WIL 15 Willesden Urban District Council. 1914. The 39th ANNUAL Health Report. GEORGE F. BUCHAN, Medical Officer. "London: Hanbury, Tomsett & Co., Printers, Kensal Rise, N.W. 1915. 5 WILLESDEN URBAN DISTRICT COUNCIL, 1914-1915. 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, (Vice-Chairman). †*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 (Chairman). Mr. Councillor C. H. HOGG. Mr. Councillor E. LANE. Mr. Councillor T. G. MATTHEWS. Mr. Councillor C. PINKHAM, J.P. Mr. Councillor H. B. PRATT. *Mr. Councillor W. C. RAPKIN. †*Mr. Councillor W. RILEY, J. P. (Chairman of the Health and Hospital Committees). *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. Mr. Councillor W. WAY. * Member of the Health Committee. + Member of the Hospital Committee. 6 MEMBERS OF THE EDUCATION COMMITTEE, 1914-15. Mr. Councillor J. ANDREWS. Mr. Councillor J. E. BALL. *Mr. Councillor W. BLACKI.OCK. *Mr. Councillor W. M. BOLTON. *Mr. Councillor I'. BOND. *Mr. Councillor S. D. BUMSTEAD. Mr. Councillor E. T. BUTTERISS. *Mr. Councillor J. COMBER. Mr. Councillor H. H. GRIMWOOD, Mr. Councillor G. H HISCOCKS. Mr. Councillor I. E. HILL. Mr. Councillor W. A. HILL. *Mr. Councillor C. W. HOGG. *Mr. Councillor E. LANE (Chairman of the Education Committee). Mr. Councillor H. ROGERS. *Mr. Councillor The Rev. R. SILBY (Chairman Of the Children's Care Committee). Mr. Councillor H. DAVEY TURNER. Mr. Councillor W. WAV. *Mr. J. CASH, J.I'. *Mr. W. J. DOWDELL. *Mr. E. W. ESSEL (Vice-Chairman of the Education Committee). *Miss M. A. LUPTON. *Mr. G. OSW1N. Mr. H. E. SCOTT. *Mr. E. J. TOZER. Mr. A. E. WARREN. *Mr. D. T. WILLIAMS. * Member of the Children's Care Committee. 7 Municipal Offices, Dyne Road, Kilburn, N.W., 15th March, 1915. To the Willesden Urban District Council— The Local Sanitary Authority. The Local Education Authority. I beg to submit herewith the 39th Annual Health Report for Willesden for the year 1914. This report includes:— 1. The 39th Annual Report on the Health and Sanitary Condition of the District. 2. The 7th Annual Report on the Health of Children attending the Public Elementary Schools. 3. The 23rd Annual Hospital Report. Vital Statistics. The population of Willesden estimated at mid-summer, 1914, was 166,634, as compared with the census population, 154,344 in 1911. 4,115 Births occurred in the district during the year, giving a birth-rate of 24.7 per 1,000 of the population. This birth-rate, which equals that of last year, is the lowest recorded. 1,752 Deaths occurred in the district during the year, giving a death-rate of 10.51 per 1,000, as compared with 10.24 in 1913, and 9.8 in 1910, when the death-rate in Willesden was lowest. The death-rate differs in the various wards, being highest in South Kilburn, with a rate of 13.90, and lowest in Kensal Rise, with a rate of 8.96. 337 Deaths of Infants under one year of age occurred in 1914, giving an infant mortality rate of 82 per thousand. 8 Sanitary inspection. The number of occupiable houses in Willesden at midsummer, 1914, was 23,350. 724 houses have been inspected during the year under The Housing (Inspection of District) Regulations, 1910, as compared with 213 in the preceding year. 5,095 houses were awaiting inspection at the end of the year. Slaughter houses, and premises where food is prepared, have been kept under continuous supervision, 535 visits having been made in 1914, as compared with 89 in 1913. The total number of inspections and re-inspections made by the Sanitary Inspectors during the year was 19,576. Infectious Diseases. 1,665 cases of Compulsorily Notifiable Infectious Diseases, including Tuberculosis, were notified during the year. This is the highest number recorded, and is due in the main to increased prevalence of Scarlet Fever and Diphtheria. No part of the district was specially affected. The type of Diphtheria prevailing was more than usually virulent, and the fatality rate rose to 79 per 1,000 cases, which is the highest recorded since 1902, when the fatality rate was 122. 735 notifications of Tuberculosis were received during the year, 416 of which related to new cases. Tuberculosis became a notifiable disease in 1909, and since that date 1,815 cases have been notified in Willesden, of which 777 were resident in the district at the end of the year 1914. Information respecting 1,247 cases of Measles and Whooping Cough was received during the year, mainly from the schools. 682 cases of Scarlet Fever, 258 cases of Diphtheria, 12 cases of Enteric Fever, and 27 cases of other diseases, or cases from other districts, making a total of 979 cases 9 in all, were admitted to the Willesden Isolation Hospital during the year. This is the highest number of cases dealt with at the Hospital in any one year, and considerably taxed the accommodation. Medical Inspection and Treatment. There were 23,655 children attending Willesden schools in the middle of the year 1914. 7,358 were submitted to routine medical inspection during the year, and 3,396 parents attended the examinations. 4,971 children were specially referred to the medical staff on account of 5,340 defects. An increase in the number of health visitors and the establishment of clinics for the treatment of ringworm in 1913, and eyes in October, 1914, has enabled the Medical Service of the Authority to deal with 2,050, or 38.4 per cent., of these defects. 1,657, or 31.0 per cent., received treatment from voluntary hospitals, charitable institutions, or private practitioners; while 1,633, or 30.6 per cent., obtained no treatment. The 1,633 defects in which no treatment was obtained were mainly defects where special skill and appliances are required, and the need for extending the clinics to embrace the treatment of diseases of the throat, nose, ear, and teeth is strongly emphasised. Need for Open-Air School. Progress was made during the year with this matter, and plans were submitted to and approved by the Board of Education. The war, however, has delayed the operation of these proposals. A general review of the conditions found amongst school children emphasises more than ever the need for a school of this character in Willesden. The results of medical inspection show that there are 142 children of school age suffering from tuberculosis, and 267 in such a state of health as to make tuberculosis to them an imminent danger. In addition, a proportion of the children suffering from anaemia, malnutrition, enlarged glands, adenoids, etc., 10 should be educated under open-air conditions. These two latter classes of children have come to be known as the "Pretubercular," as experience has shown that if proper measures are not adopted the majority of them develop tuberculosis. It is likely that the benefits to be derived from a school of this kind would be of even more advantage to the two latter classes named above than to those children who are definitely tubercular, as it would prevent the development of the disease in the "Pre-tubucular," while it could do not more than arrest it in those already affected with tuberculosis. I do not desire to minimise the importance of this result, but it must ever be borne in mind that to deal with disease by prevention rather than by cure is essentially the work of the Local Authority, and the only sure means of raising- the health and physical condition of the people. Certain Considerations. At the present time, with the country at war and the demand for men and fit men imperative, a review of the work which has been done by the Council in past years for the improvement of the health of the population and the results achieved may not be out of place. It is some forty years since the first great measure relating to public health was passed, namely, the Public Health Act, 1875. This Act, which is still in operation, gives power to Local Authorities to enforce the remedy of insanitary conditions injuriously affecting health. The scope of the principal Act has been enlarged from time to time by amending and kindred Acts, notably the Public Health Acts Amendment Acts, 1890-1907; the Housing Acts, 1890-1909; and the Factory and Workshop Act, 1901. These Acts all deal with questions of environment or external circumstances relative to health. The first Act, dealing with the question of disease relative to the health of the community, was passed 11 in 1889. In this year the Infectious Disease Notification Act became law, and there followed in quick succession the Infectious Disease Prevention Act in 1890 and the Isolation Hospital Act in 1893. These three acts were passed not primarily for the care and treatment of the individual, but for the protection of the public by the isolation of persons suffering from infectious diseases. It was not until the year 1907 that the individual came to be considered in the general scheme of public health. In this year two important Acts were passed, namely, the Notification of Births Act and the Education (Administrative Provisions) Act, under which latter the medical inspection of school children is carried on and power given to make arrangements for attending to their health and physical condition. The Saving in Lives and Money. It would be difficult to assess the exact part that each of the measures passed since 1875 has played in improving the national health, but so far as Willesden is concerned the broad fact is that the death-rate in 1875 was 21.4 per 1,000 and in 1914, 10.51 per 1,000. In other words, if Willesden people had died at the same rate in 1914 as in 1875, 1,814 additional deaths would have been recorded. This saving of lives has a commercial value. Dr. Farr in 1876, in the 39th Annual Report of the Registrar-General, reckoned that the mean net value of each male person in the community was £150, as estimated by the standard of the agricultural labourer of that day. For the whole population, including females, he thought the standard might be lowered to £110. It should be noted that Willesden is an urban and generally educated community as compared with the agricultural labourer class of 1876, and that consequently these 12 figures understate the value of the unit of the population when applied to Willesden in 1914. But taking the lower figure above given, it will be seen that the saving of 1,814 lives in 1914 as compared with 1875 means a saving of £199,540 during the year 1914. Three Questions. I do not wish it to be thought that the diminished deathrate is wholly the result of the activities of the Council. During the period 1875-1914 the birth-rate has fallen from 44.7 to 24.7 per 1,000 of the population, and this diminution in the birth-rate has led to a reduction in the proportion of persons living under five years of age when the death-rate is highest. It should not, however, be deduced from this statement that a high birth-rate is incompatible with a low death-rate, for under normal healthy conditions a high birth-rate would mean that a large proportion of the population were living between the ages of 5 and 45 when the death-rate is lowest. Properly speaking, therefore, and under the best conditions of living, a high birth-rate and a low death-rate are synonymous terms, and it is a matter for consideration under what conditions they may become so. This problem is not easy of solution, but can be simplified by resolving it into three cardinal questions:— 1. How can the falling birth-rate be restored to its former level? 2. How can the high death-rates under five years of age be diminished? 3. How can the death-rates at ages over five years be still further diminished? 13 Three Answers. The first of these questions presents considerable difficulty. An examination of Table la. of Appendix A, which gives the birth-rates in each ward, shows that these are least in Brondesbury Park and Cricklewood Wards, and highest in Stonebridge and South Kilburn. That is to say. the birth-rates are lowest in the best residential areas of Willesden and highest in the poorest, and generally it may be said that the lack of fertility is greatest in the most valuable stocks. The fall in the birth-rate, especially amongst the middle and upper classes, is difficult to explain. It is not wholly explained on physical, social, or economic grounds, because in a number of instances not one of these causes operates, and yet families are restricted or do not exist. On the other hand in many cases economic circumstances prevent the rearing of families or of large families, and the time has come when the national interests demand that attention should be given to the problem. Within recent years the idea of large families has not been popular amongst married people. But the position in which the empire finds itself to-day shows that large families are a national asset of the highest possible importance, and the nation must do what it can to encourage and support them. It is not easy to say how this can best be done. But it has been suggested that it may be desirable to subsidise maternity or to give a bonus for every child after the second, so as to encourage and enable parents to bring up larger families. Other solutions will no doubt be suggested of this most difficult problem, which requires the concentrated thought and attention of every member of the Council and community. The second question, "How can the high death-rates under five years of age be diminished?" can be more easily answered. All the agencies of medical science must be 14 brought to bear on the problem, and the child and expectant mother taken care of. The various measures which may be adopted have been placed before the Council, and appear in Appendix D of the present report. According to the Memorandum of the Local Government Board on the subject, they include:— (1) Arrangements for the local supervision of Midwives. (2) Arrangements for Ante-Natal Care— (1) An Ante-Natal Clinic for expectant Mothers. (2) The home visiting of expectant mothers. (3) A Maternity Hospital or beds at a hospital in which complicated cases of pregnancy can receive treatment. (3) Arrangements for Natal Care— (1) Such assistance as may be needed to ensure the mother having skilled and prompt attendance during confinement at home. (2) The confinement of sick women, including women having contracted pelvis or suffering from any other condition involving danger to the mother or infant, at a hospital. (4) Arrangements for Post-Natal Care— (1) The treatment in a hospital of complications arising after parturition, whether in the mother or in the infant. (2) The provision of systematic advice and treatment for infants at a Baby Clinic or Infant Dispensary. 15 (3) The continuance of these Clinics and Dispensaries, so as to be available for children up to the age when they are entered on a school register, i.e., the register of a Public Elementary School, Nursery School, Creche, Day Nursery, School for Mothers or other school. (4) The systematic home visitation of infants and of children not on a school register as above defined. The establishment of the agencies above mentioned must be regarded as a means for the education of the people in respect of the matters which produce ill-health and disease. Advice to a mother as to how to keep well during pregnancy and how to take care of the child after it is born is really education. It is not education in the same sense that the subjects taught in our schools of to-day are education, and in no way competes with them, but advice on the lines indicated above must be personally applied and given by individuals who have made the study of the problems affecting health a life work, and a life work of the highest national importance. The inauguration of these measures means expenditure, but the cost will be amply repaid in the protection and consequent improvement of the health of the mother, the saving of child life, and the improved physical well-being of the race. The Government realise the importance of this work, and are prepared to pay fifty per cent. of the expenditure, and it remains for the Council to take up its share. The answer to the third question, "How to diminish still further the death rates at ages over five years?" is that all measures at present in operation for the improvement and protection of the public health must be continued, and, where necessary, amplified. Greater regard must be paid 16 to the conditions of living of the population, housing conditions, the protection of the food supply, the milk supply, the sanitary and hygienic conditions of schools, factories, workshops, shops, offices, and workplaces, and generally every possible measure must be taken and effort made to secure healthy conditions of life and work. If these problems are approached with a full realisation of their importance and the relative responsibilities of individuals, local authorities, and the state, and an earnest desire to act for the public weal, we may look forward to the building up of a race of ever increasing health and strength, and fully able to resist any strain, physical, moral or financial, to which it may be put. I am, Your obedient servant, GEORGE F. BUCHAN, Medical Officer. WILLESDEN URBAN DISTRICT COUNCIL. THE 39th ANNUAL REPORT FOR THE YEAR 1914 on the HEALTH AND SANITARY CONDITION of the URBAN DISTRICT OF WILLESDEN. by GEORGE F. BUCHAN, m.d., d.p.h. Medical Officer. 18 A.—NATURAL & SOCIAL CONDITIONS OF THE DISTRICT. Physical Features.—These are described on p. 13 of the Health Report for the year 1913. Census Populations since 1851.—The following Table, No. 1, gives the population of Willesden at each census since 1851:— Method of Estimating Population in Willesden.— Room Factor.—These were explained in detail in the Health 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. 1. Census. Population. 1851 2,960 1861 3,879 1871 15,869 1881 27,453 1891 61,265 1901 114,811 1911 154,344 19 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 1914 166,634 2,990 2,363 166,634, the number appearing opposite 1914 above, is the figure which has been used throughout this Report as the Midsummer population for the calculation of the 1914 rates. The following Table, No. 3, gives certain particulars as to the estimated population of 166,634 at Midsummer, 1914 Table NO. 3.—POPULATION ESTIMATED AT MIDSUMMER, 1914. WARD. Population estimated on the number of rooms in occupation in each Ward as ascertainec by enumeration. 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 unoccupied. Partly empty. No. having one or more empty tenements. Empty tenements, exclusive of those houses wholly unoccupied. Total. No. occupied. No. empty. 1 room 2 rooms 3 rooms over 3 rooms (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) (13) (14) (15) (16) (17) Met. Drain Area. 1. South Kilburn 14745 1311 26 79 5 73 10 4 10349 10010 339 ... ... ... 1.98 3.27 2. Mid Kilburn 14587 1765 62 24 2 12 12 3 13661 13083 578 ... ... 3 3.51 4.23 3. North Kilburn 12611 2047 51 21 ... ... 9 12 17068 16506 562 1 ... ... 244 3.29 4. Brondesbury Park 9834 1407 14 13 ... ... 12 1 11363 11200 163 1 6 ... 0.92 1.43 5. Kensal Rise 14169 1881 17 15 ... 1 5 9 12442 12278 164 6 ... ... 0.58 1.31 6. Harlesden 17114 2553 32 30 1 8 6 15 17911 17589 322 12 35 ... 0.78 1.79 Total Met. Drain. Area 83060 10964 202 182 8 94 54 44 82794 80666 2128 20 41 3 1.66 2.57 Brent Drain Area. 7. Stonebridge 17742 2080 30 9 ... ... 8 1 13848 13637 211 12 ... ... 0.87 1.52 8. Round wood 15657 2196 27 13 2 ... 7 4 15601 15350 251 ... ... ... 1.22 1.60 9. Church End 14121 1942 12 12 ... 5 4 3 12188 12090 98 2 43 ... 0.51 0.80 10. Willesden Green 16742 2438 22 21 5 4 9 3 16317 16114 203 ... 6 ... 0.90 1.24 11. Cricklewood 19312 3730 97 24 ... 2 7 18 28989 28111 878 37 15 ... 1.62 3.02 Total Brent Drain area 83574 12386 188 79 7 11 35 86943 85302 1641 51 64 ... 1.11 r88 Willesden U.D. *166634 23350 390 261 15 105 89 73 169737 165968 3769 71 105 3 1.37 2.22 Do. Xmas, 1913 *165433 23232 418 306 20 91 129 88 168929 164834 4095 58 56 39 1.5 2.4 * Aggregate of Wards. 20 21 B.—SANITARY CIRCUMSTANCES OF THE DISTRICT. Water Supply—Rivers and Streams—Drainage and Sewerage—Closet Accommodation.—Particulars under the above headings are contained in the Health Report for the year 1913, pages 31-32. No alteration requires to be made for the year under review. Scavenging.—The Health Department is responsible for the removal of house refuse within the district. The work is actually carried out by a contractor, who disposes of the refuse by tipping or by destructor. The destructor used belongs to a private firm, as one is not provided by the Council. In the following Tables, Nos. 4-8, are given the chief data relating to House Refuse removal. Table No. 4. DATA RELATING TO REMOVAL OF HOUSE REFUSE. Year. Maximum No. of carts employed. Minimum No. of carts employed. Average No. of carts employed. Maximum No. of men employed Minimum No. of men employed. Total No. of complaints. Percentage of complaints to total No. of houses. (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 1914 24 8 18 41 16 255 1.09 Table No. 5. REMOVAL OF HOUSE REFUSE. TABLE OF QUANTITIES. Year. Annual quantity collected. + Standard Quantities in cubic yards No. of Occupied H ouses in District, Michaelmas. Population of district, Michaelmas. Amount of Refuse collected per house per annum. Amount of Refuse per head of population. In cubic yds. In tons. (0 (2) (3) (4) (5) (6) (7) (8) 1900-1 79.875 25,905 84,100 16,820 115,201 Cubic yds. Cubic yd. 4.7 69 1901-2 83,587 27,109 86,290 17,258 117,619 4.8 .71 1902-3 91,170 29,568 90,940 18,188 123,987 5.0 .73 1903-4 99,761 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 76,719 20,735 140,692 4.3 .63 1906-7 79,137 25,666 78,103 21,109 142,772 3.7 .55 1907-8 80,100 25,978 79,494 21,485 144,912 3.7 .55 1908-9 86,062 27,912 80,830 21,846 149,744 3.9 .57 1909-10 80,558 26,127 81,655 22,069 151,000 3.7 .53 1910-11 80,417 26,081 82,824 22,385 154,298 3.6 .52 1911-12 84,367 27,362 83,912 22,679 157,717 3.7 .53 1912-13 87,106 28,250 84,815 22,923 l6l,l88 3.8 .54 1913-14 79,450 25,767 85,870 23,208 164,538 3'4 .48 1914 76,002 24,649 86,132 23,279* 166,634* 3.3 .45 † Standard quantities are calculated upon the respective mean quantities of refuse collected per house (50 cubic yards during the quinquennium 1900-4 and 3.7 cubic yards during the ten years 1905-14). 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. *Midsummer. 22 Table NO. 6.—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 1 142 3.13 1901-2 2,475 1,895 3,452 £7,822 £8,449 22.5 9 0¾ 16.0 3.45 I902-3 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 4i 18.3 3.83 1904-5 3,445 3,489 3,995 £10,929 £9,796 26.4 10 11 19.3 3.99 1905-6 2,500 2,150 2,800 £7,450 £5,978 20.1 7 2 1/4 12.8 2.60 1906-7 *1,930 *2,156 *2,258 £6,250 £6,085 19.0 5 11 10.5 2.10 1907-8 *2,300 *2,450 *2,250 £6,850 £6,194 20.5 6 4½ 11.3 2 .20 1908-9 *1,955 *1,925 *2,055 £5,855 £6,298 16.3 5 4 1/4 9 .4 1.84 1909-10 1,715 1,939 1,9550 £5,604 £6,363 16.7 5 0¾ 8.9 1.73 1910-11 ... ... ... £6,547 £6,454 19.5 5 10 1/4 10.2 1.99 1911-12 ... ... ... £6,547 £6 538 18.6 5 9 1/4 10.0 1 .97 1912-13 ... ... ... £6,547 £6,609 18.0 5 8½ 97 1'93 1913-14 ... ... ... £6,163 £6,691 186 5 3l 90 177 1914 ... ... ... £6,436 £6,711 20.3 5 6i 9'3 1-85 * Alternative to inclusive contract for the District. † Standard cost is calculated upon the mean cost of removal (23.5d. per cubic yard during the quinquennium 1900-4 and 18.7d. during the ten years 1905-14). 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. 23 24 Table No. 7. Total actual No. of loads removed. Average No. per day. Average cost per van load. Average capacity of van. (1) (2) (3) (4) 10,083 32.2 s. d. cubic yards. 12 10 7.54 Table No. 8. Month. No. of working days. Total cubic yards removed. Average quantity per day (cubic yards). (1) (2) (3) (4) 1914. January 27 7,133 264 February 24 6,130 255 March 26 6,619 255 April 24 6,700 279 May 26 6.450 248 June 25 6,432 257 July 27 6,522 242 August 25 5.575 223 September 26 5,787 223 October 27 6,114 226 November 25 6,087 243 December 25 6,450 258 Sanitary Work.—The following. Table, No. 9, 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. 9.—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. 26 Adoptive Acts in force in Willesden: *Public Health Acts Amendment Act, 1690, Part III. *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, s. 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, 5. 13). Small Holdings and Allotment Act, 1908. Underground Rooms (Section 17 (7) of the Housing, Town Planning, etc., Act, 1909). *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.) 10 Health Visitors. (Also engaged in Medical Inspection.) 11 Clerks. (Also engaged in Medical Inspection.) 26 2 Disinfectors. 2 Drain Testers and Labourers. Inspections: Number of premises inspected on complaint 859 Number of premises inspected in connection with infectious diseases 181 Number of premises under periodical inspection 808 Houses inspected from House to House (Housing, Town Planning, &c., Act, 1909) 724 Total number of inspections and re-inspections made 19,576 Action Taken (other than under Housing, Town Planning, &c., Act, 1909): Cautionary or Intimation Notices Issued 1,029 Number complied with 736 Statutory Orders issued 36 Number complied with 21 Summonses served 5 Number of convictions obtained 5 Summonses withdrawn ,, dismissed Notices under Section 36 of the Housing, Town Planning, &c., Act, 1909, issued 732 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 ion17) 48 Number of representations made by M.O.H. (Section 17) 48 Number of houses made habitable without closing orders 0 27 Number of closing orders made by L.A. (Section 17) 48 Number of houses closed voluntarily 0 Number of closing orders determined after repairs (Section 17) 24* Number of houses demolished— (a) by order of L.A. (Section 17) It (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 2B Number of contraventions 3 Canal Boats used as Dwellings : Number inspected under the Acts 83 Number of contraventions of Regulations 10 Movable Dwellings, Caravans, Tents, &c. : Number observed during the year 4 Number of nuisances therefrom abated 0 Number removed from district 4 Bakehouses: Number in district 68 Contraventions of Factory Acts 47 Slaughter-houses: Number on register 9 Number of inspections made 411 Frequency of inspection weekly Contraventions of Bye-laws 0 *21 of which were closed during the year 1913. †Closed during the year 1913. 28 Cowsheds: Number on register 7 Number of inspections made 60 Frequency of inspection quarterly Contraventions of regulations 4 Number of milch cows in district 90 Dairies and Milkshops: Number on register 143 Number of inspections made 253 Frequency of inspection twice yearly Contraventions of regulations 34 Unsound Food: Meat (including organs) seized and surrendered 1,826 lbs. Poultry and game seized and surrendered 14 lbs. Fish seized and surrendered 260 lbs. Fruit and vegetables seized and surrendered 0 Other articles seized and surrendered 0 Method of disposal Incinerated in boiler furnace at Dust Destructor Adulterated Food: Samples taken 0 Found adulterated 0 Offensive Trades: Number of premises in district 11 Number of inspections made 45 Contravention of Bye-laws 8 Water Supply and Water Service: Wells- New sunk 0 Cleansed, repaired, etc. 0 Closed as polluted 0 29 Percentage of houses supplied from public water service 100 Cisterns—New provided 8 Cleansed, repaired, covered, etc. 204 Draw-taps placed on mains 185 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 465 Percentage of houses provided with water closets 100 Drains— Examined, tested, exposed, etc. 621 Unstopped, repaired, trapped, etc. 299 Waste pipes, rain-water pipes, disconnected, repaired, etc. 433 New soil pipes or ventilating shafts, fixed 142 Existing soil pipes or ventilating shafts repaired 108 Disconnecting traps or chambers inserted 83 Re-constructed 72 Cesspools— Rendered impervious, emptied, cleansed, etc. 0 Abolished and drain connected to sewer 0 Percentage of houses draining into sewers 100 30 Disinfection: Rooms disinfected— (a) Ordinary infectious diseases 1,197 (b) Phthisis 92 Rooms stripped and cleansed 71 Articles disinfected or destroyed— (a) Ordinary infectious diseases 26,064 (b) Phthisis 720 Dust: New bins provided 213 Periodical frequency of dust removal weekly. Number of complaints of non-removal received 255 Method of disposal By tipping and private destructor Sundry Nuisances abated: Overcrowding 24 Smoke 24 Accumulations of refuse 75 Foul ditches, ponds, etc., and stagnant water 11 Foul pigs and other animals 30 Dampness 286 Yards and forecourts paved, repaved or repaired 678 Walls and ceilings cleansed 1,228 Leaky roofs made watertight 220 Additional ventilation provided under floors 196 Dilapidated plaster repaired 86 Flooring and other woodwork repaired 182 Damp-proof courses inserted 16 Water supply reinstated 39 Washhouse floors repaved 61 Fireplaces and stoves repaired 10 Decayed brickwork repaired and repointed 117 Additional sinks provided 40 Additional light and ventilation to staircases 59 31 Larders or food cupboards provided 70 Gutters and rainwater pipes repaired 58 Smoke observations 97 Additional water closets constructed 48 Miscellaneous 52 Inspection of Premises where Food is prepared: Butchers' shops 31 Fish shops 43 Eating houses 16 Greengrocers' shops 18 Ice-cream premises 16 32 Inspection of Manholes.—The following Table, No. 10, shows the results of inspection of manholes during a period of ten years- 905-14:— Table No. 10. 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 4,710 112 24 61 1.3 ,, ,, 1914 835 38 46 31 3.8 Total 57,248 1,750 31 1,656 2.9 Exemptions from Inhabited House Duty.—Table No. 11 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. 11. Customs and Inland Revenue Act, 1890, Section 26. No. of applications received 65 No. granted 61 No. refused 1 No. under consideration at the end of the year 3 33 Canal Boats Acts, 1877 and 1884.—The following Table, No. 12, presents a summary of the work done, and also shows in detail the contraventions observed and remedied during the year under these Acts:— Table No. 12. Infringements of the Acts and Regulations with respect to Carried forward from 1913. Found during 1914. Remedied during 1914. Carried forward from 1914. (a) Registration ... ... ... ... (b) Notification of change of Master ... ... ... ... (c) Certificates 2 4 5 1 (d) Marking 5 ... 5 ... (e) Overcrowding ... 2 2 ... (f) Separation of the sexes ... ... ... ... (g) Cleanliness ... ... ... ... (h) Ventilation ... ... ... ... (i) Painting ... ... ... ... (j) Provision of Water Cask 1 1 2 ... (k) Removal of Bilge Water ... ... ... ... (/) Notification of Infectious Disease ... ... ... ... (m) Admittance of Inspector ... ... ... ... (n) Habitable Condition ... 3 2 1 Totals 8 10 16 2 34 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. 13, sets out the accommotion in each of the common lodging houses:— Table No. 13. Situation of Common Lodging House. Total No. of rooms No. with 3 beds in room. No. with 4 beds in room. No. with 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 1 & 2, Malvern Gardens 20 ... 12 ... 2 1 1 3 144 34 9 16 2 2 1 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 Health Report for the year 1912. Offensive Trades.—Rag and bone dealers are brought under the above heading by virtue of Section 51 of the Public Health Acts Amendment Act. 1907. There are eleven rag and bone dealers in the district. With one exception they are of the usual type common in most districts, where rags, bones, etc., are purchased from house-holders by rag and bone dealers who carry on small businesses. In the case of the remaining dealer, rags, bones, paper, and other decomposable material from itinerant vendors, dustmen and private persons are purchased on a large scale. The 35 mises were frequently visited, and on no occasion were nuisances observed. No complaints were received during the year from residents in the vicinity. This freedom from complaints is the result of enforcing the removal of the accumulations by the rag and bone dealer at frequent intervals. As the premises used for sorting and storing are now properly constructed brick buildings, the possibility of nuisances is reduced. In one instance a large bottle sorting establishment was closed during the year 1914, in consequence of the proprietor failing to carry out certain structural alterations and necessary requirements, in order to put the premises in a reasonable state of repair. The piggery, where fat boiling is carried on, was visited frequently, and on all occasions was found to be managed satisfactorily. No complaints were received from residents, either with respect to the pig keeping or the fat boiling. Cowsheds.—Sixty visits were paid to the cowsheds in the district, in order to ascertain whether the requirements of the Council with respect to cleanliness, ventilation, lighting, drainage, and water supply were duly observed. Generally speaking, the cows were found in a clean condition, and the floors and walls of the sheds free from offensive deposits. It is, however, necessary continually to urge cowkeepers to exercise greater cleanliness in respect of the cows. This is so more especially with new comers from districts where the standard of cleanliness is not so high as in Willesden. At the end of September one of the cowkeepers discontinued the keeping of milch cows, on account of the unsuitability of his premises, and in accordance with an undertaking given by him to the Council at the end of the year 1913. 36 Veterinary Inspection of Milch Cows and Sampling of Milk for Detection of Tubercle Bacilli.—The quarterly examinations of milch cows at the farms in the district for the detection of animals suffering from tuberculosis of the udder, have been continued by the Council's veterinary surgeon. In all, 426 cows were examined, and, in 42 instances, samples of milk were taken from cows showing signs of udder lesions, wasting, or respiratory affections. These samples were forwarded to the Lister Institute for biological examination. Tubercle bacilli were found to be present in three of the samples. In one instance two cows in the same herd from which samples of milk had been taken on the same day were found to be affected. The County Veterinary Surgeon was communicated with in accordance with the Tuberculosis Order, 1913, and the cows were removed from the herd, taken to the Cattle Market and slaughtered. Compensation was given to the owner, as provided by the Order. With respect to the remaining case, the farmer had, two weeks prior to the receipt of the bacteriological report, disposed of the affected cow at the Cattle Market. Thirty-two samples were taken from local milk shops, and in two instances tubercle bacilli were found to be present. In one, the milk was obtained from a shop supplied by a large distributing agency in London. The sample was a mixed one, and it was impossible to trace its source. The other sample came from a farm in Staffordshire. The County Medical Officer, the farmer and also the distributing agent were notified. A report was duly received from a veterinary surgeon to the effect that he had examined the cows in the farmer's herd, and at the time of his examination the cows were all clinically free from tuberculosis. He, however, stated that some weeks prior to the receipt bv 37 the farmer of the notification from the Council, the farmer, acting on his recommendation, had removed from the herd a cow suffering with tuberculosis, and sent it to a knacker's yard, where the animal had been destroyed. The following Table, No. 14, shows the results of the examinations of samples of milk taken during the year 1914: Table No. 14. 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 42 3 39 Samples of milk taken from milkshops supplied by Cowkeepers outside the district 26 1 25 Samples of milk taken from milkshops supplied by Agencies distributing from a London Depot 5 1 4 Samples of milk taken from milkshops supplied by Cowkeepers in the district 1 ... 1 Totals 74 5 69 38 The following Table, No. 15, gives the results of examinations of samples of milk for tubercle bacilli in each completed year since the methods of sampling and examination indicated above have been in operation in Willesden:— Table No. 15. 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 58 1913 149 9 6.0 1914 74 5 6.8 Food Inspection.—Considerable attention has been given to this subject, especially on Saturday nights and Sunday mornings. Except in two cases it was not found necessary to resort to compulsory seizure. In one instance the presence of a cow's head exposed for sale induced the Inspector to examine all the meat in the shop, and also the offal at the rear of the shop, with the result that tuberculous mesenteric glands were discovered, indicating that tuberculous meat had at a recent period been brought to the shop. As, however, no additional evidence of diseased meat was found, it was not possible to take legal action against the shopkeeper. In the other case, the carcases of three sheep in a partially decomposed condition were found hanging up in a slaughterhouse. Upon enquiry, it was elicited that the carcases had been presented at Christmas time to a charitable institution and sent to the butcher for storage purposes. Owing to the sudden illness of the person responsible for them, the carcases were forgotten by the owners, until the Inspector's visit. As the explanation given was deemed to 39 be satisfactory no further action was taken. In the above two cases the articles seized were taken before a Justice of the Peace, condemned and afterwards destroyed. The following is a list of the foodstuffs voluntarily surrendered and destroyed:— Approximate Weights. 1 box of bloaters 10 lbs. 1 box of bloaters 10 lbs. 1 box of dabs 30 lbs. 2 boxes of plaice 60 lbs. 1 box of haddock 30 lbs. 2 boxes of haddock 60 lbs. 1 box of plaice 30 lbs. 1 box of whiting 30 lbs. 1 turkey 14 lbs. 274 lbs. Slaughterhouses.—There are nine slaughterhouses in the district. These were regularly visited when slaughtering was in operation. In all, 411 visits of inspection were made during the year. The carcases, organs, and offal, were all subjected to close inspection for the detection of disease. The following were found to be diseased and were surrendered:— Carcases or organs. Approximate weight in lbs. Disease. 1 Heifer 750 Generalised Tuberculosis. 1 Heifer 780 Generalised Tuberculosis. 1 liver (Bovine) 12 Pyaemic Abscess. 1 liver (Bovine) 12 Pyaemic Abscess. 1 liver (Bovine) 12 Pyaemic Abscess. 1 liver (Bovine) 12 Tuberculosis. 1 tongue (Bovine) 8 Actinomycosis. 3 Sheep 240 Decomposed. 40 In all instances the premises were found to be kept in a clean condition, and in no case was it found necessary to serve notice in respect of contravention of the Bye-laws. Milkshops.—Twenty additional persons were registered as purveyors of milk during the year 1914, making a total of 144 on the register. In all instances the premises where milk is sold were visited twice, and in some cases three times during the year. Generally, they were found to be kept and conducted under cleanly conditions; but in a few cases the provision made for the washing and cleansing of utensils, cans, etc., was unsatisfactory. Thirty-four notioes to remedy insanitary conditions—principally defective paving— existing in connection with milkshops were served. Of this number 28 have been complied with, and the remaining six were outstanding at the end of the year. Bakehouses.—There are 47 bakehouses above ground and 21 underground. These were all visited twice, and with the exception of a few minor defects were found in a satisfactory condition. No structural alterations or improvements were effected during the year. Forty-seven notices were served, principally in respect of whitewashing and cleansing of the bakehouses. These were duly complied with. In the case of underground bakehouses, whitewashing is required more frequently than in those above ground. 41 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. 16, showing the work done in Willesden, has been kindly supplied by Mr. Robinson, Chief of the Weights and Measures Staff. Table No. 16. Samples taken during the year ended December 31st, 1914. Article. Formal. Informal. Taken. Adulterated. Taken. Adulterated. Butter 31 10 454 41 Milk 279 49 147 18 Cream ... ... 10 ... Pepper ... ... 7 ... Coffee ... ... 3 ... German Sausage ... ... 2 2 Liver Sausage ... ... 1 ... Black Pudding ... ... 2 1 Ale 1 ... 1 1 White Precipitate Ointment ... ... 7 ... Liquid Paraffin ... ... 7 2 Tincture of Iodine ... ... 7 1 Epsom Salts 1 ... 1 1 312 59 649 67 Housing Inspection.—The periodical inspection of houses in pursuance of the Housing (Inspection of District) Regulations, 1910, has made steady progress. 42 The following Table, No. 17, has been prepared in accordance with these Regulations, and shows the number of houses awaiting inspection at the end of the year 1913, the number inspected during the year 1914, and the number awaiting inspection at the end of the year 1914. Table No. 17. 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 No. on list at 27/12/13 5819 No. added to list during 52 weeks ending 26/12/14 0 Total No. appearing on list during 52 weeks ending 26/12/14 5819 No. inspected, excluding houses represented as unfit for human habitation, during 52 weeks ended 26/12/14 676 No. inspected and represented as unfit for human habitation during 52 weeks ending 26/12/14 48 Total No. inspected during 52 weeks ending 26/12/14 724 Total No. remaining on list at 26/12/14 5095 From the above Table, No. 17, it will be noted that 724 houses were inspected during the year, and that 48 of these were represented as unfit for human habitation. Of the remaining 676 houses, 41 were found in good repair, and no action was taken in regard to them. The following Table, No. 18, shows the action taken in respect of the houses brought forward from 1913, as well as the houses coming under review during the present year : 43 Table No. 18. Brought forward from 1913. 1914. Premises. No. of houses inspected and requiring notices which were not served during year ending 27/12/13. No. of houses with intimation notices outstanding at 27/12/13. No. of houses with statutory notices outstanding at 27/12/13. No. of houses inspected during the year ending 26/12/14. No. of houses in which no notices were required. No. of houses on which intimation notices were served during year ending 26/12,14. No. of houses on which intimation notices were complied with during year ending 26/12/14. No. of houses with intimation notices outstanding at 26/12/14. No. of houses on which statutory notices were served during year ending 26/12/14. No. of houses on which statutory notices were complied with during year ending 26/12/14. No. of houses with statutory notices outstanding at 26/12/14. No. of houses inspected and requiring notices which were not served during year ending 26/12/14. Meyrick Road, 22-46, 1-39 ... ... ... 33 ... 33 28 ... 5 ... 5 ... Cobbold Road, 1, 7-55, 61-93, 99, 107-123, 2-10, 18-26 ... ... ... 62 6 56 38 6 12 6 6 ... Canterbury Yard, 1-2 ... ... ... 2 1 ... ... 1 ... ... ... ... Granville Road, 1-29, 4-30 ... ... ... 79 ... 65 17 48 ... ... ... 14 Disraeli Road, 1-53, 26-42 ... 30 ... ... ... ... 17 1 12 12 ... ... Disraeli Road, 8-24 ... ... ... 9 ... 9 3 4 2 2 ... ... Steele Road 1-63, 2-50 ... ... ... 55 2 53 13 15 25 3 22 ... Barrett's Green Road, 17-77, 83-91 Barrett's Green Road, 97-101 ... ... ... 39 ... 39 1 38 ... ... ... ... Greyhound Road, 2-68 ... 30 ... ... ... ... 30 ... ... ... ... ... Greyhound Road, 1-61 ... ... ... 31 1 30 29 ... 1 ... 1 ... Harrow Road, 744-748, 754-758, 762-768, 786-794, 798, 802-806, 810, 850-864, 870-874 ... ... ... 29 5 24 20 4 ... ... ... ... 44 Table No. 18—(continued). Brought forward from 1913. 1914. Premises. No. of houses inspected and requiring notices which were not served during year ending 27/12/13. No. of houses with intimation notices outstanding at 27/12/13. No. of houses with statutory notices outstanding at 27/12/13. No. of houses inspected during the year ending 26/12/14 No. of houses in which no notices were required. No. of houses on which intimation notices were served during year ending 26/12/14. No. of houses on which intimation notices were complied with during year ending 26/12/14. No. of houses with intimation notices outstanding at 26/12/14. No. of houses on which statutory notices were served during year ending 26/12/14. No. of houses on which statutory notices were complied with during yeat ending 26/12/14. No. of houses with statutory notices outstanding at 26/12/14. No. of houses inspected and requir' ing notices which were not served during year ending 26/12/14. Wellington Street, 1 ... ... ... 1 1 ... ... ... ... ... ... ... Napier Road, 1-35 ... ... ... 18 3 15 12 3 ... ... ... ... Albert Road, 80-118 ... 20 ... ... ... ... 17 1 2 2 ... ... Albert Road, 2-78, 81 ... ... ... 40 ... 40 29 7 4 ... 4 ... Salusbury Road, 1-35, 2-4 ... ... ... 20 1 19 1 18 ... ... ... ... Belton Road, 1-39, 2-26, 36-42 Castle Villas, 1-2 ... ... ... 39 6 33 33 ... ... ... ... ... Villiers Road, 1-141, 2-60 ... ... ... 102 15 87 45 35 7 7 ... ... Lincoln Mews, 1-17 ... ... ... 17 ... 17 2 15 ... ... ... ... Rucklidge Avenue, 15-21,85-89 ... 23 ... ... ... 7 18 ... 12 6 6* ... Rucklidge Avenue, 3-7, 91-169, 2-36, 38-98 ... ... ... 94 ... 94 53 7 34 6 28 ... Honeywood Road, 5-11 ... ... ... 2 ... 2 ... ... ... ... ... ... Manor Villas, Acton Lane, 4 ... ... ... 1 ... 1 1 ... ... ... ... Ranelagh Road, 1, 24, 45 ... ... ... 3 ... 3 ... 3 ... ... ... ... Totals 7 103 ... 676 41 628 407 208 116 44 72 14 *One Closed voluntarily. 46 Houses Unfit for Human Habitation.—The following Table, No. 19, shows the number of dwelling houses inspected under Section 17 of the Housing, Town Planning, etc., Act, 1909, and represented as unfit for human habitation, and action taken thereunder. Table No. 19. Total number of houses inspected 724 Number considered to be unfit for human habitation 48 Number represented by Medical Officer of Health 48 Closing Orders made by Local Authority 48 Appeals against Closing Orders 0 Notices served on occupying tenants 1 Occupying tenants summoned 0 Orders made by Court requiring tenants to quit 0 Number of tenants ejected by order of Court 0 Closing Orders determined 24† Demolition Orders made 0 Appeals against Demolition Orders 0 Demolition Orders obeyed 1* Number of demolitions carried out without Orders being made 0 * Closed during 1913. † 21 of which were closed during 1913. The following Table, No. 20, gives detailed information as to the action taken during the year in respect of houses represented as unfit for human habitation. Table No. 20.—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. Demolition orders enforced. Orange Tree Terrace, Harlesden, 1-7 7 27/1/14 Harrow Road, 778-784, 820-822 6 24/2/14 Harrow Road, 824 1 21/7/14 10/3/14 24/3/14 1/4/14 24/10/14 Harrow Road, 826-828 2 23/6/14 l9/514 Harrow Road, 830-834 3 • 23/6/14 Earlsmead Road, 29 1 24/3/14 Earlsmead Road, 31 1 26/5/14 Harrow Road, 770-774 2 17/2/14 17/3/14 24/3/14 1/4/14 15/4/14 29/9/14 46 Table No. 20.—SECTION 17 (1) OF HOUSING, TOWN PLANNING, &c., ACT, 1909.—Continued. 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. Demolition orders enforced. Harrow Road, 776 1 17/2/14 19/5/14 26/5/14 8/6/14 22/6/14 29/9/14 Canterbury Yard, 3-7 5 19/5/14 16/6/14 17/11/14 24/11/14 10/12/14 24/12/14 Rucklidge Avenue, 9-13 3 22/9/14 20/10/14 27/10/14 11/11/14 25/11/14 "Cottage," Willesden Paddocks 1 22/9/14 20/10/14 27/10/14 11/11/14 25/11/14 28/11/14 Harrow Road, 772 1 22/9/14 20/10/14 27/10/14 11/11/14 25/11/14 Harrow Road, 876, 880 2 20/10/14 17/11/14 l5/l2/14 22/12/14 Wellington Road, 2 & 3 2 20/10/14 17/11/14 24/11/14 10/12/14 24/12/14 Harrow Road, 856 1 20/10/14 17/11/14 24/11/14 10/12/14 24/12/14 Avenue Close, 1 -26 26 17/11/14 15/12/14 22/12/14 Lydia Terrace, Regent Street, 1 -4 4 17/11/14 15/12/14 22/12/14 47 48 Regulations for Underground Rooms.—These regulations have been in operation during the whole of the year, and Granville Road, one of the oldest and most thickly populated roads in the district, has been inspected under them. The houses in this road consist of four storeys, and have each floor occupied by one or more families. Seventy-four houses were inspected and the various owners were notified of the regulations and requested to comply with them. In 24 houses the requirements of the regulations have been complied with, 12 are in progress, and in 42 instances at the end of the year the work had not been put in hand. The work required by the regulations has entailed considerable outlay on the part of owners, but it has effected a lasting improvement in the properties concerned. Insanitary and unhealthy conditions previously existing have been removed, walls rendered damp-proof, and basement rooms and underground premises generally rendered thoroughly fit for human habitation and sleeping. 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 fire 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; 49 (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 a statement of the number of inspections made and defects noted is to be found in Tables Nos. 21, 22, 23, 24 and 25, duly filled in as required by the Home Office. 50 Table No. 21. 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) 119 30 Workshops (including Workshop laundries) 213 58 Workplaces (other than Outworkers' premises included in Part 3 of this Report) 71 41 Total 403 129 Table No. 22. DEFECTS FOUND. Particulars. Number of Defects. Number of Prosecutions. Found. Remedied. Referred to H.M. Inspector (1) (2) (3) (4) (5) Nuisances under the Public Health Acts:— Want of Cleanliness 44 39 Want of Ventilation Overcrowding Want of drainage of floors 6 5 Other Nuisances 73 54 Sanitary accommodation— Insufficient 4 2 Unsuitable or defective 24 20 Not separate for Sexes 4 4 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 33 Other offences (Excluding offences relating to out-work which are included in Part 3 of this Report). 9 5 Total 199 162 Table No. 23. 3.—HOME 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, 110. Lists received from Employers. Failing to keep or permit inspection of lists. Failing 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, 110. 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. 40 36 41 8 4 6 62 10 10 Cleaning and Washing 8 2 7 4 2 4 14 Household linen Lace, lace curtains, and nets 2 2 2 Furniture and upholstery 4 2 3 2 2 8 1 1 1 Umbrellas, &c. Total 52 40 51 16 6 14 86 11 11 1 51 52 Table No. 24. REGISTERED WORKSHOPS. Workshops on the Register (s. 131) at the end of the year. Number. (1) (2). Factories 60 Factories, Laundries 48 Workshops, Laundries 37 Domestic Laundries 9 Bakehouses 56 Dressmakers 40 Outworkers 131 Blouse Makers 2 Tailors 29 Bootmakers 31 Metal Workers 13 Wood Workers 6 Seamstresses 0 Motor and Cycle Makers 13 Upholsterers 1 Milliners 2 Miscellaneous 11 Total number of Workshops on Register 489 Table No. 25. OTHER MATTERS. Class. Number (1) (2) Matters notified to II.M. Inspector of Factories:— Failure to affix Abstract of the Factory and Workshop Act (s. 133) 2 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 9 Reports (of action taken) sent to H.M. Inspector Other 2 Underground Bakehouses (s. 101):— Certificates granted during the year 11 In use at the end of the year 9 53 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 insanitary conditions; (ii) 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. Note by Chief Sanitary Inspector.—Taking a retrospect of the last 25 years, one cannot help being struck by the gradual, steady progress made year by year in the improvement of the hygienic conditions in the environments of the workers in workshops and workplaces in Willesden. In the early days it was no uncommon sight to see both men and women, working at their several occupations, in illlighted, badly ventilated and overcrowded workshops. These premises were often situated in underground rooms or basements, where it was necessary, even in the daytime to have resort to artificial light. These undesirable conditions were brought about by two principal factors: (1) The inadequate powers, prior to the 54 passing of the Factory and Workshops Act, 1901, possessed by local authorities governing factories and workshops; (2) The practice of converting ordinary private dwelling houses into workshops, irrespective of their adaptability or suitability for the work in question. Workshops of the above description have, fortunately, for some years past, been steadily on the decrease, giving place to the modern and upto-date factory or workshop premises. In these latter, provision is made for adequate lighting, ventilation, and cubic space, together with suitable and sufficient sanitary and lavatory accommodation, and the general surroundings both for the comfort and convenience of the workers are in every way considered. In no branch of work are the improvements in the working conditions of the workers more marked than in those of laundries. Twenty-five years ago Willesden had many insanitary laundries. In certain parts of the district most of the private dwelling houses were converted into laundries of this description. Houses consisting of from two to four stories were used for laundry purposes, and in nearly all instances, owing to the ordinary domestic washhouse being too small to accommodate the number of women at the wash tub, a portion of the back yard, between the two houses, was covered in with rough boards and glass, in order to afford more room. These temporary makeshifts, at the best, afforded but poor accommodation for the women, who were compelled to work in them. They were usually dark, badly ventilated and evil smelling, and so inadequately drained, that the workers were compelled to stand on pieces of board, in order to keep their feet out of the shallow pools of water on the surface. The rooms used for ironing were generally overheated, and so badly ventilated that often in the summer time the women worked with a minimum of clothing, and 55 often on the verge of collapse. These were conditions to be seen day by day all over the district, but, happily, now are only rarely seen, and even then in a modified degree.The steady increase year by year of power laundries, together with the constant enforcement by the Local Authority of the provisions of the Factory and Workshops Act in regard to sanitary conditions has had the effect of gradually diminishing the number of these unsatisfactory laundries, so that only a small percentage remain in use in the district at the present time. The abolition of such premises is undoubtedly good for all parties concerned, and we may reasonably look forward in the near future to all laundry workers being employed under thoroughly satisfactory conditions. C.—PREVALENCE OF, AND CONTROL OVER, ACUTE INFECTIOUS DISEASES. Notifications.—The following Table, No. 26, shews the number of notifications of infectious diseases in Willesden each year since 1892:- 56 Table No. 26. 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. ** Ophthalmia Neonatorum. ‡Pulmonary T uberculosis. Other forms of Tuberculosis. Totals. Rate per 1,000 of population. (1) (2) (3) (4) (4) (6) (7) (8) (9) (10) (11) (12) (13) (14) (15) (16) (17) (18) (19) 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 9.5 1896 2 1 ... 173 101 475 ... 52 ... ... 10 ... ... ... ... ... 815 10.3 1897 ... 2 ... 275 107 510 ... 52 ... 1 9 ... ... ... ... ... 956 8.4 1898 1 ... ... 335 70 361 ... 66 ... ... 2 ... ... ... ... ... 935 8.3 1899 ... 1 ... 319 82 414 ... 79 ... ... 0 ... ... ... ... ... 901 6.4 1900 ... ... ... 226 89 335 ... 77 ... ... 8 ... ... ... ... ... 735 9.5 1901 10 ... 1 404 79 553 ... 57 ... ... 2 ... ... ... ... ... 1106 9.6 1902 88 ... ... 440 104 466 ... 73 ...... ... 8 ... ... ... ... ... 1 179 6.7 1903 7 ... ... 221 76 502 ... 45 ... ... 11 ... ... ... ... ... 862 5.9 1904 12 ... ... 353 73 326 ... 38 ... ... 5 ... ... ... ... ... 807 5.8 1905 ... ... ... 275 86 397 ... 41 ... ... 13 ... ... ... ... ... 1082 7.6 1906 ... ... ... 286 103 637 ... 46 ... 1 9 ... ... ... ... ... 1016 7.0 1907 ... ... ... 254 77 641 ... 28 ... ... 13 3 ... ... ... ... 1016 7.3 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 ... ... 11 ... ... ... 61 ... 648 4.2 1911 ... ... ... 192 114 326 ... 13 ... ... 16 ... ... ... 230 ... 891 5.7 1912 1 ... ... 222 109 430 ... 13 ... ... 10 ... 4 ... 487 ... 1276 8.0 1913 ... ... ... 233 93 504 ... 18 ... ... 11 3 3 ... 368 146 1379 8.4 1914 ... ... ... 303 121 765 ... 13 ... ... 12 6 ... 29 326 90 1665 10.1 * Notifiable 5th August, 1907, to 4th August, 1908. Notifiable permanently 29th March, 1912. † Notificable permanetly from 1st March, 1912. ‡Poor Law Cases of this disease became notifiable on ist January, 1909. Hospital Cases became notifiable on 1st May. 1911, and all cases became notifiable on 1st January, 1912. § Became notifiable 1st February, 1913. ** Became notifiable 1st April, 1914. 57 Incidence of Infectious Diseases.—The following Table, No. 27, shows the Incidence Rate per 1,000 of the population estimated to the middle of 1914, of infectious diseases notified during the year in each Ward and for the whole District:— Table No. 27 Ward. Small Pox. Cholera. Plague. Diphtheria (Including Membranous Croup). Erysipelas Scarlet Fever. Typhus Fever. Enteric Ftvcr. Relapsing Fever. Continued Fever. Puerperal Fever. Cerebro-Spinal Meningitis. Poliomyelitis. Ophthalmia Neonatorum. Pulmonary Tuberculosa. Other forms of Tuberculosis. (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) (13) (14) (15) (16) ] South Kilburn ... ... ... 2.30 1 22 6.71 ... 0.13 ... ... 0.06 ... ... 0.20 3.73 0.67 Mid Kilburn ... ... ... 1.85 1 .09 5.21 ... 0.06 ... 0.13 0.13 ... 0.13 2.05 089 North Kilburn ... ... ... 1.42 0.63 3.88 ... ... ... ... 0.15 ... ... 0.31 1.98 0.55 Brondesbury Park ... ... ... 1.62 0.91 5.69 ... 0.10 ... ... ... 0.10 ... 0.10 1.11 0.20 Kensal Rise ... ... ... 1.97 0.56 3.59 ... 0.14 ... ... 0.14 ... ... 0.14 1.48 0.56 Harlesden ... ... ... 2.33 0.64 5.49 ... ... ... ... ... ... ... 0.46 1.51 0.35 Stonebridge ... ... ... 1.57 0.95 4.95 ... ... ... ... 0.05 0.05 ... 0.16 1.35 0.67 Round wood ... ... ... 1.53 0.51 4.08 ... 0.12 ... ... 0.06 0.06 ... 0.12 1.91 0.57 Church End ... ... ... 2.19 0.56 3.54 ... 0.21 ... ... ... ... ... 0.07 2.47 0.77 Willesden Green ... ... ... 1.61 0.71 3.10 ... 0.05 ... ... 0.05 ... ... 0.11 1.91 0.29 Cricklewood ... ... ... 1.55 0.31 4.45 ... 0.05 ... ... 0.10 0.05 ... 0.05 1.91 0.36 Willesden U.D. ... ... ... 1.81 0.72 4.59 ... 0.07 ... ... 0.07 0.03 ... 0.17 1.95 0.54 58 Scarlet Fever.—During the year 765 cases of this disease were notified, and of this number 682, or 89.1 per cent. were removed to Hospital. The following Table, No. 28, shows the number of cases notified, the number and percentage removed to Hospital, and the Incidence and Fatality rates each year since 1892:— Table No. 28. 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 2.9 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 1914 765 682 89.1 4.6 7 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. 29, gives certain particulars with regard to the occurrence of "return cases" since 1905: 59 Table No. 29. Year. Notifications of Scarlet Fever. Infecting Cases. Return Cases. No. of Infecting Cases giving rise 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 ii 1 ... ... ... ... 12 1909 638 4.4 56 8.7 66 10.3 48 7 ... ... ... ... ... ... 1910 314 2.0 15 4.7 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 ... ... ... ... ... ... 1914 765 4.6 34 5.0 42 5.5 29 4 ... ... 1 ... ... ... Totals 5387 3.5 261 48 328 6.0 215 35 5 4 1 ... 1 15 * Records incomplete. 60 The following Table, No. 30, shows the number of days during which the 34 infecting cases shown in Table No. 29 were isolated in hospital or at home, and the number of days elapsing after release from isolation before the 42 "return cases" appearing in Table No. 29 occurred. 61 Table No. 30. Initials of Infecting Cases. No. of days isolated. Initials of Return Cases. No. of days elapsing between release from isolation of infecting case and onset of illness of return case. 1 w.b. 34 p.b. 20 2 I.C.C. 88 E R.C. 33 3 C.C. 56 J.C. 40 4 PJ. or D.J. 1 39 K.J. 99 42 252 5 t.b. 40 J.S. 138 6 C.C. 34 p.h. 17 7 E.D.* 46 K.D. 41 8 r.b.t 49 m.E.b. 10 9 i.w.m.h. 50 S.J.T. 33 10 E.J. 41 F.J. 4 11 J.W. 49 P.D.W. 10 R.W. 22 12 E.H. or j.h. 42 l.G. 37 35 44 13 A.C. 37 m.C. 14 14 C.b. 42 G.b. 46 15 G.D. or L.D. 37 C.D. 16 30 23 16 F.C. 37 E.C. 20 17 W.C. 33 A. F. 12 E.H.C. 10 18 E.M.C. 39 R.C.C. 32 19 E.C. 50 W.C. 5 20 A.F.* 46 W.F. 58 21 F.E.† 84 O.E. 8 G.E. 5 A.E. 6 L.E. 9 L.E. 8 22 r.G.h. 40 D.M.H. 5 23 E.h. 36 A. H. 74 24 V.h. 50 l. H. 23 25 E.G.* 42 F.G. 102 26 O.G.† 51 E.G. 36 H.G. 34 27 K.C. 34 J.C. 34 N.G. 62 28 D.J. 42 P.M.J. 120 29 M.L. 18 I.M. 115 30 A.M. 42 S.M. 9 31 P.R. 71 b.r. 10 32 b.r. or P.R. No. 31 25 14 A.G.R. 49 7 33 d.s. 48 o.m.s. 1 5 34 T.W.* 53 G.W. 21 * Isolated at home. † Isolated in M.A.B. Hospital. All the other cases were isolated in Willesden Isolation Hospital. 62 Multiple Cases of Scarlet Fever.—The following Table, No. 31, shows the number of scarlet fever cases notified from each house in which scarlet fever occurred in each year since 1910:— 63 TABLE No. 31. 1910. 1911. 1912. 1913. 1914. 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. No. of Houses. Per cent. of Houses. No. of Cases. Per cent. of Cases. Houses in which:- 1 case occurred 193 80.4 193 61.4 194 78.8 194 59.5 253 80.5 253 58.8 317 82.3 317 62.9 507 82.8 *507 66.2 2 cases occurred 30 12.5 60 19.1 35 142 70 21.5 34 10.8 68 15.8 40 10.4 80 15.9 75 12.2 å150 19.6 3 10 4.1 30 9.5 11 4.4 33 10.1 15 4.7 45 10.4 15 3.9 45 8.9 20 3.3 ‡6o 7.9 4 >. 5 2.0 20 6.3 3 1.2 12 3.7 6 1.9 24 5.5 7 1.8 28 5.6 7 1.1 **28 3.6 5 1 .4 5 1.6 1 .4 5 1.5 2 .6 10 2.3 3 .8 15 2.9 4 .6 ††20 2.7 6 1 .4 6 1.9 2 .8 12 37 1 .3 6 1.3 2 .5 12 2.4 ... ... ... ... 7 ... ... ... ... ... ... ... ... 2 .6 14 3 .2 1 .3 7 1.4 ... ... ... ... 8 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 9 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 10 ,, ... ... ... ... ... ... ... 1 .3 10 2.3 ... ... ... ... ... ... ... ... Total 240 100 314 100 246 100 326 100 314 100 430 100 385 100 504 100 613 100 765 100 * Includes I return case of which the primary case occurred outside Willesden and therefore does not appear, and 5 return cases of which the primary case occurred in 1913. and was counted in the 1913 return. † Includes 17 primary cases with 1 return case each, 1 return case preceded by I primary case in 1913, and 1 secondary case in 1914, and 2 return cases following upon 1 return case which occurred in 1913. ‡ Includes 3 primary cases with 2 return cases each, 1 primary case with 1 secondary and 1 return case, 3 primary cases each with 1 return case, and 1 other case notified as Scarlet Fever but diagnosed in Hospital as not Scarlet Fever. ** Includes 1 primary case with 1 secondary case, 1 return case and 1 case notified as Scarlet Fever but diagnosed in Hospital as not Scarlet Fever. ††Includes a group of 5 return cases following on 1 primary case which occurred outside Willesden. For footnotes on 1913, 1912 and 1911 cases see reports of these years. 64 Diphtheria and Membranous Croup.—During the year 303 cases of this disease were notified, and 258, or 85.2 per cent., were treated in hospital. The following Table, No. 32, shows the number of cases notified, the number and percentage removed to hospital, and the incidence and fatality rates each year since 1892. Table No. 32. 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 275 132 48.0 2.9 250 1898 335 217 64.7 3.3 204 1899 319 183 57.3 2.9 .48 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 1914 303 258 85.2 1.8 79 65 Enteric Fever.—During the year 13 cases were notified and 12, or 92.3 per cent., were removed to hospital. The following- Table, No. 33, shows the number of cases notified, the number and percentage removed to hospital, and the incidence and fatality rates each year since 1892:- Table No. 33. 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 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 52 16 30.7 0.56 230 1898 66 38 57.5 0.66 136 1899 79 32 40.5 0.73 128 1900 77 32 414.5 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 1914 13 12 92.3 0.07 231 66 Small Pox.—No case of Small Pox was notified during the year. The following Table, No. 34, shows the number of cases notified and the number and percentage removed to hospital each year since 1892:- Table No. 34. 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 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 ... ... ... 1914 ... ... ... Cerebro-Spinal Meningitis and Poliomyelitis.— Six cases (including one of posterior basic meningitis) of Cerebro-Spinal Meningitis were notified during the year. One was admitted to Willesden Isolation Hospital, and died there, the cause of death being certified as "Tuberculous Meningitis." One was admitted to Hampstead General Hospital, and one to St. George's Hospital. Both these cases died. Two cases were treated at home and died. About the other no information was obtained. No case of Poliomyelitis was notified during 1914. 67 Ophthalmia Neonatorum.—This disease was made compulsorily notifiable by an order of the Local Government Board on 1st April, 1914. It is a very prevalent disease, especially among the children of the poor, and it has been computed that one-tenth of all the cases of blindness in the country and one-third of all the institutional cases of blindness are due to this cause. It is due to infection of the child's eyes by discharge in the maternal passages, during birth, and is usually of gonorrhoeal origin. As it is a disease which may produce serious effects, and is at the same time easily preventable, as a rule, by simple means, it is one in which administrative measures may be expected to be of great value. Twenty-nine cases were notified during the last nine months of 1914. Of these, 17 were cured, 3 died and 3 were still under observation at the end of the year. In the case of the other six the result is not known. Three of the cases attended the Eye Clinic, and of these one was cured and two were still under observation at the end of the year. The provision of one or two hospital beds for serious cases of this disease would be of great value. In very acute cases the only hope of saving the child's eyesight lies in thorough treatment, which the mothers have neither the time nor knowledge to carry out, and, indeed, it is questionable if any but a trained person has the necessary skill. The cases which are so acute as to demand hospital treatment are few in number, and the expense would therefore be small. On the other hand the saving of a child's eyesight is not only a matter of the utmost importance to the child, but saves the community a considerable expense in maintaining and educating him. 68 The whole subject of the treatment of Ophthalmia Neonatorum was dealt with during the year in a special report, which appears as Appendix B in the present volume. Administrative Action to Prevent the Spread of Notifiable Infectious Diseases.—An isolation hospital with 166 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 disease, except small-pox 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 Nos. 28, 32 and 33, 89.1 percent. of scarlet fever cases, 85.2 per cent. of diphtheria cases, and 92.3 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. 69 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. Land has now been purchased in the neighbourhood of Kingsbury, and the Council has at present under consideration a scheme for the erection of a Small-Pox Hospital. This matter was dealt with by me during the year in a special report, which appears as Appendix I to the present report. Vaccination Statistics.—The following Table, No. 35, gives statistics of the Vaccination Returns in this district since 1898 :— Table No. 35. Years No. of Births on Register of Vaccination Officer. Successfully Vaccinated. Insusceptible. Dead. Conscientious Objectors. Postponed by Doctor. Gone Away. Un vaccinated. Percentage of Survivors unprotected by Vaccination. Conscientious Objectors per 100 Children Vaccinated. Cases of Small-pox Notified. (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 3,560 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 24.0 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 00 .0 0 1914 3,974 1,745 16 241 1,092 118 260 502 53 62.6 0 70 Ophthalmix Neonatorum.—When a case is notified the District Health Visitor visits the house and ascertains whether the child is under medical treatment. If so, she endeavours to find out if treatment is being satisfactorily carried out, and assists the mother to carry it out. If the child is not being attended by a doctor she advises that the child should be taken to the Eye Clinic,a where appropriate treatment is given, the Health Visitor visiting at the home to help and advise the mother as to the curative measures to be adopted. Some cases which are not notified are discovered by the Health Visitors in their visits under the Notification of Births Act, 1907. In these cases the same procedure is followed. 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 539 cases of measles and 708 of whooping cough were notified during 1914. Children are excluded from school under Regulations adopted by the Education Committee, and appearing on pp. 150 and 151 of my Annual Report for 1913. 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 5 deaths occurred from scarlet fever, 24 from diphtheria, and 3 from enteric fever, for which diseases hospital accommodation is provided, while 8 deaths occurred from measles and 34 from whooping cough. (2) The death rate from scarlet fever, enteric fever, and diphtheria has declined generally during the past twenty years, since the provision of isolation hospitals, but in respect of measles and whooping cough the death rate 71 generally has not diminished during the same period, and these diseases are still considerable 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 for measles and whooping cough would be the means of saving the lives of many sufferers from these diseases. The provision which requires to be made in Willesden in respect of measles, whooping cough, bronchitis, and pneumonia is fully set out in my report on Maternity and Child Welfare, appearing as Appendix D to this Report. 72 Measles.—The following Table, No. 36, shows 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. 36. 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 N o. 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 1912 1.665 17 1.02 18 1,763 48 3,428 1913 1,656 21 1. 26 48 3,785 30 5,441 1914 539 0 0.00 8 *664 *45 1,203 Totals 12,027 145 1.20 189 15,347 44 27,374 * These figures are based on the average for the years 1907-1914. 73 D.—PREVALENCE OF, AND CONTROL OVER, TUBERCULOSIS Tuberculosis Notifications.—The following Table No. 37, shows the number of notifications received during the year ending 26th December, 1914 :— Table No. 37. No. of notifications of all forms of tuberculosis received from 28/12/13 to 26/12/14, both dates inclusive— On Form A., i.e., from medical practitioners of cases not previously notified 510 On Form B, i.e., from School Medical Inspectors of cases not previously notified by them 15 On Form C., i.e., from Medical Officers of Poor Law Institutions and Sanatoria of cases previously notified and admitted to these institutions 97 On Form D., i.e., from Medical Officers of Poor Law Institutions and Sanatoria of cases previously notified and discharged from these institutions 113 Total number of notifications received for the 52 weeks ending 26th December, 1914 738 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, No. 37, that certain cases may be notified four times at least, by the medical practitioner, by the school 74 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 416, the percentage of multiple notifications being 43.4. The following Table, No. 38, shows the number of notifications and the number of new cases each year since 1909: Table No. 38. 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 ... 230 ... 230 † 1912 (52 weeks) 851 ... 487 ... 487 ‡ 1913 („ „ ) 693 181 368 146 514 1914( „ „ ) 613 122 326 90 416 Total 2734 303 1579 236 1815 *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 777 of the 1,815 cases of Tuberculosis notified in Willesden since 1909 were living in the area at the end of the year. The 326 new cases of pulmonary tuberculosis notified in 1914 include 9 in which the lung disease was associated with disease in other organs: glands 2, bowels 2, larynx 4, testes 1. 76 Localisation of Disease in Age and Sex Groups.— The following Table, No. 39, shows the localisation of the disease according- to the age and sex groups, of the 416 new cases notified during the 52 weeks ending 26th December, 1914. Table No. 39. Age. Lungs. Bones or Glands. Brain or Meninges. Abdomen. Other or several Organs. Total. Male female Male female Male Female Male Female Male Female Male Female Male Female 0—1 ... ... ... ... ... ... 2 3 ... ... 1 ... 3 3 1—2 ... ... ... ... ... 1 4 1 ... ... ... ... 4 9 2-5 1 ... ... 1 ... 1 3 4 ... ... 1 1 9 5-5 19 19 5 4 11 7 ... ... 2 ... 4 ... 41 30 15-25 32 26 3 2 3 4 ... ... 1 1 2 4 41 37 25—45 84 72 2 1 1 ... ... ... ... ... 2 2 59 75 45—65 46 18 ... ... ... 1 ... ... ... ... 1 46 20 Over 65 4 3 ... ... ... ... ... ... ... ... ... ... 4 3 Total 186 140 12 8 17 14 9 8 3 1 10 8 237 179 76 Occupations.—The following Table, No. 40, shows the occupations of the 416 new cases of tuberculosis notified during the year 1914:- Table No. 40. Domestic Employment (including Laundry Workers) 85 School Children, Students 62 No Occupation 54 Shop-keepers (including Assistants) 12 Office Workers 18 Engaged in Transport 11 Not Ascertained 30 Labourers 26 Indoor Trades 27 Painters 8 Dressmakers, Milliners, Tailors 11 Public Service 7 Miscellaneous Occupations 47 Professional 5 Factory Workers 4 Printers, Compositors, Music Engravers 9 416 77 Ward Distribution.—The following Table, No. 41, shews the notified cases of Tuberculosis allocated to each Ward in each year since 1909:- Table No. 41. Wards. 1909 1910 1911 1912 1913 1914 Pulmonary. Pulmonary. Pulmonary. Pulmonary. Pulmonary. Other Forms. Pulmonary. Other Forms. South Kilburn 23 15 41 67 50 17 55 10 Mid. Kilburn 15 8 23 56 45 26 30 13 North Kilburn 2 1 6 32 15 6 25 7 Brondesbury Park 3 2 10 23 15 7 11 2 Kensal Rise 4 2 33 41 29 18 21 8 Harlesden 6 3 17 69 23 13 26 6 Stonebridge 21 † 14* 24 56 42‡ 18‡ 24 12 Round wood 9 6 29 37 40 10 30 9 Church End 11 7 15 36 40 12 35 11 Willesden Green 11 2 16 33 33 10 32 5 Cricklewood 2 1 16 37 36 9 37 7 Total 107 61 230 487 368 146 326 90 514 416 † Includes 7 with address " Infirmary" only. * Includes 6 with address " Infirmary" only. ** Includes 3 with address "Infirmary" only. ‡ Includes 2 with address "Infirmary" only. 78 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 431 primary visits and 1,855 subsequent visits, making a total of visits and revisits of 2,286. The Health Visitor makes enquiries as to home conditions, history and condition of the patient and state of health of contacts. At the same time she gives and explains a pamphlet of directions intended to aid the patient in combating the disease, and to prevent its spread to other members of the community. She revisits the house as may be necessary. If enquiries with regard to the contacts suggest that any of them may be suffering from tuberculosis, they are requested to attend their own doctor or the Middlesex Tuberculosis Dispensary, in order that they may be examined. When a tuberculosis patient dies or removes, disinfection of his room is carried out if considered necessary. Bacteriological examination of sputum is carried out free of charge at the Council's laboratory. Bacteriological testing of milk and veterinary inspection of cows is also carried out. Enamelled plates are provided and fixed in factories giving information about consumption and its prevention. 79 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. 42, gives the results:Table No. 42. No. of cases. Within 1 month of onset 37 After 1 month but within 3 months of onset 73 „ 3 months „ „ 6 2 „ „ „ 45 „ 6 „ „ „ 12 „ „ „ 44 „1 year of onset 168 No information available 49 Total 416 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, No. 42, as the disease is insidious and of very gradual onset in the majority of cases. Family History.—This was investigated in 304 instances. In 180, or 59.2 per cent., a history of the disease in one or more near relatives was obtained. Sleeping Accommodation.—The following Table, No. 43, shows the sleeping arrangements of the cases in respect of which this information was obtained. Table No. 43. *In Room. †in Bed. Patient slept alone 104** 181 In same Room. In same Bed Patient slept with 1 other 87 104 „ „ „ 2 others 57 12 „ „ „ 3 „ 25 1 „ 4 3 ... „ „ 5 „ 2 ... * No informaiion as regards 138 out of 416 cases. † No information as regards 118 out of 416 cases. ** In one of these cases patient slept in a shelter in the garden. 80 In only 104 of these cases in which the patient slept alone in a separate room can the sleeping accommodation be said to be entirely satisfactory. In 181 cases in which the patient had a separate bed the condition may be said still to be satisfactory. In all other cases, namely, 117 out of 298, or 39.2 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 one patient was living in a common lodging house, 30 in institutions, 229 in tenement houses, 74 in self-contained flats or separate houses, and no information was obtained in 82 cases. The following Table, No. 44, gives the housing accommodation and the number of persons per room as regards the 350 cases in respect of which information is available:— Table No. 44. Size of House. No. of Tuberculosis Cases occupying houses of size shewn. No. of Persons in these houses. Average No. of Persons per room. I room 15 34 2.27 2 rooms 45 179 1.99 3 „ 141 679 1.60 4„ 82 411 1.25 5 „ 26 142 1.09 6 „ 22 126 0.95 7 „ and over 19 108 0.81 From the above Table, No. 44, 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 81 the notified case is investigated, and as a result 10 persons were referred for examination to their medical attendant. The actual number of contacts so examined was eight, three of whom were found to be affected with tuberculosis. In one case the diagnosis was doubtful, and it was referred for further examination to the County Tuberculosis Officer, who reported that he did not find evidence of Tuberculosis. Many other contacts were examined by the Tuberculosis Officer of the Middlesex County Council, but information as to their number and the results is not to hand. 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 especially important in connection with the spread of tuberculosis. In 11 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 in six of these cases. 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- The clauses of the National Insurance Act, 1911, dealing with Tuberculosis aimed at providing appropriate treatment—Domiciliary, Dispensary, Sanatorium or Hospital— for every case of Tuberculosis. The authority under the Act for carrying out this work is the County Council, and treatment is, therefore, not in the hands of the Willesden Council. The Middlesex County 82 Council has established a Dispensary in Willesden at 3, Priory Park Road, at which their Tuberculosis Officer, Dr. D. G. M. Munro, attends for two hours, twice weekly, to see old cases and for one hour twice weekly to see new cases, and at other times by appointment. Patients are also visited by Dr. Munro or by a nurse, at home, when necessary. Dr. Munro is responsible for the treatment of Tuberculosis in the whole of County District No. 3, including Harrow, Kingsbury, Ruislip-Northwood, Wealdstone, Wembley, Willesden and Hendon (Rural) Districts, comprising not only the densely populated area of Willesden but also a scattered outlying area with, in many cases, no convenient means of transit from one part to the other. Suitable cases, insured and non-insured, are sent to various approved sanatoria. An agreement has now been concluded between the Willesden Council and the Middlesex County Council, by which the former undertake to admit a certain number of cases of Tuberculosis, on and after 1st February, 1915, to their Isolation Hospital for purposes of isolation, in return for which the County Council will make payments to the Willesden Council. E.—INVESTIGATION OF OTHER DISEASES. 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 National 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. 45, shows the number of deaths during the past 11 years from the diseases specified:— 83 Table No. 45. Disease. 1904. 1905. 1906. 1907. 1908. 1909. 1910. 1911. 1912. 1913. 1914. All forms of Respiratory Diseases including Bronchitis and Pneumonia 260 268 234 331 276 288 258 272 282 285 256 Bronchitis, including Laryngitis and Acute and Chronic Bronchitis 123 112 82 142 111 128 122 108 130 134 117 Pneumonia (all forms) 128 147 130 176 154 140 113 144 126 126 115 All forms of Tuberculosis, including Tuberculosis of the Lungs 187 194 188 188 153 196 174 179 188 165 198 Tuberculosis of the Lungs 141 146 139 138 120 13' 116 132 148 136 147 Heart Disease, including Pericarditis, Endocarditis and Angina Pectoris 115 132 126 111 142 149 136 155 147 160 180 Rheumatic Fever and Rheumatism of the Heart 9 12 11 7 5 11 5 4 7 12 12 Diarrhoea and Enteritis, including Gastritis 177 121 167 60 78 62 49 196 34 73 113 Cancer 111 115 111 108 112 120 154 115 154 159 155 Influenza 14 25 24 33 38 36 23 16 17 24 16 Rickets 4 4 3 1 3 2 - 2 2 3 1 84 Table No. 46. The following Table, No. 46, shows the death rates per 1,000 of the population during the past 11 years from the causes specified:— Disease. 1904 1905 1906 1907 1908 1909 1910 1911 1912 1913 1914 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 1.763 1.741 1.536 Bronchitis (including Laryngitis and acute and Chronic Bronchitis) .914 .79s .578 .983 .744 .852 .796 .689 .813 .819 .702 Pneumonia (all forms) .951 1.044 .917 1.219 1.033 .932 .737 .919 .788 .769 .690 All forms of Tuberculosis (including Tuberculosis of the Lungs) 1.389 1.378 1.326 1.302 1.026 1.305 1.35 1.143 1.175 1.008 1.188 Tuberculosis of the Lungs 1.048 l.037 .980 .955 .805 .872 .756 .843 .925 .831 .882 Heart Diseases (including Pericarditis, Endocarditis, and Angina Pectoris) .854 .937 .889 .768 .952 .992 .887 .989 .919 .977 1.080 Rheumatic Fever and Rheumatism of the Heart .066 .085 .077 .048 .033 .073 .032 .025 .043 .073 .072 Diarrhœa and Enteritis (including Gastritis) 1.315 .859 1.178 .415 .523 .412 .319 1.251 .212 .446 .678 Cancer .825 .817 .783 .748 .751 .799 1.004 .734 .963 .971 .930 Influenza .104 .177 .169 .228 .254 .239 .150 .102 .106 .46 .096 Rickets .029 .028 .021 .006 .020 .013 ... .012 .012 .018 .006 85 The above Tables, Nos. 45 and 46, 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 the combined death rate from Heart Disease and Rheumatism is higher than in any of the previous years. (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. In 1913 it was .446. This year it is .678, an increase of over 50 per cent. (5) That the death rate from cancer is lower than in either of the two preceding years. (6) That the death-rate from Influenza is lower than in any of the preceding years. (7) That the death rate from Rickets is the lowest on record, being the same as that in 1907. 86 Death Rates from Certain Infectious Diseases.— I he following Table, No. 17, shows the death rates per 100,000 of the population from scarlet fever, diphtheria, enteric fever, measles and whooping cough since 1875:— Table No. 47. 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 20 174 1879 35 35 9 13 27 1880 99 8 15 75 99 1881 47 3 22 25 47 1882 24 3 15 141 86 1883 20 11 17 14 34 1884 13 16 11 11 58 1885 13 36 23 52 44 1886 2 15 4 67 79 1887 28 12 16 59 22 *1888 22 22 17 66 77 1889 4 12 3 14 17 1890 3 31 11 55 70 1891 3 11 6 8 67 1892 12 27 9 73 55 1893 21 63 13 15 49 1894 9 21 15 60 42 895 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 30 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. 1914 3 14 2 5 20 • Infectious Disuses Notification compulsory in Willesden from this year. 87 The foregoing Table, No. 47, shows (1) That the death rate from Scarlet Fever is lower than last year. (2) That the death rate from Diphtheria is nearly three times as high as last year. Table No. 32 shows that this is only slightly due to an increased incidence, and almost entirely due to an increased fatality rate, indicating that a severe type of the disease has prevailed. (3) That the death rate from Enteric Fever is stationary and low. (4) That the death rate from Measles is exceptionally low. (5) That there is a considerable increase in the death rate from Whooping Cough over that of last year. 88 † No record. DEATHS FROM TUBERCULOSIS.—The following Table, No. 48, 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. 48. Year. Tuberculosis (All Forms). Tuberculosis of the Lungs. Willesden. Total number of Deaths. Willesden. Death Rate per 1,000 of the population. England and Wales. Death Rate per 1,000 of the population. Willesden. Total number of Deaths. Willesden. Death Rate per 1,000 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 I.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 1.6o 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 1.73 1888 82 1.54 2.22 47 .87 1.61 1889 82 1.43 2.26 55 96 1.56 1890 109 1.77 2.37 73 1.18 1.57 1891 100 1.60 2.30 67 1.07 1.68 1892 83 1.26 2.13 65 .98 1.59 1893 † ... 2.14 73 98 1.46 1894 † ... 1.07 72 1.05 1.38 1895 † ... 2.06 96 .98 1.38 1896 † ... 1.89 88 1.08 1.39 1897 † ... 1.92 86 1.02 1.30 1898 † ... 1.91 100 .92 1.33 1899 † ... 1.90 135 1.00 1.31 1900 133 1.15 1.90 103 .89 1.33 1901 143 1.23 1.80 96 .8l 1.26 1902 160 1.30 1.74 111 .909 1.23 1903 165 1.27 1.74 113 .873 1.20 19 4 188 1.39 1.77 141 .873 1.20 1905 194 1.37 1.62 146 1.04 1.23 19 6 188 1.32 1.64 139 1.037 1.14 1907 188 1.30 1.6o 138 .981 1.15 1908 153 1.02 1.58 120 .805 1.14 1909 196 1.30 1.53 131 .872 1.11 1910 174 1.13 1.43 116 .757 1.09 1911 179 1.14 1.46 132 .843 1.01 1912 188 1.17 1.37 148 .925 1.08 1913 165 1.00 ... 136 .831 1.04 1914 198 118 ... 147 882 ... 89 The following Table, No. 49, shows the age distribution of deaths from Tuberculosis in Willesden since 1877:— Table No. 49. Year. 0 to1. 1 to 5. 5to 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 1914 7 29 12 21 126 3 198 * Records incomplete. 90 The following' Table, No. 50, shows the age distribution of deaths from Tuberculosis in Willesden, since 1907:— Table No. 50. 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 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 1914 7 9 20 6 6 13 8 39 44 27 16 2 1 ... 198 The following Table, No. 51, shows the tuberculosis deaths and death rates per 1,000 of the population in Wards in Willesden since 1910:— Table No. 51. Wards 1910. 1911. 1912. 1913- 1914. 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 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 25 1.96 Mid. Kilburn 25 1.73 21 1.45 18 1.21 30 2.05 25 1.71 North Kilburn 9 74 7 .58 12 .98 13 1 05 15 1.81 Brondesbury park 9 .74 15 1.60 9 .94 3 30 10 1.01 Kensal Rise 9 .64 14 1.01 10 73 13 .93 14 .98 Harlesden 20 1.38 13 .84 23 1.42 11 .66 15 .87 Stonebridge 12 .82 23 1.37 30 1.80 10* .57 21 .87 Roundwood 17 1.18 21 1.39 23 1.51 13 83 19 1.18 Church End 23 1.76 18 1.34 13 .93 13 .92 26 1. 21 Willesden Green 14 .93 7 .45 15 .96 19 1.15 16 1. 41 Cricklewood 13 75 15 .86 16 .87 10 .53 18 .95 Ward unknown 1 ... 1 ... ... ... ... ... ... ... Willesden U.D. 174 1.13 179 1 .14 188 1.1 7 165 1.00 198 1.18 * Includes one address " Infirmary" only. 91 Cancer Deaths.—The following Table, No. 52, 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. 52. 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 1ll .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 1.02 1913 65 94 159 .971 ... 1914 58 97 155 .930 ... The above Table, No. 52, 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, but that it is lower this year than either of the two preceding years. 92 The following Table, No. 53, shows the age distribution of deaths from Cancer in Willesden since 1877 :— Table No. 53. Year. 0 to 1. 1 to 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 ... ... ... 1 5 2 8 *1881 ... ... ... ... ... ... ... 1882 ... ... ... ... 9 5 14 1883 ... ... 1 ... 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 ... ... ... ... ... ... ... *1899 ... ... ... ... ... ... ... 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 1906 ... ... 1 1 73 36 111 1907 ... ... ... 2 67 39 108 1908 ... ... ... 1 85 26 112 1909 ... 2 ... 1 66 51 120 1910 ... ... 2 1 92 59 154 1911 ... 1 ... 1 7i 42 "5 1912 ... 1 1 ... 85 67 154 1913 ... 1 2 2 92 62 159 1914 ... ... 1 ... 99 55 155 * Records incomplete. 93 The following Table, No. 54, shows the age distribution of deaths from Cancer in Willesden since 1907:— Table No. 54. 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 1911 ... 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 1914 ... ... ... ... 1 ... ... 3 11 42 43 35 19 1 155 The foregoing Tables, Nos. 53 and 54, show that the main increase in deaths from Cancer in Willesden has occurred over the age of 65, there being 55 deaths from this cause reported for this age period in 1914, as against a similar figure of 19 for the year 1900. The following Table, No. 55, shows the Cancer Deaths and Death Rates per 1,000 of the population in Wards in Willesden since 1910:— Table No. 55. Wards 1910. 1911. 1912. 1913. 1914. 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 No. of Deaths Death Rate per 1,000 Total No. of Deaths Death Rate per 1,000 South Kilburn 22 1.47 9 .64 11 78 20 1 .41 17 1.15 Mid. Kilburn 16 1.11 15 1. 04 19 1.28 19 1.30 22 1.50 North Kilburn 12 .99 7 .58 13 1.07 9 0.72 17 1.34 Brondesbury Park 14 1.45 8 .85 14 1.46 13 1.34 15 1.52 Kensal Rise 8 .57 9 .65 6 0.43 16 1.14 14 0.98 Harlesden 13 .89 11 .71 6 0.37 20 1.20 11 0.64 Stonebridge 12 .83 *12 .65 16 0.96 12 0.68 9 0.50 Roundwood 20 1.39 10 .66 19 1.25 16 1. 02 11 0 .70 Church End 14 1.07 5 .37 13 .93 6 0.42 12 0.84 Willesden Green 13 0.87 11 .71 13 .83 13 0.79 7 0.41 Cricklewood 10 0.57 18 1.04 24 1.31 15 0.79 20 1.03 Willesden U.D. 154 1.00 115 0.73 154 0.96 159 0.97 155 0.93 * Includes one with address " Infirmary" only. 94 V enereal Diseases.—Syphillis and Gonorrhoea—About these diseases, the control of which is a most important matter to the community, we have at present no means of obtaining any but the most fragmentary information. I he death returns are of very little value in estimating the prevalence of disease. Gonorrhoea, though undoubtedly very prevalent, is seldom a cause of death, and Syphilis, although often indirectly a cause of death, as it is the forerunner of many fatal diseases, does not often appear as a cause of death in death certificates. The notification of cases of Ophthalmia Neonatorum should be of some value as an indication of the prevalence of Gonorrhœa. Probably all cases of Tabes Dorsalis and General Paralysis are the result of Syphilis, and Syphilis is generally considered to be an important factor in a large proportion of cases of aneurism and other diseases of the bloodvessels and nervous system. It is also a very frequent cause of Abortion, and Still Birth. The above considerations, however, are not of much value since the number of deaths from Tabes Dorsalis and General Paralysis is small, and of the deaths from diseases of the bloodvessels, etc., it is impossible to estimate what proportion is due to Syphilis.- Again, the proportion of Still Births and Miscarriages due to Syphilis is not known, nor is there any means of ascertaining the incidence of the latter. Although we are not in a position at present either to collect much information about fhese diseases, or to make any attempt to control them, the question is one which merits consideration. Public opinion is at present being awakened to the importance of making an attempt at prevention of these diseases for the sake of the health of the whole community. A Royal Commission is sitting on the subject, and there is little doubt that when its report is issued an attempt of some 95 kind will be made to cope with these diseases. There has been a remarkably unanimous expression of opinion by those giving evidence before the Commission that compulsory notification is not desirable, and that in these, as in so many other diseases, the most effective measure of prevention would be prompt and efficient treatment of those suffering from the diseases in question. The line of action that will probably be taken is provision of diagnosis and treatment to all who have contracted the diseases, and who are willing to avail themselves of these facilities, and encouragement of the sufferers by every possible means to take advantage of such treatment as may be provided. F. MEANS FOR PREVENTING MORTALITY IN CHILDBIRTH AND INFANCY. Maternity and Child Welfare.—This question of Maternity and Child Welfare has received consideration during the year, and interest in it has been stimulated by the offer of the Government to provide 50 per cent. of the cost of approved schemes. No subject is of greater national importance at the present time, especially as the nation must look forward to the time when the men now lost in the war have to be replaced. A flat grant of 50 per cent. from the Government is perhaps not quite fair to suburban areas like Willesden, where the property is mainly of a residential character, from the occupants of which many richer London areas draw their supply of workers. The following statement compares the child population of Willesden and Westminster, and shows the rateable value of both areas:— 96  Population at April, 1911. Children under 5 years at April, 1911. Rateable value at October, 1911. Rateable value per head of population. Westminster 160261 9755 £6422553 £40.07 Willesden 154344 17784 £897555 £5.81 It must be remembered that the above figures represent an extreme case, and that again some portion of the City of Westminster's wealth will come back to Willesden in the grant due from the State in respect of Child Welfare work. But having regard even to these facts it is not unreasonable for Willesden to expect proportionately a greater grant from Imperial sources than Westminster. On the other hand it must be remembered that the greater the proportion of the cost defrayed by the Government the greater will be their control, and it is always open to argument if bureaucratic is superior to the popular control exercised by a properly constituted local authority. In any case, however these problems are settled, there is no doubt that the need for beginning some definite scheme of Child Welfare work in Willesden is urgent. The methods which may be adopted are set out in my Report on this subject, which appears as Appendix D in the present report, and I would urge the Council to make a start on the lines suggested, at an annual cost to the rates of £1,712. 97 Infant Mortality.—The following Table, No. 56, shows the number of deaths of infants under one year of age from all causes, and from diarrhoea and enteritis respectively together with the infant mortality rates per 1,000 births from 1875:— Table No. 56. Year. No. of deaths of Infants under 1 year of age from all causes. No. of Deaths of Infants under 1 year ol age from Diarrhoea and Enteritis. Infant Mortality. Rate per 1,ooo 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 1914 337 73 82 *Records incomplete. 98 The above Table, No. 56, shows that the Infant Mortality Rate of 82 for the year 1914 is, with the exception of the years 1910, 1912 and 1913, when the figure was 80, the lowest recorded. The rate for this year would have been the lowest on record but for the increased number of deaths of infants under one year due to diarrhoea and enteritis. The following Table, No. 57, shows the infant mortality rate in Wards in Willesden since 1910:— Table No. 57. Wards. 1910 1911 1912 1913 1914 (1) (2) (3) (4) (5) (6) South Kilburn 91 134 131 106 86 Mid. Kilburn 83 147 83 75 73 North Kilburn 77 83 75 56 65 Brondesbury Park 76 86 60 33 54 Kensal Rise 63 92 93 51 50 Harlesden 73 95 68 57 71 Stonebridge 83 165 73 118 116 Roundwood 85 177 80 102 91 Church End 83 119 85 117 109 Willesden Green 100 108 68 68 83 Cricklewood 52 93 42 63 76 Willesden U. D. 80 124 80 80 82 The above Table, No. 57, shows that the infant mortality rates are not uniform throughout the Wards. In Stonebridge and Church End the infant mortality rate is highest, and lowest in Kensal Rise and Brondesbury Park. These high rates are mainly due to want of maternal feeding, want of knowledge of infant care, and want of medical treatment. 99 Infant Mortality of Legitimate Infants.—The following Table, No. 58, shows the number of deaths of legitimate infants and the infant mortality rate per 1,000 legitimate births in Willesden since 1904:— Table No. 58. 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 1914 315 80 Infant Mortality of Illegitimate Infants.—The following Table, No. 59, shows the number of deaths of illegitimate infants and infant mortality rate per 1,000 illegitimate births in Willesden since 1904:— Table No. 59. 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 1914 22 218 100 Tables No. 58 and 59 show that the proportion of infant deaths amongst illegitimate children is very much greater than amongst legitimate infants. During last year the rates were 218 and 80 per 1,000 illegitmate 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 Infant Mortality.— During the year 1913 there were 337 deaths amongst infants under one year of age. Of these, 124 died under the age of four weeks, and their deaths are attributed in the majority of cases to some congenital defect or weakness. Many of these lives might have been saved with a good system of antenatal work amongst expectant mothers. The remaining 213 deaths occurring between the ages of one month and one year may be classified as follows:— CAUSES. Diarrhœa, Enteritis 66 Measles 1 Whooping Cough 16 Broncbitis 17 Pneumonia 30 Tuberculosis 7 Wasting 20 Other diseases 56 Total 213 The majority of deaths from the above causes are not only curable, but in many cases the disease itself is preventable, and it is to deal with, amongst others, these conditions both by way of prevention and cure that a scheme of Child Welfare should be begun. 101 Notification of Births Act, 1907.—The Notification of Births Act was adopted in this District in 1908, and the following Table, No. 60, shows the number of births notified in each complete year since its adoption, together with certain other particulars:— Table No. 60. 1909 1910 1911 1912 1913 1914 Total number of births notified in each complete year since its adoption 3748 3390 3694 3671 3550 3439 (a) Attended by doctors 2220 2072 2266 2324 2273 2207 (b) Attended by midwives Number of stillbirths notified in 1528 1318 1428 1347 1277 1232 each of the same years Number of births registered in 95 79 88 92 104 118 each of the same years 4172 3923 4001 4075 4037 4115 Births are usually visited after the expiry of ten days, and a booklet on Infant Care and Feeding 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 re-visiting is being gradually extended, and the following Table, No. 61, shows the number of revisits paid during each of the last three years. Table No. 61. Year. No. of re-visits made to cases requiring same under the Notification of Eirths Act, 1907. 1912 180 1913 976 1914 1,052 102 If the full value of these re-visits is to be obtained it is necessary that there should be associated with them a clinic or dispensary, to which the mothers of infants who are not thriving may be referred for medical advice. The Babies' Welcome, Lower Place.—An infant consultation, known as the "Babies' Welcome," is held on one afternoon a week in one of the poorest localities of Willesden, and is conducted by one of the Health Visitors. Like the visits paid under the Notification of Births Act, 1907, the work of the Welcome is educative in character. The mothers are given short talks on baby care, and are shown practically as far as possible what to do for the baby. An extension of the work of this Clinic so that medical advice may be also given to the mothers is urgently necessary, as dealt with in my Report on Maternity and Child Welfare, which appears as Appendix D to this Report. The following is the report of the Health Visitor on the work during 1914:— "Since September this has been held in the small kitchen at the above address on Monday afternoons, and is attended on an average by 14 mothers and 10 babies. "With few exceptions, the babies attending are those whose mothers have been advised to give them "Glaxo," which is sold to them. "Owing to want of space the mothers and babies are dealt with in turn, and their departure hastened to make room for others. The work is thus limited to weighing the child, enquiring as to its condition since the last visit, and advising accordingly; selling the "Glaxo" required, and giving the mother a cup of tea and biscuits. "Any mother whose baby shows signs of ill-health is advised to take it to a hospital or doctor. 103 "Attendance at a Hospital on Mondays often results in failure to attend or late attendance at the "Welcome," much expenditure of time on the part of the mother, with the discomfort unwittingly imposed upon the baby of being weighed twice in the same day. "All the conditions seen at the "Welcome" point to the necessity of development. E. M. Carter." Summer Diarrhcea.—Table No. 56 shows that the deaths of infants under one year of age from Diarrhcea during 1914 were 73, as compared with 45 in 1913 and 22 in 1912. In order to prevent as much as possible deaths of infants from summer diarrhcea, which is the main cause of infants' deaths during the third quarter of the year, booklets on Infant Care and Feeding are forwarded to the parents of all children born during the summer months, if summer diarrhcea 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 it were possible to undertake an organised system of visiting, during the summer months, of infants born, say, six months previously. Such a measure would tend towards the reduction of the number of deaths from this cause. It should be observed that visits of this kind are for the purpose of educating parents in respect of the precautions they should take during the summer months, and the full effect of these visits is cumulative, and can only be obtained if they are regularly and periodically carried out year by year. 104 Infant Death Inquiries.—In this district, in addition to the above measures taken for the prevention of infant mortality, inquiries are also made into the deaths of children under one year of age, with a view to ascertaining the causes predisposing to such deaths. The following Table, No. 62, shows the number of infant death inquiries made during the past two years:— Table No. 62. Year. No of Deaths of Infants under 1 year. No. of Infant Death Inquiries. 1913 325 300 1914 337 231 The information ascertained from these inquiries would show that in a number of cases the child does not receive treatment until a comparatively late stage of its illness. Early treatment of disease is important in the case of adults, but in the case of infants it is imperative, and the difficulties that many parents have in seeking the necessary medical advice mainly on account of expense is a matter which the Local Authority require to consider in connection with the care of infants. In certain areas excellent treatment clinics have been established by the municipalities under their own control, and similar arrangements require to be made in Willesden. 105 G. VITAL STATISTICS OF THE DISTRICT. Marriages.—The following Table, No. 63, shows the total number of marriages in Willesden, and the marriage rate in Willesden as compared with England and Wales generally since 1900: Table No. 63. Year. Willesden. 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 16.0 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 14.6 1910 994 13.o 15.0 1911 1047 13.4 15.2 1912 1147 14.3 15.5 1913 1153 14.1 15.5 1914 1305 15.7 15.9 106 Births.—The following. Table, No. 64, shows the total number of births in Willesden and the birth rate in Willesden as compared with England and Wales generally since 1875:— Table No. 64. 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 ... 144.1 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 i900 3559 31.2 28.7 ... 115.6 i90i 3762 32.2 28.5 ... 114.2 i902 3916 31.3 28.5 ... 114.1 i903 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 i906 4272 30.1 27.0 107 .6 108.3 i907 4247 29.4 26.3 105.8 105.1 i908 4095 27.5 26.5 98.8 106.1 i909 4172 27.8 25.6 99.9 103.2 i9io 3923 25 .6 24.8 95.O 100 6 191 i 4001 25.6 24.4 94.9 97.8 1912 4075 25.5 23.8 94.6 95 6 1913 4037 24.7 23.9 91.6 ... 1914 4115 24.7 23.8 91.7 ... 107 The foregoing Table, No. 64, shows 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.two years, 1881.1914, the birth rate still further fell by 9.7 per 1,000. The birth rate for 1914 is the same as that for 1913, and the lowest on record. The figures at our disposal show that the birth rate in Willesden, calculated per 1,000 of the female population of child.bearing age, is 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 39 years, 1875.1914, that for England and Wales has fallen during the same period by 11.6 per 1,000. The following Table, No. 65, shows the births and birth rates per 1,000 of the population in each Ward in Willesden since 1910:— Table No. 65. Wards. 1910, 1911. 1912. 1913 1914 Total No. of Births. Birth Rate. 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 28.58 444 30.11 Mid. Kilburn 375 26.1 380 26.4 397 26.77 361 24.73 343 23.51 North Kilburn 207 171 217 18.2 226 18.03 216 17.45 230 18.23 Brondesbury Park 197 20.5 175 18.7 200 20.92 182 18.79 149 15.15 Kensal Rise 333 24.0 357 25.9 355 25.94 315 22.56 396 27.94 Harlesden 411 28.4 398 25.8 383 23.74 421 25.36 393 22 96 Stonebridge 447 31.2 462 27.7 517 31.14 515 29.47 554 31.22 Round wood 435 30.3 424 28.1 443 29.21 401 25.75 440 28.10 Church End 397 30.5 404 30.1 388 28.04 369 26.38 368 26.06 Willesden Green 399 26.8 426 27.9 413 26.46 440 26.82 423 25.26 Cricklewood 326 18.8 323 18.7 334 18.28 351 18.64 3.5 16.31 Willesden U.D. 3923 25.6 4001* 25.6 4075 25.5 4037† 24.7 4115** 24.7 * Including lo births (Wards unknown) received from Registrar General at end of year, † ,, 61 ,, ,, ,, ,,, ,, * * ,, 6o ,, ,, ,, 108 Illegitimate Births.—The following Table, No. 66, shews the number of illegitimate births and the illegitimate birth rates per 1,000 total births in Willesden since 1882:— Table No. 66. 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 25.85 1899 56 16.59 1883 25 21 40 1900 56 1573 1884 23 18.65 1901 48 12.75 1885 43 31.47 1902 48 1225 †1886 ... ... 1903 87 21.05 1887 53 31.94 1904 108 24.42 1888 31 l8.22 1905 107 25.47 1889 57 29.54 1906 125 29.26 1890 42 23.19 1907 125 29.43 1891 34 16.51 1908 94 22.95 1892 54 25.89 1909 130 31.16 1893 45 19.94 1910 122 31.09 1894 39 17.22 1911 138 34.49 1095 54 21.87 1912 130 31.90 1896 59 21.46 1913 132 32.69 1897 55 19.05 1914 149 36.20 1898 63 20.05 + No record. 109 Deaths.—The following Table, No. 67, 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. 67. Year. Willesden. Total No of Deaths. Willesden. Death Rate 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 1,000 of the population. 1875 385 21.4 22.7 1895 1,143 14.5 18.7 1876 401 21.7 20.9 1896 1,312 15.3 17.1 1877 346 17.7 20.3 1897 1.343 14.4 17.4 1878 441 21.4 21.6 1898 1,388 13.9 17.5 1879 376 16.8 20.7 1899 1.643 15.2 18.2 1880 471 18.7 20.5 1900 1,577 13.6 18.2 1881 490 17.6 18.9 1901 1,529 13.2 16.9 1882 587 18 . 1 19.6 1902 1,709 13.9 16.3 1883 538 15.4 19.6 1903 1,655 12.8 15 .5 1884 530 14.7 19.7 1904 1,645 12.2 16.3 1885 632 16.2 19.2 1905 1,744 12.4 15.3 1886 685 15.5 19.5 1906 1,672 11.8 15.5 1887 701 14.3 19.1 1907 1,704 11.8 151 1888 835 15 .8 18.1 1908 1,623 10.9 14.8 1889 686 12.0 18.2 1909 1,678 11.2 14.6 1890 882 14.4 19.5 1910 1,506 98 13 .5 1891 860 13.8 20. 2 1911 1,848 11.8 i4.6 1892 945 14.4 19.0 1912 1,603 10.0 13.3 1893 1,070 15.5 19.2 1913 1,677 10.2 13.8 1894 917 13.2 16.6 1914 1,752 10.5 14.0 110 The following Table, No. 68, shews the total deaths in Willesden at different age periods since 1877:— Table No. 68. 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 1878 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 1882 202 145 26 18 120 76 587 1883 196 89 31 25 142 55 538 1884 203 87 31 20 122 67 530 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 1666 1904 509 187 66 58 522 303 1645 1905 490 212 66 63 563 35° 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 3'3 155 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 1914 337 144 62 62 641 506 1752 111 The following Table No. 69, shews the total deaths in Willesden at different age periods since 1904:— Table No. 69. 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. 1904 509 101 86 43 23 26 32 102 120 124 176 148 121 34 1645 190S 490 120 92 46 20 30 33 102 132 153 176 1 84 136 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 i50 162 170 207 150 41 1678 1910 313 94 61 43 25 31 28 92 il6 153 174 188 145 43 1506 1911 495 144 97 38 23 28 36 hi 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 1914 337 73 71 37 25 34 28 94 146 180 221 263 198 45 1752 The following Table, No. 70, 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 :— 112 Table No. 70. 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 WTillesden 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 i.8 21 211 30 25 3.8 4.0 5.3 67 8.8 119 151 297 29 .3 52.3 62.5 126.8 1319 217.9 284.7 1905 381 44 .9 3.o 3 4 1.5 2. 1 23 29 2.4 37 3.8 5.2 7.0 8 6 140 14.9 28 .4 287 62 2 61.6 136.3 127.7 184.0 286.6 1906 368 45 .6 21 35 1 9 2. 1 2.6 2.9 2.4 3 .6 3.2 5. 70 87 119 149 27.2 29.2 58.4 62.i 140.3 129.8 1890 301.1 1907 37.2 412 2.4 3.4 1.4 2 .0 17 2.8 2.6 3.5 3.4 5.1 6.3 87 137 150 25 o 29.8 64.6 65 0 1299 132.6 185.6 303 9 1908 29.3 409 2.6 3.2 1.9 19 I.5 2.6 27 3 .4 29 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 29 3.3 1.5 1.9 1.9 2.7 2.5 3.3 37 4.8 7.5 83 139 148 257 29 .3 65.6 67.4 1408 136.2 2356 310.8 1910 23.3 34 2 2.6 29 17 1.8 22 2.5 1.9 3. 3. 4.5 57 7.8 12.9 .39 257 27.3 58.3 62.3 133.4 1247 241.6 285.4 1911 408 437 2.2 3.4 1 .6 2.1 2.1 29 2 7 3 .5 3 8 4.5 61 7.3 1o.4 130 22.8 26.1 457 56.4 1063 1242 2548 246.2 1912 24 6 32.4 2 .o 3.1 1 .4 1.9 3.0 2.8 2.8 3 3 3 4 4.3 5.6 7.2 96 I2.9 23.! 26.1 533 57.1 117.0 126 7 207.5 252 9 .9.3 263 ... 2.4 ... 1.5 ... 2.5 ... 2 . 1 ... 3.3 ... 57 ... 10.8 ... 23.4 ... 52.8 ... 1163 ... 216 .6 ... 1914 2.5 1 ... 2.1 ... 1.6 ... 2.4 ... 2.0 ... 3.0 ... 6.1 ... ... ... 25.6 ... 57 .3 ... 129 2 ... 203 .6 ... 113 The foregoing Tables, Nos. 67, 68, 69, and 70, would appear to shew that the saving of life, as illustrated by the low death rates of 1914 and immediately preceding years is mainly accomplished under the age of five years while i here is a definite tendency for the death rates to increase in recent years over the age of 65 years. H. METEREOLOGICAL OBSERVATIONS. Metereological Observations.—The following Tables Nos. 71 and 72 give the results of the metereological observations for 1914, and for the 12 years 1902-13 inclusive:— 114 TABLE NO. 71.—METEOROLOGICAL OBSERVATIONS. Taken at the Hospital, Dog Lane, JNeasden. Readings at 9.0 a.m. aaiiy. 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 H umidity. Rainfall in inches. Number of days on which Rain was measured. NumLer of Hours of bright Sunshine. No. of hours of blight 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) (») (3) (4) (5) (6) (7) (8) (9) (10) (») <.*) (■3) January 55 0 17-0 38 O 46-34 3521 48 00 45-75 84° 0-47 4 27-50 2015 February ... 59'° 30 0 29 O 51 '89 42-03 46 00 45-00 88° 2-40 9 70-25 106-12 58'O 29-0 29'0 55 "51 44-19 46-00 45 00 86° 3'25 16 9275 88-04 April 73'5 41 'O 325 63-i5 50-94 47-25 45-00 78° 0'70 5 21600 231-90 May 81 •£> 32 0 49-O 6292 43-28 50 00 47-75 75° 1-30 4 199 00 208 -94 June 83-0 38 0 45 -o 69-41 46-04 54 00 50-50 74° Il8 8 257-72 267 00 July 91 "O 42'O 49 0 72-85 54-66 57-00 54-00 76' I-4I 12 168 80 178-87 August 90'O 43° 47'0 73 70 51-66 57-00 56-5° 84° °73 5 162-50 18414 September ... Si-5 3°'° SI'S 6871 45-85 57-50 57 00 81J °'77 5 173-00 204*00 October 67'S 300 37'5 59'41 43I5 57-00 54-00 90° 1-07 10 56-25 66*96 November ... 62'O 26 'O 36-0 46-20 38-5° 55-00 54-5° 88° 1 -oi 7 44-50 63-90 December ... 58-0 21 S 36-5 49-62 37'43 55-50 49 00 87° 7-10 17 2875 39-99 Means 71-6 31-6 40*0 5997 44-41 52-52 50-33 82° Totals 2139 102 1497-02 1660-01 115 TABLE NO. 72.—METEOROLOGICAL OBSERVATIONS. 12 YEARS, 1902-1913 INCLUSIVE. Month. temperATure Shown in degrees Fahrenheit. Mean No. of Days on which Rain was Measured. Of the Air. Of the earth at a depth of 4-ft. Mean degree of Humidity. Mean Rainfall in Inches. Highest. Lowest. Mean Monthly Range. Mean Monthly Highest. Mean Monthly Lowest. Maximum Minimum (1) (2) (3) u) (s) (6) (7) (8) (9) (10) (") January 60-5 1906 14-0 1906 34'° 44'' 33'' 47'50 44 29 00 00 183 II February 57'9 >903 107 1902 34 "4 45'4 33'5 45-00 43-23 00 00 1-30 II March 69-0 1907 ii'o 1909 37'9 48'5 347 45'5° 00 82° 2 03 14 April .. 717 1909 15-0 1906 42-1 54'8 35'6 46 09 44-11 76° 1 '5° IO May 89 0 ■9*3 17 0 1906 47 "3 62 '0 42'4 49-46 46 00 73° 182 12 June... 84 2 1913 24-o 1906 42-3 67-0 47'6 54 00 4975 73° 2-80 12 J«iy 92 0 1911 23 2 1913 40 7 72'I 5'7 56'58 00 to u-> 7'° 2 07 II August 97 o 1911 25 5 1905 42-1 704 5''2 57 52 55'oo 75° 2 39 12 September .. 92 0 1906 26 5 1905 427 65'0 47'3 57-43 5400 77° i-68 9 October 790 1908 io'O '9°5 38 4 581 42-8 5581 53-3I 84° 2 73 15 November .. 65'5 '9'3 11 "5 1905 35'O 49'4 35'9 54-00 49-52 00 00 2 c6 12 December .. P oo 1908 10-5 1908 33 "6 45'9 35'6 5i-°o 4670 89° 2-27 14 Means 75 °7 ■873 39'2 56'9 40 9 Si'7 48-84 80° Totals ... 24-48 143 WILLESDEN URBAN DISTRICT EDUCATION COMMITTEE. THE SEVENTH ANNUAL REPORT FOR THE YEAR ENDING 31st DECEMBER, 1914, ON THE HEALTH OF CHILDREN ATTENDING THE PUBLIC ELEMENTARY SCHOOLS IN WILLESDEN. by GEORGE F. BUCHAN, m.d., d.p.h. Medical Officer. 119 A. GENERAL. School Accommodation.—There were 32 public elemenmentary schools, with 81 departments and accommodation for 25,311 children, in Willesden on 31st December, 1914. In addition, there were three special schools, maintained by the Local Education Authority, two for mentally defective and one for physically defective children. Certain details of construction with regard to Willesden schools are to be found in the Annual Report 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. Organization and Supervision of Medical Inspection.—In accordance with resolutions passed at the end of 1913, two whole-time Assistant Medical Officers and two Health Visitors were appointed at the beginning of 1914 to carry out medical inspection, in place of the 36 part-time Medical Officers previously employed. The appointed Assistant Medical Officers commenced duty in March, 1914, and the method of medical inspection was reorganised, a new scheme being introduced, which has now been in opertion for ten months with satisfactory results. The need for closer association between the School Attendance Department and the School Medical Service, to which attention was drawn by the Board of Education on 18th of September, 1913, and on which I reported to the Education Committee on 3rd October, 1913, is still under consideration. In September, 1914, the appointment of a third Assistant Medical Officer was made, on account of the Treatment of Eyes, and the extra work thrown on the Department 120 through the coming into operation of the Act and Regulations dealing with Mentally Defective Children. Disturbance of School Arrangements by Medical Inspection.—This is minimised as far as practicable, and dates and hours are altered when possible to suit the convenience of teachers and the schools generally. A Health Visitor visits the school at least two days prior to medical inspection to weigh and measure each child and examine as to cleanliness. The cards are left until the day of medical inspection with the Head Teacher, who makes notes with respect to certain items of the schedule, viz. : Date of Admission, Standard, Regularity, Speech, Mental Condition, and Hearing. If the Head Teacher considers any of these matters abnormal they receive special attention when the Assistant Medical Officer examines the child. After the visit of the Assistant Medical Officer, the Health Visitor brings back the completed cards for abstraction and filing. In respect of schools now in process of erection, the Education Committee is making special provision for Medical Inspection so that school arrangements may be disturbed to the least possible extent and Medical Inspection conducted under the best possible circumstances. Children Selected for Medical Inspection.—The following groups of children were examined according to the Public Elementary School Code during the year 1914:— i. Children to be examined between the Christmas and Easter vacations:— (a) Children born between 1-1-08 and 1-1-09 and not already examined. (b) Children entering school for the first time and having attended no school before 1-1-14. 121 (c) Children born before 1-1-02 and not having been examined since reaching the age of 12 years. ii. Children to be examined between the Easter and Summer vacations :— (a) Children born between 1-1-09 and 1-4-09 and not already examined. (b) Children entering school for the first time having attended no school before 1-4-14. (c) Children born before 1-4-02 and not having been examined since reaching the age of 12 years. iii. Children to be examined between the Summer and Christmas vacations:— (a) Children born between 1-4-09 and 1-9-09 and not already examined. (b) Children entering school for the first time and having attended no school before 1-9-14. (c) Children born before 1-9-02 and not having been examined since reaching the age of 12 years. Attendance of Parents at Medical Inspection.—As it is desirable that parents should attend during Medical Inspection, a notice is sent to each parent intimating the day, and as nearly as possible the hour, of examination, and requesting them to be present if possible. Durine the year 7,358 children were examined, and in 3,396 cases, or 46.15 per cent., the parents attended the examination. Extent and Scope of Medical Inspection.—The total number of children on the roll in the Public Elementary Schools in Willesden in June, 1914, was 23,655, and during the year 7,358 were medically inspected. 122 The medical inspection of school children included inspection and examination in respect of the following:— Height and Weight. Clothing and Footgear. Cleanliness of Head and Body. Nutrition. Nose and Throat. Cervical or Neck Glands. External Eye Disease. Ear Disease. Teeth. Heart and Circulation. Lungs. Nervous system. Skin. Rickets. Deformities. Tuberculosis—Non-pulmonary. Speech. Mental Condition. Squint. Vision. Tnfectiious Illness History. B. ROUTINE MEDICAL INSPECTION. Number of Children Inspected.—The following Table, No. 73, gives the number of children inspected during 1914, classified for age and sex, and is in the form required by the Board of Education:— 123 Table No. 73. Age. Boys. Girls. Total. Entrants 5 and under 6 701 543 1244 2836 6 and under 7 644 633 1277 7 and under 8 156 159 315 Other ages (classified as leavers) 8 and under 9 35 29 64 9 and under 10 11 19 30 10 and under 11 6 10 16 11 and under 12 10 10 20 Leavers 12 and under 13 664 615 1279 4522 13 and under 14 1044 1009 2053 14 and over 588 472 1060 3859 3499 7358 The following Table, No. 74, shews the number of children inspected at each school and the number referred for treatment together with certain other particulars:— 124 Table No. 74. No. examined. No. absent. No. of objections by parents. No. unable to be examined. No. notified to parent as requiring treatment. Acton Land (Mixed) 80 6 ... ... 38 Acton Lane (Infants) 54 7 2 ... 24 Bridge Road (Mixed and Infants) 107 14 ... ... 45 Chamberlayne Wood Road (Boys) 123 5 3 2 38 Chamberlayne Wood Road (Girls) 95 17 14 1 47 Chamberlayne Wood Road (Infants) 96 19 3 46 Christchurch (Boys) 50 ... ... 26 Christchurch (Girls) 46 2 8 ... 26 Christchurch (Infants) 63 10 3 ... 22 Carbon Vale (Girls) 69 8 3 ... 28 Carlton Vale (Infants) 245 42 3 4 84 College Road (Mixed and Infants 43 9 ... ... 12 Disraeli Road (Infants) 107 8 ... ... 39 Dudding Hill (Boys) 134 4 ... ... 40 Dudding Hill (Girls) 125 5 1 ... 75 Dudding Hill (Infants) 188 4 12 1 84 Furness Road (Senior Mixed) 192 10 16 1 86 Furness Road (Junior Mixed) ... ... ... ... Furness Road (Infants) 131 24 ... ... 59 Gladstone Park (Mixed and Infants) 65 6 1 ... 24 Gibbons Road (Mixed) 227 20 ... ... 99 Gibbons Road (Infants) 158 15 1 ... 73 Gordon Memorial (Boys) 68 7 1 ... 31 Gordon Memorial (Girls) 80 8 ... ... 37 Gordon Memorial (Infants) 69 8 ... ... 29 Holy Trinity (Boys) 54 4 ... ... 23 Holy Trinity (Girls) 39 ... ... ... 20 Holy Trinity (Infants) 49 5 ... ... 15 Harlesden C. of E. (Boys) 32 3 ... ... 9 Harlesden C. of E. (Girls) 26 10 ... ... 8 Harlesden C. of E. (Infants) 40 8 ... ... 12 Harlesden R.C. (Mixed) 55 3 ... ... 23 Harlesden R.C. (Infants) 32 10 ... ... 18 Keble Memorial (Boys) 59 4 ... ... 26 Keble Memorial (Girls) 23 2 4 ... 8 Keble Memorial (Infants) 51 12 ... ... 20 Kensal Rise (Boys) 133 4 2 2 49 Kensal Rise (Girls) 158 9 4 ... 59 Carried forward 3366 332 96 11 1402 125 Table No. 74—(continued). No. examined. No. absent. No. of objections by parents. No. unable to be examined. No. notified to parent as requiring treatment. Brought forward 3366 332 96 11 1402 Kensal Rise (Infants) 141 42 1 ... 44 Kilburn Park (Girls) 49 3 ... ... 31 Kilburn Park (Infants) 63 13 ... ... 21 Leopold Road (Boys) 155 8 1 ... 42 Leopold Road (Girls) 115 5 ... ... 37 Leopold Road (Infants) 137 1 ... 75 Lower Place (Boys) 78 5 ... ... 30 Lower Place (Girls) 66 2 ... ... 33 Mora Road (Boys) 109 7 1 ... 46 Mora Road (Girls) 104 9 ... ... 42 Mora Road (Infants) 85 12 ... ... 43 Neasden National (Mixed) 45 14 ... ... 16 Neasden National (Infants) Oldfield Road (Boys) 131 5 1 ... 51 Oldfield Road (Girls) 137 9 1 ... 47 Oldfield Road (Infants) 216 27 1 ... 100 Percy Road (Boys) 127 10 ... ... 59 Pound Lane (Mixed) 223 10 5 ... .93 Pound Lane (Infants) 119 12 3 ... 44 Princess Frederica (Boys) 112 7 2 43 Princess Frederica (Girls) 83 15 8 ... 33 Princess Frederica (Infants) 106 9 ... ... 53 Salusbury Road (Mixed) 280 14 3 ... 106 Salusbury Road (Infants) 155 17 1 ... 43 Stonebridge (Boys) 96 4 ... ... 33 Stonebridge (Girls) 171 7 4 ... 60 Stonebridge (Infants) 134 31 ... ... 35 St. Andrew1s (Boys) 105 6 8 ... 57 St. Andrew1s (Girls) 70 10 8 ... 29 St. Andrew1s (infants) 57 11 1 ... 20 St. John1s (Boys) 61 3 ... ... 26 St. John1s (Girls) 60 3 ... ... 23 St. John1s (Infants) 45 7 ... ... 16 St. Mary1s (Boys) 69 2 1 ... 21 St. Mary1s (Girls) 50 19 11 ... 21 St. Mary1s (Infants) 49 13 1 ... 19 St. Mary1s R.C. (Mixed) 28 6 1 ... 14 St. Mary1s R.C. (inlants) 46 2 ... ... 19 Wesley Road (Junior Mixed) ... ... Wesley Road (Infants) 121 14 ... ... 39 Totals *7364 736 168 15 2766 * This number diflers by 6 from the number 7358 used throughout the report as 6 children were not completely examined on account of absence when either the Health Visitor or Doctor attended the School, and are therefore excluded from the tabulated results. 126 Notice to Parents of Defective Conditions in Children Requiring Treatment.—From the foregoing Table, No. 74, it will be noted that 2,766 children medically inspected were referred for medical or dental treatment. In all these cases notices were sent to the parents calling their attention to the defects and advising them to seek remedial measures. Urgent cases were still further referred for home visitation with the view of assisting parents to secure treatment. Heights and Weights of the Children Inspected.— The following Table, No. 75, shews the average heights and weights of the children examined during 1914, classified according to age and sex :— 127 Table No. 75. Age in Years. BOYS. girls. No. Examined. Total Height in Centimetres. Average Height in Centimetres. Total Weight in Kilogrammes Average Weight in Kilogrammes No. Examined. Total Height in Centimetres. Average Height in Centimetres. Total Weight in Kilogrammes Average Weight in Kilogrammes 5—6 70I 73757.4 105.2 12289.4 17-5 543 56852.3 104.8 9705.4 00 6—7 644 69185.6 107.4 11850.0 00 tn 633 67964.4 107.3 II504.5 18.1 7-8 156 1768.9 113.3 3141.0 20.1 159 17961.8 112.9 3164.9 19.9 On 00 35 4150.0 118.0 788.5 22.5 29 3428.8 118.2 625.1 21.5 9—10 11 1394.° 126.0 287.8 26.2 19 2334.2 122.8 444.6 23.4 10—11 6 794.5 132.4 170.3 28.3 10 1276.1 I27.6 251.4 25.1 11—12 10 1407.1 140.7 323.9 32.4 10 1394 .5 I37.4 309.3 30.9 12—13 664 92326.4 139.0 21470.6 32.3 615 86819.6 I4I.I 20225.0 32.8 13—14 1044 147776.2 141.5 35534.6 34.0 1009 145416.0 I44.I 35494.5 35.1 14-15 588 85668.2 145.7 21830.7 37. 1 472 70099.7 148.5 18300.20 38.7 128 The following Table, No. 76, gives the average heights and weights of all the children examined during the six. year period 1909.14, classified according to age ana sex :— Table No. 76. Age in Years. BOYS. GIRLS. No. Examined. Total Height in Centimetres. Average Height in Centimetres. Total Weight in Kilogrammes Average Weight in Kilogrammes No. Examined. Total Height in Centimetres. Average Height in Centimetres. Total Weight in Kilogrammes Average Weight in Kilogrammes 5—6 6313 663725.2 105.1 111441 .3 17.6 5832 610128.2 104.6 100515.4 17.2 6—7 2385 260823.6 109.3 45274.8 l8.9 2366 257684.6 108.9 43727.5 18.4 7-8 4197 486557.8 115.8 88664.6 21.1 4116 476736.3 115.8 84836.3 20.6 8-9 2034 247047.6 121.4 47741.9 23.4 1532 184225.3 120.2 34422.7 22.4 9—10 1017 128101 .0 125.9 25904.7 25 5 928 1104.3 124.8 22648.4 24.4 10—11 4200 549951.1 1309 17425.9 279 4176 54501.8 10.5 112470.2 26.9 11—12 1615 217547 .5 134.7 47992.4 29.7 1382 187270.7 1.5 40813.1 29.5 12—13 1447 200982 5 138.9 47102.6 32 5 1352 190655 0 141 0 44354.6 32.8 13—14 5034 722887.1 143.6 177988.6 32.3 4723 690829.4 146.2 172572.2 36.5 14—15 919 135178.4 147.0 34788.7 37.8 713 106372.4 149. 27677.3 38.8 129 Condition of the Children Inspected.—The following return, Table No. 77, gives details in respect of the condition of the 7,358 children submitted to routine medical inspection during the year:— 130 Table No. 77.—Return as required by the Board of Education showing the Condition of Children submitted to Routine Medical Inspection. Total Inspected. ENTRANTS. LEAVERS. TOTAL. Boys. Girls. Total. Per cent. Boys. Girls. Total. Per cent. Boys. Girls. Total. Per cent. 1501 1335 2836 2358 2164 4522 3859 3499 7358 Clothing Satisfactory 1449 1290 2739 96.58 2254 2108 4362 96.46 3703 3398 7101 96.50 Unsatisfactory 52 45 97 3.42 104 56 160 3.54 156 ioi 257 3.50 Footgear - Satisfactory 1429 1251 2680 94 .50 2233 2085 4318 95'49 3662 3336 6998 95.11 Unsatisfactory 72 84 >56 6.0 '25 79 204 4.51 197 163 360 4.89 Cleanliness of Head - Clean ... 1315 968 2283 80.50 2156 i369 3525 77 .95 3472 2336 5808 78.93 Nits 98 291 389 13.72 104 668 772 1.707 202 959 1161 15.78 Pediculi 62 67 129 4.55 72 99 171 3.78 133 167 300 4.08 Other Dirty Conditions 26 9 35 1.23 26 28 54 1.20 52 37 89 1.21 Cleanliness of Body - Clean ... 1434 1278 2712 95.63 2274 2097 4371 96.66 37o8 3375 7083 9626 Dirty 18 7 25 .88 24 10 34 .75 42 '7 59 .80 Pediculi 11 11 22 .78 26 10 36 •80 37 21 58 .79 Fleabitten 38 39 77 2.71 34' 47 8. 1 .79 72 86 158 2.15 Nutrition- Excellent 1 1324 1221 2545 89.74 2144 1967 411. 90.91 3468 3188 6656 90.46 Below Normal 140 104 244 8.60 179 166 345 7.63 3i9 270 589 8.0 Bad 37 10 47 1.66 35 31 66 1-46 72 41 113 1.54 131 Nose and Throat. No Defect 999 911 1910 67 .35 1765 1635 340o 75. 19 2764 2546 5310 72.17 Enlarged Tonsils 305 284 589 20.77 416 413 829 1..33 721 697 1418 19.27 Adenoids 24 23 47 1. 65 35 24 59 1. 30 59 47 106 1.44 Enlarged Tonsils and Adenoids 140 98 238 8. 40 107 65 172 3.8o 247 163 410 5.57 Other Conditions 33 19 52 1. 83 35 27 62 1.38 68 46 114 .55 Cervical or Neck Glands. Normal 1258 1156 2414 85.11 2208 2027 4235 93.66 3466 3183 6649 90.36 Enlarged 243 179 422 14.89 .50 .37 287 6.34 393 316 709 9.64 External Eye Disease. No Disease 1445 1303 2748 96.90 2305 2095 4400 97..30 375o 3398 7148 97.14 Blepharitis 42 23 65 2.30 23 40 63 1. 40 65 63 128 1.74 Conjunctivitis 14 2 16 .56 19 16 35 .78 33 18 51 .70 Corneal Opacities 4 4 .14 3 4 7 .15 3 8 11 .15 Other Diseases 3 3 .10 8 9 17 ..37 8 12 20 . .27 Ear Disease— No Disease 1456 1298 2754 97.10 2281 2079 4360 96.42 3737 3377 71 14 96.70 Chronic Suppuration of Middle Ear 33 29 62 2.19 33 38 71 1.57 66 67 .33 1. 80 Chronic Catarrh of Middle Ear ... ... ... ... ... ... ... ... ... ... ... ... Wax 3 1 4 .14 1 1 2 .04 4 2 6 .08 Other Disease 9 7 16 .57 43 46 89 1.97 52 53 105 1.42 Teeth. Sound .., 623 54o 1163 41.00 1086 66 3 1749 38.67 1709 1203 2912 39. 57 Less than Four Decayed 419 422 841 29.65 877 1210 2087 46.15 1296 1632 2928 39. 79 Pour or More Decayed 459 373 832 29.33 388 282 670 14.81 847 655 1502 20.41 Sepsis 7 9 16 .35 7 9 16 .21 Heart and Circulation. No Disease 1382 1244 2626 92.60 2180 1979 4159 91.97 3562 3223 6785 92.21 Organic Disease 21 15 36 1.27 66 63 129 2.86 87 78 165 2. 24 Functional Disease 2 4 6 .21 9 18 27 .59 11 22 33 .45 Anaemia 91 71 162 57.1 91 104 195 4.32 182 175 357 4.86 Other Defect 5 1 6 .21 12 12 .26 17 18 .24 132 Table No 77—(continued). ENTRANTS. LEAVERS. TOTAL. Boys. Girls. Total. Per cent. Boys. Girls. Total. Per cent. Boys. Girls. Total. Percent. Total Inspected. 1501 1335 2836 2358 2164 4522 3859 3499 7358 Lungs. No Disease 1423 1294 2717 9580 2284 2110 4394 97.17 3707 34.04 7111 9665 Chronic Bronchitis and Bronchial Catarrh 57 33 90 318 25 16 41 .90 82 49 131 179 Tuberculosis 5 5 .18 2 9 II .25 2 14 16 .22 Tuberculosis Suspected 18 1 19 .67 38 26 64 1.42 56 27 83 1.12 Other Disease 3 2 5 .17 9 3 12 26 12 5 17 .22 Nervous System No Disease 1495 1329 2824 9960 2349 2159 4508 9970 3844 3488 7332 9970 Epilepsy 1 4 5 17 2 3 5 .11 3 7 10 12 Chorea 1 1 .03 1 2 .04 2 1 3 .03 Other Disease 4 2 6 .20 6 1 7 ..5 io 3 .3 .15 Skin. No Disease 1482 1310 2792 98.44 2329 2141 4470 98.85 38" 345. 7262 98.69 Ringworm : Body 4 10 14 .49 4 3 7 .15 8 .3 21 .28 Ringworm : Head Impetigo 6 7 13 .45 4 7 11 .24 io 14 24 .32 Scabies 1 1 .03 i 1 .O1 Other Disease 8 8 16 .56 21 .3 34 75 29 21 5.0 .67 Rickets. No Disease 1466 .331 2797 9862 2332 2152 4484 99.15 3798 3483 7281 98.95 Slight 35 4 39 1.37 26 12 38 .84 61 l6 77 1. 04 Marked 133 Deformities. No Deformity 1442 1293 2735 96.44 2196 1959 4155 91.88 3638 3252 6890 93.49 Deformity Present 59 42 101 3.56 162 205 367 8.10 221 247 468 6.36 Tuberculosis, Non.pulmonary— No Disease 1494 1333 2827 99 .68 2356 2157 4513 99 .80 3850 3490 7340 99.75 Glandular 1 .03 2 3 .06 2 2 4 .05 Bones and Joints 3 1 4 .14 1 ... 1 .01 4 1 5 .06 Other Forms 3 1 4 .14 ... 5 5 .11 3 6 9 .11 Speech— Not Defective 1480 1329 2809 99.04 98.78 7276 98.88 Defective Articulation l7 5 22 .78 .74 Stammering 4 j 1 5 .18 18 5 23 .51 22 6 28 .38 Mental Condition. Normal 1481 1319 2800 98.73 2168 2001 4169 92.19 3649 332° 6969 94.72 Dull or Backward 18 13 31 1.09 184 149 333 7.36 202 162 .564 4.94 Mentally Defective (all grades) 2 3 5 .17 6 14 20 .44 8 17 25 .33 Squint. No Squint ... ... ... ... ... ... ... ... 3821 3452 7273 98.85 Squint Present ... ... ... ... ... ... ... ... 38 47 85 1.15 Vision— Both Eyes Normal ... ... ... ... 149° 1185 2675 59.16 I490 1185 2675 59.16 One Eye Normal ... ... ... ... 243 208 45. 9.97 243 208 451 9.97 Both Eyes 6/9 ... ... ... ... 287 348 635 14.04 287 348 635 14.04 One Eye 6/9, Other 6/12 or less.. ... ... ... ... 98 141 239 5.29 98 141 239 5.29 Both Eyes 6/12 or less ... ... ... ... 240 282 522 11.54 240 282 522 11.54 134 Clothing and Footgear.—From the foregoing return it will be observed that the clothing of children was unsatisfactory in 257 cases, or 3.5 of the total number inspected, and that the footgear was unsatisfactory in 360 cases, or 4.89 of the total number inspected. Cleanliness of Head and Body.—The return given above shows that the condition of the head was otherwise than clean in the case of 1,163 girls and 387 boys, viz., 1,550 in all, or 21.1 per cent. of the total examined. In the case of 151 boys and 124 girls, viz., 275, or 3.7 per cent. of the total examined, it will be seen that the state of the body or skin generally could not be classified as clean, while 0.79 per cent. exhibited signs of pediculi or body lice. This latter condition is an extremely unsatisfactory one, and is nearly always accompanied by a verminous state of the head. Dirty and verminous conditions are generally due to ignorance, carelessness, and lack of perseverance on the part of the mother, as the same case frequently comes under observation several times. Soap, water, and industry will effect a cure. Work requires to be done to bring home to parents what they can accomplish in respect of dirty conditions, and for this purpose the work of the Health Visitors should be extended in the schools and the homes. The children, in a class or classes, should be examined periodically from time to time as regards their freedom from vermin and nits, and those suffering should be excluded at once, promptly followed up to their homes, and the parents given practical demonstrations on how to cleanse. Cleansing should be effected by the parents within 14 days. Nutrition.—The return above given as respects nutrition is important, and especially so with regard to the provision of school meals, as it shows that 9.54 per cent. of the children inspected were below the normal standard 135 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 9.54 per cent. of children noted above as suffering from malnutrition in greater or less degree. Diseases of the Nose, Throat, and Ear.—In 2,048 cases, or 27.83 per cent. of the 7,358 children examined, diseased conditions of the nose and throat were noted, and in 244 cases, or 3.3 per cent. of the children examined, diseases of the ear were found. Defective conditions of the throat, nose, and ear are especially important in relation to school-life, as they interfere with education both by way of absence from school and by producing mental dullness in the child. The majority of these conditions are easily remediable, and a report on the subject of their treatment is at present under consideration by the Education Committee. This report, included with a report on the Treatment of Ringworm, appears as Appendix E herewith, and it should be observed that the adoption of the remedial measures suggested would be amply repaid to the Committee by the improved health and attendance of children who at present suffer from these complaints. External Eye Diseases, Squint, Vision.—210 cases of external eye disease were noted. 761 children with vision = 6/12 or less in one or other or both eyes, and 635 children with a defect of 6/9 in both eyes, were examined in the course of medical inspection. In addition 85 cases of squint were recorded. 136 The 210 cases of external eye disease and the 761 children with vision = 6/12 or less all require treatment, and it is satisfactory to be able to record that the Committee by establishing an Eye Clinic is now in a position to deal with these cases. In addition many cases of 6/9 vision are astigmatic, and suffer from eye strain; and the cases of squint require investigation as to the cause. Such children are also referred to the Eye Clinic for further examination and treatment where necessary. Teeth, Cervical or Neck Glands.—Only 2,912 out of 7,358 children examined, or 39.57 per cent., were found to have sound teeth. 1,502 children, or 20.4 per cent, of the total examined, had more than four teeth decayed, and it was quite exceptional to find that any treatment had been obtained in these cases.' Children with this number oi decayed teeth urgently require treatment. In a large number of cases the parents are willing to obtain treatment, but are unable to do so, on account of the expense incurred, and attendance at a dental hospital often means much delay and waiting, with consequent loss of valuable time to the parents. The establishment of a Dental Clinic would ensure the early treatment of these cases, and preserve in childhood many of those permanent teeth which under existing circumstances have to be extracted. Other diseases, secondary to dental caries, would also be prevented. Such diseases include Enlarged Cervical or Neck Glands, which were noted in 709 cases, or 9.6 per cent, of the children examined. In some cases the glands are Tuberculous, but in the majority of cases the enlargement is secondary to carious teeth or septic conditions of the mouth, throat, ears, or scalp. 137 Glands enlarged from septic conditions return to their normal size when the source of irritation is removed. The urgent need for a Dental Clinic to deal with the numerous cases of dental caries is thus apparent. Previous Illness History.—The following Table, No. 78, shews the diseases from which children had suffered when enquiries were made at the time of Medical Inspection.— Table No. 78. ENTRANTS. LEAVERS. TOTAL. Boys. Girls. Per cent. Boys. Girls. Per cent. Boys. Girls. Per cent. No. of Observations. 970 947 605 861 1575 1808 Measles 598 608 63.0 534 785 90.0 1132 1393 74.6 Whooping Cough 428 433 44.9 363 536 61. 3 791 969 52.0 Scarlet Fever 60 49 5.7 105 137 16.5 165 186 10.3 Diphtheria 29 25 2.8 31 70 6.8 60 95 4.6 Chicken Pox 273 295 29.6 347 460 55.0 620 755 40.6 Mumps 75 79 8.o 117 172 19.7 192 251 13.1 German Measles 8 5 .7 28 45 4.9 36 50 2.5 Other Diseases 159 135 15.3 54 82 9.2 213 217 12.7 The above Table, No. 78, shews that 63 per cent. of children had had Measles when they were examined as entrants, and 90 per cent. when examined as leavers; that is to say that 27 per cent. contracted the disease during schoollife, as against 63 per cent. before admission to school. Similarly it may be stated that 16.4 per cent. of children contracted Whooping Cough during school-life, as compared with 44.9 per cent. before attendance at school. Measles and Whooping Cough are specially fatal in children under five, and these facts shew not only that school is a less potent factor in their spread than is generally supposed, but also the necessity of dealing with these diseases in young children under school age. 138 C. SPECIAL CASES—FOLLOWING-UP. Special Cases.—192 of the 7,358 children medically inspected were referred for further examination at the next medical inspection, or at the inspection clinic, without home visitation. These were cases where the diagnosis was doubtful, or where the child's state of health was low without any definite signs of disease being present. Special Cases—Following-up.—4,971 cases with 5,340 defects were referred for home visitation during the year 1914 with the view of medical treatment being obtained, remedial measures carried out, or other action taken. The following Table, No. 79, shews how the cases came under notice, and also gives corresponding figures for previous years:— Table No. 79. No. referred by Medical Inspection and Officers of Health Department. Head Teachers. Attendance Officers. Others. Total. 1914 2322 2401 108 140 4971 1913 1092 1912 1102 1911 1030 1910 941 139 Remedial Measures — Medical Treatment — The Results of "Following-up."—The following Table, No. 80, shows the nature and the number of the defects from which the 4,971 special cases referred to in the preceding paragraph were suffering, the number of visits and medical examinations made in connection with these cases, and the extent to which remedial measures or medical treatment were carried out during 1914:— 140 Table No. 80. condition. No. of Defects found for which Treatment was considered necessary. No. of Visits made on account of these Defects. No. of Medical Examinations made on account of these Defects. No. of Defects for which no Report is available. No. of Defects Treated. Results of Treatment. No. of Defects not Treated. Percentage of Defects Treated. Remedied. Improved. ; Unchanged. Clothing. Unsatisfactory 8 29 2 0 7 7 0 0 1 87.50 Footgear. Unsatisfactory ... ... ... ... ... ... ... ... ... ... Cleanliness of Head. Nits 284 917 286 6 256 212 26 18 22 90.4 Pediculi 682 2332 1142 32 637 586 41 10 13 93 .40 0ther Dirty Conditions 39 113 39 0 28 26 2 0 II 71.79 Cleanliness of Body. Dirty ... ... ... ... ... ... ... ... ... ... Pediculi 68 297 116 2 63 59 4 0 3 92.65 Fleabitten 2 2 0 0 1 1 0 0 1 50.00 Nutrition— Below Normal 14 59 18 4 0 0 0 0 10 0 Bad 1 0 1 1 0 0 0 0 0 0 Nose and Throat Enlarged Tonsils 285 966 300 21 129 53 8 68 135 45.26 Adenoids 52 191 50 3 28 12 2 14 21 53 85 Enlarged Tonsils and Adenoids 113 286 111 5 55 26 4 25 53 48.67 Other Conditions 240 533 82 6 189 165 14 10 45 78.75 Cervical or Neck Glands. Enlarged 110 258 66 3 80 42 22 16 27 72 .73 External Eye Disease Blepharitis 63 195 73 2 48 40 5 3 13 76.19 Conjunctivitis 184 631 318 7 •55 128 19 8 22 84.24 Corneal Opacities i 17 3 0 1 0 1 0 0 1oo.'oo Other Diseases 33 87 46 2 22 16 1 5 9 66.67 Ear Disease — Chronic Suppuration of Middle Ear 57 149 48 1 36 9 14 13 20 63.16 Chronic Catarrh of Middle Ear ... ... ... ... ... ... ... ... ... ... Wax 2 2 3 1 1 1 0 0 0 50.00 Other Disease 28 76 3i 3 16 3 4 9 9 57.14 Teeth. Less than Four Decayed ... ... ... ... ... ... ... ... ... ... Four or More Decayed 199 587 167 16 105 17 43 45 78 52.76 Sepsis 16 45 22 1 7 0 7 0 8 43.75 Heart and Circulation. Organic Disease 38 89 46 2 29 4 6 19 7 76.32 Functional Disease ... ... ... ... ... ... ... ... ... ... Anaemia 6 17 1 0 3 0 2 3 50.00 Other Defect 5 15 6 0 2 1 1 0 3 40.00 141 142 Table N0. 80—(c0ntinued). CONDITIONS. Number 0f Defects f0und f0r which Treatment was c0nsidei ed necessary. N0. 0f Visits made 0n acc0unt 0f these Defects. N0. 0f Medical Examinati0ns made 0n acc0unt 0f these Defects. N0. 0f Defects f0r which n0 Rep0rt is available. N0. 0f Defects Treated. Results 0f Treatment. N0. 0f Defects n0t Treated. Percentage 0f Defects Treated. Remedied. Impr0ved. Unchanged. Lungs- Chr0nic Br0nchitis and Br0nchial Catarrh 46 110 28 1 33 31 2 0 12 71.74 Tubercul0sis 14 42 20 I 7 I 5 6 50.00 Tubercul0sis Suspected 54 140 72 0 24 6 5 !3 3° 44.44 Other Disease 5 ii 4 0 4 2 1 1 80..00 Nerv0us System- Epilepsy 5 22 5 3 2 0 0 2 0 40.00 Ch0rea 16 39 14 2 9 4 3 2 5 56.25 Other Disease 7 8 4 0 2 0 0 2 5 28.57 Skin- Ringw0rm—B0dy 513 1691 1077 24 464 351 "3 0 25 90.45 Ringw0rm—Head Impetig0 231 926 3°5 1 218 209 6 3 12 94.37 Scabies 63 325 102 1 60 53 3 4 2 95.24 Other Disease 267 1031 312 6 235 210 15 10 26 88.01 Ricketts— Slight Marked 143 Deformities. Deformity Present 50 110 40 4 23 1 3 19 23 46.00 Tuberculosis (Non.pulmonary)— Glandular 5 19 9 0 3 2 1 0 2 60 .00 B0nes and J0ints 6 25 8 0 3 0 0 3 3 50.00 Other Forms 3 5 4 0 0 0 0 0 3 0'00 Speech— Defective Articulation 7 16 9 0 5 2 1 2 2 71 43 Mental Condition. Dull 0r Backward 27 58 31 0 0 0 0 0 27 0'00 Mentally Defective (all grades) ... ... ... ... ... ... ... ... ... ... Squint. Squint Present 47 120 65 3 32 11 2 19 12 68.09 Vision. One Eye Normal 1012 3630 1576 95 500 439 14 47 417 49.41 B0th Eyes 6/9 One Eye 6/9 Other 6/12 0r less 1 Hoth Eyes 6/12 0r less J Miscellaneous 432 1066 248 16 185 '35 >9 31 231 42.82 Totals 5340 17287 6910 275 3707 2866 413 428 1358 69.42 144 From the foregoing Table, No. 80, it will be seen that 3,707 of the 5,340, or 69.42 per cent., of the defects noted received treatment during the year. Of this number many cases were treated at home by the parents under the direction of the Health Visitors, acting under the Medical Officer. These cases include all, or practically all, those referred on account of clothing and cleanliness. In addition during the year the Ringworm Clinic dealt with 353 cases of Ringworm. Many cases of minor skin diseases received no medical treatment, but treatment was carried out at home by the parents, under the direction of the Health Visitors. About 66 per cent., or 342, of these minor skin conditions were dealt with in this manner. The Eye Clinic was opened on the 2nd October, 1914, and 363 cases were in attendance for treatment up to the end of the year. From these figures it will be seen that the medical and nursing staff were responsible for the treatment of 2,050 of the 3,707 actually receiving treatment during the year. Prosecutions.—16 prosecutions were conducted by the Attendance Officers on the recommendation of the Medical Officer for non-attendance in respect of exclusion from school on account of dirty and verminous conditions. 3 of these cases were withdrawn, as the children meanwhile had been cleansed. In the remaining 13 cases fines were inflicted by the Magistrate varying in amount from 2s. 6d. to 20s. D. CLINIC. The Clinic maintained by the Authority deals with Ringworm and Eye cases. The following Table, No. 81, shews the work that has been done at the Clinic during the year under review :— 145 Table No. 81. Clinic.—(Ringworm and Eyes.*) Ringworm. Eyes. Under 5 years. Over 5 years. No. of cases under treatment at 27th December, 1913 43 0 0 No. of cases coming under treatment 421 7 372 Total No. of cases under treatment 464 7 372 No. of cases cured or relieved:— (a) By X Rays 99 ... (b) By provision of Spectacles 0 176 (c) By other means 106 3 53 No. of cases previously attending Clinic cured by other agencies or removed 111 0 9 No. of cases not requiring treatment 35 1 23 Total No. of cases remaining under treatment at 26th December, 1914 113 3 111 "The Eye Clinic was not opened until 2nd October, 1914. Ringworm Cases.—The Clinic has been open for the treatment of Ringworm cases during the whole of the year under review. 513 cases of Ringworm came under observation during the year, and it will be noted from the Table, No. 80, that 464 received treatment during the year, that no report was available in respect of 24 cases, and that 25 were not known to have received treatment. In 35 of the 464 cases put down as receiving treatment, no treatment was necessary ; and of the remaining 429 cases, 205 were cured at the Ringworm Clinic and 113 were still under treatment there at the end of the year. The remaining 111 cases were cured by other agencies. These 111 cases actually came under treatment at the Ringworm Clinic during the year, but the majority of them left on account of the long time which elapses before it is possible to apply X-Rays. There would be considerable advantage if provision could be made as suggested in Appendix E to prevent this delay, as the long time—several months sometimes—before the child's turn comes prolongs the opportunities for the spread of the disease. In no case treated by X-Rays has there been permanent baldness or other ill-effects from the treatment. 146 The total number of attendances made by children at the Ringworm Clinic during the year was 1,432. The greatest number attending on any one day was 64, and the average attendance on each morning on which the Clinic was open throughout the year 34. Eye Cases.—The Clinic was opened for the Treatment of Eye Cases on 2nd October, 1914. Table No. 80 shews that 1,012 cases of Defective Vision, 47 cases of Squint and 281 cases of External Eye Disease, or a total of 1,340, came under observation during the year as requiring treatment. Of this number 758 received treatment, including 363 cases, which received treatment at the Eye Clinic during the last quarter of the year. Between 2nd October and 26th December, 1914, 1,085 attendances were registered at the Eye Clinic. The greatest number attending on any one day was 54, and the average attendance during the period in question was 26 on each day on which the Clinic was open. Cost ok Equipment of Eye Clinic.—The cost of the equipment of the Eye Clinic is shown as follows :— £ s. d. Building alterations, dark rooms, plumbing, etc. 16 4 0 Furniture 21 17 84 Ophthalmic instruments, lenses, etc. 54 0 6 Gas fittings 4 13 5 Electric fittings 4 13 6 Stationery, register, prescription forms, etc. ... 3 0 5 Sundries 2 18 6 £ 107 8 The above cost includes equipment for two medical workers, as this is the most convenient arrangement. 147 Prices for Spectacles.—During the year the Education Committee entered into an agreement with Messrs. George Spiller, Ltd., for the supply of Spectacles at the following rates:— s. d. Spectacle frame complete with spherical lenses and case 2 0 Ditto, with piano-eye lenses 2 9 Ditto, with sphero-eye lenses 4 0 (1) Spectacle frame empty 1 3 (2) One spherical lens 0 9 (3) Two similar spherical lenses 1 6 (4) One cylindrical lens 1 0 (5) Two similar cylindrical lenses 2 0 (6) One sphero-cylindrical lens 1 3 (7) Two similar sphero-cylindrical lenses 2 6 (8) Tinted lenses, per pair extra 1 6 (9) Cases, each 0 H These prices include the attendance of a competent fitter to measure the children for the frames when they attend to have their vision tested by the Medical Officers. E. EXCEPTIONAL CHILDREN. Exceptional Children.—The following Table, No. 82, gives a classified list of exceptional children in the area. The figures are based in some cases on the number coming under observation during the year. 148 Table No. 82. Boys Girls Total Blind (including partially blind). Attending Public Elementary Schools — — — Attending Certified Schools for the Blind 8 7 IS Not at School †2 4 6 Deaf and Dumb (including partially deaf). Attending Public Elementary Schools I — 1 Attending Certified Schools for the Deaf 8 3 11 Not at School — — — Mentally Deficient. Feeble Minded. Attending Public Elementary Schools — — Attending Certified Schools for Mentally Defective Children ‡66 60 126 Notified to the Local (Control) Authority during the year 12 4 16 Not at School **3 2 S Imbecii.es. At School — Not at School 5 2 7 Idiots. 3 2 5 Epileptics. Attending Public Elementary Schools 15 9 24 Attending Certified Schools for Epileptics 2 6 8 Not at School 10 17 Physically Defective. Pulmonary Tuberculosis. Attending Public Elementary Schools *7 *45 *52 Attending Certified Schools for Physically Defective Children Not at School 2 — 2 Other Forms of Tuberculosis. Attending Public Elementary Schools *29 *29 *58 Attending Certified Schools for Physically Defective Children 15 9 24 Not at School 7 3 10 Cripples Other Than Tubercular. Attending Public Elementary Schools 1 3 4 Attending Certified Schools for Physically Defective Children 15 20 35 Not at School 10 4 14 Dull or Backward. Retarded 1 year 11 5 16 Retarded 2 years 4 4 8 Retarded 3 years 2 1 3 "These numbers are estimated from the numbers of children found suffering from these conditions at routine medical inspection. † Also feeble-minded. ** Two also partially blind. ft One also partially blind. 149 Blind and Partially Blind Children.—A school for blind children is not maintained by the Authority, but children are sent to day or residential institutions as may be necessary. The following Table, No. 83, gives certain particulars with regard to the blind and partially blind children being educated by the Education Committee at the end of the year 1914:— Table No. 83. Initials of Child. Date of Birth Date Examined. Date reported by Medical Officer to Committee and Case No. Date entered Institution. Name of Institution. F.H. 2-11-'93 3- 7-'02 Royal Normal College (Scholarship Resident) W.L.W 26- 5-'01 27- 1-'o8 Swiss Cottage (Day) D.I.C. 2- 1-'01 16- 3-'09 Edinborough Road, London (Day) 14- 1-'14 Swiss Cottage (Resident) R.S. 10- 9-'01 20- 9-'10 Royal Normal College (Resident) R.B. 21- 3-'02 10-10-'10 Swiss Cottage (Resident; E.S. 11-11-'04 10-10-'10 Edinborough Road, London 27- 4-14 Swiss Cottage (Resident) E.D. 31-12-'02 25- 4-'11 Royal Normal College (Resident) C.R.H. 16-11-'99 — 9-'11 Swiss Cottage (Resident) F.L. 8- 6-'02 8- 1-'12 Barlby Road (Day) 10-11-'13 Swiss Cottage (Resident) W.G.G. 4-11-'04 8- 1-'13 Swiss Cottage (Day) H.G.L. 27-3-'04 26- 9-'11 30-10-'11 23- 9-'14 Swiss Cottage (Resident) H.G. 5-10-'01 19- 6-'l2 23- 9-'l2 26- 3-'13 Swiss Cottage (Day) E.M.S. 11- 6-'05 19- 2-'l3 31- 3-'13 17-11 -'3 Swiss Cottage (Day) In hospital 12-3-'15 Will require Resident Institution on discharge A.S.Mc.I. 11- 1-'07 30- 1-'14 4- 2-' 14 23- 2-'l4 Swiss Cottage (Day) S.H.* 1.11-'08 15- 9-'l4 26-10-'l4(ll) Under school age P.V.* 16- 8-'03 30- 9-'14 26-10-'l4(23) 14- 9-'14 Leinster Road, M.D. School (Day) F.C.* 28-10-'03 27-1 l-'l4 Awaiting admission to Leinster road M.D. School (Day) E.B. 25- 6-'99 3-10-'14 28- 9-'l4 20-10-'l4 Swiss Cottage. (Day) F.M.B. 15- 9-'03 6-11-'14 21 -1 2-' 14(26) ... Awaiting admission W.W. 16-11-'01 20-11-'14 2i-i2-'14(9) ... Awaiting admission N.G. 4- 6-'04 28-11-'l4 23-11 -'l4( 17) ... Awaiting admission E.T. 27- 9-'03 14-112-'14 25- 1-'15(I2) ... Awaiting admission * Also feeble-minded. Instruction given by Special Teacher. 150 In addition to blind children there is a certain number of children who may be called partially 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 speoial provision requires to be made for them. Children of this class may pass beyond school-age in a practically uneducated state (it having been found impossible to gain admission to any suitable school). As an example, the case of W.W. may be quoted. At the agt of eight years this child was found to be highly shortsighted. She had been taken to various hospitals, and as soon as the Committee's Clinic was opened, was brought there. Now, with the aid of very strong glasses, she can see 6/12 and 6/18. Being now nearly 14 years old, she cannot be sent to an ordinary elementary school on account of her backwardness, even if her sight were sufficiently good for her to profit by ordinary teaching. Application was therefore made to all institutions where she might possibly be taken as a day pupil, but nowhere could she be admitted. Attendance at a class for semi-blind children would in a year or two doubtless fit her to earn her own living in some capacity, as she is quite a bright child. Special class-rooms are needed for the education of the partially blind child, provided with the best possible illumination. Preferably all work necessitating the use of the eyes should be done in daylight, the time during which artificial light is used being given up to drill, games, and oral teaching. All work involving any eye-strain must be carefully avoided, and teaching should be as much as possible oral, which can frequently be arranged with other classes of normal-sighted children. Manual and physical training 151 should play an important part in the curriculum. These children, like all abnormals, need frequent medical examination, both as to their general physical condition and as to the eye defect, which frequently changes rapidly. Myopic, i.e., shortsighted, children who can see just well enough to remain in an ordinary elementary school and yet who really should be classified as "partially blind," may easily have great harm done to their already poor eyesight by the strain of attempting to keep up with the other children, in class-rooms which may be insufficiently lighted, and where in any case it is impossible to make special provision for one afflicted child. The sight of a great number of blind and partiallyblind children would have been saved if proper treatment had been obtained early, especially in the case of impaired vision due to ophthalmia neonatorum, or inflammation of the eyes of new-born babies. Unless immediate and efficient treatment is carried out total or partial blindness nearly always follows this disease. Provision for the treatment of this condition is now made at the Eye Clinic. Deaf and Partially Deaf Children.—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. 84, gives particulars of deal children being educated by the Education Committee at the end of the year 1914. 152 Table No. 84. Initials of Child. Date of Birth Date examined. Date reported by Medical Officer to Committee, and Case No. Date entered Institut10n. Name of Institution. e.m. i0-i0-'02 1- 6-'10 - 9-'10 Margate (Resident). t.ii.b. 23- 7-'°3 5- 7-'11 31. 8-'11 do. H.a.h. 17- 6-'02 5- 7-'11 31. 8-' 11 do. E.G.S. 17- 5-'o4 5- 7-'11 31- 8-'1 1 do. W.S. 31-10-'o6 l6- 2-'l2 i-10-'I3 11-11-13 do. a.r.n. 23- S11'°S 19- 3-'l2 and 6-12-'13 (29- 5-'l2 ) and 27- 1-'13 14- 4-'13 do. l.j.t. 8- 8-'05 19- 3-'12 29- 5-'12 11-11-13 do. f.j.h. 30-10-'o6 1- 7-'13 22- 9-'13 11-11-'13 do. i.m.h. 9- 1-'09 1-10-'13 27-10-'13 27- 8-'14 do. s.n. 27- 7-'02 6- 8-'14 7-10-'14 27- 8-'14 do. e.c.n. 18- 4-'09 6- 8-'14 7-10-'14 27- 8-'14 do. *c.p. 13- 5-'04 30- 9-'14 26-10-'14 (14) 'Partially deaf child attending a Willesden school, but residing in London, awaiting being taken over by the London Authority. As in the case of blind children, so in the case of deaf, there are to be found children not suitable for educat10n 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 definit10n of deaf. They are not, however, totally deaf, and should be taught in a class specially adapted for 11hard of hearing11 children. In some respects the case of the 11partially deaf11 child is even harder than that of the 11partially blind.11 Frequently the defect is not recognised, and a child is treated as inattentive or stupid whereas he may be neither. Especially is this likely to happen in those cases in which the deafness varies considerably from time to time. On some days the child hears easily, and on others with great difficulty. Again, a bright child learns to lip read to a considerable 153 extent, so that when he happens to be looking at the speaker he answers intelligently, and at other times misses questions entirely. When the defect is very slight the child may be taught in a class with other children by placing him in the front row. Even then the teacher has to give him special attention to be sure that he is hearing the lesson. Children who are more than slightly deaf, but not stone deaf should be taught by themselves in small classes of not more than ten, and conducted under the best possible hygienic conditions. Such classes exist in London and other parts of England, but the need is at present far in excess of the supply. It must be noted here that, as in the case of the blind children, the defect is in many instances preventable. Many children would have been saved from deafness if efficient treatment had been obtained early, but either the difficulty of obtaining it was too great, or the seriousness of the case was not recognised. Medical inspection associated with a complete system of medical treatment should go far to prevent deafness, but it must be remembered that many of the diseases giving rise to deafness begin before school-age, and similar attention must therefore in addition be given to young children. The Mentally Defective.—Two schools for this class of children are maintained by the Education Authority, as under:— Effective No. No. awaiting Name of School. accommodation, on roll, admission, 8-3-'15 8-3-'15 8-3-'15 Leinster Road, Mentally Defective 80 73 0 Leopold Road, do. 38 45 0 In addition, one mentally defective Willesden boy is being educated at St. Hubert's, a mentally defective school maintained by the London County Council. 154 Each of the Willesden Mentally Defective Schools is visited weekly by the Assistant Medical Officer, and once a term or oftener by Dr. Shuttleworth, the Committee's consultant for Mentally Defective cases. At the routine weekly inspections any physical defects in children attending the school are brought under the notice of the Medical Officer, and are dealt with as may be necessary. Each child is examined as to its mental and physical condition at least once a year, the parent usually being present for this examination. New cases referred by head teachers of ordinary elementary schools, school attendance officers, or others, are in the first place seen and examined at the offices in Dyne Road. Each child should be examined alone, in a quiet room with no distractions, and preferably with no one else but the parent present. These conditions can seldom be obtained in the ordinary schools. If the child is found on first examination to be feeble-minded and educable it is admitted to one of the Council schools for Mentally Defective children as soon as possible. It has happened that admission has been delayed owing to lack of ambulance accommodation even when there were vacancies in the school. An additional ambulance has, however, now been hired, which has relieved the overcrowding in existing ambulances, and enable all educable feeble-minded children to be admitted to school. The Binet Simon tests as translated and adapted by Goddard are used as the basis of mental examination. Various alterations have had to be made. The pictures published in America were found to be unsatisfactory, portraying as they did scenes unfamiliar to children here. Other pictures shewing streets, with motors, trams, policemen, soldiers, etc., parks with children playing, and similar well-known sights, have therefore been prepared, and are found to be much more suitable. 155 The Binet Simon tests have hardly been in use in England long enough for judgment to be passed as to their satisfactoriness or otherwise. Modifications will doubtless have to be made from time to time, and more control experiments will have to be made with normal children. The tests for children under nine or ten years appear more satisfactory than those for older children. The eleven and twelve-yearold tests are decidedly difficult, and it is probable that a number of normal children leaving an ordinary elementary school would fail to pass them. Anyone familiar with French children will realise that the gift of verbal self-expression is more developed with them than with corresponding English children, and it is precisely in those tests which involve self-expression that the Binet Simon questions appear somewhat too difficult for the English child. In this connection it was interesting to hear the experiences of Dr. Boulanger, who visited the Leinster Road School in December with Dr. Shuttleworth. Dr. Boulanger has specialised in mental work in Brussels. He said that there the Binet Simon tests are more accurate for the Belgian French children than the Belgian Flemish, who, like the English, are lacking in powers of expression. The method of dealing with the Educable FeebleMinded child is satisfactory, but such is not the case with children who are either worse or a little better. When a child is found at the first examination to be non-educable— either idiot or imbecile—or after trial at a special school is found to be "not further educable," it has to be referred to the Middlesex County Council, as have various other groups of defectives, such as "not educable in a special school without detriment to the other children." At present the County has not the means of dealing with such children, and there is a number awaiting institutional treatment. The state of the large class of children certified after examination to be "Dull and Backward" is also 156 tory. At present there is no provision for these children, and nothing can be done beyond recommending for the younger ones an extra term or two in the Infants' Department, which is far from an ideal arrangement for the child concerned, the other children, or the teachers. Many of the children if suitably treated would regain the average standard. As it is, they either wade through their school life considerably behind children of their own age, or they get so far behind that they have ultimately to be certified as feeble-minded. The best method of treating the dull and backward child is by the provision of special classes under open-air conditions, with teachers specially trained and interested in the dull and backward child. The defect in many cases is in some cases more physical than mental, the removal of adenoids, cure of anæmia, good feeding, and regular rest often changing a delicate dull and backward child into a healthy normal one. Epileptic Children.—Cases of severe epilepsy are best dealt with by residential institutions. The Willesden Education Authority does not maintain any such institution, but in certain cases pays for the maintenance of children at epileptic colonies or other recognised institutions. Mild cases sometimes only have fits during the night, and such children can attend an ordinary elementary school. Great difficulty has been experienced in finding institutions which will take the badly mentally-deficient epileptic children. Such cases, however, now come under the care of the Middlesex County Council. The Physically Defective.—One school is maintained by the Authority for this class of children, viz.:— Effective No. No. awaiting Name of School. accommodation, on roll, admission, Furness Road, Physically Defective 69 75 46 157 The following Table, No. 85, shows the various conditions from which the above children are suffering:— Table No. 85. On Roll of Furness Road Physically Defective School. On Waiting List for Furness Road Physically Defective School or Open-air School. 1. Tuberculosis— Pulmonary — 1 Non-Pulmonary 24 7 2. Paralysis 25 15 3. Deformities not included in 1 and 2 12 2 4. Uncompensated Heart Disease 9 12 5. Other Conditions 5 9 Total 75 46 The Board of Education have continued their grant in respect of Furness Road Physically Defective School, on the understanding that a scheme for an open-air school will be proceeded with, and the Education Committee have under consideration the erection of a suitable school on the lines stated in Appendix K. One of 'the Assistant Medical Officers visits this school once a fortnight. Each child is examined by him once a year, and a record of the examination is kept. In addition, children referred by the Head Teacher are examined as occasion arises. Need for an Open-Air 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 Education Committee, which appears in Appendix I. of the Report for 1912. Of the 121 children on the roll and on the waiting list of Furness Road Special School there are 32 children suffering from Tuberculosis. 158 These children are in urgent need of an open-air school. Of the 7,358 children examined at the Routine Inspections during the year, 34 were found to be suffering from Tuberculosis. Assuming that the same proportion of children who were not examined suffered from Tuberculosis, and taking the total number of children attending the schools in Willesden at 23,655 (the number attending in June, 1914), the total number of school children suffering from Tuberculosis would be 110. These children also are in urgent need of an open-air school. Of the 7,358 children examined at the Routine Inspections, 83 were suspected to be suffering from Tuberculosis; that is to say, they were probably in an early stage of the disease, although the physical signs were not sufficiently developed to warrant a positive diagnosis. On the same basis of calculation, the estimated total number of these children attending the schools is 267. Besides these 409 children a considerable proportion of the children suffering from one or more of the following conditions: anaemia, mal-nutrition, enlarged glands, and adenoids, etc., should be in attendance at an open-air school. They form the class of children commonly spoken of as "Pretubercular," a term which indicates that, while there is no evidence of tubercular disease, the children are in a condition which has been observed to be very frequently followed by its development. Indeed, it is a question if the last two classes of children (Pretubercular and suspected Tubercular), although not so urgently in need of special provision as the definitely tubercular, are not the class for which in the long run the establishment of an open-air school is most desirable, since we have good reason to hope that by sending them to an open-air school we can prevent them from developing the disease which is hanging over them, and turn them out 159 robust citizens, whereas the most we can hope for in those definitely affected is the arrest of the disease, and a building up of the constitution which will enable them to resist the disease in the future—a highly desirable result, but still less satisfactory than complete prevention. , F. NON-NOTIFIABLE INFECTIOUS DISEASES AMONGST SCHOLARS. Non-Notifiable Infectious Diseases Amongst Scholars.— The following Table, No. 86, shows the notifications of Measles, Whooping Cough, Mumps, ChickenPox, and German Measles received from the schools during 1914:— 160 Table No. 86. SCHOOL. Measles. Whooping Cough. Mumps. Chicken-pox. German Measles. Acton Lane Mixed ... 1 17 ... ... Do. Infants 1 3 31 2 1 Bridge Road Mixed and Infants 25 15 3 28 1 Carlton Vale Girls ... 1 6 1 ... Do. Infants ... 39 35 17 ... Chamberlayne Wood Road Boys 1 ... 24 28 ... Do. Girls 1 1 31 13 ... Do. Infants ... 40 45 79 ... Christchurch Boys ... ... 2 3 ... Do. Girls ... 2 ... 1 1 Do. Infants ... 4 3 26 ... College Road Mixed and Infants 6 6 9 3 ... Disraeli Road Infants ... 8 13 7 ... Dudden Hill Boys ... 3 ... ... ... Do. Girls ... ... 1 1 ... Do. Infants 30 32 ... 14 ... Furness Road Senior Mixed ... ... 3 5 1 Do. Junior Mixed 1 ... 4 5 1 Do. Infants 4 9 3 24 ... Gladstone Park Mixed and Infants 51 ... ... 2 1 Gibbons Road Mixed 3 5 6 6 ... Do. Infants 45 17 22 34 ... Gordon Memorial Boys ... ... 3 1 ... Do. Girls ... 1 6 ... ... Do. Infants ... 8 33 18 ... Harlesden C. of. E. Boys ... ... 1 2 1 Do. Girls ... ... ... 3 ... Do. Infants 23 14 ... 15 ... Harlesden R.C. Mixed 2 ... 3 ... ... Do. Infants ... 6 2 12 1 Holy Trinity Boys ... ... ... ... ... Do. Girls ... 2 1 ... ... Do. Infants ... 2 ... 1 ... Keble Memorial Boys ... ... ... 2 ... Do. Girls 1 ... ... 1 1 Do. Infants 7 12 ... 31 ... Kensal Rise Boys ... ... 4 1 ... Do. Girls 2 ... 4 1 ... Do. Infants 2 49 65 36 1 Kilburn Park Girls ... 1 ... 1 ... Do. Infants ... 17 13 4 1 Leopold Road Boys ... ... 9 ... ... Do. Girls 2 3 12 5 ... Do. Infants 80 31 35 40 ... Lower Place Boys ... ... 9 2 ... Do. Girls ... ... 14 1 ... Carried forward 287 332 472 476 11 161 SCHOOL. Measles. Whooping Cough. Mumps. Chicken-pox German Me&sles. Brought forward 287 332 472 476 11 Mora Road Boys ... ... 2 3 ... Do. Girls ... ... 3 1 ... Do. Infants ... 43 4 52 ... Neasden National Mixed and Infants ... 2 ... 23 ... Oldfield Road Boys 2 ... ... 7 ... Do. Girls ... ... 2 1 ... Do. Infants 11 13 1 7 ... Percy Road Boys ... 1 1 1 ... Pound Lane Mixed ... 1 3 1 ... Do. Infants 25 22 2 11 1 Princess Frederica Boys ... ... 25 4 ... Do. Girls ... 1 31 2 ... Do. Infants ... 18 90 12 ... St. Andrew's Higher Grade ... ... ... ... ... Do. Boys ... ... ... ... ... Do. Girls ... ... ... ... ... Do. Infants ... ... ... 16 ... St. John's Boys ... ... 1 2 ... Do. Girls ... 1 1 2 ... Do. Infants 3 8 4 2 ... St. Mary's Boys ... ... ... ... ... Do. Girls ... ... ... 1 ... Do. Infants 1 5 ... 4 ... St. Mary's R.C. Mixed ... ... 2 ... ... Do. Infants 1 11 4 5 ... Salusbury Road Mixed ... 1 6 2 ... Do. Infants 1 28 26 56 1 Stonebridge Boys 1 1 2 1 ... Do. Girls ... 1 5 ... ... Do. Infants 16 35 21 9 ... Wesley Road Junior Mixed ... 3 9 1 ... Do. Infants 7 8 35 16 ... SPECIAL SCHOOLS. Furness Road, P. D. Boys ... ... ... 1 ... Do. Girls ... ... 3 ... ... Leinster Road, M.D. Boys ... ... 1 ... ... Do. Girls ... ... 1 1 ... Leopold Road, M.D. Boys ... ... ... ... ... Do. Girls ... ... ... ... ... Totals 355 535 757 720 13 All the above cases were visited and children were excluded from school in accordance with the Regulations of the Committee which appeared in the Annual Report for 1913. 162 G. PROVISION OF MEALS. Education (Provision of Meals) Acts, 1906 & 1914.— During the year the Education (Provision of Meals) Act, 1914, became law. This Act modifies the 1906 Act in the following particulars:— 1. It legalises the provision of meals during holidays, and on other days when the school is not open. 2. It repeals the limit imposed by Section 3 of the 1906 Act, under which the expenditure of the Local Education Authority on the provision of food was limited to the produce of a halfpenny rate. 3. It abolishes the necessity of obtaining the sanction of the Board of Education to expenditure out of the rates on the provision of food. The relationship of the working of the principal Act to the School Medical Service was dealt with in the Annual Reports for 1912 and 1913. 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 the School Medical Service. On June 25th, 1914, the Board of Education issued regulations under which grants in aid of the provision of meals for children attending public elementary schools will be given. Article 4 of these regulations states the points which the Board will take into account in distributing the grant. They are as follows:— (a) The extent to which the work is co-ordinated with that of the School Medical Service. (b) The care exercised in the selection of children for admission to the meals. (c) The sufficiency and suitability of the dietary. (d) The extent to which attention is given to the cational aspect of the work. 163 (e) The suitability of the accommodation and equipment and the efficiency of the service of the meals. (j) The completeness of the arrangements made for ascertaining and recording the effect of the meals on the physical and mental condition of the children. (g) The economical administration of the work. On the 18th November, 1914, a letter was received from the Board of Education making certain criticisms and suggestions with regard to the working of the Education (Provision of Meals) Acts, 1906 and 1914, in Willesden, and asking for the observations of the Authority thereon. This letter was referred to a Special Committee, and the Medical Officer was asked to report thereon. This report appears as Appendix J to the present report. The Board's letter and the Medical Officer's report were still under consideration at the end of the year. H. MOTHER CRAFT AND MOTHER CRAFT SCHOOLS. 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 1914 was 82, we do not merely mean that 82 out of every 1,000 babies born alive died before the first year, but that the same conditions 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. 164 In many places throughout the country 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 doll. The scope of the work varies somewhat in different schools, but the course includes 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 Willesden an excellent class is conducted by Miss Webster, the Head Teacher, at Chamberlayne Wood Road Girls' School, and recently a class on similar lines has been arranged at Mora Road Girls' School. Girls over fourteen 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. An extension of this work to yet other schools would 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 places, usually in connection with a "Babies' Welcome" or "Infant Consultations." The classes are made known in the district by the Health Visitor 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. 165 In Fulham, for instance, a Medical Officer attends twice a week. The actual lessons or lectures should be short and very practical. There is no school of this sort in Willesden, although there is certainly a need for it. With the further development of Infant Care work such classes would properly be arranged. Willesden Urban District Council. Hospital Report For the Year 1914. By A. ROMANES, M.A., M.B., Ch.B. Acting Medical Superintendent. 169 HOSPITAL ANNUAL REPORT FOR 1914 To the Chairman and Members of the Willesden Urban District Council. Gentlemen, I have the honour to submit the Twenty-third Annual Hospital Report. The number of patients admitted during last year was 979, the highest figure yet attained. In 1913 the admissions were 721. Of the 979 cases, 556 suffered from Scarlet Fever. In 1913 there were 385 256 „ „ Diphtheria. „ „ „ 204 10 „ „ Enteric Fever. „ „ „ 6 157 „ „ Other Diseases. „ „ „ 126 979 721 On December 31st, 1913, 112 patients remained in Hospital, so that the total number of cases under treatment during 1914 was 1,091, compared with 795 in 1913. All diseases have shared in the increase, though Scarlet Fever has been exceptionally prevalent. Diphtheria cases were most numerous during the last three months of the year, and in a large number was of a very virulent type, so that the mortality rate in that disease was considerably higher than in 1913, being 8.62 per cent, compared with 4.45 in the latter. The death rate in Scarlet Fever remains low. The average number of patients under treatment each day during the year was 102.17, compared with 69.8 in the previous year. For all diseases, the average stay of patients was 38.09 days, the stay in 1913 being 38.7. Of these, the Scarlet Fever patients were in Hospital for an average of 46.12 days each, Diphtheria patients 28.13 days, Enteric Fever patients 44.7, and those suffering from other diseases 18.95. 170 The accommodation in the Hospital (166 beds) proved sufficient even for the large numbers admitted, the increase having been more or less general throughout the year. "Separation" accommodation is, however, inadequate, considering that a fair proportion of the cases require special isolation for a time. It is probable that with twenty beds reserved for Tuberculosis patients accommodation for ordinary fever cases will be insufficient. Table No. 1. Scarlet Fever. Diphtheria. Enteric Fever. Other Diseases. No. of cases admitted, 1914 556 256 10 157 No. under treatment at 31/12/13 79 19 0 14 Total No. „ during 1914 635 275 10 171 No. discharged „ 1914 563 230 7 157 No died „ 1914 5 22 2 4 Mortality % „1914 .88 8.62 21.05 2.51 Remaining in Hospital 31/12/14 67 23 1 10 171 Table No. 2. Month. Scarlet Fever. Diphtheria. Enteric Fever. Other Diseases. Total Admissions. Total Deaths. Admissions. Deaths. Admissions. Deaths. Admissions. Deaths. Admissions. Deaths. January 44 - 21 4 - - 18 - 83 4 February 38 - 26 2 1 - 13 1 78 3 March 45 - 22 — 4 1 9 - 80 1 April 47 - 15 1 — - 10 - 72 1 May 60 - 10 1 3 - 5 - 78 1 June 35 - 15 — — - 13 - 63 0 July 40 - 23 2 — - 10 1 73 3 August 34 - 15 — — - 5 1 54 1 September 44 1 27 2 1 1 20 - 91 4 October 82 1 24 — — - 23 - 129 1 November 47 2 27 2 — - 17 - 91 4 December 40 1 31 8 1 - 15 1 87 10 Total 556 5 256 22 10 2 158 4 979 33 172 Table No. 3. SCARLET FEVER. age. males. FEMALES. TOTAL. Admissions. Deaths. Admissions. Deaths. Admissions. Deaths. Under 1 1 - - - 1 - 1 to 2 2 - 1 — 3 — 2 to 3 12 - 9 - 21 - 3 to 4 17 - 24 2 41 2 4 to 5 21 1 15 - 36 1 5 to 10 111 1 134 - 245 1 10 to 15 59 1 70 - 129 1 15 to 20 14 — 22 - 36 - 20 to 25 4 - 4 - 8 - 25 to 30 7 - 9 - 16 - 30 to 35 4 - 3 - 7 - 35 to 40 2 - 8 - 10 - 40 to — 1 - 2 - 3 — Total 255 3 301 2 556 5 173 Table No. 4. Chief Complications of Scarlet Fever. Number of Cases. Rheumatism 61 Albuminuria 42 Nephritis 10 Otorrhœa 49 Adenitis 80 „ Suppurative 7 Mastoiditis 1 Relapse 3 One patient underwent operation for acute appendicitis. Coexistent Diseases. Scarlet Fever and Diphtheria 13 Scarlet Fever and Chicken Pox 9 Scarlet Fever and Measles 2 174 Table No. 5. DIPHTHERIA. age. males. FEMALES. TOTAL. Admissions. Deaths. Admissions. Deaths. Admissions. D'ths. Under 1 yr ... ... ... ... ... ... 1 to 2 11 1 4 1 15 2 2 to 3 7 ... 10 5 17 5 3 to 4 8 ... 8 1 16 1 4 to 5 11 ... 15 3 26 3 5 to 10 50 7 51 3 101 10 10 to 15 16 1 24 ... 40 1 15 to 20 3 ... 6 ... 9 ... 20 to 25 4 ... 6 ... 10 ... 25 to 30 3 ... 6 ... 9 ... 30 to 35 1 ... 3 ... 4 ... 35 to 40 1 ... 4 ... 5 ... 40 to — 3 ... 1 ... 4 ... Total 118 9 138 13 256 22 Table No. 6. Complications of Diphtheria. No of Cases. Paralysis 14 Albuminuria 24 Otitis Media 4 Broncho-Pneumonia 4 34 cases suffered from laryngeal symptoms. Tracheotomy was performed on 18 patients, of whom 12 recovered. 175 Table No. 7. DIPHTHERIA. Day of Disease on Admission. Admissions. Deaths. Case Mortality. 1st 7 0 0 2nd 52 1 1.92 3rd 57 5 8.77 4th 45 4 8.88 5th 37 5 13.51 6th and over 58 7 12.08 176 Table No. 8. Showing cases wrongly diagnosed and diseases for which they were mistaken. Certified as suffering from Diagnosed in Hospital as suffering from Scarlet Fever. Diphtheria. Enteric Fever. 41 6 ... Tonsillitis ... 3 ... Broncho-Pneumonia 1 ... ... Lobar Pneumonia 23 1 ... No apparent disease 35 ... ... Erythema 2 ... ... Gastric Catarrh 5 ... ... Septic rash ... 1 ... Measles 2 ... ... Rotheln ... ... 2 Pleurisy 4 ... ... Dermatitis ... ... 3 Constipation 1 ... ... Herpes facialis 1 ... ... Otitis Media 1 ... ... Nephritis 1 ... ... Rhinitis 1 ... ... Adenitis 1 ... ... Urticaria 119 11 5 135 177 Coexistent Diseases. Twenty-two patients were, on admission, found to be suffering from more than one disease. The diseases were combined as follows:— Scarlet Fever and Diphtheria 11 Scarlet Fever and Chicken Pox 9 Scarlet Fever and Measles 1 Diphtheria and Rheumatic Fever 1 22 Other Diseases. Eighteen patients suffering from diseases not as a rule treated in this Hospital were admitted for special reasons. They were: Chicken Pox, 7; Meningitis, 2; Mastoid Disease, 1; Whooping Cough, 3; Erysipelas, 4; Puerperal Fever, 1; while four infants were accommodated whose mothers were admitted as patients. Bacteriological Department. The number of examinations (1,592) conducted in the Hospital laboratory was 438 in excess of the previous year's total. As the following Tables indicate, the specimens examined were chiefly swabs from throat and nose, and of sputum. Practitioners in the district continue to avail themselves of the facilities for examination, 143 more specimens being sent by them than in the previous year. 149 examinations were conducted for the Public Health Department, compared with 94 in 1913. 178 Table No. 9. A. Nature of Specimens examined. Positive Result. Negative Result. Total. 1. Throat and Nose Swabs for Diphtheria Bacilli, &c. 251 1086 1337 2. Sputum for Tubercle Bacilli 41 200 241 3. Blood for Widal Test 4 10 14 Total 296 1296 1592 B. Source of Specimens examined. 1. From Patients in the Hospital 722 2. From Practitioners 721 3. From Health Department 149 Total 1592 179 Sick Staff. A larger number of members of the staff were incapacitated for duty for more than twenty-four hours at a time last year than in 1913, the corresponding numbers being 54 in the former year and 45 in the latter. Nevertheless, the aggregate number of days they were ill was only 660, 383 fewer than in 1913, and the average period off duty was 12.2 days, as against 23.1 days per person in the previous year. Two nurses, two ward maids, and one porter contracted Scarlet Fever, and one nurse Diphtheria, all of whom made good recoveries. Hospital Buildings. No additions or alterations calling for comment were made during the year. I remain, Gentlemen, Your obedient servant, A. ROMANES. March 4th, 1915. Table No 1. 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 1914 AND PREVIOUS YEARS. Year. Population estimated to Middle of each Year. Births. Total Deaths Registered in the District. Transferable Deaths‡ 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 1 Year of Age. At all Ages. Number. † Rate. Number. * Rate per 1,000 Nett Births. Number. * Rate. (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) (13) 1909 150,145 ... 4,172 27.8 1,448 9.6 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 9.8 1911 156,572 3,863 4,001 25.6 1,618 10.3 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 10.02 1913 163,644 3,891 4,037 24.7 1,449 89 23 251 325 80 1,677 10.24 1914 166,634 3,971 4,115 24.7 1,501 9.0 32 283 337 82 1,752 10.51 181 APPENDIX A. LOCAL GOVERNMENT BOARD TABLES 182 Table 1a. VITAL STATISTICS OF THE WARDS—1914. 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. Number † Rate. Number. * Rate. Number * Rate per 1000 Nett Births. Number. * Rate. (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) (13) South Kilburn 14,745 428 444 30.11 176 11.93 1 30 38 85.58 205 13.90 Mid Kilburn 14,587 329 343 23.51 152 10.42 ... 28 25 72.88 180 12.33 North Kilburn 12,611 221 230 18.23 112 8.88 1 29 15 65.21 140 11.10 Brondesbury Park 9,834 147 149 15.15 76 7.72 7 24 8 53.69 93 9.45 Kensal Rise 14,169 391 396 27.94 105 7.41 2 24 20 50.50 127 8.96 Harlesden 17,114 388 393 22.96 145 8.47 1 21 28 71.24 165 9.64 Stonebridge 17,742 550 554 31.22 163 9.18 7 28 64 115.52 184 10.37 Roundwood 15,657 424 440 28.10 161 10.28 6 14 40 90.90 169 10.79 Church End 14,121 365 368 26.06 125 8.85 4 17 40 108.69 138 9.77 Willesden Green 16,742 413 423 25.26 122 7.28 ... 34 35 82.74 156 9.31 Cricklewood 19,312 313 315 16.31 164 8.49 3 34 24 76.19 195 10.09 183 NOTES TO TABLES 1. and la. Tables 1. 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 the 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 o/. the deaths under 1 year, included in the number given in Column 8, and by addition of the deaths under 1 year, included in the number given in Column 9. †Column 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 outside and subtracting the number occurring in the district but belonging to other districts. †Column 8.—This number is the number of deaths excluded from the returns of the local Registrar as transferable deaths defined below. †Column 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 (b) below. The following special cases arise as to Transferable Deaths:— (1) Persons dying in Institutions for the sick or infirm; such as hospitals, lunaitic asylums, workhouses, and nursing homes (but not almshouses) must be regarded as residents of the district in 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, if 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 154,344 Number of inhabited houses 21,525 At Census, 1911 Average number of persons per house 7.16 184 TABLE II.— CASES OF INFECTIOUS DISEASE NOTIFIED DURING THE YEAR 1914. Notifiable Disease. Number of Cases Notified. Total Cases Notified in each Ward. At all ages. 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. Under 1. 1 and under 5. 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-pox .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Cholera (C) Plague (P) .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Diphtheria (including Membranous croup) 303 2 74 168 25 28 6 .. 34 27 18 l6 28 40 28 24 31 27 30 258 Erysipelas 121 7 3 11 16 35 41 .. 18 10 8 9 8 11 17 8 8 12 6 19 Scarlet Fever 765 3 147 504 66 41 4 .. 99 76 49 56 51 94 88 64 50 52 86 682 Typhus Fever .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Enteric Fever 13 .. .. 4 2 6 1 .. 2 1 .. 1 2 .. .. 2 3 1 1 12 Relapsing Fever (R) Continued Fever (C) .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Puerperal Fever 12 .. .. .. 3 9 .. .. 1 2 2 .. 2 .. 1 1 .. 1 2 4 Cerebro-spinal Meningitis 6 2 1 2 1 .. .. .. .. 2 .. 1 .. .. 1 1 .. .. 1 4 Poliomyelitis .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Ophthalmia Neonatorum 29 29 .. .. .. .. .. .. 3 2 4 1 2 8 3 2 1 2 1 3 Pulmonary Tuberculosis 326 .. 3 38 58 156 64 7 55 30 25 11 21 26 24 30 35 32 37 .. Other forms of Tuberculosis 90 6 22 33 20 8 1 .. 10 13 7 2 8 6 12 9 11 5 7 .. Totals 1665 49 250 760 191 283 117 15 222 169 113 97 122 185 174 141 139 132 171 982 The Willesden Isolation Hospital, Neasden, with 166 beds is provided by the Willesden District Council for patients suffering with infectious diseases other than Small Pox. 185 TABLE III. CAUSES OF, AND AGES AT DEATH DURING THE YEAR 1914. Causes of Death. 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) 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) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) All causes Certified (c) 1750 337 72 71 62 62 240 401 505 350 Uncertified 2 .. 1 .. .. .. .. .. 1 .. Enteric Fever 3 .. .. .. 1 .. 1 1 .. 3 Small-pox .. .. .. .. .. .. .. .. .. .. Measles 8 2 6 .. .. .. .. .. .. .. Scarlet Fever 5 .. .. 2 2 1 .. .. .. 4 Whooping-cough 34 17 15 2 .. .. .. .. .. 5 Diphtheria and Croup 24 .. 2 13 9 .. .. .. .. 25 Influenza 16 1 .. .. .. 2 1 7 5 .. Erysipelas 7 2 .. .. .. .. 1 1 3 2 Phthisis (Pulmonary Tuberculosis) 147 1 .. 2 3 19 80 39 3 26 Tuberculous Meningitis 31 4 8 13 5 1 .. .. .. 7 Other tuberculous diseases 20 2 1 5 4 1 3 4 .. 2 Cancer, malignant disease 155 .. .. .. 1 .. 14 85 55 22 Rheumatic Fever 11 .. .. 1 4 2 1 3 .. .. Meningitis (d) 17 4 5 3 2 1 1 .. 1 2 Organic Heart Disease 169 .. .. .. 3 4 25 56 81 32 Bronchitis 116 20 3 2 .. 1 3 17 70 19 Pneumonia (all forms) 115 32 12 6 3 4 16 18 24 26 Other diseases of Respiratory organs 25 3 2 1 .. .. .. 9 10 4 Diarrhœa and Enteritis (e) 97 73 9 2 .. 2 3 3 5 14 Appendicitis and Typhlitis 7 .. .. .. 3 1 2 1 .. 2 Cirrhosis of Liver 23 .. .. .. 1 .. 4 12 6 4 Alcoholism 5 .. .. .. .. .. 2 2 1 1 Nephritis and Bright's Disease 62 .. .. 1 3 1 8 25 24 12 Puerperal Fever 7 .. .. .. .. 1 6 .. .. 3 Other Accidents and Diseases of Pregnancy and Parturition 6 .. .. .. .. 2 4 .. .. 2 Congenital Debility and Malformation, including Premature Birth 115 112 1 .. 1 .. 1 .. .. 12 Violent Deaths, excluding Suicide 55 14 3 9 5 8 5 3 8 11 Suicide 14 .. .. .. .. .. 8 6 .. 3 Other Defined Diseases 454 49 6 9 11 11 51 108 209 107 Diseases ill-defined or unknown 4 1 .. .. 1 .. .. 1 1 .. Totals 1752 337 73 71 62 62 240 401 506 350 SubEntries. included in above figures. Cerebro-spinal Meningitis 3 1 .. .. 1 1 .. .. .. 1 Poliomyelitis .. .. .. .. .. .. .. .. .. .. Pneumonia other than Boncho Pneumonia 66 7 2 1 3 3 15 15 20 20 186 NOTES TO TABLE III. The classification of Causes of Death are those of the "Short List" on page XXV. of the Manual of the International List of Causes of Death. (a) All "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 in 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 of 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 "Certified"; all other deaths are regarded as "Uncertified." (d) Exclusive of "Tuberculous Meningitis" but inclusive of Cerebro-Spinal Meningitis. (e) Includes deaths from Diarrhoea and Enteritis at all ages. 187 TABLE No. IIIa. 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 1750 205 180 140 93 127 165 184 169 137 155 195 Uncertified 2 .. .. .. .. .. .. .. .. 1 1 .. Enteric Fever 3 1 1 .. .. .. .. .. 1 .. .. .. Small Pox .. .. .. .. .. .. .. .. .. .. .. .. Measles 8 .. .. .. .. .. .. 1 4 3 .. .. Scarlet Fever 5 .. .. 1 .. 1 3 .. .. .. .. .. Whooping Cough 34 4 1 1 2 1 3 4 7 2 4 5 Diphtheria and Croup 24 4 .. 3 2 2 3 4 1 2 3 .. Influenza 16 1 3 2 1 2 3 .. 1 .. .. 3 Erysipelas 7 .. .. 1 1 .. 1 .. .. 1 1 2 Phthisis (Pulmonary Tuberculosis) 147 16 19 10 8 13 13 16 12 14 12 14 Tuberculous Meningitis 31 7 5 2 .. 1 1 2 2 5 4 2 Other Tuberculous Diseases 20 2 1 3 2 .. 1 3 5 1 .. 2 Cancer, malignant disease 155 17 22 17 15 14 11 9 11 12 7 20 Rheumatic Fever 11 1 .. .. 1 2 .. 1 1 1 1 3 Meningitis 17 2 3 .. 1 2 1 1 2 .. 2 3 Organic Heart Disease 169 22 15 13 12 12 18 15 14 14 11 23 Bronchitis 116 18 12 7 3 4 13 7 13 14 16 9 Pneumonia (all forms) 115 18 14 7 2 6 15 13 8 5 16 11 Other Diseases of Respiratory Organs 25 1 2 3 4 3 3 2 .. 6 .. 1 Diarrhoea and Enteritis 97 12 8 1 1 5 8 25 13 8 8 8 Appendicitis and Typhlitis 7 .. .. 2 .. .. .. 2 2 .. .. 1 Cirrhosis of Liver 23 4 .. 4 .. 3 .. 1 3 2 4 2 Alcoholism 5 2 .. 1 .. .. .. .. .. .. .. 2 Nephritis and Bright's Disease 62 10 6 9 4 2 9 5 3 2 5 7 Puerperal Fever 7 .. .. 2 .. 2 .. 1 .. .. .. 2 Other Accidents and Diseases of nancy and Parturition 6 .. .. .. 1 1 .. 3 .. 1 .. .. Congenital Debility and Malformation, including Premature Birth 115 14 4 11 4 7 8 21 12 13 14 7 Violent Deaths, excluding Suicide 55 9 7 1 2 2 6 4 10 7 2 5 Suicide 14 2 .. 1 .. .. 1 .. 6 1 .. 3 Other Defined Diseases 454 38 56 38 27 42 43 44 38 24 45 59 Diseases ill-defined or unknown 4 .. 1 .. .. .. 1 .. .. .. 1 1 Totals 1752 205 180 140 93 127 165 184 169 138 156 195 SubEntries, included in above figures Cerebro-spinal Meningitis 3 .. 2 .. .. .. .. .. .. .. .. 1 Poliomyelitis .. .. .. .. .. .. .. .. .. .. .. .. Pneumonia other than Broncho-Pneumonia 66 8 8 6 1 4 11 8 2 3 9 6 188 TABLE IIIB.— RATES PER 1,000 POPULATION, YEAR 1914. 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 0.0180 0.0678 0.0685 .. .. .. .. .. 0.0638 .. .. .. Small Pox .. .. .. .. .. .. .. .. .. .. .. .. Measles 0.0480 .. .. .. .. .. .. 0.0563 0.2554 0.2124 .. .. Scarlet Fever 0.0300 .. .. 0.0792 .. 0.0705 0.1752 .. .. .. .. .. Whooping Cough 0.2040 0.2712 0.0685 0.0792 0.2033 0.0705 0.1752 0.2254 0.4470 0.1416 0.2389 0.2589 Diphtheria and Croup 0.1440 0.2712 .. 0.2378 0.2033 0.1411 0.1752 0.2254 0.0638 0.1416 0.1791 .. Influenza 0.0960 0.0678 0.2056 0.1585 0.1016 0.1411 0.1752 .. 0.0638 .. .. 0.1553 Erysipelas 0.0420 .. .. 0.0792 0.1016 .. 0.0584 .. .. 0.0708 0.0597 0.1035 Phthisis (Pulmonary Tuberculosis) 0.8821 1.0851 1.3025 0.7929 0.8135 0.9174 0.7595 0.9018 0.7664 0.9914 0.7167 0.7249 Tuberculous Meningitis 0.1860 0.4747 0.3427 0.1585 .. 0.0705 0.0584 0.1127 0.1277 0.3540 0.2389 0.1035 Other Tuberculous Diseases 0.1200 0.1356 0.0685 0.2378 0.2033 .. 0.0584 0.1690 0.3193 0.0708 .. 0.1035 Cancer, Malignant Disease 0.9301 1.1529 1.5081 1.3480 0.5253 0.9880 0.6426 0.5072 0.7025 0.8497 0.4181 1.0356 Rheumatic Fever 0.0660 0.0678 .. .. 0.1010 0.1411 .. 0.0563 0.0638 0.0708 0.0597 0.1553 Meningitis 0.1020 0.1356 0.2056 .. 0.1016 0.1411 0.0584 0.0563 0.1277 .. 0.1194 0.1553 Organic Heart Disease 10.141 1.4920 1.0283 1.0308 1.2202 0.8469 1.0516 0.8454 0.8941 0.9914 0.6570 1.1909 Bronchitis 0.6961 1.2207 0.8226 0.5550 0.3050 0.2823 0.7595 0.3945 0.8302 0.9914 0.9556 0.4660 Pneumonia (all forms) 0.6901 1.2207 0.9597 0.5550 0.2033 0.4234 0.8763 0.7327 0.5109 0.3540 0.9556 0.5695 Other Diseases of Respiratory Organs 0.1500 0.0678 0.1371 0.2378 0.4067 0.2117 0.1752 0.1127 .. 0.4248 .. 0.0517 Diarrhoea and Enteritis 0.5821 0.8138 0.5484 0.0792 0.1016 0.3528 0.4673 1.4090 0.8302 0.5665 0.4778 0.4142 Appendicitis and Typhlitis 0.0420 .. .. 0.1585 .. .. .. 0.1127 0.1277 .. .. 0.0517 Cirrhosis of Liver 0.1380 0.2712 .. 0.3171 .. 0.2117 .. 0.0563 0.1016 0.1415 0.2389 0.1035 Alchoholism 0.0300 0.1356 .. 0.0792 .. .. .. .. .. .. .. 0.1035 Nephritis and Bright's Disease 0.3720 0.6781 0.4113 0.7136 0.4067 0.1411 0.5258 0.2818 0.1916 0.1415 0.2986 0.3624 Puerperal Fever 0.0420 .. .. 0.1585 .. 0.1411 .. 0.0563 .. .. .. 0.1035 Other Accidents and Diseases of Pregnancy and Parturition 0.0360 .. .. .. 0.1016 0.0705 .. 0.1690 .. 0.0708 .. .. Congenital Debility and Malformation, including Premature Birth 0.6901 0.9494 0.2742 0.8722 0.4067 0.4940 0.4673 1.1836 0.7664 0.9206 0.8362 0.3624 Violent Deaths, excluding Suicide 0.3300 0.6103 0.4798 0.0792 0.2033 0.1411 0.3505 0.2254 0.6386 0.4957 0.1194 0.2589 Suicide 0.0840 0.1356 .. 0.0792 .. .. 0.0584 .. 0.3832 0.0708 .. 0.1553 Other Defined Diseases 2.7245 2.5771 3.8390 3.0132 2.7455 2.9642 2.5122 2.4799 2.4270 1.6995 2.6878 3.0550 Diseases ill-defined or unknown 0.0240 .. 0.0685 .. .. .. 0.0584 .. .. .. 0.0597 0.0517 All Causes 10.5140 13.9030 12.3397 11.1014 9.4569 8.9632 9.6401 10.3708 10.7938 9.7726 9.3178 10.0973 189 Table IIIc. DEATHS OF WILLESDEN RESIDENTS DURING THE YEAR 1914. The Detailed International List of Causes of Death as adapted for use in England and Wales. CAUSE OF DEATH. All Ages. 0 to 1 1 to 5 5 to 10 10 to 15 15 to 20 20 to 25 25 to 35 35 to 45 45 to 55 55 to 65 65 to 75 75 to 85 85 & Up. (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) (13) (14) (15) 1.—General Diseases,. Enteric Fever 3 ... ... ... 1 ... ... 1 ... 1 ... ... ... ... Typhus ... ... ... ... ... ... ... ... ... ... ... ... ... ... Relapsing Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... Malaria ... ... ... ... ... ... ... ... ... ... ... ... ... ... Small Pox ... ... ... ... ... ... ... ... ... ... ... ... ... ... Measles 8 2 6 ... ... ... ... ... ... ... ... ... ... ... Scarlet Fever 5 ... 2 1 1 1 ... ... ... ... ... ... ... ... Whooping Cough 34 17 17 ... ... ... ... ... ... ... ... ... ... ... Diphtheria 24 ... 15 8 1 ... ... ... ... ... ... ... ... ... Influenza 16 1 ... ... ... 1 1 ... 1 4 3 4 ... 1 Miliary Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... Asiatic Cholera ... ... ... ... ... ... ... ... ... ... ... ... ... ... Cholera Nostras ... ... ... ... ... ... ... ... ... ... ... ... ... ... Dysentery ... ... ... ... ... ... ... ... ... ... ... ... ... ... Plague ... ... ... ... ... ... ... ... ... ... ... ... ... ... Yellow Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... Leprosy ... ... ... ... ... ... ... ... ... ... ... ... ... ... Erysipelas 7 2 ... ... ... ... ... ... 1 1 ... 1 2 ... Other Epidemic Diseases 1 1 ... ... ... ... ... ... ... ... ... ... ... ... Pyæmia ... ... ... ... ... ... ... ... ... ... ... ... ... ... Septicæmia 4 1 1 ... ... ... ... 1 1 ... ... ... ... ... Vaccinia ... ... ... ... ... ... ... ... ... ... ... ... ... ... Glanders ... ... ... ... ... ... ... ... ... ... ... ... ... ... Anthrax (Splenic Fever) ... ... ... ... ... ... ... ... ... ... ... ... ... ... Rabies ... ... ... ... ... ... ... ... ... ... ... ... ... ... 190 Table IIIc.— DEATHS OF WILLESDEN RESIDENTS—continued. CAUSE OF DEATH. All Ages. 0 to 1 1 to 5 5 to 10 10 to 15 15 to 25 20 to 25 25 to 35 35 to 45 45 to 55 56 to 65 65 to 75 75 to 85 85 & Up. (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) (13) (14) (15) Tetanus 1 1 ... ... ... ... ... ... ... ... ... ... ... ... Mycoses: Actinomycosis 1 ... ... ... ... ... ... ... ... ... ... 1 ... ... Pellagra 1 ... ... ... ... ... ... ... 1 ... ... ... ... ... Beri-Beri ... ... ... ... ... ... ... ... ... ... ... ... ... ... Pulmonary Tuberculosis (not acute) 101 1 1 1 ... 5 7 29 31 15 11 ... ... ... Phthisis (not acute and not defined as Tuberculosis) 40 ... ... ... ... 6 1 6 12 8 4 2 1 ... Acute Phthisis 3 ... ... ... 1 ... ... 2 ... ... ... ... ... ... Acute Miliary Tuberculosis 3 ... 1 1 ... ... ... ... ... 1 ... ... ... ... Tuberculous Meningitis 31 4 21 2 3 1 ... ... ... ... ... ... ... ... Tabes Mesenterica ... ... ... ... ... ... ... ... ... ... ... ... ... ... Other Peritoneal and Intestinal Tubercle 6 1 1 1 ... 1 ... 1 ... 1 ... ... ... ... Tuberculosis of Spinal Column 3 ... 1 1 ... ... ... ... ... ... 1 ... ... ... Tuberculosis of Joints 1 ... ... ... 1 ... ... ... ... ... ... ... ... ... Tuberculosis of other organs 5 ... ... ... 1 ... ... 1 1 2 ... ... ... ... Disseminated Tuberculosis 5 1 4 ... ... ... ... ... ... ... ... ... ... ... Rickets, Softening of Bones 1 1 ... ... ... ... ... ... ... ... ... ... ... ... Syphilis 6 2 3 ... ... ... ... ... 1 ... ... ... ... ... Other Venereal Diseases 1 ... ... ... ... ... ... ... ... ... 1 ... ... ... Cancer of Buccal Cavity 9 ... ... ... ... ... ... ... ... 4 1 4 ... ... Cancer of the Stomach, Liver, &c. 48 ... ... ... ... ... ... ... 3 8 17 10 9 1 Cancer of Peritoneum, Intestines and Rectum 30 ... ... ... ... ... ... ... 3 8 10 5 4 ... Cancer of the Female Genital Organs 22 ... ... ... ... ... ... 1 2 9 6 4 ... ... Cancer of the Breast 13 ... ... ... ... ... ... ... 1 4 3 5 ... ... Cancer of the Skin ... ... ... ... ... ... ... ... ... ... ... ... ... ... Cancer of other or unspecified organs 33 ... ... ... 1 ... ... 2 2 9 6 7 6 ... Other Tumours (situation undefined 3 2 ... ... ... ... ... ... ... 1 ... ... ... ... Rheumatic Fever 11 ... 1 4 ... 2 ... ... 1 1 2 ... ... ... Chronic Rheumatism ... ... ... ... ... ... ... ... ... ... ... ... ... ... Osteo-Arthritis 4 ... ... ... ... ... ... ... ... ... 3 ... 1 ... 191 Table IIIc.— DEATHS OF WILLESDEN RESIDENTS—continued. Gout 2 ... ... ... ... ... ... ... ... 1 ... ... 1 ... Scurvy ... ... ... ... ... ... ... ... ... ... ... ... ... ... Diabetes 20 ... ... ... ... ... ... ... 2 2 6 6 4 ... Exophthalmic Goitre 1 ... ... ... ... ... ... ... 1 ... ... ... ... ... Addisons Disease 1 ... ... ... ... ... ... ... 1 ... ... ... ... ... Leucocythoemia (Leuchœmia) ... ... ... ... ... ... ... ... ... ... ... ... ... ... Lymphadenoma 2 ... ... ... ... ... ... 2 ... ... ... ... ... ... Anæmia, Chlorosis 6 ... 1 ... ... ... ... 1 ... ... 1 3 ... ... Other General Diseases 2 1 ... 1 ... ... ... ... ... ... ... ... ... ... Alcoholism (Acute or Chronic) 5 ... ... ... ... ... ... ... 2 1 1 1 ... ... Chronic Lead Poisoning ... ... ... ... ... ... ... ... ... ... ... ... ... ... Other Chronic Occupational Poisoning ... ... ... ... ... ... ... ... ... ... ... ... ... ... Other Chronic Poisoning ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2.—Diseases of the Nervous System and of the Organs of Special Sense. Encephalitis 1 ... ... ... ... ... ... ... ... ... 1 ... ... ... Cerebro-spinal Fever 2 1 ... ... ... 1 ... ... ... ... ... ... ... ... Posterior Basal Meningitis 3 1 1 ... ... ... ... ... ... ... ... ... ... ... Meningitis, other forms 12 2 7 1 ... ... ... ... 1 ... ... 1 ... ... Locomotor Ataxy 7 ... ... ... ... ... ... ... ... ... 3 3 1 ... Other Diseases of the Spinal Cord 7 ... ... ... ... ... ... ... ... 1 1 3 1 1 Apoplexy 11 ... ... ... ... ... ... ... ... 1 1 6 2 1 Serous Apoplexy and Oedema of Brain ... ... ... ... ... ... ... ... ... ... ... ... ... ... Cerebral Congestion ... ... ... ... ... ... ... ... ... ... ... ... ... ... Cerebral Atheroma ... ... ... ... ... ... ... ... ... ... ... ... ... ... Cerebral Hæmorrhage 73 ... ... ... 1 ... 1 1 1 11 15 22 17 4 Softening of Brain 3 ... ... ... ... ... ... ... ... ... ... 2 ... 1 Hemiplegia 6 ... ... ... ... ... ... ... ... 1 1 2 2 ... Paraplegia 1 ... ... ... ... ... ... ... ... 1 ... ... ... ... Other Forms of Paralysis 2 ... ... ... ... ... ... 1 ... ... ... ... 1 ... General Paralysis of the Insane 15 ... ... ... ... ... ... 2 5 4 4 ... ... ... Other Forms of Mental Alienation 1 ... ... ... ... ... ... ... ... ... 1 ... ... ... 192 Table IIIc.— DEATHS OF WILLESDEN RESIDENTS—continued. CAUSE OF DEATH. All Ages. 0 to 1 1 to 5 5 to 10 10 to 15 15 to 20 20 to 25 25 to 35 35 to 45 45 to 55 55 to 65 65 to 75 75 to 85 85 & up. (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) (13) (14) (15) Epilepsy 8 ... ... ... ... 2 1 1 2 ... 1 1 ... ... Convulsions (non puerperal; 5 years and over) ... ... ... ... ... ... ... ... ... ... ... ... ... ... Infantile Convulsions under 5, with teething ... ... ... ... ... ... ... ... ... ... ... ... ... ... Other Infantile Convulsions under 5 13 10 3 ... ... ... ... ... ... ... ... ... ... ... Chorea ... ... ... ... ... ... ... ... ... ... ... ... ... ... Hysteria, Neuralgia, Neuritis 2 ... ... ... ... ... ... ... ... ... 2 ... ... ... Idiocy, Imbecility ... ... ... ... ... ... ... ... ... ... ... ... ... ... Cretinism ... ... ... ... ... ... ... ... ... ... ... ... ... ... Cerebral Tumour 5 ... ... ... ... ... ... 2 2 ... 1 ... ... ... Other Diseases of the Nervous System 3 ... 1 ... ... ... ... ... 1 ... 1 ... ... ... Diseases of the Eyes and Annexa ... ... ... ... ... ... ... ... ... ... ... ... ... ... Mastoid Disease 1 ... ... ... ... ... 1 ... ... ... ... ... ... ... Other Diseases of the Ears 6 1 2 1 1 ... ... 1 ... ... ... ... ... ... 3.—Diseases of the Circulatory System. Pericarditis 3 ... ... ... 1 ... ... ... ... ... 1 ... 1 ... Acute Myocarditis ... ... ... ... ... ... ... ... ... ... ... ... ... ... Infective Endocarditis 3 ... ... ... ... 1 1 ... 1 ... ... ... ... ... Other Acute Endocarditis 1 ... ... ... ... ... 1 ... ... ... ... ... ... ... Valvular Disease 53 ... ... 2 ... 2 2 4 5 6 9 16 5 2 Fatty Degeneration of Heart 14 ... ... ... ... ... ... ... 1 2 3 7 1 ... Other Organic Disease of the Heart 102 ... ... ... 1 ... ... 5 10 15 21 30 17 3 Angina Pectoris 4 ... ... ... ... ... ... ... ... ... 3 1 ... ... Aneurysm 7 ... ... ... 1 ... ... ... 1 2 2 1 ... ... Arterial Sclerosis 15 ... ... ... ... ... ... ... ... 3 ... 5 7 ... Other Diseases of Arteries ... ... ... ... ... ... ... ... ... ... ... ... ... ... Cerebral Embolism and Thrombosis 11 ... ... ... ... ... ... 1 3 2 2 2 1 ... Other Embolism and Thrombosis 1 ... ... ... ... ... ... ... ... ... 1 ... ... ... 193 Table IIIc.— DEATHS OF WILLESDEN RESIDENTS—continued. Diseases of the Veins (Varices, Hemorrhoids, Phlebitis, &c.) 3 ... ... ... ... ... ... ... ... ... 1 1 1 ... Status Lymphaticus ... ... ... ... ... ... ... ... ... ... ... ... ... ... Other Diseases of the Lymphatic System ... ... ... ... ... ... ... ... ... ... ... ... ... ... Hæmorrhage; other Diseases of the Circulating System 1 ... ... ... ... ... ... ... ... ... ... ... 1 ... 4. —Diseases of the Respiratory System. Diseases of the Nasal Fossæ 1 ... ... ... ... ... ... ... ... ... ... 1 ... ... Diseases of the Larynx 1 1 ... ... ... ... ... ... ... ... ... ... ... ... Diseases of the Thyroid Body ... ... ... ... ... ... ... ... ... ... ... ... ... ... Bronchitis 116 20 5 ... ... ... 1 1 2 4 13 30 30 10 Broncho-Pneumonia 49 25 15 ... ... 1 ... ... 1 3 ... 3 1 ... Lobar Pneumonia 17 1 ... ... ... ... 2 5 2 1 3 2 1 ... Pneumonia (type not stated) 49 6 3 2 1 1 ... 2 6 5 6 11 6 ... Empyema 2 ... 2 ... ... ... ... ... ... ... ... ... ... ... Other Pleurisy 1 ... ... ... ... ... ... ... ... ... ... ... 1 ... Pulmonary Apoplexy and Infarction ... ... ... ... ... ... ... ... ... ... ... ... ... ... Pulmonary Oedema and Congestion 7 2 ... ... ... ... ... ... ... ... 1 1 3 ... Hypostatic Pneumonia ... ... ... ... ... ... ... ... ... ... ... ... ... ... Collapse of Lung (3 months and over) ... ... ... ... ... ... ... ... ... ... ... ... ... ... Gangrene of the Lung 2 ... 1 ... ... ... ... ... ... ... 1 ... ... ... Asthma 9 ... ... ... ... ... ... ... ... 4 1 3 1 ... Pulmonary Emphysema ... ... ... ... ... ... ... ... ... ... ... ... ... ... Fibroid Disease of Lung 1 ... ... ... ... ... ... ... ... 1 ... ... ... ... Other Disease of the Respiratory System 1 ... ... ... ... ... ... ... ... 1 ... ... ... ... 5.—Diseases of the Digestive System. Diseases of the Teeth and Gums 2 1 ... ... ... ... ... 1 ... ... ... ... ... ... Other Diseases of the Mouth and Annexa 1 1 ... ... ... ... ... ... ... ... ... ... ... ... Diseases of Pharynx, Tonsillitis 6 ... 1 2 2 ... ... ... 1 ... ... ... ... ... Diseases of Oesophagus ... ... ... ... ... ... ... ... ... ... ... ... ... ... Perforating Ulcer of Stomach 7 ... ... ... ... ... ... ... 3 2 1 ... 1 ... Inflammation of Stomach 16 7 3 ... ... ... ... 2 1 1 1 ... ... 1 194 Table IIIc.— DEATHS OF WILLESDEN RESIDENTS—continued. CAUSE OF DEATH. All Ages. 0 to 1 1 to 5 5 to 10 10 to 15 15 to 20 20 to 25 25 to 35 35 to 45 45 to 55 55 to 65 65 to 75 75 to 85 85 & Up. (1) (2) (3) (4) (5) (6) 7) (8) (9) (10) (11) (12) (13) (14) (15) Other Diseases of the Stomach 1 ... ... ... ... ... ... ... ... ... ... ... 1 ... Infective Enteritis 46 41 5 ... ... ... ... ... ... ... ... ... ... ... Diarrhœa, not returned as infective 22 15 3 ... ... ... ... ... ... 1 1 1 1 ... Enteritis, not returned as infective 11 5 3 ... ... ... 1 ... 1 ... ... ... 1 ... Gastro-Enteritis, not returned as infective 13 12 ... ... ... ... ... ... 1 ... ... ... ... ... Dyspepsia, under 2 years ... ... ... ... ... ... ... ... ... ... ... ... ... ... Colic ... ... ... ... ... ... ... ... ... ... ... ... ... ... Ulceration of Intestines 2 ... ... ... ... ... ... 1 ... ... ... ... 1 ... Duodenal Ulcer 3 ... ... ... ... ... 1 ... ... ... 1 ... 1 ... Ankylostomiasis ... ... ... ... ... ... ... ... ... ... ... ... ... ... Other Intestinal Parasites ... ... ... ... ... ... ... ... ... ... ... ... ... ... Appendicitis 7 ... ... 1 2 1 ... 1 1 1 ... ... ... ... Hernia 4 ... ... ... ... ... ... ... ... ... 1 1 2 ... Intestinal Obstruction 10 3 ... ... ... 1 ... ... ... ... 4 2 ... ... Other Diseases of the Intestines 2 ... ... ... ... ... ... ... 1 ... 1 ... ... ... Acute Yellow Atrophy of Liver ... ... ... ... ... ... ... ... ... ... ... ... ... ... Hydatid of Liver 1 ... ... ... ... ... ... 1 ... ... ... ... ... ... Cirrhosis of Liver (not returned as alcoholic) 20 ... ... ... 1 ... ... ... 4 6 4 5 ... ... Cirrhosis of Liver (returned as alcoholic) 2 ... ... ... ... ... ... ... ... ... 1 1 ... ... Diseases formerly classed to "Other Diseases of Liver and Gall Bladder" 1 ... ... ... ... ... ... ... ... ... 1 ... ... ... Biliary Calculi 2 ... ... ... ... ... ... ... ... ... 2 ... ... ... Other Diseases of the Liver 2 ... ... ... ... ... ... ... ... ... 2 ... ... ... Diseases of the Spleen ... ... ... ... ... ... ... ... ... ... ... ... ... ... Peritonitis (cause unstated) 6 1 ... 1 ... 1 ... ... 2 ... 1 ... ... ... Other Diseases of the Digestive System ... ... ... ... ... ... ... ... ... ... ... ... ... ... 195 Table IIIc.— DEATHS OF WILLESDEN RESIDENTS—continued. 6. —Non- Venereal Diseases of the Genito- Urinary System and Annexa. Acute Nephritis 6 ... 1 1 ... ... ... 1 ... 1 ... 2 ... ... Brights Diease as in 1901 list 41 ... ... ... 1 ... ... 1 2 5 16 11 4 1 Nephritis (unqualified), 10 years and over, uraemia 15 ... ... ... 1 1 ... 2 2 2 1 2 3 1 Chyluria ... ... ... ... ... ... ... ... ... ... ... ... ... ... Other Diseases of Kidney and Annexa 2 ... ... ... ... ... ... ... ... 1 1 ... ... ... Calculi of the Urinary Passages 1 ... ... ... ... ... ... ... ... ... ... 1 ... ... Diseases of the Bladder 3 ... ... ... ... ... ... ... ... ... 1 ... 1 1 Diseases of the Urethra, Urinary Abscess, &c. 2 ... ... ... ... ... ... ... ... 2 ... ... ... ... Diseases of the Prostrate 2 ... ... ... ... ... ... ... ... ... ... 2 ... ... Non-venereal Diseases of Male Genital Organs ... ... ... ... ... ... ... ... ... ... ... ... ... ... Uterine Hæmorrhage (non-puerperal) ... ... ... ... ... ... ... ... ... ... ... ... ... ... Uterine Tumour (non-cancerous) 1 ... ... ... ... ... ... ... 1 ... ... ... ... ... Other Diseases of the Uterus ... ... ... ... ... ... ... ... ... ... ... ... ... ... Ovarian Cyst, Tumour (non-cancerous) 1 ... ... ... ... ... ... ... ... ... ... ... 1 ... Other Diseases of the Female Genital Organs 1 ... ... ... ... ... ... 1 ... ... ... ... ... ... Non-puerperal Diseases of the Breast (non-cancerous) ... ... ... ... ... ... ... ... ... ... ... ... ... ... 7. — The Puerperal State. Abortion ... ... ... ... ... ... ... ... ... ... ... ... ... ... Hæmorrhage of Pregnancy ... ... ... ... ... ... ... ... ... ... ... ... ... ... Uncontrollable Vomiting 1 ... ... ... ... ... ... 1 ... ... ... ... ... ... Ectopic Gestation ... ... ... ... ... ... ... ... ... ... ... ... ... ... Other Accidents of Pregnancy ... ... ... ... ... ... ... ... ... ... ... ... ... ... Puerperal Hæmorrhage 2 ... ... ... ... ... 1 ... 1 ... ... ... ... ... Other Accidents of Childbirth 1 ... ... ... ... ... ... 1 ... ... ... ... ... ... Puerperal Fever 7 ... ... ... ... 1 ... 4 2 ... ... ... ... ... Puerperal Albuminuria and Convulsions 1 ... ... ... ... ... ... 1 ... ... ... ... ... ... Puerperal Phlegmasia Alba Dolens and Phlebitis 1 ... ... ... ... ... 1 ... ... ... ... ... ... ... Puerperal Embolism and Sudden Death ... ... ... ... ... ... ... ... ... ... ... ... ... ... Puerperal Insanity ... ... ... ... ... ... ... ... ... ... ... ... ... ... Puerperal Diseases of the Breast ... ... ... ... ... ... ... ... ... ... ... ... ... ... 196 Table IIIc.— DEATHS OF WILLESDEN RESIDENTS—continued. CAUSE OF DEATH. All Ages. 0 to 1 1 to 5 5 to 10 10 to 15 15 to 20 20 to 25 25 to 35 35 to 45 45 to 55 55 to 65 65 to 75 75 to 85 85 & Up. (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) (13) (14) (15) 8.—Diseases of the Skin and of the Cellular Tissue. Senile Gangrene 4 ... ... ... ... ... ... ... ... ... ... 2 2 ... Gangrene, other types 2 ... ... ... ... ... ... ... ... 1 1 ... ... ... Carbuncle, Boil 2 ... ... ... ... ... 1 ... 1 ... ... ... ... ... Phlegmon, Acute Abscess 1 1 ... ... ... ... ... ... ... ... ... ... ... ... Ulcer, Bedsore 1 ... ... ... ... ... ... ... ... 1 ... ... ... ... Eczema ... ... ... ... ... ... ... ... ... ... ... ... ... ... Pemphigus ... ... ... ... ... ... ... ... ... ... ... ... ... ... Other Diseases of the Integumentary System 1 1 ... ... ... ... ... ... ... ... ... ... ... ... 9.—Diseases of the Bones and of the Organs of Locomotion. Diseases of the Bones ... ... ... ... ... ... ... ... ... ... ... ... ... ... Diseases of the Joints 1 ... ... ... ... ... ... ... ... ... ... 1 ... ... Amputations ... ... ... ... ... ... ... ... ... ... ... ... ... ... Other Diseases of the Locomotor System ... ... ... ... ... ... ... ... ... ... ... ... ... ... 10. —Malformations. Congenital Hydrocephalus ... ... ... ... ... ... ... ... ... ... ... ... ... ... Phimosis ... ... ... ... ... ... ... ... ... ... ... ... ... ... Congenital Malformation of Heart 11 8 1 ... 1 ... ... ... 1 ... ... ... ... ... Other Congenital Malformations 6 6 ... ... ... ... ... ... ... ... ... ... ... ... 11.-Diseases of Early Infancy. Pemature Birth 58 58 ... ... ... ... ... ... ... ... ... ... ... ... Infantile Atrophy, Debility and Marasmus 37 37 ... ... ... ... ... ... ... ... ... ... ... ... 197 Table IIIc.—DEATHS OF WILLESDEN RESIDENTS—continued. Icterus Neonatorum 1 1 ... ... ... ... ... ... ... ... ... ... ... ... Sclerema and Oedema Neonatorum ... ... ... ... ... ... ... ... ... ... ... ... ... ... Want of Breast Milk 2 2 ... ... ... ... ... ... ... ... ... ... ... ... Diseases of Umbilicus, &c. ... ... ... ... ... ... ... ... ... ... ... ... ... ... Atelectasis 9 9 ... ... ... ... ... ... ... ... ... ... ... ... Injuries at Birth 2 2 ... ... ... ... ... ... ... ... ... ... ... ... Cyanosis Neonatorum ... ... ... ... ... ... ... ... ... ... ... ... ... ... Lack of Care 3 3 ... ... ... ... ... ... ... ... ... ... ... ... 12.—Old Age. Old Age 84 ... ... ... ... ... ... ... ... ... 1 20 46 17 13.—Affections Produced by External Causes. Suicide by Poison 3 ... ... ... ... ... ... ... ... 3 ... ... ... ... Suicide by Asphyxia 1 ... ... ... ... ... ... 1 ... ... ... ... ... ... Suicide by Hanging or Strangulation 2 ... ... ... ... ... ... 1 ... ... 1 ... ... ... Suicide by Drowning 3 ... ... ... ... ... ... ... 2 1 ... ... ... ... Suicide by Firearms 1 ... ... ... ... ... ... ... 1 ... ... ... ... ... Suicide by Cutting or Piercing Instruments 2 ... ... ... ... ... ... ... 1 ... 1 ... ... ... Suicide by Jumping from High Place ... ... ... ... ... ... ... ... ... ... ... ... ... ... Suicide by Crushing 2 ... ... ... ... ... ... ... 2 ... ... ... ... ... Other Suicides ... ... ... ... ... ... ... ... ... ... ... ... ... ... Poisoning by Food ... ... ... ... ... ... ... ... ... ... ... ... ... ... Other Acute Poisonings ... ... ... ... ... ... ... ... ... ... ... ... ... ... Conflagration ... ... ... ... ... ... ... ... ... ... ... ... ... ... Burns (conflagration excepted) 9 ... 6 1 ... 1 ... ... ... ... ... ... 1 ... Absorption of Deleterious Gases (conflagration excepted) 12 12 ... ... ... ... ... ... ... ... ... ... ... ... Accidental Drowning 3 ... ... 1 ... 1 ... ... ... ... ... ... 1 ... Injury by Firearms ... ... ... ... ... ... ... ... ... ... ... ... ... ... Injury by Cutting or Piercing Instruments ... ... ... ... ... ... ... ... ... ... ... ... ... ... Injury by Fall 9 ... 2 1 ... ... ... 1 1 1 1 1 1 ... Injury in Mines and Quarries ... ... ... ... ... ... ... ... ... ... ... ... ... ... 198 Table IIIc.— DEATHS OF WILLESDEN RESIDENTS—continued. CAUSE OF DEATH. All Ages. 0 to 1 1 to 5 5 to 10 10 to 15 15 to 20 20 to 25 25 to 35 35 to 45 45 to 55 55 to 65 65 to 75 75 to 85 85 & Up. (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) (13) (14) (15) Injury by Machines ... ... ... ... ... ... ... ... ... ... ... ... ... ... Injury by Other Crushing, Vehicles, Railways, Landslides,&c. 9 ... 2 1 ... 2 2 ... 1 1 ... ... ... ... Injury by Animals ... ... ... ... ... ... ... ... ... ... ... ... ... ... Starvation ... ... ... ... ... ... ... ... ... ... ... ... ... ... Excessive Cold ... ... ... ... ... ... ... ... ... ... ... ... ... ... Effect of Heat ... ... ... ... ... ... ... ... ... ... ... ... ... ... Lightning ... ... ... ... ... ... ... ... ... ... ... ... ... ... Electricity (lightning excepted) ... ... ... ... ... ... ... ... ... ... ... ... ... ... Homicide by Firearms ... ... ... ... ... ... ... ... ... ... ... ... ... ... Homicide by Cutting or Piercing Instruments ... ... ... ... ... ... ... ... ... ... ... ... ... ... Homicide by Other Means 6 2 1 1 ... ... ... ... 2 ... ... ... ... ... Fractures (cause not specified) 1 ... ... ... ... ... ... ... ... ... ... 1 ... ... Other Violence 6 ... 1 ... ... ... 2 ... ... ... ... 2 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) 2 ... ... ... ... ... ... ... ... 1 ... 1 ... ... Atrophy, Debility, Marasmus (aged 1 year and under 70) ... ... ... ... ... ... ... ... ... ... ... ... ... ... Teething ... ... ... ... ... ... ... ... ... ... ... ... ... ... Pyrexia ... ... ... ... ... ... ... ... ... ... ... ... ... ... Other Ill-defined Deaths 2 1 ... 1 ... ... ... ... ... ... ... ... ... ... Cause not Specified ... ... ... ... ... ... ... ... ... ... ... ... ... ... Totals 1752 337 144 37 25 34 28 94 146 180 221 263 198 45 199 TABLE IV.— INFANT MORTALITY. 1914.—Nett Deaths from Stated Causes at various 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 Certified 67 22 20 15 124 65 77 37 34 337 Uncertified .. .. .. .. .. .. .. .. .. .. Small-pox .. .. .. .. .. .. .. .. .. .. Chicken-pox .. .. .. .. .. .. 1 .. .. 1 Measles .. .. 1 .. 1 .. .. .. 1 2 Scarlet Fever .. .. .. .. .. .. .. .. .. .. Whooping Couch .. .. 1 .. 1 6 6 2 2 17 Diphtheria and Croup .. .. .. .. .. .. .. .. .. .. Erysipelas .. .. 1 .. 1 .. 1 .. .. 2 Tuberculous Meningitis .. .. .. .. .. .. 2 1 1 4 Abdominal Tuberculosis (a) .. .. .. .. .. .. .. 1 .. 1 Other Tuberculous Dis. .. .. .. .. .. 1 1 .. .. 2 Meningitis (not Tuberculous) .. .. .. .. .. 1 .. 3 .. 4 Convulsions 2 3 .. 1 6 2 1 1 .. 10 Laryngitis .. .. .. .. .. .. .. .. 1 1 Bronchitis .. .. 1 2 3 4 9 1 3 20 Pneumonia (all forms) 1 .. .. 1 2 4 10 6 10 32 Diarrhœa .. 1 1 .. 2 6 6 1 .. 15 Enteritis .. 1 2 2 5 11 19 11 12 58 Gastritis .. .. 1 .. 1 1 3 .. 2 7 Syphilis .. .. .. .. .. .. 1 1 .. 2 Rickets .. .. .. .. .. .. .. .. 1 1 Suffocation, overlying 1 1 1 .. 3 2 5 .. .. 10 Injury at birth 2 .. .. .. 2 .. .. .. .. 2 Atelectasis 7 1 .. 1 9 .. .. .. .. 9 Congenital Malformations(b) 4 3 .. 1 8 4 1 1 .. 14 Premature birth 37 4 5 3 49 9 .. .. .. 58 Atrophy, Debility and Marasmus 6 6 6 2 20 10 9 1 .. 40 Lymphangioma of Neck 1 .. .. .. 1 .. .. .. .. 1 Abdominal Tumour 1 .. .. .. 1 .. .. .. .. 1 Septic Absorption .. .. .. .. .. .. .. 1 .. 1 Cellulitis .. .. .. 1 1 .. .. .. .. 1 Erythema Nodosum .. .. .. .. .. 1 .. .. .. 1 Stomatitis .. .. .. .. .. .. 1 .. .. 1 Parotid Abscess .. .. .. .. .. 1 .. .. .. 1 Hœmophilia .. 1 .. .. 1 .. .. .. .. 1 Tetanus .. 1 .. .. 1 .. .. .. .. 1 Peritonitis .. .. .. 1 1 .. .. .. .. 1 Intussusception .. .. .. .. .. .. .. 3 .. 3 Otitis Media .. .. .. .. .. .. .. 1 .. 1 Influenza .. .. .. .. .. .. .. 1 .. 1 Want of proper attention at Birth 3 .. .. .. 3 .. .. .. .. 3 Congestion of Lungs .. .. .. .. .. 1 1 .. .. 2 Suffocation Accidental (other than overlying) .. .. .. .. .. 1 .. 1 .. 2 Wilful Murder 1 .. .. .. 1 .. .. .. 1 2 Natural Causes 1 .. .. .. 1 .. .. .. .. 1 67 27 30 15 124 67 77 37 34 337 Nett Births in Legitimate 3,966 Nett Deaths in legitimate infants 315 the year illegitimate 149 theyear of illegitimate infants 22 (a) Under Abdominal Tuberculosis are included deaths from Tuberculosis Peritonitis and Enteritis and from Tables Mesenterica. (b) Want of Breast Milk is included under Atrophy and Debility. 200 TABLE IVA.— INFANT MORTALITY. 1914.—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 38 25 15 8 20 28 64 40 40 35 24 337 Uncertified .. .. .. .. .. .. .. .. .. .. .. .. Small Pox .. .. .. .. .. .. .. .. .. .. .. .. Chicken Pox .. .. .. .. 1 .. .. .. .. .. .. 1 Measles .. .. .. .. .. .. .. 1 1 .. .. 2 Scarlet Fever .. .. .. .. .. .. .. .. .. .. .. .. Whooping Cough 1 1 .. 2 1 2 3 4 1 2 1 17 Diphtheria and Croup .. .. .. .. .. .. .. .. .. .. .. .. Erysipelas .. .. .. .. .. .. .. .. 1 .. 1 2 Tuberculous Meningitis .. .. .. .. .. .. 1 .. 2 1 .. 4 Abdominal Tuberculosis .. .. 1 .. .. .. .. .. .. .. .. 1 Other Tuberculous Diseases .. .. .. .. .. .. 2 .. .. .. .. 2 Meningitis (not Tuberculous) .. 1 .. .. .. .. 1 .. .. 1 1 4 Convulsions .. .. 1 .. 1 1 4 1 .. 1 1 10 Laryngitis .. .. .. .. .. 1 .. .. .. .. .. 1 Bronchitis 3 1 1 .. 1 .. 3 2 5 3 1 20 Pneumonia (all forms) 7 4 .. .. .. 4 6 3 1 3 4 32 Diarrhœa 2 3 .. 1 2 1 1 1 2 1 1 15 Enteritis 6 3 1 .. 3 6 19 8 6 3 3 58 Gastritis 1 2 .. .. .. 1 .. 1 1 1 .. 7 Syphilis .. .. .. .. 1 .. 1 .. .. .. .. 2 Rickets .. .. .. .. .. .. 1 .. .. .. .. 1 Suffocation, overlying 3 .. .. .. .. 1 1 3 2 .. .. 10 Injury at birth .. 1 .. .. .. .. .. .. .. .. 1 2 Atelectasis .. 2 1 .. .. .. .. .. 4 2 .. 9 Congenital Malformations 1 2 1 .. 2 .. 1 3 .. 3 1 14 Premature Birth 7 2 8 2 4 4 6 5 8 9 3 58 Atrophy, Debility and Marasmus 5 .. 1 2 1 4 14 4 5 2 2 40 201 TABLE IVa.— INFANTILE MORTALITY, 1914.—continued. Lymphangioma of Neck .. .. .. .. .. 1 .. .. .. .. .. 1 Abdominal Abscess .. .. .. .. 1 .. .. .. .. .. .. 1 Septic Absorption .. .. .. .. .. .. .. 1 .. .. .. 1 Cellulitis .. .. .. .. .. .. .. .. .. 1 .. 1 Erythema Nodosum .. .. .. .. .. 1 .. .. .. .. .. 1 Stomatitis .. 1 .. .. .. .. .. .. .. .. .. 1 Parotid Abscess .. .. .. .. .. .. .. 1 .. .. .. 1 Hæmophilia .. .. .. .. .. 1 .. .. .. .. .. 1 Tetanus .. .. .. .. .. .. .. .. 1 .. .. 1 Peritonitis .. .. .. .. .. .. 1 .. .. .. .. 1 Intussusception .. .. .. .. 1 .. .. .. .. 2 .. 3 Otitis Media 1 .. .. .. .. .. .. .. .. .. .. 1 Influenza 1 .. .. .. .. .. .. .. .. .. .. 1 Want of proper attention at Birth .. .. .. .. .. .. .. 1 .. .. 2 3 Congestion of Lungs .. .. .. 1 1 .. .. .. .. .. .. 2 Suffocation, Accidental (other than overlying) .. 1 .. .. .. .. .. .. .. .. 1 2 Wilful Murder .. .. .. .. .. .. .. 1 .. .. 1 2 Natural Causes .. 1 .. .. .. .. .. .. .. .. .. 1 Total 38 25 15 8 20 28 64 40 40 35 24 337 Deaths Legitimate 37 24 13 8 20 27 59 36 36 33 22 315 Illegitimate 1 1 2 .. .. 1 5 4 4 2 2 22 Births Legitimate 427 335 222 149 394 386 540 431 361 402 307 3954* Illegitimate 17 8 8 .. 2 7 14 9 7 21 8 101* Total Births 444 343 230 149 396 393 554 440 368 423 315 4055 Infant Mortality Rate Legitimate 86.65 71.64 58.55 53.69 50.76 69.94 109.25 83.52 99.72 82.08 71.66 79.66 Illegitimate 58.82 125.00 250.00 0.00 0.00 142.85 357.14 444.44 571.42 95.23 250.00 217.82 Infant Mortality Rate 85.58 72.88 65.21 53.69 50.50 71.24 115.52 90.90 108.69 82.74 76.19 81.89 Population 14745 14587 12611 9834 14169 17114 17742 15657 14121 16742 19312 166634 * Does not include 60 of the 146 Births received from Registrar-General at end of year, 48 of which were stated to be illegitimate— no addresses given. 202 APPENDIX B. Treatment of Ophthalmia Neonatorum. Municipal Offices, Dyne Road, Kilburn, N.W., 10th March, 1914. To the Chairman and Members' of the Health Committee. Gentlemen, Public Health (Ophthalmia Neonatorum) Regulations, 1914. Treatment of Ophthalmia Neonatorum. In accordance with instructions, I beg to report as to the steps which may be taken by the Council with the view of curative treatment being afforded to cases of Ophthalmia Neonatorum from time to time notified under the above Regulations, which come into operation on April 1st, 1914. Powers of the Council as to treatment. The preamble to the Regulations states that they have been framed under powers conferred on the Local Government Board by Section 130 of the Public Hearth Act, 1875, with a view to the treatment of persons suffering from this disease and for preventing the spread of the disease. The Regulations relate only to the notification of the disease by midwives and doctors, but the powers in Sections 131 and 133 of the Public Health Act, 1875, are available in connection with any scheme of treatment decided upon by the Council. These sections are as follows:— Section 131. Any local authority may provide for the use of the inhabitants of their district hospitals or temporary 203 places for the reception of the sick, and for that purpose may— Themselves build such hospitals or places of reception ; or Contract for the use of any such hospital or part of a hospital or place of reception; or Enter into any agreement with any persons having the management of any hospital, for the reception of the sick inhabitants of their district, on payment of such annual or other sum as may be agreed on. Two or more local authorities may combine in providing a common hospital. Section 133. Any local authority may, with the sanction of the Local Government Board, themselves provide or contract with any person to provide a temporary supply of medicine and medical assistance for the poorer inhabitants of their district. Definition of Ophthalmia Neonatorum. According to the regulations, the expression "Ophthalmia Neonatorum" means a purulent discharge from the eyes of an infant, commencing within twenty-one days from the date of its birth. Effects of Ophthalmia Neonatorum. The results of Ophthalmia Neonatorum are well summarised in a report of the Local Government Board for Scotland on the Incidence of Ophthalmia Neonatorum in Scotland, as follows :— (1) In Great Britain there are from seven to eight hundred blind persons per million of the population; 204 (2) Of these, from ten to fifteen percent. are "blind from birth"; (3) Of those so classified, the vast majority owe their loss of vision to Ophthalmia Neonatorum or it may be said that, of the blindness occurring in early life, and, therefore, of prime economic significance, 25 to 45 percent. is ascribable to ophthalmia neonatorum. Effect of Treatment. The report above referred to states that the disease is to be regarded as preventable or curable in ninety to ninetyeight percent. of all cases; but this really means that by taking suitable precautions all cases can be prevented, and that cases which do occur, if submitted to treatment at a sufficiently early age, will recover without injury to vision. Estimated Prevalence of the Disease in Willesden. The following table shows the number of cases of this disease occurring in certain areas:— District. Total Births, 1912. Cases of Ophthalmia Neonatorum. No. per 1000 Births. London 113,798 (1913) 634 5.5 Kensington 3,079 (1912) 22 7.1 Glasgow 21,755 (1912) 208 10.4 Paddington 2,774 (1912) 31 11.7 Manchester 18,169 (1912) 503 27.6 Stoke-on-Trent 7,445 (1912) 246 33.4 From these figures it will be seen that the prevalence of this disease varies from 5.5 in London, as a whole, to 11.7 in Paddington to 33.4 per 1,000 births in Stoke-onTrent. It may therefore be assumed that in Willesden the rate is somewhere between the extremes noted, and probably near the figure for Paddington, say twelve per 1,000 births. 205 During 1913 there were 4,037 births in Willesden, and thus the estimated number of cases of Ophthalmia Neonatorum which will fall to be dealt with per annum should approximate 48. Inspection and Treatment. Upon notification of a case it will be necessary to make enquiries among other matters as to the facilities for treatment. The importance of early treatment cannot be overrated, and every effort should be made to secure it. The earlier treatment is begun the less is the probability of total or partial permanent blindness. Treatment may be either (1) Domiciliary, (2) Institutional. Domiciliary Treatment. Domiciliary treatment will be sufficient for the majority of cases of Ophthalmia Neonatorum, and consists in the efficient cleansing of the eyes at frequent intervals. This should be carried out by a trained nurse, under medical supervision. As these cases are recovering, and as the mother becomes able to take her child out, it would be possible to deal with them at established clinics. Institutional Treatment. In some cases a virulent inflammation of the eyes occurs soon after birth, and as the condition in these cases is extremely acute, and the eyes require cleansing very frequently, it is necessary to remove the child to hospital. In such cases it is inadvisable to separate the mother from the child, and provision requires to be made for the mother to stay in hospital while the baby's eyes are under continuous treatment. It is probably correct to estimate that of the 48 cases above it will be possible to deal with forty by domiciliary measures and eight by institutional means. 206 COST. Domiciliary. The treatment of forty cases by domiciliary means probably means that each case wants twenty visits by a trained nurse, and the time of each visit can be put at one hour. This means that 800 hours, or 22 weeks per annum, would be devoted to this work, or approximately half her time. Her work would have to be carried out under medical supervision, and advice which, including attendances at clinics, would probably occupy the time of a doctor about one day and a half a week. The Committee will recognise that this work is a new departure, and that no provision exists in the way of staff or otherwise for carrying it on. Hospital Cases. The eight cases for hospital would probably remain in hospital for a matter of, say, four weeks each. The Medical Superintendent of the Isolation Hospital informs me that he would be able to deal with these cases from time to time, provided the existing accommodation at the Hospital was not fully occupied by cases of other infectious diseases. ANNUAL COST. Domiciliary. £ Ophthalmia bags and outfit 4 Proportion of salary of Health Visitor (£108 —£138 per annum) 54 Proportion of salary of Assistant Medical Officer (£300) 80 Travelling expenses, upkeep of outfit, etc. 5 £143 207 Hospital Cases. Eight cases (mother and child), each in Hospital for four weeks, at £2 per week 64 Total £207 Against this estimated annual cost of £207 should be noted the following facts :— (1) If the estimated number of forty-eight cases of Ophthalmia Neonatorum are not efficiently treated, at least three are likely to be blinded or partially blinded as a result of the disease. (2) The estimated cost of the education of a blind child is £350, compared with about £50 in the case of an average child with normal vision. (3) During the year 1912, eleven Willesden children were being educated in blind schools or institutions. (4) The cost of educating blind children (blindness being due to any cause) belonging to Willesden is approximately £330 per annum. (5) The economic and other disabilities of a blind adult. I am, Your obedient servant, GEORGE F. BUCHAN, Medical Officer. 208 APPENDIX C. Abnormal Children and the Mental Deficiency (Notification of Children) Regulations, 1914; together with certain recommendations consolidating the recommendations arising out of this report with those already put forward in respect of the Treatment of Eyes. Municipal Offices, Dyne Road, Kilburn, N.W., 4th May, 1914. To the Chairman and Members of the Children's Care Committee. Abnormal Children. I beg to enclose herewith the following documents isued by the Board of Education :— (a) Mental Deficiency (Notification of Children) lations, 1914. (b) Model Arrangements, under Section 1 (1) of the Elementary Education (Defective and Epileptic Children) Act, 1899, and Section 31 (1) of the Mental Deficiency Act, 1913. (c) Circular 829, being a Memorandum on (a) and (b) above. In considering the foregoing papers and the methods to be employed for ascertaining and classifying mentally defective children, it may be useful to the Committee, in view of these new Regulations and the new whole-time medical service now in existence, if I survey the whole subject of abnormal children and consolidate the present methods in vogue. 209 Abnormal children may be classified as follows:— A. Mentally Abnormal. 1. Idiot. 2. Imbecile. 3. Feeble-minded. 4. Moral Imbecile. 5. Dull or Backward. 6. Epileptic. B. Physically Abnormal. 7. Physically Defective. 8. Blind. 9. Deaf. Idiot—i.e., a child so deeply defective in mind from birth or from an early age as to be unable to guard itself against common physical dangers. [Mental Deficiency Act, 1913. Section 1 (a).] This class of child is ineducable, but the Education Committee are required under Section 31 (1) of the Mental Deficiency Act, 1913, to ascertain what children over the age of seven years within their area are idiots, and under Section 2 (2) to notify such children to the Middlesex County Council. Paragraph 8 of Circular 829, herewith enclosed, also suggests that the Education Committee should furnish the Middlesex County Council with information as to the children under the age of seven years who appear to be idiots. Imbecile—i.e., a child in whose case there exists from birth or from an early age mental defectiveness not amounting to idiocy, yet so pronounced that he is incapable of being taught to manage himself or his affairs. [Mental Deficiency Act, 1913. Section 1 (b).] This class of child is ineducable, but the Education Committee are required under Section 31 (1) of the Mental Deficiency Act, 1913, to ascertain what children over the 210 age of seven years within their area are imbeciles, and under Section 2 (2) to notify such children to the Middlesex County Council. Paragraph 8 of Circular 829, herewith enclosed, also suggests that the Education Committee should furnish the Middlesex County Council with information as to children under the age of seven years who appear to be imbeciles. Feeble-minded—i.e., a child in whose case there exists from birth or from an early age mental defectiveness not amounting to imbecility, yet so pronounced that he, by reason of such defectiveness, appears to be permanently incapable of receiving proper benetrt from the instruction in ordinary schools. [Mental Deficiency Act, 1913. Section 1 (c).] This class of child may be sub-divided into (a) the ineducable, (b) the educable. (a) The ineducable. The Education Committee are quired under Section 31 (1) of the Mental Deficiency Act, 1913, to ascertain what children over the age of seven years are ineducable feeble-minded, and under Section 2 (2) to notify such children to the Middlesex County Council. Paragraph 8 of Circular 829, herewith enclosed, also suggests that the Education Committee should furnish the Middlesex County Council with information as to children under the age of seven years who appear to be of this class. Paragraph 3 of Circular 829 suggests that before any child is notified as ineducable it should be given a trial in a special school, preferably a residential school. (b) The educable.—The Education Committee are quired under Section 31 (1) of the Mental Deficiency Act, 1913, to ascertain what children over the age 211 of seven years are educable feeble-minded. The Education Committee are not required under Section 2 (2) to notify these children to the Middlesex County Council, unless— (i.) They cannot be instructed in a special school or class without detriment to the interests of other children; or (ii.) The Board of Education certify that there are special circumstances which render it desirable that they should be dealt with under this Act by way of supervision or guardianship; or (iii.) On or before attaining the age of 16 years they are about to be withdrawn or discharged from a special school or class, and the Education Committee are of opinion that it would be to the benefit of the children that they should be sent to an institution or placed under guardianship. Paragraph 8 of Circular 829, herewith enclosed, however, suggests that the Education Committee should furnish the Middlesex County Council with information as to the children under or over the age of seven years who appear to belong to the class of educable feeble-minded. Moral Imbecile—i.e., a child who from an early age displays some permanent mental defect, coupled with strong vicious or criminal propensities, on which punishment has little or no deterrent effect. [Mental Deficiency Act, 1913. Section 1 (d).] The Education Committee are required under Section 31 (1) of the Mental Deficiency Act, 1913, to ascertain what children over the age of seven years are moral imbeciles. As practically all the children coming within the definition given above also belong to the class who cannot be instructed in a special school without detriment to the interests 212 of the other children, it follows that generally they would require to be notified to the Middlesex County Council, under Section 2 (2) of the Mental Deficiency Act, 1913. Paragraph 8 of Circular 829, herewith enclosed, however, suggests that the Education Committee should furnish the Middlesex County Council with information as to children under or over the age of seven years who appear to belong to the class of moral imbecile. Dull. Backward—i.e., a child who does not belong to any of the preceding classes, but is incapable by reason of delay in the development of its mental faculties of competing on equal terms with its normal fellows of corresponding age. It should be noted that backwardness in some instances may be due to lack of opportunity of obtaining education. This condition is one of degree as compared with the educable feeble-minded, and these children will require to be examined by the same tests as those to be applied to the latter class. Epileptic—i.e., a child who suffers from epilepsy. A child suffering from epilepsy may be unfit to attend an ordinary school on account of the severity or frequency of the attacks giving rise to— (a) Serious danger to itself; (b) Serious danger to other children ; (c) Serious disturbance to the work of the school; (d) Serious retardatiton in the educational progress of the child. At the present time there is no compulsion upon any Authority to educate epileptic children, and special difficulties arise in connection with educating these children, on account of the occurrence of fits, the special care and 213 tion necessary immediately after a fit, and the progressive tendency towards mental deterioration exhibited by the majority of these children. Cases of epilepsy other than those indicated above under (a), (b), (c) and (d) may be fit to attend an ordinary school or with even more advantage an open-air school, but other cases, including (a), (b), (c) and (d) would be best suited by attendance at a residential institution. Physically Defective—i.e., a child who is incapable by reason of physical defect of receiving proper benefit from the instruction in the ordinary public elementary schools, but not incapable by reason of such defect of receiving benefit from instruction in special classes or schools. [Elementary Education (Defective and Epileptic Children) Act, 1899.] The conditions from which physically defective children suffer include the following:— (1) Tuberculosis—Lungs, bones or joints, abdomen, glands, etc. (2) Anaemia, malnutrition and conditions not yet sufficiently developed for accurate diagnosis—Pre-tuberculous conditions—so-called delicate children. (3) Chronic conditions—Chronic bronchitis, asthma, chronic rheumatism, exophthalmic goitre, chronic glandular enlargements, chronic inflammatory conditions of the eyes, ears, mouth, nose, throat, etc. (4) Convalescence after St. Vitus' Dance, pneumonia, pleurisy, rheumatism, operations, e.g., for removal of enlarged tonsils or adenoids, for empyaema, etc. (5) Uncompensated heart disease. (6) Oral Sepsis. (7) Paralysis. 214 (8) Various deformities, if— (a) The deformity renders the child liable to injury at the ordinary school. (b) The deformity is increasing. (c) The child is under treatment or observation on account of the deformity. (d) Orthopaedic instruments liable to injury are worn. Physically defective children should be educated at an open-air school. Blind—i.e., a child too blind to be able to read the ordinary school books used by children. [Elementary Education (Blind and Deaf Children) Act, 1893. Section 15.] These children may be classified as follows:— (1) Suitable for Special School or Institution. (2) Suitable for Special Myope i.e., short-sighted class attached to ordinary school. These children have a reasonable degree of visual acuity, but owing to visual defect, have the habit of peering and groping at their work. The experience in London would indicate that it is better to have these classes attached to the ordinary rather than the special blind school, as the children are not then marked down as blind children. These children also may be taught with the normal children in respect of all forms of oral teaching, and a better classification of the children is obtainable for this purpose where they form a special class of a large school than would be the case in a special blind school, with limited numbers. Manual work in which the fixed attention of the eyes is not required should be used to the fullest extent in the education of these children. 215 (3) Suitable for ordinary school with easy teaching as regards eye work. Groups (2) and (3) above mentioned should be taught in class rooms with perfect natural illumination. All work requiring the fixed attention of the eyes should cease when the daylight fades. Group (1) includes the essentially blind, who require education by blind methods. Groups (2) and (3) represent primarily seeing scholars whose education requires modification to meet their physical defect. Many of them, with a good general training and special attention to the development of thought, and, if possible initiative, are able to fill positions of usefulness and responsibility as sighted citizens. Deaf—i.e., a child too deaf to be taught in a class of hearing children in an elementary school. [Elementary Education (Blind and Deaf Children) Act, 1893. Section 15.] These children may be classified as follows:— (1) Suitable for Deaf and Dumb Residential Institution or Day Special School. These are generally "deaf mutes," requiring training by methods applicable to the deaf and dumb. (2) Suitable for classes for the partially deaf ("hard of hearing"). These are children who possess residues of hearing power, i.e., "hard of hearing" children. They require a large measure of instruction by the methods commonly applied to the deaf and dumb. (3) Suitable for ordinary schools (front row). These are children with hearing power not greatly diminished. 216 Legal Enactments and Regulations. In order that the Education Committee may deal as required with all the foregoing groups of children, the following enactments and regulations require attention :— Elementary Education (Defective and Epileptic Children) Act, 1899:— Section 1.—(1) A school authority, as defined by the Elementary Education (Blind and Deaf Children) Act, 1893, may, with the approval of the Education Department, make such arrangements as they think fit for ascertaining— (a) What children in their district, not being imbecile, and not being merely dull or backward, are defective, that is to say, what children, by reason of mental or physical defect, are incapable of receiving proper benefit from the instruction in the ordinary public elementary schools, but are not incapable by reason of such defect of receiving benefit from instruction in such special classes or schools as are in this Act mentioned; and (b) What children in their district are epileptic children, that is to say, what children, not being idiots or imbeciles, are unfit by reason of severe epilepsy to attend the ordinary public elementary schools. (3) For the purpose of ascertaining whether a child is defective or epileptic within the meaning of this section, a certificate to that effect by a duly qualified practitioner approved by the Education Department shall be required in each case. The certificate shall be in such form as may be prescribed by the Education Department. 217 Mental Deficiency (Notification of Children) Regulations, 1914. (1) The School Medical Officer of the Local Education Authority and such other duly qualified medical practitioners approved by the Board of Education under the Elementary Education (Defective and Epileptic Children) Act, 1899, as the Local Education Authority may nominate for that purpose, hereinafter called Certifying Officers, shall be the Medical Officers for the purpose of these Regulations. Regulations applicable to Special Schools for Blind, Deaf, Defective and Epileptic Children. General Regulations. 2—(a) No child may be admitted to a Special School who has not been ascertained to be blind or deaf within the meaning of the Elementary Education (Blind and Deaf Children) Act, 1893, or to be defective or epileptic within the meaning of the Elementary Education (Defective and Epileptic Children) Act, 1899, nor may any child be retained in a Special School (1) who becomes mentally and physically fit to attend an ordinary Public Elementary School, or (2) who is ascertained to be incapable of profiting by instruction in a Special School. (b) No child may be admitted to a Special School who has not completed five years of age, and no child may be retained in a Special School after completing sixteen years of age, except with the special consent of the Board. (c) In the case of each child, proper records must be made at the time of admission and periodically afterwards— 218 (i.) As to the child's capacity, habits, attainments, and health; (ii.) As to the family history of the child; (iii.) As to the progress of the child. (d) The decision of the Board as to whether a child may or may not be retained in a Special School is final. Special Regulations applicable to Schools for Defective or Epileptic Children. (24) Provision must be made for the examination from time to time of every child in a Defective or Epileptic School at least once a year, by a suitably qualified medical man, in order to ascertain whether (a) he has attained such a mental and physical condition as to be fit to attend an ordinary class in a public elementary school, or (b) he is so defective as to be incapable of profiting by education of any kind. For the purpose of giving effect to the foregoing enactments and regulations I would suggest that the following be nominated under Section 1 (3) of the Elementary Education (Defective and Epileptic Children) Act, 1899, by the Committee for the approval of the Board of Education: George Frederick Buchan, M.D., Ch.B., D.P.H. John MacMillan, M.B., Ch.B., D.P.H. Irene Davy Eaton, M.B., B.S., D.P.H. George Edward Shuttleworth, B.A., M.D., M.R.C.S., L.S.A. 219 Administrative Measures. Abnormal Children—(A)—Mentally Abnormal, including— (1) Idiot. (2) Imbecile. (3) Feeble-minded. (4) Moral Imbecile. (5) Dull or Backward. (6) Epileptic. (B) Physically Abnormal, including— (7) Physically Defective. (8) Blind. (9) Deaf. Children belonging or suspected as belonging to one or other of the above groups as hereinbefore defined, should be notified by Head Teachers in respect of children attending school and by School Attendance Officers in respect of children not in attendance at school, and whether under or over seven years of age to the School Medical Officer on the "Specially Referred" salmon coloured card. The School Medical Officer shall have the children so referred duly examined by one or other of the Approved Certifying Officers. The examination of children referred under (A) Mentally Abnormal above will require to be reported in the manner provided by the schedules printed on pp. 3, 4, 5 and 6 of the Model Arrangements published by the Board of Education under Section I (1) of the Elementary Education (Defective and Epileptic Children) Act, 1899, and Section 31 (1) of the Mental Deficiency Act, 1913. The examination of children referred under (B), Physically Abnormal Children, will be conducted on similar lines 220 and in order that uniformity may be preserved as respects these examinations I have added to the Schedules given in the Model Arrangements and produced one consolidated schedule suitable to all classes of abnormal children. The School Medical Officer shall submit the results of examinations of abnormal children, together with recommendations as to treatment and the most suitable schools or institutions, to each meeting of the Children's Care Committee. The general scheme for dealing with the Abnormal or Alleged Abnormal Children referred to in this report is diagrammatically represented on the following pages. ABNORMAL OR ALLEGED ABNORMAL CHILDREN over or under seven years of age. 221 ABNORMAL OR ALLEGED ABNORMAL CHILDREN over or under seven years of age—(cont.). 222 H.T.—Head Teacher. NOTES.—Combinations of the above classifications occur, S.A.O.—School Attendance Officer. Paragraph 3 of Circular 829 suggests that in any case where it is proposed to S.M.O.—School Medical Officer. notify a blind or deaf child to the Middlesex County Council under the C.C.C.— Children's Care Committee. Mental Deficiency Act. 1913. the approval of the Board of Education E.C.—Education Committee, should first be obtained. M.C.C.—Middlesex County Council. B. of E,—Board of Education. 223 From the prescribed schedule of the Board of Education and the consolidated form submitted herewith, it will be observed that the examination of these scholars will occupy considerable time. It is probable that in no case will the time be less than one hour, and in some cases it may be two hours, say, on the average, 1½ hours. The number of children requiring this extended examination per annum includes all the children in the Special Schools and those referred by Head Teachers and School Attendance Officers, and is not likely to fall short of 300 per annum. This means that the examination of these cases will occupy the time of a medical officer at least eighteen out of the forty-four weeks in the school year. I would, therefore, recommend the Committee to take steps to appoint an additional assistant medical officer, so that this work and work arising out of the treatment of eyes might be undertaken. (Vide report to Children's Care Committee, dated 19/1/14, on Medical Treatment—Eyes and Teeth, and report to Health Committee, dated 10/3/14, on Treatment of Ophthalmia Neonatorum.) All doubtful or difficult cases of mental defect examined at special or routine examinations by the assistant medical officers would be referred to Dr. Shuttleworth for further examination and report. Consolidated Recommendations. Mental Deficiency. Treatment of Eyes. Treatment of Ophthalmia Neonatorum. Consolidating the above report with that portion of my report on Medical Treatment—Eyes and Teeth, relating to Eyes, and my report on Ophthalmia Neonatorum, the following recommendations arise:— 224 (1) The establishment of an Eye Clinic, at an estimated cost of £60, with an additional £4 for Ophthalmia bags and outfit. (2) The appointment of an Assistant Medical Officer at £300 per annum. (3) The appointment of an oculist to act as consultant only in difficult eye cases, at a salary at the rate of £1 Is. per hour. (4) The appointment of a Health Visitor at the scale salary of £108—£138 per annum. (5) The appointment of a fourth-class clerk at the scale salary of £52—£80 per annum. Annual Cost. The annual cost as nearly as I can estimate would be allocated as follows :— £ £ Mental Deficiency *Dr. Shuttleworth (£3 3s. per day) (estimated) 30 (Education) Assistant Medical Officer (£300 per ann.) 100 Fourth Class Clerk (£52-£80 per ann.) 15- 20 Total £145-150 Eyes (Education) Oculist as Consultant only (£1 Is. per hour) (estimated) 30 Assistant Medical Officer (£300 per ann.) Health Visitor (£108-£138 per ann.) 100 54- 69 Fourth Class Clerk (£52-£8o per ann. 35- 57 Total £219-256 Eyes. Ophthalmia Oculist as Consultant only (£1 is. per hour) (estimated) 5 Neonatorum Assistant Medical Officer (£300 per ann.) 100 (Public Health) Health Visitor (£108-£138 per ann.) 54-69 Fourth Class Clerk (£53-£8o per ann.) 2-3 Total £161-177 TOTAL £525-583 *Dr. Shuttleworth has received payments as follows during the last three years:—1912-13, £25 4s-; 1911-12, £22 Is.; 1910-11, £22 Is. I am, Your obedient servant, GEORGE F. BUCHAN, Medical Officer. 225 APPENDIX D. Maternity and Child Welfare. Municipal Offices, Dyne Road, Kilburn, N.W., 8th October, 1914. To the Chairman and Members of the Health Committee. Maternity and Child Welfare. I beg to report on the above subject, in accordance with the following recommendation of the Health Committee, duly adopted by the Council at its meeting held on the 29th September, 1914:— "Your Committee have received letters from the Local Government Board, the Women's Co-operative Guild, the Willesden National Relief Fund Executive Committee, and the Willesden Branch of the National Women's Labour League, calling attention to the urgent necessity for making special provision for expectant and nursing mothers, and for child welfare, and recommend that the Medical Officer of Health be instructed to submit a scheme dealing with these matters." The Medical Inspection of School Children has revealed the fact that many children entering school at the age of five are not up to the normal standard for that age in general health, and in order to trace the causes operating to bring about this lowered standard of vitality in young children it is necessary to consider Ante-natal, Natal, and Post-natal conditions. Ante-natal Conditions. At the present time there is no reliable data available regarding these conditions, but it is well-known that many 226 families are chronically underfed, and it is not too much to say that generally the mothers suffer most. Under these circumstances it is not surprising that many infants are born puny and ill-nourished, and without the necessary reserve energy to resist the new conditions of the outer world into which they have been brought. Some idea of the ill effects on the child, to say nothing of the mother, of want of proper and sufficient nourishment during pregnancy may be obtained from the large proportion of children who die within four weeks of birth. Out of 325 deaths of children under one year of age occurring in Willesden during 1913, 128 died under the age of four weeks. Some work has been done at the"Babies' Welcome," Lower Place, which was established in 1911, in relation to ante-natal conditions. A few expectant mothers have attended the Welcome in connection with illness or malnutrition of one child, and have been advised by the Health Visitor in connection with a second pregnancy occurring during that time. Although the numbers have been small, on account of the limited attendances of the Health Visitor, the work has shown the great need of its extension, especially in respect of providing additional medical advice and nourishment for both mother and child. Natal Conditions. In the year 1908 the Council adopted the Notification of Births Act, 1907, and this Act has been of considerable value in bringing under the notice of the Council certain facts with regard to the births of children in the area. The following table shows the number of births notified in each complete year since the adoption of the Act, together with certain other particulars. 227 Table No. 1. 1909 1910 1911 1912 1913 Total 1909-13 Total number of births notified in each complete year since its adoption 3748 3390 3694 3671 3550 18053 (a) Attended by doctors 2220 2072 2266 2324 2273 11155 (b) Attended by midwives 1528 1318 1428 1347 1277 6898 Number of stillbirths notified each year 95 79 88 92 104 458 Number of births registered each year 4172 3923 4001 4075 4037 20208 From the foregoing table it will be observed that out of 18,053 births occurring during the five year period 1909-13, 6,898, or 38 per cent., were attended by midwives only. This number probably includes all the cases where the social circumstances of the parent do no permit of the nourishment and attention required by a mother during pregnancy and after delivery. The Notification of Births Act, 1907, applies only to children born either alive or dead after the expiration of the twenty-eighth week of pregnancy, and in this connection it is noteworthy that during the five years shown in the above table 458 still births were recorded, or, on the average, 91 per annum. It should, however, be noted that this represents the number of still births only after the seventh month of pregnancy, and it may be fairly concluded that the number of mis-carriages prior to the seventh month of pregnancy is considerably greater than the number of still births recorded. In fact, it would probably be under-estimating the position to say that the average number of mis-carriaees and still births per annum is at least equal to the average number of deaths of infants under one year per annum. It is difficult without further enquiry to state to what extent these deaths of infants in utero are preventable, but there is little doubt that a large proportion is due to 228 nutrition of the parent, and especially in cases of first pregnancy to want of knowledge. If, therefore, steps are to be taken to prevent this wastage of infant life and at the same time the suffering and permanent injury which occurs to many women as a result of mis-carriages and still births, facilities require to be provided for the feeding, nourishment, supervision and instruction of expectant mothers. In connection with the question of natal conditions, the following table gives the number of deaths due to Puerperal Fever and other accidents and diseases of Pregnancy and Parturition occurring in each year since 1909. Table No. 2. Year. No. of deaths due to Puerperal Fever. No. of deaths due to other Accidents and Diseases of Pregnancy and Parturition. Total. 1909 2 10 12 1910 5 10 15 1911 8 10 18 1912 3 9 12 1913 2 7 9 Total 20 46 66 Post-natal Conditions. The following table shows the total deaths of children under one year of age, between one and five, and between five and fifteen, together with the total deaths at all ages which have occurred in this district in each year since 1909, together with the deaths from certain specified causes:— Table No. 3. Causes of Deaths. 1909 1910 1911 1912 1913 1909-13 Under 1 year. 1-5. 5-15. At all ages. Under 1 year. 1-5. 5-15. At all ages. Under 1 year 1-5. 5-15. At all ages. Under 1 year. 1-5. 5-15. At all ages. Under 1 year. 1-5. 5-15. At all ages. Under 1 year. 1-5. 5- 15. At all ages. Total from all causes 391167 70 1678 313 '55 68 1506 495 241 6l 1848 328 126 56 1603 325 171 66 1677 1852 860 321 8512 I. Congenital Malformation Premature Birth, Atrophy, Debility, Marasmus 159 5 0 165 134 1 0 135 143 2 0 145 126 2 0 128 122 3 0 125 684 13 0 698 2. Diarrhoea, Enteritis 51 6 2 62 32 5 1 40 158 27 0 196 22 1 0 34 45 9 0 66 308 48 3 398 3. Measles 9 30 2 41 4 23 3 30 8 37 6 51 9 24 2 35 11 49 7 69 41 163 20 226 4. Whooping Cough 25 17 1 43 8 15 3 26 29 53 2 84 10 17 1 28 9 14 0 23 81 116 7 204 5. Bronchitis 21 4 0 125 21 9 0 118 16 10 2 106 31 9 0 126 22 4 1 132 111 36 3 607 6. Pneumonia 33 24 3 140 24 36 5 113 38 45 2 144 44 21 7 126 39 33 4 126 178 159 21 649 Total, from above named six causes 298 86 8 576 223 89 12 462 392 174 12 726 242 74 10 477 248 112 12 541 1403 535 54 2782 229 230 From the foregoing Table, No. 3, it will be observed that during the five years 1909-13, 1,852 deaths from all causes occurred under one year of age, 860 between one and five years of age, while only 321 occurred between five and fifteen years of age, during what is practically the school age period. In other words, it may be said that the deaths of infants under one year of age are more than twice the number of deaths occurring during the four years at ages from one—five years, and more than five times the number of deaths occurring during the ten years of school life, i.e., at ages from five—fifteen years. In this connection it is especially important to observe that a large number of infant deaths represents a still larger amount of infant deterioration, as, after all, the dead child is next of kin to the defective child. The birth rate in Willesden has steadily fallen since the year 1875, when it was 44.7 per thousand, to the year 1913, when it was 24.7 per thousand of the population, which birth rate is the lowest yet recorded in Willesden. A similar statement applies to the country generally. As, therefore, a smaller and smaller number of children is born, it is of all the more importance that every possible step should be taken to save infant life, and at the same time raise the standard of health of all children. The causes enumerated in Table No. 3 account for 1,403 deaths, out of a total number of 1,852 deaths of infants under one year of age during the five year period 1909-13, and it will, therefore, be seen that the above-named represent the principal causes of the deaths of infants. The large bulk of infant deaths can accordingly be saved by a successful campaign against these six conditions, namely :— 1. Congenital Malformation, Premature Birth, Atrophy, Debility, Marasmus. 2. Diarrhoea, Enteritis. 231 3. Measles. 4. Whooping Cough. 5. Bronchitis. 6. Pneumonia. (1) Congenital Malformation, Premature Birth, Atrophy, Debility, Marasmus. It will be observed that these causes account for 684 out of the total of 1,852 deaths of infants under one yeai during the five year period 1909-13. Congenital Malformations and Premature Birth are due mainly to ante-natal causes, and indicate the importance of advising and taking care of the expectant mother, as well as supervising the midwife. But, on the other hand, such conditions as Atrophy, Debility and Marasmus are due to weakness of the child at birth, or weakness of the child appearing subsequent to birth. As to the weakness of the child at birth, this is again a condition depending entirely upon the health and nutrition of the mother during: pregnancy. Weakness of the child appearing subsequent to birth usually arises from want of maternal nursing, usually due to the mother having to go to work or not receiving proper or sufficient nourishment after confinement; improper feeding of the child, due to want of knowledge on the part of the mother; or generally want of cleanliness and dirty home conditions. (2) Diarrhoea and Enteritis. It will be observed that fifty-one deaths of infants under one year of age occurred from these causes in 1909, 32 in 1910, 158 in 1911, 22 in 1912, and 45 in 1913, i.e., a total of 308 during the five year period 1909-13. The majority of these deaths take place during the hot weather, and in respect of infants who are artificially fed. In connection 232 with these deaths, and, indeed, in connection with the deaths generally of infants under one year of age, the importance of maternal nursing cannot be too strongly insisted upon. The want of maternal nursing is probably the greatest single cause of infant deaths. Not only are 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. (b) Need of the mother returning to work. Both of these conditions are probably due to the same cause, namely, the social circumstances of the parents. In some cases, however, artificial feeding may be a necessity, and under such conditions it is essential that the method and amount of artificial feeding should be explained individually to the parents concerned, just in the same way as any other abnormal condition would receive the individual attention and skilled treatment of a doctor. (3) Measles, Whooping Cough, Bronchitis and Pneumonia. It should be noted that, in respect of children, these diseases are closely allied, as deaths in respect of Measles are usually due to complications such as Bronchitis or Broncho-Pneumonia, and the same may be said of deaths due to Whooping Cough. It should be observed that these four causes accounted for the deaths of 88 children under one, and 75 between one and five, in 1909, of 57 under one and 83 between one and five in 1910, of 91 under one and 145 between one and five in 1911, of 94 under one and 71 between one and five in 1912, and of 81 under one and 100 between one and five in 1913, or a total of 411 children under one and 474 children between one and five years of age during the five year period, 1909-13. Deaths from such causes occur in cases where the resistance of the child is 233 lowered from want of proper or sufficient nourishment, and are especially numerous in insanitary and overcrowded dwellings. Proper and sufficient nourishment, abundance of light (except in measles), fresh air, warmth and skilled nursing are especially necessary in connection with these diseases. The above figures refer only to deaths, and give but little idea of the total number of cases or of the number of cases which recover with some permanent lung or other weakness as the result. This latter number, at a low estimate, would at least equal the number of deaths. As to the total number of cases of Measles, this may be estimated by assuming that the number of deaths amongst unknown cases prior to death occurs at the same rate as amongst known cases prior to death. The following Table No. 4, shows the results for the five year period, 1909-13. Table No. 4. 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. 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 1912 1,665 17 1.02 18 1,763 48 3,428 1913 1,656 21 1 .26 48 3,785 30 5,441 Totals 8,368 94 1 ,12 132 11,659 42 20,027 As to the number of cases of Whooping Cough occurring among infants, no definite information is to hand, but 520 cases of Whooping Cough were notified voluntarily by head teachers and others during the year 1913. No means are available for ascertaining or estimating the total number of cases of Bronchitis or Pneumonia in any one year. 234 Scheme for Maternity and Child Welfare. The above facts and figures indicate the importance of the care of mothers and infants, and it is now necessary for me to put before the Committee a definite scheme for dealing with these matters, in accordance with instructions received. This object, I think, will be best accomplished by accepting as a basis the scheme outlined in the memorandum of the Local Government Board, which has already been circulated to the Council, and framing our requirements stage by stage. 1. Arrangements for the Local Supervision of Midwives. At the present time the local supervision of midwives in Willesden is carried out by the Middlesex County Council, but in a properly co-ordinated scheme for the care of mothers and children it will be necessary to secure that the Willesden Council is made responsible for the supervision of midwives practising in their area. Section 9 of the Midwives Act, 1902, gives power to the County Council to delegate their powers to the District Council. This section is as follows:— "A county council may delegate, with or without any restrictions or conditions as they may think fit, any powers or duties conferred or imposed upon them by or in pursuance of this Act, to any district council within the area of the county, and the powers and duties so delegated may be exercised by a committee appointed by such district council, and consisting either wholly or partly of members of the district council, and women shall be eligible to serve on any such committee. Any expenses incurred by a district Council in the execution of any powers or duties so delegated, shall, to an amount not exceeding such sum as may be prescribed by the county council, be repaid to such 235 trict council as a debt by the county council, and any excess above the sum so prescribed shall be borne by the district council as part of their ordinary expenses. The provisions of this section shall apply to the administrative county of London in like manner as if each metropolitan borough were a county district and the borough council were the district council of that district." The number of midwives practising in Willesden at the end of 1912 was 24, according to the report of the County Medical Officer. 2. Ante-natal Arrangements. (1) Antenatal clinic for expectant mothers. It is somewhat difficult to estimate the necessary provision in respect of this matter, but it may be assumed that very largely this clinc would apply to women bearing children for the first time. Having regard to the fact that a number of marriages are sterile, and that in a number of first births the marriages occurred outside Willesden, the total number of marriages occurring in Willesden per annum may be taken as the number of first births per annum, as shown in the following Table:— Table No. 5. Year. Total No. of Births. No. of Marriages taken as the No. of first births. 1909 4172 1036 1910 3923 994 1911 4001 1047 1912 4075 1147 1913 4037 1153 Average per ann. 4042 1075 236 An examination of Table No. 1 shows that the number of births attended by midwives is 38 percent. of the total number of births, and it may, therefore, fairly be assumed that 38 percent. of 1,075, or 408, is the number per annum that would make use of the Ante-natal Clinic. It may also be assumed that they would attend for five out of the nine months of pregnancy, on an average twice a month, i.e., 4,080 attendances would be made by them per annum. Assuming that the examination at the clinic occupied ten minutes per attendance, it will be noted that 680 hours would be spent per annum by a doctor at this clinic. (2) The Home Visiting of Expectant Mothers. Expectant mothers would require home visitation in a certain proportion, say one per cent., of cases, that is, a total of four out of the 408 under consideration. Such cases would probably require two visits per week for twenty weeks on the average, and the time taken to each visit might be reckoned at forty-five minutes. This represents 120 hours of a doctor's time. This estimate includes provision for an occasional home visit as may be necessary to an otherwise regular attender at the ante-natal clinic. (3) A Maternity Hospital, or Beds at a Hospital, in which complicated cases of Pregnancy can receive Treatment. Provision of this kind will also require to be made, and it is likely that about one percent. of the 408 cases attending the ante-natal clinic, or four cases in all, would require to be treated in Hospital during pregnancy. 3. Natal Arrangements. (1) Such Assistance as may be needed to insure the Mother having Skilled and Prompt Attendance during Confinement at Home. The report of the County Medical Officer for Middlesex for 1912 shows that in the whole County 11,020 births were 237 attended by midwives, and in 883 of these cases medical aid was called in. The same report shows that during that year 1,435 births were attended by midwives in Willesden, and in the same proportion it follows that in 115 confinements occurring in Willesden the midwife in attendance required the services of a medical man. Assuming that each case would occupy the time of a doctor for four hours, the total number would occupy him for 460 hours. It should be observed that the above figures do not take into account mis-carriages, of which I have already indicated there are probably at least 200 per annum in Willesden, and it is probable that a considerable call would be made on the medical officers of the Authority in respect of such cases. (2) The Confinement of Sick Women, including Women having contracted Pelvis, or suffering from any other condition involving danger to the mother or infant at a Hospital. Conditions of the kind enumerated in this heading apply not only to necessitous mothers, but to all classes of the community. 4,042 births have occurred on the average in Willesden per annum during the five years 1909-13, and probably 0.5 percent. of these cases, or twenty in all, would require operative or other hospital treatment. 4. Post-natal Arrangements.. (1) The Treatment in a Hospital of Complications arising after Parturition, whether in the mother or in the infant. (a) The Mother.—Table II. aboves hows that twenty deaths from Puerperal Fever and forty-six from other accidents and diseases of Pregnancy and Parturition occurred in Willesden during the five year period 1909-13, or, on an average, thirteen such deaths per annum. Generally, it may be taken that three times this number, or thirty-nine cases in all, would require hospital treatment per annum. 238 (b) The Infant.—During the year 1909, 133 children died under four weeks; in 1910, 129 children died under four weeks; in 1911, 140 children died under four weeks; in 1912, 133 died under four weeks; and in 1913, 128 died under four weeks; that is, 132 children on an average died each year during the past five years, 1909-13, before reaching the age of four weeks. The principal causes of these deaths are premature birth and wasting, for both of which conditions hospital treatment is required in certain cases, and provision should accordingly be made. Having regard to the fact that 38 percent. of such births are attended by midwives, and that for a certain proportion of these cases hospital treatment would be unavailing, I think the present necessity of the case would be met by providing for the hospital treatment of twenty percent. of all cases dying within four weeks, i.e., for twenty-six cases. (2) The Provision of Systematic Advice and Treatment for Infants at a Baby Clinic or Infant Dispensary. It has already been stated that 1,852 deaths of infants under one year of age occurred in Willesden during the five year period 1909-13, or on an average, 370 per annum. The number of cases of sickness bringing about these deaths would probably be at least five times the number of deaths, that is, 1,850 per annum. If we assume that 38 percent. of these cases would utilise a baby clinic, or infant dispensary, it follows that 703 cases would be in attendance per annum. Each case would be ill for a period of four weeks on the average, and would make on the average two attendances per week, that is to say, 5,624 attendances would be made by these ill babies per annum. Each examination at the baby clinic would take, on the average ten minutes, and consequently 937 hours of a doctor's time would be taken up in respect of the work of examining, advising and prescribing for unwell babies. 239 But the object of a babies' clinic is not only to examine and advise as to sick babies, but to keep under continuous observation all babies, so that diseases may be anticipated and prevented. To the above figures, therefore, should be added the total number of children born attended by midwives only, that is 38 percent. of 4,042, or 1,536. These children would probably each make one attendance per month, and therefore 18,432 additional attendances must be provided for, i.e., 3,072 additional hours of a doctor's time. In connection with the treatment of infants at a baby clinic or dispensary, and in connection with child hygiene generally, it will be necessary to arrange for a certain number of hospital beds to deal with certain classes of cases. The cases specially suitable for hospital treatment are those producing the greatest number of deaths of children, namely:— (a) Diarrhœa, Enteritis. (b) Measles. (c) Whooping Cough. (d) Bronchitis. (e) Pneumonia. (a) Diarrhoea, Enteritis. 308 deaths from these conditions, or, on the average, 61 deaths per annum, occurred among infants under one year of age during the five year period 1909-13. In epidemic years this number increases, and during the year 1911 as many as 158 deaths were certified from these causes under one year of age. It is quite certain that if the cases were placed under supervision when the first symptoms begin, a very large number of these deaths would be prevented. Hospital provision for the worst cases is a necessity, and already exists in the case of the larger municipalities. 240 Associated with the removal to hospital of the worst cases there should be an extended system of home nursing, under the supervision of the Infant Dispensaries, to assist mothers and aid in carrying out in the proper manner, the treatment and preventive measures to be applied to each case. In respect of hospital treatment, provision should be made for a number of cases equal to three times the average number of deaths per annum, i.e., 183 cases per annum. In respect of home visitation, provision should be made so that all cases have medical supervision and the skilled services of a nurse as and to the extent that may be necessary. (b) Measles. Table No. 4 above, shows that there were, on the average, during the five year period 1909-13, approximately 4,005 cases of measles per annum. I have already indicated that in respect of this disease proper nourishment, ventilation, warmth and skilled nursing are essentials. These should be supplied : (1) At the hospital, (2) At the home. 204 deaths from measles occurred during the five year period 1909-13 amongst children under five years, or 41 on the average per annum. Provision should be made for hospital accommodation for three times this number, or 123 cases, and all cases should have adequate medical attendance and nursing at home to the extent that may be necessary. (c) Whooping Cough. (d) Bronchitis, (e) Pneumonia. All the remarks made in respect of measles apply to the above diseases, with the exception that the figures require amendment in the light of the following Table:— 241 Table No. 6. Disease. Total No. of deaths under 5 years during the 5 year period 1909-13. Average No of deaths in each year during the 5 year period 1909-13. Estimated No. of cases per annum requiring hospital treatment. Whooping Cough 197 39 117 Bronchitis 147 29 87 Pneumonia 337 67 201 (3) A continuation of these Clinics and Dispensaries so as to be available for Children up to the age when they are entered on a School Register. (4) The Systematic Home Visitation of Infants and Children not on a School Register as above defined. The following Table No. 7 gives particulars of children under school age at the Census, 1911, as compared with those between the ages of five and fourteen. Table No. 7. Under 1 3562 1-2 3424 2-3 3589 3-4 3695 4-5 3514 Total under 5 years 17784 5-10 16692 10-13 8926 13-14 2844 Total School Age 5-14 years 28462 The number of children on the roll of Public Elementary Schools, including special schools, reported to the Education Committee at its meeting held 5th April, 1911, was 22,090. 242 If the same proportion of Public Elementary School Children exists between the ages of 1-5 as between the ages of 5-14, it follows that there were in Willesden at the Census of 1911, 11,038 children between the ages of 1-5, who would in the course of time be in attendance at the Public Elementary Schools. This number of children would require as much medical attention as the 22,090 children attending Public Elementary Schools, among whom (5-15 years) only 321 deaths occurred, as compared with 860 deaths which occurred amongst children between the ages of 1-5 during the five year period 1909-13. Teeth. The necessity for the care of the teeth in young children under school age is now recognised as a matter of vital importance to health. All food must enter the body via the mouth, and if decay of the teeth and oral sepsis, i.e., suppuration, are present in the mouth, harmful bacteria enter the body with the food-stuffs, and give rise to various diseases, depending upon the nature of the bacteria ingested. In connection, therefore, with Infant Welfare, it is necessary that at least one dentist should be appointed, and this practice is, in fact, in operation in several baby clinics already established. Nutrition. I have already indicated the important part that want of proper or sufficient nourishment of the mother and child plays in the deaths of infants, and the crippled health of young children. In this connection it cannot be too strongly urged that efforts made to anticipate the need for help are infinitely more valuable and less wasteful than the cure or relief of the break-down which is the inevitable result of insufficient feeding. 243 The Annual Report of the Chief Medical Officer of the Board of Education for 1911 shows that in Willesden 115,386 dinners were provided to children in attendance in Publc Elementary Schools, at a total cost of ,£1,717. These children are usually brothers and sisters of children under five years of age, and the sons and daughters of expectant mothers, and it would appear that all the reasons advanced for feeding the older children apply with even more force to the younger children and expectant and nursing mothers. The average number of births per annum during the five year period 1909-13 was 4,042, and if we assume that each mother is to be fed during five months of pregnancy, and nurses her child for a period of six months, the total number of expectant and nursing mothers who may be fed during any one year is 4,266. The total number of children under school age is 17,784. The cost of feeding the necessitous mothers and children amongst this total of 22,050 would be proportional to the cost of feeding necessitous school children. In 1911, only dinners were provided to necessitous school children on five days a week, but now the Education Committee propose to give three meals a day on seven days. If the same practice is adopted in respect of expectant mothers and children under five years of age, the estimated cost of feeding them will become £5,598 per annum. Schools for Mothers. The foregoing resume of the conditions affecting maternity and child welfare indicates especially the importance of the training of mothers, and the greatest educational value should be obtained out of the clinics and institutions which it is proposed should be established. Mothers should not only receive individual instruction in how to take care of their baby when the baby is ill, but should receive such instruction individually and collectively prior to and after the birth of the infant. 244 The fullest possible use should be made of baby clinics and infant dispensaries to instruct mothers, not only in the care and management of infants and young children and themselves during pregnancy and after confinement, but also in such allied subjects as domestic and personal hygiene, home nursing, sewing and cookery. In connection with this last matter again, the fullest possible use should be made of the kitchens to be established for the cooking of dietaries suitable to all ages, as represented by children un3er five and adult women. SUMMARY. The scope of the work as outlined in the foregoing report may be summarised in the following Table. 245 Table No. 8. Nature of work to be undertaken or provision to be made. Estimated No. of cases per ann. which will come under supervision. *Estimated No. of Assistant Medical Officers required. Estimated No. of beds required. Local supervision of midwives 24 ... ... Ante-natal Clinic 408 0.41 ... Home Visiting of Expectant Mothers 4 0.07 ... Hospital beds for complicated cases of pregnancy 4 ... 1 tSkilled and prompt attendance during confinement at home 115 0.28 ... Hospital beds for difficult cases or child birth 20 ... 2 Hospital beds for complications in in mother after birth 39 ... 3 Hospital beds for complications in infant after birth 26 ... 2 Baby Clinic 703 (ill) 1536 (under supervision) 2.4 ... Hospital beds for:— Diarrhoea, Enteritis 183 ... 56†† Measles 123 ... 38†† Whooping Cough 117 ... 36†4 Bronchitis 87 ... 13** Pneumonia 201 ... 31** Clinic for children between 1-5 years Home visitation of children between 1-5 years 11038 4.0 ... Dental Clinic for children up to 5 years, say 3-5 years 7209 1 dentist ... Feeding of expectant mothers and children up to 5 years. Schools for mothers. *The estimated time of an assistant medical officer per annum is 1656 hours. †This does not include provision for attendances at miscarriages, of which there are probably 200 per annum in Willesden. ††These figures are based on a three months' prevalence of the disease and four weeks' duration in hospital. **These figures are based on a six months' prevalence of the disease and four weeks' duration in hospital. 246 COST. Staff. Assistant Medical Officers.—The foregoing Table No. 8 shows that to cover the work required in connection with maternity and child welfare, at least seven assistant medical officers will be required. Health Visitors.—The experience in connection with the medical inspection of school children and public health work generally, shows that in order to secure the maximum service and efficiency from each medical worker, it is necessary to allocate to him four health visitors to be in attendance at the examinations as required, and to do the necessary "following up" of cases. Dentist.—In respect of the dentist to be employed, it will be necessary to allocate one health visitor to dental work. Clerks.—With each doctor, there requires to be appointed a third-class clerk. In addition to the foregoing officers, certain specialist officers will be required. Pathologist and Bacteriologist.—In connection with the work of maternity and child welfare, it will be necessary to employ a pathologist and bacteriologist, at £400 by £25 to £500 per annum. Diseases of Children.—A specialist on these diseases should be appointed to give his services as consultant at a salary of 120 guineas per annum, for three hours a week for forty weeks per annum. Skin Diseases.—These are relatively common amongst infants and young children, and the services of the Council's Specialist in respect of Ringworm, should be utilised here. His present salary is ,£100 a year for three hours per week, 247 and I think he should be appointed at the same salary as that suggested for the consultant in respect of Diseases of Children, to cover all the Council's skin work. Eye Diseases.—The Consulting Ophthalmic Surgeon, recently appointed, is paid at the rate of one guinea per hour. I think he should be appointed at the annual salary proposed to be paid to other consultants, to include all the Council's eye work. Throat, Nose and Ear Diseases.—These also require the services of a consultant, and I would suggest that he be paid at the same rate as the other consultants referred to above. Diseases of Women.—A consultant would also be required in respect of these conditions, but I would suggest that until evidence accrues as to what extent he may be called upon, that the Medical Officer of Health be authorised to employ a consultant as and when necessary, and to report *A proportion of these salaries would be repayable Out of the Education Fund. on each occasion to the Committee. The cost per annum in respect of additional staff, therefore, would be:— £ £ Seven assistant Medical Officers at salaries of £400 by £25 a year to £500 per annum 2800—3500 Existing three assistant Medical Officers to be put on the same scale (increase) 300— 600 The salaries of 28 Health Visitors at the scale salaries of £108 to £138 per annum 3024—3864 Three additional Health Visitors in respect of three existing assistant Medical Officers 324— 414 The salary of one Dentist at £300 per annum 300— 300 The salary of one Health Visitor (Dental) at a scale salary of .£108—£138 per annum 108— 138 The salaries of seven third class Clerks at the scale salaries of £80—£120 per annum 560— 840 Pathologist and Bacteriologist 400— 500 Laboratory Assistants 100— 100 Consultants—Diseases of Children 126— 126 *Skin Diseases 126— 126 *Eye Diseases 126— 126 *Throat, Nose and Ear Diseases 126— 126 Diseases of Women (say) 50- 50 Total £8470—£10810 248 Hospital Beds. In respect of the number of hospital beds required, it should be noted that the greatest prevalence of Diarrhcea and Enteritis is during July, August and September; Measles during November, December and January, and again in May and June; Whooping Cough during March and April; and Bronchitis and Pneumonia during October, November, December, January, February and March. From the above statement it will be observed that the beds required for Diarrhoea and Enteritis in the summer would be available for Measles, Bronchitis and Pneumonia in the winter, and for Whooping Cough in the spring. The beds, therefore, required for Measles and Whooping Cough and some of those required for Bronchitis and Pneumonia may be deducted, and the total number of beds which would fall to be provided for in connection with maternity and child welfare would be 71, or say, 72, to allow for administrative convenience. From the Report of the Local Government Board on Isolation Hospitals, the following information as to the price of beds is taken:— Hospital Authority. No. of Ward Blocks. No. of Beds Cost per Beo without Site. £ Acton 4 69 320 Brighouse 3 3° 398 Colne & Holme 4 5° 466 Croydon Rural 5 62 473 East Ham 3 58 306 Walthamstow 4 82 482 Waltham 4 40 336 West Ham 7 212 637 249 From the above figures it would appear that the cost per bed for a hospital to be erected in the grounds of the Willesden Isolation Hospital would be about £500 per bed, as in connection with certain maternity and other cases, provision would require to be made for operative interference. For administrative convenience it would be necessary to arrange the hospital in three blocks, each of 24 beds, or 72 in all, as follows:— Cases of pregnancy} Difficult cases of childbirth and after-} 1 ward of 12 beds}1 block of 24 beds complications in the mother or child} . Cases of Diarrhcea and Enteritis} 1 ward of 12 beds.} Measles and Whooping Cough 1 block of 24 beds. Cases of Bronchitis and Pneumonia 1 block of 24 beds. Capital Expenditure.—This hospital, therefore, would mean an estimated expenditure of approximately £36,000. Annual Upkeep.—The estimated annual upkeep, including medical and nursing assistance, may be taken at 30s. per week per bed, or a total of £5,616. Premises. Central Offices.—In connection with the work, it is necessary that there should be adequate accommodation at the Central Offices for the Health Department, and I would therefore advise that steps be taken to acquire a sufficient site in a central situation in Willesden in order to meet immediate and future public requirements. As the present scheme probably only represents a portion of the work which the Health Department will be called upon to do in future years, the central site should be one capable of meeting the full expansion of the work of the department. 250 Local Centres.—In addition, it will be necessary to establish a number of local centres, and for this it will be necessary either to have premises specially built for the purpose or to adapt existing premises, if this is practicable. Probably as a beginning it would be advisable to establish one centre in the Kilburn area and one in the Church End, Stonebridge, Roundwood area. Each centre could probably be rented at £100 per annum, and would cost, to furnish, equip, alter and decorate, say £500. In addition to the annual rent above mentioned there would be an annual outlay in respect of caretakers' wages at 35s. per week, i.e., £91 per annum. Allowing £109 for other charges, the annual cost of maintenance would become £300. Nutrition. The cost of this has already been put down at £5,598 per annum, but the above centres do not include provision for the feeding of expectant mothers and young children. This work is, to my mind, essential, and if it is to be undertaken it will probably be found necessary to have centres specially built, in order that this necessity may be met. Centres so built could also be used in respect of schools for mothers. SUMMARY OF COST. The total estimated cost indicated in respect of all the above work is as follows :— Capital Expenditure— £ Hospital accommodation 36,000 Two local centres (Baby Clinics) 1,000 Further local centres, to include provision for feeding and schools for mothers Total £37,000 251 Annual Expenditure— £ Staff 8,470 Hospital upkeep (including staff and maintenance) 5,616 Maintenance of two local centres (Baby Clinics) 600 Maintenance of further local centres Feeding 5,798 Schools for Mothers Total £20,484 It should be observed that half the above cost will be payable by the Local Government Board if the scheme of the Council is approved. Recommendations. It is obvious that to give effect to all the foregoing proposals a certain amount of time must elapse, and it may be desirable, to progress step by step. Under these circumstances I would therefore recommend that the following should be the order in which these matters should be dealt with :— 1. The Local Supervision of Midwives. Application should be made to the Middlesex County Council for the delegation of their powers to the Willesden District Council, under Section 9 of the Midwives Act, 1902. 2. The Provision of Systematic Advice and Treatment for Infant? under one year of age at a Baby Clinic or Infant Dispensary. This may be begun at once by:— (a) Establishing and equipping two local centres, as suggested, at an estimated cost of £1,000, and an annual outlay of £600. 252 (b) Making the necessary appointments, namely, a Consultant on Diseases of Children, two Assistant Medical Officers, eight Health Visitors, together with three Health visitors in respect of the three existing Assistant Medical Officers, and two thirdclass clerks involving an estimated annual cost made up as follows:— Per Annum. Consultant (Diseases of Children) £126 - £126 Two Assistant Medical Officers 800 — 1000 Three existing Assistant Medical Officers on same rate (increase) 300 — 600 Eleven Health Visitors 1188 — 1518 Two Clerks 160 — 240 Total £2574 —£3484 (c) Making the necessary provision for the housing of the increased staff, at a capital expenditure of £250 and an annual outlay of £250. 3. The provision of suitable Central Offices.. 4. The provision of a suitable number of properly equipped Local Centres, so as to enable the Council to deal comprehensively with:— (a) 1 and 2 above. (b) An Ante-natal Clinic for expectant mothers. (c) The home visiting of expectant mothers. (d) The provision of assistance to ensure the mother having skilled and prompt attendance during confinement at home. (c) The establishment of Clinics, available for children up to five years of age. 253 (f) The systematic home visitation of children up to five years of age. (g) The feeding of expectant mothers and children up to five years of age. (h) Schools for Mothers. (i) The teeth of young children. 5. The provision of 72 Hospital Beds at the Isolation Hospital. SUGGESTED RESOLUTIONS. Under these circumstances the resolution which it is suggested should be passed to meet the needs of Willesden in respect of Maternity and Child Welfare are as follows:— 1. That the necessary steps be taken to put into ation (1) and (2) (a) (b) and (c) under recommendations above. 2. That the Medical Officer be instructed to report as to suitable sites and premises in connection with (3) and (4) under recommendations above. 3. That the Engineer be instructed to prepare and submit plans as to (5) under recommendations above. 4. That this report be forwarded to the Local ment Board for their approval, so that the full grant may be obtained by the Council for their Maternity and Child Welfare work. I am, Your obedient sen ant, GEORGE F. BUCHAN, Medical Officer. 254 APPENDIX E. The Treatment of Ringworm. Municipal Offices, Dyne Road, Kilburn, N.W., 19th October, 1914. To the Chairman and Members of the Children's Care Committee, Treatment of Ringworm. I beg to report on the above, in accordance with the following instructions of the Children's Care Committee, given at their meeting on the 28th September last:— "Treatment of Ringworm. Treatment of Teeth. "We have directed the Medical Officer to submit to us at our next meeting a report dealing with the above matters, especially having regard to the long periods which elapse before X-Rays can be applied in the majority of cases of ringworm." Ringworm. The Ringworm Clinic was opened on the 30th August, 1913, and the following Table shows the number of cases of ringworm coming under observation during the periods mentioned, together with the number discharged as cured. No. of Weeks. Period ending. No. of cases. No. of cases discharged as cured. 4 4-10-13 27 2 4 1-11-13 24 10 4 29-11-13 29 8 4 27-12-13 19 16 4 24- 1-14 30 12 4 21- 2-14 56 18 4 21- 3-14 55 18 4 18- 4-14 55 11 4 16- 5-14 66 31 16 5- 9-14 144 75 4 3-10-14 33 11 56 538 212 255 From the above Table it will be seen that 538 cases of Ringworm came under observation during the fifty-six weeks ending 3rd October, 1914, the period during which the Clinic has been opened, and that of this number 212 were discharged cured. At the 3rd October, 1914, 141 cases of Ringworm were known to exist amongst school children in the District, 123 of which were in attndance at the Ringworm Clinic. Eightythree of this latter number were awaiting the application of X-Rays. The difference between these figures and the total of 538, namely 185, represents cases which have been dealt with by agencies other than the Clinic, or have left the District and been lost sight of. Of the 212 cases discharged as cured from the Clinic it should be observed that 101 were cured by X-Rays (i.e., cases of Ringworm of the Scalp), and the remaining 111 were cured by other treatment (i.e., cases of Ringworm of the Skin). From these figures it will be noted that in order to cope with the 83 outstanding cases of Ringworm now bwaiting application of X-Rays, forty-six weeks must elapse. Taking this fact into consideration, and also that practically ten new cases of Ringworm come under observation each week, it is necessary in order to cope with fresh cases as they occur that the existing Clinic should be opened on five half days of the week for three hours each day. Dr. Haldin Davis, who is at present employed for the treatment of Ringworm is paid at the rate of ^100 per annum for three hours per week, and his attendance for a period of five half days per week of three hours each would cost ^500 per annum, while the whole time services of one Health Visitor would also be required, making a total of ;£608 per annum. I do not, however, propose to recommend this course to the Committee, as, having regard to the number of 256 ditions still requiring treatment, I do not think such an arrangement the most economical. Conditions occurring amongst School Children still requiring Treatment. The conditions occurring amongst school children for which provision for treatment still requires to be made are: (1) The Outstanding Cases of Ringworm. (2) Diseases of the Skin other than Ringworm. (3) Diseases of the Nose and Throat. (4) Diseases of the Ear. (5) Malnutrition and Anaemia. Diseases of the Skin.—'The diseases of the skin other than ringworm, which commonly occur amongst school children, are Scabies, Eczema, Impetigo, Sores, Acne, etc. These conditions easily yield to simple treatment if properly and efficiently carried out. They are, however, frequently the cause of long absence from school, owing to want of treatment or to treatment improperly carried out. In a special return presented to the Education Committee in 1912 it was shown that 89 cases of Scabies came under the notice of the School Medical Officer, between January 9th, 1911, and July 1th, 1912. These cases lost 7,074 attendances, the average period of exclusion in each case being eight weeks. Scabies is a condition which should recover in the course of one week by proper treatment, and much school time would therefore be saved by establishing treatment for this and other skin conditions. The Annual Reports of the School Medical Officer for 1912 and 1913 show that 1,308 cases of skin diseases, including Ringworm, were brought under notice in 1912, and that 1,126 cases of skin diseases, excluding Ringworm, came under notice in 1913. 257 Diseases of the Nose and Throat. The following Table shows the number of cases of these diseases which came under notice in the course of medical inspection in the year 1912 and 1913:— 1912. 1913 No. of observations 9867 9343 No. with enlarged tonsils only 1883 1741 No. with adenoids only 279 250 No. with enlarged tonsils and adenoids 905 924 No. of mouth breathers 533 463 No. with nasal catarrh 239 205 No. with fauces congested 8 10 No. with polypus 2 2 No. with other diseases of the nose and throat 93 52 Total diseases of nose and throat 3942 3647 From the foregoing Table it will be noted that 3,600 children in 1912, and 3,378 in 1913, or 36 per cent, of all 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 dullness 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 the cost of treatment would be amply repaid in the improved health and attendance of children who suffer. 258 Disease of the Ear. The following Table shows the results of observations made in the course of Medical Inspection in respect of these diseases in the years 1912-13:— 1912. 1913. No. of observations 9867 9343 No. with "running" ears 142 104 No. with other diseases of the ear 27 17 In connection with this Table it may be said that the 142 children in 1912 and the 104 in 1913 suffering with "running" ears are in 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. In addition, it should be noted that the cost of educating a deaf child in a residential school is about ^50 per annum, and in a day school about ^18 per annum, while the cost of educating the normal child is less than ^6 per annum. The Annual Report of the School Medical Officer for 1912 shows that 939 children suffering from one or other of the above conditions came under notice during the year, and that, in 1913, 905 such cases came under notice. These conditions are exceedingly important, and children suffering from them should receive adequate and proper attention under medical supervision. Malnutrition and Anaemia are most commonly the forerunners of consumption, which condition can be prevented by building up the bodies of the children under good hygenic conditions. Children, therefore, suffering from these conditions should in many cases receive school meals selected with a proper regard to sufficiency and suitability. Cod Liver Oil and Malt Extracts are also valuable adjuncts in Malnutrition and Anæmia. 259 this connection. With a large expenditure on the provision of school meals and other remedies it is wasteful to neglect the home conditions which may be undoing the good obtained by the remedies above suggested. Every possible step, therefore, should be taken to co-ordinate this work of improving home conditions with other ameliorative health measures, viz., the provision of school meals and medical treatment, especially in respect of children suffering from I he conditions above mentioned. Summary of conditions occurring amongst School Children still requiring treatment at School Clinic. The following Table summarises the number of cases still requiring treatment at a School Clinic:— 1912. 1913 *Outstanding cases of Ringworm Diseases of the Skin, including Scabies, Eczema, Impetigo, Sores, Acne, etc 1308 (including Ringworm) 1126 (excluding Ringworm) Diseases of the Nose and Throat 3942 3647 Diseases of the Ear 169 121 Malnutrition and Anaemia 939 905 *The number of cases waiting for X-Ray treatment at 3-10-14 was 83. The great bulk of the above work, including the X-Ray treatment for Ringworm for the cases in arrears could be carried out by employing the services of one whole-time Assistant Medical Officer, supported by an adequate staff of Health Visitors. Certain special assistance would also be necessary. Diseases of the Skin. In certain cases difficulties in respect of diagnoses and treatment arise from time to time, especially in the more chronic conditions, and I should therefore advise that Dr. 260 Haldin Davis, who is at present employed only for the treatment of Ringworm, should be employed as Consulting Dermatologist. Diseases of the Nose, Throat and Ear. Similar difficulties in respect of diagnosis and treatment arise in connection with these diseases, and, in addition, operative treatment is from time to time necessary. I would therefore advise that the Committee should employ a consultant in respect of these diseases, to carry out such operations as may be necessary, and consult in cases of special difficulty. A certain number of hospital beds would be required for operation cases. The Health Committee at tht present time have under consideration the extension of their hospital accommodation, and I would suggest that the Council be approached with a view to providing six beds necessary for operations in respect of diseases of the nose, throat and ear occurring amongst school children. 261 Summary of Work and Cost. The following Table shows the relative work and cost involved in the foregoing proposals. Proposals relating to ringworm only. Proposals recommended relating to Ringworm and other conditions occurring amongst school children still requiring treatment. Work to be done Approx. No. of cases per annum. Approx. No. of cases per annum. Ringworm 500 Ringworm 500 Diseases of the Skin other than Ringworm 1000 Diseases of the Nose and Throat 3800 Diseases of the Ear 150 Malnutrition and Anæmia 900 Total 500 Total 6350 Staff required Time of Specialist for 5 half-days 1 Assistant Medical Officer at £400— £500 per annum. of 3 hours each per week at 4 Health Visitors each at ,£108—^138 per annum. £500 per ann. 1 Third Class Clerk at £80—£120 per annum 1 Health Visitor at £108-£138 per annum Consulting Dermatologist for 3 hours a week for 40 weeks at £126 per annum. Consultant on Diseases of the Throat, Nose and Ear for 3 hours a week for 40 weeks at £126 per annum. Capital Charges No additional 6 Hospital beds with necessary equipment for operations, etc £3000 Equipment of Clinic for Disease of the Skin other than Ring worm S £30 Equipment of Clinic for Disease of the Nose, Throat and Ea £50 Linoleum, Blinds, Furniture Decorating, Plumbing, etc £80 Annual Charges £608 Upkeep of Hospital Beds, in eluding repayment of capita charges, etc £546 Staff £1164 Rent of Clinic £50 Upkeep of Clinic £100 Half of the above charges are repayable by the Board of Education. 262 It may be pointed out that some time will elapse before it is likely that hospital beds will be available, and that, meantime, the other portion of the scheme, involving an estimated capital outlay of £160, and an estimated annual charge of £1,314, half of which charges are repayable by the Board of Education, may be undertaken. Recommendations. (1) That the necessary alterations be made at 225, High Road, Kilburn, for the treatment of Skin Diseases, in addition to Ringworm, at an estimated cost of £30. (2) That a Clinic be established in suitable premises for the treatment of Diseases of the Throat, Nose and Ear, Malnutrition and Anasmia, at an estimated capital cost of £160, and an estimated annual maintenance of £1,314. (3) That the following staff be appointed:— (a) An Assistant Medical Officer, at £400, by £25 per annum, to £500 per annum. (b) Four Health Visitors, at the scale salaries of £108 to £138 per annum. (c) A third-class clerk, at the scale salary of £80 to £120 per annum. (d) Dr. Haldin Davis, as Consultant Dermatologist, at a salary of £126 per annum for forty attendances of three hours each. (e) A Consultant on Diseases of the Throat, Nose and Ear, at a salary of £126 per annum, for forty attendances of three hours each. 263 (4) That the Council be requested to provide six beds and the necessary equipment for operations for the operative treatment of Throat, Nose and Ear Diseases occurring amongst school children. (5) That this report be forwarded to the Board of cation for approval. I am, Your obedient servant, GEORGE F. BUCHAN, Medical Officer. APPENDIX F. The Treatment of Teeth. Municipal Offices, Dyne Road, Kilburn, N.W., 19th October, 1914. To the Chairman and Members of the Chidren's Care Committe, Treatment of Teeth. I beg to report on the above, in accordance with the following instruction of the Children's Care Committee, given at their meeting on the 28th September last:— "Treatment of Ringworm—Treatment of Teeth.—We have directed the Medical Officer of Health to submit to us at our next meeting a report dealing with the above matters, especially having regard to the long periods which elapse before X-Rays can be applied in the majority of cases of ringworm." The Committee will remember that I submitted a report on the Treatment of Teeth on the 26th January, 1914, in 264 accordance with instructions received. (Minutes of the Education Committee, 3rd December, 1913, page 393.) This previous report was associated with certain proposals in respect to the treatment of eyes. The present report in respect of the treatment of teeth practically reproduces the previous report, except that provision for the treatment of teeth is considered separately. Amount of Dental Decay.—The following Tables show the extent to which decay of 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 these children. 1909 5633 38 1741 2.4 1010 5594 37 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 646 2377 24.0 1913 9343 5654 60s 2112 22.6 The foregoing Tables reveal a large amount of dental decay amongst scholars. Causes ok Dental Decay.—The decay of teeth is due to many causes, e.g.— 1. Failure to keep the teeth clean. 2. Over-lapping, irregularity, or too close an ment of the teeth in the gums, preventing the teeth being thoroughlv cleansed. 265 3. The consumption of sloppy food-stuffs and the sequent 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, abcess of glims, 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. Thirty-one per cent, of the children medically inspected during 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. 266 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 ot 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 of 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 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 (pp. 196 and 197). 267 "Basis of a Satisfactory Dental Scheme. "As a result of the experience gained in the working of dental schemes in different parts of the country, it appears to be necessary for the satisfactory working of a scheme of 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 for the School Medical Officer 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 for conservative dental treatment, and are competeni 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 six—eight 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 by filling rather than by extraction. Conservative dentistry 268 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 bv 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 (o) 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.—There is no space now available at the School Clinic at 225, High Road, Kilburn, for a Dental Clinic, and I would advise, therefore, that the necessary premises be obtained elsewhere. Cost of Dental Clinic.—The cost is estimated as follows:— Capital Charges. £ s. d. Dental Outfit 80 0 0 Linoleum, Blinds, Furniture, Plumbing, etc. 60 0 0 Total £140 0 0 269 Annual Maintenance Charges. £ s. d. Salary of Dentist 300 0 0 Salary of Health Visitor (Scale £108—£138) 108 0 0 Rent 30 0 0 Dental Requisites 60 0 0 Miscellaneous 22 0 0 Total £520 0 0 Half of the above expenditure, both capita' and maintenance, is repayable by the Board of Education, so that the total charges to the Education Committee would be— Capital Account £70 Annual Maintenance Account £260 Recommendations. The recommendations involved in the above proposals are:— (1) The establishment of a Dental Clinic, at an estimated capital cost of £140. (2) The appointment of a whole-time Dentist, at a salary of ^300 per annum. (3) The appointment of a Health Visitor at a scale salary of £108—^138. I am, Your obedient servant, GEORGE F. BUCHAN, Medical Officer. 270 APPENDIX G. Municipal Offices, Dyne Road, Kilburn, N.W., 16th November, 1914. To the Chairman and Members of the Children's Care Committee. Re Dust Allaying Materials. I beg to report on the above matter, in accordance witn the instructions of the Education Committee given at their meeting of July 1st, 1914. In connection with the above instructions I addressed the following letter to Head Teachers on the 3rd September last:— "Dust Allaying Materials.—The Education Committee has issued from time to time the following instructions regarding the above matter:— "(1) That the slipperiness, dirtiness and dark appearance of the floors, caused by dust allaying materials, could be diminished if the amount and frequency of the application were considered in connection with the nature of the floor, i.e., boarded or blocked, old or new. "(2) That slipperiness could be further diminished by the application of non-slip powder. "(3) That the accumulation of greasy dirt on the floors could be diminished by more frequent and vigorous brushing. "(4) That the floors should be washed at least three times a year, namely, during the periods ending respectively at the Easter, Midsummer and Christmas holidays. 271 "(5.) That the Caretakers and Cleaners act under the direction of the head teachers with regard to the application of dust allaying materials. "(6) That Mersal non-slip powder and Dusmo be placed on the requisition lists for use in the schools, and the necessary quantities ordered by the head teachers as and when required ; the cost, however, not to be a charge against the allowance per scholar for stock and stores." The Education Committee, at their meeting on 1st July last, passed the following report of the Children's Care Committee:— "Dust Allaying Materials. (10) "We have received a report from the Clerk of Works in regard to the use of dust allaying materials and their effect on the wood floors of the schools. We have asked the School Medical Officer to report to us on the whole question of dust allaying preparations and school cleaning." At the same time I was instructed to obtain as far as possible the opinions of Head Teachers regarding the use of dust allaying materials, and I should be much obliged for any observations you may have to make on the subject. So far as I have been able to ascertain, the advantages and disadvantages of oily dust allaying preparations, for example, Mersal or Dustolio, may be set out as follows :— Advantages. 1. Dust allayed. 2. Breathing of children and teachers improved. 3. Sore throats less frequent. 4. Loss of voice of teachers less frequent. 5. Labour of floor scrubbing practically abolished. 272 6. Dusting less. 7. Re-decoration required less frequently. 8. Gas mantles last longer. 9. Sleeves of teachers not so quickly soiled by dust. 10. Dust on stock diminished. 11. It has also been alleged that the floor lasts longer, on account of less frequent washing. Disadvantages. 1. The floor surface is made slippery, especially after a fresh dressing, and this prevents the infants playing with "abandon," and increases the liability to falls. 2. The floor surface is made dirty, and thereby Kindergarten games are interfered with, the children being prevented from sitting or kneeling on the floors. Similarly articles falling on the floors, e.g., paper or needlework, and teachers' skirts, especially when sitting, are soiled. 3. The floor is given a dark and dirty appearance, and does not, therefore, present to the children a good object lesson in cleanliness. At the same time, the bright and cheerful aspect of the class-rooms, so necessary in infants' schools particularly, is diminished. 4. Greasy dirt accumulates on floors, and is carried by the boots of scholars and others to steps, which are thereby rendered more slippery. 5. Increased cost of preparation. 6. Increased labour of sweeping. 7. Inflammability. From experiments conducted by myself it has appeared that oily dust allaying preparations increased the inflammability of the wood. 273 You will observe, however, that the Clerk of Works has raised the question of the effect of these materials on the wood floors, and I should be obliged for any observations you may have to make as to the result of your experience in your school on this subject. I may say that I am also communicating with the Architect of the Education Committee thereon. As to the question of school cleaning, it has been suggested that the accumulation of greasy dirt which occurs is not advantageous, and should be removed. It would appear that this can be done with vigorous brushing or washing, either method effectively carried out probably involving the same amount of labour. I should, therefore, be glad if you would kindly consider this point, and also how often you think your school ought to be washed (no dust allaying materials being used), so that the atmosphere may remain approximately as free from dust particles as it does now with dust allaying preparations in use. Please consider the whole question of dust allaying preparations versus school cleaning, as on trial, and let me have any opinions you may have to offer as to the relative advantages of the two methods, or any other points arising out of this letter as the result of your own experience and observations. "I shall be glad to have a reply at your convenience, and, if possible, before Monday, 14th September, 1914." Effect of Dust Allaying Materials on Floors. Only a few Head Teachers reply as to the effect of this material on the wood floors, and these replies indicate that they have not observed any deleterious effect on the floors from the use of dust allaying materials. In the same connection, the Architect writes on the 17th September, 1914, as follows:— 274 "In reply to your letter of the 2nd instant, I am of opinion that Mersal non-slip powder and Dusmo cannot have an injurious effect on the wood floors; nor can Mersal be injurious, provided it is not used sufficiently frequently to unduly soften the wood. "Frequent washing has an extremely injurious effect upon block floors, causing the blocks to swell, shrink, work loose and splinter." Accumulation of Greasy Dirt. As to the question of the accumulation of greasy dirt on the surface, which is one of the main disadvantages of oily preparations, it would appear from the replies of the Head Teachers that this can be minimised by the application of smaller quantities of the oily preparation. In addition, it is recommended that the quantities used should be applied mainly where the preparation has been worn off. Vacuum Cleaning Apparatus. I may say that I have experimented respecting the removal of the accumulations of greasy dirty with a Portable Electric Vacuum Cleaning Apparatus, at one of the schools for a week, but the opinion of the head teacher, the caretaker, and myself was that this apparatus was not of sufficient power to be of use for school purposes. For some time back I have been in communication with another firm as to a Fixed Electric Vacuum Cleaner, but as this firm has German associations I am unable to proceed further in the matter. General Opinion and Conclusions. The general opinion from the evidence which I have accumulated from head teachers appears to be:— 275 (1) That the advantages and disadvantages are generally accurately set out in my letter to head teachers of the 3rd September last. (2) That the advantages outweigh the disadvantages. (3) That the most important element in the prevention of any accumulation of greasy dirt on the surface of the floors is proper discrimination as to the quantity, place of application, and time of application of the preparation in question. Under these circumstances, I am not in a position to make any recommendation to the Committee regarding the use of dust allaying materials and school cleaning, at present, but think it desirable that it should be impressed upon head teachers that they have power to discriminate on the lines suggested in item (3) above, within the limits of the instructions issued to them by the Education Committee. I am, Your obedient servant, GEORGE F. BUCHAN, Medical Officer. APPENDIX H. Municipal Offices, Dyne Road, Kilburn, N.W., 19th November, 1914. To the Chairman and Members of the Children's Care Committee. Payments for Spectacles. On the 17th August, 1908, the Board of Education issued Circular (596), in which appeared the following paragraph relating to the provision of spectacles:— 276 "Provision of Spectacles, etc.—In cases where medical inspections show that the provision of spectacles is necessary for the treatment of defective eyesight, the Board will be prepared to consider proposals 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." Since the 7th of June, 1911, up to the present time, spectacles have been provided by the Willesden Education Committee, with the sanction of the Board of Education, through voluntary hospitals and approved opticians, the parents contributing a proportion of the cost of the glasses provided. Under this arrangement, since the date above mentioned up to and including the 23rd November, 1914, 435 pairs of spectacles have been provided at a total cost of £73 13s. Of this cost the parents have promised to contribute jQ20 4s. Id., but only ^8 3s. 2d. has, in fact, been paid. The deficit, therefore, is £12 0s. lid. The report of the Auditor of the Local Government Board of the accounts of the Education Committee for the year ending 31st March, 1913, contained the following :— "I have found it impossible to check the sums recovered in respect of the cost of spectacles supplied to children, and would suggest that an account in regular form should be kept, showing the cost of every pair of spectacles supplied, the amount to be re-paid in each case, the amounts received, written off, and outstanding." 277 This report was duly considered by the Education Committee at its meeting on the 3rd and 4th of June, 1914, when the following report was passed :— "We have considered that portion of the report of the Local Government Board Auditor referring to the provision of spectacles which has been referred to us by the Education Committee. We recommend— "(b) That it be referred to the officers concerned to take any necessary action to meet the views of the Auditor in regard to the expenditure for the provision of spectacles." I have been in consultation with the Accountant regarding this resolution of the Committee, and in order to comply he is of opinion that a register with the following heads would be necessary :— (a) Date. (b) Official Order No. (c) Cost of spectacles. (id) Name and address of child. (e) Date of birth of child. (/) School and department child attending-. (g) Name and address of person undertaking to contribute to cost. (h) Amount to be contributed as fixed by mittee. (») Initials of School Medical Officer. (;) Amount received by Health Visitors. (k) Receipt number of Health Visitor. (l) Irrecoverable— (i.) Difference between actual and agreed contributions. 278 (ii.) Written off on account of being unco llectable. (iii.) Reason. (m) Date of Committee's resolution authorising writing off. (n) Amount carried forward. (o) Payments to Cashier. (i.) Amounts. (ii.) Date. (iii.) Receipt No. of Cashier. (p) Remarks. From these headings it will be observed that the clerical work involved over a period of 3£ years to collect £12 Os. lid. in respect of 435 pairs of spectacles would cost more than the proportion of the £12 Os. lid. which would be actually recovered. The Board of Education on the 11th July last, when considering the new proposals of the Education Committee relating to the treatment of eyes wrote as follows:— "I am to add for the information of the Authority that as indicated in paragraph 4 of Circular 792, the Board regard arrangements for the further examination of cases of defective eyesight as coming under the head of ancillary work and not under that of medical treatment proper. The question whether ancillary work as a whole or any particular form of it is medical treatment within the meaning of the Local Education Authorities (Medical Treatment) Act, is a question which can only be definitely determined by a Court of Law, and it is not one on which the Board can express an authoritative opinion. The Board, however, are disposed to regard refraction work as not being medical treatment within the meaning of the Act, and they consider it undesirable that a charge should be made for it." 279 Under these circumstances, and having regard to— (a) The extract from the letter of the Board above quoted; (b) The fact that every endeavour has been made during the past 3$ years to obtain the provision of spectacles by the child's parents or by voluntary associations, as required by Circular 596 above quoted, with only partial success, as shown by the fact that only 435 pairs of spectacles were provided during the past 3J years, as against 499 cases awaiting treatment (mainly the provision of spectacles) at the Eye Clinic on the 31st October, 1914; (c) The fact that the cost of keeping a register in the form above required, would be considerably more than the actual amounts recovered; I think that the Education Committee might take into consideration the advisability of passing a resolution to exclude spectacles from the procedure indicated by the Auditor under the Local Education Authorities (Medical Treatment) Act of 1909, especially as in view of the Board's letter of the 11th July last it appears doubtful if the provision of spectacles comes within the scope of Section 1 of the Act in question. This section 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 280 require the payment of that amount from that parent, and any such amount may be recovered summarily as a civil debt." I am, Your obedient servant, GEORGE F. BUCHAN, Medical Officer. APPENDIX I. Provision for Small Pox Patients.—Kingsbury Hospital. Municipal Offices, Dyne Road, Kilburn, N.W., 8th December, 1914. To the Chairman and Members of the Hospital Committee. Small Pox Hospital, Kingsbury. The Clerk of the Council informed me on the 28th November last that the purchase of land for the purposes of the above Hospital had been completed. Under these circumstances it is necessary to consider what provision should be made for cases. The last outbreak of Small Pox occurred in 1902, when 88 cases were notified, of which 76 were admitted to the Hospital at Kingsbury between February 22nd, 1902, and June 14th of the same year. The Hospital was open in that year from February 22nd until July 5th. Estimated number of cases to be treated at any one time. The greatest number of cases at any one time in the Hospital during the last outbreak is indicated in the follow- 281 Following Table, which gives the average daily number of patients in the Hospital during the weeks when this number was greatest. Year 1902. Week ending— Average Daily Number of Patients. March 8th 25.8 March 15 th 28.5 March 22nd 28.7 March 29th 23.5 From these figures it may be assumed that the greatest number in Hospital on any one day during the epidemic of 1902 was, say, thirty. In 1902 the population of Willesden was estimated at Midsummer at 122,211. The Midsummer population ot 1914 was estimated at 106,634. If an outbreak of equal prevalence to that of 1902 should now occur, it would appear from these figures that the greatest number of patients who might be under treatment in Kingsbury Hospital on any one day during the epidemic would be 41; for administrative convenience, say 47. Existing Accommodation.—On April 23rd, 1912, a fire occurred at Kingsbury Hospital, which demolished the Administration Block and certain ward accommodation. The Insurance Co. paid ^937 19s. lid. on account of the damage done. The accommodation left and now existing at Kingsbury Hospital is:— One Ward of fourteen beds, with sanitary annexe. One Ward of six beds with sanitary annexe. One Ward, kitchen with scullery, storage accommodation and W.C. (now used by Caretaker). 282 Three small Wards of one bed each (now used by Caretaker). Proposal No. 1.—The existing accommodation provides a nucleus of 23 beds, and this number would suffice at the beginning of an outbreak of Small Pox, and could be added to as and when necessary during the course of an epidemic by the erection of suitable huts of a temporary character. It this course were adopted it would be necessary to erect an administrative block capable of housing the staff for twentythree patients, and providing for the requirements of forty* seven patients and staff. The excess staff when the number of patients should exceed twenty-three would similarly have to be housed by the erection of suitable huts of a temporary character. Proposal No. 2.—On the other hand, the Committee may desire to provide for all possible emergencies by completing a hospital for forty-seven patients now. 283 The following Table shows the necessary additions at Kingsbury in respect of each of the foregoing proposals:— Proposal No. 1. Proposal No. 2. One kitchen large enough to cook for 80. Ditto. One large scullery. One pantry. One provision store. One linen store for patients. One linen store for staff. One mess and sitting room combined, for twelve nurses. One mess and sitting room combined, for twelve maids. One mess and sitting room for youth porters. One bath and one W.C. and two wash hand basins for twelve nurses. One bath and one W.C. and two wash hand basins for twelve maids. One bath and one W.C. and one wash hand basin for youth porters. One doctor and matron's office. One dispensary. One bedroom, one sitting room, bath, W.C. and lavatory accommodation for doctor. One bedroom, one sitting room, bath, W.C. and lavatory accommodation for matron or sister. One box room for nurses and maids.- One maids' pantry. Three rooms for general porter and caretaker. Seven bedrooms for seven nurses. Twelve bedrooms for twelve nurses. Seven bedrooms for seven maids. Twelve bedrooms for twelve maids. One bedroom for youth porter. Two bedrooms for two youth porters. Temporary huts for patients and additional staff to be added as required. One pavilion of twenty-four beds. 284 In connection with the adoption of either of the foregoing proposals, the following matters also require attention :— Alterations to Existing Pavilion.—These are:— 1. The enlargement of the Ward Linen Store to at least double its present capacity. 2. The provision of a wash-hand basin for the use of th i staff. 3. The replacement of the sink in the scullery by one of suitable depth and size. 4. The replacement of the sinks in the Sanitary Annexes to the Ward by wash-hand basins. 5. The replacement of the slop sinks by linen sluice sinks. 6. The provision of a small room attached to each tary Annexe for the discharge of patients. 7. The conversion of the three rooms now used by the Caretaker into three separate wards for isolation, observation or special cases, as might be necessary. 8. The necessary repairs. Alterations to the Outhouse.—These include :— 1. Provision for coals, both house coal and steam coal. It is desirable that the latter should be stored near the boiler. 2. The enlargement of the steeping chamber to take in the two small adjacent chambers. 3. Repairing the mortuary. 4. The conversion of an existing chamber into a shop for general repairs. 5. The conversion of an existing chamber into a niture, etc., store. 285 Heating.—The heating of the Pavilions and the Administration Block should be by hot water radiators, In addition, stoves or open fireplaces should be provided to be used as and when required. Lighting.—I am informed that the Metropolitan Electric Supply Co. have a cable extending to within half-a-mile of the Hospital. Under these circumstances the installation of electric lighting would be desirable. Sewage Disposal.—This matter will require consideration. In any case, whatever system of treatment is adopted, I do not think it is possible to treat without nuisance occurring, and nuisances would be more liable to occur with the hospital constantly in use, the land or bacteria beds therefore not receiving rest. Under these circumstances I do not think at the present time it is possible to contemplate the use of Kingsbury Hospital continuously, and it will, therefore, only be in use during Small Pox epidemics, or during epidemic periods of exceptional prevalence to relieve possible overcrowding at Dog Lane Hospital. Minimum Provision at Minimum Cost.—Under the conditions mentioned in the foregoing paragraph, it would appear desirable that only the minimum provision should be made at Kingsbury Hospital, at a minimum cost. I am of opinion that the provisions outlined in either of the proposals above are minimal provisions, and cannot very well be reduced, and every possible economy should be effected in construction. The Sub-Committee which inspected various forms of so-called temporary structures were of opinion that brick and slate or tile was the cheapest form of construction, having regard to the fact that it appeared from the enquiries of the Sub-Committee that the cost of these temporary structures is about 75 per cent, of the cost of similar structures erected 286 in brickwork, and the loan period of the former is about fifteen years, as against thirty years in respect of the latter. In connection with this subject, the following points from the Board's memoradum on the Provision of Isolation Hospital Accommodation by Local Authorities (dated May, 1902), and a Report to the. Board on Isolation Hospitals (dated July, 1912) should be noted:— "Site.—The site, or so much of it as is to form the grounds of the hospital, should be enclosed by a wall or close fence at least six feet six inches in height, and every building which is to contain infected persons or things should be at least forty feet distant from the boundary. (In very unfrequented situations a stout hedge or shrubbery between two rows of barbed wire fencing or unclimbable iron railing may sometimes suffice in place of a wall or close fence.)" (Memorandum, 1902.) "Hospital Buildings.-—These should be of three classes, viz., 1st, ward-blocks for the reception of the sick; 2nd, administration block for the housing of the staff and stores; and 3rd, out-offices, as laundry and mortuary. In hospitals for permanent use these buildings should be of brick and stone. Temporary buildings, as, for instance, buildings constructed of wood or corrugated iron, are illsuited for permanent use as hospitals, for the reason that it is difficult to maintain them at a proper temperature during extremes of hot and cold weather; moreover, they are less durable than brick or stone buildings, requiring more frequent repairs, in order to keep them in a properly weather proof condition, and they are liable to be destroyed by fire and storm. It is not the practice of the Local Government Board in ordinary cases to sanction loans for iron hospitals or for hospital buildings of temporary character." (Memorandum, 1902.) 287 "Timber buildings deteriorate more rapidly than brick or stone ones when unoccupied. For a frame building covered externally with weather-boarding or corrugated iron, and lined internally with plaster or incombustible material (not match-boarding), a period of loan of ten or twelve years, or perhaps even fifteen years, might appropriately be allowed. (The period allowed by the Board for a building of brick or stone is thirty years.) But in the later years of its life a frame building would require frequent expenditure on repairs to keep it in a habitable condition, and it would be undesirable that instalments of repayment of loan should have to be made at the same time. "The Board would no doubt be willing to sanction the use in hospital construction of the more recently introduced materials and methods in any case in which they could be shown to be cheaper than the ordinary materials in use in the locality. The report of the Departmental Committee of the Board of Education already referred to recommended that Local Education Authorities should be encouraged to submit proposals for the use of novel materials or methods of construction for public elementary schools, and that a loan period of thirty years should be regarded as normally appropriate to such cases, instead of the period of fifty years allowed in cases where ordinary methods are used, but that it should be made a condition of approval that provision should be made for the periodical inspection of the structure. "It must be remembered that as many of these special materials are not impervious to moisture, buildings constructed of them require to be coated with cement on the outside, and that owing to the thinness of the walls more lample provision for warming is necessary than in brick or stone buildings. Until experience has been obtained of 288 their durability the loan period for such buildings should probably be shorter than for those of brick." (Report, 1912.) I am, Your obedient servant, GEORGE F. BUCHAN, Medical Officer. APPENDIX J. Provision of Meals. Municipal Offices, Dyne Road, Kilburn, N.W., 23rd December, 1914. To the Chairman and Members of the Provision of Meals Special Sub-Committee. Provision of Meals. At the meeting of the Sub-Committee held on Monday, the 14th December, 1914, I was instructed to report on the above subject, and to formulate a scheme which, in view of the grants-in-aid now to be made, would meet the requirements of the Board of Education. Historical Review. In order that the Committee may be in a position to place the Feeding of School Children on a sound basis, and in proper relationship to the other activities of the Authority, it may be well in the first instance to review the position briefly from the historical aspect. So far as records are available, it would appear that the feeding of school children began during the last twenty years of the nineteenth century, when funds were raised in several of the large towns on a purely voluntary basis for 289 this purpose. These voluntary agencies had in view the giving of charitable aid to the poorest classes of the population, and the children fed were those who attended school in an ill-nourished, ragged and neglected condition. The first official reference to the subject of Feeding of School Children is to be found in the report of the Royal Commission on Physical Training (Scotland), which was appointed in 1902, and reported in the following year. This Committee represented the need for the Medical Inspection and Feeding of School Children. The following extract from the report relates to the subject of feeding :— "We consider that the question of the proper and sufficient feeding of children is one which has the closest possible connection with any scheme which may be adopted for their physical, and equally for their mental, work. It is evident that among the causes which tell against the physical welfare of the population, the lack of proper nourishment is one of the most serious. The subject demands special notice, not only as regards the existing state of affairs, but still more in view of any increase of physical training throughout the State-aided schools which may commend itself." In September, 1903, the Physical Deterioration Committee was appointed, and presented its report in 1904. This Committee likewise recommended both the Medical Inspction and Feeding of School Children. In March, 1905, the Marquis of Londonderry, then President of the Board of Education, appointed a Committee, whose terms of reference were as follows :— "(1) To ascertain and report on what is now being done and with what result in respect of Medical Inspection of Children in Public Elementary Schools. "(2) And, further, to inquire into the methods employed, the sums expended, and the relief given by various 290 voluntary agincies for the provision of meals for children at Public Elementary Schools, and to report whether relief of this character could be better organised, without any charge upon public funds, both generally and with special regard to children who, though not defective, are from malnutrition below the normal standard." This Committee reported on the 9th November, 1905. On the 21st December, 1906, the Education (Provision of Meals) Act, 1906, was passed, and this Act has been made use of in the area administered by the Willesden Education Authority up to the present time. In the same year proposals for the Medical Inspection of School Children were placed before Parliament in the Education Bill of 1906, but these were abandoned on the withdrawal of the Bill as a whole. The proposals regarding Medical Inspection, however, re-appeared in the Education (Administrative Provisions) Act, 1907, and duly came into operation on the 1st January, 1908. From the foregoing review it will be seen that in the minds of the legislature there has been the closest possible connection between the Medical Inspection and the Feeding of School Children, and so far as the Central Department of Education is concerned this policy is adopted and advocated, as described in the following extract from the Annual Report of the Chief Medical Officer of the Board of Education of 1910:— ". . . The Board of Education attach much importance to the close association of the administration of this Act with the School Medical Service, whether central or local, and, so far as relates to their own administrative action, they have placed the general supervision of this branch of their work in the hands of their Medical Department " During the year 1914 provision was made by Parliament for grants-in-aid of the Provision of Meals for Children 291 attending Public Elementary Schools, and on the 19th June, 1914, regulations were issued stating the factors that the Board would take into consideration in distributing the grant. On the 7th August, 1914, the Education (Provision of Meals) Act, 1914, was passed, extending the operation of the original Act to the Feeding of School Children on days other than school days, removing the limit of a id. rate as the total expenditure to be incurred by a Local Education Authority, and abolishing the necessity of obtaining the sanction of the Board of Education to expenditure out of the rates on the provision of food. The Position in Willesden. On the 18th November, 1914, a letter was received by the Willesden Local Education Authority from the Board of Education making certain criticisms of the arrangements in operation in the Willesden area, and the Committee desire to know how in my view these criticisms may be met, and to what extent the School Medical Officer, or other officers, should take part in the arrangements made for the Provision of Meals. In considering this matter it is desirable that the Committee should have before them the specific points to which their attention has been directed. These are :— (A) The points raised in the letter of the Board of Education above referred to, and set out as follows:— (1) There appears to be practically no co-ordination with the School Medical Service, and no supervision over either the dietary or the arrangements for cooking and serving the meals. In this connection I am to call the attention of the Authority to paragraph 309 of the Annual Report for 1910 of the Board's Chief Medical Officer. 292 (2) The accommodation is inadequate, the premises in two cases (Salvation Army Centre and Lower Place Centre) being most unsuitable, owing to the unsatisfactory kitchen accommodation. Alternative premises should be found in these two cases, and I am to suggest that it might be possible to make further use of the Laundry Centres, without interference unduly with the instruction at those Centres. (3) Greater attention should be paid to securing food of good quality and sufficient quantity, to cooking it in an economical and palatable way, and to serving it in a more orderly manner. (4) Better arrangements are needed in connection with the investigation of the cases selected for feeding. (B) Paragraph 309 of the Annual Report for 1910 of the Board's Chief Medical Officer setting out the function and duties of the School Medical Officer as follows.:— (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, 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 feeding- list of children who are temporarily excluded on medical grounds from school attendance should be notified to him. 293 (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. (C) Article 4 of the Regulations under which grants-in=aid will be paid as follows:— In distributing the grant the Board will take into consideration— (a) The extent to which the work is co-ordinated with that of the School Medical Service; (b) The care exercised in the selection of the children for admission to the meals; (c) The sufficiency and suitability of the dietary; (d) The extent to which attention is given to the educational aspect of the work; (e) The suitability of the accommodation and equipment and the efficiency of the service and supervision of the meals; (/) The completeness of the arrangements made for ascertaining and recording the effect of the meals on the physical and mental condition of the children ; (g-) The economical administration of the work. 294 Scheme Suggested. Having duly considered the foregoing matters, it seems to me that the arrangements to be made for the Provision of Meals naturally fall under three headings, namely :— I. The work of the School Medical Officer. II. The work of the Accountant. III. The work of the Committee, Sub-Committees and Clerk. I. The work of the School Medical Officer. Having due regard to paragraph (A) (B) and (C.) above, the duties and functions of the School Medical Officer will be seen to group themselves under the following five headings : (1) Hygienic conditions of the Feeding Centres; (2) The Diet. In connection with this subject it should be observed that there requires to be not only a standard dietary approved by the Committee on the recommendations of the School Medical Officer, but also the School Medical Officer should have power to vary the dietary to meet the requirements of young children and the needs of children who for physical reasons are unable to profit by normal feeding. (3) The quality, quantity, cooking and service of the food. In the six centres now in use by the Education Committee various standards have been adopted by the persons in charge of each centre. The result is that in some centres the quantity is at fault, in others the quality, in others, again, the cooking, and, still, in others, the service. In order that this work may be adequately controlled and all subsidiary matters with reference thereto, such as stores and equipment, be dealt with efficiently, it will be necessary for me to make use of the services of one of tht 295 Health Visitors almost solely in connection with this work. She would also be responsible for seeing that the children were well-behaved, that attention was paid to orderliness, tidy eating, cleanliness of the hands, etc., and for referring to me from time to time children in attendance who did not appear to require school meals, as well as those who did not appear to profit by the meals received. I think the maximum salary of this Health Visitor should be increased by annual increments of ,£10 to ,£160, instead of ,£130 as at present, and that she should be replaced in her district work by a Health Visitor, to be appointed on the usual terms. (4) The Selection of Children. This is a matter of extreme importance. The original Circular 552 of the Board of Education, relating to the provision of Meals, issued on 1st January, 1907, contains the following passage:— ". . . . Its object (i.e., the object of the Act) is to ensure that children attending public elementary schools shall, so far as possible, be no longer prevented by insufficiency of suitable food from profiting by the education offered in our schools, and it aims at securing that for this purpose suitable meals shall be available, just as much for those whose parents are in a position to pay as for those to whom food must be given free of cost. It is obvious that the passing of this Act opens up possibilities of a most beneficial nature, if its operation is handled with full circumspection and on carefully thought-out lines by the local authorities and voluntary agencies, to whom these great responsibilities are entrusted by Parliament; since it furnishes unrivalled opportunities to the earnest, yet wise, social reformer for mitigating some of the deepest physical injuries that beset the children of the rising generation, par- 296 licularly in 'slum areas,' without necessarily involving (if care and thought be exercised in its administration) undue intervention by the State in the sphere of parental responsibilities or in the duties and influences of any properlyordered home " In Willesden children are selected on a poverty basis. While not in any way suggesting that this basis should be forgotten, it was not by any means the primary intention of the Legislature that this should be the basis on which children should be selected, and it seems to me important, and, indeed, necessary, that the physical test should be associated with the poverty test. By the physical test is meant that primary regard should be had to the evidences of insufficient feeding, as shown or indicated by the child, and this should be considered in connection with the social or economic circumstances of the parent, before a child is removed from the feeding list. Primarily it would be the duty of the teacher, acting in or without consultation with the Medical Officer, as the urgency of the case might demand, to place a child on the feeding list. It would then be the duty of the Medical Officer to bring before the Committee a report on the case, dealing with the state of nutrition of the child, and the economic circumstances of the family, in order that the Committee might decide as to the advisability or otherwise of retaining the child's name on the feeding roll. In order that these social enquiries may be made without delay, it will be necessary to add a Health Visitor to the existing staff. At the present time the making of such enquiries and the keeping of the records of the changes in home circumstances, is more than one person's, and probably two persons' work, but under normal circumstances it is probably less than the full-time occupation of one Health Visitor. It is, therefore, important that the person 297 appointed for this work should be able to devote herself to other duties when she becomes less fully occupied. In connection with home enquiries, it is also important to note that often a remedy may be suggested in respect of improper feeding by a suitably qualified woman, who may in other ways be in touch with, and of service to, the mother of the family. (5) The effect of feeding school children. This is a matter which requires to be properly determined, and should be the subject of report from time to time by the School Medical Officer on information obtained from all engaged in the work-—Health Visitors, teachers and others—as well as by systematic investigation of groups of children by the Assistant Medical Officers at the Schools. II. The Work of the Accountant. The financial control, in my view, ought to be under the supervision of the Accountant, in the same way as the other financial work of the Education Committee. The economical administration of the work is one of the factors on which the grant of the Board of Education will depend, and on that account should be the subject from month to month of careful review by the responsible Committee. III. The Work of the Committee, Sub-Committees and Clerk. This is no doubt a matter about which the Committee will be guided by the Clerk, having regard to the general scheme of the Committee work of the Education Committee. In my opinion, however, and having regard to the congestion of business at the Children's Care Committee, it would be desirable that this Committee should have at least two Sub-Committees to deal with the whole of the work of the School Medical Officer. These Sub-Committees, amongst 298 other matters, should review monthly, or at such intervals as may be determined, the feeding lists and the work of the feeding centres, so that proper and continuous control may be exercised with due regard to efficiency and economy. Conclusion. The above scheme, in my opinion, meets the objections which have been urged from time to time against the present system of feeding, as well as the requirements of the Board of Education. I am sure it will prove, if adopted, of the greatest possible value to the children and the Authority. The present selection of children on a poverty basis by associating with the meals the stigma of pauperism goes far to defeat the object of the Act, which is to improve the physical condition of the children so as to enable them to profit by the educational advantages offered by the Authority. Such is indeed the immediate object of the Act, but remote advantages likewise arise from improvement in the physical candition of underfed and ill-nourished children, as it enables them to resist attacks of disease in later life, and thus to retain their places in the struggle for existence, and so prevent their dependents in their turn coming below the "poverty line" in the future. It is also the case that many children suffer as much from unsuitability as from lack of food, and the careful organisation of the Provision of Meals on the lines indicated above would certainly educate those children to provide in later life for themselves a dietary suitable to their particular needs, and generally it would enable all children to recognise and acquire a taste for nutritious and health-giving food stuffs. In this way the interests of the parents of the future in distinctly homely and personal matters would be aroused so that we may hope that successive generations will grow up strong and healthy under the best possible conditions of parental interest and control. Not only so, but it may not 299 be even overmuch to expect that the wise and beneficient administration of an Act of this description will by the rearing of a vigorous people and the consequent effacement of disease and destitution lead to its final abandonment. Matters for the Consideration and Decision of the Committee. 1. The work of the School Medical Officer, dealt with in this report under I. (1), (2), (3), (4) and (5) above, and with which is included—The appointment of two Health Visitors at the scale salaries of .£100;£130 per annum, with ;£8 for uniform—one to replace the Health Visitor to be allocated to assist the School Medical Officer in connection with I. (3) above, namely, the quality, quantity, cooking and service of the food, and matters relative thereto; and the other to be added for the purposes of I. (4) above, namely, enquiries into home circumstances in connection with the selection of children. (The maximum salary of the Health Visitor replaced to be increased by annual increments of .£10 to ,£160 per annum, instead of ;£130, as at present.) 2. The work of the Accountant. 3. The work of the Committee, Sub-Committees, ana Clerk, with which is included— (a) The number of Sub-Committees or Divisional Care Committees to be formed. (b) The functions of the Sub-Committees or Divisional Care Committees. 300 (c) The constitution of the Sub-Committees or Divisional Care Committees. (d) The meetings of the above. I am, Your obedient servant, GEORGE F. BUCHAN, Medical Officer. APPENDIX K. Open Air School—Report of Visiting Committee. Municipal Offices, Dyne Road, Kilburn, N.W., July 17th, 1914. To the Chairman and Members of the Education Committee. Open Air Recovery Schools. Report of Visiting Deputation. Letter of Board of Education. The Education Committee at its last meeting on 1st July, 1914, had before it the letter of the Board of Education, dated 15th June, 1914, as follows:— "15th June, 1914. "1. Willesden. "2. Proposed Open Air School. "M. 2753/14. "Sir, "1. With reference to Dr. Bridges' letter of the 24th March last (F), I am directed to state that the Board of Education have been in communication with the Local Government Board regarding the proposal of the Authority to purchase a site at Dudden Hill for the purpose of an 301 Open Air School for Physically Defective Children, and they are now prepared to approve the proposal. "2. The Board note from the letter under reply that, although the present proposal relates only to the erection of an Open Air School for 240 Physically Defective Children, the Authority, when choosing the site, had in view possible developments in regard to their work of educating defective children. They note from the figures supplied in the statement by the School Medical Officer, which accompanied Dr. Bridge's letter of the 18th October last (F) that, as regards Physically Defective Children alone, there is reason to anticipate that increased accommodation will be required in the not distant future. The Board further understand that a portion of the proposed site would be suitable for the erection of a school for Mentally Defective Children, should the Authority decide in the future to utilise it for such purpose. "The Board's formal approval of the site is enclosed. The plan of the site is returned herewith. "3. The plans of the proposed building, which accompanied Mr. Jobbins' letter of the 6th March, 1913, have also been considered by the Board, who desire to invite the attention of the Authority to the following points :— "(a) As regards the type of building, a quite simple form of construction of the nature of weather boarded sheds would, in the Board's opinion, serve the purpose intended, and would be less expensive than a building of the Dcecker type, as shown on the plan. "(b) The arrangements of the buildings should be considered carefully from the point of view of the uses to which the remainder of the site may be put in the future. 302 "(c) The Board think that it would be preferable if the buildings shown on the plans were re-arranged, so that the class-rooms were spread out in a single line facing south, with the administrative portion in the middle. "(d) The teaching verandahs might with advantage be separated from the main building. "4. The plans of the proposed buildings are also returned herewith, in order that they may receive further consideration in the light of the above suggestions. The Board will now await the submission of the amended plans. "5. In conclusion, I am to express the regret of the Board that an earlier communication has not been sent to the Authority. "I am, sir, "Your obedient servant, "(Signed) E. H. PELHAM." Reference. In connection with this letter the Education Committee had also before it a report of the Children's Care Committee, which was adopted, as follows:— "Open Air School. "1. We have received a letter from the Board of Education (15th June, 1914), stating that they are prepared to approve the proposal to purchase a site of 7.3 acres for the purposes of an open air school at Denzil Road, and enclosing their formal approval. The Board nave returned the plans, and in connection therewith make certain suggestions as to the type of building and the arrangement of the class-rooms and administrative block. We have carefully considered the Board's suggestions, and recommenc— 303 "(a) That the District Council be asked to proceed with the purchase of the site of 7.3 acres at Denzil Road, and to raise the necessary loan. "(b) That the Architect be requested to prepare revised sketch plans of the proposed school, in the light of the suggestions contained in the Board's letter, and that it be referred to the Chairman of the Children's Care Committee and the Chairman of the School Accommodation Committee, with the Medical Officer and the Architect, to report thereon, and also on the method of construction, to the School Management Committee, and also to visit recently erected institutions of the same character as the school now proposed." Visits to Schools and Institutions. In accordance with the instructions contained in resolution (b) above, we have to report that we have visited open air schools and similar institutions, as follows:— 1. The Open-Air Recovery Schools, Kettering. These schools were opened in December, 1913. The buildings are of brick and slate, for twenty Tuberculous, forty Delicate, and forty Mentally Defective Children, and stand on about one acre of land. They have been erected by the Kettering Local Education Authority, which has a school population of about 5,000. The schools are for day scholars only. In connection with the Kettering Open Air Recovery Schools the following points arose or were specially brought to our notice:— (1) There is no need to separate the phthisical from the delicate children, as there is no danger of infection under open air conditions. 304 (2) The class-room for phthisical cases opens on three sides, the two end class rooms for delicate and mentally defective children respectively open on two sides, but the class-rooms adjacent to and the drill and dining hall itself have practically only one side open to the air. (3) The desks provided are movable but somewhat heavy. The seats are separate. (4) The heating of the class-rooms is by means of low pressure hot water, with radiators at back and special floor plates around front of rooms. It was specially designed, but has little heating effect, as the sides of the class-rooms are always widely open, except in wet and story weather. The children and teachers are supplied with blankets and flannel coats during the cold season. The children are also supplied with felt-lined clogs. (5) One large resting shed separate from the class-rooms is provided. This shed has a wooden floor raised on pillars about three feet from the ground. The back portion of the roof is boarded and fluted with galvanised iron, and the front portion is covered with patent glazing. The shed is too hot in summer. The disadvantages of the single large resting shed are:— (a) The larger the shed, the greater is the tendency for the air therein to be stagnant; (b The larger the number of children resting at once the more difficult is it to get them off to sleep; (c) The difficulty of the same shed being used by two or more different classes at once for different forms of rest or exercise. 305 On the other hand, the advantage appears to be: (d) A smaller number of the staff can look after all the children in the school while resting. (6) The girls' cloak rooms are about twice the size of the boys' cloak rooms, and this seems to be the correct proportion. (7) The kitchen is used for educational purposes, especially for the teaching of cookery, but, as planned, it is too small. So also is the scullery. Cooking is carried out by electricity, costing 1d. per unit. The total cost per week being 6/- to 7/6 for 100 scholars and nine members of the staff. The electricallyfitted cooking stove is not dangerous to the children and does not create fumes. (8) There is no laundry where the towels, table linen, etc., can be washed and the children at the same time receive instruction in laundry. (9) There is no manual centre for instructional purposes. (10) There are twelve spray baths for 100 children, and a dressing room. The dressing room, as planned, is too small, as three sets of children have to use it at once—one set (bathed) dressing, the other (getting ready to bath) undressing, and a third set (bathing) have their clothes there waiting for them. (11) Too little land has been provided in connection with this school. (12) These are mixed schools, the children ranging from 5—14 years. (13) The children are asked to pay -1d. per day for their food—cost price. This is remitted in necessitous cases. 306 (14) The children receive instruction from the cook, but a laundry and cooking mistress should be on the staff. (15) The staff employed at these schools is:—1 head teacher, 5 class teachers, 1 nurse, 1 cook, 1 scullery maid and 1 caretaker. (16) Open air teaching is equally beneficial to the tally Defective. II. Uffculme Open Air School, Birmingham. This is a permanent building of brick and tile, designed for 120 delicate children. It is for day scholars only, and is easy of access by tram. It stands on 1½ acres, but in addition has the use of a park of 25 acres when not in use for Sunday school and other holiday treats. The school has been open three years, and was presented to the City of Birmingham by Mr. and Mrs. Barrow Cadbury. In connection with this school the following points were noted:— (1) Three class-rooms are arranged corner to corner, thus allowing all four sides to be separate, but only three sides open. The fourth class-room is attached to the dining hall, and two sides open. The sides open right up to the ceiling, so as to prevent pockets of air forming. (2) The desks provided are movable. The seats are separate. (3) The kitchen is placed on the first floor, the idea being to prevent the smell of cooking entering the school proper. In the kitchen the drawers, in which mugs are stored, also serve as trays. (4) The girls' cloak room, which is the same size as the boys, is too small. 307 (5) The ten spray baths are so arranged that either seven or ten must be in use at once. The sprays themselves are too large. Both factors make for the use of a larger amount of hot water than is really necessary, and is also dis-advantageous, in that all the seven or ten children using the sprays are not equally nimble. Some form of sink or small basin should be provided below each spray, so that a child may soap and wash itself. This means, however, that the floor must not be slippery, as otherwise the child is apt to fall and possibly hurt itself on the edge of the basin. Some form of wooden tressel would prevent this happening. A slipper bath is also provided. (6) There are ten lavatory basins provided for 130 ren in attendance, but this proportion is too small. It should be not less than one to eight. (7) Ample cupboard accommodation is necessary for the clogs worn by the children out of doors, the blankets, jerseys, woollen mittens and caps used by the children in cold weather. (8) The resting shed is separate from the class-rooms. (9) This is a mixed school, the children ranging from 6—14 years. (10) The cost of the school is 4/- per week per head more than the ordinary elementary school, meals costing 2/- to 2/2 per week. Children are expected to pay this additional cost, but the Education Committee have power to remit charges. In practice, the average payment per child works out at 1/- per week. Payment in respect of forty children is remitted. (11) The staff at this school consists of 1 head teacher, 4 class teachers, 1 nurse, 1 cook, 1 kitchen maid, 1 additional maid and 1 caretaker. 308 (12) The teachers have their meals in the same room as the children, but at a separate table. III. Woodlands, Northfield. This is a Residential Open Air School for Tuberculous, Bone and Joint Cases. It was opened on 1st December, 1913, and is maintained by the Birmingham and District Cripples' Union. All the children in this school are actually suffering or are convalescent from tuberculous disease. The majority of cases are children who need to lie in bed for a long time in special splints. The institution is a mansion which has been adapted for its present purpose. The children are nursed in three open air wards on the first floor, ranged round three sides of an open quadrangle. One of these wards is new, while the two others are converted lofts. The sides of the wards immediately surrounding the quadrangle are open except for the supporting pillars, and protection is afforded from the rain when necessary by canvas curtains. The other sides of the wards are solid, but amply supplied with windows, which may be opened widely. There are 66 children in this institution at ages ranging from 2-16 years, 50 of these are on the school register. Three teachers provided by the Birmingham Education Committee visit the institution daily. Teaching is conducted on the verandah or quite out of doors in fine weather. The sanitary annexes are of recent construction, and small handrails are found useful for the cripples who use the closets provided. A completely fitted operating theatre has recently been added to this institution. 309 IV. Worcestershire Open Air School, West Malvern. This is a residential school for 10 delicate children. It was opened in June, 1914. It is a gift of Miss C. F. Severn Burrow, and the beds are maintained by the County of Worcester, the City of Worcester, and the Borough of Kidderminster. The school is situated on 3½ acres of land. The contract price was £1,095, and extras have amounted to about £150. (1) The structure is wood framing, covered internally by match-boarding and beaver boards. The roof is of eternite sheeting. (2) There is one class-room which is also used as the dining-room. Much of the work is done out of doors, and the class-room is only used in wet weather. The side of the class room open to the prevailing winds can be closed by detachable match-boarded doors which fit in the spaces. (3) The desks used are very light and of the nature of an artist's sketch-board. (4) No heating is provided. (5) The dormitories are constructed of the same material. (6) Spray baths are provided, each spray having a separate pull. (7) The school is for girls only ranging from 5 to 13 years of age. (8) The children share such of the home duties as they are fitted for. (9) Provision is made for a 12 hours' night and a 2 hours' afternoon rest. (10) The staff consists of 1 head teacher, 1 teacher, 1 nurse, 1 cook matron, 1 scullery maid, 1 dormitory matron (not yet appointed). 310 V. "Kindercot" Sanatorium School, Peppard Common, Oxfordshire. This school is attached to the Maitland Sanatorium but is entirely separate from the adult institution. It is for 20 children, sent there by the Berkshire and Bucks County Councils. The area on which the entire institution stands is about 50 acres. (1) The school building is of weather boarding lined by matchboarding. It was presented as a gift to the institution some years ago, and although additional windows have been provided since its erection it is still not of a sufficiently "open air" character, according to the Medical Superintendent, Dr. Esther Carling. As much teaching as possible is given out of doors. (2) A new school building for 60 children is under sideration, the three class-rooms to be placed along three sides of a central hall. (3) The dormitories for the children are partly open-air shelters and partly open-air wards. (4) The floors of the wards are composed of petropine, which is a form of wood composition which is stated to wear well and to be easily kept clean. (5) One teacher is employed. VI. St. Vincent's Cripples' Home Eastcote, near Pinner. This is an institution similar in character to "Woodlands," Northfield. There are 115 beds for children suffering mainly from tuberculous disease of the bones and joints. The home is under the care of the Sisters of Charity of St. Vincent de Paul. The area of the site is about 25 acres. During our visit the following points especially were brought to our notice:— (1) An old house has been adapted for administrative purposes. 311 (2) The other buildings for the wards and the school are of weather boarding and match-boarding with eternite roofing. (3) School is carried on in the wards for the children who are unable to get out of bed, and in a special school building with two class-rooms for convalescent children who are able to get about. (4) The buildings have been up only about two and a half years, but the weather-boarding in places is beginning to split. (5) Heating is provided for in the class-rooms by a stove which is placed against a portion of the wall which has been erected and carried up in brickwork the height of the chimney. (6) The floors of the buildings are boarded. (7) The south side of the class-rooms can open widely by means of doors of wood and glass. The north side has large windows. A louvre ventilatior is placed at each gable end. (8) The open-air wards are open along the south side except for the supporting pillars. Protection is afforded from rain and sun in these wards by canvas blinds. These, however, were stated not to be rigid enough. (9) Each ward has a small kitchen for keeping food hot, but there is a central kitchen for cooking for the whole establishment. (10) A separate playshed has been built, but this is practically only now used for brushing boots. (11) A fully equipped operating theatre is provided. (12) Two teachers have been appointed for the class-rooms and one for the wards. In addition there are instructors of tailoring and bootmaking, and a visiting teacher for wood carving. 312 VII. Harpenden Sanatorium lor Children. This is a branch of the National Children's Home and Orphanage. It is a two storeyed building for 60 consumptive children, and is certified as a school for 25. The entire site is about 100 acres including the home adjoining. The following points were noted:— (1) The buildings are of brick, rough cast and tile roof. (2) There are some open air shelters in the ground. (3) The playshed is detached from the main building. (4) The ground floor consists of a dining and day room in which the school is conducted, and two wards. A wide verandah is provided, which is protected above by the overhanging balcony of the first floor, and may be protected from driving rain by blinds. Lessons are given on the verandah or entirely in the open air according to the weather. The first floor is composed of wards with an open balcony. (5) The institution is for boys and girls, and the class is a mixed one. It is proposed shortly to open two additional classes for 20 children each. (6) One teacher is at present provided. (7) The cases taken in are generally pulmonary tuberculosis. VIII. Regent's Park Open Air School (Marylebone Tuberculosis Dispensary). This is a school for 48 children, conducted in the bandstand off the Broad Walk, Regent's Park, by a voluntary association, namely, the Marylebone Dispensary for Tuberculosis. The cases taken are delicate children with a 313 family history of consumption. The children bring their own food and have two meals a day, one at 12 noon, and the other at 4 p.m. The children are supplied during cold or wet weather with clogs, rugs, shawls and foot and hand warmers as may be required. The heating agencies in the warmers are slow combustion briquettes. The school is conducted all the year round. Two teachers are employed, one certificated and the other un-certificated. In addition a man is employed to teach leather work. IX. Regent's Park Open Air School (L.C.C.). This is a school for 64 delicate children who are drawn from Stanhope Street and Hawley Crescent Schools. The children leave these schools at 9 o'clock each morning to attend the Open Air School at Regent's Park, near York Gate, and get back at 4 p.m. to their schools again. This School is open from May to October. The children are fed at the school by the Alexandra Trust, getting one meal a day. The buildings in which the children are taught are wood farming with canvas roofs and awnings for two sides, which are put up on the sides according to the weather and direction of the wind. The floor is of earth covered with gravel. The children are provided with blankets and a macintosh. There are two classes and two teachers, and two women are employed for 1½ hours during the dinner interval. X. Shooter's Hill Open Air School (L.C.C.). This is a school for 100 delicate children. It is situate on 6 acres of land, 3½ of which are wooded. The buildings consist of a head teacher's room, a nurse's room, a tool shed, a clog room, and a large bungalow with canvas sides and wood floor. As much teaching as possible is done in the open air, and the bungalow is only used in exceptional weather and for singing. The teaching of the children is 314 mainly practical; in fact all subjects are taught practically, if this is at all possible. The bungalow is artificially heated only when the temperature falls to 40 degrees, additional clothing being advocated instead. Clogs and jerseys are supplied, but only children who are abundantly clothed and shod are allowed to attend this school. The Head Teacher, Mr. Turner, who conducted us round the school, laid stress on the increased mental alertness of the children after a short attendance. The children receive three meals a day, prepared and served at Plum Lane School, close by, where the children go at the appointed time. Suggested Plan of Willesden Open Air School. Having duly considered the arrangements at the above schools and our reference, we beg to submit a plan in respect of which the following points are to be noted.— (1) Disposition of Class Rooms on Site. The class rooms all face south, and are arranged with a due regard for the levels obtaining on the site. To place the class rooms in a single line facing south would require considerable expenditure in respect of excavations without any corresponding benefit. In deciding upon the arrangement of the class rooms now submitted consideration has also been given to possible future developments, as the dotted class rooms or pavilions shew. It has also been thought desirable that as large an area as possible should separate the class rooms from the houses to be built in Denzil Road, and we anticipate that this area will be utilized for school gardening, etc., and be properly laid out and adorned as the development of the school proceeds. (2) Class Rooms.—So far as we could see, these were kept practically always open in the schools we visited on 315 the south and west sides. We therefore have dispensed with the large doors of wood and glass shown on the original plan, and instead have provided rolling wooden shutters for protecting the children against wet. As therefore the only supports required are those to carry the roof and take the wooden shutters, we are of opinion that these supports should be of wood and iron construction for the pavilions and the dining hall. We do not recommend the provision of stoves or the installation of a heating system for the classrooms, but suggest that hot water bottles should be supplied to the children if necessary. This practice is adopted at "Woodlands," Northfield, and provision has been made for heating tht bottles, as will be seen on the plan. The desks to be used must be light and portable, and the chairs must be separate. We were not particularly impressed by any of the types which we saw, and are inclined to consider favourably the ordinary folding examination desk. (3) Verandahs or Resting Sheds.—Having regard to the advantages and disadvantages of having only one large verandah or resting shed as already set out, we are of opinion that the idea in the original plan of having a small verandah or resting shed attached to each pair of class-rooms should be retained. We do not think it necessary to have any ceiling provided in connection with these verandahs, but the roof ridge should be widely separated so as to provide ample ventilation. Beds are required for the afternoon rest, and the best form known to us is that in use at Birley House Open Air School, L.C.C. Here the canvas is stretched round the ends of the frame and laced. 316 By this means, wearing at the edges and sagging of the canvas can be effectually dealt with; and at the same time such beds can be provided at a minimum cost. (4) Dining Hall.—This has been constructed and should be furnished so that it may serve as an assembly hall. (5) Kitchen.—This has been enlarged so as to cook for an increased number of children, and to provide for cookery instruction. We have not yet decided as to whether cooking should be by means of gas or electricity, and propose going further into the matter. We were much impressed by the electrical cooking installation seen at Kettering, where electricity was supplied at 1d. per unit, and have been in communication with the Electrical Engineer of the Council about the matter. We beg to submit his comments:— "In the matter of electricity for cooking, I regret that at the moment we have no Flat Rate of 1d., but our 1½d. rate may be reduced by a system of discounts to a 1d. per unit if the average daily use exceeds three hours. I fear, however, that this condition is hardly suitable for the installation you mention, but I shall be pleased to place the matter before my Committee, if you will make a definite applicaton for a supply for this purpose. "With regard to comparative costs of gas and electricity at 1d. per unit for cooking, there is very little in it as to the cost of cooking, but the apparatus is somewhat more costly, although this is more than balanced by the hygienic value of the electrical apparatus as compared with the best gas cooking apparatus that can be obtained." 317 (6) Laundry.—This did not appear on the original plan, but has been added, so that the laundry work necessary may be done on the premises and the children at the same time receive instruction. It should be observed that a number of the cripple children attending the Willesden Open Air School will require teaching in both cookery and laundry, while the same form of instruction may be useful in "hardening" tuberculous or pre-tuberculous or delicate children about to leave school to take up employment outside. Both laundry and kitchen have been planned on open air lines. (7) Baths.—The number of baths in the schools visited was usually in the proportion of one bath to ten children. The original number of baths has, therefore, been increased from twelve to thirty, i.e., twenty-eight spray baths and two slipper baths. This number allows for development. Small sinks or basins have been provided under each spray. The arrangement of the baths has been altered, so that the greatest number has been compressed into the least space. Dressing accommodation has also been provided, and is of sufficient size to take (1) the bathed, (2) the clothes of those bathing and (3) those getting ready to bathe. (8) Lavatory Basins.—The experience of the schools visited shows that these should be provided in the proportion of one to every eight children. We have accordingly provided forty basins, instead of the original twenty-four. This number will also allow for development. Ample space has also been provided here for towels and for small bags to contain tooth brushes, hair brushes, etc. (9) Cloak-rooms and Cupboard Accommodation.—The girls' cloak rooms are twice as large as the boys' 318 and accommodation has been provided for the children's clogs, blankets, flannel coats, mittens, caps, waterproof capes, etc. (10) Paved Playground.—This has been provided at the north-west corner, so as not to interfere with future developments. (11) Slopes.—Slopes have been provided instead of steps, which some cripple children are unable to negotiate. (12) Trees.—The children attending this school must spend a maximum number of hours actually in the open air and sunlight, and in this connection it would appear to be wise to take steps to plant a number of quickly-growing trees, under which the children may work. This should be done even before the building is commenced, as if trees are not planted this autumn, they cannot be put in for another twelve months, and a valuable year will have been lost. The children, it is found, come to regard some portion of the ground with a feeling of familiarity, and love to do their work under the shade of a particular tree. Materials Proposed. (1) Screens and Walls.—The class-rooms, verandahs, workshops, etc., have open sides and ends and fitted with wooden roller shutters. The sides of dining hall and the ends of kitchen and laundry to be fitted with similar shutters. The roofs of these buildings to be supported on steel stancheons. The walls of Administrative Block, Assistant Teachers' Room, Offices and Lodge to be brick. The external walls to be nine inches thick and rough cast on the outside. 319 (2) Floors.—All floors to be formed with cement concrete, 4ins. thick, and covered with "Woodura" or "Decolite" composition—except the floors of washhouse, bottle-heating room and heating chamber, these to be granolithic. (3) Roofs.—All roofs to be of wood construction, covered with slate battens, felt and red "poilite," or similar asbestos slates and red ridge tiles. (4) Internal Finishings.—The internal walls of tive Block to be faced with glazed bricks, except Doctor's, Teachers' and Nurses' Rooms, Dining Hall and Bottle Heating Room and Heating Chamber. The ceilings of verandahs or resting sheds to be open to apex of roof and lined with match boarding. All other ceilings to be plastered. (5) Ventilation.—The verandahs or resting sheds and class-rooms to have ventilating ridges; all other rooms to have ceiling outlets. (6) Heating.—The Cloak Rooms, Dressing Room and Corridors of Administrative Block to be heated with hot water apparatus; the Doctor's, Teachers' and Nurses' Rooms to have open fireplaces. (7) Lighting.—To be by electricity. (8) Tar Paving.—The paths surrounding the buildings and the playground to be tar paved. Comparisons and Estimated Costs. The following Table compares the original scheme on the Sewage Farm Site, for which an estimate was submitted, and the scheme now presented to the Committee:— 320  Original Scheme on Sewage Farm Site. Scheme now presented on Dudden Hill Lane Site. Site Flat square site on Sewage Farm Irregular site with considerable falls on Dudden Hill. Area covered by buildings 17,422 sq. ft. 23,872 sq. ft. Additional accommodation not provided in original scheme Not provided 2 workshops. 2 verandahs or resting sheds. Laundry and washhouse. Bottle heating room. Larger kitchen. Larger bath room. Dressing room. Larger cloak rooms. Larger lavatories. Additional store rooms. Larger dining hall. Playground. Estimated Cost. Estimated Cost. Buildings (permanent) £ 11,050 £9,420 (including additional accommodation shewn above) Levelling, drainage, tar-paving, paths, roads, &c. 900 1,800 (including playground) Fir fences 7 ft. high to boundary 250 430 Total £l2,200 £11,650 Dœcker buildings £2,000 less than above. General Observations on Open Air Schools. We were impressed in all the institutions that we visited by the testimony which was borne to the value of open-an schools. The children in attendance increased in weight and chest measurement. Their nutrition, as measured by their carriage, general health, blood tests and colour, improved quickly under the conditions obtaining at these schools. Their mentality also increased. In particular it was recorded 321 that the prevalence of infectious diseases was practically nil, and that when the children returned to the ordinary elementary school their attendance was much more regular, and quite up to the normal standard. In view of the character of the ailments of children for whom such a school caters, it is essential that they should be taught how to "live," and that the school should endeavour to secure that the children form healthy habits, and so do much to combat the evils which arise in many instances from the unhygienic circumstances in which they are reared. How far this is being done may to some extent be guaged by the typical daily routine which the children undergo. At Shooter's Hill Open Air School (L.C.C.) this is as follows:— 9 a.m. Breakfast—Bread and milk, raw apples. 9.35. Assembly for Prayers, Scripture or Hymns. 9.55. Class talks. 10.5. Arithmetic. 10.10. Recreation. 10.55. Nature Study. 11.25. Breathing Exercises. 11.30. Drawing. 12 noon. Prepare beds for afternoon rest. Personal Hygiene. 12.45 p.m. Dinner—Roast beef, cabbage and potatoes, boiled rice and stewed fruit. 1.30. Rest. 3.15. Recreation. 3.30. Gardening. 4.15. Reading. 322 5.0. Pack-up apparatus. Assembly for Prayers. 5.30. Tea—Cocoa, bread and butter, jam. 6.0. Dismissal. From the foregoing time-table it will be noted that the open-air school is not merely school in the open air, but is in fact a new process. In every open-air school time has to be set apart for:— (1) Meals. (2) Personal hygiene. (3) Rest. (4) Out of door oral lessons. (5) Physical exercises. (6) Nature study. Gardening. Object lessons. (7) Manual training. Woodwork. Leather work. Needlework. (8) Trades. Sir George Newman, Chief Medical Officer of the Board of Education, has put it that the open-air school process comprises a new and regular mode of life and a system of treatment including the following :— (i.) Fresh air and sunlight; (ii.) Proper diet; (iii.) Rest; (iv.) The hygienic way of life; (v.) Individual attention; (vi.) Medical treatment; (vii.) Special educational methods. If the best results are to be obtained from the institution of a school of this kind it is essential that the staff should be chosen with the utmost care. The responsibilities 323 of the head of a school of this character are manifold. He has to combine the functions of a head teacher and an experienced caterer, while he has to take as keen a personal interest in the child as its parents, and his hours are long. He will have to possess distinctive organising ability, for the making of the varied arrangements for the curriculum, the meals, baths, and the thousand and one small duties will necessitate the greatest attention to minute detail if the school is to be successful, and to run smoothly. The difficulties will be increased by reason of the fact that many children of widely varying capacities, both physical and mental, will be in the school for a comparatively short period. The head teacher will be, even more than in the elementary school, the guardian of the child, and will have to give close attention to the individual's progress, almost from day to day. The success of the school will largely depend upon the adequacy of the organization. Shooter's Hill School was the only school we visited where male teachers were provided. All the reasons which are urged for the employment of male teachers in ordinary schools apply here with even greater force, and we are of opinion that the employment of some male teachers at the open air school should receive the favourable consideration of the Committee. It will also probably be considered desirable by the Committee that the teachers should preside at the meal tables from time to time, for the meals provide an excellent opportunity for the influence of the teacher to be felt. The teachers at the Regent's Park Open Air School (L.C.C.) exercise supervision over the boys at meal times. At Uftculme, Birmingham, all the teachers sat at one table, but this arrangement did not impress us favourably, and, in fact, was not considered an ideal arrangement by the teachers themselves. 324 Future Developments. Possible uses of the Site. In the Board's letter of 15th June, 1914, now under consideration, reference is made to the above matters, which we have considered in connection with our inspection and review of open-air schools and methods. Physically Defective Children. Open Air Treatment.—The open-air school movement probably had its origin in the children's country holiday fund, but was actually foreshadowed in the open-air treatment of consumption inaugurated by Dr. Bodington about the middle of last century. Since Bodington's time open-air treatment has been advocated in connection with other forms of tuberculosis, and was in fact in operation at two residential institutions and schools visited by us, viz., "Woodlands," Northfield, and Eastcote, Pinner, where tuberculosis of the bones and joints are under treatment. Treloar's Cripples' Home, at Alton, Hants., visited by the Committee during the winter, is an institution and school for children suffering from similar diseases of the bones and joints. The histories of cases of tuberculosis show that the actual disease is generally preceded by chronic ill-health, anaemia and malnutrition, and investigations made in this country in connection with the feeding of school children and subsequently medical inspection have shown that similar conditions predisposing to tuberculosis exist among a considerable proportion of school children. The Open-Air Day School.—The doctor insisted that children showing the signs of disease or predisposition to disease should be cured or protected from its development, while the teacher insisted on the mental training of the same children. To meet both views, and having regard to the experience gained in connection with tuberculous diseases, the open-air day school was instituted. At first it dealt mainly with tuberculous cases, but now it is generally 325 cognised that those suffering from malnutrition and anæmia, i.e., delicate children, should be specially catered for at a school of this character. The school which it is proposed to erect in Willesden will deal amongst others with children belonging to one or other of the three types described above, viz.:— (1) Delicate children, suffering from anaemia and nutrition and predisposed to disease, especially tuberculosis—As seen at Kettering, Birmingham, Regent's Park and Shooter's Hill. (2) Phthisical children in the early stages—As seen at Kettering, Harpenden and Maitland. It should be noted that the difference between (1) and (2) is merely one of degree. (3) Children who have been crippled by tuberculosis and other conditions—As seen at Northfield, Eastcote and Alton. The Open-Air Residential School.—The next development in connection with the open-air school movement was that seen at Malvern and Maitland, where the schools are residential in their character. The Malvern School is residential for the so-called pre-tuberculous or delicate child, while the residential school at Maitland is for both the pretuberculous and the early tuberculous, as it is difficult to differentiate between these two classes. In both cases the idea of the treatment is to take the child away from its surroundings and to put it under more favourable conditions, where it is likely to grow up in a strong and healthy condition, and at the same time receive education. The day open-air school, in which the child spends only fifty or sixty out of 168 hours per week at the school has been found not 326 to be sufficient to render the best aid to the child, and for this reason the residential open-air school has been instituted. It is not unlikely that as experience is gained in Willesden of the open-air school about to be erected, the Committee will be impressed with the necessity for establishing a residential open-air recovery school, so that the children may benefit to the greatest possible extent. Sanatorium School.—The next stage in the development of the open-air school movement was that represented at "Woodlands," Norlhfield, Eastcote, Harpenden, and Alton, Hants., where sanatorium schools were seen. In all these institutions children are taken in who require medical or surgical treatment, and in some of them operating theatres are provided. The children taken into these institutions are generally cases requiring prolonged rest in bed, during which period it is advisable that their education should not be neglected. Such a school as this is also required in Willesden, and will be one of the developments which the Committee will consider as their knowledge and experience of the open air school movement extends. Mentally Defective Children. At Kettering the open-air school process is applied to mentally defective children, and the head teacher of this school bore testimony to the advantages of open-air teaching for the mentally defective. The mentally defective child has got to be brought into the best physical state of health, and taught by methods in which the brain and nervous system generally is called upon to respond to sensory impressions obtained by methods of teaching similar to those adopted in the open-air school, that is, bathing, gardening, nature study, manual training and so on. The proposal now before the Committee to transfer the mentally defectives in both Leinster Road and Leopold Road 327 School to an allotted part of the open-air site is one which in the light of experience gained we view with favour. Dull or Backward Children. All that has been said of the mentally defective child applies with even more force to the merely dull or backward child, who naturally will respond more quickly than the mentally defective, and receive greater educational profit from open-air methods. The possibility of establishing classes for such children on the Dudden Hill or other openair site is a matter which the Committee should bear in mind. Conclusion. In all that we saw we were particularly struck by the enthusiasm of those engaged in the work and the good work which is being done throughout the country in the cure and prevention of disease and the education of delicate children. Everywhere we receive testimony as to the value of the educational and health processes at work in connection with the open-air schools we visited, and we feel that the establishment of a school of this character in our midst will be in the highest interests of health and education generally, and of the cripple and delicate children in the district in particular. At the present time no facilities exist for the education of many of these children in Willesden, and they are thus deprived of those educational advantages which are especially necessary to them. We recommend— (1) That the plan as submitted be approved. (2) That the plan be forwarded to the Board for approval, together with the report now presented. (3) That upon the approval of the plans by the Board of Education, the Architect be instructed to prepare 328 working drawings for submission to the Education Committee. We are, Your obedient servants, R. SILBY, Chairman of the Children's Care Committee. A. E. WARREN, Chairman of the School Accommodation Committee. G. E. T. LAURENCE, Architect. GEORGE F. BUCHAN, Medical Officer. 329 INDEX. Page Abnormal Children (Appendix C) 208-224 Accommodation—Schools 119 Acts in Force—Willesden 24-25 Acts, Regulations, etc. 24-25 Babies' Welcome 102-103 Backward Children 155-156 Bacteriological Department 177-178 Bakehouses 27, 40 Binet-Simon Tests 154-155 Births and Birth Rates 12, 106-108 ,, Legitimate and Illegitimate 106-108 ,, Notification of Births Act, 1907 101-102 Blind Children 149-151 Body, Cleanliness of 130, 134, 140 Bye-laws in Force 25 Canal Boats Acts, 1877 and 1884 27, 33 Cancer, Deaths from 91 ,, ,, and Age Distribution of 92, 93 ,, ,, and Ward Distribution of 93 Caravans, Movable Dwellings, Tents, etc. 27 Cerebro-Spinal Meningitis 66 Cesspools 29 Childbirth and Infancy, Means of Preventing Mortality in 95-104 Children, Exceptional 147-159 Children Inspected, Condition of the 129-133 Children's Care Committee 6 Child Welfare, Maternity and 95-96 Cleanliness of Head and Body 130, 134, 140 Clinic 144-147 Clothing 130, 134, 140 Closet Accommodation 21 330 Page Common Lodging Houses 27, 34 Condition of the Children Inspected 129-133 Councillors, 1914-15 5 Cowsheds 28, 35 Cows, Veterinary Inspection of 36-38 Customs and Inland Revenue Act, 1890 32 Dairies and Milkshops 28 Deaths, Age Periods of 110-111 Death Inquiries, Infant 104 Deaths and Death Rates 12, 109 ,, ,, per 100,000, Scarlet Fever, Diphtheria, Enteric Fever, Measles, Whooping Cough 86 Death Rates at Age Periods 111-113 Deaf Children 151-153 Deformities 133, 143 Diarrhoea and Enteritis, Deaths of Infants due to 97, 103 Diphtheria and Membranous Croup 64 ,, Cases admitted to Willesden Hospital 64, 170-171, 174 ,, Complications of 174 ,, Death Rate per 100,000 86 ,, Incidence and Fatality Rates 64 ,, Removal of Cases 64 Disinfection 30 Drainage and Sewerage 21 ,, ,, of Existing Buildings 29 Dull or Backward Children 155-156 Dust, Removal of, etc. 21-24, 30 Dust Allaying Materials (Appendix G) 270-275 Ear, Diseases of 131, 135, 141 Education Committee, Members of 6 Enteric Fever 65 ,, ,, Death Rate per 100,000 86 ,, ,, Incidence and Fatality Rates 65 ,, ,, Removal of 65, 170-171 331 Page Epileptic Children 156 Exceptional Children 147-159 Eye Diseases (External) 131, 135-136, 141 Eye Clinic 144-147 ,, ,, Cost of Equipment of 146 Factory and Workshop Act, 1901 48-55 ,, ,, ,, Inspections under 50 Feeble-minded Children, Educable 155 Following up 138-144 Food and Drugs Acts 41 Food, Adulterated 28 ,, Inspection 31, 38-39 ,, Unsound 28, 38-39 Footgear 130, 134, 140 Glands, Enlarged 131, 136, 137, 141 Gonorrhoea 94 Head and Body, Cleanliness of 130, 134, 140 Health Committee 5 Health Considerations and the War 10 Heights and Weights 126-128 „ ,, Average for 6 years 128 Heart and Circulation, Diseases of 131, 141 Home Work 51 Hospital Buildings 179 Hospital Committee 5 Hospital Report 169-179 Hospital, Sick Staff at 179 House Refuse, Removal of 21-24 Houses Let in Lodgings 27, 34 ,, Unfit for Human Habitation 45-47 Housing, Town Planning, &c., Act, 1909, Action taken under 26 Housing Inspection 26, 41-44 ,, (Inspection of District) Regulations 26, 44-44 Infant Death Inquiries 104 Infant Mortality 97 332 Page Infant Mortality—Causes and Prevention of 100 ,, ,, Illegitimate 99-100 ,, ,, Legitimate 99-100 ,, ,, Medical Treatment, Want of 98 ,, ,, Wards 98 Infectious Diseases 8, 55-72, 86, 169 Infectious Diseases, Administrative Action 68 ,, ,, Control over 55 ,, ,, Death Rates from certain 86 ,, ,, Incidence of 57 ,, ,, Non-Notifiable amongst Scholars 159-161 ,, ,, Notifications, Table of 56 „ „ „ „ (in Wards) 57 ,, ,, Prevalence of 55 Inhabited House Duty, Exemption from 32 Inspections 26, 41, 45 Investigation of Other Diseases 82-95 Local Government Board Tables (Appendix A) 181-201 Table I—Population, Births and Deaths since 1909—District 181 ,, Ia—Population, Births and Deaths in Wards 182 ,, II—Infectious Diseases 184 ,, III—Causes of Deaths (Short Classification Table) 185 ,, IIIa—Causes of Deaths—in Wards 187 ,, IIIb—Death Rates from Various Causes 188 ,, IIIc—Causes of Deaths (Long Classification Table) 189-198 ,, IV—Infant Mortality under 1 year of age—Causes of Deaths 199 ,, IVa—Infant Mortality under 1 year of age—Causes of Deaths—in Wards 200-201 Lungs, Diseases of 132, 142 Manholes, Inspection of 32 333 Page Marriages 105 Maternity and Child Welfare 95-96 Maternity and Child Welfare, Report on (Appendix D) 225-253 Measles 70-72 ,, Death Rate per 100,000 86 ,, Table of Known Cases since 1907 72 Meals, Provision of 162-163 Meals, Provision of, Report on (Appendix J) 288-300 Medical Inspection and Treatment 9, 119-165 Medical Inspection, Attendance of Parents at 121 ,, ,, Children Selected for 120 ,, ,, Extent and Scope of 121-122 ,, M Notice to Parents 126 ,, ,, Number Inspected 122-125 ,, ,, Organisation and Supervision of 119 ,, ,, Routine 122-137 Medical Treatment 139-144 Meningitis, Cerebro-Spinal 66 Mentally Defective Children 153-156 Mental Condition 133, 143 Mental Deficiency (Notification of Children) Regulations, 1914, Report on (Appendix C) 208-224 Meteorological Observations, Tables of 113-115 Milch Cows, Veterinary Inspection of 36-38 Milkshops 28, 40 Milk Samples 37-38 Mother-Craft 163-164 Mother-Craft Schools 161-165 Movable Dwellings, Caravans, Tents, etc. 27 Natural and Social Conditions of the District 18-20 Neck Glands Enlarged 131, 136-137, 141 Nervous System, Diseases of 132, 142 Nose and Throat, Diseases of 131, 135, 141 Notification of Births Act, 1907 101-102 Nuisances, Sundry, abated 30 334 Page Nutrition 130, 134-135, 140 Offensive Trades 28, 34-35 Open Air School, Report of Visiting Committee on (Appendix K) 300-328 Open Air School, Need for 9, 157-159 Ophthalmia Neonatorum 67-68, 70 Ophthalmia Neonatorum, Treatment of, Report on (Appendix B) 202-207 Overcrowding 30 Physical Features 18 Physically Defective Children 156-157 Poliomyelitis 66 Population—Census 18 ,, Method of estimating in Willesden 18 ,, Midsummer, 1914 (in Wards)—Estimated at 19-20 ,, Midsummer, Estimated 18-19 ,, Room Factor in relation to 18 Prevalence of and Control over Acute Infectious Diseases 55-72 Prevalence of and Control over Tuberculosis 73-82 Prevalence of Certain Diseases 82 Previous Illness History 137 Prosecutions 144 Reports 202-328 Respiratory Diseases, Table of 83 ,, ,, Death Rates 84 Regulations made by Local Authority in force in Willesden 25 Remedial Measures 139-144 Rickets 132, 142 Ringworm, Treatment of, Report on (Appendix E) 254-26.') Ringworm Clinic 144-146 Rivers and Streams 21 Room Factor in relation to Population 18 Sale of Food and Drugs Acts 41 Sanitary Circumstances of the District 21-55 Sanitary Inspection 8, 26-31 335 Page Sanitary Work 24 Saving, The, in Lives and Money 11 Scarlet Fever, Cases admitted to Willesden Hospital 58, 170-172 ,, ,, Complications of 173 ,, ,, Death Rate per 100,000 86 ,, ,, Incidence and Fatality Rates in 58 ,, ,, Removal of Cases of 58 ,, ,, Return Cases of 58-61 ,, ,, Multiple Cases 62-63 Scavenging, Removal of House Refuse—Statistics relating to 21-24 School Accommodation 119 School Arrangements, Disturbance of, by Medical Inspection 120 School Medical and Public Health Services, Co-relation of 119 Sewerage and Drainage 21, 29 Skin, Diseases of 132, 142 Slaughterhouses 27, 39-40 Small Pox, Cases Notified and Removed to Hospital 66, 69 Small Pox Patients, Provision for, Report on (Appendix I) 280-288 Social Conditions of District, Natural and 18-20 Special Cases 138-144 Spectacles, Report on Payments for (Appendix H) 275-280 Spectacles, Prices for 147 Speech 133-143 Squint 133, 135-136, 143 Staff 25, 179 Statutory Notices, Number of 26 Streams and Rivers 21 Summer Diarrhœa 103 Summonses Served 26 Syphilis 94 Teeth 131, 136-137, 141 ,, Treatment of, Report on (Appendix F) 263-269 336 Page Tenement Houses 27 Throat, Nose and Ear, Diseases of 131, 135, 141 Tuberculosis 73-82, 88-90 ,, Administrative Action 78 ,, Non-Pulmonary 133, 143 ,, Age Group of Cases Notified 75 ,, Contacts 80 ,, Dates of Onset and Notification 79 ,, Death Rates from 1875-1914 88 ,, Deaths and Death Rates in Wards 90 ,, Deaths from and Age Distribution of 89-90 ,, Detection of, in Milk 36-38 ,, Disinfection, Cleanliness, Disposal of Discharges 81 ,, Family History of Patients 79 ,, Housing Accommodation of Patients 80 ,, Localisation of Disease, Age and Sex Groups 75 ,, In Children Medically Inspected 132-133 ,, Occupation of Persons Notified as Suffering 76 ,, Prevalence of, and Control Over 73-82 ,, Sleeping Accommodation of Patients 79 ,, Table of Notifications Received 73, 74 ,, Treatment 81 ,, Ward Distribution of 77 Underground Rooms, Regulations for 48 Vaccination Statistics 69 Venereal Diseases 94 Veterinary Inspection of Milch Cows 36-38 Vision 133, 135-136, 143 Vital Statistics 7, 105-113 War, Health Considerations, and the 10 Water Supply 21, 28 Whooping Cough 70-71 ,, ,, Death Rate per 100,000 86 Workshops on the Register 52 337 APPENDICES. Appendix. Page A — Local Government Board Tables 181 B — Treatment of Ophthalmia Neonatorum 202 C — Abnormal Children and the Mental Deficiency (Notification of Children) Regulations, 1914; together with certain recommendations consolidating the recommendations arising out of this report with those already put forward in respect of the Treatment of Eyes 208 D — Maternity and Child Welfare 225 E — Treatment of Ringworm 254 F — Treatment of Teeth 263 G — Dust Allaying Materials 270 H. — Payments for Spectacles 275 I — Provision for Small Pox Patients—Kingsbury Hospital 280 J — Provision of Meals 288 K — Open Air School 300