with the Compliments of the Medical Officer, Willesden AC 439 (1) WILLESDON M WIL 30 Borough of Willesden. 1934. THE 59th 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; Vice-President, Royal Sanitary Institute. London: WIGHTMAN & CO., LIMITED, Regency Street, Westminster, S.W. 1, and Dugdale Street, S.E. 5. 2 CORPORATION OF WILLESDEN, 1934-35. HIS WORSHIP THE MAYOR. ALDERMAN W. A. HILL, J.P. Deputy Mayor. † Alderman GEORGE H. HISCOCKS, J.P. Aldermen. †‡BLAXLAND, H. C. *†‡CLEE, J. BOLTON, C. HICKS, M.A. *†‡§COWAN, Miss N. M. *†‡§BOLTON, W. M. *DORAN, A. E. *†‡§BOND, P. (Chairman, Health Committee LEIGH MOSSLEY, H. and Housing Act 1930 Sub-Committee.) SAVORY, H. J. Councillors. AYRES, G. *†‡MARSHALL, H. C. †‡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. (Chairman Education Committee.) *†HILL, W. J. SAMUELS, P. J. HOBBS, J. R. †SCOTT, S. †HOBSON, C. R. STILTON, W. A. HURLEY, G. J. *THORLEY, H. JEFFRIES, W. *†§WALLIS, Mrs. V. B. (Chairman, Health Visiting Sub-Committee.) †§JONES, A. E. WESTON, GEO. KELLY, H. J. J WHITE, Mrs. R. *†KEN YON, J. G. *WILKINS, R. H. LLOYD, Rev. T. D.. B.A. *WILLIAMS, Mrs. S. E. H. (Chairman, Children's Care Sub-Committee.) *†WORSFOLD, Mrs. A. B. * Member of the Children's Care Sub-Committee. † Member of Health Committee. ‡ Member of Housing Act 1930 Sub-Committee. § Member of Health Visiting Sub-Committee. 3 Town Hall, Dyne Road, Kilburn, N.W. 6. 1st April, 1935. 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 1934. This Report includes:— (i.) The 59th Annual Report on the health and sanitary condition of the district; (ii.) The 27th Annual Report on the health of children attending the public elementary schools; (iii.) The 15th Annual Report on the health of children attending secondary and trade schools; (iv.) The 17th 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 5th Annual Report on the Supervision of Midwives; (vi.) The 5th Annual Report on the Registration of Nursing Homes; (vii.) The 5th Annual Report on Infant Life Protection; (viii.) The 15th Annual Report on home nursing; (ix.) The 20th Annual Report on the provision of meals to children attending the public elementary schools; (x.) The 43rd Annual Report on the Municipal Hospital; (xi.) The 4th Annual Report on the Maternity Hospital; (xii.) The 5th Annual Report on the health of patients attending the Middlesex County Council Occupation Centre for Mentally Defectives, Buller Road, Willesden; (xiii.) The 4th Annual Report on Nursery Classes. (xiv.) The 1st Annual Report on the work in connection with Abnormal Children. 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, 1934, was 195,295. 2,743 live births were registered during 1934, giving a birth rate of 14.05 per 1,000 of the population, as against 13.99 in 1933. 96 still births were registered, giving a still birth rate of 33.81 per 1,000 total live and still births. 1,940 deaths were registered in 1934, giving a death rate of 9.93 per 1,000 of the population. These figures compare with a total number of deaths of 1,885 and a death-rate of 9..88 in 1933. The infant mortality rate in 1934 was 43.38 per 1,000 births. This is the lowest ever recorded in Willesden, the lowest up till this year having been 46.05 in 1933. 119 deaths of infants under one year occurred. 99 or 83.2 per cent. of these 119 deaths were due to:— Congenital Malformations 16, Premature Birth 29, Atrophy, Debility and Marasmus 7, Atelectasis 9. Diarrhoea and Enteritis 20; Measles 1; Whooping Cough 1; Bronchitis 1, and Pneumonia 15. Year by year these causes of death account for round about 80 per cent. of all deaths of infants under one year of age and active measures are required to prevent these conditions proving fatal. 4 CANCER. In Willesden in 1934 there were 281 deaths from Cancer, as compared with 260, 250, 250, 214, 239, 240 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 have been continued, but there is still a great disproportion in the number of deaths as recorded above and the number of persons attending the clinics. There has, however, been an increase in the number of new cases who attended. During 1934, 57 patients attended these Clinics, of whom 41 were new cases (17 men and 24 women) and 9 had attended during 1933 and were still under observation at the end of that year. The total attendances made in 1934 was 75. Of the 41 new cases 3 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 38 cases after examination were disposed of as follows:— 20 were referred to a hospital for further investigation; 3 were referred back to their own doctors; 4 were kept under observation and asked to re-attend (2 of these were finally discharged before the end of the year); 3 were referred to special clinics (2 of these were reassured and discharged, and 1 is still under observation); 7 were reassurred and discharged on their first visit; 1 is under observation, pending reference to hospital. Of the 20 who were referred to hospital:— 10 were found to require operation (7 have been operated upon; 1 has refused operation; 1 is awaiting operation; and 1 had left the district before operation was performed); 4 have received or are receiving treatment at hospitals as out-patients, or are being kept under observation there; 2 were advised to attend their own doctor for medical treatment; 1 was found to be pregnant and referred back to the Ante-Natal Clinic. 3 were re-assured and discharged. The pathological conditions from which 39 of the new cases suffered are briefly as follows 5 cases had abnormal breast conditions; 3 had chronic inflammation; 2 had cysts; 5 cases suffered from affections of the female genital organs, all these had conditions often found to be pre-cancerous; 9 cases had conditions affecting the digestive tract which occasionally lead to cancer; 6 cases had similar conditions of the mouth and throat; 5 cases had innocent tumours of the body wall or skin; 9 cases had conditions unconnected with cancer, but which were causing anxiety or required treatment; Of the remaining 2 new cases, one was found to be pregnant and the other was a man of 54 who came for an overhaul as he considered it desirable for a person of his age. The nurse attached to the Clinic pays following-up visits to the homes of patients attending. During last year 53 such visits were made. The nurse also visits homes where disinfection has been requested, generally after a death from cancer has taken place or after a patient has been moved 5 elsewhere. 22 houses were visited in this way. In 3 cases there had been apparently no delay in seeking medical advice. In 4 cases there appeared to have been delay between the date when the patient saw a doctor and the time when further investigation was sought. In 7 cases the delay was due either to the patients ignoring the warning signs or to their reluctance to see a doctor. One patient moved out of the district and was lost sight of, and in the remaining 7 cases no information was forthcoming. INFECTIOUS DISEASES. During the year 1934, 2,503 cases of Infectious Disease were notified as compared with 2,445 in the previous year. The total of 2,503 includes 365 notifications of Diphtheria as compared with 392 in 1933. 811 cases of Scarlet Fever as compared with 694 in 1933, 324 cases of Pneumonia as compared with 335 in 1933, 480 cases of Whooping Cough as compared with 524 in 1933, and 111 cases of Erysipelas as compared with 100 in 1933. The number of cases of Scarlet Fever is the highest since the epidemic of 1921, in which 1,527 cases were recorded. Return Cases of Scarlet Fever.—The following statement gives the return cases that have occurred during 1934:— I. Home Cases.—Approximately 70. (a) No. of infecting cases giving rise to return cases not longer than 28 days after release from isolation2 return cases they gave rise to 4 „ infecting cases per cent. of total home cases 2.8 return cases per cent. of total home cases 5.7 (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 741. (a) No. of infecting cases giving rise to return cases not longer than 28 days after discharge 28 ,, return cases they gave rise to 36 „ infecting cases per cent. of total hospital cases 3.8 „ return cases per cent. of total hospital cases 4.9 (b) No. of infecting cases giving rise to return cases more than 28 days after discharge 16 „ return cases they gave rise to 20 of infecting cases per cent. of total hospital cases 2.2 „ return cases per cent. of total hospital cases 2.2 Small Pox.—No cases of Small Pox were notified during 1934. No vaccinations were performed by the Medical Officer of Health under the Public Health (Small Pox Prevention) Regulations, 1917. Typhoid Fever.—Seven cases were notified during 1934 as against 13 in 1933 and 10 in 1932. Of the 7 cases notified, 6 were removed to hospital—5 to the Willesden Municipal Hospital and 1 to another hospital—and 1 to a Nursing Home. Of the 5 cases removed to the Willesden Municipal Hospital, 1 was diagnosed as Paratyphoid B, 1 as malignant disease of the bowel, 1 as Empyema, 1 as Acidosis and 1 Slight Sore Throat—otherwise normal. The case in the other hospital was that of a trained nurse who had been nursing a case of Typhoid Fever, result unknown. The case admitted to the Nursing home was diagnosed as (a) Lobar Pneumonia (b) Enteric Fever. This case proved fatal. Of the 5 cases admitted to the Municipal Hospital, 2 were transferred to the Central Middlesex County Hospital, 1 was advised as to suitable diet, 2 made a good recovery. Malaria.—One case of Malaria was notified during 1934. This patient had lived in Palestine and India for 6½ years and returned to England in 1933. He had suffered from previous attacks when abroad. A private doctor attended this patient in his own home and he recovered. Continued Fever.—One case of Continued Fever was notified during the year. This patient a child of 5 years was admitted to the Municipal Hospital. Diagnosis—Measles, Complications BronchoPneumonia and Otorrhoea. Made a good recovery. Infectious Diseases of the Nervous System—Cerebro-Spinal Meningitis, Poliomyelitis, Encephalitis Lethargica and Acute Polio-Encephalitis.—19 cases of these diseases were notified in 1934. 8 proved fatal, giving a fatality rate of 42 per cent. of notified cases. In one of the fatal cases the death was attributed to Polio-Encephalitis, and in 1 to Poliomyelitis. The 6 other deaths were certified as due to Cerebro-Spinal Fever. 6 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. 480 cases were notified during the year, but a total of 880 cases coming to their knowledge were visited by the Health Visitors. There were 8 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 1934, 1,805 cases of measles, which is not notifiable in Willesden, were visited by the Health Visitors. There were 22 deaths from Measles, 21 occurring in children under 5 years. MOTHERS AND CHILDREN UNDER FIVE YEARS. Municipal Centres.—At the Municipal Centres, including the Ringworm Centre, expectant mothers attended the medical consultations on 6,997 occasions; nursing mothers 24,759, and children under 5, 43,143, making a total of 74,899 attendances. Out of the total number of 2,743 children born alive during the year, 1,523 or 55.5 per cent. subsequently attended the Municipal Welfare Centres. Altogether, however, 1,837 children under 1 year of age attended the Municipal Centres for the first time during the year. This represents 69.7 per cent. of the 2,635 notified live births belonging to Willesden, and 67 per cent. of the 2,743 registered live births belonging to Willesden. 603 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 1,010; 70.2 per cent. of these mothers with their babies subsequently attended the Welfare Centres. Maternity Hospital— Bookings.—The following table shows the bookings year by year for hospital confinement under the Council's schemes since hospital provision was first made by the Council for such cases:— Table No. 1. Year. No. of Confinement Cases Booked. 1918 (part-year) 99 Maternity Pavilion at Municipal Hospital opened. 1919 267 1920 444 Restrictions began to be placed on bookings. 1921 335 1922 266 1923 140 Municipal Hospital Pavilion closed, 30th April, 1923. Cases sent to Park Royal Hospital. 1924 99 1925 146 1926 220 • 1927 221 1928 272 1929 334 1930 402 1931 535 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 1934 666 Willesden Maternity Hospital extended, 29th December, 1934. Extension.—A feature of the year's work was the extension of the Maternity Hospital. From a hospital of 31 beds, its size has been nearly doubled. In its original form the hospital had 5 labour beds, 24 lying-in beds and 2 separation beds. As extended the hospital comprises of 8 labour beds, 38 lying-in beds, 4 isolation cubicle beds and 8 ante-natal beds. The Opening Ceremony was performed by Sir Comyns Berkeley, M.A., M.D., F.R.C.P., F.C.O.G., Hon. M.M.S.A. on the 29th December, 1934. In his opening address he emphasised the importance of Ante-Natal Care and drew special attention to the provision which the Council had made in this respect in their extended hospital. 7 During 1934, 322 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 220 Not resident in Willesden 58 *Will not have had 12 months' residence in Willesden prior to expected date of confinement 34 Unable to pay fee 3 †Sufficient home accommodation 6 Balance in respect of last confinement still owing to Council 1 322 * This was changed to 3 months as from the 1st April, 1934. † This restriction removed as from 1st April, 1934. The following Table shows the fees at which the 666 cases were booked:— Table No. 3. Fee. No. of Cases. Fee. No. of Cases. £10 0s. 0d 1 £4 10s. 0d 20 £9 10s. 0d 1 £4 0s. 0d 19 £8 0s. 0d 2 £3 10s. 0d 28 £7 10s. 0d 1 £3 0s. 0d 30 £7 0s. 0d 2 £2 10s. 0d 46 £6 10s. 0d 7 £2 0s. 0d 55 £6 0s. 0d 9 £1 10s. 0d 90 £5 10s. 0d 10 £1 5s. 0d 19 £5 0s. 0d 12 £1 0s. 0d 120 Free 194 The average fee per case is approximately £1 13s. 9d. Hospital Confinements.—During 1934, 550 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, 587 births of Willesden residents being notified from such outside institutions— 161 from Queen Charlotte's Hospital, 59 from Queen Mary's Maternity Home, Hampstead, 70 from St. Mary's Hospital, 18 from University College Hospital, 27 from Middlesex Hospital, and smaller numbers from other hospitals; 75 from a nursing home and smaller numbers from other nursing homes. These, together with some 312 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. A report on the Willesden Maternity Hospital by Mr. Arnold Walker, F.R.C.S., the Council's Consultant Obstetrician, appears later on in this report. Ante-Natal Work for Institutions not under the Council.—Requests are received from the Middlesex County Council and from various London Hospitals for home visits to expectant mothers, and special reports by the Council's Health Visitors in connection with women who are to be confined in these Hospitals. 137 such reports were supplied to London Hospitals and 154 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 and the Children's Hospital, Cold Ash, during 1934:— Table No. 4. Willesden General Hospital. St. Monica's Home Hospital. Children's Hospital Cold Ash. Total. No. of Children in Hospital at 31st December, 1933 0 2 0 2 No. of Children admitted during 1934 130 10 3 143 Total No. of Children under treatment during 1934 130 12 3 145 No. of Children discharged during 1934 127 8 2 137 No. of Children died in Hospital during 1934 2 2 0 4 Mortality % 1.55 16.7 0 1.38 No. of Children remaining in Hospital at 31st December, 1934 1 2 1 4 8 The following table gives particulars of the conditions for which children were treated during 1934, the treatment carried out and the results of such treatment:— Table No. 5.—Children under 5 Years under Treatment in Hospital during 1934. 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 2 22 24 - 20 - 7 9 4 4 Enlarged Tonsils and Adenoids - 121 121 121 - - 121 - - 0 Total 2 143 145 121 20 - 128 9 4 4 Puerperal Fever.—During 1934, 9 cases of Puerperal Fever were notified as against 13 in 1933, 8 in 1932, 14 in 1931, 5 in 1930 and 6 in 1929. This gives a case rate of 3.3 per thousand registered live births, as against 4.9 in 1933, 2.9 in 1932, 4.9 in 1931, 1.7 in 1930 and 2.21 in 1929. The figure per 1,000 registered total births is 3.2 for 1934 against 4.7 for 1933. Of the 9 notified cases 1 proved fatal. The other death appearing in the death table under puerperal sepsis was notified as puerperal pyrexia. Taking the 1 death occurring amongst the 9 cases of puerperal fever notified in Willesden, this gives a case mortality of 11.1 per cent. as against 30.8 per cent. in 1933, 25 per cent. in 1932, 14.3 per cent. in 1931, 20 per cent. in 1930, 50 per cent. in 1929, and 33.4 per cent. in 1928. The maternal mortality from sepsis for 1934 was 1.5 per thousand registered live births and 1.4 per thousand registered total births. The corresponding figures for 1933 were:—2.6 per thousand registered live births and 2.5 per thousand registered total births. The maternal mortality from all causes was 3.28 per thousand registered live births and 3.17 per thousand registered total births. The corresponding figures for 1933 were:—5.2 and 5.1 respectively. In 2 of the 9 notified cases a private doctor was in attendance at the confinement at home. In both instances the patient was subsequently removed to hospital and recovered. In 2 cases a midwife attended the confinement at home. These patients were subsequently removed to hospital. One died and one made a good recovery. Five cases were confined in hospital. These all recovered. Table No. 6.—Puerperal Fever Cases, 1934. Home Circumstances. Number of Cases. Number of Rooms. Number of occupants, including new-born baby. Under 10 years. Over 10 years. Total. 1 3 1 2 3 1 3 2 2 4 1 3 3 2 5 1 (fatal) 3 2 3 5 5 Occurred in Hospital. Puerperal Pyrexia.—30 cases were notified during the year. 2 of these 30 cases proved fatal, 1 of the deaths being attributed to Puerperal Sepsis and 1 to Bilateral Broncho-Pneumonia. During 1934 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 my Annual Report for 1930, p. 10. During 1934, 177 were supplied free, 17 at full cost and 1 at part cost. 9 (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. 11 such consultations were paid for in 1934. (3) Provision of Ancesthetist.—The Council further accept responsibility for the payment of a fee to an anaesthetist, called in by a medical practitioner in connection with confinement cases. No such fee was paid in 1934. 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. 8 cases were inquired into during 1934. 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. 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 defects found in 544 children examined during the year. Table No. 7. Age Period. 18 months. 2 years. 3 years. 4 years. Total. Percentage. Number of children inspected 167 177 103 97 544 Malnutrition (including slight degrees) 11 18 6 15 50 9.2 Skin Conditions 12 12 8 4 36 6.6 Eyes—Blepharitis and Conjunctivitis - - - - 0 Squint 4 2 4 0 10 14 2.6 Other conditions 1 1 - 2 4 Ears, Otitis Media 2 2 2 3 9 1.6 Nose and Throat—Enlarged tonsils or adenoids or both 19 23 20 24 86 15.8 Enlarged Cervical Glands 5 3 7 6 21 3.9 Teeth—Dental Diseases 7 9 17 35 68 12.5 Heart and Circulation (including anaemia) 2 7 4 6 19 3.5 Lung Disease (non-tubercular) 11 10 7 8 36 6.6 Nervous System (including functional conditions) 9 9 10 4 32 5.9 Deformities—Rickets 16 15 8 7 46 8.5 Others 14 21 10 8 53 9.7 Other Defects 4 14 6 7 31 5.7 Ophthalmia Neonatorum.—The number of cases of this disease notified during the year was 28, as against 20 last year, giving a case rate of 10.2 per 1,000 registered live births. A private doctor attended at the confinement in 5 cases, a midwife in 8 cases, and 15 cases were born in hospital. Treatment was obtained at a hospital in 5 cases, at the Municipal Centres in 13 cases, and by a private doctor at home in 10 cases. Complete recovery with unimpaired vision occurred in 26 cases. 1 case died from congenital heart disease and in 1 case the result of treatment was not ascertained. 15 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. 10 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 1934,532 Mothercraft sessions were held, with 5,337 attendances of mothers, and 4,726 attendances at the nurseries. This gives an average of 10.03 attendances of Mothers per session. 378 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. 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, 1934, the average number of scholars on the Public Elementary School Rolls, including the Special Schools, in Willesden was 21,387. 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 1934 was 13,471. Findings of Medical Inspections.—(a) Uncleanliness.—Cleanliness inspections were carried out in the schools on 612 occasions during the year 1934, the average number of visits paid to each school by the Health Visitor being 18. The total number of examinations and re-examinations made during the year was 62,697. 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 1934, however, the percentage rose to 4.8. The first reverse in the steady decline which had been maintained since 1920 was in 1933, when the percentage rose to 4.1. 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% 1934 4.8% 11 (b) Tonsils and Adenoids.—During 1934 at routine and special medical inspections, 689 cases of enlarged tonsils and adenoids were discovered, as compared with 1,361 found in 1933, 1,394 in 1932, 1,668 in 1931, 2,021 in 1930, 1,773 in 1929. (c) Skin Disease.—During 1934, at routine and special medical inspections, 1,264 cases of skin disease were detected, as compared with 1,727 in 1933, 1,607 in 1932, 1,807 in 1931, 1,888 in 1930, 1,809 in 1929. (d) Enlarged Cervical Glands (non-tuberculous).—During 1934, at routine and special medical inspections 162 cases of this defect were noted as compared with 275 in 1933, 285 in 1932, 302 in 1931, 505 in 1930, 380 in 1929. Infectious Diseases.—The action taken to detect and prevent the spread of infectious diseases was as set forth in my Annual Report for 1925. Appendix N. Following Up.—All defects found requiring treatment at medical and dental inspections are notified to the parents, and it is the duty of the Health Nurses to follow up these cases in their homes as may be necessary, in order to ascertain if the treatment has been obtained. If nothing has been done the Health Nurse again explains the necessity for treatment to the parent, and advises as to the best method of obtaining such treatment. Medical Treatment.—During the year 1934 school children were followed up by the Health Department on account of 16,653 medical defects and 7,321 dental defects. Of those defects found to require treatment, medical or dental treatment was obtained for 14,605 and domestic treatment was obtained for 3,707. 83.6 per cent. of the medical defects were treated, 61.0 per cent. receiving medical treatment and 22.6 per cent. domestic treatment, 60 per cent. of the dental defects followed up were treated. No record is available of defects requiring treatment which were not followed up. 92 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 8 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 Public Assistance. In connection with the defects treated, the children concerned made 90,174 attendances at the Health Centres in 1934, as compared with 101,160 in 1933. 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. The first Annual Report on the work in connection with Abnormal Children appears later in this report. 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. 1,011 examinations of secondary school pupils have been carried out during the year 1934. 433 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 1935 the scheme of treatment for defective vision and dental defects referred to in the 1930 annual report. PARENTS PAYMENTS. The recovery of the cost of certain forms of treatment from parents of children attending Public Elementary Schools is made according to the Council's Economic Circumstances Scale, which is based on the net income per head per week of the family. For cases of enlarged tonsils, adenoids, and deflected septum, the payment for operation and the first 3 days in hospital is either the full cost of 24s. part cost, or if below the minimum of the Economic Scale, nil. The charge per day after the first 3 days is 4s. 6d. full cost, and pro rata of part cost. Spectacles are provided either at the full cost of 4s., at half-price, or free if below the Economic Scale. In cases of certain nutrient drugs, prescribed by the Health Centre Medical Officers, these are supplied free, if below the Economic Scale, otherwise cost price is charged. Vouchers issued by certain Hospital Associations and Sickness Funds are accepted in lieu of payment for the provision of spectacles and for operation in cases of enlarged tonsils, adenoids and deflected septum. 12 HEALTH EDUCATION. The new edition of the Handbook of Suggestions on Health Education, issued by the Board of Education has been distributed to all the schools. It well illustrates the variety of means by which Hygiene may be taught to school children. While the School Medical Staff does not take formal part in the work of teaching hygiene, a considerable amount of informal help is given by the doctors and the school nurses. The medical inspection itself is a method of instruction which is likely to leave an impression of educational value on the minds of the school children. It enables the doctor to teach them individually and affords him the opportunity to give health advice to the parents, a large percentage of whom attend the medical inspection of their children at some stage during their school life. The work of the school nurses is largely devoted to instilling by practical means good habits of personal hygiene into the children, and the cleanliness surveys they carry-out are not only a particularly arresting method of health education to the children but also to the parents. The medical treatment at the Health Centres is also of educational value to the boys and girls who attend, and parents who visit the Centres also learn much in regard to the health and general care of their children. A school for mothers is held daily at the Health Centres during the afternoons and a short talk is given either by one of the Assistant Medical Officers or by a school nurse. These talks cover a wide range of subjects pertaining to Health in its broadest sense. Last year at the three Health Centres, 378 individual mothers attended the school. Copies of Better Health, the official journal of the Central Council for Health Education are available at the Health Centres for mothers and school children to take home and this periodical is circulated monthly to all head teachers for their use in the schools. PROVISION OF MEALS. 241,905 meals were supplied in 1934 as compared with 197,338 in 1933, 197,821 in 1932, 138,361 in 1931, and 119,831 in 1930. 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 404 cases during the year, and in connection with such cases paid 3,819 visits. 1,096 of these visits were paid in the South Kilburn Ward, 968 in the Mid-Kilburn Ward, 494 in the North Kilburn Ward, 239 in the Roundwood Ward, 323 in the Stonebridge Ward, 114 in the Willesden Green Ward, 282 in the Cricklewood Ward and smaller numbers in the other wards of Willesden. Of the 404 cases nursed during the year, 387 were new cases. 337 of these 387 new cases were referred by the Health Department for nursing, 20 by private doctors and 30 by Hospitals, Associations and private persons. Ophthalmia neonatorum received 140 visits and other ophthalmia cases 650 visits. SANITARY WORK. The number of houses in Willesden at the end of 1934 was 32,125. (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 28,677 as compared with 21,290 in 1933. The houses inspected under the Housing Acts numbered 1,403 as compared with 870 in 1933. The number of complaints received, 2,266 is higher than in 1933. The total number of Notices issued and nuisances abated were 5,383, and 22,039 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, the 6 remaining in 1933 have now been demolished. The above is exclusive of work carried out in connection with Clearance Areas. 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. During the year 9 areas were declared by the Council to be Clearance Areas. 13 The first three areas, viz.: "Alpha Place North," "Alpha Mews," and "Canterbury Road," were declared on 24th April, 1934, involving the displacement of 198 families and 744 persons. Compulsory Purchase Orders were made in respect of these areas. After a Public Inquiry held on the 23rd July, 1934, the Orders in respect of "Alpha Place North," and "Alpha Mews," were confirmed with modifications; the Order respecting Canterbury Road was not confirmed. The modifications made by the Minister of Health reduced the number of families and persons to be displaced to 105 and 435 respectively. The next three areas, viz.: "Pembroke Place," "Cambridge Mews East," and "Cambridge Mews West," were declared Clearance Areas on 24th July, 1934, involving the displacement of 37 families and 148 persons. Compulsory Purchase Orders were made in respect of these areas. A Public Inquiry was held on 4th December, 1934; the result is not yet to hand. The next three areas, viz.: "Bridge Street," "Market Place Yard," and "Park Road Mews," were declared to be Clearance Areas on the 18th December, 1934, involving the displacement of 31 families and 119 persons. The number of lands involved in the Orders made by the Council are shown in a table in Appendix G together with total inspections and re-inspections made in connection therewith. Social Conditions.—The District is to a great extent of a residential character, and the population, in addition to persons daily engaged elsewhere in the Metropolis, is composed of persons locally engaged in industry and trade. Apart from the numerous and important shopping centres in the District, there are several local industrial undertakings such as railways, and large electrical, motor engineering, and coachbuilding works, biscuit manufacturers, bedstead and mattress manufacturers, printing, etc. I am indebted to the Manager of the Willesden Employment Exchange for the following information regarding unemployment. Unemployed.— Men. Women. Total. January, 1934 4,719 713 5,432 January, 1935 4,783 745 5,528 Noise.—Increased business in certain trades necessitated night-work being carried on pending the extension of the respective premises. Occupiers of nearby houses complained of the noises from machinery and considered the Local Authority should be in a position to regulate the periods during which work should be done and the machinery run. Section 56, Middlesex County Council Act, 1930, reads as follows:— “Noise Nuisance—56.—(1) A noise nuisance shall be liable to be dealt with in accordance with the provisions relating to nuisances of the Public Health Act, 1875: Provided that no complaint shall be made to a justice under section 105 of the said Act unless it is signed by not less than three householders or occupiers of premises within the hearing of the noise nuisance complained of. (2) For the purposes of this section a noise nuisance shall be deemed to exist where any person makes or continues or causes to be made or continued any excessive or unreasonable or unnecessary noise and where such noise— (a) is injurious or dangerous to health; and (b) is capable of being prevented or mitigated having due regard to all the circumstances of the case: Provided that if the noise is occasioned in the course of any trade, business or occupation it shall be a good defence that the best practicable means of preventing or mitigating it having regard to the cost have been adopted. (3) The provisions of this section shall not extend or apply to the carrying on of an undertaking authorised by Act of Parliament or by an Order confirmed by or having the force of an Act of Parliament." As the noises complained of were not "excessive or unreasonable or unnecessary" and the "best practicable means," etc., had been adopted, no legal action could be taken. The firms in question, however, continued night shifts only as long as was necessary to fulfil their contracts and with the minimum of night staff working. PUBLIC MORTUARY. 106 bodies were deposited at the mortuary during the year 1st January to 31st December, 1934, as follows:—Accommodations 4, Post-Mortems 56, Post-Mortems and Inquests 13, Inquests only 33. The existing arrangements continue to give satisfaction to the Medical Practitioners attending the mortuary for post-mortems. 14 MOTOR AMBULANCE SERVICE. The demands on the Motor Ambulance Service continue. During the year 5,617 calls were made for the Council's ambulances as compared with 5,633 in 1933, 5,497 in 1932, 5,171 in 1931, 5,016 in 1930 and 4,728 in 1929. Altogether 132,548 miles were run in 1934 as compared with 132,168 in 1933, 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 20th year of working of the Motor Ambulance Service appears as Appendix C. EXTENSION OF BOUNDARIES. Approximately 320 acres were added to the district on 1st April, 1934, from the Urban District of Wembley and the Borough of Ealing. The Wembley area included some 86 houses. The Ealing area included 208 houses and some factories. This latter area is being developed for industrial and residential purposes. MUNICIPAL HOSPITAL. The 43rd Annual Report on the Municipal Hospital written by Dr. Troup appears later in this report. Your obedient Servant, GEORGE F. BUCHAN, Medical Officer of Health. 15 THE FIFTY-NINTH ANNUAL REPORT FOR THE Year ending 31st December, 1934, ON THE HEALTH AND SANITARY CONDITION OF THE BOROUGH OF WILLESDEN. GENERAL STATISTICS. Area (acres) to 31st March, 1934 =4,384 acres. From 1st April, 1934 4,703.6 Population (estimated Midsummer, 1934) 195,295* Population Census (1931) (not including areas taken over on 1st April, 1934) 185,300 Number of inhabited houses (end of 1934) according to Rate books 40,101 (Flats separately assessed counted as one house.) Rateable value at 31st March, 1934 £1,480,566 Sum represented by a penny rate £5,575 * Registrar General's estimate Midsummer, 1934 188,286 EXTRACTS FROM VITAL STATISTICS OF THE YEAR. Live Births— Total. M. F. Total. Legitimate 2,649 1,386 1,302 2,688 Birth Rate per 1,000 of the estimated resident population 14.05 15.04 Illegitimate 94 78 61 139 Stillbirths 96 59 40 99 Rate per 1,000 total (live and still) births 33.81 33.83 Deaths 1,940 1,954 Death Rate per 1,000 of the estimated resident population 9.93 10.39 Deaths from puerperal causes (Headings 29 and 30 of the Registrar-Generals short List:— Deaths. Rates per 1,000 total (Live and Still) Births. No. 29—Puerperal sepsis 4 3 1.41 1.03 No. 30—Other puerperal causes 4 6 1.41 2.05 Total 8 9 2.82 3.08 Death Rate of Infants under one year of age All infants per 1,000 live births 43.38 42.45 Legitimate infants per 1,000 legitimate live births 40.77 40.92 Illegitimate infants per 1,000 illegitimate live births 117.02 71.94 Deaths from Measles (all ages) 22 22 „ „ Whooping Cough (all ages) 8 8 „ „ Diarrhoea (under 2 years of age) 22 21 Figures in italics (other than rates) supplied by Registrar-General. Table No. 8. NOTIFIABLE DISEASES DURING THE YEAR. Disease. Total Cases Notified. (1) Cases admitted to Total Deaths. (4) Willesden Municipal Hospitals. (2) Other Hospitals. (3) Diphtheria 365 341 14 18 Scarlet Fever 811 714 27 4 Enteric Fever (including Paratyphoid) 7 5 1 1 Puerperal Fever 9 4 5 2 Puerperal Pyrexia 30 4 26 - Pneumonia 324 3 -* 121 Small Pox - - - - Cholera - - - - Plague - - - - Erysipelas 111 47 34 13 Typhus Fever - - - - Relapsing Fever - - - - Continued Fever 1 1 - - Cerebro-spinal Meningitis 13 6 7 6 Poliomyelitis 5 1 3 1 Ophthalmia Neonatorum 28 1 7 - Malaria 1 - - - Dysentery - - - - Encephalitis Lethargica 1 1 - - Acute Polio-Encephalitis - - - 1 Anthrax - - - - Tuberculosis:— (a) Pulmonary 253 - -* 128 (b) Non-Pulmonary 64 - -* 15 Whooping Cough 480 32 - 8 For analysis of the age groups see Appendix “A” Table IV. No complete record. 16 Table No. 9. TUBERCULOSIS. New Cases and Mortality during 1934. 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. N on-Respiratory. Respiratory. Non-Respiratory. M. F. M. F. M. F. M. F. 0 0 0 0 0 0 0 0 0 1 1 0 4 4 0 0 2 1 5 3 3 5 4 0 0 1 1 10 1 3 8 2 1 0 1 0 15 11 9 1 4 2 3 0 3 20 19 29 1 5 5 12 1 0 25 37 44 5 10 20 17 1 0 35 28 13 1 2 14 6 0 1 45 20 11 2 1 17 9 1 0 55 12 3 0 2 14 2 0 1 65 and upwards 4 2 1 2 6 0 0 1 Totals 136 117 28 36 79 49 7 8 The ratio of non-notified tuberculosis deaths to total tuberculosis deaths was 1:9. 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. 1 case was dealt with under the above regulations during 1934. PUBLIC HEALTH ACT, 1925. SECTION 62. Removal to hospital of infectious persons suffering from pulmonary tuberculosis. No action was taken under this section during 1934. 17 GENERAL PROVISION OF HEALTH SERVICES FOR THE AREA. LABORATORY FACILITIES. Laboratory facilities are dealt with in the Annual Report on the Municipal Hospital, page 69. 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 1933-34 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. Page 13, Home Nursing Service. 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. During the year the Council resolved to extend the Willesden Maternity Hospital. The extension was opened on 29th December, 1934. The Hospital, as extended, will be able to deal with approximately 1,000 cases per annum. MIDWIFERY AND MATERNITY SERVICES. Midwifery. In accordance with Section 10 of the Midwives Act, 1902, 40 Midwives gave notice in the month of January, 1935, of their intention to practice in Willesden. 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 except as under Hospitals above. HEALTH VISITORS—INFANT LIFE PROTECTION—ORTHOPÆDIC 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. 18 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 water supply of Willesden is derived from the mains of the Metropolitan Water Board and the Colne Valley Water Company. 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 in the Borough of Willesden and Wembley 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 Health Department during the year. Closet Accommodation.—All houses are supplied with closets on the water carriage system. Each house has at least one water closet, and in the better class tenement house there is generally a water closet provided on each floor. » Scavenging.—Since the year 1919-20, the Health Department has not been responsible for the removal and disposal of house refuse, that work having been taken over by the Surveyor's Department. 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. 19 Following the experiment at Twyford, a gradually extending use is being made of controlled tipping as a method of disposing of the town's refuse, and while the original scheme for raising land at Twyford continues to develop, house refuse is being used also to fill in the old course of the River Brent at Stonebridge. Thus by this system the disposal of over half the refuse collected from the Borough is at present being carried out in a satisfactory manner within its boundaries, the remainder being barged away by contract as formerly. Drainage and Sewerage.—During the year the work of relieving the periodic flooding on the Brentwater Estate was extended by the provision of 290 yards of sewer, varying in diameter from 18 ins. to 30 ins., and it is hoped to complete this work next year. A further short length of the Mitchell Brook adjoining Bridge Road has been covered in, which has eliminated a source of nuisance for many years. In connection with the disposal of the sewage from the new area taken over from Ealing at Twyford, negotiations are proceeding with the Middlesex County Council for permission to discharge this sewage into the West Middlesex Main Sewer, which runs parallel and adjacent to the northern boundary of this area. Sanitary Inspection of the Area. Tabular summary of the work of the Sanitary Department during the year and action taken under the Public Health Acts, Housing Acts, etc. Inspections: Number of premises inspected on complaint 2,266 Number of premises inspected in connection with infectious diseases 85 Number of periodical inspections of premises 4,818 Houses inspected from House to House (Housing Acts) 1,403 For Certificates under the Rent Acts 3 Public House Urinals 275 Mews and Stables 474 Miscellaneous 110 Total number of inspections and re-inspections made 28,677 Smoke Observations 133 Action under Rent and Mortgage Interest (Restriction) Acts, 1920-1933. Number of applications received for Certificates 8 Number of Certificates granted 2 Number of Certificates refused 1 Number of applications withdrawn 5 Action Taken (under Housing Acts and Health Acts): Notice to Inspect (Section 127, Housing Act, 1925) 2,662 Cautionary or Intimation Notices Issued 2,580 Number complied with 2,047 Statutory Orders issued 118 Number complied with 112* Summonses served 2 Number of convictions obtained 0 Summonses withdrawn 2 „ dismissed 0 House Let in Lodgings (Tenement Houses): Number registered under Bye-laws 0 Number of contraventions 0 Common Lodging Houses: Number registered under Bye-laws 1 Number of Inspections made 27 Number of contraventions 2 Number remedied 2 Canal Boats used as Dwellings: Number of contraventions of Regulations 2 Number remedied 2 Movable Dwellings, Caravans, Tents, &c.: Number observed during the year 16 Number of nuisances therefrom abated 0 Number removed from district 0 * Includes a certain number issued in 1933. 20 Bakehouses: Number in district 60 Number of Inspections 254 Contraventions of Factory Acts 14 Contraventions remedied 10 Slaughter-houses: Number on register 5 Inspections of carcases, etc. 246 Contraventions of Bye-laws 0 Contraventions remedied 0 Cowsheds: Number on register 0 Number of milch cows in district 0 Dairies and Milkshops: Number of premises on register 239 Number of itinerant milk sellers registered 49 Number of inspections made 518 Contraventions of Milk and Dairies Order, 1926 10 Contraventions remedied 8 Unsound Food: Meat (including organs) seized and surrendered 563 lbs. Fish (wet and dried) surrendered 352 lbs. Poultry surrendered 25 lbs. Bacon surrendered 627 lbs. Tinned and Cooked Meat surrendered 144 lbs. Tinned and Evaporated Milk surrendered 37 lbs. Fruit surrendered 180 lbs. Total 1,928 lbs. Method of disposal Destroyed. Offensive Trades: Number of premises in district (Rag and Bone Dealers) 6 Number of inspections made 17 Contravention of Bye-laws 0 Contravention remedied 0 Water Supply and Water Service: Percentage of houses supplied on constant system 100 Cisterns:— New provided 17 Cleansed, repaired, covered, etc. 214 Draw-taps placed on mains 39 Drainage and Sewerage of existing Buildings: Water Closets:— Number of water closets substituted for dry receptacles 0 Repaired, supplied with water or otherwise improved 696 Additional Closets constructed 26 Percentage of houses provided with water closets 100 Drains:— Examined, tested, exposed, etc. 243 Unstopped, repaired, trapped, etc. 308 Waste pipes, rain-water pipes, disconnected, repaired, etc. 689 New soil pipes or ventilating shafts fixed 170 Existing soil pipes or ventilating shafts repaired 221 Disconnecting traps or chambers inserted 141 Re-constructed 92 Cesspools:— Rendered impervious, emptied, cleansed, etc. 0 Abolished and drain connected to sewer 0 Percentage of houses draining into sewers 100 21 Disinfection and Disinfestation. Rooms disinfected:— (a) Phthisis 68 (b) Other diseases and conditions 897 Articles disinfected or destroyed:— (a) Phthisis 347 (b) Other diseases and conditions 1,392 Dust: New bins provided 367 Periodical frequency of dust removal weekly Method of disposal By tipping and barging Sundry Nuisances abated: Overcrowding 24 Smoke 9 Accumulations of refuse 153 Foul ditches, ponds, etc., and stagnant water 5 Fowls, pigs, and other animals 20 Dampness 651 Yards and forecourts paved, repaved or repaired 672 Walls and ceilings cleansed 5,535 Verminous rooms purified 516 Leaky roofs made watertight 640 Additional ventilation provided under floors 266 Dilapidated plaster repaired 1,999 Flooring and other woodwork repaired 1,641 Damp-proof courses inserted 137 Water supply reinstated 38 Washhouse floors repaired or repaved 279 Fireplaces and stoves repaired 863 Decayed brickwork repaired and repointed 665 Sinks provided or replaced 266 Additional light and ventilation provided to staircases 72 Larders or food cupboards provided or ventilated 236 Gutters and rainwater pipes repaired or renewed 683 New sash cords and glass provided to windows 2,474 Miscellaneous 1,215 Total number of Nuisances Abated 22,039 Inspection of Premises where Food is prepared: Butchers', Provision, and General Shops 1,016 Fish shops (wet, dried and fried) 276 Eating houses 166 Greengrocers' shops 145 Ice-cream premises 68 Stalls 458 Canal Boats Acts, 1877-1884.—The number of boats inspected during the year 1934 was 34 (44 inspections). Two contraventions of the Regulations were found:— (i) Cabin not weatherproof. (ii) Defective stove. 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 6 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. 22 Underground Sleeping Rooms.—There are 723 houses with basements and approximately 400 rooms are used as sleeping apartments. The Regulations of the Council governing this class of property were amended to conform to Section 18, Housing Act, 1925. Disposal of the Dead.—The Council at present own a cemetery within the district and it is estimated that a further 7,608 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 1,444. 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, now the Wembley Urban District, practically abutting on the north-western boundary of the district. There are two Jewish cemeteries situate in the district, one in Beaconsfield Road and another in Pound Lane, and it is estimated there are sufficient grave spaces to last approximately 30 and 65 years respectively before these cemeteries are full. Schools.—The whole of the schools in Willesden have a good and sufficient water suppy and sanitary accommodation. Rag Flock Acts, 1911-28.—There are no premises in the district on which rag flock is manufactured, and no sampling under these Acts has been carried out during the year. HOUSING. Number of inhabited houses* in Willesden (end of 1934) according to the Rate Books 40,101. * Flat separately assessed counted as one house. Number of houses* in Willesden (end of 1934), 32,125 (approx.). * Flats contained under one roof are counted as one house. The following table shows building activities during the periods stated:— Table No. 10. 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 1934 15 388 185 588 Total for 14 years 1,128 3,073 4,302 8,503 The erection of smaller houses in the Northern part of the district continues. HOUSING STATISTICS FOR THE YEAR 1934. Number of New Houses erected during the Year:— (a) Total (including numbers given separately under (b):— (i.) By the Local Authority 15 (ii.) By other Local Authorities Nil (iii.) By other bodies and persons 573 (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 15 (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 23 1.—Inspection of Dwelling-houses during the Year:— (1) (a) Total number of dwelling-houses inspected for housing defects (under Public Health or Housing Acts) 3,754 (b) Number of inspections made for the purpose 21,460 (2) (a) Number of dwelling-houses (included under sub-head (1) above) which were inspected and recorded under the Housing Consolidated Regulations, 1925 1,403 (b) Number of inspections made for the purpose 9,192 (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 36 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 1,461 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 34 (2) Number of dwelling-houses which were rendered fit after service of formal notices:— (a) By owners 21 (b) By local authority in default of owners 9 B.—Proceedings under Public Health Acts: (1) Number of dwelling-houses in respect of which notices were served requiring defects to be remedied 62 (2) Number of dwelling-houses in which defects were remedied after service of formal notices:— (a) By owners 78* (b) By local authority in default of owners 4 *Includes a certain number outstanding in 1933. C.—Proceedings under sections 19 and 21 of the Housing Act, 1930 : (1) Number of dwelling-houses in respect of which Demolition Orders were made 0 (2) Number of dwelling-houses demolished in pursuance of Demolition Orders 0 D.—Proceedings under section 20 of the Housing Act, 1930: (1) Number of separate tenements or underground rooms in respect of which Closing Orders were made 0 (2) Number of separate tenements or underground rooms in respect of which Closing Orders were determined, the tenement or room having been rendered fit 0 INSPECTION AND SUPERVISION OF FOOD. Milk Supply.—There are 2 wholsale dealers and 237 retail milk purveyors in this district. Their premises and utensils are frequently inspected. In addition there are 49 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 1934:— 24 Table No. 11. (a) "Certified" milk 10 (b) "Grade A (Tuberculin Tested)" milk 19 (c) "Grade A (Tuberculin Tested)" Bottling Establishment 1 (d) "Grade A" milk 10 (e) "Pasteurised" milk 28 (f) "Pasteurised" milk (supplementary) 1 (g) "Pasteurisers" 3 (h) "Grade A Pasteurised" 1 There were no refusals or revocations of licences under the Milk (Special Designations) Order 1923, during the year. Thirteen 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 two "Grade A (T.T.)") were taken during the year for examination for the presence of tubercle bacilli under the Milk and Dairies (Consilidation) Act, 1915. Six samples (Nos. 0/356, 0/359, 0/374, 0/376, 0/377 and 0/381), representing 12.5 per cent. of the total number sampled, were found to contain tubercle bacilli, and action was taken resulting in an examination of the herds at the supplying farms situate in the counties of Buckinghamshire (4), Leicestershire (1), Bedfordshire (1). The other 42 samples showed no evidence of tuberculosis. The following are particulars of the six positive samples:— 0/356.—Two cows individually sampled. Microscopical examination showed the presence of excess of cells and a notice restricting the sale from these cows served. Animal inoculation tests revealed no tubercle infection. 0/359.—Samples of milk collected from the whole of the herd belonging to the producer proved on biological examination to be negative. Cow sent to the knacker prior to the veterinary inspection of the herd apparently the culprit. 0/374.—"Bulk" sample of milk contained living tubercle. Miscroscopical report of one cow, individually sampled, stated acid fast bacilli were found. This cow was slaughtered. Animal inoculation test of all the other samples taken proved negative. 0/376.—Investigations made by the County Council's Veterinary Surgeon, but the source of the tubercle found in the sample remains undiscovered. A number of "bulk" samples were taken and also samples from two individual animals which proved negatives. 0/377.—Herd examined by a Veterinary Surgeon and two cows were individually sampled, in addition to "bulk" sample being taken from the remainder, all of which proved negative. It is probable that an old cow in the herd when the milk was sampled by this Authority was responsible for the infection. This cow was disposed of for slaughter at the time investigations at the farm commenced. 0/381.—Herd examined by Veterinary Surgeon and certain individual samples were taken. In addition a "bulk" sample was taken from the remainder of the herd. One of the cows individually sampled was made a subject of a Detention Notice under the provision of the Tuberculosis Order, and has since been slaughtered. The post-mortem certificate indicated that this animal was suffering from Tuberculosis of the Udder—not an advanced case. 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. 12. In 1920. 1925. 1934. Registered 4 4 2 Licensed 5 4 3 Total 9 8 5 25 Inspection and Supervision of Other Foods.—Inspections were made of all the bakehouses and other premises in the district where food is prepared. The 60 bakehouses in the district were inspected on 254 occasions, Notices being served in 14 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 1934:— Table No. 13. List of Samples Taken during the Year ended 31st December, 1934. Article. Taken. Adulterated. Milk 486 11 Milk, sterilised 2 - Cream 2 - Cream Pastry 4 4 Flour 1 - Gin 4 - Grape Fruit Squash 1 - Hake 2 - Lemon Sole 3 2 Meat 3 - Meat, cooked 1 - Meat Pies 13 2 Minced Beef 46 9 Olive Oil 1 - Preservative Powder 1 - Sausages 14 1 Whisky 1 - 585 29 Number of Prosecutions 10 Number of Convictions 9 Summons withdrawn 1 Artificial Cream Act, 1929. Public Health (Condensed and Dried Milk) Regulations, 1923. Inspections were made under the above in order to see that the requirements with respect to labelling were complied with, but no infringements were discovered. ADMINISTRATION OF FACTORY AND WORKSHOP ACT, 1901. The following tables shew the number of premises visited in pursuance of the provisions of the Factory and Workshop Act and the action taken in connection therewith. Table No. 14. Factories, Workshops, Laundries and Workplaces. Inspection.—Including Inspections made by Sanitary Inspectors. Premises. (1) Number of Inspections. (2) Written Notices. (3) Prosecutions. (4) Factories (including Factory laundries) 226 18 - Workshops (including Workshop laundries) 255 10 - Workshops (other than Outworkers' premises) 3 1 - Total 484 29 - 26 Table No. 15.—Defects Found. Particulars. (1) Number of Defects. Found. (2) Remedied. (3) Referred to H.M. Inspector. (4) Number of Prosecutions. (5) Nuisances under the Public Health Acts :— Want of Cleanliness 10 10 - - Want of Ventilation 1 1 - - Overcrowding 1 1 - - Want of drainage of floors 3 3 - - Other Nuisances 11 11 - - Sanitary accommodation— Insufficient 2 2 - - Unsuitable or defective 10 10 - - Not separate for Sexes 1 1 - - 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) - - - - Other offences (Excluding offences relating to outwork) - - - - Total 39 39 - - Table No. 16.—Registered Factories, Workshops and Outworkers. Workshops on the Register (s. 131) at the end of the year. (1) Number. (2) Factories 181 Factories, Laundries 38 Workshops, Laundries 23 Domestic Laundries 6 Bakehouses 60 Dressmakers 74 Outworkers 978 Blouse Makers 6 Tailors 56 Bootmakers 104 Metalworkers 25 Wood Workers 24 Seamstresses - Motor and Cycle Makers 63 Upholsterers 12 Milliners 20 Miscellaneous 145 Total number on Register 1,815 27 Table No. 17.—Other Matters. Class. (1) Number. (2) Matters notified to H.M. Inspector of Factories:— Failure to affix Abstract of the Factory and Workshop Act (s. 133) - 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 3 Reports (of action taken) sent to H.M. Inspector 3 Other - Underground Bakehouse (s. 101):— Certificates granted during the year - In use at the end of the year 17 28 THE TWENTY-SEVENTH ANNUAL REPORT for the Year ending 31st December, 1934, on the HEALTH OF CHILDREN ATTENDING THE PUBLIC ELEMENTARY SCHOOLS IN WILLESDEN. Giving the Tables required by the Board of Education. Table No. 18.—Corresponding to Table 1 of the Board of Education's Medical Statistical Tables. Return of Medical Inspections for the year ended 31st December, 1934:— A.—Routine Medical Inspections. Number of Inspections in the prescribed Groups:— Entrants 2,496 Second Age Group 2,438 Third Age Group 1,894 Total 6,828 Number of other Routine Inspections 0 B.—Other Inspections. Number of Special Inspections 6,643 Number of Re-inspections 20,354 Total 26,997 Table No. 19.—Corresponding to Table 2 of the Board of Education's Medical Statistical Tables. A.—Return of Defects Found by Medical Inspection in the Year ended 31st December, 1934. Defect or Disease. (1) Routine Inspections. Specials. No. of Defects. No. of Defects. Requiring treatment. (2) Requiring to be kept under observation but not requiring treatment. (3) Requiring treatment. (4) Requiring to be kept under observation but not requiring treatment. (5) Skin Malnutrition 13 33 83 - Ringworm: Scalp - - 2 - Body 1 - 14 - Scabies 3 - 101 - Impetigo 9 - 130 - Other Diseases (nontuberculous) 59 - 1,184 - Blepharitis 14 - 83 - Conjunctivitis 10 — 196 - Keratitis - - 1 - Corneal Opacities - - 7 - Eye Defective Vision (excluding Squint) 299 216 255 1 Squint 21 1 60 1 Other Conditions 12 3 121 - Spectacles broken - - 241 - Spectacles lost - - 16 - 29 A.—Return of Defects found by Medical Inspection in the Year ended 31st December, 1934.—continued. Defect or Disease. (1) Routine Inspections. Specials. No. of Defects. No. of Defects. Requiring treatment. (2) Requiring to be kept under observation but not requiring treatment. (3) Requiring treatment. (4) Requiring to be kept under observation but not requiring treatment. (5) Ear Defective Hearing 3 - 6 - Otitis Media - - 221 - Other Ear Diseases 37 5 85 - Chronic Tonsillitis only 306 372 135 1 Nose and Throat Adenoids only 32 6 6 - Chronic Tonsillitis and Adenoids 51 39 202 - Other Conditions 27 3 172 - Enlarged Cervical Glands (non-tuberculous) 4 5 137 4 Defective Speech - 4 5 — Heart and Circulation Heart Disease: Organic 4 12 9 - Functional 4 326 26 1 Anaemia 6 1 8 - Bronchitis 42 - 45 - Lungs Other Non-Tuberculous Diseases 3 10 15 - Tuberculosis Pulmonary:— Definite - - 4 - Suspected - - 1 - Non-Pulmonary:— - Glands - - 1 - Bones and Joints - - 1 - Skin - - — - Other forms 1 - 1 - Epilepsy - - 2 - Nervous System Chorea 1 - 12 - Other Conditions 4 7 15 - Rickets 1 - 3 - Deformities Spinal Curvature 39 - 22 - Other forms 56 94 78 2 Other Defects and Diseases (excluding Uncleanliness and Dental Diseases) 228 57 2,642 1 B.—Number of Individual Children found at Routine Medical Inspection to require Treatment (excluding Uncleanliness and Dental Diseases). Group. (i) Number of Children. Percentage of Children found to require treatment. (4) Inspected. (2) Found to require treatment. (3) Prescribed Groups— Entrants 2,496 457 18.3 Second Age Group 2,438 390 16.0 Third Age Group 1,894 292 15.4 Total (Prescribed Groups) 6,828 1,139 16.7 Other Routine Inspections 0 0 0 30 Table No. 20.—Corresponding to Table IV. of The Board of Education's Medical Statistical Tables. Return of Defects Treated during the Year ended 31st December, 1934. Treatment Table. Group I.—Minor Ailments (excluding Uncleanliness, for which see Group VI). Disease or Defect. (1) Number of Defects Treated, or under Treatment during the Year. Under the Authority's Scheme. (2) Otherwise. (3) Total. (4) Skin:— Ringworm—Scalp 2 (2) 1 (1) 3 (3) (Show separately in brackets the number which were treated by X-Rays.) Ringworm—Body 15 4 19 Scabies 114 3 117 Impetigo 243 16 259 Other Skin Diseases 2,014 44 2,058 Minor Eye Defects (external and other, but excluding cases falling in Group II.) 509 33 542 Minor Ear Defects 454 56 510 Miscellaneous (e.g., Minor Injuries, Bruises, Sores, Chilblains, etc.) 3,816 598 4,414 Total 7,167 755 7,922 31 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. (i-) Under the Authority's Scheme. (ii.) Otherwise. Errors of Refraction (including squint) (Operations for squint should be recorded separately in the body of the School Medical Officer's Report.) See Tables A and B following. 573 30 478 122 Other Defect or Disease of the Eyes (excluding those recorded in Group I) Total 573 30 478 122 * 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. 32 TABLE A. Defect or Disease. (1) Number of Defects dealt with. Under the Authority's Scheme. (2) By private practitioner or at hospital apart from the Authority's Scheme. (3) Otherwise. (4) Total. (5) Errors of Refraction (including squint) 719 25* 0 744 Other Defect or Disease of the Eyes (excluding those recorded in Group I.) 7 0 0 7 Total 726 25 0 751 * In addition to this number, 140 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 719 and 25 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. (1) Number of Defects dealt with. Under the Authority's Scheme. (2) By private practitioner or at hospital apart from the Authority's Scheme. (3) Otherwise. (4) Total. (5) Errors of Refraction (including squint) 2,328 141 2,469 Other Defect or Disease of the Eyes (excluding those recorded in Group I.) 0 0 0 0 Total 2,328 141 2,469 Group III.—Treatment of Defects of Nose and Throat. Number of Defects. Received Operative Treatment. Received other forms of Treatment. (4) Total number treated. (5) Under the Authority's Scheme in Clinic or Hospital. (1) By private practitioner or Hospital, apart from the Authority's Scheme. (2) Total. (3) (i) (ii) (iii) (iv) (i) (ii) (iii) (iv) (i) (ii) (iii) (iv) 1 1 340 1 39 5 50 0 40 6 390 1 236 673 (i) Tonsils only, (ii) Adenoids only, (iii) Tonsils and adenoids, (iv) Other defects of the nose and throat. 33 Group IV.—Orthopaedic 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 orthopaedic clinic, (iii) Number of children treated 30 ordinary elementary school children 0 402 5 2 11 450 There were in addition 3 children treated under the Special Schools Vote and not under Section 80 of the Education Act, 1921. Group V.—Dental Defects. Vide 17th 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 18 (ii.) Total number of examinations of children in the schools by School Nurses 62,697 (iii.) Number of individual children found unclean 1,953 (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 6 (b) Under the School Attendance Bye-Laws 0 (vi.) No. of school sessions at which inspections were conducted 612 (vii.) (i.) Original Inspections:— Children examined (i.e., Cases not individual children) 53,939 Found unclean 2,610 Percentage found unclean 4.8 Excluded on account of uncleanliness 0 (ii.) Re-inspections:— Children examined (i.e., Cases not individual children) 8,758 Found unclean 6,382 Percentage found unclean 72.8 Excluded on account of uncleanliness 4 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. 34 Record of cases in which legal proceedings were taken:— The following information has been supplied by the Director of Education to whom cases for prosecution are referred. Cases Under Section 87 of the Education Act, 1921. No. of Cases. Amount Adjourned Standing Fined. of Fine. Withdrawn. Sine die. Dismissed. adjourned at end of Year. 1 10/- 3 — — 1 2 7/6 3 5/- Certain Statistical Data. No. of Public Elementary Schools (excluding two Special Schools) at December, 1934 34 No. of School Departments at December, 1934 69 Average Public Elementary School Roll (excluding two Special Schools), year ended 3,1st March, 1934 21,108 Total No. of Children medically inspected at Routine and Special Inspections 13,471 Total No. of Children dentally inspected 19,441 Total No. of Defects of every description "followed up" during 1934 25,208 Total No. of Defects of every description for which treatment was obtained during 1934— Medical or Dental Treatment 14,605 Domestic Treatment 3,707 Total 18,312 Total No. of Attendances at the School Clinics during 1934 90,174 35-36 Table No. 21.—In this Table is embodied the information required in the N.B. to Notes on Table IV. of the Board of Education's Medical Statistical Tables. 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 1934. 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 Scheme. Voluntary Hospital or other charitable Institution. Hospital Doctor under M.C.C. Private Practitioner. Total. Domestic Treatment only. Grand Total. Excluding Domestic Treatment. Including Domestic Treatment. Removed from observation. Remaining under observation. Total. Brought forward from previous New. Total. 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 9 12 - - - - - - - 12 12 12 - - - - 100. - - - - Footgear- Unsatisfactory - - - - - - - - - - - - - - - - - - - - - - Cleanliness of Head— Nits 232 2,321 2,553 13 - 194 - - - 194 2,123 2,317 2,296 - - 20 7.6 90.8 34 189 223 209 Pediculi 63 278 341 1 - 163 - - - 163 160 323 323 - - - 47.8 94.7 1 16 17 16 Other dirty conditions 2 - 2 - - - - - - - 2 2 2 - - - - 100.0 - - - - Cleanliness of BodyDirty 4 11 15 - - - - - - - 13 13 12 - - 1 - 86.7 - 2 2 3 Pediculi - 1 1 - - 1 - - - 1 - 1 - - - 1 100.0 - - - - 1 Fleabitten - 4 4 - - - - - - - 3 3 3 - - - - 75.0 - 1 1 1 Malnutrition 56 96 152 - - 100 3 1 2 106 14 120 55 1 - 64 69.7 78.9 15 17 32 81 Nose and ThroatEnlarged Tonsils 283 412 695 14 49 101 34 4 1 140 - 140 137 - - 3 20.1 - 278 214 492 217 Adenoids 25 27 52 2 7 6 3 2 - 11 - 11 10 - 1 21.2 - 15 17 32 18 Enlarged Tonsils and Adenoids 119 320 439 3 13 229 47 2 1 279 - 279 271 - - 8 63.6 - 93 51 144 59 Other conditions 53 325 378 4 16 177 21 15 36 249 78 327 299 1 - 27 65.9 86.5 16 15 31 42 Cervical or Neck Glands— Enlarged (non T.B.) 155 210 365 3 8 158 15 2 12 187 51 238 202 7 3 26 51.2 65.2 60 56 116 82 External Eye Disease— Blepharitis 35 116 151 1 - 1127 3 - - 130 16 146 116 1 - 29 86.1 96.7 1 3 4 32 Conjunctivitis 20 238 258 2 - 224 7 - 6 237 18 255 242 3 - 10 91.9 98.8 1 - 1 10 Corneal Opacities 3 7 10 1 - 6 2 - - 8 - 8 - 3 2 3 80.0 - 1 - 1 3 Keratitis - 1 1 - - - - - 1 1 - 1 - 1 - - 100.0 - - - - - Other conditions 18 196 214 2 3 152 10 - 4 166 36 202 193 - - 9 77.6 94.4 4 3 7 12 Ear Diseases— Chronic Suppuration of Middle Ear 62 271 333 5 5 252 27 - 4 283 27 310 265 3 - 42 85. 93.1 10 3 13 45 Defective Hearing 13 17 30 2 5 6 - - - 6 - 6 3 1 - 2 20.0 - * 12 5 17 7 Wax 15 107 122 - 1 106 1 - 2 109 7 116 112 - - 4 89.3 95.1 3 2 5 6 Other diseases 21 111 132 - 2 90 17 2 3 112 15 127 121 - - 6 84.8 96.2 2 1 3 7 Teeth—See Dental Returns Heart and Circulation— Organic Disease 6 14 20 - 1 2 6 - - 8 - 8 - - 2 6 40.0 - 10 1 11 7 Functional Disease 26 38 64 2 2 21 14 - 3 38 - 38 11 9 — 18 59.4 — 17 5 22 23 Anaemia 26 13 39 - - 18 3 2 1 24 10 34 19 5 2 8 61.5 87.2 2 3 5 11 Other conditions - 5 5 - - 2 1 - - 3 - 3 - - — 3 60.0 — — 2 2 5 Lungs- Bronchitis and Bronchial Catarrh 39 97 136 1 44 8 6 32 90 41 131 112 7 1 11 66.2 96.3 3 1 4 12 Tuberculosis 6 6 - - — 1 1 - 2 — 2 - 1 1 33.3 4 - 4 1 T.B. suspected 3 7 10 5 — 1 — — 1 — 1 — — — 1 10.0 — 4 - 4 1 Other diseases (non-T.B.) 29 22 51 — 1 22 6 1 8 37 6 43 31 1 — 11 72.5 84.3 7 - 7 11 Nervous System— Epilepsy 1 5 6 - - - 1 - 1 2 - 2 - - 1 1 33.3 - 2 2 4 3 Chorea 11 17 28 2 — 4 15 — 1 20 — 20 2 7 2 9 71.4 - 5 1 6 10 Other conditions 29 22 51 1 1 22 5 1 3 31 10 41 17 11 — 13 60.8 80.4 7 1 8 14 Skin- Ringworm Head 2 2 4 - - 2 1 - 3 - 3 3 - - - 75.0 - 1 - 1 - „ Body 3 19 22 — — 15 — — 4 19 2 21 21 — — — 86.4 95.5 1 — 1 — Impetigo 29 282 311 1 — 243 4 — 12 259 46 305 285 — — 20 83.3 98.1 2 3 5 23 Scabies 14 109 123 — 1 114 — — 3 117 2 119 113 — — 6 95.1 96.7 3 — 3 6 Minor injuries 67 1,241 1,308 5 5 1,179 32 4 10 1,225 67 1,292 1,243 — 2 47 93.7 98.8 6 — 6 47 Other conds. (non-T.B.) 232 2,164 2,396 7 19 2,014 24 1 19 2,058 272 2,330 2,074 7 14 235 85.9 97.2 28 12 40 247 Deformities— Rickets 2 10 12 - - 6 2 1 - 9 - 9 - 2 3 4 75.0 - 1 2 3 6 Spinal Curvature 38 65 103 — 1 64 1 — 2 67 — 67 2 15 11 39 65.0 — 17 18 35 57 Other forms 136 163 299 9 32 167 4 — 1 172 5 177 44 38 20 75 57.5 59.2 61 20 81 95 Tuberculosis Non-Pulmonary— Definite—Glands 1 1 2 - - - - - 1 1 - 1 - 1 - - 50.0 - 1 - 1 - „ Spine - - - - - - - - - - - - - - - - - - - - - - „ Hip — 4 4 — 1 - - - - - - - - - - - - - 2 1 3 1 „ Bones and joints - - - - - - - - - - - - - - - - - - - - - - „ Skin — — - - - - - - - - - - - - - - - — — — - - - - Other forms - 1 1 - - 1 - - - 1 - 1 - - - 1 100.0 - - - - 1 Suspected Glands 5 - 5 - - 1 - - - 1 — 1 — — - 1 20.0 - 4 - 4 1 „ Bones and joints 2 — 2 — - — 2 — — 2 — 2 — — 1 1 100.0 — — — 1 „ Other conditions Speech— Defective Articulation 1 9 10 — 2 1 — — 1 - 1 — 1 - — 10.0 — 5 2 7 2 Squint— Squint present 25 102 127 - 12 77 10 — 2 89 — 89 30 34 12 13 70.1 — 16 10 26 23 Vision— Defect not ascertained 37 160 197 2 49 113 4 2 119 119 85 1 21 12 60.4 - 15 12 27 24 One Eye normal 18 65 83 2 18 37 1 — 5 43 — 43 31 1 3 8 51.8 - 16 4 20 12 Both eyes 6/6 2 56 58 — 38 17 — - - 17 — 17 14 — 3 — 29.3 — 2 1 3 1 Both eyes 6/9 5 39 44 - 14 23 2 - - 25 - 25 14 3 4 4 56.8 - 2 3 5 7 One eye 6/9, other 6/12 or less 20 122 142 1 12 83 4 2 89 89 68 4 1 16 62.7 - 19 21 40 37 Both eyes 6/12 or less 61 248 309 2 14 182 11 — 10 203 203 132 41 5 25 65.7 — 52 38 90 63 Spectacles broken 42 300 342 2 5 280 4 - 32 316 1 317 300 - 1 16 92.4 92.7 7 11 18 27 Spectacles lost 11 24 35 1 6 19 1 - 2 22 22 21 - - 1 62.9 - 2 4 6 5 Debility 380 699 1,079 12 9 776 27 6 23 832 158 990 625 76 26 263 77.1 91.8 40 28 68 291 Miscellaneous 408 2,551 2,959 19 375 1,507 175 51 153 1,886 513 2,399 1,993 31 18 357 63.7 81.1 109 57 166 414 Grand Totals 2,893 13,760 16,653 121 733 9,147 561 102 404 10,214 3,708 13,922 11,964 317 159 1,482 61.3 83.6 1,019 858 1,877 2,340 Re-examiDations in respect of Defective Vision, other than Lost and Broken Spectacles, and in respect of other conditions— No. of cases dealt with 1,845. 37 Table No. 22. Return showing No. of Cases referred for following-up in 1934 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. 1934 4,441 1,384 58 7,514 13,397 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 38 THE FIRST ANNUAL REPORT for the Year ending 31st December, 1934, on the WORK IN CONNECTION WITH ABNORMAL CHILDREN. Up to the year 1934 a summary of the work done in connection with these children was incorporated in the body of the Report. 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 1934, 1,213 special children were examined or re-examined. Of the 392 original examinations included in the 1,213 examined, 80 were found to be physically defective, 20 mentally defective, 8 blind and partially blind, 35 dull and backward, 215 anaemic and debilitated, 17 defective speech, 6 deaf and dumb, 2 epileptic, 3 unstable, and 6 cases of behaviour problem. 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, 1934, was 128. The average attendance for the year was 110. There were 4 children awaiting admission to this school at the end of the year owing to want of room on the school omnibus. The staff consists of one Head Teacher, one full-time Assistant Master and four full-time Assistant Mistresses. There are in addition three part-time Instructors—one for boot-making, one for handicraft and one for domestic economy. Five children were allowed to leave school before reaching the age of 16 years ; 8 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 5 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. 108 such examinations were made during 1934. 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. 109 children were examined, 7 of whom were found to require medical and 29 dental treatment, and the following table gives a return of the defects found at medical inspection:— Table No. 23. Defects. Found to require treatment. Requiring to be kept under observation but not requiring treatment. Anaemia 1 - Malnutrition — - Skin Disease — - Eye—Blepharitis — - Defective vision (ex. squint) 2 - Squint — - Other conditions 1 - Ear—Defective hearing — - Other ear diseases — - Nose and Throat—Enlarged tonsils only — - Adenoids only 1 - Enlarged Tonsils and Adenoids — - Enlarged cervical glands (non-tuberculous) — - Defective speech — - Defective Teeth 29 - Heart and Circulation—Heart functional — 1 Anaemia — - Lungs—Bronchitis — - Other non-tuberculous diseases — - Other defects and diseases 2 - Total 36 1 39 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 153, the actual number on the roll on the 31st December, 1934, being 159. The average attendance for the year was 126. There were no children awaiting admission at the 31st December, 1934. The school takes physically defective children between 5 and 16 years of age. The staff consists of one Head Teacher and seven full-time Assistants. During the year 13 children were allowed to leave school before reaching the age of 16 years, 9 children were allowed to attend ordinary elementary schools, 1 child was transferred to Leinster M.D. School, and 1 child, who was also mentally defective, was notified to the Middlesex County Council under the Mental Deficiency Acts, 1913-27, as requiring supervision and guardianship. The school dinners are brought from Gibbons Road Feeding Centre and are served in the School Hall. On an average 100 of the children take the school dinners. One trained Nurse is attached to the school. She treats minor ailments as required and supervises the personal cleanliness and the care of the teeth and hair of the children. She arranges for the repair of surgical instruments and boots. She also gives the children the nutritive drugs ordered by the doctor. The school is visited by the Certifying Medical Officer once a fortnight, and each child is seen every six months. The parents are notified of any defects found which require attention. The majority of the children at this school who are actually crippled attend periodically an Orthopaedic Hospital or an Orthopaedic Department of a General Hospital; and in addition, facilities for treatment of this kind are available at the Stonebridge Health Centre, where a Specialist visits twice monthly and the requisite nursing staff is in daily attendance. Convalescence.—The Education Committee have made arrangements with the Russell-Cotes School of Recovery, Parkstone, near Bournemouth, for the reservation of places for 9 boys and 4 girls. This home was provided by the donors as a country residence near the sea for poor town boys and girls who are anaemic and debiliated, and who are physically defective within the meaning of the Education Act, 1921; and it is recognised by the Board of Education as a Special Residential School. The boys and girls are selected both from the physically defective and the ordinary elementary schools, and the duration of the stay is six weeks, except in special cases when an additional six weeks stay can be arranged. All the cases which have been to the institution have shown a distinct improvement on their return home. In all 66 boys and 29 girls were admitted to the school during the year. In view of the larger number of boys than girls found to require convalescent treatment, the Education Committee rearranged the number of places reserved for them by increasing to 11 (from 5) those for boys at St. Dominic's Open Air School, Godalming, Surrey, and reducing to 4 (from 10) those for girls at St. Patrick's Open Air School, Hayling Island, Hants. The children are selected from both the physically defective and the ordinary elementary schools, and the duration of stay is six weeks. Towards the end of the year under review, owing to the large number of children awaiting convalescence, the Committee arranged for an additional number of temporary places to be available at these two open air schools in order to reduce the period of waiting to approximately three months. All the cases sent have shown a definite improvement on their return home. In all 70 boys and 52 girls were admitted during the year. Defective Vision and Squint.—During the year 1934, 7 children attending the Special Schools were found to be suffering from errors of refraction (including squint), and 1 child was suffering from another defect of the eyes. They were all dealt with under the Authority's scheme. Spectacles were prescribed for 5 children and 3 obtained them under the Authority's scheme; 1 child obtained them from another source. Defects of Nose and Throat.—During the year 2 children attending the Special Schools received operative treatment under the Authority's scheme, and 1 child received other forms of treatment. Orthopaedic and Postural Defects.—During the year 21 children attending the Special Schools were treated; 4 of these received residential treatment with education, and 17 non-residential treatment at an orthopaedic clinic under the Authority's scheme. During the year there were 119 Special School cases referred for following up with the view of medical treatment being obtained, remedial measures carried out, or other action taken. Work of the Willesden Branch of the Invalid Children's Aid Association, 1934— 199 new cases were referred to this Association during the year, 48 of these being referred by the Willesden Health Department. The majority of the patients were suffering from anaemia and debility. In addition 15 surgical appliances were supplied. Stammering Children.—There are three classes for stammering children held twice weekly at Wesley Road, Leinster Road and Chamberlayne Wood Road Schools, and conducted by Mr. A. D. Bradfield. The class at Leinster Road consists of boys, and the classes at Wesley Road and Chamberlayne Wood Road 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. 40 Table No. 24.—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) Active Tuberculosis. Deafness (not Partial Deafness). Crippling (as defined in the penultimate Mental Defect. category of the Table). Epilepsy. 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 5 Of the 5 children suffering from multiple defects, 1 is in attendance at a certified school for mentally defective children and suffers from infantile paralysis; 3 are in attendance at a certified school for physically defective children, and are also mentally defective, and 1 is in attendance at an epileptic colony and is also mentally defective. 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 3 At Public Elementary Schools — At Other Institutions - At no School or Institution - Total 3 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 13 At Certified Schools for the Partially Blind 8 At Public Elementary Schools — At other Institutions — At no School or Institution — Total 21 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 13 At Public Elementary Schools — At other Institutions — At no School or Institution — Total 13 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 6 At Public Elementary Schools — At other Institutions 1 At no School or Institution 1 Total 11 41 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. Details of such children are given on page 42. At Certified Schools for Mentally Defective Children 124 At Public Elementary Schools 1 At other Institutions — At no School or Institution 3 Total 128 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 1 Total 3 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 Schools† — At other Institutions 3 At no School or Institution — Total 3 (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 11 At Public Elementary Schools† — At other Institutions — At no School or Institution — Total 11 † 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. 42 At Certified Special Schools 75 At Public Elementary Schools 301 At other Institutions — At no School or Institution 1 Total 377 (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 64 At Public Elementary Schools — At other Institutions — At no School or Institution 1 Total 65 (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 59 At Public Elementary Schools 1 At other Institutions — At no School or Institution 2 Total 62 Statement of the Number of Children Notified during the Year ended December 31st 1934, 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 (b) Imbeciles 1 1 (c) Others 3 3 (ii.) Children unable to be instructed in a Special School without detriment to the interests of other children: (a) Moral defectives — — (b) Others — — 2—Feeble-minded children notified on leaving a Special School on or before attaining the age of 16 3 1 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 7 6 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 1934:— Table No. 25. Special Schools in Willesden. Special Schools outside Willesden. Total. Blind and Partially Blind — 27 27 Deaf — 22 22 Mentally Defective 142 11 153 Epileptic — 6 6 Physically Defective ... 215 271* 486* Total 357 337* 694* *221 of these were debilitated children sent to Certified Residential Schools for six weeks convalesence. 43 Table No. 26. SPECIAL SCHOOLS. Medical defects referred for following up at Routine Medical Inspection. Cases seen by A.M.O.'s at other than Routine Medical Inspections. Cases not seen by A.M.O.'s. CONDITIONS. 1 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 treatment. No. of defects not treated. No. of defects under observation at end of year, and carried forward to succeeding year. Remedied. Improved. Unchanged. Jnder observation it end of year (result of treatment not known). Brought forward from previous year. New Total. School Clinic or Hospital or other Institution under Council Scheme. VoluntaryHos pital or other charitable In- Hospital Doctor under M.C.C. Private Practitioner. Total. Domestic Treatment only. Grand Total. Exclud-' ing Domestic Treatment. Including Domestic Treatment. Removed from observation. Remaining under observation. Total. 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 Cleanliness of Head—Nits - 8 8 - — 3 — — — 3 5 8 8 — — — 37.5 100.0 — — — — Nose and Throat— Enlarged Tonsils 1 2 3 - 1 - - - - - - - - - - - - - 1 1 2 1 Enlarged Tonsils and - 2 2 - - 2 - - - 2 - 2 2 - 100.0 - Other conditions - 1 1 - - - 1 — - 1 - 1 — 1 100.0 — — — — Ear Diseases- Chronic suppuration of Middle Ear 1 4 5 - - 4 - - - 4 1 5 3 - - 2 80.0 100.0 - - - 2 Other conditions - 1 1 - -- 1 - - - 1 - 1 - 1 100.0 — — — — - Defective Hearing 1 1 2 - - - - - - - - - - - - - - - 2 - 2 — External Eye DiseaseBlepharitis - 1 1 - - 1 - - - 1 - 1 1 - 100.0 - - - - - Corneal Ulcers - 1 1 - 1 — — — 1 — 1 — 1 — — 100.0 - — — — — Malnutrition - 1 1 - - - - - - - 1 1 - 1 - 100.0 - - - - Heart and CirculationOrganic Disease - 2 2 - - - 1 - - 1 - 1 - 1 50.0 - 1 - 1 - Functional Disease 1 1 2 - - 1 - — 1 - 1 — 1 — — 50.0 - 1 — 1 — Other conditions — 1 1 - - - 1 - - 1 - 1 1 — — — 100.0 - — — — — LungsBronchitis 1 2 3 - - - 1 - 1 2 - 2 2 - - - 66.6 - 1 - 1 - Other Diseases, nonT.B. 1 - 1 - - 1 - — 1 — 1 — 1 — — 100.0 - — — — - T.B. suspected - 1 1 - - 1 - - — 1 — 1 — — — 1 100.0 — — — — 1 Nervous System— Chorea - 1 1 - - - - - 1 1 — 1 — 1 — — 100.0 — — — — — Skin- Minor Injuries - 14 14 - - 13 1 - - 14 - 14 14 - - - 100.0 - - - - - Impetigo — 3 3 - - 2 - - - 2 1 3 3 - — — 66.6 100.0 — — — - Scabies - 1 1 - - 1 - — 1 — 1 1 - — — 100.0 - — — — - Other diseases, non-T.B. 1 17 18 1 - 16 - - — 16 1 17 17 — — — 88.8 94.4 — — — — Deformities— Spinal Curvature - 5 5 - 1 3 - - - 3 - 3 - - - 3 60.0 - 1 - 1 3 Other Forms 5 15 20 - 3 14 - - - 14 — 14 — 4 2 8 70.0 - 3 — 3 8 Tuberculosis— Non-Pulmonary— Definite—Hip - 1 1 - - 1 - - - 1 - 1 - 1 - - 100.0 - - - - - Vision— Defect not ascertained 3 1 4 - - 2 1 - - 3 - 3 3 - - - 75.0 - 1 - 1 - Both eyes 6/6 - 1 1 - - - - - - - - - - - - - - - - - - - One eye normal - 1 1 - - 1 - - - 1 - 1 1 - - - 100.0 — - - One eye 6/9, other 6/12 or less - 1 1 - - 1 - - - 1 - 1 1 - - - - - - - - - Both eyes 6/12 or less... - 1 1 - - 1 — - — 1 - 1 - — — 1 100.0 — — - — 1 Lost Glasses - 1 1 - - — - - — — - - — — — - - - 1 - 1 - Broken Glasses - 3 3 - - 2 - - 1 3 - 3 3 — — - 100.0 - - — — — Debility 4 - 4 - - 3 1 - — 4 - 4 3 1 — - 100.0 - - - - — Miscellaneous 2 29 31 2 9 4 4 1 2 11 2 13 12 — - 1 35.5 41.9 7 - 7 1 Totals 21 124 145 3 15 78 12 1 5 96 11 107 75 14 2 16 66.2 73.8 19 1 20 17 Re-examinations in respect of Defective Vision other than Lost and Broken Spectacles, and in respect of other Conditions. No. of cases dealt with 17 44 Table No. 27.—Corresponding to Appendix E of the Annual Report of the Chief Medical Officer of the Board of Education for 1919. Form of Annual Return of the After-Careers of Children under 21 Years of Age Formerly Attending Special Schools. Oldfield Road Physically Defective School. Leinster Mentally Defective School. Boys. Girls. Boys. Girls. 1. Number of children who have left the school and are under 21 years 46 53 46 31 2. Number who:— (a) Have since died 1 5 3 1 (b) Are known to be incapable by reason of mental or physical defect of undertaking employment 3 3 1 1 (c) Are in attendance at an Institution for further education (give details), and †2 - §3 §4 (d) Are in any other Institution (specify Asylum, Workhouse, Colony for Epileptics, &c.) *2 ††l **5 **3 3. Number who are employed in:— (a) Industrial or manual occupations 29 12 20 6 (b) Agricultural or rural occupations — — 1 — (c) Domestic occupations, including those who are helping in the domestic work at home - 5 1 10 (d) Commercial professional or clerical work 5 12 - - (e) Blind alley or other precarious occupations - - 1 - 4. Number who have left the neighbourhood or whose after-careers have not been traced 4 15 11 6 † 1 is in attendance at a technical school and 1 is at an institution learning bootmaking. * 1 is in Hospital on account of epileptic lits and 1 is in an institution for mental defectives, †† In Harefield Sanatorium. § In attendance at an occupation centre. ** In institutions for mental defectives. 2 Mentally Defectives and 2 Physically Defectives are unemployed. Dental Defects. (1) Number of children who were:— (a) Inspected by the Dentists— Aged 5 years — Aged 11 years 32 „ 6 „ 4 „ 12 „ 34 „ 7 „ 4 „ 13 „ 43 ,, 8 „ 10 „ 14 „ 41 „ 9 „ 17 „ 15 „ 6 „ 10 „ 16 „ 16 „ 3 Total 210 Specials 16 Grand Total 226 (b) Found to require treatment 147 (c) Actually treated at the Authority's Health Centres 34 (2) Half-days devoted to Inspections 4 Total 11 Treatment 7 (3) Attendances made by the children for treatment 79 (4) Fillings Permanent teeth 31 Total 31 Temporary teeth - (5) Extractions Permanent teeth 44 Total 109 Temporary teeth 65 (6) Administration of general anaesthetics For extractions 28 Total 31 Local 3 (7) Other operations Permanent teeth 16 Total 16 Temporary teeth - 45 Table No. 28. Medical and Dental Treatment—Attendances at Health Centres, 1934. Condition. (1) Mothers, and Children under Five. Total (Cols. 2—5). (7) School Children. (8) Grand Total. (Cols. 7 and 8). (9) Expectant Mothers. (2) Nursing Mothers. (3) Children under Five. 0—1. (4) 1—5. (5) Total (Cols. 4 and 5). (6) 1. Cleansing 1 - 4 9 13 14 342 356 2. Throat, Nose and Ear Diseases 2 4 149 607 756 762 5,240 6,002 3. Minor Ailments 25 121 1,579 3,925 5,504 5,650 37,365 43,015 4. Eye Diseases 1 9 236 574 810 820 5,662 6,482 5. Ringworm, etc. 9 42 117 209 326 377 632 1,009 6. Artificial Sunlight Treatment — 1 390 3,259 3,649 3,650 7,573 11,223 7. Orthopaedics — 18 529 2,099 2,628 2,646 5,357 8,003 8. Medical Consultations 6,988 24,717 26,177 16,640 42,817 74,522 — 74,522 9. Diphtheria Immunisationt — 1 — 30 30 31 41 72 10. Total (1—9) 7,026 24,913 29,181 27,352 56,533 88,472 62,212 150,684 11. Dental Consultations 1,829 2,017 — 1,190 1,190 5,036 13,095 18,131 12. Total (10—11) 8,855 26,930 29,181 28,542 57,723 93,508 75,307 168,815 13. School for Mothers — —- — — — 5,337 — 5,337 14. Nursery — — — — — 4,726 — 4,726 15. Miscellaneous — — — — — 14,338 14,867 29,205 16. Grand Total (12-15) 8,855 26,930 29,181 28,542 57,723 117,909 90,174 208,083 (1) Health Centre (1) Health Centre (2) Health Centre (3) Grand Total. (11) Mothers and Children under Five. (2) School Children (3) Total. (4) Mothers and Children under Five. (5) School Children (6) Total. (7) Mothers and Children under Five. (8) School Children (9) Total. (10) 17. Medical Attendances 13,979 17,139 31,118 41,433 14,526 55,959 33,060 30,547 63,607 150,684 18. Dental Attendances 1,078 2,443 3,521 1,649 3,622 5,271 2,309 7,030 9,339 18,131 19. School for Mothers 1,499 0 1,499 1,806 0 1,806 2,032 0 2,032 5,337 20. Nursery Attendances 2,117 0 2,117 1,011 0 1,011 1,598 0 1,598 4,726 21. Miscellaneous 6,668 4,069 10,737 4,175 6,137 10,312 3,495 4,661 8,156 29,205 22. Total 25,341 23,651 48,992 50,074 24,285 74,359 42,494 42,238 84,732 208,083* * In addition the following attendances were made by adults:—Cleansing 158, Ringworm, etc. 19, Varicose Ulcers 756, making a total of 934 which together with the 208,083 above makes a grand total of 209,017. Table No. 29. 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 112051 1922 27,505 894 28,399 39,989 7,025 47,014 75,413 1,616 2,190 79,219 1923 23,271 533 23.804 40,381 3,599 43,980 67,784 2,761 3,270 73,815 1924 17,082 520 17,602 34,845 2,460 37,305 54,907 2,896 2.808 60,611 1925 26,119 936 27 055 41,695 5,123 46,818 73,873 4,074 3 812 81,759 1926 39,084 1,491 40,575 47,786 5,909 53,695 94,270 4,126 3,645 102,041 1927 40,958 1,593 42,551 47,199 6,583 53,782 96,333 3,847 3,291 103,471 1928 40,787 1,733 42,520 43,956 6,484 50,440 92,960 4,485 3,355 100,800 1929 43,419 1,598 45,017 39,698 6,307 46,005 91,022 4,523 3,446 98,991 1930 59,372 2,341 61,713 49,610 10,537 60,147 121,860 5,958 5,371 133,189 1931 76,395 3,473 79,868 65,942 15,180 81,122 160,990 6,928 6,985 21,884 196,787 1932 84,342 4,385 88,727 67,964 16,094 84,058 172,785 6,536 6,227 28 817 214 365 1933 84,782 4,791 89,573 71,587 15,652 87,239 176,812 5,297 5,268 27,256 214,633 1934 88,472 5,036 93,508 62,212 13,095 75,307 168,815 5,337 4,726 30,139* 209,017 * This includes the 934 attendances by adults which are shown in the footnote to Table No. 28. 46 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. 9,727 Individual School Children attended the Municipal Centres during 1934. Hospital Treatment of School Children under the Council's Scheme. Table No. 30. Hospital Treatment of School Children during 1934. No. of School Children in Willesden General Hospital at 31st December, 1933 0 „ „ „ admitted during 1934 343 „ „ „ under treatment during 1934 343 discharged during 1934 342 „ „ died in Hospital during 1934 1 remaining in Willesden General Hospital at 31st December, 1934 0 Table No. 31. School Children under Treatment in Hospital during 1934. 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 — 342 342 342 — 341 — — 1 — Total — 343 343 343 — 342 — — 1 — No School Children were admitted to St. Monica's Home Hospital. It will be seen that one application was not granted. The reason was that the child was suffering from a Heart defect following Rheumatism. Employment of Children in Entertainments Rules, 1933. Particulars as to applications received in 1934 for certificates from the School Medical Officer. No. of Applications. No. Granted. Boys. Girls. Total. Boys. Girls. Total. Original applications 3 27 30 3 26 29 Applications for renewals 2 8 10 2 8 10 5 35 40 5 34 39 47 THE FIFTEENTH ANNUAL REPORT for the Year ending 31st December, 1934, 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. 32.—Corresponding to Table I. of the Board of Education's Medical Statistical Tables. Return of Medical Inspections for the Year ended 31st December, 1934. 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 1 0 1 0 0 0 1 0 1 0 0 0 0 0 0 2 0 2 0 0 0 2 0 2 11 „ 63 0 63 0 0 0 49 0 49 53 0 53 0 0 0 112 0 112 53 0 53 165 0 165 12 „ 26 75 101 0 0 0 12 45 57 13 44 57 2 0 2 40 120 160 13 44 57 53 164 217 13 „ 1 0 1 34 0 34 3 0 3 3 0 3 56 0 56 60 0 60 37 0 37 97 0 97 14 „ 1 0 1 34 0 34 3 0 3 0 0 0 28 0 28 32 0 32 34 0 34 66 0 66 15 „ 2 71 73 3 42 45 0 26 26 0 27 27 0 30 30 2 127 129 3 69 72 5 196 201 16 „ 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 17 „ 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 1 0 1 0 0 0 1 0 1 Total 95 146 241 71 42 113 68 71 139 69 71 140 86 30 116 249 247 496 140 113 253 389 360 749 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 11 0 3 2 1 15 2 17 Number of Re-inspections 72 35 43 53 42 157 88 245 Total 83 35 46 55 43 172 90 262 48 Table No. 33.—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, 1934. Defect or Disease. (1) Routine Inspections. Special Inspections. Number of Defects. Number of Defects. Requiring treatment. (2) Requiring to be kept under observation, but not requiring treatment. (3) Requiring treatment. (4) Requiring to be kept under observation, but not requiring treatment. (5) Kilburn Grammar School (Boys). Willesden Polytechnic Trade School (Girls). Willesden County School. Willesden Polytechnic Building Trade School (Boys). Kilburn Grammar School (Boys). Willesden Polytechnic Trade School (Girls). Willesden County School. Willesden Polytechnic Building Trade School (Boys.) Kilburn Grammer School (Boys). Willesden Polytechnic Trade School (Girls). Willesden County School. Willesden Polytechnic Buildine 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). - - - - - 1 - - - - - - - - - - - - - - Eye Blepharitis - - - - - - - - - - - - - - - - - - - - Conjunctivitis - - - - - - - - - - - - - - - - - - - - Keratitis - - - - - - - - - - - - - - - - - - - - Corneal Opacities - - - - - - - - - - - - - - - - - - - - Defective Vision (excluding Squint) 14 - 12 8 5 7 2 6 7 - 2 - - - - - - 1 - - Squint 1 1 — — 1 1 - - - - - - - - - - - - - - Other Conditions — i — — 2 1 2 - - - - - - - - - - - - - Ear Defective Hearing - - - - - 1 - - - - - - - - - - - - - - Otitis Media - - 1 - - - - - - - - - - - - - - - - - Other Ear Diseases - - - - - - - - - - - - - - - - - - - - Nose & Throat Enlarged Tonsils only. 1 1 1 2 — 1 — 3 1 — — — — — — — — — — — Adenoids only 2 - - - - - - - - - - - - - - - - - - - Enlarged Tonsils and Adenoids. 1 - - - - - - - - - - 1 - - - - - - - - Other Conditions - - - - - - - - 1 - - - - - - - - - - - Enlarged Cervical Glands (Non-Tuberculous). - - - - - - - - - - - - - - — 1 — — — - Defective Speech - - - - - - - - - - - - - - - - - - - - Teeth—Dental Diseases 37 19 19 28 26 — 2 1 — 1 — — — — — — — — — Heart and Circulation Heart Disease:— Organic - - - - - 2 2 1 - - - - - - - - - - - Functional — — — — 2 16 6 7 9 2 - - - - - 1 - - - - Anasmia - - - 1 - - - - - - - - - - - - - - - - Lungs Bronchitis - - - 1 - - - - - - - - - - - - - - - - Other Non-Tuberculous Diseases. - - - - - 1 - - - 1 - - - - - 2 - - - - Tuberculosis Pulmonary:— Definite - - - - - - - - 1 - - - - - - - - - - - Suspected - - - - - - - - - - - - - - - - - - - - Non-Pulmonary: Glands - - - - - - - - - - - - - - - - - - - - Bones and Joints - - - - - - - - - - - - - - - - - - - - Skin - - - - - - - - - - - - - - - - - - - - Other forms - - - - - - - - - - - - - - - - - - - - Nervous System Epilepsy - - - - - - - - - - - - - - - - - - - - Chorea - - - - - - - - - - - - - - - - - - - - Other Conditions - - - - - - - - - - - - - - - - - - - - Deformities Rickets - - - - - - - - - - - - - - - - - - - - Spinal Curvature — 2 - - - - - - - - - - - - - - - - - - Other Forms 13 16 2 3 3 1 2 - - - - - - - 1 - - - - - Flat Foot 25 5 15 12 16 - 1 2 1 — - - - - - - - - - - Other defects and diseases 6 — 7 1 2 3 — 5 2 3 — — — — — 2 — 1 — — Total 100 45 57 56 57 35 17 24 23 6 3 - 1 - 1 6 - 2 - - 49 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) 95 20 21.1 71 14 19.7 68 18 26.5 69 11 16.0 86 17 19.1 Pupils aged 12 years 75 22 29.3 1 0 0.0 45 9 20.0 44 11 25.0 0 0 0.0 Pupils aged 15 years 71 16 22.5 41 10 24.1 26 10 38.5 27 6 22.2 30 12 40.0 Total (Prescribed Groups) 241 58 24.7 113 24 21.2 139 37 26.6 140 28 20.0 116 29 25.0 * * Other Routine Inspections ... - - - - - - - - - - - - - - - ** During 1934 the following groups have been submitted to Routine Medical Inspection at the Secondary Schools in Willesden, and are all included under the Code Group Heading:— (a) All entrants. (b) Pupils aged 12 years. (c) Pupils aged 15 years. Table No. 34.—Corresponding to Table IV. of The Board of Education's Medical Statistical Tables. Return of Defects Treated during the Year ended 31st December, 1934. 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. Bo vs. (2) Girls. (3) Boys. (4) Girls. (5) Boys. (6) Treated under the Authority's Scheme. Otherwise. Total. Treated under the Authority's Scheme. Otherwise. Total. Treated under the Authority's Scheme. Otherwise. Total. Treated under the Authority's Scheme. Otherwise. Total. Treated under the Authority's Scheme. Otherwise. Total. Skin:— Ringworm—Scalp - - - - - - - - - - - - - - - Body (Show separately in brackets the number which were treated by X-rays) - - - - - - - - - - - - - - - Scabies - - - - - - - - - - - - - - - Impetigo - - - - - - - - - - - - - - - Other skin diseases - - - - 1 1 - - - - - - - 1 1 Minor Eye Defects (External and other, but excluding cases falling in Group II.) - - - - - - - - - - - - - - - Minor Ear Defects - - - - 1 1 - - - - - - - - - Miscellaneous (e.g., Minor Injuries, Bruises, Sores, Chilblains, etc.) - - - - - - - - - - - - - - - Total - - - - 2 2 - - - - - - - 1 1 50 Group II.—Defective Vision and Squint (excluding Minor Eye Defects treated as Minor Ailments—Group I.). No treatment has been arranged for by the Local Education Authority, but at the Kilburn Grammar School (Boys).—In 5 instances the School Medical Inspector noted on re-inspection that the pupils were wearing suitable spectacles; in 9 instances the pupils were under treatment, in 7 instances the vision had been re-tested and suitable spectacles obtained, and in 1 instance 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. Willesden County School.—In 10 instances (girls) and 6 instances (boys) the School Medical Inspector noted on re-inspection that suitable spectacles were being worn. In 3 instances (girls) and 6 instances (boys) the vision had been re-tested and suitable spectacles obtained. In 1 instance (girls) and 3 instances (boys) the pupils were under treatment. Willesden Polytechnic Building Trade School (Boys).—In 2 instances the School Medical Inspector noted on re-inspection that the vision had been re-tested and suitable spectacles obtained, and in 1 instance the pupil was under treatment. Group III.—Treatment of Defects of Nose and Throat. Kilburn Grammar School (Boys).—In 1 instance the School Medical Inspector noted on reinspection that the pupil was under treatment. Willesden Polytechnic Trade School (Girls).—Nil noted. Willesden County School.—In 1 instance (boys), the pupil was awaiting admission to hospital for operation, and in 1 instance (girls) the School Medical Inspector noted on re-inspection that the tonsils had been removed. Willesden Polytechnic Building Trade School (Boys).—Nil noted. Group IV.—Orthopædic and Postural Defects. Orthopædic 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:—1 case at the Kilburn Grammar School (boys), 6 cases at the Willesden Polytechnic Trade School (girls), 9 cases (boys) and 4 cases (girls) at the Willesden County School, and 4 cases 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. 35. (a)—KILBURN GRAMMAR SCHOOL. Defect. No. Result. Deformities—Flat Foot 5 Having Exercises. Postural Defect 2 Having Exercises. Round Shoulders 4 Having Exercises. Scoliosis and Round Shoulders 1 Having Exercises. Other Defects and Diseases 4 Under Hospital treatment. 1 Had Operation, cured. 51 (b)—WILLESDEN POLYTECHNIC. Defect. No. t. Deformities—Round Shoulders 1 Having Exercises. Flat Foot 2 Improving with Exercises. Postural Defect 1 (c)—WILLESDEN COUNTY SCHOOL. Defect. No. Result. Boys. Girls. Deformities—Flat Foot 3 6 Having Exercises. „ „ 0 1 Satisfactory after exercises. Round Shoulders 3 3 Having Exercises. „ „ 0 1 Satisfactory after exercises. Other Defects and Diseases 0 2 Having Treatment. „ „ „ „ 0 1 Has had operation. Now well. (d)—WILLESDEN POLYTECHNIC BUILDING TRADE SCHOOL (BOYS). Defect. No. Result. Deformities—Flat Foot 6 Having Exercises. „ „ 1 Wears Shoe Supports. Round Shoulders 1 Having Exercises. Other Defects and Diseases 1 Has had treatment. 52 THE SEVENTEENTH ANNUAL REPORT for the Year 1934, on DENTAL WORK in connection with SCHOOL CHILDREN, EXPECTANT and NURSING MOTHERS and CHILDREN under 5 years. By E. A. JENNINGS, L.D.S., R.C.S.Eng. I have the privilege to submit the Seventeenth Annual Report. PART I. The Staff. The dental staff consists of four Dental Surgeons, four Dental Nurses and a part time Anaesthetist. One Dental Officer resigned on October 1st, 1934, and the vacancy was filled on December 3rd, 1934. A Locum Tenens was employed during the intervening period. The total number of sessions recorded by the staff is as follows:— At the Centres 1,570 At the Schools 347 Administration and organisation 20 Absent on account of illness *75 (*18 of these were worked by a Locum Tenens.) The Anaesthetist attended for 183 sessions. Duties. (1) Duties include the inspection and treatment of all nursing and expectant mothers and children under 5 years of age, referred from the Municipal Post- and Ante-Natal Clinics, from a local voluntary Centre and from hospitals and institutions outside the Authority's jurisdiction, where Willesden residents are receiving treatment. (2) Inspection and treatment of all nursery school children and all scholars attending elementary schools. (3) To co-ordinate the work of Maternity and Child Welfare with the School Medical Service, by means of lectures and talks given by the staff and outside agencies (such as the Dental Board and the British Red Cross Society.) Economic Enquiry. In April, the simple declaration form, hitherto in use for patients seeking dental treatment free of cost, was discarded. In place of it, the elaborate economic circumstances enquiry form is used, thus subjecting patients for simple dental treatment, to the same investigation as patients requiring hospital treatment, spectacles, tonsillectomy, dentures, etc. It is necessary to point out here, that the adoption of this uniform enquiry with its detailed questionnaire, is proving a serious hindrance to the work of the School Dentist. X-ray. A valuable recent adjunct to the service has been the provision of facilities for X-ray examination of the mouth and teeth. Arrangements have been made with the Willesden General Hospital authorities to carry out this work. 53 The Year's Work. 19,667 school children, 1,286 mothers and infants were inspected, making a total of 20,953 for the year. Of these 13,934 were found to have defective teeth. 8,773 teeth were filled, 16,355 teeth were removed, which, with 5,841 incidental forms of treatment (scaling, cleaning, dressing, silver nitrate, etc.), make a total of 30,969 operations. A Summary of the year's work compared with the years 1930 to 1933 is tabulated as follows :— Table No. 36. Comparative Table of Work done for Years 1934, 1933, 1932 and 1931. 1934 1933 1932 1931 Total inspected— Mothers, Infants and School Children 20,953 22,270 23,044 23,306 Number defective 13,934 15,106 16,454 16,588 „ treated 5,323 6,046 6,397 5,718 Teeth removed 16,355 17,081 17,660 17,393 „ filled 8,773 10,621 10,311 8,725 Sundry operations 5,841 6,401 6,473 4,513 General anaesthetics 3,883 3,946 3,919 3,970 Treatment sessions 1,570 1,600 1,572 1,523 Inspection sessions 347 361 400 408 Table No. 37. Comparative Table of Work per Session. Attendances. Fillings. Extractions. Sundry. Total Operations per Session. 1934 9.9 5.6 10.4 3.7 19.7 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 indicates that each dentist performed an average of 19.7 operations for 9.9 patients during every treatment session at the Centres. These operations include 5.6 fillings, 10.4 extractions and 3.7 sundries. Anæsthetics. Nitrous oxide with oxygen and carbondioxide mixture, supplemented in some cases with ethyl chloride, was administered nasally by the Anaesthetist to 3,883 patients. This work was carried out with complete satisfaction to all concerned. At one Centre the latest type of Magill apparatus is in use, and at each of the other Centres a Walton apparatus. In November, the Anaesthetist exhibited his film "Sodium Evipan Anaesthesia" at the Town Hall, Dyne Road. There was a large and appreciative audience, among whom were the Chairman of the Children's Care Sub-Committee, practically the whole of the Dental, Medical and Nursing staff of the Health Department, and some private Medical and Dental practitioners. It is suggested that this form of anaesthesia, or the still more recent Barbiturate, might with advantage, be made use of in certain cases at the Centres. PART II. SCHOOL DENTAL SERVICE. Inspection. Routine.—18,272 children out of an approximate school population of 21,400 were examined during the year. 11,167 or 61.1 per cent. were found defective. 54 As hitherto, the procedure of the school inspection sessions, has been to supplement the examination with individual talks to children and parents, and a liberal distribution of leaflets, 343 inspection sessions were absorbed thus. Specials.—1,395 children were inspected at the Health Centres, which number is 60 less than in 1933. This figure not only includes all neglected cases in request of urgent treatment, but also the many patients (particularly "Leavers") as well as parents with their children who seek advice at the Health Centres on account of some minor or even trivial defect or abnormality, between routine inspection. Treatment. 4,425 out of the 12,693 children referred have received their treatment at the Health Centres, an acceptance rate of 36 per cent. It must be assumed that since the condition of the teeth of the elementary school children has been steadily improving over the last few years, that many, as the result of routine inspection are treated elsewhere. It is in accordance with the Willesden scheme that treatment should be obtained either at hospital or privately, and not necessarily at the Centres'. The work includes 7,802 fillings, 9,915 teeth extractions and 4,712 miscellaneous treatments. General anaesthetics were given to 2,937 patients and local anaesthetics were given to 378. The total attendances amounted to 11,451 and the treatment sessions recorded were 1,237. The average work done per session by each dentist is indicated in the Table below. Table No. 38. Work Done per Session. Attendances. Fillings. Extractions. Other Operations. Total Operations. 9.3 6.3 8.0 3.8 18.1 Tables dealing with the Year's Work. Table No. 39. corresponding to Table IV of the Board of Education's Statistical Tables, Group V.—Dental Defects. (1) Number of children who were:— Children attending Special Schools. (i) Inspected by the Dentists. Aged:— Children attending Public Elementary Schools. 5 1,227 - 6 1,754 4 7 1,766 4 8 1,939 10 9 2,077 17 10 2,080 16 11 1.886 32 12 1,897 34 13 1,950 43 14 1,469 41 15 17 6 16 - 3 Total 18,062 210 Specials 1,379 16 Grand Total 19,441 226 (ii) Found to require treatment 12,546 147 (iii) Actually treated at the Authority's Health Centres 4,391 34 (2) Half days devoted to Inspection 343 Treatment 1,230 4 Total 1,573 7 Total 11 (3) Attendances made by the children for treatment 11,372 79 (4) Fillings Permanent teeth 7,265 Temporary teeth 506 31 Total 7,771 - Total 31 55 (5) Extractions Permanent teeth 1,610 Temporary teeth 8,196 44 Total 9,806 65 Total 109 (6) Administration of general anaesthetics— For extractions 2,909 Local 375 28 Total 3,284 3 Total 31 (7) Other operations Permanent teeth 4,542 Temporary teeth 154 16 Total 4,696 - Total 16 Table No. 40. 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 1934 at the health visitor's last visit. Total number of defects coming under observation during 1934. 7,225 Brought forward 1934 651 New during year 6,574 Number of defects treated. 4,472 Health Centre 4,425 Otherwise 47 Percentage of defects followed up needing treatment which were known to have received treatment 61.7% No report available 31 No. of defects for which no treatment had been undertaken at Health Visitor's final visit 1,845 Carried forward to 1935 775 Number not needing treatment 102 The foregoing tables show that compared with 1933 there has been a decrease of 841 in the number of children treated, of 1,808 fillings, and of 1,416 teeth extracted, than in the previous year. The reason for this decline is probably due to the fact that in April last the simple declaration form was incorporated in the comprehensive form for all treatments. This has not unlikely been a deterrent to the acceptance of treatment of early dental diseases, such as detected at routine inspections. It can easily be understood that when disease is extensive and apparent, the forms are completed and fees are readily paid. It is not of course the case that the returns have been greatly reduced, although it is clear that the importance of early treatment may be lost sight of. HEALTH EDUCATION. Each Health Centre has its own School for Mothers, where talks and lectures on the care of the teeth are given to mothers and school children. The Dental Board's series of Exhibitions have not been made use of on the same extensive scale as in previous years. One demonstration only was given. Experience shows that, in spite of the fact that children take interest and appear to derive pleasure on seeing the models, and listening to the lectures, and even to the extent of writing excellent essays on the subject, they are singularly absent when notified of treatment. Additions to the Service.—The nursery classes of children under 5 years of age, now attached to various schools, and numbering 200, automatically come under the scheme for inspection and treatment; also arrangements have been made with the Middlesex County Council to include in 1935 the inspection and treatment of pupils in Secondary Junior Technical, Junior Commercial and Junior Art Schools in Willesden, numbering 2,277. Arrangements for recovering the Cost of Treatment from Parents.—(a) Children attending Elementary Schools. (b) Pupils attending Secondary Schools. (a) Parents whose incomes are shown to be above the economic rate, as set by the Committee, are required to pay 2s. 6d. for the complete treatment. After inspection the parent attends the clerical department of the respective Health Centres, pays the fee, and is given and appointment for treatment. That payment has been made is indicated on the inspection card. (b) No provision for treatment of secondary school pupils during year under review. 56 MATERNITY AND CHILD WELFARE. Marked progress has again to be reported, and a further 19 sessions have had to be reserved for this work, making 333 in all. The total attendances recorded were 3,993, which make an average of 12 cases per session. As most of these patients are desirous of treatment the circumstances which have checked the school work do not apply to the same extent to mothers and infants. Cases inspected amounted to 1,286, as against 1,186 in 1933. The number of mothers treated has increased from 412 to 482, and the infants from 367 to 416 ; a total rise of 119 cases. 6,440 teeth were removed, and 971 conserved by filling, with other operations at 1,129. The proportion of work done on the infants is 1,460 extractions, 281 fillings, and 31 silver nitrates. General anaesthetics were given to 946 cases and local to 45. 254 dentures and 2 repair cases have been supplied to the mothers ; 199 were free, and the remainder at part cost to the patient. There is no need to give further detail as a full summary comparing 1933 and 1934 is given in the table below. Table No. 41. Expectant and Nursing Mothers and Children under Five. 1933 1934 Total E.M. N.M. 0-5 Total E.M. N.M. 0-5 No. inspected 1,186 407 303 476 1,286 479 293 514 No. brought forward from previous year 265 74 150 41 234 86 124 24 Total number under observation during year 1,451 481 453 517 1,520 565 417 538 No. completed 767 161 239 367 852 192 244 416 No. partially completed 13 4 8 1 46 26 20 - No. not availing themselves of treatment 362 220 75 67 249 188 23 38 No. treated by other agencies 8 2 4 2 16 7 2 7 No. carried forward 234 86 124 24 312 146 121 45 No. of attendances 3,862 1,310 1,690 862 3,993 1,487 1,560 946 No. of teeth removed 5,750 1,634 2,861 1,255 6,440 2,185 2,795 1,460 No. of teeth filled 1,011 354 420 237 971 416 274 281 No. of other operations on the teeth and gums 1,326 426 846 54 1,129 442 656 31 No. of general anaesthetics 873 224 315 334 946 260 316 370 No. with no defect 67 8 3 56 45 6 7 32 No. of local anaesthetics 129 41 86 2 120 59 57 4 No. of treatment sessions 314 333 57 THE FIFTH ANNUAL REPORT for the Year ending 31st December, 1934, 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 1934 and 1935 respectively. 1934 1935 In Willesden— 1. Private District Midwives 11 13 2. Queen Charlotte's District Home, 40, Princess Road, Kilburn, N.W. 6. 3 2 3. Central Middlesex County Hospital 9 8 Outside Willesden— 1. Private District Midwives 9 9 2. Queen Charlotte's District Home, 176, Ladbroke Grove, Kensington 2 4 3. Kilburn and West Hampstead District Nursing Association, 20, Dennington Park Road, Hampstead, N.W. 6 4 4 Total 38 40 Table No. 43. Number of additional Midwives who, from 1st February to 31st December, 1934, gave Notice of their Intention to Practise in Willesden in 1934. In Willesden. 1. Private District Midwives 2 2. Queen Charlotte's District Home, 40, Princess Road, Kilburn, N.W. 6 8 3. Central Middlesex County Hospital 8 Outside Willesden. 1. Private District Midwives 1 2. Queen Charlotte's District Home, 176, Ladbroke Grove, Kensington 3 3. Kilburn and West Hampstead District Nursing Association, 20, Dennington Park Road, Hampstead, N.W. 6 2 Total 24 During 1934, from January 1st to December 31st, 62 Midwives gave notice of their intention to practise in Willesden. 58 Table No. 44. Number of Cases attended by Midwives Practising and Living in Willesden during 1934. Private District Midwives. No. of Cases attended Total. Remarks. As Midwife. As Maternity Nurse. 1 18 11 — 2 76 22 — 3 8 7 — 4 3 4 — 5 25 None — 6 41 4 — 7 46 2 — 8 29 9 — 9 9 13 — 10 4 11 — 11 13 78 *72 were attended on the district attached to St. Thomas's Hospital. 12 None None — Midwives attached to Willesden District Nursing Association, 17 and 19, Park Avenue, N.W. 2 None 188 - Midwives attached to Queen Charlotte's Hospital District Home, 40, Princess Road, N.W. 6. 325 None - Midwives at the Central Middlesex County Hospital, Acton Lane, N.W. 10 **564 **75 **These patients were all confined in the Central Middlesex County Hospital. Total ... 1,161 424 = 1,585 in all. Table No. 45. Number of Cases attended by Midwives practising in but Living Outside Willesden during 1934. Private District Midwives. No. of Cases attended in Willesden. Total. As Midwife. As Maternity Nurse. A None None B None None C None None D 8 None E 8 3 F 5 None G 2 None H 2 None I 5 None T 2 None Midwives attached to Kilburn and West Hampstead District Nursing Association, 20, Dennington Park Road, Hampstead, N.W. 6 35 None Midwives attached to Queen Charlotte's Hospital District Home, 176, Ladbroke Grove, W.10 26 None Total 93 3 From Table 44 it will be observed that Midwives living in Willesden attended 1,161 cases as Midwives and 424 cases as Maternity Nurses or 1,585 in all. 59 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 76 and that the largest total of cases any single Midwife attended was 98, being 76 cases which she attended as a Midwife and 22 as a Maternity Nurse. This Midwife (No. 2) with 98 cases and another Midwife (No. 11) with 91 cases may be making a living at midwifery, although the case of No. 11 who takes St. Thomas's students may be different from Midwife No. 2 as it is not unlikely that Midwife No. 11 receives a salary from St. Thomas's Hospital. The next highest total number of cases attended by a District Midwife was 48 and this cannot conceivably represent whole-time work. It will, therefore, be observed that all the Private District Midwives in Willesden who are practising midwifery must practise it as an adjunct to some other work which in my opinion is unsatisfactory. During the year ended 31st December, 1934, 145 notifications were received from Midwives practising in Willesden in accordance with the rules of the Central Midwives Board. Of these 145 notifications 111 were received from Midwives living and practising in Willesden and 34 from Midwives practising in, but living outside Willesden. Of the 145 notifications received 120 were in respect of calling in medical aid, 87 being in respect of the mother and 33 in respect of the child. In addition 8 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, 1934, amounted to £73 19s. 0d., and the total fees paid by the Council to Midwives amounted to £167 14s. 0d.—£145 1 1s. 0d., where the Midwife was acting as a Midwife and £22 3s. Od. where the Midwife was acting as a Maternity Nurse. (The maternity nursing cases were all dealt with by the Willesden District Nursing Association, 17-19, Park Avenue, Willesden, N.W.2.) 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 44 (Up to 4th Feb., 1935, 40 have notified intention to practise in Willesden during 1935.) (b) Number (i.) employed by the Council 0 (ii.) directly subsidised by the Council 0 (iii.) employed by Voluntary Associations in Willesden 12 ► (Queen's Nurses, 17/19, Park Avenue, Willesden—(These act as Maternity Nurses —not as Midwives. 2 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 ► 7 (Queen Charlotte's Hospital District Nurses' Home, 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— 75 where the midwife was acting as a midwife. 18 where the midwife was acting as a maternity nurse. II. (a) Number of cases attended by midwives during the year:— In Willesden by all Outside Willesden by midwives practising midwives resident in Willesden. in Willesden. (i.) As midwives 1,097 157 (ii.) As maternity nurses 337 90 (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—120. 60 Table No. 47. Notifications received from Midwives in accordance with the Rules of the Central Midwives Board, 1st January to 31st December, 1934. From Midwives living and practising in Willesden. From Midwives practising in Willesden but living outside. Notifications of:— Sending for Medical Help 93 27 Having laid out a dead body 5 - Liability to be a source of infection 1 3 Death of child 3 - Still Birth 7 3 Artificial feeding 2 1 Table No. 48. Reasons for Sending for Medical Help. Medical Help sought by Midwives. Medical Help sought by Midwives. For Mother. Living in Willesden. Living outside Willesden. For Child. Living in Willesden. Living outside Willesden. Ante-Natal examinations 2 - Cleft Palate 1 Collapse 1 - Ante-partum Haemorrhage 7 - Chest trouble 2 - Cyanosis - 1 Adherent placenta 3 - Dangerous Albumin in Urine 3 - prematurity 2 - Abscess between buttocks 1 - Premature infant 4 1 Severe cold 1 - Breech with extended legs 1 - Sticky eyes 5 5 Twin (28 weeks Delayed labour 9 2 nancy) bad colour 1 - Depressed nipples 1 - Vomiting Fainted after delivery History of heart disease 1 - Meconium 1 - 1 Watery eyes 4 1 Jaundiced 3 - Loss and shock after twins 1 Laceration of perineum 15 6 Multiple pregnancy 1 - Malpresentation 2 2 Marked varicose veins Pain and inflammation of leg Post-partum hæmorr¬hage 1 1 2 1 3 1 Prolapsed cord 2 - Swelling of leg 1 1 Severe headache and insomnia 2 - Severe cough and sleeplessness 1 - Septic sports on hands and rash on body 1 - Rise of temperature 7 5 68 19 25 8 Table No. 49. Fees Paid to Medical Practitioners under Section 14 of the Midwives Act, 1918. January 1st to December 31st, 1934. Number of notifications of Sending for Medical Help 120 „ „ „ in respect of which fees paid 62 Total fees paid by Council £73 19s. 0d. 61 THE FIFTH ANNUAL REPORT for the Year ending 31st December, 1934, on the REGISTRATION OF NURSING HOMES. NURSING HOMES REGISTRATION ACT, 1927. Table No. 50. Maternity and Nursing Homes, January 1st, 1934, to December 31st, 1934. (1) Number of applications for registration:— (a) Maternity Homes 1 (b) Nursing Homes 2 (2) Number of Homes registered 2 (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 4 (7) Number of cases in which exemption has been— (a) Granted 4 (b) Withdrawn 0 (c) Refused 0 (8) Nursing Homes closed by voluntary retirement 4 At the close of the year there were 8 Nursing Homes on the Register of the Corporation of Willesden with accommodation for 56 patients. The Arrangements made for the Supervision of Maternity and other Homes Registered under the Act. Maternity and Nursing Homes in Willesden are visited once in every three months, for the purpose of routine inspection. This includes inspection of the home, enquiries as to the staff, inspection of register and report book required to be kept under the Nursing Homes Registration Act, 1927, and the bye-laws made by the Council under section 4 of the Act. In addition, special visits are made to the homes for all other conditions requiring attention. The inspections are carried out by a qualified nurse with special experience in midwifery. She is directly responsible to the Medical Officer of Health in giving reports as to the condition of the homes and for receiving instructions. The keepers of Maternity or Nursing Homes are required under the Children and Young Persons Act, 1932, to send particulars to the Local Authority of any child under the age of 9 years received into the homes, both at the time of reception and of removal, unless the child is accompanied by a parent or guardian. 62 THE FIFTH ANNUAL REPORT for the Year ending 31st December, 1934, 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, 1908-1933, 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 as set out in the 1933 Annual Health Report—see page 61. One certificate of exemption was granted under Section 69 (c) of the Children and Young Persons Act, 1932. One foster child died during the year. The cause of death was due to pneumonia. Table No. 51. Foster Mothers. Number of Foster Mothers at 31st December, 1933 126 Number of Foster Mothers at 31st December, 1934 103 Number of Licences granted by Council in 1934 42 „ ,, refused by Council in 1934 9 Number of applications to take additional children agreed to by Council 13 „ „ „ „ „ refused by Council 0 Number of applications for re-issue of Licence agreed to by Council 18† „ „ „ „ „ refused by Council 0 Foster Children. Coming under observation— Number of Foster Children at 31st December, 1933 190 Number of Foster Children received during 1934 269 Number entered Willesden with their Foster Mothers 17 Total 476‡ †Of these 18 cases 12 were re-issued in respect of new premises and 3 were re-issued in respect of amendments of the Children Act, 1908, as contained in the Children and Young Persons Act, 1932. ‡The actual number of new individual Foster Children who came under observation was 216. 63 Removed from observation— Number given up 269 ,, reached the age of 9 years 14 ,, died 1 „ legally adopted 3 ,, ceased to be taken for gain or taken over by Public Assistance Committee 1 ,, left Willesden with their Foster Mothers 15 Total 303 Remaining under observation— Number of Foster Children at 31st December, 1934— (a) Under 5 years of age 117 (b) Between 5 and 9 years of age 56 Total 173 Table No. 52. The 173 Foster Children under observation at 31st December, 1934, were maintained in the care of Foster Mothers as follows:— Maintained by-— Parent or Guardian 144* Crusade of Rescue, 48, Compton Street, W. 26 National Adoption Society, 4, Baker Street, W. 3 Received with lump sum 0 Total 173 * In 29 cases the parents or guardians were living in Willesden at the time the child entered the care of the Foster Mother. In 115 of these cases the parents or guardians were not living in Willesden at the time the child entered the care of the Foster Mother. Table No. 53. The following Table shows the length of time each of the 173 Foster Children under observation at 31st December, 1934, had been in the care of their Foster Mothers. Under 6 months 51 Over 6 months, under 1 year 35 Over 1 year, under 1½ years 18 Over 1½ years, under 2 years 25 Over 2 years, under 2½ years 13 Over 2½ years, under 3 years 11 Over 3 years, under 3½ years 5 Over 3½ years, under 4 years 5 Over 4 years, under 4½ years 0 Over 4½ years, under 5 years 2 Over 5 years, under 5½ years 0 Over 5½ years, under 6 years 0 Over 6 years, under 6½ years 0 Over 6½ years, under 7 years 0 Over 7 years, under 7½ years 4 Over 1½ years, under 8 years 2 Over 8 years, under 8½ years 1 Over 8½ years, under 9 years 1 Total 173 Of the 318 individual Foster Children under observation during the year 1934, 169 changed hands during that period. 139 made 1 change, 18* made 2 changes, 11 made 3 changes, 1 made 4 changes. These changes do not include the first reception of the child. *Of these, 9 were admitted to Hospital returning to same Foster Mother. 64 THE FIFTEENTH ANNUAL REPORT for the Year ending 31st December, 1934, on HOME NURSING. A record of work done is given in the three following tables:— Table No. 54. Shewing sources from which cases were referred for Home Nursing during the Year 1934. Referred by Number. Health Department 337 Private Doctors 20 Others 30 Total 387 Table No. 55. Shewing cases Home Nursed in Wards during 1934. Ward No. of Cases brought forward from 1933. No. of Cases referred in 1934. Total. No. of Visits paid. 1. South Kilburn 3 93 96 1,096 2. Mid-Kilburn 9 79 88 968 3. North Kilburn 3 54 57 494 4. Brondesbury Park 1 10 11 60 5. Kensal Rise — 12 12 84 6. Harlesden — 18 18 84 7. Stonebridge — 30 30 323 8. Roundwood 1 13 14 239 9. Church End — 18 18 75 10. Willesden Green — 25 25 114 11. Cricklewood — 35 35 282 Total 17 387 404 3,819 THE TWENTIETH ANNUAL REPORT FOR THE Year ending 31st December, 1934, 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. Dinners are served in the main hall at each school. On February 3rd, 1934, the feeding of school children on seven days a week, instead of on five days as heretofore, was commenced in the four feeding centres controlled by the Education Committee. Breakfasts.—The practice of serving breakfasts has been continued throughout the year at Carlton Vale School House, and on April 30th, 1934, breakfasts were commenced at all Education Committee's centres, and also at the Granville Road Voluntary Centre. The Corporation of Willesden decided to raise the economic scale 1s. per head on April 1st, 1934, and to allow all children in receipt of free dinners also to receive free breakfasts. The breakfasts consist of cocoa made with dried milk, brown or white bread and vitamin margarine with jam or marmalade, or currant 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 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 706. Recommendations are no longer received from the Local Public Assistance Officers as the arrangement 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. Kilburn Feeding Centre Dinners.—The children of the South Kilburn area are fed at the Voluntary Centre established at the Presbyterian Mission Hall, Granville Road. A change has been made with regard to the serving of the meals. The first course is now served in earthenware soup plates instead of the old shallow enamel ones, and one spoon is now supplied for each course. The menu has been revised, and the children now receive the same 15-day menu as that in operation at the Education Committee's Centre, with the exception of the roast and boiled meat dinners. This revised menu commenced on 2nd April, 1934. 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 still have to hurry through their meal, and scramble out of their seat as soon as they have finished, in order 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. Breakfasts have been given on six days a week instead of 5 days a week as heretofore as from April 30th, 1934. Breakfasts have also been supplied at the Voluntary Centre, Granville Road, on five days a week as from April 30th, 1934. The price paid per meal is 3d. 65—66 table no. 56.—showing cases dealt with during 1934 and results. Disease. Cases being Nursed at end of 1933. New Cases during 1934. Removed from Observation during 1934—Results of Treatment. Still being Nursed at end of 1934. Number of Visits Paid during 1934. Died. Removed to Hospital or other Institution. Recovered. Expectant Mothers. Nursing Mothers. Children. under Five. School Children Others. Total. Expectant Mothers. Nursing Mothers. Children. under Five. School Children. Others. Total. Expectant Mothers. Nursing Mothers. Children under Five. School Children. Others. Total. Expectant Mothers. Nursing Mothers. Children under Five. School Children. Others. Total. Expectant Mothers. Nursing Mothers. Children under Five. School Children. Others. Total. Expectant Mothers. Nursing Mothers. Children Under Five. School Children. Others. Total. Expectant Mothers. Nursing Mothers. Children under Five. School Children Others. Total. Adenitis - - - - - - - - - - - - - - - - - - - - - - - - - - 1 - - 1 - - - - - - - - 15 - - 15 Bathing Cases - - - - - - - - 3 - - 3 - - - - - - - - - - - - - - 3 - - 3 - - - - - - - - 26 - - 26 Burns and Scalds - - - - - - - 1 3 2 — 6 - - - - - - - - - - - - - 1 3 2 - 6 - - - - - - - 4 33 6 - 43 Circumcision - - - - - - - - 10 - - - - - - - - - - - - - - - - - 10 - - 10 - - - - - - - - 66 - - 66 Constipation - - - - - - 1 - - - - 1 - - - - - - - - - - - - 1 - - - - 1 - - - - - - 1 - - - - 1 Douching Cases - - - - - - - 2 - - 1 3 - - - - - - - 1 - - - 1 - - - 1 1 2 - - - - - - - 2 - 9 3 14 Eczema - - - - - - - - 9 - - 9 - - - - - - - - 1 - - 1 - - 7 - - 7 - - 1 - - 1 - - 130 - - 130 (?) Fever - - - - - - - 1 2 - 1 4 - — — - — — — — 1 — — 1 — 1 1 1 — 3 - - - - - - - 2 18 9 — 29 Haemorrhage after Extraction - - - - - - - 1 - 2 - 3 - - - - - - - - - - - - - 1 - 2 - 3 - - - - - - - 2 - 7 - 9 Haemorrhage— Veinous - - - - - - - - - - 1 1 - - - - - - - - - - - - - - - - 1 1 - - - - - - - - - - 1 1 Impetigo - - 2 - — 2 — — 4 1 — 5 - - - - - - - - — — — — — — 6 1 - 7 - - - - - - - - 59 4 - 63 Lacerated Perineum - - - - - - - 1 - - - 1 - - - - - - - - - - - - - 1 - - - 1 - - - - - - - 31 - - - 31 Leucorrhœa - - - - - - 2 - - - - 2 - - - - - - - - - - - - 2 - - - - 2 - - - - - - 7 - - - - 7 Mastitis - - - - - - - 4 - - - 4 - - - - - - - 2 - - - 2 - 2 - - - 2 - - - - - - - 119 - - - 119 Maternity Cases - - - - - - - 4 - - - 4 - - - - - - - - - - - - - 4 - - - 4 - - - - - - - 45 - - - 45 Measles - - - - - - - - - 1 - 1 - - - - - - - - - - - - - - - 1 - 1 - - - - - - - - - 26 - 26 Ophthalmia - - 1 - - 1 - - 43 4 - 47 — — — — — — — - 1 — — 1 - — 43 4 — 47 — — — — - — — — 634 16 - 650 Ophthalmia Neonatorum - - - - - - - - 14 - - 14 - - - - - - - - 1 - - 1 - - 13 - - 13 - - - - - - - - 140 - - 140 Otorrhoea - - 5 1 - 6 - - 41 14 - 55 — — - — _ — — — 3 — — 3 — — 40 13 — 53 — — 3 2 — 5 — 914 147 - 1061 Otorrhœa and Chicken Pox - - - - - - - - 1 - - 1 - - - - - - - - - - - - - - 1 - - 1 - - - - - - - - 23 - - 23 Phlebitis - - - - - - - 2 - - - 2 - - - - - - - 1 - - - 1 - 1 - - - 1 - - - - - - - 46 - - - 46 Pneumonia - - - - - - - - 1 - - 1 - - 1 - - 1 - - - - - - - - - - - - - - - - - - - - 3 - - 3 Prematurity - - 1 - - 1 - - - - - - - - - - - - - - - - - - - - 1 - - 1 - - - - - - - - 10 - - 10 Puerperal Pyrexia - - - - - - - 1 - - - 1 - - - - - - - - - - - - 1 - - - 1 - - - - - - - 4 - - - 4 Refraction - - - - - - - - - 1 - 1 - - - - - - - - - - - - - - - 1 - 1 - - - - - - - - - 5 - 5 Septic Condition - - - - - - - 4 36 6 - 46 - - — — — — — — 4 1 - 5 - 4 32 5 — 41 - - - - - - - 64 295 49 - 408 Skin Condition - - - 2 - 2 - - 4 - - 4 - - - - - - - - - - - - - - 4 2 - 6 - - - - - - - - 26 13 - 39 Thread Worms — - - 2 - 2 1 - 101 48 - 150 — — — - - - - - - - - - 1 - 99 47 - 147 - - 2 3 - 5 3 — 405 202 - 610 Thrombosis 1 - - - - 1 - - - - - - - - - - - - 1 - - - - 1 - - - - - - - - - - - - 8 - - - - 8 Varicose Ulcer - — - - 1 1 1 1 - — 2 4 — - - — - - — — — - 1 1 1 1 — — 1 3 - - - - 1 1 3 16 - - 126 145 Varicose Veins 1 - - - - 1 - - - - - - - - - - - - - - - - - - 1 - - - - 1 - - - - - - 2 - - - - 2 Whooping Cough - - - - - - - - 3 - - 3 - - - - - - - - - - - - - - 3 - - 3 - - - - - - - - 40 - - 40 Total 2 - 9 5 1 17 5 22 276 79 5 387 - - 1 - - 1 1 4 11 1 1 18 6 17 267 80 3 373 - - 6 5 1 12 24 335 2837 493 130 3819 68 The number of application forms received from the South Kilburn area for the year was— Dinners 465, Breakfasts 352. Meals.—A 15-day menu was commenced in all feeding centres on April 2nd, 1934. This provides two meatless dinners, two cheese, one fish, one roast or boiled meat, two stews, two pie or pudding, and two minced meat dinners, each being followed by a pudding or stewed fruit and custard. The price per meal for non-necessitous cases is 5d. as heretofore. STATISTICAL INFORMATION, YEAR ENDING 31 st DECEMBER, 1934. Table No. 57—No. of Meals Supplied. Supplied to:— Breakfasts. Dinners. Free. Free. Paying. Total. Education Committee's Centres 11,577 112,632 951 125,160 Kilburn Voluntary Centre 18,893 62,411 - 81,304 Special Schools - 14,236 14,112 28,348 Feeding Centre Assistants 3,312 3,781 - 7,093 Total 33,782 193,060 15,063 241,905 Table No. 58.—Occupation List, 1934. Occupation. No. of Children Fed during 1934. No. of Families Involved. Percentage. 1933 1934 1933 1934 Unemployed 958 421 403 67.14 62.87 Widows 118 52 58 8.29 9.05 Deserted Wives 67 30 28 4.78 4.36 Orphans 3 8 3 1.28 .47 Labourers 162 29 53 4.62 8.26 Railwaymen 28 12 11 1.91 1.71 Hawkers 61 22 17 3.51 2.65 Others 130 53 68 8.45 10.60 1,527 627 641 Approximate average cost of food only 2.73. Total (gross) 4.66d. 69 THE FORTY-THIRD ANNUAL REPORT on the MUNICIPAL HOSPITAL By ARTHUR G. TROUP, M.D., D.P.H., Medical Superintendent. During 1934, 1,425 patients were admitted to hospital as compared with 1,201 in 1933, 869 in 1932, 842 in 1931, 1,029 in 1930 and 955 in 1929. Cerebro-Spinal Fever. Three cases of this disease were treated in hospital during the year and two deaths occurred. In one fatal case death occurred within 24 hours of the onset of the disease. In the other the patient was in a comatose condition when admitted to hospital, and the serum treatment had no apparent effect on the course of the disease. She died within three days. Diphtheria. 303 cases were admitted to hospital as compared with 291 cases during 1933. These may be classified as follows:—Faucial 219, Nasal 49, Laryngeal 15, Bacteriological 13, Aural 7. It was necessary to perform the operation of tracheotomy on four of the laryngeal cases. It has recently been shown that there are two principal types of the Diphtheria Bacillus and they have been designated the Bacillus Gravis and the Bacillus Mitis respectively. The former is responsible for the severe toxic cases of diphtheria with a comparatively high mortality while the latter causes a milder form of the disease with a low mortality. The severe type of infection has been prevalent during recent years in certain of the big towns of the north of England. During the latter part of 1934 it was observed that the cases of diphtheria admitted to hospital were of a severer type, and the number showing symptoms of cardiac complications relatively increased. The total number of deaths during the year was 16, giving a mortality rate of 5-1 per cent, calculated on the total number under treatment, but excluding the bacteriological cases. The causes of death in the fatal cases were as follows:—Cardiac Paralysis 11 cases, Haemorrhagic and Toxic cases 3, Laryngeal cases 2. In this connection it is satisfactory to report that the number of parents who have made arrangements to have their children immunised against diphtheria has shown a considerable increase since the beginning of 1935. The following table shows the diphtheria mortality rates for Willesden and England and Wales for the years 1929 to 1934, and it will be noted that the Willesden rate shows an increase this year. Year. Diphtheria Willesden. Mortality Rate per cent. England and Wales. 1929 2.8 5.4 1930 2.9 4.7 1931 1.6 5.3 1932 4.5 5.4 1933 1.8 5.5 1934 51 (Not yet available) Table No. 59. Diseases. Number in Hospital on 1st Jan., 1934. Admitted Total under treatment. Discharged recovered. Died. Mortality per cent. Remaining on 31st Dec., 1934. Cerebro-Spinal Fever 1 2 3 1 2 66.0 - Diphtheria 32 290 322 253 16 5.0 53 Diphtheria Bacteriological - 13 13 12 - - 1 Enteric Fever 1 1 1 - - - Erysipelas 3 58 61 53 3 4.9 5 Measles 9 134 143 127 16 11.2 — Mixed Infections - 10 10 10 - - — Puerperal Infections 2 18 20 18 - - 2 Scarlet Fever 70 707 777 683 5 0.64 89 Whooping Cough 1 26 27 21 6 22-2 — Other Diseases 1 166 167 152 11 — 4 Totals 119 1,425 1,544 1,331 59 - 154 70 Enteric Fever. One case of Paratyphoid Fever B was admitted during the year. The disease ran a moderate course and there were no complications. Erysipelas. Sixty-one cases of this disease were treated during the year. This number is considerably above the average. Three deaths occurred. Measles. An epidemic of measles occurred in the district during the spring months and 143 cases of this disease were treated in hospital. In a considerable number of these patients the disease was of a toxic type and 16 deaths occurred. The causes of death in the fatal cases were as follows:— Broncho-Pneumonia 13 cases. Toxaemia 2 „ Cancrum Oris 1 „ The following table illustrates the fact that measles is more dangerous in children under 5 years of age than in those who are over that age. It follows therefore that the longer a child can be guarded against an attack the less chance there is of the disease proving fatal. Table No. 60. Under 1 1—2 2—3 3—4 4—5 5—15 Over 15 Number of Cases 6 29 25 17 16 44 6 Fatal Cases - 6 4 3 1 2 - Number of cases under 5 years of age 93 Number of deaths under 5 years of age 14 Case mortality 15% Number of cases over 5 years of age 50 Number of deaths over 5 years of age 2 Case mortality 4% Chief Complications. Broncho-Penumonia 48 Otitis Media 22 Laryngitis 6 Enteritis 5 Cancrum Oris 1 Convalescent Measles Serum. I am pleased to report that during 1934 arrangements were made whereby a limited supply of convalescent measles serum was made available for use in suitable circumstances. Practically everybody resident in this country is attacked by measles at some period of his or her life, and should the individual be an older child or young adult the consequences are not at all likely to be serious. It is a different matter, however, when a child afflicted with some other disease is exposed to infection. During an epidemic of measles patients incubating this disease and suffering from some other complaint are almost certain to be admitted to hospital with subsequent risk to the susceptible children in the ward. The serum was employed on four occasions in these circumstances in the scarlet fever wards of the hospital. Twenty susceptible children who had been exposed to infection were injected with a suitable dose of serum during the first five days of the incubation period and complete protection was obtained in all but one case. The latter developed an attenuated attack in which the rash was scanty and the catarrhal symptoms and pyrexia absent. The donors ought to be healthy young adults, and no difficulty was experienced in obtaining suitable patients to act in this capacity. The blood is collected in a special apparatus and dispatched to the London County Council Laboratory at Hither Green where it is tested and refined and subsequently supplied in ampoules of 5 c.c. and 10 c.c. capacity. A total amount of 900 c.c. of serum was obtained from 7 donors. Mixed Infections. Scarlet Fever and Mumps 3 Scarlet Fever and Diphtheria 2 Scarlet Fever and Whooping Cough 2 Scarlet Fever and Chicken Pox 1 Scarlet Fever and Measles 1 Measles and Whooping Cough 1 10 71 Puerperal Infections. The 18 cases of Puerperal Infections which were admitted during the year may be classified as follows Local Uterine Sepsis 8 Phlebitis 2 Septicaemia 1 Phlebitis with gangrene of the leg 1 Pelvic Cellulitis 1 Uterine Haemorrhage 1 Trauma—Cervix 1 Subinvolution of Uterus 1 Mammary Abscess 1 Mastitis 1 The case of septicaemia was due to a streptococcal infection and eventually recovered after a prolonged illness. All the other cases also recovered. Scarlet Fever. The number of cases of scarlet fever treated in hospital during the year reached the high figure of 777. In the great majority of these patients the disease was of a moderate or mild type, but a few septic and toxic cases were admitted. Five deaths occurred. Two of these were due to streptococcal septicaemia with septic arthritis affecting several of the large joints, two were due to pneumonia and the fifth died the day after admission to hospital from endocarditis and pericarditis. Whooping Cough. Twenty-seven cases were treated and six deaths occurred, all of which were due to pneumonia. Other Diseases. Tonsillitis 55 Empyema 1 Rubella 17 Otitis Media 1 Erythema 8 Polio-Encephalitis 1 Chicken-Pox 8 Septic Meningitis 1 Laryngitis 8 Adenitis 1 Mumps 6 Acidosis 1 Pneumonia 6 Nephritis 1 Ophthalmia Neonatorum 4 Arthritis 1 Septic Rash 3 Impetigo 1 Bronchitis 3 Heat Stroke 1 Rhinitis 3 Stomatitis 1 Mastoiditis 3 Rupture of Heart 1 Quinsy 3 Carcinoma 1 Cellulitis 3 Malignant Endocarditis 1 Dermatitis 2 Thrush 1 Pulmonary Tuberculosis 2 Influenza 1 Vincents Angina 2 Acute Gastro-Enteritis 1 Streptococcal Meningitis 2 Bronchiectasis 1 Drug Rash 1 Negative Cases 9 Total 166 11 deaths occurred:— Pneumonia 3 Acute Gastro-Enteritis 1 Meningitis (Streptococcal) 2 Bronchiectasis 1 Meningitis (Septic) 1 Rupture of Heart 1 Polio-Encephalitis 1 Malignant Endocarditis 1 Sick Staff. Seven cases of infectious disease occurred amongst members of the nursing staff, namely Diphtheria 2, Measles 2, Mumps 2 and Rubella 1. No cases of infectious disease occurred amongst the domestic staff. Duration of Stay in Hospital. (1) Scarlet Fever. The average length of detention of scarlet fever patients in hospital is about the same as last year, and 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 1933—32.1 1928—37.0 1934—33.3 72 (2) Diphtheria. The average length of detention of diphtheria patients is also approximately the same as last year:— 1931—56.2 1933—42.0 1932—45.6 1934—42.1 (3) Other Diseases. Average stay in hospital of patients suffering from " other diseases," 1931—1934:— 1931—29.3 1933—25.5 1932—27.2 1934—22.6 Cases Admitted from Other Authorities. During the year 107 cases were admitted from Authorities other than the Borough of Willesden. These may be tabulated as follows:— Table No. 61. Name of Authority. No. of Cases. Disease. No. of Cases. Harrow Urban District Council 34 Erysipelas 1 Scarlet Fever 23 Diphtheria 10 Middlesex County Council 32 Measles 15 Diphtheria 6 Erysipelas 6 Scarlet Fever 4 Ophthalmia Neonatorum 1 Borough of Heston and Isleworth 18 Scarlet Fever 8 Diphtheria 6 Measles 4 Borough of Ealing 15 Scarlet Fever 7 Diphtheria 7 Measles 1 Wembley Urban District Council 8 Erysipelas 8 A considerable 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 £1,855 6s. 4d. The corresponding figures for last year were—Number of patients 51, amount of income £1,211 2s. Od. 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 8 cases of diphtheria have occurred, 1 in 1927, 1 in 1928, 1 in 1929, 2 in 1930, 1 in 1932 and 2 in 1934. It is becoming clearer that immunisation is not infallible in preventing diphtheria, and the position may be expressed in the following terms. Immunisation against diphtheria is a 100 per cent. security against a fatality and a 95 per cent. security against an attack of the disease. The following table demonstrates the benefits derived from this method of preventive medicine : Table No. 62. (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 1934 (after immunisation was carried out) 8 (4) Incidence rate per annum (taking 30 as average number of probationer nurses). 3.3% (5) Number of nurses Schick Tested (1927 to 1934 inclusive) 212 (6) Number of nurses giving a positive reaction 105 (7) Percentage of nurses giving a positive reaction 49.5 (8) Number of nurses re-Schick Tested 54 (9) Number of nurses re-Schick Tested giving a positive reaction 17 (10) Percentage of nurses re-Schick Tested giving a positive reaction 31.4 73 (2) Willesden Residents. This clinic was made available for Willesden residents in May, 1927. The following are the figures for the year 1927 to 1934, 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 1934 22 47 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. Table No. 63. Nature of Specimens Examined. Postive Result. Negative Result. Total. 1 Swabs for Diphtheria Bacilli 442 4,607 5,049 2 Swabs for Diphtheria Bacilli with Virulence 17 10 27 3 Blood for Widal Reaction 9 12 21 4 Sputurns for Tubercle Bacilli 136 689 825 5 Swabs and Smears for Gonococci 31 103 134 6 Pus for organisms — — 16 7 Blood Cultures — — 26 8 Swabs and Smears for Vincents Angina 4 15 19 9 Cerebro-spinal fluids (general examination) — — 31 10 Pleural fluids (general examination) — — 10 11 Faeces for Organisms — — 13 12 Urine (chemical examination) — — 139 13 Urine (microscopical examination) — — 63 14 Urine (bacteriological examination) — — 57 15 Swabs and Smears for Streptococci and others organisms — 242 16 Blood for all counts - — 8 17 Post-mortem specimens - — 5 18 Blood films (general examination) - — 5 19 Hairs for Ringworm - — 3 1 Total 6,693 Table No. 64. Sources of Specimens Examined. Total. 1. Willesden Municipal Hospital 2,453 2. Municipal Health Centres and Health Nurses 1,153 3. Private Practitioners 2,125 4. Central Middlesex County Hospital 805 5. Other Hospitals 157 6,693 Annual Number of Specimens. 1932—4,526 1933—5,908 1934—6,693 74 THE FOURTH ANNUAL REPORT on the WILLESDEN MATERNITY HOSPITAL. REPORT ON THE WORK FROM 1st JANUARY, 1934, to 31st DECEMBER, 1934, By ARNOLD WALKER, M.A., M.B., B.Ch., F.R.C.S., M.C.O.G. The extension to the hospital was completed by the end of the year, and the new wards were immediately put into use. Certain alterations had to be carried out in the old buildings after the new wards had been taken over, and the whole hospital was in full use by the beginning of February, 1935. 3The extension has had the effect of converting what was an inconvenient and unsatisfactory maternity unit into a well.balanced hospital. Although the actual number of beds has been doubled, it will not be possible to take in quite the equivalent number of extra patients, because the additional beds include four isolation rooms and a ward of eight beds for ante.natal cases. This ward might be called the most important in the hospital, because it is in the management of these cases that maternal mortality is reduced. In spite of the inconvenience caused by the presence of the builders, 53 more cases were dealt with during 1934 than during 1933. Even during the period when the new buildings were being taken into use and the old handed over to the builders, the normal work went on, and no patient suffered the least inconvenience. This was entirely due to the excellent arrangements made by the Matron, and the efficiency with which she organised her staff. Again no booked patient died, although two deaths occurred in cases admitted as emergencies. Both patients were seen in their own homes by the Consulting Obstetrician at the request of the doctors concerned. The first case had suffered from puerperal sepsis following a miscarriage several years ago. She was in hospital for over a year and, from the records of the hospital concerned, it is remarkable that she survived. Although the patient was apparently fit to stand a pregnancy, the possible dangers were well realised by her doctor, and she was under his constant supervision for months. At the first signs of trouble the doctor asked for help. Within an hour or two the patient was seen and was admitted to the hospital. Although there was nothing to suggest at the consultation that the patient was gravely ill, eclamptic fits started in the ambulance and the patient died a short time after admission. Co.operation between the patient, her doctor and the Council's service was excellent, but in spite of this the woman lost her life. It is difficult to see what more could have been done. The second case was admitted after being in labour for several days. She had been seen privately by a senior obstetrician a short time before term, and passed as normal. Labour was complicated by uterine inertia, a complication which cannot be prevented or anticipated. She was eventually delivered in the hospital after a labour of five days, and all went well for three days. Quite unexpectedly the patient had secondary post.partum haemorrhage, from which she recovered, only to die suddenly from what appeared to be pulmonary embolism. In this case again everything was done to ensure a successful result. The statistical data is again presented in the same form as before, and next year it is proposed that the combined results of the first five years be tabulated with the results for the year for purposes of comparison. As the bulk of obstetric cases are classified as normal, conclusions can only be drawn from large numbers. Again a considerable number of cases of Toxaemia of Pregnancy were detected at the Antenatal Clinics, and were all safely delivered. The excellent results which have been obtained in the treatment of these cases, and in the treatment of Heart Disease show the value of proper ante.natal care. Many.other cases are admitted for ante.natal treatment, but these two groups are, by far, the most important. The excellent accommodation for them now is one of the most progressive features of the new hospital. The number of cases in which interference was required is smaller, and both the "forceps rate" and the " Caesarian Section rate " are lower. This is very satisfactory. Puerperal Pyrexia occurred in nearly twice as many cases as in the previous year. This increase was entirely due to causes not associated with childbirth and calls for no comment. 75 Statistical Details of the 548 Cases dealt with during the Year. Cases completed 548 A. Booked at the Health Centres 534 Discharged well 529 Transferred 5 Died 0 B. Admitted as Emergencies 14 Discharged well 11 Transferred 1 Died (one undelivered) 2 Of the 534 booked cases, 244 were primipara and 290 were multipara. Of the 14 emergency cases 9 were primipara and 5 were multipara. Presentations— Occipito Anterior 486 Occipito Posterior 32 Normal Breech 2 Abnormal Breech 14 Twins 8 Face 1 Shoulder 1 Miscarriages 3 Ante.partum Haemorrhage— Placenta Prævia 4 Accidental Haemorrhage 2 Post.partum Haemorrhage 3 Manual Removal of Placenta 3 Prolapse of Cord 6 Organic Heart Disease 7 Hydramnios 1 Toxaemia of Pregnancy admitted for Treatment 32 Eclampsia 1 Puerperal Pyrexia 29 Uterine Infection 5 Breast Infection 6 Urinary Infection 3 No cause found 7 Sundries 8 Operations performed— Forceps Delivery 29 The "forceps rate" was therefore 5.3 per cent. Caesarian Section 6 Heart Disease 3 Contracted Pelvis 3 Induction of Premature Labour 4 552 viable children were born to 544 mothers. Of these, 517 left hospital alive and well, 26 were stillborn and 9 died. 502 were fed on breast milk alone. In 14 the milk of the mother had to be supplemented by artificial food, and in 1 case the child was fed on artificial food alone. 76 THE FIFTH ANNUAL REPORT for the Year ending 31st December, 1934, 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 19 patients were medically inspected, 4 patients attended the Health Centres for treatment, the total number of attendances being 10. 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. 65. Defect or Disease. Requiring Treatment. Received Treatment at Health Centre. Defective Teeth 4 1 In addition two children not referred for treatment attended the Health Centre and received treatment. The attendances were in respect of defective vision and verminous head. The child who attended the Health Centre for dental treatment was also treated for dermatitis of the face. 77 THE FOURTH ANNUAL REPORT ON NURSERY CLASSES for the Year ending 31st December, 1934. LOWER PLACE NURSERY CLASSES. 30 children attending Lower Place Nursery Classes were medically examined last year, 21 of whom (group A) were examined for the first time, and 9 (group B) had their second routine medical inspection according to the scheme in force. Group A.—5 were examined between 2 and 3 years of age. 11 were examined between 3 and 4 years of age. 3 were examined between 4 and 5 years of age. 2 were 5 years of age. Group B.—1 was between 3 and 4 years of age. 8 were between 4 and 5 years of age. In addition there were 3 re.examinations. Group A.—The following defects were found in this group of children. Enlarged Tonsils.—10 were found to have enlarged tonsils in varying degrees. 2 have since had them removed, one of whom had suffered from profuse otorrhœa. 1 was admitted to hospital for the operation, but this had to be postponed as he was found to have bronchitis. The parents of 2 other cases who were advised to have tonsillectomy by the Council's Laryngologist are postponing the operation until the children are older. 2 more whose tonsils are only moderately enlarged, and which are up to the present causing no symptoms, are booked for re.examination in 6 months' time. In the remaining 3 cases the enlargement was very slight and uncomplicated. Bony Affections.—10 cases were found. (1) Postural Kyphosis.—1 case was found in association with Enlarged Tonsils, Otorrhcea and a functional systolic bruit. (2) Outward Curvature of Tibia and Genu Varum.—This case improved under treatment in the Orthopaedic Department. (3) Overlapping Toes.—1 case was found in which there was no disability, so that the parent did not wish treatment at present. (4) Genu Valgum.—7 cases of this condition in varying degrees were found. 2 were slight and are being seen again in 1 year. 1 has had treatment at the Orthopaedic Department. 1, a manifestation of rickets associated with a protuberant abdomen, has had Ultra Violet Ray Therapy at the Health Centre. 2 cases, 1 of whom had recently had tonsillectomy as advised, were unable to attend for treatment. 1 was a re.examination referred from last year, and was found to have improved. Respiratory Affections.—4 children were found to be suffering from Bronchial Catarrh. The first was associated with Enlarged Tonsils which have since been removed. The second was associated with Enlarged Tonsils, and is having tonsillectomy later on. The third was associated with subnormal nutrition. The fourth was associated with slightly Enlarged Tonsils and Genu Valgum. All were treated by private doctors. Cardiac Conditions.—1 child, who had recovered from Diphtheria, was found to have a functional systolic bruit. He is being re.examined in 3 months. Group B.—The following defects were found among the children comprising this group. 78 Enlarged Tonsils.—1 whose tonsils had been enlarged at the first medical inspection had had them removed as advised, while another was having the operation when he was older. The slight enlargement which had been noted in 3 cases at their first medical inspection had subsided, and the children appeared in good health. 2 were found to be slightly enlarged, and will be re.examined in 6 months. Bony Affections.—There were 5 cases of Genu Valgum, all of which had been found at the previous medical inspection. 1 had been treated at the Orthopaedic Department, and had improved. 1 had been associated with general debility, and had improved along with the child's general condition which had been treated. The 3 remaining cases, noted to be slight at the first medical inspection, had improved. Cardiac Conditions.—2 cases were found. 1 was a functional apical bruit associated with Enlarged Tonsils and Debility. The second was associated with Enlarged Tonsils and a history of pneumonia. Skin Conditions.—1 child had a naevus which has been since treated at Paddington Green Children's Hospital. Another child had Impetigo which has cleared up under treatment at the Health Centre. Respiratory Conditions.—2 children suffering from Bronchial Catarrh were found. Both had also Enlarged Tonsils and some degree of Genu Valgum, which in 1 case had been treated. General Debility.—2 children who were found to be suffering from General Debility at their first medical inspection, were found to have improved very much. Dental Caries.—6 of the children who had their first medical inspection were found to have defective teeth, all of whom had enlarged tonsils as well. 3 at the second medical inspection were found to have defective teeth, 2 in association with Enlarged Tonsils. Nutrition. Group A.—In 2 of this group the nutrition was considered above the normal. In 12 the nutrition was normal. In 7 the nutrition was subnormal. Of the latter 2 had Enlarged Tonsils; 1 suffered from Chronic Bronchial Catarrh; 1 had defective teeth and Enlarged Tonsils; 1 had Rickets; 1 had Dental Caries. Group B.—4 of this group whose nutrition had been noted as normal at the first medical inspection had satisfactorily gained in weight and height. 5 of this group whose nutrition had been noted as sub.normal at the first medical inspection one year previous, had now attained the normal standard. This testifies to the benefit in health gained by these children through attending the Nursery Classes. Cleanliness.—The standard of cleanliness of hair, skin and clothing was considered to be even higher than last year. Again no child out of the 136 examined by the Health Visitor was excluded, and no Cleansing Notices were served on parents. Infectious Diseases.—The Incidence of Infectious Diseases was notably low, and is as follows :— (1) There were 4 cases of Diphtheria. The first case occurred in March and the remaining 3 practically simultaneously in May. All were moderate in type, and were admitted to the Willesden Municipal Hospital 1 only developed a complication, viz.: Nephritis. 1 was noted to have Enlarged Tonsils and Adenoids, and was referred to the Council's Laryngologist. (2) There were 2 cases of Measles, 1 of which occurred in March, and 1 in July. They were mild and uncomplicated, and treated by private medical practitioners. (3) There was 1 case of Chicken Pox. (4) There was 1 case of Whooping Cough which was mild in type. (5) In addition there were 2 cases of Pneumonia, both of whom were admitted to the Central Middlesex County Hospital. 1 occurred in March and the other in November, and both made a good recovery. Nursery Classes were started in October, 1934, at the following Schools: Bridge Road, Carlton Vale, Kensal Rise, Chamberlayne Wood Road, Braintcroft and Dudden Hill Infants. Medical inspections do not commence until February, 1935. These Classes have been visited frequently by the School Medical Officers who report, that all arrangements made were being carried out in an entirely satisfactory manner. No child has been specially referred either by the Head teachers or Health Visitors to the School Medical Officers since the opening of these classes. 79 APPENDICES. APPENDIX A—VITAL STATISTICS. Appendix A.—Table I. VITAL STATISTICS OF WHOLE DISTRICT DURING 1934 AND PREVIOUS YEARS; VITAL STATISTICS OF THE WARDS DURING 1934. 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 popu. tion. (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 1934 195,295 1,924 2,743 14.05 1,908 9.77 322 354 119 43 1,940 9.93 wards. * Census population—Re-adjusted by Registrar-General to167,200. 1. S. Kilb'n 13,740 171 236 17.18 156 11.35 1 38 17 72.03 193 14.05 2. Mid K'b'n 13,996 133 216 15.43 150 10.72 3 41 8 37.04 188 13.43 3. N. Kilb'n 12,997 72 160 12.31 133 10.23 10 26 7 43.75 149 11.46 4. Brondsb'y Park 9,941 59 109 10.96 89 8.95 9 15 2 18.35 95 9.56 5. Kensal Rise 13,268 86 162 12.21 131 9.87 2 27 2 12.35 156 11.76 6. Harl'd'n 16,563 149 233 14.07 135 8.15 2 22 20* 85.84* 155 9.36 7. Stone. bridge 23,077 473 300 13.00 377 16.34 218 22 15 50.00 181 7.84 8. Round. wood 15,431 167 262 16.98 165 10.69 36 26 7 26.72 155 10.04 9. Church End 16,242 143 222 13.67 121 7.45 10 28 12 54.05 139 8.56 10. Willesden Green 16,289 157 275 16.88 145 8.90 1 36 16 58.18 180 11.05 11. Cricklewood 43,751 314 568 12.98 306 6.99 30 73 13 22.89 349 7.98 Area of District in acres (land and inland water) 4,703.6. 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. * 3 out of the 20 deaths occurred in children at the National Adoption Society's Hostel, Connaught House, Acton Lane, N.W. 10. Subtracting these 3, the infant mortality rate for the Harlesden Ward is 72.96. APPENDIX A.—TABLE II.—DEATHS OF WILLESDEN RESIDENTS DURING THE YEAR 1934. CAUSE OF DEATH. All Ages. 0 to 1 1 to 5 5 to 10 10 to 15 15 to 20 20 to 25 25 to 35 35 to 45 45 to 55 55 to 65 65 to 75 75 to 85 85 Up. Total deaths, whether of "Residents" or "Non.Resi.dents," in Institutions in the District (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) (13) (14) (15) (16) All Causes < Certified 1,940 119 68 33 18 28 46 116 98 193 340 426 353 102 1079 Uncertified – – – – – – – – – – – – – – – 1.—Infectious and Parasitic Diseases Typhoid Fever 1 – – – – – – – 1 – – – – – 1 Paratyphoid Fever – – – – – – – – – – – – – – – Typhus Fever – – – – – – – – – – – – – – – Relapsing Fever. (" Spirillum Obermeieri ") – – – – – – – – – – – – – – – Undulant Fever – – – – – – – – – – – – – – – Small Pox – – – – – – – – – – – – – – – Measles 22 1 20 1 – – – – – – – – – – 19 Scarlet Fever 4 – 2 2 – – – – – – – – – – 4 Whooping Cough 8 1 7 – – – – – – – – – – – 8 Diphtheria 18 – 7 11 – – – – – – – – – – 18 Influenza 12 – – – – 1 – – 3 1 – 4 3 – 2 Cholera – – – – – – – – – – – – – – – Dysentery – – – – – – – – – – – – – – – Plague – – – – – – – – – – – – – – – Erysipelas 13 – – – 1 – – – – 1 3 4 4 – 11 Acute Poliomyelitis 2 – 1 – – 1 – – – – – – – – 1 Encephalitis Lethargica – – – – – – – – – – – – – – – Cerebro.Spinal Fever 6 – 2 1 2 – – 1 – – – – – – 6 Glanders – – – – – – – – – – – – – – – Anthrax – – – – – – – – – – – – – – – Rabies – – – – – – – – – – – – – – Tetanus 1 – – – – – – – – 1 – – – – – Tuberculosis of the Respiratory System 128 – – – 1 5 17 37 20 26 16 6 – – 41 Tuberculosis of the Central Nervous System 9 – 3 2 1 2 – – – 1 – – – – 11 Tuberculosis of the intestines and peritoneum 2 – – – – – 1 – – – 1 – – – – Tuberculosis of the vertebral column 1 – – – – 1 – – – – – – – – – Tuberculosis of other bones and joints 1 – – – – – – – – – – 1 – – 1 Tuberculosis of skin and subcutaneous tissues – – – – – – – – – – – – – – – Tuberculosis of lymphatic system (abdominal and bronchial glands excepted) – – – – – – – – – – – – – – – Tuberculosis of genito.urinary system 2 – – – – – – 1 1 – – – – – – 80 81 Appendix A—Table II—DEATHS OF WILLESDEN RESIDENTS (continued) CAUSE OF DEATH. All Ages. 0 to 1 1 to 5 5 to 10 10 to 15 15 to 20 20 to 25 25 to 35 35 to 45 45 to 55 55 to 65 65 to 75 75 to 85 85 Up. Total deaths, whether of "Residents" or "Non.Residents,"in Institutions in the District. (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) (13) (14) (15) (16) Tuberculosis of other organs Disseminated Tuberculosis — — — — — — — — — — — — — — — Leprosy — — — — — — — — — — — — — — — Syphilis 5 1 — 1 1 2 — — 3 Other venereal diseases — — — — — — — — — — — — — — — Purulent infection, septicaemia 6 — — — 1 1 1 2 — — 1 — — — 5 Yellow Fever — — — — — — — — — — — — — — — Malaria — — — — — — — — — — — — — — — Other diseases due to protozoa — — — — — — — — — — — — — — — Ankylostomiasis — — — — — — — — — — — — — — — Hydatid cysts — — — — — — — — — — — — — — — Other diseases due to helminths — — — — — — — — — — — — — — — Mycoses 2 — — 1 — — — 1 — — — — — — 2 Other infectious or parasitic diseases — — — — — — — — — — — — — — — 2.—Cancer and other tumours. Cancer of the buccal cavity, and pharynx 15 — — — — — — — — 2 3 5 4 1 6 Cancer of the digestive organs and peritoneum 147 — — — — — — 1 2 16 42 47 37 2 79 Cancer of the respiratory organs 27 — — — — — — 2 3 9 9 3 1 — 20 Cancer of the uterus 18 — — — — — — — 3 5 3 2 5 — 9 Cancer of other female genital organs 6 — — — — — — — 1 2 3 — — — 6 Cancer of the breast 36 — — — — — — — 1 13 6 9 5 2 20 Cancer of the male genito.urinary organs 16 — 1 — — — — — 5 5 2 2 1 10 Cancer of the skin 1 — — — — — — — — — — — — 1 — Cancer of other or unspecified organs 15 — — — — — — — — 1 5 7 2 — 7 Non.malignant tumours 3 — — — — — — — 1 1 — 1 — — 2 Tumours of undetermined nature 5 — 1 — 1 — — — — 1 1 1 — — 3 3.—vRheumatism, Diseases of Nutrition and of Endocrine Glands and the General Diseases. Rheumatic Fever 16 — — 1 1 1 1 3 2 2 1 3 1 — 11 Chronic rheumatism, Osteo.Arthritis 7 — — — — — — 1 — 1 1 4 — — 5 Gout 1 — — — — — — — — — — 1 — — — Diabetes 24 — — — — — — 1 — 6 6 7 4 — 19 Scurvy — — — — — — — — — — — — — — — 82 Beri.beri – – – – – – – – – – – – – – – Pellagra – – – – – – – – – – – – – – – Rickets – – – – – – – – – – – – – – – Osteomalacia – – – – – – – – – – – – – – – Diseases of the pituitary gland – – – – – – – – – – – – – – – Diseases of the thyroid and parathyroid glands 4 – – – – – – 1 1 1 – 1 – – 2 Diseases of the Thymus – – – – – – – – – – – – – – 1 Diseases of the adrenals 2 – – – – – 1 – 1 – – – – – 1 Other general diseases – – – – – – – – – – – – – – – 4.—Diseases of the Blood and blood forming organs. Hæmorrhagic conditions 3 – – – – – – 1 – 1 – – – 1 2 Anaemia Chlorosis 12 – – – – – – – 1 3 2 6 – – 9 Leukaemia, Aleukaemia 9 – – – – 1 – 2 3 – 2 1 – – 4 Diseases of the Spleen – – – – – – – – – – – – – – – Other diseases of the blood and blood forming organs – – – – – – – – – – – – – – – 5.—Chronic Poisoning. Alcoholism (acute or chronic) 1 – – – – – – – – 1 – – – – 2 Chronic poisoning by other organic substances – – – – – – – – – – – – – – – Chronic poisoning by mineral substances – – – – – – – – – – – – – – – 6.—Diseases of the Nervous System and Sense Organs. Encephalitis 5 – – – – – 1 1 – 2 1 – – – 4 Meningitis 6 1 2 1 – 1 – – 1 – – – – – 5 Tabes Dorsalis (Locomotor ataxy) 3 – – – – – – – – – – 2 1 – 2 Other diseases of the spinal cord 4 – – – – – – – 1 – 3 – – – 2 Cerebral haemorrhage, Apoplexy, etc. 107 5 – – – – – 1 2 12 21 29 34 3 76 General Paralysis of the Insane 4 – – – – – – – 1 2 1 – – – 1 Other forms of insanity 4 – – – – – – – 1 1 1 1 – – 1 Epilepsy 8 – – – – 1 2 1 – – 2 2 – – 2 Infantile convulsions (under 5 years of age) 2 2 – – – – – – – – – – – – – Other diseases of the nervous system 19 – – – – – – – 2 – 5 8 4 – 9 Diseases of the eye and annexa – – – – – – – – – – – – – – – Diseases of the ear and of the mastoid sinus 5 1 – 2 – – – 1 – – 1 – – – 7 7.—Diseases of the Circulatory System. Pericarditis 1 – – – – – – – – – – – – – 1 Acute endocarditis 9 1 – – – 2 2 2 1 – 1 – – – 3 Chronic endocarditis, Valvular disease 64 – – – 1 – 1 8 4 8 9 21 9 3 15 Diseases of the Myocardium 257 – – – – 1 – 2 2 8 52 78 86 28 78 Diseases of the coronary arteries, Angina pectoris 27 – – – – – – – – 3 9 10 4 1 5 Other diseases of the heart 41 – – – – – – 1 2 7 12 12 5 2 34 83 Appendix A.—TABLE II—DEATHS OF WILLESDEN RESIDENTS (continued) CAUSE OF DEATH. All Ages. 0 to 1 1 to 5 5 to 10 10 to 15 15 to 20 20 to 25 25 to 35 35 to 45 45 to 55 55 to 65 65 to 75 75 to 85 85 Up. Total deaths, whether of " Residents" or " Non.Residents," in Institutions in the District. (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) (13) (14) (15) (16) Aneurysm 6 – – – – – – 1 – – 3 2 – – 4 Arteriosclerosis 77 – – – – – 1 – – 7 15 24 22 8 36 Gangrene 6 – – – – – – – – – 1 2 3 – 4 Other diseases of the arteries 2 – – – – – – – – – 1 1 – – 1 Diseases of the veins (varix, haemorrhoids, phlebitis, etc.) 1 – – – – – – – – 1 – – – – – Diseases of the lymphatic system (lymphangitis, etc.) 1 – – – – 1 – – – – – – – – – Abnormalities of blood pressure 2 – – – – – – – – – – 1 1 – – Other diseases of the circulatory system – – – – – – – – – – – – – – – 8.—Diseases of the Respiratory System. Diseases of the nasal fossae and annexa – – – – – – – – – – – – – – – Diseases of the larynx 2 1 – 1 – – – – – – – – – – – Bronchitis 64 1 1 1 – – – – 2 2 10 18 18 11 15 Broncho.Pneumonia 64 15 7 – – –– 1 2 6 2 6 12 12 1 40 Lobar Pneumonia 42 – 3 1 – – 1 1 4 3 10 13 6 – 18 Pneumonia (not otherwise defined) 15 – 1 – – – 2 2 2 – 4 1 3 – 13 Pleurisy 5 – – – – – 1 1 – 1 – 1 1 – 5 Congestion and haemorrhage infarct of lung etc. 17 – – – – 1 1 – – 4 1 3 3 4 9 Asthma 6 – – – – – 1 1 1 2 1 – – 4 Pulmonary Emphysema – – – – – – – – – – – Other diseases of the respiratory system 1 – – – – – – – – – 1 – – – 2 9.—Diseases of the Digestive System. Diseases of the buccal cavity, pharynx, etc. 7 2 1 1 – – 1 1 1 – – – – 7 Diseases of the oesophagus 1 – – – – – – – – – – 1 – – – Ulcer of the stomach or duodenum 27 – – – – – – 3 1 7 10 4 1 1 23 Other diseases of the stomach 3 – – – – – – 1 1 – 1 – – 1 Diarrhoea and Enteritis 28 20 2 – 1 – – 2 1 – – 2 – – 20 Appendicitis 13 – 1 1 2 2 – 1 1 2 2 1 – – 14 Hernia, Intestinal obstruction 14 – – – – – – – 1 3 4 1 5 – 11 84 Other diseases of the intestines 3 – – – – – – – 1 1 1 — — — 4 Cirrhosis of the Liver 4 — — 1 — — — — — — 1 2 — — 5 Other diseases of the liver 2 1 – – – – 1 – – – – – – – 2 Biliary calculi 3 — — — — — — — — 1 1 — 1 — 3 Other diseases of the gall bladder and ducts 4 — — — — — — — 1 — 3 — — — 4 Diseases of the pancreas 4 — — 1 — — 1 — — — 1 1 — — 1 Peritonitis without stated cause 1 – – – – – – 1 – – – – – – 1 10.—Non.Venereal Diseases of the Genito.Urinary System and Annexa. Acute nephritis 4 — 1 — — — — 1 — 1 1 — — — 2 Chronic nephritis 44 – – – – – 1 4 3 5 14 12 5 — 25 Nephritis not stated to be acute or chronic 10 – – – – – – 2 1 — 2 3 1 1 2 Other diseases of the kidney and annexa 7 – – – – 1 — — 1 1 3 — 1 — 5 Calculi of the urinary passages 3 – – – – – – 1 1 1 — — — — 3 Diseases of the bladder 2 – – – – – – – – – – – 2 — 4 Diseases of the urethra, urinary abscess etc. – – – – – – – – – – – – – – – Diseases of the prostate 13 – – – – – – – – – 2 5 5 1 10 Diseases of the male genital organs – – – – – – – – – – – – – – – Diseases of the female genital organs 1 – – – – – – 1 – – – – – – – 11.—Diseases of Pregnancy, Childbirth and the Puerperal State. Post abortive sepsis 2 – – – – – – 1 1 – – – – – 2 Abortion not returned as septic – – – – – – – – – – – – – – – Ectopic gestation 1 – – – – – 1 – – – – – – – – Other accidents of pregnancy – – – – – – – – – – – – – – – Puerperal haemorrhage 1 – – – – 1 – – – – – – – – 1 Puerperal sepsis 2 — — — — — — 2 — — — — — — 2 Puerperal albuminuria and convulsions – – – – – – – – – – – – – – – Other toxaemias of pregnancy 1 – – – – – – – 1 – – – – – – Puerperal phlegmasia alba dolens, embolism, and sudden death 1 – – – – – – 1 – – – – – – – Other accidents of childbirth – – – – – – – – – – – – – – 1 Other or unspecified conditions of the puerperal state – – – – – – – – – – – – – – – 12.—Diseases of the Skin and Cellular Tissue. Carbuncle, Boil 1 – – – – – – 1 – – – – – – 2 Cellulitis, Acute abscess 2 – – – – – – – 1 – – 1 – – 2 Other diseases of the skin and its annexa 1 – – 1 – – – – – – – – – – 1 85 Appendix A—Table II—DEATHS OF WILLESDEN RESIDENTS (continued). CAUSE OF DEATH. All Ages. 0 to 1 1 to 5 5 to 10 10 to 15 15 to 20 20 to 25 25 to 35 35 to 45 45 to 55 55 to 65 65 to 75 75 to 85 85 Up. Total deaths, whether of " Residents" or " Non.Residents," in Institutions in the District. (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) (13) (14) (15) (16) 13.—Diseases of the Bones and Organs of Locomotion. Acute infective osteomyelitis and periostitis 3 1 – – – 1 1 – – – – – – – 2 Other diseases of the bones – – – – – – – – – – – – – – – Diseases of the joints and other organs of locomotion 1 – – – – – – 1 – – – – – – 1 14.—Congenital Malformation. Congenital malformations 17 16 1 – – – – – – – – – – – 7 15.—Diseases of Early Infancy. Congenital debility 7 7 – – – – – – – – – – – – 6 Premature birth 29 29 – – – – – – – – – – – – 14 Injury at birth 5 5 – – – – – – – – – – – – 3 Other diseases peculiar to early infancy 10 10 – – – – – – – – – – – – 7 16.—Old Age. Old age 93 – – – – – – – – – 1 23 43 26 93 17.—Deaths from Violence. Suicide by solid or liquid poisons and corrosive substances 4 – – – – – – 1 – 1 2 – – – 2 Suicide by poisonous gas 8 – – – – – 1 1 1 1 2 – 2 – 1 Suicide by hanging or strangulation – – – – – – – – – – – – – – – Suicide by drowning 2 – – – – – – – 1 – – – – 1 – Suicide by firearms 2 – – – – – – – – – 2 – – – – Suicide by cutting or piercing instruments 2 – – – – – – – – 1 – 1 – – 3 Suicide by jumping from high place 2 – – – – – – 1 – – – – 1 – 2 Suicide by crushing 1 – – – – – – – – – 1 – – – – Suicide by other means – – – – – – – – – – – – – – – 86 Infanticide (under one year) — — — — — — — — — — — — — — — Homicide by firearms — — — — — — — — — — — — — — — Homicide by cutting or piercing instruments — — — — — — — — — — — — — — — Homicide by other means — — — — —. — — — — — — — — — — Attack by venomous animals — — — — — — — — — — — — — — — Food poisoning — — — — — — — — — — — — — — — Accidental absorption of irrespirable or poisonous gas — — — — — — — — — — — — — — — Other acute accidental poisoning (not by gas) — — — — — — — — — — — — — — — Conflagration — — — — — — — — — — — — — — — Accidental burns (Conflagration excepted) 3 — 2 — — — — — — 1 — — — — 2 Accidental mechanical suffocation 1 1 — Accidental drowning 3 — — 2 1 — — — — — — — — — — Accidental injury by firearms 1 — — — — — — — 1 — — — — — 1 Accidental injury by cutting or piercing instruments 1 — — — — — — 1 — — — — — — — 17.—Deaths from Violence—continued. Accidental injury by fall, crushing, etc 42 — — 1 4 2 5 8 3 3 7 6 3 28 Cataclysm — — — — — — — — — — — — — — — Injury by animals (poisoning by venomous animals excepted) — — — — — — — — — — — — — •— — Hunger or thirst — — — — — — — — — — — — — — — Excessive cold — — — — — — — — — — — — — — — Excessive heat — — — — — — — — — — — — — — — Lightning — — — — — — — — — — — — — — — Electricity (lightning excepted) 1 — 1 — — — — — — — — — — — 1 Other and unstated forms of accidental violence 1 — — — — — — — — — — 1 — — — Violent deaths of unstated nature [i.e. accidental, suicidal, etc.) 2 — — — — — 1 — — — 1 — — — — Wounds of war — — — — — — — — — — — — — — — Execution of civilians by belligerent armies — — — — — — — — — — — — — — — Execution — — — — — — — — — — — — — — — 18.—IIIDDefined Diseases. Sudden death — — — — — — — — — — — — — — — Cause of death unstated or ill.defined 1 — — — — — — — — — — 1 — — 1 Totals 1,940 119 68 33 18 28 46 116 98 193 340 426 353 102 1079 87 Appendix A.—Table II(a). CAUSES OF DEATH IN BOROUGH OF WILLESDEN AS CIRCULATED BY REGISTRAR-GENERAL.—1934. Causes of Death- M. F. All Causes 969 985 1. Typhoid and paratyphoid fevers 1 – 2.Measles 12 10 3.Scarlet fever 3 1 4.Whooping cough 2 6 5.Diphtheria 12 6 6.Influenza 6 5 7.Encephalitis lethargica – – 8.Cerebro-spinal fever 2 4 9.Tuberculosis of respiratory system 80 51 10.Other tuberculous diseases 7 9 11. Syphilis 4 – 12. General paralysis of the insane, tabes dorsalis 6 3 13. Cancer, malignant disease 124 160 14. Diabetes 12 12 15. Cerebral haemorrhage, etc. 43 52 16. Heart disease 169 217 17. Aneurysm 5 3 18. Other circulatory diseases 38 46 19. Bronchitis 26 37 20. Pneumonia (all forms) 70 57 21. Other respiratory diseases 22 14 22. Peptic ulcer 24 8 23. Diarrhoea, etc (under 2 years) 11 10 24. Appendicitis 8 6 25. Cirrhosis of liver 5 2 26. Other diseases of liver, etc. 5 4 27. Other digestive diseases 23 19 28. Acute and chronic nephritis 34 31 29 Puerperal sepsis – 3 30- Other puerperal causes – 6 31- Congenital debility, premature birth, malformaations, etc- 43 31 32- Senility 23 66 33- Suicide 16 5 34- Other violence 37 18 35- Other defined diseases 94 83 36- Causes ill-defined or unknown 2 – Special Causes (included in No- 35 above):— – Small-pox – – Poliomyelitis – – Polioencephalitis – – Deaths of Infants under 1year Total 69 51 Legitimate 60 50 Illegitimate 9 1 88.89 APPENDIX A. TABLE III.—INFANT MORTALITY DURING 1934. Nett Deaths from Stated Causes at various ages under 1 year of age. Nett Deaths from all causes under 1 year of age classified in Wards. Cause of Death. Under 1 Week. 1.2 Weeks. 2.3 Weeks. 3.4 Weeks. Total under 4 Weeks. 4 Weeks and under 3 Months. 3 Months and under 6 Months. 6 Months and under 9 Months. 9 Months and under 12 Months. Total Deaths under 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 f Certified ... 45 5 6 6 62 18 14 15 10 119 17 8 7 2 2 16 12 7 12 16 13 \ Uncertified – — — — — – — — — — — — — — — – – – – – – Small Pox – – – – – – – – – – – – – – – – – – – – Chicken Pox – – – – – – – – – – – – – – – – – – – – – Measles – – – – – – – 1 – 1 1 – – – – – – – – – – Scarlet Fever – – – – – – – – – – – – – – – – – – – – – Whooping Cough – – – – – – – 1 – 1 – – – – – – 1 – – – – Diphtheria and Croup – – – – – – – – – – – – – – – – – – – – – Erysipelas – – – – – – – – – – – – – – – – – – – – – Tuberculous meningitis – – – – – – – – – – – – – – – – – – – – – Abdominal Tuberculosis (a) – – – – – – – – – – – – – – – – – – – – – Other Tuberculous Diseases – – – – – – – – – – – – – – – – – – – – – Meningitis (Not Tuberculous) – – – – – – – – – – – – – – – – – – – – – Convulsions 2 – – – 2 – – – – 2 – – 1 – – – 1 – – – – Laryngitis – – – – – – – – – – – – – – – – – – – – – Bronchitis – – – – – – 1 – – 1 – – 1 – – – – – – – – Pneumonia (all forms) — – 2 – 2 3 2 4 4 15 4 — — — — 3 3 2 1 1 1 Diarrhoea Enteritis – – – 1 1 3 6 6 4 20 8 1 1 – – 2 1 2 4 1 – Gastritis – – – – – – – – – – – – – – – – – – – – – Syphilis – – – – – – – – – – – – – – – – – – – – – Rickets – – – – – – – – – – – – – – – – – – – – – Suffocation, overlying – – – – – – – 1 – 1 – – – 1 – – – – – – – Injury at birth 3 1 1 – 5 – – – – 5 – – 2 – – 1 1 – – 1 – Atelectasis 9 – – – 9 – – – – 9 2 – – – – 1 – – 2 – 1 Congenital Malformations (b) 7 – – 3 10 1 3 1 1 16 – 2 1 – – 3 2 1 – 5 2 Premature Birth 19 3 2 1 25 4 – – – 29 2 2 – – 1 7 4 2 2 6 3 Atrophy, Debility and Marasmus 1 – – 1 2 5 – – – 7 – – – – 1 2 – – 2 1 1 Other Causes 4 1 1 – 6 2 1 1 1 11 – – 1 1 – 1 1 – 1 1 5 Total Deaths 45 5 6 6 62 18 14 15 10 119 17 8 7 2 2 20 15 7 12 16 13 Deaths. Legitimate 44 5 5 5 59 15 12 13 9 108 16 6 7 2 2 16 12 7 12 15 13 Illegitimate 1 – 1 1 3 3 2 2 1 11 1 2 – – – 4 3 – – 1 – Births. Legitimate ... ... ... ... ... ... ... ... ... 2,649 228 205 154 105 158 230 289 245 214 264 557 Illegitimate ... ... ... ... ... ... ... ... ... 94 8 11 6 4 4 3 11 17 8 11 11 Total Births ... ... ... ... ... ... ... ... ... 2,743 236 216 160 109 162 233 300 262 222 275 568 Infant Mortality Rate— Legitimate ... ... ... ... ... ... ... ... ... 40.77 70.18 29.27 45.46 19.05 12.66 69.57 41.52 28.57 56.07 56.82 23.34 Illegitimate ... ... ... ... ... ... ... ... ... 117.02 125.00 181.82 — — — *1333.33 272.73 — — 90.91 — Infant Mortality Rate ... ... ... ... ... ... ... ... ... 43.38 72.03 37.04 43.75 18.35 12.35 85.84 50.00 26.72 54.05 58.18 22.89 Population ... ... ... ... ... ... ... ... ... 195295 13,740 13,996 12,997 9,941 13,268 16,563 23,077 15,431 16,242 16,289 43,751 (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. * Three of these four 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 333.33. 90 APPENDIX A—Table IV-—CASES OF INFECTIOUS DISEASE NOTIFIED DURING THE YEAR 1934. 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 15. 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 – – – – – – – – – – – – – – – – – – – – – – – – – Cholera (C) Plague (P) – – – – – – – – – – – – – – – – – – – – – – – – – Diphtheria (including Membranous Croup) Erysipelas 365 5 12 22 30 33 140 56 19 38 8 2 — 50 38 24 9 22 15 83 37 25 31 31 341 111 1 — — — — 2 5 5 19 18 45 16 9 10 6 8 7 14 17 5 4 11 20 47 Scarlet fever 811 2 23 38 59 76 358 133 34 70 17 1 — 73 37 40 35 60 50 140 60 71 60 185 714 Typhus fever — — — — — — — — — — — — — — — — — — — — — — — — — Enteric fever 7 — — — — — 2 — — 2 2 — 1 — — — — 2 1 — — 1 — 3 5 Relapsing fever (R) Continued fever (C) 1 — — — — — 1 — — — — — — — — 1 — — — — — — — — 1 Puerperal fever 9 — — — — — — – 1 8 — — — 2 1 — — — 1 3 2 — — — 4 Puerperal pyrexia 30 — — — — — — — 3 25 2 — — 2 4 2 — 2 1 4 5 2 3 5 4 Cerebro-spinal meningitis 13 — 1 — — 1 5 2 — 4 — — — 2 1 — — – — 2 3 — 2 3 6 Poliomyelitis 5 — — 2 — — 1 1 1 — — — — — — 2 — 1 — — — 1 1 1 Ophthalmia neonatorum 28 28 — — — — — — — — — — — 7 7 2 — — — 2 2 1 5 2 1 Pulmonary tuberculosis 253 — 1 — — — 6 4 20 129 41 46 6 26 16 20 17 16 16 32 26 23 24 37 — Other forms of tuberculosis 64 — 1 4 2 1 9 10 5 21 3 5 3 12 5 3 3 6 3 3 5 3 11 10 — Whooping cough 480 58 53 54 59 58 183 6 4 3 1 1 — 69 41 26 9 16 67 75 36 49 37 55 32 Pneumonia 324 17 19 19 13 14 45 18 21 44 34 57 23 58 21 20 6 22 10 75 23 33 17 39 3 Malaria 1 — — — — — — — — 1 — — — — 1 — — — — — — — — — — Dysentery — — — — — — — — — — — — — — — — — — — — — — — — — Encephalitis lethargica 1 — — — — — — — — — — 1 — 1 — — — — — — — — — — 1 Acute polio encephalitis — — — — — — — — — — — — — — — — — — — — — — — — — Anthrax — — — — — — — — — — — — — — — — — — — — — — — — — Totals 2,503 111 110 139 163 183 752 235 113 364 126 158 49 311 182 146 87 154 178 436 204 213 201 391 1,160 91 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 1934. Statutes:— Water Supplies (Exceptional Shortage Orders) Act, 1934. Ministry of Health:— Circulars:— No. 1139.—(Revised) Housing Act, 1930. No. 1370.—Nutrition. No. 1371.—Public Health (Imported Food) Regulations, 1925. No. 1374.—International agreement for the treatment of seamen suffering from venereal disease. No. 1374a.—Venereal Diseases. No. 1378.—Water Supplies. No. 1393.—Rural Water Supplies. No. 1397.—The Local Government Act, 1933. No. 1405.—Water Supplies (Exceptional Shortage Orders) Act, 1934. No. 1406.—Nutrition. No. 1407.—Housing Act, 1930 : Part I. No. 1408.—Birth Control. No. 1412.—Housing Acts, Housing (Rural Workers) Acts, etc. No. 1425.—Housing Authorities. No. 1427.—Public Health (Imported Food) Regulations. 1925. Bacteriological examination with reference to Puerperal Sepsis. Board of Education:— Rules:— No. 971.—The Employment of Children in Entertainment Rules, 1933. 92 APPENDIX C. MOTOR SERVICE. I beg to report on the above for the twentieth completed year ended 31st March, 1934. During the year ended 31st March, 1934, 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 100,019 £892 2. M.H. 3808 £26 Crossley 3/1925 School work 88,832 £823 *3. M.H. 8989 £16 Berliet 7/1925 Education Department and Miscellaneous 63,992 £405 4. M.P. 3711 £18 Dennis 5/1928 School work 53,538 £760 5. M.P. 3712 £18 Dennis 5/1928 School work 54,423 £760 6. M.T. 810 £20 Armstrong 11/1928 Health Department 56,816 £800 7. M.Y. 967 £18 Dennis 8/1929 School work 47,130 £762 8. M.Y. 19 £20 Armstrong 11/1929 Education Department 56,725 £538 9. M.Y. 26 Nil. Armstrong 2/1930 Sickness and Accidents 59,454 £854 10. H.X. 12 Nil. Armstrong 1/1931 Sickness and Accidents 56,995 £860 11. H.X. 5178 £18 Dennis 8/1931 School work 24,643 £665 12. H.X. 5179 £18 Dennis 8/1931 School work 26,311 £665 13. M.V. 1800 Nil. Armstrong 4/1932 Infectious cases 13,230 £825 14. M.V. 2860 £18 Dennis 7/1932 School work 17,674 £687 15. A.M.C. 175 £25 Morris 3/1933 Disinfection, Laundry and Kingsbury. 7,629 £289 * Taken out of Commission, September, 1934. 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 2,112 2. School Omnibus M.H. 3808 3,399 3. Education Department and Miscellaneous M.H. 8989 1,035 4. School Omnibus M.P. 3711 7,582 5. School Omnibus M.P. 3712 8,937 6. Health Department M.T. 810 11,278 7. School Omnibus M.Y. 967. 9,118 8. Education Department M.Y. 19 12,885 9. Sickness and Accident Ambulance M.Y. 26 12,484 10. Sickness and Accident Ambulance H.X 12 19,052 11. School Omnibus H.X. 5178 8,690 12. School Omnibus H.X. 5179 9,642 13. Infectious Ambulance M.V. 1800 7,741 14. School Omnibus M.V. 2860 11,036 15. Disinfection Van A.M.C. 175 7,557 Total 132,548 93 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 1933.34 132,548 Total 1,690,756 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 1/4/33 to 31/3/34 Grand Total 1913.1934. Disinfection Van 16,673 1,250 1,130 1,063 933 1,293 22,342 Ambulance Calls, including Sickness, Accident, Maternity and Infectious Cases 34,993 3,766 4,041 4,434 4,700 4,324 56,258 51,666 5,016 5,171 5,497 5,633 5,617 78,600 Table No. 5. The following gives details of the miles run during the year under review:— Acton Borough Council 382 Special school work 54,279 Accidents, Sickness and Infectious cases 28,254 Disinfection 5,873 Education Department 9,469 Education—Elementary 194 Accounts Department 1,032 Engineer's Department 115 Clerk's Department 7,692 Health Department 7,688 Municipal Hospital work 54 Miscellaneous 5 Maternity Hospital, Kingsbury 14,330 Clerk of Works 1,299 Provision of Meals 1,635 Election 247 132,548 94 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 1933-34 132,548 11,196 11.841 12.576 Vehicle No. 1 (Table 1). This vehicle has now been replaced. Vehicle No. 3 (Table 1). The Insurance Company after an accident in August, 1933, paid £26 in respect of this vehicle which was not worth repairing. A sum of £200 is allowed in the estimates for 1934-35 for its replacement. During the financial year 1935-36 it will 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, MH3808, is rapidly becoming unserviceable. 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 diseases to hospitals. 4,324 such cases were removed in 1933.34. (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) Conveyance of children to feeding centres from Wykeham, Braintcroft, Wesley Road and Stonebridge Schools. (6) 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 15 motor drivers. There are thus 15 vehicles to be manned and a night service to be maintained with only 15 drivers. Of the 15 motor drivers two are wholly employed on Vehicles No. 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 6 men to man 4 ambulances and do the miscellaneous work. The work of these 6 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 3i 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. It should further be noted that with Saturday and Sunday feeding of school children and the payment of wages on Saturday mornings, 3 'buses are in use every Saturday and 2 'buses every Sunday. Three motor drivers and the fitter's mate are still on the temporary list. 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 and paved spaces uncovered for approximately 12 more. 95 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, but accommodation is required for stores. Cost.—The analytical table of costs prepared by the Finance Department is appended. GEORGE F. BUCHAN, Medical Officer of Health. 96 BOROUGH OF WILLESDEN. MOTOR SERVICES. Year Ended 31st March, 1934. Year 1932.33. Cost per mile. Expenditure. Year 1933.34. Cost per mile. £ s. d. £ s. d. d. £ s. d. £ s. d. d. Running Expenses— 709 13 4½ Petrol 700 2 7 41 10 10 Oil and grease 43 17 11 102 4 3 Tyres 80 19 7 — 853 8 5½ 1.500 — 825 0 1 1.494 Wages and Emoluments—. 380 0 0 Mechanic Superintendent 380 0 0 3,267 0 2½ Drivers, etc. 3,463 12 11½ 34 3 1 National Insurance 37 13 0 — 3,681 3 3½ 6.684 — 3,881 5 11½ 7.026 Fixed and General Charges— 187 0 0 Rent (Garage and Mess Room) 187 0 0 123 15 10 Repairs, plant, etc. 139 19 11 89 2 4 Painting, etc., bodies of vehicles 69 13 8 79 3 0 Coal, gas, etc. 78 18 6 97 9 0 Uniforms and Overalls 73 0 6 110 12 9 Insurance of vehicles 107 15 1 207 3 3 Motor car registration 210 5 2 6 5 0 Drivers' licences, etc. 7 2 6 58 1 10 Accessories and sundries 59 11 8 217 0 0 Loan charges on New Garage 236 15 9 — 1,175 13 0 2.135 — 1,170 2 9 2.118 Depreciation and Interest Charges— 1,320 5 0 Amount written off value of vehicles in accordance with Medical Officer of Health's Valuation 946 0 0 164 13 4 Interest on Capital employed 124 13 3 — 1,484 18 4 2.696 — 1,070 13 3 1.938 7,195 3 1 13.065 6,947 1 0½ 12.576 Income. Use of vehicles for :— 13 0 0 Conveyance of children 8 3 0 72 4 0 Conveyance of patients 47 0 0 – Election purposes 2 9 0 £85 4 0 £57 12 0 11,102 gallons Petrol consumed 11,196 gallons. 132,168 Miles run by all vehicles 132,576 11.905 Miles run per gallon of petrol consumed 11.841 Vehicles in use:— 31st March, 1933 15 31st March, 1934 14 Finance Department, Town Hall, Dyne Road, N.W. 6. July, 1934. APPENDIX D. REPORT ON DERMATOLOGICAL AND ACTINOTHERAPEUTIC DEPARTMENT FOR THE YEAR ENDED DECEMBER 31st, 1934, by H. D. HALDIN-DAVIS, M.D., F.R.C.P., F.R.C.S. No development of any very novel kind has taken place in this department during the past year, but the usual activities have been pursued and the numbers of the patients attending the various sessions have been well maintained. Certainly the "Artificial Sunlight" has proved its continued popularity, as is shown by the published figures, which show that it is well patronised both by children of school age and those who are still under the care of the Maternity and Child Welfare departments. The majority of the patients suffer from rather vague forms of debility, and the stimulating effect of the treatment prevents more serious developments. 97 The cases are analysed in the tables appended. The clinic for the treatment of ulcerated legs and allied conditions, e.g. varicose veins and dermatitis has also been well patronised during the past year; 58 patients were treated during 1934, all female except one. It cannot be claimed that in every case healing was obtained, but over 30 patients were discharged with their wounds healed and in all improvement took place with very considerable alleviation of pain and discomfort. The diminution of the number of cases of ringworm of the scalp occurring in the borough continued. During the whole of the year 1934 only two cases were submitted to X.ray treatment, the smallest number since the X.ray treatment of ringworm was instituted by the Council in 1913, and only eight cases of ringworm were seen altogether, including both ringworm of the scalp and ringworm of the rest of the body. APPENDIX E. REPORT ON WORK IN THE EYE DEPARTMENT FOR THE YEAR ENDED 31st DECEMBER, 1934, By B. R. MEDLYCOTT. M.B., B.S.(Lond.), M.R.C.S.. L.R.C.P., 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. 1931 6,118 1932 7,303 1933 7,385 1934 6,482 Refraction Cases. Appointments made. Appointments kept. Percentage Attendance. 1931 1,427 1,220 85.5% 1932 1,782 1,546 86.7% 1933 1,525 1,352 88.7% 1934 977 858 87.8% The general routine of the sessions has been carried on as in the preceding year. The optician has been in attendance at each session. The quality of the work and accuracy of the dispensing is quite satisfactory. All spectacles ordered have been checked by me before being issued. The treatment of cases requiring home visiting or daily attendance at the Clinics has been most efficient, and the following-up of cases for re-examination has been conscientiouslv carried out. The figures for the year are as follows:— Total Attendances. Table I. Total Attendances. Number of Sessions. Average Number of Attendances per Session. Clinic 1 1,680 47 35.7 Clinic 2 2,371 48 49.4 Clinic 3 2,431 47 51.7 Refraction Cases. Table II. Appts. made. Average per Session. Appts. kept. Average per Session. Percentage Attendance. Clinic 1 270 5.7 236 5 87.4% Clinic 2 324 6.8 294 6.1 90.7% Clinic 3 383 8.1 328 7 85.6% The following table shows an analysis of diseases appearing for the first time, and congenital abnormalities found in new cases during the year. Among the cases of concomitant squint are included a few old cases that required refraction during 1934. Table III. Diseases of the Eyelids, Conjunctiva and Lachrymal Apparatus. Disease. No. of cases. Conjunctivitis 116 Hordeolum 18 Blepharitis 40 Meibomian Cyst 13 Nsevus 1 Injuries and infections of eyelids 11 Ophthalmia Neonatorum 4 Warts 1 Subconjunctival Ecchymosis 3 Ectropion 1 Infected Socket 1 Epiphora 11 Dacryocystitis 1 Occlusion of Lachrymal Duct 11 Lachrymal Abscess 1 ARTIFICIAL SUNLIGHT TREATMENT, YEAR 1934. Conditions. Cases brought forward from 1933, i.e. : Treatments, Waiting List, Observation Cases. (1) New Cases. (2) Total Cases Treated. (3) Discharged not Treated, 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 1935, i.e 'Treatments, Waiting List, Observation Cases. (11) Attendances Treated. (12) 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. N.M. 0-5 5-14 E.M. N.M. 0-5 5-14 E.M. N.M. 0-5 5-14 E.M. N.M. 0-5 5-14 E.M. N.M. 0-5 5-14 E.M. N.M. 0-5 5-14 E.M. N.M. 0-5 5-14 E.M. N.M. 0-5 5-14 E.M. N.M. 0-5 5-14 E.M. N.M. 0-5 5-14 E.M. N.M. 0-5 5-14 E.M. M.N. 0-5 5-14 Tuberculous Glands - - - 1 - - - - - - - 1 - - - - - - - - - - - - - - - 1 - - - - - - - - - - - - - - - - - - - 35 Pre-Tubercular - - - 1 - - - - - - - 1 - - - - - - - - - - - - - - - - - - - - - - - 1 - - - - - - - - - - - 24 - - - 2 - - - - - - - 2 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 59 General Debility 1 - 40 58 - - 100 136 - - 121 175 1 - 17 14 - - 2 5 - - 3 2 - - 63 96 - - 26 30 - - 5 5 - - 24 42 - - 29 49 - - 2,032 3,910 Anæmia - - 1 8 — — - 4 — — — 11 — — 1 1 — — — — — — — — — — — 5 — — — 5 — — - - - - - 1 - - - 1 - - - 183 Rickets - 18 - — — 29 1 — — 46 1 — — — — — — 1 — — — 6 — — — 23 — — - 7 1 — — 1 — - - 9 - - - 16 - - - 649 3 Enlarged Glands - - 2 5 - - 5 8 — — 7 13 — — — — — — — — — — 1 — — — 3 10 — — — 2 - - 1 1 - - 2 - - 3 - - - 161 276 Cervical Adenitis - - - - - - - 1 - - - 1 - - - - - - - - - - - - - - - - - - - - - - - - - - - 1 - - - 1 - - - 31 Rheumatism - - - 4 - 1 - 2 - - - 6 - 1 - - - - - - - - - - - - - 5 - - - - - - - - - - - 1 - - - 1 - - - 88 Nerves 1 3 - - 3 5 — - 4 8 - - - - - - - - - - - - - - 3 7 - - - - - - - - - - 1 1 - - 1 - - - 161 168 Pink Disease - - - - - - 1 - - - 1 - - - - - - - - - - - - - - - - - - - - - - 1 - - - - - - - - - - - 12 - Genu Valgum - - - 1 - — 1 — — — 1 - - - - - - - - - - - - - - - 1 - - 1 - - - - - - - - - - - - - - - 31 56 1 - 62 79 - 1 139 157 - - 180 216 1 1 18 15 - - 3 5 - - 10 2 - - 92 124 - - 34 38 - - 8 6 - - 36 46 - - 49 53 - — 3,046 4,715 Chronic Blepharitis - - - 2 - - 1 11 - - 1 11 - - - 1 - - - 1 - - - 1 - 1 6 - - - 1 - - - - - - - 3 - - - 5 - - 17 273 Phlyctenular Conjunctivitis - - - - - - 1 9 — 1 9 - - - - - - - - - - - - - 1 66 — — — 2 — — 1 - - - - - - - - - - 27 144 Corneal Ulcer - - - 2 - - - 2 - - - - - - - - - - - 1 - - - - - - - - - - - - - - 1 - - - 2 - - - 33 - - - 2 - - 2 22 - - 2 22 - - - 1 - - - 1 - - - 2 - - 2 12 - - - 3 - - - 1 - - - 4 - — — 7 — — 44 450 Asthma - - 1 15 - - - 7 - - 1 21 - - - 1 - - - - - - - 1 - - - 9 - - 1 3 - - - - - - - 8 - - - 9 - - 3 650 Bronchitis Alopecia Areata - - 6 16 - — 10 21 — — 15 36 — — — 1 — — 1 — — — — 2 — - 9 16 — — 2 5 - - - 3 — - 4 10 — - 5 12 — — 322 637 - - 7 31 - - 10 28 - - 16 57 - - - 2 - - 1 - - - - 3 - - 9 25 - - 3 8 - - - 3 - - 4 18 - — 5 21 — - 325 1,287 - - - 2 - - 2 9 - - 2 11 - - - - - - - - - - 1 - - - - 3 - - 2 - - - - - - 1 6 - - 2 6 - - 53 274 Impetigo - - - - - - - 8 - - - 8 - - - - - - - - - - - - - - - 8 - - - - - - - - - - - - - - - - - - - 106 Acne - - - - - - - 4 - - - 4 - - - - - - - - - - - - - - - 4 - - - - - - - - - - - - - - - - - - - 100 Eczema - - — — — — 2 1 — — 2 1 - - - - - - - - - - - - - - 1 - - - 1 1 - - - - - - - - - - - - - - 24 3 Ecthyma - - - - - - - 1 - - - 1 - - - - - - - - - - - - - - - - - - - - - - - - - - - 1 - - - 1 - - - 14 - - - 2 - - 4 23 - - 4 25 - - - - - - - - - - 1 - - - 1 15 - - 1 3 - - - - - - 1 7 - — 2 7 — — 77 497 Otorrhœa - - - 2 - - 1 4 - - 1 5 - - - 1 - - - - - - - - - - - 3 - - 1 - - - - - - - - 2 - - - 2 - - 5 128 Furunculosis - - - - - - - 2 - - - 2 - - - - - - - - - - - - - - - - 1 - - - - - - 1 - - - 1 - - - 43 Enuresis - - - - 3 - - 1 6 - - 1 8 - - 1 - - - - - - - - - - - 3 - - 1 2 - - - 1 - - - 2 - - - 2 - - 2 103 Hirschsprung's Disease - - - 1 - - - - - - - 1 - - - - - - - - - - - - - - - 1 - - - - - - - - - - - - - - - - - - - 33 Malnutrition - - - - - - 1 1 - — 1 1 - - - - - - - - - - - - - - 1 - - - - - - - - - - - - 1 - - - 1 - — 25 8 - - - 6 - - 3 13 - - 3 17 - - - 2 - - - - - - - - - - 1 7 - - 2 3 - - - 1 - - - 6 - — - 6 - - 32 315 Total 1 - 69 122 - 1 158 243 - - 205 339 1 1 18 20 - - 4 6 - - 11 7 - - 105 184 - - 40 55 - - 8 12 - - 1 41 81 - - 56 94 - — 3,524 7,323 192 402 544 40 10 18 289 95 20 122 150 10,847 TOTAL NUMBER OF ATTENDANCES, YEAR 1934. E.M. N.M. 0-5 School. Total. Attended and Treated - - 3,511 7136 10,847 Attended for examination, e.g., new cases, cases treated and still under observation, unsuitable cases - 1 138 37 376 Total - 1 3,649 7 173 11,223 Total number of sessions 513 Average attendance per session 21.87 Average treatment per child 21.14 CASES REFERRED BY E.M. N.M. 0-5 School. Total. Clinic Doctors ... j 153 262 416 Private Doctors - — 5 15 20 Hospital ... - 4 3 7 Total - ■ 162 280 443 98 100 Concomitant Squint. Type of Squint. No. of cases. Alternating Convergent 13 Alternating Divergent 1 Right Convergent 48 Right Divergent 3 Left Convergent 86 Left Divergent 3 Left Upward 1 Diseases of the Eye-ball. Disease. Mo. of cases. Iridocyclitis 1 Corneal Abrasion 3 Corneal Ulcer 15 Corneal Nebulae 3 Phlyctenular Keratitis 1 Leucoma adherens 1 Corneal Foreign Body 6 Episcleritis 1 Macula Degeneration 2 Detachment of Retina 1 Traumatic Cataract 1 Congenital Glaucoma 1 Neurological Diseases. Disease. No. of cases. Migraine 1 Post-diphtheritic Paresis 1 Post-influenzal Paresis 1 Cerebral Tumour 1 Juvenile Tabes 1 Congenital Malformations and Defects. Defect. No. of cases. Congenital Nystagmus 5 Microphthalmos 1 Epicanthus 2 Congenital Ptosis 2 Congenital Inequality of Pupils 1 Persistent Pupillary Membrane 1 Congenital Lens Opacities 3 Bilateral Dislocation of Lens 1 Bilateral Coloboma of Iris and Choroid 1 Opaque Nerve Fibres 1 Congenital Pigmentation of Retina 1 The medicinal treatment of cases of progressive myopia, with calcium and para-thyroid, has been continued. Cases for investigation and operation have been admitted to Guys Hospital under my care. For investigation Juvenile Tabes 1 For operation Squint 11 Congenital Glaucoma 1 Total 13 101 APPENDIX F. REPORT ON THE WORK OF THE ORTHOPÆDIC CENTRE FOR THE YEAR ENDED 31st December, 1934. by H. J. SEDDON, F.R.C.S., Orthopaedic Surgeon to the Council. During the past year there has been an encouraging absence of severe deformities due to rickets. No case came to operation, and only a few cases of bow-legs were sufficiently marked to require splinting. My impression of rickets in Willesden during the past four years is that it is becoming less frequent, and certainly less severe. Now it can hardly be considered a crippling disease. Knock knee, appearing between the ages of two and six years, is the commonest complaint that we deal with. In the vast majority of cases alterations to the shoes and splinting will correct the deformity, but it has been necessary to admit two children for operative treatment. The cause of this troublesome condition is still obscure. Rickets and muscular weakness following acute illnesses undoubtedly account for a few cases, but in the greater number no obvious cause can be found. Recent work in Germany suggests that knock knee may be a type of congenital deformity (though not necessarily apparent at birth), and if this proves to be the case, preventive treatment becomes almost impossible. Our present efforts are being directed to early recognition and prompt corrective treatment. The loyal co-operation of Child Welfare and School Medical Officers contributes very largely to our success in controlling this deformity. Twenty cases of old infantile paralysis continue to absorb much of our time and energies. It is most unfortunate that we have no certain means of combating this most damaging disease. During the past year three children have been admitted for " stabilising " operations on the feet. This form of treatment makes it possible for the patient to walk moderately well without instruments, but the function of the lower limbs is never restored to normal. Birth injuries have been few in number, which speaks well for the efficiency of the Maternity Service. There has been only one case of obstetrical nerve injury during the year. The affected limb was splinted immediately; recovery commenced after twelve days, and was complete within three months. The attendance of patients at the Clinic has been regular, and I have no suggestions to make for the better running of the department. The following are the particulars of 19 cases transferred to the Royal National Orthoptedic Hospital, Stanmore, during the year :— A.T.—Age 13 ; was admitted on 6.12.33 with old tuberculous disease of the right hip, which had become partially fixed in a position of considerable deformity. The deformity was first corrected by an operation on the joint, and the hip was fixed in a good position in plaster. At a later date a bone grafting operation was done to ensure that the correction already obtained would be permanent. The boy was discharged wearing plaster on 22.6.34. In November the plaster was removed and an X-ray showed that the graft had united perfectly. It is fairly certain that this boy will be entirely free from trouble in his hip for the rest of his life. K.L.—Age 8 ; was admitted on 14.5.34 with stiffness of both hips, the result of acute arthritis following scarlet fever. As the child was too young for any extensive operation on the hips we endeavoured to restore some degree of movement by powerful traction. This was continued for five months, but unfortunately the original damage was so great that no movement could be produced in either hip. We have taught her to walk in spite of having stiff joints, and she was able to leave Hospital on 4.1.35. It will be necessary to readmit her in five or six years' time for a radical operation on one hip. H.C.—Age 2; was sent to the Orthopaedic Clinic on account of difficulty in walking. It was found that both hips were dislocated (a congenital condition) and she was admitted for treatment on 22.2.33. Reduction of the dislocations by manipulation was accomplished without great difficulty. She has been discharged and readmitted five times for X-ray examination and a change of plaster. In May, 1934, the plaster was finally removed and she has been walking since. It is almost certain that the ultimate result will be perfect, and due in no small measure to early recognition of her disability at the Infant Welfare Centre. R.C.—Age 11 ; was admitted on 28.3.34 with old osteomyelitis of the left tibia. There were two discharging sinuses above the ankle. At operation a cavity was found a few inches above the ankle joint; it was obviously the cause of the persistent discharge. All diseased bone was removed and the cavity was obliterated. From this time on the wound slowly healed, and the boy was discharged on 22.8.34, walking well and with a very sound leg. 102 O.C.—Age 14 ; was admitted on 10.12.34 with an old fracture of the right elbow and considerable limitation of movement in the joint due to new bone formation at the tip of the olecranon (the point of the elbow). The new bone was removed by operation but no immediate improvement in the range of movement was noted. However, it is quite possible that with appropriate after-treatment the range of extension will increase. The child was discharged to the Clinic for treatment on 15.1.35. L.B.-—Age 5; was admitted for investigation on 10.8.34. In January, 1934, she sustained a fracture of the right elbow which was treated elsewhere, and resulted in a lateral angulation of the joint. X-ray examination showed that the deformity was likely to increase in spite of operative correction. We decided therefore to postpone operation until the degree of angulation had become maximal. The child was discharged on 22.8.34 and is now attending the Clinic for regular inspection. R.L.—Age 7; was admitted for investigation on 12.7.34. In August, 1933, his skull was fractured and a large piece of the vault was lost. Consequently there was a gap in the cranium about 2 ins. in diameter. In view of his age it was considered inadvisable to attempt to close the gap by bone grafting. A protective metal cap was supplied and he was discharged on 3.8.34. The question of operation will be reconsidered in about three years time. M.Y.—Age 7 days ; was admitted on 23.2.34 with a birth fracture of the right humerus and paralysis of the musculo-spiral nerve. This combination of injuries is extremely rare, and this is the first example of the condition that we have encountered. The mother was admitted at the same time, so that the nursing of the child should not be interrupted. The arm was dealt with appropriately and the fracture joined in 12 days. By this time the paralysis was beginning to clear up, and the mother and child were discharged on 9.3.34. Since then, the arm has become perfectly normal. R.A.—Age 9; was admitted on 20.7.34, with a congenital club foot. He had been under treatment at Great Portland Street since birth, but the deformity had resisted treatment by manipulation. Two operations were performed with considerable improvement in the position of the foot, but a little residual deformity still remains. The final stage of the treatment must be deferred for a few years, as the boy is too young for the necessary bone operation. He was discharged on 28.12.34. R.H.—Age 11; was admitted on 25.7.34 with 2½ ins. of knock knee. The deformity was corrected by a bone operation and the result has been most satisfactory. He was discharged on 6.11.34, and is attending the Clinic regularly. A.S.—Age 4|; was a similar case. She was admitted on 23.4.34 and discharged on 10.8.34. D.G.—Age 14 ; was admitted on 17.9.34 with persistent pain in the back. Although there was considerable deformity of the spine we could find no sign of organic disease. The outlook is therefore good, and it should be possible to correct her deformity by regular exercises and a frame to sleep on at night. The frame has been supplied and the girl is now attending the Clinic for treatment. She was discharged on 12.10.34. K.B.—Age 13; was admitted on 15.11.34 for operative correction of a hammer toe. She was discharged on 10.12.34. G.W.—Age 8; was admitted on 13.3.34 with stiffness of the neck following acute rheumatism. We suspected a partial dislocation, but the X-ray showed a normal spine. Shortly after admission the stiffness began to disappear, and the final conlusion was that it had been caused by enlargement of the glands in the neck secondary to infection of the tonsils. The boy was discharged on 24.4.34, with a request that the tonsils might be removed at a later date. K.M.—Age 5; was admitted on 1.1.34 with congenital spastic paralysis. Owing to shortening of the achilles tendons the child was unable to get her heels to the ground. The tendons were lengthened by open operation and the child was discharged very much improved on 24.4.34. B.W.—Age 4 ; was a similar case. She was admitted on 16.2.34, and discharged on 18.5.34. K.G.—Age 11; admitted on 3.9.34 with old infantile paralysis, which had given him a flail right foot. An operation was performed to make the foot stable and the child was discharged in plaster on 12.10.34. The plaster has since been removed and he is now walking well. G.G.—Age 10; was admitted on 29.1.34 with old infantile paralysis which had affected both feet. Stabilising operations were performed, and the boy was discharged in plaster on 23.3.34. He was readmitted in June for removal of the plasters and his subsequent progress has been most satisfactory. J.B.—Age 10; was admitted on 6.12.33 with a similar disability. Operations were performed on both feet and he was finally discharged on 11/6/34. 103—104 ORTHOPÆDIC DEPARTMENT.—REPORT FOR YEAR 1934. Defects Treated. Brought Forward. New. Total. Treatments completed. Treatments ceasing before completion. Carried forward. 0-1 1-5 5-14 N.M. 0-1 1-5 5-14 N.M. 0-1 1-5 5-14 N.M. Total. 0-1 1-5 5-14 N.M. Total, 0-1 1-5 5-14 N.M. Total. 0-1 1-5 5-14 N.M. Total. General Bone Disease 35 92 41 - 20 114 20 - 55 206 61 - 322 3 29 13 - 45 10 86 18 - 114 42 91 30 - 163 Deformities of Feet 11 42 56 1 6 32 70 1 17 74 126 2 219 - 9 25 - 34 2 20 24 1 47 15 45 77 1 138 Congenital Deformities 19 2 7 - 11 1 3 - 30 3 10 - 43 4 1 2 - 7 8 1 - - 9 18 1 8 - 27 Tubercular Conditions — 1 6 - - 1 2 - - 2 8 - 10 - - - - - - - - - - - 2 8 - 10 Postural Defects of Spine 1 8 63 — - 5 57 - 1 13 120 - 134 - 1 18 - 19 1 3 37 - 41 - 9 65 - 74 Infantile Paralysis 1 2 13 - - 3 3 - 1 5 16 - 22 - - 1 - 1 - - 1 - 1 1 5 14 - 20 Erbs Paralysis 1 - 1 - - - 1 - 1 - 2 - 3 - - - - - - - - - - 1 - 2 - 3 Spastic Paralysis 1 6 8 1 - 4 3 - 1 10 11 1 23 - - 2 1 3 - - - - - 1 10 9 - 20 Paresis of Digits 1 - 2 - - - 1 1 1 - 3 1 5 - - - - - - - - - - 1 - 3 1 5 Traumatic Conditions — - 11 - 3 5 24 - 3 5 35 - 43 - - 13 - 13 1 1 8 - 10 2 4 14 - 20 Debility 4 6 4 1 2 11 6 - 6 17 10 1 34 - 1 4 - 5 - 1 2 - 3 6 15 4 1 26 Lymphiangioma — 1 — - - - - - - 1 - - 1 - - - - - - - - - - - 1 - - 1 Ganglia — - 3 — 1 1 1 - 1 1 4 - 6 - - 2 - 2 - — 1 - 1 1 1 1 — 3 Total 74 160 215 3 43 177 191 2 117 337 406 5 865 7 41 80 1 129 22 112 91 1 226 88 184 235 3 510 No. of individual cases treated 70 155 215 3 43 167 187 2 113 322 402 5 842 7 41 80 1 129 18 112 91 1 222 88 169 231 3 491 No. of attendances at Centre for Treatment 526 2,006 5,292 18 7,842 Do. do. do. Massage 438 1,072 1,218 - 2,728 Do. do. do. Electrical 20 404 919 - 1,343 Do. do. do. Application of Splints 72 411 195 - 678 Do. do. do. Gymnastic Exercises 44 757 3,965 3 4,769 Total 574 2,644 6,297 3 9,518 No. of Individual Cases not requiring Treatment 6 58 63 - 127 No. of attendances at Centre 3 93 65 — 161 Total attendance at Centre 529 2,099 5,357 18 8,003 Entered for Hospital Inpatient Treatment— Admitted. Discharged. - Referred for Hospital Inpatient Treatment General Bone Diseases R.C. 28. 3.34 22. 8.34 1 - 1 General Bone Diseases R.C. - - 1 - 1 R.H. 27. 7.34 8.11.34 1 - 1 K.L. - - 1 - 1 K.L. 14. 5.34 4. 1.35 1 3 1 R.H. - - 1 - 1 A.S. 23. 4.34 10. 8.34 1 - 3 1 J.M. - 1 - - 1 G.W. 13. 3.34 24. 4.34 1 - 1 Deformities of Feet G.B. - - 1 - 1 D.F. 3. 9.34 1 - 1 D.B. - - 1 - 1 Deformities of Feet D.B. 15.11.34 10.12.34 1 18 1 Infantile Paralysis R.A. - - 1 - 1 Congenital Deformities R.A. 20. 7.34 7. 1.35 1 - 1 P.B. - - 1 - 1 P.B. 12.10.34 15.11.34 1 - 1 Infantile Paralysis G.G. - - 1 - 1 Infantile Paralysis re-entered h.c. 7. 2.34 16. 2.34 1 - - 1 K.G. - - 1 - 1 H.C. 14. 5.34 20. 7.34 1 - 3 1 Spastic Paralysis B.W. - - 1 - 1 K.M. 1. 1.34 24. 4.34 1 3 1 B.C. - - 1 - 1 K.G. 3. 9.34 12.10.34 1 - 1 Postural Defects of Spine D.G. - - 1 - 1 re-entered g.g. 29. 1.34 23. 3.34 1 - 1 Traumatic Conditions Baby Y. 1 - - - 1 G.G. 11. 6.34 25. 7.34 1 - 1 R.L. - - 1 - 1 W.H. 23. 3.34 1 - 1 L.B. - - 1 - 1 Spastic Paralysis B.W. 16. 2.34 18. 5.34 1 - 1 M.D. - 1 - - 1 Postural Defects of Spine D.G. 17. 9.34 12.10.34 1 - 1 - Traumatic Conditions O.C. 10.12.34 18. 1.35 1 - 1 - L.B. 10. 8.34 22. 8.34 1 - 1 - R.L. 12. 7.34 3. 8.34 — — 1 — 1 - Total — 3 18 - 21 Total 1 2 14 — 17 105 APPENDIX G. HOUSING ACTS, 1925 and 1930. Clearance Areas. Areas. Number of Lands on which Compulsory Purchase Orders were made. Number of Lands on which Compulsory Purchase Orders Confirmed without modification by Minister of Health. Number of Lands on which Compulsory Purchase Orders Confirmed with modification by Minister of Health. Number of Lands on which Compulsory Purchase Orders were made and excluded by the Minister of Health. Number of Occupiers of dwellings on Lands. Confirmed. Not Confirmed. Part I. Part II. Part I. Part II. Part I. Part II. Part I. Part II. Part I. Part II. Part I. Part II. Canterbury Road 5 — — — — — 5 — — — 19 — Alpha Place North 30 22 30 9 — — - 13 225 69 225 159 Alpha Mews 29 22 19 — 7 — 3 22 109 32 148 193 Cambridge Mews West 5 1 — — — — — — — — — — Cambridge Mews East 10 — — — - — — — — — — - Pembroke Place 14 — — — - - — — — — — - The following numbers of Notices were served:— For all areas dealt For above areas, with during 1934. Section 127, Housing Act, 1925 193 271 Section 42, Housing Act, 1930 286 341 Notices of Compulsory Purchase Orders 348 446 Number of Premises inspected 208 Number of visits for the purpose 788 Total inspections and re-inspections made 996