View report page

14
because owing to the mass of defects discovered amongst children and the urgent need for treatment,
time is not available for the study and application of measures for prevention which should
proceed parri passu with treatment.
The preservation and improvement of health represents a new field for medicine Present day
doctors have all been educated in respect of the treatment of disease, in fact their whole training
has been in respect of the diagnosis and treatment of pathological or diseased conditions rather than
the maintenance of normal physiological functions. A large field for inquiry in Preventive Medicine
is thus open and the Ministry of Health and Board of Education urge that inquiries into the causation
of disease should be undertaken. The need for inquiries of this kind is evident, if only a few examples
be taken from this report.
Table No. 44 shews that 1,338 or 9.96 per cent, of the special cases referred to the School
Medical Officer during the year, were suffering from defective ear conditions and defective conditions
of the upper respiratory passages. Defective hearing is a definite handicap in industry, "running"
ears are usually associated with defective hearing and are a danger to life, while defective conditions
of the upper respiratory tract, mean constant ill-health. The need for increasing attention, therefore,
to this subject, with the view of elucidation of the causes of these conditions and their eradication,
will not only help the individual sufferer but the nation generally, in respect of better health and
greater working capacity. Again, it will be observed in the same Table, that 503 children or 3-7
per cent, of the special cases referred to the School Medical Officer, were referred on account of visual
defects. In 53 per cent, of these cases, vision was brought up to normal at the Municipal Clinics
by the provision of Spectacles. This of course, is merely palliative treatment, and enquiry needs
to be conducted to ascertain to what extent the production of visual defect is attributable to the
hygienic conditions of the school or conditions of work or play or home surroundings or otherwise.
Table No. 61, in connection with an enquiry as to absences from school, conducted in certain
Willesden Schools during 4 months in 1920, shews that 69.5 per cent, of the absences were due to
actual or alleged illness of the child, and that 23.7 per cent, were unconnected with illness of the
child, as far as ascertained. Nearly half of the 23.7 per cent, of absences were caused by children
being sent to the country for a holiday, and some of such absences were therefore very likely connected
with ill-health or debility in the child. The principal illnesses causing absences from school
were: Infectious diseases, accounting for 13.2 per cent, of the total attendances lost, diseases of the
Lungs and Upper Respiratory Passages, 21.7 per cent; Skin diseases, 6.6 per cent.; andDebility,
8.2 per cent. The need for an intensive study of the physical condition of the child, in relation to
school and home, with the view of prevention of illness amongst scholars and consequent loss of
schooling, is again work waiting to be undertaken.
Table No. 25 also shews that, out of 17,491 children from 0-14, who came under the observation
of the Medical Officers of the Willesden Council during the year 1920, 8 or 0-045 per cent, were
found shewing signs of congenital or acquired syphillis. This number is not large, but the disease
is of a kind which transmits itself to others or reproduces itself in the offspring, frequently with
mental and physical disabilities, and is therefore one of national importance.
These items which I have noted will, I trust, shew the need for scientific enquiry in the
development of the work of preventive medicine. With every member of the Medical Staff of the
Authority having more routine work than he or she can reasonably perform, it is impossible to give
the necessary attention to subjects of the kind I have mentioned. They are, nevertheless, of firstrate
importance. It is only by such enquiries, scientifically conducted, that truth is reached and
progress attained. The importance of scientific research is accepted in industry. Scientific research
has enabled operative surgery to be undertaken to-day with little, if any, risk to the patient, and
so again scientific research will enable investigator after investigator gradually to build up the principles
on which the maintenance and improvement of individual and national health may be achieved.
While much work remains to be done, I do not wish it to be thought that much has not already
been accomplished. Fifty years ago the expectation of life at birth in males in England and Wales
was 41 -35 years. To-day it is 51 -50 years. Taking Willesden, and going back 40 years, we find
that the death rate in Willesden in 1880 was 18-7 per thousand of the population,and the Infant
Mortality rate 173 per thousand births. Twenty years ago the death rate in Willesden was 13-6
per thousand of the population and the Infant Mortality rate 139 per thousand births. Last year,
in 1920, the death rate in Willesden was 9 -78 per thousand of the population and the Infant Mortality
rate 65 per thousand births.
The difference in the death rates between 1880 and 1920 represents a saving of 1,520 lives in
Willesden per annum. It is not easy to put down the value of this Health work in terms of money,
but Dr. Farr, in 1876, in the 39th Annual Report of the Registrar General, reckoned that the mean
net value of each male person in the community was £150, as estimated by the standard of the agricultural
labourer of that day. For the whole population, including females, he thought the value
might be lowered to £110.
Willesden is an urban community, and having regard to the lower value of money to-day,
it is not unfair on Dr. Farr's estimate to put the value of each life in Willesden at £250* in 1920, as
* Since this was written Mr. Edgar Crammond, in his address to the Institute of Bankers, on 28th June,
1921, estimated the national wealth at £16,400,000,000 in 1913. Sir Josiah Stamp estimates the national wealth
in 1913 at £14,319,000,000. On the lower figure the value per head of the population in 1913 was £313, from
which it will be seen that my estimate of £250 in 1920 considerably understates the case.—G.F.B.