C.I VOIL 27 ACU 39(1) WILLESDEN Willesden Urban distritct Council 1931 THE 56th 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. London: WIGHTMAN & CO., LIMITED, Regency Street, Westminster, S.W. 1, and Dugdale Street, S.E. 5. 2 WILLESDEN URBAN DISTRICT COUNCIL, 1931-32. WILLESDEN URBAN DISTRICT EDUCATION COMMITTEE, 1931-32. †M.r Councillor GEO. H. HISCOCKS, J.P. (Chairman of the Council). †Miss Councillor M. E. ROYLE, J.P. (Vice-Chairman of the Council, and Chairman, Education Committee). †Mr. Councillor C. BERESFORD. Mr. Councillor C. L. BLAND. †Mr. Councillor H. C. BLAXLAND. †*Mr. Councillor C. HICKS BOLTON, M.A. †Mr. Councillor W. M. BOLTON. †*MR. Councillor P. BOND. †*Mr. Councillor S. BOWN. Councillor Dr. J. S. BRIDGES. Mr. Councillor J. W. CATLOW. *Mr. Councillor J. A. CLARK. †*Mr. Councillor J. CLEE. (Chairman, Health Committee). †*Miss Councillor N. M. COWAN. *Mr. Councillor A. E. DORAN. Mr. Councillor E. DROWN. (Resigned 29th Sept., 1931). Mr. Councillor J. FERNLEY. (Elected 24th Oct., 1931). *Mr. Councillor H. E. DULCKEN. Mr. Councillor G. J. B. FURNESS. Mr. Councillor L. H. GILLIS. †Mr. Councillor H. J. GOLBY. Mr. Councillor W. A. HILL, J.P. Mr. Councillor J. R. HOBBS. †*MR. Councillor C. R. HOBSON. Mr. Councillor F. W. HORNE. Mr. Councillor W. JEFFRIES. †Mr. Councillor A. E. JONES. Mr. Councillor M. JONES. Mr. Councillor H. J. KELLY. Mr. Councillor H. LEIGH MOSSLEY. †Mr. Councillor J. L. MAGNUS. Mr. Councillor A. C. MELLUISH. †*MR. Councillor J. MORSE. *Mr. Councillor GEO. PAGE. (Chairman, Children's Care Sub-Committee.) Mr. Councillor H. W. PROTHERO. *Mr. Councillor N. A. REMMERS. Mr. Councillor W. H. RYDE. Mr. Councillor J. M. SALMOND. Mr. Councillor P. J. SAMUELS. *Mr. Councillor T. J. SANDFORD. Mr. Councillor H. J. SAVORY. Mr. Councillor H. THORLEY. †*Mr. Councillor W. H. WALLIS. Mr. Councillor GEO. WESTON. †*Mrs. Councillor A. B. WORSFOLD. * Member of the Children's Care Sub-Committee. † Member of Health Committee. 3 Town Hall, Dyne Road, Kilburn, N.W. 6. 1st May, 1932. 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 1931. This Report includes:— (i.) The 56th Annual Report on the health and sanitary condition of the district; (ii.) The 24th Annual Report on the health of children attending the public elementary schools; (iii.) The 12th Annual Report on the health of children attending secondary and trade schools; (iv.) The 14th Annual Report on dental work in connection with children attending the public elementary schools, expectant and nursing mothers and children under 5 years ; (v.) The 2nd Annual Report on the Supervision of Midwives. (vi.) The 2nd Annual Report on the Registration of Nursing Homes. (vii.) The 2nd Annual Report on Infant Life Protection. (viii.) The 12th Annual Report on home nursing ; (ix.) The 17th Annual Report on the provision of meals to children attending the public elementary schools; (x.) The 40th Annual Report on the Municipal Hospital. (xi.) The 1st Annual Report on the Maternity Hospital ; (xii.) The 2nd Annual Report on the health of patients attending the Middlesex County Council Occupation Centre for Mentally Defectives, Buller Road, Willesden. (xiii.) The 1st Annual Report on Nursery Classes. 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, 1931, was 185,704. 2,838 live births were registered during 1931, giving a birth rate of 15.28 per 1,000 of the population, as against 15.99 in 1930. 105 still births were registered, giving a still birth rate of 35.68 per 1,000 total live and still births. 1,935 deaths were registered in 1931, giving a death rate of 10.42 per 1,000 of the population. These figures compare with a total number of deaths of 1,762 and a death-rate of 9.82 in 1930. The infant mortality rate in 1931 was 60.25 per 1,000 births. 171 deaths of infants under one year occurred. 133 or 77.8 per cent. of these 171 deaths were due to:— 1. Congenital Malformations 9, Premature Birth 51, Atrophy, Debility and Marasmus 9, Atelectasis 9; 2. Diarrhoea and Enteritis 16; 3. Whooping Cough 6; 4. Measles 0; 5. Bronchitis 3, and 6. Pneumonia 30. Year by year these six causes of death account for some three-quarters of all deaths of infants under one year of age and active measures are required to prevent these conditions proving fatal. The infantile mortality rate in 1931 was 60.25 per 1,000 births. In Appendix A will be found the infantile mortality rate in each of the wards in Willesden. It is interesting to observe that the highest infant mortality rate was in the Brondesbury Park ward, where it was 116.27, followed by the Stonebridge Ward, where it was 78.55. The lowest infant mortality rate was in Kensal Rise, where it was 36.58, Mid-Kilburn being next with 44.00. The position of the Brondesbury Park ward in this respect shows that the prevention of infant mortality is largely a matter of the special education of the mother and the special care of the child under one year of age. Because a person is well off and generally well educated it does not necessarily follow that she has the necessary special knowledge for the up-bringing of an infant. 4 CANCER Cancer continues to take a heavy toll of the population. In 1931 there were 250 deaths from this cause as compared with 214 in 1930, 239 in 1929, 240 in 1928, and 217 in 1927. The Council continues to carry on a campaign against this disease. The public is kept informed by posters and leaflets displayed in the local press, schools, libraries and health centres. The subject is dealt with in the talks given at the schools for mothers, and by articles published at regular intervals in the local newspapers. The effect of these measures is shown in the attitude of patients attending the cancer clinics who are less afraid and more appreciative of the prevention of the disease. Facilities for early diagnosis and treatment are provided in connection with the two Cancer Clinics, which continue to be held on the first four Thursdays of the month between 7 and 8 o'clock in the evening. Patients remain attached to one Clinic and see the same doctor at each visit. No treatment is attempted, the object being to get early contact, as suggested in the Ministry's Circular 1136, to secure expert diagnosis and early treatment if necessary, or to give reassurance as the case may be. For the purposes of further diagnosis and treatment the working arrangement made by the Council with certain of the larger London hospitals continues to be very satisfactory, and patients constantly express gratitude for the assistance available. If a patient is under a private doctor who can be located, the latter is communicated with, and the result of any examination at hospital is made known to him as soon as possible. It happens occasionally, however, that the patient does not wish to disclose his doctor's name. During 1931 95 patients attended these clinics, 23 men and 72 women; 80 were new cases, and 15 had attended during 1930, and were still under observation at the end of the year. The total of attendances made was 151, making an average of just over 3 per session. The largest number attending on any one evening was 10, and the largest number of new cases at one session was 7. Of the 80 new cases 4 were found to live out of the district and were dismissed, and 1 mistook the Clinic for a gynaecological hospital. The remaining 75 new cases, after examination, were disposed of as follows:— 8 were reassured and dismissed. 24 were given hygienic advice and instructed to return after an interval for observation. 15 of these were finally dismissed by the end of the year. 11 were referred back to their own doctors, or to a hospital which they had been attending. 2 were referred to a dentist. 30 were referred to a hospital for further investigation. Of the 30 who were referred to hospital:— 7 were found to require operation. (4 have been operated upon; 1 is awaiting operation; 2 have refused operation). 15 have received or are receiving treatment at hospital as outpatients, or are being kept under observation there. 5 were reassured and dismissed after the first visit. 3 are still being investigated. The pathological conditions from which the 75 new cases suffered are briefly as follows:— 4 cases had cancer, 2 being men and 2 women. One woman had cancer of the nipple following Paget's Disease, and this had been overlooked in the sense that she had seen a doctor some time before on account of irritation of the breast, and had been reassured, and the cancer had developed between that consultation and her attendance at the Council's Clinic. The other woman had been operated upon a year previously for cancer of the uterus, and although she had had symptoms suggesting recurrence for some months, it had not been located and time had thus been lost. She was sent to hospital, the diagnosis made, and deep X-ray Therapy commenced. Both of the cases in men were recurrences, one being a rapidly growing cancer of the lip with gland involvement, and the other a rodent ulcer of the nose. Both were got in touch with the surgeons who had previously dealt with them and had prompt treatment. 1 other case in which the pathological findings are not yet complete is suspected to be early cancer of the uterus. All these 5 cases gratefully and promptly took advantage of the facilities offered by the Clinic, but for which, in at least 4 of them, there would have been dangerous delay. 5 10 cases suffered from affections of the female genital organs. 4 had conditions recognised to be pre-cancerous. 6 had conditions unconnected with cancer but requiring treatment. 14 cases had abnormal breast conditions. 1 had an innocent tumour, which occasionally later on becomes malignant. 2 had cystic inflammation. 11 (including 2 men) had chronic inflammation. 17 cases had affections of the alimentary tract—11 women and 6 men. These included 2 cases of gastric, and 1 case of duodenal ulcer, and 10 other conditions liable to become cancerous. 3 cases had innocent tumours of the body wall. 26 cases suffered from a variety of general conditions giving rise to symptoms which were causing them anxiety, but which were found to be unconnected with cancer. With a view to obtaining further information about cancer, the Medical Officer in the course of examining patients makes inquiry into the causes of delay in seeking advice or in obtaining treatment, and into any predisposing factor in work, habits, or previous health. The Nurse attached to the Clinic also, where these are welcomed, pays following-up visits to the homes of patients attending. During last year 105 of these visits were paid. Similar inquiries are pursued by her on these occasions, and also in the course of special visits which she pays when disinfection is asked for after a death from cancer. The object in the death inquiry visits is to obtain facts as to the site and duration of the disease and the time that elapsed between the first symptom and the seeking of medical advice. Only 29 such requests were made in 1931, and no deductions can be drawn from the figures available, but this line of inquiry may ultimately yield information about a sufficient number of cases to be reliable as a guide to future action. All the above investigations are somewhat difficult as yet. There is a special reticence on the part of patients connected with the subject. They seem to desire anonymity, and this wish is respected in the hope that with the spread of knowledge this feeling will abate, and still more satisfactory results be obtained. INFECTIOUS DISEASES. During the year 1931, 2,212 cases of Infectious Disease were notified as compared with 2,029 in the previous year. The total of 2,212 includes 310 notifications of Diphtheria as compared with 491 in 1930, 467 cases of Scarlet Fever as compared with 518 in 1930, 392 cases of Pneumonia as compared with 266 in 1930 and 514 cases of Whooping Cough as compared with 229 in 1930. Return Cases of Scarlet Fever.—The following statement gives the return cases that have occurred during 1931:— I. Home Cases.—Approximately 58. (a) No. of infecting cases giving rise to return cases not longer than 28 days after release from isolation 2 „ return cases they gave rise to 2 ,, infecting cases per cent. of total home cases 3.4 ,, return cases per cent. of total home cases 3.4 (b) No. of infecting cases giving rise to return cases more than 28 days after release from isolation 0 ,, return cases they gave rise to 0 ,, infecting cases per cent. of total home cases 0 ,, return cases per cent. of total home cases 0 II. Hospital Cases.—Approximately 409. (a) No. of infecting cases giving rise to return cases not longer than 28 days after discharge 18 „ return cases they gave rise to 20 ,, infecting cases per cent. of total hospital cases 4-4 „ return cases per cent. of total hospital cases 4-9 Note.—One 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 4 „ return cases they gave rise to 6 „ of infecting cases per cent. of total hospital cases 1.0 „ return cases per cent. of total hospital cases 1.5 6 Small Pox.-—2 cases of Small Pox were notified in 1931 as against 9 in 1930 and 47 in 1929. The patients were admitted to the Small Pox Hospital of the London County Council and recovered. No vaccinations were performed by the Medical Officer of Health under the Public Health (Small Pox Prevention) Regulations, 1917. Typhoid Fever.—Fifteen cases were notified during 1931 as against 10 in 1930 and 6 in 1929. Fourteen of these cases were removed to the Municipal Hospital. Two were diagnosed as Typhoid Fever and recovered. The source of infection was untraced. Five were diagnosed as paratyphoid B; 4 recovered and 1 was still in hospital at the end of the year. Two of these patients were sisters who took ill together the day before returning home after a week's holiday at a seaside resort. The source of infection was untraced. Of the other 3 cases the first was a patient, the second a theatre maid, and the third a theatre nurse at a hospital in Willesden. These occurred within a short time of each other. The nurse had been in contact with the maid, but there was no history of contact between either of these and the patient. Of the other 7 notified cases removed to the Municipal Hospital 1 was diagnosed as enteritis. 1 as pleurisy, 1 as influenza, and 1 as (?) influenza (?) malaria. All these 4 recovered. The remaining 3 patients died, one death being certified after postmortem as due to malignant endocarditis, and two to tubercular meningitis. The fifteenth notified case was nursed in St. Andrew's Hospital and recovered. The source of infection was untraced. No deaths were recorded from Typhoid Fever during 1931. Infectious Diseases of the Nervous System, Cerebro-Spinal Meningitis, Poliomyelitis, Encephalitis Lethargica and Acute Polio-Encephalitis.—14 cases of these diseases were notified in 1931, 5 proved fatal, giving a fatality rate of 36 per cent. of notified cases. 7 deaths in all were attributed to these diseases in 1931; 2 of these related to cases which had not been notified in Willesden. Whooping Cough is a notifiable disease in Willesden. 514 cases were notified during the year, but a total of 930 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 1931, 408 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 County 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 5,077 occasions; nursing mothers, 21,046, and children under 5, 50,272, making a total of 76,395 attendances. Out of the total number of 2,838 children born during the year, 1,378 or 49 per cent. subsequently attended the Welfare Centres. The number of births occurring amongst expectant mothers who attended the Ante-Natal Clinics was 808; 63 per cent. of these mothers with their babies subsequently attended the Welfare Centres. Hospital Maternity Cases.—The Willesden Maternity Hospital was opened on February 14th, 1931, and on and after midnight, February 14th-15th, the Council's maternity cases were admitted to this Hospital instead of to the Central Middlesex County Hospital (formerly Park Royal Hospital). The following table shows the bookings year by year for hospital confinement under the Council's schemes since hospital provision was first made by the Council for such cases:— 7 Table No. 1. Year. No. of Confinement Cases Booked. 1918 (part-year) 99 Maternity Pavilion at Municipal Hospital opened. 1919 267 1920 444 Restrictions began to be placed on bookings. 1921 335 1922 266 Municipal Hospital Pavilion closed, 30th April, 1923. Cases sent to Park Royal Hospital. 1923 140 1924 99 1925 146 1926 220 1927 221 1928 272 1929 334 1930 402 1931 535 Willesden Maternity Hospital opened, 14th February, 1931. Cases no longer sent to Park Royal Hospital. During 1931 440 women were admitted to the Willesden Maternity Hospital for confinement, and 57 to the Central Middlesex County Hospital under the Council's scheme. In addition to these 497 an approximately equal number of Willesden mothers were confined in institutions outside Willesden, 495 births of Willesden residents being notified from such outside institutions — 233 from Queen Charlotte's Hospital, 71 from Queen Mary's Maternity Home, Hampstead, and smaller numbers from other hospitals; 52 from a nursing home and smaller numbers from other nursing homes. These, together with some 200 in the Central Middlesex County Hospital, approximate one-half of the births belonging to Willesden and show the desire of the present-day mother for institutional confinement. Table No. 2.—Maternity Cases Admitted to the Central Middlesex County Hospital during 1931 up to 14th February, 1931. No. delivered of live infants 53 No. delivered of infants born dead 3 No. confined 56 No. of miscarriages 0 No. of cases of complications caused by pregnancy 2 Total No. of cases admitted to Hospital 58 Note.—2 cases were admitted not in labour and both of these were subsequently readmitted and confined. The Willesden Maternity Hospital was opened on February 14th, 1931, after which date the Council discontinued sending their cases to the Central Middlesex County Hospital. A report on the Willesden Maternity Hospital by Mr. Arnold Walker, the obstetrician, appears later on in this report. 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 1931: — Table No. 3. Willesden General Hospital. St. Monica's Home Hospital. Total. No. of Children in Hospital at 31st December, 1930 2 3 5 No. of Children admitted during 1931 158 21 179 Total No. of Children under treatment during 1931 160 24 184 No. of Children discharged during 1931 154 11 165 No. of Children died in Hospital during 1931 1 6 7 Mortality % 62 25.0 3.80 No. of Children remaining in Hospital at 31st Dec., 1931 5 7 12 8 The following table gives particulars of the conditions for which children were treated during 1931, the treatment carried out and the results of such treatment:— Table No. 4.—Children under 5 Years under Treatment in Hospital during 1931. Condition. Brought forward. Admitted during Year. Total under Treatment. Treatment Completed. In Hospital at end of Year. Forms of Treatment. Results of Treatment. Operative. General. Other Forms. Remedied. Improved. Unchanged Died. Marasmus 4 31 35 — 27 — 2 16 2 7 8 Enlarged Tonsils and Adenoids 1 148 149 144 — 1 144 — 1 — 4 Total 5 179 184 144 27 1 146 16 3 7 12 Puerperal Fever.—During 1931 14 cases of Puerperal Fever were notified as against 5 in 1930, 6 in 1929, 6 in 1928, 5 in 1927, and 16 in 1926. This gives a case rate of 4.9 per 1,000 registered live births, as against 1.7 in 1930, 2.21 in 1929, 2.25 in 1928, 1.95 in 1927, 5.93 in 1926. Of these 14 notified cases 2 proved fatal. The 4 other deaths appearing in the death table under puerperal sepsis were those of a case notified as puerperal pyrexia in 1930 and 3 cases which occurred in institutions outside Willesden. Taking the 2 deaths occurring amongst the 14 cases of puerperal fever notified in Willesden, this gives a case mortality of 14.3 per cent. as against 20 per cent. in 1930, 50 in 1929, 33.4 in 1928, 60 in 1927, 25 in 1926, 12.5 in 1925 and 16.7 in 1924. The maternal mortality from sepsis was 2.1 per 1,000 registered live births. The maternal mortality from all causes was 3.2 per 1,000 registered live births. In 5 of the notified cases a private doctor was in attendance at the confinements at home. 3 of these confinements were instrumental. In 1 case a midwife attended the confinement at home. In 1 case the birth occurred in a nursing home, and in 4 cases in hospital, but in one of these last the onset of the illness took place after the patient's return home. The other 3 cases were cases of miscarriage at home. Puerperal Pyrexia.—30 cases were notified during the year. 2 of these 30 cases proved fatal. One of the fatal cases was also notified as Puerperal Fever, and the death has been recorded under that heading. In the other fatal case the death was certified as due to Pulmonary Tuberculosis. During 1931 the Council have continued their efforts to deal effectively with the subject of maternal mortality. (1) Sterilised Accouchment Sets.—These sets are supplied in accordance with the arrangements stated in last year's report. Table No. 5.—Puerperal Fever Cases, 1931. Home Circumstances. Number of Cases. Number of Rooms. Number of occupants, including new.born baby. Under 10 years. Over 10 years. Total. 1 (miscarriage) (fatal) 1 - 2 2 1 2 3 5 8 1 2 4 2 6 1 3 5 2 7 1 (miscarriage) 3 1 4 5 1 3 1 2 3 1 3 1 3 4 1 4 1 2 3 1 (miscarriage) 5 . 2 2 5 (1 fatal) Occurred in Institutions. 9 During 1931 they have been increasingly made use of. 87 were supplied free, 7 at full cost and 3 at part cost. (2) Specialist Help.—The Council 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. 3 such consultations were paid for in 1931. (3) Provision of Aneesthetist.—The Council further accept responsibility for the payment of a fee to an anaesthetist, called in by a medical practitioner in connection with confinement cases. No such fees were paid in 1931. 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 the Council's Consultant Obstetrician. 13 cases were inquired into during 1931. The services of the Council's Consultant Obstetrician are also available in cases of Puerperal Fever and Puerperal Pyrexia when desired by the practitioner in attendance. During the year the Council had under consideration Circular 1167 and Memorandum 156/MCW relative to maternity and child welfare and maternal mortality. Notes by the Medical Officer of Health appear as Appendix L. Arising thereout, the Council passed the following recommendations:— (i.) That a booklet be prepared giving full information as to the facilities which exist in respect of Maternity and Child Welfare. (ii.) That such booklet be given to all doctors and midwives. (iii.) That the booklet or similar information be given to such others of the public as may be considered desirable. (iv.) That arrangements be made for doctors, if they so desire, to examine at the Health Centre patients, either those who directly engage the doctor, or those in respect of whom the doctor may be called in by the midwife in an emergency. (v.) That if it is so desired, the Council will be prepared to make up the deficit in cases where midwives are employed as Maternity Nurses whenever a Maternity Nurse is required. (It may be that in some cases home helps would be employed with midwives.) (vi.) That steps be taken to secure the recognition of Willesden Maternity Hospital as a Training Centre for Midwives. (vii.) That all practising midwives be afforded the opportunity of attending lectures and refresher courses from time to time. Such a booklet has now been prepared, and the other recommendations are in operation with the exception of the recognition of the Willesden Maternity Hospital as a Training School for Midwives, which is in hand. Health Visiting of Children between the Ages of 1 and 5 Years. Children between the ages of 1 and 2 years are visited in their homes six monthly, and children between the ages of 2 and 5 years annually. Where the children are ailing or the home conditions unsatisfactory, visits are made as often as necessary and possible. Regular attendance at the Health Centres is advised, and in addition where the parents are agreeable, appointment cards are given for special medical inspection by the Health Centre Doctor at the ages of 18 months, 2 years, 3 years and 4 years, on the lines of the school medical inspection. The feeding of the young child requires supervision, and the mother frequent advice as to its care and management. Dental defects, rickety conditions, general debility, irregular habits, insufficient sleep, uncleanliness, lack of control and unsuitable management are too long in coming to notice under the present arrangements. Sir George Newman states in his 1930 Annual Report on the Health of the School Child that rickets can be prevented by proper diet, sunlight, fresh air and exercise. Yet 156 children under 5 years of age received treatment for rickets at the Council's Orthopaedic Clinic during 1931, and 112 received treatment for general debility at the Sunlight Clinics. Children should be visited at home as a routine practice at least three-monthly during their second year of life, and at least six-monthly between the ages of 3 and 5 years. Ophthalmia Neonatorum.— The number of cases of this disease notified during the year was 41, giving a case rate of 14.4 per 1,000 registered live births. A private doctor attended at the confinement in 18 cases, a midwife in 6 cases, 16 cases were born in hospital, and in 1 case no information was available. Treatment was obtained at a hospital in 16 cases, at the Municipal Centres in 12 cases, and by a private doctor at home in 13 cases. 1 child died from convulsions and otitis media, and in 6 cases the result was not known. 10 The following table gives particulars:— Table No. 6. Cases. Vision unimpaired. Vision impaired. Total Blindness. Deaths. Result not known. Notified. Treated. At Home. In Hospital. 16 - 16 9 3 - - 4 12 - 12 Centres 11 - - - 1 13 13 — 11 - - 1 Convulsions and Otitis media 1 17 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. Teaching of Mothercraft at the Centres. An important part of the work of each Health Centre is its Mothercraft Section. This is in special charge of one Health Visitor at each Centre, and holds its sessions in the afternoons. Expectant and nursing mothers and those with children under 5 years of age may attend, and practical instruction is given in the care and management of children and in the maintenance of health in the family. This instruction comprises—(1) sewing and knitting classes; (2) practical lessons in the care and feeding of infants; (3) lessons in invalid cookery, catering and simple home nursing. Health talks are given regularly by the Centre Medical Officers and Dentists on such subjects as the Care of the Expectant and Nursing Mother, Breast and Artificial Feeding, Character Training, Infectious Disease, the Treatment of Minor Ailments and on General Hygiene and Dietetics, and the Care of the Teeth. From time to time, in order to stimulate effort and provide a test of progress small competitions are held, and prizes given and the work submitted to outside criticism. While mothers are attending Mothercraft classes their young children may be left in the nursery attached to each Centre for this purpose, and are not only safely guarded by a competent attendant, but learn to adapt themselves to the society of other children. During 1931 all these activities were continued. 544 Mothercraft sessions were held, with 6,928 attendances of mothers, and 6,985 attendances at the nurseries. The most interesting event was the winning by the Mothercraft Section of Health Centre (1), 9, Willesden Lane, of the Mildred Lister Silver Challenge Cup, which is the award for second place in the National Mothercraft Competition promoted by the Association of Maternity and Child Welfare Centres, of Carnegie House, 117, Piccadilly, London, and held annually in July. This competition is open to affiliated centres all over the country. The cup was presented to Dr. Nicoll, the Centre Medical Officer, at the National Baby Week Conference in Cardiff, and was later handed over to the Council at a special session, to which the competing team of mothers was invited in order to receive official congratulations on the honour they had won for their district. 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. 11 Medical Inspection.—During 1931 the average number of scholars on the Public Elementary School Rolls in Willesden was 20,748. 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 1931 was 13,180. Findings of Medical Inspections.—(a) Uncleanliness.—Cleanliness inspections were carried out in the schools on 627 occasions during the year 1931, the average number of visits paid to each school by the Health Visitor being 18. The total number of examinations and re.examinations made during the year was 60,071. This is highly important work. In 1914, when it was first begun, the percentage of nitty or verminous children in the schools was as high as 20. In these days a child was not called nitty or verminous except there were many nits on the hair. In 1931 the percentage of nitty or verminous children in the schools was only 3.6, when a child with only a few nits is placed in this category. It will therefore be noted that enormous improvement has been effected, far greater actually than the figures show. (b) Tonsils and Adenoids.—During 1931, at routine and special medical inspections, 1,668 cases of enlarged tonsils and adenoids were discovered, as compared with 2,021 found in 1930, 1,773 in 1929, 2,070 in 1928, 1,988 in 1927. (c) Skin Disease.—During 1931, at routine and special medical inspections, 1,807 cases of skin disease were detected, as compared with 1,888 in 1930, 1,809 in 1929, 2,241 in 1928, 2,134 in 1927. (d) Enlarged Cervical Glands (non.tuberculous).—During 1931 at routine and special medical inspections 302 cases of this defect were noted as compared with 505 in 1930, 380 in 1929, 315 in 1928, 566 in 1927. 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 1931 school children were followed up by the Health Department on account of 17,403 medical defects and 9,295 dental defects. Of those defects found to require treatment, medical or dental treatment was obtained for 15,492 and domestic treatment was obtained for 3,928. 85.3 per cent. of the medical defects were treated, 61.9 per cent. receiving medical treatment and 23.4 per cent. domestic treatment; 55 per cent. of the dental defects followed up were treated. No record is available of defects requiring treatment which were not followed up. 86 per cent. of the total medical defects treated and 98 per cent. of the total dental defects treated were dealt with by the Education Committee. The remainder, or 14 per cent. of the medical defects and 2 per cent. of the dental defects treated were dealt with by private practitioners, voluntary hospitals, or other charitable institutions, or the Poor Law. In connection with the defects treated, the children concerned made 92,231 attendances at the Health Centres in 1931, as compared with 60,147 in 1930. Crippling Defects and Orthopedics.—An Orthopaedic Clinic staffed by an Orthopaedic Surgeon and a specially qualified 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 1931 1,348 special children were examined or re.examined. Of the 405 original examinations included in the 1,348 examined, 75 were found to be physically defective, 18 mentally defective, 2 blind and partially blind, 32 dull and backward, 245 anaemic and debilitated, 20 defective speech, 3 nervousness, 10 normal. 12 Leinster Mentally Defective School.—The certified accommodation at this school is for 140 children and during the year under review the average number on the roll was 128. The actual number on the roll at 31st December, 1931, was 134. The average attendance for the year was 111. There were 2 children awaiting admission to this school at the end of the year. 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. Six children were allowed to leave school before reaching the age of 16 years. The Certifying Medical 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. 85 such examinations were made during 1931. The school dinner is brought from Furness Road Feeding Centre, and served in the school hall. On an average 75 children take dinner, and the remainder bring their own meal. Oldfield Road Physically Defective School.—The certified accommodation at this school is for 140 children. During the year under review the average number on the roll was 150. The actual number on the roll at 31st December, 1931, being 156. The average attendance for the year was 125, and there was 1 child awaiting admission at 31st December, 1931. The school takes physically defective children between 5 and 16 years of age. The staff consists of one Head Teacher and six full-time Assistants. During the year six children were allowed to leave school before reaching the age of 16 years. Twenty-one children were allowed to attend ordinary elementary schools ; one child was transferred to an ordinary elementary school at the parents' request. Three children obtained scholarships, one at an Art School and two at Pitman's College. 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 nutritive drugs ordered by the doctor. 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 Stonebridge Health Centre, where a Specialist visits twice monthly and the requisite nursing staff is 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 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 83 boys and 18 girls were admitted to the school during the year. The Education Committee have 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 60 boys and 85 girls were admitted during the year. The Education Committee have made arrangements 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. In all 8 boys and 7 girls were admitted to this Institution during the year. Work of the Willesden Branch of the Invalid Children's Aid Association, 1931.— 126 new cases were referred to this Association during the year, 40 of these being referred by the Willesden Health Department. The majority of the patients were suffering from anaemia and debility. In addition 22 surgical appliances were supplied. 13 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. 984 examinations of secondary school pupils have been carried out during the year 1931. 273 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. The Middlesex County Council have not up to the present arranged to put in operation the scheme of treatment for defective vision and dental defects referred to in last year's report. PROVISION OF MEALS. 138,361 meals were supplied in 1931 as compared with 119,831 in 1930, and 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 341 cases during the year, and in connection with such cases paid 3,869 visits. 1,340 of these visits were paid in the South Kilburn Ward, 867 in the Mid-Kilburn Ward, 401 in the North Kilburn Ward, 354 in the Stonebridge Ward, 249 in the Cricklewood Ward, 202 in the Church End Ward, and smaller numbers in the other wards of Willesden. Of the 341 cases nursed during the year, 332 were new cases. 257 of these 332 new cases were referred by the Health Department for nursing, 36 by private doctors and 39 by Hospitals, Associations and private persons. Ophthalmia neonatorum received 443 visits and other ophthalmia cases 499 visits. SANITARY WORK. The number of houses in Willesden at the end of 1931 was 30,377. During the year the total number of inspections and re-inspections made by the Sanitary Staff was 22,071 as compared with, 26,975 in 1930. The houses inspected under the Housing Acts numbered 876, as compared with 969 in 1930. The number of complaints received, 2,277, is lower than last year. The total number of Notices issued and nuisances abated were 5,951 and 18,857 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 and Sulphurous Fumes.—During the year the district has been troubled by these nuisances from three generating stations:— (1) In one instance, despite the installation of special apparatus to reduce the emission of grit from pulverised fuel, residents in the vicinity of the works continue to be affected. The matter was taken up by the Legal Committee, who sought Counsel's opinion. (2) Another generating station which had introduced pulverised fuel created a nuisance frorr grit. Experiments and alterations to the plant at these works have effected improvement. (3) Complaints of a nuisance from grit and the sulphurous condition of the atmosphere were received from residents in the neighbourhood of the third generating station. Upon investigation it appeared that the grit was emitted at night time during the process of "soot blowing," whilst the effect of the fumes was particularly noticeable by the scorched and shrivelled appearance of vegetation within a belt extending approximately 200 yards by 600 yards. By the end of the year the Company had installed additional plant which had considerably relieved the pressure upon the older plant. A new gas washing plant is nearing completion. PUBLIC MORTUARY. During the year there were 115 admissions to the Mortuary, as compared with 121 in 1930; 9 of these were admitted for accommodation only; 42 were admitted for an inquest only; 54 were admitted for a post-mortem only ; and 10 were admitted for post-mortem followed by an inquest. The total number of post-mortems performed during the year was 64. 14 The doctors who have performed these post-mortem examinations have almost invariably expressed their satisfaction with the 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 conditions obtaining at the Mortuary. MOTOR AMBULANCE SERVICE. The demands on the Motor Ambulance Service continue to increase. During the year 5,171 calls were made for the Council's ambulances as compared with 5,016 in 1930 and 4,728 in 1929. Altogether 131,564 miles were run in 1931 as compared with 125,528 in 1930 and 111,338 in 1929. Approximately 300 defective children are on the lists for daily conveyance by the Council's school ambulances to and from school. The detailed report of the 17th year of working of the Motor Ambulance Service appears as Appendix C. MUNICIPAL HOSPITAL. The 40th Annual Report on the Municipal Hospital written by Dr. Troup appears later in this report. Your obedient Servant, GEORGE F. BUCHAN, Medical Officer of Health. 15 THE FIFTY.SIXTH ANNUAL REPORT FOR THE Year ended 31st December, 1931, ON THE HEALTH AND SANITARY CONDITION OF THE URBAN DISTRICT OF WILLESDEN. GENERAL STATISTICS. Area (acres) 4,384 Population (estimated Midsummer, 1931) 185,704* Population Census (1931) 185,300 Number of inhabited houses (end of 1931) according to Rate books 36,940 Rateable value at 31st March, 1931 £1,265,863 Sum represented by a penny rate £5,101 * Registrar General estimate Midsummer, 1931 185,630. EXTRACTS FROM VITAL STATISTICS OF THE YEAR. Births— Total. Legitimate *2,727 Birth Rate (R.G.) 15.88 Illegitimate † 111 Death Rate (R.G.) 10.44 Deaths ‡ 1,935 *(R.G.) M. 1,370. F. 1,426.—Tota+l 2,796 (R.G.). † M. 87. F. 65.—Total 152. ‡ (R.G.) 1938). Deaths from diseases and accidents of pregnancy and from sepsis 6 childbirth from other causes 3 Death Rate of Infants under one year of age per 1,000 live births:— Legitimate 56.84 Illegitimate 144.14 Total 60.25 Deaths from Measles (all ages) 5 Whooping Cough (all ages) 8 „ „ Diarrhoea (under 2 years of age) 17 Stillbirths registered 105 Stillbirth rate per 1,000 total (live and stillbirths) births 35.68 Table No. 7. NOTIFIABLE DISEASES DURING THE YEAR. Disease. Total Cases Notified. Cases admitted to Willesden Municipal Hospitals. Total Deaths. Diphtheria 310 295 5 Scarlet Fever 467 394 5 Enteric Fever (including Paratyphoid) 15 15 — Puerperal Fever 14 4 4 Puerperal Pyrexia 30 4 — Pneumonia 392 3 166 Small Pox 2 2§ — Cholera — — — Plague — — — Erysipelas 77 29 9 Typhus Fever — — — Relapsing Fever — — — Continued Fever — — — Cerebro.spinal Meningitis 8 3 4 Poliomyelitis 4 — — Ophthalmia Neonatorum 41 4 — Malaria 1 — — Dysentery 1 — 1 Encephalitis Lethargica 2 — 3 Acute Polio.Encephalitis — — — Anthrax — — — Tuberculosis:— (a) Pulmonary 262 — 140 (b) Non-Pulmonary 72 — 32 Whooping Cough 514 26 8 For analysis of the age groups see Appendix "A" Table IV. § Admitted to London County Council Hospital. 16 Table No. 8. TUBERCULOSIS. Age-Periods. New Cases. Deaths. Pulmonary. Non-Pulmonary. Pulmonary. Non-Pulmonary. M. F. M. F. M. F. M. F. 0 0 1 5 3 0 0 4 3 1 0 1 5 2 0 0 0 1 5 6 1 6 7 0 0 1 3 10 2 6 3 5 0 1 1 3 15 12 7 9 8 6 4 2 2 20 32 19 3 1 11 7 4 3 25 26 39 5 5 20 21 1 2 35 24 20 0 2 16 9 1 0 45 25 14 0 2 19 6 1 0 55 12 9 0 1 8 7 0 0 65 and upwards 4 2 0 0 4 1 0 0 Totals 143 119 36 36 84 56 15 17 The ratio of non-notified tuberculosis deaths to total tuberculosis deaths was 1 : 12. 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. The Public Health (Tuberculosis) Regulations, 1930, came into operation on January 1st, 1931. They place clearly upon the District Medical Officer of Health the duty to take such steps as are necessary or desirable for investigating the source of infection, for preventing the spread of infection and for removing conditions favourable to infection. Since the beginning of the year the Council's Health Visitor has visited cases of Tuberculosis. She has investigated the source of infection and given advice for preventing the spread of infection. She is able to arrange for the provision of paper handkerchiefs and sputum bottles with disinfectant. She is also able to arrange for the loan of bed and bedding to enable the patient to sleep in a separate bed, but in most cases the patients are not able to avail themselves of the offer because there is no space in the home in which to fit it in. Ring pillows have been provided in emaciated cases with a view to the prevention of bed sores. Contacts are advised to attend at the Tuberculosis Dispensary of the Middlesex County Council for examination. Many of the patients appear to need medical and nursing care in their homes whilst waiting admission to a sanatorium or when ill at home. On page 51 of the Middlesex County Council 1928 Annual Report is set out the Middlesex County Council Scheme for home nursing of cases of tuberculosis. On page 50 of the 1929 Report, paragraph (iii.), appears the remark: "there was very little call upon the service provided, possibly because its existence was not fully appreciated by all the various nursing associations functioning in the County, and possibly also on account of the very necessary restrictions imposed by the County Council with regard to the type of case suitable to be dealt with by a service of this nature." The treatment of patients and the supply of dressings, where necessary, do not appear to be undertaken by the Middlesex County Council at their Tuberculosis Dispensary. Delicate or debilitated children who are receiving treatment at the Health Centres of the Willesden Council, or who are under consideration for a stay in a Convalescent Home under the Willesden Council's Scheme, cease to have these benefits if they become notified cases of Tuberculosis. The housing conditions of the majority of tuberculosis families are unsuitable, and make measures for the care of the patient and the prevention of spread of the disease difficult, if not indeed, impossible. 17 PUBLIC HEALTH (PREVENTION OF TUBERCULOSIS) REGULATIONS, 1925. No case was dealt with under the above regulations during 1931. PUBLIC HEALTH ACT, 1925. SECTION 62. Removal to hospital of infectious persons suffering from pulmonary tuberculosis. No action was taken under this section during 1931. GENERAL PROVISION OF HEALTH SERVICES FOR THE AREA. Nursing in the Home. (a) General Nursing. (b) Nursing of infectious diseases. There have been no changes in the arrangements for the above outlined in last year's Annual Report. Midwives—Employment of, or subsidy to, practising Midwives, by Public Health Authority. The only change under this head during the year is that the Council resolved that an expectant mother who provides at her own cost a midwife to act as a maternity nurse may have the difference between the fees of this midwife who is a maternity nurse, and the fees of a maternity nurse who is not a midwife, made up to her by the Council. In accordance with Section 10 of the Midwives Act, 1902, 33 Midwives gave notice in the month of January, 1932, of their intention to practise in Willesden. CLINICS AND TREATMENT CENTRES. These remain as given in the Annual Health Report for 1930, but during 1931 the treatment of Varicose Ulcers was undertaken at Municipal Health Centre 1. A report on this work appears in Appendix D. HOSPITALS. There is no change to record in the Hospital services set out in last year's Report. INSTITUTIONAL PROVISION FOR UNMARRIED MOTHERS, ILLEGITIMATE INFANTS AND HOMELESS CHILDREN IN THE DISTRICT. These remain as stated in the Annual Health Report for 1930. AMBULANCE FACILITIES. Motor Ambulances are available as follows:— (a) For infectious cases— 1 ambulance. (b) For non-infectious cases, accident cases and maternity cases— 3 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 1930-31 will be found in Appendix C. LABORATORY WORK. Pathological and Bacteriological Examinations. The agreement entered into by the Council on the 1st February, 1925, was still in operation during 1931. 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 1931:— Table No. 9. Nature of Specimens examined. Positive Result. Negative Result. Total. 1. Swabs for Diphtheria Bacilli 381 3,364 3,745 2. Swabs for Diphtheria. (Virulence Tests.) 9 28 37 3. Blood for Widal Reaction 6 32 38 4. Sputum for Tubercle Bacilli 119 653 772 5. Swabs for Gonococci 36 6. Swabs from Eye 23 7. Blood Culture 15 8. Films for Gonococci 16 9. Cerebro-Spinal Fluid 33 10. Faeces for Organisms 13 11. Urine 18 12. Vaginal Discharge 12 13. Swab from Ear 4 14. Pus 2 15. Swabs for Organisms 6 Grand Total 4,770 18 Table No. 10.—Sources of Specimens Examined. From Willesden Municipal Hospital 1,339 From Private Practitioners 1,734 From Municipal Health Centres and Health Nurses 1,225 From Park Royal Hospital 458 From other Hospitals 14 Total 4,770 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. A doptive 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 Willesden area came under the notice of the Health Department during the year. 19 Drainage and Sewerage.—Some important works of sewerage and drainage have been carried out during the year as follows:— (a) Reconstruction of Neasden Valley Main Sewer, £52,000. (b) Kensal Rise Intercepting Sewer, £11,600. (c) Culverting in of ditch at rear of Drayton Road, £2,100. The above three schemes have been carried out with the assistance of grants from the Unemployment Grants Committee. 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. 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. Sanitary Inspection of the Area. Tabular summary of the work of the Sanitary Department during the year and action taken under the Public Health Acts, Housing Acts, etc. Inspections: Number of premises inspected on complaint 2,277 Number of premises inspected in connection with infectious diseases 63 Number of premises under periodical inspection 2,717 Houses inspected from House to House (Housing Acts) 876 For Certificates under the Rent Acts 7 Public House Urinals 343 Mews and Stables 526 Miscellaneous 203 Total number of inspections and re-inspections made 22,071 Action under Rent and Mortgage Interest (Restriction) Acts, 1920-25. Number of applications received for Certificates 7 Number of Certificates granted 6 Action Taken (under Housing Acts and Health Acts): Notice to Inspect (Section 127, Housing Act, 1925) 2,857 Cautionary or Intimation Notices Issued 2,867 Number complied with 2,326 Statutory Orders issued 221 Number complied with 161 Summonses served 5 Number of convictions obtained 5 Summonses withdrawn 0 „ 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 8 Number of contraventions 1 Number remedied 1 Canal Boats used as Dwellings: Number of contraventions of Regulations 0 Number remedied 1* * Outstanding year 1930. 20 Movable Dwellings, Caravans, Tents, &c.: Number observed during the year 6 Number of nuisances therefrom abated 1 Number removed from district 1 Bakehouses: Number in district 54 Number of Inspections 146 Contraventions of Factory Acts 18 Contraventions remedied 15 Slaughter-houses: Number on register 7 Inspections of carcases, etc. 282 Contraventions of Bye-laws 1 Contraventions remedied 1 Cowsheds: Number on register 1 Number of inspections made 8 Contraventions of regulations 2 Contraventions remedied 2 Number of milch cows in district 5 Dairies and Milkshops: Number on register 217 Number of inspections made 196 Contraventions of regulations 16 Contraventions remedied 14 Unsound Food: Meat (including organs) surrendered 1,155 lbs. Fish (wet, dried and shell) surrendered 479 lbs. Poultry surrendered 15 lbs. Bacon surrendered 796 lbs. Tinned and Cooked Meat surrendered 228 lbs. Tinned and Evaporated Milk surrendered 68 lbs. Tinned Fish surrendered 5 lbs. Tinned fruit surrendered 20 lbs. Total 2,766 lbs. Method of disposal Destroyed. Offensive Trades: Number of premises in district (Rag and Bone Dealers) 6 Number of inspections made 6 Contravention of Bye-laws 0 Contravention remedied 0 Water Supply and Water Service: Percentage of houses supplied on constant system 100 Cisterns:— New provided 42 Cleansed, repaired, covered, etc. 473 Draw-taps placed on mains 50 Drainage and Sewerage of existing Buildings: Water Closets:— Number of water closets substituted for dry receptacles 0 Repaired, supplied with water or otherwise improved 547 Additional Closets constructed 16 Percentage of houses provided with water closets 100 Drains:— Examined, tested, exposed, etc. 379 Unstopped, repaired, trapped, etc. 236 Waste pipes, rain-water pipes, disconnected, repaired, etc 703 New soil pipes or ventilating shafts fixed 108 Existing soil pipes or ventilating shafts repaired 265 Disconnecting traps or chambers inserted 203 Re-constructed 80 21 Drainage and Sewerage of existing Buildings—continued. 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 652 (b) Phthisis 108 Articles disinfected or destroyed:— (а) Ordinary infectious diseases 586 (b) Phthisis 730 Dust: New bins provided 721 Periodical frequency of dust removal weekly Method of disposal By tipping and barging Sundry Nuisances abated: Overcrowding 42 Smoke 10 Accumulations of refuse 150 Foul ditches, ponds, etc., and stagnant water 28 Fowls, pigs, and other animals 39 Dampness 590 Yards and forecourts paved, repaved or repaired 621 Walls and ceilings cleansed 3,885 Verminous rooms purified 216 Leaky roofs made watertight 736 Additional ventilation provided under floors 216 Dilapidated plaster repaired 1,669 Flooring and other woodwork repaired 1,210 Damp-proof courses inserted 81 Water supply reinstated 54 Washhouse floors repaired or repaved 451 Fireplaces and stoves repaired 773 Decayed brickwork repaired and repointed 619 Sinks provided or replaced 79 Additional light and ventilation provided to staircases 20 Larders or food cupboards provided or ventilated 32 Gutters and rainwater pipes repaired or renewed 817 New sash cords and glass provided to windows 2,083 Smoke observations 165 Miscellaneous 613 Total number of Nuisances Abated 18,857 Inspections of Premises where Food is prepared: Butchers', Provision, and General Shops 476 Fish shops (wet, dried and fried) 179 Eating houses 44 Greengrocers' shops 61 Ice-cream premises 76 Stalls 561 Canal Boats Acts, 1877-1884.—The number of boats inspected during the year, 1931, was 21 (36 inspections). One infringement of the Regulations was remedied that was outstanding in 1930. 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 6 Rag and Bone Dealers carrying on this business in the district, all complying with the Bye-laws. 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. 22 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 9,180 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 1929 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. HOUSING. Number of inhabited houses* in Willesden (end of 1931) according to the Rate Book, 36,940. * Flat separately assessed counted as one house. Number of houses in Willesden (end of 1931), 30,377 (approx.). * Flats contained under one roof are counted as one house. The following table shews building activities during the periods stated Table No.11 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 1926-30 737 1,622 2,734 5,093 1931 8 591 50 649 Total for 11 years 1,006 2,278 3,693 6,977 Activity in the erection of smaller houses in the Northern part of the district continues. HOUSING STATISTICS FOR THE YEAR 1931. Number of New Houses erected during the Year:— (a) Total (including numbers given separately under (b)): (i.) By the Local Authority 8 (ii.) By other Local Authorities Nil (iii.) By other bodies and persons 630 (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 11 1.—Inspection of Dwelling-houses during the Year:— (1) (a) Total number of dwelling-houses inspected for housing defects (under Public Health or Housing Acts) 3,222 (b) Number of inspections made for the purpose 15,813 (2) (a) Number of dwelling-houses (included under sub-head (1) above) which were inspected and recorded under the Housing Consolidated Regulations, 1925 876 (b) Number of inspections made for the purpose 5,256 23 (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 43 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 1,917 3.—Action under Statutory Powers during the Year:— A.—Proceedings under sections 17, 18 and 23 of the Housing Act, 1930 : (1) Number of dwelling-houses in respect of which notices were served requiring repairs 37 (2) Number of dwelling-houses which were rendered fit after service of formal notices:— (a) By owners 15 (b) By local authority in default of owners 9 B.—Proceedings under Public Health Acts: (1) Number of dwelling-houses in respect of which notices were served requiring defects to be remedied 82 (2) Number of dwelling-houses in which defects were remedied after service of formal notices:— (a) By owners 66 (b) By local authority in default of owners 4 C.—Proceedings under sections 19 and 21 of the Housing Act, 1930: (1) Number of dwelling-houses in respect of which Demolition Orders were made 0 (2) Number of dwelling-houses demolished in pursuance of Demolition Orders 0 D.—Proceedings under section 20 of the Housing Act, 1930: (1) Number of separate tenements or underground rooms in respect of which Closing Orders were made 0 (2) Number of separate tenements or underground rooms in respect of which Closing Orders were determined, the tenement or room having been rendered fit 0 E.—Proceedings under section 3 of the Housing Act, 1925: (1) Number of dwelling-houses in respect of which notices were served requiring repairs 0 (2) Number of dwelling-houses which were rendered fit after service of formal notices:— (a) By owners 16 (b) By local authority in default of owners 1 (3) Number of dwelling-houses in respect of which Closing Orders became operative in pursuance of declarations by owners of intention to close 0 F.—Proceedings under sections 11, 14 and 15 of the Housing Act, 1925: (1) Number of dwelling-houses in respect of which Closing Orders were made 0 (2) Number of dwelling-houses in respect of which Closing Orders were mined, the dwelling-houses having been rendered fit 0 (3) Number of dwelling-houses in respect of which Demolition Orders were made 0 * (4) Number of dwelling-houses demolished in pursuance of Demolition Orders 0 INSPECTION AND SUPERVISION OF FOOD. Milk Supply.—There are 2 wholesale dealers, 217 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) 0rder, 1923, during the year 1931:— 24 Table No. 12. (а) "Certified" milk 15 (b) "Grade A (Tuberculin Tested)" milk 24 (c) "Grade A (Tuberculin Tested)" Bottling Establishment 1 (d) "Grade A" milk 4 (e) " Pasteurised" milk 21 (f) "Pasteurisers" 2 There were no refusals or revocations of licences under the Milk (Special Designations) Order, 1923, during the year. No application for registration as a dairyman or for the registration of premises for use as a dairy was refused. The following Table gives the result of examination of samples of designated milk taken during the year 1931:— Table No. 13. No. of Sample. Designation. Result of Examination. No. of Bacteria per 1 c.c. Presence of Bacillus coli. Remarks. D/90 Certified 6,100 - Satisfactory. " D/91 Pasteurised 2,100 — D/92 Pasteurised 5,600 — " D/93 Grade "A" (T.T.) 13,400 — " D/94 Certified 6,400 — " D/95 Pasteurised 9,800 — " D/96 Grade "A" (T.T.) 4,100 — " D/97 Pasteurised 22,000 — " D/98 Certified 4,700 — " D/99 Pasteurised 42,000 — " D/100 Certified 1,600 — " D/101 Certified 14,000 — " D/102 Certified 6,400 — " D/103 Pasteurised 73,000 — " D/104 Certified 1,900 — " D/105 Certified 3,100 — " D/106 Certified 1,800 — " D/107 Pasteurised 54,000 — " D/108 Certified 4,900 — " D/109 Certified 2,580 — " D/110 Pasteurised 13,000 — " D/111 Certified 7,300 — " D/112 Certified 2,330 — " D/113 Certified 2,200 — " D/114 Certified 3,210 — " D/115 Pasteurised 18,000 — " D/116 Pasteurised 15,000 — " D/117 Certified 5,200 — " D/118 Certified 3,500 — " D/119 Pasteurised 91,000 — " D/120 Pasteurised 3,600 - " Forty-nine samples of milk were taken during the year for examination for the presence of tubercle bacilli under the Milk and Dairies (Consolidation) Act, 1915. Six samples (Nos. 0/213, 0/215, 0/216, 0/221/0/230 and 0/245) were found to contain tubercle bacilli, and action was taken resulting in the examination of the herds at the supplying farms. 0/213.—Three cows were individually sampled. In addition a bulk sample was taken from the remainder of the herd. Microscopical examination of one cow individually sampled shewed the presence of excess of cells, and a notice restricting the sale of milk from that cow was immediately served upon the owner. Animal inoculation tests revealed living tubercle bacilli in one individual sample, and the animal was slaughtered. The result of the remaining bulk sample proved positive. The herd was re-examined and one cow was sampled owing to a slight induration of the udder. In addition, a bulk sample was collected from the cows not suspected. No tubercle bacilli was found in either of the samples. In view of the complex nature of the investigations, milk from this farm is being closely watched. 25 0/215.—Samples of milk taken from a cow which was considered to have a suspicious udder, and also a bulk sample, proved to be negative. It is assumed that the offending animal was removed from the herd prior to the Veterinary Surgeon's inspection. 0/216.—On 22nd May, 1931, the Veterinary Officer inspected the farm. He took 4 samples of milk from individual cows which he thought might be suffering from tuberculosis, but these individual samples were negative. On 22nd June, 1931, the Veterinary Officer divided the farmer's herd of cattle into 3 groups, and took a mixed sample of milk from each group. One of these samples from a group of 9 cows proved to be positive ; the samples from the other 2 groups were negative. Subsequently the Veterinary Officer paid another visit to the farm with the view of sampling individually the 9 cows in the positive group, but 3 cows had been removed by the farmer and the remaining 6 cows were negative to the tuberculosis test. The following letter, dated 20th October, 1931, has been received from the Medical Officer of Health of Warwickshire relative to this matter:— " In reply to yours of the 8th instant, the Clerk of the Council communicated with Mr. C. on 1st August, 1931, referring in his letter to the animal he disposed of at the cattle market on the 22nd July, and which Mr. C. admitted had shown signs of losing flesh and had developed a cough, and drew attention to his responsibility under the Tuberculosis Order. The Clerk of the Council in his letter said:— ' You will no doubt appreciate that under the above Articles, you are liable for prosecution for failing to report the animal above referred to. This Local Authority, however, do not propose to institute legal proceedings against you in this instance, but I am to warn you that in the event of a similar occurrence the necessary legal proceedings will be instituted under the Articles referred to above.' The animal referred to was sold for slaughter on July 22nd, but unfortunately I have not been able to obtain particulars of the condition of the animal ' post-mortem.' I think, however, it can quite safely be concluded that this was the source of tubercle in the milk. The last bulk sample of the remaining six cows, you will no doubt remember, proved negative." 0/221.—The Veterinary Surgeon took samples which proved negative. He arranged to take further samples from 4 animals, which were dry at the time of the inspection, when they were again milking. The Inspector visited the farm and sampled two of the cows, which were previously dry, but the samples proved to be negative. He found one cow had been slaughtered and another had been sold. 0/230.—The Veterinary Surgeon took samples. One sample taken from an individual cow was found to be positive and the case reported under the Tuberculosis Order, 1925. 0/245.—The Veterinary Surgeon inspected the farm. The result of investigations not to hand at time of going to print. In 40 instances the result of the examination proved negative. In 3 instances the guinea pig inoculated with a 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. 14. In 1920. In December, 1925. In December, 1931. 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 54 bakehouses in the district were inspected on 146 occasions, Notices being served in 18 instances for minor contraventions of the Factory and Workshop Acts. 26 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 durine the vear 1931 Table No. 15. List of Samples Taken during the Year ended 31st December, 1931. Article. Taken. Adulterated. Milk 637 5 Milk, Sterilised 4 - Milk, Separated 1 - Butter 1 - Cream, Artificial 1 - Gin 3 - Meat 19 - Minced Beef 51 6 Pears 1 - Prawns, Tinned 1 - Sausages 49 8 Seasoning 2 — Tomatoes, Tinned 1 — Whisky 3 — 774 19 Artificial Cream Act, 1929. Public Health (Condensed and Dried Milk) Regulations, 1923. Inspections were made under the above 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. 16. 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) 152 26 - Workshops (including Workshop laundries) 216 32 — Workplaces (other than Outworkers' premises) 9 1 — Total 377 59 — Number of Prosecutions 8 Number of Convictions 8 Fines and Costs imposed £67 4s. Od. 27 Table No. 17.—Defects Found. Particulars. (1) Number of Defects. Number of Prosecutions (5) Found. (2 Remedied. (3) Referred to H.M. Inspector. (4) Nuisances under the Public Health Acts:— Want of Cleanliness 18 15 - - Want of Ventilation 3 3 - - Overcrowding — — - - Want of drainage of floors 2 2 - - Other Nuisances 8 6 - - Sanitary accommodation— Insufficient 2 1 - - Unsuitable or defective 20 16 - - Not separate for Sexes 4 2 — - Unscreened for Sexes — — - - 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) 18 15 - - Other offences (Excluding offences relating to outwork) - - - - Total 75 60 - - Table No. 18.—Registered Workshops. Workshops on the Register (s. 131) at the end of the year. Number. (1) (2) Factories 176 Factories, Laundries 38 Workshops, Laundries 22 Domestic Laundries 6 Bakehouses 54 Dressmakers 58 Outworkers 761 Blouse Makers 3 Tailors 48 Bootmakers 89 Metal Workers 52 Wood Workers 43 Seamstresses 1 Motor and Cycle Makers 52 Upholsterers 9 Milliners 20 Miscellaneous 107 Total number of Workshops on Register 1,539 Table No. 19.—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) 1 Action taken in matters referred by H.M. Inspector as remediable under the Public Health Acts, but not under the Factory and Workshop Act (s. 5)— Notified by H.M. Inspector 5 Reports (of action taken) sent to H.M. Inspector 3 Other - Underground Bakehouses (s. 101):— Certificates granted during the year In use at the end of the year 17 29 THE TWENTY-FOURTH ANNUAL REPORT FOR THE Year ending 31st December, 1931, ON THE HEALTH OF CHILDREN ATTENDING THE PUBLIC ELEMENTARY SCHOOLS IN WILLESDEN. Giving the Tables required by the Board of Education. Table No. 20.—Corresponding to Table 1 of the Board of Education's Medical Statistical Tables as amended by Administrative Memorandum No. 80, dated 12th January, 1931. Return of Medical Inspections for the year ended 31st December, 1931. A.—Routine Medical Inspections. Number of Code Group Inspections— Entrants 2,157 Intermediates 2,381 Leavers 1,400 Total 5,938 Number of other Routine Inspections 0 B.—Other Inspections. Number of Special Inspections 7,242 Number of Re-inspections 19,170 Total 26,412 Table No. 21.—Corresponding to Table 2 of the Board of Education's Medical Statistical Tables as amended by Administrative Memorandum No. 80, dated 12th January, 1931. A.—Return of Defects Found by Medical Inspection in the Year ended 31st December, 1931. 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 25 45 75 9 Uncleanliness (see Table IV, Group V) - - - - Ringworm: Skin Scalp 5 - 15 - Body 4 - 12 - Scabies 2 - 84 - Impetigo 11 - 243 - Other Diseases (non- tuberculous) 55 - 1,376 - Eye Blepharitis 23 - 106 - Conjunctivitis 5 - 119 - Keratitis - - 1 - Corneal Opacities - - 0 - Defective Vision (excluding Squint) 245 13 368 8 Squint 21 - 67 - Other Conditions 18 3 118 - Spectacles broken - - 297 - Spectacles lost - - 31 - 30 A.—Return of Defects found by Medical Inspection in the Year ended 31st December, 1931—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 8 - 17 - Otitis Media 28 - 141 - Other Ear Diseases 29 - 188 - Nose and Throat Enlarged Tonsils only 668 331 230 38 Adenoids only 70 7 15 4 Enlarged Tonsils and Adenoids 25 6 271 3 Other Conditions 62 18 145 5 Enlarged Cervical Glands (non-tuberculous) 106 4 185 7 Defective Speech 3 5 6 - Teeth Dental Diseases (see Table IV, Group IV) 1,498 1 - — Heart and Circulation Heart Disease: Organic 4 3 11 1 Functional 12 250 17 15 Anæmia 109 9 74 1 Lungs Bronchitis 19 2 97 - Other Non-Tuberculous Diseases 34 13 19 - Tuberculosis Pulmonary:— Definite - - 3 - Suspected - - 21 - Non-Pulmonary:— Definite:— Glands - 1 2 - Spine - 1 - - Hip 1 1 1 - Other Bones and Joints - - 1 - Skin - - - - Other forms - - - - Suspected:— Glands - - 2 - Bones and Joints - - 2 - Other forms - - 3 - Nervous System Epilepsy - - 3 - Chorea 2 5 11 - Other Conditions 12 9 48 3 Deformities Rickets - 1 3 - Spinal Curvature 33 6 117 2 Other forms 69 5 59 1 Other Defects and Diseases 294 131 2,699 39 B.—Number of individual Children found at Routine Medical Inspection to require Treatment (excluding Uncleanliness and Dental Diseases). Group. Number of Children. Percentage of Children found to require treatment. Inspected. Found to require treatment. (i) (2) (3) (4) Code Groups— Entrants 2,157 591 27.4 Intermediates 2,381 604 25.4 Leavers 1,400 320 22.9 Total (Code Groups) 5,938 1,515 25.5 Other Routine Inspections 0 0 0 31 Table No. 22.—Corresponding to Table III. of The Board of Education's Medical Statistical Tables as amended by Administrative Memorandum No. 80, dated 12th January, 1931. Return of all Exceptional Children in the Area. No child is entered under more than one heading. Boys. Girls. Total. Children suffering from the following types of Multiple Defect, i.e., any combination of Total Blindness, Total Deafness, Mental Defect, Epilepsy, Active Tuberculosis, Crippling (as defined in the penultimate category of the Table), or Heart Disease The actual combination of defects and the type of School, if any, attended should be indicated on a separate sheet. 4* 1† 5 Blind (including partially blind) (i.) Suitable for training in a School for the totally blind. (ii) Suitable for training in a School for the partially Blind. At Certified Schools for the Blind 2 1 3 At Public Elementary Schools 0 0 0 At other Institutions 0 0 0 At no School or Institution 0 0 0 At Certified Schools for the Blind or partially Blind 9 8 17 At Public Elementary Schools 0 0 0 At other Institutions i 0 1 At no School or Institution 1 1 2 Deaf (including deaf and dumb and partially deaf). (i.) Suitable for training in a School for the totally deaf or deaf and dumb. At Certified Schools for the Deaf 7 2 9 At 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 for the partially deaf. At Certified Schools for the Deaf or Partially Deaf 3 3 6 At Public Elementary Schools 0 0 0 At other Institutions 0 0 0 At no School or Institution 0 0 0 Mentally Defective. Feebleminded At Certified Schools for Mentally Defective Children 78 51 129 At Public Elementary Schools 3 0 3 At other Institutions 1 2 3 At no School or Institution 0 1 1 Notified to the Local Mental Deficiency Authority during the year. Details should be given on Form 307 M. - - - Epileptics. Suffering from severe Epilepsy At Certified Schools for Epileptics 1 2 3 At Certified Residential Open Air Schools 0 0 0 At Certified Day Open Air Schools 0 0 0 At Public Elementary Schools 0 0 0 At other Institutions 0 0 0 At no School or Institution 0 0 0 Suffering from epilepsy which is not severe. At Public Elementary Schools 14 4 18 At no School or Institution 0 0 0 Physically Defective. Active pulmonary tuberculosis (including pleura and intrathoracic glands). At Sanatoria or Sanatorium Schools approved by the Ministry of Health or the Board 2 1 3 At Certified Residential Open Air Schools 0 0 0 At Certified Day Open Air Schools 0 0 0 At Public Elementary Schools ... 0 0 0 At other Institutions 0 0 0 At no School or Instituton 0 0 0 Quiescent or arrested pulmonary tuberculosis (including pleura and intrathoracic glands). At Sanatoria or Sanatorium Schools approved by the Ministry of Health or the Board 0 0 0 At Certified Residential Open Air Schools 0 0 0 At Certified Day Open Air Schools 2 0 2 At Public Elementary Schools ... 40 19 59 At other Institutions 0 5 5 At no School or Institution 1 4 5 Tuberculosis of the peripheral glands. At Sanatoria or Sanatorium Schools approved by the Ministry of Health or the Board 1 1 2 At Certified Residential Open Air Schools 0 0 0 At Certified Day Open Air Schools 0 0 0 At Public Elementary Schools 0 0 0 At other Institutions 0 0 0 At no School or Institution 0 0 0 Abdominal tuberculosis At Sanatoria or Sanatorium Schools approved by the Ministry of Health or the Board 1 0 1 At Certified Residential Open Air Schools 0 0 0 At Certified Day Open Air Schools 0 0 0 At Public Elementary Schools 0 0 0 At other Institutions 0 0 0 At no School or Institution 0 1 1 Tuberculosis of bones and joints (not including deformities due to old tuberculosis). At Sanatoria or Hospital Schools approved by the Ministry of Health or the Board 3 2 5 At Public Elementary Schools 0 0 0 At other Institutions 0 0 0 At no School or Institution 1 0 1 32  Boys. Girls. Total. Physically Defective (continued). Tuberculosis of other organs (skin, etc.). At Sanatoria or Hospital Schools approved by the Ministry of Health or the Board 0 0 0 At Public Elementary Schools 0 0 0 At other Institutions 0 0 0 At no School or Institution 0 0 0 Delicate Children, i.e., all children (except those included in other groups) whose general health renders it desirable that they should be specially selected for admission to an Open Air School. At Certified Residential Cripple Schools 0 0 0 At Certified Day Cripple Schools 21 29 50 At Certified Residential Open Air Schools 12 20 32 At Certified Day Open Air Schools 0 0 0 At Public Elementary Schools 182 131 313 At other Institutions 0 0 0 At no School or Institution 0 2 2 Crippled Children (other than those with active tuberculous disease) who are suffering from a degree of crippling sufficiently severe to interfere materially with a child's normal mode of life. At Certified Hospital Schools 0 0 0 At Certified Residential Cripple Schools 2 1 3 At Certified Day Cripple Schools 45 30 75 At Certified Residential Open Air Schools 0 0 0 At Certified Day Open Air Schools 0 0 0 At Public Elementary Schools 3 (2) 1 (1) 4 (3)§ At other Institutions 0 0 0 At no School or Institution 0 1 (1) 1 (1)§ Children with heart disease, i.e., children whose defect is so severe as to necessitate the provision of educational facilities other than those of the public elementary school. At Certified Hospital Schools 2 0 2 At Certified Residential Cripple Schools 0 0 0 At Certified Day Cripple Schools 22 16 38 At Certified Residential Open Air Schools 0 0 0 At Certified Day Open Air Schools 0 0 0 At Public Elementary Schools 0 3 3 At other Institutions 0 1 1 At no School or Institution 2 1 3 * These boys are in attendance at a certified school for mentally defective children, and in addition to their mental condition, two of them are suffering from rickets, one from infantile paralysis, and one from epilepsy. † This girl is in attendance at a certified school for mentally defective children, and in addition to her mental condition she is suffering from heart disease. § The figures in brackets indicate the number of these children who should be receiving Special School education. Table No. 23.—Corresponding to Table IV. of The Board of Education's Medical Statistical Tables as amended by Administrative Memorandum No. 80, dated 12th January, 1931. Return of Defects Treated during the Year ended 31st December, 1931. 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 16 3 19 Body 15 6 21 Scabies 85 5 90 Impetigo 326 31 357 Other Skin Diseases 1,929 58 1,987 Minor Eye Defects (external and other, but excluding cases falling in Group II.) 398 20 418 Minor Ear Defects 387 48 435 Miscellaneous (e.g., Minor Injuries, Bruises, Sores, Chilblains, etc.) 3,525 788 4,313 Total 6,681 959 7,640 33 Group II.—Defective Vision and Squint (excluding Minor Eye Defects treated as Minor Ailments—Group I.). Defect or Disease. Number of Defects dealt with. 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.) 1,038 8* 0* 1,046 Other Defect or Disease of the Eyes (excluding those recorded in Group I.) 5 0 2 7 Total 1,043 8 2 1,053* * In addition to this number 176 cases of visual defect received attention by Voluntary Hospital, Private Practitioner or Optician, but it was not known whether they were submitted to refraction. Total number of children for whom spectacles were prescribed:— (a) Under the Authority's scheme 905 (b) Otherwise 63 Total number of children who obtained or received spectacles:— (a) Under the Authority's scheme 783 (b) Otherwise 101 Group III.—Treatment of Defects of Nose and Throat. Number of Defects. Received Operative Treatment. Received other forms of Treatment. Total Number Treated. Under the Authority's Scheme in Clinic or Hospital. By Private Practitioner or Hospital apart from the Authority's Scheme. Total. (1) (2) (3) (4) (5) 510 281 791 221 1,012 Group IV.—Dental Defects. Vide 13th 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 17.9 (ii.) Total number of examinations of children in the schools by School Nurses 60,071 (iii.) Number of individual children found unclean 1,875 (iv.) Number of children cleansed under arrangements made by the Local Education Authority 342 34 (v.) Number of cases in which legal proceedings were taken:— (a) Under the Education Act, 1921 12 (b) Under the School Attendance Bye-Laws 0 (vi.) No. of school sessions at which inspections were conducted 627 (vii.) (i.) Original Inspections:— Children examined (i.e., Cases not individual children) 51,742 Found unclean 2,549 Percentage found unclean 4.9 Excluded on account of uncleanliness 72 (ii.) Re-inspections:— Children examined (i.e., Cases not individual children) 8,329 Found unclean 5,792 Percentage found unclean 69.5 Excluded on account of uncleanliness 23 (iii.) Total:— Examinations 60,071 Exclusions on account of uncleanliness 95 Board of Education's Medical Statistical Tables as amended by Administrative Memorandum No. 80, dated 12th January, 1931. Notes on Table IV. (e). “ 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. Thorough domestic cleansing of the home is advised by the Health Visitor, disinfection not being generally resorted to in verminous cases. Baths are also given for scabies and other skin conditions as necessary. Record of cases in which legal proceedings were taken:— 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. Amount Standing Fined. of Fine. Withdrawn. Dismissed. adjourned at end of Year. 5 10/- 2 Nil. 2 2 7/6 1 5/- Statement of the Number of Children Notified during the Year ended December 31st, 1931, by the Local Education Authority to the Local Mental Deficiency Authority. Total Number of Children notified: 5. 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 1 - (b) Imbeciles 1 3 (c) Others - - (ii.) Children unable to be instructed in a Special School without detriment to the interests of other children: (a) Moral defectives - - (b) Others - - 2. —Feeble-minded children notified on leaving a Special School on or before attaining the age of 16 - - 3. —Feeble-minded children notified under Article 3 of the 1928 Regulations, i.e., "special circumstances cases" - - 4. —Children who in addition to being mentally defective were blind or deaf - - Total 2 3 35-36 Table No. 24—In this Table is embodied the information required in the N.B. to Notes on Table IV. of the Board of Education's Medical Statistical Tables as amended by Administrative Memorandum No. 80. Return showing the nature and number of all medical defects referred for following up, whether referred from Routine Medical Inspection, Medical Inspection of "Specials," or from other Sources, these latter never having been inspected by the Education Committee's Medical Officers; and the extent to which remedial measures were carried out during 1931. CONDITIONS No. of defects followed up. No. of defects for which no report is available. No. of defects not needing treatment. No. of defects treated. Domes- Treatment only. Grand Total. Results ot Treatment. Percentage of defects treated. No. of defects not treated. No of defects under obrvation at end of year, and carried forward to succeeding year. Remedied. lm¬proved Unchanged. Under observation at end 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 M.C.C. Private Practitioner. Total. Excluding Treat¬ment Including Do- Treatment. Removed from observa- Remaining under observation. Total. Brought forward from previous New. Total. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 #] % % Clothing— Unsatisfactory 2 7 9 - - - - - - - 9 9 9| - - - - 100. 0 - - - - Footgear— Unsatisfactory - 1 1 - - - - - - - - - - - - - - - 1 - 1 - Cleanliness of head— Nits 243 2,142 2,385 12 - 120 - - - 120 2,118 2,238 2,192 - - 46 5.1 94.3 22 113 135 59 Pediculi 30 304 334 - - 125 - - - 125 170 295 293 - - 2 37.4 88.3 2 37 39 39 Other dirty conditions - 2 2 - - - - - - 2 2 1 - - 1 - 100.0 - - - 1 Cleanliness of Body— Dirty - 6 6 - - 1 - - - 1 5 6 5 - - 1 16.7 100.0 - - - 1 Pediculi - 4 4 - - 1 - - - 1 2 3 3 - - - 25.0 75.0 - 1 1 1 Fleabitten 2 12 14 - - - - - - - 14 14 14 - - - - 100.0 - - - - Malnutrition 28 107 135 1 1 87 5 - 3 95 17 112 64 5 - 43 71.4 84.2 6 15 21 58 Nose and Throat— Enlarged Tonsils 530 752 1,282 17 67 186 104 5 4 299 - 299 294 -. - 5 25.0 25.0 540 359 899 364 Adenoids 41 39 80 1 10 5 3 - 8 - 8 6 1 - 1 11.6 11.6 28 33 61 34 Enlarged Tonsils and Adenoids 155 590 745 2 10 251 144 - - 395 5 400 396 - 4 53.9 54.6 165 168 333 172 Other conditions 36 234 270 1 3 133 10 1 31 175 53 228 193 4 - 31 65.8 85.7 19 19 38 50 Cervical or Neck Glands— Enlarged (non-T.B.) 239 356 595 1 21 170 44 2 19 235 37 272 235 8 2 27 41.0 47.5 119 182 301 209 External Eye Diseases— 19 143 162 - - 124 4 - 2 130 28 158 129 1 - 28 80.2 97.5 - 4 4 32 Conjunctivitis 15 140 155 1 - 136 2 - 5 143 9 152 136 3 - 13 92.9 98.7 - 2 2 15 1 - 1 - - - 1 - 1 - 1 - - - 1 100.0 100.0 - - - 1 - 1 1 - - - 1 - - 1 - 1 - - - 1 100.0 100.0 - - - 1 Other conditions 14 161 175 - 4 138 6 - 1 145 23 168 151 - - 17 84-8 98-2 1 2 3 19 Ear Diseases— Chronic Suppuration of Middle Ear 60 191 251 5 4 179 16 - 10 205 24 229 173 8 2 46 84.7 94.6 8 5 13 51 Defective Hearing 7 34 41 1 7 21 5 - 1 27 - 27 6 7 3 11 81.8 81.8 2 4 6 15 Wax 14 130 144 - - 124 2 1 2 129 4 133 117 - - 16 89.6 92.4 2 9 11 25 Other diseases 7 85 92 - - 63 8 1 2 74 15 89 69 - - 20 80.4 96.7 - 3 3 23 Teeth—See Dental Returns Heart and Circulation— Organic Disease 6 19 25 1 - 5 10 - 5 20 - 20 - 6 3 11 83.3 83.3 2 2 4 13 Functional Disease 6 30 36 1 5 13 10 - - 23 2 25 3 13 1 8 76.7 83.3 - 5 5 13 Anaemia 107 117 224 3 1 117 15 - 13 145 33 178 97 28 - 53 65.9 80.9 6 36 42 89 Other conditions 4 6 10 - 2 4 4 - - 8 - 8 2 1 - 5 100.0 100.0 - - - 5 Lungs— Bronchitis and Bronchial Catarrh 27 191 218 2 - 75 17 - 56 148 58 206 143 6 3 54 68.5 95.4 - 10 10 64 Tuberculosis 2 4 6 - - - 1 - - 1 - 1 1 - - - 16.7 16.7 5 - 5 - T.B. Suspected 8 24 32 2 3 9 9 - 3 21 2 23 7 4 6 6 77.8 85.2 2 2 4 8 Other diseases (non-T.B.) 20 35 55 1 - 31 7 3 4 45 4 49 18 4 1 26 83.3 90.7 5 - 5 26 Nervous System— Epilepsy 4 5 9 2 - 2 2 1 5 - 5 - 2 2 1 71.4 71.4 2 - 2 1 Chorea 19 24 43 1 1 2 22 6 6 36 - 36 19 6 2 9 87.8 87.8 4 1 5 10 Other conditions 10 62 72 - 2 41 12 - 4 57 4 61 26 7 1 27 81.4 87.1 2 7 9 34 Skin— Ringworm { Head & Body} 6 35 41 1 - 31 2 - 7 40 - 40 33 - - 7 100.0 100.0 - - - 7 Impetigo 32 412 444 - - 326 2 1 28 357 83 440 407 - 1 32 80.4 99.1 - 4 4 36 Scabies 3 90 93 1 1 85 2 - 3 90 1 91 80 - 11 98.9 100.0 - - - 11 Minor Injuries 58 1,068 1,126 4 - 979 43 - 15 1,037 81 1,118 1,055 1 2 60 92.4 99.6 2 2 4 62 Other conds. (non. T.B.) 205 2,089 2,294 13 11 1,928 21 2 35 1,986 248 2,234 2,032 2 4 196 87.5 98.4 15 21 36 217 Deformities— Rickets 10 6 16 1 1 6 1 - - 7 - 7 1 1 1 4 50.0 50.0 6 1 7 5 Spinal Curvature 48 153 201 1 2 184 1 - - 185 - 185 72 36 23 54 93.4 93.4 8 5 13 59 Other forms 35 138 173 1 7 120 3 1 3 127 - 127 19 10 16 82 77 0 77 0 26 12 38 94 Tuberculosis (Non-Pulmonary)— Definite—Glands - 5 5 - 1 1 3 - - 4 - 4 - 1 - 3 100.0 100.0 - - - 3 ,, Bones and joints - 3 3 - - 2 1 - - 3 - 3 - - 1 2 100.0 100.0 - - - 2 ,, Other conditions - 1 1 - - - - - - - - - - - - - - - 1 - - - Suspected—Glands 2 5 7 - 1 2 3 1 - 6 - 6 3 - 1 2 100.0 100.0 - - - 2 „ Bones and joints - 2 2 - - - 2 - - 2 - 2 - - - 2 100.0 100.0 - - - 2 ,, Other conditions - 3 3 - - - - - - - - - - - - - - 2 1 3 1 Speech— Defective Articulation 7 10 17 2 1 4 - - - 4 3 7 1 5 - 1 28.6 50.0 4 3 7 4 Squint— Squint present 47 103 150 1 2 103 15 1 - 119 - 119 18 55 18 28 81 0 81.0 17 11 28 39 Vision- Defect not ascertained 36 315 351 5 33 266 9 - 3 278 - 278 203 14 12 49 88.8 88.8 21 14 35 63 One eye normal 26 40 66 - 4 39 3 - 2 44 - 44 32 5 - 7 71.0 71.0 8 10 18 17 Both eyes 6/6 9 21 30 - 13 15 - - - 15 - 15 12 - 1 2 88.2 88.2 1 1 2 3 6/9 10 23 33 2 6 19 - - - 19 - 19 13 - 3 3 76.0 76.0 4 2 6 5 One eye 6/9 other 6/12 or less 33 76 109 1 3 74 4 - 8 86 - 86 60 7 3 16 81.9 81.9 9 10 19 26 Both eyes 6 /12 or less 89 208 297 - 8 194 20 - 11 225 - 225 171 16 8 30 77.9 77.9 36 28 64 58 Spectacles broken 26 311 337 2 1 300 1 - 21 322 1 323 292 - 1 30 96.4 96.7 4 7 11 37 „ lost 5 36 41 - 1 33 1 - 2 36 - 36 31 - - 5 90.0 90.0 1 3 4 8 Debility 328 788 1,116 8 10 762 32 2 35 831 164 995 565 88 8 334 75.7 | 90.6 29 174 103 408 Miscellaneous 385 2,448 2,833 24 267 1,273 242 12 211 1,738 709 ; 2,447 1,992 53 30 372 68.4 96.3 51 44 95 416 Grand Totals 3,056 14,347 17,403 122 514 8,909 875 39 556 10,379 3,928 14,307 11,894 t| 408 159 1,846 61 9 85 3 1,188 ! 1,272 2,460 3,118 Re-examinations in respect of Defective Vision, other than Lost and Broken Spectacles, and in respect of other conditions— No. of cases dealt with 1,664 37 Certain Statistical Data. No. of Public Elementary Schools (excluding Special Schools) at December, 1931 35 No. of School Departments at December, 1931 71 Average Public Elementary School Roll (excluding Special Schools), year ended 31st March, 1931 20,502 Total No. of Children medically inspected at Routine and Special Inspections 13,180 Total No. of Children dentally inspected 22,410 Total No. of Defects of every description "followed up" during 1931 26,698 Total No. of Defects of every description for which treatment was obtained during 1931:— Medical or Dental Treatment 15,492 Domestic Treatment 3,928 Total 19,420 Total No. of Attendances at the School Clinics during 1931 92,231 Special (Day) Schools in Willesden. No. of Physically Defective Schools 1 No. of Mentally Defective Schools 1 No. of children attending certified Special (Day and Residential) Schools during 1931:— Table No. 25. Special Schools in Willesden. Special Schools outside Willesden. Total. Blind and Partially Blind - 21 21 Deaf - 16 16 Mentally Defective 143 1 144 Epileptic - 3 3 Physically Defective 206 330* 536* Total 349 371* 720* * 261 of these were debilitated children sent to Certified Residential Schools for six weeks convalesence. Table No. 26.—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 33 41 32 24 2. Number who:— (a) Have since died 2 1 - - (b) Are known to be incapable by reason of mental or physical defect of undertaking employment 1 - 2 - (c) Are in attendance at an Institution for further education (give details), and †3 ††l §2 §4 (d) Are in any other Institution (specify Asylum, Workhouse, Colony for Epileptics, &c.) - *1 **7 §§6 3. Number who are employed in:— (a) Industrial or manual occupations 11 15 11 5 (b) Agricultural or rural occupations - - - - (c) Domestic occupations, including those who are helping in the domestic work at home - 8 1 9 (d) Commercial, professional or clerical work 8 14 - - (e) Blind alley or other precarious occupations 1 - 6 - 4. Number who have left the neighbourhood or whose after-careers have not been traced 7 1 3 - † 1 is in attendance at a technical school, 1 at Willesden Polytechnic, and 1 at an institution learning bootmaking. †† In attendance at Pitman's School. § In attendance at an Occupation Centre. * In the Royal National Orthopaedic Hospital, Stanmore. ** 5 are in Institutions for Mentally Defectives. 1 is in a Poor Law Institution and 1 is in Middlesex Hospital. §§ In Institutions for Mentally Defectives. 8 Mentally Defectives and 8 Physically Defectives are unemployed. 38 Table No. 27. Return showing No. of Cases referred for following-up in 1931 and previous years with the view of Medical Treatment being obtained, Remedial Measures carried out, or other action taken. Year. Referred by Total. Medical Inspection and Officers of Health Department. Head Teachers. Attendance Officers. Others. 1931 4,928 1,426 89 7,036 13,479 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 39 Table No. 28. Medical and Dental Treatment—Attendances at the Municipal Health Centres, 1931. Condition. Mothers, and Children under Five. School Children. Grand Total. (Cols. 7 and 8). Expectant Mothers. Nursing Mothers. Children under Five. Total (Cols. 2—5). 0—1. 1—5. Total (Cols. 4 and 5). (1) (2) (3) (4) (5) (6) (7) (8) (9) 1. Cleansing 1 19 34 237 271 291 2,314 2,605* 1 0 106 495 601 602 6,560 7,162 3. Minor Ailments 6 50 1,897 3,709 5,606 5,662 36,378 42,040† 4. Eye Diseases 1 6 142 474 616 623 5,495 6,118 5. Ringworm, etc. 11 49 150 211 361 421 513 934†† 6. Artificial Sunlight Treatment 0 0 180 4,135 4,315 4,315 8,693 13,008 7. Orthopaedics 0 40 404 2,010 2,414 2,454 5,946 8,400 8. Medical Consultations 5,057 20,882 22,534 13,541 36,075 62,014 0 62,014 9. Diphtheria Immunisation 0 0 0 13 13 13 43 56‡ 10. Total (1—9) 5,077 21,046 25,447 24,825 50,272 76,395 65,942 142,337 11. Dental Consultations 887 1,541 0 1,045 1,045 3,473 15,180 18,653 12. Total (10—11) 5,964 22,587 25,447 25,870 51,317 79,868 81,122 160,990 13. School for Mothers 0 0 0 0 0 6,928 0 6,928 14. Nursery 0 0 0 0 0 6,985 0 6,985 15. Miscellaneous 0 0 0 0 0 10,700 11,109 21,809 16. Grand Total (12—16) 5,964 22,587 25,447 25,870 51,317 104,481 92,231 196,712§ * In addition there was 1 attendance by an adult, making 2,606 attendances in all. † In addition there were 4 attendances by adults, making 42,044 attendances in all. †† In addition there were 7 attendances by adults, making 941 attendances in all. ‡ In addition there were 7 attendances by adults, making 63 attendances in all. § In addition there were 56 attendances for the treatment of varicose ulcers, which, together with the 19 additional attendances above, makes a grand total of 196,787. 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. 17. Medical Attendances 14,967 21,590 36,557 34,526 14,804 49,330 26,902 29,548 56,450 142,337 18. Dental Attendances 897 4,019 4,916 1,010 3,374 4,384 1,566 7,787 9,353 18.653 19. School for Mothers 2,171 0 2,171 1,850 0 1,850 2,907 0 2,907 6,928 20. Nursery Attendances 2,904 0 2,904 898 0 898 3,183 0 3,183 6,985 21. Miscellaneous 4,518 4,702 9,220 3,169 3,875 7,044 3,013 2,532 5,545 21,809 22. Total 25,457 30,311 55,768 41,453 22,053 63,506 37,571 39,867 77,438 196,712 Table No. 29. Shewing attendances at the Municipal Centres each year since 1913. Year. Mothers and Children under 5 years. School Children. Total. School for Mothers. Nursery. Miscellaneous. 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 3,847 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 1931 76,395 3,473 79,868 65,942 15,180 81,122 160,990 6,928 6,985 21,884* 196,787 * This includes the 75 attendances by adults, which are shewn in the footnotes to Table No. 28. 40 13 School Children and 1 child under 5 years of age were treated by X-rays for Ringworm of the Scalp. 1 school child and 2 children under 5 years of age were treated by X-rays for other skin conditions. 8,618 Individual School Children attended the Municipal Centres during 1931. Hospital Treatment of School Children under the Council's Scheme. Table No. 30. Hospital Treatment of School Children during 1931. No. of School Children in Willesden General Hospital at 31st December, 1930 2 „ „ „ admitted during 1931 512 „ „ „ under treatment during 1931 514 „ „ „ discharged during 1931 510 „ „ „ died in Hospital during 1931 0 „ ,, ,, remaining in Willesden General Hospital at 31st December, 1931 4 Table No. 31. School Children under Treatment in Hospital during 1931. Condition. Brought forward. Admitted during Year. Total, under treatment. Treatment Completed. Remaining in Hospital at end of Year. Forms of Treatment. Results of Treatment. Operative. General. Remedied. Improved. Unchanged Died. Mastoid Abscess - 1 1 1 - 1 - - - - Deflected Septum - 1 1 1 - 1 - - - - Enlarged Tonsils & Adenoids 2 510 512 508 - 508 - - - 4 Total 2 512 514 510 - 510 - - - 4 No School Children were admitted to St. Monica's Home Hospital. Employment of Children in Entertainments Rules, 1920. Particulars as to applications received in 1931 for certificates from the School Medical Officer. No. of Applications. No. Granted. Boys. Girls. Total. Boys. Girls. Total. Original applications 2 11 13 2 11 13 Applications for renewals 0 1 1 0 1 1 2 12 14 2 12 14 41 THE TWELFTH ANNUAL REPORT for the Year ending 31st December, 1931, on the HEALTH OF PUPILS ATTENDING SECONDARY AND TRADE SCHOOLS IN WILLESDEN. Giving the Tables required by the Board of Education. Medical Inspection has been carried out at the Secondary and Trade Schools in accordance with the arrangements set out in last year's report. The Middlesex County Council have not put into operation their scheme of treatment for Defective Vision and Dental Defects which was reported last year as under consideration. Table No. 32.—Corresponding to Table 1. of the Board of Education's Medical Statistical Tables as amended by administrative memorandum No. 80, dated 12th January, 1931. Number of Pupils Inspected 1st January, 1931, to 31st December, 1931. 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 6 0 6 0 0 0 0 0 0 0 0 0 0 0 0 6 0 6 0 0 0 6 0 6 11 „ 71 0 71 0 0 0 43 0 43 41 0 41 0 0 0 114 0 114 41 0 41 155 0 155 12 „ 13 75 88 1 0 1 11 26 37 20 23 43 1 0 1 25 101 126 21 23 44 46 124 170 13 „ 0 0 0 13 0 13 3 0 3 1 0 1 14 0 14 17 0 17 14 0 14 31 0 31 14 „ 0 0 0 34 0 34 4 0 4 0 0 0 31 0 31 35 0 35 34 0 34 69 0 69 15 „ 1 85 86 0 43 43 1 27 28 0 25 25 1 41 42 3 153 156 0 68 68 3 221 224 16 „ 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 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 91 160 251 48 43 91 62 53 115 62 48 110 47 41 88 200 254 454 110 91 201 310 345 655 Note that in the above table a pupil examined as an entrant, and subsequently as having attained his or her birthday during the preceding term, appears twice, that is as 2 cases. B.—Other Inspections. Kilburn Grammar School. Polytechnic Trade School. Willesden County School. Willesden Polytechnic Building Trade School Total. Boys. Girls. Boys. Girls. Boys. Boys. Girls. Total.[/##] Number of Special Inspections 0 1 0 2 2 2 3 5 Number of Re-inspections 153 15 40 52 64 257 67 324 Total 153 16 40 54 66 259 70 329 42 Table No. 33.—Corresponding to Table II. of the Board of Education's Medical Statistical Tables as amended by Administrative Memorandum No. 80, dated 12th January, 1931. A —Return of Defects Found by Medical Inspection in the Year Ended 31st December, 1931. 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. 1 Boys. Girls. Boys. Girls. Malnutrition - - - - - - - - - - - - - - - - - - - - Uncleanliness (See Table IV., Group V.) - - - - - - - - - - - - - - - - - - - - Skin Ringworm:— Scalp - - - - - - - - - - - - - - - - - - - - Body - - - - - - - - - - - - - - - - - - - - Scabies - - - - - - - - - - - - - - - - - - - - Impetigo - - - - - - - - - - - - - - - - - - - - Other Diseases (Non-Tuber_ culous). - - - 2 - - 1 - - - - - - - - - - - - - Eye Blepharitis - - - - - - - - - - - - - - - - - - - - Conjunctivitis - - 1 - - - - - - - - - - - - - - - - - Keratitis - - - - - - - - - - - - - - - - - - - - Corneal Opacities - - - - - - - - - - - - - - - - - - - - Defective Vision(excluding Squint). 36 8 8 13 5 6 - 1 - 2 - 1 - 1 1 - - - - - Squint - - 1 - - - 1 - - - - - - - - - - - - - Other Conditions - - - - - - - - - - - - - - - - - - - - Ear Defective Hearing - - - - - - - - - - - - - - - - - - - - Otitis Media - - - - - - - - 1 - - - - - - - - - - - Other Ear Diseases - - - - - - - - - - - - - - - - - - - - Nose & Throat 'Enlarged Tonsils only. 1 1 3 - 1 5 1 1 3 1 - - - - - - - - - - Adenoids only - - - - - - - - - - - - - - - - - - - - Enlarged Tonsils and Adenoids. - - - - - - - - - - - - - - - - - - - - Other Conditions - - - - - - - 2 - - - - - - - - - - - - Enlarged Cervical Glands (non-T uberculous). - - - - - - - - - - - - - - - - - - - - Defective speech - - - - - - - - - - - - - - - - - - - - Teeth—Dental Diseases 32 2 19 10 11 6 - - 1 - - - - - - - - - - - Heart and Circulation. Heart Disease:— Organic 2 - - - - 3 - - - - - - - - - - - - - - Functional - 4 2 - - 16 2 3 2 5 - - - - - - - - - 1 Anaemia 1 - - - - 2 - - - - - - - - - - - - - - Lungs Bronchitis - - - - - - - - - - - - - - - - - - - - Other Non-Tuberculous Diseases. - - - - 1 1 - - - - - - - - - - - - - - Tuberculosis Pulmonary:— Definite - - - - - - - - - - - - - - - - - - - - Suspected - - - - - - - - - - - - - - - - - - - - Non-Pulmonary : Glands - - - - - - - - - - - - - - - - - - - - Spine - - - - - - - - - - - - - - - - - - - - Hip - - - - - - - - - - - - - - - - - - - - Other bones and Joints. - - - - - - - - - - - - - - - - - - - - Skin - - - - - - - - - - - - - - - - - - - - L Other forms - - - - - - - - - - - - - - - - - - - - Nervous System Epilepsy - - - - - - - - - - - - - - - - - - - - Chorea — — 1 - - - - - - - - - - - - - - Other Conditions - - - - - - - - - - - - - - - - - - - - Deformities. Rickets - - - - - - - - - - - - - -- - - - - - - Spinal Curvature 2 5 2 2 2 - - - - - - - - - - - - - - - Other Forms 1 4 - 3 - - - - - - - - - 1 - - - - - - Flat Foot 1 3 1 3 - - - - - - - - - - - - - - - - Other defects and diseases - 1 2 2 - - - 1 1 1 - - - - - - - - - - Total 76 28 39 35 20 40 5 8 8 9 - 1 - 2 1 - - - - 1 43 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) 91 13 14.3 48 11 22.9 62 10 16.1 62 14 22.6 47 4 8.5 Pupils aged 12 years 75 12 16.0 0 0 0.0 26 4 15.4 23 4 17.4 0 0 0.0 Pupils aged 15 years 85 19 22.4 43 11 25.6 27 5 18.5 25 5 20.0 41 5 12.2 Total (Code Groups) 251 44 17.5 91 22 24.2 115 19 16.5 110 23 20.9 88 9 10.2 ** Other Routine Inspections - - - - - - - - - - - - - - - ** During 1931 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. (c) Pupils aged 15 years. Table No. 34.—Corresponding to Table IV. of The Board of Education's Medical Statistical Tables, as amended by Administrative Memorandum No. 80, dated 12th January, 1931. Return of Defects Treated during the Year ended 31st December, 1931. 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. Total. Treated under the Authority's Scheme Otherwise. Total. Treated under the Authority's Scheme Otherwise. Total. Skin:— Ringworm—Scalp - - - - - - - - - - - - - - - Body - - - - - - - - - - - - - - - Scabies - - - - - - - - - - - - - - - Impetigo - - - - - - - - - - - - - - - Other skin diseases 1 1 - 1 1 - - - - 1 1 - - - Minor Eye Defects (External and other, but excluding cases falling in Group II.) - - - - - - - - - - - - - - - Minor Ear Defects - - - - - - - - - - - - - 1 1 Miscellaneous (e.g., Minor Injuries, Bruises, Sores, Chilblains, etc.). - - - - 1 1 - - - - - - - - - Total - 1 1 - 2 2 - - - - 1 1 - 1 1 44 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 22 instances the School Medical Inspector noted on re-inspection that the pupils were wearing suitable spectacles ; in 8 instances the pupils were under treatment, and in 3 instances the vision had been re-tested and suitable glasses obtained. Willesden Polytechnic Trade School (Girls).—In 3 instances the School Medical Inspector noted on re-inspection that suitable spectacles had been obtained. Willesden County School.—In 4 instances (girls) and 8 instances (boys) the School Medical Inspector noted on re-inspection that suitable spectacles were being worn. In 1 instance (girls) and 2 instances (boys) the vision had been re-tested and suitable glasses obtained, and in 1 instance (boys) a pupil was under treatment. Willesden Polytechnic Building Trade School (Boys).—In 3 instances the School Medical Inspector noted on re-inspection that suitable spectacles had been obtained. In 1 instance the vision had been re-tested and suitable spectacles obtained for reading ; and in 1 instance a pupil was under treatment. Group III.—Treatment of Defects of Nose and Throat. Kilburn Grammar School (Boys).—In 4 instances the School Medical Inspector noted on reinspection that the tonsils had been removed. Willesden Polytechnic Trade School (Girls).—In 1 instance the School Medical Inspector noted on re-inspection that the tonsils had been removed. Willesden County School.—In 1 instance (boys) the School Medical Inspector noted on reinspection 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 38 cases at the Kilburn Grammar School (boys), 12 cases at the Willesden Polytechnic Trade School (girls), 11 cases (boys) and 7 cases (girls) at the Willesden County School, and 13 cases at the Willesden Polytechnic Building Trade School (boys) had received dental treatment. Group V.—Uncleanliness and Verminous Conditions. Inspection and treatment of uncleanliness is not undertaken by the School Nurses in the Secondary and Trade Schools. Treatment of other Types of Defect. (a) The measures adopted for providing treatment or for securing improvement:— No measures have been adopted by the Authority for providing treatment. Notices were sent to parents informing them of the conditions requiring treatment, and the Head Teachers were notified of conditions requiring special exercises and the like. Pupils with defects referred for treatment or requiring to be kept under observation were referred for re-examination at a subsequent visit of the School Medical Inspector. (b) The effect of the measures taken. The School Medical Inspector noted as follows:— Table No. 35. (a)—KILBURN GRAMMAR SCHOOL. Defect. No. Result. Anaemia 1 Improved. Malnutrition 1 Improved with nutritive foods. Deformities—Flat Foot 2 Improving with exercises. Flat Foot 2 Normal after exercises. Other Forms 2 Improving with exercises. Other Forms 1 Normal after exercises. Other Forms 1 Receiving treatment. Other Defects and Diseases 1 Treated by private practitioner. 45 (b)—WILLESDEN POLYTECHNIC. Defect. No. Result. Heart Disease—Functional 1 Having moderated exercises. Anaemia 1 Remedied. Deformities—Spinal Curvature 2 Improving with exercises. Other Forms 3 Improved with exercises. Flat Foot 1 Improving with exercises. Other Defects and Diseases 1 Improved, having exercises. Other Defects and Diseases 1 Improved. (c)—'WILLESDEN COUNTY SCHOOL. Defect. No. Result. Boys. Girls. Heart Disease—Organic 1 0 Violent games restricted. Functional 1 0 Exercises moderated. Deformities—Spinal Curvature 2 2 Improved with exercises. Round Shoulders 5 0 Improved with exercises. Flat Feet 3 2 Normal after exercises. 2 9 Improving with exercises. 1 1 Improved. Inside supports to shoes. Other Forms 1 0 Had operative treatment. Cervical Glands—Enlarged 1 0 Improving, private treatment. Ear Disease—Other Diseases 0 1 Has had operative treatment. Other Defects and Diseases 0 1 Treatment under private practitioner. 0 1 Treatment from General Hospital. (d)—WILLESDEN POLYTECHNIC BUILDING TRADE SCHOOL (BOYS). Defect. No. Result. Heart Disease—Organic 1 No violent exercises taken. Functional 1 Having modified exercises. Lungs—Other Diseases 1 Having treatment privately. Ear—Otitis Media 1 Has had Ear-Nose-Throat Hospital treatment. Scoliosis 1 Having special exercises. Nervous System—Other Diseases 1 Attends Hospital 3-monthly. 46 THE FOURTEENTH ANNUAL REPORT FOR THE Year 1931, 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. I beg to submit herewith the Annual Report on the Dental Service for the year 1931. This is the first occasion on which the year under review deals with the results obtained by four dental surgeons working a complete year. 896 mothers and children under 5 years and 1,490 school children were inspected by the dentists at the Council's Health Centres and 20,920 scholars were subject to routine inspection at the schools making a total of 23,306 for the year. 5,718 patients received treatment at the Centres for whom 8,725 teeth were preserved, 17,393 teeth were removed and 4,513 other forms of treatment making a total of 30,631 dental operations for the year. General anaesthetics were administered to 3,970 cases during 180 sessions making an average of 22 per session. For other operations the injection of local anaesthetics were employed on 735 occasions. The total number of sessions devoted to treatment was 1,523 and the number of visits made by the dentists to the schools amounted to 408. Comparative Table of Work done for Year 1931 and 1930. Table No. 36. 1931. 1930. Total inspected 23,306 18,069 „ defective 16,588 14,924 Patients treated 5,718 4,638 Teeth removed 17,393 14,421 „ filled 8,725 5,837 Other operations 4,513 1,916 General anaesthetic cases 3,970 3,037 Treatment sessions 1,523 1,347 Inspection sessions 408 357 The above table of comparative figures shows that there has been an all round increase in work done. The number inspected has increased from 18,069 to 23,306, the number of patients treated from 4,638 to 5,718 and numbers of teeth filled and removed have risen from 5,837 and 14,421 of the previous year to 8,725 and 17,393 respectively, while the total number of general anaesthetic cases and sundry treatments is 3,970 and 4,513 as against 3,037 and 1,916. In connection with these results it should be noted that the figures relating to teeth removed and patients treated have been largely brought about by the decision of the Council to appoint a special Anaesthetist for dental operations. As was expected this valuable addition to the Service has proved to be not only a great boon to both patients and operators but also an economy. The appreciation of the patients can be judged by their attendances for dental operations under general anaesthetics which amount to 22 per session, or approximately 88 per cent, of the appointments made. As to the work of the Anaesthetist it may be said that the safe and successful administration of prolonged anaesthesia to 3,970 cases of all types of mother, children of school age and under, in various states of health is a colossal number of lives for any single person to be responsible for and is surely a noteworthy performance. These comparisons are, however, mentioned to show that the public is recognising more and more the value and the importance of healthy teeth as a means to a healthy body. It must be gratifying also for the Council to know that the work which has been quietly and continuously carried out by their Health Department generally during past years is influencing the public to this extent. 47 SCHOOL DENTAL SERVICE. Inspections. Routine.—A total of 22,410 elementary school children have been inspected by the dental surgeons during the year. Of this number 6,685 were found on inspection to be free from caries. The remaining 15,725 who had defective dentitions were all advised as to the necessary treatment. 5,094 received their treatment at the Health Centres and 92 are reported to have been treated at hospitals or by private dentists. 408 sessions were devoted to routine inspection at the schools where 20,920 children were inspected and conditions found charted, each child being advised on the care of the teeth and given a pamphlet for home use. The average number inspected was 51 per session. It is the practice in Willesden for the dental officer not only to inspect a given number of scholars but also to include propaganda work at each inspection. The visits to the schools are considered to be the most opportune time for individual talks to both parents and scholars. Also the most suitable time to gain the interest and help of the school teachers. Instilling into the parent the importance of obtaining treatment in the early stages of disease is perhaps the greatest obstacle which confronts the dental officers. Parents do not realise that most children require some attention to their teeth every year. Many are still adverse to conservation work of any kind and others become disappointed and too ready to condemn the work if a tooth once filled does not remain immune from caries for ever more, forgetting that many teeth have 5 surfaces with 6 vulnerable points of attack for disease. These are some of the problems the dental surgeons are trying to overcome during the school inspection sessions. Special Cases.—1,490 children were inspected at the Health Centres. They include those who were missed at school either through absence from illness or other cause, some whose parents believe that one annual inspection at the school is not sufficient and a number of "Leavers" who wish for an overhaul before leaving school. The great bulk of them however, are the children who failed to take advantage of the advice offered on former occasions and have consequently developed serious dental lesions requiring immediate attention. This group constitutes the bete noir of the dental service as their teeth are usually in a very neglected condition. Much of the dental operators' time which might be given to other children is taken for the correction of defects which should never have been allowed to occur. Treatment. Fillings.—1,219 sessions were devoted to treatment at the Centres. 8,066 fillings were done, 6,978 of which were on permanent teeth and 1,088 temporary teeth. The materials used for fillings were silver, tin, amalgam, Synthetic and Oxyphosphate cements. The metal fillings in many cases were used in conjunction with cement lining and zinc oxide protection to the pulp. Extractions.—13,467 teeth were extracted. 2,081 of these were permanent teeth which were removed either on account of extensive caries or for the relief of over crowding of the dental arches. Ratio of Fillings.—The proportion of fillings to extractions shows an improvement on that of the preceding year. During 1930, 2.2 teeth were removed for every tooth filled. In the year under review (1931) the proportion is as 1.6 extractions to every tooth filling. Other Operations.—In addition to the above work the returns show that 3,765 other operations have been performed. These sundry treatments include silver nitrate dressing to temporary teeth, sedative dressing, gum and root treatment, cleaning and polishing. The total attendances of the children at the Centres for treatment was 13,433. Table No. 37 is a summary of the year's work. Table No. 37. (1) Number of children who were:— (a) Inspected by the Dentists:— Aged:— 5 890 6 2,055 7 2,183 8 2,709 9 2,669 10 2,584 11 3,006 12 2,131 13 1,593 14 1,024 15 69 16 7 Total 20,920 Specials 1,490 Grand Total 22,410 48 (b) Found to require treatment 15,725 (c) Actually treated at the Authority's Health Centres 5,094 (2) Half days devoted to *{Inspection 408 Treatment 1,219} Total 1,627 (3) Attendances made by the children for Treatment 13,433 (4) Fillings {Permanent teeth 6,978 Temporary teeth 1,088} Total 8,066 (5) Extractions {Permanent teeth 2,081 Temporary teeth 11,386} Total 13,467 (6) Administration of anaesthetics for extractions— General 3,332 Local ... 650} Total 3,982 (7) Other operations {Permanent teeth 3,330 Temporary teeth 435} Total 3,765 * 304 treatment sessions allocated to Maternity and Child Welfare work and 10 administration sessions are not included in this figure. Dental Nurses.—Before referring to the following table a praiseworthy note should be made as to the Dental Nurses whose enthusiasm and interest in their work are well shown by the successful manner in which they have undertaken the "following up" of cases in addition to their appointed duties. Such returns of their work are included in table below together with the work of the Health Visitor proper. Table No. 38. 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 1931 at Health Visitor's last visit. Total number of defects coming under observation during 1931. Brought forward 1931 627 New during year 8,668 9,295 Number of defects treated Health Centres 5,021 Otherwise 92 5,113 Percentage of defects followed up which were known to have received treatment 55% No report available 24 Number of defects for which no treatment has been under taken at Health Visitor's final visit 3,325 Carried forward to 1932 812 Number of visits made by Health Visitors 6,893 Number not needing treatment 21 MATERNITY AND CHILD WELFARE. 304 sessions, approximately one-fifth of the dental officers' time, have been set aside for Maternity and Child Welfare work. 313 expectant mothers, 343 nursing mothers and 453 children under 5 years have been under observation during the year, a total of 1,109 patients. 549 patients had their treatment completed and their mouths put into a healthy condition. 75 were partially treated but did not have all the work done which they were advised to have. 236 did not avail themselves of the service offered, 33 infants had no defect and 216 still under observation were carried forward to 1932. Treatment. For the mothers, 364 teeth were filled and 2,858 removed. For the infants, 295 teeth were filled and 1,068 removed, in addition a total of 748 cleaning, swabbings, dressings and other sundry treatments were carried out. 176 mothers were fitted with dentures of which 121 were supplied free, 46 at part cost and 9 at full cost to the applicant. The total attendance recorded by the patients amount to 3,463. 49 Table No. 39. The following table shows details of the children inspected—0-5 years 406 No. with no defects 36 No. with decayed teeth (Temporary) savable 158 No. „ „ „ ( „ ) unsavable 309 No. „ „ „ (Permanent) savable 0 No. „ „ „ ( „ ) unsavable 0 No. of decayed temporary teeth savable 445 No. „ „ „ unsavable 1,116 No. „ permanent „ savable 0 No. „ „ „ unsavable 0 The above Table is a record of the conditions found in those children under 5 years who were examined during the year. This Table is included yearly in the report to show what effect ante-natal and post-natal care of mother and child is having in regard to the immunity to dental caries. Of the 406 children inspected 36 were free from caries, a percentage of 8-8 as against 7 of the previous year 1930. These children had a total number of 1,561 decayed teeth that is 3.8 per child which is an exactly similar figure to last year (1930). Of the 1,561 decayed teeth, 1,116 or 2.7 per child were in an unsavable condition and needed extraction. It would not be correct to say the above figures are a true representation of all children attending the Centres, since only a proportion of them are seen by the dental officers. The Table however, does give some information which might be quite useful for comparison in future years. 50 THE SECOND ANNUAL REPORT for the Year ending 31st December, 1931, on the SUPERVISION OF MIDWIVES. Table No. 40. Number of Midwives who, during the Month of January, gave Notice of their Intention to Practice in Willesden in 1931 and 1932 respectively. 1931 1932 In Willesden— Private District Midwives 15 15 Queen Charlotte's District Home, 40, Princess Road, Kilburn, N.W. 6 3 3 Central Middlesex County Hospital 2 2 Outside Willesden— Private District Midwives 6 7 West Hampstead District Nurses' Association 3 3 Queen Charlotte's District Home, 176, Ladbroke Grove 3 3 Total 32 33 Table No. 41. Number of Cases attended by Midwives Practising and Living in Willesden during 1931. Midwives living in Willesden. No. of Cases attended. Total. Remarks. As Midwife. As Maternity Nurse. 1 4 7 - 2 2 None - 3 1 None 4 48 2 - 5 44 19 - 6 45 2 - 7 37 12 - 8 26 21 - 9 1 1 - 10 6 2 - 11 23 16 - 12 3 4 13 9 None - 14 16 3 - 15 1 10 These cases were attended in this Midwife's Nursing Home. 16 None 4 -- 17 35 3 - Midwives attached to Willesden District Nursing Association None 183 - Midwives attached to Queen lotte's District Home, 40, Princess Road, Kilburn 406 None - Midwives in the Central Middlesex County Hospital 223 10 - Total 930 299 - 51 Table No. 42. Number of Cases attended by Midwives practising in but Living Outside Willesden during 1931. Midwives Living outside Willesden. No. of Cases attended in Willesden. Total. As Midwife. As Maternity Nurse. A 1 None B 2 None C 2 None D 5 None E 1 None Midwives attached to Kilburn and West Hampstead District Nursing Association 27 None Midwives attached to Queen Charlotte's District Home, 176, Ladbroke Grove, W. 10 36 None Total 74 None From Table No. 41 it will be observed that midwives living in Willesden attended 930 cases as midwives and 299 cases as maternity nurses, or 1,229 in all. Of the midwives living in Willesden it will be observed that apart from institutions or associations, the largest number of midwifery cases that any single midwife attended as a midwife was 48, and that the largest total of cases that any single midwife attended was 63, being 44 cases which she attended as a midwife and 19 as a maternity nurse. From these figures it will be observed that no district midwife living in Willesden devotes her whole time to the practice of midwifery. During the year ended 31st December, 1931, 179 notifications were received from midwives in accordance with the Rules of the Central Midwives Board. Of these 179 notifications, 145 were received from midwives living and practising in Willesden, and 34 from midwives practising in, but living outside Willesden. Of the 179 notifications received 149 were in respect of calling in medical help, 99 being in respect of the mother and 50 in respect of the child. The total fees paid by the Council to Medical Practitioners called in by midwives during the year ending December 31st, 1931, was £74 7s. 6d., £10 18s. 6d. of which was recovered from patients. Table No. 43. 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 12th Feb., 1932, 36 have notified intention to practise in Willesden during 1932) 42 (b) Number (i.) employed by the Council 0 (ii.) subsidised by the Council 0 (iii.) employed by Voluntary Associations in Willesden 4 (Queen Charlotte's Hospital District Nurses' Association, 40, Princess Road, Kilburn) 5 (Queen's Nurses, 19, Park Avenue, Willesden—These act as Maternity Nurses only (iv.) employed by Voluntary Associations outside Willesden 11 (c) t 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 777 227 (ii.) As maternity nurses 284 15 (d) Number of cases during the year in which the Council paid or contributed to the fee of a midwife— 19 where the midwife was acting as a midwife. 11 where the midwife was acting as a maternity nurse. 52 Table No. 44. Notifications received from Midwives in accordance with the Rules of the Central Midwives Board, 1st January to 31st December, 1931. From Midwives living and practising in Willesden. From Midwives practising in Willesden but living outside. Notifications of:— Sending for Medical Help 115 34 Having laid out a dead body 6 - Liability to be a source of infection 10 - Death 2 - Still Birth 9 - Artificial feeding 3 - Table No. 45. 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 6 4 Baby suffering with wind 3 - Weak labour pains 5 - (?) Bronchitis 1 - Delayed labour 16 1 Asphyxiated baby 2 - Laceration of perineum 24 4 Persistent snuffles 1 - Haemorrhage from bowels 1 - Abortion 2 - Threatened antepartum haemorrhage 4 2 Sticky eyes 6 9 Watery eyes 8 1 Retained placenta 2 - Spina bifida 1 1 Vaginal discharge 2 - Vomiting after feeds 1 - Prolapse of cord 1 - Jaundiced 1 - Bad varicose veins 2 1 Lump on baby's head 1 - Post-partum haemorrhage 3 - Premature feebleness of infant 7 1 Not being able to find presenting part 1 - Blocked tear duct - 1 Breech with extended legs 3 - Deformity - 2 (?) Pemphigus - 1 Raised temperature 4 4 Discharging nose 1 - Footling and pains not good 1 - Bladder trouble and cough 1 2 Premature labour 2 - Sleeplessness 2 - Total 81 18 34 16 Table No. 46. Fees Paid to Medical Practitioners under Section 14 of the Midwives Act, 1918. January 1st to December 31 st, 1931. Number of notifications of Sending for Medical Help 179 „ „ „ in respect of which fees paid 60 Total fees paid by Council £74 7s. 6d. „ „ recovered from Patients £10 18s. 6d. 53 THE SECOND ANNUAL REPORT for the Year ending 31st December, 1931. on the REGISTRATION OF NURSING HOMES. NURSING HOMES REGISTRATION ACT, 1927. Table No. 47. Maternity and Nursing Homes, January 1st, 1931, to December 31st, 1931. (1) 1 Number of applications for registration:— (a) Maternity Homes 1 (b) Nursing Homes 1 (2) Number of Homes registered 3 (3) Number of Orders made refusing or cancelling registration 1 (4) Number of appeals against such Orders 0 (5) Number of cases in which such Orders have been— (a) Confirmed on appeal 0 (b) Disallowed 0 (6) Number of applications for exemption from registration 3 (7) Number of cases in which exemption has been— (a) Granted 3 (b) Withdrawn 0 (c) Refused 0 (8) Nursing Homes closed by voluntary retirement 1 At the close of the year there were 9 Nursing Homes on the Register of the Willesden Urban District Council with accommodation for 46 patients. 54 THE SECOND ANNUAL REPORT for the Year ending 31st December, 1931, on INFANT LIFE PROTECTION. The arrangements made by the Council for discharging the functions of the Local Authority under Part I. of the Children Act, 1908, were dealt with in last year's Annual Health Report. The existing Health Visitors have been appointed Infant Protection Visitors. The Council fix the number of children to be kept by each foster mother. They consider cases where there appears to be any contravention of Part I. of the Children Act, 1908, or where the foster mother or foster home appears unsuitable. They draw the attention of the public to the requirements of the Act from time to time by means of posters, handbills, and advertisements in the local press. A report on Infant Life Protection appears as Appendix G. Table No. 48. Foster Mothers. Number of Foster Mothers at 3rd January, 1931 128 „ „ „ at 2nd January, 1932 139 Number of Licences granted by Council, 3rd Jan., 1931 to 2nd Jan., 1932 45 „ „ refused by Council, 3rd Jan., 1931 to 2nd Jan., 1932 13 Number of applications to take additional children agreed to by Council 13 „ „ „ „ „ refused by Council 3 Number of applications for re-issue of Licence agreed to by Council 25* „ „ „ „ refused by Council 3 Foster Children. Coming under observation— Number of Foster Children at 3rd January, 1931 200 „ „ „ received 3rd Jan., 1931 to 2nd Jan., 1932 215† Number entered Willesden with their Foster Mothers 5 Total 420 Removed from observation. Number given up 190 „ reached the age of 7 years 16 „ died 1 „ legally adopted 3 „ ceased to be taken for gain 1 „ left Willesden with their Foster Mothers 9 Total 220 Remaining under observation— Number of Foster Children at 2nd January, 1932— (a) Under 5 years of age 173 (b) Between 5 and 7 years of age 27 Total 200 * Of these 25 cases 11 were re-issued in respect of new premises: † The actual number of new individual Foster Children who came under observation, 163. 55 Table No. 49. The 200 Foster Children under observation at 2nd January, 1932, were maintained in the care of Foster Mothers as follows Maintained by- Parent or Guardian 128* Crusade of Rescue, 48, Compton Street, W. 66 National Adoption Society, 4, Baker Street, W. 5 Received with lump sum 1 Total 200 * In 46 cases the parents or guardians were living in Willesden at the time the child entered the care of the Foster Mother. In 82 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. 50. The following Table shows the length of time each of the 200 Foster Children under observation at 2nd January, 1932 had been in the care of their Foster Mothers. Under 6 months 53 Over 6 months, under 1 year 41 Over 1 year, under 1½ years 21 Over 1½ years, under 2 years 15 Over 2 years, under 2½ years 19 Over 2½ years, under 3 years 14 Over 3 years, under 3½ years 3 Over 3½ years, under 4 years 11 Over 4 years, under 4½ years 6 Over 4½ years, under 5years 5 Over 5 years, under 5½ years 3 Over 5½ years, under 6 years 2 Over 6 years, under 6½ years 2 Over 6½ years, under 7 years 5 Total 200 Of the 363 individual Foster Children under observation during the year 1931, 184 changed hands during that period. 145 made 1 change, 26* made 2 changes, 9§ made 3 changes, 1† made 4 changes, 3‡ made 5 changes. These changes do not include the first reception of the child. * Of these, 6 were admitted to Hospital returning to same Foster Mother. Of these, 6 went on holidays with their parents returning to the same Foster Mother. § Of these, 1 included an admission to Hospital and return to the same Foster Mother. † This child was admitted once to Hospital returning to the same Foster Mother, and also went once for holiday with its parent, returning again to the same Foster Mother. ‡Of these, 2 were twice admitted to Hospital. THE TWELFTH ANNUAL REPORT For the Year ending 31st December, 1931, on HOME NURSING. A record of work done is given in the three following tables :— 56—57 Table No. 51.—showing cases dealt with during 1931 and Results. Disease. Cases being nursed at end of 1930. New Cases during 1931. Removed from Observation during 1931—Results of Treatment. Still being Nursed at end of 1931. Number of Visits Paid during 1931. 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.  Accident - - - - - - - - 1 - - 1 - - - - - - - - - - - - - - 1 - - 1 - - - - - - - - 4 - - 4 Adenitis - - - - - - - - 1 - - 1 - - - - - - - - - - - - - - 1 - - 1 - - - - - - - - 7 - - 7 Bathing Cases - - - - - - - - 2 - - 2 - - - - - - - - - - - - - - 2 - - 2 - - - - - - - - 23 - - 23 Blepharitis and Eczema - - - - - - - - 1 - - 1 - - - - - - - - - - - - - - 1 - - 1 - - - - - - - - 93 - - 93 Bronchitis - - - - - - - - 1 - - 1 - - - - - - - - - - - - - - 1 - - 1 - - - - - - - - 17 - - 17 Burns and Scalds — — — — — — — — 3 3 — 6 — — — — — — — — — _ — — — 3 3 _ 6 _ — _ _ _ _ _ _ 25 21 — 46 Circumcision - - — — — — - — 11 3 — 14 — — — — — - — — — — — — — — 11 3 — 14 — — — — _ — — — 51 7 — 58 Constipation - - - - - - 1 1 4 - - 6 - - - - - - - - - - - - 1 1 4 — — 6 — — — — — — 1 1 6 — — 8 Dental Cases - - - - - - - - - 2 - 2 - - - - - - - - - - - - - - - 2 - 2 - - - - - - - - - 4 — 4 Diarrhœa - - - - - - - - 3 - - 3 - - - - - - - - - - - - - - 3 - - 3 - - - - - - - - 7 - - 7 Eczema - - - - - - - - 2 - - 2 - - - - - - - - - - - - - - 2 - - 2 - - - - - - - - 38 - - 38 Enlarged Glands - - - - - - - - 1 - - 1 - - - - - - - - 1 - - 1 - - - - - 2 - - - - - - - - 5 - - 5 Fistula - — - — 1 1 - - - - - - - - - - - - - - - - - 1 - - - - 1 1 - - - - - - - - - - 11 11 Impetigo - - - - - - - - 1 3 - 4 - - - - - - - - - — — — - 1 3 - 4 - - — — — — — — 11 27 - 38 Influenza - — — — — - — — 2 1 — 3 — — — — - — — — — — — — — 2 1 — 3 — — — — — — — _ 18 11 — 29 Injury to Ankle - - - - - - - - - 2 - 2 - - - - - - - - - - - - - - - 2 - 2 - - - - - - - - - 10 — 10 Leucorrhœa - - - - - - 4 1 - - - 5 - - - - - - - - - - - - 4 1 - - - 5 - - - - - - 25 4 - - - 29 Measles and BronchoPneumonia - - - - - - - - - 1 - 1 - - - - - - - - - - - - - - - 1 - 1 - - - - - - - - - 17 - 17 Measles and Whooping Cough - - - - - - - - 1 - - 1 - - - - - - - - - - - - - - 1 - - 1 - - - - - - - - 8 - - 8 Ophthalmia - — 2 - — 2 — - 39 5 - 44 — — - - - — - - - - — - - - 40 5 — 45 - - 1 — - 1 — — 448 51 — 499 Ophthalmia Neonatorum - - - - - - - - 22 - - 22 - - - - - - - - 1 - - 1 - - 21 - - 21 - - - - - - - - 443 - - 443443 Otorrhœa — — 5 1 — 6 — — 22 13 — 35 — — 1 — — i — — — — — — — — 23 12 — 35 — — 3 2 — 5 — — 528 647 — 1175 Otorrhœa and Conjunctivitis - - - - - - - - 1 - - 1 - - - - - - - - - - - - - - 1 - - 1 - - - - - - - - 15 - - 15 Pemphigus — — — — — — — — 3 1 — 4 — — - — — — — — 1 — — 1 — — 1 1 — 2 — — 1 — — 1 — — 39 40 — 79 Phlebitis - - - - - - - 1 - - - 1 - - - - - - - - - - - - - 1 - - - 1 - - - - - - - 19 - - - 19 Pneumonia - - - - - - - - 1 2 1 4 - - - - - - - - - - - - - - - 2 1 3 - - 1 - - 1 - - 28 67 28 123 Puerperal Pyrexia - - - - - - - 1 - - - 1 - - - - - - - 1 - - - 1 - - - - - - - - - - - - - 6 - - - 6 Puerperium - - - - - - - 1 - - - 1 - - - - - - - - - - - - - 1 - - - 1 - - - - - - - 4 - - - 4 Pyelitis - - - - - - 2 - - - - 2 - - - - - 1 - - - - 1 - - - - - 1 - - - - - - 23 - - - - 23 Pyrexia - - - - - - - 1 2 1 - 4 - - - - - - - - - - - - - 1 2 1 — 4 - - - - - - - 5 14 7 — 26 Rheumatism - - - - - - - - - 2 - 2 - - - - - - - - - 1 - 1 - - - 1 - 1 - - - - - - - - - 33 — 33 Septic Conditions - - - - - - - - 23 8 - 31 - - — - - - — - - — — — — - 22 8 — 30 — — 1 — — 1 — — 257 47 — 304 Skin Conditions - - - — - - - - 2 1 - 3 - - - - - - — — - — — — — — 1 1 — 2 — — 1 — — 1 — — 17 3 — 20 Thread Worms - — — - - — - - 69 46 - 115 - — - — — - — — 1 — — 1 — — 68 46 — 114 — — — — — — — — 377 233 — 610 Throat Conditions — — - — - - - — 4 1 — 5 - - - - - - — — — — — - — — 4 1 — 5 — — — — — — — - 20 4 — 24 Varicose Veins - - - - - - - 1 - - - 1 - - - - - - - - - - - - - 1 - - - 1 - - - - - - - 14 - - - 14 Total — - 7 1 1 9 7 7 222 95 1 332 — — 1 — - 1 1 1 4 1 - 7 6 6 216 93 2 323 - - 8 2 - 10 49 53 2499 1229| 39 3869 58 Table No. 52. Shewing Sources from which cases were referred for Home Nursing during the Year 1931. Referred by Number. Health Department 257 Private Doctors 36 Others 39 Total 332 Table No. 53. Shewing cases Home Nursed in Wards daring 1931. Ward. No. of Cases brought forward from 1930. No. of Cases referred in 1931. Total. No. of Visits paid. 1. South Kilburn 4 67 71 1,340 2. Mid-Kilburn 3 92 95 867 3. North Kilburn 1 51 52 401 4. Brondesbury Park 0 6 6 60 5. Kensal Rise 1 6 7 76 6. Harlesden 0 11 11 143 7. Stonebridge 0 18 18 354 8. Roundwood 0 8 8 72 9. Church End 0 17 17 202 10. Willesden Green 0 16 16 105 11. Cricklewood 0 40 40 249 Total 9 332 341 3,869 59 THE SEVENTEENTH ANNUAL REPORT FOR THE Year ending December 31st, 1931, 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 628. 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 438, Breakfasts 49. 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 meat pie 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, 1931. Table No. 54.—No. of Meals Supplied. Supplied to:— Breakfasts. Free. Dinners. Total. Free. Paying. M.C.C. Education Committee's Centres 4,653 51,048 1,293 6,117 63,111 Kilburn Voluntary Centre — 33,005 — 4,645 37,650 Special Schools — 11,606 20,113 609 32,328 Feeding Centre Assistants 2,452 2,820 — — 5,272 Total 7,105 98,479 21,406 11,371 138,361 60 Table No. 55. Occupation List 1931. Occupation. No. of Children Fed during 1931. No. of Families Involved. Percentage. 1930. 1931. 1930. 1931. Unemployed Widows 683 95 178 60 295 49 47.2 15.9 63.17 10.5 Deserted Wives 49 17 29 4.5 6.2 Orphans Labourers 4 102 2 49 3 38 0.5 13.0 0.6 8.1 Railwaymen Hawkers 47 24 17 13 17 10 4.5 3.4 3.6 2.1 Others 60 41 26 10.8 5.5 1,064 377 467 Approximate average cost of food only, 3d. ; total (gross), 5½d. 61 THE FORTIETH ANNUAL REPORT on the MUNICIPAL HOSPITAL By ARTHUR G. TROUP, M.D., D.P.H., Medical Superintendent. During 1931,842 patients were admitted to Hospital as compared with 1,029 in 1930, 955 in 1929, 1,037 in 1928, 767 in 1927 and 846 in 1926. Cerebro-Spinal Fever. Four cases of this disease were admitted during the year. One was of the malignant or fulminating type, and died within 24 hours of admission to hospital. Another case is of particular interest. Owing to certain difficulties it was not practical to administer serum by the usual inthrathecal route. Optic atrophy developed and the child was apparently blind for some considerable time. Recovery gradually took place, and six months after the child had been discharged from hospital she was in very good health and the eyesight normal. Diphtheria. 250 cases were admitted as compared with 420 cases during 1930. These cases may be classified as follows:-Faucial 152, Nasal 59, Faucial and Nasal 15, Laryngeal 12, Aural 7, Bacteriological 5. It was necessary to perform the operation of tracheotomy on four of the laryngeal cases, of which 3 recovered and 1 died from acute septic pneumonia. The total number of deaths from diphtheria was 5, giving a mortality rate of 1.69 per cent. This rate is calculated on the total number of cases treated during the year excluding the bacteriological cases. The rate is the lowest ever recorded at the Municipal Hospital. The corresponding mortality rate for England and Wales for the year 1930 was 4.73 per cent. Table No. 56. Diseases. Remaining on 1st Jan., 1931. Admitted. Total under treatment. Discharged recovered. Died. Mortality per cent. Remaining on 31st Dec., 1931. Cerebro-Spinal Fever - 4 4 2 1 25.0 1 Diphtheria 50 245 295 258 5 1.69 32 Diphtheria logical) - 5 5 5 - - - Enteric Fever — 7 7 5 — — 2 Erysipelas 4 23 27 21 3 11.11 3 Measles 4 30 34 29 1 2.94 4 Mixed infections 1 10 11 11 — - - Puerperal infections 1 16 17 16 1 5.88 - Scarlet Fever 35 375 410 358 3 0.73 49 Whooping Cough 3 27 30 27 3 10.0 — Other diseases 1 100 101 96 4 3.96 1 Totals 99 842 941 828 21 — 92 Enteric Fever. Two cases of Typhoid Fever and 5 of Paratyphoid Fever B were admitted during the year. All the patients had moderate attacks of the disease with no serious complications. One case has developed into a carrier, and was still in hospital at the time of writing this report. Erysipelas. Twenty-seven cases of this disease were treated during the course of the year. Most of these patients had severe virulent attacks and 4 deaths occurred. Measles. Thirty cases of this disease were treated in hospital during the year. No measles cross infection occurred in any of the wards. I would draw attention to the remarks made in last year's report regarding the serum treatment of measles and the prevention of cross infection in hospitals. 62 Mixed Infections. The following cases of mixed infections were admitted during the year:— Diphtheria and Scarlet Fever 3 Diphtheria and Chicken Pox 3 Diphtheria and Whooping Cough 1 Scarlet Fever and Whooping Cough 1 Scarlet Fever and Chicken Pox 1 Measles and Whooping Cough 1 Puerperal Infections. The 16 cases of Puerperal Infection which were admitted during the year may be classified as follows:— Local Uterine Sepsis 7 Mammary Abscess 3 Pelvic Cellulitis 2 Mastitis 2 Septicaemia 1 Cystitis 1 The infecting organism in the case of septicaemia was of a very virulent type, and the patient died within four days. All the other cases made very good recoveries. Scarlet Fever. During the past year 375 cases of Scarlet Fever were admitted to hospital, as compared with 421 during 1930. Three deaths occurred, giving a mortality rate of 0.73 per cent. In one case the primary cause of death was lobar pneumonia. Another case developed gangrene of the right hand and foot, and the third fatal case was of a severe toxic haemorrhagic type. Whooping Cough. Twenty-seven cases were admitted and three deaths occurred, all due to broncho-pneumonia Other Diseases. One hundred patients were admitted under this heading as follows:— Tonsillitis 27 Teething Rash 2 Chicken-Pox 14 Gastro-Enteritis 2 Influenza 5 Pleurisy 1 Ophthalmia Neonatorum 4 Pemphigus Neonatorum ... 1 Laryngitis 4 Acidosis 1 Tubercular Meningitis 3 Abscess of Leg 1 Pneumonia 3 Diabetes Mellitus 1 Bronchitis 3 Excision of Tonsils 1 Mumps 3 Rubella 1 Rhinitis 3 Chicken Pox Contact 1 Cellulitis 3 Malignant Endocarditis 1 Quinsy 2 Injuries to Scalp 1 Adenitis of Neck 2 Negative Cases 10 Four deaths occurred:— Tubercular Meningitis 3 Malignant Endocarditis 1 Sick Staff. The following are the figures for the past four years for the Nursing Staff:— Number of Nurses who were off Number of days duty for 24 hours or more. off duty. 1928 36 342 1929 24 373 1930 31 521 1931 33 483 The health of the Nursing Staff has been satisfactory. Four nurses contracted scarlet fever. All had moderate attacks with no serious complications. The other 29 nurses had comparatively mild illnesses, 15 of which were attacks of tonsillitis, and the average number of days off duty from this cause was 9.7. The following are the figures for the past four years for the domestic staff:— Number of Maids who were off Number of days duty for 24 hours or more. off duty. 1928 17 202 1929 23 298 1930 11 286 1931 15 212 The health of the Domestic Staff has been satisfactory. One maid contracted scarlet fever and recovered. 63 Duration of Stay in Hospital. (1) Scarlet Fever. The average length of detention of scarlet fever patients shows a slight increase this year, but the figure is considerably lower than it was a few years ago. The minimum period of stay in hospital is 28 days from the onset of the illness, and 289 patients out of a total of 375, or 77.0 per cent., were discharged between the 28th and the 35th day. Average stay in hospital of scarlet fever patients, 1926-1931:— 1926-47.2. 1929—36.1. 1927—38.1. 1930—32.9. 1928—37.0. 1931—34.5. (2) Diphtheria. Average stay in hospital for diphtheria patients, 1928-1931:— 1928—52.8. 1930—53.3. 1929—51.7. 1931-56.2. (3) Other Diseases. Average stay in hospital for patients suffering from " other diseases," 1928-1931:— 1928—28.1. 1930—27.1. 1929—23.4. 1931—29.3. 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 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. None occurred during 1931. The particulars regarding these cases have been given in previous Annual Reports. The following table demonstrates the benefits derived from this method of preventive medicine— 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) 45% Number of cases of diphtheria occurring amongst probationer nurses from 1927 to 1931 inclusive (after immunisation was carried out) ... ... 5 Incidence rate per annum (taking 30 as average number of probationer nurses) 3.3% Number of nurses Schick tested (1927 to 1931 inclusive) 160 Number of nurses giving a positive reaction 76 Percentage of nurses giving a positive reaction 47•5% Number of nurses re-Schick tested 34 Number of nurses re-Schick tested giving a positive reaction 13 Percentage of nurses re-Schick tested giving a positive reaction 38.2% Number of nurses who had to go off duty after an injection of toxoid antitoxin 2 (2) Health Centre. This clinic was made available for Willesden residents in May, 1927. The number attending for treatment have gradually fallen off, and this year they are so small that it is hardly worth while continuing the work. The following are the figures for the years 1927 and 1931 respectively:— 1927 1931 Number attending for preliminary Schick Test 82 4 Number attending for Active Immunisation Injections 94 8 Hospital Buildings. (1) Cubicles.—The two remaining cubicle pavilions each containing 10 beds were completed during the year. They have not, however, been furnished or equipped to receive patients. (2) A new block, containing a bacteriological laboratory, a post-mortem room, a viewing chapel and a store was built during 1931. The laboratory was opened for work on 1st January, 1932. (3) The heating of "E" ward was by coal fires only, and it was found that this method was insufficient to maintain a reasonable temperature in the ward during the winter months. It was decided to supplement the coal fires by an electric heating apparatus, and this was completed during the summer. This ward is kept in reserve and has not been in use since the new installation was completed. It has not been possible, therefore, to test accurately the combined heating methods, but from a preliminary investigation it would appear that the amount of electric current consumed is considerable. (4) A gladiron has been installed in the laundry, and has proved to be very useful in the ironing of large garments. 64 THE FIRST REPORT on the WILLESDEN MATERNITY HOSPITAL. REPORT ON THE WORK FROM OPENING ON THE 14th FEBRUARY, 1931, to 31st DECEMBER, 1931, By ARNOLD WALKER, M A., M.B., B.Ch., F.R.C.S., M.C.O.G. I have the honour to present the Report of the working of the Maternity Hospital, from the opening on February 14th, 1931, until 31st December, 1931. The Council's Maternity Service may be divided into three stages—(1) before admission to the hospital, (2) in hospital, and (3) after discharge from hospital, and this service has proved to be efficient from the obstetric point of view. Before Admission to Hospital. All patients who book for confinement at the Willesden Maternity Hospital attend for antinatal care at one of the Health Centres provided by the authority. I visit the ante-natal clinics regularly, and see cases which the Council's medical staff refer to me. In addition, and in every instance, I see all first pregnancies and all patients with a bad obstetric history at the 36th week of pregnancy, and as often as may be necessary subsequently. It is a great advantage to the ante-natal case to be able to attend an ante-natal clinic near her home. To some extent, however, it is not so easy for the hospital, but the difficulty of linking up the continuous supervision given before admission with the confinement in hospital, and after discharge, has been overcome by certain arrangements which have been instituted. These have worked very satisfactorily, and the whole records are always before me when the case arrives at the hospital for confinement. In Hospital. The case usually reaches the hospital by ambulance, but in a few instances the patients come by Omnibus. During the period from the opening on the 14th February, 1931, to the 31st December, 1931, 440 patients were admitted to hospital; 416 were discharged, and 2 died, leaving 22 still in hospital at the end of the year. Particulars with regard to the 418 cases will be found below. With regard to the 2 deaths the first was primarily due to advanced heart disease. Treatment was difficult on account of the disinclination of the patient to carry out instructions. In the second case, the patient was admitted already infected by one of the organisms causing gas gangrene. In spite of the use of every known form of treatment these patients died. On several occasions the London Blood Transfusion Service has been called upon to provide blood donors. The speed with which this organisation provides a suitable donor is a great tribute to the efficiency of the service as a whole, and the self-sacrifice of the men and women who give their blood without reward or recognition is beyond praise. At the end of the year the hospital was working at full capacity. During the last four weeks of the year the average daily number of patients in hospital was 21, and the maximum number on any one day 31. As the total beds normally available for patients is only 26, including the 2 isolation beds, the extra patients could only be accommodated by temporarily adding beds to the general wards. In spite of these difficulties, the internal arrangements of the hospital have worked well, but it must always be remembered that the buildings were originally designed as a Small Pox Hospital, and although the alterations have converted it into an excellent Maternity Hospital there are still some points which I hope will receive consideration when the time is ripe for further development. The points that I have in mind are more space in connection with the labour wards and some provision for isolation accommodation which it is always necessary to have at hand in a Maternity Hospital. 424 viable children were born to 416 mothers. Of these, 397 left hospital alive and well, 16 were stillborn and 11 died. 365 were fed on breast milk alone. In 30 the milk of the mother had to be supplemented by artificial food, and in only 2 cases was the child fed on artificial food alone. 65 After Discharge from Hospital. Arrangements are made whereby the Health Centres are informed of the discharge of a patient and her baby from hospital The patient is subsequently visited and continues under supervision at the Health Centre, and receives all necessary advice as to her own condition and the up-bringing of the child. From time to time cases of mothers discharged from hospital are referred to me for special advice. Details of the 418 Cases dealt with in the Hospital during the Year. Cases completed 418 A. Booked at the Health Centres 415 Discharged well 408 Transferred 5 Died 2 B. Admitted as Emergencies 3 Discharged well 3 Of the 415 booked cases, 199 were primipara and 216 were multipara. Of the 3 emergency cases, 1 was a primipara and 2 were multipara. Presentations— Occipito Anterior 377 Occipito Posterior 20 Normal Breech 3 Abnormal Breech 6 Twins 8 Face 1 Brow 1 Ante-partum Haemorrhage— Placenta Praevia 3 Accidental Haemorrhage 3 Post-partum Haemorrhage 4 In one of these cases the placenta was removed manually. Prolapse of Cord 1 Organic Heart Disease 4 Toxaemia of Pregnancy admitted for treatment before Term 10 In no case did eclampsia develop. Puerperal Pyrexia according to the B.M.A. standard 17 Uterine Infection 8 Breast Infection 6 Urinary Infection 2 No cause found 1 Miscarriage 2 Operations performed— Forceps 33 The" forceps rate" was therefore 7.9 per cent. Caesarian Section 3 Contracted Pelvis 2 Multiple Hydatid Cysts 1 Induction of Premature Labour 2 Internal Version 2 Perforation of a dead child 2 66 THE SECOND ANNUAL REPORT for the Year ending 31st December, 1931, on the HEALTH OF PATIENTS ATTENDING THE MIDDLESEX COUNTY COUNCIL OCCUPATION CENTRE FOR MENTALLY DEFECTIVES, BULLER ROAD, WILLESDEN During the year the Council continued 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 Health 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, spectacles, nutritive foods or hospital treatment. During the year 24 patients were medically inspected, 4 patients attended the Health Centres for treatment, the total number of attendances being 11. 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:— In addition one child attended the Health Centre on three occasions for treatment for tonsillitis. Table No. 57. Defect or Disease. Requiring Treatment. Received Treatment at Health Centre. Defective Vision 1 0 Defective Teeth 6 3 67 THE FIRST ANNUAL REPORT ON NURSERY CLASSES for the Year ending 31st December, 1931. LOWER PLACE NURSERY CLASSES. On the 20th April, 1931, the Willesden Urban District Council opened a Nursery Department in Lower Place School. This school, built in 1915 to take 420 scholars, stands in an industrial neighbourhood, where many of the mothers go out daily to work. Four classrooms, a lobby and a playground in the Infant School have been used to form the new department. Two of the rooms were converted into nurseries (green nursery and blue nursery). The third was used as a store-room, and the fourth fitted up as a cloak-room, each child having, and recognising by means of a special design, his or her own peg for hat and coat, shoe rack, facecloth and soap, mug and tooth-brush. The lobby was made into a bathroom. The asphalt playground, walled off from the other playgrounds, was so reconstructed that it contains two grass plots, a sand pit and a shed to provide shelter for the beds in Summer. The department is in charge of the Head Teacher of the Infant School, who has the Montessori Diploma. She is assisted by two certificated teachers and a nursery attendant. Under the mothercraft scheme a girl from the Senior School attends daily to gain experience in the management and care of toddlers. There is room for sixty children. At present there are, on an average, twenty-five in either class. The conditions of entry are as follows:— (1) the child to be between two and five years old. (2) the child to be normal, clean and free from infection. (3) the parents to give one penny a day for milk, and co-operate with the staff for the child's benefit. One hour a day is allotted to open-air play in the playground, weather permitting, while an hour in the afternoon, when the older children are in class, is devoted to sleep. Each child has a half-pint of milk in the forenoon for lunch. Arrangements have been made to examine the children medically once a year, the following children being examined in any term:— (1) Children admitted during the preceding term. (2) Children who reach the age of 3 years during the preceding term. (3) Children who reach the age of 4 years during the preceding term. (4) Special cases. An invitation card, stating that the child is going to be examined, is sent out to the parents one week before the date of the inspection. 39 children have been examined up-to-date. Of these— (1) 7 were between 2 and 3 years of age. (2) 8 were between 3 and 4 years of age. (3) 21 were between 4 and 5 years of age. (4) 3 were 5 years of age. The interest the mothers are taking in this part of the new scheme is shown by the fact that 30 attended the inspections, many of them getting time off from their employers to do so, while 4 who were unable to come themselves, but were anxious to know the result of the examination, had arranged for the grandmothers to come in 2 cases, for an aunt in the third and for a friend in the fourth. Cleanliness.—Cleanliness of skin, hair and clothing was a noteworthy feature of all the children examined. 68 That the children are being sent cleaner to the nursery school since its opening, is shown by the quarterly cleanliness inspections of the Health Visitor thus:— of Inspection. No. of Children examined. No. of Children found unclean. No. of Children excluded from school because of uncleanliness. 8.6.31 43 4 2 7.9.31 48 5 0 22.1.32 37 3 0 2.5.32 39 1 0 This shows that the mothers appreciate what is being done for the toddlers and that they are being stimulated to care for them along the right lines. General Physique.—The heights and weights of the children were then considered. It was found that:— (1) Of the 7 children between 2 and 3 years of age, 3 were underweight, one of whom was also undersized. (2) Of the 8 children between 3 and 4 years of age, 6 were underweight, one of whom was also below the average height. (3) Of the 21 children between 4 and 5 years of age, 13 were underweight, but all were up to, or above, standard height. (4) Of the 3 children aged 5 years, one was both underweight and undersized. The other 2 were up to standard. When weighed and measured some months later, all the children had grown taller and all had gained in weight except 2 who had lost. One of the latter, a boy of 3 years and 11 months, suffered from rheumatism. He was referred at the medical inspection for enlarged tonsils and knock knee. Tonsillectomy was refused by the father, but the boy was treated in the orthopaedic department of the Health Centre for the knock knee. He has since left the nursery school, the family having moved out of the district. The other, a girl of 4½ years of age, was found, when examined, to have bronchitis to which she was subject. Prior to entering the nursery school she had had a tonsillectomy and mastoidectomy. It is not surprising, then, that neither of these two gained weight. Defects found at Routine Medical Inspections. 35 of the 39 children were found to be suffering from one or more defects. (1) Enlarged Tonsils and Adenoids.—28 children were found to have some degree of enlargement of the tonsils. 14, of a slight degree and without symptoms, were scheduled to be kept under observation for 6 months, while the remaining 14 were recommended to see an Ear, Nose and Throat Specialist. 4 have since had their tonsils removed, while 5 are waiting for operation. In 2 cases the parents wished the operation postponed until the children were older, and 3 have refused to consider it. (2) Defective Teeth.—Defective teeth were noted in 14 of the children. At the time of the inspections 6 were having dental treatment, while of 2 cases referred one only completed the treatment. It is a point of some interest, in view of the theory that dental caries may be a factor in causing septic proliferation of the lymphoid tissue of the nose and throat or adenoids, that of these cases, 8 had enlarged tonsils in addition. Tooth-brush drill between 9.30 a.m. and 9.45 a.m. forms an important part of the daily programme of the nursery school. This, apart from establishing a necessary habit, should help greatly in keeping the mouth healthy and thus increasing the resistance of the pre-school child against infection. (3) Bony Deformities.—Spinal curvature was noted in one child and genu valgum in another. Both were subsequently examined by the Orthopaedic Surgeon at the Health Centre, and treatment prescribed. One unfortunately is unable to attend for home reasons. A slight tendency to round shoulders, associated with general debility, was noted in 2 cases. The mothers were accordingly advised, and both children were entered up for re-examination in three months. (4) Pulmonary Affections.—1 case was found to be suffering from bronchitis, and 2 were suffering from bronchial catarrh, all 3 clearing up under treatment. (5) General Debility.—Debility was noted, as part of the general condition, in a pre-rheumatic child, in a rheumatic child and in an under-nourished child. Some degree of improvement has since been noted in all 3. 69 (6) Rheumatism.—1 child with an apical systolic bruit of the heart was an old standing case of rheumatism, which has since left the district. The other was considered to be pre-rheumatic in type and is scheduled for re-examination in 3 months' time. (7) Skin Conditions.—1 child had lichen urticatus and another pityriasis alba. Both cleared up under treatment. The Incidence of Infectious Disease. Chicken pox was prevalent in the Lower Place area during the Autumn, and Measles after Christmas. The following table shows the incidence of Infectious Disease in the nursery school, and in the Infant and Mixed schools, since the opening of the nursery classes 12 months ago. Infectious Diseases. Lower Place Nursery School. Lower Place Mixed and Infants School. No. of Cases. No. of Scholars. No. of Cases. No. of Scholars. Measles 14 25 Chicken Pox 10 36 Whooping Cough 13 60 15 363 Mumps 6 22 Diphtheria 4 7 Scarlet Fever 1 1 In 8 of the 10 cases of Chicken pox occurring in the nursery school, the source of the infection was definitely traced to the home, where some member of the family was suffering or had suffered from it. It is at the age period of 2 to 5 years that Measles proves most fatal, but except for 2 who developed lung complications from which they recovered, the remaining 12 children in the nursery school had mild attacks. 70 APPENDICES. APPENDIX A.—VITAL STATISTICS. Appendix A.—Table I. VITAL STATISTICS OF WHOLE DISTRICT DURING 1931 AND PREVIOUS YEARS; VITAL STATISTICS OF THE WARDS DURING 1931. 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 165,674* 3,442 3,464 20.91 1,469 8.87 54 262 255 74 1,677 10.12 1922 168,900 3,106 3,160 18.71 1,570 9.30 59 273 188 59 1,784 10.56 1923 169,831 2,977 3,063 18.04 1,380 813 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 1931 185,704 2,066 2,838 15.28 1,676 9.03 133 392 171 60 1,935 10.42 * Census population—Re-adjusted by Registrar-General to 167,200. wards. 1. S. Kilb'n 13,954 209 271 19.42 154 11.04 1 38 18 66.42 191 13.69 2. Mid K'b'n 14,115 178 250 17.71 132 9.35 1 35 11 44.00 166 11.76 3. N. Kilb'n 12,970 116 172 13.26 136 10.48 4 35 9 52.32 167 12.88 4. Brondsb'y Park 9,841 78 129 13.10 95 9.65 6 28 15 116.27 117 11.89 5. Kensal Rise 13,350 117 164 12.28 99 7.42 0 35 6 36.58 134 10.04 6. Harl'd'n 16,632 155 226 13.59 136 8.18 1 36 17 75.22 171 10.28 7. Stonebridge 20,597 328 331 16.07 221 10.73 63 26 26 78-55 184 8-93 8. Roundwood 15,551 202 266 17.11 164 10.55 30 27 16 60.15 161 10.35 9. Church 15,866 163 221 13.93 121 7.63 2 22 13 58.82 141 8.89 10. End Willesden 16,376 175 262 16.00 151 9.22 0 33 12 45.80 184 11.24 11. Green Crickle- wood 36,452 345 546 14.98 267 7.32 25 77 28 51.28 319 8.75 Area of District in acres (land and inland water) 4,384 Total population at all ages ‡ 185,300 at Census. 1931. ‡ Re-adjusted by the Registrar-General to 185,300 from 184,410 because of movement of population. 71 Appendix A.—Table II.—DEATHS OF WILLESDEN RESIDENTS DURING THE YEAR 1931. 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) All Causes Certified 1,935 171 44 23 20 37 56 107 109 220 304 401 325 118 772 Uncertified — — — — — — — — — — — — - - — 1.—Infectious and Parasitic Diseases. Typhoid Fever — — — — — — — — — — — — - - — Paratyphoid Fever — — — — — — — — — — — — - - — Typhus Fever — — — — — — — — — — — — - - — Relapsing Fever. (" Spirillum Obermeieri") - - - - - - - - - - - - - - - Undulant Fever — — — — — — — — — — — — - - — Small Pox — — — — — — — — — — — — - - — Measles 5 — 4 1 — — — — — — — — - - 1 Scarlet Fever 5 — 2 2 1 — — — — — — — - 3 Whooping Cough 8 6 1 — 1 — — — — — — — - - 2 Diphtheria 5 — 1 3 — — — 1 — — — — - - 4 Influenza 49 1 1 — — — 1 3 3 3 10 12 13 2 6 Cholera — — — — — — — — — — - - - - - Dysentery 1 — — — 1 — — — — — — — — — - Plague — — — — — — — — — — — — — — - Erysipelas 9 3 — — — — — 2 — 2 — — 2 — 7 Acute Poliomyelitis — — — — — — — — — — — — — — — Encephalitis Lethargica 3 — — — — — 1 1 — 1 — — — — 1 Cerebro-spinal Fever 5 1 2 1 — — — — — — 1 — — — 6 Glanders — — — — — — — — — — — — — — — Anthrax — — — — — — — — — — — — — — — Rabies — — — — — — — — — — — — — — — Tetanus — - — - - — — — - - - - - - - Tuberculosis of the respiratory system 140 — — — 1 10 18 41 25 25 15 3 2 — 33 Tuberculosis of the central nervous system 22 7 1 4 3 4 2 1 — — — — — — 17 Tuberculosis of the intestines and peritoneum - - - - - - - - - - - - - - 1 Tuberculosis of the vertebral column 1 — — — — — — — 1 — — Tuberculosis of other bones and joints — — — — — — — — — — — Tuberculosis of skin and subcutaneous tissues - - - - - - - - - - - - - - - Tuberculosis of lymphatic system (abdominal and bronchial glands excepted) - - - - - - - - - - - - - - Tuberculosis of genito-urinary system 2 — — — - — 1 1 - - - - - - 1 79. Tuberculosis of other organs - — — — — - - - - - - - - - - Disseminated tuberculosis 7 — — — 1 — 4 1 — 1 — — — — 1 Leprosy — — — — — — — — — — — — — — — Syphilis 4 1 — — — 1 — — — 1 1 — — — 2 Other venereal diseases — — — — — — — — — — — — — — — Purulent infection, Septicaemia 1 — — — — — — 1 — — — — — — 2 Yellow Fever — — — — — — — — — — — — — — — Malaria — — — -' — — — — — — — — — - - Other diseases due to protozoa — — — — — — — — — — — — — — — Ankylostomiasis — — — — — — — — — — — — — — — Hydatid cysts — — — — — — — — — — — — — — — Other diseases due to helminths — — — — — — — — — — — — — — Mycoses 2 1 — — — — — — — — — — — 1 — Other infectious or parasitic diseases — — — — — — — — — — — — — — -- 2.—Cancer and other Tumours. Cancer of the buccal cavity and pharynx 11 - - - - - 1 - - - 3 7 — — 5 Cancer of the digestive organs and peritoneum 126 - - - - - - 2 6 18 35 44 16 5 52 Cancer of the respiratory organs 26 — — — 1 — — 1 4 10 5 4 — 1 6 Cancer of the uterus 19 - - - - - - - 2 6 4 4 3 — 9 Cancer of other female genital organs 4 — — — — — — — — 1 1 2 — — — Cancer of the breast 26 - - - - - - - 2 7 6 6 4 1 14 Cancer of the male genito-urinary organs 15 - - - - - - - - 2 6 4 3 — 4 Cancer of the skin 1 — — — — — — — — — — — 1 — — Cancer of other or unspecified organs 22 - - - - - 3 1 2 2 9 4 1 — 3 Non-malignant tumours 2 — — — — — — — — 1 1 — — — 1 Tumours of undetermined nature 7 — 1 — — — — — 2 2 2 — — — 2 3.—Rheumatism, Diseases of Nutrition and of Endocrine Glands and the General Diseases. Rheumatic Fever 9 — — 2 2 1 — 1 1 — 1 — 1 — 3 Chronic rheumatism, Osteo-Arthritis 11 - - - - - - - - - 4 4 3 — 2 Gout 1 — — — — — — — — — — — 1 — 1 Diabetes 20 — — — — 2 — — 1 — 5 8 3 1 8 Scurvy — — — — — — — — — — — — — — — Beri-beri — — — — — — — — — — - - - - - Pellagra — — - — — — — — — — — — — — — Rickets 1 1 — — — — — — — — — — — — 1 Osteomalacia — — — — — — — — — — - - - - - Diseases of the pituitary gland 1 — — — — — — — — — — 1 — — 1 Diseases of the thyroid and parathyroid glands 3 - - - - - - - - 2 - 1 - - - Diseases of the Thymus 2 2 — — — — — — — — — — — — - Diseases of the adrenals 3 — — — — — 1 - 1 - 1 1 Other general diseases — — — — — — — — — — — — — — 1 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) 4.—Diseases of the Blood and Blood-forming Organs. (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) (13) (14) (15) (16) Haemorrhagic conditions 1 - - - 1 - - - - - - - - - 1 Anaemia Chlorosis 13 - — — - 1 — 1 — 2 1 6 2 - 5 Leukaemia, Aleukaemia 6 - — — - — — 3 — 2 1 — — - 1 Diseases of the Spleen 1 - - - - - - - - - - - 1 - - Other diseases of the blood and blood-forming organs - - - - - - - - - - - - - - - 5.—Chronic Poisoning. Alcoholism (acute or chronic) 1 - - - - - - - - - - 1 - - - Chronic poisoning by other organic substances - - - - - - - - - - - - - - Chronic poisoning by mineral substances - - - - - - - - - - - - - - - 6.—Diseases of the Nervous System and Sense Organs. Encephalitis 3 - 1 - - — — 1 — — — 1 — - 3 Meningitis 6 1 1 2 - — 1 1 — — — — — 2 Tabes Dorsalis (Locomotor ataxy) 6 - - - - - - - - 1 3 1 1 - 3 Other diseases of the spinal cord 3 - — — - — — 1 — — 2 — — - 2 Cerebral haemorrhage, apoplexy, etc 105 - - - - - - 1 — 10 23 30 35 6 63 General Paralysis of the Insane 7 - — — 1 — — — 1 2 3 — — — 4 Other forms of insanity 5 - - - - - - - 1 1 3 — — — 2 Epilepsy 6 - — — - 1 1 — — 1 1 1 1 — 1 Infantile convulsions (under 5 years of age) - - - - - - - - - - - - - - - Other diseases of the nervous system 6 - - - - - - - - 1 1 4 — — 2 Diseases of the eye and annexa - - - - - - - - - - - - - - - Diseases of the ear and of the mastoid sinus 8 4 3 — 1 - - - - - - - - - 3 7.—Diseases of the Circulatory System. Pericarditis - - - - - - - - - - - - - - - Acute endocarditis 8 — — — - 2 2 2 1 — — — 1 — 2 Chronic endocarditis, Valvular disease 74 — — — - 2 2 2 3 9 16 24 14 2 3 Diseases of the myocardium 192 - - - - - - 1 7 11 33 56 65 19 52 Diseases of the coronary arteries, Angina pectoris 23 - - - - - - - - 6 5 10 1 1 2 Other diseases of the heart 62 — — — 1 1 1 2 5 6 11 18 13 4 39 74 Aneurysm 6 - - - - - 1 - - - 2 2 1 - 3 Arterio-sclerosis 75 - — — — — — — - 5 10 32 19 9 18 Gangrene 2 - — — — — — — - — — — 1 1 1 Other diseases of the arteries 4 - — — — — — — - - - 3 1 - 2 Diseases of the veins (varix,haemorrhoids, phlebitis, etc.) - - - - - - - - - - - - - - - Diseases of the lymphatic system (lymphangitis, etc.) - - - - - - - - - - - - - - - Abnormalities of blood pressure — - — — — — — - - - - - - - - Other diseases of the circulatory system — - — — — — — — - — — - — - — 8.—Diseases of the Respiratory System. Diseases of the nasal fossae and annexa 1 - - - - - - - 1 - - - - - - Diseases of the larynx 2 - — — - - - - - - - 1 1 - - Bronchitis 69 3 2 — — — — — 1 6 11 18 22 6 12 Broncho-pneumonia 103 26 15 2 1 — 2 2 3 11 8 12 14 7 55 Lobar pneumonia 31 2 — — 1 3 1 5 4 7 3 2 1 2 7 Pneumonia (not otherwise defined) 33 1 2 — — 2 — 2 3 8 8 3 4 - 30 Pleurisy 1 — — — — — — - — - 1 - - - 1 Congestion and haemorrhagic infarct of lung, etc 8 — — — — — 1 — 1 2 1 1 1 1 5 Asthma 14 — — - - - - - - 2 3 7 2 - 1 Pulmonary emphysema — — — — — — — - — - - - - - - Other diseases of the respiratory system 2 - - - - - - - - - - - - - - 9.—Diseases of the Digestive System. Diseases of the buccal cavity, pharynx, etc. 2 - - - - - - - - - 2 - - - 1 Diseases of the oesophagus — — — - - - - - - - - - - - - Ulcer of the stomach or duodenum 19 - - - - - - 4 1 4 7 2 1 - 10 Other diseases of the stomach 5 3 - - - - - - - - - - 1 1 4 Diarrhoea and Enteritis 21 16 2 1 - - - - - - 1 - 1 13 Appendicitis 16 — — 1 1 — 1 - 2 2 3 4 2 - 14 Hernia, Intestinal obstruction 27 2 — — - - - 2 3 3 4 5 7 1 16 Other diseases of the intestines 2 — - - - - - - - - 1 1 - - 2 Cirrhosis of the liver 5 - - - - - - - - 1 1 2 1 - 3 Other diseases of the liver 1 — - - - - - 1 - - - - - - 1 Biliary calculi 4 — — — - - - - - - 1 2 1 - 1 Other diseases of the gall bladder and ducts 2 — — - - - - - - - 1 1 - - 1 Diseases of the pancreas 2 — — - - - - - 1 - 1 - - - 2 Peritonitis without stated cause 3 1 - - - - - 1 - - 1 - - - 1 75 Table II.—DEATHS OF WII.LESDEN 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"cr "Non-Residents,"in Institutions in the District. (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) (13) (14) (15) (16) 10.—Non-Venereal Diseases of the Genito-Urinary System and Annexa. Acute nephritis 4 — — — — 1 — — 2 — — — — 1 — Chronic nephritis 40 - - - - - - 1 2 13 8 11 4 1 23 Nephritis not stated to be acute or chronic 12 - - - - - - - - 3 2 2 4 1 6 Other diseases of the kidney and annexa 10 — 1 — — — — 1 1 2 1 4 — — 7 Calculi of the urinary passages 1 - - - - - - - - - - 1 - — 1 Diseases of the bladder 2 - - - - - - - - - - - 2 — 1 Diseases of the urethra, urinary abscess, etc - - - - - - - - - - - - - - - Diseases of the prostate 11 - - - - - - - - 1 — 6 2 2 8 Diseases of the male genital organs - - - - - - - - - - - - - - - Diseases of the female genital organs 2 - - - - - - - 2 - - - - - 1 11.—Diseases of Pregnancy, Childbirth and the Puerperal State. Post abortive sepsis 2 - - - - - 1 1 - - - - - - 2 Abortion not returned as septic 1 - - - - - - 1 - - - - - - 1 Ectopic gestation 1 - - - - - - 1 - - - - - - 1 Other accidents of pregnancy - - - - - - - - - - - - - - - Puerperal haemorrhage - - - - - - - - - - - - - - - Puerperal sepsis 4 - - - - - - 3 1 - - - - - 1 Puerperal albuminuria and convulsions 1 - - - - - - 1 - - - - - - 1 Other toxaemias of pregnancy - - - - - - - - - - - - - - - Puerperal phlegmasia alba dolens,embolism, and sudden death - - - - - - - - - - - - - - - Other accidents of childbirth - - - - - - - - - - - - - - - Other or unspecified conditions of the puerperal state - - - - - - - - - - - - - - - 12.—Diseases of the Skin and Cellular Tissue. Carbuncle, Boil 4 - - - - - - - - - 1 2 1 — 3 Cellulitis, Acute abscess - - - - - - - - - - - - - 1 Other diseases of the skin and its annexa 2 - - - - - - - - - - 1 1 — 1 76 13.—Diseases of the Bones and Organs of Locomotion. Acute infective osteomyelitis and periostitis 1 - - - - - - - - - - - - - - Other diseases of the bones — - - - - - - - - - - - - - - Diseases of the joints and other organs of locomotion 1 - - - - - - - - - - - - 2 14.—Congenital Malformation. Congenital malformations 11 9 1 1 - - - - - - - - - - 5 15.—Diseases of Early Infancy. Congenital debility 9 9 - - - - - - - - - - - - 6 Premature birth 51 51 - - - - - - - - - - - - 8 Injury at birth 6 6 - - - - - - - - - - - - - Other diseases peculiar to early infancy 10 10 - - - - - - - - - - - - 1 16.—Old Age. Old age 83 - - - - - - - - - 1 9 36 37 57 17.—Deaths from Violence. Suicide by solid or liquid poisons and corrosive substances 3 - - - - - - - - 3 - - — — 1 Suicide by poisonous gas 12 - - - - - 1 1 5 3 1 1 — — 2 Suicide by hanging or strangulation - - - - - - - - - - - - - - - Suicide by drowning 2 - - - - - - 1 1 - - - - - - Suicide by firearms, - - - - - - - - - - - - Suicide by cutting or piercing instruments 4 - — — — — i — 1 — 1 — 1 — 3 Suicide by jumping from high place 2 - - - - - - - - 1 1 — — — — Suicide by crushing 1 - - - - - - - - - - - - - - Suicide by other means 1 - - - - - - - - - - - - - 1 Infanticide (under one year) - - - - - - - - - - - - - - Homicide by firearms - - - - - - - - - - - - - - - Homicide by cutting or piercing instruments - - - - - - - - - - - - - - - Homicide by other means - - - - - - - - - - - - - - - Attack by venomous animals - - - - - - - - - - - - - - Food poisoning - - - - - - - - - - - - - - - Accidental absorption of irrespirable or poisonous gas 1 - - - - - - 1 - - - - - - - Other acute accidental poisoning (not by gas) - - - - - - - - - - - - - - - Conflagration - - - - - - - - - - - - - - - Accidental burns (Conflagration excepted) 5 - 1 — — — — — 1 1 — — 2 — 4 Accidental mechanical suffocation 2 2 - - - - - - - - - - - - - Accidental drowning 3 — — — 1 — 1 — — — 1 — — — — Accidental injury by firearms - - - - - - - - - - - - - - - Accidental injury by cutting or piercing unstru-ments - - - - - - - - - - - - - - - 77 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 in the District. (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) (13) (14) (15) (16) 17.—Deaths from Violence—continued. Accidental injury by fall, crushing, etc. 49 — 2 3 1 6 4 5 5 5 3 8 4 3 27 Cataclysm — — — — — — — — — — — — — — — Injury by animals (poisoning by venomous animals excepted) - - - - - - - - - - - - - - - Hunger or thirst - - - - - - - - - - - - - - - Excessive cold - - - - - - - - - - - - - - - Excessive heat - - - - - - - - - - - - - - - Lightning - - - - - - - - - - - - - - - Electricity (lightning excepted) 1 - - - - - - - - 1 - - - - - Other and unstated forms of accidental violence 1 1 - - - - - - - - - - - - 1 Violent deaths of unstated nature (i.e. accidental, suicidal, etc.) 1 - - - - - - - - - 1 - - - 1 Wounds of war - - - - - - - - - - - - - - - Execution of civilians by belligerent armies - - - - - - - - - - - - - - - Execution - - - - - - - - - - - - - - - 18.—Ill-Defined Diseases. Sudden Death - - - - - - - - - - - - - - - Cause of death unstated or ill-defined 3 1 - - - - - - - - 1 - - 1 - Totals 1,935 171 44 23 20 37 56 107 109 220 304 401 325 118 772 78 Appendix A—Table 11(a) CAUSES OF DEATH IN WILLESDEN URBAN DISTRICT AS CIRCULATED BY REGISTRAR-GENERAL.—1931. Causes of Death. M. F. All Causes 960 978 1. Typhoid and paratyphoid fevers — — 2. Measles 3 2 3. Scarlet fever 1 4 4. Whooping cough 4 5 5. Diphtheria 2 3 6. Influenza 21 29 7. Encephalitis lethargica 1 2 8. Cerebro-spinal fever 2 3 9. Tuberculosis of respiratory system 89 56 10. Other tuberculous diseases 11 16 11. Syphilis 2 1 12. General paralysis of the insane, tabes dorsalis 13 2 13. Cancer, malignant disease 116 141 14. Diabetes 7 15 15. Cerebral haemorrhage, etc 47 61 16. Heart disease 163 195 17. Aneurysm 5 3 18. Other circulatory diseases 28 41 19. Bronchitis 42 27 20. Pneumonia (all forms) 87 76 21. Other respiratory diseases 18 12 22. Peptic ulcer 15 4 23. Diarrhoea, etc. (under 2 years) 14 5 24. Appendicitis 8 10 25. Cirrhosis of liver 5 3 26. Other diseases of liver, etc. 2 5 27. Other digestive diseases 29 18 28. Acute and chronic nephritis 27 29 29. Puerperal sepsis — 5 30. Other puerperal causes — 4 31. Congenital debility, premature birth, malformations, etc 46 39 32. Senility 28 47 33. Suicide 11 14 34. Other violence 42 23 35. Other defined diseases 70 77 36. Causes ill-defined or unknown 1 1 Special causes (included in No. 35 above):— Small-pox — — Poliomyelitis — — Polioencephalitis - - Deaths of Infants under 1 year Total 101 71 Legitimate 88 67 Illegitimate 13 4 (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. 79—80 APPENDIX A. TABLE III.—INFANT MORTALITY DURING 1931. 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 59 8 7 7 81 31 28 15 16 171 18 11 9 15 6 17 26 16 13 12 28 Uncertified — — — — - — — — - - - - — — — — — — — Small Pox - - - - - - - - - - - - - - - - - - - - - Chicken Pox — — — — — — — — — — — — — — — — — — Measles — — — — — — — — — — — — — •— — — — — Scarlet Fever — — — — — — — — — — — — — — —. — Whooping Cough - - - - - - 1 2 3 6 — — — 2 — 1 1 1 1 Diphtheria and croup - - - - - - - - - - - - - - - - - - - - - Erysipelas — — — 1 1 — 1 1 — 3 - - - - - 1 —- — — 2 Tuberculous Meningitis - - - - - 1 1 1 4 7 — 1 — — 1 1 1 1 1 — 1 Abdominal tuberculosis (a) - - - - - - - - - - - - - - - - - - - - - other Tuberculous Diseases — — — — — — — — — — — - Meningitis (not Tuberculous) — — 1 — 1 - 1 — — 2 — — — 1 — l — — Convulsions — — — — — — — — — — — — — — — — — — — — Laryngitis — — — — — — — — — — — — — — — — — — — Bronchitis — — — — 1 2 — — 3 1 1 - - - - - - - - - Pneumonia (all forms) 2 — 1 2 5 7 8 4 6 30 6 3 1 — 1 l 7 3 1 1 6 Diarrhoea — 1 — — 1 6 6 2 1 16 1 — 1 1 l 3 2 3 2 2 Enteritis - — — — — — — — — — — — — - Gastritis - — — — — 1 2 — — 3 — — — 1 — 2 - - Syphilis — — — — — 1 — — — 1 — — —. 1 — — — — — — — Rickets - - - - - - 1 - 1 - 1 - - - - - - - - - Suffocation, overlying — 1 — — 1 1 - - - - - - - - - - - - - - - Injury at Birth 6 — — — 6 — — — — 6 1 — — 2 — — — — 1 — 2 Atelectasis 9 — — — 9 — — — — 9 1 — — 1 — — -— 1 1 1 4 Congenital Malformations (6) 3 — 1 — 4 1 1 2 1 9 1 — 2 2 — — 1 — 1 2 Premature Birth 37 4 2 3 46 5 — — — 51 6 1 3 3 4 8 8 5 3 3 7 Atrophy, Debility and Marasmus - 1 1 1 3 4 2 - - 9 - 1 - - - 2 6 - - - - Other Causes 2 1 1 4 3 3 2 1 13 1 3 2 1 — - - — 1 1 4 Total Deaths 59 8 7 7 81 31 28 15 16 171 18 11 9 15 6 17 26 16 13 12 28 Deaths Legitimate 56 8 6 6 76 26 24 14 15 155 16 11 8 14 6 10 23 15 13 12 27 Illegitimate 3 - 1 1 5 5 4 1 1 16 2 - 1 1 - 7 3 1 - - 1 Births Legitimate ... ... ... ... ... ... ... ... ... 2,727 258 242 161 124 160 213 313 257 212 257 530 Illegitimate ... ... ... ... ... ... ... ... ... 111 13 8 11 5 4 13 18 9 9 5 16 Total Births ... ... ... ... ... ... ... ... ... 2,838 271 250 172 129 164 226 331 266 221 262 546 Infant Mortality Rate— Legitimate ... ... ... ... ... ... ... ... ... 56.84 62.02 45-46 49.69 112.90 37.50 46.95 73.48 58.37 61.32 46.69 50.94 Illegitimate ... ... ... ... ... ... ... ... ... 144.14 153.85 — 90.91 200.00 — 538.46 168.67 111.11 — — 62.50 Infant Mortality Rate ... ... ... ... ... ... ... ... ... 60.25 66.42 44.00 52.32 116.27 36.58 75.22 78.55 60.15 58.82 45.80 51.28 Population ... ... ... ... ... ... ... ... ... 185704 13,954 14,115 12,970 9,841 13,350 16,632 20,597 15,551 15,866 16,376 36,452 89—90 ORTHOPÆDIC DEPATRTMENT.-REPORT FOR YEAR ENDING JANURY 2ND, 1932 Defects Treated. Brought Forward. New. Total. Treatments completed. Treatments ceasing before completion. Still under Treatment. Carried forward. 0-1 1-5 5-14 N.M. 0-1 1-5 5-14 N.M. 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. Absence of Fibula — — 1 — - - — — 1 — 1 - — — — — — - - — — — 1 1 Fragilitas Ossium — — — — — 1 - — 1 1 — — — — — — — — — — 1 1 Diaphyseal Aclasia — — — — — 2 — — 2 — — —- — — —* — — — — 2 2 Achondroplasia — — — — 1 — — 1 — 1 — — — — — — — — — 1 — l Osteochondroma — — — — 1 — — 1 1 — — — — — — — — —. — 1 1 Cretinism - - - - — — 1 — — 1 1 - — — - - - - - — — — — 1 1 Knock Knees 36 12 1 51 19 1 87 31 119 1 15 5 21 - 17 7 24 — 55 19 74 Flat Feet 4 13 1 — 16 32 1 — 20 45 2 67 - 1 12 1 14 — 2 10 1 13 — 17 23 40 Talipes 4 6 1 7 12 6 11 18 7 — 36 4 3 — 7 1 1 — 2 6 14 7 27 Hammer Toes — 1 3 3 3 4 3 4 7 — 14 1 1 1 3 — - 2 — 2 2 3 4 9 Pes Cavus — — — — — 4 — — 4 — 4 — — 1 1 — 1 1 — — 2 2 Hallux Valgus — — — - — 3 — — — - — 3 — — — — — — — — -— — 3 3 Deformed Scapula — — 1 — — — — — 1 — 1 — — 1 1 — — - — — — — Sprengel's Shoulder — — — — 1 1 — 1 1 — 2 - - - - - - - - - - - 1 1 2 Congenital Dislocation of Hip — 1 1 — — 1 — 1 2 — 3 — — — — — — — — 1 2 3 Congenital Subluxation of Radii — — 1 — — — — — 1 — 1 — — 1 — 1 — — — — — — — Torticollis 1 — 2 5 2 5 6 2 7 — 15 — 1 — 1 2 - 1 3 4 1 6 11 Polydactyly — 1 — — — — — 1 — — 1 — — — — — — — — 1 — 1 Syndactyly — — — 2 — — 2 — — — 2 — — — — — — ! — — 2 — — 2 Congenital Deformities — — — 3 — 3 3 — 3 — 6 — — —' — — —i- 1 1 3 — 2 5 Rickets 5 50 4 22 79 2 27 129 6 — 162 6 26 2 34 5 20 2 27 16 83 2 101 Joint Injuries — — — 1 — 7 1 — 7 — 8 — — 4 4 — — 1 1 1 — 2 3 Synovitis of Knee — — — — — 1 — — 1 — 1 — — — — — — 1 1 — — — — Fractured Forearm — — — — — 1 — — 1 — 1 — — 1 1 — — — — — — — — Calcaneal Epiphysitis — — 1 — — — — — 1 — 1 — i — — — — - — — — — 1 1 Teno Synovitis — — — 1 — — — — — — 1 1 — — — 1 1 - - - - - - - - - - Fibrositis of Neck — — — — — 1 — — 1 — 1 — — 1 — 1 — — — — — — — — Spinal Caries — 1 2 - - - - - - 1 2 — 3 — — — — — — 1 1 — 1 1 2 Tubercular Hip — — 1 — — 1 — — 2 — 2 — — — — — - - - — — 2 2 Scoliosis 1 — 20 1 3 — 30 4 — 50 1 55 2 - 10 - 12 1 - 9 1 11 1 31 32 Kyphosis — — 34 — — 72 — — 106 — 106 — — 28 — 28 - — 32 32 — — 46 46 Lordosis — — 10 — — 3 16 — 3 26 — 29 — — 8 8 — - 15 15 — 3 3 6 Funnel Chest — — 1 — — 2 — — 3 — 3 — — 1 1 — — — — - — 2 - 2 Peripheral Neuritis — — — — 1 — — 1 — — 1 — — — - - 1 - - 1 — — — — Infantile Paralysis — 2 4 — 1 16 — 3 ! 20 — 23 — 1 4 — 5 — • — 5 — 5 — 2 11 13 Hemiplegia — 1 2 1 1 4 1 2 6 — 9 - - - - - - - - - -- 1 2 6 9 Paraplegia — 1 — — 1 1 — 2 1 — 3 — — — — — 1 — 1 — 1 1 2 Tetraplegia 1 — 1 1 1 1 2 1 2 — 5 — — 1 1 2 — — 2 — 1 1 2 Erbs Paralysis 1 1 1 — — 1 1 1 2 — 4 1 — — — 1 — 1 — 1 — — 2 2 Osteomyelitis 1 2 — — — 1 1 2 1 — 4 — — 1 1 1 1 — 2 — 1 — 1 Paresis of Digits — 1 2 1 — 2 1 1 4 — 6 — 1 1 — 2 — — — — 1 — 3 4 Debility — — — 2 2 5 2 2 5 — 9 — 1 3 — 4 — — — — 2 1 2 5 Bat Ears — — — 2 — — 2 — — — 2 — — — — 1 — — 1 1 — — 1 Papilloma of Toe — — — — — 1 — — 1 — 1 — — 1 1 — — — — — — | — — Deformity following Post Basal Meningitis - - - - - 1 — - - 1 — - 1 - - - - - - - - - - - 1 - - 1 Muscular Atrophy — — — — 1 — — 1 — — 1 — — — — — — 1 — 1 — — — — Amputation of Arm — — — — — 1 — — 1 — 1 — — — — — — — — — — 1 1 Lymphangioma - - — - 1 - - - 1 - - 1 — — — — - — - — — — — 1 — 1 Total 14 108 118 3 54 178 249 1 68 286 367 4 725 15 50 87 2 154 13 45 88 2 148 40 191 192 — 423 No. of individual cases treated 13 98 102 2 54 161 209 1 67 259 311 3 640 14 43 66 1 124 13 39 66 2 120 40 177 179 — 396 No. of Attendances made at Centre for Treatment 397 1,955 5,865 39 8,256 Referred for Hospital In-patient Treatment. Rickets H. H - 1 - - 1 Do. do. do. Massage 294 1,454 2,414 30 4,192 Do. do. do. Electrical Treatments — 264 571 27 862 Do. E. B - 1 - - 1 Do. do. do. Gymnastic Exercises — 1,362 5,097 35 6,494 Do. F. I. - 1 - - 1 Do. do. do. Application of Splints 116 199 91 - 406 Do. D. B - 1 — 1 Total Do. J. S - 1 - 1 410 3,279 8,173 92 11,954 Infantile Paralysis I. F. - - 1 1 No. of Individual Cases not requiring Treatment 17 21 21 — 59 Do. do S. H. - — 1 1 Do. do. Attendances at Centre 7 55 81 1 144 Do. do. J. B. - - 1 - 1 Total Attendances at Centre. Do. doG. B. - - 1 1 404 2,010 5,946 40 8,400 Hemiplegia K. B - — 1 1 Entered Hospital for In-patient Treatment Do. B. A. - — 1 1 Pes Cavus S. K. — — 1 1 Rickets E. B — i — — 1 Do. do F. E. — — 1 1 Infantile Paralysis I. F — — 1 — 1 Hallux Valgus K. S — — 1 1 Hemiplegia B. A — — 1 — 1 Congenital Scoliosis S. W. — — 1 1 Pes Cavus .S. K. — — 1 — 1 Papilloma of Toe G. H. — — 1 1* Do F- E — — 1 — 1 Congenital Deformities L. C. — 1 1 Hallux Valgus K. S — — 1 — 1 Spastic Tetraplegia M. C. — — 1 1† ? Sarcoma of Leg E. P. 1 — — 1 ? Sarcoma of Leg E. P. 1 — — 1 Congenital Dislocation of Hip M. C — 1 — — 1 Congenital Dislocation of Hip M. C. — l — 1 Polydactyly .. M. L — 1 — — 1 Polydactyly M. L. — l — 1 Arthritis, Right Hip C. C. — 1 — 1 Arthritis, Right Hip C. C — — 1 — 1 Total 1 3 6 — 10 Total 1 7 14 - 22 * Referred to Willesden General Hospital. t Referred to Sussex County Hospital. 91 APPENDIX G. To the Chairman and Members of the Health Committee. INFANT LIFE PROTECTION. The Willesden Urban District Council became the authority for Infant Life Protection on the 1st April, 1930. The Ministry of Health advised the local authority to appoint its Health Visitors as Infant Protection Visitors, and the Council acted accordingly on 28th January, 1930. In Willesden there are usually some 130 mothers receiving some 200 children for reward. On receipt of a notice that a child has been received for reward the Infant Protection Visitor visits forthwith, so that inter alia she may record the condition of the child when first received by the foster mother. She also visits each foster mother not less frequently than once every two months, in order to satisfy herself as required by the Children Act, 1908, as to the proper nursing and maintenance of the infants, and to give any necessary advice or directions as to their nursing and maintenance. During the nine months ended 31st December, 1930, 769 visits were paid to foster homes, and from the 1st January to the 10th October of this year 786 visits have been paid. Certain rules as to the reception of children are laid down in the Children Act. Children must not be received for reward where the following conditions exist:— (a) If the foster mother is one from whose care children have been removed under Part I. of the Children Act, 1908, or under the Infant Life Protection Act, 1897. (b) If the premises are premises from which an infant has been removed under Part I. of the Children Act, 1908, on account of the premises being dangerous or insanitary, or under the Infant Life Protection Act, 1897, on account of the premises being so unfit as to endanger the infants' health. (c) If the foster mother is one who has been convicted of offences under Part II. of the Children Act or the Prevention of Cruelty to Children Act, 1904. Similarly, children may be removed from their foster homes if the following conditions exist:— (a) If the premises are overcrowded, dangerous or insanitary. (b) If the foster mother is unfit to have care of the child owing to negligence, ignorance, inebriety, immorality, criminal conduct or other similar cause. When visiting a foster home the Infant Protection Visitor interviews the foster mother and inspects the premises and the bedding. She examines the foster child, its clothing and its skin. She also has regard to the following:— 1. The age and capability of the foster mother. 2. The number, age and sex of the other members of the household. 3. The demands on the foster mother's time. 4. Any assistance that the foster mother may have available. 5. The accommodation, equipment, orderliness, and cleanliness of the house. 6. The proposed regime for the foster child. In considering the number of foster children who are to sleep in a room, the Infant Protection Visitor has regard to the size of the room, the amount of furniture in the room, ventilation, lighting and the number of other persons that the room accommodates. The Willesden Bye-laws for Houses let in Lodgings require that a sleeping room shall have 400 cubic feet of air space for a person over 10 years of age and 250 cubic feet of air space for children under 10. The Model Bye-laws of the Ministry of Health relating to Improvement Schemes suggest that a sleeping room should allow 40 square feet of floor space for each person of school age and 30 square feet for each person under school age, provided that the average height of the room is 8 ft. The Infant Protection Visitor requires that a child under 3 years should have a separate bed. She does not insist that older children should sleep separately, but as a fact foster children generally have separate beds, except where they are brothers or sisters. Where a mother is making an application to take an additional foster child the Infant Protection Visitor also takes into consideration the manner in which she has dealt with her existing foster children. It is not easy to suggest standards. Foster homes vary very considerably, and are found in every locality in Willesden. The charges at these foster homes vary greatly, being from as low as 7s. 6d. per week to as high as £2 2s. Od. per week. The average is probably from 12s. to 12s. 6d. per week. These charges generally include clothing. Foster homes to suit the particular person concerned are not always easy to obtain. Many of the parents looking for foster homes are single girls, who cannot afford more than minimum charges, and if suitable foster homes within their means are not available they send their children to relatives, where they often live under poor conditions and without supervision by any authority. GEORGE F. BUCHAN, November, 1931. Medical Officer of Health. 92 APPENDIX H. RHEUMATISM AND HEART DISEASE. I beg to report in accordance with the following minute of the Education Committee "With reference to our report of 19th November, 1930 (para. 7), we have had before us the report on the Joint Conference on Problems relating to those handicapped by Physical and Psychological defects. The Conference was convened by the Invalid Children's Aid Association, and the Central Council for the Care of Cripples, and was held on the 13th and 14th November, 1930. Copies of the report have been sent to all members of the Education Committee. We particularly desire to direct the attention of the Committee to that portion of the report dealing with rheumatism in childhood. Arising out of this, we have asked the School Medical Officer to submit to us at a future meeting a full report on the whole situation dealing particularly with rheumatic and heart cases of the kind referred to in the report."—(Education Committee Minutes, 1930-31, p. 390.) The Extent of the Problem. The following figures taken from the Registrar-General's Statistical Report for 1929 show the deaths from Rheumatic Fever and Heart Disease which occurred in England and Wales and Willesden, respectively, in 1929:— England and Wales. Willesden. Rheumatic Fever 1,417 7 Pericarditis 291 3 Acute Endocarditis and Myocarditis 1,955 10 Angina Pectoris 4,807 14 Other Diseases of the Heart 89,414 336 Total—Heart Disease 96,467 363 Total—Rheumatic Fever and Heart Disease 97,884 370 It is important to note that Heart Disease and Rheumatic Fever cause the greatest number of deaths year by year. The following table shows the five principal causes of death in 1929 in England and Wales, and Willesden, respectively:— Year 1929. England and Wales. Willesden. Total deaths from diseases of the heart, including Rheumatic Fever 97,884 370 Total deaths from diseases of the respiratory system 83,351 314 Total deaths from all forms of Cancer 56,896 239 Total deaths from all diseases of the nervous system 43,740 164 Total deaths from all forms of Tuberculosis 37,990 179 Cases of Heart Disease of Rheumatic Origin. The Annual Report of the Chief Medical Officer of the Ministry of Health for 1929 states that 40 per cent. of deaths from heart disease are of rheumatic origin. Acute or Sub-Acute Rheumatism almost invariably impairs the heart, and in some cases the affection is so acute that death occurs during the first attack of Rheumatism. 1,417 deaths from Rheumatic Fever in England and Wales, and 7 deaths from Rheumatic Fever in Willesden probably occurred in such circumstances. An affection of the heart means impaired efficiency, with the result that the individual so affected is not able to undertake a normal amount of work, is frequently sick, and ultimately dies prematurely. Heart Disease in the manual worker obviously subjects him to greater disabilities on account of the greater strain put upon his heart than in the case of a man employed in a sedentary occupation. It is not a practical proposition at the present time to attempt to deal with all forms of Heart Disease, but good results can be achieved by tackling those cases of Heart Disease which are of rheumatic origin. The seeds of the heart condition are laid down in rheumatism, which commences usually in childhood or early adolescence. The child may suffer from growing pains without any 93 degree of acute discomfort; the child may suffer from an acute attack of rheumatism with high temperature, and tender joints; or the child may have the jerky movements of chorea, i.e., St. Vitus' Dance. It is the joint affection which is usually referred to as rheumatism, but it is seldom that an attack of rheumatism is confined to the joints only. It spreads to the heart, which it may affect in one way or another, e.g., the lining membrane of the heart may be affected (Endocarditis), or the heart muscle may be affected (Myocarditis), or the external covering of the heart may be affected (Pericarditis). Cases which have once suffered from Rheumatism are very liable to recurrent attacks. Estimated Number of Heart Cases amongst Willesden School Children. World-wide investigations during the past 10 years have shewn the extent of the occurrence of Heart Disease among the rising generation. The following table is quoted from the Ministry of Health's Report for 1929:— Number of School Children Examined. Percentage of Organic Heart Disease. England and Wales— Board of Education Report, 1924 598,167 0.7% London— London County Council Report, 1924 10,000 0.1 % under 5 years 0.25% „ 7 „ 0.7 % „ 12 „ Glasgow—1924 170,000 Boys 0.8% Age 5 years Girls 0.6% ,, 5 ,, Boys 0.8% „ 9 „ Girls 0.9% „ 9 „ Boys 0.8% „ 13 „ Girls 0.7% „ 13 „ New York—1918 250,000 1.6% 1918-22 1,336,343 1.4% Chicago—1923 156,826 0.9% 1924 153,671 1.5% 1925 130,266 1.7% This shows that in city communities children of school age suffer from some definite heart lesion to the extent of at least 1 per cent. of their number ; and this pretty well corresponds with the findings of medical inspection in Willesden. It would accordingly appear that there are at least 200 children attending the elementary schools in Willesden who are actually suffering from rheumatic heart disease. In dealing with rheumatic heart conditions the London County Council estimated to have 10,000 cases of heart disease registered in their school population of some 500,000, or approximately 2 per cent., but this expectation has been exceeded, 11,000 being registered. On this basis, i.e. 2 per cent., there would be 400 children suffering from rheumatic heart disease in Willesden. Objects in View. In considering the setting up of an organisation for dealing with rheumatism and heart disease the objects in view should be the following:— (1) The ascertainment of cases. (2) The diminution of the severity of attacks of rheumatism. (3) The prevention or mitigation of heart disease in rheumatism. (4) The prevention of rheumatism. In the present state of medical knowledge the prevention of rheumatism cannot be assured, but much can be done by an efficient organisation to ascertain cases of rheumatism and heart disease and mitigate the ravages of these diseases. It is found, for example, that the intervals between attacks can be greatly increased by careful supervision, and this result is not only beneficial in itself but gives good reason for hope in the future. 94 The Organisation. The organisation for the supervision of cases of rheumatic heart disease amongst children includes:— (1) A Rheumatism Supervisory Centre. (2) Hospital Beds. At the Rheumatism Supervisory Centre the following work would be undertaken:— (a) Ascertainment. (b) Diagnosis of doubtful cases. (c) Supervision. The rheumatic cases or rheumatic heart cases would be classified and supervised according to the stage of the disease. In a certain proportion of cases hospital beds will be required. These are generally for cases in the acute stage. Other cases again, unable to secure a hospital bed or for some other reason, would require to be excluded from school. Another class of case—usually one which has returned home from treatment in hospital—will be able to attend school, but with physical exercises restricted. This class of case will require systematic examination at the Centre to ascertain the progress of the heart. Another class, again, may attend school without restriction, the head teacher being advised to keep a watchful eye on the child. Other cases may require to attend the P.D. School on account of permanent heart damage. The work of centres already established shews that approximately 50 per cent. of the attendances need examination and supervision only; 25 per cent. need restriction of games, with more frequent examination and more strict supervision; 20 per cent. need exclusion from school and treatment ; while 5 per cent. need prolonged institutional care. All poorly nourished children should have adjuncts given them in the shape of cod liver oil and malt and nutritive foods. All these various classes will require supervision at the Centre, at the school, and at the home, so that complete co-operation between doctor, nurse, teacher and parent can be secured. With regard to the number of beds required, the Rheumatism Clinic at Great Ormond Street Hospital, with 600 cases on the register, has 120 beds for such cases, or one bed for every 5. The London County Council, with 11,000 cases on its register, has 520 beds, including 350 beds recently established at Carshalton, or approximately one bed for every 20 patients on the register. It is to be noted that cases attending Great Ormond Street Hospital would generally be more acute than those which would come within the general purview of the School Medical Officer. The proportion of beds, therefore, required in connection with rheumatism supervision in Willesden would more nearly approximate that provided by the London County Council, that is, one for every 20 cases, or 20 beds. The Committee will observe that the estimates are based on school children. No doubt a number of children under school age would also require to be dealt with, as approximately 12 per cent. of all rheumatic heart cases begin under the age of 5. But at the outset the figure of 20 beds suggested may be considered sufficient. It may also be of interest to note that some parents in Willesden have heard of the help to be obtained through Heart Clinics already in operation at Paddington, Kensington and elsewhere, and have been asking the Health Visitors to make appointments at Heart Clinics in Willesden, under the impression that they were also established here. Staffing and Cost. Rheumatism Supervisory Centre.—This would be organised in connection with existing Health Centres. The additional expenses involved would be the attendance of a Medical Consultant (£3 3s. per attendance) and a Health Nurse. Hospital Beds.—The required 20 beds could be established at Kingsbury, where space is available. The cost of erection of the last new pavilion, excluding foundations in part (12 beds on 2,000 cubic feet basis) was £4,169. Annual Maintenance of Rheumatism Supervisory Centre and Hospital Beds. Medical Consultant to attend the Centre once a week, and the Hospital once a week, and at such other times as may be necessary £300 Health Nurse (£255—£15—£345) £255 20 Hospital beds at £4 4s. per week, per bed £4,328 Clerical assistance. Total £4,883 GEORGE F. BUCHAN, Medical Officer of Health. 95 P.S.—With regard to the provision of 20 beds at Kingsbury, it should be noted : (1) That the maternity beds there provided are practically constantly full, and that there is no space to allow for the fluctuations in admissions of maternity cases. (2) That it has also been suggested that beds should be available at Kingsbury for the tions on tonsils and adenoids and deflected nasal septum for which the Council are responsible. (Note.—There were 552 such operations in 1930—106 in children under 5, and 446 in school children.) (3) That in connection with heart cases, some provision should be made for education while in hospital. It might, therefore, appear to the Committee desirable to consider the provision of beds with the other Committees concerned. In the meantime, however, it might be desirable to proceed with the establishment of the Rheumatism Supervisory Centre as outlined above. May, 1931. G. F. B. APPENDIX I. VARICOSE ULCERS. MEMORANDUM BY THE MEDICAL OFFICER OF HEALTH. The Health Committee at its last meeting had before them a letter from Dr. Haldin-Davis, the Council's Dermatologist, dated the 26th March, 1931, and instructed me to report further on the matter. Varicose Ulcers are frequent amongst working class women especially those who have borne children. Varicose ulcers constitute a distressing and painful condition and hitherto healing of the ulcers could only be successfully accomplished by a prolonged stay in bed, aided by other measures. The method of treatment referred to by Dr. Haldin-Davis in his letter enables healing of the ulcer to proceed while the patient goes about his or her usual avocation. I have consulted with Dr. Haldin-Davis as to the provision which might be made to give opportunities for this treatment in Willesden. As a tentative measure Dr. Haldin-Davis is prepared to see patients at the ordinary sessions at which he now comes to Willesden, namely, Wednesday and Thursday each week at Health Centres (1) and (3). It is not easy to say exactly how many patients will attend, but in any case such a tentative arrangement will enable information to be obtained. If provision is made by which these arrangements may become operative after the summer holidays, I would suggest that the sum of £100 would cover all the expenses likely to be incurred. GEORGE F. BUCHAN, Medical Officer of Health. June, 1931. 52, Harley Street, W. 1. 26th March, 1931. Dear Dr. Buchan, I should like to call your attention to the advances recently made in the treatment of varicose ulcer. As is well known ulceration of the leg, as a rule associated with varicose veins, is one of the most disabling and painful of the chronic but non-fatal complaints which affect the working population. These ulcers often last for many years, are always productive of a great degree of disability and in many cases absolutely debar those who suffer from them from doing work. The public hospitals (i.e., the institutions up till recently known as infirmaries) are always full of them, but the economic loss to the community by no means ends with the cases incarcerated in these buildings. Every medical man who is familiar with the out-patient departments of the hospitals all over the country can testify to the frequency with which patients suffering from "bad leg" throng the clinics. He will also admit, or he would have admitted until lately, the difficulty of treating them successfully. Owing to the unsatisfactory nature of these cases, and the difficulties of treatment they are not welcome patients and they are commonly relegated by those in charge of the clinics to the care of their assistants and frequently they fall into the hands of nurses and even of quite unqualified quacks. Within recent years however very important progress has been made in the treatment of this affliction. Largely owing to the work of Mr. Dickson Wright, a young London surgeon, we have learnt actually to cure ulcers of the leg without confining the patient to bed. In the past, bed has always been considered absolutely essential to their successful treatment and this has been one of the chief difficulties in dealing with these patients because there could never be a sufficient number of beds available for a sufficient time. Three months is a quite ordinary period for a bed to be 96 occupied by a patient before an ulcer can be healed soundly. Now however, owing to the development of certain principles it is possible to get ulcers of very considerable size to heal steadily without putting the patient to bed, and while he or she (more often she than he) continues normal avocations. I myself have been able to get ulcers measuring 3 ins. by 2 ins. to heal within three months. I enclose photographs illustrating a case. This treatment depends principally on the use of certain bandages which possess both adhesive and elastic properties. One of the chief elements in their success is the support which they give to the leg and the reduction of swelling which takes place in consequence. I venture to suggest that if the Council could see its way to undertake the treatment of ulcers in the leg on the lines indicated above they would be conferring a great boon on the working population of Willesden. I am of course aware that the question of expense is an important one and no new departure in medical treatment can be made without incurring some outlay of public money, but I really think that a good deal could be done for these sufferers without any considerable expenditure, and that to a large extent compensation would ultimately accrue by the release of beds now occupied by sufferers from ulcerated legs and by increased efficiency and earning power in those who are cured of the complaint. The progressive policy of Willesden in all matters relating to public health is well known and I submit that here is an excellent opportunity for the Council to add to its reputation in this respect and to do real good to the inhabitants of the district under its care. Believe me, Yours sincerely, (Signed) H. HALDIN-DAVIS. To be presented to the Health Committee, May 12th, 1931. APPENDIX J. MEMORANDUM BY THE MEDICAL OFFICER OF HEALTH. PRINCESS ROAD VOLUNTARY INFANT WELFARE CENTRE, 84, PRINCESS ROAD, KILBURN, N.W. 6. The Medical Officer of Health and the Chief Health Visitor visited the above on Wednesday, 28th January, 1931, at 2 p.m. The general arrangements of the waiting room, preparation rooms and doctor's room were satisfactory. There was also a room available for the isolation of a suspicious case. This room is also used from time to time as a School for Mothers. The Doctor and the Matron were interviewed. The average number of babies seen by the doctor at an afternoon session is approximately 25. The average number of ante-natal cases seen by the Doctor at a morning session is about 8. The methods of record keeping appeared satisfactory. Afterwards Mrs. Figgis, the Hon. Secretary and Dr. Radford, the Medical Officer, put the following points froward for consideration:- (1) That the Princess Road Infant Welfare Centre should be able to give free supplies of nutritive foods to mothers and children on the same conditions as free supplies are given at the Municipal Centres. (2) That for the purposes of clinic attendance and visitation of expectant and nursing mothers and children under five years, the Council should allocate a definite area in South Kilburn to the Princess Road Infant Welfare Centre. The Medical Officer of Health stated that it was likely that a booklet setting out the Council's Maternity and Child Welfare arrangements would be prepared shortly. He suggested that copies should be sent to Princess Road Infant Welfare Centre, that the Committee of the Princess Road Infant Welfare Centre should consider whether they desired to adopt any of the Council's arrangements, and that the Council in their tum might consider whether they desired to adopt any of the arrangements of the Princess Road Infant Welfare Centre, so that methods within the area might be as uniform as possible. THE " PRINCESS " DAY NURSERY, 45 & 47, CHICHESTER ROAD, KILBURN. The Medical Officer of Health and the Chief Health Visitor visited the Princess Day Nursery on Wednesday, 28th January, 1931, after the above visit. The general arrangements for the reception of children and the care of children at this Nursery are satisfactory. The Nursery is so arranged as to take 8 children under the age of 1 year, 20 children between the ages of 1 and 2½ years, and 24 children between the ages of 2½ and 5 years, or 52 in all. 97 The children pay 9d. a day, including two meals. For the children over 2½ years the room is arranged as a Nursery School under the charge of a teacher who has been trained at the Rachel MacMillan Nursery School. All the children seemed bright, clean and happy and the Nursery appeared to be well run. GEORGE F. BUCHAN, 10th February, 1931. Medical Officer of Health. APPENDIX K. To the Chairman and Members of the Health Committee. In accordance with instructions I beg to report on the powers of the Council where a sample of milk has been found to be tuberculous. Milk and Dairies (Consolidation) Act, 1915. 1. Power to take samples of milk is given under Section 8 of the above Act to the Medical Officer of Health or any person provided with authority in writing from the Local Authority. The samples of milk may be taken at any time before it is delivered to the consumer, but only within the area of the Local Authority unless a special authorisation to take a sample outside the area is given by the Minister of Health. Samples in Willesden for purposes of tuberculosis examination are taken from churns at the depots as received from the farms. 2. When the Sanitary Inspector takes the sample he ascertains the source of supply, i.e. the farm from which the milk came. 3. A sample of milk so taken is sent to the Lister Institute for examination as to tuberculosis. 4. Under Section 4 of the above Act if tuberculosis is found the Medical Officer of Health of the County in which the cows from which the milk was obtained are kept is informed of the fact. 5. It is the duty of the Medical Officer of Health of such county to cause the cattle in the dairy to be inspected, and to make such other investigations as may be necessary. The Medical Officer of Health of Willesden has the right to be present at the inspection, if he so desires, or the Willesden Council may send a qualified veterinary surgeon to accompany the veterinary surgeon of the county concerned. 6. The County Council concerned must inform the Willesden Council of any reports which have been made by the County Medical Officer or Veterinary Inspector or otherwise. The County Council must also give information as to the action which has been taken on these reports. Tuberculous Milk from Warwickshire. The Committee will remember that a particular sample of milk supplied by a farmer in Warwickshire was found to be tuberculous. The sample was taken on the 17th April, and tuberculosis was notified to the County Medical Officer on the 19th May, 1931. 22nd May, 1931.—The County Veterinary Officer inspected the farm. He took 4 samples of milk from individual cows which he thought might be suffering from tuberculosis, but these individual samples were negative. 22nd June, 1931.—The County Veterinary Officer divided the farmer's herd of cattle into three groups, and took a mixed sample of milk from each group. One of these samples from a group of nine cows proved to be positive ; the samples from the other two groups were negative. Subsequently the County Veterinary Officer paid another visit to the farm with the view of sampling individually the nine cows in the positive group, but three cows had been removed by the farmer, and the remaining six cows were negative to the tuberculosis test. The following letter, dated 20th October, 1931, has been received from the Medical Officer of Health of Warwickshire relative to this matter:— "In reply to yours of the 8th instant, the Clerk of the Council communicated with Mr. Cottrell on 1st August, 1931, referring in his letter to the animal he disposed of at the cattle market on the 22nd July, and which Mr. Cottrell admitted had shown signs of losing flesh and had developed a cough, and drew attention to his responsibility under the Tuberculosis Order. 98 The Clerk of the Council in his letter said:— 'You will no doubt appreciate that under the above Articles you are liable for prosecution for failing to report the animal above referred to. This Local Authority, however, do not propose to institute legal proceedings against you in this instance, but I am to warn you that in the event of a similar occurrence the necessary legal proceedings will be instituted under the Articles referred to above.' The animal referred to was sold for slaughter on July 22nd, but unfortunately I have not been able to obtain particulars of the condition of the animal 'post-mortem.' I think, however, it can quite safely be concluded that this was the source of tubercle in the milk. The last bulk sample of the remaining six cows, you will no doubt remember, proved negative." Tuberculosis Order. The Tuberculosis Order referred to in the above letter is administered by County Councils and County Borough Councils. The particular Article against which the farmer offended appears to be Article 11, which is as follows:— "11.—(1) Every person having in his possession or under his charge any cow which is, or appears to be, suffering from chronic disease of the udder, or any bovine animal which is, or appears to be, suffering from tuberculous emaciation, or is suffering from a chronic cough and showing definite clinical signs of tuberculosis, shall keep the animal isolated as far as practicable from other bovine animals, and also keep the animal in his possession or under his charge until the animal has been examined by a Veterinary Inspector in accordance with the provisions of this Order, and the owner or person in charge thereof has been notified that this Article has ceased to apply to the animal. (2) A Local Authority, or a Veterinary Inspector on their behalf, shall by written notice to the owner or person in charge of the animal, apply this Article to every bovine animal examined under this Order, and such Article shall apply accordingly." GEORGE F. BUCHAN, November, 1931. Medical Officer of Health. APPENDIX L. WILLESDEN URBAN DISTRICT COUNCIL. MATERNITY AND CHILD WELFARE. MATERNAL MORTALITY. NOTES BY THE MEDICAL OFFICER OF HEALTH ON CIRCULAR 1167 AND MEMO. 156/M.C.W. OF THE MINISTRY OF HEALTH. These documents state that not less than 50 per cent. of maternal deaths are preventable by:— (1) Ante-natal care. (2) Better practice and treatment by doctors and midwives. (3) Reasonable facilities for effective medical care. (4) Better attention by the patient to the medical advice offered. Ante-Natal Care. This has to be provided for the following classes:— (1) Insured women— (a) who arrange for hospital confinement: (b) who arrange for confinement at home by a midwife ; (c) who arrange for confinement at home by a doctor. (2) Uninsured women— (a) who arrange for hospital confinement; (b) who arrange for confinement at home by a midwife; (c) who arrange for confinement at home by a doctor. Insured Women. (a) Who arrange for their confinement at a hospital. These women usually receive antenatal care at or in connection with the hospital. (b) Who arrange for confinement at home by a midwife. These women may have antenatal care at the Municipal Health Centres. Otherwise they may have ante-natal care from their Panel Doctor, as according to Memo. 156/M.C.W., p. 3, para. 4, the insurance practitioner is responsible for medical attendance during pregnancy. (c) Who arrange for confinement at home by a doctor. These women may have ante-natal care from the doctor engaged for the confinement or from their Panel Doctor. 99 Uninsured Women. (a) Who arrange for their confinement at a hospital. These women usually receive antenatal care at or in connection with the hospital. (b) Who arrange for confinement at home by a midwife. These women may have ante-natal care at the Municipal Health Centres. (c) Who arrange for confinement at home by a doctor. These women may have ante-natal care from the doctor engaged for the confinement. While the foregoing is a statement of the general position, it should be observed that in Willesden a considerable proportion of women either insured or uninsured who engage a midwife attend the Health Centres for ante-natal care. This proportion is increasing, since the Willesden Council became the local supervising authority under the Midwives Acts. Memo. 156/M.C.W. states that "it is desirable to associate doctors and midwives practising in the area much more directly with the clinic and its staff." As stated above, midwives may send patients to the centre. Midwives always receive reports from the doctors at the Centres as to the condition of their patients. If their patients fail to attend the Centres the midwives are informed, so that they may follow up the case as they may consider desirable. In respect of doctors, they seldom refer their cases, whether insured or uninsured, to the antenatal centres of the Local Authority. But the ante-natal services provided at the Centres are available for the patients of doctors should such patients attend. Paragraph 5 of Memo. 156/M.C.W. states: "and in towns there are many women who cannot be persuaded to attend the Centres." I doubt if this applies to Willesden. For such women, however, it is suggested in the Memo. that arrangements might be made by the Willesden Council with private medical practitioners for the ante-natal examination at home of those uninsured women who are reluctant to visit the Centre. Such uninsured persons might be the prospective patients of a midwife or doctor at confinement. In any case, it is suggested that the private practitioner with whom these ante-natal arrangements are made should be the doctor likely to be called in at the confinement. It is also suggested in the circular that the doctor should be provided with the services of a nurse or health visitor for the following up of the case and the subsequent supervision. Paragraph 7 of the Memo. 156/M.C.W. is somewhat involved. It states that ante-natal supervision is to be adequately performed. It states that the Medical Officer of an ante-natal centre requires special experience in midwifery and ante-natal work. It states that it may be advantageous to employ part-time private practitioners with such special experience. But it also states that any doctor, whether qualified by the regulations or not, should be able to see his patient at the Centre if the patient or doctor (the paragraph does not make clear which) so desires. Any pregnant woman in Willesden may have ante-natal care at the Council's Health Centres. This includes examination by a Consultant Obstetrician and following up at the home by a qualified nurse, who is also a midwife. The Ante-natal Clinics are available for patients of midwives if they care to send them. They are also available for the patients of doctors and the Council's Obstetrician will consult with the doctor, and advise as to the course to be taken in any ante-natal case that the doctor cares to send to the Centres. In the case of those women who book for confinement in the Willesden Maternity Hospital ante-natal care is obtained from the Consultant Obstetrician, who subsequently is responsible for the confinement. It would probably be desirable that a statement should be issued to doctors and midwives practising in Willesden, stating what facilities are provided, so that they may utilise them as they may consider necessary. (2) Better Practice and Treatment by Doctors and Midwives. This really depends on a higher standard of education and training of both doctors and midwives. In respect of doctors, the Local Authority at present does not provide facilities for the training of doctors. In respect of midwives I am of opinion that with the establishment of the Maternity Hospital steps should be taken at an early date to provide suitable training for pupil midwives. The hospital presents admirable facilities for such training. It should also be noted that if the hospital were a training school the untrained probationer would be replaced by a trained nurse who was a pupil midwife in training, and thus considerable advantage would accrue to the patients. A difficulty that may arise is in connection with midwifery in the district, each pupil midwife having to conduct 5 cases in the district, in addition to 15 in the hospital. Paragraph 3, on p. 5 of Memo. 156/M.C.W., refers to the distribution of midwives and the employment of municipal midwives. In Willesden there are 26 private practising midwives, and according to the records received each conducts on the average about 25 confinements per annum. Allowing that payment is received at the rate of 2 guineas per case, it will be observed that the private practising midwife makes on the average but poor living. Paragraph 4, on p. 5, suggests the importance of having a midwife to act as a maternity nurse where the doctor is engaged for the confinement. This practice has been adopted by the 100 Willesden Council in all necessitous cases for which they assume responsibility. The suggestions in this paragraph are that it should extend to all cases, and the Local Authority should make up any difference in the fees payable. In order to do this the co-operation of the doctors practising in the district is required, as stated in the paragraph. If the Council agree to this suggestion, practising doctors should be informed accordingly, and prior applications should be received from the patients concerned. (3) Reasonable Facilities for Effective Medical Care. All facilities, including the services of a Consultant, are available in Willesden for the medical care of the expectant mother and at her confinement. The number of beds at the Willesden Maternity Hospital (for 500 cases per annum) is not more than sufficient to meet the present requirements, and the present demand under the conditions of admission which have been laid down by the Council. The numbers booked for confinement have shown a steady rise during the last few years, as follows No. of Cases Booked for Year Confinement in Hospital 1924 99 1925146 1926 220 1927 221 1928 272 1929 334 1930 402 In addition to the above cases a number were admitted on account of complications of pregnancy or arising after confinement. Under Section 4 (hospital beds) on p. 6 of Memo. 156/M.C.W., it is suggested that the practicability of offering facilities for private practitioners to attend their own cases in maternity institutions should be considered. With regard to Section 5 on p. 6 (Provision of Ancillaries), all the items there mentioned are provided in Willesden. In respect of sub-section 3, however (Supply of milk for expectant and nursing mothers) this is only available for women who attend the Health Centres, if recommended by the doctor at the Centre. (4) Better Attention by the Patient to the Medical Advice offered. This can only be secured by the education of the patient as to the importance of care during pregnancy and at confinement. A step towards this education would be taken if the public generally were aware of the services the Council considered desirable in connection with maternity. It is suggested that a booklet should be issued to doctors and midwives stating the facilities available. Emphasis might be put on the importance of the utilisation by the patient of the various services. It might also be represented that the co-operation of patient, midwife and doctor, one with the other and all with the Local Authority, is highly desirable in the best interests of the community, and that each has a part to play. Recommendations. 1. That a booklet be prepared giving full information as to the facilities which exist in respect of Maternity (and Child Welfare). 2. That such booklet be given to all Doctors and Midwives. 3. That the booklet or similar information be given to such others of the public as may be considered desirable. 4. That arrangements be made for doctors, if they so desire, to examine at the Health Centres, patients—either those who directly engage the doctor or those in respect of whom the doctor may be called in by the midwife in an emergency. 5. That if it is so desired, the Council will be prepared to make up the deficit in cases where midwives are employed as Maternity Nurses whenever a Maternity Nurse is required. It may be that in some cases Home Helps would be employed with Midwives. 6. That steps be taken to secure the recognition of Willesden Maternity Hospital as a Training Centre for Midwives. 7. That all practising Midwives be afforded the opportunity of attending lectures and refresher courses from time to time. 8. That the Committee consider the question of the supply of milk for expectant and nursing mothers attending Allied Centres on the same terms as this supply is given at the Municipal Centres. GEORGE F. BUCHAN, 10th February, 1931. Medical Officer of Health.