CI AC 439(1) WILLES DEN WIL 26 Tuillesden urban District Council. 1930. THE 55th ANNUAL HEALTH REPORT. GEORGE F. BUCHAN, M.D., M.R.C.P., D.P.H., Medical Officer of Health, Willesden; Lecturer in Public Health, Guy's Hospital Medical School; Lecturer in Public Health Administration and Practice, London School of Hygiene and Tropical Medicine ; Examiner in State Medicine, University of London ; Examiner in Public Health, Conjoint Examining Board, England ; President, Society of Medical Officers of Health, 1925-26; Hon. Fellow, American Public Health Association, 1928. L.onbon: WIGHTMAN & CO., LIMITED, Regency Street, Westminster, S.W. 1, and Dugdale Street, S.E. 5. 2 WILLESDEN URBAN DISTRICT COUNCIL, 1930-31. WILLESDEN URBAN DISTRICT EDUCATION COMMITTEE, 1930-31 *+Miss Councillor M. E. ROYLE, J.P. (Chairman of the Council). *+MR. Councillor W. A. HILL (Vice-Chairman of the Council). Mr. Councillor T. V. BANISTER. Mr. Councillor C. BERESFORD. +MR. Councillor H. C. BLAXLAND. Mr. Councillor C. HICKS BOLTON, M.A. +Mr. Councillor W. M. BOLTON (Chairman, Health Committee.) +MR. Councillor P. BOND. +MR. Councillor S. BOWN. Mr. Councillor J. W. CATLOW. (Chairman, Education Committee). ♦+MR. Councillor J. CLEE. +MR. Councillor J. COMBER, J.P. +Miss Councillor N. M. COWAN. +Mr. Councillor A. E. DORAN. Mr. Councillor E. DROWN. Mr. Councillor H. E. DULCKEN. Mr. Councillor G. FITZGIBBON. Mr. Councillor W. F. FRANKLIN. Mr. Councillor G. J. B. FURNESS. +Mr. Councillor H. J. GOLBY. +MR. Councillor S. GREENFIELD. Mr. Councillor G. H. HISCOCKS. Mr. Councillor J. R. HOBBS. fMR. Councillor F. W. HORNE. Mr. Councillor W. JEFFRIES. +Mr. Councillor E. R. E. JONES. Mr. Councillor M. JONES. +Mrs. Councillor L. A. LARKIN. +Mr. Councillor J. L. MAGNUS. *+Mr. Councillor A. C. MELLUISH. (Chairman, Hospital Visiting Committee.) *+Mrs. Councillor R. MOORE. *+Mr. Councillor J. MORSE. Mr. Councillor H. LEIGH-MOSSLEY. *+Mr. Councillor G. PAGE. (Chairman, Children's Care Sub-Committee.) Mr. Councillor H. W. PROTHERO. *+Mr. Councillor W. H. RYDE. *Mr. Councillor T. J. SANDFORD. Mr. Councillor W. A. SAVILLE. Mr. Councillor H. J. SAVORY. Mr. Councillor W. A. STILTON. Mr. Councillor H. THORLEY. *Mrs. Councillor E. C. TUCKER. Mr. Councillor R. W. J. TUCKER. ♦+MR. Councillor G. WESTON. « Member of the Children's Care Sub-Committee. f Member of Health Committee. J Member of Hospital Visiting Sub-Committee. 3 Town Hall, Dyne Road, Kilburn, N.W. 6. 1st May, 1931. 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 1930. This Report includes:— (i.) The 55th Annual Report on the health and sanitary condition of the district; (ii.) The 23rd Annual Report on the health of children attending the public elementary schools; (iii.) The 11th Annual Report on the health of children attending secondary schools ; (iv.) The 13th 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 1st Annual Report on the Supervision of Midwives. (vi.) The 1st Annual Report on the Registration of Nursing Homes. (vii.) The 1st Annual Report on Infant Life Protection. (viii.) The 11th Annual Report on home nursing ; (ix.) The 16th Annual Report on the provision of meals to children attending the public elementary schools ; (x.) The 39th Annual Report on the Municipal Hospital. (xi.) The 1st Annual Report on the health of patients attending the Middlesex County Council Occupation Centre for Mentally Defectives, Buller Road, Willesden. The Report is written in accordance with the requirements of the Ministry of Health and Board of Education. VITAL STATISTICS. The estimated population of Willesden at Midsummer, 1930, was 179,368. 2,869 births occurred in Willesden during 1930, giving a birth rate of 15-99 per 1,000 of the population, as against 15-25 in 1929. 1,762 deaths occurred in 1930, giving a death rate of 9-82 per 1,000 of the population. These figures compare with a total number of deaths of 2,019 and a death-rate of 11 - 34 in 1929. The infant mortality rate in 1930 was 60-99 per 1,000 births. 175 deaths of infants under one year occurred. 147 or 84 per cent, of these 175 deaths were" due to :— 1. Congenital Malformations 11, Premature Birth 57, Atrophy, Debility and Marasmus 15, Atelectasis 5 ; 2. Diarrhoea and Enteritis 24 ; 3. Whooping Cough 2 ; 4. Measles 4 ; 5. Bronchitis 2, and 6. Pneumonia 27. Year by year these six causes of death account for some 80-85 per cent, of all deaths of infants under one year of age and active measures are required to prevent these conditions proving fatal. CANCER Cancer continues to take a heavy toll of the population. In 1930 there were 214 deaths from this cause as compared with 239 in 1929, 240 in 1928, and 217 in 1927. The two Cancer Clinics, one at Health Centre (1) and the other at Health Centre (2), have continued during 1930. Dr. Agnes Nicoll writes a report on the work done at Health Centre (1) during the year 1930, and Dr. Bessie Mackenzie writes a similar report on the work done at Health Centre (2) during the year 1930. These reports appear as Appendices G and H. INFECTIOUS DISEASES. During the year 1930, 2,029 cases of Infectious Disease were notified as compared with 2,843 in the previous year. The total of 2,029 includes 491 notifications of Diphtheria as compared with 413 in 1929, 518 cases of Scarlet Fever as compared with 574 in 1929, 266 cases of Pneumonia as compared with 402 in 1929 and 229 cases of Whooping Cough as compared with 912 in 1929. 4 Return Cases of Scarlet Fever.—The following statement gives the return cases that have occurred during 1930:— I. Home Cases.—Approximately 70. (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 (b) No. of infecting cases giving rise to return cases more than 28 days after release from isolation 2 „ return cases they gave rise to 2 ,, infecting cases per cent. of total home cases 2.9 „ return cases per cent, of total home cases 2.9 II. Hospital Cases.—Approximately 448. (a) No. of infecting cases giving rise to return cases not longer than 28 days after discharge 21 „ return cases they gave rise to 27 „ infecting cases per cent, of total hospital cases 4.7 ,, return cases per cent, of total hospital cases 6.0 Note.—Two of these return cases occurred after the 28 days, but the first return case had occurred within the 28 days. (b) No. of infecting cases giving rise to return cases more than 28 days after discharge 6 „ return cases they gave rise to 6 „ of infecting cases per cent, of total hospital cases 1.3 ,, return cases per cent, of total hospital cases 1.3 Small Pox.—9 cases of Small Pox were notified in 1930 as against 47 in the previous year. 8 cases were nursed in the Willesden Small Pox Hospital, Kingsbury, and 1 was admitted to the Small Pox Hospital of the London County Council. The disease was again of the mild type. All patients recovered. The first two cases occurred at the beginning of February, one in the Willesden Green area and the other in Stonebridge. There were no further cases till the beginning of April, when two cases in one family came to light at Neasden, the rashes of the two patients appearing on consecutive days. The next three cases appeared in Kilburn during the latter part of May and beginning of June. Two of these were in one family, the second case contracting the disease from the first, who was her husband. At the end of June an isolated case appeared in Harlesden. Previous cases of Small Pox had occurred at this patient's workplace outside Willesden. The last case occurred in September in an elderly patient who had been in contact outside Willesden with relatives suffering from Small Pox. Of the 9 patients 7 were unvaccinated. One of these, aged 35 years, was stated to have been unsuccessfully vaccinated 3 times in infancy. 1 patient was a contact vaccinated for the first time the day following the first patient's removal to Hospital, 7 days after the appearance of the rash, 12 days after the onset, and 5 days before the onset of her own illness. The ninth patient, aged 66 years, had been successfully vaccinated in infancy. During 1930, 2,511 visits of supervision were paid to Small Pox contacts residing or working in Willesden. No vaccinations were performed by the Medical Officer of Health under the Public Health (Small Pox Prevention) Regulations, 1917. In connection with the infectivity of the disease it is of interest to note that one of the patients after remaining in bed during the first 3 days of his illness, on the 4th day played in a football match at which 6 of the players at least were unvaccinated, and played in a dance band at an evening function on the same day, visited a family of 5 people on the 5th day, returned to clerical workjon the 6th day, when the rash appeared, and continued at work on the 7th and 8th days, all without as far as could be ascertained infecting anybody. 5 Typhoid Fever.—Ten cases were notified during 1930 as against six in 1929. Seven of these cases were removed to the Municipal Hospital where 1 was diagnosed as typhoid fever and recovered, 1 as para typhoid A and recovered, 1 as paratyphoid B and recovered. There appeared to be no connection between these cases and the source of infection in each instance was untraced. Of the other four cases removed to the Municipal Hospital, 1 was diagnosed as gastro enteritis and peritonitis and died, 1 as a severe toxic case of scarlet fever in a woman of 42 years and died. In 1 case the symptoms suggested tuberculosis of the mediastinal glands and in 1 case tubercular peritonitis. Both these patients improved and were discharged. One case occurred in a child who had been admitted to a nursing home on account of tubercular glands. This was diagnosed as a case of paratyphoid B, was nursed in the nursing home and recovered. There was a history of the patient having eaten watercress and winkles one to two weeks prior to the onset of her illness. One case was nursed in the Willesden General Hospital and recovered. One case was nursed at home and recovered. The source of infection in these cases was untraced. One death from Typhoid Fever was recorded during the year. This occurred in a Willesden resident who was an inmate of an institution outside Willesden. Infectious Diseases of the Nervous System, Cerebro-Spinal Meningitis, Poliomyelitis, Encephalitis Lethargica and Acute Polio-Encephalitis.—15 cases of these diseases were notified in 1930, 9 proved fatal, giving a fatality rate of 60 per cent, of notified cases. 13 deaths in all were attributed to these diseases. 4 of these related to cases which had notabeen notified. Whooping Cough is a notifiable disease in Willesden. 229 cases were notified during the year, but a total of 359 cases coming to their knowledge were visited by the Health Visitors. Non-Notifiable Acute Infectious Diseases are reported from the Public Elementary Schools and are found by the Health Visitors during the course of home visitation. During 1930, 2,284 cases of measles, which is not notifiable in Willesden, were visited by the Health Visitors. Prevalence of Rats or Mosquitos.—Several complaints as to the presence of rats were received. After verification the complaints were forwarded to the Inspector of Rat Destruction, Middlesex Count}'Council, who administer The Rats and Mice (Destruction) Act, 1919. No complaints have been received as to the presence of mosquitos in the district. MOTHERS AND CHILDREN UNDER FIVE YEARS. Municipal Centres.—At the Municipal Centres, including the Ringworm Centre, expectant mothers attended the medical consultations on 3,941 occasions ; nursing mothers, 17,471, and children under 5, 37,960, making a total of 59,372 attendances. Out of the total number of 2,859 children born in Willesden during the year, 1,260 or 44 per cent, subsequently attended the Welfare Centres. The number of births occurring amongst expectant mothers who attended the Ante-Natal Clinics was 692 ; 63 per cent, of these mothers with their babies subsequently attended the Welfare Centres. 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 6 Table No. 1.—Hospital Confinement Bookings—continued. Four weeks ended No. of Confinement Cases Booked. 25.1.19 14 22.2.19 13 22.3.19 17 19.4.19 12 New Council 1919-22. 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 21.2.20 41 20.3.20 32 17.4.20 23 Memo. 24.3.20. Hospital full. Cases from half of district only admitted. 15.5.20 24 12.6.20 32 Memo. 8.6.20. Cases admitted from whole of district, but for medical reasons or home circumstances only. 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 19.2.21 34 19.3.21 36 16.4.21 35 £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). 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 25.2.22 33 Memo, re cases living in more than 3 rooms to show sound reason why they should be booked. 25.3.22 22 New Council 1922-1925. 22.4.22 15 From 1.4.22 cases to be booked for hospital not to exceed 32 per month (including Expectant and Nursing Mothers). 20.5.22 24 17.6.22 19 Illegitimate cases not admitted, except on surgical grounds, after 23.5.22. 15.7.22 31 12.8.22 22 9.9.22 17 14.9.22. Letters handed to applicants that they would probably go to Park Royal Hospital. Conditions re payment in advance and withholding Admission Cards until payment complete imposed. 7.10.22 18 4.11.22 10 9.10.22. Solicitor's revised Admission Form and signature of husband required. 2.12.22 21 30.12.22 7 Total (1922) 266 7 Table No. 1.—Hospital Confinement Bookings—continued. Four weeks ended No. of Confinement Cases Booked. 27.1.23 28 24.2.23 20 24.3.23 19 21.4.23 5 New Scheme, 1.4.23. 19.5.23 7 On and after Midnight 30.4.23, cases sent to Park Royal Hospital. 16.6.23 5 Council meeting 29.5.23. Illegitimate cases 12 months residents of Willesden may be booked. 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 23.2.24 3 22.3.24 8 19.4.24 6 Letter from Board of Guardians—Special Ward will not be reserved for Council cases after 1.4.24. 17.5.24 2 14.6.24 6 12.7.24 10 9.8.24 11 6.9.24 4 4.10.24 11 Revised new scheme in force, 25.9.24 (Council meeting 23.9.24.) 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 28.2.25 13 28.3.25 7 25.4.25 8 New Council, 1925-1928. 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 30.1.26 17 27.2.26 24 27.3.26 19 24.4.26 16 22.5.26 17 19.6.26 12 17.7.26 11 14.8.26 22 11.9.26 20 9.10.26 22 6.11.26 15 4.12.26 15 1.1.27 10 Total (1926) 220 8 Table No. 1—Hospital Confinement Bookings—continued. Four weeks ended No. of Confinement Cases Booked. 29.1.27 22 26.2.27 24 26.3.27 11 23.4.27 16 21.5.27 17 18.6.27 18 16.7.27 20 13.8.27 10 10.9.27 15 8.10.27 18 5.11.27 20 3.12.27 20 31.12.27 10 Total (1927) 221 28.1.28 16 25.2.28 30 24.3.28 20 21.4.28 14 19.5.28 22 New Council, 1928-1931. 16.6.28 16 14.7.28 26 11.8.28 19 Cases booked on payment of full cost to the Council irrespective of home circumstances or medical reasons (Council Meeting, 24/7/28). 8.9.28 15 6.10.28 30 3.11.28 23 1.12.28 18 29.12.28 23 Total (1928) 272 26.1.29 20 23.2.29 19 23.3.29 30 20.4.29 31 18.5.29 30 15.6.29 24 13.7.29 41 10.8.29 27 7.9.29 27 5.10.291 23 2.11.29 22 30.11.29 23 28.12.29 17 Total (1929) 334 25.1.30 25 22.2.30 30 22.3.30 37 19.4.30 31 17.5.30 29 Health Centre (3) opened 28.4.30. 14.6.30 27 12.7.30 42 9.8.30 31 6.9.30 26 4.10.30 29 1.11.30 32 29.11.30 31 3.1.30 (5 weeks) 32 Total (1930—53 weeks) 402 9 Table No. 2.—Maternity Cases Admitted to Park Royal Hospital during 1930. No. delivered of live infants 372 No. delivered of infants born dead 5. No. confined 377 No. of miscarriages 2 No. of cases of complications caused by pregnancy 10 Total No. of cases admitted to Hospital 389 Note.—28 cases were admitted not in labour and 19 of these were subsequently readmitted and confined. 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 1930 : — Table No. 3. — Willesden General Hospital. St. Monica's Home Hospital. Total. No. of Children in Hospital at 31st December, 1929 1 3 4 No. of Children admitted during 1930 111 19 130 Total No. of Children under treatment during 1930 112 22 134 No. of Children discharged during 1930 108 17 125 No. of Children died in Hospital during 1930 2 2 4 Mortality % 1-78 9-09 2-985 No. of Children remaining in Hospital at 31st Dec., 1930 2 3 5 The following table gives particulars of the conditions for which children were admitted during 1930, the treatment carried out and the results of such treatment:— Table No. 4.—Children under 5 Years Admitted to Hospital during 1930. Condition. No. Admitted. Forms of Treatment. Result of Treatment. In Hospital at end of 1930. Operative. General. Other forms. Remedied. Improved. Unchanged Died. Marasmus 24 — 24 — — 14 2 4 4 Enlarged Tonsils and Adenoids 106 106 — — 105 — — — 1 Total 130 106 24 — 105 14 2 4 5 Puerperal Fever.—During 1930, 5 cases of Puerperal Fever were notified as against 6 in 1929, 6 in 1928, 5 in 1927 and 16 in 1926. This gives a case rate of 1.7 per 1,000 registered live births, as against 2.90 in 1923, 4.20 in 1924, 5.80 in 1925, 5.93 in 1926, 1.95 in 1927, 2.25 in 1928, and 2.21 in 1929. One of these 5 notified cases proved fatal. The two other deaths appearing in the death table under puerperal sepsis were those of cases notified as puerperal pyrexia. Taking the 1 death occurring amongst the notified cases of pureperal fever this gives a case mortality of 20 per cent, as against 50 per cent, in 1929, 33.4 per cent, in 1928, 60 per cent, in 1927, 25 per cent, in 1926, 12.5 per cent, in 1925 and 16.7 per cent, in 1924. The maternal mortality from puerperal sepsis was 1 .04 per 1,000 registered live births. The maternal mortality from all causes was 3 83 per 1,000 registered live births. In 3 of the 5 notified cases a private doctor was in attendance at birth and in 1 case the birth occurred in hospital. The fifth was a case of incomplete abortion at home. The other particulars of the 5 cases are as follows :— 1 case—confined at home—instrumental delivery—labour 30 hours—child 10J lbs.— 4 vaginal examinations. Removed to hospital on the 8th day. Recovered. First confinement. 1 case—confined at home—instrumental delivery—post partum haemorrhage—large cervical tear—3 stitches—removal to hospital on the 13th day—died on the 17th day. First confinement. 10 1 case—confined at home—normal delivery—removed to hospital on the 10th day— diagnosed parametritis—examination showed mass of inflammatory tissue in broad ligament—recovered. First confinement. 1 case—confined in hospital—instrumental delivery—prolonged labour—ruptured perineum—pelvic peritonitis—2 stitches—baby died at 17 days—cerebral haemorrhage. Mother recovered. First confinement. 1 case—incomplete abortion at home. Removed to hospital 3rd day—recovered. 5 2 cases were treated in the Municipal Hospital and recovered. 1 case was treated in Park Royal Hospital and recovered. 2 cases were treated in Hospitals outside Willesden, one recovered and one died. 5 Puerperal Fever Cases, 1930. Home Circumstances. Table No. 5. Number of Cases. Number of Rooms. Number of occupants, including new-born baby. Under 10 years. Over 10 years. Total. 1 2 1 2 3 1 (fatal) 4 1 3 4 1 3 3 3 6 1 5 1 6 7 1 Occurred in an Institution. Puerperal Pyrexia.—34 cases were notified during the year. Two of these 34 cases proved fatal, the deaths being recorded as puerperal septicaemia. During 1930 the Council have continued their efforts to deal effectively with the subject of maternal mortality. (1) Sterilised Accouchment Sets.—These sets are supplied either free or on payment according to a scale sanctioned by the Minister of Health. They are available for :— (a) Expectant mothers attending the health centres. (b) Expectant mothers not attending the health centres but whose finement will be attended by a midwife. (c) Expectant mothers not attending the health centres but whose finement will be attended by a doctor. and may be obtained from the Municipal Health Centres by the doctor, the midwife or the expectant mother on presenting a written recommendation from her doctor or midwife. During 1930 these sterilised accouchment sets have been increasingly made use of. 48 were supplied free, 13 at the full cost and 1 at part cost. (2) Specialist Help.—-The Council now accept responsibility for the payment of the fee of one of their specialists called in by a medical practitioner to assist him in connection with a difficult case of labour occurring in a Willesden resident. 11 such consultations were paid for in 1930. (3) Provision of Aneesthetist.—The Council further accept responsibility for the payment of a fee (not exceeding 1 guinea) to an anaesthetist, called in by a medical practitioner in connection with confinement cases. Three such fees were paid in 1930. Maternal Mortality.—The Council has continued to take part in the investigation of deaths of mothers in childbirth for the Maternal Mortality Committee of the Ministry of Health. The investigations are carried out by a consultant obstetrician. 14 cases were inquired into during 1930. The Council also provides the services of a consultant in cases of Puerperal Fever and Puerperal Pyrexia when desired by the practitioner in attendance. 6 such consultations were paid for by the Council in 1930. 11 Ophthalmia Neonatorum.—The number of cases of this disease notified during the year "was 38, giving a case rate of 13-2 per 1,000 registered births. A private doctor attended at the confinement in 18 cases, a midwife in 7 cases, and 13 cases were born in hospital. Treatment was obtained at a hospital in 9 cases, at the Municipal Centres in 13 cases, and by a private doctor at home in 16 cases. Complete recovery with unimpaired vision occurred in all cases. The following table gives particulars :— Table No. 6. Cases. Vision unimpaired. Vision impaired. Total Blindness. Deaths. Notified. Treated. At Home. In Hospital. 9 9 9 — — — 13 — 13 Centres 13 — — — 16 16 — 16 — — — 10 cases of inflammation of or discharge from the eyes of infants were visited by the Health Nurses. All recovered without any permanent injury to the eyes. School for Mothers at Health Centre 1. The year 1930 has been one of great activity and may be considered very satisfactory. Owing to the opening of Health Centre 3 at Stonebridge and the consequent re-distribution of districts, a large number of attendants from Centre 1 area have been transferred to other centres. In spite of this the numbers continue very much the same. The total attendance was 2,523 as against 2,616 in 1929. 224 sessions were held giving an average attendance of 11-2 per session as against 11-4 for the previous year. There were 98 new attendants during the year. Expectant mothers have availed themselves of all the opportunities and much appreciated the advantages afforded them of learning to cut out and make baby outfits and other suitable garments. A great deal of work is done in the reconstruction of clothing, which is not only practical, but extremely valuable from an economic point of view. Many lectures and practical demonstrations were given. In addition to her own talks Dr. Nicoll gave special instruction on the General Principles of Child Welfare, based on the book " To Mothers and Fathers," published by the Association of Infant Welfare and Maternity Centres, and from which the questions were set for the All-England Mothercraft Competitions. The Centre entered for this Competition, which took place in June, with very gratifying results, obtaining third place out of all England. The following is the result of the Competitions :— Class 1.—Six Mothercraft Questions. Compulsory. Honours Certificate. Class 2.—Records consisting of Ante-Natal records, a Health Visitor's record, Weight Chart, and a comprehensive Medical Record. Three sets, one set for each child of six months, 18 months and three years respectively. Honours Certificate. Class 4.—Household needlework. Honours Certificate. Class 5.—Knitting. Honours Certificate. Class 6.—Reconstruction of a garment. Honours Certificate. Class 7.—Patching and Darning. 2nd Class Certificate. Class 10.—Practical Cookery. Honours Certificate. Class 13.—Home nursing. Honours Certificate. In addition there was an optional class for singing and reciting. Each of the two entries had an Honours Certificate, one with special mention for her dramatic talent. The National League entertained the Competitors to tea at the L.C.C. School, Cosway Street, Marylebone Road, where the Challenge Shield and Certificates were publicly presented during National Baby Week. In December, the Chairman and three lady members of the Willesden Urban District Council paid a visit to the Centre, congratulated, the mothers who had entered for the Competitions, and emphasised the importance of Mothercraft. Thus a great deal of encouragement was given to the section, and it is hoped that in 1931 they will do even better and bring home the shield. The Nursery continued to do very good work. The number of attendances during the year being 2,978, an increase of 440 on the previous year. The children show a high standard of personal hygiene and clothing. 12 School for Mothers at Health Centre 2. Classes are held 3 afternoons weekly when the dental clinic is not in use. During 1930, 112 sessions were held at which 1,593 mothers attended, making an average of 14-2 per session and 643 children attended the nursery—an average of 5-7. This average in a room where comfortable seating is limited to 9 and where the usual cup of tea and a biscuit cannot be offered indicates the mother's desire to attend these classes which provide valuable opportunities for teaching " better health." The Council's land adjoining the clinic and now covered with derelict buildings affords the ground space for suitable accommodation now lacking. In July, 15 mothers entered for a written examination on subjects dealt with in the Health Talks and Dr. Nicoll, Centre Medical Officer, Health Centre 1, kindly marked these papers and reports as follows :— " The paper set was an interesting one, and the various questions have been very well answered. I have been particularly struck by the excellence of the replies to the question on Home Building, which were not only well expressed but showed that all the essentials were fully understood, and that the teaching had been practical. The School for Mothers is to be congratulated on its progress." In December, 22 mothers entered for a knitting and needlework competition. Their work was judged by Miss McAuliffe, Head Teacher, Oldfield Road Girls School, who reports as follows :— " My first impression of the work was that although the number of entries was not large, the standard of attainment was very high. This made the task of judging a most difficult one. The work was divided into 4 sections—one section was devoted to wool work, either knitting or crochet. This section is certainly the favourite, for the number of entries was higher than that of any other section. The work was most good and showed a distinct variety of tastes—from the dainty baby clothes to the strongly knitted jersey for the growing boy. In coming to the actual sewing work we find three sections ; one was for a garment that could be made by hand, or by machine, thus giving every mother who was willing to make the effort the opportunity of competing. Another section was more decorative, and although the number of garments (decorated by smocking) shown was small, yet the smocking was most exquisite and the little garments could compare quite favourably in daintiness, finish and utility with those we can see in quite expensive baby linen shops. The third needlework section was most interesting, for there we saw how new clothes could be had for old ones. Little boys' knickers were made out of an old lady's coat. Again the number of entries was small but such work must be of great help to a mother with several boys and girls to clothe. The work as a whole is wonderfully good and one only wishes that more of the mothers of Willesden would avail themselves of the opportunities given." Prizes were given to the successful candidates and the examination lists of marks were eagerly scanned by the competitors. School for Mothers at Lower Place. During the first quarter of the year 12 weekly sessions were held at the above centre, at which 117 mothers and 150 children attended. Of these 3 mothers and 3 children were new attendants. The centre closed at the end of March and the mothers were transferred to the School for Mothers at the New Stonebridge Health Centre, opened on April 28th, 1930. School for Mothers at Health Centre 3. The Centre opened on 28th April, 1930, and 151 Mothercraft Sessions were held, up to the end of the year. 120 individual mothers made 1,725 attendances, an average of 11.4 per session, and 70 children under 5 years were cared for in the nursery and made 1,600 attendances, an average of 22.9. A syllabus of short health talks was drawn up at the beginning of each term, and the mothers were interested and eager to attend. A competition was organised at the conclusion of the autumn term and the entries received showed a very fair standard of work. Miss E. M. Fisher, of Wesley Road Senior Mixed School, very kindly judged the work. Her report is as follows :— 13 Report on the Needlework done by Members of the Mothercraft Class at the Stonebridge Health Centre. The work which was divided into four Sections was examined on December 11th. In Section (a) were knitted garments for very young babies. (b) Knitted garments for toddlers. (c) Knitted garments for adults. (d) Other home-made garments. The work in the first two sections was very interesting. The little garments were daintily made, the wools and silks chosen were suitable and there was a large variety of patterns. A particularly high standard of work was reached in these sections. In Section (c) the entries showed that much patience, care and hard work had been exercised by the competitors. Here again the choice of materials, patterns and colours was excellent. In the fourth section was a variety of garments which included new ones, and those which had been " made-over " from cast-off clothes. Amongst those shown a baby's silk robe, a hand-made shirt and a smocked frock call for special mention. Altogether, the display of garments was most interesting and great credit is due to all those mothers who have used their limited spare time to such useful purpose, and also to those under whose guidance the work is done. E. M. Fisher. THE SCHOOL MEDICAL SERVICE. Schools.—There are 37 public elementary schools in the district. Of this number 24 are Council and 13 church or non-provided schools. Included in the number of the Council schools are 2 special schools, 1 for mentally defective and 1 for physically defective children. 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. Medical Inspection.—During 1930 the average number of scholars on the Public Elementary School Rolls in Willesden was 21,073. 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 had not been examined on reaching the age of 12. The total number of children medically inspected at routine and special inspections during 1930 was 13,800. Findings of Medical Inspections.—(a) Uncleanliness.—Cleanliness inspections were carried out in the schools on 595 occasions during the year 1930, the average number of visits paid to each school by the Health Visitor being 17. The total number of examinations and re-examinations made during the year was 57,846. The effect of this work is illustrated in the following table:— Percentage of nitty and verminous children recorded upon routine inspection at the schools from year to vear 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% 1926 5.9% 1927 4.7% 1928 47% 1929 4.0% 1930 3.7% 14 (b) Tonsils and Adenoids.—During 1930, at routine and special medical inspections, 2,021 cases of enlarged tonsils and adenoids were discovered, as compared with 1,773 found in 1929, 2070 found in 1928, 1,988 found in 1927, 1,858 found in 1926, 2,033 found in 1925, and 1,348 in 1924. (c) Skin Disease.—During 1930, at routine and special medical inspections, 1,888 cases of skin disease were detected, as compared with 1,809 cases in 1929, 2,241 cases in 1928, 2,134 cases in 1927, 1,863 cases in 1926, and 1,519 cases in 1925. (d) Enlarged Cervical Glands (non-tuberculous).—During 1930 at routine and special medical inspections 505 cases of this defect were noted as compared with 380 in 1929, 315 in 1928, 566 in 1927, 670 in 1926 and 369 in 1925. Infectious Diseases.—The action taken to detect and prevent the spread of infectious diseases was as set forth in my Annual Report for 1925. 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 necessary treatment has been obtained. If nothing has been done the Health Nurse again explains the necessity for treatment to the parent, and advises as to the best method of obtaining such treatment. Medical Treatment.—During the year 1930 school children were followed up by the Health Department on account of 16,630 medical defects and 8,759 dental defects. Of those defects found to require treatment, medical or dental treatment was obtained for 13,865 and domestic treatment was obtained for 3,933. 85-2 per cent, of the medical defects were treated, 60-6 per cent, receiving medical treatment and 24 • 6 per cent, domestic treatment ; 47-8 per cent, of the dental defects followed up were treated. No record is available of defects requiring treatment which were not followed up. 84 per cent, of the total medical defects treated and 96 per cent, of the total dental defects treated were dealt with by the Education Committee. The remainder, or 16 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 60,147 attendances at the School Centres in 1930, as compared with 46,005 in 1929, 50,440 in 1928, 53,782 in 1927, 53,695 in 1926, 46,818 in 1925 and 37,305 in 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 Centres Table No. 8. Four weeks ending M. & C.W. Centres Attendances. S.M.S. Centres Attendances. Total Centres 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 forM. 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 15 Table No. 8 (continued). Four weeks ending. M. & C.W. Centres Attendances. S.M.S. Centres Attendances. Total Centres Attendances. Remarks. 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 16.6.23 2,082 3,008 5,090 Includes holidays. 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 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 Includes holidays. Totals, 1923 (52 weeks) 23,804 43,980 67,784 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 operation 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. 10.10.2 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 16 Table No. 8 (continued). Four weeks ending M. & C.W. Centres Attendances. S.M.S. Centres Attendances. Total Centres Attendances. Remarks. 30.1.26 2,559 2,873 5,432 Includes holidays. 27.2.26 3,048 4,249 7,297 Nutritive foods sold to all Clinical attendants when prescribed without income limit 23.2.26. 27.3.26 2,972 4,969 7,941 24.4.26 2,645 3,742 6,387 Includes holidays. 22.5.26 3,120 4,573 7,693 19.6.26 2,947 4,324 7,271 Includes holidays. M. & C.W. Cases to be personally seen by Clinic Doctors limited as far as possible as from 26.5.26. 17.7.26 3,233 4,450 7,683 14.8.26 2,836 2,374 5,210 Includes holidays. 11.9.26 3,387 3,265 6,652 Includes holidays. 9.10.26 3,885 5,352 9,237 6.11.26 3,693 5,145 8,838 4.12.26 3,413 5,095 8,508 Ministry of Health approved Scheme for free issue of nutritive foods, 18.11.26. 1.1.27 2,837 3,284 6,121 Includes holidays. Totals, 1926 (52 weeks) 40,575 53,695 94,270 29.1.27 3,175 3,697 6,872 Includes holidays. 26.2.27 3,353 4,811 8,164 26.3.27 3,621 4,917 8,538 23.4.27 3,234 3,605 6,839 Includes holidays. 21.5.27 3,629 4,866 8,495 18.6.27 3,275 4,223 7,498 Includes holidays. 16.7.27 3,337 4,567 7,904 13.8.27 2,988 2,390 5,378 Includes holidays. 10.9.27 3,251 3,151 6,402 Includes holidays. 8.10.27 3,412 5,011 8,423 5.11.27 3,572 4,880 8,452 3.12.27 3,384 4,768 8,152 31.12.27 2,320 2,896 5,216 Includes holidays. Totals, 1927 (52 weeks) 42,551 53,782 96,333* 28.1.28 3,208 3,811 7,019 Includes holidays. 25.2.28 3,375 4,857 8,232 24.3.28 3,223 4,333 7,556 21.4.28 2,688 2,870 5,558 Includes holidays. 19.5.28 3,258 4,321 7,579 16.6.28 3,023 3,956 6,979 Includes holidays. 14.7.28 3,482 4,814 8,296 11.8.28 3,045 2,676 5,721 Includes holidays. 8.9.28 3,256 2,216 5,472 Includes holidays. 6.10.28 3,898 4,599 8,497 3.11.28 3,839 4,210 8,049 1.12.28 3,580 4,768 8,348 29.12.28 2,645 3,009 5,654 Includes holidays. Totals, 1928 (52 weeks) 42,520 50,440 92,960f 17 Four weeks ending M. & C.W. Centres Attendances. S.M.S. Centres Attendances. Total Centres Attendances. Remarks. 26.1.29 3,184 3,356 6,540 Includes holidays. 23.2.29 3,019 3,750' 6,769 23.3.29 3,520 4,222 7,742 20.4.29 3,306 3,492 6,798 Includes holidays. 18.5.29 3,670 4,411 8,081 15.6.29 3,304 3,946 7,250 Includes holidays. 13.7.29 3,691 3,941 7,632 10.8.29 2,954 2,087 5,041 Includes holidays. 7.9.29 3,478 1,926 5,404 Includes holidays. 5.10.29 4,104 4,001 8,105 2.11.29 4,075 4,134 8,209 30.11.29 3,702 3,974 7,676 28.12.29 3,010 2,765 5,775 Includes holidays. Totals, 1929 (52 weeks) 45,017 46,005 91,022+ 25.1.30 4,067 3,774 7,841 Includes holidays. 22.2.30 3,940 4,280 8,220 22.3.30 4,279 4,436 8,715 19.4.30 3,923 3,463 7,386 Includes holidavs. 17.5.30 4,455 3,851 8,306 Includes holidays. Health Centre 3 opened 28/4/30 14.6.30 4,613 4,855 9,468 Includes holidays. 12.7.30 5,278 5,269 10,547 9.8.30 4,361 3,726 8,087 Includes holidays. 6.9.30 4,378 2,816 7,194 Includes holidays. 4.10.30 5,423 5,484 10,907 1.11.30 5,966 6,874 12,840 29.11.30 5,218 6,213 11,431 3.1.31 (5 weeks) 5,812 5,106 10,918 Includes holidays. Totals, 1930 (53 weeks) 61,713 60,147 121,860§ * In addition 31 attendances were made by adults in respect of Diphtheria Immunisation, making 96,364 attendances in all. t In addition 26 attendances were made by adults in respect of Diphtheria Immunisation, making 92,986 attendances in all. J In addition 12 attendances were made by adults in respect of Diphtheria Immunisation, making 91,034 attendances in all. § In addition 22 attendances were made by adults in respect of Diphtheria Immunisation, making 121,882 attendances in all. Crippling Defects and Orthopaedics.—An Orthopaedic Clinic staffed by an Orthopaedic Surgeon and a specially qualified health nurse began work on June 14th, 1930, after the Stonebridge Health Centre was opened. The report of the Orthopaedic surgeon appears as Appendix F. Abnormal Children.—Under this category are included the following classes of children :— Merely dull or backward, mentally defective (feeble-minded), imbecile, moral defective, 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 1930 1,194 special children were examined or re-examined. Of the 353 original examiations included in the 1,194 examined, 70 were found to be physically defective, 41 mentally defective, 2 deaf, 7 blind and partially blind, 8 epileptic, 20 dull and backward, 185 anaemic and debilitated, 16 defective speech, 3 nervous instability, 1 delinquency. Leinster Mentally Defective School.—The certified accommodation at this school is for 145 children and during the year under review the average number on the roll was 117. The actual number on the roll at 31st December, 1930, was 124. The average attendance for the year was 79. There were 7 children awaiting admission to this school at the end of the year. 18 The staff consists of one Head Teacher, one full-time Assistant Master and four full-time Assistant Mistresses. There are in addition three part-time Instructors—one for boot-making, one for handicraft and one for domestic economy. Three children were reported to the Local Control Authority as incapable of receiving further benefit from instruction in the school; two were suitable for transfer to an ordinary elementary school, and one was allowed to leave school. 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. 98 such examinations were made during 1930. The school dinner is brought from Furness Road Feeding Centre, and served in the school hall. On an average 70 children take dinner, and the remainder bring their own meal. Oldfield Road Physically Defective School.—The certified accommodation at this school is for 145 children. During the year under review the average number on the roll was 151. The actual number on the roll at 31st December, 1930, being 150. The average attendance for the year was 127, and there were 9 children awaiting admission at 31st December, 1930. The school takes physically defective children between 5 and 16 years of age. The staff consists of one Head Teacher and five full-time Assistants. During the year four children were allowed to leave school before reaching the age of 16 years. Nine children were allowed to attend ordinary elementary schools ; one child was transferred to a residential institution. The school dinners are brought from Gibbons Road Feeding Centre and are served in the School Hall. Practically all of the children take the school dinners. One Trained Nurse is attached to the school. She treats minor ailments as required, 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. 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. The school is 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 this school who are actually crippled attend periodically an Orthopaedic Hospital or an Orthopaedic Department of a General Hospital; and in addition, facilities for treatment of this kind are available at the new Stonebridge Health Centre, where a Specialist visits twice monthly and one full-time Masseuse and one part-time Masseuse are in daily attendance. Convalescence.—Convalescent Homes for children attending the Physically Defective Schools are 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 places for 10 boys and 2 girls. 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 and girls 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 shown a distinct improvement on their return home. In all 48 boys and girls were admitted to the school during the year. The Education Committee have now arranged the reservation of places for 12 girls at St. Patrick's Open Air School, Hayling Island, Hants, and 8 boys at St. Dominic's Open Air School, Godalming, Surrey. The children are selected both from the Physically Defective and the ordinary Elementary Schools, and the duration of stay is six weeks. All the cases sent have shown a definite improvement on their return home. In all 41 boys and 89 girls were admitted during the year. The Education Committee also made arrangements during the course of the year with the Middlesex Edward VII. Memorial Fund for the reservation of four places at Collington Manor, Bexhill, for anaemic and debilitated children. The children are admitted at intervals of six weeks during the months October to May. 8 children were admitted to this Institution during the year. Work of the Willesden Branch of the Invalid Children's Aid Association, 1930.— 102 children were referred by the Health Department to the Invalid Children's Aid Association for convalescence. The majority of these were suffering from anaemia and debility. In addition, surgical appliances were supplied to 21 children. It is to be noted that the work of this Association continuously increases. 181-new cases were referred as against 160 in 1929 and 137 in 1928. 19 Stammering Children.—There are three classes for stammering children held twice weekly at Wesley Road, Percy Road and Kensal Rise Schools, and conducted by Mr. A. D. Bradfield. The class at Percy Road consists of boys, and the classes at Wesley Road and Kensal Rise include both boys and girls. Each class lasts one hour. Cases of stammering are referred to the Health Department for examination as to their suitability for admission to the stammering class. SECONDARY AND TRADE SCHOOLS. During the year the arrangement by which the medical staff of the Willesden Council carry out the inspection of pupils attending Secondary and Trade Schools in Willesden on behalf of the Middlesex County Council has continued. 854 examinations of secondary school pupils have been carried out during the year 1930. 449 defects were found amongst the scholars examined. Parents and Head Teachers are notified of defects and are advised as to the action to be taken. At the end of the year the Middlesex County Council was in negotiation with the Willesden Council with respect to a scheme of treatment for defective vision and dental defects. PROVISION OF MEALS. 119,831 meals were supplied in 1930 as compared with 98,104 in 1929. The recipients of these meals are mainly children of the unemployed, widows and deserted wives. HOME NURSING SERVICE. The Home Nurse employed by the Council nursed 360 cases during the year, and in connection with such cases paid 3,714 visits. 1,148 of these visits were paid in the South Kilburn Ward, 535 in the Mid-Kilburn Ward, 447 in the North Kilburn Ward, 396 in the Kensal Rise Ward, 342 in the Harlesden Ward, 280 in the Cricklewood Ward and smaller numbers in the other wards of Willesden. Of the 360 cases nursed during the year, 351 were new cases. 198 of these 351 new cases were referred by the Health Department for nursing, 32 by private doctors and 121 by Hospitals, Associations and private persons. Circumcision cases referred from Hospitals received 256 visits. Ophthalmia neonatorum received 218 visits and other ophthalmia cases 317 visits. SANITARY WORK. The number of houses in Willesden at the end of 1930 was 29,736. During the year the total number of inspections and re-inspections made by the Sanitary Staff was 26,975 as compared with, 23,713 in 1929. The houses inspected under the Housing Acts numbered 969, as compared with 1,281 in 1929. The number of complaints received, 2,827, is higher than last year. The total number of Notices issued and nuisances abated were 6,218 and 23,159 respectively. Work done under the Housing Acts is shown in the tabular statement in the body of the report. Of the twelve houses closed as unfit for human habitation in 1925, three are still in occupation. Smoke.—The nuisance caused by the emission of grit from the use of pulverised fuel at a large generating station continued off and on during the year. In 1928 the Company gave an undertaking to adopt measures to abate the nuisance and in the latter part of 1929 the necessary building was completed and the apparatus installed. During the year alterations and modifications of this apparatus were carried out with a view to improving its efficiency. Early in 1931 an official test was arranged. Representatives of the Department of Scientific and Industrial Research were present on behalf of the Council. Noise.—Noise and grit nuisance from a mechanical coal tipping plant belonging to and situate on Railway Company's property was the subject of a complaint from nearby residents. This matter is fully dealt with in Appendix J. PUBLIC MORTUARY. During the year there were 121 admissions to the Mortuary ; 27 of these were admitted for accommodation only ; 36 were admitted for an inquest only ; 47 were admitted for a post-mortem only ; and 11 were admitted for post-mortem followed by an inquest. The total number of post-mortems performed during the year was 58. 20 The doctors who have performed these post-mortem examinations have almost invariably expressed their satisfaction with the new arrangements now existing for post-mortem examination. It is also worthy of record that the undertakers bringing bodies merely for accommodation have equally expressed their appreciation of the better conditions now obtainable at the Mortuary. MOTOR AMBULANCE SERVICE. The demands on the Motor Ambulance Service continue to increase. During the year 5,016 calls were made for the Council's ambulances as compared with 4,728 in 1929, and 3,956 in 1928. Altogether 125,528 miles were run in 1930 as compared with 111,338 in 1929, and 103,587 in 1928. Approximately 290 defective children are on the lists for daily conveyance by the Council's school ambulances to and from school. The detailed report of the 16th year of working of the Motor Ambulance Service appears as Appendix C. MUNICIPAL HOSPITAL. The 39th Annual Report on the Municipal Hospital written by Dr. Troup appears later in this report. There are certain features of this report which are worthy of attention. The first is that the average duration of stay of patients suffering from scarlet fever has been reduced to 32-9 days. This result is very satisfactory. It has always seemed to me that generally uncomplicated cases of Scarlet Fever should be released from isolation 28 days after onset. When I came to Willesden in 1912, the average duration of stay of scarlet fever cases in hospital in that year was 51 days. During the War years when I was in clinical charge of the patients I made an effort to reduce the stay in hospital, and in 1916 got it down to 36 days. Since the termination of the War the average duration of stay has varied up to nearly 46 days, but during the last 4 years the average duration of scarlet fever cases in hospital has been under 40 days. The figure for this year, namely 32.9 days, represents to my mind what should generally be about the average duration of scarlet fever cases in hospital, where a large number of cases are treated, and taking into account the complications which arise in connection with this disease. Dr. Troup's report dealing with active immunisation against diphtheria is particularly interesting. He shows that as a result of the immunisation of nurses only 4.1 per cent, cases of diphtheria now occur amongst probationers, as against 45 per cent, in the pre.immunisation days. He is hopeful that even this 4.1 per cent, can be eliminated if it were not necessary from time to time to put on probationer nurses in the diphtheria wards before their period of immunisation had been completed. This method of protection against diphtheria is safe and sure and it is unfortunate that the public do not make greater use of the facilities offered to their children for protection against diphtheria—a relatively fatal disease. The cubicle pavilion, the necessity for which I first called the attention of the Council to in 1920, has now been working for the full period under review. During 1930 a total of 137 cases were treated in the cubicle pavilion without any cross infection. This is a very satisfactory result having regard to the large variety of infectious diseases which have been treated in this cubicle pavilion during the year. FEATURES OF THE YEAR'S WORK. Stonebridge Health Centre.—A special feature of the year's work was the opening of the Stonebridge Health Centre on April 8th, 1930, by the Minister of Health, the Rt. Hon. Arthur Greenwood. This Centre has been specially designed for the purpose of maternity and child welfare and school medical work, and is one of the very few centres in this or any other country specially built for this combination of work. The arrangements whereby the varieties of work coming under the above headings are combined lead to great economy in working. General Medical Work.—It was anticipated that the opening of this Centre would increase the work of the department by something like 25 per cent., but although the Centre was only in full operation for barely half the year, the general medical work of the department has gone up by over 33 per cent., the total clinic attendances during 1930 having been 133,189 as compared with 98,991 in the previous year. Dental Work.—This increase includes an increase in dental work for mothers and children under 5, and school children, by practically 100 per cent., as the dental staff has been doubled. Artificial Light Treatment.—Included in the above figures is also an increase of 100 per cent, in Artificial Light treatment, as this department is now available for the whole of the Urban District of Willesden. Prior to the opening of the Stonebridge Health Centre it was only available for half the area of Willesden at Health Centre (1). 21 Orthopedics.—There has also been established in connection with the Stonebridge Health Centre a new department of work, namely, orthopaedic work. At this Orthopaedic Clinic an Orthopaedic Surgeon, who is also the Medical Superintendent of the country branch of the Royal National Orthopaedic Hospital at Stanmore, attends twice a month and gives directions as to the treatment to be pursued. The treatment is carried out by a specially trained orthopaedic nurse. The attendances at this Orthopaedic Centre have been so great that it has been necessary for the Council to employ a second orthopaedic nurse for the purpose of carrying out the remedial exercises, massage and electrical treatment which are given for the many cases of paralysis, and greater or less deformities which attend. Any case which the surgeon finds requiring in-patient treatment, for example, some operative procedure in order to correct a deformity, is referred by him to the country branch of the Royal National Orthopaedic Hospital at Stanmore, where the case is under his direct supervision. The importance of continuous supervision by the same orthopaedic surgeon cannot be over emphasised. New Methods.—In addition to the extension of work, as indicated above, there have been new methods introduced of carrying out work previously undertaken. Eye Work.—Eye work for school children is now wholly undertaken by a specialist medical officer, namely, Mr. Law, who was appointed by the Council on March 25th, 1930. Mr. Law has only been on duty during 8 months of the year, but during the whole year 976 cases have been dealt with by refraction as compared with 604 in the previous year. This is a satisfactory result, as I have been of opinion for some time that there was a greater amount of leakage than was desirable in connection with eye rases. Mr. Law's report on his work during the year appears as Appendix E. Dental Anaesthesia.—Another arrangement which was introduced concurrently with the opening of the Stonebridge Health Centre was the administration of anaesthetics by a specially qualified medical man. For this purpose Dr. Jarman was appointed. His duty is to give anaesthesia in connection with dental cases. The dentists report that his methods of administration of anaesthesia are much superior to the old methods, whereby gas was given by various medical officers in rotation. The dentists state that they are now able to carry out their work with the patients under complete anaesthesia, and without having to watch the condition of the patients, as this is carefully attended to by Dr. Jarman. Dr. Jarman's report on his work is included with the report on dental work by Mr. Jennings. Local Government Act, 1929 (Supervision of Midwives, Infant Life Protection).— The operation of this Act has led to additional work being taken over by the Council, with a consequent increase in the work to be undertaken by the Health Department. I refer notably to the Supervision of Midwives and Infant Life Protection, reports on which appear in the body of this report. The Supervision of Midwives and of Nursing Homes and Infant Life Protection are important work so far as the Willesden Council, as a Maternity and Child Welfare authority is concerned, and tend to make complete under one authority all matters relating to maternity and child welfare. Registration of Nursing Homes.—In addition the work of Registration and Supervision of Nursing Homes has been added to the department, and is likewise specially dealt with in the body of the report. Housing Act, 1930.—This Act came into operation on 16th August, 1930. The object of the Act is to remove insanitary areas, called clearance areas, and to ameliorate the conditions in other insanitary areas, called improvement areas, and to abate overcrowding. In short, the Act makes for the abolition of slums and the prevention of slums. It places considerable duties upon the Council, and the action to be taken in respect of suitable areas of Willesden will require careful consideration during the course of the year. Your obedient Servant, GEORGE F. BUCHAN, Medical Officer of Health. 22 THE FIFTY-FIFTH ANNUAL REPORT FOR THE Year ended 31st December, 1930, ON THE HEALTH AND SANITARY CONDITION OF THE URBAN DISTRICT OF WILLESDEN. GENERAL STATISTICS. Area (acres) 4,384 Population (estimated Midsummer, 1930) 179,368 Population Census (1921) 167,200 Number of inhabited houses (Census, 1921) 23,719 Number of families or separate occupiers (Census, 1921) 41,235 Rateable value £1,258,304 Sum represented by a penny rate £5,296 (Approx.) EXTRACTS FROM VITAL STATISTICS OF THE YEAR. Births— Total. Legitimate *2,776 Birth Rate (R.G.) 17.45 Illegitimate +93 Death Rate (R.G.) 10.03 Deaths +1,762 * (R.G.) 2,869. tH2. t 1,730. Number of women dying in, or in consequence of, childbirth from sepsis 3 from other causes 8 Death Rate of Infants under one year of age per 1,000 live births :— Legitimate ... 56 Illegitimate 204 Total 60.99 Deaths from Measles (all ages) 26 ,, ,, Whooping Cough (all ages) 5 „ „ Diarrhoea (under 2 years of age) 26 Stillbirths registered 95 Stillbirth rate per 1,000 births 32.05 Table No. 9. NOTIFIABLE DISEASES DURING THE YEAR. Disease. Total Cases Notified. Cases admitted to Willesden Municipal Hospitals. Total Deaths. Diphtheria 491 457 19 Scarlet Fever 518 439 3 Enteric Fever (including Paratyphoid) 10 7 1 Puerperal Fever 5 2 3 Puerperal Pyrexia 34 3 — Pneumonia 266 3 122 Small Pox 9 8 — Cholera — — — Plague — — — Erysipelas 81 20 10 Typhus Fever — — — Relapsing Fever — — — Continued Fever — — — Cerebro-spinal Meningitis 3 1 5 Poliomyelitis 4 — 5 Ophthalmia Neonatorum 38 2 — Malaria 2 — — Dysentery — — — Encephalitis Lethargica 3 1 3 Acute Polio-Encephalitis 5 — — Anthrax — — — Tuberculosis:— (a) Pulmonary 258 — 124 (b) Non-Pulmonary 73 — 14 Whooping Cough 229 6 5 23 Table No. 10. TUBERCULOSIS. Age-Periods. New Cases. Deaths. Pulmonary. Non-Pulmonary. Pulmonary. Non-Pulmonary. M. F. M. F. M. F. M. F. 0 0 0 3 1 0 0 1 0 1 0 1 11 8 0 0 1 4 5 1 2 10 4 1 1 0 1 10 4 2 4 3 0 0 1 0 15 14 13 6 4 3 7 0 1 20 15 31 2 5 7 13 1 1 25 32 31 5 2 15 17 0 1 35 30 23 1 0 15 6 0 0 45 25 10 1 2 20 3 0 1 55 17 0 0 1 8 1 0 0 65 and upwards 4 3 0 0 4 3 1 0 Totals 142 116 43 30 73 51 5 9 The ratio of non-notified tuberculosis deaths to total tuberculosis deaths was 1 : 4. When a death from tuberculosis is registered and no record of notification is found, a letter is sent to the medical practitioner certifying the death, asking for his reasons, and the answers have in all cases proved satisfactory—the medical practitioner having believed that the case had previously been notified. PUBLIC HEALTH (PREVENTION OF TUBERCULOSIS) REGULATIONS, 1925. No case was dealt with under the above regulations during 1930. PUBLIC HEALTH ACT, 1925. SECTION 62. Removal to hospital of infectious persons suffering from pulmonary tuberculosis. No action was taken under this section during 1930. Table No. 11. 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. Remarks. Hospital . Clinic. Private Dr. Home Nurse Attend ing. No Defect. One Eye Perman ently Injured. Both Eyes Perman ently Injured. 38 18 13 7 9 » 13 16 17 38 – – – – 24 SUMMARY OF NURSING ARRANGEMENTS, HOSPITALS AND OTHER INSTITUTIONS. AVAILABLE FOR THE DISTRICT. 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 primarily to nurse grant earning cases under the Maternity and Child Welfare regulations. [Grant-earning cases are : Nursing of expectant mothers, maternity nursing, nursing of puerperal fever, puerperal pyrexia, measles in young children, whooping cough in young children, epidemic diarrhcea in young children and ophthalmia neonatorum.] The Nurse is provided on application to the Matron, Municipal Centre (1), 9, Willesden Lane, Kilburn, N.W. 6; or to the Matron, Municipal Centre (2), 381, High Road, Willesden, N.W. 10, or to the Matron, Municipal Centre 3, Harrow Road, Stonebridge, N.W. 10. The Council's Nurse acts under the direction of the Medical Practitioner in attendance upon the case. (ii.) Willesden District Nursing Association (in affiliation with the Queen Victoria's Jubilee Institute for Nurses) was established in October, 1926, for the purpose of providing visiting nurses for the sick and infirm in all classes of the community. The address of the Association is 19, Park Avenue, N.W. 2. (iii.) 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, and by the Willesden District Nursing Association, to which the Council made a grant of £52 10s. in 1930 in respect of this work. 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 lis. 6d., but for a first confinement, £2 2s. In accordance with Section 10 of the Midwive's Act, 1902, 32 Midwives gave notice in the month of January, 1931, of their intention to practise in Willesden. CLINICS AND TREATMENT CENTRES. Name. Situation. Nature of Accommodation. By whom provided. Work Undertaken. Municipal Centre (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 Artificial Sun- Municipal Centre (2) 381, High Road, Willesden, N.W. 10 Ditto Ditto > light Clinic at Centres (1) and (3), Orthopaedic Clinic at Centre (3), Cancer Clinics at Centres (1) and (2) Municipal Centre (3) Harrow Road, Stonebridge, N.W. 10 Health Centre specially designed, built and equipped for Modern Health work Ditto Diphtheria Immunisation J at Centre (1). Health Department 54, Winchester Avenue, N.W. 6 Suitably equipped Medical Officer's room Ditto Examination of abnorma 1 children Tuberculosis Dispensary Pound Lane, Willesden, N.W. 10 — Middlesex County Council Tuberculosis Dispensary. 25 CLINICS AND TREATMENT CENTRES—Continued. Name. Situation. Nature of Accommodation. By whom provided Work Undertaken. 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—Art ificial Light Treatment. 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. 26 Name of Hospital or Institution. Situation. Purpose. No. of Beds available. If also used by Persons outside the area. Management. In the case of Hospitals under the control of the Local Authority, the number and classification of Medical and Nursing Staffs and arrangements for employment of Consultants. County Sanatorium Harefield, Middlesex Sanatorium — Yes Middlesex County Council — — Clare Hall Sanatorium South Mimms, Middlesex Sanatorium — Yes Middlesex County Council — — Park Royal Hospital Acton Lane, N.W. 10 General, Maternity, Children — Yes Middlesex County Council — In 1930 the Willesden Council sent Maternit} cases to this Hospital under its Maternity anc Child Welfare Scheme by arrangement with the Middlesex County Council. Willesden Municipal Hospital Brentfield Road, Neasden, N.W. 10 Infectious disease 132 No Willesden Urban District Council 1 Medical Superintendent 1 House Surgeon 1 Matron with Sisters, Staff Nurses and Probationers — Willesden Maternity Hospital Kingsburv, N.W. 9 Maternity 26 No Willesden Urban District Council 1 Consultant Obstetrician (part time) 1 House Surgeon 1 Matron, with Sisters, Staff Nurses and Probationers Opened 14th Feb., 1931 St. Monica's Home Hospital 16, Brondesbury Park, N.W. Children — Yes Voluntary Agency — 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, N.W. For boys aged 5-14 years suffering from heart disease and rheumatism Yes Voluntary Agency (Invalid Children's Aid Association) — Willesden General Hospital Harlesden Road, N.W. General — Yes Voluntary Agency — The Willesden Council sends cases of Enlargec Tonsils and Adenoids, Deflected Nasa Septum and Marasmus to this Hospital under its Maternity and Child Welfare anc School Medical Service schemes, by arrangement with the Committee of the Hospital. St. Andrew's Hospital Dollis Hill, N.W. General — Yes Voluntary Agency — Adjacent London Hospitals are also available for Willesden. In respect of orthopaedic conditions in children under 5 years of age and Public Elementary School Children the Council has made arrangements for in-patient treatment at the Royal National Orthopaedic Hospital and its Country Branch at Stanore. 27 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 (Middlesex County Council) and 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 ambulance. lb) For non-infectious cases and accident cases— 2 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 is in operation but it is only partial as there is only one driver on duty and any calls received when he is out cannot be dealt with. A detailed report on the service for the financial year 1929-30 will be found in Appendix C. LABORATORY WORK. Pathological and Bacteriological Examinations. The agreement entered into by the Council on the 1st February, 1925, is still in operation. The provisions of the agreement are set out on page 23 of the Annual Report of the Medical Officer for 1927. The following table shews the examinations made during the year 1930 :— Table No. 12. Nature of Specimens examined. Positive Result. Negative Result. Total. 1. Swabs for Diphtheria Bacilli 701 4,306 5,007 2. Swabs for Diphtheria. (Virulence Tests.) 17 32 49 3. Blood for Widal Reaction 3 26 29 4. Sputum for Tubercle Bacilli 98 468 566 5. Swabs for Gonococci 11 6. Swabs from Eye 14 7. Blood Culture 1 8. Films for Gonococci 2 9. Cerebro-Spinal Fluid 10 10. Fluid for Tubercle Bacilli 2 11. Fluid from Pleural Cavity 5 12. Faeces for Organisms 11 13. Urine 12 14. Vaginal Discharge 18 Grand Total 5,737 Table No. 13.—Sources of Specimens Examined. From Willesden Municipal Hospital 2,197 From Private Practitioners 2,010 From Municipal Health Centres and Health Nurses 1,218 From Park Royal Hospital 299 From other Hospitals 13 Total 5,737 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 ; further parts adopted 18.9.1911 ; further parts adopted 9.4.1928 Public Health Acts Amendment Act, 1907, Part VI. Adopted 1925. *Public Health Act, 1925. 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). Revised and Adopted 26.7.1927 *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. New Streets and Buildings (Public Health Act, 1875, s. 157 and Public Health Acts Amendment Act, 1890, s. 23). Revised and adopted 1.5.28. New Sewers (Willesden Local Board Act, 1887). Adopted 9.10.1888. Pleasure Grounds (Public Health Act, 1875, s. 164). Adopted 28.1.1896. *Rag and Bone Dealer (Public Health Act, 1875 s. 113). Adopted 29.9.1908. For the Regulation of Black Smoke (Public Health (Smoke Abatement) Act, 1926, s. 2). Adopted 22.5.30. Local Regulations :— 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, and amended to conform with Section 18, Housing Act, 1925. * 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. Rivers and Streams— The River Brent forms the Northern and Western boundary of the district. The Mitchell Brook, a tributary of the Brent, is a small stream running in a westward direction through the district. A large sheet of water known as the Welsh Harp is formed at the extreme northern boundary by the damming up of the Brent, thus forming a reservoir about a mile in length and about a quarter of a mile in width, or 160 acres in extent. The boundary line between Willesden and Kingsbury Urban Districts passes through the length of this reservoir, leaving an area of about 68 acres of it in Willesden. No pollution of any of these waters in the WTillesden area came under the notice of the Health Department during the year. Closet Accommodation— All 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. 29 Every house in the district is called at once each week. Electrically operated vehicles are used. Quite 99 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 few 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, Willesden. It is conveyed in barges down the Canal, unloaded by the Contractor and deposited on land immediately adjoining the Canal, where it is dealt with under the Controlled Tipping system. The system of dumping road sweepings at given points and later collecting by carts has been discontinued. The sweepings are now deposited in bins and conveyed in street orderly trucks to given positions where they are emptied into motors and taken to barges. Sanitary Inspection of the Area. Tabular summary of the work oj the Sanitary Department during the year and action taken und the Public Health Acts, Housing Acts, etc. Inspections : Number of premises inspected on complaint 2,827 Number of premises inspected in connection with infectious diseases 71 Number of premises under periodical inspection 2,782 Houses inspected from House to House (Housing Acts) 969 For Certificates under the Rent Acts 8 Public House Urinals 381 Mews and Stables 466 Miscellaneous 239 Total number of inspections and re-inspections made 26,975 Action under Rent and Mortgage Interest (Restriction) Acts, 1920-25. Number of applications received for Certificates 8 Number of Certificates granted... 4 Action Taken (under Housing Acts and Health Acts) : Notice to Inspect (Section 127, Housing Act, 1925) 2,862 Cautionary or Intimation Notices Issued 3,352 Number complied with 2,646 Statutory Orders issued 387 Number complied with 317 Summonses served 8 Number of convictions obtained 7 Summonses withdrawn 1 „ dismissed 0 Houses Let in Lodgings (Tenement Houses) : Number registered under Bye-laws 0 Number of contraventions 0 Common Lodging Houses : Number registered under Bye-laws 1 Number of Inspections made 20 Number of contraventions 5 Number remedied 5 Canal Boats used as Dwellings : Number of contraventions of Regulations 4 Number remedied 3 Movable Dwellings, Caravans, Tents, &c. : Number observed during the year 9 Number of nuisances therefrom abated 2 Number removed from district 5 Bakehouses : Number in district 58 Number of Inspections 171 Contraventions of Factory Acts 23 Contraventions remedied 19 Slaughter-houses: Number on register 7 Inspections of carcases, etc. 344 Contraventions of Bye-laws 1 Contraventions remedied 1 30 Cowsheds: Number on register 1 Number of inspections made 12 Contraventions of regulations 1 Contraventions remedied 1 Number of milch cows in district 5 Dairies and Milkshops : Number on register 200 Number of inspections made 256 Frequency of inspection half-yearly Contraventions of regulations 11 Contraventions remedied 11 Unsound Food: Meat (including organs) surrendered 116 lbs. Fish (wet and dried) surrendered 663 lbs. Fruit and vegetables surrendered 188 lbs. Bacon surrendered 638 lbs. Tinned and Cooked Meat surrendered 301 lbs. Tinned and Evaporated Milk surrendered 175 lbs. Tinned Fish surrendered 35 lbs. Tinned fruit surrendered 30 lbs. Total 2,146 lbs. Method of disposal Destroyed. Offensive Trades: Number of premises in district (Rag and Bone Dealers) 7 Number of inspections made 33 Contravention of Bye-laws 1 Contravention remedied 1 Water Supply and Water Service : Percentage of houses supplied on constant system 100 Cisterns:— New provided 35 Cleansed, repaired, covered, etc 495 Draw-taps placed on mains 49 Drainage and Sewerage of existing Buildings : Water Closets:— Number of water closets substituted for dry receptacles 0 Repaired, supplied with water or otherwise improved 612 Additional Closets constructed 23 Percentage of houses provided with water closets 100 Drains:— Examined, tested, exposed, etc. 439 Unstopped, repaired, trapped, etc. 266 Waste pipes, rain-water pipes, disconnected, repaired, etc 526 New soil pipes or ventilating shafts fixed 161 Existing soil pipes or ventilating shafts repaired 247 Disconnecting traps or chambers inserted 279 Re-constructed 109 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 773 (b) Phthisis 60 Articles disinfected or destroyed:— (а) Ordinary infectious diseases 877 (b) Phthisis 226 Dust: New bins provided 927 Periodical frequency of dust removal weekly Method of disposal By tipping and barging 31 Sundry Nuisances abated: Overcrowding 26 Smoke 3 Accumulations of refuse 159 Foul ditches, ponds, etc., and stagnant water 19 Fowls, pigs, and other animals 36 Dampness 677 Yards and forecourts paved, repaved or repaired 662 Walls and ceilings cleansed 6,386 Verminous rooms purified 238 Leaky roofs made watertight 1,005 Additional ventilation provided under floors 328 Dilapidated plaster repaired 2,216 Flooring and other woodwork repaired 1,223 Damp-proof courses inserted 114 Water supply reinstated 68 Washhouse floors repaired or repaved 503 Fireplaces and stoves repaired 788 Decayed brickwork repaired and repointed 766 Sinks provided or replaced 52 Additional light and ventilation to staircases 17 Larders or food cupboards provided or ventilated 48 Gutters and rainwater pipes repaired 1,010 New sash cords and glass provided to windows 2,625 Smoke observations 84 Miscellaneous 464 Total number of Nuisances Abated 23,159 Inspections of Premises where Food is prepared : Butchers', Provision, and General Shops 612 Fish shops 260 Eating houses 66 Greengrocers' shops 86 Ice-cream premises 57 Stalls 466 Canal Boats Acts, 1877-1884.—The number of boats inspected during the year 1930, was 19 (23 inspections). The following infringements of the Regulations were observed and Notices given to the owners:— Marking not legible 1 Boat not registered 1 Master without certificate 2 Three contraventions were remedied. One is outstanding. No legal proceedings were taken during the year. No case of Infectious Disease has been notified or traced, and no boats were detained for cleansing or disinfection. The Willesden Urban District Council is not a Registration Authority. Offensive Trades.—There are 7 Rag and Bone Dealers carrying on this business in the district, all complying with the Bye-laws. Underground Sleeping Rooms.—There are 723 houses with basements and approximately 400 rooms are used as sleeping apartments. The Regulations of the Council governing this class of property were amended to conform to Section 18, Housing Act, 1925. Disposal of the Dead.—The Council at present own a cemetery within the district and it is estimated that a further 7,860 grave spaces could be laid out before that cemetery is full; the average number of burials therein annually for the past ten years has been approximately 1,350. The Council realising that the accommodation of their present cemetery will within a few years be exhausted purchased a site in the Kingsbury Urban District practically abutting on the north-western boundary of the district. There are two Jewish cemeteries situate in the district, one in Beaconsfield Road and another in Pound Lane, and it is estimated there are sufficient grave spaces to last approximately 30 and 65 years respectively before these cemeteries are full. Schools.—The whole of the schools in Willesden have a good and sufficient water supply and sanitary accommodation. Rag Flock Acts, 1911-28.—There are no premises in the district on which rag flock is manufactured, and no sampling under these Acts has been carried out during the year. 32 HOUSING. The total number of houses in Willesden is 29,736. The following table shews building activities during the periods stated :— Table No. 14. Year. For working classes. Not for working classes. Total. Houses erected by the Council. Houses erected by private enterprise. Houses erected by private enterprise. 1921-25 261 65 909 1,235 1926-29 716 1,172 2,269 4,157 1930 21 450 465 936 Total for 10 years 998 1,687 3,643 6,328 Activity in the erection of smaller houses in the Northern part of the district continues. HOUSING STATISTICS FOR THE YEAR 1930. Number of New Houses erected during the Year:— (a) Total (including numbers given separately under (6)) : (i.) By the Local Authority ' 21 (ii.) By other Local Authorities Nil (iii.) By other bodies and persons 915 (b) With State assistance under the Housing Acts :— (i.) By the Local Authority. (a) For the purpose of Part II. of the Act of 1925 Nil (b) For the purpose of Part III. of the Act of 1925 Nil (c) For other purposes Nil (ii.) By other bodies or persons Nil 1.—Inspection of Dwelling-houses during the Year:— (1) Total number of dwelling houses inspected for housing defects (under Public Health or Housing Acts) and the number of inspections made 3,796 (2) Number of dwelling-houses (included under sub-head (1) above) which were inspected and recorded under the Housing Consolidated Regulations, 1925, and the number of inspections made 969 (3) Number of dwelling-houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation 0 (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 69 2.—Remedy of Defects during the Year Without Service of Formal Notices. Number of defective dwelling-houses rendered fit in consequence of informal action by the Local Authority or their officers 2,541 3.—Action Under Statutory Powers during the Year. A. Proceedings under section 3 of the Housing Act, 1925 (and Sec. 17, 1930). (1) Number of dwelling-houses in respect of which notices were served requiring 56 repairs (2) Number of dwelling-houses which were rendered fit after service of formal notices :— (а) By owners 63* (б) By Local Authority in default of owners 4 (3) Number of dwelling-houses in respect of which Closing Orders became tive in pursuance of declarations by owners of intention to close 0 * Includes a certain number outstanding in 1929. 33 B. Proceedings under Public Health Acts. (1) Number of dwelling-houses in respect of which formal notices were served requiring defects to be remedied 173 (2) Number of dwelling-houses in which defects were remedied after service of formal notices :— (a) By owners 168* (b) By Local Authority in default of owners 11 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 0 (2) Number of dwelling-houses in respect of which Closing Orders were made 0 (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 **2 * Includes a certain number outstanding in 1929. ** Demolition Orders made in 1928. HOUSING CONDITIONS. 1. General Observations as to Housing Conditions.—The housing conditions in Willesden vary greatly. In some parts of the area the houses are of good 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 some other parts of the area better housing conditions prevail, but owing to the overcrowded state of many properties and the consequent considerable usage constant visits by the Sanitary Inspectors are necessary to maintain them in a fair state of repair. There are approximately :— 3,110 houses over 50 years old. 5,040 „ between 40 and 50 years old. 7,880 „ „ 30 and 40 „ „ 6,730 „ „ 20 and 30 „ „ 890 „ „ 10 and 20 „ „ 6,070 ,, built within the last 10 years. The general character of the defects found to exist in unfit houses are :—Dampness of walls, caused by absence of or perished damp-proof courses, earth or other deposits above damp-proof courses, defective gutters and rain water pipes; leaky roofs; absence of or defective paving of yards; defective or perished plastering; choked or defective drains; windows—perished woodwork; defective ventilation; staircase—worn out treads; floors—worn out floor boards; dirty and uncovered cisterns; grates and ranges broken and unusable; W.C.'s insufficiently supplied with water; offensive accumulation or deposits in yards; insufficient food storage accommodation; woodwork generally perished and brickwork generally perished or pointing defective. 2. Sufficiency of Supply of Houses.—(a) 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 working classes. During the past 10 years, 2,695 houses have been erected for persons of the working classes, namely, 1,008 by the Council and 1,687 by private enterprise. Of this latter figure practically all were built for sale and from information received from the builders, at least 50 per cent, were sold to purchasers other than Willesden residents. (b) The erection of factories in the North-East and South-West areas has increased the number of the artisan classes requiring accommodation. (c) It is estimated there are approximately 80 acres of building land available within the District of which the Council has recently acquired 15 acres for housing purposes. The remainder has been purchased by private concerns who are erecting properties for sale only. 3. Overcrowding.—(a) Extent. It is practically impossible without taking a census of the population to state definitely the extent to which overcrowding exists, and it is also difficult to form a reliable estimate. (b) Causes. Vacant houses or rooms to be let are few, and insufficient to cope with the demand, with the result that rents charged are correspondingly high and beyond the means of the average worker, many of whom are unemployed, which leads to sub-letting. (c) Six overcrowded families were allocated accommodation on the Council's estates. 4. Fitness of Houses.—(a) No great difficulty arises in working the Public Health Acts or Housing Acts excepting:— (1) Delays are occasioned by work being carried out in a piece-meal manner, necessitating frequent visits by the Sanitary Inspectors before the work is finally completed. (2) The absence of any standard—the Officers of the Council having to accept indifferent workmanship, which although remedying the defects, is not of a lasting character, so that these defects recur within a short time. 34 (b) It has not been necessary to make any special arrangements for the gradual carrying out of repairs. The Council do work in default and where desired allow repayment by instalments. (c) All houses in the District have an internal water supply from the mains of the Metropolitan Water Board. (d) All houses have water closet accommodation within their own curtilage. Under the Willesden Urban District Council Act, 1903, the Council are empowered to call upon owners to provide proper and sufficient water closets ; this power is used whenever necessary. 5. Unhealthy Areas. No area was dealt with as an unhealthy area during the year. 6. Byelaws relating to Houses let in Lodgings, and to Tents, Vans, Sheds, etc. Byelaws were made by the Urban District Council of Willesden with respect to houses intended or used for occupation by the working classes and let in lodgings or occupied by members of more than one family, on the 26th July, 1927. These were allowed by the Minister of Health on 18th April, 1928. Up to the present no staff has been appointed to administer these byelaws. With the exception of a van which halted for a few weeks, Willesden has not been troubled by van dwellers. The necessity for byelaws relating to van dwellers has not arisen. GENERAL OBSERVATIONS ON HOUSING MATTERS NOT ALREADY COVERED. 7. One of the difficulties experienced in cases of overcrowding is to control vacated premises from which the Council has removed a family, the owners frequently reletting the rooms at a higher rental, thus creating similar conditions to those just remedied. New tenants to meet the increased rentals resort to subletting. INSPECTION AND SUPERVISION OF FOOD. Milk Supply.—There are 2 wholesale dealers, 198 retail milk purveyors, and 1 cowkeeper in this district. Their premises and utensils are frequently inspected. The following table shows the number of licences granted for the sale of graded milk under the Milk (Special Designations) Order, 1923, during the year 1930 :— Table No. 15. (a) "Certified" milk 12 (b) "Grade A (Tuberculin Tested) " milk 20 (c) "Grade A (Tuberculin Tested) " Bottling Establishment 1 (d) "Grade A" milk 4 (e) "Pasteurised" milk 19 (/) "Pasteurisers" 2 There were no refusals or revocations of licences under the Milk (Special Designations) Order, 1923, during the year. One application for registration as a dairyman and for the registration of certain premises for use as a dairy was refused ; the applicant failed to show that the public health would not be likely to be endangered by the registration of the premises as a dairy. The following Table gives the result of examination of samples of designated milk taken during the year 1930 :— Table No. 16. No. of Sample. Designation. No. of Bacteria per 1 c.c. Remarks. D/73 "Pasteurised" 25,000 Passes D/74 "Pasteurised " 90,000 Passes D/75 "Pasteurised " 38,000 Passes D/76 "Pasteurised " 94,000 Passes D/77 "Pasteurised " 34,000 Passes D/78 "Pasteurised " 78,000 Passes D/79 "Pasteurised " 48,500 Passes D/80 "Pasteurised" 73,000 Passes D/81 "Certified " 42,000 Fails D/82 "Pasteurised" 28,000 Passes D/83 "Grade A (Tuberculin Tested)" 52,000 Passes D/84 "Pasteurised" 22,000 Passes D/85 "Grade A (Tuberculin Tested)" 850 Passes D/86 "Pasteurised" 5,100 Passes D/87 "Grade A (Tuberculin Tested)" 310,000 Fails D/88 "Grade A (Tuberculin Tested)" 3,440 Passes D/89 "Pasteurised " 12,000 Passes 35 Sample No. D/81, which was taken from a large multiple firm did not pass the bacterial standard required for "Certified " Milk, having more than 30,000 bacteria per cubic centimetre. The matter was reported to the Minister of Health. Sample No. D/87, which was taken from a large milk depot in Willesden, did not pass the bacterial standard required for "Grade A (Tuberculin Tested)" Milk, having more than 200,000 bacteria per cubic centimetre. A communication was sent to the firm calling their attention to the unsatisfactory sample and asking them to take steps to discover the causes and to remedy them if due to any default of their own or to arrange with the producer to do so if the latter was responsible. A reply was received stating that the firm were taking every precaution to ensure milk being supplied in accordance with the regulations of the Minister of Health. Further samples are to be taken from this firm. 49 Samples of Milk were taken during the year for examination for the presence of tubercle bacilli under the Milk and Dairies (Consolidation) Act, 1915. 3 samples (Nos. 0/165, 0/181 and 0/183) were found to contain tubercle bacilli and action was taken resulting in the examination of the herds at the supplying farms. In the case of Sample No. 0/165, 3 samples of milk, 2 from individual cows and a bulk sample from the rest of the herd, were submitted to the bacteriologist. He certified one of the individual samples to contain living tubercle bacilli and the cow was slaughtered. The other 2 samples were found to be negative. In the case of Sample No. 0/181, the animals at the producer's farm were examined. Samples of milk (2 single and 4 mixed) were taken, covering the whole of the animals on the farm ; these proved negative on innoculation test. Further enquiry showed that during the month preceding the Veterinary Surgeon's visit, a cow in milk was removed from the farm to the premises of a butcher, where it was slaughtered and passed fit for human consumption. In the case of Sample No. 0/183, 5 cows were individually sampled. In addition, a bulk sample was taken from the remainder of the herd. In consequence of the examination, notices restricting the sale of milk from 3 cows were immediately served on the owner. The animal innoculation tests revealed living tubercle bacilli in the milk of one cow. This cow was reported to the Diseases of Animals Acts Authority, for action under the tuberculosis order. In 44 instances the result of the examination proved negative. In 2 instances the guinea pig innoculated with the sample of milk succumbed to an acute infection by some organism contained in the milk other than tubercle bacilli. Meat Inspection.—The Inspectors visit the slaughter-houses at the times set apart for slaughtering and examine the carcases and organs for evidence of disease. Shops and stalls are also kept under close observation. The number of private slaughter-houses in use in the area at the dates mentioned was :— Table No. 17. In 1920. In December, 1925. In December, 1930. Registered 4 4 3 Licensed 5 4 4 Total 9 8 7 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 in the district were inspected on 171 occasions, Notices being served in 23 instances for minor contraventions of the Factory and Workshop Acts. Food and Drugs Acts.—These Acts are administered by the Middlesex County Council and 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 1930:— 36 List of Samples taken During the Year ended 31st December, 1930. Article. Taken. Adulterated. Milk 620 9 Milk, Sterilized 14 2 Cream 3 — Butter 14 — Bacon 6 — Icing Sugar 3 — Margarine 2 — Minced Beef 14 3 Meat 79 8 Rum 2 — Sausages 27 6 Meat, Cooked 1 — Gin 10 1 Whisky 4 — Saeurkraut 1 — 800 29 Number of Prosecutions, 8. Number of Convictions, 7. Case Pending 1. Public Health (Condensed and Dried Milk) Regulations, 1923. Inspections were made under these Regulations in order to see that the requirements with respect to labelling were complied with, but no infringements were discovered. 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. 19. 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) 254 43 — Workshops (including Workshop laundries) 201 38 — Workplaces (other than Outworkers' premises) 11 1 — Total 466 82 — 37 Table No. 20.—Defects Found. Particulars. Number of Defects. Found. Remedied. Referred to H.M. Inspector. Number of Prosecutions. (1) (2) (3) (4) (5) Nuisances under the Public Health Acts :— Want of Cleanliness 23 19 — — Want of Ventilation 1 1 — — Overcrowding ... 1 1 — — Want of drainage of floors 6 5 — — Other Nuisances 43 39 — — Sanitary accommodation— Insufficient 3 2 — — Unsuitable or defective 17 15 — — Not separate for Sexes — — — — Unscreened for Sexes 7 7 — — 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) 23 19 — — Other offences (Excluding offences relating to outwork) — — — — Total 124 108 — — Table No. 21.—Registered Workshops. Workshops on the Register (s. 131) at the end of the year. (1) Number. (2) Factories 177 Factories, Laundries 38 Workshops, Laundries 22 Domestic Laundries 6 Bakehouses 58 Dressmakers 53 Outworkers 730 Blouse Makers 3 Tailors 36 Bootmakers 88 Metal Workers 24 Wood Workers 26 Seamstresses 1 Motor and Cycle Makers 46 Upholsterers 8 Milliners 17 Miscellaneous 134 Total number of Workshops on Register 1,467 Table No. 22.—Other Matters. Class. Number. (1) (2) Matters notified to H.M. Inspector of Factories::— Failure to affix Abstract of the Factory and Workshop Act (s. 133) — Action taken in matters referred by H.M. Inspector as remediable under the Public Health Acts, but not under the Factory and Workshop Act (s. 5)— Notified by H.M. Inspector 6 Reports (of action taken) sent to H.M. Inspector 2 Other — Underground Bakehouses (s. 101) :— Certificates granted during the year — In use at the end of the year 18 39 THE TWENTY-THIRD ANNUAL REPORT FOR THE Year ending 31st December, 1930, ON THE HEALTH OF CHILDREN ATTENDING THE PUBLIC ELEMENTARY SCHOOLS IN WILLESDEN. Giving the Tables required by the Board of Education. Table No. 23.—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, 1930. A.— Routine Medical Inspections. Number of Code Group Inspections— Entrants 2,355 Intermediates 2,316 Leavers 1,574 Total 6,245 Number of other Routine Inspections 0 B.— Other Inspections. Number of Special Inspections 7,555 Number of Re-inspections 17,627 Total 25,182 Table No. 24.—Corresponding to Table 2 of Appendix H of the Annual Report of the Chief Medica Officer of the Board of Education for 1923. A.—Return of Defects Found by Medical Inspection in the Year ended 31st December, 1930. Defect or Disease. Routine Inspections. Specials. No. of Defects. No. of Defects. Requiring treatment. Requiring to be kept under observation but not requiring treatment. Requiring treatment. Requiring to be kept under observation but not requiring treatment. (1) (2) (3) (4) (5) Malnutrition 34 54 23 — Uncleanliness (see Table IV, Group V) — — — — Skin "Ringworm : Head 1 — 13 — Body — — 29 — Scabies 3 — 35 — Impetigo 13 — 315 — Other Diseases (nontuberculous) 51 — 1,428 — Eye 'Blepharitis 26 — 90 — Conjunctivitis 12 — 103 — Keratitis — — 2 — Corneal Opacities 1 — 4 — Defective Vision (excluding Squint) 220 13 302 5 Squint 22 3 71 — Other Conditions 12 9 63 — Spectacles broken — — 202 — Spectacles lost — — 9 — 40 A.— Return of Defects found by Medical Inspection in the Year ended 31st December, 1930—continued. Defect or Disease. Routine Inspections. Specials. No. of Defects. No. of Defects. Requiring treatment. Requiring to be kept under observation but not: requiring treatment. Requiring treatment. Requiring to be kept under observation but not requiring treatment. (1) (2) (3) (4) (5) Ear 'Defective Hearing 7 — 10 1 Otitis Media 14 — 149 — Other Ear Diseases 38 — 162 2 Nose and Throat 'Enlarged Tonsils only 938 435 201 8 Adenoids only 66 12 12 — Enlarged Tonsils and Adenoids 75 2 270 2 Other Conditions 44 21 157 — Enlarged Cervical Glands (non-tuberculous) 177 58 268 2 Defective Speech 1 7 13 1 Teeth Dental Diseases (see Table IV, Group IV) 'Heart Disease : 1,672 6 Heart and Circulation Organic 8 6 7 1 Functional 5 168 4 — Anaemia 109 2 214 — Bronchitis 24 4 50 — Lungs Other Non-Tuberculous Diseases 15 20 18 — Tuberculosis Pulmonary :— Definite — 1 2 — Suspected — 1 12 — Non-Pulmonary :— Definite :— Glands — 3 1 — Spine — — — — Hip — — — — Other Bones and Joints — — — — Skin — — — — Other forms — — — — Suspected :— Glands — — — — Bones and Joints — — — — t Other forms — — — — Nervous System rEpilepsy — — 5 — Chorea 8 6 30 — ^Other Conditions 7 5 13 1 Deformities '"Rickets — — 4 — Spinal Curvature 22 16 19 — Other forms 30 9 28 7 Other Defects and Diseases 315 77 2,704 1 Total 3,970 938 7,042 31 B.—Number of individual Children found at Routine Medical Inspection to require Treatment (excluding Uncleanliness and Dental Diseases). Number of Children. Percentage of Children found to require treatment. Group. Inspected. Found to require treatment. (i) (2) (3) (4) Code Groups— Entrants 2,355 1,247 530 Intermediates 2,316 890 38.4 Leavers 1,574 530 33.7 Total (Code Groups) 6,245 2,667 42.7 Other Routine Inspections 0 0 0 41 Table No. 25.—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 §1 0 1 At no School or Institution 0 0 0 (ii.) Suitable for training in a School or Class for the partially blind. Attending Certified Schools or Classes for the Blind 8 7 15 0 0 0 At other Institutions 0 1 1 At no School or Institution 1 3 4 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 10 3 13 Attending Public Elementary Schools 0 0 0 At other Institutions 0 0 0 At no School or Institution 0 0 0 (ii.) Suitable for training in a School or Class for the partially deaf. Attending Certified Schools or Classes for the Deaf 2 2 4 Attending Public Elementary Schools 0 1 I At other Institutions 0 0 0 At no School or Institution 0 0 0 Mentally Defective Feeble-minded (cases not notifiable to the Local Control Authority). Attending Certified Schools for Mentally Defective Children *78 *47 125 3 3 6 At other Institutions 0 0 0 At no School or Institution 1 1 2 Epileptics. Suffering from severe Epilepsy. Attending Certified Special Schools for Epileptics 1 1 2 In Institutions other than Certified Special Schools 0 0 0 Attending Public Elementary Schools 0 0 0 At no School or Institution 0 0 0 Suffering from Epilepsy which is not severe. Attending Public Elementary Schools 12 5 17 At no School or Institution 0 2 2 Physically Defective. Infectious Pulmonary and Glandular Tuberculosis. At Sanatoria or Sanatorium Schools approved by the Ministry of Health or 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 1 0 1 0 0 0 At Certified Day Open Air Schools 3 0 3 At Public Elementary Schools 0 0 0 At other Institutions 0 0 0 At no School or Institution 0 0 0 Delicate Children (e.g., pre-or latent Tuberculosis, Malnutrition, Debility, Anaemia, etc.). At Certified Residential Open Air Schools 14 17 31 At Certified Day Open Air Schools 1 0 1 At Public Elementary Schools † † 202 † † 145 347 At other Institutions **19 25 44 At no School or Institution 2 1 3 Active Non-Pulmonary Tuberculosis. At Sanatoria or Hospital Schools approved by the 0 0 0 0 0 0 At other Institutions 0 1 1 At no School or Institution 1 0 1 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 1 3 4 At Certified Residential Cripple Schools 2 0 2 At Certified Day Cripple Schools 74 47 121 At Public Elementary Schools 2 4 6 At other Institutions 0 3 3 At no School or Institution 6 6 12 * 4 boys are also Physically Defective. * 1 girl is also Physically Defective. ** 1 boy is also Partially Blind. † 1 boy is also Mentally Defective. § This boy is also Epileptic, ††å 133 boys and 90 girls have been in Convalescent Homes. 42 Table No. 26.—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, 1930. Treatment Table. Group I.—Minor Ailments (excluding Uncleanliness, for which see Group V.). Disease or Defect. Number of Defects Treated, or under Treatment during the Year. Treated. Under the Authority's Scheme. Otherwise. Total. (1) (2) (3) (4) Skin :— Ringworm—Scalp 41 10 51 Body Scabies 32 10 42 Impetigo 380 62 442 Other Skin Diseases 1,836 69 1,905 Minor Eye Defects (external and other, but excluding cases falling in Group II.) 292 28 320 Minor Ear Defects 360 42 402 Miscellaneous (e.g., Minor Injuries, Bruises, Sores, Chilblains, etc.) 3,470 729 4,199 Total 6,411 950 7,361 Group II.—Defective Vision and Squint (excluding Minor Eye Defects treated as Minor Ailments—Group I.). Defect or Disease. Nu mber of Def ects dealt v fith. Under the Authority's Scheme. Submitted to refraction by private practitioner or at hospital apart from the Authority's Scheme. Otherwise. Total (1) (2) (3) (4) (5) Errors of Refraction (including squint) (Operations for squint should be recorded separately in the body of the Report.) 976 9 0 985 Other Defect or Disease of the Eyes (excluding those recorded in Group I.) 0 0 0 0 Total 976 9 0 985* Total number of children for whom spectacles were prescribed :— (a) Under the Authority's scheme 805 (b) Otherwise 81 Total number of children who obtained or received spectacles :— (a) Under the Authority's scheme 608 (b) Otherwise 162 * In addition to this number 179 cases of visual defect received attention by Voluntary Hospital Private Practitioner or Optician, but it was not known whether they were submitted to refraction. 43 Group III.—Treatment of Defects of Nose and Throat. Number of Defects. Received other forms of Treatment. Total Number Treated. Received Operative Treatment. % 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) 446 339 785 246 1,031 Group IV.—Dental Defects. Vide 12th 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 17 0 (ii.) Total number of examinations of children in the schools by School Nurses 57,846 (iii.) Number of individual children found unclean 1,859 (iv.) Number of children cleansed under arrangements made by the Local Education Authority . 280 (v.) Number of cases in which legal proceedings were taken (a) Under the Education Act, 1921 8 (b) Under the School Attendance Bye-Laws 0 (vi.) No. of school sessions at which inspections were conducted 595 (vii.) (i.) Original Inspections :— Children examined (i.e., Cases not individual children) 50,562 Found unclean 2,495 Percentage found unclean 4-9 Excluded on account of uncleanliness 28 (ii.) Re-inspections :— Children examined (i.e., Cases not individual children) 7,284 Found unclean 5,157 Percentage found unclean 70-8 Excluded on account of uncleanliness 21 (iii.) Total :— Examinations 57,846 Exclusions on account of uncleanliness 49 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 three Municipal Centres. Children suffering from nitty or verminous conditions are given the opportunity of being cleansed at these Centres. The mothers are encouraged to attend with the children, so that they may see how the cleansing should be carried out. Steel nit combs are sold at the Centres at cost price. Baths are also given for scabies and other skin conditions as necessary. Record of cases in which legal proceedings were taken. 44 The following information has been supplied by the Director of Education, 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. 3 10/- 1 Nil. 2 7/6 2 5/- Verminous Persons.—During 1930, adults made 9 attendances, children under 5 years 1,006 attendances, and school children 3,414 attendances at the Council's Centres for verminous conditions of scalp and body and treatment of skin conditions such as scabies. Thorough domestic cleansing of the home is advised by the Health Visitor, disinfection not being generally resorted to in verminous cases. Statement of the Number of Children Notified during the Year ended December 31st, 1930, by the Local Education Authority to the Local Mental Deficiency Authority. Total Number of Children notified : 16. Analysis of the above Total. Diagnosis. Boys. Girls. 1.—(i.) Children incapable of receiving benefit or further benefit from instruction in a Special School: (a) Idiots — — (b) Imbeciles 6 4 (c) Others 1 2 (ii.) Children unable to be instructed in a Special School without detriment to the interests of other children : (a) Moral defectives — — (6) Others — — 2.—Feeble-minded children notified on leaving a Special School on or before attaining the age of 16 — 2 3.—Feeble-minded children notified under Article 3 of the 1928 Regulations, i.e., "special circumstances cases " 1 — 4.—Children who in addition to being mentally defective were blind or deaf — — Grand Total 8 8 45 Table No. 27—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 Educatioi 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 othe' Sources, these latter never having been inspected by the Education Committee's Medical Officers; and the extent to which remedial measures were carried out during 1930 CONDITIONS No. of delects followed up No. of defects for which no report is available. No. of defects not needing treatment. No. of defects treated. Results of Treatment. Percentage of defects treated. No. of defects not treated. !o. of defects under ob ;rvation at end of year, and carried forward to succeeding year Remedied. Improved. Unchanged. uder observation at; d of year (result of treatment not known). School Clinic or Hospital or other Institution under Council Scheme, Voluntary Hospital or other charitable In- Hospital Doctor under M.C.C. Private Practitioner. Total. Domestic Treat- only. Grand Total. 1- xcluding Do- Treat- ■ Including Domestic Treatment. Removed from observation. Remaining under ■ observation. Total. Brought forward from previous New. Total. 1 2 3 4 5 6 7 8 9 10 11 12 IS 14 15 16 17 18 19 20 21 22 ■4 S23 Clothing- Unsatisfactory . — 5 5 — — — — — — — 4 4 3 — — 1 % % 80-0 — 1 1 2 Footgear- Unsatisfactory . 1 1 — — — — — — — 2 2 2 — — — — 100 0 — — - ' — Cleanliness of Head— 198 2,084 2,282 17 — 64 — — — 64 2,149 2,213 2,004 — — 209 2-8 97-7 18 34 52 243 . 4 4 4 4 4 4 — — — 100 0 100-0 — — — — Fleabitten 1 12 13 — — 2 — — — 2 11 13 11 — — 2 15-4 100 0 — — — 2 Malnutrition 26 38 64 2 - 20 3 2 25 13 38 17 10 - 11 40-3 61-3 7 17 24 28 Nose and Throat— 555 1,011 1,566 33 66 120 215 1 10 346 1 347 343 4 23-6 23-7 594 526 1,120 530 Adenoids 50 81 131 3 12 16 10 1 27 1 28 27 — — 1 23-3 24-1 48 40 88 41 Enlarged Tonsils and 251 481 732 8 7 329 82 1 412 9 421 416 5 57-5 58-7 146 150 296 155 Other conditions 28 234 262 5 6 138 6 36 180 55 235 203 3 — 29 71-7 93-6 9 7 16 36 Cervical or Neck Glands— Enlarged (non-T.B.) 120 471 591 5 13 255 28 — 37 320 56 376 283 3 I 89 55-8 65-6 47 150 197 239 External Eye Diseases- 28 120 148 1 116 2 5 123 20 143 126 1 16 83-7 97-3 1 3 4 19 12 125 137 1 108 7 5 120 14 134 118 2 14 88-2 98-5 1 1 2 15 1 4 5 3 3 3 2 I 60-0 60-0 1 1 2 1 1 2 3 2 2 2 1 I 66-7 66-7 1 1 Other conditions 14 88 102 1 63 8 1 72 24 96 83 I 12 71-3 95-0 3 2 5 14 Ear Diseases- Chronic Suppuration of 56 195 251 4 1 182 18 1 6 207 22 229 168 12 49 84-1 93-1 6 11 17 60 7 26 33 1 11 15 15 15 7 3 I 4 71-4 71-4 3 3 6 7 Wax 8 113 121 1 106 2 108 3 111 102 — — 9 90 0 92-5 4 5 9 14 Other conditions 14 81 95 1 8 57 10 1 4 72 11 83 75 1 — 7 83-7 96-5 3 — 3 7 Teeth—See Dental Returns Heart and Circulation- 10 12 22 2 1 10 3 13 1 14 7 3 4 68-4 73-7 3 2 5 6 Organic Disease Functional Disease 6 17 23 2 4 2 5 2 9 1 10 1 7 1 1 52-9 58-8 2 5 7 6 Anaemia 72 266 338 12 1 208 40 14 262 28 290 165 45 — 80 80-6 89-2 8 27 35 107 Other conditions 2 5 7 — 1 1 3 — ' 4 — 4 — — — 4 66-7 66-7 2 2 4 Lungs— Bronchitis and Bronchial Catarrh 25 117 142 4 21 7 2 43 73 58 131 105 3 23 52-9 94 9 3 4 7 27 Tuberculosis 5 5 2 , 3 3 3 __ — 1 2 100 0 100-0 — — — 2 T.B. Suspected ... 8 16 24 1 2 1 9 2 1 13 2 15 7 2 — 6 61 -9 71-4 4 2 6 8 Other diseases (non-T.B.) 30 37 67 4 — 25 10 — 12 47 13 60 31 9 20 74-6 95-2 3 — 3 20 Nervous System— Epilepsv ... 9 9 1 1 5 1 7 7 2 2 3 87-5 87-5 1 1 4 r ir J Chorea 14 55 69 2 1 6 34 15 55 1 56 26 15 1 14 83-3 84-8 5 5 10 19 Other conditions 22 23 45 4 1 14 12 — 3 29 8 37 19 8 — 10 72-5 92-5 3 3 10 Skin- Ringworm f Head \ l RnHv i 3 57 60 1 41 3 7 51 6 57 51 6 86-4 96-6 2 2 6 L ooQy J Impetigo ... ... 30 525 555 3 2 380 1 1 60 442 102 544 514 30 80-4 98-9 4 2 6 32 Scabies 43 43 32 3 4 3 42 42 39 3 97-7 97-7 1 — 1 3 Minor Injuries ... ... 67 907 974 2 9 852 25 13 890 66 956 903 53 92-4 99-3 2 5 7 58 Other disease (non. T.B.) 183 2,007 2,190 9 10 1,833 23 1 45 1,902 248 2,150 1,951 1 1 197 87-6 99-0 13 8 21 205 Deformities*— Rickets 5 7 12 6 3 9 9 li 1 7 750 75 0 3 3 10 Spinal Curvature 8 64 72 5 30 8 2 40 40 1 8 2 29 59-7 59-7 8 19 27 48 Other forms 9 47 56 4 4 29 9 1 — 39 — 39 2 5| 3 29 81-3 81-3 3 6 9 35 Tuberculosis (Non-Pulmonary)— Definite—Glands 1 1 2 1 1 1 1 50-0 50-0 1 1 ,, Bones and joints 1 . 2 3 — 2 2 2 1 1 — 66-7 66-7 1 — 1 Other forms Suspected—Glands 1 4 2 1 6 1 1 1 3 4 1 ~ "5 2 1 2 80-0 100-0 _ _ 2 „ Bones and joints „ Other forms 1 — 1 1 Speech— Defective Articulation ... 4 16 20 1 1 5 _ — — 5 _ 5 — — 1 4 27-8 27-8 10 3 13 7 Squint— Squint present ... 32 98 130 2 4 93 9 - 102 102 8 50 5 39 82-3 82-3 14 8 22 47 Vision- Defect not ascertained ... 11 74 85 1 10 58 5 63 63 16 16 1 30 85 1 85-1 5 6 11 36 One eye normal... 39 59 98 9 5 51 9 2 62 62 25 18 2 17 73-8 73-8 13 9 i, 22 26 Both eyes 6/6 4 49 53 10 34 34 34 17 11 6 79-1 79-1 6 3 9 9 6/9 16 36 52 1 6 35 2 — 1 38 _ 38 12 14 5 7 84-4 84-4 4 3 7 10 One eye 6/9 other 6/12 or less 53 105 158 3 6 98 15 4 117 117 56 35 6 20 78-5 78-5 19 13 32 33 Both eyes 6 /12 or less... 117 244 361 8 12 241 35 7 283 283 150 56 16 61 83 0 83-0 30 2S 1 58 89 Spectacles broken 41 211 ; 252 1 5 222 4 11 237 _ 237 217 20 96-3 96-3 3 1 6 ; 9 26 „ lost ... 16 14 30 3 5 16 1 — 1 18 — 18 10 — 5 1 3 81-8 81-8 2 ! 2 ! 4 5 Debility 276 ! 662 938 12 3 664 60 - 48 772 108 880 495 86 3 296 83-6 95-3 11 32 : 43 ! 328 Miscellaneous 286 2,513 2,799 26 224 1,391 176 7 191 1,765 662 2,427 2,052 60 '! 2 312 1 69-2 | 95-2 5( ) 7S ! 122 1 385 Grand Totals 2,827 13,803 16,630 209 453 8,132 924 21 599 9,67 6 3,933 13,608 11,214 t| 487 78 i 1,83C ) 60 6 85 2 1,13J i 1,22( > 2,359 I 3,056 46 Certain Statistical Data. No. of Public Elementary Schools (excluding Special Schools) at December, 1930 35 No. of School Departments at December, 1930 70 Average Public Elementary School Roll, year ended 31st March, 1930 21,073 Total No. of Children medically inspected at Routine and Special Inspections 13,800 Total No. of Children dentally inspected 17,152 Total No. of Defects of every description "followed up" during 1930 25,389 Total No. of Defects of every description for which treatment was obtained during 1930:— Medical or Dental Treatment 13,865 Domestic Treatment 3,933 Total 17,798 Total No. of Attendances at the School Clinics during 1930 60,147 Special Schools. No. of Physically Defective Schools 1 No. of Mentally Defective Schools 1 No. of children attending Special Schools during 1930:— Table No. 28. In Willesden. Outside Willesden. Total Blind and Partially Blind 1* 17 18 Deaf — 19 19 Mentally Defective 142 2 144 Epileptic — 4 4 Physically Defective 191 222 413 Total 334 264 598 * This boy is also Epileptic. Table No. 29.—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. Oldfield 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 38 41 37 28 2. Number who:— (a) Have since died 2 1 1 1 (b) Are known to be incapable by reason of mental or physical defect of undertaking employment 1 1 3 3 (c) Are in attendance at an Institution for further education (give details), and tl tt2 §5 (d) Are in any other Institution (specify Asylum, Workhouse, Colony for Epileptics, &c.) *2 ** 4 ♦♦5 3. Number who are employed in:— [a) Industrial or manual occupations 17 13 21 3 (6) Agricultural or rural occupations — — — — (c) Domestic occupations, including those who are helping in the domestic work at home — 7 — 8 (d) Commercial, professional or clerical work 6 9 1 (e) Blind alley or other precarious occupations 5 2 1 4. Number who have left the neighbourhood or whose after-careers have not been traced 6 6 5 2 f In attendance at Boarding School for further education, ft In attendance at Clark's College for further education. § 4 are in attendance at an Occupation Centre, and 1 is in a Convent. * In the Royal National Orthopaedic Hospital, Stanmore. ** In Institutions for Mentally Defectives. 7 Mentally Defectives and 5 Physically Defectives are unemployed. 47 Table No. 30. Return showing No. of Cases referred for following-up in 1930 and previous years with the view oi Medical Treatment being obtained, Remedial Measures carried out, or other action taken. Referred by Year. Medical Inspection and Officers of Health Department. Head Teachers. Attendance Officers. Others. Total. 1930 5,233 1,541 105 6,700 13,579 1929 5,293 2,558 88 5,597 13,536 1928 5,890 2,643 122 6,253 14,908 1927 6,305 2,925 114 6,354 15,698 1926 6,937 3,152 131 5,982 16,202 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. 31. Medical and Dental Treatment—Attendances at the Municipal Health Centres, 1930 Condition. Mothers, and Children under Five. Grand Total. (Cols. 7 and 8) Expectant Mothers. Nursing Mothers. Child ren under Five. Total (Cols. 2—5). School Children. 0—1. 1—5. Total (Cols. 4 and 5). (1) (2) (3) (4) (5) (6) (7) (8) (9). 1. Cleansing 3 6 11 995 1,006 1,015 3,414 4,429 2. Throat, Nose and Ear Diseases 0 0 11 381 392 392 3,973 4,365 3. Minor Ailments 6 46 1,010 2,719 3,729 3,781 29,993 33,774 4. Eye Diseases... 0 1 50 254 304 305 5,568 5,873 5. Ringworm, etc. 2 17 48 227 275 294 403 697 6. Artificial Sunlight Treatment 0 0 149 3,094 3,243 3,243 4,611 7,854 7. Orthopaedics ... 0 31 99 1,112 1,211 1,242 1,582 2,824 8. Medical Consultations 3,930 17,370 17,667 10,102 27,769 49,069 0 49,069 9. Diphtheria Immunisation ... 0 0 3 28 31 31 66 97* 10. Total 1—9 3,941 17,471 19,048 18,912 37,960 59,372 49,610 108,982 11. Dental Consultations 471 995 0 875 875 2,341 10,537 12,878 12. Grand Total ... 4,412 18,466 19,048 19,787 38,835 61,713 60,147 121,860 * In addition 22 attendances were made by adults, making 119 in all. 48 Table No. 31—[continued).  Health Centre (1) Health Centre (2) Health Centre (3) Grand Total. Mothers and Children under Five. School Children Total. Mothers and Children under Five. School Children Total. Mothers and Children under Five. School Children Total. 13. Medical Attendances 14. Dental Attendances 15,428 645 19,879 3,939 35,307 4,584 26,527 880 14,909 2,871 41,436 3,751 17,417 816 14,822 3,727 32,239 4,543 108,982 12,878 15. Total 16,073 23,818 39,891 27,407 17,780 45,187 18,233 18,549 36,782 121,860 Table No. 32. Shewing attendances at the Municipal Centres 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 1926 39,084 1,491 40,575 47,786 5,909 53,695 94,270 4,126 3,645 102,041 1927 40,958 1,593 42,551 47,199 6,583 53,782 96,333 3,S47 3,291 103,471 1928 40,787 1,733 42,520 43,956 6,484 50,440 92,960 4,485 3,355 100,800 1929 43,419 1,598 45,017 39,698 6,307 46,005 91,022 4,523 3,446 98,991 1930 59,372 2,341 61,713 49,610 10,537 60,147 121,860 5,958 5,371 133,189 The defects of School Children which were treated at the Centres during 1930 are shown in Table No. 27. 12 School Children and 1 child under 5 years of age were treated by X-rays for Ringworm of the Scalp. 1 nursing mother and 1 child under 5 years of age were treated by X-rays for other skin conditions. 8,023 Individual School Children attended the Municipal Centres during 1930. Table No. 33. Return respecting the Provision of Spectacles during 1930. No. of pairs of Spectacles provided 564 Cost of Spectacles provided £103 10 10 Average cost per pair ... 3 8 No. of pairs provided at full charge made by Council 465 No. of pairs provided free or at reduced charge 99 Total amount received as above £96 1 6 Cost of repairs £40 14 3 Total amount received for repairs £20 5 0 49 Hospital Treatment of School Children under the Council's Scheme. Table No. 34. Hospital Treatment of School Children during 1930. No. of School Children in Willesden General Hospital at 31st December, 1929 0 „ „ „ admitted during 1930 450 „ „ under treatment during 1930 . 450 „ „ discharged during 1930 450 „ „ died in Hospital during 1930 0 ,, „ „ remaining in Willesden General Hospital at 31st December, 1930 .. 2 Table No. 35. Treatment of defects of Children admitted in 1930. Defect. No. Admitted. Forms of Treatment. Results of Treatment. Remaining in Hospital December 31st, 1930. Operative. General. Remedied Improved. Unchanged Died. Deflected Septum 1 1 1 Enlarged Tonsils and Adenoids 449* 445 445 — — — — Total 450 446 446 i — — — * 4 of these cases were not operated on. No School Children were admitted to St. Monica's Home Hospital. Employment of Children in Entertainments Rules, 1920. Particulars as to applications received in 1930 for certificates from the School Medical Officer. No. of Applications. No. Granted. Boys. Girls. Total. Boys. Girls. Total. Original applications 2 6 8 2 6 8 Applications for renewals 1 2 3 1 2 3 3 8 11 3 8 11 50 THE ELEVENTH ANNUAL REPORT FOR THE Year ending 31st December, 1930, 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. The modified arrangements of the Middlesex Education Committee for Medical Inspection in Secondary Schools as set out in the letter of the Divisional Organising Officer, dated 16th January, 1926, require that medical inspection of pupils in these schools shall take place as follows:— (1) All pupils to be examined on commencing education in a Secondary School, such examination to be carried out before the close of the term in which a pupil is admitted. (2) All pupils to be examined at the age of 12 years. (3) All pupils to be examined at the age of 15 years. (4) In addition to the above routine groups, Headmasters and Mistresses to bring to the notice of the Medical Officers as " specials " any pupils suspected of being unfit. Arrangements have therefore been made to carry out medical inspection in Secondary Schools in accordance with the above schedule. In any term pupils are examined as follows:— (1) Pupils admitted during the current term. (2) Pupils who reached the age of 12 years during the preceding term. (3) Pupils who reached the age of 15 years during the preceding term (4) Special cases. At the end of the year the Middlesex County Council was in negotiation with the Willesden Council with respect to a scheme of treatment for Defective Vision and Dental Defects. 51 Table No. 36.—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, 1930, to 3 1st December, 1930. 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 3 0 3 0 0 0 0 0 0 0 0 0 0 0 0 3 0 3 0 0 0 3 0 3 11,, 81 0 81 0 0 0 27 0 27 22 0 22 0 0 0 108 0 108 22 0 22 130 0 130 12 „ 13 69 82 0 0 0 3 24 27 8 27 35 0 0 0 16 93 109 8 27 35 24 120 144 13 „ 4 0 4 35 0 35 0 0 0 1 0 1 24 0 24 28 0 28 36 0 36 64 0 64 14 „ 1 0 1 25 0 25 1 0 1 0 0 0 28 0 28 30 0 30 25 0 25 55 0 55 15 ,, 0 74 74 0 33 33 0 35 35 1 29 30 1 55 56 1 164 165 1 62 63 2 226 228 16 „ 2 0 2 0 0 0 0 0 0 0 0 0 0 0 0 2 0 2 0 0 0 2 0 2 17 „ 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Total 104 143 247 60 33 93 31 59 90 32 56 88 53 55 108 188 257 445 92 89 181 280 346 626 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. Wilksden Counnty School. Willesden Polytechnic Building Trade School Total. Boys. Girls. Boys. Girls. Boys. Boys. Girls. Total. Number of Special Inspections 2 4 1 5 1 4 9 13 Number of Re-inspections 90 49 19 28 29 138 77 215 Total 92 53 20 33 30 142 86 228 52 Table No. 37.—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, 1930. 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 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). 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 1 - - - - - - - - - - - - Uncleanliness (See Table IV., Group V.) - - - - - - - - - - - - - - - - - - - - Skin Ringworm:— Scalp - - - - - - - - - - - - - - - - - - - - Body - - - - - - - - - - - - - - - - - - - - Scabies - - - - - - - - - - - - - - - - - - - - Impetigo - - - - - - - - - - - - - - - - - - - - Other Diseases (Non-Tuberculous). 1 - 1 - - 1 2 - - - - - 1 - - - - - - - Eye Blepharitis - - - - - - - - - - - - - - - - - - - - Conjunctivitis - - - - - - - - - - - - - - - - - - - - Keratitis - - - - - - - - - - - - - - - - - - - - Corneal Opacities - - - - - - - - - - - - - - - - - - - - Defective Vision (excluding Squint). 16 8 9 12 7 17 - 1 - 1 - - - 2 - - - - - - Squint - - - - - - - - - - - - - - - - - - - - Other Conditions - - - - - - - - 1 - - - - - - - - - - - Ear - Defective Hearing - - - - 1 - - - - - - - - - - - - - - Otitis Media - - - - 1 - - - - - - - - - - - - - - Other Ear Diseases - - - - - - - - - - - - - - - - - - - - Nose & Throat - Enlarged Tonsils only. 14 2 1 5 3 9 7 1 2 4 - - - - - - 1 - - - Adenoids only - - - - - - - - - - - - - - - - - - - - Enlarged Tonsils and Adenoids. - - - 1 - - - - - - - - - - - - - - - - Other Conditions - - - - - - - - - - - - - - - - - - - - Enlarged Cervical Glands (non-t uberculous). - - - 1 - - - - - - - - - - - - - - - - Defective Speech - - - - - - - - - - - - - - - - - - - - Teeth—Dental Diseases 60 21 28 16 34 4 1 - - - - 1 - - - - - - - - Heart and Circulation. Heart Disease:— Organic - - 1 1 - - - - 2 1 - - - - - 1 - - - - Functional - 1 - - - 19 5 2 2 4 - - - - - 1 - - - - Ansemia 3 1 — — 1 8 1 - - - - - - - - - - - - - Lungs Bronchitis - - - - - - - - - - - - - - - - - - - - Other Non-Tuberculous Diseases. - - - - - 1 - - - 1 - - - - - - - - - - Tubeculosis Pulmonary:— Definite - - - - - - - - - - - - - - - - - - - - Suspected - - - - - - - - - - - - - - - - - - - - Non-Pulmonary: Glands - - - - - - - - - - - - - - - - - - - - Spine - - - - - - - - - - - - - - - - - - - - Hip - - - - - - - - - - - - - - - - - - - - Other bones and Joints. - - - - - - - - - - - - - - - - - - - - Skin - - - - - - - - - - - - - - - - - - - - Other forms Nervous System Epilepsy - - - - - - - - - - - - - - - - - - - - Chorea - - - - - - - - - - - - - - - - - - - - Other Conditions - - - - - 2 1 - - - - - - - - - - - - - Deformities. Rickets - - - - - - - - - - - - - - - - - - - - Spinal Curvature 2 9 1 3 — 11 4 2 4 2 - - - - - - - - - - Other Forms — 1 — — - 7 1 1 - 1 - - - - - - - - - - Flat Foot — — 2 — — — 3 9 3 - - - - - - - - - - Other defects and diseases 1 1 — 2 — 6 2 2 2 1 — 2 - 1 — — — — 2 1 Total 97 44 43 41 47 85 26 13 22 18 — 3 1 3 — 2 1 — 2 1 53 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) 104 16 15.4 60 15 25.0 31 6 19.4 32 14 43.8 53 6 11.3 Pupils aged 12 years 69 5 7.2 0 0 0.0 24 2 8.3 27 4 14.8 0 0 0.0 Pupils aged 15 years 74 13 17.6 33 6 18.2 35 7 20.0 29 5 17.2 55 7 12.7 Total (Code Groups) 247 34 13.8 93 21 22.6 90 15 16.7 88 23 25.0 108 13 12.0 **Other Routine Inspections - - - - - - - - - - - - - - - ** During 1930 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. (b) Pupils aged 12 years. (e) Pupils aged 15 years. Table No. 38.—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, 1930. 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. Kilburn Grammar School. Willesden Polytechnic Trade School. Willesden County Schools. Willesden Polytechnic Building Trade School Boys. Girls. Boys. Girls. Boys. (1) (2) (3) (4) (5) (6) Treated under the Authority's Scheme Otherwise. Total. Treated under the Authority's Scheme Otherwise. Total. Treated under the Authority's Scheme Otherwise. 1 Total. Treated under the Authority's Scheme Otherwise. i Total. Treated under the Authority's Scheme Otherwise. Total. Skin:— Ringworm—Scalp - - - - - - - - - - - - - - - Body — — — - - - - - — — — — - — — Scabies - - - - - - - - - - - - - - - Impetigo - - - - - - - - - - - - - - - Other skin diseases — 3 3 - 4 4 - - - - 1 1 - ?. ?. Minor Eye Defects (External and other, but excluding cases falling in Group II.) - - - - - - - - - - - - - - - Minor Ear Defects - - - - - - - - - - - - - 6 6 Miscellaneous (e.g., Minor Injuries, Bruises, Sores, Chilblains. etc.). - - - - 1 1 - 1 1 - - - - - - Total — 3 3 - 5 5 — 1 1 — 1 1 - 8 8 54 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 10 instances the School Medical Inspector noted at a subsequent examination that the pupils were wearing suitable spectacles ; in 4 instances the pupils were under treatment. Willesden Polytechnic Trade School (Girls).—In 4 instances the School Medical Inspector noted on re-examination that suitable spectacles had been obtained. Willesden County School.—In 6 instances (girls) the School Medical Inspector noted on reinspection that suitable spectacles were being worn. In 1 instance glasses had been obtained but required alteration. Willesden Polytechnic Building Trade School (Boys).—In 2 instances the School Medical Inspector noted on re-inspection that suitable spectacles had been obtained, and in 1 instance that vision had been retested and suitable spectacles obtained. Group III.—Treatment of Defects of Nose and Throat. Kilburn Grammar School (Boys).—In 3 instances the School Medical Inspector noted at a subsequent examination that the tonsils had been removed. In 1 instance adenoids had been removed. In 7 instances tonsils and adenoids had been removed. In 3 instances the tonsils were normal on re-examination. In 1 instance of deviated septum a plate was still being worn. Willesden Polytechnic Trade School (Girls).-—In 1 instance the School Medical Inspector noted on re-examination that the tonsils had been removed. Willesden County School.—In 2 instances (Boys) the School Medical Inspector noted at a subsequent examination that the tonsils had been removed ; and in 5 instances (Girls) that the tonsils and adenoids had been removed. Willesden Polytechnic Building Trade School (Boys).—In 2 instances the School Medical Inspector noted at a subsequent examination that the tonsils had been removed. 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 10 cases at the Kilburn Grammar School (boys), 15 cases at the Willesden Polytechnic Trade School (Girls), 5 cases (Boys) and 5 cases (Girls) at the Willesden County School, and 8 cases at the Willesden Polytechnic Building Trade School (Boys) had received dental treatment. Group V.—Uncleanliness and Verminous Conditions. Inspection and treatment of uncleanliness has not been undertaken by the School Nurses in the Secondary Schools in 1930. One case of nitty condition of the hair was noted at Routine Medical Inspection at the Willesden Polytechnic Trade School (Girls), and the attention of the parent was directed to this defect. 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:— 55 Table No. 39. (a)—KILBURN GRAMMAR SCHOOL. Defect. No. Result. Anaemia 2 Improved Lungs—Other diseases (non Tuberculous) 1 Improved. Deformities:— Spinal Curvature 5 Improving with exercises. Flat Foot 4 Improving with exercises. Other Forms 3 Improving with exercises. Other Defects and Diseases 2 Improved. (b)—WILLESDEN POLYTECHNIC. Defect. No. Result. Heart Disease—Functional 1 Under private doctor's treatment. Deformities:— Stooping 7 Improved. Other Defects and Diseases 1 Improved. (c)—WILLESDEN COUNTY SCHOOL. Defect. No. Result. Boys. Girls. Heart Disease—Organic 1 — Under Hospital treatment. Deformities:— - 1 To continue with exercises. Spinal Curvature - 1 Corrected with exercises Round Shoulders - 1 Remedied. 5 7 Still having exercises. Other forms 1 1 Exercises practised. Flat Foot 7 18 Improving with exercises. 1 1 Normal after exercises. l 1 Improved. Shoes wedged. 0 (d)—WILLESDEN POLYTECHNIC BUILDING TRADE SCHOOOL (BOYS). Defect. No. Result. Heart Disease—Organic 1 No violent exercises taken. Functional 2 Having modified exercises. Scoliosis 1 Having special exercises. 56 THE THIRTEENTH ANNUAL REPORT for the Year 1930, 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. SCHOOL DENTAL SERVICE. During the year several important changes have occurred, the outstanding feature being the opening of Health Centre 3 at Stonebridge Park on April 8th, by the Minister of Health. The New Clinic.—The Centre is an entirely new building constructed on modern lines with all rooms arranged on one floor. There is a large entrance and waiting hall with clerical office adjoining. A series of rooms is equipped in the right wing of the main building for sunlight, orthopaedic and X-ray treatment. In the central portion are the doctors' consulting rooms and in the left wing complete accommodation is made for two Dental Surgeons. The dental suite comprises :—Two operating rooms, one waiting and one recovery room, all suitably placed and inter-communicating. This arrangement allows patients who have received treatment and others waiting to pass from room to room without disturbance. All rooms are appropriately furnished, lighted and heated. Each operating room is equipped with the necessary dental requisites including electric engine and sterilizer. The dental chairs are of the latest pattern and accommodate both small children and adults. Anaesthetics.—The appointment of an expert Anaesthetist marks another advance which will contribute largely to the success of the Council's scheme. The Council also by sanctioning the installation of the latest type of gas oxygen apparatus have enabled the Anaesthetist to render his best services and professional skill. A separate contribution on the technique and advantages of the apparatus is made in other pages of the Annual Report by the Anaesthetist, Dr. Jarman, and there is no need to make further reference here. The total number of administrations of general anaesthetic by the Anaesthetist since appointment in May to the end of the year is 2,485. Dental Staff.—With the appointment of additional dentists and dental nurses at Health Centre 3 the total dental staff now consists of four dental surgeons, four fully trained nurses and one anaesthetist. Extra nursing assistance is provided on general anaesthetic sessions. Re Distribution of Work.—The opening of a third Health Centre necessitated the re-distribution of the work formerly undertaken by Health Centres 1 and 2. This has been effected as set out in tne Table below. Table No. 40.—Distribution of Schools. Schools. Roll for year ended 31st March, 1929. Centre No. 1. Gordon Memorial 738 9, Willesden Lane. Area 1. Kilburn Park 353 -1,091 St. Mary's R.C 354 St. John's 444 Percy Road Boys' 394 -1,192 Carlton Vale 807 Holy Trinity Boys' 261 -1,068 Salusbury Road 1,101 Christ Church 405 4,857 57 Schools. Roll for year ended 31st March, 1929. Centre No. 2 High Road, Willesden Kensal Rise 1,036 Chamberlayne Road 892 Oldfield Road 712 St. Mary's 381 Oldfield Road P.D. 126 -1,219 Areas 2 and 3. Neasden Council 98 Neasden National 212 Dudden Hill Temp. 248 - 558 Brain tcroft 350 Pound Lane 727 Dudden Hill 1,155 -1,882 Gladstone Park 423 St. Andrews 627 Willesden Green R.C 145 -1,195 Mora Road 984 8,116 Centre No. 3. Stonebridge Park. Princess Frederica 658 Leinster M.D. 105 Area 4. Harlesden Church of England 100 Furness Road 1,070 - 1,170 Keble Memorial 586 Leopold Road 1,005 1,591 Bridge Road 810 4,334 Area 5. Lower Place 407 Acton Lane 457 Harlesden R.C 223 -1,087 Stonebridge 895 Wesley Road 766 -1,661 Gibbons Road 1,027 3,775 Grand Total 21,082 In addition to the School work each Centre is responsible in its respective area for the inspection and treatment of expectant and nursing mothers and infants under school age. School Dental Work.—The Council's scheme which was put into operation in October, 1924, is still in force and provides for:— (1) Routine dental inspection of all school children to be carried out annually in order that any defects requiring attention may be detected and parents informed as early as possible and advised to obtain treatment. (2) Public elementary school children found on examination to be suffering from dental defects requiring attention are referred to a private registered dentist. (3) Public elementary school children found to be suffering from dental defects and who are necessitous under the scale adopted by the committee may be treated at the Centres free of charge. (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 at the Centres on payment of 2s. 6d. 58 It has not been possible to include the whole school population in the routine inspection at school during the year. The two dental surgeons at Health Centre 3 commenced duties in April and June respectively, so that the full benefit of that Centre has not been felt. With the complete staff working the full year this omission is not likely to again occur and all public elementary school children in Willesden will have the opportunity of having their teeth inspected once a year, with the option of treatment of any defects at the Centres. Out of a total of approximately 21,082 elementary school children 15,466 were subject to routine inspection at the schools and 1,686 casual cases were inspected by the dentists at the Health Centres making a total of 17,152 for the year. Of this number 14,009 were found to have defective teeth and were referred for treatment. 4,192 received their treatment at the Centres. The work done satisfactorily to treat these 4,192 children included 5,300 fillings of which 4,535 were restoration to the permanent teeth and 765 to the temporary. 10,327 temporary and 1,349 permanent teeth were extracted, for which purpose general anaesthetics were administered on 2,515 occasions and local on 723. In addition 1,495 other operations were performed. The attendances made by children for treatment amounted to 9,191 and the number of half-day treatment sessions devoted to the work was 1,347. The following Table No. 41 is a summary of the year s work:— Table No. 41. Group IV. Dental Defects. (1) Number of children who were:— (a) Inspected by the Dentists:— Aged:— 5 852 6 1,675 7 1,855 8 1,841 9 1,841 10 2,326 11 1,557 12 1,235 13 1,152 14 1,128 15 4 16 — Total 15,466 Special (see note (d)) 1,686 Grand Total 17,152 (b) Found to require treatment 14,009 (c) Actually treated at the Authority's Health Centres 4,192 (d) Re-treated during the year as the result of periodical examination 1,155 Note: (d) is included in (c). (2) Half days devoted to Inspection 357 Total 1,704 Treatment 1,347 J (3) Attendances made by the children for Treatment 9,191 (4) Fillings Permanent teeth 4,535 Total 5,300 Temporary teeth 765 (5) ExtractionsPermanent teeth 1,349 Total 11,676 Temporary teeth 10,327 (6) Administration of general anaesthetics— for extractions 2,515 Total 3,238 Local 723 J (7) Other operations Permanent teeth 972 Total 1,495 Temporary teeth 523 284 sessions have been devoted to Maternity and Child Welfan 59 Table No. 42. Return showing number of Cases referred for following up in 1930 and Previous Years with a View to Dental Treatment being Obtained. Referred by Year. Dental Inspection and Officers of Health Department. Head Teacher. Attendance Officers. Others. Total. 1930 6,200 18 - 1,971 8,189 1929 6,387 40 — 1,566 7,993 1928 3,791 58 — 1,598 5,447 1927 4,107 76 — 1,558 5,741 1926 4,799 73 — 1,544 6,416 1925 7,159 75 1 1,294 8,529 1924 9,642 34 — 570 10,246 1923 6,504 98 2 605 7,209 1922 4,383 129 — 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. 43. Return 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 1930 at health visitor's last visit. Total number of defects coming under observation during 1930. Brought forward from 1929 608 New during year 8,151 8,759 Number of defects treated:— Health Centre 4,024 Otherwise 165 4,189 Percentage of defects followed up which were known to have received treatment 47.8 No report available 47 Number of defects for which no treatment has been undertaken at Health Visitor's final visit 3,858 Number not requiring treatment 38 Carried forward to 1931 627 Number of visits made by Health Visitors 7,420 MATERNITY AND CHILD WELFARE. The Council's dental scheme for mothers and children under five provides for:— (1) The dental inspection of all expectant mothers who attend the Centres for consultation with the doctors. (2) The treatment free of cost of all expectant mothers whose incomes fall below the economic scale set out in the Declaration Form. (3) The complete treatment, including the provision of dentures for all expectant mothers either free, at part cost, or whole cost of the dentures in accordance with the economic scale set out by the Council for the provision of dentures. (4) The same benefit is extended to all nursing mothers up to a period of 12 months after the birth of the baby. (5) The construction of dentures is undertaken by private dentists under the same conditions of service as required by the National Health benefit scheme. (6) All infants under five years may be inspected and treated at the Centres either free in the case of those whose parents are below the economic scale, or on payment of 2s. 6d. for all others. 60 945 mothers and infants were inspected by the dentists during the year. 318 were brought forward from the previous year, making a total of 1,263. All received treatment and were completed. 135 commenced treatment at the Centres and were removed from observation without being completed. This latter figure includes all those who left the district or through illness were unable to attend again, as well as those who merely wished to be relieved of any teeth causing discomfort, and did not desire to have done all that was necessary to obtain a healthy mouth. 320 mothers and 139 infants did not accept any form of dental treatment in spite of their being badly in need of it; 15 were treated elsewhere other than the Centres. 30 (1 nursing mother and 29 infants) were found on inspection to be in a healthy condition, and 231 were carried forward to 1931. The work included the removal of 2,745 teeth, of which number 970 were from the mouths of the young children. 537 fillings and 431 other operations. 522 patients received general, and 65 local anaesthetics. 61 mothers were supplied with dentures, 38 free of cost and 23 at part cost. 2,345 attendances were recorded by all patients. The time devoted by the dentist to complete this work amounted to 284 half-day treatment sessions. The statistical Table No. 44 relates to the condition of the teeth found in infants under five years on the first examination by the dentist. It shows that out of a total of 443 children, 29 or 7 per cent, only were free from caries. That 296 children had decayed and septic teeth requiring extraction, and that the 386 defective children had an aggregate of 1,486 decayed teeth, or 3-8 per child. Table No. 44. The following table shows details of the children 0-5 inspected 443 No. with no defect 29 No. with decayed teeth (Temporary) savable 117 No. „ „ „ ( „ ) unsavable 296 No. „ „ „ (Permanent) savable 0 No. ,, ,, ,, ( ,, ) unsavable 0 No. of decayed temporary teeth savable 312 No. „ „ „ unsavable 1,174 No. „ permanent „ savable 0 No. ,, „ „ unsavable 0 No. referred for treatment 414 No. treated by other agencies 13 Total of Maternity and Child Welfare Sessions 284 Table No. 45 is a summary of the Health Visitors' work 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 1930. Total number of defects coming under observation during 1930 (new cases and re-examination) :— Table No. 45. 0—5 E.M. N.M. Total. Brought forward from 1929 57 56 205 318 New during year 473 320 394 1,187 Total 530 376 599 1,505 No. of visits made by Health Visitors — — — 1,370 No. of defects treated—Health Centres 285 99 129 513 Otherwise 13 1 1 15 No. of defects for which no treatment was undertaken 164 215 187 566 Carried forward, 1931 68 61 182 311 Table No. 46. The Total Year's Work by the Dentists. Maternity and Child Welfare and School children combined :— Teeth removed 14,421 Fillings 5,837 Other operations 1,916 General anaesthetic cases 3,037 Patients inspected 18,069 Patients treated 4,638 Treatment sessions 1,347 Inspection sessions 357 61 Anaesthesia at the Dental Clinics of the Willesden Health Centres by Ronald Jarman, D.S.C., M.R.C.S., L.R.C.P., Anaesthetist to the Willesden Urban District Council, Assistant Anaesthetist to Guy's Hospital and to Guy's Hospital Dental School, Anaesthetist to the Cancer Hospital, Anaesthetist to the Dreadnought Hospital, Greenwich. In May this year, the Council presented the three health centres with new Gas and Oxygen apparatus. This is called the Walton, the improved Guy's Hospital pattern. The advantages are as follows :— 1. Gas and Oxygen can be given by the nasal or the face mask method. 2. The length of anaesthesia is prolonged indefinitely thus giving the operator more time to do his work. 3. Oxygen is given the whole time, thereby reducing the risk of anaesthesia to a minimum 4. The nasal method is less frightening than the face mask, and the confidence of the children is more easily obtained. 5. The number of visits are reduced, as more work can be done in comfort by this method, thus saving the valuable time of the mothers and the children. 6. The waiting lists are considerably reduced. Emergency cases can be treated at once. 7. The Mothers are more willing to allow their children to be treated, as everything is done to abolish fear and to save the child from the slightest discomfort. 8. Nursing and Expectant Mothers can be treated in much shorter time and with no danger to the unborn child. 9. Patients with bad hearts and chests can be treated with comparative safety. 10. It will be seen by glancing at Mr. Jenning's figures that the number of children treated has risen considerably, even allowing for the new centre at Stonebridge Park. It is necessary with a certain number of the very nervous type of child to give Ethyl Chloride, which is the quickest and the kindest of anaesthetics. Children from the age of 2\ years to the age of 14 years take gas and oxygen quite easily by this method, and have soon realised the fact that there is no danger whatsoever of them feeling pain in the slightest degree. The team work of all the clinics is to be highly commended, the Dental Surgeon, anaesthetist, and the nurses all work together which enables first class work to be done. At the same time any useful suggestion can be carried out, and accepted or discarded as the case may be. Lately carbon dioxide has been used in conjunction with oxygen, as this is a direct respiratory stimulant. This again reduces the possibility of an accident and at the same time gives a smoother anaesthetic. This has been so successful that it is hoped that it will be continued altogether. 62 THE FIRST ANNUAL REPORT FOR THE Year ending 31st December, 1930, on the SUPERVISION OF MIDWIVES. SUPERVISION OF MIDWIVES. By the Willesden Urban (Supervision of Midwives) Order, 1930, the Willesden Urban District Council became the local supervising authority in respect of Midwives practising in Willesden as from 1st October, 1930. During the year 1930, 29 Midwives living in Willesden and 23 living outside Willesden notified their intention to practise in Willesden. Table No. 47. Shewing Number of Cases attended by Midwives Practising in Willesden during 1930. Midwives living in Willesden. No. of Cases attended. Total. Remarks. As Midwife. As Maternity Nurse. District Midwives. E. A None None — F. C None None — P.E — 2 — A. E 2 — — E. P — 4 — A. F 4 — — C. M 4 - — E. P — 6 — M. J 1 5 — D. I 13 - Number of cases done by this midwife since coming to live in Willesden, August, 1930. E. P 3 14 The majority of these were attended in this midwife's nursing home. G. S 18 4 — D. W 36 6 — M. R 27 13 — A. G 46 2 — C. S 42 10 — V. C 40 27 — Midwives attached to Queen Charlotte's District Nursing Home, 40, Princess Rd.,Kilburn M. C - — — W. G - — — V. S - — — B. F - 5 — M. S - — — M. C 452 This number includes all cases of any midwife connected with this district home. Midwives in Park Royal Hospital G. D 7 — — E. W 25 — — A. L 46 — - Of the total of 864 cases attended by midwives living in Willesden as midwives or as maternity nurses, 627 occurred in Willesden and the remainder outside Willesden. 63 Two district midwives, Queen Victoria Jubilee Institute, Hampstead, and Queen Charlotte's District Nursing Association in Kensington, attended in connection with 66 cases of midwifery in Willesden. Table No. 48. The following information was sent to the Ministry of Health on Form M.C.W. 96 (revised ):— Midwives. (a) Number practising in the area served by the Council for Maternity and Child Welfare at the end of the year (Up to 19th Feb., 1931, 32 have notified intention to practise in Willesden during 1931) 43 (b) Number (i.) employed by the Council 0 (ii.) subsidised by the Council 0 (iii.) employed by Voluntary Associations in Willesden 3 (Queen Charlotte s Hospital. ) (District Nurses' Association,) ( 40, Princess Road, Kilburn.) employed by Voluntary Associations outside Willesden 8 1. Ditto above in North Kensington. 2. Queen's Nurses, Hampstead. 3. Kensal Medical & Gospel Mission,W. 10. (c) Number of cases attended by midwives during the year:— In Willesden by all midwives practising in Willesden. Outside Willesden by midwives resident in Willesden. (i.) As midwives 602 229 (ii.) As maternity nurses 91 8 (d) Number of cases during the year in which the Council paid or contributed to the fee of a midwife 24 Table No. 49. Notifications received from Midwives in accordance with the Rules of the Central Midwives Board, 1st October to 31st December, 1930. From Midwives living and practising in Willesden. From Midwives practising in Willesden but living outside. Notifications of:— Sending for Medical Help 16 6 Having laid out a dead body 2 — Liability to be a source of infection 1 — Table No. 50. Reasons for Sending for Medical Help. For Mother. Medical Help sought by Midwives. For Child. Medical Help sought by Midwives. Living in Willesden. Living outside Willesden. Living in Willesden. Living outside Willesden. Ante-natal examination 3 — Discharging eyes 1 — Weak labour pains 1 — Sticky eyes 2 1 Delayed labour 2 2 Difficult respiration 1 — Laceration of perineum 3 3 Prematurity 1 — Abortion 1 — Feebleness 1 — Total 10 5 6 1 Table No. 51. Fees Paid to Medical Practitioners under Section 14 of the Midwives Act, 1918. October 1st to December 31st, 1930. Number of notifications of Sending for Medical Help 22 „ „ „ in respect of which fees paid 14 Total fees paid £11 14s. 64 THE FIRST ANNUAL REPORT FOR THE Year ending 31st December, 1930. on the REGISTRATION OF NURSING HOMES. NURSING HOMES REGISTRATION ACT, 1927. In accordance with the direction of the Minister of Health, the powers and duties of the Middlesex County Council under the Nursing Homes Registration Act, 1927, as regards the Urban District of Willesden were delegated to the Willesden Urban District Council as from the 1st October, 1930. In pursuance of Section 9 (4) of the Nursing Homes Registration Act, 1927, the maximum sum to be repaid by the County Council to the Willesden Urban District Council in respect of the expenses incurred in the execution of the powers and the performance of the duties under the said Act delegated to them by the Middlesex County Council, was fixed at £10. Any fees received by the Willesden Council under the Nursing Homes Registration Act, 1927, are required to be applied to the reduction of this £10. Table No. 52. Maternity and Nursing Homes, October 1st, 1930, to December 31st, 1930. (l) Number of applications for registration:— (a) Maternity Homes 1 (b) Nursing Homes 1 (2) Number of Homes registered 0 (3) Number of Orders made refusing or cancelling registration 0 (4) Number of appeals against such Orders 0 (5) Number of cases in which such Orders have been— (a) Confirmed on appeal, and (b) disallowed 0 (6) Number of applications for exemption from registration 2 (7) Number of cases in which exemption has been— (a) Granted 2 (b) Withdrawn 0 (c) Refused 0 (8) Nursing Homes closed by voluntary retirement 2 On the 1st October, 1930, there were registered with the Willesden Urban District Council, under the Nursing Homes Registration Act 9 Nursing Homes with accommodation for 48 patients. At the close of the year there were 7 Nursing Homes on the register of the Willesden Urban District Council, with accommodation for 43 patients. 65 THE FIRST ANNUAL REPORT for the Year ending 31st December, 1930, t on INFANT LIFE PROTECTION. INFANT LIFE PROTECTION. Since April 1st, 1930, as provided by Section 2 (a) of the Local Government Act, 1929, the functions under Part I. of the Children Act, 1908, previously discharged by the Poor Law Authorities have been discharged by the Willesden Council. The existing Health Visitors have been designated also " Infant Protection Visitors," and have been vested with the authority necessary to enable them to discharge their duties as such. These duties are periodically to visit the homes of Foster Mothers in order to inspect the premises and to satisfy themselves that the Foster Children are properly nursed and maintained, giving the necessary advice or directions as to their nursing and maintenance. The Health Visitors also have to ascertain as far as practicable whether there are any children in their districts who are being maintained for reward but in respect of whom notice has not been given to the Local Authority as required by the Act. The standard of the Foster Homes varies considerably. They are scattered in every locality in Willesden, but each home is visited not less than once every two months and a report made of the premises, the Foster Mother and the children. The majority of the Foster Children appear to benefit by the care given to them by the Foster Mothers ; but, unfortunately, a number of these children—especially those of illegitimate parentage— change hands frequently, there being no obligation on the part of either parent or foster parent to keep them in one home. The most usual reason for these changes is the omission on the part of the parent to make the regular payments. These changes would not appear to be good for the children concerned, either with regard to training or general welfare. Table No. 53. Foster Mothers. Number of Foster Mothers at 1st April, 1930 155 „ „ „ at 3rd January, 1931 128 Number of Licences granted by Council 1st April, 1930 to 3rd January, 1931 25 „ ,, refused by Council, 1st April, 1930 to 3rd January, 1931 4 Number of applications to take additional children agreed to by Council 7 „ „ refused by Council 4 Number of applications for re-issue of Licence agreed to by Council 13 „ „ refused by Council 4 Foster Children. Coming under observation:— Number of Foster Children at 1st April, 1930 215 Number of Foster Children received 1st April, 1930 to 3rd January, 1931 132* Number entered Willesden with their Foster Mothers 2* Total 349 Removed from observation:— Number given up 133 Number reached the age of 7 years 6 Number died 0 Number legally adopted 4 Number left Willesden with their Foster Mothers 6 Total 149 * Note.—The actual number of now individual Foster Children who came under notice between 1st April, 1930, and 3rd January, 1931 = 105. 66 Remaining under observation :— Number of Foster Children at 3rd January, 1931:— (a) Under 5 years of age 164 (b) Between 5 and 7 years 36 Total 200 Table No. 54. The 200 Foster children under observation at 3rd January, 1931, were maintained in the care of Foster Mothers as follows :— Maintained by— Parent or Guardians 136* Crusade of Rescue, 48, Compton Street, W. 57 National Adoption Society, 4, Baker Street, W 5 Adoption Society, 93, Westminster Bridge Road 1 Received with lump sum 1 Total 200 * In 45 of these cases the parent or guardians were living in Willesden at the time the child entered the care of the Foster Mother. In 91 of these cases the parents or guardians were not living in Willesden at the time the child entered the care of the Foster Mother. Table No. 55. The following Table shows the length of time each of the 200 Foster children under observation at 3rd January, 1931 had been in the care of their Foster mothers. Under 6 months 55 Over 6 months, under 1 year 32 Over 1 year, under 1J years 28 Over 1½ years, under 2 years 19 Over 2 years, under 2J years 19 Over 2½ years, under 3 years 16 Over 3 years, under years 9 Over 3½ years, under 4 years 5 Over 4 years, under 4£ years 6 Over 4½ years, under 5 years 6 Over 5 years, under 5J years 6 Over 5½ years, under 6 years 4 Over 6 years, under 6£ years 2 Over 6½ years, under 7 years 3 Total 200 Of the 200 Foster children under observation at 3rd January, 1931, 120 had changed hands during the year. 97 made 1 change, 15 made 2 changes, 7 made 3 changes and 1 made 4 changes. These changes do not include the first reception of the child. THE ELEVENTH ANNUAL REPORT For the Year ending 31st December, 1930, on HOME NURSING. A record of work done is given in the three following tables:— 67—68 Table No. 56.—Showing Casks dealt with during 1930 and Results. Disease. Cases being nursed at end of 1929. New Cases during 1930. Removed from Observation during 1930—Results of Treatment. Still being Home Nursed at end of 1930. Number of Visits Paid during 1930. 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. Adenitis - - - - - - - - - - 1 1 - - - - - - - - - - - - - - - - 1 1 - - - - - - - - - - 12 12 Bronchitis - - - - - - - - 1 - - 1 - - - - - - - - - - - - - - - - - 1 - - - - - - - - 6 - - 6 Burns and Scalds - - - - - - - - 5 1 1 7 - - - - - - - - - - - - - - 5 1 1 7 - - - - - - - - 67 5 28 100 Circumcision — — — — — — — — 27 2 - 29 — — — — — — — - - - - - — - 27 2 — 29 - — - - - - - - 242 14 — 256 Constipation — — — — — — — — 3 2 - 5 — — — — — — — — - — - - - — 3 2 — 5 - — — — - — — - 5 4 — 9 Dental Cases - - - - - - - 1 - - - 2 - - - - - - - - - - - - - 1 - 1 - 2 - - - - - - - 3 - 1 - 4 Dermatitis - - - - - - - - - 1 - 1 - - - - - - - - - - - - - - - 1 - 1 - - - - - - - - - 8 - 8 Douching Case - - - - - - - - - - 1 1 - - - - - - - - - - - - - - - - 1 1 - - - - - - - - - - 13 13 Eczema - - - - - - - - 1 - - 1 - - - - - - - - - - - - - - 1 - - 1 - - - - - - - - 14 - - 14 Engorged Breasts - - - - - - - 1 - - - 1 - - - - - - - - - - - - - 1 - - - 1 - - - - - - - - - - - 7 Enlarged Glands - - - - - - - - - 1 - 1 - - - - - - - - - 1 - 1 - - - - - - - - - - - - - - - 2 - 2 Enteritis - - - - - - - - 1 - - 1 - - - - - - - - - - - - - - 1 - - 1 - - - - - - - - 5 - - 5 Fistula - - - - - - - - - - 1 1 - - - - - - - - - - - - - - - - - - - - - - 1 1 - - - - 68 68 Heart Disease - - - 1 - 1 - - - - - - - - - - - - - - - - - - - - - 1 - 1 - - - - - - - - - 30 - 30 Impetigo - - — - - — - - 16 2 - 18 - — - — - — - - - - - - - - 16 2 - 18 - - - - - - - - 142 28 - 170 Injury to Knee - - - - - - - - - 1 - 1 - - - - - - - - - - - - - - - 1 - 1 - - - - - - - - - 8 - 8 Leucorrhœa - - - - - - 2 2 1 - - 5 - - - - - - - - - - - - 2 2 1 - - 5 - - - - - - 28 35 74 - - 137 Mastitis - - - - - - - 6 - - - 6 - - - - - - - 1 - - - 1 - 5 - - - 5 - - - - - - - 97 - - - 97 Mastoid - - - - - - - - 1 - - 1 - - - - - - - - - - - - - - 1 - - 1 - - - - - - - - 12 - - 12 Measles — — — - — — — — 3 1 - 4 — — — - - — - — - - - - - - 3 1 - 4 - - - - - - - - 23 4 - 27 Measles and Bronchitis Measles and Impetigo -- -- -- -- -- -- -- -- 11 -- -- 11 -- -- -- -- -- -- -- -- -- -- -- -- -- 11 -- -- -- 11 -- -- -- -- -- -- -- -- 25 26 -- -- 25 26 Myopia - - - - - - - - - 1 - 1 - - - - - - - - - - - - - - - 1 - 1 - - - - - - - - - 5 — 5 Naevus - - - - - - - - 1 - - 1 - - - - - - - - - - - - - - 1 - - 1 - - - - - - - - 13 - - 13 Ophthalmia — — 1 — — 1 — — 14 2 — 16 — — — — — — — - - — — - - - 13 2 - 15 - -1 2 - - 2 - - 272 45 - 317 Ophthalmia Neonatorum - - - - - - - - 17 - - 17 - - - - - - - - 1 - - 1 - - 16 - - 16 - - - - - - - - 218 - - 218 Otorrhcea — — 3 3 — 6 — — 19 10 1 30 — — — — — — — — 1 1 — 2 — — 16 11 1 28 — — 5 1 6 — - 455 316 9 780 Otorrhoea and Impetigo - - - - - - - - 1 - - 1 - - - - - - - - - - - - - - 1 - - 1 - - - - - - - - 32 - - 32 Pleurisy - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 19 — 19 Pneumonia — — — 1 - 1 - - 4 - 2 6 - - 1 - - 1 - - - 1 - 1 - — 3 — 2 5 — — — — — - - - 30 18 17 65 Prematurity - - - - - - - - 1 - - 1 - - - - - - - - - - - - - - 1 - - 1 - - - - - - - - 25 - - 25 Puerperal Pyrexia - - - - - - - 1 - - - 1 - - - - - - - - - - - - - 1 - - - 1 - - - - - - - 18 - - - 18 Pyrexia - - - - - - - 2 2 2 - 6 - - - - - - - - - - - - - 2 2 2 - 6 - - - - - - - 6 9 9 — 24 Rigors - - - - - - - - - 1 - 1 - - - - - - - - - - - - - - - 1 - 1 - - - - - - - - - 4 - 4 Septic Conditions — — — — — — - - 19 17 - 36 - - - - - - - - - - - - - - 19 17 - 36 - - — — - — - - 246 129 - 375 Skin Conditions - - - - - - - - 3 2 - 5 - - - - - - - - 1 - - 1 - - 2 2 - 4 - - - - - - - - 40 12 - 52 Thread Worms — - - - — - — — 42 26 - 68 - - - - - - - - - - - - - - 42 26 - 68 — — - - — - - — 297 179 - 476 Throat Conditions - - - - - - - - 22 47 2 71 — — — — — — — — 1 1 — 2 — — 21 46 2 69 - - - - - - - - 81 165 9 255 Total - — 4 5 — 9 2 13 206 121 9 351 — — 1 — — 1 — 1 4 4 — 9 2 12 198 121 8 341 — — 7 1 1 9 28 166 2359 1005 | 156 |3714 69 Table No. 57. Shewing Sources from which cases were referred for Home Nursing during the Year 1930. Referred by Number. Health Department 198 Private Doctors 32 Others 121 Total 351 Table No. 58 Shewing cases Home Nursed in Wards during 1930 Ward. No. of Cases brought forward from 1929. No. of Cases referred in 1930. Total. No. of Visits paid. 1. South Kilburn 1 94 95 1,148 2. Mid-Kilburn 1 58 59 535 3. North Kilburn 0 45 45 447 4. Brondesbury Park 0 7 7 72 5. Kensal Rise 3 28 31 396 6. Harlesden 3 22 25 342 7. Stonebridge 0 17 17 152 8. Roundwood 0 8 8 60 9. Church End 1 18 19 135 10. Willesden Green 0 17 17 147 11. Cricklewood 0 37 37 280 Total 9 351 360 3,714 70 THE SIXTEENTH ANNUAL REPORT FOR THE Year ending 31st December, 1930, 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 at Granville Road. Dinners are taken from Gibbons Road Feeding Centre to Oldfield Road Physically Defective School, and from Furness Road Feeding Centre to Leinster Mentally Defective School, College Road. The dinners are served in the main hall at each school. 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 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 523. Recommendations are also received from the Local Public Assistance Officers an agreement having been made whereby the Public Assistance Committee pay the Willesden Education Authority Is. 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 Public Assistance Committee supplying every four weeks the list of children to be fed. The economic circumstances scale was revised and raised Is. per head on 20th November, 1924. Kilburn Feeding Centre.—Dinners—The children of 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 the meals, but the table appointments have been improved, and one spoon is now supplied for each course. The menu has been revised, and the children now receive the same three weekly menu as that in operation at the Education Committee's Centres, with the exception of the roast and boiled meat dinners. This revised menu was commenced on 3rd February, 1930. The price per meal was raised from 4d. to 5d. on the 13th November, 1923. The behaviour of the children, has improved, although the earlier arrivals have to 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. 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 251, Breakfasts 48. Meals.—A three weekly menu was commenced in the Education Committee's Centres on July 23rd, 1928. This provides one meatless meal, one roast or boiled meat, one stew, one meatpie or pudding, and one cheese dinner, 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 31st DECEMBER, 1930. Table No. 59.—No. of Meals Supplied. Supplied to:— Breakfasts. Free. Dinners. Total. Free. Paying. M.C.C. Education Committees' Centres 6,760 42,787 1,560 3,529 54,636 Kilburn Voluntary Centre — 24,127 — 2,767 26,894 Special Schools - 9,094 23,732 369 33,195 Feeding Centre Assistants 2,326 2,780 — — 5,106 Total 9,086 78,788 25,292 6,665 119,831 71 Table No. 60. Occupation List 1930. Occupation. No. of Children Fed during 1930. No. of Families Involved. Percentage. 1929. 1930. 1929. 1930. Unemployed 416 234 178 66.1 47.2 Widows 107 27 60 7.6 15.9 Deserted Wives 44 16 17 4.5 4.5 Orphans 3 4 2 1.1 0.5 Labourers 114 34 49 9.6 13.0 Railwaymen 32 14 17 3.9 4.5 Hawkers 29 2 13 0.5 3.4 Others 68 23 41 6.5 10.8 813 354 377 72 THE THIRTY.NINTH ANNUAL REPORT FOR THE Year ending 31st December, 1930, ON THE MUNICIPAL HOSPITAL By ARTHUR G. TROUP, M.D., D.P.H., Medical Superintendent. During 1930, 1,029 patients were admitted to Hospital as compared with 955 in 1929, 1,037 in 1928, 767 in 1927, 846 in 1926, and 601 in 1925. Scarlet Fever. During the past year 421 cases of this disease were admitted to Hospital as compared with 454 cases during 1929. Two deaths occurred, giving a mortality rate of 0-47 per cent. In one case the primary cause of death was lobar pneumonia. The other death was due to the malignant or toxic type of the disease. The latter patient, a woman aged 42 years, was admitted to Hospital on the 5th day of the disease with a history of severe sore throat, vomiting and diarrhoea. The temperature was 102-6° and the pulse 114. The erythematous rash was intense and of characteristic distribution. It was accompanied by a petechial rash which was most marked on the flanks and groins, and in this respect resembled the hemorrhagic rash of smallpox. The fauces were intensely inflamed with a dry and stripped tongue and sordes on the teeth. There was no obvious nasal discharge and the neck glands were only sightly enlarged. Mentally the patient was dull and inclined to wander at times, but could answer questions intelligently when roused. Two days after admission, desquamation was noticed on the neck and later there was profuse desquamation on the trunk. Scarlet fever antitoxin was administered intravenously shortly after admission, and later two further doses were given intramuscularly. There was a rapid fall of temperature after the first dose, but the general condition of the patient did not show any appreciable improvement. The patient gradually passed into the typhoid state with severe prostration, rapid and feeble pulse and terminal coma, death taking place on the 11th day of the disease. A throat culture was reported as giving a profuse growth of the streptococcus haemolyticus, which is now accepted as the causal organism of scarlet fever. Malignant or toxic scarlet fever is fortunately rare now-adays, in this country; in fact this is the first example of the type to occur in this hospital for many years. Diphtheria. 420 cases were admitted or 73 more than the previous year. These cases may be classified as follows :—Faucial 293, Nasal 66, Faucial and Nasal 32, Laryngeal 14, Aural 6, Bacteriological 9. It was necessary to perform the operation of tracheotomy on 7 of the laryngeal cases, of which 4 recovered and 3 died. The total number of deaths from diphtheria was 14, giving a mortality rate of 3-40 per cent. The mortality rate for England and Wales for the year 1929 was 5-49 per cent. Four of the diphtheria deaths occurred in patients suffering from the haemorrhagic type of the disease. This form of diphtheria invariably proves fatal. In calculating the mortality rate, the bacteriological cases have been excluded. Two other cases admitted to hospital as suffering from diphtheria died, but as the cause of death was not due to this disease, they have been excluded from the diphtheria deaths. The first was a child who had received severe burns to the trunk and arms owing to an accident at her home, and death was due to this cause. The second was a child who had a mild attack of nasal diphtheria. Some time previously he had been operated on for double mastoiditis. The wounds had never healed and he subsequently died from abscess of the brain. Mixed Infections. The following cases of mixed infections were admitted :— Scarlet Fever and Chicken Pox 3 Scarlet Fever and Measles 1 Scarlet Fever and Diphtheria1 Diphtheria and Measles 1 73 Other Diseases. One hundred and eighty-two patients were admitted under this heading as follows:— Measles 82 Lacerations of vagina and cervix 1 Tonsillitis 26 Mastoiditis (Post-scarlatinal) 1 Erysipelas 20 Rheumatism (Post-scarlatinal) 1 Whooping Cogh 5 Drug Rash 1 Marasmus 4 Teething Rash 1 Rhinitis 3 Urticaria Pneumonia 3 Pemphigus 1 Ophthalmia Neonatorum 3 Septic Wound 1 Erythema 3 Tuberculosis of Mediastinal Glands 1 Chicken Pox 2 Typhoid Fever 1 Tubercular Peritonitis 1 Paratyphoid Fever (A) 1 Adenitis 1 Paratyphoid Fever (B) 1 Excision of Tonsils 1 Polio-Encephalitis 1 Acute Nephritis 1 Encephalitis Lethargica 1 Peritonitis 1 Cerebro-Spinal Fever 1 Glandular Fever 1 Puerperal Septicaemia 1 Abscess of Neck 1 Para Metritis 1 Pleurisy 1 Subinvolution of the Uterus 1 Negative Cases 5 Thirteen deaths occurred Erysipelas 3 Acute Nephritis and Uraemia 1 Measles 3 Cerebro-Spinal Fever 1 Whooping Cough 1 Polio-encephalitis 1 Broncho-Pneumonia 1 Puerperal Septicaemia 1 Peritonitis 1 The primary cause of death in one of the erysipelas cases was cancer of the rectum with secondary deposits in the liver. The case of acute nephritis and uraemia occurred in a diphtheria carrier and was admitted to the Municipal Hospital on account of the latter condition. Measles. 82 cases of measles were admitted to hospital during the course of the year. Three deaths occurred, giving a mortality rate of 3.6 per cent. In addition 14 cases occurred in the acute diphtheria ward due to a child being admitted to the ward incubating measles as well as suffering from diphtheria. It is impossible to avoid this and similar occurrences unless every patient was treated in a cubicle which is an impracticable suggestion. Although it is not desirable to adopt any method which would entirely prevent measles, for this would lead to a gradual development of a non-immune population which would be a very suitable material for the disease to attack with serious results should it be reintroduced, yet there are particular instances in which it is most desirable to avoid an outbreak of measles. In hospital where they are closely aggregated, almost 100 per cent. of susceptible children develop the disease if exposed to it. Prompt isolation of the infecting case is almost always useless, and the infected children who may be seriously ill with some other disease are liable to have a severe or even fatal attack. It is therefore highly desirable to prevent an outbreak from occurring in a hospital ward, and a means to immunize the exposed patients is essential. Four methods have been recommended during the last few years, and some reports on their efficacy are now available. The first three are in the nature of antitoxins or sera of animal origin and derived from micro organisms, which the discoverers claimed to be the cause of measles (Tunnicliffs serum, Ferry and Fisher's serum and Degkwitz's serum). All have been tried in this hospital with disappointing results and this appears to be the general experience. These sera being derived from animals are liable to produce serum reactions and this phenomenon was specially marked in cases treated with Degkwitz's serum. The fourth method is the employment of human serum derived from convalescent cases of measles, and in three recent investigations has protected 95.7 per cent. (Gunn), 98.3 per cent. (Nabarro & Signy) and 100 per cent. (Sutherland) of the exposed children respectively. The best results are obtained when the serum is given within 5-6 days of exposure, but even if given within 9 days, although the attack is not preventable, it modifies its intensity. Serum taken 3-4 months after convalescence will modify the disease, while whole blood from adults who have had measles in infancy has a similar effect. There are certain difficulties in obtaining human convalescent serum, but these are not insurmountable. In the first place it is desirable for the blood to be taken from an adult. Cases of measles occurring in adults are not nearly so common as similar cases in children. We had, however, 6 adults (over 18 years of age) out of the total of 82 cases of measles treated in this hospital during the year. Secondly, the adult must be otherwise healthy. It is suggested that the Council should consider this question, in order that arrangements could be made for a supply of human convalescence serum to be available for treatment of suitable cases. 74 Sick Staff. The following are the figures for the past four years for the Nursing Staff:— Number of Nurses who were off duty for 24 hours or more. Number of days off duty. 1927 35 402 1928 36 342 1929 24 373 1930 31 521 The health of the nursing staff has been satisfactory although the figures show an increase from last year. One nurse had an attack of pneumonia and it was feared that tuberculosis might develop. She made a complete recovery however, after 164 days off duty. Two nurses contracted diphtheria and were off duty for 80 and 43 days respectively. The particulars of these cases are given in the section dealing with immunisation against diphtheria. The other 28 nurses had comparatively mild illnesses, 19 of which were attacks of tonsillitis, and the average number of days off duty from this cause was 8.3. The following are the figures for the past four years for the domestic staff:— Number of Maids who were off duty for 24 hours or more. Number of days off duty. 1927 29 203 1928 17 202 1929 23 298 1930 11 286 The health of the maids shows an improvement from last year as shown by the decreased number who were off duty. The number of days off duty, however, shows a comparative increase and this is accounted for by the fact that one maid was off duty for a total of 135 days as the result of an accident. No maid contracted an infectious disease. Willesden Smallpox Hospital. This hospital admitted smallpox cases until the 30th September, and during this period 8 patients were dealt with. All these cases were of the mild or sub-toxic type of smallpox. The average duration of stay in hospital was 17.7 days, and no deaths occurred. Duration of Stay in Hospital. (1) Scarlet Fever. The average length of detention of scarlet fever patients again shows a decrease this year, and it is probable that this figure has now reached its lowest level. The minimum period of stay in hospital is 28 days from the onset of the disease, and 328 patients out of a total of 421 were discharged between the 28th and the 35th day. Average stay in hospital of scarlet fever patients, 1925-1930:— 1925—45.1. 1928—37.0. 1926—47.2. 1929—36.1. 1927—38.1. 1930—32.9. (2) Diphtheria. The average length of detention in Hospital for diphtheria patients remains about the same. Having regard to the more serious nature of the disease as compared with scarlet fever and the late occurrence of complications it is not to be expected that it can be reduced to any appreciable extent. Average stay in hospital for diphtheria patients, 1927-1930:— 1927—47.3. 1929—51.7. 1928—52.8. 1930—53.3. (3) Other Diseases. 1927—32.3. 1929—23.4. 1928—28.1. 1930—27.1. 75 Schick Test and Active Immunisation against Diphtheria. (1) Hospital. During 1926 a commencement was made in Schick Testing the nursing staff and immunising those nurses who proved to be susceptible to diphtheria. Since that date five cases of diphtheria have occurred, one in 1927, one in 1928, one in 1929 and two in 1930. In three instances the attack of the disease occurred in Schick positive nurses who had been immunised, but sufficient time had not elapsed since the date of immunisation for full immunity to be established. Schick positive nurses are not posted to the diphtheria wards until they have been at the hospital for at least six months. This rule, however, cannot always be strictly adhered to, and consequently cases of diphtheria are liable to occur in partially immunised nurses. In the other two cases the diagnosis of diphtheria is open to question. Both occurred in immunised nurses who had been re-Schick tested with a negative result 5 weeks and 8 days before the attack respectively. The clinical appearance of the throat was suspicious in both cases. In one the first swab taken proved negative, but a second swab taken two days later was reported positive. The other case proved to be a carrier and the tonsils had to be excised before the condition cleared up. There is reasonable grounds, therefore, for suggesting that this latter case was one of follicular tonsillitis occurring in a diphtheria carrier. Nineteen cases of sore throat occurred during 1930 amongst Schick negative or immunised nurses, and these all proved to be non-diphtheritic. The fall in incidence of diphtheria amongst the nursing staff since 1926 has been considerable, as the following figures demonstrate:— Number of cases of diphtheria occurring amongst probationer nurses during the first eight months of 1926 (before immunisation was carried out) 9 Incidence rate per annum (taking 30 as average number of probationer nurses) Number of cases of diphtheria occurring amongst probationer nurses from 45% 1927 to 1930 inclusive (after immunisation was carried out) 5 Incidence rate per annum (taking 30 as average number of probationer nurses) 4.1% Number of nurses Schick tested (1927 to 1930 inclusive) 147 Number of nurses giving a positive reaction 71 Percentage of nurses giving a positive reaction 48.3% Number of nurses re-Schick tested 29 Number of nurses re-Schick tested giving a positive reaction 11 Percentage of nurses re-Schick tested giving a positive reaction 37.9% Number of nurses who had to go off duty after an injection of toxoid antitoxin 2 (2) Health Centre. This clinic was first made available for Willesden residents in May, 1927, and consists of one afternoon session per week at Health Centre 1 at which Schick Testing and Active Immunisation against Diphtheria are carried out:— The following are the figures for this clinic since its commencement :— Table No. 61.—Preliminary Schick Test. Adults. School Children. Number Schicked 17 1927—8 114 1927—74 1928—5 1928—23 1929—0 1929—2 1930—4 1930—15 Positive Reactions 12 1927—6 94 1927—61 1928—4 1928—17 1929—0 1929—2 1930—2 1930—14 Negative Reactions 5 1927—2 20- 1927—13 1928—1 1928—6 1929—0 1929—0 1930—2 1930—1 76 Table No. 62.—Active Immunisation Injections. First Course. Second Course. Adults 12 1927—6 3 1928—4 1929—0 1930—2 School Children 102 1927—61 5 1928—25* 1929—2 1930—14 Children under 5 45 1927—27 5 1928—5 1929—7 1930—6 * Includes eight school children in whom a preliminary Schick Test was not carried out. Table No. 63.—Schick Test Performed 9 Months after Immunising Injections Adults. School Children. Children under 5. Number Schicked 7 57 26 Positive Reactions 3 (43%) All have had a 2nd Course. 8 (14%) Five have had a 2nd Course. 5 (19.2%) All have had a 2nd Course. Negative Reactions 4 (57%) 49 (86%) 21 (80.8%) It will be seen from the foregoing tables that there has been a small increase in the number of individuals taking advantage of the facilities provided by the Council for protection against diphtheria, but it might be reasonably expected that the numbers would be very considerably larger. The statistics in respect of the nursing staff can be regarded as very satisfactory. They demonstrate the value of this method of preventive medicine both as regards the benefit to individual members of the staff, and in the saving of public funds. Table No. 64. Scarlet Fever. Diphtheria. Other Diseases. Total. No. of cases admitted during 1930 421 420 188 1,029 Remaining in Hospital, December 31st, 1929 62 57 4 123 Total No. under treatment in 1930 483 477 192 1,152 No. of cases discharged during 1930 446 413 165 1,024 No. of deaths during 1930 2 14 13 29 *Mortality .47 *2.99 6.77 2.53 No. of cases remaining in Hospital December 31st 1930 35 50 14 99 * Calculated on number of cases under treatment during 1930 after deducting 9 bacteriological cases. 77 Table No. 65. Scarlet Fever. Age. Males. Females. Admissions. Deaths. Admissions. Deaths. —1 – 1 – 1—2 7 – 3 – 2—3 17 – 10 1 3—4 9 – 16 – 4—5 9 – 13 – 5—10 91 – 85 – 10—15 32 – 47 – 15—20 10 – 24 – 20—25 11 – 4 – 25—30 4 – 8 – 30—35 3 – 4 – 35— 5 – 8 1 Total 198 – 223 2 Table No. 66. Diphtheria. Age. Males. Females. Admissions. Deaths. Admissions. Deaths. —1 1 – 2 – 1—2 4 – 6 – 2—3 10 – 12 1 3—4 15 – 12 2 4—5 21 – 10 3 5—10 108 – 112 8 10—15 21 – 34 – 15—20 7 – 15 – 20—25 6 – 8 – 25—30 2 – 5 – 30—35 – – 4 – 35— 3 – 2 – Total 198 – 222 14 Table No. 67. Diphtheria.* Day of Disease on Admission. Number of Cases. Deaths. 1st 8 – 2nd 68 – 3rd 81 5 4th 64 5 5th 48 – 6th and over 70 4 Total 339 14 * Bacteriological, Aural and Nasal cases are not included in this list. 78 Table No. 68. Chief Complications of Scarlet Fever. Number of Complications. Rhinitis ... 38 Adenitis 23 Serum Rash 23 Otitis Media 19 Albuminuria 11 Rheumatism 7 Septic Sores 5 Mastoiditis 3 Bronchitis 3 Disordered Action of the Heart 2 Abscess 2 Endocarditis 2 Stomatitis 1 Gingivitis 1 Cellulitis 1 Pneumonia 1 Nephritis 1 Dilation of the Heart 1 Quinsy 1 Pericarditis 1 Total 146 Table No. 69. Chief Complications of Diphtheria. Number of Complications Paralysis and Paresis 54 Disordered Action of the Heart 29 Albuminuria 29 Serum Rash 16 Otitis Media 14 Abscess 6 Mastoiditis 2 Pneumonia 1 Nephritis 1 Dilation of the Heart 1 Appendicitis 1 Total 154 Hospital Buildings. (1) The cubicle pavilion which was brought into use during September, 1929, has proved of invaluable service in the administration of the hospital. A total of 137 cases were treated in it during 1930, without any cross infection. The number of cubicle beds is, however, too small for the number of cases which should be dealt with by this method, and the Council have decided to proceed with the erection of the two other pavilions, the building of which has been postponed owing to certain objections raised by the Ministry of Health. (2) It has been decided to replace the old fashioned kitchen ranges in the ward duty rooms by electric stoves, and this improvement is now nearly completed. (3) A fully equipped lecture room for the nurses has been established, and is proving of great service in the teaching of the probationer nursing staff. 79 THE FIRST ANNUAL REPORT FOR THE Year ending 31st December, 1930, ON THE HEALTH OF PATIENTS ATTENDING THE MIDDLESEX COUNTY COUNCIL OCCUPATION CENTRE FOR MENTALLY DEFECTIVES, BULLER ROAD, WILLESDEN. During the year the Council agreed at the request of the Middlesex County Council, to carry out the following:— 1. Medical inspection annually of every patient attending the Centre. 2. The Medical inspection of every patient admitted within at least one month after admission. 3. The treatment available at the Willesden Heath Centres to be available and provided if required for patients attending the occupation centre. The Middlesex County Council is charged at the rate of 2s. per inspection and 3s. per attendance at the Health Centres. This latter charge does not include the provision of surgical instruments, provision of spectacles, provision of nutritive foods or hospital treatment. During the year 33 patients were medically inspected, 8 patients attended the Health Centres for treatment, the total number of attendances being 39. The following table shows the number of defects found at medical inspection to require treatment and the number which were treated at the Health Centres:— Defect or Disease. Requiring Treatment. Received Treatment at Health Centre. Defective Vision 2 1 Defective Teeth 17 5 Ear Disease 1 1 Alopecia of Scalp 1 1 80 APPENDICES. APPENDIX A.—VITAL STATISTICS. Appendix A.—Table I. VITAL STATISTICS OF WHOLE DISTRICT DURING 1930 AND PREVIOUS YEARS; VITAL STATISTICS OF THE WARDS DURING 1930. 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 Eirths. 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 ‡65,674* 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 1926 173,854 2,444 2,700 15.53 1,422 8.18 88 319 143 53 1,653 9.51 1927 175,217 2,286 2,568 14.66 1,513 8.64 78 296 151 59 1,731 9.88 1928 176,589 2,326 2,666 15.10 1,509 8.55 79 298 151 57 1,727 9.78 1929 177,973 2,318 2,714 15.25 1,787 10.04 107 339 165 61 2,019 11.34 1930 179,368 2,462 2,869 15.99 1,518 8.46 83 327 175 61 1,762 9.82 wards. 1. S. Kilb'n 15,339 244 278 18.12 149 9.71 0 30 26 93.52 179 11.67 2. Mid K'b'n 14,838 220 274 18.46 136 9.17 0 36 17 62.04 172 11.59 3. N. Kilb'n 13,992 144 178 12.72 119 8.50 2 31 15 84.27 148 10.58 4. Brondsb'y Park 9,672 101 117 12.09 72 7.44 4 15 5 42.73 83 8.58 5. Kensal Rise 13,629 150 181 13.28 99 7.26 2 20 8 44.19 117 8.58 6. Harl'd'n 18,317 197 227 12.39 150 8.19 0 31 14 61.67 181 9.88 7. Stonebridge 19,700 332 350 17.77 161 8.17 17 26 21 60.00 170 8.63 8. Roundwood 17,034 247 277 16.26 158 9.28 31 22 19 68.59 149 8.75 9. Church End 16,295 213 229 14.05 107 6.57 1 16 14 61.14 122 7.49 0. Willesden Green 18,141 205 240 13.23 134 7.39 1 37 9 37.50 170 9.37 1. Cricklewood 22,411 409 518 23.11 233 10.40 25 63 27 52.12 271 12.09 Area of District in acres (land and inland water) 4,384 Total population at all ages ‡ 165.8741 at Census, 167,200 Total families or separate occupiers 41,435 * Census Population, 1921. J He-adjusted by the Reg. Gen. because of holiday movement to 167,200. 81 Appendix A.—TABLE II.—DEATHS OF WILLESDEN RESIDENTS DURING THE YEAR 1930. CAUSE OF DEATH. All Ages. 0 to 1 1 to 5 5 to 10 10 to 15 15 to 20 20 to 25 25 to 35 35 to 45 45 to 55 55 to 65 65 to 75 75 to 85 85 Up. Total deaths, whether of " Residents" 01 " Non-Residents," in Institutions in the District (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) (13) (14) (15) (16) All Causes Certified 1,762 175 75 29 23 35 42 93 103 180 282 361 277 87 685 Uncertified – – – – – – – – – – – – – – – I.—General Diseases. Enteric Fever 1 – – – – – – 1 – – – – – – – Typhus Fever – – – – – – – – – – – – – – – Relapsing Fever. ("Spirillum Obermeieri") – – – – – – – – – – – – – – – Mediterranean Fever – – – – – – – – – – – – – – – Malaria – – – – – – – – – – – – – – – Small Pox – – – – – – – – – – – – – – – Measles 26 4 20 2 – – – – – – – – – – 19 Scarlet Fever 3 – 1 1 – – – – 1 – – – – – 2 Whooping Cough 5 2 3 – – – – – – – – – – – 5 Diphtheria 19 – 7 10 2 – – – – – – – – – 17 Influenza 25 1 1 – – – 1 – 3 4 4 5 5 1 1 Miliary Fever – – – – – – – – – – – – – – – Mumps – – – – – – – – – – – – – – – Asiatic Cholera – – – – – – – – – – – – – – – Cholera Nostras – – – – – – – – – – – – – – – Dysentery – – – – – – – – – – – – – – – Plague – – – – – – – – – – – – – – – Yellow Fever – – – – – – – – – – – – – – – Spirochætosis ictero-hæmorrhagica – – – – – – – – – – – – – – – Leprosy – – – – – – – – – – – – – – – Erysipelas 10 3 – – – – – 1 – 2 1 2 – 1 7 Acute Poliomyelitis 5 – 3 – 1 – – – – – 1 – – – 2 Encephalitis Lethargica 3 – – – 1 – – – – – 1 1 – – 2 Meningococcal Meningitis 5 – 1 – 1 1 – 2 – – – – – – 3 Other Epidemic and Endemic Diseases – – – – – – – – – – – – – – – Glanders – – – – – – – – – – – – – – – Anthrax – – – – – – – – – – – – – – – Rabies – – – – – – – – – – – – – – – Tetanus 1 – – – – – – – – 1 – – – – 1 Mycoses – – – – – – – – – – – – – – – 82 Tuberculosis of the respiratory system 124 – – 2 – 10 20 32 21 23 9 7 – – 27 Tuberculosis of the central nervous system 6 – 4 1 1 – – – – – – – – – 3 Tuberculosis of intestines and peritoneum 2 – 1 – – – 1 – – – – – – – 2 Tuberculosis of vertebral column 1 – – – – – 1 – – – – – – – – Tuberculosis of joints – – – – – – – – – – – – – – – Tuberculosis of other organs 2 – – – – 1 – – – – – 1 – – 1 Disseminated tuberculosis 3 1 – – – – – 1 – 1 – – – – 1 Syphilis 2 1 – – – – – – – – 1 – – – 2 Soft chancre – – – – – – – – – – – – – – – Gonococcal infection – – – – – – – – – – – – – – – Purulent infection, Septicaemia 1 – – – 1 – – – – – – – – – 2 Other Infectious Diseases – – – – – – – – – – – – – – – 2.—General Diseases not included above. Cancer of the Buccal Cavity 13 – – – 1 – – – 1 1 3 5 2 – 6 Cancer of the pharynx, oesophagus, stomach, liver and annexa70 70 – – – – – – 2 4 7 21 27 8 1 24 Cancer of the Peritoneum, Intestines and Rectum 53 – – – – 1 – 4 3 12 10 14 9 – 18 Cancer of the Female Genital Organs 17 – – – – – – – 1 7 5 1 3 – 7 Cancer of the Breast 22 – – – – – – 1 1 5 5 4 4 2 8 Cancer of the Skin 1 – – – – – – – – – – – 1 – 1 Cancer of other or Unspecified Organs 38 – – 2 – – 1 1 1 4 14 10 5 – 10 Tumours not returned as Malignant (Brain and Female Genital Organs excepted) 1 – – – – – – – – 1 – – – – 1 Rheumatic Fever 11 – 1 1 1 2 1 – 1 1 – 3 Chronic Rheumatism, Osteo-arthritis, Gout 16 – 1 – – – – – – 1 4 5 2 3 2 Scurvy – – – – – – – – – – – – – – – Pellagra – – – – – – – – – – – – – – – Beri-beri – – – – – – – – – – – – – – – Rickets 1 – 1 – – – – – – – – – – – 1 Diabetes 23 – 1 – – – – 2 1 3 5 6 5 – 8 Anaemia, Chlorosis 3 – – – – – – – 2 – 1 – – – 2 Diseases of the Pituitary Gland – – – – – – – – – – – – – – – Diseases of the Thyroid Gland 2 – – – – – – – – 1 – 1 – – 2 Diseases of the Parathyroid Glands – – – – – – – – – – – – – – – Diseases of the Thymus – – – – – – – – – – – – – – – Diseases of the Adrenals 2 – – – – – 1 1 – – – – – – 1 Diseases of the Spleen – – – – – – – – – – – – – – – Leukaemia, Lymphadenoma 10 – – 1 – 1 – – 1 2 4 1 – – 1 Alcoholism (acute or chronic) 4 – – – – – – – – 1 3 – – – – Chronic Poisoning by Mineral Substances – – – – – – – – – – – – – – – Chronic Poisoning by Organic Substances – – – – – – – – – – – – – – – Other General Diseases 2 1 – – – – – – – – – – – – – 83 Table II.– DEATHS OF WILLESDEN RESIDENTS– continued. CAUSE OF DEATH. All Ages. 0 to 1 1 to 5 5 to 10 10 to 15 15 to 20 20 to 25 25 to 35 35 to 45 45 to 55 55 to 65 65 to 75 75 to 85 85 Up. Total deaths, whether of "Residents" or "Non-Residents," in Institutions in the District. (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) (13) (14) (15) (16) 3.– Diseases of the Nervous System and Sense Organs. Encephalitis 3 – – 1 – – – – 1 – – 1 – – 4 Meningitis 1 1 – – – – – – – – – – – – 1 Tabes Dorsalis (Locomotor Ataxy) 5 – – – – – – – 2 – 2 1 – – 2 Other Diseases of the Spinal Cord – – – – – – – – – – – – – – – Cerebral Haemorrhage, Apoplexy, etc. 112 1 1 – – – – – 2 12 20 38 31 7 50 Paralysis of Unstated Origin 1 – – – – – – – – – – – 1 – – General Paralysis of the Insane 3 – – – – – – – – 1 1 – – 1 – Other forms of Insanity 2 – – – – – – – 1 – 1 – – – – Epilepsy 9 – – – – – 1 1 1 1 1 2 1 1 1 Convulsions (non-Puerperal, 5 years and over) – – – – – – – – – – – – – – – Infantile Convulsions (under 5 years of age) 1 1 – – – – – – – – – – – – – Chorea – – – – – – – – – – – – – – – Hysteria and Neuritis – – – – – – – – – – – – – – – Cerebral Softening 1 – – – – – – – – – – 1 – – – Other Diseases of the Nervous System 12 1 – – – 1 – – 2 1 6 1 – – 5 Diseases of the Eye and Annexa – – – – – – – – – – – – – – – Diseases of the Ear and of the Mastoid Sinus 1 – – – – 1 – – – – – – – 1 4.– Diseases of the Circulatory System. Pericarditis 4 – – 1 – – – – – – 2 1 – – 1 Acute Endocarditis and myocarditis 5 – – 1 1 – – 1 – 2 – – – – 2 Angina Pectoris 14 – – – – – – – – 1 4 5 3 1 – Other Diseases of the Heart 285 – – 1 2 3 – 4 12 22 67 93 65 16 97 Diseases of the Arteries 82 – – – – – – 1 2 5 17 28 22 7 22 Embolism and Thrombosis (not Cerebral) 5 – – – – – – 1 1 2 – 1 – – – Diseases of the Veins (Varix, Haemorrhoids, Phlebitis, etc.) – – – – – – – – – – – – – – – Diseases of the Lymphatic System (Lymphangitis, etc.) – – – – – – – – – – – – – – – Haemorrhage without stated cause – – – – – – – – – – – – – – – Other Diseases of the Circulatory System – – – – – – – – – – – – – – – 84 5.– Diseases of the Respiratory System. Diseases of the Nasal Fossae and Annexa – – – – – – – – – – – – – – – Diseases of the Larynx – – – – – – – – – – – – – – – Bronchitis 56 2 2 – – – – – 1 4 5 16 15 11 5 Broncho-pneumonia 63 21 14 – – 1 – – 3 1 3 6 11 3 34 Pneumonia, Lobar, or not otherwise defined 59 6 3 – – – 4 3 4 11 14 11 3 – 26 Pleurisy 1 1 – – – – – – – – – – – – – Congestion and Hæmorrhagic Infarct of Lungs 6 – – – – – – – – – – – 5 1 2 Gangrene of the Lung – – – – – – – – – – – – – – – Asthma 2 – – – – – – – 1 1 – – – – – Pulmonary Emphysema – – – – – – – – – – – – – – – Other Diseases of the Respiratory System 3 – – – – – – – – 1 – – 1 1 – 6.– Diseases of the Digestive System. Diseases of the Buccal Cavity and Annexa 1 – – – – – – – – – – 1 – – 1 Diseases of the Pharynx and Tonsils 1 – – – – – – – – – 1 – – – 1 Diseases of the Œsophagus – – – – – – – – – – – – – – – Ulcer of the Stomach or duodenum 23 – – – – – – 1 5 5 7 4 1 – 10 Other diseases of the Stomach 5 1 1 – – – – – – – – 1 2 – 2 Diarrhoea and Enteritis 33 24 4 1 – – 1 1 1 – – – – 1 17 Ankylostomiasis – – – – – – – – – – – – – – – Diseases due to other Intestinal Parasites – – – – – – – – – – – – – – – Appendicitis 13 – – – 3 2 – 2 – 3 1 1 1 – 13 Hernia, Intestinal Obstruction 16 1 – – – 1 – 2 2 2 3 2 3 – 9 Other Diseases of the Intestines 1 – – – – – – – – – – – – – 1 Acute Yellow Atrophy of the Liver – – – – – – – – – – – – – – – Hydatid Tumour of the Liver – – – – – – – – – – – – – – – Cirrhosis of the Liver 8 – – – 1 – – – – 2 3 2 – – 4 Biliary Calculi 5 – – – – – – – – 1 – 2 2 – 1 Other Diseases of the Liver 3 – – – – – – 1 – 1 1 – – – 3 Diseases of the Pancreas 1 – – – – – – – – – – – – – – Peritonitis without stated cause 2 – – 1 1 – – – – – – – – – 1 Other diseases of the Digestive System – – – – – – – – – – – – – – – 7.– Non-Venereal Diseases of the Genito-Urinary System and. Annexa. Acute Nephritis (including unspecified under 10 years of age) 5 – – – 1 1 – – 1 1 – 1 – – 2 Chronic Nephritis (including unspecified over 10 years of age) 47 – – 1 – 1 1 1 5 8 8 14 4 4 12 Chyluria – – – – – – – – – – – – – – – – Other Diseases of the Kidney and Annexa 4 1 – – – – – – 2 – l – – – 2 Calculi of the Urinary Passages 4 – – – – – – 1 1 – 2 – – – 3 Diseases of the Bladder 1 – – – – – – – – – – – 1 – – 85 Table II.—DEATHS OF WILLESDEN RESIDENTS—continued. CAUSE OF DEATH. All Ages. 0 to 1 1 to 5 5 to 10 10 to 15 15 to 20 20 to 25 25 to 35 35 to 45 45 to 55 55 to 65 65 to 75 75 to 85 85 Up. Total deaths, whether of Residents" or "Non-Residents," in Institutions in the District. (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) (13) (14) (15) (16) 7.—Non-Venereal Diseases of the Genito-Urinary System and Annexa—continued. Diseases of the Urethra, Urinary Abscess, etc. 1 – – – – – – – – – 1 – – – – Diseases of the Prostate 12 – – – – – – – – – 1 3 8 – 8 Non-Venereal Diseases of the Male Genital Organs – – – – – – – – – – – – – – – Cysts, and other Tumours of the Ovary not returned as malignant 3 – – – – – – – – 1 2 – – – 1 Salpingitis and Pelvic Abscess in Females – – – – – – – – – – – – – – – Tumours of the Uterus not returned as malignant – – – – – – – – – – – – – – 1 Non-Puerperal Uterine Haemorrhage – – – – – – – – – – – – – – – Other Diseases of the Female Genital Organs – – – – – – – – – – – – – – – Non-Puerperal Diseases of the Breast 1 – – – – – – – – 1 – – – – – 8.—The Puerperal State. Accidents of Pregnancy 1 – – – – – – 1 – – – – – – 2 Puerperal Haemorrhage 1 – – – – – – 1 – – – – – – 1 Other Accidents of Childbirth 5 – – – – – – 3 2 – – – – – 2 Puerperal Sepsis 3 – – – – – 1 2 – – – – – – 1 Puerperal Phlegmasia Alba Dolens, and Sudden Death – – – – – – – – – – – – – – – Puerperal Albuminuria and Convulsions 1 – – – – – – 1 – – – – – – 1 Childbirth not assignable to other headings (Puerperal Insanity) – – – – – – – – – – – – – – – Puerperal Diseases of the Breast – – – – – – – – – – – – – – – 9.—Diseases of the Skin and Cellular Tissue. Gangrene 4 – – – – – – – – – – – 2 2 2 Carbuncle, Boil 3 – – – – – – – – 1 1 1 – – 1 Cellulitis, Acute Abscess 6 – – 1 – – 1 – – – – 1 3 – 6 Other diseases of the Skin and its Annexa 2 – – – – – – – – – – 1 1 – 1 10.—Diseases of the Bones and Organs of Locomotion. Diseases of the Bones 1 – – – – – – 1 – – – – – – 1 Diseases of the Joints 1 – – – – – 1 – – – – – – – – 86 Amputation – – – – – – – – – – – – – – – Other Diseases of the Organs of Locomotion 1 – – – – – – – – 1 – – – – 1 11.—Congenital Malformations. Congenital Malformations 13 11 2 – – – – – – – – – – – 4 12.—Diseases of Early Infancy. Congenital Debility, Sclerema and Icterus 15 15 – – – – – – – – – – – – 5 Premature Birth, Injury at Birth 62 62 – – – – – – – – – – – – 24 Other Diseases peculiar to early infancy 5 5 – – – – – – – – – – – – 1 Lack of Care 4 4 – – – – – – – – – – – – – 13.—Old Age. Old Age 78 – – – – – – – – – 1 21 34 22 56 14.—External Causes. Suicide by solid or liquid poisons and corrosive substances 7 – – – – – – 4 – 2 1 – – – – Suicide by Poisonous Gas 11 – – – – – – 1 3 4 3 – – – – Suicide by Hanging or strangulation 2 – – – – – – 1 1 – – – – – – Suicide by Drowning – – – – – – – – – – – – – – – Suicide bv Firearms – – – – – – – – – – – – – – – Suicide by Cutting or Piercing Instruments 1 – – – – – – – – – 1 – – – 1 Suicide by Jumping from High Place – – – – – – – – – – – – – – – Suicide by Crushing 2 – – – – – 1 – – – – – 1 – 1 Suicide by other means – – – – – – – – – – – – – – – Food Poisoning – – – – – – – – – – – – – – – Poisoning by Venomous Animals 1 – – – – – – – – – – – 1 – 1 Other Acute Accidental Poisoning (not gas) – – – – – – – – – – – – – – – Conflagration – – – – – – – – – – – – – – – Accidental Burns (conflagration excepted) 3 – 1 – – – – – 1 – 1 – – – 4 Accidental Mechanical Suffocation 4 2 – – – – – – – – 1 – 1 – – Accidental Absorption of Irrespirable or Poisonous Gas – – – – – – – – – – – – – – – Accidental Drowning 6 – – – 1 2 – – 1 – 2 – – – – Accidental Injury by Firearms – – – – – – – – – – – – – – – Accidental Injury by Cutting or Piercing Instruments 2 – – – – – – 1 – – – – 1 – 2 Accidental Injury by fall 11 1 – – – – – 2 – – 2 4 2 – 8 Accidental Injury in Mining and Quarrying – – – – – – – – – – – – – – – Accidental Injury by Machinery 1 – – – 1 – – – – – – – – – – Accidental Injury by other forms of Crushing (road vehicles or railways) 39 – 2 1 3 5 5 4 4 2 3 4 6 – 19 87 Table II.—DEATHS OF WILLESDEN RESIDENTS—continued. CAUSE OF DEATH. All Ages. 0 to 1 1 to 5 5 to 10 10 to 15 15 to 20 20 to 25 25 to 35 35 to 45 45 to 55 55 to 65 65 to 75 75 to 85 85 Up. Total deaths whether of "Residents" or " Non-Residents," in Institutions in the District. (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) (13) (14) (15) (16) 14.—External Causes—continued. Injury by Animals (poisoning by venomous animals excepted) – – – – – – – – – – – – – – – Wounds of War – – – – – – – – – – – – – – – Execution of Civilians by Belligerent Armies – – – – – – – – – – – – – – – Hunger or Thirst – – – – – – – – – – – – – – – Excessive Cold – – – – – – – – – – – – – – – Excessive Heat 2 1 – – – – – – – 1 – – – – 2 Lightning – – – – – – – – – – – – – – – Electricity (lightning excepted) – – – – – – – – – – – – – – – Homicide by Firearms – – – – – – – – – – – – – – – Homicide by Cutting or Piercing Instruments – – – – – – – – – – – – – – – Homicide by other means 1 – – – – – – 1 – – – – – – 1 Infanticide (under one year) – – – – – – – – – – – – – – – Fracture (cause not specified) 1 – – – – – – – – – – 1 – – – Other and unstated forms of accidental violence (Execution) 2 – – – – – – 1 – – – – – 1 – Violent Deaths of unstated nature [i.e., accidental, suicidal, &c.) and cause – – – – – – – – – – – – – – – 15.—Ill-Defined Diseases. Sudden Death 1 – – – – – – – – – – 1 – – – Cause of death unstated or ill-defined – – – – – – – – – – – – – – – Totals 1,762 175 75 29 23 35 42 93 103 180 282 361 277 87 685 88 Appendix A.—Table 11(a). CAUSES OF DEATH IN WILLESDEN URBAN DISTRICT AS CIRCULATED BY REGISTRAR-GENERAL.—1930. Causes of Death. M. F. All Causes 863 867 1. Enteric Fever – 1 2. Small-pox – – 3. Measles 15 11 4. Scarlet Fever 1 2 5. Whooping Cough 2 3 6. Diphtheria 9 10 7. Influenza 13 12 8. Encephalitis Lethargica 3 – 9. Meningococcal Meningitis 3 3 10. Tuberculosis of Respiratory System 73 53 11. Other Tuberculous Diseases 6 8 12. Cancer, Malignant Disease 96 120 13. Rheumatic Fever 4 3 14. Diabetes 13 9 15. Cerebral Haemorrhage, etc. 38 65 16. Heart Disease 137 163 17. Arterio-sclerosis 27 33 18. Bronchitis 18 35 19. Pneumonia (all forms) 75 43 20. Other Respiratory Diseases 5 12 21. Ulcer of Stomach or Duodenum 19 5 22. Diarrhoea, etc. (under 2 years) 17 11 23. Appendicitis and Typhlitis 9 5 24. Cirrhosis of Liver 5 4 25. Acute and Chronic Nephritis 26 27 26. Puerperal Sepsis – 4 27. Other accidents and diseases of Pregnancy and Parturition – 7 28. Congenital Debility and Malformation, Premature Birth 53 31 29. Suicide 12 11 30. Other Deaths from Violence 54 18 31. Other Defined Diseases 130 157 32. Causes ill-defined or unknown – 1 Special Causes (included above):— Poliomyelitis 1 – Polioencephalitis 2 2 Deaths of Infants under 1 year Total 107 66 Illegitimate 12 6 89—90 APPENDIX A. table iii.—infant mortality during 1930. Nett Deaths from Stated Causes at Various Ages under 1 Year of Age. Nett Deaths from all Causes under 1 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. Stonebridge. Roundwood. Church End. Willesden Green. Cricklewood. (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) (13) (14) (15) (16) (17) (18) (19) (20) (21) (22) All Causes Certified 60 18 5 6 89 37 19 14 16 175 26 17 15 5 8 14 21 19 14 9 27 Uncertified – – – – – – – – – – – – – – – – – – – – – Small Pox – – – – – – – – – – – – – – – – – – – – – Chicken Pox – – – – – – – – – – – – – – – – – – – – – Measles – – – – – – – 2 2 4 3 – – – – – 1 – – – – Scarlet Fever – – – – – – – – – – – – – – – – – – – – – Whooping Cough – – – – – 1 – – 1 2 – 1 – – 1 – – – – – – Diphtheria and Croup – – – – – – – – – – – – – – – – – – – – – Erysipelas – – – – – – 1 1 1 3 – 1 – – – – – – 1 – 1 Tuberculous Meningitis – – – – – – – – – – – – – – – – – – – – – Abdominal Tuberculosis (a) – – – – – – – – – – – – – – – – – – – – – Other Tuberculous Diseases – – – – – – – 1 – 1 – – – – – – 1 – – – – Meningitis (not Tuberculous) – – – – – – – – 1 1 – – – – – – – 1 – – – Convulsions 1 – – – 1 – – – – 1 – – – – – – – – – – 1 Laryngitis – – – – – – – – – – – – – – – – – – – – – Bronchitis – – 1 – 1 – 1 – – 2 – – 1 – – – – – – 1 – Pneumonia (all forms) – 2 1 – 3 7 7 4 6 27 5 4 – – 2 4 4 4 1 1 2 Diarrhoea – 1 1 1 3 10 6 3 2 24 2 3 2 1 2 4 2 1 1 4 Enteritis – – – – – – – – – – – – – – – – – – – – – Gastritis – – – 1 1 – – – – 1 – – – – – – – – 1 – – Syphilis – – – – – – 1 – – 1 – – 1 – – – – – – – – Rickets – – – – – – – – – – – – – – – – – – – – – Suffocation, overlying – – – – – 1 – 1 – 2 1 – – – – – – – 1 – – Injury at Birth 4 1 – – 5 – – – – 5 1 – 1 – – – – 1 1 – 1 Atelectasis 4 1 – – 5 – – – – 5 – – 1 1 1 – – – – – 2 Congenital Malformations (b) 4 2 – – 6 5 – – – 11 1 – – 1 – 2 1 2 – 1 3 Premature Birth 42 8 1 1 52 4 1 – – 57 8 6 4 2 1 3 9 7 – 4 8 Atrophy, Debility and Marasmus 2 3 1 2 8 7 – – – 15 3 1 3 – 1 – 1 2 1 1 2 Other Causes 3 – – 1 4 2 2 2 3 13 2 1 2 – – 1 2 1 1 – 3 Total Deaths 60 18 5 6 89 37 19 14 16 175 26 17 15 5 8 14 21 19 14 9 27 Deaths- Legitimate 56 18 5 6 85 32 14 12 13 156 23 14 14 5 8 12 19 17 12 7 25 Illegitimate 4 – – – 4 5 5 2 3 19 3 3 1 – – 2 2 2 2 2 2 Births— -Legitimate ... ... ... ... ... ... ... ... ... 2,776 265 255 169 116 176 225 345 266 225 231 503 Illegitimate ... ... ... ... ... ... ... ... ... 93 13 19 9 1 5 2 5 11 4 9 15 Total Births ... ... ... ... ... ... ... ... ... 2,869 278 274 178 117 181 227 350 277 229 240 518 Infant Mortality Rate— Legitimate ... ... ... ... ... ... ... ... ... 56.19 86.79 54.90 82.84 43.10 45.45 53.33 55.07 63.91 53.33 30.30 49.70 Illegitimate ... ... ... ... ... ... ... ... ... 204.30 230.77 157.89 111.11 – – 100.00 400.00 181.81 500.00 222.22 133.33 Infant Mortality Rate ... ... ... ... ... ... ... ... ... 60.99 93.53 62.04 84.26 42.73 44.20 61.67 60.00 68.59 61.13 37.50! 52.12 Population ... ... ... ... ... ... ... ... ... 179368 15,339 14,838 13,992 9,672 13,629 18,317 19,700 17,034 16,295 18,141 22,411 (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. 91 APPENDIX A—TABLE IV.-CASES OF INFECTIOUS DISEASE NOTIFIED DURING THE YEAR 1930. Notifiable Disease. Number of Cases Notified. Total Cases Notified in each Ward. At all ages. At Ages—Years. South Kilburn. Mid-Kilburn. North Kilburn. Brondesbury Park. Kensal Rise. Harlesden. Stonebridge. Roundwood. Church End. Willesden Green. Cricklewood. Total Cases removed to 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) (9) (10) (ID (12) (13) (14) (15) (16) (17) (18) (19) (20) (21) Small Pox 9 – – 1 3 4 – 1 2 – – 1 – 1 1 1 – 1 2 8* Cholera (C) Plague (P) – – – – – – – – – – – – – – – – – – – – Diphtheria (including Membranous Croup) 491 4 106 311 43 24 3 – 73 55 21 17 22 37 56 66 46 40 58 457 Erysipelas 81 3 3 8 7 28 23 9 7 8 4 6 10 6 12 7 6 4 11 20 Scarlet Fever 518 3 99 317 61 34 4 – 46 56 28 25 54 32 82 37 46 31 81 439 Typhus Fever – – – – – – – – – – – – – – – – – – – – Enteric Fever 10 – – 5 3 2 – – 1 – 2 – – 1 – – 2 3 1 7 Relapsing Fever (R) Continued Fever (C) Puerperal Fever 5 – – – 1 4 – – 1 – – 1 1 – 1 – – – 1 2 Puerperal Pyrexia 34 – – – 13 21 – – 2 3 6 4 3 2 4 2 – 1 7 3 Cerebro-spinal Meningitis 3 – 1 – 1 1 – – 1 – – – – 1 1 – – – – 1 Poliomyelitis 4 – 2 2 – – – – – – – – 1 – 1 – – 1 1 – Ophthalmia Neonatorum 38 38 – – – – – – 3 3 2 2 – 4 5 6 6 2 5 2 Pulmonary Tuberculosis 258 – 1 9 73 116 52 7 17 32 17 11 20 20 37 23 20 26 35 – Other forms of Tuberculosis 73 4 19 21 17 8 4 – 6 7 2 3 9 9 13 7 2 8 7 – Whooping Cough 229 38 90 97 2 1 1 – 11 15 9 6 9 32 45 63 6 15 18 6 Pneumonia 266 13 33 36 36 71 57 20 41 44 13 4 11 18 55 26 23 13 18 3 Malaria 2 – – – – 2 – – – – – – – 1 – – – 1 – – Dysentery – – – – – – – – – – – – – – – – – – – – Encephalitis Lethargica 3 – – 1 – – 1 1 – 1 – – – 1 – – 1 – – 1 Acute Polio Encephalitis 5 – 4 – – – 1 – 2 1 – – – – 1 – – – 1 – Anthrax – – – – – – – – – – – – – – – – – – – – Totals 2,029 103 358 808 260 316 146 38 213 225 104 80 140 165 314 238 158 146 246 949 * Removed to Willesden Small Pox Hospital, Kingsbury, Middlesex. 92 APPENDIX B. Showing Acts of Parliament, Local Government Orders, Memoranda, and Circular Letters issued by Government Departments with regard to the Public Health, Maternity and Child Welfare and School Medical Services during the Year 1930. MINISTRY OF HEALTH. Circulars. No. 1067. Local Government Act, 1929; Transfer of Functions. No. 1072. Local Government Act, 1929. No. 1081. Psittacosis. No. 1068. Local Government Act, 1929, Public Vaccination. No. 1100. Local Government and Other Officers' Superannuation Act, 1922. No. 1108. Psittacosis. No. 734. 1. Local Government Act, 1929. 2. Mental Deficiency Acts, 1913-1927. 3. Grants to Voluntary Associations, etc. No. 1107. Public Health (Tuberculosis) Regulations. No. 1127. Local Government and Other Officers' Superannuation Act, 1922. No. 1136. Cancer—VII. No. 1138. Housing Act, 1930. No. 1139. Housing Act, 1930. No. 1142. Annual Statistical Review. No. 1153. Housing Act, 1930. Memoranda. No. 151. Med.—Psittacosis. L.G.A. 33.—Public Vaccination. Memorandum on Cancer as a subject for the attention of Local Authorities. Memorandum on Housing Act, 1930. No. 154/R.G.—Annual Statistical Review. L.G.A. 40.—Survey and Scheme under Section 63 for the Provision of Hospital Accommodation for Infectious Diseases. L.G.A.—Welfare of the Blind. Regulations. No. 69. The Local Government (Qualifications of Medical Officers and Health Visitors) Regulations, 1930. No. 289. The Elementary Education (Substantive Grant) Regulations, 1930. No. 277. The Road Vehicles (Registration and Licensing) Amendment Regulations, 1930 No. 572. The Public Health (Tuberculosis) Regulations, 1930. Statutes. Housing Act, 1930. Schemes. Maternity and Child Welfare. Local Government Act, 1929.—Treatment of Tuberculosis. MINISTRY OF TRANSPORT. Road Traffic Act, 1930. 93 APPENDIX C. MOTOR SERVICE. I beg to report on above for its sixteenth complete year, ending 31st March, 1930. There are 14 vehicles used in connection with this service. Reg. No. Tax. Make. Year of Purchase. Work required for. Seating capacity. Purchase Price. 1. *M.X. 1884 £20 Napier 12/1913 Disinfection, Laundry and Kingsbury – £445 2. *M.X. 2057 Free ,, ,, School work 18 £492 3. *M.X. 2059 £15 15s. ,, ,, School work 18 £492 4. *M.X. 2060 Free ,, ,, School work 18 £489 5. *M.X. 2061 ,, ,, ,, Infectious ambulance – £492 6. M.F. 4117 ,, Crossley ... 4/1924 Accident ambulance – £892 7. M.H.3808 ,, ,, 3/1925 School work 20 £823 8. M.H.8989 £16 Berliet 7/1925 Education Department – £405 9. M.P. 3711 £18 Dennis 5/1928 School work 30 £760 10. M.P. 3712 Free 5/1928 School work 30 £760 11. M.T. 810 £20 ArmstrongSiddeley 11/1928 Health Department – £800 12. M.Y. 967 Free Dennis 8/1929 School work 28 £762 13. M.Y. 19 £20 ArmstrongSiddeley 11/1929 Education Department – £538 14. M.Y. 26 Free ,, 2/1930 Accident ambulance – £854 * Purchased by 10 years' loan, last payment made September, 1923. Six of the others were purchased out of revenue and three by loan. There are 12 routes run by School Ambulances daily for Physically and Mentally Defective and Blind Children. 290 children are on lists for daily conveyance and approximately 210 are in average attendance. During the year under review the chief work has been:— Ambulance Calls; Conveyance of Physically and Mentally Defective children; Blind and Stammering children; disinfection and return of bedding; and transport of supplies and staff to Small Pox Hospital; Board of Guardians' cases; Clinic and Laundry work; conveyance of meals, and certain works for other departments. Also during building of Braintcroft School, children numbering up to 54 per day were conveyed from Brentwater Estate to Mora Road School. M.X. 2059 was specially licensed for this work. A day and night service is in operation for ambulance calls. (Only one man is on duty during the night). The personnel of the service consists of:— 1 Mechanic Superintendent and Engineer. I Assistant Engineer. 12 Motor Drivers. 1 Disinfector. The working hours are 47 per week per man. The Service, in addition to the foregoing, undertakes work as called for for Engineer's Department, Fire Brigade and other departments. All engineering work of Municipal and Kingsbury Hospitals is also carried out by the Mechanic Superintendent and his staff. Calls for the ambulances are very heavy, especially in removal of illness cases to and from Hospital for treatment. Not infrequently it occurs that several cases are waiting for removal. In these circumstances the most serious have priority. A certain number of accident calls are not answered, or are delayed owing to car or driver being engaged and lack of means of calling assistance. 94 Total Number of Miles Run. The following table shows the number of miles run year by year since the inception of the service:— 7 Total Miles Rum. 1913-15 56,669 1915-20 259,936 1920-25 319,862 1925-26 87,030 1926-27 98,318 1927-28 103,587 1928-29 111,338 1929-30 125,528 Total 1,162,268 The following table gives details of the miles run during last year 1929-30 1929-30 Special School work 54,129 Accidents, Sickness and Infectious cases 28,153 Disinfection 6,023 Education Department 11,709 Accountant's Department 1,420 Engineer's Department 127 Clerk's Department 2,190 Health Department 9,924 Hospital work 252 Miscellaneous 130 Library Department 1,128 Small Pox Hospital, Kingsbury 3,051 Elections 259 Braintcroft Estate (School work) 7,033 Total 125,528 The following gives the miles run by each vehicle during the year under review Miles. 1. Van M.X. 1884 7,839 2. School Ambulance M.X. 2057 9.913 -3. School Ambulance M.X. 2059 6,536 4. School Ambulance M.X. 2060 7,792 5. Ambulance M.X. 2061 8,684 6. Ambulance M.F. 4117 10,648 7. School Ambulance M.H. 3808 9,860 8. Education and School M.H. 8989 9,807 9. School Ambulance M.P. 3711 10,199 10. School Ambulance M.P. 3712 10,243 11. Health Department M.T. 810 11,780 12. School Ambulance M.Y. 967 6,280 13. Education Department M.Y. 19 4,969 14. Accident Ambulance M.Y. 26 1,978 Total 125,528 Calls. The following table shows the number of calls for the Disinfecting Van, Infectious, Accident and Illness Ambulances respectively:— Delivery (1913) to 31/3/27. 1/4/27 to 31/3/28. 1/4/28 to 31 /3/29. 1/4/29 to 31/3/30. Grand Total 1913-1930. *Disinfecting Van 14,368 1,045 1,260 1,250 17,923 *Infectious Ambulance 12,983 892 1,159 1,062 16,096 *Accident and Illness Ambulances 15,631 2,019 2,309 2,704 22,663 42,982 3,956 4,728 5,016 56,682 * 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. 95 Miles per Gallon and Cost per Mile Run. Total Number of miles run by all vehicles. Total Number of gallons of petrol consumed. Number of miles per gallon of petrol consumed. Cost in pence per mile run. 1914-15 44,098 3,988 11.0 13.4 1915-20 259,936 25,284 10.39 13.90 1920-25 319,862 28,628 11.03 16.22 1925-26 87,030 7,189 12.106 13.654 1926-27 98,318 7,121 13.807 11.892 1927-28 103,587 7,680 13.488 10.830 1928-29 111,338 9,011 12.358 12.391 1929-30 125,528 10,225 12.277 12.378 Storage Plant.—The petrol storage plant installed in January, 1915, is still working satisfactorily, and saves on present consumption about £40 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 one delivery hose. 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 during the year where our drivers were at fault. Replacements.—Five of the vehicles attached to this service had been in constant use for 16 years, but during this financial year 1 school ambulance, 1 accident and illness ambulance, and 1 car have been purchased, but owing to increased work others were not put out of service. Five of the original vehicles are still running. The extra ambulance and extension of garage now under consideration are very necessary. GEORGE F. BUCHAN, Medical Officer of Health. WILLESDEN URBAN DISTRICT COUNCIL. MOTOR SERVICES. Year Ended 31st March, 1930. Year 1928-29. Cost per Mile. Expenditure. Year 1929-30. Cost per Mile. £ s. d. £ s. d. d. £ s. d. £ s. d. d. Running Expenses— 467 9 10 Petrol 656 12 10 25 19 6 Oil and Grease 26 5 10½ 151 1 11 Tyres 138 15 3 — 644 11 3 1.389 — 821 13 11½ 1.571 Wages and Emoluments— 303 3 3 Mechanic Superintendent 322 1 7 2.962 8 51 Drivers, etc. 3,170 8 2½ 25 16 9 National Insurance (Employer's Contributions) 26 17 9 3,291 8 5½ 7.096 3,519 7 6½ 6.733 Fixed and General Charges— 187 0 0 Rent (Garage and Mess Room) 187 0 0 165 13 1 Repairs, Plant, etc. 126 4 5 41 8 2 Painting, etc., Bodies of Vehicles 27 0 9 75 7 8 Coal, Gets, etc. 78 0 4 118 10 9 Uniforms and Overalls 72 18 3 87 14 0 Insurance of Vehicles 87 8 1 112 0 4 Motor Car Registration 97 11 8 4 10 0 Drivers' Licences, etc. 5 5 0 54 2 10 Accessories and Sundries 65 10 4 846 6 10 1.824 746 18 10 1.430 £4,782 6 6½ 10.309 Carried forward £5,088 0 4 9.734 96 Year 1928-29. Year 1929-30. Cost per Mile. Expenditure. Cost per Mile. £ s. d. £ s. d. d. £ s. d. £ s. d. d. 4,782 6 6½ 10.309 Brought forward 5,088 0 4 9.734 Depreciation and Interest Charges— 870 13 10 Amount written off value of vehicles in accordance with Medical Officer of Health's Valuation 1,264 7 4 95 3 0 Interest on Capital Employed 118 18 7 965 16 10 2.082 1,383 5 11 2.644 £5,748 3 4½ 12.391 £6,471 6 3 12.378 Income— £ s. d. Use of Vehicles for :— £ s. d. 90 5 0 Conveyance of patients 56 18 6 2 18 0 Election purposes 12 19 0 £93 3 0 £69 17 6 9,011 Gallons Petrol Consumed 10,225 Gallons 111,338 Miles Miles run by all vehicles 125,528 Miles 12.358 Miles Miles run per gallon of petrol consumed 12.277 Miles Vehicles in use :— 31st March, 1929 11 31st March, 1930 14 Finance Department, Town Hall, Dyne Road, Kilburn, N.W. 6. July, 1930. APPENDIX D. REPORT ON ARTIFICIAL LIGHT TREATMENT FOR THE YEAR ENDED 31ST DECEMBER, 1930. BY H. HALDIN DAVIS, M.D., M.R.C.P., F.R.C.S., Dermatologist to the Council. The great event of the year 1930 was the opening of the new Health Centre at Stonebridge at the end of April. The privilege of working in a new building well equipped with all modern appliances has been much appreciated bv the staff. We would also point to the figures which bear eloquent testimony to the popularity of the Centre with the patients. The Sunlight Department at Stonebridge is now provided not only with a room of adequate size in which are housed a double carbon arc and also two mercury vapour lamps, but also in addition with a good bath room fitted with plunge and shower baths and ample dressing accommodation. The two mercury vapour lamps are so arranged that two or three children can be treated seated together on a bench and receive even irradiation, front and back, simultaneously. As a general rule, all patients commence their treatment with a course of carbon arc radiation and the mercury vapour lamps are reserved for those who do not appear to make satisfactory progress with carbon alone. The opening of the Stonebridge Clinic has also indirectly been of great advantage to the original Sunlight Department which has now been working over four years in the No. 1 Clinic at Willesden Lane. Space has become available for the more satisfactory accommodation of the Department which has now climbed out of the cellar and established itself on the second floor. Here there is a good room with adequate ventilation for the actual Light treatment itself and the Medical Officer is now provided with a separate consulting room, and no longer has to examine patients and interview parents in the corner of an apartment crowded with noisy children in an atmosphere wherein the temperature often reaches 70° or more. The chief facilities in which the Sunlight Department at No. 1. Clinic is still lacking are baths and decent waiting accommodation. There are no baths at all, although these are really an essential part of the equipment of a Light Clinic and the patients and their parents are compelled to use the landing and staircase as waiting room. Here they are much exposed to fierce draughts, which are not the same thing by any means as fresh air. Nevertheless, and notwithstanding the rival attractions of the new Stonebridge Centre which supplies the needs of certain parts of the district which were formerly supplied by Willesden Lane, the old Clinic maintains its popularity and the numbers of the patients and their attendances show only a slight falling off from last year. The X-ray apparatus is still housed in the basement where it is employed principally for the treatment of ringworm of the scalp and also to a smaller extent for chronic eczema and sometimes for acne. Ringworm of the scalp for the treatment of which the Council's Skin Department was originally opened nearly nineteen years ago has now become a comparatively rare disease. In 1914 about 120 cases were treated with X-rays and there was always a long waiting list. In 1930 only 13 cases were treated. The diminution in the numbers is very gratifying and shows that the efforts of the Council to stamp out this annoying complaint which in the past has been the cause of very serious interruption to the education of large numbers of school children, have attained a large measure of success. 97 As regards the type of case attending the Sunlight Clinics there is not much to be said which has not been said in previous years. The great majority are children suffering from vague forms of debility and anaemia and there are also a good many cases of chronic bronchitis, asthma, blepharitis, furunculosis, rheumatism, and neurosis. Considerable benefit accrues to the patients from the administration of light and in addition much good results from the fact that their parents are brought into frequent contact with the personnel of the Council's Health Centres from whom they carry away, both consciously and unconsciously, valuable training in hygiene to put into practice in their own homes. 98-99 ARTIFICIAL LIGHT TREATMENT, YEAR ENDED 3rd JANUARY, 1931. Conditions. Brought forward from 1929 : Treatments, WaitingList, Observation Cases. ' New, 1930. Total Treated. Discharged not Treated, i.e., Unable to attend, Unsuitable, Left District. Waiting List. Condition Improved. Treatment suspended but still under Observation. RESULTS OF TREATMENT. Discharged. Still under Treatment. Carried forward to 1931, i.e. : Treatments, WaitingList Observation Cases. Improved or Cured. Unable to attend or Left district. Unsuitable or no Improvement. 2 3 4 5 6 7 8 9 10 11 0-5 School 0-5 School. 0-5 School. 0-5 School. 0-5 School. 0-5 School. 0-5 School. 0-5 School. 0-5 School. 0-5 School. 0-5 School. Tuberculosis—Glands Neck - 2 - 1 - 2 - - - - - - - - - 1 - - - 1 - 1 Pre-Tubercular 2 8 1 5 2 9 1 4 - - — 2 1 — - 2 — 1 1 4 1 6 2 10 1 6 2 11 1 5 — — — 2 I — — 3 — 1 1 5 1 7 General Debility and Malnutrition 9 28 76 70 69 67 12 23 4 8 11 16 13 7 7 4 2 2 36 38 51 62 Anaemia 4 4 5 12 5 14 4 2 - - - - 1 5 1 1 1 1 2 7 2 7 Rickets 15 1 37 2 43 3 9 - -- - 4 2 15 - 7 - 2 - 15 1 19 3 Nervousness - 2 2 3 2 4 - 1 - — - 1 - — - — - — 2 3 2 4 Chilblains - - - 2 - 2 - - - - - 1 - - - - - - - 1 - 2 Delayed Dentition - — 1 - 1 - - — - — — - - — — — — — 1 - 1 - 28 35 121 89 120 90 25 26 4 8 15 20 29 12 15 5 5 3 56 50 75 78 Chronic Blepharitis 1 3 1 3 2 5 - 1 - - - 1 1 1 - 1 - - 1 2 1 3 Chronic Conjunctivitis 1 — - - - - 1 - - - - - - - - - - - - - - - 2 3 1 3 2 5 1 1 - — — 1 1 1 — 1 — — 1 2 1 3 Psoriasis - 1 - 1 - 2 - - - - - - - 1 - 1 - - - - - - Alopecia Areata - 1 1 4 1 5 - - - - - 1 - 1 - 1 - - 1 2 1 3 Pityriasis Rubra. - 1 - - - 1 - - - - - 1 - - - - - - - - - 1 Chronic Eczema and Asthma - 1 - 1 - 1 - 1 - - - 1 - - - - - - - - - 1 Prurigo - - - 1 - 1 - - - - - - - 1 - - - - - - - - — 4 1 7 1 10 - 1 — — — 3 — 3 — 2 — — 1 2 1 5 Asthma - 8 3 7 3 12 - 2 - - - - - 4 1 2 - 1 2 5 2 5 Chronic Bronchitis 1 8 5 6 6 10 - 4 - — 2 1 - 2 - 2 1 - 3 5 5 6 1 16 8 13 9 22 - 7 - - 2 1 — 6 1 4 1 1 5 10 7 11 Enlarged Glands Neck 2 4 7 10 6 10 1 3 2 1 - 2 5 3 - 1 - 1 1 3 3 6 Enuresis - ] - - - 1 - - - - - - - 1 - - — - - - - - Rheumatism - 4 - 2 - 5 - 1 - - - - - 2 - - - 1 - 2 - 2 Chorea - 2 - 2 - 4 - - — — 2 — 1 — 1 — - — - — 2 Anorexia 1 - - - - ** 1 - - - - - — - — - - - - - - - Abscess Neck - 1 - 1 - 1 - 1 - - - - - 1 - - - - - - - - Marasmus 2 - 1 - 3 - - - - - - - 1 - 1 - - - - - 1 - Tabes Mesenterica - 1 - 1 - 2 - - - - 1 — - — - 2 — — - - - - Fragillitis Ossium - 1 - - - - - 1 - - - - - - - - - - - - - - Genu Valgum 2 - 2 1 4 j - - - - - 1 1 - 1 - - - 1 - 2 1 Talipes Valgus - - 1 - 1 - - - - - 1 - - — - — — — 1 - 1 - Otorrhœa - 1 1 2 1 2 - - - 1 - — — 1 — 1 — — 1 — 1 1 7 15 12 19 15 26 2 6 2 2 2 5 7 9 2 5 — 2 4 5 8 12 Total 40 83 144 137 149 164 29 46 6 10 19 32 38 31 18 20 6 7 68 74 93 116 123 281 313 75 16 51 69 38 13 142 209 TOTAL NUMBER OF ATTENDANCES, YEAR ENDING JANUARY 3rd, 1931. Attended and Treated Attended for examination, e.g., new cases, cases treated and still under observation ; unsuitable cases 0-5 School. Total. 3,064 4,338 7,402 179 273 452 3,243 4,611 7,854 CASES REFERRED BY Clinic Doctors Private Doctors Hospital 0-5 School. Total. 127 112 239 1 7 8 4 0 4 132 119 251 Total number of sessions ... ... 443 Average attendance per session... ... ... 17-7 Average treatment per child ... 16-7 100 APPENDIX E. REPORT ON WORK IN THE EYE DEPARTMENT FOR THE YEAR ENDED 31st DECEMBER, 1930, by FRANK W. LAW, M.A., M.B., B.Chir., F.R.C.S., Ophthalmic Surgeon to the Council. Owing to the different arrangement under which the work in this Department is now carried out, it is impossible to compare figures or results for this year with those of any other year. Previously, all routine ophthalmic cases were seen by the Medical Officers, who referred to the Ophthalmic Surgeon only such cases as needed a specialist opinion ; there was thus virtually no separate Eye Department. On my appointment as Ophthalmic Surgeon on March 13th, 1930, a separate Eye Department was established, and it was arranged to hold sessions once a week at each of the three Clinics, at which all Ophthalmic cases should be seen. My duties were commenced on April 29th, 1930 ; the period covered by this report is thus that of the last eight months of the year. In the interregnum during the alteration of arrangements, the work had got considerably in arrears ; indeed, after about six weeks work there was a waiting list of Refraction appointments at each Clinic of from two to three months—a highly unsatisfactory state of affairs, resulting inevitably in a large percentage of unkept appointments. These waiting lists occurred in spite of the fact that at each Clinic the number of appointments being made for each Session was between 10 and 15—in some cases even 20 and over. The average time for a refraction and general rapid examination (under Atropine) may be taken as 5 minutes ; it will be appreciated that this number of Refraction cases, together with all the ordinary ophthalmic cases attending the Clinic, made the Sessions of an unmanageable length. The situation was relieved in part by the booking of the large numbers of appointments already referred to, in part by the holding of special Refraction Sessions at extra times, at which none but appointment cases were seen—usually about 30 in number. As a happy result, there is now no waiting list at any Clinic—that is to say, any case having to return for refraction after the instillation of a cycloplegic is given the drug, with instructions for its use, and told to return for the next Session. It is expected that a considerable increase in the percentage of appointments kept will result. The Department is mainly occupied with Refraction work, i.e., the examination, with a view to the prescribing of glasses, if necessary, of cases referred from the School examinations as suffering from defective visual acuity, or of children complaining of symptoms suggestive of refractive error. In all cases where glasses are prescribed, the patient is instructed to return so that glasses may be examined and checked as to accuracy of dispensing, and also to see that they fit correctly and comfortably. The glasses are almost invariably prescribed from the objective examination alone ; only in rare cases is a subjective test carried out, where this seems specially indicated, since generally speaking subjective tests in the case of children are considered to be valueless. The remainder—" treatment cases "—consists mostly of cases of Blepharitis (sore lids), Conjunctivitis (" pink-eye "), Hordeola (styes), and Chalazia (cysts of the lids). One case of Chronic Blepharitis—very severe and of long standing—was, on account of its resistance to treatment, referred to Moorfields Hospital for the opinion of the Staff there, and sent to Paddington Green Children's Hospital for intensive in-patient treatment ; a case of Lamellar Cataract is, at the time of writing, an in-patient of the same Hospital undergoing operative treatment. A few cases from the Clinics were shown at meetings of the Ophthalmological Section of the Royal Society of Medicine, either on account of their extreme rarity or for the purpose of obtaining the benefit of the opinions of the other Ophthalmic Specialists there ; these included cases of Bilateral Corectopia, Pseudo-Coloboma of the Iris, Abnormal Retinal Pigmentation, and ? Staphyloma Posticum Verum. Statistical. The figures of attendances at each Clinic are shown in the following Tables : (1) Total Attendances (May-Dec., 1930 inc.). Total Attendances. Number of Ordinary Sessions. Average Attendance per Session. Clinic 1 1,203 29 41.5 Clinic 2 1,288 31 41.5 Clinic 3 1,249 31 40.3 101 (2) Refraction Cases. Appts. made. Average per Session. Appts. kept. Average per Session. Percentage Attendance. Clinic 1 426 14.2 299 10 70.4 Clinic 2 484 14.7 367 11.1 75.5 Clinic 3 441 13.4 364 11.0 82.1 APPENDIX F. REPORT ON THE WORK OF THE ORTHOPAEDIC CENTRE FOR THE YEAR 1930. by J. B. BARNETT, F.R.C.S., Orthopaedic Surgeon to the Council. The work of the Orthopaedic Centre extends only over the half-year from June 14th, 1930 until January 3rd, 1931. As will be observed from the analysis of cases appended, a large number of different types of deformity have been seen and treated. Conspicuously successful among cases under treatment have been patients with knock-knees, scoliosis, flat-feet and with rickety deformities of the tibiae. It is particularly in these cases that the work of the Clinic is so important. Conditions such as these, easily curable in their early stages, if left untreated, would involve severe and often, progressive deformity which can be treated only by long and expensive residence in a hospital. Co-operation with other sections and centres has been mutually satisfactory. It is likely that in a few years time, the number of cases seen, and of treatments given, will diminish, and as time goes on relatively fewer patients should be available owing to the general decrease of deformity in the Willesden area directly due to the work of the Clinic. Of the patients admitted for treatment at the Royal National Orthopaedic Hospital at Stanmore, under the Council's scheme, K.S., suffering from a severe infantile paralysis, has had the function of her left leg considerably increased by operation. V.W., suffering from congenital equino-varus, a deformity of both feet, is still under treatment. P.N., with Tuberculosis of the bones of his neck, is still in hospital, and will be for some months to come. Two cases are still waiting admission. 102 ORTHOPEDIC DEPARTMENT—OPENED JUNE 14th, 1930. REPORT FOR 29 WEEKS ENDED 3RD JANUARY, 1931. Defects Treated. Total. Treatment completed. Treatments ceasing before completion. Still under Treatment. Carried forward. 0-1 1-5 5-14 n.m. Total. 0-1 1-5 5-14 n.m. Total. 0-1 1-5 5-14 n.m. Total. 0-1 1-5 5-14 n.m. Total. Knock Knees — 36 12 — 48 — — — — — — — — — — — 36 12 — 48 Scoliosis 1 — 22 1 24 — — — — — — — 2 — 2 1 — 20 1 22 Kyphosis — — 37 — 37 — — — — — — — 3 — 3 — — 34 — 34 Lordosis — — 10 — 10 — — — — — — — — — — — — 10 — 10 Flat Feet — 4 14 1 19 — — — — — — — 1 — 1 — 4 13 1 18 Rickets 5 55 4 — 64 — 2 — — 2 — 3 — — 3 5 50 4 — 59 Infantile Paralysis — 2 4 — 6 — — — — — — — — — — — 2 4 — 6 Haemiplegia — 1 2 — 3 — — — — — — — — — — — 1 2 — 3 Paraplegia — 1 — — 1 — — — — — — — — — — — 1 — — 1 Diplegia 1 1 — — 2 — — — — — — 1 — — 1 1 — — — 1 Torticollis 1 1 2 — 4 — — — — — — 1 — — 1 1 — 2 — 3 Talipes Valgus and Varus . 5 8 1 — 14 — 1 — — 1 1 1 — — 2 4 6 1 — 11 Hammer Toes 1 2 4 — 7 — — — — — 1 1 1 — 3 — 1 3 — 4 Paresis of Digits — 1 2 — 3 — — — — — — — — — — — 1 2 — 3 Absence of Fibula — — 1 — 1 — — — — — — — — — — — — 1 — 1 Calcaneal Epiphysiosis — — 2 — 2 — — — — — — — 1 — 1 — — 1 — 1 Tuberculous Hip — — 1 — 1 — — — — — — — — — — — — 1 — 1 Spinal Caries — 1 2 — 3 — — — — — — — — — 1 2 — 3 Tieno Synovitis — — — 1 1 — — — — — — — — — — — — — 1 1 Funnel Chest — — 1 — 1 — — — — — — — — — — — — 1 — 1 Cong. Subluxation of Ractii. — — 1 — 1 — — — — — — — — — — — — 1 — 1 Spastic Monoplegia — — 1 — 1 — — — — — — — — — — — — 1 — 1 Palsies 1 1 1 — 3 — — — — — — — — — — 1 1 1 — 3 Osteomyelitis 1 2 — — 3 — — — — — — — — — — 1 2 — — 3 Deformed Scapula — — 1 — 1 — — — — — — — — — — — — 1 — 1 Cong. Dislocation of Hip — 1 1 — 2 — — — — — — — — — — — 1 1 — 2 Polydactyly — 1 — — 1 — — — — — — — — — — — 1 — — 1 Total 16 118 126 3 263 — 3 — — 3 2 7 8 — 17 14 108 118 3 243 No. of individual cases treated 15 108 107 2 232 3 3 2 7 5 14 13 98 102 2 215 No. of attendances made at Centre for treatment 97 1,092 1,555 31 2,775 Referred for Hospital Inpatient Treatment — 3 3 — 6 K. S. Infantile Paralysis — — 1 — 1 Do. Massage 69 877 1,037 14 1,997 M. H. Spinal Caries — — 1 — I Do. Electrical Treatments — 176 248 15 439 V. W. Congenital Equino Varus — 1 — — 1 Do. Gymnastic Treatments — 372 1,203 23 1,598 Palydactyly — 1 — — 1 Do. Application of Splints 39 110 — 3 152 P. N. Spinal Caries — 1 — — 1 Total 108 1,535 2,488 55 4,186 T. S. Spastic Haemiplegia — — 1 — 1 No. of individual cases not requiring treatment 1 17 30 1 49 Entered for Hospital Inpatient Treatment — 2 1 — 3 K. S. Infantile Paralysis — — 1 — 1 No. of attendances made at Centre 2 20 27 — 49 V. W. Congenital Equino Varus — 1 — — 1 P. N. Spinal Caries — 1 — — 1 Total Attendances at Centres 99 1,112 1,582 31 2,824 103 APPENDIX G. REPORT ON THE WORK OF THE CANCER CLINIC AT HEALTH CENTRE (1), 9, WILLESDEN LANE, KILBURN, N.W. 6. For the Year, 1930. by AGNES HILL NICOLL. M.A., M.B., Ch.B., D.P.H. This Clinic is held on the first and third Thursdays of the month from 7 to 8 p.m. During the year 1930, 43 patients attended, of whom 30 were women, and 13 were men. 21 women and 11 men were new cases, and 9 women and 2 men had attended during 1929, but were still under observation at the end of that year. The total attendances for the year was 83, giving an average of 3 to 4 per session. The ways by which the clinic had become known to these 43 patients were as follows :— 14 had read articles on the subject in the local press. 8 had seen the Council's advertisement in the local press. 6 had seen the posters displayed in the Health Centres, shops, libraries, etc. 5 had heard of it from the Council's health visitors. 5 had heard of the subject during their attendance at the Mothercraft classes held at the Centre. 4 had been recommended to go by friends who had themselves attended, or by councillors. 1 had read an article in Better Health. The 43 patients came to the clinic complaining of the following conditions :— 21 had pain or irritation in some part of the body, the most frequent sites being the abdomen, the breast, and the tongue. 9 had a lump or swelling. 6 had discharge from the uterus. 1 had irregularity of menstruation. 6 had chronic digestive or intestinal troubles. In about one third of the cases the complaint had existed for under three months ; in another third, the duration was from three months to one year ; while in the remainder, symptoms had persisted for periods which varied from one to ten years. In every case an attempt was made to find out the reason for delay in seeking relief of the symptom complained of. In 12 cases the matter had not been considered important, until the existence of the Clinic and its objects had been brought to notice. In 11 cases the patients were too busy to " waste time " going to doctors or hospitals, and had only come because the symptoms were getting worse. In 10 cases some treatment had been obtained at the beginning, but had either been inadequate in itself or had not been continued, and had failed to give relief. The patients had given up hope, until, hearing of this Clinic, they had decided to try again. In 3 cases an investigation had already been made in hospital, but had been negative. In 3 cases the patients had consulted their own doctors and been reassured, but the symptoms had continued. In 3 cases the patients feared cancer, and had not sought relief lest their suspicions should be confirmed. In 1 case some time previously an operation had been advised, but at a fee which the patient could not afford. After inquiry into the history, and a careful physical examination, each case was disposed of according to its needs, the guiding principle being a preventive one. Thus, if there was the slightest doubt as to the diagnosis the case was referred to hospital for further opinion or special investigation ; if any condition was found which, even if not definitely pre-cancerous might lead to chronic irritation, or, might later change its character, the patient was advised to have it treated or removed, and was sent to hospital, doctor, or dentist for the purpose ; and if the symptom complained of was found to be due to some cause quite remote from cancer or its pre-disposing causes, the patient was as far as possible put in the way of obtaining appropriate relief. Of the 43 cases dealt with : 25 were referred to various hospitals for further investigation or treatment. 9 were sent back to their own doctor or to the hospital which they had already been attending. 2 were advised to get Dental treatment. 104 3 were given certain hygienic advice. 3 left the district after the first visit or could not be traced. 1, on finding that medical treatment was not given at the Clinic, expressed indignation and refused to be examined. Of the 25 cases referred to Hospitals : 7 were admitted for operation : 1 for cancer of the breast. This was one of the cases who had seen a doctor previously and been reassured, and had done nothing till she heard of the Clinic. 5 for conditions which are recognised to be frequently pre-cancerous. 1 for a rupture which had been causing the symptoms but which had not been diagnosed. 5 were admitted to hospital for special investigation, after which 4 were found to be free from suspicion of cancer or pre-cancerous conditions, and were dismissed. 1 was recommended to have operation for a pre-cancerous condition and refused. 4 were found to be free from cancer and were dismissed. 5 received special treatment for non-cancerous conditions and were relieved. 4 failed to keep the appointments made for them. The following is a classification of the pathological conditions from which the patients were found to be suffering : Women, 30. I. Conditions affecting the uterus, 7. Erosion of the cervix 3 Septic Endometritis 1 Cervicitis 1 Prolapse 1 Fibroid Growths 1 II. Conditions affecting the Breast, 3. Paget's Disease of the Nipple 1 Lipoma 1 Fibro-adenoma 1 III. Conditions affecting the Intestinal Canal, 8. Chronic Dyspepsia 4 Dilatation of the Stomach 2 Colitis 1 Ventral Hernia 1 IV. General Conditions, 10. Pyelitis 2 Intercostal Neuralgia 2 Glossitis 1 Pharyngitis 1 Bursitis 1 Cyst of the Eyelid 1 Naevus of the Lip 1 Exophthalmic Goitre 1 V. Diagnosis incomplete 2 Men, 13. I. Conditions affecting the mouth and throat, 6. Glossitis 4 Smoker's Throat 1 Leukoplakia of mouth 1 105 II. General Conditions, 6. Seborrhoeic Warts 1 Pruritis Ani 1 Rectal Polypi 1 Lipoma of Axilla 1 Floating Kidney 1 Inguinal Hernia 1 III. Diagnosis Incomplete, 1. At the end of the year, 21 women and 9 men had been dealt with and discharged, and 9 women and 4 men still remained under observation. In appropriate cases following up visits were paid to the patients' homes by the nurse attached to the Clinic, with the object of inquiry into any difficulty in connection with the arrangements made for diagnosis or treatment, and in order to keep the case under observation until it had been satisfactorily disposed of. During the year 74 of these visits were paid. APPENDIX H. REPORT ON THE WORK OF THE CANCER CLINIC AT HEALTH CENTRE (2), 381, HIGH ROAD, WILLESDEN, N.W. 10, FOR THE YEAR 1930, by BESSIE R. MACKENZIE, M.D., M.B., Ch.B., D.P.H. During 1930 a cancer session was held on the 2nd and 4th Thursdays of the month at Health Centre (2). The hour chosen was 7-8 p.m. This affords to men and women, engaged during the day, an opportunity of seeking medical advice without losing time from their work. Many people, also, who believe they are suffering from cancer, are sensitive about letting others know they are getting advice, and this evening session allows them to consult a doctor without having to give the reason to their employer or friends. Sixty-one attendances were made during the year, and of these 39 were new cases. More women attended than men-—26 to 14. Statistics show that the death rate is rather lower in men than in women, the proportion being 1,000 deaths in men to 1,171 in women. It is probable, also, that women are more ready than men to seek advice. This may be due to the fact that, owing to their child-bearing function and their domestic duties they are brought more intimately in contact with illness and doctors and are therefore not so reluctant as men to discuss their symptoms. Of the 39 new cases which attended the Centre, 23 were referred to hospital for further diagnosis. The results of these further examinations were as follows :— Six patients were found to have conditions requiring operation and these operations were performed. One of the cases had a definite cancer of the breast, while 4 of the other five cases suffered from pre-cancerous conditions. Three patients, after examination, were discharged as requiring no treatment. Three patients were X-rayed and medically treated. Nine patients were kept under observation and medically treated. Two patients, owing to private reasons, failed to attend Hospital in accordance with the arrangements made for them. The other cases who attended the Cancer Clinic and were not referred to Hospital were either assured on their first visit that their complaint was not cancer or, after being kept under observation for a few weeks, were discharged as fit or, as happened in 5 cases, were advised to get treatment from their own doctor for some condition which was obviously not malignant. A careful note was made in each case of how the existence of the clinic had come to the notice of the patient. It was found that 19 were attracted by reading the advertisement in the local press ; 10 by reading an article on cancer in the paper ; 4 by seeing the poster in front of the clinics ; 4 were recommended to come by friends, and 2 were sent by Councillors. It would seem, therefore, from the above that the most useful way of bringing the Cancer Clinic to the notice of the public is through the press. Propaganda was carried out also by the Health Visitors in the course of their duties ; by talks given by the Medical Officers at the Centres and by distribution of Cancer Leaflets when suitable opportunities arose. 106 The continued existence of the Cancer Clinic is, I think, justified by the fact that in even 23 of the cases which attended the centre there was a sufficient element of doubt regarding the diagnosis to warrant these cases being referred to Hospital for further examination. The Clinic does not set out to deal necessarily only with cases of established cancer, but also to investigate to the full those precancerous conditions which we know from experience so often precede the appearance of a malignant growth. APPENDIX I. WILLESDEN EDUCATION COMMITTEE. SUPPLY OF MILK TO SCHOOL CHILDREN. In accordance with the instructions of the Education Committee (vide Minutes 1929-30, p.433), I beg to report on the above matter. The following schools where milk has been supplied have been considered :— (1) Carlton Vale. No. on Roll 807 No. receiving milk Girls 150 Infants 160 since Midsummer, 1929. (2) Kilburn Park. No. on Roll 353 No. receiving milk Girls 105 Infants 115 since September, 1929. (3) St. John's. No. on Roll 444 No. receiving milk Girls 30 Infants 60 since January, 1930. (4) Oldfield Road. No. on Roll 712 No. receiving milk Junior Dept. 140 Senior Dept. 110 since November, 1929. The milk supplied costs Id. per head, the quantity given being one-third of a pint in sealed bottles and sucked up by a straw. It is taken between 10 and 11 a.m. The children who do have it have had it on the whole continuously since it was begun. The milk has been purchased by the parents and the children have not been selected for health reasons. It has not been possible to keep a complete physical record of these children during the time that they have had milk as this matter was only referred to me at the end of February, 1930. In the Senior Department at Oldfield Road, however, the children were weighed shortly after the experiment was begun, and again at the end of April. The girls in this department put on an average weight of some 3 to 4 lbs. in a period of some four months. In the case of the boys the increase was not so great, being only 2 lbs. on the average. In no case was a decrease of weight recorded. I have no corresponding figures of the weight put on by children of similar age groups, who did not receive milk. The result of the observations of parents, teachers and health visitors on those children who have had milk appears to be that the children are better for having it. Certain reservations, however, are made in respect of this opinion by a few parents, e.g., that certain children are not hungry for their dinner after having had the milk, that certain children do not take breakfast because they are going to have milk for lunch. On the whole, it would appear that if children get a good breakfast at home before they leave for school, lunch between 10 and 11 a.m. is not called for. This opinion, however, may require to be modified in those few cases where parents go early to work and children consequently have an early breakfast. The most important fact, however, in connection with the supply of this milk has been the unanimous opinion of those engaged in the work, that those who need it most get it least. 107 Generally speaking, there can be no doubt that children should be well-fed, but it would seem to me doubtful whether it is necessary or even desirable for a child who gets a good breakfast before coming to school and a good dinner at midday to have a lunch in the interval. Supplemental feeding at school is only necessary where children are of a peculiarly delicate constitution, or where they do not receive sufficient nourishment at home on account of the economic circumstances of their parents. In these latter cases, which more particularly should engage the attention of the Education Committee, one-third of a pint of milk although better than nothing can hardly be regarded as an adequate additional adjunct to an insufficient dietary. GEORGE F. BUCHAN, Medical Officer of Health. APPENDIX J. For the consideration of the Health Committee (14/10/30). L.M.S. RAILWAY SIDING—HARLEY ROAD. COMPLAINT OF NOISE AND DUST FROM MECHANICAL TIPPING APPARATUS. MEMORANDUM BY THE MEDICAL OFFICER OF HEALTH. (1) The site of operations and the complainants have been visited frequently since the 10th September, 1930, by the District Sanitary Inspector, on several occasions by the Chief Sanitary Inspector, while I myself have also visited. (2) The mechanical tipping apparatus in question is in the Urban District of Acton and approximately 150 yards south of the nearest property in Harley Road. (3) The complainants are residents in Harley Road and neighbourhood. (4) The apparatus is used for filling the tenders of railway locomotives with coal. The process is as follows :— (a) A loaded coal waggon is put under a waterspray and the coal is sprayed until the water runs out of the floor of the waggon. (ib) The waggon is pushed on to the weighbridge and weighed. (c) A lifting gear raises the waggon and part of the weighbridge to a height of about 40 feet. (d) At the top the waggon is tilted, the contents falling into a hopper. (e) The waggon is lowered. (f) The tenders of the engines are fed from the hopper. (5) The noise complained of arises from the tilting of the waggon and the coal falling into the hopper. (6) The dust complained of also arises from the same cause. (7) There is no doubt that noise is associated with the operation as described. This noise is mainly caused by the coal being tilted from the waggon into the hopper. Comparatively little noise arises from the filling of the tenders from the hopper and as this latter operation takes place at a height of only about 10-12 feet, dust is not likely to reach the adjoining property in Harley Road as a building about 20 feet high intervenes. (8) Neither the District Sanitary Inspector, the Chief Sanitary Inspector nor myself have been able to verify the complaint that dust blows from the apparatus towards the Harley Road area. No high winds, however, have been blowing from that direction on the days on which visits have been made, and in addition some of the days have been wet. (9) Assuming, however, that the complaints both as to noise and as to dust are capable of legal proof, the question arises as to what powers the Council possess for dealing with two such nuisances. (10) As to noise. The only power possessed by the Council is that given by Section 56 of the Middlesex County Council Act of 1930. To prove a noise under this Section, it is necessary to prove all of the following propositions :— (a) that the noise is either excessive or unreasonable or unnecessary ; (b) that the noise is injurious or dangerous to health, and (c) that the noise is capable of being prevented or mitigated, having due regard to all the circumstances of the case. (11) It is a good defence that the best practicable means of preventing or mitigating the noise having regard to the cost, have been adopted. (N.B.—the provisions of Section 56 of the Middlesex County Council Act, 1930, do not apply to the carrying on of an undertaking authorised by an Act of Parliament or by an order confirmed by or having the force of an Act of Parliament). 108 (12) In all these circumstances it would appear that the local Authority have no legal powers to deal with this complaint of noise. (13) As to dust. The only section of the Public Health Act that appears to me possibly to give the Council power to deal with this nuisance is Section 91 (6) of the Public Health Act, 1875, which states as follows : " Any factory, workshop or workplace not kept in a cleanly state, or not ventilated in such a manner as to render harmless as far as practicable any gases, vapours, dust or other impurities generated in the course of work carried on therein that are a nuisance or injurious to health .... shall be deemed to be a nuisance." (14) If this section is applicable and if the complainants' statements as to dust are upheld the Council would be able to deal with this matter of dust in the same way as they can deal with other nuisances, namely, by serving a Statutory Notice to abate the nuisance and stating the remedy and in the event of non-compliance by making complaint to the magistrates. (15) Having regard, however, to the somewhat doubtful and in any case limited powers possessed by the Council it might appear preferable to endeavour to get the L.M.S. Railway to effect improvement. For that purpose it might be suggested to them : (a) That the apparatus be used only between the hours of 7 a.m. and 7 p.m. (b) That only such coal be used as is least likely to give rise to dust, and that coal known to give rise to much dust be excluded from use by this apparatus. (c) That the spraying of the coal in the waggon be increased so that all the coal is wetted. At the present time there is only one spray placed lengthwise over the waggon. (id) That the coal when it is being tipped into the hopper be effectively sprayed at this point also. (e) That steps be taken to enclose completely the apparatus while coal is being tipped into the hopper so as to reduce noise and prevent the escape of dust. GEORGE F. BUCHAN. NOTE BY CLERK AND SOLICITOR TO THE COUNCIL. I have read the foregoing memorandum of the Medical Officer of Health and so far as it goes, generally speaking, I agree with his statement of the Council's powers with regard to the particular nuisance. It must, however, be borne in mind that the Public Health Acts do not create fresh nuisances, but only provide a procedure for dealing with certain nuisances in a summary manner. One has, therefore, to look to the Common Law, and in the case of Statutory Undertakings such as Railway Companies, to the construction which the Courts have placed on the various statutes authorising such undertakings. It will be appreciated that Railway Companies are under a statutory obligation to run their trains and to do such acts as may be necessary for carrying out that duty, and a Railway Company which is given power by Statute to do an act which would otherwise amount to an interference with the rights of the public, e.g., an actionable common law nuisance, are not liable to proceedings for a public nuisance nor does an action lie against a Railway Company for doing an act which is authorised by statute but which would be a nuisance if not so authorised. Further, where the Company is under a statutory duty it is only bound to exercise its powers in the performance of such duty with moderation and discretion in a proper manner and without negligence. The case of Truman v. The London Brighton and South Coast Railway appears to me to be directly in point, and the foregoing observations are based upon the judgments delivered in the House of Lords in that case. I therefore reach the conclusion that unless it can be proved that the Company are using the apparatus referred to in a negligent manner (and at present I see no evidence of that) no action will lie against them. I cannot, of course, express any opinion upon the suggestions following paragraph 15, but experience shows that Railway Companies are always willing to consider practical suggestions which would tend to ameliorate any inconvenience caused to occupiers of adjoining property consistent with the due performance of their statutory duty. E. A. PRATT. 109 APPENDIX K. REPORT OF THE MEDICAL OFFICER OF HEALTH ON THE HOUSING ACT, 1930, IN SO FAR AS IT AFFECTS THE WORK OF THE HEALTH COMMITTEE. The Willesden Urban District Council is required :— (1) To consider the housing conditions in their area. (2) To consider the needs of the area with respect to the further provision of housing modation for the working classes. (3) To submit to the Minister proposals for the provision of new houses for the working classes. (N.B.—This is to be done as often as occasion arises, or three months after notice by the Minister.) (4) In the year 1930 and each fifth succeeding year to submit to the Minister a general ment of the measures which they propose to take during the five next succeeding years for dealing with— (a) the housing conditions of their area, and (b) the provision of further housing accommodation. The Medical Officer of Health is required to make an official representation wherever he is of opinion— (1) That any area is an area which should be dealt with as a clearance area. (2) That any area is an area which should be dealt with as an improvement area. (3) That any dwelling house is unfit for human habitation. The local authority is required to take into consideration any official representation of the Medical Officer of Health. Clearance Area. Clearance areas contain dwelling-houses and buildings. Dwelling houses can only be included in a clearance area if they are— (a) unfit for human habitation, or (b) dangerous or injurious to the health of the inhabitants of the area owing to their bad arrangement, or the narrowness or bad arrangement of the streets. Buildings other than dwelling-houses can only be included in a clearance area if they are dangerous or injurious to the health of the inhabitants of the area owing to their bad arrangement or the narrowness or bad arrangement of the streets. All the buildings in a clearance area must be demolished. The area of a clearance area may be of irregular shape. The local authority, however, may purchase adjoining property in order to secure a cleared area of convenient shape and size. Property in the clearance area will be purchased at site value or less, but property adjoining a clearance area will be purchased at market value. The demolition of a clearance area may be carried out— (1) By requiring the owners to demolish ; (2) By purchase of the area either by agreement or compulsion by the local authority who will then carry out the necessary demolition. Before a clearance area is taken in hand on the above lines, the following conditions require to be satisfied :— (1) That the resources of the local authority are sufficient ; (2) That the necessary re-housing accommodation will be provided in advance of displacements of the persons for whom re-housing is required. It will therefore be noted that an undertaking to re-house is a necessary antecedent of any action in respect of a clearance. The object of the Act in dealing with clearance areas is the abolition of slums. Improvement Area. An improvement area unlike a clearance area may contain fit as well as unfit houses. It is not necessary that all the houses should be demolished, but a great improvement in an improvement area can be secured if the worst houses are removed ; if steps are taken to remove 110 obstructive buildings and let in light and air ; if the necessary repairs to dwellings are carried out ; and if the surplus population is taken from the area and provided for elsewhere. Before dealing with an improvement area the local authority must be satisfied that the area is one in which the housing conditions are unhealthy and can be effectively remedied— (1) By the demolition of some of the dwelling-houses ; (2) By the repair of others ; (3) By the purchase of land for the purpose of opening out the area ; and (4) By the abatement of overcrowding. Prior to taking action it is necessary that the local authority should give an undertaking to the Minister that the provisions of the necessary houses for the persons displaced will be ready ahead of the displacements. Fairly large areas should be selected for improvement, but not areas of unmanageable size. The area should be such that the housing conditions in it can be effectively remedied within a reasonable time. Should the local authority determine to deal with an area as an improvement area they must make byelaws— (1) To prevent and abate overcrowding ; (2) To secure improvement of the housing conditions ; and (3) To secure the subsequent maintenance of a proper standard of housing conditions in the area. The object of the Housing Act in respect of improvement areas is the prevention of slums. Individual Unfit Houses. Under the Act these are divided into two categories :— (1) Houses unfit for human habitation, but capable of being rendered fit at a reasonable expense ; (2) Houses unfit for human habitation, but not capable of being rendered fit at a reasonable expense. In respect of (1), i.e. houses regarded as capable of repair, the procedure is much the same as under Section 3 of the Housing Act, 1925, in that the local authority serves notice upon the person having control of the house that the work be done, and, if the notice is not complied with, the local authority may do the work and recover the cost. In respect of (2), i.e. houses not regarded as capable of repair, the person having control of the house is asked to appear before the Council, who will take into consideration— (1) Any proposals for the execution of works in connection with the house ; or (2) Any proposals for the future user of the house. The local authority may accept an undertaking from the owner— (a) To do the works necessary to render the house fit; or (b) Not to use the house for human habitation until it has been rendered fit. If such undertaking is accepted, but subsequently broken, the demolition order is forthwith made in respect of the dwelling-house. If, on the other hand, such an undertaking is not accepted, the demolition order would be made. Appeals. Objections and appeals are made to the Minister in respect of— (1) Notice of a clearance order ; (2) Notice of a compulsory purchase order. Objections and appeals are made to the County Court in respect of— (1) Notice to execute works ; (2) Demand for recovery of expenses of local authority in carrying out works specified in notice ; (3) Order made by local authority in respect of such expenses ; (4) Demolition order ; (5) Closing order or refusal to determine closing order. GEORGE F. BUCHAN, 8/11/30 Medical Officer of Health.