WIL2I Willesden Urban District Council. 1921. THE 46th 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. 1922. 3 WILLESDEN URBAN DISTRICT COUNCIL, 1921-22. †*Mr. Councillor W. M. BOLTON, J.P. (Chairman). Mr. Councillor BRIGGENSHAW. *Mr. Councillor W. L. TRANT BROWN. Mr. Councillor T. CHELLEW. †*Mr. Councillor J. COMBER. 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. Mr. Councillor E. W. B. HUTT. †*Mrs. Councillor E. J. KENT. *Mr. Councillor E. J. LANE (Vice-Chairman). *Mr. Councillor H. LATHAM. Mr. Councillor G. C. MINTER. †*Mrs. Councillor R. MOORE. *Mr. Councillor J. MORSE. Mr. Councillor M. NODES LELLO. *Mr. Councillor W. J. PYKE. *Mr. Councillor C. REED. †*Mr. Councillor W. RILEY, J.P. (Chairman of Health and Health Sub-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. *Denotes Member of Health Committee. † Denotes Member of Health Sub-Committee. WILLESDEN EDUCATION COMMITTEE, 1921-22. Mr. Councillor W. M. BOLTON, J.P. Mr. Councillor T. CHELLEW. †Mr. Councillor A. GARDNER. Mr. Councillor W. A. HILL. Mr. Councillor W. J. HILL. Mr. Councillor G. H. HISCOCKS. Mr. Councillor C. W. HOGG. 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 (Vice-Chairman). †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. (Chairman of Children's Care Committee.) †Miss M. A. LUPTON. †The Rev. G. MARTIN, M.A. †Mr. G. H. PLYMEN, B.Sc. †The Rev. H. MARTIN THORPE, M.A. (Chairman). †Mr. D. T. WILLIAMS. † Denotes Member of the Children's Care Committee. 5 Town Hall., Dyne Road, Kilburn, N.W. 6. 4th April, 1922. 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 1921. This Report includes:— (i.) The 46th Annual Report on the health and sanitary condition of the district; (ii.) The 14th Annual Report on the health of children attending the public elementary schools; (iii.) The 2nd Annual Report on the health of children attending secondary schools ; (iv.) The 4th Annual Report on dental work in connection with children attending the public elementary schools, expectant and nursing mothers and children under 5 years ; (v.) The 2nd Annual Report on home nursing ; (vi.) The 7th Annual Report on the provision of meals to children attending the public elementary schools ; (vii.) The 30th Annual Report on the Municipal Hospital. Alterations in the Contents of Annual Reports.—The Ministry of Health issued Circular 269, dated 28th December, 1921, curtailing their requirements as to Annual Reports, and this Report is written in accordance therewith. In future Annual Reports of a full and detailed character will be known as Survey Reports, and will normally be required by the Ministry at intervals of not more than 5 years. The Annual Report for Willesden for 1920 will be treated as constituting the first of the series of Survey Reports, and the Annual Report for the year 1921 therefore follows the more simple lines now laid down by the Ministry for Annual Reports as distinguished from Survey Reports. The primary object of future Survey Reports will be to review the needs of the area in relation to the protection of public health and the progress made in meeting these needs since the date of the preceding Survey Report. The Ministry will issue special instructions with regard to the preparation of the next Survey Report. Vital Statistics. Population.—The decennial census was taken in June, 1921, and gave the population of Willesden as 165,669. The Registrar-General points out that the Census taken in June, 1921, was probably to some extent affected by the holiday movement of the population, and he has deemed it necessary therefore to make an adjustment by measuring the extent of the non-resident population in certain areas and by effecting its redistribution throughout the country. He therefore estimates the population of Willesden at 167,200 in June, 1921. Birth Rate.—In 1921, 3,464 births were registered as compared with 4,232 in 1920. The birth rate of Willesden, according to the Registrar-General for the year 1921 is 21.30 per thousand of the population. Death Rate.—During the year 1921, 1,677 deaths were registered as belonging to Willesden, as compared with 1,672 in 1920. The death rate for Willesden for 1921, according to the RegistrarGeneral, is 10.03 per thousand of the population, being the lowest recorded except in 1912, when it was 10.02, and 1920, when it was 9.78, but this latter rate was calculated on too high a population as the Census now shews. Infant Mortality Rate.—255 deaths of infants occurred under 1 year of age, giving an infant mortality rate of 74 per thousand, which, except for the year 1920, is the lowest recorded in the health annals of Willesden. The infantile mortality rate amongst legitimate births was 66.4 and illegitimate births 337.0 per 1,000 births. INFECTIOUS DISEASES. 3,346 cases of infectious diseases were notified during the year. The greatest number previously recorded was 4,559 cases in 1917, which, however, included 3,425 cases of Measles or German Measles, which diseases are not now notifiable. Diphtheria and Scarlet Fever.—The total of 3,346 includes 767 notifications of Diphtheria and 1,508 notifications of Scarlet Fever. The number of notifications of Diphtheria and Scarlet Fever indicates that these diseases were epidemic in Willesden during the year. Epidemics of Scarlet Fever and Diphtheria were widespread throughout the country in 1921, and difficulty in making provision for the hospital treatment of all notified cases has been reported from various large centres of population, including London and Manchester. During the year 1921 the Willesden Municipal Hospital admitted 1,599 notified cases of infectious diseases, a greater number than ever before, the greatest previous number being 1,207 in 1920. All cases of Diphtheria desiring Hospital treatment have been admitted on account of the dangerous nature of the disease, but only the more urgent cases of Scarlet 6 Fever have been admitted. It is worthy of note that only 3 deaths from Scarlet Fever occurred during the year out of 1,508 cases notified, while 62 deaths of Diphtheria were reported out of 767 notified cases of Diphtheria. Return Cases of Scarlet Fever.—The following statement gives the return cases that have occurred during 1921:— I. Home Cases.—Approximately 581. (a) No. of infecting cases giving rise to return cases not longer than 28 days after release from isolation 8 „ return cases they gave rise to 9 „ infecting cases per cent. of total home cases 1.4 „ return cases per cent. of total home cases 1.5 (b) No. of infecting cases giving rise to return cases more than 28 days after release from isolation 9 „ return cases they gave rise to 9 „ infecting cases per cent. of total home cases 1.5 „ return cases per cent. of total home cases 1.5 II. Hospital Cases.—Approximately 927. [Note.—907 Municipal Hospital cases plus approximately 20 in other hospital cases, e.g., M.A.B. London Fever Hospital, etc.] (a) No. of infecting cases giving rise to return cases not longer than 28 days after discharge 56 „ return cases they gave rise to 83 [Note.—7 of these occurred after the 28 days, but the first return case had occurred within the 28 days.] No. of infecting cases per cent. of total hospital cases 6.0 „ return cases per cent of total hospital cases 9.0 (b) No. of infecting Cases giving rise to return cases more than 28 days after discharge 21 „ return cases they gave rise to 28 „ infecting cases per cent. of total hospital cases 2.3 „ return cases per cent. of total hospital cases 3.0 It will be noted that return cases occurred alike after hospital treatment and home treatment, but that the percentage is greater after hospital treatment as shewn from the above figures. Any general conclusions made on the small number of cases presented are apt to be misleading, but the greater number of return cases resulting from hospital treatment is what epidemiologists and clinicians would expect. No doubt the segregation of cases of infectious disease exposes such cases to the risk of septic infection from other cases, thus rendering them more liable to retain infection for long periods. Puerperal Fever.—During the year 7 cases of puerperal fever were notified and investigated. In 5 cases a private doctor was in attendance at birth, and in 1 case a midwife was in attendance at birth. The remaining case was a miscarriage, where a doctor was called in, and the patient was afterwards removed to the Infirmary. One case was removed to the Municipal Hospital and recovered; 4 cases were removed to other hospitals and the Infirmary, 3 of these recovered, and 1 was still under treatment at the end of the year, while 2 cases treated at home by private doctors recovered. Pneumonia.—118 cases of this disease were notified under the Public Health (Pneumonia) Regulations, and 127 deaths from Pneumonia were recorded in Willesden. A circular letter was sent to medical practitioners on the 24th January, 1922, calling their attention to the requirements of the Regulations as to notification. Ophthalmia Neonatorum.—Forty cases of this disease were notified and investigated during the year ; 24 of these cases were attended by a doctor at the confinement and 16 by a midwife; 3 of these cases were still under treatment at the end of the year, 1 at home, 1 in the Municipal Hospital, and 1 in another hospital. In 35 cases the length of treatment varied from 7 days to 126 days and the eyesight was unimpaired, while in the 2 remaining cases one eye was permanently injured and one of the cases was still under observation and treatment at the end of the year for the left eye. SANITARY WORK. During the year 1921, 3,371 complaints were received as to the condition of premises, and the same have received attention. One thousand and fifty-five Bake-houses, Milkshops, Laundries, Worshops, Factories and similar places are under periodical inspection by the Sanitary Inspectors. Three hundred and fifty visits were made to premises where foodstuffs are sold or stored. Two hundred and fifty-one applications were granted by the Council under the Rent Restriction Act of 1920, and 45 refused. Four thousand one hundred and fifty-two notices have been served requiring the remedying of insanitary conditions. These are now complied with without the delay which was experienced during the War and the following year or so, and generally it may be stated that the pre-War standard of housing conditions in Willesden will soon be attained again. In only eight cases has it been necessary for the Council to take legal proceedings to enforce the notices served. During the year the Council framed new Bye-laws relating to Slaughter Houses, and these were duly approved by the Ministry of Health and are now in operation. 7 MOTOR AMBULANCE SERVICE. The Motor Vehicles are all in their ninth year of service, and have covered a total of 443,577 miles. During the year under review the calls upon them have been exceptionally heavy, and it is satisfactory to record that these have been met without accident. There have been 3,600 calls for ambulances (including infectious cases), 2,300 houses visited for disinfection, and 130 mentally and physically defective children have been carried to and from school each day. MOTHERS AND CHILDREN UNDER FIVE YFARS. Municipal Centres.—At the Municipal Clinics expectant mothers attended the medical consultations on 2,490 occasions; nursing mothers 11,791; and children under 5 years, 27,186; making a total of 41,467 attendances. There was a considerable fall, approximating 42 per cent., in the number of attendances during the last quarter of 1921, as compared with the previous quarter, after the inauguration of the annual registration fee of 2s. 6d. on the 1st October, 1921. During the year 1921, 255 children under 1 year died in Willesden. Of this number 65 attended the Clinics, and 190 did not, giving an infant mortality rate of 65.7 per thousand births amongst babies attended the clinics, and 76.7 per 1,000 births amongst those who were not in attendance. The infant mortality rate for all babies was 73.6 per thousand births. These 65 deaths of Clinic babies are reckoned as Clinic deaths, no matter how many months elapse between death and the last Clinic attendance, and no matter how few attendances have been made at the Clinics. In 12 cases (including two children under one month) only one attendance was made, and in addition, in 2 cases 2 months elapsed between death and the last Clinic attendance, in 4 cases 3 months elapsed, in 1 case 4 months elapsed, in 1 case 5 months elapsed, and in 1 case 6 months elapsed between death and the last Clinic attendance, or 21 deaths in all who only attended once or otherwise did not attend for a considerable interval before death. In addition, 1 child under 1 month died who attended the Clinic twice. Of the 65 deaths reckoned as Clinic deaths 36 were certified by Private Doctors, 16 by the Municipal Hospital, 10 by other Hospitals, 2 by Inquest, and 1 by a Clinic Medical Officer. I have set out the basis on which deaths are reckoned as Clinic deaths as misunderstanding seems to have arisen. Statistical evidence cannot be treated as a problem in pure mathematics, but has got to be carefully balanced in the light of all possible sources of error. When all these sources have been considered the comparison of the Infantile Mortality rate of Clinic babies with non-clinic babies still points to the conclusion that the continuous medical supervision of the mother and child is of great benefit to the community. Voluntary Centres.—Two Voluntary Maternity and Child Welfare Centres are at work in Willesden, namely, the Princess Road Infant Welfare Centre and the Infant Welfare Centre, carried on by the Women's Civil Corps. Both do good work. A scheme of Co-ordination was submitted during the year by the Committee of the Princess Road Infant Welfare Centre, but owing to financial restrictions the Scheme was not put into operation. PUBLIC ELEMENTARY SCHOOL CHILDREN. Medical Inspection.—Article 58 (b) of the Code of Regulations for Public Elementary Schools requires annually the medical inspection of the following groups of children to be undertaken:— (1) All children admitted to the schools. (2) All children between 8 and 9 years of age; and (3) 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. No routine medical inspection has been carried out since the summer term of 1918, when the Medical inspection of two age groups in part of the district was discontinued. Arrangements have been made, however, for the Medical Inspection of one age group, namely, " entrants," to commence on the 24th January, 1922, and the work will be extended to include the two remaining age groups, when suitable arrangements can be made to deal efficiently with the additional work entailed by the inspection of these three code groups according to regulations. With 24,152 children on the school roll this would mean the annual inspection of over 8,000 children. Medical Treatment.—During the year 1921, school children came under the notice of the Medical Officer on account of 19,137 medical defects and 5,734 dental defects. Treatment was obtained for 21,923 of the defects which came under notice and were found to require treatment. 97.7 per cent. of the medical defects were treated and 70.7 per cent. of the dental defects. Of the total medical defects treated, 87.2 per cent., and of the total dental defects treated, 95.8 per cent. were dealt with by the Education Committee through the Clinics, Municipal Hospital or Home Visitation. The remainder or 12.8 per cent. of the Medical defects and 4.2 per cent. of the dental defects treated were dealt with by private practitioners, voluntary Hospitals or other charitable institutions or the Poor Law. In connection with the defects treated, the children concerned made 64,750 attendances at the school clinics in 1921, as compared with 75,258 in the previous year, and spent a total of, approximately, 4,300 days in hospital in 1921, as compared with 6,000 days in 1920. The decrease in the attendances at the School Clinics was due to the fact that on October 1st, 1921, an annual registration fee of 2s. 6d. was instituted for every case attending on and after that date. The fee had the effect of reducing attendances by some 45 per cent. 8 Cleanliness in the Schools.—Cleanliness inspections were carried out in the schools on 1,074 occasions during the year 1921, the average number of visits paid to each school by the Health Visitors being 34, and the number of examinations made being 46,010. Approximately 24,152 individual children were examined and 3,537 individual children, or 14.6 per cent. were found to be nitty or verminous. The cleanliness inspections held at the schools bring to the notice of the Health Visitor many cases which would otherwise not be reported, and are the chief sources of information as to the cleanly or uncleanly condition of the children. They also enable the Health Nurse to keep in touch with cases requiring constant supervision, and more co-operation is received from parents in their endeavour to keep the children free from nits and vermin when they realise that by these weekly inspections, neglect on their part results in a warning notice, and may terminate in prosecution if a certain standard of cleanliness is not maintained. Co-operation of Parents, Teachers and Attendance Officers.—As the Teachers, School Attendance Officers and Health Visitors are all closely interested in the welfare of the school child on educational and health grounds, the complete co-ordination of these three factors is essential in any scheme organised for the future benefit of school children, and only with their mutual co-ordination can the best results be obtained with the minimum expenditure of labour. To a great extent, the Health Visitors rely on information supplied by the Teachers and School Attendance Officers, and by visiting the school departments weekly they are able to keep in close touch with conditions in school children, relative to health. They are then able to carry out their part of of the scheme by visiting the homes, interviewing parents and explaining what conditions required attention, how such attention can be obtained, and advocating the need of medical advice when the condition warrants. The co-operation of the parent is probably the most important link in the chain, as without this practically no remedial measures would result. No scheme of work undertaken for the physical welfare of school children can be in any way perfect, which deals solely with the compilation of numerical defects and fails to procure the necessary treatment by which the child benefits. As a result of educational progress in health matters on the part of the parent, advancement has been made since 1914 in the co-operation given by them in reporting defective conditions to the School Medical Officer, and also in obtaining the appropriate treatment for conditions when notified of the fact. During 1921, 38 per cent. of the cases referred to the School Medical Officers were so referred by parents as compared with 3 per cent. in the year 1914. Abnormal Children.—All children thought to be abnormal either as regards their mental or physical condition, and who appear unsuitable to attend an ordinary elementary school, are referred to the School Medical Officer for special consideration. Information regarding these children is received from Head Teachers, Parents, Health Nurses, Attendance Officers, Private Medical Practitioners, Voluntary Societies, other Local Authorities and Hospitals. Cases so referred are submitted to a special examination and recommendations are made to the Education Committee as to the best method of dealing with each case, according to the abnormality found. Instruction in a special day school or residential institution may be considered advisable or surgical appliances or treatment in a special hospital may be necessary. During the year 1921,163 children were referred for special examination, and 115 were examined, 66 were found to be physically defective, 27 mentally defective, 3 blind, 3 deaf, 4 epileptic, 6 normal, and 6 dull and backward. Forty-eight were awaiting examination at the end of the year. Leinster Road Mentally Defective School.—The certified accommodation at this School is for 100 children, and during the year 1921 the average number on the roll was 87. As there are 13 mentally defective children at present awaiting admission, full use could be made of the maximum accommodation if facilities were available for their conveyance to and from school; but the present School Ambulance service is taxed to the utmost, and no additional children can be dealt with. The staff consists of 1 Head Teacher, 4 Assistant Teachers, and 1 Blind Teacher, who gives special instruction in Braille methods. The progress made by the children during the year has, with few exceptions, been satisfactory, the unsatisfactory cases being due to the inability of the children to benefit by further instruction in a Special School. During the year 4 such cases were referred to the Middlesex County Council as being ineducable; and 4 cases were also referred who required supervision or guardianship on leaving school at 16 years of age. Two children had made sufficient progress to warrant their transference to an Ordinary Elementary School for their last year, and although backward for their age, favourable reports have been received of their continued progress. Instruction is given by the Blind Teacher in Braille methods, and special manual instruction to two partially blind boys; and, in addition, several exceptional cases who lack co-ordination and control over their hands, receive constant individual instruction which cannot be given in a Special School class of 20. The manual work undertaken has been extended during the year, now that more material is available. A suitable occupational centre and training department run in conjunction with a Special School of this description is still very essential. 9 Although defective in ordinary school subjects after prolonged teaching, both boys and girls acquire a certain degree of skill at some of their occupations which compares favourably with work done by the ordinary school child. The majority of the children attending Special Schools are only capable of being taught reading, writing and arithmetic, etc., up to a certain point, depending upon the grade of their intelligence ; and beyond that point further instruction in one or all of these subjects is of no avail. On the other hand, almost to compensate, they are often proficient in manual work, and are still capable of acquiring practical knowledge. If facilities were at hand—once they had acquired their maximum school knowledge—for them to concentrate more on manual and occupational training, and specialise in a useful occupation, many of these children could be placed in better situations on leaving school. At present the work undertaken is too limited in scope, and insufficient time is devoted to it. It is not surprising that the majority of the children invariably drift into blind alley occupations on leaving school, and consider themselves fortunate in having obtained a situation. The cost of education of a child at a Special School for Defective Children is high, and under present conditions it cannot be admitted that the money is spent to the best advantage in the interest of the child. Knowing that the ordinary channels of employment are closed to most of them, their future should be taken more into consideration in their education. Children should be considered individually, and special aptitude encouraged and special training given at the occupational centre with a view to the child having some definite knowledge of a craft on leaving school. The reward for the money so spent would be apparent in later years in the comparison of the after careers of the children. The present statistics are far from encouraging, and point openly to the deficiencies in the present system. It is not every Teacher, however good he or she may be, who has the special aptitude for dealing with these abnormal children, and such a Teacher lacking in this respect is never likely to get the best result from them. It is essentia], in the teaching of specialised occupational subjects, as in routine school work, that instruction should be given only by teachers familiar with defective children, who fully realise and know how to deal with the peculiarities and peccadillos of these abnormal children ; otherwise the value of the training is greatly diminished. The extension of the present scheme of education at this School may be impracticable at the present time, but from a social and economic point of view the question should receive consideration on some favourable opportunity. The School is visited each week by one of the Medical Officers for the re-examination of selected cases, and during the year 1921 91 children were examined and a report made as to their progress. Furness Road Physically Defective School.—The certified accommodation at this School is for 60 children, the effective accommodation being for 70 children. During the year 1921 the average number of children on the roll was 66, the actual number on the roll on 31st December being 70. The work and health of the children during the year has been satisfactory, but under improved conditions, better results could be obtained both physically and educationally. The accommodation at this school, which would not be considered good for normal children, is poor for physically defective children who, in the majority of cases, have been semi-invalids up to the time of admission to school, and who are consequently of inferior physique and have less stamina than the average normal child. Games, exercises and outdoor occupations likely to be beneficial to them cannot be undertaken owing to lack of suitable recreation ground. The best results, both mentally and physically, can only be expected from these children when they are suitably fed and educated under open-air conditions in surroundings which will give them all the requirements essential for a healthy life. Better facilities are urgently required for the teaching of handicraft work to both boys and girls whose choice of employment on leaving school is limited owing to their physical defect. Owing to the general trade depression, it has been more difficult this year for " leavers " to be placed in suitable situations and this partly accounted for the maximum number of 70 being on the roll at the end of the Christmas term. As both Furness Road and Leopold Road Physically Defective Schools have been full throughout the year it is apparent that there is some considerable delay before new cases can be admitted to either of these schools. If the full accommodation could be utilised at Leopold Road School by an extension of the School Ambulance service, physically defective children could be graded in the two schools, and every case could be dealt with, and children would no longer be required to remain many months at home until a suitable vacancy occurred. The school is visited every fortnight by one of the Medical Officers for re-examination of selected cases and the examination of cases specially referred by the Head Teacher. During 1921, 115 children were re-examined, and the parents notified in all cases where defects were found requiring attention. Leopold Road Physically Defective School.—The certified accommodation at this school is for 40 children, but from the 13th December, 1920, when the school was re-opened, to 31st December, 1921, it has only been possible to admit 20 children, owing to the lack of available ambulance transport to convey the children to and from school. 10 To deal with the 20 children in attendance an extra journey is made by one of the school ambulances after children have been conveyed to Furness Road Physically Defective School. The school is consequently unable to commence the morning session until 10.45 a.m., and the ambulance is not free to return for these children until 4.30 p.m. The result is that several of the children do not arrive home until after 5 p.m. Having only one teacher at this school, younger children from 6 to 8 years were specially selected to simplify teaching. The school hours, therefore, and the time spent in travelling to and from school are too long for children of this age, who are, without exception, less robust than children attending an ordinary school, and towards the end of the afternoon the children frequently show signs of weariness—and this is especially marked during the winter. The appointment of a second Teacher is dependent upon an improved ambulance service, and until this is piovided no further use can be made of the accommodation available, although there are children awaiting admission to both physically defective schools. Again, if the whole school could be utilised the present school house could be altered to the benefit of the children in attendance. A trained nurse acts as Nurse Ambulance Attendant, and supervises the general physical welfare of the children during school hours, and also gives the daily treatment frequently required for conditions arising in conjunction with the physical defects from which these children suffer. The school is visited every month by one of the Medical Officers, and after re-examination of the children the parents are notified of any defect requiring attention. After Care.—The after careers of Physically and Mentally Defective Children is undertaken in Willesden by a Voluntary Committee. Children leaving the Special Schools and requiring after care are notified to the Committee as a matter of routine. The cases are visited during the year, revisited when necessary, and a general record kept of each case receiving supervision. Trade depression and the closing down of works during the year has been responsible for a good deal of unemployment among the physically defective cases, although previously doing well and in regular employment. For these cases the difficulty of obtaining fresh employment is increased, as owing to their physical disability alternative work is usually impossible. The mentally defective cases are less severely affected. Employment with them is invariably of a temporary nature in a blind alley or precarious occupation. Unsatisfactory mentally defective cases found to require more than after care are reported to the Middlesex County Council for institutional treatment, but there is usually considerable delay, frequently two to three years elapsing before the cases are placed. An Occupational Centre, under the charge of the After-Care Committee, was opened at 225, High Road, Kilburn. A few children attend on Wednesday mornings, and are taught the most elementary games and hand work. As the children in attendance are feeble-minded (ineducable) or imbeciles awaiting transference to an institution, the work undertaken has very little, if any, educational value attached to it, although a source of enjoyment to the children. Examination of Teachers.—Sixty teachers were examined during the year by the School Medical Service, and all were certified physically fit to perform the duties of a teacher. SECONDARY SCHOOL CHILDREN. Medical inspection of the two Secondary Schools in Willesden, namely, the Kilburn Grammar School and the Polytechnic Day Trade School, has been carried out on similar lines to last year, at the request of and by arrangement with the Middlesex County Council. Particulars of the examinations will be found in the Tables accompanying this report. DENTAL WORK. 5,861 school children and 687 expectant and nursing mothers and children under five years of age were dealt with by the two Dentists employed by the Council during the year. Of the school children 4,812 came under notice at routine inspection, 3,278 for the first time and 1,534 who had been previously treated by the Dentists at periods varing from six months to 3½ years previously. It is satisfactory to record that 9 per cent. more children were found with no defect amongst those previously treated than those inspected for the first time, which shows that a large amount of permanent work has been done, especially when it is borne in mind that in many cases three years had elapsed between the inspections. HOME NURSING. The work of the Home Nursing Service has shown steady progress during the year 1921. 840 cases were nursed during 1921, as against 681 during 1920; 18,077 visits were paid during the year, or an average of 10 visits per Nurse on each working day. Of these 7,353 were paid to mothers and children under five, 4,677 to school children, and 6,047 to others. Difficulty was experienced 11 in some cases, such as pneumonia, in satisfactorily nursing these cases owing to lack of warm clothing ; but to meet this difficulty a small stock of flannel gowns and blankets was procured for use during illness, and these have proved beneficial. The loan of nursing requisites, such as bed pans, air cushions, feeding cups, etc., has also proved very useful and helpful to the comfort and better nursing of many cases. One branch of the work which has shown progress is the after-care of patients referred from voluntary hospitals, 56 such cases being referred during the year, and the services of the Home Nurses have been greatly appreciated by these Institutions. Many letters and messages of thanks and appreciation have been received during the year from patients and friends, expressing their gratitude for services rendered. PROVISION OF MEALS. 193,485 meals have been supplied to school children during the year at the Centres of the Education Committee and at the Voluntary Centre in South Kilburn ; 2,519 meals were supplied to mothers and children during the first four months of the year only, but were finally discontinued in May, 1921. MUNICIPAL HOSPITAL. 2,617 cases were admitted to the Municipal Hospital during 1921, 1,599 being notified cases of Infectious Diseases, 219 children under five years, 347 school children and 452 women. The work at the Hospital has been well done under difficult conditions. The lack of cubicle or isolation accommodation for patients, and the lack of sufficient and suitable accommodation for the Nursing and Domestic staff are the main disadvantages under which Hospital administration has to be carried out. The Annual Report of the Medical Superintendent is appended. Your Obedient Servant, GEORGE F. BUCHAN, Medical Officer of Health. 13 THE FORTY-SIXTH ANNUAL REPORT FOR THE Year ending 31st December, 1921, ON THE HEALTH AND SANITARY CONDITION OF THE URBAN DISTRICT OF WILLESDEN. GENERAL STATISTICS. Area (acres) 4,384 *Population (1921) 165,669 (Census) Number of inhabited houses (1921) 23,518 (estimated Midsummer, 1921} Number of families or separate occupiers (1921) 37,960 (estimated) Rateable value £970,482 Sum represented by a penny rate £3,790 * The Registrar General, in a Memorandum dated the 1st March, 1922, points out that the Census taken in June, 1921, was probably to some extent affected by the holiday movement of the population, and he has deemed it necessary, therefore, to make an adjustment by measuring the extent of the non-resident population in certain areas and by effecting its re-distribution throughout the country. He therefore estimates the population of Willesden at 167,200. EXTRACTS FROM VITAL STATISTICS OF THE YEAR. Births— Total. M. F. Legitimate *3,372 1792 1580 Birth Rate (R.G.) 21.30 Illegitimate †92 54 38 Death Rate (R.G.) 10.03 Deaths ‡1677 869 802 *(R.G.) 3429. † 133. ‡1678. Number of women dying in, or in consequence of, childbirth from sepsis 0 from other causes 4 Deaths of Infants under one year of age per 1,000 births:— Legitimate ... 224. Illegitimate ... 31. Total 255. Deaths from Measles (all ages) 4 „ Whooping Cough (all ages) 28 „ „ Diarrhoea (under 2 years of age) 34 NOTIFIABLE DISEASES DURING THE YEAR. Disease. Total Cases Notified. Cases admitted to Hospital. Total Deaths. Diphtheria 767 683 62 Scarlet Fever 1,508 907 3 Enteric Fever (including Paratyphoid) 16 7 3 Puerperal Fever 7 1 — Pneumonia 118 2 127 Other diseases notifiable, generally or locally 608 9 39 Tuberculosis:— (a) Pulmonary M. 146 F. 115 — 105 Total 261 (b) Non-Pulmonary M. 28 F. 33 — 47 Total 61 Ophthalmia Neonatorum. Cases. Vision Unimpaired. Vision impaired. Total Blindness. Deaths. Under treatment at end of year. Notified. Treated. At Home. In Hospital. 40 31 9 35 1 0 0 4 14 SUMMARY (FOR REFERENCE) OF NURSING ARRANGEMENTS, HOSPITALS AND OTHER INSTITUTIONS AVAILABLE FOR THE DISTRICT. Professional Nursing in the Home. (a) General— (i.) The Willesden District Council has established a Home Nursing Service. The Council's Nurses are fully trained Hospital Nurses. They visit in the homes once or twice daily as necessary to nurse cases of illness, particularly amongst mothers and children. Nurses are provided on application to the Home Nursing Matron, Municipal Clinic (1), 9, Willesden Lane, Kilburn, N.W. 6; or to the Matron, Municipal Clinic (2), 381, High Road, Willesden, N.W. 10. The Council's Nurses act under the direction of the Medical Practitioner in attendance upon the case. (ii.) A few District Nurses are also at work in connection with Nursing Associations, Churches, Missions, etc. (b) For infectious diseases, e.g., Measles, etc.— Carried out by the Council's Home Nursing Staff. Midwives—Employment of, or subsidy to, practising Midwives, by Public Health Authority. The Council pays the fees of Midwives in home confinement cases where the economic circumstances of the patient are below the Council's scale. The fee agreed with the North West Middlesex Midwives' Association is £1 l1s. 6d., but for a first confinement, £2 2s. The number of Midwives who at the beginning of 1922 had notified the Middlesex County Council of their intention to practise in Willesden during 1922 was 17, two of whom were engaged in institutions. CLINICS AND TREATMENT CENTRES. Name. Situation. Nature of Accommodation. By whom provided. Work Undertaken. Municipal Clinic (1) 9, Willesden Lane, Kilburn, N.W. 6 Two houses adapted and equipped for undertaking care and supervision of the expectant and nursing mother and child up to school leaving age Willesden Urban District Council Maternity and Child Welfare and School Work—Medical and Dental— School for Mothers (Clinic 1). Municipal Clinic (2) 381, High Road, Willesden, N.W. 10 Ditto Ditto Special Skin Clinic 225, High Road, Kilburn, N.W. 6 Three rooms suitably equipped for the X-ray treatment of Ringworm Ditto X-ray treatment of Ringworm and treatment of Skin diseases. Town Hall Dyne Road, N.W. 6 Suitably equipped Medical Officer's room Ditto Examination of abnormal children. Tuberculosis Dispensary 3, Priory Park Road, Kilburn, N.W. 6 - Middlesex County Council Tuberculosis Dispensary. Infant Welfare Centre and Club 84, Princess Road, Kilburn, N.W. 6 A house adapted and equipped for infant welfare work Voluntary Committee. Hon. Sec., Mrs. Howard Figgis Maternity and Child Welfare School for Mothers. "Princess" Day Nursery 47 and 49, Chichester Road, Kilburn, N.W. 6 Tw o houses adapted and equipped as a Day Nursery Ditto Day Nursery. ERRAIUM. Page I5. Hospitals provided or subsidised by the Looal Authority or bv the County Council. The following Hospitals appearing under the above heading should appear under a separate heading as "Other Hospitals available for the District" as none of them are provided or subsidised as above Under "(3) Children" - St. Monioa's Home Hospital and Edgar Lee Home for Invalid Boys and Under "(6) Other" - all the Hospitals mentioned. 15 CLINICS AND TREATMENT CENTRES.—Continued. Name. Situation. Nature of Accommodation. By whom provided. Work Undertaken. The Willesden Special Surgery Clinic for Disabled Ex-Service Men. 84, Priory Park Road, Kilburn, N.W. 6. One house adapted and equipped St. John's Voluntary Aid Detachment, Middlesex, 58 (Women's) Electrical treatment and massage. Willesden Women's Civil Corps, Child Welfare Committee St. Mary's Parish Room, Church End, Willesden Willesden Women's Civil Corps. Child Welfare. Venereal Diseases Clinics The Middlesex County Council have made arrangements with General Hospitals in London, The Prince of Wales Hospital, Tottenham, in Middlesex, and the Royal Hospital, Richmond, in Surrey, for the treatment of persons suffering from these complaints. HOSPITALS PROVIDED OR SUBSIDISED BY THE LOCAL AUTHORITY OR BY THE COUNTY COUNCIL. (1) Tuberculosis County Sanatorium, Harefield, Middlesex. Middlesex County Council. Clare Hall Sanatorium. „ „ „ {2) Maternity Willesden Municipal Hospital, Brentfield Road, Neasden, N.W. 10. Supported wholly by the Willesden Urban District Council. The Maternity Pavilion provides accommodation in 3 wards for 16 beds with a separate Labour Ward containing 1 bed. There is an operating theatre and a sanitary annexe, consisting of lavatories, sterilising room, bath room and pantry. (3) Children Willesden Municipal Hospital, Brentfield Road, Neasden, N.W. 10. ported wholly by the Willesden Urban District Council. 32 beds for diseases of children up to 14.years of age. St. Monica's Home Hospital for Sick Children, 16, Brondesbury Park, N.W. 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. (4) Fever Willesden Municipal Hospital, Brentfield Road, Neasden, N.W. 10. ported wholly by the Willesden Urban District Council. 150 beds. (5) Smallpox Willesden Smallpox Hospital, Kingsbury. (6) Other Park Royal Hospital, Acton Lane, N.W. Provided by the Willesden Guardians. General cases, Maternity Ward, Children's Ward. Willesden General Hospital, Harlesden Road, N.W. General cases. St. Andrew's Hospital, Dollis Hill, N.W. 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. Dollis Hill House Convalescent Hospital, Gladstone Park, N.W. Ministry of Pensions. Adjacent London hospitals are also available for Willesden. ANY INSTITUTIONAL PROVISION FOR UNMARRIED MOTHERS, ILLEGITIMATE INFANTS AND HOMELESS CHILDREN IN THE DISTRICT. (1) Unmarried mothers are admitted to the Maternity Wards of the Willesden Municipal Hospital for confinement. (2) Queen Charlotte's Lying-in Hospital Convalescent Home, 20, Victoria Road, Kilburn, N.W. 6. (3) Harrow and Willesden Ruri-decanal Association for Preventive and Rescue Work, St. Mary's Home, 34, Craven Park, N.W. 10. (4) Park Royal Hospital (Willesden Guardians) and Guardians' Scattered Homes. See the Willesden Annual Health Report for 1919 for further details of Clinics, Hospitals, other Institutions, etc. 16 AMBULANCE FACILITIES. Motor Ambu lances are available as follows:— (a) For infectious cases— 1 infectious ambulance. (b) For no.n-infectious and accident cases— 1 accident ambulance. These Motor Ambulances have been established and are maintained by the Willesden Urban District Council. The garage is situated at the Municipal Hospital, Brentfield Road, Neasden, N.W. 10. An all-night service has been established, but this is only partial,- as there is only one man on duty, and any calls coming when he is out cannot be dealt with at once. LABORATORY WORK. Drs. Thresh and Beale (The Counties' Public Health Laboratories), of 91, Queen Victoria Street, London, E.C., continue to act as the Council's Bacteriologists. The arrangements were, however, reorganised in the early part of the year under review. An agreement, dated the 29th March, 1921, was made between Drs. Thresh and Beale and the Council whereby the former undertook to carry out the examination of— (1) Diphtheria swabs; (2) Sputa for Tubercle; (3) Blood for Typhoid; and (4) Swabs and Fluid for Meningitis, for the sum of £236 5s. 0d., plus postage, telegrams and telephone charges. It was further agreed that the Bacteriologists should supply free of charge 4 gross of swabs for distribution to the medical practitioners and the hospitals in Willesden. The arrangements now made provide for the result of the swab to be telegraphed or telephoned to the medical practitioner direct, followed by a written report of the result, together with a sterile swab in the place of the one submitted. Sterile swabs can also be obtained by medical practitioners at Health Department (Town Hall), the Fire Stations and the Municipal Hospital. The following table shews the Chemical and Bacteriological examinations made during the year 1921 Table No. 1. Table shewing Chemical and Bacteriological Examinations made during the year 1921. Nature of Specimens examined. Positive Result. Negative Result. Total. 1. Swabs for Diphtheria Bacilli 575 1,707 2,282 2. Sputum for Tubercle Bacilli 38 152 190 3. Blood for Widal Reaction 6 14 20 4. Urine 6 3 9 5. Cerebro-Spinal Meningitis Fluid - 4 4 6. Fluid from Ventricle of Brain — 1 1 7. Pleural Fluid — 1 1 8. Synovial Fringes from Ankle joint histologically ... — 1 1 9. Pus from Ear — 1 1 10. Pus from Furuncle 1 — 1 11. Pus from Tubercle Bacilli — 3 3 12. Pus from Rectal Abscess for Bacillus Typhosus — 1 1 13. Swab for Meningococci — 2 2 14. Swab for Streptococci and Staphylococci 1 — 1 15. Swab from case of Ophthalmia — 1 1 16. Uterine Swab 3 — 3 17. Swabs taken from Vaginal Discharge 1 3 4 18. Blood for Organisms — 1 1 19. Blood Films for Malaria — 3 3 20. Phlegmon on Chin for Organisms — 1 1 21. Specimen for Gonorrhoea — 2 2 22 Dermoid Cyst from Scalp — 1 I 23. Tumour removed from Brain 1 — 1 24. Tumour removed from Jaw 1 — 1 25. Faeces for Bacillus Typhosus — 5 5 633 1,907 2,540 17 Table No. 2.—Sources of Specimens Examined. From Municipal Hospital 1,301 From private practitioners 719 From clinics and health visitors 396 From Willesden Infirmary 82 From other Hospitals or Institutions 42 Total 2,540 ISSUE OF DIPHTHERIA ANTITOXIN OR OTHER SERA OR VACCINES. Diphtheria antitoxin is given to Medical Practitioners on application at the Health Department (Town Hall), Fire Stations and Municipal Hospital. A supply of influenza vaccine is kept at the Health Department (Town Hall), and given to Medical Practitioners on application. SANITARY ADMINISTRATION. *List of Local Acts, Adoptive Acts, Bye-laws and local Regulations in force in the District, with date of adoption. Local A cts:— Willesden Local Board Act, 1876. Royal Assent 27.6.1876. Willesden Local Board Act, 1887. Royal Assent 8.8.1887. Willesden Sewerage Act, 1896. Royal Assent 14.8.1896. *Willesden Urban District Council Act, 1903. Royal Assent 11.8.1903. Adoptive Acts:— *Public Health Acts Amendment Act, 1890, Part III. Adopted 11.11.1890. *Public Health Acts Amendment Act, 1907, Parts II., III., IV., and X. Adopted 24.1.1911. Baths and Washhouses Acts, 1846-99. Adopted 14.2.1899. Burial Acts, 1852-1900. Public Libraries Acts, 1892-1901. Adopted 19.2.1891. Bye-laws:— *Common Lodging Houses (Public Health Act, 1875, s. 80). Adopted 14.10.1879. *Houses Let in Lodgings (Public Health Act, 1875, s. 90). Adopted 8.11.1892. *Slaughter Houses (Public Health Act, 1875, s. 169 and Towns Improvement Clauses Act, 1847, s. 128). Revised and adopted 27.9.1921. *Prevention of Nuisances (Public Health Act, 1875, s. 44). Adopted 26.9.1876. New Streets and Buildings (Public Health Act, 1875, s. 157 and Public Health Acts Amendment Act, 1890, s. 23). Adopted 16.10.1906. New Sewers (Willesden Local Board Act, 1887). Adopted 9.10.1888. Pleasure Grounds (Public Health Act, 1875, s. 164). Adopted 28.1.1896. *Drainage of Buildings (Public Health Acts Amendment Act, 1890, s. 23). Adopted 16.10.1906. *Rag and Bone Dealer (Public Health Act, 1875, s. 113). Adopted 29.9.1908. Local Regulations:— *Dairies, Cowsheds and Milkshops (Dairies, Cowsheds and Milkshops Order, 1885, s. 13). Adopted 12.3.1889. Small Holdings and Allotment Act, 1908. Adopted 25.11.1913. *Relating to underground sleeping rooms, Housing, Town Planning, etc., Act, 1909, s. 17 (7). Adopted 23.9.1913. * These are administered wholly or partly by the Health Committee. The unstarred are administered by other Committees of the Council. Tabular summary of the work of the Sanitary Department during the year and action taken under the Public Health Acts or Bye-laws, etc., mentioned above. Inspections: Number of premises inspected on complaint 3,371 Number of premises inspected in connection with infectious diseases 114 Number of premises under periodical inspection 1,055 Houses inspected from House to House (Housing Acts, 1890 to 1919) 0 Total number of inspections and re-inspections made 16,767 18 Action Taken (other than under Housing Acts, 1890 to 1919) : Cautionary or Intimation Notices Issued 3,455 Number complied with 2,995 Statutory Orders issued 697 Number complied with 535 Summonses served 8 Number of convictions obtained 8 Summonses withdrawn 0 „ dismissed 0 Notices under Section 36 of the Housing, Town Planning, etc., Act, 1909, issued 0 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) 0 Number of houses closed under Section 28 (Housing, Town Planning, &c., Act, 1919) 0 Number of houses found to be in a state dangerous or injurious to health, Section 17 (Housing, Town Planning, &c., Act, 1909) 3 Number of representations made by Medical Officer of Health, Section 17 (Housing, Town Planning, &c., Act, 1909) 3 Number of houses made habitable without closing orders 0 Number of closing orders made by Local Authority, Section 17 (Housing, Town Planning, &c., Act, 1909) 3 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 1 Number of Inspections made 11 Number of contraventions 4 Number remedied 4 Canal Boats used as Dwellings: Number of contraventions of Regulations 5 Number remedied 5 Movable Dwellings, Caravans, Tents, &c.: Number observed during the year 46 Number of nuisances therefrom abated 9 Number removed from district 42 Bakehouses: Number in district 62 Number of Inspections 133 Contraventions of Factory Acts 36 Contraventions remedied 35 Slaughter-houses: Number on register 9 Inspections of carcases, etc. 283 Contraventions of Bye-laws 4 Contraventions remedied 4 Cowsheds: Number on register 1 Number of inspections made 26 Contraventions of regulations 2 Contraventions remedied 2 Number of milch cows in district 34 Dairies and Milkshops: Number on register 125 Number of inspections made 308 Frequency of inspection half-yearly Contraventions of regulations 23 Contraventions remedied 23 19 Unsound Food: Meat (including organs) seized and surrendered 435 lbs. Poultry and game surrendered 0 lbs. Fish surrendered 952 lbs. Fruit and vegetables surrendered 664 lbs. Butter surrendered 10 lbs. Eggs surrendered 5 lbs. Dried Fruit 276 lbs. Tinned Milk 236 lbs. Tinned Vegetables 17 lbs. Tinned Fish 3 lbs. Tinned Fruit 42 lbs. Tinned Meat 42 lbs. Method of disposal 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 (Rag and Bone Dealers) 13 Number of inspections made 24 Contravention of Bye-laws 1 Contravention remedied 1 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 8 Cleansed, repaired, covered, etc. 147 Draw-taps placed on mains 28 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 489 Percentage of houses provided with water closets 100 Drains:— Examined, tested, exposed, etc. 194 Unstopped, repaired, trapped, etc. 229 Waste pipes, rain-water pipes, disconnected, repaired, etc. 217 New soil pipes or ventilating shafts fixed 37 Existing soil pipes or ventilating shafts repaired 105 Disconnecting traps or chambers inserted 52 Re-constructed 19 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 2,092 (b) Phthisis 38 Articles disinfected or destroyed:— (а) Ordinary infectious diseases 7,050 (b) Phthisis 112 Dust: New bins provided 1,365 Periodical frequency of dust removal weekly Method of disposal By tipping and barging 20 Sundry Nuisances abated: Overcrowding 3 Smoke 9 Accummulations of refuse 55 Foul ditches, ponds, etc., and stagnant water 8 Fowls, pigs, and other animals 49 Dampness 261 Yards and forecourts paved, repaved or repaired 306 Walls and ceilings cleansed 2780 Leaky roofs made watertight 561 Additional ventilation provided under floors 165 Dilapidated plaster repaired 1002 Flooring and other woodwork repaired 284 Damp-proof courses inserted 47 Water supply reinstated 34 Washhouse floors repaved 201 Fireplaces and stoves repaired 256 Decayed brickwork repaired and repointed 75 Additional sinks provided 9 Additional light and ventilation to staircases 5 Larders or food cupboards provided 0 Gutters and rainwater pipes repaired 554 Smoke observations 64 Additional water closets constructed 6 Miscellaneous 644 Inspection of Premises where Food is prepared: Butchers' shops 134 Fish shops 77 Eating houses 44 Greengrocers' shops 66 Ice-cream premises 29 Canal Boats Acts, 1877 and 1884.—During the year 72 visits were made to the Canal, and 55 boats inspected. The following Table No. 3 shews the contraventions observed and remedied during the year:— Infringement of the Acts and Regulations with respect to:— Carried forward from 1920. Found during 1921. Remedied during 1921. Carried forward from 1921. (a) Certificates — 1 1 — (b) Habitable condition — 4 4 — Totals — 5 5 — STATEMENT OF STAFF OF HEALTH DEPARTMENT. Contribution of Salary repaid to Council by Government Grant under Appointment. No. of Staff. Whole or part time. Ministry of Health. Board of Education. Special Schools. Special qualification. Public Health Acts. Maternity and Child Welfare Grant. Medical Inspection and Treatment. Provision of Meals. Medical Officer of Health 1 Whole Yes Yes Yes. Yes M.D., D.P.H. Asst. Medical Officer 1 Whole Yes. Registered Asst. Medical Officer 4 Whole Yes Yes Medical Practitioner, D.P.H. Specialist Medical Officers. Mental Deficiency 1 Part Yes M.D., F.R.S.E., L.R.C.P., M.R.C.S. Dermatologist 1 Part Yes Yes B.A., M.D., Ch.B.,F.R.C.S. 21 STATEMENT OF STAFF OF HEALTH DEPARTMENT—Continued. Contribution of Salary repaid to Council by Government Grant under Appointment. No. of Staff. Whole or part time. Ministry of Health. Board of Education. Special qualification. Public Health Acts. Maternity and Child Welfare Grant. Medical Inspection and Treatment. Provision of Meals. Special Schools. Specialist Medical Officers. Ophthalmic Surgeon 1 Part Yes Yes M.A., M.B., B.C., F.R.C.S. Throat, Nose and Ear Surgeon 1 Part Yes Yes F.R.C.S., M.R.C.S., Surgeon 1 Part Yes Yes L.R.C.P. M.B., CH.B., F.R.C.S. Dentist Chief Sanitary Inspector 2 Whole Yes Yes Yes L.D.S., R.C.S. Cert. R.S.Inst., Cert. Meat Inspector, Royal S. Inst. 1 Whole District Sanitary Inspectors 7 Whole Yes Cert. R.S.I., or San. Insp. Ex. Bd., Cert. Meat Inspect. R.S. Inst. Chief Health Visitor 1 Whole Cert. San. Insp. Ex. Bd., Fellow Queen's College, London. Clinic Matrons 2 Whole Yes Yes Trained Nurses. Asst. Matron 1 Whole Yes C.M.B. Certif. Senior Health Visitors 2 Whole Yes Yes Cert. R.S. Inst. Health Visitors 20 Whole Yes Yes or San. Insp. Clinic Nurses 6 Whole Yes Yes Ex. Bd. Home Nurses 8 Whole Yes Trained Nurses, C.M.B. Cleansing Nurses 2 Whole Yes Yes Have had nursing experience. Dental Nurses - 2 Whole Yes Yes Trained nurses. C.M.B. Cert., Cert. R.S. Inst, or San. Insp. Ex. Bd. Nursery Attendant 1 Whole Yes Yes Has had nursing experience. Dispensers 2 Whole Yes Yes Apoth. Hall (Certif.). Special School Nurses 2 Whole Yes Have had nursing experience. Meals Supervisor 1 Whole Yes Asst. Investigator 1 Whole Yes Chief Clerk 1 Whole Yes Yes Principal Asst 1 Whole Yes Yes 1st Class Clerk 2 Whole Yes Yes 2nd Class Clerk 1 Whole 2nd Class Clerk 1 Whole Yes Yes Yes 3rd Class Clerks 4 Whole Yes Yes 3rd Class Clerk 1 Whole Yes Yes Yes 3rd Class Clerks 1 Whole Yes .Yes Yes 4th Class Clerks 6 Whole Yes Yes 4th Class Clerks 4 Whole Yes Junior Clerks 4 Whole Yes Yes 22 HOUSING. Number of new houses erected during the year:— (a) Total 207 (b) As part of a municipal housing scheme 154 2.—Unfit Dwelling-Houses. I.—Inspection. (1) Total number of dwelling-houses inspected for housing defects (under Public Health or Housing Acts) 3,374 (2) Number of dwelling-houses which were inspected and recorded under the Housing (Inspection of District) Regulations, 1910 0 (3) Number of dwelling-houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation 3 (4) Number of dwelling-houses (exclusive of those referred to under the preceding sub-heading) found not to be in all respects reasonably fit for human habitation *251 * Certificates granted under Rent and Mortgage Interest (Restrictions) Act, 1920. II.—Remedy of Defects without Service of Formal Notices. Number of defective dwelling-houses rendered fit in consequence of informal action by the Local Authority or their officers 0 III.—Action under Statutory Powers. A. Proceedings under section 28 of the Housing, Town Planning, &c., Act, 1919. (1) Number of dwelling-houses in respect of which notices were served quiring repairs 0 (2) Number of dwelling-houses which were rendered fit— (а) by owners 0 (b) by Local Authority in default of owners 0 (3) Number of dwelling-houses in respect of which Closing Orders became operative in pursuance of declarations by owners of intention to close 0 B. Proceedings under Public Health Acts. (1) Number of dwelling-houses in respect of which notices were served quiring defects to be remedied *3,371 (2) Number of dwelling-houses in which defects were remedied— (a) by owners †3,239 (b) by Local Authority in default of owners 0 * Includes a certain number outstanding end of year 1921. † Includes a certain number outstanding end of year 1920. C. Proceedings under sections 17 and 18 of the Housing, Town Planning, &c., Act, 1909. (1) Number of representations made with a view to the making of Closing Orders 3 (2) Number of dwelling-houses in respect of which Closing Orders were made 3 (3) Number of dwelling-houses in respect of which Closing Orders were determined, the dwelling-houses having been rendered fit 0 (4) Number of dwelling-houses in respect of which Demolition Orders were made *†5 (5) Number of dwelling-houses demolished in pursuance of Demolition Orders 0 * Demolition Order made 1920. † Further appeal to Minister of Health, 1921. 23 THE THIRTEENTH ANNUAL REPORT FOR THE Year ending 31st December, 1921, ON THE HEALTH OF CHILDREN ATTENDING THE PUBLIC ELEMENTARY SCHOOLS IN WILLESDEN. Giving the Tables required by the Board of Education. Table No. 4—Corresponding to Table 1 of Appendix G of Annual Report of Chief Medical Officer of Board of Education for 1919. Number of Children inspected 1st January, 1921 to 31st December, 1921. A.—Routine Medical Inspection.* Nil. Routine Medical Inspection was not carried out during 1921. * Routine Medical Inspection is medical inspection carried out on the lines of the approved Schedule at the time when routine medical inspection is due and made on the School premises or other place sanctioned by the Board of Education under the Code. B.—Special Inspections. Special Cases. † Re-examinations (i.e., No. of Children Re-examined). Boys 6,657 771 Girls 8,284 1,129 Totals 14,941 1,900 † "Special Cases" are those children specifically referred to the Medical Officer and not due for routine medical inspection under the Code at the time when specially referred. Such children may or may not be of Codegroup age, and may be referred to the Medical Officer at the School or the Clinic by the Committee, Medical Officers-, School Nurses, Teachers, Attendance Officers, Parents or otherwise. In this area, where routine inspections have been suspended and the "ailing children" basis adopted, the number of children dealt with has been entered here. C.—Total Number of Individual Children Inspected by the Medical Ofitcer, whether as Routine or Special Cases (No Child being Counted more than Once in One Year). Number of Individual Children Inspected 10,782 Table No. 5.—Corresponding to Table II. of Appendix G of Annual Report of Chief Medical Officer of Board of Education for 1919. 24 Return of Defects Found in the Course of Medical Inspection in 1921. Defect or Disease. Routine Inspections Specials. Number referred for treatment. Number requiring to be kept under observation but not referred for treatment. Number referred for treatment. Number requiring to be kept under observation but not referred for treatment. (1) (2) (3) (4) (5) Malnutrition — — 88 — Uncleanliness:- Head — — 2,723 — Body — — 29 — Skin Ringworm:— Head — — 263 — Body Scabies — — 202 — Impetigo — — 1,072 — Other Diseases (nontubercular) — — 682 — Eye Blepharitis — — 174 — Conjunctivitis — — 239 — Keratitis — — 7 — Corneal Ulcer — — 3 — Corneal Opacities — — 9 — Defective Vision — — 356 — Squint — — 79 — Other Conditions — — 67 — Spectacles broken — — 383 — Spectacles lost — — 62 — Ear 'Defective Hearing — — 4 — Otitis Media — — 217 — Other Ear Diseases — — 155 — Nose and Throat Enlarged Tonsils — — 86 — Adenoids — — 65 — Enlarged Tonsils and Adenoids — — 353 — Other Conditions — — 634 — Enlarged Cervical Glands (non-tubercular) — — 297 — Defective Speech — — 19 — Teeth Dental Diseases (see Dental Statements) — — — — Heart and Circulation Heart Disease:— Organic — — 26 — Functional — — 25 — Anaemia — — 92 — Lungs Bronchitis — — 438 — Other Non-Tubercular Diseases — — 7 — Tuberculosis Pulmonary :— Definite ... — — 1 — Suspected — — 70 — Non-Pulmonary Definite:— Glands — — 12 — Spine — — 1 — Hip — — 1 — Other Bones and Joints — — 0 — Skin — — 0 — Other forms — — 0 — Suspected:— Glands — — 12 — Bones and Joints — — 9 — Other forms — — 2 — Nervous System Epilepsy — — 25 — Chorea — — 77 — Other Conditions — — 44 — Deformities Rickets — — 6 — Spinal Curvature — — 23 — Other forms Other Defects and Diseases — — 6,739 — Total — — 15,878 — 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. (2) Under the heading "Specials" (see columns 4 and 5 above), are included all special cases which were medically inspected during the year, whether the inspection took place in the Schools or at the Clinics, and from whatever source the cases were derived. Number of Individual Children having Defects which required Treatment or to be kept under observation 10,257 25 Table No. 6.—Corresponding to Table III. of Appendix G of Annual Report of Chief Medical Officer of Board of Education for 1919. Numerical Return of all Exceptional Children in the area in 1921. Boys. Girls. Total. Blind (including partially blind). Attending Public Elementary Schools 1 0 1 Attending Certified Schools for the Blind 7 2 9 Not at School 2 2 4 Deaf and Dumb (including partially deaf). Attending Public Elementary Schools 1 0 1 Attending Certified Schools for the Deaf 13 5 18 Not at School 1 1 2 Mentally Deficient. Feeble Minded. Attending Public Elementary Schools 4 3 7 Attending Certified Schools for Mentally Defective Children †* 65 48 113 Notified to the Local (Control) Authority during year 2 6 8 Not at School † 7 2 9 Imbeciles. At School 0 0 0 Not at School †† 11 2 13 Notified to the Local (Control) Authority during year ††† 3 1 4 Idiots. Notified to the Local (Control) Authority during year 0 1 1 Epileptics. Attending Public Elementary Schools 6 4 10 Attending Certified Schools for Epileptics 4 2 6 Not at School ** 2 2 **4 Physically Defective. Pulmonary Tuberculosis Attending Public Elementary Schools 54 35 89 Attending Certified Schools for Physically Defective Children 4 1 5 Not at School 12 10 22 Other Forms of Tuberculosis Attending Public Elementary Schools 35 29 64 Attending Certified Schools for Physically Defective Children 30 19 49 Not at School 9 9 18 Cripples Other Than Tubercular. Attending Public Elementary Schools 2 0 2 Attending Certified Schools for Physically Defective Children 24 21 45 Not at School 1 3 4 Physically Defective Other Than Tubercular and Other Than Cripples Attending Public Elementary Schools 21 10 31 Attending Certified Schools for Physically Defective Children 23 20 43 Not at School 2 6 8 § Dull or Backward. Retarded 1 year 2 3 5 Retarded 2 years 2 0 2 Retarded 3 years 1 1 2 § Judged according to age and standard. † One boy is also Epileptic. ††† Two boys are also Epileptic. †† Three boys are also Epileptic. * Three boys are also partially blind. ** One boy is also mentally deficient. 26 Table No. 7.—Corresponding to Table IV. of Appendix G of the Annual Report of the Chief Medical Officer of the Board of Education for 1919. Treatment of Defects of Children during 1921. A.—Treatment of Minor Ailments. Defect or Disease. Number of Children. Referred* for Treatment. Treated.† Under Local Education Authority's Scheme. Otherwise. Total. Skin:— Ringworm—Head 263 295 35 330 Ringworm—Body Scabies 202 191 35 226 Impetigo 1,072 1,079 68 1,147 Minor Injuries 682 694 61 755 Other Skin Disease Ear Disease 376 462 66 528 Eye Disease (external and other) 499 575 38 613 Miscellaneous 7,014 6,496 1,256 1 7,752 B.—Treatment of Visual Defects. Number of Children. Referred for Refraction.* Submitted to Refraction. For whom Glasses were Prescribed For whom Glasses were Provided. Recommended for Treatment other than by Glasses. Received other Forms of Treatment. For whom no Treatment was considered necessary. Under Local Education Authority's Scheme— Clinic or Hospital. By Private Practitioner or Hospital. Otherwise. Total. 496 497 1 0 498 457 451 4 5 37 C.—Treatment of Defects of Nose and Throat. Number of Children. Referred for Treatment.* Received Operative Treatment. Received other forms of Treatment. Under Local Education Authority's Scheme—Clinic or Hospital. By Private Practitioner or Hospital. Total. 1,138 174 134 308 1,146 D.—Treatment of Dental Defects. (1) Number of Children dealt with. (2) Particulars of time given and of operations undertaken. Vide 4th Annual Report on Dental Work in connection with children attending the public elementary schools, expectant and nursing mothers and children under 5 years, herewith. * i.e., referred for treatment or refraction during 1921, whether from original inspection or re-examination. † Includes all children who received any treatment during 1921. Some were referred during 1920 or previous years and received treatment in 1921, or in both 1921 and previous years. This applies also to Tables B and C, and Board's Table V. 27 E.—Treatment of Uncleanliness. a) The average number of visits per annum made by the School Nurses to each School 34 (b) The total number of examinations made of children by School Nurses in the year in the Schools 46,010 (c) The number of individual children found unclean 3,537 (d) The arrangements made by the Authority for cleansing, and the number of children cleansed under these arrangements 761 The Authority has established a cleansing room at each of its two Municipal Clinics. Children excluded from School for nitty or verminous conditions are given the opportunity of being cleansed at these Clinics. The mothers are encouraged to attend with the children so that they may see how the cleansing should be carried out. Baths are also given for scabies and other skin conditions as necessary. (e) A record of legal proceedings taken under the Children Act, 1908. or the School tendance Bye-laws. The following information has been supplied by the Chief Education Officer, to whom cases for prosecution are referred. Children Act, 1908. Two cases were taken under this Act:— One case was fined 7s. 6d. One case was adjourned for four weeks, on account of parents' illness, and then withdrawn, as the child was putting in full attendance. School Attendance Bye-Laws. 22 cases were taken under these Bye-laws. In 13 cases fines were inflicted, the amounts ranging from 5s. to 15s., 6 were adjourned or withdrawn, and 3 were dismissed. (f) No. of school sessions at which inspections were conducted 1,074 (g) (i.) Original Inspections:— Children examined 36,030 Children excluded on account of uncleanliness 473 (ii.) Re-inspections:— Children examined 9,980 Children excluded on account of uncleanliness 302 (iii.) Total:— Examinations 46,010 Exclusions on account of uncleanliness 775