the ratio of the population of Willesden to that of England and Wales at the various age and sex groupings. Table No. 8. Age period. England and Wales. Willesden. England and Wales. Males. Males. Females. Females. 0-5 100 107 109 100 5-10 100 106 105 100 10-15 100 95 99 100 15-20 100 85 95 100 20-25 100 90 105 100 25-30 100 105 114 100 30-35 100 112 118 100 35-40 100 107 112 100 40-45 100 103 107 100 45-50 100 96 100 100 50-55 100 94 93 100 55-60 100 80 88 100 60-65 100 71 83 100 65-70 100 66 80 100 70-75 100 56 85 100 75-80 100 61 84 100 80-85 100 47 83 100 85-90 100 63 78 100 90 and over 100 83 92 100 100 97 103 100 The above Table, No. 8, shows that in Willesden there is an excess of children under 10 years, then a deficiency for two quinquennia in the case of females, and for three in the case of males, and then an excess up to age 45 in both sexes, followed by a deficiency in the remaining groupings. This distribution of population is characteristic of the suburbs around London, and the explanation probably lies in the following. The population of Willesden is composed in part of young married couples, who have probably moved out of London as their families became larger, possibly on account of cheaper houses, and possibly 21 with the idea of obtaining better external surroundings for their children. The above would explain the two periods of excess. The first period of deficiency is possibly due to the fact that at the ages 15-25 young members of the family leave home in order to obtain work elsewhere, the earlier rise to the second period of excess in the case of females being possibly due to the younger age at which females marry or perhaps to an influx of domestic servants. The second period of deficiency over 45 years is due to the fact that the district is young and the influx of young people has been sufficiently marked to prevent the preponderance of older ones, exactly the converse of the effect of emigration on a population. Sex Distribution.—The following Table, No. 9, shows the proportion of females to every 100 males in each of the wards of the District. Table No. 9. Ward. Males. Females. South Kilburn 100 106 Mid Kilburn 100 116 North Kilburn 100 141 Brondesbury Park 100 121 Kensal Rise 100 106 Harlesden 100 108 Stonebridge 100 102 Roundwood 100 112 Church End 100 99 Willesden Green 100 107 Cricklewood 100 142 Willesden Urban District 100 114 Conjugal Conditions.—The following Table, No. 10, shows the numbers of the population, single, married, and widowed, at various ages, as compiled from Vol. VII of the Census returns. TABLE NO. 10. Condition Under 15. 15 and under 20. 20 and under 25. 25 and under 30. 30 and under 35. 35 and under 40. 40 and under 45. 45 and under 50. 50 and under 55. 55 and under 60. 60 and under 65. 65 and under 70. 70 and under 75. 75 and under 80. 80 and under 85. 85 and under 90. 90 and under 95. 95 and under 100. 100 and upwards. All Ages. M 24.29s 6,025 4,899 2,770 1,285 710 404 300 199 117 68 61 29 12 3 4 ... ... 1 41,182 87,605 Unmarried F 24,606 6,773 5,683 3,151 1,866 1,226 883 676 431 339 264 189 173 90 51 20 1 1 ... 46,423 Married M ... 4 890 3,739 5,243 4,933 4,242 3,347 2,685 1,752 1,165 755 349 159 41 16 4 ... ... 29,324 59 557 F ... 65 1,787 4,691 5,614 5,012 4.081 3,159 2,329 1,569 932 569 304 95 22 4 ... ... ... 30,233 Widowed M ... .... 5 23 56 no 98 152 190 203 206 218 189 164 70 29 83 8 2 ... 1,723 F ... ... 11 52 121 215 316 438 566 626 741 746 669 474 238 29 3 1 5,329 7,052 Percentage of females between the ages of 15 and 45, manied —51 *146. Percentage of females over 15, married = 52 '690. Percentage of males over 15, married = 61 *175. 23 Excluding all persons under 15 from the above Table, No. 10, it will be seen that 52.7 per cent, of all females are married and 61.2 per cent. of all males, the difference in the percentages being due to the different numbers of males and females. The number of married females, between the ages of 15 and 45 is 21,250, being a percentage of the entire female population at these ages of 51.1. Density of Population.—The following Table, No. 11, gives certain particulars with regard to the density of the population as judged by (a) the number of persons per acre, (b) the number of houses per acre, and (c) the number of persons per house at the Census of 1911. Table No. 11. Wards. Population. Area in Acres. No. of Persons per Acre. No. of Houses. * No. of Houses per Acre.* No of Institutions. No. of Persons per House. NonInstitutional. Institutional. Total. South Kilburn 13,838 128 13,966 71 19670 3.267 46.01 4 4'23 Mid-Kilburn 14,065 71 14,136 35 104 71 3.256 24.11 4 431 North Kilburn 11,707 ... 11,707 277 4226 2,724 9.83 429 Brondesbury Park 9,154 174 9,328 309 30-18 2,357 7.62 4 3-88 Kensal Rise 13,607 .... 13,607 37 99-32 3,276 23.91 - 4-15 Harlesden 15,283 di 15,324 225 68-io 3,830 17.02 4 3 "99 Stonebridge 15,334 724 16,058 634 25'32 3,120 4.92 8 4-91 Round wood 14,560 231 14,791 252 58-69 3,252 12-90 10 4'47 Church End 12,902 95 12,997 661 19 60 2,850 4.31 4 4-52 Willesden Green 15,150 37 I5,187 323 47-01 3,520 10.89 i 4'30 Cricklewood 17,037 76 I7,113 1,360 i2-58 3,982 2'93 5 4-27 * Not including institutions and large establishments. 24 25 A house, as far as the above Table is concerned, is defined as any place of abode in which the occupier is entitled to a separate schedule, not including institutions. Proportion of Families Living in Various Sized Tenements or Houses.—The following Table, No. 12, shows the number of families and the percentage proportion of these families occupying various sized tenements or houses in Willesden and the corresponding percentage figure for England and Wales at the Census of 1911. Table No. 12. No. of Rooms. No. of Families. Percentage proportion of Families at the Census 1911. I'ercenlage Proportion of Families at the Census 1911. Willesden. England and Wales 1 2,011 5'68 3.20 2 3.619 1023 8.'31 3 10.367 29-31 13 95 4 7,629 2157 24'95 5 3.538 io'oo 20-64 6 2,521 713 13 72 7 2,080 5-88 5. 8 1.394 3 94 3'55 9 984 278 197 10 & over 1,222 3'45 3'80 It will be seen from the above Table, No. 12, that the preponderating size of tenement in Willesden is that consisting of three rooms, and that that of four rooms comes next, the commonest type in England and Wales as a whole being the four roomed tenement, followed by that of five rooms. 26 Proportion of Population Living in Various Sized Tenements or Houses.—The following Table, No. 13, shows the population and the proportion percentage of the population occupying various sized tenements or houses in Willesden, and the corresponding percentage figure for England and Wales. Table No. 13. No. of Kooms. Population. Percentage proportion of the Population at the Census 1911. Percentage proportion of the Population at the Census 1911. Willesden. England and Wales. i 3.947 2.6o 1.40 2 12,418 8-17 6.06 3 4-2.634 28 02 i2'8o 4 33.518 22-03 24.70 5 17,200 n'31 22.40 6 12,673 S'33 14.79 7 10,271 675 6.45 8 7,016 4*61 3.97 9 S.150 3 39 3.29 io & over 7,284 479 5.4 This Table, No. 13, corresponds very closely with Table No. 12, relating to families. Both Tables 12 and 13 would indicate that the conditions under which the population of Willesden is housed are less satisfactory than for England and Wales generally. 27 Average Number of Occupants Per Room.—The following; Table No. 14 shews this figure in relation to the size of the tenement or house. Table No. 14. No. of Rooms in tenement in which persons live. Average Number of Occupants Per Room. Willesden. England and Wales. Urban. Rural. 1 1.96 1.90 1.91 1.57 2 1.72 1.59 1.62 1.40 3 1.37 1.33 1.36 1.24 4 1.10 1.08 no 1.02 5 .97 .95 .96 .90 6 .84 .78 .79 .76 7 .71 .68 .68 .66 8 .63 .61 .61 .61 9 .58 .56 .56 .57 1 to 9 1.05 .95 .97 .89 The above Table, No 14, is really a better index of the density of a population than the figures per acre; the density per room being of much more vital importance than the density per acre. Then, again, the question of the separation of the sexes has to be considered. If the children of the household are of tender years the question may not arise, but as they grow up the question may become acute. From these points of view the room density figure of Willesden as compared with that of the three comparative areas above is not altogether satisfactory. •28 Occupations—The Census returns of England and Wales, 1911, contain interesting data relative to social conditions and the numbers employed in occupations of special local importance, among males and females at 10 years and upwards, in the Urban District of Willesden, as shewn in the following Table, No. 15. Table No. 15. Males over io years. Females over 10 years. 55,003 Total Occupied and Unoccupied 64,775 8,639 Retired or Unoccupied 43,786 46,364 Engaged in Occupations 20,989 1,933 National and Local Government 310 462 Teaching... 1,011 137 Domestic Indoor Service 6,133 ... Charwomen 479 268 Laundry Workers 2,680 2,966 Commercial Clerks 1,319 332 Law Clerks 15 4,319 On Railways 26 330 Motor Car Drivers ... 748 Cycle and Motor Car Workers ... I»436 Carmen, Carters ... 1,397 Messengers, Porters 16 i io Farmers, Farm Workers 4 333 Builders ... 700 Builders' Labourers ... 1,133 Carpenters ... 794 Bricklayers ... 114 Masons ... 1,809 Painters ... 451 Plumbers ... 813 Others in Building Trade 1 284 Navvies, Road Labourers 52 Dressmakers 2,644 29 Of the 46,364 males and 20,989 females employed in various occupations the following Table, No. 16, gives the percentage proportion of those engaged. Table No. 16. Males. Females. National and Local Governmen 4.16 Teaching 4.81 Commercial and Law Clerks. 7.11 Domestic Indoor Service ... 29.22 On Railways 9.31 Laundry Workers 12.75 Motor Car Drivers and Cycle Commercial & Law Clerks 6.36 and Motor Car Workers 2.32 Dressmakers 12.59 Carmen, Carters 3.09 Messengers, Porters ... 3.01 Builders, Builders' Labourers Carpenters, Bricklayers Masons, Painters, Plum hers and others in Building Trade 13.25 30 The following Table, No. 17, sets out under generalised headings the total number of males and females engaged in occupations at ages 10 years and upwards. Table No. 17. Males. Females. I General or Local Government of the Country 1933 310 II Defence of the Country 123 III Professional Occupations and their Subordinate Services ... 2398 1994 IV Domestic Offices or Services 1145 9793 V Commercial Occupations 5167 1393 VI Conveyance of Men, Goods and Messages 9432 128 VII Agriculture 46o 7 VIII Fishing ... ... IX In and About, and Working and Dealing in the Products of, Mines and Quarries 110 3 X Metals, Machines, Implements and Conveyances 4400 231 XI Precious Metals, Jewels, Watches, Instruments and Games 965 74 XII Buildings and Works of Construction 6452 1 XIII Wood, Furniture, Fittings, Decorations 1513 159 XIV Brick, Cement, Pottery and Glass 156 30 XV Chemicals, Oil, Grease, Soap, Resin, etc. 599 83 XVI Skins, Leather, Hair and Feathers 286 70 XVII Paper, Prints, Books and Stationery 1304 263 XVIII Textile Fabrics 786 643 XIX Dress 2117 3966 XX Food, Tobacco, Drink and Lodgings 4447 1466 XXI Gas, Water, and Electricity Supply and Sanitary Service 688 XXII Other, General, and Undefined Workers and Dealers 1883 46364 375 20989 31 B.—SANITARY CIRCUMSTANCES OF THE DISTRICT. Water Supply.—The district is supplied with water by the Metropolitan Water Board, the supply being constant and of good quality. A frequent cause of contamination arises from the presence of dead mice and birds, dirt and other matters in the storage cisterns, and in many instances owing to the cisterns being placed in inaccessible and unsuitable positions, cleansing is difficult and seldom done. In all such cases the owners are requested to provide a supply direct from the rising main, without, however, removing the cistern which the Metropolitan Water Board requires to be placed in every house. Power to make Bye-Laws as to Cisterns, etc.—The Council has power under Section 17 of the Willesden Urban District Council Act, 1903, to make bye-laws as to cisterns, etc. The Section runs^-"The Council may make bye-laws for securing the accessibility for purposes of cleansing and the cleanliness and freedom from pollution of tanks, cisterns, and other receptacles used for the storing of water used or likely to be used by man for drinking or domestic purposes or for manufacturing any liquid to be used by man for drinking whether aerated or otherwise." Rivers and Streams.—The River Brent forms the Northern and Western boundary of the district. The Mitchell Brook, a tributary of the Brent, is a small stream running in a Westward direction through the district. A large sheet of water known as the Welsh Harp is formed at the extreme Northern boundary by the damming up of 32 the Brent, thus forming a reservoir about a mile in length and about a quarter of a mile in width, or 160 acres in extent. The boundary line between Willesden and Kingsbury Urban Districts passes through the length of this reservoir, leaving an area of about 68 acres of it in Willesden. No pollution of any of these waters in the Willesden area came under the notice of the Public Health Department during the year. Drainage and Sewerage.—The drainage, sewerage and sewage disposal are on the water carriage system, and since the year 1911 have been taken by gravitation into the London sewers. Closet Accommodation.—With the exception of two or three outlying premises all the houses in the district are provided with closets on the water carriage system. Scavenging.—The Public Health Department is responsible for the removal of house refuse within the district. The work is actually carried out by a contractor, who is under contract to call at each house in the distirct at least once in each week and remove the domestic refuse. Under the terms of the three years' contract, which expires on 31st March, 1916, the contractor is required to dispose of the house refuse outside the district so as not to create a nuisance in Willesden. No destructor is provided by the Council. With the exception of a few streets in the older part of the district, where fixed receptacles for house refuse still exist, moveable receptacles are now generally in use. Steps are being taken to replace gradually the fixed by moveable receptacles from time to time. 33 In the following Tables Nos. 18-22 are given the chief data relating to House Refuse removal. Table No. 18. DATA RELATING TO REMOVAL OF HOUSE REFUSE. Year. Maximum No. of carts employed. Minimum No. of carls 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. (1) (2) (3) (4) (5) (6) (7) (8) 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 1908-9 26 18 21 45 36 334 1.52 1909-10 23 15 18 42 30 111 0.50 1910-11 28 17 20 50 34 123 0.55 1911-12 29 12 21 50 23 204 0.90 1912-13 28 18 20 51 36 99 0.43 1913-14 27 13 19 44 26 178 0.77 Table No. 19. REMOVAL OF HOUSE REFUSE. TABLE OF QUANTITIES. Year. Annual quan In cubic yds. tity collected. In tons. Standard Quantities in cubic yards No. of Houses in District, Michaelmas. Population of district, Michaelmas. Amount of Refuse collected per house per annum. Amount of Refuse per head of population. (1) (2) (3) (4) (5) (6) (7) (8) Cubic yds. Cubic yd. 1900-1 79,875 25,905 84,100 16,820 115,201 4.7 .69 1901-2 83,587 27,109 86,290 17,258 117,619 4.8 .71 1902-3 91,170 99,761 29,568 90,940 18,188 123,987 5.0 .73 1903-4 32,354 95,860 19,172 130,621 5.2 .76 1904-5 99,510 32,273 100,045 20,009 135,613 4.9 .73 1905-6 88,860 28,819 78,793 20,735 140,692 4.3 .63 1906-7 79,137 25,666 80,214 21,109 21,485 142,772 3.7 .55 1907-8 80,100 25,978 81,643 144,912 3.7 55 1908-9 86,062 27,912 83,015 21,846 '49,744 3. 9 .57 1909-10 80,558 26,127 83,862 22,069 151,000 154,298 3.7 .53 1910-11 80,417 26,081 85,063 22,385 3.6 .52 1911-12 84,367 27,362 86,180 22,679 157,717 3.7 .53 1912-13 87,106 28,250 87,107 22,923 l6l,l88 164,538 3. 8 .54 1913-14 79,450 25,767 88,190 23,208 3.4 .48 †Standard quantities are calculated upon the respective mean quantities of refuse collected per house (5 0 cubic yards during the quinquennium 1900-4 and 3.8 cubic yards during the nine years 1905-13). They represent the theoretical number of cubic yards of refuse removed per annum on the assumption that the mean quantity per house had remained constant for all houses during the respective periods. The quantity in the respective periods rises steadily and proportionately to the number of new houses added to the district. 34 Table NO. 20.—REMOVAL OF HOUSE REFUSE. TABLE OF COST. Year Total Cost of Collection. Standard Cost.† Cost per Cubic Yard. Cost per House. Cost per Head of Populatiou. Rate in the £. Sub-Districts. Total. 1 2 3 (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) £ £ £ d. s. d. d. d. 1900-1 2,095 1,600 3,127 £6,822 £8,235 20.5 8 1 14.2 3.13 1901-2 2,475 1,895 3,452 £7,822 £8,449 22.5 9 0¾ 16.o 3.45 1902-3 2,725 2,495 3,752 £8,972 £8,905 23.6 9 10½ 17.4 3.69 1903-4 3,100 2,950 3,895 £9,945 £9,386 23.9 10 4½ 18.3 3.83 1904-5 3,445 3,489 3,995 £10,929 £9,796 26.4 10 11 193 3.99 1905-6 2,500 2,150 2,800 £7.450 £6,105 20.1 7 2¼ 12. 8 2 .60 1906-7 *1,930 *2,156 *2,258 £6.250 £6,215 19.0 5 11 10.5 2.10 1907-8 *2,300 *2,450 *2,250 £6,850 £6,326 20.5 6 4½ 11.3 2 .20 1908-9 *1,955 *1,925 *2,055 £5,855 £6,432 16.3 5 4¼ 9.4 1.84 1909-10 1,715 1,939 1,950 £5,604 £6,498 16.7 5 0¾ 8.9 1.73 1910-11 ... ... ... £6,547 £6,591 19.5 5 10¼ 1o.2 1.99 1911-12 ... ... ... £6,547 £6,677 1.6 5 9¼ 1o.o 1.97 1912-13 ... ... ... £6,547 £6,749 18.0 5 8½ 9.7 1.93 1913-14 ... ... ... £6,163 £6,834 18.6 5 3¾ 9.0 1.77 * Alternative to inclusive contract for the District. t Standard cost is calculated upon the mean cost of removal (23.5d. per cubic yard during the quinquennium 1900-4 and l8.6d. during the nine years 1905-13. This standard cost represents the theoretical total cost per annum for house refuse removal on the assumption that the mean number of cubic yards per house collected and the price per cubic yard had remained constant during the respective periods. The standard cost in each of the respective periods rises steadily and proportionately to the number of new houses added each year to the district. 35 36 Table No. 21. Total actual No. of loads removed. Average No. per day. Average cost per van load. Average capacity of van. (1) (2) (3) (4) 10,892 35.2 s. d. 11 4 cubic yards. 7.29 Table No. 22. Month. No. of working days. Total cubic yards removed. Average quantity per day (cubic yards). (1) (2) (3) (4) 1913-14. April 26 7,56 287 May 26 7,63 291 June 25 6,683 267 July 27 6,986 259 August 25 5,810 232 September 26 5,20 228 October 27 6,400 237 November 25 6,049 242 December 25 6,701 268 January 27 7,33 264 February 24 6,130 255 March 26 6,619 255 Sanitary Work.—The following Table, No. 23, indicates the nature and amount of work accomplished by the Sanitary Officers during the year, and is in the form desired by the County Medical Officer of Health:— Table No. 23.—Sanitary Work. Local Acts in force in Willesden: Willesden Local Board Act, 1876. Willesden Local Board Act, 1887. Willesden Sewerage Act, 1896. Willesden Electric Lighting Order, 1898. Willesden Urban District Council Act, 1903, 37 Adoptive Acts in force in Willesden: *Public Health Acts Amendment Act, 1890, Part 111. *Public Health Acts Amendment Act, 1907, Parts II, *III., *IV., and X. *Notification of Births Act, 1907. Baths and Washhouses Acts, 1846-99. Burial Acts, 1852-1900. Public Libraries Acts, 1892-1901. Bye-laws in force in District: *Common Lodging Houses (P.H.A. 1875, s. 80). *Houses Let in Lodgings (P.H.A. 1875, 5. 90). *Slaughter Houses (P.H.A., 1875, s. 169 and T.I.C.A., 1847, s. 128). *Prevention of Nuisances (P.H.A., 1875, s. 44). New Streets and Buildings (P.H.A., 1875, s. 157 and P.H.A.A.A., 1890, s. 23). Pleasure Grounds (P.H.A., 1875, s. 164). *Drainage of Buildings (P.H.A.A.A. 1890, s. 23). *Rag and Bone Dealer (P.H.A., 1875, s. 113). Regulations made by Local Authority in force in District: *Dairies, Cowsheds and Milkshops (D.C.M.O., 1885, s. 13). Small Holdings and Allotment Act, 1908. •These are administered wholly or partly by the Health Committee. The unstarred are administered by other Committees of the Council. Staff employed in Sanitary Department: 1 Chief Inspector of Nuisances. 8 District Inspectors of Nuisances. 1 Chief Health Visitor. (Also engaged in Medical Inspection.) 8 Health Visitors.( Also engaged in Medical Inspection.) 8 Clerks. (Also engaged in Medical Inspection.) 2 Disinfectors. 2 Drain Testers and Labourers. 38 Inspections: Number of premises inspected on complaint 1,038 Number of premises inspected in connection with infectious diseases. 249 Number of premises under periodical inspection 551 Houses inspected from House to House (Housing, Town Planning, &c., Act, 1909) 213 Total number of inspections and re-inspections made 11,800 Action Taken (other than under Housing, Town Planning, &c., Act, 1909): Cautionary or Intimation Notices Issued 1,388 Number complied with 1,2-43 Statutory Orders issued 48 Number complied with 43 Summonses served 4 Number of convictions obtained 4 Summonses withdrawn 0 „ dismissed 0 Notices under Section 3G of the Housing, Town Planning, &c., Act, 1909, issued 161 Dwelling Houses and action under Housing, Town Planning, &c., Act, 1909: Number of houses dealt with under Section 15 0 Number of houses found to be in a state dangerous or injurious to health (Section 17) 22 Number of representations made by M.O.H. (Section 17) 22 Number of houses made Habitable without closing orders 0 39 Number of closing orders made by L.A. (Section 17) 22 Number of houses closed voluntarily 0 Number of closing orders determined after repairs (Section 17) 1 Number of houses demolished— (a) by order of L.A. (Section 17) 5 (b) voluntarily 0 Illegal Underground Rooms vacated 0 Houses Let in Lodgings (Tenement Houses): Number registered under Bye-laws 0 Number of contraventions 0 Common Lodging Houses: Number registered under Bye-laws 2 Number of Inspections made 19 Number of contraventions 3 Canal Boats used as Dwellings: Number registered under the Acts — Number of contraventions of Regulations 26 Movable Dwellings, Caravans, Tents, &c.: Number observed during the year 20 Number of nuisances therefrom abated 0 Number removed from district 10 Bakehouses: Number in district 68 Contraventions of Factory Acts 39 Slaughter-houses: Number on register 8 Number of inspections made 89 Frequency of inspection monthly Contraventions of Bye-laws 3 40 Cowsheds: Number on register 5 Number of inspections made 41 Frequency of inspection quarterly Contraventions of Regulations 15 Number of Milch Cows in district 100 Dairies and Milkshops: Number on register 143 Number of inspections made 426 Frequency of inspection quarterly Contraventions of regulations 44 Unsound Food: Meat (including organs) seized and surrendered — Poultry and game seized and surrendered — Fish seized and surrendered 206 lbs. Fruit and vegetables seized and surrendered Other articles seized and surrendered — Method of disposal Buried on slop shoot Adulterated Food: Samples taken — Found adulterated — Offensive Trades: Number of premises in district 12 Number of inspections made 21 Contravention of Bye-laws 8 Water Supply and Water Service: Wells- New sunk 0 Cleansed, repaired, etc. 0 Closed as polluted 0 41 Percentage of houses supplied from public water service 100 Cisterns—New provided 1 Cleansed, repaired, covered, etc. 200 Draw-taps placed on mains 50 Percentage of houses supplied on constant system 100 Number of samples obtained for analysis from— (a) Local Wells 0 (b) Public supply 0 Drainage and Sewerage of existing Buildings: Water Closets— Number of water closets substituted for dry receptacles 0 Repaired, supplied with water or otherwise improved 297 Percentage of houses provided with water closets 100 Drains— Examined, tested, exposed, &c. 273 Unstopped, repaired, trapped, &c. 358 Waste pipes, rain-water pipes, disconnected, repaired, &c. 275 New soil pipes or ventilating shafts fixed 72 Existing soil pipes or ventilating shafts repaired 52 Disconnecting traps or chambers inserted 66 Re-constructed 39 Cesspools— Rendered impervious, emptied, cleansed, &c 0 Abolished and drain connected to sewer 0 Percentage of houses draining into sewers 100 42 Disinfection: Rooms disinfected— (a) Ordinary infectious diseases 1,254 (b) Phthisis 188 Rooms stripped and cleansed 123 Articles disinfected or destroyed— (a) Ordinary infectious diseases 12,252 (b) Phthisis 1,128 Dust: New bins provided 217 Periodical frequency of dust removal weekly. Number of complaints of non-removal received 178 Method of disposal By tipping and private destructor Sundry Nuisances abated: Overcrowding 28 Smoke G4 Accumulations of refuse 106 Foul ditches, ponds, &c., and stagnant water 13 Foul pigs and other animals 52 Dampness 171 Yards repaved or repaired 388 Other nuisances 1,273 41 Inspection of Manholes.—The following Table, No. 24, shews the results of inspection of manholes during a period of nine years—1905-13:— Table No. 24. Date. Total Inspections. Drains choked at Interceptor. Percentage. Stoppers of raking arm missing. Percentage. October, 1905 6,745 288 4.3 654 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 „ „ 1908 5,548 190 3.4 83 1.5 „ „ 1909 6,144 158 2.6 110 1.8 „ „ 1910 6,739 181 2.7 73 1.1 „ „ 1911 9,735 202 2.1 161 1.7 „ „ 1912 9,739 209 2.1 143 1.5 „ „ 1913 4,7 IO 112 2.4 61 1.3 Total 56,413 1,712 3.0 1,625 2.9 Exemptions from Inhabited House Duty.—Table No. 25 shows the number of applications made for certificates of exemption from Inhabited House Duty under section 26 of the Customs and Inland Revenue Act, 1890. Table No. 25. Customs and Inland Revenue Act, 1890, Section 26. No. of applications received 99 No. granted 95 No. refused 4 No. under consideration at the end of the year 0 In dealing with this subject it should be noted that in certificates for exemption from Inhabited House Duty under the above Act the Medical Officer of Health is required to certify that the house in respect of which such a certificate is granted "is so constructed as to afford suitable accommodation for each of the families or persons inhabiting it, and that due provision is made for their sanitary requirements." 44 In dealing with applications for the above exemption certificates special importance is attached to the following matters:— 1. Water Closet Accommodation. That a separate and sufficient water closet is provided for each separate dwelling or tenement. 2. Sinks. That a separate glazed stoneware sink is provided for each separate dwelling or tenement. 3. Water Supply. That a separate draw-off tap taking its water supply direct from the rising main is provided over each separate sink in each separate dwelling or tenement. 4. Drainage. That every drain is properly constructed and capable of standing the smoke test. 5. Yard, Forecourt, etc. That the yard, forecourt, and ground immediately abutting upon the house is properly and sufficiently paved and drained. 6. Access to the Yard. That access to the yard is provided for each separate dwelling either by means of a common passage way or several separate passage ways. 7. Storage of Refuse. That suitable and sufficient provision is made for the storage of refuse. 45 8. Washing Accomodation. That suitable and sufficient washing accommodation is provided. 9. Storage of Food. That a food cupboard suitably lighted and ventilated to the external air is provided for each separate dwelling or tenement. 10. Sanitary Conditions. That the sanitary conditions of each separate dwelling or tenement are otherwise satisfactory. Canal Boats Acts, 1877 and 1884.—The following is the report of the Inspector under these Acts:— Gentlemen, In accordance with Section 3 of the Canal Boats Act, 1884, I beg herewith to present the Annual Report for the year ending 31st December, 1913, on the work carried out under the above Acts, and the Regulations relating to canal boats issued by the Local Government Board. The Canal at Lower Place is situated at the extreme border of the district, about three-quarters of a mile of it passing through Willesden. During the year 85 visits were made to the canal, 81 boats were inspected, and of this number 21 were found to be contravening the Regulations by one or more infringements, the remaining 60 were found to be in good structural repair and in a cleanly condition. 46 The following Table, No. 26, is a summary of the work done and also shows in detail the contraventions observed and remedied during the year— Table No. 26. Infringements of the Acts and Regulations with respect to Carried forward from 1912. Found during 1913- Remedied during 1913- Carried forward from 1913. (a) Registration ... ... ... ... (b) Notification of change of Master ... ... ... ... (c) Certificates 1 13 12 2 (d) Marking 1 8 5 4 (e) Overcrowding ... 1 1 ... (f) Separation of the sexes ... ... ... ... (g) Cleanliness ... ... ... ... (h) Ventilation ... ... ... ... (i) Painting ... ... ... ... (j) Provision of Water Cask ... 3 2 1 (k) Removal of Bilge Water ... ... ... ... (l) Notification of Infectious Disease ... ... ... ... (m) Admittance of Inspector ... ... ... ... (n) Habitable Condition ... 1 1 ... Totals 2 26 21 7 In all instances where contraventions were found notices were at once served on the owner of the boat, and these notices were duly complied with during the year with the seven exceptions above noted as carried forward to 1914. In no instance was it found necessary to institute legal proceedings. No illness of an infections nature was discovered or notified as occurring among the occupants of the boats. H. D. WOODS, "Inspector of Canal Boats." 5th February, 1914. 47 Common Lodging Houses.—The two common lodging houses in the district were inspected at frequent intervals and generally found to be kept in a clean condition and conducted in an orderly manner. No alterations have been made during the year with reference to the accommodation. The following Table, No. 27, sets out the accommodation in each of the common lodging houses :— Table No. 27. Situation of Common Lodging House. Total No. of rooms No. with 3 beds in room. No. with 4 beds in room. No. with 6 beds in room. No. with 8 beds in room. No. with 9 beds in room. No. with 11 beds in room. No. with 18 beds in room. Total No. of Beds. 108,Villiers Rd. 14 9 4 1 ... ... ... ... 49 i & 2, MalvernGardens 20 ... 12 ... 2 1 1 3 144 34 9 16 2 2 1 ... 3 193 Houses Let in Lodgings.—No alteration has been effected with reference to the amendment of the bye-laws relating to the above, referred to in the report for the year 1912. This is a matter which should receive the early attention of the Council. Offensive Trades.—With the exception of the trades of fat boiler and rag and bone dealer no trade of an offensive nature, as specified in Section 112 of the Public Health Act, 1875, and Section 51 of the Public Health Acts Amendment Act, 1907, is established in the district. Fat boiling is carried on ancillary to the trade of pig keeping. The food for the pigs, which consists of wash collected from the hotels and restaurants in London, is boiled, and, during the process, the fat rises to the sur- 48 face and is drawn off into casks and sold for the manufacture of soap. No nuisance has been observed in connection with this process. Cow Sheds.—There are 7 dairy farms in the district, as follows:— Name of Farm. Where situated. Average No. of Cows. Dollis Hill Farm Dollis Hill Lane 27 Upper Oxgate Farm Oxgate Lane 11 Stud Farm Neasden Lane 15 Salters Chambers Lane 9 Welford's Harlesden Road 22 Grange Farm Lower Place 6 Jennings Rupert Road, Kilbarn 16 106 During the year a detailed inspection of the above cowsheds was made, special attention being directed to the lighting, ventilation, cubic space, paving, drainage of the premises, and adequate and suitable accommodation for the cleansing of cans, utensils, etc. Communications were sent to the various cow-keepers drawing attention to instances where their premises fell below the standard recommended and with one exception alterations were at once put in hand. Very considerable improvements have been effected. With regard to the one exception, the cowkeeper, owing to the expense that would be incurred and to the uncertainty of his lease on the property, undertook to give up the keeping of cows at the end of September, 1914. Veterinary Inspection of Milch Cows and Sampling of Milk for Detection of Tubercle Bacilli. —The Council's Veterinary Surgeon on his quarterly visits to the farms in the district, in accordance with articles 13 and 15 of the Dairies, Cowsheds and Milkshops Order, 1899, has on each occasion examined, on an average, 106 cows. 49 During the year 53 samples of milk were taken from cows showing induration or other abnormality of the udder or respiratory trouble with emaciation. Of the 53 samples taken two were found, after biological examination, to contain tubercle bacilli. In each instance the County Veterinary Inspector was communicated with under the Tuberculosis Order, 1913. In one case the suspected cow was removed from the herd and taken to a farm in Hendon where it was kept under observation for some time and afterwards released by another authority as free from tuberculosis. The other suspected animal, in accordance with the provisions of the above-mentioned Order, was slaughtered. The post-mortem examination revealed evidence that the animal was affected with generalised tuberculosis. Compensation under the Order was made to the owner. Thirty-nine samples of milk were taken from milkshops in the district supplied by cow-keepers outside the district, and five of these were found to contain tubercle bacilli. With regard to these five samples two were taken from milk-shops which obtained the milk in question from farms in Buckinghamshire and the other three from a farm in Kingsbury. The Medical Officer of Health of Buckingham was duly notified by letter on each occasion of the existence of tubercle bacilli in milk sent into this district from farms in Buckinghamshire. The history of the other three samples is as follows. Early in February, 1913, the first sample of milk, taken at a shop supplied from a farm in Kingsbury, was reported to contain tubercle bacilli. The Council's Veterinary Surgeon at once visited the farm and examined all the cows in the herd. Six were found to have some abnormality of 50 the udder, and from each a sample was taken for biological examination, the cows being isolated. In accordance with the Willesden Urban District Council Act, 1903, the farmer was requested to cease supplying milk from the six cows under suspicion of tuberculosis. A report was received giving the results of the examination, stating that the samples were free from tubercle bacilli. The farmer was compensated for loss of milk during a period of 31 days. In September a second sample of milk was taken from the same shop, which, on examination, was found to contain tubercle bacilli. As there was a doubt as to whether this might have come from a mixed sample, a third was taken in October, direct from the churn upon its arrival at the shop. The examination of this third sample shewed tubercle bacilli. Upon receipt of this information samples of milk were taken from all the cows in the suspected herd and examined with negative results. The explanation of the failure to trace the infected animal probably lies in the fact that tubercle bacilli are in some cases only given off at irregular intervals by an animal suffering from the disease. Nineteen samples of milk were taken from milk shops in the district supplied by distributing agents. Two of these samples proved on examination to contain tubercle bacilli. In one case the milk came from a farm in Wiltshire, and in the other from a farm in Somerset. In both instances the County Medical Officer was notified and acknowledgements were received stating that the matter was receiving attention. The distributing agents concerned were also notified, and ceased sending milk from the infected source into Willesden until the suspected herd had been examined and declared free from tuberculosis by a Veterinary Surgeon. 51 The following table, No. 28, shews the results of the examinations of samples of milk taken during the year 1913: Table No. 28. No. of samples taken. No. found to contain Tubercle Bacilli. No. found to be free from Tubercle Bacilli. Samples of Milk taken by Veterinary Surgeon from cows in the district suspected to be suffering with tuberculosis of the udder 53 2 51 Samples of milk taken by Veterinary Surgeon or Chief Sanitary Inspector from cows outside the district suspected to be suffering with tuberculosis of the udder 37 ... 37 Samples of milk taken from milkshops supplied by Cowkeepers outside the district 39 5 34 Samples of milk taken from milkshops supplied by Agencies distributing from a London Depot 19 2 17 Samples of milk taken from milkshops supplied by Cowkeepers in the district 1 ... 1 Totals 149 9 140 52 The following Table, No. 29, gives the results of examinations of samples of milk for tubercle bacilli in each completed year since the above methods of sampling and examination have been in operation in Willesden:— Table No. 29. Year. No. of Samples taken. No. found to contain Tubercle Bacilli. Percentage found to contain Tubercle Bacilli. 1910 40 5 12.5 1911 48 3 6.2 1912 86 5 5.8 1913 149 9 6.0 Food Inspection.—On no occasion during the year was it necessary to resort to compulsory seizure of diseased meat or unsound food. The following foodstuffs were surrendered voluntarily by local fishmongers and subsequently destroyed: Approximate Weight. 1 box of herrings 60 lbs. 1 box of codling 30 lbs. 3 boxes of kippers 30 lbs. 1 box of kippers 10 lbs. 1 box of cod roes 40 lbs. 1 box of skate 36 lbs. 206 lbs. Slaughter Houses.—The slaughter houses in the district were inspected during the process of slaughtering as frequently as possible, and the organs of all the animals seen slaughtered examined. In no instance was evidence of disease discovered during the year. The premises were kept in a cleanly condition and the bye-laws duly observed. 53 Milkshops.—There are 143 milkshops in the district, all of which were inspected at least three times during the year. On the whole the premises were found to be kept in a satisfactory condition. 44 contraventions of the Dairies, Cowsheds & Milkshops Order were observed, and notices in all instances were served and duly complied with. Bakehouses.—There are 68 bakehouses in the district, 47 of which are above ground and 21 underground. They were all inspected at least twice during the year. Generally the conditions relating to cleanliness, lighting and ventilation were well maintained. 39 contraventions of the Factory and Workshop Act were discovered, notices served and duly complied with. Sale of Food and Drugs Acts.—The administration of these Acts is in the hands of the Middlesex County Council, and the following Table, No. 30, shewing the work done in Willesden, has been kindly supplied me by Mr. Robinson, Chief of the Weights and Measures Staff. Table No. 30. Samples taken during the year ended December 31st, 1913. Article. Formal. Informal. Taken. Adulterated. Taken. Adulterated. Butter 3 1 66 ... Milk 315 54 60 17 Cream ... ... 12 ... Pepper ... ... 2 ... Mustard ... ... 2 ... Linseed ... ... 13 ... Seidlitz Powder ... ... 2 ... Pearl Barley ... ... 27 2 318 55 184 19 54 Housing Inspection.—The following Table, No. 31, gives particulars with respect to houses inspected under Section 17 of the Housing, Town Planning, &c., Act, 1909, excluding those represented as unfit for human habitation, and action taken in connection therewith. Table No. 31. Premises. No. of houses inspected during the year ending 27/12/13. No. of houses on which intimation notices served No. of houses on which intimation notices complied with. No. of houses with intimation notices outstanding at 27/12/13. No. of houses on which statutory notices served No. of houses on which statutory notices complied with. No. of houses with statutory notices outstanding at 27/12/13. Brett Road, 73-79, 82-94 11 11 11 ... ... ... ... Cambridge Road, 168-204 19 9 9 ... ... ... ... Melville Road, 14-36, 1-43 34 34 34 ... ... ... ... Harrow Road 816, 818 836-840 5 5 5 ... ... ... ... Meyrick Road, 2-16 8 7 7 ... ... ... ... Albert Road, 80-118 20 20 ... 20 ... ... ... Greyhound Road, 2-20, 24-68 33 33 3 30 ... ... ... Disraeli Road, 1-5. 11-19, 29-53, 26-42 30 30 ... 30 ... ... ... Rucklidge Avenue, 15 67 85-89 30 23 ... 23 ... ... ... 55 Houses Unfit for Human Habitation.—The following Table, No. 32, shews the number of dwelling houses inspected under Section 17 of the Housing, Town Planning, &c., Act, 1909, and represented as unfit for human habitation, and action taken thereunder. Table No. 32. Total number of houses inspected (191 +22) 213 Number considered to be unfit for human habitation 22 Number represented by Medical Officer of Health 22 Closing Orders made by Local Authority 22 Appeals against Closing Orders - Notices served on occupying tenants 21 Occupying tenants summoned - Orders made by Court requiring tenants to quit - Number of tenants ejected by order of Court - Closing Orders determined 1* Demolition Orders made 1 Appeals against Demolition Orders - Demolition Orders obeyed 5* Number of demolitions carried out without Orders being made - * Closed during 1912. The following Table, No. 33, gives detailed information as to the action taken during the year in respect of houses represented as unfit for human habitation. 56 Table No. 33.—SECTION 17 (1) OF HOUSING, TOWN PLANNING, &c., ACT, 1909. Dwelling Houses represented as Unfit for Human Habitation. Situation of Dwelling Houses. No. of Houses. Date of representation of M.O.H. Date of consideration of closing. Date of making closing orders. Date of service of closing orders. Date of operation of closing orders. Date of notice to occupying tenants. Date of determination of closing orders. Date of consideration of demolition. Date of making demolition orders. Date of service of demolition orders. Date of operation of demolition orders. Demolition orders obeyed or enforced “Fish shop,” Grange Road I 14/11/11 14/11/11 28/11/11 30/11/11 14/12/11 9/7/12 17/9/12 24/9/12 5/10/12 26/10/12 6/9/13 6, 10 and 12, Dudden Hill Lane 3 12/3/12 12/3/12 26/4/12 29/4/12 13/5/12 24/5/12 3/12/12 17/12/12 3/1/13 24/1/13 14/1/13 53, Cricklewood Broadway 1 11/6/12 11/6/12 25/6/12 17/7/12 31/7/12 21/8/12 3/12/12 17/12/12 3/1/13 24/1/13 6/9/13 1, 2 and 3, Newton Place 3 15/10/12 15/10/12 22/10/12 20/11/12 4/12/12 20/5/13 “Old Six Bells,” Church End 1 19/11/12 19/11/12 26/11/12 5/12/12 19/12/12 27/5/13 St. Ann's Cottage High Street 1 11/3/13 20/5/13 27/5/13 5/6/13 19/6/13 21/10/13 28/10/13 11/11/13 2/12/13 1-7, Orange Tree Terrace, Harlesden 7 20/5/13 17/6/13 24/6/13 30/6/13 14/7/13 8/8/13 778-784, 820-834, Harrow Road 12 16/9/13 21/10/13 28/10/13 11/11/13 25/11/13 1/12/13 29 and 31, Earlsmead Road 2 16/9/13 21/10/13 28/10/13 11/11/13 25/11/13 1/12/13 57 The following Table, No. 34, has been prepared in accordance with the Housing (Inspection of District) Regulatonsof the Local Government Board, and shews the number of houses awaiting inspection at the end of the year 1913. Table No. 34. Statement as to Dwelling Houses on list for early inspection. No. on list at 28/12/12 0 No. added to list during 52 weeks ending 27/12/13 6032 Total No. appearing on list during 52 weeks ending 27/12/13 6032 No. inspected, excluding houses represented as unfit for human habitation, during 52 weeks ending 27/12/13 191 No. inspected and represented as unfit for human habitation during 52 weeks ending 27/12/13 22 Total No. inspected during 52 weeks ending 27/12/13 213 5819 Regulations for Underground Rooms.—Towards the end of the year the Local Government Board sanctioned regulations made by the Council pursuant to Section 17 (7) of the Housing, Town Planning, &c., Act, 1909. The regulations are as follows:— URBAN DISTRICT OF WILLESDEN. REGULATIONS Prescribed by the Urban District Council of Willesden under Section 17 (7) of the Housing, Town Planning, &c., Act, 1909. Every room habitually used as a sleeping place, the surface of the floor of which is more than three feet below the surface of the part of the street adjoining or nearest to the room, shall comply with the following regulations, namely:— 1. The subsoil of the site of the room shall be effectually drained by means of a subsoil drain properly trapped and ventilated wherever the dampness of the site renders such a precaution necessary. E 58 2. Every drain passing under the room, other than a drain for the drainage of the subsoil of the site of the room, shall be properly constructed and capable of standing the smoke or coloured water test or other similar tests (not including a test by water under pressure.) 3. The room shall be effectually protected against the rising of any effluvium or exhalation by means of a layer of asphalte or of good concrete at least six inches thick, or four inches thick if properly grouted, laid upon the ground of the site of the entire room, or in some equally effectual manner; any such concrete shall be composed of at least one part of good Portland cement thoroughly incorporated with six parts of stone ballast or other suitable material. 4. The space, if any, beneath the floor of the room shall be provided with adequate means of through ventilation. 5. (i) Every wall of the room shall be provided with a proper horizontal damp-proof course which, if the floor of the room be formed of woodwork, shall be beneath the level of the lowest timbers or woodwork of such floor, and in every other case shall be not less than one inch below the level of the upper surface of such floor. (ii.) No part of any wall of the room shall, where it is practicable to avoid it, be in contact with the ground or earth. Provided that where any wall of the room is in contact with the ground or earth, such wall or such part thereof as is so in contact shall, unless constructed as a hollow wall, have an efficient vertical damp-proof course extending from the base thereof to a height of at least six inches above the surface of such ground or earth. A damp-proof course for the purposes of these regulations shall consist of sheet lead, asphalte, vitrified stoneware, or a double layer of slates laid 59 to break joint, bedded top and bottom in cement in the proportion of not more than one part of sharp clean sand to one of cement. 6. Unless the room is provided with a fireplace and a flue properly constructed and properly connected with such fireplace, it shall be provided with special and adequate means of ventilation by one or more suitably placed apertures or air shafts. 7. There shall be outside of and adjoining the room and extending along the entire frontage thereof, except as regards the portion of the frontage occupied by the steps hereinafter mentioned, and open upwards from six inches below the level of the floor thereof, an area or open space of a mean width not less than the height of the room from the floor to the surface of the street, and in no case less than 3ft. 6in., properly paved and effectually drained in every part. Provided that in the area there may be placed steps necessary for access to the room, and over and across such area there may be steps necessary for access to any building above the room if the steps in each case be so placed as not to be over or across any external window of the room. 8. The room shall have in every part thereof at least three feet of its height above the surface of the street adjoining or nearest to the room. Provided that if an area be constructed as aforementioned the height of the room above such surface may be less than three feet, but in no case more than one foot below such surface. 9. (i.) The room shall be effectually lighted by means of one or more windows opening directly into the external air. 60 (ii.) Every such window shall be so constructed that one-half at the least may be opened, and that the opening may extend to the top of the window. (iii.) The total area of such window or windows, clear of the sash frames, shall be equal at the least to one-eighth of the floor area of the room. (iv.) In estimating the area of the window or windows for the purpose of this regulation no account shall be taken of any part of any such window which is above the mean level of the ceiling of the room. (v.) Any such window or windows shall overlook the area or open space provided in pursuance of the regulation in that behalf. The above regulations were approved and adopted by the Urban District Council of Willesden, and their Common Seal duly affixed thereto, at a meeting held on the 23rd day of September, 1913, in the presence of L.S. C. PINKHAM, Chairman of the Council. REGINALD C. GRAVES, Deputy Clerk of the Council. The consent of the Local Government Board is hereby given to the foregoing Regulations this 16th day of December, 1913. H. C. MONRO, Secretary. L.S. Acting on behalf of the said Board under the authority of their General Order dated the 26th day of May, 1877. 61 Report on the Administration of the Factory and Workshop Act, 1901, in Connection with Factories, Workshops and Workplaces.—The above Act places upon the Local Authority the following duties relating to:— A. Factories:— (1) Seeing that means of escape in case of fi t are provided; (2) Enforcing the provision of suitable and sufficient sanitary conveniences; B. Workshops and Workplaces:— (1) Sanitary condition, including (a) cleanliness, (b) air space, (c) ventilation, (d) drainage of floors, and (e) sanitary accommodation; (2) Provision of means of escape from fire in workshops; (3) Special sanitary regulations for bakehouses; (4) Home work. These duties are discharged by the Inspectors of Nuisances and Health Visitors and a statement of the number of inspections made and defects noted is to be found in Tables Nos.35, 36, 37, 38, and 39, duly filled in as required by the Home Office. 62 Table No. 35. FACTORIES, WORKSHOPS, LAUNDRIES, WORKPLACES AND HOMEWORK. INSPECTION—Including Inspections made by Sanitary Inspectors or Inspectors of Nuisances. Premises. Number of Primary Inspections. Written Notices. Prosecutions. (1) (2) (3) (4) Factories (including Factory laundries) 166 20 ... Workshops (including Workshop laundries) 502 60 ... Workplaces (other than Outworkers' premises included in Part 3 of this Report) 79 10 ... Total 747 90 ... Table No. 36. DEFECTS FOUND. Particulars. Number of Defects. N umber of Prosecutions. Found. Remedied. Referred toH.M. Inspector (1) (2) (3) (4) (5) Nuisances under the Public Health Acts:— Want of Cleanliness 48 44 ... ... Want of Ventilation 2 2 ... ... Overcrowding 2 2 ... ... Want of drainage of floors 6 6 ... ... Other Nuisances 33 29 ... ... Sanitary accommodation— Insufficient 8 6 ... ... Unsuitable or defective 59 52 ... ... Not separate for Sexes 3 3 ... ... Offences under the Factory and Workshop Act:— Illegal occupation of underground bakehouses (S. 101) ... ... ... ... Breach of special sanitary requirements for bakehouses (SS. 97 to 100) 35 35 ... ... Other offences 8 8 ... ... (Excluding offences relating to out-work which are included in Part 3 of this Report). Total 204 187 ... ... Table No. 37. 3.—HOKE WORK. Nature of Work. Outworkers' Lists, Section 107. Notices served on Occupiers as to keeping or sending lists. Prosecutions. Outwork in Unwholesome Premises. Section 108. Outwork in Infected Premises, Sections 109, no. Lists received from Employers. Failing to keep or permit inspection of lists. Fail ng to send lists. Sending twice in the Year. Sending once in the Year. Instances. Notices served. Prosecutions. Instances. Orders made, S. no. Prosecutions, Section 109, no. Lists. Outworkers. Lists. Outworkers. Contractors. Workmen. Contractors. Workmen. (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) (13) (14) (15) (16) Wearing Apparel— Making, &c. 36 33 44 7 6 5 58 ... ... 17 17 ... 3 ... ... Cleaning and Washing 6 2 6 3 1 3 13 ... ... ... ... ... ... ... ... Household linen ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Lace, lace curtains, and nets ... ... ... 1 ... 1 1 ... ... ... ... ... ... ... ... Furniture and upholstery 4 2 4 1 ... 1 6 ... ... ... ... ... ... ... ... Umbrellas, &c. ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Total 46 37 54 12 7 10 78 ... ... 17 17 ... 3 ... ... 64 Table No. 38. REGISTERED WORKSHOPS. Workshops on the Register (s. 131) at the end of the year. N umber. (1) (2). Factories 36 Factories, Laundries 60 Workshops, Laundries 51 Domestic Laundries 14 Bakehouses 68 Dressmakers 77 Outworkers 155 Blouse Makers 9 Tailors 50 Bootmakers 60 Metal Workers 12 Wood Workers 8 Seamstresses 3 Motor and Cycle Makers 17 Upholsterers 4 Milliners 6 Miscellaneous 11 Total number of Workshops on Register 641 Table No. 39. 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) 21 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 1 Reports (of action taken) sent to II M. Inspector 1 Other 2 Underground Bakehouses (s. 101):— Certificates granted during the year ... In use at the end of the year 21 65 As regards Home Work, the powers given to district Councils of controlling the conditions under which certain classes of work are done in the homes of workers are important. These powers have for their object the prevention of home work being done (i) in dwellings which are injurious or dangerous to the health of the workers themselves, e.g., through overcrowding, want of ventilation, or other sanitary conditions; (iij in premises where there is dangerous infectious disease. In order that the Council may be fully informed as to home workers, the Act provides that all manufacturers should send to the local Authority the names and addresses of the out-workers whom they employ, in August and February of each year. Three cases of infectious diseases were reported on the premises of out-workers during the year. In seventeen instances notices were served as to the condition of the premises in which home workers were employed and all have been complied with. 66 C.—PREVALENCE OF, AND CONTROL OVER, ACUTE INFECTIOUS DISEASES. Notifications.—The following Table, No. 40, shews the number of notifications of infectious diseases in Willesden each year since 1892:— 67 Table No. 40. Year. Small Pox. Cholera. Plague. Diphtheria (including membranous Croup). Erysipelas. Scarlet Fever. Typhus Fever. Enteric Fever. Relapsing Fever. Continued Fever. Puerperal Fever. *Cerebral Spinal Meningitis. Poliomyelitis. ‡Pulmonary Tuberculosis. Other forms of §Tuberculosis. Totals. Rate per 1,000 of population. (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) (13) (14) (15) (16) (17) (18) 1892 5 1 ... 145 85 366 ... 28 ... ... 4 ... ... ... ... 634 9.4 1893 23 1 ... 229 139 589 1 47 ... ... 6 ... ... ... ... 1035 15.0 1894 21 1 ... 129 63 268 ... 70 ... 2 4 ... ... ... ... 558 7.5 1895 5 ... ... 186 81 392 ... 69 ... ... 8 ... ... ... ... 741 9.3 1896 2 1 ... 173 101 475 ... 52 ... 1 10 ... ... ... ... 815 9.5 1897 ... 2 ... 275 107 510 ... 52 ... 1 9 ... ... ... ... 956 10.3 1898 1 ... ... 335 70 361 ... 66 ... ... 2 ... ... ... ... 835 8.4 1899 ... 1 ... 319 82 414 ... 79 ... ... 6 ... ... ... ... 901 8.3 1900 ... ... ... 226 89 335 ... 77 ... ... 8 ... ... ... ... 735 6.4 1901 10 ... 1 404 79 553 ... 57 ... ... 2 ... ... ... ... 1106 9.5 1902 88 ... ... 440 104 466 ... 73 ... ... 8 ... ... ... ... 1179 96 1903 7 ... ... 221 76 502 ... 45 ... ... 11 ... ... ... ... 862 67 1904 12 ... ... 353 73 326 ... 38 ... ... 5 ... ... ... ... 807 5.9 1905 ... ... ... 275 86 397 ... 41 ... ... 13 ... ... ... ... 812 5.8 1906 ... ... ... 286 103 637 ... 46 ... 1 9 ... ... ... ... 1082 7.6 1907 ... ... ... 254 77 641 ... 28 ... ... 13 3 ... ... ... 1016 7.0 1908 ... ... ... 215 78 737 ... 41 ... ... 7 3 ... ... ... 1081 7 .3 1909 ... ... ... 207 94 638 ... 41 ... ... 8 ... ... 107 ... 1095 7.3 1910 ... ... ... 166 72 314 ... 23 ... ... 12 ... ... 61 ... 648 4.2 1911 ... ... ... 192 114 326 ... 13 ... ... 16 ... ... 230 ... 891 57 1912 1 ... ... 222 109 430 ... 13 ... ... 10 ... 4 487 ... 1276 80 1913 ... ... ... 233 93 5°4 ... 18 ... ... 11 3 3 368 146 1379 8.4 *Notifiable 5th August, 1907, to 4th August, 1908. Notifiable permanently 29th March, 1912. † Notifiable permanently from 1st March, 1912. ‡ Poor Law Cases of this disease became notifiable on 1st January, 1909. Hospital Cases became notifiable on 1st May. 1911, and all cases became notifiable on 1st January, 1912. § Became notifiable 1st February, 1913. Table No. 41 Ward. Small Pox. Cholera. Plague. Diphtheria (Including Membranous Croup). Erysipelas. Scarlet Fever. Typhus Fever. Enteric Fever. Relapsing Fever. Continued Fever. Puerperal Fever. Cerebro-Spinal Meningitis. Poliomyelitis. Pulmonary Tuberculosis. Other forms of Tuberculosis. Incidence of Infectious Diseases.—The following Table, No. 41, shews the Incidence Rate per 1,000 of the population estimated to the middle of 1913, of infectious diseases notified during the year in each Ward and for the whole District:— (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) (13) (14) (15) (16) South Kilburn ... ... ... 2 .68 0.63 3.95 ... 0.07 ... ... ... 0.14 ... 352 1.19 Mid Kilburn ... ... ... 2.74 0.61 5.07 ... 0.13 ... ... 0.06 ... ... 3.08 178 North Kilburn ... ... ... 169 0.40 3.47 ... 0.16 ... ... 0.08 ... 0.16 1.21 0.48 Brondesbuiy Park ... ... ... 0.92 0.41 3.20 ... 0.30 ... ... ... ... ... 1.54 0.72 Kensal Rise ... ... ... 0.85 0.35 2.22 ... ... ... ... 0.07 0.07 ... 2.07 1.28 Harlesden ... ... ... 0 54 0.47 1.86 ... 0.12 ... ... ... ... ... 1.38 0.78 Stonebridge ... ... ... 1.43 0.45 3.54 ... 0.11 ... ... 0.17 ... ... 2.40 1.03 Roundwood ... ... ... 1.60 0.89 2.63 ... 006 ... ... 0.19 ... ... 2.56 0.64 Church End ... ... ... 2.00 1.28 479 ... 0.14 ... ... ... ... 007 2.86 0.85 Willesden Green ... ... ... 0.91 0.48 2.43 ... 0.06 ... ... 0.06 ... ... 2.01 060 Cricklewood ... ... ... 0.58 0.31 1.48 ... 0.10 ... ... 0.05 ... ... 191 047 Willesden U.D. ... ... ... 1.42 0.56 3.07 ... 0.10 ... ... 0.06 0.01 0.01 2.24 0.89 68 69 Scarlet Fever.—During the year 504 cases of this disease were notified, and of this number 446, or 88.5 per cent., were removed to Hospital. The following Table, No. 42, shews the number of cases notified, the number and percentage removed to Hospital, and the Incidence and Fatality rates each year since 1892:— Table No. 42. Year. No. of Cases notified. No. of Cases removed to Hospital. Percentage of Cases removed to Hospital. Incidence Rate. Cases per 1,000 population. Fatality Rate. Deaths per 1,000 cases. 1892 366 49 13.3 5.5 22 1893 589 107 18.1 8.5 25 1894 268 83 30.9 3.6 26 1895 392 243 61.9 4.9 43 1896 475 282 59.3 5.5 35 1897 510 320 62.7 5.4 21 1898 361 209 57.8 3.6 28 1899 414 220 53.1 3.9 38 1900 335 188 56.1 29 35 1901 553 265 47.9 4.9 21 1902 466 282 60.5 3.8 27 1903 502 393 78.2 3.8 22 1904 326 242 74.2 2.4 6 1905 397 328 82.6 2.8 13 1906 637 543 85.2 4.5 17 1907 641 547 85.3 4.4 30 1908 737 651 88.3 5.0 19 1909 638 556 87.1 4.4 25 1910 314 265 84.3 2.0 0 1911 326 226 69.3 2.1 15 1912 430 373 86.7 2.7 2 1913 504 446 88.5 3.1 14 Return Cases of Scarlet Fever.—A "return case" of scarlet fever may be defined as a case which occurs in the same household after a case of scarlet fever has been set free from isolation at hospital or at home, as the case may be. The latter case is called the "infecting case." The following Table, No. 43, gives certain particulars with regard to the occurrence of "return cases" since 1905: Table No. 43. Year. Notifications of Scarlet Fever. Infecting Cases. Return Cases. No. of Infecting Cases giving r ise to 1 Return Case. No. of Infecting Cases giving rise to 2 Return Cases. No. of Infecting Cases giving rise to 3 Return Cases. No. of Infecting Cases giving rise to 4 Return Cases. No. of Infecting Cases giving rise to 5 Return Cases. No. of Infecting Cases giving rise to 6 Return Cases. No. of Infecting Cases giving rise to 7 Return Cases. No. of additional cases occurring in houses secondary to Return Cases not necessarily themselves Return Cases. No. of Notifications. Incidence rate per 1,000 of Population. No. of Infecting Cases. Percentage of Cases notified. No. of Return Cases. Percentage of Cases notified. (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) (13) (14) (15) 1905 397 2.8 14 3.5 18 4.5 12 1 ... 1 ... ... ... * 1906 635 4.5 23 3.6 26 4.1 20 3 ... ... ... ... ... * 1907 641 4.4 27 4.2 28 4.4 26 1 ... ... ... ... ... * 1908 737 5.0 51 6.9 70 9.5 37 11 1 2 ... ... ... * 1909 638 4.4 56 8.7 66 10.3 48 7 ... 1 ... ... ... 12 1910 314 2.0 15 47 21 6.7 10 4 1 ... ... ... ... ... 1911 326 2.1 11 3.4 15 4.6 9 ... 2 ... ... ... ... 3 1912 430 2.6 12 2.7 16 3.7 9 2 1 ... ... ... ... ... 1913 504 3.1 18 3.6 26 5.2 15 2 ... ... ... ... 1 ... Totals 4624 3.4 227 4.9 286 6.2 186 31 5 4 ... ... 1 15 * Records incomplete. 71 The following Table, No. 44, shews the number of days during which the 18 infecting cases shewn in Table No. 43 were isolated in hospital or at home, and the number of days elapsing after release from isolation before the 26 "return cases" appearing in Table No. 43 occurred. Table No. 44. Initials of Infecting Cases. No. of days isolated. Initials of Return Cases. No. of days elapsing after release from isolation of infecting case before onset of illness of return case. F.A.M J. 97 F.A.T. 33 M.N. 77 M.E.N. 31 R.A.N. 44 F.W.G. 74 T.A.G. 25 D.S. 68 R.S. 7 A.N. 63 A.T. 13 D.S. or 60 L.S. 7 23 L.S. 47 W.C. 55 D.C. 50 E.V.B. 49 E.R. 15 E.C. 46 F.C. 10 A.D. 46 F.F. 28 R.F. 35 W.H. 45 F.H. 7 F.D. 44 R.D. 15 M.E.N. 42 G.S.N. 12 L.K. 40 D.K. 5 C.S. 39 G.D.S. 3 A.F. 35 N.F. 2 D.F. 3 B.F. 3 V.S. 3 R.S. 5 A.F. 6 R.F. 15 T. L.‡ * M.L. 17 H.P. † E.P. 38 All these cases were isolated in Hospital except the one marked ‡, which occurred in Germany—method of isolation not ascertained. *The infecting case suffered from scarlet fever in Germany—number of days isolated not ascertained. † The infecting case contracted scarlet fever whilst nursing in one of the M.A.B. Hospitals—number of days isolated not ascertained. 72 Multiple Cases of Scarlet Fever.—The following Table, No. 45, shews the number of scarlet fever cases notified from each house in which scarlet fever occurred in each year since 1910:— 73 TABLE No. 45. 1913. 1912 1911 1910 No. of Houses. Per cent, of Houses. No. of Cases. Per cent, of Cases. No. of Houses. Per cent, of Houses. No. of Cases. Per cent, of Cases. No. of Houses. Per cent, of Houses. No. of Cases. Per cent, of Cases. No. of Houses. Per cent, of Houses. No of Cases. Per cent, of Cases. Houses in which 1 case occurred 317 82.3 317 62.9 253 80.5 253 58.8 194 78.8 194 59.5 193 80.4 193 61.4 Houses in which 2 cases occurred 40 10.4 *80 15.9 34 10.8 68 15.8 35 14.2 70 21.5 30 12.5 60 19.1 „ 3 „ 15 3.9 **45 89 15 4.7 45 10.4 11 4.4 33 10.1 10 4.1 30 9.5 „ 4 „ 7 1.8 †28 5.6 6 1.9 24 5.5 3 1.2 12 3.7 5 2.0 20 6.3 „ 5 „ 3 8 15 29 2 .6 10 2.3 1 .4 5 l.5 1 .4 5 1.6 „6 „ 2 .5 12 2.4 1 3 6 1.3 2 .8 12 3.7 1 .4 6 1 .9 „ 7 „ 1 .3 ‡7 1.4 2 .6 14 3.2 ... ... ... ... ... ... ... ... „ 8 „ ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... „ 9 „ ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... „ 10 „ ... ... ... ... 1 3 10 2.3 ... ... ... ... ... ... ... ... Total 385 100 504 100 314 100 430 100 246 100 326 100 240 100 314 100 * Includes 4 primary cases with 1 return case each ** Includes 1 primary case and 1 secondary case with 1 return case. † Includes 1 primary case and 1 secondary case with 2 return cases; also 1 primary case with 2 return cases, and 1 return case the primary case of which was one of the return cases just mentioned. ‡ Includes 7 return cases. The primary case does not appear, as it was notified as suffering from Diphtheria, and found to have Scarlet Fever later when in Hospital. This accounts for 17 return cases. The remaining 9 return cases appear amongst houses in which only one case occurred, because in 5 instances the primary case occurred in 1912, and was counted in the 1912 return. In 3 instances the primary cases occurred whilst the patients were staying outside Willesden, and therefore do not appear at all. In one instance the family moved from one address in Willesden to another after the occurrence of the primary case and before the occurrence of the return case. § For footnotes on 1912 and 1911 cases see reports of these years 74 Diphtheria and Membranous Croup.—During the year 233 cases of this disease were notified, and 215, or 92.3 per cent., were treated in hospital. The following Table, No. 46, shews the number of cases notified, the number and percentage removed to hospital, and the incidence and fatality rates each year since 1892. Table No. 46. Year. No. of Cases notified. No. of Cases, removed to Hospital. Percentage of Cases removed to Hospital. Incidence Rate. Cases per 1,000 population. Fatality Rate. Deaths per 1,000 cases. 1892 145 14 9.6 2.1 127 1893 229 0 0.0 3.1 199 1894 129 8 6.2 1.7 126 1895 186 66 35.4 2.2 190 1896 173 51 29.4 2.1 169 1897 275 32 48.0 2.9 250 1898 335 217 64.7 3.3 204 1899 319 183 57.3 2.9 148 1900 226 120 53.1 1.9 124 1901 404 190 47.0 3.4 138 1902 440 222 50.4 3.5 122 1903 221 122 55.2 1.6 46 1904 353 290 82.1 2.6 54 1905 275 227 82.5 1.9 51 1906 286 222 77.6 2.0 57 1907 254 186 73.2 1.7 71 1908 215 175 81.3 1.4 65 1909 207 171 82.6 1.4 48 1910 166 142 85.5 1.1 66 1911 192 130 67.7 1.2 57 1912 222 191 86.0 1.4 45 1913 233 215 92 3 1.4 34 75 Enteric Fever.—During the year 18 cases were notified and 10, or 55.6 per cent., were removed to hospital. The following Table, No. 47, shews the number of cases notified, the number and percentage removed to hospital, and the incidence and fatality rates each year since 1892:— Table No. 47. Year. No. of Cases notified. No. of Cases removed no Hospital. Percentage of Cases removed to Hospital. Incidence Rate. Cases per 1,000 population. Fatality Rate. Deaths per 1,000 cases. 1892 28 3 10.7 0.42 214 1893 47 ... ... 0.66 191 1894 70 4 5.7 0.96 157 1895 69 13 18.8 0.87 174 1896 52 5 9.6 0.66 211 1897 1898 52 16 30.7 0.56 230 66 38 57.5 0.66 136 1899 79 32 40.5 0.73 128 1900 77 32 41.5 0.68 181 1901 57 7 12.2 0.49 175 1902 73 14 19.1 0.60 205 1903 45 16 35.5 0.34 290 1904 38 12 31.5 0.27 211 1905 41 26 63.4 0.29 293 1906 46 33 71.7 0.32 152 1907 28 14 50.0 0.19 143 1908 41 27 65.8 0.27 195 1909 41 34 82.9 0.27 146 1910 23 16 69.5 0.15 87 1911 13 9 69.2 0.08 308 1912 13 6 46.1 0.08 231 1913 18 10 55.6 0.10 222 76 Small Pox.—No case of Small Fox was notified during the year. The following Table, No. 48, shews the number of cases notified and the number and percentage removed to hospital each year since 1892:— Table No. 48. Year. No. of Cases notifed. No. of Cases removed to Hospital. Percentage removed to Hospital. 1892 5 3 60.0 1893 23 21 91.3 1894 21 21 100.0 1895 5 5 100.0 1896 2 2 100.0 1897 ... ... ... 1898 1 ... 00.0 1899 ... ... ... 1900 ... ... ... 1901 10 7 70.0 1902 88 88 100.0 1903 7 7 100.0 1904 12 12 100.0 1905 ... ... ... 1906 ... ... ... 1907 ... ... ... 1908 ... ... ... 1909 ... ... ... 1910 ... ... ... 1911 ... ... ... 1912 1 1 100.0 1913 ... ... ... Cerebro-Spinal Meningitis and Poliomyelitis.— Three cases (including one of posterior basic meningitis) of cerebro-spinal meningitis were notified during the year. All three died, the cause of death in one case being given as tuberculous meningitis. Two were treated at home and one in Willesden Infirmary. Three cases of anterior poliomyelitis were notified. All three recovered. Two cases were treated at home and one was removed to Paddington Green Children's Hospital, 38 days after the onset of 77 Administrative Action to Prevent the Spread of Notifiable Infectious Diseases.—An isolation hospital with 164 beds is provided by the Council for cases of scarlet fever, diphtheria, and enteric fever. In addition arrangements have been made to isolate in the Hospital, provided accommodation is available, cases of cerebro-spinal meningitis, poliomyelitis, and any other notifiable infectious diseases, except smallpox and tuberculosis. All cases of scarlet fever, diphtheria, enteric fever, cerebro-spinal meningitis and poliomyelitis are offered isolation there. In certain cases home isolation is permitted, and then visits are paid by the health visitors to ascertain that effective isolation is being maintained. During the year, as will be seen from Tables No. 42, 46 and 47, 88.5 per cent. of scarlet fever cases, 92.3 per cent. of diphtheria cases, and 55.6 per cent. of enteric fever cases were isolated in Hospital. Besides isolation, administrative action includes disinfection, search for suspicious cases amongst contacts, and exclusion of contacts from school. Disinfection is carried out by officers of the Health Department in every case of scarlet fever, diphtheria or enteric fever. This is not a measure, however, which is now regarded as of first importance in tending to prevent the spread of infectious disease, as it is recognised that infectious persons and not rooms or articles are the agencies by which disease is spread. In all instances in scarlet fever, diphtheria, and enteric fever, the health of the other members of the family is enquired into, and if suspicious, they are referred to a doctor or a swab or blood specimen, as the case may require, is taken for examination at the Council's Laboratory. Small Pox.—During the year it has not been necessary to adopt any measures against the spread of this disease, as no case occurred in Willesden. 78 The Council have now obtained powers for the compulsory acquisition of about ten acres of land in the adjoining district of Kingsbury for the erection of a small pox hospital. Vaccination Statistics.—The following Table, No. 49, gives statistics of the Vaccination Returns in this district since 1898:— Table No. 49. Years. No. of Births on Register of Vaccination Officer. Successfully Vaccinated. Insusceptible. Dead. Conscientious Objectors. Postponed by Doctor. Gone Away. Unvaccinated. Percentage of Survivors unprotected by Vaccination. Conscientious Objectors per 100 Children Vaccinated. Cases of Small Pox Notified (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) 1898 3,125 1,474 13 257 37 117 259 968 48 2.5 1 1899 3,375 1,615 24 345 63 76 91 1,161 46 3.9 0 1900 3,56o 1,704 8 253 106 56 268 1,165 48 6.'2 0 1901 3,670 2,351 12 304 120 40 280 563 30 5.1 10 1902 3,835 2,548 28 353 84 39 352 430 27 3.3 88 1903 4,070 2,687 27 346 84 52 322 552 27 3.1 7 1904 4,357 2,697 19 308 100 56 355 852 35 3.7 12 1905 4,135 2,448 15 286 75 64 297 950 36 3.0 0 1906 4,190 2,325 19 290 102 68 348 1,038 40 4.3 0 1907 4,170 2,314 15 269 157 61 329 1,025 40 6.7 0 1908 4,030 2,096 16 225 378 61 319 935 44 18.0 0 1909 4,066 2,015 17 244 495 61 319 915 47 24.6 0 1910 3,810 1,742 8 206 607 24 277 946 52 34.8 0 1911 3,865 1,592 16 254 748 46 261 948 56 47.0 0 1912 3,955 1,804 10 227 1,020 53 247 594 52 56.0 1 1913 3,920 1,659 0 202 1.108 63 265 623 55 66.8 0 Measles and Whooping Cough.—These diseases are not compulsorily notifiable, and cases come to the knowledge of the Health Department usually through Head Teachers. In this way 1,656 cases of measles and 520 of whooping cough were notified during 1913. Beyond the exclusion of children from school, as detailed in the report of the School Medical Officer, no special action is taken to deal with these cases. 79 No provision exists for the treatment of these diseases in hospital, although it is desirable that hospital treatment for the worst cases should be provided, for the following reasons:— (1) During the year 7 deaths occurred from scarlet fever, 8 from diphtheria, and 4 from enteric fever, for which diseases hospital accommodation is provided, while 69 deaths occurred from measles and 23 from whooping cough. (2) The death rate from scarlet fever, enteric fever, and diphtheria has declined during the past twenty years, since the provision of isolation hospitals, but in respect of measles and whooping cough the death rate has not diminished during the same period, and these diseases are still potent factors in the causation of deaths. (3) The after-complications of measles and whooping cough are much more serious than those of the three diseases mentioned above, for which hospital accommodation is provided, ear, eye and chest complications being especially much more common, frequently giving rise to some form of permanent disability. (4) When the conditions under which treatment in hospital is carried out are compared with the surroundings, the badly ventilated and over-heated atmosphere, and the lack of nursing facilities prevailing in many of the smaller tenements, little room is left for doubt that the provision of hospital accommodation from measles and whooping cough would be the means of saving the lives of many sufferers from these diseases. 80 Measles.—The following Table, No. 50, shews in each year since 1907 the number of cases coming under the notice of the Health Department, and the number of deaths occurring among these cases; the number of deaths occurring among unknown cases, and the probable number of these cases assuming the fatality rate to have been the same in each class:— Table No. 50. Year. Total No. of Cases known before death. Cases unknown prior to death. Percentage of all probable Cases coming to knowledge. Total. Cases. Deaths. Fatality Rate per cent. Deaths. Estimated No. of Cases. 1907 1,442 25 1.75 20 1,153 55 2,595 1908 1,678 26 1.55 29 1,871 47 3,549 1909 1,445 17 1.17 24 2,040 41 3,485 1910 1,757 13 0.74 17 2,297 43 4,054 1911 1.845 26 1.40 25 1,774 51 3,619 1012 1,665 17 1.02 18 1,763 48 3,428 1913 1,656 21 1.26 48 3,785 30 5,441 Totals 11,488 145 1.26 181 14,683 44 26,171 81 The following Table No. 51 shows the incidence of Mensles upon children definitely exposed to infection, distributed according to age and history of previous attack:- Table No. 51. CONTACTS STEAD NOT TO HAVE SUFFERED PREVIOUSLY. Age Periods. 1908. 1909. 1910. 1911. 1912. 1913. No. of Contacts in House. No. of Contacts 1 attacked. Percentage attacked. No. of Contacts in House. No. of Contacts attacked. Percentage attacked. No. of Contacts in House. No. of Contacts attacked. Percentage attacked. No. of Contacts in House. No. of Contacts attacked. Percentage attacked. No. of Contacts in House. No. of Contacts Attacked. Percentage attacked. No. of Contacts in House. No. of Contacts attacked. Percentage attacked. (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) (13) (14) (15) (16) (17) (18) (19) Years. 0-½ ... ... ... 73 6 8.2 49 6 12.2 52 6 11.5 78 14 17.9 43 8 18.6 ½.1 ... ... ... 41 39 95.1 80 52 65.0 88 70 79.5 108 66 61.1 67 44 59.7 1—2 ... ... ... ... ... ... 134 108 80 .6 108 96 88.9 132 102 77.3 93 78 83.9 2—3 ... ... ... ... ... ... 142 127 89.4 106 94 88.7 135 114 84.4 85 74 87.1 3-4 ... ... ... ... ... ... 160 141 88.1 163 150 92 0 175 39 79.4 112 89 79.5 0-4 256 202 78.9 454 339 74.7 565 434 78.8 517 416 80.5 628 435 69.3 400 293 73.3 4-5 34 28 82.3 72 53 73.6 101 86 85.1 109 96 88.1 162 117 72.2 79 63 79.7 5—6 20 14 70.0 48 30 62.5 57 41 71.9 47 39 83.0 46 34 73.9 36 17 47.2 6—7 11 8 72.7 35 24 68.5 36 26 722 21 9 42.9 50 33 66.0 22 7 31.8 7-8 15 11 733 35 14 40.0 46 27 58.7 29 13 44.8 45 25 55.5 27 11 40.7 8-9 11 5 45.4 27 11 40.8 26 10 38.4 24 13 54.2 26 13 50.0 16 5 31.3 9—10 10 5 50.0 19 7 36.8 22 10 45.4 17 7 41.2 36 6 16.7 21 6 28.6 10—15 25 2 8.0 35 7 20.0 82 19 23.1 59 9 15.3 54 6 11.1 24 5 20.8 15 and up 20 ... ... 73 4 5.5 75 1 1.3 26 3 11.5 38 5 13.1 11 1 9.1 402 275 68.4 798 489 61.3 1010 654 64.7 849 605 71.3 1085 674 62.1 636 408 64.2 82 Table No. 51—continued. CONTACTS STATED TO HAVE SUFFERED PREVIOUSLY. Age Periods. 1908. 1909. 1910. 1911. 1912. 1913. No. of Contacts in House. No. of Contacts attacked. Percentage attacked. No. of Contacts in House. No. of Contacts attacked. Percentage attacked. No. of Contacts in House. No. of Contacts attacked. Percentage attacked. No. of Contacts in House. No. of Contacts attacked. Percentage attacked. No. of Contacts in House. No. of Contacts attacked. Percentage attacked. No. of Contacts in House. No. of Contacts attacked. Percentage attacked. (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) (13) (14) (15) (16) (17) (18) (19) Years 0-½ ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... 1 ... ... ½-1 ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... 1—2 ... ... ... ... ... ... 3 1 33.3 3 1 33.3 2 ... ... 2 ... ... 2-3 ... ... ... ... ... ... 5 ... ... 10 1 10.0 4 ... ... 5 3 60.0 3—4 ... ... ... ... ... ... 12 2 16.6 20 5 25.0 21 ... ... 6 1 16.7 0—4 63 2 3 .2 46 5 10.9 22 3 11.6 33 7 21.2 27 ... ... 14 4 28 6 4-5 33 4 12.1 34 2 5 9 26 4 15.3 42 4 9.5 33 8 24.2 24 0 ... 5—6 40 2 5 0 39 1 2.6 34 1 2.9 42 2 4.8 40 1 2.5 39 3 7.7 6—7 55 2 3.6 66 1 1.5 62 ... ... 65 1 1.3 47 1 2.1 61 2 3.3 7-8 62 2 3.2 105 ... ... 94 3 3.2 111 3 2.7 102 3 2.9 71 0 ... 8—9 57 ... ... 125 6 4.8 121 1 0.8 123 3 2.4 113 7 6.2 79 3 3.8 9-10 69 2 2.9 139 1 0.7 134 ... ... 120 ... ... 165 ... ... 99 4 4.0 10—15 280 1 0.3 466 3 0.6 579 5 0.8 574 1 0.2 597 4 0 6 405 4 1.0 15 and up 1122 3 0.2 1735 ... ... 2078 1 0.0 2126 ... ... 2649 4 0.1 1653 0 ... Totals 1781 18 1.0 2755 19 0.7 3150 18 0.6 3236 21 0.6 3773 28 07 2445 20 0.8 83 D.—PREVALENCE OF, AND CONTROL OVER, TUBERCULOSIS Notifications.—On 1st February, 1913, all forms of tuberculosis became notifiable by Order of the Local Government Board. Previous to that date only pulmonary tuberculosis was notifiable. The following Table, No. 52, shews the number of notifications received during the year ending 27th December, 1913:— Table No. 55. No. of notifications of pulmonary tuberculosis received between 28th December, 1912, and 31st January, 1913 7.1 No. of notifications of all forms of tuberculosis as received from 1st February to 27th December, 1913, both dates inclusive— On Form A., i.e., from medical practitioners of cases not previously notified 572 On Form B, i.e., from School Medical Inspectors of cases not previously notified by them 35 On Form C., i.e., from Medical Officers of Poor Law Institutions and Sanatoria of cases previously notified and admitted to these institutions 102 On Form D., i.e., from Medical Officers of Poor Law Institutions and Sanatoria of cases previously notified and discharged from these institutions 91 Total number of notifications received for the 52 weekending 27th December, 1913 871 84 A distinction has to be drawn between the number of notifications received and the actual number of persons affected with tuberculosis. Tuberculosis differs from the other notifiable diseases in the fact that it is in most cases essentially chronic, and so the liability to multiple notification of any case is increased. It will also be apparent from the above Table that certain cases may be notified four limes at least, by the medical practitioner, by the school medical inspector, and by the superintendent of a poor law institution or a sanatorium on two occasions. In addition it may be notified by more than one private practitioner. During the year the actual number of persons notified as suffering with tuberculosis was 514, the percentage of multiple notifications being 41.18. The follow ing Table, No. 53, shews the number of notifications and the number of new cases each year since 1909. Table No. 53. Year. No. of notifications received. No. of new cases to which notifications refer. Pulmonary. Other forms. Pulmonary. Other forms. Total. * 1909 (calendar year) 196 ... 107 ... 107 1910 („ „) 140 ... 61 ... 61 **1911 ( „ ) 241 ... 210 ... 230 † 1912 (52 weeks) 851 ... 487 ... 487 ‡ 1913 („ „) 693 181 368 146 514 Total 2121 181 1253 146 1399 *Poor Law Cases of Pulmonary Tuberculosis notifiable from 1st January, 1909 **Hospital „ „ „ „ „ „ 1st May, 1911 †All „ „ „ „ „ „ 1st January, 1912 ‡All Cases of all forms of „ „ „ 1st February, 1913 The 368 new cases of pulmonary tuberculosis notified in 1913 include 6 in which the lung disease was associated with disease in other organs: glands 3, abdomen 2, miliary 1. 85 Localisation of Disease in Age and Sex Groups.— The following Table, No. 54, shews the localisation of the disease according to the age and sex groups, of the 514 new cases notified during the 52 weeks ending 27th December, 1913. Table No. 54. Age. Lungs. Bones or Joints. Glands. Brain or Meninges. Abdomen. Other or several Organs. Total. Male Female Male Female Male Female Male Female Male Female Male Female Male F'ml'e 0—1 1 ... ... 1 1 ... ... 1 2 ... ... ... 4 2 1—2 1 3 ... 1 ... ... ... ... ... 1 1 ... 2 5 2-5 5 2 1 2 4 2 ... 1 1 1 ... ... 11 8 5—15 29 30 16 9 18 11 2 1 2 2 7 2 74 55 15—25 29 40 12 7 3 6 ... ... ... 2 4 ... 48 55 25—45 91 74 1 3 2 9 ... ... ... ... 2 5 96 91 45—65 30 21 ... ... ... ... ... ... ... ... 3 ... 33 21 Over 65 2 4 1 1 ... ... ... ... ... ... 1 ... 4 5 Total 188 174 31 24 28 28 2 3 5 6 18 7 272 242 86 Occupations.—The following Table, No. 55, shews the occupations of the 514 new cases of tuberculosis notified during the year 1913:— Table No. 55. Domestic Employment (including Laundry Workers) 131 School Children (119), Students (3) 122 No Occupation 54 Shop-keepers (including Assistants) 39 Office Workers 28 Engaged in Transport 27 Not Ascertained 20 Labourers 14 Indoor Trades 14 Iron Workers 14 Dressmakers, Milliners, Tailors 12 Public Service 10 Miscellaneous Occupations 10 Professional 8 Factory Workers 7 Printers, Compositors, Music Engravers 4 514 87 Ward Distribution.—The following Table, No. 56, shews the notified cases of Tuberculosis allocated to each Ward in each year since 1909:— Table No. 56. Wards. 1909 1910 1911 1912 1913 Pulmonary. Pulmonary. Pulmonary. Pulmonary. Pulmonary. Other Forms. South Kilburn 23 15 41 67 50 17 Mid. Kilburn 15 8 23 56 45 26 North Kilburn 2 1 6 32 15 6 Brondesbury Park 3 2 10 23 15 7 Kensal Rise 4 2 33 41 29 18 Harlesden 6 3 17 69 23 13 Stonebridge 21† 14* 24** 56 42‡ 18‡ Round wood 9 6 29 37 40 10 Church End 11 7 15 36 40 12 Willesden Green 11 2 16 33 33 10 Cricklewood 2 1 16 37 36 9 Total 107 61 230 487 368 146 514 † includes 7 with address "Infirmary" only. * Includes 6 with address "Infirmary" only. ** Includes 3 with address "Infirmary" only. ‡ Includes 2 with address "Infirmary" only. 88 Of the total number of 1,399 cases of tuberculosis notified since January 1st, 15)09, as shown in Table No. 53, 720 remained under observation at the end of the year 1913. The following Table, No. 57, shews the distribution of these 720 cases in the various Wards of the district:— Table No. 57. Wards. Localization of Disease. Total. Lungs. Bones or Joints. Glands Brain or Meninges. Abdomen Other or Several Organs 1. South Kilburn 89 2 6 ... 1 4 102 2. Mid Kilburn 62 7 6 2 2 6 85 3. North Kilburn 24 1 4 ... ... ... 29 4. Brondesburv Park 25 1 3 ... ... 3 32 5. Kensal Rise 62 7 9 ... 2 3 83 6. Harlesden 54 4 3 ... 3 ... 64 7. Stonebridge *80 ‡9 5 ... ... 5 99 8. Round wood 60 5 2 ... ... ... 67 9. Church End 49 6 5 ... ... ... 60 10. Willesden Green 43 2 3 ... ... 5 53 11. Cricklewood 37 2 3 ... ... 2 44 Unknown § 2 ... ... ... ... ... 2 Total. 587 46 40 2 8 28 720 * 15 of these in Infirmary—no other address known. ‡3„„„„„„„„ § 2 notified from Napsbury Asylum. Administrative Action With Regard to Tuberculosis—Visitation.—On receipt of the notification of a case of tuberculosis, a health visitor visits the house. During the year the health visitors paid 531 primary visits and 1,471 subsequent visits, making a total of \isits and revisits of 2,002. 89 Relationship Between Date of Notification and Onset of Tuberculosis.—In the course of their visits the health visitors made enquiries into this point, and the following Table, No. 58, gives the results:— Table No. 58. No. of cases. Within I month of onset 69 After I month but within 3 months of onset 74 „ 3 months „ „ 6 „ „ „ 49 „ 6 „ „ „ 12 „ „ „ 57 „ 1 year of onset 209 No information available 56 514 The figures given above refer to the history as given by the patient, or in the case of a child the parent. In reality, they show the relationship between the date of notification and the period when symptoms of ill-health first attracted the patient's attention. There is little doubt, however, that the date of onset is much more antecedent to the date of notification than would appear from the above Table, as the disease is insidious and of very gradual onset in the majority of cases. Family History.—This was investigated in 461 instances. In 217, or 47 per cent., a history of the disease in one or more near relatives was obtained. Sleeping Accommodation.—The following Table, No. 59, shews the sleeping arrangements of 433 cases in respect of which this information was obtained. Table No. 59. In Room. In Bed. Patient slept alone 144 250 In same Room. In same Bed. Patient slept with 1 other 160 163 „„„ 2 others 97 18 „„„ 3 „ 25 2 „„„ 4 „ 4 ... „„„5 „ 3 ... G 90 In only 144 of these cases in which the patient slept alone in a separate room can the sleeping accommodation be said to be entirely satisfactory. In 250 cases in which the patient had a separate bed the condition may be said still to be satisfactory. In all other cases, namely, 183 out of 433, or 42.3 per cent., the sleeping accommodation was not satisfactory, in so far as it involved a definite risk to those sharing the same bed. Housing Accommodation.—At the time of notification two patients were living in common lodging houses and one in an institution. 318 lived in tenement houses, and 109 lived in self-contained flats or separate houses, and no information was obtained in 63 cases. The following Table, No. 60, gives the housing accommodation and the number of persons per room as regards the 430 cases in respect of which information is available:— Table No. 60. Size of House. No. of Tuberculosis Cases occupying houses of size shewn. No. of Persons in these houses. Average No of Persons per room. 1 room 19 46 2.42 2 rooms 53 227 2.14 3 „ 160 783 1.63 4 „ 96 467 1.21 5„ 41 221 1.07 6 „ 38 241 1.05 7 „ and over 23 141 .87 From the above Table, No. 60, it will be noted that the smaller the house in which a tuberculosis patient lives the greater the chance of infection of others, as shewn by the greater average number of persons per room. Health of Contacts.—In connection with the enquiries made by health visitors, the health of those associated with 91 the notified case is investigated, and as a result 36 persons were referred for examination to their medical attendant under the scheme provided by the Council. The actual number of contacts so examined was 32, five of whom were found to be affected with tuberculosis. In five cases the diagnosis was doubtful, and these were referred for further examination to the County Tuberculosis Officer. Disinfection, Cleanliness, Disposal of Discharges. —Disinfection is carried out only in cases where the house is dirty and disinfection appears desirable. The Health Visitors endeavour to secure a constant state of cleanliness in the home which is essentially important in connection with the spread of tuberculosis. In 24 cases notified to the Health. Department and visited by the Health Visitors, the method of disposal of discharges, i.e., sputum, etc., was considered unsatisfactory, but instruction and subsequent visitation effected the necessary remedy. Treatment.—This area as far as the treatment of tuberculosis is concerned, is under the control of the Middlesex County Council. During the year the arrangements to be made for the treatment of persons suffering from tuberculosis in Willesden were not completed. 92 E.—INVESTIGATION OF OTHER DISEASES. Meteorological Observations.—The following Tables, Nos. 61 and 62, give the results of the meteorological observations for 1913, and for the 11 years 1902-1912 inclusive:— 93 TABLE NO. 61.—METEOROLOGICAL OBSERVATIONS. Taken at the Hospital, Dog Lane, Neasden. Readings at 9.0 a.m. daily. Altitude of ground at Meteorological Station, 97.64 O.D. Altitude of Rim of Rain Gauge, 102.36 O.D. Month. TEMPERATURE shewn in degrees Fahrenheit Mean degree of Humidity. Rainfall in inches. Number of days on which Rain was measured. Number of Hours of bright Sunshine. No. of hours of bright Sunshine recorded at Greenwich. of the Air. of the Earth at a depth of 4 feet. Highest. Lowest. Range. Mean of all Highest. Mean of all Lowest. Max. Min. (1) (2) (3) (4) (5) 6) (7) (8) (9) (10) (11) (12) (13) January 51.50 23.50 28.00 45.74 35.48 47.50 45.0O 84° 2.49 15 53.6 63.8 February 55 50 24.00 31.50 45.97 34.85 45.00 44.00 81° 0.79 13 46.7 58.1 March 58.50 25.50 33.00 51.79 36.20 45.50 44.00 85° 1.91 18 89.7 89.8 April 70.50 25.00 45.50 54.20 39.51 45.00 46.00 77° 2.64 17 108.2 136.6 May 89.00 32.50 56.50 64.95 44.88 49.00 46.00 74° 1.60 12 203.2 188.0 June 84.25 40.50 43.75 69.09 49.56 54 00 49.75 66° 0.27 6 201.5 189.6 July 76.50 23.25 53.25 67.82 49.17 55.00 54.00 76° 0.37 12 107.7 120.0 August 85.00 40.00 45.00 72.04 51.72 57.00 55.00 77° 0.31 5 141.2 1320 September 78.50 39.00 39.50 67.35 49.35 56.75 54.00 81° 1.74 8 123.0 123.8 October 72.50 30.00 42.50 60.05 41.79 55.75 54.00 84° 2.83 11 80.7 137.3 November 65.50 26.00 39.50 55.80 36.03 54.00 51.00 83° 1.08 6 65.8 69.8 December 55.75 26.00 29.75 50.44 35.50 51 00 48.50 82° 0.67 4 39.5 185 Means 70.25 29.60 40.64 58.77 42.00 51.29 49.27 79° ... ... ... ... Totals ... ... ... ... ... ... ... ... 16.70 127 1260.8 1327.3 94 TABLE NO. 62.—METEOROLOGICAL OBSERVATIONS. II YEARS, 1902-1912 INCLUSIVE. Month. TEMPERATURE Shown in degrees Fahrenheit. Mean degree of Humidity. Mean Rainfall in Inches. Mean No. of Days on which Rain was Measured. Of the Air. Of the earth at a depth of 4-ft Highest. Lowest. Mean Monthly Range. Mean Monthly Highest. Mean Monthly Lowest. Maximum Minimum (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) January 60.5 1906 l4.0 1906 34.6 44.0 32.9 46.52 44.29 88° 1.77 11 February 57.9 1903 10.7 1902 34.7 45.4 33.4 44.43 43.23 88° 1.35 11 March 69.0 1907 11.0 1909 38.4 48.2 34.6 44.43 43.18 82° 2.05 14 April 71.7 1909 15.0 1906 41.8 54.9 35.2 46.09 44.11 76° 1.40 10 May 82.0 1909 17.0 1906 46.5 61.7 42.2 49.46 46.16 73° 1.85 12 June 82.5 1911 24.0 1906 42.2 66.8 47.4 53.26 49.75 73° 3.04 13 July 92.0 1911 37.2 1905 39.6 72.5 51.9 56.58 53.18 71° 2.23 11 August 97.0 1911 25.5 1905 41.8 70.2 51.1 57.52 56.35 74° 2.58 13 September 92.0 1906 26.5 1905 43.0 64.8 47.1 57.43 55.86 77° 1.68 9 October 79.0 1908 10.0 1905 38.0 57.9 42.9 55.81 53.31 84° 2.73 15 November 64.5 1908 11.5 1905 34.6 48.8 35.9 53.20 49.52 88° 2.15 12 December 58.0 1908 10.5 1908 33.9 45.5 35.6 49.27 46.70 89° 2.42 15 Means 75.51 17.74 39.1 56.7 40.8 51.17 48.80 80° ... ... Totals ... ... ... ... ... ... ... ... 25.25 146 95 Prevalence of Certain Diseases.—There are no means at present of gauging the prevalence of disease, other than notifiable disease, except by the death rates, and even this method is not reliable as the fatality rates vary in different diseases, and again, in the same disease from time to time. It is to be hoped, however, that when the Nationial Insurance Act statistics come to be published, some clearer light will be thrown on the incidence of the various diseases on the insured and general populations. The following Table, No. 63, shows the number of deaths during the past ten years from the diseases specified:— 96 Table No. 63. Disease. 1904. 1905. 1906. 1907. 1908. 1909. 1910. 1911. 1912. 1913. All forms of Respiratory Diseases including Bronchitis and Pneumonia 260 268 234 331 276 288 258 272 282 285 Bronchitis, including Laryngitis and Acute and Chronic Bronchitis 123 112 82 142 111 128 122 108 130 134 Pneumonia (all forms) 128 147 130 176 154 140 113 144 126 126 All forms of Tuberculosis, including Tuberculosis of the Lungs 187 194 188 188 153 196 174 179 188 165 Tuberculosis of the Lungs 141 146 139 138 120 131 116 132 148 136 Heart Disease, including Pericarditis, Endocarditis and Angina Pectoris "5 132 126 111 142 149 136 155 147 160 Rheumatic Fever and Rheumatism of the Heart 9 12 11 7 5 11 5 4 7 12 Diarrhoea and Enteritis, including Gastritis 177 121 167 60 78 62 49 196 34 73 Cancer 111 115 111 108 112 120 154 115 154 159 Influenza 14 25 24 33 38 36 23 16 17 24 Rickets 4 4 3 1 3 2 — 2 2 3 97 The following Table, No. 64, shows the death rates per 1,000 of the population during the past 10 years from the causes specified:— Table No. 64. 1904 1905 1906 1907 1908 1909 1910 1911 1912 ] All forms of Respiratory Diseases (including Bronchitis and Pneumonia) 1.932 1.903 1.651 2.292 1.851 1.918 1.683 1.737 1763 1741 Bronchitis (including Laryngitis and acute and Chronic Bronchitis) .914 .795 .578 .983 .744 .852 .796 .689 .813 .819 Pneumonia (all forms) .951 1.044 .917 1.219 1.033 .932 .737 .919 .788 .769 All forms of Tuberculosis (including Tuberculosis of the Lungs) 1.389 1.378 1.326 1.302 1.026 1.305 1.135 1.143 1.175 1.008 Tuberculosis of the Lungs 1.048 1.037 .980 .955 .805 .872 756 .843 .925 .831 Heart Diseases (including Pericarditis, Endocarditis, and Angina Pectoris) .854 .937 .889 .768 .952 .992 .887 .989 .919 .977 Rheumatic Fever and Rheumatism of the Heart .066 .085 .077 .048 .033 .073 .032 .025 .043 .073 Diarrhoea and Enteritis (including Gastritis) 1.315 .859 1.178 .415 .523 .412 .319 1.251 .212 .446 Cancer .825 .817 .783 .748 .751 .799 1.004 .734 .963 .971 Influenza .104 .177 .169 .228 .254 .239 .150 .102 .106 .146 Rickets .029 .028 .021 .006 .020 .013 ... .012 .012 .018 98 The above Tables, Nos. 63 and 64, show (1) That the decline in all forms of respiratory diseases still continues. (2) That all forms of tuberculosis, including tuberculosis of the lungs, are on the decline 'in Willesden. (3) That comparing 1913 with 1912 there is a slight vance in the combined death rates from heart disease and rheumatism. (4) That there is a large increase in the death rate from diarrhoea and enteritis. In 1912 the death rate from these diseases was .212, the lowest ever recorded in Willesden. This year, 1913, it is .446. (5) The death rate from cancer continues to increase. 99 Death Rates from Certain Infectious Diseases.— The following Table, No. 65, shews the death rates per 100,000 of the population from scarlet fever, diphtheria, enteric fever, measles and whooping cough since 1875 :— Table No. 65. Year. Scarlet Fever. Diphtheria. Enteric Fever. Measles. Whooping Cough. 1 (2) (3) (4) (5) (6) 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 II 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 10 65 8 49 24 1899 15 42 10 23 3° 1900 10 24 12 45 26 1901 10 45 9 7 49 1902 10 43 12 54 20 1903 9 7 7 65 52 1904 1 14 6 33 7 1905 4 10 9 36 47 1906 8 11 5 17 17 1907 13 12 3 31 51 1908 9 9 5 36 8 1909 11 7 4 27 22 1910 0 7 1 20 17 1911 3 7 3 33 54 1912 1 6 2 22 18 1913 4 5 2 42 14 * Infectious Diseases Notification compulsory in Willesden from this year. The foregoing Table, No. 65, shows that the death rates from scarlet fever, diphtheria, and enteric fever are gradually diminishing, and that during 1913 only 11 deaths per 100,000 of the population occurred from these causes. 100 Deaths from Tuberculosis.—The following Table, No. 66, shows the total number of deaths from tuberculosis (all forms), and from tuberculosis of the lungs, together with the death rates per 1,000 in Willesden as compared with England and Wales generally:— Table No. 66. Year. Tuberculosis (All Forms). Tuberculosis of the Lungs. Willesden. Total number of Deaths. Willesden. Death Rate per1t,000 of the population. England and Wales. Death Kate per 1,000 of the population. Willesden. Total number of Deaths. Willesden. Death Rate per t,ooo of the population. England and Wales. Death Rate per 1,000 of the population. 1875 53 2. 92 2-99 37 2.03 2.20 1876 50 2.71 2.85 24 1.30 2.11 1877 56 2.87 2.84 32 1.64 2.07 1878 61 2.95 2.82 40 1.94 2.11 1879 57 2.54 2.76 35 1.56 2.02 1880 82 3.25 2.70 36 1. 42 1.86 1881 † 2.53 44 1.6o 1.82 1882 56 1.72 2.58 27 .83 1.85 1883 84 2.40 2.59 56 1.'60 1.88 1884 61 1.68 2.57 35 .96 1.82 1885 77 1.99 2.43 55 1.42 1.77 1886 78 1.76 2.47 35 .79 1.73 1887 83 1.69 2.28 47 .95 1.61 1888 82 1.54 2.22 47 .87 1.56 1889 82 1.43 2.26 55 .96 1.57 1890 109 1.77 2.37 73 1.18 1.68 1891 100 1.6o 2.30 67 1.07 1.59 1892 83 1.26 2.13 65 .98 1.46 1893 † ... 2.14 73 1. 05 1.46 1894 † ... 1.97 72 ..98 1.38 1895 † ... 2.06 96 1.08 1.39 1896 † ... 1.89 88 1.02 1.30 1897 † ... 1.92 86 .92 1.33 1898 † ... 1.91 100 1.00 1.31 1899 † ... 1.90 135 1.25 1.33 1900 133 1.15 1.90 103 .89 1.33 1901 143 1.23 1.80 96 .81 1.26 1902 160 1.30 1.74 111 .909 1.23 1903 165 1.27 1.74 113 .873 1.20 1904 188 1.39 1.77 141 1..04 1.23 1905 194 1.37 1.63 146 1.037 1.14 1906 188 1.32 1.64 139 .981 1.15 1907 188 1.30 1 60 138 .955 1.14 1908 153 1..02 1.58 120 •805 1.11 1909 196 1.30 1.53 131 .872 1.09 1910 174 1.13 1.43 116 .757 1.01 1911 179 1.14 1.'46 132 .843 1.08 1912 188 1.17 ... 148 •925 ... 1913 165 1.00 ... 136 .831 ... No record. 101 It will be seen from the above Table, No. 66, that the death rates from tuberculosis in England and Wales and in Willesden have gradually fallen during the past forty years and that this year it is the lowest on record in Willesden. If this Table, No. 66, is compared with Tables Nos. 67 and 68 it will be seen that the improvement during 1913 is mainly under '25 years. The following Table, No. 67, shows the age distribution of deaths from Tuberculosis in Willesden since 1877 :— Table No. 67. Year. 0 to 1. 1 to 5. 5 to 15. 15 to 25. 25 to 65. 65 and upwards. Total. 1877 13 11 2 3 25 2 56 1878 10 12 1 4 31 3 61 1879 13 11 1 6 26 ... 57 1880 24 16 5 6 30 1 82 *1881 ... ... ... ... ... ... ... 1882 13 14 3 8 17 1 56 1883 . 18 10 3 13 40 ... 84 1884 16 12 5 7 21 ... 61 1885 15 10 6 10 35 1 77 1886 27 20 3 2 25 1 78 1887 23 17 6 3 32 2 83 1888 19 14 5 5 37 2 82 1889 21 6 6 4 45 ... 82 1890 20 18 2 11 56 2 109 1891 21 8 14 12 44 1 100 1892 11 9 7 11 42 3 83 *1893 ... ... ... ... ... ... ... *1894 ... ... ... ... ... ... ... *1895 ... ... ... ... ... ... ... *1896 ... ... ... ... ... ... ... *1897 ... ... ... ... ... ... ... *1898 ... ... ... ... ... ... ... *1899 ... ... ... ... ... ... ... 1900 13 14 11 24 70 1 133 1901 20 24 15 11 67 6 143 1902 19 22 14 20 81 4 160 1903 17 22 10 24 88 4 165 1904 19 20 16 16 111 6 188 1905 10 20 16 24 117 7 194 1906 22 19 13 35 97 2 188 1907 22 20 13 28 98 7 188 1908 11 14 11 21 87 9 153 1909 16 30 16 24 106 4 196 1910 17 25 14 20 91 7 174 1911 14 25 11 21 107 1 179 1912 8 13 12 32 113 10 188 1913 6 14 10 20 104 11 165 * Records incomplete. 102 The following Table, No. 68, shows the age distribution of deaths from Tuberculosis in Willesden, since 1907: — Table No. 68. Year. 0 to 1 1 to 2 2 to 5 5 to 10 10 to 15 '5 to 20 20 to 25 25 to 35 35 to 45 45 to 55 55 to 65 65 to 75 75 to 85 85 and up- Total. 1907 22 10 10 5 8 11 17 36 21 30 11 5 2 ... 188 1908 11 9 5 7 4 5 16 23 31 18 15 7 2 ... 153 1909 16 15 15 10 6 7 17 43 32 21 10 3 1 ... 196 1910 17 13 12 4 10 14 6 34 26 22 9 7 ... ... 174 1911 14 14 11 4 7 9 12 44 28 18 17 1 ... ... 179 1912 8 7 6 5 7 17 15 46 27 27 13 7 3 ... 188 1913 6 5 9 6 4 11 9 39 31 24 10 9 2 ... 165 An examination of the two foregoing Tables, Nos. 67 and 68, relating to the distribution of deaths from tuberculosis in Willesden at the different age groups shows that the number of deaths from this cause under the age of fifteen has diminished, but above this age the number of deaths has not declined generally. It would therefore appear that the improvement in the general death rate from tuberculosis has been one which has improved the death rate especially in the early years of life. 103 The following' Table, No. 69, shows the tuberculosis deaths and death rates per 1,000 of the population in Wards in Willesden since 1910:— Table No. 69. Wards. 1910. 1911. 1912. 1913- Total No. of Deaths Death Rate per 1,000 Total No. of Deaths Death Kate per 1,000 Total No. of Deaths Death Rate per 1,000 Total No. of Deaths Death Rate per 1,000 South Kilburn 22 1.47 24 1.72 19 1.35 30 2.11 Mid. Kilburn 25 1 73 21 1.45 18 1.21 30 2.05 North Kilburn 9 .74 7 .58 12 .98 13 1.05 Brondesbury Park 9 .93 15 1.60 9 .94 3 .30 Kensal Rise 9 .64 14 1.01 10 .73 13 .93 Harlesden 20 1.38 13 .84 23 1.42 11 .66 Stonebridge 12 .82 23 1.37 30 1.80 10* .57 Round wood 17 1.18 21 1.39 23 1.51 13 .83 Church End 23 1.76 18 1.34 13 .93 13 .92 Willesden Green 14 .93 7 .45 15 .96 19 1.15 Cricklewood 13 .75 15 .86 16 .87 10 0.53 Ward unknown 1 ... 1 ... ... ... ... ... Willesden U.D 174 1.13 179 1.14 188 1.17 165 1.'00 * Includes one address " Infirmary" only. 104 Cancer Deaths.—The following Table, No. 70, shows the sex distribution and total number of deaths from Cancer, together with the death rates per 1,000 of the population in Willesden and England and Wales since 1904:— Table No. 70. Year. Willesden Cancer Deaths. Willesden Cancer Death Rate per 1,000 of the population. England and Wales Cancer Death Rate per 1,000 of the population. Males. Females. Total. 1904 42 69 111 .825 .879 1905 41 74 115 .817 .889 1906 46 65 111 .783 .922 1907 36 72 108 .748 .914 1908 50 62 112 .751 .931 1909 38 82 120 .799 .962 1910 64 90 154 1.005 .967 1911 39 76 115 .734 0.99 1912 56 98 154 .963 ... 1913 65 94 159 .971 ... The above Table, No. 70, shows that from year to year there is a big preponderance of deaths of females from Cancer over deaths of males from the same cause. The table also shows that the death rate from Cancer in Willesden, as also in England and Wales, is on the increase. 105 The following Table, No. 71, shows the age distribution of deaths from Cancer in Willesden since 1877:— Table No. 71. Year. 0 to1. 1to 5. 5 to 15. 15 to 25. 25 to 65. 65 and upwards. Total. 1877 ... ... ... ... 7 1 8 1878 ... ... ... ... 14 2 16 1879 ... ... ... ... 7 3 10 1880 ... ... ... i 5 2 8 *1881 ... ... ... ... ... ... ... 1882 ... ... ... ... 9 5 14 1883 ... ... ... ... 7 2 10 1884 ... ... ... ... 15 5 20 1885 ... ... ... ... 16 5 21 1886 ... ... ... ... 13 5 18 1887 ... ... ... ... 9 3 12 1888 ... ... ... 3 29 4 36 1889 ... ... ... ... 15 10 25 1890 ... ... ... 2 15 12 29 1891 ... ... ... ... 22 14 36 1892 ... ... ... ... 27 8 35 *1893 ... ... ... ... ... ... ... *1894 ... ... ... ... ... ... ... *1895 ... ... ... ... ... ... ... *1896 ... ... ... ... ... ... ... *1897 ... ... ... ... ... ... ... *1898 ... ... ... ... ... ... ... *l899 ... ... ... ... ... ... ... 1900 ... ... ... 1 53 19 73 1901 ... ... ... 2 57 28 87 1902 ... ... ... 3 59 34 97 1903 ... ... ... 2 67 38 107 1904 ... ... ... 3 73 35 111 1905 ... ... ... ... 71 44 115 19O6 ... ... 1 1 73 36 111 1907 ... ... ... 2 67 39 108 1908 ... ... ... 1 85 26 112 1909 ... ... ... 1 66 51 120 1910 ... ... 2 1 92 59 154 1911 ... 1 ... 1 71 42 115 1912 ... 1 1 ... 85 67 154 1913 ... 1 2 2 92 62 159 * Records incomplete. 106 The following" Table, No. 72, shows the age distribution of deaths from Cancer in Willesden since 1907:— Table No. 72. Year. 0 to 1 1 to 2 2 to 5 5 to 10 10 to 15 15 to 20 20 to 25 25 to 35 35 to 45 45 to 55 55 to 65 65 to 75 75 to 85 85 and up. Total. 1907 ... ... ... ... ... 1 1 3 9 22 33 26 12 1 108 1908 ... ... ... ... ... 1 ... 4 20 16 45 16 8 2 112 1909 ... ... 2 ... ... ... 1 5 10 18 33 29 20 2 120 1910 ... ... ... 2 ... 1 ... 2 12 34 44 39 20 ... 154 1011 ... 1 ... ... ... ... 1 7 10 28 26 28 12 2 115 1912 ... ... 1 ... 1 ... ... 5 19 25 36 45 20 2 154 1913 ... ... 1 2 ... 1 1 3 14 39 36 39 21 2 159 The foregoing Tables, Nos. 71 and 72 show that the main increase in deaths from Cancer in Willesden has occurred over the age of 65, there being 62 deaths from this cause reported for this age period in 1913, as against a similar figure of 19 for the year 1900. The following Table, No. 73, shows the Cancer Deaths and Death Rates per 1,000 of the population in Wards in Willesden since 1910:— Table No. 73. Wards. 1910. 1911. 1912. 1913. Total No. of Deaths Death Rate per 1,000 Total No. of Deaths Death Rate per 1,000 Total No. of Deaths Death Rate per 1,000 Total N'o. of Deaths Death Rate per 1,000 South Kilburn 22 1.47 9 .64 11 .78 20 1.41 Mid. Kilburn 16 1.ll 15 1 .04 19 12.8 19 1.30 North Kilburn 12 .99 7 .58 13 10.7 9 0 .72 Brondesbury Park 14 1.45 8 .85 14 1.46 13 1.34 Kensal Rise 8 .57 9 .65 6 0.43 16 1.14 Harlesden 13 .89 11 .71 6 0.37 20 1.20 Stonebridge 12 .83 * 12 .65 16 0.96 12 0.68 Roundwood 20 1.39 10 .66 19 1.25 16 1.02 Church End 14 1.07 5 .37 13 .93 6 0.42 Willesden Green 13 0.87 11 .71 13 .83 13 0.79 Cricklewood 10 0.57 18 1.04 24 1.31 15 0.79 Willesden U.D 154 1.00 115 0.73 154 0.96 159 0.97 * Includes one with address " Infirmary" only. 107 F—MEANS FOR PREVENTING MORTALITY IN CHILDBIRTH AND INFANCY. Midwives Act.—The Midwives Act, 1902, is administered in Willesden by the Middlesex County Council. 108 Infant Mortality.—The following Table, No. 74, shows the number of deaths of infants under one year of age from all causes, and from diarrhoea and enteritis respectively together with the infantile mortality rates per 1,000 births from 1875:— Table No. 74. Year. No. of deaths of Infants under 1 year of age from all causes. No. of Deaths of Infants under 1 year of age from Diarrhoea and Enteritis. Infantile Mortality. Rate per 1,000 births. 1875 131 27 162 1876 120 * 149 1877 113 7 140 1878 167 19 201 1879 118 9 130 1880 168 24 173 1881 ... * ... 1882 202 27 186 1883 196 24 167 1884 203 36 164 1885 235 28 172 1886 265 28 164 1887 264 40 159 1888 290 32 170 1889 276 36 143 1890 287 34 158 1891 273 25 132 1892 333 30 159 1893 345 35 153 1894 299 * 132 1895 373 * 150 1896 460 * 167 1897 444 * 155 1898 427 * 136 1899 537 * 159 1900 497 124 139 1901 495 110 131 1902 436 100 130 1903 509 81 123 1904 509 135 115 1905 490 100 117 1906 493 133 115 1907 451 49 106 1908 397 62 97 1909 391 51 94 1910 313 39 80 1911 495 158 124 1912 328 22 80 1913 325 45 80 *Records incomplete. 109 Table No. 74 shows that the infantile mortality rate for 1913 was again as low as any on record for the district, being 80, a figure reached twice before, viz., in 1910 and 1912. The following Table, No. 75, shews the infantile mortality rate in Wards in Willesden since 1910:— Table No. 75. Wards. 1910 1911 1912 1913 (1) (2) (3) (4) (5) South Kilburn 91 134 131 106 Mid. Kilburn 83 147 83 75 North Kilburn 77 83 75 56 Brondesbury Park 76 86 60 33 Kensal Rise 63 92 93 51 Harlesden 73 95 68 57 Stonebridge 83 165 73 118 Roundwood 85 177 80 102 Church End 83 119 85 117 Willesden Green 100 108 68 68 Cricklewood 52 93 42 63 Willesden U. D. 80 124 80 80 Table No. 75 shews that the infantile mortality rates are not uniform throughout the Wards. In South Kilburn, Stonebridge, Roundwood and Church End the infantile mortality is high. The housing conditions in these districts are not so good as other parts of the district, and this, no doubt, is one of the causes of the high rate. The matter calls for further consideration and attention. 110 Infantile Mortality of Legitimate Infants.—The following Table, No. 76, shows the number of deaths of legitimate infants and infantile mortality rate per 1,000 legitimate births in Willesden since 1904:— Table No. 76. year. No. of deaths of legitimate infants under one year of age. No. of deaths of legitimate infants under one year of age, per 1,000 legitimate births. 1904 459 106 1905 440 107 1906 471 114 1907 424 103 1908 359 90 1909 361 89 1910 293 77 1911 452 117 1912 306 78 1913 306 79 Infantile Mortality of Illegitimate Infants.—The following Table, No. 77, shews the number of deaths of illegitimate infants and infantile mortality rate per 1,000 illegitimate births in Willesden since 1904:— Table No. 77. YEAR. No. of deaths of illegitimate infants under one year. No. of deaths of illegitimate infants under one year per 1,000 illegitimate births. 1904 50 463 1905 50 467 1906 22 176 1907 27 216 1908 38 404 1909 30 231 1910 20 82 1911 43 312 1912 22 169 1913 19 204 111 Tables No. 76 and 77 shew that the proportion of infantile death amongst illegitimate children is very much greater than amongst legitimate infants. Duning last year the rates were 204 and 7'J per 1,000 illegitimate and legitimate births respectively. An illegitimate child at birth is in no way less healthy than a legitimate one, and this enormous death rate is due largely to lack of maternal care and nursing. Causes and Prevention of Infantile Mortality.— During the year 1913 there were 325 deaths amongst infants under one year of age. Of these, 128 died under the age of four weeks, and their deaths are attributed in the majority of cases to some congenital defect or weakness. Doubtless many of these lives might have been saved with a good system of antenatal work amongst the expectant mothers. Of the remaining 197 who died between the ages of one month and one year, the majority may be classified as "avoidable deaths." Amongst the commonest causes of avoidable Infantile Deaths are:— I. Want of maternal nursing; improper feeding. II. Want of knowledge of infant care. III. Want of medical treatment. I. Want of Maternal Nursing; Improper Feeding. It may be said that the greatest single cause of infantile deaths is lack of maternal nursing. Not only are all intestinal disorders far commoner amongst artificially fed children, but many other diseases are indirectly due to the same cause. The chief reasons for hand feeding are— (a) Insufficiency or poorness of the maternal milk— rare, and usually due to malnutrition of the mother. 112 (b) Need of the mother returning to work. This occurs with both married and unmarried women, but more especially with the latter. Even under the very best conditions, a baby artificially fed has not as good a chance as one brought up on mother's milk; but in the poorer cases the difficulties are still greater. Children kept at home may, with care, be brought up by hand for a moderate sum. But when, in addition, payment has to be made for supervision the case is different. Illegitimate children are often boarded out at such small fees that artificial feeding with cheap foodstuffs is inevitable, and this is doubtless the main cause of the great excess of the Infantile Mortality rate of illegitimate children over legitimate. The problems raised are wide and difficult. It must always be remembered that the question of Infantile Mortality really involves not merely the stated loss of life, but also the permanent impairment of physique which the same causes have produced amongst many of the children who survive. II. Want of Knowledge of Infant Care. The second great factor in Infantile Mortality is want of knowledge of Infant care, more especially on the part of the mother. Many children lose their lives or health every year simply through the parents' lack of elementary knowledge of infant feeding and care. A great deal is already being done in the way of education by the Health Visitors in connection with the Notification of Births Act, 1907. 113 Notification of Births Act, 1907.—The Notification of Births Act was adopted in this District in 1908, and the following Table, No. 78, shews the number of births notified in each complete year since its adoption, together with certain other particulars :— Table No. 78. 1909 1910 1911 1912 1913 Total number of births notified in each complete year since its adoption 3748 3390 3694 3671 3550 (a) Attended by doctors 2220 2072 2266 2324 2273 (b) Attended by midwives 1528 1318 1428 1347 1277 Number of stillbirths notified in each of the same years 95 79 88 92 104 Number of births registered in each of the same years 4172 3923 4001 4075 4037 Births are usually visited after the expiry of ten days, and a booklet on Infant Care and Feeding (Appendix B) is given and explained to the mother. Approximately half the births are visited. Revisits are made in cases in which the condition of the child on the first visit appears in any way unsatisfactory. The work of revisiting is being gradually extended, 976 revisits having been made during 1913, as compared with 180 during 1912. Nevertheless, the fact that 325 infants died during the year 1913 under one year of age, shews that there is still much work to be done, and to do the work thoroughly more time than is at present possible should be given to it. "The Babies' Welcome," Lower Place.—In addition to periodic visiting by the Health Visitors, there has been at work in this district since April, 1911, an Infant Consultation, known as "The Babies' Welcome." It is situated in one of the poorest localities, and one of the Health Visitors attends once a week from 2 to 4.30 p.m. Like the visits paid under the Notification of Births Act, 1907, 114 it is educative in character. The mothers are given short talks on baby care, and are shewn practically as far as possible what to do for the baby. An extension of this work on approved lines is urgently necessary. The following is the report of the Health Visitor on the work during 1913:— "There is not much to add to last year's report. The number of mothers who attend regularly is steadily increasing, several of the women bringing friends who need advice for their babies. At the end of the year the Welcome was moved from No. 19, Barrets Green Road to No. 51 in the same road, but this change has in no way affected the attendance. The knitting club is still in existence, and most of the babies now wear vests knitted for them by their mothers. "Much more could be done for the mothers at the weekly meetings with the assistance of an additional worker. With the increased attendance it is almost impossible for one person to carry on the work efficiently. M. MacColl. " Summer Diarrhcea.—In order to prevent as much as possible deaths of infants from summer diarrhæa, which is the main cause of infants' deaths during the third quarter of the year, booklets on Infant Care and Feeding, above referred to, are forwarded to the parents of all children born during the summer months, if summer diarrhoea is prevalent, and within the last few years the Inspectors of Nuisances have made rapid surveys of the district, for the detection and abatement of nuisances in districts in which infant mortality specially prevails during hot weather. In addition to these measures, it would be well if lit were possible to undertake an organised system of visiting, during the summer months, of infants born, say, six months previously. Such a measure would, I am sure, still further reduce the number of deaths from this very potent cause. 115 Infantile Death Inquiries.—In this district, in addition to the above measures taken for the prevention of infantile mortality, inquiries are also made into the deaths of children under one year of age, with a view to ascertaining the prevalent causes predisposing to such deaths. The number of infant death inquiries during 1913 was 300, out of a total of 325 deaths. III. Want of Medical Treatment. This, likewise, is a potent factor in Infantile Mortality. In many cases the treatment which would save the child's life is not obtained on account of the parent not having money to attend a private doctor, or time to attend hospitals. Efficient private advice and treatment would often cause considerable expense, and although such treatment can be obtained at hospitals, obtaining it is not always an easy matter. Distances are considerable, and fares a serious consideration, and the loss of time, and, therefore, money to a working woman, makes attendance at a hospital frequently a last resource. Health authorities have established excellent treatment clinics under their own control, where diseases of infants are dealt with. Similar provision requires to be made in Willesden in the interests of child life, and the matter should receive the attention of the Health Committee at an early date. 116 G. Vital Statistics of the District. Marriages.—The following Table, No. 79, shews the total number of marriages in Willesden, and the marriage rate in Willesden as compared with England and Wales generally since 1900: Table No. 79. Year. Willesrlen. Total No. of Marriages Willesden. Marriage- Rate per 1000 of the population. England and Wales. Marriage-Rate per 1000 of the population. 1900 622 10.8 l6.0 1901 658 11.2 15.9 1902 760 12.4 15.9 1903 834 12.9 15.6 1904 840 12.4 15.2 1905 891 12.7 15.3 1906 926 13.1 15.6 1907 949 13.1 15.8 1908 971 13.0 14.9 1909 1036 13.8 I4.6 1910 994 13.0 15.0 1911 1047 I3.4 15.2 1912 1147 14.3 ... 1913 1153 14.1 ... 117 Births.—The following Table, No. 80, shews the total number of births in Willesden and the birth rate in Willesden as compared with England and Wales generally since 1875 :— Table No. 8o. Year. Willesden. Total No. of Births. Willesden. Birth Rate per 1,000 of the population. England and Wales Birth Rate per 1,000 of the population Willesden. Birth Rate per 1,000 of female population between 15-45 years. England and Wales. Birth Rate per 1,000 of female population between 15-45 years. 1875 805 44.7 35.4 ... ... 1876 805 43.4 36.3 ... 157.5 1877 803 41.1 36.0 ... 155.9 1878 830 40.2 35.6 ... 154.5 1879 903 37 .6 34.7 ... 150.5 1880 967 38.3 34.2 ... 148. 3 1881 960 34.4 33.9 ... 147.0 1882 1083 33.3 33. 8 ... 145.8 1883 1168 33.3 33.5 ... I44.1 1884 1233 34.1 33.6 ... 144.2 1885 1366 35.6 32. 9 ... 140.7 1886 1584 35.7 32. 8 ... 140.2 1887 1659 33.8 31.9 ... 135.5 1888 1701 32.1 31. 2 ... 132.3 1889 1929 33. 7 31.1 ... 131.7 1890 1811 29.4 30.2 ... 127..6 1891 2059 33.1 31.4 ... 132.1 1892 2085 31.7 30.4 ... 127.3 1893 2256 32.5 30.7 ... 127.9 1894 2264 30.7 29. 6 ... 122.4 1895 2469 31.2 30.3 ... 124.8 1896 2749 32.2 29.6 ... 121.5 1897 2887 31.0 29.6 ... 120.7 1898 3142 31.5 29.3 ... 118.9 1899 3375 31. 5 29.1 ... 117.7 1900 3559 31. 2 28.7 ... 115.6 1901 3762 32.2 28.5 ... 114.2 1902 3916 31.3 28.5 ... 114.1 1903 4132 31 .9 28 .4 ... 113.8 1904 4421 32.9 27. 9 116.5 111. 8 1905 4201 29. 8 27.2 107.4 108. 9 1906 4272 30.1 27.o 107.6 108.3 1907 4247 29.4 26.3 105.8 105.1 1908 4095 27.5 26.5 98.8 106.1 1909 4172 27.8 25 .6 99.9 103.2 1910 3923 25.6 24.8 95.0 100.6 1911 4001 25.6 24.4 94.9 97.8 1912 4075 25.5 23.8 94.6 ... 1913 4037 247 ... 91.6 ... 118 The foregoing Table, No. 80, shews that in the six years 1875-81, the birth rate in Willesden fell by 10.3 per 1,000 of the population, and that in the thirty-one years, 1881-1913, the birth rate still further fell by 9.7 per 1,000. The lowest birth rate on record lis recorded during the year now under review. The figures at our disposal shew that the birth rate in Willesden, calculated per 1,000 of the female population of child-bearing age, us likewise steadily diminishing. It should also be noted that while the birth rate in Willesden has fallen by 20.0 per 1,000 during the 38 years, 1875-1913, that for England and Wales has fallen during the 37 years, 1875-1912 by 11.6 per 1,000. The following Table, No. 81, shews the births and birth rates per 1,000 of the population in each Ward in Willesden siince 1910:— Table No. 81. Wards. 1910, 1911. 1912. 1913. Total No. of Births. Birth Rate. Total No. of Births. Birth Rate. Total No. of Births. Birth Rate. Total No. of Births. Birth Rate. South Kilburn 396 26.5 425 30.5 419 29.77 405 28.58 Mid. Kilburn 375 26.1 380 26.4 397 26.77 361 24.73 North Kilburn 207 17.1 217 18.2 226 18.63 216 1 7.45 Brondesbury Park 197 20.5 175 18.7 200 20.92 182 18.79 Kensal Rise 333 24.0 357 25.9 355 25.94 315 22.56 Harlesden 411 28.4 398 25.8 383 23.74 421 25.36 Stonebridge 447 31.2 462 27.7 517 31.14 5.15 29.47 Roundwood 435 30.3 424 28.1 443 29.21 401 25.75 Church End 397 30.5 404 30.1 388 28.04 369 26.38 Willesden Green 399 26.8 426 27.9 413 26.46 440 26.82 Cricklewood 326 18.8 323 18.7 334 18.28 351 18.64 Willesden U.D. 3923 25.6 4001* 25.6 4075 25.5 4037† 24.7 * Including Io births (Wards unknown) received from Register General at end of year. † ,, 6l ,, ,, ,, ,, ,, 119 Illegitimate Births.—The following Table, No. 82, shews the number of illegitimate births and the illegitimate birth rates per 1,000 total births in Willesden since 1882:— Table No. 82. Year. No. of Illegitimate Births. Illegitimate Birth-Rate per 1000 Total Births. Year. No. of Illegitimate Births. Illegitimate Birth-Rate per 1000 Total Births. 1882 28 25.58 1898 63 20.05 1883 25 21.40 1899 56 16.59 1884 23 18.65 1900 56 15.73 1885 43 31.47 1901 48 I2.75 + 1886 ... ... 1902 48 12.25 1887 53 31.94 1903 87 21.05 1888 31 18.22 1904 108 24.42 1889 57 29.54 1905 107 25.47 1890 42 23.19 1906 125 29.26 1891 34 16.51 1907 125 29.43 1892 54 25.89 1908 94 22.95 1893 45 19 .94 1909 130 31.16 1894 39 17 .22 1910 122 31.09 189S 54 21 .87 1911 138 34.49 1896 59 21 .46 1912 130 31.90 1897 55 19.05 1913 132 32.60 + No record. 120 Deaths.—The following Table, No. 83, shews the total number of deaths in Willesden and the death rates in Willesden as compared with England and Wales generally since 1875 :— Table No. 83. Year. Willesden. Total No of Deaths. Willesden. Death Kate per 1,000 of the population. England & Wales Death Rate per 1,000 of the population. Year. Willesden. Total No. of Deaths. Willesden. Death Rate per 1 000 of the population. England & Wales. Death Rate per l,oco of the population. 1875 385 21.4 227 1895 1.143 14-5 187 1876 401 21.7 20-9 1896 1,312 153 171 1877 346 17.7 2° 3 1897 1.343 14 4 ■7'4 1878 441 21.4 21. 1898 1,388 13 9 i7'5 1879 376 16.8 20.7 1899 1.643 15-2 18*2 1880 471 18.7 20.5 1900 1.577 13-6 182 1881 490 17.6 18.9 1901 1,529 13-2 i6'9 1882 587 18.1I 19.6 1902 1,709 ■3'9 163 1883 538 15.4 19.6 1903 1.655 128 15 *5 1884 530 14 .7 19.7 1904 1.645 12 2 163 1885 632 i6.2 19.2 190s 1.744 I2-4 15 "3 1886 685 15.5 19.5 1906 1,672 11 8 i5"5 1887 701 14.3 19 .1 1907 1,704 II-8 151 1888 835 15 .8 18 .1 1908 1,623 io-9 I4'8 1889 686 12.0 l8.2 1909 1,678 11 2 14-6 1890 882 14.4 19.5 1910 1,506 98 i3'5 1891 860 13.8 20.2 1911 1,848 11-8 14-6 1892 945 14.4 19.0 1912 1,603 10 0 13*3 1893 1,070 15.5 19.2 1913 1,677 io*2 1894 917 13.2 16.6 121 The following Table, No. 84, shews the total deaths in Willesden at different age periods since 1877:— Table No. 84. Year. 0 to 1 1 to 5 5 to 15 15 to 25 25 to 65 65 and up. At all ages. 1877 113 75 15 10 90 43 346 1S78 167 79 13 9 125 48 441 1879 118 50 20 15 109 64 376 1880 168 109 27 18 103 46 471 1881 ... ... ... ... ... ... 490 1852 202 145 26 18 120 76 587 1883 196 89 31 25 142 55 538 1884 203 87 31 20 122 67 53° 1885 235 105 20 22 173 77 632 1886 265 163 15 13 145 84 685 1887 264 123 44 12 163 95 701 1888 290 175 42 26 194 108 835 1889 276 85 27 15 180 103 686 1890 287 170 42 24 222 137 882 1891 273 110 42 30 260 145 860 1892 333 152 37 33 251 139 945 1893 345 130 51 34 304 150 1014 1894 299 160 44 32 255 127 917 1895 373 132 48 38 295 198 1084 1896 460 240 46 28 280 156 1210 1897 444 160 63 37 302 167 1173 1898 427 199 69 26 276 200 1197 1899 537 178 64 46 383 240 1448 1900 497 190 67 71 476 276 1577 1901 476 203 95 57 437 270 1538 1902 536 200 72 58 501 348 1715 1903 509 260 69 58 484 286 l666 1904 509 187 66 58 522 303 1645 1905 490 212 66 63 563 350 1744 1906 493 189 59 67 518 346 1672 1907 451 251 57 59 526 360 1704 1908 397 175 69 60 545 377 1623 1909 391 167 70 63 589 398 1678 1910 313 155 68 59 535 376 1506 1911 495 241 61 64 584 403 1848 1912 328 126 56 78 564 451 1603 1913 325 171 66 63 592 460 1677 122 The following Table No. 85, shews the total deaths in Willesden at different age periods since 1904 :— Table No. 85. Year. 0 to 1 1 to 2 2 to 5 5 to 10 10 to 15 15 to 20 20 to 25 25 to 35 35 to 45 45 to 55 55 10 65 65 to 75 75 10 85 85 and up. Total. 1904 509 101 86 43 23 26 32 102 120 124 176 148 121 34 1645 1905 490 120 92 46 20 30 33 102 132 153 176 184 136 30 1744 1906 493 104 85 33 26 34 33 86 132 130 170 174 141 31 1672 1907 451 137 114 38 19 22 37 93 121 153 159 196 133 31 1704 1908 397 92 83 42 27 21 39 83 132 143 187 194 145 38 1623 1909 391 90 77 48 22 26 37 107 150 162 170 207 150 41 1678 1910 313 94 61 43 25 31 28 92 116 153 174 188 145 43 1506 1911 495 144 97 38 23 28 36 111 137 151 185 197 153 53 1848 1912 328 60 66 35 21 40 38 101 128 144 191 235 172 44 1603 1913 325 94 77 43 23 34 29 99 135 165 193 238 175 47 1677 The following Table, No. 86, shews the death rates at different age periods per 1,000 of the population at these age periods in Willesden and England and Wales since 1904 :— 123 Table No. 86. 0 to 5 5 to 10 10 to 15 15 to 20 20 to 25 25 to 35 35 to 45 45 to 55 55 to 65 65 to 75 75 to 85 85 and up Year. Willesden England & Wales Willesden England Wales Willesden England & Wales Willesden England & Wales Willesden England & Wales Willesden England & Wales Willesden England & Wales Willesden England & Wales Willesden England & Wales Willesden England & Wales Willesden England & Wales Willesden England & Wales 1904 39.5 51.8 2.9 3.5 1.8 2.1 2.1 3.0 2.5 3.8 4.0 5.3 6.7 8.8 119 15.1 29.7 29.3 52.3 62.5 126.8 131.9 217.9 284.7 1905 38.1 44.9 3.0 3.4 1.5 2.1 2.3 2.9 2.4 3.7 3.8 5.2 7.0 8.6 14.0 14.9 28.4 28.7 62.2 61.6 136.3 127.7 184.0 286.6 1906 36.8 45.6 2.1 3.5 1.9 2.1 2.6 2.9 2.4 3.6 3.2 5.1 7.0 8.7 11.9 14.9 27.2 29.2 58.4 62.1 140.3 129.8 189.0 301.1 1907 37.2 41.2 2.4 3.4 1.4 2.0 1.7 2.8 2.6 3.5 3.4 5.1 6.3 8.7 13.7 15.0 25.0 29.8 64.6 65.0 129.9 132.6 185.6 303.9 1908 29.3 40.9 2.6 3.2 1.9 1.9 1.5 2.6 2.7 3.4 2.9 4.9 6.6 8.3 12.4 14.6 28.4 28.9 61.9 63.8 I37.2 131.1 2197 295.2 1909 28.4 37.1 2.9 3.3 1.5 1.9 1.9 2.7 2.5 3.3 3.7 4.8 7.5 8.3 13.9 14.8 25.7 29.3 65.6 67.4 140.8 136.2 235.6 310.8 1910 23.3 34.2 2.6 2.9 1.7 1.8 2.2 2.5 1.9 3.1 3.1 4.5 5.7 7.8 12.9 13.9 25.7 27.3 58.3 62.3 133.4 124.7 241.6 285.4 1911 40.8 43.7 2.2 3.4 1.6 2.1 2.1 2.9 2.7 3.5 3.8 4.5 6.1 7.3 10.4 13.0 22.8 26.1 45.7 56.4 106.3 124.2 254.8 246.2 1912 24.6 ... 2.0 ... 1.4 ... 3.0 ... 2.8 ... 3.4 ... 5.6 ... 9.6 ... 23.1 ... 53.3 ... 117.0 ... 207.5 ... 1913 26.3 ... 2.4 ... 1.5 ... 2.5 ... 2.1 ... 3.3 ... 5.7 ... 10.8 ... 23.4 ... 52.8 ... 116.3 ... 216.6 ... 124 The foregoing Tables, Nos. 83, 84, 85 and 86, would appear to shew that the saving of life, as illustrated by the low death rates of 1913 and immediately preceding years is mainly accomplished under the age of five years while there is a definite tendency for the death rates to increase in recent years over the age of 65 years. WILLESDEN URBAN DISTRICT EDUCATION COMMITTEE. the SIXTH ANNUAL REPORT OF THE MEDICAL OFFICER FOR THE YEAR ENDING 31ST DECEMBER, 1913. BY GEORGE F. BUCHAX, m.d. d.p.h., Medical Officer. 126 MEMBERS OF THE EDUCATION COMMITTEE, Mr. Councillor J. ANDREWS. Mr. Councillor J. E. BALL. *Mr. Councillor W. BLACKLOCK. *Mr. Councillor W. M. BOLTON. *Mr. Councillor P. BOND. Mr. Councillor S. D. BUMSTEAD. Mr. Councillor E. T. BUTTERISS. *Mr. Councillor J. COMBER. *Mr. Councillor H. H. GRIMWOOD, (Vice-Chairman of the Education Committee.) *Mr. Councillor G. H. HISCOCKS. (Chairman of the Education Committee.) Mr. Councillor J. E. HILL. Mr. Councillor W. A. HILL. *Mr. Councillor C. W. HOGG. Mr. Councillor E. LANE. Mr. Councillor H. ROGERS. *Mr. Councillor The Rev. R. SILBY. Mr. Councillor H. DAVEY TURNER. Mr. Councillor W. WAY. *Mr. J. CASH, J.P. *Mr. W. J. DOWDELL. *Mr. E. W. ESSELL, (Chairman of the Children's Care Committee.) *Miss M. A. LUPTON. *Mr. G. OSWIN. Mr. H. E. SCOTT. *Mr. E. J. TOZER. Mr. A. E. WARREN. *Mr. D. T. WILLIAMS. * Member of the Children's Care Committee. GEORGE F. BUCHAN, Medical Officer. 127 Municipal Offices, Dyne Road, Kilburn, N.W., 3rd June, 1914. To the Chairman and Members of the Willesden Urban District Education Committee. I beg to present herewith the Sixth Annual Report of the School Medical Officer for the year ending December 31st, 1913. During the year 9,343 children were medically examined. Amongst this number there were found to be 813 suffering with malnutrition, 1,108 with dirty, nitty or verminous conditions of the scalp or body, 130 with ringworm, or other skin diseases, 2,112 with four or more carious teeth, 3,(547 with diseases of the nose and throat including enlarged tonsils and adenoids, and 930 with defective vision. A Ringworm Clinic was established during the year, and the Committee have before them schemes for the treatment of eyes and teeth. The large proportion of children noted to be suffering from malnutrition merits the consideration of the Committee. The feeding of school children and open air teaching, associated with proper schemes of medical treatment are the essential remedies. Little progress has been made during the year with the establishment of an Open Air School in Willesden, mainly on account of delay in connection with Government Departments. But it is hoped that the Committee will be in a position at an early date to make the necessary provision 128 in this matter as there is a long list of children awaiting admission to a school of this kind. During the year under review the part-time system of medical inspection and the relationship of the School Attendance Department to the School Medical Service have been adversely criticised by the Board of Education, and in consequence, a deduction of £213 3s. 4d. has been made in the Medical Grant for the year ending July 31st, 1913. I am, Your obedient servant, GEORGE F. BUCHAN, School Medical Officer. 129 School Accommodation.—There were 32 public elementary schools, with 77 departments and accommodation for 25,241 children in Willesden at 31st December, 1913. In addition, there were two mentally defective schools and one physically defective school, with accommodation for 180 children, maintained by the Local Education Authority. Certain details of construction with regard to these schools are to be found in the Annual Report of the School Medical Officer for 1909. Co-relation of School Medical and Public Health Services.—This matter is dealt with in my Annual Report for 1912. Complete co-relation exists as the Medical Officer of Health is also School Medical Officer. Organisation and Supervision of Medical Inspection.—The organisation and supervision of "Medical Inspection during 1913 follow ed the same lines as in 1912, and will be found described in my Annual Report for that year. In June, 1913, a visit was made by Dr. Langdon, one of the Medical Inspectors of the Board of Education, and a letter dated 18th September, 1913, was received from the Board adversely criticising the arrangements on three main grounds:— (i) The employment of part-time medical inspectors. (ii) The unsatisfactory "following up" of cases found to be defective at routine medical inspection. (iiii) The need for closer association between the School Attendance Department and the School Medical Service. I dealt with the subject matter of this letter fully in a report to the Education Committee dated 3rd October, 1913, 130 and appearing as Appendix C to the present report. Before the end of the year 1913 the Education Committee passed a resolution dealing with (i) and (ii) above and recommending the appointment of two whole time Assistant Medical Officers in lieu of the part-time Medical Inspectors and the appointment of two additional Health Visitors. The questions involved in (iii) above were still under discussion by the Committee at the end of the year. Disturbance or School Arrangements by Medical Inspection.— This matter is dealt with fully as regards each school in my Annual Report for 1912. In respect of schools now in process of erection the Education Committee is making special provision for Medical Inspection so that school arrangements are disturbed to the least possible extent and Medical Inspection is conducted under the best possible curcumstances. Attendance ok Parents at Medical Inspection.— The methods adopted to secure the attendance of parents are described in my Annual Report for 1912, continued in operation during 1913. During the year 9,343 children were examined, and in 5,024 cases, or 53.77 per cent., the parents attended the examination. Notice to Parents or Defective Conditions in Children Requiring Treatment.—In all cases in which defective conditions requiring treatment are discovered during medical inspection, the parents are informed, either verbally, or by letter, of the fact. Subsequently, visits are paid by Health Visitors to the homes of cases more urgently requiring treatment, to ascertain to what extent treatment has been sought. Such cases are also re-examined at the schools by the Assistant School Medical Officers. During the year, 1,199 children were referred for visitation and in 1,062 cases remedial measures of some kind were stated to have been undertaken by the parents. 131 Extent and Scope of Medical Inspection.—The total number of children on the roll in the Public Elementary Schools in Willesden at 31st December, 1913, was 23,830, and during the year 9,343 were medically inspected. The medical inspection of school children included inspection and examination under the following heads:— Clothing and Footgear. Height and W eight. Nutrition. Skin and Scalp. Teeth, Nose and Throat, Neck Glands. Eves, Vision. Ears, Hearing. Speech. Mental Condition. Heart and Circulation. Lungs. Nervous system. Deformities and other defects. Infectious Illness History. 132 Visits to Schools and Departments.—Each school or department is visited weekly by the Assistant School Medical Officer who is attached to it, and the following' Table, No. 87, shews the days and hours of such visits during 1913:— Table No. 87. School and Department. No. on roll 31-12-13 Assistant School Medical Officer. Day. Hour. Acton Lane .Mixed 306 Dr. R. T. Jones Monday 2 p.m. Do. Infants 183 do. do. do. Bridge Road (Temp.) Mixed 412 Dr. J. Mechan Wednesday Do. Infants do. do. Carlton Vale Girls 216 Dr. J. Snowman Monday 2.15 p.m. Do. Infants 327 do. do. do. Chamberlayne Wood Road. Boys 399 Dr. W. W. Walker Thursday 2.30 p.m. Do. Girls 422 Dr. T. Smurthwaite Wednesday 2 p.m. Do. Infants 310 do. do. do. Christ Church Boys Dr. J. F. Parr Tuesday 3 p.m Do. Girls 149 do. do. do. Do. Infants 114 do. do. do. College Road Mixed 260 Dr. W. W. Walker Do. Infants do. Dudden Hill Boys 466 Dr. H. S. Faber do. 2 p.m. Do. Girls 470 do. do. do. Do. Infants 397 Dr. J. Mechan Wednesday do. Furness Road Senior 407 Dr. G. W. K. Skene do. 2.15 p.m. Do. Junior 426 do. Monday 9.15 a.m. Apl.-Oct. 2.15 p.m. Nov.-Mar. Do. Infants 436 Dr. C. K. Rawes Tuesday 2.30 p.m. Gibbons Road Mixed 763 Dr. C. W. Cooks Tuesday and 3 p.m. Thursday Do. Infants 387 Dr. W. Bell Thursday 2 30 p.m. Gordon Memorial Boys 323 Dr. A. L. Saunders Monday do. Do. Girls 338 do. do. do. Do. Infants 265 do. do. do. Harlesden C. of E— Boys 170 Dr. o. Roberts Tuesday 2 p.m. Do. Girls 152 do. do. do. Do. Infants 142 do. do. do. Harlesden R.C. Mixed 137 Dr. A. Bindley Wednesday 3.30 p.m. Do. Infants 91 do. do. do. Holy Trinity Boys 155 Dr. H. Knox Thursday 3 p.m. Do. Girls 154 do. Wednesday do. Do. Infants 180 do. do. do. Keble Memorial Boys 197 Dr. C. E. Armitage Tuesday 2.20 p.m. Do. Girls 247 do. do. do. Do. Infants 130 do. do. do. Kensal Rise Boys 404 Dr. j. Spurway Monday 3.30 p.m. Do. Girls 412 do. do. 2.45 p.m Do. Infants 423 do. do. 2.15 p.m. Kilburn Park Rd. Girls 164 Dr. J. Macfarlane Thursday 2 p.m. Do. Infants 182 do. do. do. 133 School and Department. No. on Roll at 31-12-13 Assistant School Medical Officer. Day. Hour. Leopold Road Boys 450 Dr. G. H.Mitchell Wednesday 9.35 a.m. Do. Girls 452 Dr. T. Wilson Thursday 3.30 p.m. Do. Infants 425 Dr. J. S. Crone Tuesday 2.30 p.m. Lower Place Boys 216 Dr. J. D. G. Evans Thursday 2 p.m. Do. Girls 208 do. do. do. Do.(Disraeli Rd.)Infants 196 do do. do. Mora Road Boys 333 Dr. W. N. Soden Tuesday (alternate) 2.30 p.m. Do. Girls 325 do. do. do. Do. Infants 288 do. Thursday do. Neasden National Mixed 128 Dr. J. Mechan Wednesday 3.45 p.m. Do. Infants 43 do. do. do. Oldfield Road Boys 398 Dr. F.J. Beresford do. 2 p.m. Do. Girls 406 do. do. do. Do. Infants 420 Dr.J. C. Clayton Thursday 2.30 p.m. Percy Road Boys 368 Dr. J. Macfarlnne Monday- 2 p.m. Pound Lane Boys ) 827 Dr. R. C. Cruden Tuesday 3.15 p.m. Do. Girls . Dr. F.. N. Smith Monday do. Do. Infants 378 do. Thursday 3 p.m. Princess Frederica Boys 376 Dr. W. W. Walker Tuesday do. Do. Girls 352 Dr. J. M. Schaub Thursday do. Do. Infants 226 do. do. 2.30 p.m. St. Andrew's Boys 393 Dr. H. A. Seagrove Tuesday- 2.15 p.m. Do. Girls 333 do. do. do. Do. Infants 226 Dr. R. C. Cruden Wednesday do. St. John's Boys 276 Dr J. P. Cassidy Tuesday 9 a.m. Do. Girls 195 do. Thursday do. Do. Infants 195 do. Friday 9 a.m. St. Mary's Boys 231 Dr. J. McD. Tudge Thursday 1.45 p.m. Do. Girls 206 do. do. do. Do. Infants 158 do. do. do. St. Mary's R.C. Mixed 147 Dr. j. P. ( assidy Monday 9 a.m. Do. Infants 148 do. do. do. Salusbury Road Mixed 847 Dr. H. J. Mac-voy Tuesday 2 p.m. Do. Infants 455 Dr. A. J. Moran Wednesday 2.15 p.m. Stonebridge Boys 360 Dr. A. Bindley Friday do. Do. Girls 367 Dr. D. V. Muller Tuesday or Thursday 2 p.m. Do. Infants 400 Dr. N. Greeves Wednesday 9.30 a.m. Wesley Road. Junior Mixed 459 Dr. D. V. Muller Tuesday or Thursday 3 p.m. Do. Infants 347 Dr. E. D. Cardinail Friday 2 p.m. SPECIAL SCHOOLS Fumess Road P.D. 69 Dr. C. K. Rawes Wednesday 12.30 p.m. Leinster Road M.D. 87 Dr. j. P. Cassily do. 9.30 a.m. Leopold Road M.D. 48 Dr. T. Wilson Thursday 3 P.m 134 Children Selected for Medical Inspection.—The following- Table, No. 88, shows the principle on which the selection of the children for medical inspection during 1913 has been based:— Table No. 89. Age. Boys. Girls. Total. 5 and under 6 1281 1241 2522 6 and under 7 282 336 618 7 and under 8 530 533 1063 8 and under 9 448 334 782 9 and under 10 129 128 257 10 and under 11 818 775 1593 11 and under 12 366 303 669 12 and under 13 127 95 222 13 and under 14 795 728 1523 14 and over 50 44 94 4,826 4,517 9,343 Table No. 88. Infant's' Departments. (a) Children under (i years of age. (b) Only those children over seven years who are specially detained on account of being backward. L'pper Departments. (a) Children between 7 and 8 years. (b) Children between 10 and 11 years. (c) Children over 13 years. Both Departments. Children specially referred by the teacher. Number of Children Inspected.—The following Table, No. 89, gives the number of children inspected during 1913 classified for age and sex:— 135 Clothing.—During the year the clothing of all children inspected was examined as to cleanliness, sufficiency and state of repair. The following Table, No. 90, gives the results :— Table No. 90. Cleanliness– Clean 9245 or 98.9 per cent. Dirty 98 or 1.1 ,, ,, Total No. of observations 9343 Sufficiency Sufficient 9325 or 99.8 per cent. Insufficient 18 or 0.2 ,, ,, Total No. of observations 9343 Stale of Repair Good 6455 or 69.1 percent. Average 2728 or 29.2 ,, ,, Bad 160 or 17 ,, ,, Total No. of observations 9343 Footgear.—Note was made of the condition of the footgear on similar lines to clothing, and the following Table, No. 91, shows the results:— Table No. 91. Sufficiency— Sufficient 9322 or 99.8 per cent. Insufficient 21 or 0.2 ,, Total No. of observations 9343 State of Repair— Good 6724 or 72.0 per cent. Avenge 241s or 25.9 „ „ Had 201 or 21 ,, ,, Total No. of observations 9343 136 Heights and Weights.—The following Table, No. 92, shews the average heights and weights of the children examined during 1913 classified according to age and sex:— Table No. 92. Age in Years. BOYS. GIRLS. No. Examined. Height in Centimetres. Weight in Kilogramme No. Examined. Height in Centimetres. Height in Kilogrammes 5—6 1269 105.9 17.9 1227 105.3 17.4 6—7 276 110.6 19.4 325 109.8 19.0 7—8 517 116.9 21.6 524 116.2 20.9 8—9 442 122.6 23.8 526 121.7 22.8 9—10 129 126.3 25.9 121 126.5 24.6 10- 11 810 131.1 28.2 767 130.6 27.1 11—12 356 134.2 29.7 298 135.4 29.6 12—13 126 136.0 32.4 94 141.5 33.7 13—14 787 144.7 34.9 712 147.5 36.1 14—15 49 150.6 40.0 42 151.5 39.9 137 Nutrition.—Note has been made as to this condition in the case of each child medically inspected during 1913. Nutrition is judged not merely by the height and weight of a child but also by its general appearance, complexion, expression and response. The following Table, No. 94, shows the results recorded:— TABLE NO. 94. Boys. Girls. No. of observations 4826 4517 No. with nutrition good 2146 or 44.5 per cent 2095 or 46.4 per cent Do. normal 2231 or 46.2 ,, 2058 or 45.5 „ Do. below normal 431 or 8.9 „ 338 or 7.5 „ Do. bad 18 or 0.4 „ 26 or 0.6 „ This table is important, and especially so with regard to the provision of school meals, as it shows that 8.7 per cent. of the children inspected were not up to the normal state of nutrition. In some cases this may have been the direct result of disease, but in many the cause has to be considered in reference to feeding and home circumstances. Some of these children were actually underfed, some improperly fed, some perhaps were overworked out of school and were in want of sleep, while others again were living under insanitary and unwholesome conditions. All these causes contributed to the making up of the 8.7 per cent. of children noted above as suffering from malnutrition in greater or less degree. K 138 Scalp. Body.—The following Tables, Nos. 95 and 96, classify the observations made as to the condition of the scalp and body in the cases of the 9,343 children medically inspected during the year:— Table No. 95. Scalp. Boys. Girls. No. of observations 4826 4517 Clean 4274 or 88.6 per cent 3997 or 88.5 per cent Fairly clean 516 or 10.7 „ 475 or 10.5„ Dirty 36 or 0.7 „ 45 or 1.0 „ Nitty, Verminous 139 or 2.9 „ 717 or 15.9 „ Ringworm 7 or 0.1 „ 6 or 0.1 „ Other Diseases 16 or 0.3 „ 2 or 0.04 ,, Table No. 96. Body. Boys. Girls. No. of observations 4826 4517 Clean 4197 or 87. per cent 4023 or 89. per cent Fairly clean 589 or 12.2 „ 440 or 9.7 „ Dirty 40 or 0.8 54 or 1.2 „ Verminous 35 or 0.7 „ 42 or 0.9,, Ringworm ... ... Other Diseases 56 or 1.2 „ 43 or 0.9 „ Dirty, Nitty and Verminous Conditions.—Generally it should be noted that 11.4 per cent. of the scalps examined were in want of washing, and that 2.9 per cent. of the boys and 15.9 per cent. of the girls had their heads in a nitty or verminous condition. As regards the state of the body or skin generally, it will be seen again that 11.9 per cent. of the children examined could not be classified as clean, while 0.8 per cent. exhibited signs of body lice—an exceedingly dirty condition. 139 These dirty and verminous conditions generally are due to parental ignorance and neglect. Soap, water and industry will effect a cure. Work requires to be done to bring home to the parents their responsibilities in connection with these matters, and for this purpose the work of the Health Visitors should be extended to the schools and the homes. The children, in a class or classes, should be from time to time periodically examined as regards their freedom from vermin and nits, and those suffering should be at once excluded, promptly followed up to their homes, and the parents given practical demonstrations on how to cleanse. Cleansing thereafter should be effected by the parents within 14 days. Ringworm and Other Skin Diseases.—During the year the Committee decided to establish a Clinic for the Treatment of Ringworm and a report on the work of this Clinic appears as Appendix D to this Report. Treatment is still required for other skin diseases, especially scabies, eczema, and impetigo, which often lead to considerable absence from school. They yield to simple treatment if effectively carried out. Teeth.—The following Table, No. 97, classifies the observations made on the teeth of school children — Table No. 97. Boys. Girls. No. of observations 4826 4517 No. with no carious teeth ... 1816 or 37.6 per cent 1873 or 41.5 per cent No. with 4 or more carious teeth ... 1144 or 23.7 per cent 968 or 21.4 per cent The above Table shows that only 39.5 per cent of children attending public elementary schools have sound teeth, the remaining 60.5 per cent or so having one or 140 more teeth defective. In 22.5 per cent of cases, children have four or more carious, and these urgently need treatment. Only a very small proportion of children receive dental treatment from private sources. The question of dental treatment engaged the attention of the Education Committee during the year, and my report on the subject appears in Appendix E to this report. Diseases of the Nose and Throat.—The following Table, No. 98, shows the results of medical inspection in connection with these diseases during the year under review :— Table No. 98. Boys. Girls. No. of observations 4826 4517 No. with enlarged tonsils only 875 = 18.1 per cent. 866=19.2 percent. No. with adenoids only 141= 2.9 „ 109= 2.4 „ No. with enlarged tonsils and adenoids 518=10.7 „ 406=9.0 ,, No. of mouth breathers 301= 6.2 „ 162=3.6 „ No. with nasal catarrh 151= 3.1 „ 54=1.2 „ No. with fauces congested 5= 0.1 „ 5=0.1 „ No. with polypus 2=0.04 „ No. with other diseases of the nose and throat 20= 0.4 ,, 32= 0.7 „ From the foregoing it will be noted that 36 per cent of the children examined were mouth-breathers or suffered from enlarged tonsils, adenoids, or enlarged tonsils with adenoids. These conditions directly affect health and education. Adenoids frequently cause running ears and subsequent deafness. Adenoids and mouth-breathing are also very commonly associated with dulness and mental incapacity. Enlarged tonsils expose the sufferer to frequent attacks of tonsillitis, with consequent loss of school attendance; while diphtheria caught under such conditions is very dangerous. All these conditions are easily remediable, and 141 the cost of treatment would be amply repaid in the improved health and attendance of children who suffer from these complaints. Enlarged Neck Glands.—The number of children noted as suffering from enlarged neck glands during medical inspection in 1913 is shown in Table No. 99, as follows:— Table No. 99. Boys. Girls No. of observations 4826 4517 No. with enlarged neck glands 1680 1439 From the above Table it will be noted that 33 per cent. of children suffer from this condition. In some cases it is tuberculous, and in other cases due to other causes. In any case, it is evident that one of the first lines of defence against disease, namely, the glands, has been invaded. Many of these children require education under open air conditions, and it is hoped that this will soon be available for them in Willesden. External Eye Diseases.—The following Table, No. 100, gives the results of observations made as to these diseases during 1913:— Table No. 100. Boys. Girls. No. of observations 4826 4517 No. with squint 58= 1.2 per cent. 48 = 1.1 per cent. No. with conjunctivitis 7=0.1 ,, 11=0.2 ,, No. with blepharitis 23 = 0.5 „ 29 = 0.6 ,, No. with other diseases 22 = 0.5 ,, 18 = 0.4 ,, 142 Vision.—The results of vision testing are noted in the following Table, No. 101:— Table No. 101. Boys. Girls. i No. of observations 3190 2947 2 Both eyes normal 1931 = 60.5 per cent. 1351 =45.8 per cent. 3 Only one eye normal 345 = 10.8 „ 245= 8.3 „ 4 Both eyes 6/9 516=16.2 ,, 819 = 27.8 „ 5 i One eye 6/9 ; other 6/12 or less 153= 4.8 „ 140= 4.7 „ 6 Both eyes 6/12 or less 245= 7.7 „ 392= 13.3 „ All children in classes 5 and 6 above should have spectacles. This means that 930 children out of a total of 6,137 or over 15 per cent. of the children attending the public elementary schools require glasses. Parents in some instances obtained the necessary spectacles at their own cost, and 87 pairs were ordered by the Education Committee, during the year ending 31st July, 1913. From the foregoing figures it will be observed that a considerable number of children although requiring glasses do not obtain them, and I was asked to report on the matter during the year. Thiis Report appears as Appendix E to the present Report. 143 Diseases of The Ear.—The results of observations made in the course of medical inspection are classified in the following Table, No. 102:— Table No. 102. Boys. Girls. No. of observations 4826 4517 No. with "running" ears 56 = 1.2 per cent. 48 = 1.1 per cent. No. with other diseases of the ear 10 = 0.2 ,, ,, 7 = 0.2 „ „ It may be said that the 104 children or 1.12 per cent. of the children examined, found to have "running" ears are in very imminent danger of becoming permanently deaf. The handicap which a deaf child or person suffers in the race for employment is enormous, and early treatment for these cases is imperative if the child is to have the best chance in after life of earning its living. Table No. 103. Condition needing attention. Number brought forward from preceding year. Number referred for visitation during 1913. Number visited during 1913. Number receiving treatment at first visit. Number treatment result of receiving as a direct visiting. Number moved or left School before any kind of treatment was undertaken. Number given up as hopeless. Total number to be carried forward Medical. Domestic. Medical. Domestic. (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) Nutrition ... ... ... ... ... ... ... ... ... ... Vermin and want of cleanliness ... 385 387 1 210 1 172 2 ... 1 Teeth 3 4 7 ... ... 3 ... ... 2 2 Nose and Throat 17 37 56 5 ... 22 ... 4 9 16 Eyes ... 42 43 11 l8 13 ... 1 ... Vision 49 184 252 24 ... 139 ... 23 23 43 Ear Discharge 2 18 24 15 3 5 ... ... ... 1 Speech ... ... ... ... ... ... ... ... ... ... Mental Condition ... ... ... ... ... ... ... ... ... ... Heart ... 1 1 ... ... 1 ... ... ... ... Lungs ... 2 2 2 ... ... ... ... ... ... Nervous Disorders ... 3 3 3 ... ... ... ... ... ... Tuberculosis. 1 8 9 8 ... 1 ... ... ... ... Deformities 1 1 ... ... ... ... 1 ... Infectious and Contagious Diseases ... 377 380 97 195 68 18 1 ... 1 Other Defects 2 3i 34 16 5 6 ... 1 2 4 Totals 1913 75 1092 1199 182 431 259 190 32 37 68 1912 106 1102 1261 170 430 3°3 211 24 48 75 1911 112 1030 1066 167 325 284 225 ... ... 106 1910 79 941 1010 166 308 199 268 ... ... 112 *This includes cases found by Health Visitors when visiting those referred to under column 3. The numbers in column 4 are therefore generally greater than the numbers in columns 3 + column 2. Action of Health Visitors in Obtaining Treatment. —The following Table, No. 103, indicates the work done by the Health Visitors in obtaining treatment of defects in cases urgently requiring the same— 144 145 Excluding the cases classified as "vermin and want of cleanliness," it is to be noted that 812 cases were visited by the Health Visitors as cases urgently requiring treatment. Of this number, 439 obtained medical or satisfactory treatment ; 239 obtained domestic or unsatisfactory treatment; and 134 obtained no treatment. It would thus appear that only 54 per cent. of children receive satisfactory treatment for their ailments. It is important to note that out of the 439 children who received treatment, 258, or 59 per cent., obtained it subsequent to visitation by the Health Visiitor. 146 Other Diseases or Defects.—The following Table, No. 104, classifies the various conditions coming under this heading noted during medical inspection in 1913 :— Table No. 104. No. of scholars examined 9343 Speech— Indistinct or imperfect 86 = 0.9 per cent. Husky, thick or muffled 79 = 0.8 per cent. Stammering, jerky, or hesitating 42 = 0.4 per cent. Lisping 39 = 0.4 per cent. Nasal or twangy 14 = 0.1 per cent. 260 or 2.8 per cent. Heart and Circulation— Organic heart disease 66=1.8 per cent. Functional heart disease 87=0.9 per cent. Congenital heart disease 1 =0.01 per cent. Anaemia 92 = 1.0 per cent. 346 = 37 per cent. Lungs (excluding tuberculosis)— Bronchitis 108 = 1 .2 per cent. Asthma 4=0.04 per cent. Other diseases 89 = 1.0 per cent. 201 =2.2 per cent. Nervous diseases— Epilepsy 6=0.06 per cent. Night terrors 4=0.04 per cent. Other diseases 97 = 1.0 per cent. 107 = 1.1 per cent. Tuberculosis— Lungs 11 =0.1 per cent. Other organs 18=0.2 per cent. 29=0.3 per cent. Rickets 242 = 2.6 per cent. 242=2.6 per cent. Deformities, spinal disease, &c. 98 = 1 .0 per cent. 98= 1.0 per cent. Infectious diseases (not including infectious skin diseases) 0= — per cent. 0= — per cent. Other diseases or defects — Rupture 21 =0 2 per cent. Phimosis 10=0.1 per cent. Chorea 6=0.06 per cent. Incontinence of urine 14=0.1 per cent. Enlarged thyroid 3=0.03 per cent. Congenital syphilis 3=0.03 per cent. Other diseases or defects 142 = 1.5 per cent. 199 = 2.1 per cent. 117 In connection with the foregoing- table, it should be noted that at least 50 per cent, of the children suffering from organic heart disease, all the children suffering from lung diseases, at least 50 per cent, of the children suffering from nervous diseases, all the children suffering from tuberculosis —i.e.,366 suffering from these diseases—together with a considerable proportion of those suffering from rickets, deformitiies, spinal disease, etc., and other diseases or defects should be educated by open air methods, and the necessity for this form of education in Willesden is obviously a pressing one. Infectious Diseases.—The following Table, No. 105, shows the notifications in 1913 of cases of infectious diseases amongst scholars attending public elementary schools in Willesden :— 148 Table No. 105. NAME OF SCHOOL AND DEPARTMENT. Scarlet Fever. Diphtheria. Measles. Whopping Cough. Mumps. Chicken-pox. Ringworm. Ophthalmia. Other Non-noti fiable Infectius Diseases. Acton Lane Boys 1 ... 2 1 3 1 6 ... 1 Do. Girls 3 3 2 1 1 3 5 ... 7 Do. Infants 4 ... 38 6 6 36 9 ... 11 Bridge Road Boys ... ... ... ... ... ... ... ... 3 Do. Girls ... ... 1 ... ... ... 3 ... 5 Do. Infants ... 4 6 1 19 2 ... 14 Percy Road (late Cambridge Road Temporary) 2 ... ... 1 1 ... 2 ... 4 Carlton Vale Girls 3 ... ... ... 5 ... 1 5 7 Do. Infants ... 2 19 4 1 8 3 1 45 Chamberlayne Road Boys ... 1 6 ... 4 1 4 3 40 Do. Girls ... ... 8 ... 3 4 1 ... 92 Do. Infants 16 1 45 22 33 49 4 6 37 Christ Church Boys 3 2 6 ... ... ... ... ... ... Do. Girls 6 1 ... ... ... 1 ... ... 3 Do. Infants 4 ... 7 1 ... ... ... ... 3 College Road Mixed ... ... 2 ... ... 2 ... ... 2 Do. Infants ... 2 11 1 3 4 ... ... 5 Dudden Hill Boys 1 5 10 4 1 ... 4 ... 5 Do. Girls 1 ... ... ... ... ... ... ... ... Do. Infants 4 4 74 1 9 16 15 ... 7 Furness Road Sen. Boys 3 ... ... ... ... 1 ... ... 1 Do. Sen. Girls ... ... ... ... ... 1 2 ... 1 Do. Jun. Boys ... 2 9 2 5 5 4 ... 57 Do. Jun. Girls ... ... 11 4 5 10 ... ... 83 Do. Infants 13 2 26 ... 16 17 2 ... 16 Gibbons Road Boys ... 1 2 ... 5 5 1 21 Do. Girls 3 ... 4 1 5 2 1 ... 16 Do. Infants 3 3 34 4 11 6 4 2 35 Gordon Memorial Boys 2 ... ... ... ... ... ... ... 5 Do. Girls 3 ... 1 ... 1 ... 7 1 52 Do. Infants 7 2 19 9 5 4 3 ... 18 Harlesden National Boys 2 ... 1 ... 2 ... ... ... 1 Do. Girls 3 ... ... ... ... ... ... ... 1 Do. Infants 3 ... 3 ... 3 2 2 ... 3 Harlesden R.C. Boys ... 1 ... 1 3 ... ... ... ... Do. Girls ... ... ... ... 4 ... 1 ... ... Do. Infants ... ... 5 1 9 3 ... ... Holy Trinity Boys ... 1 3 1 1 ... ... ... ... Do. Girls 1 3 ... ... ... ... ... ... ... Do. Infants 4 3 6 ... ... ... ... ... 6 Keble Memorial Boys ... ... 4 ... 7 ... ... ... 7 Do. Girls 1 ... ... ... 53 ... 1 ... 1 Do. Infants 2 ... 10 ... 20 2 1 ... ... Kensal Rise Boys 1 2 ... ... ... ... ... ... 1 Do. Girls 5 ... ... 2 2 ... 3 ... ... Do. Infants 4 2 18 59 10 4 19 1 28 Kilburn Park Road ... Girls ... ... 2 ... 2 1 3 1 30 Do. Infants 4 3 9 22 2 14 21 ... 54 Leopold Road Boys 3 ... 3 1 2 3 3 ... 15 Carried forward 117 51 407 149 244 225 138 25 743 119 NAME OF SCHOOL AND DEPARTMENT. Scarlet Fever. Diphtheria. Measles. Whooping Cough. Mumps. Chicken-pox Ringworm. Ophthalmia. Other Non-notifiable Infeciious Diseases. Brought forward 117 51 407 149 244 225 138 25 743 Leopold Road Girls 13 ... ... ... ... 3 2 3 16 Do. Infants 8 ... 12 11 9 3 8 ... 4 Lower Place Boys 3 ... 5 1 5 2 2 ... 5 Do. Girls 4 ... 6 ... ... ... 10 ... 16 Do. Infants 4 2 38 ... 4 9 10 ... 57 Mora Road Boys 1 ... ... ... 1 ... 2 ... ... Do. Girls ... ... 6 ... 3 ... 2 ... ... Do. Infants ... 1 12 4 8 2 19 ... 23 Neasden Boys ... ... ... ... ... ... 1 ... ... Do. Girls ... ... 1 ... ... ... ... ... 2 Do. Infants ... ... 1 1 1 1 2 ... 1 Oldfield Road Boys 5 ... 4 1 2 5 8 ... 7 Do. Girls 4 1 ... 1 2 3 1 ... 7 Do. Infants 14 4 6 4 1 5 17 ... 34 Pound Lane Boys 2 2 2 1 ... 1 ... ... ... Do. Girls 3 2 ... 1 ... ... ... ... 2 Do. Infants 5 1 63 6 8 12 ... ... 21 Princess Frederica Boys 2 ... 2 ... ... 3 ... ... 8 Do. Girls 1 ... 13 4 1 3 1 ... 10 Do. Infants ... ... 40 12 1 2 ... ... 18 St. Andrew's Boys ... 2 ... ... ... ... ... ... ... Do. Girls ... ... 3 ... ... ... ... ... ... Do. Infants 4 ... 46 ... ... ... ... ... 3 St. John's Boys ... 1 ... ... ... ... 2 1 4 Do. Girls 4 ... 1 ... ... 3 3 1 15 Do. Infants 4 1 5 ... ... 2 7 ... 20 St. Mary's R.C Boys ... ... ... ... ... ... ... ... 1 Do. Girls ... 3 ... ... ... ... 1 ... 3 Do. Infants 2 10 3 ... ... 1 5 ... 2 St. Mary's Willesden Boys 3 ... ... ... ... ... 2 ... 3 Do. Girls 1 ... ... ... ... ... 2 ... 10 Do. Infants 3 ... 4 ... ... ... 1 ... 10 Salusbury Road Boys 3 ... 1 ... ... ... 1 ... 2 Do. Girls 9 1 1 ... ... 1 1 ... 3 Do. Infants 17 2 36 31 10 14 13 ... 30 Stonebridge Boys 3 ... ... ... 1 1 2 ... 1 Do. Girls 2 2 2 4 ... 1 1 ... 7 Do. Infants 4 4 7 2 8 10 4 11 Wesley Road Boys 3 ... ... ... ... ... 3 ... 3 Do. Girls 2 1 3 1 ... ... 2 ... 6 Do. Infants 6 4 13 4 5 22 2 ... 11 SPECIAL SCHOOLS. Furness Road, P.D. Boys ... ... 2 ... ... ... ... ... 2 Do. Girls 1 ... ... ... ... ... 1 ... 4 Leinster Road, M.D. Boys ... ... ... 1 ... ... ... ... ... Do. Girls ... ... ... ... ... ... ... ... 1 Leopold Road, M.D. Boys ... ... ... ... ... ... ... ... ... Do. Girls ... ... ... ... ... ... ... ... ... Totals 257 95 745 244 318 334 289 33 1,126 150 Regulations for the Control of Infectious Diseases.—Experience has taught that the control of infectious disease depends mainly on the control of the individuals suffering, and that "missed" cases and so-called " carriers " are the principal means whereby infection is spread. The exclusion of contacts from school is only important, therefore, where there is a probability that such contacts will develop the disease—and this probability is small where the contact has already suffered from the disease in question. These are the principles on which the Willesden Education Committee have based their regulations for dealing with infectious diseases, and the following regulations, which have been adopted, and are now in operation, are based on the same principles:— Regulations for the Control of Infectious Diseases in the Schools. (i.) Common Infectious Diseases. Disease. Children suffering from Disease stated in Col. 1. Children living in tenements where Disease stated in Col. 1. occurred, i-e. Contacts. Contacts who have previously suffered. Contacts who have not previously suffered. (1) (2) (3) (4) • Small Pox Excluded. Re-admitted upon receipt of notice from Medical Officer of Health Excluded. Re-admitted upon receipt of notice from Medical Officer of Health Excluded. Re-admitted upon receipt of noticefrom Medical Officer of Health Scarlet Fever Excluded. Re-admitted upon receipt of noticefrom Medical Officer of Health Not excluded Excluded. Re-admitted 10 days after date of disinfection as notified by Medical Officer of Health Diphtheria Excluded. Re-admit ted upon receipt of noticefrom Medical Officer of Health. Not excluded Excluded. Re-admitted 12 days after date of disinfection as notified by Medical Officer of Health 151 Disease. Children suffering from Disease stated in Col. 1. Children living in tenements where Disease stated in Col. 1. occurred. i.e. Contacts. Contacts who have l.ieviously suffered. Contacts who have not previously suffered. (1) (2) (3) (4) Measles Excluded. Re-admitted 3 weeks from onset Not excluded Excluded. Re-admitted 3 weeks from onset of primary case in tenement German Measles Excluded. Re-admitted 3 weeks from onset Not excluded Excluded. Re-admitted 3 weeks from onset of primary case in tenement Mumps Excluded. Re-admitted 3 weeks from onset Not excluded Excluded. Re-admitted 3 weeks from onset of primary case in tenement Chicken Pox Excluded. Re-admitted 3 weeks from onset Not excluded Excluded. Re-admitted 3 weeks from onset of primary case in tenement Whooping Cough Excluded. Re-admitted 6 weeks from onset of 44 whoop " Not excluded Excluded. Re-admitted 3 weeks from onset of primary case in tenement Typhoid Fever Excluded. Re-admitted upon receipt of noticefrom Medical Officer of Health Not excluded Not excluded Erysipelas Excluded. Re-admitted upon receipt of noticefrom Medical Officer of Health Not excluded Not excluded Meningitis Action in accordance with instructions received from MedicalOfficerof Health Not excluded Not excluded Poliomyelitis Action in accordance with instructions received from Medical Officer of Health Not excluded Not excluded Tuberculosis Action in accordance with instructions received from Medical Officer of Health Not excluded Not excluded 152 (ii.) Infectious Skin Diseases. Disease. Exclusion of Children suffering from disease stated in Col. 1. (1) (2) Ringworm Excluded. Re-admitted upon receipt of notice from School Medical Officer. Scabies Excluded. Re-admitted upon receipt of notice from School Medical Officer. Eczema Excluded. Re-admitted upon receipt of notice from School Medical Officer. Impetigo Excluded. Re-admitted upon receipt of notice from School Medical Officer. (iii.) Infectious Eye Diseases. Disease. (1) Exclusion of Children suffering from disease stated in Col. 1. (2) Ophthalmia Excluded. Re-admitted upon receipt of notice from School Medical Officer. (iv.) Verminous Conditions. Disease Exclusion of Children suffering from the condition stated (i) (2) Body Lice Head Lice Nits Excluded. Re-admitted upon receipt of notice from School Medical Officer. (v.) Teachers suffering with infectious diseases, or living in a tenement where infectious disease has occurred. The foregoing regulations apply to teachers except where a teacher has not previously suffered and is living in a tenement where Scarlet Fever, Diphtheria, Measles, German Measles, Mumps, Chicken-pox, or Whooping Cough has occurred. In such cases the teacher communicates personally if possible, with the School Medical Officer, and does not attend school unless authorised by him. If, in any of the above cases, the teacher is required, as a condition of his return to school, to remove temporarily to other rooms 153 and does not comply, no salary is allowed for the time during which the teacher is absent from school on account of his non-compliance with the requirements of the School Medical Officer. The Blind.—A School for Blind Children is not maintained by the Authority. But children are sent to day or residential institutions for the blind from time to time. During the year one blind child was reported to the Education Committee by the School Medical Officer. The following Table, No. 10G, gives certain particulars with regard to the blind children being educated by the Education Committee, at the end of the year 1913:— Table No. 106 Initials of Child: Date of Birth Date Examined. Date reported by School Medical. Officer to Education Committee. Date entere'l 1 nstitution. Name of Institution. W.L.W. 26- 5-01 ... ... 27- 1-08 Swiss Cottage. D.I.C. 2- 1-01 ... ... l6- 3-09 Edinboro' Road, London. E.H.* 8- 4-98 ... ... 19- 9-10 Hastings and St. Leonard's. R.S. 10- 9-01 ... ... 20- 9-10 Royal Normal College. R.B. 21- 3-02 ... ... 10-10-10 Swiss Cottage. E.S. 11-11-04 ... ... 10-10-10 Edinboro' Road, London. E.I). 3I-I2-'o2 ... ... 25- 4-11 Royal Normal College. C.R.H. 16-11- 99 ... ... ???- 9-11 Swiss Cottage. F.L. 8- 6-'O2 ... ... 8- 1-l2 do. W.G.G. 4-11-04 ... ... 8- 1 -13 do. H.G. 5-10-01 19-6-12 23- 9-'12 26- 3-13 do. H.L. 04 26-9-11 ;o-io- 11 ... Awaiting vacancy at Swiss Cottage. F.H. 2-11-93 ... ... 3- 7-02 Royal Normal College, E.M.S. 11- 6- 05 19-2- 13 3i- 313 17-11- 13 Swiss Cottage. *This child is also mentally defective. L 154 In addition to blind children there are a certain number ot children who may be called semi-blind. These children are not suitable for education by methods applicable to the totally blind, nor yet by methods applicable to children with normal vision. They come within the definition of "blind" given in the Act of 1893, viz., "too blind to be able to read the ordinary school books used by children," and special provision requires to be made for them. The Deaf.—~A school for the deaf is not maintained by the local Education Authority, but certain children resident within the area of the Authority are educated by deaf methods at approved institutions. The following Table, No. 107, gives particulars of deaf children being educated by the Education Committee at the end of the year 1913. Table No. 107. Initials of Child. Date of Birth Date examined. Date reported by School Medical Officer to Education Committee. Date entered Institution. Name of Institution. H.L. 24-10-98 ... ... ???-11-08 Homerton. E.M. 10-10-02 ... ... ???- 9-10 Margate. T.II.B. 23- 7-03 ... ... 31- 8-11 do. H.A.H. 17- 6-02 ... ... 31- 8-11 do. E.G.S. 17- 5-04 ... ... 31- 8-11 do. E.H. 22- 7-04 ... ... 14- 2-12 Ackmar Rd., London. J.S.R. 15- 7-99 ... ... ???- 12 Margate. A.R.N. 23- 5-05 19-3-12 - and 1 6-12-13 ( 29- 5-l2 ) and ( 27- 1 -13 ) 14- 4-13 do. E.W. 17-12-03 19- 7-12 23- 9-12 - 2-13 do. FJ.H. W.S. 3-10-o6 1- 7-13 22- 9- 13 11 -11 -13 do. 3i-10-o6 16- 2-12 ... 11-11-13 do. L.J.T. 8- 8-05 19- 3-12 29- 5-12 11-11-13 do. I.M.H. ???- 09 1-10-13 27-10-13 ... ... F.J.I. 6- 3-99 26- 9-11 3o-1o-11 ... ... F.W. -???-01 27- 6-13 22- 9-13 ... In Hospital for nervous diseases Maida Vale. 155 As in the case of blind children, so in the case of deaf, there are to be found children not suitable for education by means applicable to the totally afflicted. Many children are too deaf to be taught in a class of hearing children in an elementary school, and come within the definition of deaf. They are not, however, totally deaf, and should be taught in a class specially adapted for "hard of hearing" children. The Mentally Defective.—Two schools for this class of children are maintained by the Education Authority, as under:— Name of School. Effective accommodation, 27-i2-13 No. on roll, 27-12-13 No. awaiting admission, 27-12-13 Leinster Road, Mentally Defective 80 62 9 Leopold Road, do. 38 52 22 The children in these schools are inspected annually, by Dr. G. E. Shuttleworth. In addition to the routine inspection of children attending the above special schools, a certain number of children are referred to Dr. Shuttleworth for examination as to their mental condition. Some of these are children attending the ordinary public elementary schools without apparent benefit, and others are children who have not begun school life on account of alleged mental incapacity. The following Table, 156 No. 108, gives the results of such examinations during 1913 :— Table No. 108. Examined at Leinster Kd. Mentally Defective School. Examined at Leopold Rd. Mentally Defective School. Totals. Certified as suitahle for admission to mentally defective school 22 30 52 Certified as epileptic ... 2 2 Certified as imbecile 2 2 4 Certified as morally defective and fit for residential institution ... 2 2 Certified as fit for deaf school ... 2 2 Certified as suitable for admission to physically defective school 2 3 Certified as fit to attend ordinary elementary school 16 32 48 Certified as unfit for school 1 1 2 Certified as fit for transfer from mentally defective to ordinary school 1 ... 1 Certified as fit to leave mentally defective school at 14 years 1 ... 1 Totals 44 73 117 The Physically Defective.—One school is maintained by the Authority for this class of children, viz.:— Name of School. Effective accommodation, 27-12-l3 No. on roll, 27-12-l3 No. awaiting admission, 27-12.l3 Furness Road, Physically Defective 69 68 48 The Board of Education have intimated to the Authority that they will be unable to continue to recognise this school after 31st March, 1913, and in consequence the Education Committee have under consideration the erection of a suitable school. The best and most advantageous arrangements which can be made in respect of these children were fully discussed by me in a special report to the Childrens Care 157 mittee, which appears in the Appendix to my Report for 1912. Dr. Rawes is the Assistant School Medical Officer attached to this school, and attends weekly. The children in attendance are examined by him from time to time, and records of such examinations are kept. Epileptic.—During the year enquiries made regarding this class of children showed that there were 49 epileptic children on or about the 4th June, 1913, living within the school area of Willesden. These may be classified according to age and sex as follows:— Age in Years o 1 2 3 4 | 5 : 6 7 8 9 10 11 12 13 14 15 Total. Boys ... ... ... ... ... 4 2 5 5 ... 2 3 2 1 ... 24 Girls ... ... ... ... ... ... 2 2 4 1 3 4 2 1 25 Total ... ... ... ... ... 4 4 7 5 4 9 6 6 3 1 49 These 19 children attend schools as under :— No. of epileptic children attending Ordinary Public Elementary Schools 24 No. of epileptic children attending Day Special Schools 4 No. of epileptic children attending Residential Special Schools 3 No. of epileptic children not attending school 18 Total 49 158 Children attending Ordinary Public Elementary Schools. The following Table shows the age at which the first epileptic seizure occurred in the 24 cases in this group:— Age in Years. o 1 2 3 4 5 6 7 8 9 io 11 12 13 14 15 Total. Boys 2 1 2 2 1 1 2 1 ... 2 1 ... ... ... ... ... 15 Girls 1 1 2 ... ... ... ... ... ... 1 2 1 ... ... 1 ... 9 Total 3 2 4 2 1 1 2 1 ... 3 3 1 ... ... 1 ... 24 First Onset in Relation to School Children.— Of these 24 children 11 had their first attack prior to going to school. Of these 11 children one entered school at the age of three years, one at the age of four years, six at the age of fixe years, two at the age of six years, one at the age of eight years, so that in only one of these cases can it be said that epilepsy prevented the attendance of the child at school prior to the age of six years. The Severity and Frequency of Epileptic Seizures. —The severity of the epileptic seizures in these cases varies from the condition known as petit mal in some cases to severe epileptic convulsions in others, lasting for five minutes, followed by sleep and semi-consciousness of nine hours duration. In those cases, however, in which the epileptic seizures are severe the) are infrequent, occurring at interval; usually of two, four, six, nine or twelve months duration, while in some cases there has been only one attack at any time. Regularity of School Attendance.—The regularity of school attendance in all these cases is good. 159 Mental Condition.—In four cases the mental condition is bright. In eleven cases it is average. In nine cases it is dull. In two of the dull cases the children are respectively described as mischievous and wilful. Children Attending Day Special Schools. 1 he following' Table shews the age at which the first epileptic seizure occurred in the four cases in this group:— Age in Years. o 1 2 3 4 5 6 7 8 9 1o 11 12 13 14 15 Total. Boys ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... 1 Girls 1 ... ... ... 1 1 ... ... ... ... ... ... ... ... ... ... 3 Total 1 ... 1 ... 1 1 ... ... ... ... ... ... ... ... ... ... 4 First Onset in Relation to School Attendance.— All these four children had their first attack prior to attendance at any school. Of these four children three started in ordinary elementary schools but were unable to continue at those schools on account of the severity or frequency of the epileptic seizures. Two of these three children attended the ordinary elementary school at The age of six and one at the age of seven. The four children entered the Day Special Schools as follows:—One at the age of seven, two at the age of eight, and one at the age of ten. Regularity of Attendance.—In two of these cases the children are regular in their attendance at school, but in the remaining two the attendance is irregular. Mental Condition.—In two cases the mental condition is bright, and in two dull. One of the dull children gets into rages. 160 Children Attending Residential Special Schools. The following Table shows the age at which the first epileptic seizure occurred in the three cases in this group:— Age in Years. 0 1 2 3 4 5 6 7 8 9 1o 11 12 13 14 15 Total. Hoys ... ... ... ... ... ... ... ... ... ... ... ... ... ... ...... ... ... Girls ... ... ... ... ... ... ... 1 ... 1 1 ... ... ... ... ... 3 Total ... ... ... ... ... ... ... 1 ... 1 1 ... ... ... ... ... 3 First Onset in Relation to School Attendance.— These children had their first epileptic seizures subsequent to their commencing school. Their school attendance began in the ordinary elementary schools at the following ages :—One at the age of four and two at the age of five. They had their first epileptic seizure one at the age of seven, one at the age of nine, and one at the age of ten. In all these cases the epileptic seizures are severe. They all entered Residential Special Schools at the age of eleven. Mental Condition.—Their mental condition are described as, one bright, one average and one dull. Epileptic Children not in Attendance at School. The following Table shows the age at which the first epileptic seizure occurred in the eighteen cases in this group:— Age in Years. o 1 2 3 4 5 6 7 8 9 1o 11 12 13 14 15 Total. Boys 2 1 ... 1 ... 1 ... 1 1 ... ... 1 ... ... ... ... 8 Girls 1 ... 1 2 1 ... ... 1 ... 3 ... 1 ... ... ... ... 1o Total 3 1 1 3 1 1 ... 2 1 3 ... 2 ... ... ... ... 18 161 First Onset in Relation to School Attendance.— There are eighteen children of this class, five of whom have never attended school. Of the remaining thirteen, two began school at three, one at the age of four, four at the age of five, five at the age of six, and one at the age of nine. Of the thirteen who have attended school, three had epileptic seizures prior to admission, the other ten developing epilepsy after admission to school. These eighteen children are now unable to attend school on account of the frequency or severity of the epileptic seizures or their mental condition. Twelve have severe attacks of epilepsy, and in six cases the attacks are slight but frequent, occurring daily, twice weekly, fortnightly, every two months and every five months. The child who has slight fits every two months has only shown these symptoms recently and has been excluded by the School Medical Officer under observation. The child who has fits every five months is weak minded. Mental Condition.—The mental conditions of these children may be classified as follows:— Bright, two (one suitable for Epileptic Colony, one has not attended school for the past four years on account of severe epilepsy). Average, five (one of these mischievous). Dull, 11 (one irresponsible, one weak-minded). Mother Craft.—The need of providing instruction on Infant Care for the older girls in the Public Elementary Schools and for mothers becomes more and more apparent. A great proportion of infant mortality is due to ignorance on the part of those whose duty it is to care for the baby. It should also be remembered that when we say that the infant mortality rate in Willesden during 1913 was 80, we do not merely mean that 80 out of every 1,000 babies born alive died before the first year, but that the same 162 ditions which caused their deaths have permanently marred the health of a far greater number of living children. It is obviously, therefore, of the utmost importance to prevent this wholesale spoiling of lives, and the need of providing adequate instruction on this subject of infant care is being more and more recognised in all parts of the country. In a great many places classes are being held in the elementary schools for the older girls. In some cases the practical work in connection with them is carried out at neighbouring Creches or Baby Welcomes. In others instruction is given on a do'l. The scope of the work varies somewhat in different schools, but the course lincludes instruction on washing, feeding, clothing and carrying an infant, making baby clothes and the elements of sick nursing. The courses are given either by the teachers or health visitors, or in a few cases by medical practitioners. In our own district an excellent class is conducted by Miss Webster, the Head Teacher, at Chamberlayne Wood Road Girls' School. Girls over 14 are taught thoroughly the methodical washing and dressing of a young baby. Dolls are used, of the size and weight of a month old baby. The class consists of eight to ten girls, and the children thoroughly enjoy the work. The improvement in method and speed after a few lessons is marked. I examined this class again this year with Dr. T. E. Smurthwaite, and am amply satisfied with the excellent work that is being done in connection with this subject at this school. An extension of this work to other schools would undoubtedly be of considerable value in the reduction of infantile mortality rates in the future. Mother Craft Schools.—Classes for mothers and expectant mothers are being held in many districts, usually in connection with a "Babies' Welcome" or "Infant 163 tations." The classes are made known in the district by the Health Viisitor when visiting under the Notification of Births Act, 1907, and mothers are invited to attend and bring their babies for regular weighing, inspection and advice. In some cases the classes are entirely conducted by the Health Visitor, in others a Medical Officer attends on certain days. In Fulham, for instance, a Medical Officer attends twice a week. The actual lessons or lectures should be short and very practical. Education (Provision of Meals) Act, 1906.—The relationship of this Act to the School Medical Service was dealt with in my Annual Report for 1912. In this District the Act is administered merely as a means whereby necessitous parents are relieved, whereas the object of the Act is really to feed children who are "unable by reason of lack of food to take full advantage of the education provided for them." In the absence of disease .it is actually the physical state of the child, and not the necessity of the parent, that is all important in deciding whether or not a child should be fed, and this matter requires the best consideration of the Authority. In the Annual Report of the Chief Medical Officer of the Board of Education for 1910 the following observations are made as to the administration of this Act and the functions of the School Medical Officer in connection therewith:— " . . . . Indeed, in areas in which the Act is in operation, the following important functions in relation to its working may appropriately devolve upon the School Medical Officer and his assistants. (1) He should report to the Local Education Authority all cases of bad or insufficient nutrition observed in the course of medical inspection (whether routine inspection or special inspection). Such cases should be put on the feeding-list pending (investigation as to the cause of malnutrition—unless, 164 of course, it is already obvious that the malnutrition is due to conditions in which the Local Education Authority's meals will be of no use. (2) Cases of doubt as to the propriety of keeping any child (whether selected as a result of medical inspection or otherwise) on the feeding-list should be referred to him for report before the decision is taken. (3) Cases of the temporary exclusion from the feedinglist of children who are temporarily excluded on medical grounds from school attendance should be notified to him. (4) He should periodically inspect the registers of the attendance at meals, both as regards the attendance generally and as regards the attendance of individual children with whose cases he has previously been concerned. (5) He should approve the dietary. (6) He should satisfy himself of the hygienic conditions of the feeding centres. (7) He should supervise the quality, quantity, cooking and service of the food. (8) He should attempt to form and to record a judgment upon the effects of the proceedings taken under the Act upon the physical well-being of the children, both generally and as regards individual cases." The provision of meals is really an ameliorative measure for the improvement of the health of the children and as such its administration should be closely associated with ;he School Medical Service. 165 APPENDIX A. LOCAL GOVERNMENT BOARD TABLES. Table No1. In recording the facts under the various headings of the following tables attention has been given to the notes on the tables supplied by the Local Government Board. VITAL STATISTICS OF WHOLE DISTRICT DURING 1913 AND PREVIOUS YEARS. Year. Population estimated to Middle of each Year. Births. Totai. Dhaths Registered in the District. Transferable Deaths t Nett Deaths belonging to the District. Uncorrected Number. Nett. Number. Rate. of nonresidents registered in the District, † † of residents not registered in the District † Under i Year of Age. At all Ages. Number † Rate. Number. Rate per 1,000 Nett Births. Number. Rate. (0 (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) (13) 1908 149.035 ... 4.095 27.5 1.543 97 11 181 397 97 1,623 10 9 1909 150.145 ... 4.172 27.8 1,448 96 12 242 391 94 1,678 11 2 1910 153,253 ... 3.923 25.6 1.313 8.6 13 206 313 80 1,506 98 1911 156,572 3.863 4,001 25.6 1,618 103 10 240 495 124 1,848 11 8 1912 159,868 3.912 4.075 25 .5 1,307 8.7 27 233 328 80 1,603 1002 1913 163,644 3,891 4,037 24.7 1,449 8.9 23 251 325 80 1,677 10.24 166 TablE la. VITAL STATISTICS OF THE WARDS—1913. WARDS. Population estimated to Middle of Year. Births. Total Deaths Registered in each Ward. Transferable Deaths Nett Deaths belonging to each Ward. Uncorrected Number. Nett. of nonresidents registered in each Ward. † of residents not registered in each Ward. † Under 1 year of Age. At all Ages. N umber † Rate. Number. * Rale. Number * Rate per 1000 Nett Births. Number. * Rate. (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) ((13) South Kilburn 14,170 387 405 28.58 189 13.35 3 39 43 106.17 225 15.87 Mid Kilburn 14,595 334 361 2173 156 10.68 I 29 27 74.79 184 I 2 60 North Kilburn 12.378 207 216 17.45 93 7.5i 3 17 12 55.55 107 8 64 Brondesbury Park 9.683 180 181 1879 66 6 81 4 14 6 32.96 76 7 84 Kensal Rise 13.961 312 315 22 56 106 7.59 0 19 16 50.79 l25 8 95 Harlesden 16,599 419 421 25.36 125 7 53 1 29 24 57 .00 153 9.21 Stonebridge 17.475 518 515 29.47 187 10.70 1 18 61 118 .44 204 11 .67 Roundwood 15,568 397 401 25 75 U2 912 5 20 41 102.24 157 10.08 Church End 13,986 365 . 369 26.38 134 9.58 1 15 43 116.53 148 1058 Willesden Green 16,402 427 440 26.82 139 8 47 0 23 30 68.18 162 9 87 Cricklewood 18,827 345 35. 18 64 112 5.94 4 28 22 62.67 .36 7.22 167 NOTES TO TABLES I. and la. Tables I. and la. are arranged to show the gross births and deaths in the District, and each ward, and the births and deaths properly belonging to them with the corresponding rates. The rates are calculated per 1,000 of the estimated gross population. *In Column 6 are included the whole of thie deaths registered during the year as having actually occurred within the district. *In Column 12 is entered the number in Column 6, corrected by subtraction of the number in Column 8 and by addition of the number in Column 9. *In Column 10 the deaths are similarly corrected by subtraction Ci the deaths under 1 year, included in the number given in Column 8, and by addition of the dieaths under 1 year, included in the number given in Column 9. tColumn 4.—This number has been obtained by adding to the number shewn in Column 3 the number of births belonging to the district but occurring outsidie and subtracting the number occurring in the district but belonging to other districts. tColumn 8.—This number is the number of deaths excluded from the returns of the local Registrar as transferable deaths defined below. tColumn 9.—This number is the number of deaths transferred to the district by the Registrar-General. Transferable Deaths " are deaths of persons who, having a fixed or usual residence in England or Wales, die in a district other than that in which they resided. The deaths of persons without fixed or usual residence, e.g., casuals, are not included in Columns 8 or 9, except in certain instances under 3 (!>) below. The following special cases arise as to Transferable Deaths :— (1) Persons dying in Institutions for the sick or infirm ; such as hospitals, lunatic asylums, workhouses, and nursing homes (but not almshouses) must be regarded as residents of the district ;n which they had a fixed or usual residence at the time of admission. If the person dying in an Institution had no fixed residence at the time of admission, the death is not transferable. If the patient has been directly transferred from one such institution to another, the death is transferable to the district of residence at the time of admission to the first Institution. (2) The deaths of infants born and dying within a year of birth in an Institution to which the mother was admitted lor her confinement should be referred to the district of fixed or usual residence of the parent. (3) Deaths from Violence are to be referred (a) to the district or residence, under the general rule ; (b) if this district is unknown, or the deceased had no fixed abode, to the district where the accident occurred, if known; (c) failing this, to the district where death occurred, ill known; and (d) failing this, to the district where the body was found. Area of District in acres (land and inland water), 4,384. Total population at all ages 154,214 Number of inhabited houses 21,525 1-At Census, 1911 Average number di persons per house 7.16 I 168 TABLE II.—CASES OF INFECTIOUS DISEASE NOTIFIED DURING THE YEAR 1913. Notifiable Disease. Number of Cases Notified. Total Cases Notified in each Ward. At Ages—Years. South Kilburn. Mid-Kilburn. North Kilburn. Brondesbury Park. Kensal Rise. Harlesden. Stonebridge. Roundwood. Church End. Willesden Green. Cricklewood. Total Cases removed to Hospital. At all ages. Under 1. 1 and under 5. j 5 and under 15. ! 15 and under 25. 25 and under 45. 45 and under 65. 65 and upwards. (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) (13) (14) (15) (16) (17) (18) (19) (20) (21) Small-port .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Cholera (C) Plague (P) .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Diphtheria (including Membranous croup) 233 .. 50 125 22 27 4 .. 38 40 21 9 12 9 ,5 25 2S 15 11 215 Erysipelas 93 .. 5 11 8 35 28 .. 9 9 5 4 5 7 8 14 18 8 6 *7 Scarlet Fever 504 .. 92 347 46 16 .. .. 56 74 43 31 31 31 62 41 67 40 28 446 Typhus Fever .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Enteric Fever 18 .. 2 6 5 3 2 .. 1 2 2 3 2 2 1 2 1 2 10 Relapsing Fever (R)Continued Fever (C) .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Puerperal Fever 11 .. .. .. 1 10 .. .. .. 1 1 .. 1 .. 3 3 .. 1 1 5 Cerebro-spinal Meningitis 3* .. 1 1 1 .. .. .. 2 .. .. .. 1 .. .. .. .. .. .. .. Poliomyelitis 3 .. 2 1 .. .. .. .. .. .. 2 .. .. .. .. .. 1 .. .. .. Pulmonary Tuberculosis 368 .. 10 64 72 163 53 5 50 45 15 15 29 23 † 42 40 40 33 36 .. Other forms of Tuberculosis 146 5 15 66 33 21 3 3 17 26 6 7 18 13 118 10 12 10 9 .. Totals 1379 15 177 621 188 275 90 13 173 '97 95 69 97 85 160 134 168 108 93 691 The Willesden Isolation Hospital, Neasden, with 164 beds is provided by the Willesden District Council for patients suffering with infectious diseases other than Small Pox. * 1 case of Port Basic Meningitis. f Includes 2 with address " Infirmary " only. 169 TABLE III. CAUSES OF, AND AGES AT DEATH DURING THE YEAR 1913. Nett Deaths at the subjoined ages of " Residents " whether occurring within or without the District, (a) Total Deaths whether of "Residents" or "NonResidents" in Institutions in the District. (b) Causes of Death. All Ages. Under 1 year. 1 and under 2. 2 and under 5. 5 and under 15. 15 and under 25. 25 and under 45. 45 and under 65. 65 and upwards. (1) (3) (3) (4) (5) (6) (7) (8) (9) (1o) (11) All causes Certified (c) 1676 325 94 77 66 63 234 358 459 284 Uncertified 1 .. .. .. .. .. .. .. .. .. Enteric Fever 4 .. .. .. 2 .. 1 1 .. 1 Small-pox .. .. .. .. .. .. .. .. .. .. Measles 69 11 29 20 7 1 1 .. .. 5 Scarlet Fever 7 4 2 .. 1 .. .. 7 Whooping-cough 23 9 9 5 .. .. .. .. .. 3 Diphtheria and Croup 8 .. 1 3 2 1 .. .. .. 6 Influenza 24 .. .. 1 1 .. 7 10 5 .. Erysipelas 6 .. 1 .. .. .. 4 .. 1 3 Phthisis (Pulmonary Tuberculosis^ 136 1 .. 3 3 20 .. 33 8 27 Tuberculous Meningitis 15 2 2 5 5 .. 1 .. .. 4 Other tuberculous diseases 14 3 3 1 2 .. 1 1 3 2 Cancer, malignant disease 159 .. .. 1 2 2 7 75 62 29 Rheumatic Fever 12 1 .. .. 1 3 3 4 .. 1 Meningitis (d) 13 1 5 2 4 .. 1 .. .. 2 Organic Heart Disease 150 1 1 .. 8 6 14 47 73 Bronchitis 132 22 1 3 1 .. 3 24 78 15 Pneumonia (all forms) 126 39 23 10 4 2 17 20 11 18 Other diseases of Respiratory organs 27 1 .. 2 .. .. 0 7 14 5 Diarrhtea and Enteritis (e) 66 45 7 2 .. 3 2 5 2 7 Appendicitis and Typhlitis 13 .. .. .. .. 3 3 3 4 2 Cirrhosis of Live 16 .. .. .. .. .. 4 7 5 5 Alcoholism 4 .. .. .. .. .. 3 1 .. 3 Nephritis and Bright's Disease 47 1 .. .. .. .. 6 21 19 10 Puerperal Fever 2 .. .. .. .. .. 2 .. .. .. Other Accidents and Diseases of Pregnancy and Parturition 7 .. .. .. .. 1 6 .. .. 1 Congenital Debility and Malformation, including Premature Birth 125 122 2 1 .. .. .. .. .. 5 Violent Deaths, excluding Suicide 53 8 4 5 7 4 .. 7 1 .. Suicide 20 .. .. .. .. 3 6 9 2 .. Other Defined Diseases 398 57 5 9 15 14 49 83 166 87 Diseases ill-defined or unknown .. 1 .. .. .. .. .. .. .. 1677 325 94 77 66 63 234 358 460 284 SubEntries. included in above figures. Cerebro-spinal Meningitis 1 .. .. .. 1 .. .. .. .. .. Poliomyelitis 1 1 .. .. .. .. .. .. .. .. M NOTES TO TABLE III. The classification of Causes of Death are those of the 44 Short List " on page XXV. of the Manual of the International List of Causes of Death. (a) All 44 Transferable Deaths " of residents, i.e., of persons dent in the District who have died outside it, are included with the other deaths in columns 2-10. Transferable deaths of non-residents, i.e., persons resident elsewhere in England and Wales who have died lin the District, are in like manner excluded from these columns. (b) All deaths -occurring in Institutions for the sick and infirm situated Within the district, whether oli residents or nonresidents, are entered in the last column of Table III. (c) All deaths certified by registered Medical Practitioners and all Inquest cases are classed as 44 Certified. "; all other deaths are regarded as 44 Uncertified." (d) Exclusive of 44 Tuberoulous Meningitis " but inclusive of Cerebrospinal Meningitis. (e) Includes deaths from Diarrhcea and Enteritis at all ages. 171 TABLE No. III a. CAUSES OF DEATH CLASSIFIED IN WARDS. Causes of Death. Willesden U. D. South Kilburn. Mid-Kilburn. North Kilburn. Brondesbury Pk. Kensal Rise. Harlesden. Stonebridge. Roundwood. Church End. Willesden Green. Cricklewood. (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12 (13) All causes Certified 1676 225 184 107 76 125 153 203 i57 148 162 X36 Uncertified i 1 Enteric Fever 4 j 1 x 1 Small Pox Measles 69 4 3 3 3 11 11 12 11 4 Scarlet Fever 7 1 2 x 1 2 Whooping Cough .. 23 1 3 1 3 5 3 2 2 Erysipelas 6 2 2 2 Phthisis (Pulmonary Tuberculosis) 136 25 21 11 3 12 9 8 10 12 16 Tuberculous Meningitis 15 3 1 1 2 3 2 1 Other Tuberculous Diseases 14 6 2 1 1 1 Cancer, malignant disease 159 20 19 9 13 16 20 12 16 6 13 15 Rheumatic Fever 12 i 1 1 2 2 1 3 1 Meningitis 13 3 3 1 1 Organic Heart Disease 150 22 13 10 13 13 14 19 14 12 12 8 Pneumonia (all forms) 132 126 15 21 m '4 11 4 5 *4 7 11 12 16 20 7 8 16 8 12 16 11 Other Diseases of Respiratary Organs- 27 2 1 3 2 2 7 3 2 Diarrhoea and Enteritis 66 ii 1 3 7 4 15 11 10 x 3 Appendicitis and Typhlitis 13 i 1 1 1 1 2 1 2 1 2 Cirrhosis of Liver 16 2 2 2 1 3 2 2 1 1 Alcoholism 4 i 1 1 1 Nephritis and Bright's Disease.. 47 4 7 4 3 5 5 6 3 1 7 2 Puerperal Fever 2 Other Accidents and Diseases of Pregnancy and Parturition 7 2 1 1 2 1 Congenital Debility and Malformation, including Premature Birth 125 'I 1.3 3 3 7 10 23 19 15 7 12 Violent Deaths, excluding Suicide 53 8 4 3 2 3 1 12 3 3 10 4 Suicide 20 1 5 2 1 1 2 1 3 4 Other Defined Diseases 398 S2 47 30 17 20 43 38 31 40 3^ 42 Diseases ill-defined or unknown.. 1 i 1677 225 184 107 76 125 153 204 157 148 162 X36 Sub- Cerebro-spinal Meningitis 1 i .. .. .. .. .. .. .. .. .. .. Entries, included in above figures Poliomyelitis 1 .. .. .. .. 1 .. .. .. .. .. .. 172 TABLE IIIB.—RATES PER i,ooo POPULATION, YEAR 1913. CAUSES OF DEATH. Willesden U. D. South Kilburn. Mid.Kilburn. North Kilburn. Biondesbury Pk. Kensal Rise. Harlesden. Stonebridge. Roundwood. Church End Willesden Green ! Cricklewood (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) (13) Enteric Fever 0.0244 0.0705 0.0685 0.0807 .. 0.0716 .. .. .. .. .. .. Small Pox .. .. .. .. .. .. .. .. .. .. .. .. Measles 0.4216 0.4940 0.2740 0.2423 .. 0.2148 0.1807 0.6294 0.7665 0.8580 0.6706 0.2124 Scarlet Fever 0.0427 .. .. .. .. 0.0716 0 . 1204 .. .. 0.0715 0.0609 0.1062 Whooping Cough 0.1405 0.2117 0.0685 0.2423 .. 0.0716 0.1807 0.286l 01927 .. 0.1218 0.1062 Diphtheria and Croup 0 0488 0.2I17 .. 0.0807 .. 0.0716 .. .. 0.1284 0.0715 .. .. Influenza .. 0.1466 .. 0.2740 0.1615 0.4130 0.4297 0.0602 0.0572 0.1927 0.0715 .. 0.1062 Erysipelas 0.0366.. .. .. .. .. .. 0.1204 .. 0.1284 0.1430 .. .. Phthisis (Pulmonary Tuberculosis) .. 0.8310 1.7642 1.4388 0.8886 0.3098 0.8595 0.5422 0.4577 0.6423 0.8580 0.9754 0 4780 Tuberculous Meningitis 0.0916 0.141 I 0.2055 0.0716 0.0602 O.II44 0.1927 0.1218 0.0531 Other Tuberculous Diseases 0.0855 0.2117 0.4110 0.1615 0.0602 0.0715 0.0609 Cancer, Malignant Disease 0.9716 1.4114 1.3018 0.7270 1 "3425 1.1460 I .2048 o.6866 1.0277 0..290 0.7925 0.7967 Rheumatic Fever 0 0733 0.0705 .. 0.0807 0.1032 0.1204 0.1144 0.0715 0.1829 0.0531 Meningitis 0.0794 0.3528 0.2148 0.1716 0.0715 0.0609 Organic Heart Disease 0.9:00 I.5525 0.8907 0.8078 1.3425 0.9311 0.8434 1 .0872 0.8992 0 8580 0.7316 0.4249 Bronchitis 0.8066 1.0585 0.9592 o.8886 0.8261 1 .0027 0.6626 o"9i55 0.4496 1.1440 07416 0.4249 Pneumonia (all foi ms) 07699 1 .4820 o.9592 0.3231 0.5163 0.5014 0.7229 11444 0.5138 0.5720 L.9754 0.5842 Other Diseases of Respiratory Organs 0.1649 0.2117 0.1.70 0 .0807 0.3098 0.1432 0.1204 0.4005 0.1284 0.1829 0.1062 Diarrhoea and Lnteritis 04033 0.7762 0.0685 0.2421 0.5014 0.2409 o.8;83 0.7065 0.7150 O.O6C9 0.1503 Appendicitis and Typhlitis 0.0794 0.0705 0.0685 0.0807 0.1032 0.0716 0.1204 0.0572 0.1284 0.0609 o"iot 2 Cirrhosis of Liver 0.0977 0.1411 0.1370 0.1615 0.0716 0.1807 0.1284 0.1430 0.0609 0.0531 Alchoholism 0.0244 0.0705 0.0602 0.0=72 0.0642 Nephritis and Blight.s Disease 0.2872 0.2822 0.4796 0.3231 0.3098 0.3581 0.3012 0.3433 0.1927 0.0715 0.4267 0.1062 Puerperal Fever.. 0.0122 .. .. .. .. .. .. .. 0.0642 0.0609 Other Accidents and Diseases of Pregnancy and Parturition 0.0427 0.1370 0.0572 0.0642 0.1430 0.0531 Congenital Debility and Malformation, including Premature Birth 0.7638 0.9174 0.8907 0.2423 0.3098 0.5014 0.6.24 l.3l6l 1 .2204 1.0725 0.4267 0.6373 Violent Deaths, excluding Suicide .. o.3 >38 0.5645 0.2740 0.2423 0.2065 0.2148 0.0602 o.c866 0.1927 0.2145 0.6096 0.2124 Suicide 0.1222 0.0705 0.3425 0.1615 0.0602 o.o<;72 0.1284 0.0715 0.1829 0.2I2A Other Defined Diseases 2.4321 3 6697 3 "2202 2.4236 i.7556 i"4325 2.5905 2.1745 1 .9912 2.8600 2.3167 2.2308 Diseases ill.defined or unknown o.oo61 0.0705 All Causes 10.2478 15.8786 12.6070 8.6443 7.8488 8.9535 9.2174 11.6738 10.0847 10.5820 9.8768 7.2236 173 Table IIIC. DEATHS OF WILLESDEN RESIDENTS DURING THE YEAR 1913. Tiie Detailed International List of Causes of Death as adapted for use in England and Wales CAUSE OF DEATH. All Ages. U to 1 1 to 5 5 to 10 10 to 15 15 to 20 2U to 25 25 to 35 35 to 45 45 to 55 55 to 65 05 to 75 75 to 85 85 & Up. (15) (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) (13) (14) I — General Diseases. Enteric Fever 4 ... ... ... 2 ... ... ... 1 ... ... ... ... Typhus ... ... ... ... ... ... ... ... ... ... 1 ... ... Relapsing Fever ... ... ... ... ... ... ... ... ... ... ... ... ... Malaria ... ... ... ... ... ... ... ... ... ... ... ... ... Small Pox ... ... ... ... ... ... ... ... ... ... ... ... ... Measles ... ... ... ... ... ... ... ... ... ... ... Scarlet Fever 69 - 11 49 7 ... ... ... ... 1 ... ... ... ... \\ hiinninrr ( rvnrrli 7 ... 4 ... ... ... ... 1 ... ... ... ... ... Whooping cough 23 9 14 ... ... ... ... ... ... ... ... ... ... Diphtheria 8 1 ... ... ... ... ... ... ... ... ... ... ... Influenza ... 4 ... ... ... ... ... ... ... ... ... ... Miliary Fever 24 ... 1 ... ... ... ... ...4 ...3 ... ... ... ... Asiatic Cholera ... ... ... ... ... ... ... ... ... ... ... ... ... Cholera Nostras ... ... ... ... ... ... ... ... ... ... ... ... ... Dysentery ... ... ... ... ... ... ... ... ... ... ... ... ... Plague ... ... ... ... ... ... ... ... ... ... ... ... ... Yellow Fever ... ... ... ... ... ... ... ... ... ... ... ... ... Leprosy .. ... ... ... ... ... ... ... ... ... ... ... ... ... Erysipelas ... ... ... ... ... ... ... ... ... ... ... ... Other Epidemic Diseases ... ... ... ... ... ... ... ... ... ... ... ... ... Pyaemia ... ... ... ... ... ... ... ... ... ... ... ... ... Septicaemia ... ... ... ... ... ... ... ... ... ... ... ... Vaccinia ... ... ... ... ... ... ... ... ... ... ... ... ... Glanders ... ... ... ... ... ... ... ... ... ... ... ... ... Anthrax (Splenic Fever) ... ... ... ... ... ... ... ... ... ... ... ... ... Rabies ... ... ... ... ... ... ... ... ... ... ... ... ... 174 Table IIIc.—DEATHS OF WILLESDEN RESIDENTS—continued. CAUSE OF DEATH. (1) All Ages. (2) 0 to 1 (3) 1 to 5 (4) 5 to 10 (5) 10 to 15 (6) 15 to 20 (7) 20 to 25 (8) 25 to 35 (9) 35 to 45 (10) 45 to 55 (11) 55 to 65 (12) 65 to 75 (13 75 to 85 (14) 85 & Up. (15) Tetanus 1 ... ... ... ... ... ... 1 ... ... ... ... ... ... Mycoses: Actinomycosis ... ... ... ... ... ... ... ... ... ... ... ... ... ...... Pellagra 1 ... ... ... ... ... ... ... ... 1 ... ... ... ... Beri-Beri ... ... ... ... ... ... ... ... ... ... ... ... ... ... Pulmonary Tuberculosis not acute) 89 1 1 1 ... 9 4 26 21 15 5 5 1 ... Phthisis (not acute and not defined as Tuberculosis) 41 ... 1 ... ... 2 5 10 8 8 5 ... ... ... Acute Phthisis 3 ... ... ... ... ... ... 2 ... ... ... ... 1 ... Acute Miliary Tuberculosis 3 ... 1 1 ... ... ... ... 1 ... ... ... ... ... Tuberculous Meningitis 15 2 7 3 ... ... ... ... 1 ... ... ... ... ... Tabes Mesenterica 1 ... 1 ... ... ... ... ... ... ... ... ... ... ... Other Peritoneal and Intestinal Tubercle 5 2 1 1 ... ... ... 1 ... ... ... ... ... ... Tuberculosis of Spinal Column 1 1 ... ... ... ... ... ... ... ... ... ... ... ... Tuberculosis of Joints 2 ... ... ... ... ... ... ... ... ... ... 2 ... ... Tuberculosis of other organs 3 ... ... ... 1 ... ... ... ... 1 ... 1 ... Disseminated Tuberculcsis 2 ... 2 ... ... ... ... ... ... ... ... ... ... ... Rickets, Softening of Bones 3 3 ... ... ... ... ... ... ... ... ... ... ... ... Syphilis 7 4 ... ... ... ... ... 1 ... 1 ... ... ... ... Other Veneral Diseases ... ... ... ... ... ... ... ... ... ... ... ... ... ... Cancer of Buccal Cavity 11 ... ... ... ... 1 ... ... 1 5 1 1 2 ... Cancer of the Stomach, Liver, &c. 53 ... ... ... ... ... ... ... 4 9 12 19 8 1 Cancer of Peritoneum, Intestines and Rectum 30 ... ... ... ... ... ... ... 3 7 9 5 5 ... Cancer of the Female Genital Organs 18 ... ... ... ... ... ... ... 3 5 4 3 2 ... Cancer of the Breast 20 ... ... ... ... ... ... ... 3 7 3 5 2 ... Cancer of the Skin ... ... ... ... ... ... ... ... ... ... ... ... ... ... Cancer of other or unspecified organs 27 ... ... ... ... ... ... ... ... 6 7 6 2 ... Other Tumours (situation undefined) 2 ... ... ... ... ... ... ... 1 1 ... ... ... ... Rheumatic Fever 12 1 1 ... 3 ... 3 ... 2 2 ... ... ... Chronic Rheumatism ... ... ... ... ... ... ... ... ... ... ... ... ... ... Osteo-Arthritis 5 ... ... ... ... ... ... ... ... ... ... 4 1 ... 175 Table IIIc—DEATHS OF WILLESDEN RESIDENTS—continued. Gout 1 ... ... ... ... ... ... ... ... ... 1 ... ... ... Scurvy 1 ... ... ... ... ... ... ... 1 ... ... ... ... ... Diabetes 17 ... ...... 2 ... 1 ... 1 1 1 2 7 2 ... Exophthalmic Goitre 1 ... ... ... ... ... ... ... ... ... ... ... ... ... Addisons Disease 2 ... ... ... ... ... 1 ... 2 ... ... ... ... ... Leucocythoemia (Leuchoemia) 4 ... ... 1 ... ... ... 1 ... 2 ... ... ... ... Lymphadenoma ... ... ... ... ... ... ... ... ... ... ... ... ... ... Anaemia, Chlorosis 3 ... 1 ... ... 1 ... ... 1 ... ... ... ... ... Other General Diseases 4 ... 4 ... ... ... ... ... ... ... ... ... ... ... Alcholism (Acute or Chronic) 4 ... ... ... ... ... ... ... ... ... ... ... ... ... Chronic Lead Poisoning 1 ...... ... ... ... ... ... 3 ... ... 1 ... ... ... Other Chronic Occupational Poisoning ... ... ... ... ... ... ... ... ... ... 1 ... ... ... Other Chronic Poisoning ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2. —Diseases of the Nervous System and of the Organs of Special Sense. Encephalitis 1 ... ... ... ... ... 1 ... ... ... ... ... ... Cerebro-spinal Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... Posterior Basal Meningitis 1 ... 1 ... ... ... ... ... ... ... ... ... ... ... Meningitis, other forms 12 1 6 3 1 ... ... 1 ... ... ... ... ... ... Locomotor Ataxy 3 ... ... ... ... ... ... ... 1 1 1 ... ... ... Other Diseases of the Spinal Cord 10 1 ... ... ... ... ... 1 ... 1 3 3 1 ... Apoplexy 14 ... ... ... ... ... ... ... 1 3 5 2 3 ... Serous Apoplexy and Oedema of Brain ... ... ... ... ... ... ... ... ... ... ... ... ... ... Cerebral Congestion 1 ... ... ... ... ... ... ... 1 ... ... ... ... ... Cerebral Atheroma ... ... ... ... ... ... ... ... ... ... ... ... ... ... Cerebral Haemorrhage 48 ... ... ... ... ... ... 1 7 6 10 15 8 1 Softening of Brain 4 ... ... ... ... ... ... ... ... ... 2 1 1 ... Hemiplegia 7 ... ... ... ... ... ... ... ... ... ... 4 2 1 Paraplegia ... ... ... ... ... ... ... ... ... ... ... ... ... ... Other Forms of Paralysis 3 ... 1 ... 1 ... ... ... ... ... 1 ... ... ... General Paralysis of the Insane 6 ...... ... ... ... ... ... ... 5 1 ... ... ... ... Other Forms of Mental Alienation 2 ... ... ... ... ... ... 1 ... 1 ... ... ... ... 176 Table IIIc.— DEATHS OF WILLESDEN RESIDENTS—continued. CAUSE OF DEATH. (1) All Ages. (2) 0 to 1 (3) 1 to 5 (4) 5 to 10 (5) 10 to 15 (6) 15 to 20 (7) 20 to 25 (8) 25 to 35 (9) 35 to 45 (10) 45 to 55 (11) 55 to 65 (12) 65 to 75 (13) 75 to 85 (14) 85 & Up. (15) Epilepsy 11 ... ... ... ... 2 2 2 1 1 ... 3 ... ... Convulsions (non puerperal; 5 years and over) 3 ... ... 1 ... ... ... ... ... 1 ... 1 ... ... Infantile Convulsions under 5, with teething 4 3 1 ... ... ... ... ... ... ... ... ... ... ... Other Infantile Convulsions under 5 21 20 1 ... ... ... ... ... ... ... ... ... ... ... Chorea ... ... ... ... ... ... ... ... ... ... ... ... ... ... Hysteria, Neuralgia, Neuritis 1 ... ... ... ... ... ... ... 1 ... ... ... ... ... Idiocy, Imbecility 1 ...... ... ... ... ... ... ... ... 1 ... ... ... Cretinism ... ... ... ... ... ... ... ... ... ... ... ... ... ... Cerebal Tumour 2 ... ... ... ... ... ... ... ... 1 ... ... ... ... Other Diseases of the Nervous System 2 ... ... ... ... ... 1 ... ... ... ... ... 1 ... Diseases of the Eyes and Annexa ... ... ... ... ... ... ... ... ... ... ... ... ... ... Mastoid Disease 3 ... ... 1 1 1 ... ... ... ... ... ... ... ... Other Diseases of the Ears 7 ... 1 1 ... ... 1 2 ... 2 ... ... ... ... 3. —Diseases of the Circulatory System. Pericarditis 3 ... 1 1 1 ... ... ... ... ... ... ... ... ... Acute Myocarditis 3 ... ... 1 ... ... 1 ... ... 1 ... ... ... ... Infective Endocarditis 4 ... ... 1 ... 1 ... ... ... 1 1 ... ... ... Other Acute Endocarditis ... ... ... ... ... ... ... ... ... ... ... ... ... ... Valvular Disease 57 ... ... 2 2 ... 2 3 5 4 15 13 9 2 Fatty Degeneration of Heart 9 ... ... ... ... ... ... ... ... 3 1 2 3 ... Other Organic Disease of the Heart 84 ... 1 1 3 2 2 1 5 10 14 31 11 2 Angina Pectoris 3 ... ... ... ... ... ... ... ... ... 1 1 1 ... Aneurysm 1 ... ... ... ... ... ... ... ... 1 ... ... ... ... Arterial Sclerosis 8 ... ... ... ... ... ... ... ... ... ... 2 6 ... Other Diseases of Arteries ... ... ... ... ... ... ... ... ... ... ... ... ... ... Cerebral Embolism and Thrombosis 6 ... ... ... ... ... ... 1 2 ... ... ... 2 1 Other Embolism and Thrombosis 2 1 ... ... ... ... ... ... 1 ... ... ... ... ... 177 Table IIIc.—DEATHS OF WILLESDEN RESIDENTS—continued. Diseases of the Veins (Varices, Hemorrhoids, Phlebitis, &c. ... ... ... ... ... ... ... ... ... ... ... ... ... ... Status Lymphaticus ... ... ... ... ... ... ... ... ... ... ... ... ... ... Other Diseases of the Lymphatic System ... ... ... ... ... ... ... ... ... ... ... ... ... ... Hcemorrhage ; other Diseases of the Circulating System ... ... ... ... ... ... ... ... ... ... ... ... ... ... 4. —Diseases of the Respiratory System. Diseases of the Nasal Fossae ... ... ... ... ... ... ... ... ... ... ... ... ... ... Diseases of the Larynx 2 1 1 ... ... ... ... ... ... ... ... ... ... ... Diseases of the Thyroid Body 2 ... ... ... ... ... ... ... ... ... 1 1 ... ... Bronchitis 132 22 4 1 ... ... ... 1 2 9 15 32 34 12 Broncho-Pneumonia 49 24 17 1 ... ... ... ... 1 1 2 1 1 1 Lobar Pneumonia 22 ... 6 ... ... ... ... 3 4 4 2 ... 2 ... Pneumonia (type not stated) 55 15 10 1 ... ... ... 5 4 3 8 5 1 ... Empyema 1 ... ... ... ... ... ... ... ... ... 1 ... ... ... Other Pleurisy 1 ... ... ... ... ... ... ... ... ... ... ... 1 ... Pulmonary Apoplexy and Infarction ... ... ... ... ... ... ... ... ... ... ... ... ... ... Pulmonary Oedema and Congestion 7 ... ... ... ... ... ... ... 2 ... 1 2 1 1 Hypostatic Pneumonia 2 ... ... ... ... ... ... ... ... ... ... ... 2 ... Collapse of Lung (3 months and over) ... ... ... ... ... ... ... ... ... ... ... ... ... ... Gangrene of the Lung ... ... ... ... ... ... ... ... ... ... ... ... ... ... Asthma 11 ... 1 ... ... ... ... ... 1 ... 4 2 3 ... Pulmonary Emphysema ... ... ... ... ... ... ... ... ... ... ... ... ... ... Fibroid Disease of Lung ... ... ... ... ... ... ... ... ... ... ... ... ... ... Other Disease of the Respiratory System 1 ... ... ... ... ... ...... ... ... ... ... 1 ... ... 5.—Diseases of the Digestive System. Diseases of the Teeth and Gums 1 ... ... ... ... ... ... ...... ... ... 1 ... ... ... Other Diseases of the Mouth and Annexa ... ... ... ... ... ... ... ... ... ... ... ... ... ... Diseases of Pharynx Tonsillitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... Diseases of Oesophagus ... ... ... ... ... ... ... ... ... ... ... ... ... ... Perforating Ulcer of Stomach 13 ... ... ... ... ... ... 2 2 5 2 2 ... ... Inflammation of Stomach 7 2 ... 1 ... ... ... ... 1 ... ... 1 2 ... 178 Table IIIc.—DEATHS OF WILLESDEN RESIDENTS—continued. CAUSE OF DEATH. (1) All Ags. (2) 0 to 1 (3) 1 to 5 (4) 5 to 10 (5) 10 to 15 (6) 15 to 20 (7) 20 to 25 (8) 25 to 35 (9) 35 to 45 (10) 45 to 55 (11) 55 to 65 (12) 65 to 75 (13) 75 to 85 (14) 85 & Up. (15) Other Diseases of the Stomach 2 ... ... ... ... ... ... ... ... 1 ... ... 1 ... Infective Enteritis 20 15 4 ... ... ...... ... 1 ... ... ... ... ... Diarrhoea, not returned as infective 20 15 2 ... ... 2 ... ... ... ... ... ... 1 ... Enteritis, not returned as infective 8 5 1 ... ... 1 ... ... ... ... 1 ... ... ... Gastro-Enteritis, not returned as infective 14 10 2 ... ... ... ... ... ... ... 2 ... ... ... Dyspepsia, under 2 years ... ... ... ... ... ... ... ... ... ... ... ... ... ... Colic ... ... ... ... ... ... ... ... ... ... ... ... ... ... Ulceration of Intestines ... ... ... ... ... ... ... ... ... ... ... ... ... ... Duodenal Ulcer 4 ... ...... ... ... ... ... ... 1 ... 1 ... ... ... Ankylostomiasis ... ... ... ... ... ... ... ... ... ... ... ... ... ... Other Intestinal Parasites ... ... ... ... ... ... ... ... ... ... ... ... ... ... Appendicitis 13 ... ... ... ... 1 2 3 ... 1 2 2 2 ... Hernia 7 ... ... ... ... ... ... ... 1 ... 1 5 ... ... Intestinal Obstruction 12 ... ... ... ... ... ... ... 1 ... 3 3 ... ... Other Diseases of the Intestines 3 ... ... ... ... ... ... ... 2 ... ... ... ... ... Acute Yellow Atrophy of Liver ... ... ... ... ... ... ... ... ... ... ... ... ... ... Hydatid of Liver ... ... ... ... ... ... ... ... ... ... ... ... ... ... Cirrhosis of Liver (not returned as alcoholic) 13 ... ... ... ... ... ... ... 2 ... 2 2 2 ... Cirrhosis of Liver (returned as alcoholic) 2 ... ... ... ... ... ... ... ... ... 2 ... ... ... Diseases formerly classed to "Other Diseases of Liver and Gall Bladder" 1 ... ...... ... ... ... ... ... ... ... 1 ... ... Biliary Calculi 2 ... ... ... ... ... ... ... ... ... ... 1 ... ... Other Diseases of the Liver 3 ... ... ... ... ... ... ... ... ... ... 1 1 1 Diseases of the Spleen ... ... ... ... ... ... ... ... ... ... ... ... ... ... Peritonitis (cause unstated) 1 ... ... ... ... ... ... ... ... ... 1 ... ... ... Other Diseases of the Digestive System 1 ... ... ... ... ... ... ... ... 1 ... ... ... ... 179 Table IIIc.—DEATHS OF WILLESDEN RESIDENTS—continued. 6. —Non- Venereal Diseases of the Genito- Urinary System and Annexa. Acute Nephritis 4 1 ... ... ... ... ... 1 ... ... ... 1 1 ... Brights Disease as in 1901 list 35 ... ... ... ... ... ... ... 5 6 9 8 7 ... Nephritis (unqualified), 10 years and over, uraemia 8 ... ... ... ... ... ... ... ... 4 2 2 ... ... Chyluria ... ... ... ... ... ... ... ... ... ... ... ... ... ... Other Diseases of Kidney and Annexa 1 ... ... ... ... ... ... ... ... ... ... ... 1 ... Calculi of the Urinary Passages ... ... ... ... ... ... ... ... ... ... ... ... ... ... Diseases of the Bladder 1 ... ... ... ... ... ... ... ... ... 1 ... ... ... Diseases of the Urethra, Urinary Abscess, &c. 1 ... ... ... ... ... ... ... ... ... 1 ... ... ... Diseases of the Prostrate 2 ... ... ... ... ... ... ... ... ... 1 ... 1 ... Non-venereal Diseases of Male Genital Organs ... ... ... ... ... ... ... ... ... ... ... ... ... ... Uterine Hoemorrhage (non-puerperal) ... ... ... ... ... ... ... ... ... ... ... ... ... ... Uterine Tumour (non-cancerous) 1 ... ... ... ... ... ... ... ... 1 ... ... ... ... Other Diseases of the Uterus 2 ... ... ... ... ... ... ... ... ... 1 ... ... ... Ovarian Cyst Tumour (non-cancerous) ... ... ... ... ... ... ... ... ... ... ... ... ... ... Other Diseases of the Female Genital Organs 1 ... 1 ... ... ... ... ... ... ... ... ... ... ... Non-puerperal Diseases of the Breast (non-cancerous) ... ... ... ... ... ... ... ... ... ... ... ... ... ... 7. — The Puerperal State. Abortion 1 ... ... ... ... ... ... 1 ... ... ... ... ... ... Hœmorrhage of Pregnancy ... ... ... ... ... ... ... ... ... ... ... ... ... ... Uncontrollable Vomiting ... ... ... ... ... ... ... ... ... ... ... ... ... ... Ectopic Gestation ... ... ... ... ... ... ... ... ... ... ... ... ... ... Other Accidents of Pregnancy ... ... ... ... ... ... ... ... ... ... ... ... ... Puerperal Hœmorrhage 2 ... ... ... ... ... ... 1 1 ... ... ... ... ... Other Accidents of Childbirth 3 ... ... ... ... ... 1 2 ... ... ... ... ... ... Puerperal Fever 2 ... ... ... ... ... ... 2 ... ... ... ... ... ... Puerperal Albuminuria and Convulsions ... ... ... ... ... ... ... ... ... ... ... ... ... ... Puerperal Phlegmasia Alba Dolens and Phlebitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... Puerperal Embolism and Sudden Death ... ... ... ... ... ... ... ... ... ... ... ... ... ... Puerperal Insanity 1 ... ... ... ... ... ... ... 1 ... ... ... ... ... Puerperal Diseases of the Breast ... ... ... ... ... ... ... ... ... ... ... ... ... ... 180 Table IIIc.— DEATHS OF WILLESDEN RESIDENTS —continued. CAUSE OF DEATH. (1) All Ages. (2) 0 to 1 (3) 1 to 5 (4) 5 to 10 (5) 10 to 15 (6) 10 to 20 (7) 20 to 25 (8) 25 to 35 (9) 35 to 45 (10) 45 to 55 (11) 50 to 65 (12) 65 to 75 (13) 75 to 85 (14) 80 & Up. (15) 8.—Diseases of ike Skin and of the Cellular Tissue. Senile Gang ene 2 ... ... ... ... ... ... ... ... ... ... 1 ... 1 Gangrene, other types ... ... ... ... ... ... ... ... ... ... ... ... ... ... Carbuncle Boil 1 1 ... ... ... ... ... ... ... ... ... ... ... ... Phlegmon, Acute Abscess 5 1 ... ... ... ... ... ... ... 1 1 1 1 ... Ulcer, Bedsore ... ... ... ... ... ... ... ... ... ... ... ... ... ... Eczema 3 2 ... ... ... ... ... ... ... ... ... ... 1 ... Pemphigus ... ... ... ... ... ... ... ... ... ... ... ... ... ... Other Diseases of the Integumentary System ... ... ... ... ... ... ... ... ... ... ... ... ... ... 9.—Diseases of the Bones and of the Organs of Locomotion. Diseases of the Bones 3 ... 1 ... 1 ... 1 ... ... ... ... ... ... ... Diseases of the Joints ... ... ... ... ... ... ... ... ... ... ... ... ... ... Amputations ... ... ... ... ... ... ... ... ... ... ... ... ... ... Other Diseases of the Locomotor System ... ... ... ... ... ... ... ... ... ... ... ... ... ... 10. —Malformations. Congenital Hydrocephalus 2 ... 2 ... ... ... ... ... ... ... ... ... ... ... Phimosis ... ... ... ... ... ... ... ... ... ... ... ... ... ... Congenital Malformation of Heart 4 3 1 ... ... ... ... ... ... ... ... ... ... ... Other Congenital Malformations 8 8 ... ... ... ... ... ... ... ... ... ... ... ... 11.—Diseases of Early Infancy. Premature Birth 75 75 ... ... ... ... ... ... ... ... ... ... ... ... Infantile Atrophy, Debility and Marasmus 32 32 ... ... ... ... ... ... ... ... ... ... ... ... 181 Table IIIc.— DEATHS OF WILLESDEN RESIDENTS—continued. Icterus Neonatorum 3 3 ... ... ... ... ... ... ... ... ... ... ... ... Sclerema and Oedema Neonatorum ... ... ... ... ... ... ... ... ... ... ... ... ... ... Want of Breast Milk 1 1 ... ... ... ... ... ... ... ... ... ... ... ... Diseases of Umbilicus, &c. ... ... ... ... ... ... ... ... ... ... ... ... ... ... Atelectasis 13 13 ... ... ... ... ... ... ... ... ... ... ... ... Injuries at Birth 4 4 ... ... ... ... ... ... ... ... ... ... ... ... Cyanosis Neonatorum ... ... ... ... ... ... ... ... ... ... ... ... ... ... Lack of Care ... ... ... ... ... ... ... ... ... ... ... ... ... ... 12.—Old Age. Old Age 69 ... ... ... ... ... ... ... ... ... 4 15 29 21 13.—Affections Produced by External Causes. Suicide by Poison 5 ... ... ... ... ... 1 ... 1 ... 2 1 ... ... Suicide by Asphyxia 1 ... ... ... ... ... ... ... 1 ... ... ... ... ... Suicide by Hanging or Strangulation 4 ... ... ... ... 1 ... ... ... 2 1 ... ... ... Suicide by Drowning 2 ... ... ... ... ... ... ... 1 ... ... 1 ... ... Suicide by Firearms 2 ... ... ... ... ... ... ... ... 2 ... ... ... ... Suicide by Cutting or Piercing Instruments 1 ... ... ... ... ... ... ... 1 ... ... ... ... ... Suicide by Jumping from High Place ... ... ... ... ... ... ... ... ... ... ... ... ... ... Suicide by Crushing 5 ... ... ... ... ... 1 1 1 1 1 ... ... ... Other Suicides ... ... ... ... ... ... ... ... ... ... ... ... ... ... Poisoning by Food ... ... ... ... ... ... ... ... ... ... ... ... ... ... Other Acute Poisonings 1 ... ... ... ... ... ... ... ... 1 ... ... ... ... Conflagration ... ... ... ... ... ... ... ... ... ... ... ... ... ... Burns (conflagration excepted) 9 ... 4 ... 1 1 ... ... 1 1 ... 1 ... ... Absorption of Deleterious Gases (conflagration excepted) 7 6 ... ... ... ... ... 1 ... ... ... ... ... Accidental Drowning 5 ... ... 2 2 ... ... ... 1 ... ... ... ... ... Injury by Firearms ... ... ... ... ... ... ... ... ... ... ... ... ... ... Injury by Cutting or Piercing Instruments 1 ... ... ... ... ... ... ... 1 ... ... ... ... ... Injury by Fall 7 ... 1 ... ... ... ... ... 1 ... 2 1 2 ... Injury in Mines and Quarries ... ... ... ... ... ... ... ... ... ... ... ... ... ... 182 Table IIIc.—DEATHS OF WILLESDEN RESIDENTS—continued. CAUSE OF DEATH. (1) All Ages. (2) 0 to 1 (3) 1 to 5 (4) 5 to 10 (5) 10 to 15 (6) 15 to 20 (7) 20 to 25 (8) 25 to 35 (9) 35 to 45 (10) 15 to 55 (11) 55 to 65 (12) 65 to 75 (13) 75 to 85 (14) 85 & Up. (15) Injury by Machines ... ... ... ... ... ... ... ... ... ... ... ... ... ... Injury by Other Crushing, Vehicles, Railways, Landslides,&c. 16 ... ... 1 ... 2 1 2 3 3 ... 1 ... ... Injury by Animals ... ... ... ... ... ... ... ... ... ... ... ... ... ... Starvation ... ... ... ... ... ... ... ... ... ... ... ... ... ... Excessive Cold ... ... ... ... ... ... ... ... ... ... ... ... ... ... Effect of Heat ... ... ... ... ... ... ... ... ... ... ... ... ... ... Lightning ... ... ... ... ... ... ... ... ... ... ... ... ... ... Electricity (lightning excepted) ... ... ... ... ... ... ... ... ... ... ... ... ... ... Homicide by Firearms ... ... ... ... ... ... ... ... ... ... ... ... ... ... Homicide by Cutting or Piercing Instruments 2 1 ... 1 ... ... ... ... ... ... ... ... ... ... Homicide by Other Means 1 1 ... ... ... ... ... ... ... ... ... ... ... ... Fractures (cause not specified) 2 ... ... ... ... ... ... ... ... ... ... 1 1 ... Other Violence 2 ... 1 ... ... ... ... ... 1 ... ... ... ... ... 14.—Ill-defined Causes. Dropsy ... ... ... ... ... ... ... ... ... ... ... ... ... ... Syncope (aged 1 year and under 70) ... ... ... ... ... ... ... ... ... ... ... ... ... ... Sudden Death (not otherwise defined) ... ... ... ... ... ... ... ... ... ... ......... ... ... ... Heart Failure (aged 1 year and under 70) ... ... ... ... ... ... ... ... ... ... ... ... ... ... Atrophy, Debility, Marasmus (aged 1 year and under 70) 1 ... 1 ... ... ... ... ... ... ... ... ... ... ... Teething ... ... ... ... ... ... ... ... ... ... ... ... ... ... Pyrexia ... ... ... ... ... ... ... ... ... ... ... ... ... ... Other Ill-defined Deaths ... ... ... ... ... ... ... ... ... ... ... ... ... Cause not Specified ... ... ... ... ... ... ... ... ... ... ... ... ... ... Totals 1677 325 171 43 23 34 29 99 135 165 193 238 175 47 183 TABLE IV.—INFANTILE MORTALITY. 1913.—Nett Deaths from Stated Causes at uirious Ages under 1 Year of Age. Cause of Death. Under 1 week. 1-2 Weeks. 2-3 Weeks. 3-4 Weeks. Total under 4 Weeks. 4 Weeks and under 3 Months. 3 Months and under 6 Months. 6 Months and under 9 Months. 9 Months and under 12 Months. Total Deaths under One Year. (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) All causes Cerrified 78 20 17 13 128 57 51 42 47 325 Uncertified .. .. .. .. .. .. .. .. .. .. Small-pox .. .. .. .. .. .. .. .. .. .. Chicken-pox .. .. .. .. .. .. .. .. .. .. Measles .. .. .. .. .. .. .. 2 8 11 Scarlet Fever .. .. .. .. .. .. .. .. .. .. Whooping Cough .. .. .. .. .. .. .. 4 2 9 Diphtheria and Croup .. .. .. .. .. .. .. 1 .. 1 Erysipelas .. .. .. .. .. .. .. .. .. .. Tubeiculous Meningitis .. .. .. .. .. .. .. 1 1 2 Abdominal Tuberculosis .. .. .. .. .. .. 2 .. .. 2 Other Tuberculous Dis. .. .. .. .. .. .. .. 1 1 2 Meningitis (not Tuberculous) .. .. .. .. .. .. 1 .. .. 1 Convulsions .. .. .. .. .. .. .. .. .. .. Laryngitis .. .. .. .. .. .. .. .. 1 1 Bronchitis .. .. .. .. .. 8 2 7 3 22 Pneumonia (all forms,) .. .. .. .. .. 10 7 11 11 39 Diarrhœa .. .. .. .. .. 6 3 2 4 15 Enterits .. .. .. .. .. 5 13 5 6 30 Gastritis .. .. .. .. .. .. .. 1 1 2 Syphilis .. .. .. .. .. 3 .. .. 1 4 Rickets .. .. .. .. .. .. .. 2 1 3 Suffocation, overlying 1 .. .. 1 2 3 1 .. .. 6 Atelectasis 11 2 .. .. 13 .. .. .. .. 13 Congenital Malformations 3 .. .. 1 4 5 2 .. .. 11 Premature birth 45 13 7 5 70 1 4 .. .. 75 Atrophy, Debility and Marasmus 7 1 6 5 19 9 6 1 1 35 Acute Poliomyelitis .. .. .. .. .. .. .. .. 1 1 Dentitition (Convulsions) .. .. .. .. .. .. .. 2 1 3 Convulsions 6 3 2 .. 11 5 4 .. .. 20 Cardiac Thrombosis (Septic) .. .. .. .. .. 1 .. .. .. 1 Intestinal Obstruction .. .. .. .. .. .. .. 1 1 2 Carbuncle .. .. .. .. .. .. 1 .. .. 1 Cellutitis .. .. .. .. .. .. 1 .. .. 1 Eczema .. .. .. .. .. .. .. 1 1 2 Injuries at birth 3 .. .. .. 4 .. .. .. .. 4 Wilful Murder 2 .. .. .. 2 .. .. .. .. 2 Rheumatism .. .. .. .. .. .. .. .. 1 1 Organic Heart Disease .. .. .. .. .. .. .. .. 1 .. Nephritis .. .. .. .. .. .. 1 .. .. 1 78 20 17 13 128 57 51 42 47 325 Nett Births in the year legitimate 3.905 Nett Death in the year of legitimate infants 306 illegitimate 132 illegitimate infants 19 184 TABLE IVA.—INFANTILE MORTALITY. 1913.—Nett Deaths from all Causes under one year of age classified in Wards. CAUSE OF DEATH. WARDS. South Kilburn. Mid Kilburn. North Kilburn. Brondesbury Park. Kensal Rise. Harlesden. Stonebridge. Roundwood. Church End. Willesden Green. Cricklewood. Total for District. (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) (13) All Causes Certified 43 27 12 6 l6 24 6l 41 43 30 22 325 Uncertified .. .. .. .. .. .. .. .. .. .. .. .. Small Pox .. .. .. .. .. .. .. .. .. .. .. .. Chicken Pox .. .. .. .. .. .. .. .. .. .. .. .. . Measles .. .. .. .. .... 1 2 2 3 1 1 11 Scarlet Fever .. .. .. .. .. .. .. .. .. .... .. .. Whooping Cough .. 1 1 .. .. 3 2 1 .. .. 1 9 Diphtheria and Croup .. .. .. .. .. .. .. .. .. .. .. 1 Erysipelas .. .. .. .. .. .. .. .. .. .. .. .. Tuberculous Meningitis .. 1 .. .. .. .. 1 .. .. .. .. 2 Abdominal Tubercultosis 1 1 .. .. .. .. .. .. .. .. .. 2 Other Tuberculous Diseases .. 1 .. .. .. .. 1 .. .. .... .. 2 Meningitis (not Tuberculous) 1 .. .. .. .. .. .. .. .. .. .. 1 Convulsions .. .. .. .. .. .. .. .. .. .. .. .. Laryngitis .. .. .. .. .. .. 1 .. .. .. .. 1 Bronchitis 3 1 .. .. .. 1 2 4 4 4 1 22 Pneumonia (all forms) 6 3 2 2 .. 3 10 .. 1 9 3 39 Diarrhœa 1 .. 1 .. 1 .. 3 2 7 .. .. 15 Enteritis 9 1 1 .. .. .. 7 7 1 1 1 30 Gastritis .. 1 .. .. .. .. 1 .. .. .. .. 2 Syphilis 2 .. .. .. 1 .. 1 .. .. .. .. 4 Rickets .. 2 .. .. 1 .. .. .. .. .. .. 3 185 TABLE IVa.—INFANTILE MORTALITY, 1913. continued. Suffocation (overlying) 3 .. .. .. .. .. 2 .. 1 .. .. 6 Atelectasis .. 3 1 .. .. 1 .. .. 6 2 .. 13 Congenital Malformations 2 3 .. .. .. 2 .. 3 .. .. 1 11 Pren.ature Birth 6 7 2 .. 6 5 14 8 13 4 .. 75 Atrophy, Debility and Marasmus 5 3 1 .. 1 3 9 7 2 2 .. 36 Acute Poliomyelitis .. .. .. .. 1 .. .. .. .. .. .. .. Dentition Convulsions .. .. .. .. .. .. .. 2 1 .. .. .. Convulsions 1 .. 3 .. .. 3 3 2 4 3 1 20 Cardiac Thrombosis (septic) .. .. .. .. .. .. .. .. .. 1 .. 1 Intestinal Obstruction .. .. .. .. .. .. .. .. .. .. 1 2 Carbuncle .. .. .. .. .. .. 1 .. .. .. .. 1 Cellulitis .. .. .. .. 1 .. .. .. .. .. .. .. Eczema .. .. .. .. .. .. .. .. .. 2 .. 2 Injuries at Birth .. .. .. 1 .. 1 .. 1 .. .. 1 4 Wilful Murder .. .. .. .. .. .. .. 1 .. .. 1 2 Rheumatism .. .. .. .. .. .. .. .. .. 1 .. 1 Organic Heart Disease .. .. .. .. .. .. 1 .. .. .. .. 1 Nephritis .. .. .. .. .. 1 .. .. .. .. .. 1 Total 43 27 12 6 16 24 61 41 43 30 22 325 Deaths Legitimate 40 25 12 6 16 24 58 37 37 30 21 306 Illegitimate 3 2 .. .. .. .. 3 4 6 .. 1 19 Births Legitimate 393 349 211 179 310 412 500 391 364 428 346 3883* Illegitimate 12 12 5 3 5 9 15 10 5 12 5 93* Total Births 405 361 216 182 315 421 515 401 369 440 351 3976 Infantile Mortality Rate— Legitimate 101.78 71.63 36.87 33.51 51.61 58.25 116.00 94.62 101.64 70.09 60.69 78.80 Illegitimate 250.00 166.66 0.00 0.00 0.00 0.00 200.00 400.00 1200.00 0.00 200.00 204.30 Infantile Mortality Rate 106.17 74.79 55.55 32.96 50.79 57.00 118.44 102.24 116.53 68.18 62.67 80.50 Population 14170 14595 12378 9683 13961 16599 17475 15568 13986 16402 18827 163644 *Does not'include 61 Births received from Registrar-General at end of year, 39 of which were stated to be illegitimate—no addresses given. †Not comparable owing to ex-cess of Deaths over Births registered. 186 APPENDIX B. INFANT CARE AND FEEDING.—GENERAL RULES. CLEANLINESS. Keep the baby at all times clean, dry and warm. Wash the baby's eyes once a day. If they appear red consult a doctor at once. Otherwise the baby may lose its sight. Cleanse the nipple after suckling with clean warm water. It will often save much misery. Always wash your hands and all vessels, bottles and teats used before preparing the baby's milk. Cleanse all vessels, bottles and teats again immediately after use. Don't delay. If the milk, when purchased, is dirty or shows any sediment on standing or straining, report this to the Health Visitor. Store milk in a clean, covered vessel in a clean, cool, airy place, protected from flies and dust. Comforters should not be used, as they cannot be properly cleansed, and lhe child sucks air into the stomach. Biting a bone ring does no harm. REGULARITY. Teach the child regular habits. Feed the child regularly. Put the child to sleep regularly. A young child should get plenty of sleep—15 to 18 hours every 24 hours. Teach the child to sleep alone. It is dangerous for the child to sleep in the same bed as the mother. Place the child in its cot in the bedroom at an early hour and leave it there. Do not nurse it to sleep. Take the child out regularly. Let it be warmly clad and have plenty of sunlight and fresh air. 187 Weigh the baby at regular intervals. Use purgatives only very rarely. FEEDING. A mother must be prepared to give herself up to her baby for twelve months. A mother must feed well. If she loses weight rapidly, has night sweats or feels run down, she ought to consult a doctor without any delay. Breast feeding is the best. Put the baby to the breast for five minutes every two hours until the milk comes. Feeding by breast and bottle combined is next best. Mottle feeding alone should be given only when the mother nas no milk or is in delicate health. Where bottle feeding is employed, two bottles should be in alternate use. The bottles must be boat-shaped. Do not take the babv oft the breast in August or September, or during hot weather, as fatal diarrhoea is apt to set in. The milk used must be fresh and clean. A healthy baby will empty the breast in from 10 to 15 minutes. When there is evidence that the baby is not thriving or that its bones are becoming bent or its joints enlarged, a doctor should be consulted at once. Weaning should be gradual and the baby should not have the breast after nine months if four teeth are cut, and in no case after twelve months. No solid food should be given a child until a'l its teeth have been cut (usually at the age of two years). Infants are unable to digest the food of grown up people. It acts as a poison to them. 188 Do not rock the baby after feeding. Do not sit a child up until it is able to do so—that is, until it is about five months old. Do not give soothing powders or fever powders, or any medicine, except by a doctor's orders. THE BABY'S FOOD. When a baby is fed artificially the following matters require the most careful attention :— Storage of Milk. The hands must be washed before handling the milk. As soon as milk is delivered, strain through clean, fine muslin into a clean, scalded jug. If there is any dirt in the strainings, report to the Health Visitor. Put a quantity of the strained milk (sufficient for the baby till the next delivery of milk) into a saucepan and bring slowly to the boil. Immediately the milk boils, replace it in the clean scalded jug, cover and stand in a cool place. Preparation of a feed. The hands must be washed before preparing a feed.—When a feed is to be made, add the quantity of strained boiled milk as per table on page G to the required quantity of clean boiling water in a clean, scalded jug. Add the amount of sugar of milk, which can be got from any chemist, shewn on the table on page 6. (The teaspoonfuls shou'd be small and not heaped up.) 189 The Amounts and Times of Feeding. Age of Child. Amount of mixture of milk and water to be given at each feed. When to be fed. (Whether breast fed or artificially fed). Milk previously strained and heated to boiling. Boiling water. Sugar of Milk. During day. 6 a.m. to 10 p.m. During night. 10 p.m. to 6 a.m. At end of 1 month 1 tablespoonful 3 tablespoonsful £ small Every 2 hours Every 3 hours teaspoonful ¼small 2 months 2 tablespoonsful 4 „ teaspoonful „ 3 „ „ 3 „ ½small 3 „ 4 „ 4 „ teaspoonful „ 4 „ 4 „ ¾small 4 „ 6 ,, 4 „ teaspoonful „ 4 „ 4 „ 1 small 6 „ 8 „ 4 „ teaspoonful „ 4 „ „ 4 ,, 1½ small (but not if sleeping) 7 „ 12 „ 4 „ teaspoonsful „ 14 „ Every 4 hours 2 small (but not if sleeping) 8 „ 16 „ none teaspoonsful „4 „ Every 4 hours (but not if sleeping) Take care that the baby's feed is at body heat. 190 The Bottle. The hands must be washed before handling the bottles and teats.—The bottle must be boat-shaped, and both bottle and teats must be cleansed immediately belore and after use. Feeding in the later months. At nine months, a little broth made from fresh meat, a few crumbs soaked in gravy, a little bacon fat twice a week, a little milk pudding, porridge, bread and milk or small pieces of bread and butter may be given as well as pure milk. But pure milk should still be the main food. At twelve months, a lightly boiled egg may be added. At eighteen months, a little minced meat, pounded fish, mashed potatoes with gravy or fresh broth may be given once in the day. The child should be weighed regularly during the above feeding. If the increase in weight is regular no alteration in the feeding is required. Loss of weight may be due to overfeeding with consequent vomiting or diarrhoea, or both, or to underfeeding. If the child is overfed, reduce the above quantities proportionately. If the child is underfed, increase the above quantities proportionately. Use your common sense in feeding, and obtain the responsible advice of a doctor when you are in doubt. GEORGE F. BUCHAN, m.d., d.p.h., Medical Officer of Health. 18th November, 1913. Municipal Offices, Dyne Road, Kilburn, N.W. 191 APPENDIX C. Report on the School Medical Service, including the ReOrganisation of the School Attendance Department. Municipal Offices, Dyne Road, Kilburn, N.W., 3/10/13. To the Chairman and Members of the Education Committee. Miss Lupton and Gentlemen, SCHOOL MEDICAL SERVICE. The Board of Education have recommended the appointment of two whole-time assistant medical officers instead of the existing 36 part-time assistant medical inspectors, for the following reasonsi: (1) That greater uniformity would be secured. (2) That the "following up" of cases found to be tive at routine medical inspection is, under the existing system, unsatisfactory, and would be difficult to organise efficiently. (3) That the present system is unnecessarily expensive, and the Board will not be able to pay grant at the full rate unless they are satisfied that the arrangements made for School Medical Inspection are efficient and economical. (4) That the re-organisation of the school attendance department with a view to bringing it into closer association with the School Medical Service would be facilitated. 192 (1) Lack of Uniformity. (a)—As to Results Obtained.—The lack of uniformity of School Medical Inspection under the existing system of part.time assistant school medical officers lis exemplified by the following results for 1912:— School. No. of Children Examined. No. noted as suffering from the condition indicated at the side. % Noted as suffering from the oondition indicated at the side. Adenoids 1 188 166 88.3 2 511 15 2.9 Mouth Breathers 5 525 41 7.8 2 511 8 1.5 Heart Affections 3 470 89 18.9 4 579 7 1.2 Good Nutrition 5 525 1 0.2 6 284 239 84.1 Glandular Enlargements 7 582 359 61.6 8 621 58 9.3 (b)—As to Cases Referred for "Following Up."— The following Table shews the number of children referred to the School Medical Officer during 1912 for "following up" by the Health Visitors at the homes to ascertain to what extent treatment had been secured. 193 It will be noted that the percentage of cases examined so referred varies within wide limits, viz., 45.3 per cent. and 0.0 per cent. SCHOOL. No. of Children Examined. No. Referred for "following up" at the Homes. % Referred for "following up" at the Homes. 16 B.G 130 59 45.3 25 M.I 76 31 40 .8 16 I 128 48 37.5 23 B.G 188 67 36.5 28 J.M 105 30 28.6 27 G. 137 35 25.5 8 I 280 67 23.9 1 M.I 219 52 23.7 7 S.J 276 65 23.5 26 I 182 41 22.5 21 G.I 261 55 21.1 15. B 182 38 20.9 19 I 274 55 20.1 8 M 341 66 19.3 15 G. 162 27 16.7 10 M.I 73 12 16.4 9 G.I 412 66 16.0 19 B.G 251 39 15.5 27 B. 129 19 14.7 5 B.G.I 225 31 13.7 4 B 140 18 12.8 7 I 308 35 11.3 21 B. 174 19 10.9 2 B.G.I 231 25 10.8 27 I. 242 23 9.5 24 B.G. 195 17 8.7 17 B.G.I 357 26 7.3 23 I 162 9 5.5 15 I 167 9 5.4 6 B.G 343 12 4.9 24 I 95 4 4.2 22 I. 104 4 3.8 3 B 141 5 3.5 20 G.I 341 12 3.5 11 B 96 3 3.1 13 B.G 378 9 2.4 26 M 333 8 2.4 4 G.I 293 5 1.7 14 G.I 188 3 1 .6 20 B. 129 2 1.5 6 I 236 3 1.3 13 I 204 1 0.5 12 B.G.I 245 1 0.4 22 B.G 224 1 0.4 18 M.I 110 0 0.0 9 B 143 0 0.0 11 G. 1 188 0 0.0 A certain proportion of these cases referred for "following up" at their homes as well as a number of other cases 194 which should be kept by the Assistant School Medical Officer under observation ought to be marked to be medically re-examined at a later date ; but few of these cases requiring re-examination are actually noted for later examination, and the Assistant School Medical Officer generally depends on the teacher for calling his attention subsequently to them. (c)—As to Work Performed by Teachers.—In this district the following work in connection with medical inspection is usually left to the teachers :— (1) Sending out preliminary notices to parents as to medical inspection. ('2) Keeping a record of those parents who desire to be present. (3) Informing parents desiring to be present of the day and hour of the medical inspection of their children. (-1) Filling up on the medical inspection cards the record supplied by the parent of the previous illnesses of the child. (5) Taking and recording the heights and weights of the children to be examined. (6) Making a preliminary classification of the vision of children due for medical inspection by use of sight testing cards. (7) Dressing and undressing the younger children and girls whose parents do not attend the medical inspection. (8) Handing notices to parents where the defects of children require attention. (9) Examining and re-examining verminous and nitty cases. (10) Filing the medical inspection cards and keeping records of notices sent to parents and others. 195 Some of the teachers give a great deal of their time to the above work, and all are interesied in it, but the care and accuracy with which it is done varies considerably from school to school, and this lack of uniformity ds a drawback to the efficiency of ihe School Medical Service. (d)—As to Record Keeping.—As an 'instance of the difficulty experienced in obtaining information which may be required from time to lime by the Education Committee or Board of Education, 1 may state that at the end of 1912 certain information was required by the Board for the purpose of allocating grant to the Education Committee on behalf of ihe School Medical Service. I accordingly sent out to the Assistant School Medical Officers a circular letter which I asked them to fill up so that I might have the information required. These circulars related to 75 schools and departments, but in the cases of only 17 schools and departments were full answers returned, while in 7 others only a small proportion ol the information required was not forthcoming. In the cases of the remaining 51 schools or departments, the information was either not complete or approximations were given. (2) "Following-up." It should be noted that the proceeding known as "followiing up" is of no less importance than medical inspection itself. It is adopted with the view of securing treatment for children found defective on medical examination. The steps necessary to insure the adequate "following up" of medical inspection are :— (a) To inform the parent of any defect or disease found in the child ; (b) To make inquiries, after a reasonable interval, as to whether remedy has been obtained; 196 (c) To ascertain in cases where action has not been taken, what is the reason for failure to obtain treatment ; (d) To take steps to remove obstacles in the way of children obtaining treatment; (e) To re-examine all defective children at a reasonable interval after the primary examination, in order to ascertain any change there may be in the condition oniginally noted, or the effect of any treatment received. All the above work is specially important in enabling Ihe Local Education Authority to determine to what extent treatment for school children may be required in the district. The following up of cases at their homes by Health Visitors under item 2 (b), (c) and (d) above is not effective where, as in this District, Health Visitors do not attend and assist in the actual Medical Inspection of the cases. 1'he information obtained by such enquiries should be checked by the Assistant School Medical Officers under item 2 (e) above, which 1 have already indicated is not properly carried out. (3) Cost. In comparing the cost it is necessary to consider the question in relation to the two systems when both are approximately equally efficient. (a)—Part-Time.—With regard to the existing system, in which .'36 part-time Assistant Medical Officers are employed, I was of op'nion at the end of 1912 (vide Annual Report of School Medical Officer, page 32) that four Health Visitors would require to be added to the then existing staff:— (a) To undertake the bulk of the work now performed by teachers under 1 (d) above; (b) To be present at medical inspection; (c) To render the process of following up effective on the lines indicated in 2, above. 197 '1 his would have made a staff of 10 Health Visitors composed of one chief Health Visitor wiith nine available for visiting the schools when the 36 Assistant School Medical Officers attended. The Assistant School Medical Officers visiit as follows Day of Week. Number of Assistant School Medical Officers attending. Monday, a.m. 2 9 ,, p.m 7 Tuesday, a.m. 1 12 ,, p.m 11 Wednesday, a.m. 3 11 ,, p.m 8 Thursday, a.m. 1 14 „ p.m 13 Friday, a.m 1 3 „ p.m 2 Since the end of 1912, one Health Visitor has been appointed for ringworm purposes, so that the number now to be added with the existing system can be reduced to three. But even with this staff it will be seen that a rearrangement of the days of attendance of the 36 part-time Assistant School Medical Officers would be necessary, especially as Fridays are not usually available for school medical inspections, owing to school arrangements. The following would be the cost of thiis system for purposes of comparison :— Salaries of 36 part-time assistant school medical officers for year ending June, 1912 956 6 Salaries of 3 additional health visitors 7,3240 —£414 d1280 6 * The figure for the year ending December, 1913, is estimated by the Accountant at ^995 8s. iod. The increase is due to the greater number of children on the roll for which payment is made to the assistant school medical officers at ihe rate of iod. per scholar. (b)—Whole-Time.—With regard to the system of employing two whole-time assistant school medical officers, as suggested by the Board, it will be necessary to add two health visitors. 198 The following would be the cost of this system for purposes of comparison:— Salaries of two whole-lime assistant school medical officers £6oo Salaries of two health visitors £216 —£276 £816 No. 3 of the School Medical Service Grants Regulations of the Board of Education reads as follows :— "Where, in the Board's opinion, the provision made for the School Medical Service is adequate, and its working is efficient, grant will be paid at a rate of one-half of the expenditure; in other cases the Board may either pay at a lower rate or withhold the grant." Having regard to the fact that the actual work of school medical inspection can be performed efficiently at a cost of ^816, half of which, or ^408, would be repaid by the Board of Education, it is open to question if the Board would be likely to pay, in view of their letter, a materially higher grant than this, whatever the amount paid by the Local Education Authority in the actual medical inspection of school children might Be. (4) General. In further discussion the question of whole-time or parttime assistant school medical officers, it should be borne in mind that the work of the School Medical Service is a specialised work, and it is a distinct advantage to the Education Committee to have men dealing wiith this work who proposed to devote themselves to it. Many points arise out of the Acts of Parliament and the Regulations of the Board and the Elementary School Code which are not known to the part-time Assistant School Medical Officer, and are of little interest to him, but would be of importance to the whole-time Assistant School Medical Officer intending to devote himself to the public service. 199 It should also be noted that the cost of administration in the case of the 36 part-time Officers is considerable, any directions which require to be issued having to be dictated, cyclostyled and posted with, in addition, in some cases, personal explanations or further correspondence. Such instructions to whole-time assistants would be verbally and quickly communicated, and points of difficulty arising would be personally settled. (5) Re-organisation of School Attendance Department. The work of the School Attendance Officer may be classified as follows :— (i) School Attendance. (a) Visiting- the schools to obtain the records of the children's attendances. (b) Visiting the homes to ascertain the reasons for non-attendance. (c) Attending Attendance Committee Meetings. (d) Attending Court. (ii) School Meals. (a) Visiting the homes to enquire into the social circumstances of children requiring school meals. (iii) Accommodation. (a) Inspecting the application for admission registers at the schools. (b) Preparing and revising from time to time the "fair schedule," which should contain the names of all children who ought to be attending public elementary schools in Willesden. (c) Keeping records of attendances of London children in Willesden schools and of Willesden children in London schools. 200 In connection with the above it should be noted that the bulk of the work comes under (i.) and (ii.), and that (iii.) is subsidiary to (i.) and (ii.) For example, when the homes are visited in connection with enquiries into the social circumstances of children requiring school meals an opportunity is afforded for revising the "fair schedule," and again the same opportunity arises when the homes are visited in connection with absences from school. With regard to the work of keeping records of attendances of Inter-London children it should be noted that in this district this is not an increasing but a diminishing factor. The problem therefore before the Education Committee is how best to organise the work under (i.) and (ii.) above, i.e., the work associated with school attendance and school meals, and the work under (iii.) will naturally fall into line. School Attendance.—The School Medical Officer is definitely interested in school attendance, and the Board of Education have stated that he should be in a position to supervise children absent from school on medical grounds in order that on the one hand the children may return to school as soon as they are fit to do so and on the other may not return too soon to their own detriment or that of other scholars. This view of the Board is the outcome of recent legislation, notably the Education (Administrative Provisions) Act, 1907, relating to School Medical Inspection. Prior to the passing of this Act the question of attendance at school was dealt with only by the school attendance officer, and his main concern was to get the children into school without regard to any other consideration. He was usually an untrained officer, and doubtless had a difficult task to perform without any professional assistance or advice. Under such circumstances children were often lorced into school who ought not to have been in school, and similarly children were allowed to be in school who ought properly to have been excluded. 201 The introduction of Article 53 (b) into the Education School Code of 1908 giving power to the School Medical Officer to exclude children from school for health or educational reasons, has, no doubt, still further influenced the position which the Board now take up with regard to the relationship between the School Medical Service and the School Attendance Department. In 1912 the Board of Education were in a position for the first time to give grants in respect of the School Medical Service, and in announcing the conditions on which these grants would be paid they stated in Par. 6 of Circular 792 that the arrangements made for securing co-ordination between the School Medical Service and the school attendance department would be taken into consideration in assessing the grants to be paid. In my view arrangements for such co-ordination can be made in the most effective and administratively most economical manner in Willesden by placing the school attendance officers under the direction of the School Medical Officer, so that the latter may have all necessary information required by the Board for the maximum grant, and that there may be no overlapping between the work of the school attendance officers and health visitors, to which I have already drawn the attention of the Committee in my Annual Report for 1912 on pages 13-20. Causes of Non-Attendance.—Broadly the causes of non-attendance at school may be classified as follows:— (a) Ill-health. (b) Exclusions—As a possible source of danger to other children, e.g., a doubtful case of infectious illness or contacts in cases of infectious illness. (c) Wilful detention on the part of the parent—Usually alleged to be due to ill-health or want of clothing or foot-gear. (d) Wilful absence on the part of the child. O 202 (a) Ill-health, (b) Exclusions.—These two items constitute the reasons for the bulk of non-attendance at school, and during the last year about 7,000 children, or 30 per cent. of the school population in Willesden actually came under the notice of the School Medical Officer and were officially excluded by him for one or other of these reasons as required by the Code. It ought also to be noted that the work of "following up" after medical inspection already described is almost entirely work under these two headings, and the Health Visitor in doing this work is now actually doing school attendance work, (c) Wilful detention on the part of the parent.—When this cause operates the usual excuses giiven are (a) ill-health, (b) want of clothing or feet, gear. The investigation of such excuses comes particularly within the scope of a woman's work, especially when she has had the value of a nurse's training. These three causes (a), (b) and (c) practically include all the reasons for non-attendance, as probably not five per cent. of non-attenders come within classification (d), that is, "Wilful absence on the part of the child." Overlapping. Double Visits.—At the present time much overfapping of effort takes place in connection with cases absent on account of (i) ill-health and (Li) exclusion above by reason of visits being paid to the homes both by health visitors and school attendance officers and the immediate advantage of unifying the work of health visitors and school attendance officers under the School Medical Officer would be that of restricting the number of officials visiting at the homes for one purpose or another. Multiplication of Officials.—It is indeed possible at the present time that a house may be visited by— (1) The Sanitary Inspector. (2) The Health Visitor. (3) The School Attendance Officer. Appointed by the District Council. 203 (4) The Vaccination Officer. Appointed by the (5) The Relieving Officer. j Board of Guardians. (C) The Tuberculosis Nurse. Appointed by the (7) The Midwives Inspector. County Council. Amalgamation of Officers.—It will, therefore, be noted that inspection of the public is constantly increasing, and ought to be reduced where practicable by the amalgamation of offices. It is eminently practicable to do so in connection with the work of health visitors and attendance officers, and this has, indeed, already been done in certain areas, notably in Gloucestershire, Derbyshire and Somerset with satisfactory results. It would not, of course, be possible to interfere with the existing appointments of school attendance officers, but this process of unification should be begun by putting the existing staff of school attendance officers on the staff of the School Medical Officer, and filling vacancies in their ranks as they occur by qualified health visitors. Attending Attendance Committee Meetings.—At the present time the attendance officers present cases of bad attendance at these Committee meetings. During my period of office here I have had the occasion to draw the attention of the Education Committee to cases in which the Attendance Committees ordered prosecution where on medical grounds prosecution was not, in my opinion, justifiable. This has occurred because the Attendance Committees have not had full information at their disposal. I am, therefore, of opinion that the Attendance Committees should be attended by the whole-time assistant school medical officers whom it is proposed to appoint. Under these circumstances cases summoned before the Attendance Committees will have passed through the consolidated school medical department suggested in this report, and there will be no possibility of 201 the Committee not having all information regarding any particular case. Attending Court.—In cases where prosecutions are ordered it is my opinion that they should be presented in proper form to the Magistrates. The cases arising under the Public Healt Acts are taken by the Clerk's Department of the Council, and similar arrangements should be made for the presentation of cases arising out of the Education Acts or Attendance Bye-laws. School Meals.—It is the school attendance officer who makes enquiries into the social circumstances of children requiring to be fed. If the Education Committee are to be in possession of complete information in regard to each child fed the results of enquiries into social circumstances should be considered in relation to the nutrition of the child. Further, if the Education Committee are to obtain the best results from the school meals provided, the following duties in addition in relation to this subject should be placed on the School Medical Officer :— (1) To report on all cases receiving or recommended for school meals, including cases of insufficient nutrition noted at medical inspection. (2) To report on all cases of doubt as to the propriety of keeping any child on the feeding list. (3) To keep under observation cases temporarily excluded from the feeding list on account of exclusion from school. (4) To inspect the register of attendances at meals, both as regards the attendance generally and the attendance of certain individual children. (5) To approve the dietary. (6) To report on the hygienic conditions of feeding centres. 203 (7) To supervise the quality, quantity, cooking and vice of the food. (8) To attempt to form a judgment as to the beneficial results of feeding generally as well as in particular cases. Items Nos. 1, 2, 3, 4 and 8 above cannot be properly undertaken except with a full knowledge of the social circumstances of the children and enquiries into the home conditions should therefore be made by officers acting under the control of the School Medical Officer. Work of this character is already done in the Medical Officer's Department in connection with the Notification of » Births Act, Infantile Mortality, the Provision of Spectacles, the recent inquiry of the Board of Trade into the cost of living, etc., and the co-relation of the additional enquiries to be made iin connection with school meals is merely a detail of administrative procedure. Accommodation.—The work under this heading is practically not carried out at the present time in Wiillesden. I have already indicated that practically it runs side by side with inquiries into non-attendance and. social circumstances. It is largely statistical in character, and is of the same nature as the statistical work of the Public Health Department, with which it naturally falls into line. The preparation of the "fair schedule" is the most important item. This means keeping a record of each family living in houses under £30 a year rental, shewing Names of parents, Names of children, with dates of birth, Names of schools attending, If not on roll of a school, the reason, Previous convictions for non-attendance, if any. The statistical information of the Public Health Department in connection with Census taking and empty houses, 200 and enquiries into infectious illness, can be made use of for helping to check and maintain this schedule, and the concentration of this work in one office would make for efficient and economical administration. In this connection, year by year, when the "fair schedule" is accurately checked, or from time to time as required by the Education Committee, a full statement of children not attending school should be presented, in order that the needs of the district for further school accommodation may be accurately gauged. Amalgamation of Committees.—In the foregoing pages I have dealt with this question of re-organisation from the point of view of the office administration, but the relationship of the official workers to the responsible Committees must also be considered. I have indicated that the following subjects are inseparably linked up, all actually coming under the heading of the Care of the Children— (a) The health of the children, Including Medical Inspection, Following up, and Medical Treatment. (b) The supervision of children absent from school. (c) The provision of school meals. It seems to me, therefore, important that these matters should be under the control of one Committee, and for this purpose Attendance Committees and School Care Committees should be merged into divisional Care Committees for such schools or districts as might be necessary. Personally, I would suggest eight divisional Care Committees, each meeting monthly. Under these circumstances the general scheme of amalgamation and re-organisation in its final form might be diagrammatically represented, thus: S.A.O.—School Attendance Officer. H.V.—Health Visitor. S.A.O. and H.V. visiting at Schools and homes in their districts in connection with "Following up" after Medical Inspection ; Cases of illness ; Cases of exclusion ; School meals enquiries ; Cases of non-attendance ; Preparation and revision of " Fair Schedule," etc. A.S.M.O.—Assistant School Medical Officer. A.S.M.O. attending Divisional Care Committee Meetings ; Performing Medical Inspection ; Supervising the work of S.A.O. and H.V., etc. S.M.O.—School Medical Officer. S.M.O. attending Central Care Committee Meetings and organising and supervising the work of A.S.M.O., S.A.O. and H.V. Divisional Care Committees performing the work of existing Attendance and School Care Committee, and each supervising the official work in each District. Central Care Committee—the existing Children's Care Committee receiving reports of the work of Divisional Care Committees and supervising the work of the S.M.O. 208 It should be observed that all this work would be linked up with the entire scheme of education administration, as naturally a clerk from the Education Office would take the minutes of the Divisional Care Committee Meetings for report to the Central Care Committee, which would be attended as now by the Education Officer. This general scheme, as outlined, would fall in line with Regulation 4 (e) of the School Medical Service Grants, which states that in fixing the rate of grant the Board will take into consideration the scope, character and efficient working of the authority's provision and arrangements for rendering the School Medical Service an integral part of the system of Elementary Education in the area. Recommendations. 1. That notice be given to the existing part-time Assistant School Medical Officers to terminate their engagements. (Their appointments are yearly ones, and terminate annually at the 31st December.) 2. That the necessary steps be taken to appoint (a) Two whole-time Assistant School Medical Officers at a salary of ,£300 a year each. (b) Two Health Visitors, each at the scale salary of £100-£130 per annum, with £8 uniform allowance. 3. That the School Attendance Officers be placed in the department of the School Medical Officer, who shall be held responsible to the Education Committee for the due performance of their duties. i. That the existing Children's Care Committee be the Central Care Committee. 5. That the Education Committee take steps to form eight Divisional Care Committees to perform the work of the existing School Attendance Committees and School Care Committees. 209 6. That the Education Committee make arrangements for the proper presentation of cases summoned for nonattendance before the Magistrates. I am, Your obedient servant, GEORGE F. BUCHAN, School Medical Officer. APPENDIX D. Report on Ringworm Clinic and Treatment. Municipal Offices, Dyne Road, Kilburn, N.W., 25th February, 1914. To the Chairman and Members of the Willesden Education Committee. I beg to present herewith a report by Dr. Haldin Davis on the treatment of ringworm as carried out at the Willesden Education Committee's Clinic, 225, High Road, Kilburn. Establishment.—It will be remembered that the Committee decided to establish this Clinic on the 5th March, 1913, and that Dr. Haldin Davis was appointed Medical Officerin-charge on 4th June, 1913, to attend one half day of three hours per week. The fitting up of the Clinic, which was opened for the first time for the reception of patients on the 30th August, 1913, was carried out under the advice of Dr. Davis. Cost.—The total cost of equipment has been £175 4s. lid., as against an estimated cost of £225 as set out in my report to the Education Committee of the 18th December, 1912. From the experience of the past five months the maintenance charges of the Clinic may be put at £16 per month, or £192 per annum. The estimated annual charges in my original report to the Education Committee 210 were ££286 5s. This figure, however, included two items which should now be deleted, viz. :— (1) £11 5s. in respect of 5 per cent. interest on capital charges (as the equipment of the Clinic was paid for out of revenue), and (2) £60 in respect of the salary of the nurse (as only £10 of her salary of £100 is attributable to ringworm treatment). Administration.—All cases reported from the schools as cases of ringworm are visited by the Health Visitor and treatment is offered at the Ringworm Clinic. It is satisfactory to observe that of the 68 known cases of ringworm at the 31st January, 1914, occurring amongst school children 59 were under treatment at the Committee's Clinic. A certain number of these, however, are waiting for treatment by X-rays. As only two or three cases can be treated by this means during the morning of each week on which the Clinic is open some time must elapse before the 59 under treatment at the date mentioned will be discharged as cured. In the meantime, further cases will no doubt be added as the result of Medical Inspection, which begins again on the 2nd March next. I am, Your obedient servant, GEORGE F. BUCHAN, School Medical Officer. Treatment of Ringworm. To the Chairman and Members of the Willesden Education Committee. I have the honour to report that this Clinic which the Committee decided to establish on the 5th March, 1913, was first opened for the reception of patients on August 30th, 1913. On this date four children were examined and one 211 was treated with X-rays. On the same date the total number of Willesden school children who were reported as suffering from ringworm was 130. Since then the Clinic has been open every Saturday morning from 9.30 to 12.30, with the exception of the Saturday after Christmas, December 27th, and the number of children attending has very materially increased on each occasion. The average number attending on each Saturday is 13, the maximum being 26 on January 17th, 1914. The total number of children who have attended up to January 31st, 1914, is 120. The total number of attendances made is 299. Of the 120 children who have attended the Clinic, 87 were suffering from ringworm of the scalp, 18 from ringworm of other parts and 15 were found not to be suffering from ringworm at all. Up to January 31st, 1914, 50 children had been discharged as cured. Of these 28 had been treated with X-rays, and 22 by other means. All the children who were treated by X-rays had been suffering from ringworm of the scalp. Of those who were treated by other means, five were suffering from ringworm of the scalp, 11 from ringworm of other parts and six were cured when first examined. On January 31st, 1914, the total number of Willesden school children suffering from ringworm was 68. Of this number 59 were under treatment at the Committee's Clinic and nine by other agencies, which includes medical men in private practice, hospitals, and others. It will be seen, therefore, that on that date the numbers attending the Committee's own Clinic greatly exceeded those attending elsewhere. As regards treatment it should be noted that ringworm of the smooth parts is much more amenable to treatment 212 by "other means," i.e., lotions and ointments, than ringworm of the scalp, which is now generally treated by X-rays. This latter form of treatment forms the most important and responsible portion of the work, and I propose to go into greater detaiil with regard to it for the information of the Committee. Each child is exposed once to the action of the rays. About fifteen days after the exposure the hair on the exposed areas begins to fall out, and tht scalp is practically completely without hair at the end of the third week. At the end of the fourth week the scalp is quite smooth and bald, and the child is now free from infection and may safely go back to school. The hair begins to return about the sixth to the eighth week and at the end of three months from exposure the scalp is fairly well covered. Time does not permit more than three children to be treated with X-rays on the same morning, so the maximum number of children that can be treated in one year is about 150. This number will not be reached during the first year of the Clinic's work, for on the days during the first few weeks that the centre was open only one or two children were treated per week. This c'aution was necessary lest an overdose might be given before the workers became quite familiar with the apparatus. The result was that several children had to have a second dose, as the first proved insufficient. However, during January, 1914, in which there were five Saturdays, fourteen children were successfully treated. Again, some of the cases, especially those an which there is, when first seen, only one patch of ringworm, are not cured after a single exposure, because when they reappear a month after the exposure, although the patch which was originally treated is cured, in the meantime other patches have become infected, so that after all the whole 213 head may have to be treated. This most often takes place when the parents are unable for one reason or another to take the necessary precautions against the spread of the eruption. As regards the financial side of the Clinic, the original outlay involved in preparing and setting the Clinic in working order was ;£175 4s. lid., made up as follows:— £ s. d. Electrical work, etc 14 14 2 Gas fittings, etc. 6 9 0 Decorating, lavatory fittings, etc. 14 13 6 Furniture 33 7 0½ X-ray apparatus 80 14 2 Miscellaneous X-ray apparatus 21 12 3 Long white coat 0 6 6 Sign board 2 7 6 Miscellaneous 1 0 9½ £175 4 11 The maintenance expenditure up to 31st December, 1914, was as follows:— £ s. d. Salary of Medical Officer 41 13 4 Salary of Nurse 13 6 8 Rent 17 10 0 Electricity 0 13 1 X-ray notices 0 16 10 White caps 0 8 4 Coals 0 1 4 Ointments, crotan oil, etc 0 8 7 Cleaning and washing linen 3 5 1 Miscellaneous 0 10 3½ £78 13 6½ 214 The cost per case treated by X-rays may be estimated by dealing with a month during which the Clinic was in full working order. If January, 1914, is taken we find that the maintenance cost was as follows:— £ s. d. Salary of Medical Officer 8 6 8 Salary of Nurse 3 6 8 Rent 2 18 4 Cleaning and washing linen (estimated) 0 14 0 Drugs (estimated) 0 9 0 Electricity (estimated) 0 3 1 Coals (estimated) 0 1 6 £15 19 3 The actual number of cases treated by means of X-rays during that month was, as stated above, fourteen. But in January, 1914, there were five Saturdays. It would therefore probably be fair to assume that the average number per month which can be treated by X-rays while the Clinic is in full working order is eleven. Assuming that this number is treated per month, and taking £15 19s. 3d. as the expense of upkeep per month, the cost per case works out at twenty-nine shillings. In this estimate nothing has been allowed for depreciation of apparatus and fittings. In any event, this is a small item, and is probably balanced by the fact that in this estimate no allowance has been made for the cost of treatment of cases by other means, the whole cost of maintenance being allocated against the cases treated by X-rays. I am, Your obedient Servant, HALDIN DAVIS, Medical Officer for the Treatment of Ringworm. 215 APPENDIX E. Report on Medical Treatment—Eyes and Teeth. Municipal Offices, Dyne Road, Kilburn, N.W., 19th January, 1914. To the Chairman and Members of the Children's Care Committte. Miss Lupton and Gentlemen, I beg to report in accordance with the following: Minutes of the Education Committee, 3rd December, 1913, p. 393. CHILDREN'S CARE COMMITTEE REPORT. "Medical Treatment—Eyes and Teeth. 14. We have instructed the School Medical Officer to prepare and submit a report in regard to the above matters." Eyes. Amount or Defective Vision.—Vision testing is a prescribed portion of Medical Inspection, and the following results obtained since Medical Inspection began :in this district in 1909 indicates the amount of defective vision amongst school children which requires attention. 1909-10-11.—8/9, or less, in each eye. 1909 1910 1911 Total Right Eye. Left Eye. Right Eye. Left Eye. Right Eye. Left Eye. Right Eye. Left Eye. No. of Observations 8522 7263 4915 20,700 No. of Scholars 3497 3619 2911 3042 I928 200I 8336 8662 216 1912-13.—6/9or less, in both eyes. 1912 1913 No. of Observations 7065 6137 No. of Scholars 2683 2265 1912-13.—6/9, or less, in one eye; 6/12, or less, in the other eye. 1912 1913 No. of Observations 7065 6137 No. of Scholars 1108 930 It may be stated generally that children who see 6/9 or less in one eye and 6/12 or less in the other eye, require glasses. This means that 1108 children out of a total of 7,065 examined in 1912, or over 15 per cent. and 930 out of a total of 6,137 examined in 1913, or again over 15 per cent., required further investigation of their eyes with a view to the provision of glasses. Effects of Defective Vision.—In this connection it should be borne in mind that a child who cannot see quickly and accurately is at a considerable disadvantage from the educational standpoint, and that this disadvantage is accentuated on account of the pains in the eyes and head which are present more or less constantly in many children suffering from eye-strain. It should also be noted that strain on the growing eye distorts its shape, and causes a progressive loss of acuity of vision. Provision of Spectacles.—The importance, therefore, of providing glasses is apparent, and has, in fact, been 217 recognised by the Education Committee, who have secured the sanction of the Board of Education from time to time to spend certain sums of money in providing spectacles for school children. The following Table shews the work which has been done under this arrangement:— PERIOD. No. of School Children for whom Spectacles were ordered. Actual Expenditure. Expenditure sanciioned by Board of Education. *3 Months ending July 31, 1911 56 … £30 Year ending july 31. 1912 55 £16 1 2 £50 Year ending July 31, 1913 87 £19 10 7 £20 * First order written for spectacles—1-5-1911. The following is an extract from the Minutes of Education Committee, 1st October, 1913, p. 276; Children's Care Committee Report relating to the conditions on which the Board's sanction has been given to the provision of spectacles:— "8.—We report that the Board of Education have sanctioned the expenditure of £20 on the provision of spectacles for those children whose eyesight is found to be defective on medical inspection, during the year ending 31st March, 1914. The Board's sanction is subject to the following conditions :— (i) That the prescriptions for the spectacles will be given by a specially qualified medical practitioner. (ii) That the arrangements will be under the vision of the School Medical Officer. (iii) That provision will be made for the re-inspection from time to time of the children who have been p 218 supplied with spectacles in order that it may be ascertained whether the spectacles are being worn regularly and with satisfactory results. (iv) That an account of the working of the arrangements, including particulars as to the expenditure incurred and the number of cases in which spectacles were provided, will be given in the School Medical Officer's annual report." Difficulty of Obtaining Prescriptions for Glasses. —The difficulty that arises in connection with these conditions is that of obtaining proper prescriptions for the necessary glasses. According to the requirements of the Board of Education, prescriptions must be obtained from a duly qualified and experienced oculist. Parents are, therefore, obliged to take their children to the special departments of general hospitals or to special eye hospitals, and the time and money involved in this procedure is often more than the parents can afford. In addition, in some cases the hospitals will not part with the prescription, except it is taken to the hospital optician, who is not always one of the approved contracting opticians to the Willesden Education Committee. In both cases the result is that the child has frequently to go without glasses altogether, or obtains them only after a long delay, during which its eyesight has generally become worse. Establishment of Eve Clinic.—The difficulty referred to in the foregoing paragraph would be at once met by the establishment of an Eve Clinic by the Education Committee. Accommodation for Eve Clinic.—The necessary accommodation for this Eye Clinic is available at 225, High Road, Kilburn, where the Ringworm Clinic is established. 219 Cost of Eye Clinic.-—The estimated cost of an Eye Clinic is as follows Capital Charges : Oculist's trial case, including spheres, prisms, cylinders, coloured glasses, discs, trial frame, test types, sphere lenses, etc. £40 0 0 Linoleum, blinds, desk, etc. 20 0 0 Total £60 0 0 Annual Maintenance Charges : Salary of Oculist for attendance three hours per week £100 0 0 * Proportionate Salary of Nurse (scale £108—£138) 28 0 0 * Proportionate Salary of Third Class Clerk (scale ^80—^120).. 20 0 0 Proportionate Rent Charge 8 0 0 Cost of Spectacles and drugs 50 0 0 Miscellaneous... 10 0 0 £216 0 0 * Vide Teeth. Half of the above expenditure, both Capital and Maintenance, is repayable by the Board of Education, so that the actual charges to the Education Committee would be :— Capital Account £30 0 0 Annual Maintenance Account 108 0 0 The attendance of an oculist three hours per week would allow an average of eight cases to be dealt with per week, or about 400 cases per annum. This number is below the estimated number of 1,108 and 930 requiring spectacles in 1912 and 1913 respectively, but with an adequate system of "following up," as indicated in my report on Medical Inspection—Administrative Measures, it is not unlikely that a considerable proportion of these would secure treatment from other agencies. 220 Functions of Eye Clinic.—It should be noted that the functions of an Eye Clinic include the following :— i. Complete examination of eyes with defective vision. ii. Prescribing glasses, and ascertaining that they are (a) actually procured, (b) correctly measured, (c) rightly fitted, and (d) regularly worn. iii. Treating external eye diseases. iv. Re-examination at suitable intervals. Prevention and Treatment of Defective Vision.— In connection with this subject of Eye Treatment I desire to quote from the Annual Report for 1912 of the Chief Medical Officer of the Board of Education (p. 152), as follows:— " The School oculist should be in close touch with the school teacher and cognisant of and interested in the school curriculum and school arrangements generally. This is of special importance in the case of the treatment of squint. "Nor is this all. There are, as has been previously pointed out, further questions of importance connected with defective vision which call for attention, such as heredity, general health, nutrition, home conditions, and, above all, school conditions, including the design, arrangement, and height of the desks, the lighting of the schoolroom, the size and character of the print of the school books, the fatigue of the child, and educational methods generally. Many of these matters call for further investigation, and all of them for further consideration by authorities attempting to 221 grapple with defective vision. There is no panacea for the treatment of defective vision, one of the most serious of all physical defects. Its proper remedy depends, first upon prevention, and secondly upon a thoroughly well-organised and complete system of treatment, persistently and patiently applied. Teeth. Amount of Dental Decay.—The following Tables shew the extent to which decay of the teeth among school children has been noted since medical inspection began in Willesden in 1909:— No. of Children in which temporary teeth were found defective. Average No. of temporary teeth defective in these children. No. of Children in which permanent teeth were found defective. Average No. of permanent teeth defective in there children. 1909 5633 3.8 1741 2.4 1010 5594 3.7 1495 2.3 1911 4418 3.5 968 2.3 No. of Children examined. No. with 1 or more carious teeth. % with 1 or more carious teeth. No. with 4 or more carious teeth. % with 4 or more carious teeth. 1912 9867 6321 64.6 2377 24.0 1913 9343 5654 60.5 2112 22.6 The foregoing Tables reveal a large amount of dental decay amongst scholars. Causes of Dental. Decay.—The decay of teeth is due to many cases, e.g., 1. Failure to keep the teeth clean. 2. Overlapping, irregularity, or too close an arrangement of the teeth in the gums, preventing the teeth being thoroughly cleansed. 222 3. The consumption of sloppy food-stuffs and the consequent decay of the teeth as they become functionless. 4. Chipping of the enamel by hard or gritty substances in the food-stuffs, thus allowing the entrance of bacteria. 5. Septic conditions of the throat, or mouth, or passages communicating with the mouth, e.g., tonsillitis, abscess of gums, etc. 6. Mouth breathing, due to adenoids or other nasal obstruction. 7. Rickets leading to early decay of the teeth. 8. The retention of decayed first teeth without adopting means to prevent the spread of the decay to the second teeth upon their appearance in the gums. To this list of causes may be added many others, but it is easy to see from the above list that much dental mischief and decay may be prevented. Importance of Sound Teeth.—The importance of having sound teeth cannot be exaggerated. Decayed teeth allow food-stuffs to accumulate 'in their cavities, which thereby become breeding grounds for the bacilli of disease, including tuberculosis. 31 per cent. of the children medically inspected Suring 1912 were found to be suffering from enlarged glands, and there is little doubt that this condition in a large number of cases is due to the condition of the teeth. Indigestion and dyspepsia, foul and suppurating conditions of the mouth, such as abscess, tonsillitis, or sore throat, and tuberculosis, very frequently are caused by decayed teeth. Early Treatment.—Early treatment of the teeth would prevent a large number of cases of these diseases, and to that extent would be a direct means of prolonging life. 223 Principles of Dental Treatment.—In considering the question, therefore, of dental treatment it should be noted that the cases which the Education Committee should commence to treat are not those in the most advanced state of decay, but rather those in the least. The crucial age in the life of a child's teeth is about the sixth year, when the permanent set begins to appear. The so-called six year old molar appears first, behind the complete set of temporary teeth and without disturbance to them. About this age, or generally between the ages of five and eight, children about 8,000 in number in Willesden, should have their teeth inspected by a dentist with mirror and probe, and conservative dentistry should be practised. This consists mainly of "stopping," or "filling," and re-examination at suitable intervals during school life in order to maintain the teeth in a healthy state. Number of Dentists Required.—It is impossible to say how many dentists will ultimately be required in Willesden to overtake the work indicated in the preceding paragraph, as no authority has yet had a scheme of dental treatment in operation sufficiently long. In Cambridge a scheme embracing all children between five and eleven has been in operation for six years, and two full-time dentists are employed, the school population being 8,500. As, however, the work of dental inspection and treatment as outlined above is of a cumulative character as the children grow older and remain under supervision, I would suggest that one dentist and one nurse or health visitor be appointed now, and the staff increased as necessity arises. Basis of a Satisfactory Dental Scheme.—As all schemes of treatment require the sanction of the Board of Education I desire to quote the following in relation to Dental Treatment from the Annual Report for 1912 of the Chief Medical Officer of the Board of Education (p. 196 and 197). 224 "Basis of a Satisfactory Dental Scheme. "As a result of the experience gained in the working ol dental schemes in different parts of the country it appears to be necessary for the satisfactory working of a scheme ol dental inspection and treatment that the following points should be observed :— "1. The arrangements, including' the keeping of records, should be under the control and supervision of the School Medical Officer, on whose staff the dentist undertaking the work should be formally appointed. "2. Dental inspection should be carried out by a qualified dentist, preferably by the dentist undertaking the treatment. In exceptional circumstances the Board are prepared, in the case of rural areas, to consider proposals tor the School Medical Olficer or Assistant School Medical Officer to undertake dental inspection, provided that it can be shown that they are conversant with the indications pointing to the need lor conservative dental treatment, and are competent to perform— "(a) Adequate dental examination with probe and mirror; "(b) Proper dental recording. Dental inspection should, as a rule, take place on the school premises and in school hours. "3. Attention should be concentrated in the first instance on the group of children from 6-8 years of age. Some dentists prefer to begin with five-year-old children. The "critical" age is, of course, the time of the emergence of the permanent teeth. "4. An accurate record should be kept of each mouth examined and of the treatment carried out. "5. The treatment should be conservative in character, and accordingly the bulk of the treatment work should be 225 by filling rather than by extraction. Conservative dentistry includes also preventive measures, such extraction work as contributes to the preservation of the dentition as a whole, and any mechanical devices necessary to regulate the teeth. "6. A school nurse, or other attendant, should be present to assist the dentist at the time of treatment. "7. General anaesthetics, if required, should in all cases be administered by one of the Authority's medical officers, or by some other qualified medical practitioner. "8. Provision should, as far as practicable, be made for the re-examination at intervals of not more than a year, of children who have received dental treatment, and for supplementary treatment if such is found to be necessary. "9. The accommodation proposed for a dental clinic should include as a minimum (a) a waiting room, (b) an operating room, and (c) a small rinsing room, which can be used also for recovery after the administration of an anaesthetic." Situation of Dental Clinic.—The necessary rooms for the establishment of a clinic for one dentist, exist at 225, High Road, Kilburn, N.W., where the ringworm clinic is established. 226 Cost of Dental Clinic.—The cost is estimated as follows :— Capital Charges. Dental Outfit £80 0 0 Linoleum, blinds, etc. ... 20 0 0 £100 0 0 Annual Maintenance Charges. Salary of Dentist £500 0 0 * Proportionate Salary of Nurse (scale ^108—£138) 80 0 0 * Proportionate Salary of Third Class Clerk (scale ^80 —£120) 60 0 0 Proportionate Rent Charge 12 0 0 Dental Requisites 60 0 0 Miscellaneous 28 0 0 £540 0 0 Vide Eyes. Half of the above expenditure, both capital and maintenance, is repayable by the Board of Education, so that the actual charges to the Education Committee would be— Capital Account £50 0 0 Annual Maintenance Account £270 0 0 Recommendations. The recommendations involved in the above proposals are :— (1) The establishment of an Eye Clinic at an estimated capital cost of £60. (2) The establishment of a Dental Clinic at an estimated capital cost of £100. (3) The appointment of an oculist at a salary of £100 per annum, for an attendance of three hours per week. 227 (4) The appointment of a whole-time dentist at a salary of £300 per annum. (5) The appointment of a health visitor at the scale salary of £108-£138 per annum. • (6) The appointment of a third-class clerk at the scale salary of £80-£120 per annum. General. In connection with the question of medical treatment I desire to call the attention of the Committee to Section 1 of the Local Education Authorities (Medical Treatment) Act, 1909, which is as follows:— "Where any local education authority provides for the medical treatment of children attending any public elementary school under Section thirteen of the Education (Administrative Provisions) Act, 1907, there shall be charged to the parent of every child in respect of any treatment provided for that child such an amount not exceeding the cost of treatment, as may be determined by the local education authority, and in the event of payment not being made by the parent, It shall be the duty of the authority, unless they are satisfied that the parent is unable by reason of circumstances other than his own default to pay the amount, to require the payment of that amount from that parent, and any such amount may be recovered summarily as a civil debt." Further, in connection with the provision of spectacles, I desire to call the attention of the Committee to Circular 596, Sub-Section D, 7 (f):— "Provision of Spectacles, &c.—In cases where medical inspection shows that the provision of spectacles is necessary for the treatment of defective eyesight, the Board will be prepared to consider proposals 228 from a Local Education Authority to provide suitable and inexpensive spectacles free of charge. They will, however, only sanction such an 'arrangement' if they are satisfied that every endeavour will first be made to obtain the provision of the spectacles by the child's parents or by any voluntary associations which exist for the purpose. The Board will, of course, require that due precautions should be taken to secure accurate examination and appropriate prescription by qualified medical men of suitable experience." In connection with this latter matter, I desire to call the attention of the Committee to the following extracts from their Minutes :— "Children's Care Committee Report. 7th June, 1011, p. 91. "List of Children Supplied with Glasses under the Committee's Scheme. "We beg to report (a) that the Board of Education (18th April, 1911) have sanctioned under Section 13 (1) (b) of the Education (Administrative Provisions) Act, 1907, the expenditure, in respect of the period ending 31st July, 1911, of a sum not exceeding £30 on the provision of inexpensive spectacles for children whose eyesight is found defective on medical inspection. "(b) The School Medical Officer has submitted a list of 35 children to whom spectacles have been supplied at a cost of £6 1s. 1d., together with a statement of the reasonable amounts which the parents might be asked to contribute, and we have given instructions to have the circumstances of the cases investigated and the rendering of any necessary accounts. "(c) We have received a letter from the head master of one of the Committee's schools in reference 229 to the procedure as to the supply of spectacles, and have referred the matter to the School Medical Officer." Children's Care Committee, 1th October, 1911, p. 253. "Provision of Spectacles. (a) We reported on the 7th June, 1911 (p. 91), that the Board of Education had sanctioned under Section 13 (1) (b) of tbe Education (Administrative Provisions) Act, 1907, the expenditure in respect of the period ending 31st July, 1911, of a sum not exceeding £30 on the provision of inexpensive spectacles for children wnose eyesight is found defective on medical inspection. We recommend that application be made to the Board of Education for sanction to the necessary expenditure, estimated at £50, to 6e incurred during the year ending 31st July, 1912. "(b) The School Medical Officer has submitted a list of 22 children to whom spectacles have been supplied at a cost of £3 10s. 9d., toegther with a statement of. the reasonable amounts which the parents might be asked to contribute. We have given instructions for the contributions to be collected, subject to the circumstances of the families." Children's Care Committee, 1st November, 1911, p. 318. "Supply of Spectacles. "(a) The School Medical Officer has submitted a list of four children to whom spectacles have been supplied at a cost of 17s., together with a statement of the reasonable amounts which the parents might be asked to contribute. We have given instructions for the contributions to be collected subject to the circumstances of the families. 230 "(b) The Accountant has reported that no money has been paid into the education account on the two lists previously submitted by the School Medical Officer, and referred to the Attendance Officers for report and collection. The Local Education Authority may enforce payment from parents who are in a position to contribute, and we have accordingly instructed the Attendance Officers to immediately furnish the reports asked for with an explanation in cases where no sums have been collected. "(c) The School Medical Officer reported that in some cases prescriptions for glasses can only be dispensed by opticians other than those selected firms in the Willesden district authorised by the Committee on the 1st March, 1911 (p. 447). We accordingly recommend— " That the School Medical Officer be authorised to obtain glasses, where necessary, from other than Willesden firms, subject to the cost not exceeding the amount now being paid to local firms." Children's Care Committee Report. 7th February, 1912, p. 461. "Supply of Spectacles. "We report that spectacles have been supplied to certain children attending Willesden Schools, at a cost of £10 9s. 5d. The total of the amounts fixed as reasonable contributions from parents is £35s. 9d., and of this sum 18s. 6d. has been collected to date by the Attendance Officers. We think it is advisable that contributions should be obtained, if possible, before the spectacles are supplied, and accordingly recommend that the School Medical Officer be authorised to empower 231 the lady health visitors to collect contributions when making their first enquiries, and to report in due course on the whole question." Children's Care Committee, 3rd April, 1912, p. 607. "Supply of Glasses. "We have made arrangements for the collection, as far as possible, of contributions from parents by the lady health visitors, when enquiries are made in the first instance. We also consider that it would be advantageous if head teachers were authorised to receive contributions, and recommend accordingly." From the foregoing extracts (Sec. 1, Local Education Authorities (Medical Treatment) Act, 1909) it will be seen that it is necessary for an allocation to be made in respect of every child receiving treatment from the Education Committee, and that the sum charged against the parent may be remitted, provided that the Committee is satisfied that the parent is unable by reason of circumstances, other than his own default, to pay the amount. In order that this work may be carried out it will be necessary to appoint, in addition to the foregoing:— (1) A fourth-class clerk, at the scale salary of £52-£80 per annum, whose main duty will be to assist in allocations above mentioned. (2) A health visitor, at the scale salary of £108-£138 per annum, whose main duty will be to enquire into the circumstances of parents, so that the Committee may be in a position to recover such amounts as they consider desirable in each case. 232 It should also be noted that provision will require to be made for the collection of the amounts when it is ascertained to what extent this is necessary or desirable. I am, Your obedient Servant, GEORGE F. BUCHAN, School Medical Officer. Willesden Urban District Council. HOSPITAL REPORT FOR THE YEAR 1913, WILLIAM J. J. STEWART, M.D., C.M. (Edin.), D.P.H. (Camb.), medical superintendent. o members of the Public heath AND hospital Visiting Committee, 1913. Councillor W. RILEY (Chairman). „ J. J. BATE. „W. BLACKLOCK. „ W. M. BOLTON. „ P. BOND. „ S. BOWN. „ J. E. CONLON. „ J. E. HILL. „ C. PINKHAM. „ W. C. RAPKIN. „ H. ROGERS. „ C. E. P. TAYLOR. „ H. D. TURNER. Hospital Annual Report for 1913. To the Chairman and Members of the Willesden Urban District Council. Gentlemen, I have the honour to submit to you the Twenty-Second Annual Hospital Report. The number of patients admitted during the past year shows a substantial increase over recent years, and reached an aggregate of 721 cases. In 1912 there were 599 cases admitted, as against 470 in 1911, and 437 in 1910. Of the 721 cases, 385 suffered from Scarlet Fever. In 1912 there were 338 ,, 204 „ „ Diphtheria. „ ,, 172 „ 6 „ „ Enteric F. „ „ 3 „ 126 „ ,, Other Diseases ,, ,, 86 721 599 To the total of 721 cases, there is to be added 74 cases admitted during 1912, and still in hospital on December 31st, making a grand total of 795 cases under treatment for the year. In 1912 there were 690 cases. 235 Having regard to the increase in the number of cases admitted, as compared with the previous year, the larger number of deaths which occurred was to be expected, but notwithstanding that fact, it is satisfactory to note that the mortality rate remains still at a low level. The average number of patients under treatment each day during the year was 69 8, as compared with 731 in 1912 The figures for other years are here shown :— 1906 103.5 1909 104.7 1907 98.6 1910 50.5 1908 108.0 1911 46.4 With regard to the average stay of patients in hospital, this varies very little from year to year, and it is difficult to see where any reduction can be made, unless it is in connection with Scarlet Fever patients. These, as I have previously mentioned, are isolated at least 6 weeks, but, in my opinion, a certain number of them might safely be discharged at an earlier date—that is before desquamation is completed. Taking all the diseases together, the average stay of patients last year was 38.7 days, in 1912 it was 39.2 days, and in 1911, 38.9 days. 236 By separating the diseases up into the various classes, it appears that Scarlet Fever patients remained under treatment an average stay of 45.5 days, Diphtheria patients 29 3 days, Enteric Fever 50.2 days, and Other Diseases 23.8 days. In connection with the accommodation provided in this hospital (164 beds), it is to be reported that it proved amply sufficient. It is to be borne in mind, however, that although there was an increase in the numbers of cases admitted last year, and that the accommodation proved equal to the demand put upon it, yet the total admissions did not equal that of 1908 (854), in which year the accommodation proved to be insufficient. Added to that, it is to be remembered that in the year mentioned, Kingsbury Hospital (32 beds). since burned down, was then available for patients. TABLE No. 1. Disease. Remaining in Hospital, December 31st, 1912. Admitted during 1913. Total number under treatment during 1913. Discharged during 1913. Died during 1913. Mortality per cent. Remaining in Hospital December 31st, 1913. Scarlet Fever 53 385 438 353 6 I .61 79 Diphtheria 15 204 219 191 9 4.45 19 Enteric Fever 0 6 6 5 . 1 16.6 0 Other Diseases 6 126 132 115 3 2.45 14 Total 74 721 795 664 19 270 112 237 238 TABLE No. 2. Month. Scarlet Fever. Diphtheria. Enteric Fever. Other Diseases. Total Admissions. Total Deaths. Admissions. Deaths. Admissions. Deaths. Admissions. Deaths. Admissions. Deaths. January 17 - 17 - 2 - 11 1 47 1 February 30 1 25 - 1 - 8 - 64 1 March 14 - 17 1 1 - 9 - 41 1 April 16 - 7 2 - 1 10 - 33 3 May 16 - 10 - - - 7 1 33 1 June 21 2 7 - - - 3 - 31 2 July 17 - 12 - - - 10 - 39 — August 21 - 36 1 1 - 9 - 67 1 September 53 1 18 - 1 - 8 1 80 2 October 48 - 13 1 - - 31 - 92 1 November 65 - 19 - - - 10 - 94 - December 67 2 23 4 - - 10 - 100 6 Total 385 6 204 9 6 1 126 3 721 19 239 TABLE No. 3. SCARLET FEVER. AGE. MALES. FEMALES. TOTAL. Admitted. Died. Admitted. Died. Admitted. Died. Under 1 1 - 0 0 1 - 1 to 2 0 - 0 - 0 - 2 to 3 6 1 6 1 12 2 3 to 4 10 - 11 - 21 - 4 to 5 15 1 6 - 21 1 5 to 10 81 1 119 1 200 2 10 to 15 37 - 50 - 87 - 15 to 20 11 - 10 - 2 1 - 20 to 25 5 - 4 - 9 - 25 to 30 1 - 5 1 6 1 30 to 35 2 - 5 - 7 - 35 to 40 0 - 0 - 0 - 40 to — 0 - 0 - 0 - Total 169 3 216 3 385 6 240 TABLE No 4. Complications of Scarlet Fever. Number of Cases. Rheumatism 13 Albuminuria 13 Nephritis 11 Otorrhœa 29 Adenitis 33 „ Suppurative 6 Mastoiditis 2 Relapse 5 In connection with the cases admitted with Diphtheria, 16 of these suffered from laryngeal, oxcroup symptoms, 9 of which required tracheotomy. Of the 9 so operated upon, 6 recovered. 241 TABLE No. 5. DIPHTHERIA. AGE. MALES. FEMALES. TOTAL. Admissions. Deaths. Admissions. Deaths. Admissions. D'ths. Under 1 4 ... 0 ... 4 ... 1 to 2 2 ... 4 ... 6 .. 2 to 3 4 ... 3 ... 7 ... 3 to 4 9 1 7 ... 16 1 4 to 5 9 1 10 2 19 3 5 to 10 48 2 45 2 93 4 10 to 15 15 ... 11 ... 26 ... 15 to 20 1 ... 9 ... 10 ... 20 to 25 1 ... 8 1 9 1 25 to 30 0 ... 2 ... 2 ... 3° to 35 2 ... 5 ... 7 ... 35 to 40 0 ... 2 ... 2 ... 40 to — 0 ... 3 ... 3 ... Total 95 4 109 5 204 9 TABLE No. 6. Complications of Diphtheria. No of Cases. Paralysis 16 Albuminuria 5 Relapse 0 Broncho Pneumonia 2 242 CO-EXISTENT DISEASES. Attacks of more than one disease in the same patient occurred in 12 instances. One attack only proved fatal. The diseases occurred in the following combinations :— Scarlet Fever and Diphtheria 3 ,, ,, „ Chicken Pox 2 ,, „ „ Measles 2 Diphtheria „ Measles 5 243 TABLE No. 7. Table showing the cases wrongly diagnosed, and the diseases for which they were mistaken. Certified as suffering from Diagnosed in Hospital as suffering from Scarlet Fever. Diphtheria. Enteric Fever. 27 21 0 Tonsillitis ... 3 ... Broncho-Pneumonia 7 ... ... No apparent disease 23 ... ... Erythema 2 ... ... Gastric Catarrh 3 2 ... Measles 1 ... ... Rotheln 3 ... ... Gum Rash ... ... 1 Pleurisy 2 ... ... Urticaria ... 1 ... Pyorrhoea Alveolar is ... ... 1 Appendicitis 1 ... ... Thrush 1 ... ... Impetigo 2 ... ... Tuberculous Glands of Neck 72 27 2 101 244 OTHER DISEASES. Twenty-five cases of disease belonging to a class not ordinarily admitted were treated during the year. The cases admitted were as follows :— Measles 11. Chicken Pox 4. Erysipelas 8. Whooping Cough 1. Puerperal Fever 1. BACTERIOLOGICAL DEPARTMENT. The work in connection with this particular department of the hospital still increases and occupies a considerable amount of time. The compulsory notification of Tuberculosis to a great extent accounts for this increase, as the following figures show :—Thus in 1913 there were 229 specimens of tuberculous sputa examined, whilst in 1912 there were 131, and in 1911 only 32. All the examinations were made in connection with patients living in the district, and outside the hospital. The total number of examinations made last year was 1,154, as compared with 1,120 in 1912. The following tables show the nature of the examination, and the sources from which the specimens were taken:— 245 TABLE A. Nature of Specimens examined. Positive. Negative. Total. 1. Throat Swabs for Diphtheria, Bacilli, &c. 180 726 906 2. Sputa for Tubercle Bacilli 33 196 229 3. Blood Examinations. Widal Test, &c. 2 17 19 "54 TABLE B. Source of Specimens examined. 1. From Patients in Hospital 482 2. From Practitioners 578 3. From Public Health Department 94 ii54 SICK STAFF. Although a smaller number of staff were off duty through sickness than usual, the aggregate number of days they were incapacitated far exceeds that of previous years. This unfortunate circumstance is due to the fact that in addition to four 246 nurses contracting Scarlet Fever one member of the needle room staff developed an attack of Tuberculosis, which confined her to bed for just over 8 months. At the end of that time she was able to be removed to her home. The total number of sick staff (I refer only to those who were off duty for more than 24 hours at a time) amounted to 45, and the aggregate number of days they were ill was 1,043, or an average of 231 days per sick person. In 1912 the average was 11.4 days. As regards those members of the staff who contracted Scarlet Fever, all made good recoveries. HOSPITAL BUILDINGS. An addition to these has to be recorded in the shape of the Motor Garage, which has been built on the site of the old ambulance station stable yard. This building, which is brick built, with corrugated iron and wood roof, is in every way complete and measures 80 ft. x 40 ft. Of the three 2-stalled stables, one has been converted into a motor accessory store, the other two into one large workshop. The old harness room has been converted into an office and 247 telephone room, whilst a small passage has been partially built up and converted into a uniform room. The dwelling house occupied by the head ambulance driver still remains as it was. Before concluding, I would like to express my thanks to the Chairman (Mr. W. Riley) and to the members of the Hospital Committee for their help and encouragement. I would also like to convey to the Principal Officers and other members of the Hospital Staff my thanks for their willing assistance. I remain, Gentlemen, Your obedient Servant, W. J. J. STEWART. March 14th, 1014.