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vague kind, sometimes cases in which on account of the family history or for some other reason Tuberculosis
is feared. Cases with readily diagnosable and definite diseases are infrequent. In fact the
centre may justly be considered as a preventive rather than a curative institution. For this reason
radiographic and photographic records of patients, although very interesting, are not likely to show
great changes as a result of treatment, except perhaps in a very few instances. If it is desired that
they should be made considerable additional accommodation and personnel will be required.
(13), (14), (15) and (16) Six and a half weeks is a very short time in which to get many definite
results from the action of artificial sunlight, especially as during the first two or three weeks not many
patients had been submitted, but it is gratifying to be able to state that most of the patients showed
some signs of improvement. Perhaps the most striking case up to the present has been that of a
boy of 12 years old, who had suffered for many years with asthma and had a severe attack almost
every night of his life ; after the first treatment the attacks ceased altogether for three weeks, they
then began again, but were neither so severe nor so frequent. Subsequently they diminished rapidly,
both in intensity and frequency, and now (January 27th) he has been totally free for over three weeks.
It is probable that the sudden cessation of the attacks after the first treatment was largely due to the
influence of suggestion, but that the gradual but striking amelioration which has since taken place
may be justifiably ascribed to the artificial sunlight.
Another striking case was one of severe alopecia areata. This case, in a boy suffering from
heart disease, had resisted ordinary treatment for several months, but after six weeks of artificial
sunlight all the numerous bald areas were well covered with strong new hair.
The points to which attention has been directed in estimating the progress of the patients
have been (1) gain in weight, (2) improvement of appetite, (3) improvement of temper and liveliness.
(1) As regard gain in weight, this has not been very striking, many cases lose weight during the first
three weeks, but afterwards they pick it up again. There are, however, some cases of babies which
have been referred to the department principally because, although healthy in other ways, refused
to gain weight, which immediately began to put on weight. (2) As regards appetite, the loss of which
is an extremely common symptom in delicate children, the effect of the sunlight was very striking,
and (3) as regards temper and fretfulness, the reports of the mothers of puny babies have been most
gratifying and their testimony is amply confirmed by our observation of the little patients' behaviour
after their first few attendances at the department. In almost every case they seem quite to enjoy
themselves, and although they make a good deal of noise, there is no crying amongst them.
As regards the question of pigmentation of the skin, I am unable to correlate this phenomenon
with the improvement of the patient, but, it must be added, that the conditions of the department
make it very difficult to estimate the degree of pigmentation accurately, as the work is done in the
basement where real sunlight seldom penetrates, and it is impossible to judge slight degrees of pigmentation
by the artificial variety.
(17) The average cost of current per hour is approximately 9.36d.
(18) As none of the treatments were actually completed within the period under review it is
not possible to give the average cost of each patient's treatment.
APPENDIX N.
HEALTH VISITING.
by
Bessie R. Mackenzie, M.B., Ch.B., D.P.H.
Development of Health Visiting.
The first Health Visitor was appointed by the Willesden Urban District Council in December,
1903. Six months later a second appointment was made, and in 1905 a third Health Visitor was
added to the Staff. During these years the work of the Health Visitors consisted chiefly in the home
visitation of all notifiable and non-notifiable infectious diseases ; contagious diseases, e.g., scabies
and impetigo and verminous conditions reported from the Public Elementary Schools ; home visitation
of all registered births (one visit only unless the child was ailing or neglected) ; inquiries into all infant
deaths ; and the inspection of laundries, workshops and workplaces where women were employed,
and of the homes of women outworkers. In 1909 School Medical Inspections were instituted, and
two other Health Visitors were appointed to cope with the work. 1917 found the Health Visiting
Staff still further increased and the scope of work under the Maternity and Child Welfare Scheme was
then extended to include the home visitation and supervision of the expectant and nursing mother
and the child right up to the age of 5 years. It will be seen from this short survey that Health Visiting
has gradually come to be a very important branch of the Public Health Service. There are at the
present time 20 District Health Visitors in Willesden.