C.I WIL 18 AC 439 (1) WILLESDEN Willesden Urban District Council. 1917. With the Compliments of the Medical Officer, Willesden. The 42nd ANNUAL Health Report. GEORGE F. BUCHAN, Medical Officer. London: Hanbury, Tomsett & Co., Printers, Kensal Rise, N.W. Wil 18 Willesden Urban District Council With the Compliments of the Medical Officer, Willesden. 1917. The 42nd ANNUAL Health Report. GEORGE F. BUCHAN, Mcdical Officer. London: Hanbury, Tomsett & Co., Printers, Kensal Rise, N.W. 3 WILLESDEN URBAN DISTRICT COUNCIL, 1917-1918. 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, Resigned 22/5/17. †*Mr. Councillor S. BOWN. Mr. Councillor H. C. BROWN. Mr. Councillor S. D. BUMSTEAD. Mr. Councillor E. T. BUTTERISS. †*Mr. Councillor J. COMBER. †*Mr. Councillor J. E. CONLON. Mr. Councillor W. J. CREAGH. Appointed 26/6/17. Mr. Councillor J. G. CRELLIN. Mr. Councillor W. H. DOBBS. Mr. Councillor A. E. DORAN. Mr. Councillor J. E. HILL, Resigned 22/5/17. Mr. Councillor W. A. HILL. Mr. Councillor G. H. HISCOCKS. *Mr. Councillor C. W. HOGG, J.P. (Chairman). Mr. Councillor II. II. GRIMWOOD, Resigned 22/5/17. Mr. Councillor E. L. E. JONES. Appointed 26/6/17. Mr. Councillor E. LANE. Mr. Councillor T. G. MATTHEWS. *Mrs. Councillor R. MOORE. Appointed 26/6/17. Mr. Councillor C. PINKHAM, j.P. *Mr. Councillor G. H. PLYMEN. †'Mr. Councillor W. RILEY, J. P. (Chairman of the Health and Hospital Committees). *Mr. Councillor H. ROGERS. Mr. Councillor W. A. SAVILLE. Mr. Councillor H. E. SCOTT. Appointed 7/3/18. Mr. Councillor G. A. SEXTON. Mr. Councillor A. SMITH. *Mr. Councillor C. E. P. TAYLOR. Mr. Councillor H. D. TURNER, Resigned 22/1/18. *Mr. Councillor W. WAY (Vice-Chairman). * Member of the Health Committee. †Member of the Hospital Committee. 4 WILLESDEN EDUCATION COMMITTEE, 1917-18. Mr. Councillor J. ANDREWS Mr. Councillor J. E. BALL. *Mr. Councillor W. BLACKLOCK (Chairman). Mr. Councillor P. BOND. Resigned 22/5/17. Mr. Councillor C. H. BOLTON, M.A., Appointed 22/6/17. *Mr. Councillor W. M. BOLTON. Mr. Councillor S. D. BUMSTEAD. *Mr. Councillor E. T. BUTTERISS. *Mr. Councillor W. J. CREAGH. Appointed 26/6/17. Mr. Councillor J. COMBER. *Mr. Councillor H. H. GRIMWOOD. Resigned 22/5/17. Mr. Councillor G. H. HISCOCKS. *Mr. Councillor J. E. HILL. Resigned 22/5/17. *Mr. Councillor W. A. HILL. *Mr. Councillor C. W. HOGG, J.P. *Mr. Councillor E. LANE. *Mrs. Councillor R. MOORE. Appointed 22/6/17. *Mr. Councillor G. H. PLYMEN. Mr. Councillor H. ROGERS. Mr. Councillor H. E. SCOTT. Mr. Councillor G. A. SEXTON. Mr. Councillor H. D. TURNER. Resigned 22/1/18. Mr. E. B. C. ARROWSMITH. Appointed 25/9/17. *Mr. J. CASH, J.P. *Mr. W. J. DOWDELL (Vice-Chairman). The Rev. E. R. FORD. Appointed 26/3/18. *Miss M. A. LUPTON. *The Rev. G. MARTIN, M. A. The Rev. H. M. RELTON. Resigned 14/8/17. *The Rev. MARTIN THORPE. (Chairman of Children's Care Committee. Mr. A. E. WARREN. *Mr. D. T. WILLIAMS. *Member of the Children's Care Committee. 5 Municipal Offices, Dyne Road, Kilburn, N.W. 1st June, 1918. To the Willesden Urban District Council— The Local Sanitary Authority. The Local Education Authority. I beg to submit herewith the 42nd Annual Health Report for Willesden for the year 1917. This Report includes:— (1) The 42nd Annual Report on the Health and Sanitary condition of the district. (2) The 10th Annual Report on the Health of Children attending the Public Elementary Schools. (3) The 26th Annual Hospital Report. The present Report has been condensed to the smallest bulk consistent with the continuity of records. The tables given have the same numbers as those containing similar information in the Annual Report of 1916. Vital Statistics. The population of Willesden estimated at mid-summer, 1917, was 169,344. The death rate during the past year has been 10'73 per 1,000 of the population, while the infant mortality rate has been 110 per 1,000 births. The birth rate has been the lowest ever recorded in Willesden, namely, 16 62 per 1,000 of the population. 6 Infectious Diseases. During the year 1917, 4,559 cases of infectious diseases were notified under acts and orders. This number exceeds by 2,046 the highest number previously on record. This large increase is due to the compulsory notification of measles, German measles and whooping cough. Municipal Hospital. 510 Cases of illness were treated in the Hospital in 1917. Included in this number are 75 cases of diseases of children under 5 years. Maternity and Child Clinic. This Clinic was opened on the 1st November, 1916 and has been in constant use during the year 1917. Its popularity has exceeded all expectations. During the year 1,153 children were entered on the books of the Clinic, 32 expectant mothers, and 137 nursing mothers. The total number of attendances recorded by mothers and children during the year was 8,440. Arrangements were made by the Clinic for the confinements of 20 necessitous women during the year. Medical Inspection and Treatment of School Children. 3,398 of the 24,312 children attending Willesden Schools were routine medically inspected during the year. 6,463 defects were noted amongst school children including defects found in the course of Medical Inspection and those specially referred by Teachers and School Attendance Officers. 5,837 of these defects were treated, 4,357 by the Staff of the Local Education Authority, 772 by Voluntary Hospitals or other charitable Institutions, 33 by the Poor Law, and 675 by private practitioners. 7 9,649 Attendances have been registered at the School Clinics during the year, 3,126 being attendances at the Inspection Clinics, 5,669 at the Eye Clinic and 854 at the Ringworm Clinic. Provision of Meals and Glaxo to Expectant and Nursing Mothers and Children under 14 years of age. The feeding of School Children has been carried on under the same conditions as hitherto. Appendix I iii. gives certain statistical information relative thereto. The feeding of expectant and nursing mothers and chilrden under 5 years of age was begun during the week ending December 23rd, 1916, and between that date and December 29th, 1917, 3,805 meals were supplied to expectant and nursing mothers and 10,010 meals to children under five. In addition, Glaxo has been supplied free under certain conditions to expectant and nursing mothers and to children under five, between the same dates. During this period 1,409 lbs. of Glaxo have been supplied to expectant and nursing mothers and 3,352 lbs. of Glaxo to children under five. On July 6th, 1917, a new scale for the free provision of meals and Glaxo to expectant and nursing mothers and school children was adopted as follows:— No. in family. Net income per head of the family per week. 2 10/- or under 3 8/- or under 4 7/6 or under 5 6/6 or under 6 or over 6/- or under 8 Day and Night Nursery. The Day and Night Nursery for the children of Munition Workers was opened on 19th February, 1917. During the year 20,190 attendances, each of 12 hours, were registered, by the children attending. The average cost per attendance was approximately l/8½d., of which 7d. is paid by the Ministry of Munitions, 6d. by the parents and 7½d. by the Council. The demand for accommodation at the nursery varies directly with the number of women employed on munitions in the vicinity. Open Air School. The need for an open air school in Willesden is as great as ever. Unfortunately the Education Authority has been unable to proceed with the erection of a temporary open air school in one of the public parks. Other solutions, however, are under consideration by the Committee and it is hoped that at an early date a satisfactory method of dealing with the problem may be devised. Sanitary Department. House Refuse Removal.—The removal of house refuse has been an increasingly difficult problem throughout the year. The calling up of men of military age engaged on this work has made regular collection a matter of much difficulty, giving serious concern to the department. These difficulties are not likely to diminish during the period of the war. Flooding of South Kilburn.—The excessive flooding of the South Kilburn area in June, 1917, was promptly dealt with by the Health Department in conjunction with the Engineer's Department. All foul bedding was replaced by 9 the Council and all necessary cleansing of premises was carried out. 70 Families were affected and the total cost of bedding and disinfectants supplied was £137 12s. 3d. Food Control Orders.—From the 2nd July, 1917, to 31st December, 1917, the Food Control Orders, relating mainly to fixed prices, were administered by the Sanitary inspectors under the direction of the Health Committee, but a subsequent order of the Food Controller placed the administration of these orders on the Food Control Committee as from the 1st January, 1918. During the period that the orders were administered by the Health Department 126 orders were issued by the Food Controller, 1,082 shops were visited to detect infringements and 128 cautions were given. Shops Acts.—Owing to the Shops Inspectors being engaged on other work, the administration of the Shops Acts and the Employment of Children Act were placed upon the Health Department as from the 25th September, 1917. From that period to the end of the year 648 shops were visited and 75 infringements of the Shops Acts and Orders were detected. Regulations, Housing, etc.—The work of Housing and Abatement of Nuisances has been largely in abeyance during the year owing to the difficulty of securing labour and materials for the necessary remedial measures. An enormous amount of work in this direction remains to be done after the war, and is a matter to which the Health Committee will have to devote a very large amount of attention, as housing and health are indissolubly related. I am, Your obedient servant, GEORGE F. BUCHAN, Medical Officer of Health. 10 STATISTICAL INFORMATION RELATIVE TO THE 42nd ANNUAL REPORT FOR THE YEAR 1917 on the HEALTH AND SANITARY CONDITION of the URBAN DISTRICT OF WILLESDEN. POPULATION.—Table No. 1. Population estimated at Midsummer, 1917 169,344 Estimated increase since Midsummer, 1916 1,534 Natural increase, i.e., excess of births over deaths since 1916 998 11 POPULATION ESTIMATED AT MIDSUMMER, 1917.—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 or unoccupiable Percentage of empty houses exclusive of houses recently erected Percentage of empty rooms inclusive of those in. houses recently erected. Total. Wholly unoccupied. Empty Houses. 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 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 14949 1306 23 24 2 20 3 1 10334 10149 185 ... ... 5 1.76 1.79 2. Mid Kilburn 149I3 1762 35 7 ... 1 1 6 13635 13375 260 ... ... ... 1.98 1.90 3. North Kilburn 12663 2047 45 10 ... 4 2 4 17068 16574 494 ... ... ... 2.19 2.89 4. Brondesbury Park 9999 1421 7 2 2 11463 11388 75 ... ... ... .49 .65 5. Kensal Rise 14347 1895 4 13 ... 2 5 6 12514 12432 82 ... ... ... .21 .65 6. Harlesden 17603 2592 12 2 1 ... ... 1 18182 18091 91 ... ... ... .46 .50 Total Met. Drain. Area 84474 11023 126 58 3 27 11 20 83196 82009 1187 ... ... 5 1.14 1.42 Brent Drain Area. 7. Stonebridge 17938 2090 15 4 1 ... 2 1 13895 13788 107 ... ... ... .71 .77 8. Roundwood 15837 2196 8 14 5 ... 6 3 15631 15526 105 ... ... ... .36 .67 9. Church End 14302 1980 24 3 1 ... ... 2 12382 12245 137 ... ... ... 1.21 1.10 10. Willesden Green. 17047 2482 23 10 ... 1 3 6 16594 16407 187 ... ... ... .92 1.12 11. Cricklewood 19746 3766 61 10 ... 2 3 5 29288 28743 545 ... ... ... 1.61 1.86 Total Brent Drain, area 84870 12514 131 41 7 3 14 17 87790 86709 1081 ... ... ... 1.04 1.23 Total 169344 23537 257 99 10 30 25 37 170986 168718 2268 ... ... 5 1.09 1.32 12 REMOVAL OF HOUSE REFUSE. Table No. 3. Maximum number of carts employed on any one day in 1917 36 Minimum number of carts employed on any one day in 1917 3 Average number of carts employed daily in 1917 18 Maximum number of men employed on any one day in 1917 76 Minimum number of men employed on any one day in 1917 6 Total number of complaints received in 1917 1526 Percentage of complaints to total number of houses 648 Table No. 4. Quantity collected in cubic yards in 1917 72,673 Quantity collected in tons in 1917 23,569 Total cost of collection as per contract in 1917 £9,596 Number of houses occupied at Midsummer, 1917 23,537 Population at Midsummer, 1917 169,344 Refuse collected per house in 1917 in cubic yards 31 Refuse collected per head in 1917 in cubic yads 0.43 Cost per cubic yard 31.7d. Cost per house 8s. l¾d. Cost per head 13.6d. Table No. 5. Total number of loads removed in 1917 9,630 Average number of loads per day 30.7 Average cost per load 19s. 11¼d. Average load in cubic yards 7.55 13 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) 1917. January 27 7,336 272 February 24 6,912 288 March 27 7,769 288 April 25 5,923 237 May 27 5,912 219 June 26 5,604 216 July 26 5,429 209 August 26 5,450 210 September 25 4,967 199 October 27 5,910 219 November 26 6,022 232 December 28 5,439 194 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 1916. Found during 1917. Remedied during 1917. Carried forward from 1917. (a) Registration ... ... ... ... (b) Notification of change of Master ... ... ... ... (c) Certificates 1 1 2 ... (d) Marking 1 ... 1 ... (e) Overcrowding ... ... ... ... (f) Separation of sexes ... ... ... ... (g) Cleanliness ... ... ... ... (h) Ventilation ... ... ... ... (i) Painting ... ... ... ... (j) Provision of Water Cask ... ... ... ... (k) Removal of Bilge Water ... ... ... ... (l) Notification of Infectious Disease ... ... ... ... (m) Admittance of Inspector ... ... ... ... (n) Habitable Condition ... ... ... ... Totals 2 1 3 ... HOUSES UNFIT FOR HUMAN HABITATION. Tables No. 8 and 9—Omitted. 14 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) 146 24 ... Workshops (including Workshop laundries) 178 18 ... Workplaces (other than Outworkers' premises included in Part 3 of this Report) Total 39 4 ... 363 46 ... Table No. 11. DEFECTS FOUND. Particulars. Number of Defects. Number of Prosecutions. Found. Remedied. Referred toH.M. Inspector (1) (2) (3) (4) (5) Nuisances under the Public Health Acts:— Want of Cleanliness 9 8 ... ... Want of Ventilation ... ... ... ... Overcrowding ... ... ... ... Want of drainage of floors 4 4 ... ... Other Nuisances 19 19 ... ... Sanitary accommodation— Insufficient 5 5 ... ... Unsuitable or defective 27 27 ... ... Not separate for Sexes 5 5 ... ... Offences under the Factory and Workshop Act:— Illegal occupation of underground bakehouses (S. 101) ... ... ... ... Breach of special sanitary requirements for bakehouses (SS. 97 to 100) 7 7 ... ... Other offences (Excluding offences relating to out-work which are included in Part 3 of this Report). ... ... ... ... Total 76 75 ... ... 15 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. Failing to keep or permit inspection of lists. Failing to send lists. Sending twice in the Year. Sending once in the Year. Instances. Notices served. Prosecutions. Instances. Orders made, S. 110. Prosecutions, Section 109, 110. Lists. Outworkers. Lists. Outworkers. Contractors. Workmen. Contractors. Workmen. (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) (13) (14) (15) (16) Wearing Apparel— Making, &c. 11 27 27 3 ... 4 23 ... ... 3 3 ... ... ... ... Cleaning and Washing ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... Household linen ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Lace, lace curtains, and nets ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Furniture and upholstery 1 ... 1 1 1 ... 3 ... ... ... ... ... ... ... ... Umbrellas, &c. ... ... ... 1 1 ... ... ... ... ... ... ... ... ... ... Total 12 27 28 5 2 4 27 ... ... 3 3 ... ... ... ... 16 Table No. 13. REGISTERED WORKSHOPS. Workshops on the Register (s. 131) at the end of the year. Number. (1) (2). Factories 89 Factories, Laundries 42 Workshops, Laundries 17 Domestic Laundries 8 Bakehouses 57 Dressmakers 30 Outworkers 150 Blouse Makers 6 Tailors 19 Bootmakers 38 Metal Workers 5 Wood Workers 10 Seamstresses ... Motor and Cycle Makers 11 Upholsterers 7 Milliners 8 Miscellaneous 13 Total number of Workshops on Register 510 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) ... Action taken in matters referred by H.M. Inspector as remediable under the Public Health Acts, but not under the Factory and Workshop Act (s. 5)— Notified by H.M. Inspector 1 Reports (of action taken) sent to H.M. Inspector ... Other ... Underground Bakehouses (s. 101):— Certificates granted during the year ... In use at the end of the year 18 17 INFECTIOUS DISEASES.—Table No. 15. No. of Notifications of— Diphtheria 254 Erysipelas 56 Scarlet Fever 166 Enteric Fever 9 Puerperal Fever 6 Cerebro-Spinal Fever 8 Poliomyelitis 3 Ophthalmia Neonatorum 29 Measles and German Measles 3424 Pulmonary Tuberculosis 302 Other forms of Tuberculosis 64 *Whooping Cough 238 Total 4559 *Became compulsorily notifiable 1st October, 1917. SCARLET FEVER.—Table No. 16. Number of cases notified 166 Number of cases removed to Hospital 141 Percentage of cases removed to Hospital 84.9 Incidence Rate per 1,000 of population 0.98 Fatality Rate per 1,000 cases 12 RETURN CASES OF SCARLET FEVER.—Table No. 17. Number of infecting cases 2 Number of infecting cases per cent. of cases notified 1.2 Number of return cases 2 Number of return cases per cent. of cases notified 1.2 18 Table No. 18. Giving particulars of Infecting and Return Cases of Scarlet Fever during 1917. 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. H.D. 25 L.D. 28 W.J. or 30 M.J. 41 V.J. 11 60 Table No. 19. Giving particulars of multiple cases of Scarlet Fever occurring in houses in 1917. No. of Houses. Per cent. of Houses. No of Cases. Per cent. of Cases. Houses in which:— 1 case occurred 119 87.5 119 717 2 cases occurred 9 6.6 18 10.9 3 ,, 5 3.7 15 9.0 4 ,, 2 1.5 8 4.8 5 ,, 0 0 0 0 6 ,, 1 7 6 3.6 Totals 136 100.0 166 100.0 Tables Nos. 20, 21, 23. Giving particulars of cases of Diphtheria, Small Pox and Enteric Fever. Table 20. Table 21. Table 23. Diphtheria. Smallpox. Enteric Fever. No. of cases notified 254 0 9 No. of cases removed to Hospital 234 0 8 Percentage of cases removed to Hospital 92.1 0 88.8 Incidence rate per 1,000 of population 1.5 0 .05 Fatality rate per 1,000 cases 79 0 111 VACCINATION STATISTICS. Table No. 22—Omitted. 19 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 1917 2,979 36 1.21 12 993 75 3,972 Totals 17,824 208 1.17 255 21,597 45 39,421 *These figures are based on the average for the years 1907-1914. TUBERCULOSIS.—Table No. 25. Notifications received—Pulmonary 609 Other forms 92 New cases to which notifications refer—Pulmonary 302 Other forms 64 713 of the total of 2,928 cases of Tuberculosis notified in Willesden since 1909 when notification began were living' in the area at the end of the year 1917. DEATH RATES FROM CERTAIN INFECTIOUS DISEASES.—Table No. 26. Scarlet Fever 1 per 100,000 of the population. Diphtheria 12 ,, ,, ,, Enteric Fever 1 ,, ,, ,, Measles 28 ,, ,, ,, Whooping Cough 14 ,, ,, ,, 20 INFANT MORTALITY.—Table No. 27. Number of deaths of infants under 1 year from all causes 309 Number of deaths of infants under 1 year from diarrhoea and enteritis 40 Infant Mortality Rate per 1,000 births 110 INFANT MORTALITY RATE IN WARDS. Table No. 28. South Kilburn 117 Mid Kilburn 119 North Kilburn 104 Brondesbury Park 101 Kensal Rise 84 Harlesden 88 Sonebridge 154 Roundwood 122 Church End 109 Willesden Green 93 Cricklewood 93 BIRTHS AND BIRTH RATES IN WARDS. Table No. 36. No. of Births. Birth Rate per 1,000 of Population. 266 17.79 253 16.96 163 12.87 138 13.80 227 15.82 306 17.38 364 20.29 294 18.56 257 17.96 300 17.59 248 12.55 INFANT MORTALITY OF LEGITIMATE INFANTS. Table No. 29. Number of deaths of legitimate infants under 1 year 270 Infant Mortality per 1,000 legitimate births 100 INFANT MORTALITY OF ILLEGITIMATE INFANTS. Table No. 30. Number of deaths of illegitimate infants under 1 year 39 Infant Mortality per 1,000 illegitimate births 348 21 NOTIFICATION OF BIRTHS ACTS, 1907 and 1915. Table No. 31. Notified births attended by doctors 1405 Notified births attended by midwives 1146 Total 2551 Number of still births notified 59 Net number of births registered 2816 Table. No. 32. Table shewing the number of visits, re visits, and still-birth enquiries under the Notification of Births Acts, 1907 and 1915, and otherwise since 1912. Year. No. of first visits to children under 1 year of age. No. of revisits to children under 1 year of age. No. of visits and revisits to children between 1 and 5 years of age. No. of still-birth inquiries. 1912 ... 180 ... ... 1913 ... 976 ... ... 1914 ... 1,052 ... ... 1915 2,464 920 ... ... 1916 2,590 2,492 ... ... 1917 2,218 6,835 1,399 33 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 1917 309 230 MARRIAGES.—Table No. 34. Total number of marriages in Willesden 1237 Marriage Rate in Willesden per 1,000 of population 146 Marriage Rate in England and Wales per 1,000 of population 138 22 BIRTHS.—Table No. 35. Total number of births in Willesden 2816 Birth Rate in Willesden per 1,000 of population 166 Birth Rate in England and Wales per 1,000 of population 17.8 BIRTHS AND BIRTHS RATES IN WARDS. Table No. 36. Vide Table No. 28. ILLEGITIMATE BIRTHS.—Table No. 37 Number of Illegitimate Births 112 Illegitimate Births per 1,000 total births 39.77 DEATHS.—Table No. 38. Total number of deaths in Willesden 1818 Death Rate in Willesden per 1,000 of population 10.7 Death Rate in England and Wales per 1,000 of population 14.4 STATISTICAL INFORMATION RELATIVE TO THE TENTH ANNUAL REPORT FOR THE YEAR ENDING 31st DECEMBER, 1917, ON THE HEALTH OF CHILDREN ATTENDING THE PUBLIC ELEMENTARY SCHOOLS IN WILLESDEN. 24 CERTAIN STATISTICAL DATA. No. of Public Elementary Schools at December, 1917 33 No. of School Departments at December, 1917 77 No. of Children on School Rolls at December, 1917 24,312 Total No. of Children medically inspected 3,398 Total No. of Defects of every description "followed up" during 1917 6,463 Total No. of Defects of every description for which treatment was obtained during 1917 5,837 Maximum daily Average daily Total Attendances at Ringworm Clinic 30 19 854 Attendances at Eye Clinic 59 29 5,669 Attendances at Inspection Clinic (Municipal Offices) 59 37 1,632 Attendances at Inspection Clinic (Leopold Road) 67 34 1,494 Total — — 9,649 No. of Physically Defective Schools 1 No. of Mentally Defective Schools 2 (1 of which was closed temporarily on 25/7/17) No. of Children attending Special Schools :— In Willesden Outside Willesden Total Blind and partially blind 0 18 18 Deaf . 0 22 22 Mentally defective 103* 5† 108 Epileptic 2 8 10 Physically defective 73 8 81 Total. 178 61 239 *3 are partially blind and receiving special education for the blind. † 1 is also deaf. 25 TABLE I. OF APPENDIX G OF ANNUAL REPORT OF CHIEF MEDICAL OFFICER OF BOARD OF EDUCATION FOR 1916. Number of Children inspected 1st January, 1917, to 31st December, 1917. A.—"Code" Groups. Age. Entrants. 3 4 5 6 Other Ages. Total. Boys ... ... 821 ... ... 821 Girls ... ... 661 ... ... 661 Totals ... ... 1482 ... ... 1482 Age. Intermediate Group. Leavers. Grand Total. 8 12 13 14 Other Ages. Total. Boys ... ... 883 ... ... 883 1704 Girls ... ... 776 ... ... 776 1437 Totals ... ... 1659 ... ... 1659 3141 B.—Groups other than "Code." (1) Intermediate Group other than 8 years. (2) Special Cases. (3) Re-examinations (i.e., No. of Children Re-examined). (4) Boys ... 131 10 Girls ... 126 7 Totals ... 257 17 26 Table No. 39.—Corresponding to Table II. of Appendix g of Annual Report of Chief Medical Officer of Board of Education for 1916. Return of Defects found in the course of Medical Inspection in 1917. Defect or Disease. Code Groups. Specials. Number referred for treatment. Number requiring to be kept under observation, but not referred for treatment. Number referred for treatment. Number requiring to be kept under observation, but not referred for treatment. (1) (2) (3) (4) (5) Malnutrition 16 3 23 9 Uncleanliness: Mead 97 0 0 0 Body 22 0 0 4 Skin Ringworm : Head 2 0 5 0 Body 1 0 0 0 Scabies 7 0 21 4 Impetigo 9 0 36 0 Other Disease 0 2 3 1 Eye Defective Vision and Squint 168 0 3 1 External Eye Disease ... 16 0 6 1 Ear Defective Hearing 4 0 8 0 Ear Disease 4 0 7 0 Teeth Nose and Throat Dental Disease. 94 19 5 0 Enlarged Tonsils 142 4 3 2 Adenoids 25 3 15 1 Enlarged Tonsils and Adenoids 9 0 2 0 Heart and Circulation Defective Speech 0 0 3 0 Heart Disease : Organic 1 0 5 0 Functional 12 3 2 1 Anaemia ... 4 3 5 1 Lungs Pulmonary Tuberculosis : Definite 0 5 5 0 Suspected 2 11 11 0 Chronic Bronchitis 11 0 4 0 Other Disease . 0 2 6 0 Nervous System Epilepsy 1 3 0 0 Chorea 2 5 1 Other Disease 11 0 1 1 Non-Pulmonary Tuberculosis : Glands 1 4 1 0 Bones and Joints 2 0 0 0 Other Forms 0 1 1 0 Rickets 3 0 3 0 Deformities 3 0 3 2 Other Defects or Diseases 13 2 12 5 Total 682 66 204 34 27 Table No. 40. Return showing No. of Special Cases referred in 1917 and previous years with the view ol 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. 1917 1227 3372 441 427 ‡5467 1916 1436 3264 313 394 †5407 1915 1308 3429 109 298 *5144 1914 2322 240i 108 140 4971 1913 1092 1912 1102 191 1030 1910 941 * Including 206 cases of Mental Defect. † Including 64 cases of Mental Defect. ‡ Including 48 cases of Mental Defect. 28 Table No. 41.—Corresponding to Table IV. appendix G of the 1916 Annual Report of the Chief Medical Officer of the Board of Education. 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 1917. 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. of defects not needing treatment. School Clinic. No. ot 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. Brought forward from previous year. New. Total. 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 1 6 7 19 0 0 0 0 7 0 0 0 7 3 4 0 0 100.00 0 0 0 0 Footgear- Unsatisfactory 0 5 5 7 0 0 0 0 4 0 0 0 4 3 1 0 0 80.00 1 0 1 0 Cleanliness of Head - Nits 25 208 233 880 249 5 0 0 209 0 0 0 209 154 51 2 2 89.70 1 18 19 20 Pediculi 30 763 793 2834 1217 0 0 6 756 4 0 1 767 599 156 1 11 96.72 1 16 17 27 Other Dirty Conditions 1 8 9 15 1 3 0 0 6 0 0 0 6 6 0 0 0 66.67 0 0 0 0 Cleanliness of Body- Dirty 0 4 4 7 0 0 0 0 4 0 0 0 4 3 1 0 0 100.00 0 0 0 0 Pediculi 1 31 32 59 21 1 0 0 31 0 0 0 31 29 2 0 0 96.88 0 0 0 0 Fleabitten 0 10 10 24 1 0 0 0 10 0 0 0 10 5 5 0 0 100.00 0 0 0 0 Nutrition— Below Normal 1 4 5 15 1 0 0 0 2 2 0 1 5 0 3 1 1 100.00 0 0 0 1 Bad ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 29 Nose and Throat- Enlarged Tonsils 29 108 137 515 5 5 0 0 1 48 0 8 57 39 7 7 4 41.61 29 46 75 50 Adenoids 29 53 82 298 8 0 1 0 0 24 0 7 31 17 2 9 3 37.80 17 33 50 36 Enlarged Tonsils and Adenoids 21 35 56 180 5 3 1 0 1 29 0 2 32 31 1 0 0 57.14 3 17 20 17 Other Conditions 13 148 161 383 12 2 1 0 75 23 0 56 154 126 23 0 5 95.65 1 3 4 8 Cervical or Neck Glands- Enlarged 7 119 126 290 19 2 0 0 78 19 0 21 118 71 41 2 4 93.65 0 6 6 10 External Eye Disease - 83 Blepharitis 64 96 160 475 1008 4 0 126 20 3 0 3 152 41 1 27 95.00 0 4 4 31 Conjunctivitis 45 130 175 536 661 1 0 122 23 16 0 10 171 105 48 0 18 97.71 1 2 3 20 Corneal Opacities 1 0 1 14 5 0 0 1 0 0 0 0 1 0 1 0 0 100.00 0 0 0 0 Other Disease. 5 39 44 122 87 2 0 17 16 9 0 0 42 26 8 2 6 95.45 0 0 0 6 Ear Disease- Chronic Suppuration of Middle Ear 37 45 82 324 16 1 0 0 22 39 0 13 74 25 28 6 15 90.24 2 5 7 20 Chronic Catarrh of Middle Ear ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Wax 3 6 9 23 6 1 0 4 1 2 0 1 8 5 1 0 2 88.89 0 0 0 2 Other Disease 13 20 33 115 3 1 2 1 8 12 0 2 23 14 7 0 2 69.70 2 5 7 7 Teeth- Irregular 2 3 5 21 0 0 0 0 0 3 0 0 3 0 3 0 0 .60 1 1 2 1 Less than Four Decayed 3 15 18 50 3 0 0 1 1 6 0 *4 12 10 0 0 2 66.67 1 5 6 7 Four or More Decayed 39 60 99 351 4 3 0 0 1 60 0 *8 69 62 4 0 3 69.70 7 20 27 23 Sepsis 5 16 21 68 3 1 0 0 3 7 0 *5 15 0 4 0 2 71.43 2 3 5 5 Heart & Circulation- Organic Disease 2 1 3 16 3 0 0 0 0 0 0 1 1 0 0 1 0 33.33 0 2 2 2 Functional Disease 4 15 19 47 10 1 3 0 0 6 0 7 13 3 7 1 2 68.42 1 1 2 3 anæmia 3 17 20 57 10 2 0 0 3 7 0 5 15 3 8 1 3 75.00 1 2 3 5 Other Defect 0 4 4 13 1 0 0 0 1 1 0 1 3 0 3 0 0 75.00 0 1 1 1 *Includes those treated by dentist. 30 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. of defects not needing treatment. 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. Brought 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 01 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. Lungs— Chronic Bronchitis and Bronchial Catarrh 8 87 95 239 6 0 0 0 41 14 2 34 91 60 26 0 5 9579 0 4 4 9 * Tuberculosis Tuberculosis Suspected 7 22 29 115 19 3 0 0 5 4 l6 1 26 1 11 9 5 89.66 0 0 0 5 Other Disease 4 24 28 104 9 0 0 0 1 9 1 17 28 10 9 1 8 100.00 0 0 0 8 Nervous System- Epilepsy 0 5 5 13 0 0 0 0 0 4 0 1 5 0 3 1 1 100.00 0 0 0 1 Chorea 10 25 35 206 18 1 0 0 2 23 1 7 33 11 13 2 7 94.29 1 0 1 7 Other Disease 2 16 18 63 7 O O O 5 8 0 4 17 4 10 1 2 94.44 1 0 1 2 Skin- Ringworm—Body :s6 261 317 835 647 2 2 182 65 26 O 29 302 248 4 3 47 95'27 O ii ii 58 Ringworm—Head Impetigo 35 790 82 s 3231 3'9 3 o 7 620 77 2 90 796 713 28 0 55 9648 o 26 26 81 Scabies 39 w 432 2325 374 i i S 243 Q2 77 420 SSO 12 2 56 97-22 O io io 66 Other Disease . 17 370 387 I°43 85 14 18 4 236 3> 0 72 343 290 41 3 9 88 63 i 11 12 20 Rieketts— Slight 0 7 7 18 3 i 0 0 1 2 o 0 0 1 1 1 42'86 1 2 3 3 Marked . * Thiiteen cases were notified by the Assistant School Medical Officers during the year, and were dealt with as notifiable infectious d;seases. X The remaining it appearing as carried forward in 1916 are dealt with in 1917 among children under 5 years of age. 31 Deformities- Deformity Present 4 12 16 50 6 1 3 0 1 10 0 0 11 0 7 1 4 68-75 1 0 4 Tuberculosis (Non-pulmonary)— ^Glandular "Bones and Joints ***Other Forms ... Suspected—Glandular ... 4 3 7 40 1 0 0 0 0 4 2 1 7 2 3 0 2 ioo'oo „ Bones & Joints 2 1 3 17 0 0 0 0 0 3 0 0 3 0 1 ,, Other Forms ... 0 3 3 '3 3 0 0 0 0 3 0 0 3 0 2 1 0 ioo'oo Speech- Defective Articulation ... O 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 Squint- Squint Present 45 37 82 197 170 1 2 60 0 7 0 0 0 3 81-71 9 3 9 Vision- Defect not ascertained ttsi 28 59 150 37 5 6 H 0 6 0 +5 25 5 W 1 42 37 J3 23 One Eye Normal ii 66 77 108 218 1 11 61 0 1 0 0 62 18 34 0 10 80-52 3 0 3 Beth Eyes 6/6 ... 3 59 62 7S '39 0 32 27 1 1 0 0 29 9 14 1 5 46-77 1 0 1 5 Both Eyes 6/9 ... 0 27 27 33 78 0 8 18 0 0 0 0 18 8 5 1 4 1 4 One Eye 6/9,Other 6/12 or less 7 50 57 61 160 0 2 43 0 1 0 +2 46 10 29 3 4 8070 5 4 9 8 Both Eyes 6/12 or less 45 218 263 35° 769 1 3 23* 0 3 0 ^ 1 242 59 8 24 92.02 11 6 1/ 30 Spectacles Broken 13 3^4 397 288 701 2 0 382 0 3 0 +2 38; 365 4 1 17 97 4» 3 5 8 Spectacles Lost 4 70 74 121 l66 0 0 73 0 0 0 ij 44 9» 05 Debility 15 86 ioi 331 27 6 0 0 40 24 3 26 93 27 53 1 12 92 x>8 0 2 2 14 Miscellaneous 46 657 7°3 1483 21 7 5 0 421 96 3 15° 670 53i 109 5 25 95 '31 0 21 21 46 Grand Totals +792 5671 6463 man 7402 96 101 1392 2965 772 S3 675 5837 4173 1150 84 430 90-31 120 309 429 739 Mental Condition—Dull or Backward and Mentally Detective (all grades)— No. of New Cases examined during 1917 ••• 4& found on Examination to be Dull or Backward 21 Found on Examination to be Mentally Defective 27 Re examinations for Defective Vision other than T,ost nnd Broken Spectacles—No. of Visits... 1110 No. of Mediral Exnmi-ations... iqXo One case wusuuiiaea uy uic risMMaut ocuwoi iviedical Othcer during the year, and was dean wun as a notifiable intectiuus disease. ** One ,, ,, » n >» »> » *** One ,, ,, ,, »» »• » ft The remaining 17 appearing in 1916 as carried forward appearamong the cases brought forward in 1917 as follows One eye normal...2 Both eyes 6/6.. 2 One eye 6/9 other 6/12 or less.. 1 Both eyes 6/1-s or less.. 12 X Includes those treated by Optician, t The remaining n of the 803 appearing as carried forward in the 1916 Report were under 5 years of age and are dealt with separately in 1917. 32 Table No. 42. Return of work done at the School Clinic during 1917. Clinic.—(Ringworm and Eyes.) Ringworm. Eyks. Under 5 y»"s- Over 5 yrs. Under S years- Over 5 years. No. of cases under treatment at 31st December, 1916 4 53 8 180 No. of cases coming under treatment ... 39 192 13 634 Total No. of cases under treatment ... 43 245 21 814 No. of cases cured or relieved :— (a) By X Rays 12 45 (b) By provision of Spectacles ... 6 420 (c) By other means 4 99 14 242 No. of cases previously attending Clinic cured by other agencies or removed 2 7 0 23 No. of cases not requiring treatment ... 6 56 0 64 Total No. of cases remaining under treatment at 29th December, 1917 ... !9 38 1 65 Re-examinations of children previously treated at Eye Clinic... 3 1020 Table No. 43. Return respecting the Provision of Spectacles during 1917. No. of pairs of Spectacles provided 581 Cost of Spectacles provided... £104 19 9 Average cost per pair £0 3 7 No. of pairs wholly paid for by parents 7 No. of pairs partly paid for by parents 89 Total amount received as above ^5 7 6 Cost of repairs £13 9 6 Total amount received for repairs ... £2 3 9 33 Table No. 44.—Corresponding to Table III. of appendix G of Annual Report of C hie Medical Officer of Board of Education for 1916. Numerical Return of all Exceptional Children in the area in 1917. Boys Girls Total Blind (including partially blind). Attending Public Elementary Schools ... 1 i 2 Attending Certified Schools for the Blind 11 7 18 Not at School 0 0 o Deaf and Dumb (including partially deaf). Attending Public Elementary Schools ... Attending Certified Schools for the Deaf Not at School 3 15 1 1 7 0 4 22 1 Mentally Deficient. Feeble Minded. Attending Public Elementary Schools ... 4 S 9 Attending Certified Schools for Mentally Defective Children *53 55 108 Notified to the Local (Control) Authority during the year ... 0 1 , Not at School 3 +3 6 Imbeciles. At School ... 6 2 8 Not at School 10 J6 16 Idiots. 4 §4 8 Epileptics. Attending Public Elementary Schools ... 2 , 3 Attending Certified Schools for Epileptics 6 4 10 Not at School 2 0 2 Physically Defective. Pulmonary Tuberculosis. Attending Public Elementary Schools ... So 45 95 Attending Certified Schools for Physically Defective Children ... 3 3 6 Not at School 7 9 16 Other Forms of Tuberculosis. Attending Public Elementary Schools ... 17 IS 32 Attending Certified Schools for Physically Defective Children ... 11 12 23 Not at School 7 5 12 Cripples Other Than Tubercular. Attending Public Elementary Schools ... 9 2 11 Attending Certified Schools for Physically Defective Children 20 19 39 Not at School 4 3 7 Physically Defective other than Tubercular and other than Cripples. Attending Public Elementary Schools ... 4 1 ,S Attending Certified Schools for Physically Defective Children ... 6 7 13 Not at School 1 1 2 **Dull or Backward. Retarded 1 year 11 5 16 Retarded 2 years ... 8 2 10 Retarded 3 years ... 0 2 2 *Three of these boys are also partially blind and receiving special education for the blind and i boy is semi-mute. •(•One of these girls is also suffering from infantile paralysis. jOne ot these girls is also epileptic. §One of these girls is also epileptic. **These fieures refer to children who were examined or re-examined during 1917. 34 TABLE V. OF APPENDIX G. OF ANNUAL REPORT OF CHIEF MEDICAL OFFICER OF BOARD OF EDUCATION FOR 1916. Inspection, Treatment, etc., of Children during 1917. 1. The total number of children medically inspected (whether Code Group, special or ailing child) 3398 2. The number of children in (1) suffering from defects (other than uncleanliness or defective clothing or footgear) who require to be kept under observation (but not referred for treatment) ... ... ... ... ... ... 94 3. The number of children in (1) who were referred for treatment (excluding uncleanliness, defective clothing, etc.) ... ... ... ... 837 4. The number of children in (3) who received ment for one of more defects (excluding uncleanliness, defective clothing, etc.) ... 774 Tables Nos. 45, 46, 47, 48, 49 and 50—Omitted. 35 STATISTICAL INFORMATION RELATIVE TO THE TWENTY-SIXTH ANNUAL Hospital Report For 1917. Tabi.e No. 51. Return giving particulars of patients under treatment during 1917. Scarlet Fever. Diphtheria. Enteric Fever. Other Diseases. Tuber' culosis. Total. No. of cases admitted, 1917 ... 121 196 8 >85 Sio No. under treatment at 31/12/16 9 12 — 1 17 39 Total No. „ during 1917 i30 208 8 186 17 549 No. discharged „ 1917 io7 131 5 141 IS 399 No. died ,, 1917 2 16 1 27 2 48 Mortality °/c „ 1917 1*5 7-6 12*5 17-3 i*"7 87 Remaining in Hospital 31/12/17 21 6. 2 18 — i02 Average daily number of patients under treatment during 1917 ... 47*36 Average stay in days in Hospital of Scarlet Fever patients during 1917 39*01 Average stay in days in Hospital of Diphtheria Patients during 1917 ... 43*77 Tables Nos. 52, 53, 54, 55 and 56—Omitted. 36 ro n > r* o o <! M s > Z 19 2 * m z z H 2 »* O 5> > * » a H > CO r- m C/i Table No i. VITAL STATISTICS OF WHOLE DISTRICT DURING 1917 AND PREVIOUS YEARS. Year. Population estimated to Middle of each Year. Births. Total Deaths Registered in the District. Transferable Deaths x Nett Deaths belonging to the District. Uncorrected Number. Nett. of nonresidents registered in the District. t of residents not registered in the District. t Under i Year of Age. At all Ages. Number. * Rate. Number. * Rate per 1,000 Nett Births. Number. Rate. Number, t Rate. (1) h) (3) (4) (s) (6) (7) (8) (9) (ro) <n) (12) (t3) I9II ... x 156,572 3.863 4,OOI 25-6 i,6l8 10-3 IO 240 495 124 1,848 11 *8 1912 159,868 3-912 4.075 25 "5 1,307 87 27 233 328 80 1,603 10 02 1913 163,644 3.891 4,037 247 ',449 8'9 23 251 325 80 1,677 1024 1914 166,634 3.971 4,115 247 1,501 9-0 32 283 337 82 1,752 10*51 191s 166,840 3.64I 3,775 22'6 1,792 107 44 282 344 91 2,030 i2'l6 1916 167,810 3.557 3,668 219 1,436 8'55 34 308 283 77 i,7lO 10*19 1917 169,344 2,704 2,816 16*62 1,571 9-27 45 292 309 110 1,818 10-73 37 Table la. VITAL STATISTICS OF THE WARDS—1917. wards. (1) Population estimated to Middle of Year. (2) Births. Total Deaths Registered in each Ward. Transferable Deaths Nett Deaths belonging to each Ward. Uncorrected Number. (1) Nett. of nonresidents registered in each Ward. + (8) of residents not registered in each Ward. + (9) Under t year of Age. At all Ages. Number + (4) Rate, (s) Number. (6) Rate. (7) N umber (10) Rate per 1000 Nett Births. ('■) Number. * <■*> Rate. (13) I. South Kilburn ... 14,949 237 266 1779 178 11-90 4 40 31 116-54 214 I4'3I 2. Mid Kilburn 14,913 235 253 16-96 00 11-93 3 32 30 118-57 207 1388 3. North Kilburn ... 12,663 ■si 163 12-87 119 939 3 25 17 10429 141 11 "13 4. Brondesbury Park 9,999 134 138 13-80 90 9 00 4 21 14 101-44 107 1070 5. Kensal Rise 14.347 220 227 15-82 117 8-15 1 20 19 83-70 136 9'47 6. Harlesden 17.603 293 306 00 ro 142 806 2 26 27 88-23 166 9'43 7. Stonebridge 17.938 352 364 2029 214 11-92 11 26 56 153'84 229 1276 8. Round wood 15.837 281 294 18-56 132 8 33 2 24 36 12244 154 9'72 9. Church End 14,302 252 257 17-96 137 957 3 20 28 108-94 154 10-76 10. Willesden Green 17.047 290 300 17-59 142 S32 2 27 28 93 33 167 979 11. Cricklewood 19.746 259 248 1255 122 6-17 10 31 23 92-74 '43 7-24 38 NOTES TO TABLES 1. and la. Tables I. and la. are arranged to show the gross births and deaths in the District, and each ward, and the births and deaths properly belonging to them with the corresponding rates. The rates are calculated per 1,000 of the estimated gross population. *In Column 6 are included the whole of 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 numbei 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 djeaths under 1 year, included in the number given in Column 9. tColumn 4.—This number has been obtained by adding to the number shewn in Column 3 the number of births belonging to the district but occurring outside and subtracting the number occurring in the district but belonging to other districts. tColumn 8.—This number is the number of deaths excluded from the returns of the local Registrar as transferable deaths defined below. tColumn 9.—This number is the number of deaths transferred to the district by the Registrar-General. J** Transferable Deaths " are deaths o-f persons who, having a fixed o/r 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.y casuals, are not included in Columns 8 or 9, except in certain instances under 3 (b) below. The following speciial cases arise as to Transferable Deaths:— (1) Persons dying in Institutions for the sick or infirm ; such as hospitals, lunatic asylums, workhouses, and nursing homes (but not almshouses) must be regarded as residents of the district ;n which they had a fixed or usual residence at the time of admission. If the person dying in an Institution had no fixed residence at the time of admission, the death is not transferable. If the patient has been directly transferred from one such institution to another, the death is transferable to the district of residence at the time of admission to the first Institution. (2) The deaths of infants born and dying within a year of birth in an Institution to which the mother was admitted 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 fixed abode, to the district where the accident occurred, if known; (c) failing this, to the district where death occurred, if known ; and (d) failing this, to the district where the body was found. Area of District in acres (land and inland water), 4,384. Total population at all ages 154,344) A( Census 19U Total families or separate occupiers ... 35,478) 39 TABLE II.—CASES OF INFECTIOUS DISEASE NOTIFIED DURING THE YEAR 1917. Notifiable Disease. Number of Cases Notified. Total Cases Notified in each Ward. V bD a 15 < At Ages—Years. South Kilburn. Mid-Kilburn. North Kilburn. Brondesbury Park. Kensal Rise. Harlesden. Stonebridge. Round wood. Church End. Willesden Green. Cricklewood. Total Cases removed to Hospital. Under i. 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) (0) (10) (n) (12) (n) <14) (1=) (16) <t7> (18) (19) (,20) 21) Small-pox Cholera (C) Plague (P) Diphtheria (including Membranous croup) 254 4 46 167 25 12 23 12 13 8 20 24 29 18 25 71 11 234 Erysipelas 56 5 8 7 9 4 8 3 4 2 5 4 11 0 5 4 0 Scarlet Fever 166 27 hi 20 8 9 12 10 11 16 18 13 25 10 n 29 m1 Typhus Fever Enteric Fever 9 2 2 5 1 3 1 4 8 Relapsing Fever (R) Continued Fever (C) Puerperal Fever 6 3 3 3 1 1 1 Cerebro-spinal Meningitis 8 2 1 1 i 2 1 1 1 1 4 Poliomyelitis 3 3 1 1 1 Ophthalmia Neonatorum 29 29 2 3 2 2 5 6 5 1 3 0 Measles and German Measles 3i«4 90 1045 1856 294 128 9 2 491 469 312 176 298 367 308 30' 254 221 227 12 Pulmonary Tuberculosis 302 1 8 33 81 140 36 3 4i 32 18 14 30 24 23 32 28 35 25 0 Other forms of Tuberculosis 64 2 15 21 14 8 3 1 9 10 2 0 4 9 9 5 10 4 2 0 Whooping Cough 238 *7 116 102 3 18 54 28 3 12 34 11 28 41 7 2 0 Totals 4^9 148 1260 2305 448 317 68 t3 509 602 380 217 *85 485 404 4*0 380 3S9 30q 399 The Willesden Municipal 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. 40 MILITARY CASES OF INFECTIOUS DISEASES NOT INCLUDED IN Table II. Register N o. Infectious Disease. Age. Ward. 163 Cerebro-spinal Meningitis ... 21 7 1,814 Pulmonary Tuberculosis 30 6 1,830 i * >» ••• ... 24 11 2,000 }) >» ••• 20 4 2,002 J) »> 31 7 30 Measles 19 7 220 1j • • • • • * •" ' ' • 28 3 41 Table III. CAUSES OF, AND AGES AT DEATH DURING THE YEAR 1917. 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 i 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. <>) « (3) (4) (5) (6) (7) (8) (9) (10) (») All causes j Certified (<r) .. 1815 107 89 84 74 77 229 39- 563 417 Uncertified .. 3 2 1 Enteric Fever 1 i 1 Small-pox 0 Measles 48 0 21 2 3 2 Whooping-cough 8 6 8 20 16 Influenza 27 1 2 8 16 3 Erysipelas 6 1 S 3 Phthisis (Pulmonary Tuberculosis^ 167 2 1 2 8 43 64 4 1 6 56 Tuberculous Meningitis 1 2 Other tuberculous diseases 24 2 2 3 s 2 2 9 Cancer, malignant disease 160 T 19 79 61 34 Rheumatic Fever 10 1 1 Meningitis ((f).. .. .. .. 15 4 4 2 3 2 2 Organic Heart Disease 208 2 4 s as 04 108 43 Bronchitis .. .. : 122 23 10 3 5 11 70 »7 Pneumonia (all forms) 164 4b 28 18 H 4 1Q 2S 16 24 Other diseases of Respiratory organs 3' 8 1 2 s 8 7 2 Diarrhoea and Enteritis (e) .. 55 40 4 1 1 2 7 19 Appendicitis and Typhlitis 6 s 1 x Cirrhosis of Liver 1 8 6 Alcoholism 1 x 1 Nephritis and Bright's Disease 5° 1 2 1 29 J3 Puerperal Fever 0 1 Other Accidents and Diseases of Pregnancy and Parturition 9 q 3 Congenital Debility and Malformation, including Premature Birth 112 112 25 Violent Deaths, excluding Suicide .. 6 6 11 11 Suicide 13 6 1 Other Defined Diseases 453 5i 5 4 6 11 44 95 237 136 Diseases ill-defined or unknown Totals 1818 309 ?9 84 74 77 229 39* 564 417 SubEntries. included in above figures. Cerebro-spinal Meningitis 2 2 1 Poliomyelitis Pneumonia other than Broncho Pneumonia 79 11 8 6 3 3 *7 20 11 12 42 NOTES TO TABLE III. The classification of Causes of Death are those of the " Short List " on page XXV. of the Manual of the International List of Causes of Death. (a) All " Transferable Deaths " of residents, i.e., of persons dent in the District who have died outside it, are included with the other deaths in columns 2-10. Transferable deaths of non-residents, i.e., persons resident elsewhere in England and Wales who have died in the District, are in like manner excluded from these columns. (b) All deaths occurring in Institutions for the sick and infirir situated within the district, whether ot residents or nonresidents, are entered in the last column of Table III. (c) All deaths certified by registered Medical Practitioners and all Inquest cases are classed as "Certified"; all other deaths are regarded as " Uncertified." (d) Exclusive of " Tuberculous Meningitis " but inclusive of Cerebro-spinal Meningitis. (e) Includes deaths from Diarrhoea and Enteritis at all ages. 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. 43 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. | Crkklewood. (I) h) (3) (5) (6) (7) (8) Co) (10) (11) (12) (n) Alt causes Certified 1815 214 207 141 107 136 l66 227 Uncertified .. 3 2 1 Enteric Fever 1 Small Pox 0 Measles 48 15 9 1 3 i 2 6 8 3 Scarlet Fever 2 1 1 Whooping Cough 1 1 1 1 2 1 2 Diphtheria and Croup 20 1 1 2 I Influenza 27 3 3 3 2 ! 2 I 1 1 2 8 Erysipelas 6 2 1 2 1 Phthisis (Pulmonary Tuberculosis) 167 24 14 14 10 *5 14 19 12 10 20 15 1 uberculous Meningitis .. 23 6 1 2 2 2 2 Other Tuberculous Diseases 24 3 2 2 s 3 2 Cancer, malignant disease 160 13 23 14 12 11 12 IS 13 11 19 Rheumatic Fever .. 10 3 2 2 1 1 1 Meningitis 15 1 1 2 2 2 Organic Heart Disease 208 27 2 5 is IS 12 21 2 S 13 22 Bronchitis 122 TR 11 12 8 Other Diseases of Respiratory Organs. 3i 2 3 2 S Diarrhoea and Enteritis 55 6 2 3 S IS 7 3 3 Appendicitis and Typhlitis 6 1 1 1 i Cirrhosis of Liver 14 2 1 2 2 1 fi Puerperal Fever 0 Other Accidents and Diseases of Pregnancy and Parturition 9 1 1 1 2 1 2 Congenital Debility and Malformation, including Premature Birth 112 10 IS 8 12 21 10 6 Violent Deaths, excluding Suicide 54 s P 4 2 1 6 14 3 Suicide 13 1 2 2 2 Other Defined Diseases 453 4; 46 49 32 34 44 45 36 40 44 40 Diseases ill-defined or unknown.. Totals 1818 214 207 141 107 136 166 229 154 154 167 '43 SubEntries, included in above figures Cerebro-spinal Meningiti- 2 1 I Poliomyelitis Pneumonia other than Broncho-Pneumonia .. 79 12 14 6 2 3 9 4 6 9 8 6 44 Table IV.—INFANT MORTALITY. 79/7.—Nett Deaths from Stated Causes at various Ages under / Year of Age. Causes of Death. Under 1 week. 1-2 Weeks. 2-3 Weeks. 3-4 Weeks. Total under 4 Weeks. -0 -5 £ c 0 Si s & c> s •o-e c £ Jl •5 ^ C 0 0 u 4} ro C 3 6 Months and under 9 Months. 9 Months and under 12 Months. Total Deaths under One Year. («) (2) (3) (4) (5) (6) (7) (8) (9) (10) ("> All causes - Certified.. 77 30 *3 r9 139 46 45 35 42 307 Uncertified 1 2 1 Small-pox Chicken-pox J Measles 6 | Scarlet Fever Whooping Cough 2 2 2 *8 v Diphtheria and Croup Erysipelas 1 /Tuberculous Meningitis 1 1 ■| Abdominal Tuberculosis (a) r 2 ^Other Tuberculous Dis. .. 2 2 Meningitis (not Tuberculous) 2 1 4 Convulsions 4 1 6 1 2 1 10 Laryngitis 1 1 2 Bronchitis j j 1 ■a 6 6 3 23 Pneumonia (all forms) 2 0 3 8 10 9 16 46 / Diarrhoea z 2 3 2 3 3 12 \ Enteritis 2 3 2 7 4 7 8 28 Gastritis 1 2 2 2 8 Syphilis 2 1 3 3 2 9 Rickets Suffocation, overlying 1 1 X 2 Injury at birth 3 3 3 Atelectasis .. 4 I 5 5 / Congenital Malformations(^) 8 2 1 11 2 1 14 1 Premature birth 39 7 6 3 55 1 2 58 I Atrophy, Debility and V Marasmus.. 7 9 2 2 20 11 5 1 3 40 Other Causes 8 1 1 2 12 2 5 2 4 25 Totals 77 30 13 19 139 47 46 35 42 309 Nett Bird the yea 1S ;n | legitimate 2,704 Nett Deaths in J the year j legitimate infants 270 1 illegitimate 112 illegitimate infants . 39 (a) Under Abdominal Tuberculosis are included deaths from Tuberculous Peritonitis and Enteritis and from Tabes Mesenterica. (£) Want of Breast Milk is included under Atrophy and Debility. 45 TABLE IVA.—INFANT MORTALITY. 79/7.—Nett Deaths from all Causes under one year of age classified in JVards. Causes of Death. WARDS. Total for District. South Kilburn. Mid Kilburn. North Kilburn. Brondesbury Park. Kensal Rise. Harlesden. Stonebridge. Roundwood. Church End. Willesden Green. Cricklewood. <>) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (.2) (X3) All Causes Certified 3* 30 17 19 27 54 36 28 28 23 307 Uncertified .. 2 2 /Small Pox Chicken Pox ] Measles .. 1 1 1 <5 1 Scarlet Fever Whooping Cough 1 "l 2 8 V Diphtheria and Croup .. Erysipelas 1 X /Tuberculous Meningitis 1 i J Abdominal Tuberculosis 1 X 2 1 Other Tuberculous V Diseases 1 1 2 Meningitis (not Tuberculous) 1 1 1 X 4 Convulsions 1 1 1 1 1 3 2 IO Laryngitis 1 1 2 Bronchitis j 1 2 2 3 3 5 1 1 2 27 Pneumonia (all forms) .. 5 7 3 1 4 6 6 7 7 J 46 J Diarrhoea 2 1 1 3 2 1 12 t Enteritis 2 2 2 2 9 5 2 2 28 Gastritis 1 3 2 1 8 Syphilis 1 x 1 2 1 x 9 Rickets Suffocation overlying .. 1 1 2 Injury at birth 1 1 1 3 Atelectasis 1 1 1 i 5 ( Congenital Malformations 1 3 3 3 3 *4 J Premature Birth .. 8 10 2 4 2 8 11 4 5 1 3 58 I Atrophy, Debility and V Marasmus 2 4 2 3 1 7 5 5 5 6 4° Other Causes 2 1 2 3 1 2 1 4 3 3 3 25 Totals 3i 30 17 19 27 56 36 28 28 23 309 Deaths— Legitimate 25 -7 16 »3 17 26 48 28 26 24 29 270 Illegitimate 6 3 1 1 2 1 8 8 2 4 3 39 Births—1 legitimate 253 242 159 >37 222 297 343 268 252 291 240 2704 llegitimate *3 11 4 5 9 21 26 5 9 8 112 Total Births .. 266 253 163 138 227 306 364 294 257 300 248 2816 Infant Mortality Rate— Legitimate 98*81 111 '57 100*62 04*89 76'57 87'54 139*94 104*47 103*17 82*47 83*33 99*85 Illegitimate 461*53 272*72 250*00 100000 400*00 iii'ii 380*95 307*69 400*00 444*44 375'00 348*21 Infant Mortality Pate .. 11654 "8*57 104*29 101 "44 83*70 88*23 153*84 122*44 108*94 93'33 92*74 *°9'73 Population '4949 *49*3 12663 9999 14347 17603 I7Q38 15837 14302 17047 19746 109344 46 APPENDIX B. Shewing Acts, Circulars, Regulations, and Orders issued during the year 1917, relating to the work of the Health Department. School Medical Inspection.—Circular 976 and Medical Grant Regulations re :— (i) The Medical Inspection and Medical Treatment ot children attending public elementary schools; (ii) The Medical Treatment and Care of children attending certain "special" schools; and (iii) The organisation and supervision of Physical Training in public elementary schools. Board of Education, 10th February, 1917. SmalLPox.—The Public Health (Small-Pox Prevention) Regulations, 1917. Local Government Board, 12th February 1917. Food Control.—The Local Authorities (Food Control) Order (No. 1), 1917. Local Government Board, 8th May, 1917. The enforcement (England and Wales) Order, 1917. Food Controller, 9th November, 1917. Whooping Cough.—Order making Whooping Cough a Notifiable Disease as from 1st October, 1917. Approved by Local Government Board, 8th August, 1917. APPENDIX C. To the Chairman and Members of the Children's Care Committee. OPEN AIR SCHOOL. Site and Size of School.—The most suitable Park for the erection of a Temporary Open-Air School is King Edward VII. Recreation Ground. The school should be for 60 children and the site should be about two acres in extent. 47 Contributory Schools.—The following schools would probably be contributory schools to an Open-Air School situated in King Edward VII. Park:— Approximate No. on Roll. Chamberlayne Wood Road ... ... 1200 College Road ... ... ... ... ... 400 Princess Frederica ... ... ... ... 900 Kensal Rise ... ... ... ... ... 1200 Furness Road ... ... ... ... 1300 Pound Lane ... ... ... ... ... 1200 Acton Lane ... ... ... ... ... 500 Keble Memorial ... ... ... ... 600 Harlesden C. of E. ... ... ... ... 400 Leopold Road ... ... ... ... 1200 Oldfield Road ... ... ... ... 1200 St. Andrew's ... ... ... ... 900 Total 11,000 It may be assumed that at least 2 per cent, of these children require education in an Open-Air School, so that the suggested school for 60 scholars would be constantly full. The Building.—T he school will consist of two buildings: 1. Administration Block:— Teachers', Doctors' and Nurses' room. W.C. and washhand basin for staff. Store room. Girls' cloakroom. Boys' cloakroom. 8 Washhand basins for boys and girls. 1 Slipper and 6 shower baths. 4 W.C.'s for girls. 2 W.C.'s and a 5 ft. urinal for boys. 48 2. The School Block:— 1 Classroom for 25. 2 Classrooms for 20. 2 Rest sheds between the classrooms. The Architect, Mr. Laurence, has prepared a sketch plan of the proposed school which would be constructed of the cheapest possible materials consistent with suitability for the purpose. He states that it is difficult to prepare very reliable estimates under existing conditions but approximately the cost would be as follows:— 1. The Administrative Block and Latrines. Constructed with fir quartering, the roof covered with boarding and "waterproof" roofing material, the external and internal walls and the ceilings covered with "Poilite" asbestos sheeting, the floors formed with cement concrete finished on top with "Decolite" and including bath and W.C., etc., fittings, plumbing, hot water service and hot water heating £570 Drainage ... 80 £650 2. The School Block:— Constructed with fir posts and roof timbers, the foof covered with 1 inch boarding and "waterproof" roofing material, the floor formed with cement concrete and finished on top with Portland cement ... ... ... ... £450 White cotton duck removable blinds one end and one side of building ... 65 Economic fencing and drainage ... 250 £765 Total £1415 49 General Daily Routine at the Open-Air School. Provision will be made for strict attention to the following:— 1. Meals (at the Furness Road Feeding Centre). 2. Personal hygiene. 3. Mid-day rest. 4. Individual attention. 5. Medical treatment. 6. Special educational methods— (a) Open air work. (b) Manual methods. The following specimen time-table will shew how the above may be accomplished :— 50 OPEN-AIR SCHOOL — MORNING TIME - TABLE. Day. Class. 8.50— 9.0 9.0— 9.25 9.25— 9.55 9.55— 10.0 10.0 — 10.30 10.3010.45 10.45— 11.15 IMS— II.30 11.30— 12.0 12.0— 12.20 I2.20- I2.30 12.301.30 Monday 1 Assembly, Prayers, Registers. ture or Hymns Manual Breathing Exercises. Geog. Recreation. Nature Study Recit. Draw. Morning School ends. Prepare Beds. Personal Hygiene. Walk to Dinner. Dinner. 2 Arith. Hist. Comp. Phys. Ex. Sing. 3 ,, Geog. ,, Recit. Read. Tuesday 1 ,, Ariih. Sing. Comp. Phys. Ex. Read. 2 ,, ,, Geog. Nature Study Recit. Draw. 3 ,, ,, Hist. Literature Phys. Ex. Sing. Wednesday 1 ,, Manual Hist. Literature Recit. Read. 2 ,, Arith. ,, Comp. ,, ,, 3 ,, ,, Geog. Nature Study ,, Draw. Thursday . 1 ,, Arith. Geog. Nature Study- Phys. Ex. Draw 2 ,, ,, ,, Literature Recit. Read. 3 ,, ,, Sing. Comp. Phys. Ex. ,, Friday 1 ,, Manual Hist. Comp. Recit. Sing. 2 ,, Arith. Sing. Nature Study Phys Ex. Draw. 3 ,, ,, Hist. ,, Recit. ,, Registers—9.25. 51 OPEN-AIR SCHOOL—AFTERNOON TIME TABLE. Day. Class. 1.30 1.30— 3-30 3.30— 4.30 4.30— 5.0 5.0— 5.15 5.15— 5.45 Monday 1 Assembly. Registers. Rest and Sleep Classes 1 and 2—Boys—Gardening Reading Packing up. Assembly. Prayers. Tea & Dismissal 2 ,, ,, ,, Girls—Needlework 11 ,, 3 ,, 3—Cardboard Modelling ,, ,, Tuesday 1 ,, Drawing Organised Games for all ,, ,, 2 ,, ,, 11 ,, 3 ,, ,, ,, ,, Wednesday 1 ,, Classes 1 and 2—Boys—Gardening ,, ,, 2 ,, ,, ,, Girls—Needlework 11 ,, 3 ,, 3 —Plastic Modelling—Boys Needlework—Girls if 11 ,, Thursday 1 ,, 1—Cardboard or Paper Modelling 19 ,, 2 ,, 2 ,, ,, ,, 11 ,, 3 ,, 3—Mat-Weaving 11 ,, Friday 1 ,, 1—Plastic Modelling Organised Games 11 ,, 2 ,, ,, 11 ,, 3 ,, 3—Boys—Drawing Girls—Needlework 11 ,, 52 Principles underlying the Curriculum.—Throughout the day the scheme of work will be such that the children will learn by "doing" and by the employment of their bodily activities, so as to develop resourcefulness and self reliance. The curriculum is arranged so as not to make too great a demand upon the physical or mental energy of the children but to arouse in them that keen interest in their surroundings which ought to characterise all children. Arithmetic will be largely practical and outdoor, utilising the material at hand in the Park. The courses in Nature Study, Geography and Gardening, will be drawn up with the same end in view. The time-table is practically on a half-hour lesson basis, thus lessening strain and providing plenty of change. Considerable attention will be given to the personal cleanliness of the children, while the baths, feeding, mid-day rest, the free life in the open-air, the specially adapted curriculum, and physical exercises will all help to bring about the required improvement in the physical and mental condition of the children. The children will be under constant medical supervision and the doctor will attend for regular medical examination one day a fortnight. Staff.—The Staffing of this school should be as follows :— Mr. Tobutt. 3 Women teachers. A part time nurse. Cleaning assistance. The three teachers to be appointed should be young teachers with the latest training in new methods of teaching and open-air school work. The salaries to be paid should be at the rate of £100 per annum with, if the experiment 53 continues, the prospect of rising to £160 by £10 annual increments. Estimated Cost of Maintenance for 6 months. Expenditure. £ Stock 45 Furniture (including clothing) 142 Meals—dinners and teas 298 Salaries of the teaching staff . 250 Nurse . 30 Cleaning assistance and materials 25 Sundries 60 Total £850 Income. £ Meals 100 Board of Education Grant at the rate of £3 per scholar for six months, say 180 Medical Grant at the rate of £1 10s. per scholar for six months, say 90 Total £370 Generally.—Sanction to establish the school is required from the Board of Education. A Priority Certificate for the erection of the school is required from the War Office. Sanction to use two acres of King Edward VII. Park is required from the District Council. 54 Notes by Chief Education Officer.—With the exception of the notes of the Architect (not then ready) the foregoing in draft was reviewed by the Chief Education Officer whose observations are appended. I am, your obedient servant, GEORGE F. BUCHAN, Medical Officer. Remarks on Open-Air School. 22nd March, 1917. Dear Dr. Buchan, Thanks very much for your draft Scheme, it is excellent. 1. Site and size of school.—I agree with you that King Edward VII. Recreation Ground is most suitable and central. The Scheme may be extended later to the other Parks. 2. Contributory Schools.—I feel that your pe centage of 2 per cent, is a low one for some of the schools named. 3. Buildings.—The style of our Dollis Hill House Hospital Huts would be a good pattern for Mr. Laurence to follow. They have proved very satisfactory. As to cost, of course, it will be nearly double pre-war prices. 4. General Daily Routine.—Ideal for an Open-Air School. I shall be very interested to know how the children take to the mid-day rest. 5. Time-table.—The only criticisms I have to offer are:— 55 Nature Study should be largely in the form of rambles in the Park, there will be plenty of material to hand. I can help Mr. Tobutt in this. 1 especially note that the Arithmetic is to be largely practical, and nothing ambitious should be attempted—no Stocks and Shares, etc. They will be able to measure up the Park. 6. Staffing.—Admirable. I will do all I can to help you in this. JOS. S. BRIDGES, Chief Education Officer. APPENDIX D. 27th November, 1917. To the Chairman and Members of the Health Committee. MOTOR SERVICE. I beg to report on the above for its third complete year ending March 31st, 1917. The seven motor vehicles owned by the Council came into use in December, 1913, and up to the end of March, 1917, had covered a total of 154,233 miles. During the year certain work occasioned by the war was continued in connection witB Belgian refugees, the meeting of convoys of wounded soldiers, the conveyance of wounded soldiers to entertainments, and air-raid calls. In addition a certain number of miles were run for other departments of the Council. 56 Miles run and work done.—The following table shews the number of miles run under the various heading's since the inception of the service:— Miles run during year ended 31st March, 1914 1915 1916 1917 Total School Work — 20592 17579 20530 58701 Medical Officer — 6343 9857 9664 25864 Accidents, Sickness and Infectious Cases — 9491 8002 7871 25364 Disinfection — 5977 4998 4488 15463 Conveyance of Wounded Soldiers to Hospitals and Entertainments - - 1978 5020 6998 Concert parties to Hospitals for Wounded Soldiers — — 138 378 516 Accountant's Department. — 416 2292 1546 4254 Engineer's Department — 243 90 119 452 Clerk's Department — — — 75 75 Registration — - 1217 — 1217 Refugee Work — 774 209 56 1039 Recruiting Demonstrations — 28 681 — 709 Hospital Work — 181 242 73 496 Dollis Hill House Hospital Committee — — 75 311 386 Miscellaneous — 53 75 — 128 General including all foregoing 12571 — — — 12571 Total 12571 44098 47433 50131 154233 57 Miles run by each vehicle.—The following table shews the number' of miles run by each vehicle during- the three complete financial years from April 1st, 1914, to March 31st, 1917, and since delivery to the latter date. Car Number. delivery to 31/3/14 1/4/14 to 31/3/15 1/4/15 to 31/3/16 1/4/16 to 31/3/17 Miles run since delivery to 31/3/17 Disinfecting Van, M.X. 1884 2755 6440 5196 4605 18996 Landaulette, M.X. 2056 1466 6385 10579 10248 28678 School 'Bus, M.X. 2057. l801 7648 6915 10208 26572 Infectious Ambulance, M.X. 2058 14l8 5591 3912 2803 13724 School 'Bus, M.X. 2059 2254 7176 9036 10680 29146 Accident Ambulance, M.X. 2060 725 3900 4686 4961 14272 School 'Bus, M.X. 2061 2152 6958 7109 6626 22845 Totals 12571 44098 47433 50131 154233 Calls.—The following table shows the number of calls for the disinfecting van, infectious ambulance, and accident ambulance, respectively during the three complete financial years, April 1st, 1914, to March 31st, 1917, and since delivery to the latter date:— Delivery to 31/3/14. 1/4/14 to 31/3/15 1/4/15 to 31/3/16 1/4/16 to 31/3/17 Since delivery to 31/3/17 No. of Calls for Disinfecting Van 370 1167 957 787 3281 No. of Calls for Infectious Ambulance 250 940 696 528 2414 No. of Calls for Accident Ambulance 40 372 388 471 1271 53 Petrol Consumption and Cost per Mile.—The following is a statement of mileage, petrol consumption, and cost per mile for the three complete years ended March 31st, 1917:— Year Ending 31st March. 1915 1916. 1917. Total number of miles run by the seven vehicles 44098 47433 50131 Total number of gallons of Petrol consumed 3998.5 4035.5 4673 Number of Miles per gallon of Petrol consumed 11.0 11.75 10.73 Cost in pence per mile run 13.4 12.08 11.78 Plant.—The garage workshop has been equipped during the year with pit and overhead lifting gear, so that the heavier work of fire engine repairs could be undertaken. The cost of this equipment has been borne by the Motor Service. The petrol storage plant installed in January, 1915, is working satisfactorily. Staff.—The present staff employed is:— 1 Mechanic Superintendent, 5 men drivers, 1 woman driver, and 1 apprentice. The Mechanic Superintendent in addition to his responsibility for the Motor Service generally, has carried out the mechanical work of the Municipal Hospital and Fire Brigade during the whole of the year under review. Three extensive repairs have been undertaken to a First Aid Machine and Pump and two new drivers have been instructed on Fire Brigade engines. Difficulties have arisen during the year in respect of obtaining and retaining staff. The night service is still discontinued, the garage being closed from 10 p.m. to 7.30 a.m., except when called up for convoys of wounded soldiers or air-raids. It will be necessary to re-arrange the night service during the financial year commencing on 1st April, 1918, on account of the admission of maternity cases by day or night to the Municipal Hospital. 59 The Mechanic Superintendent calls attention to the fact that it is desirable to consider the purchase of a spare vehicle as a relief while extensive overhauls take place. Overhauls are now imminent in respect of all the vehicles which have been in continuous service for practically four years at the date of this report. The Mechanic Superintendent suggests that it would be possible to secure a type adaptable for relieving one of the cars in the Motor Service or the First Aid Machine or one of the Fire Engines of the Fire Brigade provided it were equipped with detachable brackets for fire escape and chemical extinguisher. I am, your obedient servant, GEORGE F. BUCHAN, Medical Officer. Expenditure upon the Motor Service—year ended 31st March, 1917. Amount. Total. Cost per mile. Running Expenses— £ s. d. £ s. d. d. Petrol 433 5 6 Tyres 281 17 5 Oils and greases 15 17 8 Sundries 0 18 6 731 19 1 3.50 Wages and Emoluments, etc.— Mechanic Supt., see Note (a) 177 11 6 Drivers 619 6 3 State Insurance (Employers' Contribution) 3 19 9 800 17 6 383 Fixed and General Charges— Rent (Garage and Messroom) 187 0 0 Insurance of vehicles 73 8 0 Carried forward £1532 16 7 7.33 60  Amount. Total. Cost per mile. £ s. d.. £ s. d. d. Brought forward 1532 16 7 7-33 Rent of telephone 20 14 1 Tax on landaulette 6 6 0 Drivers' Licences 1 10 0 Electric lighting and power 9 3 11 Fuel and water supply 45 10 10 Alterations and repairs see Note (b) 69 10 1½ Plant, tools, etc. 18 9 6 Uniforms and Overalls 38 19 5 Sundries 19 4 7i 2.35 489 16 6 9.68 Loan Charges 437 19 4 210 Total . £2,460 12 5 11.78 Note (a).—Net figure after deducting £17 1s. 1d. in respect of services rendered by the Mechanic Superintendent in connection with the inspection and repair of motor fire appliances. Note (b).—Net cost after deducting £17 7s. 6½d. charged to Fire Brigade account for repairs to motor fire appliances. Total miles run by all vehicles—50,131. Petrol consumed during year—4,673 gallons. Miles per gallon—10 73 Income—Conveyance of patients—£43 3s. 3d. Wm. A. HENDERSON, Accountant. 61 APPENDIX E. 23rd June, 1917. MIDWIFERY ARRANGEMENTS FOR NECESSITOUS CASES. Provision of a Midwife. Conference with Midwives.—Held at the Municipal Offices, Dyne Road, Kilburn, N.W.6, on Friday, 22nd June, 1917, at 4 p.m. Present:— Dr. Buchan in the Chair. (1) Nurse Trafford. (2) Mrs. Layton. (3) Mrs. Wheeler. (4) Nurse Knipe. (5) Nurse Lilley. (6) Nurse Jackson. (7) Nurse Parry. (8) Mrs. Taylor. 24 Invitations were sent out. Telegram received from Nurse Bowman stating that she was unable to come. Letter received from Nurse Mathieson stating that she and her mother would not come. Letter addressed to Nurse Nicholson returned through the post. The following conclusions were unanimously arrived at by the conference:— The fee for confinements in necessitous cases or in cases referred to midwives from the Council's Cinic for confinement should be £1 1s., to include:— (a) Attendance at the confinement. (b) Two visits during the next 24 hours. (c) One visit every 24 hours during the next 9 days making 11 visits in all and attendance at the confinement. 62 It was further agreed that midwives when engaged for necessitous cases should notify such cases to the Medical Officer as soon as possible, so that the necessary enquiries might be made and the midwife informed as to whether or not the Council would be responsible for the fee. The midwives further were of opinion that some system of Home Helps should be introduced by the Council. Home Helps would be employed in necessitous cases where there was no other woman assistant available. The duties of the Home Help would be:— (a) To assist the midwife at the confinement and to clean up. (b) To live in probably for the first night and (c) To attend afterwards daily at the home to do the necessary domestic work. The midwives were of opinion that whole time Home Helps should be retained for this work. Arising out of a question by Nurse Trafford the midwives were informed:— (a) That the Clinic of the Council established at 9, Willesden Lane would receive ante-natal cases sent by the midwife, who in turn would receive a medical report of any condition likely to complicate pregnancy or labour ; and (b) That a similar procedure should be followed if practicable in respect of complications arising in the mother or the child after confinement, the rules of the Central Midwives Board and Official Regulations being at the same time carried out. GEORGE F. BUCHAN, Medical Officer. 63 APPENDIX F. 5th September, 1917. MIDWIFERY ARRANGEMENTS FOR NECESSITOUS CASES. Provision of a doctor called in by a midwife. The Willesden Medical Organisation at their meeting on Tuesday, July 17th came to the following conclusions. That in cases in which a doctor is called in by a midwife under Rules 20 and 21 of the Central Midwives Board the following shall apply:— (1) That all medical fees are exclusive of medicines and dressings. (2) That under Rule 21 (1)—In all cases in which a woman during pregnancy, labour or lying-in appears to be dying or is dead:— First visit, 5/-; subsequent visits, 3/6 per visit. If called between 8 p.m. and 8 a.m. double fee to be charged. Immediately the charges amount to £2 2s. a statement of account to be sent to the Medical Officer who will give instructions as to continuance of attendance, etc. (3) That under Rule 21 (2).—Pregnancy.—In the case of a pregnant woman when there is any abnormality or complication :— Fees as under (2) above except abortion, then fees as for labour. 54 (4) That under Rule 21 (3).—Labour.—In the case of a woman in labour at or near term where there is any abnormality or complication:— Fee £'2 2s. for the emergency and subsequent attendance necessary with an additional fee of £\ Is. when an anaesthetist is called in. (5) That under Rule 21 (4).—Lying-in.—In the case of a lying-in woman when there is any abnormality or complication Fees as under (2) above. (6) That under Rule 21 (5).—The Child.—In the case of the child when there is any abnormality or complication :— Fees as under (2) above. (7) That the doctor summoned be (a) The family doctor; failing whom (b) The doctor chosen by the patient; and failing whom (c) The nearest doctor. GEORGE F. BUCHAN, Medical Officer. APPENDIX G. Report as amended and approved by the Health Committee, 4th December, 1917. To the Chairman and Members of the Hospital Committee. Maternity and Child Welfare. HOSPITAL RE-ORGANISATION, etc. Addition of 59 beds for patients and 8 beds for staff. 65 The following table shews the present uses and arrangement of beds at the Municipal Hospital and the uses and arrangement when B and C Wards, now in course of alteration, are complete. Present Arrangements. Arrangements at 1st April, 1918. Beds Cots Uses. Beds. Cots. Baby Cots. Uses. H 12 6 Isolation Ward for typhoid fever, cases of doubtful diagnosis and other diseases. 14 10 Isolation Ward for typhoid, fever, cerebro spinal fever, and cases of doubtful diagnosis and other diseases. G 18 2 Scarlet Fever. 18 10 Scarlet Fever. F 18 2 Scarlet Fever. 18 10 Scarlet Fever. E l6 4 Scarlet Fever. 16 12 Air Raids. D 24 4 Diphtheria. 24 16 Diphtheria. C 16 4 Scarlet Fever. 36 Diseases of Children. B l6 4 Isolation Ward for typhoid fever, cases 'jf doubtful diagnosis and other diseases. 15 6 Cases of Pregnancy and Parturition and Diseases of Women. W l6 Convalescent Scarlet Fever. 16 Convalesent Scarlet Fever. 136 26 121 94 6 162 221 66  Present No. of Beds and Cots. No. of Beds and Cots at 1st April, 1918. Scarlet Fever 96 72 Diphtheria 28 40 Isolation for Typhoid Fever, Cerebro Spinal Fever, and cases of doubtful diagnosis and other diseases 38 24 Total 162 136 Air Raids 0 28 Total 162 164 Diseases of Children 0 36 Cases of Pregnancy and Parturition and Diseases of Women 0 21 Total 162 221 It will be observed that under the arrangement to come into operation on 1st April, 1918, there will be no reduction in the number of beds available for infectious diseases although the isolation accommodation will be less. If E Ward were not reserved for air raids the total number of beds available for infectious diseases would be 164 as compared with 162 previously. With E Ward reserved for air raids it will be possible to admit only a few, if any, cases of measles and whooping cough, depending on the accommodation which from time to time may be available. Medical and Nursing Staff.—The staff required for the hospital with 221 beds taking in the various diseases mentioned above and including the admission by day and night of cases of pregnancy, parturition and diseases of women and children is as follows:— 2 Resident Medical Officers. 1 Visiting Obstetrician and Gynaecologist. 1 Matron. 67 43 Nurses distributed as follows:— Wards. No. of Beds. Sisters. Staff Nurses. Probationers. Day. Night Day. Night. Day. Night. H 24 1 1 2 1 G 28 1 2 1 F 28 1 3 1 E 28 1 2 1 D 40 1 1 1 4 1 C 36 1 1 1 3 1 B 21 1 1 1 1 2 1 W 16 2 1 5 1 6 3 20 8 6 9 28 43 As all the 221 beds are not likely to be in use at one time and as E with 28 beds is at present reserved for air raids and W is a Convalscent Ward where little nursing is required, I do not think it is necessary to provide for the staffing of E and W. The total nursing staff may therefore be reduced to 36, made up of 6 sisters, 8 staff nurses and 22 probationers. This number allows for the necessary off duty time, holidays and sickness. Domestic Staff.—The domestic staff required numbers 31 made up as follows :— 8 Ward maids. 6 Laundry maids. 5 Kitchen maids. 4 Dormitory maids. 2 House maids. 2 Dining Room maids. 2 Mess Room maids. 2 Needle Room maids. Beds for Staff.—The re-arrangement of the lodge, steward's offices, and stores and other alterations at present 68 in progress provides the necessary 8 additional beds for the doctors, matron and staff of 36 nurses and 31 maids without any spare accommodation. Additional Furniture required.—There has been taken into stock at the Municipal Hospital all available stock at Kingsbury Hospital including two cots. All the adult beds necessary have been provided out of existing beds leaving 7 over, which have been transferred to Kingsbury. The Health Committee at its meeting on the 4th December, 1917, approved the purchase from various firms of the following furniture for which estimates had been obtained. Cost. £ s. d 10 Patients' Basket Chairs. 21 5 0 5 Small Easy Chairs 13 15 0 15 Cushions for Chairs 3 11 3 6 Nursing Chairs 5 2 0 24 Small Children's Chairs . 9 12 0 36 Lockers 96 6 0 1 Writing Desk 13 5 0 1 Writing Table 4 7 6 2 Writing Desk Chairs 6 6 0 1 Book Case 12 10 0 1 Book Shelf 0 15 0 2 Coal Scuttles 3 1 0 2 Fire Irons 0 10 0 2 Small Folding Tea Tables 5 0 0 1 Table 12 18 6 6 Chairs 9 3 0 1 Settee 10 10 0 5 Small Bedroom Tables 3 18 9 3 Dressing Chests 25 14 6 3 Bedroom Chairs 1 10 6 Carried forward £259 1 0 69 Brought forward £259 1 0 7 Wardrobes 82 16 0 1 Linen Cupboard 24 4 0 6 Carpets and Underfelts 47 0 7 6 Bassinettes 11 18 6 6 Bassinette Mattresses 5 11 0 6 Bassinette Pillows 1 10 0 66 Cots 165 0 0 12 Mattresses 24 0 0 4 Patients' Couches 24 5 0 38 Bedboards 12 16 6 Total £658 2 7 In addition to the furniture, etc., shewn in the foregoing, blinds are required for B Ward and blinds and linoleum for the new staff quarters and the necessary furniture and instruments for the operating theatre. Estimates for the blinds and linoleum will be obtained and submitted subsequently. A sum of £400 should be included in next year's estimate for the equipment of the operating theatre. Stock.—The war was calculated to last three years and the stock in hand at the Municipal Hospital had fallen very low at 31st March, 1917. Apart from provisions and necessaries it was as follows:— £ s. d. £ s. d. Drapery and clothing 134 5 0 Furniture and utensils:— China and glass 8 9 3 Enamelled ware 16 8 8 Hardware 45 6 6 70 4 5 Oilman's goods and cornchandlery 78 15 0 70 It will be noted that 59 beds for patients and 8 beds for staff or 67 beds in all will be added to the hospital and stock has had to be purchased for these additional beds with a certain amount over to replenish the stores and to allow for increased consumption owing to the total number of beds having increased from 162 to 221 for patients and 62 to 70 for staff, or from a total of 224 to 291. Drapery and Clothing. Blankets.—The 67 additional beds each require 4 blankets (3 upper and 1 under) for current use and all the 291 beds require 2 blankets (1 upper and 1 under in reserve), 850 blankets in all were required as a minimum and 950 have been purchased. These have been difficult to obtain. The contractors, Atkinson & Co., could only supply 60, but 132 of the remainder have been obtained from Barker & Co., 118 from Shoolbred & Co., and 640 from Maple & Co. These purchases have been effected at a saving of £92 17s. as compared with contract prices, the total cost being £368 14s. The other purchases for the additional 67 beds under the heading of drapery and clothing include brown blankets, bedside mats, table linen, bed linen, clothing and uniform and have been made out of contract at an estimated cost of £468 4s. 1d. This will not increase the present low stock in hand. I am of opinion that it is necessary to set aside a special sum of £200 for this purpose in next year's estimate. Furniture and Utensils. An estimated amount of £388 10s. 3d. has been spent up to 24th November, 1917, under this head made up as follows:— 71  £ s. d. £ s. d. Crockery 78 11 0 Hardware 52 2 9 Cutlery 30 0 0 160 13 9 Furniture 227 16 6 £388 10 3 The furniture above referred to is for general use and includes blinds, ice safe, dinner trolley, coal barrow, laundry truck, store bins, linen baskets, etc. The crockery, hardware and cutlery costing £160 13s. 9d. is made up of £67, the amount estimated as required for the additional 67 beds, and £93 13s. 9d., to replace breakages and give a small stock in store. I am of opinion that a special sum of £250 should be allowed as a special item in next year's estimates to bring the hospital stock up to requirements, especially as regards hardware and enamelled iron and to have a reasonable amount of stock in hand. Maternity and Child Welfare Costs. 59 Additional beds for patients and 8 beds for staff, or 67 beds in all have been added to the Hospital. Wards B and C set apart for Maternity and Child Welfare together contain 57 beds and require 14 staff or 71 beds in all. Some of these beds, however, were already in use and it is therefore suggested that all the new stock as above purchased or to be purchased excluding stock to be taken into stores should be charged against Maternity and Child Welfare Initial Expenditure as follows :— 72 Maternity and Child Welfare:— £ s. d. Furniture, etc., as shewn above. 658 2 7 Blankets (284 out of 850 at an average cost of 8/8 per blanket) 123 1 4 Brown blankets, bedside mats, table linen, bed linen, clothing and uniform 468 4 1 Crockery, hardware, cutlery 67 0 0 1,316 8 0 Blinds and linoleum (estimated) 100 0 0 Other expenditure (say) 75 0 0 Total £1,491 8 0 The 9um allowed for Maternity and Child Welfare in the current estimates is £2,000. 73 HOSPITAL EXPENDITURE GENERALLY. The following Table shows the position with reference to the items dealt with in this Report :— (1) Sum allowed in Estimates for Year ending 31/3/18. (2) Estimated Purchases including Estimates submitted herewith up to 24/11/17 in respect of Maternity and Child Wel-% fare Extension. (3) Total Estimated Purchases up to 24/11 /17 including Maternity and Child Welfare Extension (Col. 3). (4) Estimated necessary Purchases yet to be made before 31/3/18. (5) Estimated Total Expenditure up to 31/3/18. Cols. 4 and 5.) (6). Drapery and Clothing £450 Blankets £123 1 4 Blankets £368 14 0 /loo £1148 14 0 Other £468 4 1 Other £680 0 0 Total £591 5 5 Total £1048 14 0 Furniture and Utensils £100 Crockery £67 0 0 Croekery £160 13 9 £200 (including Blinds and Linoleum £100). £1246 12 0 Hardware Hardware Cutlery Cutlery Furniture £658 2 7 Furniture £885 19 1 Oilman's Goods and Corn Chandlery £300 Total £725 2 7 Total £1046 12 10 £359 12 6 £50 £409 12 6 Maternity and Child Welfare £2,000 Total £2850 £1316 8 0 £2454 19 4 £350* £2804 19 4 *Half of this sum attributable to Maternity and Child Welfare and Initial Equipment. I am, Your obedient Servant, GEORGE F. BUCHAN, Medical Officer. 74 APPENDIX H. 4th December, 1917. SOME OBSERVATIONS ON MATERNITY AND CHILD WELFARE, BY THE MEDICAL OFFICER. To the Chairman and Members of the Health Committee. Mr. Chairman.—With your permission I would like to place before the Committee a few observations on Maternity and Child W'elfare, and at the same time state as briefly as 1 can the present position of Willesden in relation to the movement. We all know that there is an enormous wastage of human life going- on abroad and it behoves us who are at home to consider how best the wastage may be made good. This may be effected by one or other or both of two methods, viz. : by increasing the birth rate or reducing the infant mortality rate. Before the war the birth rate in Willesden was falling. It had fallen from 44'7 per 1,000 of the population in 1875 to 24'7 per 1,000 in 1913. Since war broke out the fall has been more rapid. Over 4,000 births occurred in Willesden in each year from 1903 up to and including 1913. In 1914 the number of births was 4,115, but in 1915 the number fell to 3,775, in 1916 to 3,6(58 while in 1917 at the present rate the number is not likely to exceed 2,766, or a drop of 32'8 per cent, since 1914. The war and the circumstances attending upon it account for the recent rapid diminution in the number of births but not for the falling birth rate in normal times which requires to be countered if the necessary reconstruction of human life is to proceed. There is little doubt that with the spread of knowledge prevention of 75 ception has become more and more common. In some cases prevention is practised because the people concerned do not want to have children. In other instances the practice is adopted by people who desire to have children but who cannot afford them. With the former class I do not know that you as representing the State in the area of Willesden are particularly concerned, but the latter class probably merits attention. The State requires children, and it has therefore been suggested that the State must assume an even greater responsibility in the future in respect of them by way of encouraging large families and rearing the children in a healthy manner under good environmental conditions. In some quarters it has been suggested that State subsidies should be given for every birth or for every birth after the first, second or third. I do not propose to examine the merits or demerits of these proposals but would leave them with you for reflection and consideration. Now 1 come to the second method, the conservation of human life by the reduction of infant mortality. I would particularly emphasize that infant mortality is a highly complex problem and that the full benefit of special measures directed against this evil can be obtained only if they are coupled up with general measures for sanitary and social improvement. You have already had before you to-night the fact that 38 deaths of infants occurred in Willesden during the eight weeks ended 3rd November, 1917. Everybody knows that there is much loss of infant life—before birth, at birth, and after birth—but the causes of these deaths have not yet been fully investigated and revealed. Venereal diseases account for a large number of abortions and miscarriages, but further scientific research is necessary to elucidate the particular physiological and pathological processes which go to determine the death of a child before birth, the birth of a child of low vitality and consequent 76 early death, or the birth of a healthy child living the number of years allotted to man. Willesden of course cannot solve these problems for the Universe, but as such problems arc vast and intricate, Willesden can very well take its share in helping to find the solution. But the practical question before the Committee is the saving of child life and the rearing of healthy children. These two problems are inseparable. For every life that is saved some other child is reared in a yet more healthy manner. I would like the Committee to get clearly in. their minds that a child is a living unit from the time that conception occurs in the mother's womb. It will therefore be readily understood and conceded that everything that helps the mother helps the child. The first problem then is how can the mother be helped. There are many methods. There should be no industrial employment of women before and for some time after childbirth. Indeed it would be to the national advantage if there were no employment of married women who are rearing families. The mother during the period of bearing and nursing the child must be well fed. Willesden has recognised this fact and has provided hot and wholesome mid-day meals for expectant and nursing mothers. 907 such meals were provided during the eight weeks since the Committee last met. Medical advice should be available for the mother during pregnancy and a Municipal Antenatal Clinic has been established at 9, Willesden Lane, for expectant mothers. This has proved a boon and is being increasingly made use of. Such clinics will also be associated with the other clinics the Committee have in view. Confinements should not take place in unsuitable dwellings. The Council have under alteration a pavilion at the Municipal Hospital which will take in necessitous cases of confinement, where the home conditions are unsuitable. There should be available for every woman at confinement the 77 vices of a trained and competent midwife and I am of opinion that these could best be obtained by the establishment of a Municipal Midwifery Service. In the meantime the Committee have decided to utilise the services of local midwives under conditions to be approved by the Local Government Board. In confinements at home it is necessary that Home Helps should be provided. The function of these women is to assist the midwife during the confinement and to clean up and look after the home for 14 days or so afterwards. Although no regular service of Home Helps has been established by the Committee, arrangements have been made from time to time to pay women in individual cases for rendering these domestic services at confinements and during the lying-in period. Medical aid should be at hand for cases which midwives are unable to accomplish. The medical men employed should be the most efficient to be found and they should receive adequate remuneration. 1 would specially emphasize that the cheapest in cases of difficult midwifery is really the dearest and that lack of manipulative skill often results in a life of misery for the patient. The medical men called in in such cases should issue reports to the Local Authority. This practice would be in the interests of the mother and the child and help to secure the efficiency of the midwifery service. The Committee now pay for the services of a medical man called in by a midwife in urgent and necessitous cases, and are in communication with the Local Government Board for approval to a scheme which has been submitted. Hospital accommodation should be provided for cases requiring operative interference. Some additions and alterations to a pavilion at the Municipal Hospital are at present in hand with a view to early admission of such cases. Nothing has struck me more in connection with enquiries into the economic circumstances of families in relation to the 78 provision of school meals or the provision of a midwife in necessitous cases than the fact that the husband only gives the wife enough to cover the bare necessaries of existence while he himself conceals his actual earnings. The result is that the woman during the years of her life when she is bearing and rearing children is subjected to undue physical stress and mental anxiety. I think proper safe-guards should be instituted with a view of eliminating this inequality which is not in the national interests. More recently the matter of mothers' pensions or mothers' wages—it does not matter which you call them—has been advocated, as well as increased maternity benefit. The relationship of illegitimacy to infant mortality is particularly striking. Roughly 3 per cent, of all births are illegitimate and it is found that the infant mortality rate amongst these children is twice that of legitimate children. I am not concerned with the moral problem involved, but i am anxious that the lives of these children should be saved. As far as possible, every child should be under the care of its mother, but in some cases an institutional mother may be necessary and should be provided. Every child from birth upwards should be under regular medical supervision and there should be in addition advice at hand when the child is out of sorts. Parents only too frequently, on account of the cost, put off seeking medical advice until it is too late. Medical advice can now be had at the Council's Clinic which, however, at present is much over-crowded. Skilled medical treatment should be available for the child at home, at the clinic, and at the hospital. However this provision is made it should not be by any recognition or extension of the principle of panel practice. The doctors employed by the Local Authority should be eager, skilled clinicians, anxious to do the best thing 79 ble for the patients, without regard to any other consideration. They should be in a position to study their cases carefully with the most recent scientific appliances and to prescribe the line of treatment best calculated to restore health within the shortest time. Further hospital accommodation is required for children. The Committee have in course of provision 36 beds at the Municipal Hospital for the diseases of children. In connection with children's ailments it is especially important to be in a position to put the child under proper hospital regime from the commencement of the illness. Hitherto it has been comparatively easy to secure a hospital bed for a child suffering from some gross pathological condition and consequently more or less unlikely to recover. On the other hand, it has always been a matter of extreme difficulty to secure the necessary accommodation for an ailing case from the hospital treatment of which the best results are to be expected. In addition to the children who are occasionally ill there are children who chronically have poor health. Such children do well in Convalescent Homes and especially under Open Air treatment and it is desirable that these should be provided for them. Children of this class if sent into the country and given good food and care soon repay the trouble and expense by complete restoration to vigorous vitality. In connection with child life the control of the milk supply is important. I think the Local Authority should be in a position to supply the infants of Willesden with fresh milk straight from the farm. At the present time milk is sold which is old and otherwise unsatisfactory and which has often lost in a great measure the vital properties so important to the young child. Infant foods, too, should be under control so that no advertisements regarding them are issued likely to mislead the public. 80 I have only one more word and it relates to Government Grants to Local Authorities. Mr. Councillor Taylor stated at the last meeting of the Council that, after all, Government Grants come out of the pockets of the people and that whether they come to the district coffers via a Government Department or the Local Rates it is the business of the Local Authority to see that they are wisely and profitably spent. I think that is a correct observation. Every new Government Grant is now associated with the issue of directions from the department concerned as to how it is to be spent and with the appointment of some new official or officials to see that the money is so spent. Much public time and money are wasted in the drafting and reading of minutes between departments. The principle on which Government Grants are at present distributed is bad, the tendency being to reduce the Health service to the level of the Poor Law service with the corollary of departmental orders and restrictions and loss of local freedom of choice and action. I would like you to be clear that I am not dealing with the question of the incidence of taxation but merely with the fact that the responsibility for the spending of public money on behalf of Willesden should, subject to proper and efficient safe-guards, be in the hands of the popularly elected Local Authority rather than under the bureaucratic control of a Government Department. All these matters which I have put before you are important. They mean increased cost, but it is a cost that will repay you. It will repay you in respect of increased manpower—I do not mean for the purposes of war, but for the peaceful pursuit of commerce and industry after the war— and I commend them to your careful attention. GEORGE F. BUCHAN, Medical Officer. 81 APPENDIX I. GRANTS IN AID. 1.—Maternity and Child Welfare (Local Government Board). Summary of expenditure incurred during the 12 months ended 31st March. 1. Inspectors of Midwives and Health Visitors— 1916. 1917. £ s. d. £ s. d £ s. d. (a). Salaries including War Pay 167 8 10 447 8 3 (b). Allowances for Uniforms Included with Salaries 19 13 9 (c). Travelling Expenses (Assistant Medical Officers & Health Visitors) 8 12 6 19 12 7½ 486 14 7½ 2. Centres— (a). Salaries of Medical Officer (Including War Pay 55 8 2 410 4 1 (b). Rent, Rates and Taxes 9 15 0 64 5 6 (c). Furniture&Equipment, 9 Willesden Lane 0 15 3 155 13 11 (d). Heating, Lighting, and Cleaning 1 12 0 25 2 2 (e). Drugs and other Medical requisites 5 7 4 17 3 11 (f) Alteration & adaptation of 9 Willesden Lone as Maternity & Child Welfare Centre 215 6 8 887 16 3 Carried forward £248 19 1 £1374 10 10½ 82 Brought forward £48 19 1 £ 374 10 10½ 3. Payment to Midwives, etc. — (b). Midwives 1 9 0 4. Provision of Home Nursing - - - 5. Hospital Provision— (a). Directly by the Council 60 15 0 6. Sundries— (a). Printing, Station ery, Postage, &c. 26 6 6 31 7 7½ (b). Other Items:- 1. Clerical Staff—Proportion of Salaries and War Pay 5 10 0 80 8 2 2. Estimated Expenses—Clerks Accounts Dept. 83 10 0 3. Medical Officer of Health's Travelling Expenses 20 0 0 4. Grant to Women's Civil Corps 20 0 0 5a. Purchase of Glaxo 129 6 10 227 l6 4 5b. Purchase of Virol 2 12 11 6. Home Helps (Wages) 3 15 0 7. Caretaker,9 Willesden Lane (Wages) 5 2 5 8 Provision of Offices '4 0 0 58 5 7 9. Maintenance „ 18 0 0 80 6 10 Registrar's Returns 38 8 4 35 12 9½ Carried forward £480 10 9 £649 6 4 £1436 14 10½ 83 Brought forward £480 10 9 £649 6 4 £ 1436 14 10½ 11. State Insurance 1 12 0 12. Sundries 10 11 2 4 2 9½ Total 491 1 11 655 1 1½ 2091 16 0 Deduct following Receipts— Sale of Glaxo 120 0 0 222 1 7 Sale of Virol 1 7 6 Grant for Year 1916 17 based 011 Expenditure for 1915-16 142 1 9 365 10 10 NETT EXPENDITURE Incurred 370 16 3 1726 5 2 For the purposes of grant the Board have deducted the following:— £ s. d. (a) Purchase of Glaxo 227 16 4 (b) Sale of Virol 1 7 6 (c) Home Helps 3 15 0 (d) Returns of Births 35 12 9½ (e) Clerical staff—Proportion of salaries 80 8 2 (f) Establishment expenses—Proportion 83 10 0 (g) Provision of Offices 58 5 7 (h) Maintenance of Offices 80 15 6 1916-17.—The Board have made a grant of £729 15s. 1d. Certain items are still under discussion with the Board. 84 II.—School Medical Service (Board of Education). Summary of payments made during the year ended 31st March:- 1. Salaries— 1915. 1916. 1917. £ s. d. £ s. d. £ s. d. (a) Salary of School Medical Officer 89 15 1 148 0 0 100 0 0 (b) Salaries of Assistant School Medical Officers 424 13 10 1,178 8 11 456 18 6 (c) Salaries of Specialist Officers (e.g., Ophthalmic Surgeon, Dental Surgeon) Spe:ialist, X-ray Clinic 140 4 2 150 6 7 119 13 5 (d) Salaries of School Nurses 447 17 10 935 16 0 649 6 10 (e) Clerical assistance 315 0 1 732 2 3 537 3 1 2. Travelling expenses 126 11 5 128 1 2 146 6 1 3. Printing, stationery, postage, etc. 267 2 8 257 2 4 112 10 10 4. Drugs, materials, etc. 36 5 7 61 17 11 68 9 10 5. Apparatus (e.g., weighing machines, ophihalmos copic, dental, X-ray apparatus) 95 7 3 42 7 9 8 4 6. Provision of spectacles 80 0 11 63 1 9 84 1 4 10 Carried forw.rd £2022 l8 10 £3697 4 8 £2275 1 9 85 Brought forward £2022 18 10 £3697 4 8 £2275 1 9 7. Coniributiors to external bodies (e.g., Hospitals, Infirmaries, Mursing 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 7 110 5 6 10. . Maintenance of premises (e.g., rent, rates,heating, lighting, cleaning, upkeep of furniture 146 19 0 320 2 0 226 14 6 11. Any expenditure not included in 1—10 above 7 11 3 14 9 2 10 15 1 Total £2,295 17 10 4,166 8 5 2,622 16 10 Total amount paid by, or recovered from, parents 1 17 9 3 15 6 6 2 9 Net Total £2,294 0 1 4,162 12 i 1 2,616 14 1 For the year 1916-17 a Grant of £1,177 10s. 4d., assessed at the rate of 45 per cent, of the expenditure, was made. 86 III.—Provision of Meals (Board of Education). Summary of payments actually made and sums actually received within the year ended 31st March. 1916. 1917. 1. Payments— £ s. d. £ s. d. (1) Purchase of food 1,202 1 5 749 11 9 (2) Salaries and wages 956 6 11 659 11 3 (3) Provision of premises — 11 5 7 (4) Maintenance of premises (e.g., heating, lighting, cleaning, rent, rates, taxes) ... 364 18 10 345 18 7 (5) Furniture and equipment— (a) Initial equipment of new premises 51 12 1 - (b) Annual repairs, replacements, etc 48 19 3 12 1 8 (6) Printing, stationery, postages, etc. 27 4 6 25 19 11 (7) Conveyance of children —- - (8) Carriage of food, etc. — - (9) Any expenditure not included in (1)—(8) above 57 15 1 28 1 7 2,708 18 1 1,832 10 4 Less meals supplied to children attending Special Schools 237 6 3 221 5 8 Total £2,471 11 10 £1,611 4 8 87 2. Receipts— Amount paid or recovered from parents 44 7 3 79 7 6 Amount received from voluntary contributions... — — Miscellaneous receipts — — Total ... 44 7 3 79 7 6 Net total expenditure £2,427 4 7 £1,531 17 2 Total number of meals provided: Dinners, 56,248; other meals, 694; Total, 56,942. Average total cost per meal: Dinners, 6'524d. ; other meals, 1d. Average cost per meal for food only: Dinners, 2.696d. ; other meals, 1d. 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 260, partly 2. 1916=17. The Board have deducted from the Authority's claim the sums of £15 and £14 19s. 8d. representing respectively "Proportion of salaries of the Education Staff" and "Gas supplied at the Leopold Road Centre," and the sum of £140 being the allocated rent of the Leopold Road, Gibbons Road and Furness Road Council Schools. The Board have paid a grant amounting to £680 18s. 9d. equal tr. 50 per cent. of the remaining expenditure.