WIL 33 M AC 439 (1) WILLESDEN Borough of Willesden. 1937. THE 62nd ANNUAL HEALTH REPORT. GEORGE F. BUCHAN, M.D., F.R.C.P., D.P.H., Medical Officer of Health. London: JAS. TRUSCOTT & SON, LTD., Suffolk Lane, Cannon Street, London, E.C.4. 66056 INDEX. page Acreage of District 16 Adoptive Acts in force in District 19 After Care of Mentally and Physically Defective Children 47 Ambulance Service 15, 18, 80 Bakehouses 22, 27 Birth Rate 5, 16, 84 Blind Children and Prevention of Blindness 42,131 Bye-laws 19 Canal Boats 22,24 Cancer 6 Caravans 22 Child Guidance 42 Closet Accommodation 20,23 Common Lodging Houses 22 Confinements in Hospital 10 Convalescence—Schoolchildren 41 Cowsheds 22 Crippled Children 44 Crippling Defects 13 Child Life Protection 67-69, 114 Dairies and Milkshops 22 Dead—Disposal of 24 Deaf and Partially Deal Children 43 Death Rate 5,16,84 Deaths—Causes of 85 Delicate Children 44 Dental Work—School Children and Maternity and Child Welfare 54-58 Diphtheria Immunisation 74 Disinfection and Disinfestation 21,23 Drainage and Sewerage 20, 23 Employment of Children in Entertainments 39 Epileptic Children 43 Exceptional Children—Return of 42 Eye Department work 98 Factory and Workshop Act, 1901 28 Feeding Centres—Schoolchildren 14,59 Following-up 12 Food—Inspection and Supervision of 24, 26 Food and Drugs Acts 28 Health Centres 18, 37, 120 Health Education 13 Health Services—Development and Extension of 123 Home Nursing 14,18,70 Hospital Treatment—Children under 5 years 10, 39 —School Children 38 House Refuse 20, 23 Houses Let in Lodgings 22,24 Housing and Housing Acts 14,22,25 Infant Mortality 5, 6, 84, 93 Infectious Diseases Hospital 72 Infectious Diseases—Notifiable 7,17,94 —Non-Notifiable 8 Inhabited Houses 16 Laboratory Facilities 76,118,123 Marasmus 39 Mastoid Disease 39 Maternal Mortality 10 Maternity Hospital 9,78,133 Meals—Provision of, to School Children 14, 59 page Meat Inspection 27 Medical Inspection of Children under 5 11 Medical Inspection of School Children 12, 30-34 Medical Treatment of School Children 12, 30-34 Members of the Corporation 4 Mental Deficiency Acts—Children notified to Local Authority 45 Mentally Defective Children 40,43 Midwifery Services 19,61-65 Midwives—Supervision of and Midwives Act, 1936 61-65, 103 Milk 26 Mothercraft 11 Mothers and Children under 5 8,19 Mortuary 15 Movable Dwellings 22 Municipal Hospital 15, 72 Nuisances abated 24 Nursery Classes 48 Nursing Homes—Registration of 66 Nursing Staff—48 hour week 116,128 Nutrition 32 Offensive Trades 23, 24 Ophthalmia Neonatorum 11 Orthopaedics 13, 100 Overcrowding 15, 26, 127 Payments by Parents 13 Physically Defective Children 41, 43 Population 16 Rag Flock Acts 24 Rateable Value 16 Rent and Mortgage Interest (Restriction) Acts, 1920-33 22 Rivers and Streams 20 Sanitary Administration 19 Sanitary Work and Inspections 14, 21 Scarlet Fever—Return Cases 7 School Medical Service 11 Schools 24 Secondary and Junior Technical, etc., Schools —Routine Medical and Dental Inspection and Treatment 13, 49-53, 57-58 Skin Disease 13, 96 Slaughter-houses 22 Small Pox 8 Smoke Abatement 20 Social Conditions 15 Special Schools—Routine Medical Inspection 46 Squint 33 Stammering Children 42 Statistical Data—School Children 35 Still-birth Rate 5, 16 Sunlight Treatment 97 Swimming Baths and Pools 20 Tonsils and Adenoids—Operation for removal of 12, 102 Tuberculosis—Notifications and Deaths 17 Tuberculous Children 43 Underground Rooms 24, 127 Unemployed 15 Unsound Food 23 Verminous School Children 12,34 Vital Statistics 5,16,84 Vocational Guidance 13 Water Supply 20, 23 APPENDICES. page A.—Table I. Vital Statistics 84 ,, II. Deaths of Willesden Residents 85 „ II. (a) Causes of death as circulated by Registrar-General 92 ,, III. Infant Mortality 93 ,, IV. Cases of Infectious Disease notified 94 B.—List of Acts of Parliament, Local Government Orders, etc., etc., issued by Government Departments 95 C.—Annual Report on Dermatological and Actinotherapeutic Departments 96 D.—Annual Report on the Eye Department 98 E.—Annual Report on the Orthopaedic Clinic 100 F.—Annual Report on the work of the Ear, Nose and Throat Department 102 G.—Scheme under the Midwives Act, 1936 103 H.—Memorandum by the Medical Officer of Health on Infant Life Protection 114 I.—Memorandum by the Medical Officer of Health on Nursing Staff, Municipal Hospital 116 page J.—Memorandum by the Medical Officer of Health on Laboratory Technician 119 K.—Summary of additional estimated costs for new Health Centre (2) 120 L.—Regulations governing the appointment of a Laboratory Technician 123 M.—Memorandum by the Medical Officer of Health on Clinic Work and Clinics 123 N.—Memorandum by the Medical Officer of Health on Overcrowding and Basement Dwellings 127 O.—Report of the Chairman of the Hospital Visiting Sub-Committee on a 48 hour week for the Nursing Staff of the Municipal Hospital 128 P.—Memorandum by the Medical Officer of Health on Circular 1621 of the Ministry of Health—Prevention of Blindness 131 Q.—Preliminary Report by the Medical Officer of Health on the extension of the Willesden Maternity Hospital 133 CORPORATION OF WILLESDEN, 1937-38. HIS WORSHIP THE MAYOR. ALDERMAN H. W. PROTHERO, J.P. Deputy Mayor. Councillor G. AYRES. Aldermen. *§†BOND, P., J.P. J§†COWAN, Miss N. M. *C. HICKS BOLTON, J.P., M.A. HILL, W. A., J.P. ‡*§†HILL, W. J. (Chairman, Health Committee). *†HISCOCKS, G. H. JEFFRIES, W. §†RYDE, W. H. SAVORY, H. J. STILTON, W. A. *† WILLIAMS, Mrs. S. E. H. (Chairman, Children's Care Sub-Committee). *†WORSFOLD, Mrs. A. B. Councillors. BLAXLAND, H. C. *§†BOWN, S. BRIDGES, J. S., LL.D. ‡†CARNE, G. T. CATLOW, J. W., J.P. †‡CLARK, J. A. *COOPER, J. S. *†DORAN, A. E. *DORE-BOIZE, G. EVANS, F. T. EXTON, F. G. *FERNLEY, J. †*‡FORBES, Mrs. M. R. (Chairman, Housing Act (1936) Committee). †‡FREEMAN, Miss R. G. N. GILLIS, L. H. *ASKELL, V. C. †*ENDERSON, Miss J. M. ‡HISCOCKS, E. H. HOBSON, C. R. *UGGINS, Mrs. V. E. A. HURLEY, G. J. *‡JONES, A. E. KELLY, H. J. †LEIGH MOSSLEY, H. LEVY, R. C. S., LL.M. ‡MARSHALL, H. C. *†§McLAUCHLAN, J. OWENS, G. *PERRY, A. SAUNDERS, J. J. †SCOTT, S. THORLEY, H. WALFORD, A. A. *†§WALLIS, Mrs. V. B. ( Chairman, Hospital Visiting Sub-Committee). *WATSON, A. T. W. WATTS, C. K. ‡†WESTON, GEO., F.A.I. WHITE, Mrs. R. * Member of the Children's Care Sub-Committee. † Member of Health Committee. ‡ Member of Housing Act (1936) Committee. § Member of Hospital Visiting Sub-Committee. 5 Town Hall, Dyne Road, Kilburn, London, N.W. 6. 1st May, 1938. 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 1937. This Report includes:— page (i.) The 62nd Annual Report on the Health and Sanitary Condition of the District 16 (ii.) The 30th Annual Report on the Health of Children attending the Public Elementary Schools 30 (iii.) Certain Statistical Data relative to School and Maternity and Child Welfare Work 35 (iv.) The 4th Annual Report on the work in connection with Abnormal Children 40 (v.) The 7th Annual Report on Nursery Classes 48 (vi.) The 18th Annual Report on the Health of Pupils attending Secondary and Technical Schools 49 (vii.) The 20th Annual Report on Dental Work in connection with School Children, Expectant and Nursing Mothers, and Children under 5 years 54 (viii.) The 23rd Annual Report on the provision of Meals to Children attending the Public Elementary Schools 59 (ix.) The 8th Annual Report on the Supervision of Midwives 61 (x.) The 8th Annual Report on the Registration of Nursing Homes 66 (xi.) The 8th Annual Report on Child Life Protection 67 (xii.) The 18th Annual Report on Home Nursing 70 (xiii.) The 46th Annual Report on the Municipal Hospital 72 (xiv.) The 7th Annual Report on the Maternity Hospital 78 (xv.) The 23rd Annual Report on the Ambulance Service 80 (xvi.) Vital Statistical Tables—Appendix A 84 It also includes reports for the year 1937 by the specialists in charge of the following departments:— (a) The Dermatological and Actinotherapeutic Department—Appendix C. {b) The Eye Department—Appendix D. (c) The Orthopaedic Department-—Appendix E. (d) The Ear, Nose and Throat Department—Appendix F. It also includes various special reports made during the year—Appendices G to Q. 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 1937, was 203,385. 3,058 live births were registered during 1937, giving a birth rate of 15.04 per 1,000 of the population, as against 14.00 in 1936. 100 still births were registered, giving a still birth rate of 31.67 per 1,000 total live and still births. 1,979 deaths were registered in 1937, giving a death rate of 9.73 per 1,000 of the population. These figures compare with a total number of deaths of 2,113 and a death-rate of 10.43 in 1936. The infantile mortality rate for the year 1937 was 64.42 per 1,000 births. Altogether 197 children under one year of age died in 1937. 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 1937:— Table No. 1. 1924 1925 1926 1927 1928 1929 1930 1931 1932 1933 1934 1935 1936 1937 Congenital Malformations 11 11 6 13 12 17 11 9 10 10 16 11 25 16 Premature Birth 45 43 42 43 35 61 57 51 40 35 29 53 44 50 Atrophy, Debility and Marasmus 32 13 10 13 13 7 15 9 12 11 7 7 7 7 Atelectasis 2 8 4 4 5 9 5 9 4 11 9 8 5 12 Diarrhoea and Enteritis 10 13 10 9 9 11 24 16 31 27 20 57 24 57 Measles 10 3 3 0 4 0 4 0 4 0 1 0 2 0 Whooping Cough 8 13 4 8 5 7 2 6 1 5 1 2 7 2 Bronchitis 12 6 6 6 7 7 2 3 3 2 1 5 9 3 Pneumonia 36 30 31 21 30 22 27 30 26 10 15 16 22 22 Total Infantile Mortality Rate (rate per 1,000 live births) 73 62 53 59 57 61 61 60 61 46 43 66 60 64 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 25 per 1,000 births, whereas amongst non-clinic attendants it was 145 per 1,000 births. These figures are arrived at by knowing that out of the 3,058 Willesden children born alive in 1937, 2,053 attended the Health Centres, of whom 51 died, giving an infantile mortality rate amongst clinic attendants of 25 per 1,000 births. 1,005 children born in Willesden in 1937 did not attend the clinics and of this number 146 died before reaching the age of one, thus giving an infantile mortality rate amongst non-clinic attendants of 145 per 1,000 births. It should be noted that the infantile mortality rate of 25 amongst clinic attendants compares with a rate of 24 in 1936 and 30 in 1935, and the infantile mortality rate of 145 amongst non-clinic attendants compares with a rate of 120 in 1936 and 121 in 1935. CANCER. In Willesden, in 1937, there were 281 deaths from Cancer, as compared with 302, 266, 281, 260, 250, 250, 214, 239, in each of the previous eight years. The 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 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 diagnosis is obtained at certain of the larger London Hospitals with which the Council has made satisfactory working arrangements. If a patient is under a private doctor, who can be located, the latter is communicated with and the result of any examination, or advice as to treatment, is made known to him as soon as possible. Propaganda in the form of posters, leaflets, advertisements, articles in the press and talks, has been continued. During 1937, 74 patients attended the Clinics, of whom 46 were new cases (8 men and 38 women), and 28 had attended during 1936 or previously. The total attendances made during 1937 were 93. Of the 46 new cases, 4 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 42 cases, after examination, were disposed of as follows:— 27 were referred to a hospital for further investigation; 6 were referred back to their own doctors; 6 were kept under observation and asked to re-attend (5 of these were finally discharged before the end of the year); 3 were reassured and discharged on their first visit. 7 Of the 27 who were referred to hospital— 7 were found to require operation (6 have been operated on and 1 is awaiting operation); 14 required treatment (all have received it—10 were discharged by the end of the year and 4 are still under treatment or observation); 4 were reassured and dismissed; 1 was found to have inoperable cancer and was treated at home and later in Central Middlesex County Hospital, where she died; 1 cannot be traced. The pathological conditions from which the 46 new cases suffered are briefly as follows:— 3 had cancer of the uterus; 6 had chronic mastitis; 14 had affections of the generative organs often found to be pre-cancerous (some were operated on, others had special treatments); 7 had conditions affecting the digestive tract, which occasionally lead to cancer. 3 had similar conditions of the Mouth, Throat or Nose. 4 had innocent tumours of the skin or body wall. 1 had a non-malignant tumour of the mouth requiring operation. 8 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 patients attending. During 1937, 61 such visits were paid. She was well received and patients expressed gratitude for the services of the Clinic. INFECTIOUS DISEASES. During the year 1937, 2,429 cases of Infectious Disease were notified as compared with 2,517 in the previous year. The following table gives the number of notifications of certain diseases included in the above total of 2,429, together with the corresponding figures for 1936:— Table No. 2. Number of Cases notified. 1936 1937 Diphtheria 382 400 Scarlet Fever 556 477 Pneumonia 352 409 Whooping Cough 743 626 Erysipelas 88 68 Return Cases of Scarlet Fever.—The following statement gives the return cases that have occurred during 1937:— I. Home Cases.—46. (ia) No. of infecting cases giving rise to return cases not longer than 28 days after release from isolation 1 „ return cases they gave rise to 1 „ infecting cases per cent. of total home cases 2.2 „ return cases per cent. of total home cases 2.2 (b) No. of infecting cases giving rise to return cases more than 28 days after release from isolation 0 „ return cases they gave rise to 0 „ infecting cases per cent. of total home cases 0 „ return cases per cent. of total home cases 0 8 II. Hospital Cases.—431. (a) No. of infecting cases giving rise to return cases not longer than 28 days after discharge 12 „ return cases they gave rise to 17 „ infecting cases per cent. of total hospital cases 2.8 „ return cases per cent. of total hospital cases 3.9 (b) No. of infecting cases giving rise to return cases more than 28 days after discharge 5 „ return cases they gave rise to 5 „ of infecting cases per cent. of total hospital cases 1.2 „ return cases per cent. of total hospital cases 1.2 Small Pox.—No cases of Small Pox were notified during 1937. No vaccinations were performed by the Medical Officer of Health under the Public Health (Small Pox Prevention) Regulations, 1917. Enteric Fever.—Ten cases were notified as Typhoid or Para-typhoid Fever during 1937, as against 10 in 1936, 10 in 1935, 7 in 1934 and 13 in 1933. Nine cases were removed to hospital—7 to the Willesden Municipal Hospital, 1 to the Central Middlesex County Hospital and 1 to a London Hospital. One case was nursed at home. Of the 7 cases removed to the Willesden Municipal Hospital, 4 were diagnosed as Para-typhoid Fever B, 1 as Enteritis and 2 as Influenza. All these recovered. The case removed to the Central Middlesex County Hospital proved fatal. The death was certified as due to Para-typhoid B and was allocated to Acton as the patient was an Acton resident. The case removed to a London hospital also proved fatal, the death being certified as due to Typhoid Fever. This patient took ill on her way home from Palestine. The case nursed at home was a case of Para-typhoid Fever B. This patient recovered. Malaria.—No cases of Malaria were notified during 1937. Infectious Diseases of the Nervous System—Cerebro-Spinal Meningitis, Poliomyelitis, Encephalitis Lethargica and Acute Polio-Encephalitis.—22 cases of these diseases were notified in 1937, 4 of these notified cases proved fatal, giving a fatality rate of 18 per cent. of notified cases. Two of the deaths were certified as due to Cerebro-Spinal Fever, 1 to acute Polio-encephalitis and 1 to acute Polio-myelo-encephalitis. In addition there were 8 further deaths from these diseases in Willesden residents, and 2 further deaths in non-Willesden residents in institutions in Willesden. 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.—35 cases were notified during 1937. 1 in January, 2 in March, 1 in April, 3 in October, 20 in November, and 8 in December. 6 patients were admitted to the Municipal Hospital, 12 to other hospitals, and 17 were nursed at home. 1 child aged 3 years died after 3 days in the Municipal Hospital, the death being certified as due to Gastro-enteritis. Anthrax.—1 case was notified during 1937 and proved fatal. The patient was a woman of 34 years who was a spinner at some hair works and was concerned with the working of hair from Russia and Siberia. Whooping Cough is a notifiable disease in Willesden. 626 cases were notified during the year but a total of 1,119 cases coming to their knowledge were visited by the Health Visitors. There were 11 deaths from Whooping Cough, all occurring in children under 5 years of age, 8 of these 11 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 1937, 252 cases of measles which is not notifiable in Willesden were visited by the Health Visitors. There were no deaths from Measles. MOTHERS AND CHILDREN UNDER FIVE YEARS. Municipal Centres.—At the Municipal Centres, expectant mothers attended the medical consultations and treatment Clinics onl3,479 occasions; nursing mothers 31,266, and children under 5, 63,188, making a total of 107,933 attendances or 11,695 more than last year. Out of the total number of 3,058 children born alive during the year, 2,053 or 67 per cent. subsequently attended the Municipal Welfare Centres. Altogether, however, 2,431 children under 1 year of age attended the Municipal Centres for the first time during the year, excluding transfers from other districts. This represents 80 per cent. of the 3,036 notified live births belonging to Willesden, and 79 per cent. of the 3,058 registered live births belonging to Willesden. 398 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 1,503; 74 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 lay 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. Cases sent to Park Royal Hospital which later became the Central Middlesex County 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 Central Middlesex County 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 1937 1,069 During 1937, 360 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 305 Not resident in Willesden 48 Will not have had 3 months' residence in Willesden prior to expected date of confinement 5 Unable to pay fee 2 360 The following Table shows the fees at which the 1,069 cases were booked Table No. 5. Fee. No. of Cases. Fee. No. of Cases. £ s. d. £ s. d. 15 0 0 2 5 10 0 11 14 10 0 2 5 0 0 21 11 10 0 1 4 10 0 21 11 0 0 1 4 0 0 45 9 10 0 1 3 10 0 55 8 10 0 2 3 0 0 62 8 0 0 1 2 10 0 80 7 10 0 3 2 0 0 84 7 0 0 12 1 10 0 114 6 10 0 6 1 0 0 124 6 0 0 15 Free 406 The average fee per case is approximately £1 14s. 3d. 10 Hospital Confinements.—During 1937, 1,014 women were confined in the Willesden Maternity Hospital. In addition to these a number of Willesden mothers were confined in institutions outside Willesden, 508 births of Willesden residents being notified from such outside institutions—106 from Queen Charlotte's Hospital, 50 from Queen Mary's Maternity Home, Hampstead, 56 from St. Mary's Hospital, 15 from University College Hospital, 24 from Middlesex Hospital, and smaller numbers from other hospitals; 72 from a nursing home and smaller numbers from other nursing homes. These, together with some 411 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. 140 such reports were supplied to London Hospitals and 278 to the Middlesex County Council during the year. 85 Expectant Mothers booked for confinement in the Central Middlesex County Hospital were referred to the Willesden Health Centres for Ante-natal care. Puerperal Fever.—Puerperal Fever ceased to be notifiable on October 1st, 1937, when the Public Health Act 1936 came into force. During the first 9 months of the year 13 cases were notified as against 6 in the whole of 1936 and 3 in 1935. Three of these patients died. Puerperal Pyrexia.—32 cases were notified during the year. 1 of these 32 cases proved fatal, the death being attributed to other accidents of childbirth. This was a patient living in London but confined in Willesden and her death is allocated to London. Maternal Mortality.—During 1937 there were 10 deaths classed to pregnancy and childbearing—3 to Puerperal Sepsis, and 7 to other puerperal causes. The puerperal mortality rate from Sepsis was, therefore, 0.98 per 1,000 registered live births and 0.95 per 1,000 registered total births. The corresponding figures for 1936 were 0.71 per 1,000 registered live births and 0.68 per 1,000 registered total births. The total puerperal mortality rate was 3.27 per 1,000 registered live births and 3.17 per 1,000 registered total births. The corresponding figures for 1936 were 1.76 per 1,000 registered live births and 1.71 per 1,000 registered total births. During 1937 there were, in addition, 2 maternal deaths from non-puerperal causes and 2 maternal deaths from criminal abortion. The total maternal mortality from all causes excluding criminal abortion, was thus 3.92 per 1,000 registered live births and 3.80 per 1,000 registered total births as against 3.17 and 3.08 in 1936. The total maternal mortality from all causes including criminal abortion was 4.58 per 1,000 registered live births and 4.43 per 1,000 registered total births as against 3.53 and 3.42 in 1936. Sterilised Accouchment Sets.—These sets are supplied in accordance with the arrangements stated in my Annual Report for 1930, p. 10. During 1937, 338 were supplied free, 10 at full cost and 21 at part cost. 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. 1 such consultation was paid for in 1937. 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. Provision of Ancssthetist.—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 1937. 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. 14 cases were inquired into during 1937. Hospital Treatment of Children under 5 Years of Age (See page 39). 11 Health Visiting and Medical Inspection of Children between the Ages of 1 and 5 Years. The practice described under this heading on page 9 of the Annual Report for 1931 was continued during the current year. The aims and methods adopted were outlined on pages 9 and 10 of the Annual Report for 1932. Findings of Medical Inspections.—The following table shows the numbers and percentages of individual defects found in 495 children examined during the year. Table No. 6. Age Period. 18 months. 2 years. 3 years. 4 years. Total. Percentage. Number of children inspected 143 190 111 51 495 Malnutrition (including slight degrees) 9 5 11 1 26 5.2 Skin conditions 4 8 5 2 19 3.8 Eyes—Blepharitis and Conjunctivitis — 1 — — 1 2.8 Squint 2 4 3 — 9 Other conditions — 1 1 2 4 Ears, Otitis Media 1 2 1 1 5 1.0 Nose and Throat—Enlarged tonsils or adenoids or both ... 3 7 15 5 30 6.0 Enlarged Cervical Glands 2 3 6 — 11 2.2 Teeth—Dental Diseases 2 17 15 19 53 10.8 Heart and Circulation (including anaemia) 1 11 2 — 14 2.8 Lung Disease (non-tubercular) 4 4 1 4 13 2.6 Nervous System (including functional conditions) 4 7 — 1 12 2.4 Deformities—Rickets 17 12 10 — 39 7.8 Others 16 34 16 9 75 15.0 Other Defects 3 10 9 1 23 4.7 Thus some 500 children out of a total of about 10,000 were given a full routine medical inspection during the year. This is work that the department have been striving to do for years but have been unable to overtake on account of lack of accommodation and staff. The Ministry of Health Circular issued in 1936 exhorted the Council to provide for this work, and in their reply to the Minister the Council promised to do so when Health Centre (2) was rebuilt. The completed plans for this centre are now under consideration by the Council. Ophthalmia Neonatorum.—The number of cases of this disease notified during the year was 28, as against 19 last year. This gives a case rate of 9 2 per 1,000 registered live births. A private doctor attended at the confinement in 2 cases, a district midwife in 8 cases, 17 cases were born in hospital and 1 just before arrival at hospital. Treatment was obtained at a hospital in 12 cases, at the Municipal Centres in 11 cases, and by a private doctor at home in 5 cases. Complete recovery with unimpaired vision occurred in 20 cases. In 1 case there was corneal opacity of the left eye, 6 cases left the district and 1 case died the death being certified as due to prematurity. 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 1937, 497 Mothercraft sessions were held, with 4,257 attendances of mothers, and 4,092 attendances at the nurseries. This gives an average of 8-6 attendances of Mothers per session. 333 individual mothers attended. THE SCHOOL MEDICAL SERVICE. Schools—There are 35 public elementary schools in the district. Of this number 23 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. The more modern schools are quite satisfactory 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. 12 Medical Inspection.—During the year ending 31st March, 1937, the average number of scholars on the Public Elementary School Rolls, including the Special Schools, in Willesden was 19,534. The following groups of children were examined during the year:— (1) All children admitted to school for the first time; (2) All children between 8 and 9 years of age; and (3) All children between 12 and 13 years of age, together with children over 13 years of age who had not been examined on reaching the age of 12. The total number of children medically inspected at routine and special inspections during 1937 was 13,627. Findings of Medical Inspections.—(a) Uncleanliness.—Cleanliness inspections were carried out in the schools on 634 occasions during the year 1937, the average number of visits paid to each school by the Health Visitor being 19. The total number of examinations and re-examinations made during the year was 55,452. 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 1937, the percentage was 4.2. 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% 1937 4.2% (b) Tonsils and Adenoids.—During 1937 at routine and special medical inspections, 1,161 cases of enlarged tonsils and adenoids were discovered, as compared with 1,165 found in 1936, 1,114 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 1937, at routine and special medical inspections, 1,545 cases of skin disease were detected as compared with 1,507 in 1936, 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 1937, at routine and special medical inspections, 144 cases of this defect were noted, as compared with 145 in 1936, 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 1937, school children were followed up by the Health Department on account of 16,954 medical defects and 7,467 dental defects. Of those defects found to require treatment, medical or dental treatment was obtained for 14,810 and domestic treatment was obtained for 3,310. 86 per cent. of the medical defects were treated, 66 per cent. receiving medical treatment and 20 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. 95 per cent. of the total medical defects treated and 99 per cent. of the total dental defects treated were dealt with by the Education Committee. The remainder, or 5 per cent. of the medical defects and 1 per cent. of the dental defects treated, were dealt with by private practitioners, voluntary hospitals or other charitable institutions, or Public Assistance. In connection with defects treated, the children concerned made 97,669 attendances at the Health Centres in 1937. 13 Crippling Defects and Orthopaedics.—An Orthopaedic Clinic staffed by an Orthopaedic Surgeon and a specially qualified nurse is held at the Stonebridge Health Centre. The report of the Orthopaedic Surgeon appears as Appendix E. The Fourth Annual Report on the work in connection with Abnormal Children appears later in this report. Vocational Guidance.—In the year ended July, 1937, medical reports were made on 1,558 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. 461 children were advised to avoid the type of occupation contra-indicated by their condition. SECONDARY AND JUNIOR TECHNICAL, ETC., 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. The total number of pupils on the rolls of the Secondary and Technical Schools in Willesden now included in this arrangement is 2,700. 1,547 medical examinations and 525 re-examinations of Secondary and Technical School pupils have been carried out during the year 1937. 438 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. 2,396 pupils were dentally inspected during the year, 1,559 were found to require treatment and 532 were treated at the Willesden Council's Dental Clinics. 2,359 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. 14 PROVISION OF MEALS. 283,367 meals were supplied in 1937 as compared with 260,822 in 1936, 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 431 cases during the year, and in connection with such cases paid 4,069 visits. 1,669 of these visits were paid in the Carlton Ward, 616 in the Kilburn Ward, 567 in the Mapesbury Ward, 248 in the Willesden Green Ward, and smaller numbers in the other wards of Willesden. Of the 431 cases nursed during the year, 413 were new cases. 362 of these 413 new cases were referred by the Health Department for nursing, 18 by private doctors and 33 by Hospitals, Associations and private persons. Ophthalmia neonatorum received 99 visits and other ophthalmia cases 638 visits. SANITARY WORK. The approximate number of houses in Willesden at the end of 1937 was 33,384, smaller flats 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 26,176 as compared with 27,984 in 1936. The houses inspected under the Housing Acts numbered 1,265 as compared with 1,237 in 1936. The number of complaints received 2,695 as compared with 3,265 in 1936. The total number of Notices issued and nuisances abated were 5,655, and 30,235 respectively. Work done under the Housing Acts is shown in the tabular statement in the body of the Report. 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, and ending at 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, 1936. 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—Hie re-housing of the families displaced by the various Clearance and Compulsory Purchase Orders has proceeded as the new flats and houses became ready for occupation, and practically all the houses in the areas concerned 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. 15 Overcrowding.—The first steps for dealing with overcrowding have now been completed. The Minister of Health fixed 1st July, 1937, as the appointed day after which newlycreated overcrowding became an offence, and the same day was fixed as the terminal date by which a statement showing the permitted number of persons applicable to each house was to be inserted by the landlord in the rent books. By the 31st December, 1937, 47,611 dwelling-houses were measured and the permitted number ascertained and recorded. The information needed for insertion in the rent books by the landlords is now available upon application. Comparatively few landlords applied for this information, and in accordance with the Council's instructions the permitted numbers have been sent without application; in order to do this, a temporary clerk and a temporary typist have been employed. The information obtained by the survey and the measurement of these 47,611 dwelling-houses forms 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. By 31st December, 1937, 108 overcrowded families were rehoused by the Council and 166 overcrowded families removed to accommodation other than that provided by the Council. So far as is known, the houses vacated by overcrowded families have not been re-occupied in circumstances so as to be overcrowded, but as no powers exist to control the re-letting of privatelyowned houses, save to ensure no fresh overcrowding occurs, it is not possible to say how far the provision of new houses will contribute to the abatement of overcrowding in the Borough. 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 1937 3,317 496 3,813 January, 1938 4,875 963 5,838 PUBLIC MORTUARY. 107 bodies were deposited at the Mortuary during the year ending 31st December, 1937, as follows:-6 Accommodations, 57 Post-Mortems, 17 Poit-Mortems and Inquests, and 27 Inquests only. AMBULANCE SERVICE. The demands on the Ambulance Service increase year by year. During the vear 8,535 calls were made for the Council's ambulances as compared with 7,685 in 1936, 6,856 in 1935, 5,617 in 1934, 5,633 in 1933, 5,497 in 1932 and 5,171 in 1931. Altogether, 164,761 miles were run in 1937 as compared with 153,459 in 1936, 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 23rd year of working of the Ambulance Service appears on pages 80-83. MUNICIPAL HOSPITAL. The 46th 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. 16 THE SIXTY-SECOND ANNUAL REPORT for the Year ending 31st December, 1937, on the HEALTH AND SANITARY CONDITION OF THE BOROUGH OF WILLESDEN. GENERAL STATISTICS. Area (acres) 4632.5 Population (estimated Midsummer, 1937) 203,385* Population Census (1931) (not including areas taken over on 1st April, 1934) 185,300 Number of inhabited houses (end of 1937) according to Rate books (Flats separately assessed counted as one house.) 41,598 Rateable value at 31st March, 1937 £1,574,888 Sum represented by a penny rate £6,365 * Registrar General's estimate Midsummer, 1937 187,640 EXTRACTS FROM VITAL STATISTICS OF THE YEAR. Live Births— Total. M. F. Total. Legitimate 2,913 1,488 1,431 2,919 Birth Rate per 1,000 of the estimated resident population 15.04 16.62 Illegitimate 145 109 97 206 Stillbirths 100 55 44 99 Rate per 1,000 total (live and still) births 31.67 30.71 Deaths 1,979 2,004 Death Rate per 1,000 of the estimated resident population 9.73 10.66 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 3 3 0.95 0.93 No. 30—Other puerperal causes 7 7 2.22 2.17 Total 10 10 3.17 3.10 Death Rate of Infants under one year of age:— All infants per 1,000 live births 64.42 63.68 Legitimate infants per 1,000 legitimate live births 53.90 53.44 Illegitimate infants per 1,000 illegitimate live births ... 275.86 208.73 Deaths from Cancer (all ages) 281 2S4 „ „ Measles (all ages) 0 0 „ „ Whooping Cough (all ages) 11 11 „ „ Diarrhoea (under 2 years of age) 57 53 Figures in italics (other than rates) supplied by Registrar-General. 17 Table No. 7. NOTIFIABLE DISEASES DURING THE YEAR. Disease. Total Cases Notified. Cases admitted to Total Deaths. Willesden Municipal Hospital. Other Hospitals. (1) (2) (3) (4) Diphtheria 400 383 14 17 Scarlet Fever 477 419 12 — Enteric Fever (including Paratyphoid) 10 7 2 1 Puerperal Fever 13 — 13 3 Puerperal Pyrexia 32 2 25 — Pneumonia 409 1 —* 144 Small Pox — — — — Cholera — — — — Plague — — — — Erysipelas 68 31 17 2 Typhus Fever — — — — Relapsing Fever — — — — Continued Fever — — — — Cerebro-spinal Meningitis ... 11 9 2 3 Poliomyelitis ... 10 3 7 3 Ophthalmia Neonatorum ... 28 2 10 — Malaria — — — — Dysentery 35 6 12 — Encephalitis Lethargica — — — 4 Acute Polio-Encephalitis 1 — 1 — Anthrax 1 — — 1 Tuberculosis :— (a) Pulmonary ... 246 — —* 111 (b) Non-Pulmonary 62 — —* 16 Whooping Cough 626 59 —* 11 For analysis of the age groups see Appendix "A" Table IV. * No complete record. Table No. 8. TUBERCULOSIS. New Cases and Mortality during 1937. This table includes primary notifications received from Medical Practitioners, cases not notified but included in the death returns and cases transferred from other areas. Age-Periods. New Cases. Deaths. Respiratory. Non-Respiratory. Respiratory. Non- Respiratory. M. F. M. F. M. F. M. F. 0 1 0 0 0 1 0 0 0 1 4 1 0 6 0 0 1 3 5 4 2 6 1 0 0 2 0 10 2 3 4 5 1 2 2 0 15 12 15 4 4 3 3 1 0 20 27 23 5 7 7 10 0 1 25 32 40 4 5 15 16 2 0 35 27 12 3 5 14 2 1 0 45 15 7 1 0 12 3 0 0 55 10 3 1 1 12 3 3 0 65 and upwards 5 1 0 0 5 2 0 0 Totals 139 107 28 34 70 41 12 4 The ratio of non-notified tuberculosis deaths to total tuberculosis deaths was 1 : 10. 18 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 1937. PUBLIC HEALTH ACT, 1925. SECTION 62. PUBLIC HEALTH ACT, 1936. SECTION 172. Removal to hospital of infectious persons suffering from pulmonary tuberculosis. No action was taken under these sections during 1937. GENERAL PROVISION OF HEALTH SERVICES FOR THE AREA. LABORATORY FACILITIES. Laboratory facilities are dealt with in the Annual Report on the Municipal Hospital, page 76. 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 1936-37 will be found on page 80. 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. 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 again 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. 19 MIDWIFERY AND MATERNITY SERVICES. Midwifery. In accordance with Section 10 of the Midwives Act, 1902, 74 Midwives gave notice in 1937 of their intention to practise in Willesden. The provision made for a domiciliary Service of Midwives in pursuance of the Midwives Act 1936 is dealt with in the 8th Annual Report on the Supervision of Midwives, pages 61-65. Maternity Service. The Service is dealt with in other parts of the Report. INSTITUTIONAL PROVISION FOR MOTHERS OR CHILDREN. There are no developments or changes to record. HEALTH VISITORS—CHILD LIFE PROTECTION—ORTHOPAEDIC TREATMENT. There is nothing to record except what is set out elsewhere in the Report. SUPERVISION AND INSPECTION OF REGISTERED MATERNITY AND OTHER NURSING HOMES. This is dealt with in the 8th Annual Report on the Registration of Nursing Homes, page 66. SANITARY ADMINISTRATION. List of Local Acts, Adoptive Acts, Dye-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., IV., and X. Adopted 24.1.1911. Public Health Acts Amendment Act, 1907, Part VI. Adopted 1925. *Public Health Act, 1925. Burial Acts, 1852-1900. Public Libraries Acts, 1892-1901. Adopted 19.2.1891. 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. 20 SANITARY CIRCUMSTANCES OF THE AREA. Alteration of Boundary.—The Ministry of Health Provisional Order Confirmation (Ealing Extension) Act, 1937, confirmed a Provisional Order of the Minister of Health relating to the Borough of Ealing. This Order transferred from Willesden to Ealing an area of approximately 71.1 acres. The area transferred extends on the south side to the ninth house eastward of the junction of Iveagh Avenue and Twyford Abbey Road and on the northern boundary to the eastern side of a new road running north westward from the North Circular Road to a few yards beyond Iveagh Avenue. 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 Boroughs of Willesden and Wembley 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 about two years time. Drainage and Sewerage.—The culverting of the Mitchell Brook through the grounds of the Municipal Hospital and between Brentfield Road and the North Circular Road has now been completed. Application has been made to the Ministry for loan sanction in respect of the section between Dudden Hill Lane and Neasden Lane. The culverting of the final section of the Harlesden Brook is about to be commenced. Schemes for the relief of flooding in various parts of the Borough are in course of preparation and work will shortly commence in Lennox Gardens and Oxgate Lane. The reconstruction of the brick sewer in Rudolph Road, Kilburn, is now completed and plans are being prepared for similar work in Canterbury Road. The sewers and surface water drains in the second section of the Church End Housing Estate have also been completed. Smoke Abatement.—At one of the electrical generating stations, a new chimney stack some 236 feet high was erected to which has been connected the outlet of a new gas washing chamber. This new gas washing chamber receives the flue gases from the majority of the boilers and it is proposed to duplicate the gas washing chamber so that the flue gases from the remaining boilers can be washed, also that gases from either battery can be passed into either washing chamber. Swimming Baths and Pools.—The Council have 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. 21 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 65 Number of Council houses disinfested 65 Number of other houses found to be infested 224 Number of other houses disinfested 224 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 224. Of this number 129 were disinfested by the owners and 95 by the Council at the owners' request. 1,190 reinspections were made by the Disinfector and 425 by the Sanitary Inspectors to ascertain if the measures taken had been successful. The method used by the Department for freeing infested houses from bed bugs was sulphur fumigation. This was used in 174 rooms, a second application being necessary in 13 rooms. 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 by a Contractor. Furniture and bedding is removed to the Municipal Hospital 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, 66 families from the Slum Clearance and 108 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. Sanitary Inspection of the Area. Tabular summary of the work of the Sanitary Department during the year and action taken under the Public Health Acts, Housing Acts, etc. Inspections: Number of premises inspected on complaint 2,695 Number of premises inspected in connection with infectious diseases 63 Number of periodical inspections of premises. 3,002 Houses inspected from House to House (Housing Acts) 1,265 For Certificates or Reports under the Rent Acts 2 Public House Urinals 211 Mews and Stables 315 Miscellaneous 58 Total number of inspections and re-inspections made 26,176 Smoke Observations 184 22 Action under Rent and Mortgage Interest (Restriction) Acts, 1920-1933: Number of applications received for Certificates 2 Number of Certificates granted — Number of Certificates refused 2 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 157, Housing Act, 1936) 2,933 Cautionary or Intimation Notices issued 2,486 Number complied with 2,174 Statutory Orders issued 236 Number complied with *110 Summonses served 0 Number of convictions obtained 0 Summonses withdrawn 0 ,, dismissed 0 * Includes a certain number issued in 1936. 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 14 Number of contraventions 0 Number remedied 0 Canal Boats used as Dwellings: Number of contraventions of Regulations 2 Number remedied 2 Movable Dwellings, Caravans, Tents, etc.: Number observed during the year 9 Number of nuisances therefrom abated 1 Number removed from district 8 Bakehouses: Number in district 61 Number of Inspections 129 Contraventions of Factory Acts 22 Contraventions remedied 22 Slaughter-houses: Number on register 3 Inspections of carcases, etc. 188 Contraventions of Bye-laws 0 Contraventions remedied 0 Cowsheds: Number on register 0 Number of milch cows in district 0 Dairies and Milkshops: Number of dairymen on register 266 Number of itinerant milk sellers registered 45 Number of inspections made 290 Contraventions of Milk and Dairies Order, 1926 7 Contraventions remedied 7 23 Unsound Food: Meat (including organs) seized and surrendered 138 lbs. Fish (wet and dried) surrendered 197 lbs. Poultry surrendered 0 Bacon surrendered 1,020 lbs. Tinned and Cooked Meat surrendered 536 lbs. Fruit surrendered 2,808 lbs. Condensed Milk 22 lbs. Method of disposal Destroyed. Offensive Trades: Number of premises in district (Rag and Bone Dealers) 6 Number of inspections made 6 Contravention of Bye-laws 0 Contravention remedied 0 Water Supply and Water Service: Percentage of houses supplied on constant system 100 Cisterns:— New provided 11 Cleansed, repaired, covered, etc 250 Draw-taps placed on mains 68 Drainage and Sewerage of existing Buildings: Water Closets:— Number of water closets substituted for dry receptacles 0 Repaired, supplied with water or otherwise improved 812 Additional Closets constructed 25 Percentage of houses provided with water closets 100 Drains:— Examined, tested, exposed, etc 213 Unstopped, repaired, trapped, etc. 279 Waste pipes, rain-water pipes, disconnected, repaired, etc. 786 New soil pipes or ventilating shafts fixed 201 Existing soil pipes or ventilating shafts repaired 218 Disconnecting traps or chambers inserted 118 Reconstructed 41 New manhole covers 9 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 63 (b) Other diseases and conditions 790 Articles disinfected or destroyed:— (a) Phthisis 308 (b) Other diseases and conditions 586 Dust (House Refuse): New bins provided 419 Periodical frequency of dust removal weekly Method of disposal by tipping 24 Sundry Nuisances abated: Overcrowding (under Public Health Acts) 4 Smoke 3 Accumulations of refuse 94 Foul ditches, ponds, etc., and stagnant water 1 Fowls, pigs, and other animals 2 Dampness 1,444 Yards and forecourts paved, repaved or repaired 889 Walls and ceilings cleansed 6,825 Verminous rooms purified 485 Leaky roofs made watertight 1,278 Additional ventilation provided under floors 283 Dilapidated plaster repaired 2,921 Flooring and other woodwork repaired 2,435 Damp-proof courses inserted 374 Water supply reinstated 38 Washhouse floors repaired or repaved 402 Fireplaces and stoves repaired 1,162 Decayed brickwork repaired and repointed 760 Sinks provided or replaced 380 Additional light and ventilation provided to staircases 94 Larders or food cupboards provided or ventilated 442 Gutters and rainwater pipes repaired or renewed 1,133 New sash cords and glass provided to windows 3,328 Miscellaneous 2,211 Total number of Nuisances abated 30,235 Inspection of Premises where Food is prepared: Butchers', Provision, and General shops 580 Fish shops (wet, dried and fried) 268 Eating houses 58 Greengrocers' shops 247 Ice-cream premises 59 Stalls 300 Canal Boats Act, 1877, and Public Health Act, 1936.—The number of boats inspected during the year 1937 was 5 (7 inspections). 2 contraventions of the Regulations were found. In one case the contravention was remedied by certain repairs being carried out and in the other case the use of the boat for human habitation was discontinued. No legal proceedings were taken during the year. No case of infectious disease was notified or traced and no boats were detained for cleansing. 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 1,395 rooms which can be made to comply with the basement regulations 271 have been made to comply. Of 348 rooms which cannot be made to comply, 53 rooms have been closed for human habitation under section 12, Housing Act, 1936. Some 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 5,934 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 1,473. 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 Borough of Wembley, 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. 25 HOUSING. Number of inhabited houses* in Willesden (end of 1937) according to the Rate Books, 41,598. * Flat separately assessed counted as one house. Number of housesf in Willesden (end of 1937), 33,384 (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. 9. 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 1931-36 304 1,873 910 3,087 1937 115 1 252 368 Total for 17 years 1,417 3,561 4,805 9,783 HOUSING STATISTICS FOR THE YEAR 1937. Number of New Houses erected during the Year:— (а) Total (including numbers given separately under (b)):— (i.) By the Local Authority Flats 115 (ii.) By other Local Authorities Nil (iii.) Bv other bodies and persons Houses 36 Flats 217 (б) With State assistance under the Housing Acts:— (i.) By the Local Authority. (a) For the purpose of the Housing Act of 1930 and 1935 Flats 115 (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) 4,311 (b) Number of inspections made for the purpose 20,157 (2) (a) Number of dwelling-houses (included under sub-head (1) above) which were inspected and recorded under the Housing Consolidated Regulations, 1925 and 1932 1,265 (b) Number of inspections made for the purpose 10,094 (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 122 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 2,089 3.—Action under Statutory Powers during the Year:— (a).—Proceedings under sections .9, 10 and 16 of the Housing Act, 1036: (1) Number of dwelling-houses in respect of which notices were served requiring repairs 122 (2) Number of dwelling-houses which were rendered fit after service of formal notices:— (a) By owners 84 (b) By local authority in default of owners 6 26 (b).—Proceedings under Public Health Acts: (1) Number of dwelling-houses in respect of which notices were served requiring defects to be remedied 19 (2) Number of dwelling-houses in which defects were remedied after service of formal notices:— (a) By owners *19 (b) By local authority in default of owners 1 * Includes 1 outstanding in 1936. (c).—Proceedings under sections 11, 13 and 14 of the Housing Act, 1936: (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 12 of the Housing Act, 1936: (1) Number of separate tenements or underground rooms in respect of which Closing Orders were made 53 rooms (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, 1936.—Overcrowding:— (a) (i) Number of dwellings overcrowded at the end of the year 1,698 (ii) Number of families dwelling therein 1,698 (iii) Number of persons dwelling therein 8,938 (b) Number of new cases of overcrowding reported during the year 494 (c) (i) Number of cases of overcrowding relieved during the year 274 (ii) Number of persons concerned in such cases 1,240 (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 21 (b) Number of cases of overcrowding which have been relieved in the course of slum clearance operations 15 INSPECTION AND SUPERVISION OF FOOD. Milk Supply.—There are 2 wholesale dealers and 264 retail milk purveyors in the 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 1937:— Table No. 10. (a) "Tuberculin Tested" 10 (b) "Accredited" 2 (c) "Pasteurised" 22 (d) "Tuberculin Tested" Bottling Establishment 1 (e) "Pasteurised" milk (supplementary) 1 (f) "Pasteurisers" 2 There were no refusals or revocations of licences under the Milk (Special Designations) Order. 1936, during the year. Twelve samples of designated milks were examined during the year, all of which complied with the bacterial standard. 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. 27 One sample (No. 0/502, representing 2 per cent. of the total number sampled) was found to contain tubercle bacilli, and action was taken resulting in an examination of the herds at the supplying farm situate in the county of Buckingham. The other 47 samples showed no evidence of tuberculosis. The following are particulars of the positive sample:— 0/502.—A cow giving tuberculous milk found in the ordinary course of the County Council's work a few days after the infected sample was taken in Willesden was slaughtered under the Tuberculosis Order. This cow appeared to be responsible for the infection. 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. 11. In 1920. 1925. 1937. Registered 4 4 1 Licensed 5 4 2 Total 9 8 3 Table No. 12. The following Table shows the number of carcases inspected and the number of condemnations:— Cattle, excluding cows. Cows. Calves. Sheep and lambs. Pigs. Number killed 98 - 40 635 242 Number inspected 90 - 35 419 218 All diseases (except T.B.), whole carcase condemned - - - - - Carcases where part or organs condemned 1 - - - - Percentage of number inspected affected other than T.B. 1% - - - - Tuberculosis only. Whole Carcases condemned — — — - — Carcases, part, or organs condemned 3 - - - 10 Percentage of number inspected affected with tuberculosis 3.3 — — — 4.5 Inspection and Supervision of Other Foods.—Inspections were made of all the bakehouses and other premises in the district where food is prepared. The 61 bakehouses in the district were inspected on 129 occasions, Notices being served in 22 instances for minor contraventions of the Factory and Workshop Act. Sale of Beer in Public Houses.—An inspection has been made of some 52 public houses in this area. The conditions found were generally satisfactory. The cellars are regularly washed down and the walls regularly limewashed. The glasses used are cleansed after use and the wash-up sinks for this purpose are fitted with hot and cold water supplies. The pumps and pipe lines are dismantled weekly, soaked in hot soda water overnight and rinsed in cold water next morning. In some cases glass or stainless steel is used instead of lead piping and in other cases it was stated that the lead piping would be replaced by one or other of these materials. The surplus beer from the serving returns to the barrels through the utiliser filter and this appears to be a satisfactory arrangement. Waste beer, on the other hand, is specially collected in a separate barrel and returned to the brewers. In this area the brewers send their own inspectors frequently round the public houses. These inspectors examine and report on the cleanliness of bars, engines, pipe lines, cellars, temperature and storage. A record card of each inspection and report is kept by the publican and a number of these have been seen by the Sanitary Inspectors of this Department. 28 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 1937:— Table No. 13. List of Samples taken during the Year ended 31st December, 1937. Article. Taken. Adulterated. Milk 617 4 Almond ground 1 — Butter 1 - Lambs' liver 1 1 Meat 5 - Sardines 1 - Sausage 3 2 Sweets 1 — Vinegar 1 — Whisky 3 1 634 8 Number of Prosecutions 2 Number of Convictions 2 Artificial Cream Act, 1929. Public Health (Condensed and Dried Milk) Regulations, 1923. Inspections were made under the above in order to see that the requirements with respect to labelling were complied with, but no infringements were discovered. ADMINISTRATION OF FACTORY AND WORKSHOP ACT, 1901. The following tables shew the number of premises visited in pursuance of the provisions of the Factory and Workshop Act and the action taken in connection therewith. Table No. 14. Factories, Workshops, Laundries and Workplaces. Inspection.—Including Inspections made by Sanitary Inspectors. Premises. Number of Inspections. Written Notices. Prosecutions. (1) (2) (3) (4) Factories (including Factory laundries) 183 10 - Workshops (including Workshop laundries) 172 11 - Workshops (other than Outworkers' premises) 2 - - Total 357 21 — 29 Table No. 15.—Defects Found. Particulars. Number of Defects. Found. Remedied. Referred to H.M. Inspector. Number of Prosecutions. (1) (2) (3) (4) (5) Nuisances under the Public Health Acts:— Want of Cleanliness 2 2 - - Want of Ventilation 1 1 - - Overcrowding — — - - Want of drainage of floors 1 1 - - Other Nuisances 17 17 - - Sanitary accommodation—. Insufficient0 4 4 - - Unsuitable or defective 8 7 - - Not separate for Sexes 1 1 - - Unscreened for Sexes 4 4 — - 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) 22 22 - - Other offences (Excluding offences relating to outwork) - - - - Total 60 59 — - Table No. 16.—Registered Factories, Workshops and Outworkers. On the Register (s. 131) at the end of the year. Number. (1) (2) Factories 332 Factories, Laundries 38 Workshops, Laundries 22 Domestic Laundries 6 Bakehouses 61 Dressmakers 40 Outworkers 478 Blouse Makers 2 Tailors 40 Bootmakers 46 Metalworkers 23 Wood Workers 19 Seamstresses 1 Motor and Cycle Makers 23 Upholsterers 9 Milliners 17 Miscellaneous 133 Total number on Register 1,290 Table No. 17.—Other Matters. Class. Number. (1) (2) Matters notified to H.M. Inspector of Factories:— Failure to affix Abstract of the Factory and Workshop Act (s. 133) — Action taken in matters referred by H.M. Inspector as remediable under the Public Health Acts, but not under the Factory and Workshop Act (s. 5):— Notified by H.M. Inspector 19 Reports (of action taken) sent to H.M. Inspector 18 Other — Underground Bakehouse (s. 101):— Certificates granted during the year — In use at the end of the year 17 30 THE THIRTIETH ANNUAL REPORT for the Year ending 31st December, 1937, on the HEALTH OF CHILDREN ATTENDING THE PUBLIC ELEMENTARY SCHOOLS IN WILLESDEN. Giving the Tables required by the Board of Education. Table No. 18.—Corresponding to Table 1 of the Board of Education's Medical Statistical Tables. Return of Medical Inspections for the year ended 31st December, 1937:— A.—Routine Medical Inspections. Number of Inspections in the prescribed Groups — Entrants 2,103 Second Age Group 2,268 Third Age Group 1,770 Total 6,141 Number of other Routine Inspections 0 Grand Total 6,141 B.—Other Inspections. Number of Special Inspections 7,486 Number of Re-inspections 14,971 Total 22,457 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). Group. For defective Vision (excluding squint). For all other conditions recorded in Table IIA. Total.* (1) (2) (3) (4) Entrants 19 459 438 Second Age Group 167 272 411 Third Age Group 144 195 315 Total (Prescribed Groups) 330 926 1,164 Other Routine Inspections 0 0 0 Grand Total 330 926 1,164 *Note.—No individual child is counted more than once in any column of this table. A child suffering from defective vision and from adenoids appears once in column (2), once in column (3), and once only in column (4). A child suffering from two defects other than defective vision appears once only in column (3) and once only in column (4). 31 Table No. 19.—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, 1937. 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 - - 3 - (2) „ Body — — 11 - (3) Scabies 14 — 150 - (4) Impetigo 6 — 206 - (5) Other Diseases (non-tuberculous) 48 2 1,105 - Total (Heads 1 to 5) 68 2 1,475 - Eye (6) Blepharitis 14 1 55 - (7) Conjunctivitis 5 - 77 - (8) Keratitis — — — - (9) Corneal Opacities 1 — — - (10) Other Conditions (excluding Defective Vision and Squint) 17 1 90 - Total (Heads 6 to 10) 37 2 222 - (11) Defective Vision (excluding Squint) 330 47 200 - (12) Squint 21 — 70 - Spectacles broken — — 209 - Spectacles lost - - 29 - Ear (13) Defective Hearing 14 3 12 - (14) Otitis Media 3 - 146 - (15) Other Ear Diseases 16 2 133 - Nose and Throat (16) Chronic Tonsillitis only 314 165 125 - (17) Adenoids only 53 6 12 - (18) Chronic Tonsillitis and Adenoids 106 1 379 - (19) Other Conditions 56 13 446 2 (20) Enlarged Cervical Glands (non-tuberculous) 30 3 111 — (21) Defective Speech 4 1 2 — Heart Disease:— Heart and Circulation (22) Organic - 2 3 - (23) Functional 2 160 9 - (24) Anæmia 4 2 8 - Lungs J '(25) Bronchitis ... 23 2 55 - 1_(26) Other Non-Tuberculous Diseases 1 3 17 — Pulmonary:— Tubercul'sis (27) Definite - - - - (28) Suspected — — 1 — Non-Pulmonary:— (29) Glands - - - - (30) Bones and Joints ... - - - - (31) Skin - - - - (32) Other Forms - - - - Suspected—Glands — - 1 — ,, Bones and Joints - - - - „ Other Forms — — — — Total (Heads 29 to 32) — — 1 — Nervous System (33) Epilepsy - - 1 - (34) Chorea - - 6 - (35) Other Conditions 5 2 1 - Deformities (36) Rickets - - - - (37) Spinal Curvature 42 17 22 — (38) Other Forms 132 36 100 — (39) Other Defects and Diseases (excluding Defects of Nutrition, Uncleanliness and Dental Diseases) 145 52 2,392 — Total Number of Defects 1,406 521 6,187 2 32 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 2,103 98 4.7 1,889 89.8 108 5.1 8 0.4 Second Age-group 2,268 173 7.6 1,950 86.0 143 6.3 2 0.1 Third Age-group 1,770 158 8.9 1,538 86.0 73 4.1 1 0.1 Other Routine Inspections - - - - - - — — — Total 6,141 429 7.0 5,377 87.5 324 5.3 11 0.2 Table corresponding to Table III of the Board of Education's Medical Statistical Tables.— Return of all Exceptional Children in the Area—vide the Fourth Annual Report on the Work in CONNECTION WITH ABNORMAL CHILDREN, page 40. Table No. 20.—Corresponding to Table IV. of the Board of Education's Medical Statistical Tables. Return of Defects Treated during the Year ended 31st December, 1937. 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 5 — 5 (ii) Other Treatment — — — Ringworm—Body 15 1 16 Scabies 162 9 171 Impetigo 373 19 392 Other Skin Diseases 2,591 41 2,632 Minor Eye Defects (external and other, but excluding cases falling in Group II) 304 8 312 Minor Ear Defects 350 33 383 Miscellaneous (e.g., Minor Injuries, Bruises, Sores, Chilblains, etc.) 3,715 246 3,961 Total 7,515 357 7,872 33 Group II.—Defective Vision and Squint (excluding Minor Eye Defects Treated as Minor Ailments—Group I). TABLE A. Number of Defects Dealt with Under the Authority's Scheme. Otherwise. Total. (1) (2) (3) ##] Errors of Refraction (including squint) (operations for squint should be recorded separately in the body of the School Medical Officer's Report). 721 66 787 Other defect or disease of the eyes (excluding those recorded in Group I) 1 — 1 Total 722 66 788 Under the Authority's Scheme. Otherwise. Total. No. of children for whom spectacles were— (a) Prescribed 589 64 653 (b) Obtained 390 179 569 In the above table the figures of 721 and 66 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. Number of Defects Dealt with Under the Authority's Scheme. Otherwise. Total. (1) (2) (3) (4) Errors of Refraction (including squint) 2,162 93 2,255 Other defect or disease of the eyes (excluding those recorded in Group I) 1 — 1 Total 2,163 93 2,256 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) 632 1,176 9 17 434 7 77 544 (i) Tonsils only, (ii) Adenoids only, (iii) Tonsils and adenoids, (iv) Other defects of the nose and throat. 34 Group IV.—Orthopædic and Postural Defects. Under the Authority's Scheme. Otherwise. Total* number treated. Residential treatment with education. Residential treatment without education. Nonresidential treatment at an orthopædic clinic. Residential treatment with education. Residential treatment without education. Nonresidential treatment at an orthopædic clinic. (i) (ii) (iii) (i) (ii) (iii) No. of children treated 21 ordinary elementary school children 0 406 0 0 5 411 *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 20th Annual Report on Dental Work in connection with school children, expectant and nursing mothers and children under 5 years, herewith, page 54. Group VI.—Uncleanliness and Verminous Conditions. (i.) Average number of visits per school made during the year by the School Nurses 19 (ii.) Total number of examinations of children in the schools by School Nurses 55,452 (iii.) Number of individual children found unclean at the School Cleanliness Inspections 1,938* (iv.) Number of individual children cleansed under Section 87 (2) and (3) of the Education Act, 1921 1951† (v.) Number of cases in which legal proceedings were taken:— (a) Under the Education Act, 1921 13 (b) Under the School Attendance Bye-laws 0 (vi.) Number of school sessions at which inspections were conducted 634 (vii.) (i.) Original Inspections:— Children examined (i.e., cases not individual children) 46,235 Found unclean 2,635 Percentage found unclean 5.7 Excluded on account of uncleanliness — (ii.) Re-inspections:— Children examined (i.e., cases not individual children) 9,217 Found unclean 6,571 Percentage found unclean 71-3 Excluded on account of uncleanliness 2 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 = 2,064. † The total number of individual children cleansed = 357. Record of cases in which legal proceedings were taken:— The following information has been supplied by the Director of Education to whom cases for prosecution are referred. Cases Under Section 87 of the Education Act, 1921. No. of Cases. Fined. Amount of Fine. Bound over. Dismissed. Standing adjourned at end of Year. 2 3/6 0 0 0 7 5/- 4 10/- 35 CERTAIN STATISTICAL DATA. I.—GENERAL. Public Elementary Schools—excluding Special Schools and Nursery Classes. Number of Public Elementary Schools, excluding two Special Schools, at December, 1937 33 Number of School Departments at December, 1937 68 Average Public Elementary School Roll, excluding two Special Schools, year ended 31st March, 1937 19,251 Total number of children medically inspected at Routine and Special Inspections 13,627 Total number of children dentally inspected 16,074 Total number of Defects of every description "followed up" during 1937 24,421 Total number of Defects of every description for which treatment was obtained during 1937:— Medical or Dental Treatment 14,810 Domestic Treatment 3,310 Total 18,120 Total number of Attendances at the School Clinics during 1937 97,669 Table No. 21. Return showing No. of School Cases referred for following-up in 1937 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. 1937 4,188 670 76 8,710 13,644 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 36 Table No. 22.—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 1937. 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. Improved. Unchanged Under observation atend of year(result of treatment not known). School Clinic, Hospital or other Institution under Council Scheme. VoluntaryHos pital or other Charitable Institutions. Hospital or Doctor under M.C.C. Private Practitioner. Total. Domestic Treatment only. Grand Total. Remedied. ' Excluding Domestic Treatment. Including Domestic Treatment. Removed from observa tion. Remaimn, under - observa tion. s Total. Brought forward from previous year. New. Total. l 2 3 4 5 6 7 8 9 10 11 13 13 14 15 16 17 18 19 20 21 22 23 Clothing- Unsatisfactory 1 6 7 - - - - - - - 7 7 7 - - - - - - - - - Footgear— Unsatisfactory - - - - - - - - - - - - - - - - - - - - - - Cleanliness of Head— Nits 235 2,345 2,580 — — 65 — — — 65 2,242 2,307 2,307 — — — 2.5 89.0 13 260 273 260 Pediculi 2 256 258 — — 248 — — — 248 9 257 257 — — - 96.0 100.0 — 1 1 1 Other dirty conditions 7 3 10 — — 2 — — — 2 8 10 10 — — — 20.0 100.0 — — — — Cleanliness of Body- Dirty 2 4 6 - - - - - - - 5 5 5 — — - — 83.0 1 — 1 — Pediculi — — — — — — — — — — — — — — — — — — — — — — Flea-bitten — 1 1 - - - - - - - 1 1 1 — — — — 100.0 — — — — Malnutrition 85 62 147 - 4 110 3 1 - 114 11 125 39 9 4 73 80.0 87.0 9 9 18 82 Nose and Throat— Enlarged Tonsils 245 442 687 — 41 58 24 — — 82 — 82 66 — 3 13 13.0 13.0 297 267 564 280 Adenoids 45 49 94 — 9 20 4 1 — 25 — 25 18 2 — 5 29.0 29.0 28 32 60 37 Enlarged Tonsils and Adenoids 164 571 735 - 3 413 44 1 1 459 - 459 383 - 3 73 63.0 63.0 100 173 273 246 Other conditions 91 586 677 — 3 505 6 2 20 533 78 611 477 1 7 126 79.0 91.0 26 37 63 163 Cervical or Neck Glands— Enlarged (non T.B.) 143 201 344 — 12 129 6 1 13 149 29 178 139 — 1 38 45.0 54.0 52 102 154 140 External Eye Disease— Blepharitis 36 80 116 — 1 90 2 — 2 94 11 105 76 — — 29 82.0 91.0 1 9 10 38 Conjunctivits 5 91 96 — — 88 1 — 1 90 4 94 87 — — 7 94.0 98.0 — 2 2 9 Corneal Opacities — 3 3 — — 1 — — — 1 — 1 — — 1 — 33.0 33.0 2 — 2 — Keratitis 1 — 1 — — — — — — — — — — — — — — — 1 — 1 — Other conditions 20 132 152 — 3 126 1 - 1 128 16 144 121 — 2 21 86.0 97.0 — 5 5 26 Ear Diseases— Chronic Suppuration of Middle Ear 49 187 236 - 2 190 8 - 7 205 16 221 166 - 8 47 88.0 94.0 10 3 13 50 Defective Hearing 12 25 37 — 5 15 3 — — 18 — 18 5 4 2 7 56.0 56.0 8 6 14 13 Wax 2 73 75 — — 70 — — 1 71 1 72 67 — — 5 95.0 96.0 — 3 3 8 Other diseases 15 90 105 — 2 74 8 3 3 88 10 98 77 — 2 19 85.0 95.0 3 2 5 21 Heart and Circulation- Organic Disease 3 8 11 — 1 2 2 — — 4 — 4 — — — 4 40.0 40.0 3 3 6 7 Functional Disease 13 20 33 — 7 10 5 — 1 16 — 16 — 6 1 9 62.0 62.0 8 2 10 11 Anæmia 22 12 34 — — 20 1 — — 21 6 27 11 2 3 11 62.0 79.0 3 4 7 15 Other conditions 1 2 3 — — — 3 — — 3 — 3 — 2 — 1 100.0 100.0 — — — 1 Lungs— Bronchitis and Bronchial Catarrh 24 95 119 — 1 66 — — 19 85 23 108 89 1 1 17 72.0 92.0 2 8 10 25 Tuberculosis - - - - - - - - - - - - - - - - - - - - - - T.B. Suspected 4 6 10 — 2 2 3 — — 5 1 6 1 1 2 2 62.0 75.0 1 1 2 3 Other diseases (non T.B.) 11 26 37 — — 18 8 1 1 28 — 28 10 1 4 13 76.0 76.0 5 4 9 17 Nervous System- Epilepsy 1 1 2 — — — 1 — — 1 — 1 — — — 1 50.0 50.0 - 1 1 2 Chorea 5 10 15 — — 5 7 — 12 — 12 4 1 1 6 80.0 80.0 3 - 3 6 Other conditions 14 7 21 - 2 8 2 - 2 12 3 15 2 9 — 4 63.0 79.0 3 1 4 5 Skin- Ringworm—Head 1 3 4 — — 4 — — — 4 — 4 2 — — 2 100.0 100.0 — — — 2 ,, Body 4 14 18 — — 15 — — 1 16 1 17 15 — — 2 89.0 94.0 1 — 1 2 Impetigo 39 406 445 — — 373 6 1 12 392 47 439 389 — 2 48 88.0 99.0 4 2 6 50 Scabies 6 170 176 — — 162 5 — 4 171 5 176 162 — — 14 97.0 100.0 — — — 14 Minor injuries 38 555 593 — 2 550 6 — 4 560 30 590 555 — 2 33 95.0 99.0 1 — 1 33 Other conds. (non T.B.) 346 2,550 2,896 — 5 2,591 23 — 18 2,632 212 2,844 2,551 1 9 283 91.0 99.0 21 26 47 309 Deformities- Rickets 2 1 3 — 1 - - - - - - - - - - - - - 1 1 2 1 Spinal Curvature 80 104 184 — 12 117 5 — — 122 — 122 20 17 19 66 71. 71. 32 18 50 84 Other forms 129 233 362 — 21 232 1 — 1 234 — 234 64 24 28 118 69.0 69.0 77 30 107 148 Tuberculosis Non-Pulmonary— Definite—Glands - - - - - - - - - - - - - - - - - - - - - - „ Spine - - - - - - - - - - - - - - - - - - - - - - „ Hip - - - - - - - - - - - - - - - - - - - - - - ,, Bones and Joints - - - - - - - - - - - - - - - - - - - - - - ,, Skin - - - - - - - - - - - - - - - - - - - - - - Other forms - - - - - - - - - - - - - - - - - - - - - - Suspected Glands 1 1 2 - — 1 — — - 1 - 1 - - - 1 50.0 50.0 1 — 1 1 ,, Bones & Joints - - - - - - - - - - - - - - - - - - - - - - ,, Other conditions 1 1 2 — 1 - - - - - - - - - - - - - 1 - 1 - Speech— Defective Articulation 6 8 14 — 1 1 1 — 2 — 2 — — 2 — 15.0 15.0 5 6 11 6 Squint— Squint present 22 113 135 — 7 99 8 — 2 109 — 109 10 53 30 16 85.0 85.0 9 10 19 26 Vision- Defect not ascertained 19 72 91 - 21 42 2 - 2 46 - 46 38 1 4 3 66.0 66.0 13 11 24 14 One eye normal 8 44 52 - 9 24 4 — 2 30 - 30 27 - 1 2 70.0 70.0 6 7 13 9 Both eyes 6/6 2 48 50 - 39 9 — — - 9 - 9 6 - - 3 82.0 82.0 2 — 2 3 Both eyes 6/9 10 69 79 — 34 28 — — — 28 — 28 19 — 1 8 62.0 62.0 3 14 17 22 One eye 6/9, other 6/12 or less 40 151 191 29 97 8 - 3 108 - 108 85 - 3 20 67.0 67.0 24 30 54 50 Both eyes 6/12 or less 91 266 357 — 17 230 16 — 6 252 — 252 191 2 5 54 74.0 74.0 45 43 88 97 Spectacles broken 22 233 255 - 0 318 3 1 8 230 2 232 221 - - 11 90.0 91.0 13 10 23 21 Spectacles lost 5 32 37 - 1 28 - - - 28 - 28 26 - - 2 78.0 78.0 2 6 8 8 Debility 512 721 1,233 2 3 1,030 7 6 1,043 124 1,167 627 4 25 511 85.0 95.0 33 28 61 539 Miscellaneous 421 2,702 3,123 2 652 1,782 74 8 85 1,949 408 2,357 1,895 9 27 426 79.0 95.0 54 58 112 484 Grand Totals 3,063 13,891 16,954 4 953 9,968 311 20 226 10,525 3,310 13,835 11,328 150 203 2,154 66.0 86.0 927 1,235 2,162 3,389 Re-examinations in respect of Defective Vision, other than Lost and Broken Spectacles, and in respect of other conditions— No. of cases dealt with 1,630. 37 II.—HEALTH CENTRES. ATTENDANCES. Table No. 23. Medical and Dental Treatment—Attendances at Health Centres, 1937. Condition. Mothers, and Children under Five. School Children. Grand Total (Cols. 7 and 8). Expectant Mothers. Nursing Mothers. Children under Five. Total (Cols. 2—5). 0—1. 1—5. Total (Cols. 4 and 5) (1) (2) (3) (4) (5) (6) (7) (8) (9) 1. Cleansing - - - 3 3 3 401 404 2. Throat, Nose and Ear Diseases 1 5 105 1,319 1,424 1,430 10,118 11,548 3. Minor Ailments 71 151 1,405 3,803 5,208 5,430 42,514 47,944 4, Eye Diseases 14 17 266 561 827 858 5,315 6,173 5. Skin Diseases 119 50 241 213 454 623 669 1,292 6. Artificial Sunlight Treatment — — 628 3,325 3,953 3,953 5,467 9,420 7. Orthopædics 2 41 577 2,326 2,903 2,946 6,419 9,365 8. Medical Consultations 13,272 31,002 31,807 16,609 48,416 92,690 — 92,690 9. Diphtheria Immunisation — — 34 748 782 782 718 1,500 10. Total (1—9) 13,479 31,266 35,063 28,907 63,970 108,715 71,621 180,336 11. Dental Consultations 2,375 1,734 — 1,034 1,034 5,143 11,250 16,393 12. Total (10—11) 15,854 33,000 35,063 29,941 65,004 113,858 82,871 196,729 13. School for Mothers — — — — — 4,257 - 4,257 14. Nursery — — — — — 4,092 — 4,092 15. Miscellaneous — — — — — 23,279 15,516 38,795 10. Grand Total (12—15) 15,854 33,000 35,063 29,941 65,004 145,486 98,387 243,873* Health Centre (1) Health Centre (2) Health Centre (3) Grand Total. Mothers and Children under Five. School Children Total. Mothers and Children under Five School Children Total Mothers and Children under Five. School Children Total. (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) 17. Medical Attendances 17,781 18,509 36,290 47,463 18,559 66,022 43,471 34,553 78,024 180,336 18. Dental Attendances 1,055 1,859 2,914 1,702 3,416 5,118 2,386 5,975 8,361 16,393 19. School for Mothers 1,290 - 1,290 1,236 - 1,236 1,731 — 1,731 4,257 20. Nursery Attendances 2,203 — 2,203 747 - 747 1,142 — 1,142 4,092 21. Miscellaneous 9,331 4,477 13,808 7,529 6,493 14,022 6,419 4,546 10,965 38,795 22. Total 31,660 24,845 56,505 58,677 28,468 87,145 55,149 45,074 100,223 243,873* *In addition 2,359 attendances were made by secondary and technical school children and the following attendances by adults:—Cleansing 102, Skin Diseases 17, Diphtheria Immunisation 21, Varicose Ulcers 875, making a total of 3,374 which together with the 243,873 above makes a grand total of 247,247. 38 Table No. 24. 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 1937 108,715 5,143 113,858 71,621 11,250 82,871 196,729 4,257 4,092 42,169* 247,247 * This includes the 2,359 attendances made by Secondary and Technical School children and the 1,015 by adults which are shown in the footnote to Table No. 23. 5 School Children and 1 child under 5 years of age were treated under the Council's Scheme by X-rays for Ringworm of the Scalp. 9,166 Individual Public Elementary School Children attended the Municipal Centres during 1937. 6,267 ,, Children under 5 years of age attended the Municipal Centres during 1937. 2,376 ,, Expectant Mothers ,, ,, ,, ,, 3,261 „ Nursing Mothers „ ,, ,, ,, „ ,, III. HOSPITAL TREATMENT OF CHILDREN UNDER THE COUNCIL'S SCHEME. Excluding Orthopaedic Treatment which is dealt with in Appendix E and excluding cases of Infectious Disease. A.—SCHOOL CHILDREN. Table No. 25. No. of School Children in Willesden Municipal Hospital at 31st December, 1936 0 „ „ „ admitted during 1937 480 „ „ „ under treatment during 1937 480 „ „ „ discharged during 1937 480 „ „ „ died in Hospital during 1937 0 ,, ,, ,, remaining in Hospital at 31st December, 1937 0 39 Table No. 26. School Children under Treatment in Hospital during 1937. 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 or Unchanged. Died. Deflected Septum - - - - - - - - - Enlarged Tonsils & Adenoids - 458 458 458 — 458 - — — Mastoid - 14 14 14 — 14 - — — Antrum Puncture - 7* 7* 6* 1 7* - — — Plastic operation on ear - 1 1 1 — 1 - — — Total — 480 480 479 1 480 — — — * 1 also enlarged tonsils, 1 also adenoids. B.— CHILDREN UNDER 5 YEARS OF AGE. Table No. 27. Willesden Municipal Hospital. Children's Hospital, Cold Ash. Noel Convalescent Home, Letchworth. Total. No. of Children in Hospital at 31st December, 1930 4 0 0 4 No. of Children admitted during 1937 174 3 1 178 Total number of Children under treatment during 1937 178 3 1 182 No. of Children discharged during 1937 159 3 1 163 No. of Children died in Hospital during 1937 9 0 0 9 No. of Children remaining in Hospital at 31st December, 1937 10 0 0 10 Table No. 28. Children under 5 Years under Treatment in Hospital during 1937. 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 or Unchanged. Died. Marasmus 4 52 56 — 56 15 24 9 8 Enlarged Tonsils and Adenoids 0 123 123 123 — 121 — - 2 Mastoid Disease 0 3 3 3 — — — — — Total 4 178 182 126 56 136 24 9 10 IV.—EMPLOYMENT OF CHILDREN IN ENTERTAINMENTS RULES, 1933. Particulars as to applications received in 1937 for certificates from the School Medical Officer. No. of Applications. No. Granted. Boys. Girls. Total. Boys. Girls. Total Original applications 3 18 21 3 18 21 Applications for renewals — 2 2 — 2 2 3 20 23 3 20 23 40 THE FOURTH ANNUAL REPORT for the Year ending 31st December, 1937, 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 1937, 1,071 special children were examined or re-examined. Of the 333 original examinations included in the 1,071 examined, 46 were found to be physically defective, 14 mentally defective, 2 partially blind, 25 dull and backward, 205 anaemic and debilitated, 19 defective speech, 3 deaf or partially deaf, 11 normal, and 8 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 120. The actual number on the roll at the 31st December, 1937, was 112 (including 28 children from the Middlesex area). The average attendance for the year was 104. 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. Eleven children were allowed to leave school before reaching the age of 16 years and 12 children were notified to the Middlesex County Council, which is the local authority under the Mental Deficiency Acts, 1913-27, as requiring supervision or guardianship. The Certifying Medical Officer visits the school weekly for the purpose of revision of classification and for medical examination of the children. 109 such examinations were made during 1937. The school dinners are brought from Furness Road Feeding Centre and served in the school hall. On an average 75 children take the school dinners and the remainder bring their own meal. During the year routine medical and dental inspection of the children attending this school was carried out. 96 children were medically examined and 91 were dentally inspected. Five were 41 found to require medical treatment and 52 were found to require dental treatment, and the following table gives a return of the defects found at medical and dental inspection:— Table No. 29. Defects. Found to require treatment. Requiring to be kept under observation but not requiring treatment. Anæmia - - Malnutrition - — Skin Disease - — Eye—Blepharitis 1 — Defective vision (excluding squint) - — Squint - — Other conditions - — Ear— Defective hearing - — Other ear diseases - — Nose and Throat- -Enlarged tonsils only - — Adenoids only 1 — Enlarged tonsils and adenoids 1 — Enlarged cervical glands (non-tuberculous) - — Defective speech - — Defective Teeth 52 — Heart and Circulation— Heart disease, functional — — Anæmia — — Lungs— Bronchiti' — — Other non-tuberculous diseases — — Deformities— Spinal curvature — — Other forms 1 — Other defects and diseases 2 — Total 58 - 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 170, the actual number on the roll on the 31st December, 1937, being 161 (including 22 children from the Middlesex area). The average attendance for the year was 139. There were no children awaiting admission at the 31st December, 1937. 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, 12 children were allowed to attend ordinary elementary schools, 1 child was recommended for transfer to a residential institution for epileptics, and 1 child, who was also mentally defective, was notified to the Middlesex County Council under the Mental Deficiency Acts, 1913-27. The school dinners are brought from Gibbons Road Feeding Centre and are served in the School Hall. On an average 102 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 weekly 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 66 boys and 29 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 46 boys and 71 girls were admitted during the year. 42 Defective Vision and Squint.—During the year 1937, 15 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 15 children. Eight obtained them under the Authority's scheme, and 4 otherwise. Defects of Nose and Throat.—During the year 5 children attending Special Schools received operative treatment under the Authority's scheme, and 1 received operative treatment apart from the Authority's scheme. Four children received other forms of treatment. Orthopaedic and Postural Defects.—During the year 39 children attending the Special Schools were treated; 3 of these received residential treatment with education, under Section 80 of the Education Act, 1921, and 39 non-residential treatment at an orthopaedic clinic under the Authority's scheme. In addition 8 children received residential treatment with education under the Special Schools vote. Following-up.—During the year there were 170 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, 1937.— 153 new cases were referred to this Association during the year, 33 of these being referred by the Willesden Health Department. The majority of the patients were suffering from anaemia and debility. In addition 1 surgical appliance was 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 a qualified teacher. 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. 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 twelvemonths. At the end of the first twelvemonths 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. Table No. 30.—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 are 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 thev 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 4 At Certified Schools for the Partially Sighted 10 At Public Elementary Schools 1 At other Institutions — At no School or Institution — Total 15 43 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 16 At Public Elementary Schools — At other Institutions — At no School or Institution 1 Total 17 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 3 At Certified Schools for the Partially Deaf 4 At Public Elementary Schools — At other Institutions — At no School or Institution — Total 7 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 31, page 45. At Certified Schools for Mentally Defective Children 87 At Public Elementary Schools — At other Institutions 1 At no School or Institution — Total 88 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 of Education are of opinion that children who are subject to attacks of major epilepsy in school should be recorded as "severe" cases and excluded from ordinary Public Elementary Schools. At Certified Special Schools 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 Schools — At other Institutions 2 At no School or Institution — Total 2 (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 8 At Public Elementary Schools † — At other Institutions 1 At no School or Institution — Total 9 † 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. 44 (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 82 At Public Elementary Schools 387* At other Institutions — At no School or Institution — Total 469 *Total number of children referred during the year for convalescent treatment. (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 68 At Public Elementary Schools At other Institutions — At no School or Institution Total 68 (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 46 At Public Elementary Schools — At other Institutions — At no School or Institution — Total 46 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 1 — — — 1 Heart Disease and Feeble-minded 2 — — — 2 Severe Epilepsy and Feeble-minded 1 — — — 1 Deaf and Feeble-minded - - - 1 1 45 Table No. 31. Statement of the Number of Children Notified during the Year ended December 31st, 1937, by the Local Education Authority to the Local Mental Deficiency Authority. Total Number of Children notified : 21. Analysis of the above Total. Diagnosis. Boys. Girls. 1.—(i.) Children incapable of receiving benefit or further benefit from instruction in a Special School: (a) Idiots — — (b) Imbeciles 1 1 (c) Others 3 — (ii.) Children unable to be instructed in a Special School without detriment to the interests of other children: (a) Moral defectives — — (b) Others — — 2.—Feeble-minded children notified on leaving a Special School on or before attaining the age of 16 8 8 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 12 9 Special (Day) Schools in Willesden. Number of Physically Defective Schools 1 Number of Mentally Defective Schools 1 Table No. 32. Number of children attending certified Special (Day and Residential) Schools during 1937:— Special Schools in Willesden. Special Schools outside Willesden. Total. Blind and Partially Blind - 23 23 Deaf — 26 26 Mentally Defective 141** 7 151 Epileptic — 5 5 Physically Defective 214† 276* 490* Total 358 337* 695* *237 of these were debilitated children sent to Certified Residential Schools for six weeks' convalescence. ** 29 of these children lived in the Middlesex area and attended the school by arrangement with the Middlesex Education Committee. † 17 do. do. do. do. 46 Table No. 33. 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). Brought forward from previous New. Total. School Clinic, Hospital or other Institutions under Council Scheme. VoluntaryHos pitals or other Charita ble 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. 1 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 3 8 11 — — 3 — — — 3 7 10 8 — — 2 27.0 91.0 — 1 1 3 Pediculi — 3 3 — — 1 — — — 1 2 3 3 — — — 330 100.0 — — — — Nose and Throat— Enlarged Tonsils 1 3 4 — — 1 — — — 1 — 1 1 — — — 25.0 25.0 2 1 3 1 Enlarged Tonsils and Adenoids — 5 5 — — 4 — — — 4 — 4 3 — — 1 80.0 80.0 — 1 1 2 Other Conditions 2 4 6 — — 5 — — — 5 1 6 4 — — 2 83.0 100.0 — — — 2 Cervical or Neck Glands— Enlarged (Non T.B.) 1 — 1 — — — — — — — — — — — — — — — 1 — 1 — External Eye Disease— Blepharitis 1 — 1 — — — — — — — — — — — — — — — 1 — 1 — Conjunctivitis — 1 1 — — 1 — — — 1 — 1 1 — — — 100.0 100.0 — — — — Ear Diseases- Chronic Suppuration of Middle Ear 2 10 12 10 2 12 12 9 2 1 100-0 100-0 1 Defective Hearing 1 1 1 1 1 1 100-0 100-0 1 Wax 1 1 2 2 2 . 2 2 100-0 100-0 Other Diseases 2 — 2 — — 2 — — — 2 2 1 — — 1 100-0 100-0 — — 1 Heart and Circulation— Organic Disease 2 3 5 — — — — — — — — — — — — — — — 4 1 5 1 Functional Disease 1 — 1 — — — — — — — — — — — — — — — — 1 1 1 Lungs— Bronchitis and Bronchial Catarrh — — — — — — — — — — — — — — — — — — — — — — Other Diseases (nonT.B.) 2 — 2 — — 1 — — — 1 — 1 — — — 1 50.0 50.0 1 — 1 1 Tuberculosis—Definite — — — — — — — — — — — — — — — — — — — — — — ,, —Suspected — — — — — — — — — — — — — — — — — — — — — — Nervous System— Chorea — — — — — — — — — — — — — — — — — — — — — — Skin- Impetigo — 4 4 — — 3 — — — 3 1 4 2 — — 2 75.0 100.0 — — — 2 Scabies 1 5 6 — — 5 — — — 5 — 5 5 — — — 83.0 83.0 — 1 1 1 Minor Injuries — 2 2 — — 1 — — 1 2 — 2 1 — — 1 100.0 100.0 — — — 1 OtherConditions(nonT. B.) 7 22 29 — — 27 — — 1 28 1 29 25 — — 4 97.0 100.0 — — — 4 Deformities— Spinal Curvature 3 5 8 — — 6 — — — 6 — 6 1 1 1 3 75.0 75.0 1 1 2 4 Other Forms 12 13 25 — — 21 1 — — 22 — 22 5 3 — 14 88.0 88.0 3 — 3 14 Tuberculosis— Non-Pulmonary— Definite Spine — — — — — — — — — — — — — — — — — — — — — — Bones and Joints 1 — 1 — — — — — — — — — — — — — — — 1 — 1 — Squint- Squint Present — 1 1 — — 1 — — — 1 — 1 — 1 — — 100.0 100.0 — — — — Vision— Defect not ascertained 1 — 1 — — 1 — — — 1 — 1 — — — 1 100.0 100.0 — — — 1 Both eyes 6/6 — — — — — — — — — — — — — — — — — — — — — — ,, 6/9 — 4 4 — 3 1 — — — 1 — 1 — — — 1 100.0 100.0 — — — 1 One eye 6/9, other 6/12 or less — 2 2 — — 2 — — — 2 — — 2 — — — 100.0 100.0 — — — Both eyes 6/12 or less 1 2 3 — — 3 — — — 3 — — 2 — — 1 100.0 100.0 — — — 1 Spectacles Broken — 2 2 — — 2 — — — 2 — 2 2 — — — 100.0 100.0 — — — — Spectacles Lost — — — — — — — — — — — — — — — — — — — — — — Debility 7 7 14 — — 13 — — — 13 1 14 6 — — 8 93.0 100.0 — — — 8 Miscellaneous 2 62 64 — 30 24 2 1 — 27 2 29 22 — — 7 79.0 85.0 5 — 5 7 Grand Totals 53 170 223 — 33 141 5 1 2 149 15 164 105 5 3 51 78.0 86.0 19 7 26 58 Re-examinations in respect of Defective Vision, other than Lost and Broken Spectacles, and in respect of other Conditions. No. of cases dealt with 87. 47 Table No. 34.—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 51 55 50 35 2. Number who :— (a) Have since died 1 2 2 1 (b) Are known to be incapable by reason of mental or physical defect of undertaking employment 6 4 1 3 (c) Are in attendance at an Institution for further education (give details), and †1 ††2 §1 §2 (d) Are in any other Institution (specify Asylum, Workhouse, Colony for Epileptics, etc.) – – *11 *7 3. Number who are employed in :— (a) Industrial or manual occupations 18 21 20 8 (b) Agricultural or rural occupations — — — — (c) Domestic occupations including those who are helping in the domestic work at home — 6 — 11 (d) Commercial, professional, or clerical work 5 4 — — (e) Blind alley or other precarious occupations 3 — 4 — 4. Number who have left the neighbourhood or whose after-careers have not been traced 17 16 11 3 * In institutions for mental defectives. †Attending Cripples' Training College. § In attendance at an occupation centre. †† Attending Pitman's College. ** In hospital. Dental Defects. Vide, 20th Annual Report on Dental Work in connection with School Children, Expectant and Nursing Mothers, and children under 5 years, page 54. 48 THE SEVENTH ANNUAL REPORT on NURSERY CLASSES for the Year ending 31st December, 1937. At the end of 1937 there were 12 Nursery Classes at 11 Public Elementary Schools. During the year, 218 children were examined and the following table shows the numbers and percentages of defects found :— Table No. 35. Age Period. 2 years. 3 years. 4 years. 5 years. Total. Percentage. Number of children inspected 2 75 135 6 218 Malnutrition (including slight degrees) — 8 14 — 22 10.0 Skin's conditions — 3 13 — 16 7.3 Eyes—Blepharitis and Conjunctivitis — — — — — 2.3 Squint — 1 2 1 4 Other conditions — — 1 — 1 Ears, Otitis Media — 4 4 — 8 3.7 Nose and Throat—Enlarged tonsils or adenoids or both 2 21 36 — 59 27.1 Enlarged cervical glands — 5 16 — 21 9.6 Teeth—Dental diseases — 8 31 2 41 18.8 Heart and circulation (including anaemia) — 3 9 1 13 5.9 Lung Disease (non-tubercular) — 8 7 1 16 7.3 Nervous system (including functional conditions) 6 6 — 12 5.5 Deformities—Rickets — — 2 — 2 .9 Others 1 11 13 1 26 11.9 Other defects — 8 11 — 19 8.7 Twenty-five children were found nitty or verminous at the school cleanliness inspections. During the year children attending the Nursery Classes were followed up in respect of 252 defects. 49 THE EIGHTEENTH ANNUAL REPORT for the Year ending 31st December, 1937, on the HEALTH OF PUPILS ATTENDING SECONDARY AND JUNIOR TECHNICAL, ETC., 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. 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 Junior Technical, etc., 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. Table No. 36.—Corresponding to Table I. of the Board of Education's Medical Statistical Tables. Return of Medical Inspections for the Year ended 31st December, 1937. A.—Routine Medical Inspections. Number of Inspections in the prescribed Groups.* Pupils examined. Aged. Secondary Schools. Junior Technical, etc., Schools. Total. Boys. Girls. Total. Boys. Girls. Total. Boys. Girls. Total. 10 years 7 1 8 — — — 7 1 8 11 ,, 96 117 213 — — — 96 117 213 12 „ 125 219 344 1 9 10 126 228 354 13 „ 4 24 28 89 33 122 93 57 150 14 „ — — — 85 64 149 85 64 149 15 „ 129 175 304 165 172 337 294 347 641 16 „ — — — 1 — 1 1 — 1 17 „ — — — — — — — — — Total 361 536 897 341 278 619 702 814 1,516 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, is counted twice, that is as 2 cases. * During 1937 the following groups have been submitted to Routine Medical Inspection at the Secondary and Junior Technical, etc., Schools in Willesden :— (a) All entrants. (6) Pupils aged 12 years. (c) Pupils aged 15 years. B.—Other Inspections. Secondary Schools. Junior Technical, etc., Schools. Total. Boys. Girls. Total. Boys. Girls. Total. Boys. Girls. Total. Number of Special Inspections 7 4 11 7 13 20 14 17 31 Number of Re-inspections 106 173 279 99 147 246 205 320 525 Total 113 177 290 106 160 266 219 337 556 50 Table No. 37.—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, 1937. 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) Secondary Schools. Junior Technical, etc., Schools. Total. Secondary Schools. Junior Technical, etc., Schools. Total. Secondary Schools. Junior Technical, etc., Schools. Total. Secondary Schools. Junior Technical, etc., Schools. Total. Skin (1) Ringworm—Scalp – — — — — — — — — — — — (2) „ Body — — — — — — — — — — — — (3) Scabies — — — — — — — — — — — — (4) Impetigo — — — — — — — — — — — — (5) Other Diseases (NonTuberculous) 3 6 9 — — — 1 — 1 — — — Total (Heads 1 to 5) 3 6 9 — — — 1 — 1 — — — Eye (6) Blepharitis 1 3 4 — — — — — — — — — (7) Conjunctivitis — 1 1 — — — — — — — — — (8) Keratitis — — — — — — — — — — — — (9) Corneal Opacities — — — — — — — — — — — — (10) Other conditions (excluding Defective Vision and Squint) — — — — 3 3 1 — 1 — — — Total (Heads 6 to 10) 1 4 5 — 3 3 1 — 1 — — — (11) Defective Vision (excluding Squint) 58 82 140 7 13 20 1 3 4 — — — (12) Squint Ear (13) Defective Hearing — — — — 1 1 — — — — — — (14) Otitis Media 1 1 2 — — — — — — — — — (15) Other Ear Diseases — — — — — — — — — — — — Nose and Throat (16) Chronic Tonsillitis only 4 3 7 1 5 6 — — — — — — (17) Adenoids only — — — — — — — — — — — — (18) Chronic Tonsillitis and Adenoids — 1 1 — 1 1 — — — — — — (19) Other Conditions 1 2 3 — 3 3 — 1 1 — — — (20) Enlarged Cervical Glands (NonTuberculous) 1 — 1 — — — — — — — — — (21) Defective Speech — — — — — — — — — — — — Heart and Circulation Heart Disease :— (22) Organic — — — 2 3 5 — — — — — — (23) Functional — 3 3 4 6 10 — — — — 1 1 (24) Anaemia — — — 1 1 2 — — — — — — Lungs (25) Bronchitis — — — — — — — — — — — — (26) Other Non-Tuberculous Diseases 2 — 2 2 — 2 — — — — 1 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 1 — 1 — — — — — — — — — (34) Chorea — — — 1 — 1 — — — — — — (35) Other Conditions — — — — — — — — — — — — Deformities (36) Rickets — — — — — — — — — — — — (37) Spinal Curvature 13 11 24 — — — — — — — — — (38) Other Forms (e.g., Flatfoot) 32 15 47 8 10 18 1 — 1 — — — Postural Curvature (e.g.. Round Shoulders) 29 9 38 5 2 7 — 1 1 — 1 1 (39) Other Defects and Diseases (excluding Uncleanliness and Dental Diseases) 3 10 13 12 34 46 1 2 3 1 — 1 Grand Total 149 147 296 43 82 125 5 7 12 1 3 4 Dental Diseases 30 21 51 — — — — — — — — — 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). B (Normal). C (Slightly Sub-normal). d (Bad). No. % No. °/ /o No. % No. % Secondary Schools. Entrants (at any age) 480 36 7.5 434 90.4 10 2.1 — — Pupils aged 12 years 212 23 10.8 182 85.8 7 3.3 — — Pupils aged 15 years 205 17 8.3 180 87.8 8 3.9 — — Total 897 76 8.5 796 88.7 25 2.8 — — Junior Technical, etc., Schools. Entrants (at any age) 392 55 14.03 337 86.0 — — — — Pupils aged 12 years — — — — — — — — — Pupils aged 15 years 227 42 18.5 184 81.1 1 .4 — — Total 619 97 15.7 521 84.2 1 .2 — — Total Entrants (at any age) 872 91 10.4 771 88.4 10 1.1 — — Pupils aged 12 years 212 23 10.8 182 85.8 7 3.3 — — Pupils aged 15 years 432 59 13.7 364 84.3 9 2.1 — — Total 1,516 173 11.4 1,317 86.9 26 1.7 — — 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). Group. No. of pupils Percentage of Pupils found to require treatment. Inspected. Found to require treatment. Secondary Schools 897 146 16.3 Junior Technical, etc., Schools 619 132 21.3 Total 1,516 278 18.3 Table No. 38.—Corresponding to Table IV. of the Board of Education's Medical Statistical TablesReturn of Defects Treated during the Year ended 31st December, 1937. Treatment Tables. Group I.—Minor Ailments (excluding Uncleanliness, for which see Group VI.). Number of Defects Treated or Under Treatment During the Year. 5 defects were treated during the year :—4 were cases of Skin Disease other than Ringworm, Scabies or Impetigo and 1 was a minor ear defect. These cases received treatment from a private practitioner. 52 Group II.—Defective Vision and Squint (Excluding Minor Eye Defects Treated as Minor Ailments—Group I.). No. of Defects Dealt with. Secondary Schools. Junior Technical, etc., Schools. 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) 79 20 99 61 7 68 140 27 167 (Operations for Squint should be recorded separately in the body of the School Medical Officer's Report.) Other Defect or Disease of the Eyes (excluding those recorded in Group 1) – – – – – – – – – Total 79 20 99 61 7 68 140 27 167 No. of Children for whom Spectacles were :— (a) Prescribed 52 20 72 40 7 47 92 27 119 (b) Obtained 4 67 71 5 42 47 9 109 118 Group III.—Treatment of Defects of Nose and Throat. Secondary Schools.—In two instances the School Medical Inspector noted on re-inspection that the tonsils had been removed. Junior Technical, etc., Schools.—In one instance the School Medical Inspector noted on reinspection that the tonsils had been removed. Group IV.—Orthopaedic and Postural Defects. The Middlesex County Council has not arranged for orthopaedic work in connection with the Secondary Schools in Willesden but a few Secondary School children are dealt with by the Willesden Council under Section 181 (2) (a) of the Public Health Act, 1936. Group V.—Dental Defects. Vide, 20th Annual Report on Dental Work in connection with School children, Expectant and Nursing Mothers, and children under 5 years, herewith, page 54. Group VI.—Uncleanliness and Verminous Conditions. Inspection and treatment of uncleanliness are not undertaken by the School Nurses in the Secondary and Technical, etc., Schools. 53 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. 39. Defect. Secondary schools. Junior Technical etc., schools. Result. Heart Disease—Functional 5 4 Restricted exercises. — 1 Improved with restricted games. 6 — Under hospital treatment. — 1 Under treatment by private doctor. Nose and Throat—Nasal Obstruction 1 — Having breathing exercises. Enlarged Cervical Glands 1 — X-ray treatment at hospital. Deformities—Flat Foot 30 5 Having exercises. Flat Chest — 2 Having breathing exercises. Slack Back 3 — Having exercises. Round Shoulders 2 — Having exercises. Postural Defects 21 8 Having exercises. Talipes Pes cavus 1 — Under hospital treatment. Other Defects and Diseases 13 11 Under hospital treatment. 5 6 Under treatment by private doctor. 54 THE TWENTIETH ANNUAL REPORT for the YEAR 1937, 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. Extensions. The question of the supply of orthodontic appliances to elementary school children came under notice during the year. The Council, with the approval of the Board of Education, agreed to include such provision in the Authority's scheme for dental treatment, on condition that in each case the parents contribute towards the cost according to their means. Parents unable to pay the full cost of such appliances are required to complete the Council's Economic Enquiry form for the consideration and recommendation of the appropriate committee. The work of the Health Centres is in no way affected by this provision. Patients are still to be referred to a Dental Hospital or other recognised institutions for their orthodontic treatment. Improvements and Renovations. The dental surgery at Health Centre (1), which has been in constant use for twenty years, has been renovated to accommodate two dental chairs and additional equipment. The latest type Rathbone Unit, Model No. 1 and new Rathbone chair with rubber surround, occupy •one window space, where conservative dentistry only is done. The remaining window space is occupied by the other chair and is utilised for general anaesthetic sessions. These alterations have greatly improved the Dental surgery. The Year's Work. There has been no change in the staff, which includes four dental officers, four nurses and anaesthetist. The total working sessions amounted to 1,939, which were utilised as follows :— Treatment sessions at the Centre 1,590 Routine inspection sessions 325 Administrative sessions 24 Total 1,939 Sessions lost on account of sickness 43 Total sessions attended by Anaesthetist 187 20,548 mothers, infants, elementary and secondary school children were inspected. 16,498 or 80% were defective, and 5,830 or 35 % were treated at the centres. 14,207 teeth were extracted, 9,019 fillings done and 4,106 sundry operations, making a total of 27,332 treatments. 18,402 attendances were registered by these patients. A summary of the work is given in the following table with comparative figures for the two preceding years. 55 Table No. 40. Comparative Table of Work done for Years 1935, 1936 and 1937. 1935. 1936. 1937. Total inspected:— 1. Mothers, Infants and School Children 21,638 21,858 20,548 2. Number defective 15,083 15,419 16,498 3. Number treated 5,654 5,606 5,830 4. Teeth removed 14,764 15,118 14,207 5. Teeth filled 9,501 9,030 9,019 6. Sundry operations 6,125 6,540 4,106 7. General anaesthetics 3,777 4,127 3,876 8. Treatment sessions 1,575 1,610 1,590 9. Inspection sessions 347 337 325 The average work done on a sessional basis is set out in the following table together with the years 1935 and 1936. Table NO. 41. Comparative Table of Work per Session. Year. Attendances. Fillings. Extractions. Sundries. Total operations per Session. 1935 11.5 6 9.3 3.9 19.2 1936 10.9 5.6 9.4 4 19 1937 11.5 5.6 8.9 2.5 17 It is evident from the above table that the amount of work done corresponds very closely with the previous years. The number of fillings at 5.6 per session is identical with the year 1936 ; the number of extractions and sundry operations has declined slightly, while attendances have risen to the 1935 level. General Anaesthetics. Reports have appeared in the dental press of the successful use of Vinyl Ether as a general anaesthetic in Hospital out-patients Dental work. As the drug gave promise of value and no elaborate apparatus was required in its administration, it was decided to see if it provided any improvement on our existing method. Approximately 100 cases were thus treated at the centres. It was found to produce a smooth, quiet, safe and quick anaesthesia, with rapid recovery and no after effects, the patient maintaining a good colour throughout. It has, however, a limited time of anaesthesia and most of the cases treated required to be supplemented with nasal gas to complete the operation. This, in our view, negatived its claim as a rival to nasal N2O and Oxygen and its use at the centres was discontinued. Its high inflammability and objectionable odour tend also to bring the drug into disfavour. 187 general anaesthetic sessions were held during the year, 3,786 cases being treated ; an average of 20 per session. ELEMENTARY, NURSERY AND SPECIAL SCHOOLS. Inspection. Routine.—15,769 children out of a total roll of approximately 20,000 were inspected at the schools during 293 visits, an average of 54 per visit. 11,869 children, or 75%, were found defective and referred for treatment. Complete recording of all defects found was done and " Care of the Teeth " pamphlets issued to all scholars, which is the same procedure as in former years. Special Cases.—848 children were inspected at the centres as compared with 1,535 during the previous year. Included in this figure are cases of minor defect which had developed between routine inspections, together with those children leaving school and seeking a final treatment. Every effort was made for these children to complete their treatment. Treatment. Out of a total of 11,869 children referred as defective, 4,421 received treatment at the centres, an increase of 292 over last year's figure. 9,015 teeth were extracted, of which 1,390 were permanent. 5,499 fillings were done on permanent teeth and 955 on temporary, making a total of 6,454. In addition, 1,945 sundry treatments were performed. These include root fillings to anterior teeth, gum treatments, dressings of zinc oxides and sedatives, together with silver nitrate applications. 11,246 attendances for treatment were registered at the centres. Treatment sessions totalled 977 and the average work done is indicated in the table below. 56 Table No. 42. Work done per Session. Attendances. Fillings. Extractions. Sundries. Total operations. 11.5 6.5 9.2 1.9 17.6 Fillings per 100 children =145. Extractions per 100 children =204. Tables Dealing with the Work on Elementary School Children During the Year. Table 43, 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— Aged : Children attending Public Elementary Schools. Children attending Special Schools. Children attending Nursery Schools. 3 — — 65 4 — — 146 5 986 — 64 6 1,713 6 — 7 1,879 8 — 8 1,789 11 — 9 1,659 18 — 10 1,731 33 — 11 1,368 19 — 12 1,385 33 — 13 1,543 32 — 14 1,205 31 — 15 — 25 — 16 — 20 — Total 15,258 236 275 b. Specials 816 9 23 c. Total (Routine and Specials) 16,074 245 298 2. Number found to require treatment 11,538 165 166 3. Number actually treated at the Authority's Health Centres 4,342 36 43 4. Attendances made by children for treatment 11,063 93 90 5. Half days devoted to Inspection 284½ 4 4½ Treatment 959 9 9 Total 1,243½ 13 13½ 6. Fillings—Permanent teeth 5,456 43 — Temporary teeth 823 — 28 Total 6,279 43 28 7. Extractions-—Permanent teeth 1,348 42 Temporary teeth 7,454 39 132 Total 8,802 81 132 8. Administration of general anaesthetics for extractions 2,613 27 35 ,, Local Anaesthetics 405 3 2 Total 3,018 30 37 9. Other operations—Permanent teeth 1,903 12 — Temporary teeth 26 — 4 Total 1,929 12 4 57 Table No. 44. Return showing the number of Dental Defects referred for following-up, and the extent to which remedial measures were carried out during 1937 at Health Visitor's last visit. Total number of defects coming under observation during 1937 : Brought forward, 1936 904 New during year 6,563 7,467 Number of defects treated— Health Centre 4,243 Otherwise 42 4,285 Percentage of defects followed up needing treatment which were known to have received treatment 57% No report available 6 Number of defects for which no treatment had been undertaken at Health Visitor's final visit 2,333 Carried forward to 1938 742 Number not needing treatment 101 Willesden Secondary and Junior Technical, etc., Schools. Inspection. 2,390 pupils were inspected at the schools and 6 at the Health Centres, making a total of 2,396 inspections for the year, which is an increase of 73 above the corresponding figure for last year. 32 visits were made to the schools to inspect 2,390 pupils, an average of 74 per session. 1,559, or 65%, were found defective. The beneficial effect of systematic inspection and treatment in these schools is reflected in the following table. Defective Percentages since the Commencement of the Scheme. 1935 69% defective. 1936 68% defective 1937 65% defective Treatment. 532 or 34% of the defective cases were treated at the centres. The number of fillings as compared with 1936 has increased by 193 to 1,520 and likewise, teeth extracted has risen by 159 to 458. The total attendances made amount to 2,028 and the estimated number of treatment sessions to 168. A Table of the year's work in the respective groups is set out below. Table No. 45. 1. Number of pupils who were inspected by the Dentist— a. Routine age-groups. Willesden Junior Technical, etc., Schools. Willesden Secondary Schools. Total. Aged: 11 — 139 139 12 — 282 282 13 53 400 453 14 216 351 567 15 262 287 549 16 94 219 313 17 4 81 85 18 — 1 1 19 — 1 1 Total 629 1,761 2,390 b. Specials 6 — 6 635 1,761 2,396 58  Willesden Junior Technical, etc., Schools. Willesden Secondary Schools. Total. 2. Number found to require treatment 423 1,136 1,559 3. Number actually treated at the Authority's Health Centres 115 417 532 4. Attendances made by pupils for treatment 309 1,719 2,028 5. Half-days devoted to Inspection 8 24 32 Treatment 25 143 168 Total 33 167 200 6. Fillings—Permanent Teeth 247 1,267 1,514 Temporary teeth — 6 6 Total 247 1,273 1,520 7. Extractions—Permanent teeth 57 316 373 Temporary teeth 8 77 85 Total 65 393 458 8. Administration of general anaesthetics for extractions 42 201 243 Administration of local anaesthetics 2 — 2 Total 44 201 245 9. Other operations—Permanent teeth 73 558 631 Temporary teeth — — — Total 73 558 631 Maternity and Child Welfare. A full summary of the year's work is given in the tables below. Expectant and Nursing Mothers and Children under Five. Table No. 46. E.M. N.M. 0-5 Total. Number brought forward from previous year 194 172 74 440 Number inspected 755 336 444 1,535 Total number under observation during year 949 508 518 1,975 Number completed 279 262 296 837 Number partially completed 31 6 3 40 Number not availing themselves of treatment 361 73 104 538 Number treated by other agencies 1 2 1 4 Number carried forward 263 151 64 478 Number of attendances 2,356 1,735 1,037 5,128 Number of teeth removed 2,131 1,524 1,079 4,734 Number of teeth filled 543 323 283 1,149 Number of other operations on the gums and teeth 714 744 72 1,530 Number of general anaesthetics 435 230 293 958 Number with no defect 14 14 50 78 Number of local anaesthetics 78 99 4 181 Treatment sessions – – – 445 Number of Patients who received Dentures during 1937. Table No. 47. At cost to Council. At cost to Applicant. At part cost to Applicant. Total. 172 4 54 230 Repairs. 2 – – 2 59 THE TWENTY-THIRD ANNUAL REPORT for the Year ending 31st December, 1937, 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. A new feeding centre with seating accommodation for 140 was opened at Gibbons Road on July 26th, 1937. 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 of 1s. per head on 1st April, 1934, and to allow all children in receipt of free dinners 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 Centres throughout the year was 760. 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 number of application forms received from the South Kilburn area for the year was 341. 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 charged per meal by the Local Authority to non-necessitous cases is 5d. Milk.—The provision of 1/3 pint of milk to all children who are receiving free meals was commenced on 24th May, 1937. The children drink the milk at school during the mid-morning recess. 60 STATISTICAL INFORMATION, YEAR ENDING 31st DECEMBER, 1937. Table No. 48.—No. of Meals supplied. Supplied to:— Breakfasts. Dinners. Total. Free. Free. Paying. Education Committee's Centres 10,923 132,796 1,451 145,170 Kilburn Voluntary Centre 24,864 76,323 — 101,187 Special Schools — 14,067 15,472 29,539 Feeding Centre Assistants 3,490 3,981 — 7,471 39,277 227,167 16,923 283,367 Table No. 49.—Occupation List, 1937. Occupation. No. of Children Fed during 1937. No. of Families Involved. Percentage. 1936. 1937. 1936. 1937. Unemployed 937 289 394 48.41 47.93 Widows 156 52 82 8.71 9.97 Deserted wives 36 33 21 5.53 2.55 Orphans 2 2 1 .33 .12 Labourers 452 108 177 18.09 21.53 Railwaymen 25 9 11 1.51 1.34 Hawkers 34 13 17 2.18 2.07 Others 241 91 119 15.24 14.48 1,883 597 822 Approximate average cost of food only 3.32d. Total (gross), 5.21d. Milk.—Total No. 1/3 pints of milk supplied, 115,528. Cost, £240 13s. 8d. 61 THE EIGHTH ANNUAL REPORT for the Year ending 31st December, 1937, on the SUPERVISION OF MIDWIVES. Table No. 50. Number of Midwives who gave notice of their Intention to practise in Willesden in 1936 and 1937 respectively. 1936 1937 In Willesden— 1. Private District Midwives 13 12* 2. Municipal Midwives — 2 3. Queen Charlotte's District Home, 40, Princess Road, Kilburn, N.W.6. 8 8 4. Central Middlesex County Hospital 14 25 Outside Willesden— 1. Private District Midwives 13 12 2. Queen Charlotte's District Home, 176, Ladbroke Grove, Kensington 6 5 3. Kilburn and West Hampstead District Nursing Association, 20, Dennington Park Road, Hampstead, N.W.6 7 10 Total 61 74 * Of these 12 Midwives, 3 became Municipal Midwives in Willesden as from the 31st October, 1937, and 4 surrendered their Central Midwives Board Certificates under the Midwives Act, 1936 (2 voluntary surrender and 2 compulsory surrender). Table No. 51. Number of Cases attended by Midwives practising and living in Willesden during 1937. Private District Midwives. No. of Cases attended Total. Remarks. As Midwife. As Maternity Nurse. 1 33 7 2 153* 25* *Out of 153 cases and 25 cases respectively, 20 cases were dealt with after the midwife was appointed as a Municipal Midwife on 31-10-37, but they were cases booked prior to the midwifery scheme coming into operation. 3 75* 8 *Out of 75 cases, 6 cases were dealt with after the Midwife was appointed as a Municipal Midwife on 31-10-37, but they were cases booked prior to the midwifery scheme coming into operation. 4 9 2 – 5 12 None – 6 None None – 7 28 None – 8 61* 6* *Out of 61 cases and 6 cases respectively, 12 cases were dealt with after the midwife was appointed as a Municipal Midwife on 31-10-37, but they were cases booked prior to the midwifery scheme coming into operation. 9 35 7 – 10 11 1 – 62 Table No. 51 (Contd.) Private District Midwives. No. of Cases attended Total. Remarks. As Midwife. As Maternity Nurse. 11 None 1 – 12 2 1 – Municipal Midwives (Since 31-10-37) 15 None – Midwives attached to Queen Charlotte's Hospital District Home, 40, Princess Road, N.W.6. 323* None *Out of 323 cases, 35 cases were dealt with on or after 31-10-37, 34 of which were booked prior to 31-10-37, and 1 booked under the midwifery scheme. Midwives attached to Willesden District Nursing Association, 17-19, Park Avenue, N.W.2. None 203* *Out of 203 cases, 39 cases were dealt with on or after 31-10-37, 33 of which were booked prior to 31-10-37, and 6 booked under the midwifery scheme. Midwives at the Central Middlesex County Hospital, Acton Lane, N.W.10. 683* 72* *These 755 patients were all confined in the Central Middlesex County Hospital. Total 1,440 333 =1,773 in all. Table No. 52. Number of Cases attended by Midwives practising in but living outside Willesden during 1937. Private District Midwives. No. of Cases attended in Willesden. Total. As Midwife. As Maternity Nurse. A 0 0 B 5 0 C 2 0 D 0 0 E 0 0 F 0 0 G 3 0 H 1 0 I 0 0 J 4 1 K 2 0 L 1 0 Midwives attached to Kilburn and West Hampstead District Nursing Association, 20, Dennington Park Road, Hampstead, N.W.6 59 0 Midwives attached to Queen Charlotte's Hospital District Home. 176, Ladbroke Grove, W.10 27 0 Total 104 1 Table No. 53. Notifications received from Midwives in accordance with the Rules of the Central Midwives Board, 1st January to 31st December, 1937. From Midwives living and practising in Willesden. From Midwives practising in Willesden but living outside. Notifications of:— Sending for Medical Help 158 57 Having laid out a dead body 2 1 Liability to be a source of infection 1 3 Death of child 2 1 Still Birth 9 1 Artificial feeding 3 5 Total 175 68 In addition, 12 notifications were received from Midwives acting as Maternity Nurses. 63 Table No. 54. 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. Adherent placenta 2 — Abnormality of left hand 1 – Albumen in urine 4 — Ante-partum haemorrhage 8 4 Asphyxiated baby 1 — Baby looks ill — 1 Breech presentation 1 — Blisters on fingers — 1 Cold and cough 1 4 Convulsions 1 — Critical condition of patient 1 — Discharge from eyes 1 4 Dangerous prematurity 4 2 Dangerous hæmorrhoids 1 — Deformed feet — 1 Dangerous varicose veins 1 – Excessive vomiting and diarrhoea 1 – Delayed first stage of labour 8 2 Feeble baby 7 2 Feverish condition of baby 1 – Difficult first labour 4 – Delayed second stage of labour 19 2 Infant drowsy, colour poor – 1 Extended breech 1 — Jaundiced baby 1 — Face presentation 1 — Rash on baby 3 1 Fainting attack — 1 Septic finger — 1 Foetal distress posterior position 4 – Septic spots 1 — Suspected pemphigus 1 – Foot presentation 1 — Free loss and laceration of soft parts 1 – Suspected Hernia 1 — Spina bifida 1 — High blood pressure and albumen in urine 1 1 Sticky eyes 11 4 Sudden death of baby 1 — Inflammation of breast 2 1 Swelling of labia 1 — Wheezy cold on chest 1 — Laceration of perineum 40 14 Miscarriage 1 — Painful breast 2 1 Patient collapsed — 1 Patient feeling ill . 1 1 Patient wishing for forceps 1 – Pain in right side 1 — Post partum hæmorrhage 1 Premature labour 1 1 Prolapsed cord 1 — Retained membrane 1 — Red lochia (excessive) 1 — Rise of temperature 4 3 Severe abdominal pain 1 — Severe cough 1 — Swelling of face 1 — Transverse lie 1 — Varicose veins — 2 Total 120 38 39 18 Table No. 55. Fees Paid to Medical Practitioners under Section 14 of the Midwives Act, 1918. 1st Tanuary to 31st December, 1937. Number of notifications of Sending for Medical Help 215 „ ,, ,, in respect of which fees paid 143 Total fees paid by Council £174 1s. 0d. 64 Table No. 56. Cases in which the Council paid or contributed to the fee of a Midwife during 1937. No. of cases. Fees paid by Council. Midwife acting as Midwife 213 Midwife acting as Maternity Nurse 14 Total 227 £448 10s. 0d. Table No. 57. The following information was sent to the Ministry of Health on Form M.C.W. 96 (revised) :— Domiciliary Midwives. Midwives in Institutions. Totals. 1. Total number of Midwives practising at the end of the year in the area of the Local Supervising Authority:— (a) Employed by the Local Supervising Authority 5 — 5 (b) Employed by other Welfare Councils— (i) under arrangements made with the Local Supervising Authority in pursuance of Section 1 of the Midwives Act, 1936 — — — (ii) others—Middlesex County Council in their Central Middlesex County Hospital — 12 12 (c) Employed by Voluntary Associations— (i) under arrangements made with the Local Supervising Authority in pursuance of Section 1 of the Midwives Act, 1.936 7½ — 7½ (ii) others 7 — 7 (d) In private practice 14 — 14 Totals 331 12 45½ 2. Number of cases in the area of the Local Supervising Authority attended during the year by midwives :— (a) Employed by the Council (31-10-37—31-12-37) As Midwives 50 — 50 As Maternity Nurses 3 — 3 (b) Employed by other Welfare Councils— (i) under arrangements made with the Local Supervising Authority in pursuance of Section 1 of the Midwives Act, 1936 As Midwives — — — As Maternity' Nurses — — — (ii) others—Middlesex County Council in their Central Middlesex County Hospital As Midwives — 683 683 As Maternity Nurses — 72 72 (c) Employed by Voluntary Associations— (i) under arrangements made with the Local Supervising Authority in pursuance of Section 1 of the Midwives Act, 1936 (31-10-37—31-12-37) As Midwives 35 — 35 As Maternity Nurses 39 — 39 (ii) others As Midwives 242* — 242 As Maternity Nurses 163* — 163 (d) In private practice As Midwives 379 — 379 As Maternity Nurses 47 — 47 Totals As Midwives 706 683 1,389 As Maternity Nurses 252 72 324 3. Number of cases in which medical aid was summoned during the year under Section 14 (i) of the Midwives Act, 1918, by a midwife (i) engaged in domiciliary practice 215 Total 215 (ii) in institutional practice None 4. Number of domiciliary births during the year in the area of the Local Supervising Authority 1,225 notified. * Includes cases attended by the two voluntary associations prior to arrangements made with the Local Supervising Authority under Section 1 of the Midwives Act, 1936. 65 MIDWIVES ACT, 1936. A special report on the Midwives Act will be found as Appendix G, the scheme as set out in this report was adopted by the Willesden Council on the 26th January, 1937, and was subsequently submitted to the Minister of Health for his approval. The Minister of Health, however, directed the authority to make certain changes in the scheme as submitted. The scheme, as amended in accordance with the Minister's directions, will be found as Appendix G (II). This amended scheme was approved by the Council on the 27th July, 1937, and was submitted to the Minister of Health, who notified his approval in August, 1937. The scheme for Domiciliary Midwifery in Willesden came into operation on the 31st October, 1937. For the purpose of domiciliary Midwifery, Willesden is divided into two areas : (1) the South Kilburn area and (2) the rest of Wiliesden. The South Kilburn area is allotted to Queen Charlotte's Hospital District Home, 40, Princess Road, Kilburn, N.W.6, with the equivalent of 2½ district Midwives, and the rest of Willesden is divided into five areas with a Municipal Midwife resident within each of the areas. The Municipal Midwifery Service is linked up with the Ante-natal Clinics held at the Municipal Health Centres. Maternity Nursing for the whole of Willesden is undertaken by the Willesden District Nursing Association. The following Table gives a summary of the bookings under the Scheme from the commencement of the Scheme on 31st October, 1937, up to 23rd April, 1938. Table No. 58. Expecting Confinement in :— Municipal Midwives (Acting as Midwives). Queen Charlotte's Hospital District Home (Acting as Midwives). Willesden District Nursing Association (Acting as MaternityNurses). Total. Booked Cancelled Net Bookings Booked Cancelled Net Bookings Booked Cancelled Net Bookings Booked Cancelled Net Bookings Nov., 1937 1 — 1 — — 0 1 — 1 2 — 2 December 3 — 3 2 — 2 4 — 4 9 — 9 Jan., 1938 22 — 22 3 — 3 11 — 11 36 — 36 February 41 — 41 13 — 13 12 — 12 66 — 66 March 48 5 43 19 2 17 29 — 29 96 7 89 April 47 3 44 9 1 8 23 3 20 79 7 72 May 42 4 38 22 — 22 19 2 17 83 6 77 June 38 1 37 12 — 12 18 — 18 68 1 67 July 41 — 41 8 — 8 10 — 10 59 — 59 August 14 — 14 6 — 6 10 — 10 30 — 30 September 12 — 12 1 — 1 6 — 6 19 — 19 October 2 — 2 1 — 1 3 — 3 6 — 6 Total 311 13 298 96 3 93 146 5 141 553 21 532 66 THE EIGHTH ANNUAL REPORT for the Year ending 31st December, 1937, on the REGISTRATION OF NURSING HOMES. PUBLIC HEALTH ACT, 1936. SECTIONS 187 TO 195. Table No. 59. Maternity and Nursing Homes, 1st January, 1937, to 31st December, 1937. (1) Number of applications for registration :— (a) Maternity Homes 0 (b) Nursing Homes 1 (2) Number of Homes registered l (3) Number of Orders made refusing or cancelling registration 0 (4) Number of appeals against such Orders 0 (5) Number of cases in which such Orders have been— (a) Confirmed on appeal 0 (b) Disallowed 0 (6) Number of applications for exemption from registration 3 (7) Number of cases in which exemption has been— (a) Granted 3 (b) Withdrawn 0 (c) Refused 0 (8) Nursing Homes closed by voluntary retirement 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 Public Health Act, 1936, and the bye-laws made by the Council under section 190 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 Public Health Act, 1936, 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 EIGHTH ANNUAL REPORT for the Year ending 31st December, 1937, on CHILD LIFE PROTECTION. The arrangements made by the Council for discharging their duties in connection with Child Life Protection were dealt with in the 1930 Annual Health Report. The Health Visitors have been appointed Child 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 law or where the foster mother or foster home appears unsuitable. They draw the attention of the public to the requirements of the law 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, and a memorandum on Child Life Protection appears as Appendix H in 1937. The provisions of the Children & Young Persons Act, 1932, relating to Child Life Protection, came into operation on 1st January, 1933. These provisions amended Part 1 of the Children Act, 1908. The principal amendments were as set out in the 1933 Annual Health Report, page 61. On October 1st, 1937, the Public Health Act, 1936, came into operation and Part I of the Children Act, 1908, and the Children and Young Persons Act, 1932, were repealed. The 1936 Act is a consolidating Act with certain amendments. The principal amendments introduced are as follows :— 1. Infant Life Protection now becomes Child Life Protection. 2. The word " foster child " is introduced in the law for the first time. 3. The authority administering the Child Life Protection Law is called the Welfare Authority. 4. Emergency notices of reception may now be given within 24 hours instead of within 12 hours of reception. 5. The manner in which notices are to be given is omitted in the 1936 Act and is governed by Section 286 of the Local Government Act, 1933. 6. The 1936 Act makes it clear that the Welfare Authority have power to grant a certificate of exemption from the provisions of the Child Life Protection Part of the Act to a boarding school—a point which previously had been in some doubt. 7. Hitherto Voluntary Homes were exempted as a whole from the Infant Life Protection Law, but under the 1936 Act it becomes necessary for the authorities of such homes to apply to the Welfare Authority for a certificate of exemption if they desire to be exempted. 8. Provision is made that the part of the Act relating to Child Life Protection shall not apply to any person who undertakes the nursing or maintenance of a child under any act for the relief of the poor or any order made under the Act or undertakes the nursing and maintenance of a child boarded out under sub-section (3) of Section 84 of the Children and Young Persons Act, 1933. 9. Provision is made enabling the Welfare Authority to exempt persons who take children for short holidays from bona fide charitable institutions from giving notices in respect of each individual child but notice must still be given in respect of the first child received in each year. All the children however are to be considered as foster children. 10. The prohibition of anonymous advertisements offering to undertake the care of children under 9 years of age is extended to include all children and not only children under 9 years of age. 11. A new power of defraying the expenses of maintenance of a child in a place of safety is conferred on the Welfare Authority. Two foster children died during the year. The cause of death in one case was certified as broncho-pneumonia and prematurity. There was no post mortem and no inquest in this case. In the other case there was a post mortem and an inquest and the cause of death was certified as concussion through fall on head—accidental. In addition, seven children died in hospital within a few hours to 17 days of admission to hospital from foster homes. The causes of death were certified as :—4 GastroEnteritis ; 1 Marasmus, 1 Bronchitis and Enteritis, 1 Broncho-pneumonia. The Council decided not to grant exemption from the child life protection provisions of the Public Health Act 1936, to voluntary homes. 68 Table No. 60. Foster Mothers. Number of Foster Mothers at 31st December, 1936 124 Number of Foster Mothers at 31st December, 1937 115 Number of Licenses granted by Council in 1937 411 ,, ,, refused by Council in 1937 10 Number of applications to take additional children agreed to by Council 9 „ ,, „ „ „ refused by Council 2 Number of applications for re-issue of License agreed to by Council 15* ,, ,, ,, ,, refused by Council 2 Foster Children. Coming under observation— Number of Foster Children at 31st December, 1936 196 Number of Foster Children received during 1937 328 Number entered Willesden with their Foster Mothers 13 Total 5371 J In addition 17 mothers took foster children for short periods in most cases during the confinement of the mother, but did not wish to become registered foster mothers. * In these 15 cases the licenses were re-issued in respect of new premises. t The actual number of new individual Foster Children who came under observation was 253. Removed from observation— Number given up 294 „ reached the age of 9 years 17 „ died 2 „ legally adopted 9‡ ,, ceased to be taken for gain or taken over by Public Assistance Committee 2 „ left Willesden with their Foster Mothers 10 Total 334 Remaining under observation— Number of Foster Children at 31st December, 1937— (a) Under 5 years of age 132 (b) Between 5 and 9 years of age 71 Total 203 } 8 of these were legally adopted by their Foster Parents. Table No. 61. The 203 Foster Children under observation at 31st December, 1937, were maintained in the care of Foster Mothers as follows :— Maintained by— Parent or Guardian 160* Crusade of Rescue, 48, Compton Street, W. 26 National Adoption Society, 4, Baker Street, W. 17 Church Army 0 Received with lump sum 0 Total 203 * In 35 cases the parent or guardian was living in Willesden at the time the child entered the care of the Foster Mother. In 168 of these cases the parent or guardian was not living in Willesden at the time the child entered the care of the Foster Mother. 69 Table No. 62. The following Table shows the length of time each of the 203 Foster Children under observation at 31st December, 1937, had been in the care of their Foster Mothers. Under 6 months 66 Over 6 months, under 1 year 47 Over 1 year, under 1½ years 19 Over 1½ years, under 2 years 19 Over 2 years, under 2½ years 19 Over 2½ years, under 3 years 13 Over 3 years, under 3½ years 4 Over 3½ years, under 4 years 4 Over 4 years, under 4½ years 1 Over 4½ years, under 5 years 3 Over 5 years, under 5½ years 0 Over 5½ years, under 6 years 2 Over 6 years, under 6½ years 2 Over 6½ years, under 7 years 3 Over 7 years, under 7½ years 1 Over 7½ years, under 8 years 0 Over 8 years, under 8½ years 0 Over 8½ years, under 9 years 0 Total 203 Of the 449 individual Foster Children under observation during the year 1937, 257 changed hands during that period. 215* made 1 change, 31 made 2 changes, 8 made 3 changes, 3 made 4 changes. These changes do not include the first reception of the child. * Of these, 9 were admitted to Hospital returning to same Foster Mother. 70 THE EIGHTEENTH ANNUAL REPORT for the Year ending 31st December, 1937, on HOME NURSING. A record of work done is given in the three following tables :— Table No. 63. Showing sources from which cases were referred for Home Nursing during the Year 1937. Referred by Number. Health Department 362 Private Doctors 18 Others 33 Total 413 Table No. 64. Showing cases Home Nursed in Wards during 1937. Ward. No. of Cases brought forward from 1936. No. of Cases referred in 1937. Total. No. of Visits paid. 1. Carlton 7 123 130 1,669 2. Kilburn 3 78 81 616 3. Brondesbury Park — 13 13 56 4. Kensal Rise — 16 16 125 5. Manor — 5 5 17 6. Harlesden 1 18 19 177 7. Stonebridge — 16 16 75 8. Roundwood 1 17 18 99 9. Church End — 22 22 162 10. Willesden Green 3 26 29 248 11. Mapesbury 2 37 39 567 12. Neasden — 17 17 134 13. Cricklewood 1 25 26 124 Total 18 413 431 4,069 71 Table No. 65—Showing Cases Dealt with during 1937 and Results. Disease. Cases being nursed at end of 1936. New Cases during 1937. Removed from Observation during 1937—Results of Treatment. Still being Nursed at end of 1937. Number of Visits Paid during 1937. Died. Removed to Hospital or other Institution. Recovered. Expectant Mothers. Nursing Mothers. Children under Five. School Children. Others. Total. Expectant Mothers. Nursing Mothers. Children under Five. School Children. Others. Total. Expectant Mothers. Nursing Mothers. Children under Five. School Children. Others. Total. Expectant Mothers. Nursing Mothers. Children under Five. School Children. Others. Total. Expectant Mothers. Nursing Mothers. Children under Five. School Children. Others. Total. Expectant Mothers. Nursing Mothers. Children under Five. School Children. Others. Total. Expectant Mothers. Nursing Mothers. Children under Five. School Children. Others. Total. Bathing Case — — — — — — — — 1 — — 1 — — — — — — — — — — — — 1 — — 1 — — — — — — — — — — — 3 Bronchitis. — — — — — — — — 2 — — 2 — — — — — — — — — — — — — — 2 — — 2 — — — — — — — — — — — 25 Burns and Scalds — — 1 — — 1 — — 5 2 — 7 — — — — — — — — — — — — — — 55 2 — 7 — — 1 — — 1 — — 46 17 — 63 Circumcision — — — — — — — — 11 — — 11 — — — — — — — — — — — — — — 11 — — 11 — — — — — — — — 60 — — 60 Constipation — — — — — — 1 — — — — 1 — — — — — — — — — — — — 1 — — — 1 — — — — — — 1 — — —— —— 1 Douching Case 1 — — — — 1 — — — — — — — — — — — — — — — — — — 1 — — — 1 — — — — — — 8 — — — — 8 Eczema — — — — — 1 — — 9 — — 9 — — — — — — — — — — — — — — 10 — — 10 — — — — — — — — 87 — — 87 Feeding Difficulty — — — — — — — — 1 — — 1 — — — — — — — — 1 — — 1 — — — — — — — — — — — — — 2 — — 2 Impetigo —- — — — — — — — 16 — — 16 — — — — — — — — 11 — — 1 — — 15 — — 15 — — — — — — — — 218 — — 218 Injury to Toe — — — — — — — — — — 1 1 — — — — — — — — — — — — — — — 1 1 — — — — — — — — — — 6 6 Mastitis — — — — — — — 7 — — — 7 — — — — — — — — — — — — — 6 — — — 6 — 1 — —- — 1 — 45 — — — 45 Maternity Case —— — — — — — — 2 — — — 2 — — — — — — — — — — — — — 1 — — — 1 — 1 — — — 1 — 21 — — — 21 Miscarriage — — — — — — — — 1 — — 1 — — — — — — — — — — — — — 1 — — — 1 — — — — — — — 1 — — — 1 Ophthalmia — — — — — — — 3 57 4 — 64 — — — — — — — — 2 — — 2 — 3 55 4 — 62 — — — — — — — 31 594 13 638 Ophthalmia Neonatorum — — 1 — — 1 — — 5 — — 5 — — — — — — — — — — — — — 5 — — 5 — — 1 — — — — 92 — — 92 Otorrhœa — — 4 1 — 5 — — 26 10 — 36 — — — — — — — — 7 — — 7 — — 19 10 — 29 — — 4 1 — 5 — — 797 166 — 963 Pemphigus — — — — — — — — 3 — — 3 — — — — — — — — — — — — — — 3 — — 3 — — — — — — — — 42 — — 42 Puerperal Pyrexia — — — — — — — 1 — — — 1 — — — — — — — — — — — — — 1 — — — 1 — — — — — — — 8 — — — 8 Rhinitis ... — — — — — — — — 3 1 — 4 — — — — — — — — — — — — — — 3 — — 3 — — — 1 — 1 — — 27 134 _ 161 Round Worms — — — — — — — — 1 — — 1 — — — — — — — — — — — — — — 1 — — 1 — — — — — — — — 3 — — 3 Septic Conditions — — 3 — — 3 2 — 54 30 — 86 — — — — — — — — 5 — — 5 2 50 29 — 81 — — 2 1 — 3 7 — 414 214 635 Skin Conditions — — 1 — — 1 — — 4 — — 4 — — — — — — — — — — — — — — 5 — — 5 — — — — — — — — 39 — — 39 Stomatitis — — — — — — — — 1 — — 1 — — — — — — — — — — — — — — 1 — — 1 — — — — — — — — 4 — — 4 Thread Worms — 1 3 — — 4 — 2 87 158 — 147 — — — — — — — — — — — — — 3 89 57 — 149 — — 1 1 — 2 — 9 432 449 _ 890 Tonsillectomy — — — — — — — — 1 — — 1 — — — — — — — — — — — — — — 1 — — 1 — — — — — — — — 5 — — 5 Vaginal Discharge — — — — — — 1 — — — — 1 — — — — — — — — — — — — — — — — — 1 — — — — — — 3 — — — 46 3 Varicose Ulcer — — — — 1 1 — — — — — — — — — — — — — — — — — — — — — 1 1 — — — — — — — — — — 46 46 Total 1 1 14 1 1 18 4 16 287 105 1 413 — — — — — — — — 16 — — 16 5 15 276 102 2 400 — 2 9 ! 4 — 15 19 115 2890 993 52 4069- 72 THE FORTY-SIXTH ANNUAL REPORT on the MUNICIPAL HOSPITAL By ARTHUR G. TROUP, M.D., D.P.H. Medical Superintendent. During 1937, 1,762 patients were admitted to Hospital as compared with 1,754 in 1936, 1,156 in 1935, 1,425 in 1934, 1,201 in 1933. During the past two years cases requiring treatment for ear, nose and throat conditions and infants suffering from marasmus have been admitted to Hospital, and this accounts for the numbers of patients as compared with previous years. Cerebro-Spinal Fever. Ten cases of this disease were treated in Hospital during the year and three deaths occurred. The fatal cases were aged 25 years, 6 years and 1 year respectively. One patient died within an hour of being admitted to Hospital, and the other two fatal cases were of a malignant type and failed to respond to serum treatment. Diphtheria. 303 cases were admitted to Hospital as compared with 290 cases during 1936. These may be classified as follows:—Faucial 182, Naso-Pharyngeal 62, Nasal 42, Laryngeal 9, Aural 5, Carriers 3. The total number of cases under treatment was 368. It was necessary to perform the operation of tracheotomy on three of the laryngeal cases, of which two recovered and one died. Two cases subsequently diagnosed as laryngitis also had to have this operation carried out, one of which recovered and the other died. The mortality rate of 4T% shows a decrease of 15% over the figure for last year, The immediate causes of death in the 15 fatal cases were:—Myocarditis 9 cases, Toxaemia 4 cases, Laryngeal Obstruction and Broncho-Pneumonia 1 case each. Enteric Fever. Five cases of Paratyphoid Fever B were admitted during the year. All were of a moderate type and no deaths occurred. Erysipelas. Forty-six cases of this disease were treated during the year. No deaths occurred. Measles. Measles was not epidemic during 1937, and only 33 cases were admitted to Hospital. No deaths occurred. Convalescent Measles Serum. Measles infection was introduced into the female scarlet fever ward, and there were five susceptible contacts. All of these received a prophylactic dose of convalescent measles serum and all were fully protected. For the past few years the L.C.C. have prepared this serum from the blood supplied, but owing to increased pressure of work they are no longer able to continue this service. In future the necessary tests and preparation of the serum will be carried out at the laboratories of Messrs. Evans, Lescher and Webb. Liverpool. Mixed Infections. Scarlet Fever and Whooping Cough 3 Scarlet Fever and Diphtheria 3 Scarlet Fever and Mumps 1 Scarlet Fever and Chicken-Pox 1 Diphtheria and Chicken-Pox 2 Diphtheria and Whooping Cough 1 Chicken-Pox and Mumps 1 Puerperal Fever and Puerperal Pyrexia. The 16 Puerperal cases which were admitted to Hospital were diagnosed as follows:— Puerperal Septicaemia 1 Puerperal Mania 1 Local Uterine Sepsis 1 Mastitis 6 Mammary Abscess 4 Bacilluria 1 Common Cold 1 Phlebitis 1 The case of puerperal mania was transferred to another institution. All the other patients made a good recovery. 73 Scarlet Fever. The number of cases treated in Hospital was 427 as compared with 487 for the previous year. There was one fatality, the immediate cause of death being meningitis. Whooping Cough. Seventy-four cases were treated and nine deaths occurred, eight of which were due to bronchopneumonia and one to convulsions. Other Diseases. Tonsillitis 64 Angio-neurotic Oedema 2 Chicken-Pox 23 Herpes 2 Otitis Media 20 Polio-encephalitis 1 Mumps 15 Facial Paralysis 1 Bronchitis 13 Dermatitis 1 Enteritis 10 Drug Rash 1 Erythema 7 Impetigo 1 Laryngitis 7 Urticaria 1 Rhinitis 6 Schorrhoea 1 Dysentery 6 Tonsillectomy 1 Abscess 5 Dysmenorrhœa 1 Food Rash 4 Burn 1 Influenza 4 Streptococcal Carrier 1 Quinsy 3 Anaemia 1 Poliomyelitis 3 Convulsions 1 Rubella 3 Ophthalmia Neonatorum 1 Cellulitis 3 Mentally Defective 1 Vincents' Angina 2 Malnutrition 1 Tubercular Meningitis 2 Meningitis 1 Teething Rash 2 Negative Cases 8 Total Number:—231. Eight deaths occurred, two from laryngitis, two from tubercular meningitis and one each from polio-encephalitis, convulsions, dysentery and meningitis respectively. Two of the laryngitis cases required to have the operation of tracheotomy performed. One recovered and one died. Marasmus Cases. Since 1st April 1936 infants suffering from "Marasmus" have been admitted to the Hospital for treatment, and the number so admitted this year has been 46. These cases may be classified as follows:— Dietetic Diarrhoea 19 Infective Diarrhoea 7 No appreciable disease—under normal weight 14 Prematurity 2 Congenital Stenosis of Pylorus Pinks' Disease 2 1 Broncho-Pneumonia 1 Total Number 46 Deaths:—11. 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, dealt with:— The following table shows the number of cases dealt with:— Removal of tonsils and/or adenoids 587 Mastoidectomy (Chronic Otitis Media) 15 Other conditions 8 Cases admitted but not operated on 8 Total 618 Hospital cases treated at ear, nose and throat clinic:— Removal of tonsils and/or adenoids 16 Antrum Puncture 1 Mastoidectomy 3 Total 20 Sick Staff. Two cases of diphtheria occurred amongst the nursing staff, and one case of scarlet fever and one case of mumps amongst the domestic staff. 74 Duration of Stay in Hospital. Scarlet Fever. The average length of detention of scarlet fever patients is the lowest recorded, certain of the mildest cases being discharged from Hospital on the 25th day of the disease. 1926 1928 1933 47.2 days 37.0 „ 32.1 „ 1934 1936 1937 33.3 days 35.0 „ 31.5 „ Diphtheria. The average length of detention of diphtheria patients shows a decrease from last year, but this figure must vary from year to year according to the number of severe cases treated. 1931 56.2 days 1935 46.5 days 1932 45.6 „ 1936 49.1 ,, 1934 42.1 „ 1937 48.7 „ schick test and active immunisation against diphtheria. (1) Nursing Staff. During 1926 a commencement was made in Schick Testing the Nursing Staff and immunising those nurses who proved susceptible to diphtheria. Since that date 13 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, 2 in 1936 and 2 in 1937. The details of the latter two cases are as follows :—Probationer Nurse M. R. commenced duties on January 21st, 1936. She was Schick Tested on February 22nd, 1936, and gave a negative reaction. On January 3rd, 1937, she developed a mild attack of diphtheria. There were no complications. Probationer Nurse E. J. commenced duties on September 24th 1936. She was Schick Tested on October 2nd, 1936, and gave a positive reaction. On MarchlOth, 1937, she was re-Schick Tested and the reaction proved negative. She developed a moderate attack of diphtheria on August 8th 1937, and made an uneventful recovery. Table No. 66. (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 1937 (After immunisation was carried out) 13 (4) Incidence rate per annum (Taking 30 as average number of probationer nurses) 3-9% (5) Number of nurses Schick Tested (1927-1937 inclusive) 270 (6) Number of nurses giving a positive reaction 121 (7) Percentage of nurses giving a positive reaction 44-8% (8) Number of nurses re-Schick Tested 61 (9) Number of nurses re-Schick Tested giving a positive reaction 17 (10) Percentage of nurses re-Schick Tested giving a positive reaction 27.9% (2) Willesden Residents. This clinic was made available for Willesden residents in May 1927. The following are the figures for the years 1927 to 1937 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 237 201 1937 393 409 It will be observed that the number of individuals attending this clinic is the largest yet recorded —more than double the number of persons as compared with last year being immunised. 75 Further particulars regarding this year's attendances are as follows :—- (1) Number of persons attending:— 1—5 years 260 5—14 years (School Children) 212 Over 14 years (Adults and Secondary School Children) 4 Total 476 (2) Schick Test:— Primary Positive 159 Negative 44 203 Secondary Positive 11 Negative 179 190 Total 393 (3) Immunisation:— Number immunised 399 Number re-immunised 10 Total 409 (4) Total Attendances 1521 (5) Twenty-seven cases failed to attend a sufficient number of times for the complete course of immunisation injections to be carried out. Two children actually developed diphtheria while attending the clinic. (6) No reactions occurred after the immunising injections. Cases in Municipal Hospital during the Year 1937. Table No. 67. Diseases. No. in Hospital on 1-1-37 Admitted. Total under treatment. Discharged recovered. Died. Mortality. per cent. Remaining on 31-12-37 Cerebro-Spinal Fever 1 9 10 6 3 30 1 Diphtheria 65 300 365 254 15 4.1 96 Diphtheria (Bacteriological) — 3 3 1 — — 2 Enteric Fever — 5 5 4 — — 1 Erysipelas 2 44 46 45 — — 1 Measles 2 33 35 28 — — 7 Mixed Infections — 12 12 10 — — 2 Puerperal Infections 3 16 19 19 — — — Scarlet Fever 45 382 427 397 1 .23 29 Whooping Cough 11 63 74 65 9 12.2 — Other Diseases 9 231 240 224 8 3.3 8 Marasmus 4 46 50 30 11 22.0 9 Tonsil & Adenoid Cases — 618 618 615 — — 3 Totals 142 1,762 1,904 1,698 47 — 159 76 Cases Admitted from Other Authorities. During the year 1937, 79 cases were admitted from areas other than the Borough of Willesden. These may be classified as follows :— Table No. 68. Name of Authority. No. of Cases. Disease. No. of Cases. Harrow Urban District Council 44 Measles 13 Erysipelas 12 Whooping Cough 9 Chicken-Pox 3 Cerebro-Spinal Fever 2 Scarlet Fever 2 Enteric Fever 1 Poliomyelitis 1 Alveolar Abscess 1 Middlesex County Council 17 Erysipelas 4 Whooping Cough 3 Diphtheria 3 Cerebro-Spinal Fever 3 Measles 3 Scarlet Fever 1 Borough of Wembley 15 Erysipelas 4 Diphtheria 4 Mumps 2 Enteric Fever 1 Whooping Cough 1 Scarlet Fever 1 Measles 1 Chicken-Pox 1 Borough of Acton 3 Erysipelas 2 Measles 1 Totals 79 79 Table No. 69. The following table shows the number of cases admitted from outside Authorities from 1933 to 1937 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 1937 79 1,265 14 6 Hospital Buildings. No additions were made to the hospital buildings during the year. Laboratory. The bacteriological laboratory was opened for work on January 1st, 1932. It undertakes the examination of the routine bacteriological specimens from the district, the Municipal Hospital and other local Institutions. 77 Table No. 70. Nature of Examination. Positive result. Negative result. Total. 1 Swabs for diphtheria bacilli 302 4,612 4,914 2 Swabs for diphtheria bacilli with virulence test ... 5 25 30 3 Swabs for diphtheria bacilli with isolation on tellurite media — — 46 4 Sputum for tubercle bacilli 25 355 380 5 Blood for Widal reaction 10 7 17 6 Blood cultures — — 7 7 Blood counts — — 9 8 Blood films for abnormal cells or parasites — — 2 9 Urine for chemical examination — — 29 10 Urine for microscopical examination — — 25 11 Urine for bacteriological examination — — 59 12 Faeces for bacteriological or chemical examination — — 54 13 Pleural fluids for bacteriological examination — — 1 14 Cerebro-spinal fluids—various examinations — — 76 15 Water for presumptive B. Coli test — — 120 16 Water for enumeration of total organisms — — 120 17 Swabs and smears for gonococci — — 71 18 Swabs and smears for Vincent's angina — — 17 19 Swabs and smears for streptococci and other organisms — — 320 20 Pus for organisms — — 2 21 Post-mortem specimens — — 2 22 Drugs for sterility — — 4 Total 6,305 Table No. 71. Sources of Specimens Examined 1937. Total. Municipal Hospital 2,247 Private Practitioners 2,252 Municipal Health Centres and Health Visitors 1,502 Middlesex County Council Tuberculosis Dispensary 22 Other Hospitals 42 Borough Engineer's Department 240 6,305 Annual Number of Specimens. 1932 4,526 1933 5,908 1934 6,693 1935 7,774 1936 7,075 1937 6,305 78 THE SEVENTH ANNUAL REPORT on the WILLESDEN MATERNITY HOSPITAL. Report on the work from 1st January, 1937, to 31st December, 1937. By ARNOLD WALKER, M.A., M.B., B.Ch., F.R.C.S., F.C.O.G. Although there has been no increase in the number of beds at the Hospital, more than a hundred additional cases were dealt with during 1937 than during 1936. The 1,037 cases delivered must be regarded as representing the maximum number which can safely be undertaken with the present accommodation. At times during the year, the hospital has been overcrowded but this is inevitable in maternity work and is offset by slack periods. When the hospital is extended, it is to be hoped that a reserve ward will be provided which will greatly facilitate periodic cleaning. The remarkable series of booked deliveries without a maternal death has unfortunately been ended. Two booked cases and one unbooked case died during the year. The first booked case collapsed after an easy normal delivery and died from a rare condition known as obstetric shock. The second case is obscure. The patient was admitted when seven months pregnant, having been ill at home without calling in a private doctor or notifying the Health Centre. She had attended the Ante-natal Clinic regularly, but failed to make use of the services available when taken ill a day or two after her last attendance. When admitted, her condition was very serious, but no diagnosis could be made by the obstetrician nor by a consulting physician who was called in. A post-mortem examination was carried out by a pathologist which was also inconclusive and every possible pathological investigation has since been carried out on material which he removed. The case is still not satisfactorily explained although the sections are still circulating amongst leading pathologists. From the full information in the records, nothing has come to light to suggest that the death of this woman could have been prevented. The unbooked case died from shock following a prolonged labour and difficult delivery. This and the first booked death are true maternal deaths from complications which are not avoidable by antenatal care and for the treatment of which every facility was available. At the moment, almost 5,000 cases have been delivered in the Willesden Maternity Hospital with five booked deaths. There is no doubt that a maternal mortality rate of one per thousand must be somewhere near the irreducible minimum although the sequence of about 3,400 in the middle of the series without a death makes one hope for a repetition. Statistical Details of the 1,037 Cases dealt with during 1937. Cases Completed 1,037 A. Booked at the Health Centres 1,021 Discharged well 1,015 Delivered elsewhere 2 Transferred (discharged well) 2 Died 2 B. Admitted as Emergencies 16 Discharged well 15 Died 1 Of the 1,021 booked cases, 554 were primiparae and 467 were multiparae. 79 Statistical Details—(continued). Of the 16 emergency cases, 7 were primiparae and 9 were multiparae. Presentations— Occipito Anterior 919 Occipito Posterior 64 Normal Breech 19 Abnormal Breech 1 Twins 13 Triplets 1 Brow 2 Face 1 Miscarriages 13 Ante-partum Haemorrhage— Placenta Praevia ... 4 Accidental Haemorrhage ... 2 Prolapse of Cord ... 5 Organic Heart Disease ... 14 Toxaemia of Pregnancy admitted for treatment ... 52 Puerperal Pyrexia ... 36 Uterine Infection 10 Breast Infection 6 Urinary Infection 6 Chest Infection 9 Thrombo-phlebitis 2 No cause found 3 Operations performed— Forceps Delivery ... 47 The forceps rate was therefore 4.6 per cent. Caesarean Section ... 9 Disproportion 3 Previous Caesarean 2 Heart Disease 1 Prolapsed Cord 1 Placenta Praevia 1 Previous Trauma 1 Manual Removal of Placenta ... 13 Embryotomy ... 2 Hysterotomy and Sterilisation ... 4 Heart Disease 2 Chronic Nephritis 2 Induction of Premature Labour ... 11 1,033 viable children were born to 1,018 mothers. Of these, 32 were stillborn and 22 died. 80 THE TWENTY-THIRD ANNUAL REPORT on the AMBULANCE SERVICE. During the year 1936-37 the following vehicles were in use :— Table No. 72. No. Registration No. Tax. Make. Year of Purchase. Work required for Total miles run with vehicles. Purchase Price. £ £ 1 MP. 3711 18 Dennis 5/1928 School Work 81,381 760 2 MP. 3712 18 ,, 5/1928 ,, 81,881 760 3 MT. 810 20 Armstrong 11/1928 Health Dept. 89,719 800 4 MY 967 18 Dennis 8/1929 School Work 78,298 762 5 MY 19* 20 Armstrong 11/1929 Education Dept. 86,185 538 6 MY 26 Nil ,, 2/1930 Sickness and Accidents 94,039 854 7 HX 12 Nil ,, 1/1931 ,, 102,422 860 8 HX 5178 18 Dennis 8/1931 School Work 56,167 665 9 HX 5179 18 ,, 8/1931 ,, 57,406 665 10 MV 1800 Nil Armstrong 4/1932 Infectious cases 32,313 825 11 MV 2860 18 Dennis 7/1932 School Work 50,739 687 12 AMC 175 25 Morris 3/1933 Disinfection, Laundry and Kingsbury 32,758 289 13 BME 565 Nil Armstrong 4/1934 Sickness and Accidents 40,104 770 14 CMC 401 12 Austin 2/1935 Miscellaneous 20,973 214 15 CML 985 Nil Armstrong 6/1935 Sickness and Accidents 11,827 710 16 DMP 964 18/15/- Dennis 5/1936 School Work 9,334 568 17 EMF 962 12/15/- Armstrong 9/1936 Education Dept. 7,416 526 * Disposed of by auction on purchase of emf. 962. I desire to call attention to the miles run by vehicles Nos. 6 and 7 in the above table, both of which are ambulances. Vehicle No. 6 came into use in February, 1930, and by 31st March, 1937, had run 94,039 miles (i.e., in a little more than 7 years). Vehicle No. 7 came into use in January, 1931, and by the 31st March, 1937, had run 102,422 miles (i.e. in a little more than 6 years). It should be kept in mind that an ambulance which has run approximately 100,000 miles cannot be considered any longer as reliable as ambulances should be and it will therefore be seen that it is proper to assess the life of a sickness and accident ambulance at round about 7 years, having regard to the demands made on the service. Table No. 73. The following gives the miles run by each vehicle in service during the year under review:— 1. School 'Bus (MP 3711) 9,443 2. School 'Bus (MP 3712) 7,518 3. Health Department (MT 810) 9,158 4. School 'Bus (MY 967) 10,138 5. Education Department (MY 19) 4,712 6. Sickness and Accident Ambulance (MY 26) 12,845 7. Sickness and Accident Ambulance (HX 12) 13,868 8. School 'Bus (HX 5178) 9,894 9. School 'Bus (HX 5179) 9,699 10. Infectious Ambulance (MV 1800) 6,160 11. School 'Bus (MV 2860) 10,083 12. Disinfection Van (AMC 175) 8,585 13. Sickness and Accident Ambulance (BME 565) 15,190 14. Education Department and Miscellaneous (CMC 401) 12,786 15. Sickness and Accident Ambulance (CML 985) 7,932 16. School 'Bus (DMP 964) 9,334 17. Education Department (EMF 962) 7,416 Total 164,761 81 Table No. 74. Total Number of Miles Run. The following table shows the number of miles run year by year since the inception of the service:— Total Miles Run. 1913-15 56,669 1915-20 259,936 1920-25 319,862 1925-30 525,801 1930-35 672,045 1935-36 153,459 1936-37 164,761 Total 2,152,533 Table No. 75. Calls. The following table shows the number of calls for the Disinfection Van and Ambulances :— 1913 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 1/4/36 to 31/3/37 Grand Total 1913-1937 Disinfection Van 20,116 993 1,293 1,546 1,093 1,188 26,229 Ambulance Calls, including Sickness, Accident, Maternity and Infectious cases 47,234 4,700 4,324 5,310 6,592 7,347 75,507 67,350 5,693 5,617 6,856 7,685 8,535 101,736 Table No. 76. The following gives details of the miles run during the year ended 31st March, 1937:— Special school work 55,965 Accidents, Sickness and Infectious cases 35,195 Disinfection 6,984 Education Department 10,967 Education—Elementary 112 Accounts Department 1,624 Engineer's Department 193 Clerk's Department 13,661 Health Department 8,167 Municipal Hospital work 170 Miscellaneous 50 Maternity Hospital, Kingsbury 23,052 Provision of Meals 8,402 Election 125 Library Department 71 Electricity Department 7 Fire Brigade 16 164,761 Table No. 77. 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 10.28 13.90 1920-25 319,862 28,628 11.17 16.22 1925-30 525,801 41,226 12.75 12.19 1930-35 672,045 56,264 11.94 12.41 1935-36 153,459 12,936 11.863 11.810 1936-37 164,761 13,822 11.920 11.943 82 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 290 such children on the list for conveyance and on the average 226 are conveyed daily along 13 different routes. (2) The conveyance of cases of sickness, accident, maternity and infectious disease to hospitals. 7,347 such cases were removed in 1936-37. A number of these cases are out-patients taken to and from hospital for treatment. (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. Staff—The staff at 31st March, 1937, consisted of a Mechanic Superintendent, who is also Engineer to the Hospital; one assistant engineer ; one fitter's mate (skilled handy man) ; and 19 motor drivers. Since that date one motor driver has been added to the staff as provided for in estimates 1937-38. There are thus 16 vehicles to be manned and a night service to be maintained with 20 drivers. Of the 20 motor drivers three are wholly employed on vehicles Nos. 3, 14 and 17 (Table 72) ; six are allocated to seven school 'buses, six of which are in regular use and the seventh in occasional use; one driver is wholly employed on the Disinfection Van. This leaves ten men to man five ambulances and do the miscellaneous work. The work of these ten 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 3£ 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 or are undermanned when answered. It should also be noted that it is only exceptionally that any man is employed as a holiday relief. It should further be noted that with Saturday feeding of school children and the payment of wages on some Saturday mornings, three 'buses are frequently in use on Saturdays. One motor driver is on the temporary list. Special Note on Staff. Table 75 above shows the rapid increase in ambulance calls. During the three years 1-4-31 to 31-3-34 the number of calls per annum was fairly constant, being round about 4,400, but since then the calls have gone up by 1,000 each year, being over 5,000 in 1934-35, over 6,000 in 1935-36 and over 7,000 in 1936-37. This rapid increase of demands on the service requires the consideration of the Committee as calls are sometimes refused or kept waiting which is not as the Committee would desire. The reason for this delay is not on account of lack of ambulances but on account of lack of staff. In addition to delay it often happens that an ambulance is sent to an accident with only one man which is very undesirable, and often leads the public on the spot to make uncomplimentary remarks as to the inadequacy of the ambulance service. The London County Council Ambulance Service is staffed on the basis of 6 men per ambulance, which would mean that the Willesden Authority would employ 30 men instead of 10 as now employed. A great improvement in the present position would be effected if the ambulance staff were brought up to 3 men per ambulance, making 15 men for the 5 ambulances instead of 10 as at present. From records kept the greatest number of calls on the ambulance service is made between 7 a.m. and 6 p.m. With this number of staff it would be possible to have 6 men on duty for ambulance service only between the hours of 7 a.m. and 6 p.m. and 3 men on duty for ambulance service only between the hours of 6 p.m. and 7 a.m. The Resident Chauffeur would also be available in respect of any particular emergency that might arise. 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.—A petrol storage plant was installed in January, 1915, at a cost of £91 and saves about £86 per annum on present consumption, being the difference between the cost of bulk petrol and petrol in 2 gallon tins. The school 'buses and the disinfecting van, which ran last year 74,694 miles consuming 6,585 gallons of petrol, could very well use commercial petrol which is 2d. per gallon cheaper and would result in a saving of £55 per annum at the present rate of consumption. I am of opinion that an extra plant, therefore, for commercial spirit should be installed. The approximate cost of such a plant at present day rates would be £103, plus builders' work. Workshop Plant.—This is in good order and effects a great saving both in motor and hospital repairs. Certain additions are required to this plant, for example, apparatus for brake testing and welding. It would not be necessary to get these appliances for the Ambulance Station only but they would be used at the central workshop which the Council have under consideration. A tyre press, however, is desirable for the removal of the tyres; without this apparatus it is rather a heavy business for the men. The approximate cost of this tyre press is £15. Cost.—The analytical table of costs prepared by the Finance Department is appended. 83 Recommendations for the consideration of the Committee. (1) That 5 additional men be added as Motor Drivers : Approximate annual cost, £1,150. *(2) That a Storage Plant for commercial petrol be : Approximate cost—£103+builders'work, installed. (3) That a Tyre Press be purchased Approximate cost—£15. * In respect of the use of commercial petrol there would be an approximate saving of £55 per annum. MOTOR SERVICES. Year ended 31st March, 1937. EXPENDITURE. Year 1935-36. Cost per mile. Year 1936-37. Cost per mile. £ s. d. £ s. d. d. £ s. d. £ s. d. d. Running Expenses— 817 r l 4 Petrol 873 3 2 41 10 1 Oil and grease 41 2 2 108 l 11 Tyres 139 3 2 966 13 4 1-512 1,053 8 6 1.535 Wages and Emoluments— 380 0 0 Mechanic Superintendent 380 0 0 4,004 6 0 Drivers, etc 4,425 0 5 50 7 2 National Insurance 58 18 10 4,434 13 2 6-935 4,863 19 3 7.085 Fixed and General Charges— 187 0 0 Rent (Garage & Messroom) 187 0 0 157 11 11 Repairs, plant, etc. 178 17 10 68 5 6 Painting, etc., bodies of vehicles 37 13 5 79 18 9 Coal, gas, etc. 78 18 5 106 16 11 Uniforms and overalls 96 18 0 103 3 6 Insurance of vehicles 116 1 7 168 13 4 Motor car registration 169 14 3 7 10 0 Drivers' licences, etc. 8 0 0 57 11 4 Accessories and sundries 95 14 9 205 19 4 Loan charges on new garage 196 6 1 1,142 10 7 1.787 1,165 4 4 1.697 6,543 17 1 10.234 7,082 12 1 10317 DEPRECIATION AND INTEREST CHARGES. 907 13 6 Amount written off value of vehicles in accordance with Medical Officer of Health's Valuation ... 1,028 8 1 99 19 2 Interest on capital employed 88 3 4 1,007 12 8 1.576 1,116 11 5 1.626 7,551 9 9 11.810 8,199 3 6 11.943 INCOME. Use of vehicles for:— 6 13 0 Conveyance of children ... — 94 19 6 Conveyance of patients ... 34 19 6 14 1 0 Election purposes ... — 115 13 6 34 19 6 12,936 Petrol consumed (gallons) 13,822 153,459 Miles run by all vehicles 164,761 11.863 Miles run per gallon of petrol 11.920 Vehicles in use— 31st March, 1936—15 31st March. 1937—16 finance Department, Town Hall, Dyne Road, N.W.6. August, 1937. 84 APPENDICES. Appendix A.—VITAL STATISTICS. APPENDIX A.—TABLE I. VITAL STATISTICS OF WHOLE DISTRICT DURING 1937 AND PREVIOUS YEARS; VITAL STATISTICS OF THE WARDS DURING 1937. Year. Population estimated to Middle of each Year. Whole District. Births. Total Deaths Registered in the District. Transferable Deaths Nett Deaths belonging to the District. Uncor rected Number. Nett. Number. Rate per 1,000 population . of nonresi dents registered in the District. of residents not registered in the District. Under 1 Year of Age. At all Ages. Number. Rate per 1,000 population. Number. Rate per 1,000 Nett Births. Number. Rate per 1,000 popution. (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) (13) 1911 156,572 3,863 4,001 25.6 1,618 10.3 10 240 495 124 1,848 11.8 1912 159,868 3,912 4,075 25.5 1,307 8.7 27 233 328 80 1,603 10.02 1913 163,644 3,891 4,037 24.7 1,449 8.9 23 251 325 80 1,677 10.24 1914 166,634 3,971 4,115 24.7 1,501 9.0 32 283 337 82 1,752 10.51 1915 166,840 3,641 3,775 22.6 1,792 10.7 44 282 344 91 2,030 12.16 1916 167,810 3,557 3,668 21.9 1,436 8.55 34 308 283 77 1,710 10.19 1917 169,344 2,704 2,816 16.6 1,571 9.27 45 292 309 110 1,818 10.73 1918 169,358 2,520 2,651 15.65 1,975 11.66 35 338 258 97 2,278 13.45 1919 170,625 2,843 2,924 17.13 1,519 8.90 39 286 242 83 1,766 10.35 1920 170,892 4,203 4,232 24.76 1,427 8.35 50 295 274 65 1,672 9.78 1921 165,674* 3,442 3,464 20.91 1,469 8.87 54 262 255 74 1,677 10.12 1922 168,900 3,106 3,160 18.71 1,570 9.30 59 273 188 59 1,784 10.56 1923 169,831 2,977 3,063 18.04 1,380 8.13 72 280 162 53 1,588 9.35 1924 171,161 2,685 2,843 16.61 1,574 9.20 78 286 208 73 1,782 10.41 1925 172,503 2,552 2,755 15.97 1,465 8.49 83 304 170 62 1,686 9.77 1926 173,854 2,444 2,700 15.53 1,422 8.18 88 319 143 53 1,653 9.51 1927 175,217 2,286 2,568 14.66 1,513 8.64 78 296 151 59 1,731 9.88 1928 176,589 2,326 2,666 15.10 1,509 8.55 79 298 151 57 1,727 9.78 1929 177,973 2,318 2,714 15.25 1,787 10.04 107 339 165 61 2,019 11.34 1930 179,368 2,462 2,869 15.99 1,518 8.46 83 327 175 61 1,762 9.82 1931 185,704 2,066 2,838 15.28 1,676 9.03 133 392 171 60 1,935 10.42 1932 188,216 1,945 2,745 14.58 1,653 8.78 163 348 168 61 1,838 9.77 1933 190,875 1,855 2,671 13.99 1,716 8.99 213 383 123 46 1,885 9.88 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 1937 203,385 1,943 3,058 15.04 2,042 10.04 465 403 197 64 1,979 9.73 * Census population—Re-adjusted by Registrar.General to 167,200. 1. Carlton 19,087 250 358 18.76 192 10.06 2 45 31 86.60 235 12.31 2. Kilburn 16,334 99 223 13.65 126 7.71 — 37 8 35.87 163 9.98 3. Bron. desbury Park 11,434 77 130 11.37 94 8.22 7 27 5 38.46 114 9.97 4. Kensal Rise 13,363 82 175 13.10 122 9.13 1 31 7 40.00 152 11.37 5. Manor 13,497 106 191 14.15 98 7.26 — 33 18 94.24 131 9.71 6. Harl'n 16,284 172 298 18.30 183 11.24 30 23 27 90.60 176 10.81 7. Stone. bridge 18,133 466 271 14.95 501 27.63 368 15 12 44.28 148 8.16 8. Round. wood 13,381 164 283 21.15 124 9.27 1 26 23 81.27 148 11.06 9. Church End 15,836 122 239 15.09 133 8.40 8 35 15 62.76 160 10.10 10. Wille'n Green 13,673 137 265 19.38 138 10.09 — 25 18 67.92 163 11.92 11. Mapes. bury 20,208 122 213 10.54 147 7.27 6 52 13 61.03 193 9.55 12. Neas. den 14,152 62 195 13.78 63 4.45 1 24 10 51.28 86 6.08 13. Crickle. wood 18,003 84 217 12.05 121 6.72 41 30 10 46.08 110 6.11 Area of District in acres (land and inland water) 4,632.5 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. 85 Appendix A.—Table II.—DEATHS OF WILLESDEN RESIDENTS DURING THE YEAR 1937. CAUSE OF DEATH. All Ages. 0 to 1 1 to 5 5 to 10 10 to 15 15 to 20 20 to 25 25 to 35 35 to 45 45 to 55 55 to 65 65 to 75 75 to 85 85 Up. Total deaths, whether of " Residents" or "Non-Residents " in Institutions in the District. (1) (2) (3) (4) (5) (6) (?) (8) (9) (10) (11) (12) (13) (14) (15) (16) All Causes. Certified 1,979 197 49 31 19 17 38 98 102 177 342 420 364 125 1,331 Uncertified — — — — — — — — — — — — — — — 1.—Infectious and Parasitic Diseases. Typhoid Fever 1 — — — — — — 1 — — — — — — — Paratyphoid Fever — — — — — — — — — — — — — — 1 Tvphus Fever — — — — — — — — — — — — — — — Relapsing Fever (" Spirillum Obermeieri ") — — — — — — — — — — — — — — — Undulant Fever — — — — — — — — — — — — — — — Small Pox — — — — — — — — — — — — — — — Measles — — — — — — — — — — — — — — — Scarlet Fever — — — — — — — — — — — — — — — Whooping Cough 11 2 9 — — — — — — — — — — — 9 Diphtheria 17 9 8 — — — — — — — — — — 17 Influenza 76 1 — — — 1 1 3 4 11 12 20 17 6 53 Cholera — — — — — — — — — — — — — — — Dysentery — — — — — — — — — — — — — — Plague — — — — — — — — — — — — — — Erysipelas 2 — — — — — — 1 — — — 1 — 4 Acute Poliomyelitis 3 — 2 1 — — — — — — — — 2 Encephalitis Lethargica 4 — — — — — — — 2 — 1 1 — — 3 Cerebro-spinal Fever 3 — — 1 — — — 1 1 — — — — — 5 Glanders — — — — — — — — — — — — Anthrax 1 — — — — — — 1 — — — — — — 1 Rabies — — — — — — — — — — — — — — — Tetanus — — — — — — — — — — — — — — — Tuberculosis of the Respiratory System 111 1 — — 3 6 17 31 16 15 15 7 — — 65 Tuberculosis of the Central Nervous System 6 — 2 1 1 — 1 1 — — — — — — 4 Tuberculosis of the intestines and peritoneum 1 — — — — — — — — — 1 — — — 1 Tuberculosis of the vertebral column 2 — — — — — — — 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 86 Tuberculosis of other organs — — — — — — — — — — — — — — — Disseminated Tuberculosis 7 — 2 1 1 1 — 1 — — 1 — — — 5 Leprosy — — — — — — — — — — — — — — Syphilis 8 1 — — 1 — — — 2 1 1 2 — — 4 Other venereal diseases — — — — — — — — — — — — — — Purulent infection, septicaemia — — — — — — — — — — — — — — 1 Yellow Fever — — — — — — — — — — — — — — — Malaria — — — — — — — — — — — — — — — Other diseases due to protozoa — — — — — — — — — — — — — — — Ankylostomiasis — — — — — — — — — — — — — — — Hydatid Cysts — — — — — — — — — — — — — — 1 Other diseases due to helminths — — — — — — — — — — — — — — — Mycoses 1 — — — — — — 1 — — — — — — 1 Other infectious or parasitic diseases 1 — 1 — — — — — — — — — — — 2.—Cancer and other Tumours. Cancer of the buccal cavity, and pharynx 10 — — — — — 2 3 4 1 — 12 Cancer of the digestive organs and peritoneum 143 — — 1 — — — 2 2 16 49 43 29 1 94 Cancer of the respiratory organs 38 — — — — — — 1 2 9 12 9 5 — 27 Cancer of the uterus 20 — — — — — — 4 6 5 3 2 — 17 Cancer of other female genital organs 6 — — — — — — 1 1 2 1 1 — — 1 Cancer of the breast 28 — — — — — — 1 1 7 6 10 1 2 15 Cancer of the male genito-urinary organs 14 — — — — — — 1 2 9 2 — 16 Cancer of the skin 2 — — — — — — — — — 1 — 1 — 2 Cancer of other or unspecified organs 20 — — 1 1 — 1 1 2 1 7 5 1 — 9 Non-malignant tumours 5 — — — — — — 2 — 1 1 — 1 — 8 Tumours of undetermined nature 6 — — — — — — — 1 — 5 — — — 6 3.-—Rheumatism, Diseases of Nutrition and of Endocrine Glands and the General Diseases. Rheumatic fever 21 — 1 — 1 2 1 3 6 2 2 3 — — 16 Chronic rheumatism, Osteo-Arthritis 12 — — 1 — 3 5 3 4 Gout — — — — — — — — — — — — — — — Diabetes 31 — 1 — 1 — 1 — — 3 6 12 7 — 15 Scurvy — — — — — — — — — — — — — — Beri-beri — — — — — — — — — — — — — — — Pellagra — — — — — — — — — — — — — — — Rickets 1 1 — — — —. — — — — — — — — 1 Osteomalacia — — — — — — — — — — — — — — — Diseases of the pituitary gland — — — — — — — — — — — — — — — Diseases of the thyroid and parathyroid glands 4 — — — — — 1 — 1 — 1 — 1 — 2 Diseases of the thymus — — — — — — — — — — — — — 1 Diseases of the adrenals — — — — — — — — — — — — — — 1 Other general diseases 1 — — — — — — — — — — 1 — — 1 87 Appendix A.—Table II.—DEATHS OF WILLESDEN RESIDENTS (continued). CAUSE OF DEATH. All Ages. 0 to 1 1 to 5 5 to 10 10 to 15 15 to 20 20 to 25 25 to 35 35 to 45 45 to 55 55 to 65 65 to 75 75 to 85 85 Up Total deaths, whether of " Residents" or " Non-Residents," in Institutions in the District. (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) (13) (14) (15) 16 4.—Diseases of the Blood and Blood-forming Organs. Hemorrhagic conditions — — — — — — — — — — — — — — — Anaemia Chlorosis 10 — 1 — — — — — 1 2 — 3 3 — 9 Leukasmia, Aleukaemia 8 1 — — — — — 1 2 2 1 1 — 10 Diseases of the Spleen — — — — — — — — — — — — — — — Other diseases of the blood and blood-forming organs 1 — — — — — — — — — 1 — — — 1 5.—Chronic Poisoning. Alcoholism (acute or chronic) — — — — — — — — — — — — — — — Chronic poisoning by other organic substances — — — — — — — — — — — — — — — Chronic poisoning by mineral substances — — — — — — — — — — — — — — — 6.—Diseases of the Nervous System and Sense Organs. Encephalitis 4 — — 2 — — 1 — — 1 — — — — 3 Meningitis 1 — — — — — — — — 1 — — — — 2 Tabes Dorsalis (Locomotor ataxy) 1 — — — — — — — — — — 1 — — — Other diseases of the spinal cord 4 — — — — — — 1 1 — 1 — 1 — 3 Cerebral haemorrhage, Apoplexy, etc. 83 — — — — 1 — 1 1 5 14 29 24 8 48 General Paralysis of the Insane 4 — — — — — — — 1 2 — 1 — — — Other forms of Insanity 5 — — — — — — 1 2 — 2 — — — 1 Epilepsy 4 — — — 1 — 1 — 1 1 — — — — 1 Infantile convulsions (under 5 years of age) — — — — — — — — — — — — — — Other diseases of the nervous system. 23 1 — — — 2 — — 1 1 9 4 5 — 17 Diseases of the eye and annexa — — — — — — — — — — — — — — — Diseases of the ear and of the mastoid sinus 7 2 — 2 — — — 1 2 — — — — — 8 7.—Diseases of the Circulatory System. Pericarditis 1 — — — — — — — — — — 1 — 2 Acute endocarditis 3 — — — 1 — — 1 — — 1 — — — 1 Chronic endocarditis, Valvular disease 51 — — — — — — 4 3 7 10 16 9 2 21 Diseases of the Myocardium 233 — — — — — — 2 6 16 40 60 80 29 62 88 Diseases of (he coronary arteries, Angina pectoris 60 — — — — — — 1 — 6 15 28 8 2 28 Other diseases of the heart 38 — — — — — — 1 2 2 9 8 9 7 24 Aneurysm 8 — — — — — — — — 1 3 3 1 — 8 Arterio-sclerosis 66 — — — — — — — — 4 14 24 16 8 30 Gangrene 5 — — — — — — — — 3 2 — 5 Other diseases of the arteries 1 — — — 1 — — — — — — — 1 Diseases of the veins (varix, haemorrhoids, phlebitis, etc.) 1 — — — — — — — — — — 1 — — 1 Diseases of the lymphatic system (lymphangitis, etc.) — — — — — — — — — — — — — — Abnormalities of blood pressure 23 — — — — — — — 5 12 4 1 1 19 Other diseases of the circulatory system — — — — — — — — — — — — — — — 8.—Diseases of the Respiratory System. Diseases of the nasal fossae and annexa 1 — 1 Diseases of the larynx 1 1 — — — 1 Bronchitis 66 3 3 1 — — — 3 5 9 10 22 10 24 Broncho-Pneumonia 105 21 10 1 — 4 1 7 13 21 23 4 102 Lobar Pneumonia 34 1 1 1 — — 2 3 4 3 8 7 2 2 28 Pneumonia (not otherwise defined) 5 — 1 — — — 2 1 1 — 4 Pleurisy 2 — — — — 1 — 1 — — — 3 Congestion and hæmorrhage infarct of lung, etc. 5 — 1 — i 1 1 1 — 2 Asthma 10 — i 1 3 2 1 2 — 4 Pulmonary Emphysema 1 — — — — — — 1 — — — — — 2 Other diseases of the respiratory system 8 — — — — — — 1 1 1 — 4 1 — 5 9.—Diseases of the Digestive System. Diseases of the buccal cavity, pharynx, etc. 6 — — 2 2 _ — — — — 2 8 Diseases of the oesophagus — — — — — — — — — — Ulcer of the stomach or duodenum 21 — — 1 — 2 1 1 6 2 6 2 — 25 Other diseases of the stomach — — — — — — — — — 1 Diarrhoea and Enteritis 69 57 2 1 4 1 1 1 1 1 — 85 Appendicitis 15 1 — 1 1 1 1 2 2 3 2 1 18 Hernia, Intestinal obstruction 21 1 — — 1 1 1 2 8 3 2 2 20 Other diseases of the intestines 2 — — — — 1 1 — — 3 Cirrhosis of the Liver 2 — 2 — — — 3 Other diseases of the Liver — — — — — — — — — 1 Biliary calculi 5 — — — — — — 2 2 1 — 3 Other diseases of the gall bladder and ducts 4 — — — — 1 — 1 1 1 — 5 Diseases of the pancreas 1 — — — — 1 — — — — Peritonitis without stated cause 1 — — 1 — — — — — — — — — — — 89 Appendix A.—Table II.—DEATHS OF WILLESDEN RESIDENTS (continued). CAUSE OF DEATH. All Ages. 0 to 1 1 to 5 5 to 10 10 to 15 15 to 20 20 to 25 25 to 35 35 to 45 45 to 55 55 to 65 65 to 75 75 to 85 85 Up. Total deaths, whether of " Residents " or " Non-Residents," in Institutions in the District. (1) (2) (3) (4) (5) (6) (V (8) (9) (10) (11) (12) (13) (14) (15) (16) 10.—Non-Venereal Diseases of the Genitourinary System and Annexa. Acute nephritis 3 — — — — — 2 — — — 1 — — — 3 Chronic nephritis ... 25 — — — — — — — 3 1 4 5 11 1 21 Nephritis not stated to be acute or chronic 1 — — — — — — — — 1 — — — — 3 Other diseases of the kidney and annexa 4 — — — — — — — 2 — — 1 1 — 3 Calculi of the urinary passages 1 — — — — — — — — — — 1 — — 2 Diseases of the bladder 3 — — — — — — — — — 1 — 2 — 4 Diseases of the urethra, urinary abscess, etc. 1 — — — — — — — — — — — 1 — 1 Diseases of the prostate 16 — — — — — — — — 1 2 5 8 — 13 Diseases of the male genital organs — — — — — — — — — — — — — — Diseases of the female genital organs 1 — — — — — — — — 1 — — — — 1 11.—Diseases of Pregnancy, Childbirth and the Puerperal State. Post-abortive sepsis 1 — — — — — — 1 — — — — — — 1 Abortion not returned as septic — — — — — — — — — — — — — — — Ectopic gestation 1 — — — — — — — 1 — — — — — 1 Other accidents of pregnancy — — — — — — — — — — — — — Puerperal haemorrhage 1 — — — — — 1 — — — — — — — — Puerperal sepsis 2 — — — — — — 2 — — — — — — 2 Puerperal albuminuria and convulsions — — — — — — — — — — — — — — — Other toxaemias of pregnancy — — — — — — — — — — — — — — — Puerperal phlegmasia alba dolens, embolism, and sudden death 1 — — — — — — — 1 — — — — — — Other accidents of childbirth 3 1 2 2 Other or unspecified conditions of the puerperal state 1 1 12.—Diseases of the Skin and Cellular Tissue. Carbuncle, Boil 2 1 — — — — — — — — 1 — — — 2 Cellulitis, Acute abscess 1 — — — — — — 1 — — — — — 1 Other diseases of the skin and its annexa 2 1 — — — — — — — — 1 — — — 2 90 13.—Diseases of the Bones and Organs of Locomotion. Acute infective osteomyelitis and periostitis 2 — — 1 — — — — — 1 — — — — 4 Other diseases of the bones 1 — — — — — — — — — — 1 Diseases of the joints and other organs of locomotion — — — — — — — — — — — — — — 1 14.—Congenital Malformation. Congenital malformations 18 16 — — 1 — 1 — — — — — 3 15.—Diseases of Early Infancy. Congenital debility 7 7 — — — — — — — — — — — — 7 Premature birth 50 50 — — — — — — — — — — — — 29 Injury at birth 9 9 — — — — — — — — — — — — 4 Other diseases peculiar to early infancy 12 12 — — — — — — — — — — — — 5 16.—Old Age. Old age 85 — — — — — — — — — — 14 39 32 91 17.—Deaths from Violence. Suicide by solid or liquid poisons and corrosive substances 2 — — — — 1 — — — — — 1 — — 1 Suicide by poisonous gas 8 — — — — — — 3 1 — 3 1 — — — Suicide by hanging or strangulation 2 — — — 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 — — — — — — — — — — — — — — — Suicide by crushing — — — — — — — — — — — — — — Suicide by other means 2 — — — — 1 — 1 — 2 Infanticide (under one year) — — — Homicide by firearms — — — — Homicide by cutting or piercing instruments Homicide by other means 1 1 — — — — — — — — — — — — — Attack by venomous animals — — — — — — — — — — — — — — — Food poisoning — Accidental absorption of irrespirable or poisonous gas 1 — — — — — — — — — 1 — — — — Other acute accidental poisoning (not by gas) 2 — — — — — — — — 1 1 — — — 1 Conflagration — — — — — — — — — — — — — — — Accidental burns (Conflagration excepted) 5 — 1 — — — — — 2 — 1 1 — — 8 Accidental mechanical suffocation 5 3 2 — — — — — — — — — — — — 91 Appendix A.—Table II.—DEATHS OF WILLESDEN RESIDENTS (continued). CAUSE OF DEATH. All Ages. 0 to 1 1 to 5 5 to 10 10 to 15 15 to 20 20 to 25 25 to 35 35 to 45 45 to 55 55 to 65 65 to 75 75 to 85 85 Up. Total deaths, whether of " Residents" or " Non-Residents," in Institutions in the District. (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) (13) (14) (15) (16) Accidental drowning 2 — — 1 — — — — — 1 — — — — — Accidental injury by firearms — — — — — — — — — Accidental injury by cutting or piercing instruments — — — — — — — — — — — — — — — Accidental injury by fall, crushing, etc. 39 — — 4 2 — 3 5 3 4 3 8 5 2 29 Cataclysm ... — — — — — — — Injury by animals (poisoning by venomous animals excepted) Hunger or thirst — — — — — — Excessive cold — — — — — — — Excessive heat — — — — — — — — — — — Lightning — — — — — — — Electricity (lightning excepted) — — — — — — — 1 Other and unstated forms of accidental violence 4 2 — — — 1 1 — 1 Violent deaths of unstated nature (i.e., accidental, suicidal, etc.) Wounds of war — — Execution of civilians by belligerent armies Execution — — — — — — — — — — — — — — — 18.—Ill-Defined, Diseases. Sudden death — — — — — — — — — Cause of death unstated or ill-defined 2 1 — — — — — — — — — — 1 — 2 1,979 197 49 31 19 17 38 98 102 177 342 420 364 125 1,331 92 Appendix A.—Table II (a). CAUSES OF DEATH IN BOROUGH OF WILLESDEN AS CIRCULATED BY REGISTRAR-GENERAL.—1937. Causes of Death. M. F. All Causes 1,004 1,000 1. Typhoid and paratyphoid fevers — 1 2. Measles — — 3. Scarlet fever 1 — 4. Whooping cough 5 6 5. Diphtheria 6 11 6. Influenza 40 44 7. Encephalitis lethargica 2 2 8. Cerebro-spinal fever 2 1 9. Respiratory tuberculosis 74 41 10. Other tuberculosis 12 4 11. Syphilis 4 3 12. General paralysis of the insane, etc. 5 1 13. Cancer 146 138 14. Diabetes 13 17 15. Cerebral haemorrhage 25 53 16. Heart disease 184 212 17. Aneurysm 8 4 18. Other circulatory diseases 52 48 19. Bronchitis 33 32 20. Pneumonia 79 76 21. Other respiratory diseases 14 14 22. Peptic ulcer 19 4 23. Diarrhoea, etc. (under 2 years) 27 26 24. Appendicitis 9 4 25. Cirrhosis of liver 2 — 26. Other diseases of liver 2 6 27. Other digestive diseases 22 23 28. Nephritis 15 15 29. Puerperal sepsis — 3 30. Other puerperal causes — 7 31. Congenital causes, etc. 54 40 32. Senility 25 60 33. Suicide 10 8 34. Other violence 39 22 35. Other defined causes 75 74 36. Ill-defined causes — — Special Causes (included in No. 35 above):— Small-pox — — Poliomyelitis — — Polioencephalitis 3 1 Anthrax — 1 Deaths of Infants under 1 year Total 108 91 Legitimate 86 70 Illegitimate 22 21 93 APPENDIX A. TABLE III.—INFANT MORTALITY DURING 1937. 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. Roundwood. 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 55 13 10 3 81 59 29 20 8 197 31 8 5 7 18 27 12 23 15 18 13 10 10 UnCertified - - - - - - - - - - - - - - - - - - - - - - - Small Pox - - - - - - - - - - - - - - - - - - - - - - - Chicken Pox - — — - - - - - - - - - - - - - - - - Measles - — — — — — - - - - - - - - - - Scarlet Fever — — — — - - - - - - - - - - - - - - Whooping Cough — - - - - 2 - - 2 - - 1 - - - 1 - - - - - Diphtheria and Croup - - - - - - - - - - - - - - - - - - - - - - - Erysipelas — — : — - - - - - - - - - - - - - - Tuberculous Meningitis - - - - - - - - - - - - - - - - - - - - - - - Abdominal Tuberculosis (a) ... - - - - - - - - - - - - - - - -- - - - - - - - 1 Other Tuberculous Diseases — - - - - 1 - - I - -- - - - 1 - - - - - Meningitis (not Tuberculous) - - - - - - - - - - - - - - - - - - - - - - - Convulsions — - - - - - - - - - - - - - - - - - - - -- - Laryngitis — 1 — 1 - — - - - 1 - - - - - - - Bronchitis — 1 2 — 3 2 — — — — — — 1 - - - - - Pneumonia (all forms) — 1 1 2 8 6 3 3 22 2 2 1 2 - 3 - 3 4 2 1 1 1 Diarrhoea - 2 1 1 4 23 15 11 4 57 9 — — 2 6 6 5 7 2 8 4 5 3 Enteritis Gastritis — — — — — — — — — — - — — — — - - - - Syphilis — — 1 1 — — — — 1 - - - - - - - - 1 - - - - Rickets — — — — - - 1 - 1 - - - - - 1 - - - - - - Suffocation, overlying — — - 1 - 2 - 3 1 2 - - - - - - - - - - - Injury at birth 9 — 9 - - - - 9 1 - - - 1 1 - - - 1 3 2 Atelectasis 8 1 - - 9 3 - - - 12 1 2 1 1 2 2 ; 3 l Congenital Malformations (6) 4 2 1 1 8 6 2 16 1 1 1 2 4 2 - - 1 1 1 1 1 Premature Birth 31 7 6 44 6 50 10 1 1 6 1 9 4 6 4 5 2 1 2 I Atrophy, Debility and Marasmus - - - - - 6 - - 1 7 2 1 1 - - - - 1 - - - - - Other Causes 3 1 — — 4 4 1 3 - 12 2 1 1 — — 1 1 1 1 2 1 - 1 Total Deaths 55 13 10 3 81 59 29 20 8 197 31 8 5 7 18 - 12 23 15 18 13 10 10 Deaths—Legitimate 49 11 8 3 71 39 23 17 7 157 27 4 4 6 16 17 9 19 12 17 9 9 8 Illegitimate 6 2 2 - 10 20 6 3 1 40 4 4 1 1 2 10 3 4 3 1 4 1 2 Births—Legitimate ... ... ... ... ... ... ... ... ... 2,913 334 206 126 172 188 281 255 271 228 256 201 190 205 Illegitimate ... ... ... ... ... ... ... ... ... 145 24 17 | 4 3 3 17 16 12 11 9 12 5 12 Total Births ... ... ... ... ... ... ... ... ... 3,058 358 223 130 175 191 298 271 283 239 265 213 195 217 Infant Mortality Hate— Legitimate ... ... ... ... ... ... ... ... ... 53-90 80-84 19-42 31-75 34-88 85-11 60-50 35-29 70-11 52-63 66-41 44-78 47-37 39-02 Illegitimate ... ... ... ... ... ... ... ... ... 275-86 166-67 235-29 250-0 333-33 666-67 588-24 187-50 333-33 272-73 1 111-11 333-33 200-00 166-67 Infant Mortality Rate ... ... ... ... ... ... ... ... ... 64-42 86-60 35-87 38-46 40-00 94-24 90-60 44-28 81-27 62-76 67-92 61-03 51-28 46-08 Population ... ... ... ... ... ... ... ... 203,385 19,087 16,334 11,434 13,363 13,497 16,284 18,133 j 13,381 15,836 13,673 20,208 14,155 18,003 (а) Under Abdominal Tuberculosis are included Deaths from Tuberculous Pertonitis, and Enteritis, and from Tabes Mesenterica. (б) Want of Breast Milk is included under Atrophy and Debility. 94 APPENDIX A—Table IV.—CASES OF INFECTIOUS DISEASE NOTIFIED DURING THE YEAR 1937. 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. Round wood. 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) Smallpox - - - - - - - - - - - - - - - - - - - - - - - - - - - Cholera (C) Plague (P) — - — — — - — — — — — — — — — — — — — — — — — — — — — Diphtheria (including Membranous Croup). 400 6 18 20 35 39 171 68 8 33 1 1 — 126 29 13 8 11 20 64 45 29 17 9 22 7. 383 Erysipelas 68 1 1 — — 1 2 2 4 15 14 18 10 8 2 3 1 5 6 15 5 4 5 9 5 — 31 Scarlet fever 477 2 11 23 30 49 223 71 17 39 10 2 - 36 33 17 28 24 38 34 45 46 72 32 31 41 419 Typhus fever — — - - - - - - - — - - - — — — — — — ' — — — — — — — — Enteric fever 10 - - - - - - 2 3 4 - 1 - 1 - 5 — — — 1 1 1 1 — — — 7 Relapsing fever (R) - - - - - - - - - - - - - - - - - - - - - - - - - - - tinued fever (C.) Puerperal fever 13 - - - - - - - 1 11 1 — — 1 - 1 1 — — 6 — 1 — 1 2 — — Puerperal pyrexia 32 - - - - - - - 2 26 4 - - 8 1 3 — — 4 7 2 - 2 4 1 — 2 Cerebro-spinal meningitis 11 2 1 - 3 — 1 — 1 3 — — — — 2 - — — — 5 1 — 1 1 — 1 9 Poliomyelitis 10 - - 1 1 - 4 2 2 - - - — — — — — 1 2 2 — 3 1 — — 1 3 Ophthalmia neonatorum 28 28 - - - - - - - - - - - 4 - - - 2 5 5 3 2 3 3 — 1 2 Pulmonary tuberculosis 246 1 2 - 2 1 6 5 27 122 39 35 6 29 24 13 15 13 17 20 21 18 17 28 17 14 — Other forms of tuberculosis 62 1 — 2 2 1 7 9 8 21 8 3 - 7 6 6 5 2 5 5 5 6 3 5 2 5 — Whooping cough 626 67 90 79 81 86 208 6 3 3 2 1 - 80 46 34 39 37 65 68 72 41 36 25 36 47 59 Pneumonia 409 13 21 15 10 8 36 11 15 69 51 102 58 68 34 12 29 27 27 61 38 46 22 19 6 20 1 Malaria — - — — - — — — — — — — — — — — — — — — — - — — — — — Dysentery 35 - 3 3 1 4 5 5 4 7 1 1 1 6 1 2 3 6 3 1 - 2 1 2 8 - 6 Encephalitis lethargica - - - - - - - - - - - - - - - - - - - - - - - - - - - Acute polio-encephalitis 1 - - - - - - - - 1 - - - - - - - - - 1 - - - - - - - Anthrax 1 - - - - - - - - 1 - - - - - - - - 1 - - - - - - - - Totals 2,429 121 147 143 165 189 663 181 95 355 131 164 75 374 178 109 129 128 193 295 238 199 181 138 130 137 922 Note :—Puerperal Fever and Continued Fever ceased to be notifiable after 30th Sept., 1937. 95 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 1937. Statutes :— Education (Deaf Children) Act, 1937. Hydrogen Cyanide (Fumigation) Act, 1937. Public Health (Drainage of Trade Premises) Act, 1937. Factories Act, 1937. Air Raid Precautions Act, 1937. Ministry of Health :— Circulars :— No. 1591.—Overcrowding—Housing Act, 1935. No. 1596.—Notification and Treatment of Ophthalmia Neonatorum. No. 1597.—Public Health Act, 1936. No. 1598.—1. Annual Reports of Medical Officers of Health. 2. Special Reports of Medical Officers of Health to Minister of Health. No. 1599.—Public Health (Imported Food) Regulations, 1925. No. 1602.—Housing (Rural Workers) Acts, Publicity. No. 329.—The Public Health (Imported Food) Regulations, 1937. No. 1522.— Do. do. do. No. 1600.—Public Health Act, 1936—Moveable dwellings. No. 1609.—Departmental Committee on the Cost of Hospitals. No. 1605.—Local Government Act, 1929—Welfare of Blind Persons. No. 1611.—Housing Acts, 1935 and 1936, Housing (Rural Workers) Acts, etc. No. 1614.—Treatment of Tuberculosis. No. 1622.—Maternal Mortality. No. 1652.—Housing Acts 1935 and 1936. No. 1651.—Meat Inspection. No. 1639.—Public Health (Imported Food) Regulations, 1937. No. 1621.—Prevention of Blindness. No. 1643.—Local Health Services. No. 1643a.— Do. No. 1643b.— Do. No. 1646.—Midwives Act, 1936. No. 1519.—Expectant Mothers. Supply of Milk. No. 1620.—Supervision of Midwives. No. 1666.—Public Health (Imported Food) Regulations, 1937. Regulations :— No. 35.—The Public Health (Ophthalmia Neonatorum) Amendment Regulations, 1937. No. 78.—The Housing Act (Form of Orders and Notices) Regulations, 1937. No. 398.—Supervision of Midwives. Public Health (Imported Food) (Amendment) Regulations, 1937. Memoranda :— No. 62a.—Foods. Meat Inspection. 96 Orders :— No. 784.—The Midwives (Certifying Hospitals and Institutions) Order, 1937. Scheme :— Local Government Act, 1929. Welfare of the Blind (Contributions) Scheme, 1937. Local Government Act, 1929. Treatment of Tuberculosis. Home Office:— Circulars:— No. 701255/3.—Air Raid Precautions. No. 701582/10.— Do. No. 701092/14.— Do. No. 701529/42.—Anti Gas Training. No. 701562/22.— Do. No. 4.—Air Raid Wardens. APPENDIX C. REPORT ON DERMATOLOGICAL AND ACTINOTHERAPEUTIC DEPARTMENT FOR THE YEAR ENDED 31st DECEMBER, 1937. By H. D. HALDIN-DAVIS, M.D., F.R.C.P., F.R.C.S. The work of the Skin and Artificial Sunlight Clinics has continued on much the same lines as usual during the last year, the numbers of children attending both departments being well maintained, and there is no doubt about their continued popularity among the Mothers of Willesden. A step has been taken in the direction of making the skin clinic more independent and self-contained by the purchase of a diathermy machine, and its utilisation for the purpose of dealing surgically with warts, moles, nsevi, and other cutaneous blemishes, which previously had to be referred to various hospitals for treatment, as there were no facilities for this purpose in the Borough Health Centres. The Department for the treatment of ulceration of the legs and allied conditions has once more proved its utility and treated successfully many patients suffering from these disabling complaints. The clinic has now completed seven years' work. Owing to the improvement in general in the treatment of ulceration of the leg, we seldom meet with the enormous lesions previously common. Ulceration of the leg is no longer regarded by patients as more or less hopeless, and they present themselves for treatment at earlier stages, and with, on the average, excellent results. A few of the patients who attended soon after the clinic was originally opened, still present themselves for treatment from time to time, for even when it is possible to effect the healing of long standing ulceration, the resulting scar frequently tends to break down for trivial causes, and hence renewed attention becomes necessary. Nevertheless there is no doubt that with modern methods large numbers of patients, especially women, are maintained in comfort, and are enabled to do their work and enjoy life, who previously were condemned to chronic invalidism. 97 ARTIFICIAL SUNLIGHT TREATMENT, 1937. Conditions. Cases brought forward from 1936, i.e., Treatments, Waiting List Observation Cases. New Cases. Total Cases Treated. Discharged not Treated, i.e., Unable to attend, Unsuitable, Left District Waiting List. RESULTS OF TREATMENT. Cases carried forward to 1937, i.e., Treatments, WaitingList Observation Cases. Attendances Treated. Condition Improved. Treatment suspended but still under Observation. Improved or Cured. Unable to attend or Left District before treatment completed. Unsuitable or no Improvement. Cases still under Treatment (Result not yet known). (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) 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. Pre T.B - - 1 2 - 2 1 - - - - - - - - - - - - 1 -- 1 - 30 - — 1 2 — 2 1 - - - - - - 1 - - - - - 1 - 1 — 30 Debility 33 56 130 116 152 168 7 3 4 1 5 4 66 93 37 33 4 4 40 34 49 39 1,975 3,006 Anaemia 2 2 3 9 4 11 1 — — - - 2 2 2 2 2 - - - 5 - 7 37 161 Rickets 14 — 33 — 40 - 2 - 5 - 1 - 23 - 6 - 1 - 9 - 15 - 276 - Enlarged Glands 2 1 — 3 2 4 - - - - - - 1 1 1 - X-- - 3 - 3 20 28 Rheumatism — 3 — 5 — 8 — — 1 - 2 - 3 - - - 1 - 2 - 48 Nerves 2 4 3 8 5 12 - - - - - - 3 9 1 1 - - 1 2 1 2 84 176 53 66 169 141 203 203 10 3 9 1 6 7 95 107 47 39 5 5 50 45 65 53 2,392 3,419 Chronic Blepharitis - - - 7 - 6 - 1 - - - - - 2 — 3 — - — 1 - 1 - 111 Styes — 1 - - - 1 - - - - - - - 1 - - - - - - - - - 25 - 1 — 7 — 7 — 1 — - - - - 3 - 3 - — — 1 — 1 — 136 Asthma - 8 - 4 - 12 - - - - - - - 4 — 4 — — - 4 - 4 32 316 Bronchitis 6 20 16 22 21 42 1 — — - - 3 9 19 7 10 - - 5 10 5 13 1,166 754 6 28 16 26 21 54 1 — — - - 3 9 23 7 14 — — 5 14 5 1 17 1,198 1,070 Alopecia Areata - 2 - 2 - 4 - - - - - - - - - 1 — 1 — 2 - 2 - 174 General Eczema — 1 - - - 1 - - - - - - - 1 - - - - - - - - - 43 Impetigo — — 1 1 1 1 - - - - - - 1 - - 1 - - - - - - 25 2 — 3 1 3 1 6 - - - - - - 1 1 - 2 — 1 — 2 — 2 25 219 Enuresis 1 5 5 7 6 10 - 2 - - 1 - 2 7 2 2 - - 1 1 2 1 120 188 Chorea — 1 — 1 — 2 - - - - - - - 2 - - - - - - - - - 85 Chilblains — 2 - - - 2 - - - - - - - - - 1 - 1 - - - - - 12 Gastritis — 1 - - 1 - - - - - - - 1 - - - - - 1 - 1 - 10 Furunculosis — — — 3 — 3 — — — — — - 2 - - - - - 2 - 2 - 45 Otorrhoea — — — 3 — 3 — - -— - — - - 1 - - - - - - - - 9 24 Septic Spots - - 1 - 1 - - - - - - - 1 - - - - - - - - - 1 9 6 14 7 21 — 2 - - 1 3 13 2 3 — 1 1 4 2 4 129 364 Total 60 107 193 193 232 293 12 6 9 1 7 10 108 148 56 61 5 7 56 67 72 78 3,744 5,238 167 386 525 18 10 17 256 117 12 123 150 8,982 TOTAL NUMBER OF ATTENDANCES, YEAR 1937. CASES REFERRED BY 0-5 School. Total. 0-5 Attended and Treated 3,744 5,238 8,982 Clinic Doctors 188 180 368 Attended for examination, e.g., new cases, . s 19 cases treated and still under observation, Private Doctors unsuitable cases 209 , 229 438 _ 1 5 6 Hospital 1 0 0 Total 3,953 j 5,467 9,420 Total 193 193 386 Total number of sessions 446 I—————— Average attendance per session 21-12 Average treatment per child 20.13 98 APPENDIX D. REPORT ON WORK IN THE EYE DEPARTMENT FOR THE YEAR ENDED 31st DECEMBER, 1937. 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 six years are given for comparison. Total attendances. 1931 6,118 1932 7,303 1933 7,385 1934 6,482 1935 6,404 1936 6,025 1937 5,585 Refraction Cases. Appointments made. Appointments kept. Percentage Attendance. 1931 1,427 1,220 85.5% 1932 1,782 1,546 86.7% 1933 1,525 1,352 88.7% 1934 977 858 87.8% 1935 831 737 88.7% 1936 1,055 916 86.8% 1937 941 821 87.2% The figures for the year are as follows :— Table I. Total Attendances. Number of Sessions. Average Number of Attendances per Session. Clinic 1 1,711 48 35.6 Clinic 2 1,789 48 37.3 Clinic 3 2,085 48 43.4 Refraction Cases. Table II. Appts. made. Average per S ession. Appts. kept. Average per Session. Percentage Attendances. Clinic 1 304 6.3 253 5.3 83.2 Clinic 2 313 6.5 278 5.8 88.8 Clinic 3 324 6.8 290 6.0 89.5 The following table shows an analysis of diseases and congenital abnormalities found in new cases during; the vear:— Table III. Diseases of the Eyelids, Conjunctiva and Lachrymal Apparatus. Disease. 1934 No. of cases. 1935 1936 1937 Conjunctivitis 116 164 138 122 Hordeolum 18 38 30 23 Blepharitis 40 30 48 38 Meibomian Cyst 13 18 11 19 Sebaceous Cyst - 1 4 2 Eczema — 2 2 3 Injuries and infections of lids 11 27 26 17 Ophthalmia Neonatorum 4 4 3 1 Warts 1 1 1 2 Subconj unctival Ecchymosis 3 2 9 2 Ectropion ... 1 — 1 — Obstruction and infection of Lachrymel passages 13 17 28 32 99 Type of Squint. Concomitant Squint. No. of cases. 1934 1935 1936 1937 Alternating Convergent 13 15 26 19 Alternating Divergent 1 2 1 1 Right Convergent 48 55 44 43 Right Divergent 3 — 2 3 Left Convergent 86 87 50 68 Left Divergent 3 2 3 5 Right Upward — 1 — — Left Upward 1 1 — Diseases of the Eyeball. Disease. 1934 No. of cases. 1935 1936 1937 Corneal ulcer and abrasion 21 12 8 13 Interstitial Keratitis — 1 1 1 Foreign Body 6 9 9 14 Episcleritis 1 — 1 2 Iridocyclitis 1 — 1 3 Cataract 1 — — 1 Buphthalmos 1 1 — — Retina (diseases of) 3 2 5 3 Choroid (diseases of) — 2 1 1 Congenital Malformations and Defects. Defect. 1934 No. of cases. 1935 1936 1937 Congenital Nystagmus 5 5 3 3 Microphthalmos 1 1 3 2 Epicanthus 2 4 6 2 Congenital Ptosis 2 3 2 4 Persistent pupillary membrane 1 — 1 2 Congenital Cataract 3 4 2 4 Dislocation of Lens 1 1 1 1 Coloboma of Iris 1 1 — 1 Congenital Abnormalities of Retina and Optic Disc ... 2 2 2 2 Dermoid Cyst — 1 1 1 Neurological Cases. 1934 1935 1936 1937 Number of cases 5 4 3 10 The following cases were admitted to Hospital for operation :— Squint 5 Detachment of Retina 1 Perforating Injury 1 Total 7 The routine at the Health Centres has remained unaltered. The work of the nursing staff, optician and district visitors has been efficiently maintained. The padbridge spectacle frame adopted in 1936 has remained deservedly popular on account of its greater strength and more pleasing appearance. Several cases of squint attended the Orthoptic Department of the Royal Westminster Ophthalmic Hospital during the year. There has been a noticeable absence of severe cases of chronic blepharitis and conjunctivitis during 1936 and 1937, although mild cases are relatively common. 100 APPENDIX E. REPORT ON THE WORK OF THE ORTHOPAEDIC CENTRE FOR THE YEAR ENDED 31st December, 1937. By' H. J. SEDDON, F.R.C.S., Orthopaedic Surgeon to the Council. In my report on the work of the Orthopaedic clinic during the year 1936 I drew attention to certain defects in the organisation due, not to any fault peculiar to Willesden, but to the limitations imposed on us by the legislation providing for the care of the cripple. I was concerned most of all with those children whose condition is such that it is desirable that they should be kept under observation, and perhaps treated, long after school-leaving age. On September 11th, 1937, the leading article in the "Lancet" dealt at some length with this same subject, under the title "Continuity in Orthopaedics," and the Willesden report was quoted extensively. The "Lancet" however, developed the theme on broader lines, and so wisely that I am taking the liberty of repeating what was said : "The orthopaedic clinic is only open to children attending a welfare centre or a public elementary school; other municipal services, such as provision for the treatment of tuberculosis and for vaccination, the fever and maternity hospitals and V.D. clinics are available for all ratepayers. The solution of the particular evils to which Mr. Seddon has properly drawn attention should be amenable to the broad principle which has been successful in a neighbouring field. Tuberculous disease, whatever the site of the lesion or the age of the patient, is recognised by the State for purposes of treatment. The principle is the same whether the disease is or is not pulmonary ; for our present argument tuberculous disease of the joints is most instructive. An orthopaedic surgeon attends a clinic in a county borough, which is a recognised authority for treating tuberculosis. He sees cases of joint tuberculosis side by side with ordinary orthopaedic cases. Among the first group he is free to treat or follow up a case to any age ; in the second, official recognition ceases the moment the child leaves school. True, a post-school patient may be dealt with, so far as payment for treatment is concerned, under public assistance, but this entails the drawback that every case has to be considered by the committee on its merits. Why should not non-tuberculous crippling diseases be put on the same footing as the other conditions that we have just enumerated ? A cripple may not be a menace to society like the patient with pulmonary tuberculosis or venereal disease—but neither for that matter is the patient with a tuberculous joint. He is, however, often a burden to society, to his family, and to himself; financially, too, a persistent burden, for his disease does not, as a rule, diminish his expectation of life. The logical step would be to extend official supervision to the crippled or maimed of all ages, not forgetting the manifold forms of arthritis. It will be objected that the cost would be prohibitive. But someone is paying already for the maintenance of people crippled through lack of adequate treatment, or for treatment that is not properly equipped and organised. Efficient handling of children has already banished the more gross crippling defects, and long periods of hospital treatment are becoming less necessary. Such expenditure has come to be regarded as a long-term investment, and for young adults the term would still be long. The cost would be diminished by the fact, of which they need no reminder, that local authorities are at liberty to recover part or all of the money spent on treatment from the patient himself or from his family. Whatever may be the derivation of the word orthopaedics—and no word in the medical vocabulary has been more misunderstood—the orthopaedic hospital and the orthopaedic surgeon have long ceased to limit their activities to straightening children. Orthopaedics has grown up and the State would do well to recognise its majority." It is, unfortunately, only too clear that until the legal limitations of our work are removed, conditions will remain satisfactory only for the majority of pre-school and school children. However, Willesden has done its best to extend the service of the Orthopaedic Clinic along the lines suggested and, on October 5th, I received the following memorandum from Dr. Buchan, the Medical Officer of Health : "In December last, authority was given for the Middlesex County Council to be approached on the question of the treatment of orthopaedic cases above school age, as the County Council were then the competent authority. The Council are now authorised to afford this treatment by Section 181 of the Public Health Act, 1936, and we recommend that the Medical Officer of Health be instructed to carry out this work in conformity with the Act." The Borough may congratulate itself on having made excellent use of one of the provisions of the 1936 Act; we are already beginning to benefit from this new ruling, and its value will be cumulative. 101 ORTHOPEDIC DEPARTMENT.—REPORT FOR YEAR 1937. 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-! 1-5 5-14 N.M. Total. 1. Congenital Defects— Club Foot 12 5 4 — 1 — 12 6 4 - 22 1 - 1 - 2 - 1 1 - 2 11 5 2 - 18 Dislocation of Hip — 1 5 - - - - - 1 5 - 6 - - 1 - 1 - 1 - - 1 - - 4 - 4 Spastic Paralysis 1 15 8 - — 1 2 - 1 16 10 - 27 - 2 - - 2 - 3 1 - 4 1 11 9 - 21 Metatarsal Varus 3 16 — 1 7 — 4 23 - - 27 - - - - - 1 - - - 7 3 17 - - 20 Irregular Toes — — — 11 8 11 11 g 11 - 30 3 2 g - 13 2 3 3 - 8 6 3 - - 9 Hammer Toes — — 5 — — — 1 - - - 6 - 6 - - 2 - 2 - - - - - - - 4 - 4 Other Conditions 17 30 25 8 11 5 25 41 30 - 96 2 5 6 - 13 3 17 10 - 30 20 19 14 - 53 Spina-Bifida — 1 — 1 3 1 1 4 1 - 6 1 2 - - 3 - - - - - - 2 1 - 3 2. Birth Injuries— Nerve Injuries - 4 2 — — — - 4 2 — 6 - 1 - - 1 - - - - - - 3 2 - 5 Torticollis 15 2 3 - 13 3 1 - 28 5 4 - 37 2 - 1 - 6 1 - - 7 20 4 - 27 Other Conditions — 1 — — - 2 - - - 3 - - 3 - - - - - - 1 - - 1 - 2 - - 2 3. Rickety Deformities Bow Legs 4 24 1 — 5 50 2 - 9 74 3 - 86 5 29 2 - 36 2 15 1 - 18 2 30 - - 32 Knock Knees 1 7 3 — 9 6 1 16 9 - 26 - - 2 1 5 - 1 2 - 3 1 12 5 - 18 Other Conditions 1 9 1 — 15 5 - 1 24 6 - 31 - I 2 - 3 - 5 1 - 6 1 18 3 - 22 4. Knock Knees, non-Rickety — 55 41 — 56 44 - - 111 85 - 196 - 12 23 - 35 - 36 13 - 49 - 63 49 - 112 4a. Bow Legs, non-Rickety 12 62 — — 9 — 12 71 — — 83 6 9 - - 15 4 20 - - 24 2 42 - - 44 5. Postural Defects of the Spine 1 7 60 1 1 83 - 2 8 143 - 153 2 43 - 45 - 37 38 2 5 63 - 70 6. Structural Defects of the Spine — 1 9 — — 1 7 — 2 16 18 - - 4 - 4 - - 4 - 4 - 2 8 - 10 7. Flat Feet 1 39 38 1 1 19 45 3 2 58 83 4 147 — 4 27 1 32 1 8 26 1 36 1 46 30 2 79 Hallux Valgus - - 4 - - - - - - - 4 - 4 - - - - - - - 4 - 4 - - - - - 8. Infantile Paralysis 4 7 14 — 1 1 - - 8 15 — 23 - 1 2 - 3 - - 3 - 3 - 7 10 - 17 9. Sequelae of Acute Fevers— Scarlet Fever 3 — — 1 1 - - 4 1 - 5 - 2 1 - 3 - - - - - - 2 - - 2 Diphtheria — 2 — 1 1 — - 1 3 — 4 - - 2 - 2 - - - - - - 1 1 - 2 Mastoid 1 — 2 — - 1 - 1 - 3 - 4 - - - - - - - - - - 1 - 3 - 4 Whooping Cough — — — 1 - - - 1 — — 1 - - - - - - - - - - - 1 - - 1 Pneumonia — — - — — 1 — - - 1 — 1 - - - - - - - - - - - - 1 - 1 10. Fractures and other Injuries 3 15 4 5 86 2 4 8 101 2 115 3 4 74 I 82 - 2 20 1 23 1 2 7 - 10 11. Tuberculosis Joints 3 7 — 1 4 - - 4 11 — 15 - - - - - - 1 - 2 - 3 10 - 13 12. Other Bone Diseases, non-T.B. - Schlatter's Disease - - 3 - - - - - - - 3 - 3 - - - - - - - - - - - - 3 - 3 Perthes' Disease - - 3 - - - 2 - - - 5 - 5 - - 2 - 1 - - - - - - - 4 - 4 Calve's Osteochondritis — — 1 - - - - - - - 1 - 1 - - - - - - - - - - - - 1 - 1 Arthritis of the Knee - - - - - I - - - 1 - - 1 - - - - - - - - - - - 1 - - 1 Exostosis of Os Calcis - — 4 - - - 12 - - - 16 16 - - 9 - 9 - - 2 - 2 - - 5 - 5 Tumour of the Scapula — — 1 - - - 1 - 1 - - - - 1 - - - - - - - - - - Prominence of Costal Cartilage — 1 — — — 2 — - 1 2 — 3 - - 1 - 1 - - 1 - 1 - 1 - - 1 13. Osteomyelitis - - - - - - - - - - - - - - - - - - - - - - - - - - - - 14. Other Conditions — —' — - - 4 2 - - 4 2 — 6 - - - - - - I - - 1 - 3 2 - 5 Debility and Delayed Walking - 5 - - - 5 - - l 10 - - 11 - 2 - - 2 - 3 - - 3 1 5 - - 6 Fibrositis — 1 1 1 - - - - - 1 1 1 3 - 1 - 1 2 - - 1 - 1 - - - - - Muscular Dystrophy — 1 1 — — — — — 1 — 2 — — 1 1 — 2 Ganglion 1 1 1 — - 3 — 1 1 4 — 6 1 1 1 2 - — 1 1 - 2 Postural I ntoeing — — — - - 5 - - - 5 — — 5 - - - - - - 1 - ' 1 - 4 - - 4 Sciatica — — — — - - 2 - — 2 2 2 2 15. Non-Orthopaedic — — — 1 8 11 1 g 11 — 1 20 j 2 8 10 24 1 1 1 6 2 9 Nothing Abnormal Diagnosed - 10 5 2 7 9 4 - 7 19 9 2 37 6 12 6 - 1 5 3 1 10 - 2 - 2 3 Un-Diagnosed — — - 1 — 3 - 1 - 3 — 4 — - - — — - - - — 1 — 3 - 4 Total 70 314 269 4 55 238 347 7 125 552 616 11 1,304 29 96 228 3 356 21 132 137 3 293 75 324 251 5 655 No. of Individual Cases treated 68 186 257 2 39 194 264 2 107 380 521 4 1,012 29 96 228 2 355 21 132 137 - 290 57 152 156 2 367 No. of attendances at Centre for Treatment 505 1,772 5,754 37 8,068 Do. do. do. Massage 423 '823 1,187 32 2,465 Do. do. do. Electrical Treatment 209 727 18 954 Do. do. do. Gymnastic Exercises 638 4,001 24 4,663 Do. do. do. Application of Splints 82 140 41 — 263 ‡ Total 505 1,810 5,956 74 8,345 No. of attendances at Centre for examination only 72 554 665 4 l,295f Total attendances at Centre 577 2,326 6,419 41 9,363f Patients entered Hospital for In-patient Treatment— Congenital Defects— Admitted. Discharged. Club Foot . G.D 22. 2.37 14. 7.37 1 - — - 1 M.L 26. 6.37 21. 7.37 - 1 - - 1 Dislocation of Hip J-B 16. 4.37 24. 5.37 - 1 - - 1 M.W 4.10.37 - - 1 - 1 Spastic Paralysis . H.B 19. 8.37 27. 8.37 1 - 1 Pes Cavus J.Y 23. 3.37 25. 6.37 - - 1 - 1 D.B 27. 4.37 5. 7.37 - 1 - 1 Friedreich's Ataxia . C.S 23. 4.37 5. 7.37 - - 1 - 1 Deformed Fingers . A.D 25. 8.37 - - 1 - - 1 Birth Injuries—Torticollis . E.B 26.: 11.37 28.11.37 — - 1 - 1 Rickets—Bow Legs JH 23. 3.37 28. 6.37 - 1 — - 1 L.A 14. 7.37 4. 8.37 - 1 — — 1 J-B 6. 8.37 7. 9.37 — 1 — — 1 J-J 26. 8.37 29.10.37 - 1 - - 1 Knock Knees . R.H 15. 6.37 23.10.37 - - 1 - 1 Flat Feet JL 12.: 11.37 - - 1 - 1 Hallux Valgus K.M 23. 3.37 16. 4.37 - - 1 - 1 Infantile Paralysis M.T 4. 2.37 16. 3.37 - - 1 - 1 6. 4.37 29. 4.37 — — — — 10. 8.37 13.10.37 - - - - - D.O 14. 2.37 12.11.37 - 1 - 1 Dislocation of Shoulder . E.L 16. 3.37 7. 4.37 - - 1 - 1 Tuberculosis Joints . M.W 29. 1.37 - - 1 - - 1 D.G 4. 2.37 27. 8.37 - - 1 - 1 Removal of Osteophytes . A.S 5. 7.37 10. 8.37 - - 1 - 1 'Perthes' Disease J.P 1. 9.37 11. 9.37 - - 1 - 1 Amputation of Toe . N.G 22. 2.37 13. 3.37 — - 1 - 1 Investigation J-J 20. 3.37 16. 4.37 — — 1 — 1 K.C 5. 7.37 25. 7.37 - - 1 - 1 I.A 6. 8.37 - - 1 - - 1 M.K 30. i 11.37 24.12.37 - - 1 - 1 P.G 22. 12.37 1 - - — 1 Total 2 0 19 30 In addition to the above the Council agreed to bear the cost of treatment of 1 child under 5 years of age and 1 child over 5 years of age at the Royal National Orthopaedic Hospital and also of 1 child over 5 years of age who was transferred to the Royal National Orthopaedic Hospital from the Willesden Municipal Hospital after Poliomyelitis. lne * This case was treated for the middlesex county Council who bore the cost of treatment. † In addition there were 2 attendances by adults for examination only for flat feet. ‡ These totals are greater than those under JSJo. of attendances at Centre for treatment " above because a child may receive more than one type of treatment at one attendance. 102 APPENDIX F. REPORT ON THE WORK OF THE EAR, NOSE AND THROAT DEPARTMENT for the Year Ended 31st December, 1937. By G. H. LIVINGSTONE, F.R.C.S., Ear, Nose and Throat Surgeon to the Council. During the year 1937 children with enlarged tonsils and adenoids have been operated upon at the Municipal Hospital. This is the first report on a full year's work. The total number of children referred to the Throat Specialist from the three Health Centres is 1,284. The number of cases referred for operation on tonsils and adenoids is 946. The total number of operations carried out at the Hospital is 618. Centre 1 Centre 2 Centre 3. Total. Total No. of M.C.W. 25 101 cases seen. S.M.S. 266 — 424 291 468 525 Cases seen 1,284 Total No. referred M.C.W. 22 94 68 for operation. S.M.S. 220 259 283 242 353 351 Referred for operation 946 Boys. Girls. Boys. Girls. Boys. Girls. N o. of operations M.C.W. 8 3 28 30 40 28 performed. S.M.S. 48 49 95 89 119 68 108 242 255 Operations performed 605 Children who have had their operations are returned to Centres 1 and 3 for breathing exercises which have proved most beneficial. Municipal Hospital—Ear, Nose and Throat Cases Admitted during 1937. For : Boys. Girls. T otal. Removal of tonsils and adenoids 306 254 560 Removal of adenoids only 15 12 27 Mastoidectomy 8 7 15 Other conditions 3 5 8 Cases admitted, but not operated on for various reasons 5 3 8 337 281 618 Patients in Hospital operated on for : Tonsils and adenoids 8 8 16 Antrum punctures 1 — 1 Mastoidectomy 2 1 3 11 9 20 During 1937 cases with chronic mastoid disease have been admitted to the Hospital for operation. The average period of these cases is three weeks, and after this time the children attend for dressings at their respective health centres, or, in particular cases, the surgical block at the Hospital. The total of cases operated on for mastoid disease is 18 (15 from the health centres and 3 acute cases from the Hospital). The Scheme is working smoothly and the numbers of cases referred, and operations performed, are increased compared with the corresponding period last year. 103 APPENDIX G. MIDWIVES ACT, 1936. I.—SPECIAL REPORT OF HOSPITAL VISITING COMMITTEE. (.Adopted by the Willesden Town Council on the 2&h January, 1937.) 1.—The Midwives Act, 1936, places large responsibilities upon the Willesden Borough Council. The Minister of Health has issued Circular 1569 and Memo. 200/M.C.W. explanatory of the Act. In paragraph 1 of the Circular he states that the principal object of the Act 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. Your Committee have kept this object before them throughout the prolonged consideration they have given to the many problems that have arisen during their discussions. 2.—Your Committee have received communications from and have had consultations with all voluntary organisations known to them as employing or willing to employ domiciliary midwives and organisations representing midwives and medical men practising in Willesden, namely, Queen Charlotte's Maternity Hospital, Kilburn and West Hampstead District Nursing Association, the North West Middlesex Branch of the Midwives' Institute, the Willesden District Nursing Association and the Willesden Division of the British Medical Association. 3.-—The scheme which is now submitted for carrying out the Act has been prepared by your Committee in accordance with the requirements of the Act and embraces provision for the employment of whole-time salaried midwives and maternity nurses. For the information of the Council it should be stated that a midwife is a midwife when she is engaged to deliver a woman and that a midwife is a maternity nurse when she is employed to assist a medical practitioner who has been so engaged. 4.—As regards midwifery your Committee are of opinion that the arrangements to be made under the Act should be such as to secure for the mothers of Willesden the best possible midwifery in their homes properly linked up with complete arrangements for dealing with any emergency that may arise. They have accordingly divided Willesden into two areas, namely (1) the South Kilburn area, i.e., the area bounded on the North by L.M.S. Railway, on the West by and including Claremont Road and on the South and East by the Boundaries of Willesden ; and (2) the rest of Willesden. Your Committee propose that the South Kilburn area be allotted to Queen Charlotte's Maternity Hospital with its home situate at 40, Princess Road in that area and that midwifery in the rest of Willesden be provided for directly by the Council by the establishment of a midwives' home linked up with the maternity service of the Council and the Willesden Maternity Hospital. It will be observed that both the areas are thus ultimately dependent on first-class maternity hospitals. 5.—WTith regard to maternity nursing your Committee propose that the maternity nursing for the whole of Willesden should be carried out by the Willesden District Nursing Association. 6.'—Paragraph 4 of Circular 1569 states that "one of the main objects of the Act is to improve the status of the midwifery profession. Accordingly the Minister regards it as of the utmost importance that the midwives employed in the new service should be adequately remunerated. The work to be carried out by them is in his view at least as important as the work carried out by health visitors, and he feels confident that local authorities will in respect of the midwives appointed by them adopt scales of salaries which are comparable with those applicable to health visitors employed in the same district, together with appropriate allowances for travelling expenses, and that their contributions to voluntary organisations will be sufficient to enable those organisations to pay adequate salaries to all the midwives they employ." Your Committee accept this view and are of opinion that the midwives employed directly by the Council and by Queen Charlotte's Maternity Hospital and the maternity nurses employed by the Willesden District Nursing Association should possess the same qualifications and have as nearly as possible the same conditions of service. The bodies concerned have agreed that the domiciliary midwives to be employed by them will be fully trained general nurses holding the C.M.B. Certificate, subject to the condition that in the case of Queen Charlotte's Hospital this will not apply until the present midwives employed by Queen Charlotte's Hospital District Home, Kilburn, come to be replaced. With regard to salaries your Committee propose that the midwives directl_v employed by the Council shall receive salaries at the same rate as those of Health Visitors with a deduction of £150 per annum for board, lodging, washing and other emoluments. Queen Charlotte's Maternity Hospital have also agreed to this scale of salaries. The Willesden District Nursing Association refuse to pay this scale of salaries to the midwives employed by them on behalf of the Council on the grounds that the salaries of their nurses are fixed by the Queen's Institute to which the Willesden District Nursing Association are affiliated. Your Committee are unable to accept this refusal as they feel strongly that all persons similarly employed under the auspices of the Authority should receive similar rates of pay. Your Committee have accordingly included in the estimates for Maternity Nursing submitted in this report an additional provisional sum of £100, subject to final revision, so that the Willesden District Nursing Association may be able to pay the salaries as required by the Authority. 7.—Your Committee have considered a scale of fees applicable on an income basis for persons using the midwifery or maternity services provided under the Act. This scale of fees is attached to 104 this report. Your Committee have had discussions with Queen Charlotte's Hospital and the Willesden District Nursing Association as to the collection of these fees. These bodies have expressed the opinion that the collection of these fees either in whole or in part should rest with them. We have been unable to come to agreement on this point as we are of opinion that the Council should assess and collect the fees for the whole of Willesden on the same basis so that as far as possible all residents receive the same measure of consideration. The machinery already exists in the Health Department for this purpose and after prolonged consideration of this subject we remain of the opinion that this is a matter with which the Council alone should deal. The Extent of the Problem. 8.—The following table gives particulars of midwifery in Willesden.— Year. Births notified by District Midwives. Births notified by Doctors. Births in Institutions. Total Births notified. 1931 515 1,174 1,110 2,799 1932 457 997 1,220 2,674 1933 532 776 1,357 2,665 1934 610 680 1,436 2,726 1935 589 568 1,706 2,863 It will be observed from the foregoing table that the number of births in institutions is increasing, the number of births dealt with by district midwives is more or less stationary, while the number of births attended by doctors is diminishing. 9.—The Act requires the Council to secure that there shall be available in the area for attendance on women in their own homes either as midwives or as maternity nurses, an adequate number of whole-time salaried midwives. From the foregoing table it may reasonably be assumed that the Council require to secure the provision of whole-time salaried midwives for 600 cases of district midwifery per annum, being the approximate number of cases now annually notified by district midwives in the above table, and midwives as maternity nurses for a proportion of the approximate number of 600 cases notified by doctors. It is estimated that 400 of these 600 doctors' cases would utilise the maternity nurses provided under the Act and that the remaining 200 doctors' cases would probably make their own private arrangements for maternity nursing. It is estimated then that the Council have to make provision for 600 cases of midwifery and 400 cases of maternity nursing. Midwifery. 10.—The Council have to secure the provision of midwives for 600 cases of midwifery per annum by the employment of whole-time salaried midwives either directly or through voluntary associations. In estimating the total number of midwives necessary for this work it has to be borne in mind that ante-natal attendances on a case, attendance at labour and nursing for the prescribed period of 14 days afterwards will on an average occupy 28 hours of a midwife's time. It has also to be remembered that from time to time a midwife will be off duty on account of sickness or infection and will be required to attend refresher courses under the Act. (The Central Midwives Board in a Circular Letter dated 10th December, 1936, propose that this refresher period shall be for one month in every seven years.) Taking all these factors into consideration, the number of cases that a midwife will be able to attend per annum is 65-70 and on the basis of the figures in the previous table the Council would require to secure the employment of nine whole-time salaried midwives for the estimated 600 cases. 11.—Present System of District Midwifery.—During the past five years the estimated number of 600 cases of district midwifery in Willesden has been dealt with as under :— 1931. 1932. 1933. 1934. 1935. (1) Queen Charlotte's Hospital District Home—Kilburn 229 206 194 189 162 (2) Queen Charlotte's Hospital District Home—Ladbroke Grove 36 25 21 26 20 (3) Kilburn and West Hampstead District Nursing Home 27 23 31 35 51 (4) Independent district midwives living and practising in Willesden 251 249 233 251 267 (5) Independent district midwives practising in but living outside Willesden 11 15 30 32 36 Totals 554 518 509 533 536 Note.—It will be observed that the annual totals do not correspond with the figures for births notified by district midwives in the preceding table but the totals for the five years in the respective tables are 2,650 and 2,703. The figures in the above table are obtained from midwives at the end of the year by circular letter while the figures in the first table are obtained by the addition of the births notified under the Notification of Births Acts, 1907 and 1915. 105 12.—Arrangements proposed under the Act.—Paragraph 16 of Memo. 200/M.C.W. of the Minister of Health states that the Act requires that the proposal submitted by the Authority to the Minister should include particulars of the parts of the area to be served by the midwives to be employed. It is accordingly proposed that the nine whole-time salaried midwives required be employed as under :— By arrangement with Queen Charlotte's Maternity 3 midwives for approximately Hospital for the South Kilburn area as defined 200 cases. Employed directly by the Local Authority for the 6 midwives for approximately rest of Willesden 400 cases. 13.—Queen Charlotte's District Home, Kilburn.—This is a midwives' home maintained by Queen Charlotte's Maternity Hospital for district midwifery and the training of pupil midwives. Your Committee desire to state that the proposals now submitted will not in any way restrict this valuable work of training. Queen Charlotte's Maternity Hospital have not hitherto been paid any sums by the Council in respect of any necessitous cases of district midwifery which they may have undertaken. An agreement has been reached by your Committee by which Queen Charlotte's Maternity Hospital agree to employ three whole-time salaried midwives at the Queen Charlotte's Hospital District Home, Kilburn, and carry out the whole of the midwifery in the South Kilburn area as defined, the local authority on their part paying to Queen Charlotte's Hospital a sum of £1,180, being the estimated cost for the first year of working. The details of the agreement which it is proposed to enter into with Queen Charlotte's Maternity Hospital will be found in Appendix I. 14.—Kilburn and West Hampstead District Nursing Association.—The Kilburn and West Hampstead District Nursing Association does comparatively little midwifery work in Willesden over a wide area on the borders of Willesden from Kilburn Park Road to Cricklewood Broadway, a distance of over two miles and about half a mile westward. The number of cases with which this Association deals has only recently increased, apparently by reason of the payments which the Council have been making to the Association since May, 1933. The following table gives particulars of the total number of cases dealt with by the Association in Willesden since 1931 together with the approximate number of cases paid for by the Willesden Borough Council:— Approximate No. of cases paid for Total Cases. by Willesden. in Willesden. Borough Council. 1931 27 0 1932 23 0 1933 31 5 1934 35 18 1935 51 48 1936 (Jan. 1st to Dec. 17th) 70 59 Having regard to the wide area in which this Association does few cases and to the other facts mentioned above, it does not appear to be practicable or desirable to enter into any formal agreement with this Association and your Committee do not propose that any arrangements shall be made with them under the Act. 15.—Willesden District Nursing Association.—Your Committee have received communications from this Association to the effect that they are willing to undertake midwifery in Willesden. The Willesden District Nursing Association have not hitherto done any midwifery work and your Committee think it undesirable to encourage any new agency in connection with midwifery—a subject to which the Council have given great attention over a number of years and with the difficulties and emergencies in relation to which they have become familiar as the result of their experience of ante-natal work and the admission of cases to their Maternity Hospital. In these circumstances it is not proposed that any arrangements be made with the Willesden District Nursing Association for midwifery work. 16.—Employment of Midwives by the Local Authority.—With regard to the number of midwives to be employed by the Council, it is stated above that six would be required for the annual number of midwifery cases with which it is estimated the Council would be called upon to deal. Apart from the favourable position in which the Council find themselves for undertaking midwifery work with their very complete ante-natal clinics and Maternity Hospital as supporting institutions, it should be remembered that with a district midwifery service such pupil midwives in training at the Willesden Maternity Hospital as may require district training will be able to obtain it at the Council's own district home. 17.—Scale of Fees for Midwifery.—Under the Act the Council is required to fix a scale of fees payable for the attendance of midwives and to recover the fees except in cases in which the Council remit the fees in whole or in part on account of the financial circumstances of the patient. It is proposed that the economic circumstances scale should be one-half that for confinement in hospital, and that assessment and collection be carried out by the Borough Council for all cases in the same way as for Hospital confinements and other services. 106 18.—Estimated Costs of Midwifery Arrangements.—It is estimated that the cost to carry out the Act on the foregoing lines will be as follows (1) Contribution to Queen Charlotte's Maternity Hospital 1,180 1,379 (2) Cost of Midwives employed directly by the Council. Annual repayment of loans :— £ i One House. £4,000 at 3i% for 30 years 216 216 Alterations and repairs : £1,000 at 3i% for 10 years 120 120 Furniture and equipment : £2,000 at 3J% for 10 years 240 240 Heated garage accommodation: £500 at 3£% for 30 years 28 28 Salaries and Allowances Superintendence of Midwives 188 218 Seven midwives (resident) (£105—£15—£195) 735 1,365 Uniform allowances—Seven midwives at £12 per annum 84 84 Car allowances 364 364 One Cook-Housekeeper (resident) (£80—£10—£100) 80 100 Three maids (£60—£10—£80) (resident) 180 240 Holiday and sickness domestic relief 30 30 Uniform—Four domestic staff at £5 20 20 Food 360 360 Lighting, heating and laundry 300 300 Rates and taxes 100 100 Telephone 80 80 Repairs to houses 100 100 Replacements of furniture, ironmongery, table and household linen 30 50 Disinfectants, drugs, etc. 100 100 Refresher courses 20 20 Insurance—Third party 10 10 Clerical assistance and investigations 100 100 Printing, stationery and postage 10 10 Superannuation and State Insurance 175 215 Garden and window cleaning 60 60 Contingencies 100 100 Gross Cost 3,830 4,630 Less : Sums now paid for necessitous cases of midwifery £350 Sums paid for training of pupil midwives 80 430 430 3,400 4,200 Cost of one midwife acting as maternity hospital ambulance nurse including salary and emoluments, uniform and superannuation 283 376 £3,117 £3,824 Annual Income. 600 midwifery cases. Payments by patients. Say, £1 per case £600 £600 Maternity Nursing. 19.—The Council have to secure that whole-time salaried midwives shall be available for maternity nursing. Maternity nurses act under the supervision of a doctor, and, as estimated above, maternity nurses to deal with 400 cases per annum require to be available. Maternity nurses may be employed either through a voluntary association or directly by the Council. A maternity nurse, although she must be a whole-time salaried servant of the employing voluntary association or Council, need not devote all her time to maternity nursing. As a maternity nurse requires to spend nearly as much time on a case as a midwife the number of maternity nurses required should be on the basis of one for about 80 cases, allowing for holiday duty, sick leave, suspension in case of infection and attendances at refresher courses. In all then, five maternity nurses would be required for the 400 cases. 20.—Present arrangements as to maternity nursing.—Existing district midwives may do maternity nursing but in fact do little—on the average only about six cases per annum each. The only organised arrangements for maternity nursing in Willesden at the present time are carried on under the auspices of the Willesden District Nursing Association. The number of maternity cases nursed by this Association during the past five years in Willesden is shown in the following table which also gives the number of such cases in respect of which direct payments were made by the Council. Such direct 107 payment has usually been made at the rate of 25s. per case, being approximately the same rate as the Council pay in respect of home helps. No. of cases No. of cases in which payment of Maternity was made by Year. Nursing. the Council. 1931 183 11 1932 205 11 1933 158 9 1934 188 19 1935 188 16 In addition, the Council pay to this Association per annum a sum of £300 in respect of nursing of expectant mothers, maternity nursing, nursing in puerperal fever and any complications of pregnancy and nursing of children under five years. 21.—Arrangements to be made under the Act.—It is proposed by your Committee that arrangements be made with this Association to undertake the whole of maternity nursing in Willesden. 22.—Scale of Fees for Maternity Nursing.—The Council are required to fix a scale of fees for maternity nursing subject to the remission of such fees in cases unable to pay. It is proposed that the scale of fees for maternity nursing be the same as for midwifery or where a maternity nurse is not engaged at the confinement, a daily attendance fee of half that of the daily fee chargeable to a hospital midwifery case as indicated on the Council's economic circumstances scale. Your Committee further propose that the assessment and collection of these fees be undertaken by the Council in the same way as for cases of midwifery. 23.—Estimated costs of Maternity Nursing.—Your Committee provisionally recommend that the Willesden District Nursing Association be paid a sum of £1,715 (this figure is subject to final revision —vide paragraph 6 of this report) for the year 1937-38 in respect of the maternity nursing to be carried out by them in the whole of Willesden under the Act. The payments hitherto made to the Willesden District Nursing Association for nursing have been as follows :— (a) Fixed Annual Contributions.—£200 from the Block Grant and £100 by way of voluntary Grant from Council in respect of the following nursing :— 1934. Cases. Visits. Maternity, Pregnancy and Miscarriage 295 4,743 Children under five years 266 3,134 1935. Maternity, Pregnancy and Miscarriage 270 4,790 Children under five years 273 3,050 From the above figures it would be fair to say that this Association already receives £180 per annum in respect of maternity nursing (i.e., maternity and pregnancy and miscarriage in the above table). (b) Payments on case basis. 1934 £22 3s. Od. 1935 £20 10s. Od. It would, therefore, appear that while the Local Authority will pay the Willesden District Nursing Association a total sum of £1,715 (subject to final revision—vide paragraph 6 of this report) the actual additional payment which will rank for Government Grant under the Act will be that sum less approximately £200 already paid by the Council to the Willesden District Nursing Association. The details of the agreement which it is proposed should be entered into with the Willesden District Nursing Association showing the salaries to be paid to the maternity nurses to be employed by them appear in Appendix II to this report. 24.—Government Grant in respect of midwifery and maternity nursing.—The Ministry's Memo. 200/M.C.W. states that the ad hoc grant (i.e., grant payable other than for compensation) is payable in respect of estimated additional expenditure as compared with the year 1935-36 during each year of the third fixed grant period (1937-42) and will be one half, scaled up or down in proportion to the extent to which the relative needs of the area, as measured by the grant formula for weighted population at present used for the calculation of grants under the Local Government Act, 1929, are relatively greater or less than the average of all Counties and County Boroughs in England and Wales as determined by that grant formula. Memo. 200/M.C.W. states further that: "In order to minimize detailed control and examination, and to simplify the grant arrangements in respect of local authorities' direct expenditure, the grant in respect of the cost of the employment of midwives by local supervising authorities themselves will be calculated on a "unit" basis, this unit representing the estimated average annual cost for the country as a whole of the salary and expenses of a municipal midwife, less the estimated average annual receipts from fees." 108 25.—The Grant is also payable in respect of contributions paid by the Council to Voluntary Associations and will be reckoned on the same formula. Memo. 200/M.C.W. states: "As regards midwives employed by voluntary organisations, the additional expenditure to be taken into account for the purposes of grant will be the excess of the amount of the annual contributions made by each authority to such organisation for domiciliary midwifery and maternity nursing over the contributions which were made to them by the authority during the financial year 1935-36 in respect of those services in the area of the authority." SUMMARY OF ESTIMATED COSTS OF OPERATING THE MIDWIVES ACT, 1936. From 31st July, 1937, to 30th July, 1938. Midwifery. £ Contribution to Queen Charlotte's Hospital 1,180 Cost of Midwifery Service of Council 3,117 4,297 Less Income. 600 midwifery cases. Payments by patients at, say, £1 per case... 600 3,697 Deduct Government Grant on £3,697, estimated at 25% 924 Net cost chargeable to rates £2,773 Maternity Nursing. Contribution to Willesden District Nursing Association. £1,615 as per letter of the Association dated 17/12/36. Add *£100 for adjustment of salaries ... 1,715 Less Income. 400 maternity nursing cases. Payments by patients at, say, £1 per case 400 1,315 Deduct Government Grant on £1,315 less £200, being the sum already paid to this Association for maternity nursing, estimated at 25% 279 Net cost chargeable to rates £1,036 Total net cost chargeable to rates in respect of midwifery and maternity nursing as above £3,809 *Subject to final revision—vide paragraph 6 of this report. Compensation. 27.—The Act does not prohibit the continuance of independent practising midwives but for all practical purposes it is unlikely that such midwives will get much work to do after the Act is in operation. The Act has accordingly made provision for independent midwives who cease practice either voluntarily or compulsorily. The whole-time salaried midwives to be employed under the Act may be recruited from existing practising independent midwives in the area. None of these independent practising midwives in Willesden, however, are fully trained general nurses, although all of them have the C.M.B. Certificate. In the opinion of your Committee it is highly desirable that all midwives employed in the whole-time salaried service established by the Council under the Act should be fully trained general nurses as well as certified midwives. 28.—Voluntary Surrender.—If a midwife has given notice of her intention to practise between the 1st January, 1935, and 18th March, 1936, she may voluntarily surrender her certificate before 31st July, 1939, and be compensated by a sum equal to three times the average net annual emoluments derived from her practice as midwife or maternity nurse. 29.—Compulsory Surrender.—If a midwife has given notice of her intention to practise on or after the 1st January, 1936, and the Council is of opinion that by reason of age or infirmityof m ir.d or body, she is incapable efficiently to discharge her duties as a midwife, then the Council may require her to surrender her certificate at a compensation valuation of five times the net annual emoluments derived from her practice as midwife or maternity nurse. Where the Council requires a midwife to surrender her certificate by reason of age or infirmity as aforesaid, the midwife has the right to appeal to the Minister. 30.—If as a result of the passing of the Act the present independent district midwives obtain compensation on the above basis, your Committee estimate that the total compensation to be paid will be in the neighbourhood of £2,500. 31.—Government Grant in respect of Compensation.—The Act provides for the payment to local supervising authorities by the Exchequer pf one half of their actual expenditure on payment of compensation to midwives. 109 Right of Appeal of Voluntary Organisations. 32.—The Council are required to transmit a copy of the scheme they send to the Minister to each of the organisations which have been consulted. If a voluntary association which employs domiciliary midwives in the area is dissatisfied with the Council's scheme they may appeal to the Minister within two months from the date the Council submit their proposals to the Minister. The Minister, as he thinks fit, after consulting the authority, may direct the Council to alter their proposals. Recommendations. 33.—Your Committee recommend :— (a) That the foregoing report and proposals contained therein be approved and adopted. (b) That the report as approved and adopted by the Council be submitted to the Minister of Health. (c) That a copy of the report as approved and adopted by the Council be forwarded to Queen Charlotte's Maternity Hospital, Kilburn, and West Hampstead District Nursing Association, Willesden District Nursing Association, the North-West Middlesex branch of the Midwives' Institute and the Willesden Division of the British Medical Association. January, 1937. N. M. COWAN, Chairman. APPENDIX I. Heads of Agreement to be made between the Corporation of Willesden as the Local Supervising Authority under the Midwives Acts, 1902-36, and the Queen Charlotte's Maternity Hospital. 1.—The Queen Charlotte's Maternity Hospital (hereinafter called " The Hospital ") undertakes to employ for the area indicated in the first column of the First Schedule the number of certified midwives specified in relation thereto in the second column of the schedule, and in addition undertakes to employ such number of certified midwives as may be necessary to provide for the temporary replacement of such of the midwives employed for the area in question as may frcm time to time be rendered unavailable for service. 2.—The Hospital will make such arrangements as will secure, so far as practicable, that the number of midwives specified in the First Schedule in relation to the area are always available for service in the area. 3.—The midwives provided under this Agreement shall be the whole-time servants of the Hospital. 4.—The midwives so employed shall be available for attendance on women in their own homes as midwives during pregnancy, at the confinement and afterwards as may be necessary in conformity with the rules for the time being of the Central Midwives Board. 5.—The qualifications, salaries and other emoluments paid to the midwives so employed shall be those specified in the Second Schedule hereto. 6.—The Hospital shall supply the Authority with a list of the names and addresses of the midwives employed by them in pursuance of this Agreement, and shall forthwith inform the Authority of any change in the list. 7.—The Hospital shall forward to the Medical Officer of Health of the Authority on forms to be provided by the Authority the names and addresses and such other particulars as may be required of all cases booked for confinement by Queen Charlotte's Maternity Hospital under this Agreement within 48 hours of booking. 8.—The Hospital shall keep records of the cases attended by the midwives employed by them in pursuance of this Agreement, and of the numbers of their attendances in each case. 9.—The Authority will charge fees to patients in accordance with the scale in the Third Schedule hereto and Section 3 of the Midwives Act, 1936. The economic circumstances of patients shall not be enquired into by the Hospital. No fees shall be accepted by the Hospital from or on behalf of any patients attended by the midwives under this Agreement. 10.—The Hospital shall supply the Authority with such financial and other returns as the Authority may reasonably require, including a copy of the audited annual accounts of the Hospital and the records kept by the Hospital shall be open to inspection by the Medical Officer of Health of the Authority or by any other officer of the Authority specially authorised for that purpose. 11.-—The Authority undertakes during the currency of this agreement to pay to the Hospital the sum of £1,180 per annum (until the same shall be altered or varied under Clause 12 (ii) hereof) by equal quarterly payments on the following days, viz., on the 31st day of March, the 30th June, the 30th September and the 31st December, in each year, the first payment being a proportionate part of a quarterly payment, and amounting to £197 to be made on the 30th day of September, 1937. 110 12.—The Hospital agrees with the Authority that :— (i) Any difference or dispute between the Authority and the Hospital arising out of this Agreement shall be referred to a single arbitrator appointed by agreement between the parties, or, in default of agreement, by the Minister of Health, and (ii) This Agreement shall have effect as from the 31st July, 1937, and shall continue in force, subject to any variations which may be agreed between the Authority and the Hospital, until it is determined either by agreement between the said parties or by not less than six months' notice in writing terminating on the 31st day of March in any year given with the consent of the Minister by either of the said parties. First Schedule. No. of Midwives Area to be served. to be employed. The area bounded on the north by the L.M.S. Railway, on the west by and including Claremont Road, and on the soiith and east by the boundaries of Willesden Three. Second Schedule. The midwives to be employed under this Agreement shall be fully trained general nurses holding "the C.M.B. Certificate. This condition, however, shall not apply to the midwives who at the date of this Agreement are employed at Queen Charlotte's District Home, Kilburn, but shall apply to their successors. The salaries of midwives employed by the Hospital under the terms of this Agreement shall be £105 rising by annual increments of £15 to £195 per annum with, in addition, board and lodging of a cash value estimated at £150. Superannuation in accordance with the Federated Superannuation Scheme for Nurses and Hospital Officers. Travelling allowances—car provided. Third Schedule. One half of the fees set out in the Council's economic circumstances scale applicable to patients confined or treated at the Council's Maternity Hospital. APPENDIX II. Heads of Agreement to be made between the Corporation of Willesden as the Local Supervising Authority under the Midwives Acts, 1902-36, and the Willesden District Nursing Association. 1.—The Willesden District Nursing Association (hereinafter called " the Association ") undertakes to employ for the area indicated in the first column of the First Schedule the number of certified midwives specified in relation thereto in the second column of the schedule, and in addition undertakes to employ such number of certified midwives as may be necessary to provide for the temporary replacement of such of the midwives employed for the area in question as may from time to time be rendered unavailable for service. 2.—The Association will make such arrangements as will secure, so far as practicable, that the number of midwives specified in the First Schedule in relation to the area are always available for service in the area. 3.—The midwives provided under this Agreement shall be the whole-time servants of the Association. 4.—The midwives so employed shall be available for attendance on women in their own homes as maternity nurses in childbirth, and afterwards as may be necessary in conformity with the rules for the time being of the Central Midwives Board. 5.—The qualifications, salaries and other emoluments paid to the midwives so employed shall be those specified in the Second Schedule hereto. 6.—The Association shall supply the Authority with a list of the names and addresses of the midwives employed by them in pursuance of this Agreement, and shall forthwith inform the Authority of any change in the list. 7.—The Association shall forward to the Medical Officer of Health of the Authority on forms to be provided by the Authority the names and addresses and such other particulars as may be required of all cases nursed by the Willesden District Nursing Association under this Agreement within 48 hours of booking. 8.—The Association shall keep records of the cases attended by the midwives employed by them in pursuance of this Agreement, and of the numbers of their attendances in each case. 9.—The Authority will charge fees to patients in accordance with the scale in the Third Schedule and Section 3 of the Midwives Act, 1936. The economic circumstances of patients shall not be enquired into by the Association. No fees shall be accepted by the Association from or on behalf of any patient attended by the midwives under this Agreement. 111 10.—The Association shall supply the Authority with such financial and other returns as the Authority may reasonably require, including a copy of the audited annual accounts of the Association and the records kept by the Association shall be open to inspection by the Medical Officer of Health of the Authority, or by any other officer of the Authority specially authorised for that purpose. 11.—The Authority undertakes during the currency of this Agreement to pa}- to the Association the sum of £1,715 per annum (until the same shall be altered or varied under Clause 12 (ii) hereof by equal quarterly payments on the following days, viz., on the 31st day of March, the 30th June, the 30th September and the 31st December, in each year the first payment being a proportionate part of a quarterly payment and amounting to £286 to be made on the 30th day of September, 1937. (These figures are subject to final revision—vide paragraph 6 of the foregoing report.) 12.—The Association agrees with the Authority that:— (i) Any difference or dispute between the Authority and the Association arising out of this Agreement shall be referred to a single arbitrator appointed by agreement between the parties, or, in default of agreement, by the Minister of Health, and (ii) This Agreement shall have effect as from the 31st day of July, 1937, and shall continue in force, subject to any variations which may be agreed between the Authority and the Association until it is determined either by agreement between the said parties or by not less than six months' notice in writing terminating on the 31st day of March in any year given with the consent of the Minister by either of the said parties. First Schedule. No. of Midwives Area to be served. to be employed. The borough of Willesden. Five. Second Schedule. The midwives to be employed under this Agreement shall be fully trained general nurses holding the C.M.B. certificate. Salaries of midwives employed by the Association under the terms of this Agreement shall be £105 rising by annual increments of £15 to £195 per annum with, in addition, board and lodging of a cash value estimated at £150. Superannuation in accordance with the Federated Superannuation Scheme for Nurses and Hospital Officers. Travelling—all travelling expenses paid. Third Schedule. One half of the fees set out in the Council's economic circumstances scale applicable to patients confined or treated at the Council's Maternity Hospital. II.—EXTRACT FROM COUNCIL MINUTES, 27th JULY, 1937. REPORT OF HOSPITAL VISITING SUB-COMMITTEE. GENERAL. 1.—In accordance with the reference from the Health Committee we have considered letters received from the Minister of Health in regard to the Council's scheme under the Midwives Act, 1936, copies of which have been circulated to all members. We also had before us a memorandum prepared by the Medical Officer of Health showing the changes required by the Minister and their effect on the scheme. Midwifery. 2.—The Minister has raised certain questions as to the number of cases which should be allocated to a midwife and has finally stated that he is prepared to leave the matter to the Council's discretion on the assumption that they will review the point in the future when experience of the actual operation of the arrangements has been obtained. As it is more convenient to increase the number of midwives rather than to discharge a midwife recently appointed and having regard to the diminishing number of domiciliary confinements, we recommend that the number of cases to be allocated to a midwife in the first place be increased from 65 to 70, as originally proposed, to 80 per annum. In those circumstances the Council would employ :— (1) by arrangement with Queen Charlotte's Maternity Hospital, for the South Kilburn area as defined, the equivalent of 2£ midwives for approximately 200 cases ; (2) directly, for the rest of Willesden, 5 midwives for approximately 400 cases. The arrangement proposed by the Council's original scheme with Queen Charlotte's Hospital in respect of their District Home in South Kilburn will, therefore, remain unaltered except that the number of midwives to be employed will be reduced from 3 to 2 J. In these circumstances it is estimated, subject to confirmation by Queen Charlotte's Hospital, that the sum payable to the Hospital by the Council would be £1,032 for the first year of working instead of £1,180. 112 Employment of Midwives by the Council. 3.—We recommend that the 5 whole-time midwives to be employed directly by the Council be appointed upon the following altered conditions of service :— (1) That the first appointments be open to independent midwives already in practice in Willesden, whether married or single, and whether fully trained general nurses or not ; (2) That in the event of a sufficient number of efficient independent midwives already in practice in Willesden not being available, the Council shall appoint as midwives candidates who are— (a) fully trained general nurses, and (b) certified midwives, and (c) unmarried. (3) That the midwives appointed be required to live in such parts of the Borough as the Council may determine, but not in a Home provided by the Council; (4) That all midwives entering the service under the foregoing conditions be required to pass the usual medical examination prior to confirmation of their appointment, and that they be placed in established posts ; (5) That midwives employed by the Council be allowed four weeks annual holiday ; (6) That arrangements be made whereby a complete 24 hour period free of duty be allowed each week, and one period of 48 hours (including the 24 hours previously mentioned) every four weeks. These appointments will require to be made by a Committee having the fullest possible knowledge of the factors and difficulties to be overcome, and we therefore recommend, subject to the concurrence of the Establishment Committee, that we be empowered to make the necessary appointments. Salaries of Council employed Midwives. 4.—We have considered the salaries payable under the foregoing scheme and recommend :— (a) That the salary of midwives employed by the Council who are not fully trained general nurses be fixed at £255 ; (b) That the salary scale for midwives who have qualified as general trained nurses be fixed at £255, rising by annual increments of £15 to £345 per annum. Maternity Nursing. 5.—The Minister of Health has not definitely required any alteration in the proposed arrangements with the Willesden District Nursing Association for maternity nursing, but he has suggested that the Council should consult with the Association on the question of maternity nurses'salaries and the fees to be charged to patients. Salaries of the nurses employed by the Association are fixed by the Queen's Institute, to which the Association is affiliated, and the Association desire to pay the same scale to the maternity nurses to be employed for the purposes of the scheme. On the basis of such salaries the cost of maternity nursing to the Council for the first year of working would be £1,615 instead of £1,715, as allowed in the Council's original scheme, which included provision for the payment of the maternity nurses at the same rate as midwives. We recommend that the Council agree to the Association adhering to the scale fixed by the Queen's Institute. Scale of Fees to Patients. 6.—Consequent upon the adoption of the foregoing salary scale for maternity nurses, the maximum fee for maternity nursing will be £4. This charge will be scaled down according to the economic circumstances of the patient, and would be subject to review in the light of experience of the working of the Act and the costs involved. Submission of Amended Scheme to Minister of Health. 7.—We recommend that the scheme as amended in this report be transmitted to the Minister of Health for approval and that immediately upon receipt thereof, advertisements of the vacancies for midwives be issued and notice given to independent midwives as provided by the Midwives Act, 1936. 113 Estimated Cost of Midwifery Arrangements. 8.—It is estimated that the cost to carry out the Act on the foregoing lines will be as follows :— Contribution to Queen Charlotte's Maternity Hospital £1,032 Cost of midwives employed directly by the Council. Salaries and allowances :— Superintendence of Midwives. £188-218 £188 Midwives. 5 at £255 per annum £1,275' Uniform. 5 at £12 per annum £60 Laundry. 5 at £10 per annum £50 Travelling Allowance. 5 at £20 each per annum £100 Telephone. 5 at £12 each per annum £60 Disinfectants and drugs £10O Refresher courses £20 Insurance £10 Clerical assistance and investigations £100 Printing, stationery and postage £10 Superannuation and State Insurance £82 Contingencies £100 £2,155 Less: Sums now paid for necessitous cases of midwifery £350- £1,805 Annual income. 600 midwifery cases. Payments by patients. Say, 15s. per case £450 Summary of Estimated Costs. 9.— Midwifery. Contribution to Queen Charlotte's Hospital £1,032 Cost of midwifery service to Council 1,805- Less Income—600 midwifery cases. Payments by patients at, say, 15s. per case ... 450 2,387 Deduct Government Grant on £2,387, estimated at 25 per cent 597 Net cost chargeable to rates £1,790 Maternity Nursing. Contribution to Willesden District Nursing Association as per letter dated 17/12/36 £1,615 Less Income—400 maternity nursing cases. Payments by patients at 15s. per case 300 1,315 Deduct Government Grant on £1,315 less £200, being the sum already paid to this Association for maternity nursing, estimated at 25 per cent 279 Net cost chargeable to rates £1,036 Total net cost chargeable to rates based on a year's working in respect of midwifery and maternity nursing as above £2,826 Dated this 21st day of July, 1931 Dated this 27th day of July, 1937. N. M. COWAN, Chairman. W. J. HILL, Chairman. 114 APPENDIX H. February 9th, 1937. MEMORANDUM ON INFANT LIFE PROTECTION. By THE MEDICAL OFFICER OF HEALTH. Powers. The Children and Young Persons Acts, 1908-32, make certain provisions for the care of Foster Children. The Maternity and Child Welfare Act, 1918, gives power to any local authority within the meaning of the Notification of Births Act, 1907, to make such arrangements as may be sanctioned by the Ministry of Health for attending to the health of expectant and nursing mothers and of children who have not attained the age of five years and are not being educated in schools recognised by the Board of Education. Failure. Notwithstanding this, there were two cases before the Health Committee at its meeting on the 8th December, 1936, in which the arrangements in force in Willesden under the above provisions failed to ensure suitable care for the children. In the case of the foster child, K.C., aged 5 months, the child's mother, although reported to be earning 38s. 6d. a week, failed to keep up her payments to the foster mother. The foster mother, finding it impossible to keep the child without money and being unable to find the mother, applied to the Public Assistance Officer to take the child into the Institution. This was not done but as a result of instructions received, the foster mother left the child at its mother's address with the result that the child was subsequently found abandoned in a church porch. In the case of Mrs. E., without contravening the law she has succeeded in getting a child aged 6 months into her care although the home conditions are unsuitable. Problems. Even apart from such cases as these the care of foster children is not all that could be desired. The majority of foster children are illegitimate. Their mothers are frequently in employment and may work up to a month before the confinement. During this last month when they are not employed, they must keep themselves and make some provision for the child. They are confined for the most part in hospital. At the end of 10 days or a fortnight they are discharged. They have no money left. They have nowhere to go. They are handicapped by the child. It is important that they get work at once. What often happens seems to be that such a mother finds some woman who, perhaps out of kindness or perhaps in hope of money later on, takes the child whilst the mother searches for work. The child may be well cared for or not, but in any case the mother probably in the circumstances does not enquire too closely. She is glad to get anybody to take the child. If she gets work and pays the woman, it may be that the child stays on for a time but if the payments are small and irregular, the child may be passed from one woman to another, finding no stability in life at all. Shortage of Foster Mothers. At present there is a shortage of foster mothers and requests are constantly received from rescue workers, hospital almoners and others for addresses of possible foster mothers. It is not unusual for them to state when they ring up Willesden that they have already tried London and neighbouring districts. Suitable women are chary of becoming foster mothers on account of— 1. The small payments. 2. The irregularity of the payments. 3. The possible or even probable lapse of payments altogether. 4. The difficulty and delay in getting help from the Public Assistance Departments when foster children are left on their hands. 5. The knowledge that at any time a child whom they may have grown to love may have to be parted with for lack of money. 115 Health of the Foster Children. 1 lie solving of the difficulties indicated requires careful consideration not only for the reasons above-mentioned, but also because— (a) the children are suffering on account of their hazardous lives from the time they leave hospital until their mothers get work ; (b) the children are suffering too on account of the frequent changes of home and the different mothers under whose care they come ; (c) illegitimacy is not decreasing. Year in and year out there are round about 100 Willesden illegitimate births. Altogether, there are 200 foster children in Willesden. (d) the number of illegitimate children dying between the ages of 4 weeks and 1 year is 3 times as great as the number dying under 4 weeks of age whereas in the case of legitimate children, the figures are equal. During the 5-year period 1931-35, the death rate for legitimate children under 4 weeks of age was 25 per 1,000 legitimate births and for legitimate children between 4 weeks and 1 year of age, it was the same. But the death rate for illegitimate children under 4 weeks of age was 50 per 1,000 illegitimate births and for illegitimate children between 4 weeks and 1 year of age it was 151 per 1,000 illegitimate births. Are any Remedies reasonably possible ? Suggestions. 1. The establishment by the Local Authority of a Home or Clearing House to which these girls could come with their babies straight from hospital until they find work and are able to find and pay suitable foster mothers. (Maternity and Child Welfare Act, 1918, Section 1.) (Note.-—Such a home might also be used as a home for the pregnant mother during the last weeks of pregnancy. It might also be used for such mothers as might desire or be induced to continue to breast feed their babies.) 2. Payment of foster mothers by Local Authority. Actually, in practice, homes for babies have not been found very satisfactory and it maybe that a better arrangement would be for the babies to be taken straight to the foster mothers with whom they are to remain. This could only be done if foster mothers' payments were secure and sufficient, which is unlikely to be the case if they are dependent on the type of parent now under consideration. They would be made secure and sufficient if the Council paid the foster mothers and recovered all or part from the parents. (Maternity and Child Welfare Act, 1918, Section 1.) 3. Mothers' pensions. It hardly seems that these would solve this particular problem although they might be given in some cases. Although illegitimacy is not the severe social handicap it was years ago, the majority of these girls still desire to keep the knowledge from their friends and usually do not want to be hampered with a baby. They prefer to work and be free. Any scheme which the Committee may devise as a result of the consideration of this question would require the sanction of the Minister of Health under Section 1 of the Maternity and Child Welfare Act, which is as follows :— "Any local authority within the meaning of the Notification of Births Act, 1907, may make such arrangements as may be sanctioned by the Local Government Board, for attending to the health of expectant mothers and nursing mothers, and of children who have not attained the age of five years and are not being educated in schools recognised by the Board of Education : Provided that nothing in this Act shall authorise the establishment by any local authority of a general domiciliary service by medical practitioners." The Circular of the Ministry of Health, M. & C.W. 4, dated 9th August, 1918, deals with Homes for Children in paragraph 33, which is as follows "The health of infants and young children who lack the support of a father often needs special attention, and it is on all grounds desirable that the mother and child should be kept together in such cases, especially during the first year. It is notorious that the death rate of illegitimate infants, the only infants in this category for whom separate statistics are published, is about twice the death rate of legitimate infants. To some extent this is due to the difficulty experienced by their mothers in making a home for them. The mothers generally go out to work and leave their infants with foster-mothers. As a result of the war fewer suitable fostermothers are prepared to take the children at a charge which their mothers can afford to pay. The Board have, therefore, obtained the Treasury assent to the extension of the grant to homes at which mothers and children can be kept together in certain cases, and to such other arrangements as the Board may approve for attending to the health of the children under consideration. In some cases it may be desirable to pay a good foster-mother to look after a child whose mother cannot afford the whole of its keep, or to assist the mother to stay at home to attend to the child. Any scheme for this purpose should be submitted for the Board's approval before expenditure is incurred on it if a grant is desired." 116 February 24th, 1937. APPENDIX I. MEMORANDUM ON NURSING STAFF. Municipal Hospital. The following table gives the details regarding the 108 probationer nurses obtained during the six years 1931 to 1936:— Year. No. who commenced duties. No. who have left. No. still in Hospital. No. who stayed 2 yrs. or more. No. who passed State Exam. No. who left during probationary period. No. who stayed between 2 mths. & 2 yrs. Percentage who passed State Exam. 1931 12 12 - 9 4 - 3 44.4 1932 18 18 — 11 9 3 4 81.8 1933 21 21 — 10 5 6 5 50.0 1934 15 13 2 6 5 3 6 83.3 1935 18 10 8 — — 3 7 - 1936 24 6 18 — — 5 1 — Total 108 80 28 36 23 20 26 63.9 It will be observed that out of 108 nurses joining the service of the Hospital, 20 left within their probationary period of two months, and 26 up to the present date have failed to complete their two years' training. Of 66 nurses commencing their training during 1931 to 1934 inclusive, only 36 stayed for 2 years or more and of these 23 have passed the State Examination. Last winter, owing to the failure to obtain the requisite number of probationer nurses, private nurses had to be employed as follows:— Number of Private Nurses employed. Total number of weeks employed. Total expense. 11 89 4/7 £184 17s. 0d. At the present time, the establishment of 39 probationer nurses is short by 12 probationer nurses. One ward, however, is closed. If it were opened it would require 4 probationer nurses to staff it, so that the actual shortage of probationers is 8 for the present numbers in hospital. The matter is one which requires careful consideration in order to ascertain what improvements in the terms of service are necessary, so as to secure a sufficient number of suitable applicants. The following points are submitted for consideration as likely to cause such an improvement in nursing conditions that the requisite number of probationer nurses will be obtained and will complete the prescribed period of training. (1) Working Hours. Nurses are on duty more hours per week than most other people and many find the strain too severe. A reduction of working hours has already taken place in London County Council and Middlesex County Council Hospitals. The following table gives the particulars:— L.C.C. M.C.C. Willesden Municipal Hospital. Day. Night. All grades. Nursing Staff all grades. Day and night. Nursing Staff all grades. Day and night. Sisters. Staff Nurses. Probationer Nurses. No. of hours on duty:— 54 48 55 58 56 60½ 117 In this connection it is necessary to consider the number of staff employed in each grade. The following table shows the proportion of trained to untrained staff at a London County Council Fever Hospital, Manchester Fever Hospital and the Willesden Municipal Hospital:— Hospital. Total Nursing Staff. Number of trained Staff. Number of untrained Staff. Percentage of trained to untrained Staff. Trained. Untrained. L.C.C. 210 106 104 50.5 49.5 Manchester 152 70 82 46.0 54.0 Willesden 60 21 39 35.0 65.0 It will be observed that the number of trained staff at the Willesden Municipal Hospital is proportionately less than in London or Manchester. This deficiency of trained staff means that probationer nurses are called upon to undertake duties which ought to be carried out by more experienced persons. It is highly desirable that the proportion of trained to untrained staff should be increased to approximately 45-55. The approximate increase of staff required on the present establishment to institute a 48-hour week is shown as follows:— Rank. Number. Hours per week. Total hours per week Extra Staff required. Day. Night. Day. Night. Sisters 8 1 55 60 500 1 9 1 48 48 480 Staff Nurses 11 1 58 60 698 3 13 2 48 48 720 Probationer Nurses 24 15 56 60 2,244 8 28 19 48 48 2,256 The extra staff required, therefore, can be estimated at 12 and in order that the proportion may be correct it is suggested that the total staff for a 48 hours' week should be:— Sisters 11 Staff Nurses 21 Probationer Nurses 40 (2) Salaries. The following are the salary scales of the Nursing Staff at the Municipal Hospital:— Senior Sister and Sister Tutor £110 by £10 to £140. Night Superintendent £105 by £5 to £120. Sisters £85 by £5 to £100. (After 8 years' service by £5 to £110.) Staff Nurses £65 by £5 to £75. (Plus £5 extra if both General and Fever trained.) Probationer Nurses £37 by £2 to £39. Under present conditions it is almost impossible to get the proper complement of probationer nurses and from time to time there is difficulty in getting senior staff. (3) Accommodation in Nurses' Home. Total number of beds 56 Existing Establishment of Nursing Staff 60 Establishment required for 48-hour week 72 At the present time 4 members of the existing establishment of nurses live out. (4) Living Out or Living In. The age at which probationer nurses are accepted for fever training is 18. Some girls start even younger. Practically no candidates from the London area apply. The largest number come from Wales and Ireland with a smaller proportion from the Provinces and Scotland. Living-in accommodation should be provided for all probationer nurses and a certain proportion of the sisters and staff nurses. A short time ago, owing to insufficient accommodation, the Sisters and Staff Nurses were requested to indicate whether they desired to live out. Four out of a total of 21 have asked for permission to do so. Two of these had arranged to live with their sisters and the other two with friends. The remainder preferred to live in. 118 Estimated additional annual cost of a 48 hours' week for Nurses at the Municipal Hospital. The estimated additional cost of the institution of a 48 hours' week for nursing staff at the Municipal Hospital is submitted as follows:— 2 Sisters at £85—£100 170 9 Staff Nurses at £70—£80 630 1 Probationer at £37—£39 37 837 There are at present 56 beds for Nurses at the Municipal Hospital and on the assumption that there is no new Nurses' Home built, 16 nurses would require to live out. The present living-out allowance is £60 per annum, so that the increased cost of this provision would be in respect of the Municipal Hospital 16 less 4 (as 4 already live out) x £60 = 720 If the salaries of probationer nurses at the Municipal Hospital are increased to, say, for estimating purposes £45—£50 per annum, there would be an additional cost in respect of the 40 probationer nurses to be employed of 40 X £8 = 320 To these costs a sum of 12 x £26 or £312 has to be added in respect of meals, uniform, etc., provided in the Hospital while the 12 living-out nurses are on duty = 312 The cost of the Council's Superannuation Contribution and State Insurance would be approximately 106 Total £2,295 Other Considerations at the Municipal Hospital. There are certain matters in connection with the Nurses' Home which have a bearing on the conditions of service of the Nursing Staff:— (a) Matron.—At present the Matron is provided with a bath in her bedroom which is not a satisfactory arrangement. In view of the fact that the present Matron will soon reach retiring age, it is desirable to have better provision made before a new Matron is appointed. (b) Sisters.—The Sisters' sitting-room measures 12 ft. 9 ins. by 12 ft. to accommodate nine Sisters and the Dispenser. The size of this room is totally inadequate for the number of persons using it. (c) Staff Nurses.—At present the Staff Nurses have to share a sitting-room with the Probationers. They ought to have their own sitting-room. (d) Senior Sister and Sister Tutor.—Most hospitals provide a sitting-room for such a member of the nursing staff who also acts as Deputy Matron and it would be desirable if provision were made for such accommodation at the Willesden Municipal Hospital. (e) Cloak Room for Nurses.—During cold and wet weather the nurses wear cloaks while proceeding from the Home to the Wards or Mess-room. There is no adequate cloak-room accommodation in the Home for these garments. (/) Heating.—There is no provision for heating the older part of the Nurses' Home, and complaints are made every winter regarding this. Maternity Hospital. The total nursing staff at the Willesden Maternity Hospital is as follows:— 1 Senior Sister and Sister Tutor. 4 Ward Sisters. 10 Staff Nurses. 15 Pupil Midwives. Sisters on day duty do a 50 hours' week. Sisters on night duty do a 66 hours' week. Staff Nurses on day duty do a 54 hours' week. Staff Nurses on night duty do a 66 hours' week. Pupils on day duty do a 56 hours' week. Pupils on night duty do a 75 hours' week. To institute a 48 hours' week 1 Sister, 2 Staff Nurses and 5 Pupil Midwives would be required. There has been no difficulty experienced at the Maternity Hospital in respect of obtaining sisters but recently the College of Nursing have queried the conditions of appointment of staff nurses who live out with the result that there has been difficulty recently in obtaining staff nurses. There has never been any difficulty in obtaining pupil midwives. 119 Estimated additional annual cost of a 48 hours' week for Nurses at the Maternity Hospital. £ 1 Sister at £85—£100 85 2 Staff Nurses at £70—£80 140 5 Pupil Midwives at £24 (+£16 for fees) 200 425 Living-out allowance—8 nurses at £60 480 Meals, uniform, etc., while on duty—8 nurses at £26 208 Council's Superannuation Contribution and State Insurance 37 Total £1,150 Other Considerations at the Maternity Hospital. It should be observed that the addition of 8 nurses to the Maternity Hospital would involve consideration of accommodation for changing and other matters in respect of the staff generally at the Hospital but I have not gone into this matter particularly at the present time having regard to possible developments in connection with this Hospital. GEORGE F. BUCHAN, Medical Officer of Health. February 24th, 1937. APPENDIX J. Health Department. Laboratory Technician. (1) The work undertaken includes the following:— (a) The preparation of culture media; (b) The dispensing of chemical re-agents and stains; (c) The culture and isolation of organisms; (d) The preparation of bacteriological films, agglutination tests, etc.; (e) The chemical analysis of various fluids; (f) The bacteriological examination of water. (2) When the post was first instituted, the Council decided that a suitable boy should be obtained from a local Secondary School and trained, and that the appointment be held temporarily for not less than one year. The minimum qualification required is that he should have passed the Matriculation Examination, Chemistry being one of the subjects. Matriculation Chemistry does not cover all the chemical knowledge required, but assuming that the boy is studying for the Inter B.Sc., this course would prove sufficient. (3) The first assistant held the post for two years, and it was then decided that the appointment be for a minimum period of 18 months and a maximum period of two years, and that four months' notice of termination of the appointment be required. This assistant left the service of the Council to do laboratory work at Heinz factory. (4) The second assistant appointed was granted permission to retain the post at the expiration of two years as he was studying for the Degree of Bachelor of Science, which Degree he subsequently obtained. (5) Experience has shown that the present terms of appointment are unsatisfactory for the following reasons:— (a) The frequent changing of the Assistant is very upsetting to the work, and not conducive to the smooth working of the laboratory and the hospital; (b) The four months' notice of termination of appointment is too long a period to be required, as it is a great handicap on the Assistant obtaining another post. Most local authorities or commercial firms will not wait longer than one month; (c) Mr. Burman has been looking out for a post for nearly six months without, so far, any success. The chief difficulty is due to the fact that his experience gained in the laboratory is not of the same nature as his degree subjects. For most good bacteriological posts the certificate of the Laboratory Assistants' Association is required. Candidates for this must be at least 22 years of age. Under the present arrangement, a boy appointed from school could not sit for this examination within two years, but if the post were made available for a longer period and at a more attractive progressive salary, the possession of a degree as well as this certificate would be a great help towards obtaining a good post. 120 (6) The following are the salaries paid to Laboratory Technicians by certain Authorities:— (a) Borough of Willesden— 42/3 per week (£110 per annum). (b) London County Council— Grade C 45/- to 60/- per week. „ B 62/-to 90/- ,, ,, „ A 90/-to 110/- „ ,, A (Senior) 110/-to 130/- ,, ,, (c) Middlesex County Council— Assistant 35/-to 60/-per week. Senior Assistant £240 10s. 0d. to £286 per annum. (d) Government of Southern Rhodesia— £375 by £25 to £600 per annum. (e) Laboratory Assistants' Association Scale— Improver 40/- per week. Junior Assistant 70/- ,, ,, Senior Assistant £250 to £300 per annum. Chief Assistant £300 to £450 ,, ,, (7) The following suggestions are made as to the future terms of appointment of the Laboratory Assistant:— (1) The post be a permanent and established one with one month's notice on either side; (2) The salary be on a progressive scale. It is suggested that the basis be that of Improver (40/-) to Junior Assistant (70/-) of the Laboratory Assistants' Association Scale. (3) The holder of the post be required to pass the examination for the Certificate of the Laboratory Assistants' Association within two years of becoming eligible to sit for the examination. George F. Buchan, Medical Officer of Health. APPENDIX K. April 2nd, 1937. NEW HEALTH CENTRE (2). Summary of Additional Estimated Costs. 1937-38. £ £ 1938-39. £ £ 1939-40. £ Loans on Equipment - - — - 611 Loans on Land — - 85 - 85 Loans on Buildings — 3,021 3,021 Annual Maintenance — — 9,795 Total 3,106 13,512 Less Grant—M.C.W. — 517 2,252 S.M.S. — 517 2,252 1,034 4,504 Total Net Additional Maintenance Costs — £2,072 £9,008 The above additional estimated costs are based on the assumption that the New Health Centre (2) will be completed and ready for use on the 1st April, 1939. NEW HEALTH CENTRE (2). Additional Estimated Annual, Maintenance Costs. (a) New Services:— (1) Orthopaedics— £ £ Surgeon 24 sessions at £4 4s. 101 1 Orthopaedic nurse, £255—£345 255 Uniform 8 Hospital treatment 266 Surgical instruments 33 Carried forward £663 121 (a) New Services—continued:— £ £ Brought forward 663 (2) Artificial sunlight and minor skin conditions— Specialist 227 1 health nurse, £255—£345 255 Uniform 8 Electricity, etc. 32 522 (3) Resident caretaker— Wages and holiday relief 163 163 (4) Isolation Nil. (5) Rheumatism— No estimate submitted as this depends on provision of hospital beds. (6) X-ray department— 1 X-ray technician, £260—£15—£320 260 Materials, extra current, etc. 100 360 (b) Extensions to existing services:— (7) Mothercraft Classes— ½ Health Nurse, £255—£345 128 Uniform 4 132 (8) Nursery— Nursery Nurse, £170—£200 170 Occasional Nursery Assistance 14 184 (9) Test feeding and re-establishment of breast feeding— ½ Health Nurse, £255—£345 128 Uniform 4 132 (10) Dentistry— Dental Surgeon ,£600-£675 600 Dental Nurse, £180—£240 180 Uniform 8 Materials 137 925 (11) Pharmacy- Assistant Dispenser, £200—£230 200 Drugs, dressings, etc. 100 300 (12) Children 1-5 years— 1 Centre Medical Officer, £600-£750 600 2 Health Nurses, £255—£345 510 Uniform 16 1,126 (c) Additions to and modifications of existing arrangements:— (13) Dental Mechanics and Orthodontic Work— Dental Surgeon, £600—£675 600 Dental Mechanic, £200—£260 200 Laboratory Boy, £75—£121 75 Dental Nurse, £180—£240 180 Uniform 8 Materials for Dentures, etc. 200 Orthodontic Specialist, 24 attendances 63 1,326 (14) Squint Clinic— Specialist, 48 attendances 126 ½General Nursing Assistant, £180—£240 90 Uniform 4 220 (15) Throat, Nose and Ear Conditions— Specialist Nil ½ General Nursing Assistant, £180—£240 90 Uniform 4 94 122 £ £ (d) General Items:— (16) Staff— 3 Health Nurses, £255—£345 765 Uniform 24 2 Junior Clerks 150 939 (17) Cleaning Assistance— 330 hours per week at 11d. per hour 787 787 (18) Rates, Taxes, Heating, Lighting and Cleaning, including electricity, coal, gas, coke, replacements, window cleaning, etc. 1,200 1,200 (19) Superannuation and State Insurance 360 360 (20) Miscellaneous— Investigations 16 Travelling Expenses 20 Printing, Stationery and Postage 100 Dried Milk 140 Virol 40 Apparatus—Inspection and replacements 16 Conveyance of children 5 Hospital Treatment (Tonsils and Adenoids and Marasmus) 230 Other Sundries 400 10,400 Less: Saving of 2/5ths of present costs of dentures 535 Income—Dental fees 70 605 Total additional annual maintenance costs excluding loan charges 9,795 Add: Loan Charges— *Equipment, £5,000 at 4 per cent. 10 years 611 Land £1,480 at 4 per cent. 30 years 85 Building £52,500 at 4 per cent. 30 years 3,021 Total additional annual maintenance costs including loan charges 13,512 †Less: Grant M.C.W.—25 per cent. on two-thirds of costs 2,252 S.M.S.—50 per cent. on one-third of costs 2,252 4,504 Total Net additional annual maintenance costs including loan charges, less Grant £9,008 † Note.—The amount of Grant payable particularly in respect of Maternity and Child Welfare is somewhat problematical. * Additional Equipment—Provisional Estimate £5,000. This estimate has not been worked out in detail. The equipment for Health Centre (3) cost £1,600 in 1930. Health Centre (2) is four times the size of Health Centre (3). The estimate of £5,000 includes unit dental equipment for three Dentists at £200 per Dentist, equipment of X-ray Room and X-ray Dark Room, £1,200—leaving £3,200 for general equipment, the equipment of the additional rooms, and the special equipment for the Squint Clinic, Skin Surgery and Dental Mechanic's Room. There is some equipment in the present Health Centre (2) which will be transferred. Existing Health Centre (2)—This will remain as an asset to the Council. GEORGE F. BUCHAN, Medical Officer of Health. 123 APPENDIX L. April 28th, 1937. Health Department. Laboratory Technician. Regulations governing the appointment. 1. The appointment is open to candidates who have passed the London Matriculation Examination. Candidates must have taken chemistry as one of the subjects of such examination or otherwise produce evidence of a knowledge of chemistry. 2. The holder of the post will be required to pass the Examination for the Certificate of the Laboratory Assistants' Association within two years of becoming eligible to sit the Examination at the age of 22 years. 3. The post will be an established post. 4. The salary will be 40s. per week rising by annual increments of 10s. per week to a maximum of 70s. per week. 5. The holder of the post must undertake to remain in the Council's service until he has passed the Examination for the Certificate of the Laboratory Assistants' Association, after which the post is terminable by a month's notice on either side. 6. The appointment will be automatically determined in the case of any candidate who fails to pass the Laboratory Assistants' Examination within two years of his becoming eligible to sit for it. 7. Preference will be given to candidates who are Willesden residents or who have been educated in Willesden schools. GEORGE F. BUCHAN, Medical Officer of Health. May 14th, 1937. APPENDIX M. MEMORANDUM ON CLINIC WORK AND CLINICS. Prepared by the Medical Officer of Health in accordance with instructions given by the Health Committee at its meeting on Tuesday, 11th May, 1937. Before proceeding to discuss the growth of Clinic work generally and its relation to the individual items in the estimate dated 2nd April, 1937, relating to new Health Centre (2), I think it would tend to clarify the position if I pointed out how difficult it is to make a line clearly dividing new work from old as in many instances both old and new work are interlocked. For example, in connection with the provision to be made for the new medical work for children 1 to 5 years it has to be remembered that the existing medical work is beyond the actual capacity of the doctors now employed. The same statement applies to dental work. Health Centre (3) was opened in April, 1930, and based on the expected increase of work, the Council provided roughly an increase of clinic staff of about 25 per cent. The total clinic attendances in 1929 were 98,991 and, in 1930, 133,189, or an increase of 34.5 per cent., being a greater increase than was anticipated. Since 1930, clinic attendances have continued to increase and last year, namely, 1936, they reached the record figure of 231,164 or 73.5 per cent. over 1930. During these years, 1930-36, the only increases of staff have been an orthopaedic nurse, a general nursing assistant and a junior clerk. In addition, it should be noted that the general population of Willesden during the same period has gone up from approximately 180,000 to approximately 200,000. Medical Work. The following items represent additions to the medical work of the Clinics:— 1. Nursery Classes.—Although there are only some 300 children in nursery classes, nevertheless these classes require strict supervision in connection with infectious diseases, because the age period 2.5 years is the period when children are particularly susceptible to infections. The nurses attached to these classes have, therefore, to visit them regularly each week. 2. Secondary Schools.—2,500 children have come under health supervision by arrangement with the Middlesex County Council in secondary and technical schools. They are dealt with for purposes of medical inspection in the schools and for eye treatment and the provision of spectacles at the Clinics. 3. Maternity and Child Welfare.—These attendances, which, of course, are included in the general clinic attendances, have greatly increased. In 1930, there were 3,930 ante-natal attendances alone, while, in 1936, there were 11,293. In addition, in 1930, there were 2,883 visits made to expectant 124 mothers in the homes by Health Visitors while in 1936, there were 9,098 such visits made. I refer particularly to this work as the clinic attendances of expectant mothers take up much more time than the average run of clinic attendances and special provision has got to be made for such women. In addition, it has to be remembered that the operation of the Midwives Act, 1936, and the contemplated extension of the Maternity Hospital will both have the effect of further increasing these already large attendances. 4. Tuberculosis Visits.—2,523 such visits were made by Health Visitors in 1936 and none in 1930. These visits practically take up the time of one Health Visitor. Generally speaking a Health Visitor can make something between 4,000 and 5,000 visits per annum taking one visit with another, but a tuberculosis visit takes more time than the average visit and 2,523 visits to tuberculous patients, as I have said above, means practically the time of one Health Visitor. 5. Infant Life Protection.—This is a service which was not provided for in 1930 as it did not come into operation until after Health Centre (3) was built. There were paid in 1936 2,405 visits in connection with infant life protection and, again, this takes up the time of practically one Health Visitor for the same reason as 2,523 visits to tuberculous patients take up the time of one Health Visitor. 6. Inspection of Midwives and Inspection of Nursing Homes.—This has also been undertaken by the Council since 1930 without any increase in staff for this work. 7. Then, again since 1930, and more particularly within the last two or three years, there has been a large demand on the department, which is rapidly increasing, for the medical inspection and the cleanliness inspection of children about to be sent away for country holidays and school journeys. In 1936, 830 children received such medical inspection and at least three cleanliness inspections before departure and some of these children had also to be cleansed at the clinic. 8. In addition, there are some minor matters all of which represent an increase to an overburdened staff: e.g., the examination of children under the Employment of Children in Entertainment Rules; the medical examination of staff for admission to the Superannuation scheme; the treatment of varicose ulcers (958 attendances in 1936) and diphtheria immunisation (1,032 attendances in 1936). It will also be remembered that when the matter was under consideration about a year ago it was generally considered desirable that there should be a medical examination of children nearer the school leaving period than 12 years of age with the view of assisting in the choice of employment but this examination has not been undertaken. It will be appreciated that it has only been possible to encompass the foregoing work by cutting down work in other directions or not urging clinic attendances. For example, breathing exercises are very necessary after the removal of Tonsils and Adenoids. Such exercises are only available at Health Centre (1) and Health Centre (3). Some of the mothers in the Willesden Green area do not send their children for these exercises and a Health Visitor is sent to enquire the reason why. When the mother states it is too far the matter is left at that and she is not pressed to make her child attend because, in fact, if she is induced to send the child and subsequently the child fails to attend, a further visit by the Health Visitor is necessary to ascertain the cause of the second or subsequent failure. The basis of the proposed extension of Health Centre (2) so far as medical work is concerned, is the addition of one whole-time Medical Officer. At the present time there are two such Medical Officers engaged at Health Centre (2) and the average number of cases that they saw during the whole of 1936 was 41 and 30 per session respectively. It is certain that where a doctor is seeing an average of 30 cases per session these cases are not receiving sufficient attention. Some authorities make a limit of 25 as the number to be seen at one infant welfare session and probably this figure is correct as, obviously, 30 cases in a 2½-hours session means that one case is dealt with every five minutes which is a very short time when it is remembered that an expectant mother seldom occupies the time of a doctor for less than 15 minutes. The additional doctor would, therefore, have to deal with approximately 4,000 children between 1 and 5 years resident in Clinic (2) area and also relieve to some extent the existing doctors of their excess of work. I think it would be well to note that the work to be done in respect of existing services is greater than the above average numbers of cases seen by the doctors now employed indicate, because as a result of the pressure of attendances doctors do not now see many cases who would nevertheless be seen and profit by a medical consultation were time available. This is shown by the fact that the doctors in the employ of the Council saw in 1930, the cases under their observation 65 per cent, of the occasions on which they attended but in 1935, this percentage had fallen to 49 per cent. Having regard to the above considerations, it will, I think, be noted that neither the plans nor estimates which have been submitted are beyond the requirements of the area served by Health Centre (2). (Incidentally, it should be observed that the doctor at Health Centre (1) in 1936 saw 27 cases on the average per session and the two doctors at Health Centre (3) saw 29 and 34, respectively, on the average.) 125 Dental Work. The total number of children including secondary school children which the Council undertake to look after in respect of teeth is approximately 23,000. The Board of Education state that for 23,000 school children dentists should be employed in the proportion of 1 to 5,000, i.e., 4.6 dentists should be employed. At the present time the Council employ 3.6 dentists for the 23,000 school children under their control. It is reckoned that the remaining 0.4 dentist is employed in connection with mothers and children under 5. In this connection it should be observed that confining our attention only to the public elementary schools, in 1933, the dental surgeons inspected all the children in these schools in that year, but in 1936, they inspected 15,833 out of 19,845 on the roll or 80 per cent., instead of 100 per cent., as required by the Board of Education. It should be observed, however, that in Willesden only 34 per cent. of the school children actually requiring treatment receive it and, therefore, if the present 3.6 dentists employed in school work alone were brought up to 4.6 it would only encompass the work now to be done without improvement in the rate of acceptance of treatment which is urgently necessary. It has been reckoned that if all children requiring treatment accepted such treatment, 1 dentist would be able to deal with not more than 3,000 school children. Extract from Annual Report of Chief Medical Officer of Board of Education for 1929, p. 60— "The Dental Staff required for a complete service would depend then upon what is understood by the word 'complete.' According to existing standards, found by averaging the results for the country as a whole, the number of children who would be expected to attend for treatment if every child was inspected annually would be approximately 2,000,000. But in a fully-developed service these numbers would be nearly doubled. The average output of the whole-time school dentist has remained practically constant for a number of years, the number of children treated being approximately 2,300 yearly. This is a rather high figure which includes about 400 casual cases; it would necessarily be reduced if the standards suggested by Mr. Pitts—the cutting out of fissures, conservative work on certain temporary teeth and the use of orthodontic measures on occasion—were universally adopted. To give really adequate treatment on these lines to 1,500 children (allowing sufficient time for inspection) would represent a full year's work. To complete a School Dental Service, inspecting every child annually, offering treatment to all who will accept, and carrying out all the necessary conservative and other treatment, would therefore necessitate, at the present time, a total staff of about 1,300 dentists (i.e., about 1 to 4,000 of the school population) an increase of about 800 on the existing numbers. As the work developed and measures for educating the parents and children were increasingly successful, the numbers attending the clinics would steadily increase to a stage at which they would include nearly all those referred for treatment, and a school dentist, instead of being able to deal with 4,000 children, would be able to undertake the care of 2,300 only. For this, the final and really complete state of the School Dental Service, the employment of more than 2,100 whole-time dentists would be required, 1,600 more than at the present time. The annual cost of dental services, including the salaries of dentist and attendant, travelling expenses and the running expenses of the clinics, may be roughly estimated at £850 for each whole-time dentist. On this basis, the additional cost of a complete service would be £680,000 at the present time, rising steadily to about £1,400,000. Whatever may be said for or against a complete scheme of this magnitude and cost, it is certain that the present scheme covers less than half the ground." In the circumstances it will be noted that it is very difficult to separate completely the provisions under 10 relating to dentistry and 13 relating to dental mechanics and orthodontic work in the estimate of the Medical Officer of Health dated 2/4/37. The basis of the additional dental work at Health Centre (2) is the addition of two dental surgeons. At the present time there is one dental surgeon employed and he has 8,084 school children to look after, approximately 2,000 expectant and nursing mothers and, approximately, 4,000 children between 1 and 5. The addition of one dentist only would not enable this work to be done properly if it is aimed at getting more than 34 per cent. acceptances of children for treatment as should obviously be the case. A second dental surgeon would make up this deficiency in inspection and treatment and he would also have time to deal with the provision of dentures and the regulation of teeth in young children as already outlined. From this, 1 think it will be again noted that the provision for dental work which is included in the plans and estimates is by no means excessive provision and is likely to be insufficient over a number of years. (Incidentally, it should be observed that one dentist at Health Centre (1) endeavours unsuccessfully to cope with 5,010 school children, approximately 1,000 expectant and nursing mothers and approximately 2,000 children under the age of 5, while 2 dentists at Health Centre (3) similarly endeavour to cope with 9,275 school children, approximately 2,000 expectant and nursing mothers, and 4,000 children between 1 and 5.) General. In connection with the proposed plan for new Health Centre (2) it should be observed that the only provision which is made in the plan and estimates, which is a general provision for the whole of Willesden, is the X-ray department. At the present time certain X-ray work is done by the Middlesex County Council, certain other by the Willesden General Hospital, some by the Royal National Orthopaedic Hospital and some ringworm cases by private arrangement with the Council's Specialist at his private surgery. 126 Estimates. The following information is submitted as the basis of the 1937 estimate of new Health Centre (2). (1) Orthopaedics. This work has rapidly increased. In 1934, there were 8,000 clinic attendances and it was on this figure that the 1935 estimate was based. But, in 1936, there were 10,000 clinic attendances and it was on this figure that the 1937 estimate has been based. Similarly, in 1934-35, the estimated cost of hospital orthopaedic cases was £500 but, in the 1937-38 estimates, the sum included is £800 based on the expenditure of the previous year. (2) Artificial Sunlight and Minor Skin Conditions. The 1935 estimate did not include the surgical and X-ray treatment of minor skin conditions to which the Skin Specialist drew attention in his 1935 report published in 1936. (6) X-ray Department. This was not included in the 1935 estimate. As explained above under "General," the provision here made will enable all diagnostic and curative X-ray work to be done at this Centre for the whole of Willesden with the necessary consultations betewen the medical staff and the technician employed in X-ray work and consequent benefit to the patients. (10) Dentistry; and (13) Dental Mechanics and Orthodontic Work. This matter is dealt with under "Dental Work" above. (11) Pharmacy. This was not included in the 1935 estimates but with the increasing attendances and additional work, this provision is necessary. (12) Children 1-5 years. This work was not included in the 1935 estimate but it is work that the department have been striving to do for years but have been unable to do on account of lack of accommodation and staff. The Ministry of Health Circular issued in 1936 exhorted the Council to undertake this work and in their reply to the Minister the Council promised to do so when Health Centre (2) was rebuilt. As explained under "Medical Work" above, it is difficult to separate this provision from the present excessive work of Health Centre (2) doctors. (14) Squint Clinic. This was not included in the 1935 estimate as this form of treatment was first reported on by the Council's Eye Specialist in his report in 1935, published in 1936. This provision is made in other areas, e.g., Hendon. (15) Throat, Nose and Ear Conditions. This provision exists at Health Centre (1) and Health Centre (3) but cannot be arranged for at Health Centre (2) until accommodation is provided. (16) Staff. Many of these items are not strictly the result of a new Health Centre but represent the provisions necessary to cope with the increased work which already exists and is not in fact accomplished. These provisions were not included in the 1935 estimate which dealt only with new Health Centre (2). The work, however, has greatly increased since 1935 and without the extension of Health Centre (2) it is impossible to make provision to cope with existing work which continues to increase. (20) Miscellaneous. All these items are corollaries to the various preceding items in the estimate dated 2nd April, 1937. Recommendations. Having regard to all the foregoing considerations, I am of opinion that the Council should proceed as rapidly as possible with (1) the building of new Health Centre (2); (2) the extension of Health Centre (3); (3) the acquisition of a suitable site for a new Health Centre (1) at a point which would be convenient for the South Kilburn and Kensal Rise areas. GEORGE F. BUCHAN, Medical Officer of Health. 127 June 8th, 1937. APPENDIX N. HEALTH DEPARTMENT. Sanitary Work. Overcrowding—Basement Dwellings. Memorandum by the Medical Officer of Health. Overcrowding.—The Overcrowding Survey which was due to be completed by the 30th June, 1937, will be completed by that date. During the period some 47,000 dwelling houses will have been measured. (Note.—A dwelling house for this purpose means any premises used as a separate dwelling by members of the working classes or of a type suitable for such use.) Section 62 (1) of the Housing Act, 1936, makes the landlord responsible for the insertion in the rent book of the prescribed form showing the permitted number of persons in relation to the house. So far applications have been received for the permitted number in respect of only 9,000 of the above dwelling houses. In these circumstances I am of opinion that whether the landlord asks for it or not it is desirable that the prescribed form showing the permitted number, which information is now in the possession of the Health Department, should be sent to the landlord in respect of the remaining 38,000 or so dwelling houses. When this has been done the Authority will then be in a strong position to enforce the overcrowding provisions of the Housing Act, 1936. This work of issuing the prescribed forms to landlords will involve the retention of the temporary clerk and the temporary typist now employed for a further period of some seven to nine months, but there is sufficient provision in the housing estimate approved in connection with the Health Department estimates for this purpose. If any infringement of overcrowding coming within the terms of the Act is reported after the 1st July, 1937, the Committee may deal with such overcrowding in one of three ways:— (1) By granting a licence authorising the use for such period as may be specified in the licence of the house for such number of persons in excess of the permitted number as may be specified in the licence. (Section 61 of the Housing Act, 1936.) (2) Circular 1591 of the Ministry of Health suggests that if overcrowding is ascertained after the appointed day, the Committee should deal with the case on its merits and endeavour to assist the family by finding alternative accommodation. (Note.—Such alternative accommodation would only be the subject of grant if the alternative accommodation offered was accommodation which had been built by the Council with the intention of relieving overcrowding.) (3) The Committee may prosecute to secure compliance with the Act. Basement Dwellings.—This is a matter on which the Committee will probably want to concentrate as these basement dwellings certainly produce unsatisfactory housing conditions. There are in all approximately 1,228 houses in Willesden containing 2,016 basement rooms. Only some 125 of these basement rooms comply with the Council's Regulations; 1,270 of them could probably be made to comply; 348 probably cannot be made to comply; while 273 of these rooms are now used as stores. With regard to basement rooms, the Council have the following powers:— (a) to close them so long as they do not comply with the Regulations, but if the necessary work is done to make them comply they can again be used as dwellings ; (b) to close them, but the use of such rooms may be permitted for such other purpose as may be sanctioned by the Council, subject to the proviso that this sanction must not be unreasonably withheld. Staff. In order to carry out the above work the two temporary Sanitary Inspectors now in the employ of the Council should be put on the permanent staff. Provision for this exists in the estimates. When this is done it is proposed to divide the Borough into 11 areas each of which will as nearly as possible contain equal amounts of work having regard to the number of basement dwellings and the probable amount of overcrowding in the areas concerned. It is also proposed to retain Mr. Taylor to deal particularly with the work which is still going on with regard to the transference of persons from clearance areas or overcrowded houses and also with the overcrowding problems that will arise as the Act becomes fully operative. Mr. Dibblin, the Chief Sanitary Inspector, will be responsible for all the other work. GEORGE F. BUCHAN, Medical Officer of Health. 128 July 21 st, 1937. APPENDIX O. HEALTH DEPARTMENT. Municipal Hospital. Nursing Staff Re-organisation. 48 Hours' Week. As requested by the Committee, I now submit the following report on the reorganisation of the nursing staff in accordance with the following Minute of the Council:— Council Meeting, 23rd March, 1937. "Following on our report of last month on the dearth of recruits to the nursing staff, we have received a memorandum by the Medical Officer of Health on the hours and conditions of the various nursing grades at the Council's hospitals. The difficulty is not confined to Willesden, but appears to be more or less general throughout the country, and we attribute it largely to the unattractive conditions of service generally offered to the nursing profession. "We desire to express our strong conviction that the first step to be taken toward removing the difficulty of maintaining the nursing staff at its proper level is to reduce the number of working hours, and we recommend that the Council accept the principle of a forty-eight hour week at the hospitals, leaving the details of the consequential re-organisation to be worked out at a later date. "We have requested our Chairman and the Medical Officer of Health to prepare a report, for submission to our next meeting, on a complete scheme embodying details of the necessary re-arrangements of staff, living out allowances, and alterations and additions in the residential accommodation at the Municipal Hospital. "The question, so far as it affects the Maternity Hospital, will be the subject of a later report." The report of the Medical Officer dated 24th February, 1937, which was before the Hospital Visiting Committee showed that in order to provide a forty-eight hours' week and to have the necessary proportion of trained to untrained staff, the nursing staff to be employed at the Municipal Hospital should be made up as follows:— Sisters 11 Staff Nurses 21 Probationers 40 In connection with the introduction of a forty-eight hours' week the Medical Officer reported that certain other matters would require to be considered to which attention has now been given. These matters can all be dealt with by the following re-arrangements:— (a) Bathroom for Matron.—This can be provided by the conversion of an existing bedroom into a bathroom. (b) Sisters' Sitting Room.—This can be provided by extending the present sitting room to include the adjacent bedroom. (c) Staff Nurses' Sitting Room- This can be provided by converting an existing double-bedded bedroom into a sitting room. (d) Senior Sister and Sister Tutor.—A sitting room can be provided for this Officer by converting an existing bedroom into a sitting room. (e) Cloakroom for Nurses.—This can be provided by building a suitable room in connection with the side entrance to the Home. (f) Heating.—The low temperature in the older part of the Nurses' Home in the winter time can be overcome by the installation of electric radiators at suitable points. The above alterations will result in the loss of 6 beds to the Hospital, reducing the 56 beds now available for nurses to 50. As the nursing staff will total 72, this means that 22 nurses will require to live out. As 4 nurses live out at present, the additional provision for nurses living out will therefore be 18. Estimated additional annual costs of a 48 hours' week for nurses at the Municipal Hospital, including the cost of the alterations recommended in this report. (1) Cost of alterations To be referred to the Engineer. (2) Salaries for additional nurses: £ £ 2 Sisters at £85—£100 170 9 Staff Nurses at £70—£80 630 1 Probationer at £37—£39 37 837 (3) Cost of uniform in respect of the 12 additional nurses (12 x £8) 96 (4) Living-out Allowances: 18 nurses living out at £60 per annum being the present living-out allowance 1,080 129 *(5) Additions to existing living-out allowance which the Committee con£ sidered inadequate and will be still more so when a 48 hours' week is operative : 22 nurses living out at £18 396 *(6) Costs in respect of meals, etc. provided in the Hospital in respect of the 12 additional nurses who will live out: 12 x £26 312 (7) Council Superannuation Contribution and State Insurance 163 * These items (5) and (6) have been arrived at having regard to the particulars supplied by the Medical Officer of Health as to the costs of living-in and living-out of nurses in the statement attached. Particulars supplied by the Medical Officer of Health as to the living-in and living-out costs of nurses. Living-in. (1) A nurse living in is provided with:— (a) Meals, including cooking and service— Breakfast. Lunch, consisting of tea, biscuits with butter and cheese. Dinner. Tea. Supper consisting of fish or meat or eggs with cheese and biscuits or fruit or pudding. (b) Laundry—consisting of uniform, bed linen and blankets and household linen, and personal laundry including underwear and non-uniform dresses. (c) Bedroom, including heating, lighting, cleaning. (d) Baths. (e) Sitting Room, provided in common with other staff. Living-out. (2) A nurse living out and working, say, a 56-60 hours' week has to provide outside : (a) Meals including cooking and service— Breakfast daily. Lunch 1 day in 14. Dinner 1 day in 14. Tea every other day. Supper every other day. (b) Laundry—bed-linen and blankets and household linen and personal laundry. (c) Bedroom, including heating, lighting, cleaning. (d) Baths. (Baths may be taken at the Hospital). (e) Sitting Room. (Usually a bed-sitting room is acquired). (3) The Medical Officer of Health submitted to the Hospital Visiting Committee on the 27th May, 1936, a report on the cost of living of nurses. In this report it was estimated that the living costs to the Council of a living-in nurse were 41/- per week. This estimate has been again revised by the Medical Officer of Health in conjunction with the Stewards of the Municipal and Maternity Hospitals, and they are of opinion that this cost is probably more nearly 35/- per week. The Medical Officer of Health has also estimated the cost of living of living-out nurses. This cost comes under two categories:— (a) Emoluments received while on duty. This has been estimated by the Medical Officer of Health in conjunction with the Stewards of the Hospitals at 14/11 per week. (b) Payments by nurses in respect of accommodation, etc., provided outside the Hospital. The Medical Officer has obtained from nurses at present living out and on a 56-60 hours' working week their actual costs which are as follows:— Municipal Hospital— Staff Nurse 33/- per week. 32/6 „ „ 32/3 „ „ 39/11 „ „ 130 Maternity Hospital— Sister 25/6 per week. ,, 23/6 ,, ,, ,, 23/3 ,, ,, ,, 23/2 „ Staff Nurse 22/2 ,, ,, ,, ,, 22/2 „ „ ,, ,, 25/10 ,, ,, ,, ,, 26/10 ,, ,, ,, ,, 24/9 ,, ,, ,, ,, 23/6 ,, ,, ,, ,, 22/2 ,, ,, ,, ,, 26/2 ,, ,, ,, ,, 25/— ,, ,, ,, ,, 26/- ,, ,, ,, ,, 24/10 „ „ ,, ,, 25/6 ,, ,, Pupil Midwife 22/4 ,, „ Total 550/4 Average 26/3 It will therefore be observed that the estimated costs are as follows:— Nurse Living In. Nurse Living Out. Estimated value of emoluments per week. Estimated value of emoluments while on duty per week. Average payments made by nurse in respect of living out per week. 35/— 14/11 26/3 35/— 41/2 It will therefore be observed that it is estimated that it would be cheaper so far as the Council is concerned for nurses to live in rather than live out although the exact ramifications of the addition of considerable numbers to the living-in staff are difficult to estimate. On the other hand it would not be equitable to reckon the value of the emoluments for superannuation purposes of a nurse living in at 35/- and the value of the emoluments of a nurse living out at 41/2. It is therefore suggested that it would probably be fair if for superannuation purposes the value of emoluments of a nurse whether living in or living out were reckoned at 40/- per week. In order that this may be apportioned in the case of a living-out nurse, it is suggested that 10/- of this should be reckoned as the value of the emoluments the nurse receives while on duty and that 30/- should be reckoned to be the cost of the provision the nurse has to make for living out. Such an apportionment compares with the following living-out allowances decided upon by the London County Council: London County Council. Status. Cash Allowance. Valuation for superannuation purposes of meals in hospital (6 days), including cooking and service. £ £ Assistant matrons, superintendent nurses, all administrative grades of sister and dietician 120 39 Sisters and departmental sisters 110 32 Staff nurses and acting staff nurses 90 27 Assistant and probationer nurses, midwifery pupils and nursery governesses 80 26 Willesden Borough Council. Nurse. (It is usually a Sister or Staff Nurse who lives out) 78 26 131 Observations by the Chairman. If the above estimates and allowances are accepted by the Committee, I would suggest that the following alterations be made in respect of certain allowances now made to staff:— (1) That for superannuation purposes the Council value the emoluments of nursing staff at £104 per annum plus £8 per annum uniform allowance. (At present these emoluments are valued at the Municipal Hospital at £60 per annum and at the Maternity Hospital at £60 per annum plus £8 per annum uniform allowance). (2) That the Council value the living-in emoluments of living-out nurses at £26 per annum plus £8 per annum uniform allowance. (3) That the Council value the cost of living out by living out nurses at £78 per annum. (4) That the Council allow 20/- per week as a ration allowance to a living-in nurse on holiday. {At present this allowance is 15/- per week.) (5) That the Council allow 10/- per week as a ration allowance to a living-out nurse on holiday. {At present the Council allow 10/- per week.) Domestic Staff. This matter is outside the terms of reference, but I think it is desirable that the Committee should realise that alterations in the emoluments of nurses may reflect on the domestic staff. The domestic staff while on duty receive the same emoluments as the living-out nurse while on duty. In these circumstances I would suggest for the consideration of the Committee (6) That the Council value the emoluments received by the domestic staff while on duty at 10/— per week plus 1/8 per week uniform allowance. (The Council at the present time value this at 6/- per week plus 1/8 per week uniform allowance.) (7) That the Council allow 10/- per week as a ration allowance to domestic staff while on holiday. (The Council at present allow 6/- per week.) N. COWAN, Chairman. To be presented to the Hospital Visiting Committee at its meeting on Wednesday, 21st July, 1937. P.S.—In the foregoing report no allowance has been made for any increase of salary to any grade of nurse. (N.C.) October 12 th, 1937. APPENDIX P. HEALTH DEPARTMENT. Prevention of Blindness. Circular of Ministry of Health, No. 1621. Number of Blind Persons. I was instructed at the last meeting of the Committee to endeavour to get information as to the magnitude of this problem. The total number of registered blind persons in England on March 31st, 1935, was 60,389. Strictly on the basis of population this would mean 323 such blind persons in Willesden. The number of such blind persons in Willesden on the register kept by the Middlesex Association for the Blind, a voluntary association appointed by the Middlesex County Council to carry out their responsibilities under the Blind Persons Act, 1920, was at October, 1936, 201. These persons are registered under the Blind Persons Act of 1920, for which the County Council is the local authority. This Act does not authorise the provision of treatment to prevent a sighted person from becoming blind. The benefits of the Act are limited to those who are already blind and refer principally to the Welfare of the Blind, namely, "The provision and maintenance or contribution towards the provision and maintenance of workshops, hostels, homes or other places for the reception of blind persons." The Model Scheme for the Prevention of Blindness. Circular 1621 of the Ministry of Health refers to the importance of the prevention of blindness and suggests that the Model Scheme prepared by the Standing Committee on the Prevention of 132 Blindness of the Union of Counties' Associations for the Blind forms a suitable basis for action. The Model Scheme set out in the Circular includes— (1) The notification of persons threatened with blindness. (2) Systematic visiting of persons ascertained to be threatened with blindness to secure that they avail themselves of the facilities provided for expert treatment and supervision. (3) The provision of treatment for the prevention of blindness to persons so threatened either as in-patients or as out-patients at hospital dispensaries, clinics or other approved places or otherwise. (4) The provision of financial or other assistance to cases where necessary to enable them to take advantage of the facilities for treatment. (5) Recovery of whole or part of the cost of treatment according to the circumstances of the patient. (6) The dissemination of literature or information regarding the prevention of blindness. Pre-School and School Children. Children under five years of age and children attending Willesden Public Elementary Schools threatened with blindness are already dealt with so far as they come to knowledge under the Maternity and Child Welfare Scheme or the School Medical Service Scheme of the Local Authority. Ante-natal Work and the Prevention of Blindness. It should be observed, however, that the child of a pregnant woman who is suffering from a vaginal discharge or syphilis is in fact threatened with blindness. The Minister in Circular 1474, dated 9th April, 1935, called attention to the need for the better linking up of the ante-natal services with the treatment of such discharges and the treatment for syphilis. This is again emphasised in Circular 1621 on the Prevention of Blindness, which is now before the Health Committee. The Prevention of Blindness Committee above referred to has had this matter under consideration and in connection with it have issued the following statement which appears in the Report on the Prevention of Blindness by the Standing Committee on the Prevention of Blindness of the Union of Counties' Associations for the Blind published in 1936:— "63. The development of ante-natal services and of the means of securing early treatment in cases where venereal disease is present or suspected, should do much to secure for the newborn child a greater measure of immunity than formerly from the diseases or infections which threaten eyesight in the early days of life. "The Annual Report of the Chief Medical Officer of the Ministry of Health for 1932 referred to the special arrangements made 'at a number of Maternity and Child Welfare Centres for the diagnosis and treatment of gonorrhœa and syphilis in their patients,' and emphasised the value of ante-natal treatment in the prevention of gonorrhceal ophthalmia and congenital syphilis, and the Annual Report for 1933 recorded that 'a number of Local Authorities have not yet given serious consideration to the co-ordination of ante-natal work with that for venereal disease.' We hope that the importance of arranging and maintaining close liaison between the ante-natal work of an authority and the centres or clinics for the treatment of venereal disease will become generally realised as time goes on. We recognise, however, the difficulties of establishing a satisfactory link between the Maternity and Child Welfare Department and the Venereal Disease Department in areas where the population is scattered and where the only available treatment centre for venereal disease is a considerable distance away, but we consider that no effort should be spared in arranging for adequate ante-natal supervision and providing the best treatment possible in the circumstances. An examination of the various methods employed by the Public Health Authorities has led us to the conclusion that where it is possible to arrange for women and children to receive treatment for venereal disease at a clinic in association with a Maternity and Child Welfare Clinic, such an arrangement is desirable, and its success has been demonstrated by far greater willingness on the part of the patient to make the necessary attendances. The Ministry of Health recommend the provision of treatment on such lines in their Circular 1474, issued 9th April, 1935." In connection with the above it should be observed that with a view to the prevention of blindness it is necessary to treat patients suffering from vaginal discharge or syphilis. Vaginal Discharges. There is very great difficulty in dealing with the vaginal discharges of patients. The bulk of such discharges are not of venereal origin, but whatever the origin they should have a course of treatment for their cure. It is invidious to send such patients to a venereal department of a hospital, and of those so referred from the ante-natal clinics of this Authority some go, but many do not. In addition, of those who do go few continue their treatment at these clinics on account of the time and distance and the possible stigma which may be attached to attendance at such clinics. The Royal Free Hospital runs a special ante-natal clinic for such cases and some of the Kilburn expectant mothers attend there, but speaking generally, this clinic is too far away for Willesden women. The only satisfactory solution of this problem in Willesden would be for clinics to be held regularly at the Health Centres with a medical officer in attendance with special knowledge of these conditions. 133 Syphilis. Syphilis in the pregnant woman may lead to eye disease and blindness of the baby. Syphilis is a disease of long duration and can be diagnosed clinically only during the acute or later stages of the disease. For a long period the woman may be infectious without showing symptoms and a diagnosis can only be made by a blood test. In some ante-natal clinics such a test is carried out as a matter of routine and the number of cases actually detected is of the order of 1 to 2 per cent. Such a procedure is desirable, but it has not been recommended in Willesden because existing services have been used so fully. Other Considerations. There are at least 201 blind persons within the meaning of the Blind Persons Act, 1920, in Willesden. Without practical experience of the working of a scheme such as is indicated by the Minister, it is not in any way easy to estimate the number of such persons who either might have come under a scheme for the prevention of blindness or are still in need of treatment to prevent further blindness. The importance of provision for the prevention of blindness may be realised when it is stated that the total net expenditure for England and Wales in 1936-37 out of the rates on work for the welfare of the blind was £1,093,691, and to this sum must be added the cost of granting old age pensions to blind persons at an earlier age than to the other pensioners (at 50 instead of at 70) and the comparatively large sums subscribed voluntarily by the public for objects connecting with the welfare of the blind. In my opinion this matter of the prevention of blindness is of great importance. There would not be any great difficulty in working a scheme in the proposed new Health Centre (2). At the present time, however, there is neither sufficient accommodation nor staff to deal with existing services and the extension of services depends on the premises and staff which the Committee decide to provide. GEORGE F. BUC.HAN, Medical Officer of Health. December 22nd, 1937. APPENDIX Q. HEALTH DEPARTMENT. Willesden Maternity Hospital—Extension. Preliminary Report by the Medical Officer of Health. I beg to report in accordance with the following minute "Arising from the Conference with the County Council's representatives on the question of the provision of maternity hospital accommodation in the Borough, we have requested the Medical officer of Health to submit a memorandum to us setting out the considerations involved in any extension of the Maternity Hospital." (Report of Hospital Visiting Sub-Committee, 21-7-37.) The Extent of the Problem. The following table indicates the trend of midwifery since 1931:— Willesden—Births. Year. Domiciliary cases attended by Midwives. Domiciliary cases attended by Doctors. Births in Hospitals and Nursing Homes. Total Births notified. 1931 515 1,174 1,110 2,799 1932 457 997 1,220 2,674 1933 532 776 1,357 2,665 1934 610 680 1,436 2,726 1935 589 568 1,706 2,863 1936 646 516 1,745 2,907 It will be observed from the above table that the proportion of institutional to domiciliary confinements is steadily and rapidly increasing. 1,745 births took place in institutions in 1936, as follows:— Willesden Maternity Hospital 885 Central Middlesex County Hospital 387 Other institutions or nursing homes 473 Total 1,745 134 In connection with the 1,745 births which took place in institutions in 1936 and the 1,162 births which occurred at home, it should be observed that application is made for admission to the Willesden Maternity Hospital by something like 300 cases who have to find accommodation elsewhere on account of lack of beds in the Hospital. Of these 300 cases, although there is no exact record, it is probable that 150 are confined in the Central Middlesex County Hospital and other institutions and 150 are confined at home. The demand, therefore, for institutional confinement is not less than 1,745 plus 150, or say, 1,900 per annum, and this demand is increasing. Should the demand continue at the same rate as during the past six years it is not unlikely that in the course of a few years accommodation will be required for a number not far short of the total births occurring in Willesden, namely, approximately 2,900 per annum. In all these circumstances it would appear necessary to contemplate an extension of the Hospital to deal with 2,000 cases of midwifery per annum. The Existing Hospital and the extent of its use. At the present time the Hospital has— A Labour Unit of 3 delivery beds and 5 labour beds. 9 Ante-natal beds. 43 Lying-in beds. 4 Observation beds. These beds were occupied as follows during the period 1st April, 1936, to 31st March, 1937:— Labour Beds. 0 on 33 days. 1 „ 80 „ 2 „ 92 „ 3 „ 74 „ 4 „ 50 „ 5 „ 19 „ 6 „ 12 „ 7 „ 3 „ 8 „ 1 „ 9 „ 0 „ 10 „ 1 ,, 9 Ante-natal Beds. Admitted for complications only:— 7 and under on 300 days. 8 „ 28 „ 9 „ 25 „ 10 „ 8 „ 11 „ 4 „ 43 Lying-in Beds. 39 and under on 289 days. 40 „ 12 „ 41 „ 7 „ 42 „ 17 „ 43 „ 12 „ 44 „ 9 „ 45 „ 7 „ 46 „ 6 „ 47 „ 4 „ 48 „ 1 „ 49 „ 1 „ Total Ante-natal beds and Lying-in beds (52). 49 and under on 325 days. 50 „ 13 „ 51 „ 10 „ 52 „ 5 ,, 53 „ 6 „ 54 „ 4 „ 55 „ 1 „ 57 „ 1 „ 4 Isolation beds. 3 and under on 245 days. 4 „ 120 „ It will be noted from the above figures that the present Hospital dealing with approximately 900 cases per annum has from time to time been quite full. 995 cases have been booked to be confined during 1937 and 1,000 may, therefore, be taken as the maximum number of cases per annum with which the existing hospital can deal. 135 The additional provision required. In order to make the provision necessary to deal with 2,000 cases per annum the following additions are required:— Beds. (1) Labour Unit comprising 3 delivery beds and 3 labour beds and 1 larger room for patients who do not necessarily require to be in bed. (2) 11 Ante-natal beds. (3) 45 Lying-in beds. (If it is decided to demolish Block C a corrugated iron building, 15 additional beds will be required to replace those in Block C.) These 45 lying-in beds to be provided as follows (a) 30 Lying-in beds for ordinary cases. (b) 15 Lying-in beds for— (i) Mothers with premature babies. (ii) Mothers with sick babies. (4) 6 separate cubicle isolation beds. (5) A nursery of 14 cots for existing B Block. Nursing Staff. The following table shows the present nursing staff at the Hospital on the present basis of hours and the staff required to deal with 2,000 cases per annum on the basis of a 48 hours' week:— Present Nursing Staff. (1,000 cases and 56 hours' week.) Cursing Staff required for extended Hospital (2,000 cases and 48 hours' week.) 1 Matron. 1 Matron. 1 Sister-Tutor and Ward Sister. 1 Home Sister. 4 Sisters. 1 Sister-Tutor. 10 Staff Nurses. 1 Labour Ward Sister. 16 Pupil Midwives. 1 Night Sister. 11 Sisters. 20 Staff Nurses. 40 Pupil Midwives. Total 32 76 Living in or Living Out.—The following table shows the nursing staff who might live in and those who might live out:— Living In. Living Out. 1 Matron. 1 Labour Ward Sister. 1 Home Sister. 11 Sisters. 1 Sister Tutor. 20 Staff Nurses. 1 Night Sister. 40 Pupil Midwives. 44 32 Note.—I have had a conference with all nurses at the Maternity Hospital. With the exception of a few nurses who live at home or with friends they all prefer to live in. They state that it is difficult to get suitable accommodation in the neighbourhood of the hospital and that provided they had satisfactory bedrooms with a sufficient number of common sitting rooms and suitable provision for recreation and as much freedom from restrictions as possible, they would much prefer to live in. In fact, they would like the Nurses' Home to be as like a real home as possible. Domestic Staff. The following table shows the present domestic staff and the staff required for the extended Hospital:— Present Domestic Staff. Domestic Staff required for extended Hospital on basis of a proportion of nurses living out. Domestic Staff required for extended Hospital on basis of all nurses living in. 1 Cook. 1 Cook. 1 Cook. 1 Assistant Cook. 1 Assistant Cook. 2 Kitchen Maids. 3 Kitchen Maids. 4 Kitchen Maids. 2 Pantry Maids. 4 Pantry Maids. 4 Pantry Maids. 1 Dormitory Maid. 4 Dormitory Maids. 5 Dormitory Maids. 5 Ward Maids. 9 Ward Maids. 9 Ward Maids. 2 Relief Maids. 4 Relief Maids. 5 Relief Maids. 1 Doctor's Maid. 1 Doctor's Maid. 1 Doctor's Maid. 1 Matron's Maid. 1 Matron's Maid. 1 Matron's Maid. 1 Sewing Maid. 2 Sewing Maids. 2 Sewing Maids. 16 30 33 All the domestic staff would live out. 136 Steward's Department. The following table shows the existing staff and the staff required for the extended Hospital:— Existing Staff. Staff required for the Extended Hospital. Porter (Stokers) 4 4 Storekeeper 1 1 Gardener 1 1 Porters (only) —. 4 Skilled Handyman — 1 6 11 Administration Block, etc. As a consequence of the increased Hospital the following extensions and additions would be required:— General An extension of existing Kitchen. Provision of two additional larders. An extension of existing Pantry. Nursing Staff Lecture Room. Study Room. (a) If 44 live in and 32 live out— An extension of the Nurses' Dining Room. Provision of 28 additional bedrooms, with bathrooms and w.c.'s. Provision of additional nurses' sitting room. Cloakroom with bathroom and w.c. accommodation for nurses living out. or (b) If 76 live out— A Nurses' Hostel with 64 bedrooms and the necessary sitting rooms, recreation rooms, and other accommodation would be required. Domestic Staff Provision of new Dining Room for Maids. Cloakroom with bathroom and w.c. accommodation for maids living out Sewing Maid Provision of new Sewing Room. Male Staff Provision of a new messroom for Male Staff. Cycle Shed A larger shed is required for cycles of nursing, domestic and male staff. Dispensary Extension of dispensary stores accommodation. Mortuary Provision of a Mortuary, P.M. Room and Chapel. Incinerator-Ashpit New Incinerator and Ashpit required. Children's Room The provision of a room for children who come with patients' visitors. Roads The provision of Roads. Ambulance The provision of an additional ambulance and three drivers. Provision of Steam, Laundry, Heating, Water Softening. Steam.—The only place where steam is used for sterilising at the present time at the Hospital is in the Disinfector situated in the Steward's block. The use of electricity for sterilising has not been altogether satisfactory and it is desirable that steam should be available at all times for sterilisation in connection with the Labour Ward and the Operating Theatre. If, however, steam were made available, it would probably be desirable to use it in connection with sterilisation in all the wards. Laundry.—The approximate total number of pieces dealt with per annum at the Municipal Hospital Laundry on behalf of the Maternity Hospital is 128,000 and the number which the Municipal Hospital deal with for themselves is 348,000. If extension takes place the number of pieces will be in the neighbourhood of 300,000 per annum for the Maternity Hospital alone, and it would appear to be economical to provide a laundry in connection with this Hospital as the present running to and from the Municipal Hospital four times a week and the necessary separation of articles at the Municipal Hospital Laundry involve considerable expense. Heating generally—Hot water for washing purposes is supplied at present from three domestic boilers, one for the Administration Block and two for the Wards. Water for heating purposes is obtained at present from three heating boilers, one for the Administration Block and two for the Wards. It is suggested that the whole method of heating and supply of hot water should be considered in relation to the extensions to the Hospital including a Laundry and the use of steam for sterilising purposes. Water Softening—This would fall to be considered in connection with the question of heating generally. 137 Visits. In connection with the extension, the Committee may consider it desirable to visit more or less recently equipped Maternity Hospitals. Should they so decide I would suggest that they might visit some of the following:- (1) Middlesex County Council— Redhill County Hospital—Maternity Department of approximately 60 beds nearing completion 2-11-37. (2) London County Council— Hammersmith Hospital—Maternity Department. Lewisham Hospital—Maternity Department. (3) Southampton— Municipal Maternity Hospital—49 beds. (4) Croydon— Mayday Maternity Hospital—48 beds. (5) Ealing— Maternity Hospital—40 beds. (6) Walthamstow— Thorpe Combe Maternity Hospital—35 beds. (7) Northampton-— Barratt Maternity Home—36 beds. (8) Preston— Maternity Hospital—43 beds. (9) Rochdale— Birch Hill Hospital—Maternity Department—50 beds. GEORGE F. BUCHAN, Medical Officer of Health.