Willesden Urban District Council. MED. LIBRARY 1925. THE 50th 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. 2 WILLESDEN URBAN DISTRICT COUNCIL, 1925-26. †mr. Councillor a. e. doran, j.p. (Chairman). ‡†Mr. Councillor W. M. BOLTON (Vice-Chairman). Mr. Councillor T. V. BANISTER (Elected 22nd February, 1926). Mr. Councillor J. H. BIGNELL. *†mr. Councillor H. C. BLAXLAND. †Mr. Councillor C. HICKS BOLTON, M.A. *‡(†Mr. Councillor P. BOND. Mr. Councillor W. L. TRANT BROWN (Died 14th May, 1925). *‡†Mr. Councillor A. CAMERON. Mr. Councillor J. P. CLARKSON. †Mr. Councillor J. CLEE. †Mr. Councillor J. COMBER, J.P. ‡†Miss Councillor N. M. COWAN. Mr. Councillor E. DROWN. Mr. Councillor H. E. DULCKEN. (Elected 20th June, 1925.) Mr. Councillor W. F. FRANKLIN. Mr. Councillor H. L. GAUNTLETT. †Mr. Councillor H. J. GOLBY. ‡†mrs. Councillor K. E. GREGORY. Mr. Councillor W. A. HILL. Mr. Councillor G. H. HISCOCKS. †Mr. Councillor F. HOLMES. Mr. Councillor E. W. B. HUTT. Mr. Councillor W. JEFFRIES. Mr. Councillor E. R. E. JONES. Mrs. Councillor L. A. LARKIN. Mr. Councillor E. J. W. LOKER. Mr. Councillor J. G. MARDELL. ‡†MR. Councillor A. C. MELLUISH. ‡†mrs. Councillor R. MOORE. *†MR. Councillor J. MORSE. Mr. Councillor H. L. MOSSLEY. Mr. Councillor C. REED. ‡†Miss Councillor M. E. ROYLE (Chairman, Hospital Visiting Committee). Mr. Councillor H. J. SAVORY. Mr. Councillor R. T. SEARCH. Mr. Councillor G. A. SEXTON, J.P. *‡†Councillor Dr. G. W. R. SKENE (Chairman, Health Committee). Mr. Councillor A. SMITH, J.P. Mr. Councillor W. A. STILTON. ‡†mr. Councillor H. THORLEY. ‡†Mr. Councillor F. W. W. VIDLER. Mr. Councillor T. WATTS. Mr. Councillor E. L. WESTELL. †Mr. Councillor W. D. WILLISON. Mr. Councillor W. J. WOOD, O.B.E. (Resigned 26th January, 1926.) †Member of Health Committee. ‡Member of Hospital Visiting Committee. *Member of Health Assessment Sub-Committee. WILLESDEN EDUCATION COMMITTEE, 1925-26. Mr. Councillor E. L. WESTELL (Chairman). Mr. Councillor E. W. BRIDGES HUTT (Vice-Chairman). Mr. Councillor T. V. BANISTER. (Elected 23rd February, 1926.) Mr. Councillor C. HICKS BOLTON, M.A. Mr. Councillor W. M. BOLTON. †Mr. Councillor P. BOND. ‡†Mr. Councillor A. CAMERON. †Mr. Councillor J. CLEE. ‡†MR. Councillor J. COMBER, J.P. †Mr. Councillor H. L. GAUNTLETT. Mr. Councillor W. A. HILL. Mr. Councillor G. H. HISCOCKS. ‡†mrs. Councillor R. MOORE. Mr. Councillor J. MORSE. †Miss Councillor M. E. ROYLE. †mr. Councillor A. SMITH, J.P. Mr. Councillor F. W. W. VIDLER. ‡†Mr. Councillor T. WATTS (Chairman of the Children's Care Committee). Mr. Councillor W. J. WOOD, O.B.E. (Resigned 26th January, 1926.) †Mr. C. C. CARTER. ‡†MR. A. R. CLARK. Mr. F. SHEPPARD. Mr. E. B. C. ARROWSMITH. †Rev. A. E. SMITH. Mr. A. E. SMITH. Dr. M. EPSTEIN, M.A., Ph.D. Mr. J. KELLY. ‡†Miss M. ALEXANDER, M.A. †Member of the Children's Care Committee. ‡Member of the Children's Care Assessment Sub-Committee. 3 Town Hall, Dyne Road, Kilburn, N.W. 6. 30th April, 1926. 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 1925. This Report includes:— (i.) The 50th Annual Report on the health and sanitary condition of the district; (ii.) The 18th Annual Report on the health of children attending the public elementary schools; (iii.) The 6th Annual Report on the health of children attending secondary schools; (iv.) The 8th 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 6th Annual Report on home nursing; (vi.) The 11th Annual Report on the provision of meals to children attending the public elementary schools; (vii.) The 34th Annual Report on the Municipal Hospital. The Report is written in accordance with the requirements of the Ministry of Health and Board of Education. VITAL STATISTICS. The population of Willesden at Midsummer, 1925, was 172,503. 2,755 births occurred in Willesden during 1925, giving a birth rate of 15.97'per 1,000 of the population. Excluding the War year 1918, this is the lowest birth rate ever recorded in Willesden. 1,686 deaths occurred in 1925, giving a death rate of 9.77 per 1,000 of the population. The infant mortality rate in 1925 was 62 per 1,000 births. This infant mortality rate is an improvement on the 73 per 1,000 births of 1924, but did not fall to the low level of the two previous years, 1923 and 1922, when it was only 53 and 59 respectively. 170 deaths of infants under one year occurred. 140 or 82.4 per cent. of these 170 deaths were due to:— 1. Congenital Malformations 11, Premature Births 43, Atrophy, Debility and Marasmus 13, Atelectasis 8; 2. Diarrhoea and Enteritis 13; 3. Whooping Cough 13; 4. Measles 3; 5. Bronchitis 6; and 6. Pneumonia 30. Year by year these six causes of death account for some 80 per cent. of all deaths of infants under one year of age and active measures are required to prevent these conditions proving fatal. INFECTIOUS DISEASES. During the year 1925, 1,883 cases of Infectious Disease were notified as compared with 1,458 in the previous year. The total of 1,883 includes 304 notifications of Diphtheria, as compared with 327 in 1924, and 263 cases of Scarlet Fever as compared with 244 in the previous year. Return Cases of Scarlet Fever.—The following statement gives the return cases that have occurred during 1925:— I. Home Cases.—Approximately 28. (a) No. of infecting cases giving rise to return cases not longer than 28 days after release from isolation 0 „ return cases they gave rise to 0 „ infecting cases per cent. of total home cases 0 „ return cases per cent. of total home cases 0 4 (b) No. of infecting cases giving rise to return cases more than 28 days after release from isolation 0 „ return cases they gave rise to 0 „ infecting cases per cent. of total home cases 0 „ return cases per cent. of total home cases 0 II. Hospital Cases.—Approximately 235. (a) No of infecting cases giving rise to return cases not longer than 28 days after discharge 5 „ return cases they gave rise to 5 No. of infecting cases per cent. of total hospital cases 2.1 „ return cases per cent. of total hospital cases 2.1 (b) No. of infecting cases giving rise to return cases more than 28 days after discharge 3 „ return cases they gave rise to 5 „ infecting cases per cent. of total hospital cases 1.3 „ return cases per cent. of total hospital cases 2.1 Small Pox.—There were no cases of Small Pox notified in Willesden during 1925. Typhoid Fever.—6 cases of this disease were notified during 1925, as against 19 in 1924. Of these 6, 1 was treated in the Municipal Hospital, 1 in Park Royal Hospital, and 4 in their own homes. The case removed to the Municipal Hospital was diagnosed as not typhoid fever, and recovered. The case removed to Park Royal Hospital was diagnosed as not Typhoid Fever. Of the 4 cases treated at home 3 recovered and 1 proved fatal, this being the only death recorded from Typhoid Fever during 1925. Acute Encephalitis Lethargica, Acute Poliomyelitis, Acute Polio-Encephalitis, Cerebro-Spinal Fever.—16 cases of these diseases were notified in 1925. 4 Encephalitis Lethargica proved fatal. 1 Cerebro-Spinal Fever proved fatal. 2 Poliomyelitis proved fatal, 1 death being certified as acute infantile paralysis and the other as anterior Poliomyelitis. This latter 1 death was included in 1924, although the case was not notified until 1925. 1 Acute Polio-Encephalitis proved fatal. MOTHERS AND CHILDREN UNDER FIVE YEARS. Municipal Centres.—At the Municipal Clinics, including the Ringworm Clinic, expectant mothers attended the medical consultations on 1,029 occasions; nursing mothers, 7,850, and children under 5,17,240, making a total of 26,119 attendances. These figures when compared with the corresponding figures for 1924 show an increase of 9,037 attendances. The regulations in force as regards the admission of cases to hospital for confinement, and of cases for medical or dental treatment at the Clinics were modified during 1925. The alterations account for the increased number of attendances. Out of the total number of children born in Willesden during the year, 680 or 24.7 per cent. subsequently attended the Welfare Centre. The number of births occurring amongst expectant mothers who attended the Ante-Natal Clinic was 249; 54 per cent. of these mothers with their babies subsequently attended the Welfare Centre. Hospital Maternity Cases.—The following table shows the bookings for hospital confinement under the Council's schemes since hospital provision was first made by the Council for such cases:— Table No. 1.—Hospital Confinement Bookings. Four weeks ended No. of Confinement Cases Booked. 10.4.18 1 18.5.18 1 15.6.18 1 13.7.18 2 10.8.18 22 7.9.18 23 5.10.18 13 2.11.18 14 30.11.18 10 28.12.18 12 Total (1918) 99 5 Table No. 1.—Hospital Confinement Bookings—continued. Four weeks ended No. of Confinement Cases Booked. 25.1.19 14 New Council 1919-22. 22.2.19 13 22.3.19 17 19.4.19 12 17.5.19 16 14.6.19 17 12.7.19 21 9.8.19 20 6.9.19 25 4.10.19 36 1.11.19 20 29.11.19 26 27.12.19 30 Total (1919) 267 24.1.20 43 Memo. 24.3.20. Hospital full. Cases from half of district only admitted. Memo. 8.6.20. Cases admitted from whole of district, but for medical reasons or home circumstances only. 21.2.20 41 20.3.20 32 17.4.20 23 15.5.20 24 12.6.20 32 10.7.20 43 7.8.20 36 4.9.20 31 2.10.20 37 30.10.20 40 27.11.20 28 25.12.20 34 Total (1920) 444 22.1.21 31 £2 fee imposed at Council meeting, 22.3.21. 5.5.21. Cases to be booked for Hospital limited to 28 per month or 336 for the year (including Expectant and Nursing Mothers). 19.2.21 34 19.3.21 36 16.4.21 35 14.5.21 40 11.6.21 18 9.7.21 28 6.8.21 12 3.9.21 19 1.10.21 18 29.10.21 29 26.11.21 23 31.12.21 (5 weeks) 12 Total (1921) 335 28.1.22 27 Memo, re cases living in more than 3 rooms to show sound reason why they should be booked. New Council 1922-1925. From 1.4.22. cases to be booked for hospital not to exceed 32 per month (including Expectant and Nursing Mothers). Illegitimate cases not admitted, except on surgical grounds after 23.5.22. 25.2.22 33 25.3.22 22 22.4.22 15 20.5.22 24 17.6.22 19 15.7.22 31 12.8.22 22 Carried forward 193 6 Table No. 1.—Hospital Confinement Bookings—continued. Four weeks ended No. of Confinement Cases Booked. Brought forward 193 14.9.22. Letters handed to applicants that they would probably go to Park Royal Hospital. Conditions re payment in advance and with-holding Admission Cards until payment complete imposed. 9.10.22. Solicitor's revised Admission Form and signature of husband required. 9.9.22 17 7.10.22 18 4.11.22 10 2.12.22 21 30.12.22 7 Total (1922) 266 • 27.1.23 28 New Scheme, 1.4.23. On and after Midnight 30.4.23, cases sent to Park Royal Hospital. Council meeting 29.5.23. Illegitimate cases 12 months residents of Willesden may be booked. 24.2.23 20 24.3.23 19 21.4.23 5 19.5.23 7 16.6.23 5 14.7.23 14 11.8.23 10 8.9.23 8 6.10.23 6 3.11.23 1 1.12.23 6 29.12.23 11 Total (1923) 140 26.1.24 9 Letter from Board of Guardians—Special Ward will not be reserved for Council cases after 1.4.24. Revised new scheme in force, 25.9.24 (Council meeting 23.9.24.) 23.2.24 3 22.3.24 8 19.4.24 6 17.5.24 2 14.6.24 6 12.7.24 10 9.8.24 11 6.9.24 4 4.10.24 11 1.11.24 10 29.11.24 4 27.12.24 11 3.1.25 (one week) 4 Total (1924) 99 31.1.25 10 New Council, 1925-1928. 28.2.25 13 28.3.25 7 25.4.25 8 23.5.25 9 20.6.25 11 18.7.25 8 15.8.25 9 12.9.25 12 10.10.25 14 7.11.25 14 5.12.25 14 2.1.26 17 Total (1925) 146 7 During 1925, 136 maternity cases were admitted to Park Royal Hospital under the Council's scheme. Of these 136 women 127 were confined, and 9 proved not to be in labour. Of the 127 who were confined 126 were delivered of live infants, and in 1 case the child was born dead. The following table gives particulars of the 127 confinements:— Table No. 2.—Giving Particulars as to Confinements of Maternity Cases admitted to Park Royal Hospital under the Council's Scheme during 1925. Normal Confinement 88 Infant Premature weight 4 lbs. 1 Child Talipes Calcaneovalgus (left foot worse) 1 Slight Conjunctivitis not purulent 1 Ophthalmia Neonatorum recovered 1 Mother Systolic bruit 1 Child 9 1bs. 13 ozs. one Suture Perineum, mother but little milk 1 One suture perineum 2 Unreduced left Occipito Posterior 1 Right Occipito Posterior Vertex 1 Right Sacro Anterior 1 Uterine Inertia 2 Puerperal Mania, slight 1 Adherent Placenta 1 Adherent Placenta, perineum sutured, chloroform, uterus wiped out with iodine because of a rigor. Perineorrophy 17th day 1 Born before admission 3 Born before admission—severe haemorrhage—child large cephalhematoma 1 Forceps, left Occipito Anterior, infant 6 lbs. 12 ozs. 1 Forceps, male child 8 lbs. 6 ozs., Congenital Hydrocele 1 Forceps uterine inertia 2 Chloroform, uterine inertia, forceps delivery 1 Uterine inertia, primary forceps delivery, chloroform, small measurements 1 Forceps delivery, small measurements, slow 2nd stage 1 Forceps, delayed 2nd stage 1 Forceps, vertex, slow 2nd stage 1 Albuminuria, small measurements, chloroform 1 Induction of labour 1 Mother pyelitis albuminuria, induction 14.10.25, confined 15.10.25, twins, chloroform and forceps because of slow progress (male vertex, female podalic version), adherent placenta, male child 4 lbs. 8 ozs., female 3 lbs. 12 ozs 1 Adherent placenta, chloroform, manual extraction, perineum 1 suture 1 Chloroform administered, cephalic version, twin boy 4 lbs., died 3rd day, twin girl 4 lbs. premature, 1 vertex female, 1 footling male, normal labour 1 Cephalic version before admission, footling, forceps after coming head, small vaginal orifice ... 1 Small round pelvis, induction 16.10.25, confined 18.10.25,chloroform, forceps, large caput succedaneum, 1 suture in perineum, right occipito anterior, male child slight facial paralysis 1 Unreduced occipito posterior 1 Unreduced occipito posterior, axis traction, forceps and chloroform, 3 sutures perineum, child slight facial paralysis 1 Caesarean section 1 127 Hospital Treatment of Children under 5 Years of Age.—The following table gives particulars of the children under treatment at the Willesden General Hospital and St. Monica's Home Hospital under the Council's scheme during 1925:— Table No. 3. - Willesden General Hospital. St. Monica's Home Hospital. Total. No. of Children in Hospital at 31st December, 1924 0 1 1 No. of Children admitted during 1925 77 6 83 Total No. of Children under treatment during 1925 77 7 84 No. of Children discharged during 1925 75 5 80 No. of Children died in Hospital during 1925 1 0 1 Mortality % 1.3 0 1.2 No. of Children remaining in Hospital at 31st Dec., 1925 1 2 3 8 The following table gives particulars of the conditions for which children were admitted during 1925, the treatment carried out and the results of such treatment:— Table No. 4.—Children under 5 Years Admitted to Hospital during 1925. Condition. No. Admitted. Forms of Treatment. Result of Treatment. Operative. General. Other forms. Remedied. Improved. Unchanged Died. In Hospital at end of 1925. Marasmus 15 - 15 - 3 10 - 2 2 Enlarged Tonsils and Adenoids *68 67 — — 67 — — — 1 Total 83 67 15 - 70 10 — 2 3 *One case not operated on. Puerperal Fever.—During 1925 16 cases of Puerperal Fever were notified. This gives a case rate of 5.80 per 1,000 registered births, as against 2.90 in 1923, and 4.20 in 1924. 2 of these notified cases proved fatal, which gives a case mortality of 12.50 per cent., as against 16.7 per cent. in 1924, and a maternal mortality from this cause of 0.7 per 1,000 births. The maternal mortality from all causes was 2.2 per 1,000 births. In 8 of the 16 notified cases a private doctor was in attendance at birth, in 1 case the doctor arrived after the birth of the child, in 3 cases the birth was attended by a midwife, in 1 case the mid wife arrived after the birth of the child, and in 3 cases the birth occurred in a Hospital. The other particulars of the cases are as follows:— Table No. 5. 1 case miscarriage 5 months. 4 cases instrumental delivery (1 stillborn—macerated foetus). 1 case breech presentation—chloroform—post partum hæmorrhage. 1 case prolonged labour—post partum hæmorrhage. 1 case cord round neck, otherwise normal. 6 cases normal as far as ascertained. 2 cases—no details. 16 3 cases were treated at home. All recovered. 5 cases were treated in hospitals outside Willesden, 1 proved fatal, 3 recovered and 1 was still in hospital and improving at end of year. 6 cases were treated in Park Royal Hospital, 1 (miscarriage) proved fatal and 5 recovered 2 cases were treated in the Municipal Hospital and recovered. 16 Puerperal Fever Cases, 1925. Home Circumstances. Table No. 6. Number of Cases. Number of Rooms. Number of occupants, including new-born baby. Under 10 years. Over 10 years. Total. 2 1 1 2 3 2 1 2 2 4 1 1 3 2 5 1 2 2 2 4 1 3 1 2 3 1 3 1 4 5 1 3 2 (no baby, stillbirth) 2 4 1 4 1 2 3 1 5 1 5 6 2 No record (1 occurred in Paddington). Occurred in hospitals. 3 9 Ophthalmia Neonatorum.—The number of cases of this disease notified during the year was 37, giving a case rate of 13.4 per 1,000 registered births. A private doctor attended at the confinement in 16 cases, a midwife in 17 and the remaining 4 cases were born in hospital. Treatment was obtained at a hospital in 8 cases, at the Municipal Clinics in 15 cases, at a voluntary clinic in 1 case and by a private doctor at home in 13 cases. Complete recovery with unimpaired vision occurred in 34 cases, in one case one eye was permanently injured, while two cases were still under treatment at the end of the year. During the year the Health Authority took out summonses against two persons for failure to notify under the Public Health (Ophthalmia Neonatorum) Regulations, 1914. In one case—a doctor— the summons was dismissed, but in the other case—a midwife—the defendant was fined £20. Subsequently this midwife was struck off the roll. School for Mothers at Clinic 1.—The year as a whole may be considered satisfactory. There has been a total attendance of 2,953 mothers and 3,034 children. The average attendance of mothers per session was 12.56. These figures for the attendance of mothers show an increase of 643 on the total and 3.0 on the average attendances compared with the previous year. The children who attended with their mothers shewed a very satisfactory standard of clothing and personal hygiene. Thirty expectant mothers availed themselves of the opportunities afforded them of learning how to make baby outfits and other necessary things. Bathing demonstrations have been given on various occasions, the mothers kindly lending their babies. An exhibition was held on the 16th, 17th and 18th of December, for the purpose of showing the different garments made by the mothers. Over 80 garments were exhibited. There was also a dietary and a bathing section. Both were highly appreciated. A talk was given on each of the days of the exhibition as follows:— "Household Hints" by Miss Holman, Meals Supervisor; "Care of the Teeth," by Mr. Jennings, Dental Officer; and "Health Talks" by Dr. Skene, Chairman of the Health Committee. Many scholars from the Council schools put in an appearance, and were undoubtedly very much interested in the lectures and Exhibition. School for Mothers at Clinic 2.—The total attendance at this school for mothers, with 3 sessions weekly, apart from school holidays, were 708 mothers and 425 children, giving an average per session of 6.1 mothers and 3.6 children. The classes have been continued on the same lines and under the same conditions as in 1924 Insufficient room seriously hinders the work. At Clinic 2, 858 mothers attended medical consultations on 5,161 occasions, yet the accommodation for the Mothercraft Class is only sufficient for 6 mothers and the Nursery for 6 children. There is evidence that class instruction in Infant Care and Management and Home and Social Hygiene is popular with and useful to the mothers, and it is suggested that a valuable opportunity for health propaganda at this Clinic is not being utilised. School for Mothers at Lower Place.—For the second year in succession Mothercraft Classes have been held in the Medical Inspection Centre, where, as reported in 1924, the attendances have outgrown the accommodation. With 1 session weekly the attendances of mothers amounted to 413 and of children 353, giving an average per session of 9.8 mothers and 8.4 children. Good mothering and improved home conditions are urgently needed in this district. The mothers are interested in the classes, and if facilities for teaching were available the need to a large extent would be met. The children and prams are cared for in the lobby, 14¼ ft. X 13½ ft., which is badly lighted, ill-ventilated and cold and where the space does not permit the children to run about. The premises do not answer the purpose for which they are required. Subjects of Health Talks. The Health Talks given by members of the Health Staff at the foregoing Schools for Mothers included talks on the following subjects:— (1) Composition of Air. Respiration. (2) Effects of impure air. Colds. Bronchitis. Effects of pure fresh air. (3) Ventilation. Arrangement of bedroom. Draughts. (4) Sunlight—Health giving properties. Nature's disinfector. (5) Visible dirt. Invisible dirt. Method of cleansing room to get rid of both. 10 (6) Sickness and its probable causes. (7) Home nursing of— Broncho-pneumonia. Whooping Cough. Consumption. (8) First aid treatment of burns, scalds, etc. (9) The different kinds of food. (a) Body building. (b) Energy and warmth producing. (c) Purifying foods. Water. Other factors. (10) The use of food— Growth—warmth—repair—energy. Special usefulness of different kinds of foods. Outline of digestive process. (11) Why people eat various kinds of food, and why they are wise to do so. The consequences of eating too much. The importance of taking food at regular intervals. The consequences of taking food which is unsuitable to the age or habits of the individual. (12) Rickets. Defective teeth. (13) Breast feeding. (14) Weaning. (15) Feeding of child 1 to 3 years. (16) How to make—Albumen water. Peptonised milk. Whey. (17) The Health of the Mother—Personal Hygiene—Rest—Food and Exercise. (18) Talk to Nursing Mothers. (19) Care of the Expectant Mother. (20) Baby's exercise and sleep. (21) Possible cause of fretfulness in infants and young children. Practical Demonstrations.—These included :— (1) How to make and apply a linseed poultice. (2) How to prepare and apply a fomentation and turpentine stupe. (3) How to bathe and dress an infant. (4) How to prepare baby's bottle. (5) How to give a blanket bath. (6) How to improvise a meat safe and butter cooler. THE SCHOOL MEDICAL SERVICE. Schools.—There are 35 public elementary schools in the district. Of this number 23 are Council and 12 church or non-provided schools. Included in the number of the Council schools are 3 special schools, 1 for mentally defective and 2 for physically defective children. Two of the Council schools are temporary buildings. The hygienic condition of the schools in Willesden is very variable. Many of the more modern schools leave little to be desired as regards ventilation, lighting, warming, equipment and sanitation, but some of the other schools fall short of the standard desirable. Water to the schools is supplied in all instances direct from the mains of the Metropolitan Water Board. Adequate facilities are provided for the supply of drinking water for the scholars. I have on several occasions reported on the unsatisfactory condition of the sanitary conveniences provided at the Boys' Department of St. Andrew's School, with the result that during the year plans were submitted and passed by the Council for the erection of a new annexe. The work has been carried out and the building fitted with new modern waterclosets and adequate provision made for urinal accommodation. Co-ordination with Other Health Services.—Since January, 1925, an arrangement has been in force whereby the records of infancy of each child, obtained by the Health Nurses at their visits or by the Clinic Medical Officers as a result of the child being brought to one of the Council's Child Welfare Clinics, are carried forward in the form of a summary on to the child's school medical inspection card. The School Medical Officers at their inspections are thus provided with valuable information as to the previous medical history of the entrants they are examining. 11 Medical Inspection.—During 1925 the average number of scholars on the Public Elementary School Rolls in Willesden was 21,649. The following groups of children were examined during the year:— (1) All children admitted to school for the first time; (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. The total number of children medically inspected at routine and special inspections during 1925 was 13,332. Findings of Medical Inspections.—(a) Uncleanliness.—Cleanliness inspections were carried out in the schools on 779 occasions during the year 1925, the average number of visits paid to each school by the Health Visitor being 24. The total number of examinations and re-examinations made during the year was 46,490. The effect of this work is well illustrated in the following table:— Percentage of nitty and verminous children recorded upon routine inspection at the schools from year to year since 1914:— Table No. 7. 1914 20% 1915 23% 1916-19 Results not recorded owing to war. 1920 11.9% 1921 9.8% 1922 8.3% 1923 8.2% 1924 7.1% 1925 6.0% (b) Tonsils and Adenoids.—During 1925, at routine and special medical inspections, 2,033 cases of enlarged tonsils and adenoids were discovered, as compared with 1,348 found in 1924, an increase of 685 or 51 per cent. (c) Skin Disease.—During 1925, at routine and special medical inspections, 1,519 cases of skin disease were detected, as compared with 1,152 cases in 1924, an increase of 367 or 31 per cent. About one-third of this increase was made up of cases of impetigo, and the remainder by miscellaneous skin affections. No significant alteration occurred in the numbers of other defects found at medical inspections. Infectious Diseases.—The action taken to detect and prevent the spread of infectious diseases was substantially the same as set forth in my Annual Report for 1913. Minor alterations were, however, made by the Education Committee in June, 1925, in their regulations with regard to the closure of and exclusion from school, in order to bring these regulations into accord with the principles laid down bv the Ministry of Health and Board of Education in their joint memorandum on this subject issued in 1925. These alterations are as follows:— (a) Scarlet Fever.—Contacts who have not previously suffered from the disease are excluded and re-admitted 7 days, instead of 10 days, after the date of disinfection. (b) German Measles.—Children suffering from this disease are now re-admitted 2 weeks, instead of 3 weeks, from the date of onset. (c) Mumps.—In cases of this disease the date of re-admission was also altered to 2 weeks, instead of 3 weeks from the date of onset. Moreover it was decided not to exclude any contacts from school, whether they had previously suffered from the disease or not. (d) Meningitis, Poliomyelitis and Encephalitis Lethargica.—The direction not to exclude contacts from these diseases was qualified by the addition of the phrase "Except on instructions of Medical Officer of Health." Following Up.—All defects found at medical and dental inspections are notified to the parents, and it is the duty of the Health Nurses to follow up these cases in their homes in order to ascertain if the necessarv treatment has been obtained. If nothing has been done she again explains the necessity for treatment to the parent, and advises as to the best method of obtaining such treatment. Besides following up the Nurse undertakes the following work:— (a) Preliminary visits to schools a few days before a medical inspection for the purpose of weighing, measuring, testing the vision and examining the scalps, bodies and clothing of the children. (b) Attending the medical inspections and preparing the children for examination by the School Medical Officer. (c) Paying periodical visits to the schools for the purpose of cleanliness inspections, which are held weekly in each school, as far as this is practicable. (d) Weekly visits to the schools to confer with the Head Teachers as to cases requiring attention. (e) Attendance at the police court from time to time, as required, in connection with prosecutions under Section 87 of the Education Act, 1921 (verminous children). The Dental Nurse attends the dentist at the school dental inspections and keeps dental records. Only one visit is at present paid in connection with each case requiring dental treatment, and this appears to be insufficient to secure the necessary treatment for these children. Medical Treatment.—During the year 1925 school children were followed up by the Health Department on account of 18,701 medical defects and 8,818 dental defects. Of those defects found to require treatment, medical or dental treatment was obtained for 11,363 and domestic treatment was obtained for 6,367. 88.6 per cent. of the medical defects were treated, 52.9 per cent. receiving medical treatment and 35.7 per cent. domestic treatment; 22 per cent. of the dental defects followed 12 up were treated. No record is available of defects requiring treatment which were not followed up. Of the total medical defects treated 83 per cent., and of the total dental defects treated 96 per cent., were dealt with by the Education Committee. The remainder, or 17 per cent, of the medical defects and 4 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 46,818 attendances at the School Clinics in 1925, as compared with 37,305 in the previous year, 1924. In April, 1923, and again in September/October, 1924, revised schemes for Maternity and Child Welfare and School Medical Treatment came into force. The following table shews the effect of the revisions made from time to time on the attendances at the Council's Clinics:- Table No. 8. Four weeks ending M. & C.W. Clinic Attendances. S.M.S. Clinic Attendances. Total Clinic Attendances. Remarks. 22.1.21 3,953 5,250 9,203 Includes holidays. 19.2.21 4,140 7,205 11,345 19.3.21 3,875 7,250 11,125 16.4.21 3,697 5,292 8,989 Includes holidays. 14.5.21 4,125 6,558 10,683 11.6.21 3,497 5,321 8,818 Includes holidays. 9.7.21 3,505 6,004 9,509 6.8.21 3,147 3,381 6,528 Includes holidays. 3.9.21 3,420 3,290 6,710 Includes holidays. 1.10.21 3,557 5,990 9,547 29.10.21 1,971 2,824 4,795 Registration fee imposed 1/10/21 for M. and C.W. and S.M.S. 26.11.21 2,022 3,083 5,105 31.12.21 (5 weeks) 2,320 3,302 5,622 Includes holidays. Totals, 1921 (53 weeks) 43,229 64,750 107,979 28.1.22 2,076 2,781 4,857 Includes holidays. 25.2.22 2,516 3,443 5,959 25.3.22 2,334 3,423 5,757 22.4.22 2,117 2,459 4,576 Includes holidays. 20.5.22 2,340 3,196 5,536 17.6.22 2,117 2,767 4,884 Includes holidays. 15.7.22 2,168 3,640 5,808 Registration fee withdrawn 10.7.22 in respect of S.M.S. only. M. and C.W. registration fee still operative. 12.8.22 1,998 2,360 4,358 Includes holidays. 9.9.22 2,115 2,693 4,808 Includes holidays. 7.10.22 2,350 5,378 7,728 4.11.22 2,238 5,191 7,429 Includes holidays. 2.12.22 2,265 5,559 7,824 30.12.22 1,765 4,124 5,889 Includes holidays. Totals, 1922 (52 weeks) 28,399 47,014 75,413 27.1.23 2,123 4,627 6,750 Includes holidays. 24.2.23 2,032 5,339 7,371 24.3.23 2,323 4,841 7,164 Registration fee in respect of M. and C.W. withdrawn 28.2.23. 21.4.23 2,284 3,254 5,538 Includes holidays. First Revised M. and C.W. and S.M.S. Schemes came into operation, 1.4.23. 19.5.23 2,284 3,266 5,550 Includes holidays. 16.6.23 2,082 3,008 5,090 14.7.23 2,230 3,139 5,369 11.8.23 1,889 1,959 3,848 Includes holidays. New Declaration Form for M. and C.W. Cases in force, 30.7.23. 8.9.23 1,304 1,617 2,921 Includes holidays. 6.10.23 1,558 3,547 5,105 Includes holidays. 3.11.23 1,473 3,426 4,899 1.12.23 1,235 3,543 4,778 29.12.23 987 2,414 3,401 Totals, 1923 (52 weeks) 23,804 43,980 67,784 13 Table No. 8 (continued). Four weeks ending. M. & C.W. Clinic Attendances. S.M.S. Clinic Attendances. Total Clinic Attendances. Remarks. 26.1.24 1,219 2,435 3,654 Includes holidays. 23.2.24 1,477 3,527 5,004 22.3.24 1,477 3,476 4,953 19.4.24 1,203 2,792 3,995 Includes holidays. 17.5.24 1,272 2,984 4,256 Includes holidays. 14.6.24 1,200 2,914 4,114 Includes holidays. 12.7.24 1,428 2,897 4,325 9.8.24 760 1,155 1,915 Includes holidays. Clinic 2 closed for repairs. 6.9.24 745 960 1,705 Includes holidays. Clinic 2 closed for repairs. 4.10.24 1,614 3,452 5,066 Second Revised M. and C.W. Scheme in operation 25.9.24 Second RevisedS.M.S. Scheme in operattion 3.10.24. 1.11.24 1,831 3,815 5,646 29.11.24 1,771 3,614 5,385 3.1.25 (5 weeks) 1,605 3,284 4,889 Includes holidays. Totals, 1924 (53 weeks) 17,602 37,305 54,907 31.1.25 1,744 3,356 5,100 Includes holidays. 28.2.25 1,861 4,167 6,028 28.3.25 2,174 4,759 6,933 25.4.25 1,971 3,188 5,159 Includes holidays. 23.5.25 2,184 4,248 6,432 20.6.25 1,957 3,700 5,657 Includes holidays. 18.7.25 2,062 3,843 5,905 15.8.25 1,882 1,613 3,495 Includes holidays. 12.9.25 2,141 2,738 4,879 Includes holidays. 10.10.25 2,558 4,722 7,280 7.11.25 2,457 4,533 6,990 5.12.25 2,258 3,671 5,929 2.1.26 1,806 2,280 4,086 Includes holidays. Totals, 1925 (52 weeks) 27,055 46,818 73,873 Arrangements for Medical Treatment.—(a) Minor Ailments of school children are treated every morning at the two Municipal Clinics under the directions of the Clinic Medical Officers. (b) Tonsils and Adenoids.—These cases are examined at the Clinics by the Medical Officers, and are referred, if necessary, to the Council's ear, nose and throat specialist, who attends each Clinic once a month. This specialist advises as to operative treatment for this condition, and where operation is advised and the parents are willing the children are admitted to the Willesden General Hospital for this purpose under an arrangement of the Council with the hospital, the parents being required to contribute towards the cost of the treatment according to their means on the basis of the Council's economic circumstances scale. (c) Tuberculosis.—The Tuberculosis Authority for the area is the Middlesex County Council, to whose Tuberculosis Officer all children suspected or known to be suffering from this disease are referred. (d) Skin Disease in school children is usually dealt with in the same way as minor ailments, but special cases and, in particular, all cases of ringworm, are referred to the Council's skin specialist, who attends at Clinic No. 1 once a fortnight for this purpose. This specialist has at his disposal an X-Ray apparatus for the treatment of ringworm. Moreover, during 1925, the Council was presented with a carbon arc lamp for artificial sunlight treatment by the Save the Children Fund. This lamp has been in use since November 16th, 1925, and is employed for the treatment of various diseases and affections, including rickets, alopecia areata, general debility, etc. This treatment is carried out under the direction of the skin specialist, who attends once a week for the purpose of examining children and prescribing treatment, to which six sessions a week are devoted. 14 (e) External Eye Disease and Defects of Vision.—Children suffering from these conditions are examined by the Clinic Medical Officers and treatment or glasses prescribed. Treatment, for which there are facilities at the Clinics, is given free, but the provision of glasses and their repair is charged for in accordance with the Council's economic circumstances scale. The Council's Consulting Ophthalmic Surgeon attends each Clinic once a month, and any special cases are referred to him by the Clinic Medical Officers. (/) Ear Disease and Hearing.—Children suffering from ear disease or deafness are examined by the Clinic Medical Officers and simple treatment given, special cases being referred to the Council's ear, nose and throat specialist or the parents given a medical notice advising them to consult their own doctor. (g) Dental Defects.—An account of the treatment of these defects is given in the report of the Council's Dentist attached hereto. A review of the present arrangements for dental inspection and treatment, together with recommendations for the improvement and extension of this service, is given in a special report presented to the Children's Care Committee on December 9th, 1925, which will be found in Appendix L. (h) Crippling Defects and Orthopcedics.—No general scheme for the treatment of such defects has yet been adopted, work of this kind being at present limited to the provision of instruments in necessitous cases and the maintenance of crippled children in special institutions, such as the Heritage Craft School Chailey, Sussex, and the Royal National Orthopaedic Hospital, Great Portland Street. These institutions provide not only treatment for the medical conditions of the children, but also education, being certified for this purpose by the Board of Education. Open-Air Education.—(a) Playground Classes.—As a rule classes are not held in the playgrounds of the schools, although in the warm days of summer a few schools give open-air lessons. The majority of the school playgrounds, however, are not suitable for such classes. When the weather is fine physical exercises and organised games are always taken in the playground. (b) School Journeys.—These are frequently taken by the upper standards in the majority of the schools, such places as Kew Gardens, the Zoological Gardens, or the local parks being visited. (c) School Camps-There is no system of school camps in operation, but many children take advantage of the camps organised by the Boy Scouts, Girl Guides, etc. (d) Open-Air Classrooms.—There are no open-air classrooms in any of the schools. (e) Open-Air Schools.—A full account of the position at the end of 1924, with regard to this question, was given in my last annual report. For the financial year 1926-27 a sum of £200 has been provided in the estimates for the provision of an open-air school. In January the Board of Education's Circular 1,349 was received, drawing attention to the lack of open-air accommodation for defective children in some areas. In October the School Medical Officer was instructed to report on a site in Pound Lane as regards its suitability for the purpose of an open-air school, and in view of the report made the Children's Care Committee came to the conclusion that this site was not large enough for this particular purpose. At the present time another and larger site is under consideration. Physical Training.—The Board of Education's syllabus is used in every school, and this part of the curriculum is carefully supervised. Children are frequently referred by Head Teachers and parents to the School Medical Officers for advice with regard to physical training, and games and special instructions are given for the correction of certain defects (e.g., kyphosis, scoliosis, flat-foot, etc.) by such means. In the girls' schools special attention is paid to the teaching of folk and country dancing. There is a strong local folk dancing society which holds inter-school competitions. Dancing is taught in some of the boys' schools and an effort is being made to increase the teaching of this side of physical training. Sports are well organised in both the boys' and girls' schools. Periodical matches are held throughout the year, and there is also an annual athletic competition between the schools. Swimming is also well organised and efforts are being made to develop this by the provision of more swmming baths. An annual swimming gala is held in the King Edward Open-Air Bath. Co-operation of Parents, Teachers and Attendance Officers.—The co-operation of parents in the work of the School Medical Service is increasingly satisfactory. This continued improvement is largely due to the excellent work of the Health Nurses, ably seconded in many cases by the Teachers, with whom they keep in close touch by means of the weekly visits they pay to the schools whenever possible. The remarkable improvement noticeable in the standard of cleanliness and tidiness of the children in some of the schools during the past few years would have been impossible without the enthusiastic co-operation of the Head Teachers concerned. Similarly the co-operation of the School Attendance Officers with the School Medical Service continues to be of the greatest advantage to both departments. The cordial relations that exist in nearly all cases between the parents and the Health Nurses are largely the outcome of the visits paid by the latter to the children's homes in connection with defects which have come under notice and in connection with their work among the children prior to their admission to school. Co-operation of Voluntary Bodies.—(1) Invalid Children's Aid Association (Willesden Branch).-—The objects of this Association are:— (1) To visit regularly the invalid and cripple children of this district. (2) To help the parents to procure competent medical advice and to act upon it. (3) To obtain admission for the children into suitable hospitals, convalescent or nursing institutions. (4) To supply surgical instruments and appliances, and supervise their use, and to lend spinal carriages. 15 The aim of the I.C.A.A. is to encourage parents in all efforts for the good of their invalid children and not to interfere with their responsibility. When expenditure is incurred the parents are asked to contribute. During 1925 the Willesden Branch of the I.C.A.A. had 123 new cases referred to it, of which 54 were referred by the medical staff of the Council. 75 children were sent to convalescent homes, 10 to nursing homes, 2 to special hospitals and 6 were boarded out. Surgical boots and appliances were provided in 33 cases. (2) National Society for the Prevention of Cruelty to Children.—During 1925 this Society investigated in the Willesden area 101 cases of alleged cruelty to children. Of these 87 were cases of neglect, 10 of ill-treatment and 4 of other wrongs. 276 supervisions were made, affecting 272 children and involving 143 offenders (82 male and 61 female). Two prosecutions were instituted, a conviction being recorded in each case. Of the above cases 41 were reported to the Society by this Authority. In 1 case so reported the Society's Medical Branch arranged for hospital treatment. (3) Central Association for Mental Welfare—Willesden After-Care Association.—The objects of this Association are fully set forth in my Annual Report for 1919, page 17. The Association had 140 cases on its books at the end of 1925, 18 new cases were referred during the year and 128 visits were paid. 2 girls were placed in institutions, 1 was sent to a Mental Hospital for treatment and 2 were sent to voluntary training homes. Visits were paid to girls in service and to the homes of others who were looking for work, and parents were advised and helped with suggestions about home training. An Occupation Centre is held every afternoon during school term at Pember Hall, Kilburn, from 2.30 to 4.30 p.m. There are 16 children who attend regularly. (4) The Middlesex Memorial to King Edward VII.—The object of this fund is to send necessitous children attending Middlesex schools to the seaside for a holiday or convalescence. During 1925 35 boys and girls from Willesden were received at the Children's Hostel, Heme Bay, of whom 10 had a fortnight's holiday and 25 a week. (5) Willesden Open-Air Fund.—During 1925 this Fund sent away 48 children for an aggregate period of 128 weeks. Most of these children were sent to Dover, but 8 girls went to Wrotham, in Kent, where they stayed in cottages on a farm, and 2 or 3 went to Chorley Common. Abnormal Children.—Under this category are included the following classes of children— merely dull or backward, Mentally Defective (feeble-minded), Imbecile, Moral Imbecile, Idiot, Physically Defective, Blind or Partially Blind, Deaf-mute or semi-mute or semi-deaf, and Epileptic. These cases are reported to the Authority by Parents, Head Teachers, Health Nurses, School Attendance Officers, Hospitals and similar Institutions, Voluntary Societies and Private Medical Practitioners. They are submitted to a special medical examination and are placed in a Special Day or Residential School or ordinary elementary school according to the character and degree of the abnormality. During the year 1925, 430 special children were examined or re-examined. Of the 152 original examinations included in the 430 examined, 32 were found to be physically defective, 36 mentally defective, 2 idiots, 2 imbeciles, 10 blind or partially blind, 5 deaf or partially deaf, 4 epileptics, 30 dull or backward, 20 debilitated and anaemic, and 11 normal. The types of children most difficult to deal with are the dull and backward and those physically defectives suffering from anaemia and debility and other diseases in an incipient stage. Dullness and backwardness may be due to defective intelligence, but in many cases it is caused by impaired vitality due to defective frame, improper feeding and unfavourable environment. If these children are compelled to attend an ordinary elementary school and more particularly one where ventilation and lighting are deficient and where the general hygienic conditions are subnormal, their condition cannot improve and in every probability it will be aggravated. If they are kept away from their school their education must suffer. What they require is teaching under the best possible hygienic conditions and this can be accomplished at an open-air school, where the child will be fed regularly and properly, given an adequate amount of play and rest and treated with sunshine, baths and exercises in the open air. The child who is dull or backward but whose general health is good, also requires special consideration. He cannot receive the individual attention and particular supervision he requires in a class of an ordinary elementary school suitable to his age, and there are many objections to older children being taught in classes where the large majority of the children are considerably younger. In fact these children require special classes for themselves, where the numbers are limited and where each child can be given tuition suitable to his degree of backwardness. As a beginning it would probably be best to institute classes for dull and backward children in particular areas and the children could be drawn from the group of schools in each area. At one school in Willesden, namely, Lower Place Senior Mixed School, a special class for the following types of children has been formed, (1) dull or backward, (2) children who are too old for an Infants' Department and who have attended school so irregularly as not to be fit from an educational point of view to be placed in a class in a Senior Department, (3) children of awkward temper and character who have reached Standard 2 and who are better suited in a Senior Department where the discipline is stricter. This class was instituted a few years ago and in 1923 it was decided to restrict the numbers to about 25. The course given is an intensive one, and certain subjects are taught by means of simple plays. The progress of the children is reviewed at frequent intervals and those children who are considered to have made sufficient advancement are drafted into the ordinary classes. Physically defective children suffering from anaemia and debility and other diseases in an incipient stage can only be satisfactorily dealt with when an open-air school is established in Willesden. At present the more pronounced cases may be sent to a Convalescent Home or Residential Open Air School, but unless the favourable conditions are maintained after their return from the country, they are almost certain to drift back again to their former state of health. 16 Leinster Road Mentally Defective School.—The certified accommodation at this school is for 90 children, and during the year under review the average number on the roll was 98, the actual number on the roll at 31st December, 1925, being 104. The average attendance for the year was 84. There were no children awaiting admission to this school at the end of the year. The staff which was reduced by one full-time assistant in 1923 remains at one Head Teacher and three full-time assistants. Arrangements were made for the provision of a part-time assistant to train a class of boys in bootmaking, and this assistant started work early in 1925. There are in the school 35 boys over 11 years of age suitable to attend this class, but the number to be admitted is limited to 8, leaving 27 boys for whom no provision has been made. Owing to the loss of the fulltime assistant teacher in 1923, it has been found necessary to cut down the time given to instruction in handiwork by more than one half. In order to provide sufficient vocational training, the services of a full-time instructor in manual work is required. This would allow of a class of eight boys receiving instiuction for 4 hours per week. At present the hall of the school is used for manual work which is not a satisfactory arrangement and more accommodation is required. Two children were reported to the Local Control Authority as incapable of receiving further benefit from instruction in the school, 2 were reported as Imbeciles, and 1 was reported as incapable of being instructed without detriment to the interests of the other children, 3 with a view to being placed under guardianship, 1 was allowed to leave school, and 1 was transferred to a residential institution. The certifying officer visits the school weekly for the purpose of revision of classification and for medical examination of the children. The parents are notified of any defects requiring attention. 89 such examinations were made during 1924. The school dinner is provided at the Granville Road Mission. On an average 35 children take dinner, 30 bring their own lunch, and the remainder go home. Furness Road Physically Defective School.—The certified accommodation at this school is for 60 children, and during the year the average number on the roll was 49, the actual number on the roll on the 31st December, 1925, being 53. The average attendance for the year was 41 and there are no children awaiting admission. This school takes the physically defective children over 12 years of age, the younger children attending Leopold Road Physically Defective School. The staff consists of one Head Teacher and one full-time assistant. The Head Teacher also acts as Head Teacher for the Junior School, the latter being in the care of an Assistant-in-Charge. The school premises at this school are unsatisfactory from several points of view. The class room is situated between two playgrounds which are used by the children attending the ordinary elementary school, and the following time-table shews how much the work of the physically defective school is being interrupted:— 10.30 a.m. Commencement of the Physically Defective School's morning session. 10.30 a.m. to 10.45 a.m. Playtime for Furness Road Ordinary Elementary School. 12 noon. Ordinary Elementary School dismissed. 12 noon to 2.0 p.m. Games in the playground, e.g., football, netball. 1.0 p.m. Dinner hour for the Physically Defective School. 2.0 p.m. Ordinary Elementary School re-assembles. 2.30 p.m. Physically Defective School re-assembles. 3.0 p.m. to 3.15 p.m. Playtime for the Ordinary Elementary School. During every day that the weather is fine, drill and organised games for the pupils attending the ordinary elementary school are held in the back playground. These drills and games are held both during the morning and afternoon sessions and are of 20 to 30 minutes duration. More accommodation is required. As a minimum two ordinary class rooms ought to be provided with a rest room, a work room and a dining hall. At present a part of a cloakroom is improvised as a Doctor's and Nurse's room, which is unsatisfactory. During fine weather it is desirable in a physically defective school to conduct the classes in the open air. Owing to the playground at this school being also used by the ordinary elementary school it is not possible for this arrangement to be carried out. During the year 3 children were transferred to ordinary elementary schools and 1 was allowed to leave school before reaching the age of 16 years. The school dinner is provided at the Furness Road Feeding Centre. 28 children have their dinners there, 8 bring their own lunch and the remainder go home. Leopold Road Physically Defective School.—The certified accommodation at this school is for 40 children. During the year the average number on the roll was 45, the actual number on the roll on the 31st December, 1925, being 45. The average attendance for the year was 39, and there were 4 children awaiting admission at the end of the year. The staff consists of two assistant teachers, the senior being in charge. The dinners are brought from Strode Road Feeding Centre and are served in the Laundry Centre of Leopold Road School. All the children take the school dinners. The lack of a heating apparatus for the Doctor's room has now been remedied, a gas stove having been provided. An inside lavatory is required as some of the younger cripple children are unable to proceed to the outside latrine unescorted. During the year 7 children were transferred to ordinary elementary schools. 17 A trained nurse who also acts as ambulance attendant is attached to each of the Physically Defective Schools. She treats such minor ailments as require it and supervises the personal cleanliness and the care of the teeth and hair of the children. She arranges for the repair of surgical instruments and boots and undertakes the massage of the children who have been ordered this treatment by their Surgeon and who are unable to attend a Hospital for this purpose. She also gives the children the medicines and nutritive drugs ordered by the Doctor, such as Syr. Ferri Phos. Co. Virol and Cod Liver Oil. Both schools are visited by the Certifying Medical Officer once a fortnight and each child is seen every six months. The parents are notified of any defects found which require attention. The majority of the children at these schools who are actual cripples attend periodically either an Orthopaedic Hospital or the Orthopaedic Department of a General Hospital. In a few cases difficulty is found in getting the parents to keep their children under the care of an Orthopaedic Surgeon. The cost of travel and the distances to the nearest hospitals are the chief factors in preventing this being carried out. Difficulty also arises when a case is ordered special daily treatment which can only be carried out in an Orthopaedic Department. When the Orthopaedic Clinic to be established in Willesden is in working order, these difficulties will disappear, and it will be practicable for every cripple child to be kept under the care of a Specialist and also to have such treatment as is considered necessary for the particular defect. A new school ambulance purchased by the Education Committee was delivered at Easter, 1925. This vehicle accommodates 20 children, 1 driver and 1 attendant. After Care.—At present the after care of the Mentally Defective Children in Willesden is undertaken by a Voluntary Society. The names of the children leaving the Mentally Defective School are notified to the Society and the cases are visited periodically and a record is kept of each case visited. The Society have an Occupation Centre for Mentally Defective Children at Pember Hall, Pember Road, Kensal Green, N.W. 10. It is open daily from 2.30 p.m. to 4.30 p.m. The children in attendance are chiefly imbeciles and ineducable feeble-minded who are awaiting admission to an Institution or whose parents wish to keep them at home. The children are taught rug-making, basket-making and cane-chair-making. Children leaving the Mentally Defective School and in whose case it is considered necessary that they should be placed under supervision or guardianship are reported to the Middlesex County Council. The number of children and adolescents under 21 years of age who have attended the MentallyDefective School and who are still in the district is 73. 13 of these are known to be incapable of employment by reason of their mental defect, 12 are in Institutions, 2 being there for further education and 10 for safety or guardianship. Of the remaining 48, 23 are employed in industrial or manual occupations, 1 in agricultural or rural occupation, 18 in domestic work, 1 in commercial work and 5 in blind alley or other precarious occupations. The number of physically defective children and adolescents under 21 years of age who are still in the area is 36. 2 are attending a secondary school. 2 cases are known to be incapable of work by reason of their physical defect and 2 are in a Cripple Home or Institution. Of the remaining 30, 18 are engaged in industrial or manual occupations, 6 in domestic employment and 4 have obtained situations in commercial, professional or clerical work. 2 are employed in blind alley or other precarious occupations. Convalescence.—Convalescent homes for children attending the Physically Defective Schools is arranged by the Invalid Children's Aid Association and by the Shaftesbury Society. The Stamford Hill Cripples' Home has a branch at Thorpe Bay near Southend-on-Sea and this institution admits Willesden children at a reduced rate. The Education Committee have made arrangements with the Russell-Cotes School of Recovery, Parkstone, near Bournemouth, for the reservation of two beds at this Institution for Willesden boys. This home was provided by the donors as a country residence near the sea for poor town boys and girls who are anaemic and debilitated and who are physically defective within the meaning of the Education Act, 1921, and it is recognised by the Board of Education as a Special Residential School. The boys are selected both from the physically defective and the ordinary elementary schools and the duration of the stay is six weeks, except in special cases when an additional six weeks' stay can be arranged. All the cases which have been to the Institution have shewn a distinct improvement on their return home. Stammering Children.—The special class for stammering children, privately conducted by Mr. A. D. Bradfield at Percy Road Council School during 1924, was taken over by the Council with the approval of the Board of Education on 3rd February, 1925, and has been conducted with considerable success ever since. This class consists of 10 boys, who receive 2 1-hour lessons per week. The following table shows the degrees of defect present and the results of treatment up to January, 1926. Table No. 9. Degree of Stammering. No. of Children. Results of Treatment. Remarks. Severe 5 1 completely cured, 2 much improved and 2 improved. 1 case attends badly, 2 are very lazy. Moderate 3 1 nearly cured, 2 much improved Treatment interrupted in 1 case by illness. Slight 2 1 cured, 1 much improved. 18 The Council opened a second stammering class under the same teacher at the Pound Lane Council School, with the approval of the Board of Education, in February, 1926. This class is for 12 children, 6 of each sex. The formation of a third class of the same constitution as that at Pound Lane is now under consideration to serve the Kensal Rise area. Employment of Children and Young Persons.—There is no scheme in operation at present for the co-ordination of the work of the School Medical Service with that of the Juvenile Employment Committee and of the certifying factory surgeon. SPECIAL ENQUIRIES. During 1925 the Medical Staff voluntarily undertook to co-operate with the Board of Education in carrying out certain special enquiries. Defective Vision Inquiry. This enquiry was instituted by a special committee of the Board of Education with the object of discovering the factors in childhood leading to the development of defective vision and squint. The following methods of enquiry were chosen by the Committee:— (1) The examination by refraction and enquiry into the environment and family history of unselected children at the age of 6 years and the periodic examination of these children throughout school life. (2) The examination by refraction and enquiry into the environment and family history of unselected children of each age from 6 to 16, both inclusive. (3) The examination by refraction and enquiry into the environment and family history of unselected children between the ages of 1 year and 5 years and their subsequent reexamination at intervals of approximately 6 months. (4) The examination by refraction of children who habitually work in well-lit and badly-lit classrooms respectively. (5) Investigation into the subsequent history of cases of defective vision detected in 1919-1921, both inclusive, and in earlier years where reliable records are available. These different portions of the enquiry were all undertaken by the different Clinic Medical Officers. In spite of considerable difficulties which have been encountered, such as the difficulty of carrying out retinoscopics on small children and the failure or refusal of parents to bring their children up for examination more than once, during 1925, no less than 71 schedules were completed and sent up to the Board. Anthropometric Enquiry. The Council's Medical Staff also agreed to co-operate with the Board's Anthropometric Committee in its enquiries. The object of this Committee is " to enquire into certain factors governing the growth and development of healthy children from infancy up to the age of 18 years and living under varied conditions, with a view to obtaining a series of anthropometric figures (norms) from all parts of the country which would be of value to School Medical Officers and others in the estimation and comparison of nutrition, physique, etc." To complete the schedule in each case involves the ascertainment of the following : Name, address, age, nationality, place of origin of father and mother, occupations of parents, order of child in family, standing height, sitting height, weight, chest measurement, colour of eyes (compared with test glass eyes), colour of hair (compared with test hanks of hair), three head measurements and any abnormality or disease. As all these facts must be ascertained with great accuracy to render them of any value for the purposes of the enquiry a considerable expenditure of time and care is involved in the completion of the schedule for each child. Owing to delay in obtaining the special apparatus required no schedules had been completed at the end of the year, but the work is now proceeding. Enquiry into the Health of the Pre-School Child. The Council's Medical Staff were invited by the Ministry of Health to take part in the above enquiry, but owing to general pressure of work and the additional responsibilities they had already incurred in connection with the Board of Education's Defective Vision Enquiry they felt unable to accept the invitation of the Ministry. SECONDARY SCHOOL CHILDREN. Medical Inspection in Secondary Schools is undertaken at the request of the Middlesex County Council and is carried out in accordance with the arrangements made by them. Medical Inspection at the Kilburn Grammar School and Willesden Polytechnic Trade School was first undertaken in the Summer Term of 1920. During 1925 two additional schools were added, viz., the Willesden County School in March, 1925, and the Willesden Polytechnic Building Trade School in November, 1925. At these Secondary Schools during 1925, 342 routine medical inspections were conducted in addition to 110 special inspections and re-inspections or a total of 452 examinations during the year. The number of pupils found to require treatment, excluding uncleanliness and dental diseases, varied from 11.9 per cent. in the Willesden Polytechnic Trade School (Girls) to 31.8 per cent. in the Willesden Polytechnic Building Trade School (Boys). Parents were notified in the usual way of the defects found which required medical treatment and appropriate advice was given to teachers or pupils in regard to matters of school or personal hygiene. 19 DENTAL WORK. The Eighth Annual Report of the Dental work of the Council shows that during the year 13,550 public elementary school children were dentally inspected as compared with 20,231 in the previous year. 10,151 of these children were found to require treatment as compared with 14,192 in the previous year. It is satisfactory to record that 4,384 attendances were made by children at the Authority's Clinics for treatment in 1925 as compared with 2,148 such attendances in 1924. It is further satisfactory to record that 22 per cent. of the defects followed up by the Health Nurses were ascertained to have received treatment during the year as compared with only 11 per cent. in 1924. This percentage of children treated is likely to continue to increase under the new scheme of dental inspection adopted by the Education Committee at its meeting on 3rd February, 1926, after consideration of my report on the working of the dental scheme of October, 1924, appearing as Appendix L to this report. HOME NURSING SERVICE. The Home Nurse employed by the Council nursed 332 cases during the year, and in connection with such cases paid 3,407 visits. 602 of these visits were paid in the Mid-Kilburn Ward, 533 in the Harlesden Ward, 472 in the Kensal Rise Ward, 461 in the South Kilburn Ward, 362 in the North Kilburn Ward and smaller numbers in the other wards of Willesden. Of the 332 cases nursed during the year, 325 were new cases. 103 of these 325 new cases were referred by the Health Department for nursing, 31 by private doctors and 191 by Hospitals, Associations and private persons. During 1925, 688 visits were paid to cases of Ophthalmia Neonatorum, as against 219 in 1924, and 52 visits to Puerperal Fever as against 3 in 1924. Visits to measles numbered 86 in 1925 as against 65 in 1924, and to Whooping Cough 52 in 1925 against 5 in 1924. Circumcision cases referred from Hospitals received 283 visits in 1925 as against 126 in 1924. Throughout 1925 the Council's Home Nurse has had practically continuously cases of Ophthalmia Neonatorum under treatment. It is unsatisfactory to discontinue the treatment of such cases over the week ends, as during this interval much of the good result achieved during the preceding week may be annulled and recovery thereby delayed. The Council has recognized this and, in February, 1925, granted authority to the Medical Officer of Health to engage such extra nursing assistance as and when, in his opinion, it might be necessary to cope with such cases. Assistance has been engaged from time to time, but the difficulty of obtaining a suitable nurse practised in this particular branch of nursing at short notice is considerable. SANITARY WORK. During 1925 two sanitary inspectors were added to the staff, making 10 in all. These additional inspectors, however, did not come on duty until November, 1925. During the year the total number of inspections and re-inspections made by the sanitary staff was 18,595, as compared with 17,509 in the previous year. The time of the sanitary inspectors becomes more and more occupied in endeavouring to secure a reasonable standard of repair of dwelling houses. The statutes give only limited powers to the Local Authority, and much time is occupied in endeavouring to persuade the persons on whom notices have been served that it is necessary that such notices should be complied with. Nevertheless, good work is being done, although the procedure is cumbersome and the time that elapses between the service of a notice and compliance is in many instances over long. I referred in my last Annual Report to the necessity for the extension of the definition of " nuisances " for purposes of the Public Health Acts and of the powers of the Council in relation to repairs to house property. It is hoped that in any extension or consolidation of the law relating to Public Health these matters will receive attention. In accordance with the suggestion of the Ministry of Health greater use has been made during the present year of Section 3 of the Housing Act, 1925, but even this section is cumbersome in its working and, if the landlord is unwilling to comply with notices served under this section, as much as twelve months may be occupied in giving effect to all necessary legal formalities before the much needed repairs are carried out. Twelve houses were closed as unfit for human habitation during the year, but in consequence of the housing shortage and the inability of obtaining vacant possession these dwelling houses still remained "closed," but in occupation at the end of the year. The Public Health (Meat) Regulations which came into force on the 1st April, 1925, are gradu ally being complied with by the meat traders in Willesden. Cases of overcrowding not infrequently were brought to the notice of the Sanitary Inspectors in the course of their duties. These cases were reported to the Council, but they have felt unable to take action on account of the fact that alternative accommodation is not at present available. MOTOR AMBULANCE SERVICE. The Motor Ambulance Service now numbers 9 vehicles, 7 of these came into use in December 1913, 1 in April, 1924, and 1 in March, 1925. 20 Up to 31st March, 1926, the 9 vehicles had covered a total of 723,897 miles. The 7 vehicles, which are now over 12 years old, are breaking down more frequently, and it is desirable that they should be gradually replaced. During the year the work of the Ambulance Service has included the conveyance of approximately 130 defective children daily to the Special Schools in Willesden and Swiss Cottage Blind School, and the conveyance of 2,597 patients to Hospitals and Nursing Homes and the disinfection of 843 houses. It is satisfactory to record that all this work has been carried through without accident. PROVISION OF MEALS. 78,156 meals have been supplied at the Committee's centres as compared with 75,197 in the previous year. The arrangement with the Willesden Board of Guardians by which 1/- per head per week or part of a week is paid for each child fed on their recommendation at the Feeding Centres of the Education Committee continues in force. Breakfasts are served to the children of parents who are unusually poor. These breakfasts consists of cocoa, made with dried milk, sugar, and bread and margarine. 5,217 breakfasts were supplied during the year, all in the South Kilburn area. MUNICIPAL HOSPITAL. During the year 601 patients were admitted to the Municipal Hospital, 203 of whom were suffering from Scarlet Fever, 259 from Diphtheria, 57 from Tonsilitis which proved to be simple and not Scarlet Fever or Diphtheria, and 82 from other diseases. Amongst the 82 other diseases were 9 cases of Ophthalmia Neonatorum, 1 case of Puerperal Fever, 1 case of Endometritis, 16 cases of Whooping Cough, 8 cases of Measles and 3 cases of infectious diseases of the Central Nervous System. SPECIAL REPORTS AND ARTICLES. There are three special reports and articles appearing as Appendices M., N. and O., to which I would specially direct attention. Artificial Light Treatment.—Appendix M. is the report of Dr. Haldin-Davis, the Dermatologist to the Council, on Artificial Light Treatment, which began on the 16th November, 1925. His report is written in the form required by the Ministry of Health, and indicates the value of this type of treatment and the striking results obtained in certain cases. Health Visiting.—Appendix N. deals with Health Visiting and is written by Dr. Bessie MacKenzie. It sets out very clearly the work which a Health Visitor has to do and her objectives. It indicates that in respect of the reduction of Infant Mortality from 130 deaths of children under 1 year of age per thousand births in 1902, the year before there were any Health Visitors at work in Willesden, to 62 deaths per thousand births last year, and in respect of the reduction of unclean children in the Public Elementary Schools from 20 per cent. in 1914 to 6 per cent. in 1925, that some of these objectives are being obtained. Dr. MacKenzie's article is informative and should make for the better understanding of a Health Visitor's duties. Cancer.—The other special article is on Cancer and is written by Dr. W. D. Champneys. It appears as Appendix O. to this report. This article is very important and shows how Cancer has increased in Willesden. In 1911 the deaths in Willesden from Cancer were 115 out of a total of 1,848 deaths from all causes in a population of 154,000, or 675 deaths from Cancer per million of the population, but in 1925 there were 241 deaths from Cancer out of a total of 1,686 deaths from all causes in a population of 172,000 or 1,402 deaths from Cancer per million of the population. It will therefore be seen that in the course of 14 years the death rate from Cancer has more than doubled in Willesden, and that in 1925 1 out of every 7 deaths was caused by Cancer. It is true that the cause of Cancer has not been finally established, but there are certain facts concerning the disease which are well-known and enable action to be taken to stop or diminish the ravages of this disease. Dr. Champneys has carefully reviewed the Cancer problem in the light of the experiences of many countries and sets out in outline a scheme for the control of Cancer which is worthy of the closest and most earnest consideration in the interests of the Public Health. VISIT OF FOREIGN MEDICAL OFFICERS. Early in 1925 Willesden had the honour of being selected as an area in England and Wales for the demonstration of English Public Health to five Medical Officers representing Canada, Esthonia, France, Italy and Russia. These visitors from abroad spent a period of three weeks in Willesden during which time facilities were afforded them for achieving the object of their visit. All of them expressed their high appreciation of the methods in operation and their hope that they would be able to make use of the experience they gained here in their home countries. A visit of this kind is very helpful to the department. The entire organisation was reviewed and demonstrated to our foreign visitors, and this survey of our own work was exceedingly useful, as it brought the officers of the department up to concert pitch so that they might show the foreign 21 Medical Officers the best that Willesden could do. The interchange of ideas, too, between men who came from countries where health administration is not of a high standard was also helpful in the light of the organisation that exists in Willesden. I am quite sure that periodical visits of this nature are highly beneficial, not only to the visitors, but also to the officers who are engaged in the Public Health work administered by the Local Authority as well as to the members of the Authority itself who had the opportunity of meeting those distinguished doctors from other lands. This interchange of Public Health personnel is provided for by the Health Organisation of the League of Nations and, in addition to the direct benefit to Public Health, it must be regarded as a practical expression in the domain of Public Health of the principles of international co-operation that underlie the whole of the activities of the League. OBITUARY. Within less than 12 months the department has suffered the loss of two of its principal officers. Dr. W. J. J. Stewart.—Dr. W. J. J. Stewart, the Medical Superintendent of the Hospital since February, 1903, died in June, 1925, after more than 22 years faithful service with the Council. Dr. Stewart held an outstanding position amongst Medical Superintendents of Isolation Hospitals in this country. He was recognised as an authority on Infectious Diseases and on Isolation Hospital Administration. Within recent years his health was not good, but characteristically he continued to place his duty first, and did not give up work until late in February, 1925. The many letters received by the Council on the occasion of his death from parents who had had children under his charge in the Hospital bore testimony to the high esteem in which he was held by the public. Mr. H. de L. Woods.—As this report is in the press the untimely death of Mr. H. de L. Woods, who had been in the Health Department of the Council for 35 years and Chief Sanitary Inspector for 27 years, has occurred. I had been associated with Mr. Woods for over 13 years, and during that time I saw him practically every morning. I can testify to the keen interest that he took in his work and to the great assistance he was to me in carrying out the laws in relation to housing, nuisances and food supply, so far as they were entrusted to the administration of my Office. Mr. Woods' work was always well done, and he spared himself in no way to give of his best to the Council. His experience of the health needs of Willesden was invaluable to the department, and his advice on all sanitary questions was invariably sound and reliable. The Staff join with me in mourning the loss of an able colleague, a wise counsellor and a loyal friend. Your Obedient Servant, GEORGE F. BUCHAN, Medical Officer of Health. 22 THE FIFTIETH ANNUAL REPORT FOR THE Year ended 31st December, 1925, ON THE HEALTH AND SANITARY CONDITION OF THE URBAN DISTRICT OF WILLESDEN. GENERAL STATISTICS. Area (acres) 4,384 Population 172,503 (estimated Midsummer, 1925) Number of inhabited houses 23,719 (Census 1921) Number of families or separate occupiers 41,235 (Census, 1921) Rateable value £1,028,315 Sum represented by a penny rate £4,290 (approx.) EXTRACTS FROM VITAL STATISTICS OF THE YEAR. Births— Total. Legitimate *2,665 Birth Rate (R.G.) 16.97 Illegitimate †90 Death Rate (R.G.) 10.01 Deaths ‡1,686 *(R.G.) 2746. †121. ‡1,691 Number of women dying in, or in consequence of, childbirth from sepsis 2 from other causes 4 Deaths of Infants under one year of age per 1,000 births:— Legitimate 157. Illegitimate 13. Total 170. Deaths from Measles (all ages) 13 „ „ Whooping Cough (all ages) 18 „ „ Diarrhoea (under 2 years of age) 14 Table No. 10. NOTIFIABLE DISEASES DURING THE YEAR. Disease. Total Cases Notified. Cases admitted to Municipal Hospitals. Total Deaths. Diphtheria 304 287 10 Scarlet Fever 263 230 2 Enteric Fever (including Paratyphoid) 6 1 1 Puerperal Fever 16 2 2 Pneumonia 356 4 147 Small Pox — — — Cholera — — — Plague — — — Erysipelas 57 5 5 Typhus Fever — — — Relapsing Fever — — — Continued Fever — — — Cerebro-spinal Meningitis 3 1 1 Poliomyelitis 3 — — Ophthalmia Neonatorum 37 8 — Malaria 2 — — Dysentery 2 — — Trench Fever — — — Encephalitis Lethargica 9 5 4 Acute Polio Encephalitis 1 — 1 Anthrax — — — Tuberculosis:— (a) Pulmonary 244 — 133 (b) Non-Pulmonary 43 — 16 Whooping Cough 537 14 18 23 Table No. 11. TUBERCULOSIS. Age-Periods. New Cases. Deaths. Pulmonary. Non-Pulmonary. Pulmonary. N on-Pulmonary. M. F. M. F. M. F. M. F. 0 0 0 1 0 1 0 1 0 1 0 0 1 0 0 0 3 1 5 1 1 4 3 0 1 0 1 10 5 8 3 2 0 1 2 0 15 5 3 6 3 2 3 1 1 20 10 17 3 2 7 7 0 0 25 12 23 0 3 18 19 2 0 35 37 30 4 4 21 9 1 0 45 25 15 1 0 15 6 1 0 55 24 13 1 0 11 6 0 0 65 and upwards 10 5 1 1 5 1 1 1 Totals 129 115 25 18 80 53 12 4 Table No. 12. OPHTHALMIA NEONATORUM. No of cases Notified. Dr. in Attendance at Birth. Born in Hospital. Midwife in Attendance at Birth. Treatment. Results of Treatment. Still under treatment. Hospital. Clinic. Private Dr. Home Nurse Attending. No Defect. One Eye Permanently Injured. Both Eyes Permanently Injured. 37 16 4 17 8 16 13 19 34 1 0 2 SUMMARY OF NURSING ARRANGEMENTS, HOSPITALS AND OTHER INSTITUTIONS AVAILABLE FOR THE DISTRICT. Professional Nursing in the Home. (a) General— (i.) The Willesden District Council employs one fully trained Hospital Nurse. She visits in the homes once or twice daily as necessary to nurse primarily grant earning cases under the Maternity and Child Welfare regulations. [Grant-earning cases are : Nursing of expectant mothers, maternity nursing, nursing of puerperal fever, measles in young children, whooping cough in young children, epidemic diarrhoea in young children and ophthalmia neonatorum.] The Nurse is provided on application to the 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 Nurse acts under the direction of the Medical Practitioner in attendance upon the case. (ii.) 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 Nurse as above. 24 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 11s. 6d., but for a first confinement, £2 2s. The number of Midwives who up to March, 1926, had notified the Middlesex County Council of their intention to practise in Willesden during 1926 was 22, 1 of whom was engaged in an institution. 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 the 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— Schools for Mothers Municipal Clinic (2) 381, High Road, Willesden, N.W. 10 Ditto Ditto Town Hall Dyne Road, N.W. 6 Suitably equipped Medical Officer's room Ditto Examination of abnormal children. Lower Place School for Mothers Lower Place, Acton Lane, Harlesden, N.W. 10. Separate building in School Playground. Two rooms and usual offices Ditto School for Mothers. 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 Two houses adapted and equipped as a Day Nursery Voluntary Committee. Hon. Sec., Mrs. Howard Figgis Day Nursery. The Willesden V.A.D. Clinic 159, Willesden Lane, Kilburn, N.W. 6. One house adapted and equipped St. John's Voluntary Aid Detachment, Middlesex, 58 (Women's) Massage—Radiant Heat—Electricity —Medical Gymnastics. 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. There are also Centres situated in adjacent districts which are used by Willesden residents. 25 HOSPITALS FOR WILLESDEN. (a) 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 Park Royal Hospital, Acton Lane, N.W. 10. Provided by the Willesden Guardians. (3) Fever Willesden Municipal Hospital, Brentfield Road, Neasden, N.W. 10. vided by the Willesden Urban District Council. 122 beds (Ministry of Health Standard). (4) Smallpox Willesden Smallpox Hospital, Kingsbury. Provided by the Willesden Urban District Council. (b) Other Hospitals available for the District. (1) Children St. Monica's Home Hospital for Sick Children, 16, Brondesbury Park, N.W. The Willesden Council sends cases of Marasmus to this hospital under its Maternity and Child Welfare Scheme by arrangement with the Committee of the Hospital. Edgar Lee Home for Invalid Boys, 14, Stonebridge Park. The Home is for boys of 5-14 years of age suffering from heart disease and rheumatism. (2) General, etc. Park Royal Hospital, Acton Lane, N.W. Provided by the Willesden Guardians. General cases, Maternity Ward, Children's Ward. The Willesden Council sends Maternity cases to this hospital under its Maternity and Child Welfare Scheme by arrangement with the Guardians. Willesden General Hospital, Harlesden Road, N.W. General cases. The Willesden Council sends cases of Enlarged Tonsils, Adenoids, Deflected Nasal Septum and Marasmus to this hospital under its Maternity and Child Welfare and School Medical Service Schemes by arrangement with the Committee of the Hospital. 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. Adjacent London hospitals are also available for Willesden. INSTITUTIONAL PROVISION FOR UNMARRIED MOTHERS, ILLEGITIMATE INFANTS AND HOMELESS CHILDREN IN THE DISTRICT. (1) Queen Charlotte's Lying-in Hospital Convalescent Home, 20, Victoria Road, Kilburn, N.W. 6. (2) Harrow and Willesden Ruri-decanal Association for Preventive and Rescue Work, St. Mary's Home, 34, Craven Park, N.W. 10. (3) 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, including the Invalid Children's Aid Association, etc. AMBULANCE FACILITIES. Motor Ambulances are available as follows:— (a) For infectious cases— 1 infectious ambulance. (b) For non-infectious and accident cases— 2 accident ambulances. 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. 26 LABORATORY WORK. For some years the Council had a contract with the Counties Public Health Laboratories, 91, Queen Victoria Street, London, E.C., but terminated this contract on the 31st January, 1925, on account of the distance of this laboratory from Willesden. Since that date the laboratory work for the Willesden Council has been carried on under contract by the Willesden General Hospital. On the 26th January, 1925,1 directed the following letter to medical men practising in Willesden as to the new arrangements :— 26th January, 1925. Dear Sir, or Madam, Pathological and Bacteriological Examinations. The Council have entered into an agreement with the Willesden General Hospital, Harlesden Road, Willesden, N.W. 10, to carry out Pathological and Bacteriological work sent by Medical Practitioners in respect of Willesden Residents. This work includes the following :— Examinations for Diphtheria Bacilli, Tubercle Bacilli, Meningococci, Gonococci, Pus organisms, and other germs. Blood examinations for Widal's reaction, or other reactions for Malaria or other conditions. Bacteriological examination of urine, or other fluids. Pathological examinations. Generally any other Bacteriological or Pathological examinations which may be required by a Medical Practitioner. It will be assumed that all specimens from Willesden Residents sent by medical practitioners to the Willesden General Hospital for examination will come within the contract existing between the Council and the Hospital, except such cases as are marked " Private " by the medical practitioners. The cost of the examination of specimens of such marked " Private " cases will be due to the Willesden General Hospital from medical practitioners sending such specimens. The Hospital charges for such examinations are as follows :— £ s. d. Throat swabs for Diphtheria 0 3 6 Sputum for T.B. 0 3 6 Blood count (total and differential) 110 Blood Sugar 0 15 0 Blood urea 012 6 Widal 0 10 6 Wassermann 0 15 0 Faces. General Microscopic examination 010 6 Occult blood 04 0 Stomach contents. Test meal 010 6 Urines. General 0 5 0 Qualitative estimates of albumen sugar or urea, each 0 2 6 Vaccines from 110 0 Cerebrospinal Fluid. General 010 6 Bacteriologica 0 10 6 Wassermann 015 0 Hair. Ringworm 0 5 0 Histological examination with report 1 1 0 All applications for the necessary outfits should be made by Medical Practitioners to the Pathologist, Willesden General Hospital, Harlesden Road, N.W. 10. Procedure. The procedure relative to the above mentioned examinations will be as follows :— (1) All swabs and other specimens should be sent direct to the Pathologist, Willesden General Hospital, Harlesden Road, N.W. 10. (2) The Pathologist, Willesden General Hospital, will notify positive swabs direct to Medical Practitioners by telegram or telephone. (3) The Willesden General Hospital will forward to Medical Practitioners one sterile swab to replace each swab sent for examination. (4) A greater stock than two sterile swabs should not be retained by you, and I shall be glad to receive any outfits above that number from time to time. 27 Outfits—Anti-toxin. Outfits for sending— Swabs of suspected Diphtheritic exudate or discharge, Blood from suspected Typhoid cases, Sputum from suspected cases of Pulmonary Tuberculosis, and Supplies of Diphtheria Anti-toxin may be obtained from any of the following depfits night or day :— Kilburn Fire Station, Salusbury Road, N.W. 6. Willesden Green Sub-Fire Station, near Public Library, Harlesden Road, N.W. 10. Municipal Hospital, Brentfield Road, N.W. 10. General Hospital, Harlesden Road, N.W. 10. The above outfits and anti-toxin may be obtained during the day except Saturday afternoons and Sundays from the following :— Health Department, Town Hall, Dyne Road, N.W. 6. Municipal Clinic (1) No. 9, Willesden Lane, N.W. 6. Municipal Clinic (2) No. 381, High Road, Willesden, N.W. 10. Messrs. Beeson Bros., High Street, Harlesden, N.W. 10. Yours faithfully, GEORGE F. BUCHAN, Medical Officer of Health. The following table shews the Chemical and Bacteriological examinations made during the year 1925 :— Table No. 13. Nature of Specimens examined. Positive Result. Negative Result. Total. 1. Swabs for Diphtheria Bacilli 455 2,834 3,289 2. Swabs for Diphtheria (Virulence Tests) 15 3 18 3. Blood for Widal Reaction 3 19 22 4. Sputum for Tubercle Bacilli 77 324 401 5. Wassermann Test — 4 4 6. Swabs for Meningococci — 4 4 7. Swabs for Cerebro Spinal Meningitis — 4 4 8. Swab from Ear — — 1 9. Cerebro Spinal Fluid — — 22 10. Fluid from Pleural Cavity — — 4 11. Fluid from Joint — — 1 12. Blood Count — — 3 13. Blood Culture — — 3 14. Blood for Sugar Estimation — — 2 15. Films for Gonococci — — 1 16. Urethal Discharge for Gonococci — — 2 17. Eye Discharge for Gonococci — — 7 18. Vaginal Discharge — — 7 19. Urine (General) — — 16 20. Pus — — 4 21. Tissue for Microscopical examination — — 7 22. Hair for Ringworm — — 1 23. Faeces for Organisms — — 1 24. Fallopian Tube — — 1 Grand Total 3,825 Table No. 14.—Sources of Specimens Examined. From Municipal Hospital 1,811 From private practitioners 1,114 From clinics and health nurses 380 From Park Royal Hospital 500 From other Hospitals or Institutions 20 Total 3,825 28 SANITARY ADMINISTRATION. List of Local Acts, Adoptive Acts, Bye-laws and local Regulations in force in the District, with date of adoption. Local Acts:— 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). Revised and adopted 13.7.1922 Bye-laws:— 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), Revised, and came into force 1.8.1923. 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. Sanitary Circumstances of the Area. Water.—The whole of the water supply of Willesden is derived from the mains of the Metropolitan Water Board. The service is constant and the water of excellent quality. The total number of houses in Willesden is 24,654, and all are provided with a supply direct to each house. Quite 50 per cent, of the better class tenement houses have a supply separate for each tenement. A supply for drinking purposes direct off the rising main is year by year becoming more general. The regulations of the Metropolitan Water Board, however, require each house to be provided with a storage cistern. There are still a large number of houses occupied by several families in the older parts of the district with only one draw off tap for water situated either in the basement or upon the ground floor. 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 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.—With the exception of a few isolated factories and other outlying buildings situated on the northern heights of Dollis Hill, the whole of Willesden is drained and sewered on the water carriage system. 29 Prior to the year 1911, Willesden was divided into two drainage areas for sewerage purposes, known respectively as the Metropolitan and Brent areas, one forming the watershed of the River Thames and the other that of the River Brent. The sewage of the houses in the Metropolitan area drained into the sewers of the Metropolis, while the sewerage of the houses in the Brent was taken to the sewage farm at Stonebridge and treated by chemical precipitation, the effluent being discharged into the Brent. In 1911 satisfactory arrangements were made with the London County Council for all of the sewage of the Brent area to be taken by gravitation into the London sewers, consequently all the drainage and sewerage of Willesden is now discharged into the London sewers. A few old settling tanks at the Sewage Farm have, however, been retained for the purpose of storage of overflow water during periods of heavy rainfall. Closet Accommodation.—With the exception of a few isolated cottages situated in the outlying parts of the district, all of the houses are supplied with closets on the water carriage system. Each house has at least one water closet, and in the better class tenement house there is generally a water closet provided on each floor. Scavenging.—Since the year 1919-20, the Health Department has not been responsible for the removal and disposal of house refuse, that work having been taken over by the Surveyor's Department, which now supervises the work both of collection and disposal. Every house in the district is called at once in each week. Electrically operated vehicles are used. Quite 98 per cent, of the houses in the district are provided with movable receptacles. Fixed receptacles in the older houses are rapidly decreasing in number, and during the next two or three years should entirely disappear. The disposal of house refuse is by contract. The refuse is collected by the Council and tipped into barges on the Canal, one wharf being situated in the Harrow Road in the Metropolitan Borough of Paddington, and the other one at Lower Place in Willesden. It is conveyed in barges down the Canal, unloaded by the contractor and deposited on land immediately adjoining the Canal. Sanitary Inspection of the Area. Tabular summary of the work oj the Sanitary Department during the year and action taken under ihe Public Health Acts, Housing Act, etc. Inspections: Number of premises inspected on complaint 2,117 Number of premises inspected in connection with infectious diseases 69 Number of premises under periodical inspection 1,643 Houses inspected from House to House (Housing Act, 1925) 828 For Certificates under the Rent Acts 32 Public House Urinals 73 Mews and Stables 178 Miscellaneous 87 Total number of inspections and re-inspections made 18,595 Action under Rent and Mortgage Interest (Restriction) Acts, 1920-25. Number of applications received for Certificates 32 Number of Certificates granted 16 Action Taken (under Housing and Health Acts) : Cautionary or Intimation Notices Issued 3,067 Number complied with 2,745 Statutory Orders issued *263 Number complied with 107 Summonses served 2 Number of convictions obtained 1 Summonses withdrawn 0 ,, dismissed 1 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 18 Number of contraventions 2 Number remedied 2 * Majority issued late in year. 30 Canal Boats used as Dwellings : Number of contraventions of Regulations 1 Number remedied 0 Movable Dwellings, Caravans, Tents, &c.: Number observed during the year 11 Number of nuisances therefrom abated 2 Number removed from district 9 Bakehouses: Number in district 58 Number of Inspections 141 Contraventions of Factory Acts 27 Contraventions remedied 27 Slaughter-houses: Number on register 8 Inspections of carcases, etc 353 Contraventions of Bye-laws 3 Contraventions remedied 3 Cowsheds: Number on register 1 Number of inspections made 19 Contraventions of regulations Contraventions remedied 1 Number of milch cows in district 25 Dairies and Milkshops : Number on register 156 Number of inspections made 480 Frequency of inspection half-yearly Contraventions of regulations 15 Contraventions remedied 13 Unsound Food: Meat (including organs) seized and surrendered 153 lbs. Poultry and game surrendered 0 lbs. Fish surrendered 412 lbs. Fruit and vegetables surrendered 232 lbs. Butter surrendered 0 lbs. Eggs surrendered 0 lbs. Dried Fruit 0 lbs. Tinned Milk 64 lbs. Tinned Vegetables 0 lbs. Tinned Fish 0 lbs. Tinned Fruit 0 lbs. Tinned Meat 0 lbs. Method of disposal Destroyed. Adulterated Food: Samples taken 0 Found adulterated 0 Offensive Trades: Number of premises in district (Rag and Bone Dealers) 12 Number of inspections made 32 Contravention of Bye-laws 2 Contravention remedied 2 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 14 Cleansed, repaired, covered, etc. 244 Draw-taps placed on mains 32 Percentage of houses supplied on constant system 100 Number of samples obtained for analysis from :— (a) Local We Us 0 (b) Public supply 0 31 Drainage and Sewerage of existing Buildings : Water Closets:— Number of water closets substituted for dry receptacles 0 Repaired, supplied with water or otherwise improved 389 Additional Closets constructed 7 Percentage of houses provided with water closets 100 Drains:— Examined, tested, exposed, etc. 215 Unstopped, repaired, trapped, etc. 195 Waste pipes, rain-water pipes, disconnected, repaired, etc 219 New soil pipes or ventilating shafts fixed 41 Existing soil pipes or ventilating shafts repaired 100 Disconnecting traps or chambers inserted 32 Re-constructed 15 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 555 (b) Phthisis 56 Articles disinfected or destroyed :— (а) Ordinary infectious diseases 1,744 (b) Phthisis 210 Dust: New bins provided 475 Periodical frequency of dust removal weekly Method of disposal By tipping and barging Sundry Nuisances abated: Overcrowding 26 Smoke 4 Accummulations of refuse 45 Foul ditches, ponds, etc., and stagnant water 1 Fowls, pigs, and other animals 30 Dampness 102 Yards and forecourts paved, repaved or repaired 226 Walls and ceilings cleansed 2,223 Leaky roofs made watertight 499 Additional ventilation provided under floors 85 Dilapidated plaster repaired 828 Flooring and other woodwork repaired 194 Damp-proof courses inserted 16 Water supply reinstated 22 Washhouse floors repaved 135 Fireplaces and stoves repaired 282 Decayed brickwork repaired and repointed 120 Additional sinks provided 11 Additional light and ventilation to staircases 11 Larders or food cupboards provided 0 Gutters and rainwater pipes repaired 579 Smoke observations 20 New sash cords and glass provided to windows 1,461 Miscellaneous 233 Inspection of Premises where Food is prepared : Butchers', Provision, and General Shops 120 Fish shops 70 Eating houses 46 Greengrocers' shops 68 Ice-cream premises 110 Stalls 36 Canal Boats Acts, 1877 and 1884.—During the year 46 visits were made to the Canal, and 16 boats inspected. Only 1 minor contravention was observed. Smoke Abatement.—There are 3 large electric generating stations in Willesden, namely the Metropolitan Electric Supply Co., at Lower Place, the North Metropolitan Electric Power Supply Co., at Taylor's Lane, and the Metropolitan Railway Power Station, at Neasden, together with several other large factories in various parts of the district. 32 Each power station is provided with one or more tall brick chimney shafts and also several smaller ones constructed of iron. Streams of brown smoke issue from all of the shafts continuously, and occasionally black smoke. Whenever black smoke is observed by an Inspector, he calls either at the factory or communicates over the telephone to the Engineer, drawing attention to the nuisance. An official letter follows, and the nuisance is generally forthwith abated. No necessity has arisen during the year for legal action to be taken in connection with smoke nuisances. Houses Let in Lodgings.—In 1920, the Council had under consideration the advisability of adopting the Model Byelaws issued by the Ministry of Health relating to Houses Let in Lodgings. Draft Byelaws were prepared and considered by the Health Committee. Correspondence with the Ministry of Health failed to obtain a suitable interpretation of the definition of the words " Lodging House," with the result that the Council did not proceed further in the matter. It is, however, important that these Byelaws, at an early date, should be made operative in Willesden. Offensive Trades.—With the exception of Rag and Bone Dealers, there are no other offensive trades in Willesden scheduled under section 112, Public Health Act, 1875, as amended by section 51, Public Health Acts Amendment Act, 1907. At the latter part of the year, two applications were received by the Council for permission to establish the business of a Rag and Bone Dealer at 28, Brett Road, and on vacant land at the corner of Villiers Road. A Sub-Committee of the Health Committee viewed the applicant's premises and afterwards, by request, interviewed both applicants. In each instance the application was refused. There are 12 Rag and Bone Dealers in the district, these are all kept under frequent inspection, and in two instances Notices were served requiring strict observance of the Byelaws. With these exceptions the businesses were carried on without nuisances arising. Underground Sleeping Rooms.—The Regulations of the Council governing Underground Sleeping Rooms [Housing Act, 1925, sec. 18 (1)] were not during the year put actively into operation. In order satisfactorily to carry out the work required under the Regulations it is an indispensable condition that the rooms be vacated. Owing, however, to the shortage of housing accommodation, more especially for the class inhabiting this type of dwelling, it was found practically impossible to get the people out, with the result that in no instance during the year were the Regulations enforced. HOUSING. The housing conditions in Willesden vary greatly. In some parts of the area the houses are high class, but in other parts really bad housing conditions prevail. In South Kilburn, for example, houses are occupied by several families. Originally these houses were constructed for occupation by one family and have not been specially adapted for use by several families. The result is that they are not provided with the sanitary accommodation, including sinks, water closets and washing arrangements, necessary or suitable for four, five or more families. Fortunately for the health of the inmates of these houses, the rooms are large and airy. In other parts of the area better housing conditions prevail, but owing to the overcrowded state of many properties and the consequent considerable usage they get, constant visits by the Sanitary Inspectors are necessary to maintain them in a fair state of repair. Extent of Shortage or Excess of Houses. In Willesden at the present time there is a serious shortage of houses, more especially of that type of house suitable for occupation by the labouring or artisan class of the population. During the last 12 years there has not been a single house erected in Willesden with accommodation suitable for, and at a rent which a labouring man with a wife and several children can afford to pay, with the result that year by year the existing available housing accommodation gets less and less with all of its attendant evil results. Measures Taken or Contemplated to Meet any Shortage. The following table gives the total number of houses erected in the district since the year 1921. Table No. 15. Year. Houses erected by Council. Houses erected by private enterprise. Total. 1921 154 53 207 1922 105 55 160 1923 2 176 178 1924 — 305 305 1925 — 385 385 Total 261 974 1,235 33 It will be noted that of the total number of houses erected during the past five years, 261 were erected by the district council. The 974 houses erected by private enterprise are not for working class people. The Council have during the next year or so provided for an additional 200 houses to be erected on their building estate at Stonebridge. Overcrowding.—Overcrowding in the poorer type of tenement house in Willesden is year • by year becoming more and more prevalent. It is impossible without taking a special census of the district to estimate accurately the extent of the overcrowding existing at the present time in Willesden, but that it is extensive is borne out by information coming to the notice of the health officials during visits of inspection and by receipt of complaints. The following table gives some particulars of cases of overcrowding which have come to the notice of the Health Department. Table No. 16. Premises. Room or rooms occupied by family. No. of occupants of adult age (10 years) No. of occupants under adult age (10 years). Total number of occupants. Cubic capacity of room (or rooms). Cubic capacity required by family. Deficit in cubic feet. 22, Round wood Road Small back-room, first floor 2 2 4 447 900 453 75, Brett Road Ground floor, backroom 4 1 5 773 1,350 577 Do. First floor, front room 3 3 6 1,279 1,800 521 Do. First floor, backroom 4 4 8 773 1,500 727 137, Malvern Road Ground floor, anteroom 3 2 5 674 1,200 526 5, Victoria Mews First floor, front room 2 3 5 1,133 1,400 267 Do. First floor, back-room 2 4 6 1,229 1,600 371 147, Canterbury Road First floor, kitchen ... 2 1 3 714 1,000 286 67, Oldfield Road First floor, two rooms (bedroom) 2 3 5 470 1,050 580 123, Rucklidge Avenue First floor, front room 6 — 6 1,270 1,800 530 22, Steele Road Ground floor, front room 2 3 5 1,108 1,400 292 108, Kilburn Park Road First floor, back-room 2 5 7 1,265 1,800 535 155, Cambridge Road Basement, back-room 2 2 4 915 1,200 285 17, Bridge Road Ground floor, backroom 2 2 4 924 1,200 276 71, Carlyle Avenue ... Ground Floor, backroom 2 4 6 746 1,600 854 37, College Road First floor, back-room 2 5 7 897 1,800 903 67, Denmark Road ... Ground floor, backroom 2 5 7 1,048 1,350 302 20, Brownlow Road ... Middle room, ground floor 3 4 7 1,006 2,000 994 32, Cobbold Road Middle room, ground floor 8 4 12 911 1,650 739 194, Chapter Road Top floor, room 2 2 4 824 1,200 376 148, Rucklidge Avenue Ground floor, front and back 6 4 10 (back (front) ) 836 1,315 1,650 814 52, Beaconsfield Road Back-room, ground floor 7 — 7 1,223 2,800 1,577 Ditto Front room, ground floor 4 4 8 1,629 1,800 171 17, Holly Lane Back-room, ground floor 5 — 5 1,277 2,000 723 23, Denton Road Back-room, first floor 2 3 5 688 1,400 712 *5, Victoria Place First floor room, Ground floor room 6 3 9 974 1,001 3,000 1,025 60, Canterbury Road Second floor, backroom 2 5 7 1,156 1,800 644 93, Cambridge Road... Second floor, backroom 2 2 4 1,003 1,200 197 105, Villiers Road Ground floor, backroom 4 1 5 1,024 1,800 776 Do. Ground floor, anteroom 1 3 4 496 750 254 Do. First floor, back-room 2 4 6 1,024 1,600 576 357, Chapter Road ... Ground floor, backroom 2 3 5 899 1,400 501 •Two families occupy two rooms but live and sleep as one family. 34 The reasons for overcrowding include the following. (1) The total absence in the district of housing accommodation available and suitable for families of the working classes, such for instance as one, two or three-roomed tenements. (2) When the children in a family grow up, and get married, the new wife or husband as the case may be, is brought home to live with the parents. (3) The original tenant in consequence of the higher rent and cost of living, has of necessity to sub-let a room or rooms to another family. (4) The natural increase of births over deaths yearly adds to the number of persons in a family. (5) The use of small rooms not originally built as living rooms, but as box rooms, attics, lumber rooms or such like and constructed without fireplaces or other efficient means of permanent ventilation. Overcrowding of persons per house brings to the notice of health officers other attendant or adverse conditions affecting the amenities of the inmates, such as for example :— (1) Insufficient water closet accommodation. (2) Insufficient accommodation for cleanliness, i.e., domestic washing, ordinary cleanliness of the person, inability to bathe a child. (3) Lack of sink accommodation. (4) Lack of proper cooking accommodation. The moral aspect of the subject is one that does not enter into the consideration of health officers, but it is one that cannot altogether be ignored. It must be admitted that young children brought up under existing unfavourable conditions have their moral sense blunted at an early age, .and it is to be remembered that what is instilled into the minds of youths and of young girls lasts with them for all times. This also equally applies to personal and environmental cleanliness and generally healthy living and good citizenship. Measures Taken for Dealing with Overcrowding.—Forty-two cases of overcrowding were reported to the Council during the year. Intimation notices were served in all instances, but owing to the impossibility of obtaining ejectment orders, Statutory Notices were not served, the Council recognizing the uselessness of taking formal legal proceedings. Fitness of Houses.—The 24,654 houses in Willesden may be classified as follows :— (a) 4,529 houses of the better residential class occupied by one family only ; (b) 12,324 houses of the better tenement class occupied generally by not more than two families; and (c) 7,801 houses occupied by three, four or more families. The houses in class (a) have, on an average, about five persons per house and represent about 13 per cent, of the total population ; those in class (6) have, on an average, about 6-5 persons per house and represent about 47 per cent, of the total population ; while those in class (c) have, on an average, about nine persons per house and constitute about 40 per cent, of the total population. Class (c) houses are generally situate in the older portions of the district and their general standard of fitness is bad. General Character of the Defects Found to Exist in Unfit Houses.—The general character of the defects found to exist in unfit houses are : Dampness of walls, caused by the 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 ; water closets 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. Difficulties Found in Remedying Unfitness.—For many years past the health officials of the Council have experienced considerable difficulty in getting remedied the common or minor defects in house property, such for instance as broken window frames, broken window glass, defective cooking stoves, broken plastering, dirty and loose wallpaper, cracked and loose ceilings, broken hinges to doors, etc., etc. The difficulties experienced are caused by the fact that no definition of " nuisance " exists which includes the above common or minor defects. The Willesden Council, in May, 1923, requested the Minister of Health to receive a deputation to urge that amended legislation should be introduced to extend the definition of " nuisance " under section 91, Public Health Act, 1875, by the inclusion of the common defects referred to in the Manual of the Ministry of Health on Unfit Houses and Unhealthy Areas, Volume 1, page 11, under " general repairs." The Ministry replied that the powers contained in section 26-28, Housing, Town Planning, &c., Act, 1919 (now sections 6 and 3 of the Housing Act, 1925) appeared to the Minister of Health to be sufficiently wide to enable the Council to carry out such objects as they had in view, and that it did not appear that there would be any advantage in receiving a deputation as suggested. 35 The Willesden Council made a further request to the Ministry, who ultimately agreed to receive a deputation. On Wednesday, the 26th March, 1924, a deputation of the Council consisting of the Chairman of the Health Committee and two Councillors, together with the Clerk of the Council, the Medical Officer of Health and the Chief Sanitary Inspector, were received by the Ministry. The case on behalf of the Council was presented by the Clerk of the Council, amplified by the Medical Officer of Health and the Chairman of the Health Committee. After considerable discussion the deputation was informed that the Health Minister declined to accept the suggestions of the Willesden Council, as he was of opinion that the powers already possessed were adequate for all purposes. In course of conversation the deputation were informed that the Torquay Council, in a private Bill, had included many of the items referred to by the Willesden deputation, but that these had been disallowed by the Local Legislation Committee. (Vide 49th Annual Health Report, Willesden, page 76, appendix D.) Unhealthy Areas.—12 houses were closed during the year under Closing Orders dated 24th March, 1925, as unfit for human habitation. No further steps, however, have been taken, although the owner has been interviewed on two occasions by the Health Committee, owing to the housing shortage and the difficulty of vacating the premises in question. HOUSING STATISTICS FOR THE YEAR 1925. Number of houses erected during the year:— (a) Total (including numbers given separately under (b) ) 385 (b) With State assistance under the Housing Acts :— (i.) By the Local Authority 0 (ii.) By other bodies or persons 65 1.—Unfit Dwelling Houses. Inspection— (1) Total number of dwelling houses inspected for housing defects under Public Health or Housing Acts 2,945 (2) Number of dwelling-houses which were inspected and recorded under the Housing (Inspection of District) Regulations, 1910, or the Housing Consolidated Regulations, 1925 82$ (3) Number of dwelling-houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation 12 (4) Number of dwelling-houses (exclusive of those referred to under the preceding sub-head) found not to be in all respects reasonably fit for human habitation 5$ 2.—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 652 3.—Action Under Statutory Powers. A. Proceedings under section 3 of the Housing Act, 1925. " (1) Number of dwelling-houses in respect of which notices were served requiring repairs 42 (2) Number of dwelling-houses which were rendered fit after service of formal notices:— (a) By owners 1 (b) By Local Authority in default of owners 1 (3) Number of dwelling-houses in respect of which Closing Orders became tive 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 requiring defects to be remedied 2,715 (2) Number of dwelling-houses in which defects were remedied after service of formal notices :— (a) By owners 2,631 (b) By Local Authority in default of owners 0 C. Proceedings under Sections 11, 14 and 15 of the Housing Act, 1925. (1) Number of representations made with a view to the making of Closing Orders 12 (2) Number of dwelling-houses in respect of which Closing Orders were made ... 12 (3) Number of dwelling-houses in respect of which Closing Orders were mined, the dwelling-houses having been rendered fit 0 (4) Number of dwelling-houses in respect of which Demolition Orders were made 0 (5) Number of dwelling-houses demolished in pursuance of Demolition Orders 0 36 INSPECTION AND SUPERVISION OF FOOD. Milk Supply.—Cow-keeping in^Willesden has for some years past been slowly but steadily declining. At the end of the year only one cow-keeper remained in Willesden. The premises are situated in the most populated part of the district, and the number of cows kept average about 25. During no part of the year are the animals let out in the fields to graze, but are confined in the sheds continuously. The amount of milk produced in the district from this one farm is a negligible percentage of the amount consumed and, for all practical purposes, the total milk supply of Willesden is brought into the district. There are 156 retail milk purveyors in the district. These are inspected on an average three times yearly. Particular attention is paid to the facilities provided for the washing and cleansing of the utensils. A marked improvement has taken place during the last few years in the distribution of milk. Glass bottles are more used now than formerly and are gradually taking the place of the unsatisfactory metal can. As an example, I would state that one large multiple milk firm have arranged to withdraw all the metal milk cans now in use at each of their depots and to substitute glass bottles instead. They also undertake to provide their customers with pasteurised milk without any extra charge. No action was taken under the tuberculosis clauses of the Milk and Dairies (Consolidation) Act, 1915, which came into operation in September, 1925. The following table shows the number of licenses granted for the sale of graded milk under the Milk (Special Designations) Order, 1923, during the year 1925 Table No. 17. (a) " Certified " milk 17 (b) " Grade A (Tuberculin Tested) " milk 3 (c) " Grade A " milk 3 (d) " Pasteurised " milk 13 One license was granted by the Council to a local firm for the pasteurization of milk. The type of apparatus used by this firm for pasteurizing the milk is of Danish invention, known as the " Silkeborg," and is supplied and fixed by an English firm. The holder has a capacity permitting four hundred gallons of milk to be treated per hour. The amount of milk treated daily by this pasteurizing plant averages from 2,000 to 3,000 gallons. There were no refusals or revocations of retailers licenses for sale of graded milk during the year. The following table gives the result of examination of samples of graded milk taken in the district during the years 1923, 1924 and 1925 :— Table No. 18. Designation. No. taken. Result of Bacteriological examination. Satisfactory. Unsatisfactory. 1923. (a) " Certified " 4 4 — (b) " Grade A (Tuberculin Tested) " 1 1 — (c) " Grade A " — — — (d) " Pasteurised " 1 1 1924. — (a) " Certified " 5 4 1 (b) " Grade A (Tuberculin Tested) " — — — (c) " Grade A " — — — (d) " Pasteurised " — 1925. — (a) " Certified " 4 3 1 (b) " Grade A (Tuberculin Tested) " 2 2 — (c) " Grade A " — — — (d) " Pasteurised " Total 17 15 2 37 The two samples shown in the Table of " Certified " milk which upon bacteriological examination proved to be below the standard contained in the Milk (Special Designations) Order, 1923, were both obtained from the same producer, one being taken in the year 1924 and the other in 1925. The Ministry of Health were in each instance communicated with and replies were received stating that the Ministry were taking the matter up with the producer, and that no action on the part of the District Council was necessary. The Council not being satisfied when the second case occurred as to the action taken by the Ministry, directed that the two local Members of Parliament should be made acquainted with all particulars relative to the matter. As a result of the action taken by the Members, the Ministry undertook to take up the question of the repeated failure of the producer to conform to the prescribed bacteriological examination and the unsatisfactory state of affairs was not allowed to be continued. Meat Inspection.—Willesden, owing to its close proximity to the Metropolis, depends almost entirely upon the large London markets for its supply of meat. On an average not more than 12 bullocks and 80 sheep are killed weekly in the slaughter-houses in Willesden. This is relatively a very small percentage of the total amount necessary for human consumption by a population of over 170,000 persons. | The Inspectors of the Health Department visit the slaughter-houses as frequently as possible upon the day and time set apart under the regulations for slaughtering. The carcases are examined for evidence of disease, also the viscera and organs removed during the process of slaughtering. Administration of the Public Health (Meat) Regulations, 1924, as regards Stalls, Shops, Stores and Vehicles.—The Public Health (Meat) Regulations, 1924, came into operation on the 1st April, 1925. The Council being desirous that the Regulations should be put into operation with the minimum of inconvenience to the shop-keepers, a conference with the meat traders of Willesden was called and held at the Town Hall, Dyne Road, Kilburn, on the 19th March, 1925. The Chairman of the Council presided at the meeting. The conference was well attended, not less than one hundred and thirty traders of Willesden being present. The Regulations in detail were fully discussed, but it was evident from the traders' point of view that Article 20 (5) was the one in which the greatest difficulty in administration was likely to occur. The clause referred to is as follows :— " (5) The occupier of any such room— (a) shall take all such steps as may be reasonably necessary to guard against contamination of the meat therein by flies and shall cause the meat to be so placed as to prevent mud, filth or other contaminating substance being splashed or blown thereon ; " It was generally admitted that shops for the sale of meat should have fixed glass fronts for preventing contamination of meat in shops and stalls, and the following resolution was unanimously passed:— " That the meat traders in Willesden are prepared to fall in with the suggestions contained in Articles 19 and 20, that all shops and stalls for the sale of meat should have glass fronts, provided this is universal throughout the whole of the country, and that a reasonable time is allowed for the necessary alterations to be made." It was further decided that stalls should be treated in the same way as shops. Since the date of the Conference, considerable improvements have been effected by many of the traders in the shops where meat is exposed for sale. In several instances new glass fronts have been provided and other improvements effected with a view of conforming with the provisions of the Regulations, but there are still a few traders who expose their meat for sale without protection against contamination. Number of private slaughter-houses in use in the area at the dates mentioned :— Table No. 19. In 1920. In January, 1925. In December, 1925. Registered 4 4 4 Licensed 5 4 4 Total 9 8 8 Inspection and Supervision of Other Foods.—Inspections were made of all the bakehouses and other premises in the district where food is prepared. The 58 bakehouses were all inspected twice during the year, and in 27 instances Notices were served upon the proprietors drawing attention to contraventions of the Factory and Workshop Act. 38 Food Unfit for Human Consumption.—The following is a list of the articles seized or surrendered during the year as unfit for food. Fish (surrendered) 412 lbs. Fruit and Vegetables (surrendered) 232 lbs. Tinned Milk (surrendered) 64 lbs. Bacon (seized) 50 lbs. Bacon (surrendered) 58 lbs. Lambs (two) (surrendered) 45 lbs. Total 861 With regard to the 50 lbs. of unsound bacon seized as unfit for human consumption, legal proceedings were instituted by the Council against the shopkeeper. The Council obtained a conviction, and a fine was imposed of £15 and costs by the Magistrate. The Middlesex County Council is the Authority in Willesden for purposes of the Food and Drugs Acts. I am indebted to Mr. R. Robinson, Chief Officer, Public Control Department, for the following tabular statement, shewing the number of samples taken in Willesden and the result of prosecutions instituted under the Acts during the year 1925 :— Table No. 20. [st of Samples Taken During the Year ended 31st December, 1925. Article. Taken. Adulterated. Milk 733 28 Butter 75 — Cream 3 — Arrowroot 1 — Cinnamon 8 1 Coffee 4 — Curry Powder 5 — Egg Powder 1 — Fruit, Dried 1 — Fruit, Tinned 1 — Ginger, Ground 1 — Macaroni 3 — Meat, Cooked 1 — Mustard 1 — Nutmeg, Ground 8 — Pepper 2 — Prescription 3 — Spice 3 — Sweets 4 — Whisky 21 5 White Precipitate Ointment 1 — 880 34 Prosecutions, 2. Convictions, 2. Public Health (Milk & Cream) Regulations, 1912-1917. Public Health (Condensed Milk) Regulations, 1923. Public Health (Dried Milk) Regulations, 1923. The regulations are administered in Willesden by the Middlesex County Council, and I am indebted to their Public Control Officer for the following statement :— " Inspections were made under these various regulations in order to see that the requirements with respect to labelling were complied with, but as in numerous instances the inspector was able to satisfy himself on this point without taking samples for analysis, I am not able to give statistics of any value showing the work under this heading." 39 ADMINISTRATION OF FACTORY AND WORKSHOP ACT, 1901. The following tables shew the number of premises visited in pursuance of the provisions of the Factory and Workshop Act and the Action taken in connection therewith. Table No. 21. Factories, Workshops, Laundries, Workplaces and Homework. Inspection—Including Inspections made by Sanitary Inspectors. Premises. (1) Number of Primary Inspections. (2) Written Notices. (3) Prosecutions. (4) Factories (including Factory laundries) 237 29 Workshops (including Workshop laundries) 359 33 — Workplaces (other than Outworkers' premises) 40 10 — Total 636 72 Table No. 22.—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 15 15 — — Want of Ventilation 2 2 — — Overcrowding 1 1 — — Want of drainage of floors 1 1 — — Other Nuisances 19 19 — — Sanitary accommodation— Insufficient 6 6 — — Unsuitable or defective 28 26 — — Not separate for Sexes 5 3 — — Unscreened for Sexes 2 2 — — 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) 27 27 — — Other offences (Excluding offences relating to outwork) — — Total 106 102 — — Table No. 23.—Registered Workshops. Workshops on the Register (s. 131) at the end of the year. (1) Number. (2) Factories 180 Factories, Laundries 57 Workshops, Laundries 14 Domestic Laundries 10 Bakehouses 58 Dressmakers 50 Outworkers 210 Blouse Makers 4 Tailors 33 Bootmakers 76 Metal Workers 33 Wood Workers 26 Seamstresses 4 Motor and Cycle Makers 32 Upholsterers 7 Milliners 12 Miscellaneous 60 Total number of Workshops on Register 866 40 Table No. 24.—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) 1 Action taken in matters referred by H.M. Inspector as remediable under the Public Health Acts, but not under the Factory and Workshop Act (s. 5)— Notified by H.M. Inspector 11 Reports (of action taken) sent to H.M. Inspector 1 Other — Underground Bakehouses (s. 101) Certificates granted during the year — In use at the end of the year 17 41 Table No. 25. 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. Contractors. (3) Workmen. (4) Contractors. (6) Workmen. (7) Wearing Apparel— Making, &c. 14 7 27 2 2 4 21 — — — __ Cleaning and Washing — — — — — — — — — — — — — — Household linen — — — — — — — — — — — — — — — Lace, lace curtains, and nets — — — — — — — — — — — Furniture and upholstery 2 2 2 — — — 2 — — — — — — — — Umbrellas, &c — — — — — — — — — — — —- — — — Total 16 9 29 2 2 4 23 — — — — — — — — 43 THE EIGHTEENTH ANNUAL REPORT FOR THE Year ending 31st December, 1925, ON THE HEALTH OF CHILDREN ATTENDING THE PUBLIC ELEMENTARY SCHOOLS IN WILLESDEN. Giving the Tables required by the Board of Education. Table No. 26.—Corresponding to Table 1 of Appendix H of the Annual Report of the Chief Medical Officer of the Board of Education for 1923. Return of Medical Inspections for the year ended 31st December, 1925. A.—Routine Medical Inspections. Number of Code Group Inspections— Entrants 2,595 Intermediates 2,345 Leavers 1,621 Total 6,561 Number of other Routine Inspections 0 B.—Other Inspections. Number of Special Inspections 6,771 Number of Re-inspections 18,865 Total 25,636 Table No. 27.—Corresponding to Table 2 of Appendix H of the Annual Report of the Chief Medical Officer of the Board of Education for 1923. A.—Return of Defects Found by Medical Inspection in the Year ended 31st December, 1925. Defect or Disease. (1) Routine Inspections. Specials. No. of Defects. No. of Defects. Requiring treatment. (2) Requiring to be kept under observation but not requiring treatment. (3) Requiring treatment. (4) Requiring to be kept under observation but not requiring treatment. (5) Malnutrition 55 52 9 — Uncleanliness (see Table IV, Group V) — — Skin 'Ringworm : • Head 1 — 40 — Body 5 — 51 — Scabies 0 — 3 — Impetigo 19 — 345 — Other Diseases (nontuberculous) 61 5 982 7 Eye 'Blepharitis 48 1 100 — Conjunctivitis 10 — 126 — Keratitis 0 — 5 — Corneal Opacities 0 1 7 — Defective Vision (excluding Squint) 382 16 275 17 Squint 18 2 36 1 Other Conditions 15 3 98 — Spectacles broken — — 376 — Spectacles lost 1— — 31 — 44 A.—Return of Defects found by Medical Inspection in the Year ended 31st December, 1925—continued. Defect or Disease. (1) Routine Inspections. Specials. No. of Defects. No. of Defects. Requiring treatment. (2) Requiring to be kept under observation but not requiring treatment. (3) Requiring treatment. (4) Requiring to be kept under observation but not requiring treatment. (5) Ear Defective Hearing 6 2 13 2 Otitis Media 20 1 119 — Other Ear Diseases 25 2 198 — Nose and Throat Enlarged Tonsils only 777 331 216 3 Adenoids only 69 17 12 2 Enlarged Tonsils and Adenoids 245 18 342 1 Other Conditions 104 26 108 1 Enlarged Cervical Glands (non-tuberculous) 92 67 210 — Defective Speech 1 6 3 — Teeth Dental Diseases (see Table IV, Group IV) 1,619 10 Heart and Circulation Heart Disease : Organic 3 23 7 2 Functional 12 106 16 1 Anaemia 14 8 22 — Lungs "Bronchitis 29 23 32 — Other Non-Tuberculous Diseases 13 17 20 Tuberculosis "Pulmonary :— Definite 0 1 0 — Suspected 0 2 9 — Non-Pulmonary :— Definite :— Glands 0 1 0 — Spine 1 0 0 — Hip 0 0 0 — Other Bones and Joints 0 0 0 — Skin 0 0 0 — Other forms 0 0 0 — Suspected :— Glands 0 0 1 — Bones and Joints 0 0 3 — Other forms 0 0 1 — Nervous System Epilepsy 0 0 9 — Chorea 3 3 14 — Other Conditions 4 15 12 — Deformities Rickets 1 2 4 — Spinal Curvature 8 9 3 — Other forms 32 28 33 2 Other Defects and Diseases 136 139 2,597 107 Total 3,828 937 6,488 146 B.—Number of individual Children found at Routine Medical Inspection to require Treatment (excluding Uncleanliness and Dental Diseases). Group. (1) Number of Children. Percentage of Children found to require treatment. (4) Inspected. (2) Found to require treatment. (3) Code Groups— Entrants 2,595 736 28.4 Intermediates 2,345 670 28.6 Leavers 1,621 423 26.1 Total (Code Groups) 6,561 1,829 27.9 Other Routine Inspections 0 0 0 45 Table No. 28.—Corresponding to Table III. of Appendix H of the Annual Report of the Chief Medical Officer of the Board of Education for 1923. Return of all Exceptional Children in the area. Boys. Girls. Total. Blind (including partially blind) (i.) Suitable for training in a School or Class for the totally blind. Attending Certified Schools or Classes for the Blind 3 0 3 Attending Public Elementary Schools 0 0 0 At other Institutions 0 0 0 At no School or Institution 1 0 1 (ti.) Suitable for training in a School or Class for the partially blind. Attending Certified Schools or Classes for the Blind 6 8 14 Attending Public Elementary Schools 1 2 3 At other Institutions 0 0 0 At no School or Institution 1 2 3 Deaf (including deaf and dumb and partially deaf.) (i.) Suitable for training in a School or Class for the totally deaf or deaf and dumb. Attending Certified Schools or Classes for the Deaf 7 3 10 Attending Public Elementary Schools 0 0 0 At other Institutions 0 0 0 At no School or Institution 1 5 6 (ii.) Suitable for training in a School or Class for the partially deaf. Attending Certified Schools or Classes for the Deaf 1 1 2 Attending Public Elementary Schools 3 0 3 At other Institutions 0 0 0 At no School or Institution 1 0 1 Mentally Defective. Feeble-minded (cases not notifiable to the Local Control Authority.) Attending Certified Schools for Mentally Defective Children 69* 42* 111 Attending Public Elementary Schools 1 3 4 At other Institutions 1 1 2 At no School or Institution 4 3f 7 Notified to the Local Control Authority during the year. Feeble-minded 7 2 9 Imbeciles 0 2 2 Idiots 2 0 2 Epileptics. Suffering from severe Epilepsy. Attending Certified Special Schools for Epileptics 5 2 7 In Institutions other than Certified Special Schools 0 2 2 Attending Public Elementary Schools 0 0 0 At no School or Institution 1 1 2 Suffering from Epilepsy which is not severe. Attending Public Elementary Schools 12 9 21 At no School or Institution I 1 2 Physically Defective. Infectious Pulmonary and Glandular Tuberculosis. At Sanatoria or Sanatorium Schools approved by the Ministry of Health or the Board of Education 0 0 0 At other Institutions 0 0 0 At no School or Institution 0 0 0 Non-infectious but active Pulmonary and Glandular Tuberculosis. At Sanatoria or Sanatorium Schools approved by the Ministry of Health or the Board of Education 1 0 1 At Certified Residential Open Air Schools 0 0 0 At Certified Day Open Air Schools 0 1 1 At Public Elementary Schools 0 0 0 At other Institutions 1 1 2 At no School or Institution 4 4 8 Delicate Children (e.g., pre- or latent Tuberculosis, Malnutrition, Debility, Anaemia, &c. At Certified Residential Open Air Schools 2 1 3 At Certified Day Open Air Schools 0 0 0 At Public Elementary Schools 92 64 156 At other Institutions 8 5 13 At no School or Institution 2 1 3 Active Non-Pulmonary Tuberculosis. At Sanatoria or Hospital Schools approved by the Ministry of Health or the Board of Education 2 3 5 At Public Elementary Schools 0 1 1 At other Institutions 0 2 2 At no School or Institution 2 3 5 Crippled Children (other than those with active Tuberculous disease), e.g., Children suffering from Paralysis, etc., and including those with severe Heart Disease. At Certified Hospital Schools 0 1 1 At Certified Residential Cripple Schools 2 0 2 At Certified Day Cripple Schools 44 44 88 At Public Elementary Schools . 7 10 17 At other Institutions 3 2 5 At no School or Institution 2 7** 9 * 4 boys are also Physically Defective. * 5 girls are also Physically Defective. **2 girls are also Mentally Defective. t One girl is also Physically Defective. 46 Table No. 29.—Corresponding to Table IV. of Appendix H of the Annual Report of the Chief Medical Officer of the Board of Education for 1923. Return of Defects Treated during the Year ended 31st December, 1925. Treatment Table. Group I.—Minor Ailments (excluding Uncleanliness, for which see Group V.) Disease or Defect. (1) Number of Defects Treated, or under Treatment during the Year. Treated. Under the Authority's Scheme. (2) Otherwise. (3) Total. (4) Skin :— Ringworm—Scalp Body 94 22 116 Scabies 4 8 12 Impetigo 352 36 388 Other Skin Diseases 994 122 1,116 Minor Eye Defects (external and other, but excluding cases falling in Group II.) 365 40 405 Minor Ear Defects 376 65 441 Miscellaneous (e.g., Minor Injuries, Bruises, Sores, Chilblains, etc.) 2,574 1,448 4,022 Total 4,759 1,741 6,500 Group II.—Defective Vision and Squint (excluding Minor Eye Defects treated as Minor Ailments—Group I.) Defect or Disease. (1) Number of Defects dealt with. Under the Authority's Scheme. (2) Submitted to refraction by private practitioner or at hospital apart from the Authority's Scheme. (3) Otherwise. (4) Total. (5) Errors of Refraction (including squint) (Operations for squint should be recorded separately in the body of the Report.) 667 5 0 672 Other Defect or Disease of the Eyes (excluding those recorded in Group I.) 0 0 0 0 Total 667 5 0 672* Total number of children for whom spectacles were prescribed :— (a) Under the Authority's scheme 587 (b) Otherwise 124 Total number of children who obtained or received spectacles :— (a) Under the Authority's scheme 506 (b) Otherwise 129 * In addition to this number 201 cases of visual defect received attention by Voluntary Hospital, Private Practitioner or Optician, but it was not known whether they were submitted to refraction. 47 Group III.—Treatment of Defects of Nose and Throat. Number of Defects. Received Operative Treatment. Received other forms of Treatment. (4) Total Number Treated. (5) Under the Authority's Scheme in Clinic or Hospital. (1) By Private Practitioner or Hospital apart from the Authority's Scheme. (2) Total. (3) 400 391 791 412 1,203 Group IV.—Dental Defects. Vide 7th Annual Report on Dental Work in connection with children attending the public elementary schools, expectant and nursing mothers and children under 5 years, herewith. Group V. Uncleanliness and Verminous Conditions. (i.) Average number of visits per school made during the year by the School Nurses 24.3 (ii.) Total number of examinations of children in the schools by School Nurses 46,490 (iii.) Number of individual children found unclean 2,240 (iv.) Number of children cleansed under arrangements made by the Local Education Authority 396 (v.) Number of cases in which legal proceedings were taken :— (a) Under the Education Act, 1921 16 (b) Under the School Attendance By-Laws 0 (vi.) No. of school sessions at which inspections were conducted 779 (vii.) (i.) Original Inspections :— Children examined (i.e., Cases not individual children) 37,430 Found unclean 2,954 Percentage found unclean 7.9 Excluded on account of uncleanliness 81 (ii.) Re-inspections :— Children examined (i.e., Cases not individual children) 9,060 Found unclean 5,450 Percentage found unclean 60.2 Excluded on account of uncleanliness 47 (iii.) Total:— Examinations 46,490 Exclusions on account of uncleanliness 128 Appendix H of the Annual Report of the Chief Medical Officer of the Board of Education for 1923. Notes on Table IV. (/). " A Statement as to the arrangements made by the Local Education Authority for cleansing verminous children and a record of the cases in which legal proceedings were taken, should be included in the body of the School Medical Officer's Report." The Authority has established a cleansing room at each of its two Municipal Clinics. Children suffering from 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. Record of cases in which legal proceedings were taken. 48 The following information has been supplied by the Chief Education Officer, to whom cases for prosecution are referred. Cases Under Section 87 of the Education Act, 1921. No. of Cases. A Fined. Amount of Fine. Withdrawn. Dismissed. 5 10/- 7 Nil. 2 7/6 2 51- 49—50 Table No. 30.—In this Table is embodied the information required in the N.B. to Notes on Table IV. of Appendix H of the Annual Report of the Chief Medical Officer of the Board of Education for 1923. Return showing the nature and number of all medical defects referred for following up, whether referred from Routine Medical Inspection, Medical Inspection of " Specials," or from other Sources, these latter having never been inspected by the Education Committee's Medical Officers; the number of visits and medical examinations made in connection therewith, and the extent to which remedial measures were carried out during 1925. CONDITIONS. l No. of defects followed up No. of visits made 5 on account of these defects. No. of Medical Examinations 6 made on account of these defects. No. of times attended by Clinic 7 Nurse only on account of these defects. No. of defects for 8 which no report is available. No. of defects not needing treatment. No. of defects treated. Grand Total. 17 Results of Treatment. Percentage of defects treated. No. of defects not treated. Wo. of defects under observation at end of year 27 and carricd forward to succeeding year. Remedied. 18 Improved 19 Unchanged 20 Under observation at end of year (result of 21 treatment not known) School Clinic. 10 Hospita (under Council Scheme) 11 Volun- taryHos [| pital or other charitable In stitution 12 Infirmary or Poor Law. 13 Private Practitioner. 14 Total. 15 Domestic Treatment only. 16 - Exclud ing Domestic Treatment. 22 Inluding Domestic Treatmen*. 1 23 Removed froju obierva tion. 24 Still under observa tion at end of year. 25 Total. 26 Brough forward from previou year. 2 New. 3 Total. 4 Clothing— Unsatisfactory 3 15 18 33 1 — 2 — — — — — 16 16 13 — — 3 % 100.0 % 100.0 3 Footgear— Unsatisfactory — 1 1 — — — — — — — — — — — — — — — — — — — — — 1 1 Cleanliness of Head— Nits 180 2,668 2,849 530 140 107 26 2 140 — — — 1 141 2,606 2,747 2,612 — — 135 5.0 97.4 3 71 74 206 Pediculi 18 461 479 444 270 141 4 — 229 — — — 1 230 237 467 437 — — 30 48.4 98.3 1 7 8 37 Other dirty conditions — 5 5 8 — — — — — — — — — — 5 5 5 — — — — 100.0 — — — — Cleanliness of Body— Dirty — 28 28 60 4 — — — — — — — — — 28 28 27 — — 1 — 100.0 — — — 1 Pediculi — 3 3 9 1 — — — — — — — — — 3 3 — — 100.0 — Fleabitten 3 70 73 135 6 — 2 — — — — — — — 70 70 67 — — 3 — 98.6 — 1 1 4 Malnutrition 53 39 92 161 81 — 8 1 11 — 7 — 8 26 40 66 32 18 — 16 31.3 79.5 4 13 17 29 Nose and Throat— Enlarged Tonsils 317 902 1,219 3,441 1,210 708 40 81 107 84 159 3 22 375 14 389 293 17 3 76 34.2 35.4 293 416 709 492 Adenoids 41 65 106 294 94 4 1 5 3 17 17 — 2 39 1 40 37 — 1 2 39.0 40.0 39 21 60 23 Enlarged Tonsils and Adenoids 283 744 1,027 3,342 1,733 519 14 16 72 290 195 2 11 570 6 576 481 8 — 87 57.2 57.8 248 173 421 260 Other conditions 46 243 289 572 435 285 4 10 90 2 17 1 81 191 63 254 212 9 1 32 69.5 92.4 11 10 21 42 Cervical or Neck Glands— Enlarged (non-T.B.) 98 439 537 870 544 92 7 2 213 — 31 — 63 307 164 471 397 13 — 61 58.1 89.2 15 42 57 103 External Eye Disease— Blepharitis 30 141 171 316 517 329 — — 116 — 8 — 6 130 26 156 119 1 — 36 76.0 91.2 3 12 15 48 Conj uncti vitis 26 160 186 290 603 382 — — 135 — 6 — 5 146 37 183 171 2 — 10 78.5 98.4 2 1 3 11 Corneal Opacities 4 10 14 18 37 26 3 — 6 — 3 — 1 10 10 3 5 — — 90.9 90.9 1 — — 2 Keratitis 2 6 8 32 14 1 — — 6 — 2 — 8 8 2 6 — — 100.0 100.0 — — — Other conditions 16 123 139 172 325 108 1 3 100 — 5 1 3 109 24 133 122 — 11 80.7 98.5 2 — 2 11 Ear Disease— Chronic Suppuration of Middle- Ear 71 163 234 580 1,142 1,891 6 — 155 — 22 — 14 191 22 213 147 5 — 61 83.8 93.4 10 5 15 66 Defective Hearing 6 26 32 61 55 19 2 7 10 — 1 2 13 1 14 9 — 5 56.5 60.9 4 5 9 10 Wax 11 116 127 106 278 181 1 — 119 — 1 1 121 3 124 111 1 — 12 96.0 98.4 2 2 12 Other Disease 16 131 147 253 294 146 — — 92 — 10 — 14 116 21 137 118 — — 19 78.9 93.2 4 6 10 25 Teeth—See Dental Returns Heart and Circulation— Organic Disease 14 14 28 62 25 — 2 3 — 7 1 1 9 6 15 10 1 4 39.1 65.2 7 1 8 — Functional Disease 12 29 41 81 40 —. 1 3 4 — 8 9 21 7 28 7 11 10 56.8 77.7 3 6 9 16 Anaemia 31 30 61 86 53 — 4 1 — — 10 8 18 35 53 30 12 11 32.1 94.6 1 2 3 13 Other defects 8 5 13 19 8 — — 1 — — 6 — 2 8 2 10 3 4 — 3 66.7 83.3 2 — 2 3 Lungs— Bronchitis 62 229 291 663 95 1 1 — 33 — 136 169 102 271 225 3 -— 43 58.5 93.8 10 8 18 51 Tuberculosis 2 2 4 8 4 — — — — — — — — — — — — — — — — — 3 — 3 — T.B. Suspected 13 18 31 67 38 — 5 2 17 2 19 3 22 10 3 — 9 79.2 91.7 — 2 2 11 Other disease (non-T.B.) 17 70 87 236 60 — 3 4 16 — 19 3 28 66 12 78 61 6 — 11 82.5 97.5 1 1 2 12 Nervous System — Epilepsy 4 21 25 69 16 — 3 2 — — 4 — 3 7 — 7 — 4 — 3 35.0 35.0 9 4 13 7 Chorea 18 48 66 262 33 — 2 1 — 35 1 19 55 4 59 29 8 1 21 87.3 93.7 4 — 4 21 Other Conditions 9 34 43 139 35 4 — 1 4 — 17 — 14 35 4 39 18 9 — 12 83.3 92.9 2 1 3 13 Skin- Ringworm Body Head 15 117 132 256 395 88 3 1 94 — 9 1 12 116 10 126 114 — — 12 90.6 98.4 1 1 9 13 Impetigo 33 508 541 1,040 977 1,862 — — 352 — 14 22 388 146 534 474 — 60 71.7 98.7 4 3 7 63 Scabies 2 10 12 36 10 10 — — 4 — 2 6 12 — 12 12 — — — 100.0 100.0 — — — Minor Injuries 51 1,268 1,319 1,367 3,093 4,407 2 24 998 — 36 1 33 1,068 215 1,283 1,200 1 S2 82.6 99.2 8 2 10 84 Other disease (non T B.) 101 1,331 1,432 2,190 3,069 2,342 8 16 994 — 33 3 86 1,116 279 1,395 1,286 1 3 105 79.3 99.1 10 3 13 108 Deformities— Rickets 4 5 9 22 5 — — — 1 — 4 — 1 6 2 8 — 5 3 66.7 88.9 1 — 1 3 Spinal Curvature 12 5 17 33 11 1 3 — — 6 o 8 2 10 — 8 2 57.1 71.4 3 1 4 3 Other forms 19 65 84 191 66 3 7 4 6 — 24 — 2 32 15 47 11 21 3 12 43.8 64.4 18 8 26 20 Tuberc ulosis (Non-Pulmonary)— Definite 2 — 2 7 7 14 2 — — — — — — — — — — — — — — — — — — — Suspected—Glands 1 1 2 5 1 — — 1 1 2 2 1 — 1 100.0 100.0 — I ,, Bones and joints 2 4 6 18 9 2 — — 2 — •> 1 1 33.3 33.3 4 4 1 „ Other forms 1 2; 3 14 1 — — — — — 3 — — 3 — 3 2 1 — 100.0 100.0 — — — Speech— Defective Articulation 1 5 6 10 4 — — 1 1 — — — 1 2 1 3 1 1 — 1 40.0 60.0 2 — 2 1 Squint— Squint present „ 31 58 89 197 150 57 3 1 43 — 10 — 2 55 55 26 16 3 10 64.7 64.7 11 19 30 29 Vision— Defect not ascertained 27 46 73 132 69 32 3 8 20 — 9 — 5 34 — 34 21 7 1 5 54.8 54.8 19 9 28 14 One eye normal 52 112 164 409 277 72 12 14 81 — 14 4 99 — 99 57 23 4 15 71.7 71.7 24 15 39 30 Both eyes 6/6 5 56 61 94 110 27 — 30 23 — 1 24 — 24 20 — 1 3 77.4 77.4 5 2 7 5 6/9 15 64 79 155 147 23 4 9 41 — 2 — 3 46 — 46 23 12 1 10 69.7 69.7 16 4 20 14 One eye 6/9 other 6/12 or less 55 101 156 374 317 89| 7 3 87 — 9 4 100 — 100 46 28 4 22 68.5 68.5 29 17 46 39 Both eyes 6/12 or less 120 320 440 1,081 917 271 12 10 276 — 45 10 331 — 331 180 76 19 56 79.2 79.2 39 48 87 104 Spectacles broken 31 391 422 341 757 59 3 1 384 — 3 16 403 1 404 362 42 96.4 96.7 9 5 14 47 „ lost 8' 36 44 46 71 3 — — 37 — — — 1 38 — 38 27 — — 11 86.4 86.4 4 2 6 13 Debility 147' 365 512 1,185 731 11 7 — 172 — 80 2 95 349 132 481 343 25 — 113 69.1 95.2 13 11 24 124 Miscellaneous 300 4,322 4,622 8,219 4,500 633 26 366 1,175 — 263 13 608 2,059 2,002 4,061 3.725 49 9 278 48.7 96.0 104 65 169 343 Grand Totals 2,449 18,252 18,701 30,841 23,885 14,949 244 635 6,418 393 1,210 33 1,369 9,423 6,367 15,790 13.732 429 56 1,573 52.9 88.6 1,008 1,024 2,032 2,597 Re-examinations in respect of Defective Vision other than Lost and Broken Spectacles and other conditions— No. of Visits 3,063 No. of times attended by Clinic Nurse only... ... 452 No. of Medical Examinations 2,595 51 Certain Statistical Data. No. of Public Elementary Schools at December, 1925 32 No. of School Departments at December, 1925 74 Average Public Elementary School Roll, year ended 31st March, 1925 21,649 Total No. of Children medically inspected at Routine and Special Inspections 13,332 Total No. of Children dentally inspected 13,550 Total No. of Defects of every description "followed up" during 1925 27,519 Total No. of Defects of every description for which treatment was obtained during 1925 Medical or Dental Treatment 11,363 Domestic Treatment 6,367 Total 17,730 Total No. of Attendances at the School Clinics during 1925 46,818 Special Schools. No. of Physically Defective Schools 2 (1 school formerly for mentally defective children was closed on 25/7/17 and re-opened on 13/12/20 for physically defective children). No. of Mentally Defective Schools 1 No. of children attending Special Schools during 1925:— Table No. 31. In Willesden. Outside Willesden. Total. Blind and Partially Blind — 19 19 Deaf — 21 21 Mentally Defective 124 5 129 Epileptic — 8 8 Physically Defective 133 10 143 Total 257 63 320 Table No. 32.—Corresponding to Appendix E of the Annual Report of the Chief Medical Officer of the Board of Education for 1919. Form of Annual Return of the After-Careers of Children under 21 Years of Age Formerly Attending Special Schools. Furness Road Physically Defective School. Leinster Road Mentally Defective School. Boys. Girls. Boys. Girls. 1. Number of children who have left the school and are under 21 years 20 28 53 37 2. Number who:— (a) Have since died 2 4 1 3 (b) Are known to be incapable by reason of mental or physical defect of undertaking employment 2 - 7 6 (c) Are in attendance at an Institution for further education (give details), and †1 † 1 † 2 - (d) Are in any other Institution (specify Asylum, Workhouse, Colony for Epileptics, &c.) ††1 * 1 ** 7 **3 3. Number who are employed in:— (a) Industrial or manual occupations 9 9 22 1 (6) Agricultural or rural occupations - - 1 - (c) Domestic occupations, including those who are helping in the domestic work at home - 6 - 18 (d) Commercial, professional or clerical work 1 3 1 (e) Blind alley or other precarious occupations 2 - 5 - 4. Number who have left the neighbourhood or whose after-careers have not been traced 2 4 7 6 † In attendance at Technical, or Secondary Schools for further education. †† In a Home for Cripples. * In Caterham Asylum. ** In Institutions for Mentally Defectives. 4 Mentally Defectives and 4 Physically Defectives are unemployed. 52 Table No. 33. Return showing No. of Cases referred for following-up in 1925 and previous years with the view of Medical Treatment being obtained, Remedial Measures carried out, or other action taken. Year. Referred by Total. f Medical Inspection and Officers of Health Department. Head Teachers. Attendance Officers. Others. 1925 6,224 4,003 121 4,939 15,287 1924 6,142 4,983 116 3,927 15,168 1923 4,900 4,230 131 4,715 13,976 1922 4,004 5,720 236 4,580 14,540 1921 4,203 4,779 248 5,711 14,941 1920 2,949 4,774 353 5,354 13,430 1919 1,796 4,167 451 3,538 9,952 1918 1,674 4,163 395 1,150 7,382 1917 1,227 3,372 441 427 5,467 1916 1,436 3,264 313 394 5,407 1915 1,308 3,429 109 298 5,144 1914 2,322 2,401 108 140 4,971 1913 1,092 1912 1,102 1911 1,030 1910 941 Table No. 34. Medical and Dental Treatment—Attendances at the Municipal Clinics, 1925. Condition. Mothers and Children under 5. School Children. Grand Total. Expectant Mothers. Nursing Mothers. Children under five. Total. 1. Cleansing 22 35 793 850 4,481 5,331 2. Throat, Nose and Ear Diseases 0 0 296 296 2,794 3,090 3. Minor Ailments 52 128 2,639 2,819 28,417 31,236 4. Eye Diseases 0 1 138 139 5,478 5,617 5. Ringworm, etc. 0 0 47 47 339 386 6. Artificial Sunlight* 0 0 44 44 186 230 7. Medical Consultations 955 7,686 13,283 21,924 0 21,924 8. Total 1—7 1,029 7,850 17,240 26,119 41,695 67,814 9. Dental Consultations 121 469 346 936 5,123 6,059 10. Grand Total 1,150 8,319 17,586 27,055 46,818 73,873 *Artificial Sunlight Treatment commenced 16/11/25. 53  Clinic (I.). Clinic (II.). Mothers and Children under Five. School Children Total. Mothers and Children under Five. School Children. Total. Grand Total. 11. Medical Attendances 11,177 23,365 34,542 14,942 18,330 33,272 67,814 12. Dental Attendances 364 2,486 2,850 572 2,637 3,209 6,059 13. Total 11,541 25,851 37,392 15,514 20,967 36,481 73,873 Table No. 35. Shewing attendances at the Municipal Clinics each year since 1913. Year. Mothers and Children under 5 years. School children. Total. School for Mothers. Nursery. Grand Total. Medical. Dental. Total. Medical. Dental. Total. 1913 0 0 0 299 0 299 299 0 0 299 1914 0 0 0 2,517 0 2,517 2,517 0 0 2,517 1915 0 0 0 5,674 0 5,674 5,674 0 0 5,674 1916 389 0 389 9,593 0 9,593 9,982 0 0 9,982 1917 8,641 0 8,641 9,448 0 9,448 18,089 0 0 18,089 1918 32,169 1,165 33,334 15,811 2,403 18,214 51,548 44 220 51,812 1919 32,870 878 33,748 46,179 11,024 57,203 90,951 1,089 2,814 94,854 1920 51,468 1,823 53,291 64,588 10,670 75,258 128,549 2,354 3,452 134,355 1921 41,562 1,667 43,229 57,032 7,718 64,750 107,979 1,716 2,356 112,051 1922 27,505 894 28,399 39,989 7,025 47,014 75,413 1,616 2,190 79,219 1923 23,271 533 23,804 40,381 3,599 43,980 67,784 2,761 3,270 73,815 1924 17,082 520 17,602 34,845 2,460 37,305 54,907 2,896 2,808 60,611 1925 26,119 936 27,055 41,695 5,123 46,818 73,873 4,074 3,812 81,759 The defects of School Children which were treated at the School Clinics during 1925 are shown in Table No. 30. 33 School Children and 5 children under 5 years of age were treated by X-rays for Ringworm of the Scalp. 6,146 Individual School Children attended the Municipal Clinics during 1925. Table No. 36. Return respecting the Provision of Spectacles during 1925. No. of pairs of Spectacles provided 533 Cost of Spectacles provided £90 16 3 Average cost per pair 3 5 No. of pairs provided at full charge made by Council 461 No. of pairs provided free or at reduced charge 72 Total amount received as above £93 10 0 Cost of repairs £38 9 7 Total amount received for repairs £25 16 0 Hospital Treatment of School Children under the Council's Scheme. Table No. 37. Hospital Treatment of School Children during 1925. No. of School Children in Willesden General Hospital at 31st December, 1924 8 „ „ „ admitted during 1925 354 „ „ „ under treatment during 1925 362 „ „ „ discharged during 1925 354 „ „ „ died in Hospital during 1925 1 ,, „ „ remaining in Willesden General Hospital at 31st December, 1925 7 54 Table No. 38. Treatment of defects of Children admitted in 1925. Defect. No. Admitted. Forms or Treatment. Results or Treatment. Remaining in Hospital December 31st, 1925. Operative. General Remedied. Improved. Unchanged Died. Enlarged Tonsils and Adenoids 353* 349 — 348 — — 1 7 Septic Throat 1 — 1 1 — — — — Total 354 349 1 349 — — 1 7 * 4 of these cases were not operated on. No School Children were admitted to St. Monica's Home Hospital. Table No. 39.—Employment of Children in Entertainments Rules, 1920. Particulars as to applications received in 1925 for certificates from the School Medical Officer. No. of Applications. No. Granted. Boys. Girls. Total. Boys. Girls. Total. Original applications 0 2 2 0 2 2 Applications for renewals 0 1 1 0 1 1 0 3 3 0 3 3 55 THE SIXTH ANNUAL REPORT, for the Year ending 31st December, 1925. on the HEALTH OF PUPILS ATTENDING SECONDARY SCHOOLS IN WILLESDEN. Giving the Tables required by the Board of Education. Kilburn Grammar School—Boys. Willesden Polytechnic Trade School—Girls. Willesden County School—Boys and Girls. Willesden Polytechnic Building Trade School—Boys. Table No. 40.—Corresponding to Table I. of Appendix H of the Annual Report of the Chief Medical Officer of the Board of Education for 1923. Number of Pupils Inspected 1st January, 1925, to 31st December, 1925. A.—Routine Medical Inspections. Number of Code Group Inspections. Pupils examined. Aged. Kilburn Grammar School. Polytechnic Trade School. Willesden County School. Willesden Polytechnic Building Trade School. Total. Boys. Girls. Boys. Girls. Boys. Boys. Girls. Total. Entrants. Others. Total. Entrants. Others. Total. Entrants. Others. Total. Entrants. Others. Total. Entrants. Others. Total. Entrants. Others. Total. Entrants. Others. Total. Entrants. Others. Total. 10 years 0 0 0 0 0 0 0 0 0 1 0 1 0 0 0 0 0 0 1 0 1 1 0 1 11 .. 7 0 7 0 0 0 13 0 13 8 0 8 0 0 0 20 0 20 8 0 8 28 0 28 12 „ 39 20 59 0 0 0 23 18 41 18 7 25 0 0 0 62 38 100 18 7 25 80 45 125 13 „ 8 0 8 6 0 6 4 0 4 8 0 8 0 0 0 12 0 12 14 0 14 26 0 26 14 „ 0 0 0 17 0 17 7 0 7 6 0 6 17 0 17 24 0 24 23 0 23 47 0 47 15 „ 2 62 64 3 33 36 0 5 5 2 3 5 5 0 5 7 67 74 5 36 41 12 103 115 Total 56 82 138 26 33 59 47 23 70 43 10 53 22 0 22 125 105 230 69 43 112 194 148 342 Note that in the above table a pupil examined as an entrant, and subsequently as having attained his or her birthday during the preceding term, appears twice, that is as 2 cases. B.—Other Inspections. Kilburn Grammar School. Polytechnic Trade School. Willesden County School. Willesden Polytechnic Building Trade School Total. Boys. Girls. Boys. Girls. Boys. Boys. Girls. Total. Number of Special Inspections 1 3 0 0 0 1 3 4 Number of Re-inspections 63 28 5 10 0 68 38 106 Total 64 31 5 10 0 69 41 110 56 Table No. 41.—Corresponding to Table II. of Appendix H of the Annual Report of the Chief Medical Officer of the Board of Education for 1923. A.—Return of Defects Found by Medical Inspection in the Year Ended 31st December, 1925. Defect or Disease. (1) Routine Inspections. Special Inspections. Number of Defects. Number of Defects. Requiring treatment. (2) Requiring to be kept under observation, but not requiring treatment. (3) Requiring treatment. (4) Requiring to be kept under observation, but not requiring treatment. (5) Kilburn Grammar School (Boys). Willesden Polytechnic Trade School (Girls). Willesden County School. Willesden Poly technic-Building Trade School (Boys). Kilburn Grammar School (Boys). Willesden Polytechnic Trade School (Girls). Willesden County School. Willesden Polytechnic Building Trade School (Boys). Kilburn Grammar School (Boys). Willesden Polytechnic Trade School (Girls). Willesden County School. Willesden Polytechnic Building Trade School (Boys). Kilburn Grammar School (Boys). Willesden Polytechnic Trade School (Girls). Willesden County School. Willesden Polytechnic Building Trade School (Boys). Boys. Girls. Boys. Girls. Boys. Girls. Boys. Girls. Malnutrition 1 - - - - 2 - - - - - - - - - - - - - - Uncleanliness (See Table IV., Group V.) - - - - - - - - - - - - - - - - - - - - -Skin Ringworm:— Scalp - - - - - - - - - - - - - - - - - - - - Body - - - - - - - - - - - - - - - - - - - - Scabies - - - - - - - - - - - - - - - - - - - - Impetigo - - - - - - - - - - - - - - - - - - - Other Diseases (Non-Tuberculous). - - - - - - - - - - - - - - - - - - - - Eye Blepharitis - - - - - - - - - - - - - - - - - - - - Conjunctivitis - - - - - - - - - - - - - - - - - - - - Keratitis - - - - - - - - - - - - - - - - - - - - Corneal Opacities - - - - - - - - - - - - - - - - - - - Defective Vision (excluding Squint). 8 3 4 7 2 - - - 1 - - - - - - - - - - - Squint - - - - - 2 - - 2 - - - - - - - - - - - Other Conditions - - - - 2 - - - - - - - - - - - - - - - Ear Defective Hearing - - - - 1 - - - - - - - - - - - - - - Otitis Media - - - - - - - - - - - - - - - - - - - - Other Ear Diseases - - - - - - - - - - - - - - - - - - - - Nose & Throat Enlarged Tonsils only. 8 2 2 - 1 2 2 - - - - - - - - - - - - - Adenoids only - - - - - - - - - - - - - - - - - - - Enlarged Tonsils and Adenoids. - - 3 5 - - - - - - - - - - - - - - - - Other Conditions 2 - - - - - - - - - - - - - - - - - - - Enlarged Cervical Glands (non-Tuberculous). 3 - - - - 2 - - - - - - - - - - - - - - Defective Speech - - - - - - - - - - - - - - - - - - - - Teeth—Dental Diseases 25 15 9 4 7 1 - - 1 - - - - - - - - - - - Heart and Circulation. Heart Disease:— - - - - - - - - - - - - - - - - - - - - Organic - - - - - - - - - - - - - - - - - - - Functional - - - - - 1 2 - - - - - - - - - - - - - Anaemia 1 1 - - - - 1 - - - - 1 - - - - - - - - Lungs Bronchitis - - - - - - - - - - - - - - - - - - - - Other Non-Tuberculous Diseases. - - - - - - - - - - - - - - - - - - - - Tuberculosis Pulmonary:— - - - - - - - - - - - - - - - - - - - - Definite - - - - - - - - - - - - - - - - - - - - Suspected - - - - - - - - - - - - - - - - - - - - Non-Pulmonary: - - - - - - - - - - - - - - - - - - - - Glands - - - - - - - - - - - - - - - - - - - - Spine - - - - - - - - - - - - - - - - - - - - Hip - - - - - - - - - - - - - - - - - - - - Other bones and Joints. - - - - - - - - - - - - - - - - - - - - Skin - - - - - - - - - - - - - - - - - - - - Other forms - - - - - - - - - - - - - - - - - - - - Nervous System Epilepsy - - - - - - - - - - - - - - - - - - - - Chorea - - - - - 1 - - - - - - - - - - - - - - Other Conditions - - - - - - - - - - - - - - - - - - - - Deformities. Rickets - - - - - - - - - - - - - - - - - - - - Spinal Curvature - 1 4 1 - - 8 1 4 - - - - - - - - - - - Other Forms - - - - - - - - - - - - - - - - 1 - - - Flat Foot 2 - 4 2 - 4 1 1 3 - - 1 - - - - - - - - Other defects and diseases - - - - 1 - 7 1 2 - - 1 - - - - - - - - Total 50 22 27 19 14 15 29 3 14 - - 3 - - - - 1 - - - 57 B.—Number of Individual Pupils found at Routine Medical Inspection to Require Treatment (Excluding Uncleanliness and Dental Diseases). Group. Kilburn Grammar School. Willesden Polytechnic Trade School. Willesden County School. Willesden Polytechnic Building Trade School. Boys. Girls. Boys. Girls. Boys. Number of Pupils Percentage of Pupils found to require treatment. Number of Pupils Percentage of Pupils found to require treatment. Number of Pupils Percentage of Pupils found to require treatment. Number of Pupils Percentage of Pupils found to require treatment. Number of Pupils Percentage of Pupils found to require treatment. Inspected. Found to require treatment. " Inspected. Found to require Treatment. Inspected. Found to require Treatment. Inspected. Found to require treatment. Inspected. Found to require Treatment. Code Groups:— Entrants (at any age) 56 11 19.6 26 5 19.2 47 12 25.5 43 11 25.6 22 7 31.8 Pupils aged 12 years 20 3 15.0 0 0 0.0 18 2 11.2 7 2 28.6 0 0 0.0 Pupils aged 15 years 62 6 9.7 33 2 6.1 5 1 20.0 3 0 0.0 0 0 0.0 Total (Code Groups) 138 20 14.5 59 7 11.9 70 15 21.4 53 13 24.5 22 7 31.8 **Other Routine Inspections - - - - - - - - - - - - - - - ** During 1925 the following groups have been submitted to Routine Medical Inspection at the Secondary Schools in Willesden, and are all included under the Code Group Heading:— (a) All entrants except any pupil who had been medically examined at an Elementary School within the past 2 years, and in whose case the record of such examination was available for the inspecting Officer. (b) Pupils aged 12 years. (c) Pupils aged 15 years. Table No. 42.—Corresponding to Table IV. of Appendix H of the Annual Report of the Chief Medical Officer of the Board of Education for 1923. Return of Defects Treated during the Year ended 31st December, 1925. Treatment Table. Group I.—Minor Ailments (excluding Uncleanliness, for which see Group V.). Number of Defects Treated or Under Treatment During the Year. Defect or Disease. (I) Kilburn Grammar School. Willesden Polytechnic Trade School. WiHesden County Schools. Willesden Polytechnic Building Trade School Boys. (2) Girls. (3) Boys. (4) Girls. (5) Boys. (6) Treated under the Authority's Scheme Otherwise. Total. Treated under the Authority's Scheme Otherwise. Total. Treated under the Authority's Scheme Otherwise. Total. Treated under the Authority's Scheme Otherwise. Total. Treated under the Authority's Scheme Otherwise. Total. Skin:— Ringworm—Scalp - - - - - - - - - - - - - - - Body - - - - - - - - - - - - - - - Scabies - - - - - - - - - - - - - - - Impetigo - - - - - - - - - - - - - - - Other skin diseases - 1 1 - 1 1 - - - - - - - - - Minor Eye Defects (External and other, but excluding cases falling in Group II.) - 3 3 - - - - - - - - - - - - Minor Ear Defects - 1 1 - 1 1 - - - - - - - - - Miscellaneous (e.g., Minor Injuries, Bruises, Sores, Chilblains. etc.). - - - - - - - - - - - - - - - Total - 5 5 - 2 2 - - - - - - - - - 58 Group II.—Defective Vision and Squint (excluding Minor Eye Defects treated as Minor Ailments—Group I.). No treatment has been arranged for by the Local Education Authority, but at the Kilburn Grammar School (Boys).—In 9 instances the School Medical Inspector noted at a subsequent examination that the defect had been treated. In 2 instances the School Medical Inspector noted on re-examination that the eyes had been tested and that glasses were not now required to be worn. Willesden Polytechnic Trade School (Girls).—In 1 instance the School Medical Inspector noted on re-examination that the defect had been treated. Willesden County School.—In the case of 1 boy and 3 girls the School Medical Inspector noted at a subsequent examination that glasses had been provided. Willesden Polytechnic Building Trade School (Boys).—No cases were recorded as having received treatment as only 1 medical inspection has been held at this School. Group III.—Treatment of Defects of Nose and Throat. Number of Defects. Received Operative Treatment. Received other forms of Treatment. Total number treated. Under the Authority's Scheme in Clinic or Hospital. By Private Practitioner or Hospital, apart from the Authority's Scheme. Total. (1) (2) (3) (4) (5) No Treatment has been arranged for by the Local Education Authority. Kilburn Grammar School. 1 Kilburn Grammar School. 1 Kilburn Grammar School. 4 Kilburn Grammar School. 5 At the Willesden Polytechnic Trade School (Girls), the Willesden County School (Boys and Girls) and the Willesden Polytechnic Building Trade School (Boys), there were no cases recorded as having received treatment. Group IV.—Dental Defects. Dental work is not done in connection with the Secondary Schools in Willesden. The School Medical Inspectors noted at the examinations during the year that of the cases previously referred for dental treatment 26 cases at the Kilburn Grammar School (boys), 6 cases at the Willesden Polytechnic Trade School (Girls) and 4 cases (1 boy and 3 girls) at the Willesden County School (Boys and Girls) had received dental treatment. At the Willesden Polytechnic Building Trade School (Boys) there were no cases recorded as having received treatment as only 1 Medical Inspection has been held at this School. Group V.—Uncleanliness and Verminous Conditions. Inspection and treatment of uncleanliness has not been undertaken by the School Nurses in the Secondary Schools in 1925. Treatment of other Types of Defect. (a) The measures adopted for providing treatment or for securing improvement:— No measures have been adopted by the Authority for providing treatment. Notices were sent to parents informing them of the conditions requiring treatment, and the Head Teachers were notified of conditions requiring special exercises and the like. Pupils with defects referred for treatment or requiring to be kept under observation were referred for re-examination at a subsequent visit of the School Medical Inspector. (b) The effect of the measures taken. The School Medical Inspector noted as follows:— Table No. 43. (a)—KILBURN GRAMMAR SCHOOL. Defect. No. Result. Malnutrition 2 Improving. Anaemia 2 Treated. 1 Improving. Deformities:— Flat Foot 1 Improved. Other Defects and Diseases:— Nœvus, left leg 1 Treatment not now required. Undescended Testicle 1 Treated. Indigestion 1 Treated. 59 (b)—WILLESDEN POLYTECHNIC. Defect. No. Result. Heart and Circulation:— Heart Disease— Organic 0 Functional 1 Still present—under medical care. Anæmia 1 Improved. 1 Remedied. Nervous System:— Epilepsy 0 Chorea 0 Other Conditions 1 Remedied. Deformities:— Spinal Curvature 3 1 still present. 2 Improving. Other Defects and Diseases 1 Under medical care. (c)—WILLESDEN COUNTY SCHOOL. Defect. No. Result. Boys. Girls. Deformities:— Spinal Curvature 1 Improving. 1 Under treatment. Flat foot 1 Improving. At the Willesden Polytechnic Building Trade School (Boys) there is nothing to record as only one Medical Inspection has been held at this School. 61 THE EIGHTH ANNUAL REPORT for the Year 1925, on DENTAL WORK in connection with SCHOOL CHILDREN, EXPECTANT and NURSING MOTHERS and CHILDREN under 5 years. By E. A. JENNINGS, L.D.S., R.C.S.Eng. The new conditions under which patients may now attend the Clinics have resulted in an increase in the amount of work during the year over that of 1924. 1,860 children have actually received treatment and 4,384 attendances for treatment were recorded. 2,202 fillings were done, and 4,217 teeth removed, for which general anaesthetics were administered on 1,267 occasions and local on 726. In addition, 435 other operations were performed on the mouths. It has been necessary to devote 7 sessions for treatment at the Clinics and to reduce the school inspection session to 4 per week, in consequence of which only about two-thirds of the total school population have been subject to inspection. Additional propaganda work has been undertaken during the year. This was made possible by the Dental Board's offer to loan free films on the care of the teeth. This offer was accepted by the Education Committee and the proprietors of all the local cinemas were appealed to, 7 of whom oftered to exhibit the films during the ordinary week-end programmes, while special matinees were arranged at 2 theatres for children to attend during school hours at an admission charge of 2d. per head. These pictures are instructive and entertaining, and a series of exhibitions were arranged from April to August, and although over 42,000 people witnessed them wider publicity is still required. The following Table No. 44, corresponding to Table IV., Group IV., of Appendix H. of the Annual Report of the Chief Medical Officer of the Board of Education for 1923, gives details of the age groups of children inspected, together with time given and work done at the Clinics on those cases, which received treatment under the Council's scheme. Table No. 44. Dental Defects. (1) Number of children who were:— (a) Inspected by the Dentists:— Routine Age Groups 5 years 615 6 „ 1,274 7 „ 842 8 „ 908 9 „ 1,353 10 „ 1,400 11 „ 1,661 12 „ 1,586 13 „ 1,545 14 „ 1,012 15 „ 39 16 „ 1 Total 12,236 Specials 1,314 Grand Total 13,550 62 (b) Found to require treatment 10,151 (c) Actually treated at the Authority's Clinics 1,860 (d) Re-treated during the year as the result of periodical examination 199 Note.—(d) is included in (c). (2) Half days devoted to Inspection 319 Treatment 681 Total 1,000 (3) Attendances made by children for treatment 4,384 (4) Fillings Permanent Teeth 1,777 Temporary Teeth 425 Total 2,202 (5) Extractions Permanent Teeth 714 Temporary Teeth 3,503 Total 4,217 (6) Administrations of anaesthetics:— General—For extractions 1,267 Local 726 (7) Other Operations Permanent Teeth 288 Temporary Teeth 147 Total 435 Table No. 45. Return showing number of cases referred for following-up in 1925 and previous years, with a view to Dental treatment being obtained. Year. Referred by Total. Dental Inspections and Officers of the Health Department. Head Teacher. School Attendance Officers. Others. 1925 7,159 75 1 1,294 8,529 1924 9,642 34 0 570 10,246 1923 6,504 98 2 605 7,209 1922 4,383 129 0 930 5,442 1921 2,624 293 16 1,116 4,049 1920 1,386 466 6 1,379 3,237 1919 2,833 654 17 1,371 4,875 Table No. 46. Return showing the number of dental defects referred for following up, the number of visits and dental examinations made in connection therewith and the extent to which remedial measures were carried out during 1925. Total number of defects coming under observation during 1925. (New cases and re-examination):— Brought forward, 1924 289 New during year 8,529 Total 8,818 Number of visits made by Health Visitors 8,135 Number of defects treated:— Clinic 1,860 Otherwise 80 Total 1,940 Number of defects for which no treatment had been undertaken at Health Visitors visit 6,138 Percentage of defects followed up which were known to have received treatment 22 Number still under observation at end of year 740 63 Expectant and Nursing Mothers and Children Under 5. The records of the year give the following details concerning the Maternity and Child Welfare section of the Clinic work. 369 mothers and children under 5 years were inspected and 46 brought forward, making a total of 415 under observation during the year. 147 of these were completed at the Clinics, 191 partially treated and removed, 7 refused treatment and 1 was treated by other agencies, leaving 69 carried forward to 1926. 936 attendances were recorded, 947 teeth removed, 180 teeth filled and 134 other operations on the gums and teeth. General anaesthetics were administered on 245 occasions and Local on 70. 21 mothers received dentures free and 1 obtained them at cost price. Table No. 47. The following table shows details of the 181 children inspected. Number with decayed temporary teeth Savable 74 Unsavable 126 Number with decayed permanent teeth Savable 6 Unsavable 0 Number of decayed temporary teeth Savable 180 Unsavable 386 Number of decayed permanent teeth Savable 7 Unsavable 8 Number with Sepsis 61 Number with other defects 4 Number referred for treatment 166 Number refusing treatment after inspection 4 Number treated by other agencies 0 123 applications were made for treatment at the Clinics, 80 of these were granted free and 26 on payment of 2/6, the remaining 17, who either did not return forms or refused payment, were removed from observation. Table No. 48. Showing the number of dental defects referred for following up, the number of visits made in connection therewith and the extent to which remedial measures were carried out during 1925. (It should be noted that only the dental defects referred for the attention of the Health Visitors appear in this table.) Total number of defects coming under observation during 1925. (New cases and re-examinations):— Brought forward from 1924 46 New during year 156 T otal 202 Number of visits made by Health Visitors 133 Number of defects treated:— Clinic 99 Otherwise 1 Total 100 Number of defects for which no treatment was undertaken 56 Carried forward 1926 46 THE SIXTH ANNUAL REPORT For the Year ending 31st December, 1925, on HOME NURSING. There has been no alteration in the Council's Scheme for Home Nursing during 1925. A record of the work done is attached herewith. 23 new cases of Ophthalmia Neonatorum have been dealt with, which necessitated engaging a nurse for holiday duty from 10/7/25—1/8/25, according to the Council's Agenda, 24th February, 1925, page 291, para. 19. 65 Table No. 49.—Showing Cases dealt with during 1925 and Results, Disease. Cases being nursed at end of 1924. New Cases during 1925. Removed from Observation during 1925—Results of Treatment. a Still being Home Nursed at end of 1925. Number of Visits Paid during 1925. Died. Removed to Hospital or other Institutions. Recovered. Expectant Mothers. Nursing Mothers. Children under Five. School Children. Others. Total. Expectant Mothers. Nursing Mothers. Children under Five. School Children. Others. Total. Expectant Mothers. Nursing Mothers. Children under Five. School Children. Others. Total. Expectant Mothers. Nursing Mothers. Children under Five. School Children. Others. Total. Expectant Mothers. Nursing Mothers. Children under Five. School Children. Others. Total. Expectant Mothers. Nursing Mothers. Children under Five. School Children. Others. Total. Expectant Mothers. Nursing Mothers. Children under Five. School Children. Others. Total. Arthritis Rt. Knee — — — — — — — — — 1 — 1 — — — — — — — — — — — — — — — 1 — 1 — — — — — — — — — 2 — 2 Bathing Case — — — — — — — — 3 — — 3 — — — — — — — — — — — — — — 3 — — 3 — — — — — — — — 8 — — 8 Bronchitis — — — — — — — — 1 — — 1 — — — — — — — — — — — — — — — — — — — — 1 — — 1 — — 18 — — 18 Burns & Scalds — — — — — — — — 4 3 — 7 — — — — — — — — — — — — — — 4 3 — 7 — — — — — — — — 92 18 — 110 Chill — — — — — — — 1 — — — 1 — — — — — — — — — — — — — 1 — — — 1 — — — — — — — 3 — — — 3 Circumcision — — — — — — — — 20 4 — 24 — — — — — — — — — — — — — — 20 4 — 24 — — — — — — — — 249 34 — 283 Constipation — — — — — — — — 1 1 — 2 — — — — — — — — — — — — — — 1 1 — 2 — — — — — — — — 1 1 — 2 Convulsions — — — — — — — — 1 — — 1 — — — — — — — — — — — — — — 1 — — 1 — — — — — — — — 6 — — 6 Deformity — — — — — — — — 1 — — 1 — — — — — — — — — — — — — — 1 — — 1 — — — — — — — — 6 — — 6 Diarrhœa — — — — — — — — 2 1 — 3 — — — — — — — — — — — — — — 2 1 — 3 — — — — — — — — 5 13 — 18 Diarrhoea & Gingivitis — — — — — — — — 1 — — 1 — — — — — — — — — — — — — — 1 — — 1 — — — — — — — — 3 — — 3 Dislocation Right Shoulder&Paralysis — — — — — — — — 1 — — 1 — — — — — — — — — — — — — — 1 — — 1 — — — — — — — — 4 — — 4 Douching Case — — — — — — 1 — — — — 1 — — — — — — — — — — — — 1 — — — — 1 — — — — — — 34 — — — — 34 Eczema — — — — — — — — 2 — — 2 — — — — — — — — — — — — — — 1 — — 1 — — 1 — — 1 — — 60 — — 60 Feverishness & Headache — — — — — — — — — 1 — 1 — — — — — — — — — — — — — — — 1 — 1 — — — — — — — — — 4 — 4 Impetigo — — — — — — — — 2 2 — 4 — — — — — — — — — — — — — — 2 2 — 4 — — — — — — — — 25 19 — 44 Injury to Foot — — — — — — — — 1 1 — 2 — — — — — — — — — — — — — — 1 1 — 2 — — — — — — — — 12 16 — 28 Mastitis — — — — — — — 3 — — — 3 — — — — — — — — — — — — — 3 — — — 3 — — — — — — — 48 — — — 48 Maternity Case — — — — — — — 3 — — — 3 — — — — — — — 1 — — — 1 — 2 — — — 2 — — — — — — — 40 — — — 40 Measles & Conjunctivitis — — — — — — — — 1 — — 1 — — — — — — — — — — — — — — — — — — — — 1 — — 1 — — 24 — — 24 Measles & Otorrhœa — — — — — — — — 2 — — 2 — — — — — — — — — — — — — — 2 — — 2 — — — — — — — — 40 — — 40 Measles & Pneumonia — — — — — — — — 1 — — 1 — — — — — — — — — — — — — — 1 — — 1 — — — — — — — — 22 — — 22 Ophthalmia — — 2 2 — 4 — 1 10 1 — 12 — — — — — — — — — — — — — 1 11 3 — 15 — — 1 — — 1 — 29 289 104 — 422 Ophthalmia Neonatorum — — 1 — — 1 — — 23 — — 23 — — — — — — — — 2 — — 2 — — 21 — — 21 — — 1 — — 1 — — 668 — — 668 Osteomyelitis — — — — — — — — — 1 — 1 — — — — — — — — — 1 — 1 — — — — — — — — — — — — — — — 8 — 8 Otorrhœa — — 1 — — 1 — — 6 4 — 10 — — — — — — — — 1 — — 1 — — 5 3 — 8 — — 1 1 — 2 — — 310 107 — 417 Pneumonia — — — — — — — — 2 — — 2 — — — — — — — — — — — — — — 2 — — 2 — — — — — — — — 41 — — 41 Poliomyelitis — — — — — — — — — 1 — 1 — — — — — — — — — — — — — — — 1 — 1 — — — — — — — — — 1 — 1 Puerperal Fever — — — — — — — 1 — — — 1 — — — — — — — — — — — — — 1 — — — 1 — — — — — — — 52 — — — 52 (?) Ringworm — — — — — — — — 1 — — 1 — — — — — — — — — — — — — — 1 — — 1 — — — — — — — — 2 — — 2 Septic Condition — 1 — — — 1 — 2 12 8 — 22 — — — — — — — — — — — — — 3 12 8 — 23 — — — — — — — 7 116 63 — 186 Throat Conditions — — — — — — — — 28 121 5 154 — — — — — — — — — — — — — — 28 121 5 154 — — — — — — — — 122 440 9 571 UterineHæmorrhage — — — — — — 1 — — — — 1 — — — — — — 1 — — — — 1 — — — — — — — — — — — — 3 — — — — 3 Whooping Cough — — — — — — — — 3 — — 3 — — 1 — — 1 — — — — — — — — 2 — — 2 — — — — — — — — 33 — — 33 Whooping Cough & Ophthalmia — — — — — — — — 1 — — 1 — — — — — — — — — — — — — — 1 — — 1 — — — — — — — — 12 — — 12 Whooping Cough & — — — — — — — — 1 — — 1 — — — — — — — — 1 — — 1 — — — — — — — — — — — — — — 7 — — 7 Worms — — — — — — — — 16 10 — 26 — — — — — — — — — — — — — — 16 10 — 26 — — — — — — — — 123 54 — 177 Total — 1 4 2 — 7 2 11 147 160 5 325 — — 1 — — 1 1 1 4 1 — 7 1 11 140 160 5 317 — — 6 1 — 7 37 179 2,298 884 9 3,407 66 Table No. 50. Shewing Sources from which cases were referred for Home Nursing during the Year 1925. Referred by Number. Health Department 103 Private Doctors 31 Others 191 Total 325 Table No. 51. Shewing cases Home Nursed in Wards during 1925. Ward. No. of Cases brought forward from 1924. No. of Cases referred in 1925. Total. No. of Visits paid. 1. South Kilburn 1 66 67 461 2. Mid-Kilburn 2 54 56 602 3. North Kilburn 1 36 37 362 4. Brondesbury Park 0 18 18 123 5. Kensal Rise 1 25 26 472 6. Harlesden 1 22 23 533 7. Stonebridge 1 42 43 288 8. Roundwood 0 24 24 264 9. Church End 0 15 15 162 10. Willesden Green 0 13 13 79 11. Cricklewood 0 10 10 61 Total 7 325 332 3,407 67 THE ELEVENTH ANNUAL REPORT FOR THE Year ending 31st December, 1925, ON THE PROVISION OF MEALS TO SCHOOL CHILDREN IN WILLESDEN. Feeding Centres.—Meals have been supplied at the four Feeding Centres under the control of the Education Committee, namely Gibbons Road, Furness Road, Strode Road and Lower Place, and at one voluntary centre in Granville Road. Dinners are still taken from Strode Road Feeding Centre to Leopold Road Physically Defective School. The dinners are served in the Laundry Centre by an Assistant from Strode Road Feeding Centre. Breakfasts.—The practice of serving breakfasts to children whose parents are unusually poor has been continued throughout the year. All these cases have been in the South Kilburn area. The meal consists of cocoa made with dried milk, and sugar, and bread and margarine. Staffing.—The staff employed at each of the Feeding Centres is approximately one assistant to every 50 children fed. Selection of Children.—Recommendations are accepted as heretofore from School Teachers Health Nurses and the Clinic Medical Staff, subject to review by immediate investigation of the economic circumstances of the family. The total number of new application forms presented to the Education Committee's Centres throughout the year was 363. Recommendations are also received from the Willesden Board of Guardians, an agreement having been made whereby they pay the Willesden Education Authority 1/- per head per week or part of a week for each child fed at the Education Committee's Centres on their recommendation. This scheme came into operation on 30th October, 1922, the Guardians supplying every four weeks the list of children to be fed. The economic circumstances scale was revised and raised one shilling per head on the 20th November, 1924. Kilburn Feeding Centre.—Dinners.—The children of the South Kilburn area are fed at the Voluntary Centre established at the Presbyterian Mission Hall, Granville Road. No change has been made with regard to the serving of meals, and the table appointments are still one spoon. A change has been made in the dietary and the meals are appetising but monotonous. The price per meal was raised from 4d. to 5d. on the 12th November, 1923. The earlier arrivals hurry through their meal and scramble out as soon as they have finished to make room for the newcomers, thereby making a constant stream of children through the dining room and destroying all possibility of order. Kilburn Breakfasts.—The provision of breakfasts at Carlton Vale School House has been continued throughout the year, the arrangements being carried out by the Caretaker. The number of application forms received from South Kilburn for the year was—Dinners 116—Breakfasts 38. Meals.—A two weekly menu was commenced in Education Committee's Centres on April 6th 1925. This provides four meat meals and one meatless meal one week, and three meat meals and two meatless meals the second week, each being followed by a pudding or stewed fruit. The price of meals for non-necessitous cases is 5d. as heretofore. STATISTICAL INFORMATION, YEAR ENDING 31 st DECEMBER, 1925. Table No. 52.—Number of Meals Supplied. Supplied to:— Breakfasts. Free. Dinners. Total. Free. Paying. Guardians. Education Committees' Centres - 29,132 937 6,773 36,842 Kilburn Voluntary Centre 5,217 13,139 - 5,300 23,656 Special Schools - 3,372 10,386 321 14,079 Feeding Centre Assistants 1,717 1,862 - - 3,579 Total 6,934 47,505 11,323 12,394 78,156 68 Table No. 53. Occupational List, 1925. List of the parents whose children were fed during 1925 with comparative column for 1924. Occupation. No. of Children Fed during 1925. No. of Families Involved. Percentage. 1924. 1925. 1924. 1925. Unemployed 366 153 164 60.9 62.1 Widows 70 45 41 17.9 15.6 Deserted Wives 21 14 12 5.6 4.5 Orphans 6 1 3 .4 1.1 Labourers 50 10 21 4.0 7.9 Railwaymen 19 8 7 3.2 2.6 Hawkers 3 2 1 .8 .4 Others 35 18 15 7.2 5.6 Approximate average cost per meal for food only, 2¾d.; total cost, 6¼d. 69 THE THIRTY-FOURTH ANNUAL REPORT FOR THE Year ending 31st December, 1925, ON THE MUNICIPAL HOSPITAL By A. G. TROUP, M.D., D.P.H. During 1925, 601 patients were admitted as compared with 626 in 1924, 674 in 1923, 1,132 in 1922, and 1,556 in 1921, in which year Scarlet Fever was epidemic. Scarlet Fever. During the past year 203 cases of this disease were admitted, 2 of which died. There were 141 in 1924. The large proportion of these cases were of a mild nature, a few, however, were of a severe toxic type. Diphtheria. 259 cases were admitted, or 14 more than in the previous year. Although the prevailing type of Diphtheria was of a moderate nature, a small proportion of the cases was of a severe type. 5 cases were tracheotomied, 4 recovered. 21 Carrier cases were admitted. For the purpose of calculating the mortality rate, they have been excluded. Combined attacks occurred as follows:— Diphtheria and Whooping Cough 3 cases. Diphtheria and Chicken-pox 2 cases. 57 cases admitted either as Scarlet Fever or Diphtheria proved to be suffering from Tonsilitis. Other Infectious Diseases. 82 patients were admitted under this heading, as follows:— German Measles 10 Laryngitis 1 Measles 8 Chicken Pox 1 Ophthalmia Neonatorum 9 Septic Rash 1 Erysipelas 3 Cerebro Spinal Fever 1 Cellulitis of Face 1 Encephalitis Lethargica 2 Puerperal Fever 1 Tubercular Meningitis 1 Whooping Cough 16 Post Influenzal Debility 3 Mumps 3 Hysteria 1 Pneumonia 7 Endometritis 1 Eczema 1 Empyema 1 Dermatitis 1 Gastric Catarrh 1 Gastro Enteritis 2 Erythema 3 Urticaria 1 Negative cases 2 Three deaths occurred:— Tubercular Meningitis 1 Pneumonia 2 Duration of Stay in Hospital. The following figures show the average stay in days for certain diseases:— Scarlet Fever, 45.1; Diphtheria, 50.4; and Other Diseases, 27.7. Sick Staff. The number of nurses who were off duty from sickness for 24 hours or more was 38, as compared with 25 in 1924. The number of days they were off duty was 581, 317 days more than the previous year. 2 nurses contracted Scarlet Fever, 1 Measles, 1 Erysipelas, and 1 Mumps—all recovered. Amongst the Domestic Staff, 17 maids were off duty for a total of 256 days. In 1924, there were 63 members off duty for 556 days. No cases of infectious disease occurred amongst the members of the Domestic Staff. 70 Hospital Buildings. No additions have been made to the Hospital during the year, but alterations have been carried out to E. Ward, the lavatories being enlarged and lavatory basins installed. A new feed pump of larger capacity has been provided for the boiler. The Council at its meeting on the 15th April, 1924, passed the following:— "Your Committee is satisfied that the needs of the district require— (1) That accommodation should be provided for 32 beds at Kingsbury for a possible small-pox outbreak. (2) The erection of a two-storied cubicle observation ward at the Municipal Hospital, each story of which should contain 16 beds. (3) That the existing nursing accommodation at the Municipal Hospital should be increased concurrently with any such extensions as indicated in (2) above. We are of opinion, however, that the above additional accommodation should be proceeded with stage by stage, and recommend, therefore that during the current financial year the Council proceed with (1) above, the intention being that the 32 beds to be provided shall serve as an overflow for ordinary infectious diseases cases, so long as the beds are not required for small-pox cases, thus serving to reduce the present deficit of beds for treatment of infectious cases generally." The Ministry of Health have held an enquiry into the proposal to rebuild Kingsbury Hospital, and their formal sanction has now been obtained. A. G. TROUP, Medical Superintendent. Table No. 54. Scarlet Fever. Diphtheria. Other Diseases. Total. No. of cases admitted during 1925 203 259 139 601 Remaining in Hospital, December 31st, 1924 14 18 8 40 Total No. under treatment in 1925 217 277 147 641 Cases discharged 1925 177 235 140 552 No. of deaths 1925 2 9 3 14 Mortality .92% 3.24% 2.04% 2.18% Remaining in Hospital, December 31st, 1925 38 33 4 75 Table No. 55. Scarlet Fever. Age. Males. Females. Admissions. Deaths. Admissions. Deaths. —1 — — — — 1—2 2 — — — 2—3 6 — 7 1 3—4 9 — 5 — 4—5 9 — 6 — 5—10 46 — 54 1 10—15 9 — 13 — 15—20 4 — 10 — 20—25 — — 7 — 25—30 2 — 3 — 30—35 2 — 1 — 35— 2 — 6 — 71 Table No. 56. Diphtheria. Age. Males. Females. Admissions. Deaths. Admissions. Deaths. —1 5 — 4 — 1—2 8 1 4 — 2—3 11 — 11 2 3—4 9 — 8 — 4—5 8 — 8 — 5—10 50 4 44 1 10—15 30 — 29 — 15—20 3 — 6 — 20—25 — — 3 — 25—30 1 — 4 — 30—35 — — 6 — 35— 1 — 6 1 Table No. 57. Diphtheria. Day of Disease on Admission. Number of Cases. 1st 10 2nd 58 3rd 65 4th 44 5th 30 6th and over 52 Total 259 Table No. 58. Chief Complications of Scarlet Fever. Number of Complications Adenitis 40 Rheumatism 17 Otitis Media 19 Albuminuria 6 Nephritis 1 Empyema 1 Suppurative Arthritis 2 Total 86 Table No. 59. Chief Complications of Diphtheria. Number of Complications. Toxaemia 2 Paralysis 14 Cardiac Failure 3 Albuminuria 4 Adenitis 10 Otitis Media 13 Serum Eruption 6 Total 52 73 APPENDICES. APPENDIX A.—VITAL STATISTICS. Appendix A.—Table I. VITAL STATISTICS OF WHOLE DISTRICT DURING 1925 AND PREVIOUS YEARS; VITAL STATISTICS OF THE WARDS DURING 1925 Year. Population estimated to Middle of each Year. Whole District. Births. Total Deaths Registered in the District. Transferable Deaths Nett Deaths belonging to the District. Uncor rected Number. Nett. Number. Rate. of nonresi dents registered in the District. of residents not registered in the District. Under 1 Year of Age. At all Ages. Number. Rate. Number. Rate per 1,000 Nett Births. Number. Rate. (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) (13) 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 83 1,766 10.35 1920 170,892 4,203 4,232 24.76 1,427 8.35 50 295 274 65 1,672 9.78 1921 ‡165,674* 3,442 3,464 20.91 1,469 8.87 54 262 255 74 1,677 10.12 1922 168,900 3,106 3,160 18.71 1,570 9.30 59 273 188 59 1,784 10.56 1923 169,831 2,977 3,063 18.04 1,380 8.13 72 280 162 53 1,588 9.35 1924 171,161 2,685 2,843 16.61 1,574 9.20 78 286 208 73 1,782 10.41 1925 172,503 2,552 2,755 15.97 1,465 8.49 83 304 170 62 1,686 9.77 wards. 1. S. Kilb'n 14,980 297 330 22.03 162 10.81 2 31 24 72.73 191 12.75 2. Mid K'b'n 14,661 257 291 19.85 157 10.71 3 45 22 75.60 199 13.57 3. N.Kilb'n 13,366 143 169 12.64 115 8.60 9 22 7 41.42 128 9.58 4. Brondsb'y Park 9,587 94 107 11.16 81 8.45 5 27 6 56.07 103 10.74 5. Kensal Rise 13,632 172 183 13.42 104 7.63 0 18 11 60.11 122 8.95 6. Harl'd'n 17,499 220 240 13.72 126 7.20 5 38 15 62.50 159 9.09 7. Stonebridge 18,693 358 368 19.69 175 9.36 14 20 26 70.65 181 9.68 8. Roundwood 16,431 278 296 18.01 142 8.64 18 19 22 74.32 143 8.70 9. Church End 15,375 226 234 15.22 104 6.76 2 29 16 68.38 131 8.52 10. Willesden Green 17,333 287 298 17.19 127 7.33 4 20 14 46.98 143 8.25 11. Cricklewood 20,946 220 239 11.41 172 8.21 21 35 7 29.29 186 8.88 Area of District in acres (land and inland water) 4,384 Total population at all ages ‡165,6741 Total families or separate occupiers 41,435 at Census, 1921. * Census Population, 1921. ‡ Re-adjusted by the Reg. Gen. because of holiday movement to 167,200. Appendix A.—Table II.—DEATHS OF VVILLESDEN RESIDENTS DURING THE YEAR 1925. 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) All Causes 'Certified 1,686 170 60 21 18 37 39 92 133 199 276 303 259 79 567 Uncertified ... ... ... ... ... ... ... ... . . . ... ... ... ... ... ... 1.—General Diseases. Enteric Fever 1 ... ... ... ... ... ... 1 ... ... ... ... ... ... ... Typhus ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Relapsing Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Malaria ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Small Pox ... ... ... ... ... ... ... ... ... ... ... ... ... ... 8 Measles 13 2 3 7 2 ... 1 ... ... ... ... ... ... ... ... ... 1 Scarlet Fever 18 13 5 4 ... ... ... ... ... ... ... ... ... ... ... 6 Whooping Cough 61 ... ... ... ... ... ... ... 1 ... ... ... ... ... 9 Diphtheria ... ... ... ... ... ... ... ... 6 ... ... ... ... ... ... Influenza ... 4 2 ... 1 ... 3 ... ... 9 15 6 10 ... 11 Miliary Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Asiatic Cholera ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Cholera Nostras ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Dysentery ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Plague ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Yellow Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Leprosy ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Erysipelas 5 ... ... ... ... ... ... ... ... 1 2 ... 1 ... 5 Other Epidemic Diseases ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Pyaemia 1 ... ... ... ... ... ... ... ... 1 ... ... 1 ... 1 Septicaemia 3 1 ... ... ... ... l ... ... ... ... ... ... 1 Vaccinia ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Glanders ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Anthrax (Splenic Fever) ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Rabies ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Tetanus ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Mycoses: Actinomycosis 1 ... ... ... ... ... ... ... ... 1 ... ... ... ... 1 Pellagra ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Beri-Beri ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Pulmonary Tuberculosis (not acute) 120 ... ... 1 1 5 11 35 30 18 13 6 ... ... 25 Phthisis (not acute and not defined as Tuberculosis) 9 ... ... ... ... ... 1 2 ... 3 3 ... ... ... ... Acute Phthisis 3 ... ... ... ... ... 9 ... ... ... 1 ... ... ... Acute Miliary Tuberculosis 1 1 ... ... ... ... ... ... ... ... ... ... ... ... ... Tuberculous Meningitis 8 1 4 ... 1 ... ... 1 ... ... ... ... ... ... ... Tabes Mesenterica ... ... ... ... ... ... ... ... ... ... ... ... ... ... 6 Other Peritoneal and Intestinal Tubercle 1 ... ... ... ... ... ... ... ... ... ... 1 ... ... ... Tuberculosis of Spinal Column 5 ... ... ... ... ... ... 1 ... 1 ... ... ... ... 2 Tuberculosis of Joints 1 ... ... ... ... ... ... ... 1 ... ... ... ... ... 3 Tuberculosis of other organs 1 ... ... ... ... ... ... ... ... ... ... ... 1 ... ... Disseminated Tuberculosis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Rickets, Softening of Bones 1 1 ... ... ... ... ... ... ... ... ... ... ... ... 1 Syphilis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Other Venereal Diseases ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Cancer of Buccal Cavity 10 ... ... ... ... ... ... 1 ... 1 4 3 ... ... 6 Cancer of the Stomach, Liver, &c 51 ... ... ... ... ... ... 1 2 9 15 16 1 7 1 15 Cancer of Peritoneum, Intestines and Rectum 56 ... ... ... ... ... 1 1 4 10 14 17 8 1 28 Cancer of the Female Genital Organs 21 ... ... ... ... ... ... 1 1 5 6 6 2 ... 5 Cancer of the Breast 26 ... ... ... ... ... ... 3 o ... 8 2 5 1 10 Cancer of the Skin 3 ... ... ... ... ... ... ... ... ... 2 1 ... ... 2 Cancer of other or unspecified organs 74 ... 2 ... ... 1 2 1 5 16 24 16 7 ... 17 Other Tumours (situation undefined) 2 ... ... ... ... 1 ... ... ... 1 ... ... ... ... ... Rheumatic Fever 3 ... ... ... 1 1 ... ... ... ... 1 ... ... ... 2 Chronic Rheumatism 1 ... ... ... ... ... ... ... ... 1 ... ... ... ... ... Osteo-Arthritis 2 ... ... ... ... ... ... ... ... ... 1 1 ... ... ... Gout ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Scurvy ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Diabetes 12 ... ... ... ... ... ... 1 ... 1 3 3 3 1 1 Exophthalmic Goitre 3 ... ... ... ... ... 2 ... ... ... ... ... ... ... 1 Addison's Disease 1 ... ... ... ... ... ... 1 ... ... ... ... ... ... 1 Leucocythoemia (Leuchcemia) 3 ... ... ... ... ... ... ... 1 ... 1 ... ... ... 1 Lymphadenoma 1 ... ... ... ... ... ... 1 ... ... ... ... ... ... 2 Anaemia, Chlorosis 12 ... ... ... ... ... ... ... 1 5 2 3 ... ... 1 Other General Diseases 5 ... 2 ... ... ... ... ... 1 1 ... 1 ... ... 1 Alcoholism (Acute or Chronic) ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 Chronic Lead Poisoning ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Other Chronic Occupational Poisoning ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Other Chronic Poisoning ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2—Diseases of the Nervous System and of the Organs of Special Sense. Encephalitis 3 ... ... ... 1 1 ... ... ... ... ... ... 1 ... ... Cerebro-spinal Fever 1 ... 1 ... ... ... ... ... ... ... ... ... ... 1 Posterior Basal Meningitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Meningitis, other forms 9 2 2 1 ... 1 ... ... 2 ... ... ... ... ... 6 74 75 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) 2.—Diseases of the Nervous System and of the Organs of Special Sense—Continued. Locomotor Ataxy 7 ... ... ... ... ... ... ... ... 5 ... 2 ... 2 Other Diseases of the Spinal Cord 13 ... ... ... 1 ... ... 1 ... 1 1 3 2 1 5 Apoplexy 4 ... ... ... ... ... ... ... ... ... 1 3 ... ... ... Serous Apoplexy and Oedema of Brain ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Cerebral Congestion ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Cerebral Atheroma ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Cerebral Hemorrhage 71 1 ... ... ... ... ... 1 1 6 17 24 19 2 34 Softening of Brain 1 ... ... ... ... ... ... ... ... ... ... ... ... 1 ... Hemiplegia 5 ... ... ... ... ... ... ... ... ... ... 1 3 1 ... Paraplegia 1 ... ... ... ... ... ... ... ... 1 ... ... ... ... ... Other Forms of Paralysis 2 ... ... ... ... ... ... ... 1 1 ... ... ... ... ... General Paralysis of the Insane 3 ... ... ... ... ... ... ... 1 1 1 ... ... ... ... Other Forms of Mental Alienation 3 ... ... ... ... ... ... ... 1 ... 2 ... ... ... 1 Epilepsy 8 ... ... ... 1 1 ... 2 1 1 2 ... ... ... 1 Convulsions (non-puerperal; 5 years and over) 1 ... ... ... ... ... ... ... ... ... ... ... 1 ... ... Infantile Convulsions under 5, with teething ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Other Infantile Convulsions under 5 3 3 ... ... ... ... ... ... ... ... ... ... ... ... ... Chorea ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Hysteria, Neuralgia, Neuritis 1 ... ... ... ... ... ... ... ... ... ... ... 1 ... ... Idiocy, Imbecility ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Cretinism ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Cerebral Tumour 4 ... 1 ... ... ... ... 1 ... 1 1 ... ... ... 1 Other Diseases of the Nervous System 2 ... ... ... ... ... ... ... ... ... ... 2 ... ... 1 Diseases of the Eye and Annexa ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Mastoid Disease 1 ... ... ... ... 1 ... ... ... ... ... ... ... ... ... Other Diseases of the Ears 4 ... ... ... ... 1 1 ... 1 ... ... ... ... ... 1 3.—Diseases of the Circulatory System. Pericarditis 2 ... ... 1 1 ... ... ... ... ... ... ... ... ... 1 Acute Myocarditis 3 ... ... ... ... ... ... ... l ... 1 1 ... ... ... Infective Endocarditis 2 ... ... ... ... ... ... ... l 1 ... ... ... 2 Other Acute Endocarditis 8 ... ... ... ... 2 1 l l 3 ... ... ... ... 3 Valvular Disease 53 ... 1 ... 1 2 ... 5 3 4 11 14 9 3 5 Fatty Degeneration of Heart 23 ... ... ... ... ... ... ... 1 2 7 10 3 ... 1 Other Organic Disease of the Heart 130 ... ... ... ... 3 ... 1 6 11 25 30 38 16 48 Angina Pectoris 11 ... ... ... ... ... ... ... 1 3 3 2 2 ... ... Aneurysm 5 ... ... ... ... ... ... ... 1 1 3 ... 15 ... 2 Arterial Sclerosis 50 ... ... ... ... ... ... ... ... 8 8 14 5 12 Other Diseases of Arteries 2 ... ... ... ... ... ... ... ... ... ... 1 1 ... 1 Cerebral Embolism and Thrombosis 7 ... ... ... ... ... ... ... ... 1 2 ... 4 ... 1 Other Embolism and Thrombosis 2 ... ... ... ... ... ... ... ... 1 1 ... ... ... ... Diseases of the Veins (Varices, Hemorrhoids, Phlebitis, &c.) ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Status Lymphaticus ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Other Diseases of the Lymphatic System ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Haemorrhage; other Diseases of the Circulatory System ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 4.—Diseases of the Respiratory System Diseases of the Nasal Fossae 1 ... ... ... 1 ... ... ... ... ... ... ... ... ... 1 Diseases of the Larynx ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... Diseases of the Thyroid Body 1 ... ... ... ... ... ... ... ... ... ... 36 8 16 Bronchitis 100 6 1 ... ... ... 1 ... 4 2 8 34 Broncho-Pneumonia 73 25 12 1 ... ... ... 2 4 7 6 5 6 5 39 Lobar Pneumonia 33 3 2 1 ... 1 3 1 5 7 1 5 4 ... 9 Pneumonia (type not stated) 41 2 3 ... 1 ... 1 5 5 4 6 6 7 1 27 Empyema 2 ... ... ... ... ... ... ... 1 1 ... 1 ... ... ... Other Pleurisy 2 ... ... ... ... ... ... ... ... ... ... ... 1 1 Pulmonary Apoplexy and Infarction ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Pulmonary Oedema and Congestion 2 1 ... ... ... ... ... ... ... ... 1 ... ... ... ... Hypostatic Pneumonia 3 ... ... ... ... ... ... ... ... ... ... 2 1 ... 2 Collapse of Lung (3 months and over) ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Gangrene of the Lung ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... Asthma 3 ... ... ... ... ... ... ... ... ... 2 ... ... 1 Pulmonary Emphysema 1 ... ... ... ... ... ... ... ... ... ... 1 ... ... Fibroid Disease of Lung 3 ... ... ... ... ... ... ... ... ... 1 2 ... ... ... Other Disease of the Respiratory System ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 5.—Diseases of the Digestive System. Diseases of the Teeth and Gums 1 ... ... ... ... ... ... ... ... ... 1 ... ... ... ... Other Diseases of the Mouth and Annexa ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Diseases of Pharynx, Tonsillitis 1 ... ... 1 ... ... ... ... ... ... ... ... ... ... Diseases of Oesophagus ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 Perforating Ulcer of Stomach 14 ... ... ... ... ... ... 1 2 6 4 ... 1 ... 5 Inflammation of Stomach 5 2 ... ... ... ... ... ... ... ... 1 1 ... 1 1 Other Diseases of the Stomach 2 ... ... ... ... ... ... ... ... ... ... 2 ... ... ... 76 77 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 m the District. (16) 5.—Diseases of the Digestive System—Continued. Infective Enteritis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Diarrhoea, not returned as infective 4 3 ... ... ... ... ... ... ... ... ... ... 1 ... 1 Enteritis, not returned as infective 2 2 ... ... ... ... ... ... ... ... ... ... ... ... 2 Gastro-Enteritis, not returned as infective 9 8 ... ... ... ... ... ... ... ... ... ... ... ... 5 Dyspepsia, under 2 years ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Colic 1 ... ... ... ... ... ... ... ... ... 1 ... ... ... ... Ulceration of Intestines ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Duodenal Ulcer 5 ... ... ... ... ... ... ... 3 ... l ... ... ... 1 Ankylostomiasis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Other Intestinal Parasites ... ... ... ... ... ... ... ... ... ... ... ... ... Appendicitis 17 ... ... ... ... ... ... 2 4 3 3 1 ... ... 8 Hernia 3 ... ... ... ... ... ... ... 1 ... 2 ... ... ... 3 Intestinal Obstruction 6 1 ... ... ... ... ... ... ... 1 1 1 1 ... 4 Other Diseases of the Intestines 5 1 ... ... ... ... ... ... 1 2 ... ... ... ... 2 Acute Yellow Atrophy of Liver ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Hydatid of Liver ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Cirrhosis of Liver (not returned as Alcoholic) 9 ... ... ... ... ... ... ... 2 2 4 ... l ... 3 Cirrhosis of Liver (returned as Alcoholic) ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Diseases formerly classed to " Other Diseases of Liver and Gall Bladder" ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Biliary Calculi 3 ... ... ... ... ... ... ... ... ... 1 1 l ... 2 Other Diseases of the Liver 5 ... ... ... ... ... ... 1 ... ... ... 3 ... ... 2 Diseases of the Spleen ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Peritonitis (cause unstated) 4 ... ... 1 ... ... ... ... 1 ... 1 1 ... ... 2 Other Diseases of the Digestive System 1 ... ... ... ... ... ... 1 ... ... ... ... ... ... 2 6.—Non-Venereal Diseases of the Genito-Urinary System and Annexa. Acute Nephritis 5 ... ... ... ... ... 1 ... 1 1 1 1 ... ... 1 Bright's Disease 28 ... ... ... 1 1 ... 1 2 2 7 9 5 ... 10 Nephritis (unqualified), 10 years and over, Uraemia 8 ... ... ... ... ... ... ... 2 1 ... 2 2 1 5 Chyliuria ... ... ... ... ... ... ... ... ... ... ... ... ... ... Other Diseases of Kidney and Annexa 5 ... 1 ... ... ... ... ... 1 ... ... 3 ... ... 3 Calculi of the Urinary Passages 3 ... ... ... ... ... ... ... 1 ... 2 ... ... ... ... Diseases of the Bladder 3 ... ... ... ... ... ... ... ... 1 ... 1 1 ... 1 Diseases of the Urethra, Urinary Abscess, &c. 1 ... ... ... ... ... ... ... ... ... ... ... ... ... Diseases of the Prostate 13 ... ... ... ... ... ... ... ... 4 3 6 ... 9 Non-venereal Diseases of Male Genital Organs ... ... ... ... ... ... ... ... ... ... ... ... ... ... Uterine Haemorrhage (non-puerperal) ... ... ... ... ... ... ... ... ... ... ... ... ... ... Uterine Tumour (non-cancerous) 3 ... ... ... ... ... ... ... 3 ... ... ... ... ... Other Diseases of the Uterus ... ... ... ... ... ... ... ... ... ... ... ... ... ... Ovarian Cyst, Tumour (non-cancerous) 1 ... ... ... ... ... ... ... ... ... 1 ... ... 1 Other Diseases of the Female Genital Organs ... ... ... ... ... ... ... ... ... ... ... ... ... 1 Non-puerperal Diseases of the Breast (non-cancerous) ... ... ... ... ... ... ... ... ... ... ... ... ... ... 7.—The Puerperal State. Abortion 2 ... ... ... ... ... ... 1 1 ... ... ... ... ... 2 Haemorrhage of Pregnancy ... ... ... ... ... ... ... ... ... ... ... ... ... ... Uncontrollable Vomiting ... ... ... ... ... ... ... ... ... ... ... ... ... ... Ectopic Gestation ... ... ... ... ... ... ... ... ... ... ... ... ... 1 Other Accidents of Pregnancy ... ... ... ... ... ... ... ... ... ... ... ... ... ... Puerperal Haemorrhage ... ... ... ... ... ... ... ... ... ... ... ... ... ... Other Accidents of Childbirth 1 ... ... ... ... ... ... ... 1 ... ... ... ... ... ... Puerperal Fever 2 ... ... ... ... ... ... 1 1 ... ... ... ... ... 2 Puerperal Albuminuria and Convulsions 1 ... ... ... ... ... ... 1 ... ... ... ... ... ... Puerperal Phlegmasia Alba Dolens and Phlebitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... Puerperal Embolism and Sudden Death ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Puerperal Insanity ... ... ... ... ... ... ... ... ... ... ... ... ... ... Puerperal Diseases of the Breast ... ... ... ... ... ... ... ... ... ... ... ... ... ... 8.—Diseases of the Skin and of the Cellular Tissue. Senile Gangrene 6 ... ... ... ... ... ... ... 1 ... 1 3 1 4 Gangrene, other types ... ... ... ... ... ... ... ... ... ... ... ... ... ... Carbuncle, Boil 3 ... ... ... ... ... ... 1 1 1 ... ... ... 3 Phlegmon, Acute Abscess 2 1 ... ... ... ... ... ... ... ... 1 ... ... 3 Ulcer, Bedsore ... ... ... ... ... ... ... ... ... ... ... ... ... ... Eczema ... ... ... ... ... ... ... ... ... ... ... ... ... ... Pemphigus ... ... ... ... ... ... ... ... ... ... ... ... ... ... Other Diseases of the Integumentary System ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 9.—Diseases of the Bones and of the Organs of Locomotion. Diseases of the Bones 4 ... ... 1 ... 1 ... 1 1 ... ... ... ... ... 2 Diseases of the Joints 1 ... 1 ... ... ... ... ... ... ... ... ... ... ... 1 Amputations ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Other Diseases of the Locomotor System ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 78 79 80 81 Table 11.—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 0) 35 to 45 (10) 45 to 55 (H) 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 3 2 ... 1 ... ... ... ... ... ... ... ... ... ... 2 Phimosis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Congenital Malformation of Heart 5 4 1 ... ... ... ... ... ... ... ... ... ... ... 1 Other Congenital Malformations 5 5 ... ... ... ... ... ... ... ... ... ... ... ... ... 11.—Diseases of Early Infancy. Premature Birth 43 43 ... ... ... ... ... ... ... ... ... ... ... ... 7 Infantile Atrophy, Debility and Marasmus 13 13 ... ... ... ... ... ... ... ... ... ... ... ... 6 Icterus Neonatorum 2 2 ... ... ... ... ... ... ... ... ... ... ... ... ... Sclerema and Oedema Neonatorum ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Want of Breast Milk ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Diseases of Umbilicus, &c ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Atelectasis 8 8 ... ... ... ... ... ... ... ... ... ... ... ... ... Injuries at Birth 2 2 ... ... ... ... ... ... ... ... ... ... ... ... ... Cyanosis Neonatorum ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Lack of Care ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 12.—Old Age. Old Age 68 ... ... ... ... ... ... ... ... ... ... 11 33 24 34 13.—Affections produced by External Causes. Suicide by Poison 8 ... ... ... ... ... ... ... 3 1 1 3 ... ... 2 Suicide by Asphyxia 5 ... ... ... ... ... ... ... ... 3 ... ... ... ... ... Suicide by Hanging or Strangulation 1 ... ... ... ... ... ... ... ... ... 1 ... ... ... ... Suicide by Drowning ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Suicide by Firearms 4 ... ... ... ... ... ... ... ... 1 1 1 ... ... ... Suicide by Cutting or Piercing Instruments 3 ... ... ... ... ... ... ... ... 1 2 ... ... ... 1 Suicide by Jumping from High Place 1 ... ... ... ... ... ... ... ... 1 ... ... ... ... ... Suicide by Crushing ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Other Suicides ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Poisoning by Food ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Other Acute Poisonings 2 ... ... ... ... ... ... ... ... ... ... ... ... ... 2 Conflagration ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Burns (conflagration excepted) 5 2 ... ... ... ... 1 ... ... ... ... 2 ... ... 4 Absorption of Deleterious Gases (conflagration excepted) 3 1 ... ... ... ... ... ... ... ... 1 1 ... ... ... Accidental Drowning 2 ... ... 1 ... ... 1 ... ... ... 1 l ... ... 1 Injury by Firearms ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Injury by Cutting or Piercing Instruments ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Injury by Fall 18 ... 1 ... ... 3 1 1 1 4 1 4 1 ... ... Injury in Mines or Quarries ... ... ... ... ... ... ... ... ... ... ... ... ... ... 6 Injury by Machines ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Injury by Other Crushing, Vehicles, Railways, Landslides, &c 22 ... 1 ... 2 3 1 4 3 2 3 2 1 ... 5 Injury by Animals ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Starvation ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Excessive Cold ... ... ... ... ... ... ... ... ... ... ... ... ... ... Effect of Heat ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Lightning ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Electricity (lightning excepted) ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Homicide by Firearms 3 ... ... ... ... ... ... ... ... ... ... ... ... ... ... Homicide by Cutting or Piercing Instruments ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Homicide by Other Means 2 ... ... 1 ... ... ... 1 ... ... ... ... ... ... ... Fractures (cause not specified) 1 ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 Other Violence 5 1 1 ... ... 1 ... ... 1 ... ... 1 ... ... 2 14.—Ill-defined Causes. Dropsy ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Syncope (aged 1 year and under 70) ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Sudden Death (not otherwise defined) ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Heart Failure (aged 1 year and under 70) ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Atrophy, Debility, Marasmus (aged 1 year and under 70) ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Teething ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Pyrexia ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Other Ill-defined Deaths 1 ... ... ... ... ... ... ... ... 1 ... ... ... ... ... Cause not Specified 1 1 ... ... ... ... ... ... ... ... ... ... ... ... ... Totals 1,686 170 60 21 18 37 39 92 133 199 276 303 259 79 567 83 APPENDIX A.—Table III.—INFANT MORTALITY DURING 1925. 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. MidKilburn. North Kilburn. Brondesbury Park. Kensal Rise. Harlesden. Stone bridge. 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 52 12 8 1 73 36 19 19 23 170 24 22 7 6 11 15 26 22 16 14 7 Uncertified — — - — - - — — — - - - - - - - - - - - - Small Pox — — - — - - — — — — - — - - - - — - - - - Chicken Pox - - - — - - — — — — — — — - — - — — — - — Measles - - - — - - — — 3 3 1 1 - - - 1 - - - - - Scarlet Fever - - - — - — — — — — — — - — - — — — - — Whooping Cough — - — — — 3 2 2 6 13 2 2 — — 1 — 3 1 3 1 — Diphtheria and Croup - - - - - - - - - - - - - - - - - - - - Erysipelas - - - — - — — - - — - - - - - - - - - - - Tuberculous Meningitis - - - — - — — 1 — 1 — — — - — - 1 — — - — Abdominal Tuberculosis (a) - - - - - - - - - - - - - - - - - - Other Tuberculous Diseases - - - — - — — — 1 1 - - - - - - - 1 - - - Meningitis (not Tuberculous) - - - - — - 2 - 2 -_ 1 - - - - 1 - - - - Convulsions 2 - 1 — 3 — — — — 3 — — — 1 2 - - - - - - Laryngitis — - - — — — — — — — — — — - — - — — — - — Bronchitis — - - — — 3 1 1 1 6 — 2 2 - 1 - 1 — — - — Pneumonia (all forms) — - - — — 10 7 8 5 30 7 5 — - 2 2 7 1 4 2 — Diarrhoea — 1 - — 1 — I 1 3 — — 1 1 — — — 1 — — — Enteritis — - - — 1 6 2 — 1 10 1 - 1 1 - 2 2 2 1 - - Gastritis — - - — — — 1 1 — 2 1 - - - 1 - - - - - Syphilis — - - - — — — — — — — — — - — — — — — — — Rickets — - - - - — - — 1 1 - 1 - - - - - - - - - Suffocation, overlying — - - - — — - — 1 1 - - - - - - - - - - 1 Injury at birth 2 - - — 2 — - — — 2 1 - - - - 1 - - - - Atelectasis 6 1 1 — 8 — - — — 8 1 1 — 1 — 3 — 1 — 1 - Congenital Malformations (b) 2 1 1 — 4 6 1 — — 11 2 — - - 1 1 1 '2 2 - 2 Premature Birth 32 5 3 1 41 2 — — — 43 8 4 2 2 1 3 6 6 3 5 3 Atrophy, Debility and Marasmus 4 3 — - 7 3 1 1 1 13 — 3 — — — 2 1 4 1 1 1 Other Causes 4 1 1 — 6 3 3 3 2 17 — 2 1 — 3 — 2 3 2 4 — Total Deaths 52 12 8 1 73 36 19 19 23 170 24 22 7 6 11 15 26 22 16 14 7 Deaths—Legitimate 48 10 7 1 66 34 18 18 21 157 23 21 7 6 10 15 20 20 15 14 6 Illegitimate 4 2 1 7 2 1 1 2 13 1 1 1 6 2 1 1 Births—Legitimate ... ... ... ... ... ... ... ... ... 65 316 282 163 106 176 237 352 283 228 293 229 Illegitimate Total Births Infant Mortality Rate— ... ... ... ... ... ... ... ... ... 90 14 9 6 1 7 3 16 13 6 5 10 ... ... ... ... ... ... ... ... ... 2,755 330 291 169 107 183 240 368 296 234 298 239 Legitimate ... ... ... ... ... ... ... ... ... 58-91 72-78 74-47 42-94 56-60 56-82 63-29 56-82 70 67 65-79 47-78 26-20 Illegitimate ... ... ... ... ... ... ... ... ... 144-44 71-43 111 11 — —I 142-86 — 375-00 153-85 166-67 — 100-00 Infant Mortality Rate Population ... ... ... ... ... ... ... ... ... 61-71 72-73 75-60 41-42 56 07 60-11 62-50 70.65 74-32 68-38 46-98 29-29 ... ... ... ... ... ... ... ... ... 172503 14,980 14,661 13,366 9,587 13,632 17,499 18,693 16.431 15,375 17,333 20.946 (a) Under Abdominal Tuberculosis are included Deaths from Tuberculous Peritonitis and Enteritis and from Tabes Mesenterica. (b) Want of Breast Milk is included under Atrophy and Debility. 84 APPENDIX A—TABLE IV.-CASES OF INFECTIOUS DISEASE NOTIFIED DURING THE YEAR 1925. Notifiable Disease. Number of Cases Notified. Total Cases Notified in each Ward. At all ages. At Ages—Years. South Kilburn. Mid-Kilburn. North Kilburn. Brondesbury Park. Kensal Rise. Harlesden. Stonebridge. Round wood. Church End. Willesden Green. Cricklewood. Total Cases removed to Willesden Municipal 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) 0) (10) (11) (12) (13) (14) (15) (16) (17) (18) (19) (20) (21) Small Pox - - - - - - - - - - - - - - - - - - - - Cholera (C) Plague (P) - - - - - - - - - - - - - - - - - - - - Diphtheria (including Membranous Croup) 304 14 75 169 19 20 6 1 33 39 20 7 13 34 64 31 27 24 12 287 Erysipelas 57 — 2 2 1 14 26 12 11 5 6 2 2 4 6 7 9 2 3 6 Scarlet Fever 263 1 50 161 30 18 3 - 25 30 15 10 11 24 37 -39 23 16 33 230 Typhus Fever - - - - - - - - - - - - - - - - - - - - Enteric Fever 6 — — 1 1 1 3 - - - - - - 2 — 1 — 1 2 1 Relapsing Fever (R) Continued Fever (C) - - - - - - - - - - - - - - - - - - - - Puerperal Fever 16 — — — 6 10 — — 2 1 1 1 — 1 6 2 2 — — 2 Cerebro-spinal Meningitis 3 — 2 1 - - - - - - - - - - - - - - - 1 Poliomyelitis 3 — 2 — 1 — — — — — — — - 1 1 1 — — — — Ophthalmia Neonatorum 37 37 - - - - - - 3 3 2 1 2 7 5 6 2 3 3 8 Pulmonary Tuberculosis 244 — — 15 35 102 77 15 27 34 17 15 13 14 27 28 31 24 14 — Other forms of Tuberculosis 43 1 1 12 14 11 2 2 8 6 2 2 1 7 6 4 4 3 — — Whooping Cough 537 71 295 162 1 7 1 - 107 105 25 18 20 32 85 61 26 42 16 14 Pneumonia 356 31 77 53 39 70 64 22 89 102 12 11 22 11 42 25 21 14 7 4 Malaria 2 — — — 1 1 — - — — — 1 1 — — — — — — — Dysentery 2 — — — — 1 1 - - - - - - - - - - - - - Trench Fever - - - - - - - - - - - - - - - - - - - — Encephalitis Lethargica 9 — 1 2 — 4 1 1 2 2 1 — — — — 1 — 2 1 5 Acute Polio Encephalitis 1 - - - - - - - - - 1 - - - - - - - - - Anthrax - - - - - - - - - - - - - - - - - - - - Totals 1,883 155 505 579 118 259 184 53 308 327 102 68 87 138 279 206 146 131 91 557 85 APPENDIX B. Showing Acts of Parliament, Local Government Orders, Memoranda, and Circularletters issued by Government Departments with regard to the Public Health, Education and Maternity and Child Welfare Services during the Year 1925. Circular No. 557 (Ministry of Health).—Training of Health Visitors. Circular No. 565 (Ministry of Health).—Public Health (Foreign Meat) Regulations. Memorandum No. 100 (Maternity and Child Welfare).—Keeping of Records. Memorandum No. 101 (Maternity and Child Welfare).—Explanatory of Grants for the Training of Health Visitors. Regulation No. 273.—The Public Health (Imported Food) Regulations, 1925. Housing Act, 1925. The Elementary Education Provisional Code, 1922. Amending Regulations No. 2, 1924. Circular No. 593.—Pemphigus Neonatorum Memorandum. Circular No. 559.—Public Health (Imported Food) Regulations, 1925. Circular No. 604.—Public Health (Meat) Regulations, 1924. The Foot and Mouth Disease (Emergency) Restrictions Order of 1925. Circular No. 606.—.Public Health (Preservatives in Food, etc.) Regulations, 1925. Circular No. 615.—-Public Health (Prevention of Tuberculosis) Regulations, 1925. Public Health (Preservatives in Food, etc.) Regulations, 1925. Public Health (Prevention of Tuberculosis) Regulations, 1925. The Foot and Mouth Disease (Emergency) Restrictions Order, 1925. The Housing Act (Appeal Procedure) Rules, 1925. Circular No. 612.—The Milk and Dairies Consolidation Act. The Milk and Dairies Consolidation Act, 1925 (Commencement of Operation) Order, 1925. Memorandum on purchase and utilisation of the Annual Statistical Review of the Registrar General. Circular No. 18 (Ministry of Agriculture and Fisheries).—Tuberculosis Order of 1925, No. 2. Ministry of Agriculture and Fisheries.—Tuberculosis Order of 1925. The Foot and Mouth Disease (Amendment) Order of 1925. Elementary Education.—Regulations for substantive grant to Local Education Authorities. The Public Health Act, 1925. Circular No. 622 (Ministry of Health).—Puerperal Fever. Circular No. 624 (Ministry of Health).—Canal Boats Amendment Regulations, 1925. Regulation No. 843.—Canal Boats (England). The Housing Consolidated Regulations, 1925. The Board of Education Regulation No. 835.—Special Services. Ministry of Pensions (Leaflet).—Widows' and Orphans' Old Age Contributory Pensions Act, 1925. The Widows' and Orphans' Old Age Contributory Pensions Act, 1925. Circular No. 1,341 (Board of Education).—Mentally Defective Children. Circular No. 648 (Ministry of Health).—Annual Reports of Medical Officers of Health for 1925. 86 APPENDIX C. To the Chairman and Members of the Health Committee. Re Nos. 3, 5, 7, 9, 11, 13, 15, 17, 19, 21, 23, and 25, Victoria Place. I beg to report that I visited the above 12 houses on Wednesday, 7th January, 1925. The cottages are of 2 storeys each and are occupied by 89 persons. There are 2 rows of 5 and 6 cottages respectively, with an isolated detached cottage (No. 25) at the rear. Nos. 3, 5, 7, 9, 11 and No. 25. Nos. 3 and 5 have 1 room down and 1 room up. Nos. 7, 9 and 25 have 2 rooms down and 2 rooms up. No. 11, 4 rooms down and 4 rooms up. The above 6 cottages are all in a dilapidated worn-out condition and are, indeed, beyond repair. The brickwork generally is decayed and, in some instances, rotten. This is particularly noticeable in the back additions and out-houses, such as wash-houses and water closets. The woodwork generally, that is sashes, frames of windows and doors, floors, floor joists and treads of staircases, are decayed and perished, except the ground floor of Nos. 3 and 5, which have solid floors. The staircases are rickety, while the plaster of the walls and ceilings is bulged, badly cracked and in several places broken away from the lathes. The walls and ceilings are dirty. The roofs in 4 instances are of tiles and in 1 instance slates, badly sunk, and in a leaky condition. The gutters and rain-water pipes are rusted and perished. Grates unusable. In some instances the floors are below the garden level and in other instances are level with the ground. The rooms on the ground floor are cold owing to the dampness of site of premises. Nos. 13, 15, 17, 19, 21 and 23 consist of a row of 5 roomed houses. They are all damp and the remarks with reference to No. 3 to 11, etc., apply here also, but in lesser degree. I submit detailed reports on each property. In my opinion these houses, namely, Nos. 3, 5, 7, 9, 11, 13, 15, 17, 19, 21, 23 and 25, Victoria Place, are in a state so dangerous or injurious to health as to be unfit for human habitation, and I beg to submit an official representation accordingly. GEORGE F. BUCHAN. 7th January, 1925. Medical Officer of Health. APPENDIX D. To the Chairman and Members of the Health Committee. KENILWORTH ROAD (14 HOUSES). I visited., Kenilworth Road in company with Mr. Woods and Mr. Smith, on Tuesday, 10th February, 1925. This is one of 14 houses all reported in similar condition and in one ownership. This is a 3-storey house with back addition. It is occupied downstairs by Mrs. G. (4 rooms), who sublets a furnished back addition room on mezzanine landing to two young ladies. Mrs. G. pays 22/6 to the landlord, per week and receives from the two young ladies 35/- per week for board and lodging. The first and second floors are rented by Mrs. D. from the landlord. Mrs. D. sublets her top floor front room to Mrs. B. Mrs. D. pays the landlord 30/- per week rent and receives from Mrs. B. 10/- a week rent for the part furnished front room. Mrs. G.'s family is composed of man, wife and three children. Two young ladies occupy the back addition room. Mrs. D.'s family consists of man, wife and 1 child, and Mrs. B.'s family consists of man, wife and 1 child. Altogether therefore the house is occupied by 13 persons and the total rent receivable by the landlord is £2 12s. 6d. per week. The yard, side passage and forecourt are unpaved. The earth at several points is above the level of the damp-proof course and on a level with the grating for ventilation underneath the floors. The unpaved condition of the yard, the fact that the earth is above the damp-proof course in some places and that the surface water is able to enter through the air-brick make the walls of the ground floor damp in certain parts. 87 Internally there exists a number of minor sanitary defects, namely:— Ground Floor. Front room.—Floor broken ; fireplace—jambs falling. Back room.—Sash lines missing. Scullery.—Cistern dirty; portion of ceiling fallen down. Passage.—Wall plaster broken ; ceiling dirty. 1st Floor. Back room.—Sink waste-pipe untrapped, approximately 14 feet. Back addition room.—Sash lines broken. 2nd, Floor. Staircase.—Cistern on back roof dirty—dilapidated cover; walls have been partially stripped (now bare) ; window—sash lines broken. The condition of this property is such that proceedings under section 94 of the Public Health Act, 1875, if taken into Court would not, in my opinion be successful. It is open to question as to whether the conditions named render the house in all respects not reasonably fit for human habitation in accordance with the provisions of section 28 of the Housing Town Planning, &c., Act, 1919. On the other hand, it would appear that the tenants have reasonable grounds of complaint. In these circumstances I would be glad to receive the instructions of the Committee as to whether in their opinion action should be taken by the Council under one or other of the sections above referred to. GEORGE F. BUCHAN, Medical Officer of Health. To be submitted to the Health Committee on 10th March, 1925. APPENDIX E. CONFERENCE WITH MEAT TRADERS IN WILLESDEN REGARDING ADMINISTRATION OF PUBLIC HEALTH (MEAT) REGULATIONS, 1924. Arising out of the decision of the Health Committee, a Conference between the Willesden Meat Traders and the Council was held at tha Town Hall, Dyne Road, Kilburn, N.W. 6, on Thursday, the 19th day of March, 1925, at 3 o'clock in the afternoon. Approximately 120 members of the trade attended, the Willesden Council being represented by the Chairman and Vice-Chairman of the Council and Councillors Bown, Melluish, Mossley, Miss Royle, Seal, Dr. Skene, Vidler, and Willison. The Vice-Chairman of the Council was in the chair. The Vice-Chairman of the Council, upon opening the proceedings, briefly stated the object of the Health Committee in convening the Conference. He pointed out that, under Article 3, it was the duty of the Local Authority to enforce and execute the Public Health (Meat) Regulations, and it was the desire of the Council to ascertain any difficulties which, in the opinion of the trade, would be imposed by the Regulations. The Medical Officer of Health explained the Regulations, the chief of which are:— Article 1.—The regulations shall come into force on the 1st April, 1925. Article 2.—Included amongst the definitions— "Meat" means the flesh of cattle, swine, sheep or goats, including bacon and ham and edible offal and fat, which is sold or intended for sale for human consumption, and 'animal' means any animal from which meat is derived." Article 3.—The Local Authority shall enforce and execute the provisions of the regulations in their district. Articles 4 and 5.—The Medical Officer of Health and Sanitary Inspectors at all reasonable times to have power to enter and inspect all premises to which the regulations apply, and reasonable assistance is to be given them by traders in the execution of their duties under the regulations. Slaughter Houses and Slaughtering. Article 8.—Under this Article not less than three hours' notice must be given to the Local Authority of Slaughtering, but where it is the regular practice to slaughter at fixed times on fixed days, special notice shall not be required to be given to the Local Authority. In case of emergency an animal may be slaughtered outside these fixed days and times, providing notice is given to the Local Authority as soon as reasonably possible, whether before or after the slaughtering takes place. 88 Article 9.—Notice must be given forthwith to the Local Authority of cases where, on the slaughter of an animal for sale for human consumption, it is found that such animal is diseased or unsound. Article 10.—The carcase of a slaughtered animal, including the mesentery, and internal organs, other than the stomach, intestines and bladder, shall not be removed from the place of slaughter until the carcase and its organs have been inspected on behalf of the Local Authority, provided that the removal of the carcase may take place on the expiration of three hours from the time of slaughter, or six hours from the delivery of a notice of intention to slaughter, except that such carcase cannot be removed between 7 p.m. on one day and 7 a.m. on the next day. This Article does not, however apply in the case of a sheep or in the case of an animal of whose slaughter special notice is not required to be given. Article 12.—No gut scraping or tripe cleaning may be carried on in a slaughter house. Meat Marking. Article 15.—Upon the application of the Local Authority to the Minister of Health the Minister may, subject to such conditions as he may impose, authorize the Local Authority to use for the purpose and in the manner specified in the regulations, a distinctive mark of a design approved by him for the purpose of marking meat that has been inspected and passed. The Local Authority is empowered to make a charge for the marking of such carcases, but the charge shall not in any case exceed a sum calculated at the rate of Is. per carcase. Stalls. Article 19.—This Article provides that a person selling meat, or exposing, or offering meat for sale from any stall, shall cause such stall (if not placed in an enclosed and covered market place) to be suitably covered over and to be screened at the sides and back thereof, in such manner as to prevent mud, filth, or other contaminating substance being splashed or blown from the ground upon any meat on the stall, and shall take all reasonable steps to guard against the contamination of the meat by flies. All trimmings, refuse and rubbish are to be placed in properly covered receptacles kept for the purpose apart from any meat intended for sale. Shops, Stores, etc. Article 20.—The chief provisions of this article are contained in Sub-Section 5. The occupier of any shop in which meat is sold or exposed for sale, shall take all such steps as may be reasonably necessary to guard against the contamination of the meat therein by flies, and shall cause the meat to be so placed as to prevent mud, filth, or other contaminating substance being splashed or blown thereon. He shall cause all trimmings, refuse and rubbish to be placed in properly covered receptacles kept for the purpose apart from any meat intended for sale. « Transport and Handling. Article 21.—This Article provides that every person who conveys any meat in a vehicle shajl cause to be kept clean the inside and covering of the vehicle and the receptacles in which the meat is placed, and if the vehicle is opened at the top, back or sides, or if any other commodity is being conveyed therein, shall cause the meat to be adequately protected by means of a clean cloth or other suitable material. COMMENTS OF CONFERENCE. The members of the meat trade had no comments to make on Articles 1 to 11 inclusive. With regard to Article 12 it was stated that no gut scraping, tripe cleaning, etc., is carried out in any slaughter-houses in Willesden. With regard to Article 15 it was agreed that if the meat traders in Willesden desired the Local Authority to make arrangements to mark inspected meat, the traders who are slaughterers should apply to the Council, when the applications would receive consideration. The present method (which appears to be universally adopted amongst butchers) for the disposal of trimmings, etc., was, in the opinion of the Conference, sufficient to meet the Minister's requirements that such trimmings shall be placed in properly covered receptacles. This method is that all trimmings when cut off the joints are immediately placed in a drawer under the block, which is cleared once or twice a day, and put into a properly covered bin in the backyard to await collection. Discussion centred around the provisions of Articles 19 and 20 of the regulations regarding the prevention of contamination of meat in shops and stalls, and the following resolution was unanimously passed:— " That the meat traders in Willesden are prepared to fall in with the suggestions contained in Articles 19 and 20, that all shops and stalls for the sale of meat should have glass fronts, provided this is universal throughout the whole of the country, and that a reasonable time is allowed for the necessary alterations to be made." It was further decided that stalls should be treated in the same way as shops for purposes of Article 19. 89 Members of the meat trade asked that to assist them in preventing contamination of meat by handling by customers, the Council should have notices issued to the trade, asking customers to abstain from handling meat whilst exposed for sale. It was agreed that the object of Article 21 would be met if all meat conveyed in open baskets on bicycles, etc., was wrapped in paper and the baskets suitably covered. At the conclusion of the discussion, the Chairman of the Council assured the members of the meat trade that the Council desired to interpret the Regulations in such a manner as would cause the least possible disturbance, commensurate with the duty which had been imposed upon the Council by the Minister of Health. The trade would find the Local Authority and its officers at all times willing to consider any points or suggestions brought to notice regarding the administration of the Regulations. He thanked the members of the trade for their attendance and helpful criticisms. The proceedings closed with a vote of thanks to the Chairman of the Conference. A. E. DORAN, Dated this 24th day of March, 1925. Chairman. APPENDIX F. For the information of the Health Committee. MANURE HEAPS IN CONNECTION WITH MEWS AND ALLOTMENTS. The powers of a sanitary authority in dealing with accumulations of manure in mews, stables and other similar places are contained in sections 49, 50 and 91(4), Public Health Act, 1875. Briefly put the sections are as follows:— Section 49.—Where in an urban district it appears to the Sanitary Inspector that any accumulation of manure, dung, filth, etc., ought to be removed, he shall give notice to the person to whom the same belongs to remove the same ; and if the notice is not complied with within twenty-four hours, the manure, dung, filth, etc., shall be vested in and sold by the urban authority. Any expenses incurred by the authority in the removal, so far as they are not covered by the same may be recovered from the person to whom the accumulations belong. Section 50.—Gives the authority power to serve notices either by public announcement or otherwise for the periodical removal of manure from mews, stables or other premises. If the person does not remove or permits further accumulations and does not continue to remove at such intervals as the urban authority directs, he shall be liable to a penalty of twenty shillings for each day which such manure is permitted to accumulate. Section 91(4).—States that for the purposes of the Public Health Act, 1875, " any accumulation or deposit which is a nuisance or injurious to health " shall be deemed a nuisance liable to be dealt with summarily. This means the service of a Statutory Notice in respect of each accumulation and subsequent legal proceedings when the nuisance has to be proved. So far as allotments are concerned the only proviso in the Council's rules is that no manure shall be placed on the public road within the allotment grounds. Where manure is placed in contravention of this rule, the Council may remove the manure which then becomes the property of the Council. Rule 7(2) states that an allotment holder shall not cause any nuisance or annoyance to the occupier of any other allotment. GEORGE F. BUCHAN, Medical Officer of Health. APPENDIX G. To the Chairman and Members of the Health Committee. MOTOR SERVICE. I beg to report on the above for its eleventh complete year ending March 31st, 1925. There are 9 motor vehicles in this department owned by the Council, 7 of which came into use in December, 1913, 1 in April, 1924, and 1 in March, 1925, and up to the end of March, 1925, the 9 vehicles had covered a total of 636,467 miles. 90 A 10 year loan was obtained to purchase the first 7 cars and build garage, the last payment of which was made in September, 1923. All the cars are still in service and not one of them has been away from the garage for repairs during their 11 years of life. Over 395,000 journeys have been made by defective children to and from school. 23,532 patients have been conveyed to Hospital. 12,727 houses have been disinfected. It is worthy of note that all the above mentioned patients and children have been conveyed without injury or accident to any of them. During the year under review the chief work has been—Conveyance of ambulance patients and defective children ; disinfection ; certain work for other departments. A day and night service is in operation for ambulance calls. The staff, working hours and work to be done include the following:— Staff— 1 Mechanic Superintendent. 10 Motor Drivers. 1 Driver Mechanic. Working Hours— 47 per week. Work to be done— Health Department, Engineer's Department (including Fire Brigade), 17 vehicles, including Fire Brigade engines. Engineering work of Municipal Hospital. Calls for the Ambulance are heavy, and at times several cases are waiting when, as far as possible, the most serious are removed first, but even with this arrangement delay at times results. A certain number of accident calls have not been answered owing to car or driver being engaged, and lack of means of calling assistance. The following table shews the number of miles run under the various headings since the inception of the service:— Miles Run during Year ending March 31st. 1914. 1915. 1916. 1917. 1918. 1919. 1920. 1921. 1922. 1923. 1924. 1925. Total. School Work - 20,592 17,579 20,530 22,933 23,365 24,454 25,445 30,440 30,792 31,106 31,322 278,558 Medical Officer — 6,343 9,857 9,664 7,857 8,731 9,222 7,266 5,706 6,232 7,630 8,871 87,379 Accidents, Sickness and Infectious Cases - 9,491 8,002 7,871 6,965 12,703 20,275 23,664 24,403 19,407 16,669 16,653 166,103 Disinfection — 5,977 4,998 4,488 3,337 4,534 5,055 4,947 5,923 5,248 4,460 5,037 54,004 Conveyance of Wounded to Hospitals and Entertainments - - 1,978 5,020 1,636 1,173 49 - - - - - 9,856 Conveyance of Grave Diggers - - - - - 263 - - - - - - 263 Concert Parties to Hospitals for Wounded Soldiers, etc. - - 138 378 72 126 77 192 - - - - 983 Education Department - - — — — 123 287 341 313 689 807 435 2,995 Accountant's Department — 416 2,292 1,546 1,321 1,290 647 104 12 — 9 — 7,637 Engineer's Department, including Committees - 243 90 119 120 205 67 207 234 286 366 185 2,122 Clerk's Department - - — 75 89 105 8 56 99 50 27 18 527 Health Department - - - - - 313 239 156 60 171 34 — 973 Registration Department — — 1,217 — — 15 — — — — — — 1,232 Refugee Work — 774 209 56 — 78 84 - - - - - 1,201 Recruiting Demonstration - 28 681 — — — — — — — — — 709 Hospital Work - 181 242 73 275 256 238 394 251 239 86 388 2,623 Dollis Hill House Hospital Committee — — 75 311 200 82 95 60 136 119 115 — 1,193 Food Control — - — — 1,591 601 407 33 — — — — 2,632 Miscellaneous - 53 75 — 496 24 30 60 51 404 271 671 2,135 General, including all foregoing 12,571 - - - - - - - - - - - 12,571 Elections - - - - - 187 72 — 71 144 73 126 673 Library Committee - - - - - - - - - 17 — 37 54 Investigation Committee - - - - - - - - - - - - 44 12,571 44,098 47,433 50,131 46,892 54,174 61,306 62,925 67,699 63,842 61,653 63,743 636,467 91 Miles Run by each Vehicle. Car Number. Delivery. to 31/3/14. 1/4/14 to 31/3/15. 1/4/15 to 31/3/16. 1/4/16 to 31/3/17. 1/4/17 to 31/3/18. 1/4/18 to 31/3/19. 1/4/19 to 31/3/20. 1/4/20 to 31/3/21. 1/4/21 to 31/3/22. 1/4/22 to 31/3/23. 1/4/23 to 31/3/24. 1/4/24 to 31/3/25. Miles run since delivery to 31/3/25. Disinfecting Van M.X. 1884 2,755 6,440 5,196 4,605 3,926 5,229 5,318 3,943 6,054 5,336 4,475 4,877 58,154 Landaulette M.X. 2056 1,466 6,385 10,579 10,248 7,981 8,947 9,358 7,746 6,222 7,375 8,727 9,470 94,504 School Bus m.X. 2057 1,801 7,648 6,915 10,208 8,735 7,275 8,711 8,114 8,335 9,049 10,350 9,586 96,727 Infectious Ambulance M.X. 2058 1,418 5,591 3,912 2,803 3,596 4,728 11,383 11,327 9,964 8,808 5,138 4,140 72,808 School Bus M.X. 2059 2,254 7,176 9,036 10,680 9,060 7,604 8,609 5,954 10,603 12,318 8,939 11,267 103,500 Accident Ambulance M.X. 2060 725 3,900 4,686 4,961 6,240 8,899 11,235 15,715 15,754 10,086 13,483 10,104 105,788 School Bus M.X. 2061 2,152 6,958 7,109 6,626 7,354 11,492 6,692 10,126 10,767 10,870 10,541 10,216 100,903 Ambulance M.F. 4117 — — — — — - - - — — - 3,697 3,697 School Bus M.H. 3908 — — — — — — — — — — — 386 386 Totals 12,571 44,098 47,433 50,131 46,892 54,174 61,306 62,925 67,699 63,842 61,653 63,743 636,467 The above table shews the number 01 miles run by each vehicle during the eleven complete financial years from April 1st, 1914, to March 31st, 1925, and since delivery to the latter date. Calls. The following table shews the number of calls for the Disinfecting Van, Infectious Ambulance, and Accident Ambulance respectively during the eleven complete years, 1st April, 1914, to 31st March, 1925, 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. 1/4/19 to 31/3/20. 1/4/20 to 31/3/21. 1/4/21 to 31/3/22. 1/4/22 to 31/3/23. 1/4/23 to 31/3/24. 1/4/24 to 31/3/25 Total. No of calls for Disinfecting Van 370 1,167 957 787 653 716 1,276 1,661 2,464 1,194 741 665 12,651 *No of calls for Infectious Ambulance 250 940 696 528 641 672 1,601 1,653 1,811 1,472 896 394 11,554 *No of calls for Accident and Illness Ambulances 40 372 388 471 426 797 1,009 1,779 2,078 1,440 1,484 1,514 11,798 * Owing to the demand on the ambulances it is impossible to keep them to the work specified, and infectious cases are sometimes removed on the Accident Ambulance and non-infectious on Infectious Ambulance. The Accident and Illness Ambulances also do relief school work. Year ending March 31st. 1915. 1916. 1917. 1918. 1919. 1920. 1921. 1922. 1923. 1924. 1925. Total No. of miles run by the 9 vehicles 44,098 47,433 50,131 46,892 54,174 61,306 62,925 67,699 63,842 61,653 63,743 Total No. of gallons of petrol consumed 3,988-5 4,035-5 4,673 4,619 5,569 6,388 6,702 6,038 5,370 5,167 5,351 No. of miles per gallon of petrol consumed 11-0 11-75 10-73 1015 9-73 9-59 9-05 11-21 11-888 11-932 11-89 Cost in pence per mile run 13-4 1208 11-78 13-64 15-03 16-98 190 16-95 14-924 13-826 16-405 Storage Plant.—The petrol storage plant installed in January, 1915, is still working satisfactorily, and is now supplying the Engineer's Department of the Council alffc, saving that department -/I per gallon, or £25 per annum. This plant, which finished paying for itself in 1919 by its saving in taking bulk supply, has cost nothing in upkeep except the replacement of the delivery nose. Workshop Plant—This is in good order and effects a great saving, both in Motor and Hospital repairs, which are both increasing. Accidents.—I am pleased to report that no accidents occurred. Additional Vehicle Required.—7 of the vehicles attached to this service have now been in constant use for 11 years, and as the demands on the Service are increasing, and the repairs to the vehicles become more frequent, replacements should be considered. 3 of these vehicles have covered more than 100,000 miles each. • The new Crossley Ambulance installed March, 1924, is in regular service, as also is the Crossley School Ambulance purchased March, 1925. GEORGE F. BUCHAN, Medical Officer of Health. To be submitted to the Health Committee, September, 1925. 92 WILLESDEN URBAN DISTRICT COUNCIL. PUBLIC HEALTH DEPARTMENT MOTOR SERVICES. Year ended 31st March, 1925. Cost per mile Expenditure. £. s. d d. Running Expenses:— Petrol 327 0 0 Oils and Greases 43 3 1 Tyres 179 0 6 549 3 7 2.068 Wages and Emoluments:— Mechanic Superintendent 284 12 9 Drivers 2,167 17 1½ National Insurance (Employers' Contributions) 31 3 9 2,483 13 1½ Fixed and General Charges:— 9.351 Rent (Garage and Mess Room) 187 0 0 Repairs, Plant, etc 124 19 11 Painting, &c., Bodies of Vehicles 56 2 9 Coal, Gas, etc. 117 14 11 Uniforms and Overalls 73 18 0 Insurance of Vehicles 53 9 7 Motor Car Tax 65 1 0 Drivers' Licences 300 Accessories and Sundries 51 19 4 733 5 6 2.761 3,766 2 8½ 14.180 Depreciation and Interest Charges in respect of capital expenditure out of Revenue:— Amount written off value of vehicles purchased from Revenue account in accordance with Medical Officer of Health's Valuation ... ... ... ... 550 0 0 Interest on capital employed 41 0 5 591 0 5 2.225 £4,357 3 1½ 16.405 Income. Use of Vehicles for— Conveyance of Patients 178 17 6 Election purposes 717 6 £186 15 0 Petrol consumed 5,351 galls. Miles run by all vehicles 63,743 „ run per gallon of petrol consumed 11-912 Finance Department, 31st July, 1925. APPENDIX H. To the Chairman and Members of the Children's Care Committee. MENTALLY DEFECTIVE CHILDREN.—DULL AND BACKWARD CHILDREN. I beg to report in accordance with the following minute of the Children's Care Committee of the 6th March, 1925 :— "No. 2381, A.G. (24.5.15)-—Mentally Deficient. 14.-—With reference to our report of 4th February, 1925, (par. 11), the parent refuses to allow this child to attend the Leinster Road M.D. School and desires more time to consider this matter. We have therefore requested the Medical Officer to make satisfactory arrangements, having regard to the circumstances of the case. We are of opinion, however, that the question of forming classes for dull and backward children should be thoroughly considered and have instructed the Medical Officer to submit to us at a later date a full report regarding this matter from the medical point of view." 93 In considering provision for dull and backward children, it is necessary to consider precisely the types of children who are educationally below normal. These are:— (1) The mentally defective child as defined by the Mental Deficiency Act, 1913. (2) The mentally defective child as defined by the Education Act, 1921. (3) The dull child. (4) The backward child. (1) The Mentally Defective Child as Defined, by the Mental Deficiency Act, 1913. Section 1 (c) of the Mental Deficiency Act, 1913, states as follows "Feeble-minded persons ; that is to say, persons in whose case there exists from birth or from an early age mental defectiveness not amounting to imbecility, yet so pronounced that they require care, supervision, and control for their own protection or for the protection of others, or, in the case of children, that they by reason of such defectiveness apeear to be permanently incapable of receiving proper benefit from the instruction in ordinary schools. The Board of Education issued revised model arrangements, dated 31st August, 1914, under the Elementary Education (Defective and Epileptic Children) Act, 1899, and the Mental Deficiency Act, 1913. (Note.—The Elementary Education (Defective and Epileptic Children) Act, 1899, has now been repealed and substantially re-enacted in the Education Act, 1921.) In these arrangements the following certificate requires to be furnished by the Certifying Officer to the Local Education Authority : "I certify that this child, not being merely dull or backward, and not being an idiot, or imbecile, or a moral imbecile, is feeble-minded within the meaning of the Mental Deficiency Act, 1913, but is not incapable by reason of mental defect of receiving benefit from instruction in a special school or class under the Education Act, 1921." A normal individual must be able to form a judgment and have the capacity of looking ahead and forming a plan. He must also be able to shape his conduct and control his actions in accordance with the plan. Any breakdown in this sequence is an indication of feeble-mindedness. The various class of mental defectives mentioned in this Act (Idiot, Imbecile, Feeble-minded, Moral Imbecile) are defined as shewing a social or biological incapacity. This incapacity is quite apparent to the ordinary individual in the two grosser forms of defectiveness (Idiot and Imbecile). In the feeble-minded and more particularly the higher grades it is not so evident. A feeble-minded person can adapt himself to his surroundings, he has a certain degree of intelligence, but he lacks wisdom. He can earn money, but he cannot spend it to his own advantage, in fact he requires care, supervision and control. A certain proportion of feeble-minded children are ineducable, and the remainder receive the greatest benefit by instruction in manual work, e.g., boot-making, carpentry, metal work, rug-making, cane chair making, needlework, etc. It is at such occupations that the feeble-minded person has the greatest chance of earning his own living. (2) The Mentally Defective Child as defined by the Education Act, 1921. Section 55 (1) (a) of the Education Act, 1921, states as follows:— " (a) what children in their area, not being imbecile and not being merely dull or backward, are defective, that is to say, what children by reason of mental or physical defect are incapable of receiving proper benefit from the instruction in the ordinary public elementary schools, but are not incapable by reason of that defect of receiving benefit from instruction in such special class or school as under this Part of this Act may be provided for defective children ; " The form of certificate prescribed by the Board of Education for the purposes of this section is as follows "(a) For Defective Children—I., A.B., a duly qualified practitioner, approved by the Board of Education, certify that Y.Z., not being imbecile and not being merely dull or backward, is, by reason of (1) mental or (2) physical defect, incapable of receiving proper benefit from the instruction in an ordinary public elementary school, but is not incapable, by reason of such defect, of receiving benefit from instruction in a certified special class or school." The children in this category shew three or more years retardation in ordinary school subjects. They are generally well-behaved, able to take an intelligent interest in games and able to hold their own in every-day life. The parents of these children usually state that apart from backwardness at school no other abnormality has been noticed. There is, of course, a natural antipathy on the part of all parents to admit that their child is mentally defective and a still greater antipathy to consent to their child being sent to the "silly" school. The term "mental defect" in this Act may mean, as far as it is possible to interpret any Act of Parliament without a decision by the Courts, an educational disability only, but this view is not accepted by all authorities. If the term is interpreted to mean a mental defect similar to that needed for certification under the Mental Deficiency Act, difficulties arise as a child with an educational retardation without a mental defect could not legally be compelled to attend a Special School. 94 A considerable proportion of mentally defective children under this Act prove later to be mentally defective under the Mental Deficiency Act, but an individual with a low scholastic capacity does not necessarily require "care, supervision and control for his own protection or the protection of others," in other words, there is no social or biological incapacity present. Approximately 40 per cent, of the children attending Leinster Road M.D. School are educationally retarded and might be dealt with under the Education Act, 1921, subject to the legal interpretation of mental defect under the Act. The remaining 60 per cent, of the children are mentally defective within the meaning of the Mental Deficiency Act. The majority of the former cases would be suitable for transference to classes for Dull and Backward children if such were available. (3) The Dull Child.—There is no definition of a dull child in any Act of Parliament. The dull child comes between the normal child and the definitely mentally defective child, the dullness being due to an inborn mental impairment, i.e., to intrinsic or mental factors. There is, however, no sharp line of demarcation between the normal child and the dull child on the one hand and the dull child and the mentally defective child on the other hand, the various grades merging into one another. Later in life dull children are capable of maintaining themselves in an occupation without care, supervision or control. They shew 1 to 2 years' retardation in ordinary school subjects. The causes of dullness are various as may be seen from the following classification taken from the Annual Report of the Chief Medical Officer to the Board of Education for 1922:— Dull Children—Intrinsic or mental factors. (a) Weak General Ability—Inferiority of all-round mental efficiency, not sufficiently pronounced to be denominated mental deficiency. (b) Specific Scholastic Inability—Affecting several or one group of subjects, often compensated by aptitude in other directions. (c) Character defects—Inborn instability. (d) Impaired Mental Growth—Associated with slow physical development. (4) The Backward Child.—This child also stands between the normal child and the definitely mentally defective child, the backwardness being due to extraneous or non-mental factors. There would appear to be no reason why such a child should not develop into a normal individual provided he receives the appropriate treatment, scholastic, medical or otherwise. The causes of backwardness are various, as may be seen from the following classification taken from the Annual Report of the Chief Medical Officer to the Board of Education for 1922:— Backward Children—Extraneous or non-mental factors. (a) Irregular Attendance—Late admission, frequent or prolonged absence due to ill-health, exclusion for uncleanliness, infectious diseases, home negligence, migration. (b) Inefficient teaching in earlier years—Discontinuity between infants and senior ments, change of teaching methods with change of school. (c) General Physical defect, General Physical weakness, malnutrition, loss of sleep, excessive fatigue from out of school employment, bad home conditions. (d) Special Physical Defects—Tonsils and Adenoids, visual and dental defects, deafness, external eye and ear diseases, skin defects, paralysis, speech defects, &c. (e) Character Defects—Arising out of environmental experiences, laziness, inattention, temper, disobedience, &c. Ascertainment of Mentally Defective or Dull or Backward Children. For the purpose of ascertaining the mental category to which a child belongs examination is carried out by means of the Standford Revision of the Binet-Simon Tests, and the mental age is ascertained. The ratio of the mental age to the chronological age is expressed as the Intelligence Quotient (I.Q.) or Mental Ratio (M.R.), i.e., Mental age x 100 Chronological age. = Intelligence Quotient or Mental Ratio. For example, the Intelligence Quotient of a child whose mental and chronological ages are both nine years would be 100. If, however, the mental age was 7 years and the chronological age 9 years, the Intelligence Quotient would be j x 100 = 77. It is also necessary in arriving at a diagnosis to ascertain the scholastic attainments of a child, and for this purpose a series of tests have been devised by which it is possible to determine the child's mental age for Reading, Spelling, Dictation and Arithmetic. The following classification of Intelligence Quotients are regarded as standards:— Intelligence Quotient. Classification of Child. Above 140 Near a genius or a genius. 120—140 Very Superior intelligence. 110—120 Superior intelligence. 90—110 Average or normal intelligence. 80— 90 Dullness. 70— 80 Borderline deficiency. 50— 70 Mental Deficiency (low, middle and high). 20— 50 Imbeciles. Below 20 Idiots. 95 Treatment. It is obvious that with the various classes and sub-classes of the foregoing classes of abnormal child, different forms of treatment are required. In fact each individual child must be considered from a scholastic, social and medical point of view before any decision can be made. Moreover, treatment must vary from time to time as a child progresses or proves to be unsuitable for the treatment originally recommended. The backward child of normal intelligence and average health requires special attention in the subjects in which he is specially backward. The backward child who is in poor health requires, in the first place, to receive the appropriate medical or dental treatment, special attention being paid to eye and ear, nose or throat conditions, and then perhaps he ought to be sent to an open-air school. The dull child requires special tuition in a small class and certain children who are mentally defective within the meaning of the Education Act, 1921, could also be admitted to these classes. Children who are mentally defective within the meaning of the Mental Deficiency Act, 1913, and a certain proportion of those who are mentally defective within the meaning of the Education Act, 1921, must go to a special school, where the curriculum is specially adapted to meet the particular requirements of these children. Provision to be Made. Having regard to the foregoing and the difficulties of certifying a child as educationally backward by reason of mental defect it would appear desirable to retain one school for the lowest grade of educable feeble-mindedness, that is to say, for the children who are definitely certifiable mentally deficient within the meaning of the Mental Deficiency Act, 1913. All other cases might be sent to classes for dull and backward children to be established in Willesden. Such classes would require to serve groups of schools and should be distributed over Willesden at suitable centres. Already a class for dull and backward children has been established at Lower Place School to meet the needs of that area, and an extension of this principle would appear to be desirable. The exact schools and centres at which dull and backward classes might be established is a matter primarily for the Education Officer. If such classes were established those children who in the opinion of the teachers at ordinary schools appeared to be mentally defective would first be drafted to the dull and backward classes and, if necessary, be referred subsequently to the Medical Officer for possible transference to the mentally defective class, by the teachers of those dull and backward classes after they had knowledge of the child's capacity. Addendum. It will be observed that in the foregoing statement I have indicated that in order to be able to enforce the attendance of a child at a special class or school the Certifying Officer has to certify that this is necessary by "reason of mental defect," and the crux of the question is as to what is" mental defect " ? In this connection I beg to submit correspondence with Mr. Wood of the Board of Education which states the unofficial view of the Board. GEORGE F. BUCHAN, Medical Officer of Health. To be presented to the Children's Care Committee on 9th September, 1925. Board of Education, Medical Branch, 54, Victoria Street, London, S.W. 1. 31st July, 1925. Dear Dr. Buchan, I have been reading your Report for 1924, and am rather puzzled by the three paragraphs on top of page 9. So far as I understand them your argument is, that a child may be mentally defective within the meaning of Section 55 of the Education Act, 1921, but that it cannot be sent to a Special School or class for defective children unless it also can be certified as being feeble-minded within the meaning of Section 1 (c) of the Mental Deficiency Act, 1913. If this is what you mean, surely you must be under some misapprehension. If a child is mentally defective within the meaning of the Education Act you can quite clearly certify it as mentally defective and send it to a Special School, quite regardless of anything in the Mental Deficiency Act. I am not writing this merely with a view to criticising your report, but rather to remove the misunderstanding which, if I understand it right, is preventing you from dealing with some of your mentally defective children in the way that you would wish to. If I have not understood your report correctly or there is some difficulty which I have overlooked, please let me know. Yours sincerely, (Signed) A. H. WOOD. 96 Willesden Urban District Council, Health Department, Town Hall, Dyne Road, Kilburn, N.W. 6. 6th August, 1925. Dear Mr. Wood, I am afraid that I did not make myself quite clear in the three paragraphs in my Annual Report for 1924, which you refer to in your letter of the 31st ult. The difficulty is as to the precise meaning of the term " Mental Defect," which requires to exist before certification that a child is incapable of receiving proper benefit, etc. (Education Act, 1921, Section 55 (1) (a) ). If this term is interpreted to mean a defect of educational capacity only, the position is clear, but if, on the other hand, it is interpreted to mean a defect of education capacity plus a social incapacity, i.e., a defect similar to that required for certification under the Mental Deficiency Act, 1913 (vide definition of feeble-minded children, Mental Deficiency Act, 1913, Section 1 (c) ), difficulties arise. The following case which was recently considered by the Children's Care Committee of this Authority will illustrate what I mean:— A.H. was examined on the 21st November, 1924, and was certified as Mentally Defective under the Education Act, 1921, by the Certifying Officer. Her chronological age was 12, her mental age 8 and her intelligence quotient 66. Her educational capacity in reading reached about a 7 year old standard and her spelling and arithmetic about a 6 year old standard. Her writing was of poor quality. On the other hand she had a sufficient degree of ordinary intelligence to adapt herself to her environment and could "hold her own" with other children, in other words, there was not any appreciable degree of social incapacity present. The parents refused to allow the child to attend the Special School for Mentally Defective Children, and the case was seen by Dr. Tredgold, the Council's Specialist for Mental Deficiency, and I attach a copy of his report for your information. In view of the opinion he expressed, the Authority did not see their way to take the matter to the Law Courts, and this child was allowed to remain in an ordinary elementary school. I would be very glad to hear from you on this matter for future guidance. Yours truly, GEORGE F. BUCHAN, Medical Officer of Health. A. H. Wood, Esq., Board of Education, Medical Branch, 54, Victoria Street, London, S.W. 1. Board of Education, Medical Branch, 54, Victoria Street, London, S.W. 1. 11th August, 1925. Dear Dr. Buchan, (1) Thanks for your letter of August 6th. I know Dr. Tredgold's views and have, in fact, discussed them with him. He knows that we disagree with him on this particular point and, I am sure, that he would not mind my telling you so. The view of the Board is that in deciding whether or not a child should be sent to a Special School, the Local Education Authority have to consider the bearing of Section 55 (i.) of the Education Act, 1921, and that alone. Any definitions or requirements of the Mental Deficiency Act are, for this purpose, quite beside the point and do not come into the matter at all. (2) In the case you mention it is agreed apparently by all parties that the child A.H. could not profit by the instruction in an ordinary Public Elementary School, but could profit from the instruction in a Special School. That appears to us to settle the question. The fact that there is no social incapacity present is immaterial. I have no doubt whatever myself that the child ought to go to a Special School, and I cannot imagine any court of law taking any other view. I think it would be fair to put the matter as follows. Dr. Tredgold holds, and we should probably all agree with him, that there are two types of mental defect, one of which we may for the sake of convenience, call an intelligence defect, and the other a social or temperamental defect. We, at the Board, hold quite clearly that if a child is suffering from the first type of defect, that is sufficient ground for putting it 97 into a Special School. Dr. Tredgold holds that you cannot send a child to a Special School unless it is suffering from both types of defect. I can only repeat that I see nothing whatever in the Education Act which justifies this view, and I shall be surprised if you find any Local Education Authority in England which acted upon it. (3) If it were argued that a child might be sent to a Special School if it were suffering only from social or temperamental defect while it was possessed of normal intelligence, this, no doubt, would be a very different affair and one on which I should hesitate to dogmatise. The argument would be that social or temperamental incapacity was, in fact, a form of mental defect and brought a child within the meaning of Section 55 (i.), in spite of normal intelligence in academic subjects. I think this raises difficult questions, and you would, no doubt, walk warily in such a case. But the point does not arise in the case of A.H. This child admittedly suffers from mental defect from the intelligence point of view, and that appears to us to clench the matter. (4) I may add that quite apart from this, we do not agree with Dr. Tredgold that the definition of a feeble-minded child in the Mental Deficiency Act differs substantially from the definition of a mentally defective child in the Education Act. In our view, the words in Section 1 (c) of the Mental Deficiency Act which refer to care, supervision and control, do not apply to children and we hold, therefore that the definitions of the mentally defective child in Section 55 (i.) of the Education Act and of the feeble-minded child in Section 1 (c) of the Mental Deficiency Act are practically identical. Even, therefore, if the Mental Deficiency Act affected the action of an authority under Section 55 (i.) of the Education Act in deciding whether or not to send a child to a Special School (which we do not think it does) we should still not agree that social incapacity came into the picture. (5) You will, of course, regard this letter as unofficial; but I feel fairly clear myself that if your authority thought that it was to the interest of A.H. that she should be sent to a Special School they would be on perfectly safe grounds in proceeding to secure her attendance. Both your Certifying Officer and Dr. Tredgold consider that she is incapable of receiving proper benefit from the instruction in an ordinary Public Elementary School, and I cannot myself see what more you want, or how any court of law could take any other view. Yours sincerely, A. H. WOOD Report on A.H., Aged 12 Years. I have to-day examined the above named girl and find as follows. She is much retarded educationally and of sub-normal scholastic capacity, so much so that I consider she may fairly be described as incapable of receiving proper benefit from the instruction in an ordinary public elementary school. In addition, she is timid, nervous, and below the average of her years in general knowledge and in the capacity for making mental comparisons, forming judgments and reasoning. She has, however, sufficient intelligence to adapt herself satisfactorily to her environment, and my opinion regarding this was confirmed by the statement of her father, that she could hold her own in games, and could employ herself in a satisfactory manner in the performance of simple household duties. In the event of little further development of the higher mental functions taking place it is possible that at a later age, and when she is called upon to face responsibilities unaided, she might prove unequal to the task, and that she might then be certifiable under the Mental Deficiency Act ; but at the present time I do not regard her as so certifiable. Her certifiability as a mentally defective child under the Education Act depends upon the interpretation of the term "Mental Defect" in that Act. If this term is interpreted to mean a defect of educational capacity only, then she could be certified and sent to a special school. If, on the other hand, the term is interpreted to mean a defect similar to that needed for certification under the Mental Deficiency Act, then she could not be so certified. This is an important distinction which has not yet been settled, and the precise interpretation will probably need a decision by the Courts. I think it is quite likely that in this particular case, if it were decided to send the child to a special school and the parent contested this decision, the Court might decide in favour of the father. I am of the opinion that the child is undoubtedly in need of more special, practical, and individual training than she can obtain in an ordinary elementary school ; but I think that, in view of the comparatively slight social incapacity which she presents this training would best be afforded by a practical or backward class in an ordinary school, rather than by a special school, were such available. (Signed) A. F. TREDGOLD, M.D. 12th January, 1925. 98 APPENDIX I. INFECTIOUS DISEASES—EXCLUSION OF CHILDREN FROM SCHOOL. Statement showing regulations of the Willesden Education Committee, revised June 3rd, 1925. Disease. (1) Children suffering from Disease stated in Column 1. (2) Children living in tenements where Disease stated in Column 1 occurred, i.e., Contacts. Contacts who have previously suffered. (3) Contacts who have not previously suffered. (4)' (i.) Common Infectious Diseases. 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 7 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 mitted 3 weeks from onset. Not excluded. Excluded. Re-admitted 3 weeks from onset of primary case in tenement. German Measles Excluded. Re-admitted 2 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 upon 6 weeks from onset of " whoop." Not excluded. Excluded. Re-admitted 3 weeks from onset of primary case in tenement. Mumps Excluded. Re-admitted 2 weeks from onset. Not excluded. Not excluded. 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. Acute Polio-Encephalitis, Acute Poliomyelitis, Acute Encephalitis Lethargica, Cerebro-Spinal Fever. Action in accordance with instructions received from Medical Officer of Health. Not excluded, except on instructions of Medical Officer of Health. Not excluded, except on instructions of Medical Officer of Health. Tuberculosis Ditto. Not excluded. Not excluded. 99 Disease. Children suffering from disease stated in Column 1. (ii.) Infectious Skin Diseases. Ringworm Excluded. Re-admitted only upon receipt of notice from School Medical Officer. Scabies Excluded. Re-admitted upon receipt of notice from School Medical Officer or certificate of private medical practitioner in attendance on the child, stating the child is fit to return to school. This certificate must be forwarded at once to the appropriate Clinic. Eczema Ditto. Impetigo Ditto. (iii.) Infectious Eye Diseases. Ophthalmia Ditto. Blepharitis Ditto. (iv.) Verminous Conditions. Body Lice Head Lice Nits Ditto. (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. APPENDIX J. To the Chairmen and Members of the Children's Care Committee. STAMMERING CHILDREN.—KILBURN AREA. I beg to report in accordance with the following Minute of the Children's Care Committee of the 3rd December, 1924:— "Treatment of Stammering Children. 15.—With reference to our report of 5th November, 1924 (par. 16), we are informed that there are sufficient stammering children in the Kilburn area to justify such a class being formed. Mr. Bradfield, who has recently been conducting these classes, is prepared to treat 10 children for a period of three months, two one-hour lessons per week, the fee for which, including books, papers, etc., would be £6 6s. Od. per month. In the event of such a class being formed, it would be examined once a month for the purpose of reporting progress. After full consideration of this matter, and subject to a concurrent report by the Finance Committee, we recommend— (a) That, subject to the approval of the Board of Education, a class of 10 children from the Kilburn area be formed at the Percy Road Council School under the charge of Mr. A. D. Bradfield. (b) That the fee for treating 10 children at this school for a period of three months, two one-hour lessons per week, including books, papers, etc., be £6 6s. Od. per month. (c) That, at the end of three months a report be obtained on the cases treated with cular reference to the benefit each child has derived." The information has been compiled from the reports of Head Teachers, Parents, and from the results obtained at the examination of the children by Dr. Troup. GEORGE F. BUCHAN, Medical Officer of Health. To be presented to the Children's Care Committee on the 13th May, 1925. 100 Name and Age. Condition at Commencement of Class. Present Condition. H., W. (12J years). 1. Consonantal difficulties. 2. Breath control faulty. 1. Reading : Fluent with occasional slight tion. 2. Conversation : Occasional stammer. 3. Improved breath control. Generally improved. W., F. (11J years). 1. Consonantal and vowel difficulties. 2. Breath control faulty. 3. Twitching of forehead and jerky movement of the legs. 1. Reading : Slight stammer and hesitation at certain words. 2. Conversation : Very occasional stammer. 3. Improved breath control. 4. All movements have now ceased. Generally a decided improvement. S„ A. (10J years) 1. Consonantal and vowel difficulties. 2. Breath control faulty. 3. Contortion and jerky movement of the limbs. 4. Defective articulation. 1. Reading: Occasionally misses or misinterprets a word—some hesitation. Child is backward in reading for his age. No distinct stammer. Articulation improved. 2. Conversation ; Occasional slight hesitation. 3. Movements have ceased. F„ R. (13J years). 1. Consonantal difficulties. 2. Faulty breathing. 1. Reading : Slight hesitation at certain words. 2. Conversation : Ditto. 3. Breath control normal. Generally improved. J., R. (13J years). Can scarcely read aloud—efforts are •accompanied by jerky movements of legs and arms—distressing. Practically cured. Very rarely shews signs of stammering. C„ H. (14 years). 1. Consonantal difficulties. 2. Breath control faulty. 3. Jerky movement of legs and twitching of forehead. Left school at Easter. Much improved. G„ J. (10J years). 1. Consonantal and vowel difficulties. 2. Contortion. 3. Breath control faulty. 4. Could not read at all before his class. 1. Reading: Practically no hesitation. able improvement. 2. Conversation : Ditto. 3. Movements ceased. H„ T. (12 years). 1. Consonantal difficulties—at times distressing. 2. Breath control faulty. 3. Jerky movement of legs. 1. Reading: Fluent with no stammer—occasional hesitation at the beginning of a sentence. 2. Conversation : Fluent. 3. Movements ceased. R„ J. ; (12J years). 1. Consonantal difficulties—stammering very marked. 2. Breath control faulty. 3. Contortion and jerky movements of the legs. 1. Reading: Slight hesitation and tion (substitution) of certain words. Improved. 2. Conversation : Slight and occasional stammer. 3. All movements have now ceased. W., H. (10J years). 1. Consonantal and vowel difficulties. 2. Breath control faulty. 3. Contortion. 4. Articulation very defective. 1. Reading : Occasionally stammers. Backward for his age in reading. 2. Conversation : Improved, but still has difficulty with certain letters. 3. Boy is brighter and more cheerful with the stant trouble of stammering lightened. APPENDIX K. INFORMATION REQUIRED BY THE CHILDREN'S CARE COMMITTEE AS TO PROPOSED OPEN-AIR SCHOOL ON POUND LAND SITE. (i.) Area. Total area of Plot bounded by Pound Lane, Jews' Cemetery, Drill Hall and existing school = 2.056 acres. Area of site of Juvenile Employment Bureau = 0.072 acres. Area available for Open-Air School = 1.984 acres. (ii.) Number of Children suitable for admission to proposed Open-Air School. (a) Number of Children on Roll at Leopold Road Physically Defective School = 51 (b) Number of Children on Roll at Furness Road Physically fective School =47 98 101 Brought forward 98 (c) Delicate Children— (1) Cases of pre- or latent Tuberculosis =140 (2) Cases of malnutrition, anaemia and debility discovered at routine medical inspection during 1924 = 289 (3) Cases of malnutrition, anaemia and debility referred as special cases during 1924 = 37 (4) Other conditions = 49 515 Total 613 This figure of 613 is corroborated by the probable number of crippled and delicate children in Willesden based on the Board of Education's index figure. This figure represents the number of abnormal children which it is expected would be found in any area, and is based on a figure which is half-way between the ascertained number of abnormal children in the London area and the average number in 208 other areas. For Willesden it works out at 562. All the above 613 or 562 children do not require to be in continuous attendance at an Open-Air School, but the 98 children in attendance at the Physically Defective Schools do, and a considerable proportion of the 515 or 464 remaining. All of them, however, should have open-air education for some part of their school lives. (iii.) A site for an Open-Air School should be large enough to permit the establishment of a playing field and a school garden and 2 acres is considered to be the minimum area for a school accommodating 100-120 children. The site at Pound Lane, which is approximately 2 acres, would be large enough to accommodate the children attending the present Physically Defective Schools, namely, 98, and provide 22 places for the 515 or 464 delicate children who require open-air education in Willesden. GEORGE F. BUCHAN, Medical Officer of Health. To be presented to the Children's Care Committee on the 14th October, 1925. APPENDIX L. To the Chairman and Members of the Children's Care Committee. REPORT ON THE WORKING OF THE DENTAL SCHEME OF OCTOBER, 1924 I beg to report in accordance with the following Minute :— " School Medical Service Scheme. 21.—With reference to our report of 6th March, 1925 (p. 507) and to the letter from the Board of Education (1/10/1924), els to the review of the working of the revised dental scheme, we have requested the Medical Officer to report hereon at our next meeting." (Minutes dated 2nd December, 1925.) On June 6th, 1923, the Education Committee adopted a School Medical Service Scheme, which was approved by the Board of Education on June 23rd, 1923. This scheme included a Dental Scheme. On July 2nd, 1924, the School Medical Service Scheme, including the Dental Scheme, was revised and received the general approval of the Ministry of Health on August 11th, 1924, and the Board of Education on October 1st, 1924. The Board of Education, however, took exception to the Dental Scheme. On November 5th, 1924, the Willesden Education Committee, in view of the Board's criticism, recommended " that the revised (dental) scheme, as submitted to the Board, be given a year's trial." This course was agreed to by the Board in a letter dated December 23rd, 1924, which expressed the intention of the Board to reconsider the matter at the end of this period. In October, 1924, the revised dental scheme was put into operation, and has been in operation ever since. The trial period of one year has therefore elapsed and the scheme is due for review. The Dental Scheme of October, 1924, is as follows :— (1) All public elementary school children shall be dentally examined at the Schools. (2) Public elementary school children found, on examination, to be suffering from dental defects requiring attention shall be referred to a private dental practitioner. (3) Public elementary school children found to be suffering from dental defects and found to be necessitous (in accordance with the Committee's Economic Circumstances Scale), and in respect of whom a postcard has not been received from a private dental practitioner stating that he is undertaking the treatment of the case may be treated at the Clinics (free of charge). 102 (4) Public elementary school children found to be suffering from dental defects and who are not necessitous under the scale adopted by the Committee may be treated on payment as set out in this memorandum, provided that a postcard has not been received from a private dental practitioner, stating that he is undertaking the treatment of the case. Criticisms and Suggestions Offered by the Board of Education in their Letter to the Authority, dated 1st October, 1924. " I am therefore to suggest that the Authority should reconsider their dental arrangements, and should adopt a progressive scheme on the lines indicated in the report for 1921, concentrating their activity in the first instance on as many age groups, beginning from the age of 5, as can be dealt with by the staff, inspecting a new 5 year old group annually as it matures, and reinspecting the children in the groups previously examined and giving supplementary treatment where necessary in any event Board cannot regard it as satisfactory that the dentists should spend so much of their time in the dental inspection of large numbers of children who remain untreated, and I am therefore to ask for an assurance that a due proportion may be observed in the time devoted to inspection and treatment respectively and that larger numbers of children should not be inspected than are likely to be dealt with, either by private dentists or at dental treatment sessions conducted in the Authority's Clinics." Conditions of a Satisfactory Dental Scheme. (Sir George Newman, Annual Report of the Chief Medical Officer of the Board of Education for the year 1921.) Sir George Newman, in this report, lays down the following conditions (among others) for a satisfactory dental scheme. 1. " Attention should, be concentrated in the first instance on the group of children from five to seven years of age. This is essential for the following reasons :— (a) To anticipate and prevent the encroachment of dental caries it is advisable to inspect the children at as early an age as possible. (b) To begin early is to enhance the chances of saving teeth. (c) To inspect and treat early is to make adequate provision for the ' critical age,' which is, of course, the time of the emergence of the permanent teeth. 2. After the first year the dental scheme should provide for the examination or re-examination of all children in the age groups previously inspected by the dentist, and for such treatment or supplementary treatment as may be found necessary. In this way it is expected that the whole of the children of elementary school age will eventually be brought under adequate dental inspection and treatment, and enabled to leave school with healthy dentures. The annual re-inspection of children is as important as the inspection and treatment of new cases ; if this work is allowed to get seriously into arrears the benefit of the conservative work already done will be largely nullified. 3. The treatment should be conservative in character, and accordingly the bulk of the treatment work should be by filling rather than by extraction. Conservative dentistry includes also preventive measures, such extraction work as contributes to the preservation of the dentition as a whole, and simple mechanical devices necessary to regulate the teeth. 4. With the development of the scheme it will, of course, be necessary for local Education Authorities to review their provision in order to secure that the dental staff is adequate to meet the extension of their duties. The aim of the School Dental Service should be to secure that as many children as possible shall leave school free from dental disease and trained in the care of the teeth. 5. So long as the supply of dentists is limited, their services should be confined to carrying out the scheme of conservative treatment; only in exceptionally urgent cases should children falling outside the groups included in the scheme be treated. As the scheme develops in the course of natural extension these cases will tend to disappear. Above all, no dental scheme can be considered satisfactory which fails to approach the problem from a preventive standpoint." Results Obtained During Year of Operation of Scheme of October, 1924. Table No. 1 below shows the relations between the number of children inspected and the number actually treated during the period under review. Table No. 1. Number Inspected. Number Requiring treatment. Number treated Number treated at Clinics. elsewhere. Routine 13,482 9,431 898 100 (approx.) J 998 Special 1,149 1,114 887 21 908 103 It is apparent from the above figures that only a small proportion of the routine cases actually receive treatment. The result of this is, that the mouths of the great bulk of children are left untreated and become in a progressively worse condition as revealed by the school inspections. The reasons for the small attendance of routine cases are as follows :— (1) The following-up of cases is limited to one visit by the Health Visitor, and this is sufficient. (2) The payment of 2/6 is an obstacle to the re-treatment of routine cases. Parents willingly pay the fee for the urgent and special cases, but are not prepared to pay it in the case of minor defects, which are those which should be dealt with in order to prevent gross conditions of the mouth. Table No. 2 shows the number of attendances, fillings and teeth removed during the 12 months preceding and the 12 months subsequent to the coming into operation of the revised scheme. Table No. 2. 12 Months Prior to Operation of Scheme. 12 Months Subsequent to Operation of Scheme Number of Attendances. Number of Fillings. Number of Extractions. Number of Attendances. Number of Fillings. Number of Extractions. 1,914 759 1,459 4,832 2,247 4,044 It is evident from the above table that the alteration in the scheme has resulted in an increase in the attendance and the amount of work done at the Clinics. Considerable difficulty is now being experienced in dealing with this increasing amount of work, and, in order to cope with it, one extra session has been allocated to treatment since April 20th, 1925. A dentist now spends 4 sessions per week on dental inspection at the schools and 7 sessions per week on dental treatment. However satisfactory this increase may appear to be from the point of view of providing dental treatment, it is really work of a character outside the proper scope of a dental scheme as defined by Sir George Newman in the report quoted above. The dentists are at present engaged in dealing with cases (of which approximately 50 per cent. are specially referred) of the most neglected and difficult type requiring many visits before their mouths can be put into reasonable order, instead of the treatment and completion of a large number of children with minor defects. The treatment given is therefore very largely of a palliative nature, instead of being preventive and constructive, in accordance with the principles laid down in the Chief Medical Officer's report. 6. Recommendations.—I beg to submit the following recommendations for the consideration of the Committee, whereby the scheme may be brought into accord with the principles laid down by the Board of Education :— (1) That during the year 1926, all children under 9 years of age (approximately 9,000) be inspected and offered treatment, together with such special cases (see recommendation 5) as may attend for treatment at the Clinics. (2) That during the year 1927, an increase in staff of one dentist be made, this increase in staff being necessary to deal with the extra work entailed by the influx of entrants to the schools, the probable increased demand for dental treatment, and especially the need for regulation of the teeth generally required about the age of 9-10 years. (3) That provision be made for the addition of dentists in succeeding years until the staff is sufficient to cope with the dental care of all school children. (Probably 5 dentists in all would be required for school work.) (4) That all cases referred from routine school inspections be visited by the Health Visiting Staff at least 3 times. (5) That the present charge of 2/6 be operative only in cases specially referred to the Clinics and not arising out of routine inspection. (Note.—Every effort should, in the opinion of the dental staff, be made to reduce the number of special cases—as they are a hindrance to the successful working of any dental scheme—and to encourage the conservative treatment of early dental caries.) (6) That tooth brushes be supplied at the Clinics free or at cost price, depending on stances. GEORGE F. BUCHAN, Medical Officer of Health. To be presented to the Children's Care Committee at their meeting on 9th December, 1925. 104 APPENDIX M. REPORT ON ARTIFICIAL LIGHT TREATMENT FROM THE COMMENCEMENT OF TREATMENT ON THE 16th NOVEMBER, 1925, TO THE 31st DECEMBER, 1925, by H. Haldin-Davis, M.D., M.R.C.P., F.R.C.S., Dermatologist to the Council. (1) The Medical Officer in charge of the treatment is H. Haldin-Davis, M.A., M.D., B.Ch., F.R.C.S., M.R.C.P., Dermatologist to the Willesden Urban District Council and Royal Free Hospital. His appointment was approved by the Board of Education and the Ministry of Health on the 31st August, 1925. (2) The Nursing Staff employed in connection with the Artificial Light Therapy consists of :— Sybil Miriam Smith. Fully trained nurse, London Hospital, 4 years ; 3 months in the Light Department of the London Hospital giving treatments by means of the Finsen and Mercury Lamps ; conjoint certificate Chartered Society of Massage and Medical Gymnastics; C.M.B. Certificate ; Health Visitors' Certificate Royal Sanitary Institute. Miss Smith has been doing the Artificial Sunlight work since the Clinic opened, on the 16/11/25. (3) The type of lamp used is a Flaming Carbon Arc of Siebe & Gorman, working at 30 amps. (4) The current used is direct. The voltage from the main is 240, but this is reduced by means of a resistance to 95 at the terminals of the lamp. The lamp hangs in the middle of a small room. Round it is arranged a quadrangular barrier, which keeps the patients at a proper distance. About 10 patients can be treated simultaneously. (5) The diseases treated have been as follows :— Under 5 years of age. Over 5 years of age. Total. Anaemia 1 0 1 Alopecia Areata 0 2 2 Asthma 0 1 1 Rickets 3 1 4 Chr. Blepharitis 0 1 1 Rheumatism 0 1 1 Chr. Bronchitis 0 1 1 Enlarged Glands 1 7 8 Debility and Malnutrition 3 6 9 8 20 28 The 28 patients were all referred to the Light Department by the whole-time Medical Officers at the Council's Clinics. (6) The general plan of campaign is to give each patient three treatments a week, beginning with 5 minutes exposure only, back and front, on the first occasion, and subsequently lengthening the exposure by 5 minutes each time, until a maximum of half-an-hour, back and front, is attained, so that after a fortnight each patient has an hour's exposure at each attendance. In the case of very young babies these exposures have been diminished, especially at the beginning of treatment. (7) It is intended to make three months the usual period for each patient to attend the department, only in exceptional circumstances will they be allowed to attend for longer periods. This limitation is necessary in order to make room for new patients, of whom there is no lack. (8) The temperature and pulse of each child is not taken before and after each treatment. It has been taken occasionally and no effect has been noted. No febrile patients are treated. The same remarks are true of blood pressure, if there is any change in the blood pressure after a treatment it is in the direction of a fall, but it is very slight. It is impossible for the single hard-working nurse to attend to the children and also to take these observations. If they are necessary at least one additional nurse will have to be provided. (9) Treatment was begun on the 16th November, 1925. (10) The total number of patients treated between 16th November, 1925, and 31st December, 1925, was 28. (11) A weekly record of weights is kept, and we are now making arrangements to keep a weekly record of heights of the patients. (12) There are no facilities for making either photographic or radiographic records of patients. In this connection it is advisable to bear in mind that the type of case treated is, as a rule, not severe, because the cases are supplied from the municipal clinics and are mostly cases of debility, often of a 105 vague kind, sometimes cases in which on account of the family history or for some other reason Tuberculosis is feared. Cases with readily diagnosable and definite diseases are infrequent. In fact the centre may justly be considered as a preventive rather than a curative institution. For this reason radiographic and photographic records of patients, although very interesting, are not likely to show great changes as a result of treatment, except perhaps in a very few instances. If it is desired that they should be made considerable additional accommodation and personnel will be required. (13), (14), (15) and (16) Six and a half weeks is a very short time in which to get many definite results from the action of artificial sunlight, especially as during the first two or three weeks not many patients had been submitted, but it is gratifying to be able to state that most of the patients showed some signs of improvement. Perhaps the most striking case up to the present has been that of a boy of 12 years old, who had suffered for many years with asthma and had a severe attack almost every night of his life ; after the first treatment the attacks ceased altogether for three weeks, they then began again, but were neither so severe nor so frequent. Subsequently they diminished rapidly, both in intensity and frequency, and now (January 27th) he has been totally free for over three weeks. It is probable that the sudden cessation of the attacks after the first treatment was largely due to the influence of suggestion, but that the gradual but striking amelioration which has since taken place may be justifiably ascribed to the artificial sunlight. Another striking case was one of severe alopecia areata. This case, in a boy suffering from heart disease, had resisted ordinary treatment for several months, but after six weeks of artificial sunlight all the numerous bald areas were well covered with strong new hair. The points to which attention has been directed in estimating the progress of the patients have been (1) gain in weight, (2) improvement of appetite, (3) improvement of temper and liveliness. (1) As regard gain in weight, this has not been very striking, many cases lose weight during the first three weeks, but afterwards they pick it up again. There are, however, some cases of babies which have been referred to the department principally because, although healthy in other ways, refused to gain weight, which immediately began to put on weight. (2) As regards appetite, the loss of which is an extremely common symptom in delicate children, the effect of the sunlight was very striking, and (3) as regards temper and fretfulness, the reports of the mothers of puny babies have been most gratifying and their testimony is amply confirmed by our observation of the little patients' behaviour after their first few attendances at the department. In almost every case they seem quite to enjoy themselves, and although they make a good deal of noise, there is no crying amongst them. As regards the question of pigmentation of the skin, I am unable to correlate this phenomenon with the improvement of the patient, but, it must be added, that the conditions of the department make it very difficult to estimate the degree of pigmentation accurately, as the work is done in the basement where real sunlight seldom penetrates, and it is impossible to judge slight degrees of pigmentation by the artificial variety. (17) The average cost of current per hour is approximately 9.36d. (18) As none of the treatments were actually completed within the period under review it is not possible to give the average cost of each patient's treatment. APPENDIX N. HEALTH VISITING. by Bessie R. Mackenzie, M.B., Ch.B., D.P.H. Development of Health Visiting. The first Health Visitor was appointed by the Willesden Urban District Council in December, 1903. Six months later a second appointment was made, and in 1905 a third Health Visitor was added to the Staff. During these years the work of the Health Visitors consisted chiefly in the home visitation of all notifiable and non-notifiable infectious diseases ; contagious diseases, e.g., scabies and impetigo and verminous conditions reported from the Public Elementary Schools ; home visitation of all registered births (one visit only unless the child was ailing or neglected) ; inquiries into all infant deaths ; and the inspection of laundries, workshops and workplaces where women were employed, and of the homes of women outworkers. In 1909 School Medical Inspections were instituted, and two other Health Visitors were appointed to cope with the work. 1917 found the Health Visiting Staff still further increased and the scope of work under the Maternity and Child Welfare Scheme was then extended to include the home visitation and supervision of the expectant and nursing mother and the child right up to the age of 5 years. It will be seen from this short survey that Health Visiting has gradually come to be a very important branch of the Public Health Service. There are at the present time 20 District Health Visitors in Willesden. 106 Work of the Health Visitors. The work undertaken by the Health Visiting Staff is very varied, but may with advantage be described under three headings :— (i.) Maternity and Child Welfare. (ii.) School Medical Service. (iii.) Infectious Diseases. For purposes of visiting Willesden is divided into districts each containing as far as possible an equal amount of work. Each Health Visitor has charge of a district with an approximate population of 8,558, and it is usual for her to have about 1,000 cases under observation at any one time. In her district she acts as Health Visitor and School Nurse, and is responsible for the family, whether it be for an infectious disease, a school child, a mother or a baby. This arrangement minimises the time spent in travelling and, what is always desirable, reduces official visits to the home to a minimum. Her duties may be described in more detail as follows :— A. Maternity and Child Welfare Service. (1) Expectant Mothers.—Expectant Mothers whom the Health Visitors come to know of are visited in their homes and advised regarding the general hygiene and management of pregnancy, including the special care of the teeth. They are advised to seek ante-natal care from their own medical man or at one of the ante-natal clinics. The Health Visitor must also be in a position to explain to the patient, if desired, what arrangements are made by the Council for confinement cases , viz., Hospital Provision or Home Provision (including midwife and home help). (2) Children under 5 years.—Notified births are visited on the 11th day, when, presumably, the doctor or midwife has finished with the case. If the child is healthy and the parents raise no objection a visit every 3 months is paid during the first year, a visit every 6 months during the second year and a visit every 12 months from the second to the fifth year. If the child is ailing the visits are paid as often as may be necessary or possible. Advice is given to the mother on the feeding of the baby. The importance of breast feeding is explained and encouraged wherever possible. Where the child has to be artificially fed advice is given on the necessity for cleanly utensils, suitable storage of milk and precautions necessary for the prevention of summer diarrhoea which takes such a toll of infant life. Suitable clothing for the child and the necessity for fresh air and open windows are subjects which receive attention during these visits. (3) The Nursing Mother.—In addition to the supervision of the baby the Health Visitor gives attention to the mother herself. She advises regarding the care of the breasts, teeth and general hygiene, and gives helpful advice regarding the weaning of the child at the necessary time. (4) Still Births and Deaths of Children under 5 Years.—Special visits and inquiries are made into these cases to ascertain if possible whether the condition was preventible, and thus to throw more light on what further steps may be taken to reduce infantile mortality. B. School Medical Service. (1) Medical Inspections.—Some days before a medical inspection the Health Visitor pays a preliminary visit to the school during which she weighs and measures the children due for examination, inspects their scalps, body and clothing for cleanliness, and tests their vision. On the day of the inspection she attends with the doctor and prepares the children for his inspection. (2) " Following-up " in the Homes.—All defects found at Medical or Dental Inspections are communicated to the parents, and it is the Health Visitors' duty to follow up these cases later and ascertain if the necessary treatment has been obtained. If nothing has been done she again explains the necessity to the parent and advises how they may best set about getting the condition attended to. (3) Cleanliness Inspections.—As far as possible the Health Visitor carries out a cleanliness inspection weekly at each school and brings to the attention of the parent any abnormal condition which may be found. (4) Cases Specially Referred by the Head Teacher.—The Health Visitor also endeavours to visit every department of her school once a week so that the Head Teacher may have an opportunity of bringing to her notice any child she thinks requires medical attention. (5) Attendance at Court.—From time to time Health Visitors are required to attend the Court with reference to verminous cases prosecuted under Section 87 of the Education Act, 1921. C. Infectious Diseases. (1) Investigation into the Source of an Infectious Disease.—Infectious Diseases are classified as Notifiable {e.g., Scarlet Fever, Diphtheria, Typhoid, etc.) and Non-notifiable (e.g., Mumps, Measles, Chicken Pox, etc.). The former are notified to the Medical Officer of Health by a medical practitioner, the latter come to the knowledge of the Health Department usually through the School Teacher, Attendance Officer or Parent. In either case, on receipt of such a notification the Health Visitor visits the home and makes certain inquiries which deal chiefly with the history of the disease and the possible source of infection. (2) Prevention of Spread of Disease.—Where necessary the Health Visitor makes arrangements for the patient to be removed to Hospital and gives instructions about disinfection. The sanitary conditions and overcrowding or otherwise in the house are important matters for her supervision. Contacts must be isolated, and if these are school children the Health Visitor must arrange for their exclusion and re-admission to schoool, as the case demands. When a patient suffering from an infectious disease is being nursed at home the Health Visitor must see that suitable isolation is maintained and at the end of the period of infection must make arrangements for disinfection. 107 In addition to the above duties the Health Visitor is at the call of any resident in her district who wishes to obtain her advice on matters appertaining to health. The Health Visitor reports daily to the Medical Officer in charge of her district. Qualifications of Health Visitors. The Willesden Urban District Council require their Health Visitors to be :— (a) Fully trained General Nurses. (b) Certified Midwives. (c) Certified Sanitary Inspectors or Health Visitors. In addition to the above qualifications certain characteristics are necessary in the good Health Visitor. Her mission is not an easy one, and it must be remembered that she has no right of entry, but approaches the home as a " visitor " in the literal sense of the word. Plenty of tact and a pleasing manner and address are therefore essential if she would gain the goodwill and confidence of her people. Some sense of humour in conjunction with a thorough knowledge of her work and plenty of common sense go far to make the successful Health Visitor. Rationale of Health Visiting. This may conveniently be discussed under the same headings as the scope of work. A. Maternity and Child Welfare. The chief objects of Health Visiting under this heading are :— (1) The reduction of Maternal Mortality. (2) The reduction of Chronic Disabilities in the mother following childbirth. (3) The reduction of Infant Mortality. (4) The Supervision of the Pre-School Child and the setting out in life of an A1 citizen. Unfortunately, there are still every year a large number of women who lose their lives in childbirth and, on the examination of statistics, it would appear that many of these could have been saved if only efficient ante-natal care had been given. The public are gradually becoming educated regarding the need for ante-natal supervision, but there are still many mothers who through ignorance or press of domestic duties do not seek advice until labour has actually commenced or some complication has arisen. It is with this latter class that the Health Visitor may use her influence. Being as she is a certified midwife, she is able on her visits to note from the patient's statements and symptoms any danger signals and urge her to obtain medical advice before it is too late. In the same way the Health Visitor may prevent much chronic disability and invalidism in the nursing mother by explaining to her the importance of getting suitable treatment for any injuries received at the time of the confinement. The reduction of Infant Mortality has been receiving great public attention for some years past, and from the following figures for Willesden I think one is justified in attributing the reduction in great part to the work of the Health Visitors :— 1902—130 deaths per 1,000 births occurred. (The year before the appointment of first Health Visitor.) 1922— 59 1923— 53 ,, „ ,, 1924— 73 1925— 62 Artificially fed children are found to be more prone to disease than those who receive the natural breast milk, therefore the Health Visitor's aim must be to encourage wherever possible breast feeding. With the advance of civilization and the hurry of modern life the tendency is gradually towards the use of patent foods and dried milks, but the following figures would suggest that the work of the Health Visitors is bearing some fruit in this direction also :— Children, under the observation of the Health Visitors, who were:— A. Entirely breast fed for 9 months. B. Solely hand fed from birth. During 1920—15 per cent. During 1920—6 per cent. 1921—17 „ „ 1921—7 1922—22 „ „ 1922—5 1923—22 „ „ 1923—7 1924—19 „ „ 1924—4 1925—19 „ „ 1925—4 The period from 2—5 years in the life of the child is not under such constant supervision as the first year and during this time many ailments occur which are not discovered until the child comes under observation again at school medical inspection at the age of 5 years, e.g., discharging ears, enlarged tonsils and adenoids, neglected rickets, etc. A large number of mothers now bring their babies to the infant welfare centres pretty constantly during the first 12-18 months, but after that the attendances drop off, and it then falls to the lot of the Health Visitor to keep these " Toddlers " under supervision in their homes. 108 B. School Medical Service. The chief objects of Health Visiting under this heading are :— (1) To aid in the work of School Medical Inspection by " following-up " cases found to be defective by the School Medical Officer. (2) To prevent the spread of infection in the schools. (3) To maintain a high standard of cleanliness in the schools and instil a knowledge of hygiene and healthful living into the coming generation. Since Routine Medical Inspections were instituted statistics have shown a considerable improvement in the health of the school child, but these inspections can only be of benefit if the defects found are subsequently treated. The " following-up " therefore of the Health Visitor is a very important part of this work, and by tact and perseverence she may do much towards getting these defects attended to by the parent. The prevention of the spread of infectious disease in the schools is always something of a problem. It is now generally accepted that nothing is gained by the wholesale closure of schools in time of epidemics, but much more good may be done by the constant supervision of scholars in the classes affected and the early exclusion of those showing premonitory signs of the disease. This supervision can best be carried out by the Health Visitor on her visits to the schools. Since the Health Visitor included cleanliness inspections in the scope of her school work the standard of cleanliness in the schools has improved very markedly. In 1914 the percentage of scholars in the Willesden Council Schools found to have unclean heads was 20 per cent., in 1924 it was 7 per cent., and in 1925 6 per cent. C. Infectious Diseases. The chief objects of Health Visiting under this heading are :— (1) Investigation into Source of Disease. (2) Prevention of Spread. (3) Diminution of the Severity of the attack and the prevention of complications in home nursed cases. Much help is given to the Medical Officer by the Health Visitor in investigating the source of an infectious disease. By suitable inquiries and inspection of the home she may be able to trace the source of the infection, e.g., to a milk supply, defective sanitary arrangements, a possible " carrier," etc. By her supervision of isolation in home nursed cases, her dealings with contacts, and arrangements for disinfection she aids in the prevention of the spread of infection. Most infectious diseases are liable to be followed by complications, many of which may be fatal or produce chronic disability or invalidism. The complications following Measles and Whooping Cough, in particular, are responsible for a large percentage of infant deaths, and it is in these cases, which are generally treated at home, that the Health Visitor may do much to prevent complications by her supervision of the isolation and general hygiene and by explaining the necessity for medical advice in severe cases. Speaking generally the Health Visitor is our chief method of Health Propaganda. She carries advice on health and hygiene actually into the home, and affecting, as it does for the time being, some particular member of the family, her words carry far more weight that any newspaper article, lecture or film could hope to do. APPENDIX 0. CANCER. by W. D. Champneys, M.A., B.M., B.Ch., D.P.H. (Oxon.), M.R.C.P. Introduction. In the following memorandum I have attempted to discuss briefly this extremely difficult, but most important, subject in the light of our present knowledge, and to indicate what methods of attack have been employed elsewhere in the fight against this dread disease and what methods might be employed in Willesden. With such an aim in view it has seemed to me most important to avoid making any assertions which do not rest on a firm basis of ascertained facts. I have, however, thought it of use to refer briefly to certain recent attempts to elucidate the nature and cause of Cancer which, though far from resting at present on the firm foundation referred to above, have excited a good deal of attention on the part of both the scientific and the lay public. 1. The Nature of Cancer.—The morbid conditions to which the term " Cancer " is applied differ very widely among themselves in many of their characters, but they all possess in common certain features which justify their inclusion in one category. These common features may be summarised as follows :— 109 (i.) They are manifestations of disordered overgrowth of some tissue of the body. In the development of the body " we are aware of a delicate but effective power which controls, possibly by way of the nervous system, the relations of tissues to one another " (W. G. McCallum) ; such a mechanism is not operative in the case of tumours. The cells composing tumours have no regular architectural arrangement, they never form organs that could be of any possible use, they pay no regard to the rights of other organs, but burst their way recklessly through their boundaries and their tissues, destroying their cells as they go. No tumour of glandular character has a duct nor are its glands arranged in a such a way that it could discharge a secretion. No tumours are known to be under the control of the nervous system, the only nerves they possess appearing to be accidental inclusions. Nor are they subject to the normal conditions of nutrition, withstanding in an astonishing manner starvation which produces wasting in the rest of the body. (ii.) The cancer cells grow at the expense of the organism in which they serve no useful purpose. (iii.) The growths are at first local. In many cases, as I shall point out later, it is apparently some local factor, such as chronic irritation, which determines the appearance of Cancer. Moreover, it is just this local character of Cancer in its early stages which in many cases gives us some hope of success in treatment, if the disease can be diagnosed early enough. (iv.) The growths are not encapsuled. Herein, as we shall see, lies the greatest difficulty in the eradication of the disease. Cancerous growths scatter their isolated cells like spray in every direction, or send out long threads of cells which insinuate themselves between the cells and fibres of the tissues and even into the walls of the blood vessels and lymphatics. This method of spread, and the fact that it is not possible with the means now at our disposal to distinguish with certainty a cancer cell from a normal one are the reasons why it is a practical impossibility to determine in the living patient, even at operation, the complete dispositions of the invading army whose far-flung outposts are so cunningly hidden. Therefore— (v.) Cancerous growths progressively invade the deeper parts. (vi.) They readily undergo degeneration. (vii.) They tend to become disseminated to distant parts of the body. (viii.) They lead sooner or later to the death of the individual in the vast majority of cases (hence the epithet " malignant " applied to all cancerous growths). This " malignant " character of cancerous growths has been shewn by experimental work to be inherent in the cancer cells themselves, which alone survive transference to a new host. The rate of growth of cancer cells is very variable, and though in some forms it is extremely rapid, even in the most rapidly invading forms the rate of growth is not to be compared with that of the growing embryo. Nevertheless some investigators regard malignant growth as a reversion to the habits of those primitive cells which, in their search for nourishment for the growing embryo, eat their way into the maternal tissues and eventually open up the blood channels. 2. Its Distribution.—Cancer was formerly believed to be confined to the human race and to the higher or so-called civilised races. Savages and other primitive races were thought to be exempt. But extended study of the geographical and ethnological distribution of the disease tends more and more to shew that no country, no district, no race, no nation can be considered as possessing immunity from Cancer. Moreover it has been established beyond dispute that animals also suffer from this disease, and not only those which come into frequent contact with man, but also purely wild animals, and even deep sea fishes. The fact that in man Cancer is more liable to occur in old subjects than in the young and that among animals few are allowed to attain old age may account, in part at least, for the comparative rarity of Cancer among the latter. As regards the sex distribution of Cancer in mankind there is a considerable excess of deaths of females over those of males. But it is important to note that this excess is entirely due to malignant disease of the breast and generative organs ; in most other parts of the body a considerable excess is recorded for males. 3. Its Cause.—There is no space here to describe all the numerous theories, plausible or fantastic, which have been formulated to account for this peculiar and mysterious disease or group of diseases. Though much valuable light has been thrown on the subject by recent researches one can still assert, with confidence, that the true cause of Cancer remains undiscovered. It is, however, of great importance that attention should be drawn to the following :— (i.) Hereditary predisposition to Cancer in man has not been proved. (ii.) There is no sound scientific evidence of the action of any particular article of food in predisposing to or preventing the occurrence of Cancer. (iii.) No known drug can prevent or cure Cancer. (iv.) No scientific proof has been produced of danger from so-called " cancer houses " and " cancer districts " in which the disease happens to have been unusually prevalent. (v.) There is weighty scientific evidence against the supposition that Cancer is an infectious or contagious disease. The importance of chronic and prolonged irritation as a predisposing or determining factor in Cancer has been established by modern experimental research, and this fact is of great practical importance. But this factor alone is insufficient to determine the onset of the disease. The palm of the hand, though constantly exposed to irritation of all kinds, has only once been recorded as the seat of Cancer. Other tissues, however, shew a special tendency to develop Cancer, e.g., the tongue, lips, skin of the face, inside of the cheeks, the lower part of the bowel and the neck of the womb. 110 Syphilitic disease of the tongue or female external generative organs and tuberculosis of the skin (lupus) are liable to end in Cancer. Workers in tar, aniline or paraffin, chimney sweeps and mule spinners are apt to suffer from Cancer in special parts as a consequence of repeated irritation by the particular agent concerned. Two recently expressed views of the nature of Cancer require, perhaps, special mention. (i.) Gye and Barnard's Theory.—These workers, as the result of experiments with certain special varieties of malignant growths in animals, have come to the conclusion that there are two factors invariably concerned in the production of Cancer, viz., (a) a filter passing virus widely distributed in animals and man and not peculiar to any species, and (b) a chemical substance peculiar to each species and to each variety of cancerous growth, the nature of the malignant growth being determined entirely by the nature of this substance. In their view neither the non-specific virus nor the specific chemical substance is capable by itself of causing the formation of a malignant growth, which depends on the concurrent action of these two factors. Barnard, moreover, claims to have demonstrated the Cancer virus microscopically with the aid of light of very short wave-length. There are at present certain grave difficulties in the way of accepting the results of these workers, and much independent work will be necessary before their theory can be finally accepted or rejected. (ii.) Blair Bell's Conception.—Another recently formulated conception of Cancer is that of Professor Blair Bell and his co-workers at Liverpool. These investigators consider that research can be more profitably directed to the investigation of the true nature of the cancerous process than to the search for a specific cause. They regard malignant growth as a " reversion to the nourishmentproviding proclivities normally possessed in a special degree by the chorionic epithelium " (i.e., those cells which serve to attach the developing embryo to the wall of the womb). In accordance with this conception the " predisposing causes " or " exciting factors " of malignant development are those agencies which produce an " unhealthy " condition of the cells, i.e., permanent injury to the cells without their death, the formation of a new growth which is innocent or malignant being determined by the condition of the cells on -which the common factors are acting. Much interesting chemical and biological work has been done by this group which they believe affords valuable confirmation of their views, and it was by deduction from the above premises that they were led to the discovery of a new treatment for Cancer which has met with some success in specially selected cases. Nevertheless experience has repeatedly shewn that such success cannot be regarded in itself as a proof on the correctness of their views, which can only be regarded by the scientific world, as indeed they are regarded by these workers themselves, as constituting a working hypothesis. 4. Cancer Mortality.—In considering this aspect of the subject the important questions from a Public Health point of view are the following :— (i.) Is the death rate from Cancer really increasing, and if so, is this increase confined to any particular country or part of the world ? (ii.) At what ages does the increase occur ? (iii.) What parts of the body are most concerned in this increase. (1) The death rate per 1,000 of the population for England and Wales has gradually increased from 0.32for 1851-60 to l.12for 1911-20, 1.21 for 1921 and 1.29 for 1924. Even when full allowance has been made for the increased proportion of the population that is now in those ages at which Cancer commonly occurs it is still clear that the recorded mortality has trebled in the space of two generations. " During the period of 20 years from 1901 to 1921, in which Cancer increased by 20 per cent., the general death rate fell by 32 per cent., that of infants by 45 per cent., and that from Tuberculosis by 38 per cent., while substantial declines were recorded in respect of most other causes of mortality." (Memo, of Departmental Commission on Cancer.) The question as to whether this increase is a real one has been long and hotly debated. It has been argued that improvements in diagnosis and more accurate certification were sufficient to account for the apparent increase; but it is now generally admitted that these factors, though undoubtedly contributory, cannot account for the whole of the recorded increase. Taking as an instance Cancer of the tongue, in males we find an increase from 38 per million living in 1901 to 53 in 1921. Again, in the case of Cancer of the female breast, the figures shew an increase from 148 per million living in 1901 to 190 in 1921. This increase in Cancer mortality is not by any means confined to our own country, but is seen, wherever statistics are available, to apply to all countries and races. (2) As regards the age periods at which this increase occurs the latest available returns shew that the death rate from Cancer is not increasing for males up to 45 years of age or for females up to 60. The most rapid increase is in extreme old age. (3) Lastly, the Registrar General's returns bring out the fact that the increase of deaths attributed to Cancer is referable to certain anatomical regions and not to others. Thus for males the main increase falls on the alimentary tract, especially the stomach. The liver and gall bladder and the skin shew no, or only a slight, increase. For females the increase, although it falls mainly on the alimentary tract (stomach and intestines) affects also the breast, while the womb, ovary, liver and gall bladder, rectum and skin shew little or no increase. Moreover the incidence is very unequally distributed among the different situations, the whole curve of incidence being often quite different for different organs. A progressive increase up to the highest age periods is characteristic of the face, lip, mouth, bladder, urethra and breast only. The other organs shew a distinct diminution in the highest age periods. Ill Cancer Mortality in Willesden.—The Cancer mortality figures for Willesden residents (set out in the tables below) shew the same tendency as those for the whole of England and Wales. Table 1.—Mortality per Million Persons Living Year. England and Wales. Willesden. *1911 992 675 *1921 1,215 1,099 1924 1,297 1,250 1925 (Not yet available) 1,402 * Census years. Table 2.—Willesden Residents—Cancer Deaths. Years. All Ages Classified as to Ages. 0-1 1-2 2-5 5-15 15-25 25-45 45-65 65 and over 1914 155 — — — 1 — 14 85 55 1915 169 — — 1 — . 2 20 82 64 1916 174 — — 1 1 — 19 81 72 1917 160 — 1 — — — 19 79 61 1918 171 — — — — 2 18 88 63 Classified as to Ages. 0-1 1-5 5-10 10-15 15-20 20-25 25-35 35-45 45-55 55-65 65-75 75-85 85 and over 1919 172 — — — — 1 — 7 18 43 51 34 16 2 1920 176 — — — 1 — — 4 17 38 45 47 21 3 1921 183 — — — 1 — 5 13 45 48 49 19 3 1922 170 — — — — 1 1 6 19 28 51 39 23 2 1923 199 — — — — 1 1 — 18 47 56 52 21 3 1924 214 1 — — — — — 1 15 36 62 65 28 6 1925 241 — 2 -— — 1 3 8 14 46 73 61 30 3 5. Prevention.—In the absence of any certain knowledge of the cause of Cancer, we are faced with a whole host of supposed pre-disposing factors against which we are called upon to be on our guard. Many, however, of these supposed factors are beyond our control, and in confining our attention to the few which seem to have established some claim to our consideration, we may be reassured by the statement of G. W. Crile that there is " scarcely an instance of a complete account of a case of visible Cancer that does not give a clear pre-cancerous history—a history of chronic irritation, ulcer, scar, hyperplasia, innocent tumour, or a combination of these factors." The factors of proved importance may be considered under the following headings :— (1) Pre-cancerous conditions. (2) Local manifestations of other diseases, e.g., syphilis. (3) Sources of chronic inflamation and irritation. (1) Pre-cancerous conditions.—It is now more than thirty years since Keen first asserted that pigmented moles may, under certain circumstances, develop into Cancer, an assertion which has been abundantly confirmed by many surgeons since then. The list of conditions accused on more or less substantial evidence of being pre-cancerous is very large, and includes such varied phenomena as elevated angioma, X-ray dermatitis, rodent ulcer, adenoma, lymphangioma, tuberosum multiplex, etc. (2) Local Manifestations of Other Diseases.—The chief conditions of this kind which have been associated by various observers with Cancer are lupus (tuberculosis of the skin), leukoplakia (of the tongue), syphilis and psoriasis. It is an undoubted fact, at any rate, that Cancer is not infrequently superimposed upon local manifestations of other diseases, upon the tissue subjected to chronic irritating discharges or upon the scar tissue resulting from such local lesions. (3) Sources of Chronic Inflammation and Irritations.—I have emphasised the very great importance of this factor when discussing the causation of Cancer. Many different kinds of irritants may aid in the production of a malignant tumour, chemical, mechanical, actinic or bacterial. There are very few portions of the body which are exempt from one or other of the various forms of irritation. 112 Preventive Measures.—Having reviewed the various conditions that predispose to malignant growth formation, we are now in a position to consider what methods may be adopted to avoid the onset of the disease. It will be clear that the effective prevention of the disease depends upon the cooperation of the patient and the doctor, both of whom must be instructed in their own part. Here we are at once met by the difficulty that the patient cannot be expected to recognise in himself all the various conditions that call for prophylactic measures, many of these Conditions being difficult or even impossible of detection by the trained observer. Consequently in practice a method must be adopted whereby the patient is brought at frequent intervals under the observation of the doctor. The only method by which this could be accomplished would be for everyone to submit themselves to periodic systematic examinations by a doctor, who would then be in a position to recommend such treatment as might be indicated for any possible predisposing condition found by him. Certain large insurance companies in the United States have made an annual medical inspection one of the conditions on which their life policies are granted. I am afraid, however, that at present the British public, as a whole, are far from being educated to the point of accepting such a suggestion. We should not for this reason be deterred from making this our aim and taking every opportunity of pointing out the advantages of such a scheme. After all a considerable portion of the public have by now realised the importance of submitting to a yearly or even half-yearly dental examination as a prophylactic measure. In the meanwhile much may be done by the physician keeping the possibility of Cancer pre-disposition constantly in his mind, whatever may be the complaint for which he has been consulted. In this connection the importance of the very careful supervision of labour and the injuries that may occur during this process can hardly be over emphasised. At the same time the public should be informed of the possible danger of such conditions as jagged teeth or ill-fitting plates, sore lips or tongue from smoking, chronic constipation, etc. As I have indicated in discussing the cause of Cancer, various special precautions must be taken by those pursuing certain occupations, such as chimney sweeping, mule-spinning, tar, aniline or paraffin working, etc. 6. Diagnosis.—We must recognise at the outset that the certain diagnosis of Cancer, at any rate in its operable stage, is often impossible, yet as will be shewn when discussing treatment, early diagnosis is of the very greatest importance. It is clear, therefore, that in the interests of the patient the medical adviser should err on the side of safety. For as Rodman says in writing of Cancer of the breast, " it is better to take away a breast unnecessarily than that the patient should die a hopeless death." Now early diagnosis implies not only the diagnosis of actual Cancer, but even more important, the diagnosis of predisposing conditions. This, as pointed out above, depends upon the co-operation of doctor and patient. It is not sufficient for this purpose that the public should be instructed in the danger signals of this disease, they must also be advised and encouraged, if uneasy as to their condition, to consult a properly qualified medical practitioner. The danger to the Cancer patient from charlatans was forcibly expressed by Sir Charles Bell in 1823, who wrote, " By much the larger portion of patients received into the Cancer Ward of the Middlesex Hospital have spent their last penny, and, what is worse, they have lost that precious time in which they might have been cured in attendance on a set of the most unfeeling wretches that ever disgraced a country." Now there is one dread character of Cancer which militates more than anything else against early diagnosis on which so much depends. This character is its almost constant painlessness in its early stages, and sometimes throughout its course. This most insidious danger is responsible for the death of a very large proportion of those patients who seek medical advice too late to be cured. The painlessness of Cancer is one of the facts about this disease which should be brought to the attention of the public, who should be urged to seek medical advice for any of the following conditions (i.) A lump in the breast or an abnormal and persistent swelling anywhere in the body. (ii.) An ulcerated condition of the lip, tongue, cheek, gums or skin which persists for more than a few days. (iii.) A mole or wart shewing a tendency to grow. (iv.) Blood or mucus passed in the stools. (v.) A bloody or offensive discharge at other times than the normal monthly periods, especially at or after the change of life. (vi.) Persistent hoarseness. (vii.) Chronic indigestion or constipation with loss of weight and general weakness. Such conditions call for treatment in any case, and only after careful and skilled examination can decide whether they are actually associated with Cancer or are only liable to become cancerous. 7. Treatment. (i.) Surgical.—In studying the literature of Cancer one is met everywhere by the complaint of the surgeons that patients come to them too late for effective treatment, and one cannot help being surprised at the number of cases in which the patients were relatives of doctors, and yet appeared in an almost inoperable condition. This frequent delay in seeking medical advice is partly to be accounted for by the failure of patients to realise the seriousness of a painless condition, partly by their fear that the condition may be Cancer and that an operation will be necessary. In the case of a disease with such an insidious mode of growth and with such indefinite limits in the tissues, no surgeon would feel justified in guaranteeing a permanent cure from operation, however early, but the extremely hopeful results of early operation in most forms of Cancer are not sufficiently riealised by the general public. 113 Let me take, as an instance, Cancer of the Breast. Dr. Janet Lane-Claypon, in a brilliant and careful analysis of the literature of about 20,000 cases, arrives at the following conclusion with regard to the results of early treatment: " We do not think there is any exaggeration in the statement that if by dint of increased dissemination of knowledge and greater facilities for surgical treatment, women suffering from Cancer of the breast could be brought to receive the best available treatment of the present time, the average number of years of life lived by those who now die without treatment would be increased by almost ten years." In many cases, of course, the removal of a cancerous growth by operation has resulted in a complete and permanent cure, the patient dying years afterwards from an entirely different cause. The importance of early operation cannot be too strongly emphasised. As Dr. Lane-Claypon says : " The stage of the disease at operation is seen to exercise an influence fully as great as and, sometimes, greater than the variety of Cancer." This statement applies not only to Cancer of the breast, but to all Cancer in an operable situation in the body. Though our aim in every case should be the diagnosis and removal of a malignant growth in its earliest possible stage, yet we must admit that t will be a long time before we approach such an ideal. In the meanwhile surgical treatment can make it possible for many people to live a natural life in comfort for a number of years and, in advanced cases, much may be done to prevent and relieve prolonged suffering. (ii.) Lead.—A new treatment for Cancer, which appears to give some hope of cure in certain selected cases, has recently been described by Professor Blair Bell and his colleagues at Liverpool. This treatment depends upon the selective lethal action found to be exercised by lead on the cells of malignant growths. The lead is administered in a very finely divided form (collosol) by injection into a vein and has been shewn to cause the death and coagulation or even liquefaction of the cells of malignant growths. Of the 200 cases which had been treated up to the time of Professor Blair Bell's announcement 50 or so were believed to be still alive and well. Such results are very encouraging, but it is obvious from the very nature of the changes produced that the treatment is very limited in its scope. Cases can, in fact, only be considered suitable for lead treatment when no " vital " organ or structure is believed to be involved in the malignant change, and even then the risk of an inaccurate diagnosis is clearly far from negligible. (iii.) Radiation.—A word must be said here about the present position of radiation (radium or X-rays) in the treatment of Cancer. Cancer of certain varieties and in certain situations can be treated quite as successfully, and with far less inconvenience and risk to the patient, by radiation as by surgery. But in the majority of cases surgical removal with or without radiation gives the only hope of permanent cure. The attitude of investigators towards radiotherapy is now very different from what it was a few years ago. Our ideas as to the mode of action of the rays and consequently the objects with which we apply them are now radically changed. At first the rays were regarded in the light of a caustic, but as such they were found to be inferior to many already in use. Later the varying radiosensibility of cells was recognised and a selective destruction of Cancer cells was aimed at, an unattainable goal with the comparatively crude methods in use. Lastly many radiologists have come to regard radiation as a means of so altering the Cancer cells that they may, by acting on the patient's normal tissues, evoke an immunity reaction by the production of a substance or substances inimical to themselves. According to this conception the course of every case of Cancer depends upon the degree to which these substances are formed. Unfortunately this formation of cancer-destroying substance is almost always inadequate, but there is some hope that in the future by the more skilful use of radiation such a production of antagonistic substances may be evoked as shall be sufficient to hold in check and ultimately to destroy the Cancer cells. 8. What Public Authorities Have Done.—It would be out of place in this short memorandum to give a review of the measures taken for the Control of Cancer in the different countries of the world. But before describing what has been done in this country I think it will be useful to refer briefly to some of the work done in the United States of America. The moving force in Cancer prevention in that country has been the American Society for the Control of Cancer. The activities of this influential and representative organisation include (1) Education, by means of lectures, newspaper and magazine articles, moving pictures, radio talks, posters, circulars, handbooks, a periodical and private correspondence ; (2) Special Campaigns, such as National Cancer Weeks ; (3) Cancer Clinics, which are of two kinds, (i.) Temporary Clinics, formed for educational purposes in connection with one of the Society's campaigns, or (ii.) Permanent Clinics, the object of which is to secure prompt and efficient diagnosis and treatment for those persons who cannot afford to pay the fees which able Cancer specialists usually receive ; (4) Statistical and Other Researches. The report of the Pennsylvania Cancer Commission, issued in 1924, attributes considerable success to the efforts of the Society in that State during the thirteen years, from 1910-1923. This success was shewn by:— (i.) Patients going to doctors in increasing numbers. (ii.) Patients applying to doctors at an earlier stage of the disease. (iii.) An increasing desire for sound information. The same report states that, comparing the years 1910 and 1923 the average time between th2 discovery of the first symptoms in superficial Cancer and the first call on the doctor has been reduced from 18 months to 14.6 months, or 20 per cent., while in cases of deep-seated Cancer the interval has been reduced by nearly one half. 114 I come now to what has been done in England and Wales. The Ministry of Health issued in July, 1923, a Memorandum on Cancer prepared by its Departmental Committee on Cancer, in which it was suggested that Local Public Health Authorities might periodically consider such questions as the following :— (1) Improving the local facilities for clinical consultations and for pathological examinations. (2) Improving the local facilities for Cancer treatment (operative or provision of X-ray and radium apparatus) and of considering the adequacy of arrangements for this purpose at hospitals, local institutions, etc., which serve the area. (3) Improving the facilities for transport of patients. (4) Arranging locally for post-graduate demonstrations, lectures or courses on Cancer for medical men practising in the area. (5) Arranging locally for the education of the public. Moreover, in the Memorandum and in three others issued subsequently by the Ministry a concise and non-technical summary was given of our present knowledge as to the nature and incidence of Cancer, the effects of radium and X-rays, the results of surgical operation in cases of Cancer of the Breast and lastly a survey was given of the ground broken by experimental Cancer research at that date (July, 1924). It has been my object in the first part of this memorandum to amplify this summary and bring it up to date, without detracting from its value by the introduction of any contentious matter. The Departmental Committee has since its formation initiated an interesting and valuable investigation into the statistics of Cancer of the Breast. This investigation has been confined to certain large towns where, in the opinion of the Committee, special facilities existed for conducting such an investigation, and valuable information has already been obtained which is now serving as a guide to further researches. On reviewing now the measures taken for the control of Cancer by Local Health Authorities, it will at once be seen that though much work of great value has been accomplished, only a small part of the field outlined in the Ministry's first memorandum on Cancer has been covered, and that an enterprising Local Authority still has an unique opportunity of breaking new and valuable ground. (1) Cancer Committees and Research.—Such Committees have been formed in response to the suggestion of the Ministry in the following towns: Manchester, Leeds, Bradford, Leicester, Sheffield, Birmingham, Nottingham, Bristol and Cardiff. In most cases these bodies appear to be of the nature of Advisory Sub-Committees convened by the Health Committee of the Local Authority and consisting almost entirely of local medical men representing the hospitals and other medical institutions of the city. The special investigation into the statistics of Cancer of the Breast being now carried out by some of these Committees has been referred to above. Liverpool and Newcastle-upon-Tyne, though having no Cancer Committee, are also co-operating in this investigation. At Leeds, moreover, an additional investigation into Cancer of the Female Generative Organs is also being carried out, and a special Medical Officer, whose salary is being paid by the Health Committee of the Town Council, has been put in charge of these two investigations. At Manchester, an After-Care, Follow-up and Treatment Sub-Committee has been appointed to undertake (i.) the continuous supervision of each case of Cancer in the city, (ii.) the provision of suitable treatment without delay for any recurrence of growth, (iii.) the establishment of a regular and complete system of record-keeping of Cancer cases in all the city hospitals and in private practice, (iv.) microscopic examination of specimens from each case, etc. A special Medical Officer is being appointed to carry on this work. At Cardiff a system of voluntary notification of cases of Cancer with the usual fee attached is in operation with the object of obtaining more complete data. (2) Facilities for Treatment.—As far as I can ascertain, the only real effort in this direction made by Local Authorities has been at Bradford, where an apparatus for Deep X-ray treatment for Cancer has lately been installed in the Municipal General Hospital. (3) Direct Cancer Propaganda.—The pioneer effort in this direction (so far as this country is concerned) was made at Portsmouth as long ago as January, 1914, when a leaflet drawn up by the Medical Officer, Dr. Mearns Fraser, setting forth the chief known facts about the disease and urging the public to consult a doctor for certain conditions was distributed. The contents of this leaflet were also inserted once a fortnight in the local press, but this practice was eventually discontinued, on the grounds of economy, though definite evidence was obtained that the reading of this leaflet had resulted in a number of patients applying to their doctors at an early stage of the disease. The leaflet is, however, still issued to Nursing Bodies, Midwives and other workers among the poor. Similar leaflets have also been issued at Bristol, Leeds, Leicester and Cardiff (Cancer of the Breast). I may also mention here that leaflets on Cancer of the Womb and of the Breast, drawn up by the Chairman, have been issued by the Central Midwives Board ever since 1908. The Manchester Cancer Committee has appointed a Propaganda Sub-Committee to which the Public Health Committee has delegated its powers with regard to propaganda under Section 67 of the Public Health Act, 1925. As regards Lectures on Cancer, so far as I can ascertain, nothing of the kind has yet been organised by public authorities in this country. 115 (4) Cancer Clinics.—In spite of the valuable results obtained by this method in America, only one attempt has been made in this country to form such a clinic. More than a year ago the Brentford Union called a conference of public health authorities as the result of whose deliberation they attempted to establish a Cancer Clinic at the West Middlesex Hospital (the Poor Law Infirmary) to which patients of all classes might go for diagnosis and suitable treatment. This attempt, however, came to nothing, chiefly owing to the state of the law which, it was decided, made it illegal for the Guardians to treat any persons who did not come within the scope of the Poor Law. 9. What Local Authorities can do.—The following outline of a scheme shows what might be done by a Local Authority for the control of Cancer, and I would observe that, though the scheme as a whole is novel, the individual measures suggested have all stood the test of experience either in this country or in the United States of America. Outline of Scheme for the Control of Cancer. 1. Propaganda.—This may be considered in two parts :— A. As regards the Medical Profession. B. As regards the General Public. A. The Medical Profession. The co-operation of the medical profession is obviouslv essential for the success of any Cancer campaign. (1) Meetings of Local Medical Practitioners to be convened for the purpose of considering the means to be employed for the control of Cancer. (Vide Ministry of Health Circular 426, para. 19.) (2) Postgraduate lectures and Demonstrations for the Medical Practitioners in the area conducted by recognised authorities on the subject. (3) Cancer Clinic. (See below under Diagnosis.) B. The General Public. (1) Leaflets for Distribution, treating either of the disease as a whole or of certain forms of it, e.g., Cancer of the Breast. Such leaflets could be distributed to patients attending the Municipal Clinics, to Municipal Employees, to householders, etc. (2) Posters which should, if possible, be pictorial, and each of which should aim at teaching one lesson only in a simple manner. (3) Advertisements in the local press. (4) Articles in the same place. (5) Lectures. 2. Diagnosis.—After very careful and prolonged consideration of the subject, I am convinced that by far the most important measure for securing the early diagnosis and treatment of Cancer— and one that has not so far been tried in this country—is the— Cancer Clinic for Free Diagnosis. (Vide Ministry of Health Circular 426, Para .20 (1)). The organisation of such a Clinic (or clinics) should be as follows :— (i.) Clinic to be established or maintained by the Local Council. (ii.) X-ray equipment should be provided. About 60 per cent. of cases of Cancer cannot be diagnosed without the use of X-rays. (iii.) Beds should be provided for the temporary admission of patients suspected of suffering from Cancer of the alimentary tract, etc., to enable a thorough examination to be made by means of a Barium Meal and X-rays. (iv.) Diagnosis should be Free and available to all persons applying for it. In the case of persons admitted for the purpose of a Barium Meal a small charge in respect of maintenance might perhaps be made. (v.) Staff.—The minimum staff necessary for the efficient conduct of such a clinic would be :— (a) Surgical Specialist. (b) Radiologist for X-ray diagnosis. (c) Nurses—the number required depending upon the number of patients examined and the number of beds provided for the temporary accommodation of patients. (vi.) Sessions.—Two sessions per week might be sufficient as a beginning, being subsequently increased as necessary. 3. Treatment. (i.) Conveyance by ambulance of patients to and from hospital, i.e., any hospital where arrangements were made for their treatment by surgical means or otherwise. (Vide Ministry of Health Circular 426, para. 20(3).) (ii.) Deep X-ray Therapy at a hospital established or subsidised by the Council. (iii.) Surgical Treatment at the same place. 116 4. Research.—This might be of two kinds (i.) In connection with the work of the Departmental Committee of the Ministry of Health. (ii.) Independent investigations, e.g., enquiry into certain varieties of Cancer (as at Leeds). Conclusion. Whatever view you may take of the various proposals for the control of Cancer, I hope that I have, at least, shewn that— (1) Cancer is steadily increasing in Willesden, as is the case in England and Wales in general. (2) Although the true nature and origin of this disease is still unknown, enough is known about the conditions under which it occurs and the early symptoms to which it gives rise to form the basis of a successful scheme for its prevention or cure in a great many cases. In conclusion, I cannot do better than quote the words of Sir George Newman in his preface to Dr. Janet Lane-Claypon's " Further Report on Cancer of the Breast," 1926, in which he writes : " It is well .... once more to insist that there are many right and useful things that ought to be done now without waiting for the solution of Cancer problems to which we may look forward in the near future. . . . The promise of these investigations and researches should not be allowed to blind us to the fact .... that in this and other countries a mass of disease and suffering is still needlessly continuing which we already have ample means at our disposal to prevent."