WIL 019 Willesden Urban District Council. 1919. THE 44th ANNUAL HEALTH REPORT. GEORGE F. BUCHAN, M.D., D.P.H., Medical Officer of Health. London: WIGHTMAN & CO., LTD., Regency Street, Westminster, S.W. 1. 1920. 3 INDEX. PAGE Abnormal Children 9 Acute Polio Encephalitis 37 Additional Accommodation required at existing Clinics 121 Adults 76, 84 Anthrax 42 Appendix 86 Bacteriological Examinations 39 „ Outfits 38 Births 14, 96 „ Notification of 45, 96 Rates 14 Cerebro-spinal Meningitis 37 Chemical Examinations 39 Children 75 Children's Care Committee, Members of 5 Clinics, Additional Accommodation required at 121 Co-existent Disease 75 Convalescent Home 117 Council, Members of 5 Deaths 15, 88,96 „ Rates 15,40, 96 Dental and Medical Treatment—Attendances at Clinics 55 Diagnoses, Wrong 75, 82 Diphtheria 36, 74, 81 „ Antitoxie serum 38 „ Early Treatment 36, 143 Disinfection 39 Duration of Stay in Hospital 77 Dysentery 38 Education Committee, Members of 5 Encephalitis Lethargica 37 Enteric Fever 37, 74 Environmental Hygiene 7 Exceptional Children 58 Factories, Workshops, Laundries, Workplaces and Homework 52 Feeding of School Children 99 „ in South Kilburn Area 98 Food 29 „ —Method of Calculation as to income per head 30 German Measles 40 Grants in aid 151 Gynaecological Cases 77, 84 Health Committee, Members of 5 Home Nursing 114 Hospital Accommodation—extension of Municipal Hospital 144 Hospital Committee, Members of 5 Hospital Report 73 Hospital Treatment 63, 106 House refuse, removal of 21,109,143 House refuse, collection, removal and disposal of, by Direct Labour-Electric Vehicles 109 „ „ „ „ „ Contractor 1ll Houses—Number inspected 50 Housing 48 Hygiene—Instruction in 130 Illegitimate Births 15 „ Rates 15 Infant Death inquiries 46 Infant Mortality 44, 96 „ „ of Illegitimate Infants 45, 96 ,, ,, ,, Legitimate „ 45, 96 „ Rate 44,96 Infectious Cases 74 4 page Infectious Disease—Notifications 33, 97 Influenza 40 „ vaccine 38 Instruction in Hygiene 139 Isolation 39 Malaria 38 Marriages 14 „ Rates 14 Maternity Cases 76, 83 Maternity and Child Welfare 42 „ „ Grants in Aid 151 Meals, Provision of 9, 67, 153 Measles 40,41 Medical and Dental Treatment—Attendances at Clinics 55 Medical Inspection—defects found 57 Medical Staff 79 Membranous Croup 36 Method of Calculation as to income per head 30 Mothers, School for 130 Motor Ambulance Service 9, 138 Municipal Hospital 9 „ „ Extension of 144 Natural and Social Conditions of the District 11 Non-Infectious Cases 75 Nursing Staff 78 Open-air School 123 Ophthalmia Neonatorum 44 " Other Infectious Diseases 44,74 Other Services 48 Out-Patients 77 Overcrowding 49 Personal Hygiene 7 Pneumonia 37 Poliomyelitis 37 Poor Law Relief 15 Population 12, 96 Premises and Occupations which can be controlled by Bye-laws or Regulations 26 Prevalence of and control over Infectious Diseases 33 Provision of Meals 9,67 „ „ „ Grants in Aid 153 Puerperal Fever 44 Rabies 42 Regulations of the Willesden Education Committee for the Control of Infectious Diseases in the Schools 28 Resignations of Staff 79 Sanitary Administration 47 „ Circumstances of the District 20 „ Inspection of District 23 Scarlet Fever 33, 74, 81 School Medical Service 106, 140 „ „ „ Grants in Aid 152 „ for Mothers 130 Sex Hygiene, Teaching of in Public Elementary Schools 105 Sickness amongst Staff 78 Smallpox 42 Special Schools 56, 123 Staff Resignations 79 Surgical Staff Visiting 77 Trench Fever 38 Tuberculosis 41 Vaccination 42 Venereal Diseases 42 Vital Statistics 14, 86 5 WILLESDEN URBAN DISTRICT COUNCIL, 1919-20. †* M«. Councillor W. M. BOLTON (Vice-Chairman'). Mr. Councillor W. L. TRANT BROWN. Mr. Councillor T. CHELLEW. †* MR. Councillor J. COMBER. †* Mr. Councillor J. E. CONLON. Mr. Councillor A. E. DORAN. Mr. Councillor A. GARDNER. * Mr. Councillor P. GARDNER. †* Councillor Dr. J. D. GRANGER-EVANS. Mr. Councillor H. G. GREENER. Mr. Councillor W. A. HILL. Mr. Councillor W. J. HILL. Mr. Councillor G. H. HISCOCKS. * Mr. Councillor C. W. HOGG, J.P. (Chairman). *Mr. Councillor E. W. B. HUTT. *Mrs. Councillor E. J. KENT. Mr. Councillor E. LANE. Mr. Councillor H. LATHAM. Mr. Councillor T. G. MATTHEWS. Mr. Councillor G. C. MINTER. †* Mrs. Councillor R. MOORE. * Mr. Councillor J. MORSE. * Mr. Councillor W. J. PYKE. Mr. Councillor C. REED. †* MR. Councillor W. RILEY, J.P. (Chairman of the Health and Hospital Committee) Mr. Councillor I. M. ROSENBAUM. * Miss Councillor M. E. ROYLE. Mr. Councillor H. J. SAVORY. * Mr. Councillor H. E. SCOTT. Mr. Councillor G. A. SEXTON. * Mr. Councillor A. SMITH, J.P. Mr. Councillor J. M.,SMITH. * Mr. Councillor S. P. VIANT. * Member of Health Committee. f Member of Hospital Committee. WILLESDEN EDUCATION COMMITTEE, 1919-20. Mr. Councillor W. M. BOLTON. *Mr. Councillor T. CHELLEW. Mr. Councillor A. GARDNER. Mr. Councillor W. A. HILL (Chairman). Mr. Councillor W. J. HILL. Mr. Councillor G. H. HISCOCKS. Mr. Councillor C. W. HOGG, J.P. Mr. Councillor E. W. B. HUTT. * Mr. Councillor H. LATHAM. * Mrs. Councillor R. MOORE. * Mr. Councillor J. MORSE. * Mr. Councillor W. J. PYKE. Mr. Councillor C. REED. * Miss Councillor M. E. ROYLE. * Mr. Councillor H. J. SAVORY. Mr. Councillor H. E. SCOTT. Mr. Councillor J. M. SMITH. Mr. Councillor S. P. VIANT. Mr. E. B. C. ARROWSMITH. * Mr. A. R. CLARK. Mr. W. J. DOWDELL. The Rev. E. R. FORD, M.A. (Vice-Chairman). * Miss M. A. LUPTON. * The Rev. G. MARTIN, M.A. * Mr. G. H. PLYMEN, B.Sc. * The Rev. H. MARTIN THORPE, M.A. (Chairman of Children's Care Committee). * Mr. D. T. WILLIAMS. * Member of the Children's Care Committee. 7 Municipal Offices, Dyne Road, Kilburn, N.W. 6. 1st June, 1920. To the Willesden Urban District Council— The Local Sanitary Authority, and the Local Education Authority. I beg to submit herewith the Annual Health Report for Willesden for the year 1919. This report includes:— (i.) the 44th Annual Report on the health and sanitary condition of the district; (ii.) the 12th Annual Report on the health of children attending the public elementary schools; (iii.) the 5th Annual Report on the provision of meals to school children, and to expectant and nursing mothers, and children, under 5 years of age ; and (iv.) the 28th Annual Report on the Municipal Hospital. The present report has been written strictly in accordance with instructions from the Ministry of Health, the headings of each paragraph being those supplied by the Ministry. The report discloses the efforts which are being made by the Council and the staff of the Health Department to maintain and improve the health of the population of Willesden, which was estimated at Midsummer at 170,625. Health depends upon two factors—(i.) Environmental and (ii.) Personal. Environmental Hygiene. Environmental hygiene is represented mainly by the work of the Sanitary Inspectors, which includes housing inspection, the abatement of nuisances, the supervision of drainage work, and the regulation of common lodging houses, slaughter houses, canal boats, moveable dwellings, factories and workshops, offensive trades and the like. Of recent years this work has not bulked to the same extent in the public eye as it did 10 years ago, but it is to be observed that the work of this section of the Health Department is practically as great in volume to-day as it has ever been, as may be seen from the following Table No. 1. Table No. 1. Total Number of Inspections made by Sanitary Inspectors each year since 1910. Year. Total Inspections. 1910 13,176 1911 13,301 1912 16,397 1913 11,800 1914 19,576 1915 15,596 1916 12,021 1917 6,344 1918 6,060 1919 12,484 Personal Hygiene. In Willesden steps are now taken to conserve the health of the people from infancy up to the end of school life through the Maternity and Child Welfare Scheme of the Council, and the Medical Inspection and Treatment Schemes of the Education Committee. Maternity and Child Welfare.—The first Clinic established under the Maternity and Child Welfare Scheme of the Council was the Baby Clinic opened in November, 1916. Subsequently other clinics were established, and there are now in working order ante-natal clinics for expectant mothers, clinics for nursing mothers, and clinics for children up to five years of age. These clinics provide the patients attending them with advice as to the care of their health and treatment of defects. They are worked in close association with the Municipal Hospital, where cases suitable only for hospital treatment are referred. 8 The ante-natal clinics have been of great use in anticipating dangers at confinement, and saving much suffering at childbirth and afterwards. During 1919, 36 confinements were arranged for at home, and 273 were booked up for the Municipal Hospital. In connection with the home confinements, midwives and home helps are provided by the Council in those cases in which the economic circumstances fall below the scale adopted by the Council. The success of the Infant Clinics may be gathered from the fact that in 1918 the infant mortality rate per 1,000 births among babies attending the clinics was only 46.1; among the babies not attending the clinics 161.6; and for all babies 97. In 1919 the infant mortality rate per 1,000 births among babies attending the clinics was 38.5; among babies not attending the clinics 110.1; and for all babies 82.8. The marked difference between the infant mortality rate of babies attending the clinic as compared with babies not attending the clinic in two successive years testifies to the character of the work which has been accomplished at the clinics established by the Council. It should be observed that these satisfactory results have been achieved under great pressure and at a time when it was impossible for the Medical Staff to give to each infant attending at the Clinic sufficient time for the thorough investigation of the case and subsequent advice to the mother as to any necessary treatment and more important still the care and maintenance of the health of the child. School for Mothers.—During the year 1919, 1,089 attendances were made by mothers. The mothers attending are mainly those who are pregnant with their first child, and desire information as to their health and the subsequent care of the baby. They also want instruction in sewing, dressmaking, and the cutting out of garments for themselves in pregnancy, confinement and the baby after birth. Owing to the large amount of work to be undertaken by the staff in other directions, it has not been possible to give this school the attention it deserves, but now that the Council have appointed a needle-woman to assist the assistant-matron in charge of the school, attendances are already improving, and further good work is anticipated. Medical Inspection of School Children.—The Board of Education requires the Authority to undertake the medical inspection (i.) of all children admitted to schools in the area in the year ending on 31st March ; (ii.) of all children between 8 and 9 years of age ; and (iii.) of all children between 12 and 13 years of age, together with children over 13 years of age who have not been examined on reaching the age of 12. This work, which will involve some 8,000 inspections of children at the schools per annum, is not at present being carried out owing to insufficient staff and accommodation. It is, however, obligatory on the Authority, and will be carried out as soon as the arrangements contemplated have been decided upon. Specially Referred Children.—During the year 1919, 9,952 children were specially referred by head teachers, attendance officers and others. Of this number 6,240 were medically examined, the others being dealt with by the nurses attached to the Health Department. Medical Treatment of School Children.—Medical Treatment of school children is compulsory upon the Local Education Authority under the Education Act of 1918. Clinics have been established in Willesden for this purpose. The first clinic established was a ringworm clinic in 1913, and since that time, eye clinics, minor ailment clinics, throat, nose and ear clinics, and cleansing and skin clinics have been established. In addition, the Board of Education have sanctioned the treatment of school children at the Municipal Hospital. Dental Work.—Dental Clinics for mothers and children were opened by the Council and Education Committee in 1918. 878 attendances were made at the Dental Clinics by mothers and children under five years of age during 1919. Difficulty was experienced in dealing with the mothers on account of the fact that no provision existed at the end of the year for the supply of dentures. The Council have now arranged to make such provision, and in these circumstances it is hoped that, with additional dental assistance, it will be possible to deal with the cases of dental caries, pyorrhoea, and oral sepsis found in expectant and nursing mothers. These conditions are not only harmful to the mother, but are also prejudicial to the health of the child she is rearing. During 1919, 2,804 children in the infants' departments were examined by the dentists at the routine school inspections, and 2,332 children were specially referred by head teachers and others to the clinics for dental examination or treatment.' 11,024 attendances were made by scholars at the clinics for extractions, fillings and other treatment. Dispensaries.—Simple prescriptions were made up at the dispensaries attached to the clinics for expectant and nursing mothers and children. 13,880 prescriptions were thus dispensed during 1919. Clinic Attendances.—The following Table No. 2 shews the growth of Clinic Work, the total attendances rising from 299 in 1913 to 90,951 in 1919. 9 Table No. 2. Shewing attendances at the Municipal Clinics each year since 1913. Year. Mothers, and Children under 5 years. School children. , Grand Total. Medical. Dental. Total. Medical. Dental. Total. 1913 0 0 0 299 0 299 299 1914 0 0 0 2,517 0 2,517 2,517 1915 0 0 0 5,674 o 5,674 5,674 1916 389 0 389 9,593 0 9,593 9,982 1917 8,641 0 8,641 9,448 0 9,448 18,089 1918 32,169 1,165 33,334 15,811 2,403 18,214 51,548 1919 32,870 878 33,748 46,179 11,024 57,203 90,951 Control of Infectious Diseases.—3,268 cases of notifiable infectious diseases were notified during 1919, and visited and dealt with by the health visitors. In addition, 1,300 non-notifiable infectious diseases intimated from the public elementary schools received attention. Work of the Health Nurses.—Health visitation is undertaken at the homes by fully-trained nurses appointed by the Council in connection with notified births, the health of expectant and nursing mothers and children up to five years of age, and infant mortality enquiries. The Health Nurses also follow up at the homes defects of school children notified from the schools or under treatment at the clinics, such as want of cleanliness, eye diseases, diseases of the nose, throat and ear, skin diseases, defective teeth and the like. The total number of visits made by the Health Visitors during the year 1919 was approximately 60,000. It is satisfactory to record that, in respect of school children, they succeeded in securing treatment for 15,129 out of 17,035 defects, or 90.6 per cent. Home Nursing.—The Council had this question under consideration in connection with the home nursing of pneumonia, measles, whooping cough, epidemic diarrhoea and ophthalmia neonatorum, and other conditions particularly amongst mothers and children. The Council decided to put this service into operation, and the Ministry of Health sanctioned half the cost of the service as attributable to maternity and child welfare. The service came into operation on 19th January, 1920. Abnormal Children. The Health Department is also responsible for the care of the abnormal child, i.e., the blind, the deaf, physically defective and the mentally defective. All cases of abnormal children are submitted to a special examination, and placed in day schools or residential schools, suitable to their attainments and special disability, subject to the sanction of the Education Committee. At the end of 1919 there were 14 blind, 28 deaf and dumb, 191 mentally defective, 20 epileptic and 403 physically defective children under the observation of the Health Department. The 403 physically defective children should be in attendance at an Open Air School, the provision of which is now compulsory upon the Local Education Authority, and is under their consideration. Provision of Meals. Meals are provided by the Council and the Education Committee at three centres provided and maintained by the Education Committee, and one voluntary centre, to expectant mothers and children under five years of age, and school children in cases where the circumstances of the family come below the economic scales fixed by the Council or Education Committee. During 1919, 1,140 mothers and children under five were provided with 13,455 meals, and 7,638 school children were provided with 102,632 meals. Motor Ambulance Service. This service continues to do excellent work, and is much appreciated by the public. Daily some 100 abnormal children are taken to the mentally and physically defective schools. About 600 cases of infectious disease are removed each year, and some 1,000 cases of sickness or accident are also removed. In addition, about 700 journeys per annum are made in connection with disinfection of bedding and other articles. Seven motor vehicles are at work, and the total number of miles travelled per annum is 50,000. Municipal Hospital. The detailed report on the Municipal Hospital herewith deserves the notice of every member of the Council as well as the general public of Willesden. 10 56 beds were added to the Hospital in June, 1918, and since that date the Municipal Hospital has dealt with Maternity cases, cases of diseases of children and adults, as well as Infectious diseases. The year 1919 was the first full year of working under the new conditions, and during that year 1,704 cases were admitted and 249 cases seen at the special out-patient consultations held at the Hospital by the Gynaecologist and Surgeon. While only 56 beds have been added to the Hospital, or 33 per cent, of the original number, the work during the year 1919 has been 100 per cent, more than that of any previous year. The demand for hospital accommodation has been so great that it became necessary for the Council, in March, 1920, to restrict admissions to the hospital. The need for additional hospital accommodation in Willesden is urgent, as the tendency is for people generally to prefer hospitals for the treatment of minor as well as more serious conditions, and the Medical Practitioner more and more desires to have hospital accommodation for the treatment of his patients, as well as facilities for enabling him to improve his knowledge and enhance his experience at a well-equipped and properly appointed institution. It is gratifying to note that of the 325 children under five years of age who were admitted to the Municipal Hospital, 51 were so admitted at the request of private medical practitioners. It is difficult to estimate the number of beds which will be required in a community, in the near future with the development of public opinion in the direction of hospital treatment, but it is probably no exaggeration to say that the number of hospital beds to be provided for all conditions other than mental diseases approximates 1 per cent, of the population, which would mean something like 1,700 for Willesden. There are in Willesden at present approximately 200 beds at the Municipal Hospital, 430 at the Infirmary, 72 beds at the Willesden Cottage Hospital, 24 beds at St. Monica's Home, and 97 beds in use by Tuberculosis cases from Willesden provided by the Middlesex County Council, or approximately 823 beds in all for Willesden people, showing a deficiency of approximately 877 beds. The proposal therefore before the Council to extend the Municipal Hospital by 200 beds is but a modest measure of the present needs of Willesden for additional hospital accommodation. Your obedient Servant, GEORGE F. BUCHAN, Medical Officer of Health. 11 THE FORTY-FOURTH ANNUAL REPORT For the Year 1919 on the HEALTH and SANITARY CONDITION of the URBAN DISTRICT OF WILLESDEN. 1. NATURAL AND SOCIAL CONDITIONS OF THE DISTRICT. Population (Census 1911, and estimated 1919).—The following Table, No. 3, shews the population estimated by the method in vogue in Willesden, at Midsummer of each year since 1901, together with the estimated annual increase and the natural increase as indicated by the excess of births over deaths:— Table No. 3. Year. Estimated Midsummer population. Estimated annual increase of population. Natural increase of population, i.e excess of births over deaths. 1901 116,089 - 2,141 1902 122,211 6,122 2,120 1903 129,315 7,104 2,477 1904 134,539 5,224 2,776 1905 140,758 6,219 2,457 1906 142,871 2,113 2,600 1907 146,107 3,236 2,543 1908 149,035 2,928 2,472 1909 150,145 1,110 2,494 1910 153,253 3,108 2,417 1911 154,344 Census Population — 1911 156,572 3,319 2,151 1912 159,868 3,296 2,472 1913 163,644 3,776 2,360 1914 166,634 2,990 2,363 1915 166,840 206 1,745 1916 167,810 970 1,958 1917 169,344 1,534 998 1918 169,358 14 373 1919 170,625 1,267 1,158 The following Table, No. 4, gives certain particulars as to the estimated population of 170,625 at Midsummer, 1919.— 12 TABLE NO. 4.—POPULATION ESTIMATED AT MIDSUMMER, 1919. 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 of houses recently erected- Empty Houses. Total. Wholly unoccupied. Partly Empty. No. having one or more empty tenements. Empty tenements, exclusive of those houses wholly unoccupied. Total No. occupied. No. empty. 1 room. 2 rooms. 3 rooms. over 3 rooms. (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) (13) (14) (15) (16) (17)  Met. Drain Area. 1. South Kilburn 15,132 1,306 9 7 — 6 1 — 10,334 10,273 61 — — — .68 .59 2. Mid Kilburn 15,079 1,762 17 — — — — — 13,635 13,524 111 — — — .96 .81 3. North Kilburn 12,844 2,047 22 1 — — — 1 17,068 16,812 256 — — — 1.07 1.49 4. Brondesbury Pk. 10,019 1,421 5 — — — — — 11,463 11,411 52 — — — .35 .45 5. Kensal Rise 14,433 1,895 1 — — — — — 12,514 12,507 7 — — — .05 .05 6. Harlesden 17,642 2,592 7 — — — — — 18,182 18,132 50 — — — .27 .27 TotalMet.Drain Area 85,149 11,023 61 8 — 6 1 1 83,196 82,659 537 — — — .55 .64 Brent Drain Area. 7. Stonebridge 17,954 2,090 14 3 — — 1 2 13,895 13,800 95 — — — .66 .68 8. Roundwood 15,932 2,196 1 — — — — — 15,631 15,620 11 — — — .04 .07 9. Church End 14,393 1,980 13 1 — — 1 — 12,382 12,323 59 — — — .65 .47 10. Willesden Gn. 17,213 2,482 6 3 — — 3 — 16,594 16,567 27 — — — .24 .16 .11. Cricklewood 19,984 3,766 26 1 — — — 1 29,288 29,089 199 — 2 — .69 .67 TotalBrentDrain Ar. 85,476 12,514 60 8 — — 5 3 87,790 87,399 391 — 2 — .47 .44 Total 170,625 23,537 121 16 — 6 6 4 170,986 170,058 928 — 2 — .51 .54 13 Physical Features and General Character of the District.—Willesden is an Urban District in the County of Middlesex immediately adjacent to the County of London on its North-West borders. It is bounded on the North-East and North by the Borough of Hampstead and the Urban District of Hendon; on the North-West and West by the Urban Districts of Kingsbury, Wembley and Greenford; and on the South and East by the Urban District of Acton, and the Boroughs of Hammersmith, Kensington and Paddington. It covers an area of 4,384 acres, and is situated on the London clay, which is generally bare throughout the district. The lowest point of Willesden is near the spot where the boundary line between Willesden and Wembley crosses Harrow Road, and is 78 feet above O.D., and the highest point is at Dollis Hill, 242 feet above O.D., the usual average variation within the district being from 100 to 170 O.D. A ridge dividing the district into two unequal areas crosses it in a south-westerly direction, thus creating two distinct drainage areas. The smaller area to the south of the ridge draining to the Thames contains 1,154 acres, the larger area north of the ridge draining to the Brent consists of 3,230 acres. The crest of the ridge has an elevation of about 200 O.D. in the North-East, falling to about 150 O.D in the South-West. Social Conditions, including the Chief Occupations of the Inhabitants, and the Influence of any Particular Occupation on Public Health.—The census returns of England and Wales, 1911, contain data relative to social conditions and the numbers employed in occupations of special local importance, among males and females of 10 years and upwards, in the Urban District of Willesden, as shewn in the following Table, No. 5. Table No. 5. Males over 10 years. Females over 10 years. 55,003 Total Occupied and Unoccupied 64,775 8,639 Retired or Unoccupied 43,786 46,364 Engaged in Occupations 20,989 1,933 National and Local Government 310 462 Teaching 1,011 137 Domestic Indoor Service 6,133 - Charwomen 479 268 Laundry Workers 2,680 2,966 Commercial Clerks 1,319 332 Law Clerks 15 4,319 On Railways 26 330 Motor Car Drivers — 748 Cycle and Motor Car Workers — 1,436 Carmen, Carters — 1,397 Messengers, Porters 16 110 Farmers, Farm Workers 4 333 Builders — 700 Builders' Labourers — 1,133 Carpenters — 794 Bricklayers — 114 Masons — 1,809 Painters — 451 Plumbers — 813 Others in Building Trade 1 284 Navvies, Road Labourers — 52 Dressmakers 2,644 Of the 46,364 males and 20,989 females, employed in various occupations the following Table, No. 6, gives the percentage proportion of those engaged. 14 Table No. 6. Males. Females. National and Local Government 4.16 Teaching 4.81 Commercial and Law Clerks 7.11 Domestic Indoor Service 29.22 On Railways 9.31 Laundry Workers 12.75 Motor Car Drivers and Cycle and Motor Car Workers 2.32 Commercial and Law Clerks. 6.36 Dressmakers 12.59 Carmen, Carters 3.09 i" Messengers, Porters 3.01 Builders, Builders' Labourers, Carpenters, Bricklayers, Masons, Painters, Plumbers and others in Building Trade 13.25 The following Table, No. 7, sets out under generalised headings the total number of males and females engaged in occupations at ages 10 years and upwards. Table No. 7. Males. Females. I. General or Local Government of the Country 1,933 310 II. Defence of the Country 123 — III. Professional Occupations and their Subordinate Services 2,398 1,994 IV. Domestic Offices or Services 1,145 9,793 V. Commercial Occupations 5,167 1,393 VI. Conveyance of Men, Goods and Messages 9,432 128 VII. Agriculture 460 7 VIII. Fishing — — IX. In and About, and Working and Dealing in the Products of, Mines and Quarries 110 3 X. Metals, Machines, Implements and Conveyances 4,400 231 XI. Precious Metals, Jewels, Watches, Instruments and Games 965 74 XII. Buildings and Works of Construction 6,452 1 XIII. Wood, Furniture, Fittings, Decorations 1,513 159 XIV. Brick, Cement, Pottery and Glass 156 30 XV. Chemicals, Oil, Grease, Soap, Resin, etc. 599 83 XVI. Skins, Leather, Hair and Feathers 286 70 XVII. Paper, Prints, Books and Stationery 1,304 263 XVIII. Textile Fabrics 786 643 XIX. Dress 2,117 3,966 XX. Food, Tobacco, Drink and Lodgings 4,447 1,466 XXI. Gas, Water, and Electricity Supply and Sanitary Service 688 — XXII. Other, General, and Undefined Workers and Dealers 1,883 375 46,364 20,989 During the period of the war a considerable number of munition factories were established in and around Willesden. These factories employed large numbers of workpeople, both male and female, who immigrated into the District from all parts of the country. Although the manufacturing of munitions of war has ceased, many of the ex-munition workers are employed in connection with Metal and Wood working industries recently established in Willesden. Vital Statistics.—The population of Willesden estimated at Midsummer, 1919, was 170,625. Marriages.—Table No. 8. Total number of marriages in Willesden 1,558 Marriage Rate in Willesden per 1,000 of population 18.26 Marriage Rate in England and Wales per 1,000 of population 19.7 Births.—Table No. 9. Total number of births in Willesden 2,924 Birth Rate in Willesden per 1,000 of population 17.13 Birth Rate in England and Wales per 1,000 of population 18.5 15 Illegitimate Births.—Table No. 10. Number of Illegitimate Births 122 Illegitimate Births per 1,000 total births 41.72 Deaths.—Table No. 11. Total number of deaths in Willesden 1,766 Death Rate in Willesden per 1,000 of population 10.35 Death Rate in England and Wales per 1,000 of population 13.8 242 deaths of infants under one year of age occurred during 1919, giving an Infant Mortality Rate of 82.76 per 1,000. The Amount of Poor Law Relief.—The following Table, No. 12, shewing the proportion of persons in receipt of relief to the population on or about January 1st, 1919, has been kindly supplied by Mr. J. Hutton Haylor, Clerk to the Willesden Board of Guardians:— Table No. 12. Ratio per 1,000 of estimated population. Indoor Poor. Outdoor Poor. Total chargeable (including lunatics). England and Wales 4.9 7.6 14.7 County of London 10.4 4.5 18.6 County of Middlesex 3.7 3.7 9.6 Willesden Urban District 5.8 3.3 10.9 Mr. Haylor explains that the higher proportion of indoor poor in Willesden as compared with Middlesex generally is owing to the large number of sick cases which have been admitted to the Infirmary owing to the dearth of Hospital accommodation and to the large number of children of demobilised soldiers remaining under the care of the Guardians owing to want of house accommodation. The Extent to which Hospital and other Forms of Gratuitous Medical Relief are Utilised.—Many of the large London Hospitals are made use of by Willesden residents, St. Mary's Hospital and Paddington Green Children's Hospital probably being the most used. The extent to which Hospitals are utilised may be gauged from the following Table No. 13, which shews that 6 per cent, of the deaths of Willesden residents occurred in the Municipal Hospital and 13 per cent, in other Hospitals. Table No. 13.—Shewing total deaths of Willesden residents and number occurring at home, in Workhouses, or Hospitals:— No. Per cent, of Total Deaths. Total Deaths 1,766 Deaths of persons dying in their own homes 1,162 66 Deaths of persons dying in Workhouses 277 15 Deaths of persons dying in Municipal Hospital 102 6 Deaths of persons dying in other Hospitals 225 13 The following is a list of voluntary and other charitable agencies within the district established in the interests of sick persons, or public health as the case may be:— (1) District Nurses in connection with Nursing Associations, Churches, Missions, etc. A number of district nurses are at work in connection with one or other of the above-named bodies. (2) Hospital Saturday Fund.—Willesden Committee, Secretary, Mr. G. R. Bennett, 70, Sellons Avenue, N.W. 10. 16 (3) Invalid Children's Aid Association:— Aims and Methods.—To obtain for the children the best medical advice and treatment available, and to equip them as far as possible to earn their living in the future, by:— (1) Arranging for the necessary treatment in Hospitals or Nursing Homes. (2) Providing Convalescent Treatment. (3) Sending away for prolonged boarding-out in the country. (4) Providing surgical instruments and carriages. (5) Regular visiting in their own homes. The parents of the children are expected to contribute according to their means towards the cost of the treatment. Three Branches of this Association are at work in Willesden, viz.:— (a) The Willesden Branch, Hon. Secretary, Miss Emmeline Fisher, 14, Aylestone Avenue, Brondesbury Park, N.W. 6. Cases dealt with during 1919. Number of children on Register at beginning of year 449 Cases referred during 1919 100 Cases marked off, over age, etc. 39 Present number on Register 510 New Cases in 1919. Tuberculosis—Lungs 8 Bones (non-tubercular) 1 Spine 2 Skin 2 Hip 8 Eye 6 Ankle 1 Congenital Deformities 7 Glands 4 Infantile Paralysis 6 Tubercular Peritonitis 3 Injuries 5 Anaemia and Debility 25 Heart 2 Debility after Acute Illness 2 Diseases of the Nervous System 2 Rickets 3 Hernia 1 Diseases of Lung (non-Tubercular) 1 Spinal Curvature 2 Bronchitis 6 Bright's Disease 1 Asthma 1 Graves' Disease 1 Help given to Old and New Cases in 1919. Sent to— Convalescent Homes 32 Nursing Homes 7 Special Hospitals 1 Boarded out 25 Extensions from previous year 5 Visits paid (over) 2,090 Provided with— Surgical Instruments and Boots 40 Invalid Carriages 9 Crutches 2 Massage and Exercises 4 Clothing Many Assisted by Middlesex County Council 6 Relieved by Poor Law 3 Started work 10 (b) The Paddington and Kilburn Branch, Hon. Secretary, Miss Streatfeild, 9, Craven Terrace, Lancaster Gate, W. 2. (c) The Edgar Lee Home for Invalid Boys, 14, Stonebridge Park. The Home is for boys of 5 to 14 years of age suffering from Heart Disease and Rheumatism. It accommodates 22 boys who stay at the Home for periods of from 3 months upwards. (4) Kilburn, Maida Vale and St. John's Wood General Dispensary, 13, Kilburn Park Road, Hon. Secretary, R. Newnham Davis, Esq., M.R.C.S., L.R.C.P., 19, Greville Road, N.W. 6. The Dispensary deals with cases occurring in Willesden South of Dyne Road and Winchester Avenue, and East of Salusbury Road, i.e., about half of North Kilburn and practically the whole of Mid Kilburn and South Kilburn. (5) Kilburn Provident Medical Institute, 1, Greville Road, Kilburn, Secretary, H. T. Carter,, 84, Belsize Road, N.W. 6. 17 Objects.—Established 1874, to afford to the working classes the opportunity of securing medical attendance for themselves and their families when ill, by small weekly payments all the year round, on the plan of a club or benefit society. (6) Central Association for the Care of the Mentally Defective, Willesden Branch, Willesden After-Care Committee for the Mentally Defective, Hon. Secretary, C. Hicks Bolton, Esq., M.A., 15, Montrose Avenue, Kilburn, N.W. The objects of this Association are as follows:— 1. To do all such things as may, in the opinion of the Council of the Association, conduce to the efficiency of voluntary work, whether paid or unpaid, in connection with the Mentally Defective, or with any persons coming under the supervision of the Board of Control, or which may tend to promote or ensure the suitable treatment of defectives in England and Wales. 2. To render assistance, either directly or indirectly, through other bodies, societies, or persons, to Public Authorities in the administration of Acts relating to the care, control, treatment or education of defectives, when such assistance may be requested by such authorities. 3. To form, or assist in the formation of, Local Voluntary Associations in the different statutory areas in England and Wales, such associations to have as their main object the co-ordination of work for defectives in the area, and particularly the friendly visiting in their own homes of defectives not in Institutions. 4. To promote co-operation between Voluntary Societies dealing with defectives and between Public Authorities and Voluntary Societies, and to act as a means of communication between Local Voluntary Associations and Voluntary Bodies and Government Departments or Public Authorities. 5. To organise the training of teachers, visitors, guardians, attendants and others cerned in the care, treatment and supervision of defectives, and to assist in providing such persons for Public Authorities, Voluntary Associations or Institutions. 6. To keep records of (a) Defectives moving from one area to another, and (b) Societies, Institutions, etc., dealing with defectives. 7. To provide, or assist in providing, places of safety, observation homes, occupation, or occupation centres for defectives, and to make special provision for "double" defectives. 8. To issue literary publications, leaflets and pamphlets. 9. To promote, watch, support or oppose any legislation or amendment of existing lation, relating to defectives. 10. To assist in the care of individual defectives who are not already under the Statutory Authorities in all areas where no Local Voluntary Associations are formed. The following is an extract from the last published Annual Report dealing with the year 1918, and shews the scope of the work of the Willesden Branch of this Association "The work of this Committee has been greatly hampered owing to War conditions and the difficulty of securing the services of new Voluntary Visitors; there are now 18 voluntary visitors, besides the part-time paid visitor. The number of defectives supervised is 115. An endeavour is made to call four times a year on each defective except in a few cases where parents are hostile, or where home conditions are so favourable that supervision is not needed. With few exceptions, defectives who come under the care of the Committee are passed on from Special Schools. During the year two defectives have been placed in Institutions by the Local Authority, at the instance of the Committee. Every eftort has been made to induce employers in skilled trades to give employment to high grade mentally defective lads, but the Committee regret without success. The Middlesex Education Authorities have, however, consented to consider any suitable case in which a Trade Scholarship would benefit a mental defective, and it is hoped in this way to afford a technical training to high grade defectives which will enable them to take their place in the labour market. At present, the only industry in which boys have been placed by the Committee is the bootrepairing trade. There is no difficulty in finding situations as domestic servants fcr highgrade girls." (7) Passmore Edwards Hospital for Willesden, Harlesden Road, N.W. Hon. Secretary, George P. Dineen, Esq., Royston, 108, London Road, Wembley. This is a Cottage Hospital, and deals with in-patients and out-patients. Accommodation, 1918 72 beds. No. of In-patients admitted during 1918 583 No. of Out-patients 1,045 18 (8) Queen Charlotte's Lying-in Hospital, Convalescent Home, 20, Victoria Road, Kilburn, N.W. Established in connection with Queen Charlotte's Lying-in Hospital, Marylebone Road, N.W. Secretary, Arthur Watts, Esq. Patients are admitted before or after confinement on payment of 10s. a week per patient. Accommodation 13 beds. No. of In-patients admitted during 1918 119 (9) St. Monica's Home Hospital for Sick Children, 16, Brondesbury Park, N.W. Secretary, Arthur Watts, Esq. Boys between 2 and 13 years and girls between 2 and 15 years are admitted as in-patients for medical and surgical treatment on payment of 10s. a week (washing included) paid in advance. Cases of mental derangement, fits, and those suffering from infectious diseases are excluded. There are no out-patients. Accommodation 24 beds. No. of In-patients admitted during 1919 95 (10) St. Andrew's Hospital, Dollis Hill, N.W. 2. The Hospital was opened in 1913 for the reception of patients who, while not suitable subjects for free treatment in charitable institutions, are yet unable to meet the charges necessary to secure adequate medical or surgical treatment in Private Nursing Homes. Medical and surgical cases are received, but those of a mental, contagious, consumptive, or chronic nature are not admitted. In a certain number of beds preference is given to patients of French-speaking countries. Accommodation:— No. of beds (average during 1919) 50 No. of In-patients admitted during 1919 660 (11) Mothers' and Babies' Welcome and Club for Sailors' and Soldiers' Wives and Relatives, 84, Princess Road, Kilburn, N.W. 6. Hon. Secretary, Mrs. Howard Figgis. The following is an extract from the Annual Report of the above for 1918-1919. "Mothers' and Babies' Welcome is held every Tuesday afternoon; 1,241 attendances were made last year, 71 new babies were brought, and 1,439 visits have been paid. Friends who would like to see the work on that busy afternoon are heartily welcomed. Downstairs in one large sitting-room tea is served, in the other woolly garments are sold, as well as oatmeal, cod-liver oil and malt, etc. There, too, mothers may pay into the War Savings Association and take part in the Health Talk held towards the close of every afternoon. The mothers pass in turn upstairs to the Baby Weighing-room, where half-a-dozen mothers are busy undressing and re-dressing their babies. The Health Visitor dispenses simple remedies when prescribed by the doctor, gives advice as to clothing, etc., and settles which babies shall pass on to the Medical Officer in the room opposite. The Health Committee of the District Council sanctioned the free distribution of Glaxo and Virol in necessitous cases, and this is done under the direction of the Medical Officer of Health. Simple treatment when prescribed by the Doctor is given by the Health Visitor at a special hour each morning." (12) Harrow and Willesden Ruri-Decanal Association for Preventive and Rescue Work. St. Mary's Home, 34, Craven Park, N.W. 10. Superintendent and Worker, Miss Johnson. Worker's Report. "During the year 1919, 172 girls have come under the influence of the Home, all with a sad story to relate, all needing practical help, sympathy, and an inspiration to start afresh. 70 stayed at St. Mary's. (14 Police Court cases.") 31 were placed in Maternity Homes or Hospitals. 22 were placed in situations. 9 sent for special medical treatment. 4 sent to Long Homes. 24 passed on to their local workers. 2 married. 6 certified as mentally deficient. 2 restored to their parents. 4 made their own arrangements. 10 assisted in obtaining payment from the father of the child." 19 (13) Dollis Hill House Convalescent Hospital, Gladstone Park, Willesden, N.W. 2. Hon. Secretary, Dr. Bridges. This Hospital was taken over by the Ministry of Pensions in May, 1919. First pensioner patient admitted 12th June, 1919. Number of in-patients treated up to 23rd March, 1920 155 No. of beds 43 (40 during 1919). No. of operations 24 . No. of out-patients for quarter ended 25th March, 1920 37 Medical Officer in Charge—Dr. Cruden, Anson Road, Cricklewood. Visiting Surgeon—Mr. Maynard-Smith, St. Mary's Hospital. Patients receive also massage and electric treatment. (14) Willesden Women's Civil Corps, Child Welfare and Nursery Committee, St. Mary's Road Parish Room, Church End, Willesden. Hon. Secretary, Miss V. L. James, 6, Craven Mansions, N.W. 10. A session is held every Tuesday afternoon at the People's Hall, Goodson Road, for children under 5. A trained nurse is in attendance. Dr. Granger Evans attends alternate Tuesdays. March, 1918—March, 1919. No. of attendances of children under 5 1,142 Average attendance per session 47 No. of first visits paid by salaried worker 200 Total number of visits paid by salaried worker 400 (15) 23rd Middlesex Voluntary Aid Detachment (British Red Cross Society), Willesden Section. Headquarters, 69, Manor Park Road, Harlesden, N.W. 10. Commandant, H. H. Bobart, M.B.E. Hon. Secretary, H. Hayward. The Willesden Section of the 23rd Middlesex (Men's) Voluntary Aid Detachment consists at the present time of about 20 members, who have all obtained their First Aid Certificates. They have been actively engaged during the War chiefly in the transport of wounded soldiers from Central Military Hospitals to Auxiliaries. The members are keeping up their practice in First Aid and are prepared to assist in the case of street accidents to the best of their ability. The section is still maintaining an ambulance, which is available for civilian cases by arrangement. The cost of upkeep and petrol is met by the proceeds of occasional Whist Drives and Concerts, and a charge of 1s. per mile made for running the ambulance when patients are in a position to pay. In cases where the patients are too poor to make any payment, the Section has been pleased to undertake ambulance work gratis. (16) Voluntary Aid Detachment, Middlesex 58 (Women's). Commandant, Mrs. Aubrey Richardson, St. John Vicarage, Kilburn, N.W. 6. This Detachment was demobilised from Dollis Hill House Auxiliary Military Hospital at the end of March, 1919. Upon the urgent request of the County-Director and the Joint Committee of the Order of St. John's and British Red Cross Society, and because of the desire of the majority of the members to carry on for civil health and welfare work, and for Nursing Service with the Territorial Force, the Detachment did not disband. Drills and Meetings have been held at irregular intervals during the year April 1919 to April 1920. Its membership now is 80. Classes for Home Nursing and First Aid for the Order of St. John's Ambulance Certificates have been held; A. C. Mowbray-Swertz, Esq., M.B., Ch.B., B.A.O., being the Honorary Lecturer. In July 1919, the Detachment gave a "Welcome Home" Garden Party to the Disabled and Discharged Men of the South Kilburn District, in the Paddington Recreation Ground. Nearly 400 men and their wives attended, and these with friends of the Detachment who helped in providing for the guests, made up a party of over 800. The men were given a substantial and attractive supper in a marquee. A good tea was provided for the women. Sports and a Cricket Match for Prizes were arranged, and there was a Band for Dancing and a Musical Entertainment. The cost of the Garden Party was £84 10s. 7d., besides the value of Members' Food Contributions and other gifts in kind. For two evenings weekly since November, the Detachment has managed a canteen in connection with the St. John's, Kilburn, Ex-Service Men's Club at the Mission Hall, Carlton Vale. The refreshments provided have been much appreciated. 20 Members have also done duty as helpers at the Princess Day Nursery, Chichester Road, and have visited tor the Invalid Children's Aid Association and for the Medical Superintendent of the Kilburn Dispensary. Some are now detailed for Sunday relief duty in the Willesden Cottage Hospital. A Sewing Section for Provision of surgical requisites for Medical Missions and saleable articles for a Bazaar for the V.A.D. Funds, has been formed. At Christmas, a Carol Party collected for the National Institute for the Blind and for the Memorial Chapel in St. John's, Kilburn, to the 200 men of the Parish who lost their lives in the War. Sir Arthur Pearson sent a letter of warm thanks for the collection for his fund. In March, 1920, the Commandant organised two Public Red Cross Lectures in Cricklewood, which were kindly given by Dr. Charles Porter, Medical Officer of Health of St. Marylebone, on "The Place of Women in the Health Services." A. Qualifications, Training and Duties of Vocational Workers in Maternity and Child Welfare Clinics. B. The Sphere of Voluntary Institutions and Helpers. Lady Oliver, R.R.C., D.B.E., of the Joint Women's V.A.D. Committee, presided at the first, when over 70 women attended/and Dr. G. F. Buchan, Medical Officer of Health, Willesden, took the chair at the second, when the audience numbered 42. Some valuable information and ideas were interchanged. An important aim of the Detachment has been to establish an Orthopaedic and Tropical Disease Day and Evening Clinic for Disabled men under the Pensions Ministry, but so far, in spite of the most strenuous searches, the Housing shortage has prevented the acquisition of any suitable premises. (17) St. John Ambulance Brigade, No. 1 District; No. 56 Cricklewood Division, Divisional Headquarters, Midland Railway Institute, Edgware Road, Cricklewood; L. F. Eaton, 11, Midland Brent Terrace, Cricklewood, Divisional Secretary. (18) The Willesden Open Air Fund. Hon. Secretary, Miss Wheddon, 39, Ellesmere Road, Dollis Hill. This organisation sends delicate children for holidays in the country or children of parents who, through illness or other reason, are temporarily unable to look after them. During 1919, 66 children were sent away. The parents of the children contribute to the cost of the holiday according to their means. 2.—SANITARY CIRCUMSTANCES OF THE DISTRICT. Water.—The district is supplied with water by the Metropolitan Water Board, the supply being constant and of good quality. A frequent cause of contamination arises from the presence of dead mice and birds, dirt and other matters in the storage cisterns, and in many instances owing to the cisterns being placed in inaccessible and unsuitable positions, cleansing is difficult and seldom done. In all such cases the owners are requested to provide a supply direct from the rising main, without, however, removing the cistern which the Metropolitan Water Board requires to be placed in every house. Rivers and Streams.—The River Brent forms the Northern and Western boundary of the district. The Mitchell Brook, a tributary of the Brent, is a small stream running in a Westward direction through the district. A large sheet of water known as the Welsh Harp is formed at the extreme Northern boundary by the damming up of the Brent, thus forming a reservoir about a mile in length and about a quarter of a mile in width, or 160 acres in extent. The boundary line between Willesden and Kingsbury Urban Districts passes through the length of this reservoir, leaving an area of about 68 acres of it in Willesden. No pollution of any of these waters in the Willesden area came under the notice of the Health Department during the year. Drainage and Sewerage.—The drainage, sewerage and sewage disposal are on the water carriage system, and since the year 1911 have been taken by gravitation into the London sewers. Closet Accommodation.—With the exception of two or three outlying premises all the houses in the district are provided with closets on the water carriage system. Scavenging.—The Health Department was responsible for the removal of house refuse within the district during the year 1919-20. The work was actually carried out by a contractor, who was under contract to call at each house in the district at least once in each week and remove the domestic refuse. 21 Under the terms of the contract, which expired on 31st March, 1920, the contractor was required to dispose of the house refuse so as not to create a nuisance in Willesden. No destructor is provided by the Council. With the exception of a few streets in the older part of the district, where fixed receptacles for house refuse still exist, moveable receptacles are now generally in use. Steps are being taken to replace gradually the fixed by moveable receptacles from time to time. Removal of House Refuse.—Table No. 14. 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) 1919. January 30 6,354 211 February 28 7,381 263 March 31 7,574 244 April 25 6,467 259 May 27 6,433 238 June 23 5,304 231 July 26 5,932 228 August 24 5,054 211 September 26 5,610 216 October 27 6,339 235 November 25 6,494 260 December 25 6,739 270 Removal of House Refuse—Table No. 15. Shewing number of carts and men employed and complaints received. Year. Maximum No. of carts employed. Minimum No. of carts employed. Average No. of carts employed, Maximum No. of men employed. Minimum No. of men employed. Total No. of Complaints. Percentage of complaints to total No. of houses. (1) (2) (3) (4) (5) (6) (7) (8) V / 1901-2 34 20 24 58 36 189 1.09 1902-3 38 21 24 69 38 167 0.91 1903-4 39 22 25 70 36 139 0.72 1904-5 37 24 27 70 43 104 0.51 1905-6 29 18 19 58 36 198 0.95 1906-7 27 18 20 54 36 220 1.04 1907-8 22 10 18 44 20 105 0.48 1908-9 26 18 21 45 36 334 1.52 1909-10 23 15 18 42 30 111 0.50 1910-11 28 17 20 50 34 123 0.55 1911-12 29 12 21 50 23 204 0.90 1912-13 28 18 20 51 36 99 0.43 1913-14 27 13 19 44 26 178 0.77 1914 24 8 18 41 16 255 1.09 1915 41 6 19 78 12 1,611 6.86 1916 24 4 18 47 8 2,111 8.97 1917 36 3 18 76 6 1,526 6.48 1918 24 5 16 47 8 2,060 8.75 1919 26 6 18 48 12 1,889 8.02 22 Removal of House Refuse.—Table No. 16. Relating to quantities and costs. Year. Annual quantity collected. Total cost of collection as per contract. No. of Occupied Houses at Michaelmas. Population at Michaelmas. Amount of Refuse collected in cubic yards per house per annum. Amount of Refuse in cubic yards per head of population per annum. Cost per cubic yard. Cost per house. Cost per head of the population. Rate in the In cubic yds. In tons. (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) £ d. s. d. d. d. 1901-1 79,875 25,905 6,822 16,820 115,201 4.7 .69 20.5 8 1 14.2 3.13 1901-2 83,587 27,109 7,822 17,258 117,619 4.8 .71 22.5 9 0¾ 16.0 3.45 1902-3 91,170 29,568 8.972 18,188 123,987 5.0 .73 23.6 9 10½ 17.4 3.69 1903-4 99,761 32,354 9,945 19,172 130,621 5.2 .76 23.9 10 4½ 18.3 3.83 1904-5 99,510 32,273 10,929 20,009 135,613 4.9 .73 26.4 10 11 19.3 3.99 1905-6 88,860 28,819 7,450 20,735 140,692 4.3 .63 20.1 7 2¼ 12.8 2.60 1906-7 79.137 25.666 6,250 21,109 142,772 3.7 .55 19.0 5 11 10.5 2.10 1907-8 80,100 25,978 6,850 21,485 144,912 3.7 .55 20.5 6 4½ 11.3 2.20 1908-9 86,062 27,912 5,855 21,846 149,744 3.9 .57 16.3 5 4¼ 9.4 1.84 1909-10 80,558 26,127 5 604 22,069 151,000 3.7 .53 16.7 5 0¾ 8.9 1.73 1910-11 80,417 26,081 6,547 22,385 154,298 3.6 .52 19.5 5 10¼ 10.2 1.99 1911-12 84,367 27,362 6,547 22,679 157,717 3.7 .53 18.6 5 9¼ 10.0 1.97 1912-13 87,106 28,250 6,547 22,923 161,188 3.8 .54 18.0 5 8½ 9.7 1.93 1913-14 79,450 25,767 6,163 23,208 164,538 3.4 .48 18.6 5 3¾ 9.0 1.77 1914 76,002 24,649 6,436 23,279* 166,634* 3.3 .45 20.3 5 6¼ 9.3 1.85 1915 74,621 24,201 6,433 23,489* 166,840* 3.2 .45 18.9 5 5¾ 9.2 1.85 1916 72,694 23,576 8,283 23,543* 167,810* 3.1 .43 27.3 7 1 11.8 2.28 1917 72,673 23,569 9,596 23,537* 169,344* 3.1 .43 31.7 8 1¾ 13.6 2.61 1918 69,686 22,600 12,207 23,537* 169,358* 3.0 .41 42.02 10 4½ 17.3 3.29 1919 75,682 24,545 17,007 23,537* 170,625* 3.2 .44 53.9 14 5¼ 23.9 4.62 * Midsummer, 23 Removal of House Refuse.—Table No. 17. Relating to loads and costs. Total actual No. of loads removed. Average No. of loads per day. Average cost per van load. Average capacity of van in cubic yards. (1) (2) (3) (4) s. d. 10,941 34.5 31 1 6.92 Early in the year the Council had under consideration a special report submitted by the Medical Officer of Health, shewing the estimated relative costs of the collection and disposal of house refuse in Willesden by (a) collecting the refuse from a portion of the district only by Electric Vehicles, (b) collecting the refuse from the whole of the district by Electric Vehicles, and (c) collecting the refuse from the whole of the district by Horse-drawn Vehicles. The Council decided:— (1) To collect house refuse from that part of the district known as the South Kilburn area, containing 3,924 houses, by Electric Vehicles. (2) To enter into a contract for the barging away of house refuse at a sum of 5s. 6d. per ton, the contractor to provide a shoot. (3) To hire a Wharf at Harrow Road from the Grand Junction Canal Co. at a rental of £75 per annum. Three Electric Vehicles were accordingly purchased from Messrs. Ransome, Sims & Jefferies, of Ipswich, at a cost of £1,151 each, and work commenced on the 1st November, 1919. During the months of November and December the three vehicles were found to be satisfactory and capable of doing the work required of them. The experience gained in this short period is not sufficient to enable reliable or comparative figures to be presented at this stage. The Council, after further consideration, decided that dust collection from the whole of the Willesden district be undertaken by direct labour, and with Electric Vehicles, as from the 1st April, 1920. Eleven additional vehicles were accordingly ordered from Messrs. Ransome Sims & Jefferies. As from April 1st, 1920, the work of House Refuse collection will be under the supervision of the Surveyor to the Council. Sanitary Inspection of District. Table No. 18. Inspections: Number of premises inspected on complaint 2,559 Number of premises inspected in connection with infectious diseases 34 Number of premises under periodical inspection 796 Houses inspected from House to House (Housing Acts, 1890 to 1919) 278 Total number of inspections and re-inspections made 12,484 Action Taken (other than under Housing Acts, 1890 to 1919): Cautionary or Intimation Notices Issued 2,387 Number complied with 1,854 Statutory Orders issued 344 Number complied with 241 Summonses served 40 Number of convictions obtained 40 Summonses withdrawn 0 ,, dismissed 0 Notices under Section 36 of the Housing Acts, 1890 to 1919, issued 278 Dwelling Houses and action under Housing Acts, 1890 to 1919: Number of houses dealt with under Section 15 (Housing, Town Planning, &c., Act, 1909) 0 Number of houses dealt with under Section 28 (Housing, Town Planning, &c., Act, 1919) 8 Number of houses closed under Section 28 (Housing, Town Planning, &c., Act, 1919) 5 24 Number of houses found to be in a state dangerous or injurious to health, Section 17 (Housing, Town Planning, &c., Act, 1909) 2 Number of representations made by Medical Officer of Health, Section 17 (Housing, Town Planning, &c., Act, 1909) 2 Number of houses made habitable without closing orders 1 Number of closing orders made by Local Authority, Section 17 (Housing, Town Planning, &c.,.Act, 1909) 2 Number of closing orders determined after repairs, Section 17 (Housing, Town Planning, &c., Act, 1909) 0 Number of houses demolished— (a) by order of Local Authority, Section 17 (Housing, Town Planning, &c., Act, 1909) 0 (b) voluntarily 0 Illegal Underground Rooms vacated 0 Houses Let in Lodgings (Tenement Houses): Number registered under Bye-laws 0 Number of contraventions 0 Common Lodging Houses: Number registered under Bye-laws 2 Number of Inspections made 17 Number of contraventions 5 Canal Boats used as Dwellings: Number of contraventions of Regulations 3 Movable Dwellings, Caravans, Tents, &c.: N umber observed during the year 2 Number of nuisances therefrom abated 0 Number removed from district 0 Bakehouses: Number in district 64 Contraventions of Factory Acts 18 Slaughter-houses: Number on register 9 Inspections of carcases, etc. 428 Contraventions of Bye-laws 2 Cowsheds: Number on register 3 Number of inspections made 32 Contraventions of regulations 1 Number of milch cows in district 51 Dairies and Milkshops: Number on register 127 Number of inspections made 135 Frequency of inspection yearly Contraventions of regulations 8 Unsound Food: Meat (including organs) seized and surrendered 3,881 1bs. Poultry and game surrendered 272 1bs. Fish surrendered 4,780 1bs. Fruit and vegetables surrendered 36,162 1bs. Bacon surrendered 473 1bs. Flour surrendered 70 1bs. Cheese surrendered 63 1bs. Butter surrendered 56 1bs. Jam and Marmalade surrendered 308 1bs. Eggs surrendered 1,450 Method of disposal Part sent fat extractors, part for fowl and pig feeding, part manure, rest destroyed. Adulterated Food: Samples taken 0 Found adulterated 0 Offensive Trades: Number of premises in district 1 Number of inspections made 48 Contravention of Bye-laws 4 25 Water Supply and Water Service : Wells:— New sunk 0 Cleansed, repaired, etc. 0 Closed as polluted 0 Percentage of houses supplied from public water service 100 Cisterns:— New provided 5 Cleansed, repaired, covered, etc. 68 Draw-taps placed on mains 24 Percentage of houses supplied on constant system 100 Number of samples obtained for analysis from (a) Local Wells 0 (b) Public supply 0 Drainage and Sewerage of existing Buildings: Water Closets:— Number of water closets substituted for dry receptacles 0 Repaired, supplied with water or otherwise improved 171 Percentage of houses provided with water closets 100 Drains:— Examined, tested, exposed, etc. 85 Unstopped, repaired, trapped, etc. 113 Waste pipes, rain-water pipes, disconnected, repaired, etc. 131 New soil pipes or ventilating shafts fixed 25 Existing soil pipes or ventilating shafts repaired 60 Disconnecting traps or chambers inserted 32 Re-constructed 11 Cesspools:— Rendered impervious, emptied, cleansed, etc. 0 Abolished and drain connected to sewer 0 Percentage of houses draining into sewers 100 Disinfection : Rooms disinfected:— (a) Ordinary infectious diseases 730 (b) Phthisis 24 Rooms stripped and cleansed 15 Articles disinfected or destroyed:— (a) Ordinary infectious diseases 6,000 (b) Phthisis 120 Dust: New bins provided 1,448 Periodical frequency of dust removal weekly. Number of complaints of non-removal received 1,889 Method of disposal By tipping and barging. Sundry Nuisances abated: Overcrowding 6 Smoke 6 Accummulations of refuse 37 Foul ditches, ponds, etc., and stagnant water 1 Fowls, pigs, and other animals 36 Dampness 145 Yards and forecourts paved, repaved or repaired 85 Walls and ceilings cleansed 596 Leaky roofs made watertight 74 Additional ventilation provided under floors 49 Dilapidated plaster repaired 331 Flooring and other woodwork repaired 62 Damp-proof courses inserted 22 Water supply reinstated 19 Washhouse floors repaved 44 Fireplaces and stoves repaired 28 Decayed brickwork repaired and repointed 55 Additional sinks provided 5 Additional light and ventilation to staircases 3 Larders or food cupboards provided 5 26 Gutters and rainwater pipes repaired 164 Smoke observations 20 Additional water closets constructed 8 Miscellaneous 0 Inspection of Premises where Food is prepared: Butchers' shops 55 Fish shops 46 Eating houses 28 Greengrocers' shops 46 Ice-cream premises 6 Canal Boats Acts, 1877 and 1884.—Table No. 19.—Return shewing the contraventions observed and remedied during the year:— Infringement of the Acts and Regulations with respect to:— Carried forward from 1918. Found during 1919. Remedied during 1919. Carried forward from 1919. (a) Registration — — — — (.b) Notification of change of Master — — — — (c) Certificates 1 2 3 — (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 1 3 4 — During the year 55 visits were made to the Canal, but only twelve boats were found there. These have been inspected. Three were found to be contravening the regulations. The other nine were in order and good condition. Since and during the war the transport work on the Canal, so far as Willesden is concerned, seems to have fallen off as compared with years previous to 1914. Premises and Occupations which can be Controlled by Bye-laws or Regulations. (1) Houses Let in Lodgings.—Reference to this subject is made later in the report. (2) Offensive Trades.—The following trades are recognised as offensive trades under Section 112 of the Public Health Act, 1875, viz.:— Blood boiler. Bone boiler. Fellmonger. Soap boiler. Tallow melter. Tripe boiler. 27 In addition, under Section 51 of the Public Health Acts Amendment Act, 1907, the following were scheduled as offensive trades in this district, with the approval of the Local Government Board, on the 12th day of February, 1912, viz.:— Blood drier. Fat melter and fat extractor. Glue maker. Gut scraper. Leather dresser. Rag and bone dealer. Size maker. Tanner. Early in the year a petition was received from residents living in the immediate neighbourhood of Brentfield Road, Neasden, complaining of offensive odours proceeding from a Factory used for the manufacturing of Dope and Varnish. Upon investigation, the nuisance complained of was found to be caused by the escaping vapours given off during the process of the boiling of ingredients used in the manufacture of Varnish. Considerable sums were spent by the owners in devising means to remedy the nuisance, by installing exhaust fans, condensing chambers, etc., ultimately with successful results. Since the completion of the apparatus, no further complaints have been received, and the premises, when visited, were found to be free of the irritating fumes. A communication was sent to the Ministry of Health, enquiring whether in any other district the trade of a Dope and Varnish maker had been scheduled as an offensive trade. A reply in the negative was received. With the exception of Rag and Bone Dealers, there are no trades established in Willesden coming within the trades defined in the above Schedules. An application was received during the year for permission to establish the business of a Rag and Bone Dealer at Lower Place, which the Council refused. There are ten Rag and Bone Dealers in Willesden, and in no instance were their trades found to be carried on unsatisfactorily. (3) Common Lodging Houses.—During the year one of the two common lodging houses in the district has been closed. In the case of the other common lodging house, the accommodation has been reduced by half. (4) Underground Sleeping Rooms.—Regulations governing underground sleeping rooms were made by the Council in 1913. The Annual Report of that year contains a full reprint of the same. During the greater period of the war, work in connection with the Regulations ceased, owing to the difficulty of obtaining labour and materials, but is now being partially resumed. Other Sanitary Conditions Requiring Notice.—Note should be made of any important matters of Sanitary environment which have received attention during the year 1919, or demand special consideration now, and are not included in the above headings. Nothing of any importance has occurred during the year relating to the above heading. Schools.—The sanitary condition and water supply of schools, especially public elementary schools, should be reported on. The total number of Public Elementary Schools in the district is 34. Of this number, 22 are Council Schools and 12 Church or Non-Provided Schools. Included in the total number are two special schools, one for mentally, and the other for physically defective children. Two of the Council's Schools are temporary buildings. The Council's Schools are of modern construction. The sanitary arrangements are quite satisfactory and in accordance with the Regulations of the Board of Education relating to Public Elementary Schools. The Non-Provided Schools, although not of modern construction, have had, as far as practicable, the sanitary arrangements amended in accordance with modern principles. Water is supplied to the schools in all instances from the main of the Metropolitan Water Board, and adequate facilities are provided in the playgrounds for supplying drinking water for the scholars. Schools.—The action taken in relation to the health of the scholars and for preventing the spread of infectious disease (c.f., Memorandum on Closure of and Exclusion from School, 1909). Experience has taught that the control of infectious disease depends mainly on the control of the individuals suffering, and that "missed" cases and so-called "carriers" are the principal means whereby infection is spread. The exclusion of contacts from school is only important therefore, where there is a probability that such contacts will develop the disease—and this probability is small where the contact has already suffered from the disease in question. On receipt of a notification of infectious illness, the house is visited by a Health Visitor, who advises the parent as to the best means to adopt to prevent the spread of infection, and exclusion of scholars is carried out according to the following regulations:— 28 Regulations of the Willesden Education Committee for the Control of Infectious Diseases in the Schools. (i.) Common Infectious Diseases. Disease. I Children suffering from Disease stated in Col. 1. Children living in tenements where Disease stated in Col. 1 occurred, i.e., Contacts. Contacts who have previously suffered. Contacts who have not previously suffered. 1 2 3 4 Small Pox Excluded. Re-admitted upon receipt of notice from Medical Officer of Health Excluded. Re-admitted upon receipt of notice from Medical Officer of Health Excluded. Re-admitted upon receipt of notice from Medical Officer of Health Scarlet Fever Excluded. Re-admitted upon receipt of notice from Medical Officer of Health Not excluded Excluded. Re-admitted 10 days after date of disinfection as notified by Medical Officer of Health Diphtheria Excluded. Re-admitted upon receipt of notice from Medical Officer of Health Not excluded Excluded. Re-admitted 12 days after date of disinfection as notified by Medical Officer of Health Measles Excluded. Re-admitted 3 weeks from onset Not excluded Excluded. Re-admitted 3 weeks from onset of primary case in tenement GermanMeasles Excluded. Re-admitted 3 weeks from onset Not excluded Excluded. Re-admitted 3 weeks from onset of primary case in tenement Mumps Excluded. Re-admitted 3 weeks from onset Not excluded Excluded. Re-admitted 3 weeks from onset of primary case in tenement Chicken Pox Excluded. Re-admitted 3 weeks from onset Not excluded Excluded. Re-admitted 3 weeks from onset of primary case in tenement Whooping Cough Excluded. Re-admitted 6 weeks from onset of "whoop" Not excluded Excluded. Re-admitted 3 weeks from onset of primary case in tenement Typhoid Fever Excluded. Re-admitted upon receipt of notice from Medical Officer of Health Not excluded Not excluded Erysipelas Excluded. Re-admitted upon receipt of notice from Medical Officer of Health Not excluded Not excluded Meningitis Action in accordance with instructions received from Medical Officer of Health Not excluded Not excluded Poliomyelitis Action in accordance with instructions refrom Medical Officer of Health Not excluded Not excluded Tuberculosis Action in accordance with instructions received from Medical Officer of Health Not excluded Not excluded 29 (ii.) Infectious Skin Diseases. Disease. Exclusion of Children suffering from disease stated in Col. 1. 1 2 Ringworm Excluded. Re-admitted upon receipt of notice from School Medical Officer. Scabies Excluded. Re-admitted upon receipt of notice from School Medical Officer. Eczema Excluded. Re-admitted upon receipt of notice from School Medical Officer. Impetigo Excluded. Re-admitted upon receipt of notice from School Medical Officer. (iii.) Infectious Eye Diseases. Disease. 1 Exclusion of Children suffering from disease stated in Col. 1. 2 Ophthalmia Excluded. Re-admitted upon receipt of notice from School Medical Officer. (iv.) Verminous Conditions. Disease. 1 Exclusion of Children suffering from the condition stated in Col. 1. 2 Body Lice Excluded. Re-admitted upon receipt of notice from School Medical Officer. Head Lice Nits (v.) Teachers Suffering with Infectious Diseases, or Living in a Tenement where Infectious Disease has Occurred. The foregoing regulations shall apply to teachers except where a teacher has not previously suffered, and is living in a tenement where Scarlet Fever, Diphtheria, Measles, German Measles, Mumps, Chicken-pox, or Whooping Cough has occurred. In such cases the teacher shall communicate personally if possible with the School Medical Officer, and shall not attend school unless authorised by him. If in any of the above cases the teacher is required, as a condition of his return to school, to remove temporarily to other rooms and does not comply, no salary shall be allowed for the time during which the teacher is absent from school on account of his non-compliance with the requirements of the School Medical Officer. Each Assistant Medical Officer has charge of the Schools in his own district, and his duties include all Health work in his area. He therefore has a complete knowledge of all infectious illness occurring in his Schools or the neighbourhood. Whenever it appears desirable on account of the prevalence of any infectious disease, the Schools are visited by the Assistant Medical Officer or Health "Visitor, with a view to examining children, taking swabs for bacteriological examination, etc., and excluding or taking other necessary action in all cases. Daring the year, 243 cases of Scarlet Fever, 287 cases of Diphtheria, 933 cases of Measles and German Measles, 113 cases of Whooping Cough, 903 cases of Mumps, and 379 cases of Chicken-pox were reported amongst Willesden scholars and dealt with. 3. FOOD. (a) Milk Supply.—The wholesomeness of the milk produced within or imported into the district and the general adequacy of the arrangements for the supply and distribution of milk of pure and wholesome character should be reported upon; also the administration of the Dairies, Cowsheds, and Milkshops Orders ; and any action taken as to tuberculous milk, whether under local Acts or under Articles 13 and 15 of the Dairies, Cowsheds, and Milkshops Order of 1885, and Article 11 of the Dairies, Cowsheds, and Milkshops Order of 1899. 30 Just prior to the war, there were seven dairy farms in the district, with from 150 to 200 cows. This number has been gradually reduced until at the end of the year 1919, but three farms remained, with a total of 51 cows. Name of Farm. Where situated. No. of Cows. Jennings Rupert Road, Kilburn 40 Welford Harlesden Road 6 Upper Oxgate Oxgate Lane 5 51 In one instance a new and additional cow-house has been constructed. In all cases the cows are kept clean and the milk produced is free from dirt contamination. There are 127 Milksellers on the register. These are kept under supervision, and generally speaking are found to be in a good and cleanly condition. No action was taken during the year under the Dairies, Cowsheds and Milkshops Orders to ascertain whether any cows kept within the district were suffering from tuberculosis of the udders. Milk {Mothers and Children) Order, 1918.—A review of the action taken by the local authority under this order should also be included. No action was taken under the above order, but Dried Milk and Meals were supplied under Circular M. and C.W. 4 of the Local Government Board, dated 9th August, 1918. During 1919, Dried Milk and Meals for Expectant and Nursing Mothers and children under 5 years of age attending the Municipal Clinics, were provided free of cost to the recipients if the net income per head of the family per week came below the following scale:— No. in family. Net income per head of the family per week. s. d. 2 10 0 or under. 3 8 0 „ 4 7 6 „ 5 6 6 „ 6 or over 6 0 „ Dried milk was given to Expectant and Nursing Mothers, and children over 18 months and under 5 years of age, only on the special recommendation of the Clinic Medical Officer. Dried milk was supplied at cost price to patients attending the Clinic, whose incomes came above the foregoing scale. The method of arriving at the family income is set out in the following statement. Method of Calculation. The net income per head of a family is defined as the income less outgoings, divided by the number in family. Income. Income is calculated under the following heads:— (A.) Wages:—(1) Parents, or guardians, weekly wage, the average for four weeks being taken; (2) the earnings of children under 14 years. (B.) Lodgers:—Children over 14 years of age working are reckoned as lodgers. Income from lodgers is reckoned on the following basis Payments received per week from Lodgers. Proportion reckoned as Income. Up to 12s. Nil. Over 12s. 50% of surplus over 12s. (C.) Letting:—The whole amount received is taken as income. 31 Outgoings. Outgoings include:—(a) rent; (b) insurance; (c) fares to and from work, and (d) care of children. Number in Family. The number in family is taken to be the parents or guardians or older sisters looking after the home and not working and children under 14 years. Applicants' statements as to wages are verified from employers. Re-inquiries into the economic circumstances of the family are made monthly. The quantity of Dried Milk is prescribed by the Clinic Medical Officers, and is issued by the dispensers at the Clinics. The meals are provided at the feeding centres of the Education Committee nearest to the homes of the applicants. During the year 12,435 lbs. of Glaxo were supplied free, and 15,551 lbs. were sold at cost price. 1,140 mothers and children under 5 were supplied with 13,455 meals. The facilities for the provision of meals to mothers and children under 5 years are not always made use of by candidates who require them chiefly on account of:— (1) The difficulty of the mother leaving her home at the specified time; (2) The impossibility of the young children attending by themselves, and (3) The necessity, as a rule, of preparing a meal for the father or other members of the family. Having regard to the circular of the Ministry of Health, dated 14th November, 1919, relative to the supply of milk to Expectant and Nursing Mothers and Infants, the Council, at its meeting on the 23rd December, 1919, decided to extend the existing practice as follows:— (1) Milk, Dried Milk, or Meals, to be provided to Expectant and Nursing Mothers and Children under 5 years of age on the following terms (a) Free, if the net income per head of the family is below the before-mentioned scale. (b) At one-fourth the cost if the net income of the family is not more than 1s. per head per week above the before-mentioned scale. (c) At one-half the cost, if the net income of the family is not more than 2s. per head per week above the before-mentioned scale. (d) At three-fourth the cost, if the net income of the family is not more than 3s. per head per week above the before-mentioned scale. (e) If the net income of the family is more than 3s. per head per week above the before-mentioned scale. (i.) Dried Milk will be provided at cost price at the Clinic to Clinic patients. (ii.) If Milk is desired it will have to be obtained at their own expense in the usual way from retail vendors. (/.) Milk and Dried Milk are not, as a rule, to be supplied to children over 18 months, or to Expectant and Nursing Mothers, except on special recommendation. Subject to the foregoing conditions. Milk, or Dried Milk, or free Meals will be supplied by the Council on recommendations or applications made to the Medical Officer of Health by Medical Practititioners, Midwives, Health Visitors and others. After investigation, the Medical Officer of Health will supply to the persons admitted to any of the above benefits coupons representing the amount which the Council will pay towards the cost. A special recommendation must show that the applicant is suffering from some condition, e.g., anaemia, wasting, chronic underfeeding, or the like, in which milk is necessary or desirable. (b) Other Foods.—The following items should receive special attention:—Unsound food and food inspection; sanitary condition of premises where foods are manufactured, prepared, stored, or exposed for sale, indicating any important respects in which existing powers have been found inadequate for dealing with insanitary conditions in such places. The condition of bakehouses, meat inspection, disease in meat, and conditions of slaughter-houses; whether a public abattoir has been established in the 32 district, and, if not, what are the existing arrangements for inspection of meat at the time of slaughter; action under Section 117 of the Public Health Act, 1875, or Section 47 of the Public Health (London) Act, 1891 ; number of carcases and parts of carcases condemned for tuberculosis. The past year has been somewhat remarkable in respect of the large quantities of damaged and unsound foodstuffs voluntarily surrendered by the various shopkeepers in the district, particulars of which are given in this report under the heading "Sanitary Inspection of District." Bakehouses.—There are 64 occupied bakehouses in the district, 46 above ground and 18 underground. These are all visited twice a year, and in 18 instances notices were served on the occupiers to conform with the regulations under the Factory and Workshop Act. Slaughterhouses.—There are nine Slaughterhouses in the district, five being licensed and four registered. One of the licensed premises is used only for the killing of horses. Frequent visits are paid by the inspectors during the time that slaughtering is in operation for the purpose of examining carcases and internal organs of the slaughtered animals. In one instance a bullock, after being killed, was found on examination to be badly affected with generalised tuberculosis. The inspector at once communicated with the official allocator of the district, who consented voluntarily to surrender the carcase. The carcase was later on forwarded to a firm of fat extractors for rendering into fat for soap making. In 10 instances bullocks' livers were found to be diseased. These were all destroyed as unfit for food. A public abattoir has not been established in the district. (c) Sale of Food and Drugs Acts—A report on the work done by the local authority under these Acts should be included, with observations on special questions which have received or require attention. The administration of these Acts is in the hands of the Middlesex County Council, and the following Table, No. 20, shewing the work done in Willesden, has been kindly supplied me by Mr. Robinson, Chief of the Weights and Measures Staff. Table No. 20. Samples taken during the year ended 31st December, 1919:— Article. Formal. Informal. Taken. Adulterated. Taken. Adulterated. Milk 371 70 83 12 Separated Milk 3 — — — Butter 1 — 2 — Margarine 3 — — — Vinegar 2 1 16 1 Self-raising Flour 2 1 6 1 Nut Butter 2 — — — Nut Suet 2 — — — Evaporated Milk — — 5 — Lemon Powder — — 5 — Baking Powder — — 4 — Cream of Tartar — — 4 — Egg Powder — — 3 — Custard Powder — — 3 — Coffee — — 2 — Lard — — 2 — Dripping — — 2 — Cream — — 1 1 Cocoa — — 1 — Peas — — 1 — Sherbet — — 1 — Tota 386 72 141 15 Mr. Robinson further informs me that no action was taken under the Milk and Cream Regulations during the year. 33 4. PREVALENCE OF AND CONTROL OVER INFECTIOUS DISEASES. Infectious Diseases Generally.—The prevalence of notifiable infectious diseases during the year should be reviewed, and noteworthy facts as to the source of spread of infection should be recorded. Such matters as the supply and prompt use of diphtheria anti.toxin, the occurrence of cases of encephalitis lethargica, or the discovery of "return" cases of scarlet fever should be noted, as well as the experience of the district in regard to the diseases notifiable under the regulations of1th January, 1919, i.e., pneumonia, malaria, dysentery, and trench fever. Notifications.—Table No. 21. No. of Notifications of:— Diphtheria 494 Erysipelas 86 Scarlet Fever 418 Enteric Fever 5 Continued Fever 1 Puerperal Fever 9 Cerebro.Spinal Fever 3 Poliomyelitis 3 Ophthalmia Neonatorum 32 Measles and German Measles 1,616 Pulmonary Tuberculosis 303 Other forms of Tuberculosis 72 Whooping Cough 52 Pneumonia 88 Malaria 76 Dysentery 6 Encephalitis Lethargica 3 Acute Polio.encephalitis 1 Total 3,268 Scarlet Fever.—Table No. 22. Shewing the number of cases notified, the number and percentage removed to Hospital, and the Incidence and Fatality rates each year since 1892. Year. No. of Cases notified. No. of Cases removed to Hospital. Percentage removed to Hospital. Incidence Rate. Cases per 1,000 population. Fatality Rate. Deaths per 1,000 cases. 1892 366 49 13.3 5.5 22 1893 589 107 18.1 8.5 25 1894 268 83 30.9 3.6 26 1895 392 243 61.9 4.9 43 1896 475 282 59.3 5.5 35 1897 510 320 62.7 5.4 21 1898 361 209 57.8 3.6 28 1899 414 220 53.1 3.9 38 1900 335 188 56.1 2.9 35 1901 553 265 47.9 4.9 21 1902 466 282 60.5 3.8 27 1903 502 393 78.2 3.8 22 1904 326 242 74.2 2.4 6 1905 397 328 82.6 2.8 13 1906 637 543 85.2 4.5 17 1907 641 547 85.3 4.4 30 1908 737 651 88.3 5.0 19 1909 638 556 87.1 4.4 25 1910 314 265 84.3 2.0 0 1911 326 226 69.3 2.1 15 1912 430 373 86.7 2.7 2 1913 504 446 88.5 3.1 14 1914 765 682 89.1 4.6 7 1915 453 406 89.6 2.7 33 1916 387 350 90.4 2.3 3 1917 166 141 84.9 0.98 12 1918 131 111 84.7 0.77 23 1919 418 274 65.5 2.44 10 34 It will be seen that a larger number of cases of Scarlet Fever were notified than has been the case since 1915, the incidence rate likewise being greater than it has been since 1915. This increase in incidence was associated with a fatality rate of 10, which is lower than it has been since 1916. Owing to the tax on the Hospital accommodation in all directions it has been impossible to admit to Hospital all cases of Scarlet Fever desiring removal. Hospital removal for Scarlet Fever had to be curtailed on the 18th October, 1919, after which date only the most urgent cases were removed. From this time to the end of the year, cases of Scarlet Fever have been nursed at home wherever practicable. In such cases where application has been made proper, expenses incurred in nursing the cases at home have been allowed by the Council. Since the 18th October, out of 195 cases notified, 87, or 44.6 per cent, were removed to hospital. These were not all removed as soon as notified, but as and when beds were available. It is unsatisfactory that all cases needing or desiring removal to Hospital should not be admitted— (1) for the welfare of the patient; (2) on account in most cases of the inconvenience and expense of nursing the cases at home; (3) on account of employers, in some instances, being unwilling for other members of the family to continue work ; and (4) on account of the additional length of time scholars have to remain away from School. In view of the fact that the number of cases notified during the year, although higher than the three previous years, is not a high number, being only 29 above the average of the last 10 years, and, in view of the fact that the incidence rate is actually a low one, it is important that the Hospital accommodation required should be provided. Table No. 23. Giving Particulars of Infecting and Return Cases of Scarlet Fever during 1919. 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. C.B. 78 M.A.B. 5 B.B. 7 C.B. or B.B. or M.A.B. 78, then released for 9, re-isolated for 22 H.J.B. 18 after final release. 38 3 36 7 M.G. 60, in London Fever Hospital E.G. 7 A.G. 29 Q.B. 56 E.B. 10 S.L.C. 46 S.C. 12 Ja.C. 29 Je.C. 37 D.R. 42 I.R. 3 A1.R. 14 E.R. 15 Ar.R. 18 S.G. 11, then released for 3, re-isolated for 27 G.G. 11, after final release J.G. 37 P.G. 8 E.G. 8 35 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. C.H. or F.H. 37 E.H. 11 after release of C.H. 18 after 1st release of F.H. J 21, then released for 6, re-isolated for 21 R.H. 28 after release of C.H. 35 after 1st release of F.H. 1 after final release of F.H. L.M. 33 R.M. 5 M.M. 15 F.D. 31 H.D. 9 L.D. 14 C.D. 21 G.W 31 D.W. 4 F.W. 12 M.W. 23 F.H. 28 M.H. 139 In 8 instances the infecting case developed nasal discharge after return from Hospital, in 1 case ear discharge, and in 1 case enlarged cervical glands and nephritis. In 1 case otorrhoea was present while in Hospital. Table No. 24. Giving particulars of multiple cases of Scarlet Fever occurring in houses in 1919. No. of Houses. Per cent. of Houses. No. of Cases. Per cent. of Cases. Houses in which 1 case occurred 256 80.8 256 61.2 2 „ „ 38 12.0 76 18.2 3 „ „ 12 3.8 36 8.6 4 „ „ 8 2.5 32 7.7 5 „ „ 0 0.0 0 0.0 6 „ „ 3 .9 18 4.3 Totals 317 100.0 418 100.0 Diphtheria.—The following Table No. 25 shews the number of notifications of Diphtheria received year by year since 1892 together with other particulars. 30 Diphtheria and Membranous Croup.—Table No. 25. Shewing the number of cases notified, and number and percentage removed to hospital, and the incidence and fatality rates each year since 1892. Year. No. of Cases notified. No. of Cases removed to Hospital. Percentage of Cases removed to Hospital. Incidence Rate. Cases per 1,000 population. Fatality Rate. Deaths per 1,000 Cases. 1892 145 14 9.6 2.1 127 1893 229 0 0.0 31 199 1894 129 8 6.2 1.7 126 1895 186 66 35.4 2.2 190 1896 173 51 29.4 2.1 169 1897 275 132 48.0 2.9 250 1898 335 217 64.7 3.3 204 1899 319 183 57.3 2.9 148 1900 226 120 53.1 1.9 124 1901 404 190 47.0 3.4 138 1902 440 222 50.4 3.5 122 1903 221 122 55.2 1.6 46 1904 353 290 82.1 2.6 54 1905 275 227 82.5 1.9 51 1906 286 222 77.6 2.0 57 1907 254 186 73.2 1.7 71 1908 215 175 81.3 1.4 65 1909 207 171 82.6 1.4 48 1910 166 142 85.5 1.1 66 1911 192 130 67.7 1.2 57 1912 222 191 86.0 1.4 45 1913 233 215 92.3 1.4 34 1914 303 258 85.2 1.8 79 1915 231 213 92.2 1.4 130 1916 225 213 94.7 1.3 76 1917 254 234 92.1 1.5 79 1918 271 223 82.3 1.6 92 1919 494 461 93.3 2.9 55 This is the greatest number of cases notified since the above records were kept in 1892, and the highest incidence rate since 1902. It is satisfactory to note that notwithstanding the severe type of Diphtheria prevalent in the winter months, the fatality rate of 54.6 was lower than it has been since 1913. The cases were greatest in the Stonebridge and Roundwood wards, numbering 84 in Stonebridge and 75 in Roundwood, whereas in Willesden Green and Cricklewood they were only 15 in each ward. The notifications were high throughout the year, the first 9 four-weekly periods giving an average number of 30.5, with a variation between 24 and 38, and the last 4 an average of 55.5, with a variation from 44 to 79. Diphtheria antitoxin is supplied free to all medical practitioners on application at the Health Department or Fire Stations, or Municipal Hospital. In view of the severe type of Diphtheria prevalent in the winter, the following letter was issued to Medical Practitioners in Willesden on 5th December, 1919. To Medical Practitioners in Willesden. Diphtheria—Early Treatment. The Medical Superintendent of the Municipal Hospital, Brentfield Road, Neasden, N.W. 10, informs me that the type of Diphtheria prevalent at present is severe. Several cases have entered the Hospital at a late stage of the illness when remedial measures were too late. Early treatment— important in all diseases—is especially important in cases of Diphtheria. Sometimes Practitioners delay sending in their cases until a bacteriological examination has been made. Under all the 37 circumstances I would suggest that where the clinical signs give good reason to believe that the case is one of Diphtheria, arrangements be made with Dr. Stewart for the admission of the case, if possible, to Hospital (Telephone No. Willesden 1849), for observation and early treatment as may be necessary. Too much reliance should not be placed on bacteriological diagnosis when the clinical evidence points to Diphtheria. George F. Buchan, Medical Officer of Health. Enteric Fever.—During the year 5 cases were notified, and 2 of these were removed to Hospital. The incidence rate per 1,000 of the population is 0.03. There were no deaths. Encephalitis Lethargica and Acute Polio Encephalitis became notifiable on January 1st January, 1919. Three cases of Encephalitis Lethargica were notified during the year. The first was a man of 60 years notified on June 19th. He was removed to the Municipal Hospital, where the initial diagnosis was altered to "a cerebral condition which is yielding to antisyphilitic treatment." The patient was discharged much improved. The second was a girl of 13 years, notified on November 11th. She was removed to St. Mary's Hospital, and was still attending as an out-patient at the end of the year. The third was a boy of 15 years, notified on December 12th. He was removed to St. George's Hospital, from which he was discharged in February, 1920, convalescent, under the care of his private doctor. There does not appear to have been any connection between the cases. One case of Acute Polio-Encephalitis was notified during the year. It occurred in a man of 23 years, and was fatal when notified, death having occurred three days after onset. The case was nursed at home, being in one of the best class houses in the district. Lumber puncture was not done, nor was any post mortem examination made. Poliomyelitis.—Three cases were notified during the year. One case, a child of l10/12 years, was removed to the Municipal Hospital and recovered, but with loss of power in both legs. The other two cases, one a child, aged 3 years, and the other a child, aged 14 years, were nursed at home, and both recovered. The child of 3 years was still attending Maida Vale Hospital at the end of the year for paralysis of legs, and was reported improving. Cerebro-Spinal Meningitis.—Three cases were notified during the year. Two were treated in the Municipal Hospital, and one in Great Ormond Street Hospital. All recovered. Of the two cases removed to the Municipal Hospital, one occurring in a man of 22 years was not diagnosed clinically as cerebro-spinal meningitis in Hospital, and a swab taken was negative, the condition being diagnosed as cephalalgia and constipation. The other case, occurring in a child of 2 years, was diagnosed in Hospital as gastritis. The case removed to Great Ormond Street Hospital, a child of 8 months, was also discharged well—no paralysis. Pneumonia, Malaria, Dysentery and Trench Fever became notifiable on March 1st, 1919. Pneumonia.—Eighty-eight cases were notified, the greatest number, 37, occurring between the ages of 25 and 45. The wards with the greatest number of notifications were South Kilburn and Mid-Kilburn, with 15 and 17 respectively as against an average of 6 in the other wards. The notifications were highest during the 4 weeks ended 22nd March, 1919, and the 4 weeks ended 19th April, 1919, being 27 and 18 respectively. With these exceptions, the notifications did not rise above 8 in any of the 4 weekly periods. Five of the 88 cases notified were removed to the Municipal Hospital. Of the 88 cases notified, 29 died. Out of 84 of the notified cases in which information is available, 48 were nursed at home and 36 were removed to hospitals—5 to the Municipal Hospital, 10 to Hospitals outside Willesden, and 21 to the Willesden Infirmary. Of the 48 nursed at home, 16 died, or 33.4 per cent. Of the 36 removed to hospitals, 13 died, or 36.1 per cent., 1 death occurring in the Municipal Hospital, 3 in hospitals outside Willesden, and 9 in the Willesden Infirmary. 38 It should be noted that some of the cases were removed to Hospital at too late a stage of the illness for treatment to be of any avail. Of 45 cases nursed at home, in which information is available, in only 8 cases was trained nursing assistance provided, and in one of these it was provided by the Council. Of these 8 cases only 1 died, or 12.5 per cent., as against 12, or 32.4 per cent., of the cases nursed at home with no trained nursing assistance. The most effective measure for the reduction of mortality in pneumonia would appear to be the prompt provision of adequate trained nursing assistance. Coupled with this is the need in some cases for the provision of domestic assistance, such as home helps, though, as a general rule, the domestic assistance is adequate, except in cases of exceptional outbreaks, such as occurred in the recent influenza epidemics. Further, there is the need to see that the home cases have the means of obtaining sufficient and suitable nourishment. At the moment milk may be obtained for expectant and nursing mothers and children under 5 under the Council's scheme, but for other patients there is no provision, except for poor law cases. The question of the provision of adequate medical attendance in all cases also arises. In connection with the Council's home nursing scheme, recently started, it has been noted that a doctor will not always be called in as promptly or as often as desirable on account of the expense. Many of the cases removed to hospitals and infirmaries could be nursed at home if the necessary food and medical attendance were ensured in conjunction with the trained nursing assistance, whereas the provision oi the trained nursing assistance only might still leave it necessary for the patient's removal. At the present time, however, the lack of suitable and sufficient housing accommodation may make the patient's removal necessary. In addition to the 88 cases notified, a further 25 cases coming to knowledge through death certificates, or otherwise, were visited by the Health Visitors. Of these, 12 were fatal. Eight of the fatal cases were nursed at home, 2 were removed to the Municipal Hospital, and 2 to the Willesden Infirmary. Of the 13 cases that recovered, 3 were nursed at home, 2 were removed to the Infirmary, and 8 were removed to the Municipal Hospital. Malaria.—Seventy-six cases were notified. In 67 instances the original attack occurred whilst the patient was abroad. In 2 instances the first attack occurred after the patient had returned from abroad. In all instances, except one, the patients were males. The exception was a girl aged 11 years attending a Public Elementary School. Her first attack occurred when she was staying at Sheerness, where troops, convalescent after malaria, were stationed. It was stated that the girl had been badly bitten by mosquitoes at Sheerness. In 6 instances no definite information is available. Dysentery.—Six cases were notified. In 4 instances the disease was contracted abroad. Trench Fever.—No cases were notified. The annual report should state whether and to what extent bacteriological aids to diagnosis have been utilised, action to discover "contacts," arrangements for isolation and disinfection, as well as any action taken to deal with special difficulties, e.g., return cases, carrier cases, etc. Bacteriological outfits and diphtheria antitoxic serum are supplied to medical practitioners in the district free of charge, and can be obtained by medical practitioners at the following centres in Willesden:— (1) Municipal Offices (Health Department.). * (2) Kilburn Fire Station. * (3) Willesden Green Fire Station. (4) Harlesden (No. 42, High Street). * (5) Municipal Hospital. Influenza Vaccine can also be obtained at the Municipal Offices. * To be had at all hours day or night. 39 Arrangements have been made with Drs. Thresh and Beale, of 91, Queen Victoria Street, E.C. 4, for the examination of bacteriological specimens. Examinations, such as Wasserman Reactions, are made at St. Mary's Hospital. The following Tables, Nos. 26 and 27, show the extent to which the facilities have been made use of:— Table No. 26. Table shewing Chemical and Bacteriological Examinations made during the year 1919. Nature of Specimens examined. Positive Result. Negative Result. Total. 1. Swabs for Diphtheria Bacilli 265 960 1,225 2. Sputum for Tubercle Bacilli. 36 122 158 3. Blood for Widals Reaction 3 4 7 4. Urine 3 3 6 5. Cerebro-spinal Meningitis Fluid — 2 2 6. Blood for cultivation — 1 1 7. Swab from Cellulitis of Leg 1 — 1 8. Smears and Swabs for Gonococci 1 7 8 9. Pus from Pyaemic abscess-puerperal case 1 — 1 10. Swabs for Meningococci — 14 14 11. Pleural Fluid — 1 1 12. Spinal Fluid for Tubercular Meningitis — 2 2 13. Swab taken from Vaginal Discharge — 1 1 14. Serum for Pustule — 1 1 15. Streptococci 1 1 2 16. Staphylococcus 1 — 1 17. Wasserman Reaction 4 1 18. Faecal specimen for Entamveba Histolytica — 1 1 19. „ „ Dysentery bacilli — 1 1 Total 316 1,122 1,438 Table No. 27.—Sources of Specimens Examined. From patients in Municipal Hospital 648 From private practitioners 468 From clinics and health visitors 322 Total 1,438 Action to discover "Contacts."—In all instances of notifiable infectious diseases the health of the other members of the family is enquired into, and if suspicious, they are referred to a doctor, or a swab or blood or other specimen, as the case may require, is taken for examination. Arrangements for isolation and disinfection.— Isolation:—Isolation Wards are available at the Municipal Hospital. Beds are set aside for Diphtheria and Scarlet Fever, and other infectious diseases are taken in, as and when accommodation is available. In cases where removal to hospital is not desired, and isolation can be satisfactorily carried out at home, this is permitted, the Health Visitors paying subsequent visits to ascertain that isolation is being maintained; 65.5 per cent, of Scarlet Fever cases, 93.3 per cent, of Diphtheria cases, 40.0 per cent, of Enteric Fever cases, and 66.7 percent, of Cerebro-Spinal Meningitis cases were isolated in the Municipal Hospital during 1919. Disinfection is carried out by the Health Department. This process is not now regarded as of first importance, it being recognised that infectious persons, and not rooms or articles, are the agencies by which disease is spread. During 1919, disinfection was carried out as a routine measure after Scarlet Fever and Diphtheria. In the case of other diseases, special instructions were given by the Assistant Medical Officers as to any disinfection necessary. Such instructions related to dealing with infectious discharges, rather than to articles supposed to contain infection. 40 Action taken to deal with special difficulties, e.g., return cases, carrier cases, etc. —On the occurrence of return cases, infecting cases and suspected carrier cases are seen by the Assistant Medical Officers, and re-isolation bacteriological examination or any other necessary action, arranged for. Influenza.—114 deaths from influenza were recorded in 1919. These deaths occurred as follows throughout the year:— Month. No. of Deaths. January 11 February 57 March 23 April 5 May 2 June 1 July 0 August 1 September 0 October 3 November 4 December 4 Anti-influenza vaccine is supplied to Medical Practitioners on application at the Health Department. A special report was made on Influenza in the Annual Report of the Medical Officer of Health for 1918. The following Table No. 28 gives the death rates per 100,000 of the population from certain infectious diseases in 1919:— Table No. 28.—Death Rates from certain Infectious Diseases Scarlet Fever 2 per 100,000 of the population. Diphtheria 16 „ „ „ Enteric Fever — „ „ „ Measles 13 „ „ „ Whooping Cough 1 „ „ „ Non-notifiable acute infectious diseases should be similarly reported upon, so far as the less complete information enables this to be done. The extent to which school intimations of disease are utilised should be stated. The mortality from influenza should be stated and a note made of the results of any special inquiry made in connection with this epidemic and of action taken in the district in regard to it. All infectious illness occurring amongst Public Elementary Scholars is notified to the Health Department by the Teachers, and visited at the homes by the Health Visitors. The greater number of cases of influenza come to knowledge in this way. Measles was only compulsorily notifiable for the first case in the house. Additional cases came to knowledge through school intimations. The following table shows the various sources from which cases of measles were notified. Sources from which Notifications of Measles and German Measles were received during the Year 1919.—Table No. 29:— From * Private Doctors 1,098 ,, Head Teachers 249 ,, Clinic Doctors and other members of Health Department 57 ,, Parents 160 „ School Attendance Officers 40 „ Sources outside Willesden 12 Total 1,616 * Of these 7 were also notified by Parents and 5 were also notified by Head Teachers, and 4 were also notified by Clinic Doctors or other members of Health Department. 41 Measles.—Table No. 30. 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 1.7 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 0.80 0 0 100 871 1917 2,979 36 1.21 12 993 75 3,972 1918 1,257 10 0.79 10 1,257 *50 2,514 1919 1,375 20 1.45 3 206 87 1,581 Totals 20,456 238 1.16 268 23,060 47 43,516 *These figures are based on the average for the years 1907-1914. Of the 23 measles deaths 13 occurred in the Willesden Infirmary, 3 in the Municipal Hospital, 1 in a hospital outside Willesden and 6 at home. The Ministry would also be glad to have information as to the extent to which the requirements as to notification of tuberculosis are observed by medical practitioners, and of any action taken to enforce the regulations and secure prompt notification. Tuberculosis Notifications, etc.—Table No. 31. Notifications received—Pulmonary 682 Other forms 83 New cases to which notifications refer—Pulmonary 303 Other forms 72 1,010 of the total of 3,687 cases of Tuberculosis notified in Willesden since 1909, when notification began, were living in the area at the end of the year 1919. It has not been necessary to take any action to enforce the regulations and secure prompt notification. Tuberculosis.—As regards the treatment of Tuberculosis the Medical Officer of Health should set out in the report (a) Details of the Council's scheme, (b) the extent to which the scheme has already been developed, (c) the adequacy or otherwise of the provision made, and (d) the lines on which the scheme needs to be extended or modified as the result of experience. Other points which might be specified are : (e) The extent to which the co-operation of the medical profession has been obtained, (/) the readiness or otherwise of patients to avail themselves of the facilities provided for diagnosis and treatment, and (g) the arrangements at the dispensary for providing for home visitation, search for contacts, after-care work, etc. The treatment of Tuberculosis is carried out by the Middlesex County Council. All cases are visited in the homes and kept under observation by the Council's Health Visitors, with the view of preventing the spread of infection. 1,010 cases were under observation at the end of the year. Where desirable from the point of view of prevention of spread of infection, beds and bedding are lent by the Council. .Sputum bottles and paper handkerchiefs are supplied free to patients. It is to be regretted that the control of Tuberculosis is not entirely under the one local Health Authority whose hospital, clinics, home nursing service, provision of milk and meals scheme would all be conveniently available for patients, and there would be no overlapping of duties and duplication in home visitation or other provision. 42 Venereal Diseases.—As regards Venereal Diseases, information should be given in the report vn the lines of (a), (b), (c), (d), (e) and (f) of the paragraph relating to Tuberculosis. Information should also be given as to the facilities available for irrigation of cases of gonorrhoea during the intervals between the clinics, the need for further facilities of this character, and the extent to which any facilities provided for disinfection have been utilised by persons who have been exposed to the risk of infection. Particulars should be given of the number of medical practitioners in the area who are qualified to receive free supplies •of salvarsan substitutes, and of the number of cases for whose treatment these substitutes have been supplied to practitioners by the Council. Information should also be given as to the extent to which practitioners have availed themselves of the facilities for pathological examinations provided by the Council. The Ministry would also be glad if the Medical Officer of Health would report on any action taken in the district under the Venereal Disease Act, 1917, and the result. The above work is under the Middlesex County Council. Smallpox.—A statement of the number of (a) Primary vaccinations and (b) re-vaccinations performed by the Medical Officer of Health under the Public Health (Smallpox Prevention) Regulations, 1917, should also be included in the annual report. Other diseases which have received special attention during the year should be referred to, e.g., locally contracted Anthrax or Rabies. Vaccination.—No primary vaccinations or revaccinations were performed by the Medical Officer of Health under the above regulations. No case of Anthrax or Rabies was notified to the Medical Officer of Health. 5. MATERNITY AND CHILD WELFARE. (1) Information on the inspection of midwives and the other activities of the supervising authority under the Midwives Acts, 1902 and 1918. This work is in the hands of the Middlesex County Council. (2) Information on the general arrangements made for attending to the health of expectant and nursing mothers and children under five years of age, including the work of Health Visitors, midwives and nurses, consultation and treatment centres, and maternity homes and hospitals and other institutions for the reception of expectant and nursing mothers and young children as in-patients. Special reference should be made to investigations of stillbirths and infant deaths, methods of dealing with unmarried mothers and illegitimate children and with children permanently or temporarily deprived of a home with their own parents. The work of voluntary societies in the district in connection with maternity and child welfare and the place occupied by each in the local authority's scheme should be briefly described, as also the coordination of all the work under this sub-section with the school medical service. There are two Municipal Clinics in Willesden No. 1. 9, Willesden Lane. No. 2. 381, High Road, Willesden Green. For the care and treatment of expectant and nursing mothers and children up to 14 years of age. The staff employed at each Clinic includes 2 medical officers, 1 "dentist, for whom a medical officer acts as anesthetist on certain days of the week, 1 matron, 5 Clinic nurses, 1 dental visiting nurse, 8 Health Visitors, 1 cleansing room nurse, 6 clerks, with an addition at No. 1 Clinic of 1 Assistant matron and 4 home nurses and 1 nursery room nurse. Each Clinic is equipped for dealing with all conditions arising in the mother and child suitable for out-patient treatment. The general arrangements made for attending to the health of mothers and children under 5 years are as follows:— 1. The home visitation of mothers and children by a staff of 18 Health Visitors, who are fully trained nurses holding the C.M.B. certificate, and Health Visitors or Sanitary Inspectors' certificate. 2. Four home nurses visit homes twice daily in the following conditions Acute Primary Pneumonia. Acute Influenzal Pneumonia. Measles and its complications. Epidemic Diarrhoea. Ophthalmia Neonatorum. Any other conditions as the occasion demands. Whooping Cough and its complications. 43 3. The Clinic care and treatment of the mother before and after the birth of the child. 4. Abnormal cases, either before or after the birth of the child, are referred for advice and necessary treatment to the specialist at the Municipal Hospital. 5. The Clinic care and treatment of children. 6. The provision of a midwife or doctor for cases of confinement at home. 7. The provision of a home help as required during the lying.in period. 8. Hospital accommodation (16 beds and 14 cots) for difficult or complicated cases of pregnancy and parturition or where the home is not suitable for confinement. 9. Hospital accommodation, 32 beds, for children under 5 years and 14 for school children. 10. Dental Clinics for mothers and children. 11. A school for mothers. 12. The provision of meals at four feeding centres for necessitous mothers and children up to 14 years. 13. The provision of milk, dried milk, cod liver oil and malt or Virol, as may be necessary for necessitous mothers and children. Vide section on Milk (Mothers and Children), Order, 1918. Unmarried expectant mothers, when desired, are referred to— 1. Home for Friendless Girls, 34, Craven Park Road, Harlesden. 2. Rescue Worker, Sister Dyer, 316, High Road, Kilburn. Illegitimate children and children temporarily deprived of a home with their parents are referred to— Mrs. Holland, The Guardians, Inspector of Foster Mothers. In addition to the Municipal Hospital, some maternity cases are received into Oueen Charlotte's Hospital. The Willesden Infirmary and Paddington Green Children's Hospital also admit cases of diseases of children. Cases of venereal disease are referred to St. Mary's Hospital, Paddington. Cases of Tuberculosis are referred to the County of Middlesex Dispensary, Priory Park Road, Kilburn. The following Maternity and Child Welfare Clinics are supported by voluntary societies, and are not included in the local authority's scheme:— 1. The Women's Civil Corps, Maternity and Child Welfare Centre, Goodson Road, Willesden. 2. Soldiers' and Sailors' Wives Association, Day Nursery, 47, Chichester Road, Kilburn. Debilitated children requiring convalescent treatment are referred to the Invalid Children's. Aid Association. At the Municipal Clinics expectant mothers attended the medical consultations on 1,976 occasions ; nursing mothers, 5,749 ; and children under 5 years, 22,340 times ; making a grand total of 30,065. 38.2 per cent. of all births registered in Willesden during the year 1919 attended the Municipal Clinics. In all, 2,924 births were registered in Willesden during the year 1919. Of these 1,117 subsequently attended the Clinics. During the year 1919, 242 children under 1 year died in Willesden. Of this number 43 attended the Clinics, and 199 did not, giving an infant mortality rate of 38.5 per thousand births amongst babies attending the Clinics, and 110.1 per thousand births amongst those who were not in attendance. Total infant mortality rate, 82.8 per thousand births. During the year 1919, 105 children died before reaching the age of 1 month, but none of these children had been in attendance at the Clinics. Of the remaining 137 children who died, 43 attended the Clinics, and 94 did not, giving an infant mortality rate of 38.5 per thousand births, less deaths under 1 month amongst those babies attending the Clinics, and 52.02 amongst those who did not. In addition to the 105 children dying under 1 month, 70 stillbirths were recorded in Willesden during 1919, making a total of 175 deaths under 4 weeks, including the stillbirths. Sixteen of these 44 deaths were the children of 398 expectant mothers who attended the Clinics, giving a death rate for the children under 4 weeks, including stillbirths of these mothers of 40.2 per thousand births. Three of the above 16 deaths were "triplets." The remaining 159 were the children of 2,526 births who did not attend the Clinics, giving a death rate for children under 4 weeks, including stillbirths, of 62.9 per thousand births in cases in which the mothers did not previously seek the ante.natal care of the Clinics. The diarrhoea and enteritis death rate amongst children under 1 year attending the Clinics was 4.1 per thousand births, and amongst children not attending 6.5 per thousand births. The Maternity and Child Welfare work is closely co.ordinated with the school medical work. The Health Visitors visit children under 5 years and school children when referred. In this way labour is economised, and parents become accustomed to one particular Health Visitor. The close relationship of the two services is maintained in the Clinics, where minor ailments are treated each morning, both below 5 years and up to 14 years of age. Two mornings each are specially set aside for throat, nose and ear cases and eye cases. One morning is set aside for expectant mothers. Nursing mothers and children up to 5 years are seen in the afternoons. During the year the following papers wefe published by Dr. Vynne Borland, one of the Assistant Medical Officers:— * 1. " Prophylactic Treatment of Constipation in Children " (The Lancet, March 22nd, 1919). 2. " Preventive Treatment of Constipation in Children " (Maternity and Child Welfare, May, 1919). 3. " A Suggested Scale for the Feeding of Infants on Dried Milk " (The Lancet, January 10th, 1920). (3) Information on the incidence of puerperal fever, ophthalmia neonatorum, measles, whooping cough, epidemic diarrhoea, poliomyelitis and other infectious diseases of parturient women, infants and young children, and the methods adopted to diminish the mortality and permanent injury to health caused by these diseases, and the results achieved by these methods. In particular, details should be given of each case of ophthalmia neonatorum notified, showing whether one or both of the eyes were permanently injured, and, if so, to what extent. Puerperal Fever.—During the year 8 cases of puerperal fever were investigated ; 5 cases were removed to the Infirmary, 3 of these cases died and 2 recovered. The other 3 cases which were isolated and treated at home with adequate medical and nursing attendance all recovered. This gives a case mortality of 37.5 per 100 cases. Ophthalmia Neonatorum.—Twenty.eight cases of this disease were investigated during the year. In two of these cases no particulars are obtainable as to attendance at confinement. In respect of the remaining 26 cases, 10 were attended by a doctor at the confinement, and 16 by a midwife. In respect of the remaining 26 cases suffering from Ophthalmia Neonatorum, there is no record as to treatment in one of these cases, and another case died at the age of two weeks. In respect of the 24 remaining cases, the length of treatment varied from five days to seventy days. In 22 cases the eyesight was unimpaired, in one case one eye was permanently injured, and in the last case both eyes were permanently injured, and the child permanently blind. Other Infectious Diseases.—These are referred to in the section dealing with Infectious Diseases generally. Infant Mortality.—Table No. 32. Number of deaths of infants under 1 year from all causes ... 242 Number of deaths of infants under 1 year from diarrhoea and enteritis 31 Infant Mortality Rate per 1,000 births 83 45 Infant Mortality in Wards. Table No. 33. Births and Birth Rates in Wards. Table No. 34. No. of Births. Birth rate per 1,000 of population. South Kilburn 90 322 21.27 Mid Kilburn 99 263 17.44 North Kilburn 29 170 13.23 Brondesbury Park 51 118 11.77 Kensal Rise 71 255 17.66 Harlesden 74 310 17.57 Stonebridge 84 334 18.60 Roundwood 89 304 19.08 Church End 104 251 17.43 Willesden Green 83 324 18.82 Cricklewood 99 273 13.66 Infant Mortality of Legitimate Infants. Table No. 35. Number of deaths of legitimate infants under 1 year 208 Infant Mortality per 1,000 legitimate births 74 Infant Mortality of Illegitimate Infants. Table No. 36. Number of deaths of illegitimate infants under 1 year 34 Infant Mortality per 1,000 illegitimate births 291 Notification of Births Acts, 1907 and 1915. Table No. 37. Notified births attended by doctors 1,501 Notified births attended by midwives 1,176 Total 2,677 Number of still births notified 70 Number of births registered 2,924 Table No. 38. Table shewing the number of visits, re-visits, and still-births 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 re-visits 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 2,464 926 ... ... 1916 2,590 2,492 ... ... 1917 2,218 6,835 1,399 33 1918 2,080 5,756 6,140 56 1919 2,509 7,648 5,946 69 46 Table No. 39. Table shewing the number of visits and re-visits to Expectant and Nursing Mothers:— Year. No. of first visits to Expectant Mothers. No. of re-visits to Expectant Mothers. No. of first visits to Nursing Mothers. No. of re-visits to Nursing Mothers. 1918 195 149 1,099 2,313 1919 371 580 2,233 6,198 Infant Death Inquiries.—Table No. 40. Year. No. of deaths of Infants under 1 year No. of Infant Death Inquiries No. of deaths of Children 1 year and under 5 years No. of Death enquiries for Children 1 year and under 5 years 1913 325 300 - - 1914 337 231 - - 1915 344 266 - - 1916 283 189 - - 1917 309 230 - - 1918 258 212 192 100 1919 242 182 98 77 Table No. 41. Method of Feeding of Children attaining 1 year of age during 1919. No. of children solely breast fed for:— Less than 1 month 86 1 month and less than 2 months 88 2 months and less than 3 months 135 3 „ „ 4 „ 116 4 „ „ 5 ,, 84 5 „ „ 6 ,, 89 6 „ „ 7 „ 95 7 „ „ 8 ,, 80 8 „ 9 „ 152 9 ,. „ 10 „ 360 10 „ „ 11 „ 134 11 „ „ 12 „ 93 12 or over 52 No. of children solely hand fed 141 No. of children breast and hand fed (this does not include children who were first breast fed and subsequently breast and hand fed) 61 No. of children breast and hand fed while under 6 months of age who were originally solely breast fed 216 No. of children solely hand fed while under 6 months of age who were originally solely breast fed 314 No. of children for whom no report available who were originally solely breast fed 68 No. of cases in which breast and hand feeding was continued when the child was over 9 months of age 311 47 6. SANITARY ADMINISTRATION. 1. Sta:-Work of Sanitary Inspectors, Inspectors of Nuisances and other Officers engaged in Sanitary Work. The work or duties discharged by the Sanitarv Inspector in Willesden are those outlined in the Sanitary Officers (outside London) Order 1910, and include (1) The investigation of complaints and specifying the remedial measures to be undertaken to abate insanitary conditions. (2) The inspection of houses under the Housing Acts and the Housing (Inspection of District) Regulations, 1910. (3) Inspection of Bakehouses, Laundries, Workshops, Factories, Workplaces, and Outworkers' premises under the Factory and Workshop Act, 1901. (4) The supervision of all works carried ont in connection with the re-drainage of houses, repairs to buildings and other work incidental to, or in connection with the remedying of insanitary conditions. (5) Inspection of Cowsheds, Milkshops and Dairies. (6) Inspection of Slaughterhouses, and the examination of carcases of animals used for human consumption. (7) Inspection of premises and shops where food is prepared, stored and sold. (8) The preparation of informal and Statutory Notices incidental to, and arising out of his inspectorial duties. The work done by the Sanitary Inspectors during the year 1919 is fully set out in this report under the heading Sanitary Inspection of District. 2. Hospital Accommodation Available for Infectious Diseases, Including Smallpox ; its Character, Sufficiency and use During the Year; Hospital Administration. This subject is dealt with in the Annual Hospital Report included in this report. 3. Local Acts, Special Local Orders, or General Adoptive Acts in Force in the District (of both of which a list should be included in the report) and their Administration. Local Acts in force in Willesden:— Willesden Local Board Act, 1876. Willesden Local Board Act, 1887. Willesden Sewerage Act, 1896. Willesden Urban District Council Act, 1903. Adoptive Acts in force in Willesden:— *Public Health Acts Amendment Act, 1890, Part III. *Public Health Acts Amendment Act, 1907, Parts II., *IIL, *IV., and X. Baths and Washhouses Acts, 1846-99. Burial Acts, 1852-1900. Public Libraries Acts, 1892-1901. Bye-laws in force in District: *Common Lodging Houses (Public Health Act, 1875, s. 80). *Houses Let in Lodgings (Public Health Act, 1875, s. 90). *Slaughter Houses (Public Health Act, 1875, s. 169 and Towns Improvement Clauses Act, 1847, s. 128). *Prevention of Nuisances (Public Health Act, 1875, s. 44). New Streets and Buildings (Public Health Act, 1875, s. 157 and Public Health Acts Amendment Act, 1890, s. 23). New Sewers (Willesden Local Board Act, 1887). Pleasure Grounds (Public Health Act, 1875, s. 164). *Drainage of Buildings (Public Health Acts Amendment Act, 1890, s. 23). *Rag and Bone Dealer (Public Health Act, 1875, s. 113). 48 Regulations made by Local Authority in force in District:— *Dairies, Cowsheds and Milkshops (Dairies, Cowsheds and Milkshops Order, 1885, s. 13). Small Holdings and Allotment Act, 1908. *Relating to underground sleeping rooms, Housing, Town Planning, etc., Act, 1909, s. 17 (7). *These are administered wholly or partly by the Health Committee. The unstarred are administered by other Committees of the Council. 4. Arrangements for Chemical and Bacteriological Work During the Year 1919, and Their Results (Including Examinations of Material for Detection of Tubercle Bacilli). Any Report by the Public Analyst which it may be Considered Desirable to Append. This is dealt with in the section relating to Infectious Diseases generally. The work of the public analyst is controlled by the Middlesex County Council. 7. OTHER SERVICES. Information Should be Given or any Important Points in which the Work of the Council is related to or is in Co-operation with the Medical and Ancillary Services of National Health Insurance, or of the Voluntary Hospitals, or of the Poor Law, or of other Agencies. No information is available on this heading. 8. HOUSING. (I.) General Housing Conditions in the District. (1) Number of houses—total number ; number for the working classes ; new houses for the working classes erected during the year, or in course of erection. (2) Population—with information as to any important changes during the year or anticipated in the future. (3) (a) Extent of shortage or excess of houses, and (b) Measures taken or contemplated to meet any shortage. (1) Number of houses:— The total number of occupiable houses in Willesden at Midsummer' 1919, was 23,537. Of this number 8,708 or 37 per cent. are houses in the poorer district occupied by two, three, four or more families, generally of the labouring or of the artizan class. A class of house much in evidence is that let in two flats to families of skilled artizans, clerks, etc. If this latter class comes within the definition of " working class population "the total number of houses for the working classes is increased by 11,533, making a total of 20,241. (2) Population:— For information relating to population, see Table No. 4. (3) Shortage of houses (a) About the year 1911 building operations in Willesden commenced to decline, and since 1915 have ceased altogether. With the exception of four houses of the Bungalow type no other buildings for human habitation have been erected during the year, neither are there any in course of erection suitable for the working classes. (b) The Council have prepared a scheme for the erection of 610 houses on a portion of the Brentfield Estate, Neasden. Arising out of (a) "The shortage or excess of houses," it is of interest to note the results of the last enumeration by the Health Department of houses in Willesden at Midsummer 1919, as follows:— The total number of empty houses was 121. Of this number:— (a) 30 were shop premises. (b) 43, large houses. (c) 9, medium sized houses. (d) 39 small houses or tenements over stables. Of the 30 shop premises, the rooms over shops are not generally available until the shops are let. 49 Of the 43 large houses, 13 were sold, 1 let, the remaining 29 were not suitable for adaptation into working class tenements. Of the nine medium sized houses, 1 was sold, 3 were let and 2 were laundries, leaving only three available for letting. Of the 39 small houses, 2 cottages were closed by the Council as unfit for human habitation, 32 have been closed for some years and in several cases the houses are past repair, and in 5 instances the tenement to let was situated over stables. The total number of tenements to let was 16. Of this number:— 2-roomed tenement 3-roomed tenement. Over three-roomed tenement. 2 were tenements over shops. 1 was " to let " with shop. 2 were uninhabitable (Basements closed). 1 tenement over shop. 1 " to let " with shop. 1 tenement over shop. 1 tenement " let " but not occupied. Leaving only what appeared to be 7 available tenements for working class people. Since the above was prepared the empty houses and tenements have become less, so that at the end of the year it became practically impossible for a working class family to find a habitable dwelling or tenement " t'O let." (II.) Overcrowding. Extent and Causes.—It is practically impossible without taking a census of the population to state definitely the extent to which overcrowding exists, and it is also difficult to form a reliable estimate. The establishment during the last few years of numerous munition and other factories brought into the district from other parts of the country several hundred families of the skilled artizan and labouring classes. This added population, together with the stoppage of building operations creating a shortage of housing accommodation, led to a crowding together of families in the existing houses. At the Census in 1911 the number of persons per room in Willesden was 1.007. Taking into consideration all the factors relative to housing and population, I estimate that at the present time the number of persons per room will not fall far short of 1.075. Measures Contemplated to Deal with Overcrowding.—As stated elsewhere in the report the Council contemplate erecting over 600 houses with a view to lessening the crowding together of families. Action taken during 1919.—Individual cases of overcrowding coming to the knowledge of the Health Department are dealt with by its Officers and action taken in all cases to remedy the same. No legal action was taken during the year. (III.) Fitness of Houses. 1. (a) General Standard of Housing in the District. The standard of houses in Willesden on the whole compares favourably with other towns of equal size and population. Building activities during the last 25 years have built up thousands of houses, all of which have been constructed on modern principles of sanitation. In the older portions of the district whereliouses were built before the days of Urban Councils and before Building Bye-laws became operative there are many houses the general standard of fitness of which is bad. These broken down or worn out houses call for constant supervision on the part of the officers of the Health Department and form the bulk of the work under the Housing (Inspection of District) Regulations. (b) The General Characters of the Defects Found to Exist in Unfit Houses are:— Dampness of walls, caused by absence of or perished damp-proof courses, earth or other deposits above damp-proof courses, defective gutters and rain water pipes; leaky roofs ; absence of or defective paving of yards ; defective or perished plastering; choked or defective drains ; windows—perished woodwork ; defective ventilation; staircase—worn out treads ; floors—worn out floor boards ; dirty and uncovered cisterns; grates and ranges broken and unusable ; W.C.'s insufficiently supplied with water; offensive accumulations or deposits in yards ; insufficient food storage accommodation; woodwork generally perished and rotten and brickwork generally perished or pointing defective. 2. (a) Action Taken as regards Unfit Houses under the Public Health Act, 1875:— The total number of houses inspected from house to house during the year and dealt with under the Public Health Act, 1875 was 278. 50 The following table No. 42 gives the position in relation thereto Table No. 42.—Shewing Number of Houses Inspected during the Year, 1919. Premises. No. of Houses inspected. No. with work completed. No. with work not commenced. No. of cases taken to Court. Remarks, (on Court cases). 61. 71-75 Barrett's Green Rd. 4 - 4 - 23-35. 41. 45-51. 50. 52. Beaconsfield Road. 14 3 - 10 Adjourned. 1-3. 23-34. 31a. Bridge Street. 15 15 - - 21-43. Brownlow Road. 12 4 8 6 Order made to complete in 28 days. 181-213. Cambridge Road. 17 - 4 - 217-219. Chapter Road. 2 2 - - 1-11. Churchmead Road. 6 3 - - 1. 3. 9. 11. Denzil Road. 4 1 - - 1-5. 11-19. 29-51 8-42. Disraeli Road. 38 15 7 11 Orders made to complete in 28 days. 28-30. Dudden Hill Lane. 2 - 2 - 1-6. Gladstone Mews. 6 - 6 - 1. la. 6-15. Goodson Road. 12 8 - - 16. 18. 24. 41. 43. 51-55. 81-91. 97-101. 109-113. 125. Granville Road. 21 7 - 5 Orders made to complete in 28 days. 2-60. Greyhound Road. 30 17 - - 1-7. Heron Road. 4 - 4 - 5. Holly Lane. 1 - 1 - 9-11. Kilburn Lane. 1 - 1 - 14. 16. Malvern Road. 2 - - - 3-21. 41. 81. Melville Road. 12 - 12 - 38-46. Mevrick Road. 5 - 5 - 19." 21. 27. 31. Oldfield Road. 4 - 3 - 2. Regent Street. 1 - 1 - 25-28. St. Julian's Road. 4 - 4 - 34-38. Stafford Road. 3 - 3 - 1-25. 31-63. 2-50 Steele Road. 55 12 29 8 Orders made to complete in 28 days " The Forge " Wellington Road. 1 - 1 - 41. 43. Westbury Road. 2 — — — 278 87 95 40 51 (b) Action taken as regards Unfit Houses under the Housing Acts—Vide Appendices Section of Housing. (3) Difficulties in Remedying Unfitness.—The work in connection with the remedying of insanitary conditions in relation to housing has been seriously handicapped during the year owing to the difficulties experienced in obtaining the necessary building materials, such as bricks, lime, sand, cement, lead, iron, white lead and drain pipes. (4) Conditions, so far as they affect Housing, as regards Water Supply, Closet Accommodation, and Refuse Disposal, together with Measures taken during the Year in these Matters—Remarks under these headings respectively are reported under the Section dealing with Sanitary Circumstances of the District. (IV.) Unhealthy Areas:— (1) Action taken as regards areas represented before the beginning of the year under Part I or Part IT of the Housing Act of 1890. (2) Particulars of and action taken as regards areas represented during the year. (3) Information as to complaints made during the year that areas were unhealthy, and action taken. No action was taken by the Council during the year under Parts I and II of the Housing Act of 1890 relating to unhealthy areas. (V.) By-Laws Relating to Houses, to Houses Let in Lodgings, and to Tents, Vans, Sheds, etc. (1) As to working of existing by-laws, and (2) As to need for new by-laws or revision of existing by-laws. Houses Let in Lodgings.—The existing bye-laws with regard to these houses were approved by the Local Government Board in 1892. Since that date Willesden has nearly trebled its population, and the character of its houses has altered. Section 2 of the bye-laws in question exempts houses where the rateable value exceeds £25 per annum, and the rent of a tenement is above 5s. per week. This proviso has the effect of rendering the bye-laws inoperative with respect to houses such as those in Cambridge Road, Kilburn Park Road, and many other roads of a similar character in South Kilburn, where it is most necessary to put the bye-laws in operation. In Kensal Rise, again, and other parts of the district, small houses occupied by two families in fairly good circumstances, but rated at less than £25 per annum,come within the scope of the bye-laws. Section 26 of the Housing, Town-Planning, &c., Act, 1919, empowers local authorities to make and enforce bye-laws with respect to houses intended or used for occupation by the working classes and let in lodgings or occupied by members of more than one family. Draft bye-laws under this section are under consideration. Moveable Dwellings—Caravans, Tents, etc.—In only two instances during the year were moveable dwellings brought under notice. Investigation failed to establish nuisances arising therefrom, and no further action was taken. (VI.) General and Miscellaneous:— Generally, an account of any action bearing on the public health, not covered by the above particulars, which has been taken during the year by the local authority in connection with overcrowding, insanitary property, and housing, whether under the Housing Acts or the Public Health Acts. No particular action has been taken other than already recorded. (VII.) Appendices, Statistics for the 12 Months Ended 31st December, 1919. (1) Number of houses in respect of which complaints were made that they are unfit for human habitation by householders, 0. (2) Action under Section 17 of the Housing Act of 1909. (a) Number of houses inspected under and for the purpose of the Section, 2 ; (b) Number of dwelling houses which were considered to be unfit for human tion, 2; and (c) Number of dwelling houses, the defects in which were remedied without the making of closing orders, 0. 52 (3) Action under Section 28 of the Housing Act, 1919. (a) Number of orders for repairs issued, 9. (b) Number of cases in which repairs were carried out by Local Authority, 0. (c) Number of dwelling houses voluntarily closed on notice by owner that they could not be made fit without reconstruction, 6. (4) Closing Orders— (a) Number of representations made to the Local Authority with a view to the making of closing orders, 2. (b) Number of closing orders made, 2. (c) Number of dwelling houses in regard to which closing orders were determined on the houses being made fit for human habitation, 0. (5) Demolition Orders— (a) Number of demolition orders made, 0. (b) Number of houses demolished in pursuance of demolition orders, 0. (6) Demolition (Voluntary)— (a) Number of houses demolished voluntarily, 0. (7) Obstructive Buildings— (a) Number of representations made (Section 38 of the Housing Act of 1890.) 0. (b) Number of buildings demolished, 0. (c) Number of representations still under consideration, 0. (8) Staff Engaged in Housing Work with, Briefly, Duties of Each Officer— Staff—The Staff of the Health Department engaged in work in connection with housing are : 1 Chief Sanitary Inspector ; 6 District Sanitary Inspectors ; 1 Clerk (part time). Each Sanitary Officer carries out in his own district all of the duties prescribed under the Housing (Inspection of District) Regulations, 1910. Administration of Factory and Workshop Act, 1901. The following tables shew the number of premises visited in pursuance of the provisions of the Eactory and Workshop Act and the Action taken in connection therewith. In one instance legal proceedings were taken to enforce compliance in respect of cleanliness at a laundry. Table No. 43. Y ACTORIES, WORKSHOPS, LAUNDRIES, WORKPLACES AND HOMEWORK. Inspection—Including Inspections made by Sanitary Inspectors or Inspectors of Nuisances. Premises. (1) Number of Primary Inspections. (2) Written Notices. (3) Prosecutions. (4) Factories (including Factory laundries) 183 27 — Workshops (including Workshop laundries) 144 11 1 Workplaces (other than Outworkers' premises included in Part 3 of this Report) 24 2 — Total 351 40 1 53 Table No. 44.—Defects Found. Particulars. (1) Number of Defects. Number of Prosecutions. (5) Found. (2) Remedied. (3) Referred to H.M. Inspector. (4) Nuisances under the Public Health Acts:— Want of Cleanliness 16 14 - — Want of Ventilation — — - — Overcrowding 1 1 - — Want of drainage of floors 3 3 - — Other Nuisances 11 11 - — Sanitary accommodation— Insufficient 1 1 - — Unsuitable or defective 7 7 - — Not separate for Sexes 1 1 - — Unscreened for Sexes 10 10 - — 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) 11 10 - - Other offences — - - -— (Excluding offences relating to outwork which are included in Part 3 of this Report.) Total 61 58 — — Table No. 45.—Registered Workshops. Workshops on the Register (s. 131) at the end of the year. (1) Number. (2) Factories 124 Factories, Laundries 40 Workshops, Laundries 20 Domestic Laundries 10 Bakehouses 64 Dressmakers 26 Outworkers 125 Blouse Makers 19 Tailors 25 Bootmakers 81 Metalworkers 11 Wood Workers 6 Seamstresses 4 Motor and Cycle Makers 17 Upholsterers 13 Milliners 16 Miscellaneous 25 Total number of Workshops on Register 626 Table No. 46.—Other Matters. Class. (1) Number. (2) Matters notified to H.M. Inspector of Factories:— Failure to affix Abstract of the Factory and Workshop Act (s. 133) 2 Action taken m 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 7 Reports (of action taken) sent to H.M. Inspector 4 Other — Underground Bakehouses (s. 101):— Certificates granted during the year — In use at the end of the year 18 54 Table No. 47. 3.-—Home Work. Nature of Work. (1) Outworkers' Lists, Section 107. Notices served on Occupiers as to keeping or sending lists. (8) Prosecutions. Outwork in Unwholesome Premises. Section 108. Outwork in Infected Premises. Section 109, 110. Lists received from Employers. Failing to keep or permit inspection of lists. (9) Failing to send lists. (10) Sending twice in the Year. Sending once in the Year. Instances (11) Notices served. (12) Prosecutions. (13) Instances (14) Orders made S. 110. (15) Prosecutions, Section 109, 110. (16) Lists. (2) Outworkers. Lists. (5) Outworkers. Con- tractors. (3) Work- men. (4) Contractors. (6) Workmen. (7) Wearing Apparel— Making, &c 13 1 17 6 3 5 39 ... ... ... ... ... ... ... ... Cleaning and Washing ... ... ... ... ... ... 2 ... ... ... ... ... ... ... ... Household linen ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Lace, lace curtains, and nets ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... Furniture and upholstery 2 1 2 1 1 ... 6 ... ... ... ... ... ... ... ... Umbrellas, &c ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Total 15 2 19 7 4 5 48 ... ... ... ... ... ... ... ... 55 THE TWELFTH ANNUAL REPORT FOR THE Year Ending 31st December, 1919, ON THE HEALTH OF CHILDREN ATTENDING THE PUBLIC ELEMENTARY SCHOOLS IN WILLESDEN. Table No. 48.—CERTAIN STATISTICAL DATA. No. of Public Elementary Schools at December, 1919 34 No. of School Departments at December, 1919 79 No. of Children on School Rolls at December, 1919 24,704 Total No. of Children medically inspected 6,240 Total No. of Children dentally inspected 5,136 Total No. of Defects of every description "followed up" during 1919 17,035 Total No. of Defects of every description for which treatment was obtained during 1919 15,129 Table No. 49. MEDICAL AND DENTAL TREATMENT—ATTENDANCES AT CLINICS, 1919. Condition. Mothers and Children under 5. School Children. Grand Total. Expectant Mothers. Nursing Mothers. Children under Five. Total. 1. Cleansing 22 14 713 749 6,210 6,959 2. Throat, Nose and Ear Diseases 0 0 142 142 4,123 4,265 3. Minor Ailments 60 111 1,545 1,716 28,700 30,416 4. Eye Diseases 0 0 81 81 5,925 6,006 5. Medical Consultations 1,966 5,696 22,323 29,985 0 29,985 6. Total (1—5) 2,048 5,821 24,804 32,673 44,958 77,631 7. Dental Consultations 146 202 530 878 11,024 11,902 8. Total (6—7) 2,194 6,023 25,334 33,551 55,982 89,533 9. Ringworm Attendances 0 0 197 197 1,221 1,418 10. Grand Total 2,194 6,023 25,531 33,748 57,203 90,951 Clinic (I.). Clinic (II.). Grand Total. Mothers and Children under Five. School Children. Total. Mothers and Children under Five. School Children. Total. 11. Medical Attendances 15,533 21,537 37,070 17,140 23,421 40,561 77,631 12. Dental Attendances 430 5,503 5,933 448 5,521 5,969 11,902 13. Total 15,963 27,040 43,003 17,588 28,942 46,530 89,533 56 Table No. 50.—SPECIAL SCHOOLS. 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 9 9 Deaf 0 22 22 Mentally defective *90 5 95 Epileptic o 6 6 Physically defective 65 3 68 Total 155 45 200 *2 are also Epileptic and 1 partially blind. TABLE No. 51.—CORRESPONDING TO TABLE 1. OF APPENDIX F OF ANNUAL REPORT OF CHIEF MEDICAL OFFICER OF BOARD OF EDUCATION FOR 1917. Number of Children inspected 1st January, 1919, to 31st December, 1919. A.—" Code " Groups. Age. Entrants. 3 4 5 6 Other Ages. Total. Boys — — — — — . — Girls — — — — — - Totals - — — — — - Age. Intermediate Group. Leavers. Grand Total. 8 12 13 14 Other Ages. Total. Boys — — — — — — — Girls - - - - - - - Totals — — — 1 i — — B.—Groups other than "Code."* (1) Intermediate Group (other than 8 years). (2) Special Cases f (3) Re-examinations (i.e. No. of Children re-examined). (4) Boys — 6,240 1,298 Girls Totals — 6,240 1,298 *In this area, where routine' inspections have been suspended and the " ailing children " basis adopted, the number of children inspected has been entered in column (3). †Under this head are included all special cases which were medically inspected during the year, whether the inspection took place in the Schools or at the inspection Clinic, and from whatever source the cases were derived. 57 Table No. 52.—Corresponding to Table II. of Appendix F of Annual Report of Chief Medical Officer of Board of Education for 1917. Return of Defects found in the Course of Medical Inspection in 1919. Defect or Disease. (1) Code Groups. Specials. Number referred for treatment. (2) Number requiring to be kept under observation but not referred for treatment. (3) Number referred for treatment. (4) Number requiring to be kept under observation but not referred for treatment. (5) Malnutrition - - 36 - Uncleanliness:— Head - - 677 - Body - - 22 - Skin "Ringworm Head - - 300 - Body Scabies - - 515 - Impetigo - - 1,212 - Other Disease - - 449 - Eye "Defective Vision and Squint - - 1,030 - External Eye Disease - - 382 - Ear Defective Hearing Ear Disease f - - 501 - Teeth Dental Disease (SeeN.B.(2) below) - - — - Nose and Throat Enlarged Tonsils - - 287 - Adenoids - - 190 - Enlarged Tonsils and Adenoids - - 297 - Defective Speech - 1 - Heart and Circulation "Heart Disease: Organic - - 17 - Functional - - 14 - Anaemia - V - "Pulmonary - - Lungs Tuberculosis - Definite - - 6 - Suspected - - 68 - Chronic Bronchitis - - 240 - Other Disease - - 54 - Nervous System 'Epilepsy - - 17 - Chorea - - 62 - Other Disease - - 29 - N on-Pulmonary - Tuberculosis: - Glands - - 6 - Bones and Joints - - 1 - Other Forms - - 2 - Rickets - - 7 - Deformities - - 36 - Other Defects or - Diseases - - 4,840 - Total - - 11,375 - Notes.—(1) In this area the routine medical inspection of the groups of children prescribed by the Code is temporarily suspended, and the examination of ailing children of all ages is undertaken instead. 58 (2) Under the head "Specials" (see columns (4) and (5) of Table) are included all special cases which were medically inspected during the year, whether the inspection took place in the Schools or at the inspection clinic, and from whatever source the cases were derived. Table No. 53.—Corresponding to Table III. of appendix F of Annual Report of Chief Medical Officer of Board of Education for 1917. Numerical Return of all Exceptional Children in the area in 1919. Boys. Girls. Total. Blind (including partially blind). Attending Public Elementary Schools 2 1 3 Attending Certified Schools for the Blind 6 3 9 Not at School 1 1 2 Deaf and Dumb (including partially deaf). Attending Public Elementary Schools 3 3 6 Attending Certified Schools for the Deaf 15 7 22 Not at School 0 0 0 . Mentally Deficient. Feeble Minded. Attending Public Elementary Schools 9 4 13 Attending Certified Schools for Mentally Defective Children *† 52 55 107 Notified to the Local (Control) Authority during year 12 5 17 Not at School 6 1 7 Imbeciles. At School 6 3 9 Not at School †† 18 11 29 Idiots. 4 5 9 Epileptics. Attending Public Elementary Schools 5 8 13 Attending Certified Schools for Epileptics 3 3 6 Not at School ** 1 — 1 Physically Defective. Pulmonary Tuberculosis Attending Public Elementary Schools 43 33 76 Attending Certified Schools for Physically Defective Children 4 1 5 Not at School 18 11 29 Other Forms of Tuberculosis Attending Public Elementary Schools 33 34 67 Attending Certified Schools for Physically Defective Children 19 9 28 Not at School 10 10 20 Cripples Other Than Tubercular. Attending Public Elementary Schools 30 13 43 Attending Certified Schools for Physically Defective Children 23 21 44 Not at School 4 7 11 Physically Defective Other Than Tubercular and Other Than Cripples Attending Public Elementary Schools 25 30 55 Attending Certified Schools for Physically Defective Children 5 3 8 Not at School 10 7 17 § Dull or Backward. Retarded 1 year 23 12 35 Retarded 2 years 4 8 12 Retarded 3 years 6 2 8 § Judged according to age and standard. † Two of these boys are also Epileptic. ††Three boys and two girls are also Epileptic. * One of these boys is also partially blind and receiving special education for the Blind. ** This boy is also mentally defective. 59 Table No. 54. Return showing No. of Special Cases referred in 1919 and previous years with the view of Medical or Dental Treatment being obtained, Remedial Measures carried out, or other action taken. Year. Referred by Total Grand Total. ( Medical or Dental Inspection and Officers of Health Department. Head Teachers. Attendance Officers. Others. 1919 Medical 1,796 4,167 451 3,538 9,952 14,827 Dental 2,833 654 17 1,371 4,875 1918 1,674 4,163 395 1,150 7,382 7,382 1917 1,227 3,372 441 427 5,467 5,467 1916 1,436 3,264 313 394 5,407 5,407 1915 1,308 3,429 109 298 5,144 5,144 1914 2,322 2,401 108 140 4,971 4,971 1913 1,092 1,092 1912 1,102 1,102 1911 1,030 1,030 1910 941 941 60—61 Table No. 55.—Corresponding to Table IV., appendix F. of the 1917 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 and dental examinations made in connection therewith, and the extent to which remedial measures were carried out during 1919. CONDITION. No. of defects found for which treatment was considered necessary. No. of visits made on account of these defects. No. of Medical or Dental Examinations made on account of these defects. No. of times attended by Clinic Nurse only on account of these defects. No. of defects for which no report is available. No. of defects not needing treatment. No. of defects treated. Total. Results of Treatment. Percenrtage of cefects treated No. of defects not treated. No. of defects under observation at end of year and carried forward to succeeding year. Remedied. Improved. Unchanged Under observation at end of year (result of treatment not known at end of vear. School Clinic. Municipal Hospital Home (under supervision of Council Staff). Voluntary Hospital or other charitable Institution Infirmary or Poor Law. Private Practitioner or Dentist. Removed from observa tion. Still under observation at end of year. Total. Brough forward from previou year. †New. Total. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 Clothing— Unsatisfactory 3 12 15 37 6 0 0 0 1 0 14 0 0 0 15 14 0 0 1 100.0 c 0 0 1 Footgear— Unsatisfactory 0 4 4 12 0 0 0 0 0 0 4 0 0 0 4 4 0 0 0 100.0 0 0 0 0 Cleanliness of Head— Nits 20 349 369 1211 135 397 0 0 147 0 217 0 1 0 365 321 1 0 43 98.9 4 4 4 47 Pediculi 11 259 270 810 143 527 0 0 115 0 154 0 0 0 269 252 0 0 17 99.6 0 1 1 18 Other dirty conditions 1 37 38 95 10 4 0 0 2 0 36 0 0 0 38 37 0 0 1 100.0 0 0 0 1 Cleanliness of Body- Dirty 0 11 11 48 1 0 0 0 1 0 10 0 0 0 11 10 0 0 1 100.0 0 0 0 1 Pediculi 1 9 10 23 5 17 0 0 1 0 9 0 0 0 10 10 0 0 0 100.0 0 0 0 0 Fleabitten 0 1 1 3 0 0 0 0 0 0 1 0 0 0 1 1 0 0 0 100.0 0 0 0 0 Nutrition— Below Normal 19 17 36 114 74 0 1 0 21 0 12 1 0 1 35 16 9 0 10 100.0 0 0 0 10 Bad 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0.0 0 0 0 0 Nose and Throat— Enlarged Tonsils 80 217 297 572 544 0 0 10 114 21 10 30 0 7 182 125 3 4 50 63.4 30 75 105 125 Adenoids 103 94 197 479 409 121 3 7 80 5 8 18 0 7 118 78 3 4 33 63.1 21 48 69 81 Enlarged Tonsils and Adenoids 89 217 306 805 818 19 1 9 81 43 12 45 0 3 184 118 6 0 60 62.2 14 98 112 158 Other conditions 37 275 312 648 508 59 1 3 139 5 81 9 0 58 292 241 7 1 43 94.8 2 14 16 57 Cervical or Neck Glands— Enlarged 20 258 278 577 356 38 0 2 61 6 158 13 1 27 266 197 18 1 50 96.4 3 7 10 57 External Eye Disease— Blepharitis 28 163 191 356 643 487 0 0 149 0 33 2 1 2 187 146 0 0 41 97.9 2 2 4 43 Conjunctivitis 24 124 148 241 584 785 0 0 123 1 14 5 0 3 146 112 0 0 34 98.6 2 0 2 34 Corneal Opacities 5 13 18 44 85 110 0 1 10 4 0 2 0 0 16 8 3 1 4 94.1 1 0 1 4 Other Disease 2 24 26 42 115 65 0 0 20 0 5 0 0 0 25 18 2 0 5 96.2 1 0 1 5 Ear Disease Chronic Suppuration of Middle Ear 52 296 348 861 599 1,529 0 2 279 0 28 19 0 7 333 177 14 0 142 96.2 5 8 13 150 Chronic Catarrh of Middle Ear 1 15 16 55 55 0 0 0 9 0 1 0 0 5 15 13 1 0 1 93.7 1 0 1 1 Wax 3 44 47 85 144 66 0 0 45 0 2 0 0 0 47 32 7 0 8 100.0 0 0 0 8 Other Disease 11 85 96 227 139 105 0 4 48 0 24 4 2 4 82 56 8 0 18 89.1 8 2 10 20 Teeth— Irregular 3 27 30 42 34 0 0 2 4 0 0 5 0 0 9 4 0 3 2 32.1 13 6 19 8 Less than 4 decayed 176 1,908 2,084 2,456 2,809 0 1 5 1,688 0 0 6 0 16 1,710 1,464 49 0 197 82.3 203 165 368 362 Four or more decayed 245 2,860 3,105 4,131 6,569 0 9 0 2,632 0 0 11 0 28 2,671 2,018 94 0 559 86.3 215 210 425 769 Sepsis 2 15 17 22 47 0 0 0 14 0 0 0 0 0 14 10 0 0 4 82.4 2 1 3 5 Defect not ascertained 57 92 149 280 65 0 2 0 25 0 0 4 0 3 32 7 0 0 25 21.8 36 79 115 104 Heart and Circulation— Organic Disease 8 9 17 58 45 0 0 0 6 1 5 1 0 2 15 4 2 1 8 88.2 2 0 2 8 Functional Disease 2 12 14 46 19 0 0 0 3 0 2 2 0 2 9 6 0 0 3 64.3 4 1 5 4 Anaemia 15 62 77 230 316 0 0 0 38 1 28 0 0 1 68 30 2 0 36 88.3 8 1 9 37 Other defect 2 3 5 15 0 0 0 0 1 0 0 1 0 3 5 2 3 0 0 100.0 0 0 0 0 Lungs— Chronic Bronchitis and Bronchial Catarrh 51 189 240 814 726 0 0 0 56 4 106 11 0 53 230 127 7 2 94 95.8 10 0 10 94 Tuberculosis – – – – – – – – – – – – – – – – – – – – – – – – Tuberculosis Suspected 22 46 68 313 167 0 0 2 16 1 20 11 2 8 58 10 15 2 31 87.9 8 0 8 31 Other disease 13 41 54 149 38 0 0 0 14 3 12 7 1 14 51 47 0 0 4 94.4 1 2 3 6 Nervous System— Epilepsy 4 13 17 38 57 0 0 0 2 0 8 3 0 1 14 0 5 2 7 82.4 1 2 3 9 Chorea 18 44 62 245 111 0 0 0 4 4 13 21 0 9 51 29 4 0 18 82.3 3 8 11 26 Other disease 12 20 32 84 29 7 0 3 11 3 2 4 0 7 27 15 0 0 12 93.1 2 0 2 12 Skin— Ringworm Body Head 97 207 304 887 1,165 41 2 4 221 0 18 9 14 270 233 1 1 35 90.6 11 17 28 52 Impetigo 145 1,068 1,213 2,890 2,171 5,622 0 1 748 2 390 13 1 46 1,200 1,059 3 0 138 99.0 5 7 12 145 Scabies 87 433 520 1,348 1,352 2,779 1 5 324 6 112 21 13 25 501 447 1 0 53 97.5 9 4 13 57 Other disease 37 413 450 1,022 930 1,702 1 1 263 4 124 14 1 29 435 377 1 1 56 97.1 8 5 13 61 Ricketts— Slight Marked 3 4 7 41 11 0 0 0 4 0 0 3 0 0 7 1 1 0 5 100.0 0 0 0 5 Deformities— Deformity present 14 23 37 128 68 0 0 1 6 2 5 15 0 0 28 2 10 1 15 77.8 6 2 8 17 Tuberculosis (Non-Pulmonary)— *Glandular †Bones or Joints ‡Other form Suspected—Glandular 5 6 11 56 18 0 0 0 4 0 1 1 0 2 8 0 2 1 5 72.7 1 2 3 7 „ Bones and joints 5 8 13 24 20 0 0 1 9 0 0 3 0 0 12 0 2 2 8 100.0 0 0 0 8 „ Other forms 2 2 4 30 18 0 0 0 1 0 2 1 0 0 4 0 0 0 4 100.0 0 0 0 4 Speech— Defective Articulation 0 1 1 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0.0 1 0 1 0 Squint- Squint present 23 34 57 97 130 0 0 3 44 1 0 1 0 0 46 12 22 5 7 85.2 3 5 8 12 Vision- Defect not ascertained 35 8 43 87 16 0 0 0 14 0 0 2 0 1 17 10 1 4 2 39.5 5 21 26 23 One eye normal 26 54 80 92 237 0 2 0 68 0 0 1 0 1 70 34 17 10 9 95.9 1 2 3 11 Both eyes 6/6 15 136 151 219 359 0 2 29 112 0 0 0 0 2 114 64 18 18 14 95.0 2 4 6 18 6/9 10 47 57 58 136 0 0 1 47 0 0 0 0 0 47 26 6 5 10 83.9 3 6 9 16 One eye 6/9 other 6/12 or less 25 63 88 108 273 9 1 0 74 0 2 1 0 1 78 47 19 10 89.7 6 3 13 Both eyes 6/12 or less 61 189 250 278 796 114 0 0 234 0 0 0 0 1 235 118 67 12 38 94.0 10 5 15 43 Spectacles broken 33 264 297 214 725 10 0 2 292 0 0 0 0 1 293 272 1 0 20 99.3 1 1 2 21 „ lost 8 39 47 38 122 0 0 0 44 0 0 0 0 1 45 45 0 0 0 95.8 1 1 2 1 Debility 123 333 456 1,483 835 2 0 0 136 2 225 29 2 42 436 250 50 0 136 95.6 9 11 20 147 Miscellaneous 134 3,810 3,944 7,662 5,810 3,876 13 194 1,416 78 1,729 120 3 332 3,678 3,191 72 5 410 98.4 36 23 59 433 Grand Totals 2,028 15,007 17,035 33,027 31,598 18,491 40 297 10,021 197 3,637 468 37 769 15,129 11,947 557 8£ 2,537 90.6 716 853 1.569 3,390 Mental Condition—Dull or Backward and Mentally Defective (all grades)— No. of Cases examined during 1919 55 Found on examination to be dull or backward 30 Found on examination to be mentally defective 25 Re-examinations in respect of Defective Vision other than Lost and Broken Spectacles— No. of Visits 1,265 No. of Medical Examinations .1,788 Re-examination in respect of Dental Defects— No. of Visits 529 No. of Dental Examinations 392 † The return should show comprehensively all defects found during the year, from whatever source derived, which required treatment. * 6 Cases were notified by the Assistant School Medical Officers during the year and were dealt with as notifiable infectious diseases, † 1 Case was „ „ „ „ was „ - a notifiable infectious disease, ‡ 2 Cases were „ „ „ „ were „ notifiable infectious diseases. 62 63 Table No. 56. RETURN OF WORK DONE AT THE MEDICAL TREATMENT CLINICS DURING 1919. Ringworm and Special Skin Clinic. Eye Clinic. Throat, Nose and Ear Clinic. Minor Ailment Clinic. Cleansing Clinic. Grand Total. Expt. Mothers. Nursing Mothers. Children under 5. School Children. Total. Expt. Mothers. Nursing Mothers. Children under 5. School Children. Total. Expt. .Mothers. Nursing Mothers. Children under 5. School Children. Total. Expt. Mothers. Nursing Mothers. Children under 5. School Children. Total. Expt. Mothers. Nursing Mothers. Children under 5. School Children. Total. Expt. Mothers. Nursing Mothers. Childrenj under 5. School Children. Total. No. under treatment at 28th December, 1918 0 0 16 87 103 0 0 7 220 227 0 0 24 253 277 0 0 17 417 434 0 0 5 43 48 0 0 69 1,020 1,089 No. coming under treatment 0 0 46 233 279 0 0 13 557 570 0 0 29 47-5 504 11 41 209 3,443 3,704 3 5 80 512 600 14 46 377 5,220 5,657 Total No. under treatment 0 0 62 320 382 0 0 20 777 797 0 0 53 728 781 11 41 226 3,860 4,138 3 5 85 555 648 14 46 446 6,240 6,746 No. cured or relieved:— (a) By X Rays 0 0 15 83 98 — — — — - — — — — — — — — — - — — — - - 0 0 15 83 98 (b) By provision of Spectacles — — — — — 0 0 7 381 388 — - - - - - - - - - - - - - - 0 0 7 381 388 (c) By baths — — — — — — — — — — — — — — — — — — — - 3 1 38 257 299 3 1 38 257 299 (d) By other means 0 0 8 104 112 0 0 4 97 101 0 0 1 174 175 11 31 150 2,494 2,686 0 4 34 232 270 11 35 197 3,101 3,344 No. referred to Municipal Hospital — — — — — 0 0 1 4 5 0 0 49 234 283 0 7 45 203 255 0 0 4 3 7 0 7 99 444 550 No. previously attending Clinic cured by other than Municipal agencies or removed 0 0 15 6 21 0 0 0 7 7 0 0 1 17 18 0 1 0 119 120 0 0 5 10 15 0 1 21 159 181 No. not requiring treatment 0 0 6 60 66 0 0 0 119 119 0 0 0 26 26 0 0 2 243 245 0 0 0 0 0 0 0 8 448 456 Total No. remaining under treatment at 27th December, 1919 0 0 18 67 85 0 0 8 169 177 0 0 2 277 279 0 2 29 801 832 0 0 4 53 57 0 2 61 1,367 1,430 Re-examinations of cases previously treated at Clinics — — — — — 0 0 7 1,169 1,176 0 0 5 25 30 0 0 3 104 107 — — - — — 0 0 15 1,298 1,313 Note.—Minor ailments referred to Municipal Hospital include such conditions as bronchitis where the children were brought to the Clinic to see the Doctor and referred on to Hospital. Table No. 57. Return respecting the Provision of Spectacles during 1919. No. of pairs of Spectacles provided 942 Cost of Spectacles provided £309 17 0 Average cost per pair £0 6 7 No. of pairs wholly paid for by parents 43 No. of pairs partly paid for by parents 262 Total amount received as above £50 7 3 Cost of repairs £20 5 6 Total amount received for repairs £3 18 3 Table 59. HOSPITAL TREATMENT OF SCHOOL CHILDREN DURING 1919. (Excluding Infectious Diseases.) No. of School Children in Hospital at 31st December, 1918 11 ,, ,, admitted to Hospital during 1919 232 „ ,, discharged from Hospital during 1919 213 ,, ,, died in Hospital during 1919 3 ,, ,, remaining in Hospital at 31st December, 1919 27 Table No. 58. CORRESPONDING TO TABLE V. OF APPENDIX F. OF ANNUAL REPORT OF CHIEF MEDICAL OFFICER OF BOARD OF EDUCATION FOR 1917. Inspection, Treatment, etc., of Children during 1919. 1. The total number of children medically inspected (whether Code Group, special or ailing child) 6,240 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) 0 3. The number of children in (1) who were referred for treatment (excluding uncleanliness, defective clothing, etc.) 5,560 4. The number of children in (3) who received treatment for one or more defects (excluding uncleanliness, defective clothing, etc.) 5,560 Table No. 60. NUMBER OF SCHOOL CHILDREN AND DEFECTS TREATED IN HOSPITAL IN 1919. No of children admitted with 0 defects 5 ,, ,, 1 defect 180 ,, ,, 2 defects 43 ,, ,, 3 ,, 15 ,, ,, 4 ,, 0 ,, ,, more than 4 defects 0 Total 243 Table No. 61.—HOSPITAL TREATMENT OF DEFECTS IN SCHOOLCHILDREN IN 1919. Defects. No. of defects under treatment during the year Forms of Treatment. Results of Treatment. In Hospital at end of year. Operative. General., Other forms specify, e.g., massage, electricity, etc. Remedied. Improved. changed Died. Appendicitis 7 3 4 – 7 – — – – Hernia 5 5 — – 5 — — — — Tubercular Glands 8 2 6 – 2 5 — 1 „ Arthritis 3 — 3 – — 2 – — 1 Cellulitis 2 — 2 – 2 — — — – Abcess, Various 13 13 — – 13 — — — — Adenitis 7 — 7 – 7 — — — – „ (Pediculosis) 2 — 2 – 2 – — — Otitis Media 4 1 3 – 3 — – — 1 Mastoiditis 3 3 — – 3 – – — — Cavernous Sinus Thrombosis 1 – 1 – – – – 1 – Necrosis of Jaw 1 1 — – 1 – — — — Pyorrhoea 1 — 1 – 1 – – — — Enlarged Tonsils and Adenoids 68 68 – – 57 – — – 11 Do. do. Cum Turbinate Disease 9 9 –– – 6 – – – 3 Do. do. Otitis Media 20 20 — – 20 – — — — Fractures 7 1 6 – 7 – — — – Contusions (limbs) 2 — 2 – 2 – — —- – Periostitis 1 — 1 – 1 – – – — Burns 1 — 1 | — 1 Phimosis 6 — 6 – 5 – — — 1 Hydrocele 1 1 — – I – — —• — Enuresis 1 — – – – – – – – Strabismus 1 1 – – – – – – – Corneal Ulcc 2 — 2 1 2 – — — — Conjunctivitis 2 — 2 – 2 – – – – Torticollis 2 2 – – 2 – – – — Cleft Palate 1 1 – – 1 – — — -— Patent Thyro Glossal Duct. 1 1 – – – – – – 1 Papilloma 2 2 — – 2 – – — — Deformity of Legs, Rickety 3 3 — – 3 – — — _ Ganglion 3 3 — — 3 – — — — Angioma 1 1 — – 1 – — — — ' Septic Wounds 10 — 10 – 9 – – — 1 Lacerated Wound of Hand 1 1 – – 1 – – – – Rheumatism 6 — 6 – 5 – — — 1 Chorea 8 — 8 – 7 – – — 1 Endocarditis 1 — 1 – – – — – — Tubercular Meningitis 1 — 1 – – – – – — Neuritis 1 — – 1 1 – — – — Nephritis 2 — 2 – 1 – — – 1 Hæmoglobinuria 1 — 1 . – 1 – — – — Pyelitis 2 — 2 – 2 – — — — Pneumonia 8 — 8 – 8 – — — — Pleurisy 3 — 3 – 3 – — — — Empyema 1 1 — – — – — — 1 Bronchitis 9 — 9 – 9 – — — – Pulmonary Tuberculosis 3 — 3 – — 3 — — — Laryngitis 1 — 1 – 1 — — — — Rhinitis Suppurative ... 1 — 1 – 1 — — — — Gastric Catarrh 1 .— 1 1 — — — — Enteritis 1 — 1 – 1 — — — — Tonsillitis 36 — 36 – 35 — — — 1 Constipation 2 — 2 – 2 — — — — Tabes Mesenterica 1 — 1 – — 1 — — — Intestinal Worms 1 — 1 – 1 — — — — Scabies 4 — 4 – 4 — — — — Eczema ... 3 — 3 – 3 — — — — Furunculosis 2 — 2 – 2 — — — — Septic Rash 5 — 5 – 5 — — — — Impetigo 4 — 4 – 3 — — — 1 Debility 1 — 1 – 1 — — — — Nil 5 — 5 – — — 5 — — 316 149 166 – 270 11 5 3 27 64 65 Table No. 62.—DENTAL INSPECTION OF SCHOOL CHILDREN, 1919. Routine Dental Inspection at the Schools, Age Groups. Specials. Grand Total. 5 6 7 8 9 Total. (a) No. inspected by Dentist 564 1,031 703 454 52 2,804 2,332 5,136 (b) No. referred for treatment 342 784 613 369 47 2,155 2,332 4,487 (c) Actually treated 4,177 (d) Re-treated * (result of periodical re-examination) 141 * Cases under this head are also included under (c) above. Table No. 63.—RETURN OF WORK DONE AT THE DENTAL CLINICS DURING THE YEAR 1919. Mothers and Children under Five. School Children Grand Total. Expt. Mothers. Nursing Mothers. Children under 5. Total. No. inspected at the Clinics. 74 78 192 244 2,068 2,312 No. re-examined at the Clinics 2 3 28 33 277 310 No. under treatment during the year 74 79 172 325 4,490 4,815 Treatment carried out at Clinic No. of Fillings Temporary Teeth – – 108 108 1,901 2,009 Permanent Teeth 26 34 – 60 2,277 2,337 No. of Extractions 'Temporary Teeth – – 434 434 10,765 11,199 Permanent Teeth 203 189 – 392 1,391 1,783 No. of other operations 11 33 41 85 470 555 No. of times anaesthetics administered Local 15 17 0 32 23 55 General 43 54 153 250 4,115 4,365 67 FIFTH ANNUAL REPORT ON THE PROVISION OF MEALS TO SCHOOL CHILDREN AND TO EXPECTANT AND NURSING MOTHERS AND CHILDREN UNDER 5 YEARS IN WILLES- DEN DURING 1919. PROVISION OF MEALS—SCHOOL CHILDREN. During the year ended 31st December, 1919, there have been three Feeding Centres open, controlled by the Education Committee and one Voluntary Centre. 102,632 meals have been supplied to school children from these centres. The Staff employed at each of the Committee Centres is approximately an assistant to every 50 or 60 children, as shewn in Table No. 64, due regard being paid to the particular arrangements at each centre. Table No. 64. SHOWING PROPORTION OF STAFF TO NO. OF INDIVIDUALS FED. Feeding Centre. Week ending. No. of Staff. No. of Individuals fed. Gibbons Road 25.1.19 4 full time 209 5.7.19 2 full time 1 part time 144 11.10.19 2 full time 100 Furness Road 25.1.19 1 full time 2 part time 122 5.7.19 2 full time 148 11.10.19 2 full time 1 part time 129 Strode Road 25.1.19 2 full time 119 5.7.19 1 full time 1 part time 77 11.10.19 1 full time 1 part time 62 The dietary has been very slightly varied since that adopted in 1917, to meet the various food orders that have been issued from time to time. The dinners given are shewn in the following Table No. 65. 68 Table No. 65.—DIETARY DURING YEAR ENDED 31st DECEMBER, 1919. ■ 1st Course. 2nd Course. 1st Week:— Monday Vegetable Soup, Dumplings Baked jam roly-poly. Tuesday Meat and Potato Stew, Beans Buttered rice. Wednesday Shepherd's Pie, Cabbage Baked ginger pudding. Thursday Bean Soup, Dumplings Fruit tart. Friday Fish, Potatoes, Peas Suet pudding and treacle. 2nd Week:— Monday Lentil Soup, Dumplings Baked treacle tart. Tuesday Sailors' Pie, Cabbage Blanc mange and jam. Wednesday Scotch Barley broth. Baked fruit roll. Thursday Rice and Cheese baked Cornflour and stewed fruit. Friday Fish and potato pie, Beans Baked rice pudding. 3rd Week Monday Potato Soup Suet and jam roll boiled. Tuesday Cottage Pie and Beans Rice mould and jam. Wednesday Irish Stew and Cabbage Treacle tart. Thursday Lentil Soup and Dumplings Baked ginger pudding. Friday Cheese and potato pie gravy Cornflour and stewed fruit. Outlying districts, such as Lower Place, require a Feeding Centre more close at hand. Parents do not care to send the children far in bad weather, nor to send children of infant school age alone to the Centres. Meals are often refused by parents for children attending Christchurch and Salisbury Road schools on account of the distance to the Kilburn Feeding Centre. There is always a noticeable drop in the number on a very wet day, or during a spell of inclement weather. There is also a noticeable diminution in the numbers during the school holidays. The maximum, minimum and average number of children fed for the whole year is shewn in the following Table, No. 66. Table No. 66.—SHEWING VARIATION IN NUMBERS FED DURING YEAR ENDED 31st DECEMBER, 1919. Date. Max. No. Fed. Date. Min. No. Fed. Av. No. fed per week through| out the year. School children Week ending: 26/1/19 669 Week ending : 24/8/19 130 479.5 Children under 5 years of age 5/1/19 87 24/8/19 14 53.94 Expectant and Nursing Mothers 26/1/19 22 24/8/19 2 11.17 Selection of Children.—Economic Circumstances.—Special Cases.—No changes have been made in respect of the selection of children to be fed, but it is noticeable, particularly in the Kilburn area, that the children apply themselves for meals unauthorised by their parents. The need of the meals in many of such instances is emphasised by the fact that the same children apply again and again, although the parents refuse to allow their names to be retained on the registers. 69 A number of application forms are issued from the Clinics to children requiring in the opinion of the Assistant Medical Officers a better or more regular meal than the parents are providing for them; and a fair proportion of these forms are made use of by the parents. It has been customary to re-investigate the Economic Circumstances of the family every four weeks, and to remove from the free list, after at least five days' notice, those whose means are shewn to be above the Education Committee's Scale. Where children are specially recommended for meals on account of physical unfitness, the Children's Care Committee are asked to make a decision upon hearing the medical report. The last column in the following Table, No. 67, shews the present scale of the Education Committee for free meals, while the whole table shews the variations of the scale adopted to meet the changes in the estimated cost of living. Table No. 67.—EDUCATION COMMITTEE'S SCALES FOR THE FEEDING OF SCHOOL CHILDREN. No. in Family. 1916. November, 1916. July, 1917. December, 1918. July, 1919, to date. s. d. s. d. s. d. s. d. s. d. 2 6 0 8 0 10 0 11 0 10 0 3 5 0 6 6 8 0 9 6 8 0 4 4 6 6 0 7 6 8 0 7 6 5 4 3 5 6 6 6 7 6 7 0 6 4 0 5 0 6 0 7 6 7 0 over 6 4 0 5 0 6 0 7 6 7 0 It must not be supposed, however, that the scale of July, 1919, is adequate to meet the ever rising cost of food, and more especially clothing. Owing to the difficulty in obtaining reliable information from sufficient examples, the sum allocated to clothing (namely 1s. 9d. per head), in determining the scale, must be deemed insufficient. The unsettled prices of fuel and other necessaries render it a matter of extreme difficulty to determine a scale that shall meet the need of necessitous families. For the encouragement of decency and healthy conditions in the home it is better to adopt a generous scale for feeding and allow a larger proportion of the parents' income to be spent in accommodation, warm clothing and sound boots. The ecomonic circumstances of the family of the regularly employed workman paid at Trade Union rate of wages do not come within the committee's scale for free meals unless the children are very numerous. Applications are received, however, from the mothers of such families who have to provide for all on the proportion of the father's earnings which she receives. The children in such cases suffer materially upon removal from the Feeding List, the mother having insufficient to provide adequately for them out of her weekly allowance. Occupations.—During the year 1919 many of the families fed were in extremely poor circumstances owing to the civilian unemployment dole coming to an end after the expiry of a stated period. Table No. 68 shews the percentage of employed and unemployed parents whose children were on the free list during the four weeks ended December 20th, 1919 :— Table No. 68.—OCCUPATION OF PARENTS AND PERCENTAGE OF UNEMPLOYED PARENTS WHOSE CHILDREN WERE ON FREE LIST DURING FOUR WEEKS ENDED DECEMBER 20th, 1919. No. of Families. Percentage. 1. Unemployed 48 36 2. Widows 39 29.3 3. Deserted Wives 12 9 4. Labourers 10 7.5 5. Railwaymen 3 2 6. Hawkers 3 2 7. Orphans (Civilians) 1 .75 8. „ (Soldiers) 1 .75 9. Soldiers 1 .7 10. Other Trades 15 12 70 487 application forms were presented in all throughout the year 1919, the duration of feeding for any individual varying from the requisite time for full enquiry to be completed to the whole twelve months. The number given above does not include those children who applied directly to the Feeding Centre without first obtaining a Form. It is mostly in the South Kilburn area that such applications are made, numbering, on an average, about two per week. It is apparently the case that many children are left with their mid-day meal unprovided for while both parents are out at work. Such cases are almost invariably above the Education Committee's Scale, so that the want of a properly conducted Feeding Centre, where meals may be obtained at a small charge, is especially felt in this respect. Contracts.—No contracts were entered into during the year for the supply of goods to the Feeding Centres. The unstable condition of the markets and the varying control and prices of certain food stuffs rendered such a proceeding inadvisable. Messrs.–have continued, satisfactorily, to supply most needs—the punctuality of the deliveries having contributed to the smooth working of the Centres. Local quotations of prices for vegetables during the summer months were less than Messrs. –'s current prices, hence a change was made in this respect, and greengroceries were obtained from July onwards from Messrs.–, of Harlesden. The control of expenditure is much facilitated where one firm only is dealt with and the accounts are rendered at regular intervals. Cost.—The cost of meals varied from an average of 3.76d. for food only, and 5.9d. for the total cost per meal in the first quarter of 1919 to 3.66d. for food only and 6.23d. for the total cost per meal in the last quarter of 1919. Kilburn Feeding Centre.—Negotiations were entered into with the owner of the premises, 34, Lonsdale Road, Kilburn, which it was felt could be easily adapted as a Feeding Centre. The premises were sufficiently commodious to have seated 400 children simultaneously, with adequate space reserved for the Staff at work. Unfortunately, after the sanction of the Board of Education had been given to the purchase of the building, the landlord refused to sell to the Willesden Council. The Kilburn area has been scoured for other accommodation, but there is a regrettable absence of any suitable premises at present available in the neighbourhood. The chief points of adverse criticism to the existing arrangements at the Kilburn Voluntary Feeding Centre are as follows :— (i.) The poorness in quality of the children's meals. (ii.) The monotony of the meals. (iii.) The insufficiency of the food provided. (iv.) The lack of discipline and neglect of the educational aspect of the meal time. (v.) The entire absence of any available washing or lavatory accommodation. (vi.) The inadequacy and inferiority of the service. Special Meals.—Special Meals, consisting of a glass or mug of dried milk, are given during the morning school interval in cases judged by the Medical Staff to stand in need of extra nourishment. When school medical inspection is completely resumed, there will doubtless be brought to light a larger number of children requiring this additional feeding. During this year the number of children supplied with special meals was 3, of whom 2 paid the cost price, the other being supplied free. The total number of such meals supplied at the schools was 147. During the last month of the year three children, on account of extreme poverty, were supplied with breakfasts in addition to dinners. These meals were given at the Gibbons Road Feeding Centre and consisted of cocoa, mixed with dried milk and sweetened with sugar, and slices of bread, spread with margarine. Such a simple meal as the above can be supplied to meet emergency cases at extremely short notice. The Effect of School Feeding.—From a general point of view, and without verifying such an impression by experimental tests, children appear after not very long attendance at the Feeding Centres to be improved in appearance physically. They seem more vigorous and alert, and appear to lose the apathetic interest-lacking expression which characterises many children from very poor homes. Some of the apparent increase in vitality may be due simply to the awakened interest in new surroundings and fresh faces, but as it appears to be a lasting and not a passing change, it may be partly, at any rate, ascribed to an improved physical condition resultant on feeding. Dull, lifeless looking children become more animated, take an interest in their surroundings, respond to advances from without, and generally shew somewhat of the spirited mental activities of a child. 71 Improvement in mentality cannot be judged by observation at the Feeding Centres, but require more exact recording during school hours. It is a very noticeable fact that where a varied dietary and abundance of food is given as at the Education Committee's Centres, there are not anything like as great a proportion of children suffering from sores as among those attending the Kilburn Feeding Centre. Other factors doubtless contribute to the unhealthy appearance of many of the children drawn from the Kilburn district, but the poor food value of the meals supplied to the children, together with the housing accommodation, are responsible for the unsatisfactory condition of many attendants at the Feeding Centre. The training value of the meals should have an effect on the home life of the next generation. There is, no doubt, a very marked contrast, perfectly apparent to a child, in the well ordered, quietly served meal of the Feeding Centre, and the disorder and discomfort in many homes. It is quite a usual sight at any time in the day to see the remains of a meal set out at one end of the living room table, while " a bit of ironing," or washing, is carried on at the other. Vegetable paring, and household refuse are often in evidence in the living room at meal times—the table boasts no special cloth—the bread no plate—the margarine is served in its paper, and a single receptacle for food is common to the family assembled. A piece of bread and jam may be handed to the child, who then leaves the table with the alloted portion to eat it elsewhere. The social aspect of the meal time is entirely lacking. Habits of self-control, cleanliness in feeding and order, can never be learnt in such homes, without a great advance in social circumstances and education. The provision of meals for school children should bring about these necessary changes, but it is questionable whether five meals per week under the happiest conditions will counteract the effect of something like twenty meals per week under such conditions as those described. To make the educational value of the feeding felt, the meals should form part of the curriculum for all and not only the necessitous. A taste for plain wholesome food is inculcated by a carefully selected dietary. Economy, as represented by the use of the frying-pan instead of the oven, has contributed to a particular partiality for a certain type of food, and it is by no means uncommon for a child to decline to eat the boiled fish dinner of the Feeding Centres, stating, " We never have fish at home." Further catechism generally elicits the information that fried fish and chips and kippers are, however, enjoyed. Plain food seems rather tame and insipid to the child compared with the highly flavoured and very greasy food shared from some small eating house. Similarly, there is to be observed at the small grocers, or provision shop, a considerable trade in vinegar and pickles, and such like additions to the home fare, the children partaking with their parents of much that in better homes would not be given to the younger members of the family. The effect on the parents is difficult to express an opinion upon, but the value of the meals to the parents is evinced in many ways. It may be that better clothing and better other meals are provided on account of the relief afforded by the school meals, or possibly the improvements are more in the nature of cleanliness and general comforts, but there seems no reason to suppose, except in a very few exceptional cases, that the provision of meals for children relieves the parents of any sense of responsibility, nor leads them to neglect their children on this account. Indeed, the persistent application of some parents shew an appreciation of the value to the child of the meals supplied, and it is an oft repeated statement that " They couldn't get dinners like that at home." Actual statements as to home improvements effected or to be effected on account of the relief afforded by meals are made not infrequently. Meals for Expectant and Nursing Mothers and Children under 5 Years of Age.— 2,432 meals were supplied at the Feeding Centres to mothers and 11,023 to children under five years of age, making a total of 13,455 meals during 1919. These meals are served after the school children are dismissed, except where the non-scholars are brought to the Feeding Centres by elder brothers and sisters. At the Kilburn Feeding Centre the mothers are served with a more substantial meal than the children, the soup dinners being varied with meat stews or pie. At the Education Committee's Centres the meals are similar to those provided for the school children, due regard being paid to the quantity supplied. Application is sometimes made by mothers for permission to continue in attendance at the Feeding Centre after the child that was breast fed has been supplied with other food. Where the eldest child in a family is under school age, the mother often states the impossibility of making use of the dinner forms given at the Clinics, and availing herself of the doctor's recommendation for meals for her children. In many cases, more particularly in the Lower Place and Stonebridge districts, free meals are refused for the children because the mother herself is not eligible for meals. There appears an unavoidable gap of about three years in the life of many children, during which time a child is liable to suffer from a poor or insufficient food supply. 72 The great difference between the numbers of children under five attending the Kilburn Feeding Centre and those of the other Centres, shews how much the distance to be traversed controls the attendances. Quite a large proportion of the young children at Kilburn are drawn from Granville Road itself, whereas the Furness Road Centre being situated further from a very poor district, cannot supply the needs of quite young children to anything like the same extent. It is on account of the poverty and crowded population of the South Kilburn area that steps should be taken to make better provision for the needs of the district, and to almost as great a degree there is required a more central spot for a Feeding Centre, than that at present at the Gibbons Road school. A large number of children from Carlyle, Shakespeare and Milton Avenues, respectively, are unable by reason of the distance to attend at Gibbons Road. It is a matter for consideration whether a larger number of Centres serving smaller districts would not deal more adequately with the problem of feeding the necessitous, the question of economy of administration being met by the arrangement of a supply depot from a central kitchen. 73 Willesden Urban District Council HOSPITAL REPORT. FOR TME YEAR - - - 1919. By W. J. J. STEWART, M.D., D.P.H., Medical Superintendent. To the Chairman and Members of the Willesden Urban District Council. Ladies and Gentlemen, I have the honour to submit the Twenty-ninth Annual Hospital Report. It will be remembered that the accommodation of the hospital was increased by 56 beds in June 1918, and that it was decided by the Council as from that date to admit other than infectious cases for treatment. This Report, therefore, deals with the first complete year of the hospital's work under the new conditions. That there was ample justification for the Council's action in extending the hospital is proved by the fact that during the year under review the total number of patients admitted very nearly doubles that of any previous year. Further, there is every evidence at the time of writing (March, 1920) that the admissions for the current year will exceed those of 1919. That the hospital as it is at present constituted fills a much-felt want there can be no question. In no direction is this perhaps so noticeable as in the maternity wards, where the patients, almost without exception, speak of the great comfort and convenience it is to them to be admitted here instead of remaining at home, where, necessarily, their confinement creates something of the nature of a household upheaval. Much the same may be said of the other wards, where children under 5 years, children of school age, and adults are treated, for the average house is no better adapted for the accommodation of sick members of the family than it is for cases of confinement. It is, perhaps, advisable that I should map out before going further the method of admitting the patients to hospital, such as has been arranged by your Medical Officer of Health since the hospital was extended. When the hospital was used for isolation purposes only, practically all the cases were admitted on the strength of a notification sent in by medical practitioners to the Public Health Department, although a few cases might be admitted on the authority of that department alone. As at present arranged, the infectious cases are admitted much in the same way as hitherto, though a number of cases are sent in by the Clinic Medical Officers. As regards the non-infectious cases, however, these are drafted in by the medical officers of the Clinics, who select them from amongst the patients attending their Clinic from day to day, and after arranging by telephone with the hospital for their admission. Over and above the number admitted in that way a few cases may walk up to the hospital, and, being obviously ill, are admitted without delay. Coming now to the maternity cases, these patients are all examined by the Clinic medical officers, who notify the hospital of the date on which the mother proposes to enter the hospital for her confinement, and the names and circumstances of the particular cases are noted in the hospital books. In the event of a mother attending a Clinic and the medical officer considers her case abnormal, arrangements are made for her to enter the hospital forthwith or to attend on such day as the visiting obstetric surgeon is there, who, if he thinks fit, may admit the patient there and then, or decide that there is no urgency. Such are the methods of admission in force, and it may be said they work well. Turning now to the number of patients admitted during the year, I have separated the infectious cases from the non-infectious, as will be seen in Table No. 69. The infectious cases number 723, or 45 less than in 1918, whilst the non-infectious cases are 980, making a total of 1,703 for the year, which, if added to the 124 patients remaining over from 1918, gives a grand total of 1,827 under treatment, a remarkable record for a hospital of only 220 beds. Of the number admitted 87 died, there being 32 deaths amongst the infectious cases and 55 amongst the non-infectious. Over and 74 above these deaths there are 15 deaths to be recorded amongst infants born in hospital. Later on in this Report I will draw attention to the fact that, in my opinion, it was possible to deal with the number of cases admitted only by putting undue strain upon the members of your hospital medical and nursing staff; and, in that connection, it may be judged what is the nature of the strain at the time of writing, when the monthly admissions are more than double what they were a year ago. To my mind the necessity for more staff and for more staff accommodation is, if possible, more urgent than for ward accommodation, and it is a matter which I submit, with all due respect, the Council should take into consideration without delay. Infectious Cases. Passing to the infectious cases, there is nothing of particular note, except that the number of diphtheria cases admitted was higher than any year yet recorded, and that the number of enteric fever cases was only 2. Of the 723 infectious cases, 238 suffered from Scarlet Fever. In 1918 there were 111. „ „ 431 „ Diphtheria „ „ 223. „ „ 2 „ Enteric Fever „ „ 7. „ „ 52 „ other diseases „ „ 427. In connection with "Other Diseases" it should be noted-that this year the 52 include infectious diseases only, whereas in 1918 and previous years this class included not only these infectious cases other than Scarlet Fever, Diphtheria and Enteric Fever, but a number of wrongly diagnosed cases, most of which were of a non-infectious nature. These latter I have now included amongst the diseases set out in the tables dealing with children under 5 years of age and of school age. Scarlet Fever. By reference to Table No. 70 it will be seen that 261 cases of Scarlet Fever passed through the hospital, and of that number only 4 died. There is no doubt that this disease is becoming milder. It is an uncommon thing now to see the more severe types of attack which twenty years or more ago were comparatively common. Scarlet Fever, however, though a mild affection, is one which, if at all neglected in the earlier weeks of the illness, may prove dangerous should certain complications arise. Diphtheria. As regards this disease, a very fatal one in children if not treated early, the number admitted was unusually high. The mortality, however, in spite of the fact that the general type, in the late part of the year especially, was severe, remains at the satisfactorily low level of 4.9%. In 1918 it was 9-1%. Five cases were admitted in a hopeless condition due to toxaemia. Anti-toxin was given in all cases requiring it, and these numbered 334 out of the 431 cases admitted. It is needless to say that no death took place amongst those mild cases from which antitoxin was withheld. In a later table (No. 74) I give the day of disease on which the diphtheria patients were admitted. This day of disease is a matter of vital importance in connection with diphtheria, for it is recognised that if anti-toxin, which has brought about such a wonderful reduction in the mortality, is to have effect the patient must come under treatment at the earliest possible date. A patient with wellmarked attack has very little chance of recovery if he comes into hospital later than the fourth day, for obviously the disease has had four days' start during which the poison may have done irreparable damage to the patient. Everything should be done, therefore, to expedite the admission of the patient to hospital. Unfortunately, during the war, owing to the shortage of medical staff, the bacteriological laboratory at the hospital was closed, and arrangements were made whereby throat specimens, etc., which might be sent in by medical practitioners should be sent to London for examination and report. This arrangement means a delay of 48 hours before the result is known. I believe that this delay adversely affected the chances of recovery of certain patients admitted during the year. That being so, there is every justification, in my opinion, for the provision of the necessary medical staff and the reopening of the laboratory. Enteric Fever. Of Enteric Fever, 1 patient was admitted in the acute stages of the attack, and 1 in the convalescent stages. The former case (from a neighbouring district) ended fatally. " Other Infectious Diseases." Coming now to " Other Infectious Diseases," the total admitted was 52. I have included in this list the following cases :— Measles 29, of which 2 died. Whooping Cough 2 „ 0 „ Rubella 2 „ 0 „ Mumps 1 „ 0 „ Influenza 16 „ 4 „ Erysipelas 1 „ 0 „ Poliomyelitis Anterior Acuta 1 „ 0 „ 75 In connection with the admission and treatment of these " other infectious diseases " I would draw your attention to the great disability under which the hospital labours in consequence of the want of small ward accommodation. The infectious part of the hospital, as you are aware, consists of Blocks D, E and H, which, with the exception of the last, are large wards, obviously unsuited for these " other infectious diseases " which are admitted, so far, in small numbers at a time. H Block, which consists of one medium ward and three smaller wards, is the only block at all suitable, but for over six months of the year it is full of Scarlet Fever patients. For that period at least there is no small ward accommodation, and there is, of course, none in the non-infectious blocks of the hospital. Should, therefore, one of these " other infectious diseases " break out in hospital, as it frequently does a day or two after the patient's admission to hospital for an entirely different complaint, or should a case (of measles, say) be sent in for urgent reasons by the Health Department, the exact nature of the awkward predicament your medical staff are faced with will readily be appreciated. Small ward accommodation has to be found and at short notice. Most often this is accomplished by emptying a small ward and rapidly disinfecting it. To that way out of the difficulty there is grave objection, for it not only means moving the patients displaced into another ward already full, but it means a large amount of needless work to an already overworked staff. Even when the hospital was purely an isolation hospital there was a shortage of small wards, and that is increasingly felt now that a more varied class of infectious disease is admitted. For the above reasons I am of opinion small ward accommodation is urgently needed, and that it should be provided here to the extent of at least 10% of the infectious accommodation. Coexistent Disease. Instances where more than one infectious disease was coexistent in the same patient were admitted as follows Scarlet Fever and Diphtheria, 4 cases; Scarlet Fever and Measles, 1 case. Wrong Diagnoses. By reference to Table No. 77 it will be seen that 76 patients were admitted who subsequently proved to be suffering from some other condition than the infectious ailment for which they were certified. All these cases proved to be non-infectious; they have, therefore, been included in the tables dealing with General Diseases in the latter part of this Report. Non-Infectious Cases. By reference to Table No. 71 it will be noticed that 980 patients suffering from ailments of a general character were admitted. The experience already gained suggests that the number of these cases diminishes during the summer months, as compared with the autumn and winter months. This is unfortunate, for it is just at the latter periods that the prevalence of infectious disease is at its greatest. Could it be arranged that these general ailments and infectious diseases were most prevalent at different seasons it is possible that this hospital would not have been in the dire straits to which it was put in its endeavour to find accommodation for the patients, but, of course, that is impossible. Here, 1 would submit, is another reason, in addition to the lack of small ward accommodation already referred to, why the question of the hospital extension urgently calls for youf consideration. Towards the end of the year it was possible to accommodate all the patients only by crowding every ward to an extent that possibly might not be considered wise. It is to be remembered, too, that your hospital is probably unique in its arrangement, and that since it was made a Municipal Hospital it has done unique and excellent work, though, it has to be admitted, at the cost of putting a great strain and responsibility on your hospital staff. When a ward is full and cubic space is diminished it does not matter whether it is a general or an infectious ward, it is well known that the patients are prone to catch anything of the nature of infection that may be introduced into the ward. So far no infection has spread through the wards, and as long as that is so no question as to the efficiency or general arrangement of the hospital will be raised, but, if it were to do so, the whole record of the hospital must suffer. I cannot help feeling that it was more by good luck than anything else that the hospital got through the end of the year without any untoward event happening. It was not to be thought from what has been said that the arrangement whereby infectious and general ailments are treated in the same hospital is impracticable. Far from it; it is a perfectly safe and reasonable arrangement, but only where adequate accommodation is provided and efficient supervision is maintained. Table No. 71 sets out clearly the number of patients admitted each month, and the number which died. Tables Nos. 78, 79, 80 and 81 show the diseases from which these patients suffered as well as the causes of death. Children. Amongst children under 5 years and of school age the diseases mentioned are varied in character. Apart from enlarged tonsils and adenoids, diseases of a septic nature are perhaps the most common, and these include such ailments as Tonsillitis, Middle Ear Disease, Septic Wounds, Abscesses in various situations, as well as Impetigo and Rashes of septic origin from Septic Tonsillitis. With regard to the cases of Enlarged Tonsils and Adenoids admitted for operation, these, almost without exception, were urgent cases requiring treatment. Taking into consideration the number operated on (115), it is difficult to see how they could have received the necessary treatment had there been no Municipal 76 Hospital at which they could attend. Already this year (March, 1920) the above number lias been exceeded, and there is a waiting list of approximately 50. Although an average of 12 cases are operated on weekly, there is so far no evidence of the number on the waiting list diminishing. Removal of tonsils and adenoids, though a matter of a few minutes to a skilled operator, sometimes is followed by a fatal result. Fortunately nothing of that nature has to be reported here. By referring to the deaths column in table No. 71, it will be seen that by far the greatest number of deaths occur amongst children under 5 years of age, and that an extremely small number occur amongst older patients—clearly proving how incapable children of tender years are of resisting the effects of serious ailments, and the necessity there is for placing them under the best possible conditions, both as regards the provision of hospitals and of skilled nursing, to enable, them to pull through. As might be expected, all the children, whether under 5 years or of school age, who recoverd from their ailments made rapid and practically uninterrupted convalescence. A generous acknowledgment of the Council's wisdom in providing for their treatment, as well as a proof of the healthiness of their surroundings whilst in hospital. For the tables referring to children of school age, see Tables No. II. and IV. in the School Medical Officer's report. Adults. By a resolution of the Council, dated September 23rd last, adults are admitted to the General Wards of the hospital as from that date, a proviso being that their admission was in no way to preclude the admission of Maternity cases or of children. As a matter of fact, a few cases of adults were actually admitted prior to the date mentioned, on account of extreme urgency. Table 81, submitted, gives in detail the nature of the complaints for which these patients were admitted and the result. Maternity Cases. In no part of the hospital has the bed accommodation been so taxed as in this department. Sixteen beds, plus one in the labour Ward, are all that so far has been provided. As each mother remains in hospital for at least 14 days some idea may be formed of the difficulties to be overcome,' more especially if the monthly admissions of mothers as in table 71 be kept in mind. During the year it frequently happened that more than 17 mothers were in hospital at one time In this event accommodation had to be found elsewhere in the hospital for the excess number, and this was done by transferring those mothers who were well enough to sit up to another general ward, where they completed their stay in the hospital. Occasionally it happened that the general ward was full, in which case there was no alternative but to put up extra beds for the time being. Altogether 239 pregnant women were admitted, and out of that number 217 were confined, 10 aborted and 12 proved not to be in labour. As a result of the 217 confinements, 215 infants were born alive and 5 dead, there being included in the former 1 case of triplets and 1 of twins. Of the 215 infants, 15 died as the result of prematurity or congenital malformation or defect. Caesarean Section for delivery of the child was performed in 4 instances, the mother surviving in 3 cases and the infants in all. Forceps delivery was necessary in 8 cases only. Labour was induced in 4 cases. Unfortunately four mothers died, one from Peritonitis, after abnormal labour; one from Malignant Endocarditis; one from Gastric Ulcer and operation as above; one from Myocarditis and Heart Failure. Table No. 79, given, sets out the complications present in these 227 mothers, either before or during labour or in the puerperium. Before leaving this part of the report I think it is worthy of notice that except for the minor ailments normally, one might say, present after confinements, the mothers made excellent recoveries and that the much dreaded Puerperal Fever was conspicuous by its absence. Over and above, there was no vestige of any outbreaks of infectious disease amongst these cases. This is a most satisfactory state, and, I am of opinion, it reflects the greatest credit upon the nursing staff of the hospital, clearly demonstrating the high standard of their skill and the thoroughness of their technique. It also explodes the commonly held view that a recently confined woman is predisposed thereby to the commoner infectious diseases, more particularly Scarlet Fever. In an experience of nearly 30 years infectious work I have only seen 2 cases of this nature. Further, with regard to the complete absence of any infectious outbreak amongst these 227 mothers you will remember that certain authorities have criticised your arrangement by which infectious cases and maternity cases are treated in the same hospital, but the record of the hospital and the absence from it of a single case of septic infection must prove the error of their contention. Moreover, the visiting Obstetrical Surgeon, who has a wide experience of the large London Maternity Hospitals, is of opinion that nothing could be more satisfactory than the way in which these mothers recover. It is, consequently all the more strange that in spite of this 77 record, with which certain maternity hospitals cannot for a moment compare, and coupled, too, with the fact of the large number of cases now admitted here and the excellent opportunity they present for teaching purposes, that the Central Board has so far refused to recognise your hospital as a midwife training school. All the more astonishing is their refusal when it is borne in mind that nurses at the present time are finding the greatest difficulty in obtaining their midwifery certificate owing to the shortage of recognised training schools. At any rate such is my experience. Gynaecological Cases. The term Gynaecological is used here in a somewhat loose sense, for it is questionable if all the conditions set out in table No. 80 come under that category. A better term, however, is not available. The cases included in the table are for the most part patients admitted from the clinics with defects which it was considered desirable should be remedied by operation or general treatment in view of possible future pregnancies. Out-patients. I have mentioned that the Clinic Medical Officers refer patients under their care to the hospital on those days on which the visiting Obstetrical Surgeon, Mr Bourne, attends, in order to obtain his advice. On referring to the hospital records I find that during the year 179 patients attended for this purpose. Similarly patients suffering from general surgical ailments are sent up from the clinics for the opinion of the visiting surgeon, Mr. Campbell, who during the 6 months he has been attached to this hospital, has advised on 70 patients' cases. Inasmuch as the remaining visiting surgeons, Mr. J. O'Malley, the throat, ear and nose surgeon, and Mr. Oliver, ophthalmic surgeon, attend twice a month at the clinics for the inspection of special cases there, it is unnecessary for any such patients to attend here. Duration of Stay in Hospital. The period a patient remains under treatment has always been looked upon in this hospital as an important matter. Now that the cost of maintenance and upkeep of hospitals has increased so inordinately, and in this hospital the cost per occupied bed, inclusive of loan charges, is approximately 12s. 7d. per diem, it will be readily seen that a large amount of expenditure can be incurred if due attention is not given in this direction. Official supervision is the only prevention against overstay in hospital, and that entails a regular daily inspection of all patients in the wards by the Medical Officer in charge. In making these inspections he will bear in mind that important though it be that a patient should stay no longer than necessary, equally important is it that he or she should not be discharged too soon, and the following figures are very satisfactory, having regard to the fact that there is no convalescent home attached to the hospital. Scarlet Fever, 40.8 days; Diphtheria, 29.5 days; Other Infectious Diseases, 17.1 days. Maternity Cases, 17.3days; Diseases of Women, 20.1 days; Children under 5 years, 26.3 days; School Children, 21.3 days; Adults, 27. 9 days. Average for all, 22.7 days. Visiting Surgical Staff. The following are the names of the Visiting Surgeons who are now attached to the hospital:– A. W. Bourne M.B., F.R.C.S., Obstetric Surgeon; R. H. Campbell, M.B., F.R.C.S., Surgeon for General Surgical Diseases; M. W. B. Oliver, M.B., F.R.C.S., Ophthalmic Surgeon; J. F. O'Malley, F.R.C.S., Surgeon for ear, nose and throat disease. Each of the above surgeons attend one morning each week, with the exception of Mr. Oliver, who attends for operations as occasion may require. Three mornings, or parts of mornings, and sometimes four, are therefore taken up in this way, which necessarily interferes with the routine work of the hospital for the time being. Each surgeon attends at 9.30 a.m., at which times he sees such out-patients as have been sent up from the clinics. After this special cases are visited in the wards and finally any operations arranged for are then performed. It might be thought that the addition of a visiting staff would diminish the work of the Resident Medical Start, but this is far from being the case. First of all the resident staff have to arrange for the attendance of the great majority of out-patients and operation cases, selecting them from the waiting lists sent in weekly by the clinic medical officers. Again, during the surgeon's visit to the wards, etc., or when operating, the Resident Medical Officers have necessarily to render every assistance, and subsequently, in respect to operation cases, the special care and dressing of these fall to 78 their lot. An idea of the number and nature of the major operations performed by the visiting staff and of the minor operations performed by the resident staff may be gathered by reference to table No. 82. After the visiting staff have left, and not infrequently they do not leave before 12 and 1 o'clock* it is then only that the resident staff can start their day's work. In times of pressure it has frequently proved impossible for them to carry out the latter, either in reasonable time or with reasonable satisfaction to themselves. Nursing Staff. I would now draw your attention to the question of the nursing staff and the heaviness of the work exacted from it. Increased accommodation for patients was added to the hospital to the extent of 56 beds 18 months ago, and at the same time a considerable addition was made to the nursing staff, but, contrary to what was expected, the number of patients admitted, and, incidentally the nursing work, increased out of all proportion to the number of beds added to the accommodation. I have shown that the total bed accommodation in the hospital is quite insufficient to deal with the number of cases, and I have hinted also that the present number of nursing staff is equally incapable of satisfactorily treating these patients. Before the accommodation was increased, and when the hospital was used for isolation purposes only, the proportion of nursing staff to beds was 1 to 5. At the present time, when the hospital treats general cases as well as infectious cases, the proportion remains practically the same. A proportion of 1 to 5 beds was possibly adequate when the hospital was admitting infectious cases only, for the convalescence of most infectious cases is protracted and little nursing is required after the acute stages are past. It is a very different matter, however, with patients admitted for general medical and surgical ailments. All of them are admitted for urgent reasons, and necessarily they require a great deal of nursing as long as they are in hospital, and immediately they require none, it may be said in most cases, they are ready to be sent home. The proportion of cases requiring special nursing in the general wards here, I find, is never less than 30 per cent. (in the maternity wards it is never less than 50 per cent.) of the total cases, but in the infectious wards it is questionable if it ever exceeds 15 per cent., and then only in the autumn and winter months. These figures show how heavy the general wards are as compared with the infectious. I would suggest, therefore, that the general wards be given 1 nurse to every 3 beds, and that the infectious wards 1 nurse to 5 beds, the present proportion. Of the 220 beds in the hospital say 100 are required for infectious cases and the balance for maternity and general diseases. This would mean a total of 60 nurses, or an increase of 14 nurses on the existing number, which is anything but high. In connection with the present nursing staff, which is 46 roughly, or 1 nurse to 5 beds, may I set out the conditions under which it is working. A proportion of 1 to 5, it is to be noted, does not mean that proportion is ever available—allowance has to be made for off-duty time and for sickness. In connection with the former, as each nurse has to be given 2 or 3 hours (according to rank) off duty each day, and half a day each week, if follows that each nurse has in the aggregate at least. one whole day off duty a week, making no mention of the whole day a month to which she is entitled. In other words, out of 46 nurses on the staff, off duty time, alone, reduces the available number each week to practically 39.5 nurses. That number, it is conceivable, might serve temporarily, but, over and above the loss through off duty time there is still the loss through sickness to be considered. As to that the following figures, as they work out for the past year may prove of value. Sickness amongst Staff. Amongst a total staff of (80 nurses and female staff only) there were 236 cases of sickness during the year, and of these 66 were off duty for periods exceeding 24 hours at a time. The aggregate number of days these 66 members were off duty amounted to 922. Of these 66, 44 were nurses, and included amongst these 44 are 4 nurses with Scarlet Fever, 2 with Diphtheria, and 26 with Tonsillitis. Taking now the aggregate number of days these 44 sick nurses were off duty, it works out at 414 days or the equivalent of 1¼ nurses per diem throughout the entire year who were not available. If one takes the proportion of nurses sick during the latter months of the year, the figures are even more glaring. In the month of October 9 nurses were off duty for an aggregate of 114 days, the equivalent for the month of nearly 4 nurses each day. In November 7 nurses were off duty for 79 days, an equivalent for the month of 2½ nurses per diem, and in December 12 nurses for 85 days, the equivalent for the month of 2¾ nurses per diem. These numbers (2½ to 4 nurses) added to that which represents the number of nurses off duty on leave each day (7½ nurses) means a daily loss to the hospital during these months of from 10 to 11½ nurses. If this number is subtracted from the full staff, which is fixed at 46, it leaves 34½ to 36 nurses on duty, or a proportion no longer of 1 nurse to 5 beds but of 1 to 6 beds or thereabouts. Can it be wondered at, therefore, that the aggregate number of days the nursing staff alone was off duty sick was as much as it was, i.e., 414 days, or that that number of days is practically equal to the aggregate of days the entire female staff were off duty sick for the previous year ? I maintain that there is complete proof that the staff were overworked, and that before another winter the proportion of nurses to beds should be increased so as to give a total of 60, as compared with the 46 nurses of to-day. 79 Medical Staff. J need hardly point out that what I have said as regards overworking of nurses applies equally to the resident medical staff. The number of officers remains exactly what it was when the hospital was an isolation hospital only, and when the average number of admissions was in the neighbourhood of 700. For the year just ended the admissions were 1,703, and there is every prospect of that number being exceeded this year. These figures speak for themselves. I am aware of the difficulties that beset the Council regarding staff accommodation, but I trust they will see their way to add to the number of medical officers as well as to increase the number of nursing staff. In connection with the medical staff it is to be remembered that they have no set hours off duty, that they work seven days a week and may be called on at any time of the night, and that if they have been able to take leave from hospital it does not exceed a few hours per week. Resignations of Staff. As there has been considerable comment throughout the year regarding the resignations that take place from time to time, and as considerable misunderstanding seems to exist as to the exact reasons for these taking place, perhaps I had better give some explanation of the circumstances which bring these resignations about. It is to be borne in mind that in any hospital, no matter the size, resignations must take place, and that it is not desirable that the resignation list should disappear altogether. A low resignation list may be no matter for congratulation by the hospital authorities. It may mean slackness in supervision by the officers in charge and that good, bad and indifferent staff are all retained, as well as toleration of a low standard of work. The circumstances which operate in this hospital and which cause such resignations as do take place, and they are by no means unreasonable in number, are as follows:— 1. Every member of the staff is appointed subject to a probationary period of two months. If she does not come up to the standard of requirements she is not retained; and, even if she is retained and it so happens that subsequently she proves inefficient, her resignation is called for. For it is not to be supposed that the Council desire to retain the services of the incompetent or of any one who proves at any time incapable of making them adequate return for their outlay. 2. Another reason is the heaviness of the work, especially as regards the nursing staff, to which I have alluded. 3. The lack of suitable bedroom accommodation and staff quarters generally. 4. The fact that all the hospital blocks are separated from one another and unconnected by covered ways, which means that the staff has constantly to go out into the cold and wet, night or day, and of this they frequently complain. 5. There is in every hospital a small number of staff who have no intention of remaining in any situation more than a few months, and reference to their records show that such has been the habitual custom of these particular people in other situations. If due consideration is given to these five points I feel that any doubt which may have existed as to the reason for the resignations which take place will now be removed, and that it will be under-stood that every member of the staff is given a fair chance. It is not to be expected that the resignations will diminish or that they will remain as they are; possibly they may increase. The Council has started a vast scheme, the failure or success of which must depend to an extent on their hospital, which in its turn must rely on the high standard of work of its staff. Large numbers of staff may be engaged on probation, but only those of merit will be retained, for it rests alone with them if the object the Council has in view is to be attained. I am, Ladies and Gentlemen, Your obedient servant, W. J. J. STEWART, Medical Superintendent. 80 TABLE No. 69. Scarlet Fever. Diphtheria. Enteric Fever. Other Infectious Diseases. Total. Children under 5 years. Children of School Age. Obstetrical. Gynaecological. Diseases of Adults. Total. Grand Total. No. of cases admitted during 1919 238 431 2 52 723 324 316 239 41 60 980 1,703 No. under treatment Dec. 31st, 1918 23 43 0 0 66 27 13 8 0 10 58 124 Total No. under treatment during 1919 261 474 2 52 789 351 329 247 41 70 1,038 1,827 No. discharged during 1919 219 392 1 43 655 292 299 230 40 57 918 1,573 No. died during 1919 4 21 1 6 32 40 3 4 1 7 55 87 Mortality % 1.7 4.9 5.0 1.2 4.5 12.1 .97 1.6 2.4 11.2 5.6 5.1 Remaining in hospital, Dec. 31st, 1919 38 61 0 3 102 19 27 13 0 6 65 167 TABLE No. 70. Month. Scarlet Fever. Diphtheria. Enteric Fever. Other Infect. Diseases. Total. Total. Admissions. Deaths. Admis. sions. Deaths. Admissions. Deaths. Admissions. Deaths. Admissions. Deaths. January 7 — 33 2 1 1 — — 41 3 February 6 — 14 1 — — 14 3 34 4 March 4 — 25 — — — 4 1 33 1 April 14 2 28 2 — — 4 — 46 4 May 12 — 29 — 1 — 12 1 54 1 June 17 2 31 — — — 3 — 51 2 July 17 — 40 1 — — 3 — 60 1 August 24 — 48 — — — 8 1 80 1 September 29 — 40 1 — — 3 — 72 1 October 43 — 41 - — — — - 84 2 November 35 — 37 3 — — — - 72 3 December 30 — 65 9 - — 1 - 96 9 Total... 238 4 431 21 2 1 52 6 723 32 TABLE No. 71. Month Children under 5 years. Children of School age. Obstetrical. Gynaecological. General Diseases of Adults. Total. Admissions. Deaths. Admissions. Deaths. Admissions. Deaths. Admissions. Deaths. Admissions. Deaths. Admissions. Deaths. Jan. 38 1 15 — 18 - 1 - 3 1 75 2 Feb. 22 8 13 — 15 — 1 — 3 — 54 8 Mar. 31 2 13 1 15 2 3 — 6 1 68 6 Apr. 27 1 12 — 13 — 5 — 5 1 62 2 May 27 4 16 — 13 — 2 — 4 1 62 5 June 14 3 19 1 19 1 4 — 4 — 60 5 July 21 — 33 — 21 — 2 — 6 1 83 1 Aug. 32 — 31 — 18 — 3 — 3 — 87 — Sept. 46 9 34 — 20 — 9 1 4 1 113 11 Oct. 18 5 49 1 31 1 2 — 7 — 107 7 Nov. 20 3 44 — 26 — 7 — 4 1 101 4 Dec. 28 4 37 — 30 — 2 — 11 — 108 4 Total 324 40 316 3 239 4 41 1 60 7 980 55 81 TABLE No. 72. Scarlet Fever. Age. Males. Females. Total. Admissions. Deaths. Admissions. Deaths. Admissions. Deaths. Under 1 - - 1 - 1 - 1 to 2 3 1 — - 3 1 2 „ 3 5 — 5 - 10 - 3 „ 4 8 1 10 - 18 1 4 „ 5 5 — 7 - 12 - 5 „ 10 64 — 54 2 118 2 10 „ 15 20 — 26 — 46 — 15 „ 20 13 — 6 — 19 — 20 „ 25 — — 3 — 3 — 25 „ 30 2 — — — 2 — 30 „ 35 1 — 3 — 4 — 35 „ 40 — — 1 — 1 — 40 „ 45 — — 1 — 1 — 50 and over — — — — — — Total . 121 2 117 2 238 4 TABLE No. 73. Diphtheria. Age. Males. Females. Total. Admissions. Deaths. Admissions. Deaths. Admissions. Deaths. Under 1 3 - - - 3 - 1 to 2 3 - 5 1 8 1 2 „ 3 10 - 14 — 24 — 3 „ 4 19 2 8 — 27 2 4 „ 5 13 — 14 — 27 — 5 10 104 4 114 11 218 15 10 „ 15 32 3 42 — 74 3 15 „ 20 3 — 18 — 21 — 20 „ 25 6 — 10 — 16 — 25 „ 30 — — 2 — 2 — 30 „ 35 1 — 2 — 3 — 35 ,, 40 1 — 5 — 6 — 40 „ 45 1 — 1 — 2 — 45 „ 50 — — — — — — 50 and over - — - — — — Total 196 i 9 235 12 431 21 TABLE No. 74. Diphtheria. Day of Disease on Admission. Admissions. Deaths. Case Mortality. 1st 15 - % 2nd 91 2 2.2 3rd 99 4 4.04 4th 71 4 5.6 5th 59 5 8.4 6th and over 96 6 6.2 82 TABLE No. 75. Chief Complications of Scarlet Fever. Number of Cases Otitis Media 17 Mastoiditis 2 Adenitis 16 „ Suppurative 2 Relapse 3 Rheumatism 14 Nephritis 5 Albuminuria 10 TABLE No. 76. Chief Complications of Diphtheria. Number of Cases. Albuminuria i 31 Otitis Media 18 Paralysis 41 Adenitis 14 TABLE No. 77. Showing Cases wrongly Certified and the Diseases for which they were mistaken. Certified as suffering from Diagnosed as suffering from Scarlet Fever. Diphtheria. Enteric Fever. 19 32 - Tonsillitis. 9 — - Septic Rash. 1 — - Scabies. 2 - - Rubella. — 2 - Pneumonia. — 1 - Bronchitis. 1 — - Cervical Gland Abscess. — 2 - Laryngitis (Measles) - 1 - Rhinitis Suppurative. - - 1 Debility. 5 — — Nil. 37 38 1 88 TABLE No. 78. Children Under 5 Years. Condition. Municipal Clinic. Private Medical practitioner. Total Treatment. Result. Remaining in Hospital, Dec. 31, 1919. Operation. General Other. Remedied. Dangerous. Unchangec Died. (i) (ii) Marasmus 7 9 1 17 - 17 - 7 - - 10 0 Rheumatism o 1 0 1 — 1 — 1 — — — 0 Chorea 1 0 0 1 — 1 — — — — — 1 Bronchitis 16 16 3 35 — 35 — 33 — — 2 0 Broncho Pneumonia 8 6 4 18 - 18 - 12 - - 6 0 Pulmonary Tuberculosis 1 1 0 2 - 2 - - 1 - 1 0 Tonsillitis 7 6 5 18 - 18 —' 18 — — — 0 Otitis Media 2 1 0 3 - 3 — 3 — — — 0 Mastoiditis 1 0 0 1 1 — — 1 — — — 0 Enlarged Tonsils & Adenoids 12 5 1 18 18 0 - 18 - - - 0 Adenitis 1 1 1 3 — 3 — 3 — — — 0 Infantile Diarrhœa 12 6 6 24 — 24 — 15 — — 9 0 Gastritis 1 0 1 2 — 2 — 2 - — — 0 Gastro Enteritis 0 2 0 2 — 2 — — — — 2 0 Enteritis 3 2 0 5 — 5 — 5 - — — 0 Constipation 0 1 1 2 — 2 — 2 — — — 0 Intussusception 0 0 1 1 — 1 — 1 — — — 0 Nephritis 0 1 0 1 — 1 — 1 — — — 0 Cretinism 1 0 0 1 — 1 — — — 1 — 0 Convulsions 0 1 0 l — 1 — 1 — — — 0 Prematurity 0 0 1 1 — 1 — 1 — - — 0 Conjunctivitis 0 1 0 l — 1 — " 1 — - — 0 Corneal Ulcer 2 0 0 2 — 2 — 2 — - — 0 Ophthalmia Neonatorum... 1 2 1 4 - 4 - 3 - 1 - 0 Hernia 0 8 0 8 6 2 — 7 — — 1 0 Hydrocele 0 1 0 1 1 0 — 1 — — — 0 Angioma 0 4 0 4 3 1 — 4 — — — 0 Phimosis 14 45 10 69 56 13 — 69 — — — 0 Tubercular Joints 0 1 0 1 — 1 - — 1 — — 0 Sprain of Joint 0 1 0 1 — 1 — 1 — — — 0 Pyaemia 1 1 0 2 — 2 — 1 — — 1 0 Abscess, Various 13 12 4 29 29 0 — 29 — — — 0 Impetigo 4 1 1 6 — 6 — 5 — — — 1 Eczema 0 3 0 3 — 3 — 3 —. — — 0 Cellulitis 0 0 1 1 — 1 — 1 - — — 0 Scabies 0 3 1 4 — 4 — 4 - — — 0 Septic Wounds 1 3 0 4 — 4 — 4 - — — 0 Furunculosis 0 1 0 1 — 1 — 1 - — — 0 Meningitis Tubercular 1 1 1 3 - 3 - - - - 3 0 Meningitis, Suppurative 0 1 0 1 - - - - - - 1 0 Meningitis, Post Basic 1 1 0 2 - 2 - - - - 2 0 Encephalitis, Haemorrhage 0 1 0 1 - 1 - - - - 1 0 Burns , 2 1 1 4 — 4 — 3 - — 1 0 Teething 1 0 0 1 — 1 — 1 - — — 0 Effects of Immersion 0 0 1 1 - 1 - - - - - 0 Balanitis 2 2 0 4 — 4 - 4 - — — 0 Vulvo Vaginitis... 0 1 1 2 — 2 — 2 - — — 0 Nil 2 2 3 7 — 8 — — - 8 — 0 118 156 50 324 114 210 — 270 2 10 40 2 TABLE No. 79.—Maternity Cases. Complications. Number. Flat Pelvis 3 Contracted Pelvis 2 Placenta Previa 1 Uterine Fibroids 1 Malignant Endocarditis 1 Hyperemesis 2 Accidental Haemorrhage 1 Mastitis 5 Myocarditis 1 Eclampsia 1 84 TABLE No. 80. Gynecological Cases. Condition. Number. Uterine Fibroids 2 Ovarian Cyst 1 Rectocele 2 Cystocele 2 Salpingitis 1 Retroversion 1 Leucorrhœa 1 Procidentia Uteri 4 Endometritis 2 Mastitis (Suppurative) 4 Metrorrhagia 1 Pyelitis 1 Tubal Abortion 1 Threatened Abortion 4 Incomplete Abortion 7 Sapræmia 6 Pyaemia (after abortion) 1 Total 41 TABLE No. 81. Diseases of Adults. Condition. Number. Recovered. Unchanged. Died. Rheumatism 2 2 — — Chronic Nephritis 1 — 1 — Anaemia 1 1 — — Syphilis 1 1 — — Tonsillitis 7 7 — — Bronchitis 2 2 — — Pneumonia 16 10 — 6 Pleurisy 1 1 — — Empyema 1 1 — — Gastro-Enteritis 1 1 — — Carcinoma of Colon 1 — — 1 Acute Distension of Colon 1 1 — — Appendicitis 1 1 — — Constipation 1 1 — — Hernia 4 4 — — Tubercular Glands 2 2 — — Phlebitis 1 1 — — Cellulitis of Face 1 1 — — Cellulitis (various) 6 6 — — Abscess (neck) 1 1 — — Corneal Ulcer 1 1 — — Septic Sores 4 4 — — Rhinitis Ulcerative 1 1 — — Cephalgia 1 1 — — Nil 1 1 -— - 60 52 1 7 85 TABLE No. 82. Operation. Number. Operation. Number. Cesarean Section 4 Brought forward 50 Ventral Fixation of Uterus 2 Removal of Tubercular Glands 1 Perineorrhaphy 7 Tenotomy (Strabismus) 1 Culporrhaphy 3 Empyema 1 Currettage (Uterine) 10 Suppurative Mastitis 4 Ovariotomy 1 Tonsillectomy and Removal of Adenoids, etc 115 Salpingectomy 1 Herniotomy (Radical Operation) 14 Mastoidectomy(Radical Operation) 1 Intestinal Anastomosis 1 Tracheotomy 4 Appendicectomy 1 Removal of Angioma 2 Osteotomy 3 „ Ganglion 2 Resetting Mal-united Fracture 1 Papilloma 2 Tenotomy (Torticollis) 2 „ Hydrocele 2 Circumcision 74 Carried forward 50 Total 259 86 APPENDIX A. VITAL STATISTICS. Explanatory Notes. Table I.—This Table is arranged to show the gross births and deaths in the District, and each ward, and the births and deaths properly belonging to them with the corresponding rates. The rates are calculated per 1,000 of the estimated gross population. In Column 6 are included the whole of the deaths registered during the year as having actually occurred within the district, but excluding the deaths of soldiers and sailors. In Column 12 is entered the number in Column 6, corrected by subtraction of the number in Column 8 and by addition of the number in Column 9. In Column 10 the deaths are similarly corrected by subtraction of the deaths under 1 year, included in the number given in Column 8, and by addition of the deaths under 1 year, included in the number given in Column 9. Column 4.—This number has been obtained by adding to the number shewn in Column 3 the number of births belonging to the district but occurring outside and subtracting the number occurring in the district but belonging to other districts. Column 8.—This number is the number of deaths excluded from the returns of the local Registrar as transferable deaths defined below. Column 9.—This number is the number of deaths transferred to the district by the RegistrarGeneral. "Transferable Deaths" are deaths of persons who, having a fixed or usual residence in England or Wales, die in a district other than that in which they resided. The deaths of persons without fixed or usual residence, e.g., casuals, are not included in Columns 8 or 9, except in certain instances under 3 (b) below. The following special cases arise as to Transferable Deaths:— (1) Persons dying in Institutions for the sick or infirm; such as hospitals, lunatic asylums, workhouses, and nursing homes (but not almshouses) must be regarded as residents of the district in which they had a fixed or usual residence at the time of admission. If the person dying in an Institution had no fixed residence at the time of admission, the death is not transferable. If the patient has been directly transferred from one such institution to another, the death is transferable to the district of residence at the time of admission to the first Institution. (2) The deaths of infants born and dying within a year of birth in an Institution to which the mother was admitted for her confinement should be referred to the district of fixed or usual residence of the parent. (3) Deaths irom 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. Table II.—The classification of Causes of Death are those of the Detailed International List of Causes of Death as adapted for use in England and Wales. All "Transferable Deaths "of residents, i.e. of persons resident in the District who have died outside it, are included, and all transferable deaths of non-residents, i.e., persons resident in England and Wales who have died in the District excluded. All deaths occurring in Institutions for the sick and infirm situated within the district, whether of residents or non-residents, are entered in the last column of this Table. All deaths certified by registered Medical Practitioners and all Inquest cases are classed as " Certified " ; all other deaths are regarded as "Uncertified." 87 Table I. VITAL STATISTICS OF WHOLE DISTRICT DURING 1919 AND PREVIOUS YEARS; VITAL STATISTICS OF THE WARDS DURING 1919. Year. (1) Population esti. estimated to Middle of each Year. Whole District. (2) Births. Total Deaths Registered in the District. Transferable Deaths. Nett Deaths belonging to the District. Uncor rected Number. (3) Nett. Number. (6) Rate. (7) of non. residents registered in the District. (8) of residents not registered in the District. (9) Under 1 Year of Age. At all Ages. Number. (4) Rate. (5) Number. (10) Rate per 1,000 Nett Births. (11) Number. (12) Rate. (13) 1911 156,572 3,863 4,001 25.6 1,618 10.3 10 240 495 124 1,848 11.8 1912 159.868 3,912 4,075 25.5 1,307 8.7 27 233 328 80 1,603 10.02 1913 163,644 3,891 4,037 24.7 1,449 8.9 23 251 325 80 1,677 10.24 1914 166,634 3,971 4,115 24.7 1,501 9.0 32 283 337 82 1,752 10.51 1915 166,840 3,641 3,775 22.6 1,792 10.7 44 282 344 91 2,030 12.16 1916 167,810 3,557 3.668 21.9 1,436 8.55 34 308 283 77 1,710 10.19 1917 169,344 2,704 2,816 16.6 1,571 9.27 45 292 309 110 1,818 10.73 1918 169,358 2,520 2,651 15.65 1,975 11.66 35 338 258 97 2,278 13.45 1919 170,625 2,843 2,924 17.13 1,519 8.90 39 286 242 8,276 1,766 10.35 wards. 1. S. Kilb'n 15,132 298 322 21.27 152 10.04 1 35 29 90.06 186 12.29 2. Mid K'b'n 15,079 250 263 17.44 157 10.41 1 44 26 98.85 200 13.26 3. N. Kilb'n 12,844 166 170 13.23 123 9.57 2 23 5 29.41 144 11.21 4. Brondsb'y Park 10,019 112 118 11.77 86 8.58 6 14 6 50.84 94 9.38 5. Kensal Rise 14,433 243 255 17.66 129 8.93 1 27 18 70.58 155 10.73 6. Harl'd'n 17,642 299 310 17.57 120 6.80 2 22 23 74.19 140 7.93 7. Stone. bridge 17,954 327 334 18.60 162 9.02 7 18 28 83.83 173 9.63 8. Round. wood 15,932 295 304 19.08 165 10.35 5 14 27 88.81 174 10.92 9 Church End 14,393 249 251 17.43 122 8.47 4 23 26 103.58 141 9.79 10. Willesden Green 17,213 312 324 18.82 129 7.49 — 32 27 83.33 161 9.35 11. Crickle. wood 19,984 292 273 13.66 174 8.70 10 34 27 98.90 198 9.90 Area of District in acres (land and inland water) 4,384 Total population at all ages 154,344 Total families or separate occupiers 35,478 at Census, 1911. 88 Table II.—DEATHS OF WILLESDEN RESIDENTS DURING THE YEAR 1919. CAUSE OF DEATH. (1) All Ages. (2) 0 to 1 (3) 1 to 5 (4) 5 to 10 (5) 10 to 15 (6) 15 to 20 (7) 20 to 25 (8) 25 to 35 (9) 35 to 45 (10) 45 to 55 (11) 55 to 65 (12) 65 to 75 (13) 75 to 85 (14) 85 Up. (15) Total deaths, whether of "Residents" o Non-Residents," in Institutions in the District (16) All Causes Certified 1,765 242 98 58 28 34 44 117 122 204 222 287 252 56 ... Uncertified 1 ... ... ... ... ... ... ... ... ... ... ... 1 ... ... 1—General Diseases. Enteric Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 Typhus ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Relapsing Fever ... ... ... ... ... ... '... ... ... ... ... ... ... ... ... Malaria ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Small Pox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Measles 23 8 13 2 ... ... ... ... ... ... ... ... ... ... 16 Scarlet Fever 4 ... 2 2 ... ... ... ... ... ... ... ... ... ... 4 Whooping Cough 2 1 1 ... ... ... ... ... ... ... ... ... ... ... ... Diphtheria 27 ... 7 16 4 ... ... ... ... ... ... ... ... ... 23 Influenza 114 1 8 5 3 5 6 26 4 15 15 10 6 ... 10 Miliary Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Asiatic Cholera ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Cholera Nostras ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Dysentery ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Plague ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Yellow Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Leprosy ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Erysipelas 5 ... ... ... 1 1 ... ... ... ... 1 2 ... ... 1 Other Epidemic Diseases 1 ... ... ... ... ... ... ... ... 1 ... ... ... ... 1 Pyaemia 4 1 ... ... 2 ... ... ... 1 ... ... ... ... ... 3 Septicaemia ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Vaccinia ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Glanders ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Anthrax (Splenic Fever) ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Rabies ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Tetanus ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Mycoses: Actinomycosis 2 ... ... 1 ... ... ... ... ... 1 ... ... ... ... ... Pellagra ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Beri-Beri ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Pulmonary Tuberculosis (not acute) 114 ... 2 3 2 11 12 29 24 16 12 3 ... ... 17 89 Phthisis (not acute and not defined as Tuberculosis) 17 ... ... ... 1 1 3 5 3 1 2 1 ... ... 1 Acute Phthisis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ...... Acute Miliary Tuberculosis 2 ... ... ... ... 1 ... 1 ... ... ... ... ... ... 2 Tuberculous Meningitis 11 2 3 2 2 1 ... 1 ... ... ... ... ... ... 6 Tabes Mesenterica 1 1 ... ... ... ... ... ... ... ... ... ... ... ... ... Other Peritoneal and Intestinal Tubercle 6 2 1 ... ... ... 1 1 ... 1 ... ... ... ... 1 Tuberculosis of Spinal Column 1 ... ... ... ... 1 ... ... ... ... ... ... ... ... 2 Tuberculosis of Joints 1 ... 1 ... ... ... ... ... ... ... ... ... ... ... 1 Tuberculosis of other organs 4 ... 2 ... ... ... ... 1 1 ... ... ... ... ... ... Disseminated Tuberculosis 1 ... ... 1 ... ... ... ... ... ... ... ... ... ... ... Rickets, Softening of Bones 2 ... 1 ... ... ... ... ... ... ... ... 1 ... ... 1 Syphilis 5 5 ... ... ... ... ... ... ... ... ... ... ... ... 1 Other Venereal Diseases ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Cancer of Buccal Cavity 9 ... ... ... ... ... ... ... ... 4 3 ... 2 ... 2 Cancer of the Stomach, Liver, &c. 42 ... ... ... ... ... ... 1 4 7 14 10 5 1 8 Cancer of Peritoneum, Intestines and Rectum 38 ... ... ... ... ... ... 1 1 12 10 10 4 ... 11 Cancer of the Female Genital Organs 29 ... ... ... ... ... ... 2 6 8 8 4 ... 1 9 Cancer of the Breast 15 ... ... ... ... ... ... ... 2 5 4 2 2 ... 2 Cancer of the Skin 2 ... ... ... ... ... ... ... ... ... 1 ... 1 ... ... Cancer of other or unspecified organs 36 ... ... ... ... ... ... ... 5 7 11 8 2 ... 8 Other Tumours (situation undefined) 1 ... ... ... ... 1 ... ... ... ... ... ... ... ... ... Rheumatic Fever 7 ... ... 2 1 ... ... ... ... 1 ... 2 1 ... ... Chronic Rheumatism 1 ... ... ... ... ... ... ... ... ... 1 ... ... ... 1 Osteo-Arthritis 7 ... ... ... ... ... ... ... ... 2 2 2 1 ... 1 Gout 2 ... ... ... ... ... ... ... ... ... ... ... 2 ... ... Scurvy ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Diabetes 15 ... 1 1 1 ... ... 1 1 4 2 4 ... ... 6 Exophthalmic Goitre 2 ... ... ... ... ... ... ... 1 1 ... ... ... ... 1 Addisons Disease ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Leucocythoemia (Leuchcemia) 2 ... ... ... ... ... ... ... ... ... 1 1 ... ... ... Lymphadenoma 4 ... ... ... ... ... 1 ... ... 2 1 ... ... ... ... Anaemia, Chlorosis 7 ... ... ... 1 1 ... ... 1 1 2 1 ... ... 3 Other General Diseases 3 ... ... ... ... ... ... ... ... 1 1 ... 1 ... 10 Alcoholism (Acute or Chronic) 1 ... ... ... ... ... ... ... ... 1 ... ... ... ... 1 Chronic Lead Poisoning ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Other Chronic Occupational Poisoning ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Other Chronic Poisoning ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2.—Diseases of the Nervous System and of the Organs of Special Sense. Encephalitis 1 ... ... ... ... ... ... ... ... 1 ... ... ... ... ... Cerebro-spinal Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Posterior Basal Meningitis 4 3 ... ... 1 ... ... ... ... ... ... ... ... ... 3 Meningitis, other forms 6 1 3 1 ... ... 1 ... ... ... ... ... ... ... 1 90 Table II.—DEATHS OF WILLESDEN RESIDENTS—continued. CAUSE OF DEATH. (1) All Ages. (2) 0 to 1 (3) 1 to 5 (4) 5 to 10 (5) 10 to 15 (6) 15 to 20 (7) 20 to 25 (8) 25 to 35 (9) 35 to 45 (10) 45 to 55 (11) 55 to 65 (12) 65 to 75 (13) 75 to 85 (14) 85 Up. (15) Total deaths, whether of "Residents" "Non-Resi dents/" in Institutions in the District. (16) 2.—Diseases of the Nervous System and of the Organs of Special Sense.—Continued. Locomotor Ataxy 2 ... ... ... ... ... ... ... 1 ... ... 1 ... ... 1 Other Diseases of the Spinal Cord 6 ... ... ... ... ... 1 1 ... 1 1 2 ... ... 1 Apoplexy 9 ... ... ... ... ... ... ... ... 1 ... 3 4 1 ... Serous Apoplexy and Oedema of Brain ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Cerebral Congestion ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Cerebral Atheroma ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Cerebral Haemorrhage 69 ... ... ... ... ... ... ... 3 4 13 25 20 4 27 Softening of Brain 3 ... ... ... ... ... ... ... ... ... ... 2 1 ... 1 Hemiplegia 7 ... ... ... ... ... ... ... ... 1 1 1 3 1 ... Paraplegia 2 ... ... ... ... ... ... ... ... ... ... 1 1 ... ... Other Forms of Paralysis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... General Paralysis of the Insane 6 ... ... ... ... ... ... ... 2 3 1 ... ... ... ... Other Forms of Mental Alienation 3 ... ... ... ... ... ... ... 1 ... 1 ... 1 ... 1 Epilepsy 6 ... ... ... ... ... 2 ... 1 3 ... ... ... ... 1 Convulsions (non-puerperal; 5 years and over) ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Infantile Convulsions under 5, with teething 2 2 ... ... ... ... ... ... ... ... ... ... ... ... ... Other Infantile Convulsions under 5 8 8 ... ... ... ... ... ... ... ... ... ... ... ... 1 Chorea ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Hysteria, Neuralgia, Neuritis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Idiocy, Imbecility ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Cretinism ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Cerebral Tumour 8 ... ... ... ... 1 ... 2 ... 2 2 ... 1 ... 2 Other Diseases of the Nervous System 1 ... ... ... ... ... ... ... ... 1 ... ... ... ... ... Diseases of the Eye and Annexa ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Mastoid Disease 2 1 ... ... ... ... ... ... 1 ... ... ... ... ... 1 Other Diseases of the Ears 2 ... ... 1 1 ... ... ... ... ... ... ... ... ... 1 3.—Diseases of the Circulatory System. Pericarditis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Acute Myocarditis 1 ... ... ... ... ... ... ... ... 1 ... ... ... ... ... Infective Endocarditis 2 ... ... ... ... ... 1 1 ... ... ... ... ... ... 1 Other Acute Endocarditis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Valvular Disease 98 ... ... 1 3 1 ... 4 3 10 22 28 24 2 8 91 Fatty Degeneration of Heart 12 ... ... ... ... ... ... ... 1 1 3 5 2 ... ... Other Organic Disease of the Heart 98 ... ... ... ... 1 ... 3 5 11 19 28 21 10 22 Angina Pectoris 1 ... ... ... ... ... ... ... ... ... ... ... 1 ... ... Aneurysm 3 ... ... ... ... ... ... ... ... 2 1 ... ... ... ... Arterial Sclerosis 23 ... ... ... ... ... ... ... ... ... 6 10 5 2 ... Other Diseases of Arteries 4 ... ... ... ... ... ... ... ... ... 1 1 2 ... ... Cerebral Embolism and Thrombosis 6 ... ... ... ... ... ... ... ... ... ... 2 4 ... ... Other Embolism and Thrombosis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Diseases of the Veins (Varices, Hemorrhoids, Phlebitis, &c. 1 ... ... ... ... ... ... ... ... ... 1 ... ... ... ... Status Lymphaticus 1 ... 1 ... ... ... ... ... ... ... ... ... ... ... ... Other Diseases of the Lymphatic System ...... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Hemorrhage; other Diseases of the Circulating System 2 1 ... ... ... ... ... ... ... ... ... 1 ... ... 1 4.—Diseases of the Respiratory System. Diseases of the Nasal Fossae ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Diseases of the Larynx 1 ... 1 ... ... ... ... ... ... ... ... ... ...... ... ... Diseases of the Thyroid Body 3 ... ... ... ... ... ... 1 ... ... ... 2 ... ... 2 Bronchitis 133 21 7 ... ... ... 1 ... 4 9 13 35 36 7 27 Broncho-Pneumonia 50 12 18 1 ... ... ... 1 ... 3 4 6 5 ... 10 Lobar Pneumonia 17 ... ... 2 1 ... 1 3 5 2 2 1 ... ... 2 Pneumonia (type not stated) 64 7 9 ... ... ... 5 8 9 9 8 3 4 2 16 Empyema 2 ... ... 2 ... ... ... ... ... ... ... ... ... ... ... Other Pleurisy 2 ... ... ... ... ... ... ... ... ... 2 ... ... ... ... Pulmonary Apoplexy and Infarction 1 ... ... ... ... ... ... ... ... ... ... 1 ... ... ... Pulmonary Oedema and Congestion 6 ... ... ... ... ... ... ... ... 1 ... 3 2 ... ... Hypostatic Pneumonia 1 ... ... ... ... ... ... ... ... 1 ... ... ... ... ... Collapse of Lung (3 months and over) ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Gangrene of the Lung ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Asthma 13 ... ... 1 ... ... ... ... 2 2 3 2 3 ... ... Pulmonary Emphysema 2 ... ... ... ... ... ... ... ... 1 ... ... 1 ... ... Fibroid Disease of Lung 1 ... ... ... ... ... ... ... ... 1 ... ... ... ... ... Other Disease of the Respiratory System 1 ... ... ... ... ... ... ... ... ... ... 1 ... ... ... 5.—Diseases of the Digestive System. Diseases of the Teeth and Gums 1 ... ... ... ... ... ... ... ... ... 1 ... ... ... ... Other Diseases of the Mouth and Annexa 1 ... ... ... ... ... ... ... ... ... ... ... 1 ... ... Diseases of Pharynx, Tonsillitis 1 ... ... 1 ... ... ... ... ... ... ... ... ... ... ... Diseases of Oesophagus 1 ... ... ... ... ... ... 3 1 ... 1 ... 1 ... 1 Perforating Ulcer of Stomach 6 ... ... ... ... ... ... 3 1 ... 1 ... 1 ... 1 Inflammation of Stomach 11 5 1 ... ... ... ... ... ... 1 ... 3 1 ... 8 Other Diseases of the Stomach 5 1 ... ... ... ... ... ... ... ... ... 2 2 ... ... 92 Table II.—DEATHS OF WILLESDEN RESIDENTS—continued. CAUSE OF DEATH. (1) All Ages. (2) 0 to 1 (3) 1 to 5 (4) 5 to 10 (5) 10 to 15 (6) 15 to 20 (7) 20 to 25 (8) 25 to 35 (9) 35 to 45 (10) 45 to 55 (11) 55 to 65 (12) 65 to 75 (13) 75 to 85 (14) 85 Up. (15) Total deaths, whether of "Residents" or "Non-Residents," in Institutions in the District. (16) 5.—Diseases of the Digestive System—Continued. Infective Enteritis 7 6 1 ... ... ... ... ... ... ... ... ... ... ... ... Diarrhoea, not returned as infective 14 10 2 ... ... ... ... ... ... ... 1 ... 1 ... 6 Enteritis, not returned as infective 8 5 ... 1 1 ... ... ... ... 1 ... ... ... ... 3 Gastro-Enteritis, not returned as infective 14 10 1 2 ... ... 1 ... ... ... ... ... ... ... 5 Dyspepsia, under 2 years ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Colic 1 ... ... ... ... ... ... ... ... ... ... 1 ... ... ... Ulceration of Intestines 1 ... ... ... ... ... ... ... ... 1 ... ... ... ... ... Duodenal Ulcer 3 ... ... ... 1 ... ... ... ... 1 1 ... ... ... ... Ankylostomiasis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Other Intestinal Parasites ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Appendicitis 7 ... 1 1 ... ... ... ... 1 1 3 ... ... ... 1 Hernia 4 ... ... ... ... ... ... 1 ... ... ... 1 2 ... 2 Intestinal Obstruction 9 2 1 ... ... ... ... ... ... 1 1 2 2 ... 1 Other Diseases of the Intestines 2 ... ... ... ... ... ... ... ... l 1 ... ... ... ... Acute Yellow Atrophy of Liver ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Hydatid of Liver ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Cirrhosis of Liver (not returned as alcoholic) 9 ... 1 ... ... ... ... ... 1 1 2 4 ... ... 3 Cirrhosis of Liver (returned as alcoholic) ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Diseases formerly classed to "Other Diseases of Liver and Gall Bladder" ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Biliary Calculi 2 ... ... ... ... ... ... ... ... ... ... 2 ... ... ... Other Diseases of the Liver 1 ... ... ... ... ... ... 1 ... ... ... ... ... ... ... Diseases of the Spleen ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Peritonitis (cause unstated) 9 3 ... 1 ... 1 ... ... ... 2 1 1 ... ... 2 Other Diseases of the Digestive System ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 6.—Non-Venereal Deseases of the Genito-Urinary System and Annexa. Acute Nephritis 2 ... ... ... ... ... ... ... 1 ... 1 ... ... ... ... Brights Disease as in 1901 list 37 ... ... ... ... ... ... 1 2 12 6 7 9 ... 6 Nephritis (unqualified), 10 years and over, uraemia 13 ... 1 ... ... ... 3 ... 2 3 ... 3 1 ... 1 Chyluria ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Other Diseases of Kidney and Annexa 2 ... ... ... ... ... ... ... ... 2 ... ... ... ... ... 93 Calculi of the Urinary Passages ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Diseases of the Bladder 5 ... ... ... ... ... ... ... ... ... ... 3 2 ... ... Diseases of the Urethra, Urinary Abscess, &c. 2 ... ... ... ... ... ... ... 1 ... ... 1 ... ... 1 Diseases of the Prostate 5 ... ... ... ... ... ... ... ... ... ... 4 1 ... 1 Non-venereal Diseases of Male Genital Organs ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Uterine Haemorrhage (non-puerperal) 1 ... ... ... ... ... ... 1 ... ... ... ... ... ... ... Uterine Tumour (non-cancerous) ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Other Diseases of the Uterus ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Ovarian Cyst, Tumour (non-cancerous) ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Other Diseases of the Female Genital Organs 2 ... ... ... ... ... ... 1 1 ... ... ... ... ... 1 Non-puerperal Diseases of the Breast (non-cancerous) ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 7.—The Puerperal State. Abortion 1 ... ... ... ... ... ... ... 1 ... ... ... ... ... ... Haemorrhage of Pregnancy ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Uncontrollable Vomiting ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Ectopic Gestation 1 ... ... ... ... ... 1 ... ... ... ... ... ... ... ... Other Accidents of Pregnancy ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Puerperal Haemorrhage 1 ... ... ... ... ... ... ... ... 1 ... ... ... ... ... Other Accidents of Childbirth 5 ... ... ... ... ... ... 4 1 ... ... ... ... ... 3 Puerperal Fever 4 ... ... ... ... 1 2 ... 1 ... ... ... ... ... 4 Puerperal Albuminuria and Convulsions 2 ... ... ... ... ... ... 1 1 ... ... ... ... ... 1 Puerperal Phlegmasia Alba Dolens and Phuebitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Puerperal Embolism and Sudden Death ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Puerperal Insanity ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Puerperal Diseases of the Breast ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... S.—Diseases of the Skin and of the Cellular Tissue. Senile Gangrene 4 ... ... ... ... ... ... ... ... ... ... 2 2 ... 4 Gangrene, other types 1 ... ... ... ... ... ... ... ... 1 ... ... ... ... 1 Carbuncle, Boil ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Phlegmon, Acute Abscess 4 2 ... ... ... ... ... ... ... ... 1 1 ... ... 4 Ulcer, Bedsore 2 ... ... ... ... ... ... ... ... ... ... 1 1 ... 2 Eczema ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Pemphigus ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Other Diseases of the Integumentary System 1 ... ... ... ... ... ... ... ... 1 ... ... ... ... 1 9.—Diseases of the Bones and of the Organs of Locomotion. Diseases of the Bones 1 ... ... ... ... ... ... ... ... 1 ... ... ... ... ... Diseases of the Joints ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Amputations ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Other Diseases of the Locomotor System ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 94 Table II.—DEATHS OF WILLESDEN RESIDENTS—continued. CAUSE OF DEATH. (1) All Ages. (2) 0 to 1 (3) 1 to 5 (4) 5 to 10 (5) 10 to 15 (6) 15 to 20 (7) 20 to 25 (8) 25 to 35 (9) 35 to 45 (10) 45 to 55 (11) 55 to 65 (12) 65 to 75 (13) 75 to 85 (14) 85 Up. (15) Total deaths whether of "Residents" or "Non-Residents," in Institutions in the District. (16) 10.—Malformations. Congenital Hydrocephalus 2 1 1 ... ... ... ... ... ... ... ... ... ... ... 1 Phimosis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Congenital Malformation of Heart 6 3 ... 3 ... ... ... ... ... ... ... ... ... ... 2 Other Congenital Malformations 6 6 ... ... ... ... ... ... ... ... ... ... ... ... 2 11.—Diseases of Early Infancy. Premature Birth 59 59 ... ... ... ... ... ... ... ... ... ... ... ... 10 Infantile Atrophy, Debility and Marasmus 34 33 1 ... ... ... ... ... ... ... ... ... ... ... 8 Icterus Neonatorum 2 2 ... ... ... ... ... ... ... ... ... ... ... ... ... Sclerema and Oedema Neonatorum ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Want of Breast Milk ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Diseases of Umbilicus, &c. ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Atelectasis 5 5 ... ... ... ... ... ... ... ... ... ... ... ... ... Injuries at Birth 5 5 ... ... ... ... ... ... ... ... ... ... ... ... 1 Cyanosis Neonatorum ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Lack of Care 3 3 ... ... ... ... ... ... ... ... ... ... ... ... ... 12.—Old Age. Old Age 92 ... ... ... ... ... ... ... ... ... 1 19 50 22 34 13. Affections produced by External Causes. Suicide by Poison 1 ... ... ... ... ... ... ... ... 1 ... ... ... ... 1 Suicide by Asphyxia 4 ... ... ... ... ... ... ... 1 2 ... 1 ... ... ... Suicide by Hanging or Strangulation 3 ... ... ... ... ... ... ... ... 1 ... 1 1 ... ... Suicide by Drowning 1 ... ... ... ... ... ... ... ... 1 ... ... ... ... ... Suicide by Firearms ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Suicide by Cutting or Piercing Instruments 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... Suicide by Jumping from High Place 1 ... ... ... ... ... ... ... ... 1 ... ... ... ... ... Suicide by Crushing 1 ... ... ... ... ... ... ... ... 1 ... 1 ... ... ... Other Suicides ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Poisong by Food ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Other Acute Poisonings ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Conflagration ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 95 Burns (conflagration excepted) 7 1 3 ... ... ... 1 ... 1 ... ... ... ... 1 4 Absorption of Deleterious Gases (conflagration excepted) 3 2 ... ... ... ... ... ... ... ... ... 1 ... ... ... Accidental Drowning 7 ... 1 3 ... ... ... 3 ... ... ... ... ... ... ... Injury by Firearms ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Injury by Cutting or Piercing Instruments ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Injury by Fall 13 ... 1 ... ... 2 ... 2 1 1 1 ... 5 ... 1 Injury in Mines and Quarries ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Injury by Machines 2 ... ... ... ... 1 ... ... ... 1 ... ... ... ... 1 Injury by Other Crushing, Vehicles, Railways, Landslides, &c. 16 ... 1 2 1 1 1 1 2 i 4 1 1 ... 1 Injury by Animals ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Starvation ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Excessive Cold ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Effect of Heat 1 ... ... ... ... ... ... ... 1 ... ... ... ... ... ... Lightning ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Electricity (lightning excepted) l ... ... ... ... 1 ... ... ... ... ... ... ... ... ... Homicide by Firearms ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Homicide by Cutting or Piercing Instruments ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Homicide by Other Means 4 1 ... ... 1 1 ... ... ... ... ... 1 ... ... ... Fractures (cause not specified) ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Other Violence 7 ... ... ... ... ... ... 2 ... 1 ... ... 2 2 4 11.—Ill-defined Causes. Dropsy ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Syncope (aged 1 year and under 70) ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Sudden Death (not otherwise defined) ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Heart Failure (aged 1 year and under 70) ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Atrophy, Debility, Marasmus (aged 1 year and under 70) ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Teething ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Pyrexia ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Other Ill-defined Deaths ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Cause not Specified ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Totals 1766 242 98 58 28 34 44 117 122 204 222 288 253 56 406 96 Table III —INFANT MORTALITY DURING 1919. Nett Deaths from Stated Causes at Various Ages under 1 Year of Age. Nett Deaths from all Causes under one year of age classified in Wards. Cause of Death. Under 1 week. 1.2 Weeks. 2.3 Weeks. 3.4 Weeks. Total under 4 Weeks. 4 Weeks and under 3 Months. 3 Months and under 6 Months. 6 Months and under 9 Months. 9 Months and under 12 Months. Total Deaths under One Year. WARDS. South Kilburn. Mid. Kilburn. North Kilburn. Brondesbury Park. Kensal Rise. Harlesden. Stonebridge. Roundwood Church End. Willesden Green. Cricklewood. (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) (13) (14) (15) (16) (17) (18) (19) (20) (21) (22) All Causes Certified 67 12 17 9 105 51 40 23 23 242 29 26 5 6 18 23 28 27 26 27 27 Uncertified — — — — — — — — — — — — — — — — — — — — — Small Pox — — — — — — — — — — — — — — — — — — — — — Chicken Pox — — — — — — — — — — — — — — — — — — — — — Measles — — — — — — 2 2 4 8 2 1 — — — — — 2 1 1 1 Scarlet Fever — — — — — — — — — — — — — — — — — — — — — Whooping Cough — — — — — 1 — — — 1 — — — — — — — — — — 1 Diphtheria and Croup — — — — — — — — — — — — — — — — — — — — — Erysipelas — — — — — — — — — — — — — — — — — — — — — Tuberculous Meningitis — — — — — — — — 2 2 — — — — — 1 — — 1 — — Abdominal Tuberculosis (a) — — — — — — 2 — 1 3 1 — — 1 — — —— — — — 1 Other Tuberculous Diseases — — — — — — — — — — — — — — — — — — — — — Meningitis (not Tuberculous) — — — — — — l 3 — 4 — — — — — — — 1 1 1 1 Convulsions 3 — — 1 4 2 2 2 — 10 — 2 — — 1 2 — — 2 — 3 Laryngitis — — — — — — — — — — — — — — — — — — — — — Bronchitis 1 — 2 1 4 9 2 2 4 21 1 4 2 1 3 — 4 1 3 1 1 Pneumonia (all forms) — 1 1 — 2 8 5 3 1 19 5 1 1 — 2 2 1 — 2 3 2 Diarrhœa — — — — — 4 2 2 2 10 2 1 — — 1 — 3 — — 1 2 Enteritis — — — — — 6 8 3 4 21 3 3 — 1 1 2 4 3 3 — 1 Gastritis — — — — — 2 2 — 1 5 — 1 — — 1 — 2 — — — 1 Syphilis 1 — — 1 2 3 — — — 5 1 — — — — 1 1 — 1 1 — Rickets .— — — — — — — — — — — — — — — — — — — — — Suffocation, overlying — — — — — 1 1 — — 2 — — — — — — — — 1 — 1 Injury at birth 3 1 1 — 5 — — — — 5 — — — 1 1 1 — — — 2 Atelectasis 5 — — — 5 — — — — 5 2 — — — — — — — 1 1 1 Congenital Malformations (b) 3 2 1 — 6 1 2 — 1 10 2 1 — — — 1 — 3 — 2 1 Premature Birth 40 6 7 4 57 2 — —. — 59 3 8 — 1 5 5 6 9 4 11 7 Atrophy, Debility and Marasmus 5 2 3 2 12 10 6 2 3 33 4 3 1 1 2 8 5 5 2 — 2 Other Causes 6 — 2 — 8 2 5 4 — 19 3 1 1 — 1 — 2 3 4 3 1 Total Deaths 67 12 17 9 105 51 40 23 23 242 29 26 5 6 18 23 28 27 26 27 27 Deaths Legitimate 61 10 14 8 93 44 33 20 18 208 27 23 5 6 15 20 20 23 23 23 23 Illegitimate 6 2 3 1 12 7 7 3 5 34 2 3 — — 3 3 8 4 3 4 4 Births Legitimate ... ... ... ... ... ... ... ... ... 2,807 306 252 161 117 245 305 324 283 240 312 262 Illgitimate ... ... ... ... ... ... ... ... ... 117 16 11 9 1 10 5 10 21 11 12 11 Total Births ... ... ... ... ... ... ... ... ... 2,924 322 263 170 118 255 310 334 304 251 324 273 Infant Mortality Rate— Legitimate ... ... ... ... ... ... ... ... ... 74.10 88.23 91.26 31.05 51.28 61.22 65.57 61.72 81.27 95.83 73.71 87.78 Illegitimate ... ... ... ... ... ... ... ... ... 290.59 125.00 272.72 — — 300.00 600.00 800.00 190.47 272.72 333.33 363.63 Infant Mortality Rate ... ... ... ... ... ... ... ... ... 82.76 90.06 98.85 29.41 50.84 70.58 74.19 83.83 88.81 103.58 83.33 98.90 Population ... ... ... ... ... ... ... ... ... 170625 15,132 15,079 12,844 10,019 14,433 17,642 17 954 15,932 14,393 17,213 19,984 (а) Under Abdominal Tuberculosis are included Deaths from Tuberculous Peritonitis and Enteritis and from Tabes Mesenterica. (b) Want of Breast Milk is included under Atrophy and Debility. Table IV.—CASES OF INFECTIOUS DISEASE NOTIFIED DURING THE YEAR 1919, Notifiable Disease. Number of Cases Notified. Total Cases Notified in each Ward. At all ages. At Ages—Years. South Kilburn. Mid-Kilburn. North Kilburn. Brondesbury Park. Kensal Rise. Harleeden. Stonebridge. Roundwood. Church End. Willesden Green. Cricklewood. Total Cases removed to Hospital. Under 1. 1 and under 5. 5 and under 15. 15 and under 25. 25 and under 45. 45 and under 65. 65 and upwards. (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) (13) (14) (15) (16) (17) (18) (19) (20) (21) Small Pox — — — — — — — — — — — — — —- — — — — — — Cholera (C) Plague (P) — — — — — — — — — — — — — — — — — — — — Diphtheria (including Membranous Croup) 494 6 96 328 43 21 — — 53 39 23 33 45 53 84 75 59 15 15 461 Erysipelas 86 2 3 3 15 32 25 6 16 9 5 3 5 6 13 9 9 9 2 8 Scarlet Fever 418 4 85 283 36 10 — — 20 33 13 23 25 72 74 30 30 49 49 274 Typhus Fever — — — — — — — — — — — — — — — — — — — — Enteric Fever 5 — — 2 1 1 1 — — 1 2 1 — — — 1 — — — 2 Relapsing Fever (R) Continued Fever (C) (C) 1 — — (C) 1 — — — — — — — — — — — — — — (C) 1 — Purerperal Fever 9 — — — 4 5 — — — 4 — 1 — — 2 — — 1 1 1 Cerebro-spinal Meningitis 3 1 1 — 1 — — — — 2 — — 1 — — — — — — 2 Poliomyelitis 3 — 2 1 — — — — — — — 1 — — — — 2 — — 1 Ophthalmia Neonatorum 32 32 — — — — — — 1 3 1 1 3 8 2 5 2 3 3 4 Measles and German Measles* 1,616 55 447 1,026 53 32 3 — 237 180 125 108 168 106 204 124 119 175 70 30 Pulmonary Tuberculosis 303 1 5 36 72 142 44 3 35 31 16 14 17 40 31 28 33 32 26 — Other forms of Tuberculosis 72 2 9 39 10 10 1 1 13 8 4 6 4 3 10 7 6 8 3 — Whooping Cough 52 8 23 21 — — — — 7 8 4 2 — 2 7 — 4 4 14 3 Pneumonia* 88 — 12 9 13 37 14 3 15 17 12 4 4 9 6 5 4 3 9 5 Malaria† 76 — — 1 18 54 3 — 3 6 4 4 7 6 13 17 10 6 — — Dysentery† 6 — — — 2 3 1 — — 1 — — 2 — 1 1 1 — — — Trench Fever† — — — — — — — — — — — — — — — — — — — — Encephalitis Lethargica‡ 3 — — 1 1 — 1 .— 1 1 — — — — — — 1 — — Acute Polio Encephalitis‡ 1 — — — 1 — — — — — — — — — — — — — 1 — Totals 3,268 111 683 1,751 270 347 93 13 401 342 210 201 281 305 447 302 279 306 194 791 The Willesden Municipal Hospital, Neasden, with 220 beds, provides accommodation for patients suffering with infectious diseases other than Small Pox. *Ceased to be notifiable on December 31st, 1919. ‡Became notifiable January 1st, 1919. †Became notifiable March 1st, 1919. MILITARY CASES OF INFECTIOUS DISEASES NOT INCLUDED IN Table IV. Register No. Infectious Disease. Age. Ward. 236 Malaria 42 1 320 „ 26 7 2582 Pulmonary Tuberculosis 31 10 2692 „ „ 31 10 2779 „ „ 29 9 2791 „ „ 33 9 2933 „ „ 25 4 100 (ii.) Whether, henceforth, physical need and not the poverty or affluence of the parents shall be the criterion for eligibility. (iii.) Whether the suggestion contained in paragraph 2 is not the only means by which the objects of the Act of Parliament can be achieved. REPORT. We beg to submit the following report:— The Acts.—Meals are provided to school children under the Education (Provision of Meals) Acts, 1906 and 1914. The essential sections of the Acts are as follows:— A. Where the local education authority resolve that any of the children attending an elementary school within their area are unable by reason of lack of food to take full advantage of the education provided for them, and have ascertained that funds other than public funds are not available or are insufficient in amount to defray the cost of food furnished in meals under this Act, they may spend out of the rates such sum as will meet the cost of the provision of such food. B. There shall be charged to the parent of every child in respect of every meal furnished to that child under this Act such an amount as may be determined by the local education authority, and, in the event of payment not being made by the parent, it shall be the duty of the authority, unless they are satisfied that the parent is unable by reason of circumstances other than his own default to pay the amount, to require the payment of that amount from that parent, and any such amount may be recovered summarily as a civil debt. The Regulations.—Regulations have been framed by the Board of Education under which grants are payable to Local Authorities in respect of the Provision of Meals for children attending Public Elementary Schools in England and Wales. No. 4 of these Regulations states that in distributing the. grants the Board will take into consideration— (a) The extent to which the work is co-ordinated with that of the School Medical Service; (b) The care exercised in the selection of the children for admission to the meals; (c) The sufficiency and suitability of the dietary; (d) The extent to which attention is given to the educational aspect of the work ; (e) The suitability of the accommodation and equipment and the efficiency of the service and supervision of the meals ; (f) The completeness of the arrangements made for ascertaining and recording the effect of the meals on the physical and mental condition of the children ; (g) The economical administration of the work. The Practice in Willesden. The practice in Willesden may be best shewn by dealing with these regulations seriatim. (a) The extent to which the work is co-ordinated with that oj the School Medical Service. The provision of meals to school children is completely co-ordinated with the work of the School Medical Service, both being, subject to the direction of the Children's Care Committee, under the control of the School Medical Officer, the administration of school meals having been taken over by him on 14th April, 1915. (b) The care exercised in the selection of the children for admission to the meals. At the present time, May, 1919, children are admitted to the meals— (i.) through the schools on the application of the parents or the recommendation of the head teacher ; (ii.) through the Clinics on the recommendation of the School Medical Service; and, (iii.) on application at the Feeding Centres. During the week ending 26th April, 1919, 601 children—452 free and 149 paying—were on the Feeding Registers. Of this number, 110—all free—or 18.3 per cent. have been put on through the agency of the School Medical Service. The remaining 81.7 per cent. have been put on approximately half-and-half through the schools and by direct application at the Feeding Centres. 101 In every case put on, enquiries are made into the social or economic circumstances of the family, and if they come within the scale given below and adopted by the Education Committee as from December 1st, 1918, the children are retained on the feeding list No. in family Net, income per head of the family per week. 1 2 s. d. Two 11 0 Three 9 6 Four 8 0 Five 7 6 Six or over 7 6 This scale has been arrived at on the basis—. (а) that a child of ten years represents the average unit in a family with children attending an elementary school. (b) that such a child requires an average minimum amount of food to maintain physiological equilibrium and support its growing needs. The results of the experiences of various workers and of the Committee of the Royal Society which investigated the food supply of the United Kingdom during the War, show that the dietary requirements of the nation cannot be satisfactorily met per man per day on a less supply in the food as purchased than 100 grammes protein, 100 grammes fat, and 500 grammes carbo hydrate. The average school child of ten years requires .6 of the food requirements of a man, that is to say, 60 grammes protein, 60 grammes fat, and 300 grammes carbo hydrate. The dinners given by the Willesden Education Committee have been devised by the Medical Officer on a physiological basis and provide the following daily average : 27 grammes protein, 19 grammes fat, and 114 grammes carbo hydrate. It will therefore be noted that the meals to be provided at home will require to make good a deficiency of 33 grammes protein, 41 grammes fat, and 186 grammes carbo hydrate. This can be done by providing a breakfast and tea such as the following:— Breakfast—Porridge 2 ozs., milk 3 ozs., sugar 1 oz., tea oz., bread 2½ ozs., margarine ½ oz. Tea—Cocoa ¼ oz., milk 1¼ ozs., sugar ½ oz., bread 4 ozs., margarine ¾ oz. The cost for food only of the dinners supplied by the Education Committee at present day prices (April, 1919) is on the average 3.76d. per meal, and the cost of the model breakfast and tea above shown is for breakfast 2.52d. for tea 1.83d.—total 8.l1d. per day, or 4/8.77 say 4/9 per week. (c) that in addition to food the child requires clothing, the cost of which according to tion actually supplied in three families out of 18 which could give satisfactory particulars investigated, is 1/9 per week. (N.B.—This figure is probably too low. The investigation in question was made in March, 1918, since when the price of clothing has materially advanced.) (d) that the child also requires for its upkeep, lighting and fuel and sundries such as bedding, crockery, etc. In 18 families fed, which were investigated, these items work out on the average—lighting and fuel 11d. per head, sundries 5d. per head. 102 The following summary therefore shows the minimum cost of physiological upkeep in April 1919, of a school child of 10 years taken as the average unit of a family excluding rent, insurance s and fares to and from work and care of children— April, 1919. s. d. Food 4 9 Lighting and Fuel 0 11 Sundries 0 5 Clothing 1 9 7 10 We are of opinion that any family which has not 7/10 per head as shewn above is unable to provide the necessary food and sustenance to enable the children attending the elementary school to take full advantage of the education provided for them. This view is supported by the following table taken from the report of the Working Classes Cost of Living Committee, dated 23rd October, 1918, which gives the amount spent per head in a family of five amongst the unskilled classes in june. 1918— s. d. Food 8 7 Lighting & Fuel 0 10 Sundries 0 6 Clothing 1 7 11 6 On the basis that 7/10 per week is the minimum amount on which the average child of 10 years can be maintained in physiological health and in a state to take full advantage of the education provided then the scale in operation should be- No. in family Net income per head of the family per week. 1 2 s. d. 2 10 0 3 8 0 4 7 6 5 or over 7 0 When the value of the meals supplied by the Education Committee is added to this scale, the total amount allowed per head of the family approximates the 7/10 required as shown in the following table:— No. in family Probable No. fed Economic circumstances per week as per suggested scale Total. Relief from meals per week @ 3.76d. per meal per day Total including relief from meals Total economic circumstances per head per week. 1 2 3 4 5 6 7 s. d. £ s. d. s. d. £ s. d. s. d. 2 1 10 0 1 0 0 1 7 1 1 7 10 9 3 2 8 0 1 4 0 3 2 1 7 2 9 0 4 2 7 6 1 10 0 3 2 1 13 2 8 3 5 3 7 0 1 15 0 4 8 1 19 8 7 11 6 4 7 0 2 2 0 6 3 2 8 3 8 0 7 5 7 0 2 9 0 7 10 2 16 10 8 1 8 5 7 0 2 16 0 7 10 3 3 10 7 11 9 5 7 0 3 3 0 7 10 3 10 10 7 10 10 5 7 0 3 10 0 7 10 3 17 10 7 9 103 The majority of children requiring to he fed in order that they may be able to take full advantage of the education provided, will obviously be included by selection on the basis of the necessitous income line shewn above. In addition there will be a small minority of children suffering from malnutrition, the causes of which require investigation. We are therefore of opinion that before a child in whose case the economic circumstances are above the scale is removed from the feeding list, the child should be submitted to a medical examination. Since April, 1915, the date on which school feeding was taken over by the Medical Officer up to the present time, it has not been possible to put this into operation on account of the disorganisation of the work of the school medical service occasioned by the war, but such an arrangement can be brought into force when medical inspection is re-begun and we have instructed the Medical Officer accordingly. Similarly we have instructed the Medical Officer to investigate particularly the cases of children noted in the course of medical inspection, when it is taken up again, as suffering from malnutrition and to refer such children for school meals or, other appropriate action as may be necessary. Routine Medical Inspection as at present prescribed occurs three times in school life. It will therefore be obvious that a minority of children above the necessitous income line and suffering from malnutrition from want of proper feeding and other causes, will not come under observation. Some of these cases may be referred by head teachers, but the complete detection of such children would involve the frequent routine medical inspection of all scholars, and we are unable to make any recommendation thereon. (c) The sufficiency and suitability of the dietary. The foregoing paragraph shows that the school dinner provides approximately 2/5 of the daily requirements of a child of ten years. The dinners are suitable and well balanced, the protein, fat, and carbo-hydrate being approximately in the proportions required for a good physiological meal. The amount of fat was diminished during the war on account of scarcity, but as supplies become more plentiful the normal ratio of protein, fat and carbo-hydrate will again be introduced in the school meals. (d) The extent to which attention is given to the educational aspect of the work. The teachers were asked on 25th June, 1915, by circular letter, to see that the children who receive school meals leave school at mid-day to go to the centres clean and tidy. At the centre the food is apportioned by the superintendent or an assistant, who are paid workers, and served by monitors. The monitors are selected from the elder boys and girls attending the centre on the basis of one to every 20 children. The tables are ready when the children arrive. The monitors wait on the children at their allotted tables, and after the dinners are over, collect the plates and tidy up. The monitors have their dinners after the other children have finished. The educational aspect of the school meal is not forgotten, and, as far as the personnel of the feeding staff at the present time will allow, cleanly habits, good manners, and table discipline are inculcated among the scholars attending. In the areas of some education authorities teachers attend the centres and supervise the children during the meal hour. (e) The suitability of the accommodation and equipment and the efficiency of the service and supervision of the meals. In one instance a feeding centre has been specially equipped. In two instances the laundry and cookery centres of the schools are used. In the case of the South Kilburn area the dinners are provided by a voluntary centre where the arrangements are not satisfactory. (f) The completeness of the arrangements made for ascertaining and recording the effect of the meals on the physical and menial condition of the children. Owing to the war it has not been possible to make any arrangements for recording the effect of the meals on the physical condition of the child, nor do the Committee think this practicable or profitable except under the strict conditions necessary for scientific investigations. The Medical Inspector of a school should make a point of specially examining the children receiving school meals to note any gross improvements in the physical condition, and the teacher at the same time would be able to give information on the increased mental alertness of the children fed. In this way knowledge would be acquired as to the effect of the meals, and should be embodied in the report of the School Medical Officer. This, however, cannot be done until medical inspection is in operation again. (g) The economical administration of the work. The work is administered by a Supervisor of School Meals under the general direction of the School Medical Officer. The Supervisor is assisted by a visitor who helps in the enquiries and with the clerical work. At each centre the staff is only sufficient to meet the needs of the Centre, and is reduced or added to from time to time according to the numbers fed. 104 The following table gives certain particulars as to the centres during the week ending 5-4-19. Gibbons Rd Centre Furness Rd. Centre Strode Rd. Centre 1 2 3 4 Total No. of meals supplied 752 529 418 Average No. of meals supplied daily 150 106 84 No. of staff employed 3 2 *2 *Reduced to 1½ as from 28-4-19. CONCLUSIONS. Having considered all the matters raised in the reference to us, we are of opinion— (1) That the present system under which meals are provided on the basis of a necessitous income line is not ineffective; that by this method of selection the majority of children requiring to be fed receive the necessary meals; that the regular review of the economic circumstances of all cases fed and the further enquiries of the employer as to the earnings in the family prevent any serious abuse of this method; and that the cost is not needlessly high. (2) That as no child can be maintained in physiological health unless the parents are in a position to allot to it the sums indicated in this report for food, clothing, etc., children should be fed in all cases where poverty in this sense exists; that certain children in whose cases the economic circumstances are above the scale may yet require to be fed, and we make below certain recommendations in connection therewith. (3) We do not think that an examination of the physical need of the children attending schools is the only means by which the Act of Parliament can be achieved. In this connection we desire to quote paragraph 308 of the report of the Chief Medical Officer of the Board for 1910, as follows :— "There are, in practice, two tests, either or both of which will formally be applied by a Local Education Authority in deciding first, whether to apply their funds to the feeding of school children, and, secondly, which children shall be admissible and which inadmissible, to the meals provided—namely, the physical test and the poverty test. By the physical test I mean that regard is principally paid to physical evidence of bad or insufficient nutrition, whether arising from poverty or some other cause ; by the poverty test that the relief of the necessitous is the primary consideration, the question of nutrition being investigated subsequently, if at all. The majority of the children fed will no doubt be the same on either system, but where the Act is already in operation for the benefit of children who would be admitted to the meals whichever test was applied, there may be exceptional cases, in addition, who would satisfy only one of these two tests. "Thus it is by no means uncommon to observe children who do not appear under-nourished and yet to know enough of the home conditions (e.g., that the father is recently out of work, that there is much illness in the family, &c.) to predict with confidence that, owing to poverty, the child will quickly deteriorate in condition if not admitted to the meals. On the other hand there may be children from homes that are known not to be necessitous, who yet would obviously profit from a course of regular meals. In admitting the latter class of children to the meals, care will have to be taken no doubt to secure due payment from the parent." We desire to record our thanks to Mr. Councillor Hogg for raising the important points contained in the reference to us. We are of opinion that the provision of School Meals could practically be abolished if social conditions were such that the mother and family were provided for by the State by way of mothers' pensions or mothers' wages apart altogether from the earnings of the husband. We recommend— (1) That children be provided with meals in whose cases the family circumstances come below the scale. (2) That as and when Medical Inspection is again in operation— (a) Children be not removed from the Feeding List except after medical examination ; (b) That the cases of all Children noted at routine Medical Inspection as suffering from malnutrition be specially investigated and referred for meals or other appropriate action as may be necessary; and (c) That the Medical Officer include in his Annual Report a report on the effect of the meals on the physical and mental condition of the children. H. MARTIN THORPE, To be submitted to the Chairman, Children's Care Committee on 16th June, 1919, Children's Care Committee. 105 APPENDIX D. MEMORANDUM ON THE TEACHING OF SEX HYGIENE IN THE PUBLIC ELEMENTARY SCHOOLS. 28th October, 1918. The drain upon human resources occasioned by more than four years of war makes it incumbent upon the Hygienist to examine proposals which suggests directly or indirectly means for the restoration and improvement of National Health. Our stock of National Health is at present low. The Birth Rate is falling. During the four weeks ended 5th October, 1918, the birth rate in Willesden was only 13.24 per thousand as against a pre-war rate of 24.70 per thousand in 1914, a fall of 46.4 per cent. The medical examination of recruits for the army has revealed the fact that only 36 to 37 per cent. of the male population of military age are "A" men. Such men are suffering most heavily as the result of war, and the population therefore more than ever before will have to be carried on by men of lower categories. The measure of success achieved by the Teaching of Sex Hygiene must be judged by improvement in the foregoing conditions. One result should be a rise in the birth rate at least to the prewar rate. This will only be accomplished if the future education of the girl no longer consists in the concealment from her of the essential facts of life and if her outlook is so altered that she does not come to regard the racial instincts as low and shameful. The birth rate, however, is not likely to increase to the necessary extent unless it is impressed upon all that the rearing of large and healthy families is national work of the highest importance and the State in its turn recognises the national character of the work of child bearing. The teaching of sex hygiene includes instruction in the preservation of the health of the sexual organs. One of the results of such teaching therefore should be an early diminution in the incidence of Venereal Diseases and subsequently an increased proportion of " A " men in the population. Incidentally some diseases or conditions associated with puberty would disappear or be diminished. For example, masturbation or self abuse would be lessened. Here it should be noted as particularly important that no mention of this subject should be made to a child who already has no knowledge of it. Many girls too would be saved from the shock of the onset of menstruation, while at later ages the various forms of neurosis not uncommonly associated with this cyclic change, such as hysteria, nervousness or depression—the result of disordered fancies—would tend to diminish in consequence of healthy knowledge. These, in brief outline, are some of the main results which the Hygienist would expect to follow more or less rapidly on the education of the young in the matter of the preservation of the health of the reproductive organs. The question arises as to how the subject can be introduced in the ordinary elementary schools. Class teaching has been suggested, but in this connection the main difficulties are that children of different development and widely varying knowledge in sex matters are associated in the same class. Individual teaching for those who appear to require it has likewise been advocated, but this latter method would only lead to the instruction of the more obvious cases of abuse, as no teacher can very well say which children are or are not in need of sex education. But whether instruction is given collectively or individually, the person by whom it is given is probably the most important single factor in connection with the subject. By some the class teacher is thought to be the right person, by others a special teacher, or the doctor, or the parent. None of these, to my mind, is necessarily the right person. The kind of teacher required for a subject like this is one who is well versed in biology and physiology, and who has the gifts or the training of a teacher. The teacher, too, must be in complete sympathy with the child and have a full appreciation of the delicacy and difficulty of the subject. Above all, the teacher must have a healthy mind and the necessary tact for overcoming the inherent difficulties concerned in the enlightenment of the young on matters of Sex Hygiene. Bearing in mind the views above expressed and the objects to be attained by the teaching of Sex Hygiene, and remembering further that the education of the young in this subject is bound to include in some cases enlightenment in respect of the reproduction of the race, I am reluctantly impelled to the conclusion that sex hygiene as a separate entity cannot at present be included in the curriculum of an ordinary elementary school. I think the most that can be done in elementary schools is the establishment of a graduated course on Nature Study, over a number of years, beginning with Botany and the reproduction of plants, passing on to Zoology and the reproduction of the lower and possibly some of the higher forms of animal life, and finally Hygiene, in which I would include Elementary Physiology. I do not think that the subject of Sex Hygiene as such should be dealt with. The course should be merely Hygiene as defined above. The introduction of the word " sex " tends to make the child introspective and curious, and the reaction on the mind under these conditions is not likely to be beneficial. At one time I had thought it possible that the subject of Human Embryology might be simply dealt with and the physiological processes resulting from the fusion of the male and female elements of reproduction and the development of the fertilised ovum explained. I am of opinion now that this is not practical in the elementary schools, as some children are without the necessary rudimentary knowledge on which to superimpose additional information. 106 As a further adjunct to Sex Hygiene, children in elementary schools should be taught the Care of the Body. Well planned courses of Physical Training should be in operation from the lowest to the highest classes, not with the military idea in view, but for the purpose of stimulating the child to become an alert, upright, and vigorous unit in society, so that the race may be improved. The child on leaving school should be turned out, as it were, the complete athlete—physically, morally, and intellectually—well trained and equipped for the battle of life. Round about the age of 16 years I think the subject of Sex Hygiene as a separate subject could be dealt with. Then I think the essential facts of reproduction could be stated in quite a plain way, for it is much better that these should be learned in a healthy and clean atmosphere than under obscure and perhaps obscene circumstances. Even the marriage relationship might be touched upon at these ages with great advantage to marital happiness and domestic felicity and society generally. In all that I have said I would make it clear that I am of opinion that upon every occasion the man should speak to the boy and the woman to the girl on sex matters, and from this position I do not exclude the doctor. GEORGE F. BUC.HAN, Medical Officer of Health. APPENDIX E. The Secretary, 24th January, 1919. Medical Department, Board of Education, 19, St. James's Square, S.W. 1. WILLESDEN.—SCHOOL MEDICAL SERVICE. HOSPITAL TREATMENT. With reference to the Board's letter of 12th December, 1918, and previous correspondence, I am instructed by the Education Committee to submit for approval the following scheme for the Hospital Treatment of School Children. The Education Committee have made arrangements subject to the approval of the Board for the Hospital Treatment of their cases to be undertaken at the Willesden Municipal Hospital provided and maintained by the Willesden Urban District Council. The charge to the Education Committee would be based on the actual cost per patient per day. For the financial year 1919-20, it is estimated that this will be 10s. per patient per day, the day of admission and the day of discharge each to be counted as one day. Throat, Nose and Ear Conditions. The following Table I. shows the number of these conditions found for which treatment was considered necessary in the years 1914-17 inclusive :— Table I. No. of Defects Found for which Treatment was Considered Necessary. (1) 1914. (2) 1915. (3) 1916. (4) 1917. Average per annum, 1914-17. Enlarged Tonsils 285 119 70 108 269 Adenoids 52 50 51 53 Enlarged Tonsils and Adenoids 113 82 58 35 Total 450 251 179 196 Chronic Suppuration of Middle Ear 57 67 112 45 70 Grand Total 507 318 291 241 339 NOTES. (1) 1914. Routine Medical Inspection commenced in March. 2 age groups inspected. Total No. examined .= 7,358. (2) 1915. Routine Medical Inspection of 2 age groups. January to March. Routine Medical Inspection of 3 age groups. April to September. Routine Medical Inspection of 3 age groups in half the district only, October to November. Routine Medical Inspection discontinued on December 3rd—periodical visits paid to the Schools to select and examine cases apparently needing medical attention. Total No. examined = 5,315 (3) 1916. No Routine Medical Inspection—2 visits paid to each school department during the year to select and examine children apparently ailing. Total No. examined = 1,757. (4) 1917. Routine Medical Inspection of 2 age groups in part of the district. Total No. examined = 3,398. 107 Having regard to the above figures it is estimated that 270 cases suffering from Throat, Nose and Ear conditions would be treated per annum, namely, 260 from enlarged tonsils and adenoids and 10 on account of Chronic Suppuration of the Middle Ear. With regard to the cases of enlarged tonsils and adenoids these would be admitted to Hospital, prepared for operation on the day of admission, operated on on the following day and discharged on the third day. With regard to the 10 ear cases they would each probably be in hospital 4 weeks. Under these conditions the number of beds in daily use for Throat, Nose and Ear conditions throughout the year would be 3. These cases would be under the care of a competent Throat, Nose and Ear Specialist on the staff of the School Medical Officer and Medical Officer of Health. At the present time Mr. Norman Patterson, F.R.C.S., Surgeon to the Golden Square Throat Hospital, has been appointed temporarily to deal with throat, nose and ear conditions. Eye Conditions. In connection with the Eye Clinic of the Authority, cases arise from time to time where the condition is chronic and resistant to out-patient treatment, such as chronic blepharitis, corneal ulcers and chronic conjunctivitis. A proportion of these cases require continuous treatment, i.e., Hospital treatment. In addition a few cases require operative interference, for example, squint. The number of all such Eye cases requiring hospital treatment is not large and an average of 1 bed occupied daily throughout the year would cover requirements for these cases. Mr. M. W. B. Oliver, M.A., M.B., B.C., F.R.C.S., M.R.C.S., L.R.C.P., the permanent Eye Specialist of the Authority, would have charge of these cases. He is on the staff of the School Medical Officer and Medical Officer of Health. At present Dr. Dyce Davidson, M.B., Ch.B., M.A., is acting temporarily during Mr. Oliver's absence on military service. Other Conditions Affecting School Children. From time to time hospital treatment for school children suffering from general conditions is required. Some of these conditions are shown in the following Table II. giving the number found for which treatment was considered necessary during the years 1914-17, and the estimated number of such cases requiring Hospital treatment Table II. No. of Defects Found for which Treatment was Considered Necessary. (1) 1914. (2) 1915. (3) 1916. (4) 1917. Average per annum 1914-17. Estimated No. of cases requiring Hospital Treatment. Chronic Bronchitis and Bronchial Catarrh 46 57 69 87 65 20% =13 Lungs, Other Diseases including Pneumonia 5 16 16 24 15 20%= 3 Chorea 16 25 23 25 22 25%= 5 Debility 0 53 74 86 53 5%= 3 Tonsillitis and Sore Throat 240 184 191 148 191 5%= 9 Impetigo 231 557 651 790 557 2% =11 Eczema, Sores, Psoriasis, etc. 267 168 294 370 275 2%= 5 Scabies 63 72 232 393 190 2%= 4 Cervical Glands enlarged 110 123 153 119 126 2%= 2 Heart and Circulation. Organic Disease 38 8 5 1 13 20%= 3 Functional Disease 0 18 19 15 13 20%= 3 Anaemia 6 20 21 17 16 20%= 3 Other defects 5 5 1 4 4 25%= 1 65 (1), (2), (3), (4) Vide Notes to Table I. 108 It should be observed, however, that Some of the conditions occurring in school children requiring hospital treatment are acute and therefore such children are not seen at medical inspection although hospital treatment for them is required. Table III. below shows the causes of death in children between 5 and 15 years, excluding conditions for which hospital provision is already made generally, namely, Enteric Fever, Small Pox, Measles, Scarlet Fever, Whooping Cough, Diphtheria and Croup, Influenza, Erysipelas, Phthisis, Tuberculous Meningitis, other tuberculous diseases, and estimates the number of cases suffering from the conditions shown requiring Hospital treatment as double the number of deaths. Table III. Causes of Death in Children over 5 and under 15 Years of Age. 1914. 1915. 1916. 1917. Average per annum 1914-17. Estimated No of cases per annum requiring Hospital treatment = twice the number of deaths. Cancer 1 — 1 — .5 — Rheumatic Fever 4 3 5 1 30 6 Meningitis 2 7 5 3 4.0 8 Organic Heart Disease 3 8 5 4 5.0 10 Bronchitis — — — — — — Pneumonia 3 12 1 8 6.0 12 Other Diseases of the Respiratory Organs — 2 1 2 1.0 2 Diarrhoea and Enteritis — 3 — 1 1.0 2 Appendicitis and Typhlitis 3 4 4 5 4.0 8 Cirrhosis of Liver 1 — — — .25 — Nephritis and Bright's Disease 3 — — — .75 2 Congenital Debility and Malformation including Premature Birth 1 — — — .25 — Violent Deaths excluding Suicide 5 9 5 6 60 12 Other defined diseases 11 17 10 6 11.0 22 Diseases ill-defined or unknown 1 — — — .25 — 38 65 37 36 — 84 It will be observed that Tables II. and III. do not contain identical diseases. The necessary corrections in this respect are shown below. Table II. gives 65 cases. Add from Table III. the cases not appearing in Table II., as follows :— 6 cases of Rheumatism. 8 ,, Meningitis 2 „ Diarrhœa and Enteritis. 8 ,, Appendicitis and Typhlitis. 2 „ Nephritis and Bright's Disease. 12 „ Violent Deaths including Burns, Accidents, etc. 22 ,, Other defined diseases. 60 cases or 125 in all. 109 Similarly—Table III. gives 84 cases. Add from Table II. the cases not appearing in Table III. as follows :— 5 cases of Chorea. 3 „ Debility. 9 „ Tonsillitis and Sore Throat. 11 „ Impetigo. 5 ,, Eczema, etc. 4 ,, Scabies. 2 „ Cervical Glands. Total 39 cases or 123 in all. By these methods it will be observed that it is estimated that, per annum, 125 or 123 cases or an average of 124 cases of school children suffering from various general conditions require Hospital treatment. Assuming that the average stay in Hospital is 4 weeks, this means that approximately 10 beds would be in constant use for these cases. These general conditions would be under the medical care of the Medical Superintendent of the Willesden Municipal Hospital. At the present time it is not practical for cases of appendicitis to be taken into the Municipal Hospital as a routine measure as the necessary surgical skill is not available but the Committee desire permission to arrange for the admission of these cases should a Surgeon become available. Summary of Hospital Beds Required. Throat, Nose and Ear Conditions 3 Eye Conditions 1 General Conditions 10 Total 14 Estimated Cost Per Annum. Maintenance of 14 occupied beds at 10s. per day per occupied bed £2,555. Dental Inspection and Treatment. Mr. E. A. Jennings was appointed Temporary Dentist on 22/4/18. Mr. H. D. Hoggard was also appointed Temporary Dentist on 29/7/18. GEORGE F. BUCHAN, Medical Officer. APPENDIX F. 17th April, 1919. To the Chairman and Members of the Health Committee. WILLESDEN—COLLECTION, REMOVAL AND DISPOSAL OF HOUSE REFUSE FOR THE YEAR 1919-20 FROM 3,924 HOUSES AS PER SCHEDULE TO THE CONTRACT. By Direct Labour. By Three Electric Vehicles. 5,194 tons or 16,016 cubic yards of house refuse require to be collected annually from these houses in 279 working days. Adopting an Electric Vehicle of a capacity of 7 cube yards this means that the three vehicles purchased by the Council, each doing three loads a day, will remove 9 loads a day with a total capacity of 63 cube yards or 20.43 tons in one day equal to 17,577 cubic yards or 5,699 tons in 279 working days of one year. The house refuse would be shot into barges at a Wharf in Paddington (Harrow Road). The estimated capital cost is £4,129. The estimated annual cost is £5,050 6s. 6d., as shown on the detailed estimates which follow :— Hours of work per day = 9 Hours of work per week = 51 Tons of house refuse to be lifted by one Filler per day of 9 hours = 3.4 110 3 Electric Vehicles. Estimated Capital Costs. £ s. d. 3 Electric Vehicles at £1,151 (as per estimate) 3,453 0 0 Paving of Wharf (Harrow Road) 200 0 0 Erection of Office at Wharf 120 0 0 Charging Plant 150 0 0 Registration 6 0 0 Contingencies 200 0 0 £4,129 0 0 3 Electric Vehicles. Estimated Annual Costs. Average Daily Running of Vehicles—25 Miles per Vehicle. £ s. d. Repairs and maintenance of Vans at 5d. per mile 43 11 10 Repairs and maintenance of batteries at 4d. per mile 34 17 6 Insurance of 9 men 5 0 0 6 Fillers at £3 10s. per week 1,092 0 0 3 Drivers at £3 15s. per week 585 0 0 3 Licences at 5s. each 0 15 0 Repayment of Capital Costs for a period of 10 years on £4,129 555 0 0 125 Units of Electricity per Vehicle per week at l½d. per unit 121 17 6 Sundries at .25d. per mile 21 15 11 Removal of 5,194 tons of refuse at 5s. 6d. per ton 1,428 0 0 6 Ladders at 12s. each 3 12 0 12 Baskets at 14s. each 8 8 0 6 Shovels at 7s. 6d. each 2 5 0 Insurance of 3 Vehicles at £10 each 30 0 0 Tyres, 6,975 miles per vehicle at 1d. per mile 87 3 9 Superintendence of Garage 200 0 0 Rent of Wharf (Harrow Road) 75 0 0 Superintendent at Wharf 200 0 0 Men at Wharf to trim barges at £3 weekly 156 0 0 Foreman over dustmen at 200 0 0 Rent of Garage 50 0 0 Contingencies 150 0 0 £5,050 6 6 Recommendations. (1) That the Council take on lease for a period of 21 years, terminable at 7 or 14 years at their option, the Wharf at 429, Harrow Road belonging to The Grand Junction Canal Co., at a rent of £75 per annum. (2) That the Council enter into a contract for the barging away and disposal of the house refuse. (3) That the hours of labour be as in the foregoing report. (4) That the wages of the drivers be £3 15s. per week, fillers £3 10s. per week, trimmers £3 per week, Superintendent at Wharf £200 per annum, foremen over dustmen £200 per annum. (N.B.—The Foremen at present engaged on this work receive £143 per annum, including War Bonus.) (5) That the Electrical Engineer be instructed to engage the Drivers. (6) That the Medical Officer of Health be instructed to engage all other necessary workers. WILLESDEN.—COLLECTION, REMOVAL, AND DISPOSAL OF HOUSE REFUSE FOR THE YEAR 1920-21 FROM THE URBAN DISTRICT OF WILLESDEN. By Direct Labour. (a) By Electric Vehicles. 24,691 tons or 76,167 cube yards of house refuse require fo be collected annually in 279 working days. Adopting an Electrical Vehicle of a capacity of 7 cube yards this means that 13 vehicles of this capacity each doing 3 loads a day will remove per day 39 loads with a total cubic capacity of 273 cube yards or 88.5 tons in one day equal to 76,167 cubic yards or 24,691 tons in 279 working days or one year. 111 An additional vehicle should be added as a spare in the event of accident or breakdown or overhauling or to pick up arrears accumulating from bad weather or other emergencies. The House Refuse would be shot into barges at a Wharf in Paddington (Harrow Road) and another at Lower Place. The estimated capital cost is £21,942. The estimated annual cost is £20,609 1s. 1d. as shown on the detailed estimates, which follow : — Hours of work per day = 9 Hours of work per week = 51 Tons of house refuse to be lifted by one Filler per day of 9 hours = 3.4 (b) By Horse-drawn Vehicles. The same quantity of refuse as above has to be collected. Adopting a horse-drawn Dust Van of a capacity of 6 cube yards equal to 1.94 tons means that 19 vehicles—11 to do 2 loads a day and 8 to do 3 loads a day—will remove per day 46-loads with a total cubic capacity of 276 cube yards, or 89.5 tons in one day equal to 77,004 cube yards or 24,970 tons in 279 working days or one year. Three additional Vehicles and Horses should be added as spares. The house refuse would be shot into barges at Paddington and Lower Place as above. The estimated Capital Cost is £8,532. The estimated Annual Cost is £20,839 8s. 6d. as shown on the detailed estimates which follow :— Hours of work per day = 9 Hours of work per week = 51 Tons of house refuse to be lifted by one Filler per day of 9 hours = 2.6 (average) (Filler doing 2 loads = 1.94. Filler doing 3 loads = 2.90). By Contractor. On the same basis as above (i.e., assuming that wages and other costs remain as at present) the present Contractor's prices for next year must be increased by the additional cost of a shoot outside Willesden. Benton was prepared to let his Shoot to the Council at 6d. per cube yard, equivalent to 1s. 6½d. per ton. Sabey's tender for the removal by Canal is 5s. 6d. per ton. The difference in cost between this price and the price of Benton's Shoot will therefore have to be added to next year's contract prices, i.e., 4s. per ton or a total of £4,938 for 24,691 tons, thus increasing the contract price of £17,250 for the year 1919-20 to £22,188 for the year 1920-21. ELECTRIC VEHICLES. Estimated Capital Costs. £ s. d. 14 Vehicles as per estimate at £1,151 16,114 0 0 Garage for 14 vehicles on Council's land at Hospital 4,000 0 0 Paving of Wharf (Harrow Road) 200 0 0 Erection of platform and roadway Lower Place 210 0 0 Erection of Office (Harrow Road) 120 0 0 Erection of Office (Lower Place Wharf) 120 0 0 Charging Plant 150 0 0 Registration 28 0 0 Contingencies 1,000 0 0 £21,942 0 0 ELECTRIC VEHICLES. Estimated Annual Costs. Average Daily Running of Vehicles 25 Miles per Vehicle. £ s. d. Repairs and maintenance of vans at .5d. per mile 203 8 9 Repairs and maintenance of batteries at .4d. per mile 162 15 0 Insurance of 40 Men 19 10 0 26 Fillers at £3 10s. 4,732 0 0 14 Drivers at £3 15s. per week each 2.730 0 0 14 Licences at 5s. each 3 10 0 Repayment of Capital Costs for a period of 10 years on £17,942 2,408 0 0 Repayment of Capital Costs for a period of 30 years on £4,000 .. 289 0 0 2,697 0 0 112 125 Units of Electricity per Vehicle per week at l½d. per unit 568 15 0 Sundries at .25d. per mile 101 14 4 Removal of 24,691 tons refuse at 5s. 6d. per ton 6,790 0 6 28 Ladders at 12s. each 16 16 0 56 Baskets at 14s. each 39 4 0 28 Shovels at 7s. 6d. each 10 10 0 Insurance of 14 Vehicles at £10 each 140 0 0 Tyres 6,975 miles per Vehicle at 1d. per mile 406 17 6 Superintendence of Garage 300 0 0 Rent of Wharf (Harrow Road) 75 0 0 Superintendent at each Wharf at £200 400 0 0 Man at each wharf to assist at £3 per week 312 0 0 Foremen over dustmen (2) at £200 400 0 0 Contingencies 500 0 0 £20,609 1 1 HORSE-DRAWN VEHICLES. Estimated Capital Costs. £ s. d. 22 Dust Vans of 6 cube yards capacity at £120 each 2,640 0 0 22 Horses at £200 each 4,400 0 0 22 Sets of Harness at £16 per set 352 0 0 Paving of Wharf at Harrow Road 200 0 0 Elevated platform and roadway, Lower Place Wharf 200 0 0 Erection of Office (Harrow Road) 120 0 0 Erection of Office (Lower Place) 120 0 0 Contingencies 500 0 0 £8,532 0 0 HORSE-DRAWN VEHICLES. Estimated Annual Costs. £ s. d. 20 Drivers at £3 10s. per week 3,640 0 0 20 Fillers at £3 10s. per week 3,640 0 0 Insurance of 40 Men 19 10 0 Repairs and maintenance of Vans at £4 each 88 0 0 Fodder for 22 Horses at £2 2s. each per week 2,402 8 0 Shoeing of Horses, 18 sets per year each horse (at 10s. per set) 198 0 0 Veterinary fees at 30s. per horse per annum 33 0 0 Veterinary fees and expenses, Purchase of Horses 44 0 0 Repairs of Harness at 2s. 6d. per set per week 143 0 0 Insurance of 22 Horses at £5 110 0 0 1 Horsekeeper 250 0 0 Repayment of Capital Costs for a period of seven years on £4,752 841 0 0 Repayment of Capital Costs for a period of ten years on £2,640 355 0 0 Repayment of Capital Costs for a period of 30 years on £1,140 82 0 0 1,278 0 0 Rent of Stables for 22 Horses 300 0 0 Rates, Ground Rent and Water Rate 150 0 0 Rent of Wharf at Harrow Road 75 0 0 Superintendent at each wharf at £200 400 0 0 Man at each wharf to trim barges at £3 per week 312 0 0 Removal of 24,691 tons of refuse at 5s. 6d. per ton 6,790 0 6 28 Ladders at 12s. each 16 16 0 56 Baskets at 14s. each 39 4 0 28 Shovels at 7s. 6d. 10 10 0 2 Foremen over dustmen at £200 400 0 0 Contingencies 500 0 0 £20,839 8 6 113 SUMMARY, MAINTENANCE COSTS. DIRECT LABOUR. Electric Vehicles. Estimated, 1920-21. per ton. per ton. £ s. d. s. d. s. d. Wages 8,162 0 0 6 7.33 Barging 7,577 0 6 6 1.64 Capital Costs 2,697 0 0 2 2.21 All other charges 2,173 0 7 1 9.12 10 0.97 £20,609 1 1 16 8.30 Horse-Drawn Vehicles. Estimated 1920-21. per ton. per ton. £ s. d. s. d. s. d. Wages 7,930 0 0 6 5.08 Barging 7,577 0 6 6 1.64 Capital Costs 1,278 0 0 1 0.422 All other Charges 4,054 8 0 3 3.409 10 5.47 £20,839 8 6 16 10.55 Contractor's Charges. Estimated 1920-21. £22,188. GEORGE F. BUCHAN, Medical Officer of Health. COST OF DUST COLLECTION IN WESTMINSTER AND MARYLEBONE. Since writing the foregoing, there has come to hand the Municipal Journal of the 18th April, 1919, in which appears a report of the City Council of Westminster relative to the costs of dust collection in Westminster and Marylebone during the year 1917-18 from which I extract the following essential figures prepared by the City Comptroller of Westminster :— Westminster City Council. (Total Tons Removed, 80,715). Actual, 1917-18. £ s. d. s. d. s. d. Wages 23,992 0 0 5 11.34 Barging 23,388 0 0 5 9.54 All other Charges 14,582 0 0 3 7.36 9 4.90 61,962 0 0 15 4.24 Deduct receipts trade refuse 310 0 0 .90 £61,652 0 0 15 3.34 St. Marylebone Borough Council. (Total Tons Removed, 26,886) £ s. d. s. d. s. d. Wages 13,274 0 0 9 10.50 All other charges 15,474 0 0 11 6.13 28,748 0 0 21 4.63 Deduct Disposal of Slop £285 0 2.54 Oxford Street precept £600 0 5.35 Waste paper, etc. £3,063 Less paid dustmen £1,536 £1,527 1 1.61 2,412 0 0 1 9.50 Net Cost £26,336 0 0 Net Cost 19 7.13 114 During the year 1917-18 the following were the figures for Willesden .— Total tons removed 23,569 Contract price £9,828 0 0 Cost per ton 8 4.07d. Recommendations. (1) That the Council make arrangements for the collection and removal of house refuse in the Willesden area for the year, 1920-21 by direct labour. (2) That in view of the estimated costs submitted and the estimated tonnage to be moved daily per man by horse-drawn and electrically propelled vehicles, the Committee determine whether horse-drawn or electrically propelled vehicles are to be acquired. G.F.B. APPENDIX G. 30th April, 1919. To the Chairman and Members of the Health Committee. HOME NURSING. I beg to report in accordance with the following Minute of the Council:— MINUTE. "We have had under consideration :— (a) The Public Health (Pneumonia, Malaria, Dysentery, etc.) Regulations, 1918, and Circular from Local Government Board, dated January, 1919. (b) The Memorandum and Circular from Local Government Board on tion of Influenza. (c) The Home Nursing of Influenza, Pneumonia, Measles and Whooping Cough. "The Regulations above mentioned enable the Council to provide medical and nursing assistance in suitable cases. We have requested the Medical Officer of Health to report fully on the above matters." REPORT. (a) The Public Health (Pneumonia, Malaria, Dysentery, etc.) Regulations, 1918, came into operation on March 1st, 1919, and— (1) Impose the duty on every medical practitioner of notifying all cases of Malaria, Dysentery, Trench Fever, Acute Primary Pneumonia or Acute Influenzal Pneumonia occurring in his practice. (2) Provide for the payment to the medical practitioner of a fee of 1s. for each notification. (3) Impose the duty on the Medical Officer of Health of making such enquiries and taking such steps as are necessary or desirable for investigating the source of infection for preventing the spread of infection and for removing conditions favourable to infection, and if a medical practitioner is not in attendance, tor taking such steps as are necessary or desirable for ascertaining the nature of the case. (4) Impose special duties on the Medical Officer of Health in respect of Malaria, Dysentery, Trench Fever, Enteric Fever, Typhus Fever, and Relapsing Fever. (5) Impose the duty on the Local Authority of defraying any expenses incurred in the carrying out of the Regulations. (6) Empower the Local Authority to provide or contract for the provision of medical assistance which includes nursing for patients suffering from any of the diseases mentioned above. (b) The Memorandum and Circular from the Local Government Board on the Prevention of Influenza, state that Local Authorities should publish the local arrangements made as to nursing, domestic assistance,, hospital accommodation and ambulance provision. (c) The Home Nursing of Influenza, Pneumonia, Measles and Whooping Cough. According to the Board's Circular M. & C.W. 4, home nursing may be undertaken in respect of 115 pectant Mothers, Maternity Nursing, the nursing of Puerperal Fever, the nursing of Measles in young children, Whooping Cough in young children, Epidemic Diarrhoea in young children, and Ophthalmia Neonatorum. From the foregoing it will be observed that the Board desire that provision should be made for Home Nursing where necessary in respect of the following conditions Malaria. Dysentery. Trench Fever. Acute Primary Pneumonia. Acute Influenzal Pneumonia. Expectant Mothers. Maternity Nursing. Puerperal Fever. Measles in young children. Whooping Cough in young children, Epidemic Diarrhoea in young children, and Ophthalmia Neonatorum. Certain of these conditions may be excluded from present consideration—Malaria, Dysentery and Trench Fever because the number of cases is not likely to be great, and Expectant Mothers, Maternity Nursing, and Puerperal Fever because this is outside the scope of the reference and would be better dealt with in relation to the question of the Provision of Midwifery. There therefore remains to be considered the Home Nursing of :— Acute Primary Pneumonia. Acute Influenzal Pneumonia. Measles in young children. Whooping Cough in young children. Epidemic Diarrhœa in young children, and Ophthalmia Neonatorum. I do not think it is practicable to maintain a Staff of Nurses for Acute Influenzal Pneumonia, as these would only be needed during epidemics when all the Nurses of the Authority, including Health Visitors, might, for a short period, have to be transferred to this work. The following Table I. shows the number of deaths at all ages in each year from 1914 to 1918 on account of Pneumonia, Measles, Whooping Cough, and Epidemic Diarrhoea :— Table I. 1914. 1915. 1916. 1917. 1918. Total in 5 years. Average per annum. Pneumonia 115 177 118 164 193 767 153 Measles 8 74 7 48 20 157 31 Whooping Cough 34 55 26 23 40 178 36 Epidemic Diarrhœa 97 62 43 55 39 296 59 Total 254 368 194 290 292 1,398 279 The following Table II. shows the number of cases of Measles, Whooping Cough, and Ophthalmia Neonatorum—these being the only compulsorily notifiable diseases under consideration—notified since 1914:— Table II. 1914. 1915. 1916. 1917. 1918. *Measles — — 1,437 3,424 1,448 † Whooping Cough — — 238 610 Ophthalmia Neonatorum 29 27 28 29 38 *Became compulsorily notifiable January 1st, 1916. † Became compulsorily notifiable October 1st, 1917. 116 The following Table III. gives particulars of the deaths, probable number of cases to be nursed at home and number of nurses' visits to be made per annum :— Table III. Average No. of deaths per annum. Probable No. of cases to be nursed per annum = 3 times the No. of deaths. Probable duration of case for nursing. Average No. of visits per day per case. Total No. of visits to be paid per annum. Pneumonia 153 459 14 days 2 12,852 *Measles 31 93 14 days 2 2,604 *Whooping Cough 36 108 21 days 2 4,536 Epidemic Diarrhœa 59 177 10 days 2 3,540 Ophthalmia Neonatorum — 10 21 days 2 420 23,952 * Having regard to the number of cases notified the probable number of cases to be nursed is a low estimate. Home Nursing requires to be done in the morning and again in the evening, 7 days a week, namely, from 9 a.m. to 1 p.m., and 4.30 p.m. to 7.30 p.m. Where two visits a day are required during the acute stage of the illness the morning visit is usually the longer. Where only one visit is required it is usually paid in the morning. On the average a visit may be reckoned at 40 minutes, and one Nurse, therefore, in a day of 7 hours would do, say, 11 visits. From the foregoing estimate it will be observed that 6 Nurses would be required for the number of visits shewn on Table III., assuming that each works 7 hours a day, 7 days a week. A Nurse, however, would require a day and a half off duty per week, and the total number of Nurses needed would have to be increased to 8, or 4 Home Nurses to each Clinic. In connection with these appointments at each Clinic it will be necessary to appoint an Assistant Matron for the following reasons (1) That she may receive reports of the Home Nurses and any reports from doctors practising in Willesden as to the work of the Home Nurses ; (2) That she may be able to organise their work so that their time is utilised to the best advantage; (3) That there may be some responsible person on the premises to interview callers and able to let them know to what extent a Nurse may be available for a particular case. In addition the Assistant Matron would be required to assist the Matron with other work at the Clinic, more particularly in connection with home circumstances of cases. The above arrangements do not include provision for night duty or for the nurses living in in connection with the Clinics. Requisitions for nurses would have to be sent to the Clinics every morning from 9 a.m. till 12 noon, including Sundays. Estimated Cost. £ 2 Assistant Matrons at £160 plus £40 War Bonus plus £12 uniform 424 8 Home Nurses at £120—£150 plus £40 War Bonus plus £12 uniform 1,376 8 Nurses' Bags, Contents and Requisites (Provision and Annual Maintenance) 200 £2,000 Estimated Grant. In respect of children under 5 years suffering from measles, whooping cough, epidemic diarrhoea and ophthalmia neonatorum £500 Estimated Net Expenditure £1,500 117 Recommendations. That 2 Assistant Matrons be appointed, one at each Clinic, at an annual salary of £160 plus £40 War Bonus plus uniform. That 8 Home Nurses be appointed, four to each Clinic at an annual salary of £120—£150 by £10 annual increments plus £40 War Bonus plus uniform. That the necessary nurses' Bags, Contents and Requisites be obtained at a Cost not exceeding £200. That the foregoing Scheme be submitted to the Local Government Board for approval so that Grant may be obtainable. GEORGE F. BUCHAN, Medical Officer of Health. APPENDIX H. 20th May, 1919. To the Members of the Health Committee. CONVALESCENT HOME. I beg to report in accordance with the following Minute of the Council:— "We have had under consideration the question of the provision of a Convalescent Home for children as suggested by the Local Government Board in paragraph 32 of their memorandum on Maternity and Child Welfare (M. and C.W.4), and RECOMMEND that the Medical Officer of Health be instructed to prepare and submit to us a report and an estimate on the acquisition of a suitable property within easy reach of North West London, having accommodation for 50 beds." (Council Minutes, p. 302, 22nd October, 1918). Paragraph 32 of the Board's Circular on Maternity and Child Welfare, M. & C.W. 4, dated 9th August, 1918, is as follows :— "A stay in a convalescent home is especially important for recovery after certain cases of confinement and for some conditions in young children, especially after measles and whooping cough. It is desirable therefore that Local Authorities should, either themselves, or through a voluntary agency, arrange for beds in convalescent homes to be available as part of their schemes. As a general rule a grant will be paid to voluntary agencies providing convalescent homes only in respect of accommodation provided in connection with a local authority's scheme and approved by the Local Authority and the Board!" A Convalescent Home.—A Preventive Institution. A convalescent home, properly regarded, is an institution for the prevention of the continuance and recurrence of disease. Patients should go there not only to recuperate from some acute illness but also to prevent the frequent sequel of chronic ill health. Children suffering from debility following an acute attack of disease and requiring to be fed, nourished, and cared for in the open air especially need the advantages of a convalescent home in the country for complete restoration to health and strength to resist any further attacks of disease on return to ordinary home conditions. The convalescent home is especially important in the lung complications which follow such diseases as measles and whooping cough. A prolonged period at a convalescent home after the occurrence of such diseases would go far to prevent tuberculosis, which so frequently attacks the young adult whose previous history tells of lung complications with the exanthemata of childhood. A convalescent home too, would be used in certain cases as a rest home for the expectant mother. No. of Cases and Beds Required. The following table gives particulars of 696 cases which came under observation during the 32 weeks, 8th September, 1918, to 19th April, 1919, at the Hospital or the Clinics, and which were considered by the Medical Staff of the Authority as requiring a further period in a Convalescent Home to restore them completely to health :— 118 Condition. Women. Hospital. Children Others. Total. Clinics Total. Grand Total. Under 5. 5 to 14. Diseases of the Lungs: Bronchitis — 16 — — 16 66 82 Pneumonia, all forms 2 2 4 3 11 24 35 Other diseases — 1 1 — 2 58 60 Pregnancy and Diseases of Women: Phlegmasia alba dolens 2 — — — 2 — 2 Pregnancy 2 — — — 2 — 2 Miscarriage 9 — — — 9 - 9 Septic diseases 5 — — — 5 1 6 Other diseases and accidents of pregnancy and parturition 8 — — — 8 — 8 Diseases of Nutrition Marasmus - 9 — — 9 1 10 Enteritis 3 2 1 — 6 1 7 Rickets — 8 — — 8 - 8 Enlarged Glands 1 3 4 1 9 20 29 Other diseases - - - - - 3 3 Diseases of the Nervous System: Chorea - — 4 — 4 5 9 Meningitis - — 1 — 1 5 6 Poliomyelitis - 1 — — 1 1 2 Other Diseases - — — — — 4 4 Diseases of the Eyes and Ears — — 4 — 4 1 5 General Diseases: Influenza - 1 2 1 4 297 301 Debility - - - — — 79 79 Heart Disease - - - - - 4 4 Rheumatism - — 2 1 3 2 5 Nephritis 1 1 1 1 4 - 4 Anæmia — — — — — 10 10 Other Diseases 1 — — — 1 5 6 Total 34 44 24 7 109 587 696 The total number referred from the Clinics for Convalescent treatment is 587. This includes women, children under 5 and children from 5 to 14. As the attendances at the Clinics are practically equal for women and children under 5 and children from 5 to 14 it may be assumed that 293 of these cases were women and children under 5. The number of women and children under 5, therefore, coming under observation at the Hospital and the Clinics may be estimated as follows:— Hospital 78 Clinics 293 Total 371 in 32 weeks; Or in the same proportion 603 in 52 weeks. With regard to Hospital cases, it should be observed that the number given is a minimum, as many cases were kept longer in Hospital than otherwise they would have been, had a Convalescent Home been available for the more rapid recovery of these cases in the later convalescent stages of the illness. It will also be observed that approximately 43 per cent. of the cases are Influenza cases, and these are not likely to recur annually, but as against this it is to be noted that no Infectious Diseases appear on the list, such as Measles, Whooping Cough, Diphtheria and Scarlet Fever, many of which require prolonged convalescence for complications after the infection of the original disease has subsided. The figure therefore of 603 cases per annum may be taken as a fair estimate of the number of cases passing through the hands of the Medical Staff of the Authority requiring convalescent treatment. A Convalescent Home of 50 beds, each bed being occupied for 4 weeks, would be able to deal with 650 cases per annum. PROPERTIES. The following is a list of properties within 30 miles of Willesden, which may prove suitable for conversion into a Convalescent Home of approximately 50 beds:— 119 Address. Approx. distance from London. Extent. Approx. No. of Rooms. Additional Buildings, etc. Water Supply, etc. Price. Harefield Park 15 miles 178 acres 6 Reception Laundry Gas and water laid on £25,000 freehold 18 Bed Stabling 2 Bath Cottages Recently used as a Convalescent Home and Hospital and extensive buildings erected for the purpose. Harrow Weald Park, Harrow Weald 12 miles 53 acres 5 Reception Lodges Electric Light £25,000 freehold. 23 Bed Cottages Company's Water 5 Bath Stabling Main Drainage Farmery Central Heating Stanmore Hall, Stanmore 10 miles 39 acres 6 Reception Stables Electric Light Main Freehold. 30 Bed Garage Company's Water Price not yet settled. 4 Bath Laundry "Sanitary arrangements have been carried out in most complete manner." Cottages Fulmer Hall, Fulmer, Stoke Common, Bucks. 18 miles 44 acres 6 Reception Stables Water from Spring by gravitation £16,000 freehold. 33 Bed Farmery Cottages Sanitation on modern approved principles Loudwater House, Rickmansworth 20 miles 420 acres 6 Reception Stables Electric Light (own plant) Company's Water? £30,000 freehold. 23 Bed Garage 8 Bath 2 Houses "Sanitary arrangements on the latest principles" Water Closets 2 Farms Westbrook Hay 25 miles 1,600 to 1,700 5 or 6 Reception Stables Water Supply pumped from Well Freehold. acres or 800 29 Bed Garage £56,000 whole. acres or 300 Farmery "Probably the Sanitary arrangements would have to be re-carried out." £35,000, 800 acrs. acres Laundry £30,000, 300 acrs. 120 Address. Approx. distance from London. Extent. Approx. No. of Rooms. Additional Buildings, etc. Water Supply, etc. Price. 16 miles 69 acres 5 Reception Stabling Electric Light £30,000 freehold. 24 Bed Garages Central Heating 6 Bath Farmery Cecil Lodge, Abbots Langley, Herts. 22 miles 172 acres 6 Reception Bakehouse Company's Water £17,000 freehold. 16 Bed Home Farm Acetylene Gas Laundry (Electric Light Main in Village) Stabling Central Heating Motor House Cesspool Drainage Cottages Manor House, Little Marlow, Bucks. 29 miles 104 acres 6 Reception Stabling "Sanitary arrangements believed to be all that could be desired " £15,000 freehold. 22 Bed 2 Bath The Vache, Chalfont St. Giles, Bucks. 20 miles 350 acres 6 Reception Stables Water from Well £40,000 freehold. 19 Bed Cottages Electric Light Home Farm Modern Drainage Water Closet System Northwood Hall, Northwood 14 miles 74 acres 6 Reception Stables Electric Light £17,500 freehold. 15 Bed Farmery Company's Water and Gas Bath Cottages Drained into main sewer The Stratton Chase Estate, Chalfont St. Giles, Bucks. 20 miles 650 acres or 98 acres 4 Reception Motor Garage Lighted by Electricity from £35,000 freehold. (Government valuation, £56,339) 16 Bed Stabling private plant 3 Bath Cottage Water from Artesian Well Laundry Cesspool Drainage £16,000 for Mansion and 98 acrs. Farmery Lodges Copped Hall, Totteridge, Herts. 9½ miles 18 acres 6 Reception Stables Electric Light (own plant) £20,000 freehold. 26 Bed Garage Company's Water 4 Bath Laundry The drainage is conducted by a good fall to land on the Estate about ½ mile from the residence Cottages Twyford Manor, Buckingham - 118 acres 3 Reception Stabling Electric Light £14,000 freehold. (all pasture) 13 Bed Farm Buildings Main Water laid on 2 Bath 2 Cottages "The drainage is all new" 121 Land Attached. The land attached to the home would be available for the recreation of patients. In addition a sufficient portion of it should be in charge of a competent agriculturalist who would be able to supply the home with milk, butter, eggs, vegetables, fruit, and other forms of dairy and land produce. PROVISIONAL ESTIMATED COSTS. The estimated costs now submitted are provisional. The actual costs cannot be given until the Committee makes its selection of the property to be purchased. Capital Costs. House and Grounds say £20,000 Alterations say £5,000 Furniture and Equipment— 50 beds at £100 per bed £5,000 Total say £30,000 Maintenance Costs Per Annum. Repayment of Capital Costs:— £ House and grounds and alterations— (30 years at 6½ per cent.) 1,905 Furniture and Equipment— (10 years at 6½ per cent). 687 50 beds at £2 10s. per bed per week 6,500 Total 9,092 Less grant from Local Government Board 4,546 Total £4,546 RECOMMENDATION. That a Sub-Committee be appointed to view the foregoing properties and make recommendations to the Health Committee as to purchase for submission to the Council and Local Government Board. GEORGE F. BUCHAN, Medical Officer of Health. APPENDIX I. 27th May, 1919. ADDITIONAL ACCOMMODATION REQUIRED AT EXISTING CLINICS. Clinic (1).—No. 9, Willesden Lane, Kilburn. Clinic (2).—No. 381, High Road, Willesden Green. These Clinics are now overcrowded, and additional accommodation is required for this anc other reasons, as follows:— Additional Accommodation Required. Clinic 1. Clinic 2. General Waiting Room The present General Waiting Room is overcrowded, patients having to wait on the stairs and passage-way No. Cleansing Waiting Room Children wait in the passage-way and are subject to draughts. When they have been bathed they have again nowhere to wait before going out into the open air No. Nurses' Treatment Room Preparation and treatment are carried on in the one room. In many of the bowel conditions of babies this is very unpleasant, and a separate room is required for treatment No. 122 Additional Accommodation Required. Clinic 1. Clinic 2. (a) Dental Waiting Room School Children.—A Dentist can look after and keep in order the teeth of about 3,000 School Children per annum, when they have once been put into proper order. The provision of these rooms will make room for the additional Dentist required at this Clinic. Similarly the provision of a dental office will make room for the additional Dentist required at this Clinic. (b) Dental Office (c) Dental Workshop Mothers.—Hitherto, in many instances, mothers have been disinclined to have their teeth removed because they were not in a position to obtain the necessary false teeth. In many of these cases the mouths have been septic and the absorption of this septic matter into the system produces chronic debility and ill health; and the provision of dentures in these cases is urgently required. If the Committee decide to provide dentures to mothers it will be necessary to have two rooms for the dental workshop, one for the rough work, and the other for the finishing and fitting of the dentures Required, but existing accommodation not available. Home Nurses' Room A room requires to be set aside for Home Nurses for their clerical work and the washing up of their instruments and preparation of their bags and equipment daily Ditto. Assistant Matron's Room A room is required for the Assistant Matron in connection with Home Nursing, for interviews with parents and arrangement of the work of the Home Nurses Ditto. W.C. & Lavatory for Male Staff Now that the men clerks have come back this accommodation is essential Ditto. Clinic 1.—The above necessary additions to Clinic 1 can be obtained by the acquisition of the adjoining premises, No. 25, St. Julian's Road. Clinic 2.—The above necessary additions to Clinic 2 can be obtained by the acquisition of the adjoining property, No. 383, High Road, Willesden Green. This will not provide for Dental Workshops, a School for Mothers, ncr Caretaker's quarters. If provision is to be made for these, additional premises will require to be built. RECOMMENDATIONS. That the necessary steps be taken to acquire (1) No. 25, St. Julian's Road, and (2) No. 383 High Road, Willesden Green. GEORGE F. BUCHAN, Medical Officer of Health. 123 APPENDIX J. 8th September, 1919. To the Members of the Children's Care Committee. SPECIAL SCHOOLS. OPEN-AIR SCHOOL. I beg to report in accordance with the following Minutes:— Draft Suggestions for the Arrangement of Schemes under the Education Act, 1918. (Circular 1,096.)— "We have instructed the Medical Officer to prepare and submit a report as to the special services referred to on page 29 of the above-mentioned circular (par. 8) under the following headings:— (a) School Medical Service. (b) Special Schools. (c) Provision of Meals for children attending public elementary schools. (Education Committee's Minutes, 2nd July, 1919). Furness Road Physically Defective School— "We have had under consideration a reference from the School Accommodation Committee as to the inadequacy of the accommodation now provided for physically defective scholars at Furness Road School. We have instructed the Medical Officer to include in his report on special schools (open air school) suitable provision for the physically defective who are now in attendance at Furness Road physically defective school." (Education Committee's Minutes, 4th June, 1919). Since the above minutes were passed, Circular 1119 of the Board of Education, dated 3rd July, 1919, has been issued. It modifies in certain details Circular 1096, and for convenience therefore I propose to report under (b) above under the headings set out in Circular 1119, as follows:— 11. Special Schools. Proposals for enabling the following classes of children to obtain suitable education in certified schools:— (a) blind children, including partially blind. (b) deaf children, including partially deaf. (c) physically defective children, including delicate children for whom an open- air school is desirable. (d) mentally defective children. (e) epileptic children. (a) Blind Children, including Partially Blind. (b) Deaf Children, including Partially Deaf. Powers and duties of Education Committee.—The Elementary Education (Blind and Deaf Children) Act, 1893, requires the Education Authority to make provision for the suitable education of Blind and Deaf Children, either by the establishment and maintenance of residential schools for this purpose, or to contribute towards the maintenance of these schools. Number of Blind and Deaf Children.—The following table shews the number of these children belonging to Willesden in 1915-16-17, based on the incomplete medical inspection records for these years:— 1915. 1916. 1917. Blind 31 26 20 Deaf 19 28 27 Proposals.—Having regard to the small numbers of these children, it is suggested that the present system of sending these children to Residential or Day Schools maintained by other Authorities or Voluntary Societies and approved by the Board of Education be continued. 124 Estimated Annual Cost.—Based on charges at 15/9/19 the cost of educating Blind and Deaf Children during 1919-20 will be as follows:— Blind Children.—14 attending. £ s. d. £ s. d. 2 Day Scholars 23 6 0 p.a. 12 Residential Scholars 474 0 0 Less parents contributions 42 18 0 - 431 2 0 p.a. Deaf Children.—20 attending. 2 Day Scholars 20 0 0 p.a. 18 Residential Scholars 987 0 0 Less parents' contributions 83 4 0 - 903 16 0 p.a. Total £1,378 4 0 p.a. Less Government Grant of 50 per cent. 689 2 0 Estimated Net Expenditure £689 2 0 p.a. When medical inspection is again fully carried out the number of blind and deaf children sent to school will approximate the total numbers given above. Instead of 34 in attendance the number will be approximately 33 per cent. more and the net estimated cost approximately £920 per annum. (c) Physically Defective Children, including Delicate Children for whom an Open-Air School is Desirable. Powers and duties of Education Committee.—The Elementary Education (Defective and Epileptic Children) Act, 1899, enables the Education Authority to establish and maintain special schools for physically and mentally defective children. The Elementary Education (Defective and Epileptic Children) Act, 1914, requires the Education Authority to make suitable provision for the education of mentally defective children whose age exceeds seven years. Section 20 of the Education Act, 1918 (not yet in operation), requires the Education Authority to make suitable provision for the education of Physically Defective children whose age exceeds seven years. Conditions jrom which the Physically Dejective suffer.—The conditions from which physically defective children suffer may be classified as follows:— (A) Suitable for day open-air school. (1) Non-active cases of Tuberculosis. (2) Paralysis. (3) Various deformities if— (a) the deformity renders the child liable to injury at the ordinary school; (b) the child is under treatment or observation on account of the deformity; (c) Orthopaedic instruments are worn. (4) Certain chronic conditions, e.g., chronic lung conditions other than tuberculosis, chronic rheumatism, exophthalmic goitre, heart disease, kidney, etc. (5) Certain cases of anaemia and ill-defined conditions, e.g., the so-called pre-tuberculous child. (6) Certain nervous children. (7) Cases discharged from residential schools. (B) Suitable for residential open-air school. (1) Any severe or advancing case under 2, 3, 4, 5, 6 and 7 above. (2) Certain cases of heart disease. (3) St. Vitus dance in convalescent stage or recurrent. (4) Children for whom, although suffering from one or other of the conditions mentioned under (A), sufficient thoughtful and interested co-operation cannot be secured at home. (C) Suitable for residential sanatorium school. Active cases of tuberculosis. 125 Number of Physically Defective Children.—The following table shews the number of these children belonging to Willesden in 1915-16-17, based on the incomplete medical inspection records for these years:— 1915. 1916. 1917. Suitable for day open-air school 299 282 261 *Suitable for residential open air school 26 7 9 *Suitable for residential sanatorium sch. 50 47 28 375 336 298 * These children were not in attendance at any school. The above figures are to be regarded as under-estimated, as during the period in question medical inspection was only partial, while the figures given by other Authorities, where open-air schools have been established, shew that about 2.5 per cent. of the school population require to attend a day open-air school. The figure for 1915 given above, represents approximately 1.30 per cent. of the Willesden School population. Similarly the number of Willesden children of school age notified as suffering from Tuberculosis was 66 in 1915, 51 in 1916 and 56 in 1917. Importance of establishing suitable open-air day and residential schools.—This question has received the attention of the Education Committee upon many occasions and a report of a Visiting Committee specially appointed to visit Open Air Schools, dated July 17th, 1914, was presented to the Education Committee just before the outbreak of war. (Copy enclosed.) The plan of the Willesden Open Air School devised by this Committee was subsequently approved by the Education Committee and the Board of Education, but on the 2nd June, 1915, it was resolved that no work be commenced in connection with this matter until after the war. At the present time many Willesden children suffering from the conditions mentioned above are being inadequately educated or receive no education at all, owing to want of the kind of school accommodation which will enable them to attend regularly without health deterioration. Open-air Schools have been established with the view of placing these children under healthy conditions and at the same time educating them step by step with improvement in their physical condition. These Schools have been established by various authorities in England and Wales, and everywhere there is agreement that the pupils attending have improved mentally and physically, and that they leave these Schools in a condition which enables them to be self-supporting. Open-air Schools give free play to those most important bases of health, viz.:—fresh air, sunlight, proper dieting, rest, cleanliness and exercise. Medical inspection and supervision is more frequent and of direct value in directing the child's course of study and future career. The educational methods adopted in these Schools are more practical and education becomes more and more an individual expression of the child's capacity for doing and making. Proposals.—Having regard to the numbers shewn above, it is suggested:— (1) That an Open-air Day School be provided in Willesden for 240 pupils. (2) That provision be made for those cases suitable for a residential open-air school in connection with the proposed convalescent home for mothers and children under five. The number of those cases as at present ascertained is not sufficient to justify a separate institution. (3) That provision be made for a residential sanatorium school for 50 pupils. This also should be associated with the Convalescent Home for mothers and children. (1) The Open-air Day School.—Special attention must be given to the following points - 1. The site to be open and fairly accessible. 2. One acre of land to be available for every 40 scholars. 3. The school buildings to be of such construction as will allow the maximum admission of fresh air and sunlight, with adequate protection against stormy weather. 4. Arrangements to be made to provide sufficient warmth for the pupils in cold weather. 5. The class-room to be constructed for 25 pupils. 6. The desks to be single and of light construction. 7. The following special accommodation to be provided:-Kitchen, Dining Room, Bath Room, Doctor's Room, Nurses' Room, Manual Rooms, Laundry and Ample Store accommodation. 8. Teachers to be specially selected with special knowledge of manual instruction, laundry, nature studies, the general laws of hygenie, physical exercises and games. 126 Estimated Costs:— Capital Charges. £ s. d. Land, 6 acres in Willesden 7,200 0 0 Buildings as per plan previously submitted and approved 27,000 0 0 Total £34,200 0 0 Annual Charges. Expenditure. £ s. d. Meals 2,400 0 0 Salaries (Teachers) 2,000 0 0 Manual Instructor 200 0 0 Nurse 160 0 0 Doctor 250 0 0 Caretaker and Cleaning 400 0 0 Cooks and Helps 700 0 0 Lighting 60 0 0 Heating 60 0 0 Interest and repayment on loan £34,200 (30 years, interest 5½ per cent.) 2,341 0 0 Clerical Expenses 200 0 0 Ambulance and Travelling Expenses 2,000 0 0 Total Expenditure £10,771 0 0 Income. £ s. d. Meals, say 1/3rd of cost 800 0 0 Sales 60 0 0 860 0 0 Board of Education Grant 50 per cent. 4,955 10 0 Total Income 5,815 10 0 Approximate Net Annual Charge £4,955 10 0 (2) The Open-Air Residential School.—Special attention must be given to the following points:— (A) The provision of sufficient space for playing fields and for school gardens. (B) Provision of adequate dormitory supervision. (C) Provision of a sick-room and observation ward. This type of School should be associated with the proposed convalescent home for mothers and children under 5 years. From the figures given in the foregoing section, 20 beds would probably be occupied. This is a small number for educational purposes. Accommodation for the type of child suitable for this school should be gradually provided as the longer open-air requirements for School children are established. (3) Residential Sanatorium School.—It is suggested that a residential sanatorium school for 50 children suffering from tuberculosis in all forms be established. It would be most economical to associate this School with the proposed convalescent home for mothers and children under 5 years. It would then be possible to utilise the proposed convalescent home for mothers and children as the administrative block and to provide in addition in the grounds:— (a) 5 Open-Air Wards, each with 10 beds. (b) 1 Observation Ward divided into 4 rooms for observation and isolation purposes. (c) Offices for the above. *(d) Small operating theatre. (e) 2 Class Rooms each for 15 scholars. (f) Workshops. * If convalescent home within reasonable distance of Municipal Hospital, theatre could be dispensed with, as operations could be performed at the Hospital. 127 Estimated Costs. Capital Charges. £ s. d. 50 beds at £300 per bed 15,000 0 0 Annual Charges. 50 beds at £3 10s. per week, per bed 9,125 0 0 Less Government Grant, of 50 per cent. 4,562 10 0 Net Annual Charge to Rates £4,562 10 0 (d) Mentally Defective Children. Powers and Duties of Education Committee.—Vide under Physically Defective Children. Importance of Manual and Open-Air Education.—It is important that the education of the feeble-minded should not be neglected, because (a) They tend to get worse. (b) They tend to reproduce their kind, and (c) They form the material of the great problem of incapacity and unemployability. In the past the education of these children has been based on two main factors—handwork and small classes. Gradually the view has been taken that sedentary occupation, while necessary, is of limited use. Space is a first necessity, and this implies fresh air. At Kettering the Mentally Defective School forms a department of the Open-Air School. The results at the Kettering Open-Air School for mentally defectives bear testimony to the advantages of Open-Air teaching for the mentally defective. If open-air teaching is good for the normal child, and for the physically defective and debilitated child, it is reasonable to say that when the mentally defective child is brought into the best physical bodily state that its brain and nervous system will also improve and respond more readily to sensory impressions obtained by methods of teaching similar to those in Open-Air Schools, i.e., gardening, nature study, manual training, etc. Number of educable mentally defective children in Willesden.—The number of children attending Willesden Special Schools in— 1915 was 111, 1916, 105, and in 1917, 103. Proposals.—The Mentally Defective School should be on the adjoining site and worked in conjunction with the Open-Air Day School as at Kettering, attention being given to the following requirements of the Board of Education:— (a) Mentally Defective Children to be taught in separate schools from other defectives. (b) Separate playgrounds to be provided for boys and girls. (c) The Head Teacher of a Physically Defective School may also be Head Teacher of an adjoining Mental School. From the above it would appear possible to make arrangements for using the administrative block in large part of the physically defective school for the mentally defective school by a suitable arrangement of the time-table if these schools were placed on adjoining sites. In this way the Mentally Defective School need only consist of a small Administrative block and 6 Class Rooms with necessary offices. The dining hall, and kitchen, and bath rooms would be common to both schools. Estimated Costs:— Capital Charges. £ s. d. Open-Air School for Mentally Defective Children ... 10,000 0 0 Land for Mentally Defective Children 3,600 0 0 Total £13,600 0 0 Annual Charges. Expenditure. £ s. d. Meals 1,000 0 0 Salaries 1,000 0 0 Doctor 100 0 0 Caretaker and Cleaning 350 0 0 Lighting 30 0 0 Heating 30 0 0 Interest and repayment on loan (£13,600), 30 years interest, 5½ per cent. 931 0 0 Ambulances 1,000 0 0 Total £4,441 0 0 128 Income. £ s. d. Meals 350 0 0 Sales 20 0 0 370 0 0 Board of Education Grant, 50 per cent. 2,035 10 0 Total Income 2,405 10 0 Approximate Net Annual Charge £2,035 10 0 (e) Epileptic Children. The following table shews the number of these children belonging to Willesden in 1915-16-17, based on the incomplete medical inspection records for these years:— 1915. 1916. 1917. Epileptic 14 13 15 Proposals.—Having regard to these numbers it is suggested that these children continue to be sent to institutions maintained by voluntary societies as hitherto. Estimated Costs.—Based on charges at 15/9/19, the cost of the education of epileptic children lor 1919-20 is as follows:- Epileptic Schools.—6 attending. £ s. d. 6 Residential Scholars 373 2 0 Less Parents' Contributions 59 16 0 £313 6 0 Less Government Grant of 50 per cent. 156 13 0 Net Cost £156 13 0 With the Acts in full operation and with the provision of additional accommodation, which is scarce, it is likely that the number of children in institutions would be increased by at least 50 per cent. and the net cost would become approximately £235 per annum. Summary of Costs:- Capital Charges. £ s. d. Land—Open-Air School 7,200 0 0 Land—Mentally Defective School 3,600 0 0 Buildings—Open-Air School 27,000 0 0 Buildings and Land—Residential Sanatorium School 15,000 0 0 Buildings—Mentally Defective School 10,000 0 0 £62,800 0 0 Annual Charges. Expenditure. £ s. d. Blind Children 665 0 0 Deaf Children 1,343 0 0 Open-Air School 10,771 0 0 Residential Sanatorium School 9,125 0 0. Mentally Defective School 4,441 0 0 Epileptic 560 0 0 £26,905 0 0 129 Income. £ s. d. Parents' Contributions (Blind) 56 0 0 (Deaf) 112 0 0 „ „ (Epileptic) 90 0 0 Meals (Open-Air School) 800 0 0 „ (Mentally Defective School) 350 0 0 Sales (Open-Air School) 60 0 0 „ (Mentally Defective School) 20 0 0 £1,488 0 0 Government Grants. Blind 304 10 0 Deaf 615 10 0 Open-Air School 4,955 10 0 Residential Sanatorium School 4,562 10 0 Mentally Defective School 2,035 10 0 Epileptic 235 0 0 £12,708 10 0 Estimated Total Income £14,196 10 0 Estimated Net Total Annual Expenditure £12,708 10 0 The net annual expenditure shewn above does not represent additional annual expenditure, to arrive at which, the following deductions require to be made:— Current Net Annual Expenditure. £ s. d. Blind and Deaf Children 689 2 0 *Furness Road Physically Defective School 175 0 0 Leinster Road Mentally Defective School 507 0 0 School Ambulances 1,460 6 3 Epileptic Children 156 13 0 £2,988 1 3 * Does not include loan charges. This gives a total net additional annual expenditure on Special Schools of £9,720 8s. 9d. N.B.—In the above proposals the existing Mentally Defective School at Leinster Road is vacated No provision is made for a Residential Open-Air School. Points for Decision. 1. Whether an Open-Air School for 240 physically defective children be established. 2. Whether Furness Road Physically Defective School be discontinued. 3. Whether Leinster Road Mentally Defective School be discontinued, and if so, uses to which it may be put. 4. Whether an Open-Air School for mentally defective children be established on a site adjoining the open-air school for physically defective children. 5. Determination of a suitable site:— (6 acres of land for Physically Defective Children and 3 acres of land for Mentally Defective Children). Dudden Hill Allotments. Harlesden Road—opposite Telephone Exchange. Open ground south of Knowles Towers in Roundwood Road. Open ground in Roundwood Road—just north of previous site. Doyle Gardens (near Welford's farm). Neasden. 6. What provision should be made for the education of children suitable for a residential open-air school. 7. Whether a residential sanatorium school be established. GEORGE F. BUCHAN, To be submitted, to Children's Care Committee, 22nd September, 1919. Medical Officer of Health. 130 APPENDIX K. 11th September, 1919. To the Chairman and Members of the Health Committee. INSTRUCTION IN HYGIENE. SCHOOL FOR MOTHERS. A School for Mothers was included in the extension of the Municipal Clinic (1), 9, Willesden Lane, when the adjoining property, 24, St. Julian's Road, was taken in. This extension was completed in April, 1918, and the School for Mothers was begun in September, 1918. Enquiries were made for a teacher qualified to take:— (1) Health talks—including midwifery, mothercraft and hygiene, (2) Sewing, (3) Cookery and (4) Laundry, the following institutions being approached:— (1) National Society Training College for Teachers of Domestic Subjects, 54, Fortune Green Road, West Hampstead. (2) Battersea Polytechnic. (3) National Training School of Cookery, 72, Buckingham Palace Road. (4) L.C.C. Educational Department, Victoria Embankment. (5) King's College for Women. The most suitable candidate recommended was Miss Alexandre, the following being an extract from the letter of the Principal of the Hygiene Department of the Battersea Polytechnic with reference to her:— "The qualifications necessary are not easily to be had, but I have two students completing their training in July, one of whom more than fills your requirements. The minimum commencing salary that should be paid is £130 per annum. I could thoroughly recommend Miss Phyllis Alexandre. She has had four years' training. She has had three years as a Domestic Science teacher and she holds a Diploma in Cookery, Housewifery, Laundry work, Needle-work and Dressmaking. Since September, 1917, she has been a student in the Hygiene Department and has taken the full combined course of training for an Infant Welfare worker, Health Visitor and Sanitary Inspector. She has done some excellent work and in addition to the theoretical and practical work in the Polytechnic she has been attached for one whole day a week for practical experience in Infant Welfare work and in Home Visiting to the Infant Welfare Centre at Bethnal Green, where she has worked under Miss Barker, the Superintendent, so that her knowledge of Infant Welfare work as well as her knowledge of Domestic Science is particularly good. She is a lady by birth and education and was educated in good secondary schools at Birkdale, and obtained from School an Honours Certificate of the Senior Oxford Local Examination. She also holds the Certificate of the Sanitary Inspectors' Examination Board and in July, when she completes her training here, she will take the examinations for the Battersea Polytechnic Certificate for Infant Welfare Workers and Health Visitors, which certificate is recognised by the Local Government Board as a qualification for appointment under Municipal Authorities. I have every reason to believe that she will be awarded the certificate, as the work she has done during her training is very good indeed. Miss Alexandre is 22 years of age, but looks considerably older. She is conscientious and thorough in all she does. She is at present applying for a post at Swindon, where the same qualifications axe requited as you are requiring, but I think would prefer to be in London, as she could live at home at Pinner. There are very few candidates who hold similar qualifications to Miss Alexandre and I am finding it difficult to supply the demand for students trained at the Polytechnic." Miss Alexandre commenced duties on the 2nd September, 1918, at a salary of £120 per annum plus current war bonus, and completed the equipment of the School for Mothers. She also prepared the following syllabus:— School for Mothers. Monday, p.m. Sewing A. Tuesday, p.m. Laundry Work. Wednesday, a.m. Cooking A. Thursday, p.m. Sewing B. Friday, p.m. Cooking B. 131 Sewing A.—Cutting out and making up Infants' Clothes. Knitting. Adapting long clothes for short coating. Sewing B.—Cutting out and making up garments for children, 1 to 5 years. Knitting, mending, renovations. Laundrywork.—Preparation for washing, washing of woollens, white clothes, coloured articles, coarse cloths, washing of infants' clothes, and clothes of small children. Cookery A.—Dinners. Soups, stewing, boiling, baking, steaming, frying, reheated cooked food, building up recipes. Cookery B.—Scones, buns, plain cakes, supper dishes, potato cookery, pastry. Sewing. Mothers may bring their own material, or may buy from the School. A. Subject of Talk. Practice Class. 1. Garments for Infants. Need of wool next to skin Cutting out and making up long flannel. 2. Adaptation of pattern of long flannel. Dangers of too many clothes Finish long flannel. 3. Knitting (Vest) Baby's vest. 4. Milk Cutting out and making up white petticoat. 5. Necessity for air and light in rooms—ventilation Cutting out and making up nightgowns. 6. Knitting (Belt) Baby's belt. 7. Food Knitting. Finish other garments. 8. Necessity for exercise Knitting, etc. 9. Day gowns. Need for simplicity Cutting out, and making up day gowns. 10. Dangers of flannelette. Its use and abuse Finish off uncompleted garments. 11. Adapting long clothes for short coating 12. Personal Hygiene. Need for cleanliness Sewing B. Practice Class.—Mothers may choose the garments they wish to make; they may use their own material, or buy from the School. Subjects of Talks.— 1. Clothing ; its uses, general rules for cutting out, use of patterns. 2. Good and bad conductors of heat. Flannel. 3. Flannelette. 4. Cotton. 5. Mending, Darning. 6. Mending, Patching. 7. Renovations. 8. Need for fresh air, and light. 9. Simple health rules. 10. Infection, main routes by which germs enter the body. 11. Dustbins, and kitchen refuse. 12. Flies. 132 Laundrywork. Subject for Talks. Practice Class. 1. Cleanliness necessary for health Advantages of steeping clothes before washing; necessity for method. Mothers wash articles brought. 2. Preparation for family wash, mending, sorting, steeping articles Mending if necessary, sorting, steeping, and washing articles brought. 3. Order of work. How to economise time, labour, and materials Mothers wash articles brought. 4. Value of wool as a clothing material. How to prevent shrinking and felting of woollen articles Washing and finishing woollen articles. 5. Washing, boiling, rinsing, blueing white clothes Preservation of colour Washing and finishing white cotton and linen articles. 6. Washing and finishing coloured cottons. Use of salt and vinegar Washing and finishing coloured cottons. 7. Ironing a plain blouse Mothers wash articles brought. 8. Dangers of flannelette 9. Washing coarse cloths. Use of soda Washing and finishing coarse cloths, and articles brought. 10. Use of mangles. How to damp and fold clothes for mangling. Care of the mangle. Airing Class wash any articles brought. 11. Washing infants' clothes, and clothes of small children 12. Revision, or anything the mothers wish for Cookery A. Mothers may buy what they have made at cost price. A. Morning Class, 10.30-12.30. 1. Stocks and plain soups. 2. Food values. Use of pulses. 3. Stewing. 4. Boiling. 5. Baking. 6. Steaming. 7. Frying. 8. Fish, choice, preparation, cooking. 9. Reheating cooked foods. 10. Storing food in the home. 11. Formulation of recipes ; variety in the diet. 12. Economy in firing, gas, etc. Use and abuse of tinned foods. Cookery B. 1. Plain buns and scones. 2. Simple supper dishes. 3. Supper dishes, utilising scraps. 4. Preserving food. 5. Cookery for invalids and young children. 6. Uses of potatoes. 7. Plain cakes. 8. Pastry. 9. Beverages. 10. Oatcakes, biscuits, potato cakes. 11. Use of fish for supper dishes. 12. Value of fresh foods in the diet. 133 Under this syllabus she has been working with slight modifications from time to time, up to the date of her resignation. The classes were largely practical and the following shews the monthly attendances:— 1918.—October 9 November 25 December 9 1919.—January 25 February 65 March 59 April 60 May 65 June 71 July 134 Total 522 These attendances are satisfactory and shew substantial improvement. Now that Munition Factories are closed and women are to a much less extent industrially employed, mothers will have more opportunity of putting in regular attendances. In the mornings Miss Alexandre's time was taken up by home visiting and giving demonstrations on baby clothing on the mornings on which Expectant Mothers attended the Clinics. CURRICULUM. The syllabus which appears to me to meet the requirements of the Expectant and Nursing Mother may be divided into two parts:— I. Talks and demonstrations to be given by a suitably qualified person. II. Short additional talks to be given by a Medical Officer. An outline of such a syllabus is as follows:— I. Talks and demonstrations to be given by a suitably qualified person. (1) Care of the Mother Before, At, and After Confinement. Before Confinement— Sufficient food. Sufficient rest. Contented mind. Care in lifting weights. Avoidance of constipation. Care of the breasts. Personal hygiene. Suitable clothing for pregnant women. At Confinement— How to prepare the room for confinement. How to make the beds for confinement. Things required for confinement:— (a) For Mother, etc. (b) For Child, etc. After Confinement— Avoidance of hard work. Good food and fresh air. Breast feeding. Effect of unsuitable food and worry on the breast-milk. Effect of certain medicines on the milk. (2) Care of the Child. How to make the baby's cot. How to bath the baby. How to attend to the baby's cord. How to attend to the baby's mouth, nose and ears. How to avoid Skin trouble. Red buttocks. Powder to use. Eczema. Thrush. 134 How to dress the baby, causing the least possible disturbance to the child. The clothing required—advantages of clothes fastening down front v. back. Avoid too many clothes. Lungs, armpits and abdomen to be covered. Freedom of movement, disadvantages of long flannel when unsuitably applied. Habits:— No comforter—why?—results following its use. Regular sleep. Regular feeding. Regular action of bowels—holding out at regular intervals. Avoid lifting the child when fretful. No rocking of cradles. How to dress children (2-5 years) suitably, inexpensively and with minimum amount of work. Common errors in clothing children—too many clothes and too heavy. Evils of tight clothing, boots, garters. No clothing worn during the day to be worn at night. Habits:— Sleep—regular bed-time. Clean bed, clean room, no light. Good ventilation, light, warm bed-clothes. Care of the teeth, daily bath, clean habits. Feeding of children 2-5 years. Suitable diet. Regular meals. Cleanliness. Mastication. No food between meals. Exercise. Loose clothes, allowing freedom of movement. Plenty of fresh air. Arrangement of house work that this may be possible. Dangers of Tubercle. Toys. Avoid celluloid toys and collars. Avoid painted toys likely to be sucked. Avoid buttons, glass eyes, etc., on toys, which may be easily detached and swallowed. (3) Cookery for Sick Children. How to prepare:— Barley Water Whey Albumen Water Printed instructions to be given when asked for. Beef Tea. Meat Juice. Milk Puddings, Custard, Arrowroot, Gruel. Peptonising Milk. Lemonade. Jelly. How to boil fish. (4) General Nursing. Preparation of the sick room—well ventilated day and night. How to make a bed without disturbing the child. Advantages of the draw sheet. How to wash the child. How to feed the sick child—diet required. How to keep the child clean—care of the back. How to make a flannel (or gamgee) jacket. How to prepare and apply poultices and fomentations. How to carry out treatment in certain minor ailments. How to take a temperature. Emergency treatment in minor accidents. 135 Special Baths:— How to give a Mustard Bath. How to give a Sulphur Bath. How to give a Soda Bath. (5) House Management. Method in housework essential. Cleanliness and ventilation essential for good health. Clean beds, how to make beds. Cleanliness of cooking appliances. Cleanliness of hands and nails before cooking. Clean sinks. Spread of infection in the home, especially of such common conditions as impetigo, scabies, sore eyes, diarrhœa, vermin. Common dangers arising from flies, offensive dustbins, garbage and excreta. How to avoid such dangers. How to make muslin covers for food. Improvised safes for food. How to preserve and protect food in hot weather—e.g., milk, meat, fish, butter, bread. (6) Sewing. Advice as to suitable clothes required for babies, infants, and children of 1-5 years and 5-14 years; parents being discouraged in the making of old-fashioned garments. For the baby:— Cutting out from suitable patterns and the making of woollen garments, vests, long flannel and gowns. Knitting: belts, vests, socks, boots, coats, bonnets, leggings, garters and mittens. Advice being given on kind of wool required, good and bad stitch for knitting these clothes and what to avoid in the making. At 3 months:— Adapting long clothes to short. Renovations. Bibs—suitable and unsuitable—how to make suitable bibs—special patterns. Children 2-5 years:— Cutting out from suitable patterns and the making of garments for children 2-5 years. Combinations—knitted or made of viyella, etc. Sleeping suit or nightdress, body and knickers, body and petticoat, simple kimonas and frocks, overalls and crawlers. Help in the making of clothes for older children Renovations, adaptations. Mending and patching. The Teacher will give advice and show how to cut out, piece together and tack, but the actual cutting and sewing should be done by the mother. (7) Laundrywork. Method essential to washing. Suitable materials required for washing. Hot or cold water. Soaps. Soda. Various preparations in common use—good and bad, When to use soda. When to boil. When to soak before washing. How to wash flannels. How to wash woollens. How to wash napkins. Mangling, drying and airing. How to wash coloured clothes. How to retain the colour. Finishing and ironing of plain and fancy articles. Treatment of flannelette to resemble nonflam. II. Short additional talks to be given by a Medical Officer. 136 The Expectant Mother:— Personal Hygiene. Common ailments associated with pregnancy, important and non-important. When to seek medical advice. Advice as to the prevention of some common ailments. Care of the new born child:— Eyes—treatment—dangers of neglect. Nose, mouth and ears. Breasts—dangers of massage. Bath. When to wash a baby. When not to wash a baby. Care of the Premature Child. Napkins. Jaundice. Ophthalmia Neonatorum:— Causes, dangers and treatment. Cord:— Explain what it is—routine treatment—dangers of careless treatment—uncleanliness —sore and discharging—bleeding from cord—septic cord. Ruptures:— Explain cause—palliative treatment—how to apply a truss—how to make a truss— points to be observed in applying a truss. Deformities:— Hare lip, difficulty in feeding baby—how to feed baby. Club foot—how to massage and apply splints. Breast Feeding:— Advantages of Breast feeding. Breast feeding associated with second pregnancy. Breast feeding associated with onset of menstruation. The right way to hold the baby to the breast. The wrong way to hold the baby to the breast. Refusal to take the breast. Causes. What to do. The care of nipples. Complications likely to arise from uncleanliness. When to feed the baby. Insufficient or poor milk. How to improve the milk. Medicines taken by the Mother affecting the child. When to wean the baby. How to wean the baby. Complications which may follow too hurried weaning. Artificial Feeding:— Inferior to breast feeding. Why. Choice of suitable food. Why. Dangers of some proprietary foods. Dangers of some condensed milks. The kind to buy. Preparation— Clean hands before starting to prepare foods. Why. Clean bottles, teats, jugs and spoons. How to clean bottles, teats, jugs and spoons. Measuring Feeds:- Accurate measuring. Exact quantity according to age. How to mix the feed. Temperature of feed. How to hold the bottle. Ill effects on the baby through carelessness. Dangers of bottle feeding v. breast: constipation, diarrhœa, rickets, gastro-intestinal disorders. 137 Diluents:— Barley Water Whey Albumen Water How to prepare. Common disorders of children:— Teething—diarrhœa, rashes, thrush. Ear discharge—snuffles, wind, colic, diarrhœa, constipation, hiccup. Convulsions, head rocking. Prolapse and bleeding. Bronchitis and Pneumonia—Croup—Measles—Chicken-pox, etc. How to avoid some of these common disorders, which are often due to carelessness on the part of the mother. Vaccination. Diet after weaning. Sleep:— Separate cot. Dangers of sleeping in bed with parent. Improvised cots and cradles. Health of the baby:— Fresh air essential. Windows of bedroom and living room always open. Rooms thoroughly aired. Why. Baby to be taken out each day. Baby not to be taken out at night. What to do on wet days. Care of the School Child Clothing of boys and girls, 5-14 years. Diet. Care of the Teeth. Amusements and exercise. Puberty. Health Talks for the Mother:— General hygiene. Care of the skin and breasts. Prolapse. Leucorrhœa. Varicose Veins. How to apply bandages. Menopause. Indications for seeking medical advice:— Pain, hæmorrhage, wasting, offensive discharge, swellings or lumps. Difficulty arises in getting one suitably qualified person to render instruction in all the subjects mentioned in (I.) above. It must be remembered that Expectant and Nursing Mothers are specially interested in sewing and knitting and that they utilise their time in making either for themselves or their children suitable garments, the materials being purchased at the School for Mothers, at cost price. It appears to me that the best solution would be to appoint an Assistant Matron as suggested in my report on Home Nursing, who would give the instruction indicated in the first part of the curriculum mentioned above, and who would have a competent needlewoman under her to attend the School for Mothers every afternoon for the purpose of sewing and knitting lessons. The above arrangement does not make full provision for Laundry or Cookery work, but this would be developed as the School matured. Recommendations. (1) That the Assistant Matron recommended under the Home Nursing Scheme be required to undertake the duties under Part I. of the Curriculum above. (2) That a competent practical woman be appointed to attend the sewing and knitting classes every afternoon. GEORGE F. BUCHAN, Medical Officer of Health. 138 APPENDIX L. 30th September, 1919. To the Chairman and Members of the Health Committee. MOTOR SERVICE. I beg to report on the above for its fifth complete year ending March 31st, 1919. The 7 Motor Vehicles owned by the Council came into use in December, 1913, and up to the end of March, 1919, had covered a total of 255,299 miles and were all in service. During the year certain work occasioned by the war was continued in connection with Food Control, the conveyance of Wounded Soldiers and Air Raid calls. In addition a certain number of miles were run for conveyance of grave diggers, refugee work, coal control, disinfection of army kits and various other departments of the Council. Miles Run and Work Done. Calls for the Accident and Illness Ambulance have risen to 1,397, as compared with 471 in the year 1916.17, the highest number previously recorded. The work of the Ambulances is increasing and it is very difficult at times to get patients away, and a large proportion of the cases require 2 men. The following table shews the number of miles run under the various headings since the inception of the service:— Miles Run during year ended 31st March. 1914. 1915. 1916. 1917. 1918. 1919. Total. School Work . 20,592 17,579 20,530 22,933 23,365 104,999 Medical Officer . 6,343 9,857 9,664 7,857 8,731 42,452 Accidents, Sickness and Infectious Cases . 9,491 8,002 7,871 6,965 12,703 45,032 Disinfection . 5,977 4,998 4,488 3,337 4,534 23,334 Conveyance of Wounded Soldiers to Hospitals and Entertainments . . 1,978 5,020 1,636 1,173 9,807 Conveyance of Grave Diggers . . — — — 263 263 Concert Parties to Hospitals for Wounded Soldiers - - 138 378 72 126 714 Education Department . — — — — 123 123 Accountant's Department . 416 2,292 1,546 1,321 1,290 6,865 Engineer's Department Committee . 243 90 119 120 205 777 Clerks' Department . — — 75 89 105 269 Health Department . — — — — 313 313 Registration . — 1,217 — — 15 1,232 Refugee Work . 774 209 56 — 78 1,117 Recruiting Demonstrations . 28 681 — — — 709 Hospital Work . 181 242 73 275 256 1,027 Dollis Hill House Hospital Committee - - 75 311 200 82 668 Food Control . — — — 1,591 601 2,192 Coal Control . — — — — 24 24 Miscellaneous . 53 75 — 496 . 624 Elections . — — — — 187 187 General, including all foregoing 12,571 — — — — — 12,571 Total 12,571 44,098 47,433 50,131 46,892 54,174 255,299 139 Miles Run by each Vehicle. The following table shews the number of miles run by each Vehicle during the 5 complete financial years from April 1st, 1914 to March 31st, 1919, and since delivery to the latter date:— Car No. 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. 1/4/17 to 31/3/18. 1/4/18 to 31/3/19. Miles run since delivery to 31/3/19. Disinfecting Van M.X. 1884 2,755 6,440 5,196 4,605 3,926 5,229 28,151 Landaulette M.X. 2056 1,466 6,385 10,579 10,248 7,981 8,947 45,606 School Bus M.X. 2057 1,801 7,648 6,915 10,208 8,735 7,275 42,582 Infectious Ambulance M.X. 2058 1,418 5,591 3,912 2,803 3,596 4,728 22,048 School Bus M.X. 2059 2,254 7,176 9,036 10,680 9,060 7,604 45,810 Accident Ambulance M.X. 2060 725 3,900 4,686 4,961 6,240 8,899 29,411 School Bus M.X. 2061 2,152 6,958 7,109 6,626 7,354 11,492 41,691 Totals 12,571 44,098 47,433 . 50,131 46,892 54,174 255,299 Calls. The following table shews the number of calls for the Disinfecting Van, Infectious Ambulance, and Accident Ambulance, respectively during the five complete financial years April 1st, 1914 to March 31st, 1919, 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. 1/4/17 to 31/3/18. 1/4/18 to 31/3/19. No. of calls for Disinfecting Van 370 1,167 957 787 653 716 4,650 No. of calls for Infectious Ambulance 250 940 696 528 641 672 3,727 No. of calls for Accident Ambulance 40 372 388 471 426 1,397 3,094 Petrol Consumption and Cost Per Mile. The following is a statement of mileage petrol consumption, and cost per mile for the five complete years ended March 31st, 1919:— Year ending 31st March. 1915. 1916. 1917. 1918. 1919. Total number of miles run by the seven vehicles 44,098 47,433 50,131 46,892 54,174 Total number of gallons of petrol consumed 3,998.5 4,035.5 4,673 4,619 5,569 Number of miles per gallon of petrol consumed 11.0 11.75 10.73 10.15 9.73 Cost in pence per mile run 13.4 12.08 11 .78 13.64 15.03 Plant. The Petrol Storage Plant installed in January, 1915, is working satisfactorily. This Plant has now by its saving in taking bulk supply completely paid for itself. Staff. The Staff employed 31/3/19 was 1 Mechanic Superintendent and 8 Men drivers. 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. 140 Repairs Necessary. The garage roof is very much in need of painting and workshop roof repair, as lantern lights let rain through fast. Men's Mess Room.—This is not satisfactory and requires wood floor, window, and heating and hot water. GEORGE F. BUCHAN, Medical Officer of Health. APPENDIX M. 14th October, 1919. To the Members of the Children's Care Committee. SCHOOL MEDICAL SERVICE, ETC. I beg to report in accordance with the following Minute :.— Draft Suggestions for the Arrangement of Schemes under the Education Act, 1918. (Circular 1,096.) "We have instructed the Medical Officer to prepare and submit a report as to the special services referred to on p. 29 of the above.mentioned circular, par. 8, under the following headings:- (a) School Medical Service. (b) Special Schools. (c) Provision of Meals for children attending public elementary schools. (Education Committee's Minutes, 2nd July, 1919). Since the above Minute was passed Circular 1,119 of the Board of Education, dated 3rd July, 1919, has been issued. It modifies in certain details Circular 1,096, and for convenience therefore I propose to report under (a) above under the headings set out in Circular 1,119 as follows:— 8. School Medical Service. 9. Medical Inspection and Treatment of Children Educated in Public mentary Schools. 10. Other Medical Supervision of Children Educated in Public Elementary Schools. 8. School Medical Service. Proposals as to constitution, organisation and development of the School Medical Service. Constitution..—The School Medical Service consists of:— 1 School Medical Officer (who is also the Medical Officer of Health). 5 Assistant Medical Officers 2 Dentists 2 Dispensers 23 Clerks 1 Chief Health Visitor 2 Clinic Matrons 10 Clinic Nurses 18 Visiting Nurses 2 Cleansing Nurses 1 Nurse (Physically Defective Schools) Employed whole time by Council and perform duties in connection with Maternity and Child Welfare, School Medical Service, etc. Half.time generally is allocated to School Medical Service. 1 Specialist for Mental Deficiency 1 Specialist for Diseases of the Skin (including the X.Ray treatment of Ringworm) 1 Specialist for Diseases of the Eye 1 Specialist for Diseases of the Throat, Nose and Ear Employed part time by Council. Organisation.—For purposes of organisation Willesden is at present divided into 4 areas of approximately equal size. Each of these areas is in charge of an Assistant Medical Officer, who has 141 the necessary Nursing, Visiting and Clerical assistance, and is responsible for the following work in his area:— Control of Infectious Disease. Maternity and Child Welfare Work; and School Medical Work. The fifth Assistant Medical Officer is employed in connection with Willesden Special Schools, cases referred specially with a view to admission to Special Schools and Institutions outside Willesden and the administration of anaesthetics for dental work. Development of the School Medical Service.—The present organisation has been laid down in Willesden with the view of placing under a single control the care of the child before birth, after birth up to 5 years of age and during its school life, so that by the exercise of preventive measures in the early years a minimum amount of work will be required later. To attain this end it is necessary to have medical men and women of high attainments who are as far as practicable permanent officers. Unfortunately during the war it has not been possible to attain this end and it is not likely that the salaries now offered by the authority will attract either men or women of high professional attainments or induce such if attracted to make the medical service of the authority their life work. Medical Inspection in the Schools is and has been in abeyance since December 3rd, 1915. At the present time 3 age.groups or approximately 9,000 children per annum should be inspected according to the Code. To carry this out and deal with the necessary additional cases which will come under review for treatment will entail the employment of two additional Assistant Medical Officers with nursing and clerical assistance. Dental Work.—At the present time 2 Dentists are employed by the Authority, 2 Dental Clinic Nurses and 2 Dental Visiting Nurses. The time of the Dentists is apportioned approximately 1:8, as between Maternity and Child Welfare and School Medical Service. As a Dentist can keep in order the teeth of 3,000 school children after they have once been put right the total number of Dentists to be employed in the School Medical Service will be 8 with 8 Dental Nurses and 8 Visiting Nurses. 9. Medical Inspection and Treatment of Children Educated in Public Elementary Schools. (a) Proposals for inspection of children. With the Staff supplemented as above indicated it will be practicable to undertake the Medical Inspection of the three age groups of children required by the Code. (b) Proposals for following up. Cases found at Medical or Dental Inspection to require following up, either for observation or treatment will be referred by the Medical or Dental Inspector to the Visiting Nurses acting under their control for this purpose. Similarly cases referred by Head Teachers or others to the Medical Officer will be referred to the Visiting Nurses for following up and such other action as may be necessary. (c) Proposals for Treatment, e.g., eyes, teeth, tonsils and adenoids, and minor ailments; and remedial exercises:—Each Assistant Medical Officer holds Clinics as follows:— Minor Ailments Daily. Eyes Twice a week. A part.time Eye Specialist at present attends fortnightly to see difficult Eye cases specially referred to him by the Assistant Medical Officers. Tonsils and Adenoids Twice a week. A part.time Specialist attends fortnightly to see difficult cases of the Throat, Nose and Ear or operative cases specially referred to him by Assistant Medical Officers. He subsequently operates on cases requiring operation at the Municipal Hospital. In addition the part.time Specialist for Diseases of the Skin attends once weekly for the X.Ray treatment of Ringworm and to see Skin cases. Hospital Treatment.—.A report on this subject has been already presented and awaits the approval of the Board of Education. (Copy of report attached herewith). Teeth.—At present each Dentist holds 10 Clinics weekly for the treatment of teeth and 1 session weekly is devoted to dental inspection at the Schools. Cases treated are kept subsequently under regular supervision as far as it is practicable within the limits of the staff at present employed. Remedial Exercises.—At present no provision is made for remedial exercises. (d) Proposals for dealing with uncleanliness. At present the School Nurses make dical inspections at the Schools and issue Private Notices to parents and follow up all cases found to be nitty or verminous. In bad cases children with the consent 142 of their parents are cleansed at the Cleansing Stations which have been established in connection with the School Clinics of the Authority. All cases are kept under observation until cleansed. In a few instances it is necessary to prosecute. 10. Other Medical Supervision of Children Educated in Public Elementary Schools. (a) Proposals for medical observation and supervision of employed children (Section 15, Education Act, 1918); This Section is as follows:— (1) The local education authority, if they are satisfied by a report of the school medical officer or otherwise that any child is being employed in such a manner as to be prejudicial to his health or physical development, or to render him unfit to obtain the proper benefit from his education, may either prohibit, or attach such conditions as they think fit to, his employment in that or any other manner, notwithstanding that the employment may be authorised under the other provisions of this Act or any other enactment. (2) It shall be the duty of the employer and the parent of any child who is in employment, if required by the local education authority, to furnish to the authority such information as to his employment as the authority may require, and, if the parent or employer fails to comply with any requirement of the local education authority or wilfully gives false information as to the employment, he shall be liable on summary conviction to a fine not exceeding forty shillings. A return by the Chief Education Officer in 1913 showed that approximately 1,672 children attending the Public Elementary Schools were employed. In order to take any necessary action under the above Section of the Act of 1918, all these children should be submitted for medical inspection on the occasion of the Medical Inspector's visits to the School, and any necessary reports given to the Local Education Authority. (b) Proposals for dealing in consultation with the Sanitary Authority with infectious diseases and other matters of common interest. As and when occasion arises and in order to unify any particular matter of common interest the Children's Care Committee of the Education Committee and the Health Committee of the Council meet in conference and come to an agreed solution. (c) Proposals for medical investigations as to subnormal (dull or backward) children, or abnormal (stammering, short.sighted, etc.) children—As and when the routine matters arising out of the Medical Inspection and treatment of children are complete and in running order it is proposed from time to time to institute medical investigations to elucidate the cause, prevention, or treatment of various conditions affecting school children. (d) Proposals for ascertaining what children (whether in attendance at school or not) are blind, deaf, physically defective or epileptic for the purpose of the Special Acts; (e) Proposals for ascertaining what children are defective within the meaning of the Mental Deficiency Act, 1913, and notifying suitable cases to the Local Control Authority in accordance with the Mental Deficiency (Notification of Children) Regulations, 1914. The children referred to above may be classified as follows:— Abnormal Children:— (A) Mentally Abnormal, including:— (1) Idiot. (2) Imbecile. (3) Feeble.minded. (4) Moral Imbecile. (5) Dull or Backward. (6) Epileptic. (B) Physically Abnormal, including:— (7) Physically Defective. (8) Blind. (9) Deaf. Children belonging or suspected as belonging to one or other of the above groups as hereinbefore defined, are notified by Head Teachers in respect of children attending school and by School Attendance Officers in respect of children not in attendance at school, and whether under or over seven years of age, to the School Medical Officer on the " Specially Referred " salmon coloured card. 143 The School Medical Officer has the children so referred duly examined by one or other of the Approved Certifying Officers. The examination of children referred under (A) Mentally Abnormal above, are reported in the manner provided by the schedules published by the Board of Education under Section 1 (1) of the Elementary Education (Defective and Epileptic Children) Act, 1899, and Section 31 (1) of the Mental Deficiency Act, 1913. The examination of children referred under (B), Physically Abnormal Children, is conducted on similar lines. The School Medical Officer submits the results of examinations of abnormal children, together with recommendations as to treatment and the most suitable schools or institutions, to each meeting of the Children's Care Committee. Appropriate cases are reported to the Middlesex County Council or Board of Education. All doubtful or difficult cases of mental defect examined at special or routine examinations by the Assistant Medical Officers are referred to Dr. Tredgold; Specialist on Mentally Defective Children, for further examination and report. Cost. To complete the work of the School Medical Service as above outlined means the establishment of a Third Clinic, the additional annual cost of which at current rates would be approximately £8,000. In addition there would be the additional cost of dental work, approximately £4,000, and the extension of Hospital Treatment, say £2,000, giving a total estimated annual expenditure of £14,000, half of which would be repayable by the Board of Education. GEORGE F. BUCHAN, Medical Officer of Health. To be presented to the Children's Care Committee. 27/10/19. APPENDIX N. 5th December, 1919. To Medical Practitioners in Willesden. DIPHTHERIA—EARLY TREATMENT. The Medical Superintendent of the Municipal Hospital, Brentfield Road, Neasden, N.W. 10, informs me that the type of Diphtheria prevalent at present is severe. Several cases have entered the Hospital at a late stage of the illness when remedial measures were too late. Early treatment— important in all diseases—is especially important in cases of Diphtheria. Sometimes Practitioners delay sending in their cases until a bacteriological examination has been made. Under all the circumstances I would suggest that where the clinical signs give good reason to believe that the case is one of Diphtheria arrangements be made with Dr. Stewart for the admission of the case, if possible, to Hospital (Telephone No.: Willesden 1849) for observation and early treatment as may be necessary. Too much reliance should not be placed on bacteriological diagnosis when the clinical evidence points to Diphtheria. GEORGE F. BUCHAN, Medical Officer of Health. APPENDIX O. 2'2nd December, 1919. COLLECTION OF HOUSE REFUSE. In accordance with instructions I beg to submit herewith a statement showing the advantages and disadvantages of the work of the Collection of House Refuse being under the control and supervision of the Health department of the Council:— (1) The removal of house refuse is primarily a Health matter, and all the officers of the Health Department have been trained to regard its removal as a matter of urgent Public Health importance. 144 (2) All complaints of non-removal are made to the Health Department, whose duty it is to see that nuisances arising from accumulations of this description receive prompt attention, With the work of collection under the supervision of another Department dual control is established, and it therefore resolves itself into the Health Department supervising in some measure the work of another Department. (3) The cost of supervision of the work under the present system is kept down to a low figure. No sum either in respect of the Medical Officer of Health or the Chief Sanitary Inspector has been allocated to this work, and no additional cost for assistance as respects supervision has been incurred since the transfer from contract to direct labour. Note.—When the Council collect the refuse from the whole of the District by direct labour it will be impossible for the Chief Sanitary Inspector to be in touch with the work by personal supervision without seriously encroaching on the time he should devote to his ordinary duties relative to Sanitary administration. (4) The Health Department has now been responsible for this work for a period of at least 30 years and the cumulative knowledge gained during that time is an advantage, the value of which it is difficult to assess. In my opinion no serious disadvantage to Public Health would accrue by the work of collection of House Refuse being transferred to any other department of the Council, as the Health Department would under any circumstances require to deal with nuisances and other conditions dangerous or injurious to health arising from non.removal. GEORGE F. BUCHAN, Medical Officer of Health. APPENDIX P. 2nd January, 1920. To the Chairman and Members of the Health Committee. HOSPITAL ACCOMMODATION, ETC. Extension of Municipal Hospital. Sleeping Accommodation for Maids. Hours of Nursing and Domestic Staff. Medical Superintendent's Residence. Small Pox Hospital. I beg to report in accordance with the following minutes of the Council:— Council Minutes—23rd January, 1917. "Your Committee have referred to the Hospital Visiting Committee for consideration and report the question of Hospital accommodation after the war." Council Minutes—27th March, 1917. "We have deferred the question of works after the war to our next meeting, so far as the Hospital accommodation is concerned." Council Minutes—22nd May, 1917. "We have again deferred the question of works after the war so far as the Hospital accommodation is concerned." Council Minutes—25th September, 1917. "We have considered letters from the Local Government Board dated 13th June, 1917, with reference to the extension of the Municipal Hospital after the War, and 18th June, 1917, with reference to the provision of a Smallpox Hospital. We have referred these letters to the Medical Officer for report in due course." Council Minutes—24th September, 1918. "We have inspected the Municipal Hospital and grounds. We report that the quarters of the Ward Maids are not at all satisfactory and a suitably fitted post.mortem room, etc., is requisite. We have instructed the Medical Officer to submit a scheme dealing with the question of Hospital accommodation generally." Council Minutes—24th June, 1919. "We have deferred for a report from the Medical Officer of Health consideration of the question of sleeping accommodation for maids at the Hospital." 145 "We have deferred for a report of the Medical Officer of Health consideration as to the reduction of hours of the nurses and domestic staff at the Hospital." Council Minutes—23rd December, 1919. "Having regard to the decision of the Council to build a house for the Medical Superintendent we have instructed the Medical Officer of Health, before further considering this matter, to submit a preliminary scheme combining suggestions as to the probable extension of the Hospital." Present Accommodation. The following is the present accommodation at the Willesden Municipal Hospital:— (a) Beds for Patients. Pavilion. Beds or Cots. Bassinettes. Diseases Treated. B. 17 14 Confinement Cases. Diseases of Women. Operations. C. 32 — Diseases of Children under 5 years. D. 40 Diphtheria. E. 30 - School Children— Throat, Nose and Ear Cases. Eye Cases. General Cases. Overflow Diphtheria or Scarlet Fever Cases as may be necessary or practicable. F. 28 — General Diseases (Female). G. 28 — General Diseases (Male). H. 24 — Scarlet Fever. Total 199 14 213 (b) Beds for Staff. 2 beds for Resident Medical Officers. 1 bed for Matron. I bed for Night Sister. Nursing and Domestic Staff. 5 beds for Sisters. II beds for Staff Nurses. 32 beds for Probationer Nurses. 34 beds for Domestic Staff. The Nursing and Domestic Staff are distributed as follows:- Nurses. Maids. 15 4 in Administration Block. 23 — in Administration Block annexe. 6 — in Lodge. 4 — in two converted rooms (disused Steward's Office and Stores) separate from Administration Block. - 30 in two old corrugated iron buildings (disused wards) curtained off. 48 34 116 It should be observed that although there are 213 beds for patients at the Hospital it is impossible to have all of them filled at once. An overflow Scarlet Fever or Diphtheria case may prevent the full use of "E" ward for cases of School Children, and similarly an imported Measles case may prevent temporarily the full utilisation of any ward. It is also often found that a case requires to be placed under observation as suspicious of some infectious illness, and this puts out of action for the time being the ward in which this case is. To save accommodation it is arranged in the extension that one ward of "C" Block is provided with cubicles. Measles and Whooping Cough. Block "B" and One Ward of Block "C." Hospital accommodation is urgently required for Measles and Whooping Cough in young children. I called attention to the importance of these diseases in connection with the deaths of children under five in my report to the Council on Maternity and Child Welfare, dated 8th October, 1914. The following table gives certain particulars with regard to these diseases:— Measles. Whooping Cough. Estimated or actual No. of cases treated during 10 year period. 1909.18 119 17 Total No. of deaths during 10 year period 1909.18:— Under 5 350 365 At all ages 383 382 Average No. of deaths in each year during 10 year period 1909.18:- Under 5 35 36 At all ages 38 38 Estimated No. of cases per annum during 10 year period 1909.18 requiring Hospital treatment, say 3 times the No. of deaths:— Under 5 105 108 At all ages 114 114 The above table shows that it is estimated on the average that 114 cases of Measles and 114 cases of Whooping Cough will be treated in the Hospital every year. But these diseases appear as epidemics in certain years and at certain seasons. To meet the requirements of these diseases having regard to epidemic prevalence 57 beds should be provided. In place of this number, which would only exceptionally be required, Block "B" with 20 Beds has been set aside for Measles, and Block "C" with 12 Beds has been set aside for Whooping Cough, giving 32 beds in all which would be interchangeable for these 2 diseases, depending on the prevailing disease at any time. Observation Cubicles.—The Second Ward of Block "C." The remaining Warden Block "C" is to be provided with 10 cubicles for isolation and observation purposes. Diphtheria and Scarlet Fever. Blocks "D," "E," "F " and "G." At present 64 beds in Blocks "D" and "H" are set aside definitely for Diphtheria and Scarlet Fever cases with the use of 30 beds in Block "E" as may be available. This number is too small and during the recent epidemic prevalence of these diseases, from 20th October, 1919, to 20th December, 1919, 100 cases of Scarlet Fever have been nursed at home. All cases of Diphtheria requiring removal have been admitted to Hospital. In the extended Hospital Blocks "D," "E," "F" and "G" with 40, 30, 28 and 28 beds respectively or 126 beds in all are set aside for cases of Scarlet Fever and Diphtheria. 147 Cerebro-Spinal Fever, Erysipelas, Typhoid Fever, Puerperal Fever, Venereal Diseases, etc., Block "H." From time to time the above diseases require admission or are admitted to Hospital. It is proposed to set aside Block H. with 14 beds for these conditions. The foregoing diseases utilise all the existing Hospital Pavilions, and the following conditions therefore require the addition of new wards at the Hospital. Maternity Cases. Originally these were provided for in Block B. by 14 beds and 14 bassinettes and 1 Labour ward. This is now constantly overflowing and additional accommodation is required. This is provided in the new Block to be added, by:— 2 Wards of 16 beds and 16 bassinettes each 2 Labour Wards of 1 bed each and 1 Recovery Ward with 1 bed 32 35 beds and 32 bassinettes. Diseases of Women. The Council at their meeting on 28th January, 1919, determined to complete their arrangements for the Hospital Treatment of Women by admitting the above cases. Only a few have been admitted on account of the constant pressure on the Maternity Beds. Provision is made in the extension of the Hospital for these conditions by the setting aside of a Ward of 16 beds. Diseases of Children under 5. The utilisation of C. Block at present used for the above diseases by the admission of cases of Whooping Cough and cases for cubicle isolation as indicated, necessitates the provision of 2 Wards each of 16 beds in the extension to be erected. Diseases of School Children. Block E with 30 beds is used as available for the operative treatment of enlarged tonsils and adenoids, diseases of the ear, and treatment of general diseases occurring amongst school children. The utilisation of Block E for Scarlet Fever in future means that 2 Wards each of 16 beds require to be set aside in the new extension for diseases of School Children. General Diseases of Adults. The Council at its meeting on 23rd September, 1919, determined to admit these conditions as and when accommodation was available. During the last 6 months of 1918, 39, and during 1919 (to date), 87 cases of general diseases of adults had been admitted on the grounds of urgency. In the new extension it is proposed to set aside 80 beds for general diseases, i.e., both surgical and medical, of adults. Operating Theatre. In connection with the foregoing conditions to be treated in the extension a fully equipped operating theatre is required, and this is accordingly shewn in juxtaposition to the Wards which it would serve. The following Table shows the proposed accommodation of the extended Municipal Hospital:— Existing Hospital. Beds or Cots. Condition to be Treated. Block B. 20 Measles. Block C. 12 Whooping Cough. 10 Isolation Cases. Block D. 40 Scarlet Fever. Block E. 30 Scarlet Fever. Block F. 28 Diphtheria. Block G. 28 Diphtheria. Block H. 14 Cerebro.Spinal Fever, Erysipelas, Typhoid Fever, Puerperal Fever, Venereal Diseases, etc. Total 182 148  Beds or Cots. Condition to be Treated. Extension. 2 Wards 32 and 32 bassinettes Maternity. 2 Labour Wards 2 1 Recovery Ward 1 1 Ward 16 Diseases of Women. 2 Wards 32 Diseases of children under 5. 2 Wards 32 Diseases of School Children. 5 Wards 80 Diseases of Adults. 1 Ward 8 Sick Staff. Operating Theatre - Admission Ward - Total 203 and Additional 32 bassinettes. Grand Total 385 beds and cots and 32 bassinettes. Modernisation of Existing Pavilions. In connection with the work of extension existing Pavilions should be brought up.to.date. This will involve:- (a) The provision of admission wards. (b) The provision of Sanitary Annexes in Blocks C. and E. (c) The provision of balconies. (d) The provision of electric lighting in Block E. (e) Other re-arrangements which on detailed examination may be found necessary. Out Patient, Consultation and Special Departments. At the present time cases attend to see the Council's Specialists and no adequate provision exists for this purpose. To meet this and the other needs of a fully equipped Municipal Hospital a special pavilion is shewn for the following special and out-patient work:— 1. Pathology. 2. Ante-Natal and Gynaecological cases. 3. Throat, Nose and Ear cases. 4. Eye cases. 5. X-Ray cases. 6. Physio-therapeutic, including massage and remedial exercises, cases. 7. Casualty cases. 8. Dispensary. Mortuary, Post-Mortem Room, Carpenters' Shop, etc. These are shewn in a special block. Existing Administration Block. It is proposed to utilise this for:— 1. Medical Superintendent's office. 2. Consultant's Room. 3. Waiting Room for Patients. 4. Steward's Offices and Stores. 5. Matron's Offices and Stores. 6. Sewing Rooms. 7. Matron's Rooms. In addition a room is set aside for the use of medical practitioners who desire to make use of the Municipal Hospital to enable them to keep abreast with the progress of medical science. The necessary alterations to this Block will require to be carried out. 149 Central Kitchen. A large central kitchen with the necessary larders, pantries, etc., requires tn be built, and this is shewn in the draft plan. Medical Staff. Medical Staff will consist of:— Medical Superintendent. Visiting Consultants. Resident Medical Staff to be provided in the proportion of 1 Resident Medical Officer to 100 beds, i.e., 4 Resident Medical Officers are required. Nursing Staff. 48 Hour Week. The hours of duty of the present nursing staff vary from 48 hours per week in the case of a Day Sister to 64 hours per week in the case of a Probationer Nurse on the average. To allow for an average week of 48 hours for all nursing staff the following will be required in the extended Hospital:— 1 Matron. 1 Assistant Matron. 1 Home Sister or Housekeeper. 1 Night Sister. 12 Sisters. 25 Staff Nurses. 90 Probationer Nurses. 4 Spare Nurses to replace sick staff. Total (excluding Matron for whom 135 accommodation is already provided). To accommodate this Staff, a new Nurses' Home with 150 beds is shewn. Domestic Staff. 48 Hour Week. The hours of duty of the present domestic staff vary from 59½ hours in the case of a Laundress, to 84 hours in the case of a Mess Room Maid, on the average. To allow for an average week of 48 hours for the domestic staff, 100 will require to be employed. Accommodation for 117 is provided as follows:— Existing Annexe 25 Beds. Extension of Annexe 80 Beds. Extension of Annexe over Maids' Recreation Room 12 Beds. Total 117 Beds. Medical Superintendent's Residence. The function of the Medical Superintendent in the extended Municipal Hospital will be primarily to take the necessary steps to secure the medical and surgical efficiency of the Hospital and generally to supervise the working arrangements. The primary responsibility for the treatment of patients will be on the visiting staff duly assisted by competent resident medical officers who would always call upon the Medical Superintendent when the visiting consultant for any reason was not available in an urgent or a difficult case. Under these circumstances it is a matter of no importance from the point of view of Hospital Administration whether or not the Medical Superintendent resides on the premises, and certainly in 9 cases out of 10 the Medical Superintendent would desire to live away from his work. Miscellaneous Items. In connection with the extended Hospital the following matters will require attention:— Roads—Both within and without the Hospital grounds. Boiler House—Extension. Laundry—Additional Plant. 150 Incinerator—Shewn on Plan. Recreation grounds for convalescent patients—Shewn on Plan., Gardeners hut, etc. Land—It would appear necessary to take in immediately the vacant land facing the existing administration block for purposes of the extension suggested herein. In addition it is advisable to purchase an additional 6 to 8 acres for extension as the population grows and additional Hospital accommodation is required. Powers of the Council. The Willesden Municipal Hospital was established under Section 131 of the Public Health Act, 1875, which is as follows:— "Any local authority may provide for the use of the inhabitants of their district hospitals or temporary places for the reception of the sick and for that purpose may:— Themselves build such hospitals or places of reception; or Contract for the use of any such hospital or part of a hospital or place of reception; or Enter into any agreement with any person having the management of any hospital, for the reception of the sick inhabitants of their district, on payment of such annual sum as may be agreed on. Two or more local authorities may combine in providing a common hospital. Cost. The following information will give the Committee a preliminary estimate of the cost, b .t is not a final or detailed estimate Capital Charges Size of Proposed Hospital 385 beds and 32 basinettes. Size of Existing Hospital 199 beds and 14 basinettes. Beds to be added 186 beds. Pre.war the cost of building and equipping 186 beds including administration buildings was usually £500 per bed or £93,000. So that at present day prices the cost of the extension proposed will be approximately £250,000. Maintenance Charges, including Repayment of Loan. Under present circumstances the cost of maintenance at the existing Municipal Hospital including repayment of loan is approximately £4 4s. per occupied bed per week. On this basis the additional cost of maintenance of 186 beds if fully occupied would be £39,841 9 . per annum. This figure is probably approximately correct, for although all the additional beds will not be constantly in use, loan charges will be greater and charges for staff owing to the introduction of the 48 hour week will be greater. Income from the Government will be available in respect of Measles under 5, say 20 beds, Maternity, 35 beds, Diseases of Women, say 8 beds, Diseases of Children under 5, 32 beds and Diseases of School Children, 32 beds, or 127 in all, of which 70 are additional beds costing £15,288 per annum and yielding an income of £7,644 per annum. Small Pox Hospital, The present buildings at Kingsbury are of no use for hospital purposes as no adequate kitchen or accommodation for nurses exists. The land is unsuitable for the erection of a Hospital or Convalescent Home which would be in constant use on account of the difficulty of sewage disposal. The land is suitable for the erection of a Small Pox Hospital which would be rarely in use. The erection of such a hospital would appear to be. wasteful expenditure. It is therefore suggested that the present site at Kingsbury be disposed of, and that a site be obtained on which a Hospital or Convalescent Home could be erected and continuously used during an epidemic of Small Pox for Small Pox cases, and in the long intervals between epidemics as a Convalescent Home for discharged Hospital Patients, Residential Open Air School Children and other suitable cases. GEORGE F. BUCHAN, Medical Officer of Health. 151 APPENDIX Q, GRANTS IN AID. I.—Maternity and Child Welfare (Local Government Board). Summary of expenditure during the 12 months ended 31st March. 1916. 1917. 1918. 1919. £ s. d. £ s. d. £ s. d. £ s. d. Inspectors of Midwives and Health Visitors— Salaries including War Pay 167 8 10 447 8 3 987 3 8 1,281 4 8 Allowances for Uniform (Included with Salaries) 19 13 9 70 18 0 174 16 4 Travelling Expenses (Assistant Medical Officers & Health Visitors) 8 12 6 19 12 7½ 44 1 5 46 8 4½ 486 14 7½ 1,102 3 1 1,502 9 4½ Centres— Salaries of Medical Officers (including War Pay) 55 8 2 410 4 1 681 2 8 3,044 3 7 Rent, Rates and Taxes 9 15 0 64 5 6 120 16 9 140 0 11½ Furniture and Equipment 0 15 3 155 13 11 195 16 8½ 1,435 19 3½ Heating, Lighting and Cleaning 1 12 0 30 4 7 76 15 2½ 430 5 10 Drugs and other Medical requisites 5 7 4 17 3 11 154 1 3 305 19 8 Food—"Glaxo" 129 6 10 227 16 4 1,914 4 8½ 5,900 12 7 "Virol" 2 12 11 221 12 8 Meals provided for Mothers and Children - - - - - - 537 0 8 405 3 3 Alteration and adaptation of Premises - - - 215 6 8 341 12 2 978 17 6½ 1,123 7 11 4,021 10 1½ 12,862 15 4¼ Creches— Salaries of Medical Officers During the year 1917.18 certain expenditure was incurred in connection with a Day and Night Nursery established for the care of children of Munition workers, amounting to £955 1 4½ Salaries of Matrons Salaries of Nurses and other paid officers Rents, Rates and Taxes Furniture and Equipment Heating, Lighting and Cleaning Food and Provisions Contribution to a Creche Provision of Midwives and Maternity Nurses for— Necessitous Women - - - 1 9 0 36 19 9 129 19 0 Areas which are insufficiently supplied with this service - - - - - - - - - - - - Provision of Home Helps - - - 3 15 0 54 15 0 219 19 5 Provision for Necessitous Women of a Doctor—for illness connected with Pregnancy and for aid in Confinement - - - - - - 20 7 6 74 2 6 Provision in Necessitous Cases of Home Nursing—for cases of Measles, Whooping Cough and Epidemic Diarrhoea in young children and cases of Ophthalmia Neonatorum and Puerperal Fever - - - - - - - - - - - - Hospital Provision— Directly by the Council, Maintenance Expenses 60 15 0 (b)3,115 10 0 (a)1,994 17 0* (a)4,929 13 0 6,924 10 0 Alteration and Adaptation of Premises at Municipal Hospital - - - - - - 1,714 10 2 1,019 18 2* Furniture and Equipment - - - - - - 1,270 18 8½ 377 6 0 2,985 8 10½ 1,397 4 2 152 Sundries— Printing, Stationery, Postage, etc. 26 6 6 31 7 7½ 168 5 2 347 16 11½ Other items of Expenditure incurred:— Clerical Staff of M.O.H. (including War Pay) 5 10 0 80 8 2 608 16 5½ 644 0 11 Establishment Expenses—Clerk's and Accountant's Dept. - - - 83 10 0 300 0 0 612 14 9 Medical Officer's Travelling Expenses - - - 20 0 0 28 15 0 113 10 7 Provision of Offices and maintenance 32 0 0 139 1 1 173 0 0 173 0 0 Registrar's Returns 38 8 4 35 12 9½ 28 6 5 32 8 10 State Insurance - - - 1 12 0 7 12 9 12 1 7 Grant to Voluntary Centre - - - 20 0 0 25 0 0 - - - Sundries 10 11 2 4 1 9½ 11 2 8½ 61 15 11½ 415 14 5½ 1,350 18 6 1,997 9 7 Total £491 1 11 £2,091 16 0 £12,687 12 10 £25,108 9 4¾ Deduct Receipts:— Sales—"Glaxo" and "Virol" 120 5 8 223 9 1 850 7 10 1,439 8 1 Gift towards alterations to Clinic - - - - - - 100 0 0 - - - Sale of Waste, etc. - - - - - - 2 11 8 - - - Sundries - - - - - - - - - 61 1 1 Grant from Ministry of Health - - - 142 1 9 790 17 3 5,504 19 0 365 10 10 1,743 16 9 7,005 8 2 £370 16 3 £1,726 5 2 £10,943 16 1 £18,103 1 2¾ (a) Maternity cases. (b) Children under 5 years. 1918-19.-The Ministry have made a Grant of £13,664 0s. 11d., which is made up as follows:- £ s. d. 50 per cent. of the net eligible expenditure during the financial year 1918-19 11,262 19 11 Less amount paid in the financial year 1918-19 5,504 19 0 5,758 0 11 40 per cent. of the estimated expenditure during the financial year 1919.20, say 7,906 0 0 £13,664 0 11 II.—School Medical Service. Summary of payments made and amounts received during the year ended 31st March. 1915. 1916. 1917. 1918. 1919. 1. Salaries— £ s. d. £ s. d. £ s. d. £ s. d. £ s. d. (a) Salary of School Medical Officer 89 15 1 148 0 0 100 0 0 75 0 0 107 16 9 (b) Salaries of Assistant School Medical Officers 424 13 10 1,178 8 11 456 18 6 499 10 0 941 3 9 (c) Salaries of Specialist Officers (e.g., Ophthalmic Surgeon, Dental Surgeon), Specialist, X.Ray Clinic 140 4 2 150 6 7 119 13 5 91 7 11 328 18 6 (d) Salaries of School Nurses 447 17 10 935 16 0 649 6 10 805 4 4 1,917 18 3 (e) Clerical assistance 315 0 1 732 2 3 537 3 1 512 10 2 839 16 6½ 2. Travelling expenses 126 11 5 128 1 2 146 6 1 136 10 11 148 6 6½ 3. Printing, stationery, postage, etc. 267 2 8 257 2 4 112 10 10 198 15 2½ 284 13 11 4. Drugs, materials, etc. 36 5 7 61 17 11 68 9 10 78 7 4 143 18 8 5. Apparatus (e.g., weighing machines, ophthalmoscopic, dental, X.ray apparatus) 95 7 3 42 7 9 0 8 4 28 17 1 20 17 7 6. Provision of spectacles 80 0 11 63 1 9 84 4 10 158 1 3 197 6 7 7. Contributions to external bodies (e.g., Hospitals, Infirmaries Nursing Associations) - - - - - - - - - - - - - - - 8. Cost of conveyance of children to centres for examination or treatment 0 7 0 - - - - - - - - - - - - 9. Provision of premises, including payments in respect of loans 118 1 9 134 12 7 110 5 6 173 15 8 2,316 5 0 10. Maintenance of premises (e.g., rent, rates, heating, lighting, cleaning, upkeep of furniture) 146 19 0 320 2 0 226 14 6 139 16 5 384 8 6 11. Any expenditure not included in 1.10 above 7 11 3 14 9 2 10 15 1 12 6 104 33 8 10 Total £2,295 17 10 4,166 8 5 2,622 16 10 2,910 3 2 7,664 19 5 Total amount paid by, or recovered from, parents 1 17 9 3 15 6 6 2 9 7 10 3 23 16 9 Net Total £2,294 0 1 4,162 12 11 2,616 14 1 2,902 12 11 7,641 2 8 For the year 1917-18 a grant of £1,306 3s. 9d. has been received, being at the rate of 45 per cent., of the approved expenditure. 153 III.—Provision of Meals (Board ot Education). Summary of payments actually made and sums actually received within the year ended 31st March. 1916. 1917. 1918. 1919. Payments— £ s. d. £ s. d. £ s. d. £ s. d. (1) Purchase of food 1,202 1 5 749 11 9 1,794 18 2 2,216 19 9 (2) Salaries and wages 956 6 11 659 11 3 871 4 4 1,451 2 1 (3) Provision of premises - - - 11 5 7 404 1 11 - - - (4) Maintenance of premises {e.g., heating, lighting, cleaning, rent, rates, taxes) 364 18 10 345 18 7 351 18 4 475 2 1 (5) Furniture and equipment— (a) Initial equipment of new premises 51 12 1 - — - 36 7 10 11 5 3 (b) Annual repairs, replacements, etc. 48 19 3 12 1 8 41 4 4 81 11 8 (6) Printing, stationery, postages, etc. 27 4 6 25 19 11 26 15 6 44 18 10 (7) Conveyance of Children - - - - — - - — - - — - (8) Carriage of food, etc. - - - - — - - — - - — - (9) Any expenditure not included in (1)— (8) above 57 15 1 28 1 7 32 14 2 40 18 6 2,708 18 1 1,832 10 4 3,559 4 7 4,321 18 2 Less meals supplied to children attending Special Schools 237 6 3 221 5 8 155 10 8 209 14 3 Total £2,471 11 10 1,611 4 8 3,403 13 11 4,112 3 11 Receipts.— Amount paid or recovered from parents 44 7 3 79 7 6 197 5 11 252 11 8 Amount received from voluntary contributions - - - - — - - — - - — - Miscellaneous receipts - - - - — - 18 4 0 36 1 4 Maternity and Child Welfare - - - - — - 518 10 9 649 6 4 Total 44 7 3 79 7 6 734 0 8 937 19 4 Amount received in respect of M. & C.W., for year 1916.17 - - - - - - 30 3 5 - - - Net total expenditure £2,427 4 7 1,531 17 2 2,639 9 10 3,174 4 7  1918. 1919. Total number of meals provided:- Dinners 111,570 144,662 Other Meals 343 28 Total 111,913 144,690 Average total cost per meal 6.174d. 5.737d. Average cost per meal for food only 3.053d. 2.943d. Charge fixed under Section 2 of the Act of 1906 for each meal 4d. 4d. Number of children whose meals were paid for by their parents:— Wholly Nil. 488 Partly 378 Nil. The Board have paid a grant amounting to 50 per cent. of the expenditure £1,319 14 1 £1,587 2 3