Borough of Willesden 1933. THE 58th ANNUAL HEALTH REPORT. 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. "T.on6on : WIGHTMAN & CO., LIMITED, Regency Street, Westminster, S.W. 1, and Dugdale Street, S.E. 5. Will 29 Ac 39(1)WILLESDEN 2 WILLESDEN URBAN DISTRICT COUNCIL, 1933 (to 9th Nov.). WILLESDEN URBAN DISTRICT EDUCATION COMMITTEE, 1933 (to 9th Nov.). †MR. Councillor H. LEIGH MOSSLEY, J.P. †Mr. Councillor C. R. HOBSON. (Chairman of the Council). Mr. Councillor F. W. HORNE. †MR. Councillor GEO. H. HISCOCKS (Vice-Chairman of the Council). Mr. Councillor W. JEttRIES. †*mr. Councillor C. BERESFORD. Mr. Councillor A. E. JONES. Mr. Councillor C. L. BLAND. †MR. Councillor M. JONES. *Mr. Councillor H. C. BLAXLAND. Mr. Councillor H. J. KELLY. †MR. Councillor C. HICKS BOLTON, M.A. †*MR. Councillor J. G. KEN YON. †*MR. Councillor W. M. BOLTON. Councillor The Rev. T. D. LLOYD, B.A. †MR. Councillor P. BOND. †*Mr. Councillor A. C. MELLUISH. †*MR. Councillor S. BOWN. Mr. Councillor J. MORSE. Councillor Dr. J. S. BRIDGES. Mr. Councillor A. NEATE. Mr. Councillor J. W. CATLOW. †*Mr. Councillor GEO. PAGE. †*MR. Councillor J. A. CLARK. Mr. Councillor H. W. PROTHERO. †*MR. Councillor J. CLEE Mr. Councillor N. A. REMMERS. (Chairman, Health Committee and Children's Care Sub-Committee). Mr. Councillor W. H. RYDE. †Miss Councillor N. M. COWAN. †*MR- Councillor J. M. SALMOND. Mr. Councillor A. E. DORAN. Mr. Councillor P. J. SAMUELS. Mr. Councillor J. FERNLEY. *Mr. Councillor T. J. SANDFORD. Mr. Councillor G. J. B. FURNESS. Mr. Councillor H. J. SAVORY. Mr. Councillor L. H. GILLIS. Mr. Councillor H. THORLEY. †*mr. Councillor H. J. GOLBY. †*MR. Councillor W. H. WALLIS. Mr. Councillor W. A. HILL, J.P. Mr. Councillor GEO. WESTON. Mr. Councillor J. R. HOBBS. †Mrs. Councillor A. B. WORSFOLD. * Member of the Children's Care Sub-Committee. † Member of Health Committee. 3 CORPORATION OF WILLESDEN, 1933 (from 9th November). HIS WORSHIP THE MAYOR. ALDERMAN GEORGE H. HISCOCKS, J.P. Deputy Mayor. † Alderman Capt. H. LEIGH-MOSSLEY. Aldermen. *†‡BLAXLAND, H. C. *†CLEE, J. *†§‡BOLTON, C. HICKS, M.A. *†§‡COWAN, Miss N. M. *†§‡BOLTON, W. M. DORAN, A. E. *†§‡BOND, P. *HILL, W. A., J.P. †§ MELLUISH, A. C. Councillors. AYRES, G. MAYNARD, W. BOWN, S. NEATE, A. CATLOW, J. W. OWENS, G. EVANS, F. T. *†‡PAGE, GEO. †EXTON, F. G. *PROTHERO, H. W. GILLIS, L. H. REMMERS, N. A. *HENDERSON, Miss J. M. †‡RYDE, W. H. *HILL, W. J. SAMUELS, P. J. HOBBS, J. R. SAVORY, H. J. †HOBSON, C. R. †SCOTT, S. *†‡HUGGINS, Mrs. V. E. A. STILTON, W. A. JEFFRIES, W. *†WALLIS, Mrs. V. B. †KELLY, H. J. *†WALLIS, W. H. *†KENYON, J. G. WESTON, GEO. LLOYD, Rev. T. D.. B.A. *tWHITE, Mrs. R. †‡MARSHALL, H. C. *WILLIAMS, Mrs. S. E. H. †‡WORSFOLD, Mrs. A. B. * Member of the Children's Care Sub-Committee, † Member of Health Committee. § Member of Health Visiting Sub-Committee. ‡ Member of Housing Act 1930 Sub-Committee. 4 Town Hall, Dyne Road, Kilburn, N.W. 6. 1st May, 1934. To the Willesden Borough Council— The Local Sanitary Authority, and the Local Education Authority. I beg to submit herewith the Annual Health Report for Willesden for the year 1933. This Report includes:— (i.) The 58th Annual Report on the health and sanitary condition of the district ; (ii.) The 26th Annual Report on the health of children attending the public elementary schools ; (iii.) The 14th Annual Report on the health of children attending secondary and trade schools ; (iv.) The 16th 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 4th Annual Report on the Supervision of Midwives ; (vi.) The 4th Annual Report on the Registration of Nursing Homes ; (vii.) The 4th Annual Report on Infant Life Protection ; (viii.) The 14th Annual Report on home nursing ; (ix.) The 19th Annual Report on the provision of meals to children attending the public elementary schools ; (x.) The 42nd Annual Report on the Municipal Hospital; (xi.) The 3rd Annual Report on the Maternity Hospital ; (xii.) The 4th Annual Report on the health of patients attending the Middlesex County Council Occupation Centre for Mentally Defectives, Buller Road, Willesden ; (xiii.) The 3rd 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, 1933, was 190,875. 2,671 live births were registered during 1933, giving a birth rate of 13.99 per 1,000 of the population, as against 14.58 in 1932. 90 still births were registered, giving a still birth rate of 32.60 per 1,000 total live and still births. 1,885 deaths were registered in 1933, giving a death rate of 9.88 per 1,000 of the population. These figures compare with a total number of deaths of 1,838 and a death-rate of 9.77 in 1932. The infant mortality rate in 1933 was 46.05 per 1,000 births. This is the lowest ever recorded in Willesden, the lowest up till this year having been 53 in 1923 and again in 1926. 123 deaths of infants under one year occurred. 1ll or 90 per cent. of these 123 deaths were due to:— Congenital Malformations 10, Premature Birth 35, Atrophy, Debility and Marasmus 11, Atelectasis 11; Diarrhoea and Enteritis 27; Whooping Cough 5; Bronchitis 2, and Pneumonia 10. No death of an infant under one year of age occurred from Measles in 1933. Year by year these causes of death account for more than three-quarters of all deaths of infants under one year of age and active measures are required to prevent these conditions proving fatal. 5 CANCER. In Willesden in 1933 there were 260 deaths from Cancer, as compared with 250, 250, 214, 239, 240 and 217 in each of the previous six years. The tendency to increase, therefore, unfortunately continues. 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 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. Propaganda, in the form of posters, leaflets, advertisements, articles in the press and talks has been continued, but there is a great disproportion in the number of deaths as recorded above and the number of persons attending the Clinics. It can only be reiterated that if more sufferers attended the Clinics in the early stage of their disease, medical and surgical treatment would ensure that a greater proportion of them would be cured. During 1933, 45 patients attended these Clinics, of whom 34 were new cases (8 men and 26 women) and 11 had attended during 1932 and were still under observation at the end of that year. The total of attendances made in 1933 was 70. Of the 34 new cases 7 were found to live out of the district and were dismissed after being suitably directed as to the means of securing proper investigation and treatment. The remaining 27 cases after examination were disposed of as follows — 16 were referred to a hospital for further investigation ; 1 was referred back to her own doctor ; 5 were kept under observation and asked to re-attend (1 of these was finally charged before the end of the year and 1 did not re-attend) ; 2 were referred to special clinics, but did not have cancerous or pre-cancerous ditions; 1 was referred to the Tuberculosis Officer, but did not follow advice and was ultimately discharged. 2 were reassured and discharged on their first visit ; Of the 16 who were referred to hospital :— 9 were found to require operation (8 have been operated upon; 1 has refused operation); 6 have received or are receiving treatment at hospitals as out-patients, or are being kept under observation there ; 1 left the district before keeping her appointment at the hospital. The pathological conditions from which the 34 new cases suffered are briefly as follows :— 10 cases had abnormal breast conditions; 3 had cancer; 5 had chronic inflammation; 1 had a tumour likely to become cancerous; 1 had a benign tumour; 5 cases suffered from affections of the female genital organs; 3 had conditions often found to be pre-cancerous; 2 had simple non-cancerous conditions; 3 cases had conditions affecting the digestive tract which occasionally lead to cancer; 5 cases had similar conditions of the mouth and throat; 4 cases had innocent tumours of the body wall or skin; 7 cases had conditions unconnected with cancer, but which were causing anxiety or required treatment; 1 case was not definitely diagnosed as she did not keep her appointment at the hospital. (1 case in the above classification suffered from two affections.) 6 The Nurse attached to the Clinic pays following-up visits to the homes of patients attending. During last year 44 such visits were made. The Nurse also visits homes in which a death from cancer has taken place, and where disinfection has been requested. 12 houses were visited in this way. In 2 cases there appeared to have been no delay, and the disease gave little warning. In 2 cases there was delay between the date when the patient saw a doctor and the time when further investigation was sought. In 2 cases the delay seemed to occur at the hospital end, in one case because the investigation carried out failed to reveal the disease, and in the other because the patient was put on a waiting list for over 4 months before operation was performed. In 6 cases the delay was only on the part of the patient who ignored the warning signs, and in one case refused operation. INFECTIOUS DISEASES. During the year 1933, 2,445 cases of Infectious Disease were notified as compared with 2,164 in the previous year. The total of 2,445 includes 392 notifications of Diphtheria as compared with 247 in 1932. 694 cases of Scarlet Fever as compared with 421 in 1932, 335 cases of Pneumonia as compared with 351 in 1932, 524 cases of Whooping Cough as compared with 673 in 1932, and 100 cases of Erysipelas as compared with 66 in 1932. The number of cases of Scarlet Fever is the highest since the epidemic of 1920-21, in which two years 697 and 1,527 cases were recorded respectively. Return Cases of Scarlet Fever.—The following statement gives the return cases that have occurred during 1933:— I. Home Cases.—Approximately 58. (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 0 „ return cases they gave rise to 0 „ infecting cases per cent. of total home cases 0 „ return cases per cent. of total home cases 0 II. Hospital Cases.—Approximately 636. (a) No. of infecting cases giving rise to return cases not longer than 28 days after discharge 32 „ return cases they gave rise to 39 „ infecting cases per cent. of total hospital cases 5.0 „return cases per cent. of total hospital cases 6.1 (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 0.8 „return cases per cent. of total hospital cases 0.8 Small Pox.—Two cases of Small Pox were notified in 1933 and were admitted to the Small Pox Hospital of the London County Council. One of these cases was discharged after observation as not Small Pox. The diagnosis in the other case was confirmed. The source of infection in this case appeared to have been in Essex. The patient recovered. No vaccinations were performed by the Medical Officer of Health under the Public Health (Small Pox Prevention) Regulations, 1917. Typhoid Fever.—Thirteen cases were notified during 1933 as against 10 in 1932 and 15 in 1931. Seven of these thirteen cases were notified during the 4 weeks ended 12th August, 1933, 4 of these 7 being diagnosed in hospital as paratyphoid B, 2 as typhoid fever and 1 as enteritis. 12 of the 13 notified cases were removed to hospital—10 to the Municipal Hospital and 2 to other hospitals. Two cases were diagnosed in hospital as typhoid fever, 6 as paratyphoid B, 1 as enteritis, 1 as colitis, 1 as gastritis and 1 as influenza. The 2 typhoid fever cases occurred in the same house, the patients being nephew and uncle. The first of these cases, a boy of l¾ years, proved fatal. There appeared no connection between the other cases, who all recovered. 7 The 13th case was nursed at home. The patient took ill 14 days after returning home from 3 weeks travelling in Portugal. After 3 months illness this patient was improving at the end of the year. One death was recorded from Typhoid Fever in 1933. Infectious Diseases of the Nervous System—Cerebro-Spinal Meningitis, Poliomyelitis, Encephalitis Lethargica and Acute Polio-Encephalitis.—21 cases of these diseases were notified in 1933. 7 proved fatal, giving a fatality rate of 34 per cent, of notified cases. In one of the fatal cases the death was attributed to Streptococcal Meningitis, the patient was not a Willesden resident and the death therefore was not allocated to Willesden. In 1 case death was attributed to Secondary Carcinoma of the brain, in 1 after post-mortem to Meningitis-Non Suppurative arachnoiditis, and in 1 to Chronic Anterior Polio-myelitis. The 3 other deaths were certified as due to Cerebro-Spinal fever. 4 deaths in all are attributed to these diseases in Willesden in Appendix A, Table II. These are the 3 deaths due to Cerebro-Spinal Fever and one certified after post-mortem as due to Anterior Polio-myelitis. This last case was notified 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. 524 cases were notified during the year, but a total of 1,042 cases coming to their knowledge were visited by the Health Visitors. There were 12 deaths from Whooping Cough all occurring in children under 5 years of age. 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 1933, 511 cases of measles, which is not notifiable in Willesden, were visited by the Health Visitors. Only 1 death was recorded from Measles in 1933. Food Poisoning.—Four outbreaks came to the knowledge of the Health Department. The first to be reported occurred on 7th June. So far as could be traced 23 persons were attacked. The onset of the illness began 1 hour to 9½ hours after partaking of pressed beef. The patients suffered from abdominal pains, vomiting, diarrhoea and headache. The severity of the illness varied. 13 persons who partook of the pressed beef did not suffer at all; of the 23 sufferers 19 remained at home, 5 of those were rather severely attacked but the others were moderately ill; 4 persons were removed to hospital, 2 of whom were severely ill. One of those removed to hospital died. Enquiries showed that all these persons partook of pressed beef prepared by a local butcher. An inspection of the premises and method of manufacture was made by the Medical Officer of Health and the Chief Sanitary Inspector on the 9th June. The premises were clean and well-kept and the district sanitary inspector, who accompanied the Medical Officer of Health and Chief Sanitary Inspector, stated that the premises were always in the same condition on all previous visits that he had made there. The butcher stated that his pressed beef was usually made from "overs" from thick flanks and top pieces and briskets. During the Whitsun weekend he had prepared two consignments of pressed beef from meat bought at the Central Meat Market, London, on Thursday, 1st June. The first consignment was put into brine on Friday, 2nd June, cooked on Saturday, 3rd June, and sold on Saturday, and Tuesday, 3rd and 6th June. This consignment produced no illness. The second consignment was put into brine on Saturday, 3rd June, cooked on Tuesday, 6th June, and sold on Wednesday, 7th June, but some may have been sold late on Tuesday evening, 6th June. This is the consignment which produced the illness. The butcher had destroyed what was left of these consignments on hearing of the illness which it had caused. He had, however, given a piece to the Coroner's Officer which was subsequently transmitted to Dr. W. M. Scott of the Ministry of Health Pathological Laboratory for analysis. Samples of some of the pressed beef which had not been consumed by families were also sent to Dr. Scott for examination. There was no illness amongst any of the employees of the butcher, or of anyone who came in contact with the pressed beef. The same brine had been used for the preparation of both consignments. It was prepared in the usual way and was not more than a week old when used. The butcher's usual method of preparation of brine is to use 6 pails of Salt, 1| lbs. Saltpetre, 2 measures "Saltpanella" and 12 pails of Water. The brine is usually used for 7 days in the summer time and 14 days in the winter time. The butcher has carried out this method of preparation for many years and has not previously had any illness resulting from his preparations. 8 The fatal case above referred to died at the Central Middlesex County Hospital. The postmortem examination was conducted by the Senior Assistant Medical Officer who sent samples for pathological examination in accordance with Circular CL. II dated 1st April, 1924 of the Ministry of Health. Following, is Dr. Scott's report on the specimens sent him :— Ministry of Health, Pathological Laboratory, Dudley House, Endell Street, W.C. 2. 12th June, 1933. Dear Dr. Buchan, Food Poisoning. Many thanks for sending me the specimens from the above. The case is an interesting and unusual one. I can find no evidence of the Salmonella infection usual in "food poisoning," either in the post-mortem material or the 3 specimens of pressed beef. Nor have I found any other significant bacteria in the spleen, liver, kidney, or small intestine. But each of the three specimens of pressed beef yielded profuse cultures of staphylococcus aureus: the staphylococci were practically in pure culture and in very great numbers without affecting to an obvious extent either the appearance or the smell of the meat. As you know, staphylococcal infection of food, especially cream and cakes, has been frequently reported in connection with food poisoning in the U.S.A. (Jordan of Chicago), but cases in which it could reasonably be suspected have been rare in this country. I think there can be little doubt that your outbreak is one, however, and the character of the illness (short incubation, painful vomiting and diarrhœa with rapid recovery) agrees with the American reports. Fatal cases appear to be extremely rare, on the other hand. Yours sincerely, (Signed) W. M. SCOTT. Certain cases of food poisoning were also reported in Hornsey, and the Hornsey Borough Council stated that the pressed beef which had caused the food poisoning in that area had been made from beef purchased from the Central Meat Market, London, on the 6th and 7th June., but not from the same firm from which the Willesden meat was purchased. In the second outbreak reported, only one family was affected. This family consisted of Mr., Mrs. and Miss X. In the evening of 25th May, Miss X ate tinned cream and on the morning of 26th May, vomited and had abdominal pain and diarrhoea. She thought that the cream was the cause. The illness continued until 5th June, during which time, Miss X ate only arrowroot biscuit and drank arrowroot made with fresh milk. She was in bed the first six days, but even after that she did not handle any of the food subsequently eaten by Mr. and Mrs. X. On the 4th June at 9.30 a.m. a shoulder of lamb, purchased from a local butcher, was delivered at the house. A bit of the bone was cut off and given to the cat, the rest was immediately cooked. The meat was only handled by Mrs. X. At 1.30 p.m. some of the meat was eaten by Mrs. and Mr. X with potatoes and butter beans, which had been soaked overnight. Nothing else was eaten all day. Cups of tea were drunk, the milk used being tinned milk. At 6.30 p.m. on 4th June, Mrs. X had nausea, this continued until 6.30 p.m. on 5th June, when she had sickness and diarrhoea and pains in the stomach. Meanwhile, she had nothing to eat and only tea to drink. Mr. X had similar symptoms at the same time. He also had a headache. The meat was found to have maggots in it on 5th June, and was thrown away. It had been kept in the living room in very hot weather all the time. The illness continued and on the afternoon of 10th June, Mr. X. was removed to Hospital, where he died at 8.30 a.m. on 11th June. An inquest was held on 14th June, the verdict being ptomaine poisoning. Death by misadventure. The report of the Ministry of Health, stated that B. Aertrycke had been found in practically pure culture in the intestines, spleen and liver and kidney of Mr. X. The reasons why the patients suspected the meat as a source infection were:— (1) Because it was the chief article of their diet prior to their symptoms. (2) Because it was found to be maggotty the following day. The meat had a normal taste when eaten. The cat which had the raw bone did not become ill. The butcher had purchased twelve to fifteen carcases of imported mutton and lamb at the Central Meat Market on Friday, 2nd June, these were delivered to him the same evening and cut up into about 100 joints for sale. Mrs. X selected the shoulder of lamb on 3rd June, this was placed in 9 cold storage overnight and delivered to her the next morning. The whole consignment was sold out with the exception of some pieces of breast and scrag. There were no complaints from other customers and no sickness with the butcher or his staff. The premises and cold storage were clean and in proper order. The third outbreak occurred at a factory which ran a small canteen for about twenty workers. Two legs of lamb were purchased from a local butcher on Monday, 3rd July. The legs of lamb were roasted in a gas oven on Monday, 3rd July, and were then stored in a Refrigerator and taken out and eaten cold on Tuesday, 4th July, for lunch, 1 to 2 p.m. Salad made from lettuce, tomatoes, eggs and cucumbers, and apple tart and custard were also eaten. Lunch was served in two separate rooms. Seven people took lunch in one room and eleven in the other room. Ten of the eighteen people who had eaten this meat were taken ill with severe abdominal pains and diarrhoea. One of these was in the room where the seven lunched and nine in the room where the eleven lunched. One joint was not specially served to one room. One joint was finished and remnants thrown away and the remains of the other joint sent to the Ministry of Health Pathological Department for examination, but nothing bacteriologically significant was found. The fourth outbreak did not occur till the Autumn and was confined to one family. Two pounds of sausages were delivered about 11 a.m. on 19th October, were put into a clean enamel pie dish with 2 chops and some margarine and placed in the oven until cooked. They were eaten by the 3 children with cabbage and potatoes for dinner at 12.30 p.m. The father and mother did not have any sausage. One child complained of acute pain about 1 o'clock and later had frequent vomiting and diarrhoea with increased abdominal pain. He was ill for about a week. Another child complained of acute abdominal pain with diarrhoea and vomiting about 1.30 p.m. This child took some weeks to recover. The third child who ate only a small portion of sausage had no symptoms apart from a slight attack of diarrhoea. The mother and father were not ill. Another family in the house purchased some of the same consignment of sausages at the same time. These were cooked for breakfast the following morning but after being tasted by two members of the family, who complained of a bitter taste, they were thrown away. No illness resulted in this family. There appeared no connection between the above 4 outbreaks. In all the cases the premises from which the suspected food was obtained were satisfactory and proper care seemed to have been taken in its storage and preparation. Neither did bacteriological and pathological examination throw any light on the outbreaks. It is likely that the unusually hot weather had some influence in causing the outbreaks of food poisoning which were noted in various parts of the country. 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 5,740 occasions ; nursing mothers, 24,115, and children under 5, 54,927, making a total of 84,782 attendances. Out of the total number of 2,671 children born alive during the year, 1,536 or 58 per cent, subsequently attended the Municipal Welfare Centres. Altogether, however, 1,801 children under 1 year of age attended the Municipal Centres for the first time during the year. This represents 70 per cent, of the 2,583 notified live births belonging to Willesden, and 67 per cent, of the 2,671 registered live births belonging to Willesden. 668 children between the ages of 1 and 5 years attended the Municipal Centres for the first time during the year. The number of live births occurring amongst expectant mothers who attended the AnteNatal Clinics was 980; 69 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:— 10 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 Willesden Maternity Hospital opened, 14th February, 1931. Cases no longer sent to Park Royal Hospital. 1932 544 Bookings limited to relieve pressure on Hospital accommodation. 1933 550 During 1933, 311 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:— Table No. 2.—Applications for Booking Refused. No beds available 104 Not resident in Willesden 54 Will not have had 12 months' residence in Willesden prior to expected date of confinement 97 Unable to pay fee 16 Sufficient home accommodation 38 Balance in respect of last confinement still owing to Council 2 311 The following Table shows the fees at which the 550 cases were booked:— Table No. 3. Fee. No. of Cases. Fee. No. of Cases. £8 8s. Od. 16 £3 0s. Od 43 £6 0s. Od. 1 £2 10s. Od 56 £5 0s. Od. 5 £2 0s. Od. 53 £4 10s. Od. 13 £1 10s. Od 58 £4 0s. Od. 17 £1 5s. Od 60 £3 10s. Od. 26 £1 0s. Od 202 The average fee per case is approximately £2 0s. 9½d. Hospital Confinements.—During 1933, 499 women were confined in the Willesden Maternity Hospital. In addition to these an even larger number of Willesden mothers were confined in institutions outside Willesden, 585 births of Willesden residents being notified from such outside institutions—195 from Queen Charlotte's Hospital, 74 from Queen Mary's Maternity Home, Hampstead, 45 from St. Mary's Hospital, 20 from University College Hospital, 17 from Middlesex Hospital, and smaller numbers from other hospitals ; 51 from a nursing home and smaller numbers from other nursing homes. These, together with some 294 in the Central Middlesex County Hospital, are approximately one-half of the births belonging to Willesden and show the desire of the present-day mother for institutional confinement. 11 A report on the Willesden Maternity Hospital by Mr. Arnold Walker, the obstetrician, appears later on in this report. The Willesden Maternity Hospital is recognised as a Training School for Midwives. A report on the extension of the Hospital appears as Appendix H. Frequent requests for admission to the Willesden Maternity Hospital are received from residents in adjoining areas, and during the year a conference with neighbouring authorities was held at Hendon to discuss the general question of Maternity Hospital accommodation. Ante Natal Work for Institutions not under the Council.—Requests are received from the Middlesex County Council and from various London Hospitals for home vists to expectant mothers, and special reports by the Council's Health Visitors in connection with women who are to be confined in these Hospitals. 110 such reports were supplied to London Hospitals and 217 to the Middlesex County Council during the year. 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 1933:— Table No. 4. Willesden General Hospital. St. Monica's Home Hospital. Total. No. of Children in Hospital at 31st December, 1932 0 3 3 No. of Children admitted during 1933 170 15 185 Total No. of Children under treatment during 1933 170 18 188 No. of Children discharged during 1933 170 15 185 No. of Children died in Hospital during 1933 0 1 1 Mortality % 0 6.25 0.53 No. of Children remaining in Hospital at 31st Dec., 1933 0 2 2 The following table gives particulars of the conditions for which children were treated during 1933, the treatment carried out and the results of such treatment Table No. 5.—Children under 5 Years under Treatment in Hospital during 1933. 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 or Unchanged. Died. Marasmus 3 21 24 — 22 - 2 19 1 2 Enlarged Tonsils and Adenoids — 164 164 162 2 — 163 1 — 0 Total 3 185 188 162 24 — 165 20 1 2 Puerperal Fever.—During 1933, 13 cases of Puerperal Fever were notified as against 8 in 1932, 14 in 1931, 5 in 1930, 6 in 1929 and 6 in 1928. This gives a case rate of 4.9 per thousand registered live births, as against 2.9 in 1932, 4.9 in 1931, 1.7 in 1930, 2.21 in 1929 and 2.25 in 1928. The figure per 1,000 registered total births is 4.7 for 1933 against 2.8 for 1932. Of the 13 notified cases 4 proved fatal. The 3 other deaths appearing in the death table under puerperal sepsis were those of 2 cases notified as puerperal pyrexia and 1 case which had not been notified. 12 Taking the 4 deaths occurring amongst the 13 cases of puerperal fever notified in Willesden, this gives a case mortality of 30.8 per cent. as against 25 per cent. in 1932, 14.3 per cent. in 1931, 20 per cent. in 1930, 50 per cent. in 1929, 33.4 per cent. in 1928, and 60 per cent. in 1927. The maternal mortality from sepsis for 1933 was 2.6 per thousand registered live births and 2.5 per thousand registered total births. The corresponding figures for 1932 were:—2.2 per thousand registered live births and 2.1 per thousand registered total births. The maternal mortality from all causes was 5.2 per thousand registered live births and 5.1 per thousand registered total births. The corresponding figures for 1932 were:—4.0 and 3.9 respectively. In 4 of the 13 notified cases a private doctor was in attendance at the confinement at home. One of these confinements was instrumental and in 1 the child was born before the doctor's arrival, the midwife being present. One stitch was inserted after the doctor's arrival. These 4 patients recovered. In 4 cases a midwife attended the confinement at home. Two of these patients died and two recovered. Two cases were confined in Hospital. These both recovered. The other 3 were cases of miscarriage at home. One recovered and 2 died. Table No. 6.—Puerperal Fever Cases, 1933. Home Circumstances. Number of Cases. Number of Rooms. Number of occupants, including new-born baby. Under 10 years. Over 10 years. Total. 1 (fatal) 2 2 2 4 1 2 2 2 4 1 (fatal) 3 1 5 6 1 4 3 2 5 1 (miscarriage) 4 1 2 3 1 4 1 2 3 1 (miscarriage) (fatal) 4 2 5 7 1 (miscarriage) (fatal) 5 3 3 6 1 5 1 3 4 1 6 1 2 3 1 8 3 3 6 2 Occurred in Hospital. Puerperal Pyrexia.—36 cases were notified during the year. 3 of these 36 cases proved fatal, 2 of the deaths being attributed to Puerperal Sepsis and 1 after post mortem to uraemia due to subacute nephritis. During 1933 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 1933, 119 were supplied free, 16 at full cost and 7 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. 8 such consultations were paid for in 1933. (3) Provision of Anesthetist.—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 1933. 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. 20 cases were inquired into during 1933. 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. 13 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. The aims and methods adopted were outlined on pages 9 and 10 of the Annual Report for 1932. Findings of Medical Inspections.—The following table shows the numbers and percentages of individual defccts found in 504 children examined during the year. Table No. 7. Age Period. 18 months. 2 years. 3 years. 4 years. Total. Percentage. Number of children inspected 165 151 122 66 504 Malnutrition (including slight degrees) 7 5 3 2 17 3.4 Skin Conditions 17 9 6 3 35 6.9 Eyes—Blepharitis and Conjunctivitis — 3 1 - Squint 1 — — - 8 1.6 Other conditions 1 — 1 1 Ears—Otitis media 3 5 — 8 1.6 Nose and Throat—Enlarged tonsils or adenoids or both 23 27 30 15 95 18.8 Enlarged cervical glands 2 7 7 2 18 3.6 Teeth—Dental diseases 11 12 22 16 61 12.1 Heart and Circulation including anaemia 3 11 6 7 27 5.4 Lung disease (non tubercular) 4 4 6 2 16 3.2 Nervous system (including functional conditions) 5 7 3 15 3.0 Deformities—Rickets 20 12 10 4 46 9.1 Others 14 20 20 5 59 11.7 Other Defects 6 4 2 1 13 2.6 Ophthalmia Neonatorum.— The number of cases of this disease notified during the year was 20, as against 28 last year, giving a case rate of 7.5 per 1,000 registered live births. A private doctor attended at the confinement in 4 cases, a midwife in 5 cases, and 11 cases were born in hospital. Treatment was obtained at a hospital in 7 cases, at the Municipal Centres in 5 cases, and by a private doctor at home in 8 cases. Complete recovery with unimpaired vision occurred in 17 cases. 1 case died from epilepsy and convulsions and in 2 cases the result of treatment was not ascertained. 23 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 the 1931 Annual report. During 1933,550 Mothercraft sessions were held, with 5,297 attendances of mothers, and 5,268 attendances at the nurseries. This gives an average of 9.6 attendances of Mothers per session. 387 individual mothers attended. 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. 14 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, 1933, the average number of scholars on the Public Elementary School Rolls, including the Special Schools, in Willesden was 21,416. 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 1933 was 15,062. Findings of Medical Inspections.—(a) Uncleanliness.—Cleanliness inspections were carried out in the schools on 603 occasions during the year 1933, the average number of visits paid to each school by the Health Visitor being 17.7. The total number of examinations and re-examinations made during the year was 60,246. 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, when a child with only a few nits was placed in this category, the percentage of nitty or verminous children in the schools had dropped to 3-6. It will therefore be noted that enormous improvement had been effected, far greater actually than the figures show. In 1933, however, the percentage rose to 4.1. This is the first reverse in the steady decline which had been maintained since 1920. Percentage of Nitty and Verminous individual children recorded upon routine cleanliness inspection at the Schools from year to year since 1914. 1914 20% 1915 23% , 1916-19 Results not recorded owing to war. 1920 11.9% 1921 9.8% 1922 8.3% 1923 8.2% 1924 7.1% 1925 6.0% 1926 5.9% 1927 4.7% 1928 4.7% 1929 4.0% 1930 3.7% 1931 3.6% 1932 3.6% 1933 4.1% (b) Tonsils and Adenoids.—During 1933 at routine and special medical inspections, 1,361 cases of enlarged tonsils and adenoids were discovered, as compared with 1,394 found in 1932, 1,668 in 1931, 2,021 in 1930, 1,773 in 1929, 2,070 in 1928. (c) Skin Disease.—During 1933, at routine and special medical inspections, 1,727 cases of skin disease were detected, as compared with 1,607 in 1932, 1,807 in 1931, 1,888 in 1930, 1,809 in 1929, 2,241 in 1928. (d) Enlarged Cervical Glands (non-tuberculous).—During 1933, at routine and special medical inspections 275 cases of this defect were noted as compared with 285 in 1932, 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. 15 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. It 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 1933 school children were followed up by the Health Department on account of 18,645 medical defects and 8,106 dental defects. Of those defects found to require treatment, medical or dental treatment was obtained for 16,886 and domestic treatment was obtained for 4,022. 97.4 per cent. of the medical defects were treated, 64.8 per cent. receiving medical treatment and 32.6 per cent. domestic treatment, 66 per cent. of the dental defects followed up were treated. No record is available of defects requiring treatment which were not followed up. 89 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 11 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 101,160 attendances at the Health Centres in 1933, as compared with 99,542 in 1932. Crippling Defects and Orthopaedics.—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 1933, 1,221 special children were examined or re-examined. Of the 354 original examinations included in the 1,221 examined, 74 were found to be physically defective, 17 mentally defective, 6 blind and partially blind, 32 dull and backward, 190 anaemic and debilitated, 18 defective speech, 5 deaf and dumb, 4 epileptic, 1 defective vision, 5 unstable, 2 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 126. The actual number on the roll at the 31st December, 1933, was 131. The average attendance for the year was 111. 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. Seven children were allowed to leave school before reaching the age of 16 years, 1 child was transferred to an ordinary elementary school, 6 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 and 4 were transferred to Residential Institutions. The Certifying Medical Officer visits the school weekly for the purpose of revision of classification and for medical examination of the children. 100 such examinations were made during 1933. 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. 108 children were examined, 15 of whom were found to require treatment, and the following table gives a return of the defects found at medical inspection:— 16 Table No. 8. Defects. Found to require treatment. Requiring to be kept under observation but not requiring treatment. Malnutrition Skin Disease 2 — Eye—Blepharitis — — Defective vision (ex. squint) — — Squint — — Other conditions 2 — Ear—Defective hearing — — Other ear diseases 5 — Nose and Throat—Enlarged tonsils only 2 — Adenoids only 2 — Enlarged Tonsils and Adenoids 1 — Enlarged cervical glands (non-tuberculous) — — Defective speech — — Defective Teeth 31 — Heart and Circulation—Heart functional — 3 Anaemia 1 — Lungs—Bronchitis — — Other non-tuberculous diseases — — Other defects and diseases 2 — Total 48 3 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 155, the actual number on the roll on the 31st December, 1933, being 141. The average attendance for the year was 129 and there were 35 children awaiting admission at the 31st December, 1933. The school takes physically defective children between 5 and 16 years of age. The staff consists of one Head Teacher and six full-time Assistants. During the year 8 children were allowed to leave school before reaching the age of 16 years, 18 children were allowed to attend ordinary elementary school, 1 child was transferred to a residential institution. 1 child obtained a scholarship at Pitman's College and 2 children were 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 Orthopædic 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. 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 55 boys and 27 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. The children are selected both from the physically defective and the ordinary elementary schools and the duration of stay is six weeks. All the cases sent have shown a definite improvement on their return home. In all, 63 girls and 36 boys were admitted during the year. 17 Work of the Willesden Branch of the Invalid Children's Aid Association, 1933— 130 new cases were referred to this Association during the year, 37 of these being referred by the Willesden Health Department. The majority of the patients were suffering from anaemia and debility. In addition 20 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. 837 examinations of secondary school pupils have been carried out during the year 1933. 387 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 are making arrangements to put in operation in 1934 the scheme of treatment for defective vision and dental defects referred to in the 1930 annual report. PROVISION OF MEALS. 197,338 meals were supplied in 1933 as compared with 197,821 in 1932, 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. HOME NURSING SERVICE. The Home Nurse employed by the Council nursed 449 cases during the year, and in connection with such cases paid 3,827 visits. 1,133 of these visits were paid in the South Kilburn Ward, 1,029 in the Mid-Kilburn Ward, 547 in the North Kilburn Ward, 303 in the Roundwood Ward, 215 in the Stonebridge Ward, 142 in the Willesden Green Ward, 139 in the Cricklewood Ward and smaller numbers in the other wards of Willesden. Of the 449 cases nursed during the year, 434 were new cases. 379 of these 434 new cases were referred by the Health Department for nursing, 18 by private doctors and 37 by Hospitals, Associations and private persons. Ophthalmia neonatorum received 84 visits and other ophthalmia cases 429 visits. SANITARY WORK. The number of houses in Willesden at the end of 1933 was 31,308. (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 21,290 as compared with 26,503 in 1932. The houses inspected under the Housing Acts numbered 870 as compared with 1,107 in 1932. The number of complaints received, 1,967 is lower than in 1932. The total number of Notices issued and nuisances abated were 4,679 and 20,709 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. Clearance and Improvement Areas.—In accordance with Circular 1331 a programme of work was considered by the Housing Act, 1930 Committee and submitted to the Council, 25th July, 1933. This, however, was referred back for expansion and an amended programme was approved by the Council 13th October, 1933 and forwarded to the Minister of Health. (See Appendix G). Smoke.—Since the gas washing plant was installed at one generating station (towards the end of 1932) there has been no recurrence of soot or sulphurous emissions from these works. The nuisance caused by the emission of grit from the use of pulverised fuel at two other generating stations continues intermittently. 18 Observations of the chimneys do not reveal that smoke in such quantity as to be a nuisance is being emitted, but an examination of footpaths, forecourts, window sills, etc., in proximity to the works gives proof that grit is being emitted. Neither the electrostatic precipitation in use at one station, nor the water spray method adopted at the second station to arrest this grit seems entirely to cope with the increased amount of grit present in the flue gases during the process of " soot blowing." Doubtless during dry weather and with fair to strong winds these minute particles are carried a considerable distance whilst with light rain and fogs the particles are deposited in the vicinity of the works. Legal opinion on this matter appears to be that as the nuisance is brought about by the acts of Statutory Undertakings, no action would lie unless negligence could be proved. 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. The number of bodies that have been deposited at the mortuary during the year 1st January to 31st December, 1933, were as follows:—Accommodations 17, Post-Mortems 54, Post-Mortems and Inquests 11, Inquests only 54, making a total of 136. The existing arrangements continue to give satisfaction to the Medical Practitioners attending the mortuary for post-mortems. MOTOR AMBULANCE SERVICE. The demands on the Motor Ambulance Service continue to increase. During the vear 5,633 calls were made for the Council's ambulances as compared with 5,497 in 1932, 5,171 in 1931, 5,016 in 1930 and 4,728 in 1929. Altogether 132,168 miles were run in 1933 as compared with 132,208 in 1932, 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 19th year of working of the Motor Ambulance Service appears as Appendix C. MUNICIPAL HOSPITAL. The 42nd 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. 19 Table No. 9. NOTIFIABLE DISEASES DURING THE YEAR. Disease. Total Cases Notified. Cases admitted to Total Deaths. Willesden Municipal Hospitals. Other Hospitals. (1) (2) (3) (4) Diphtheria 392 368 10 11 Scarlet Fever 694 623 13 1 Enteric Fever (including Paratyphoid) 13 10 2 1 Puerperal Fever 13 3 6 6 Puerperal Pyrexia 36 4 25 — Pneumonia 335 3 -* 124 Small Pox 2 — 2 — Cholera — — — — Plague — — — — Erysipelas 100 37 32 4 Typhus Fever — — — — Relapsing Fever — — — — Continued Fever — — — — Cerebro-spinal Meningitis 6 2 4 3 Poliomyelitis 14 3 9 1 Ophthalmia Neonatorum 20 2 5 — Malaria — — — — Dysentery 1 — 1 — Encephalitis Lethargica 1 — 1 — Acute Polio-Encephalitis — — — — Anthrax — — — — Tuberculosis:— (a) Pulmonary 247 — -* 125 (b) Non-Pulmonary 47 — -* 16 Whooping Cough 524 21 — 12 For analysis of the age groups see Appendix " A " Table IV. * No complete record. THE FIFTY-EIGHTH ANNUAL REPORT for the Year ending 31st December, 1933, on the HEALTH AND SANITARY CONDITION OF THE BOROUGH OF WILLESDEN. GENERAL STATISTICS. Area (acres) 4,384 Population (estimated Midsummer, 1933) 190,875* Population Census (1931) 185,300 Number of inhabited houses (end of 1933) according to Rate books 38,625 (Flats separately assessed counted as one house.) Rateable value at 31st March, 1933 £1,358,468 Sum represented by a penny rate £5,635 * Registrar General's estimate Midsummer, 1933 186,900 EXTRACTS FROM VITAL STATISTICS OF THE YEAR. Live Births— Total. M. F. Total Legitimate 2,587 1,308 1,291 2,599 Birth Rate per 1,000 of the esti- Illegitimate 84 64 71 135 mated resident population 13.99 14.63 Stillbirths... 90 54 43 97 Rate per 1,000 total (live and still) births Death Rate per 1,000 of the estimated resident population 9 32.60 34.26 Deaths 1,885 1,890 99.88 10.11 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 7 7 2.54 2.47 No. 30—Other puerperal causes 7 8 2.54 2.83 Total 14 15 507 5.30 Death Rate of Infants under one year of age :— All infants per 1,000 live births 46.05 44.99 Legitimate infants per 1,000 legitimate live births 40.59 39.63 Illegitimate infants per 1,000 illegitimate live births 214.29 148.15 Deaths from Measles (all ages) 1 1 „ Whooping Cough (all ages)12 12 „ Diarrhoea (under 2 years of age) 27 24 Figures in italics (other than rates) supplied by Registrar-General. 20 Table No. 10. TUBERCULOSIS. New Cases and Mortality during 1933. This table includes primary notifications received from Medical Practitioners, cases not notified but included in the death returns and cases transferred from other areas. Age-Periods. New Cases. Deaths. Respiratory. Non-Respiratory. Respiratory. Non-Respiratory. M. F. M. F. M. F. M. F. 0 0 0 1 0 0 0 1 0 1 1 1 3 3 1 1 1 0 5 3 0 5 4 1 0 1 1 10 6 3 2 4 0 0 1 0 15 11 10 5 3 1 2 1 1 20 13 19 1 1 8 6 0 1 25 40 26 4 4 12 12 1 1 35 21 22 0 3 16 15 0 1 45 29 9 1 0 20 8 0 1 55 17 6 1 0 11 2 I 1 65 and upwards 6 4 1 1 6 3 1 1 Totals 147 100 24 23 76 49 8 8 The ratio of non-notified tuberculosis deaths to total tuberculosis deaths was 1 : 17. 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 1933. PUBLIC HEALTH ACT, 1925. SECTION 62. Removal to hospital of infectious persons suffering from pulmonary tuberculosis. No action was taken under this section during 1933. 21 GENERAL PROVISION OF HEALTH SERVICES FOR THE AREA. LABORATORY FACILITIES. Laboratory facilities are dealt with in the Annual Report on the Municipal Hospital, page 73. 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 Borough 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 1932-33 will be found in Appendix C. NURSING IN THE HOME. There have been no changes in the arrangements for the above outlined in the 1931 Annual Report. CLINICS AND TREATMENT CENTRES. There are no developments or changes to be noted. The work of the Clinics appears in other parts of the Report. HOSPITALS. There are no developments or changes to be noted. MIDWIFERY AND MATERNITY SERVICES. M idwifery. In accordance with Section 10 of the Midwives Act, 1902, 38 Midwives gave notice in the month of January, 1934, of their intention to practice in Willesden. During the year the Council increased the fees payable by the Council to Midwives in home confinement cases for which the Council are responsible from £2 2s. to £2 10s. in the case of a first confinement and from £1 11s. 6d. to £2 in the case of a second or subsequent confinement. The Council also agreed that in Midwives cases sent to Hospital for confinement on the advice of the Council's Consulting Obstetrician half the usual fee be paid to the midwife on the understanding that no fee is received by the midwife from the patient. Maternity Service. There are no developments or changes to record. The Service is dealt with in other parts of the Report. INSTITUTIONAL PROVISION FOR MOTHERS OR CHILDREN. There are no developments or changes to record. HEALTH VISITORS—INFANT LIFE PROTECTION—ORTHOPEDIC TREATMENT. There is nothing to record except what is set out elsewhere in the Report. 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. 22 Adoptive Acts :— *Public Health Acts Amendment Act, 1890, Part III. Adopted 11.11.1890. *Public Health Acts Amendment Act, 1907, Parts II., III., IV., and X. Adopted 24.1.1911 ; further parts adopted 18.9.1911 ; further parts adopted 9.4.1928. Public Health Acts Amendment Act, 1907, Part VI. Adopted 1925. *Public Health Act, 1925. Baths and Washhouses Acts, 1846-99. Adopted 14.2.1899. Burial Acts, 1852-1900. Public Libraries Acts, 1892-1901. Adopted 19.2.1891. Bye-laws :— *Common Lodging Houses (Public Health Act, 1875, s. 80). Adopted 14.10.1879. *Houses Let in Lodgings (Public Health Act, 1875, s. 90). Revised and Adopted 26.7.1927. *Slaughter Houses (Public Health Act, 1875, s. 169 and Towns Improvement Clauses Act 1847, s. 128). Revised and adopted 27.9.1921. *Prevention of Nuisances (Public Health Act, 1875, s. 44). Revised and adopted 13.7.1922. New Streets and Buildings (Public Health Act, 1875, s. 157 and Public Health Acts Amendment Act, 1890, s. 23). Revised and adopted 1.5.28. 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 the Borough of Willesden and Kingsbury Urban District 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 Heal Department during the year. Closet Accommodation.—All houses are supplied with closets on the water carriage system. Each house has at least one water closet, and in the better class tenement house there is generally a water closet provided on each floor. Scavenging.—Since the year 1919-20, the Health Department has not been responsible for the removal and disposal of house refuse, that work having been taken over by the Surveyor's Department. Every house in the district is called at once each week. 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. 23 An experiment in controlled tipping on the Bradford plan was carried out on Council's land at Twyford and having proved satisfactory is to be extended. 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 1,967 Number of premises inspected in connection with infectious diseases 59 Number of periodical inspections of premises 3,750 Houses inspected from House to House (Housing Acts) 870 For Certificates under the Rent Acts 0 Public House Urinals 191 Mews and Stables 383 Miscellaneous 741 Total number of inspections and re-inspections made >1,290 Smoke Observations 226 Action under Rent and Mortgage Interest (Restriction) Acts, 1920-1933. Number of applications received for Certificates 0 Number of Certificates granted 0 Action Taken (under Housing Acts and Health Acts) : Notice to Inspect (Section 127, Housing Act, 1925) Cautionary or Intimation Notices Issued 2,024 Number complied with 1,681 Statutory Orders issued 362 Number complied with 315 Summonses served 5 Number of convictions obtained Summonses withdrawn 4 1 dismissed 0 House Let in Lodgings (Tenement Houses) Number registered under Bye-laws Number of contraventions 0 0 Common Lodging Houses Number registered under Bye-laws 1 Number of Inspections made 8 Number of contraventions 0 Number remedied 0 Canal Boats used as Dwellings Number of contraventions of Regulations 2 Number remedied 2 Movable Dwellings. Caravans. Tents, &c. Number observed during the year 14 Number of nuisances therefrom abated 0 Number removed from district 8 Bakehouses: Number in district 59 Number of Inspections 137 Contraventions of Factory Acts 4 Contraventions remedied 4 Slaughter-houses : Number on register 5 Inspections of carcases, etc 219 Contraventions of Bye-laws 0 Contraventions remedied 0 Cowsheds Number on register 1 Number of inspections made 0 Contraventions of regulations 0 Contraventions remedied 0 Number of milch cows in district 0 24 Dairies and Milkshps Number of premises on register 240 Number of itinerant milk sellers registered 48 Number of inspections made 198 Contraventions of Milk and Dairies Order, 1926 5 Contraventions remedied 4 Unsound Food Meat (including organs) seized and surrendered 218 lbs. Fish (wet and dried) surrendered 452 lbs. Poultry surrendered 74 lbs. Bacon surrendered 577 lbs. Tinned and Cooked Meat surrendered 243 lbs. Tinned and Evaporated Milk surrendered 19 lbs. Fruit surrendered 77 lbs. Total 1 660 lbs. Method of disposal Destroyed. Offensive Trades Number of premises in district (Rag and Bone Dealers) 5 Number of inspections made 20 Contravention of Bye-laws 0 Contravention remedied 0 Water Supply and Water Service : Percentage of houses supplied on constant system Cisterns:— 100 New provided 18 Cleansed, repaired, covered, etc 422 Draw-taps placed on mains 32 Drainage and Sewerage of existing Buildings : Water Closets :— Number of water closets substituted for dry receptacles 0 Repaired, supplied with water or otherwise improved 621 Additional Closets constructed 14 Percentage of houses provided with water closets 100 Drains:— Examined, tested, exposed, etc. 270 Unstopped, repaired, trapped, etc. 233 Waste pipes, rain-water pipes, disconnected, repaired, etc. 627 New soil pipes or ventilating shafts fixed 110 Existing soil pipes or ventilating shafts repaired 232 Disconnecting traps or chambers inserted 99 Re-constructed 49 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 55 (b) Other diseases and conditions 900 Articles disinfected or destroyed:— (a) Phthisis... 325 (b) Other diseases and conditions 1,527 Dust: New bins provided 352 Periodical frequency of dust removal weekly Method of disposal By tipping and barging 25 Sundry Nuisances abated : Overcrowding 47 Smoke 6 Accumulations of refuse 198 Foul ditches, ponds, etc., and stagnant water 6 Fowls, pigs, and other animals 20 Dampness 980 Yards and forecourts paved, repaved or repaired 845 Walls and ceilings cleansed 4,623 Verminous rooms purified 281 Leaky roofs made watertight 660 Additional ventilation provided under floors 310 Dilapidated plaster repaired 1,832 Flooring and other woodwork repaired 1,222 Damp-proof courses inserted 131 Water supply reinstated 61 Washhouse floors repaired or repaved 351 Fireplaces and stoves repaired 837 Decayed brickwork repaired and repointed 585 Sinks provided or replaced 189 Additional light and ventilation provided to staircases 96 Larders or food cupboards provided or ventilated 135 Gutters and rainwater pipes repaired or renewed 742 New sash cords and glass provided to windows 2,731 Miscellaneous 742 Total number of Nuisances Abated 20,709 Inspection of Premises where Food is prepared Butchers', Provision, and General Shops 957 Fish shops (wet, dried and fried) 146 Eating houses 65 Greengrocers' shops 41 Ice-cream premises 45 Stalls 922 Canal Boats Acts, 1877-1884.—The number of boats inspected during the year 1933 was 26 (41 inspections). Three contraventions of the Regulations were found :— (i) No certificate on board. (ii) Overcrowding of boat. 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 Corporation of Willesden 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. Bye-laws 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. 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 8,194 graves 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 1,395. 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. 26 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 ef 1933) according to the Rate Book 38,625. * Flat separately assessed counted as one house. Number of houses* in Willesden (end of 1933), 31,308 (approx.). * Flats contained under one roof are counted as one house. The following table shows building activities during the periods stated :— Table No. 11. Year. For working classes. Not for working classes. Total. Houses erected by the Council Houses erected by private enterprise. Houses erected by private enterprise. 1921-30 ... 998 1,687 3,643 6,328 1931 8 591 50 649 1932 66 117 269 452 1933 41 290 155 486 Total for 13 years 1,113 2,685 4,117 7,915 The erection of smaller houses in the Northern part of the district continues. HOUSING STATISTICS FOR THE YEAR 1933. Number of New Houses erected during the Year:— (a) Total (including numbers given separately under (b)):— (i.) By the Local Authority 41 (ii.) By other Local Authorities Nil (iii.) By other bodies and persons 445 (b) With State assistance under the Housing Acts:— (i.) By the Local Authority. (a) For the purpose of Part II. of the Acts 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) 2,667 (b) Number of inspections made for the purpose 14,401 (2) (a) Number of dwelling-houses (included under sub-head (1) above) which were inspected and recorded under the Housing Consolidated Regulations, 1925 870 (b) Number of inspections made for the purpose 6,534 (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 100 27 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 1,281 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 100 (2) Number of dwelling-houses which were rendered fit after service of formal notices :— (a) By owners 140* (b) By local authority in default of owners 4 *Includes a certain number outstanding in 1932. B.—Proceedings under Public Health Acts : (1) Number of dwelling-houses in respect of which notices were served requiring defects to be remedied 128 (2) Number of dwelling-houses in which defects were remedied after service of formal notices:— (a) By owners 108 (b) By local authority in default of owners 3 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 0 INSPECTION AND SUPERVISION OF FOOD. Milk Supply.—There are 2 wholesale dealers, 240 retail milk purveyors, and 1 cowkeeper in this district. Their premises and utensils are frequently inspected. In addition there are 48 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 1933:— Table No. 12. (a) "Certified" milk 5 (b) "Grade A (Tuberculin Tested)" milk 14 (c) "Grade A (Tuberculin Tested)" Bottling Establishment 1 (d) "Grade A" milk 9 to "Pasteurised" milk 6 (/) "Pasteurisers" 3 There were no refusals or revocations of licences under the Milk (Special Designations) Order 1923, during the year. Twelve samples of designated milks were examined during the year. All of these were satisfactory. Forty-eight samples of milk (including two "Certified," one "Pasteurised" and one "Grade A") were taken during the year for examination for the presence of tubercle bacilli under the Milk and Dairies (Consolidation) Act, 1915. Seven samples representing 14.58 of the total number (Nos. 0/316, 0/326, 0/329, 0/334, 0/335, 0/340 and 0/347) were found to contain tubercle bacilli, and action was taken resulting in an examination of the herds at the supplying farms situated in the counties of Buckinghamshire, Bedfordshire (2), Leicestershire, Warwickshire, Gloucestershire and Shropshire. 28 The other forty-one samples showed no evidence of tuberculosis. The following are particulars of the six positive samples:— 0/316.—Samples of milk taken from producer's herd proved to be negative. Herd being kept under observation. 0/326.—Herd of fifty-eight cows belonging to producer examined. Fifty-three cows were found to be normal. Separate samples taken from five cows with some abnormality of the udder proved negative. 0/329.—Taken from same producer as sample No. 0/326. Bulk samples of milk from producer's herd proved negative. Investigations continuing. 0/334.—Samples from producer's herd proved negative. Veterinary Surgeon followed up a cow which had been disposed of the day previous to inspection. This cow was taken by him under the Tuberculosis Order and his diagnosis was confirmed on post-mortem examination. 0/335.—Veterinary Surgeon visited farm and inspected cows in dairy herd. Fifteen cows had "gone dry" since sample was taken. Four bulk samples taken proved negative. 0/340.—Veterinary Surgeon found three cows with bad quarters, and one red cow regarded as suspicious, was excluded from herd. Milk from bulk sample appears to have induced tuberculosis in the inoculated animal. Investigations continuing. Herd on farm, namely sixty-five animals grouped for sampling and investigations continuing. 01347.—Investigations proceeding. 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. 13. In 1920. 1925. 1933. 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 59 bakehouses in the district were inspected on 137 occasions, Notices being served in 4 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 1933:— Table No. 14. List of Samples Taken during the Year ended 31st December, 1933. Article. Taken. Adulterated. Milk 578 12 Milk, Sterilised 4 — Cream 2 — Hake 19 5 Meat 2 — Lemon Sole 8 2 Sausages 3 — Rolled Oats 1 – 617 19 Number of Prosecutions 7 Number of Convictions 7 Fines and Costs imposed £21 2s. Od. 29 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 compiled with, but no infringements were discovered. ADMINISTRATION OF FACTORY AND WORKSHOP ACT, 1901. The following tables shew the number of premises visited in pursuance of the provisions of the Factory and Workshop Act and the action taken in connection therewith. Table No. 15. Factories, Workshops, Laundries, Workplaces and Homework. Inspection.—Including Inspections made by Sanitary Inspectors. Premises. Number of Primary Inspections. Written Notices. Prosecutions. 0) (2) (3) (4) Factories (including Factory laundries) 114 16 – Workshops (including Workshop laundries) 76 8 — Workshops (other than Outworkers' premises) 3 1 — Total 193 25 — Table No. 16.—Defects Found. Number of Defects. Particulars. Found. Remedied. Referred to H.M. Inspector. Number of Prosecutions. (1) (2) (3) (4) (5) Nuisances under the Public Health Acts :— Want of Cleanliness — — — — Want of Ventilation — — — — Overcrowding — — — — Want of drainage of floors 2 1 — — Other Nuisances 7 6 — — Sanitary accommodation— Insufficient 1 1 — — Unsuitable or defective 12 9 — — Not separate for Sexes 2 2 — — Unscreened for Sexes — — — — Offences under the Factory and Workshop Act:— Illegal occupation of underground bakehouses (s. 101) — Breach of special sanitary requirements for bakehouses (sees. 97 to 100) 4 4 — Other offences — — — — (Excluding offences relating to outwork) Total 28 23 — — 30 Table No. 17.—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 59 Dressmakers 78 Outworkers 864 Blouse Makers 8 Tailors 58 Bootmakers 91 Metal Workers 37 Wood Workers 41 Seamstresses 1 Motor and Cycle Makers 53 Upholsterers 11 Milliners 17 Miscellaneous 134 Total number of Workshops on Register 1,689 Table No. 18.—Other Matters. Class. Number. (1) (2) Matters notified to H.M. Inspector of Factories:— Failure to affix Abstract of the Factory and Workshop Act (s. 133) – Action taken in matters referred by H.M. Inspector as remediable under the Public Health Acts, but not under the Factory and Workshop Act (s. 5)— Notified by H.M. Inspector 2 Reports (of action taken) sent to H.M. Inspector 2 Other — Underground Bakehouse (s. 101):— Certificates granted during the year — In use at the end of the year 17 31 THE TWENTY-SIXTH ANNUAL REPORT for the Year ending 31st December, 1933, on the HEALTH OF CHILDREN ATTENDING THE PUBLIC ELEMENTARY SCHOOLS IN WILLESDEN. Giving the Tables required by the Board of Education. Table No. 19.—Corresponding to Table 1 of the Board of Education's Medical Statistical Tables. Return of Medical Inspections for the year ended 31st December, 1933:- A.—Routine Medical Inspections. Number of Inspections in the prescribed Groups:— Entrants 2,195 Second Age Group 1,869 Third Age Group 2,752 Total 6,816 Number of other Routine Inspections 0 B.—Other Inspections. Number of Special Inspections 8,246 Number of Re-inspections 18,969 Total 27,215 Table No. 20.—Corresponding to Table 2 of the Board of Education's Medical Statistical Tables. A.—Return of Defects Eound by Medical Inspection in the Year ended 31st December, 1933. Routine Inspections. Specials. No. of Defects. No. of Defects. Defect or Disease. 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 13 35 81 — Skin Ringworm: Scalp — – 3 — Body — – 16 – Scabies 6 – 90 — Impetigo 6 – 174 — Other Diseases (nontuberculous) 89 1,343 Eye Blepharitis 14 — 108 — Conjunctivitis 10 — 178 — Keratitis — — 3 — Corneal Opacities — – 6 — Defective Vision (excluding Squint) 350* 289* 336 27 Squint 22 1 74 2 Other Conditions 17 2 159 — Spectacles broken — — 364 — Spectacles lost — — 24 — *The variation from last year's figures which were 747 Col. (21 and 42 Col. (3), may be accounted for by the modification adopted in the method of testing with + 1 sphere. 32 A.—Return of Defects found by Medical Inspection in the Year ended 31st December, 1933.—continued. Routine Inspections. Specials. No. of Defects. No. of Defects. Defect or Disease. 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 6 2 28 – Otitis Media 8 — 241 – Other Ear Diseases 28 7 271 Nose and Throat Chronic Tonsillitis only 418 344 226 9 Adenoids only 35 4 22 Chronic Tonsillitis and Adenoids 20 1 280 2 Other Conditions 30 14 202 Enlarged Cervical Glands (non-tuberculous) 40 12 221 2 Defective Speech — 3 3 — Heart and Circulation Heart Disease: Organic 1 8 8 1 Functional 1 197 16 1 Anaemia 12 8 25 Lungs Bronchitis 30 1 52 Other Non-Tuberculous Diseases 2 16 27 – Tuberculosis Pulmonary:— Definite — 2 2 – Suspected – – 9 1 Non-Pulmonary:— Definite:— Glands 1 5 2 1 Bones and Joints — — — — Skin — — 1 – Other forms — 2 — Suspected:— Glands — — 1 – Bones and Joints — — 1 – Other forms — — 1 – Nervous System Epilepsy 1 2 Chorea 3 3 11 Other Conditions 16 9 37 – Deformities Rickets — 1 1 – Spinal Curvature 138 — 25 – Other forms 17 110 90 3 Other Defects and Diseases (excluding Uncleanliness and Dental Diseases) 223 107 3,195 8 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) Prescribed Groups— Entrants 2,195 450 20.5 Second Age Group 1,869 371 19.9 Third Age Group 2,752 490 17.8 Total (Prescribed Groups) 6,816 1,311 19.2 Other Routine Inspections 0 0 0 33 Table No. 21.—Corresponding to Table III. of the Board of Education's Medical Statistical Tables. Return of all Exceptional Children in the Area. This Table is compiled from the list of exceptional children as it stands on the last day of the calendar year. No child is entered under more than one heading. Children Suffering from Multiple Defects.—Information is only given in respect of children suffering from any combination of the following types of defect:— Blindness (not Partial Blindness) Deafness (not Partial Deafness). Mental Defect. Epilepsy. Active Tuberculosis. Crippling (as defined in the penultimate category of the Table). Heart Disease. The actual combination of defects is stated below together with the type of school attended. State here the number of children suffering from any combination of the above defects 3 Of the 3 children suffering from multiple defects, 1 is in attendance at a certified school for mentally defective children and suffers from infantile paralysis; 1 is in attendance at an epileptic colony and is also mentally defective and 1 is in attendance at an epileptic colony and is a crippled child, suffering from spastic hemiplegia. Blind Children.—A blind child is a child who is too blind to be able to read the ordinary school books used by children. Entered in this Section are only children who are so blind that they can only be appropriately taught in a school for blind children. At Certified Schools for the Blind 2 At Public Elementary Schools — At Other Institutions — At no School or Institution — Total 2 Partially Blind Children.—Entered in this Section are only children who, though they cannot read ordinary school books or cannot read them without injury to their eyesight, have such power of vision that they can appropriately be taught in a school for the partially blind. Children who are able by means of suitable glasses to read the ordinary school books used by children without fatigue or injury to their vision are not included in this Table. At Certified Schools for the Blind 11 At Certified Schools for the Partially Blind 7 At Public Elementary Schools — At other Institutions 1 At no School or Institution 1 Total 20 Deaf Children.—A deaf child is a child who is too deaf to be taught in a class of hearing children in an elementary school. Entered in this Section are only children who are so deaf that they can only be appropriately taught in a school for the deaf. At Certified Schools for the Deaf 8 At Public Elementary Schools — At other Institutions — At no School or Institution — Total 8 Partially Deaf Children.—Entered in this Section only are children who can appropriately be taught in a school for the partially deaf. At Certified Schools for the Deaf 3 At Certified Schools for the Partially Deaf 1 At Public Elementary Schools 1 At other Institutions — At no School or Institution — Total 5 34 Mentally Defective Children.—Feeble-minded Children.—Mentally Defective children are children who, not being imbecile and not being merely dull or backward, are incapable by reason of mental defect of receiving proper benefit from the instruction in the ordinary Public Elementary Schools but are not incapable by reason of that defect of receiving benefit from instruction in Special Schools for mentally defective children. This category includes only those children for whose education and maintenance the Local Education Authority are responsible, and excludes all children who have been notified to the Local Authority under the Mental Deficiency Act. the Mental Deficiency Act. Details of such children are given on page 39 At Certified Schools for Mentally Defective Children 127 At Public Elementary Schools — At other Institutions 2 At no School or Institution 3 Total ... 132 Epileptic Children.—Children Suffering from Severe. Epilepsy.—In this part of the Table only those children are included who are epileptic within the meaning of the Act, i.e., children who, not being idiots or imbeciles, are unfit by reason of severe epilepsy to attend the ordinary Public Elementary Schools. For practical purposes the Board of Education are of opinion that children who are subject to attacks of major epilepsy in school should be recorded as''severe" cases and excluded from ordinary Public Elementary Schools. At Certified Special Schools 2 At Public Elementary Schools — At other Institutions — At no School or Institution — Total 2 Physically Defective Children.—Physically Defective children are children who, by reason of physical defect, are incapable of receiving proper benefit from the instruction in the ordinary Public Elementary Schools, but are not incapable by reason of that defect of receiving benefit from instruction in Special Schools for physically defective children. The exact classification of physically defective children is admittedly a matter of difficulty. Defective children are recorded below as accurately as possible under the selected sub-headings. (a) Tuberculous Children.—In this category are placed only cases diagnosed as tuberculous and requiring treatment for tuberculosis at a sanatorium, a dispensary, or elsewhere. Children suffering from crippling due to tuberculosis which is regarded as being no longer in need of treatment are recorded as crippled children, the degree of crippling being such as to interfere materially with the child's normal mode of life. All other cases of tuberculosis regarded as being no longer in need of treatment are recorded as delicate children. (i.) Children Suffering from Pulmonary Tuberculosis. (Including pleura and intra-thoracic glands.) At Certified Special Schools — At Public Elementary Schoolsf — At other Institutions 4 At no School or Institution — Total 4 (ii.) Children Suffering from Non-pulmonary Tuberculosis. (This category should include tuberculosis of all sites other than those shown in (i.) above.) At Certified Special Schools 10 At Public Elementary Schoolsf — At other Institutions 1 At no School or Institution — Total 11 J It is essential that tuberculous children who are, or may be, a source of infection to others should be promptly excluded from Public Elementary Schools. (b) Delicate Children.—This Section is confined to 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. Such children are included irrespective of the actual provision of Open Air Schools in the area, or of the practicability in present circumstances of sending the children to Residential Schools. At the same time children are not regarded as suitable for admission to an Open Air School unless the Medical Officer certifies that they are incapable by reason of physical defect of receiving proper benefit from the instruction in the ordinary Public Elementary Schools. 35 At Certified Special Schools 60 At Public Elementary Schools 318 At other Institutions 1 At no School or Institution 5 Total 384 (c) Crippled Children.-—This Section is confined to children (other than those diagnosed as tuberculous and in need of treatment for that disease) who are suffering from a degree of crippling sufficiently severe to interfere materially with a child's normal mode of life, i.e., children who generally speaking are unable to take part, in any complete sense, in physical exercises or games or such activities of the School curriculum as gardening or forms of handwork usually engaged in by other children. At Certified Special Schools 73 At Public Elementary Schools 1 At other Institutions — At no School or Institution 6 Total 80 (d) Children with Heart Disease.—This Section is confined to children whose defect is so severe as to necessitate the provision of educational facilities other than those of the Public Elementary School. At Certified Special Schools 40 At Public Elementary Schools 5 At other Institutions 2 At no School or Institution 5 Total 52 36 Group II.—Defective Vision and Squint (excluding Minor Eye Defects treated as Minor Ailments.—Group I.). Defect or Disease. (1) Number of Defects dealt with. Number of *Children for whom Spectacles were Under the Authority's Scheme. (2) By private practitioner or at hospital apart from the Authority's Scheme. (3) Otherwise. (4) Total. (5) Prescribed. (1) Obtained. (2) (i.) Under the Authority's Scheme. (ii.) Otherwise. CO Under the Authority's Scheme. (ii.) Otherwise. Errors of Refraction (including squint) 851 43 574 256 (Operations for squint should be recorded separately in the body of the School Medical Officer's Report.) See Tables A and B following. Other Defect or Disease of the Eyes (excluding those recorded in Group I) Total 851 43 574 256 * A child may be submitted to retinoscopy and have spectacles prescribed more than once in the year— in these circumstances it will appear more than once in this Table. 37 TABLE A. Defect or Disease. Number of Defects dealt with. Under the Authority's Scheme. By private practitioner or at hospital apart from the Authority's Scheme. Otherwise. Total. (1) (2) (3) (4) (5) Errors of Refraction (including squint) 1,129 18* 0 1,147 Other Defect or Disease of the Eyes (excluding those recorded in Group I.) 9 4 0 13 Total 1,138 22 0 1,160 * In addition to this number, 166 cases of visual defect received attention by Voluntary Hospital, private practitioner or optician, but it was not known whether they were submitted to refraction. In the above table the figures of 1,129 and 18 represent the cases submitted to refraction during the year no matter whether they are new cases or cases arising out of re-examination. One individual child may be submitted to refraction more than once during the year and would appear in the above table on each occasion. TABLE B. The following table shows the cases dealt with during the year whether they were submitted to refraction or not and includes new cases, cases seen for purposes of re-examination, and also cases (whether seen by the Oculist or not) receiving attention on account of lost or broken spectacles. Defect or Disease. Number of Defects dealt with. Under the Authority's Scheme. By private practitioner or at hospital apart from the Authority's Scheme. Otherwise. Total. (1) (2) (3) (4) (5) Errors of Refraction (including squint) 2,365 184 2,549 Other Defect or Disease of the Eyes (excluding those recorded in Group I.) 9 4 0 13 Total 2,374 188 2,562 38 Group III.—Treatment of Defects of Nose and Throat. Number of Defects. Received Operative Treatment. Received other forms of Treatment. Under the Authority's Scheme in Clinic or Hospital. By private practitioner or Hospital, apart from the Authority's Scheme. Total. Total number treated. (1) (2) (3) (4) (5) (i) (ii) (iii) (iv) (i) (ii) (iii) (iv) (i) (ii) (iii) (iv) 4 0 378 1 105 0 487 1 215 703 (i) Tonsils only, (ii) Adenoids only, (iii) Tonsils and adenoids, (iv) Other defects of the nose and throat. Group IV.—Orthopædic and Postural Defects. Under the Authority's Scheme. Otherwise. Total number treated. Residential treatment with education. (i) Residential treatment without education. (ii) Nonresidential treatment at an orthopaedic clinic, (iii) Residential treatment with education. (i) Residential treatment without education. (ii) Nonresidential treatment at an orthopedic clinic. (iii) Number of children treated 11 ordinary elementary school children *5 special schools children 0 374† Not available for 1933 * There were in addition 3 children treated under the Special Schools Vote and not under Section 80 of the Education Act, 1921. † Includes children attending special schools—these will be shown separately next year. Group V.—Dental Defects. Vide 16th 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 VI.—Uncleanliness and Verminous Conditions. (i.) Average number of visits per school made during the year by the School Nurses 17.7 (ii.) Total number of examinations of children in the schools by School Nurses 60,246 (iii.) Number of individual children found unclean 2,116 (iv.) Number of children cleansed under arrangements made by the Local Education Authority 325 (v.) Number of cases in which legal proceedings were taken:— (a) Under the Education Act, 1921 30 (b) Under the School Attendance Bye-Laws 0 (vi.) No. of school sessions at which inspections were conducted 603 39 (vii.) (i.) Original Inspections:— Children examined (i.e., Cases not individual children) 51,726 Found unclean 2,800 Percentage found unclean 5.4 Excluded on account of uncleanliness 1 (ii.) Re-inspections:— Children examined (i.e., Cases not individual children) 8,518 Found unclean 6,219 Percentage found unclean 73.0 Excluded on account of uncleanliness 1 Board of Education's Medical Statistical Tables. Notes on Table IV. (h). "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. Withdrawn. Adjourned Sine die. Dismissed. Standing adjourned at end of Year. 2 10/- 13 — — 4 11 51- Statement of the Number of Children Notified during the Year ended December 31st 1933, by the Local Education Authority to the Local Mental Deficiency Authority. Total Number of Children notified : 13. Analysis of the above Total. Diagnosis. Boys. Girls. 1.—(i.) Children incapable of receiving benefit or further benefit from instruction in a Special School : (a) Idiots 1 1 (b) Imbeciles 1 1 (c) Others 1 2 (ii.) Children unable to be instructed in a Special School without detriment to the interests of other children : (a) Moral defectives — — (b) Others — — 2—Feeble-minded children notified on leaving a Special School on or before attaining the age of 16 1 5 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 4 9 Certain Statistical Data. No. of Public Elementary Schools (excluding Special Schools) at December, 1933 34 No. of School Departments at December, 1933 71 Average Public Elementary School Roll (excluding Special Schools), year ended 31st March, 1933 21,128 Total No. of Children medically inspected at Routine and Special Inspections 15,062 Total No. of Children dentally inspected 21,084 Total No. of Defects of every description "followed up" during 1933 26,751 Total No. of Defects of every description for which treatment was obtained during 1933— Medical or Dental Treatment 16,886 Domestic Treatment 4,022 Total 20,908 Total No. of Attendances at the School Clinics during 1933 101,160 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 1933 :— Table No. 24. Special Schools in Willesden. Special Schools outside Willesden. Total. Blind and Partially Blind — 23 23 Deaf — 15 15 Mentally Defective 167 4 171 Epileptic — 5 5 Physically Defective 199 241* 440* Total 366 288* 654* * 201 of these were debilitated children sent to Certified Residential Schools for six weeks convalesence. Table No. 25.—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 43 39 25 2. Number who :— (a) Have since died 2 3 3 1 (b) Are known to be incapable by reason of mental or physical defect of undertaking employment 2 1 1 3 (c) Are in attendance at an Institution for further education (give details), and †2 ††2 §3 §3 (d) Are in any other Institution (specify Asylum, WTorkhouse, Colony for Epileptics, &c.) *2 – **5 §§1 3. Number who are employed in :— (a) Industrial or manual occupations 19 12 14 3 (6) Agricultural or rural occupations — — 1 – (c) Domestic occupations. including those who are helping in the domestic work at home 1 6 2 11 (d) Commercial professional or clerical work 8 10 2 – (e) Blind alley or other precarious occupations 4 – 3 – 4. Number who have left the neighbourhood or whose after-careers have not been traced 1 9 5 3 † 1 is in attendance at a technical school and 1 is at an institution learning bootmaking. * 1 is in Hospital on account of epileptic fits and 1 is in an institution for mental defectives, †† These girls are at Pitman's College learning shorthand and typewriting. § In attendance at an occupation centre. ** In institutions for mental defectives. §§ In institutions for mental defectives. 5 Mentally Defectives and 4 Physically Defectives are unemployed. 40-41 Table No. 23—In this Table is embodied the information required in the N.15. to Notes on Table IV. of the Board of Education's Medical Statistical Tables. 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 1933. 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 of Treatment Percentage of defects treated. No. of defects not treated. No. of defects under observation at end of year, and carried forward to succeeding year. Remedied. Improved. Unchanged. Under observation at end of year (result of treatment not known). School Clinic or Hospital or other Institution under Council Schcmc. Voluntary Hospital or other charitable Institution. Hospital Doctor under m.C.C. Private Practitioner. Total. Domestic Treatment only. Grand Total. Excluding Domestic Treatment. Including Do. mestic Treatment. Removed from observation. Remaining under observation. Total. B rough t forward from previous New. Total. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 Clothing Unsatisfactory 3 13 16 — — — — — — — 12 12 9 3 — — — 750 1 3 4 3 Footgear Unsatisfactory — 2 2 — — — — — — 2 2 2 — — — — 100.0 — — — — Cleanliness of Head— Nits 208 2,594 2,802 7 1 170 — — — 170 2,431 2,601 2,533 — — 68 61 93.1 29 164 193 232 Pediculi 28 322 350 — — 152 — — — 152 145 297 285 — — 12 43-4 84-9 2 51 53 63 Other dirty conditions — 7 7 — — 1 — — — 1 5 6 5 — — 1 14-3 85-7 — 1 1 2 Cleanliness of Body Dirty 2 23 25 — — 1 — — — 1 20 21 21 — — — 40 84.0 — 4 4 4 Pediculi — 1 1 — — 1 — — — 1 — 1 1 — — — 1000 100.0 — — — — Fleabitten — 5 5 — — — — — — .— 5 5 5 — — — — 100.0 — — — — Malnutrition 60 94 154 — 3 115 3 — 4 122 17 139 83 7 — 49 80.8 92.1 5 7 12 56 Nose and Throat Enlarged Tonsils 309 563 872 15 54 97 38 3 1 139 — 139 134 — — 5 17.3 17.3 386 278 664 283 Adenoids... 13 44 57 — 7 8 3 — — 11 — 11 10 — — 1 22.0 22.0 15 24 39 25 Enlarged Tonsils and Adenoids 104 443 547 5 15 242 49 2 293 293 291 2 55.6 55.6 117 117 234 119 Other conditions 42 308 350 2 7 183 16 7 43 249 62 311 265 7 — 39 73.0 91.2 16 14 30 53 Cervical or Neck Glands — Enlarged (non T.B.) 186 323 509 3 10 188 19 — 24 231 50 281 226 14 — 41 46.6 56.7 101 114 215 155 External Eye Disease - Blepharitis 33 132 165 — 1 144 3 — — 147 13 160 127 1 — 32 89.6 97.6 1 3 4 35 Conjunctivitis 19 200 219 1 — 203 3 — 4 210 8 218 196 1 1 20 96.3 100.0 — — — 20 Corneal Opacities 5 6 11 — — 7 3 — — 10 — 10 5 — 3 2 90.9 90.9 — 1 1 3 Keratitis — 3 3 — — 2 1 — — 3 3 — 2 1 — 100.0 100.0 — — — — Other conditions 16 224 240 2 5 197 8 — 3 208 21 229 210 1 17 89.3 98.3 3 1 4 18 Ear Diseases— Chronic Suppuration of Middle Ear 51 281 332 — — 262 18 1 7 288 26 314 252 — 2 55 86.7 94.6 11 7 18 62 Defective Hearing 19 35 54 0 27 2 1 2 32 5 37 20 9 1 7 65.3 75.5 6 6 12 13 Wax 16 175 191 — 183 — — 1 184 1 185 173 — — 12 96.3 96.9 3 3 6 15 Other diseases 29 139 168 1 1 111 23 3 4 141 21 162 141 — 2 19 84.9 97.6 2 2 4 21 Teeth—Sec Dental Returns Heart and Circulation— Organic Disease 3 11 14 1 — — 4 — 2 6 — 6 — — 1 5 46.2 46.2 6 1 7 6 Functional Disease 22 39 61 2 3 9 15 1 9 34 6 40 6 13 — 21 60.7 71.4 11 5 16 26 Anæmia 32 38 70 2 — 39 7 1 — 47 14 61 26 14 — 21 69.1 89.7 2 5 7 26 Other conditions 2 — 2 — 1 — — — 1 — 1 1 — — — 50.0 50.0 1 — 1 — Lungs— Bronchitis and Bronchial Catarrh 50 116 166 — — 62 10 3 43 118 39 157 105 14 4 34 71.1 94.6 4 5 9 39 T uberculosis — 3 3 — — — 1 — — 1 — 1 — 1 — 33.3 33.3 2 — 2 — T.B. suspected 7 15 22 — 5 5 — 5 2 12 4 16 8 3 2 3 70.6 94.1 1 — 1 3 Other diseases (non-T.B.) 29 39 68 1 1 36 8 3 7 54 6 60 32 1 — 27 81.8 90.9 4 2 6 29 Nervous System- Epilepsy — 2 2 — — — 1 — — 1 — 1 — — — 1 50.0 50.0 1 — 1 1 Chorea 15 25 40 2 — 2 22 1 4 29 4 33 6 16 1 10 76.3 86.8 4 1 5 11 Other conditions 34 61 95 — 2 26 28 1 7 62 17 79 33 16 6 24 66 .7 84.9 9 5 14 29 Skin- Ringworm Head 3 6 9 — — 3 5 — — 8 — 8 7 — — 1 88.9 88.9 — 1 1 2 Body 5 24 29 — — 17 1 1 8 27 2 29 26 — — 3 93.1 100.0 — — — 3 Impetigo 31 330 361 — 279 8 — 22 309 47 356 330 — 1 25 85.6 98.6 1 4 5 29 Scabies 39 123 162 — 18 125 5 1 11 142 1 143 130 — — 13 98.6 99.3 — 1 1 14 Minor injuries 66 1,325 1,391 5 7 1,260 38 2 14 1,314 60 1,374 1,309 — — 65 95.3 99.6 3 2 5 67 Other conds. (non-T.B.) 215 2,259 2,474 6 21 2,070 32 2 51 2,155 246 2,401 2,171 5 11 214 88.1 98.1 28 18 46 232 Deformities— Rickcts 9 5 14 1 2 4 — — — 4 — 4 1 2 1 — 36.4 36.4 5 2 7 2 Spinal Curvature 45 66 111 — 3 71 2 — 1 74 — 74 13 22 13 26 68.5 68.5 22 12 34 38 Other forms 126 222 348 12 19 223 9 — — 232 4 236 35 76 22 103 73.2 74.4 48 33 81 136 Tuberculosis Non-Pulmonary— Definite—Glands 3 2 5 2 — — 1 1 — 2 — 2 — 1 — 1 66.7 66.7 1 — 1 1 ,, Spine — — — — — — — — — — — — — — — — — — — — — — Hip 2 — 2 2 — — — — — — — — — — — — — — — — — — Bones and joints 1 — 1 — — — — — — — — — — — — — — — 1 — 1 — Skin — 1 1 — — — — — — — — — — — — — — — 1 — 1 — Other forms — — — — — — — — — — — — — — — — — — — — — — Suspected Glands 3 5 8 — 1 2 1 — I 4 — 4 — — — 4 57.1 57.1 2 1 3 5 ,, Bones and joints — 2 2 — — 1 1 — — 2 — 2 — — — 2 100.0 100.0 — — — 2 ,, Other conditions 1 1 2 — — — — — — — — — — — — — — — 2 — 2 — Speech— Defective Articulation 2 8 10 1 3 — — — — — — — — — — — — — 5 1 6 1 Squint— Squint present 30 96 126 1 6 94 3 — 3 100 100 10 64 12 14 84.0 84.0 8 11 19 25 Vision— Defect not ascertained 49 336 385 2 59 274 4 — 8 286 — 286 212 5 49 20 88.3 88.3 21 17 38 37 One Eye normal 23 60 83 1 3 43 1 1 45 45 37 — 4 4 57.0 57.0 20 14 34 18 Both eyes 6/6 — 20 20 — 14 3 — — — 3 — 3 1 — 1 1 50.0 50.0 2 1 3 2 Both eyes 6/9 3 34 37 — 10 21 — — — 21 — 21 16 2 3 77.8 77.8 4 2 6 5 One eye 6/9, other 6/12 or less 19 78 97 — 9 44 4 — 2 50 — 50 45 — 1 4 56.8 56.8 22 16 38 20 Both eyes 6/12 or less 68 232 300 1 15 176 12 — 9 197 — 197 153 1 16 27 69.4 69.4 53 34 87 61 Spectacles broken 52 456 508 2 6 416 1 — 57 474 2 476 445 — 1 30 94.8 95.2 12 12 24 42 Spectacles lost 8 31 39 — 3 29 — — 1 30 — 30 23 — — 7 83.3 83.3 2 4 6 11 Debility 335 893 1,228 9 5 903 34 2 37 976 153 1,129 680 85 34 330 80.4 93.0 35 50 85 380 Miscellaneous 407 2,862 3,269 27 396 1,722 204 28 180 2,134 573 2,707 2,286 48 23 350 75.0 95.1 81 58 139 408 Grand Totals 2,882 15,763 18,645 116 720 10,254 651 67 575 11,547 4,022 15,569 13,141 437 216 1,775 64.8 87.4 1,122 1,118 2,240 2,893 Re-examinations in respect of Defective Vision, other than Lost and Broken Spectacles, and in respect of other conditions— No. of cases dealt with 2,192. 43 Table No. 26. Return showing No. of Cases referred for following-up in 1933 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. 1933 5,481 1,617 62 7,956 15,116 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 44 Table No. 27. Medical and Dental Treatment—Attendances at the Municipal Health Centres, 1933. Condition. Mothers, and Children under Five. Grand Total. (Cols. 7 and 8). Expectant Mothers. Nursing Mothers. Children under Five. Total (Cols. 2—5). School Children. 0—1. 1—5. Total (Cols. 4 and 5). (1) (2) (3) (4) (5) (6) (7) (8) (9) 1. Cleansing 0 4 0 1 1 5 388 393* 2. Throat, Nose and Ear Diseases 1 7 201 724 925 933 7,268 8,201 3. Minor Ailments 30 139 1,866 3,904 5,770 5,939 43,394 49,333 4. Eye Diseases 0 4 219 497 716 720 6,665 7,385 5. Ringworm, etc. 23 57 73 177 250 330 538 868* 6. Artificial Sunlight Treatment 13 0 398 3,639 4,037 4,050 7,030 11,080 7. Orthopaedics 2 65 389 1,777 2,166 2,233 6,304 8,537 8. Medical Consultations 5,671 23,839 25,800 15,262 41,062 70,572 — 70,572 9. Diphtheria Immunisationt 0 0 0 0 0 0 0 0 10. Total (1—9) 5,740 24,115 28,946 25,981 54,927 84,782 71,587 156,369 11. Dental Consultations 1,608 2,107 0 1,076 1,076 4,791 15,652 20,443 12. Total (10—11) 7,348 26,222 28,946 27,057 56,003 89,573 87,239 176,812 13. School for Mothers 0 0 0 0 0 5,297 0 5,297 14. Nursery 0 0 0 0 0 5,268 0 5,268 15. Miscellaneous 0 0 0 0 0 12,621 13,921 26,542 16. Grand Total (12-15) 7,348 26,222 28,946 27,057 56,003 112,759 101,160 213,919* 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 15,043 19,964 35,007 39,227 18,012 57,239 30,512 33,611 64,123 156,369 18. Dental Attendances 1,115 3,264 4,379 1,472 3,790 5,262 2,204 8,598 10,802 20,443 19. School for Mothers 1,609 0 1,609 1,504 0 1,504 2,184 0 2,184 5,297 20. NurseryAttendances 2,457 0 2,457 1,034 0 1,034 1,777 0 1,777 5,268 21. Miscellaneous 6,200 3,414 9,614 3,612 5,756 9,368 2,809 4,751 7,560 26,542 22. Total 26,424 26,642 53,066 46,849 27,558 74,407 39,486 46,960 86,446 213,919* * In addition the following attendances were made by adults:—Cleansing 105, Ringworm, etc. 15, Varicose Ulcers 594, making a total of 714 which together with the 213,919 above makes a grand total of 214,633 † This is carried out at the Municipal Hospital where 19 Willesden residents attended for the Schick Test, 21 for immunisation against Diphtheria and 2 for immunisation against Scarlet Fever. Table No. 28. Showing 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 3812 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 1933 84,782 4,791 89,573 71,587 15,652 87,239 176,812 5,297 5,268 27,256* 214,633 * This includes the 714 attendances by adults which are shown in the footnote to Table No. 27. 45 1 School Child and 1 child under 5 years of age were treated under the Council's Scheme by X-rays for Ringworm of the Scalp. 10,973 Individual School Children attended the Municipal Centres during 1933. Hospital Treatment of School Children under the Council's Scheme. Table No. 29. Hospital Treatment of School Children during 1933. No. of School Children in Willesden General Hospital at 31st December, 1932 ... 0 „ ,, „ admitted during 1933 383 „ „ „ under treatment during 1933 383 ,, „ ,, discharged during 1933 383 „ ,, „ died in Hospital during 1933 0 „ ,, „ remaining in Willesden General Hospital at 31st December, 1933 0 Table No. 30. School Children under Treatment in Hospital during 1933. Condition. Brought forward. Admitted during Year. Total under treatment. Treatment Completed. Remaining in Hospital at end of Year. Forms of Treatment. Results of Treatment. Operative. General. Remedied. Improved. Unchanged . Died. Deflected Septum — 1 1 1 — 1 — — — — Enlarged Tonsils & Adenoids — 382 382 379 3 379 — 3 — — Total – 383 383 380 3 380 — 3 — — No School Children were admitted to St. Monica's Home Hospital. Employment of Children in Entertainments Rules, 1920. Particulars as to applications received in 1933 for certificates from the School Medical Officer. No. of Applications. No. Granted. Boys. Girls. Total. Boys. Girls. Total. Original applications 3 18 21 3 18 21 Applications for renewals 0 1 1 0 1 1 3 19 22 3 19 22 46 THE FOURTEENTH ANNUAL REPORT for the Year ending 31st December, 1933, on the HEALTH OF PUPILS ATTENDING SECONDARY AND TRADE SCHOOLS IN WILLESDEN. Giving the Tables required by the Board of Education. Secondary and Trade Schools are under the control of The Middlesex County Council. Medical Inspection has been carried out at the Secondary and Trade Schools, by agreement with the Middlesex County Council, in accordance with the arrangements set out in the 1930 Annual Report. Table No. 31.—Corresponding to Table I. of the Board of Education's Medical Statistical TablesReturn of Medical Inspections for the Year ended 31st December, 1933. A.—Routine Medical Inspections. Number of Inspections in the prescribed Groups. 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 2 0 2 0 0 0 0 0 0 0 0 0 0 0 0 2 0 2 0 0 0 2 0 2 11 ,, 73 0 73 0 0 0 43 0 43 39 0 39 0 0 0 116 0 116 39 0 39 155 0 155 12 „ 23 17 40 0 0 0 16 48 64 20 56 76 1 1 2 40 66 106 20 56 76 60 122 182 13 ,, 5 0 5 36 0 36 1 0 1 0 0 0 36 0 36 42 0 42 36 0 36 78 0 78 14 ,, 1 0 1 28 0 28 0 0 0 0 0 0 19 0 19 20 0 20 28 0 28 48 0 48 15 „ 0 50 50 1 40 41 1 23 24 0 29 29 1 26 27 2 99 101 1 69 70 3 168 171 16 „ 0 0 0 0 0 0 0 0 0 1 0 1 0 0 0 0 0 0 1 0 1 1 0 1 17 „ 0 0 0 0 0 0 0 0 0 1 0 1 0 0 0 0 0 0 1 0 1 1 0 1 Total 104 67 171 65 40 105 61 71 132 61 85 146 57 27 84 222 165 387 126 125 251 348 290 638 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 3 0 2 2 2 7 2 9 Number of Re-inspections 109 13 29 14 25 163 27 190 Total 112 13 31 16 27 170 29 199 47 Table No. 32.—Corresponding to Table II. of the Board of Education's Medical Statistical Tables. A.—Return of Defects Found by Medical Inspection in the Year Ended 31st December, 1933. Routine Inspections. Special Inspections. Number of Defects. Number of Defects. Requiring treatment. (2) Requiring to be kept under observation, but not requiring treatment. (3) Requiring treatment. (4) Requiring to be kept under observation, but not requiring treatment. (5) Defect or Disease. (1) 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 Grammer School (Boys). Willesden Polytechnic Trade School (Girls). Willesden County School. Willesden Polytechnic Building Trade School (Bovs). 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 — — — — — — — — — — — — — — — — — — — — Skin Ringworm:— Scalp — — — — — — — — — — — — — — — — — — — — Body — — — — — — — — — — — — — — — — — — — — Scabies — — — — — — — — — — — — — — — — — — — — Impetigo — — — — — — — — — — — — — — — — — — — — Other Diseases (Non-Tuberculous). — — — — — — — — — — — — — — — — — — — — Eye ' Blepharitis 2 — — — — — — — — — — — — — — — — — — — Conjunctivitis — 1 — — — — — — — — — — — — — — — — — — Keratitis — — — — — — — — — — — — — — — — — — — — Corneal Opacities — — — — — — — — — — — — — — — — — — — — Defective Vision 12 9 11 10 2 2 1 3 6 3 — — 2 — — — — — — — (excluding Squint) Squint — — — — — 2 — — — — — — —- — — — — — — — Other Conditions — — — — — — — — — — — — — — — — — — — — Ear Defective Hearing 1 — 1 — — — 1 — — — — — — — — — — — — — Otitis Media — — 1 — — — — — — — — — — — — — — — — Other Ear Diseases — — — — — — — — — — — — — — — — — — — — Nose & Throat Enlarged Tonsils only. 2 — — 3 — 4 2 2 2 — — — — — — — — — — — Adenoids only — — — — — — — — — — — — — — — — — — — — Enlarged Tonsils and Adenoids. — — 1 — — — — — — — — — — — — — — — — — Other Conditions — — — — — — — 1 — — — — — — — — — — 1 — Enlarged Cervical Glands (Non-Tuberculous). — — — — — — — — — — — — — — — — — — — — Defective Speech — — — — — — — — — — — — — — — — — — — — Teeth—Dental Diseases 32 20 24 22 18 — — — — — — — — — — — — — — — Heart and Circulation Heart Disease Organic — — — — — — 1 — — 2 — — — — — — — — — — Functional — — 1 1 — 14 10 11 17 6 — — — — — — — — — — Anaemia — — — — — — — — — — — — — — — — — — — — Lungs Bronchitis — — — — — — 1 — — — — — — — — — — — — — Other Non-Tuberculous Diseases. — — — — — — — — 1 — 1 — — — — — — — — — Tuberculosis Pulmonary:— Definite — — — — — — — — — — — — — — — — — — — — Suspected — — — — — — — — — — — — — — — — — — — — Non-Pulmonary: Glands — — — — — — — — — — — — — — — — — — — — Bones and Joints — — — — — — — — — — — — — — — — — — — — Skin — — — — — — — — — — — — — — — — — — — — Other forms — — — — — — — — — — — — — — — — — — — — Nervous System Epilepsy — — — — — — — — — — — — — — — — — — — — Chorea — — — — — — — — — — — — — — — — — — — — Other Conditions — — — — 1 2 1 — — — — — — — — — — — — — Deformities Rickets — — — — — — — — — — — — — — — — — — — — Spinal Curvature — — 1 — — — — — — — — — — — — — — — — — Other Forms 11 5 9 9 2 — — 1 — — — — — — — — — — — — Flat Foot 12 9 7 12 12 — — — — — — — — — — — — — — — Other defects and diseases 2 1 1 2 — 6 1 — 1 4 1 — — — — 1 — — 1 2 Total 74 45 57 59 35 30 18 18 27 15 2 — 2 — — 1 — — 2 2 48 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. Prescribed Groups:— Entrants (at any age) 104 24 23.1 65 17 26.2 61 12 19.7 61 14 23.0 57 13 22.8 Pupils aged 12 years 17 1 5.9 0 0 0.0 48 11 22.9 56 12 21.4 1 0 0.0 Pupils aged 15 years 50 9 18.0 40 6 15.0 23 8 34.8 29 5 17.2 26 2 7.7 Total (Prescribed Groups) 171 34 19.9 105 23 21.9 132 31 23.5 146 31 21.2 84 15 17.9 ** Other Routine Inspections ** During 1933 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:— (а) All entrants. (б) Pupils aged 12 years. (c) Pupils aged 15 years. Table No. 33.—Corresponding to Table IV. of The Board of Education's Medical Statistical Tables. Return of Defects Treated during the Year ended 31st December, 1933. Treatment Table. Group I.—Minor Ailments (excluding Uncleanliness, for which see Group VI.). Number of Defects Treated or Under Treatment During the Year. Defect or Disease. (1) Kilburn Grammar School. Willesden Polytechnic Trade School. Willesden County Schools. Willesden Polytechnic Building Trade School. Boys. (2) Girls. (3) Boys. (4) Girls. (S) Boys. (6) Treated under the Authority's Scheme. Otherwise. Total. Treated under the Authority's Scheme. Otherwise. Total. Treated under the Authority's Scheme. Otherwise. Total. Treated under the Authority's Scheme. Otherwise. Total. Treated under the Authority's Scheme. Otherwise. Total. Skin:— Ringworm—Scalp — — — – – — Body — (Show separately in brackets the number which were treated by X-rays) Scabies – – – – – – – – – – – – – – – Impetigo – – – – – – – – – – – – – – — Other skin diseases — 1 1 – – – – Minor Eye Defects (External and other, but excluding cases falling in Group II.) – – – – 1 1 – 1 1 – – – – 1 1 Minor Ear Defects — — — – 2 2 – – – – – – – 1 1 Miscellaneous (e.g., Minor Injuries, Bruises, Sores, Chilblains, etc.). – – – – – – – – – – – – – – – Total — 1 1 — 3 3 — 1 1 — — — — 2 2 49 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 Kilbum Grammar School (Boys).—In 12 instances the School Medical Inspector noted on re-inspection that the pupils were wearing suitable spectacles ; in 5 instances the pupils were under treatment, in 1 instance the vision had been re-tested and suitable spectacles obtained, and in 2 instances prescription had been obtained but no glasses. Willesden Polytechnic Trade School (Girls).—In 2 instances the School Medical Inspector noted on re-inspection that suitable spectacles had been obtained, and in 1 instance the pupil was under treatment. Willesden County School.—In 2 instances (girls) and 3 instances (boys) the School Medical Inspector noted on re-inspection that suitable spectacles were being worn. In 1 instance (girls) and 1 instance (boys) the vision had been re-tested and suitable spectacles obtained. In 1 instance (girls) and 2 instances (boys) the pupils were under treatment. In 1 instance (boys) operation for squint had been performed. Willesden Polytechnic Building Trade School (Boys).—In 1 instance the School Medical Inspector noted on re-inspection that the vision had been tested and suitable spectacles obtained, and in 4 instances pupils were under treatment. Group III.—Treatment of Defects of Nose and Throat. Kilbum Grammar School (Boys).—In 3 instances the School Medical Inspector noted on re-inspection that the tonsils had been removed. Willesden Polytechnic Trade School (Girls).—Nil noted. Willesden County School.—In 1 instance (boys) and 2 instances (girls) the School Medical Inspector noted on re-inspection that the tonsils had been removed. Willesden Polytechnic Building Trade School (Boys).—In 1 instance the School Medical Inspector noted on re-inspection that the tonsils had been removed. Group IV.—Orthopaedic and Postural Defects. Orthopaedic work is not done in connection with the Secondary Schools in Willesden. Group V.—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, the following had received dental treatment :—4 cases at the Kilburn Grammar School (boys), 3 cases at the Willesden Polytechnic Trade School (girls), 7 cases (boys) and 4 cases (girls) at the Willesden County School, and 1 case at the Willesden Polytechnic Building Trade School (boys). Group VI.—Uncleanliness and Verminous Conditions. Inspection and treatment of uncleanliness is not undertaken by the School Nurses in the Secondary and Trade Schools. Treatment of other Types of Defects. (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. 34. (a)—KILBURN GRAMMAR SCHOOL. Defect. No. Result Deformities—Flat Foot 1 Wears shoe supports. ,, ,, 1 Having Exercises. Other Defects and Diseases 1 Treatment under private doctor. 2 Under Hospital treatment. 50 (b)—WILLESDEN POLYTECHNIC. Defect. No. Result. Deformities—Round Shoulders 5 Improving with exercises. Flat Foot 4 Improving with exercises. (c)—WILLESDEN COUNTY SCHOOL. Defect. No. Result. Boys. Girls. Deformities—Spinal Curvature 1 0 Has had exercises. Round Shoulders 2 3 Improved with exercises. Flat Foot 2 4 Improved after exercises. (d)—WILLESDEN POLYTECHNIC BUILDING TRADE SCHOOL (BOYS). Defect. No. Result. Deformities—Flat Foot 1 Improving with exercises. 51 THE SIXTEENTH ANNUAL REPORT for the Year 1933, on DENTAL WORK in connection with SCHOOL CHILDREN, EXPECTANT and NURSING MOTHERS and CHILDREN under 5 years. By E. A. JENNINGS, L.DS, R.C.S.Eng. I have the privilege to submit the Sixteenth Annual Report. PART I. The total working sessions of the four Dental Officers amounted to 1,971, of these 1,600 were occupied at the Centres, 361 at Routine School Inspections and 10 in organization. The work done during the 1,600 sessions at the Centres included the inspection of 710 mothers and 1,931 children of school age and below. In addition 265 incompleted cases of mothers and infants from the previous year were under treatment. In all 6.046 patients were treated, for whom 10,621 tooth restorations by fillings were done, 17,081 teeth extracted and 6,401 incidental treatments. A total of 17,710 attendances for treatment at the Centres were registered by these patients. The Anaesthetist visited the Centres during 188 sessions and administered general anaesthetics to 3,946 cases, thus making an average of 20.9 per session. Also 624 patients received local anaesthesia. During the 361 visits made by the Dental Officers to the Schools 19,629 scholars were examined and the condition of the teeth of each child recorded and charted. Special attention was given to those children in the 12-13 year age group who appeared to be immune to dental caries, details of which appear hereafter. A Summary of the year's work compared with the years 1930 to 1932 is tabulated as follows :— Table No. 35. Comparative Table of Work done for Years 1933, 1932, 1931 and 1930. 1933 1932 1931 1930 Total inspected— Mothers, Infants and School Children 22,270 23,044 23,306 18,069 Number defective 15,106 16,454 16,588 14,924 ,, treated 6,046 6,397 5,718 4,638 Teeth removed 17,081 17,660 17,393 14,421 „ filled 10,621 10,311 8,725 5,837 Sundry operations 6,401 6,473 4,513 1,916 General anaesthetics 3,946 3,919 3,970 3,037 Treatment sessions 1,600 1,572 1,523 1,347 Inspection sessions 361 400 408 357 A glance at the various items shows that there has been a gradual increase in the number of patients treated, although fewer were inspected. Also that the number of fillings done, namely 10,621, is the highest figure yet attained. This represents an increase of 310 over the year 1932, and 1,896 and 4,784 over the years 1931 and 1930 respectively. On the other hand, the number of teeth extracted, compared with the two previous years, shows a promising decrease, indicating a growing appreciation of conservative work. 52 Table No. 36. Comparative Table of Work per Session. Attendances. Fillings. Extractions. Sundry. Total Operations per Session. 1933 11.6 6.6 10.67 4 21.3 1932 11.8 6.5 11.2 4.1 21.8 1931 11 5.7 11.4 2.3 19.4 The above Table is a comparative table of work done per session. It indicates that each dentist performed an average of 21.3 operations for 11.06 patients during every treatment session at the Centres. These operations include 6.6 fillings, 10.67 extractions and 4 incidental treatments, and represent a full and busy session for both dentist and nurse. PART II. SCHOOL DENTAL SERVICE. Inspection. Routine.—All the schools in Willesden have been visited by the dentists, and all scholars have had an opportunity of having their teeth inspected. 19,629 out of an approximate school population of 21,487 were examined and 12,532 or 63 per cent, were found to have defective teeth. The number of children showing defects in 1932 amounted to 68.7 per cent, and in 1931 70 per cent. From these percentages it is reasonable to assume that the incidence of caries is being satisfactorily held in check in Willesden. As hitherto, our procedure at the school inspections has been to record and chart all teeth showing caries or other abnormalities and to attempt to interest the child and parents individually in systematic care of the teeth. Our object, of course, is to encourage acceptance for treatment, either at the Centres or by the Private Practitioner. This method, which is common to other local authorities, consumes a considerable, but not unreasonable proportion of the dentist's time. For instance, 361 visits to the schools were allocated this year when 19,629 children were inspected. Specials.—1,455 casual cases were examined at the Centres, which is an increase of 487 over the previous year. There seems to be no satisfactory explanation for this surprising rise other than the fact that 1,858 children were missed on account of absence from school during the dentist's visit, as against 470 of last year. It is feasible that some of these children subsequently presented themselves at the Centres, desiring to avail themselves of the services offered, and so became included among the casuals. Treatment. Of the 13,987 children found on inspection to be defective, 5,266 were treated at the Centres. This is an acceptance rate of 38 per cent, compared with 32.3 per cent, and 29.9 per cent, in the years 1931 and 1932 respectively. It is encouraging to know that the percentage of children receiving treatment is increasing, but progress is slow, and, as yet, disappointing. 9,610 fillings were done, of which 8,956 were restorations to permanent teeth. 11,331 teeth were extracted, which figure includes 2.024 permanent teeth. For the removal of the teeth a general anaesthetic was administered 3,073 times and local 495. 1,286 treatment sessions were held at the Centres and 13,848 attendances were made by children for treatment. The average work done per session by each dentist is indicated in the table below. Table No. 37. Work Done per Session. Attendances. Fillings. Extractions. Other Operations. Total Operations. 10.7 7.4 8.8 3.9 20.1 53 Statistical Table dealing with the Year's Work. Table No. 38. corresponding to Table IV of the Board of Education's Statistical Tables, Group V.—Dental Defects. (1) Number of children who were:— (i) Inspected by the Dentists. Aged :— 5 963 6 1,711 7 1,882 8 1,813 9 2,285 10 2,286 11 2,443 12 2,307 13 2,553 14 1,357 15 29 Total 19,629 Specials 1,455 Grand Total 21,084 (ii) Found to require treatment 13,987 (iii) Actually treated at the Authority's Health Centres 5,266 (2) Half days devoted to Inspection 361 Treatment 1,286 Total 1,647 (3) Attendances made by the children for treatment 13,848 (4) Fillings Permanent teeth 8,956 Temporary teeth 654 Total 9,610 (5) Extractions Permanent teeth 2,024 Temporary teeth 9,307 Total 11,331 (6) Administration of general anaesthetics— For extractions 3,073 Local 495 Total 3,568 (7) Other operations Permanent teeth 4,881 Temporary teeth 194 Total 5,075 Table No. 39. Return showing the number of Dental Defects referred for following up, the number of visits made in connection therewith, and the extent to which remedial measures were carried out during 1933 at the Health Visitor's last visit. Total number of defects coming under observation during 1933. Brought forward 1933 603 8,106 New during year 7,503 Number of defects treated. Health Centre 5,266 5,339 Otherwise 73 Percentage of defects followed up needing treatment which were known to have received treatment 66% No report available 126 No. of defects for which no treatment had been undertaken at Health Visitor's final visit 1,959 Carried forward to 1934 651 Number not needing treatment 31 54 IMMUNITY TO DENTAL CARIES ENQUIRY The attention of school dentists was drawn by the Chief Medical Officer of the Board of Education in his Annual Report for 1931, to the lack of information regarding children who are known to be naturally free from dental disease It was suggested that an investigation, confined to children of the ages 12-13 years be conducted by all school dentists working under local authorities The data set out in the following Table is our contribution to this enquiry Table No 40 IMMUNITY TO CARIES ENQUIRY TABLE (1) No of children inspected (12-13 year group) 4,860 % (2) ,, „ immune to caries 68 14 (3) „ parents „ „ (1 deceased) 135 No of parents with good teeth 40 29 No of parents with bad teeth 95 70 (4) „ brothers and sisters 168 No of brothers and sisters with good teeth 134 79 No of brothers and sisters with bad teeth 34 21 (5) General physique With good physique 58 852 „ poor 10 148 (6) Domestic circumstances With exceptionally good 15 221 ,, average 43 632 „ poor 10 147 (7) Use of the tooth brush Regular brushing 35 514 Irregular „ 18 264 No 15 222 (8) Dietary habits— Milk consumption Milk in abundance 33 485 „ moderate or little amount 35 515 Sweet consumption Sweets in excess 7 10 ,, moderation 61 90 Cod liver oil Habitually 15 22 Occasionally 11 16 Never 42 62 Feeding during infancy Breast 48 70 Artificial 20 30 Fruit and vegetable consumption In abundance 51 75 Little 17 25 (9) Formation of jaw Good 66 97 Poor 2 3 30 of these children were subject to a more detailed examination for jaw relationship and position of teeth (1) 8 of these had excellent shaped jaws and normal relation of all their teeth (2) 5 had normal occlusion of the molars:- 1 complicated with excessive overbite 3 with irregular fronts 1 with pronounced gothic arches (3) 17 had distal occlusions:— 6 bilateral with regular fronts 2 „ ,, excessive overbite 4 unilateral with regular fronts 4 ,, ,, excessive overbite 1 with very irregular front teeth 55 PART III. MATERNITY AND CHILD WELFARE. The progress mentioned in last year's report continues, for the number of mothers and infants treated amounted to 780. Last year 767 were treated, but 67 of these failed to accept full advantage of complete restoration to oral health. Whereas, this year 13 only failed to have their mouths completely restored to a hygienic condition. The work involved in the treatment of these 780 cases included 5,750 extractions, 1,011 fillings, 1,326 various other operations and also necessitated the provision of dentures to 256 mothers. The time employed to deal with these cases was 314 sessions. Full details of inspections, treatments and other data in connection with Maternity and Child Welfare work are shown fully in the table below. Table No. 41.—Table of Work done. Expectant and Nursing Mothers and Children under Five. Total. E.M. N.M. 0-5 No. inspected 1,186 407 303 476 No. brought forward from previous year 265 74 150 41 Total No. under observation during year 1,451 481 453 517 No. completed 767 161 239 367 No. partially treated 13 4 8 1 No. not availing themselves of treatment 362 220 75 67 No. treated by other agencies 8 2 4 2 No. with no defects 67 8 3 56 No. carried forward 234 86 124 24 No. of treatment sessions 314 — — — No. of attendances 3,862 1,310 1,690 862 No. of teeth removed 5,750 1,634 2,861 1,255 No. of teeth filled 1,011 354 420 237 No. of other operations on the gums and teeth 1,326 426 846 54 No. of general anaesthetics 873 224 315 334 No. of local anaesthetics 129 41 86 2 56 THE FOURTH ANNUAL REPORT for the Year ending 31st December, 1933, on the SUPERVISION OF MIDWIVES. Table No. 42. Number of Midwives who, during the month of January, gave notice of their Intention to Practise in Willesden in 1933 and 1934 respectively. 1933 1934 In Willesden— 1. Private District Midwives 10 11 2. Queen Charlotte's District Home, 40, Princess Road, Kilburn 3 3 3. Central Middlesex County Hospital 6 9 Outside Willesden— 1. Private District Midwives 7 9 2. Queen Charlotte's District Home, 176, Ladbroke Grove, Kensington 3 2 3. Kilburn and West Hampstead District Nursing Association, 20, Dennington Park Road, Hampstead 3 4 Total 32 38 Table No. 43. Number of additional Midwives who, from 1st February to 31st December, 1933, gave Notice of their Intention to Practise in Willesden in 1933. In Willesden. 1. Private District Midwives 4 2. Queen Charlotte's District Home, 40, Princess Road, Kilburn 4 3. Central Middlesex County Hospital 10 Outside Willesden. 1. Private District Midwives 4 2. Queen Charlotte's District Home, 176, Ladbroke Grove, Kensington 2 3. Kilburn and West Hampstead District Nursing Association, 20, Dennington Park Road, Hampstead 2 Total 26 During 1933, from January 1st to December 31st, 58 Midwives gave notice of their intention to practise in Willesden. 0/ Table No. 44. Number of Cases attended by Midwives Practising and Living in Willesden during 1933. Private District Midwives. No. of Cases attended Total. Remarks. As Midwife. As Maternity Nurse. 1 26 4 - 2 42 14 - 3 5 2 - 4 6 4 - 5 28 1 - 6 51 10 - 7 29 7 - 8 35 3 - 9 15 16 - 10 8 4 - 11 None 7 - 12 None None - Midwives attached to Willesden District Nursing Association, 17 and 19, Park Avenue, N.W. 2. None 158 - Midwives attached to Queen Charlotte's Hospital District Home, 40, Princess Road, N.W. 6. 342 None - Midwives at the Central Middlesex County Hospital, Acton Lane, N.W. 10 *473 *15 *These patients have all been attended in the Hospital. Total 1,060 245 — = 1,305 in all. — Table No. 45. Number of Cases attended by Midwives practising in but Living Outside Willesden during 1933. Private District Midwives. No. of Cases attended in Willesden. Total. As Midwife. As Maternity Nurse. A 1 None B None None C None None D None None E 1 None F 7 1 G 6 1 H ... 2 None I 2 None J 2 None K 1 None L 3 1 M 5 1 Midwives attached to Kilburn District Nursing Association, 20, Dennington Park Road, Hampstead, N.W. 6. Midwives attached to Queen Charlotte's Hospital District 31 None Home, 176, Ladbroke Grove, W.10 21 None Total 82 4 From Table 44 it will be observed that Midwives living in Willesden attended 1,060 cases as Midwives and 245 cases as Maternity Nurses, or 1,305 in all. 58 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 51, and that the largest total of cases any single midwife attended was 61, being 51 cases which she attended as a Midwife and 10 as a Maternity Nurse. During the year ended 31st December, 1933, 149 notifications were received from Midwives practising in Willesden in accordance with the rules of the Central Midwives Board. Of these 149 notifications 125 were received from Midwives living and practising in Willesden, and 24 from Midwives practising in but living outside Willesden. Of the 149 notifications received 133 were in respect of calling in Medical help, 95 being in respect of the mother and 38 in respect of the child. In addition 4 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, 1933, was £68 11s. 0d. During the year £28 18s. 0d. was recovered from patients. Table No. 46. 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 43 (Up to 10th Feb., 1934, 39 have notified intention to practise in Willesden during 1934.) (b) Number (i.) employed by the Council 0 (ii.) directly subsidised by the Council 0 (iii.) employed by Voluntary Associations in Willesden 11 (Queen's Nurses, 17/19, Park Avenue, Willesden—(These act as Maternity Nurses -not as Midwives. 3 are allocated to Maternity nursing only. The remainder do Maternity Nursing as required.) 3 (Queen Charlotte's Hospital District Nurses Home, 40, Princess Road. Kilburn.) (iv.) employed by Voluntary Associations outside Willesden (Queen Charlotte's Hospital District Nurses' Home, 7 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- 33 where the midwife was acting as a midwife. 9 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 982 160 (ii.) As maternity nurses 235 14 (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—1933. 59 Table No. 47. Notifications received from Midwives in accordance with the Rules of the Central Midwives Board, 1st January to 31st December, 1933. From Midwives living and practising in Willesden. From Midwives practising in Willesden but living outside. Notifications of:— Sending for Medical Help 112 21 Having laid out a dead body 2 — Liability to be a source of infection 6 1 Death of child 3 — Still Birth 3 — Artificial feeding 3 2 Table No. 48. 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 examinations 6 - Blisters on Baby 2 - Baby Feeble 6 — Ante-partum haemorrhage 3 1 Hare Lip — 1 Premature Infant 5 — Albuminuria 7 — Peculiar Shaped Head 1 - Complicated breech 2 1 Delayed labour 15 1 Spots on child 2 — Engorged breast 2 — Sores in baby's groin 1 — Footling and cord presentation 2 - Spina bifida 1 — Sticky eyes 6 5 Hand presentation 1 - Watery eyes 8 - Laceration of perineum 21 10 Painful leg 2 — Post-partum hæmorrhage 1 - Patient passed a worm 1 - Rise of temperature 10 1 Retained placenta 4 1 Severe Headache 1 - Severe pain in side 1 — Threatened abortion 1 — 80 15 32 6 60 THE FOURTH ANNUAL REPORT for the Year ending 31st December, 1933, on the REGISTRATION OF NURSING HOMES. NURSING HOMES REGISTRATION ACT, 1927. Table No. 50. Maternity and Nursing Homes, January 1st, 1933, to December 31st, 1933. (1) Number of applications for registration:— (a) Maternity Homes 1 (b) Nursing Homes 2 (2) Number of Homes registered 3 (3) Number of Orders made refusing or cancelling registration 0 (4) Number of appeals against such Orders 0 (5) Number of cases in which such Orders have been— (a) Confirmed on appeal 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 0 At the close of the year there were 10 Nursing Homes on the Register of the corporation of Willesden with accommodation for 60 patients. 61 THE FOURTH ANNUAL REPORT for the Year ending 31st December, 1933, 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 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 the Children & Young Persons Acts, 1908-1932, 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 anyone enquiring for or offering homes for children for reward or adoption. A report on Infant Life Protection appeared as Appendix G in 1931. The provisions of the Children & Young Persons Act, 1932, relating to Infant life protection came into operation on January 1st, 1933. These provisions amend Part 1 of the Children Act, 1908. The principal amendments are:— (1) Extension of age of notifiable children.—Age raised from 7 to 9 years. (2) Period of notification.—Notification of reception of a child must now be given instead of within 48 hours after reception not less than 7 days before its reception in the case of a first child and not less than 48 hours before its reception in the case of any other child. There are certain exceptions in case of emergency and children already in foster mother's care. Notification of change of residence must be given at least 7 days prior to the change—in emergency within 48 hours after. Notification of death or transference of a child must be given within 24 hours instead of within 48 hours. (3) Additional notification.—Notification of death or transference of a child must be given not only to the local authority but also to the person from whom the child was received. (4) Manner of notification.—Subject to certain alterations this is set out on similar lines to previously. (5) Definition of " reward."—An undertaking is to be an undertaking for reward if there is any payment or gift of money or money's worth, or any promise to pay or give money or money's worth, irrespective of whether there is any intention of making a profit. (6) Time limit for prosecutions and failure to notify.—Failure to notify is made a continuing offence to facilitate bringing cases before courts of summary jurisdiction within the 6 months limit. (7) Women infant protection visitors.—At least one of the infant protection visitors for each authority must be a woman. It is assumed that in most cases the health visitors of the authority have already been appointed to these posts. (8) Scope of visits.—The scrutiny, advice and direction of the visitor should extend not only to the nursing but also to the general health and well-being of the child. (9) Prevention of overcrowding.—In addition to limiting the number of foster children in a home the Local Authority may now impose conditions to be complied with so long as the total number of children kept in the dwelling exceeds a specified number. (10) Unsuitability of premises, foster-parents or environment.—The powers of the authority to secure the removal of children kept on unsuitable premises or by unsuitable persons are extended to prevent their reception in such premises or by such persons. 62 Unfitness by reason of old age, infirmity or ill-health has been added to the class of persons unfit to have care of foster children. Detrimental environment, as well as unsuitable premises or foster parents, is recognised as a ground for action both before and after reception. (11) Legal action.—The Authority, in place of the visitor, is made directly responsible for applying to a Court of Summary Jurisdiction for an order for the removal of a child to a place of safety and the Authority's power to issue an order on the application of a visitor is rescinded— there are, however, provisions for emergency. (12) Prohibition of anonymous advertisements for children.—It is made an offence to publish any advertisement, whether of a person or a society, for children within the scope of the Acts which does not truly state the name and the residence or office of the person or society—arrangements should be made for the scrutiny of local newspapers and for investigating relevant advertisements. (13) Exemptions.—The exemption of hospitals, convalescent homes and institutions is limited to certain establishments. The Minister of Health issued Memorandum 165/M.C.W. setting out the effect of the new provisions and Memorandum 165a/M.C.W. containing a summary of the law relating to infant life protection for the guidance of infant protection visitors. These memoranda have received the careful attention of the Council and of the officers concerned with Infant Life Protection. Advertisements relative to the new Act were put in the local press, posters were displayed and handbills distributed. Possible boarding schools, institutions, nursing homes and hospitals were circularised, and leaflets of advice to foster mothers, including the new provisions, were sent to all women who at any time since 1st April, 1930, had been registered as foster mothers. 4 certificates of exemption were granted under Section 69 (b) of the Children and Young Persons Act, 1932. Under Section 2 (4) of the Children Act, 1908, all registered nursing homes were granted exemption from the liability to be visited for the purposes of the Act so long as the children are on their registers as patients in the Home. In the case of two foster mothers the Council refused to allow them to continue as foster mothers as the conditions had become unsatisfactory. One of these gave up the children, the other arranged for the foster child's mother to take a room in her house and have the child at night. The child thus ceased to come within the provisions of the Infant Life Protection Acts. In the case of two other foster mothers the Council reduced the number of children previously permitted to be kept. Proceedings were taken in one case for failure to give notice of reception of child and failure to give notice of removal of child from foster mother's care. The foster mother was fined 40s. on each summons and 15s. expenses, amounting in all to £4 15s. Two foster children died during the year. In both cases the deaths were sudden and postmortems were held. In one case the death was found to be due to syncope from enlarged thymus, and in the other to syncope from mitral valvular disease and tumour of the brain. Nine foster mothers were discovered by Health Visitors on the district or at the Health Centres who pleaded ignorance of the law of notification. Table No. 51. Foster Mothers. Number of Foster Mothers at 31st December, 1932 123 „ „ „ returned to Register 1st January, 1933, owing to the extension of the age of Foster Children from 7 to 9 years by the Children and Young Persons Act, 1932 17 Number of Foster Mothers at 31st December, 1933 126 Number of Licences granted by Council in 1933 55 „ „ refused by Council in 1933 5 Number of applications to take additional children agreed to by Council 9 „ „ ,, „ „ refused by Council 0 Number of of applications for re-issue of Licence agreed to by Council 39† „ ,, „ „ „ refused by Council 2 63 Foster Children. Coming under observation— Number of Foster Children at 31st December, 1932 169 „ „ ,, returned to Register 1st January, 1933, owing to the extension of the age of Foster Children from 7 to 9 years by the Children and Young Persons Act, 1932 23 Number of Foster Children received during 1933 345 Number entered Willesden with their Foster Mothers 6 Total 543‡ Removed from observation— Number given up 326 „ reached the age of 9 years 9 ,, died 2 „ legally adopted 1 ,, ceased to be taken for gain or taken over by Public Assistance Committee 1 „ left Willesden with their Foster Mothers 14 Total 353 Remaining under observation— Number of Foster Children at 31st December, 1933— (a) Under 5 years of age 134 (b) Between 5 and 9 years of age 56 Total 190 † Of these 39 cases 12 were re-issued in respect of new premises and 24 were re-issued owing to the extension of the age of Foster Children by the Children and Young Persons Act, 1932. ‡ The actual number of new individual Foster Children who came under observation was 310. This includes the 23 children returned to the Register 1st January, 1933, owing to the extension of the age of Foster Children. Table No. 52. The 190 Foster Children under observation at 31st December, 1933, were maintained in the care of Foster Mothers as follows:— Maintained by— Parent or Guardian 136* Crusade of Rescue, 48, Compton Street, W 37 National Adoption Society, 4, Baker Street, W 16 Received with lump sum 1 Total 190 * In 47 cases the parents or guardians were living in Willesden at the time the child entered the care of the Foster Mother. In 89 of these cases the parents or guardians were not living in Willesden at the time the child entered the care of the Foster Mother. 64 Table No. 53. The following Table shows the length of time each of the 190 Foster Children under observation at 31st December, 1933, had been in the care of their Foster Mothers. Under 6 months 65 Over 6 months, under 1 year 40 Over 1 year, under 1½ years 29 Over 1½ years, under 2 years 14 Over 2 years, under 2½ years 9 Over years, under 3 years 8 Over 3 years, under 3½ years 4 Over 3½ years, under 4 years 4 Over 4 years, under years 3 Over 4½ years, under 5 years 3 Over 5 years, under 5½ years 1 Over 5½ years, under 6 years 3 Over 6 years, under 6½ years 1 Over 6½ years, under 7 years 3 Over 7 years, under 1½ years 1 Over 1½ years, under 8 years 2 Total 190 Of the 479 individual Foster Children under observation during the year 1933, 307 changed hands during that period. 267 made 1 change, 19* made 2 changes, 15§ made 3 changes, 4† made 4 changes, 2‡ made 5 changes. These changes do not include the first reception of the child. * Of these, 6 were admitted to Hospital returning to same Foster Mother. § Of these, 7 were admitted to Hospital returning to same Foster Mother. † Of these, 1 was twice admitted to Hospital returning to same Foster Mother. ‡ Of these, 1 was once and 1 was twice admitted to Hospital returning to same Foster Mother. THE FOURTEENTH ANNUAL REPORT for the Year ending 31st December, 1933, on HOME NURSING. A record of work done is given in the three following tables:- 65-66 Table No. 54.—Showing Cases dealt with during 1933 and Results. Disease. Cases being Nursed at end of 1932. New Cases during 1933. Removed from Observation during 1933—Results of Treatment. Still being Nursed at end of 1933. Number of Visits Paid during 1933. 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 1 Mothers. Nursing Mothers. Children under Five. School Children Others. Total. Albuminuria - - - - - - - - - - - 1 - - - - - - - - - - - - - - - - - - - - - - - - - 5 - - - 5 Bathing Cases — — — — — — — — 2 — — 2 — - - - — — — — — — — — — - 2 — — 2 - — — — — — — — 24 — — 24 Bronchitis - - - - - - - - - - 1 1 - - - - - - - - - - - - - - - - 1 1 - - - - - - - - - - 14 14 Burns and Scalds - - - - - - 1 1 3 1 — 6 - - - - - - - - - - - - 1 l 3 1 — 6 - - - - - - 27 24 26 8 - 85 Circumcision - - - - - - - - 11 - - 11 - - - - - - - - - - - - - - 11 - - 11 - - - - - - - - - - - 54 Douching Cases — - - - - - 1 1 - - 1 3 - - - - — — — - — - — — 1 l - — i 3 - - — — - — 3 13 - — 1 17 Eczema — — — — — — — — 5 1 — 6 — — — — — — — — — — — — — - 5 1 — 6 — — — - — — — — 57 5 - 62 Faecal Fistula - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 20 20 Impetigo — — - - - — - - 14 1 - 15 — - - - — — — — — — - — — — 12 1 — 13 — — 2 — - 2 — — 149 6 — 155 Influenza - - - - - - - 1 - - - 1 - - - - - - - - - - - - - l - - - 1 - - - - - - - 5 - - - 5 Mastitis - 1 - - - 1 - - - - - 5 - - - - - - - - - - - - - 6 - - - 6 - - - - - - - - - - - 76 Maternity Case - - - - - - - 1 - - - 1 - - - - - - - - - - - - - 1 - - - 1 - - - - - - - 5 - - - 5 Measles - - - - - - - - - 1 - 1 - - - - - - - - - - - - - - - 1 - 1 - - - - - - - - - 11 — 11 Miscarriage. - - - - - - - 1 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 9 - - - 9 Ophthalmia — - 2 1 — 3 - 1 37 5 — 43 — - — — - - — - - - — - - 1 38 6 45 — - 1 — - 1 - 10 385 34 - 429 Ophthalmia Neonatorum - - - - - - - - 8 - - 8 - - - - - - - - 1 - - - - - - - - - - - - - - - - - - - - 84 Otorrhoea — - 4 2 — 6 - — 37 26 1 64 — - — - - - — - 1 2 - 3 - - 35 25 1 61 — - 5 1 — 6 - — 687 481 23 1191 Pemphigus - - - - - - - - 1 - - 1 - - - - - - - - - - - - - - 1 - - 1 - - - - - - - - 4 - - 4 Pneumonia - - - - - - - - - 2 - 2 - - - - - - - - - - - - - - - 2 - 2 - - - - - - - - - 40 — 40 Prematurity - - - - - - - - 1 - - 1 - - - - - - - - - - - - - - - - - - - - 1 - - 1 - - 3 - - 3 Puerperal Pyrexia - - - - - - - 1 - - - 1 - - - - - - - - - - - - - 1 - - - 1 - - - - - - - 10 - - - 10 Refraction - - - - - - - - - 1 - 1 - - - - - - - - - - - - - - - 1 - 1 - - - - - - - - - 6 - 6 Septic Conditions - - - - - - 1 3 44 19 — 67 - - - - - - - - - - - - 1 3 44 19 - 67 - - - - - - 3 24 273 143 — 443 Skin Conditions — — - - - - — 4 3 - 7 - — - - - - - - - - - — - — 4 1 - 5 - - - 2 - 2 - - 20 25 - 45 Throat Conditions - - - - - — - — 2 1 - 3 — - — — - — — - 1 - - 1 — - 1 1 - 2 - - — - - - - — 21 5 - 26 Thread Worms — - 2 - - 2 — — 91 86 - 177 - — - - — — — - - — — — — — 91 86 - 177 - - 2 — - 2 - - 349 381 - 730 Thrombosis - - - - - - 1 - - - - 1 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 12 Varicose Ulcer - - - - 1 1 - - - - - - - - - - - - - - - - - - - - - - - - - - - - 1 1 - - - 227 227 Varicose Veins - - - - - - 1 - - - - 1 - - - - - - - - - - - - - - - - - - 1 - - — - 1 6 - - - - 6 Whooping Cough - - - - — - - — 1 1 - 2 - - - - - — — - 1 - - 1 - - - 1 - 1 - - - - - - - - 7 17 - 24 Wrist Injury — - - - — — - — 1 — - 1 - - - - - - - - - - — - — — 1 — - 1 — - - - — - — — 5 — — 5 Total - 1 9 3 2 15 5 16 262 148 3 434 - - - - - - - - 4 2 - 6 3 17 256 146 4 426 2 - 11 3 1 17 51 181 2148 1162 285 3827 67 Table No. 55. Shewing sources from which cases were referred for Home Nursing during the Year 1933. Referred by Number. Health Department 379 Private Doctors 18 Others 37 Total 434 Table No. 56. Shewing cases Home Nursed in Wards during 1933. Ward No. of Cases brought forward from 1932. No. of Cases referred in 1933. Total. No. of Visits paid. 1. South Kilburn 7 115 122 1,133 2. Mid-Kilburn 0 89 89 1,029 3. North Kilburn 4 57 61 547 4. Brondesbury Park 0 6 6 63 5. Kensal Rise 1 13 14 73 6. Harlesden 0 19 19 86 7. Stonebridge 1 41 42 215 8. Roundwood 1 16 17 303 9. Church End 0 21 21 97 10. Willesden Green 1 26 27 142 11. Cricklewood 0 31 31 139 Total 15 434 449 3,827 68 THE NINETEENTH ANNUAL REPORT for the Year ending 31st December, 1933, on the PROVISION OF MEALS TO SCHOOL CHILDREN IN WILLESDEN. Feeding Centres.—Meals have been supplied at the four feeding centres under the control of the Education Committee namely :—Gibbons Road, Furness Road, Strode Road, and Lower Place, and at one voluntary centre at Granville Road. Dinners are taken from Gibbons Road Feeding Centre to Oldfield Road Physically Defective School, and from Furness Road Feeding Centre to Leinster Mentally Defective School, College Road. The dinners are served in the main hall at each school. Breakfasts.—The practice of serving breakfasts to children whose parents are unusually poor has been continued throughout the year. All these cases have been in the South Kilburn area. The meal consists of cocoa made with dried milk, and sugar, 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 748. Recommendations are no longer received from the Local Public Assistance Officers, as the agreement made between the Public Assistance Committee and the Willesden Education Authority to pay Is. per head per week or part of a week for each child fed on their recommendation ceased to operate on 25th March, 1933. The economic scale was raised Is. per head on 25th July, 1933. 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 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 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 the South Kilburn area for the year was : Dinners 434, breakfasts 82. 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 and custard. The price of meals for non-necessitous cases is 5d. as heretofore. STATISTICAL INFORMATION, YEAR ENDING 31st DECEMBER, 1933. Table No. 57—No. of Meals Supplied. Supplied to:— Breakfasts. Dinners. Total. Free. Free. Paying. Education Committee's Centres — 91,258 581 91,839 Kilburn Voluntary Centre 7,139 63,640 — 70,779 Special Schools — 13,879 14,766 28,645 Feeding Centre Assistants 2,761 3,314 — 6,075 Total 9,900 172,091 15,347 197,338 69 Table No. 58.—Occupation List, 1933. Occupation. No. of Children Fed during 1933. No. of Families Involved. Percentage. 1932 1933 1932 1933 Unemployed 960 424 421 70.08 67.14 Widows 105 55 52 9.09 8.29 Deserted Wives 58 31 30 5.12 4.78 Orphans 10 3 8 .49 1.28 Labourers 86 33 29 5.45 4.62 Railwaymen 43 15 12 2.47 1 .91 Hawkers 42 17 22 2.80 3.51 Others 75 27 53 4.46 8.45 1,379 605 627 Approximate average cost of food only 2.95. Total (gross) 4.90. 70 THE FORTY-SECOND ANNUAL REPORT on the MUNICIPAL HOSPITAL By ARTHUR G. TROUP, M.D., D.P.H, Medical Superintendent. During 1933, 1,201 patients were admitted to hospital as compared with 869 in 1932, 842 in 1931, 1,029 in 1930, 955 in 1929 and 1,037 in 1928. Cerebro-Spinal Fever. Four cases of this disease were admitted to hospital during the year, and two deaths occurred. One of the fatal cases proved on post-mortem examination to be suffering from the Posterior Basic type of Cerebro-Spinal Fever which is almost invariably fatal. The cases which recovered were in a satisfactory mental and physical condition at the date of discharge from hospital. Diphtheria. 291 cases were admitted to hospital as compared with 190 cases during 1932. These may be classified as follows:—Faucial 201, Nasal 58, Faucial and Nasal 8, Aural 10, Laryngeal 5, Bacteriological 9. It was necessary to perform the operation of tracheotomy on one of the laryngeal cases. The child made a good recovery. The prevailing type of this disease was mild and only six deaths occurred, giving a corrected mortality rate of 1.8%. This rate is one of the lowest recorded at the Municipal Hospital. The corresponding mortality rate for England and Wales for the year 1932 was 5.4%. Enteric Fever. Three cases of Typhoid Fever and six of Paratyphoid Fever B were admitted during the year. One patient had a prolonged illness with a pyrexia lasting 53 days and was in hospital for over 11 weeks. In all the others the type was of a mild or moderate nature, and no deaths occurred. Erysipelas. Thirty-eight cases of this disease were treated during the year. This number is above the average. No deaths occurred. Table No. 59. Diseases. Remaining on 1st Jan., 1933. Admitted. Total under treatment. Discharged recovered. Died. Mortality per cent. Remaining on 31st Dec., 1933. Cerebro-Spinal Fever — 4 4 1 2 50 1 Diphtheria 36 282 318 280 6 1.8 32 Diphtheria (Bacteriological) - 9 9 9 - - - Enteric Fever - 9 9 9 — - - Erysipelas 6 32 38 35 — - 3 Measles — 42 42 32 1 2.3 9 Mixed Infections — 15 15 15 — - — Puerperal Infections 1 16 17 15 — — 2 Scarlet Fever 42 616 658 587 1 .15 70 Whooping Cough — 19 19 13 5 26.3 1 Other Diseases 3 157 160 152 7 4.3 1 Totals 88 1,201 1,289 1,148 22 - 119 Measles. Forty-two cases of this disease were admitted to hospital during the year and one death occurred. The majority of the cases were admitted during the winter months. The type of measles prevailing this year was of a less toxic nature than that which occurred two years ago. Cross infection with this disease occurred in three wards with sixteen secondary cases. 71 Mixed Infections. The following cases of mixed infections were admitted during the year:— Scarlet Fever and Chicken-Pox 3 Scarlet Fever and Measles 2 Diphtheria and Whooping Cough 2 Diphtheria and Scarlet Fever 1 Diphtheria and Chicken-Pox 1 Scarlet Fever and Mumps 1 Scarlet Fever and Whooping Cough 1 Measles and Whooping Cough 1 Puerperal Infections. The sixteen cases of Puerperal Infections which were admitted during the year may be classified as follows:— Local Uterine Sepsis 4 Breast Abscess 2 Pelvic Cellulitis 1 Pyelitis 1 Mastitis 1 Erysipelas 1 Miscarriage (Septic) 1 Phlebitis 1 Carbuncle 1 Rupture of perineum and Bacilluria 1 Bronchitis 1 Pyrexia following post-partum Haemorrhage 1 16 No deaths occurred and all the cases made good recoveries. Scarlet Fever. During the year 616 cases of Scarlet Fever were admitted as compared with 346 cases last year. One patient developed gangrene affecting the left leg and subsequently died. Whooping Cough. Nineteen cases were admitted and five deaths occurred. Four of these were due to pneumonia and one to pneumonia and empyema. Other Diseases. One hundred and fifty-seven patients were admitted under this heading as follows:— Tonsillitis 44 Drug Rash 2 Rubella 14 Teething Rash 2 Rhinitis 14 Heat Stroke 2 Quinsy 13 Otitis Media 2 Chicken-Pox 9 Pyemia 1 Negative Cases 9 Colitis 1 Influenza 4 Gastritis 1 Ophthalmia Neonatorum 4 Empyema 1 Erythema 4 Vincent's Angina 1 Mumps 3 Dermatitis 1 Pneumonia 3 Acidosis 1 Laryngitis 3 Adenitis 1 Cellulitis 2 Prepatellar Bursitis 1 Septicaemia 2 Abscess of Neck 1 Enteritis 2 Impetigo 1 Marasmus 2 Rheumatism 1 Bronchitis 2 Oedema of Fauces 1 Anterior Poliomyelitis 2 Seven deaths occurred:— Septicaemia 2 Oedema of Fauces 1 Pneumonia 2 Marasmus 1 Empyema 1 One case of pneumonia and the case of empyema were admitted from another Institution in the district as diphtheria carriers. 72 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. 1930 31 521 1931 33 483 1932 28 384 1933 32 560 Included in the above figures are two members of the Nursing Staff who were off duty for 180 days and 78 days respectively, the former suffering from Chronic Nephritis and the latter from an abdominal condition which required an operation. Three nurses contracted scarlet fever. The other illnesses were of a minor nature. Duration of Stay in Hospital. (1) Scarlet Fever. The average length of detention of scarlet fever patients shows a slight decrease this year, and I think we have probably reached the lowest average it is possible to attain having regard to the minimum period of stay in hospital which is 28 days. Average stay in hospital of scarlet fever patients during recent years:- 1926—47.2 1932—34.5 1928—37.0 1933—32.1 (2) Diphtheria. The average length of detention of diphtheria patients also shows a decrease, and this can be accounted for by the fact that the majority of the cases were of a mild type. 1929—51.7 1932—45.6 1931—56.2 1933—42.0 (3) Other Diseases. Average stay in hospital of patients suffering from " other diseases " 1930—1933:— 1930—27.1 1932—27.2 1931—29.3 1933—25.5 Schick Test and Active Immunisation against Diphtheria. (1) Nursing Staff. During 1926 a commencement was made in Schick Testing the Nursing Staff and immunising those nurses who proved to be susceptible to diphtheria. Since that date 6 cases of diphtheria have occurred, 1 in 1927, 1 in 1928, 1 in 1929, 2 in 1930 and 1 in 1932. The particulars of these cases have been given in previous Annual Reports. The following table demonstrates the benefits derived from this method of preventive medicine : (1) Number of cases of diphtheria occurring amongst probationer nurses during the first eight months of 1926 (before immunisation was carried out.). 9 (2) Incidence rate per annum (taking 30 as average number of probationer nurses). 45% (3) Number of cases of diphtheria occurring amongst probationer nurses from 1927 to 1933 (after immunisation was carried out). 6 (4) Incidence rate per annum (taking 30 as average number of probationer nurses). 2.8% (5) Number of nurses Schick Tested (1927 to 1933 inclusive) 196 (6) Number of nurses giving a positive reaction 97 (7) Percentage of nurses giving a positive reaction 49.4 (8) Number of nurses re-Schick Tested 46 (9) Number of nurses re-Schick Tested giving a positive reaction 17 (10) Percentage of nurses re-Schick Tested giving a positive reaction 36.9 The following are the figures for the past four years for the Domestic Staff:— Number of Maids who were off duty far 24 hours or more. No. of days off duty. 1930 1931 1932 1933 11 15 9 13 281 212 133 131 One maid contracted diphtheria. She made a good recovery. 73 (2) Willesden Residents. This clinic was made available for Willesden residents in May 1927. The number of individuals attending for treatment is now small, but the number this year shows a small increase over last year. The following are the figures for the years 1927 to 1933 inclusive:— Year. Number attending for Schick Test. Number attending for Immunisation. 1927 82 94 1928 28 34 1929 2 9 1930 19 22 1931 4 8 1932 2 6 1933 19 23* Total 156 196 * Two of these patients were immunised against Scarlet Fever. Laboratory. The bacteriological laboratory was opened for work on the 1st January, 1932. 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 number of specimens examined shows an increase of 1,382 as compared with the number for 1932. Table No. 60. Nature of Specimens Examined. Positive Result. Negative Result. Total. 1 Swabs for Diphtheria Bacilli 412 4,321 4,733 2 Swabs for Diphtheria Bacilli with Virulence 17 48 65 3 Blood for Widal Reaction 11 36 47 4 Sputum for Tubercle Bacilli 102 715 817 5 Swabs and films for Gonococci 25 27 52 6 Specimens of Pus — — 13 7 Blood Cultures — — 5 8 Swabs and films for Vincent's Angina 2 6 8 9 Cerebro-Spinal Fluids — — 13 10 Fluid from Pleural Cavity — — 2 11 Faeces for Organisms — — 22 12 Urines (Chemical examination) — — 20 13 Urines (Pathological examination) — — 12 14 Urines (Bacteriological examination) — — 54 15 Swabs for Streptococci 18 14 32 16 Blood Counts — — 5 17 Post Mortem Specimens — — 8 5,908 Table No. 61. Sources of Specimens Examined. 1. Willesden Municipal Hospital Total. 1,662 2. Private Practitioners 2,043 3. Municipal Health Centres and Health Nurses 1,216 4. Central Middlesex County Hospital 945 5. Other Hospitals 42 5,908 74 Cases Admitted from Other Authorities. During the year 51 cases were admitted from Authorities other than the Borough of Willesden. These may be tabulated as follows:— Table No. 62. Name of Authority. Total No. of Cases. Disease. No. of. Cases. Borough of Ealing 16 Scarlet Fever 11 Enteric Fever 3 Cerebro-Spinal Fever 1 Chicken-Pox 1 Middlesex County Council 20 Scarlet Fever 8 Diphtheria 8 Measles 3 Erysipelas 1 Hendon Rural District Council 12 Diphtheria 11 Scarlet Fever 1 Borough of Heston and Isleworth Southall and Norwood Urban District Council 2 1 Scarlet Fever 2 Enteric Fever 1 51 51 The maximum number of the above cases in hospital on any one day was 14 out of a total of 114, this being the number of patients in hospital on the 24th January. Towards the end of the year a certain number of cases referred for admission to hospital by outside Authorities had to be refused as no beds were available for their accommodation. The amount of income derived from the maintenance of these patients during the year was £ 1,211 2s. 0d. Hospital Buildings. (1) Cubicles. During November the Council decided to furnish and equip the second cubicle pavilion of 10 beds and it will soon be ready for occupation. During the latter part of the year the hospital accommodation was taxed to its utmost extent and the cubicle accommodation of 10 beds, then available, was insufficient to deal with all the patients which it was desirable to treat and nurse in this manner. It is hoped that the third pavilion will be furnished and equipped to receive patients during the present year. 75 THE THIRD ANNUAL REPORT on the WILLESDEN MATERNITY HOSPITAL. REPORT ON THE WORK FROM 1st JANUARY, 1933, to 31st DECEMBER, 1933, 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 1933. The close co-operation between the Hospital and the Health Centres has been maintained and the ante-natal supervision of the booked cases continues to be efficiently carried out. The extension of the hospital which, it is hoped, will shortly be in hand, will do away with certain disadvantages in the present accommodation. Not the least of these disadvantages is the distribution of the beds between two large wards. By careful attention to detail, there has been no medical reason for closing a ward during the past three years, but the necessity for redecorating during last summer entailed a reduction in the number of cases booked for the period during which the work was in progress. This is partly responsible for the drop in the number of cases admitted during the year. When the new wards are in operation it should be possible for cleaning and decorating to take place without interfering with bookings. In November, the first batch of pupil midwives entered for the examination of the Central Midwives Board. Three candidates were sent up and all were successful. During the year, 493 cases were discharged and one died. The death occurred in a patient admitted urgently at the request of a Willesden doctor. After admission, it was found that the patient was resident in the Wembley area and should not have been admitted to this hospital. At no time could the question of transferring her be entertained. The patient was suffering from Ante-partum Haemorrhage of the type known as Accidental Haemorrhage. On admission her condition was desperate but delivery was successfully accomplished. After a blood transfusion, there was every reason to hope that she would recover but the toxaemia which had caused the haemorrhage had so damaged the kidneys that they ceased to function. During the eleven days following delivery before her death, every possible line of treatment was carried out to induce the kidneys to act, but without success. In the present state of our knowledge nothing further could have been done either before the onset of the complication or after to save this woman. The statistical data is presented in the same form as before, and the figures for the two previous years can be compared with the year under review. Of particular interest is the number of infant deaths. Only one baby died out of the 476 born alive. This was a feeble premature child which died shortly after delivery. This result is remarkable when compared with the satisfactory figure of ten deaths for the previous year. Credit for this belongs to the nursing staff. Eleven cases of Ante-partum Haemorrhage occurred against five for the preceding year. All were safely delivered and progressed satisfactorily except for the emergency case reported above. Properly managed in a well equipped hospital, a case of Ante-partum Haemorrhage can usually be delivered with little anxiety, although in a private house such cases are recognised as being amongst the most serious of all obstetric emergencies. One case was transferred to the Middlesex Hospital early in pregnancy on the advice of Dr. Evan Bedford. The patient was suffering from pernicious anaemia and an obscure heart condition. Twenty-eight cases of Toxaemia of Pregnancy were admitted for treatment and, as before, all were safely delivered. No case of Eclampsia developed in this series but one patient developed Post-partum Eclampsia without previous warning. The new ante-natal ward will be a great boon for the treatment of these undelivered women who now have to be admitted to a lying-in ward. Twelve emergency cases were admitted from doctors, some of which were admitted very soon after the complication had occurred. The results of treatment were correspondingly satisfactory. 76 Statistical Details of the 494 Cases dealt with during the Year. Cases completed 494 A. Booked at the Health Centres 482 Discharged well 478 Transferred 4 Died 0 B. Admitted as Emergencies 12 Discharged well 11 Died 1 Of the 482 booked cases, 226 were primipara and 256 were multipara. Of the 12 emergency cases, 6 were primipara and 6 were multipara. Presentations- Occipito Anterior 449 Occipito Posterior 19 Normal Breech 1 Abnormal Breech 14 Twins 4 Face 3 Brow 2 Delivered elsewhere 1 Ante-partum Haemorrhage. Placenta Prævia 7 Accidental Haemorrhage 4 Post-partum Haemorrhage 3 Manual Removal of Placenta 2 Prolapse of Cord 2 Organic Heart Disease 9 Hydramnios 2 Toxaemia of Pregnancy admitted for Treatment 28 Post-partum Eclampsia 1 Puerperal Pyrexia according to the B.M.A. Standard 15 Uterine Infection 6 Breast Infection 4 Urinary Infection 1 No cause found 2 Sundries 2 Operations performed- Forceps delivery 30 The "forceps rate" was therefore 6 per cent. Caesarian Section 12 Heart Disease 5 Contracted Pelvis 5 Placenta Prævia 2 Induction of Premature Labour 2 Hysterotomy for chronic nephritis 1 496 viable children were born to 492 mothers. Of these, 476 left hospital alive and well, 19 were stillborn and 1 died. 460 were fed on breast milk alone. In 14 the milk of the mother had to be supplemented by artificial food and in 2 cases the child was fed on artificial food alone. 77 THE FOURTH ANNUAL REPORT for the Year ending 31st December, 1933, 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, 5 patients attended the Health Centres for treatment, the total number of attendances being 19. 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. 63. Defect or Disease. Requiring Treatment. Received Treatment at Health Centre. Defective Teeth 3 2 Genu Valgum 1 0 In addition three children not referred for treatment attended the Health Centre and received treatment, and one of the children referred for dental treatment attended the Health Centre for treatment for some other condition. The attendances were in respect of sore on knee, accident to right hand, thyroid treatment and impetigo. 78 THE THIRD ANNUAL REPORT ON NURSERY CLASSES for the Year ending 31st December, 1933. LOWER PLACE NURSERY CLASSES. During 1933 39 children in the Nursery Classes were examined under the scheme in force. Group A.-22 had their first routine medical inspection. Of these:- 6 were between 2 and 3 years of age. 13 ,, 3 and 4 ,, ,, 2 ,, 4 and 5 1 was 5 years of age. Group B.-5 had their second routine medical inspection. Of these:- 2 were between 3 and 4 years of age. 3 „ 4 and 5 ,, ,, Group C.-2 had their third routine medical inspection. Of these:- 1 was between 3 and 4 years of age. 1 „ 4 and 5 ,, ,, Group D.-9 were re-examined for a defect or defects found at the routine examination or re-examination of the previous year. 1 was specially referred. Group A.-Children examined at their first routine medical inspection. Among the above children, the following medical defects were found (1) Enlarged Tonsils.-This, as usual, was the most prevalent defect. 9, 5 of whom were between the ages of 3 and 4 years, were referred to the Ear, Nose and Throat Surgeon who advised tonsillectomy in 6 cases ( 3 have not yet attended to see him). 1 child has since had the operation, the parent of another has definitely refused it, while 4 are postponing it until the children are older. 2 showed some slight tonsillar enlargement which at present is causing no symptoms. Both are being re-examined again in 6 months. (2) Bony affections.-8 cases were found. I was a case of Rickets with enlarged epiphyses and protuberant abdomen. She is now having Sunlight Treatment at the Centre. 2 had Valgus Ankles. 1 was referred to the orthopaedic department, while the other, in which the condition was very slight, was scheduled for a re-examination in 3 months. 4 had Genu Valgum. 1 was referred to the orthopaedic department, 1 was very slight and referred for re-examination in 6 months, while the remaining 2 had been under treatment at the Centre and were found to be much improved. 1 was a case of Postural Kyphosis associated with Enlarged Tonsils and fatigue. He is now attending the Centre for treatment. (3) Bronchial Catarrh and Bronchitis.-6 were noted, most of whom had medical treatment as advised. In addition there were: 2 cases of Dermatitis which were treated and cured; 1 case of Squint which is under hospital treatment; 1 case of Enuresis which is under hospital treatment; 1 case of Otorrhœa associated with Enlarged Tonsils which is attending the Centre. 1 child had a Hernia and was wearing a truss supplied at the hospital. Group B.-Children examined at their second routine medical inspection. All 5 had gained in height and weight. 3 who had been found to have Enlarged Tonsils, and had been advised tonsillectomy, had had the operation. The condition of Genu Valgum noted in 3 had improved under treatment. 1 had had a nævus, noted at the first medical inspection, treated at hospital. 1 case of Otorrhœa had been cured at the Centre. 79 Group C.-Children examined at their third routine medical inspection. Of the 2 who came up for this examination, 1 had attended the Centre for Genu Valgum and was found to be much improved. The other, whose tonsils had been found to be slightly enlarged at the second medical inspection, and were now causing symptoms, was referred to the Ear, Nose and Throat Surgeon. Both had gained well in weight and height. Group D.-Children Re-examined. (a) Of the 5 referred for tonsillar enlargement, I had had tonsillectomy. 1 was suffering from frequent colds and was referred to the Ear, Nose and Throat Surgeon. The enlargement in 2 cases had subsided to the normal, due, no doubt, to the excellent hygienic conditions prevailing in the Nursery Classes. The slight enlargement in the last case had not increased, and was giving rise to no apparent symptoms. (b) Postural Kyphosis noted 6 months previously in 2 cases had been rectified through exercises at school, and no doubt through the Nursery School routine. (c) The legs were now straight in one child who 6 months previously had had Genu Valgum. The other, re-examined for this defect, was referred to the orthopaedic centre as no improvement was found. Specially referred case.-This was a child who suffered from fatigue and frequent attacks of Bronchial Catarrh. While the Nursery School routine had undoubtedly done much to improve his physique and raise his resistance to disease, it was felt that he could be further assisted by a course of Ultra Violet Ray treatment, and he was accordingly referred to that department. Dental Caries.-It is interesting to find that of the 11 children found to have carious teeth, 9 had enlarged tonsils. 3 attended the Centre for dental treatment. Cleanliness.-The standard of cleanliness of Hair, Skin and Clothing was even better maintained than during the previous year as shown by the cleanliness inspections carried out by the Health Visitor each term (which totalled 137 examinations). No children were excluded from school on account of uncleanliness, and no Cleansing Notices were served on the parents. The Incidence of Infectious Diseases.-12 cases of Chicken Pox occurred during 1933 among the scholars attending the Nursery School. The source of infection in 4 cases was the home, where a brother or sister was lying ill with this complaint, or was just recovering from it. There were also 2 cases of Nasal Diphtheria. Both were removed to the Willesden Municipal Hospital, where 1 had his enlarged tonsils and adenoids removed. 1 case of Pneumonia occurred, and was admitted to the Central Middlesex County Hospital. 1 child had Mumps, and another had German Measles. The ncidence of Infectious Disease in the Nursery Classes during the year was notably small, while the pread of such diseases as Chicken Pox and Nasal Diphtheria were very limited, due, no doubt, to the excellent hygienic conditions prevailing in these classes. 80 APPENDICES. APPENDIX A-VITAL STATISTICS. Appendix A.-Table I. VITAL STATISTICS OF WHOLE DISTRICT DURING 1933 AND PREVIOUS YEARS; VITAL STATISTICS OF THE WARDS DURING 1933. Year. Population estimated to Middle of each Year. Whole District. Births. Total Deaths Registered in the District. Transferable Deaths Nett Deaths belonging to the District. Uncor rected Number. Nett. Number. Rate 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 population. Number. Rate per 1,000 Nett Births, Number. Rate per 1,000 popution. (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 1933 190,875 1,855 2,671 13.99 1,716 8.99 213 383 123 46 1,885 9.88 * Census population-Re-adjusted by Registrar-General to 167,200. WARDS. 1. S. Kilb'n 13,811 170 239 17.31 149 10.79 1 31 12 50.21 179 12.96 2. Mid K'b'n 14,035 130 214 15.25 135 9.62 4 27 9 42.06 158 11.26 3. N. Kilb'n 12,988 117 211 16.25 139 10.70 15 41 11 52.13 165 12.70 4. Brondsb'y Park 9,908 81 121 12.21 70 7.06 0 24 1 8.26 94 9.49 5. Kensal Rise 13,295 111 172 12.94 107 8.05 2 25 4 23.26 130 9.78 6. Harl'd'n 16,586 119 188 11.33 152 9.16 4 43 *16 85.11* 191 11.52 7. Stonebridge 21,179 367 285 13.46 268 12.65 106 34 20 70.18 196 9.25 8. Roundwood 15,471 148 234 15.13 152 9.82 30 20 8 34.19 142 9.18 9. Church End 16,116 154 220 13.65 127 7.88 3 28 15 68.18 152 9.43 10. Willesden Green 16,318 166 255 15.63 128 7.84 3 31 8 31.37 156 9.56 11. Cricklewood 41,168 292 532 12.92 289 7.02 45 78 19 35.71 322 7.82 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. *8 out of the 16 deaths occurred in children at the National Adoption Society's Hostel, Connaught House, Acton Lane, N.W. 10. Subtracting these 8, the infant mortality rate for the Harlesden Ward is 42.55. 81 Appendix A.-Table II.-DEATHS OF WILLESDEN RESIDENTS DURING THE YEAR 1933. CAUSE OF DEATH. (1) All Ages. (2) 0 to 1 (3) 1 to 5 (4) 5 to 10 (5) 10 to 15 (6) 15 to 20 (7) 20 to 25 (8) 25 to 35 (9) 35 to 45 (10) 45 to 55 (11) 55 to 65 (12) 65 to 75 (13) 75 to 85 (14) 85 Up. (15) Total deaths, whether of "Residents" or "Non-Residents," in Institutions in the District. (16) All Causes Certified 1,885 123 48 24 19 33 44 106 122 214 344 402 307 99 892 Uncertified - - - - - - - - - - - - - - - 1.-Infections and Parasitic Diseases. Typhoid Fever 1 - - - 1 - - - - - - - - - 1 Paratyphoid Fever - - - - - - - - - - - - - - 1 Typhus Fever - - - - - - - - - - - - - - - Relapsing Fever. ("Spirillum Obermeieri") - - - - - - - - - - - - - - - Undulant Fever - - - - - - - - - - - - - - - Small Pox - - - - - - - - - - - - - - - Measles 1 - - 1 - - - - - - - - - - - Scarlet Fever 1 - - - - - - - - - - - - - 1 Whooping Cough 12 5 7 - - - - - - - - - - - 9 Diphtheria 11 2 5 - 4 - - - - - - - - - 11 Influenza 55 - 1 - 1 2 - 1 5 6 13 12 13 1 11 Cholera - - - - - - - - - - - - - - - Dysentery - - - - - - - - - - - - - - - Plague - - - - - - - - - - - - - - - Erysipelas 4 - - 1 - - - - 1 1 - 1 - - 4 Acute Poliomyelitis 1 - 1 - - - - - - - - - - - 1 Encephalitis Lethargica - - - - - - - - - - - - - - - Cerebro-Spinal Fever 3 - 1 - - - - - - - - - - - 3 Glanders - - - - - - - - - - - - - - - Anthrax - - - - - - - - - - - - - - - Rabies - - - - - - - - - - - - - - - Tetanus - - - - - - - - - - - - - - 1 Tuberculosis of the Respiratory System 125 - 2 1 - 3 14 24 31 28 13 9 - - 41 Tuberculosis of the Central Nervous System 6 1 1 2 - 2 - - - - - - - - 5 Tuberculosis of the intestines and peritoneum 1 - - - - - - - - - - - - - 2 Tuberculosis of the vertebral column 3 - - - - - - 1 - 1 - - 1 - 2 Tuberculosis of other bones and joints 1 - - - - - - - - - - 1 - - - Tuberculosis of skin and subcutaneous tissues - - - - - - - - - - - - - - - Tuberculosis of lymphatic system (abdominal and bronchial glands excepted) 1 - - - - - - - - - - - - - - Tuberculosis of genito-urinary system - - - - - - - - - - - - - - - 82 Tuberculosis of other organs - - - - - - - - - - - - - - Disseminated Tuberculosis 4 - - - 1 - 1 1 1 - - - - - 1 Leprosy - - - - - - - - - - - - - - - Syphilis 7 - - - - - - 1 - 2 3 1 - - 5 Other venereal diseases - - - - - - - - - - - - - - - Purulent infection, septicaemia 1 - - - - - - - 1 - - - - - 1 Yellow Fever - - - - - - - - - - - - - - - Malaria - - - - - - - - - - - - - - - Other diseases due to protozoa - - - - - - - - - - - - - - - Ankylostomiasis - - - - - - - - - - - - - - - Hydatid cysts 1 - - - - - - - - - - 1 - - - Other diseases due to helminths - - - - - - - - - - - - - - - Mycoses - - - - - - - - - - - - - - - Other infectious or parasitic diseases - - - - - - - - - - - - - - 1 2.-Cancer and other tumours. Cancer of the buccal cavity, and pharynx 6 - - - - - - 1 - 1 2 2 - - 5 Cancer of the digestive organs and peritoneum 126 - - - - 1 - - 4 19 39 40 20 3 55 Cancer of the respiratory organs 19 - - - - - - 2 1 5 8 2 1 - 13 Cancer of the uterus 27 - - - - - - - 2 8 12 4 1 - 12 Cancer of other female genital organs 12 - - - - - - - 2 3 4 2 1 - 8 Cancer of the breast 25 - - - - - - 1 3 8 5 4 1 3 8 Cancer of the male genito-urinary organs 17 - 1 - - - - - 1 2 5 3 5 - 10 Cancer of the skin 1 - - - - - - - - - - - - 1 1 Cancer of other or unspecified organs 27 - - - - - - 2 1 6 8 7 1 2 8 Non-malignant tumours 0 - - - - - 1 1 - 3 - - - - 7 Tumours of undetermined nature 7 - - 1 1 - - 1 - 2 1 1 - - 3 3.—Rheumatism, Diseases of Nutrition and of Endocrine Glands and the General Diseases. Rheumatic Fever 11 - - - 1 3 - 2 1 2 2 - - - - Chronic rheumatism, Osteo-Arthritis 10 - - - - - - - - 2 - 3 4 1 1 Gout - - - - - - - - - - - - - - - Diabetes 22 - - - 2 1 - 2 2 3 4 8 - - 18 Scurvy - - - - - - - - - - - - - - - Beri-beri - - - - - - - - - - - - - - - Pellagra - - - - - - - - - - - - - - - Rickets 2 1 - 1 - - - - - - - - - - 1 Osteomalacia - - - - - - - - - - - - - - - Diseases of the pituitary gland - - - - - - - - - - - - - - - Diseases of the thyroid and parathyroid glands 6 - - - - - - - 2 1 1 2 - - 5 Diseases of the Thymus 1 - 1 - - - - - - - - - - - 1 Diseases of the adrenals 4 - - - - - - - 1 1 1 1 - - 1 Other general diseases 1 - - - - - - - - 1 - - - - 1 83 Appendix A.-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) 4.-Diseases of the Blood and blood forming organs. Hemorrhagic conditions 1 - 1 - - - - - - - - - - - 1 Anaemia Chlorosis 8 - - - - - - - 1 - 1 6 - - 1 Leukaemia, Aleukaemia 13 - - - - 1 2 2 1 2 3 2 - - 4 Diseases of the Spleen - - - - - - - - - - - - - - - Other diseases of the blood and blood forming organs - - - - - - - - - - - - - - - 5.-Chronic Poisoning. Alcoholism (acute or chronic) - - - - - - - - - - - - - - 1 Chronic poisoning by other organic substances 1 - - - - - - - - - - - - - - Chronic poisoning by mineral substances - - - - - - - - - - - - - - - 6.—Diseases of the Nervous System and Sense Organs. Encephalitis 5 - 1 - - 1 - 1 1 - 1 - - - 2 Meningitis 5 - 2 - - 1 2 - - - - - - - 5 Tabes Dorsalis (Locomotor ataxy) 2 - - - - - - - - - 1 - - 1 1 Other diseases of the spinal cord 4 - - - - - 1 - - - - 3 - - 3 Cerebral haemorrhage, Apoplexy, etc. 103 - - - - - - - 2 6 27 32 29 7 75 General Paralysis of the Insane 2 - - - - - - - - 2 - - - - - Other forms of insanity 5 - - - - - - 1 2 - 1 - 1 - 2 Epilepsy 8 1 - - - 1 1 4 1 - - - - - 3 Infantile convulsions (under 5 years of age) 3 2 1 - - - - - - - - - - - 1 Other diseases of the nervous system 12 - - - 1 - - - - 2 3 5 1 - 7 Diseases of the eye and annexa - - - - - - - - - - - - - - - Diseases of the ear and of the mastoid sinus 6 1 - 1 1 - - 3 - - - - - - 4 7.-Diseases of the Circulatory System. Pericarditis 3 - - - - - - 1 - 1 - 1 - - 1 Acute endocarditis 7 - - - - 2 - - 3 - - 1 - 1 3 Chronic endocarditis, Valvular disease 65 - 1 - - 1 - 4 2 6 17 20 12 2 9 Diseases of the Myocardium 207 - - - - 2 - - 2 12 44 59 68 20 49 Diseases of the coronary arteries, Angina pectoris 30 - - - - - - - 3 4 10 12 1 - 4 Other diseases of the heart 44 - - - 1 - 2 - 1 6 7 16 8 3 34 84 Aneurysm 7 - - - - - - - 4 1 2 - - - 4 Arteriosclerosis 63 - - - - - - 1 - 5 13 16 24 4 11 Gangrene 5 - - - - - - 1 - - - 2 1 1 4 Other diseases of the arteries 3 - - - - - - - - 1 - 1 1 - 1 Diseases of the veins (varix, hæorrhoids, phlebitis, etc.) - - - - - - - - - - - - - - - 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 3 - - - - 1 - 1 - - 1 - - - 2 Diseases of the larynx 2 - - - - - - - 1 - 1 - - - 1 Bronchitis 63 2 1 - 1 - 1 - - 4 13 14 17 10 10 Broncho-Pneumonia 70 9 7 1 - 2 1 - 4 7 12 13 11 3 44 Lobar Pneumonia 23 - - 1 1 - 2 2 1 2 5 6 3 - 14 Pneumonia (not otherwise defined) 31 1 2 1 - - - 4 - 9 4 7 2 1 20 Pleurisy 6 - 1 - - - - - - 2 1 1 1 - 2 Congestion and haemorrhage infarct of lung etc. 8 1 - - - - - - - 1 - 4 1 1 7 Asthma 3 - - - - - 1 - - 1 - 1 - - 3 Pulmonary Emphysema 1 - - - - - - - - - - 1 - - - Other diseases of the respiratory system 4 - - - - - - - - 3 - 1 - - 4 9.-Diseases of the Digestive System. Diseases of the buccal cavity, pharynx, etc. 7 - - 3 - 1 1 1 - - - - 1 - 6 Diseases of the oesophagus - - - - - - - - - - - - - - 1 Ulcer of the stomach or duodenum 20 - - - - - - 2 4 5 4 3 2 - 14 Other diseases of the stomach 3 - - - - - - - 1 - 1 1 - - 1 Diarrhœa and Enteritis 32 27 - - - - 1 3 - - - 1 - - 15 Appendicitis 12 - 1 - - - 1 2 1 2 3 2 - - 11 Hernia, Intestinal obstruction 22 - 1 1 - - - 1 - 1 3 9 3 3 10 Other diseases of the intestines 4 - - - - - - - - 1 2 1 - - 3 Cirrhosis of the Liver 4 - - - - - - - - 1 2 1 - - 4 Other diseases of the liver 1 - - - - - - - - 1 - - - - 1 Biliarv calculi 3 - - - - - - - - - 1 - 2 - 3 Other diseases of the gall bladder and ducts 4 - - 1 - - - - - - - 1 2 - 3 Diseases of the pancreas 1 - - - - - - - - - 1 - - - 1 Peritonitis without stated cause - - - - - - - - - - - - - - 1 85 Appendix A.- 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) 10.-Non-Venereal Diseases of the Genito-Urinary System and Annexa. Acute nephritis 6 1 1 - - - - 1 1 2 - - - - 2 Chronic nephritis 37 - - - - - 1 1 4 3 10 10 6 2 19 Nephritis not stated to be acute or chronic 8 - - - - 1 - - - 1 2 2 2 - 4 Other diseases of the kidney and annexa 8 - 1 1 - - - 1 2 - 1 1 1 - 4 Calculi of the urinary passages 1 - - - - - - - 1 - - - - - 1 Diseases of the bladder 6 - - - - - - - - - 1 3 1 1 1 Diseases of the urethra, urinary abscess etc. - - - - - - - - - - - - - - - Diseases of the prostate 15 - - - - - - - 1 - 2 7 3 2 12 Diseases of the male genital organs - - - - - - - - - - - - - - - Diseases of the female genital organs 5 - - - - - 1 - 4 - - - - - 1 11.-Diseases of Pregnancy, Childbirth and the Puerperal State. Post abortive sepsis 1 - - - - - - - 1 - - - - - 1 Abortion not returned as septic 2 - - - - - - 2 - - - - - - 1 Ectopic gestation - - - - - - - - - - - - - - - Other accidents of pregnancy - - - - - - - - - - - - - - - Puerperal haemorrhage 3 - - - - - - 3 - - - - - - 3 Puerperal sepsis 6 - - - - - - 3 3 - - - - - 1 Puerperal albuminuria and convulsions - - - - - - - - - - - - - - - Other toxaemias of pregnancy - - - - - - - - - - - - - - - Puerperal phlegmasia alba dolens, embolism, and sudden death 1 - - - - - - - 1 - - - - - - Other accidents of childbirth 1 - - - - - - 1 - - - - - - - Other or unspecified conditions of the puerperal state - - - - - - - - - - - - - - - 12.-Diseases of the Skin and Cellular Tissue. Carbuncle, Boil 4 - - - - 1 - - 2 - 1 - - - - Cellulitis, Acute abscess 6 - - - - - - - 1 1 - 2 2 - 4 Other diseases of the skin and its annexa 1 - - - - - - - - - - - 1 - 2 86 13.-Diseases of the Bones and Organs of Locomotion. Acute infective osteomyelitis and periostitis 1 - - - - 1 - - - - - - - - 1 Other diseases of the bones 1 - - - - - - - 1 - - - - - i Diseases of the joints and other organs of locomotion - - - - - - - - - - - - - - 14. -Congenital Malformation. Congenital malformations 14 10 2 1 1 - - - - - - - - - 10 15.-Diseases of Early Infancy. - - - - - - - - - - - - - - - Congenital debility 11 11 - - - - - - - - - - - 11 Premature birth 35 35 - - - - - - - - - - - - 18 Injury at birth 1 1 - - - - - - - - - - - - 1 Other diseases peculiar to early infancy 11 11 - - - - - - - - - - - - 7 16.-Old Age. Old age 81 - - - - - - - - - - 13 45 23 68 17.-Deaths from Violence. Suicide by solid or liquid poisons and corrosive substances 7 - - - - - - 3 1 2 1 - - - 1 Suicide by poisonous gas 12 - - - - - - 3 1 3 3 2 - - l Suicide by hanging or strangulation 2 - - - - - 1 - - 1 - - - - - Suicide by drowning 2 - - - - 1 - - - - 1 - - - - Suicide by firearms 1 - - - - - - - - - 1 - - - - Suicide by cutting or piercing instruments 2 - - - - - - - - - - - - - 1 Suicide by jumping from high place 1 - - - - - - 1 - - - - - - - Suicide by crushing 2 - - - - - - - 1 - - 1 - - - Suicide by other means - - - - - - - - - - - - - - - Infanticide (under one year) - - - - - - - - - - - - - - - Homicide by firearms - - - - - - - - - - - - - - - Homicide by cutting or piercing instruments 1 - - - - - - - - - - - - - - Homicide by other means 1 - - - - - - - - - - - - - - Attack by venomous animals - - - - - - - - - - - - - - - Food poisoning 2 - - - - - - - - - - - - - 2 Accidental absorption of irrespirable or poisonous gas - - - - - - - - - - - - - - - Other acute accidental poisoning (not by gas) 1 - - - - - - 1 - - - - - - 1 Conflagration - - - - - - - - - - - - - - - Accidental burns (Conflagration excepted) 8 - 4 1 - - 1 - - - 1 - 1 - 4 Accidental mechanical suffocation - - - - - - - - - - - - - - - Accidental drowning 1 - - - - - - - - - - - - - - Accidental injury by firearms - - - - - - - - - - - - - - - Accidental injury by cutting or piercing instruments 1 - - - - - 1 - - - - - - - 1 87 Appendix A.- 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 (3) 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. 58 - 1 4 1 4 5 9 2 5 9 13 2 3 35 Cataclysm - - - - - - - - - - - - - - - Injury by animals (poisoning by venomous animals excepted) - - - - - - - - - - - - - - - Hunger or thirst - - - - - - - - - - - - - - - Excessive cold - - - - - - - - - - - - - - - Excessive heat 1 - - - - - - - - 1 - - - - - Lightning - - - - - - - - - - - - - - - Electricity (lightning excepted) - - - - - - - - - - - - - - - Other and unstated forms of accidental violence 4 - - - - - - 1 - - - 1 2 - 3 Violent deaths of unstated nature (i.e. accidental, suicidal, etc.) Wounds of war - - - - - - - - - - - - - - - Execution of civilians bv belligerent armies - - - - - - - - - - - - - - - Execution - - - - - - - - - - - - - - - 18.-Ill-Defmed Diseases. Sudden death 1 - - - - - - - - - - - 1 - - Cause of death unstated or ill-defined 2 1 - - - - - - - - - - 1 - - Totals 1,885 123 48 24 19 33 44 106 122 214 344 402 307 99 892 88 Appendix A.-Table 11(a). CAUSES OF DEATH IN BOROUGH OF WILLESDEN AS CIRCULATED BY REGISTRAR-GENERAL.-1933. Causes of Death. M. F. All Causes 924 966 1. Typhoid and paratyphoid fevers 1 - 2. Measles 2 - 3. Scarlet fever 1 - 4. Whooping cough 3 9 5. Diphtheria 4 7 6. Influenza 29 24 7. Encephalitis lethargica - - 8. Cerebro-spinal fever 2 1 9. Tuberculosis of respiratory system 75 50 10. Other tuberculous diseases 8 7 11. Syphilis 5 2 12. General paralysis of the insane, tabes dorsalis 8 - 13. Cancer, malignant disease 110 154 14. Diabetes 12 12 15. Cerebral haemorrhage, etc. 40 58 16. Heart disease 164 189 17. Aneurysm 7 1 18. Other circulatory diseases 29 33 19. Bronchitis 26 36 20. Pneumonia (all forms) 67 61 21. Other respiratory diseases 12 15 22. Peptic ulcer 15 6 23. Diarrhcea etc (under 2 years) 11 13 24. Appendicitis 6 6 25. Cirrhosis of liver 2 3 26. Other diseases of liver, etc. 2 7 27. Other digestive diseases 22 24 28. Acute and chronic nephritis 23 34 29. Puerperal sepsis - 7 30. Other puerperal causes - 8 31. Congenital debility, premature birth, malformaations, etc. 49 23 32. Senility 23 58 33. Suicide 17 12 34. Other violence 53 28 35. Other defined diseases 94 78 36. Causes ill-defined or unknown 2 - Special Causes (included in No. 35 above):- Small-pox - - Poliomyelitis - 1 Polioencephalitis - - Deaths of Infants under 1 year Total 74 49 Legitimate 61 42 Illegitimate 13 7 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 1933. Statutes:- Children and Young Persons Act, 1933. Rent and Mortgage Interest Restrictions Act, 1933. Slaughter of Animals Act, 1933. Local Government Act, 1933. Ministry of Health:- Circulars:- No. 1326.-Maternity and Child Welfare-Infant Life Protection. No. 1331.-Housing Act, 1930 Part I. No. 1325.-Public Health (Imported Food) Amendment Regulations, 1933. No. 1336.-Local Government Act, 1929-Appointment of Health Visitors. No. 1337.-The Deaf and Dumb. No. 1337a.-Prevention of Deafness. No. 1345.-Public Health (Imported Food) Regulations, 1925. Public Health (Imported Food) Amendment Regulations, 1933. No. 1350.-Public Health (Imported Food) Regulations, 1925. Public Health (Imported Food) Amendment Regulations, 1933. No. 1364.-Public Health (Imported Food) Regulations, 1925. Public Health (Imported Food) Amendment Regulations, 1933. No. 1348.-Rent and Mortgage Interest Restrictions (Amendment) Act, 1923. Decontrol of working-class houses. No. 1354.-Rent and Mortgage Interest Restrictions (Amendment) Act, 1923. Decontrol of working-class houses. No. 1349.-Slaughter of Animals Act, 1933. No. 1353.-Certification of blindness. No. 1356.-Ambulance services. No. 1365.-Treatment of ex-service men suffering from tuberculosis. No. 1365a.-Treatment of ex-service men suffering from tuberculosis. No. 1368.-Treatment of tuberculosis. Statutory Rules and Orders:- Housing Consolidated Amendment Regulations, 1932 (S.R. & O., 1933, No. 648). Local Government (Qualifications of Medical Officers and Health Visitors) (Amendment) Regulations, 1933 (S.R. & O., 1933, No. 408). Public Health (Imported Food) Amendment Regulations, 1933 (S.R. & O., 1933, No. 347). Provisional Rules and Orders:- Rent and Mortgage Interest Restrictions (Amendment) Act, 1933. Provisional regulations under Section 14 for prescribing certain forms of notices and application for registration (dated 19th July, 1933). Memoranda:- No. 171/Med.-Antimony poisoning due to the use of enamelled vessels. Secretary of State:- Circular:- Children and Young Persons Act, 1933. Juvenile Offenders: Children and Young Persons in Need of Care or Protection. Regulations:- Children and Young Persons (Voluntary Homes) Regulations, 1933 (S.R. & O., 1933, No. 775). Children and Young Persons (Boarding Out) Rules, 1933 (S.R. & O., 1933, No. 787). Summary Jurisdiction (Children and Young Persons) Rules, 1933 (S.R. & O., 1933, No. 819/L.23). 89-90 appendix a. table III.-infant mortality during 1933. Nett Deaths from Stated Causes at various ages under 1 year of age. Nett Deaths from, alt causes under 1 year of age classified in Wards. Cause of Death. Under 1 Week. 1-2 Weeks. 2-3 Weeks. 3-4 Weeks. Total under 4 Weeks. 4 Weeks and under 3 Months. 3 Months and under 6 Months. 6 Months and under 9 Months. 9 Months and under 12 Months. Total Deaths under 1 year. WARDS. South Kilburn. Mid-Kilburn. North Kilburn. Brondesbury Park. Kensal Rise. Harlesden. Stonebridge. Roundwood. Church End. Willesden Green. Cricklewood. (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) (13) (14) (15) (16) (17) (18) (19) (20) (21) (22) All Causes Certified 47 6 2 6 61 24 16 13 9 123 12 9 11 1 4 16 20 8 15 8 19 Uncertified - - - - - - - - - - - - - - - - - - - - - Small Pox - - - - - - - - - - - - - - - - - - - - - Chicken Pox - - - - - - - - - - - - - - - - - - - - - Measles - - - - - - - - - - - - - - - - - - - - - Scarlet Fever - - - - - - - - - - - - - - - - - - - - - Whooping Cough - - - - - 2 - 2 1 5 2 - - - - - 2 - - - 1 Diphtheria and Croup - - - - - - - 1 1 2 - - - - - - 1 - - - 1 Erysipelas - - - - - - - - - - - - - - - - - - - - - Tuberculous meningitis - - - - - - - 1 - 1 - - 1 - - - - - - - - Abdominal Tuberculosis (a) - - - - - - - - - - - - - - - - - - - - - Other Tuberculous Diseases - - - - - - - - - - - - - - - - - - - - - Meningitis (Not Tuberculous) - - - - - - - - - - - - - - - - - - - - - Convulsions 1 - - - 1 - - 1 - 2 1 - - - - - - - 1 - - Laryngitis - - - - - - - - - - - - - - - - - - - - - Bronchitis - 1 - - 1 - 1 - - 2 1 - - - - - - - - 1 - Pneumonia (all forms) 1 - - 1 2 2 2 2 2 10 - - 1 - 1 - 3 - 1 2 2 Diarrhœa - 1 - 2 3 7 10 4 3 27 3 1 1 1 1 12 2 2 3 - 1 Gastritis - - - - - - - - - - - - - - - - - - - - - Syphilis - - - - - - - - - - - - - - - - - - - - - Rickets - - - - - - - 1 - 1 - - - - - - - - - 1 - Suffocation, overlying - - - - - - - - - - - - - - - - - - - - Injury at birth 1 - - - 1 - - - - 1 - - - - - - - - - - 1 Atelectasis 11 - - - 11 - - - - 11 - - 1 - - 1 2 - 1 1 5 Congenital Malformations (b) 4 - 1 2 7 2 1 - - 10 - 2 2 - 1 1 2 - 1 - 1 Premature Birth 25 3 1 1 30 5 - - - 35 5 2 3 - 1 1 6 3 6 2 6 Atrophy, Debility and Marasmus 3 1 - - 4 5 2 - - 11 - 3 2 - - - 2 1 2 1 - Other Causes 1 - - - 1 1 - 1 2 5 - 1 - - - 1 - 2 - - 1 Total Deaths 47 6 2 6 61 24 16 13 9 123 12 9 11 1 4 16 20 8 15 8 19 Deaths- Legitimate 44 5 2 5 56 17 12 13 7 105 10 9 11 1 3 8 15 8 13 8 19 Illegitimate 3 1 - 1 5 7 4 - 2 18 - - - - 1 *8 5 - 2 - - Births- Legitimate ... ... ... ... ... ... ... ... ... 2,587 227 212 201 115 170 185 278 221 217 246 515 Illegitimate ... ... ... ... ... ... ... ... ... 84 12 2 10 6 2 3 7 13 3 9 17 Total Births ... ... ... ... ... ... ... ... ... 2,671 239 214 211 121 172 188 285 234 220 255 532 Infant Mortality Rate- Legitimate ... ... ... ... ... ... ... ... ... 40.59 44.05 42.45 54.73 8.70 17.65 43.24 53.96 36.20 59.91 32.52 36.89 Illegitimate ... ... ... ... ... ... ... ... ... 214.29 166.67 - - - 500.00 *2666.67 714.29 - 666.67 - - Infant Mortality Rate ... ... ... ... ... ... ... ... ... 46.05 50.21 42.06 52.13 8.26 23.26 85.11 70.18 34.19 68.18 31.37 35.71 Population ... ... ... ... ... ... ... ... ... 190875 13,811 14,035 12,988 9,908 13,295 16,586 21,179 15,471 16,116 16,318 41,168 (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 8 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. 91 appendix a—Table IV.—CASES OF INFECTIOUS DISEASE NOTIFIED DURING THE YEAR 1933. Notifiable Disease. Number of Cases Notified. Total Cases Notified in each Ward. At all Ages. At ages—Years. South Kilburn. Mid-Kilburn. North Kilburn. Brondesbury Park. Kensal Rise. Harlesden. Stonebridge. Roundwood. Church End. Willesden Green. Cricklewood. Total Cases removed to Willesden Municipal Hospital. Under 1. 1 and under 2. 2 and under 3. 3 and under 4. 4 and under 5. 5 and under 10. 10 and under is. 15 and under 20. 20 and under 35. 35 and under 45. 45 and under 65. 65 and over. (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) (13) (14) (15) (16) (17) (18) (19) (20) (21) (22) (23) (24) (25) (26) Smallpox 2 - - - - - - - - 2 - - - - - - - - - - 1 - - 1 * Cholera (C) Plague (P) - - - - - - - - - - - - - - - - - - - - - - - - - Diphtheria (including Membranous Croup) 392 12 15 30 26 34 126 58 23 51 11 5 1 55 39 22 10 22 24 69 20 32 40 59 368 Erysipelas 100 2 2 1 - 1 4 5 7 20 21 24 13 13 8 6 4 4 6 22 10 6 7 14 37 Scarlet fever 694 5 24 37 55 50 304 128 36 43 8 4 - 64 85 55 23 38 35 40 78 85 59 132 623 Typhus fever - - - - - - - - - - - - - - - - - - - - - - - - - Enteric fever 13 - - - - - 2 3 1 4 1 2 - 1 - - - - 2 4 1 1 3 1 10 Relapsing fever (R) Continued fever (C) - - - - - - - - - - - - - - - - - - - - - - - - - Puerperal fever 13 - - - - - - - - 9 4 - - 2 2 1 - - 1 - 1 1 2 3 4 Puerperal pyrexia 36 - - - - - - - - 31 4 1 - 5 3 7 1 - 6 2 1 - 3 8 4 Cerebro-spinal meningitis 6 - 1 1 - - - - 1 3 - - - - 1 1 1 - - 1 1 1 - - 2 Poliomyelitis 14 - 4 1 2 1 3 2 - - - 1 - 4 - 1 - - 1 2 - 3 1 2 3 Ophthalmia neonatorum 20 20 - - - - - - - - - - - 2 - 2 1 1 1 4 3 1 2 3 2 Pulmonary tuberculosis 247 - 1 - 1 - 3 9 21 98 43 61 10 18 25 16 7 21 23 27 18 13 26 53 - Other forms of tuberculosis 47 1 2 - 2 2 9 6 8 10 3 2 2 6 4 4 - 2 5 5 2 3 4 12 - Whooping cough 524 54 68 64 71 65 190 7 1 3 - 1 - 55 36 24 13 22 55 96 73 34 73 43 21 Pneumonia 335 7 15 7 7 7 40 20 17 53 43 82 37 55 22 17 7 21 28 64 39 27 19 36 3 Malaria - - - - - - - - - - - - - - - - - - - - - - - - - Dysentery 1 - - - - - 1 - - - - - - 1 - - - - - - - - - - - Encephalitis lethargica 1 - - - - - - - - - 1 - - 1 - - - - - - - - - - - Acute polio encephalitis - - - - - - - - - - - - - - - - - - - - - - - - - Anthrax - - - - - - - - - - - - - - - - - - - - - - - - - Totals 2,445 101 132 141 164 160 682 238 115 327 139 183 63 282 225 156 67 131 187 336 248 207 239 367 1,077 * Removed to London County Council Smallpox Hospital. 93 APPENDIX C. MOTOR SERVICE. I beg to report on the above for the nineteenth completed year ended 31st March, 1933. At the 31st March, 1933, the following vehicles were in use:- Table No. 1. Reg. No. Tax. Make. Year of Purchase. Work required for. Total miles run with vehicles. Purchase Price. 1. M.F.4117 Nil. Crossley 4/1924 Sickness and Accidents 97,907 £892 2. M.H. 3808 £26 Crossley 3/1925 School work 84,833 £823 3. M.H. 8989 £16 Berliet 7/1925 Education Department and Miscellaneous 62,957 £405 4. M P. 3711 £18 Dennis 5/1928 School work 45,956 £760 5. M.P. 3712 £18 Dennis 5/1928 School work 45,486 £760 6. M.T. 810 £20 Armstrong 11/1928 Health Department 45,538 £800 7. M.Y. 967 £18 Dennis 8/1929 School work 38,012 £762 8. M.Y. 19 £20 Armstrong 11/1929 Education Department 43,840 £538 9. M.Y. 26 Nil. Armstrong 2/1930 Sickness and Accidents 46,970 £854 10. H.X. 12 Nil. Armstrong 1/1931 Sickness and Accidents 37,943 £860 11. H.X. 5178 £18 Dennis 8/1931 School work 15,953 £665 12. H.X. 5179 £18 Dennis 8/1931 School work 16,669 £665 13. M.V. 1800 Nil. Armstrong 4/1932 Infectious cases 5,489 £825 14. M.V. 2860 £18 Dennis 7/1932 School work 6,638 £687 15. A.M.C. 175 £25 Morris 3/1933 Disinfection Laundry and Kingsbury. 72 £289 Table No. 2. The following gives the miles run by each vehicle in service during the year under review:- 1. Sickness and Accident Ambulance M.F. 4117 2,627 2. School Ambulance M.H. 3808 7,076 3. Education Department and Miscellaneous M.H. 8989 4,368 4. School Ambulance M.P. 3711 7,737 5. School Ambulance. MP. 3712 7,655 6. Health Department M.T. 810 10,108 *Health Department V.C. 8519 333 7. School Ambulance M.Y. 967. 9,856 8. Education Department M.Y. 19 11,262 †Education Department G.O. 1971 295 9. Sickness and Accident Ambulance M.Y. 26 13,800 10. Sickness and Accident Ambulance H.X 12 17,789 11. School Ambulance H.X. 5178 9,085 12. School Ambulance H.X. 5179 9,989 13. Infectious Ambulance M.V. 1800 5,429 14. School Ambulance M.V. 2860 6,438 15. ‡ Disinfection Van (Sold 3/1933) M.X. 1884 8,249 15. Disinfection Van A.M.C. 175 72 Total * 132,168 * Hired during repair of M.T. 810. † Hired during repair of M.Y. 19. ‡ Sold on purchase of A.M.C. 175. 94 Table No. 3. 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 1932-33 132,168 Total 1,558,208 Table No. 4. Calls. The following table shews the number of calls for the Disinfection Van and Ambulances 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. 1/4/32 to 31/3/33. Grand Total 1913-1933. Disinfection Van 16,673 1,250 1,130 1,063 933 21,049 Ambulance Calls, including Sickness, Accident, Maternity and Infectious Cases 34,993 3,766 4,041 4,434 4,700 51,934 51,666 5,016 5,171 5,497 5,633 72,983 Table No. 5. The following gives details of the miles run during the year under review:— Special School work 59,327 Accidents, Sickness and Infectious cases 26,296 Disinfection 5,802 Education Department 10,430 Education—Elementary 170 Accounts Department 1,203 Engineer's Department 239 Clerk's Department 2,184 Health Department 9,243 Municipal Hospital work 193 Miscellaneous 163 Library Department 4 Maternity Hospital, Kingsbury 15,791 Fire Brigade 94 Juvenile Employment Department 26 Clerk of Works 1,003 132,168 95 Table No. 6. 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 1932-33 132,168 11,102 11.904 13.065 Vehicle No. 1 (Table 1)-namely, the Crossley Sickness and Accident Ambulance-has now run nearly 100,000 miles, and will have completed its tenth year of service at the end of the current financial year. Arrangements have been made to replace this ambulance, which is now no longer reliable, before April, 1934. Vehicle No. 3 (Table 1)-namely, the Berliet car-which does miscellaneous work, was purchased over 8 years ago. Its frame was fractured in 1928, and was repaired at the time. More recently, in August, 1933, the car had an accident and the Insurance Company offer £26 towards the repair of the car. Having regard to the present value of the car, it does not appear to be worth while to have it repaired, and I would recommend the Council to accept the £26 for repairs, and obtain a new light car to carry out the miscellaneous work which this car is now doing. A fourseater saloon, costing £150-£200, would be quite suitable for this work. During the financial year 1934-35 it will not be necessary to continue the scheme of replacement inaugurated by the Council as the next vehicle to be replaced, namely Vehicle No. 2 (Table 1), the Crossley School 'bus, is likely to remain serviceable throughout the year. During the year under review the chief work done by the service has been- (1) The conveyance of physically and mentally defective and blind and stammering children to and from school. There are in all 306 such children on the list for conveyance, and on the average 255 are conveyed daily along 13 different routes. (2) The conveyance of cases of sickness, accident, maternity and infectious disease to hospitals. 4,700 such cases were removed in 1932-33. (3) The transport of laundry to Kingsbury Hospital, Health Centres, Special Schools and Mortuary. (4) Conveyance of meals from the Feeding Centres to the Physically and Mentally Defective Schools. (5) Certain works for other departments. Staff.-'The staff consists of a Mechanic Superintendent and Engineer, who is also Engineer to the Hospital; one assistant engineer; one fitter's mate; and 14 motor drivers. There are thus 15 vehicles to be manned and a night service to be maintained with only 14 drivers. Of the 14 motor drivers two are wholly employed on Vehicles Nos. 6 and 8 (Table 1), 6 are allocated to 6 school 'buses and Vehicle No. 2 (Table 1)-namely, the Crossley school 'bus, which is used as a relief school 'bus and also does work in respect of the conveyance of school meals, and 1 driver is on the Disinfection Van. This leaves 5 men to man 4 ambulances and do the miscellaneous work done by Vehicle No. 3 (Table 1)-namely, the Berliet car. The work of these 5 men is supplemented by the spare time of the 6 men on the school 'buses, but when it is remembered that many of the ambulance calls require two men, and that it takes more than 3½ men to keep one man on 24 hours per day, it will be understood that although the workshop staff and even the hospital porters occasionally are used to assist the Service, that nevertheless some calls have to be refused or kept waiting because staff is not available. It should also be noted that each member of the staff gets 14 days annual leave, and that it is only exceptionally that any man is employed as a holiday relief. 96 It would, of course, require a very large staff to make sure that every call was attended to immediately, but the service would be improved if an additional man were on duty at the Ambulance Station throughout the 24 hours. This addition would make reasonable provision for a thoroughly good service for the public. It will be observed that at least three additional men would be required for this purpose, and at the current rate of wage, namely, £3 11s. 0d. per week per man, £554 per annum would be added to the cost of the Ambulance Service. The Committee may consider that the very rare complaints they receive do not justify this increase in expenditure. Garage.-During the year the extension to the garage was completed at a cost of £2,928. There is now available at the garage at the Municipal Hospital accommodation for a total of 31 vehicles allowing 200 square feet for each. 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 delivery hose. Workshop Plant.-This is in good order and effects a great saving, both in Motor and Hospital repairs which are both increasing. Cost.-The analytical table of costs prepared by the Finance Department is appended. GEORGE F. BUCHAN, Medical Officer of Health. 97 Finance Department, Town Hall, Dyne Road, N.W.6. August, 1933. APPENDIX D. REPORT ON DERMATO LOGICAL AND ACTIN OTHERAPEUTIC DEPARTMENT FOR THE YEAR ENDED DECEMBER 31st, 1933, by H. D. HALDIN-DAVIS, M.D., F.R.C.P., F.R.C.S. There is no outstanding development to report in the department for the last year. Things have worked smoothly and the number of attendances made demonstrates the continued popularity of the services rendered. There has been a considerable increase in the number of patients suffering from ulceration of the leg, who have taken advantage of the opportunities now offered by the Council for the relief and in many cases the cure of this distressing condition. This increase is probably due to the fact that WILLESDEN URBAN DISTRICT COUNCIL. MOTOR SERVICES. Year Ended 31st March, 1933. Year 1931-32. Cost per mile. Expenditure. Year 1932-33. Cost per mile £ s. d. £ s. d. d. £ s. d. £ s. d. d. Running Expenses- 596 6 7 Petrol 709 13 4½ 36 15 2 Oil and grease 41 10 10 102 11 11½ Tyres 102 4 3 735 13 8½ 1.335 853 8 5½ 1.550 Wages and Emoluments- 376 11 0 Mechanic Superintendent 380 0 0 3,305 18 l½ Drivers, etc 3,267 0 2½ 31 10 0 National Insurance 34 3 1 3,713 19 6.742 3,681 3 3½ 6.684 Fixed and General Charges- 187 0 0 Rent (Garage and Mess Room) 187 0 0 119 14 8 Repairs, plant, etc. 123 15 10 56 7 5½ Painting, etc., bodies of vehicles 89 2 4 78 14 2 Coal, gas, etc. 79 3 0 110 14 8 Uniforms and Overalls 97 9 0 118 17 3 Insurance of vehicles 110 12 9 196 5 0 Motor car registration 207 3 3 6 0 0 Drivers' licences, etc. 6 5 0 60 19 2 Accessories and sundries 58 1 10 Loan charges on New Garage 217 0 0 934 12 4i 1.697 1,175 13 0 2.135 Depreciation and Interest Charges- 1,210 0 0 Amount written off value of vehicles in accordance with Medical Officer of Health's Valuation 1,320 5 0 147 5 4 Interest on Capital employed 164 13 4 1,357 5 4 2.464 1,484 18 4 2.696 £6,741 10 6½ 12.238d £7,195 3 1 13.065d. Income. Use of vehicles for:- 23 15 6 Conveyance of children 13 0 0 71 14 0 Conveyance of patients 72 4 0 5 12 0 Election purposes - - - 1 11 0 Sale of scrap - - - £102 12 6 £85 4 0 11,055 gallons Petrol consumed 11,102 gallons. 132,208 Miles run by all vehicles 132,168 11.959 Miles run per gallon of petrol consumed 11.905 Vehicles in use:- 31st March, 1932 14 31st March, 1933 15 98 the success of the treatment offered has become more widely known in the district, and patients who had regarded themselves as hopeless have been tempted to try the more modern methods now available to them Even in those cases in which definite cure has not been possible, great relief from pain has been afforded to the patients, and nothing is more encouraging than to hear the remark "I have had the first decent night's sleep I have had for years." I have to report still further diminution in the number of cases of ringworm of the scalp occurring in Willesden-only two have had to be treated by X-ray during the whole year. The apparatus which was originally purchased for the X-ray treatment of ringworm in 1913 has now become inefficient and badly needs repair. Had there been any large number of cases to be treated a new apparatus would have been required and this would have involved the Council in considerable expense. In order to obviate this arrangements have been made to treat the few cases which from time to time are still detected, at the dermatologist's own house. The Artificial Sunlight Department works smoothly but it must be pointed out that at the Stonebridge Health Centre the dressing-room accommodation is unsatisfactory, as it is often unavoidably encroached upon, not only by the needs of the orthopaedic department, but also by the children attending the nursery. It is hoped that during next year steps will be taken to remedy this inconvenience. 99 ARTIFICIAL SUNLIGHT TREATMENT, YEAR ENDED 31st DECEMBER, 1933. Conditions. Cases brought forward from 1932,i.e.: Treatments, Waiting List, Observation Cases. (1) New Cases. (2) Total Cases Treated. (3) Discharged not Treated, i.e., Unable to attend, Unsuitable, Left District. (4) Waiting List. (5) RESULTS OF TREATMENT. Cases Still under Treatment (Result not yet known). (10) Cases carried forward to 1934, i.e Treatments, Waiting List, Observation Cases. (11) Condition Improved. Treatment suspended but still under Observation. (6) Improved or Cured. (7) Unable to attend or Left District before treatment completed. (8) Unsuitable or no Improvement. (9) E.M. 0-5 5-14 E.M. 0-5 5-14 E. M. 0-5 5-14 0-5 5-14 0-5 5-14 0-5 5-14 0-5 5-14 0-5 5-14 0-5 5-14 E. M. 0-5 5-14 E. M. 0-5 5-14 Tuberculosis -Glands - - - - - 4 - - 4 - - - - - - - 1 - 2 - - - - 1 - - 1 Pre -Tubercular - - 2 - - 1 - - 3 - - - - - - - 1 - 1 - - - - 1 - - 1 - - 2 - - 5 - - 7 - - - - - - - 2 - 3 - - - - 2 - - 2 General Debility - 41 58 1 95 104 1 129 155 6 2 1 5 6 3 58 81 29 17 3 4 1 33 50 1 40 58 Anaemia - 5 5 - 4 9 - 8 13 - 1 1 - - - 3 5 5 - - - - - 8 - 1 8 Rickets - 20 - - 36 - - 52 - - - 4 - 3 - 19 - 19 - - - - 11 - - 18 - Enlarged Glands - - 4 - 3 6 - 3 10 - - - - 1 1 1 5 - - - - - 1 4 - 2 5 Rheumatism - - 3 - - 6 - - 8 - 1 - - - 1 - 2 - 1 - 1 - - 3 - - 4 Nerves - 1 - - 2 8 - 3 7 - 1 - - - - 1 2 1 1 - 1 - 1 3 - 1 3 Chilblains - - 1 - - - - - 1 - - - - - - - 1 - - - - - - - - - - Marasmus - - - - 1 - - 1 - - - - - - - - - - - 1 - - - - - - - - 67 71 1 141 133 1 196 194 6 5 6 5 10 5 82 96 54 19 4 6 1 46 68 1 62 78 Chronic Blepharitis - - 4 - 1 2 - - 6 1 - - - - - - 2 - 2 - - - - 2 - - 2 Photophobia - 1 - - - - - 1 - - - - - - - 1 - - - - - - - - - - - - 1 4 - 1 2 - 1 6 1 - - - - - 1 2 - 2 - - - - 2 - - 2 Asthma - 1 6 - 3 17 - 4 22 - 1 - - - 3 1 6 2 1 - - - 1 12 - 1 15 Bronchitis - 11 17 - 11 24 - 20 39 1 1 2 2 2 11 22 4 2 - 1 - 3 12 - 6 16 - 12 23 - 14 41 - 24 61 1 1 1 2 2 5 12 28 6 3 - 1 - 4 24 - 7 31 Alopecia Areata - - 3 - 1 2 - 1 5 - - - - - 1 1 1 - 1 - 1 - - 1 - - 2 - - 3 - 1 2 - 1 5 - - - - - 1 1 1 - 1 - 1 - - 1 - - 2 Otorrhoea - - 1 - - 3 - - 4 - - - - - - - 1 - 1 - - - - 2 - - 2 Furunculosis - - 1 - 1 2 - 1 2 - 1 - - - - - 2 1 - - - - - - - - - Enuresis - 1 - - 1 7 - 1 6 1 1 - - - 1 - - 1 1 - 2 - - 2 - - 3 Hirschspring's Disease - - 1 - - - - - 1 - - - - - - - - - - - - - - 1 - - 1 Haemophilia - - - - - 1 - - - - 1 - - - - - - - - - - - - - - - - Genu Valgum - - - - 3 1 - 3 1 - - - - - - 2 - 1 - - - - - 1 - - 1 Delayed Physical Development - 1 - - - - - 1 - - - - - - - - - 1 - - - - - - - - - - 2 3 - 5 14 - 6 14 1 3 - - - 1 2 3 4 2 - 2 - - 6 - - 7 Total - 82 106 1 162 197 1 228 287 9 9 7 7 12 12 98 132 64 30 4 10 1 50 103 1 69 122 188 360 516 18 14 24 230 94 14 154 192 TOTAL NUMBER OF ATTENDANCES, YEAR ENDING 31st DECEMBER, 1933. E.M. 0-5 School. Total. Attended and Treated 12 3,919 6,830 10,761 Attended for examination, e.g., new cases, cases treated and still under observation, unsuitable cases 1 118 200 319 Total 13 4,037 7,030 11,080 Total number of sessions 518 Average attendance per session 21.4 Average treatment per child 20.8 CASES REFERRED BY E.M. 0-5 School. Total. Clinic Doctors 1 152 183 336 Private Doctors — 7 11 18 Hospital — 1 3 4 Total 1 160 197 358 APPENDIX E. REPORT ON WORK IN THE EYE DEPARTMENT FOR THE YEAR ENDED 31st DECEMBER, 1933, By FRANK W. LAW, M.A.,M.D.,F.R.C.S.,B.Chir., Ophthalmic Surgeon to the Council. The total figures for the year are shown below. Those for the preceding three years are also given for the purposes of comparison. Total Attendances. 1930 3,740 1931 6,118 1932 7,303 1933 7,385 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% 1933 1,525 1,352 88.7% Arrangements are now such that it is possible to keep the numbers attending the sessions within manageable limits ; it will be noticed that the average number of Refraction Appointments booked per session has fallen by just over 1, and the Refraction Attendances by almost exactly 1, at each Clinic. It has rarely been necessary to deal with an unwieldy number of refractions ; the following table shows the number of occasions upon which more than 12, and more than 15, appointments have been booked:— Table I. Over 12. Over 15. Clinic 1 12 3 Clinic 2 16 5 Clinic 3 24 7 The general routine at the sessions remains unaltered. The optical dispensing has been satisfactorily carried out; the fact that the optician has not been changed for some years has made it possible thoroughly to supervise the work, with the result that one now knows that this is efficient and thorough ; this knowledge has enabled one still further to reduce the number of unimportant attendances. Treatment cases have been enthusiastically and satisfactorily cared for ; a few cases have been, as before, admitted to the Central London Ophthalmic Hospital, or to the Paddington Green Children's Hospital, under my care, for treatment or operation. The figures for the year are as follows:- Total Attendances. Table II. Total Attendances. Number of Sessions. Average Attendance per Session. Clinic 1 2,089 45 46.4 Clinic 2 2,544 46 55.3 Clinic 3 2,752 47 58.6 Refraction Cases. Table III. Appts. made. Average per Session. Appts. kept. Average per Session. Percentage Attendance. Clinic 1 448 10 372 8.3 83% Clinic 2 511 11.1 474 10.3 92.8% Clinic 3 566 12 506 10.8 89.4% 101 Subjective Testing with a + 1.0D Sphere. -It will be recalled that this scheme, in the form in which it was proposed by the Board of Education, was abandoned last year, and that a modified scheme was adopted. This consisted in making a record, at routine school medical inspections, of all children who, with 6/6 unaided vision, show a diminution in acuity of three or more Snellen lines when a +1.0D sphere is placed before the eye. These children were then to be specially noted at the next medical inspection, and were to be referred to me if the diminution of acuity at the second examination was greater than at the first. The extremely significant result emerges that, in the fifteen months concerned, not one such case was referred. The only deduction one can draw from this is, that the leakage in the discovery of progressive myopes, which obtains in the ordinary methods of subjective testing, is nil. This is actually less to be wondered at when it is remembered that it was found last year that the leakage in the case of even stationary myopes was exceedingly small -in 52 unselected cases, sent up under the " +1-0D scheme," only one myope was discovered. Medicinal Treatment of Progressive Myopia. -This investigation is not yet complete ; a sufficient number of patients have been put under treatment for conclusions to be drawn when the time comes. From a cursory inspection of results it would appear that the measure is of definite benefit in the treatment of progressive myopia. APPENDIX F. REPORT ON THE WORK OF THE ORTHOPEDIC CENTRE FOR THE YEAR ENDED 31 st DECEMBER, 1933. by H. J. SEDDON, F. R. C. S., Orthopaedic Surgeon to the Council. The most striking feature of the work at the Stone bridge Health Centre is the rarity of severe deformity or serious bone and joint disease among the children who attend. This is, I think, to be attributed to two factors. In the first place, as Willesden is not far from several large general and special hospitals there is a tendency among the parents of children with serious deformity to attend one of these hospitals on their own initiative, and it is only when the hospital wishes out-patient treatment to be continued at a Clinic that we see these patients. Secondly, the routine examination of infants and school children is undoubtedly reducing the incidence of severe deformity ; it is now possible to correct almost every early case of club-foot by manipulative treatment at the Clinic, and similarly most cases of knock-knee yield readily to splint treatment and operative correction is rarely called for. The organisation of the orthopaedic clinic leaves nothing to be desired. The case cards never leave one in doubt as to the reason for the child's attendance at the Clinic, and the collateral information about previous illnesses and non-orthopaedic defects is most helpful. The Masseuse is to be congratulated on her enthusiasm and careful attention to the details of treatment ordered. The follow-up work on cases that have ceased to require treatment, but are in need of observation, is excellent, and one cannot recall any case of importance that has not been faithfully ''rounded up'' for re-examination at the time specified. 102—103 APPENDIX F. ORTHOPAEDIC DEPARTMENT. —REPORT FOR YEAR ENDING 31st DECEMBER, 1933. Defects Treated. Brought Forward. New. Total. Treatments completed. Treatments ceasing before completion. Still under Treatment. Carried forward. 0-1 1-5 5-14 E. M. N. M. 0-1 1-5 5-14 E. M. N. M. 0-1 1-5 5-14 E. M. N. M. Total. 0-1 1-5 5-14 E. M. N. M. Total. 0-1 1-5 5-14 E. M. N. M. Total. 0-1 1-5 5-14 E. M. N. M. Total. General Bone Diseases 29 151 41 - 34 126 32 - 63 277 73 - 413 16 66 16 - 98 12 119 16 - 147 35 92 41 - 168 Deformities of Feet 10 46 45 1 4 33 74 2 14 79 119 3 215 - 13 26 1 40 3 24 37 1 65 11 42 56 1 110 Congenital Deformities 17 3 7 - 11 5 3 - 28 8 10 46 6 3 1 - 10 3 3 2 - 8 19 2 7 - 28 Tubercular Conditions - 2 7 - - - 3 - - 2 10 - 12 - 1 4 - 5 - - - - - - 1 6 - 7 Postural Defects of Spine 2 5 86 - - 5 70 1 2 10 156 1 169 - 1 31 1 33 1 1 62 - 64 1 8 63 - 72 Infantile Paralysis - - 13 - 1 3 9 - 1 3 22 - 26 - 1 7 - 8 - - 2 - 2 1 2 13 - 16 Erbs Paralysis 1 - 2 - - - - - 1 - 2 - 3 - - 1 - 1 - - - - - 1 - 1 - 2 Spastic Paralysis 1 9 8 - 1 2 3 1 2 11 11 1 25 1 1 1 - 3 - 4 2 - 6 1 6 8 1 16 Paresis of Digits 1 - 2 - - - - - 1 - 2 - 3 - - - - - - - - - - 1 - 2 - 3 Traumatic Conditions 1 - 8 - 2 - 18 1 3 - 26 1 30 2 - 12 - 14 1 - 3 1 5 - - 11 - 11 Debility 4 8 2 - - 5 5 2 4 13 7 2 26 - 2 1 - 3 - 5 2 1 8 4 6 4 1 15 Lymphangioma - 1 - - - - - - - 1 - - 1 - - - - - - - - - - - 1 - - 1 Ganglia 1 3 1 - - 3 - 1 - 6 1 8 1 - 1 1 3 - - 2 - 2 - - 3 - 3 Total 67 225 224 2 53 179 220 7 120 404 444 9 977 26 88 101 3 218 20 156 128 3 307 74 160 215 3 452 No. of individual cases treated 63 217 214 2 53 179 220 7 116 396 434 9 955 26 87 97 3 213 20 154 122 3 299 70 155 215 3 443 No. of Attendances at Centre for Treatment 367 1,719 6,222 66 8,374 Do. do. do. Massage 258 701 1,714 61 2,734 Cases Referred for Hosnital In -Patient Treatment - Do. do. do. Electrical Treatments 7 223 569 10 809 General Bone Diseases - 3 2 - 5 Do. do. do. Gymnastic Exercise - 661 5,423 42 6,126 Deformities of Feet - - 1 - 1 Do. do. do. Application Of Splints 167 553 294 1 l015 Congenital Deformities - 1 1 - 2 Tubercular Conditions - - 2 - 2 Total 432 2,138 8,000 114 10,684 Postural Defects of Spine - - 1 - 1 No. of Individual Cases not requiring Treatment 14 44 60 1 119 Infantile Paralysis l - 1 - 2 Do. Attendances at Centre made by these 22 58 82 1 163 Spastic Paralysis - - 2 - 2 Traumatic Conditions - - 2 - 2 Total Attendances at Centre 389 1,777 6,304 67 8,537 Cases Entered Hospital for In-patient Treatment- General Bone Diseases - 3 3 - 6 Deformities of Feet _ - - 2 - 2 Congenital Deformities - 1 - - 1 Tubercular Conditions - - 1 - 1 Infantile Paralysis 1 - 3 - 4 Traumatic Conditions - - 2 - 2 Total 1 4 11 - 16 Total l 4 12 - 17 In addition to the above the Council undertook the cost of treatment of 2 children of school age in the Royal National Orthopaedic Hospital who were referred to Hospital by other agencies. Altogether, including those brought forward from last year, the Council maintained children in hospital for orthopaedic defects as follows:- I. Maternity and Child Welfare-Children under 5 years of age 9 II. School children- (a) Under arrangements made under Education Act, 1921, Section 80: (i.) Ordinary Elementary School Children 11 (ii.) Special Schools Children 5 (b) Under Special Schools Vote 3 Total School Children 19 III. Total Children 28 APPENDIX G. REPORT OF THE GENERAL PURPOSES COMMITTEE ON THE CLEARANCE AND IMPROVEMENT AREAS. -HOUSING ACT, 1930. SUBMITTED TO THE COUNCIL 13th OCTOBER, 1933. 1.-Pursuant to the reference back by the Council of our previous report we have again given the subject matter of our reference detailed consideration, and re-submit our previous recommendation in regard to Clearance Areas Nos. 1 to 13 below :- I. -We recommend that the following be provisionally adopted as constituting the Council's programme of re-housing to be undertaken during the ensuing five years under the provisions of the Housing Act, 1930 :- (1) A list of the areas in which clearance is necessary, with information of the number of houses to be demolished in each, and of the number of their inhabitants. Clearance areas. No. of dwelling houses to be demolished. No. of families. No. of inhabitants. No. of buildings not in occupation as dwelling houses to be demolished. (1) Comprising- Alpha Place North, Nos. 1, 2, 3, 4, 5, 6, 7,8,9,10,11, 12, 13a North, 13a South, 13b, and 14, 15, 16, 17, 18, 19, 20, 21, 22, 23 and 24. Alpha Yard. Newton Mews. 27 57 225 5 (2) Comprising- Alpha Place, Nos. 20 and 8a. Alpha Mews, Nos. 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15 and 16. Alpha Place West, Nos. 1, 2, 3, 4, 5, 6, 7, 8, 9, 5a, and building at rear of No. 1 Alpha Place West. 26 37 156 3 (3) Comprising- Canterbury Road, Nos. 13a, 13b, 13c, 15 and 15a 5 5 22 - (4) Comprising- Bridge Street, Nos. 1, 2, 3, 22a, building adjoining 22a, 23, 24, 25, 26, 27, 28, 29, 30, 31, 31a, 32, 33 and 34. Billiard Hall in Yard. Oxford Road, Nos. 1, 1b, 1d and lc. Kilburn High Road, Nos. 35, 37 and 39. - 22 28 117 4 (5) Comprising- Pembroke Place, Nos. 1 to 14 consecutively 14 15 70 - (6) Comprising- Park Mews, Nos. 2-32 even and 1-39 odd 33 33 146 3 (7) Comprising- Park Road Mews, Nos. 1 to 10 consecutively 10 10 49 - (8) Comprising- Stafford Mews, Nos. 1 to 21 consecutively 19 20 80 2 105 Clearance areas. No. of dwelling houses to be demolished. No. of families. No. of inhabitants. No. of buildings not in occupation as dwelling houses to be demolished. (9) Comprising- Cambridge Mews East, Nos. 1 to 9 consecutively and a single-storey food store 9 9 45 1 (10) Comprising- Cambridge Mews West, Nos. 1 to 5 consecutively and No. 1 Percy Yard 5 5 22 1 (11) Comprising- Lincoln Mews, Nos. 1 to 18 consecutively 18 18 94 - (12) Comprising- Market Place Yard, Nos. 1, 2 and 3 3 3 15 - (13) Comprising- Canterbury Yard, Nos. 1, 2, 3 and 4 1 1 5 3 192 241 1,046 22 2. -We have given further consideration to the area which we formerly recommended should be dealt with by improvement or reconditioning, and we are now of opinion that this area in whole or in part should be dealt with in conjunction with the clearance areas Nos. 1, 2 and 3. The area comprises the following:- Canterbury Road, 61 premises; Chichester Road, 13 premises; Cambridge Avenue, 8 premises ; Alpha Place, 5 premises. A total of 87 premises, involving 194 families and 626 inhabitants. We recommend accordingly. We are of opinion that areas (1) and (2) can be dealt with during the first year, and the remaining areas dealt with at later periods as our experience indicates. We further recommend that the Clerk be instructed to submit the foregoing programme to the Minister of Health in due course. The next step will be for the Medical Officer to make an official representation to the Council wherever he is of opinion:- (a) That any area is an area which should be dealt with as a clearance area ; (b) That any area is an area which should be dealt with as an improvement area ; (c) That any individual dwelling-house is unfit for human habitation. This authority is required to take into consideration any such representations of the Medical Officer and may then make any necessary clearance or improvement Order which would be subject, of course, to the confirmation of the Minister of Health. II. -Whilst the Council is required to provide accommodation in advance of demolition, it is not possible at this stage to give any precise indication of the financial aspects of the programme of re-housing contemplated during the next five years, but we feel it desirable to draw attention to the following facts:- (a) Exchequer subsidy at the rate of £2 5s. per annum for a period of 40 years is payable in respect of each person displaced, or £3 10s. per annum in cases where it is necessary to provide accommodation in tenement buildings of more than three storeys ; (b) A local subsidy of £3 15s. per annum is payable from the General Rate Fund in respect of each additional house or flat erected ; (c) There is no liability upon the Council to re-house displaced tenants at the same rents as those previously paid, but the Council is empowered to charge differing rents for the same types of property in cases where the circumstances justify this course ; 106 (d) Properties included in a clearance area may be dealt with either by(i.) Requiring the owner to demolish the properties ; or (ii.) By the Council itself acquiring the properties at site value, and afterwards undertaking demolition. (d) (ii.) is the course which it will be necessary to adopt in cases where it is desired to develop a cleared site or to retain it as an open space, and the necessary negotiations will be undertaken by the District Valuer on behalf of the Council. III. -After a preliminary survey of the question of re-housing persons displaced from the areas outlined in the foregoing programme and consideration of the Engineer's report thereon, it may not be possible to re-house the whole of such persons on the cleared sites, and we therefore recommend that in respect of any clearance or improvement areas which may be designated subsequently, the Council should agree to allocate for the erection of the necessary accommodation whatever portion of the Curzon Crescent land may be found to be required therefor, and that the consideration of any other scheme for the development of the Curzon Crescent land should be deferred until our final reports have been submitted. IV. -We would point out that the necessary detailed inspections of the properties included in the foregoing programme will involve considerable additional work in the Health Department, and we accordingly recommend the Medical Officer be authorized to advertise for two additional temporary Sanitary Inspectors at scale salary, and that the appointments be made by the Establishment Committee at its September meeting. We further recommend the Council to adopt the following scheme, which consists entirely of improvement areas, in respect of the second quinquennial period:- 1938-43. During this second five-year period work on other Improvement Areas in Willesden will be commenced. These Improvement Areas are probably all included in the following:- South Kilburn. All that portion of the Urban District that lies south of the London, Midland and Scottish Railway main line, and east of Salisbury Road, excepting the 12 Clearance Areas and the Improvement Area mentioned above. There might be several Improvement Areas scheduled here, but the bulk of the property in this area requires reconditioning. This means that 1,506 houses inhabited by 18,685 persons require to be dealt with. Lower Place. The area to be dealt with here comprises Barrett's Green Road, Corby Road, Steele Road and Disraeli Road. 159 houses inhabited by 1,714 persons are involved. Stone bridge. The properties requiring attention in this area are situate in Carle Avenue, Milton Avenue, Shakespeare Avenue, Shelley Road, Shrewsbury Road, Melville Road, Winchelsea Road, Mordant Road, Wesley Road, Brett Road, Barry Road, Denton Road and Hillside from Shrewsbury Road to Denton Road. There are 1,036 properties housing 9,297 persons to be dealt with in this group. Kensal Green. The area requiring attention here involves Hiley Road, St. Margaret's Road, Earls mead Road, Greyhound Road, Felixstowe Road, Hazel Road, Ravens worth Road, Victor Road, Napier Road, and that portion of Purses Road which lies west of College Road. This includes 603 houses with a population of 4,772. It is not easy to give an estimate of the amount of overcrowding in these areas but it is not inconsiderable, and houses would require to be provided for persons displaced from such areas. 3.-On consideration of the report dealing with the question of overcrowding, the enforcement of the bye-laws with regard to houses let in lodgings, and housing inspection generally, we are of opinion that steps should be taken to arrange for a census of the houses affected by the bye-laws mentioned, with a view to the bye-laws being actively administered. This step will, in our opinion, form an important link in the whole scheme for the amelioration of overcrowding and similar conditions. For these purposes the Medical Officer reports that two further Sanitary Inspectors (permanent) and one additional Clerk will be required, and we concur in his report. We recommend- (a) That the Medical Officer of Health be authorized to take the necessary steps to carry out the census of houses let in lodgings ; (b) That he be authorized to engage such additional assistance to the extent indicated above, as and when it becomes necessary. We would remind the Council that these three appointments are in addition to the two Inspectors already mentioned in Clause No. 1 (IV) of this Report, and that, so far as the total of four Sanitary Inspectors is concerned, the appointments will be subject to the approval of the Ministry of Health. 107 APPENDIX H. REPORT OF HEALTH (VISITING) SUB-COMMITTEE, PRESENTED TO HEALTH COMMITTEE 12th DECEMBER, 1933, AND RECOMMENDATIONS ADOPTED BY COUNCIL 19th DECEMBER, 1933. MATERNITY HOSPITAL. We report that we visited the above hospital. Extension of Maternity Hospital. The Chairman of the Health Committee reported that he had had the question of the extension of the Maternity Hospital under consideration with the Medical Officer of Health and the Engineer. Present Accommodation. -At the present time there are 24 beds in the general wards and 2 beds for isolation purposes at this hospital. The bookings for confinement in the hospital in 1932 were 544, and approximately the same number, estimated at 560, will be booked during 1933. In both years the hospital has been utilised to capacity. The Council will remember that owing to the demand for confinement in this hospital the bookings have been restricted to 45 per month since January 26th, 1932. Cases refused. The following table prepared by the Medical Officer of Health shows that some 335 cases will have been refused admission to the Willesden Maternity Hospital in 1933 against the corresponding number of 255 in 1932:- 1932. 1933. (Approximate number based on actuals up to the end of October, 1933.) Beds not available 16 109 Not resident in Willesden 37 59 Will not have had 12 months' residence in Willesden prior to expected date of confinement 125 103 Unable to pay anything 12 19 Sufficient home accommodation 63 43 Owes Council a sum from last confinement 1 2 Unwilling to give address 1 - Totals 255 335 Demand for Hospital Confinement. -It will thus be observed that the demand for institutional confinement is increasing. In 1933 approximately 867 Willesden residents will have been confined in institutions other than the Council's Maternity Hospital as compared with a corresponding figure of 687 in the previous year. The following table prepared by the Medical Officer of Health gives particulars of these cases:- 1932. 1933. (Approximate number based on information available up to 31st Oct., 1933.) Central Middlesex County Hospital 200 288 Queen Charlotte's Hospital 173 206 Queen Mary's Maternity Home 65 66 Middlesex Hospital 27 25 St. Mary's Hospital 26 43 University College Hospital 21 20 Fordwych Nursing Home 51 53 Smaller numbers from numerous hospital and nursing homes 124 166 Totals 687 867 108 In 1932 the total number of births amongst Willesden residents was 2,745, of which 1,231 (544 and 687) were born in institutions. In 1933 the total number of births will be about the same and approximately 1,427 (560 and 867) will be born in institutions. Provision for Ante-Natal Complications. -The Medical Officer of Health has reported that difficulty is experienced in securing the necessary immediate admission to the Maternity Hospital of cases with complications during pregnancy, and as it is essential in the interests of safe confinement that these cases should be adequately dealt with, provision for this group of cases has to be made in connection with any extension of the hospital. Extension required. -In all these circumstances the Chairman of the Health Committee expressed the opinion that it was essential that additional provision should be made at the Maternity Hospital for the Willesden residents refused admission to the Hospital and the admission of certain ante-natal cases for which at the moment sufficient provision does not exist. The Chairman reported that he had been in consultation with the Engineer and the Medical Officer of Health as to the cost of extension of the hospital to double its present size and the cost of equipment. Capital Cost. -The Engineer has reported that the extension would cost £19,500 if put up in brick and tile and £350 to £400 less than this if constructed in the same way as the present hospital. The Medical Officer reports that the cost of equipping the additional beds would be £1,500 Annual Maintenance. -With regard to the question of annual maintenance, it is estimated that the annual maintenance of the extension, including loan charges, would cost £6,700, less an income of £1,000 estimated to be obtained from the patients, or net £5,700 per annum, less any additional sum obtained by way of increased block grant. We have carefully considered the report of the Chairman and have heard the Medical Officer of Health and Engineer and inspected the preliminary plans. We recommend:- (1) That the report of the Chairman be approved and adopted; (2) That the Engineer be instructed to proceed with the plans ; to prepare working drawings and bills of quantities ; and to obtain tenders for the erection of the building ; (3) That a sum of £1,500 be allocated for the equipment of the building when complete ; and (4) That based on the tender accepted application be made to the Ministry of Health for the necessary loan for the building and equipment.