AC439 WIL 32 C. 1 M Borough of Willesden. 1936. THE 61st 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; JAS. TRUSCOTT & SON, LTD., Suffolk Lane, Cannon Street, London, E.C.4, INDEX. page Abnormal Children 38-45 Accouchment Sets 11 Acreage of District 17 Adoptive Acts in force in District 20 After Care of Mentally and Physically Defective Children 45 Ambulance Service 16, 19, 95 Attendances—Health Centres 45 Bakehouses 23 Birth Rate 5, 17, 83 Blind and Partially Blind Children 40 Bye-laws 21 Canal Boats 23,25 Cancer 6 Caravans 23 Child Guidance 40 Closet Accommodation 21, 24 Common Lodging Houses 23 Confinements in Hospital 9 Convalescence—School Children 39 Cowsheds 23 Crippled Children 42 Crippling Defects 14 Dairies and Milkshop 24 Dead—Disposal of 25 Deaf and Partially Deaf Children 41 Death Rate 5, 17, 83 Deaths—Causes of 84 Delicate Children 42 Dental Work—Schoolchildren 57 —Maternity and Child Welfare 57-61 Diphtheria Immunisation 75 Disinfection 24 Disinfestation 22,24,120 Drainage and Sewerage 21,24 Employment of Children in Entertainments 47 Epileptic Children 41 Exceptional Children—Return of 40 Factory and Workshop Act, 1901 29 Feeding Centres—Schoolchildren 15,71 Following-up 13 Food—Inspection and Supervision of 27 Food and Drugs Acts 29 Health Centres 20, 45, 46, 115, 118 Health Education 14 Health Services—Development and Extension of 129 Home Nursing 15, 20, 69 Hospital Treatment—Children under 5 years 10 —School Children 47 House Refuse 21, 24 Houses Let in Lodgings 23, 25 Housing 15, 26, 106, 113, 124 Housing Acts 23 Infant Life Protection 67 Infant Mortality 92 Infectious Diseases Hospital 73 Infectious Diseases—Notifiable 7,18,93 —Non-Notifiable 8 Inhabited Houses 17 Inspections—Sanitary 23 Laboratory Facilities 19, 77 page Maternal Mortality 11 Maternity Hospital 9, 79 Meals—Provision of, to School Children 15, 71 Meat Inspection 28 Medical Inspection of Children under 5 11 Medical Inspection of School Children 12, 13, 31-37 Medical Treatment of School Children 13, 31-37 Members of the Corporation 4 Mental Defectives—Occupation Centre 81 Mental Deficiency Acts—Children notified to Local Authority 43 Mentally Defective Children 38,41 Midwifery Services 20 Midwives— Supervision of 62-65 Milk 27 Mother craft 12 Motherhood 126 Mothers and Children under 5 8 Mortuary 16 Movable Dwellings 23 Municipal Hospital 16, 73 Nursery Classes 82 Nursing Homes—Registration of 66 Nutrition 33 Offensive Trades 24, 25 Ophthalmia Neonatorum 12 Orthopaedics 14, 35, 103 Overcrowding 16, 27 Payments by Parents 14 Physically Defective Children 38, 41, 121 Population 17 Rag Flock Acts 25 Rateable Value 17 Rent and Mortgage Interest (Restriction) Acts, 1920-33 23 Rivers and Streams 21 Sanitary Administration 20 Sanitary Inspection 23 Sanitary Work 15 Scarlet Fever—Return Cases 7 School Medical Service 12 Schools 25 Secondary Schools—Routine Medical and Dental Inspection and Treatment 14,48-56 Skin Disease 13, 100 Slaughter-houses 23 Small Pox 8 Social Conditions 16 Special Schools— Routine Medical Inspection 38, 44 Squint 34 Stammering Children 39 Still-birth Rate 5, 17 Swimming Baths and Pools 22 Tonsils and Adenoids—Operation for removal of 13, 20, 105 Tuberculosis—Notifications and Deaths 18 Tuberculous Children 41 Underground Rooms 25 Unemployed 16 Unsound Food 24 Verminous School Children 13 Vital Statistics 5,17,83 Vocational Guidance 14 Water Supply 21,24 APPENDICES. page A.— Table I. Vital Statistics 83 ,, II. Deaths of Willesden Residents 84 ,, II. (a) Causes of death as circulated by Registrar-General 91 ,, III. Infant Mortality 92 ,, IV. Cases of Infectious Disease notified 93 B.— List of Acts of Parliament, Local Government Orders, etc., etc., issued by Government Departments 94 C.— Annual Report on the Ambulance Service 95 D.— Annual Report on Dermatological and Actinotherapeutic Departments 100 E.— Annual Report on the Eye Department 100 F.— Annual Report on the Orthopaedic Clinic 103 G.— Annual Report on the work of the Ear, Nose and Throat Department 105 H.— Housing Acts, 1925-35—Clearance Areas 106 I.— Report of Medical Officer of Health on the Progress of Housing Programme 108 page J.— Report of School Medical Officer on Administrative Programme of Educational Development. Board of Education circular 1444 111 K.— Housing Act, 1935—Report on Overcrowding Survey by the Medical Officer of Health 113 L.— Report on the Extension of Health Centres 115 M.— Memorandum by the Medical Officer of Health on Health Centres for Willesden 118 N.— Memorandum by the Medical Officer of Health on the Disinfestation of Privately Owned Houses 120 O.— Proposed New Physically Defective School. Notes by School Medical Officer 121 P.— Housing—Report by the Medical Officer of Health 124 Q.— Memorandum by the Medical Officer of Health on Motherhood in Willesden 126 R.—Report by the Medical Officer of Health on the Development and Extension of Health Services 129 CORPORATION OF WILLESDEN, 1936-37. HIS WORSHIP THE MAYOR. ALDERMAN C. HICKS BOLTON, J. P., M. A. Deputy Mayor. Alderman H. W. PROTHERO. Aldermen. *§†BOND, P., J.P. JEFFRIES, W. ‡§†COWAN, Miss N. M. (Chairman, ‡§†RYDE, W. H. Hospital Visiting, Sub-Committee). SAVORY, H. J. HILL, W. A., J.P. STILTON, W. A. *§†HILL, W. J. (Chairman, Health *†WILLIAMS, Mrs. S. E. H. {Chairman, Committee). Children's Care Sub-Committee) HISCOCKS, G. H. *†WORSFOLD, Mrs. A. B. Councillors. AYRES, G. HURLEY, G. J. † (i) BLAXLAND, H. C. *+f JONES, A. E. ‡§†BOWN, S. KELLY, H. J. ABRIDGES, J. S., LL.D. fLEIGH MOSSLEY, H. †CARNE, G. T. LEVY, R. C. S., LL.M. CATLOW, J. W. LLOYD, Rev. T. D., B.A. ‡CLARK, J. A. JMARSHALL, H. C. *COOPER, J. S. ‡§†SMcLAUCHLAN, J. OWENS, G. *†DORAN, A. E. *†PERRY, A. *†DORE-BOIZE, G. SAUNDERS, J. J. EVANS, F. T. †SCOTT, S. *‡FORBES, Mrs. M. R. †(ii)THORLEY, H. FFRNT FY, J. WALFORD, A. A. (Elected 17th *‡FORBES, Mrs. M. R. 1937). GILLIS L H *†‡§WALLIS, Mrs. V. B. (Chairman, Housing Act (1930-35) Committee). *HASKELL, V. C. *WATSON. A. T. W. *HENDERSON, Miss J. M. WATTS C K HOBBS, J. R. (Resigned 21st May, 1937). ‡†WESTON, GEO., F.A.I. †HOBSON, C. R. WHITE, Mrs. R. *HUGGINS, Mrs. V. E. A. *WILKINS, R. H. * Member of the Children's Care Sub-Committee. †Member of Health Committee. ‡ Member of Housing Act (1930-35) Committee. § Member of Hospital Visiting Sub-Committee. (i) Resigned from Health Committee 27th April, 1937. (ii) Appointed to Health Committee 27th April, 1937. 5 Town Hall, Dyne Road, Kilburn, London, N.W. 6. Ist May, 1937. 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 1936. This Report includes :— (i.) The 61st Annual Report on the health and sanitary condition of the district ; (ii.) The 29th Annual Report on the health of children attending the public elementary schools; (iii.) The 3rd Annual Report on the work in connection with Abnormal Children. (iv.) The 17th Annual Report on the health of children attending secondary and technical schools; (v.) The 19th Annual Report on dental work in connection with school children, expectant and nursing mothers and children under 5 years ; (vi.) The 7th Annual Report on the Supervision of Midwives ; (vii.) The 7th Annual Report on the Registration of Nursing Homes ; (viii.) The 7th Annual Report on Infant Life Protection ; (ix.) The 17th Annual Report on home nursing ; (x.) The 22nd Annual Report on the provision of meals to children attending the public elementary schools; (xi.) The 45th Annual Report on the Municipal Hospital; (xii.) The 6th Annual Report on the Maternity Hospital; (xiii.) The 7th Annual Report on the health of patients attending the Middlesex County Council Occupation Centre for Mentally Defectives, Buller Road, Willesden ; (xiv.) The 6th Annual Report on Nursery Classes ; The Report is written in accordance with the requirements of the Ministry of Health and Board of Education. VITAL STATISTICS. The estimated population of Willesden at Midsummer, 1936, was 202,505. 2,835 live births were registered during 1936, giving a birth rate of 14.00 per 1,000 of the population, as against 14.35 in 1935. 86 still births were registered, giving a still birth rate of 29.44 per 1,000 total live and still births. 2,113 deaths were registered in 1936, giving a death rate of 10.43 per 1,000 of the population. These figures compare with a total number of deaths of 1,933 and a death-rate of 9.74 in 1935. The infantile mortality rate for the year 1936 was 59.96 per 1,000 births. Altogether 170 children under one year of age died in 1936. 6 The following table shows the principal causes of deaths of children under one year of age and the infantile mortality year by year up to and including 1936:— Table No. 1. 1924 1925 1926 1927 1928 1929 1930 1931 1932 1933 1934 1935 1936 Congenital Malformations 11 11 6 13 12 17 11 9 10 10 16 11 25 Premature Birth 45 43 42 43 35 61 57 51 40 35 29 53 44 Atrophy, Debility and Marasmus 32 13 10 13 13 7 15 9 12 11 7 7 7 Atelectasis 2 8 4 4 5 9 5 9 4 11 9 8 5 Diarrhoea and Enteritis 10 13 10 9 9 11 24 16 31 27 20 57 24 Measles 10 3 3 0 4 0 4 0 4 0 1 0 2 Whooping Cough 8 13 4 8 5 7 2 6 1 5 1 2 7 Bronchitis 12 6 6 6 7 7 2 3 3 2 1 5 9 Pneumonia 36 30 31 21 30 22 27 30 26 10 15 16 22 Total Infantile Mortality Rate (rate per 1,000 live births) 73 62 53 59 57 61 61 60 61 46 43 66 60 Actually few children under the age of one should lose their lives. I say this because of the fact that the infantile mortality rate amongst clinic attendants was only 24 per 1,000 births, whereas amongst non-clinic attendants it was 120 per 1,000 births. These figures are arrived at by knowing that out of the 2,835 children born alive in Willesden in 1936, 1,781 attended the Health Centres, of whom 43 died, giving an infantile mortality rate amongst clinic attendants of 24 per 1,000 births. 1,054 children born in Willesden in 1936 did not attend the clinics and of this number 127 died before reaching the age of one, thus giving an infantile mortality rate amongst non-clinic attendants of 120 per 1,000 births. It should be noted that the infantile mortality rate of 24 amongst clinic attendants compares with a rate of 30 last year and the infantile mortality rate of 120 amongst non-clinic attendants compares with a rate of 121 last year. CANCER. In Willesden in 1936 there were 302 deaths from Cancer, as compared with 266, 281, 260, 250, 250, 214, 239, in each of the previous seven years. 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. During 1936, 74 patients attended the Clinics, of whom 56 were new cases (12 men and 44 women) and 18 had attended during 1935 or previously. The total attendances made during 1936 were 119. Of the 56 new cases, 6 were found to reside out of the district and were dismissed after being examined and suitably directed as to the means of securing proper investigation and treatment. The remaining 50 cases after examination were disposed of as follows :— 26 were referred to a hospital for further investigation; 7 were referred back to their own doctors; 13 were kept under observation and asked to re-attend (10 of these were finally discharged before the end of the year). 1 was referred to a special clinic; 3 were reassured and discharged on their first visit. 7 Of the 26 who were referred to hospital:— 10 were found to require operation (7 have been operated on; 1 is awaiting operation; 2 have refused operation); 9 required treatment (all have received treatment and are still under observation) ; 3 were reassured and dismissed. 2 were reassured and referred back to the care of their own doctors. 2 failed to attend. The pathological conditions from which the 56 new cases suffered are briefly as follows:— 3 cases had Cancer (2 affecting the mouth and throat and 1 affecting the breast); 8 cases had abnormal breast conditions (2 had innocent tumours requiring operation; 4 had mastitis requiring special treatment ; 2 had other conditions); 14 cases had affections of the generative organs often found to be pre-cancerous (4 required operation); 11 had conditions affecting the digestive tract which occasionally lead to Cancer. 6 had similar conditions of the Throat and Nose; 4 had innocent tumours of the skin or body wall; 10 had conditions unconnected with Cancer but which were causing anxiety or required treatment. The Nurse attached to the Clinic pays following up visits to the homes of the patients attending. During 1936, 71 such visits were paid. She was well received and gratitude was expressed for the help given by the Clinic. The Nurse also visits homes where disinfection has been asked for after a death from Cancer has occurred or after removal of a Cancer patient elsewhere. 18 houses were visited in this way. Such visits are not, however, as well received and the information obtained is not very complete. INFECTIOUS DISEASES. During the year 1936, 2,517 cases of Infectious Disease were notified as compared with 2,315 in the previous year. The following table gives the number of notifications of certain diseases included in the above total of 2,517, together with the corresponding figures for 1935:— Table No. 2. Number of Cases notified. 1935 1936 Diphtheria 451 382 Scarlet Fever 486 556 Pneumonia 258 352 Whooping Cough 643 743 Erysipelas 91 88 Return Cases of Scarlet Fever.— The following statement gives the return cases that have occurred during 1936:— I. Home Cases.—64. (a No. of infecting cases giving rise to return cases not longer than 28 days after release from isolation 3 ,, return cases they gave rise to 3 ,, infecting cases per cent, of total home cases 4.7 „ return cases per cent, of total home cases 4.7 (b) No. of infecting cases giving rise to return cases more than 28 days after release from isolation 1 ,, return cases they gave rise to 1 ,, infecting cases per cent. of total home cases 1.6 ,, return cases per cent, of total home cases 1.6 8 II. Hospital Cases.—492. (a) No. of infecting cases giving rise to return cases not longer than 28 days after discharge 19 „ return cases they gave rise to 25 „ infecting cases per cent, of total hospital cases 3.9 ,, return cases per cent, of total hospital cases 5.1 (b) No. of infecting cases giving rise to return cases more than 28 days after discharge 6 „ return cases they gave rise to 6 ,, of infecting cases per cent, of total hospital cases 1.2 „ return cases per cent, of total hospital cases 1.2 Small Pox.— No cases of Small Pox were notified during 1936. No vaccinations were performed by the Medical Officer of Health under the Public Health (Small Pox Prevention) Regulations, 1917. Typhoid Fever.— Ten cases were notified during 1936, as against 10 in 1935, 7 in 1934 and 13 in 1933. Nine cases were removed to hospital—7 to the Willesden Municipal Hospital and 2 to the Central Middlesex County Hospital. One case was nursed at home. Of the 7 cases removed to the Willesden Municipal Hospital, 4 were diagnosed as Typhoid Fever, 2 as Gastro-Enteritis and 1 as Gastro Enteritis Debility and Senility. This last was transferred to the Central Middlesex County Hospital. The other 6 were discharged well. No death was recorded from Typhoid Fever in 1936. Malaria.— One case of Malaria was notified during 1936. Malaria was induced in hospital as part of the treatment for general paralysis. Infectious Diseases of the Nervous System—Cerebro-Spinal Meningitis, Poliomyelitis, Encephalitis Lethargica and Acute Polio-Encephalitis.—14 cases of these diseases were notified in 1936 and 2 of them proved fatal giving a fatality rate of 14 percent. of notified cases. The 2 deaths were certified as due to Cerebro-Spinal Fever. 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. Dysentery,— 20 cases were notified during 1936. 16 occurred in children in the Central Middlesex County Hospital, 15 in January and February, and 1 in November. This last was transferred to the Willesden Municipal Hospital and diagnosed as gastro-enteritis. All recovered. Of the other 4 cases, 1 occurred in a child admitted to hospital with pneumonia, 1 in a child admitted to hospital with enlarged glands in the neck and 2 occurred at home. Of these two, 1 was admitted to a London Hospital and 1 to the Willesden Municipal Hospital where it was diagnosed as suffering from gastroenteritis. All recovered. Whooping Cough is a notifiable disease in Willesden. 743 cases were notified during the year but a total of 1,189 cases coming to their knowledge were visited by the Health Visitors. There were 12 deaths from Whooping Cough, 11 occurring in children under 5 years of age and 1 in a child between 5 and 10 years of age. 11 of these 12 deaths occurred in institutions. » 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 1936, 2,446 cases of measles which is not notifiable in Willesden were visited by the Health Visitors. There were 22 deaths from Measles, 19 occurring in children under 5 years of age and 3 in children between 5 and 15 years of age. 18 of these 22 deaths occurred in institutions. MOTHERS AND CHILDREN UNDER FIVE YEARS. Municipal Centres.— At the Municipal Centres, expectant mothers attended the medical consultations and treatment Clinics on 11,413 occasions ; nursing mothers 27,930, and children under 5, 56,895, making a total of 96,238 attendances. Out of the total number of 2,835 children born alive during the year, 1,781 or 63 percent. subsequently attended the Municipal Welfare Centres. Altogether, however, 2,009 children under 1 year of age attended the Municipal Centres for the first time during the year, excluding transfers from other districts. This represents 71 percent. of the 2,823 notified live births belonging to Willesden, and 71 percent. of the 2,835 registered live births belonging to Willesden. 373 children between the ages of 1 and 5 years attended the Municipal Centres for the first time during the year, excluding transfers from other districts. 9 The number of live births occurring amongst expectant mothers who attended the AnteNatal Clinics was 1,216; 78 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. 3. 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. Gases 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. 1935 942 1936 979 During 1936, 370 applicants for confinement in the Willesden Maternity Hospital were unable to be booked for the reasons set out below :— Table No. 4.—Applications for Booking Refused. No beds available 283 Not resident in Willesden 74 Will not have had 3 months' residence in Willesden prior to expected date of confinement 11 Unable to pay fee 2 370 The following Table shows the fees at which the 979 cases were booked :— Table No. 5. Fee. No. of Cases. Fee. No. of Cases. £13 0s. 0d 1 £5 10s. 0d 14 £12 10s. 0d 1 £5 0s. 0d 17 £11 0s. 0d 1 £4 10s. 0d 16 £10 0s. 0d 2 £4 0s. 0d 27 £9 10s. 0d 1 £3 10s. 0d 44 £8 10s. 0d 1 £3 0s. 0d 50 £8 0s. 0d 3 £2 10s. 0d 69 £7 10s. 0d 2 £2 0s. 0d 84 £7 0s. 0d 4 10s. 0d 102 £6 10s. 0d 5 £1 0s. 0d 104 £6 0s. 0d 7 Free 424 The average fee per case is approximately £1 9s. 0d. 10 Hospital Confinements.— During 1936, 913 women were confined in the Willesden Maternity Hospital. In addition to these a number of Willesden mothers were confined in institutions outside Willesden, 473 births of Willesden residents being notified from such outside institutions—110 from Queen Charlotte's Hospital, 42 from Queen Mary's Maternity Home, Hampstead, 63 from St. Mary's Hospital, 17 from University College Hospital, 25 from Middlesex Hospital, and smaller numbers from other hospitals ; 66 from a nursing home and smaller numbers from other nursing homes. These, together with some 387 in the Central Middlesex County Hospital, are approximately 60 per cent. 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 for special reports by the Council's Health Visitors in connection with women who are to be confined in these Hospitals. 120 such reports were supplied to London Hospitals and 188 to the Middlesex County Council during the year. Hospital Treatment of Children under 5 Years of Age Excluding Orthopaedic Treatment which is dealt with in Appendix F and excluding 210 Cases of Infectious Disease Admitted to the Willesden Municipal Hospital—Measles, Whooping Cough, etc.— The following table gives particulars of the children under treatment at the Willesden Municipal Hospital, at the Willesden General Hospital and St. Monica's Home Hospital under the Council's scheme and at other hospitals during 1936:— Table No. 6. Willesden Municipal Hospital (since 1-4-36). Willesden General Hospital (before 1-4-36). St. Monica's Home Hospital (before 1-4-36). St. Mary's Home, Broadstairs. Dedisham Convalescent Home, Slinfold. Total. No. of Children in Hospital at 31st December, 1935 0 2 5 0 0 7 No. of children admitted during 1936 107 20 11 1 1 140 Total number of Children under treatment during 1936 107 22 16 1 1 147 No. of Children discharged during 1936 98 22 14 1 1 136 No. of Children died in Hospital during 1936 5 0 2 0 0 7 No. of Children remaining in Hospital at 31st December, 1936 4 0 0 0 0 4 The following table gives particulars of the conditions for which children were treated during 1936, the treatment carried out and the results of such treatment:— Table No. 7.— Children under 5 Years under Treatment in Hospital during 1936. 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 7 42 49 — 49 — 14 24 7 4 Enlarged Tonsils and Adenoids 0 98 98 98 — — 98 — — 0 Total 7 140 147 98 49 — 112 24 7 4 Puerperal Fever.— During 1936, 6 cases of Puerperal Fever were notified as against 3 in 1935, 9 in 1934, 13 in 1933, 8 in 1932, and 14 in 1931. This gives a case rate of 2.1 per thousand registered live births, as against 1.1 in 1935, 3.3 in 1934, 4.9 in 1933, 2.9 in 1932, 4.9 in 1931. 11 The figure per 1,000 registered total births is 2.1 for 1936 against 1.0 for 1935, 3.2 for 1934 and 4.7 for 1933. All the patients recovered. Two deaths appear in the death table under puerperal sepsis. In each case the patient was notified as suffering from puerperal pyrexia. As no deaths occurred amongst the 6 cases of puerperal fever notified in Willesden, this gives a case mortality of 0.0 per cent, as against 33.4 per cent, in 1935, 11.1 per cent, in 1934, 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. In 2 of the 6 notified cases a private doctor attended the confinement at home. One was subsequently removed to hospital and one was nursed at home. One case was attended at home by a district midwife and was subsequently removed to hospital. One was a case of miscarriage at home which was removed to hospital three days later. Two patients were confined in hospital. All recovered. Puerperal Pyrexia.— 33 cases were notified during the year. 3 of these 33 cases proved fatal, 2 of the deaths being attributed to Puerperal Sepsis, and 1 to post.abortive sepsis. This last was a patient living in Acton but confined in Willesden and her death is allocated to Acton. Maternal Mortality.— During 1936 there were 5 deaths classed to pregnancy and child. bearing—2 to Puerperal Sepsis, and 3 to other puerperal causes. The puerperal mortality rate from Sepsis was, therefore, 0.71 per 1,000 registered live births and 0.68 per 1,000 registered total births. The corresponding figures for 1935 were 1.40 per 1,000 registered live births and 1.36 per 1,000 registered total births. The total puerperal mortality rate was 1.76 per 1,000 registered live births and 1.71 per 1,000 registered total births. The corresponding figures for 1935 were 2.81 per 1,000 registered live births and 2.73 per 1,000 registered total births. During 1936 there were 4 maternal deaths from non.puerperal causes and 1 maternal death from criminal abortion. The total maternal mortality from all causes excluding criminal abortion, was thus 3.17 per 1,000 registered live births and 3.08 per 1,000 registered total births as against 2.81 and 2.73 in 1935. The total maternal mortality from all causes including criminal abortion was 3.53 per 1,000 registered live births and 3.42 per 1,000 registered total births as against 2.81 and 2.73 in 1935. During 1936 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 1936, 273 were supplied free, 6 at full cost and 16 at part cost. (2) Specialist Help.— The Council accept responsibility for the payment of the fee of one of their specialists called in by a medical practitioner to assist him in connection with a difficult case of labour occurring in a Willesden resident. 8 such consultations were paid for in 1936. (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 1936. Maternal Mortality Investigations.— 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. 10 cases were inquired into during 1936. 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. 12 Findings of Medical Inspections.— The following table shows the numbers and percentages of individual defects found in 556 children examined during the year. Table No. 8. Age Period. 18 months. 2 years. 3 years. 4 years. Total. Percentage. Number of children inspected 141 225 101 89 556 Malnutrition (including slight degrees) 6 8 3 4 21 3.8 Skin Conditions 4 8 3 — 15 2.7 Eyes—Blepharitis and Conjunctivitis — 6 1 — 7 3.6 Squint 1 1 3 1 6 Other conditions 2 2 — 3 7 Ears, Otitis Media — 1 — 2 3 0.5 Nose and Throat—Enlarged tonsils or adenoids or both 10 24 17 12 63 11.3 Enlarged Cervical Glands 2 4 9 2 17 3.0 Teeth—Dental Diseases 2 5 16 19 42 7.5 Heart and Circulation (including anaemia) 3 10 8 3 24 4.3 Lung Disease (non-tubercular) 5 11 5 4 25 4.5 Nervous System (including functional conditions) 5 1 6 2 14 2.5 Deformities—Rickets 3 5 5 1 14 2.5 Others 21 34 21 3 79 14.2 Other Defects 3 8 5 6 22 3.9 Ophthalmia Neonatorum.— The number of cases of this disease notified during the year was 19, this being the same number as last year, and giving a case rate of 6.7 per 1,000 registered live births. A private doctor attended at the confinement in 4 cases, a district midwife in 3 cases, 10 cases were born in hospital and 2 just before arrival at hospital. Treatment was obtained at a hospital in 8 cases, at the Municipal Centres in 6 cases, and by a private doctor at home in 5 cases. Complete recovery with unimpaired vision occurred in 16 cases. In 1 case there was corneal opacity of the left eye which was stated not to interfere with the vision, 1 case left the district and 1 case was still under treatment at the end of the year. Cases of inflammation of or discharge from the eyes of infants or of cases of ophthalmia neonatorum entering Willesden after notification elsewhere are also visited by the Health Nurses. 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 1936, 530 Mothercraft sessions were held, with 5,198 attendances of mothers, and 4,985 attendances at the nurseries. This gives an average of 9.8 attendances of Mothers per session. 362 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. 13 Medical Inspection.— During the year ending 31st March, 1936, the average number of scholars on the Public Elementary School Rolls, including the Special Schools, in Willesden was 20,129. 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 cf 12. The total number of children medically inspected at routine and special inspections during 1936 was 13,928. Findings of Medical Inspections.—(a) Uncleanliness.— Cleanliness inspections were carried out in the schools on 679 occasions during the year 1936, the average number of visits paid to each school by the Health Visitor being 20. The total number of examinations and re-examinations made during the year was 60,890. 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 1931, 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 1936, the percentage was 4.0. 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% 1921-25 7.9% 1926-30 4.6% 1931-35 3.8% 1936 4.0% (.b) Tonsils and Adenoids.— During 1936 at routine and special medical inspections, 1,165 cases of enlarged tonsils and adenoids were discovered, as compared with 1,114 found in 1935, 1,150 found in 1934, 1,361 in 1933, 1,394 in 1932, 1,668 in 1931, 2,021 in 1930. (c) Skin Disease.— During 1936, at routine and special medical inspections, 1,507 cases of skin disease were detected as compared with 1,580 in 1935, 1,503 in 1934, 1,727 in 1933, 1,607 in 1932, 1,807 in 1931* 1,888 in 1930. (d) Enlarged Cervical Glands (non-tuberculous).— During 1936, at routine and special medical inspections, 145 cases of this defect were noted, as compared with 107 in 1935,150 in 1934, 275 in 1933 285 in 1932, 302 in 1931, 505 in 1930. 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 1936, school children were followed up by the Health Department on account of 16,852 medical defects and 6,911 dental defects. Of those defects found to require treatment, medical or dental treatment was obtained for 14,607 and domestic treatment was obtained for 3,568. 88 per cent. of the medical defects were treated, 66 per cent. receiving medical treatment and 22 per cent. domestic treatment, 57 per cent. of the dental defects followed up were treated. No record is available of defects requiring treatment which were not followed up. 93 per cent. of the total medical defects treated and 98 per cent. of the total dental defects treated were dealt with by the Education Committee. The remainder, or 7 per cent. of the medical defects and 2 per cent. of the dental defects treated, were dealt with by private practitioners, voluntary hospitals or other charitable institutions, or Public Assistance. In connection with defects treated, the children concerned made 93,389 attendances at the Health Centres in 1936. 14 Crippling Defects and Orthopedics.— An Orthopaedic Clinic staffed by an Orthopaedic Surgeon and a specially qualified nurse is held at the Stonebridge Health Centre. The report of the Orthopaedic Surgeon appears as Appendix F. The Third Annual Report on the work in connection with Abnormal Children appears later in this report. Vocational Guidance.— In the year 1936, medical reports were made on 1,656 children who were shortly to leave school, indicating any type of occupation for which they were physically unsuited. The relevant information is collected when the child is examined at the age of 12 years, and shortly before school-leaving age this is reviewed, any additional information from the clinic record cards being added to the vocational guidance cards. 283 boys and 277 girls were advised to avoid the type of occupation contra-indicated by their condition. SECONDARY AND TECHNICAL SCHOOLS. The arrangement by which the Medical Staff of the Willesden Council carry out the inspection of pupils attending the Secondary and Technical Schools in Willesden, on behalf of the Middlesex County Council, has been continued, and during the year it was extended to one additional school, namely, the Kilburn Junior Commercial School. The total number of pupils on the rolls of the Secondary and Technical Schools in Willesden now included in this arrangement is 2,600. 1,394 medical examinations and 304 re-examinations of Secondary and Trade School pupils have been carried out during the year 1936. 394 medical 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's scheme of treatment of scholars suffering from defective vision at the Willesden Council's Health Centres, and also that of dental inspection and treatment by the Council's dental staff, has been continued. 2,323 pupils were dentally inspected during the year, 1,574 were found to require treatment and 561 were treated at the Willesden Council's Dental Clinics. 2,244 attendances were made at the Clinics during the year for Medical and Dental Treatment. PARENTS' PAYMENTS. (a) Public Elementary Schools. The recovery of the cost of certain forms of treatment from parents of children attending Public Elementary Schools is undertaken 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 three days in hospital is either the full cost of 24s. or part cost, or nil. The charge per day after the first three days is 4s. 6d. full cost, or part cost. Spectacles are provided either at the full cost of 4s., at half-price, or free if below the Economic Scale. Certain nutrient drugs prescribed by the Health Centre Medical Officers are supplied free, if the economic circumstances of the family are below the Council's 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. The arrangements for recovering the cost of treatment for dental work are dealt with in the Reports of the Dental Surgeon, Annual Report, 1934, page 55, and Annual Report, 1935, page 57. (b) Secondary and Technical Schools. Pupils attending these schools who are suffering from defective vision, may, by an arrangement of the Middlesex County Council, be examined and treated by the Willesden Council's Ophthalmic Surgeon at one of the Health Centres. No charge is made to the parent for inspection or refraction by the Ophthalmic Surgeon, but if spectacles are ordered a fee of 5s. is payable by the parent to the Head Teacher of the School. The arrangements for recovering the cost of treatment for dental work are dealt with in the Report of the Dental Surgeon for 1935, page 57. HEALTH EDUCATION. The work has proceeded on the same lines as outlined on page 12 of the Annual Report for 1934. 15 PROVISION OF MEALS. 260,822 meals were supplied in 1936 as compared with 249,509 in 1935, 241,905 in 1934, 197,338 in 1933, 197,821 in 1932 and 138,361 in 1931. 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 430 cases during the year, and in connection with such cases paid 4,543 visits. 1,958 of these visits were paid in the Carlton Ward, 1,020 in the Kilburn Ward, 451 in the Mapesbury Ward, 182 in the Harlesden Ward, 160 in the Neasden Ward, 153 in the Willesden Green Ward, 144 in the Cricklewood Ward, 137 in the Kensal Rise Ward, and smaller numbers in the other wards of Willesden. Of the 430 cases nursed during the year, 424 were new cases. 382 of these 424 new cases were referred by the Health Department for nursing, 24 by private doctors and 18 by Hospitals, Associations and private persons. Ophthalmia neonatorum received 88 visits and other ophthalmia cases 704 visits. SANITARY WORK. The approximate number of houses in Willesden at the end of 1936 was 33,034, smaller flat contained under one roof being counted as one house, larger flats in blocks being counted separately. During the year the total number of inspections and re-inspections made by the Sanitary Staff was 27,984 as compared with 27,449 in 1935. The houses inspected under the Housing Acts numbered 1,237 as compared with 1,249 in 1935. The number of complaints received 3,265 as compared with 1,168 in 1935, shows an increase 50 per cent. The total number of Notices issued and nuisances abated were 4,874, and 25,206 respectively. Work done under the Housing Acts is shown in the tabular statement in the body of the Report. The above is exclusive of work carried out in connection with Clearance Areas. Housing.— The Health Department ever since the passing of the Public Health Act, 1875, has been concerned with the housing conditions of the people. The work of the Department has from time to time been extended by the various Housing Acts which have been passed, beginning with the Housing of the Working Classes Act, 1885, andendingat present with the Housing Act of 1936. Many complaints reach the Department as to nuisances in connection with dwelling houses and these complaints generally are dealt with under the nuisance sections of the Public Health Act, 1875. The work is carried out in the vast majority of cases by an intimation notice served by the sanitary inspector and recourse to legal proceedings is only required in relatively few instances. The main work, however, of the Department relative to housing, comes under the Housing Acts. Under the Housing Consolidated Regulations, 1925 and 1932, the Department is enjoined to make regular routine inspections of the houses in the Borough. This has been carried on now for a number of years and the average number of houses which have been inspected per annum during the past ten years is approximately 1,200. As a result of these inspections the necessary work to make the houses fit for human habitation is carried out by notice served by the Department. Again the great majority of such notices are complied with, legal proceedings as a rule being unnecessary. Clearance.— As a result of the operation of the various Clearance and Compulsory Purchase Orders 241 families will be displaced. The re-housing of these families has proceeded as the new flats and houses became ready for occupation and by the end of May, 1937, practically all the houses in the areas concerned will have been vacated. For various reasons many of the families have not accepted the accommodation offered and the surplus houses built in connection with the slum clearance scheme are being allotted to families outside clearance areas who are overcrowded. It is the adopted practice of the Council to disinfest the furniture and bedding of all families leaving privately-owned dwellings for Council houses. The furniture is treated with hydro-cyanide and the bedding steam disinfected. 16 Overcrowding.— The first steps for dealing with overcrowding are approaching completion. The Minister of Health has fixed 1st July, 1937, as the appointed day after which overcrowding becomes an offence, and the same day is fixed as the terminal date by which a statement showing the permitted number of persons suitable to each house is to be inserted by the landlord in the rent book. In order that information as to the permitted number for every house should be available to the landlord before the appointed day an additional 27 officials have been temporarily employed. By the 31st May, 1937, some 42,000 houses will have been measured and by the appointed day a record of the accommodation available in some 47,000 houses will have been obtained. The information thus obtained will form the basis of a valuable record of the amount of housing accommodation existing in the Borough. Owing to the frequent changes in the manner in which many working-class houses are let out to families, the permitted number in relation to these dwelling houses will need to be revised from time to time, and constant inspection will be required to enforce the Overcrowding Standard. Social Conditions.— The District is largely 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 1936 4,026 805 4,831 January, 1937 3,317 496 3,813 PUBLIC MORTUARY. 97 bodies were deposited at the Mortuary during the year ending 31st December, 1936, as follows :—4 Accommodations, 53 Post-Mortems, 5 Post-Mortems and Inquests, and 35 Inquests only. During the year a six-compartment refrigerator was installed. AMBULANCE SERVICE. The demands on the Ambulance Service continue. During the year 7,685 calls were made for the Council's ambulances as compared with 6,856 in 1935, 5,617 in 1934, 5,633 in 1933, 5,497 in 1932 and 5,171 in 1931. Altogether, 153,459 miles were run in 1936 as compared with 143,557 in 1935, 132,548 in 1934, 132,168 in 1933, 132,208 in 1932 and 131,564 in 1931. 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 22nd year of working of the Ambulance Service appears as Appendix C. MUNICIPAL HOSPITAL. The 45th Annual Report on the Municipal Hospital, written by Dr. Troup, appears later in this Report. Your obedient Servant, GEORGE F. BUCHAN, Medical Officer of Health. 17 THE SIXTY-FIRST ANNUAL REPORT for the Year ending 31st December, 1936, on the HEALTH AND SANITARY CONDITION OF THE BOROUGH OF WILLESDEN. GENERAL STATISTICS. Area (acres) 4,703 Population (estimated Midsummer, 1936) 202,505* Population Census (1931) (not including areas taken over on 1st April, 1934) 185,300 Number of inhabited houses (end of 1936) according to Rate books 41,382 (Flats separately assessed counted as one house.) Rateable value at 31st March, 1936 £1,562,522 Sum represented by a penny rate £6,253 * Registrar General's estimate Midsummer, 1936 190,000 EXTRACTS FROM VITAL STATISTICS OF THE YEAR. Live Births— Total. M. F. Total. Legitimate 2,739 1,424 1,331 2,755 Birth Rate per 1,000 of the estimated resident population 14.00 15.36 Illegitimate 96 84 79 163 Stillbirths 86 51 38 89 Rate per 1,000 total (live and still) births 29.44 29.59 Deaths 2,113 2,072 Death Rate per 1,000 of the estimated resident population 10.43 10.90 Deaths from puerperal causes (Headings 29 and 30 of the Registrar-General's Short List) :— ] Deaths. Rates per 1,000 total (Live and Still) Births. No. 29—Puerperal sepsis 2 2 0.68 0.67 No. 30—Other puerperal causes 3 2 1.03 0.67 Total 5 4 1.71 1.33 Death Rate of Infants under one year of age :— All infants per 1,000 live births 59.96 58.26 Legitimate infants per 1,000 legitimate live births 54.76 55.53 Illegitimate infants per 1,000 illegitimate live births 208.33 104.29 Deaths from Cancer (all ages) 302 302 ,, ,, Measles (all ages) 22 22 ,, ,, Whooping Cough (all ages) 12 12 ,, ,, Diarrhoea (under 2 years of age) 25 25 Figures in italics (other than rates) supplied by Registrar-General. 18 Table No. 9. NOTIFIABLE DISEASES DURING THE YEAR. Disease. Total Cases Notified. Cases admitted to Total Deaths. (4) Willesden Municipal Hospital. Other Hospitals. (1) (2) (3) Diphtheria 382 370 6 21 Scarlet Fever 556 484 8 2 Enteric Fever (including Paratyphoid) 10 7 2 — Puerperal Fever 6 1 4 2 Puerperal Pyrexia 33 3 28 — Pneumonia 352 8 * 168 Small Pox — — — — Cholera — — — — Plague — — — — Erysipelas 88 41 25 3 Typhus Fever — — — — Relapsing Fever — — — — Continued Fever — — — — Cerebro-spinal Meningitis 9 3 6 2 Poliomyelitis 5 1 3 — Ophthalmia Neonatorum 19 3 5 — Malaria 1 — 1 — Dysentery 20 2 18 — Encephalitis Lethargica — — — — Acute Polio-Encephalitis — — — — Anthrax — — — — Tuberculosis:— (a) Pulmonary 240 * 118 (b) Non-Pulmonary 53 — * 15 Whooping Cough 743 91 * 12 For analysis of the age groups see Appendix " A " Table IV. * No complete record. Table No. 10. TUBERCULOSIS. New Cases and Mortality during 1936. 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 1 0 0 0 0 0 1 0 1 0 0 5 3 1 0 1 3 5 1 4 6 3 0 0 2 1 10 3 1 3 3 1 0 1 0 15 7 15 3 2 2 8 0 0 20 16 29 5 2 5 12 2 0 25 34 39 8 4 17 12 1 1 35 20 10 1 1 12 7 0 0 45 19 10 1 1 14 4 0 0 55 18 2 0 2 14 2 0 2 65 and upwards 8 3 0 0 5 2 0 0 Totals 127 113 32 21 71 47 8 7 The ratio of non-notified tuberculosis deaths to total tuberculosis deaths was 1:8. 19 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 1st January, 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 cannot avail themselves of the offer because there is no space in the home in which to fit in an extra bed. Ring pillows have been provided in emaciated cases with a view to the prevention of bed sores. Contacts are advised to attend at the Tuberculosis Dispensary of the Middlesex County Council for examination. The housing conditions of the majority of tuberculosis families are unsuitable, and make measures for the care of the patient and the prevention of spread of the disease difficult, if not indeed, impossible. PUBLIC HEALTH (PREVENTION OF TUBERCULOSIS) REGULATIONS, 1925. No new case was dealt with under the above regulations during 1936. In 1934 the Council ascertained that a resident in the Borough notified as suffering from pulmonary tuberculosis was employed as a milk roundsman. They put into force their powers under Article 5 of the above regulations and required the resident to discontinue his occupation. The resident thereupon made a claim for compensation under these regulations and Section 308 of the Public Health Act, 1875, as applied to these regulations and the Council paid him for a period the sum of £3 per week. Eventually negotiations were opened with the resident's solicitors as to the payment of a lump sum as full compensation and a sum of £400 in full settlement was agreed between the parties and paid by the Council in 1936. A sum of ten guineas was also paid by the Council to the claimant's solicitors towards the costs. At the close of this case the Council addressed a letter to the Minister of Health drawing his attention to the case and submitting suggestions for the amendment of the Public Health (Prevention of Tuberculosis) Regulations, 1925, so as to provide that any person so compensated may be required, at the discretion of the local authority, not to be employed in any occupation connected with the preparation or handling of food and to submit to such medical treatment as the local authority may consider necessary or desirable. The Minister replied that the points raised by the Council would receive careful consideration whenever general revision of the regulations is being undertaken. PUBLIC HEALTH ACT, 1925. SECTION 62. Removal to hospital of infectious persons suffering from pulmonary tuberculosis. No action was taken under this section during 1936. GENERAL PROVISION OF HEALTH SERVICES FOR THE AREA. LABORATORY FACILITIES. Laboratory facilities are dealt with in the Annual Report on the Municipal Hospital, page 77. AMBULANCE FACILITIES. Ambulances are available as follows:— (a) For infectious cases— 1 ambulance. (b) For non-infectious cases, accident cases and maternity cases— 4 ambulances. These 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 are only two drivers on duty and any call received when they are both out cannot be dealt with. A detailed report on the service for the financial year 1935-36 will be found in Appendix C. 20 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. TREATMENT CENTRES AND CLINICS. During the year, in connection with the Council's throat, nose and ear work, breathing exercise clinics were established at two of the Health Centres. In connection with skin work, arrangements were made for carrying out minor surgical operations at one of the Health Centres. The work of the Clinics appears in other parts of the Report. The capacity of the Clinic premises and the number of staff employed are inadequate for dealing with the patients who attend these Clinics. The question of Health Centre accommodation has been under consideration by the Council throughout the year. HOSPITALS. Since the 1st April, 1936, the operative treatment of enlarged tonsils and adenoids and the treatment of children suffering from marasmus has been carried out at the Willesden Municipal Hospital instead of at the Willesden General and St. Monica's Home Hospitals. A fourth cubicle block for 10 beds was completed during the year and opened on 4th October, 1936. MIDWIFERY AND MATERNITY SERVICES. Midwifery. In accordance with Section 10 of the Midwives Act, 1902, 61 Midwives gave notice in 1936 of their intention to practice in Willesden. Maternity Service. The Service is dealt with in other parts of the Report and attention is particularly directed to the Clinical Report of the Willesden Maternity Hospital, First Three Thousand Cases by the Council's Consultant Obstetrician, printed and circulated on 17th November, 1936, and to the Memorandum by the Medical Officer of Health, Motherhood in Willesden, Appendix Q. The year was marked by the passing of the Midwives Act, 1936, the object of which is to secure the organisation throughout the country of a domiciliary service of salaried midwives under the control of local supervising authorities as an important step in the improvement of the maternity services and in the campaign for reducing maternal mortality. The Act received the Royal Assent on 31st July, 1936, and much of the remainder of the year has been spent in drawing up a Scheme for submission to the Minister of Health as required by 30th January, 1937, which should secure for the mothers of Willesden the best possible midwifery in their homes, linked up with complete arrangements for dealing with any emergency that may arise. INSTITUTIONAL PROVISION FOR MOTHERS OR CHILDREN. There are no developments or changes to record except as under Hospitals above. HEALTH VISITORS—INFANT LIFE PROTECTION—ORTHOPAEDIC 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. 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. 21 Bye-laws:— *Common Lodging Houses (Public Health Act, 1875, s. 80). Revised and adopted 10.1.35. *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 10.1.35. *Prevention of Nuisances (Public Health Act, 1875, s. 44). Revised and adopted 10.1.35. 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). Revised and adopted 10.1.35. *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 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. Public Cleansing.— 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 Engineer's Department. 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 Borough Engineer's Department collect refuse from all premises at least once weekly. Public Cleansing, etc.— On the 31st July, 1936, the barging of refuse to tips outside the district ceased and all house refuse is now tipped at Twyford, Willesden. The Council are now considering the erection of a suitable disposal plant or the provision of some other efficient method of treatment to be available as soon as this tip is exhausted, viz., in some two to three years time. Drainage and Sewerage.— During the last twelve months the culverting of the Mitchell Brook between Bridge Road and the Municipal Hospital and under Brentfield Road has been completed and the sections through the Hospital Grounds and between Brentfield Road and the North Circular Road are now in hand. The last section of the Storm Relief Sewer in Brook Road and a length in Crest Road have also been constructed. Work on the extension of the sewers and surface water drains on section 2 of the Church End Housing Scheme has now commenced and should be completed during 1937. In connection with the drainage of the Twyford Area, the West Middlesex Main Sewer was made available for use from the 1st April of this year and now takes a large trade effluent. The bulk of the domestic soil sewage, however, discharges to the Wembley System prior to emptying into the West Middlesex. A large portion of this area is to be retransferred to Ealing in April, 1937. 22 Swimming Baths and Pools.— When the new Granville Road Baths are brought into use in the Spring of 1937 the Council will have available three open-air swimming pools and one covered bath, viz.:— Gladstone Park Bath.—Constructed 1903. Open Air. King Edward VII Bath.—Constructed 1911. Open Air. Craven Park Bath.—Constructed 1935. Open Air. Granville Road Bath.—Constructed 1936-37. Covered Bath. In all cases filtration is by pressure and sterilisation by chlorination. Bacteriological tests of water from each bath are taken weekly during the season. Eradication of Bed Bugs.— Dwellers in Clearance Areas and in overcrowded houses to be removed to Council houses or flats and the Disinfestation of privately-owned houses. The schemes for dealing with these cases were set out in Appendices M, N and Q, in the Annual Report for 1935, and have been in operation during the year. Particulars of the action taken for the eradication of bed bugs, including information as to:— 1. Number of Council houses found to be infested 86 Number of Council houses disinfested 86 Number of other houses found to be infested 215 Number of other houses disinfested 215 2. The methods employed for freeing infested houses from bed bugs. Council houses.— A workman is employed on the Maintenance Staff of the Borough Engineer's Department specially for the purpose of disinfestation. All woodwork is loosened and walls are stripped of paper, the rooms being first sprayed with a strong insecticide. The premises are then re-sprayed, and further spraying is done at intervals until a negative result is obtained on several visits. The co-operation of the tenant is sought in effecting a thorough cleaning of the premises and frequent visits are made after disinfestation to ensure that cleanliness is being maintained. When disinfestation is complete the walls and ceilings are distempered. Privately-owned houses.— Houses found to be infested on house-to-house inspection or investigation on complaint numbered 215. Of this number 72 were disinfested by the owners and 143 by the Council at the owners' request. 900 reinspections were made by the Disinfector and 499 by the Sanitary Inspectors to ascertain if the measures taken had been successful. Methods employed for freeing infested houses from bed bugs.— The methods used by the Department were:— (a) Orthodichlorbenzine was used with successful results in 13 rooms and was continued prior to the Ministry's Circular dated 22nd May deprecating the use of this material in occupied houses. (b)Sulphur was used in 204 rooms, a second application being necessary in 17 rooms. (c) Other insecticides were used in 34 rooms, a second application being necessary in 3 cases. Prior to the disinfestation of the house either by the Council or the owner the bedding is removed for steam disinfection by the Council (excepting in a few cases where infestation is slight and there is no evidence of vermin in the bedding), the wall papers stripped, mouldings and architraves removed and any defective plastering made good, the flame of a plumber's blow lamp is applied to all cracks and crevices. Methods employed for ensuring that the belongings of the tenants are free from vermin before removal to Council houses— The belongings of tenants from Slum Clearance Areas and from overcrowded premises are removed in special vans under an agreement either by the Borough of Kensington or a Contractor. Furniture and bedding is removed to the Depot where the bedding is steam disinfected and the contents of the van treated with hydro-cyanic acid gas and later in the day the whole is taken to the new premises allocated to the tenant, 61 families from the Slum Clearance and 10 families from overcrowded premises being so removed during the year. Disinfestation with hydrogen cyanide is not carried out directly by this Council. After disinfestation all privately-owned houses are revisited by the Disinfector or Sanitary Inspector twice at intervals of ten days, twice at intervals of three weeks and twice at intervals of three months. At these visits the furniture and bedding are examined and the occupiers are instructed where to search for vermin and how to keep their belongings clean. 23 Sanitary Inspection of the Area. Tabular summary of the work of the Sanitary Department during the year and action taken under the Public Health Acts, Housing Acts, etc. Inspections : Number of premises inspected on complaint 3,265 Number of premises inspected in connection with infectious diseases 53 Number of periodical inspections of premises 4,031 Houses inspected from House to House (Housing Acts) 1,237 For Certificates or Reports under the Rent Acts — Public House Urinals 224 Mews and Stables 426 Miscellaneous 240 Total number of inspections and re-inspections made 27,984 Smoke Observations 105 Action under Rent and Mortgage Interest (Restriction) Acts, 1920-1933: Number of applications received for Certificates Number of Certificates granted. — Number of Certificates refused — Number of applications withdrawn — Number of applications for Reports — Number of Reports granted - Action taken (under Housing Acts and Health Acts): Notice to Inspect (Section 127, Housing Act, 1925) 2,315 Cautionary or Intimation Notices issued 2,489 Number complied with 2,324 Statutory Orders issued 104 Number complied with 72* Summonses served 0 Number of convictions obtained 0 Summonses withdrawn 0 dismissed 0 * Includes a certain number issued in 1935. Houses Let in Lodgings (Tenement Houses): Number registered under Bye-laws 0 Number of contraventions 0 Common Lodging Houses: Number registered under Bye-laws 1 Number of Inspections made 17 Number of contraventions 0 Number remedied 0 Canal Boats used as Dwellings: Number of contraventions of Regulations 0 Number remedied 0 Movable Dwellings, Caravans, Tents, etc.: Number observed during the year 1 Number of nuisances therefrom abated 0 Number removed from district 0 Bakehouses: Number in district 60 Number of Inspections 153 Contraventions of Factory Acts 17 Contraventions remedied 17 Slaughter-houses: Number on register 5 Inspections of carcases, etc 216 Contraventions of Bye-laws 0 Contraventions remedied 0 Cowsheds: Number on register 0 Number of milch cows in district 0 24 Dairies and Milkshops: Number of dairymen on register 256 Number of itinerant milk sellers registered 45 Number of inspections made 283 Contraventions of Milk and Dairies Order, 1926 5 Contraventions remedied 3 Unsound Food: Meat (including organs) seized and surrendered 372 lbs. Fish (wet and dried) surrendered 260 lbs. Poultry surrendered 20 lbs. Bacon turrendered 1,304¼ lbs. Tinned and Cooked Meat surrendered 573 lbs. Fruit surrendered 264 lbs. Crystallized Fruit 4,256 lbs. Peeled Tomatoes 50 tins Condensed Milk 250 tins Method of disposal Destroyed Offensive Trades: Number of premises in district (Rag and Bone Dealers) 6 Number of inspections made 6 Contravention of Bye-laws 0 Contravention remedied 0 Water Supply and Water Service: Percentage of houses supplied on constant system 100 Cisterns :— New provided 15 Cleansed, repaired, covered, etc. 164 Draw-taps placed on mains 61 Drainage and Sewerage of existing Buildings : Water Closets:— Number of water closets substituted for dry receptacles 0 Repaired, supplied with water or otherwise improved 896 Additional Closets constructed 29 Percentage of houses provided with water closets 100 Drains :— Examined, tested, exposed, etc 220 Unstopped, repaired, trapped, etc. 362 Waste pipes, rain-water pipes, disconnected, repaired, etc. 700 New soil pipes or ventilating shafts fixed 127 Existing soil pipes or ventilating shafts repaired 259 Disconnecting traps or chambers inserted 131 Reconstructed 62 Cesspools:— Rendered impervious, emptied, cleansed, etc 0 Abolished and drain connected to sewer 0 Percentage of houses draining into sewers 100 Disinfection and Disinfestation: Rooms disinfected:— (a) Phthisis 59 (b) Other diseases and conditions 786 Articles disinfected or destroyed :— (a) Phthisis 338 (b) Other diseases and conditions 744 Dust (House Refuse): New bins provided 402 Periodical frequency of dust removal weekly Method of disposal by tipping 25 Sundry Nuisances abated: Overcrowding (under Public Health Acts) 4 Smoke 15 Accumulations of refuse 83 Foul ditches, ponds, etc., and stagnant water 7 Fowls, pigs, and other animals 4 Dampness 1,055 Yards and forecourts paved, repaved or repaired 761 Walls and ceilings cleansed 6,106 Verminous rooms purified 395 Leaky roofs made watertight 980 Additional ventilation provided under floors 244 Dilapidated plaster repaired 2,219 Flooring and other woodwork repaired 2,140 Damp-proof courses inserted 184 Water supply reinstated... 60 Washhouse floors repaired or repaved 235 Fireplaces and stoves repaired 961 Decayed brickwork repaired and repointed 583 Sinks provided or replaced 269 Additional light and ventilation provided to staircases 69 Larders or food cupboards provided or ventilated 249 Gutters and rainwater pipes repaired or renewed 787 New sash cords and glass provided to windows 2,824 Miscellaneous 1,538 Total number of Nuisances abated 25,206 Inspection of Premises where Food is prepared: Butchers', Provision, and General shops 670 Fish shops (wet, dried and fried) 281 Eating houses 66 Greengrocers' shop 252 Ice-cream premises 50 Stalls 325 Canal Boats Acts, 1877-1884.— The number of boats inspected during the year 1936 was 12 (15 inspections). No contraventions of the Regulations were found. No legal proceedings were taken during the year. 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.— Bye-laws were made by the Urban District Council of Willesden with respect to houses intended or used for occupation by the working classes and let in lodgings or occupied by members of more than one family, on the 26th July, 1927. These were allowed by the Minister of Health on 18th April, 1928. Underground Rooms.— There are approximaTely 1,228 houses in Willesden with basement rooms coming under the amended definition of "underground rooms." These 1,228 houses contain 2,016 basement rooms. Of these 2,016 rooms, 125 rooms have been made to comply with the basement regulations, 1,270 can be made to comply with the basement regulations, 348 rooms cannot be made to comply and 273 rooms are being used as stores. Disposal of the Dead.— The Council at present own a cemetery within the district and it is estimated that a further 6,463 grave spaces could be laid out before that cemetery is full; the average number of burials therein annually for the past ten years has been approximately 1,464. 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 supply and sanitary accommodation. Rag Flock Acts, 1911-28.— There are no premises in the district on which rag flock is manufactured, and no sampling under these Acts has been carried out during the year. 26 HOUSING. Number of inhabited houses* in Willesden (end of 1936) according to the Rate Books, 41,382. * Flat separately assessed counted as one house. Number of houses† in Willesden (end of 1936), 33,034 (approx.). † Smaller flats contained under one roof are counted as one house, larger flats in blocks being counted separately. The following table shows building activities during the periods stated Table No. 11. Year. For working classes. Not for working classes. Total. Houses and flats erected by the Council. Houses and flats erected by private enterprise. Houses and flats erected by private enterprise. 1921-30 998 1,687 3,643 6,328 1931-35 153 1,650 791 2,594 1936 151 223 129 503 Total for 16 years 1,302 3,560 4,563 9,425 HOUSING STATISTICS FOR THE YEAR 1936. Number of New Houses erected during the Year :— (a) Total (including numbers given separately under (b)):— (i.) By the Local Authority Houses 60 Flats 91 (ii.) By other Local Authorities Nil (iii.) By other bodies and persons 352 (b) With State assistance under the Housing Acts:— (i.) By the Local Authority. (a) For the purpose of the Housing Act of 1930 Houses 60 Flats 91 (ii.) By other bodies or persons Nil 1.—Inspection of Dwelling-houses during the Year:— (1) (a) Total number of dwelling-houses inspected for housing defects (under Public Health or Housing Acts) 4,439 (b) Number of inspections made for the purpose 20,178 (2) (a) Number of dwelling-houses (included under sub-head (1) above) which were inspected and recorded under the Housing Consolidated Regulations, 1925 1,237 (b) Number of inspections made for the purpose 8,334 (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 54 2.— Remedy of Defects during the Year without Service of formal Notices:— Number of defective dwelling-houses rendered fit in consequence of informal action by the Local Authority or their officers 2,227 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 54 (2) Number of dwelling-houses which were rendered fit after service of formal notices:— (a) By owners 36 (b) By local authority in default of owners 10 27 (b).—Proceedings under Public Health Acts : (1) Number of dwelling-houses in respect of which notices were served requiring defects to be remedied 30 (2) Number of dwelling-houses in which defects were remedied after service of formal notices:— (a) By owners *24 (b) By local authority in default of owners 2 * Includes a certain number outstanding in 1935. (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 4.—Housing Act, 1935.—Overcrowding :— (a) (i) Number of dwellings overcrowded at the end of the year 1,478 (ii) Number of families dwelling therein 1,478 (iii) Number of persons dwelling therein 8,051 (b) Number of new cases of overcrowding reported during the year 1,941 (c) (i) Number of cases of overcrowding relieved during the year 463 (ii) Number of persons concerned in such cases 2.236½ (d) Particulars of any cases in which dwelling-houses have again become overcrowded after the Council have taken steps for the abatement of overcrowding—No cases reported. 5.—(a) Number of cases of overcrowding in houses owned by the Council which have been relieved during the year 2 (b) Number of cases of overcrowding which have been relieved in the course of slum clearance operations 26 INSPECTION AND SUPERVISION OF FOOD. Milk Supply.—There are 2 wholesale dealers and 256 retail milk purveyors in this district. Their premises and utensils are frequently inspected. In addition there are 45 milk sellers whose premises are situate outside Willesden. The following table shows the number of licences granted for the sale of graded milk under the Milk (Special Designations) Order, 1936, during the year 1936 Table No. 12. (a) "Certified" milk 10 (b) "Certified" milk (supplementary) 1 (c) "Grade A (Tuberculin Tested)" milk 11 (d) "Grade A (Tuberculin Tested)" Bottling Establishment 1 (e) "Grade A" milk 7 (/) "Pasteurised" milk 39 (g) "Pasteurised" milk (supplementary) 1 (h) "Pasteurisers" 3 (i) "Grade A Pasteurised" 2 There were no refusals or revocations of licences under the Milk (Special Designations) Order, 1936, during the year. Seventeen samples of designated milks were examined during the year. Sixteen of these were satisfactory, and one sample failed to comply with the bacterial standard. 28 The unsatisfactory sample was reported to the Health Committee and in consequence a warning letter was sent to the firm from whom the sample was taken. Subsequent samples taken from the same firm proved satisfactory. Forty-eight samples of milk were taken during the year for examination for the presence of tubercle bacilli under the Milk and Dairies (Consolidation) Act, 1915. Four samples (Nos. 0/459, 0/473, 0/476 and 0/482, representing 8.3 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 Buckingham (2), Derby and Hertford. The other 44 samples showed no evidence of tuberculosis. The following are particulars of the positive samples:— 0/459.—Two samples from individual cows taken were found to be tuberculous and the cows were slaughtered. 0/473.—A sample from an individual cow proved positive and the animal was slaughtered. 0/476.—One cow found affected with tuberculosis of the udder was slaughtered under the Tuberculosis Order. 0/482.—One cow was slaughtered; post-mortem examination showed advanced tuberculosis of the udder. Meat Inspection.—The Inspectors visit the slaughter-houses at the times set apart for slaughtering and examine the carcases and organs for evidence of disease. Shops and stalls are also kept under close observation. The number of private slaughter-houses in use in the area at the dates mentioned was Table No. 13. In 1920. 1925. 1936. Registered 4 4 2 Licensed 5 4 3 Total 9 8 5 Table No. 14. The following Table shows the number of carcases inspected and the number of condemnations:— No. of animals killed. No. of carcases inspected. Condemnations. Tuberculosis. Other than Tuberculosis. Whole Carcase. Parts of Carcases. Whole Carcase. Parts of Carcases. Bovines 107 107 - 11 — 4 Cows — — - — — — Calves 50 50 - — — — Sheep 672 612 - — - 4 livers 3 lungs Lambs 408 373 - — - — Pigs 297 297 - 5 heads - — 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 153 occasions, Notices being served in 17 instances for minor contraventions of the Factory and Workshop Act. 29 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, showing the number of samples taken in Willesden and the result of prosecutions instituted under the Acts during the year 1936:— Table No. 15. List of Samples taken during the Year ended 31st December, 1936. Article. Taken. Adulterated. Milk 552 7 Almond Essence 1 — Biscuits 1 — Butter 3 — Cordial 1 — Cream Cakes 1 — Dripping 1 — Gin 5 — Minced Beef 1 — Olive Oil 1 — Sardines 2 — Sausages 5 2 Sausages, cooked 1 — Whisky 4 — 579 9 Number of Prosecutions 2 Number of Convictions 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. 16. 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) 244 14 - Workshops (including Workshop laundries) 182 5 - Workshops (other than Outworkers' premises) 3 1 — Total 429 20 — 30 Table No. 17.—Defects Found. Particulars. (1) Number of Defects. Number of Prosecutions. (5) Found. (2) Remedied. (3) Referred to H.M. Inspector. (4) Nuisances under the Public Health Acts :— Want of Cleanliness 1 1 - - Want of Ventilation 2 2 - - Overcrowding — — - - Want of drainage of floors 2 2 - - Other Nuisances 8 8 - - Sanitary accommodation— Insufficient 4 4 - - Unsuitable or defective 8 8 - - 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 (secs. 97 to 100) 17 17 - - Other offences (Excluding offences relating to outwork) - - - - Total 43 43 - — Table No. 18.—Registered Factories, Workshops and Outworkers. On the Register (s. 131) at the end of the year. Number. (1) (2) Factories 320 Factories, Laundries 38 Workshops, Laundries 22 Domestic Laundries 6 Bakehouses 60 Dressmakers 34 Outworkers 458 Blouse Makers 2 Tailors 40 Bootmakers 46 Metal Workers 23 Wood Workers 19 Seamstresses 1 Motor and Cycle Makers 23 Upholsterers 9 Milliners 17 Miscellaneous 133 Total number on Register 1,251 Table No. 19.—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 10 Reports (of action taken) sent to H.M. Inspector 10 Other — Underground Bakehouse (s. 101):— Certificates granted during the year — In use at the end of the year 17 31 THE TWENTY-NINTH ANNUAL REPORT FOR THE Year ending 31st December, 1936, ON THE HEALTH OF CHILDREN ATTENDING THE PUBLIC ELEMENTARY SCHOOLS IN WILLESDEN. Giving the Tables required by the Board of Education. Table No. 20.—Corresponding to Table 1 of the Board of Education's Medical Statistical Tables. Return of Medical Inspections for the year ended 31st December, 1936:— A.— Routine Medical Inspections. Number of Inspections in the prescribed Groups:— Entrants 2,374 Second Age Group 2,395 Third Age Group 2,003 Total 6,772 Number of other Routine Inspections 0 Grand Total 6,772 B.— Other Inspections. Number of Special Inspections 7,156 Number of Re-inspections 16,141 Total 23,297 C.— Children Found to Require Treatment. Number of individual children Found at Routine Medical Inspection to Require Treatment (excluding Defects of Nutrition, Uncleanliness and Dental Diseases). Prescribed Groups:— Entrants 503 Second Age Group 420 Third Age Group 350 Total (Prescribed Groups) 1,273 Other Routine Inspections 0 Grand Total 1,273 32 Table No. 21.—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, 1936. Defect or Disease. Routine Inspections. Special Inspections. No. of Defects. No. of Defects. Requiring treatment. Requiring to be kept under observation but not requiring treatment. Requiring treatment. Requiring to be kept under observation but not requiring treatment. (1) (2) (3) (4) (5) Skin (1) Ringworm— Scalp 2 — 3 - (2) ,, Body — — 10 - (3) Scabies 1 — 106 - (4) Impetigo 1 — 159 — (5) Other Diseases (non-tuberculous) 44 3 1,178 - Total (Heads 1 to 5) 48 3 1,456 - Eye (6) Blepharitis 17 - 79 - (7) Conjunctivitis 6 — 150 - (8) Keratitis — — 1 - (9) Corneal Opacities — — — - (10) Other Conditions (excluding Defective Vision and Squint) 9 1 109 - Total (Heads 6 to 10) 32 1 339 - (11) Defective Vision (excluding Squint) 353 54 211 - (12) Squint 33 6 82 - Spectacles broken — —. 271 - Spectacles lost — — 24 - Ear (13) Defective Hearing 2 3 17 - (14) Otitis Media — — 161 - (15) Other Ear Diseases 31 - 139 - Nose and Throat (16) Chronic Tonsillitis only 369 255 127 - (17) Adenoids only 39 11 27 - (18) Chronic Tonsillitis and Adenoids 40 17 280 - (19) Other Conditions 51 20 295 - (20) Enlarged Cervical Glands (non-tuberculous) 6 9 130 - (21) Defective Speech — 2 3 - Heart Disease:— Heart and Circulation (22) Organic — 2 2 - (23) Functional 2 338 11 - (24) Anæmia 8 2 14 - Lungs (25) Bronchitis 15 — 36 - (26) Other Non-Tuberculous Diseases 3 9 6 - Tubercul'sis Pulmonary:— (27) Definite - — — - (28) Suspected — — 4 — Non-Pulmonary:— (29) Glands — — 1 - (30) Bones and Joints — — — - (31) Skin — — — - (32) Other Forms - — 1 - Suspected—Glands — — — - „ Bones and Joints — — — - „ Other Forms — — — - Total (Heads 29 to 32) — — 2 - Nervous System (33) Epilepsy — 1 1 - (34) Chorea — — 7 - (35) Other Conditions 1 4 8 - Deformities (36) Rickets — — — - (37) Spinal Curvature 40 6 34 - (38) Other Forms 176 43 102 - (39) Other Defects and Diseases (excluding Defects of Nutrition, Uncleanliness and Dental Diseases) 201 75 2,438 - Total Number of Defects 1,450 861 6,227 - 33 B.— Classification of the Nutrition of Children Inspected during the Year in the Routine Age Groups. (See Administrative Memorandum No. 124, dated 31st December, 1934.) Age-groups. Number of Children Inspected. A (Excellent). B (Normal). C (Slightly subnormal). D (Bad). No. % No. % No. % No. % Entrants 2,374 151 6.36 2,105 88.67 117 4.93 1 0.04 Second Age-group 2,395 139 5.80 2,144 89.52 112 4.68 0 — Third Age-group 2,003 161 8.04 1,759 87.82 82 4.09 1 0.05 Other Routine Inspections 0 - - - - - - - - Total 6,772 451 6.66 6,008 88.72 311 4.59 2 0.03 Table corresponding to Table III of the Board of Education's Medical Statistical Tables.— Return of all Exceptional Children in the Area—vide the Third Annual Report on the Work in connection with abnormal children, page 38. Table No. 22.—Corresponding to Table IV. of the Board of Education's Medical Statistical Tables. Return of Defects Treated during the Year ended 31st December, 1936. Treatment Tables: Group I.— Minor Ailments (excluding Uncleanliness, for which see Table VI). Disease or Defect. Number of Defects Treated, or under Treatment during the Year. Under the Authority's Scheme. Otherwise. Total. (1) (2) (3) (4) Skin:— Ringworm—Scalp:— (i) X.ray Treatment. If none, indicate by dash 3 — 3 (ii) Other Treatment — — — Ringworm—Body 12 3 15 Scabies 121 10 131 Impetigo 300 19 319 Other Skin Diseases 2,670 49 2,719 Minor Eye Defects (external and other, but excluding cases falling in Group II) 415 10 425 Minor Ear Defects 385 23 408 Miscellaneous (e.g., Minor Injuries, Bruises, Sores, Chilblains, etc.) 3,783 358 4,141 Total 7,689 472 8,161 34 Group II.— Defective Vision and Squint (excluding Minor Eye Defects Treated as Minor Ailments—Group I). TABLE A. (1) Number of Defects Dealt with Under the Authority's Scheme. (2) Otherwise. (3) Total. (4) Errors of Refraction (including squint) (operations for squint should be recorded separately in the body of the School Medical Officer's Report). 679 18 697 Other defect or disease of the eyes (excluding those recorded in Group I) 2 1 3 Total 681 19 700 Under the Authority's Scheme. Otherwise. Total. No. of children for whom spectacles were— (a) Prescribed 528 18 546 (b) Obtained 331 131 462 In the above table the figures of 679 and 18 represent the cases submitted to refraction or in which spectacles were prescribed without refraction during the year, no matter whether they were 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) Otherwise. (3) Total. (4) Errors of Refraction (including squint) 2,309 123 2,432 Other Defect or Disease of the Eyes (excluding those recorded in Group I) 2 1 3 Total 2,311 124 2,435 Group III.— Treatment of Defects of Nose and Throat. Number of Defects. Received Operative Treatment. Received other forms of Treatment. Total number treated. Under the Authority's Scheme in Clinic or Hospital. By private practitioner or Hospital, apart from the Authority's Scheme. Total. (1) (2) (3) (4) (5) (i) (ii) (iii) (iv) (i) (ii) (iii) (iv) (i) (ii) (iii) (iv) 4 9 349 1 109 472 236 708 (i) Tonsils only, (ii) Adenoids only, (iii) Tonsils and adenoids, (iv) Other defects of the nose and throat. 35 Group IV.— Orthopædic and Postural Defects. Under the Authority's Scheme. Otherwise. Total* number treated. Residential treatment with education. (i) Residential treatment without education. (ii) Nonresidential treatment at an orthopædic clinic. (iii) Residential treatment with education. (i) Residential treatment without education. (ii) Nonresidential treatment at an orthopædic clinic. (iii) No. of children treated 20 ordinary elementary school children - 405 - 1 8 414 *A child may be recorded in more than one category and, therefore, the total number of children treated will not necessarily be the same as the sum of the figures in the separate categories. Group V.— Dental Inspection and Treatment. Vide 19th Annual Report on Dental Work in connection with school children, expectant and nursing mothers and children under 5 years, herewith, page 57. Group VI.— Uncleanliness and Verminous Conditions. (i.) Average number of visits per school made during the year by the School Nurses 20 (ii.) Total number of examinations of children in the schools by School Nurses 60,890 (iii.) Number of individual children found unclean at the School Cleanliness Inspections 2,007* (iv.) Number of individual children cleansed under Section 87 (2) and (3) of the Education Act, 1921 215 f (v.) Number of cases in which legal proceedings were taken :— (a) Under the Education Act, 1921 23 (b) Under the School Attendance Bye-laws — (vi.) Number of school sessions at which inspections were conducted 679 (vii.) (i.) Original Inspections :— Children examined (i.e., cases not individual children) 50,506 Found unclean 2,855 Percentage found unclean 5-7 Excluded on account of uncleanliness — (ii.) Re-inspections Children examined (i.e., cases not individual children) 10,384 Found unclean 7,522 Percentage found unclean 72-4 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. * The total number of individual children found unclean = 2,084. † The total number of individual children cleansed = 335. Record of cases in which legal proceedings were taken :— The following information has been supplied by the Director of Education to whom cases for prosecution are referred. Cases Under Section 87 of the Education Act, 1921. No. of Cases. Amount Standing Fined. of Fine. Bound over. Dismissed. adjourned at end of Year. 15 5/- 0 3 0 2 7/6 3 10/- 36 Certain Statistical Data. Public Elementary Schools—excluding Special Schools and Nursery Classes. Number of Public Elementary Schools, excluding two Special Schools, at December, 1936 34 Number of School Departments at December, 1936 68 Average Public Elementary School Roll, excluding two Special Schools, year ended 31st March, 1936 19,845 Total number of children medically inspected at Routine and Special Inspections 13,928 Total number of children dentally inspected 17,327 Total number of Defects of every description "followed up" during 1936 23,763 Total number of Defects of every description for which treatment was obtained during 1936 :— Medical or Dental Treatment 14,607 Domestic Treatment 3,568 Total 18,175 Total number of Attendances at the School Clinics during 1936 93,389 Table No. 23. Return showing No. of Cases referred for following-up in 1936 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. 1936 4,324 899 64 8,799 14,086 1935 4,609 1,129 50 8,918 14,706 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 37 Table No. 24.—In this Table is embodied the information required in Notes (c). 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 1936. 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 needing treatment 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, Hospital or other Institution under Council Scheme. Voluntary Hospital or other Charitable lnstitutions Hospital or 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 year. New. Total. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 Clothing- Unsatisfactory 6 3 9 - - - - - - - 6 6 4 2 — — — 67.0 2 1 3 1 Footgear— Unsatisfactory - - - - - - - - - - - - - - - - - - - - - - Cleanliness of Head— Nits 255 2,522 2,777 — — 84 — — 84 2,440 2,524 2,523 - - 1 3.0 91.0 19 234 253 235 Pediculi 11 255 266 — — 229 — — 229 34 263 263 - - - 86.0 99.0 1 2 3 2 Other dirty conditions 6 6 12 - - - - - - - 5 5 5 — — — - 42.0 - 7 7 7 Cleanliness of Body— Dirty 4 4 8 - - - - - - - 4 4 3 1 - - - 50.0 2 2 4 2 Pediculi - 2 2 - - - - - - - 2 2 2 - - - - 100.0 - - - - Flea-bitten — — — — — - — — — - - - - — — — — - — — — — Malnutrition 106 75 181 - 2 123 1 - 1 125 31 156 63 14 5 74 70.0 87.0 12 11 23 85 Nose and Throat— Enlarged Tonsils 253 433 686 2 42 55 45 1 1 102 - 102 96 - - 6 16.0 - 301 239 540 245 Adenoids 13 58 71 — 3 17 1 - 18 - 18 10 - - 8 26.0 - 13 37 50 45 Enlarged Tonsils and Adenoids 85 438 523 1 3 263 61 - - 324 - 324 292 - - 32 62.0 - 63 132 195 164 Other conditions 53 414 467 — 8 340 6 — 28 374 59 433 355 — 7 71 81.0 94.0 6 20 26 91 Cervical or Neck Glands— Enlarged (non T.B.) 106 258 364 — 8 147 12 — 18 177 35 212 165 — 1 46 50.0 60.0 47 97 144 143 External Eye Disease— Blepharitis 36 98 134 — — 116 1 1 118 9 127 93 1 - 33 88.0 95.0 4 3 7 36 Conjunctivitis 13 173 186 — — 166 1 5 172 13 185 180 — — 5 93.0 99.0 1 - 1 5 Corneal Opacities - - - - - - - - - - - - - - - - - - - - - - Keratitis 1 2 3 — — 2 1 — 3 — 3 - 2 - 1 100.0 - - - - 1 Other conditions 24 132 156 — — 133 2 — — 135 13 148 130 — 1 17 87.0 95.0 5 3 8 20 Ear Diseases— Chronic Suppuration of Middle Ear 41 197 238 - 2 197 7 - 5 209 18 227 180 - 5 42 89.0 96.0 2 7 9 49 Defective Hearing 7 25 32 - 1 20 1 - 2 23 1 24 7 6 3 8 74.0 77.0 3 4 7 12 Wax 5 107 112 — - 110 - - 110 2 112 110 - - 2 99.0 100.0 - - - 2 Other diseases 13 65 78 — — 58 5 - 3 66 12 78 63 — — 15 85.0 100.0 — — — 15 Heart and Circulation— Organic Disease 7 4 11 — 1 1 3 1 5 - 5 - 1 2 2 50.0 - 4 1 5 3 Functional Disease 16 20 36 — 5 14 3 3 20 3 23 6 5 1 11 65.0 74.0 6 2 8 13 Anæmia 16 25 41 — — 26 1 — 3 30 3 33 13 2 - 18 73.0 80.0 4 4 8 22 Other conditions 1 4 5 — 3 1 1 — — 2 — 2 — — 1 1 100.0 — — — - 1 Lungs— Bronchitis and Bronchial Catarrh 32 95 127 - - 46 20 - 27 93 28 121 101 1 - 19 73.0 95.0 1 5 6 24 Tuberculosis - - - - - - - - - - - - - - - - - - - - - - T.B. Suspected 1 10 11 — 5 4 1 — 5 - 5 - - 2 3 83.0 - - 1 1 4 Other diseases (non T.B.) 17 11 28 — — 11 2 1 3 17 1 18 7 1 2 8 61.0 64.0 7 3 10 11 Nervous System— Epilepsy 1 2 3 — — - - - - - - - - - - - - - 2 1 3 1 Chorea 4 11 15 — — 6 5 2 13 — 13 7 2 - 4 87.0 - 1 1 2 5 Other conditions 20 21 41 — 2 19 6 1 3 29 3 32 13 8 1 10 74.0 82.0 3 4 7 14 Skin— Ringworm—Head - 3 3 - - 3 - - - 3 - 3 2 - - 1 100.0 - - - - 1 Body - 16 16 - - 12 - 3 15 1 16 12 - - 4 94.0 100.0 - - - 4 Impetigo 14 349 363 — — 300 4 2 13 319 37 356 319 — 4 33 88.0 98.0 1 6 7 39 Scabies 14 120 134 — 1 121 5 — 5 131 1 132 126 - - 6 98.0 99.0 1 - 1 6 Minor injuries 58 800 858 — 3 800 14 1 3 818 36 854 813 - 4 37 96.0 100.0 - 1 1 38 Other conds. (non T.B.) 296 2,729 3,025 1 8 2,670 19 1 29 2,719 248 2,967 2,642 — 14 311 90.0 98.0 14 35 49 346 Deformities— Rickets 3 1 4 — 2 — 1 — — 1 - 1 - - - 1 50.0 - - 1 1 2 Spinal Curvature 86 90 176 — 6 108 6 — 3 117 — 117 21 18 21 57 69.0 - 30 23 53 80 Other forms 125 252 377 — 22 248 3 — 2 253 — 253 77 27 49 100 71.0 — 73 29 102 129 Tuberculosis Non-Pulmonary— Definite—Glands — 1 1 — — — 1 — — 1 — 1 — — 1 — 100.0 - - - - - „ Spine - - - - - - - - - - - - - - - - - - - - - - „ Hip 1 — 1 — — 1 — — — 1 — 1 — — 1 — 100.0 — - - - - „ Bones and Joints - - - - - - - - - - - - - - - - - - - - - - „ Skin - - - - - - - - - - - - - - - - - - - - - - „ Other forms — 1 1 — — — 1 — — 1 — 1 - - 1 - 100.0 - - - - - Suspected Glands 3 — 3 — — — 1 — — 1 — 1 — - 1 - 33.0 - 1 1 2 1 ,, Bones & Joints 1 — 1 1 — - - - - - - - - - - - - - - - - - ,, Other conditions — 2 2 — 1 — 1 — — 1 — 1 — — — 1 100.0 — — — — 1 Speech— Defective Articulation 3 14 17 — 8 2 1 — — 3 — 3 — — 1 2 33.0 — 2 4 6 6 Squint— Squint present 25 126 151 — 9 105 15 — 1 121 — 121 5 76 28 12 85.0 — 11 10 21 22 Vision— Defect not ascertained 14 87 101 - 36 46 3 - - 49 - 49 34 1 6 8 75.0 - 5 11 16 19 One eye normal 10 44 54 - 11 27 1 - - 28 - 28 22 - 3 3 65.0 - 10 5 15 8 Both eyes 6/6 2 46 48 - 35 9 - - 3 12 - 12 10 - - 2 92.0 - 1 - 1 2 Both eyes 6/9 13 71 84 - 36 38 1 - 1 40 - 40 33 - 2 5 83.0 - 3 5 8 10 One eye 6/9, other 6/12 or less 38 150 188 - 23 112 3 - 5 120 - 120 94 - 6 20 73.0 - 25 20 45 40 Both eyes 6/12 or less 63 260 323 — 18 195 12 — 18 225 — 225 176 — 8 41 74.0 — 30 50 80 91 Spectacles broken 23 306 329 - - 299 1 - 17 317 1 318 304 - - 14 96.0 97.0 3 8 11 22 Spectacles lost 3 27 30 - 2 25 1 - - 26 - 26 21 - - 5 93.0 - 2 - 2 5 Debility 375 784 1,159 1 2 968 13 1 15 997 100 1,097 580 13 21 483 86.0 95.0 30 29 59 512 Miscellaneous 371 2,409 2,780 1 379 1,656 93 5 120 1,874 422 2,296 1,898 7 39 352 78.0 96.0 35 69 104 421 Grand Totals 2,694 14,158 16,852 7 687 9,933 386 13 344 10,676 3,568 14,244 11,880 188 241 1,935 66.0 88.0 786 1,128 1,914 3,063 Re-examinations in respect of Defective Vision, other than Lost and Broken Spectacles, and in respect of other conditions— No. of cases dealt with 1,983. 38 THE THIRD ANNUAL REPORT for the Year ending 31st December, 1936, 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 1936, 1,149 special children were examined or re-examined. Of the 332 original examinations included in the 1,149 examined, 64 were found to be physically defective, 23 mentally defective, 1 partially blind, 28 dull and backward, 176 anaemic and debilitated, 25 defective speech, 2 deaf and dumb, 1 epileptic, 9 normal, and 3 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 124. The actual number on the roll at the 31st December, 1936, was 123. The average attendance for the year was 106. There were no children awaiting admission to this school at the end of the year. The staff consists of one Head Teacher, one full-time Assistant Master, and four full-time Assistant Mistresses. There are in addition three part-time Instructors—one for boot-making, one for handicraft and one for domestic economy. Eight children were allowed to leave school before reaching the age of 16 years; 10 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 1 was transferred to a Residential Institution. The Certifying Medical Officer visits the school weekly for the purpose of revision of classification and for medical examination of the children. 139 such examinations were made during 1936. The school dinners are brought from Furness Road Feeding Centre and served in the school hall. On an average 70 children take the school dinners and the remainder bring their own meal. During the year routine medical and dental inspection of the children attending this school was carried out. 102 children were medically examined and 95 were dentally inspected. Seven were found to require medical treatment and 49 were found to require dental treatment, and the following table gives a return of the defects found at medical and dental inspection:— Table No. 25. Defects. Found to require treatment. Requiring to be kept under observation but not requiring treatment. Anæmia - - Malnutrition - - Skin Disease - - Eye—Blepharitis - - Defective vision (excluding squint) 1 - Squint — - Other conditions — - Ear—Defective hearing — - Other ear diseases 1 - Nose and Throat—Enlarged tonsils only 1 - Adenoids only — - Enlarged tonsils and adenoids 1 - Enlarged cervical glands (non-tuberculous) — - Defective speech — - Defective Teeth 49 - Heart and Circulation—Heart disease, functional — - Anæmia — - Lungs—Bronchitis — - Other non-tuberculous diseases — - Deformities—Spinal curvature 1 - Other forms 2 - Other defects and diseases — Total 56 - 39 Oldfield Road Physically Defective School.— The certified accommodation at this school is for 165 children. During the year under review the average number on the roll was 155, the actual number on the roll on the 31st December, 1936, being 162. The average attendance for the year was 129. There were no children awaiting admission at the 31st December, 1936. 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 8 children were allowed to leave school before reaching the age of 16 years, 10 children were allowed to attend ordinary elementary schools, and 1 child was transferred to a residential institution for epileptics. The school dinners are brought from Gibbons Road Feeding Centre and are served in the School Hall. On an average 105 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 at 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 debilitated, and who are physically defective within the meaning of the Education Act, 1921 ; and it is recognised by the Board of Education as a Special Residential School. The boys and girls are selected both from the physically defective and the ordinary elementary schools, and the duration of the stay is six weeks, except in special cases when an additional six weeks stay can be arranged. All the cases which have been to the institution have shown a distinct improvement on their return home. In all 75 boys and 27 girls were admitted to the school during the year. The Education Committee have also made arrangements for the reservation of 4 places for boys and 11 places for girls at St. Dominic's Open Air School, Godalming, and St. Patrick's Open Air School, Hayling Island, respectively. The children are selected from both the physically defective and the ordinary elementary schools, and the duration of stay is six weeks. All the cases sent have shown a definite improvement on their return home. In all 37 boys and 73 girls were admitted during the year. Defective Vision and Squint.—During the year 1936, 25 children attending the Special Schools were found to be suffering from errors of refraction (including squint). They were all dealt with under the Authority's scheme. Spectacles were prescribed for 20 children and 13 obtained them under the Authority's scheme, and 4 otherwise. Defects of Nose and Throat.—During the year 1 child attending a Special School received operative treatment under the Authority's scheme, and 5 children received other forms of treatment. Orthopedic and Postural Defects.—During the year 44 children attending the Special Schools were treated; 4 of these received residential treatment with education, under Section 80 of the Education Act, 1921, and 43 non-residential treatment at an orthopaedic clinic under the Authority's scheme. In addition 5 children received residential treatment with education under the Special Schools vote. Following-up.—During the year there were 199 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, 1936.— 153 new cases were referred to this Association during the year, 29 of these being referred by the Willesden Health Department. The majority of the patients were suffering from anaemia and debility. In addition 3 surgical appliances were supplied. Stammering Children.—There are three classes for children suffering from stammering and other speech defects, held twice weekly at Bridge Road, Carlton Vale and Chamberlayne Wood Road Schools, and conducted by Mr. A. D. Bradfield. The class at Carlton Vale School consists of boys, and the classes at Bridge Road and Chamberlayne Wood Road Schools include both boys and girls. Each class lasts one hour and there is accommodation for 10 children. Cases of stammering and other speech defects are referred to the Health Department for examination as to their suitability for admission to a stammering class. After a period of treatment before discharge from the class, the child is re-examined at the Health Department and has to satisfy the Medical Officer as well as the special teacher before he ceases to attend. Cases of stammering are followed up for two terms after they have ceased to attend the class, through the Head Teachers. Should a child relapse and the stammer recur, he is re-admitted to the class for further treatment. The attendance of children at the stammering class is not for any specified period of time, as experience has shown that some children may be cured after a few months' treatment, while others need to attend for a much longer period. 40 Child Guidance.— Children who may be described as "difficult," "maladjusted," "unmanageable," are referred in the first instance to the Health Department for examination and, if suitable, are then referred by the School Medical Officer to the North Western Child Guidance Clinic, Sheldon Road, Cricklewood, for further investigation and, if necessary, treatment. In March, 1935, the Education Committee, with the subsequent approval of the Board of Education, acceded to a request from the North Western Child Guidance Clinic to recognise it as a school clinic for child guidance, and to pay to it a fee of 10s. 6d. for the first investigation of a case, and 2s. 6d. for each subsequent attendance of the case for treatment, this arrangement to pertain in the first instance for a period of twelve months. At the end of the first twelve months a report on the working of the arrangements was sent to the Board of Education and stating that the Council proposed to continue to send school children to the Clinic. The Board of Education in reply gave their approval to the proposal. During the year, three new cases were referred to the North Western Child Guidance Clinic. All three cases after investigation and with treatment or advice profited as a result of this. J. G.—A girl aged 9 was seen on account of disobedience and tendencies towards exhibitionism. The parents and teachers all complained and were totally at a loss to understand or explain her behaviour. On examination she was a healthy, intelligent child who had stumbled accidently on this sexual problem and had attempted to solve it in her own way. The kindly advice tendered and forgiveness of the offence resulted in a cure of the behaviour problem. M. A.—A girl of 12 years came to our notice with an exceptionally bad record of naughtiness, with a stubborn refusal to do anything to which she objected. The mother was heartbroken and her teachers found her difficult to deal with on account of her aggressive, spiteful and revengeful nature and blatant rudeness to them in school. The psychiatrist's examination revealed a curiously unstable nature and hostility unless coaxed. The explanation satisfied the mother that the disorder was not purposive and her co-operation would assist the child to improve. D. P.—This boy of 13 years, showed uncontrollable behaviour in school with the use of vile obscene language, so bad that it was necessary to suspend him temporarily. The Child Guidance Clinic found that he was an over-sensitive boy, lacking maternal affection and the butt of bouts of temper on the father's part. He re-acted very badly to criticism or to blame and it was thought advisable for him to receive special schooling in the subjects in which he was backward at the Child Guidance Clinic and to make a new start at another school. A report from the second school shows that he is easily brought to tears but no major disturbances have occurred in the different school. Table No. 26.—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. Blind Children.—A blind child is defined by Section 69 of the Education Act, 1921, as one who is "too blind to be able to read the ordinary school books used by children." This definition covers some children who are totally, or almost totally, blind and can only be appropriately taught in a school for blind children, and others who have partial sight and can be appropriately taught in a school for partially sighted children. Only the first class should be included in this section. At Certified Schools for the Blind 4 At Public Elementary Schools — At other Institutions — At no School or Institution — Total 4 Partially Sighted 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 sighted. 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 9 At Certified Schools for the Partially Sighted 7 At Public Elementary Schools — At other Institutions — At no School or Institution 1 Total 17 41 Deaf Children.— A deaf child is defined by Section 69 of the Education Act, 1921, as one who is "too deaf to be taught in a class of hearing children in an elementary school." This definition covers some children who are totally, or almost totally, deaf and can only be appropriately taught in a school for deaf children, and others who have partial hearing and can be appropriately taught in a school for partially deaf children. Only the first class are included in this section. At Certified Schools for the Deaf 18 At Public Elementary Schools — At other Institutions — At no School or Institution 1 Total 19 Partially Deaf Children.—Entered in this Section are children who can appropriately be taught only in a school for the partially deaf. At Certified Schools for the Deaf 2 At Certified Schools for the Partially Deaf 5 At Public Elementary Schools 1 At other Institutions — At no School or Institution — Total 8 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. The following Table includes all such children except those who have been notified to the Local Authority under the Mental Deficiency Act in accordance with Article 3 of the Mental Deficiency (Notification of Children) Regulations, 1928. Particulars relating to these children are entered in Table 27, page 43. At Certified Schools for Mentally Defective Children ... 114 At Public Elementary Schools — At other Institutions 1 At no School or Institution — Total 115 Epileptic Children.—Children suffering from Severe Epilepsy.—In this part of the Table only those children should be 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 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 3 At Public Elementary Schools — At other Institutions — At no School or Institution 1 Total 4 Physically Defective Children.—(a) Tuberculous Children.—Tuberculous children in areas other than Counties or County Boroughs who have been ascertained by the County Tuberculosis Officer should not appear in the Table for the County but in the Table for the appropriate area. Only children diagnosed as tuberculous and requiring treatment for tuberculosis at a sanatorium, a dispensary, or elsewhere are recorded in this category. Children suffering from crippling due to tuberculosis which is regarded as being no longer in need of treatment are recorded as crippled children, provided that the degree of crippling conforms to the description of a crippled child given at the head of section C below. All other tuberculous children who are regarded as being no longer in need of treatment are recorded as delicate children provided the Medical Officer is prepared to certify under Section 55 of the Education Act, 1921, that they are incapable by reason of physical defect of receiving proper benefit from the instruction in the ordinary Public Elementary Schools. (i.) Children suffering from Pulmonary Tuberculosis. (Including pleura and intra-thoracic glands.) At Certified Special Schools — At Public Elementary Schoolsf — At other Institutions 3 At no School or Institution — Total 3 (ii.) Children suffering from Non-pulmonary Tuberculosis. (This category includes tuberculosis of all sites other than those shown in (i.) above.) At Certified Special Schools 7 At Public Elementary Schools, † — At other Institutions 1 At no School or Institution — Total 8 † 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. 42 (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 under Section 55 of the Education Act, 1921, that they are incapable by reason of physical defect of receiving proper benefit from the instruction in the ordinary Public Elementary Schools. At Certified Special Schools 69 At Public Elementary Schools 330 At other Institutions — At no School or Institution 2 Total 401 (c) Crippled Children.— This Section is confined to children (other than those diagnosed as tuberculosis 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, and in whose case the Medical Officer is prepared to certify under Section 55 of the Education Act, 1921, that they are incapable by reason of such physical defect of receiving proper benefit from the instruction in the ordinary Public Elementary Schools. At Certified Special Schools 69 At Public Elementary Schools — At other Institutions — At no School or Institution 3 Total 72 (d) Children with Heart Disease.—This Section is confined to children in whose case the Medical Officer is prepared to certify, under Section 55 of the Education Act, 1921, that they are incapable by reason of such physical defect of receiving proper benefit from the instruction in the ordinary Public Elementary Schools. At Certified Special Schools 54 At Public Elementary Schools — At other Institutions 2 At no School or Institution — Total 56 Children suffering from Multiple Defects.—Information is only given in respect of children suffering from any combination of the following types of defect:— Blindness (excluding partially sighted children). Active Tuberculosis. Deafness (excluding partially Deaf children). Crippling (as defined in Section C Mental Defect (Feeble-minded). above). Severe Epilepsy. Heart Disease. The clinical condition causing the defect is not to be specified. The actual combination of defects is stated in the table below, together with the type of School attended. Combination of Defect. At Certified Special Schools. At Public Elementary Schools. At other Institutions. At no School or Institution. Total. Crippled and Feeble-minded 5 — — — 5 Severe Epilepsy and Feeble-minded 1 — — — 1 Deaf and Feeble-minded 1 - — 1 2 43 Table No. 27. Statement of the Number of Children Notified during the Year ended December 31st, 1936, by the Local Education Authority to the Local Mental Deficiency Authority. Total Number of Children notified : 31. Analysis of the above Total. Diagnosis. Boys. Girls. l.-(i.) Children incapable of receiving benefit or further benefit from instruction in a Special School: (a) Idiots — — (b) Imbeciles 6 5 (c) Others — 5 (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 10 5 3.—Feeble-minded children notified under Article 3 of the 1928 Regulations, i.e., "special circumstances cases" — — 4.—Children who in addition to being mentally defective were blind or deaf — — Total 16 15 Special (Day) Schools in Willesden. Number of Physically Defective Schools 1 Number of Mentally Defective Schools 1 Table No. 28. Number of children attending certified Special (Day and Residential) Schools during 1936:— Special Schools in Willesden. Special Schools outside Willesden. Total. Blind and Partially Blind - 20 20 Deaf — 29 29 Mentally Defective 155 9 164 Epileptic — 6 6 Physically Defective 204 260* 464* Total 359 324* 683* * 228 of these were debilitated children sent to Certified Residential Schools for six weeks' convalescence. . 44 Table No. 29 SPECIAL SCHOOLS. Medical defects referred for following up at Routine Medical Inspection. Cases seen by School Medical Officers at other than Routine Medical Inspections. Cases not seen by School Medical Officers. 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 needing treatment 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 other Institutions or Hospitals under Council Scheme. Voluntary Hospitals or other Charitable Institutions. Hospital or 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 year. New. Total. l 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 — 12 12 — — 4 — — — 4 8 12 9 — — 3 33.3 100.0 — — — 3 Pediculi 1 — 1 — — 1 — — — 1 — 1 1 - - - 100.0 - - - - - Nose and Throat— Enlarged Tonsils 1 4 5 — 1 - - - - - - - - - - - - - 3 1 4 1 Enlarged Tonsils and Adenoids 1 - 1 - - 1 - - - 1 - 1 1 - - - 100.0 - - - - - Other Conditions — 5 5 — — 4 1 — — 5 — 5 3 — 2 100.0 — — — — 2 Cervical or Neck Glands— Enlarged (Non T.B.) 1 2 3 — — 2 — — 1 3 — 3 2 — — 1 100.0 — — — — 1 External Eye Disease— Blepharitis 2 1 3 — — 2 — — — 2 1 3 2 — 1 66.6 100.0 — — — 1 Other Conditions — 1 1 — — 1 — — — 1 1 1 — — — 100.0 — - — — — Ear Diseases— Chronic Suppuration of Middle Ear - 3 3 - - 2 - - - 2 1 3 1 - - 2 66.6 100.0 - - - 2 Defective Hearing 1 - 1 - - - - - - - - - - - - - - - 1 - 1 - Wax - 2 2 - - 2 - - - 2 - 2 1 - - 1 100.0 - - - - 1 Other Diseases — 4 4 — — 4 — — — 4 — 4 2 — — 2 100.0 — — — — 2 Heart and Circulation— Organic Disease - 5 6 — — — 3 — - 3 3 - 2 1 — 60.0 — — 2 2 2 Functional Disease 2 2 4 — — — 2 — — 2 — 2 2 — — — 50.0 — 1 1 2 1 Lungs— Bronchitis and Bronchial Catarrh - - - - - - - - - - - - - - - - - - - - - - Other Diseases (nonT.B.) 3 2 5 — — 2 2 — - 4 4 3 — — 1 80.0 — — 1 1 2 Tuberculosis—Definite - - - - - - - - - - - - - - - - - - - - - - ,, —Suspected - - - - - - - - - - - - - - - - - - - - - - Nervous System— Chorea 1 — 1 — — — — — 1 1 1 1 — — — 100.0 — — — — — Skin- Impetigo - 3 3 - - 3 - - - 3 - 3 3 - - - 100.0 - - - - - Scabies - 3 3 - - 3 - - - 3 - 3 2 - - 1 100.0 — - - - 1 Minor Injuries 1 6 6 - - 6 - - - 6 - 6 6 - - - 100.0 - - - - - Other Conditions 3 28 31 — — 29 — — — 29 2 31 24 — — 7 93.5 100.0 — — — 7 Deformities— Spinal Curvature 2 5 7 — — 7 — — — 7 — 7 1 1 2 3 100.0 — — — — 3 Other Forms 4 23 27 — 2 21 — 1 — 22 — 22 1 6 5 10 81.4 — 1 2 3 12 Tuberculosis— Non-Pulmonary— Definite Spine 1 — 1 — — 1 — — — 1 — 1 — — 1 — 100.0 — — — — — Bones and Joints 2 — 2 — — 1 — — — 1 — 1 — — — 1 50.0 — 1 — 1 1 Squint— Squint Present — 1 1 — — 1 — — — 1 — 1 — 1 — — 100.0 — — — — — Vision— Defect not ascertained — 2 2 — — 2 — — — 2 — 2 1 — — 1 100.0 — — — — 1 Both eyes 6/6 1 — 1 — — 1 — — — 1 — 1 — — 1 — 100.0 — — — — — „ 6/9 — 1 1 — — 1 — — — 1 — 1 1 — — — 100.0 — — — — — One eye 6/9, other 6/12 or less - 9 9 - - 9 - - - 9 - 9 8 - 1 - 100.0 - - - - - Both eyes 6/12 or less — 5 5 — — 4 — — 1 5 — 5 4 — — 1 100.0 — — - — 1 Spectacles Broken 2 3 5 - - 5 - - - 5 - 5 5 - — — 100.0 — - - - — Spectacles Lost - - - - - - - - - - - - - - - - - - - - - - Debility 6 6 12 — — 10 — - — 10 2 12 5 — - 7 83.4 100.0 - - - 7 Miscellaneous 4 63 67 - 39 16 1 - 3 20 6 26 24 - - 2 71.0 93.0 2 - 2 2 Grand Totals 39 200 239 — 42 145 9 1 6 161 20 181 114 10 11 46 82.0 92.0 9 7 16 53 Re-examinations in respect of Defective Vision, other than Lost and Broken Spectacles, and in respect of other Conditions. No. of cases dealt with 66. 45 Table No. 30.—Corresponding to Appendix E of the Annual Report of the Chief Medical Officer of the Board of Education for 1919. Form of Annual Return of the After-Careers of Children under 21 Years of Age Formerly Attending Special Schools. Oldfield Road Physically Defective School. Leinster Mentally Defective School. Boys. Girls. Boys. Girls. 1. Number of children who have left the school and are under 21 years 41 51 51 28 2. Number who :— (a) Have since died — 3 2 1 (b) Are known to be incapable by reason of mental or physical defect of undertaking employment 2 1 3 - (c) Are in attendance at an Institution for further education (give details), and - - §1 §3 (d) Are in any other Institution (specify Asylum, Workhouse, Colony for Epileptics, etc.) **1 - *7 *6 3. Number who are employed in :— (a) Industrial or manual occupations 24 14 24 6 (b) Agricultural or rural occupations — — — — (c) Domestic occupations including those who are helping in the domestic work at home - 13 - 9 (d) Commercial, professional, or clerical work 6 5 - - (e) Blind alley or other precarious occupations 2 - 5 1 4. Number who have left the neighbourhood or whose after-careers have not been traced 6 15 9 2 * In institutions for mental defectives. § In attendance at an occupation centre. ** In hospital. Dental Defects. Vide, 19th Annual Report on Dental Work in connection with School Children, Expectant and Nursing Mothers, and children under 5 years, page 57. HEALTH CENTRES. ATTENDANCES. Table No. 31. Medical and Dental Treatment—Attendances at Health Centres, 1936. Condition. (1) Mothers, and Children under Five. School Children. (8) Grand Total (Cols. 7 and 8). (9) Expectant Mothers. (2) Nursing Mothers. (3) Children under Five. Total (Cols. 2—5). (7) 0—1. (4) 1—5. (5) Total (Cols. 4 and 5). (6) 1. Cleansing - - 1 6 7 7 348 355 2. Throat, Nose and Ear Diseases 1 - 35 722 757 758 5,876 6,034 3. Minor Ailments 55 95 946 3,532 4,478 4,628 41,677 46,305 4. Eye Diseases 8 13 171 363 534 555 5,750 6,305 5. Skin Diseases 56 29 158 290 448 533 554 1,087 6. Artificial Sunlight Treatment — — 491 3,594 4,085 4,085 6,112 10,197 7. Orthopædics — 30 550 2,669 3,219 3,249 6,877 10,126 8. Medical Consultations 11,293 27,763 28,927 14,440 43,367 82,423 — 82,423 9. Diphtheria Immunisation — — 17 473 490 490 542 1,032 10. Total (1—9) 11,413 27,930 31,296 26,089 57,385 96,728 67,736 164,464 11. Dental Consultations 2,557 2,095 — 1,100 1,100 5,752 12,325 18,077 12. Total (10—11) 13,970 30,025 31,296 27,189 58,485 102,480 80,061 182,541 13. School for Mothers — — — — — 5,198 — 5,198 14. Nursery — — — — — 4,985 — 4,985 15. Miscellaneous — — — — — 21,192 13,870 35,062 16. Grand Total (12—15) 13,970 30,025 31,296 27,189 58,485 133,855 93,931 227,786 46 (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 17,292 16,957 34,249 41,339 17,151 58,490 38,097 33,628 71,725 164,464 18. Dental Attendances 1,163 2,081 3,244 1,656 3,565 5,221 2,933 6,679 9,612 18,077 19. School for Mothers 1,757 - 1,757 1,215 - 1,215 2,226 - 2,226 5,198 20. Nursery Attendances 2,764 - 2,764 743 - 743 1,478 - 1,478 4,985 21. Miscellaneous 10,180 4,560 14,740 6,020 5,281 11,301 4,992 4,029 9,021 35,062 22. Total 33,156 23,598 56,754 50,973 25,997 76,970 49,726 44,336 94,062 227,786* * In addition 2,244 attendances were made by secondary and technical school children and the following attendances by adults :—Cleansing 117, Skin Diseases 48, Diphtheria Immunisation 11, Varicose Ulcers 958, making a total of 3,378 which together with the 227,786 above makes a grand total of 231,164. Table No. 32. Showing attendances at the Municipal Centres each year since 1913. Year. Mothers and Children under 5 years. School Children. Total. School for Mothers. Nursery. Miscellaneous. Grand Total. Medical. Dental. Total. Medical. Dental. Total. 1913 0 0 0 299 0 299 299 0 0 299 1914 0 0 0 2,517 0 2,517 2,517 0 0 2,517 1915 0 0 0 5,674 0 5,674 5,674 0 0 5,674 1916 389 0 389 9,593 0 9,593 9,982 0 0 9,982 1917 8,641 0 8,641 9,448 0 9,448 18,089 0 0 18,089 1918 32,169 1,165 33,334 15,811 2,403 18,214 51,548 44 220 51,812 1919 32,870 878 33,748 46,179 11,024 57,203 90,951 1,089 2,814 94,854 1920 51,468 1,823 53,291 64,588 10,670 75,258 128,549 2,354 3,452 134,355 1921 41,562 1,667 43,229 57,032 7,718 64,750 107,979 1,716 2,356 112,051 1922 27,505 894 28,399 39,989 7,025 47,014 75,413 1,616 2,190 79,219 1923 23,271 533 23,804 40,381 3,599 43,980 67,784 2,761 3,270 73,815 1924 17,082 520 17,602 34,845 2,460 37,305 54,907 2,896 2,808 60,611 1925 26,119 936 27,055 41,695 5,123 46,818 73,873 4,074 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 1935 92,666 5,596 98,262 63,666 12,447 76,113 174,375 5,343 5,299 32,553 217,570 1936 96,728 5,752 102,480 67,736 12,325 80,061 182,541 5,198 4,985 38,440* 231,164 *This includes the 2,244 attendances made by Secondary and Technical School children and the 1,134 by adults which are shown in the footnote to Table No. 31. 3 School Children and no children under 5 years of age were treated under the Council's Scheme by X-rays for Ringworm of the Scalp. 9,898 Individual School Children attended the Municipal Centres during 1936. 47 HOSPITAL TREATMENT OF SCHOOL CHILDREN UNDER THE COUNCIL'S SCHEME. Excluding Orthopaedic Treatment which is dealt with in Appendix F. Table No. 33. Hospital Treatment of School Children during 1936. No. of School Children in Hospital* at 31st December, 1935 0 „ „ „ admitted during 1936 363 „ ,, „ under treatment during 1936 363 „ , „ discharged during 1936 363 „ „ ,, died in Hospital during 1936 0 „ „ ,, remaining in Hospital at 31st December, 1936 0 * From and including 18/5/36, cases admitted to Willesden Municipal Hospital—prior to that date admitted to Willesden General Hospital. Table No. 34. School Children under Treatment in Hospital during 1936. 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 - - - - - - - - - - Enlarged Tonsils & Adenoids — *362 *362 *362 — *362 — — — — Other Conditions — 1 1 1 — 1 — — — — Total — 363 363 363 — 363 — — — — * One case was a child attending a Special School. EMPLOYMENT OF CHILDREN IN ENTERTAINMENTS RULES, 1933. Particulars as to applications received in 1936 for certificates from the School Medical Officer. No. of Applications. No. Granted. Boys. Girls. Total. Boys. Girls. Total. Original applications 3 21 24 3 21 24 Applications for renewals — 8 8 — 8 8 3 29 32 3 29 32 48 THE SEVENTEENTH ANNUAL REPORT FOR THE Year ending 31st December, 1936, ON THE HEALTH OF PUPILS ATTENDING SECONDARY AND TECHNICAL SCHOOLS IN WILLESDEN. Giving the Tables required by the Board of Education. Secondary and Technical Schools are under the control of the Middlesex County Council. Medical Inspection has been carried out at the Secondary and Technical Schools, by agreement with the Middlesex County Council, in accordance with the arrangements set out in the 1930 Annual Report. One additional school was included in the scheme during the year—The Kilburn Junior Commercial School. The Middlesex County Council's Scheme for Dental Inspection and Treatment of Dental Defects and for Ophthalmic Treatment came into operation during 1935. Secondary and Trade School Pupils are now inspected annually by the Council's Dental Surgeons, and Dental and Ophthalmic Treatment are available at the Council's Health Centres. 49 Table No. 35.—Corresponding to Table I. of the Board of Education's Medical Statistical Tables. Return of Medical Inspections for the Year ended 31st December, 1936. A.—Routine Medical Inspections. Number of Inspections in the prescribed Groups. Pupils examined. Aged. Kilburn Grammar School. Kilburn Technical School. Willesden County School. Willesden Building Trade School. Willesden School of Engineering. Willesden School of Art. Convent of Jesus and Mary. Brondesbury and Kilburn High School. Kilburn Junior Commercial School. Total. Boys. Girls. Boys. Girls. Boys. Boys. Boys. Girls. Girls. Girls. Boys. Girls. 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. Entrants. Others. Total. Entrants. Others. Total. Entrants. Others. Total. Entrants. Others. Total. Entrants. Others. Total. Entrants. Others. Total. Entrants. | Others. Total. 10 years 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 3 0 3 2 0 2 0 0 0 0 0 0 0 0 0 5 0 5 5 0 5 11 „ 69 0 69 0 0 0 33 0 33 52 0 52 0 0 0 0 0 0 0 0 0 0 0 0 32 0 32 44 0 44 0 0 0 0 0 0 102 0 102 128 0 128 230 0 230 12 „ 19 69 88 2 0 2 18 30 48 27 27 54 0 0 0 0 0 0 0 0 0 0 0 0 41 35 76 32 56 88 0 0 0 0 0 0 37 99 136 102 118 220 139 217 356 13 „ 1 0 1 45 0 45 0 0 0 1 0 1 40 0 40 48 0 48 1 0 1 1 0 1 3 0 3 2 0 2 2 0 2 0 0 0 92 0 92 52 0 52 144 0 144 14 „ 0 0 0 36 0 36 1 0 1 0 0 0 21 0 21 30 0 30 10 0 10 9 0 9 0 0 0 0 0 0 33 0 33 0 0 0 95 0 95 45 0 45 140 0 140 15 „ 2 78 80 3 52 55 0 61 61 0 50 50 27 45 72 1 39 40 1 13 14 4 10 14 2 42 44 2 73 75 1 0 1 0 0 0 32 236 268 11 227 238 43 463 506 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 0 0 0 1 0 1 0 0 0 0 0 0 0 0 0 1 0 1 1 0 1 17 „ 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 1 0 0 0 0 0 0 0 0 0 1 0 1 1 0 1 Total 91 147 238 86 52 138 52 91 143 80 77 157 88 45 133 79 39 118 12 13 25 14 10 24 81 77 158 84 129 213 36 0 36 0 0 0 358 335 693 345 345 690 703 680 1383 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. Kilburn Technical School. Willesden County School. Willesden Building Trade School. Willesden School of Engineering. Willesden School of Art. Convent of Jesus and Mary. Brondesbury and Kilburn High School. Kilburn Junior Commercial School. Total Boys. Girls. Boys. Girls. Boys. Boys. Boys. Girls. Girls. Girls. Boys. Girls. Boys. Girls. Total. Number of Special Inspections 4 2 2 3 0 0 0 0 0 0 0 0 6 5 11 Number of Re-inspections 80 46 28 19 23 27 8 4 38 31 0 0 166 138 304 Total 84 48 30 22 23 27 8 4 38 31 0 0 172 143 315 50 Table No. 36.—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, 1936. 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 j (Boys). Kilburn Technical School (Girls). Willesden County School. Willesden Building Trade School (Boys). Willesden School of Engineering (Boys). Willesden School of Art. Convent of Jesus and Mary (Girls). Brondesbury and Kilburn High School (Girls). Kilburn Junior Commercial School. Kilburn Grammar School (Boys). Kilburn Technical School (Girls). Willesden County School. Willesden Building Trade School (Boys). Willesden School of Engineering (Boys). Willesden School of Art. Convent of Jesus and Mary (Girls). Brondesbury and Kilburn High School (Girls). Kilburn Commercial School. Kilburn Grammar School (Boys). Kilburn Technical School (Girls). Willesden County School. Willesden Building Trade School (Boys). Willesden School of Engineering (Boys). Willesden School of Art. Convent of Jesus and Mary (Girls). Brondesbury and Kilburn High School (Girls). Kilburn Junior Commercial School. Kilburn Grammar School (Bovs). Kilburn Technical School (Girls). Willesden County School. Willesden Building Trade School (Boys). Willesden School of Engineering (Boys). Willesden School of Art. Convent of Jesus and Mary (Girls). Brondesbury and Kilburn High School (Girls). Kilburn Junior Commercial School. Boys. Girls. j Boys. Girls. Boys. Girls. Boys. Girls. Boys. Girls. Boys. Girls. Boys. Girls. Boys. Girls. Boys. Girls. Boys. Girls. Boys. Girls. Boys. Girls. Skin (1) Ringworm—Scalp — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — (2) „ Body — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — (3) Scabies — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — (4) Impetigo — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — (5) Other Diseases (NonT0uberculous) — 2 — — — — — — — — — — — 1 — — — — — — — — — — 1 — — — — — — — — — — — — — — — — — — — — — — — Total (Heads 1 to 5) — 2 — — — — — — — — — — — 1 — — — — — — — — — — 1 — — — — — — — — — — — — — — — — — — — — — — — Eye (6) Blepharitis — 1 — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — —— (7) Conjunctivitis — 1 — — — — — — — — — — — — — — — — —— — —— — — — — — — — — — — — — — — — — — — — — — — — — — — — (8) Keratitis — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — (9) Corneal Opacities — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — (10) Other conditions (excluding Defective Vision and Squint) — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — Total (Heads 6 to 10) — 2 — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — (11) Defective Vision (excluding Squint) 15 12 2 9 12 2 4 2 11 20 10 — 2 4 3 — 5 — 2 5 2 6 1 — — — — 1 — — — — — — — — — — — — — — — — — — — — -(12) Squint 1 — — — 1 — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — —Ear (13) Defective Hearing — 1 __ _ 1 1 — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — (14) Otitis Media — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — (15) Other Ear Diseases — — — — — — — — — — — — — — — — — — — — — — — — — — — — —— — — — — — — — — — — — — — — — — — — Nose and Throat (16) Chronic Tonsillitis only 3 2 1 3 — — — — 1 — — — 2 9 — — — 2 — — — — 1 — — — — — — — — — — — — — — — — — — — — — — — — — (17) Adenoids only — — — 1 — — — — 1 — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — (18) Chronic Tonsillitis and Adenoids — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — (19) Other Conditions — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — —— — — — — — — — — — — (20) Enlarged Cervical Glands (NonTuberculous) — — — — — — — — — — — — — 1 — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — (21) Defective Speech — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — Heart and Circu- lation Heart Disease :— (22) Organic — — — — — — — — — — — — — 1 — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — (23) Functional — 1 — 2 2 — — — 1 — — — 3 6 — 2 2 1 — — 12 1 — — — — — — — — — — — — — — — — — — — — — — — — — — (24) Anaemia — — — — — — — — — — — — 1 1 — — — — — — 2 — — — — — — — — — — — — — — — 2 — — — — — — — — — — — Lungs (25) Bronchitis — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — (26) Other Non-Tuberculous Diseases — — — — — 1 — — — — — — 2 — — 1 — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — Tuberculosis Pulmonary :— (27) Definite — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — (28) Suspected — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — Non-Pulmonary :— (29) Glands — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — (30) Bones and Joints — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — (31) Skin — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — (32) Other Forms — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — Total (Heads 29 to 32) — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — Nervous System (33) Epilepsy — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — (34) Chorea — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — (35) Other Conditions — — — — — — — — — — — — — — — — — — — — — — — — — — 1 — — — — — — — — — — — — — — — — — — — — — Deform- ities (36) Rickets — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — (37) Spinal Curvature — 2 — — — — — 1 1 — — 1 — — — — — — 1 — 1 — — — 1 — — — — — — — — — — — — — — — — — — — — — — (38) Other Forms 5 1 — — 1 4 — — 2 1 2 2 Flat Foot 4 4 — 1 4 4 3 1 16 1 — — — 2 — — — — 1 — — 2 1 — — — — — — — — — — — — — — — — — — — — — — — — — Postural Curvature (e.g., Round Shoulders) 4 10 — 2 — 2 3 — 1 14 1 — — 2 — — — — — — — — 1 — — — — — — — — — — — — — — — — — — — — — — — — — (39) Other Defects and Diseases (excluding Uncleanliness and Dental Diseases 2 1 1 2 — 1 — 3 1 — — 5 32 1 — 6 1 — 1 5 2 — — 1 — — 1 — — — — — — — — — 1 — — — — — — — — — — Grand Total 34 37 4 19 23 14 11 4 37 38 13 — 16 59 4 3 13 5 3 7 21 14 4 — 2 1 1 2 — — — — — — — — 2 1 — — — — — — — — — — Dental Diseases — 12 9 5 — — 1 — 2 1 5 — 1 — — — — — — — — 1 — — — — — — — — — — — — — — — — — — — — — — — — — —— 51 B.—Classification of the Nutrition of Pupils Inspected during the Year in the Routine Age Groups. School. Age-Groups. Number of Pupils Inspected. a (Excellent). No. % B (Normal.) No. % C (Slightly Sub-normal). No. % D (Bad). No. % Kilburn Grammar School (Boys). Entrants (at any age) 91 7 7.7 84 92.3 — — — — Pupils aged 12 years 69 — — 66 95.7 3 4.3 — — Pupils aged 15 years 78 3 3.8 74 94.9 1 1.3 — — Total 238 10 42 224 94.1 4 1.7 — — Kilburn Technical School (Girls). Entrants (at any age) 86 19 221 66 76.7 1 1.2 Pupils aged 12 years — — — — Pupils aged 15 years 52 18 34.6 34 65.4 — — — — Total 138 37 26.8 100 72.5 1 0.7 — — Willesden County School (Boys). Entrants (at any age) 52 23 44.2 25 48.1 4 7.7 — — Pupils aged 12 years 30 5 16.7 22 73.3 3 10 — — Pupils aged 15 years 61 1 1.6 60 98.4 — — — — Total 143 29 20.3 107 74.8 7 4.9 — — Willesden County School (Girls). Entrants (at any age) 80 8 100 71 88.8 1 1.3 Pupils aged 12 years 27 7 25.9 20 74.1 — — — — Pupils aged 15 years 50 8 160 41 82.0 1 2.0 — — Total 157 23 14.6 132 84.1 2 1.3 — — Willesden Building Trade School (Boys). Entrants (at any age) 88 23 26. 63 71. 2 2.3 Pupils aged 12 years — — — — — — — — — Pupils aged 15 years 45 14 31.1 31 68.9 — — — — Total 133 37 27.8 94 70.7 2 1.5 — — Willesden School of Engineering (Boys). Entrants (at any age) 79 5 6.3 73 92.4 1 1.3 Pupils aged 12 years — — — — — — — — — Pupils aged 15 years 39 8 20.5 31 79.5 — — — — Total 118 13 11.0 104 88.1 1 08 — — Willesden School of Art (Boys). Entrants (at any age) 12 — — 12 100 — — — Pupils aged 12 years — — — — — — — — — Pupils aged 15 years 13 — — 13 100 — — — — Total 25 — — 25 100 — — — — Willesden School of Art (Girls). Entrants (at any age) 14 — — 14 100 — — — — Pupils aged 12 years — — — — — — — — — Pupils aged 15 years 10 — — 10 100 — — — — Total 24 — — 24 100 — — — — Convent of Jesus and Mary (Girls). Entrants (at any age) 81 — — 73 90.1 8 9.9 Pupils aged 12 years 35 — — 29 82.9 6 17.1 — — Pupils aged 15 years 42 — — 42 100 — — — — Total 158 — — 144 91.1 14 8.9 — — Brondesbury and Kilburn High School (Girls). Entrants (at any age) 84 9 10.7 75 89.3 — —. — — Pupils aged 12 years 56 14 25.0 41 73.2 1 1.8 — — Pupils aged 15 years 73 2 2.7 69 94.5 2 2.7 — — Total 213 25 11.7 185 86.9 3 1.4 — — Kilburn Junior Commercial School. Entrants (at any age) 36 4 11-1 32 88-8 Pupils aged 12 years — — — — — — — — — Pupils aged 15 years 52 C—-Pupils Found to Require Treatment. Number of Individual Pupils Found at Routine Medical Inspection to Require Treatment (Excluding Defects of Nutrition, Uncleanliness and Dental Diseases). Kilburn Grammar School. Kilburn Technical School. Willesden County School. Willesden Building Trade School. Willesden School of Engineering. Willesden School of Art. Convent of Jesus and Mary. Brondesbury and Kilburn High School. Kilburn Junior Commercial School. Boys. Girls. Boys. Girls. Boys. Boys. Boys. Girls. Girls. Girls. Boys. Girls. Number of Pupils Number of Pupils Number of Pupils Number of Pupils Number of Pupils Number of Pupils Number of Pupils Number of Pupils Number of Pupils Number of Pupils Number of Pupils Number of Pupils Group. Inspected. Found to require treatment. Percentage of Pupils found to require treatment. Inspected. Found to require treatment. Percentage of Pupils found to require treatment. Inspected. Found to require treatment. Percentage of Pupils found to require treatment. Inspected. Found to require treatment. Percentage of Pupils found 1 to require treatment. Inspected. Found to require treatment. Percentage of Pupils found to require treatment. Inspected. Found to require treatment. Percentage of Pupils found to require treatment. Inspected. Found to require treatment. Percentage of Pupils found to require treatment. Inspected. Found to require treatment. Percentage of Pupils found to require treatment. Inspected. Found to require treatment. Percentage of Pupils found to require treatment. Inspected. Found to require treatment. Percentage of Pupils found to require treatment. Inspected. Found to require treatment. Percentage of Pupils found to require treatment. Inspected. Found to require treatment. Percentage of Pupils found to require treatment. Prescribed Groups— Entrants (at any age) 91 10 110 86 19 22.1 52 2 3.8 80 8 100 88 10 11.4 79 10 12.7 12 4 33-3 14 i 71 81 20 24.7 84 9 10.7 36 13 361 0 0 0.0 Pupils aged 12 years 69 10 14.5 0 0 0.0 30 1 3.3 27 5 18.5 0 0 0.0 0 0 0.0 0 0 0.0 0 0 0.0 35 5 14.3 56 15 26.8 0 0 0-0 0 0 0.0 Pupils aged 15 years 78 14 17.9 52 18 34.6 61 1 1.6 50 6 120 45 11 24.4 39 3 7.7 13 5 38.5 10 3 30.0 42 12 28.6 73 14 19.2 0 0 0.0 0 0 0.0 Total (Prescribed Groups) 238 34 14.3 138 37 26.8 143 4 2.8 157 19 121 133 21 15.8 118 13 110 25 9 36.0 24 4 16.7 158 37 23.4 213 38 17.8 36 13 36.1 0 0 0.0 ** Other Routine Inspections - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - **During 1936 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. 36a.—Corresponding to Table IV. of the Board of Education's Medical Statistical Tables. Return of Defects Treated during the Year ended 31st December, 1936. Treatment Tables. Group I.—Minor Ailments (excluding Uncleanliness, for which see Group VI.). Number of Defects Treated or Under Treatment During the Year. Only 1 defect was treated during the year :—This was a case of Skin Disease other than Ringworm, Scabies or Impetigo, and received treatment from a private practitioner. The case occurred in a pupil at the Willesden Building Trade School (Boys). es Group II.—Defective Vision and Squint (Excluding Minor Eye Defects Treated as Minor Ailments—Group I.). No. of Defects Dealt with. Kilburn Grammar. School. Kilburn Technical School. Willesden County School. Willesden Building Trade School. Willesden School of Engineering. Willesden School of Art. Convent of Jesus and Mary. Brondesbury and Kilburn High School. Kilburn Junior Commercial School. Boys. Girls. Boys. Girls. Boys. Boys. Boys. Girls. Girls. Girls. Boys. Girls. Under the Authority's Scheme. Otherwise. Total. Under the Authority's Scheme. Otherwise. Total. Under the Authority's Scheme. Otherwise. Total. Under the Authority's Scheme. Otherwise. Total. Under the Authority's Scheme. Otherwise. Total. Under the Authority's Scheme. Otherwise. Total. Under the Authority's Scheme. Otherwise. Total. Under the Authority's Scheme. Otherwise. Total. Under the Authority's Scheme. Otherwise. Total. Under the Authority's Scheme. Otherwise. Total. Under the Authority's Scheme. Otherwise. Total. Under the Authority's Scheme. Otherwise. Total. Errors of refraction (including Squint) (Operations for Squint should be recorded separately in the body of the School Medical Officer's Report.) 26 20 46 28 2 30 10 3 13 16 4 20 9 3 12 9 1 10 — 2 2 1 2 3 17 2 19 18 5 23 - - - - - - Other Defect or Disease of the Eyes (excluding those recorded in Group 1) - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Total 26 20 46 28 2 30 10 3 13 16 4 20 9 3 12 9 1 10 — 2 2 1 2 3 17 2 19 18 5 23 — — — — — — No. of Children for whom Spectacles were :— (a) Prescribed 13 14 27 14 2 16 5 4 9 5 4 9 5 3 8 4 1 5 2 2 1 2 3 7 2 9 13 5 18 - - - - - - (b) Obtained 3 23 26 2 12 14 3 6 9 1 7 8 2 5 7 1 4 5 — 2 2 — 2 2 — 6 6 1 13 14 - - - - - - 54 Kilburn Grammar School (Boys).—In one instance the School Medical inspector noted on Re-inspection that the tonsils had been removed. Kilburn Technical School (Girls).—In one instance the School Medical inspector noted on Re-inspection that the tonsils had been removed. Willesden County School.—Nil noted. Willesden Building Trade School (Boys).—Nil noted. Willesden School of Engineering (Boys).—Nil noted. Willesden School of Art (Boys and Girls).—Nil noted. Convent of Jesus and Mary (Girls).—Nil noted. Brondesbury and Kilburn High School (Girls).—Nil noted. Kilburn Junior Commercial School (Boys and Girls).—Nil noted. Group IV.—Orthopaedic and Postural Defects. Orthopaedic work is not done in connection with the Secondary Schools in Willesden. Group V.—Dental Defects. Vide, 19th Annual Report on Dental Work in connection with School children, Expectant and Nursing Mothers, and children under 5 years, herewith, page 57. Group VI.—Uncleanliness and Verminous Conditions. Inspection and treatment of uncleanliness are not undertaken by the School Nurses in the Secondary and Technical Schools. One pupil, however, at the Kilburn Technical School was found to have a verminous head at School medical inspection and was cleansed at the Health Centre at the request of the parent. 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. 37. (a)—KILBURN GRAMMAR SCHOOL. Defect. No. Result. Deformities—Flat Foot 9 Having exercises. Slack back 2 Having exercises. Postural Curvature 3 Having exercises. Heart Disease—Functional 2 Restricted exercises. Other Defects and Diseases 3 Under Hospital treatment. " " 3 Under treatment by private doctor. " " 1 Had operation for hernia—Result satisfactory. " " 1 Had operation for undescended testicles—Result satisfactory. " " " " 1 Had operation in hospital. Scrotum freed from thigh. " " " " 1 Had operation for club foot—Satisfactory result. 55 (b)—KILBURN TECHNICAL SCHOOL (GIRLS). Defect. No. Result. Deformities—Postural Defects 6 Having exercises. Flat Foot 1 Having exercises. Other Defects and Diseases 2 Under private doctor for treatment. " " " " 2 Under hospital treatment. Heart Disease—Functional 1 Restricted exercises. (c)—WILLESDEN COUNTY SCHOOL. Defect. No. Result. Boys. Girls. Nose and Throat—Nasal Obstruction 1 — Having breathing exercises. Deformities—Flat Foot 4 5 Having exercises. Round Shoulders 2 1 Having exercises. Other Defects and Diseases 2 1 Having hospital treatment. (d)—WILLESDEN BUILDING TRADE SCHOOL (BOYS). Defect. No. Result. Deformities—Flat Foot 9 Having exercises. Postural Defects 4 Having exercises. Flat Chest 1 Having breathing exercises. Other Defects and Diseases 3 Having hospital treatment. " " " " 1 Under private doctor. Heart Disease—Functional 2 Moderation in exercises. (e)—WILLESDEN SCHOOL OF ENGINEERING (BOYS). Defect. No. Result. Deformities—Flat Foot 6 Having exercises. Postural Defect 1 Having exercises. Heart Disease—Functional 1 Improved with restricted games. 1 Restricted exercises. Fracture of Arm 2 Moderation in exercises. Other Defects and Diseases 4 Under private doctor. (/)—WILLESDEN SCHOOL OF ART. Defect. No. Result. Boys. Girls. Deformities—Flat Foot 2 — Having exercises. Heart Disease—Functional 2 — Restricted exercises. Other Defects and Diseases 2 — Under private doctor. 56 (g)—CONVENT OF JESUS AND MARY (GIRLS). Defect. No. Result. Deformities—Flat Foot 16 Having exercises. Heart Disease—Functional 1 Attending hospital for treatment. (h)—BRONDESBURY AND KILBURN HIGH SCHOOL (GIRLS). Defect. No. Result. Deformities—Flat Foot 1 Having exercises. Postural Defects 8 Having exercises. Other Defects and Diseases 1 Under private doctor for treatment. (i)—KILBURN JUNIOR COMMERCIAL SCHOOL. Defect. No. 1 Result. Boys. Girls. No defects noted — — 57 THE NINETEENTH ANNUAL REPORT FOR THE YEAR 1936, 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. There has been no further development or extension to the services during the year. The work has continued along similar lines to that of the previous year and has been operated by the same four dental officers, nurses and anaesthetist. Radiology. Radiographic evidence of the condition of the teeth is now regarded as an essential preliminary to clinical examination and treatment. X-ray apparatus has become an indispensable part of the dental surgeon's armamentarium and the taking of X-ray photographs a routine practice. By this means, unsuspected disease tissue associated with root fragments, infected teeth, cysts and all such pathological conditions, which so insidiously undermine the health of the individual, are brought to light and adequately dealt with by the most suitable treatment. The Council attempted to meet these requirements in 1934, when negotiations were carried through for the X-ray of dental patients at the Willesden General Hospital. These facilities have proved to be a valuable aid in securing efficiency and accuracy in treatment, and have been appreciated by the dental officers, parents and patients. These few general remarks concerning the use of X-ray in dental practice are, of course, common knowledge, but it is not so generally understood that these same methods offer invaluable means of disclosing incipient caries of the teeth, particularly in children. Some of the most vulnerable areas of decay (interstitial caries) defy detection even by experienced persons working with the usual instruments. These areas readily come into view in Radiographs, and means can be adopted of easily and quickly preserving innumerable teeth, which would otherwise be decayed beyond repair, or at least extensively diseased. It is to these latter remarks that one desires particularly to direct attention namely, the value of Radiography in the elementary school dental service as a part of the scheme of preventive dentistry. The Board of Education recognises the value of detecting early caries and sanctions the installation of complete X-ray outfits by local authorities at their Health Centres. Willesden, sooner or later, will need to consider such an extension for the benefit of the community under their care. The Year's Work. The total working sessions for the year amounted to 1,974, which were utilized as follows:— Treatment sessions at the Centre 1,610 Routine inspection sessions 337 Administrative sessions 27 Total 1,974 Sessions lost on account of sickness 25 Total sessions attended by anaesthetist 186 21,858 mothers, infants, elementary and secondary scholars were inspected. 15,419 or 70 per cent, were defective and 5,606 or 36 per cent, were treated at the Centres. 15,118 teeth were extracted, 9,030 fillings done and 6,540 sundry operations, making a total of 30,688 treatments. 17,550 attendances were registered by these patients. A summary of the work is given in the Table (No. 38) below, with comparative figures for the two preceding years. 58 Table No. 38. Comparative Table of Work done for Years 1934, 1935 and 1936. 1934. 1935! 1936. Total Inspected :— Mothers, Infants and School Children 20,953 21,638 21,858 Number defective 13,934 15,083 15,419 Number treated 5,323 5,654 5,606 Teeth removed 16,355 14,764 15,118 Teeth filled 8,773 9,501 9,030 Sundry operations 5,841 6,125 6,540 General anaesthetics 3,883 3,777 4,127 Treatment sessions 1,570 1,575 1,610 Inspection sessions 347 347 337 It will now be noticed that the figures have varied but little from the previous year. The number of extractions has increased by 354, and the number of fillings decreased by 471. The average work done on a sessional basis is set out in the following Table together with the years 1934 and 1935. Table No. 39. Comparative Table of Work per Session. Year. Attendances. Fillings. Extractions. Sundries. Total operations per Session. 1934 9.9 5.6 10.4 3.7 19.7 1935 11.5 6 9.3 3.9 19.23 1936 10.9 5.6 9.4 4 19 Anesthetics. 186 general anaesthetic sessions were held, during which 4,127 cases were treated ; an average of 22 per session. Included in this figure are a number of pulp extirpations and cavity preparations. The method of administration was the same as previously, namely, nasal gas oxygen, supplemented occasionally, in the cases of young children, with ethyl chloride spray. Local anaesthetics were used on 777 occasions, a figure exceeding the previous year by 458. The majority of these cases were for cavity preparations in conservative dentistry and not for tooth extraction, which continues to decrease in favour of general anaesthetics. ELEMENTARY, NURSERY AND SPECIAL SCHOOLS. Inspection. Routine.—16,338 children out of an approximate school population of 21,000 were inspected during 305 visits, an average of 53 examinations per session. 12,249 children or 75 per cent, were found defective and referred for treatment. Complete recording of all defects found was done, and pamphlets issued as in former years. The invitations sent to parents to be present at the schools were accepted in large numbers at the infant and the junior schools. Special Cases.—1,535 children attended the Centres for inspection, an advance of 191 over last year's equivalent. Included in this number are many children who attended for advice between periods of their routine inspections and treatments, and were not all cases of neglect as is usually surmised. Treatment. Out of the total of 12,249 children referred as defective, 4,129 received treatment at the Centres, an acceptance rate of 33.7 per cent. Parents are not so negligent of their children's teeth as this rate suggests. Easier facilities to attend the Centres for treatment are necessary. It must be pointed out, however, that the present staff could not deal with a further influx oi children in addition to the 2,500 odd secondary school children brought into the scheme last year. 9,291 teeth were extracted of which 1,433 were permanent. 5,693 fillings were done on permanent teeth and 763 on temporary, making a total of 6,456. In addition, 3,518 sundry treatments were performed. These include root fillings to anterior teeth, gum treatments, dressings of zinc oxide and sedatives, together with silver nitrate applications to temporary dentitions. 10,639 attendances for treatment were registered at the Centres. Treatment sessions totalled 1,062, and the average work done is indicated in the Table below. 59 Table No. 40. Work done per Session. Attendances. Fillings. Extractions. Sundries. Total operations. 10 6 8.7 3.3 18 Tables Dealing with the Work Done on Elementary School Children during the Year. Table 41, corresponding to Table IV of the Board of Education's Statistical Tables, Group V— Dental inspection and treatment. (1) Number of children who were inspected by the Dentist— (a) Routine age.groups— Children attending Nursery Schools. Aged :— Children attending Public Elementary Schools. Children attending Special Schools. 2 — — 1 3 — — 61 4 105 — 164 5 883 — 62 6 1,698 1 — 7 1,716 3 — 8 1,861 10 — 9 1,733 19 — 10 1,871 15 — 11 1,572 21 — 12 1,445 25 — 13 1,678 38 — 14 1,191 37 — 15 80 30 — 16 — 18 — Total 15,833 217 288 (b) Specials 1,494 19 22 (c) Total (Routine and Specials) 17,327 236 310 (2) Number found to require treatment 11,913 149 187 (3) Number actually treated at the Authority's Health Centres 4,054 28 47 (4) Attendances made by children for treatment 10,466 89 84 (5) Half days devoted to Inspection 295J 4 H Treatment 1,046 8 8 Total 1,341½ 12 13£ (6) Fillings Permanent teeth 5,655 38 — Temporary teeth 739 2 22 Total 6,394 40 22 (7) Extractions Permanent teeth 1,395 60 Temporary teeth 7,722 20 134 Total 9,117 80 134 (8) Administration of general anaesthetics for extractions 2,957 18 40 ,, Local anaesthetics 556 - — (9) Other operations Total 3,513 18 40 —Permanent teeth 3,269 23 Temporary teeth 221 - 5 Total 3,490 23 5 60 Table No. 42. 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 1936 at Health Visitor's last visit. Total number of defects coming under observation during 1936 : Brought forward, 1935 693 New during year 6,218 6,911 Number of defects treated :— Health Centre 3,858 Otherwise 73 3,931 Percentage of defects followed up needing treatment which were known to have received treatment 58 per cent. No report available 10 Number of defects for which no treatment had been undertaken at Health Visitor's final visit 1,978 Carried forward to 1937 904 Number not needing treatment 88 Willesden Secondary and Junior Technical Schools. Inspections. Thirty-two visits were made to the Schools; 2,303 pupils inspected, thus making an average of 72 per session. In addition, 20 cases were inspected at the Centres, totalling 2,323. 1,574 or 68% were found defective, which is a slight improvement in the condition of the teeth on last year's 69%. Treatment. There has been a noteworthy increase in the amount of work done for these scholars, 561 or 35-6% of the total defective were treated at the Centres against 441 or 27-2% last year. The number of fillings done have risen from 1,008 to 1,327, and teeth extracted from 299 to 354. Of the latter, 302 were permanent. Sundry operations totalled 1,012 against 509. Attendances made by the children amounted to 1,896, and the total treatment sessions were estimated at 180. A Table of the year's work in the respective groups may be surveyed below. Table No. 43. (1) Number of pupils who were inspected by the Dentist— (a) Routine age-groups— Willesden Junior Technical Schools. Willesden Secondary Schools. Total. Aged:— 9 - 5 5 10 - 17 17 11 - 72 72 12 - 304 304 13 47 380 427 14 201 327 528 15 213 320 533 16 77 250 327 17 3 70 73 18 - 15 15 19 - 2 2 Total 541 1,762 2,303 (b) Specials 9 11 20 550 1,773 2,323 (2) Number found to require treatment 380 1,194 1,574 (3) Number actually treated at the Authority's Health Centres 97 464 561 (4) Attendances made by pupils for treatment 272 1,624 1,896 (5) Half days devoted to Inspection 7 25 32 Treatment 27 162 189 Total 34 187 221 61  Willesden Junior Technical Schools. Willesden Secondary Schools. Total. (6) Fillings Permanent teeth 221 1,090 1,311 Temporary teeth - 16 16 Total 221 1,106 1,327 (7) Extractions Permanent teeth 64 238 302 Temporary teeth - 52 52 Total 64 290 354 (8) Administration of general anaesthetics for extractions 27 151 178 „ ,, local anaesthetics ... — — — Total 27 151 178 (9) Other operations Permanent teeth 49 953 1,002 Temporary teeth — 10 10 Total 49 963 1,012 Maternity and Child Welfare. The year's returns again show evidence of expansion. 1,662 mothers and infants were inspected, an increase of 50. 906 were treated at the Centres against 890, making 16 more than 1935. A full summary of the year's work is given in the table below. Expectant and Nursing Mothers and Children under Five. Table No. 44. E.M. N.M. 0-5. Total. Number inspected 814 374 474 1,662 Number brought forward from previous year 150 167 48 365 Total number under observation during year 964 541 522 2,027 Number completed 260 290 318 868 Number partially completed 19 2 27 48 Number not availing themselves of treatment 470 70 57 597 Number treated by other agencies 7 1 — 8 Number carried forward 194 172 74 440 Number of attendances 2,228 1,904 883 5,015 Number of teeth removed 2,264 2,109 1,060 5,433 Number of teeth filled 603 307 337 1,247 Number of other operations on the gums and teeth 866 1,040 104 2,010 Number of general anaesthetics 351 300 283 934 Number with no defect 14 6 46 66 Number of local anaesthetics 76 80 13 169 Treatment sessions — 359 Number of Patients who received Dentures during 1936. Table No. 45. At cost to Council. At cost to Applicant. At part cost to applicant. Total. 221 (including 1 remodelling) 3 56 280 62 THE SEVENTH ANNUAL REPORT FOR THE Year ending 31st December, 1936, on the SUPERVISION OF MIDWIVES. Table No. 46. Number of Midwives who gave notice of their Intention to practise in Willesden in 1935 and 1936 respectively. 1935 1936 In Willesden— 1. Private District Midwives 15 13 2. Queen Charlotte's District Home, 40, Princess Road, Kilburn, N.W.6. 6 8 3. Central Middlesex County Hospital 12 14 Outside Willesden— 1. Private District Midwives 12 13 2. Queen Charlotte's District Home, 176, Ladbroke Grove, Kensington 4 6 3. Kilburn and West Hampstead District Nursing Association, 20, Dennington Park Road, Hampstead, N.W.6 5 7 Total 54 61 Table No. 47. Number of Cases attended by Midwives practising and living in Willesden during 1936. Private District Midwives. No. of Cases attended Total. Remarks. As Midwife. As Maternity Nurse. 1 20 2 - 2 127 34 - 3 43 8 - 4 9 5 - 5 12 1 - 6 38 4 - 7 31 1 - 8 44 7 - 9 22 9 - 10 2 0 - 11 0 0 - 12 0 2 - 13 1 1 - Midwives attached to Willesden District Nursing Association, 17 and 19, Park Avenue, N.W.2 0 179 - Midwives attached to Queen Charlotte's Hospital District Home, 40, Princess Road, N.W.6 263 0 - Midwives at the Central Middlesex County Hospital, Acton Lane, N.W.10 *730 *40 *These 770 patients were all confined in the Central Middlesex County Hospital. Total 1,342 293 = 1,635 in all. From Table No. 47 it will be observed that Midwives practising and living in Willesden attended 1,342 cases as Midwives and 293 cases as Maternity Nurses or 1,635 in all. These cases were not all Willesden cases and were not all attended in Willesden. Apart from institutions or associations, the largest number of midwifery cases any single one of these Midwives attended as a Midwife was 127, and the largest total of cases any single one of these Midwives attended was 161, being 127 cases attended as Midwife and 34 as Maternity Nurse. 63 Table No. 48. Number of Cases attended by Midwives practising in but living outside Willesden during 1936. Private District Midwives. No. of Cases attended in Willesden. Total. As Midwife. As Maternity Nurse. A 1 4 B 2 0 C 3 1 D 0 0 E 3 1 F 2 0 G 7 1 H 2 0 I 2 0 Midwives attached to Kilburn and West Hampstead District Nursing Association, 20, Dennington Park Road, Hampstead, N.W.6 69 0 Midwives attached to Queen Charlotte's Hospital District Home. 176, Ladbroke Grove, W.10 27 0 Total 118 7 Table No. 49. Notifications received from Midwives in accordance with the Rules of the Central Midwives Board, 1st January to 31st December, 1936. From Midwives living and practising in Willesden. From Midwives practising in Willesden but living outside. Notifications of:— Sending for Medical Help 92 56 Having laid out a dead body 13 3 Liability to be a source of infection 12 7 Death of child 3 2 Still Birth 9 1 Artificial feeding 2 7 Total 131 76 64 Table No. 50. Reasons for Sending for Medical Help. For Mother. Medical Help sought by Midwives. For Child. Medical Help sought by Midwives. Living in Willesden. Living outside Willesden. Living in Willesden. Living outside Willesden. Ante-Natal examinations - - Abscess in neck 1 Ante-partum haemorrhage 3 6 Baby found dead - 1 Albumen in urine 2 1 Bleeding from rectum 1 — ? Anaemia 1 — Abnormal presentation 2 1 Complicated breech presentation 4 Cyanosis of infant 1 2 Continuous Vomiting 1 1 Cough and pain in chest 1 6 Dangerous feebleness 3 Collapsed condition of patient after delivery 1 Discharge from eyes 1 6 Delayed labour 3 1 Foetal distress 1 — Delayed second stage of labour 8 1 Haemorrhage from umbilical cord 1 - Laceration of perineum 22 8 cord Insufficient Breast milk - -1 Miscarriage 1 1 Post partum haemorrhage 1 2 Premature baby 5 1 Retention of urine 2 - Persistent posterior position 3 Septic finger 1 - Suspicious spots on body 1 1 Persistent rapid pulse rate 1 Spina bifida - 1 Persistent vomiting - 1 Unsatisfactory condition of child - 1 Pyelitis of pregnancy 1 - Pain in left side with vomiting and diarrhoea - 2 Watery blisters on face - 1 Report on right leg before discharge of patient 1 Rise of temperature 8 1 Ret ained placent a ... 3 1 Sore throat and general debility 1 Symptoms of influenza 1 - Secondary Post-partum haemorrhage ... 1 - Swelling of legs and backache 1 - Threatened miscarriage 3 - PThrombosis of leg 1 1 Varicose veins — 4 Varicose ulcer and oedema 1 - Varicose veins and cough — 1 Total 73 40 J 19 16 V 113 T 35 Table No. 51. Fees Paid to Medical Practitioners under Section 14 of the Midwives Act, 1918. 1st January to 31st December, 1936. Number of notifications of Sending for Medical Help 148 ,, „ „ in respect of which fees paid 92 Total fees paid by Council £111 16s. 0d. 65 Table No. 52. Cases in which the Council paid or contributed to the fee of a Midwife during 1936. No. of cases. Fees paid by Council. Midwife acting as Midwife 180 - Midwife acting as Maternity Nurse 13 - Total 193 £340. Table No. 53. 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... 50 (6) 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. 4 are allocated to Maternity nursing only. The remainder do Maternity Nursing as required.) 3 (Queen Charlotte's Hospital District Home, 40, Princess Road, Kilburn.) (iv.) employed by Voluntary Associations outside Willesden 7 (Queen Charlotte's Hospital District 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— 180 where the midwife was acting as a midwife. 13 where the midwife was acting as a maternity nurse. II. (a) Number of cases in the area of the Local Supervising Authority attended by midwives during the year :— (i.) As midwives 1,336 (ii.) As maternity nurses 291 (b) Number of cases in the area of the Local Supervising Authority in which medical aid was summoned during the year by a midwife under Section 14 (1) of the Midwives Act, 1918—148. 66 THE SEVENTH ANNUAL REPORT FOR THE Year ending 31st December, 1936, on the REGISTRATION OF NURSING HOMES. NURSING HOMES REGISTRATION ACT, 1927. Table No. 54. Maternity and Nursing Homes, 1st January, 1936, to 31st December, 1936. (1) Number of applications for registration :— (a) Maternity Homes 0 (b) Nursing Homes 1 (2) Number of Homes registered 1 (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 1 At the close of the year there were 6 Nursing Homes on the Register of the Corporation of Willesden with accommodation for 32 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. 67 THE SEVENTH ANNUAL REPORT FOR THE Year ending 31st December, 1936, 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 1st January, 1933. These provisions amend Part 1 of the Children Act, 1908. The principal amendments are as set out in the 1933 Annual Health Report, page 61. Two foster children died during the year. The cause of death in one case was certified as broncho-pneumonia and in the other as infantile convulsions due to the pressure of large hard milk curds in stomach and bowels. No inquests were held in connection with deaths of foster children in 1936. In addition, four children died in hospital within 3 hours to 10 days of admission to hospital from foster homes. The causes of death were certified as :—1. Convulsions, Whooping Cough, Rickets ; 2. Whooping Cough and Pneumonia ; 3. Gastro-Enteritis ; 4. Measles and Pneumonia. Proceedings were taken in one case for failure to notify reception of child. An application from this Foster Mother to keep a Foster Child had been refused by the Council in 1933. She was sentenced to 14 days' imprisonment. Table No. 55. Foster Mothers. Number of Foster Mothers at 31st December, 1935 115 Number of Foster Mothers at 31st December, 1936 124 Number of Licenses granted by Council in 1936 40 „ „ refused by Council in 1936 9 Number of applications to take additional children agreed to by Council ... 6 „ ,, ,, „ ,, refused by Council 1 Number of applications for re-issue of License agreed to by Council 16* „ „ „ „ refused by Council 1 Foster Children. Coming under observation— Number of Foster Children at 31st December, 1935 170 Number of Foster Children received during 1936 276 Number entered Willesden with their Foster Mothers 7 Total 453† * In these 16 cases the licenses were re-issued in respect of new premises. † The actual number of new individual Foster Children who came under observation was 186. 68 Removed from observation— Number given up 233 ,, reached the age of 9 years 12 „ died 2 „ legally adopted 2 ,, ceased to be taken for gain or taken over by Public Assistance „ Committee ... 2 ,, left Willesden with their Foster Mothers 7 Total 258 Remaining under observation— Number of Foster Children at 31st December, 1936— (a) Under 5 years of age. 145 (b) Between 5 and 9 years of age 51 Total 196 Table No. 56. The 196 Foster Children under observation at 31st December, 1936, were maintained in the care of Foster Mothers as follows :— Maintained by— Parent or Guardian 161* Crusade of Rescue, 48, Compton Street, W. 29 National Adoption Society, 4, Baker Street, W. 4 Church Army 2 Received with lump sum ... 0 Total 196 * In 44 cases the parent or guardian was living in Willesden at the time the child entered the care of the Foster Mother. In 117 of these cases the parent or guardian was not living in Willesden at the time the child entered the care of the Foster Mother. Table No. 57. The following Table shows the length of time each of the 196 Foster Children under at 31st December, 1936, had been in the care of their Foster Mothers. Under 6 months . 68 Over 6 months, under 1 year 49 Over 1 year, under 1J years 23 Over 1| years, under 2 years 10 Over 2 years, under 2| years 13 Over 2J years, under 3 years 12 Over 3 years, under 3J years . 8 Over 3J years, under 4 years . 3 Over 4 years, under 4| years 1 Over 4J years, under 5 years 2 Over 5 years, under 5| years 1 Over 5| years, under 6 years 3 Over 6 years, under 6J years 0 Over 6J years, under 7 years 1 Over 7 years, under 7£ years 0 Over 1\ years, under 8 years 1 Over 8 years, under 8£ years 1 Over 8J years, under 9 years 0 Total ... 196 Of the 356 individual Foster Children under observation during the year 1936, 206 changed hands during that period. 139 made 1 change, 35* made 2 changes, 18 made 3 changes, 14 made 4 changes. These changes do not include the first reception of the child. * Of these, 10 were admitted to Hospital returning to same Foster Mother. THE SEVENTEENTH ANNUAL REPORT for the Year ending 31st December, 1936, on HOME NURSING. A record of work done is given in the three following tables :— Table No. 58. Showing sources from which cases were referred for Home Nursing during the Year 1936. Referred by Number. Health Department 382 Private Doctors 24 Others 18 Total 424 Table No. 59. Showing cases Home Nursed in Wards during 1936. Ward. No. of Cases brought forward from 1935. No. of Cases referred in 1936. Total. No. of Visits paid. 1. Carlton 2 143 145 1,958 2. Kilburn 1 110 111 1,020 3. Brondesbury Park 1 7 8 42 4. Kensal Rise — 10 10 137 5. Manor — 4 4 25 6. Harlesden 1 9 10 182 7. Stonebridge — 14 14 111 8. Roundwood — 14 14 90 9. Church End — 12 12 70 10. Willesden Green. — 23 23 153 11. Mapesbury 1 37 38 451 12. Neasden — 23 23 160 13. Cricklewood — 18 18 144 Total 6 424 430 4,543 70 Table No. 60.—Showing Cases dealt with during 1936 and Results. Disease. Cases being Nursed at end of 1935. New Cases during 1936. Removed from Observation during 1936—Results of Treatment. Still being Nursed at end of 1936. Number of Visits Paid during 1936. Died. Removed to Hospital or other Institution. Recovered. Expectant 1 Mothers. Nursing Mothers. Children under Five. School Children. Others. Total. Expectant 1 Mothers. Nursing Mothers. Children under Five. School Children. Others. Total. Expectant I Mothers. Nursing Mothers. Children under Five. School Children. Others. Total. Expectant Mothers. Nursing Mothers. Children under Five. School Children. Others. Total. Expectant 1 Mothers. Nursing Mothers. Children under Five. School Children. Others. Total. Expectant 1 Mothers. Nursing Mothers. Children under Five. School Children. Others. Total. Expectant I Mothers. Nursing Mothers. Children under Five. School Children. Others. 1 Total. Bathing Cases - - - - - - - - 3 - - 3 - - - - - - - - -- - - - - - 3 - - 3 - - - - - - - - 11 - - 11 Bronchitis - - - - - - - - - - - 2 - - - - - - - - - - - - - - 3 - - 3 - - - - - - - - 8 - - 8 Burns and Scalds - - - - - - - - 7 3 - 10 - - - - - - - - - - - - - - 6 3 - 9 - - 1 - - 1 - - 41 33 - 74 Cervicitis - - - - - - - - - - - 1 - - - - - - - - - - - - 1 - - - - 1 - - - - - - 7 - - - - 7 Chilblains - - - - - - - - - 3 - 3 - - - - - - - - - - - - -- - - 3 - 3 - - - - - - -- - - 27 - 27 Circumcision - - - - - - - - 5 - - 5 - - - - - - - - - - - - - - 5 - - - - - - - - - - - 24 - - 24 Confinement Case - - - - - - - 1 - - - 1 - - - - - - - - - -- - - - 1 - - - 1 - - - - - - - 7 - - - 7 Constipation - - - - - - 2 1 - - - 3 - - - - - - - - - - -- - 2 1 - - - 3 - - - - - - 55 - - - - 56 Douching Case - - - - - - - - - - - - - - - - - - - - - - - - - - - - 24 Eczema - - - - - - - - 7 - - 7 - - - - - - - - - - - - - - 6 - - 6 - - - - - 1 - - 172 - - 172 Haemorrhoids - - - - - - 1 - - - - - - - - - - - - - - - - - 1 - - - - 1 - - - - - - 5 - - - - 5 Impetigo - - - - - - - 1 17 2 — 20 - - - - - - - - 2 - - 2 - 1 15 2 - 18 - - - - - - - 6 155 8 - 169 Interstitial Keratitis - - - - - - - - - 1 - 1 - - - - - - - - - - - - - - - - - - - - - - - - - - 4 - 4 Mastitis - - - - - - - 7 1 - - 8 - - - - - - - - - - - - - 7 1 - - 8 - - - - - - - 42 6 - - 48 Measles - - - - - - - - 1 - - 1 - - - - - - - - - - - - - - 1 - - - - - - - - - - - 9 - - 9 Ophthalmia - - - - - - - 1 63 1 - 65 - - - - - - - - 1 - - 1 - 1 62 1 - 64 - - - - - - - 10 671 23 - 704 Ophthalmia Neonatorum - - - - - - - - 6 - - 6 - - - - - - - - - - - - - - 5 - - 5 - - 1 - - 1 - - 88 - - 88 Otorrhoea - - 2 - - 2 - 1 37 16 - 54 - - - - - - - - 1 2 - 3 - 1 34 13 - 48 - - 4 1 - 5 - 10 1013 279 - 1302 Paralysis Rt. Arm - - - - - - - - 1 - - 1 - - - - - - - - - - - - - - 1 - - 1 - - - - - - - - 5 - - 5 Phlebitis - - - - - - 1 - - - - 1 - - - - - - - - - - - - 1 - - -- - 1 - - - - - - 8 - - -- - 8 Pneumonia - - 1 - - 1 - - - - - - - - - - - - - - - - - - - - 1 - - 1 - - - - - - - - 1 1 Puerperal Pyrexia - - - - - - - 2 - - - 2 - - - - - - - - - - - - 2 - - - 2 - - - - - - - -- - - 58 Pyelitis - - - -- -- - 1 - - - - - - - - - - - - - - - - - 1 - - - - 1 - - - - - - 1 - - - - 1 Pyrexia - - - - - - - 1 - -1 - - - --- - - - - - - - 1 - 3 - - - - - 1 - - - - - - - 8 - 8 - 16 Roundworms - - - - - - - - 1 - - 1 - - - - - - - - - - - - - - - - 1 - - - - - - - - - - 3 Septic Conditions - - --- - - - 1 5 68 14 - 88 - - - - - - - - 2 - - 9 1 6 63 14 - 83 - - 3 - - 3 1 31 620 95 - 747 Skin Conditions - - - - - - - - 5 - - - - - - - - - - - -- - - - - - 4 2 - 6 - - - - - 1 31 7 - 38 Thread Worms — — — 1 — 1 - 2 74 49 — 125 - - - - - - - - - - - - - 1 71 50 — 122 — 1 3 - - 4 - 10 437 370 - 817 Throat Conditions - - - - - - - - 1 - - 1 - - - - - - - - - - - - - 1 - -1 - - - - - - -- - 3 - - 3 Varicose Ulcer - - - - 1 1 - - - -- 1 1 - - - - - - - - - - - - - - - - 1 1 - - - - 1 1 - - - - 107 107 Total - --- 4 1 1 6 0 22 299 62 1 424 - - - - - - - 6 4 - 10 9 21 283 88 1 402 1 1 14 1 1 18 101 183 3298 854 107 4543 71 THE TWENTY-SECOND ANNUAL REPORT for the Year ending 31st December, 1936, 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 3rd February, 1934, the feeding of school children on seven days a week instead of on five days a week, 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. On 30th April, 1934, breakfasts were commenced at all the Education Committee's Centres, and also at the Granville Road Voluntary Centre. The Corporation of Willesden decided to raise the economic scale Is. per head on 1st April, 1934, and to allow all children in receipt of free dinners also to receive free breakfasts. The breakfasts consist of cocoa made with milk, brown or white bread and butter with jam or marmalade or currant bread and butter. 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 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 application forms presented to the Education Committee's Centres throughout the year was 594. 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. Kilburn Breakfasts.—Breakfasts have also been supplied at the Voluntary Centre, Granville Road on five days a week, as from 30th April, 1934. The price paid by the Local Authority to this Voluntary Centre is 5d. for each dinner and 3d. for each breakfast. The provision of breakfasts at Carlton Vale School House has also been continued throughout the year, the arrangement being carried out by the Caretaker. Breakfasts have been given on six days a week instead of five days a week as heretofore, as from 30th April, 1934. The number of application forms received from the South Kilburn area for the year was 295. Meals.—A 15 day menu was commenced in all feeding centres on 2nd April, 1934. This provides two soup dinners, two cheese, one fish, one roast, and one boiled meat, two stews, three pie or pudding, and three minced meat dinners, each being followed by a pudding, or stewed fruit and custard. Fresh fruit is provided once each week. The price per meal charged by the Local Authority to non-necessitous cases is 5d. 72 STATISTICAL INFORMATION, YEAR ENDING 31st DECEMBER, 1936. Table No. 61.—No. of Meals Supplied. Supplied to :— Breakfasts. Dinners. Free. Free. Paying. Total. Education Committee's Centres 14,610 116,218 1,785 132,613 Kilburn Voluntary Centre 19,222 72,660 — 91,882 Special Schools — 14,472 14,500 28,972 Feeding Centre Assistants 3,410 3,945 — 7,355 37,242 207,295 16,285 260,822 Table No. 62.—Occupation List, 1936. Occupation. No. of Children Fed during 1936. No. of Families Involved. Percentage. 1935 1936 1935 1936 Unemployed 719 348 289 54.54 48.41 Widows 108 77 52 12.07 8.71 Deserted Wives 53 34 33 5.33 5.53 Orphans 5 3 2 .47 .33 Labourers 317 50 108 8.00 18.09 Railwaymen 30 12 9 1.88 1.51 Hawkers 34 21 13 3.29 2.18 Others 183 93 91 14.58 15.24 1,449 638 597 # Approximate average cost of food only 3.19d. Total (gross) 5T6d. 73 THE FORTY-FIFTH ANNUAL REPORT on the MUNICIPAL HOSPITAL By ARTHUR G. TROUP, M.D., D.P.H. Medical Superintendent. During 1936, 1,754 patients were admitted to hospital as compared with 1,156 in 1935, 1,425 in 1934, 1,201 in 1933, 869 in 1932, and 842 in 1931. During the year the new scheme for treating children suffering from enlarged tonsils and adenoids came in force, and 383 cases were admitted to hospital for operation. This partially accounts for the increase in number of patients dealt with. Cerebro-Spinal Fever. Four cases of this disease were treated in hospital during the year and one death occurred. The fatal case occurred in a child one year of age, and proved on post-mortem examination to be the posterior basal type of the disease. On the tenth day of illness a blockage occurred at the base of the brain, and it was impossible to obtain cerebro-spinal fluid either by lumbar or cisternal puncture. Diphtheria. 290 cases were admitted to hospital as compared with 364 cases during 1935. These may be classified as follows:—Faucial 153, Naso-Pharyngeal 64, Nasal 46, Laryngeal 11, Aural 11, and 5 Carriers. The total cases under treatment was 337. It was necessary to perform the operation of tracheotomy on five of the laryngeal cases, four of which recovered and one died. The mortality rate of 5.6 per cent. shows an increase of 1.5 per cent. over the rate for last year. Of the 19 fatal cases, eight died within 24 hours of admission to hospital, and three within two days. The immediate causes of death were toxaemia 12 cases, myocarditis six cases, and laryngeal obstruction in one case. Enteric Fever. Five cases of Typhoid Fever and one of Paratyphoid Fever B were admitted during the year. All were of a moderate type and no deaths occurred. Erysipelas. Forty-eight cases of this disease were treated during the year. One death occurred. Measles. Measles was epidemic during 1936, and 237 cases of this disease were treated in hospital. 16 deaths occurred, giving a case mortality rate of 6.7 per cent. The chief complications were Pneumonia 45 cases, Enteritis five cases. Convulsions and Cancrum Oris one case each. Convalescent Measles Serum. As practically always occurs during an epidemic, patients suffering from diphtheria or scarlet fever and incubating measles were removed to hospital and admitted to the diphtheria or scarlet fever wards respectively. The following table records the number of such patients, the number of susceptible contacts and the results obtained by the administration of convalescent measles serum. Ward. Date of admission. Date developed measles. No. of susceptible contacts. Dose of serum. Result obtained. D 4-2-36 8-2-36 3 15 c.c. All protected. D 5-2-36 8-2-36 D Nurse in Ward 22-2-36 1 10 c.c. Protected. F 15-2-36 25-2-36 6 10 c.c. One patient developed an attenuated attack. F 23-3-36 5-4-36 9 10 c.c. One patient developed an attenuated attack. G 28-1-36 7-2-36 11 15 c.c. Two patients developed attenuated attacks. i Totals :—6 cases 30 Four attenuated attacks. 26 fully protected. 74 Character of the Attenuated Attacks. All four cases were characterised by the mildness of the attack. The catarrhal symptoms were present in slight degree, the rash was faint, of morbilliform character and usual distribution. In one child the temperature reached 100°, in another 99.8°, in another 99° and in the fourth it remained normal. These pyrexias lasted only one day. At the time of writing, we have 2,255 c.c.'s of convalescent serum in stock. Mixed Infections. Measles and Whooping Cough 4 Whooping Cough and Chicken-pox . 3 Scarlet Fever and Whooping Cough 2 Scarlet Fever and Chicken-pox 2 One death occurred from Measles and Whooping Cough. Puerperal Fever and Puerperal Pyrexia. The 12 puerperal cases which were admitted to hospital were diagnosed as follows :— Local Uterine Sepsis . 2 Rupture of Perineum 1 Mammary Abscess 3 Common Cold — . 1 Mastitis 1 Influenza 1 Puerperal Insanity 1 Mumps 1 Neurasthenia 1 All these patients made good recoveries and no deaths occurred. Scarlet Fever. The number of cases treated in hospital was 487 as compared with 428 for the previous year. No deaths occurred. Whooping Cough. One hundred and one cases were treated and nine deaths occurred, six of which were due to Bronchopneumonia, two to Gastro-Enteritis and one to Convulsions. Other Diseases. Tonsillitis 87 Mastoiditis 2 Chicken-pox 15 Influenza 2 Bronchitis 11 Pneumonia 2 Rubella . 10 Food Rash 1 Erythema10 Herpes . 1 Mumps 8 Contusions 1 Laryngitis 8 Insect Bites 1 Gastro-Enteritis 8 Cellulitis 1 Quinsy 5 Burn 1 Septic Sores 5 Congenital Stenosis of Pylorus 1 Rhinitis 4 Abscess 1 Ophthalmia Neonatorum 4 Stomatitis 1 Drug Rash 3 Foreign body in ear 1 Impetigo 3 Streptococcal Carrier 1 Otitis Media 3 Adenitis 1 Poliomyelitis 2 Boil Meatus 1 Rheumatism 2 Negative Cases 11 Total cases —218. Two deaths occurred, one from cellulitis and the other as the result of a severe burn. Both the patients were admitted as they were also suffering from a mild attack of diphtheria. " Marasmus " Cases. Since April 1st, 1936, infants suffering from " Marasmus " have been admitted to the hospital for treatment, and the total number so admitted has been 24. These cases may be classified as follows :— Dietetic Diarrhoea14 Infective Diarrhoea 5 Convulsions 1 No appreciable disease—under normal weight 4 Deaths 5 24 The arrangements necessary for these cases are under consideration in connection with the Health Extension Programme of the Authority. 75 Ear, Nose and Throat Cases. On April 1st, 1936, a special clinic to deal with ear, nose and throat conditions occurring in school children and children under school age was opened, and 383 cases have been dealt with. Sick Staff. Six cases of infectious disease occurred amongst the Nursing Staff, namely Scarlet Fever 3, Diphtheria 2, and Measles 1. One case of Diphtheria occurred amongst the Domestic Staff. Duration of Stay in Hospital. Scarlet Fever. The average length of detention of Scarlet Fever patients in hospital is less than last year, as the following table shows :— 1926 47.2 days 1934 33.3 days 1928 37.0 „ 1935 37.6 „ 1933 32.1 „ 1936 35.0 „ Diphtheria. The average length of detention of Diphtheria patients shows an increase:— 193156.2days 1934 42.1 days 1932 45.6 „ 1935 46.5 „ 1933 42.0 „ 1936 49.1 „ Schick Test and Active Immunisation against Diphtheria. 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 11 cases of diphtheria have occurred :—1 in 1927, 1 in 1928, 1 in 1929, 2 in 1930, 1 in 1932, 2 in 1934, 1 in 1935, and 2 in 1936. The details of the latter two cases are as follows :—Staff Nurse W. W. commenced duties at the hospital on 1-6-35. She was Schick tested on 6-6-35, gave a positive reaction and immunised. On 14-3-36 she reported sick. On examination a small amount of exudate was found to be present on both tonsils, and the swab proved positive to K.L. bacillus. She made an uneventful recovery. Probationer Nurse M. M. commenced duties on 29-3-35. She was Schick tested on 29-4-35, gave a positive reaction and immunised. On 11-9-35 she was again Schick tested and found to give a negative reaction. On 14-3-36 she reported sick. On examination a patch of membrance was found to be present on the left tonsil only and the swab was positive to K.L. bacillus. Apart from a slight serum reaction she made an uneventful recovery. Table No. 63. (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 1936 (after immunisation was carried out) ... 11 (4) Incidence rate per annum (taking 30 as average number of probationer nurses) 3.7% (5) Number of nurses Schick tested (1927-1936 inclusive) 254 (6) Number of nurses giving a positive reaction 117 (7) Percentage of nurses giving a positive reaction . 46.0% (8) Number of nurses re-Schick tested 57 (9) Number of nurses re-Schick tested giving a positive reaction 17 (10) Percentage of nurses re-Schick tested giving a positive reaction 29.8% Willesden Residents. This clinic was made available for Willesden residents in May, 1927. The following are the figures for the years 1927 to 1936 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 1935 351 276 1936 238 201 76 It will be observed that the number of individuals attending the clinic is smaller than in 1935, but considerably larger than in any other previous year. Further particulars regarding this year's attendances are as follows :— (1) Number of persons attending:— 1-5 years174 5-14 years (school children)187 Over 14 years (adults and Secondary school children)4 (2) Schick Test:— 365 Primary Positive 76 Negative 38 114 Secondary Positive 6 Negative 117 123 Grand total 237 (3) Immunisation :— Number immunised 195 Number re-immunised 6 201 (4) Total Attendances 1,043 (5) Incompleted cases :— Nine cases failed to attend a sufficient number of times for the complete course of immunisation injections to be carried out. (6) Two cases attended the clinic for the Schick Test and the subsequent immunisation was carried out by their private doctor. (7) The diphtheria prophylactic used for immunising purposes was Toxoid-Antitoxin Floccules (T.A.F.) and in no case was there any reaction. Table No. 64. Diseases. In Hospital on 1-1-36. Admitted. Total under Treatment. Discharged recovered. Died. Mortality per cent. Remaining on 31-12-36. Cerebro-spinal Fever 4 4 2 1 25.0 1 Diphtheria 51 286 337 251 *21 5.6 65 Diphtheria Bacteriological - 4 4 4 - - - Enteric Fever - 6 6 6 — — — Erysipelas 5 43 48 45 1 2.1 2 Measles 12 225 237 219 16 6.7 2 Mixed Infections - 11 11 10 1 9.0 Puerperal fections — 12 12 9 — — 3 Scarlet Fever 45 442 487 442 — — 45 Whooping Cough 5 96 101 81 9 8.9 11 Other Diseases 2 218 220 209 2 0.9 9 Marasmus — 24 24 15 5 20.8 4 Tonsil & Adenoid Cases — 383 383 383 — — — Totals 120 1,754 1,874 1,676 56 — 142 *Two deaths are excluded for purposes of calculating the mortality rate. One patient died of valvular disease of the heart 3½ months after admission and the other died of Pneumonia three months after admission. 77 Cases Admitted from Other Authorities. During the year 101 cases were admitted from areas other than the Borough of Willesden. These cases may be classified as follows :— Table No. 65. Name of Authority. No. of Cases. Diseases. No. of Cases. Middlesex County Council 52 Measles 23 Scarlet Fever 9 Diphtheria 9 Whooping Cough 6 Erysipelas 3 Cerebro-Spinal Fever 1 Mumps 1 Harrow Urban District Council . 24 Whooping Cough 7 Erysipelas 4 Measles 4 Poliomyelitis 3 Scarlet Fever 3 Enteric Fever 2 Cerebro-Spinal Fever 1 Borough of Ealing 21 Scarlet Fever 17 Measles 1 Whooping Cough 1 Enteric Fever 1 Diphtheria 1 Wembley Urban District Council... 3 Whooping Cough 1 Erysipelas 1 Pemphigus Neonatorum 1 Borough of Southall 1 Scarlet Fever 1 Totals 101 101 Table No. 66. The following table shows the number of cases admitted from outside authorities from 1933 to 1936 inclusive, and the amount of income derived from the maintenance of these patients :— Year. No. of patients. Amount of Income. £ s. d. 1933 51 1,211 2 0 1934 107 1,855 6 4 1935 107 1,724 9 5 1936 101 2,260 5 9 Hospital Buildings. A fourth cubicle block was completed during the year, and opened for the reception of patients on 11th October, 1936. Laboratory. The bacteriological laboratory was opened for work on 1st January, 1932. It undertakes the examination of the routine bacteriological specimens from the district, the Municipal Hospital and other local Institutions. 78 Table No. 67. Nature of Examination. Positive Result. Negative Result. Total. 1 Swabs for diphtheria bacilli 531 4,453 4,984 2 Swabs for diphtheria bacilli with virulence test 32 5 37 3 Swabs for diphtheria bacilli with isolation on tellurite media 2 1 3 4 Sputum for tubercle bacilli 87 555 642 5 Blood for Widal reaction 7 17 24 6 Blood cultures — — 15 7 Blood counts — — 4 8 Blood films for abnormal cclls or parasites — — 6 9 Urine for chemical examination . — — 29 10 Urine for microscopical examination - — 27 11 Urine for bacteriological examination — — 36 12 Faeces for bacteriological or chemical examination — — 37 13 Gastric contents for bacteriological or chemical examination - - 19 14 Cerebro-Spinal fluids for complete or partial examination - - 30 15 Water for presumptive B. Coli test — — 134 16 Water for enumeration of total organisms — — 132 17 Water for ova of parasites — — 2 18 Swabs and smears for gonococci 14 89 103 19 Swabs and smears for Vincent's Angina — 12 12 20 Swabs and smears for streptococci and other organisms - 783 21 Pus for organisms - — 7 22 Post-mortem specimens - — 2 23 Museum specimens, preparation and mounting - — 1 24 Hairs for ringworm - — 1 25 Cough plates for Haemophilus pertussis 1 4 5 Total 7,075 Table No. 68. Sources of Specimens Examined. 1. Municipal Hospital 2,592 2. Private Practitioners 2,207 3. Municipal Health Centres and Health Nurses 1,364 4. Central Middlesex County Hospital 537 5. Other Hospitals 111 6. Borough Engineering Department 264 Total 7,075 Annual Number of Specimens. 1932 4,526 1933 5,908 1934 6,693 1935 7,774 1936 7,075 79 THE SIXTH ANNUAL REPORT on the WILLESDEN MATERNITY HOSPITAL. Report on the work from 1st January, 1936, to 31st December, 1936. By ARNOLD WALKER, M.A., M.B., B.Ch., F.R.C.S., M.C.O.G. The chief item of interest during 1936 has been the publication of a Clinical Report covering the first 3,000 cases dealt with at the Hospital. This Report has been well reviewed in the medical press and has done a great deal to increase the reputation of the Willesden Maternity Hospital amongst that section of the medical profession concerned with maternity work. This report was printed and circulated on November 17th, 1936. It shows that the puerperal mortality for the booked cases was 1.02 per 1,000 mothers. The puerperal mortality amongst the mothers who did not book with the Willesden Maternity Hospital and were confined at home, in other institutions either as booked or emergency cases or were admitted to the Willesden Maternity Hospital as emergency cases was 4.26 per 1,000 mothers. It is hoped that the Council will publish similar reports from time to time. Progress in the practice of midwifery has reached a point where methods of treatment can only be evaluated on a statistical basis, and the reports published by first-class institutions form the basis for much clinical research. Again, no maternal death occurred during the year. This is the second year in which no woman lost her life in the Hospital as the result of childbearing and the fourth successive year in which no patient attended by the Council's Service ante-natally and throughout labour has been lost. Over 3,300 consecutive booked cases have been delivered safely. No material changes have taken place in the Hospital during the year. Minor structural improvements have been carried out and the Hospital has been redecorated. The curtailment of admissions and the disorganisation of the work of the Hospital caused by redecoration emphasises the need for a reserve ward unit. Statistical Details of the 905 Cases dealt with during the Year. Cases completed 905 A. Booked at the Health Centres 879 Discharged well 876 Delivered elsewhere 1 Transferred (discharged well) 2 Died 0 B. Admitted as Emergencies ... 26 Discharged well . 25 Transferred 0 Not pregnant (ovarian cyst) 1 Died 0 Of the 879 booked cases, 418 were primiparae and 461 were multiparae. Of the 25 emergency cases, 14 were primiparae and 11 were multiparae. Presentations— Occipito Anterior. 792 Occipito Posterior 71 Normal Breech 15 Abnormal Breech 7 Twins 9 Face 3 Shoulder 0 Miscarriages 7 Ante-partum Haemorrhage— Placenta Praevia 4 Accidental Haemorrhage 10 Prolapse of Cord . 1 Organic Heart Disease 14 Toxaemia of Pregnancy admitted for treatment 35 80 Eclampsia 3 Puerperal Pyrexia 52 Uterine Infection 15 Breast Infection 19 Urinary Infection 5 Sundries 9 No cause found 4 Operations performed— Forceps Delivery 25 The "forceps rate" was therefore 2.8 per cent. Caesarean Section 7 Heart Disease 2 Oedema of Vulva 2 Disproportion 1 Previous Caesarean Section 1 Ovarian Cyst 1 Manual Removal of Placenta 5 Embryotomy 5 Hysterotomy and Sterilisation 2 Pulmonary Tuberculosis 1 Heart Disease 1 Induction of Premature Labour 13 906 viable children were born to 897 mothers. Of these 31 were stillborn and 22 died. 81 THE SEVENTH ANNUAL REPORT for the Year ending 31st December, 1936, 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, 8 patients attended the Health Centres for treatment, the total number of attendances being 37. The following table shows the number of defects found at medical inspection to require treatment and the number of these which were treated at the Health Centres :— Table No. 69. Defect or Disease. Requiring Treatment. Received Treatment at Health Centre. Defective Vision 1 - Defective Teeth 1 — Enlarged Tonsils 1 1 In addition seven patients not referred for treatment attended the Health Centre and received treatment. Five received dental treatment (dentures being provided in one case) and in the remaining two cases treatment was given for Impetigo and injuries to eye and hand respectively. Early in 1937, the Centre amalgamated with the Occupation Centre at Hendon and the Middlesex County Council gave notice that as a result the above arrangement would cease to operate. 82 THE SIXTH ANNUAL REPORT on NURSERY CLASSES for the Year ending 31st December, 1936. Medical inspections were carried out in the existing seven Nursery Classes as in previous years, and during 1936 Medical inspections were carried out for the first time in the Nursery Classes started in October, 1935, at the following schools:—Princess Frederica Infants' School, Leopold Road Infants' School and Oldfield Road Infants' School. During the year, 260 children were examined and the following table shows the numbers and percentages of defects found:— Table No. 70. Age Period. 2-3 years. 3-4 years. 4-5 years. 5 years. Total Percentage. Number of children inspected 7 119 129 5 260 Malnutrition (including slight degrees) 2 4 8 — 14 5.4 Skin Conditions — 9 9 — 18 6.9 Eyes—Blepharitis and Conjunctivitis — 1 2 — 3 Squint — 4 5 — 9 12 4.6 Other Conditions — — — — - Ears, Otitis Media — 5 7 — 12 4.6 Nose and Throat—Enlarged tonsils or adenoids or both 2 30 29 1 62 23.8 Enlarged Cervical Glands — 12 5 — 17 6.5 Teeth—Dental Diseases 1 23 11 1 36 13.8 Heart and Circulation (including Anaemia) — 7 9 1 17 6.5 Lung Disease (non-tubercular) 1 7 8 1 17 6.5 Nervous System (including functional conditions) 10 4 - 14 5.4 Deformities—Rickets - 3 1 - 4 1.5 Others. 1 20 17 2 40 15.3 Other Defects 1 7 11 - 19 7.3 Twenty-four children were found nitty or verminous at the School cleanliness inspections. During the year Nursery Class children were followed up in respect of 222 defects. The general incidence of infectious disease was low in the pupils of these classes. 83 APPENDICES. Appendix A.—VITAL STATISTICS. APPENDIX A.—TABLE I. VITAL STATISTICS OF WHOLE DISTRICT DURING 1936 AND PREVIOUS YEARS; VITAL STATISTICS OF THE WARDS DURING 1936. Year. (I) Population estimated to Middle of each Year. Whole District. (2) Births. Total Deaths Registered in the District. Transferable Deaths Nett Deaths belonging to the District. Uncor rected Number. (3) Nett. Number. (6) Rate per 1,000 population. (7) of nonresi dents registered in the District. (8) of residents not registered in the District. (9) Under 1 Year of Age. At all Ages. Number. (4) Rate per 1,000 population. (5) Number. (10) Rate per 1,000 Nett Births. (11) Number. (12) Rate per 1,000 popution. (3) 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 1935 198,433 1,883 2,848 14.35 1,987 10.01 438 384 188 66 1,933 9.74 1936 202,505 1,919 2,835 14.00 2,156 10.65 436 393 170 60 2,113 10.43 * Census population—Re-adjusted by Registrar-General to 167,200. wards. 1. Carlton 19,032 250 359 18.86 225 11.82 2 55 25 69.64 278 14.61 2. Kilburn 16,311 122 267 16.37 153 9.38 - 50 26 97.38 203 12.45 3. Brondesbury Park 11,227 60 118 10.51 95 8.46 4 14 2 16.95 105 9.35 4. Kensal Rise 13,350 79 159 11.91 127 9.51 — 36 6 37.74 163 12.21 5. Manor 13,476 80 136 10.09 106 7.87 1 21 7 51.47 126 9.35 6. Harl'n 15,937 144 254 15.94 183 11.48 27 31 14 55.12 187 11.73 7. Stonebridge 19,733 564 251 12.72 524 26.55 355 32 21 83.67 201 10.19 8. Roundwood 12,356 131 216 17.48 123 9.95 2 14 10 46.30 135 10.93 9. Church End 15,780 114 230 14.58 134 8.49 6 23 12 52.17 151 9.57 10. Wille'n Green 13,582 127 273 20.10 142 10.46 — 25 19 69.60 167 12.30 11. Mapesbury 19,914 98 209 10.50 156 7.83 3 53 11 52.63 206 10.34 12. Neasden 14,086 72 172 12.21 65 4.61 — 21 9 52.33 86 6.11 13. Cricklewood 17,721 78 191 10.78 123 6.94 36 18 8 41.88 105 5.93 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. 84 APPENDIX A.— TABLE II.—DEATHS OF WILLESDEN RESIDENTS DURING THE YEAR 1936. CAUSE OF DEATH. (1) All Ages. (2) 0 to 1 (3) 1 to 5 W 5 to 10 (5) 10 to 15 (6) 15 to 20 (?) 20 to 25 (8) 25 to 35 (9) 35 to 45 (10) 45 to 55 (11) 55 to 65 (12) 65 to 75 (13) 75 to 85 (14) 85 Up. (15) Total deaths, whether of Residents" or " Non-Residents " in Institutions in the District. (16) All Causes. Certified 2,113 170 60 34 13 25 48 99 110 226 366 457 378 127 1,304 Uncertified — — — — — — — — — — — — — — - 1.—Infectious and Parasitic Diseases. Typhoid Fever — — — — — — — — — — — — — — — Paratyphoid Fever - - - - - - - - - - - - - - - Typhus Fever - - - - - - - - - - - - - - - Relapsing Fever (" Spirillum Obermeieri ") - - - - - - - - - - - - - - - Undulant Fever - - - - - - - - - - - - - - - Small Pox - - - - - - - - - — — — — — — Measles 22 2 17 2 1 - - - - - - - - - 20 Scarlet Fever 2 — — 1 - 1 — — — — — — — — 1 Whooping Cough 12 7 4 1 - — — — — — — — — — 12 Diphtheria 21 — 7 11 1 — 1 — 1 — — — — — 22 Influenza 23 - - - - - — — 4 4 2 8 3 2 10 Cholera - — — - - — — — — — — — — — — Dysentery — — — - - — — — — — — — — — — Plague — — — - - — — — — — — — — — — Erysipelas 3 — — - - — — — — — 2 — 1 — 6 Acute Poliomyelitis — — — - - — —- — — — — — — — — Encephalitis Lethargica — — — - - — — — — — — — — — — Cerebro-spinal Fever 2 — 1 - - — — 1 — — — — — — 2 Glanders — — — - - — — — — — — — — — — Anthrax - - - - - - - - - - — - — — — Rabies — — — - - — — — — — — — — — — Tetanus — — — - - — — — — — — — — — — Tuberculosis of the Respiratory System 118 — 1 - 1 10 17 29 19 18 16 6 — 1 61 Tuberculosis of the Central Nervous System 8 — 2 3 1 — 2 — — — — — — — 8 Tuberculosis of the intestines and peritoneum ... 1 - - - - - - - - - - - - - 1 Tuberculosis of the vertebral column 1 - - - - - - - - - 1 - - - 1 Tuberculosis of other bones and joints - — — — - — — — — — — — — — — Tuberculosis of skin and subcutaneous tissues - - - - - - - - - - - - - - — Tuberculosis of lymphatic system (abdominal and bronchial glands excepted) - - - - - - - - - — — — — — — Tuberculosis of genito-urinary system 1 - - - - - - - - - - - - - — 85 Tuberculosis of other organs - - - - - - - - - - - - - - - Disseminated Tuberculosis 4 1 2 — — — — 1 — — — — — — 4 Leprosy - - - - - - - - - - - - - - - Syphilis 6 1 - - - - - - 1 1 3 — — — 4 Other venereal diseases - - - - - - - - - - - - - - - Purulent infection, septicaemia . 1 - - - - - - - - 1 - - - - 2 Yellow Fever - - - - - - - - - - - - - - - Malaria - - - - - - - - - - - - - - - Other diseases due to protozoa - - - - - - - - - - - - - - - Ankylostomiasis - - - - - - - - - - - - - - - Hydatid Cysts - - - - - - - - - - - - - - - Other diseases due to helminths - - - - - - - - - - - - - - - Mycoses - - - - - - - - - - - - - - - Other infectious or parasitic diseases - - - - - - - - - - - - - - - 2.—Cancer and other Tumours. Cancer of the buccal cavity, and pharynx 16 - - - - - - - - 2 5 6 3 — 10 Cancer of the digestive organs and peritoneum 158 - - - - - - 4 8 29 44 51 21 1 96 Cancer of the respiratory organs 23 - - - - - - - 2 7 11 3 — — 22 Cancer of the uterus 22 - - - - - - 1 2 9 6 3 1 — 14 Cancer of other female genital organs 12 - - - - - - 1 1 2 5 1 2 — 7 Cancer of the breast 31 - - - - - - 1 1 8 8 8 2 3 15 Cancer of the male genito-urinary organs 23 — — 1 — — — — — 3 7 7 5 — 21 Cancer of the skin 1 1 2 Cancer of other or unspecified organs 16 — 1 — — — 1 — 1 4 1 5 2 1 8 Non-malignant tumours 5 — — .— 1 — — — — 3 — — 1 — 4 Tumours of undetermined nature 13 — — — — 1 1 1 1 3 3 — 2 1 8 3.—Rheumatism, Diseases of Nutrition and. of Endocrine Glands and the General Diseases. Rheumatic fever 14 — — 1 2 1 1 3 — 5 — 1 — — 14 Chronic rheumatism, Osteo-Arthritis 7 - - - - - - - 1 1 1 1 2 1 5 Gout - - - - - - - - - - - - - - - Diabetes 29 — — — — 2 — 1 — 2 9 10 5 — 21 Scurvy - - - - - - - - - - - - - - - Beri-beri - - - - - - - - - - - - - - - Pellagra - - - - - - - - - - - - - - - Rickets - - - - - - - - - - - - - - - Osteomalacia - - - - - - - - - - - - - - - Diseases of the pituitary gland - - - - - - - - - - - - - - - Diseases of the thyroid and parathyroid glands 2 — — — — — — — 1 — — 1 — — 1 Diseases of the thymus 1 1 - - - - - - - - - - - - - Diseases of the adrenals 4 - - - - - - 1 1 1 1 — — — 1 Other general diseases - - - - - - - - - - - - - - - 86 Appendix A.—Table II.—DEATHS OF WILLESDEN RESIDENTS (continued). CAUSE OF DEATH. (1) All Ages. (2) 0 to 1 (3) 1 to 5 (4) 5 to 10 (5) 10 to 15 (6) 15 to 20 (7) 20 to 25 (8) 25 to 35 (9) 35 to 45 (10) 45 to 55 (11) 55 to 65 (12) 65 to 75 (13) 75 to 85 (14) 85 Up (15) Total deaths, whether of " Residents" or " Non-Residents," in Institutions in the District. (16) 4.—Diseases of the Blood and Blood-forming Organs. Hemorrhagic conditions - — — — — — — — — — — — — — — Anaemia Chlorosis 9 1 — — 1 — — — 1 1 1 2 2 — 3 Leukaemia, Aleukæmia 7 — — 1 2 1 — — 1 1 — 1 — - 9 Diseases of the Spleen 2 — — — — — — 1 — 1 — — — — 1 Other diseases of the blood and blood-forming organs 5.—Chronic Poisoning. Alcoholism (acute or chronic) 1 — — — — — — — — 1 — — — — — Chronic poisoning by other organic substances 1 - - - - - - - - - 1 - - - 1 Chronic poisoning by mineral substances - - - - - - - - - - - - - - - 6.—Diseases of the Nervous System and Sense Organs. Encephalitis 6 — — — — 1 — 1 3 1 — — — — 7 Meningitis 3 1 — — — — — — 1 — — 1 — — 1 Tabes Dorsalis (Locomotor ataxy) 1 — — — — — — — — — — 1 — — — Other diseases of the spinal cord 4 — — — — — 1 — 1 1 1 — — — 2 Cerebral haemorrhage, Apoplexy, etc 112 3 — — — — 1 1 3 9 22 36 29 8 89 General Paralysis of the Insane — — — — — — — — — — — — — — 1 Other forms of Insanity 5 — — — — — 1 — — 3 1 — — — 1 Epilepsy 9 — — 1 — 1 — 1 1 — 1 2 2 — 5 Infantile convulsions (under 5 years of age) 5 5 — - — — — — — — — — — — — Other diseases of the nervous system 18 — — — — — — 1 2 — 3 10 1 1 8 Diseases of the eye and annexa — — — — — — — — — — — — — - - Diseases of the ear and of the mastoid sinus 8 2 — 2 — 1 1 — 1 1 — — — — 5 7 .—Diseases of the Circulatory System. Pericarditis 4 — — — — — 2 — — 1 - — — 1 2 Acute endocarditis 3 — — — 1 — 1 1 — — — — - - 7 Chronic endocarditis, Valvular disease 71 - - - - - - 4 6 3 20 18 18 2 15 Diseases of the Myocardium 270 - - — - — — - 4 18 43 95 84 26 61 87 Diseases of the coronary arteries, Angina pectoris 48 - - - - - - 2 2 6 16 13 8 1 11 Other diseases of the heart 30 - - - - - - - - 3 7 12 8 - 18 Aneurysm 7 - - - - - - 1 1 1 4 - - - 4 Arterio-sclerosis 62 - — — - - - - - 4 10 21 20 7 22 Gangrene 1 - - - - - - - - - - 1 - - 1 Other diseases of the arteries 4 - — - - - - - 2 2 - - - - 3 Diseases of the veins (varix, haemorrhoids, phlebitis, etc.) 2 - - - - - - 1 - - 1 - - - 1 Diseases of the lymphatic system (lymphangitis, etc.) - - - - - - - - - - - - - - - Abnormalities of blood pressure 20 - — — - - - - 2 2 5 4 6 1 20 Other diseases of the circulatory system 1 - - - - - - - - - - - - - - 8.—Diseases of the Respiratory System Diseases of the nasal fossae and annexa 1 - - - - - - - - - - - - - 2 Diseases of the larynx 1 - 1 - - - - - - - - - - - 1 Bronchitis 79 9 — — - - - 1 2 8 13 20 15 11 27 Broncho-Pneumonia 102 20 9 1 - - 4 - 1 9 11 17 22 8 93 Lobar Pneumonia 59 2 2 - - 1 - 3 7 7 16 17 4 - 35 Pneumonia (not otherwise defined) 9 — 3 — - - - - - 2 2 1 - 1 4 Pleurisy 5 — — — - - - 1 1 1 1 1 - - 2 Congestion and haemorrhage infarct of lung, etc. 1 - - - - - - - - - - - - - 2 Asthma 3 — — — - - - - - - 3 - - - 4 Pulmonary Emphysema — — — - - - - - - - - - - - - Other diseases of the respiratory system - - - - - - - - - - - - - - 2 9.—Diseases of the Digestive System. Diseases of the buccal cavity, pharynx, etc. 5 — — 1 - - 1 1 1 - 1 - - - 3 Diseases of the oesophagus — — — — - - - - - - - - - - - Ulcer of the stomach or duodenum 29 — - - - - 1 3 5 6 8 6 - - 30 Other diseases of the stomach 2 - - - - - - - - - 1 - - - - Diarrhoea and Enteritis 33 24 1 1 - - - 2 2 2 - - - 1 34 Appendicitis 15 — 1 1 - - 3 1 2 2 3 1 1 - 20 Hernia, Intestinal obstruction 24 1 1 - - - - 3 3 1 4 5 3 3 18 Other diseases of the intestines 3 - - - - - - - 1 - 1 1 - - 4 Cirrhosis of the Liver 8 - - - - - - - - 2 2 1 3 - 4 Other diseases of the Liver 2 - - 1 - - - - 1 - - - - - 1 Biliary calculi 2 — - - - - - - - - - 1 - 1 1 Other diseases of the gall bladder and ducts 3 — - - - - - - - 1 1 1 - - 2 Diseases of the pancreas — — - - - - - - - - - - - - 1 Peritonitis without stated cause - - - - - - - - - - - - - - 1 88 Appendix A.—Table II.—DEATHS OF WILLESDEN RESIDENTS (continued). CAUSE OF DEATH. (1) All Ages. (2) 0 to 1 (3) 1 to 5 (4) 5 to 10 (5) 10 to 15 (6) 15 to 20 (7) 20 to 25 (8) 25 to 35 (9) 35 to 45 (10) 45 to 55 (11) 55 to 65 (12) 65 to 75 (13) 75 to 85 (14) 85 Up. (15) Total deaths, whether of " Residents" of " Non-Residents," in Institutions in the District. (16) 10.—Non-Venereal Diseases of the Genitourinary System and Annexa. Acute nephritis 5 — — 1 — 1 — 1 1 — — 1 — — 4 Chronic nephritis 30 - - - - - - 1 — 3 4 13 9 - 16 Nephritis not stated to be acute or chronic 1 - - - - - - - - 1 - - - - 1 Other diseases of the kidney and annexa 8 2 - - - - 1 2 - 2 - - 1 - 8 Calculi of the urinary passages 4 — — - — — — — — 2 2 — — — 2 Disease of the bladder 5 — — - — — — — — — 2 — 2 1 1 Diseases of the urethra, urinary abscess, etc. 1 — — — — — — — — — 1 — — — 2 Diseases of the prostate 22 — — - — — — — — — 6 7 7 2 22 Diseases of the male genital organs - - - - - - - - - - - - - - - Diseases of the female genital organs 2 — 1 - — — — — — 1 — — — — 3 11.—Diseases of Pregnancy, Childbirth and the Puerperal State. Post-abortive sepsis — — — - — — — — — — — — - - 1 Abortion not returned as septic — — — - — — — — — — — — — — 1 Ectopic gestation — — — - — — — — — — — — — — — Other accidents of pregnancy — — — - — — — — — — — — — — — Puerperal haemorrhage — — — - — — — — — — — — — — — Puerperal sepsis 2 — — - — — — 1 1 - - - - - - Puerperal albuminuria and convulsions - - - - - - - - - - - - - - - Other toxaemias of pregnancy 2 - - - - - - 2 - - - - - - 1 Puerperal phlegmasia alba dolens, embolism, and sudden death 1 - - - - - - 1 - - - - - - - Other accidents of childbirth — — — - — — — — — - - - - - - Other or unspecified conditions of the puerperal state — — — - — — — — — — — — — — — 12.—Diseases of the Skin and Cellular Tissue. Carbuncle, Boil 3 — — - — — — 2 — — 1 — — — 4 Cellulitis, Acute abscess 6 - - - - - - - - 1 2 1 1 1 7 Other diseases of the skin and its annexa - - - - - - - - - - - - - - 1 89 13.—Diseases of the Bones and Organs of Locomotion. Acute infective osteomyelitis and periostitis 4 — — 1 1 - - - 1 - - 1 - - 4 Other diseases of the bones 2 — — - - 1 - - - 1 - - - - 1 Diseases of the joints and other organs of locomotion 1 — — — — — — — — — 1 - — - 1 14.—Congenital Malformation. Congenital malformations 26 25 1 — - — — — — — — — — — 8 15.—Diseases of Early Infancy. Congenital debility 7 7 — — - - - - - - - - - - 7 Premature birth 44 44 — — - - - - - - - - - - 18 Injury at birth 2 2 — — - - - - - - - - - - 5 Other diseases peculiar to early infancy 7 7 - - - - - - - - - - - - 2 16.—Old Age. Old age 139 — — — — — — — — — 1 24 75 39 148 17.—Deaths from Violence. Suicide by solid or liquid poisons and corrosive substances 3 - - - - - 1 - - - 2 - - - 2 Suicide by poisonous gas 11 — — — — — 1 2 — 2 5 - 1 - 1 Suicide by hanging or strangulation 3 — — — — — — — - 1 - 1 1 - 1 Suicide by drowning 1 — — — — — — 1 — - - - - - - Suicide by firearms — — — — — — — - - - - - - - - Suicide by cutting or piercing instruments 2 — — — — - - - 1 - 1 - - - 1 Suicide by jumping from high place 1 — — — — — — — — — 1 - - - 1 Suicide by crushing 1 — — — — 1 — — — - - - - - - Suicide by other means 1 — — — — - - 1 - - - - - - 1 Infanticide (under one year) — — — — — — — - - - - - - - - Homicide by firearms — — — - - - - - - - - - - - - Homicide by cutting or piercing instruments - - - - - - - - - - - - - - - Homicide by other means - — — - - - - - - - - - - - - Attack by venomous animals . - — — — — — — — - - - - - - - Food poisoning - — — — — - - - - - - - - - - Accidental absorption of irrespirable or poisonous gas 1 — — — — — — — — — - 1 - — 1 Other acute accidental poisoning (not by gas) - - - - - - - - - - - - - - 1 Conflagration - - - - - - - - - - - - - - - Accidental burns (Conflagration excepted) 4 — 3 — — — — — — 1 - - - - 6 Accidental mechanical suffocation 3 3 - - - - - - - - - - - - - 90 Apendix a.—Table II.—DEATHS OF WILLESDEN RESIDENTS (continued). CAUSE OF DEATH. (1) All Ages. (2) 0 to 1 (3) 1 to 5 (4) 5 to 10 (5) 10 to 15 (6) 15 to 20 (7) 20 to 25 (8) 25 to 35 (9) 35 to 45 (10) 45 to 55 (11) 55 to 65 (12) 65 to 75 (13) 75 to 85 (14) 85 Up. (15) Total deaths, whether of " Residents" or " Non-Residents," in Institutions in the District. (16) Accidental drowning 3 - - - - 1 - 2 - - - - - - - Accidental injury by firearms - - - - - - - - - - - - - - - Accidental injury by cutting or piercing instruments Accidental injury by fall, crushing, etc. 46 - 1 3 1 1 6 7 5 6 5 5 4 2 27 Cataclysm - - - - - - - - - - - - - - - Injury by animals (poisoning by venomous animals excepted) Hunger or thirst — - - - - - - - - - - - - - - Excessive cold — - - - - - - - - - - - - - - Excessive heat — - - - - - - - - - - - - - - Lightning - - - - - - - - - - - - - - - Electricity (lightning excepted) 1 - - - - - - 1 - - - - - - - Other and unstated forms of accidental violence - - - - - - - - - - - - - - - Violent deaths of unstated nature (i.e., accidental, suicidal, etc.) 3 - - - - - - - - 1 1 1 - - 2 Wounds of war 1 - - - - - - - - - 1 - - - - Execution of civilians by belligerent armies - - - - - - - - - - - - - - - Execution . — — — — — — — — — — — 18.—Ill-Defined. Diseases. Sudden death - - - - - - - -. - - - - - - - Cause of death unstated or ill-defined 2 - 1 - - - - - - - - 1 - - - 2,113 170 60 34 13 25 48 99 110 226 366 457 378 127 1,304 91 Appendix A.—Table II (a). CAUSES OF DEATH IN BOROUGH OF WILLESDEN AS CIRCULATED BY REGISTRAR-GENERAL.—1936. Causes of Death. M. F. All Causes 1,038 1,034 1. Typhoid and paratyphoid fevers - - 2. Measles 10 12 3. Scarlet fever 2 — 4. Whooping cough 7 5 5. Diphtheria 10 11 6. Influenza 8 10 7. Encephalitis lethargica — — 8. Cerebro-spinal fever 2 — 9. Respiratory tuberculosis 69 48 10. Other tuberculosis 9 6 11. Syphilis 5 1 12. General paralysis of the insane, etc. 1 — 13. Cancer 140 162 14. Diabetes 15 17 15. Cerebral haemorrhage 40 61 16. Heart disease ... 184 208 17. Aneurysm 5 2 18. Other circulatory diseases 34 55 19. Bronchitis 40 33 20. Pneumonia 87 79 21. Other respiratory diseases 17 9 22. Peptic ulcer 21 9 23. Diarrhoea, etc. (under 2 years) 15 10 24. Appendicitis 9 6 25. Cirrhosis of liver 4 4 26. Other diseases of liver 5 4 27. Other digestive diseases 23 26 28. Nephritis 30 16 29. Puerperal sepsis — 2 30. Other puerperal causes — 2 31. Congenital causes, etc. 50 38 32. Senility 40 92 33. Suicide 11 11 34. Other violence ... 37 27 35. Other defined causes 108 67 36. Ill-defined causes — 1 Special Causes (included in No. 35 above) :— Small-pox — — Poliomyelitis — — Polioencephalitis - - Deaths of Infants under 1 year Total 100 70 Legitimate 90 63 Illegitimate 10 7 92 Appendix a. TABLE III.—INFANT MORTALITY DURING 1936. 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. Carlton. Kilburn. Brondesbury Park. Kensal Rise. Manor. Harlesden. Stonebridge. Round wood. Church End. Willesden Green. Mapesbury. Neasden. Cricklewood. (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) (13) (14) (15) (16) (17) (18) (19) (20) (21) (22) (23) (24) All Causes certified 63 8 4 5 80 32 30 15 13 170 25 26 2 6 7 14 21 10 12 19 11 9 8 Uncertified — - - - - - - - - - - - - - - - - - - - - - Small Pox . - - - - - - - - - - - - - - - - - - - - - - - Chicken Pox - - - - - - - - - - - - - - - - - - - - -- - Measles - - - - - - - - - - — 1 — — — - — — — 1 - — — Scarlet Fever - - - — — — - - — — — — — — — — — — - - - Whooping Cough - - - - - - 3 4 7 1 3 — 1 — - — — — 1 - 1 — Diphtheria and Croup - - - - - - - - - - - - - - - - - - - - - - - Erysipelas - - - - - - - - - - - - - - - - - - - - - - Tuberculous Meningitis - - - - - - - - - - - - - - - - - - - - - - Abdominal Tuberculosis (a) - - - - - - - - - - - - - - - - - - - - - - - other Tuberculous Diseases — — — — — 1 — 1 — — — — — 1 — — - 1 — — Meningitis (not Tuberculous) - — — — — — 1 — 1 — — — — - - 1 - - - 1 - - Convulsions 3 — - — 3 1 — 1 — 5 — — - - - 1 1 - - - - 1 2 Laryngitis - - - - - - - - - - - - - - - - - - - - - - - Bronchitis — — 1 — 1 2 3 2 1 9 2 — — - 1 1 1 1 - - 2 1 - Pneumonia (all forms) 1 — 1 1 3 6 6 4 3 22 4 3 — 1 — 3 3 - 3 3 2 — — Diarrhoea - - - - - 7 11 5 1 24 2 4 - 1 - 1 3 4 2 3 1 2 1 Enteritis Gastritis - - - - - - - - - - - - - - - - - - - - - - Syphilis — — — — — 1 — — 1 1 - - - - - - - - - - - - Rickets - - - - - - - - - - - - - - - - - - - - - Suffocation, overlying - - - 1 1 1 1 — — 3 — 1 — — — — 1 — — — — — 1 Injury at birth 2 — — 2 — — — — 2 — — — — — — 1 — — — 1 — — Atelectasis 5 — — 5 — — — — 5 — 3 — 1 — — 1 — — — — — — Congenital Malformations (b) 11 2 1 14 9 2 — — 25 4 5 2 1 2 2 2 - 1 3 n 1 q 1 1 Premature Birth 36 4 2 42 1 — — 1 44 5 4 — — 4 6 4 2 4 7 6 2 3 Atrophy, Debility and Marasmus - 1 2 — 3 4 — — — 7 2 — — — — — 1 3 — 1 — — — Other Causes 5 1 — — 6 1 2 2 1 12 4 2 — 1 — — 2 — 2 — — 1 — Total Deaths 63 8 4 5 80 32 30 15 13 170 25 26 2 6 7 14 21 10 12 19 11 9 8 Deaths—Legitimate 60 8 4 2 74 27 25 13 11 150 22 23 2 6 7 13 20 8 11 16 9 6 7 Illegitimate 3 - - 3 6 5 5 2 2 20 3 3 - - - 1 1 2 l 3 2 3 1 Births—Legitimate . - - - - - - - - - 2,739 342 256 114 159 134 248 244 207 224 262 195 167 187 Illegitimate - - - - - - - - - 96 17 11 4 — 2 6 7 9 6 11 14 5 4 Total Births - - - - - - - - - 2,835 359 267 118 159 136 254 251 216 230 273 209 172 191 Infant Mortality Rate— Legitimate - - - - - - - - - 54.76 64.33 89.84 17.54 37.74 52.24 52.42 81.97 38.65 49.11 61.07 46.15 35.93 37.43 Illegitimate - - - - - - - - - 208.33 176.47 272.73 — — — 166.67 142.86 222.22 166.67 272.73 142.86 600.00 250.00 Infant Mortality Rate - - - - - -. - - - 59.96 69.64 97.38 16.95 37.74 51.47 55.12 83.67 46.30 52.17 69.60 52.63 52.33 41.88 Population - - - - - - - - - 202,505 19,032 16,311 11,227 13,350 13,476 15,937 19,733 j 12,356 15,780 13,582 19,914 14,086 17,721 (а) 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. 93 appendix a—TABLE IV.—CASES OF INFECTIOUS DISEASE NOTIFIED DURING THE YEAR 1936. Notifiable Disease. Number of Cases Notified. Total Cases Notified in each Ward. At all Ages At ages—Years. Carlton. Kilburn. Brondesbury Park. Kensal Rise. Manor. Harlesden. Stonebridge. Roundwood. Church End. Willesden Green. Mapesbury. Neasden. 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) (27) (28) Cholera (C) Plague (P) — — — — — — — — — — — — — — — — — — — — — — — — — — — Diphtheria (including Membranous Croup). 382 6 12 20 22 36 171 44 15 44 7 5 — 92 22 11 32 8 24 77 36 37 23 7 8 5 370 Erysipelas 88 1 2 — — — 7 1 3 18 13 32 11 6 4 3 8 4 10 14 7 8 7 7 4 6 41 Scarlet fever 556 2 18 30 35 45 253 65 32 64 9 3 — 48 28 17 34 25 30 54 41 78 41 39 34 87 484 Typhus fever — — — — — — — — — — — — — — — — — — — — — — — — — — Enteric fever 10 — — 2 — — 3 1 1 — 1 1 1 — — 1 1 1 — 1 1 1 1 3 — — 7 Relapsing fever (R) Continued fever (C.) - - - - - - - - - - - - - - - - - - - - - - - - - - - Puerperal fever 6 — — — — — — — — 5 1 — — 1 1 1 — — 1 — 1 — — 1 — — 1 Puerperal pyrexia 33 - - - - - - - 1 29 3 — — 6 — 1 — 1 2 13 2 1 3 1 1 2 3 Cerebro-spinal meningitis 9 — 1 — — — — — 2 6 — — — — — 2 — — — 3 2 — — — — 2 3 Poliomyelitis 5 1 — 1 — 1 1 1 - - - - - - - - - - - - - - - - - - 1 Ophthalmia neonatorum 19 19 - - - - - - - - - - - 6 4 — — 2 1 1 1 — 1 2 — 1 3 Pulmonary tuberculosis 240 1 — — — — 5 4 22 118 30 49 11 26 31 19 10 10 14 23 22 18 12 24 16 15 — Other forms of tuberculosis 53 — 1 2 4 1 9 6 5 19 2 4 - 10 6 4 2 3 5 3 2 4 3 5 2 4 — Whooping cough 743 91 90 94 85 92 274 5 1 7 2 — 2 101 39 37 22 53 80 96 68 62 109 30 20 26 91 Pneumonia 352 17 18 23 24 7 30 16 17 63 41 58 38 47 16 13 26 20 29 72 30 33 24 7 9 26 8 Malaria 1 — — — — — — — — 1 — — — — — — — — — 1 — — — — — — — Dysentery 20 1 3 7 — 3 4 1 1 — — — — 3 — — — 1 1 12 — — 1 — 2 — 2 Encephalitis lethargica - - - - - - - - - - - - - - - - - - - - - - - - - - - Acute polio encephalitis. - - - - - - - - - - - - - - - - - - - - - - - - - - - Anthrax - - - - - - - - - - - - - - - - - - - - - - - - - - - Totals 2,517 139 145 179 170 185 757 144 100 374 109 152 63 348 151 109 135 128 197 371 213 244 225 126 96 174 1,014 94 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 1936. Statutes :— Midwives Act, 1936. Education Act, 1936. Housing Act, 1936. Public Health Act, 1936. Ministry of Health :— Circulars :— No. 1520.—Certification of Blindness. No. 1533.—Milk (Special Designations) Order 1936. No. 1534.—Public Health (Imported Food) Regulations 1925. No. 1536.—International Agreement for the Treatment of Seamen suffering from Venereal Diseases. No. 1536A.—Venereal Diseases. No. 1538.—1. Local Government Act 1929. 2. Maternity and Child Welfare. 3. Voluntary Associations. No. 1539.—Housing Act 1935. No. 1544.—Orthordichlorbenzene. No. 1550.—Children under school age. No. 1552.—Local Government Act 1929—Part 6. No. 1553.—Local Government Act 1929—Part 6. No. 1560.—Housing Act 1935. No. 1569.—Midwives Act 1936. No. 1574.—Nursing Homes Registration Act 1927. No. 1576.—Public Health Act 1936. No. 1580.—Milk (Special Designations) Order 1936. No. 1584.—Health Services Annual Returns. No. 1585.—Public Health (Imported Food) Amendment Regulations 1933. Orders :— No. 356.—The Milk (Special Designations) Order 1936. No. 665.—Housing Act 1935 (Operation of Overcrowding Provisions) Order 1936. Memoranda :— No. 153/M.C.W.—Birth Control. No. 197/Foods.—Sale of Milk under Special Designations. No. 200/M.C.W.— Midwives Act 1936. No. 139/Foods.—Bacteriological tests for graded milk. Schemes :— L.G.A. 49.—M.C.W. L.G.A. 50.—M.C.W. 2nd Com.—Application of the Brussels Agreement on 1st December 1924 re Treatment of Seamen suffering from Venereal Diseases. 3rd Com.—Recommendations for the Treatment of Syphilis in the case of Seamen attending Treatment Centres in Ports. 95 Regulations :— The Medical Practitioners (Fees) Regulations 1936. No. 739.—The Housing Acts (Forms of Orders and Notices) Regulations 1936. Board of Education:— Circulars:— No. 1444.—Administrative Programme on Educational Development. Home Office:— Circular :— No. 701529.—Anti-Gas Training. Memoranda :— No. 2.—Air-raid precautions—Rescue parties and clearance of debris. No. 3.—Air-raid precautions—Organisation of Decontamination Services. Poisons No. 2 (Wholesalers).—Memorandum on the Provisions of the Pharmacy and Poisons Act 1933. Poisons No. 3.—Memorandum on the Provisions of the Pharmacy and Poisons Act 1933. Poisons No. 4.—Memorandum on the Provisions of the Pharmacy and Poisons Act 1933. Ministry of Agriculture and Fisheries :— Scheme :— Supply of Milk in Schools at reduced rates. APPENDIX C. MOTOR SERVICE. I beg to report on the above for the twenty-second completed year ended 31st March, 1936. During the year 1935-36 the following vehicles were in use. Table No. 1. No. Reg. No. Tax. Make. Year of Purchase. Work required for. Total miles run with vehicles. Purchase Price. £ £ 1 MH. 3808 26 Crossley 3/1925 School work 91,122 823 2 MP. 3711 18 Dennis 5/1928 ,, ,, 71,938 760 3 MP. 3712 18 ,, 5/1928 ,, 74,363 760 4 MT. 810 20 Armstrong 11/1928 Health Department 80,561 800 5 MY. 967 18 Dennis 8/1929 School work 68,160 762 6 MY. 19 20 Armstrong 11/1929 Education Department 81,473 538 7 MY. 26 Nil ,, 2/1930 Sickness and Accidents 81,194 854 8 HX. 12 Nil ,, 1/1931 88,554 860 9 HX. 5178 18 Dennis 8/1931 School work 46,273 665 10 HX. 5179 18 ,, 8/1931 ,, 47,707 665 11 MV. 1800 Nil Armstrong 4/1932 Infectious cases 26,153 825 12 MV. 2860 18 Dennis 7/1932 School work 40,656 687 13 AMC. 175 25 Morris 3/1933 Disinfection, Laundry 24,173 289 14 BME. 565 Nil Armstrong 4/1934 and Kingsbury Sickness and Accidents 24,914 770 15 CMC. 401 12 Austin 2/1935 Miscellaneous 8,187 214 16 C.M.L. 985 Nil Armstrong 6/1935 Sickness and Accidents 3,895 710 96 The following gives the miles run by each vehicle in service during the year under review:— 1. School Ambulance (MH. 3808) 457 2. School Ambulance (MP. 3711) 9,291 3. School Ambulance (MP. 3712) 10,164 4. Health Department (MT. 810) 11,562 5. School Ambulance (MY. 967) 9,662 6. Education Department (MY. 19) 11,708 7. Sickness and Accident Ambulance (MY. 26) 7,214 8. Sickness and Accident Ambulance (HX. 12) 18,356 9. School Ambulance (HX. 5178) 10,552 10. School Ambulance (HX. 5179) 10,953 11. Infectious Ambulance (MV. 1800) 5,716 12. School Ambulance (MV. 2860) 11,597 13. Disinfection Van (AMC. 175) 8,531 14. Sickness and Accident Ambulance (BME. 565) 16,080 15. Education Department and Miscellaneous (CMC. 401) 7,721 16. Sickness and Accident Ambulance (CML. 985) 3,895 Total 153,459 Table No. 3. Total Number of Miles Run. The following table shows the number of miles run since the inception of the service:— Total Miles Run. 1913-15 56,669 1915-20 259,936 1920-25 319,862 1925-30 525,801 1930-31 131,564 1931-32 132,208 1932-33 132,168 1933-34 132,548 1934-35 143,557 1935-36 153,459 Total 1,987,772 Table No. 4. Calls. The following table shows the number of calls for the Disinfection Van and Ambulances :—- 1913 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. 1-4-34 to 31-3-35. 1-4-35 to 31-3-36. Grand Total 1913-36. Disinfection Van 19,053 1,063 933 1,293 1,546 1,093 24,981 Ambulance Calls, including Sickness, Accident, Maternity and Infectious cases 42,800 4,434 4,700 4,324 5,310 6,592 68,160 61,853 5,497 5,633 5,617 6,856 7,685 93,141 97 Table No. 5. The following gives details of the miles run during the year ended 31st March, 1936 :— Special school work 55,203 Accidents, Sickness and Infectious Cases 31,280 Disinfection 6,163 Education Department 11,143 Education—Elementary 102 Accounts Department 1,702 Engineer's Department 650 Clerk's Department 7,699 Health Department 9,872 Municipal Hospital Work 164 Miscellaneous 54 Maternity Hospital, Kingsbury 22,547 Princess Nursery 19 Provision of Meals 6,288 Election 470 Library Department 33 School Medical Service — Fire Brigade 70 153,459 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 1925-30 525,801 41,226 12.754 12.194 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 1934-35 143,557 12,257 11.712 12.172 1935-36 153,459 12,936 11.863 11.810 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 287 such children on the list for conveyance and on the average 225 are conveyed daily along 13 different routes. (2) The conveyance of cases of sickness, accident, maternity and infectious disease to hospitals. 6,592 such cases were removed in 1935-36. (3) The transport of laundry to Kingsbury Hospital, three Health Centres, Special Schools, Mortuary, Lower Place Nursery and Public Health Department. (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. 98 Staff.—The staff at 31st March, 1936, consisted of a Mechanic Superintendent and Engineer, who is also Engineer to the Hospital; one assistant engineer; one fitter's mate; and 17 motor drivers. Since that date two motor drivers have been added to the staff. There are thus 16 vehicles to be manned and a night service to be maintained with 19 drivers. Of the 19 motor drivers two are wholly employed on vehicles Nos. 4 and 6 (Table 1), six are allocated to seven school buses, six of which are in regular use and the seventh in occasional use, one driver is on the Disinfection Van, and one on late duty for Mayor's evening calls. This leaves nine men to man five ambulances and do the miscellaneous work. The work of these nine men is supplemented by the spare time of the six men on the school buses, but when it is remembered that many of the ambulance calls require two men, and that it takes more than 3½ men to keep one man on 24 hours per day, it will be understood that although the workshop staff and even the hospital porters occasionally are used to assist the Service, that nevertheless some calls have to be refused or kept waiting because staff is not available. It should also be noted that each member of the staff gets 14 days' annual leave and that it is only exceptionally that any man is employed as a holiday relief. It should further be noted that with Saturday and Sunday feeding of school children and the payment of wages on some Saturday mornings, three buses are frequently in use on Saturdays and two buses every Sunday. One motor driver is on the temporary list. Special Note on Staff. So far as the number of staff is concerned it works admirably except in respect of the ambulances. It will be noted that there are nine motor drivers for five ambulances and that these nine men get about six hours' daily assistance from the six men on the school buses. These six hours, however, are all compressed between the hours of 10 a.m. and 1 p.m. It, therefore, follows that there are really less than 10 men for five ambulances or less than two men to staff each ambulance throughout a period of 24 hours, many of the calls requiring two men. The London County Council's ambulance service is staffed on the basis of six men per ambulance. It is becoming more and more necessary on account of the increased demands on the ambulance service—ambulance calls have increased from 5,310 in 1934-35 to 6,592 in 1935-36, that is, by approximately 25 per cent.—to increase the staffing of the ambulances from two men for 24 hours' duty as at present to something approximating the six men required for 24 hours' duty as in the case of the London County Council's ambulances. In all these circumstances I am of opinion that provision should be made in the estimates for 1937-38 to increase the ambulance staff to three men per ambulance for the 24 hours' duty of the ambulance. Garage.—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. 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 two delivery hoses. Workshop Plant.-—This is in good order and effects a great saving, both in motor and hospital repairs. Cost.—The analytical table of costs prepared by the Finance Department is appended. GEORGE F. BUCHAN, Medical Officer of Health. 99 BOROUGH OF WILLESDEN. MOTOR SERVICES. Year Ended 31st March, 1936. Year 1934-35. Cost per mile. Expenditure. Year 1935-36. Cost per mile. £ s. d. £ s. d. d. Running Expenses— £ s. d. £ s. d. d. 727 18 2 Petrol 817 1 4 45 7 ll Oil and grease 41 10 1 120 19 11 894 6 0 1.495 Tyres . 108 1 11 966 13 4 1.512 Wages and Emoluments— 380 0 0 Mechanic Superintendent 380 0 0 3,628 11 10 Drivers, etc. 4,004 6 0 43 10 6 National Insurance 50 7 2 4,052 2 4 6.774 4,434 13 2 6.935 Fixed and General Charges— 187 0 0 Rent (Garage and Mess Room) 187 0 0 155 12 4 Repairs, plant, etc. 157 11 11 50 17 2 Painting, etc., bodies of vehicles 68 5 6 79 14 0 Coal, gas, etc. 79 18 9 147 9 9 Uniforms and Overalls 106 16 1 1 100 14 3 Insurance of vehicles 103 3 6 189 3 6 Motor car registration 168 13 4 6 17 6 Drivers' licences, etc. 7 10 0 95 0 3 Accessories and sundries 57 1 1 4 225 15 0 Loan charges on New Garage 205 19 4 1,238 3 9 2.070 1,142 10 7 1.787 Depreciation and Interest Charges— Amount written off value of vehicles in accordance with Medical Officer of Health's Valuation 981 13 10 907 13 6 114 5 6 1,095 19 4 1.833 Interest on Capital employed 99 19 2 1,007 12 8 1.576 7,280 11 5 12.172 7,551 9 9 11.810 Income. Use of vehicles for:— 9 10 6 Conveyance of children 6 13 0 59 13 11 Conveyance of patients 94 19 6 0 12 0 Election purposes 14 1 0 69 16 5 115 13 6 12,257 Petrol consumed (gallons) 12,936 143,557 Miles run by all vehicles 153,459 11.712 Miles run per gallon of petrol 11.863 Vehicles in use :— 31st March, 1935 15 31st March, 1936 15 Finance Department, Town Hall, Dyne Road, N. IV.6. August, 1936. 100 ARTIFICIAL SUNLIGHT TREATMENT, 1936. Conditions. Cases brought forward from 1935, i.e., reatments, Waiting List Observation Cases. (1) New Cases. (2) Total Cases Treated. (3) Discharged not Treated, i.e., Unable to attend, Unsuitable, Left District (4) Waiting List. (5) RESULTS OF TREATMENT. Cases carried forward to 1937, 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) Cases still under Treatment (Result not yet known). (10) 0-5 Sch. 0-5 Sch. 0-5 Sch. 0-5 Sch. 0-5 Sch. 0-5 Sch. 0-5 Sch. 0-5 Sch. 0-5 Sch. 0-5 Sch. 0-5 Sch. 0-5 Sch. Debility 49 49 99 132 141 176 7 2 - 3 5 1 71 81 37 38 - 4 28 52 33 56 2,411 2,860 Anaemia 2 6 2 7 4 13 — — — — — — 2 5 — 5 — 1 2 2 2 2 109 159 Rickets 9 — 33 - 40 1 — 1 — — — 19 — 8 — — — 13 — 14 — 765 — Enlarged Glands 2 5 2 1 4 6 - - - - - - 1 4 1 1 — — 2 1 2 1 76 140 Rheumatism - - - 5 5 - - - — — — — 2 — — — — — 3 — 3 — 92 Nerves - 4 4 11 4 15 - - - - - - 2 10 1 — — 2 4 2 4 92 203 Genu Valgum — - 1 - 1 - - — — — — — 1 — — — — — — — — — 15 — Fragilitis Ossum - - - 1 - 1 - - - - - - - 1 - - - - - - - - - 38 Cervical Adenitis — 3 — 1 — 4 — — — — — — — 4 — — — — — — — — — 130 62 67 141 158 194 220 8 2 1 3 5 1 96 107 46 45 - 5 47 62 53 66 3,468 3,622 Chronic Blepharitis 1 3 - 7 1 10 - - - - - - - 5 1 4 - 1 - - - - - 193 Corneal Ulcer - - - - - - - - - - - - - - - - - 1 - - - - - 1 Styes — — — 1 — 1 — — — — — — — — — — — — — 1 — 1 — 13 1 3 - 9 1 12 - - - - - - - 5 1 4 - - - 1 - 1 - 207 Asthma - 8 1 9 1 16 - - - 1 - - - 4 1 4 - 1 - 7 - 8 10 457 Bronchitis 3 16 16 42 19 58 — — — — 1 — 6 23 6 12 1 - 5 20 6 20 380 1,048 3 24 17 51 20 74 — — — 1 1 — 6 27 7 16 1 4 5 27 6 28 390 1,505 Alopecia Areata - 1 - 1 - 2 - - - - - - - - - - - - - 2 - 2 - 63 Acne — — — 1 — 1 — — — — — — — 1 — — — — — — — — — 24 Psoriasis - 1 — 1 — 2 — — — — — — — — — 1 — 1 — — — — — 8 General Eczema - - - 1 - 1 - - - - - - - - - - - - - - - - - 11 - 2 4 — 6 — — — - - - 1 - I - 1 - 3 - 3 - 106 Enuresis - 1 4 10 4 11 - - - - - - 1 4 2 2 - - 1 5 1 5 58 234 Chorea - - - 3 - 3 - - - - - - - 2 - - - - - 1 - 1 - 93 Chilblains - 1 - 3 - 4 - - - - - - - 2 - - — ' — — 2 — 2 - 59 Gastritis - - - 1 - 1 - - - - - - - - - - — — — 1 — 1 - 27 Colitis — — 1 — — - 1 — — — — — — — — — — — — — — — — — - 2 5 17 4 19 1 - - - - - 1 8 2 2 — - 1 9 1 9 58 413 Total 66 98 163 239 219 331 9 2 1 4 6 1 103 148 56 68 1 12 53 102 60 107 3,916 5,853 164 402 550 11 5 7 251 124 13 155 167 9,769 TOTAL NUMBER OF ATTENDANCES, YEAR 1936. 0-5 School. Total. Attended and Treated 3,916 5,853 9,769 Attended for examination, e.g., new cases, cases treated and still under observation, unsuitable cases 169 259 428 Total 4,085 6,112 10,197 Total number of sessions 468 Average attendance per session 21.7 Average treatment per child 20.8 CASES REFERRED BY 0-5 School. Total. Clinic Doctors 152 221 373 Private Doctors 8 16 24 Hospital 3 2 5 Total . 163 239 402 101 APPENDIX D. REPORT ON DERMATOLOGICAL AND ACTINOTHERAPEUTIC DEPARTMENT FOR THE YEAR ENDED 31st DECEMBER, 1936. By H. D. HALDIN-DAVIS, M.D., F.R.C.P., F.R.C.S. No striking new feature comes to light in the work either in the Artificial Sunlight Department or in that for the treatment of ulcerated legs. The numbers of patients attending have been well maintained and there is no doubt of the popularity of the services rendered among the citizens of Willesden. A further step in increasing the usefulness of the Skin Clinic has been taken in making arrangements for carrying out minor surgical operations on patients at one of the Borough centres instead of sending them to hospitals. This development is much appreciated as it avoids the necessity for long journeys by children and their parents with frequently a good deal of waiting at the other end. Only three cases of ringworm of the scalp occurred in the Borough during the year, showing that the measures adopted by the Council to deal with this complaint have continued to be successful. The most troublesome skin complaint which has to be dealt with is scabies which is more common than it should be, but the introduction of the Danish method of treating it gives ground for hope that it will shortly be more efficiently controlled. APPENDIX E. REPORT ON WORK IN THE EYE DEPARTMENT FOR THE YEAR ENDED 31st DECEMBER, 1936. By B. R. MEDLYCOTT, D.O.M.S., 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 five years are also given for the purposes of comparison. Total Attendances. 1931 6,118 1932 7,303 1933 7,385 1934 6,482 1935 6,404 1936 6.025 Refraction Cases. Appointments made. Appointments kept. Percentage A ttendance. 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% 1935 831 737 88.7% 1936 1,055 916 86.8% The figures for the year are as follows :— Attendances seen by Oculist. Table I. Total Attendances. Number of Sessions. Average Number of Attendances per Session. Clinic 1 1,845 47 39.3 Clinic 2 1,862 49 38.0 Clinic 3 2,318 46 50.4 Refraction Cases. Table II. Appts. made. Average per Session. Appts. kept. Average per Session. Percentage Attendance. Clinic 1 356 7.6 305 6.5 85.7 Clinic 2 336 6.9 307 6.3 91.4 Clinic 3 363 7.9 304 6.6 83.7 102 The following table shows an analysis of diseases appearing for the first time, and congenital abnormalities found in new cases during the year. Table III. Diseases of the Eyelids, Conjunctiva and Lachrymal Apparatus. Disease. No. of cases. 1934 1935 1936 Conjunctivitis 116 164 138 Hordeolum 18 38 30 Blepharitis 40 30 48 Meibomian Cyst 13 18 11 Sebaceous Cyst — 1 4 Eczema — 2 2 Nævus 1 1 1 Injuries and infections of eyelids 11 27 26 Ophthalmia Neonatorum 4 4 3 Warts 1 1 1 Subconjunctival Ecchymosis 3 2 9 Ectropion 1 — 1 Dacrocystitis 1 1 1 Occlusion of Lachrymal Duct 11 16 27 Lachrymal Abscess 1 — — Atropine Irritation — — 2 Concomitant Squint. Type of Squint. No. of cases. 1934 1935 1936 Alternating Convergent 13 15 26 Alternating Divergent 1 2 1 Right Convergent 48 55 44 Right Divergent 3 — 2 Left Convergent 86 87 50 Left Divergent 3 2 3 Left Upward 1 1 — Right Upward — 1 — Diseases of the Eye-ball. Disease. No. of cases. 1934 1935 1936 Corneal Ulcer 15 9 5 Corneal Abrasion 3 2 1 Corneal Nebula 3 1 2 Superficial Keratitis 1 1 2 Interstitial Keratitis — 1 1 Foreign Body 6 9 9 Episcleritis 1 — 1 Iridocyclitis 1 — 1 Cataract 1 — — Buphthalmos 1 1 — Macula (diseases of) 2 2 2 Retina (diseases of) 1 — 3 Choroiditis — 2 1 Congenital Malformations and Defects. Defect. No. of cases. 1934 1935 1936 Congenital Nystagmus 5 5 3 Microphthalmos 1 1 3 Epicanthus 2 4 6 Congenital Ptosis 2 3 2 Persistent Pupillary Membrane 1 — 1 Congenital Lens Opacities 3 4 2 Dislocation of Lens 1 1 1 Coloboma of Iris 1 1 — Congenital Abnormalities of Retina and Optic Disc 2 2 2 Dermoid Cyst — 1 1 103 Neurological Cases. 1931 1935 1936 Number of Cases ... 5 4 3 The following cases were admitted to Hospital for operation and treatment:— Squint 8 Detachment of Retina 1 Congenital Dislocation of Lens 1 Dermoid Cyst 1 Interstitial Keratitis 1 Total 12 Appendix. The routine at the Health Centre has remained unaltered. The work of the nursing staff, optician, and district visitors has been efficiently maintained. The new style of padbridge frame adopted during 1936 has been a distinct advance. The strength of the frame is much greater than that of the old type, and breakages and distortion of the frames have been considerably less frequent. The appearance of the spectacles is more pleasing and the change has been welcomed by parents and children. Since the publication of the 60th Annual Health Report, in which were outlined the advantages that would result from the orthoptic training of suitable cases of squint, I have observed these cases carefully. I am convinced that the number of children suitable for training would amply justify the institution of an Orthoptic Clinic. APPENDIX F. REPORT ON THE WORK OF THE ORTHOPÆEDIC CENTRE FOR THE YEAR ENDED 31st December, 1936. H. J. SEDDON, F.R.C.S., Orthopaedic Surgeon to the Council. The work of the Orthopædic clinic has run so smoothly for a number of years that one might be tempted to think that no adjustment in the organisation is called for. But the passage of time has revealed weakness at two points. There is a small group of cases in which, although the treatment may have been completed long ago, prolonged observation afterwards is necessary. Congenital dislocation of the hip is a good example. The dislocation may have been reduced, apparently satisfactorily, at the age of two years. It is not sufficient to know that the child is walking well at five years and at ten years; one should be able to see how the hip is behaving at fifteen and twenty. Such observations are not merely of academic interest; they might, and probably would, lead to improvement in methods of treatment, though it would be too late to apply them to the patients who were found to have poor joints at the age of twenty. The need for following certain cases over a long period is clear. In a second small group we find conditions that require continuous observation and perhaps treatment during the 12-20 age period; for example, infantile paralysis and scoliosis. These diseases and their treatment do not recognise any legal time limit. It is agreed that continuity of treatment and observation is one of the most important factors in successful orthopaedic practice and it is unfortunate that the present organisation does not allow of this principle being carried to its logical conclusion. The two groups referred to constitute not more than two or three per cent. of all cases attending the clinic, and yet this small minority is important and well worth our attention. I hope that some way can be found to deal with this problem. Ad hoc arrangements such as transferring these children to the care of a colleague at a town hospital, or asking them to attend (generally on a Sunday) at Stanmore, have been tried and are manifestly unsatisfactory. An analysis of the cases admitted to Hospital may throw light on the efficiency of the preventive side of our work. During the past year twenty-six children have been admitted. In eighteen cases, with our knowledge in its present state, admission to Hospital was inevitable; four of these children were admitted only for investigation. The remaining cases were as follows: club feet, 4; congenital dislocation of the hip, 1; rickets 3. The children with club feet were admitted for correction of deformity that had failed to respond to treatment at the clinic. There is no doubt that our manipulative treatment was inadequate in these three difficult cases, and I have tried to remedy it. A method of splinting recently described by Denis Browne appears to be far superior to the older methods and his results are excellent. The method has been tried out at Stanmore and is now being employed regularly at the clinic and is promising well. The child with congenital dislocation of the hip came to us late with a poor joint that had been treated elsewhere. The time for obtaining a good result was unfortunately long past. Two of the cases of rickets required operative correction of deformities. One looks forward to the time when these deformities will no longer be seen. Rickets is an easily preventable disease. 104 ORTHOPEDIC DEPARTMENT.—REPORT FOR YEAR 1936. 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. Congenital Defects— Club Foot 10 5 1 2 1 3 12 6 4 22 — 1 — — 1 — — — — 12 5 4 21 Dislocation of Hip — 2 5 — — — — 2 5 7 — — - - - - 1 - 1 - 1 5 - 6 Spastic Paralysis 1 13 6 — 2 3 1 15 9 25 - - - - - - - 1 - 1 1 15 8 — 24 Metatarsal Varus - 12 — 2 12 — — 4 24 — - 28 1 4 - - 5 - 4 - - 4 3 16 - - 19 Spina Bifida - - - - - - - - - - - - 1 - - - - - - - - - - - 1 - - 1 Other Conditions 14 18 21 10 31 26 24 49 47 120 3 5 10 18 4 14 12 30 17 30 25 — 72 Birth Injuries— - - - - - - - - - - - - - - Nerve Injuries — 4 1 1 — 1 1 4 2 7 1 — — 1 — — — — — 4 2 — 6 Fractures 1 — — - — — — 1 — — 1 1 - - - 1 - - - - - - - - - - Torticollis 12 - 3 - 7 3 — 19 3 3 25 2 1 — 3 2 — — 2 15 2 3 20 Other Conditions 1 1 — - — — 1 1 1 1 3 — — — — 1 — 1 2 — 1 — — 1 Rickety Deformities— - Bow Legs 2 6 — 6 33 5 8 39 5 - 52 - 3 1 - 4 4 12 3 - 19 1 24 1 - 29 Knock Knees 1 3 — 7 3 1 10 3 - 14 - 2 - - 2 - 1 - - 1 7 3 - 11 Other Conditions 1 1 — — 9 3 1 10 3 - 14 - 1 2 - 3 - - - - - 1 9 1 - 11 Knock Knees, non-Rickety - 93 31 45 36 - 138 67 - 205 - 25 17 - 42 - 58 9 - 67 To 55 41 - 96 Bow Legs, non-Rickety 12 62 1 - 12 33 - 24 95 1 - 120 6 18 1 - 25 6 15 - - 21 62 - - 74 Postural Defects of the Spine 1 8 74 - — — 54 1 8 128 137 — 1 26 - 27 — 42 42 l 7 60 68 Structural Defects of the Spine — — 5 — 1 6 — — 1 11 12 — — — — — 2 2 — 1 9 10 Flat Feet 1 26 36 1 - 27 66 1 1 53 102 2 158 - 3 31 - 34 11 33 1 45 39 38 1 79 Infantile Paralysis — 6 12 — 5 4 — 11 16 — 27 — 4 2 - 6 — — — — 7 14 — 21 Sequelae of Acute Fever— Scarlet Fever — 3 2 - — — — — 3 2 — 5 — — 1 - 1 - - 1 1 - 3 - — 3 Diphtheria — - 3 — — 1 — - 4 — 4 — — — - — 2 2 — — 2 — 2 Mastoid 1 — 3 — — — 1 — 3 — 4 — — — - — — 1 1 1 — 2 3 Fractures -— — 5 — — 7 — — 12 — 12 — — 4 — 4 — - 6 - 6 - - 2 — 2 Traumatic but not Fractures — 7 8 — 3 61 1 — 10 69 1 80 — 5 42 1 48 — 2 14 — 16 — 3 13 — 16 Other Bone Diseases— - Hammer Toes — — 5 — — 1 — — 6 — 6 — — — — — — 1 — 1 — — 5 — 5 Hallux Valgus — — 6 — — 5 — — 11 — 11 — — 3 - 3 - - 4 - 4 - - 4 - 4 Schlatters' Disease — — 2 — — 2 — — 4 — 4 — — — — — — 1 1 - - 3 3 Perthes' Disease - - 1 - - - 2 - - - 3 - 3 - - - - - - - - - - - - 3 - 3 Exostosis of Os Calcis — — 3 — — 5 — — — 8 — 8 — — 4 4 — - — — — — 4 — 4 Epiphysitis of the Spine — — 1 — — — — — — 1 — 1 — — 1 1 — - — — — — — — — Diaphyseal Aclasia — 1 - - - - - - - 1 - - 1 - - - - - - 1 - - 1 - - - - - Tumour of Scapulae - - 1 - - - - - - - 1 - 1 - - - - - - - - - - - - 1 — 1 Prominence of Costal Cartilage - 2 - - - - - - - 2 - - 2 — 1 — — 1 — — — — — — 1 — — 1 Calve's Osteochondritis of the Spine - - - - - - 1 - - — 1 — 1 — — — — — — — — — — — — 1 — 1 Tuberculous Joints -— 2 8 — I 5 — 3 13 — 16 - — 3 - 3 - - 3 - 3 - 3 7 - 10 Debility 1 10 1 — 4 — 1 14 1 — 16 1 3 — 4 — 6 1 7 — 5 — 5 Fibrositis — 1 1 — — — 1 — 1 1 1 3 - - - - - - - - - - - 1 1 1 3 Muscular Dystrophy — 1 1 — — — — — 1 1 — 2 — — — — — — — — — 1 1 — 2 Nothing Abnormal diagnosed 3 4 3 5 18 11 2 8 22 14 2 46 5 10 8 23 3 2 1 6 - 10 5 2 17 Ganglia 1 1 — — — 3 — 1 1 3 - 5 - - 1 - 1 - - 1 - 1 l 1 1 - 3 Total 65 292 250 1 45 236 315 5 110 528 565 6 1,209 20 87 157 1 265 20 127 139 1 287 70 314 269 4 657 No. of individual cases treated 65 178 247 1 43 222 306 3 108 400 553 4 1,065 20 87 157 1 265 20 127 139 1 287 68 186 257 2 513 No. of attendances at Centre for Treatment 518 2,382 6,674 30 9,604 Do. do. do. Massage 344 956 1,402 19 2,721 Do. do. do. Electrical Treatment — 360 405 19 784 Do. do. do. Gymnastic Exercises — 851 4,754 2 5,607 Do. do. do. Application of Splints 189 216 113 518 Total 533 2,383 6,674 40 9,630 No. of attendances at Centre for examination only 32 287 203 - 522 Total attendances at Centre 550 2,669 6,877 30 10,126 Patients entered Hospital for Inpatient Treatment— Congenital Defects— Admitted Discharged. - - - - - Club Foot M.L 14. 4.36 15. 6.36 1 — — — 1 V.W 14. 4.36 25. 6.36 1 — 1 P.S 19.11.36 - - 1 - - 1 Dislocation of Hip B.O 7.12.36 - - - 1 - 1 K.L 2. 1.36 7.11.36 - - 1 — 1 F.K 18. 3.36 8. 6.36 — — 1 — 1 19. 8.36 12. 9.36 - - - - - Spastic Paralysis B.H 25. 5.36 18. 6.36 — — 1 — 1 M.W 6.10.36 - - 1 - - 1 Abscess in Humerus V.W 24. 9.36 7.10.36 - - 1 - 1 Friederich's Ataxia C.S 30. 4.36 9. 9.36 - - 1 — 1 Birth Injuries—Torticollis F.D 21. 1.36 31. 1.36 - — 1 — 1 Rickety Deformities—Bow Legs A.W 12. 6.36 3. 7.36 - 1 - - 1 R.N 18. 6.36 28. 9.36 - - 1 — 1 L.R 18. 6.36 20. 8.36 - 1 — — 1 A.C 18. 6.36 24. 7.36 — 1 — — 1 Structural Defect of the Spine D.G 9.11.36 — — — 1 — 1 Pes Cavus J.I 20.4.36 25. 5.36 - - 1 - 1 Rigid Flat Foot E.R 14. 4.36 29. 4.36 — — 1 — 1 Traumatic B.P 5. 6.36 1.10.36 - - - - - 26. 6.36 29. 6.36 - - - 1 L.B 14. 9.36 7.10.36 - - 1 - 1 Tuberculous Joints *P.S 9. 9.36 12.10.36 - - 1 - 1 Investigation . A.E 24. 4.36 16. 7.36 — — 1 — 1 G.S 5.10.36 23.11.36 - 1 - - 1 Exostosis of Os Calcis I.S 4.10.36 — — — 1 — 1 K.F 6. 4.36 24. 4.36 — — 1 - 1 Perthes' Disease A.D 11. 8.36 26. 8.36 8. 1.36 — — 1 — 1 Total 2 7 17 — 26 In addition to the above during 1936 the Council agreed to bear the cost of treatment of 2 children under 5 years of age and 1 child over 5 years of age at the Royal National Orthopaedic Hospital, and of 1 child over 5 years of age at St. Vincent's Orthopaedic Hospital who was referred to Hospital by another agency. * This case was treated for the Middlesex County Council who bore the cost of treatment, f These totals are greater than those under " No. of Attendances at Centre for Treatment" above, because a child may receive more than one type of treatment at one attendance. 105 APPENDIX G. REPORT ON THE WORK OF THE EAR, NOSE AND THROAT DEPARTMENT for the Year Ended 31st December, 1936. By G. H. LIVINGSTONE, F.R.C.S., Ear, Nose and Throat Surgeon to the Council. In 1935 all routine tonsil and adenoid cases were operated upon at Willesden General Hospital; in 1936 a new scheme was adopted, and children with enlarged tonsils were admitted to the Municipal Hospital. A separate pavilion has been converted into two wards between which are an operating theatre and an anaesthetic room. Eight children are admitted twice weekly. This scheme has now been working for eight months and is running very smoothly. Operations. Operations. Boys. Girls. Total. Removal of tonsils and adenoids 179 170 349 Removal of adenoids only 14 10 24 Hospital infectious cases, tonsils and adenoids 8 11 19 201 191 392 The total cases seen Operations. Health Centre I 181 78 Health Centre II 270 157 Health Centre III 321 137 Total 772 372 Breathing Exercises. All children who have had tonsil or adenoid operations are automatically referred for special breathing exercises. These exercises take place at Health Centres I and III under the supervision of trained nurses. At Health Centre III they are carried out in artificial sunlight. Each child is expected to attend twice weekly for six weeks. The exercises are proving extremely beneficial to the children, and attendances are regular. Unfortunately, there is no accommodation for these classes at Health Centre II, and children who require breathing exercises have to be transferred from this Centre to Centre I or III. 106 APPENDIX H. HOUSING ACTS, 1925 to 1935. Clearance Areas. (Dealt with by Making " Compulsory Purchase " Orders.) 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 — 90 *†Alpha Mews 29 22 19 — 7 — 3 22 109 32 39 161 **†Cambridge Mews West 5 1 5 — — — — 1 21 — — 1 **† Cambridge Mews East 10 — 9 — 1 — — — 49 — — — **† Pembroke Place 14 — 14 — — — — — 78 — — — **†† Park Road Mews 10 — 10 — — — — — 45 — — — **†† Park Mews ... 34 3 34 3 — — — — 153 — — — f Orders made 1934. * Decision by Minister of Health, 1934. tt Orders made 1935. ** Decision by Minister of Health, 1935. 107 APPENDIX H—(continued). . HOUSING ACTS, 1925 to 1935. Clearance Areas. (Dealt with by Making "Clearance" Orders.) Areas. Number of Buildings on which Notice of Making a Clearance Order was made. Number of Buildings on which Notice of Making a Clearance Order was Confirmed without modification by Minister of Health. Number of Buildings on which Notice of Making a Clearance Order was made and Excluded by the Minister of Health. Number of Occupiers in Buildings. Confirmed. Not Confirmed. Bridge Street 17 13 4 54 6 *† Market Place Yard 3 3 — 14 — *† Stafford Mews 20 20 — 80 — *† Lincoln Mews 18 18 — 94 — †Orders made 1935. * Decision by Minister of Health, 1935. The following numbers of Notices were served and inspections, etc., were made during 1934, 1935 and 1936. Section 127, Housing Act, 1925 20,679 Number of premises inspected 283 Section 42, Housing Act, 1930 431 Number of visits for the purpose 1,088 Notices of Making Compulsory Purchase Orders 547 Total inspections and re-inspections 1,371 Notices of Making Clearance Orders 204 Overcrowding:— Notices to Objectors, Sect. 63, Housing Act, 1935 132 Number of rooms measured 69,739 Number of visits for the purpose 27,697 Statements of " Permitted Number " issued 1,155 108 January 6th, 1936. APPENDIX I. HEALTH DEPARTMENT. PROGRESS OF HOUSING PROGRAMME. Present Stage. (1) I beg to report upon the progress made in carrying out the programme formulated by the Council under the provisions of the Housing Act, 1930. It will be remembered that on the 13th October, 1933, the Council adopted the following programme to be carried out under the provisions of the Housing Act, 1930, during the ensuing five years. Clearance Areas. Area. Number of dwelling-houses to be demolished. Number of families. Number of inhabitants. Number of buildings not in occupation as dwellinghouses to be demolished. 1. Alpha Place North 27 57 225 5 2. Alpha Mews 26 37 156 3 3. Canterbury Road 5 5 22 — 4. Bridge Street 22 28 117 4 5. Pembroke Place 14 15 70 — 6. Park Mews 33 33 146 3 7. Park Road Mews 10 10 49 — 8. Stafford Mews 19 20 80 2 9. Cambridge Mews East 9 9 45 1 10. Cambridge Mews West 5 5 22 1 11. Lincoln Mews 18 18 94 — 12. Market Place Yard 3 3 15 — 13. Canterbury Yard 1 1 5 3 Totals 192 241 1,046 22 (2) On 24th April, 1934, the Council declared Alpha Place North, Alpha Mews and Canterbury Road to be Clearance Areas and made Compulsory Purchase Orders, in respect thereto including in the Orders relating to Alpha Place North and Alpha Mews adjoining land deemed to be necessary for the satisfactory development of the cleared sites. The numbers of families and persons to be re-housed in accordance with these Orders were as follows:— Alpha Place North Area (including land adjoining) 101 families = 384 persons. Alpha Mews Area (including land adjoining) 92 „ = 341 „ Canterbury Road Area 5 ,, =19 ,, As a result of the Public Local Enquiry into the above Orders held on the 23rd July, 1934, the Minister confirmed the Alpha Place North Compulsory Purchase Order and the Alpha Mews Compulsory Purchase Order with modifications. The Canterbury Road Compulsory Purchase Order was not confirmed. The numbers of families and persons to be re-housed in accordance with the confirmed Orders are as follows :— Alpha Place North Area (including land adjoining) ... 71 families = 294 persons. Alpha Mews Area (including land adjoining) 34 ,, =141 ,, Canterbury Road Area Nil ,, = Nil „ (3) On the 24th July, 1934, the Council declared Pembroke Place, Cambridge Mews East, and Cambridge Mews West to be Clearance Areas and Compulsory Purchase Orders were made in respect thereto. The Compulsory Purchase Order made in respect of Cambridge Mews West included land adjoining. The numbers of families and persons to be re-housed in accordance with these three Orders were as follows:— Pembroke Place Area 19 families = 78 persons. Cambridge Mews East Area 12 „ = 49 „ Cambridge Mews West Area 7 „ =22 ,, As a result of the Public Local Enquiry into these Orders, held on the 4th December, 1934, the Minister confirmed the Orders with slight modification in the case of Cambridge Mews East Area, and excluding the land adjoining in the case of Cambridge Mews West Area. 109 The number of families and persons to be re-housed in accordance with the Confirmed Orders are as follows :— Pembroke Place Area 19 families = 78 persons. Cambridge Mews East Area 12 „ = 49 „ Cambridge Mews West Area 6 ,, =21 (4) On the 18th December, 1934, the Council declared Bridge Street, Park Road Mews and Market Place Yard to be Clearance Areas. A Compulsory Purchase Order was made in respect to Park Road Mews and Clearance Orders were made in respect to Bridge Street and Market Place Yard Areas. The numbers of families and persons to be re-housed in accordance with these Orders were as follows:— Bridge Street Area 18 families = 60 persons. Park Road Mews Area 10 ,, =45 „ Market Place Yard Area 3 ,, =14 ,, As a result of the Public Local Enquiry into the above Orders, held on the 14th May, 1935, the Minister confirmed the Park Road Mews Compulsory Purchase Order and the Market Place Yard Clearance Order without modification. The Bridge Street Clearance Order was confirmed with modifications. The numbers of families and persons to be re-housed in accordance with these Confirmed Orders are as follows :— Bridge Street Area 15 families = 54 persons. Park Road Mews Area 10 ,, =45 ,, Market Place Yard Area 3 „ =14 „ (5) On the 26th March, 1935, the Council declared Park Mews, Stafford Mews and Lincoln Mews to be Clearance Areas. A Compulsory Purchase Order was made in respect to the Park Mews Area, which Order included land adjoining deemed to be necessary for the satisfactory development of the cleared sites. Clearance Orders were made in respect to the Stafford Mews and Lincoln Mews Areas. The numbers of families and persons to be re-housed in accordance with these Orders are as follows:— Park Mews Area 33 families =153 persons. Stafford Mews Area 20 „ =80 „ Lincoln Mews Area 18 ,, = 94 ,, As a result of the Public Local Enquiry into the above Orders, held on 2nd October, 1935, the Minister confirmed the Lincoln Mews Clearance Order without modification. The Park Mews Compulsory Purchase Order was confirmed subject to the omission of the clause appropriating the land for re-housing and to a payment to the owner of Reference numbers 8-17 (inclusive) under Section 64 of the Housing Act, 1935. This Section provides for certain payments to be made to the owner of a house properly included in a clearance area, which, in the opinion of the officer of the Ministry of Health, has, notwithstanding its sanitary defects, been well maintained. The Stafford Mews Clearance Order was confirmed subject to a payment to the owner of Reference numbers 3, 4, 11, 12 and 16, under Section 64 of the Housing Act, 1935, before-mentioned. The numbers of families and persons to be re-housed in accordance with these confirmed Orders are as follows :— Park Mews Area 33 families =153 persons. Stafford Mews Area 20 „ = 80 Lincoln Mews Area 18 ,, = 94 „ (6) The Canterbury Yard Area (number 13 on the programme) has not been dealt with, due to the fact that only one dwelling-house now exists in the Area. This house will fall to be dealt with under the provisions of Sections 17-20 of the Housing Act, 1930. 110 Summary of Families and Persons to be re-housed from Clearance Areas. Area. Families. Persons. Number estimated in original programme. Actual Number. Number estimated in original programme. Actual Number. 1. Alpha Place North (57) 71 (225) 294 2. Alpha Mews (37) 34 (156) 141 3. Canterbury Road (5) — (22) — 4. Bridge Street (28) 15 (117) 54 5. Pembroke Place (15) 19 (70) 78 6. Park Mews (33) 33 (146) 153 7. Park Road Mews (10) 10 (49) 45 8. Stafford Mews (20) 20 (80) 80 9. Cambridge Mews East (9) 12 (45) 49 10. Cambridge Mews West (5) 6 (22) 21 11. Lincoln Mews (18) 18 (94) 94 12. Market Place Yard (3) 3 (15) 14 13. Canterbury Yard (1) — (5) — Total (241) 241 (1,046) 1,023 Modifications Introduced by the 1935 Act. (7) Improvement Areas.—The Council's programme further provided that during the second five-year period (1938-43) work on Improvement Areas in Willesden should be commenced. Under the provisions of the Housing Act, 1935, the procedure relating to Improvement Areas contained in the Housing Act, 1930, is repealed. A new provision, namely, the Re-development Area, is introduced. (8) Re-development Areas.—The Re-development Areas introduced into the 1935 Act are not on all fours with the Improvement Areas under the 1930 Act. Memorandum C, page 5, para. 5, deals with the Re-development Area as defined in Section 13 of the 1935 Act. The following conditions must exist before an area can be declared a Re-development Area:— " (a) that the area contains 50 or more working-class houses ; " (b) that at least one-third of the working-class houses in the area are overcrowded or unfit for human habitation and not capable at reasonable expense of being rendered so fit, or so arranged as to be congested ; " (c) that the industrial and social conditions of the local authority's district are such that the area should be used to a substantial extent for re-housing ; and "(d) that it is expedient in connection with the provision of housing accommodation that the area should be redeveloped as a whole. " Such an area should include all the property within a continuous line. It may include properties belonging to the authority and properties which the authority cannot, or do not propose to, interfere with in any way. Such properties might, for example, be churches, railway property or properties belonging to private owners, the user of which it is not proposed to change." Whether and to what extent areas may be declared by the Council to be Redevelopment Areas will emerge from the enumeration and the overcrowding survey about to be conducted. In the event of any area being declared a Redevelopment Area the procedure to be adopted is laid down in Memorandum C. It really amounts to the demolition of the whole or greater part of the area and re-building or re-developing the area in such a way that overcrowding will be abated. GEORGE F. BUCHAN, Medical Officer of Health. 111 March 2nd, 1936. APPENDIX J. HEALTH DEPARTMENT. ADMINISTRATIVE PROGRAMME OF EDUCATIONAL DEVELOPMENT. Board of Education Circular 1444. SCHOOL MEDICAL SERVICE AND SPECIAL SCHOOLS. I beg to report on the above Circular in accordance with the following Minute of the Education Committee:— "We have received a copy of the above Circular (Administrative Programme of Educational Development), and have requested the Medical Officer to present to us a report hereon for consideration at our next meeting." In paragraphs 16 and 17 (a), (b), (c), (d), (e), (/) and (g) of Circular 1444 references are made to the School Medical Service and Special Schools:— "16. Under Section 80 of the Education Act, 1921, it is the duty of a Local Authority not only to provide for the medical inspection of children attending public elementary schools, but also to make adequate and suitable arrangements for attending to their health and physical condition. In view of the variations which still exist in the provision made for the School Medical Service, Authorities would do well to survey the needs of their areas and to consider what further steps should be taken to remedy any deficiencies which may be discovered in their present arrangements. Special Schools are so closely linked with the work of the School Medical Service that no such survey can be complete which does not take them into account. "17. In surveying the needs of an area, account must necessarily be taken of what has already been done as well as of the particular circumstances of the area. In all plans for development the Authorities will appreciate the desirability of using to the full the existing agencies. Taking the country as a whole, the chief deficiencies are the following:— "(a) The School Dental Service is seriously incomplete in most parts of the country. Authorities should aim at securing an initial dental inspection of every child on its entry into school life, to be followed by an annual re-examination until the child ceases to attend school. On this basis the Board estimate that, with a normal number of acceptances for treatment, a minimum standard should consist of one dentist for 5,000 children in an urban area and 4,000 children in a rural area, although this is insufficient where a high percentage of parents accept treatment for their children. The Board look to Authorities to examine their present arrangements with a view to securing that their dental staff does not fall short of the requirements of their areas." Note by Dr. Buchan. 17. (a) The School Dental Service. In the Borough of Willesden there are approximately 21,000 elementary school children and 2,400 secondary and technical school children, making 23,400 in all, who need routine dental inspection. The Council employ four dentists, who also carry out work in relation to expectant and nursing mothers and children under five years of age. The Board of Education desire that every child should be dentally inspected annually during its school life, and on this basis estimate that, with a normal number of acceptances for treatment, a minimum standard of one dentist for 5,000 children is required. It will be observed that Willesden is below this minimum standard, each dentist having 5,850 school children, with expectant and nursing mothers and children under five years in addition. "17. (b) There should, in every area, be a scheme designed in conjunction with an orthopaedic hospital to provide adequately for the ascertainment, treatment, and after-care of children suffering from crippling defects. There are at present over 70 Authorities which have not established such schemes. Even areas which have a scheme should consider the adequacy of the provision of places in orthopaedic hospital schools for children who require long periods of treatment." Note by Dr. Buchan. 17. (b) The Council has in operation an orthopaedic scheme designed in conjunction with the Royal National Orthopaedic Hospital at Stanmore. The scheme provides for— I. Ascertainment of cripples at an early age:— (i) Through the Health Visitors. (ii) Through the School Medical Officers, School Teachers, School Attendance Officers and School Nurses. (iii) Through the Health Centre—Maternity and Child Welfare Clinics; Nursery Classes. II. Treatment at the Orthopaedic Clinic in the Stonebridge Health Centre by the Orthopaedic Nurses and the Council's Orthopaedic Surgeon, with following up by the Health Visitors to maintain regular attendance. 112 III. The provision of beds by arrangement with the Royal National Orthopaedic Hospital (School), Stanmore, for in-patient treatment. IV. The provision of splints and appliances. V. After-care at the Stonebridge Orthopaedic Clinic as long as the child attends school. "17. (c) In view of the need for expert treatment of ear diseases, which may result in deafness, it is very desirable that Authorities, which have not yet done so, should arrange for the services of part-time aural specialists who would visit the areas periodically and advise as to the treatment of such cases. The work of the specialists should be closely co-ordinated with that of the aural surgeons employed by Authorities responsible for the maintenance of Isolation Hospitals, since so many ear defects in children are the result of attacks of acute infectious disease." Note by Dr. Buchan. 17. (c) The Council have arranged for the services of an Ear, Nose and Throat Surgeon who visits the Health Centres periodically and whose services are also available at the Willesden Municipal Hospital, to advise as to the treatment of ear diseases. "17. (d) There are many industrial areas where Day Open-Air Schools do not exist or their number is inadequate, and the Board would welcome proposals for increasing the number of such Schools. While day schools suffice for most children, there are some who, on account of their debilitated condition or exceptional home circumstances, require the more continuous care which can only be given in a residential school. In areas, whether urban or rural, where sufficient residential school accommodation is not available for cases of this kind, Authorities should consider the utilisation of the existing voluntary agencies or, if those prove to be insufficient, co-operate in establishing the necessary residential schools." Note by Dr. Buchan. 17. (d) There is no day open-air school in Willesden but the Education Committee have reserved places at the following residential open-air schools to which they send debilitated children for a period of six weeks in the first instance :— St. Dominic's Open-Air School, Godalming 4 places for boys. St. Patrick's Open-Air School, Hayling Island 11 places for girls. Russell-Cotes School of Recovery, Parkstone .. 9 places for boys, and 4 places for girls. making 28 places in all. Approximately 220 debilitated children are sent away for a period of convalescence each year. Children who are debilitated by such conditions as fibrosis of the lungs, asthma, rickets and require prolonged open-air treatment, are sent by the Education Committee to such residential schools as St. Catherine's School, Ventnor, or Oak Bank Open-Air School, Sevenoaks. An extension of the present arrangement of sending debilitated children to residential open-air schools for periods of six weeks' convalescence, appears to be a more satisfactory proposition than sending them to a day open-air school where they would spend less than seven hours a day on five days a week. There is at present no provision made by the Education Committee for sending debilitated children between the ages of 3 and 5, attending the nursery classes, away for short periods of convalescence in a residential open-air school, in the way that children over the age of 5 are sent at the present time. Such provision merits consideration. "17. (e) There is a need for increased provision for the special institutional treatment of children suffering or convalescent, from acute rheumatism, since this condition, if not suitably treated, may lead to heart disease. This problem is an important one, but the number of such children is comparatively small and the method of co-operation suggested above for making the necessary residential provision might be followed in this case also." Note by Dr. Buchan. 17. (e) The Education Committee have at present made no provision for the special institutional treatment of children suffering from acute rheumatism. Children convalescent from acute rheumatism are sent for a short period of convalescence to a residential open-air school, or if they are left with heart disease, they are sent to a heart home such as those at West Wickham and Lancing. It appears desirable that a number of beds be provided for the treatment of children suffering from acute rheumatism and these would best form part of a rheumatic scheme embracing a Rheumatic Supervisory Clinic. "17. (/) The problem of the sub-normal child is one which calls for careful attention. While additional Day Special Schools for Mentally Defective Children are not, as a rule, urgently required, there is need of increased residential provision for difficult children or those of lowgrade intelligence who are out of reach of, or unsuitable for, Day Special Schools, but cannot properly be retained in the ordinary public elementary school." 113 Note by Dr. Buchan. 17. (/) The Education Committee have established the Lcinster Mentally Defective School which provides adequate accommodation for those mentally defective children who are suitable to attend a special day school. Those children who are unsuitable for this school are sent by the Committee to residential schools for the mentally defective. "17. (g) The accommodation for blind and deaf children in the country is generally sufficient, but some additional provision for partially sighted and partially deaf children is desirable. In the case of partially sighted children this provision should be made in close connection with the ordinary public elementary schools on the lines recommended by the Committee on Partially Sighted Children. The question of provision for partially deaf children is at present being considered by a similar Committee, whose report will be published in due course." Note by Dr. Buchan. 17. (g) The Education Committee make provision for the education of partially deaf children by sending them to the Ackmar Road Partially Deaf School, Fulham, of the London County Council, and of partially sighted children by sending them either to the Swiss Cottage School for the Blind, the Amberley Road Myope School, Paddington, of the London County Council, or to some other suitable institution. GEORGE F. BUCHAN, Medical Officer of Health. APPENDIX K. March 26th, 1936. HOUSING ACT, 1935. REPORT ON OVERCROWDING SURVEY. The total number of families covered by the survey was 44,762, as follows :— (a) Housed under private ownership ... ... ... 43,534 (b) Housed under Council ownership ... ... ... 1,228 Total 44,762 Number and sizes of separate families. The following table shows the sizes and numbers of the separate families included in the survey as well as the overcrowding of such families :— Sizes of families. Total number of families. Number of families overcrowded. 1 person 3,694 5 1½ persons 53 0 2 11,557 23 2½ „ 4,466 67 3,, 9,215 61 3½,, 2,439 210 4,, 5,433 225 4½,, 1,284 92 5,, 2,873 138 5½,, 784 242 6,, 1,253 281 6½,, 389 115 7,, 570 118 7½,, 193 73 8,, 265 90 8½,, 90 35 9,, 83 27 9½,, 19 7 10,, 43 13 10½,, 13 7 11,, 19 6 11½„ 3 1 12,, 7 2 12½ ,, 2 1 13,, 2 1 13½,, — — 14,, 7 4 14½,, — — 15,, 1 — 15½,, — — 16,, 2 — 16½,, — — 17,, 2 — 20,, 1 1 Total 44,762 1,845 Percentage of overcrowded families :—4.12. 114 Houses required to abate overcrowding. In order to estimate the net amount of accommodation required to abate the overcrowding, it is desirable to group the families found to be overcrowded according to the size of the families. Group 1. Overcrowding was found to be greatest in families consisting of from 3£ persons to 7 persons, as follows:— Size of family. Number of families overcrowded. 3½ persons 210 4,, 225 4½ „ 92 5,, 138 5½ „ 242 6 281 6£ 115 7 118 Total 1,421 As 1,421 of the total of 1,845 overcrowded families are in this group, it is apparent that the bulk of new accommodation required must be provided for this group. A large percentage of the families in this group are at present living in tenement houses in circumstances where the removal of one family will permit the remaining families to "spread out" and it is probable that if new accommodation is provided for one half of the total number, or 710, the abatement of overcrowding will be possible for the whole number. For this group then it would appear that the Council will require to provide new accommodation for 710 families in houses or flats with 3 to 5 rooms (excluding the scullery). The standard of re-housing accommodation laid down in Section 37 of the Housing Act, 1930, is as follows :— 4 persons . 2 bedrooms. 5 „ 3 7 „ 4 The following provision of new houses would, therefore, be required for this group :— 217—2-bedroom houses for families of 3½ or 4 persons. 115—3 ,, „ ,, ,, 4½ or 5 persons. 378—4 ,, ,, ,, „ 5½, 6, 6½ or 7 persons. 710 Group 2. This group consists of families containing from 7½ persons to 10 persons. Overcrowding was found to exist in this group as follows :— Size of family. Number of families overcrowded. 7 persons 73 8 90 8 ½ 35 9 27 9½ 7 10 13 Total 245 The families in this group mainly occupy structurally separate houses or flats and their removal from this accommodation will rarely permit of de-crowding of families in the same house. Nevertheless, the premises they vacate will form an outlet for the abatement of overcrowding at present existing in families of smaller dimensions. In all the circumstances it would appear desirable that the Council should build accommodation for these 245 overcrowded families. The housing standard laid down in the Housing Act, 1930, does not provide for families of the size contained in this group, but houses with 4 or 5 bedrooms would generally give them the necessary accommodation. On this basis the following houses would be required :— 163—4-bedroom houses for families of 7½ or 8 persons. 82—5 „ „ „ „ 8½, 9, 9½, or 10 persons. 245 115 Group 3. This group consists of the remaining families. Overcrowding was found in these families as follows:— Size of family. Number of families overcrowded. 1 person 5 2 persons 23 2½ „ 67 3„ 61 156 10½ „ 7 11 „ 6 11½ „ 1 12 „ 2 12½ „ 1 13 „ 1 14 „ 4 20 „ 1 23 Total 179 It is suggested that there is no need to provide new accommodation for the smaller families in this group, namely, families of 1 to 3 persons, as the surplus accommodation resulting from the relief of the families in Groups 1 and 2 should enable these 156 families to move to bigger accommodation. In view of the size of the families with 10½ or more persons or 23 families in all, it is suggested that the Council provide the necessary houses for them as it is unlikely that they could find accommodation otherwise. Summary of total houses required. 217—2-bedroom houses for families of 3½ or 4 persons. 115—3 „ „ „ ,, 4½ or 5 persons. 378—4 „ „ ,, ,, 5½, 6, 6½, or 7 persons. 163—4 ,, ,, ,, ,, 7½ or 8 persons. 82—5 ,, „ ,, „ 8½, 9, 9½, or 10 persons. 23— houses for families of 10½ and over. 978 GEORGE F. BUCHAN, Medical Officer of Health. April 29th, 1936. APPENDIX L. HEALTH DEPARTMENT. Extension of Health Centre (3). We beg to report in accordance with the following minute of the Council dated 25th February, 1936:— "In accordance with our instructions, the Medical Officer of Health has reported to us in connection with the proposed alterations at Health Centre No. 3, upon the possible increase of work and additional services during the next ten or fifteen years. We are of opinion that the necessary accommodation could be provided by some slight alteration to the plans already submitted by the Borough Engineer and the erection of the caretaker's cottage apart from the Centre. We have, therefore, requested the Borough Engineer to prepare a further plan and to report to us hereon in conjunction with the Medical Officer of Health." Report of the Medical Officer of Health. The need for extension of Health Centre (3) arises mainly from the fact that the Ministry of Health and Board of Education in a letter dated 10th August, 1927, limited the cost of erection of Health Centre (3) to £12,000, whereas the Council wanted to build a clinic at an estimated cost of £20,500. In order, however, that the necessary enlargement might be carried out at a later date at minimum cost, the Council stated in a letter to the Board of Education dated 25th February, 1928 "that the building should be so planned and constructed that extensions can be made in the future by adding an upper storey and prolonging the wings." 116 The plan now submitted by the Engineer will, so far as I am able to foresee, meet the needs of the Health Centre for some time to come. (1) Nursery. No nursery has ever been provided for this Centre and children coming with their mothers have had to use a dressing room. The nursery now shown on the plan will be the existing artificial sunlight room and will be in direct communication with the children's playground for use during the summer weather. (2) Minor Skin Conditions. In his annual report for 1935 the Council's Dermatologist, Dr. Haldin-Davis, calls attention to the fact that he has to refer a number of cases to various hospitals for treatment for quite minor conditions such as warts on the soles of the feet and the palms of the hands; naevi, which are unsuitable for treatment with carbon dioxide; small tumours of the skin which require surgical treatment such as can be carried out in an out-patient clinic and cases of chronic dermatitis or eczema for which X-ray treatment is essential. This work, as well as the existing work of the Dermatological department, namely, consultations in respect of skin cases referred by the whole-time medical staff and artificial sunlight treatment, will be carried on in the skin specialist's room and light room on the first floor of the plan now submitted. (3) Throat, Nose and Ear Conditions. The cases of enlarged tonsils and adenoids or deflected nasal septum which have been operated upon at the Willesden General Hospital have not hitherto received the subsequent instruction and training in breathing so necessary for a complete remedy. This is due to the fact that at none of the Centres of the Authority is there any room or staff available for this purpose. In addition there are throat, nose and ear cases, e.g., chronic discharging ears, chronic catarrh, etc., requiring special treatment not now given at the Health Centres. It is proposed that the Throat, Nose and Ear Specialist recently appointed, should be required to attend the extended Health Centre weekly, not only for the purpose of carrying out his existing work, namely, the passing of cases for operation, but also to examine and deal with the cases which have been operated on by him at the Municipal Hospital. He would also be required to examine other throat, nose and ear cases referred to him and to give directions as to the best methods of dealing with them. It is proposed that this work be carried out in the room marked "Squint Clinic—Throat, Nose and Ear Clinic." (4) Squint Clinic. A number of cases of squint of children under five years and of school children attend the Health Centres. The present treatment at the Health Centres is usually by the provision of glasses which aims at achieving (1) maximum visual acuity in each eye and (2) parallel visual axis (that is, so that the squint is not apparent). There is no means whereby the correct use of both eyes at the one time can be developed so that binocular vision is secured. This requires training of the patient so that the visual acuity of the squinting eye may be increased. For this purpose a certain amount of apparatus and usually some 15 to 20 attendances on the part of each patient for 20-minute lessons about twice a week are required. It is proposed that this work should be carried out in the room marked " Squint Clinic—Throat, Nose and Ear Clinic." (5) Ante-natal Arrangements. The ante-natal arrangements at this Centre have never been quite satisfactory and they are becoming less and less satisfactory as the attendances increase. Ante-natal attendances at this Centre have been as follows in the years since the Centre was opened:— 1930 (8 months) 1,241 1931 1,843 1932 2,145 1933 2,384 1934 2,888 1935 4,128 The result of this increase is that nearly on every occasion of an ante-natal clinic expectant mothers have to wait on a form in the corridor. It is also difficult to secure suitable privacy for dressing and undressing, while no w.c. is available in this room as required. The plan shows an extension of the existing ante-natal room which will be properly fitted with curtains for the comfort and seclusion of undressing patients and with a w.c. This is shown in the room marked " Ante-natal Preparation Room." (6) Pharmacy. This work is at present accomplished by the Pharmacist attending on certain days of the week and making up stock prescriptions which, together with dried foods, are given out by a clerk who sits in the dispensary during clinic hours. Special prescriptions required have got to be specially arranged for. The increased work at the clinic would require an assistant pharmacist to be in attendance. 117 (7) Dentistry. (a) Dentures.—Dentures for expectant and nursing mothers are now obtained by arrangement with private dentists. Having regard to the large number of such dentures now provided, it would not only be more economical but also more convenient for this work to be carried out at the Health Centre. (b) Orthodontics.—A number of cases of children attend the Health Centre in which the teeth require to be regulated. This is important work because of the early decay of overcrowded and irregular teeth and also because of the adverse psychological effects which occur in many of these cases where the teeth are protruding or badly arranged, causing definite unsightliness and disfigurement. It is proposed that all this dental work, namely, dentures and orthodontics, should be carried out in the rooms marked "Denture Fitting Room," "Dental Mechanic's Room" and "Orthodontic Room." (8) Isolation. The enlarged clinic would also enable a spare room to be available for cases coming to the clinic requiring to be isolated. (9) Test Feeding. A room would also be available as a test feeding room for mothers. The ante-natal examination room or the ante-natal preparation room could be used for this purpose as might be convenient. (10) Rheumatism. The larger clinic also provides for the establishment of arrangements for dealing with cases of rheumatism occurring in children. The clinic work in connection with the supervision of these rheumatic cases would be undertaken possibly in the Skin Specialist's Room when not occupied by him or in the Squint Clinic—Throat, Nose and Ear Clinic Room if not occupied. In any case the provision exists but is necessarily dependent on the establishment of a suitable number of beds at the Municipal Hospital. (11) Toddlers. The total number of toddlers in Willesden, i.e., children between 1 year and 5 years, is between 9,000 and 10,000. Of this number approximately 300 are in attendance at nursery schools and receive annual medical inspection. In addition 556 attended the Health Centres by appointment in 1935 for medical overhaul. A considerable number of the remaining 8,144 to 9,144 children over 1 year but under 5 years attend the Health Centres from time to time for various reasons but do not receive regular medical inspection at this very important period of life. This is because there is no staff available to deal with them. An additional doctor is not required at each of the three Health Centres for this purpose, but if Health Centre (1) is rebuilt on a suitable site and a doctor added, this, with a re-arrangement of clinic areas, will give sufficient medical staff to deal with all these children. Additional Annual Maintenance Charges. The estimated additional annual maintenance costs would be:— £ (1) Nursery Nil (2) Minor Skin Conditions— Specialist 84 (3) Throat, Nose and Ear Conditions— £ Specialist 79 ½ Health Nurse (£255—£345) 127 206 (4) Squint Clinic— Specialist 126 ½ Health Nurse 128 254 (5) Ante-natal Arrangements Nil (6) Pharmacy— Assistant Dispenser (£200—£230) 200 Drugs, Dressings, etc. 35 235 (7) Dentistry— Dental Mechanic (£200—£260) 200 Laboratory Boy (£80—£120) 80 Dental Surgeon (£600—£675) 600 Dental Nurse (£180—£240) 180 Materials for Dentures, etc. 200 1,260 (8) Isolation Nil 118 £ (9) Test Feeding Nil General— Staff (1 Health Nurse—£255—£345) (1 Junior Clerk— £60—) 315 Cleaning assistance—96 hours per week at 11d. per hour) 230 Heating, Lighting and Cleaning, including electricity, gas, coal, coke, etc., replacements, cleaning materials and utensils, cleaning windows, etc. 260 Rates 70 Superannuation 92 (10) Rheumatism—no estimate submitted as this depends on provision of hospital beds Nil (11) Toddlers—no estimate submitted as this depends on extension of Health Centre (1) Nil 3,006 Less saving of two-fifths of present cost of dentures 535 Total net additional annual maintenance excluding loan charges £2,471 N.B.—No sum has been allowed in these estimates (a) for the accommodation to be provided for the Caretaker, subject to the decision of the Committee, or (b) for any grant which may be receivable from the Board of Education or by way of increase of the block grant. Cost of Equipment. The cost of equipment for the foregoing additional services is estimated at £1,000 represented by a loan charge of £120 per annum. GEORGE F. BUCHAN, Medical Officer of Health. Report of the Engineer. 20th April, 1936. Dear Dr. Buchan, Health Centre No. 3. In reply to your letter of the 16th April, I estimate the cost of the suggested additions to the above as follows:— Additional floor to front portion £5,000 0 0 New Ante-natal room, etc. 900 0 0 Caretaker's Cottage 750 0 0 Contingencies 350 0 0 £7,000 0 0 Yours faithfully, F. WILKINSON, Borough Engineer and Surveyor. April 29th, 1936. APPENDIX M. HEALTH CENTRES FOR WILLESDEN. Memorandum by the Medical Officer of Health. 1. The following statement shows the existing Willesden Health Centres and the attendances made at each Health Centre in 1935:— *Health Centre (1)— 1 Doctor and 1 Dentist 51,971 Note.—There is no orthopaedic department at this Centre. Health Centre (2)— 2 Doctors and 1 Dentist 73,137 Note.—There are no orthopaedic, artificial sunlight and special skin departments at this Centre, and only a part-time School for Mothers. Health Centre (3)— 2 Doctors and 2 Dentists 90,010 * In the area served by this Health Centre there is also a Voluntary Centre at which 5,857 attendances were recorded in 1935. 119 2. The following table shows the 20 Health Visitors' Districts and Schools and gives certain particulars of Maternity and Child Welfare Clinic Attendants from these districts. District. Schools. Average School roll year ended 31-3-35. Total M.C.W. cases on roll at end of 1935. No. of these M.C.W. cases attending the Council's Health Centres at end of 1935. Percentage of M.C.W. cases attending the Council's Health Centres at end of 1935. (1) (2) (3) (4) (5) (6) Health Centre (1). 1. South Kilburn Gordon Memorial 826 617 211 34 Kilburn Park 2. South Kilburn St. Mary's R.C. 740 443 129 29 St. John's 3. South Kilburn Carlton Vale 1,030 513 140 27 Percy Road Boys' 4. Kilburn and Brondesbury Salusbury Road 1,280 670 351 52 Holy Trinity Boys' 5. Brondesbury Christchurch 377 778 464 60 Secondary Schools 1,147 — — — 5,400 3,021 1,295 43 Health Centre (2). G. Kensal Rise Kensal Rise 1,016 560 217 39 7. Kensal Rise Chamberlayne Wood Rd. 713 501 176 35 15. Church End Oldfield Road St. Mary's 1,101 703 376 53 17. N. Cricklewood Braintcroft 921 701 318 45 18. Willesden Green, Chapel End Pound Lane Dudden Hil 1,722 909 564 62 19. Willesden Green Gladstone Park St. Andrew's 1,322 924 666 72 Willesden Green R.C. 20. Cricklewood Mora Road 1,116 638 307 48 Secondary Schools 322 — — — 8,233 4,936 2,624 53 Health Centre (3). 8. Kensal Rise (College Park) Princess Frederica 692 516 269 52 College Road M.D. 9. Harlesden Furness Road 1,247 662 262 40 Harlesden R.C. 13. Harlesden, Roundwood Keble Memorial 1,268 739 366 50 Leopold Road 10. Neasden Wykeham 1,293 859 516 60 Neasden Council Neasden National 10. Harlesden— Lower Place Lower Place Acton Lane 710 611 310 50 11. Stonebridge Stonebridge 1,506 601 251 42 Wesley Road 12. Stonebridge Gibbons Road 813 478 253 53 ]4. StonebridgeRoundwood Bridge Road 984 786 340 43 Secondary Schools 1,016 — — — 9,529 5,252 2,567 49 All Willesden 23,162 13,209 6,486 49 3. A survey of the foregoing table shows that the districts which attend the Health Centres least are those which cannot conveniently reach the Health Centres to which they are attached, notably South Kilburn and Kensal Rise. 120 4. It would, therefore, appear that one of the real needs of Willesden is the establishment of a Health Centre in the neighbourhood of the "Falcon" so that the requirements of the South Kilburn and Kensal Rise areas may be met. 5. The rebuilding of Health Centre (2) is also required as this Centre is both structurally unsuitable and insufficient for the work to be done. 6. The Committee are also aware of the need for the extension of Health Centre (3). This is the subject of a report now before the Committee. 7. The foregoing table also shows that District No. 17, that is, Braintcroft area, gives a percentage attendance of mothers and children under 5 of 45 as compared with 49 being the average for the whole of Willesden. District No. 16, the Wykeham—Neasden area, gives a percentage attendance of mothers and children under 5 of 60 as compared with 49 being the average for the whole of Willesden. It may be that a clinic in this area will be required and if this is the view of the Committee it would be desirable to earmark about an acre of land in a suitable position for a Braintcroft—Neasden Health Centre in the future. GEORGE F. BUCHAN, Medical Officer of Health. May 12th, 1936. APPENDIX N. HEALTH DEPARTMENT. Disinfestation of Privately-owned Houses. The Council at its meeting on the 17th December, 1935, decided to make arrangements for the disinfestation of privately-owned houses, and I was instructed to report on the working of the scheme at the expiry of three months. The scheme began on the 20th January, 1936, and this report deals with the work done up to 20th April, 1936. During the three months under review 54 verminous houses, representing 92 rooms, have been disinfested. Of these 92 rooms, 24 have been disinfested by the owners, who have stated that whilst the workmen were on the premises preparing the rooms, it was more convenient for them to carry on and complete the work themselves. The remaining 68 rooms have been disinfested by this Department, the owners paying the fee of five shillings per room. In 20 of the 54 cases bedding was removed to the Municipal Hospital for steam disinfection. All cases were revisited at the expiry of between 10 and 12 days after disinfestation and again 10-12 days later to ascertain if there had been any re-appearance of bugs in the furniture or premises. In two rooms bugs were noted at a subsequent visit and disinfestation was repeated in these two cases. All houses which have been disinfested by the Department will be visited at later periods to make sure that infestation has not recurred. These revisits afford the opportunity of the instruction of the tenants, where necessary, in domestic cleanliness and impressing upon them that while chemical insecticides and lethal gases can assist in disinfestation, they are actually of secondary importance to the constant vigilance of the housewife and her own efforts as regards cleansing. Mr. Berry, who was appointed by the Council for this work of disinfestation, carries it out under the supervision of the Chief Sanitary Inspector and he has the co-operation of District Sanitary Inspectors and, if need be, of Health Visitors, in assisting tenants in the cleansing and keeping clean of their rooms. Insecticides used.—Ortho-dichlor benzene, sulphur and some proprietary preparations have been used in connection with disinfestation. Having regard to various considerations, sulphur is the insecticide principally used now and the results have so far proved satisfactory. Loss of Spray.—I regret to report that the original spray which cost 50s. was stolen by an unknown person. The Disinfector had completed spraying a room and left the spray in the garden of the house for a few minutes whilst he went to a convenience; as the weather was foggy he thought that the spray would be safe. On his return he found the spray missing. The loss was reported to the police but the spray has not been recovered. 121 Complaints of vermin.—The number of complaints received during the months under review is comparatively small, but this is always the case at this time of year as will be seen from the following table giving the number of complaints in each month during 1935 and up to April, 1936:— 1935. Number of complaints of vermin received. January 8 February 14 March 13 April 20 May 46 June 35 July 34 August 47 September 31 October 22 November 12 December 6 1936. January 11 February 10 March 7 April 22 Disinfestation of Furniture and Bedding in connection with Tenants moving into Council houses for the first time or transferring from one Council house to another. Two such cases have occurred and in both instances the furniture and bedding have been disinfested by the Kensington Borough Council under the terms of the agreement. The effects of both families were done as one load. In the case of the transfer from one Council property to another, the disinfestation of the vacated house was left in the hands of the Engineer. In the case of the tenant entering a Council house for the first time, the house vacated was dealt with by the landlord on the instructions of the Health Department. This private house has been twice visited by the Inspector since and no bugs have been found in it. GEORGE F. BUCHAN, Medical Officer of Health. August 31st, 1936. APPENDIX O. PROPOSED NEW PHYSICALLY DEFECTIVE SCHOOL. Notes by the School Medical Officer. Review of the Open-Air School Movement in Willesden. In July, 1911, a Sub-Committee of the Children's Care Committee was appointed to visit various "special" schools, including Open-Air Schools in London and the Provinces. Owing to the resignation of Dr. Butler, the Medical Officer of Health and School Medical Officer, this Sub-Committee did not report. In October, 1912, a report on "Physically Defective Children "and "The Open-Air School" was submitted to the Children's Care Committee by Dr. Buchan. The Education Committee adopted the report and resolved to provide an Open-Air School of 240 places and acquire a site of six acres for the purpose. In July, 1913, the Council resolved to purchase a site at the junction of Denzil Road and Dudden Hill Lane and the approval of the Board of Education was obtained. Owing to the advent of the Great War the scheme was deferred. In July, 1917, it was proposed to establish a temporary Open-Air School in King Edward VII Recreation Ground, but the Middlesex County Council would not give their consent. In July, 1918, it was proposed to utilise "Mapesbury House," Willesden Lane, as an Open-Air School for the duration of the War, but the Ecclesiastical Commissioners would not grant a tenancy. In January, 1920, a Sub-Committee of the Children's Care Committee was appointed to consider a report by Dr. Buchan and to visit certain special schools. They recommended a day Open-Air School with accommodation for 240 children and the purchase of about six acres of land in Denzil Road for the purpose. In January, 1921, the Council sanctioned the purchase of the Denzil Road site, but owing to the financial state of the country and the report of the Geddes Committee, the scheme was temporarily abandoned. 122 Two years later in 1923 a suggestion was put forward that some of the movable wards at Dollis Hill House Hospital might be used as an Open-Air School. The Education Committee took a favourable view of the proposal but the Council, however, decided that the premises should be used for scholars visiting the British Empire Exhibition. In 1925 the Education Committee considered a site in Pound Lane but it was found to be insufficient in area for the purpose of an Open-Air School. In 1927 the Council resolved to purchase a parcel of land of 11½ acres in Neasden and to utilise six acres of it for an Open-Air School, but it was subsequently ascertained that the land had been sold. In June, 1936, the Medical Officer of Health was requested by the Children's Care Committee to report, in conjunction with the Director of Education, on the question of a new Physically Defective School. Oldfield Road Physically Defective School. The present physically defective school situated in part of the Oldfield Road School buildings is not suitable for its purpose and owing'to insufficient space cannot be made suitable. There is no restshed. In fine weather the children after the mid-day meal must rest in the playground and during inclement weather in the hall and classrooms. The cloakroom accommodation is inadequate, the playground is too small and unsuitable, and there are no facilities for lessons to be taken in the open air. Types of physically defective children who would require to attend the proposed new Physically Defective School. At the present time the Oldfield Road Physically Defective School has accommodation for 165 children and there are 163 children on the school roll. (Eight of these attend by arrangement with the Middlesex Education Committee.) The following table is an analysis of these 163 children on the roll of the Oldfield Road P.D. School, showing the types of physical defect and the number of children suffering from them:— (1) Non-active tuberculosis of bones, joints and glands 22 (2) Various deformities, other than those coming under (1) 14 (3) Heart conditions, rheumatic or congenital in origin 52 (4) Certain chronic conditions, e.g., chronic lung conditions other than tuberculosis, chronic rheumatism, chorea, kidney disease 25 (5) Paralysis 32 (6) Certain cases of anaemia, debility and other ill-defined conditions 18 Accommodation required. In addition to the children now on the roll of the Oldfield Road Physically Defective School there are approximately 320 delicate children attending the ordinary elementary schools in Willesden. Each year the Education Committee send away 250 delicate children to convalescent homes for periods of six weeks, and a number of these children would benefit by attendance for a time at the proposed new Physically Defective School if built on a favourable site and on modified open-air lines. Accommodation, therefore, in the new Physically Defective School should be for not less than 200 children. Regime at the proposed new Physically Defective School. Fresh air and sunlight it will be appreciated are only adjuncts to the treatment of these physically defective children and the improvement in their health. Good feeding, rest, cleanliness and physical exercises are equally important. At the Oldfield Road P.D. School the children arrive at 10 o'clock in the morning and leave school again at 3.30 in the afternoon. As the period required for lessons is two hours in the morning and two hours in the afternoon there remains only 1¼ hours (12.15 p.m.— 1.30 p.m.) for the mid-day meal, followed by a rest period for some of the children. This mid-day interval is inadequate. It should be at least two hours, one hour of which should be a rest period. This would entail a school day from approximately 9 a.m. to 5 p.m. The children should, therefore, be provided at the school with a light, early lunch and tea in addition to dinner. Baths also should be provided as they not only promote cleanliness but are beneficial to the children and aid in the inculcation of hygienic principles. Site. The site selected should, if possible, slope towards the south and be protected by rising land and by trees on its northern and eastern aspects. It is generally regarded that two acres is a minimum for an open-air school, accommodating 100-120 children, to permit of the necessary garden space. A school accommodating 200 children would, therefore, require a site of about three to four acres. It is desirable that a portion of the playground should be asphalted, for this is essential for the physical training lessons and the playing of games during wet weather. Type of School. The school should be built on the open-air principle with the classrooms facing south. It should not be of the open-air type with classrooms in the form of shelters open on three sides, as physically defective children suffering from rheumatic trouble, chorea and some forms of paralysis are not suitable for education under these conditions. Verandahs along the classrooms except on the north side, whether glazed or unglazed, obstruct the entry of the sun's rays during two-thirds of the year and so are not to be recommended. The school should be single storied. 123 Special requirements. (i) Rest-sheds.—A large proportion of the children attending the school should have an hour's rest after the mid-day meal. Late hours and disturbed sleep are potent causes of debility. Rest should be taken on stretchers in the open air but during inclement weather rest-sheds are required and such sheds should therefore be constructed to take the stretchers without crowding. Two sheds are better than one as children can rest undisturbed in one shed while the other can be used for recreation if necessary. (ii) Dining Room.—This would need to seat 200 children for three meals a day. (iii) A kitchen, scullery and larder are also required, suitably equipped for the preparation of meals, for washing up and storage of food and crockery, etc. (iv) Bathrooms.—Baths in the form of shower and slipper baths should be provided to enable the children to be bathed at least once a week. The bathrooms should take 20 spray and three adult baths. A dressing room also is required. (v) W.C.'s.—These should be separate for boys and girls. 14 w.c.'s are required for girls and 11 for boys, plus 20 feet of urinals for boys. Separate w.c. accommodation is required for the staff. (vi) Lavatory basins.—Thirty lavatory basins are needed and these should be supplied with hot and cold running water. Separate lavatory basins are required for the staff. (vii) Cloakroom and cupboard accommodation.—This is required for the children's coats, towels, hair and tooth brushes. Each child should have its own peg and the pegs should be placed sufficiently far apart for clothes not to overlap. The cloakrooms should be well lighted and ventilated and cut off from the teaching rooms. Provision for the drying of clothes should be made. Separate cloakroom accommodation is required for the use of the staff. (viii) School Nurse.—A whole-time nurse is required at the school to attend to any dressings needed, keep under supervision splints and other apparatus worn and superintend rest periods and cleanliness. She would also assist the School Medical Officer at his examination of the children and carry out the preliminary weighing, measuring and sight testing. (ix) Medical Room.—This is required for the use of the school nurse for the performance of minor dressings and for the use of any child suffering from slight temporary illness in school who needs to rest under the observation of the nurse. This room would also be used for medical inspections by the School Medical Officer at his periodic visits and also by the school dentist for dental inspections. The room should be 20 feet across in one direction as this distance is required for the testing of vision. (x) Kitchen Staff.—Two extra staff would be required for the present numbers and three for 200 children. (xi) Transport of scholars.—It is desirable that all children should be conveyed to and from the proposed new Physically Defective School by school bus in the same way as is carried out in the case of Oldfield Road P.D. School at the present time. The present school buses can deal with the 163 children now on the roll but if the increased accommodation suggested at the new school is fully utilised, additional school buses will be required. Additional Costs. So far as the medical and physical care of these children is concerned, the only additional cost would be represented by the provision of lunches and teas not now provided and additional kitchen staff. This additional cost is estimated at £400 per annum for lunches and teas. About 20 per cent. of the cost of meals is paid for by parents and if this percentage were maintained, the additional cost of £400 would be reduced by £80. It is doubtful, however, if parents would be prepared to pay for teas. The cost of two additional kitchen staff would be approximately £200 per annum. If an additional bus is required, the estimated additional cost would be £400 per annum. Notes by the Director of Education. From a purely educational point of view the present building is unsuited for a school of 200 children. Such a school would require eight or nine classrooms, an assembly hall, two handicraft rooms for boys and girls and a combined cookery and laundry centre. At the present school the hall is used as a dining room. The tables, chairs and forms which are used at the mid-day meal have to be moved twice daily by the senior boys, tables laid and meals prepared. The hall, which is required for the school assembly in the mornings and afternoons and also for singing, rhythmic work, games and country dancing classes during the morning and afternoon sessions is not always available for this work. It is impossible to utilise the hall properly as a combined dining room and assembly hall. Further, the majority of the children on admission to the school are backward through illness, consequent frequent absences and the re-action of physical weakness upon mental alertness. Many, however, show special aptitude towards practical subjects. Up to the present time the senior girls have been taught needlework and the senior boys light woodwork and pewter work. These subjects have been taken by the class teacher in the classroom on small desks which, in the case of the boys, have proved unsuitable for the work. In the majority of cases the employment taken by boys who leave the school is of the light manual type, e.g., with watchmakers, opticians and dental mechanics. The majority of girls on leaving school learn the dressmaking or tailoring trades. In view of the fact that these children remain at school until the age of 16 it is desirable that the last two years of their training should be purely vocational so that when they leave school they may be prepared in some measure to take their place 124 with boys and girls of their own age who have been already working for two years. To give them this training a handicraft room for boys and also a special handicraft room for girls, with specially trained teachers, are necessary. These two rooms could provide, in the case of girls, for dressmaking, bookbinding, light artistic crafts, etc., and for the boys metal work, various forms of art work and other crafts having a direct bearing on the vocation which they are likely to take up. The training would make boys familiar with the tools which they will use when they leave school. It might be possible to take a combined course, say, in watchmaking and optics, as the tools used for those two trades are very similar. It is also very desirable that the girls attending the Physically Defective School should have a course of cookery, laundry and housewifery on exactly similar lines to that given to their more healthy colleagues in the ordinary schools. At the present time none of these girls receive any instruction in domestic science. Another subject which might be of value to physically defective children is gardening. Many of these children are unsuited for indoor work, consequently if a site sufficiently large could be obtained to provide a school garden where these boys and girls could be taught the main fundamentals of market gardening, etc., it might prove both of educational and vocational value to them. Taking into account, therefore, the medical and educational needs of these children, a school with the following accommodation would be required:— (1) Assembly hall. (2) Eight or nine classrooms. (3) Handicraft room for boys. (4) Handicraft room for girls. (5) Domestic science room for girls. (6) Dining room. (7) Medical room. (8) Kitchen, scullery and larder. (9) Bathroom with 20 spray and three adult baths, together with cloakroom, lavatories, etc. (10) Rest sheds. The site should be sufficiently large to provide a school garden which could be utilised for vocational work. The estimated cost of building, furniture, equipment, etc., is as follows:— Cost of building £30,000 Cost of furnishing 900 Total £30,900 Loan charges:— Building £l,624For a full year. Furniture 108 £1,732 The cost of site would be additional. E. DAVIES, Director of Education. GEORGE F. BUCHAN, School Medical Officer. September 23rd, 1936. APPENDIX P. HEALTH DEPARTMENT. Housing. Report by the Medical Officer of Health on the present position of Housing coming within the terms of reference of the Housing Acts, 1930-35, Committee. HOUSING ACT, 1930. The Housing Act, 1930, will be repealed by the Housing Act, 1936, which comes into operation on 1st January, 1937. The provisions of the Act of 1930 as amended by the Housing Act, 1935, remain unaltered in the Housing Act, 1936. As stated in my report on Slum Clearance presented to the Committee on 6th January, 1936, each of the clearance areas included in the Council's programme has been dealt with; the re-housing of the residents of these areas is in progress. 125 The disinfestation of the furniture and other effects belonging to the families is carried out on the day of their removal to the new house under the agreement existing between the Willesden Borough Council and the Kensington Borough Council. The cost of disinfestation is proving to be a little higher than was anticipated. It was estimated that one van would be capable of removing the furniture, etc., of two families, but the experience, so far, is that the belongings of one family only make up a load. The following clearance areas have been acquired or negotiations are proceeding for their acquisition under the Compulsory Purchase Orders confirmed by the Minister of Health:— (1) Alpha Place North. (2) Alpha Mews. (3) Pembroke Place. (4) Park Mews. (5) Park Road Mews. (6) Cambridge Mews East. (7) Cambridge Mews West. The Council have plans for the future development of Alpha Place North, Alpha Mews, Cambridge Mews West and Park Road Mews for housing and educational purposes. So far the Council have not indicated the future use of the other areas mentioned above but their future development is a matter for the Housing and Town Planning Committee. The provision of trade accommodation for displaced costers and small street traders is also under consideration by the Housing and Town Planning Committee. The Committee will remember that the payment of compensation for trade disturbance as provided for in Section 41 of the Housing Act, 1930, has been agreed upon in principle by the Council but the final figures have been left for settlement when all claims have been received. Housing Act, 1935. In compliance with Section 6 (2) of the Housing Act, 1935, the measurement of working-class houses to ascertain the number constituting the "permitted number" for each dwelling is proceeding. From 1st April, 1936, to 9th September, 1936, the number of dwellings so measured is 4,274. The total number to be measured is approximately 39,000. Acting under Section 6 (2) a number of landlords and agents have made application to the Department for information as to the "permitted number" applicable to the dwellings they control. To comply with these requests as soon as they are received, the staff has to be diverted from the routine of door-to-door visitation and measurement with consequent loss of time. It is suggested that the answer to these applications be deferred in the case of large blocks of property scattered throughout the district until the routine inspections reveal the whole of the information required by the applicant. The fixing of an " appointed day," six months after which the enforcement of the overcrowding provisions will commence, is in the hands of the Minister of Health. According to Circular 1539, dated 7th May, 1936, the Minister will fix the "appointed day" after considering:— (a) the extent of the overcrowding as disclosed by the survey; and (b) the time likely to elapse before a substantial amount of the overcrowding can be remedied. The extent of the overcrowding in the district showed that some 978 new houses were required. The provision of this number of houses is in the hands of the Housing and Town Planning Committee and it will be seen from the magnitude of the work to be done that some considerable time must elapse before the Minister is satisfied that a "substantial amount of the overcrowding can be remedied." In these circumstances it is unlikely that the "appointed day" will be fixed in Willesden for some time and the duty of the landlords to insert a statement of the "permitted number" in their rent-books would not appear to be an urgent one save in cases of vacant houses which it is desired to re-let to not more than the "permitted number" of occupiers. The "Report on the Overcrowding Survey in England and Wales, 1936" is now published. It is a document of much interest, forming the first attempt in this country to put on record certain information as to the extent of overcrowding and house shortage. Apart from the picture it reveals of the extent and incidence of overcrowding, it is of interest as a means of comparing one area with another. The percentage of overcrowded families in Willesden is 4.12% as compared with 4.9% in the County of Middlesex and 3.8% for England and Wales. It is interesting to note that in addition to the 1,845 families overcrowded in Willesden at the time of the survey, 1,455 families were housed at the minimum standard. The Report shows the additional cost of the survey in various areas and it is to be noted that the additional cost to Willesden amounted to £18 per 1,000 dwellings inspected as compared with £25 in the County of London and £47 in Manchester. In only three of the areas mentioned in the Report did the additional cost fall below the Willesden figure, viz., £17 per 1,000 in Walthamstow (Essex), £17 in Swinton and Pendlebury (Lanes.), and £16 in March (Cambs.). Conclusion. It will be observed from the foregoing notes that the Housing Act, 1930-35, Committee has completed its terms of reference and that the measurement of the houses will proceed automatically as a piece of departmental work. 126 When the Minister decides on the appointed day, all landlords will have to be notified as to the permitted number and six months after the appointed day it will be the duty of the inspectorial staff to see that the Housing Act, 1936, is being complied with. Failure to comply with the Act will require to be reported in the same way as any other failure to comply with any other Act for which the Health Department is responsible. Provision as to Staff. The number of outdoor staff employed on this inspectorial work is at present seven. Three of these are non-technical assistants who are temporary and whose work will cease when all the houses have been measured. Three are qualified Sanitary Inspectors, two of whom are temporary and who will be required after the measurement is over in connection with the inspectorial work of the sanitary department. It is therefore recommended that these two temporary Sanitary Inspectors should be made permanent. They are aged 24 and 37 years, respectively, and have done satisfactory work. GEORGE F. BUCHAN, Medical Officer of Health. November nth, 1936. APPENDIX Q. HEALTH DEPARTMENT. MEMORANDUM BY THE MEDICAL OFFICER OF HEALTH. MOTHERHOOD IN WILLESDEN. In submitting the Report of the Consultant Obstetrician printed and circulated on 17th November, 1936, on the first 3,000 cases admitted to the Willesden Maternity Hospital between 19th February, 1931, and 5th February, 1936, I think I should in this covering memorandum endeavour to explain some of the terms used which are of general interest. (1) Total Puerperal Mortality.—The Registrar-General calls the number of deaths classed to pregnancy and childbirth the "Total Puerperal Mortality." The causes of these deaths are as follows:— Post-abortive sepsis. Abortion not returned as septic:— (1) Haemorrhage following abortion. (2) Without record of haemorrhage. Ectopic gestation. Other accidents of pregnancy. Puerperal hæmorrhage:— (a) Placenta Prævia. (b) Other puerperal hæmorrhage:- Post-partum hæmorrhage. Adherent or retained placenta. Accidental hæmorrhage. Puerperal sepsis not returned as post abortive. Puerperal albuminuria and convulsions. Other toxaemias of pregnancy. Puerperal phlegmasia alba dolens, embolism and sudden death. Other accidents of childbirth (e.g., contracted pelvis, craniotomy, difficult and prolonged labour, rupture of uterus, etc.). Other or unspecified conditions of the puerperal state:— (1) Puerperal insanity. (2) Puerperal diseases of the breast. (3) Childbirth (unqualified). (2) Total Mortality from or associated with Pregnancy and Childbirth.—In addition to the deaths under 1 above there are a number of deaths stated to have been complicated by the existence of the puerperal state. These deaths are not classed to pregnancy and child-bearing but are returned as associated therewith. They are classed to non-puerperal headings. The largest numbers are classed to pneumonia, heart disease, tuberculosis, influenza. They are due to risks to which the general population of women is exposed and would have occurred if the women had not been pregnant. The Registrar-General shows these as deaths from non-puerperal causes and goes on to give a " Total Mortality from or associated with pregnancy or childbirth" which includes these deaths. (3) Criminal Abortion.—The Registrar-General states that in addition to all the above deaths there are others from criminal abortion which are assigned to various forms of violence, e.g., suicide, murder, etc., but as these deaths result from illegal interference with pregnancy it is not the practice to include them in the Maternal Mortality Rate. (4) Still Births.—Reliable statistics as to still births were not available before 1928. The total births, i.e., live and still births, provide a closer approximation to the number of women exposed to the risk of dying from puerperal conditions than do live births alone. 127 Total Puerperal Mortality. Having regard to the foregoing facts, all references in this memorandum are to total puerperal mortality as defined above and rates are calculated on total birtfis, i.e., live and still births together. The following table gives the puerperal mortality rates per 1,000 live and still births for England and Wales and Willesden, respectively, since 1928:— England and Wales. Willesden. 1928 4.25 2.90 1929 4.16 3.95 1930 4.22 3.71 1931 3.94 3.06 1932 4.04 3.86 1933 4.32 5.07 1934 4.41 2.82 1935 3.93 2.73 The Total Puerperal Mortality Rate for England and Wales of round about 4 per 1,000 has given rise to much anxiety, particularly as it shows little, if any, tendency to fall. These rates not only tell of the deaths of women at a very vital period of life but also suggest that a still greater proportion are more or less permanently disabled as the result of child bearing. A number of bodies, official and unofficial, have investigated this problem and issued reports, the most important of which are (1) The Interim Report of the Departmental Committee on Maternal Mortality and Morbidity issued by the Ministry of Health in 1930. (2) The Final Report of the same Committee issued by the Ministry of Health in 1932. (3) The Report on Maternal Morbidity and Mortality in Scotland issued by the ment of Health for Scotland in 1935. The reports all come practically to the same conclusion—that approximately 50 per cent, of puerperal deaths are avoidable. Causes of Puerperal Deaths. The Interim Report of the Departmental Committee on Maternal Mortality and Morbidity issued by the Ministry of Health in 1930 states, on page 105 that these avoidable causes fall into four groups:— Per cent. (a) Absence of ante-natal care 17 (b) Errors of judgment by doctors or midwives 17 (c) Lack of reasonable facilities for effective medical care 5 (d) Negligence of the patient or her friends in respect of given medical advice 9 Total 48 per cent. The Report continues:— "This gives a total of 48 per cent. of deaths which seem to us to have been directly preventable. It leaves 52 per cent. of the deaths in which no preventable factor actually emerged. With regard to a number of cases in this last group, it must be said quite definitely that a fuller knowledge of the exact circumstances of death would probably have revealed a primary avoidable factor. In summary, our finding is that of the cases of death brought under our notice not less than one half were preventable." Reducing the Risk of Puerperal Deaths. To reduce the risk of puerperal deaths the Committee make four principal Recommendations:— (1) The better education of the medical student in obstetrics. (2) The better supervision of pregnancy, particularly by competent medical practitioners in close touch with practical obstetric work. (3) Improvement in medical practice. The Committee draw attention to the fact that in nearly a third of the cases classed as errors of judgment on the part of the doctor the mistake made was the premature application of forceps for delivery. The Committee further state that "they have evidence of need for a higher standard of knowledge and skill on the part of the medical practitioner on the spot as well as for the provision of consultant services and of an increased number of available hospital beds." (4) The Co-ordination of Maternity Services. The Conclusions by the Departmental Committee responsible for the Interim Report are summed up in the following language:— "Generally speaking, it seems clear that the cumulative experience of a generation suggest that the solution to the complex problem of maternal morbidity and mortality will be found in an all-round tightening up as well as strengthening of each link in the chain of obstetric supervision, an increased watchfulness over all stages of pregnancy and labour rather than in any single, 128 arresting or comprehensive remedy. Much of this improved supervision will come about gradually as the education and training of the medical student and the midwife equip them to appreciate the importance of painstaking attention to detail as well as to understand and apply the scientific methods of sound treatment. " The influence on the better informed public opinion and the effect of education on the mother herself, whether through direct instruction or the indirect effect of a readily available and adequate Maternity Service, should also prove beneficial in securing a higher standard of practical midwifery. It is indeed essential to preserve a due sense of proportion in dealing with this question. It is useful and necessary to pursue our search for the causes of infection and danger along many paths, but although valuable and helpful information will certainly emerge from bacteriological or pathological inquiry, these results can never be wholly fruitful unless the individual care of the patient as a whole and in every way makes steady advance. It is certain that an excessive maternal mortality can be prevented, for in some lying-in institutions and in large groups of women in confinement at home it is already being prevented by these very means. What is being done for some women can and should be done for all." Methods adopted in Willesden. The Willesden Council had all the foregoing considerations before them in reports and circulars from the Ministry of Health when they established their Maternity Hospital in 1931. Prior to this date they had been active for many years in all that appertained to Maternity and Child Welfare. A great impetus was given to their work when the Maternity and Child Welfare Act, 1918, came into operation and in that year they opened a Pavilion for confinement cases at their Municipal Hospital. But troublous times were ahead and this Pavilion was put out of use for this purpose and confinement cases were sent to the Poor Law Hospital. More settled conditions, however, gradually became established and in December, 1929, the Council resolved to convert their Smallpox Hospital at Kingsbury into a Maternity Hospital, and this conversion was completed in February, 1931. Since then progress has been uninterrupted and in February, 1935, the Hospital was extended to be able to cope with 1,000 cases per annum, and now consists of:— (1) A Labour Block with five labour and three delivery beds each in separate wards. (2) An Ante-natal Ward of nine beds. (3) Three Lying-in Blocks of 43 beds. (4) An Observation Block of four cubicles. With the opening of the Maternity Hospital by the Willesden Council in 1931 the arrangements made for mothers entering the Hospital may be stated briefly as follows:— (1) Ante-natal Care at the Health Centres under the supervision of the Council's Consultant Obstetrician. It should be noted that Health Visiting in connection with ante-natal care is essential and is fully carried out in Willesden. The results of failure or negligence on the part of the patient, referred to in the Interim Report, are reduced to a minimum by such visits which are designed to ascertain the causes of the failure or negligence with a view to the necessary assistance. (2) Hospital Confinements within the limits of the Hospital accommodation under the supervision of the Council's Consultant Obstetrician. In such confinements the best medical advice and the best facilities for effective medical care are at the disposal of the patient. (3) Post-natal Care at the Health Centres under the supervision of the Council's Consultant Obstetrician. It will be observed then that women booking for their confinements at the Willesden Maternity Hospital are dealt with under the best possible circumstances and I am unaware of any condition outlined as desirable in the foregoing Departmental Reports which is not embodied in the Willesden scheme. The First Three Thousand Cases. A Report of the first 3,000 cases admitted to the Hospital is submitted by the Council's Consultant Obstetrician, Mr. Arnold Walker, M.A., M.B., B.Ch., F.R.C.S., M.C.O.G. This report is of great clinical interest but its main feature is the fact that out of the 3,000 cases admitted 2,939 were booked and had the full benefit of the Council's arrangements for their welfare. Of this number three died, giving a puerperal mortality rate of 1.02 per 1,000. Sixty-one cases, on the other hand, were admitted as emergency cases with four deaths, giving a puerperal mortality rate amongst these cases of 65.6 per 1,000. I am satisfied as the result of this experience and particularly having regard to the fact that at present the booked cases tend to be weighted with those requiring hospital confinement for medical reasons that the Council's scheme is established on sound principles. Note.—It may be suggested that the four deaths which occurred among the 61 emergency cases should not be considered only in relation to these emergency cases but should be included with the deaths amongst all remaining mothers in Willesden who did not book for confinement in the Willesden Maternity Hospital during the period under review. During this period approximately 11,274 such women were confined with 48 deaths. The 11,274 include the 61 emergency cases and the 48 deaths include the four deaths above referred to. The 48 deaths occurring in the 11,274 cases gives a puerperal mortality rate of 4.26 per 1,000 as compared with the Hospital puerperal mortality rate for booked cases of 1.02 per 1,000 recorded above. 129 Further Requirements. There are still, however, some gaps that require to be filled and I would enumerate these briefly as follows:— (1) Increased hospital accommodation so that all Willesden residents who desire hospital confinement may have it. In spite of the fact that the extended Hospital has been open since February, 1935, 356 cases have been refused admission from that date up to the 31st October, 1936, on account of lack of accommodation. No case requiring admission for medical reasons was refused and this fact enhances the statistical records as mentioned above. (2) More should be done to improve the fitness of the mother for childbirth and nursing her baby by adequate feeding. In my opinion expectant and nursing mothers should receive meals on the same lines as school children. (3) Greater attention should be paid to the new-born baby. (a) Better hospital provision should be made for the care of the premature infant. (b) A physician skilled in the care of infants, i.e., a paediatrician, should be attached to the hospital. Mr. Walker's report shows that there were 2,966 children born to the 2,939 booked mothers who had their confinements in hospital. Of these 2,966 children, 53 died and 89 were still births, giving an infantile death rate of 18 per 1,000 and a still birth rate of 30 per 1,000, or a total infantile death rate of 48 per 1,000 including live and still births. 58 children were born to the 61 mothers admitted as emergencies. Three of these children died and 13 were still born, giving an infantile death rate of 52 per 1,000, a still birth rate of 224 per 1,000, and a total infantile death rate of 276 per 1,000 including live and still births. The infant mortality rate during the first two weeks of life is for England and Wales generally in the region of 25 to 26 per 1,000, as compared with the 18 per 1,000 amongst the booked maternity cases and 52 per 1,000 for the emergency cases. The three foregoing recommendations for the improvement of the Maternity and Child Welfare Service of the Council arise immediately out of the report of Mr. Walker on the first 3,000 cases admitted to the Willesden Maternity Hospital. These recommendations are of cardinal importance and can be given effect to without any considerable administrative difficulty. It must not be thought, however, that these recommendations embody all that might be done for mothers and children. Many mothers who leave the hospital are still in need of a further period of recuperation, and measures to enable them to obtain this are desirable. Such measures, however, involve considerations other than the mother, for example, the other members of the family and her domestic arrangements generally, and would require careful consideration. Mr. Walker's report is very satisfactory and testifies to the excellent pioneer work which is being done at the Willesden Maternity Hospital. A carefully planned expansion of the work along the lines indicated in this memorandum would give even better results and promote still further health and happiness in Willesden homes. GEORGE F. BUCHAN, Medical Officer of Health. November 25th, 1936. APPENDIX R. HEALTH DEPARTMENT. HEALTH SERVICES. Development and Extension. I beg to report in accordance with the following instruction:— "We have given further consideration to the question of the proposed extension to Health Centre 3, but we feel that the Health Services of the district would be better served by the preparation of and adherence to a systematic programme for the development and improvement of such services throughout the Borough during a period of years, and we have therefore requested the Medical Officer of Health to prepare and submit to us for our consideration in September such a programme." (Vide Council Minutes 28-7-36, Health Committee No. 9.) For the development and improvement of the Health Services the following programme is submitted:— (1) Extension of Health Centre (3). This matter is before the Committee and a further note on the subject appears later in this report. (2) Rebuilding of Health Centre (2). This matter is before the Committee, who have given instructions for detailed plans and maintenance costs to be presented to them. 130 (3) Acquisition of a site for and rebuilding of Health Centre (1). A site of about ½ to ¾ acre at a suitable point is required. (4) Acquisition of a site for and erection of Health Centre (4), North Cricklewood. A site of about ½ to ¾ acre in the North Cricklewood area is required. (5) Home Helps. The provision of home helps under various conditions is under consideration by the Committee, and a reply from the Minister of Health to a communication sent on the instructions of the Committee is awaited. (6) Provision of Foot Clinics. These clinics have been established with excellent results in a few areas. They are the means of giving great relief to many sufferers. (7) Care of Children between 1 and 5 years of age. Attention to this is directed by Circular 1550 of the Minister of Health dated 29th May, 1936. It is provided for in connection with Clinic Extensions. (8) Medical Inspection of children on leaving school with the view of employment. This is provided for in connection with Clinic Extensions. (9) Medical Inspection of children for country holidays and school journeys. This is a rapidly growing work, for which provision is made in connection with Clinic Extensions. (10) Feeding of expectant and nursing mothers and children under 5 years. This should be dealt with on the same lines as for children of sphool age. (11) Appointment of a Nutritionist. In a number of cases the medical staff have reason to doubt if the food purchased for the household is adequate in quantity and quality or if it is prepared in the best possible manner. A nutritionist or dietician should be detailed to such a home to consult with and assist the mother in the matter of the family dietary. (12) Convalescent Treatment. Provision is already made for the convalescence of school children over the age of five years by the reservation of 28 places in all at schools at Hayling Island, Godalming and Parkstone. Some provision is required for the convalescent treatment of nursing mothers and children under the age of five years. In some circumstances it is desirable that when a woman enters hospital, especially for her confinement, provision should be made for the children to be taken care of in a home. This is not strictly convalescent treatment, but the nature of the provision might very well be the same. (13) Provision for Rheumatism. This is included in the provision of Clinics and Municipal Hospital requirements. (14) Physically Defective School. This matter is before the Education Committee. (15) Mentally Defective School. This school requires to be rebuilt on modern lines. (16) Extension of the Maternity Hospital. Since the extension of this hospital was opened in February, 1935, up to 31st October, 1936, 356 cases have been refused admission on account of lack of hospital accommodation. To meet this demand additional beds are required. A ward is also required to enable the necessary redecoration and overhaul of the hospital to be carried out in a regular manner without refusing patients while the work is in progress. The subject, however, of the extension of the Maternity Hospital cannot be fully dealt with until after the Conference with the Middlesex County Council for which the Middlesex County Council have promised to fix a date. The matter of the extension of this Hospital includes consideration of accommodation for additional patients as above, ward for the re-establishment of breast feeding, provision for premature and sick babies, laundry, steam for sterilisation, accommodation for resident and non-resident nursing staff and non-resident domestic staff and mess room accommodation for porters and a 48 hours' week for the nursing staff. (17) Extension of Municipal Hospital. This Hospital has been extended from time to time and a further extension for cases of Rheumatism is required. Hospital beds are also necessary for certain cases requiring operative or post-operative dental treatment. Better provisions are necessary for cases of marasmus in young babies now admitted to the Hospital. In connection with any further extensions, however, it is necessary to consider extensions of existing essential services at the Hospital. Boilers.—The two existing Cornish Boilers were fitted in 1902 and are now 34 years old, and during that period various additional calls have been made on the steam plant, viz.:— (1) Heating of B Ward and Theatre; (2) Steam steriliser in B Ward; (3) Steam heating of stores; (4) Steam heating of maids' and nurses' mess-room; 131 (5) Steam heating of both garages; (6) Larger colorifer fitted in D Ward and hot water supply to mess-room and stores; (7) Larger demand and supply to laundry and Disinfector, etc. During the period October to April both boilers have to work at full load to keep going and often calls for additional heat cannot be met. As each winter draws to its close it becomes increasingly difficult to supply the demand due to the long run without a stop for flue cleaning, and complaints are made each spring that steam is shut down too soon and wards are not warm enough. It is desirable that the Committee should have a report from the Engineer on this matter. E Ward.—The fireplaces in this ward cause a great deal of trouble owing to faulty underdraught and consequent escape of smoke into the ward. Structural alterations appear to be necessary to remedy this defect. Sluices.—The sluices in all the older pavilions are worn out and out of date. They require to be replaced by new ones of a modern type. Kitchen.—The steam hot plate is worn out and beyond further repair. It requires replacement. Dispensary Accommodation.—Increased accommodation is required to include storage accommodation divided into a store for bottles and containers, a dressing store, drug store and one for inflammable substances and gases, i.e., oxygen, nitrous oxide, carbon dioxide, etc.; a room equipped for the preparation of heavy stock in large quantities such as emulsions, ointments, dusting powders, etc.; a dispensary proper, sterilising room and small office. Two entrances should be provided, one into the dispensary for doctors and nurses and business visitors, the other for goods. A small space should be allowed into which goods can be delivered, unpacked and checked before passing on to the various places to which they belong. Staff Quarters.—These are no longer adequate and consideration is required in respect of accommodation for Medical Superintendent and Medical Staff, Matron and Nursing Staff, Domestic Staff, Steward's Office and Stores. 48 hours' week.—The introduction of a 48 hours' week for the nursing staff also requires consideration. (18) Motor Ambulance Service. The appointment of the necessary additional drivers is under consideration by the Committee. Improved accommodation is required for the men. With the above extensions of the Health Services additional ambulances would also be necessary. (19) Extension of the Offices at 54, Winchester Avenue. (20) Medical Officer for Special Purposes and Enquiries. Extension of Health Centre (3)—Further Report. The Committee will remember that I reported to the Health Committee on the need for the extension of Health Centre (3) in accordance with the Minute of the Council dated 25th February, 1936. In this report I stated that the need for this extension was because of the restrictions imposed on the size of the original building by Government Departments as well as other reasons, including:— 1. The absence of nursery accommodation; 2. The need for better facilities for dealing with minor skin conditions; 3. Increased throat, nose and ear work; 4. The need for corrective measures in respect of squints; 5. The inadequacy of the ante-natal arrangements; 6. Pharmacy; 7. The need for the improvement of dental arrangements; 8. The need for an isolation room; 9. The provision of a test-feeding room; 10. Clinic facilities for rheumatism. 11. The care and supervision of children between 1 and 5 years of age. Since this report was written the pressure on the accommodation at this Centre has continued to increase. (1) The ante-natal arrangements are inadequate and expectant mothers now have a considerable wait before they receive attention. In addition the operation of the Midwives Act, 1936, will throw increased work on this department which is already too small to cope with existing demands. (2) The attendance of children for breathing exercises after operation has exceeded expectations and the Committee will remember that there was only bare accommodation for this purpose. The attendance of these children began on 10th September, 1936, and on the 26th October, 1936, 53 children were having breathing exercises twice a week at this clinic, making a total attendance of 106 per week, and the number is increasing. These children have to undress and dress in the orthopaedic dressing room. This dressing room is not only the dressing room for orthopaedics but also the dressing room for light cases, the nursery for children and the dressing room for children attending for breathing exercises. It is impossible to avoid clashing in respect of its use from time to time and the room in itself is too small for a nursery and small enough for any one of its other purposes. On three afternoons a week the ante-natal preparation room has to be used as a nursery, thus preventing the use of this room for an ante-natal or breast feeding or other case which may require to attend. 132 I am aware that the Committee have in contemplation the erection of a Health Centre in the North Cricklewood area but even when this Centre is erected the amount of relief given to Health Centre (3) will not be such that the extensions proposed will no longer be required having regard to the general increase in old and the new services undertaken. I have therefore been in consultation with the Engineer as to the necessary extension of this building which would enable all the work to be undertaken under reasonable conditions and meet the ultimate needs of the area it will serve. It is hoped that it will be possible to arrange for an extension to be built during the summer months so that the Centre may be ready before another winter sets in to deal with the demands upon it. Additional Annual Costs. The additional annual costs, including the repayment of loans on the extension, are estimated as follows:— (1) Nursery. £ £ Nursery Nurse, £170—£200 170 (2) Minor Skin Conditions. Specialist 84 ½ Health Nurse 128 212 (3) Throat, Nose and Ear Work NiL (4) Squint Clinic. Specialist 126 ½ Health Nurse 128 254 (5) Ante-Natal Arrangements. ½ Health Nurse 128 (6) Pharmacy. Assistant Dispenser, £200—£230 200 Drugs, Dressings, etc. 35 235 (7) Dentistry. Dental Mechanic, £200—£260 200 Laboratory Boy, £80—£120 80 Dental Surgeon, £600—£675 600 Dental Nurse, £180—£240 180 Uniform 8 Materials for Dentures, etc. 200 Orthodontic Specialist, 24 attendances 63 1,331 (8) Isolation Nil. (9) Test Feeding. ½ Health Nurse, £128 128 (10) Rheumatism—No estimate submitted as this depends on provision of hospital beds. (11) Care of Children 1-5 years of age (Toddlers). 1 Centre Medical Officer, £600—£750 600 2 Health Nurses, £255—345 510 Uniform 16 1,126 (12) General Increases. Cleaning Assistance—128 hours per week at 11d. per hour 306 Heating, Lighting and Cleaning—including electricity, gas, coal, coke, etc., replacements, cleaning materials and utensils, cleaning windows, etc. 346 Rates 93 Staff—2 Health Nurses, £255—£345 510 Uniform 16 1 Junior Clerk 60 586 Superannuation 180 (13) Sundries 50 (14) Annual Loan Charges. Capital Cost—Building ? Equipment, £2,000 240 £5,385+ loan charges on building. Less saving of two-fifths of present cost of dentures 535 Total net additional annual costs, including repayment of loans £4,850 + loan charges on building. N.B.—No sum has been allowed in these estimates for any grant which may be receivable from the Board of Education or by way of increase of the block grant or any further income which may be received. GEORGE F. BUCHAN, Medical Officer of Health.