C.I. AC 439 (1) Willesden Wil 28 Willesden Urban District Council. 1932. THE 57th ANNUAL HEALTH REPORT. London: WIGHTMAN & CO., LIMITED, Regency Street, Westminster, S.W.1, and Dugdale Street, S.E.5. GEORGE F. BUCHAN, M.D., F.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 Public Health, Conjoint Examining Board, England ; Chairman of Council, Royal Sanitary Institute. WILLESDEN URBAN DISTRICT EDUCATION COMMITTEE, 1932-33. 2 WILLESDEN URBAN DISTRICT COUNCIL, 1932-33. †Mr. Councillor H. LEIGH MOSSLEY, J.P. (Chairman of the Council). †Mr. Councillor GEO. H. HISCOCK (Vice-Chairman of the Council). †*Mr. Councillor C. BERESFORD. Mr. Councillor C. L. BLAND. †*Mr. Councillor H. C. BLAXLAND (Chairman (Acting), Health Committee). †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. †*Miss Councillor N. M. COWAN. *Mr. Councillor A. E. DORAN. Mr. Councillor H. E. DULCKEN (Resigned 24th May, 1932). Mr. Councillor J. FERNLEY. 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 J. G. KENYON (Elected 15th June, 1932). Councillor The Rev. T. D. LLOYD (Elected 25th March, 1933). †MR. Councillor J. L. MAGNUS (Resigned 15th April, 1932). †MR. Councillor A. C. MELLUISH. †MR. Councillor J. MORSE. Mr. Councillor A. NEATE (Elected 5th May, 1932). †*MR. Councillor GEO. PAGE (Chairman, Children's Care Sub-Committee). *Mr. Councillor H. W. PROTHERO. Mr. Councillor N. A. REMMERS. ‡†Miss Councillor M. E. ROYLE, J.P. (Chairman, Health Committee). 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. ‡ Died 27th February, 1933. 3 Town Hall, Dyne Road, Kilburn, N.W. 6. 1st May, 1933. 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 1932. This Report includes:— (i.) The 57th Annual Report on the health and sanitary condition of the district; (ii.) The 25th Annual Report on the health of children attending the public elementary schools; (iii.) The 13th Annual Report on the health of children attending secondary and trade schools; (iv.) The 15th 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 3rd Annual Report on the Supervision of Midwives; (vi.) The 3rd Annual Report on the Registration of Nursing Homes; (vii.) The 3rd Annual Report on Infant Life Protection; (viii.) The 13th Annual Report on home nursing; (ix.) The 18th Annual Report on the provision of meals to children attending the public elementary schools; (x.) The 41st Annual Report on the Municipal Hospital; (xi.) The 2nd Annual Report on the Maternity Hospital; (xii.) The 3rd Annual Report on the health of patients attending the Middlesex County Council Occupation Centre for Mentally Defectives, Buller Road, Willesden ; (xiii.) The 2nd 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, 1932, was 188,216. 2,745 live births were registered during 1932, giving a birth rate of 14.58 per 1,000 of the population, as against 15.28 in 1931. 107 still births were registered, giving a still birth rate of 37.52 per 1,000 total live and still births. 1,838 deaths were registered in 1932, giving a death rate of 9.77 per 1,000 of the population. These figures compare with a total number of deaths of 1,935 and a death-rate of 10.42 in 1931. The infant mortality rate in 1932 was 61.20 per 1,000 births. 168 deaths of infants under one year occurred. 131 or 78 per cent. of these 168 deaths were due to:— 1. Congenital Malformations 10, Premature Birth 40, Atrophy, Debility and Marasmus 12, Atelectasis 4; 2. Diarrhoea and Enteritis 31; 3. Whooping Cough 1; 4. Measles 4; 5. Bronchitis 3, and 6. Pneumonia 26. 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. CANCER. The heavy death-rate from cancer continues in all countries in which there are reliable statistics. In Willesden in 1932 there were 250 deaths from this cause as compared with 250, 214, 239, 240 and 217 in the years 1931 to 1927. 4 Two Cancer Clinics are held ; one at Health Centre 1 on the first and third Thursdays of the month, from 7 to 8 p.m., and the other at Health Centre 2, on the second and fourth Thursdays of the month at the same hour. No treatment is attempted, the object being to get early contact, to secure expert diagnosis and treatment if necessary, or to give reassurance as the case may be. Treatment or further diagnosis is obtained at certain of the larger London Hospitals with which the Council has made satisfactory working arrangements. If a patient is under a private doctor who can be located, the latter is communicated with, and the result of any examination or advice as to treatment is made known to him as soon as possible. There has been a slight falling off in the attendances at the Clinics held, but it is noticeable that the attendance invariably improves after any special effort at propaganda in the form of posters, leaflets, advertisements, articles in the local press or talks given at the Schools for Mothers. Further, it may well be that as a result of the efforts in this direction more patients are attending their private doctors for doubtful conditions, and are getting advice and treatment from them. But it appears that the education of the public in health, to be really effective, must be both penetrating and continuous. During 1932, 59 patients attended these Clinics, of whom 44 were new cases (14 men and 30 women) and 15 had attended during 1931 and were still under observation at the end of that year. The number of new cases during each of the last three years has been : in 1930 71, in 1931 80, and in 1932 44. The total of attendances made in 1932 was 99, making an average of about two per session. Of the 44 new cases 7 were found to live out of the district and were dismissed after being suitably directed. The remaining 37 cases after examination were disposed of as follows:— 21 were referred to a hospital for further investigation; 8 were referred back to their own doctor; or to a hospital which they had been attending; 6 were kept under observation and asked to re-attend (1 of these was finally discharged before the end of the year; 1 was reassured and discharged on first visit; 1 was referred to a dentist. Of the 21 who were referred to hospital:— 6 were found to require operation (5 have been operated upon; 1 has refused operation); 5 were reassured and dismissed after their first visit; 4 have received or are receiving treatment at hospital as out-patients, or are being kept under observation there; 6 have not attended hospital after appointments had been made, or have not completed the investigation. The pathological conditions from which the 44 new cases suffered are briefly as follows :— 5 cases suffered from affections of the female genital organs; 4 had conditions often found to be pre-cancerous; 1 was found to be pregnant; 6 cases had abnormal breast conditions; 5 (including 1 man) had chronic inflammation; 1 was an old case of treated cancer, now suffering from bronchitis ; 8 cases had conditions affecting the alimentary tract which occasionally lead to cancer; 10 cases had innocent tumours of the body wall or skin; 15 cases had conditions unconnected with cancer, but which were causing anxiety or requiring treatment. The Nurse attached to the Clinic, where these are welcomed, pays following-up visits to the homes of patients attending. During last year 102 such visits were made. The Nurse also visits homes in which a death from cancer has taken place, and where disinfection has been requested. Information obtained in this way is recorded, but so far has not brought any important facts to light. There is still a large amount of reticence shown by a sufferer from cancer, and also by the relatives of a deceased case. Part of this is undoubtedly due to a widespread dread of the disease, but part is due to the belief, still existent in the minds of many, that cancer is connected with dirt, or overcrowding, or irregularities of living, or in some other way which makes it advisable from self-respect for it to be concealed. 5 This is the worst possible attitude of mind if the Clinics are to proceed with their work of detecting the early case and providing for it suitable treatment. All that can be deduced from statistics dealing with the origins of the disease is that there is no causal connection such as mentioned above, neither is there any definite evidence that cancer is infectious, nor that a tendency to it can be inherited. At the same time, each year has shown an improvement in surgical and other technique (such as radium, X-rays, etc.) for the treatment of the disease, and it can now be safely said that in some sites, not only is early cancer curable, but easily curable. Even in the more remote sites, cancer, if taken early, shows a considerably greater successful-treatment rate than before. The essential thing, therefore, is to get the knowledge of the disease early. For this the unwholesome fears and secrecy associated with cancer must be swept away and facilities continued for its detection and for setting in motion the best possible treatment at the earliest stage. INFECTIOUS DISEASES. During the year 1932, 2,164 cases of Infectious Disease were notified as compared with 2,212 in the previous year. The total of 2,164 includes 247 notifications of Diphtheria as compared with 310 in 1931. The lowest since 1916. 421 cases of Scarlet Fever as compared with 467 in 1931, 351 cases of Pneumonia as compared with 392 in 1931 and 673 cases of Whooping Cough as compared with 514 in 1931. Return Cases of Scarlet Fever.—The following statement gives the return cases that have occurred during 1932:— I. Home Cases.—Approximately 47. (a) No. of infecting cases giving rise to return cases not longer than 28 days after release from isolation 0 „ return cases they gave rise to 0 „ infecting cases per cent. of total home cases 0 „ return cases per cent. of total home cases 0 (b) No. of infecting cases giving rise to return cases more than 28 days after release from isolation 1 „ return cases they gave rise to 1 „ infecting cases per cent. of total home cases 2.1 „ return cases per cent. of total home cases 2.1 II. Hospital Cases.—Approximately 374. (a) No. of infecting cases giving rise to return cases not longer than 28 days after discharge 21 „ return cases they gave rise to 29 „ infecting cases per cent. of total hospital cases 5.6 „ return cases per cent. of total hospital cases 7.8 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 5 „ return cases they gave rise to 5 „ of infecting cases per cent. of total hospital cases 1.3 „ return cases per cent. of total hospital cases 1.3 Small Pox.—No cases of Small Pox were notified in 1932. No vaccinations were performed by the Medical Officer of Health under the Public Health (Small Pox Prevention) Regulations, 1917. Typhoid Fever.—Ten cases were notified during 1932 as against 15 in 1931. Six of these cases were removed to the Municipal Hospital. Of these 6, 1 was diagnosed as Typhoid Fever. This was a severe toxic case which proved fatal. The patient was a man of 30 years, employed as a traveller, who visited various parts of the country each week, returning to his home in Willesden for the week-ends. One was diagnosed as Paratyphoid B and recovered. One was diagnosed as scarlet fever, 1 as influenza, and 1 as gastro-enteritis. All these 3 recovered. The sixth patient was diagnosed as suffering from enteritis and died, the immediate cause of death being lobar pneumonia and erysipelas (postmortem held). One case was admitted to University College Hospital and was progressing satisfactorily at the end of the year. The remaining 3 cases were nursed at home. Of these 1 proved fatal, a woman of 60 years, the death being certified as due to (a) broncho pneumonia, (b) paratyphoid fever. 6 One death was recorded from Typhoid Fever and 1 from Paratyphoid Fever during 1932. Infectious Diseases of the Nervous System, Cerebro-Spinal Meningitis, Poliomyelitis, Encephalitis Lethargica and Acute Polio-Encephalitis.—25 cases of these diseases were notified in 1932, 12 proved fatal, giving a fatality rate of 48 per cent. of notified cases. One of the fatal cases was not a Willesden resident, and the death, therefore, was not allocated to Willesden. In another case the patient did not die until 1933 and the death, therefore, will not appear in the death tables until next year. 10 deaths in all were attributed to these diseases in Willesden in 1932. Since the autumn of 1931, in accordance with the request of the Ministry of Health, reports have been sent to the Ministry in cases of Cerebro-Spinal Fever, giving information desired by the Ministry as to the use and results of anti-meningococcus serum treatment. Whooping Cough is a notifiable disease in Willesden. 673 cases were notified during the year, but a total of 1,189 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 1932, 1,837 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 5,777 occasions ; nursing mothers, 22,908, and children under 5, 55,657, making a total of 84,342 attendances. Out of the total number of 2,745 children born during the year, 1,496 or 54 per cent. subsequently attended the Welfare Centres. Altogether, however, 2,174 children under 1 year of age attended the Centres for the first time during the year. This represents 84 per cent. of the 2,581 notified live births belonging to Willesden, and 79 per cent. of the 2,745 registered live births belonging to Willesden. 778 children between the ages of 1 and 5 years attended the Centres for the first time during the year. The number of live births occurring amongst expectant mothers who attended the AnteNatal Clinics was 929; 71 per cent. of these mothers with their babies subsequently attended the Welfare Centres. Hospital Maternity Cases.— Bookings.—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 :— 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 1923 140 Municipal Hospital Pavilion closed, 30th April, 1923. Cases sent to Park Royal Hospital. 1924 99 1925 146 1926 220 1927 221 1928 272 1929 334 1930 402 1931 535 1 Willesden Maternity Hospital opened, 14th February, 1931. Cases no longer sent to Park Royal Hospital. 1932 544 Table No. 2.—Applications for Booking Refused. No beds available 16 Not resident in Willesden 37 Will not have had 12 months' residence in Willesden prior to expected date of confinement 125 Unable to pay anything 12 Sufficient home accommodation 63 Balance in respect of last confinement still owing to Council 1 Unwilling to give address 1 255 7 At the beginning of the year, in view of the number of applicants for admission to the Willesden Maternity Hospital, it became apparent that it would be necessary to further restrict the bookings. The Council at its meeting on the 26th January, 1932, accordingly passed the following resolution (a) That in consequence of the limited accommodation at present available at the Maternity Hospital, it be an instruction to the Medical Officer of Health to give preference in bookings to necessitous cases, whether medical or economic, thus temporarily relieving the pressure on the resources of the Hospital, the bookings for which shall not exceed 45 cases in any one month. (b) That bookings be restricted to persons having twelve months residence in the district prior to the expected date of the confinement. During 1932, 255 applicants for confinement in the Willesden Maternity Hospital were unable to be booked, either because no beds were available for the expected month of confinement, or because the applicants did not come within the Council's Scheme. The following table gives information as to the cases refused:— The following Table shows the fees at which the 544 cases were booked :— Table No. 3. Fee. No. of Cases. Fee. No. of Cases. £8 8s. Od 12 £3 0s. 0d 25 £6 0s. Od 7 £2 10s. 0d 43 £5 10s. O 0 £2 0s. 0d 47 £5 0s. Od 6 £1 10s. 0d 56 £4 10s. Od 13 £1 5s. 0d 58 £4 0s. Od 19 £1 0s. 0d 239 £3 10s. Od 19 The average fee per case is approximately £1 18s. 5d. Hospital Confinements.—During 1932, 543 women were confined in the Willesden Maternity Hospital. In addition to these an approximately equal number of Willesden mothers were confined in institutions outside Willesden, 487 births of Willesden residents being notified from such outside institutions — 173 from Queen Charlotte's Hospital, 65 from Queen Mary's Maternity Home, Hampstead, 27 from Middlesex Hospital, 26 from St. Mary's Hospital, 21 from University College Hospital, and smaller numbers from other hospitals; 51 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. A report on the Willesden Maternity Hospital by Mr. Arnold Walker, the obstetrician, appears later on in this report. Frequent requests for admission to the Willesden Maternity Hospital are received from residents in adjoining areas. Ante Natal Work for Institutions not under the Council.—Requests are received from the Middlesex County Council and from various London Hospitals for home visits to expectant mothers, and special reports by the Council's Health Visitors in connection with women who are to be confined in these Hospitals. 76 such reports were supplied to London Hospitals during the year and 37 to the Middlesex County Council during the last four months of the year. 8 Fifty such reports have been supplied to the Middlesex County Council during the first 3 months of 1933. 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 1932:— Table No. 4. — Willesden General Hospital. St. Monica's Home Hospital. Total. No. of Children in Hospital at 31st December, 1931 5 7 12 No. of Children admitted during 1932 172 13 185 Total No. of Children under treatment during 1932 177 20 197 No. of Children discharged during 1932 175 14 189 No. of Children died in Hospital during 1932 2 3 5 Mortality % 1.13 15.0 2.53 No. of Children remaining in Hospital at 31st Dec., 1932 0 3 3 The following table gives particulars of the conditions for which children were treated during 1932, the treatment carried out and the results of such treatment:— Table No. 5.—Children under 5 Years under Treatment in Hospital during 1932. 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. 8 24 32 — 29 — 6 16 2 5 3 Enlarged Tonsils and Adenoids 4 161 165 165 — — 165 — — — — Total 12 185 197 165 29 — 171 16 2 5 3 Puerperal Fever.—During 1932, 8 cases of Puerperal Fever were notified as against 14 in 1931, 5 in 1930, 6 in 1929, 6 in 1928, and 5 in 1927. This gives a case rate of 2.9 per 1,000 registered live births, as against 4.9 in 1931, 1.7 in 1930, 2.21 in 1929, 2.25 in 1928, 1.95 in 1927. The figure for 1932 is 2-8 per 1,000 registered total births. Of these 8 notified cases 2 proved fatal. One of these fatal cases was not a Willesden Resident and the death was therefore not allocated to Willesden. The 5 other deaths appearing in the death table under puerperal sepsis were those of a case notified as puerperal pyrexia and 4 cases which had not been notified. Taking the 2 deaths occurring amongst the 8 cases of puerperal fever notified in Willesden, this gives a case mortality of 25 per cent. as against 14.3 per cent. in 1931, 20 per cent. in 1930, 50 in 1929, 33.4 in 1928 and 60 in 1927. The maternal mortality from sepsis was 2.2 per 1,000 registered live births or 2.1 per 1,000 registered total births. The maternal mortality from all causes was 4.0 per 1,000 registered live births or 3.8 per 1,000 registered total births. In 3 of the notified cases a private doctor was in attendance at the confinement at home. 1 of these confinements was instrumental. In 1 case a midwife attended the confinement at home. These 4 patients recovered. The other 4 cases were cases of miscarriage at home. Two of these patients recovered and two died. 9 Table No. 6—Puerperal Fever Cases, 1932. 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 (miscarriage) 2 4 4 8 1 3 2 3 5 1 3 1 2 3 1 3 3 2 5 1 4 2 2 4 2 (miscarriages— 1 fatal) No information. Puerperal Pyrexia.—22 cases were notified during the year. 2 of these 22 cases proved fatal, one of the fatal cases being a miscarriage. During 1932 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. During 1932, 93 were supplied free, 15 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 1932. (3) Provision of Ancesthetist.—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. 1 such fee was paid in 1932. 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 1932. 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. The action taken by the Authority in the light of Circular 1167 and Memorandum 156/MCW was set out on page 9 of last year's report. The Willesden Maternity Hospital has now been recognised as a Training School for Midwives, and the training of midwives will commence as from April 1st, 1933. Health Visiting and Medical Inspection of Children between the Ages of 1 and 5 Years. The practice described under this heading on page 9 of the Annual Report for 1931 was continued during the current year. Routine medical inspection of pre-school children was commenced in September, 1930, and is held at special infant welfare consultations at the Health Centres. When a child reaches the ages of 18 months, 2 years, 3 years and 4 years it is visited by the Health Visitor, and the mother is invited to attend the Centre with it for medical inspection. If the mother accepts, a special appointment is made, and she is given an invitation card to show to the clerk on arrival. There is close co-operation between the clerk, the Health Visitor and the Medical Officer, so that every child has proper time and attention given to it. Children already under supervision at the ordinary sessions are given special appointments when they reach the medical inspection ages, as it was found that they could not be adequately dealt with at the ordinary sessions without holding up the other cases. The mothers also prefer this method. The areas dealt with vary, some being poor with many mothers out at work ; consequently only a proportion of invitations are accepted, and only a proportion of those accepting actually turn up. The existence of this examination is well recognised by now, and mothers are beginning to remind the nurse or doctor that the child is ready for his medical inspection. The aims are:— (1) To detect defects and have them remedied. 10 (2) To look out for and try to check the earliest deviation from the normal in the functioning of mind or body. These deviations may be very slight but they are entered as defects and regarded with suspicion. (3) To give the mother constructive as well as preventive ideas on the subject of mental and physical hygiene. (4) To study the previous histories as regards food, illnesses, and environmental ditions in their bearing on the production of defects. In the period under review 1,316 inspections were made of which 224 occurred in 1930, 497 in 1931 and 595 in 1932. Certain unselected records are not available, and this report is based on 1,249 inspections, grouped as follows:— 18 months 333 3 years 279 2 years 424 4 years 213 Findings of Medical Inspections.—The following table shows the numbers and percentages of individual defects Table No. 7. Age Period. 18 months. 2 years. 3 years. 4 years. Total. Percentage. Number of children inspected 333 424 279 213 1,249 Malnutrition (including slight degrees) 15 22 25 18 80 6.4 Skin conditions 9 22 18 7 56 4.5 Eyes—Blepharitis and Conjunctivitis — 10 2 - Squint 5 2 5 1 28 2.2 Other conditions — — 2 1 Ears—Otitis media 2 1 — 3 0.2 Nose and Throat—Enlarged tonsils or adenoids or both 49 122 99 68 338 26.9 Enlarged cervical glands 7 11 16 6 40 3.2 Teeth—Dental diseases 6 19 74 59 158 12.6 Heart disease and anaemia 3 5 7 3 18 1.4 Lung disease (non-tubercular) 11 20 10 2 43 3.4 Nervous system — 1 5 5 11 0.9 Deformities—Rickets 55 53 45 20 173 13.9 Others 11 2 2 1 16 1.3 Thread worms 1 2 3 9 15 1.2 Other defects 6 14 11 10 41 3.3 This medical examination of children under five years shows clearly by its findings the need for treatment before school age of many of the conditions originally discovered in school entrants. It also answers the question why these entrants do not come into school in an entirely healthy state, and points the way to improvement. It is of great interest and educative value to the medical officer, and probably of equal educative value to the mother in guiding her as to the nurture of her children. It also leads to the correction in an early stage of many conditions which might otherwise have caused serious ill health or unnecessary physical imperfection. In so far, then, as it goes, it is an excellent method of caring for the pre-school child in the area, and is a great advance on what was done previously. The weak point about routine medical inspection by invitation is that the better type of mother is the one more likely to accept it, and the children more in need of care are less likely to be reached. Indeed, it is probable that failing some statutory obligation to attend, the full benefit of all the facilities for health education and prevention of defects open to children under five years of age will not be received by them. Ophthalmia Neonatorum.—The number of cases of this disease notified during the year was 28, as against 41 last year, giving a case rate of 10.2 per 1,000 registered live births. A private doctor attended at the confinement in 9 cases, a midwife in 10 cases, 8 cases were born in hospital, and in 1 case no information was available. Treatment was obtained at a hospital in 10 cases, at the Municipal Centres in 8 cases, at a Voluntary Centre in 1 case, by a private doctor at home in 8 cases, and in 1 case no information was available. Complete recovery with unimpaired vision occurred in 25 cases. In 3 cases the result of treatment was not ascertained. 11 The following table gives particulars:— Table No. 8. Cases. Vision unimpaired. Vision impaired. Total Blindness. Deaths. Result not known. Notified. Treated. At Home. In Hospital. 10 - 10 9 - - - 1 9 - 9 (Health Centres) 9 - - - — 8 8 — 7 - - - 1 1 (No information) 1 28 cases of inflammation of or discharge from the eyes of infants or of cases of ophthalmia neonatorum entering Willesden after notification elsewhere 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. The work has proceeded on the same lines as outlined on page 10 of last year's report. During 1932, 552 Mothercraft sessions were held, with 6,536 attendances of mothers, and 6,227 attendances at the nurseries. THE SCHOOL MEDICAL SERVICE. Schools.—There are 36 public elementary schools in the district. Of this number 24 are Council and 12 church or non-provided schools. Included in the number of the Council schools are 2 special schools, 1 for mentally defective and 1 for physically defective children. The hygienic condition of the schools in Willesden is very variable. Many of the more modern schools leave little to be desired as regards ventilation, lighting, warming, equipment and sanitation, but some of the other schools fall short of the standard desirable. Water to the schools is supplied in all instances direct from the mains of the Metropolitan Water Board. Adequate facilities are provided for the supply of drinking water for the scholars. Medical Inspection.—During the year ending 31st March, 1932, the average number of scholars on the Public Elementary School Rolls, including the Special Schools, in Willesden was 21,086. 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 1932 was 13,795. Findings of Medical Inspections.—(a) Uncleanliness.—Cleanliness inspections were carried out in the schools on 579 occasions during the year 1932, the average number of visits paid to each school by the Health Visitor being 17. The total number of examinations and re-examinations made during the year was 57,842. 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 those days a child was not called nitty or verminous except there were many nits on the hair. In 1932 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 1932, at routine and special medical inspections, 1,394 cases of enlarged tonsils and adenoids were discovered, as compared with 1,668 found in 1931, 2,021 in 1930, 1,773 in 1929, 2,070 in 1928. 12 (c) Skin Disease.—During 1932, at routine and special medical inspections, 1,607 cases of skin disease were detected, as compared with 1,807 in 1931, 1,888 in 1930, 1,809 in 1929, 2,241 in 1928. (id) Enlarged Cervical Glands (non-tuberculous).—During 1932 at routine and special medical inspections 285 cases of this defect were noted as compared with 302 in 1931, 505 in 1930, 380 in 1929, 315 in 1928. 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 requiring treatment 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 as may be necessary, in order to ascertain if the 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 1932 school children were followed up by the Health Department on account of 17,371 medical defects and 8,839 dental defects. Of those defects found to require treatment, medical or dental treatment was obtained for 16,361 and domestic treatment was obtained for 3,566. 87 per cent. of the medical defects were treated, 65.6 per cent. receiving medical treatment and 21.4 per cent. domestic treatment, 62 per cent. of the dental defects followed up were treated. No record is available of defects requiring treatment which were not followed up. 90 per cent. of the total medical defects treated and 99 per cent. of the total dental defects treated were dealt with by the Education Committee. The remainder, or 10 per cent. of the medical defects and 1 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 99,542 attendances at the Health Centres in 1932, as compared with 92,231 in 1931. Removal of Enlarged Tonsils and Adenoids.—Considerable reference has been made to the necessity for this operation in the medical and lay press. In these circumstances it may be interesting to state the practice in Willesden. The tonsils, which are placed on either side of the palate at the back of the mouth, and the adenoids, which are placed above the palate at the back of the nose, are concerned, in common with all lymphatic gland structure, in preventing the spread of infection. They may be looked upon as a line of first defence. If they are infected they usually become enlarged and thus enlargement may be looked upon as evidence that they are, or have been, infected. The proportion of children suffering from enlargement of their tonsils and adenoids will vary with their exposure to infection and their powers of resistance. It is not surprising, therefore, that the numbers of children so affected are found to be greater in urban than in rural communities, since in the latter there is less exposure to infection and living generally is more healthy. The numbers of school children in Willesden, found to have enlarged tonsils or adenoids or both in the last six years, together with the numbers operated upon, are shown in the following table. An additional column is added to show the number of children under 5 years of age who also were operated upon. Table No. 9. Medical Inspection of School Children Routine and Specials. Received operative treatment * (Authority's Scheme or otherwise.) Children under 5 who received operative treatment under the Authority's Scheme. Nos. Inspected. Nos. requiring treatment. Nos. requiring observation. 1932 13,795 1,053 341 595 165 1931 13,180 1,279 389 791 144 1930 13,800 1,562 459 785 106 1929 14,378 1,575 198 859 80 1928 16,327 1,756 314 873 99 1927 15,928 1,599 386 947 96 * These numbers may include a very few other defects of the nose and throat. Mere enlargement by itself however, is, if of moderate dimensions, an insufficient indication for removal of tonsils and adenoids. Enlargement, as has been pointed out, is a reaction to infection and it may be expected that, as with other glandular structures, when the infecting element has been removed the gland will return to almost normal size. This state of affairs does, in fact, occur in some cases of enlarged tonsils or adenoids, in which event no further treatment is necessary. In the majority of cases, however, the structures remain enlarged and, what is more important, they become 13 more easily liable to subsequent infections. Further, by their being infected, they constitute a septic focus in the nose and throat and so the possibility of infection of surrounding structures is thereby heightened. Quinsies, discharging ears, infected nasal sinuses, colds, sore throats and enlarged glands in the neck are among the conditions which can be caused by direct spread of infection, and some of these troubles, in their turn, may have more serious complications produced by the further spread of infection, for example, mastoid disease, meningitis or brain abscess. In addition, because of the presence of these septic foci the child's general health frequently suffers—he fails to put on weight, he becomes anaemic, dull and listless, easily tired and unable to concentrate. But apart from the question of spread of infection, trouble may be caused mechanically by the' enlarged tonsils and adenoids. In this way they can block the internal entrance to the ears and so cause deafness, or they can block the normal air-way of the nose used for breathing and so cause mouth-breathing with all its attendant harm on the mouth, nose, teeth and the general health. In severe cases the tonsils may be so enlarged as to make breathing difficult and this may produce mal-development of the chest. Then lastly, the tonsils, if previously infected, are more susceptible to subsequent infections with other germs, especially important of which are the organisms causing scarlet fever, diphtheria and possibly rheumatism. It is obvious, therefore, that all these things must be taken into account in deciding in any particular case whether removal of enlarged tonsils or adenoids should be recommended. The procedure under the Willesden scheme is as follows:— The children, if under five years of age, are discovered either by routine medical inspection at the Health Centres or by being brought up by their parents in the ordinary way and found to be exhibiting one or more symptoms of tonsillar or adenoidal disease. If of school age they may be discovered at one of the three routine medical inspections during school life, or they may be discovered on attending a minor ailment session at a Health Centre. In any case, however discovered, an assessment is made of the degree of the diseased process and a decision is taken by the assistant medical officer as to whether the condition needs present operative treatment or whether it can be treated by conservative methods and the child observed to see if the symptoms will disappear without operation. If operative treatment is considered necessary, or if there is any doubt about the matter, the child is referred to the consultant Throat, Nose and Ear Surgeon who visits the Health Centres in turn once a month, i.e., each Clinic every third month). Should there be a considerable interval before the Surgeon is due at a particular Health Centre, and the case a relatively urgent one, it may be sent to see him at the Centre which he will next visit. The Throat, Nose and Ear Surgeon sees each case and carefully decides from its history and with the co-operation of the assistant medical officer, who is present at the examination (a) whether it requires operation for the removal of its tonsils, or its adenoids, or both; or (b) whether medical measures should be applied instead of operation; or (c) whether the case should be observed and then re-examined by him at the end of a stated period. If the assistant medical officer himself has decided that a case seen at school may safely be observed he will either see it at a subsequent medical inspection at the school or will refer it to the Health Centre where a more detailed examination can be made and more intensive observation on the symptoms exhibited can be kept. There are few operations which can be more beneficial to a child's health than that for removal of tonsils and adenoids where removal is indicated. Not only does it have a curative effect in the majority of cases of mouth-breathing, ear discharge, deafness, sore throats, coughs (when due to the local condition), nasal discharge and enlarged glands but it appears to have definite preventive value in such diseases as recurrent sore throat, rheumatic fever (if carried out before the initial attack), scarlet fever and diphtheria. To summarise, 1. Tonsillar and adenoidal tissue is primarily protective. 2. When exercising this protective function it becomes enlarged. 3. Should the infection be completely overcome the tissue will again subside to normal. 4. The persistence of enlargement generally means the presence of infection and the probability of a septic focus. 5. This chronically enlarged tissue will have lost any protective function and in most cases is a potential source of ill-health. 6. As such it usually requires removal. The success of the treatment depends on five essentials: the child must be properly prepared for the operation; the anaesthetic must be given perfectly; the surgeon must be expert at his job; the child must receive skilled nursing attention after the operation; and, lastly, faulty breathing and nasal hygiene must be attended to on recovery. If any one of these fail, success may not be complete. 14 Crippling Defects and Orthopedics.—An Orthopaedic Clinic staffed by an Orthopaedic Surgeon and a specially qualified nurse is held at the Stonebridge Health Centre. 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 1932, 1,148 special children were examined or re-examined. Of the 340 original examinations included in the 1,148 examined, 65 were found to be physically defective, 12 mentally defective, 6 blind and partially blind, 22 dull and backward, 192 anaemic and debilitated, 25 defective speech, 4 deaf and dumb, 4 epiliptic, 2 defective vision, 3 nervousness, 2 unstable, 3 normal. 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 131. The actual number on the roll at the 31st December, 1932 was 132. The average attendance for the year was 115. There were no 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. Five children were allowed to leave school before reaching the age of 16 years, 1 child was transferred to an ordinary elementary school and 3 children were notified to the Middlesex County Council, which is the local authority under the Mental Deficiency Acts, 1913-27, as requiring supervision or guardianship. The Certifying Medical Officer visits the school weekly for the purpose of revision of classification and for medical examination of the children. 152 such examinations were made during 1932. The school dinners are brought from Furness Road Feeding Centre and served in the school hall. On an average 75 children take the school dinners and the remainder bring their own meal. During the year routine medical inspection of all the children attending this school was carried out. 118 children were examined, 22 of whom were found to require treatment, and the following table gives a return of the defects found at medical inspection:— Table No. 10. Defects. Found to require treatment. Requiring to be kept under observation but not requiring treatment. Malnutrition 1 - Skin Disease 1 — Eye—Blepharitis 2 — Defective vision (ex. squint) 1 — Squint 1 — Other conditions 1 — Ear—Defective hearing 1 — Other ear diseases 2 — Nose and Throat—Enlarged tonsils only 6 — Adenoids only 2 — Enlarged cervical glands (non-tuberculous) 1 — Defective speech 1 — Defective Teeth 25 1 Heart and Circulation. Heart functional — 5 Lungs—Bronchitis 1 — Other non-tuberculous diseases — 1 Other defects and diseases 4 — Total 50 7 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 156, the actual number on the roll on the 31st December, 1932, being 158. The average attendance for the year was 132 and there were two children awaiting admission at the 31st December, 1932. 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. 15 During the year 6 children were allowed to leave school before reaching the age of 16 years, 9 children were allowed to attend ordinary elementary schools, 4 children were transferred to residential institutions, 2 children obtained scholarships at trade schools and one child was transferred to Leinster M.D. School. 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.—The Education Committee have made arrangements with the Russell-Cotes School of Recovery, Parkstone, near Bournemouth, for the reservation of places for 9 boys and 4 girls. Early in the year the number of places at this Institution was reduced to 6 boys and 4 girls but was subsequently increased to the present number. 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 66 boys and 23 girls were admitted to the school during the year. The Education Committee have arranged the reservation of places for 10 girls at St. Patrick's Open Air School, Hayling Island, Hants., and 5 boys at St. Dominic's Open Air School, Godalming, Surrey. Early in the year the number of places at these institutions was reduced to 5 girls and 3 boys respectively but was subsequently increased to the present numbers. The children are selected both from the physically defective and the ordinary elementary schools and the duration of stay is 6 weeks. All the cases sent have shown a definite improvement on their return home. In all, 81 girls and 39 boys were admitted during the year. The arrangements with the Middlesex Edward VII Memorial Fund for the reservation of 4 places at Collington Manor, Bexhill, for anaemic and debilitated children were discontinued during the year. 7 boys were admitted to this institution during the year. Work of the Willesden Branch of the Invalid Children's Aid Association, 1932.— 175 new cases were referred to this Association during the year, 38 of these being referred by the Willesden Health Department. The majority of the patients were suffering from anaemia and debility. In addition 16 surgical appliances were supplied. 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. 910 examinations of secondary school pupils have been carried out during the year 1932. 360 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 the 1930 annual report. PROVISION OF MEALS. 197,821 meals were supplied in 1932 as compared with 138,361 in 1931, 119,831 in 1930, and 98,104 in 1929. The recipients of these meals are mainly children of the unemployed, widows and deserted wives. 16 HOME NURSING SERVICE. The Home Nurse employed by the Council nursed 404 cases during the year, and in connection with such cases paid 3,895 visits. 1,015 of these visits were paid in the South Kilburn Ward, 775 in the Mid-Kilburn Ward, 684 in the North Kilburn Ward, 321 in the Kensal Rise Ward, 311 in the Stonebridge Ward, 254 in the Roundwood Ward, 205 in the Cricklewood Ward, and smaller numbers in the other wards of Willesden. Of the 404 cases nursed during the year, 394 were new cases. 327 of these 394 new cases were referred by the Health Department for nursing, 33 by private doctors and 34 by Hospitals, Associations and private persons. Ophthalmia neonatorum received 195 visits and other ophthalmia cases 747 visits. SANITARY WORK. The number of houses in Willesden at the end of 1932 was 30,829. (Flats contained under one roof being counted as one house.) During the year the total number of inspections and re-inspections made by the Sanitary Staff was 26,503 as compared with 22,071 in 1931. The houses inspected under the Housing Acts numbered 1,107 as compared with 876 in 1931. The number of complaints received, 3,554, is higher than in 1931. The total number of Notices issued and nuisances abated were 6,454 and 21,482 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.—Early in the year an adjoining district was troubled by sulphurous fumes from one of the generating stations, which " practically killed the flowers and damaged the shrubs growing in this Council's Recreation Ground." Since the installation of a new gaswashing plant at these works there has not been a recurrence. At the second generating station where electrostatic precipitators are installed there has been an improvement since coal with a lower ash content has been used. The third generating station has created nuisances in this and an adjoining district by the emission of grit from pulverised fuel, necessitating the service of Statutory Notices. At these works, where the " water spray " system is in operation, emissions were due to mechanical breakdown, mainly brought about through insufficient water supply. As a result of interviews with representatives of the Company, new pipe lines, new sprays, new pumps and a new settling tank are being installed. Chimneys of boiler plants other than the generating stations have given little trouble, and in no instance was it necessary to serve a Statutory Notice. PUBLIC MORTUARY. During the year there were 105 admissions to the Mortuary, as compared with 115 in 1931; 7 of these were admitted for accommodation only; 32 were admitted for an inquest only; 57 were admitted for a post-mortem only ; and 9 were admitted for post-mortem followed by an inquest. The total number of post-mortems performed during the year was 66. 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 5,497 calls were made for the Council's ambulances as compared with 5,171 in 1931, 5,016 in 1930 and 4,728 in 1929. Altogether 132,208 miles were run in 1932 as compared with 131,564 in 1931, 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 the special schools. The detailed report of the 18th year of working of the Motor Ambulance Service appears as Appendix C. MUNICIPAL HOSPITAL. The 41st 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. 17 THE FIFTY-SEVENTH ANNUAL REPORT FOR THE Year ended 31st December, 1932, ON THE HEALTH AND SANITARY CONDITION OF THE URBAN DISTRICT OF WILLESDEN. GENERAL STATISTICS. Area (acres) 4,384 Population (estimated Midsummer, 1932) 188,216* Population Census (1931) 185,300 Number of inhabited houses (end of 1932) according to Rate books 37,418 (Flats separately assessed counted as one house.) Rateable value at 31st March, 1932 £1,301,637 Sum represented by a penny rate £5,255 * Registrar General's estimate Midsummer, 1932 186,800. EXTRACTS FROM VITAL STATISTICS OF THE YEAR.Live Births— Total. M. F. Total. Birth Rate per 1,000 of the estimated resident population 14.58 15.42 Legitimate 2,637 1,409 1,329 2,738 Illegitimate 108 66 76 142 Stillbirths 107 71 45 116 Rate per 1,000 total (live and still) births 37.52 38.72 Deaths 1,838 1,853 Death Rate per 1,000 of the estimated resident population 9.77 9.92 Deaths from puerperal causes (Headings 29 and 30 of the Registrar-General's Short List):— Deaths. Rates per 1,000 total (Live and Still) Births. No. 29—Puerperal sepsis 6 6 2.10 2.00 No. 30—Other puerperal causes 5 4 1.75 1.34 Total 11 10 3.86 3.34 Death Rate of Infants under one year of age:— All infants per 1,000 live births 61.20 58.68 Legitimate infants per 1,000 legitimate live births 51.19 49.31 Illegitimate infants per 1,000 illegitimate live births 305.56 239.44 Deaths from Measles (all ages) 22 21 „ Whooping Cough (all ages) 6 7 ,, „ Diarrhoea (under 2 years of age) 33 34 Figures in italics supplied by Registrar-General. Table No. 11. NOTIFIABLE DISEASES DURING THE YEAR. % Disease. Total Cases Notified. Cases admitted to Total Deaths. Willesden Municipal Hospitals. Other Hospitals. Diphtheria 247 234 9 10 Scarlet Fever 421 364 10 1 Enteric Fever (including Paratyphoid) 10 6 1 2 Puerperal Fever 8 3 3 1 Puerperal Pyrexia 22 7 14 — Pneumonia 351 13 * 148 Small Pox — — — — Cholera — — — — Plague... — — — — Erysipelas 66 20 17 2 Typhus Fever — — — — Relapsing Fever — — — — Continued Fever — — — — Cerebro-spinal Meningitis 14 9 5 9 Poliomyelitis 8 2 5 — Ophthalmia Neonatorum 28 7 5 — Malaria 1 — — — Dysentery 1 — 1 — Encephalitis Lethargica 3 1 2 1 Acute Polio-Encephalitis — — — — Anthrax — — — — Tuberculosis (a) Pulmonary 249 — * 126 (b) Non-Pulmonary 62 — * 19 Whooping Cough 673 26 — 6 For analysis of the age groups see Appendix " A " Table IV. * No complete record. 18 Table No. 12. TUBERCULOSIS. Age-Periods. New Cases. Deaths. Pulmonary. Non-Pulmonary. Pulmonary. Non-Pulmonary. M. F. M. F. M. F. M. F. 0 0 0 1 2 0 0 2 2 1 3 2 5 6 0 0 3 3 5 6 0 6 6 0 0 0 0 10 2 7 3 4 0 1 0 1 15 11 14 2 3 2 2 1 1 20 19 27 1 3 8 11 1 0 25 29 31 4 7 15 14 0 0 35 19 13 3 3 15 9 1 0 45 30 10 1 0 16 5 0 1 55 12 6 0 0 14 5 0 0 65 and upwards 6 2 1 1 5 4 2 1 Totals 137 112 27 35 75 51 10 9 The ratio of non-notified tuberculosis deaths to total tuberculosis deaths was 1:24. 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 1931 the Council's Health Visitors have visited cases of Tuberculosis. They investigate the source of infection and give advice for preventing the spread of infection. They arrange for the provision of paper handkerchiefs and sputum bottles with disinfectant. They are 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. 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. PUBLIC HEALTH (PREVENTION OF TUBERCULOSIS) REGULATIONS, 1925. No case was dealt with under the above regulations during 1932. PUBLIC HEALTH ACT, 1925. SECTION 62. Removal to hospital of infectious persons suffering from pulmonary tuberculosis. No action was taken under this section during 1932. GENERAL PROVISION OF HEALTH SERVICES FOR THE AREA. Nursing in the Home. (a) General Nursing. (b) Nursing of infectious diseases. 19 There have been no changes in the arrangements for the above outlined in 1931 Annual Report. Midwives—Employment of, or subsidy to, practising Midwives, by Public Health Authority. There has been no change in the arrangements during 1932. In accordance with Section 10 of the Midwives Act, 1902, 32 Midwives gave notice in the month of January, 1933, of their intention to practise in Willesden. CLINICS AND TREATMENT CENTRES. These remain as indicated in the Annual Health Reports for 1930 and 1931. Reports of the Dermatologist, the Oculist, and the Orthopaedic Surgeon appear as appendices. HOSPITALS. There is no change to record in the Hospital services set out in the 1930 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 with the addition of the National Adoption Society's Hostel at Connaught House, Acton Lane, N.W. 10. 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 1931-32 will be found in Appendix C. SANITARY ADMINISTRATION. List of Local Acts, Adoptive Acts, Bye-laws and local Regulations in force in the District, with date of adoption. Local Acts:— Willesden Local Board Act, 1876. Royal Assent 27.6.1876. Willesden Local Board Act, 1887. Royal Assent 8.8.1887. Willesden Sewerage Act, 1896. Royal Assent 14.8.1896. *Willesden Urban District Council Act, 1903. Royal Assent 11.8.1903. Adoptive Acts:— *Public Health Acts Amendment Act, 1890, Part III. Adopted 11.11.1890. *Public Health Acts Amendment Act, 1907, Parts II., III., IV., and X. Adopted 24.1.1911 ; further parts adopted 18.9.1911 ; further parts adopted 9.4.1928. Public Health Acts Amendment Act, 1907, Part VI. Adopted 1925. *Public Health Act, 1925. Baths and Washhouses Acts, 1846-99. Adopted 14.2.1899. Burial Acts, 1852-1900. Public Libraries Acts, 1892-1901. Adopted 19.2.1891. Bye-laws:— *Common Lodging Houses (Public Health Act, 1875, s. 80). Adopted 14.10.1879. *Houses Let in Lodgings (Public Health Act, 1875, s. 90). Revised and Adopted 26.7.1927. 20 *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. Amended and allowed 22.5.1930. 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. Drainage and Sewerage. The only item of importance carried out during the year 1932 was the construction of a Relief Surface Water Sewer at the rear of premises in Neasden Lane, which was executed by direct labour and necessitated a crossing under the Canal Feeder in order to obtain outfall into the River Brent. The total cost of this work was £1,900. 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 3,554 Number of premises inspected in connection with infectious diseases 40 Number of periodical inspections of premises 3,621 21 Houses inspected from House to House (Housing Acts) 1,107 For Certificates under the Rent Acts 2 Public House Urinals 368 Mews and Stables 540 Miscellaneous 253 Total number of inspections and re-inspections made 26,503 Action under Rent and. Mortgage Interest (Restriction) Acts, 1920-25. Number of applications received for Certificates 4 Number of Certificates granted 1 Action Taken (under Housing Acts and Health Acts): Notice to Inspect (Section 127, Housing Act, 1925) 3,066 Cautionary or Intimation Notices Issued 3,111 Number complied with 2,690 Statutory Orders issued 276 Number complied with 186 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 5 Number of contraventions 0 Number remedied 0 Canal Boats used as Dwellings: Number of contraventions of Regulations 3 Number remedied 3 Movable Dwellings, Caravans, Tents, &c.: Number observed during the year 18 Number of nuisances therefrom abated 2 Number removed from district 10 Bakehouses: Number in district 58 Number of Inspections 205 Contraventions of Factory Acts 41 Contraventions remedied 37 Slaughter-houses: Number on register 5 Inspections of carcases, etc 250 Contraventions of Bye-laws 0 Contraventions remedied 0 Cowsheds: Number on register 1 Number of inspections made 2 Contraventions of regulations 0 Contraventions remedied 0 Number of milch cows in district 0 Dairies and Milkshops: Number of premises on register 233 Number of itinerant milk sellers registered 45 Number of inspections made 441 Contraventions of Milk and Dairies Order, 1926 14 Contraventions remedied 12 Unsound Food: Meat (including organs) seized and surrendered 319 lbs. Fish (wet, dried and shell) surrendered 119 lbs. Milk seized 60 lbs. Bacon surrendered 577 lbs. Tinned and Cooked Meat surrendered 161 lbs. 22 Unsound Food—continued. Tinned and Evaporated Milk surrendered 37 lbs. Fruit surrendered 1,007 lbs. Total 2,280 lbs. Method of disposal Destroyed. Offensive Trades: Number of premises in district (Rag and Bone Dealers) 5 Number of inspections made 26 Contravention of Bye-laws 0 Contravention remedied 0 Water Supply and Water Service: Percentage of houses supplied on constant system 100 Cisterns:— New provided 34 Cleansed, repaired, covered, etc 437 Draw-taps placed on mains 49 Drainage and Sewerage of existing Buildings: Water Closets:— Number of water closets substituted for dry receptacles 0 Repaired, supplied with water or otherwise improved 576 Additional Closets constructed 13 Percentage of houses provided with water closets 100 Drains:— Examined, tested, exposed, etc. 313 Unstopped, repaired, trapped, etc. 261 Waste pipes, rain-water pipes, disconnected, repaired, etc. 603 New soil pipes or ventilating shafts fixed 116 Existing soil pipes or ventilating shafts repaired 223 Disconnecting traps or chambers inserted 144 Re-constructed 61 Cesspools:— Rendered impervious, emptied, cleansed, etc. 0 Abolished and drain connected to sewer 0 Percentage of houses draining into sewers 100 Disinfection and Disinfestation. Rooms disinfected:— {a) Phthisis 54 (b) Other diseases and conditions 697 Articles disinfected or destroyed :— (a) Phthisis 326 (b) Other diseases and conditions 1,468 Dust: New bins provided 1,281 Periodical frequency of dust removal weekly Method of disposal By tipping and barging Sundry Nuisances abated: Overcrowding 40 Smoke 27 Accumulations of refuse 142 Foul ditches, ponds, etc., and stagnant water 8 Fowls, pigs, and other animals 45 Dampness 936 Yards and forecourts paved, repaved or repaired 759 Walls and ceilings cleansed 4,077 Verminous rooms purified 274 Leaky roofs made watertight 705 Additional ventilation provided under floors 281 Dilapidated plaster repaired 1,993 Flooring and other woodwork repaired 1,375 Damp-proof courses inserted 137 Water supply reinstated 72 Washhouse floors repaired or repaved 360 Fireplaces and stoves repaired 848 Decayed brickwork repaired and repointed 636 Sinks provided or replaced 169 23 Additional light and ventilation provided to staircases 85 Larders or food cupboards provided or ventilated 93 Gutters and rainwater pipes repaired or renewed 772 New sash cords and glass provided to windows 2,643 Smoke observations 302 Miscellaneous 894 Total number of Nuisances Abated 21,482 Inspections of Premises where Food is prepared: Butchers', Provision, and General Shops 853 Fish shops (wet, dried and fried) 254 Eating houses 95 Greengrocers' shops 166 Ice-cream premises 135 Stalls 614 Canal Boats Acts, 1877-1884.—The number of boats inspected during the year, 1932, was 27 (39 inspections). Three contraventions of the Regulations were found:— (i) Certificate indecipherable. (ii) Overcrowding. (iii) Registration Number on boat indistinct. These contraventions were remedied. 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 5 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. 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 8,780 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 1932) according to the Rate Book, 37,418. * Flat separately assessed counted as one house. Number of houses* in Willesden (end of 1932), 30,829 (approx.). * Flats contained under one roof are counted as one house. 24 The following table shews building activities during the periods stated:— Table No. 13. 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 1932 66 117 269 452 Total for 12 years 1,072 2,395 3,962 7,429 The erection of smaller houses in the Northern part of the district continues. HOUSING STATISTICS FOR THE YEAR 1932. Number of New Houses erected during the Year — (a) Total (including numbers given separately under (b): (i.) By the Local Authority 66 (ii.) By other Local Authorities Nil (iii) By other bodies and persons 386 (b) With State assistance under the Housing Acts:- (i.) By the Local Authority. (a) For the purpose of Part II. of the Act of 1925 Nil (b) For the purpose of Part III. of the Act of 1925 Nil (c) For other purposes Nil (ii.) By other bodies or persons Nil 1.—Inspection of Dwelling-houses during the Year:— (1) (a) Total number of dwelling-houses inspected for housing defects (under Public Health or Housing Acts) 4,386 (b) Number of inspections made for the purpose 18,033 (2) (a) Number of dwelling-houses (included under sub-head (1) above) which were inspected and recorded under the Housing Consolidated Regulations, 1925 1,107 (b) Number of inspections made for the purpose 7,325 (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 107 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 1,665 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 106 (2) Number of dwelling-houses which were rendered fit after service of formal notices:— (a) By owners 45 (b) By local authority in default of owners 7 B.—Proceedings under Public Health Acts: (1) Number of dwelling-houses in respect of which notices were served requiring defects to be remedied 85 25 (2) Number of dwelling-houses in which defects were remedied after service of formal notices:— (a) By owners 69 (b) By local authority in default of owners 5 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 became operative requiring repairs 0 (2) Number of dwelling-houses which were rendered fit after service of formal notices:— (a) By owners 0 (b) By local authority in default of owners 0 (3) Number of dwelling-houses in respect of which Closing Orders became operative in pursuance of declarations by owners of intention to close 0 F.—Proceedings under sections 11, 14 and 15 of the Housing Act, 1925: (1) Number of dwelling-houses in respect of which Closing Orders became operative 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 Order became operative 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, 231 retail milk purveyors, and 1 cowkeeper in this district. Their premises and utensils are frequently inspected. In addition there are 45 milk sellers whose premises are situate outside Willesden. The following table shows the number of licences granted for the sale of graded milk under the Milk (Special Designations) Order, 1923, during the year 1932 Table No. 14. {a) " Certified" milk 13 (b) " Grade A (Tuberculin Tested) " milk 23 (c) " Grade A (Tuberculin Tested) " Bottling Establishment 1 (d) " Grade A" milk 6 (e) " Pasteurised" milk 26 (/) " Pasteurisers " 2 There were no refusals or revocations of licences under the Milk (Special Designations) Order, 1923, during the year. Two applications for registration as dairymen were refused. Twenty-five samples of designated milks were examined during the year. 14 of these were "certified" milk and 3 of them were found not to conform to the standard laid down by the Regulations. These 3 results were reported to the Minister of Health, who is the authority issuing licences for certified milk. The remaining 11 samples were of "pasteurised," all of which were satisfactory. Fifty samples of milk were taken during the year for examination for the presence of tubercle bacilli under the Milk and Dairies (Consolidation) Act, 1915. 26 Four samples (Nos. 0/277, 0/283, 0/289 and 0/296) were found to contain tubercle bacilli, and action was taken resulting in the examination of the herds at the supplying farms. The other 46 samples showed no evidence of tuberculosis. The following are particulars of the four positive samples:— 0/277.—An animal giving tuberculous milk was found, and was slaughtered under the Tuberculosis Order, 1925, post-mortem examination showing the disease to be advanced. 0/283.—Samples of milk taken from producer's herd. The animal inoculation test revealed living tubercle bacilli in one individual sample. This cow was reported for slaughter under the Tuberculosis Order. 0/289.—Samples of milk taken from producer's herd which proved to be negative. 0/296. Two animals found on premises giving tuberculous milk. The animals were slaughtered under the Tuberculosis Order, 1925, post-mortem examination showing the disease to be advanced. 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. 15. In 1920. 1925. 1932. Registered 4 4 2 Licensed 5 4 3 Total 9 8 5 Inspection and Supervision of Other Foods.—Inspections were made of all the bakehouses and other premises in the district where food is prepared. The 58 bakehouses in the district were inspected on 205 occasions, Notices being served in 41 instances for minor contraventions of the Factory and Workshop Acts. Food and Drugs Acts.—These Acts are administered by the Middlesex County Council and I am indebted to Mr. R. Robinson, Chief Officer, Public Control Department, for the following tabular statement, shewing the number of samples taken in Willesden and the result of prosecutions instituted under the Acts during the year 1932 :— Table No. 16. List of Samples Taken during the Year ended 31st December, 1932. Article. Taken. Adulterated. Milk 610 2 Milk, Separated 1 — Milk, Sterilised 3 — Brandy Wine 1 — Butter 2 — Calcium Lactate Tablets 1 — Calomel Tablets 1 — Cream 4 — Gin 2 — Minced Beef 3 1 Perchloride of Iron Gargle 2 2 Sausages 4 — Swiss Roll 2 — Tincture of Iodine 1 — Tripe 4 — Vinegar 1 — Whisky 1 — Wine and Whisky 1 — 644 5 Number of Prosecutions 6 Number of Convictions 6 Fines and Costs imposed £23 5s. Od. 27 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. Milk and Dairies (Amendment) Act, 1922. Two purveyors of milk were convicted for selling milk under designation of " Pasteurised " otherwise than in accordance with a licence. 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. 17. Factories, Workshops, Laundries, Workplaces and Homework. Inspection—Including Inspections made by Sanitary Inspectors. Premises. Number of Primary Inspections. Written Notices. Prosecutions. (1) (2) (3) (4) Factories (including Factory laundries) 182 29 - Workshops (including Workshop laundries) 276 43 - Workplaces (other than Outworkers' premises) 10 2 — Total 468 74 - Table No. 18.—Defects Found. Particulars. Number of Defects. Found. Remedied. Referred to H.M. Inspector. Number of Prosecutions. (1) (2) (3) (4) (5) Nuisances under the Public Health Acts:- Want of Cleanliness 9 6 - - Want of Ventilation — — - - Overcrowding 1 1 - - Want of drainage of floors 1 1 - - Other Nuisances 14 13 - - Sanitary accommodation— Insufficient 5 4 - - Unsuitable or defective 23 17 - - Not separate for Sexes 2 2 — - Unscreened for Sexes 6 4 - - 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) 41 37 - - Other offences (Excluding offences relating to outwork) — — — — Total 102 85 — - 28 Table No. 19.—Registered Workshops. Workshops on the Register (s. 131) at the end of the year. Number. (1) (2) Factories 171 Factories, Laundries 38 Workshops, Laundries 22 Domestic Laundries 6 Bakehouses 58 Dressmakers 54 Outworkers 791 Blouse Makers 5 Tailors 43 Bootmakers 82 Metal Workers 36 Wood Workers 39 Seamstresses 1 Motor and Cycle Makers 49 Upholsterers 8 Milliners 16 Miscellaneous 130 Total number of Workshops on Register 1,549 Table No. 20.—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 13 Reports (of action taken) sent to H.M. Inspector 13 Other - Underground Bakehouses (s. 101):— Certificates granted during the year - In use at the end of the year 17 29 THE TWENTY-FIFTH ANNUAL REPORT FOR THE Year ending 31st December, 1932, ON THE HEALTH OF CHILDREN ATTENDING THE PUBLIC ELEMENTARY SCHOOLS IN WILLESDEN. Giving the Tables required by the Board of Education. Table No. 21.—Corresponding to Table 1 of the Board of Education's Medical Statistical Tables. Return of Medical Inspections for the year ended 31st December, 1932:— A.—Routine Medical Inspections. Number of Code Group Inspections:— Entrants 2,371 Second Age Group 2,102 Third Age Group 1,816 Total 6,289 Number of other Routine Inspections 0 B.—Other Inspections. Number of Special Inspections 7,506 Number of Re-inspections 20,096 Total 27,602 Table No. 22.—Corresponding to Table 2 of the Board of Education's Medical Statistical Tables. A.—Return of Defects Found by Medical Inspection in the Year ended 31 st December, 1932. 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 12 38 81 1 U ncleanliness — - - Skin (see Table IV, Group V) 'Ringworm: Scalp — 6 Body — 25 Scabies 2 99 Impetigo 11 211 Other Diseases (non- tuberculous) 62 1,188 3 Eye 'Blepharitis 17 — 118 — Conjunctivitis 5 — 177 — Keratitis — — 1 — Corneal Opacities 1 — 5 — Defective Vision 747* 42 310 25 (excluding Squint) Squint 24 88 3 Other Conditions 21 2 137 — Spectacles broken — — 373 — Spectacles lost — — 38 — * The increase over last year's figure, which was 245, may be accounted for by the procedure adopted during 1932 of testing with + 1 sphere. The majority of these additional cases were not found to require treatment after further examination by refraction. 30 A.—Return of Defects found by Medical Inspection in the Year ended 31st December, 1932—continued. Defect or Disease. Routine Inspections. Specials. No. of Defects. No. of Defects. Requiring treatment. • Requiring to be kept under observation but not requiring treatment. Requiring treatment. Requiring to be kept under observation but not requiring treatment. (1) (2) (3) (4) (5) Ear Defective Hearing 7 3 17 Otitis Media 6 — 170 — Other Ear Diseases 23 3 220 — Nose and Throat Enlarged Tonsils only 504 317 211 3 Adenoids only 52 10 10 5 Enlarged Tonsils and Adenoids 20 - 256 6 Other Conditions 35 21 129 — Enlarged Cervical Glands (non-tuberculous) 85 10 190 — Defective Speech 1 2 2 — Heart and Circulation Heart Disease: Organic — 3 5 — Functional 5 204 28 — Anaemia 34 8 44 — Bronchitis 23 5 71 — Lungs Other Non-Tuberculous Diseases 11 20 32 — Pulmonary:— Tuberculosis Definite — — 3 — Suspected — — 9 — Non-Pulmonary:— Definite:— Glands — — 1 — Spine — — 1 — Hip — — 5 — Other Bones and Joints — — 2 — Skin — — — — Other forms — — — — Suspected:— Glands — — 4 — Bones and Joints — — — — Other forms — — 1 — Nervous Epilepsy — 2 2 — Chorea 1 1 12 — System Other Conditions 9 2 31 1 Rickets — — 6 — Deformities Spinal Curvature 18 12 25 — Other forms 96 28 116 — Other Defects and Diseases 234 93 2,839 10 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. (1) (2) (3) (4) Code Groups— Entrants 2,371 596 25.1 Intermediates 2,102 628 29.9 Leavers 1,816 582 320 Total (Code Groups) 6,289 1,806 28.7 Other Routine Inspections 0 0 0 31 Table No. 23.—Corresponding to Table III. of The Board of Education's Medical Statistical Tables. 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 3 0 3 The actual combination of defects and the type of School, if any, attended should be indicated on a separate sheet. Blind (including partially blind) (i.) Suitable for training in a School for the totally 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 (ii) Suitable for training in a School for the partially Blind. At Certified Schools for the Blind or partially Blind 8 8 16 At Public Elementary Schools 0 1 1 At other Institutions 0 1 1 At no School or Institution 0 0 0 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 4 3 7 At Public Elementary Schools 0 0 0 At other Institutions 0 0 0 At no School or Institution 1 0 1 (ii.) Suitable for training in a School for the partially deaf. At Certified Schools for the Deaf or Partially Deaf 3 2 5 At Public Elementary Schools 1 0 1 At other Institutions 0 0 0 At no School or Institution 0 0 0 Mentally Defective. Feebleminded At Certified Schools for Mentally Defective Children 76 46 122 At Public Elementary Schools 0 0 0 At other Institutions 0 2 2 At no School or Institution 1 0 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 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 0 0 Suffering from epilepsy which is not severe. At Public Elementary Schools 10 5 15 At no School or Institution 1 0 1 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 Physically Defective. 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 1 0 1 At Public Elementary Schools 13 8 21 At other Institutions 0 0 0 At no School or Institution 0 0 0 Tuberculosis of the peripheral glands. At Sanatoria or Sanatorium Schools approved by the Ministry of Health or the Board 0 1 1 At Certified Residential Open Air Schools 0 0 0 At Certified Day Open Air Schools 0 0 0 At Public Elementary Schools 11 8 19 At other Institutions 0 0 0 At no School or Institution 2 0 2 Abdominal tuberculosis 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 0 0 0 At Public Elementary Schools 1 2 3 At other Institutions 0 0 0 At no School or Institution 0 0 0 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 7 4 11 At Public Elementary Schools 3 1 4 At other Institutions 0 0 0 At no School or Institution 1 0 1 32  Boys. Girls. Total. 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 Physically Defective (continued). 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 23 22 45 At Certified Residential Open Air Schools 17 9 26 At Certified Day Open Air Schools 0 0 0 At Public Elementary Schools 135 109 244 At other Institutions 0 0 0 At no School or Institution 0 1 1 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 1 2 3 At Certified Residential Cripple Schools 1 0 I At Certified Day Cripple Schools 43 37 80 At Certified Residential Open Air Schools 0 0 0 At Certified Day Open Air Schools 0 0 0 At Public Elementary Schools 0 1 (1) 1 (I)§ At other Institutions 0 0 0 At no School or Institution 1 (1) 2 3 (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 1 2 3 At Certified Residential Cripple Schools 3 0 3 At Certified Day Cripple Schools 22 25 47 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 1 1 At no School or Institution 4 0 4 Of the three boys suffering from multiple defects one is in attendance at a certified school for mentally defective children and suffers from infantile paralysis ; one is in attendance at a cert'fied school for mentally defective children and suffers from epilepsy, and is awaiting admission to an epileptic colony ; and the third boy is in an orthopaedic hospital school and suffers from epilepsy and spastic hemiplegia. § The figures in brackets indicate the number of these children who should be receiving Special School education. Table No. 24.—Corresponding to Table IV. of The Board of Education's Medical Statistical Tables. Return of Defects Treated during the Year ended 31st December, 1932. Treatment Table. Group I.—Minor Ailments (excluding Uncleanliness, for which see Group V.). Number of Defects Treated, or under Treatment during the Year. Disease or Defect. Treated. Total. Under the Authority's Scheme. Otherwise. (1) (2) (3) (4) Skin:— Ringworm—Scalp 6 6 12 Body 29 5 34 Scabies 104 14 118 Impetigo 305 25 330 Other Skin Diseases 1,971 56 2,027 Minor Eye Defects (external and other, but excluding cases falling in Group II.) 492 24 516 Minor Ear Defects 479 38 517 Miscellaneous (e.g., Minor Injuries, Bruises, Sores, Chilblains, etc.) 3,997 583 4,580 Total 7,383 751 8,134 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.) 1,232 8* 0* 1,240 Other Defect or Disease of the Eyes (excluding those recorded in Group I.) 8 0 4 12 Total 1,240 8 4 1,252* * In addition to this number 148 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 846 (b) Otherwise 23 Total number of children who obtained or received spectacles:— (a) Under the Authority's scheme 655 (b) Otherwise 151 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) 452 143 595 165 760 Group IV.—Dental Defects. Vide 15th 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. Uncleanhness and Verminous Conditions. (i.) Average number of visits per school made during the year by the School Nurses 17.0 (ii.) Total number of examinations of children in the schools by School Nurses 57,842 (iii.) Number of individual children found unclean 1,785 (iv.) Number of children cleansed under arrangements made by the Local Education Authority 356 34 (v.) Number of cases in which legal proceedings were taken:— (а) Under the Education Act, 1921 17 (б) Under the School Attendance Bye-Laws 0 (vi.) No. of school sessions at which inspections were conducted 579 (vii.) (i.) Original Inspections:— Children examined (i.e., Cases not individual children) 49,682 Found unclean 2,564 Percentage found unclean 5.4 Excluded on account of uncleanliness 11 (ii.) Re-inspections:— Children examined (i.e., Cases not individual children) 8,160 Found unclean 5,954 Percentage found unclean 72.96 Excluded on account of uncleanliness 15 Board of Education's Medical Statistical Tables. 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. Fined. Amount of Fine. Adjourned Standing adjourned at end of Year. Withdrawn. Sine die. Dismissed. 1 10/- 9 1 Nil. 1 5 5/- Statement of the Number of Children Notified during the Year ended December 31st, 1932, by the Local Education Authority to the Local Mental Deficiency Authority. Total Number of Children notified : 9. Analysis of the above Total. Diagnosis. Boys. Girls 1.—(i.) Children incapable of receiving benefit or further benefit from instruction in a Special School: (a) Idiots — (b) Imbeciles 3 1 (c) Others — 3 (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 2 — 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 5 4 35-36 Table No. 25—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 1932. 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. Results ot Treatment. Percentage of defects treated. No. of defects not treated. o. of defects under observation at end of year, and carried forward to succeeding year. Domestic Treatment only. Grand Total. Remedied. Improved. Unchanged Under observation at end of year (result of treatment not Known). School Clinic or Hospital or other Institution under Council Scheme. VoluntaryHos pital or other charitable Id stitution. Hospital Doctor under M.C.C. Excluding Domestic Treatment. - Including Domestic Treatment. Removed from observa tion. Remaining under observa tion. Total. Brougta forward from previous year. New. Total. Private Practitioner. Total. 11 1 2 3 4 5 6 7 8 9 10 12 13 14 15 16 817 18 19 20 21 22 23 Clothing— Unsatisfactory - 13 13 - — - - — — — 11 11 9 — — 2 — 84.6 1 1 2 3 Footgear— Unsatisfactory - - - - - - - - - - - - - - - - - - - - - - Cleanliness of Head— Nits 159 2,140 2,299 7 1 157 - - - 157 2,090 2,247 2,051 - - 196 6.9 98.1 32 12 44 208 Pediculi 39 272 311 — 1 179 - - - 179 124 303 277 - - 26 57.7 97.7 5 2 7 28 Other dirty conditions 1 3 4 — — — - — — — 4 4 4 - - - - - - - - - Cleanliness of Body— Dirty 1 18 19 — — — — — — 18 18 17 — — 1 94.7 1 1 2 Pediculi 1 2 3 - - - - - - - 3 3 3 — - 100.0 - - Fleabitten — 9 9 — — — — — — — 8 8 8 — j — — — 88.9 1 — 1 - Malnutrition 58 100 158 3 110 3 - 1 114 20 134 73 7 - 54 73.5 86.5 15 6 21 60 Nose and Throat. Enlarged Tonsils 364 547 911 17 34 100 45 1 146 4 150 148 2 17.0 17.4 403 307 710 309 Adenoids Enlarged Tonsils and 34 34 68 2 15 11 3 — — 14 — 14 14 — — — 27.5 27.5 24 13 37 13 Adenoids 172 516 688 1 14 299 78 5 1 383 3 386 380 - 6 56.9 57.4 189 98 287 104 Other conditions 50 191 241 2 5 136 8 - 23 167 46 213 175 4 - 34 71.4 91.0 13 8 21 42 Cervical or Neck Glands— Enlarged (non.T.B.) 209 288 497 3 9 177 25 3 9 214 21 235 174 9 l 51 44.1 48.5 115 135 250 186 External Eye Diseases- Blepharitis 32 150 182 4 — 150 1 - - 151 20 171 138 2 31 84.8 961 5 2 7 33 Conjunctivitis 15 198 213 3 — 188 5 1 3 197 12 209 191 — — 18 93.8 99.5 — 1 1 19 Corneal Opacities 1 7 8 — 4 3 — — 7 — 7 2 — 1 4 87.5 87.5 — 1 1 5 Keratitis 1 1 2 —• — 1 1 — — 2 2 1 1 — 100.0 100.0 — - - Other conditions 19 173 192 1 2 154 10 1 3 168 20 188 172 — — 16 88.9 99.5 1 — 1 16 Ear Diseases— Chronic Suppuration of Middle Ear 51 195 246 3 1 199 13 2 3 217 13 230 177 5 1 47 89.7 95.0 8 4 12 51 Defective Hearing 15 30 45 — 6 25 — 25 3 28 10 4 — 14 64 1 71.8 6 5 11 19 Wax 25 141 166 — 1 153 2 — 155 6 161 145 — — 16 93.9 97.6 4 — 4 16 Other diseases 23 114 137 1 1 102 11 3 4 120 12 132 102 2 1 27 88.9 97.8 1 2 3 29 Teeth—See Dental Returns Heart and Circulation— Organic Disease 13 9 22 ,— 1 8 1 3 13 1 14 6 5 3 59.1 63.6 8 8 3 Functional Disease 13 38 51 . 3 11 17 3 31 3 34 1 13 3 17 64.6 70.8 9 5 14 22 Anaemia 89 59 148 3 — 75 19 8 102 27 129 61 41 1 26 70.3 89.0 10 6 16 32 Other conditions 5 4 9 — 1 1 4 — — 5 1 6 3 1 — 2 62.5 75.0 2 — 2 2 Lungs— Bronchitis and Bronchial Catarrh 64 131 195 77 19 2 37 135 48 183 118 15 3 47 69.2 93.8 9 3 12 50 Tuberculosis — 3 3 — — 1 — — 1 — 1 — 1 — — 33.3 33.3 2 — 2 — T.B. suspected 8 9 17 8 12 1 13 2 3 1 7 70.6 76.5 4 4 7 Other diseases (non-T.B.) 26 43 69 — 38 10 2 6 56 7 63 27 6 2 28 81.2 91.3 5 1 6 29 Nervous System— Epilepsy 1 3 4 — — - 1 — - 1 — 1 — 1 — — 25.0 25.0 3 — 3 - Chorea 10 24 34 — — 3 23 — 3 29 1 30 8 9 2 11 85.3 88.2 — 4 4 15 Other conditions 34 49 83 2 2 37 12 — 5 54 19 73 31 9 2 31 68.4 92.4 3 3 6 34 Skin- Ringworm Head & Body 7 40 47 - - 35 6 - 5 46 - 46 39 - - 7 97.9 97.9 - 1 1 8 Impetigo 36 368 404 - 305 4 21 330 69 399 373 - 26 81.7 98.8 5 5 31 Scabies 11 111 122 - 1 104 4 1 9 118 1 119 81 - 38 97.5 98.3 1 1 2 39 Minor injuries 62 1,099 1,161 - 2 1,055 33 1 11 1,100 55 1,155 1,086 3 66 94.9 99.7 4 - 4 66 Other conds. (non-T.B.) 217 2,088 2,305 6 4 1,971 18 - 37 2,026 232 2,258 2,049 9 4 196 88.3 98.4 18 19 37 215 Deformities— Rickets 5 9 14 1 - 9 - - - 9 - 9 1 1 — 7 69.2 69.2 2 2 4 9 Spinal Curvature 59 58 117 - 3 78 1 — 79 79 20 17 5 37 69.3 69.3 27 8 35 45 Other forms 94 208 302 2 7 232 5 1 238 — 238 59 36 38 105 81.2 81.2 34 21 55 126 Tuberculosis Non-Pulmonary— Definite—Glands 3 2. 5 - — — 2 1 — 3 — 3 — — — 3 60.0 60.0 2 — 2 3 ,, Spine - 1 1 1 - - - - - - - - - - - - - - - - - - ,, Hip 2 5 7 2 3 - - 3 - 3 - 1 2 60.0 60.0 2 — 2 2 ,, Bones and joints - 2 2 - 1 - - - 1 - 1 - - - 1 50.0 50.0 1 1 1 „ Skin - - - - - - - - - - - - - - - - - - - - - - ,, Other forms - - - - - - - - - - - - - - - - - - - - - - Suspected—Glands 2 5 7 - - 2 2 - 1 5 - 5 2 — — 3 71.4 71.4 2 — 2 3 Bones and joints 2 - 2 - - - 1 - - 1 - 1 - 1 50.0 50.0 1 — 1 — ,, Other conditions 1 3 4 - - 3 - — — 3 1 4 3 — — 1 75.0 100.0 — — 1 Speech— Defective Articulation 4 5 9 1 2 2 — — — 2 — 2 — — 1 1 33.3 33.3 3 1 4 2 Squint— Squint present 39 126 165 — 4 112 11 1 — 124 — 124 23 63 21 17 770 77.0 24 13 37 30 Vision— Defect not ascertained 63 378 441 2 76 305 5 - 6 316 - 316 255 2 21 38 87.1 87.1 36 11 47 49 One eye normal 17 71 88 - 9 38 5 - 3 46 - 46 23 5 8 10 58.2 58.2 20 13 33 23 Both eyes 6 /6 3 65 68 - 46 6 - - - 6 -- 6 2 - 4 27.3 27.3 16 16 — Both eyes 6/9 5 51 56 - 19 14 - - 1 15 — 15 11 1 1 2 40.5 40.5 21 1 22 3 One eye 6/9/ other 6/12 or less 26 110 136 - 23 66 5 1 72 - 72 50 - 10 12 63.7 63.7 34 7 41 19 Both eyes 6/12 or less 58 387 445 5 90 211 18 6 235 - 235 173 2 30 30 67.1 67.1 77 38 115 68 Spectacles broken | 37 398 435 2 1 378 1 - 24 403 1 404 368 - - 36 93.3 93.5 12 16 28 52 Spectacles lost 8 40 48 — - 38 1 - 4 43 '---- 43 36 - - 7 ' 89.6 89.6 4 1 5 8 Debility 408 660 1,068 4 _ 794 33 3 31 861 158 1,019 585 107 ' 12 315 80.9 95.8 25 20 45 335 Miscellaneous 416 2,449 2,865 14 233 1,658 192 11 1 122 1,983 503 2,486 2,050 55 19 365 75.7 95.0 90 42 132 407 Grand Totals 3,118 14,253 17,371 89 619 9,812 677 39 395 10,923 3,566 14,489 11,811 434 202 2,042 65.6 87.0 1,334 840 2,174 2,882 Re-examinations in respect of Defective Vision, other than Lost and Broken Spectacles, and in respect of other conditions No. of cases dealt with 1,935. 37 Certain Statistical Data. No. of Public Elementary Schools (excluding Special Schools) at December, 1932 34 No. of School Departments at December, 1932 71 Average Public Elementary School Roll (excluding Special Schools), year ended 31st March, 1932 20,806 Total No. of Children medically inspected at Routine and Special Inspections 13,795 Total No. of Children dentally inspected 21,925 Total No. of Defects of every description "followed up" during 1932 26,210 Total No. of Defects of every description for which treatment was obtained during 1932:— Medical or Dental Treatment 16,361 Domestic Treatment 3,566 Total 19,927 Total No. of Attendances at the School Clinics during 1932 99,542 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 1932:— Table No. 26. Special Schools in Willesden. Special Schools outside Willesden. Total. Blind and Partially Blind - 24 24 Deaf - 16 16 Mentally Defective 152 3 155 Epileptic - 4 4 Physically Defective 217 281* 498* Total 369 328* 697* * 246 of these were debilitated children sent to Certified Residential Schools for six weeks convalesence. Table No. 27.—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 Mentally Defective School. Boys. Girls. Boys. Girls. 1. Number of children who have left the school and are under 21 years 41 41 38 27 2. Number who:— (a) Have since died 1 3 - - (b) Are known to be incapable by reason of mental or physical defect of undertaking employment 2 2 2 4 (c) Are in attendance at an Institution for further education (give details), and †4 ††1 §3 §3 (d) Are in any other Institution (specify Asylum, Workhouse, Colony for Epileptics, &c.) - *1 **7 §§5 3. Number who are employed in:— (a) Industrial or manual occupations 14 13 12 4 (b) Agricultural or rural occupations — — — — (c) Domestic occupations, including those who are helping in the domestic work at home - 4 3 10 (d) Commercial, professional or clerical work 7 12 1 - (e) Blind alley or other precarious occupations 6 2 7 1 4. Number who have left the neighbourhood or whose after-careers have not been traced 7 3 3 - † 1 is in attendance at an art school, 1 is learning handwork, 1 is in attendance at a technical school and 1 is at an institution learning bootmaking. ft This girl is at Pitman's College learning shorthand and typewriting. § In attendance at an occupation centre. * In a poor-law institution. **5 are in institutions for mentally defectives, and 2 are in poor-law institutions awaiting admission tQ institutions for mentally defectives. §§ In institutions for mentally defectives. 6 Mentally Defectives and 5 Physically Defectives are unemployed. 38 Table No. 28 Return showing No. of Cases referred for following-up in 1932 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. 1932 5,073 1,087 86 7,487 13,733 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. 29. Medical and Dental Treatment—Attendances at the Municipal Health Centres, 1932. Condition. Mothers, and Children under Five. Grand Total. (Cols. 7 and 8). Expectant Mothers. Nursing Mothers. Children under Five. School Children. 0—1. 1—5. Total (Cols. 4 and 5). Total (Cols. 2—5). (i) (2) (3) (4) (5) (6) (7) (8) (9) 1. Cleansing 0 0 0 10 10 10 374 384* 2. Throat, Nose and Ear Diseases 2 2 132 633 765 769 6,714 7,483 3. Minor Ailments 28 87 1,544 3,593 5,137 5,252 41,150 46,402* 4 Eye Diseases 3 9 102 484 586 598 6,705 7,303 5. Ringworm, etc. 17 44 107 228 335 396 621 1,017* 6. Artificial Sunlight Treatment 0 0 430 4,063 4,493 4,493 7,065 11,558 7. Orthopaedics 0 34 562 2,257 2,819 2,853 5,335 8,188 8 Medical Consultations 5,727 22,732 25,108 16,404 41,512 69,971 0 69,971 9. Diphtheria Immunisation 0 0 0 0 0 0 0 0 10. Total (1—9) 5,777 22,908 27,985 27,672 55,657 84,342 67,964 152,306 11. Dental Consultations 1,324 1,922 0 1,139 1,139 4,385 16,094 20,479 12. Total (10—11) 7,101 24,830 27,985 28,811 56,796 88,727 84,058 172,785 13. School for Mothers 0 0 0 0 0 6,536 0 6,536 14. Nursery 0 0 0 0 0 6,227 0 6,227 15. Miscellaneous 0 0 0 0 0 12,864 15,484 28,348 16. Grand Total (12—15) 7,101 24,830 27,985 28,811 56,796 114,354 99,542 213,896* * In addition the following attendances were made by adults; Cleansing 21; Minor Ailments 3; Ringworm, etc.; 24; Varicose Ulcers 421; making a total of 469, which together with the 213,896 above, makes a grand total of 214,365. 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. (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) 17. Medical Attendances 15,552 19,279 34,831 40,323 16,403 56,726 28,467 32,282 60,749 152,306 18. Dental Attendances 1,060 3,735 4,795 1,413 3,633 5,046 1,912 8,726 10,638 20,479 19 School for Mothers 2,134 0 2,134 1,564 0 1,564 2,838 0 2,838 6,536 20. Nursery Attendances 2.797 0 2,797 867 0 867 2,563 0 2,563 6,227 21. Miscellaneous 6,143 4,604 10,747 3,871 7,058 10,929 2,850 3,822 6,672 28,348 22. Total 27,686 27,618 55,304 48,038 27,094 75,132 38,630 44,830 83,460 213,896 Table No. 30. 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 1932 84,342 4,385 88,727 67,964 16,094 84,058 172,785 6,536 6,227 28,817* 214,365 * This includes the 469 attendances by adults, which are shewn in the footnotes to Table No. 29. 40 5 School Children and 1 child under 5 years of age were treated under the Council's Scheme by X-rays for Ringworm of the Scalp. 1 school child was treated by X-rays for another skin condition. 10,050 Individual School Children attended the Municipal Centres during 1932. Hospital Treatment of School Children under the Council's Scheme. Table No. 31. Hospital Treatment of School Children during 1932. No. of School Children in Willesden General Hospital at 31st December, 1931 4 „ „ admitted during 1932 449 ,, ,, under treatment during 1932 453 „ „ „ discharged during 1932 453 died in Hospital during 1932 0 remaining in Willesden General Hospital at 31st December, 1932 0 Table No. 32. School Children under Treatment in Hospital during 1932. Condition. Brought forward. Admitted during Year. Totai. under treatment. Treatment Completed. Remaining in Hospital at end of Year. Forms of Treatment. Results of Treatment. Died. Operative. General. Remedied. Improved. Unchanged Deflected Septum — 1 1 1 — 1 — — — — Enlarged Tonsils & Adenoids 4 448 452 451 1 451 — 1 — — Total 4 449 453 452 1 452 — 1 — — No School Children were admitted to St. Monica's Home Hospital. Employment of Children in Entertainments Rules, 1920. Particulars as to applications received in 1932 for certificates from the School Medical Officer. No. of Applications. No. Granted. Boys. Girls. Total. Boys. Girls. Total. Original applications 4 8 12 4 8 12 Applications lor renewals 0 1 1 0 1 1 4 9 13 4 9 13 41 THE THIRTEENTH ANNUAL REPORT FOR THE Year ending 31st December, 1932, 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. Table No. 33.—Corresponding to Table I. 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, 1932, to 31st December, 1932. 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 1 0 1 0 0 o 1 0 1 0 0 0 0 0 0 2 0 2 0 0 0 2 0 2 11 „ 74 0 74 0 0 0 41 0 41 49 0 49 0 0 0 115 0 115 49 0 49 164 0 164 12 „ 24 58 82 0 0 0 20 54 74 11 54 65 0 0 0 44 112 156 11 54 65 55 166 221 13 „ 1 0 1 36 0 36 2 0 2 1 0 1 16 0 16 19 0 19 37 0 37 56 0 56 14 „ 0 0 0 23 0 23 1 0 1 0 0 0 14 0 14 15 0 15 23 0 23 38 0 38 15 „ 0 77 77 1 38 39 0 35 35 1 35 36 0 45 45 0 157 157 2 73 75 2 230 232 16 „ 0 0 0 1 0 1 1 0 1 1 0 1 0 0 0 1 0 1 2 0 2 3 0 3 17 „ 0 0 0 1 0 1 0 0 0 1 0 1 0 0 0 0 0 0 2 0 2 2 0 2 Total 100 135 235 62 38 100 66 89 155 64 89 153 30 45 75 196 269 465 126 127 253 322 396 718 Note that in the above table a pupil examined as an entrant, and subsequently as having attained his or her birthday during the preceding term, appears twice, that is as 2 cases. B.—Other Inspections. Kilburn Grammar School. Polytechnic Trade School. Willesden County School. Willesden Polytechnic Building Trade School Total. Boys. Girls. Boys. Girls. Boys. Boys. Girls. Total. Number of Special Inspections 1 2 0 1 2 3 3 6 Number of Re-inspections 100 16 23 28 19 142 44 186 Total 101 18 23 29 21 145 47 192 42 Table No. 34—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, 1932. Defect or Disease. Routine Inspections. Special Inspections. Number of Defects. Number 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) Kilburn Grammar School (Boys). Willesden Polytechnic Trade School (Girls). Willesden County School. Willesden Polytechnic Building Trade School (Boys). Kilburn Grammar School (Boys). Willesden Polytechnic Trade School (Girls). Willesden County School. Willesden Polytechnic Building Trade School (Boys). Kilburn Grammar School (Boys). Willesden Polytechnic Trade School (Girls). Willesden County School. Willesden Polytechnic Building Trade School (Boys). Kilburn Grammar School (Boys). Willesden Polytechnic Trade School (Girls). Willesden County School. Willesden Polytechnic Building Trade School (Boys). Boys. Girls. Boys. Girls. Boys. Girls. Boys. Girls. Malnutrition — — — — — 1 1 - - - - - - - - - - - - - Uncleanliness (See Table IV., Group V.) - - - - - - - - - - - - - - - - - - - - Skin Ringworm:— Scalp - - - - - - - - - - - - - - - - - - - - Body - - - - - - - - - - - - - - - - - - - - Scabies - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Other Diseases (Non-Tuberculous). 2 - 1 - - - 1 - - - - - - - - - - - - - Eye Blepharitis — — 2 — 2 - - - - - - - - - - - - - - Conjunctivitis - - - - - - - - - - - - - - - - - - - - Keratitis - - - - - - - - - - - - - - - - - - - - Corneal Opacities - - - - - - - - - - - - - - - - - - - - Defective Vision 15 5 13 9 4 6 — 5 1 - - - - - 1 - - - - - (excluding Squint). Squint - - 1 - - - - - - - - - - - - - - - - - Other Conditions — 1 - - - - - - - - - - - - - - - - - - Ear Defective Hearing — 1 — - - - - - - - - - - - - - - - - - Otitis Media - - 1 - 1 - - - 1 - - - - - - - - - - - Other Ear Diseases 1 - - - - - - - - - - - - - - - - - - - Nose & Throat Enlarged Tonsils only. 2 3 2 2 1 1 1 1 1 - - - - - - - - - - - Adenoids only - - - 1 - - - - - - - - - - - - - - - - Enlarged Tonsils and Adenoids. - - - - - - - 1 - - - - - - - - - - - - Other Conditions - - 1 - - - - - - - - - - - - - - - - - Enlarged Cervical Glands (non-T uberculous). - - - - - - - - - - - - - - - - - - - - Defective Speech - - - - - - - - - - - - - - - - - - - - Teeth—Dental Diseases 30 11 38 19 11 2 3 - - - - - - - - - - - - - Heart and Circulation. Heart Disease:— Organic 1 1 1 - 3 - - 1 - - - - - - - - - - - Functional 2 — 1 — — 14 3 9 6 3 - - - - - 1 - - - - Anaemia — — — — - 1 - - 1 — - - - — — - — Other Conditions - - - - - - - - - - - - - - - - - - - - Lungs Bronchitis - - - - - - - - - - - - - - - - - - - - Other Non-Tuberculous Diseases. - - - - - 1 - - - - - - - - - - — - - - Pulmonary:— Definite - - - - - - - - - - - - - - - - - - - - Suspected - - - - - - - - - - - - - - - - - - - - Non-Pulmonary: - Tuberculosis Spine - - - - - - - - - - - - - - - - - - - - Hip - - - - - - - - - - - - - - - - - - - - Other bones and Joints. - - - - - - - - - - - - - - - - - - - - Skin - - - - - - - - - - - - - - - - - - - - Other forms - - - - - - - - - - - - - - - - - - - - Nervous System Epilepsy - - - - - - - - - - - - - - - - - - - - Chorea - - - - - - - - - - - - - - - - - - - Other Conditions - - - - - - - - - - - - - - - - - - - - Deform ities. Rickets - - - - - - - - - - - - - - - - - - - - Spinal Curvature 1 1 1 2 - - - - - - - - - - - - - - - Other Forms 6 11 7 9 2 - - 2 - - - - - - - - - - - Flat Foot 12 6 6 7 3 2 1 — - — — 2 — 1 — — — — — — Other defects and diseases 2 — — — 1 6 2 — 3 3 - - - - - - - - - 1 Total 73 40 75 50 25 38 13 16 18 6 - 2 1 1 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) 100 13 13.0 62 19 30.6 66 15 22.7 64 15 23.4 30 4 13.3 Pupils aged 12 years 58 11 19.0 0 0 0.0 54 6 11.1 54 7 13.0 0 0 0.0 Pupils aged 15 years 77 15 19.5 38 7 18.4 35 13 37.1 35 5 14.3 45 10 22.2 Total (Code Groups) 235 39 16.6 100 26 26.0 155 34 21.9 153 27 17.6 75 14 18.7 •* Other Routine Inspections - - - - - - - - - - - - - - - ** During 1932 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. 35.—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, 1932. 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 - 1 1 Minor Eve Defects — — — — 1 1 - - - - - — (External and other, but excluding cases falling in Group II.) Minor Ear Defects — — — — — — — — 2 2 Miscellaneous (e.g., Minor Injuries, Bruises, Sores, Chilblains, etc.). - 1 1 - - - - - - - 2 2 - - - Total — 2 2 — 1 1 — 1 1 — 3 3 — 3 3 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 14 instances the School Medical Inspector noted on re-inspection that the pupils were wearing suitable spectacles ; in 16 instances the pupils were under treatment, and in 4 instances the vision had been re-tested and suitable spectacles 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 5 instances (girls) and 3 instances (boys) the School Medical Inspector noted on re-inspection that suitable spectacles were being worn. In 1 instance (girls) the vision had been re-tested and suitable spectacles obtained, and in 2 instances (boys) the pupils were under treatment. Willesden Polytechnic Building Trade School (Boys).—In 1 instance the School Medical Inspector noted on re-inspection that the vision had been re-tested and suitable spectacles obtained. Group III.—Treatment of Defects of Nose and Throat. Kilburn Grammar School (Boys).—In 4 instances the School Medical Inspector noted on re-inspection that the tonsils had been removed. Willesden Polytechnic Trade School (Girls).—In 3 instances the School Medical Inspector noted on re-inspection that the tonsils had been removed. Willesden County School.—In 9 instances (boys) and 10 instances (girls) the School Medical Inspector noted on re-inspection that the tonsils had been removed. Willesden Polytechnic Building Trade School (Boys).—In 5 instances the School Medical Inspector noted on re-inspection 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 13 cases at the Kilburn Grammar School (boys), 2 cases at the Willesden Polytechnic Trade School (girls), 2 cases (boys) and 5 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. One case of nitty condition of the hair was noted at Routine Medical Inspection at the Willesden County School (girls), and the attention of the parent was directed to this defect. Treatment of other Types of Defect. (a) The measures adopted for providing treatment or for securing improvement:— No measures have been adopted by the Authority for providing treatment. Notices were sent to parents informing them of the conditions requiring treatment, and the Head Teachers were notified of conditions requiring special exercises and the like. Pupils with defects referred for treatment or requiring to be kept under observation were referred for re-examination at a subsequent visit of the School Medical Inspector. (b) The effect of the measures taken. The School Medical Inspector noted as follows:— Table No. 36. (a)—KILBURN GRAMMAR SCHOOL. Defect. No. Result. Anaemia. 2 Had treatment. Satisfactory. Nervous System—Epilepsy 1 Under treatment. Other conditions ... 1 Modified exercises. Deformities—Spinal Curvature 1 Having remedial exercises. Flat Foot 1 Wears shoe supports. Other Forms 4 Improving with exercises. Heart Disease—Functional 1 Under private practitioner. Lungs—Other Non-Tuberculous Diseases 1 Receiving treatment under Hospital. Other Defects and Diseases 2 Under Hospital treatment. 45 (6)—WILLESDEN POLYTECHNIC. Defect. No. Result. Deformities—Spinal Curvature 3 Improving with exercises. Other Forms 9 Improving with exercises. Flat Foot 3 Improving with exercises. Lungs—Other Non-Tuberculous Diseases 1 Having regular Hospital treatment. Other Defects and Diseases 1 Part of drill omitted. (c)—WILLESDEN COUNTY SCHOOL. Defect. No. Result. Boys. Girls. Heart Disease—Organic 1 0 Violent games restricted. Deformities—Spinal Curvature 0 2 Having exercises. Round Shoulders 4 2 Improved with exercises. Flat Feet 2 0 Improved after exercises. 0 3 Improving with exercises. 0 1 Improved. Inside supports to shoes. Other Defects and Diseases 1 0 Treatment from General Hospital. (d)—WILLESDEN POLYTECHNIC BUILDING TRADE SCHOOL (BOYS). Defect. No. Result. Lungs—Other Non-Tuberculous Diseases 1 Remedied. Kyphosis 2 Having special exercises. Round Shoulders 1 Improving with exercises. 46 THE FIFTEENTH ANNUAL REPORT for the Year 1932, 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 Fifteenth Annual Report. The following returns deal with the third year's working of the Council's extended scheme, which came into operation with the opening of Health Centre 3. Part I. is a combined report of the School Medical Service and Maternity and Child Welfare, and represents the gross output of the four Dental Officers. Parts II. and III. treat each section in greater detail. PART I. The School Medical Service and Maternity and Child Welfare. 1,119 mothers and infants and 968 school children were inspected at the Centres, and 20,957 elementary school children were subjected to routine inspection at the Schools, making a total of 23,044. 16,454 were found to be defective and advised to have treatment. Of these 6,397 received their treatment at the Centres and recorded 18,627 attendances. The treatment included the extraction of 17,660 teeth, 10,311 fillings and 6,473 sundry operations for the year. The Dental Officers recorded 400 inspection sessions at the Schools, and 1,572 at the Centres for treatment, while 10 sessions were absorbed in administrative purposes. The following table is a summary of the year's work compared with years 1930 and 1931 :— Table No. 37. Comparative Table of Work done for Years 1932, 1931 and 1930. 1932 1931 1930 Total inspected— Mothers, Infants and School Children 23,044 23,306 18,069 Number defective 16,454 16,588 14,924 ,, treated 6,397 5,718 4,638 Teeth removed 17,660 17,393 14,421 „ fillings 10,311 8,725 5,837 Sundry operations 6,473 4,513 1,916 General anaesthetic cases 3,919 3,970 3,037 Treatment sessions 1,572 1,523 1,347 Inspection sessions 400 408 357 From the above table it will be noticed that there has been a decrease in the number of cases inspected. There were actually 522 less casual cases but an increase of 223 mothers and infants inspected, thus making a nett decrease of 262. It is expected and hoped that the former figure will continue to decrease to a negligible quantity, while the mothers and infants inspected will no doubt gradually increase. The actual work done for these patients has eclipsed all previous records for the total operations during the year amount to 34,444 against 30,631 for the year 1931. Fillings have increased by no less than 1,586. Sundry operations by 1,960, while 267 more teeth were removed. Incidentally, this is a very satisfactory proportionate increase in conservative work. 47 The following table shows the average work done on a sessional basis for the years 1932 and 1931:— Table No. 38. Comparative Table of Work per Session. Attendances. Fillings. Extractions. Sundry. Total Operations per Session. 1932 11.8 6.5 11.2 4.1 21.8 1931 11.0 5.7 11.4 2.3 19.4 The Anaesthetist attended on 183 sessions and administered general anaesthetics to 3,919 patients, thus making an average of 21.4 cases per session. The patients included young children of about two years of age, school children and nursing and expectant mothers in various stages of physical fitness. During all these administrations there was nothing of an adverse nature to mention, nor have any complaints of disturbing after effects been reported to us from parents. Great credit is again due to the Anaesthetist for the highly skilful way he has handled these patients. The year's successful results are due in no small measure to the efforts of the Dental Nurses at the Centres and Schools. Their work on the district also has helped to maintain a regular supply of patients to the Centres. PART II. SCHOOL MEDICAL SERVICE. Inspection. Routine.—400 visits were made by the Dental Officers to the Schools, when 20,957 scholars were inspected out of a total school population of 21,427. 14,407 children, or 68-7 per cent, of number inspected, were found to be defective and advised to have treatment. This is an improvement on the previous year, when 70 per cent, had carious teeth. The average number inspected per session was 52. A perusal of the annual reports of local authorities shows that the average number of children inspected at a school session varies widely in different parts of the country. A fact which sometimes gives rise to comment. It is scarcely necessary to point out that this variation has no relation to the ability or energy of the officers concerned, but rather to the scheme operative under each particular authority. The School Dentist who inspects and charts, and is able to rely on others to collect consents and ensure a regular attendance of children for treatment has time to cope with more children than one not so favourably supported. The latter has to spend much time talking individually to the children, in order to arouse sufficient interest for them to want and actually ask their parents to allow them to have treatment. Casual Cases.—There has been a gratifying decrease of 522 in the number of casual cases, the figure for the year being 968, against 1,490 of the previous year. The bulk of these, of course, are neglected cases, but included among them is a group who have learned to care for their teeth and seek advice during the period intervening between school inspections. Some of them are children about to leave school. There are indications that this number is increasing but we have no accurate record. Treatment. Of the 15,375 children with defects 5,365, or approximately 35 per cent., were treated at the Centres. Progress is again shown here, for the corresponding figure in 1931 was 32-3 per cent., and in 1930 29-9 per cent. The treatment, which occupied 1,258 sessions of the Dental Officers' time, and 14,245 attendances of the children, included 9,471 fillings, of which 8,366 were done on the permanent teeth and 1,105 on the temporary. Also 12,062 teeth extractions, 1,946 of which were permanent teeth and 5,359 sundry operations of root and gum treatment, swabbing, silver nitrate, etc. The number of fillings per 100 children was 176, and the number of extractions 224. In the case of the permanent teeth 36 per 100 children were extracted. This latter figure is another which varies greatly in different parts of England. In some parts of the Provinces it is as low as 3, while in London (L.C.C.) it amounts to 39. The proportion of fillings done to teeth removed continues to improve, and for the year is as 1/1-2 compared with 1/1-6 in 1931 and 1/2-2 in 1930. 48 The following table is the summary of work done per session Table No. 39. Attendances. Fillings. Extractions. Other Operations. Total. 11.3 7.5 9.6 4.2 21.3 Table No. 40. The following table, No. 40, is a summary of the year's work (1) Number of children who were:— (a) Inspected by the Dentists:— Aged:- 5 1,106 6 1,942 7 1,925 8 2,204 9 2,176 10 2,477 11 2,556 12 3,326 13 2,075 14 1,128 15 39 16 3 Total 20,957 Specials (see Note (d)) 968 Grand Total 21,925 (b) Found to require treatment 15,375 (c) Actually treated at the Authority's Health Centres 5,365 (d) Re-treated during the year as the result of periodical examination 2,231 Note.—(d) is included in (c). (2) Half days devoted to f Inspection 400 Total 1,658 Treatment 1,258 (3) Attendances made by the children for Treatment 14,245 (4) Fillings Permanent teeth 8,366 Total 9,471 Temporary teeth 1,105 (5) Extractions Permanent teeth 1,946 Total 12,062 Temporary teeth 10,116/ (6) Administration for general anaesthetics— For extractions 3,108Total 3,779 Local 671 (7) Other operations Permanent teeth 4,987 Total 5,359 Temporary teeth 372/ * 314 treatment sessions allocated to Maternity and Child Welfare work and 10 administrative sessions are not included in this figure. Table No. 41. Return shewing 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 1932 at the Health Visitor's last visit. Total number of defects coming under observation during 1932. Brought forward 1932 812 New during year 8,027 8,839 Number of defects treated:— Health Centre 5,365 Otherwise 73 5,438 49 Percentage of defects followed up needing treatment which were known to have received treatment 62% No report available 56 Number of defects for which no treatment has been undertaken at Health Visitor's final visit 2,675 Carried forward to 1933 603 Number not needing treatment 67 Educational. Educational work has proceeded along lines similar to the previous year, and pamphlets on mouth hygiene and diet have been issued to the parents and scholars both at the Centres and Schools. Arrangements have been made for the Dental Board's demonstrations to be exhibited at a number of schools during 1933, and in addition all children leaving school within the year are to be given the booklet " What about your teeth ? " which is also supplied free by the Dental Board. Board of Education. The Chief Medical Officer, in his Annual Report for 1931, " The Health of the School Child," invites school dentists to assist in an investigation of those children in 12-13 age group, who are naturally free from dental caries. Arrangements have been made to collect all the information possible which is likely to prove of use in this enquiry. Opinions have also been asked as to the practicability of excluding from the dental scheme all those children whose parents continually ignore the advice given them at the routine inspections. For, so long as provision is made for the removal of aching teeth, so long will the parents obstinately refuse to have anything done in the nature of conservative work. On the other hand, if treatment at the Centres is withheld the parents may then be forced to attach more importance to the early detection and treatment of dental caries. The view of the Dental Officers here is that the parents do tend to minimise the reports received from the school examination, knowing full well that they can attend the Centres should any trouble intervene. But the problem is not likely to be solved by closing the Centres to them, since this district, unlike many provincial areas, is relatively close to dental hospitals and institutions where urgent treatment can always be obtained. No doubt many do successfully evade us in this way throughout their school life. The best course to pursue at present seems to be to try to overcome the fear, prejudice and ignorance which is the cause of the indifference to routine inspection reports. A child in distress with aching teeth no doubt does provide a wonderful opportunity of reform, and a considerable number are converted into routine cases. At our Centres during the last two years facilities for early relief by extraction have been increased, yet extractions and special cases have fallen while the number of routine cases and fillings have increased. Below is a table showing these results :— Table No. 42. Year. Extractions. Fillings. Specials. Routine Treated. 1932 12,062 9,471 968 4,397 1931 14,467 8,066 1,494 3,604 PART III. MATERNITY AND CHILD WELFARE. The returns show that marked progress has been made. 648 mothers and 471 infants were inspected at the Centres, which with 216 incompleted cases from the previous year make a total of 1,335. This is an increase of 226 over the corresponding figure of the year 1931. 700 of these had their treatment completed at the Centres, 67 commenced treatment and had offending teeth removed, but did not return to be completed and were removed from observation. 3 were treated by outside agencies, 40 had no defects, 2 of whom were expectant mothers ; 260 did not return for treatment, leaving 265 carried on to 1933. 50 Treatment. For the mothers 4,278 teeth were extracted, 517 fillings done and 1,060 scalings, cleanings, syringings, etc., while 224 were supplied with dentures. In the case of infants 1,320 teeth were extracted, 323 teeth filled, and 54 incidental treatments such as silver nitrate applications. The total attendances for all these patients recorded was 4,382, which occupied 314 treatment sessions, giving an average of nearly 14 per session. The following table is a summary of the conditions found on inspection of the 498 infants:— Table No. 43. No. inspected 498 No. with no defects 38 No. „ decayed teeth (temporary) savable 182 No. „ „ „ ( „ ) unsavable 314 No. of decayed temporary teeth savable 380 No. „ „ ,, unsavable 1,427 51 THE THIRD ANNUAL REPORT for the Year ending 31st December, 1932, on the SUPERVISION OF MIDWIVES. Table No. 44. Number of Midwives who, during the Month of January, gave Notice of their Intention to Practice in Willesden in 1932 and 1933 respectively. 1932 1933 In Willesden— Private District Midwives 15 10 Queen Charlotte's District Home, 40, Princess Road, Kilburn 3 3 Central Middlesex County Hospital 2 6 Outside Willesden— Private District Midwives 7 7 Queen Charlotte's District Home, 176, Ladbroke Grove 3 3 Kilburn and West Hampstead District Nursing Association 3 3 Total 33 32 Table No. 45. Number of additional Midwives who, From 1st February to 31st December, 1932, gave Notice of their Intention to Practice in Willesden in 1932. In Willesden. Private District Midwives 2 Queen Charlotte's District Home, 40, Princess Road, Kilburn 3 Central Middlesex County Hospital 7 Outside Willesden. Private District Midwives 5 Queen Charlotte's District Home, 176, Ladbroke Grove 1 Kilburn and West Hampstead District Nursing Association 2 Total 20 During 1932, from January 1st to December 31st, 53 Midwives gave notice of their intention to practice in Willesden. 52 Table No. 46. Number of Cases attended by Midwives Practising and Living in Willesden during 1932. Midwives living in Willesden. No. of Cases attended. Total. Remarks. As Midwife. As Maternity Nurse. 1 19 15 — 2 None None — 3 6 2 — 4 7 3 — 5 2 8 — 6 46 17 — 7 38 1 — 8 1 None — 9 45 5 — 10 53 9 — 11 15 7 — 12 26 13 — 13 None None — 14 8 2 — 15 None None — 16 None None — 17 None None — Midwives attached to Willesden District Nursing Association None 205 — Midwives attached to Queen Charlotte's District Home, 40, Princess Road, Kilburn 403 None — Midwives in the Central Middlesex County Hospital *361 *14 *These patients have all been attended in the Hospital. Total 1,030 301 — = 1,331 in all. Table No. 47. Number of Cases attended by Midwives practising in but Living Outside Willesden during 1932. Midwives living outside Willesden. No. of Cases attended in Willesden. Total. As Midwife. As Maternity Nurse. A None None B None None C 1 None D None None E None None F 12 None G None 1 H 2 None I None None J None None K None None L None None Midwives attached to Queen Charlotte's Hospital District Home, 176, Ladbroke Grove 25 None Midwives attached to Kilburn and West Hampstead District Nursing Association 23 None Total 63 1 53 From Table III. it will be observed that midwives living in Willesden attended 1,030 cases a midwives and 301 cases as maternity nurses, or 1,331 in all. Of the midwives living in Willesden it will be noted that apart from institutions or associations the largest number of midwifery cases any single midwife attended as a midwife was 53, and that the largest total of cases that any single widwife attended was 63, being 46 cases which she attended as a midwife and 17 as a maternity nurse. During the year ended 31st December, 1932, 147 notifications were received from midwives practising in Willesden in accordance with the rules of the Central Midwives Board. Of these 147 notifications 126 were received from midwives living and practising in Willesden, and 21 from midwives practising in but living putside Willesden. Of the 147 notifications received 124 were in respect of calling in medical help, 86 being in respect of the mother and 38 in respect of the child. In addition 21 notifications were received from midwives acting as maternity nurses. The total fees paid by the Council to Medical Practitioners called in by midwives during the year ending December 31st, 1932, was £71 8s. Od. During the year £24 1s. Od. was recovered from patients. Table No. 48. The following information was sent to the Ministry of Health on Form M.C.W. 96 (revised):— Midwives. I. (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., 1933, 36 have notified intention to practice in Willesden during 1933.) 41 (b) Number (i.) employed by the Council 0 (ii.) directly subsidised by the Council 0 (iii.) employed by Voluntary Associations in Willesden 7 (Queen's Nurses, 19, Park Avenue, Willesden—These act as Maternity Nurses —not as Midwives.) 3 (Queen Charlotte's Hospital District Home, 40, Princess Road, Kilburn.) (iv.) employed by Voluntary Associations outside Willesden (Queen Charlotte's Hospital District Nurses' Home, 6 North Kensington.) (Queen's District Nurses, Hampstead.) (c) Number of cases during the year in which the Council paid or contributed to the fee of a midwife— 37 where the midwife was acting as a midwife. 10 where the midwife was acting as a maternity nurse. II. (a) 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 879 214 (ii.) As maternity nurses 295 7 (b) Number of cases during the year in which medical aid was summoned by a midwife under Section 14 (1) of the Midwives Act, 1918—124. 54 Table No. 49. Notifications received from Midwives in accordance with the Rules of the Central Midwives Board, 1st January to 31st December, 1932. From Midwives living and practising in Willesden. From Midwives practising in Willesden but living outside. Notifications of:— Sending for Medical Help 103 21 Having laid out a dead body 14 — Liability to be a source of infection 11 — Death 5 — Still Birth 5 — Artificial feeding 9 — Table No. 50. Reasons for Sending for Medical Help. For Mother. Medical Help sought by Midwives. For Child. Medical Help sought by Midwives. Living in Willesden. Living outside Willesden. Living in Willesden. Living outside Willesden. Ante-natal examination 6 1 Premature infants 7 1 Malformation 2 — Weak labour pains 2 — Sticky eyes 7 4 Delayed labour 15 2 Watery blisters 1 — Laceration of perineum 14 4 Spots on baby's legs 3 – Abortion 2 — Sore umbilicus 1 — Ante-partum haemorrhage 1 – Watery eyes 4 — Rash on face 1 — Post-partum haemorrhage 2 – Suspicious spots 1 — Haemorrhage from navel 1 – Footling and cord presentation 1 1 Cleft palate 1 — Complicated breech 2 2 Jaundice 2 — Poor condition of mother 1 – Coloured dent on head 1 – Patient wishing for forceps 1 – Broken clavicle 1 — Raised temperature 7 – Sores on genitals — 1 Exhaustion of patient 1 1 Varicose veins 1 1 Presentation unknown 3 – Retained placenta 2 — Prolapsed cord 1 1 Septic rash on hands 1 1 Premature labour 1 — Albuminuria of pregnancy 4 1 Haemorrhoids 1 — Fainting fits 1 — Total 70 16 33 5 Table No. 51. Fees Paid to Medical Practitioners under Section 14 of the Midwives Act, 1918. January 1st to December 31st, 1932. Number of notifications of Sending for Medical Help 124 „ „ „ in respect of which fees paid 67 Total fees paid by Council £71 8s. 0d „ „ recovered from Patients £24 1s. 0d. 55 THE THIRD ANNUAL REPORT for the Year ending 31st December, 1932. on the REGISTRATION OF NURSING HOMES. NURSING HOMES REGISTRATION ACT, 1927. Table No. 52. Maternity and Nursing Homes, January 1st, 1932, to December 31st, 1932 (1) Number of applications for registration:— (a) Maternity Homes 1 (b) Nursing Homes 1 (2) Number of Homes registered 1 (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 2 At the close of the year there were 8 Nursing Homes on the Register of the Willesden Urban District Council with accommodation for 46 patients. 56 THE THIRD ANNUAL REPORT for the Year ending 31st December, 1932, 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 the 1930 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 and arrange for the advertisements in the local press to be scrutinized for any enquiring for or offering homes for children for reward or adoption. A report on Infant Life Protection appeared as Appendix G in 1931. Table No. 53. Foster Mothers. Number of Foster Mothers at 2nd January, 1932 139 „ „ „ at 31st December, 1932 123 Number of Licences granted by Council, 2nd Jan., 1932 to 31st Dec., 1932 47 „ „ refused by Council, 2nd Jan., 1932 to 31st Dec., 1932 10 Number of applications to take additional children agreed to by Council 6 ,, ,, ,, „ „ refused by Council 3 Number of applications for re-issue of Licence agreed to by Council 21* „ „ „ „ refused by Council 2 Foster Children. Coming under observation— Number of Foster Children at 2nd January, 1932 200 „ „ „ received 2nd Jan., 1932 to 31st Dec., 1932 197† Number entered Willesden with their Foster Mothers 9 Total 406 Removed from observation. Number given up 195 ,, reached the age of 7 years ... 17 „ died 0 „ legally adopted 5 „ ceased to be taken for gain or taken over by Public Assistance Committee 2 „ left Willesden with their Foster Mothers 18 Total 237 Remaining under observation— Number of Foster Children at 31st December, 1932— (a) Under 5 years of age 142 (b) Between 5 and 7 years of age 27 Total 169 * Of these 21 cases 14 were re-issued in respect of new premises. † The actual number of new individual Foster Children who came under observation, was 152. 57 Table No. 54. The 169 Foster Children under observation at 31st December, 1932, were maintained in the care of Foster Mothers as follows:— Maintained by— Parent or Guardian 111* Crusade of Rescue, 48, Compton Street, W. 52 National Adoption Society, 4, Baker Street, W. 6 Received with lump sum 0 Total 169 * In 39 cases the parents or guardians were living in Willesden at the time the child entered the care of the Foster Mother. In 72 of these cases the parents or guardians were not living in Willesden at the time the child entered the care of the Foster Mother. Table No. 55. The following Table shows the length of time each of the 169 Foster Children under observation at 31st December 1932 had been in the care of their Foster Mothers. Under 6 months 48 Over 6 months, under 1 year 31 Over 1 year, under 1½ years 21 Over 1½ years, under 2 years 15 Over 2 years, under 2½ years 10 Over 2½ years, under 3 years 8 Over 3 years, under 3½ years 8 Over 3½ years, under 4 years 11 Over 4 years, under 4½ years 2 Over 4½ years, under 5 years 6 Over 5 years, under 5½ years 2 Over 5½ years, under 6 years 3 Over 6 years, under 6½ years 2 Over 6½ years, under 7 years 2 Total 169 Of the 352 individual Foster Children under observation during the year 1932, 166 changed hands during that period. 127 made 1 change, 25* made 2 changes, 12§ made 3 changes, 1 made 4 changes, 1 made 6 changes. These changes do not include the first reception of the child. * Of these, 4 were admitted to Hospital returning to same Foster Mother. § Of these, 5 were admitted to Hospital returning to same Foster Mother. THE THIRTEENTH ANNUAL REPORT For the Year ending 31st December, 1932, on HOME NURSING. A record of work done is given in the three following tables:— Table No. 57 Shewing Sources from which cases were referred for Home Nursing during the Year 1932. Referred by Number. Health Department 327 Private Doctors 33 Others 34 Total 394 Table No. 58. Shewing cases Home Nursed in Wards during 1932. Ward No. of Cases brought forward from 1931. No. of Cases referred in 1932. Total. No. of Visits paid. 1. South Kilburn 4 96 100 1,015 2. Mid-Kilburn 0 79 79 775 3. North Kilburn 4 64 68 684 4. Brondesbury Park 0 4 4 21 5. Kensal Rise 0 17 17 321 6. Harlesden 0 16 16 116 7. Stonebridge 0 28 28 311 8. Roundwood 0 24 24 254 9. Church End 1 18 19 127 10. Willesden Green 1 11 12 66 11. Cricklewood 0 37 37 205 Total 10 394 404 3,895 58—59 Table No. 56.—Showing Cases dealt with during 1932 and Results. Disease. Cases being nursed at end of 1931. New Cases during 1932 Removed from Observation during 1932—Results of Treatment. Still being Nursed at end of 1932. Number of Visits Paid during 1932. Died. Removed to Hospital or other Institution. 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. Abdominal Pain – – – – – – – 1 – – – 1 – – – – – – – 1 – – – 1 – – – – – – – – – – – – – 7 – – – 7 Adenitis – – – – – – – – 1 – – 1 – – – – – – – – – – – – – – – – – – – – – – – – – – 5 – – 5 Bathing Cases – – – – – – – – 3 – – 3 – – – – – – – – – – – – – – – – – 3 – – – – – – – – 12 – – 12 Bronchitis – – – – – – — – – 1 1 2 – – – – – – – – – – – – – – – 1 1 2 – – – – – – – – – 12 2 14 Burns and Pneumonia – – – – – – – – 1 – – 1 – – – – – – – – – – – 1 – – – – – – – – – – – – – – 6 – – 6 Burns and Scalds – – – – – – – 1 3 3 — 7 – – – – – – – – – – – – – 1 3 3 — 7 – – – – – – – 8 15 52 – 75 Cancer – – – – – – – – – – 1 1 – – – – – – – – – – – – – – – – 1 1 – – – – – – – – – – 9 9 Circumcision – – – – – – – – 13 – – 13 – – – – – – – – – – – – – – 13 – – 13 – – – – – – – – 77 – – 77 Complication of Pregnancy – – – – – – – – – – – 1 – – – – – – – – – – – 1 – – – – – – – – – – – – 6 – – – – 6 Dental Cases – – – – – – – – – 2 – 2 – – – – – – – – – – – – – – – 2 – 2 – – – – – – – – – 3 – 3 Douching Case – – – – – – – – – – 1 1 – – – – – – – – – – – – – – – – 1 1 – – – – – – – – – – 1 1 Eczema – – – – – – – – 5 – – 5 – – – – – – – – – – – – – – 5 – – 5 – – – – – – – – 60 – – 60 Eczema and – – – – – – – – 1 – – 1 – – – – – – – – – – – – – – 1 – – 1 – – – – – – – – 35 – – 35 Faecal Fistula – – – – – – – – – – 1 1 – – – – – – – – – – – – – – – – – – – – – – 1 1 — — — — 179 179 Gastro Enteritis – – – – – – – – 1 – – 1 – – – – – – – – 1 – – 1 – – – – – – – – – – – – – – 2 – – 2 Impetigo – – – — – – – – 4 1 — 5 – — – – – – – — – — – – – – 4 1 – 5 – – – – – – – – 73 5 – 78 Impetigo and Otorrhœa – – – – – – – – 1 – – 1 – – – – – – – – – – – – – – 1 – – – – – – – – – – – 15 – – 15 Leucorrhœa – – – – – – 2 – – 1 – 3 – – – – – – – – – 1 – 1 2 – – – – 2 – – – – – – 6 – – 10 – 16 Mastitis – – – – – – – 5 – – – 5 – – – – – – – – – – – – – 4 – – – – – 1 – – – 1 – 76 – – – 76 Mastoid – – – – – – – – – 1 – 1 – – – – – – – – – 1 – 1 – – – – – – – – – – – – – – – 7 – 7 Measles and Bronchitis – – – – – – – – 1 – – 1 – – – – – – – – – – – – – – 1 – – 1 – – – – – – – – 5 – – 5 Measles and Pneumonia – – – – – – – – 1 1 – 2 – – – – – – – – – 1 – 1 – – 1 – – 1 – – – – – – – – 12 4 – 16 Ophthalmia – – 1 – – 1 — — 51 5 – 56 – — – – — — – — – — – – — — 50 4 — 54 – — 2 1 — 3 — — 603 115 – 718 Ophthalmia Neonatorum – – – – – – – – 16 – – 16 – – – – – – – – 1 – – 1 – – 14 – – 14 – – 1 – – 1 – – 195 – – 195 Ophthalmia and Sores – – – – – – – – 1 – – 1 – – – – – – – – – – – – – – 1 – – 1 – – – – – – – – 29 – – 29 Otorrhœa – – 3 2 – 5 – – 34 9 — 43 – — – – – – — – – 1 – 1 – – 33 8 – 41 – – 4 2 – 6 – – 574 279 – 853 Pemphigus – – 1 – – – – – 4 – – 4 – – – – – – – – – – – – – – 5 – – 5 – – – – – – – – 72 – – 72 Pleurisy and Thrombosis – – – – – – – 1 – – – 1 – – – – – – – 1 – – – 1 – – – – – – – – – – – – – 9 – – – 9 Pneumonia – – 1 – – 1 – – 2 2 — 4 — — — – — – — — – 1 — 1 – – 3 1 — 4 — – — – — – — — 28 56 – 84 Prematurity – – – – – – – – 2 – – 2 – – 2 – – – – – – – – – – – – – – – – – – – – – – – 5 – – 5 Pyelitis – – – – – – – – – – 1 1 – – – – – – – – – – – – – – – – 1 1 – – – – – – – – – – 11 11 Round Worms – – – – – – – – 1 – – 1 – – – – – – – – – – – – – – 1 – – 1 – – – – – – – – 3 – – 3 Septic Conditions – – 1 – – 1 — 4 30 17 – 51 – – – – – – – – – – – – – 4 31 17 – 52 – – – – – – – 14 189 118 – 321 Skin Conditions – – 1 – – 1 – 1 1 2 — 4 – – – – – – – – – – – – – 1 2 2 – 5 – – – – – – – 6 15 20 – 41 Thread Worms – – – – – – – 3 80 54 – 137 – – – – – – – – – – – – – 3 78 54 – 135 – – 2 – – 2 – 11 370 298 – 679 Thread Worms and Psoriasis – – – – – – – – – 1 – 1 – – – – – – – – – – – – – – – 1 – 1 – – – – – – – – – 8 — 8 Throat Conditions – – – – – – – – 3 3 – 6 – — – — — — – — — — — — — — 3 3 — 6 — – — — – – — — 16 18 — 34 Throat Condition & Broncho-Pneumonia – – – – – – – – – – – 1 – – – – – – – – – – – 1 – – – – – – – – – – – – – – – 11 — 11 Thrombosis – – – – – – – 1 – – – 1 – – – – – – – – – – – – – 1 – – – 1 – – – – – – – 2 – – – 2 Varicose Ulcer – – – – – – – – – – 1 1 – – – – – – – – – – – – – – – – – – – – – – 1 1 — — — – 85 85 Whooping Cough and Broncho-Pneumonia – – – – – – – – 1 – – 1 – – – – – – – – 1 – – 1 – – – – – – – – – – – – – – 5 – – 5 Whooping Cough and Impetigo – – – – – – – — 2 1 — 3 – – — – – — – – – – – – – – 2 1 – 3 – – – – – – – – 14 12 – 26 Total – – 8 2 – 10 3 17 263 105 6 394 – – 2 – – 2 1 2 4 6 – 13 2 14 256 98 4 374 — 1 9 3 2 15 12 133 2435 i 1028 287 3895 61 THE EIGHTEENTH ANNUAL REPORT FOR THE Year ending December 31st, 1932, 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 South Kilburn area. The meal consists of cocoa made with dried milk, and sugar, bread and vitamin 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 899. 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 1s. 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 PublicAssistance Committee supplying every four weeks the list of children to be fed. The economic circumstances scale was revised and raised 1s.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. A change has been made with regard to the serving of the meals. The first course is now served in earthenware soup plates instead of the old shallow enamel ones, 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. Extra supervision has been supplied at the dinner centre on account of the greatly increased numbers, and the behaviour of the children has improved, although they 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 arrangement being carried out by the caretaker. The number of application forms received from South Kilburn for the year was: Dinners 496, Breakfasts 57. Meals.—A three weekly menu was commenced in the Education Committee's Centres on July 23rd, 1928. This provides one meatless meal, one stew, one roast or boiled meat, 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 31 st DECEMBER, 1932. Table No. 59.—No. of Meals Supplied. Supplied to:— Breakfasts. Free. Dinners. Total. Free. Paying. M.C.C. Education Committee's Centres 5,018 80,124 565 9,121 94,828 Kilburn Voluntary Centre — 55,915 — 9,535 65,450 Special Schools — 11,795 18,519 1,410 31,724 Feeding Centre Assistants 2,665 3,154 — — 5,819 Total 7,683 150,988 19,084 20,066 197,821 62 Table No. 60. Occupation List 1932. Occupation. No. of Children Fed during 1932. No. of Families Involved. Percentage. 1931. 1932. 1931. 1932. Unemployed 967 295 424 63.17 70.08 Widows 106 49 55 10.5 9.09 Deserted Wives. 51 29 31 6.2 5.12 Orphans 3 3 3 0.6 0.49 Labourers 98 38 33 8.1 5.45 Railwaymen 46 17 15 3.6 2.47 Hawkers... 39 10 17 2.1 2.80 Others 89 26 27 5.5 4.46 1,399 467 605 Approximate average cost of food only, 3d. ; total (gross), 5d. 63 THE FORTY-FIRST ANNUAL REPORT ON THE MUNICIPAL HOSPITAL By ARTHUR G. TROUP, M.D., D.RH , Medical Superintendent. During 1932, 869 patients were admitted to hospital as compared with 842 in 1931, 1,029 in 1930, 955 in 1929, 1,037 in 1928 and 767 in 1927. Cerebro-Spinal Fever. Eight cases of this disease were admitted to hospital during the year, and one case remained over from the previous year, giving a total of nine cases under treatment. Five deaths occurred. In order to arrive at a true hospital mortality rate, it is the usual custom to deduct those deaths which occurred within 48 hours of admission. Three cases come under this category, and the deduction gives a mortality rate of 22.2 per cent. The cases which recovered were in a satisfactory mental and physical condition at the date of discharge from hospital. Diphtheria. 180 cases were admitted to hospital compared with 250 cases during 1931. These cases may be classified as follows:—Faucial 128, Nasal 33, Faucial and Nasal 10, Aural 10, Laryngeal 5, Bacteriological 3, Wound 1. It was necessary to perform the operation of tracheotomy on two of the laryngeal cases. Both made very good recoveries. The total number of deaths from diphtheria was 10, giving a corrected mortality rate of 4.5 per cent. The corresponding mortality rate for England and Wales for the year 1931 was 5.3 per cent. Enteric Fever. One case of Typhoid Fever, 1 of Paratyphoid Fever B, and 1 Paratyphoid Fever B carrier were admitted during the year. The case of Typhoid Fever proved fatal. He was admitted to hospital on the 11th day of illness, and subsequently had several haemorrhages. Later perforation of the intestine occurred. Erysipelas. Twenty-two cases of this disease were treated during the course of the year, and 1 death occurred. Table No. 61. Diseases. Remaining on 1st Jan., 1932. Admitted. Total under treatment. Discharged recovered. Died. Mortality per cent. Remaining on 31st Dec., 1932. Cerebro-Spinal Fever 1 8 9 4 5 55.5 – Diphtheria 32 187 219 173 10 4.5 36 Diphtheria (Bacteriological) – 3 3 3 – – – Enteric Fever 2 3 5 4 1 20.0 – Erysipelas 3 19 22 15 1 4.5 6 Measles 4 158 162 147 15 9.2 – Mixed infections – 14 14 14 – – – Puerperal infections – 15 15 13 1 6.6 1 Scarlet Fever 49 346 395 352 1 0.25 42 Whooping Cough – 18 18 15 3 18.6 – Other diseases 1 98 99 86 10 10.1 3 Totals 92 869 961 826 47 – 88 Measles. 162 cases of this disease were treated in hospital during the year, and 15 deaths occurred. The large majority of the cases were admitted during the spring months. 64 The age incidence of the cases is as follows:— Under 1 1-2 2-3 3-4 4-5 5-15 Over 15 No. of cases 11 48 25 22 9 33 10 Fatal cases 1 9 1 2 – 2 – Fatal Cases—Duration of Stay in Hospital. No. of days 1 2 3 4 5 6 over 7 No. of cases 3 2 2 1 – 1 6 Chief Complications. Broncho-Pneumonia 48 Otitis Media 11 Enteritis 5 Laryngitis 3 Mastoiditis 2 Complications in Fatal Cases. Broncho-Pneumonia 12 Toxic Measles 2 Abscess of Lung 1 Cross infection with measles occurred in the female scarlet fever ward with four secondary cases. Mixed Infections. The following cases of mixed infection were admitted during the year:— Diphtheria and Measles 7 Whooping Cough and Measles 4 Whooping Cough and Scarlet Fever 1 Whooping Cough and Chicken Pox 1 Scarlet Fever and Chicken Pox 1 One case of diphtheria and measles had to have the operation of tracheotomy performed. The patient made a good recovery. Puerperal Infections. The 15 cases of Puerperal infection which were admitted during the year may be classified as follows :— Local Uterine Sepsis 5 Septic Abortion 2 Laceration of Vagina 1 Abscess of Thigh 1 Mammary Abscess 1 Pyelitis 1 Septic Perineal Wound 1 Tonsillitis 1 Bacilluria 1 Septicaemia 1 The case of septicaemia occurred in a woman after a miscarriage, and the patient died 29 days after admission to hospital. The infecting organism proved to be the pneumococcus. All the other cases made very good recoveries. Scarlet Fever. During the year 346 cases of Scarlet Fever were admitted to hospital, as compared with 375 cases last year. One death occurred, the cause of which was pneumonia. Whooping Cough. Eighteen cases were admitted and 3 deaths occurred, all due to broncho-pneumonia. 65 Other Diseases. Ninety-eight patients were admitted under this heading as follows:— Tonsillitis 30 Cellulitis 1 Rubella 9 Meningitis 1 Chicken-Pox 7 Meningismus 1 Ophthalmia Neonatorum 7 Encephalitis Lethargica 1 Enteritis 4 Anterior Poliomyelitis 1 Marasmus 3 Adenitis 1 Laryngitis 3 Bronchitis 1 Pneumonia 3 Food Rash 1 Mumps 3 Vincents Angina 1 Tubercular Meningitis 2 Stomatitis 1 Rhinitis 2 Septicaemia 1 Otitis Media 2 Dysidrosis 1 Rheumatic Fever 2 Herpes 1 Septic Rash 2 Malignant Endocarditis 1 Teething Rash 2 Negative Case 1 Influenza 2 Ten deaths occurred:— Tubercular Meningitis 2 Septicaemia 1 Pneumonia 2 Malignant Endocarditis 1 Marasmus 2 Meningitis 1 Encephalitis Lethargica 1 The two cases of marasmus were admitted from another Institution in the district as diphtheria carriers. Sick Staff. The following are the figures for the past four years for the Nursing Staff:— Number of Nurses who were off duty for 24 hours or more. Number of days off duty. 1929 24 373 1930 31 521 1931 33 483 1932 28 348 The health of the Domestic Staff has been satisfactory. No cases of infectious diseases occurred. Duration of Stay in Hospital. (1) Scarlet Fever. The average length of detention of scarlet fever patients shows a slight decrease this year as compared with last year, and a marked decrease as compared with the year 1926. The minimum period of stay in hospital is 28 days from the onset of illness, and 267 patients out of a total of 346, or 77-2 per cent., were discharged between the 28th and 35th day. Average stay in hospital of scarlet fever patients during recent years:— 1926—47.2 1931—34.5 1928—37.0 1932—33.5 (2) Diphtheria. Average stay in hospital of diphtheria patients, 1929-1932:— 1929—51.7 1931—56.2 1930—53.3 1932—45.6 (3) Other Diseases. Average stay in hospital of patients suffering from "other diseases" 1929-1932:— 1929—23.4 1931—29.3 1930—27.1 1932—27.2 The following are the figures for the past four years for the Domestic Staff:— Number of Maids who were off duty for 24 hours or more. Number of days off duty. 1929 23 298 1930 11 281 1931 15 212 1932 9 133 The health of the Nursing Staff has been satisfactory. Two nurses contracted scarlet fever one nurse contracted measles and one nurse had to have her tonsils excised as she proved to be a diphtheria carrier. The other 24 nurses had comparatively mild illnesses with the exception of one who had to be operated on for appendicitis. 66 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 6 cases of diphtheria have occurred, 1 in 1927, 1 in 1928, 1 in 1929, 2 in 1930 and 1 in 1932. In the last case the diagnosis of diphtheria is open to question, as the nurse had been immunised and eventually proved to be a carrier. The particulars regarding the other 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 1932 (after immunisation was carried out) 6 Incidence rate per annum (taking 30 as average number of probationer nurses) 3.3% Number of nurses Schick tested (1927 to 1932 inclusive) 177 Number of nurses giving a positive reaction 87 Percentage of nurses giving a positive reaction 49.1 % Number of nurses re-Schick tested 42 Number of nurses re-Schick tested giving a positive reaction 16 Percentage of nurses re-Schick tested giving a positive reaction 38.0% (2) Health Centre. This clinic was made available for Willesden residents in May, 1927. The number of individuals attending for treatment is now very small. The following are the figures for 1927 and 1932 respectively:— 1927 1932 Number attending for preliminary Schick Test 82 2 Number attending for immunisation 94 6 Laboratory. The bacteriological laboratory was opened for work on the 1st January. It undertakes the examination of the routine bacteriological specimens from the district and the Municipal Hospital. In addition, a number of specimens are received from the Central Middlesex County Hospital and other Institutions within the area. The following table shows the number of specimens examined during the year Table No. 62. Nature of Specimens Examined. Positive Result. Negative Result. Total. 1 Swabs for Diphtheria Bacilli 250 2,398 3,648 2 Swabs for Diphtheria (Virulence Tests) 7 14 21 3 Blood for Widal Reaction 5 25 30 4 Sputum for Tubercle bacilli 103 523 626 5 Swabs and Films for Gonococci 30 33 63 6 Specimens of Pus — — 7 7 Blood Cultures — — 4 8 Swabs for Vincent's Angina 1 3 4 9 Cerebro-Spinal Fluids — — 16 10 Fluid for Tubercle Bacilli — — 6 11 Fluid from Pleural Cavity — — 5 12 Faeces for Organisms — — 12 13 Urines — — 80 14 Swabs for Scarlet Fever (Streptococci) — — 4 4,526 Table No. 63. Sources of Specimens Examined. From Willesden Municipal Hospital 1,221 „ Private Practitioners 1,475 ,, Municipal Health Centres and Health Nurses 1,007 „ Central Middlesex County Hospital 788 Other Hospitals 35 4,526 Hospital Buildings. (1) Cubicles.—The two cubicle pavilions completed during 1931 have not yet been furnished or equipped to receive patients. (2) A new washing machine has been installed in the laundry in order to cope with the extra work now received from external sources. 67 THE SECOND REPORT on the WILLESDEN MATERNITY HOSPITAL. REPORT ON THE WORK FROM 1st JANUARY, 1932, to 31st DECEMBER, 1932, 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 Maternity Hospital for the year 1932. The arrangements outlined in the last report have been continued and the working of the hospital has been carried out in close co-operation with the Health Centres. It is to be hoped that the financial situation will permit the Council to consider the addition of further accommodation. The Hospital has been recognised by the Central Midwives Board as a training school for midwives During the year, 558 patients were discharged and two died. Of these two deaths, the first was a booked case which died as a result of failure of the kidney function after the onset of labour. The patient, in spite of repeated requests, failed to attend the antenatal clinics with regularity and, although a post-mortem examination disclosed old-standing kidney disease of several years duration, it is possible that the fatal ending might have been avoided by active co-operation on the part of the patient. The second case was admitted late in labour, seriously ill. She had made arrangements for her confinement to take place in her own home and I was called in by a doctor under the Difficult Labour Scheme. She died from Acute Yellow Atrophy of the Liver, a rare form of Toxaemia of Pregnancy which is almost invariably fatal. The statistical data in this report is based on the number of cases completed during the year and not on admissions. This is in accordance with the unified system under which all maternity hospitals in this country now issue their reports. Of particular interest in the following figures are those relating to Puerperal Pyrexia, Toxaemia of Pregnancy and Post-partum Haemorrhage. Out of 560 cases, only two cases of uterine infection occurred, both mild ; no less than 32 of these women developed toxaemia of pregnancy but the disease was diagnosed promptly in the ante-natal clinics and treated actively in hospital with the result that again no case of eclampsia is reported ; only one case of post-partum haemorrhage occurred. Puerperal sepsis, eclampsia and post-partum haemorrhage are probably the most important of all causes of maternal deaths and these figures go to show the extent to which these complications may be avoided by the practice of good midwifery. The number of emergency cases admitted has increased and it is to be hoped that as time goes on, more and more of the abnormal cases which occur in Willesden will be admitted to the hospital. A considerable number of these cases reach the ante-natal clinics and are admitted on medical grounds. This section forms a proportion of the cases booked by every maternity hospital. The patients differ as a class from the true emergency admissions in that the medical staff of the hospital have had the opportunity of treating an intercurrent disease or preparing for difficulties likely to arise during labour. In the true emergency cases, the hospital staff are called upon to deal with complications which have already arisen and over which they have had no control. It is by the early diagnosis and early hospitalisation of the abnormal case that maternal mortality and morbidity will be reduced. Statistical Details of the 560 Cases dealt with in the Hospital during the Year. Cases completed 560 A. Booked at the Health Centres 546 Discharged well 542 Transferred 3 Died 1 B. Admitted as Emergencies 14 Discharged well 12 Transferred 1 Died 1 68 Of the 546 booked cases, 266 were primipara and 280 were multipara. Of the 14 emergency cases, 7 were primipara and 7 were multipara. Presentations— Occipito Anterior 488 Occipito Posterior 45 Normal Breech 4 Abnormal Breech 9 Twins 9 Face 2 Shoulder 2 Ante-partum Haemorrhage— Placenta Prævia 3 Accidental Hæmorrhage 2 Post-partum Hæmorrhage 1 Manual Removal of Placenta 5 Prolapse of Cord 2 Organic Heart Disease 7 Toxaemia of Pregnancy admitted for treatment before Term 32 In no case did Eclampsia develop. Puerperal Pyrexia according to the B.M.A. standard 19 Uterine infection 2 Breast infection 7 Urinary infection 3 No cause found 3 Sundries 4 Miscarriage 1 Operations performed— Forceps delivery 28 The " forceps rate " was therefore 5 per cent. Caesarian Section 6 Heart Disease 3 Contracted Pelvis 2 Ovarian Cyst 1 Induction of Premature Labour 4 Internal Version 3 Embryotomy 3 Children. 568 viable children were born to 559 mothers. Of these, 543 left hospital alive and well, 15 were stillborn and 10 died. 473 were fed on breast milk alone. In 65 the milk of the mother had to be supplemented by artificial food and in 5 cases the child was fed on artificial food alone. 69 THE THIRD ANNUAL REPORT for the Year ending 31st December, 1932, 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 20 patients were medically inspected, 3 patients attended the Health Centres for treatment, the total number of attendances being 16. 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:— Table No. 64. Defect or Disease. Requiring Treatment. Received Treatment at Health Centre. Defective Vision 1 0 Defective Teeth 5 2 Skin Condition 1 1 Defective Hearing 1 0 Enlarged Tonsils 1 0 In addition one boy who was reported as having left the Occupation Centre attended the Health Centre on two occasions and received dental treatment, and two children not referred for dental treatment attended the Health Centre on three occasions each and received treatment. 70 THE SECOND ANNUAL REPORT ON NURSERY CLASSES for the Year ending 31st December, 1932. LOWER PLACE NURSERY CLASSES. Since the 1st Report on the Nursery Classes in Lower Place School was submitted, 24 out of the 39 children, the results of whose medical examination appeared in it, have proceeded to the Infant School. In the interval between the publication of the report and their transference to this department, 6 had dental treatment at the Health Centre for defective teeth found at the Medical Inspection ; in addition 3 of these, as well as 3 others, who were noted to have Enlarged Tonsils had tonsillectomy at the Willseden General Hospital under the Council Scheme; while 6 were reexamined for the defects scheduled, viz.: (a) Spinal Curvature.—3 were re-examined for Spinal Curvature. The 1st, who had had a slight degree of Round Shoulders caused by general debility, had improved so much that no curvature was detected, and he was removed from observation. The 2nd was a case of Postural Kypho-lordosis which had been examined at the Health Centre by the Orthopaedic Surgeon, and treatment recommended there. The mother, however, was unable to attend, so arrangements have been made for him to have special exercises at school. Improvement was noted, and he was entered up for reexamination in 6 months. The 3rd, who had Round Shoulders and faulty posture, had been referred to the Orthopaedic Surgeon, but the mother had found it impossible to keep the appointment in the meantime. The condition was much less noticeable, and he was put down to be called up again in 6 months. (b) Enlarged Tonsils.—2 were re-examined for Enlarged Tonsils. In 1, an anaemic child, the enlargement, which had been slight, had subsided as his health improved. In the other, the condition did not call for any immediate treatment, and he will be re-examined in the Infant School. (c) General Debility.—1 was a case of Debility associated with a functional apical systolic bruit. Though the murmur was still audible, his health was much better, and he will be kept under observation in the Infant Department. Three of the 39 children included in last year's report have since left the Nursery Classes, their parents having moved out of the district. Before leaving, however, 1 with slightly Enlarged Tonsils had dental treatment at the Health Centre as advised; while another, who had been considered prerheumatic, had been followed up 3 months later by the Health Visitor in the home, and had been found much improved generally, the mother reporting that the child was eating and sleeping better. A 3rd who had had Sub-acute Rheumatism, for which he was attending hospital as an out-patient, had left shortly after he was examined. Another child had left whose parents had gone to live in Marylebone. They have now returned to Willesden, and she has been re-admitted to the Nursery Class after an absence of 6 months. Therefore, only 12 of the original batch under consideration remain in the Nursery School. Since they were medically examined last year One who was put under observation for Enlarged Tonsils, has been re-examined, and no further enlargement detected. Another has had dental treatment. Four have had their 2nd Routine Medical Inspection according to the scheme in force. 2 of these were between 3 and 4 years of age, and 2 between 4 and 5 years of age. Three parents attended. Cleanliness of hair, skin and clothing was again noted in all 4 children. All had made a very satisfactory gain in height and weight. In 2, no defect had been found at the 1st Routine Medical Inspection. In both the tonsils had become enlarged, but not sufficiently to cause any symptoms. They will be seen again in 6 months. 1 had, in addition, developed dental caries, and subsequently attended the Health Centre for treatment. In the remaining 2 the tonsils had been noted to be slightly enlarged at the 1st Medical Inspection. 1 had since suffered from Otorrhcea and Bronchial Catarrh, so he was referred to the Council's Otologist, who recommended tonsillectomy. This the parents wish to postpone until the child is older. The Impetigo, which he had, quickly cleared up under treatment. The 4th had developed Knock-knee. Long outside splints are being worn at night, and the soles and heels of the shoes have been wedged as advised by the Orthopaedic Surgeon at the Health Centre where he is attending. 71 Routine Medical Examination of New Entrants. 37 new entrants have been examined during the last 8 months. Of these:— 11 were between 2 and 3 years of age. 8 „ 3 and 4 ,, ,, 15 4 and 5 3 were over 5 years of age. Most of the children enrolled this year in the Nursery Class were, therefore, again between 4 and 5 years of age, but there was an increase in the number coming between 2 and 3 years of age (11 as against 7 last year.) Attendance of Parents at the Medical Inspections. 22 mothers out of a possible number of 33 (4 examined were Home children) attended the Inspections. 1 sent a note saying that she had not come in case she would upset the child. 3 Grandmothers and 1 Aunt deputised for parents who could not come. The Guardian came in the case of another child. This is a good attendance as many of the mothers go out daily to work. Cleanliness.—The standard of cleanliness of hair, skin and clothing was again well maintained, none of the children being excluded on account of uncleanliness at the quarterly Cleanliness Inspections of the Health Visitor. General Physique.— (a) Of the 11 children between 2 and 3 years of age, 6 were underweight, but all were up to, or above, the standard height. (b) Of the 8 children between 3 and 4 years of age, 3 were underweight, 1 of whom was also undersized. (c) Of the 15 children between 4 and 5 years of age, 9 were underweight, but all up to, or above, the average height. (d) The 3 children 5 years old were all underweight but tall for their age. This, therefore, shows that while 1 only was undersized, 21 were underweight. When weighed and measured some months later all had gained weight, except 1 who had lost. The loss was attributed to an attack of Whooping Cough, and when examined she was found to have Enlarged Tonsils with Double Otorrhœa. She is now awaiting tonsillectomy. All were taller except 2, both of whom had, however, gained weight. 1 had been referred for Enlarged Tonsils and has since had tonsillectomy. The other had carious teeth which have since been attended to. She is also waiting to have her tonsils removed. Defects found at Routine Medical Inspection. 34 of the 37 new Entrants examined were found to be suffering from one or more defects. (1) Enlarged Tonsils and Adenoids.—23 children were found to have some degree of tonsillar enlargement, carious teeth being found associated in 10 cases, Bronchial Catarrh in 3 cases, Enuresis in 1 case and Otorrhcea in another. 5 children have since had tonsillectomy. 1 is now awaiting the operation. 2 have been referred for an opinion to the Ear, Nose and Throat Specialist. 5 parents wish to postpone the operation until the children are older, while 2 have definitely refused to have it. Of the remaining 8 cases which were put under observation, 3 have been re-examined twice, of which 2 were still slight and apparently symptomless, while the 3rd now requires an operation. (2) Defective Teeth.—15 were found to have dental caries of which 10 were associated with Enlarged Tonsils, 1 with Blepharitis, 1 with Otorrhoea and 1 with Bronchial Catarrh. 5 have since come to the Health Centre and had treatment, while 1 is at present attending. (3) Bony Deformities.—A slight degree of Knock-knee was noted in 3 cases, all of whom were debilitated. The general health is being treated, and the bony condition kept under observation. 1 has been already re-examined, and shows improvement. The 4th case (Genu Valgum 1 inch) was referred to the Orthopaedic Surgeon at the Health Centre, and is being treated there. (4) Respiratory Conditions.—2 children were found to have Bronchial Catarrh, and 1 Bronchitis. All 3 cleared up under treatment, and were all associated with Enlarged Tonsils. 1 has had tonsillectomy, while the other is being kept under observation. The parent of the 3rd child wishes to postpone the operation until she is older. (5) Cardiac Affections.—2 children were found to have apical systolic bruits. There was no history of Rheumatism. In both cases some degree of anaemia was present which is being treated. (6) Otorrhcea.'—3 children were found to have Running Ears. All cleared up under treatment at the Health Centre. 1 with Double Otorrhcea was found to have Enlarged Tonsils, and he is now awaiting operation. Another had already had tonsillectomy, but his teeth were noted to be carious, and he has now had dental treatment. 72 (7) Skin Conditions.—2 cases of Lichen Urticatus were noted. 1 was already under treatment and the other attended the Health Centre. (8) Eye Conditions.—1 child was suffering from Blepharitis which was treated at the Health Centre. The carious teeth which he also had were extracted. (9) Enuresis.—1 child who suffered from Enuresis was attending Hospital for this condition. His tonsils were found to be enlarged, and he is being referred to the Council's Otologist. The Incidence of Infectious Disease in Lower Place Nursery Classes. Towards the end of the Autumn Term there was a small outbreak of Scarlet Fever in the Nursery Classes. There were 7 cases. The source of the infection was traced to the homes of one or two of the non-scholars who were relations and contacts of the Nursery School children, and who were the first sufferers. The 7 cases were removed to hospital. 4 were mild and uncomplicated, and were only detained there for 4 weeks. 1, complicated by Otorrhoea, was 6 weeks in hospital, 1, with Rhinitis, 7 weeks, while another, who unfortunately had a relapse, remained 9 weeks. Enlarged Tonsils were found in 4 of the cases. 1 has since had them removed, while 2 are awaiting the operation, which is being postponed by the parents in the case of the 4th. 73 APPENDICES APPENDIX A.—VITAL STATISTICS. Appendix A.—Table I. VITAL STATISTICS OF WHOLE DISTRICT DURING 1932 AND PREVIOUS YEARS; VITAL STATISTICS OF THE WARDS DURING 1932. Population estimated to Middle of each Year. Whole District. Births. Total Deaths Registered in the District. able Deaths Nett Deaths belonging to the District. Year. Uncor rected Number. Nett. Number. Rate per 1,000 population. of nonresi dents registered in the District. of residents not registered in the District. Under 1 Year of Age. At all Ages. Number. Rate per 1,000 populalation. Number. Rate per 1,000 Nett Eirths. Number. Rate per 1,000 population. (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) (13) 1911 156,572 3,863 4,001 25.6 1,618 10.3 10 240 495 124 1,848 11.8 1912 159,868 3,912 4,075 25.5 1,307 8.7 27 233 328 80 1,603 10.02 1913 163,644 3,891 4,037 24.7 1,449 8.9 23 251 325 80 1,677 10.24 1914 166,634 3,971 4,115 24.7 1,501 9.0 32 283 337 82 1,752 10.51 1915 166,840 3,641 3,775 22.6 1,792 10.7 44 282 344 91 2,030 12.16 1916 167,810 3,557 3,668 21.9 1,436 8.55 34 308 283 77 1,710 10.19 1917 169,344 2,704 2,816 16.6 1,571 9.27 45 292 309 110 1,818 10.73 1918 169,358 2,520 2,651 15.65 1,975 11.66 35 338 258 97 2,278 13.45 1919 170,625 2,843 2,924 17.13 1,519 8.90 39 286 242 83 1,766 10.35 1920 170,892 4,203 4,232 24.76 1,427 8.35 50 295 274 65 1,672 9.78 1921 165,674* 3,442 3,464 20.91 1,469 8.87 54 262 255 74 1,677 10.12 1922 168,900 3,106 3,160 18.71 1,570 9.30 59 273 188 59 1,784 10.56 1923 169,831 2,977 3,063 18.04 1,380 8.13 72 280 162 53 1,588 9.35 1924 171.161 2,685 2,843 16.61 1,574 9.20 78 286 208 73 1,782 10.41 1925 172,503 2,552 2,755 15.97 1,465 8.49 83 304 170 62 1,686 9.77 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 1932 188,216 1,945 2,745 14.58 1,653 8.78 163 348 168 61 1,838 9.77 * Census population -Re-adjusted by Registrar-General to 167,200. wards. 1. S.Kilb'n 13,882 184 250 18.01 143 10.30 1 26 12 48.00 168 12.10 2. Mid K'b'n 14,075 174 263 18.69 125 8.88 1 36 17 64.64 160 11.37 3. N.Kilb'n 12,979 113 176 13.56 127 9.79 7 26 14 79.55 146 11.25 4. Brondsb'y Park 9,875 68 96 9.72 89 9.01 9 29 4 41.67 109 11.04 5. Kensal Rise 13,323 127 186 13.96 100 7.51 0 18 7 37.63 118 8.86 6. Harl'd'n 16,609 121 204 12.28 137 8.25 4 32 *28 137.25* 165 9.93 7. Stonebridge 20,886 369 291 13.93 240 11.49 87 27 14 48.11 180 8.62 8. Roundwood 15,511 157 234 15.09 135 8.70 21 25 17 72.65 139 8.96 9. Church End 15,990 138 219 13.70 122 7.63 5 26 11 50.23 143 8.94 10. Willesden Green 16,347 148 253 15.48 144 8.81 1 32 17 67.19 175 10.71 11. Cricklewood 38,739 346 573 14.79 291 7.51 27 71 27 47.12 335 8.65 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. *17 out of the 28 deaths occurred in children at the National Adoption Society's Hostel, Connaught House, Acton Lane, N.W. 10. Subtracting these 17, the infant mortality rate for the Harlesden Ward is 53.92. 74 Appendix A.—Table II.—DEATHS OF WILLESDEN RESIDENTS DURING THE YEAR 1932. 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 1,838 168 59 20 12 18 42 82 124 187 319 390 324 93 811 Uncertified — — — — — — — — — — — — — — — 1.—Infectious and Parasitic Diseases. Typhoid Fever 1 — — — — — — 1 — — — — — — 1 Paratyphoid Fever 1 — — — — — — — — — 1 — — — — Typhus Fever — — — — — — — — — — — — — — — Relapsing Fever. (" Spirillum Obermeieri ") — — — — — — — — — — — — — — — Undulant Fever — — — — — — — — — — — — — — — Small Pox — — — — — — — — — — — — — — — Measles 22 4 16 2 — — — — — — — — — — 20 Scarlet Fever 1 — 1 — — — — — — — — — — — 1 Whooping Cough 6 1 5 — — — — — — — — — — — 3 Diphtheria 10 — 3 7 — — — — — — — — — — 10 Influenza 55 1 — — 1 1 — 1 2 4 10 17 15 3 9 Cholera — — — — — — — — — — — — — — — Dysentery — — — — — — — — — — — — — — Plague — — — — — — — — — — — — — — — Erysipelas 2 1 — — — — — 1 — — — — — — 2 Acute Poliomyelitis — — — — — — — — — — — — — — — Encephalitis Lethargica 1 — — — — 1 — — — — — — — — 2 Cerebro-spinal Fever 9 3 —- — — 1 — 2 — 1 2 — — — 10 Glanders — — — — — — — — — — — — — — — Anthrax — — — — — — — — — — — — — — — Rabies — — — — — — — — — — — — — — — Tetanus — — — — — — — — — — — — — — — Tuberculosis of the respiratory system 126 — — — 1 4 19 29 24 21 19 8 1 — — Tuberculosis of the central nervous system 10 3 4 — — 2 — — 1 — — — — — 8 Tuberculosis of the intestines and peritoneum 1 — — — — — — — — — — — 1 — — Tuberculosis of the vertebral column 2 — — —- — — 1 — — — — 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 — — — 75 Tuberculosis of other organs — — — — — — — — — — — — — — — Disseminated tuberculosis 4 1 2 — 1 — — — — — — — — — 1 Leprosy — — — — — — — — — — — — — — — Syphilis 7 3 — — — 1 — 1 — 1 1 — — — 3 Other venereal diseases — — — — — — — — — — — — — — — Purulent infection, Septicaemia — — — — — — — — — — — — — — 3 Yellow Fever — — — — — — — — — — — — — — — Malaria — — — — — — — — — — — — — — — Other diseases due to protozoa — — — — — — — — — — — — — — — Ankylostomiasis — — — — — — — — — — — — — — — Hydatid cysts — — — — — — — — — — — — — — — Other diseases due to helminths — — — — — — — — — — — — — — — Mycoses — — — — — — — — — — — — — — — Other infectious or parasitic diseases 2 — — — — — — — — — 1 1 — — 2 2.—Cancer and other Tumours. Cancer of the buccal cavity and pharynx 6 — — — — — — — — 1 4 — 1 — 3 Cancer of the digestive organs and peritoneum 125 — — — — — — 1 9 20 32 39 20 4 47 Cancer of the respiratory organs 24 — — — — — — — 2 7 6 7 2 — 8 Cancer of the uterus 11 — — — — — — 1 2 3 4 1 — — 6 Cancer of other female genital organs 13 — — 1 — — — — — 5 — 3 4 — 2 Cancer of the breast 23 — — — — — — — 3 6 7 6 1 — 8 Cancer of the male genito-urinary organs 22 — — — — — — — — 3 8 6 5 — 7 Cancer of the skin 4 1 — — — — — — — — — 2 1 — 3 Cancer of other or unspecified organs 22 — — — — — — — 3 6 9 — 3 1 7 Non-malignant tumours 8 — — — — — — 1 1 1 4 1 — — 7 Tumours of undetermined nature 4 — 1 — — 1 — — — 1 — 1 — — 3 3.—Rheumatism, Diseases of Nutrition and of Endocrine Glands and the General Diseases. Rheumatic Fever 6 — — — — — 2 1 1 1 — 1 — — 1 Chronic rheumatism, Osteo-Arthritis 10 — — — — — — 1 1 — 2 1 4 1 1 Gout — — — — — — — — — — — — — — — Diabetes 16 — — — — — — — 1 1 3 7 3 1 13 Scurvy — — — — — — — — — — — — — — — Beri-beri — — — — — — — — — — — — — — — Pellagra — — — — — — — — — — — — — — — Rickets — — — — — — — — — — — — — — — Osteomalacia — — — — — — — — — — — — — — — Diseases of the pituitary gland — — — — — — — — — — — — — — — Diseases of the thyroid and parathyroid glands 4 — — — — — — — — — — — — — 2 Diseases of the Thymus 2 1 — 1 — — — — — — — — — — — Diseases of the adrenals — — — — — — — — — — — — — — 1 Other general diseases — — — — — — — — — — — — — — — 76 Table II.—DEATHS OF WILLESDEN RESIDENTS— continued. CAUSE OF DEATH. All Ages. 0 to 1 1 to 5 5 to 10 10 to 15 15 to 20 20 to 25 25 to 35 35 to 45 45 to 55 55 to 65 65 to 75 75 to 85 85 Up. Total deaths, whether of "Residents" or " Non-Residents," in Institutions in the District. (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) (13) (14) (15) (16) 4.—Diseases of the Blood and Blood-forming Organs. Hemorrhagic conditions 1 1 - — — — - — — — — — — — — Anaemia Chlorosis 7 — — — 1 — — — 1 — 4 1 — — 5 Leukaemia, Aleukæmia 8 — — — 1 — — 2 2 — 2 1 — — 3 Diseases of the Spleen 1 — — — — — — — 1 — — — — — - Other diseases of the blood and blood-forming organs - - - - - - - - - - - - - - - 5.—Chronic Poisoning. Alcoholism (acute or chronic) — — — — — — — — — — — — — — — Chronic poisoning by other organic substances - - - - - - - - - - - - - - - Chronic poisoning by mineral substances — — — — — — — — — — — — - - — 6.—Diseases of the Nervous System and Sense Organs. Encephalitis 3 — — — 1 — — — — — 2 — — — 1 Meningitis 4 1 2 — — 1 — - — — — — — — 3 Tabes Dorsalis (Locomotor ataxy) 5 — — — — — — — — — 3 2 — — 2 Other diseases of the spinal cord 9 — — — — — 1 — 1 2 3 2 — — 6 Cerebral haemorrhage, apoplexy, etc. 74 3 — — — 1 — — 3 3 15 25 20 4 46 General Paralysis of the Insane 5 — — — — — — — 3 1 1 — — — 1 Other forms of insanity 7 — — — — — — 1 3 2 1 — — — 1 Epilepsy 6 — — — 1 — — — 3 — 2 — — — 2 Infantile convulsions (under 5 years of age) 1 1 - - - - - - - - - - - - - Other diseases of the nervous system 4 — — — — — — — — — — 2 2 — 2 Diseases of the eye and annexa — — — — — — — — — — — — - - - Diseases of the ear and of the mastoid sinus 5 — 2 — — — 1 — 1 — — 1 — — 1 7.—Diseases of the Circulatory System. Pericarditis 1 — — — — — — — — — — — 1 - Acute endocarditis 6 — — 1 — — — 1 2 — — 1 1 - - Chronic endocarditis, Valvular disease 76 — — — 1 — 1 2 5 8 14 30 13 2 6 Diseases of the myocardium 190 — — — — — — — 4 12 30 62 58 24 55 Diseases of the coronary arteries, Angina pectoris 35 — — — — — — — 1 7 9 10 8 — 3 Other diseases of the heart 29 — — — - — — 1 3 7 3 8 5 2 18 77 Aneurysm 7 - - - - - - 1 — 3 2 — 1 - 2 Arterio-clerosis 70 - - - - - - - 1 5 11 31 21 1 22 Gangrene 4 - - - - - - - - - - 2 2 — 4 Other diseases of the arteries 3 - - - - - - - - - - 1 1 1 1 Diseases of the veins (varix, hæmorrhoids, phlebitis, etc,) 1 - - - - - - - - - 1 - - - - Diseases of the lymphatic system (lymphangitis, etc.) - - - - - - - - - - - - - - - Abnormalities of blood pressure 1 - - - - - - - - - - 1 - - - Other diseases of the circulatory system - - - - - - - - - - - - - - - 8.—Diseases of the Respiratory System. Diseases of the nasal fossae and annexa 1 - - - - 1 - - - - - - - - 1 Diseases of the larynx 1 - - - - - - - - - - - - - 1 Bronchitis 78 3 3 — — — — 1 2 1 12 17 29 10 15 Broncho-pneumonia 74 16 7 — — — — 1 2 5 4 17 17 5 52 Lobar pneumonia 38 3 - - - - - 2 5 7 10 6 3 2 11 Pneumonia (not otherwise defined) 35 7 3 1 — — 2 4 3 1 8 1 5 — 30 Pleurisy 2 — — — — 1 — — — 1 — — — — 1 Congestion and haemorrhagic infarct of lung, etc 9 - - - - - - - 1 1 1 1 3 2 7 Asthma 4 - - - - - - - - 1 1 1 1 — 3 Pulmonary emphysema - - - - - - - - - - - - - - - Other diseases of the respiratory system 1 - - - - - - - - - - - - - 2 9.—Diseases of the Digestive System. Diseases of the buccal cavity, pharynx, etc. 9 — — 1 — — — 1 2 — 2 — 3 — 8 Diseases of the oesophagus — — — — — — — — — — — — — — — Ulcer of the stomach or duodenum 22 - - - - - 1 1 1 6 6 5 2 — 14 Other diseases of the stomach 3 - - - - - - - - - 1 1 — 1 3 Diarrhœa and Enteritis 38 31 2 - - - - - 1 1 — 2 — 1 37 Appendicitis 10 — 1 — — — 3 2 1 1 — 2 — — 8 Hernia, Intestinal obstruction 20 1 — — — 3 — — 3 3 6 3 1 — 13 Other diseases of the intestines 1 - - - - - - - - - 1 - - - 1 Cirrhosis of the liver 3 - - - - - - - - - 2 1 — — -— Other diseases of the liver 4 3 - - - - - - - - - - - - 1 Biliary calculi 5 - - - - - - - - 1 1 2 1 — 4 Other diseases of the gall bladder and ducts 9 - - - - - - - 2 — 4 1 1 1 5 Diseases of the pancreas 2 - — — — — — — — 1 — 1 — — 2 Peritonitis without stated cause - - - - - - - - - - - - - - - 78 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" o " 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 5 - - - - - - - 1 1 2 — 1 — 2 Chronic nephritis 47 — — — 1 — 1 2 1 8 13 9 10 2 23 Nephritis not stated to be acute or chronic 16 — — 1 — — — 1 2 2 7 1 2 — 9 Other diseases of the kidney and annexa 6 - - - - - - - - 2 1 3 — — 1 Calculi of the urinary passages - - - - - - - - - - - - - - - Diseases of the bladder 3 - - - - - - - - - - 1 1 1 2 Diseases of the urethra, urinary abscess, etc. 2 - - - - - - - 1 - - - 1 — 1 Diseases of the prostate 16 - - - - - - - 1 — 1 5 7 2 8 Diseases of the male genital organs - - - - - - - - - - - - - - Diseases of the female genital organs 4 - - - - - - 1 1 1 1 — — — 4 11.—Diseases of Pregnancy, Childbirth and the Puerperal State. Post abortive sepsis 3 - - - - - 1 2 - - - - - - 4 Abortion not returned as septic - - - - - - - - - - - - - - - Ectopic gestation - - - - - - - - - - - - - - - Other accidents of pregnancy - - - - - - - - - - - - - - - Puerperal haemorrhage 1 - - - - - - - 1 - - - - - - Puerperal sepsis 3 - - - - - 1 2 - - - - - - - Puerperal albuminuria and convulsions - - - - - - - - - - - - - - - Other toxaemias of pregnancy 2 — — — — — — 2 — — — — — — — Puerperal phlegmasia alba dolens, embolism, and sudden death - - - - - - - - - - - - - - - Other accidents of childbirth 1 - - - - - - 1 - - - - - - 1 Other or unspecified conditions of the puerperal state 1 - - - - - - - 1 - - - - - 1 12.—Diseases of the Skin and Cellular Tissue. Carbuncle, Boil 3 - - - - - 1 - - - - 1 1 — 2 Cellulitis, Acute abscess 6 — — 1 — — 1 1 — — 1 — 1 1 4 Other diseases of the skin and its annexa - - - - - - - - - - - - - - - 79 13-—Diseases of the Bones and Organs of Locomotion. Acute infective osteomyelitis and periostitis 4 - 1 1 - - 1 - - - - - - - 2 Other diseases of the bones 1 - - - - - - - - - - 1 - - 1 Diseases of the joints and other organs of locomotion 1 — 1 - - - - - - - - - - - - 14.—Congenital Malformation. Congenital malformations 11 10 1 — — — — — — — — — — — 7 15.—Diseases of Early Infancy. Congenital debility 12 12 - - - - - - - - - - - - 10 Premature birth 40 40 - - - - - - - - - - - - 14 Injury at birth 4 4 - - - - - - - - - - - - 2 Other diseases peculiar to early infancy 7 7 — — — — — — — — — — — — 1 16.—Old Age. Old age 67 — — — — — — — — — — 11 36 20 52 17.—Deaths from Violence. Suicide by solid or liquid poisons and corrosive substances 4 - - - - - - 1 - - - - - - - Suicide by poisonous gas 8 - - - - - - - - 2 3 1 2 - 1 Suicide by hanging or strangulation 4 - - - - - - - 1 1 2 1 - - - Suicide by drowning 2 - — — — — — 1 - 1 - - - - - Suicide by firearms 1 - — — — — — — — 1 - — — — - Suicide by cutting or piercing instruments 3 - — — — — — — 1 1 - 1 - - 1 Suicide by jumping from high place 3 - - - - - - 1 - - 1 1 - - - Suicide by crushing 1 - - - - - - - - - - - - - - Suicide by other means 1 - - - - - - 1 - - - - - - - Infanticide (under one year) - - - - - - - 1 - - - - - - 1 Homicide by firearms - - - - - - - - - - - - - - - Homicide by cutting or piercing instruments - - - - - - - - - - - - - - - Homicide by other means 2 1 1 - - - - - - - - - - - - Attack by venomous animals - - - - - - - - - - - - - - - Food poisoning - - - - - - - - - - - - - - - Accidental absorption of irrespirable or poisonous gas - - - - - - - - - - - - - - - Other acute accidental poisoning (not by gas) 1 - - - - - - - - - - - - - - Conflagration - - - - - - - - - - - - - - - Accidental burns (Conflagration excepted) 3 - 1 - - - - - - - - 1 1 - 1 Accidental mechanical suffocation 4 4 - - - - - - - - - - - - 1 Accidental drowning 1 - 1 - - - - - - - - - - - - Accidental injury by firearms - - - - - - - - - - - - - - - Accidental injury by cutting or piercing ments 2 - - - - - — — — — 2 — — — 1 80 Table II.—DEATHS OF WILLESDEN RESIDENTS—continued. CAUSE OF DEATH. (1) All Ages. (2) 0 to 1 (3) 1 to 5 (4) 5 to 10 (5) 10 to 15 (6) 15 to 20 (7) 20 to 25 (8) 25 to 35 (9) 35 to 45 (10) 45 to 55 (11) 55 to 65 (12) 65 to 75 (13) 75 to 85 (14) 85 Up (15) Total deaths, whether of " Residents" or "Non-Residents," in Institutions in the District. (16) 17.—Deaths from Violence—continued. Accidental injury by fall, crushing, etc 35 — 1 3 3 — 4 5 3 2 4 9 — 1 23 Cataclysm — — — — — — — — — — - - - - - Injury by animals (poisoning by venomous animals excepted) - - - - - - - - - - - - - - - Hunger or thirst - - - - - - - - - - - - - - - Excessive cold - - - - - - - - - - - - - - - Excessive heat - - - - - - - - - - - - - - - Lightning 1 - - - - - - - - - - - - - - Electricity (lightning excepted) - - - - - - - - - - - - - - - Other and unstated forms of accidental violence - - - - - - - - - - - - - - - Violent deaths of unstated nature (i.e. accidental, suicidal, etc.) 1 - - - - - - - - - - - - - - Wounds of war - - - - - - - - - - - - - - - Execution of civilians by belligerent armies - - - - - - - - - - - - - - - Execution - - - - - - - - - - - - - - - 18.—Ill-Defined Diseases. - - - - - - - - - - - - - - - Sudden Death — — - - - - - - - - - - - - - Cause of death unstated or ill-defined 1 1 - - - - - - - - - - - - 1 Totals 1,838 168 59 20 12 18 42 82 124 187 319 390 324 93 811 81 Appendix A.—Table 11(a). CAUSES OF DEATH IN WILLESDEN URBAN DISTRICT AS CIRCULATED BY REGISTRAR-GENERAL.—1932. Causes of Death. M. F. All Causes 958 895 1. Typhoid and paratyphoid fevers 1 1 2. Measles 14 7 3. Scarlet fever 1 — 4. Whooping cough 5 2 5. Diphtheria 7 3 6. Influenza 24 33 7. Encephalitis lethargica — 1 8. Cerebro-spinal fever 4 6 9. Tuberculosis of respiratory system 76 52 10. Other tuberculous diseases 7 11 11. Syphilis 4 2 12. General paralysis of the insane, tabes dorsalis 8 3 13. Cancer, malignant disease 119 133 14. Diabetes 7 9 15. Cerebral haemorrhage, etc 30 40 16. Heart disease 168 176 17. Aneurysm 7 3 18. Other circulatory diseases 34 33 19. Bronchitis 35 41 20. Pneumonia (all forms) 78 69 21. Other respiratory diseases 16 6 22. Peptic ulcer 17 6 23. Diarrhoea, etc. (under 2 years) 19 15 24. Appendicitis 7 3 25. Cirrhosis of liver 2 — 26. Other diseases of liver, etc. 3 14 27. Other digestive diseases 25 20 28. Acute and chronic nephritis 33 34 29. Puerperal sepsis — 6 30. Other puerperal causes — 4 31. Congenital debility, premature birth, tions, etc. 52 25 32. Senility 25 45 33. Suicide 20 8 34. Other violence 35 15 35. Other defined diseases 75 69 36. Causes ill-defined or unknown — — Special causes (included in No. 35 above):— - - Small-pox — — Poliomyelitis — — Polioencephalitis — — Total Deaths of Infants under 1 year Legitimate Illegitimate 102 67 86 49 16 18 APPENDIX B. Showing Acts of Parliament, Local Government Orders, Memoranda, and Circular Letters issued by Government Departments with regard to the Public Health, Maternity and Child Welfare and School Medical Services during the Year 1932. Statutes:— Dangerous Drugs Act, 1932. Children and Young Persons Act, 1932. Ministry of Health:— Circular.—Bacteriological Investigation with reference to puerperal sepsis. Memorandum.—Administration of anti-meningococcus serum in cases of cerebro-spinal fever. Circular No. 1243.—Nutrition. Circular 1. Local Government Act, 1929. 2. Maternity and Child Welfare. 3. Voluntary Associations. Circulars No. 1266 and 1266a.—Local Government Act, 1929. Power of Minister of Health to make Regulations re Grants. Memorandum.—The Criticism and Improvement of Diets. Schemes.—L.G.A. 44—Maternity and Child Welfare. L.G.A. 45—Maternity and Child Welfare. Circular No. 1276.—Cancer : IX. Circular No. 1267.—Precautions against shock from electro-medical apparatus. Memorandum No. 161 Med.—Precautions against shock from electro-medical apparatus. Circular No. 1285.—Maternal Mortality. Memorandum No. 164/M.C.W.—Maternal Mortality. Circular No. 1291.—Maternity and Child Welfare—Infant Life Protection. Memorandum No. 163K.—Memorandum by the Ministry of Health on the arrangements for drainage and disposal of waste matters and for water supply at schools. Memorandum No. 165/M.C.W.—Infant Life Protection. Memorandum No. 165a/M.C.W.—Summary of the Law relating to Infant Life Protection for the Guidance of Infant Protection Visitors. Circular No. 1290.—Nutrition. Board of Education:— Regulations No. 8. The Elementary Education (Substantive Grant) Amendment Regulations No. 4, 1932. Regulations No. 19.—The Board of Education (Special Services) Amendment Regulations No. 3, 1932. Regulations No. 66.—The Elementary Education Grant Regulations, 1932. Secretary of State for Home Affairs :— Order No. 850.—The Children and Young Persons Act, 1932. 82—83 appendix a. table iii.—infant mortality during 1932. 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. ause 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. Round wood. 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 49 8 8 5 70 34 29 25 10 168 12 17 14 4 7 28 14 17 11 17 27 Uncertified - — — — — — — — — — — — - — — — — — — — — Small Pox - - - - - - - - - - - - - - - - - - - - - Chicken pox - - - - - - - - - - - - -- - - - - - - - - Measles - — — — — — — 3 1 - — — — - — — — — 2 — 2 Scarlet Fever — — — — — — — — — — — — — — — — — — - — — Whooping Cough — — — — — — 1 — — 1 — — — — — 1 — — — — — Diphtheria and Croup - — — — — — - - — — — - — — — — — — — — — Erysipelas — — — — — — 1 — — 1 1 - - - - - - - - - - Tuberculous Meningitis - - - - - 1 1 1 — - — 1 1 — — — — — — 1 — Abdominal Tuberculosis (a) - - - - - - - - - - - - - - - - - - - - - her Tuberculous Diseases - - - — — — — 1 — 1 — - — - — — 1 — — — — Meningitis (not Tuberculous) - — — — — 1 1 — 2 — 2 — - — — — — — 1 1 Convulsions 1 — - — 1 — — — — 1 — — — - — — — — — — 1 Laryngitis - - - — — — — — — — — - — - — — — — — — — Bronchitis - - - - - - 1 2 - 3 — 1 — 1 1 — — — — — Pneumonia (all forms) 1 1 1 - 3 2 6 12 3 26 2 5 2 1 2 2 5 2 2 3 Diarrhoea and Enteritis - - 2 — 2 11 10 5 3 31 4 2 2 - 2 14 - 1 2 1 3 Gastritis - - - - - - - - - - - - - - - - - - - - - yphilis - - - -- - - - - - 3 1 1 1 — — — - - — — Rickets - - - - - - - - - - - - - - - - - - - - - uffocation, overlying — — — — — 2 2 — — 4 - 1 - - 1 - - 1 - - - Injury at Birth 4 - - - 4 - - - — 4 — 1 - 1 1 — 1 - — — — Atelectasis 4 - - - 4 — — — — 4 — 1 1 - 1 — — — — 1 C Congenital Malformations (b) 6 - - 1 7 2 — — 1 10 - 1 1 - — — 3 2 1 2 Premature Birth 24 5 4 3 36 3 1 — — 40 1 1 5 1 - 5 3 6 3 5 10 Atrophy, Debility and Marasmus 2 1 - - 3 8 1 — — 12 1 - 1 1 — 2 4 1 — 1 1 Other Causes 7 1 1 1 10 1 4 1 - 16 2 - - 1 - 3 - 3 - 5 - Total Deaths 49 8 8 5 70 34 29 25 10 168 12 17 14 4 7 28 14 17 11 17 27 Deaths— Lgitimate 44 8 8 5 65 21 19 22 8 135 10 16 12 3 7 11 13 15 11 14 23 Illegitimate 5 - - - 5 13 10 3 2 33 2 1 2 1 - *17 1 2 - 3 4 Births— Ligitimate ... ... ... ... ... ... ... ... ... 2,637 233 247 165 93 182 202 279 226 211 244 555 legitimate ... ... ... ... ... ... ... ... ... 108 17 16 11 3 4 2 12 8 8 9 18 Total Births ... ... ... ... ... ... ... ... ... 2,745 250 263 176 96 186 204 291 234 219 253 573 Infant Mortality Rate— Legitimate ... ... ... ... ... ... ... ... ... 51.19 42.92 64.78 72.73 32.26 38.46 54.46 46.59 66.37 52.13 57.38 41.44 Illegitimate ... ... ... ... ... ... ... ... ... 305.56 117.65 62. 50 181.82 333.33 — *8500.00 83.33 250.00 - 333.33 222.22 Infant Mortality Rate ... ... ... ... ... ... ... ... ... 61.20 48.00 64.64 79.55 41.67 37.63 137.25 48.11 72.65 50.23 67.19 47.12 Population ... ... ... ... ... ... ... ... ... 188216 13,882 14,075 12,979 9.875 13,323 16,609 20,886 15,511 15,990 16,347 38,739 (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. * These 17 illegitimate deaths occurred in children of the National Adoption Society's Hostel, Connaught House, Acton Lane, N.W. 10. Excluding these the Illegitimate Infant Mortality rate for the Harlesden Ward is nil. 84 appendix a—tABLE iv.-cases of infectious disease notified during the year 1932. Notifiable Disease. Number of Cases Notified. Total Cases Notified in each Ward. At all ages. At Ages—Years. South Kilburn. Mid-Kilburn. North Kilburn. Brondesbury Park. Kensal Rise. Harlesden. Stonebridge. Round wood. Church End. Willesden Green. Cricklewood. Total Cases removed to Willesden Municipal Hospital. Under 1. 1 and under 5. 5 and under 15. 15 and under 25. 25 and under 45. 45 and under 65. 65 and upwards. (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (id (12) (13) (14) (15) (16) (17) (18) (19) (20) (21) Small pox - — - - - - - - - - - - - - - - - - - - Cholera (C) Plague (P) - - - - - - - - - - - - - - - - - - - - Diphtheria (including Membranous Croup) 247 10 74 112 24 24 3 — 39 16 8 9 9 9 62 19 30 24 22 234 Erysipelas 66 2 4 5 8 19 24 4 5 2 7 4 2 2 9 5 4 6 20 20 Scarlet fever 421 6 107 235 43 27 2 1 48 35 25 18 14 19 63 21 44 26 108 364 Typhus fever — — — — — — — — — — — — — — — — — — — — Enteric fever 10 — — 1 4 4 1 — 1 1 — — 1 1 — — 1 1 4 6 Relapsing fever (R) Continued fever (C) - - - - - - - - - - - - - - - - - - - - Puerperal fever 8 — — — 1 7 — — — 1 1 1 — — 2 1 — 1 1 3 Puerperal pyrexia 22 — — — 5 17 — — 2 5 2 1 — 1 4 3 — 1 3 7 Cerebro-spinal meningitis 14 3 3 1 2 2 3 — — 1 — — — 2 4 1 1 3 2 9 Poliomyelitis 8 — 2 6 — — — — — — — — — — 3 2 1 2 — 2 Ophthalmia neonatorum 28 28 — — — — — — 4 4 3 — 2 3 6 1 — 3 2 7 Pulmonary tuberculosis 249 — 5 15 71 92 58 8 18 20 27 15 28 18 22 24 16 23 38 — Other forms of tuberculosis 62 3 11 19 9 17 1 2 6 6 6 2 4 3 9 5 7 7 7 — Whooping cough 673 88 311 265 2 3 4 — 22 22 6 6 27 74 164 100 58 58 136 26 Pneumonia 351 21 80 48 37 68 69 28 49 44 26 11 10 23 67 24 34 24 39 13 Malaria 1 — — — — 1 — — — 1 — — — — — — — — — — Dysentery 1 — 1 - - - - - - - - - - - 1 - - - - - Encephalitis lethargica 3 — — — 1 1 1 — - - - - - 1 — — 1 — 1 1 Acute polio encephalitis - - - - - - - - - - - - - - - - - - - - Anthrax - - - - - - - - - - - - - - - - - - - - Totals 2,164 161 598 707 207 282 166 43 194 158 Ill 67 97 156 416 206 197 179 383 692 86 APPENDIX C. MOTOR SERVICE. I beg to report on the above for its eighteenth completed year ending 31st March, 1932. At the 31st March, 1932, the following vehicles existed in connection with this service. Reg. No. Tax. Make. Year of Purchase. Work required for. Seating capacity. Purchase Price. 1. M.X. 1884 £20 Napier 12/1913 Disinfection, Laundry and Kingsbury — £445 2. *M.X. 2057 „ „ „ School work 18 £492 3. *M.X. 2059 „ „ „ School work 18 £492 4. *M.X. 2060 „ „ „ School work 18 £489 5. *M.X. 2061 Free „ „ Infectious ambulance — £492 6. M.F.4117 „ Crossley 4/1924 Sickness and Accident ambulance — £892 7. M.H.3808 £26 „ 3/1925 School work 20 £823 8. M.H.8989 £16 Berliet 7/1925 Education Department — £405 9. M.P. 3711 £18 Dennis 5/1928 School work 30 £760 10. M.P. 3712 £18 „ 5/1928 School work 30 £760 11. M.T. 810 £20 ArmstrongSiddeley 11/1928 Health Department — £800 12. M.Y. 967 £18 Dennis 8/1929 School work 28 £762 13. M.Y. 19 £20 Armstrong- 11/1929 Education Department — £538 Siddeley 14. M.Y. 26 Free „ 2/1930 Sickness and Accident ambulance — £854 15. H.X. 12 „ „ 1/1931 Sickness and Accident ambulance — £860 16. H.X. 5178 £18 Dennis 8/1931 School work 30 £665 17. H.X. 5179 „ „ „ School work 30 £665 * These 4 vehicles were sold in June, 1932 for £5. There are 12 routes run by School Ambulances daily for Physically and Mentally defective and Blind Children. 309 Willesden children, 1 child from Kingsbury and 2 children from Wembley, making 312 in all are on the lists for daily conveyance and approximately 255 are in average attendance. During the year under review the chief work has been:— Conveyance of cases of Sickness, Accident and Maternity to Hospital ; Conveyance of Physically and Mentally Defective and Blind and Stammering children to and from school; Disinfection of bedding ; Transport of laundry to Kingsbury Hospital, Health Centres, Special Schools and Mortuary ; Conveyance of meals, and certain works for other departments. A day and night service is in operation for ambulance calls but only one man is on duty during the night. The personnel of the service consists of:— 1 Mechanic Superintendent and Engineer. 1 Assistant Engineer. 14 Motor drivers. 1 Disinfector. The working hours are 47 per week per man. Calls for the ambulances are very heavy, especially in removal of illness cases to and from Hospital for treatment. Not infrequently it occurs that several cases are waiting for removal. In these circumstances the most serious have priority. A certain number of accident calls are not answered, or are delayed owing to car or driver being engaged. 87 Total Number of Miles Run. The following table shows the number of miles run year by year since the inception of the service:— Total Miles Run. 1913-15 56,669 1915-20 259,936 1920-25 319,862 1925-26 87,030 1926-27 98,318 1927-28 103,587 1928-29 111,338 1929-30 125,528 1930-31 131,564 1931-32 132,208 Total 1,426,040 The following table gives details of the miles run during the year under review :— Special School work 59,740 Accidents, Sickness and Infectious cases 25,197 Disinfection 5,954 Education Department 13,510 Accountant's Department 1,208 Engineer's Department 147 Clerk's Department 2,279 Health Department 7,484 Municipal Hospital work 162 Miscellaneous 193 Library Department 262 Elections 112 Electricity Department 97 Maternity Hospital, Kingsbury 15,863 Total 132,208 The following gives the miles run by each vehicle during the year under review :— Miles. 1. Van M.X. 1884 7,397 2. School Ambulance M.X. 2057 169 3. School Ambulance M.X. 2059 3,480 4. School Ambulance M.X. 2060 2,393 5. Ambulance M.X. 2061 4,812 6. Ambulance M.F. 4117 5,946 7. School Ambulance M.H. 3808 8,649 8. Education and School M.H. 8989 4,628 9. School Ambulance M.P. 3711 9,429 10. School Ambulance M.P. 3712 9,278 11. Health Department M.T. 810 9,120 12. School Ambulance M.Y. 967 9,967 13. Education Department M.Y. 19 13,121 14. Accident Ambulance M.Y. 26 13,115 15. Accident and Maternity Ambulance H.X. 12 17,156 16. School Ambulance H.X. 5178 6,868 17. School Ambulance H.X. 5179 6,680 Total 132,208 Calls. The following table shows the number of calls for the Disinfecting Van, Infectious, Sickness and Accident Ambulances respectively:— Delivery (1913) to 31/3/29. 1/4/29 to 31/3/30. 1/4/30 to 31/3/31. 1/4/31 to 31/3/32. Grand Total 1913-1932. Disinfection VanAmbulance calls, including 16,673 1,250 1,130 1,063 20,116 Sickness, Accident and Infections 34,993 3,766 4,041 4,434 47,234 51,666 5,016 5,171 5,497 67,350 88 Miles per Gallon and Cost per Mile Run. Total Number of miles run by all vehicles. Total Number of gallons of petrol consumed. Number of miles per gallon of petrol consumed. Cost in pence per mile run. 1914-15 44,098 3,988 11.0 13.4 1915-20 259,936 25,284 10.39 13.90 1920-25 319,862 28,628 11.03 16.22 1925-26 87,030 7,189 12.106 13.654 1926-27 98,318 7,121 13.807 11.892 1927-28 103,587 7,680 13.488 10.830 1928-29 111,338 9,011 12.358 12.391 1929-30 125,528 10,225 12.277 12.378 1930-31 131,564 10,654 12.348 12.025 1931-32 132,208 11,055 11.959 12.238 Storage Plant.—The petrol storage plant installed in January, 1915, is still working satisfactorily, and saves on present consumption about £40 per annum. This plant which finished paying for itself in 1919 by its saving in taking bulk supply has cost nothing in upkeep except the replacement of one delivery hose. Workshop Plant.—This is in good order and effects a great saving, both in Motor and Hospital repairs which are both increasing. GEORGE F. BUCHAN, Medical Officer of Health. 89 WILLESDEN URBAN DISTRICT COUNCIL. MOTOR SERVICES. Year Ended 31st March, 1932. Year 1930-31. Cost per Mile. Expenditure. Year 1931-32. Cost per Mile. £ s. d. £ s. d. d. £ s. d. £ s. d. d. Running Expenses— 636 18 5½ Petrol 596 6 7 37 3 0 Oil and Grease 36 15 2 134 3 l½ Tyres 102 11 114 808 4 7 1.474 735 13 8½ 1.335 Wages and Emoluments— 350 6 11 Mechanic Superintendent 376 11 0 3,307 12 5 Drivers, etc. 3,305 18 1½ 28 7 7 National Insurance (Employer's Contributions) 31 10 0 3,686 6 11 6.724 3 ,713 19 1½ 6.742 Fixed and General Charges— 187 0 0 Rent (Garage and Mess Room) 187 0 0 132 8 8 Repairs, Plant, etc. 119 14 8 62 9 5 Painting, etc., Bodies of Vehicles 56 7 5½ 78 18 7 Coal, Gas, etc. 78 14 2 89 5 11 Uniforms and Overalls 110 14 8 102 15 11 Insurance of Vehicles 118 17 3 109 12 0 Motor Car Registration 196 5 0 6 17 6 Drivers' Licences, etc. 6 0 0 69 15 8 Accessories and Sundries 60 19 2 839 3 8 1.531 934 12 4½ 1.697 Depreciation and Interest Charges— 1,131 10 0 Amount written off value of vehicles in accordance with Medical Officer of Health's Valuation 1,210 0 0 127 2 5 Interest on Capital employed 147 5 4 1,258 12 5 2-296 ,357 5 4 2.464 £6,592 7 7 12.025d £€ ,741 10 6½ 12.238d £ s. d. Income. Use of Vehicles for:— £ s d. Conveyance of Children 23 15 6 57 6 0 Conveyance of Patients 71 14 0 2 17 0 Election Dumoses 5 12 0 — Sale of scrap... 1 11 0 £60 3 0 £102 12 6 10,4 76 Gallon s Petrol consumed 11, )55 Gallons 131,5 64 Miles Miles run by all vehicles 132,208 Miles. 12.6 54 Miles Miles run per gallon of petrol consumed 11.959 Miles. es. Vehicles in use:— 31st March, 1931 15 31st March, 1932 14 finance Department, Town Hall, Dyne Road, Kilburn, N.W. 6. 20th June, 1932. APPENDIX D. REPORT ON DERMATOLOGICAL AND ACTINOTHERAPEUTIC DEPARTMENT. For the Year Ended 31st December, 1932. By H. D. HALDIN-DAVIS, M.D., F.R.C.P., F.R.C.S. The most important feature of last year's work was the development of the clinic for the treatment of varicose ulcers. This work was actually begun in September, 1931, but it only developed gradually as the fact that these conditions were being treated at the Council Clinic generally became known through Willesden. 42 new cases have presented themselves during the year at this Clinic. At the present time there are 21 patients attending and we have discharged during the past year ten as cured. Some of these patients have suffered from ulcers of the legs for many years and there is no doubt that they would have gone on doing so to the end of their lives had not the modern methods employed at the Clinic been made available to them. In some cases healing was obtained but subsequently owing to the fact that the newly grown skin over the ulcer is thin and poorly nourished scar tissue, it has broken down again and treatment has had to be resumed. Hence the comparatively small number entered as " cured." This is not surprising for after long continued ulceration the vitality of the tissues is much diminished and limbs which have long been the subjects of chronic 90 ulceration can never be restored to perfect health. But even in such cases patients who have been crippled for years and scarcely able to leave their homes are frequently put in the position to enjoy life once more, and we often find that not only is the condition of their legs vastly improved, but also the expressions of their faces grow brighter and their complexions grow pinker. It is permissible to add that there is no doubt of the popularity of the Clinic among the patients, who attend with exemplary regularity. As regards the other work of the department there is nothing very striking to report. We have to chronicle a still further diminution in the number of ringworm cases to be submitted to X-ray treatment, only 6 were treated during 1932. The numbers of children attending the Health Centres Nos. 1 and 3, for ultra-violet light remain much the same as in previous years, and the type of case dealt with does not materially change. We have had the pleasure of receiving as visitors medical men and others interested in health centre work in various parts of the world and the Council will be proud to know that in every case our visitors have expressed their approval and may we even add their admiration of the Council's arrangements. APPENDIX E. REPORT ON WORK IN THE EYE DEPARTMENT FOR THE YEAR ENDED 31st DECEMBER 1932. by FRANK W. LAW, M.A., M.D., F.R.C.S., B.Chir., Ophthalmic Surgeon to the Council. A comparison of the figures for this year and those for the two preceding years shows that the numbers attending this Department are steadily increasing. Tothl Attendances. 1930 3,740. 1931 6,118. 1932 7,303. Refraction Cases. Appointments made. Appointments kept. Percentage Attendance. 1930 1,351 1,030 76.2% 1931 1,427 1,220 85.5% 1932 1,782 1,546 86.7% These numbers have occasionally necessitated the booking of an undesirable number of refraction appointments for one morning,—up to twenty—especially at Clinics 2 and 3; there have also been sessions at Clinic 2 at which the total number of cases seen has been between 80 and 90. It is difficult in these circumstances to prevent the session from degenerating into a race against time ; since, however, the excessive numbers were probably largely due to the experiment in subjective testing outlined below (which has now been abandoned) it is thought that it will be possible to avoid such unmanageable numbers in the future. The general routine at the Sessions is unaltered. The standard of treatment is higher than in previous years, the cure of only a very few cases being delayed by lack of enthusiasm and cooperation in treatment at home. Operation cases have been dealt with either at the Central London Ophthalmic Hospital, or at Paddington Green Children's Hospital, as heretofore. The dispensing of Refraction prescriptions has been satisfactorily carried out. In an effort to treat progressive myopia by more than the usual recognised methods, a recent innovation in treatment has been adopted. On the presumption that the stretching of the Sclerotic, which occurs in progressive myopia, is associated with a low Calcium content, selected cases shewing definite and regular increase in myopia have been started upon a course of Calcium Lactate with small quantities of Extract of Parathyroid Gland as an adjuvant. It is necessary to continue the exhibition of these drugs for prolonged periods before any conclusions can be drawn ; the cases will therefore be tested for a year, and a report on their refractive errors then made. The figures for the year are as follows :— Total Attendances. Table I. Total Attendances. Number of Sessions. Average Attendance per Session. Clinic 1 2,196 45 48.8 Clinic 2 2,433 49 49.6 Clinic 3 2,674 49 54.5 Refraction Cases. Table II. Appts. made. Average per Session. Appts. kept. Average per Session. Percentage Attendance. Clinic 1 507 11.3 420 9.3 82.8% Clinic 2 607 12.4 550 11.2 90.6% Clinic 3 668 13.6 576 11.8 86.2% Analysis of Refraction Cases.—As mentioned in my report for 1931, I kept notes this year of the nature of the refractive error of all cases examined. The results are given below ; in classifying the cases no fixed minimum was taken for all cases, as is commonly done, since the error involved 91 ARTIFICIAL LIGHT TREATMENT, YEAR ENDED 31st DECEMBER, 1932. Conditions. Cases brought forward from 1931, i.e.: (Treatments, J WaitingList, 10bservation I Cases. New Cases. Total Cases Treated. Discharged not Treated, i.e., (Unable to 1 attend, 1 Unsuitable, I Left District. Waiting List. RESULTS OF TREATMENT Cases carried forward to 1933, i.e. Treatments, WaitingList 0bservation Cases. Condition Improved. Treatment suspended but still under Observation. Improved or Cured. Unable to attend or Left District before treatment completed. Unsuitable or no Improvement. Cases Still under Treatment (Result not yet known). I 2 3 4 5 6 7 8 9 10 11 0-5 School. 0-5 School. 0-5 School. 0-5 School. 0-5 School. 0-5 School. 0-5 School. 0-5 £ School. 0-5 School. 0-5 ! School. 0-5 S School Tuberculosis—Glands of Neck - 1 - - - 1 - - - - - - - 1 - - - - - - - - Pre-Tubercular — 3 — 3 - 4 — 2 — — — — 2 — — — — — 2 - 2 - 4 — 3 - 5 — 2 - - - - - 3 — — — — — 2 — 2 General Debility 43 68 89 88 118 140 13 14 1 2 10 13 45 55 30 24 3 5 30 C 43 41 58 c Anæmia 1 4 9 7 10 10 - 1 - - - 1 1 4 3 1 1 - 5 4 5 5 Rickets 10 2 37 — 42 1 4 1 1 — 5 — 16 1 7 — — — 14 — 20 — Enlarged Glands 2 2 — 6 2 8 - - - - - 2 2 3 — 1 — — — 2 - 4 Rheumatism - 3 - 8 - 10 - 1 - - 1 - 5 1 1 — 2 3 Chorea — 2 - - - 1 - 1 - - - - - - - - - 1 - - - - Nerves — 4 1 2 1 6 - - - - - - - 6 - - - - 1 - 1 - Chilblains — 1 — 1 — 2 — — - - - - 1 - - - - - 1 - 1 56 86 136 112 173 178 17 18 2 2 15 17 64 75 40 27 4 7 50 52 67 71 Blepharitis - 1 - 4 - 5 - — — — — — — 1 — — — - - 4 — 4 Photophobia - - 1 - 1 - - - - - - - - - - - - - 1 - 1 - Keratitis - - - 1 - 1 - - - - - - - - - 1 - - - - - - — 1 1 5 1 6 — — — — — - - 1 - 1 — - 1 4 1 4 Asthma 3 13 - 7 3 18 - 2 - - 1 - 1 12 1 — — - — 6 1 6 Bronchitis 6 23 17 17 20 40 3 — - — 3 3 5 14 4 7 — 2 8 14 11 17 9 36 17 24 23 58 3 2 — — 4 3 6 26 5 7 — 2 8 20 12 23 Alopecia Areata 1 2 - 4 1 6 - - - - - - 1 2 — 1 — — — 3 — 3 Eczema - - 1 - 1 - - - - - - - 1 - - - - - - - - - Prurigo — 1 - - - 1 - - - - - - - 1 - - - - - - - - Epidermal Defect - - - 1 - 1 - - - - - - - 1 - - - - - - - - 1 3 1 5 2 8 1 - - - - 2 4 - 1 — — — 3 — 3 Otorrhcea - - - 1 - 1 - - - - - - - - - - - - - 1 — 1 Otitis Media 1 - - 1 1 - - 1 - - - - 1 - - - - - - - - - Furunculosis - 4 - 1 - 5 - - - - - - — 4 — — — — — 1 — 1 Enuresis - - 2 2 2 2 - - - - - - 1 2 - — — — 1 — 1 - Mastitis — 1 - - - 1 - - - - - - - 1 - - - - - - - - Mesenteric Adenitis - 1 - - - 1 - - - - - - - 1 - - - - - - - - Genu Valgum 1 - - - 1 - - - - - - - 1 - - - - - - - - - Hirschspring's Disease - - - 1 - 1 - - - - - - - - - - - - - 1 — 1 Delayed Physical Development — — 1 — 1 — - — — - — — — - - - - - 1 - 1 - 2 6 3 6 5 11 - 1 — - - - 3 8 — — — — 2 3 2 3 Total 68 136 158 155 204 266 20 23 2 2 19 20 75 117 45 36 4 9 61 84 82 106 204 313 470 43 4 39 192 81 13 145 188 TOTAL NUMBER OF ATTENDANCES, YEAR ENDING 31st DECEMBER, 1932. 0-5 School. Total. Attended and Treated 4,256 6,763 11,019 Attended for examination, e.g., new cases, cases treated and still under observation, unsuitable cases 237 302 539 Total 4,493 7,065 11,558 Total number of sessions Average attendance per session Average treatment per child 509 22.0 21.4 CASES REFERRED BY- 0-5 School Total. Clinic Doctors 155 142 297 Private Doctors 2 10 | 12 Hospital 1 5 6 Total 158 157 315 93 by this means increases proportionately as the magnitude of the refractive error diminishes. Accordingly, differences of J Dioptre were taken account of in the cases with low refractive errors, and differences of ¼ Dioptre in those with high errors, the dividing line being in the neighbourhood of 5 Dioptres. The abbreviations employed are as follows:— E Emmetropia. H Hypermetropia. M Myopia. HA Hypermetropic Astigmatism. MA Myopic Astigmatism. CHA Compound Hypermetropic Astigmatism. CMA Compound Myopic Astigmatism. XA Mixed Astigmatism. I Irregular. Total number of Refraction attendances 1,546 Of these there were : Isometropic 615 Anisometropic 931 The Refractive errors were as follows:— CHA 477 Cases. H 227 „ E 168 „ CMA 116 „ M 106 „ HA 75 „ H. & CHA 65 „ M. & CMA 32 „ HA. & CHA 32 „ MA 29 „ XA 27 „ HA. & XA 24 - „ MA. & CMA 14 „ H. & HA 9 „ HA. & MA 7 „ HA. & CMA 7 „ M. & MA 6 „ E. & M 6 „ E. & XA 5 „ E. & CHA 4 „ E. & HA 4 „ MA. & XA 4 „ CHA. & XA 4 „ M. & HA 3 „ E. & H 3 „ CMA. & XA 3 „ CHA. & MA 3 „ CHA. & CMA 3 „ H. & MA 2 „ E. & MA 1 „ CHA. & M 1 „ CMA. & H 1 „ E. & I 1 „ H. & M 1 „ E. & CMA 1 „ In addition there were:— Not under Atropine 70 ,, Behaviour prohibited Examination 5 1,546 „ To one engaged in Refractive work these figures are of considerable interest. The abnormally high percentage of Emmetropes is accounted for by the operation of the scheme for testing school children subjectively with a +1.0 D. sphere, to which reference is made on next page. Compound Hypermetropic Astigmatism is by far the commonest refractive error, the proportion of the total being 30 per cent. Myopia, the most important refractive error in the child on account of its grave possibilities, may be taken as represented by the sum of M., MA., CMA., M. & MA., M. & CMA., and MA. & CMA., which gives a figure of 303 cases, or 19 per cent ; the total of Hypermetropic errors calculated in a similar fashion is 88-5, or 57 per cent. 94 Subjective testing with a +1.0D. sphere.—In the report of the Committee of Inquiry into problems connected with Defective vision in School Children (published by H.M. Stationery Office, 1931) there appears a suggestion (p. 53) that with a view to minimising the possibility of the preventible occurrence of Myopia the subjective testing of the visual acuity of school children should include the following procedure. If a child has no subjective symptoms, and reads the requisite 6/6 or 6/9 on Snellen's type, a +1.0 D. sphere should be placed before the eye to be tested and the effect of this artificial myopia recorded. The object aimed at in this procedure is the elimination of all emmetropes and low myopes who would otherwise escape detection. An extended trial of this method of testing was made by the School Medical Officers ; the result was the provision of a mass of material for refraction, which was passed on to me and made the subject of study. During the course of the year I reported to Dr. Buchan as follows :— 1. Dated April 19th, 1932. "I enclose an analysis of 52 cases sent to me under the ' +1-0 D. scheme,' on the strength of which I propose that the scheme be abandoned. Total 52 Emmetropia 29 =60% Hypermetropia 9\l4 =28°/ Hypermetropic Astigmatism 5 J Myopia 1 = 2% Those with the two eyes different:— Hypermetropic Astigmatism and Mixed Astigmatism 2 Hypermetropic Astigmatism and Emmetropia 1 Mixed Astigmatism and Emmetropia 1 Myopia and Emmetropia 1 " Did not attend." 3 52 2. Dated September 23rd, 1932. "After further prolonged trial of the Scheme of testing the visual acuity of school children with the use of a +1.0 D. sphere, I unhesitatingly reiterate the opinion I expressed to the representative of the Board of Education some months ago, namely, that it should be abandoned. My reasons for this are as follows:— 1. That it fails in its object of selecting the low myopes for correction, and that these are eliminated by the ordinary subjective tests. 2. That it selects the vast majority of low hypermetropes, who have no manifest metropia, and who need no correction. 3. That as a consequence the numbers are becoming unwieldy, and scores of children are being prevented from school work for about two weeks without good cause. As an example of this, in the last 32 refractions done at Clinic 3, no glasses were prescribed in the case of 19 of them. 4. That the confidence of some parents in the Clinics is being undermined by the fact that, as they see it, the decision of a nurse or doctor is being over-ruled and negatived by that of another doctor. It will be seen that, in 52 unselected cases sent up as a result of this method of subjective testing, but one Myope was discovered, with in addition one patient with one Myopic eye. It is evident from this that the leakage which obtains in the ordinary methods of subjective testing is minimal. The arguments outlined in my second report need no further explanation. In considering a scheme such as this it is necessary to put upon record my opinion that but slight value should be attached to subjective results in school children. So many different factors, extraneous to actual visual acuity, come into play in determining how much a child shall read to a medical examiner ; and the discovery of the varying subjective results obtained from the separate members of a group of children with identical refractive errors is a matter of common experience to an ophthalmologist. It is my experience that, whatever the optical result, the placing of a lens before a child's eye very frequently results in diminished visual acuity. In dealing with children it has always been my rule—I am speaking now with regard to refractive errors pure and simple, uncomplicated by any condition such as a squint—to correct with glasses those cases, and only those cases, who either (1) have demonstrably defective vision, or (2) present objective signs or subjective symptoms of Eye-strain ; and, a fortiori, those cases who come into both categories. 95 The reason for the large number of Hypermetropes who are eliminated in this scheme is that, except in cases with very high errors, the vast majority of young Hypermetropes have no Manifest Hypermetropia. If the latent hypermetropia which they possess causes no symptoms they are thus in my opinion excluded from the necessity for correction. The statement on page 53 of the report referred to, then, that "under this condition (with a +1.0 D. sphere) if the child is hypermetropic he will still read 6/6 "is, in my opinion, incorrect as a generalisation. Again, an Emmetrope with a +1.0 D. sphere before the eye is given an artificial far point at 1 metre distance, and naturally fails thus to read 6/6; but I consider the "correction" of static emmetropes to be in every way undesirable. The same rule applies with appropriate modifications to Astigmatic cases in the region of Emmetropia; if there is no discomfort and no diminution in acuity from their Astigmatism alone they should not, in my opinion, be compelled to wear glasses. The argument from the administrative side is given in my quoted reports ; the above is a short outline, from the academic side, of my argument for the condemnation of the suggested scheme. I have intentionally omitted any reference to the low proportion of progressive to non-progressive myopes, for it is, of course, essential in discussing cases in bulk to take care not to belittle the importance of the individual case ; I have also omitted to refer at all to the highly controversial point as to the efficacy or otherwise of the action of glasses in preventing or diminishing progress in refractive errors ; these matters, though of first importance, are in strict fairness excluded from my argument. Of considerable interest and importance is the modification of the "+1.0D. scheme" which emerged from this question, which modified scheme is now in operation in the area. This consists in keeping a record of all children who, at the subjective test, while reading 6/6 unaided, show a diminution of visual acuity to the extent of 3 or more Snellen's lines; at the subsequent tests these children in this group who show an increased diminution in acuity are to be referred to me for refraction. It is thought that, by this scheme, progressive increase in refractive error will be detected early, and definite good would thus be done by its utilisation, with which I fully agree; in addition, far less school time would be wasted than by the original scheme. The result of the trial of this modified method will be awaited with interest. 96—97 Appendix F. ORTHOPEDIC DEPARTMENT.—REPORT FOR YEAR ENDING 31st DECEMBER, 1932. H. J. SEDDON, F.R.C.S., ORTHOPAEDIC SURGEON TO THE COUNCIL. 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. General Bone Diseases 16 140 29 - 33 168 29 - 49 308 58 - 415 11 77 7 - 95 9 80 10 - 99 29 151 41 - 221 Deformities of Feet 8 34 39 7 45 57 2 15 79 96 2 192 4 15 35 i 55 1 18 16 — 35 10 46 45 1 102 Congenital Deformities 10 4 12 - 11 3 3 — 21 7 15 — 43 3 3 6 — 12 1 1 2 — 4 17 3 7 27 Tubercular Conditions — 1 4 - — 1 3 — — 2 7 — 9 - - - - - - - - - - - 2 7 - 9 Postural Defects of Spine 1 3 80 - 2 7 105 — 3 10 185 — 198 1 1 40 - 42 - 4 59 - 63 2 5 86 - 93 Infantile Paralysis — 2 11 - — — 6 — — 2 17 — 19 — 1 1 — 2 — 1 3 — 4 - - 13 - 13 Erbs Paralysis — — 2 - 2 — — — 2 — 2 — 4 — — — — — 1 — — 1 1 — 2 - 3 Spastic Paralysis 1 4 8 - — 5 1 — 1 9 9 — 19 - - - - - - - 1 - 1 1 9 8 - 18 Paresis of Digits 1 - 3 - - - - - 1 - 3 - 4 - - 1 - 1 - - - - - 1 - 2 - 3 Traumatic Conditions 1 — 2 — — 8 — 1 — 10 — 11 — — 1 — 1 — — 1 - 1 1 - 8 - 9 Debility 2 1 2 3 8 3 — 5 9 5 — 19 1 — 2 — 3 — 1 1 2 4 8 2 - 14 Deformity following Post Basal Meningitis — 1 — — — — — — 1 — — 1 — — — — — — 1 — 1 — — — — Lymphangiona — 1 — — 1 — — — 2 — — 2 — — — — — — 1 — — 1 — 1 — - 1 Excision of Bursa — — — — — 1 — — — 1 — 1 — — 1 — 1 — — — — — — — — — — Ganglia — — — 2 — 3 1 2 — 3 1 6 1 — — 1 — — — — — 1 — 3 1 5 Total 40 191 192 60 238 219 3 100 429 411 3 943 21 97 94 1 213 12 107 93 — 212 67 225 224 2 518 No. of individual cases treated 40 177 179 — 56 228 188 3 96 405 367 3 871 21 91 79 1 192 12 97 74 — 183 63 217 214 2 496 No. of Individual Cases not requiring Treatment 541 2,190 5,243 34 8,008 Referred for Hospital In-patient Treatment— Do. do. do. Massage 404 988 1,526 12 2,930 Do. do. lo. Electrical Treatmemts 64 94 428 — 586 General Bone Diseases — 3 3 — 6 Do. do. do. Gymnastic Exercises 1,079 4,672 22 5,773 Deformities of feet - - 2 - 2 Do. do. lo. Application of Splints 425 772 48 - 1,245 Congenital Deformities 1 — 2 — 3 Total Tubercular Conditions — 1 1 — 2 Postural Defects of Spine — — 2 — 2 No. of Individual Cases nor requlring Treatment 17 48 55 — 120 Infantile Paralysis — — 3 — 3 Spastic Paralysis - - 2 - 2 Traumatic Conditions - 1 1 - 2 Lymphangiona - 1 1 - 2 Cyst — — — — — Entered for Hospital In-patient Treatment General Bone Deseases — 5 1 — 6 Deformities of Feet — — 2 — 2 Congenital deformities 1 — 3 — 4 Tubercular Conditions — 1 1 — 2 Postural Defects of Spine — — 2 — 2 Infantile Paralysis — — 4 — 4 spastic Paralysis — — 2 — 2 traumatic Conditions — 1 — — 1 Total 1 7 15 — 23 Total 1 6 17 — 24 In addition to the above the Council bore the cost of Treatment of 2 children under 5 years of age, I in the Royal National Orthopaedic Hospital and 1 in St. Vincent's or Orthopaedic Hospital, who were referred to Hospital by other agencies.