C.I AC 439(I)WILLESDEN Willesden Urban District Council 1916. The 41st ANNUAL Health Report. GEORGE F. BUCHAN, Medical Officer. London: Hanbury Tomsett & Co., Printers, Kensal Rise, N.W. WIL 17 Willesden Urban District Council. 1916. The 41st ANNUAL Health Report. GEORGE F. BUCHAN, Medical Officer. London: Hanbury Tomsett & Co., Printers, Kensal Rise, N.W.. 8152 3 WILLESDEN URBAN DISTRICT COUNCIL, 1916-1917. Mr. Councillor J. ANDREWS. Mr. Councillor J. E. BALL. *Mr. Councillor J. J. BATE. •Mr. Councillor W. BLACKLOCK. Mr. Councillor C. H. BOLTON, M. A. †*Mr. Councillor W. M. BOLTON. *Mr. Councillor P. BOND. †*Mr. Councillor S. BOWN. Mr. Councillor H. C. BROWN. Mr. Councillor S. D. BUMSTEAD. Mr. Councillor E. T. BUTTERISS. †*Mr. Councillor J. COMBER. †*Mr. Councillor J. E. CONLON. Mr. Councillor J. G. CRELLIN. Appointed 15/8/16. Mr. Councillor W. H. DOBBS. Mr. Councillor A. E. DORAN. Mr. Councillor IL H. GRIMWOOD. Mr. Councillor J. E. HILL. Mr. Councillor W. A. HILL. Mr. Councillor G. H. HISCOCKS. *Mr. Councillor C. W. HOGG, J. P. (Chairman). Mr. Councillor E. LANE. Mr. Councillor T. G. MATTHEWS. Mr. Councillor C. PINKHAM, J.P. Mr. Councillor H. B. PRATT. Resigned 25/7/16. *Mr. Councillor G. H. PLYMEN. Appointed 28/11/16. †*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. Died 12/10/16. Mr. Councillor G. A. SEXTON. Appointed 11/4/16. Mr. Councillor A. SMITH. *Mr. Councillor C. E. P. TAYLOR. Mr. Councillor H. D. TURNER. *Mr. Councillor W. WAY (Vice-Chairman). * Member of the Health Committee. † M ember of the Hospital Committee. 4 WILLESDEN EDUCATION COMMITTEE, 1916-17. *Mr. Councillor J. ANDREWS Mr. Councillor J. E. BALL. Mr. Councillor W. BLACKI.OCIC (Chairman). *Mr. Councillor W. M. BOLTON. Mr. Councillor P. BOND. Mr. Councillor S. D. BUMSTEAD. *Mr. Councillor E. T. BUTTERISS. Mr. Councillor J. COMBER. Mr. Councillor H. H. GRIMWOOD. Mr. Councillor G. H. HISCOCKS. *Mr. Councillor j. E. HILL. Mr. Councillor W. A. HILL. *Mr. Councillor C. W. HOGG, J.P. *Mr. Councillor E. LANE. Mr. Councillor G. H. FLYMEN. Appointed 28/11/16. Mr. Councillor H.ROGERS. *Mr. Councillor The Rev. R. SILBY. Died 12/10/16. Mr. Councillor G. A. SEXTON. Appointed 18/11/16. Mr. Councillor H. D. TURNER. *Mr. J. CASH, J. P. (Chairman of the Children's Care Committee) Mr. W. J. DOWDELL (Vice-Chairman). Mr. J. J. HANBURY, J.P. Appointed 18/4/16. Resigned 3/10/16. *Miss M. A. LUPTON. *The Rev. G. MARTIN, M.A. Appointed 18/4/16. The Rev. H. M. RELTON. Appointed 28/11/16. *Mr. H. E. SCOTT. *The Rev. MARTIN THORPE. Appointed 18/4/16. Mr. A. E. WARREN. *Mr. D. T. WILLIAMS. • Member of the Children's Care Committee. 5 Municipal Offices, Dyne Road, Kilburn, N.W., 22iid February, 1917. To the Willesden Urban District Council— The Local Sanitary Authority. The Local Education Authority. I beg to submit herewith the 41st Annual Health Report for Willesden for the year 1916. This Report includes:— (1) The 41st Annual Report on the Health and Sanitary condition of the district. (2) The 9th Annual Report on the Health of Children attending the Public Elementary Schools. (3) The 25th Annual Hospital Report. The present Report sets forth the work undertaken by the Council as the Health Authority for Willesden to keep the population fit—mothers fit to bear healthy infants ; infants fit to enter school at the age of five; children fit to receive education while attending school, and on leaving, fit to enter upon the business of life. After this a hiatus is disclosed in the health activities of the Council for at the present time it is not directly within the scope of their functions to make provision for the care of the adult population in the same way or to the same extent as for the population up to 14 years. The various methods which the Council adopt in connection with their work of maintaining health may be thus classified:— (1) Building up the body to resist attacks of disease. 6 (2) Seaching for disease in its early stages and curing it quickly. (3) Diminishing the risk of catching disease. (4) Improving environment. 1. BUILDING UP THE BODY TO RESIST ATTACKS OF DISEASE. Feeding of School Children. The main work of the Council under this head is the feeding of school children. It is impossible for any person to be healthy unless good and regular feeding is provided. This was recognised in respect of school children by voluntary agencies during the last 20 years of the nineteenth century, when funds were raised in several of the larger cities for the feeding of poor and ill-nourished children at school. To-day the feeding of school children in Willesden is carried on under the Education (Provision of Meals) Acts, 1906 and 1914. At the beginning of the year 1916 there were seven centres at which school children received meals. Five were under the direct control of the Education Committee, one was a centre controlled by a voluntary agency, and one was a coffee shop. Owing to considerable reduction in the number of children fed, two of the feeding centres under the direct control of the Education Committee were closed on the 18th April, 1916. The dietaries in use during the year 1916 were the same as those set out in the Annual Report for 1915, pages 93 and 94. These dietaries each provide a good two course dinner. In addition, special meals consisting of half-a-pint of milk, were supplied at the schools at 11 a.m. daily except r days and Sundays to children considered by the Medical Officer to require additional nourishment. Meals were supplied on five days a week all the year round including holiday periods at all centres except the voluntary centre in Kilburn, which was closed for certain short holiday periods during the year. The total number of meals supplied in 1916 was 68,276, as compared with 179,058 in 1915, and 236,465 in 1914. In addition 1,024 special meals were supplied in 1916 as compared with 551 in 1915, and none in 1914. The total number of individual children fed during 1916 was 842, or 3.27 per cent. of the children on the roll, as compared with 1,839, or 7.6 per cent in 1915. A statement as to the payments made within the period from the 1st April, 1915, to the 31st March, 1916, is given in Appendix K. III. From this it will be seen that the average total cost for dinners was 4 861d., as compared with 2.938d. in the preceding financial year, and the average cost for food only for dinners was 2.l74d. during the financial year ended 31st March, 1916, as against 1.497 during the previous financial year. Having regard to the increased cost of food and the fall in the numbers of children fed during the year under review, the Committee instructed the Medical Officer to report on the economic circumstances of families in relation to the provision of school meals, and his reports on this matter are dated 18th September and 20th November, 1916, and appear in Appendices F. and G. From these Reports it will be observed that after deducting rent and insurance, the average cost of upkeep per week of a child of ten years, is as follows:— 8 s. d. Food 3 6 *Lighting and Fuel 0 7 Clothing 1 3 Sundries 0 3 Total 5 7 It is interesting to observe that the total incomes of families at and below which the Willesden Education Committee consider it necessary to give additional relief by way of supplying meals to the school children in order that the latter may not be prevented by reason of lack of food from taking advantage of the education provided are, with two minor exceptions, higher than the separation allowances recently published. The following is the comparative statement:— No. in family. Separation Allowances for London, including Allotments of pay. Scale of Willesden Education Com'tee. Total Incomes per week. Average Total Outgoings per family per week in respect of rent, insurance, fares to and from work and care of children. 2 23/- 22/6 6/6 3 28/- 27/- 7/6 4 31/- 32/- 8/- 5 34/6 36/- 8/6 6 37/6 38/6 8/6 7 40/6 44/- 9/- 8 43/6 49/- 9/- 9 46/6 55/- 10/- 10 49/6 60/- 10/- It is useless to speak of healthy children, and for the Treasury to give grants for certain specialised work in connection with the care of mothers and infants if the *This figure is based on Summer expenditure, and should be increased to 9d. for the present Winter months. 9 wives and families of the men who are serving the country receive less than a subsistence allowance. Owing to the shortage of Medical and Nursing Staff, it has not been possible, during the year under review, to keep accurate records of the effects of feeding on school children, but the general testimony is that the health and nutrition of the children are improved, and that the children are brighter and better able to cope with the work of education. In addition, the Supervisor has arranged, as far as the personnel at the present time will allow, to make the school meal educational, in respect of cleanly habits, good manners,, and table discipline amongst the children attending. Feeding of Expectant and Nursing Mothers and Young Children. The Willesden Health Committee fully realise the importance of good feeding in connection with Maternity and Child Welfare work and at their Meeting on December 8th, 1916, authorised the Madical Officer to provide the necessary food in cases of Expectant and Nursing Mothers and children under five years of age urgently requiring the same. 2. SEARCHING FOR DISEASE IN ITS EARLY STAGES AND CURING IT QUICKLY. The most important work under this heading is the Medical Inspection and Treatment of School Children. In 1907 Parliament made compulsory the medical inspection of school children with the view of detection of disease. While Parliament made medical inspection compulsory they did not require Education Authorities to provide the means of treatment. Records of diseases amongst school children, however, soon accumulated and made it clear to authorities that treatment was the natural sequel 10 and so, to-day, we find that provision in this respect has been made everywhere. Medical Inspection of School Children. There were 24,536 children attending the Willesden schools in the middle of the year 1916. Owing to the shortage of medical staff the medical inspection of specified age groups was not undertaken as a routine measure during the year, but instead, periodic visits were made by the available medical staff to all the schools with the view of picking out, by rapid survey, children who appeared to be ailing, for further examination. Two visits were paid to each department during the year. In this way 1,757 children were examined, and 2,286 defects were found. 1,436 of these children were referred for medical or dental treatment on account of 1,743 defects. On the whole, this method of examination cannot be considered an efficient substitute for routine medical inspection, as it only brings to light the more obvious defects such as nasal obstruction, squint, anaemia, and deformities which in the majority of instances have been previously noted by the teacher and referred to the Medical Officer. In addition it does not give the examining Medical Officer an opportunity of talking over with the parents defective conditions which may be brought to light. Medical Treatment for School Children. In addition to the cases noted by the medical staff on the occasion of their visits to the schools teachers and others continued to refer during the year, a large number of children to the Medical Officer, many of whom required medical or dental treatment. Altogether, 5,343 school children with 6,010 defects were referred for treatment during the year. 3,881 of these defects were dealt with under the supervision 11 of the Medical Staff of the Authority, 844 by Voluntary Agencies, 704 by Private Practicioners, 31 by the Poor Law and 328 were carried forward to 1917. In 79 cases the children left the district, and in 143 cases parents did not have treatment carried out. School Clinics. The Clinics have been much utilised during the year. 3,031 attendances have been registered at the Inspection Clinics on Saturday mornings at the Municipal Offices, and the Leopold Road Special School, 5,444 attendances at the Eye Clinic, and 1,199 attendances at the Ringworm Clinic making a total of 9,674 attendances. During the year the Education Committee considered a Report, appearing in Appendix H., on the Treatment of School Children. With the view of enabling children to have defects treated at once the Committee decided to extend the work of the Clinics to cover the treatment of minor ailments, enlarged tonsils, adenoids and teeth. Maternity and Child Clinic. The foregoing work of Medical Inspection and Treatment relates only to school children, but it has now been accepted that the process of searching for disease and curing it quickly, should be begun even before the age when a child enters school. With this end in view the Council opened a Maternity and Child Clinic at 9, Willesden Lane, in November, 1916, where a doctor and nurse attend every afternoon. Prior to the opening of this clinic, the Council had conducted a Babies' Welcome at Lower Place since 1910 at which, however, no medical advice was available. At the new Clinic expectant mothers are encouraged to attend up to the time of confinement. Advice, chiefly relating to matters of personal hygiene is given, medical aid 12 at home being advised in cases of serious illness. Medical supervision up to approaching confinement leads to the early detection of unfavourable symptoms or abnormal conditions likely to prove harmful to the mother or child, and enables steps to be taken to ensure, as far as possible, that proper remedies are applied. The Council are making arrangements for the provision of hospital beds for special cases. The ante-natal work of the Clinic to be effective must be co-related with that of practising midwives, who should look upon the ante-natal clinic as a centre to which they can refer their patients for advice either for genera! ill health or the ailments of pregnancy If a satisfactory relationship exists between midwives and the ante-natal clinic, the question of the notification of pregnancy, which has been discussed in certain quarters, need not arise. The post-natal work of the clin'c is chiefly the medical supervision of mothers and children up to the age of five years. Advice is given to the mother and errors of diet and the treatment to be adopted explained. The importance of breast feeding is pointed out, and any condition of the mother likely to prove detrimental to the child indicated with a view to appropriate remedial measures being applied. Unsatisfactory cases of illness or neglect are revisited by the Health Visitors. Demonstrations in the art of infant feeding are also given by the Health Visitors at the homes. Voluntary Agencies. Two Voluntary Baby Centres have recently been established, one at 84, Princess Road, Kilburn, N.W., and the other at the People's Hall, Goodson Road, Willesden, N.W. The Kilburn Voluntary Centre is mainly for the children of soldiers and sailors, and in connection therewith a Club has 13 been formed which the mothers attend, and at which, on certain days in the week, they help to make garments for their children. A doctor, paid out of voluntary funds, and one of the nursing staff of the Council, attend the infant consultations, which are held once a week. A part-time Health Visitor has also been appointed out of the voluntary funds to assist at the weekly infant consultations and to visit the homes of the children attending. The Willesden Voluntary Baby Centre works on similar lines to the Kilburn Voluntary Centre, but garments are made by voluntary workers and are sold to the mothers at the cost price of the materials. A doctor, paid out of voluntary funds, attends once weekly. At the end of 1916 this centre applied to the Council for a grant in aid, and the Council awarded .£20. Education on Health. It should be observed that the recognition of disease and the protection of health cannot be confined to the medical profession. If a healthy population is to be established and maintained, the people themselves must be educated on matters of health. This is especially important in respect of Maternity and Child Welfare, and attached to every Maternity and Child Clinic there must be in the near future a School for Mothers. Schools for Mothers. The main object of a School for Mothers is to supplement the work of infant consultations by providing class instruction for the mothers in the management, feeding and hygiene of the child. The methods of carrying out instructions given by the doctor at Infant Consultations relative to the child should also be explained. Where these simple lessons are appreciated by the mothers, the work is 14 extended to include teaching in sewing, cookery and general house management. All instruction given is made extremely simple and as practical as possible in order that the mothers may easily understand and profit by the teaching. The Classes and "Health Talks," which may be given by the Doctor or Nurse, should last about 15-20 minutes, otherwise the mothers become inattentive and gain nothing. The " Talks " may be arranged for the same afternoon as the Infant consultation. A room should be fitted up as a nursery for the use of the children, during the absence of the mother, the child being cared for by an attendant or voluntary helpers attached to the centre. Other classes may be held during the week according to requirements and provided the necessary accommodation is available. At some centres the sewing class has proved most useful. The instruction is elementary and graded to suit the type of mother attending. Simple and inexpensive model baby clothes are shown, patterns cut and supervision given in the making which may be done either at home or at the school. The mothers are also taught how to knit various woollen garments. Material, such as flannel, calico, and wool, which could not otherwise be afforded, is sold at cost price. At centres with the necessary voluntary help, baby clothes made by friends, are also sold at cost price. In this way the mothers are taught the best and most economical method of clothing a child. Where a sewing class is he'd it is essential that the person in charge should be fully qualified in the work undertaken, and also possess the necessary teaching ability. 15 Where the necessary accommodation is available a course of instruction in cookery may be arranged for about 8-10 mothers. The work should be largely practical, the mothers themselves making varions inexpensive dishes suitable for ordinary consumption in the homes. Instruction should also be given in the preparation of infant foods, barley and albumen water, whey and raw meat juice. The experience gained would, in all probability, tend to produce more comfort in the homes and later a beneficial effect upon the nutrition of the children. A School for Mothers has not yet been established in Willesden, but it is hoped that this will shortly be included in the work carried out at the Maternity and Child Clinic. Mothercraft. Instruction in Mothercraft may also be given to the older girls in the Public Elementary Schools. Girls of 12-14 years, even as young as 8 years, frequently assist at home in the care and management of younger brothers and sisters, thus becoming familiar with the handling, washing and dressing of an infant. Frequently, however, the children are instructed by mothers who are themselves ignorant of the most important details of infant management. Therefore, at an early age they become familiarised with wrong methods, difficult to correct in later years. The best way to counteract this is by the introduction of class instruction in infant care as part of the school curriculum in Public Elementary Schools. This should include, not only the nursing, washing and dressing of an infant, but also the correct method and intervals of feeding a baby and the care of the feeding bottle. Where possible this should be followed by simple practical 16 instruction in the preparation of infant foods, e.g., sterilisation and dilution of milk, artificial foods, barley and albumen water, and so on. A simple syllabus and classes should be arranged, instruction being given by a suitably qualified teacher. It is not incorrect to say that at the end of the course the majority of the girls would have a wider knowledge of infant care than some of the mothers in charge of infants at present. In some towns wider practical teaching is given by allowing some of the older girls to attend the Day Nurseries where further instruction is possible. In Willesden, an excellent class is conducted by Miss Webster, the Head Teacher, at Chamberlayne Wood 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 in the future. Venereal Diseases. This matter of educating the public to searc for disease and have it cured quickly has been especially prominent of late in respect of the recommendations of the Royal Commission relative to Venereal Diseases. There is no special mystery about these diseases, and in connection with the campaign for their control and eradication it may be well for me to set out clearly the important facts which should be in the possession of every member of the public. Venereal Diseases include Syphilis—also known as the Pox or the Bad Disorder ; Gonorrhoea—also called the Clap; 17 and Soft Chancre, or Soft Sore. Apart from a few rare cases, as, for example, when a midwife contracts the disease in the course of her duties, Venereal Diseases are acquired by sexual intercourse with persons suffering from these diseases. Venereal diseases are detrimental to the health of the sufferer, and to his or her offspring. On the 1st November, 1913, a Royal Commission was appointed to enquire into the prevalence of Venereal Diseases in the United Kingdom, their effects upon the health of the community, and the means by which those effects could be alleviated or prevented, it being understood that no return to the policy or provisions of the Contagious Diseases Acts of 1864, 1866 or 1869, was to be regarded as falling within the scope of the enquiry. The Contagious Diseases Acts referred to were concerned with the Army and Navy alone, and were applied in certain naval and military centres. They involved the surveillance and medical examination of prostitutes in those localities. Public opinion was opposed to these Acts, which were ultimately repealed in 1886. The first report of the Commission is dated 8th June, 1914, and the final report, 11th February, 1916. The latter report has not been accepted without criticism, especially in respect of the absence of recommendations relating to:— (a) The Notification of Venereal Diseases; and (b) The Prohibition of the Treatment of Venereal eases by druggists and persons not qualified to practice medicine. Arising out of these Reports the Public Health (Venereal Diseases) Regulations, 1916, dated July 12th, 1916, were issued by the Local Government Board to County Councils and County Borough Councils, and the Common Council of the City of London, requiring such Councils to prepare and submit to the Local Government Board schemes b 18 (1) For enabling any medical practioner to obtain, free of charge, a scientific report on any material which the medical practitioner may submit from a patient suspected to be suffering from venereal disease. (2) For the treatment at and in hospitals or other stitutions of persons suffering from venereal disease ; (3) For supplying medical practitioners with salvarsan or its substitutes, for the treatment and prevention of venereal disease. The Local Government Board undertake to repay 75 per cent. of the expenditure incurred under these Regulations, and approved by them. In December, 1916, the scheme of the Middlesex County Council, which includes Willesden, was forwarded by the County Medical Officer. Arrangements have been made by the Middlesex County Council with large General Hospitals and Hospitals specially associated with the treatment of Venereal Diseases in London, together with the Prince of Wales's Hospital, Tottenham. Treatment for these diseases is available at any of these Hospitals on application by any patient. The scheme of the Local Government Board is admirable in conception, but will fail as a means of checking Venerea! Diseases unless the public are fully educated as to the nature and ravages of these diseases, the methods by which they are acquired and spread, and the importance of securing the skilled treatment provided, as early as possible. In particular the following facts should be widely known:— (1) It should be understood once for all by every male person that sexual intercourse is not necessary for the ma;ntenance of perfect health. 19 (2) The greatest possible risk of acquiring venereal diseases is incurred by promiscuous sexual indulgence. (3) Venereal Diseases are not slight maladies, but are dangerous to health, and frequently lead to permanent disability. Syphilis is largely responsible for mental deficiency, insanity, imbecility, idiocy, and other nervous disorders. It is one of the main causes of diseases of the blood vessels and apoplectic strokes in early life. It is also the chief cause of miscarriages and still births. Gonorrhoea is a disease of the genital organs, and unless cured at once spreads to the bladder and kidneys. It is a frequent cause of chronic invalidism, and is probably the principal factor in producing sterility in the male or female. (4) Venereal diseases can be cured if treatment is begun early and systematically carried on until the doctor pronounces the patient out of danger. Treatment should be continued even after the early symptoms have disappeared, if the cure is to be complete, and no ill results are to follow. The value of treatment, and especially of early treatment, cannot be over-stated. Treatment in the case of Syphilis can now be given with every prospect of complete cure if the remedy is applied in the early stages of the disease. This is due to three medical discoveries:— (a) The discovery, in 1905, that Syphilis was due to a micro-organism, circulating in the blood. (b) "Ihe discovery of a Wasserman Re-action in 1906. This is a blood test by which the presence of Syphilis in the blood can be demonstrated at times when no active symptoms show themselves. This test 20 enables the pathologist to say if the patient is suffering in the early stages, and when the patient is cured in the later stages of the disease. (c) The discovery of a substance which can be injected into the*veins which, while harmless to the patient, is destructive to the micro-organism of Syphilis in the blood. (5) Treatment by a herbalist, or quack, or other unskilled person should never be resorted to if a permanent cure is to be obtained. (6) Venereal diseases are contagious and until pronounced cured by the doctor in charge, the patient must avoid sexual intercourse which will spread the disease. Ophthalmia Neonatorum. There is no condition which depends more on early recognition and early treatment for its speedy and complete cure than Ophthalmia Neonatorum. The disease was made compulsorily notifiable by an order of the Local Government Board on 1st April, 1914. It is prevalent among the children of the poor, and has been computed to cause one-tenth of all cases of blindness, and one-third of all institutional blind cases. Ophthalmia Neonatorum is due to infection of the child's eyes from the maternal passages, during birth, and is usually of gonorrhceal origin. The first manifestation of the disease may be noticed within the first few days of birth, or in the less severe cases up to three weeks after birth. In the acute cases, which develop early, there is intense swelling of the eye-lids, and a profuse purulent discharge generally both eyes being affected. 21 The infection in these cases is extremely virulent, and the sight may be permanently or partially damaged in a short time, unless the necessary treatment is carried out efficiently, the eyes requiring to be carefully and thoroughly cleansed at frequent intervals. Unfortunately, illness frequently prevents the mother giving this constant attention, and in other cases the mother is too ignorant to carry out the treatment satisfactorily, indeed, it is questionable if any but a trained person has the necessary skill. The importance of early treatment cannot be over-rated, and every effort should be made to secure this. The earlier treatment is begun, the less is the probability of total or partial blindness. 27 Cases were notified during the year 1916. Of these 23 were cured, one case was admitted to the Willesden Infirmary, and one case was still under observation at the end of the year. In the cases of the other two the results are not known. Four of the above cases attended the Eye Clinic during the year and were discharged as cured. In addition to the above, 8 cases, which had not been notified as Ophthalmia Neonatorum, were found by the Health Visitors in their visits under the Notification of Births Acts. Of these cases 4 are still under observation at the Eye Clinic, and the other 4 cases are being followed up at the homes by the Health Visitors. It is only by visiting the notified births at an early date that such cases can be brought under observation and promptly treated. During the year 112 visits and revisits were made by the Health Visitors to cases suffering from this disease. 22 According to the severity of the disease two lines of treatment may be adopted—(1) Home. (2) Institutional. (1) Efficient home treatment will be sufficient for the majority of the cases coming under observation, but it is important that these cases should remain under constant medical supervision either by attending a medical practitioner or the eye clinic, in order that other means may be adopted on the first sign of any complication. (2) In the acute cases where complications are likely to develop, and where home treatment would be inefficient, the best results can only be obtained by removing the case to hospital. The child would then be under constant medical supervision and receive the skilled nursing necessary in the early stages of this disease to prevent permanent blindness, complete or partial. In such cases, on account of feeding, it is inadvisable to separate the mother from the child, and provision has therefore to be made for the mother to stay in hospital while the child is under treatment. With the necessary provision of beds at the hospital for diseases of children, there should be little difficulty in impressing upon the mother that the best results and a speedy recovery can only be obtained by institutional treatment. In one case during the year, constant medical supervision was not obtained, with the result that the child was finally admitted to hospital, one eye being so badly affected that complete removal was necessary. 3. DIMINISHING THE RISK OF CATCHING DISEASE. The measures adopted to this end include:— (a) Protection of the Milk and food supply; 23 (b) Notification and other measures for the control of Infectious Diseases; (c) Removal of Infectious cases to Hospital; (d) Quarantine of contacts; and (e) Searching for carriers of disease. Protection of the Milk Supply. The veterinary inspection of milch cows and the sampling of milk for the detection of tubercle bacilli have been carried on in Willesden for some years, but the work in connection therewith was discontinued in April, 1916, owing to the withdrawal of the Tuberculosis Order, and to the fact that other authorities do not adopt a similar routine precedure thus discounting the work which is done in Willesden. During the year 8 samples were taken at the farms in Willesden, all of which were found to be free from tubercle. Eleven samples were obtained from milk sellers in the District, and one was found to contain tubercle. The Medical Officer of the County where the farm, from which the infected sample came, is situate, was communicated with, and as a result of the action taken by the Local Authority, an examination of the suspected herd was subsequently made by a veterinary surgeon, who found a cow suffering with a tuberculous udder. The affected cow was withdrawn from the herd. Protection of the Food Supply. Periodic inspection is made of the slaughter-houses and places where food is prepared and sold in Willesden. During the year 841bs. of fish, 2101bs. of parts of animal carcases, 41bs. of tomatoes, and 29 tins of condensed milk were voluntarily surrendered and destroyed. 24 Proceedings were instituted in three instances against butchers for exposing for sale, or depositing on the premises in preparation for sale, diseased meat intended for the food of man. The Justices regarded the cases as of the utmost importance and imposed penalties of £3, £10, and £20 respectively. The seizures were all made on the same day at three separate shops in Willesden, the source of the supply being in all instances from the same person. Suspected Tuberculous Cattle. During the year information was received by the Health Department that cows suspected of being tuberculous had been consigned to premises in Willesden. The premises in question were kept under continuous observation day and night. During the watch, several cows, emaciated, weak and apparently suffering from tuberculosis, were led out to water on one or two occasions. After observation had been kept for seven days one of the inspectors saw a man drag the carcase of a cow to the door of the shed and then hitch on a chain horse to drag the carcase out. It was then drawn up by a windlass into a float which was driven to a farm in an adjoining district. The Sanitary Officials of the adjoining district were communicated with and the carcase, while in the act of being dressed, was seized. The carcase showed Tuberculosis of the Lungs, Mesenteric Glands and various internal organs. The Council in whose area the carcase was seized, took no action. Following this incident the watch on the premises was maintained and the owner of the premises asked the Medical Officer to inspect the remaining cows, five in number. All of them were emaciated, and one was certified to be suffering from Tuberculosis by a veterinary surgeon. Two of these five were subsequently traced to slaughter houses where they were slaughtered, found to be tuberculous, and condemned. The remaining three eluded the vigilance of the Inspectors. 25 The Council gave their careful consideration to this important subject and came to the conclusion that the powers they possessed were not sufficient. The tracking down of the cattle in question had occupied the time of three inspectors and a labourer both by day and night, for a period of three weeks. The Council accordingly decided to inform the Local Government Board that in their opinion greater powers should be conferred on Local Authorities in respect of tuberculous or suspected tuberculous cattle, so as to prevent their removal without previous notice to the authority, and to prohibit the slaughtering of such animals for human consumption anywhere except in a public abattoir. Infectious Diseases. During the year 1916, 2,513 cases of Infectious Diseases were notified under Acts and Orders. This is the largest number yet recorded, and is due to the extension on the 1st January, 1916, of compulsory notification to Measles and German Measles, 1,437 cases of these diseases being included in the figure before mentioned. Ten cases of Cerebro-Spinal Meningitis were notified during the year. Two occurred in the military population and eight in the civil population. Of the two military cases one was admitted to the Willesden Isolation Hospital and recovered, and one was admitted to the Willesden Isolation Hospital and from there transferred by the Military Authorities to the Royal Herbert Hospital, Woolwich. Of the eight civil cases two were admitted to the Willesden Isolation Hospital. One died on the day of removal, while the other was still in hospital at the end of the year 1916, and has since then recovered. Two were admitted to Paddington Green Children's Hospital and died. One case died during removal to Hampstead Genera1 Hospital. Three cases died at home before removal could be carried out. In no instance did a second case occur in a family. 26 In three of the ten cases no bacteriological examination of contacts was made. In one case no information was available, as all enquiries were made by the military authorities. In 6 of the cases bacteriological examinations of contacts were made, 31 contacts being swabbed. In two instances the swabs were positive. These two positive contacts were admitted to the Willesden Isolation Hospital and discharged after treatment had rendered the throat and posterior nares free of the organism of the disease. Isolation Hospital. 666 Cases of illness were treated in the Isolation Hospital in 1916, as compared with 807 in 1915. The outstanding feature of hospital administration during the year has been the reduction of the period of isolation for Scarlet Fever patients. In 1910 the average stay of a Scarlet Fever patient was 47 days, in 1911 48 days, in 1912 51 days, in 1913 46 days, in 1914 46 days, and in 1915 47 days, and in 1916 36 days. This reduction has been effected without increasing the percentage of return cases which for the corresponding years has been: 1910, 6.7; 1911, 4.6; 1912, 3.7; 1913, 5.2; 1914, 5.5; 1915, 2.9; and 1916, 5.4. 4. IMPROVING ENVIRONMENT. The measures taken under this head are well known and have been reviewed from time to time in previous Annual Reports. They include (a) The removal of house refuse; (b) The protection of the Water Supply; (c) The abatement of Nuisances; (d) The improvement of the conditions under which persons are employed in factories and workshops; and (e) The inspection of houses with the view of dealing with bad housing conditions. 27 The work in connection with the periodical inspection of houses under the Housing (Inspection of District) Regulations, 1910, was not actively maintained during 1916 owing to the difficulties experienced in obtaining the necessary labour to remedy defects and the high cost of building material. Only the most urgent matters arising out of Housing Inspection were dealt with. MISCELLANEOUS. Under the foregoing four main headings I have outlined the steps taken by the Council for the maintenance of health. In connection with such work there are many subsidiary, but none the less essential activities and enquiries. Vital Statistics. In order that the results of the measures for securing the health of the population may be judged and new methods devised, it is necessary to have regard to the Vital Statistics of the population. The population of Willesden estimated at midsummer, 1916, was 167,810. This estimate is probably too low. It is based on the number of occupied rooms in Willesden, assuming that the number per room has remained the same as at the Census, 1911. In normal times this is a fair assumption, and gives a relatively accurate method of estimating the population, but as practically no new building has taken place since war broke out in August, 1914, and as there has been a large influx of munition workers into Willesden, it is probable that the number of persons per occupied room is greater than in normal times. The death rate during the past year has been 10.19 per thousand of the population, while the infant mortality rate has been 77 per t ousand births, or the lowest on record. In connection with this latter figure it should be noted that the birth rate during last year was likewise the lowest on 28 record, namely, 21.9 per thousand of the population. While it is satisfactory that the infant death rate has diminished, it is not so satisfactory to note that fewer babies have been born. This fact, together with the wastage of life, on account of the war, makes the care of the child an all important problem for the Local Authority and the State. Day and Night Nursery. Whatever care is taken of the physical welfare of the child contributes to the building up of a sound population. During the year 191G an increasing number of women were employed as munition workers. This demand for woman labour created the necessity for some authority to take care of the children. In Willesden, with munition factories all round, this need was especially great. The Council accordingly decided at their meeting on 7th November, 1916, to establish a Day and Night Nursery for the children of Munition Workers, the Ministry of Munitions paying 75 per cent. of the cost of initial equipment, and the Board of Education giving a grant of 7d. per day or night attendance of twelve hours. The report of the Medical Officer relative to this matter appears in Appendix D. Taking a glance into the future it would appear that If the financial commitments of the State owing to the war are to be wiped off by the nation, women must play an important part. Not only must every facility and every encouragement be given to large families, but the care of the children must be undertaken to free mothers for employment, and yet this must be done in such a way that neither the mother nor the child suffers. Open Air School. There is great need for an Open Air School in Willesden in order that children of school age who are delicate, or who are convalescent from some acute condition such as 29 chitis, may recover without any permanent damage being done. Unfortunately, the advent of war has prevented the plans of the Education Committee in connection with this matter being carried out, but the establishment of an Open Air School has been put down as the first business of the Committee when the war is over. Cleansing of Verminous Children. Vermin amongst children constitutes a disease which would be easily dealt with if the mother of every family had sufficient time and energy to devote to the care of her children. During the year 1916, 962 cases of school children were referred on account of verminous and nitty conditions. Of this number 772 were cleansed by the parents on notice being given and visits to the homes paid by the Health Visiting Staff. In 117 cases, however, summonses for non-attendance at school had to be resorted to. In 98 cases the parents were fined. In 1 case the summons was dismissed, and in 16 cases the summonses were adjourned and subsequently withdrawn on satisfactory attendance. 2 cases were pending at the end of the year. The remaining 73 cases include those which left the district and those still under observation at the end of the year. Home Helps. In connection with the question of verminous and nitty conditions amongst school children the Education Committee appointed two women on the 12th July, 1915, to cleanse the children at their homes. The services of one of these Home Helps was dispensed with on the 11th December, 1915, and of the other on the 29th July, 1916. The wages paid to the Home Helps were 15s. per week, their hours being the ordinary office hours. 30 It was reckoned that each of the visits of these Home Helps to be effective should be of two hours duration, allowing for an interval between cases, and that in all 17 visits should be paid per week. It was further reckoned that a case should be cleaned in 7 visits. Under these conditions Home Help No. 1 should have cleaned 53 instead of only 32 cases, and Home Help No. 2 133 instead of only 91 cases. It may be stated that the estimate of the work which should have been done is a minimum. It is very difficult to obtain a suitable woman to do this class of work. If the woman is one of the less intelligent type she requires constant supervision in order that a reasonable standard of work may be reached. On the other hand a woman of superior type does not care to undertake the work of cleansing dirty children. On the whole this initial experiment in the way of using Home Helps for the cleansing of verminous children cannot be said to have been successful, and it would appear necessary to establish cleansing stations. Leinster Road and Leopold Road Mentally Defective Schools. These schools provide acommodation for 80 and 40 children respectively—120 in all. They have been established with a view of educating in the best possible way the Mentally Defective child. Both these are day schools, and I am of opinion that such schools are not suitable for the true Mentally Defective child, i.e., a child, who having received chances of education is still three or more years backward. Such a child ought to be dealt with in an Institution, and the present Mentally Defective Schools might very well1 be converted into day schools for children who are merely dull, or backward, and require more individual tuition than it is possible to give them in classes of 60 as in the ordinary Elementary Schools. 31 Furness Road Physically Defective School. This school has been established for the education of children who are cripple, tuberculous, or suffering from some similar condition of ill-health. In a measure it is an aid to the cure of the disease from which the children are suffering, because a number of them are in attendance with the disease still active. A high standard of cleanliness both of head and skin is maintained by the nurse in charge. The school is visited by the school doctor once a fortnight, and the children are examined in rotation, or as may be required. Any condition requiring remedial measures is brought to attention. ADMINISTRATION. A study of the foregoing statement shows that the maintenance of health amongst the population is one continuous process, beginning with child life in utero, and extending to old age. It is unfortunate that there is no single Authority responsible for this work. In Willesden there is continuous ov erlapping and waste of effort owing to the multiplicity of Authorities. There is the Public Health Authority, the Education Authority, the Board of Guardians, the County Council, the Middlesex Insurance Committee and a number of Voluntary Agencies. The Public Health Authority and the Education Authority although actually one Authority are separately responsible to two Central Authorities, namely, the Local Government Board and the Board of Education, from which separate grants are obtained in respect of different sections of the same work. A third central authority dealing with health matters is the National Health Insuranoe Commission. Then there is the Board of Control, the Central Authority undet 32 the Mental Deficiency Act. Under such conditions the difficulties of administration are considerable and become increasingly so year by year. It a proper and effective organization in respect of the various matters relating to health is to be established and maintained for the good of the population, these involved methods of administration must be abandoned and steps taken to secure that there is a single Central Authority and one Local Authority in every area, and one only, for the furtherance of all matters relating to Public Health. I am, Your obedient servant, GEORGE F. BUCHAN, Medical Officer STATISTICAL INFORMATION RELATIVE TO THE 41st annual report FOR THE YEAR 1016 on the HEALTH AND SANITARY CONDITION of the URBAN DISTRICT OF WILLESDEN. 34 CERTAIN STATISTICAL DATA—1916. No. of Occupiable Houses 23,540 Estimated Population 167,810 No. of Marriages 1,279 Marriage Rate per 1,000 15.2 No. of Births 3,668 Birth Rate per 1,000 21.9 No. of Illegitimate Births 115 No. of Deaths 1,710 Death Rate per 1,000 10.19 No. of Infant Deaths 283 Infant Death Rate per 1,000 Births 77.15 No. of Cases of Notifiable Diseases 2,513 Scarlet Fever 387 Diphtheria 225 Cerebro Spinal Meningitis 8 Measles 871 1,437 German Measles 566 Tuberculosis 322 Erysipelas 87 Enteric Fever 3 Puerperal Fever 11 Poliomyelitis 5 Ophthalmia Neonatorum 28 35 POPULATION—Table No. I. Giving the population in Willesden at each census since 1851, and the population estimated by the method in vogue in Willesden at Midsummer of each year since 1901, together with the estima. ted annual increase and the natural increase as indicated by the excess of births over deaths. Year. Population. Estimated annual increase of population. Natural increase of population i.e. excess of births over deaths. 1851 Census 2,939 — — 1861 Census 3,879 — — 1871 Census 15,869 — — . 1881 Census 27,453 — — 1891 Census 61,265 — — 1901 Census 114,811 — — 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 Census 154,214 — — 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 1915 166,840 206 1,745 1916 167,810 970 1,958 36 POPULATION ESTIMATED AT MIDSUMMER, 1916.—TABLE NO. 2. WARD. Population estimated on the number of rooms in occupation in each Ward as ascertained 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. 1 room . 2 rooms 3 rooms over 3 rooms i Total. No. occupied. No. empty. (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) (13) (14) (15) (16) (17) Met. Drain Area. 1. South Kilburn 14757 1311 31 73 6 68 5 1 10349 10018 331 ... ... ... 2.36 3.19 2. Mid Kilburn 14712 1762 47 30 4 7 13 6 13635 13195 440 ... ... ... 2.67 3.22 3. North Kilburn 12370 2047 80 24 1 1 13 11 17068 16191 877 ... ... ... 3.90 5.13 4. Brondesbury Park 9928 1421 9 21 ... 3 8 10 11463 11308 155 ... ... ... 65 1.35 5. Kensal Rise I4310 1895 10 16 1 2 11 2 12514 12400 114 ... ... 2 .52 .91 6. Harlesden 17580 2592 11 14 ... 9 2 3 18182 18068 114 ... ... ... .42 .62 Total Met. Drain. Area 83637 11028 188 178 12 90 52 33 83211 81180 2031 ... ... 2 1.70 2.44 Brent Drain Area. 7. Stonebridge 17821 2090 27 5 ... ... 4 1 13895 13698 197 ... ... ... 1.29 1.41 8. Roundwood 15722 2196 26 7 ... ... 6 1 15631 I5414 217 ... ... ... 1.18 1.38 9. Church End 14206 1980 25 21 ... ... 16 6 12382 12163 219 ... ... ... 1.26 1.76 10. Willesden Green 16954 2482 32 17 1 1 5 10 16594 16318 276 3 ... ... 1.16 1.66 11. Cricklewood 19450 3764 91 32 ... 1 8 24 29272 28311 961 4 2 7 2.31 3.28 Total Brent Drain, area 84153 12512 201 82 1 2 39 42 87774 85904 1870 7 2 7 1.55 2.13 Total 167810 23540 389 260 13 92 91 75 170985 167084 3901 7 2 9 1.62 2.28 37 REMOVAL OF HOUSE REFUSE.—Table No. 3. Shewing number of carts and men employed and complaints received. 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 l904-5 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 1915 41 6 19 78 12 1611 6.86 1916 24 4 18 47 8 2111 8.97 38 REMOVAL OF HOUSE REFUSE.—Table No. 4. Relating to quantities and costs. Year. Annual quantity collected. Total cost of collection as per contract. No. of Occupied Houses at Michaelmas. Population at Michaelmas. Amount of Refuse collected in cubic yards per house per annum. Amount of Refuse in cubic yards per head of population per annum. Cost per cubic yard. Cos per house. Cost per head of the population. Rate in he £ In cubic yds. In tons. (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) £ d. s. d. d. d. 1900-1 79.875 25,905 6,822 16,820 115,201 4.7 .69 20.5 8 1 14.2 3.13 I901-2 83,587 27,109 7,822 17,258 117,619 4.8 .71 22.5 9 0¾ 16.0 3.45 1902-3 91,170 29,568 8,972 18,188 123,987 5.0 .73 23.6 9 10½ 17.4 3.69 1903-4 99,761 32,354 9,945 19,172 130,621 5.2 .76 23.9 10 4½ 18.3 3.83 1904-5 99,510 32,273 10,929 20,009 135,613 4.9 .73 26.4 10 11½ 19.3 3.99 1905-6 88,860 28,819 7,450 20,735 140,692 4.3 .63 20.1 7 2¼ 12.8 2.60 1906-7 79,137 25,666 6,250 21,109 142,772 3.7 .55 19.0 5 11 10.5 2.10 1907-8 80,100 25,978 6,850 21,485 144,912 3.7 .55 20.5 6 4½ 11.3 2.20 1908-9 86,062 27,912 5,855 21,846 149,744 3.9 .57 16.3 5 4¼ 9.4 1.84 1909-10 80,558 26,127 5,604 22,069 151,000 3.7 .53 16.7 5 0¾ 8.9 1.73 I910-11 80,417 26,081 6,547 22,385 154,298 3.6 .52 195 5 10¼ 10.2 1.99 I911-I2 84,367 27,362 6,547 22,679 157,717 3.7 .53 18.6 5 9¼ 10.0 1.97 1912-13 87,106 28,250 6,547 22,923 161,188 3.8 .54 18.0 5 8½ 9.7 1.93 1913-14 79,450 25,767 6,163 23,208 164,538 3.4 .48 18.6 5 3¾ 9.0 1.77 1914 76,002 24,649 6,436 23,279* 166,634* 3.3 .45 20.3 5 6¼ 9.3 .85 1915 74,621 24,201 6,433 23,489* 166,840* 3.2 .45 18.9 5 5¾ 9.2 1.85 1916 72,694 23,576 8,283 23,543* 167,810* 3.1 .43 27.3 7 1 11.8 ... * Midsummer. 39 REMOVAL OF HOUSE REFUSE.—Table No. 5. Relating to loads and costs. Total actual No. of loads removed. Average No. of loads per day. Average cost per van load. Average capacity of van in cubic yards. (1) (2) (3) (4) s. d. 9,674 31.0 17 1½ 7.51 REMOVAL OF HOUSE REFUSE—Table No. 6. Relating to monthly collection and daily averages. Month. No. of working days. Total cubic yards removed. Average No. of cubic yards removed per working day (1) (2) (3) (4) 1916. January 26 6,803 262 February 25 5,696 228 March 27 5,893 218 April 24 7,086 295 May 27 6,796 252 Tune 26 6,249 240 July 26 5,949 229 August 27 5,904 219 September 26 5,483 211 October 26 5,544 213 November 26 6,005 231 December 26 5,286 203 40 CANAL BOATS ACTS, 1877 and 1884.-Table No. 7. Return shewing the contraventions observed and remedied during the year. Infringements of the Acts and Regulations with respect to Carried forward from 1915. Found during 1916. Remedied during 1916. Carried forward from 1916. (a) Registration ... ... ... ... (b)Notification of change of Master ... ... ... ... (c) Certificates ... 3 2 1 (d) Marking ... 1 ... 1 (e) Overcrowding ... 1 1 ... (f) Separation of sexes ... ... ... ... (g) Cleanliness ... ... ... ... (h) Ventilation ... ... ... ... (i) Painting ... ... ... ... (j) Provision of Water Cask ... ... ... ... (k) Removal of Bilge Water ... ... ... ... (I) Notification of Infectious Disease ... ... ... ... ( m) Admittance of Inspector ... ... ... ... (n) Habitable Condition 2 2 4 ... Totals 2 7 7 2 HOUSES UNFIT FOR HUMAN HABITATION.—Table No. 8. Return shewing the action taken under the Housing, Town Planning, etc., Act, 1909, with respect to premises represented as unlit for human habitation. Total number of houses inspected 380 Number considered to be unfit for human habitation 0 Number represented by Medical Officer of Health 0 Closing Orders made by Local Authority 0 Appeals against Closing Orders 0 Notices served on occupying tenants 0 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 13 Demolition Orders made 5 Appeals against Demolition Orders 5* Demolition Orders obeyed 0 Number of demolitions carried out without Orders being made 0 * Demolition Orders varied by Local Government Board on appeal. 41 DWELLING HOUSES REPRESENTED AS UNFIT FOR HUMAN HABITATION.—Table No. 9. Section 17 (1) of Housing, Town Planning, &c., Act, 1909. Situation of Dwelling Houses. No. of Houses. Date of representation of M.O.H. D ite 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. Canterbury Yard, 3-7 5 25/1/16 1/2/16 22/2/l6* Wellington Road, 2 & 3 2 25/7/16 Avenue Close, 1-7 7 Converted into workshops Avenue Close, 8, 9, 10, 18, 19 5 23/5/16 Avenue Close, 11 12, 13, 14 4 27/3/16 Avenue Close, 15,16,17 3 27/3/16 . Avenue Close, 20, 21 2 27/3/16 Avenue Close, 23, 24 2 27/3/16 Avenue Close, 22, 26 2 27/3/16 Peel Road, 2-12 6 25/7/16 (Underground sleeping rooms) * Demolition Order Varied on Appeal. 42 FACTORIES, WORKSHOPS, LAUNDRIES, WORKPLACES AND HOMEWORK. Table No. 10. 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) 174 33 ... Workshops (including Workshop laundries) 201 49 ... Workplaces (other than Outworkers' premises included in Part 3 of this Report) 51 15 ... Total 426 97 ... Table No. II. 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 30 26 ... ... Want of Ventilation ... ... ... ... Overcrowding 1 1 ... ... Want of drainage of floors 5 4 ... ... Other Nuisances 25 19 ... ... Sanitary accommodation— Insufficient 1 ... ... ... Unsuitable or defective 43 30 ... ... Not separate for Sexes 1 ... ... ... 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) 34 30 ... ... Other offences (Excluding offences relating to out-work which are included in Part 3 of this Report). ... ... ... ... Total 140 110 ... ... 43 Table No. 12. 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. Sending twice in the Year. Sending once in the Year. Failing to keep or permit inspection of lists. Failing to send lists. Instances. Notices served. Prosecutions. Instances. Orders made, S. 110. Prosecutions, Section 109, 110. Lists. Outworkers. Lists. Outworkers. Contractors. Workmen. tractors men (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11} (12) (13) (14) (15) (16) Wearing Apparel— Making, &c. 17 l6 24 7 8 2 27 ... ... 4 4 ... ... ... ... Cleaning and Washing 1 2 ... ... ... ... 4 ... ... ... ... ... ... ... ... Household linen ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... Lace, lace curtains, and nets ... ... ... ... ... ... 4 ... ... ... ... ... ... ... ... Furniture and upholstery 2 1 ... 2 ... 1 4 ... ... ... ... ... ... ... ... Umbrellas, &c. ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Total 20 19 24 9 8 3 40 ... ... 4 4 ... ... ... ... u Table No. 13. REGISTERED WORKSHOPS. Workshops on the Register (s. 131) at the end of the year. (1) Number. (2). Factories 106 Factories, Laundries' 53 Workshops, Laundries 43 Domestic Laundries 11 Bakehouses 64 Dressmakers 28 Outworkers 173 Blouse Makers 6 Tailors 21 Bootmakers 47 Metal Workers 8 Wood Workers 9 Seamstresses ... Motor and Cycle Makers 17 Upholsterers 5 Milliners 4 Miscellaneous 20 Total number of Workshops on Register 615 Table No. 14. OTHER MATTERS. Class Number (1) (2) Matters notified to H.M. Inspector of Factories:— Failure to affix Abstract of the Factory and Workshop Act (s.133) 8 Action taken in matters referred by H.M. Inspector as remediable under the Public Health Acts, but not under the Factory and Workshop Act (s.5)— Notified by H.M. Inspector 1 Reports (of nction taken) sent to H.M. Inspector ... Other ... Underground Bakehouses (s. 101) : Certificates granted during the year ... In use at the end of the year 18 45 INFECTIOUS DISEASES—Table No. 15. Showing the number of notifications of infectious diseases in Willesden each year since 1892. Year. Small Pox. Cholera. Plague. Diphtheria (including Membranous Croup). Erysipelas. Scarlet Fever. Typhus Fever. Enteric Fever. Relapsing Fever. Continued Fever. Puerperal Fever. Cerebro Spinal Meningitis. Poliomyelitis. Ophthalmia Neonatorum. *Measles and German Measles. Pulmonary Tuberculosis. Other forms of Tuberculosis. Totals. (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) (13) (14) (15) (16) (17) (18) (19) 1892 5 1 ... 145 85 366 ... 28 ... ... 4 ... ... ... ... ... ... 634 1893 23 1 ... 229 139 589 1 47 ... ... 6 ... ... ... ... ... ... 1035 1894 21 1 ... 129 63 268 ... 70 ... 2 4 ... ... ... ... ... ... 558 1895 5 ... ... 186 81 392 ... 69 ... ... 8 ... ... ... ... ... ... 741 1896 2 1 ... 173 101 475 ... 52 ... 1 10 ... ... ... ... ... ... 815 1897 ... 2 ... 275 107 510 ... 52 ... 1 9 ... ... ... ... ... ... 956 1898 1 ... ... 335 70 361 ... 66 ... ... 2 ... ... ... ... ... ... 835 1899 ... 1 ... 319 82 414 ... 79 ... ... 6 ... ... ... ... ... ... 901 1900 ... ... ... 226 89 335 ... 77 ... ... 8 ... ... ... ... ... ... 735 1901 10 ... 1 404 79 553 ... 57 ... ... 2 ... ... ... ... ... ... 1106 1902 88 ... ... 440 104 466 ... 73 ... ... 8 ... ... ... ... ... ... 1179 1903 7 ... ... 221 76 502 ... 45 ... ... 11 ... ... ... ... ... ... 862 1904 12 ... ... 353 73 326 ... 38 ... ... 5 ... ... ... ... ... ... 807 1905 ... ... ... 275 86 397 ... 41 ... ... 13 ... ... ... ... ... ... 812 1906 ... ... ... 286 103 637 ... 46 ... 1 9 ... ... ... ... ... ... 1082 1907 ... ... ... 254 77 641 ... 28 ... ... 13 3 ... ... ... ... ... 1016 1908 ... ... ... 215 78 737 ... 41 ... ... 7 3 ... ... ... ... ... 1081 1909 ... ... ... 207 94 638 ... 41 ... ... 8 ... ... ... ... 107 ... 1095 1910 ... ... ... 166 72 314 ... 23 ... ... 12 ... ... ... ... 61 ... 648 1911 ... ... ... 192 114 326 ... 13 ... ... 16 ... ... ... ... 230 ... 891 1912 1 ... ... 222 109 430 ... 13 ... ... 10 ... 4 ... ... 487 ... 1276 1913 ... ... ... 233 93 504 ... 18 ... ... 11 3 3 ... ... 368 146 1379 1914 ... ... ... 303 121 765 ... 13 ... ... 12 6 ... 29 ... 326 90 1665 1915 ... ... ... 231 81 453 ... 9 ... ... 4 29 3 27 ... 335 83 1255 1916 ... ... ... 225 87 387 ... 3 ... ... 11 8 5 28 1437 259 63 2513 * Became compulsorily notifiable, January 1st, 1916. 46 SCARLET FEVER—Table No. 16. Shewing the number of cases notified, the number and percentage removed to Hospital, and the Incidence and Fatality rates each year since 1892. 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 1915 453 406 89.6 2.7 33 1916 387 350 90.4 2.3 3 47 RETURN CASES OF SCARLET FEVER.— Table NO. 17. 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 ... ... ... ... ... * 1906 635 4.5 23 3.6 26 4.1 20 3 ... ... ... ... ... * 1907 641 4.4 27 4.2 28 4.4 26 1 ... ... ... ... ... * 1908 737 5.0 51 6.9 70 9.5 37 11 1 2 ... ... ... * 1909 638 4.4 56 8.7 66 10.3 48 7 ... 1 ... ... ... 12 1910 314 2.0 15 47 21 6.7 10 4 1 ... ... ... ... ... 1911 326 2.1 11 3.4 15 4.6 9 ... 2 ... ... ... ... 3 1912 430 2.6 12 2.7 16 3.7 9 2 1 ... ... ... ... ... 1913 504 3.1 18 3.6 26 5.2 15 2 ... ... ... ... ... ... 1914 765 4.6 34 5.0 42 5.5 29 4 ... ... ... ... ... ... 1915 453 2.7 12 2.7 13 2.9 11 1 ... ... ... ... ... ... 1916 389 2.3 14 3.6 21 5.4 10 1 3 ... ... ... ... ... Totals 6229 3.3 287 4.6 362 5.8 236 37 8 4 1 ... 1 15 * Records incomplete. 48 Table No. 18. Giving particulars of Infecting and Return Cases of Scarlet Fever during 1916 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. R.S. 39 F.S. 51 R.B. 89 K.B. 28 E.B. 42 W.B. 27 C.D. 37 L.D. 10 37 A.D. 14 37 O.D. 55 A.D. 35 A.D. 14 M.G. 101 M.G. 5 101 E.G. 7 101 P.G. 7 H.H. 28 L.H. 14 28 G.H. 23 C.B. 56 D.B. 11 G.D. 41 C.D. 8 W.C. 34 E.C. 24 G.J. 48 E.J. 92 W.B. 49 L.B. 47 J.C. 31 M.C. 20 31 C.C. 3 31 V.C. 20 M.B. 37 E.B. 5 Table No. 19. Giving particulars of multiple cases of Scarlet Fever occurring in households in 1916. No. of Houses. Per cent, of Houses. No of Cases. Per cent. of Cases. Houses in which :— 1 case occurred 226 79.1 226 58.5 2 cases occurred 40 13.6 80 20.1 3 ,, 8 2.8 24 6.2 4 ,, 9 3.1 36 9.3 5 ,, 1 .4 5 1.3 6 ,, 3 1.0 18 4.6 Totals 287 100.0 389 100.0 49 DIPHTHERIA AND MEMBRANOUS GROUP.— TABLE NO. 20. Shewing the number of cases notified, and number and percentage removed to hospital, and the incidence and fatality rates each year since 1892. 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 2.9 148 1900 226 120 53.1 1.9 124 1901 404 190 47.0 3.4 138 1902 440 222 50.4 3.5 122 1903 221 122 55.2 1.6 46 1904 353 290 82.1 2.6 54 1905 275 227 82.5 1.9 51 1906 286 222 77.6 2.0 57 1907 254 186 73.2 1.7 71 1908 215 175 81.3 1.4 65 1909 207 171 82.6 1.4 48 1910 166 142 85.5 1.1 66 1911 192 130 67.7 1.2 57 1912 222 191 86.0 1 .4 45 1913 233 215 92.3 1.4 34 1914 303 258 85.2 1.8 79 1915 231 213 92.2 1 .4 130 1916 225 213 94.7 1.3 76 50 SMALL POX.— Table No. 21. Shewing the number of cases notified and the number and percentage removed to hospital each year since 1892. Year. No. of Cases notified. No. of Cases removed to Hospital. Percentage removed to Hospital. 1892 5 3 60.0 1893 23 21 91.3 1894 21 21 100.0 1895 5 5 100.0 1896 2 2 100.0 1897 ... ... ... 1898 1 ... 00.0 1899 ... ... ... 1900 ... ... ... 1901 10 7 70.0 1902 88 88 100.0 1903 7 7 100.0 1904 12 12 100.0 1905 ... ... ... 1906 ... ... ... 1907 ... ... ... 1908 ... ... ... 1909 ... ... ... 1910 ... ... ... 1911 ... ... ... 1912 1 1 100.0 1913 ... ... ... 1914 ... ... ... 1915 ... ... ... 1916 ... ... ... 51 vaccination statistics.— Table No. 22. Years No. of Births on Register of Vaccination Officer. Successfully Vaccinated. Insusceptible. Dead. Conscientious Objectors. Postponed by Doctor. Gone Away. Unvaccinated. Percentage of Survivors Unprotected by Vaccination. Conscientious Objectors per 100 Children Vaccinated. Cases of Small-pox Notified. (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) 1898 3,125 1,474 13 257 37 117 259 968 48 2.5 1 1899 3,375 1,615 24 345 63 76 91 1,161 46 3.9 0 1900 3,560 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 37 12 1905 4,i35 2,448 15 286 75 64 297 950 36 3'o 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 67 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 3.9 915 47 24.6 0 1910 3,810 1,742 8 206 607 24 277 946 52 34.8 0 1911 3,865 1,592 16 254 748 46 261 948 56 47.0 0 1912 3.955 1,804 10 227 1,020 53 247 594 52 56.0 1 1913 3,920 1,659 0 202 1,108 63 265 623 55 66.8 0 1914 3,974 1,745 16 241 1,092 118 260 502 53 62.6 0 1915 3,587 1,516 6 190 846 160 166 703 55 55.8 0 1916 3,588 1,506 3 181 1,012 99 148 639 56 67.2 0 52 ENTERIC FEVER.— Table No. 23. Shewing the number of cases notified, the number and percentage removed to hospital, and the incidence and fatality rates each year since 1892. 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 notifications. 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 41.5 0.68 181 1901 57 7 12.2 0.49 175 1902 73 14 19.1 0.60 205 1903 45 16 35.5 0.34 290 1904 38 12 31.5 0. 27 211 1905 41 26 63.4 0.29 293 1906 46 33 71.7 0.32 152 1907 28 14 50.0 0.19 143 1908 41 27 65.8 0.27 195 1909 41 34 82. 9 0.27 146 1910 23 16 69.5 0.15 87 1911 13 9 69.2 0.08 308 1912 13 6 46.1 0.08 231 1913 l8 10 55.6 0.10 222 1914 13 12 92.3 0.07 231 1915 9 9 100.0 0.05 556 1916 3 1 33.3 0.01 0 53 MEASLES.— Table No. 24. Shewing the number of cases coming under the notice of the Health Department each year since 1907 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. Year. Total No. of Cases known before death. Cases unknown prior to death. Percentage of all probable Cases coming to knowledge. Total. Cases. Deaths. Fatality Rate per cent. Deaths. Estimated No. of Cases. 1907 1,442 25 1.75 20 1,153 55 2,595 1908 1,678 26 1. 55 29 1,871 47 3,549 1909 1,445 17 1.17 24 2,040 41 3,485 1910 1,757 13 0.74 17 2,297 43 4,054 1911 1,845 26 1.40 25 1,774 51 3,619 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 1915 1,947 20 1.03 54 5,257 27 7.204 1916 871 7 .80 0 0 100 871 Totals 14,845 172 1.16 243 20,604 42 35,449 * These figures are based on the average for the years 1907-1914. TUBERCULOSIS.— Table No. 25. Showing the number of notifications and the number of new cases each year since 1909. 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 †0†1913 ( ,, ,, ) 693 181 368 146 514 1914 (,, ) 613 122 326 90 416 1915 (53 „ ) 700 98 344 81 425 1916 (52 „ ) 552 86 259 63 322 Total 3986 487 2182 380 2562 *Poor Law Cases of Pulmonary Tuberculosis notifiable from 1st January, 1909 ** Hospital ,, ,, ,, ,, ,, ,, 1st May, 1911 +A11 ,, ,, ,, ,, ,, ,, 1st January, 1912 †† All Cases of all forms of ,, ,, ,, 1st February, 1913 958 of the 2562 cases of Tuberculosis notified in Willesden since 1909 were living in the area at the end of the yeas. 54 DEATH RATES FROM CERTAIN INFECTIOUS DISEASES. Table No. 26. Shewing the death rates per 100,000 of the population from scarlet fever, diplheria, enteric fever, measles and whooping cough since 1875. Year. (1) Scarlet Fever. (2) Diphtheria. (3) Enteric Fever. (4) Measles. (5) Whooping Cough. (6) 1875 66 33 71 0 38 1876 59 27 48 78 238 1877 128 10 41 87 30 1878 19 14 29 29 174 1879 35 35 9 13 27 1880 99 8 15 75 99 1881 47 3 22 25 47 1882 24 3 15 141 86 1883 20 11 17 14 34 1884 13 16 11 11 58 1885 13 36 23 52 44 1886 2 15 4 67 79 1887 28 12 16 59 22 1888 22 22 17 66 77 1889 4 12 3 14 17 1890 3 31 11 55 70 1891 3 11 6 8 67 1892 12 27 9 73 55 1893 21 63 13 15 49 1894 9 21 15 60 42 1895 21 42 15 6 10 1896 20 34 12 144 47 1897 12 69 13 14 48 1898 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 1915 9 18 3 44 33 1916 1 10 0 4 15 * Infectious Diseases Notification compulsory in Willesden from this year. 55 INFANT MORTALITY.— Table No. 27. Shewing the number oft deaths of infants under one year of age from all causes, and from Diarrhœa and Enteritis respectively, together with the infant mortality rates per 1,000 births since 1875. Year. No. of deaths of Infants under 1 year of age from all causes. No. of Deaths of Infants under 1 year of age from Diarrhœa and Enteritis. Infant Mortality. Rate per 1,000 births. 1875 131 27 162 1876 120 * 149 1877 113 7 140 1878 167 19 201 1879 118 9 130 1880 168 24 173 1881 * * * 1882 202 27 186 1883 196 24 167 1884 203 36 164 1885 235 28 172 1886 265 28 164 1887 264 40 159 1888 290 32 170 1889 276 36 143 1890 287 34 158 1891 273 25 132 1892 333 30 159 1893 345 35 153 1894 299 * 132 1895 373 * 150 1896 460 * 167 1897 444 * 155 l898 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 I909 391 51 94 1910 313 39 80 1911 495 158 124 1912 328 22 80 1913 325 45 80 1914 337 73 82 1915 344 39 91 1916 283 29 77 * Records incomplete. 56 INFANT MORTALITY RATE in Wards in Willesden since 1910. Table No. 28. Wards. (1) 1910 (2) 1911 (3) 1912 (4) 1913 (5) 1914 (6) 1915 (7) 1916 (8) South Kilburn 91 134 131 106 86 153 107 Mid. Kilburn 83 147 83 75 73 93 97 North Kilburn 77 83 75 56 65 108 51 Brondesbury Park 76 86 60 33 54 44 49 Kensal Rise 63 92 93 51 50 89 69 Harlesden 73 95 68 57 71 68 55 Stonebridge 83 165 73 118 116 94 106 Round wood 85 177 80 102 91 113 59 Church End 83 119 85 117 109 90 73 Willesden Green 100 108 68 68 83 69 78 Cricklewood 52 93 42 63 76 56 76 Willesden U. D. 80 124 80 80 82 91 77 INFANT MORTALITY OF LEGITIMATE INFANTS since 1904. Table No. 29. 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 1915 318 88 1916 266 7? 57 INFANT MORTALITY OF ILLEGITIMATE INFANTS since 1904. Table No. 30. 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 2l8 1915 26 190 1916 17 148 NOTIFICATION OF BIRTHS ACTS, 1907 and 1915.-Table No. 31. Return shewing the number of births notified in each complete year since the adoption of the Notification of Births Act, 1907, together with certain other particulars. Year. Total number of births notified. Number of Stillbirths notified. Number of births registered. Attended by doctors. Attended by midwives. Total. 1909 2220 1528 3748 95 4172 1910 2072 1318 3390 79 3923 1911 2266 1428 3694 88 4001 1912 2324 1347 3671 92 4075 1913 2273 1277 3550 104 4037 1914 2207 1232 3439 118 4115 1915 2067 1125 3192 83 3775 1916 1932 1242 3174 85 3668 58 Table No. 32. Return shewing the number of re-visits made under the Notification of Births Acts, 1907 and 1915 since 1912. Year. No. of visits and re-visits made to cases requiring same under the Notification of Births Acts, 1907 and 1915. Visits. Re-visits. 1912 180 1913 976 1914 1,052 1915 2,464 926 1916 2,590 2,492 INFANT DEATH INQUIRIES.— Table No. 33. Year. No of Deaths of Infants under 1 year. No. of Infant Death Inquiries.[/##] 1913 325 300 1914 337 231 1915 344 266 1916 283 189 MARRIAGES —Table No. 34. Shewng the total number of marriage- in Willesden, and the marriage rate in Willesden as compared with England and Wales generally since 1900. 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.l 15.8 1908 971 13.0 14.9 1909 1036 13.8 14.6 1910 994 13.0 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 1915 1666 20.0 19.3 1916 1279 15.2 15.4 59 BIRTHS.— Table No. 35. Shewing the total number of births in Willesden and the birth rate in Willesden as compared with England and Wales generally since 1875. Year. Willesden. Total No. of Births. Willesden. Birth Rale per 1,000 of the population. I 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 805 447 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 3.41 33.6 ... 144.2 1885 1366 35.6 32.9 ... 140 .7 1886 1584 35.7 32.8 ... 140.2 1887 1659 33.8 31.9 ... 135.5 1888 1701 32.1 31.2 ... 132.3 1889 1929 33.7 31.1 ... 131.7 1890 1811 29.4 30.2 ... 127.6 1891 2059 33.1 31.4 ... 132.1 1892 2085 31.7 30.4 ... 127.3 1893 2256 32.5 30.7 ... 127.9 1894 2264 30.7 29.6 ... 122.4 1895 2469 31.2 30.3 ... 124.8 1896 2749 32.2 29.6 ... 121.5 1897 2887 31.0 29.6 ... 120.7 1898 3142 31.5 29.3 ... 118.9 1899 3375 31.5 29.1 ... 117.7 1900 3559 31.2 28.7 ... 115.6 1901 3762 32.2 28.5 ... 114.2 1902 3916 31.3 28.5 ... 114.1 1903 4132 31.9 28.4 ... 113.8 1904 4421 32.9 27.9 116.5 111.8 1905 4201 29.8 27.2 107.4 108.9 1906 4272 30.1 27.0 107.6 108.3 1907 4247 29.4 26.3 105.8 105.1 1908 4095 27.5 26.5 98.8 106.1 1909 4172 27.8 25.6 99.9 103.2 1910 3923 25.6 24.8 95.0 100.6 1911 4001 25.6 24.4 94.9 97.8 1912 4075 25.5 23.8 94.6 95.6 1913 4037 24.7 23.9 91 .6 ... 1914 4115 24.7 23.8 91.7 ... 1915 3775 22.6 21.8 84.0 ... 1916 3668 21.9 21.6 81. 1 ... 60 Table No. 36. Shewing the births and birth rates per 1,000 of the population in each Ward in Willesden since 1912. Wards. 1912. 1913. 1914 1915. 1916. 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 419 29.77 405 28.58 444 30.11 418 28.67 354 23.98 Mid. Kilburn 397 26.77 361 24.73 343 23.51 332 22.73 331 22.49 North Kilburn 226 18.63 216 17.45 230 18.23 186 14.91 214 17.29 Brondesbury Park 200 20.92 182 18.79 149 15.15 158 15.92 182 18.33 Kensal Rise 355 25.94 315 22.56 396 27.94 325 22.87 320 22.36 Harlesden 383 23.74 421 25.36 393 22.96 396 22.80 361 20.53 Stonebridge 517 31.14 515 29.47 554 31.22 467 26.36 432 24.24 Round wood 443 29.21 401 25.75 440 28.10 380 24.26 404 25.69 Church End 388 28.04 369 26.38 368 26.06 378 26.63 370 26.04 Willesden Green 413 26.46 440 26.82 423 25.26 391 23.31 384 22.64 Cricklewood 334 18.28 351 18.64 315 16.31 319 16.47 316 16.24 Willesden U.D. 4075 25.5 4037† 247 4115** 24.7 3775†† 22.6 3668 21.9 † Including 61 births (Wards unknown) received from Registrar General at end of year. ** 60 „ „ „ „ †† ,, 25 ,, ,, ,, ,, ,, ,, ,, 61 ILLEGITIMATE BIRTHS—Table No. 37. Shewing the number of illegitimate births and the illegitimate birth rates per 1,000 of the total births in Willesden since 1882. 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 1900 56 15.73 1883 25 21. 40 1901 48 12.75 1884 23 18.65 1902 48 12.25 1885 43 31.47 1903 87 21.05 †1886 ... ... 1904 108 24.42 1887 53 31.94 1905 107 25.47 1888 31 18.22 1906 125 29.26 1889 57 29.54 1907 125 29.43 1890 42 23.19 1908 94 22.95 1891 34 16.51 1909 130 31.16 1892 54 25.89 1910 122 31.09 1893 45 19.94 1911 138 34.49 1894 39 17.22 1912 130 31.90 1895 54 21.87 1913 132 32.69 1896 59 21.46 1914 149 36.20 1897 55 19.05 1915 137 36.28 1898 63 20.05 1916 117 31.89 1899 56 16.59 †No record. 62 DEATHS.— Table No. 38. Shewing the total number of deaths in Willesden and the death rates in Willesden as compared with England and Wales generally since 1875. 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 1896 1,312 15.3 17.1 1876 401 21.7 20.9 1897 1,343 14.4 17.4 1877 346 177 20.3 1898 1,388 13.9 17.5 1878 441 21. 4 21.6 1899 1,643 15.2 18.2 1879 376 16.8 20.7 1900 1,577 13.6 18.2 1880 471 18.7 20.5 1901 1,529 13.2 16.9 1881 490 17.6 18.9 1902 1,709 13.9 16.3 1882 587 18.1 19.6 1903 1,655 12.8 15.5 1883 538 15.4 19.6 1904 1,645 12.2 16.3 1884 530 14.7 19. 7 1905 1,744 12.4 15.3 1885 632 l6.2 19.2 1906 1,672 11.8 15.5 1886 685 15.5 19.5 1907 1,704 11.8 15.1 1887 701 14.3 19.1 1908 1,623 10.9 14.8 1888 835 15.8 18.1 1909 1,678 11.2 14.6 1889 686 12.0 l8.2 1910 1,506 9.8 13.5 1890 882 14.4 19.5 191.1 1,848 11.8 14.6 1891 860 138 20. 2 1912 1,603 10. 0 13.3 1892 945 14.4 19.0 1913 1,677 10.2 13.8 1893 1,070 15.5 19.2 1914 1,752 10.5 14.0 1894 917 13.2 16.6 1915 2,030 12.2 15.1 1895 1,143 14.5 18.7 1916 1,710 10.2 14.0 STATISTICAL INFORMATION RELATIVE TO THE NINTH ANNUAL REPORT FOR THE YEAR ENDING 31st DECEMBER, 1916, ON THE HEALTH OF CHILDREN ATTENDING THE PUBLIC ELEMENTARY SCHOOLS IN WILLESDEN. 64 CERTAIN STATISTICAL DATA. No. of Public Elementary Schools at December, 1916 32 No. of School Departments at December, 1916 76 No. of Children on School Rolls at June, 1916 24,536 No. of Ailing Children examined at the Schools 1,757 Total No. of Children reterred for "following up" during 1916 5,343 Total No. of Defects "followed up" during 1916 6,010 Total No. of Defects for which treatment was obtained during 1916 5,460 Maximum daily Average daily Total Attendances at Ringworm Clinic 46 27 1,199 Attendances at Eye Clinic 84 42 5,444 Attendances at Inspection Clinic (Municipal Offices) 64 36 1,612 Attendances at Inspection Clinic (Leopold Road) 45 32 1,419 Total - - 9,674 No. of Physically Defective Schools 1 No. of Mentally Defective Schools 2 No. of Children attending Special Schools :— In Willesden Outside Willesden Total Blind and partially blind 2* 17 19 Deaf 0 20† 20 Mentally defective 105‡ 1§ 106 Epileptic 0 6 6 Physically defective 57 4 61 Total 164 48 212 *Also mentally defective and attending mentally defective school in Willesden. †One also mentally defective and_attending mentally defective school outside Willesden. †Two are blind or partially blind. §Also deaf. 65 Table No. 39. Return of Defects found in the course of Medical Inspection of Ailing Children at the Schools. Total No. of ailing children examined at the Schools 1,757 Total No. of defects or diseases found 2,286 Total No. of defects or diseases referred for treatment 1,743 Total No. of defects or diseases requiring to be kept under observation but not referred for treatment 0 Details. Defect or Disease. No. found to be suffering No. referred for treatment Malnutrition 51 2 Uncleanliness: Head 245 232 Body 62 23 Skin Ringworm : Head 6 6 Body 0 0 Scabies 10 10 Impetigo 83 77 Other Disease 19 9 Eye Defective Vision and Squint 601 553 External Eye Disease 165 152 Ear Defective Hearing 50 47 Ear Disease 146 127 Teeth Dental Disease 256 133 Nose and Throat Enlarged Tonsils 86 73 Adenoids 82 57 Enlarged Tonsils and Adenoids 39 39 Defective Speech 14 1 Heart Disease : Heart and Circulation Organic 20 12 Functional 21 2 Anaemia 57 44 Lungs Pulmonary Tuberculosis : Definite 1 1 Suspected 10 9 Chronic Bronchitis 8 1 Other Diseases 0 0 Nervous System Epilepsy 0 0 Chorea 3 3 Other Diseases Non-Pulmonary Tuberculosis : 3 0 Glands 1 0 Bones and Joints 1 0 Other Forms 0 0 Rickets 5 2 Deformities 32 9 Other Defects or Diseases 209 119 Total 2,286 1,743 66 Table No. 40. Return showing No. of Special Cases referred in 1916 with the view of Medical Treatment being obtained, Remedial Measures carried out, or other action taken. Year. Referred by Total. Medical Inspection and Officers of Health Department. Head Teachers. Attendance Officers. Others. 1916 1436 3264 313 394 †5407 1915 1308 3429 109 298 *5144 1914 2322 2401 108 140 4971 1913 1092 1912 1102 1911 1030 1910 941 * Including 206 cases of Mental Defect. † Including 64 cases of Mental Defect. 68 Table No. 41. Return showing the nature and number of defects referred for treatment, the number of visits and medical examinations made in connection therewith, and the extent to which remedial measures were carried out during 1916. CONDITIONS. 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. 01 defects treated. Results of Treatment. Percentage of defects treated. No. of defects not treated. Total No. of defects under observation at end of year and carried forward to succeeding year. Carried forward from previous year. New. Total. School Clinic. Home (i.e., under supervision of Medical staff of Authority). Voluntary Hospital or other charitable Institution. Infirmary or Poor Law. Private Practitioner. Total. Remedied. Improved. Unchanged. Under observation at end of year (result of treatment not known at end of year). Removed from observation. Still under observation at end of year. Total. Clothing- Unsatisfactory 0 19 19 61 3 0 0 18 0 0 0 18 13 5 0 0 94.74 0 1 1 1 Footgear— Unsatisfactory 0 8 8 16 0 1 0 6 0 0 0 6 6 0 0 0 75. 00 1 0 1 0 Cleanliness of Head— Nits 6 323 329 1426 330 3 0 305 0 0 0 305 249 51 0 5 92.71 1 20 21 25 Pediculi 13 560 573 3178 1062 19 0 520 6 0 2 528 453 70 0 5 92.15 1 25 26 30 Other Dirty Conditions 0 5 5 13 2 0 0 4 0 0 0 4 2 2 0 0 80 .00 0 1 1 1 Cleanliness of Body- Dirty 0 10 10 18 5 1 0 9 0 0 0 9 6 3 0 0 90.00 0 0 0 0 Pediculi 0 38 38 168 50 1 0 36 0 0 0 36 35 1 0 0 94.74 0 1 1 1 Fleabitten 0 7 7 31 3 0 0 7 0 0 0 7 6 1 0 0 100.00 0 0 0 0 Nutrit on— Below Normal 0 3 3 16 0 0 0 1 2 0 0 3 0 2 0 1 100.00 0 0 0 1 Bad 2 4 6 14 5 0 0 3 1 2 0 6 0 4 2 0 100.00 0 0 0 0 69 Nose and Throat- Enlarged Tonsils 34 70 104 481 9 3 0 1 55 0 7 63 46 5 6 6 60.58 15 23 38 29 Adenoids 20 51 71 269 8 0 0 0 31 0 5 36 21 7 5 3 50.70 0 26 35 29 Enlarged Tonsils and Adenoids 16 58 74 334 7 0 0 0 44 0 4 48 27 11 4 6 64.86 11 15 26 21 Other Conditions 3 191 194 531 24 3 0 92 24 0 69 185 132 44 1 8 95.36 1 5 6 13 Cervical or Neck Glands- Enlarged 5 153 158 407 10 5 0 91 23 1 31 146 77 62 6 1 92.41 1 6 7 7 External Eye Disease- Blepharitis 15 159 174 624 730 1 117 21 11 0 12 161 62 43 2 54 92.53 2 10 12 64 Conjunctivitis 24 217 241 813 930 2 167 23 18 0 29 237 146 48 0 43 98.34 0 2 2 45 Corneal Opacities 0 2 2 9 4 0 2 0 0 0 0 2 0 0 1 1 100.00 0 0 0 1 Other Diseases 1 44 45 141 103 0 24 8 6 0 5 43 26 11 1 5 95.56 2 0 2 5 Ear Disease- Chronic Suppuration of Middle Ear 6 112 118 553 26 2 0 24 57 0 23 104 26 45 3 30 88.14 5 7 12 37 Chronic Catarrh of Middle Ear ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Wax 0 19 19 59 9 0 1 4 7 0 5 17 6 9 1 1 89.47 0 2 2 3 Other Disease 6 43 49 214 8 1 1 8 20 0 5 34 13 15 3 3 69.39 4 10 14 13 Teeth- Irregular 0 2 2 6 0 0 0 0 0 0 0 0 0 0 0 0 0 0 2 2 2 Less than Four Decayed 0 18 18 53 2 0 0 1 5 0 *8 14 14 0 0 0 77.78 1 3 4 3 Four or More Decayed 29 89 118 501 5 3 0 2 53 0 *12 67 46 14 2 5 56.78 14 34 48 39 Sepsis 0 26 26 95 4 2 0 4 8 0 *5 17 2 13 0 2 65.38 4 3 7 5 Heart & Circulation- Organic Disease 2 5 7 23 3 0 0 1 5 0 1 7 0 2 3 2 100.00 0 0 0 2 Functional Disease 0 19 19 59 7 0 0 1 8 0 9 18 2 11 2 3 94.74 0 1 1 4 Anaemia 3 21 24 117 9 1 0 1 11 0 0 21 3 16 0 2 87.50 1 1 2 3 Other Defect 0 1 1 2 2 0 0 0 1 0 0 1 0 1 0 0 100.00 0 0 0 0 * Includes those treated by dentist. 70 Table No. 41—(continued). Conditions. 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. 01 defects treated. Results of Treatment. Percentage of defects treated. No. of defects not treated. Total No. of defects under observation at end of year and carried forward to succeeding year. Carried forward from previous year. New. Total. School Clinic. Home (i.e., under supervision of Medical staff of Authority). Voluntary Hospital or other charitable Institution. Infirmary or Poor Law. Private Practitioner. Total. Remedied. Improved. Unchanged. Under observation at end of year (result of treatment not known at end of year). Removed from observation. Still under observation at end of year. Total. Lung's— Chronic Bronchitis and Bronchial Catarrh 6 69 75 220 8 1 0 22 14 1 36 7S 48 18 0 7 97.33 0 1 1 8 *Tuberculosis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Tuberculosis Suspected 4 31 35 185 21 2 0 0 10 16 4 30 0 17 8 5 85.71 1 2 3 7 Other Disease I 16 17 76 1 0 0 0 6 1 9 16 7 3 2 4 94.12 1 0 1 4 Nervous System Epilepsy 0 6 6 18 2 0 0 0 3 0 1 4 0 3 1 0 66.67 2 0 2 0 Chorea 5 23 28 163 26 0 0 4 15 1 7 27 1 17 0 9 96.43 0 1 1 10 Other Disease 7 20 27 92 16 0 0 3 17 0 5 25 8 13 2 2 92.59 2 0 2 2 Skin- Ringworm—Body Ringworm—Head 82 297 379 1337 1136 6 255 56 15 0 38 364 299 5 1 59 96.04 1 8 9 67 Impetigo 32 651 683 2678 258 6 5 531 62 0 66 664 588 54 0 22 97.22 0 13 35 Scabies 10 232 242 1257 237 1 2 125 52 1 47 227 191 10 0 26 93.80 1 13 14 39 Other Disease 9 294 303 1032 109 2 19 158 46 2 59 284 191 58 25 10 93.73 10 7 17 17 Rieketts— Slight Marked 0 4 4 14 4 0 0 0 2 0 0 2 0 2 0 0 50.00 2 0 2 0 * One case was notified by the Assistant School Medical Officer during the year, and was dealt with as a notifiable infectious disease. 71 Deformities- Deformity Present 6 12 18 71 6 0 0 0 12 0 1 13 1 8 1 3 72.22 4 1 5 4 Tuberculosis (Non-pulmonary)— Glandular ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Bones and Joints ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Other Forms ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Suspected—Glandular ... 0 10 10 50 5 0 0 0 4 1 5 10 0 6 0 4 100.00 0 0 0 4 ,, Bones & Joints 1 3 4 38 3 0 0 0 4 0 0 4 0 2 0 2 100.00 0 0 0 2 ,, Other Forms 0 1 1 19 0 0 0 0 1 0 0 1 0 0 1 0 100.00 0 0 0 0 Speech Defective Articulation 0 2 2 3 0 0 0 0 1 0 1 2 0 1 1 0 100.00 0 0 0 0 Squint- Squint Present 13 178 191 442 478 4 127 0 20 0 ‡4 151 3 101 17 30 79.06 21 15 36 45 Vision- Defect not ascertained 5 82 87 196 67 3 19 0 11 0 ‡7 37 3 23 4 7 42.53 6 41 47 48 One Eye Normal 8 35 43 69 123 1 40 0 1 0 0 41 6 24 2 9 93.35 1 0 1 9 Both Eyes 6/6 0 9 9 8 31 0 9 0 0 0 0 9 0 8 0 1 100.00 0 0 0 1 Both Eyes 6/9 1 15 16 20 47 0 15 0 0 0 0 15 8 6 1 0 93.75 1 0 1 0 One Eye 6/9, Other 6/12 or less 8 41 49 75 124 0 47 0 1 0 0 48 10 30 2 6 97.96 1 0 1 6 Both Eyes 6/12 or less 17 248 265 544 852 3 238 0 13 0 ‡2 253 66 152 4 31 95.47 7 2 9 33 Spectacles Broken 5 258 263 311 600 0 247 0 2 0 ‡8 257 247 0 0 10 9772 3 3 6 13 Spectacles Lost 0 81 81 152 291 0 73 0 2 0 ‡2 77 19 55 0 3 95.06 3 1 4 4 Debility 6 74 80 187 22 0 0 23 32 0 18 73 12 51 2 8 91.25 0 7 7 15 Miscellaneous 20 610 630 1576 55 2 0 360 102 5 143 610 440 135 4 31 96.83 3 15 18 46 Grand Totals 431 5579 6010 21065 7882 79 1408 2473 844 31 704 5460 3567 1298 120 475 90.08 143 328 471 803 Mental Condition—Dull or Backward and Mentally Defective (all grades)— No. of New Cases referred during 1916 64 Found on Examination to be Dull and Backward 50 Found on Examination to be Mentally Defective 10 Found on Examination to be Normal 2 Not Examined at end of year 2 Re examinations for Defective Vision other than Lost and Broken Spectacles— No. of Visits 1190 No. of Medical Examinations 894 ‡Includes those treated by Optician. 72 Table No. 42. Return of work done at the Clinic during 1916. Clinic.—(Ringworm and Eyes.) Ringworm. Eyes. Under 5 years. Over 5 years. No. of cases under treatment at 1st January, 1916 56 3 88 No. of cases coming under treatment 278 26 940 Total No. of cases under treatment 334 29 1028 No. of cases cured or relieved :— (a) By X Rays 95 ... ... (b) By provision of Spectacles ... 0 474 (c) By other means 103 15 224 No. of cases previously attending Clinic cured by other agencies or removed 20 6 36 No. of cases not requiring treatment 59 0 114 Total No. of cases remaining under treatment at 30th December, 1916 57 8 180 Re-examinations of children previously treated at Eye Clinic ... 0 878 Table No. 43. Return respecting the Provision of Spectacles during 1916. No. of pairs of Spectacles provided 561 Cost of Spectacles provided £85 9 9 Average cost per pair £0 3 0 No. of pairs wholly paid for by parents 6 No. of pairs partly paid for by parents 53 Total amount received as above £2 14 9 Cost of repairs £10 12 0 Total amount received for repairs £1 10 9 73 Table No. 44. Return of Exceptional Children who came under observation during 1916. Boys Girls Total Blind (including partially blind). Attending Public Elementary Schools 2 1 3 Attending Certified Schools for the Blind *12 7 19 Not at School 3 1 4 Deaf and Dumb (including partially deaf). Attending Public Elementary Schools ... 3 1 4 Attending Certified Schools for the Deaf † 14 6 20 Not at School 4 0 4 Feeble Minded. Attending Public Elementary Schools ... 3 1 4 Attending Certified Schools for Mentally Defective Children ‡54 52 106 Notified to the Local (Control) Authority during the year 2 1 3 Mentally Deficient. Not at School 4 2 6 Imbeciles. At School 1 1 2 Not at School 6 2 8 Idiots. 1 1 2 Epileptics. Attending Public Elementary Schools ... 2 3 5 Attending Certified Schools for Epileptics 2 §4 6 Not at School 2 0 2 Pulmonary Tuberculosis. Attending Public Elementary Schools 60 34 94 Attending Certified Schools for Physically Defective Children 2 1 3 Not at School 14 23 37 Other Forms of Tuberculosis. Attending Public Elementary Schools ... 20 22 42 Attending Certified Schools for Physically Defective Children 7 6 13 Not at School 4 6 10 Physically Defective. Cripples Other Than Tubercular. Attending Public Elementary Schools 11 4 15 Attending Certified Schools for Physically Defective Children 19 17 36 Not at School 2 2 4 Physically Defective other than Tubercular and other than Cripples. Attending Public Elementary Schools 11 5 16 Attending Certified Schools for Physically Defective Children 5 4 9 Not at School 1 2 3 **Dull or Backward. Retarded i year 13 11 24 Retarded 2 years 10 8 18 Retarded 3 years. 4 4 8 *Two of these also mentally defective and attending mentally defective school. †One of these boys is also mentally defective and attending a mentally defective school. ‡Two boys also partially blind and one boy semi mute. §One girl being educated by Guardians at David Lewis Colony. **These figures refer to children brought under observation during 1916. 74 Table No. 45. Return of Blind and Partially Blind Children receiving Special Education during 1916. Initials of Child. Date of Birth Date Examined. Date reported by Medical Officer to Committee and Case No. Date entered Institution. Name of Institution. Date left Institution and remarks. W.L.W. 26- 5-'o1 ... ... 27- 1-'08 Swiss Cottage (Day) ... D.I.C. 2- 1-O1 ... ... 16- 3-'09 Edinborough Road, London (Day) Reached 16 years, Jan. 2nd, 1917 (Education to be contd.) 114- 1-'l4 Swiss Cottage (Resident) R.S. 10- 9-'o1 ... ... 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 ( Scholarship Resident) Reached 16 years Nov., 1915. (Education to be continued) 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. 5-10-'01 19- 6-'l2 23- 9-'l2 26- 3-' 13 Swiss Cottage (Day) ... P.V.* 16- 8-'03 30- 9-'14 26-10-'14(23) 14- 9-'14 Leinster Road, M.D. School (Day) ... H.G.L. 27-3-'04 26- 9-'11 30-10-'11 23- 9-'14 Swiss Cottage (Resident) ... F.C.* 28-10-'03 27-11-'14 29- 3-'15(36) 11- 1 -'15 Leinster road M.D. School (Day) ... N.G. 4- 6-'04 25-10-'l4 23-1 11-'14( 17) 22- 2-'l5 St. Anne's Ophthalmia School, Portobello Rd. ... M.G. 27- 3-'03 6- 3-'15 29- 3-'15(34) 21- 4-'15 St. Anne's Ophthalmia School, Portobello Rd. ... R.W. 10- 7-'04 16- 4-'l5 19- 5-'15(32) 12- 6-'15 St. John's (Baptist) Ophthalmic School ... O.G. 27- 5-'04 13-7-'15 25-10-'15(14) 12- 7-'15 Barlby Rd. (Day) ... 5- 1-'16 Royal Normal College (Resident) ... 9-1-' 16 Barclay Home, Brighton (Resident) ... V.P.P. 21- 4-'05 13 -4-'I6 26- 6-'16(62) 20-11-' l6 Swiss Cottage (Resident) ... A. S. 27- 9-'o9 10 -7-' 16 25- 9-' 16(38) 10- 1-'17 Swiss Cottage (Resident) ... * Also feeble-minded. Instruction given by Special Teacher. 75 Table No. 46. Return of Deaf Children receiving Special Education during 1916. Initials of Child. Date of Birth Date examined. Date reported by Medical Officer to Committee, and Case No. Date entered Institution. Name of Institution. Date left Institution and remarks E.M. 10-10-'02 ... 1- 6-'10 - 9-'10 re-admitted 10- 3-'16 Margate (Resident) Removed from District temporarily, Dec., 1915 T.H.B. 23- 7-'03 ... 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-'04 ... 5- 7-'11 31- 8-'11 do. A.R.N. 23- 5-'05 9- 3-'12 and 6-12-'13 29- 5-'12 1 and 27- 1-'13 14- 4-'13 do. W.S. 31-10-'06 16- 2-'12 1-10-'13 11-11-'13 do. L.T.T. 8- 8-'05 19- 3-'l2 29- 5-'12 11-11'13 do. F.J. H. 30-10-'06 1- 7-'13 22- 9-'13 11-11-'13 do. I.M.II. 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. G.N.L.B. 19- 2-'09 1- 2-'l5 29- 3-'15 11'- 5-'15 Friar Gate, Derby (Resident) D.B. 2- 7-'06 1- 7-'15 25-10-'15 (3) 29-11-'15 Fitzroy Square (Day) H.H. 23-11-'09 28- 9-'15 25-10-'15 (59) 13- 1-'16 Margate (Resident) H.R. 25- 3-'08 12-10-'15 25-10-'15 (64) 13- 1-' 16 Margate (Resident) W.F. 6-11-'01 21- 2-'l6 27- 3-'16 (7) 5- 5-'16 Friar Gaie, Derby (Resident) A.C. 22- 9-'04 11- 9-'16 27-11-'16 (1) 28- 8-'16 15-11-'16 Hugh Myddleton School (Day) Margate (Resident) *S.B. 5-'9-'09 2- 3-'16 26- 6-'16 (39) 4- 9-'16 Bravington Road, London (M.D., Day) N.W.T. 30- 4-'09 2-10-'16 27-11-'16 (2) 19-10-'16 Margate (Resident) R. P.R.J. E. 20- 3-'09 22-11 - '16 29- 1-'16 (29) 11- 1-'17 Margate (Resident) *Semi-Mute attending M.D. School. 76 Table No- 47. Return showing Feeble Minded Children educated at Residential Institutions. Initials of Child. Date of Birth. Date Examined. Date reported by Medical Officer to Committee and Case No. Date entered Institution Name of Institution. Date left Institution and remarks. L.W. 2-5-'01 21-7-'14 28-9-'l4 (28) 21-5-'15 Western Counties Asylum, Starcross, Devon. Table No. 48. Return of Epileptic Children receiving Education in Institutions during 1916. Initials of Child. Date of Birth. Date examined. Date reported by Medical Officer to Committee, and Case No. Date entered Institution. Name of Institution. Date left Institution and remarks. K.B. 12- 2-'02 4-12-'l2 4- 6-'13 12- 6-'13 Lingfield Epileptic Colony ... W.C.M. 15-10-'01 23-I2-'l3 4- 2-'l4 11- 9-'13 Chalfont do. ... A.W. 17- 4-'01 15- 9-'14 26-10-'14 15- 6-'15 Maghull do. ... H.G.N. 2-11-'08 19- 3-'15 4- 4-'15 (37) 24- 6-'15 Lingfield do. ... W.E.A. 12- 2-'05 26- 6-'16 25- 9-'16(29) 4-I2-'16 Lingfield do. ... 77 Table No. 49. Return shewing the conditions on account of which Children were in attendance at Furness Road Physically Defective Schools, Willesden, during 1916. On Roll of Furness Road Physically Defective School. On Waiting List for Furness Road Physically Defective School or Open-air School. 1. Tuberculosis— Pulmonary - - Non-Pulmonary 12 9 2. Paralysis 28 6 3. Deformities not included in 1 and 2 8 5 4. Heart Disease 5 3 5. Other Conditions 4 2 Total 57 25 Table No. 50. Return shewing the Physically Defective Children maintained at Institutions during 1916. Initials of Child. Date of Birth. Date examined. Date reported by Medical Officer to Committee, and Case No. Date entered Institution. Name of Institution. Date left Institution and remarks. Pulmonary Tuberculosis G.O'N. 9-'02 ... ... 31-10-'14 Kensal House School Transferred from London T.E.W 21- 8-'00 19-2-'15 29-3-'15 (25) 26- 6-'15 East Anglian Sanatorium Was Willesden Education Committee's case till 21-8-'16 K.E.W. 13- 3-'03 ... ... 28- 6-'15 Kensal House School Transferred from London Other Forms of Tuberculosis J.B. 7- 6-'06 6-7-'14 28-9-'14 (34) 15-15-'14 St. Vincent's Cripples' Home, Eastcote, Pinner ... STATISTICAL INFORMATION RELATIVE TO THE TWENTY-FIFTH ANNUAL Hospital Report For the Year 1916. 80 Table No. 51. Return giving particulars of patients under treatment during 1916. Scarlet Fever. Diphtheria. Enteric Fever. Other Diseases. Tuberculosis. Total. No. of cases admitted, 1916 292 176 — 93 29 590 No. under treatment at 31/12/15 38 19 — 3 16 76 Total No. ,, during 1916 330 195 — 96 45 666 No. discharged ,, 1916 319 168 — 92 11 590 No. died ,, 1916 2 15 — 3 17 37 Mortality % ,, 1916 .6 7.6 — 34 37.7 5.7 Remaining in Hospital 31/12/16 9 12 — 1 17 39 Average daily number of patients under treatment during 1916 70.91 Average stay in days in Hospital of Scarlet Fever patients during 1916 36.03 Average stay in days in Hospital of Diphtheria Patients during 1916 31.6l Average stay in days in Hospital of other patients (excluding Tuberculosis) during 1916 15.15 Table No. 52. Return showing Chief Complications of Scarlet Fever. Chief Complications of Scarlet Fever. Number of Cases. Rheumatism 13 Albuminuria 35 Nephritis 9 Otorrhœa 12 Rhinitis 13 Adenitis 46 Mastoiditis 2 Relapse 6 Bronchitis 4 Conjunctivitis 2 Broncho-pneumonia... 3 Heart disease 7 81 Table No. 53. Return shewing Chief Complications of Diphtheria. Chief Complications of Diphtheria. No of Cases. Paralysis 8 Albuminuria 23 Bronchitis 3 Arthritis 3 Pneumonia 2 10 cases suffered from laryngeal symptoms. Tracheotomy was performed on 8 patients, of whom 5 recovered. Table No. 54. Return shewing relation of Case Mortality to day of Disease on admission in Diphtheria during 1916. Day of Disease on Admission. Admissions. Deaths. Case Mortality per cent. 1st 8 — 0 2nd 42 2 4.76 3rd 43 9 20.93 4th 20 1 5.00 5th 14 0 0.00 6th and over 35 2 5.71 Cerebrospinal Meningitis.—7 patients were admitted during the year as suffering from this disease. Of this number 3 were cases of Cerebro-spinal Meningitis, one military case was removed by Army Authorities to Royal Herbert Hospital, Greenwich, one was a case of Tuberculous Meningitis, and two were cases of other diseases. Of the three cases of Cerebro-spinal Meningitis 1 recovered, 1 died, and 1 was still in hospital at the end of the year. 82 Table No. 55. Return showing cases wrongly diagnosed and diseases for which they were mistaken. Certified as suffering from Diagnosed in Hospital as suffering from Cerebrospinal Meningitis Scarlet Fever. Diphtheria. Small Pox. 1 — — — Acute Rheumatism — 9 16 — Tonsillitis 1 — — — Appendicitis — 1 — — Broncho Pneumonia — 15 1 — No apparent disease — 9 — — Erythema — — 1 — Alveolar Abscess — 1 — — Septic Rash — 11 — — German Measles — — 1 — Mumps — — 1 — Scarlet Fever — — 1 — Quinsy 1 — — — Tuberculous Meningitis — — 1 — Stomatitis — — 3 — Bronchitis — — 1 — Tuberculous Glands — — — 1 Herpes — 1 — — Burns — 1 — — Congenital Heart Disease — 1 — — Scabies — 1 — — Eczema — 1 — — Peritonsillar Abscess 3 51 26 1 Total 81 83 Other Diseases. Six patients suffering from diseases not as a rule treated in this Hospital were admitted for special reasons. They were : Measles, 4; German Measles, 1; Erysipelas, 1. Table No. 56. Return showing the number of bacteriological examinations conducted in the Hospital laboratory during the year 1916. Nature of Specimens examined. Positive Result. Negative Result. Total. 1. Throat and Nose Swabs for Diphtheria Bacilli etc. 129 562 691 2. Sputum for Tubercle Bacilli 37 163 200 3. Blood for Widal Test — 9 9 4. Other Diseases 6 — 6 Total 172 734 906 84 APPENDIX A. LOCAL GOVERNMENT BOARD TABLES Table No I. VITAL STATISTICS OF WHOLE DISTRICT DURING 1916 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. Under 1 Year of Age. At all Ages. Number. Rate. of nonresidents registered in the District. † of residents not registered in the District. † Number. Rate per 1,000 Nett Births. Number. Rate. Number. † Rate. (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) (13) 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 4,037 247 1,449 8.9 23 251 325 80 1,677 10.24 1914 166,634 3.971 4,115 247 1,501 9.0 32 283 337 82 1,752 10.51 1915 166,840 3,641 3,775 22.6 1,792 10.7 44 282 344 91 2,030 12.16 1916 167,810 3,557 3,668 21.9 1,436 8.55 34 308 283 77 1,710 10.19 85 Table Ia. VITAL STATISTICS OF THE WARDS—1916. WARDS. Population estimated to Middle of Year. Births. Total Deaths Registere4 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) 1. South Kilburn 14,757 335 354 23.98 156 10.57 ... 36 38 107.34 192 13.01 2. Mid Kilburn 14,712 306 331 22.49 155 10.53 6 38 32 96.67 187 12.71 3. North Kilburn 12,370 202 214 17.29 124 10.02 2 31 11 51.40 153 12.36 4. Brondesbury Park 9,928 178 182 18.33 70 7.05 10 15 9 49.45 75 7.55 5. Kensal Rise 14,310 312 320 22.36 101 7.05 1 24 22 68.75 124 8.66 6. Harlesden 17,580 353 361 20.53 137 7.79 2 21 20 55.40 156 8.87 7. Stonebridge 17,821 419 432 24.24 151 8.47 3 28 46 106.48 176 9.87 8. Round wood 15,722 394 404 25.69 127 8.07 ... 29 24 59.40 156 9.92 9. Church End 14,206 359 370 26.04 127 8.93 6 22 27 72.97 143 10.06 10. Willesden Green 16,954 376 384 22.64 141 8.31 ... 29 30 78.12 170 10.02 11. Cricklewood 19,450 323 316 16.24 147 7.55 4 35 24 75.94 178 9.15 86 NOTES TO TABLES I. and Ia. Tables I. and Ia. 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, but excluding the deaths of soldiers and sailors. *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 off 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 outsidie 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, lunatic 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 for 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 of residence, under the general rule; (b) if this district is unknown, or the deceased had no fixied 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 154,3441 . Total families or separate occupiers 35,478 At Census, 1911 87 TABLE II.— CASES OF INFECTIOUS DISEASE NOTIFIED DURING THE YEAR 1916. 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 x. 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) 225 1 64 137 14 9 .. .. 19 15 7 13 24 30 16 23 27 28 23 213 Erysipelas 87 3 3 4 13 27 25 12 10 14 3 3 5 7 10 15 7 7 6 2 Scarlet Fever 387 2 77 268 26 14 .. .. 15 42 23 28 24 47 31 84 33 35 25 350 Typhus Fever .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Enteric Fever 3 .. .. .. 1 1 1 .. .. .. .. .. .. .. .. .. 1 .. 2 1 Relapsing Fever (R) Continued Fever (C) .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Puerperal Fever 11 .. .. .. 3 8 .. .. .. 2 2 1 1 .. 2 .. 1 .. 2 .. Cerebro-spinal Meningitis 8 1 1 2 3 1 .. .. 1 1 1 .. 2 .. 2 .. 1 .. .. 2 Poliomyelitis 5 1 4 .. .. .. .. .. 1 .. .. .. 1 2 .. .. .. .. 1 .. Ophthalmia Neonatorum 28 28 .. .. .. .. .. .. 2 2 2 1 .. 6 2 4 4 5 .. .. Measles and German Measles 1437 49 290 857 150 86 5 .. 37 109 76 100 95 134 149 279 78 68 312 1 Pulmonary Tuberculosis 259 1 4 31 66 112 42 3 26 26 25 15 13 35 36 25 23 17 18 .. Other forms of Tuberculosis 63 1 16 20 17 8 1 .. 10 5 4 2 4 7 5 7 9 6 4 .. Totals 2513 87 459 1319 293 266 74 15 121 216 143 163 169 268 253 437 184 166 393 569 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. Cases of Infectious Disease occurring amongst soldiers or sailors are not included in this table. 88 MILITARY CASES OF INFECTIOUS DISEASE NOT INCLUDED IN Table II. Register No Infectious Disease. Age. Ward. 1,432 Scarlet Fever 31 7 1,306 ,, ,, 36 3 846 Cerebro-spinal Meningitis 27 7 1,283 ,, ,, ,, 34 4 1,517 Pulmonary Tuberculosis 24 5 1,560 ,, ,, 20 8 1,592 ,, ,, 25 10 1,610 ,, ,, 31 1 1,627 ,, ,, 30 7 1,662 ,, ,, 30 9 1,742 ,, ,, 44 3 1,781 ,, ,, 30 7 308 Diphtheria 31 8 304 Measles 20 8 365 ,, 30 7 454 ,, 32 8 549 ,, 24 7 550 ,, 26 7 581 ,, 25 7 630 ,, 22 7 631 ,, 21 7 819 ,, 25 7 872 ,, 35 7 890 ,, 35 7 38 ,, 26 7 39 ,, 21 7 37 ,, 21 7 97 ,, 24 7 132 ,, 21 7 232 ,, 25 7 269 ,, 19 7 402 ,, 28 7 523 ,, 19 7 529 ,, 24 7 613 ,, 33 7 89 Table III. CAUSES OF, AND AGES AT DEATH DURING THE YEAR 191 6. 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) 1708 283 54 60 65 94 232 394 526 324 Uncertified 2 .. .. .. .. 1 .. 1 .. .. Enteric Fever .. .. .. .. .. .. .. .. .. .. Small-pox .. .. .. .. .. .. .. .. .. .. Measles 7 .. 1 4 2 .. .. .. .. 2 Scarlet Fever 1 .. .. 1 .. .. .. .. .. 1 Whooping-cough 26 16 7 2 1 .. .. .. .. 5 Diphtheria and Croup 17 1 2 7 6 1 .. .. .. 14 Influenza 31 .. .. 1 1 1 4 12 12 .. Erysipelas 3 1 .. .. .. .. .. .. 1 2 Phthisis (Pulmonary Tuberculosis) 163 1 .. 3 7 43 7.3 33 3 41 Tuberculous Meningitis 19 2 3 9 5 .. .. .. .. 1 Other tuberculous diseases 26 1 2 5 6 4 5 1 2 5 Cancer, malignant disease 174 .. .. 1 1 .. 19 81 72 33 Rheumatic Fever 11 .. .. .. s 2 1 2 1 .. Meningitis (d) 17 3 1 3 5 2 2 1 .. 1 Organic Heart Disease 206 2 .. .. 5 5 25 64 105 29 Bronchitis 127 19 5 2 .. .. 4 21 76 22 Pneumonia (all forms) 118 37 18 10 1 2 12 19 19 9 Other diseases of Respirator) organs 25 3 1 1 1 2 3 7 7 5 Diarrhoea and Enteritis (e) 43 29 3 3 .. .. 1 4 3 5 Appendicitis and Typhlitis .. 13 .. .. .. 4 2 1 5 .. 2 Cirrhosis of Liver 17 .. .. .. .. .. 1 11 5 6 Alcoholism 1 .. .. .. .. .. 1 .. .. .. Nephritis and Bright's Disease 45 .. 2 1 .. 1 8 15 18 6 Puerperal Fever 7 .. .. .. .. 1 6 .. .. 4 Other Accidents and Diseases of Pregnancy and Parturition 8 .. .. .. .. 1 7 .. .. 1 Congenital Debility and Malformation, including Premature Birth 103 102 1 .. .. .. .. .. .. 18 Violent Deaths, excluding Suicide 53 2 1 4 5 9 8 13 11 10 Suicide 5 .. .. .. .. .. 3 2 .. .. Other Defined Diseases 444 64 7 2 10 19 47 104 191 101 Diseases ill-defined or unknown .. .. .. .. .. .. .. .. .. .. Totals 1710 283 54 60 65 95 232 395 526 324 SubEntries. included in above figures. Cerebro-spinal Meningitis Poliomyelitis 7 2 .. 1 1 2 .. 1 .. 4 7 .. .. .. .. 1 1 2 3 1 Pneumonia other than Broncho Pneumonia 59 9 6 3 1 .. 10 18 12 9 90 NOTES TO TABLE III. The classification of Causes of Death are those of the 14 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 Diarrhœa and Enteritis at all ages. N.B.— Deaths of soldiers and sailors are excluded from the total number of deaths registered in the district, and such deaths are in like manner excluded from column 11 of Table III. 91 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. Round wood. Church End. Willesden Green. Cricklewood. (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) (13) All causes Certified 1708 194 187 151 76 123 155 176 156 142 170 178 Uncertified 2 .. .. .. .. 1 .. .. .. 1 .. .. Enteric Fever .. .. .. .. .. .. .. .. .. .. .. .. Small Pox .. .. .. .. .. .. .. .. .. .. .. .. Measles 7 i .. .. .. .. 2 .. 4 .. .. .. Scarlet Fever 1 .. .. .. 1 .. .. .. .. .. .. .. Whooping Cough 26 3 2 3 .. 3 5 2 2 2 2 2 Diphtheria and Croup 17 2 2 .. .. 2 2 1 1 3 3 1 Influenza 31 2 4 4 1 2 4 4 3 3 .. 4 Erysipelas 3 .. .. .. .. .. .. 1 1 .. 1 .. Phthisis (Pulmonary Tuberculosis) 163 20 13 11 6 11 17 19 15 14 20 17 Tuberculous Meningitis 19 1 3 .. .. .. 1 3 1 4 4 2 Other Tuberculous Diseases 26 5 1 2 1 1 2 3 3 4 1 3 Cancer, malignant disease 174 15 25 23 8 9 26 11 14 8 16 19 Rheumatic Fever 11 .. .. 4 .. 2 1 2 .. 1 1 .. Meningitis 17 1 i 2 .. 4 .. 2 1 3 3 .. Organic Heart Disease 206 20 22 20 8 9 16 23 19 17 25 27 Bronchitis 127 16 12 9 5 14 9 14 15 14 12 7 Pneumonia (all forms) 118 17 17 5 7 10 1 8 15 7 15 16 Other Diseases of Respiratory Organs 25 6 2 1 .. 3 2 3 2 3 .. 3 Diarrhœa and Enteritis 43 5 4 3 2 6 2 6 3 7 3 2 Appendicitis and Typhlitis 13 .. 2 1 .. .. 1 1 2 .. 2 4 Cirrhosis of Liver 17 3 .. 1 .. 1 4 .. 1 2 4 i Alcoholism 1 .. .. .. .. 1 .. .. .. .. .. .. Nephritis and Bright's Disease 45 3 10 4 3 3 3 3 7 2 3 4 Puerperal Fever 7 .. 1 2 1 1 .. .. .. .. .. 2 Other Accidents and Diseases of Pregnancy and Parturition 8 .. 5 1 .. .. .. .. .. .. 2 .. Congenital Debility and Malformation, including Premature Birth 103 15 11 3 4 9 6 20 8 8 9 10 Violent Deaths, excluding Suicide 53 6 4 4 3 4 4 10 7 5 1 5 Suicide 5 .. .. .. 2 .. .. 1 1 1 .. .. Other Defined Diseases 444 53 46 48 24 29 47 39 31 35 43 49 Diseases ill-defined or unknown .. .. .. .. .. .. .. .. .. .. .. .. Totals 1710 194 187 151 76 124 155 176 156 143 170 178 Sub- Entries, included in above figures Cerebro-spinal Meningitis 7 1 1 .. .. 1 .. 2 .. 2 .. .. Poliomyelitis 7 .. 1 1 .. .. 1 .. .. 1 2 1 Pneumonia other than Broncho-Pneumonia 59 9 7 2 4 8 1 6 7 2 6 7 92 Table IV.— INFANT MORTALITY. 1916.—Nett Deaths from Stated Causes at various Ages wider 1 Year of Age. Causes 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 60 24 17 7 108 61 59 22 33 283 Uncertified .. .. .. .. .. .. .. .. .. .. Small-pox .. .. .. .. .. .. .. .. .. .. Chicken-pox .. .. .. .. .. .. .. .. .. .. Measles .. .. .. .. .. .. .. .. .. .. Scarlet Fever .. .. .. .. .. .. .. .. .. .. Whooping Cough .. .. .. .. .. .. 6 5 5 16 Diphtheria and Croup .. .. .. .. .. .. .. .. .1 1 Erysipelas .. .. .. .. .. .. 1 .. .. 1 Tuberculous Meningitis .. .. .. .. .. .. .. 1 1 2 Abdominal Tuberculosis (a) .. .. .. .. .. .. .. .. .. .. Other Tuberculous Dis. .. .. .. .. .. .. .. .. 2 2 Meningitis (not Tuberculous) .. .. .. .. .. .. 1 1 1 3 Convulsions 4 5 2 .. 11 4 6 4 1 26 Laryngitis .. .. .. .. .. .. .. .. .. .. Bronchitis .. .. .. 1 1 6 9 2 1 19 Pneumonia (all forms) 2 1 1 .. 4 10 7 3 13 37 Diarrhœa .. .. .. .. .. 1 3 1 2 7 Enteritis 1 1 1 3 6 7 7 1 I 22 Gastritis .. .. 1 1 2 1 .. 1 .. 4 Syphilis .. .. 1 .. 1 3 5 1 .. 10 Rickets .. .. .. .. .. .. .. .. .. .. Suffocation, overlying .. .. .. .. .. .. .. .. .. .. Injury at birth 3 .. 1 .. 4 .. .. .. .. 4 Atelectasis 3 .. .. .. 3 .. .. .. .. 3 Congenital Malformations(b) 3 1 3 .. 7 4 1 .. .. 12 Premature birth 34 6 3 1 44 7 .. .. .. 51 Atrophy, Debility and Marasmus 5 9 3 .. 17 11 9 .. 2 39 Other Causes 5 1 1 1 8 7 4 2 3 24 Totals 60 24 17 7 108 61 59 22 33 283 Nett Births in the year legtimate 3.553 illegitimate 115 Nett Deaths in the year legitimate infants 266 illegitimate infants 17 (a) Under Abdominal Tuberculosis are included deaths from Tuberculous Peritonitis and Enteritis and from Tabes Mesenterica. (b) Want of Breast Milk is included under Atrophy and Debility. 93 Table IVa.— INFANT MORTALITY. 1916. - Nett Deaths from all Causes under one year of age classified in Wards. Causes of Death. WARDS. Total for District. South Kilburn. Mid Kilburn. North Kilburn. Brondesbury Park. Kensal Rise. Harlesden. Sfonebridge. Roundwood. Church End. Willesden Green. Cricklewood. (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) (13) All Causes Certified 38 32 11 9 22 20 46 24 27 30 24 283 Uncertified .. .. .. .. .. .. .. .. .. .. .. .. Small Pox .. .. .. .. .. .. .. .. .. .. .. .. Chicken Pox .. .. .. .. .. .. .. .. .. .. .. .. Measles .. .. .. .. .. .. .. .. .. .. .. .. Scarlet Fever .. .. .. .. .. .. .. .. .. .. .. .. Whooping Cough 3 2 2 .. .. 3 1 2 .. 1 1 16 Diphtheria and Croup .. 1 .. .. .. .. .. .. .. .. .. 1 Erysipelas .. .. .. .. .. .. .. .. .. 1 .. 1 Tuberculous Meningitis .. .. .. .. .. .. .. .. .. 2 .. 2 Abdominal Tuberculosis .. .. .. .. .. .. .. .. .. .. .. .. Other Tuberculous Diseases .. 1 .. .. .. .. 1 .. .. .. .. 2 Meningitis (not Tuberculous) 1 .. .. .. .. .. .. .. .. 1 .. 3 Convulsions 2 4 .. .. .. 2 2 1 3 5 3 26 Laryngitis .. .. .. .. .. .. .. .. .. .. .. .. Bronchitis 1 2 .. .. 3 2 5 1 2 3 .. 19 Pneumonia (all forms) 6 5 2 .. 2 .. 2 8 3 4 5 37 Diarrhœa 1 2 .. .. 1 .. .. 1 2 .. .. 7 Enteritis 2 .. 1 2 3 1 5 1 4 2 1 22 Gastritis .. .. .. .. .. .. 1 1 1 l .. 4 Syphilis 1 .. .. .. .. 1 7 .. 1 .. .. 10 Rickets .. .. .. .. .. .. .. .. .. .. .. .. Suffocation, overlying .. .. .. .. .. .. .. .. .. .. .. .. Injury at birth .. .. .. 1 .. 1 .. .. 1 .. 1 4 Atelectasis .. .. .. .. .. 1 .. .. .. 1 1 3 Congenital Malformations 1 .. .. 1 .. .. 3 1 2 I 2 12 Premature Birth 8 7 2 2 4 4 9 3 3 4 5 51 Atrophy, Debility and Marasmus 6 4 1 1 4 2 7 4 3 4 3 39 Other Causes 6 4 1 1 2 3 3 1 1 .. 2 24 Totals 38 32 11 9 22 20 46 24 30 27 24 283 Deaths -Legitimate 33 30 11 9 21 19 45 23 25 29 21 266 Illegitimate 5 2 .. .. I 1 1 1 2 1 3 17 Births— Legitimate 345 317 209 179 317 349 420 387 354 374 302 3553 Illegitimate 9 14 5 3 3 12 12 17 16 10 14 115 Total Births 354 331 214 182 320 361 432 404 370 384 316 3668 Infant Mortality Rate— Legitimate 95.65 94.63 53.63 50.27 66.24 454.44 107.14 59.43 70.62 77.54 69.53 74.86 Illegitimate 555.55 142.85 0.00 0.00 333.33 83.33 83.33 58.82 125.00 100.00 214.28 147.82 Infant Mortality Rate 107.34 96.67 51.40 49.45 68.75 55.40 106.48 59.40 72.97 78.12 75.94 77.15 Population 14757 14712 12370 9928 14310 17580 17821 15722 14206 16954 19450 167810 94 APPENDIX B. Shewing Acts, Circulars, Regulations, and Orders issued by the Local Government Board during the year 1916, relating to the work of the Health Department. Venereal Diseases.—(a) Circular issued by the Local Government Board on the 13th July, 1916; (b) Regulations made by the Local Government Board on the 12th July, 1916. Tuberculosis (Domiciliary Treatment in England) Order, 1916, dated 19th September, 1916. Maternity and Child Welfare—(a) Circular issued by the Local Government Board on the 23rd September, 1916; (b) Regulations made by the Local Government Board on the 23rd September, 1916. APPENDIX C. 3rd June, 1916. To the Chairman and Members of the Health Committee. MATERNITY AND CHILD WELFARE. Medical Work at present undertaken. The Medical Staff at present employed by the Council numbers three, namely, the Medical Officer and two assistant Medical Officers, and the following indicates the scheme of work on which they are presently occupied:— Medical Officer. 9 a.m. to 1 p.m. 1 p.m. onwards. Monday Correspondence and General matters Tuesday To receive reports from and direct work of— Hospital— Administration. Wednesday Assistant Medical Officers Sick Staff. Chief Sanitary Inspector Ward Visits. Thursday Chief Health Visitor Bacteriology. Chief Clerk Friday Meals Supervisor Outdoor work Saturday Office and Hospital Off duty 1 p.m. to 10 p.m. Sunday Hospital Off duty 1 p.m. to 10 p.m. 95 Assistant Medical Officers. Dr. Atkinson—Districts 4, 5, 6. Dr. Shannon—Districts I, 2, 3, 7. Dr. Atkinson. 2 p.m. to 4.30 p.m. Dr. Shannon. 2 p.m. to 4.30 p.m. 9 a.m. to 11 a.m. 11 a.m. to 1 p.m. Examination of Special cases at Office or home. School. School. Monday Office work. To receive reports from and direct work of Health Visitors relating to infectious diseases, births and school cases. Outdoor work. Tuesday Eye Clinic. School. Special School (till 3.30 p.m). School. Special School (till 3.30 p.m.) Wednesday Special School. Thursday Eye Clinic. School. School. Friday Eye Clinic. Inspection Clinics— Dyne Road (Dr. S.) Leopold Rd. (Dr. A.) Off duty. Off duty. Saturday Hospital (1 p.m.- 10p.m.) Hospital (1 p.m.- 10p.m.) Sunday The daily average number of patients in hospital varies from GO to 120 or over. The Board of Education in Circular 950, dated 12th May, 1916, state that they consider that in the event of temporary curtailment of the School Medical Service provision should at any rate be made for the medical inspection of children at all ages, who appear to be ailing, and for the maintenance of any treatment undertaken by the Authority. This is all that at present is being done. Arrangements have been made in the foregoing Schedule for all the schools to be visited twice per annum by the Medical Staff, to ascertain what children appear to be ailing, and, in addition, ailing children are referred by the teachers at the average rate of 92 per week. The number of attendances at the Dyne Road Inspection Clinic on Saturday mornings averages 40. The number of attendances at the Leopold Road Inspection Clinic averages 30. 96 The treatment centres are also being carried on as required. The Eye Clinic is open, as shewn in the above Schedule, and the average number of attendances of children on each day on which it is open is 42, the greatest number attending on any one day this year being 84. The number of attendances at the Ringworm Clinic averages 30. Maternity and Child Welfare. In connection with Maternity and Child Welfare, I would recommend that a clinic be established to cover the whole area of Willesden as a beginning. This might be situated in some suitable house in the south-east corner of the district. The cost of this arrangement would be as follows:— £ Capital Charge (to include cost of equipment of one Centre) 200 Additional Annual Charges— Temporary Assistant Medical Officer 438 Temporary Health Visitors 330 Rent, Rates, Taxes 90 Heating, Lighting, Cleaning 25 Printing and Stationery 20 Postages 15 Drugs 30 Materials and Medical Requisites 20 Sundries 30 Total £998 Half of these charges will be repayable to the Council by grant from the Local Government Board. The net cost, therefore, to the Council would be £599 for the first year, and £499 in subsequent years, as against £874 for the first 97 year and £674 in subsequent years as approved by the Council at its meeting on the 27th July last. In addition, in view of the enquiry of the Carnegie United Kingdom Trust, there may be a further grant from this source, thereby still further reducing the cost to the Council. I am, your obedient servant, GEORGE F. BUCHAN, Mcdical Officer. APPENDIX D. 17th July, 1916. To the Chairman and Members of the Health Committee. DAY AND NIGHT NURSERY EOR CHILDREN OF MUNITION WORKERS. As instructed by the General Purposes Committee I beg to report on the above subject. The Matron of the Women Workers at the Perivale Fuse Filling Factory brought under my notice the difficulty of obtaining and retaining the services of married women at this factory on account of their inability to make arrangements for the care of their children. She informed me that there were approximately 1,800 women workers in the factory now, and that when the buildings were completed and the factory full, there would be not less than 4,000 to 5,000 women workers. Enquiries made by her amongst the women now employed at the factory showed that at the present time there were 26 who would leave 30 children to be looked after by day, and a similar number by night, and the Matron was of opinion that the next draft of women would contain a greater proportion of married with children. 98 Strictly there is no power to enable the Council to establish a Day or Night Nursery, but the present emergency is being considered by the Local Government Board whom I have consulted and who are favourable to the establishment of such nurseries. I have also consulted the Ministry of Munitions as to the question of grant in respect of equipment and they are considering this subject. The Board of Education gives grants to Day Nurseries at a rate of not more than 4d. for each attendance of nine hours provided that in any case the total grant shall not exceed one-half of the approved net expenditure. The Lower Place disused Council School could be made suitable for purposes of a Day and Night Nursery, and it would appear that provision should be made at once for 30 children attending by day and 30 by night. The following estimate is on the basis of this number:— CAPITAL CHARGES. Alterations and Repairs. Bath Room. £ s. d. To provide and fix three 12 inch glazed stoneware sinks with 2 inch lead wastepipes (suitable for use as baths for children). Remove existing range of lavatory basins in Cloak-room and refix same in Bath room. Provide and fix three 11 inch shelves, 12 ft. long, in approved position 21 4 0 Kitchen. Provide and fix one 8 ft. dresser, fitted with shelves, four drawers and pot board 10 10 0 Carried forward 31 14 0 99  £ s. d. Brought forward 31 14 0 Larder. Provide and fix three shelves, 12-ft long, 1-ft. 6-in. wide, on two sides, return same at end 5 12 0 Scullery. Provide and fix two 10-in. glazed stoneware sinks with 1½-in. wastepipes, lay on cold water service with draw off tap to each sink. Provide and fix ½-in. lead service pipe. Provide and fix two wooden draining boards. Remove existing partition and take down all hat and cloak pegs. Provide and fix three shelves 11-in. wide, in approved positions 11 12 0 Attendants' Room. Provide and fix one housemaid's slop closet with flushing system complete, properly connected to drain. 1 Gas Copper—fitting up complete. Provide and fix one 10-in. glazed stoneware sink, with l½-in. lead waste pipe. Provide and fix three shelves 11-in wide in approved position 24 5 0 Linen Store. Shelving 4 0 0 Roofs and Gutters 2 0 0 Glazing 1 0 0 Miscellaneous 19 17 0 Total 100 0 0 Equipment. Cooking Stove and Hot Water Circulation 100 0 0 Carried forward £200 0 0 100 Brought Forward £200 0 0 Bedding and Furniture. 40 Cots and bedding 160 0 0 Linoleum for bath-room 14 0 0 Tables, chairs, cupboards, crockery, cutlery, linen, and other furniture 100 0 0 Total Capital Charges £474 0 0 Annual Maintenance Charges. Food. 66 Persons at 8d. per day 800 0 0 Salaries and Wages. 1 Superintendent at £'2 per week £104 4 Assistants at £1 per week £208 1 Cook at 17s. 6d. per week £45 2 Kitchen maids at 15s. per week £78 435 0 0 Maintenance of Premises. Heating, including cooking 125 0 0 Lighting 30 0 0 Cleaning and washing 100 0 0 Rent—rates and taxes 100 0 0 Annual repairs. 20 0 0 Printing, Stationery, Postage, etc. 10 0 0 Sundries Total Annual Maintenance Charges 20 £1,640 0 0 0 0 From the foregoing it will be noted that the initial expenditure on alterations, repairs, furniture, and equipment is lestimated at £474, and the annual expenditure is estimated at £1,640, or approximately, 1s. 6d. per child for a duration of 12 hours. Before considering what charge should be made to parents in respect of the cost per child it will be necessary for the Committee to ascertain— 1. If the Local Government Board are prepared to sanction the establishment and maintenance of a day and night nursery for the children of munition workers; and 101 2. What grant, if any, is to be given by the Local Government Board or Ministry of Munitions towards (a) The initial capital charges estimated at £474; and (b) The annual maintenance charges, estimated at £1,640 I am, your obedient Servant, GEORGE F. BUCHAN, Medical Officer. Note.—It might be possible to reduce the above costs in respect of loans or gifts of furniture, and the employment of voluntary helpers, but these are not matters which it is possible to deal with by estimate. —G. F. B. APPENDIX E. 28th August, 1916. To the Chairman and Members of the Health Committee. MOTOR SERVICE. I beg to report on the above for the year ending 31st March, 1916. New Work. The 7 motor vehicles owned by the Council have been in use throughout the entire year ended 31st March, 1916, and have covered 47,433 miles. Certain new work was undertaken during the year in connection with Belgian refugees, registration, removal of wounded soldiers, recruiting, and the Accountant's Department. New Plant. The Garage workshop has been equipped during the year with machine tools for motor and hospital engineering at a cost of £103 6s. 8d., which has been paid out of revenue. 102 The Petrol Storage Plant of 500 gallons capacity, which was installed during last year, has in addition to saving a 1½d. per gallon, proved useful in respect of time saving in filling the petrol tanks of the motor vehicles, and in enabling a larger quantity of petrol to be stored on the premises. The cost of this plant, namely, £91, was paid for out of revenue for the year ending 31st March, 1915. Miles run. The following table shows the number of miles run by each vehicle during the two complete financial years, namely, from the 1st April, 1914, to 31st March, 1916, and since delivery to the latter date. Car Number. Miles run from delivery to March 31st, 1914. Miles run from April 1st, 1914 to March 31st, 1915. Milts run from April 1st, 1915 to March 31st, 1916. Miles run since delivery to March 31st, 1916. Disinfecting Van, M.X. 1884 2755 6440 5196 14391 Landaulette, M.X. 2056 1466 6385 10579 18378 School 'Bus, M.X. 2057 1801 7648 6915 16364 Infectious Ambulance, M.X. 2058 1418 5591 3912 10921 School 'Bus, M.X. 2059 2254 7176 9036 18466 Accident Ambulance, M.X. 2060 725 3900 4686 9302 School 'Bus, M.X. 2061 2152 6958 7109 16219 Totals 12571 44098 47433 104041 Calls. The following table shows the number of calls for the Disinfecting Van, Infectious Ambulance and Accident Ambulance respectively during the two complete financial years, April 1st,. 1914, to March 31st, 1916, and since delivery to the latter date:— 103 From delivery to March 31st, 1914. From April 1st, 1914, to March 31st, 1915. From April 1st, 1915 to March 31st 1916. Since delivery to March 31st, 1916. Number of calls for Disinfecting Van 370 1167 957 2494 Number of calls for Infectious Ambulance 250 940 696 1886 Number of calls for Accident Ambulance 40 372 388 800 Staff. Difficulties have arisen during the past year on account of shortage of staff, and at one time it was necessary to suspend for a short time the motor service for defective children attending the schools. The night service also has been discontinued, and the garage is closed from 10 p.m. to 7.30 a.m., except when called up for convoys of wounded soldiers, or air-raids. The present staff employed is 1 mechanic Superintendent, 5 men drivers and 1 woman driver, none of whom are eligible for military service. 104 Expenditure. The following table shows the expenditure and costs per mile under various headings, during the financial year ended 31st March, 1916:— Cost per mile. £ s. d. £ s. d. Interest and Repayment on Loan 451 13 11 2.29 Rent:- Garage 175 0 0 Messroom 12 0 0 187 0 0 .95 Wages:— Wages 835 0 10 War Pay 51 5 11 State Insurance 4 4 3 890 11 0 Less amount overpaid for War pay refunded 67 19 10 Running Cost:— 822 11 2 4.16 Petrol 266 19 1½ Tyres 268 7 1½ Grease and Oils 9 18 7 Sundries 10 0 0 555 4 10 2.81 Fixed and General Charges:- Insurances (includes 7/14/7 Aircraft Insurance of Vehicle) 86 9 7 Lighting and Power 17 8 9 Coal, Gas and Water 43 7 2 Uniforms & Overalls 27 0 6 Licences (Drivers') 1 10 0 Rent of Telephone 11 0 9 Deposit on Telephone 2 0 0 Plant, Tools, etc. 146 15 6 Alterations & Repairs 14 5 8 Tax 6 6 0 Sundries 15 0 6 371 4 5 1.88 2387 14 4 12.08 Miles run by all vehicles 47433. Petrol Consumption 4035.5 gallons= 11.75 miles per gallon. 105 The following is a statement of comparative mileage, petrol consumption, and cost for the two complete years ended March 31st, 1916. Year ended March 31st. 1915. 1916. Total No. of Miles run by 7 Vehicles 44098 47433 No. of Miles per gallon of Petrol consumed 11.2 11.75 Total cost per mile run 13.4d. 12.08d. I am, your obedient Servant, GEORGE F. BUCHAN, Medical Officer. APPENDIX F. 18th September, 1916. To the Chairman and Members of the Children's Care Committee. Economic Circumstances in relation to the Provision of School Meals. As instructed, I beg to report on the above. At the present time the economic circumstances per head in a family are determined as follows :— A. Income. (a) Wages. These include:— (1) Parent's or guardian's weekly wage, the age for four weeks being taken. (2) The earnings of children under 14 years of age. 106 (b) Lodgers or children over 14 years. If payment under 8s. is made nothing is reckoned towards income of family If payment between 8s. and 10s. is made, 10 per cent. of payment is reckoned towards income of family. If payment between 10s. and 12s. 6d. is made, 15 per cent. of payment is reckoned towards income of family. If payment over 12s. 6d. is made, 20 per cent. of payment is reckoned towards income of family. (c) Letting. Room furnished or unfurnished—whole of amount received taken as income. B. Outgoings. These include:— (a) Rent. (b) Insurance. (c) Fares to and from work. (d) Care of children. C. Number in Family. This includes parents or guardians, or older sisters looking after the home and not working, and children under 14 years of age. D. Economic Circumstances per Head. The outgoings are subtracted from the income and the remainder divided by the number in the family. Present Scale. If the result is 3s. 6d. or less per week all the school children in the family may be fed. Food Requirements. The food requirements of a normal school child of 10 years of age to satisfy completely its physiological appetite are as follows :— Protein 60 grams. Fat 40 „ Carbohydrate .250 „ 107 The meals given by the Education Committee provide the following daily average:— Protein 29 grams. Fat 25 „ Carbohydrate 110 „ or, approximately, half the total required. The average cost per meal of school meals for food only for the year ended 31st March, 1910, was 2.174d. The total cost per meal, that is including charges for rent, fuel, lighting, supervision, etc., was 4.861d. At the present time (August, 1916), the average cost per meal of the same meals for food only is 2.85d. It will therefore be noted that to supply a child of 10 years with its physiological requirements in respect of food only costs approximately 2.85.x 2 per day, or 3s. 4d. for a week of seven days. Other Requirements. Lighting and Fuel. I he following is a statement of the actual amount spent per week in certain families in respect of the above:— No. Gas and Coal. No. in Family. Gas & Coal per head per week. Income. 1 5/3 7 9d. 45/- 2 2/4½ 7 4d. 39/4 3 3/6 5 8½d. 25/- 4 4/5 7 7½d. 39/6 5 4/9 7 8d. 43/6 6 4/- 6 8d. 29/6 7 3/- 9 4d. 28/- 8 3/7 6 7d. 28/- 9 3/8 5 8¾d. 26/- 10 2/11 8 4½d. 28/- 11 2/8 6 5½d. 30/6 12 4/7½ 9 6¼d. 33/- 13 6/- 7 10¼d. 80/6 50/9 89 For the 13 families above quoted, the average gas and coal bill per week per head is 6.84d., or approximately 7d. per week. 108 Clothing. From information supplied the cost per annum for a child of ten is at present not less than 30s., or approximately, 7d. per week. Sundries. These include bedding, washing, cleaning, crockery, furniture for which a sum of 2.69d., or approximately 3d. per head per week is the average in the cases of the above 13 families. From the foregoing it will therefore be seen that the cost of up-keep of a child of ten years exclusive of rent and insurance, is as follows:— s. d. Food 3 4 Lighting and Fuel 0 7 Clothing 0 7 Sundries 0 3 Total 4 9 As the family to be considered by the Education Committee includes only the parents or guardians or older sisters looking after the home and not working, and children under 14 years of age, it is probable that the cost of a child of ten years is slightly below the average cost per head of the family, and this should be taken into consideration in fixing the scale at which children are to be fed. Size of Family and Economic Circumstances. It is usually the case that a small family shows relatively high economic circumstances per head, although the total amount at the disposal of the head of the family is small. Scale Suggested. Having regard to the foregoing facts I would suggest a sliding scale on the following basis:— 109 If No. in family is 2 scale should be 6/- per head, „ „ „ 3 „ „ ,, 5/- per head. „ „ „ 4 ,, ,, ,, 4/6 per head. „ „ „ 5 ,, ,, ,, 4/3 per head. „ „ „ 6 or more ,, ,, ,, 4/- per head. When the relief afforded by school meals is added to the above scale, the total economic circumstances per head of the family approximates the sum of 4s. 9d. required as shewn below:— No. in family as [defined. Probable No. fed. Economic Circumstances per week per head as per suggested scale. Total. Relief from Meals at 3d per meal per day. Total and Relief from Meals. Total Economic Circumstances per week per head. 2 1 6/- 12/- 1/3 13/3 6/7 3 2 5/- 15/- 2/6 17/6 5/10 4 2 4/6 18/- 2/6 20/6 5/1 5 3 4/3 21/3 3/9 25/- 5/- 6 4 4/- 24/- 5/- 29/- 4/10 7 5 4/- 28/- 6/3 34/3 4/11 8 5 4/- 32/- 6/3 38/3 4/9 9 5 4/- 36/- 6/3 42/3 4/8 10 5 4/- 40/- 6/3 46/3 4/7 I am, your obedient Servant, GEORGE F. BUCHAN, Medical Officer. APPENDIX G. 20th November, 191G. To the Chairman and Members of the Children's Care Committee. Economic Circumstances in relation to the Provision of School Meals. Further Report. In my report of the 18th September last I stated as follows:— 110 Clothing. "From information supplied the cost per annum for a child of ten is at present not less than 30s.—or approximately 7d. per week." Since that date I have obtained further information as to the cost per annum of the clothing of children who are now on the feeding list as follows:- £ s. d. Boy aged 10 3 7 7 „ „ 11 4 15 9 „ „ 11 3 1 8½ „ ,, 10 2 12 5½ „ „ 11 2 6 4½ „ ,, 11 3 14 7½ „ ,, 8 2 5 6½ „ „ 12 3 4 9½ ,, ,, 7 3 0 8½ „ ,, 11 2 11 7½ „ ,, 12 5 13 11 „ ,, 12 3 7 3½ Girl aged 10 2 17 1½ „ ,, 10 3 0 3 „ „ 9 1 14 3¾ „ „ 11 3 10 4 „ „ 12 3 9 6½ „ ,, 10 1 18 11½ „ „ 10 3 15 10½ „ ,, 11 3 5 6½ „ ,, 11 2 13 7¾ „ „ 9 2 18 7½ „ ,, 12 5 2 5½ „ ,, 12 4 4 6 Total £78 13 5¾ Average—£3 5s. G¾d. per annum. Average—1s. 3d. per week. 111 Food. In August, 1916, the average cost per meal for food only was 2.85d. On this basis the total quantity of food required for a child aged ten years costs approximately 3s. 4d. per week. During the past 8 weeks ending 11th November, 1916, the average cost per meal for the same meals has been 3.04d., thus raising the cost of feeding a child of ten years to 3s. 6d. per week. Having regard to the foregoing facts and to my previous report of the 18th September last, it will be seen that the cost of upkeep of a child of ten years, exclusive of rent and insurance is as follows:— s. d. Food 3 6 Lighting and Fuel 0 7 Clothing 1 3 Sundries 0 3 Total 5 7 Scale Suggested. I would therefore suggest that the scale suggested in my report of September 18th last be amended as follows:— If No. in family is 2 scale should be 8/- instead of 6/-. „ „ „ 3 ,, ,, 6/6 ,, 5/-. „ „ ,, 4 ,, ,, 6/- ,, 4/6. „ „ „ 5 „ „ 5/6 „ 4/3. „ „ „ 6 ,, ,, 5/- ,, 4/-. This increases the scale previously suggested by 2s. per head in the case of a family of 2 gradually falling to 1s. per head in the case of a family of 6 or more. 112 When the relief afforded by school meals is added to the scale now recommended the total economic circumstances per head of the family approximates the sum of 5s. 7d., required thus:— No. in family as defined. Probable No. fed. Economic circumstances per week per head as per suggested scale. Total. Relief from meals at 3d per meal per day. Total and relief from meals. Total economic circumstances per week per head. 2 1 8/- 16/- 1/3 17/3 8/7 3 2 6/6 19/6 2/6 22/- 7/4 4 2 6/- 24/- 2/6 26/6 6/7 5 3 5/6 27/6 3/9 31/3 6/3 6 4 5/- 3% 5/- 35/- 5/10 7 5 5/- 35/- 6/3 41/3 5/11 8 5 5/- 40/- 6/3 46/3 5/9 9 5 5/- 45/- 6/3 51/3 5/3 10 5 5/- 50/- 6/3 56/3 5/7 I am, your obedient Servant, GEORGE F. BUCHAN, Medical Officer. APPENDIX H. 23rd November, 1916. To the Members of the Children's Care Committee. Report on the Treatment of School Children. Supplementary to Reports on- (a) Treatment of Ringworm. (b) Treatment of Teeth, dated 19th October, 1914. 113 At the present time the care of the child, apart from the immediate issue of the war, is the most important problem that the nation has to solve. In October, 1914, I reported on the steps which should be taken to complete the treatment of school children in this area, and estimated the cost, etc., as follows:— Minor Ailments. No. of Cases. Capital Charges Annual Charges £ £ £ Treatment of Minor Ailments 6350 160 1314 Operative Treatment of Adenoids and Enlarged Tonsils *3000 **546 Dental Treatment cumulative 140 520 * Includes provision of six Hospital beds, with necessary equipment for operations, etc. ** Includes upkeep of Hospital beds, including repayment of Capital Charges, etc. At that time action was deferred. It would now seem to be necessary to take some steps in the direction indicated for the following reasons:— (а) The national crisis, with its loss of adult life, and the consequent need for taking care of young life. (b) The loss of grant to the School Medical Service, 45 per cent. being awarded instead of 50 per cent., 5 per cent being deducted as stated in the Board's letter to the Authority of the 11th May, 1915, for the following reasons:— 1. During the greater part of the year in question the part-time system of Medical Inspection was in operation, as the whole-time Assistant Medical Officers did not take up their duties until March, 1914. 114 2. There was inadequate provision for co-ordina- tion between the work of the School Medical Department and that of the School Attendance Department. 3. The provision during the year in question for following up cases of defect found on Medical Inspection was not systematic. 4. No provision was made during the year in questiion for a further examination of defects of vision. 5. No provision was made during the year in question for the treatment of dental defeats 6. No provision was made during the year in question for the treatment of adenoids and enlarged tonsils. 7. No provision was made during the year in question for the treatment of minor ailments with the exception of Ringworm. (c) The present continuous overcrowding at the Eye Clinic. The Eye Clinic has been opened on 34 occasions between the 12th of September, 1916, and the 21st November, 1916, on each occasion for two hours, two doctors being in attendance; i.e., the equivalent of 136 hours of a doctor's time. During this period 327 new cases, each requiring on the average at least a quarter of an hour of a doctor's time, have passed through the Clinic, thus occupying 81¾ hours of the 136 allotted, and leaving 54¼ hours to deal with 1,319 attendances made by other cases, or an average of 2½ minutes per case. It is not possible to do justice to eye cases at this rate. 115 Having regard, therefore, to all the foregoing circumstances, I am of opinion that the time has come when it is desirable to earmark a sum of £1,500 to be provided in next year's estimate for the completion of the treatment of school children, i.e., the treatment of minor ailments, dental treat' ment, and the operative treatment of adenoids and enlarged tonsils, and the relief of the congestion at the Eye Clinic as far as this sum will go. Half of this amount, that is £750, would be repayable by the Board of Education. I am, your obedient Servant, GEORGE F. BUCHAN, Medical Officer. APPENDIX I. 4th December, 1916. To the Chairman and Members of the Hospital Committee. MATERNITY AND CHILD WELFARE. Hospital Treatment. The Council, at its Meeting on the 7th November, 1916, passed the following report of the Public Health Committee:— "The Medical Officer submitted a circular issued by the Local Government Board, with regard to Maternity and Child Welfare, and has been instructed by your Committee to report fully to them at their next Meeting, the measures which should be taken in Willesden in connection therewith." In accordance with these instructions I beg to report on Hospital Treatment, referred to in Clause 20 of the Circular above mentioned. 116 Conditions requiring Hospital Treatment. These may be classified as follows:— (a) Abnormal or diseased conditions occurring in the child; and (b) Abnormal or diseased condition occurring in the Mother. Abnormal or Diseased Conditions occuring in the Child. With regard to these conditions hospital beds are necessary in respect of:— 1. Malnutrition—Atrophy, Debility, Marasmus. 2. Diarrhoea, Enteritis. 3. Pneumonia, Bronchitis. 4. Measles. 5. Whooping Cough. Malnutrition—Atrophy, Debility, Marasmus, Diarrhoea, En- teritis, Pneumonia, Bronchitis. During the ten-year period, 1906-15, 3,253 children under 5 died from these diseases, including malformations and premature birth. A considerable reduction in the number of deaths, and a still greater reduction in future adult inefficiency, can be accomplished by the provision of hospital beds for these conditions. The Maternity and Child Clinic provides the means for the early recognition of any departure from normal health and must be supported by the means to prevent this developing into disease or permanent defect. Hospital beds are essential to this end, and some of the existing accommodation at the Council's Hospital at Dog Lane is available for the purpose. 117 Measles, Whooping Cough. At the present time it is not possible to utilise any of the existing pavilions at the Council's Hospital at Dog Lane, for cases of these diseases on account of the inadequacy ot the provision for isolation. It should be noted, however, that the number of deaths from Measles and Whooping Cough during the ten-year period 1906-1915, has been 836, as compared with 236 deaths from Scarlet Fever and Diphtheria during the same period. The problem of hospital provision is therefore urgent, especially as a good recovery from Measles and Whooping Cough is mainly dependent on skilled nursing, proper feeding and good hygenic conditions. Abnormal or Diseased Conditions occurring in the Mother. In connection with these conditions, it is likewise necessary to provide hospital beds for a certain number of cases requiring special care, constant medical supervision, or operative treatment. The cases for which accommodation would especially have to be provided are as follows : 1. Ante-Natal.—Complications occurring during nancy; e.g., Persistent Vomiting, Albuminuria, Eclampsia, Haemorrhage, Varicose Veins. 2. Natal.—The confinement of sick women; cases of Contracted Pelvis, Eclampsia, Haemorrhage, Placenta praevia, or any other condition involving danger to the mother or child. 3. Post Natal.—Adherent Plaaenta, Adherent branes, Haemorrhage Phlegmasia alba dolens Thrombosis, Puerperal Fever, Ruptured Perineum. Hospital Beds Available. Excluding Measles and Whooping Cough, Pavilion "B" can be adapted for the conditions mentioned above, giving 118 (a) 5 beds and 5 cots in one of the wards for cases of pregnancy; (b) 1 bed in the existing Duty Room to be converted into a Labour Wiard. (c) 4 beds in one of the other wards for septic cases, such as puerperal fever or ophthalmia neonatorum. (d) 1 ward to be fitted for operations. (e) The remaining ward to provide two beds and seven cots, to be utilised for children suffering from Malnutrition—Atrophy, Debility, Marasmus; Diarrhoea, Enteritis; Pneumonia and Bronchitis. This would involve certain alterations in Pavilion "B" as follows:— 1. The installation of electric light. 2. The replacing of the existing fire grates with modern fire grates. 3. The fixing of a sink and lavatory basin in the Duty Room to be used as a Labour Ward. 4. The fixing of 1 sink and 2 lavatory basins in the ward to be used for operations. 5. The converting of the door on the west side of one of the wards into a window. 6. The blocking up of the door on the west side of the Duty Room, the removal of dresser to west side, and the cutting of a door on the east side. 7. The cutting of a door on to the verandah on the East side from one of the wards. 8. The glazing of the windows in Labour Room, and ward for operations, with muranese, or similar glass in lower half. 9. The removal of the existing sanitary annexes. 119 10. The building of a sanitary annexe on the East side, so as to provide for W.C., sluice closet, two lavatory basins, a linen store with fire place, bathroom, and food pantry on the East side. 11. The extension of the verandah along the whole of the East side of the Pavilion. Nursing Staff. The Sister and Staff Nurses in these wards would require to be fully trained general nurses with a mid-wifery qualification. Cost. The following table gives particulars of the cost of maintenance of patients at the Council's Hospital, Dog Lane, during the three years ended March 31st, 1915, with approximations for the year ended 31st March, 1916, and the half-year ended 30th September, 1916. Actual Figures. Year ended 31st March. Approximations. 1913. 1914. 1915. Year ended 31st March, 1916. Halt year ended 30th Sept. 1916. Average number of beds in occupation daily during year 64.3 78.1 96.8 82.3 63.4 Total expenditure excluding re-pay ment of loans £9517 £9866 £10642 £11137 £5320 Cost per annum per occupied bed £148 £126 £110 £135 £168 Cost per day per occupied bed 8/1 6/11 6/- 7/5 9/2 120 Taking the 4 completed years, 1913-16, above given, it will be observed that the average number of beds in occupation daily during each year was 64.3, 78.1, 96.8 and 82.3 respectively, or 80.4 on the average, say 80. Pavilion "B" provides 2 beds and these will be nearly constantly occupied, say a daily average of 20. This will raise the daily number of occupied beds by 20, making 100 on the basis of the four years' average, 1913-16. The cost per occupied bed diminishes as the number of occupied beds increases, and but for the increased cost of commodities and labour, the rate of 6s. per day per bed for 1915, when 96.8 patients were in daily occupation would be reduced. But the prices have gone up since 1915 during which year pre-war contracts were operative, as will be seen by a comparison of 1916 with 1914 and the Summer halfyear ended 30th September, 1916, with the whole year ended 31st March, 1913, the number of patients being approximately the same for the periods compared. The year 1916 exceeds 1914 by 6d. per patient per day, and the Summer half-year ended 30th September, 1916, exceeds 1913 bv 1s. 1d. per patient per day, in spite of various economies effected. In addition, the patients occupying "B" generally will require more nursing and medical attention than cases of Scarlet Fever or Diphtheria, as a number of them are children under 5, who will be either spoon or bottle fed, and maternity cases from time to time will want special attention. Having regard to these facts, and to the continued increase in prices at the present time, the cost per day per occupied bed may be estimated at 8s. during the next financial year. This means that the estimated annual cost 121 of maintenance of Pavilion "B" occupied as above would be £2,920, half of which would be repayable by the Local Government Board. Recommendation. Having regard to the alterations, Pavilion "B" would not likely be ready for occupation until 1st July, 1917, and I would therefore recommend the Committee to provide in their next year's estimate for the following:— (1) Estimated cost of Maintenance of Pavilion "B" for 9 months *£2,000 (2) Cost of Alterations to Pavilion "B" as outlined above *Estimate to be obtained. *Half of both these sums would be repayable by the Local Government Board. Accommodation Generally. 1. Patients. Pavilion "B" is at present used for doubtful or complicated cases of Scarlet Fever or Diphtheria. Pavilion "C" has practically not been used at all during the past two years, mainly because the number of patients has been low, but also because the Pavilion is cold and comfortless in the winter months, when epidemics of Scarlet Fever prevail, and ill-suited on that account to receive patients. Having adapted "B" as above, it will be necessary to utilise "C" and for this purpose the following alterations are required:— (a) The installation of steam radiators. (b) The installation of electric light. (c) The provision of a new sink in the kitchen. (d) Increased shelving for storage of food. (e) A re-arrangement of the bath and lavatory basins. 122 2. Staff.—The following- alterations and re-arrangements are necessary to accommodate the additional staff required. (a) The use of the gate-keeper's lodge for this purpose. (b) The removal of the stores room and Steward's Office to the disused Porter's quarters. (c) The conversion of the present Stores rooms and Steward's Office into bedrooms. The above matters would come under general repairs to the Hospital, and a sum to cover these should be included in next year's estimates. I am, your obedient Servant, GEORGE F. BUCHAN, Medical Officer. APPENDIX J. 5th December, 1916. To the Chairman and Members of the Health Committee. MATERNITY AND CHILD WELFARE. Certain Provisions, Home Visiting, and Treatment, excluding Hospital Treatment. The Council at its Meeting on the 7th November, 1916, passed the following Report of the Public Health Committee:— "The Medical Officer submitted a Circular issued by the Local Government Board with regard to Maternity and Child Welfare, and has been instructed by your Committee to report fully to them at their next meeting the measures which should be taken in Willesden in connection therewith." 123 In accordance with these- instructions I beg to report as follows:— Inspection of Midwives. In Willesden at the present time there are 24 midwives in practice, and these are under the control and supervision of the Middlesex County Council. The Local Government Board think that there is advantage in the inspection of midwives being in the hands of the authority which is working the Maternity Scheme, and County Councils may delegate their powers under the Midwives Act, 1902, to the Councils of County districts. I am of opinion that application should be made to the Middlesex County Council for the delegation of their powers under Section 9 of the Midwives Act, 1902, to the Willesden District Council in order that the scheme of the latter for the care of mothers and children may be properly co-ordinated as regards both the work of the Midwife and Health Visitor in respect of the following:— I. Home Visitation.—At the present time births are not visited until at least 10 days after confinement when the midwife has ceased visiting. Earlier visitation would have the following advantages:— (a) The mother would be still in bed when the Health Visitor called and would have time to talk over matters relating to the child. (b) There would be greater possibility of securing breast feeding. (c) Cases of Ophthalmia Neonatorum would come under observation at an earlier date and receive the early treatment necessary to prevent total or partial blindness, of which this disease is the main cause. 124 (d) The supervision of the work of the midwife would be more effective. (e) The Health Visitor and Midwife would meet before the latter ceased attending the case. Any abnormal condition arising from the confinement, either in the mother or child, would be explained and could be closely followed up by subsequent visits paid by the Health Visitor. II. Maternity Clinic.—This Clinic is now established in Willesden and co-operation between midwives and the staff- of the Clinic would be of the greatest benefit to mothers. Expectant mothers will attend this Clinic for some time prior to confinement and the Medical Officer in attendance at the Clinic will be in a position to give valuable information to the midwife as to abnormal symptoms or possible complications likely to arise during confinement. Midwives should also be encouraged to take advantage of the Clinic by advising expectant mothers to attend and remain under observation up to the time of confinement, knowing that they will be informed of any condition likely to complicate labour. Health Visitors. The Board regard the provision of adequate home visiting as the most important element in any scheme of Maternity and Child Welfare, and consider that the Health Visiting Staff should be equivalent to one Health Visitor for each 500 births. In Willesden there are roughly 4,000 births per annum, and a staff of 8 Health Visitors would consequently be required. 125 At the present time only 3.6 Health Visitors are employed on home visitation of mothers and infants. The Board are further of opinion that the visiting of children should be extended to include all children under five years of age. The total number of children in Willesden under this age is approximately 18,000. The Board also suggest that the visiting of expectant mothers at their homes should be undertaken when necessary, and that cases of Measles, Whooping Cough and Diarrhcea occurring in young children should be visited. In respect of Measles the Board consider it desirable that nurses should be available for young children suffering from this condition and in need of skilled assistance. Provision of Midwifery. The Board state that they are anxious to secure that there should be an efficient midwifery service throughout the country so that all women may be able to obtain the services of a competent midwife for their confinement. At the present time some women do not obtain the services of a midwife because they cannot afford to pay her fee. The Board's grant is available in respect of paying half that portion of the fee which is not paid by the patient, but the Board require to be satisfied that all steps have been taken for investigating the circumstances of such cases and generally require to approve the conditions under which the services of a competent midwife are provided gratuitously or at less than the ordinary fee. Provision of Doctors. The Board will similarly make a grant of half the fee paid to a doctor called in by a midwife, under a scheme and scale of fees to be approved by the Board. 126 Provision of Maternity Nurses. The Board's grant is available in aid of arrangements approved by the Board for providing the services of a properly qualified Maternity Nurse where the assistance is needed and where the woman cannot afford to pay for it. Centres and Medical Attendance at Centres. These should provide medical supervision, advice and treatment for expectant and nursing mothers and for infants and children under five years of age as may be required. Cost. All the foregoing provisions are of the highest importance in connection with the general schemes adopted or in process of formation for the care of young life at the present time, and I am of opinion that effective action could be taken under the foregoing headings in Willesden during next financial year at an estimated additional cost of £1,600, half of which would be repayable by the Local Government Board. Committees. The establishment of a Committee in connection with this work is suggested by the Local Government Board Circular, and its possible composition indicated. At the present time there are under the Willesden District Council a Health Committee, and under the Education Committee, a Children's Care Committee dealing with the main problems of child life, and other Committees under the Council, Education Committee and other bodies dealing with problems co-relative thereto. Before considering the formation of a further principal Committee, it seems to me desirable to consider the question of consolidating existing Committees as far as may be possible ; and I would urge upon this Committee and the Council the exceeding importance at the present time of consolidating 127 all administration, and particularly administration relative to health and the care of the child, having regard to the need for economy and the importance of the problem. Recommendations. 1. That application be made to the Middlesex County Council for the delegation of their powers under Section 9 of the Midwives Act, 1902, to the Willesden District Council. 2. That an additional sum of £1,600 (half of which is repayable by grant) be provided in the estimate for the financial year ending 31st March, 1918, to deal as far as this sum will go with the items above mentioned, namely:— (a) Home Visitation. (b) The provision of a Midwife for necessitous women in confinement as may be required. (c) The provision of a Doctor for the aid in ment of necessitous women as may be required. (d) The provision of Maternity Nurses as may be required. (e) Provision of medical supervision, advice and ment for expectant and nursing mothers, and for infants and children under five years of age, as may be required. I am, your obedient Servant, GEORGE F. BUCHAN, Medical Officer. APPENDIX K. GRANTS IN AID. I.—Maternity and Child Welfare (Local Government Board). Summary of expenditure incurred during the 12 months ended the 31st March, 1916, in respect of Maternity and Child Welfare Work:— 128 £ s. d. (a) Salaries of:— (1) Medical officers 55 8 2 (2) Superintendents of Midwives - (3) Maternity and Infant Health Visitors 167 8 10 (4) Other Officers (clerical assistance) 5- 10 0 Included (b) Allowance to officers for uniform with Salaries. (c) Travelling Expenses of Officers 8 12 6 (d) Payments to midwives, nurses or doctors for the aid in confinement of necessitous women — (e) Drugs and other medical requisites supplied at Centres 5 7 4 (f) Furniture and equipment 0 15 3 (g) Rent, rates and taxes 9 15 0 (h) Heating, lighting and cleaning 1 12 0 (i) Hospital Provision— (i.) Directly by the Council — (ii.) By agreement with another local authority — (iii.) By agreement with a voluntary hospital — (j) Printing, stationery, postage, etc 26 6 6 (R) Other items of expenditure incurred (specifying them)— Registrar's Returns 38 8 4 Repairs 1 12 10 Glaxo 129 6 10 Carried forward 450 3 7 129 £ s. d. Brought forward 450 3 7 Tea, milk, sugar, etc 1 13 3 Conveyance of children to and from Centres 0 3 0 Preparation of lease and licence for Maternity and Child Welfare Centre, 9, Willesden Lane 4 4 0 Sundries and contingencies 2 18 1 Municipal offices—Provision of premises, including repayment of loans, initial expenditure on buildings, furniture, etc 14 0 0 Maintenance of premises— Rent rates, taxes, heating, lighting, cleaning 18 0 0 Total 491 1 11 Deduct receipts, if any, specifying their sources. Sale of Glaxo (patent food) 120 5 8 Total receipts 120 5 8 Net expenditure incurred £370 16 3 For the purposes of Grant the Board have deducted the sums spent on the provision of Glaxo (£129 6s. 10d.), teas (£1 13s. 3d.), less the receipts for the sale of Glaxo (£120 5s. 8d.). They have also deducted £38 8s. 4d. in respect of registrar's returns, £32 in respect of accommodation provided at the Municipal Offices, and the sum of £5 10s. 0d. in respect of clerical assistance. The Board have made a grant of £142 1s. 9d., or 50 per cent, of the remaining expenditure. Certain items are still under discussion with the Board. 130 In connection with the application for Grant for the year ending 31st March, 1915, a further sum of £4 16s. 0d. was subsequently allowed by the Board. II.—School Medical Service (Board of Education). Summary of payments made during the year ending 31st March:— 1. Salaries— 1915 1916 £ s. d. £ s. d. (a) Salary of School Mcdical Officer 89 15 1 148 0 0 (b) Salaries of Assistant School Medical Officers 424 13 10 1,178 8 11 (c) Salaries of Specialist Officers (e.g., Ophthalmic Surgeon, Dental Surgeon), Specialist, X-ray Clinic 140 4 2 150 6 7 (d) Salaries of School Nurses 447 17 10 935 16 0 (e) Clerical assistance 315 0 1 732 2 3 2. Travelling expenses 126 11 5 128 1 2 3. Printing, stationery, postage, etc. 267 2 8 257 2 4 4. Drugs, materials, etc 36 5 7 61 17 11 5. Apparatus (e.g., weighing ines, ophthalmascopic, dental, X-ray apparatus) 95 7 3 42 7 9 6. Provision of spectacles 80 0 11 63 1 9 7. Contributions to external bodies (e.g., Hospitals, Infirmaries, Nursing Associations — — 8. Cost of conveyance of children to centres for examination or treatment 0 7 0 — 9. Provision of premises, including payments in respect of loans 118 1 9 134 12 7 Carried forward 2,141 7 7 3,831 17 3 131 Brought forward 2,141 7 7 3,831 17 3 10. Maintenance of premises (e.g., rent, rates, heating, lighting, cleaning, upkeep of furniture 146 19 0 320 2 0 11 Any expenditure not included in 1—10 above 7 11 3 14 9 2 Total 2,295 17 10 4,166 8 5 Total amount paid by, or recovered from, parents 117 9 3156 Net Total £2,294 0 1 £4,162 12 11 For the year 1915 the whole of the items included under that year with the exception of £39 15s. Id. were taken into account by the Board of Education, and a grant of £1,014 8s. 3d. assessed at the rate of 45 per cent, of the expenditure was made. The £39 15s. Id., part of the School Medical Officer's salary, was not allowed as repayment. Half of this amount had been ojj^ained from other sources. In respect of the application for grant for the year ending 31st March, 1916, the Board deducted £40 10s. 10d., and paid a grant of £1,854 18s. lid., or at the rate of 45 per cent, of the remaining expenditure. The 5 per cent, deduction may be assumed to be for the same reasons as those stated in the Board's letter of 11th May, 1915, and quoted in mv Annual Report for 1915. III..—Provision of Meals (Board of Education). Summary of payments actually made and sums actually received within the period from the 1st April, 1915, to the 31st March, 1916, in respect of the provision of meals for children in Public Elementary Schools:— 132 1. Payments— £ s. d. (1) Purchase of food 1,202 1 5 (2) Salaries and wages 956 6 11 (3) Provision of premises — (4) Maintenance of premises (e.g., heating, lighting, cleaning, rent, rates, taxes) 364 18 10 (5) Furniture and equipment— (a) Initial equipment of new premises 51 12 1 (b) Annual repairs, replacements, etc. 48 19 3 (6) Printing, stationery, postage, etc. 27 4 6 (7) Conveyance of children — (8) Carriage of food, etc — (9) Any expenditure not included in (1)—(8) above 57 15 1 2,708 18 1 Less meals supplied to children attending Special Schools 237 6 3 Total £2,471 11 10 2. Receipts— Amount piad or recovered from parents 44 7 3 Amount received from voluntary contributions — Miscellaneous receipts ... — Total 44 7 3 Net total expenditure £2,427 4 7 Total number of .meals provided: Dinners, 119,632; other meals, 1,009; Total, 120,641. 133 Average total cost per meal: Dinners, 4.861d.; other meals, Id. Average cost per meal for food only: Dinners, 2.174d.; other meals, Id. Charge fixed under Section 2 of the Act of 1906 for each meal: 2d., increased from 25.10.15 to 3d. Number of children whose meals were paid for by their parents—(a) wholly 110, partly 6. The Board have deducted from the Authority's claim a sum of £20 from the item of £27 for Motor Conveyance for payment of wages at Centres, as they are not satisfied that this expenditure was reasonably economical. They have also deducted from the Authority's claim the sum of £140, being the allocated rent of the Leopold Road, Gibbons Road, and Furness Road Council Schools. The Board have decided to pay a grant amounting to £1,133 12s. 3d., equal to 50 per cent, of the remaining expenditure. 134 APPENDIX L. Staff on Military Duty—Health Department. Staff on War Service. Temporary Staff appointed. Name. Date commenced War Service. Name. Date commenced duty for Council. Date ceasing duty lor Council. Assistant Medical Officers— Dr. J. MacMillan 22- 9-14 Dr. T. S. McIntosh* 28- 9-14 15- 4-15 *Dr. McIntosh left for War service. „ Edith Shannon 15- 4-15 ,, G. R. Bruce 1-10.I4 ,, Estelle Atkinson 1-10-14 ,, I. D. Eaton 16-10-15 ,, Margaret Mason 23-10-16 Specialist Officers— Dr. Haldin Davist† 29- 8-14 Dr. H. MacCormac 29-8.14 16- 1-15 †Dr. Davis resumed duty for Council 25-1-15. „ Hogg 23- 1-15 23 1-15 Mr. Oliver 31- 8-14 Mr. Hine 2-10-14 15- 7-16 ,, Eadie 19- 9-16 Sanitarylnspectors— A. W. Loughlin ‡ 13- 3-15 ‡Died 23-7-16 on Active service in India. A. A. Waterhouse* 28-10-15 P. Rees 28-10-15 *Discharged from Army 21-9-16, Resumed duty for Council 22-9-16. Health Visitors Miss K. E. Baker (temporary) 28-10-14 Miss H. M. Bevis* 2-11-14 2- 6-15 *Miss Bevis left for War service ,, H. G. Lenanton‡ 7-11-14 ,, O. Andrews 9-11-14 23-10-15 ‡Miss Lenanton returned to duty 25-1-15. ,, C. Johnston 27- 1-15 ,, E. Dixon 5- 4-15 4-12-15 ,, E. A. Bramall 21-10-15 ,, D. E. Turner 25- 5-15 13-11-15 ,, E. M. Carter 24-11-15 Mrs. E. A. Crawley 26- 5-15 17- 7-15 Miss H. Dean 4- 6-15 18- 3-16 ,, K. Cotton§ 19-10-15 4-12-15 §Miss Cotton returned to duty on 5-1-16. ,, N. Lewis 20-10-15 4-12-15 „ V. Phillips* 23-11-14 17- 1-16 ,, E. Harris 7- 6-16 *Resumed duty for C 0 u n c i 1 17-7-16. ,, E. S. Supple 1-10-16 ,, G. Anthony 9-10-16 ,, M. L.Dawson 1-10-16 Clerks— F. H. Amor 19- 9-14 Miss L. V. Timms 30- 9-14 A. A. Gibb 23- 9-14 ,, D. Brycesonf‡ 30- 9-14 8- 2-16 †Resumed duty for Council 1 -11 -16. L.J.White 23- 9-14 Mr. G. A. Bagwell 30- 9-14 4-12-15 S. E. Windsor 10-11-14 Miss fC. Lloyd 16-11-14 15- 1-16 L. H. Sommers 10-11-14 Mr. H. T. Woods 18-11-14 L. T. James 19-11-15 Miss E. Deeks 13- 6-15 A. Paterson 29-10-15 Mrs. E. Hearn 12- 1-16 H. G. Andrews 29-10-15 Miss M. Chandler 15- 2-16 F. H. Webster 26- 8-16 ,, E. H.Holloway 27-10-16 ,, G.Wainwright 6-11-16 Staff on War Service. Temporary Staff Appointed. Name. Date commencing War Service. Name. Date commencing duty for Council. Date ceasing duty for Council. Motor Drivers— G. Domone 1- 9-14 W. Stanley 14- 9-14 7- 8-16 H. Mitchell 25- 1-15 J. Dean 4- 4-15 26-11-15 *Deceased 10-4-16 W. Cleaver 22-10-15 Miss Marston 13-12-15 E. Johnson 1-11-15 A. Dumbleton* 10-11-15 H. Stanley 3O-10-14 G. Yokes 23- 6-15 L. Williams 13- 3-16 L. Simonds 24- 7-16 G. Minter 26- 7-16 Labourer— J. Watkinson 14- 7-15 4 Isolation Hospital. Medical Supt.— Dr.W.J.J. Stewart 1-12-14 Dr. George F. Buchan 1-12-14 Asst. Medical Supt. Dr. A. Romanes 6- 6-15 Dr. A. R. H. Greig - 3-15 3- 3-16 Matron— Miss K. Keen 1-12-14 Miss M. Morley 1-12-14 Stoker — G. Bourne† 30- 8-14 H. Vincett 5-12-14 11-10-14 †Killed in action 1-6-16 J. Love 30- 8-14 Porter— E. Delderfield 20- 3-15 Wm. Champneys 15- 7-15 Laundry Porter— C. E. Turner 4- 5-14 C. A. Goodwin 5- 7-15 Gate Porter— J. Stewart 28- 9-14 E. Phipp 25- 9-14 18 -5-15 C. A. Goodwin 8- 5-16 A. Blachford 21- 5-15 7- 5-16 Engineer— C. Chantry 11-10-14 J. Love 12-10-14 4-12-15 135 . 137 INDEX. Page Acts, Regulations, etc., issued by L.G.B 94 Administration 31 Ailing children, defects found in 65 Bacteriological Work 82 Births and Birth Rates 59, 60 Births, Illegitimate 61 Blind Children 74 Building up the body to resist attacks of disease 6 Canal Boats Acts, 1877 and 1884 40 Cerebro-Spinal Meningitis 25, 81 Clinic 11, 72 Council, Willesden Urban District, Members of, 1916-17 3 Data, Certain Statistical 34, 64 Deaf Children 75 Deaths and Death Rates 62 Defects, nature and number of, amongst school children 68-71 Diminishing the risk of catching diseases 22 Diphtheria and Membranous Croup 49 ,, Case mortality and day of admission 81 ,, Chief complications of 81 Economic circumstances and School Meals 7, 105, 109 Education Committee, Willesden, Members of, 1916-17 4 Education on Health 13 138 Page Enteric Fever 52 Environment, improving 26 Epileptic Children in Institutions 76 Exceptional Children 73 Factories, Workshops, Laundries, Work Places, and Home Work 42-44 Feeble-minded Children at Residential Institutions 76 Feeding of Expectant and Nursing Mothers and Young Children 9 Feeding of School Children 6 Food Supply—Protection of the 23 Home Helps 29 Hospital—Isolation 26 ,, Patients under treatment at 80 Houses unfit for human habitation 40, 41 Infant Death enquiries 58 Infant Mortality—Rates since 1875 55 ,, ,, Wards 56 ,, ,, Legitimate 56 ,, ,, Illegitimate 57 Infectious Diseases 25 ,, ,, Notifications of 45 ,, ,, Death Rates from 54 Local Government Board Tables— Table 1—Population, Births and Deaths since 1911—District ... 84 ,, la—Population, Births and Deaths in Wards 85 139 Table II—Infectious Diseases 87 Military Cases not included in Table II 88 ,, III—Causes of Death (Short Classification Table 89 ,, 11la—Causes of Deaths—in Wards 91 ,, IV—Infant Mortality under 1 year of age—Causes of Deaths 92 ,, IVa—Infant Mortality under 1 year of age—Causes of Deaths—in Wards 93 Marriages 58 Maternity and Child Clinic 11 Maternity and Child Welfare—Certain provisions, home visiting and treatment, excluding Hospital Treatment 122 Maternity and Child Welfare—Grant in aid 127 ,, ,, ,, ,, HospitaJ Treatment 115 ,, ,, ,, ,, Medical work at present undertaken 94 Measles 53 Medical Inspection of School Children 10 Medical Treatment of School Children 10 Mentally Defective Schools, Leinster Road and Leopold Road 30 Milk Supply, Protection of the 28 Mothercraft 15 Motor Service 101 Multiple Cases of Scarlet Fever 48 140 .Page Notification of Births Acts, 1907 and 1915 57, 58 Nursery for Children of Munition Workers, Day and Night 28, 97 Open Air School 28 Opthalmia Neonatorum 20 Physically Defective School, Furness Road 31 Physically Defective Children at Furness Road Physically Defective School 77 Physically Defective Children in Institutions 77 Population 35 Population estimated at Midsummer 36 Provision of Meals, Grant in aid 131 Removal of House Refuse 37-39 Return Cases of Scarlet Fever 47, 48 Scarlet Fever 46 ,, ,, Chief complications of 80 School Children—Treatment of 112 School Clinics 11, 72 School for Mothers 13 School Medical Service, Grant in aid 130 Searching for disease in its early stages and curing it quickly 9 Separation Allowances for London and School Meals 8 Small Pox 50 Special cases referred 66 Spectacles, Provision of 72 Staff on Military Duty 134, 135 Tuberculosis 53 Tuberculous Cattle, Suspected 24 Vaccination Statistics 51 141 Page Venereal Diseases 16 Verminous Children, Cleansing of 29 Vital Statistics 27 Voluntary Agencies 12 APPENDICES. Appendix Page A — Local Government Board Tables 84-93 B — Acts, Circulars, Regulations and Orders issued by the Local Goverment Board 94 C — Maternity and Child Welfare—Medical Work at present undertaken 94-97 D — Day and Night Nursery for Children of Munition Workers 97-101 E — Motor Service 101-105 F — Economic circumstances in relation to the Provision of School Meals 105-109 G — Economic circumstances in relation to the Provision of School Meals—further report 109-112 H—Treatment of School Children 112-115 1 — Maternity and Child Welfare—Hospital Treatment 115-122 J — Maternity and Child Welfare—Certain provisions, home visiting and treatment excluding Hospital Treatment 122-127 K — Grants in aid (1) Maternity and Child Welfare 127-130 (2) School Medical Service 130-131 (3) Provision of Meals 131-133 1. — Staff on Military Duty 134-135 . . *