Act 34 Borough of Acton. ANNUAL REPORT OF THE Medical Officer of Health TOGETHER WITH THE Report on the Medical Inspection of Schools FOR THE YEAR 1931. ANNUAL REPORT OF THE Medical Officer of Health FOR THE YEAR 1931. Public Health Department, Municipal Offices, Acton, W.3. To the Mayor, Aldermen and Councillors of the Borough of Acton. Mrs. Barnes and Gentlemen, I herewith submit the Annual Report required by the Ministry of Health, together with the Annual Report on the School Medical Services. The estimated population is that of the Registrar General for the middle of the year 1931. It is, of course, based upon the figures obtained at last year's census. The birth-rate is considerably lower than that given in the report for 1930, but that is principally due to the corrected population. In last year's report the figures were based upon a much lower estimated population. Apart from this, though, the actual number of births is lower than that of 1930. The birth-rate last year was the lowest recorded for the district. The death-rate is slightly higher than that of 1930, but I have explained in previous reports that an apparently higher death-rate must be expected owing to the altered and altering age-distribution of the population. The increased number of deaths has occurred among the older persons. The death-rate at ages under 65 years of age, is, with one exception lower than in any previous year. The infantile mortality is also higher, but an infantile mortality of 60 per 1,000 births is, on the whole, satisfactory for a district such as Acton is. 4 The incidence of all the infectious diseases was considerably lower. There was no death from Whooping Cough and Scarlet Fever and a diminution in the number of deaths from Measles and Diphtheria. There were 5 maternal deaths; 3 from sepsis following abortion. There is reason to think that the practice of abortion is widespread, not only in this district but also in other surrounding districts. A feature of recent annual reports has been the inclusion of deaths from germ disease of the central nervous system, such as encephalitis lethargica, cerebro-spinal meningitis, anterior poliomyelitis, &c. Last year 4 deaths occurred from encephalitis lethargica, or sleepy sickness. Cancer still seems to be on the increase and last year claimed a higher number of deaths. The following is a summary of the vital and other statistics for the year 1931:— Area of Borough 2,305 acres Population (estimated midsummer 1931) 70,560 Population (Census 1931) 70,523 Number of inhabitated houses (Census 1931)— figures not yet available Number of inhabited houses (end of 1931) according to Rate Book 15,803 Number of families or separate occupiers (Census 1931 figures not yet available Rateable Value (1st October, 1931) £700,401 Net produce of a penny rate ((year ending 31st March, 1931) £2,812 13s. 5d Total number of births registered 1,019 Legitimate 962 Illegitimate 57 Birth-rate per 1,000 inhabitants 14.4 Number of deaths 742 Death-rate per 1,000 inhabitants 10.5 Number of women dying in, or in consequence of childbirth— from sepsis 1 from abortion 3 from other causes 1 Maternal mortality per 1,000 births 5 5 Deaths of infants under 1 year of age— 62 Legitimate 54 Illegitimate 8 Infantile mortality per 1,000 births 61 Death-rate per 1,000 Total Deaths Population. Measles 1 .01 Whooping Cough — — Diphtheria 4 .06 Scarlet Fever — —. Influenza 7 .10 Tuberculosis of Lungs 43 .60 Tuberculosis (other forms) 11 .15 Tuberculosis (all forms) 54 .76 POPULATION. Only the preliminary results of the Census have as yet been published. The preliminary report was published in August, 1931, and in that report the population was given as 70,523— 33,230 males and 37,293 females. The figure now given by the Registrar General is slightly different and is 70,560. A memorandum accompanies the estimate in which it is stated that the 1931 estimate of population noted differs from the 1931 Census population in that it purports to represent the resident popluation of the area, which is not necessarily comparable with the population enumerated at the Census. The analysis of the returns in respect of the "usual residence" question asked on the Census schedule has not yet been completed and the figure now given is to that extent approximate; it is believed, however, that it is sufficiently accurate for the purpose for which is supplied. The only other item which has been published is the ward population. This is based upon the number 70,523 and will be corrected when the final figures are published. The 70,523 inhabitants were distributed among the wards as follows :— North-East. North-West. South-East. South- West., 22,383 16,763 16,525 14,852 It was anticipated that increases had taken place in the NorthEast and North-West Wards, but it was hardly expected that there had been so large a decrease in the South-West Ward. The ward population in the last three censuses was as follows : North-East. North-West. South-East. South-West. 1911 14,576 11,492 14,599 16,830 1921 16,353 12,329 15,094 17,523 1931 22,383 16,763 16,525 14,852 6 It will be remembered that the Registrar General's estimate of the population in 1929 was 65,200 and we were asked to use this figure for 1930. The various rates were calculated upon the basis of this estimate and it is obvious that the birth-rate and death-rate given for these years are fallacious. It is important therefore to revise the population, not only for 1930 but for the other years between 1921 and 1931. It is difficult though to estimate the population for the inter-censal years. The usual method is based on the assumption that the yearly increase has been at the same rate through out the inter-censal period. The problem is similar to one of compound interest, the sum of money and the population both increasing from year to year not merely by the addition of the interest but of interest on the interest. A series of numbers is said to increase or decrease in geometrical progression when the successive numbers differ by a common ratio. It is a useful assumption, that a population increases in regular geometrical progression, but it is easy to show how wrong it is in theory, especially in a small district, where new industries are being established, or where the erection of houses had proceeded in an irregular manner during the intecensal period. Although new industries have been established in this district, and the number of new houses erected was higher in the second than in the first half of the inter-censal period, the method mentioned above is as accurate as any other. As probably it will be the method adopted by the Registrar General it will be more convenient to adopt it. The population in the ten years based on this method of calculation would be :— 1921 (Census) 61,299 1926 65,760 1922 62,170 1927 66,700 1923 63,060 1928 67,645 1924 63,945 1929 68,600 1925 64,845 1930 69,565 1931 (Census) 70,560 The number of dwelling houses and flats erected in the intercensal period was as follows :— Year ending Year ending 31st March, 1922 140 31st March, 1927 431 do. 1923 126 do. 1928 322 do. 1924 99 do. 1929 233 do. 1925 241 do. 1930 605 do. 1926 304 do. 1931 448 An examination of these two tables would suggest that the population in the years 1922— 1925 would be over-estimated, but there are certain considerations which might modify this view. The Census of 1921 was not taken until the middle of June and not as 7 usual in the beginning of April. Some holiday movement was already in progress at the time of the Census and the Registrar General from figures at his disposal made certain adjustments in the population of certain districts. The adjusted figure for Acton was 62,000. I think on the whole the estimated populations given above are as accurate as those which would be obtained by any other method of estimation. SOCIAL CONDITIONS OF THE DISTRICT. There is no change in the social conditions of the district. The northern part of the district is almost entirely covered with factories. The north-east and south-east wards are mainly residential in character, and so is the southern part of the north-west ward. In the south-west ward are situated most of the laundries in the district and the houses in this ward are small and occupied chiefly by persons of the artisan and labouring classes. AMBULANCE FACILITIES. The ambulance facilities are similar to those described in last year's report. A motor ambulance is provided for the removal of infectious cases to the hospital. There are two ambulances provided for accident and noninfectious cases. These are housed in a garage at the fire station and are available at all hours. A new ambulance was purchased by the Council in 1928, but the old one is still kept for emergencies. Last year the ambulance was called out to 432 street accidents, and on 449 occasions to private cases. Fees amounting to £87 6s. were paid for the use of the ambulance for private cases. HOSPITAL PROVISION. General.— The only General Hospital in the district is the Acton Hospital, Gunnersbury Lane, which has an accommodation of 62 beds. During the year 1286 in-patients were admitted ; this is a decrease of 18 on the previous year. Of these 370 were in for only 1 day and 108 for 2 or 3 days. 8 The Education Committee has an agreement with the Hospital for payment for the removal of tonsils and adeniods and the patients are kept in the Hospital for at least 1 night. 7223 out-patients were treated during the year, an increase of 124, and the out-patient attendances were 31,610, an increase of 2986 as compared with 1930. The Hospital supplies a great need in the District, is greatly appreciated and most of the beds are continuously occupied. Last year the average number of beds in daily occupation was 53.07 and from this figure it can be assumed that vacant beds are a rarity. Fever.— Acton Council Fever Hospital— 88 beds. Small-Pox.— Acton was one of the constituent bodies which formed the Middlesex Joint Small-Pox Board. Under the Provisional Order Confirmation Act of 1929, the Joint Board was disolved from the 1st April, 1929, and the duties of the Board transferred to the Middlesex County Council. Tuberculosis.— The Tuberculosis scheme is administered by the Middlesex County Council which has sanatoria at Clare Hall and Harefield. Child Welfare Consultation Centres.— (a)— 47, Avenue Road— Every Monday, Tuesday, Wednesday and Thursday afternoon at 2. p.m. (b)— Noel Road— Every Thursday afternoon at 2 p.m. (c)— East Acton.— Every Thursday afternoon at 2 p.m. (d)— Steele Road.— Every Tuesday afternoon at 2 p.m. Ante-Natal Consultation Centre.— School Clinic every 2nd and 4th Wednesday. Day Nursery.— 169, Bollo Bridge Road. School Clinic.— 45 Avenue Road. (The above are provided and maintained by the Borough Council). Tuberculosis Dispensary.— School Clinic on Tuesdays at 5 p.m. and Thursdays at 10.30 p.m. Treatment Centres for Venereal Diseases.— Various Hospitals in London. (The two latter are provided by the Middlesex County Council). 9 SANITARY CIRCUMSTANCES OF THE AREA. These have been noted in previous reports. All the inhabited houses are supplied from the mains of the Metropolitan Water Board. A few industrial works and the Public Baths obtain their water supply from deep wells. By arrangement with the London County Council the sewerage is discharged into the London Sewers. Storm water is filtered and emptied into the Thames. All the inhabited houses are provided with water closets and are drained into the main sewerage system. The house refuse is collected by the Council and burnt in the Destructor. Last year 19,625 tons of house refuse were collected and burnt. PROFESSIONAL NURSING IN THE HOME. General.— There are two district nurses employed by the Acton Hospital, one of which is primarily engaged in district nursing. There are also nursing associations which provides nurses for different classes of cases. Midwives.— The Supervising Authority under the Midwives Act is the Middlesex County Council and from the County Council I understand that there are 23 certified midwives practising in the Borough. LEGISLATION IN FORCE. The following local acts, special local orders, general adoptive acts and byelaws relating to Public Health are in force in the district. Adopted Infectious Diseases (Notification) Act, 1889 1889 Public Health (Amendment) Act, 1890 Infectious Diseases Prevention Act, 1890 1890 1899 Notification of Births Act, 1907 Public Health Act, 1907 (Clause 50) 1907 1921 Public Health Act, 1925 (Parts 2, 3,4 and 5) 1926 The Acton Improvement Act, 1904 New Streets and Buildings 1925 Removal of House Refuse 1899 Common Lodging Houses 1898 Slaughter Houses 1924 Nuisances, &c. 1924 10 Offensive Trades 1903 Tents, Vans and Sheds 1906 Removal of Offensive or Noxious Matters 1908 Houses Let in Lodgings 1925 Cleansing of Cisterns 1912 Emplovment of Children 1920 Fouling of Footpaths by Dogs 1929 Smoke Abatement 1930 HOUSING. In last year's report it was stated that there were no areas in the district which could be constituted into clearance or improvement areas. There were a few individual houses which were unfit for human habitation and these were represented as unfit. Some of the houses were closed and demolished before the end of the year, but in four instances, proceedings were still pending at the end of the year. The owners of the property were reluctant to eject the tenants and certain proposals were made which were not acceptable to the Council. During the year the Council erected 28 flats in seven blocks of four flats each. 16 of the flats are in Perryn Road, and 12 at the junction of Brassie Avenue and Old Oak Common Lane. The contract for the erection of the flats was let to Messrs. F. G. Cressy, Ltd., at £11,600. Each flat comprises a living room, two bedrooms, scullery and a bath room. Electric light is provided throughout and hot water is supplied from a. boiler behind the Eagle combination grate in the living room. It has been stated in previous annual reports that the contribution of the Council to the erection of houses in the district can have but a very small effect upon the housing problem. The development of the district since the war has been in such a manner that the demand for houses for the working classes will be greater than the supply. The term 'working class' is here used in a manner similar to that in which it is used in various Housing and Town Planning Acts of Parliament. Not only houses of that character, but there will always be a scarcity of all kinds of small houses oiwng to the establishment of large industries in the district, and in the adjoining districts. There will be competition for houses by people who wish to live as near as possible to the factories in which they are employed. Yet in spite of this fact, there is probably less legal overcrowding in the district than has been the case for a very long period. The figures of the Census showed that in 10 years the population of the South-West ward has decreased by 2671 inhabitants. 11 The number of houses has remained practically the same, and the diminution in the number of people has lessened the number of persons in each house. A recent house-to-house inspection of some of the streets in the ward repealed the same conditions. A few years ago a house-to-house inspection was made of these streets and in several instances notices had to be served to abate overcrowding in the houses. At the later inspection there was not a single instance of overcrowding. Under present conditions overcrowding is as much, if not more, a result of the play of social and economic factors than of scarcity of houses. Although wages are not higher (and there is certainly more unemployement) and rents are no lower, we have the seeming paradox of less overcrowding. Diminished overcrowding has resulted from the introduction of other factors. The birth-rate has for years been getting lower and lower, but until quite recently the birth-rate continued high among the class of people whose houses were overcrowded. Contraceptive methods were not generally practised by artisans, unskilled labourers, &c., and their families. Since the war, the practice of birth-spacing has spread amongst almost all classes of the population and large families are now rare exceptions to the general rule. The limitation of families has undoubtedly been the chief cause in our district of the lessened incidence of overcrowding. Although overcrowding has lessened, for the reason mentioned above, the demand for houses still continues and will continue, and there is very little prospect of reduction in the rents. HOUSING. Number of Houses erected during the year:— (a) Total (including number given separately under (b) 303 (b) With State assistance under the Housing Acts :— (i) By the Local Authority 28 (ii) By other bodies or persons Nil. 1. Inspection of Dwelling-houses during the Year 1931:— (1) (a) Total number of dwelling-houses inspected for housing defects (under Public Health or Housing Acts) 1657 (b) Number of inspections made for the purpose 4970 12 (2) (a) Number of dwelling-houses (included under sub-head (1) above, which were inspected and recorded under the Housing Consolidated Regulations, 1925 1068 (b) Number of inspections made for the purpose 3734 (3) Number of dwelling-houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation 9 Number of dwelling-houses (exclusive of those referred to under the preceding subhead) found not to be in all respects reasonably fit for human habitation 1516 2 Remedy of Defects during the Year without Service of formal Notices:— Number of defective dwelling-houses renderered fit in consequence of informal action by the Local Authority or their officers 1202 3. Action under Statutory Powers during the Year :— A— Proceedings under sections 17, 18 and 23 of the Housing Act, 1930 : (1) Number of dwelling-houses in respect of which notices were served requiring repairs 248 (2) Number of dwelling-houses which were rendered fit after service of formal notices :— (a) By owners 248 (b) By local authority in default of owners Nil. B.— Proceedings under Public Health Acts :— (1) Number of dwelling-houses in respect of which notices were served requiring defects to be remedied 66 (2) Number of dwelling-houses in which defects were remedied after service of formal notices:— (a) By owners 66 (b) By local authority in default of owners Nil. 13 C.— Proceedings under sections 19 and 21 of the Housing Act, 1930 : (1) Number of dwelling-houses in respect of which Demolition Orders were made 4 (2) Number of dwelling-houses demolished in pursuance of Demolition Orders 4 D.— Proceedings under section 20 of the Housing Act, 1930:— (1) Number of separate tenements or underground rooms in respect of which Closing Orders were made Nil. (2) Number of separate tenements or underground rooms in respect of which Closing Orders were determined, the tenement or room having been rendered fit Nil. E.— Proceedings undersection 3 of the Housing Act, 1925: (1) Number of dwelling-houses in respect of which notices were served requiring repairs Nil. (2) Number of dwelling-houses which were ered fit after service of formal notices :— (a) By owners Nil. (b) By local authority in default of owners Nil. (3) Number of dwelling-houses in respect of which Closing Orders became operative in pursuance of declarations by owners of intention to close Nil. F.— Proceedings under Sections 11, 14 and 15 of the Housing Act, 1925: (1) Number of dwelling-houses in respect of which closing Orders were made Nil. (2) Number of dwelling-houses in respect of which Closing Orders were determined, the dwelling-houses having been rendered fit Nil. (3) Number of dwelling-houses in respect of which Demolition Orders were made Nil. (4) Number of dwelling-houses demolished in pursuance of Demolition Orders Nil. 14 TABULAR STATEMENT OF INSPECTIONS AND DETAIL OF WORK CARRIED OUT BY THE SANITARY INSPECTORS. Number of Inspections and Action Taken. Total number of dwelling-houses inspected for housing fects (under Public Health or Housing Acts) 1657 (1) Dealt with by service of Informal Notice 1202 (2) Dealt with by service of Statutory Notice under Section 17, Housing Act, 1930 248 (3) Dealt with by service of Statutory Notice under Public Health Acts 66 Premises (other than defective dwelling houses) inspected for nuisances and miscellaneous defects 708 (1) Dealt with by service of Informal Notice 592 (2) Dealt with by service of Statutory Notice under Public Health Act, &c. 103 Reinspections subsequent to service of Notice 7094 Inspection after notification of Infectious Disease 158 Number of Premises under Periodical Inspection. Workshops and Workplaces 138 Bakehouses 27 Slaughterhouses 2 Public Health Urinals 37 Common Lodging Houses 1 Houses-let-in-lodgings 30 Butchers' Shops 45 Fish Shops 28 Premises where food is maunfactured or prepared 33 Milk Purveyors 95 Cowsheds Nil. Piggeries Nil. Rag and Bone Dealers 8 Mews 4 Schools 13 Show Grounds Nil. Rent Restriction Act. Number of Certificates granted 13 15 Detail of Work carried out. Sanitary Dustbins provided 544 Yards paved or yard paving repaired 267 Insanitary forecourts remedied 57 Defective drains repaired or reconstructed 88 Defective soil pipes and ventilating shafts repaired or renewed 53 Defective fresh air inlets repaired or renewed 64 Defective gullies removed and replaced by new 33 Rain water downpipes disconnected from drain 12 Dishing and curb to gullies repaired and new grating fixed 305 Defective W.C. pan and traps removed and replaced by new 55 Defective W.C. flushing apparatus repaired or new fixed 456 Defective W.C. seats repaired or new fixed 187 Defective flush pipe connections repaired 49 Insanitary sinks removed or new fixed 35 Sink waste pipes repaired or trapped 170 Insanitary wall surface over sinks remedied 97 Ventilated food cupboards provided 3 Drinking water cisterns cleaned 187 Defective covers to drinking water cisterns repaired or new fixed 62 Insanitary sites beneath floors concreted 15 Spaces beneath floors ventilated 123 Dampness in walls from defective damp-proof course remedied 103 Dampness from defective' roof, rain water gutterings, &c., remedied 853 Defective plastering repaired (number of rooms) 439 Rooms where dirty walls and ceilings have been cleansed and redecorated 3744 Defective floors repaired 124 Defective or dangerous stairs repaired 13 Defective doors and windows repaired 353 Defective kitchen ranges and fire grates repaired 165 Defective washing coppers repaired 104 Coal cupboards provided and repaired 10 Ne w W.C. apartments provided 8 Accummulations of offensive matter removed 42 Drains unstopped and cleansed 375 Overcrowding nuisances abated 12 Drains tested, exposed for examination, &c. 78 Smoke observations taken 247 Smoke nuisance abated on sendee of notice 32 Nuisances from pigs and other animals abated 3 Notifications of waste of water sent to Metropolitan Water Board 171 16 INSPECTION AND SUPERVISION OF FOOD. MILK SUPPLY. There are 85 dairies and milkshops on the register. There are at present no cowsheds in the Borough and all the milk is produced outside the district. BAKEHOUSES. There art 27 bakehouses in the district; of these 5 are underground bakehouses and were occupied before the passing of the Factory Act of1901, SMOKE INSPECTION. Considerable attention has again been paid to the factory chimneys in the district and though statutory notices has to be served in some cases, no summonses were issued. At the present time the factory chimneys in the southern part of the district are a bigger source of nuisance than those in the northern part of the district. The latter are of a more recent type and in a large number electrical power is used. MEAT INSPECTION. There are two slaughter-houses in the borough; in one of these, pigs alone are slaughtered, and in the other no pigs are slaughtered. It has been usual in the past to supply a full list of the unsound food condemned, and the following tables are inserted so that the conditions can be compared with former years. It is well known that a large part of the carcases slaughtered in this district is made into sausages, and when we consider how easy it is to convert inferior and diseased meat into sausages the importance of a rigid method of inspection is very obvious. The large firm which manufactures sausages in this district has to satisfy some of its largest customers that the inspection not only of the carcases but of the manufacture of the sausages is satisfactory. It has a large export trade and most of the countries to which the sausages and canned meats are exported are strict in their requirements as to inspection. Most of the South American States for instance refuse to allow importation of food unless a certificate 17 is obtained that an inspection has been made by the local sanitary authority of the district in which the exporters firm is situated. These countries take such measures as will ensure that the foods which are imported have been produced under proper conditions and under sanitary supervision. The primary object of meat inspection is to safeguard the public health and to prevent any meat being sold for human consumption which may be deleterious to the consumer, and not only this but an adequate system should prevent frauds being practised, such as the substitution of inferior types of meat or meat products when the purchaser is paying for the best, even if not actually in themselves harmful. Under the conditions which obtain to-day, the housewife must protect herself. When she buys an ordinary joint of meat, she can be fairly certain that it is not diseased, as it is too risky to expose a diseased carcase for sale, but even in these circumstances, it would be as well for her to buy only from a reputable butcher. When it comes to buying meat products such as sausages or canned meats, the only sure protection the housewife has is the reputation of the firm of manufacturers. It has been frequently pointed out that one of the greatest stumbling blocks to a better and more uniform system of meat inspection is the presence of so many private slaughter-houses. These undoubtedly are a menace, because in most of them the inspection is very inadequate, even when it is being attempted. But there is another menace which is more potent then many of us wish to admit. There is far too much illicit slaughtering going on up and down the country. Last October, the Sanitary Inspector seized some meat in a motor lorry in a garage in Horn Lane. The lorry contained 1 pig's carcase with head, 3 calves carcases, 3 oxen's heads, 1 ox's heart, 3 oxens' livers, 1 mesentery and 1 oxtail. With the exception of one calf's carcase, and the ox tail and ox heart, all the meat was diseased and utterly unfit for human consumption. It was all infested with tubercles. Proceedings were taken and the man was fined £33 and costs. Although we succeeded in obtaining a conviction, we were unable to ascertain the source of the meat or where it had been slaughtered, &c. Shortly afterwards, a message was received by us from the Finsbury Council that this same person had endeavoured to sell some diseased meat to a butcher in Charterhouse Street. The Finsbury Council when they heard of the previous conviction, decided to trace to its source the condemned meat and a most extraordinary state of affairs was disclosed. 18 Some of the meat belonged to carcases slaughtered under the Tuberculosis orders in Somersetshire and compensation had been paid by the County Council. The Cattle had been sent to a knackers yard for slaughter and had been bought ostensibly for cats meat. The man who had exposed the meat for sale in Smithfield had bought the meat at the knackers yard for about three shillings a hundred weight and had sold it for about twenty-five shillings. It had been dressed, and of course, was intended to be used in sausages. If the meat had passed the inspector at Smithfield, it would not have been possible to detect its diseased nature in the minced meat. Fortunately the man was caught and was sentenced to three months' imprisonment. It can be easily appreciated that a rigid inspection is necessary here, not only in the interests of the manufaturers, but also to protect the public. UNSOUND FOOD SURRENDERED DURING 1931. Diseased Meat. Tuberculosis. 2 Cows' Offals. Pigs. 3 Stirks' Offals. 13 Carcases with Heads. 1 Calf's Ofial. 3 Forequarters. 10 sets of Cows' Lungs with 1 Hindquarter. Hearts. 44 lbs. of Pork. 3 Ox Hearts. 84 Heads. 4 Ox Livers. 209 Plucks. 1 Ox Mesentery. 2201 lbs. of Chitterlings. 35 Calves' Plucks. 2 Calves' Livers. Cattle. 9 sets Calves' Lungs. 1 Bull's Carcase. 4 Cows' Carcases with Offal. 2 Stirks' Carcases with Offal. Parasites. 3 Calves' Carcases with Offal. Cattle. 1 Forequarter of Beef. 1 set Cow's Lungs with Heart. 1 Hindquarter of Beef. 5 sets Cows' Lungs. 2 Forequarters of Veal. 10 Cows' Livers. 1 Hindquarter of Veal. 7 Stirks' Livers. 1 Shoulder of Veal. 1 set Calf's Lungs with Heart. 2 Ribs of Veal. 3 Calves' Plucks. 5 Cows' Heads and Tongues. 3 Calves' Plucks. 6 Stirks' Heads and Tongues. 6 Calves' Livers. 5 Calves' Heads and Tongues. 19 Sheep. Pyaemia. 1 Sheep's Pluck. Cattle. 71 sets Sheeps' Lungs. 2 Calves Carcases with Offal. 34 Sheeps' Livers. Pseudo Hodgkins Disease. 1 Calf's Carcase with Offal. Pleurisy. Cattle. 1 calf's carcase With offal 4 Cdves'Carcases with Offal. (Emaciated) 2 gets Cows. Lungs with 3 Forequarters of Veal Heart. 10 Breasts of Veal. 22 Ribs of Veal. 2 Briskets of Beef. 9 cow' Heads and Tongues. 5 sets Cows Lungs with Hearts. 17 Calves' Plucks. Jaundice. 15 sets Calves' Lungs with 1 pig's Carcase_ Hearts. Cattle. Sheep. 4 Calves' Carcases with Offal. 2 Breasts of Mutton. 1 Sheep's Pluck. Sheep. 1 set Sheep's Lungs with 1 Sheep with Offal. Heart. Dropsy. Suppurating Pleurisy. Cattle. Cattle 1 Cows' Carcase with Offal 2 Flanks of Beef. 4 Calves Carcases with Offal (Emaciated). Cystic 3 Calves' Plucks. 7 cows' Kidneys. Sheep 4 Calves' Kidneys. 1 Sheep's Pluck. Adenitis 3 Calves' Plucks. Abscesses. 7 Calves' Livers. Cattle. 1 Short Forequarter of Veal. Melanosis. 4 lbs. Leg of Veal. 1 Calf's Pluck. 7 Calves' Heads. 2 Calves' Plucks. Fatty Infiltration. 20 Calves' Livers. 1 Cow's Liver. Sheep. Arthritis. 4 Sheeps' Livers. 2 Knuckles of Veal. 20 Nephritis. 1 Ox Head. 4 Cows' Kidneys. 2 Knuckles of Veal. 6 Stirks' Kidneys. 3 sets Calves' Feet. 2 Calves' Kidneys. Moribund. 1 Calf's Skin. 15 Calves with Offal. Fevered. Sheep. 2 Calves' Carcases with Offal. 1 Sheep with Offal. Congestion. Cirrhosis. Pigs 2 Hindquarters fo Pork. 1 Calf's Pluck. 7 Cow's Livers. Cattle 2 Calves' Livers. 1 Calf's Pluck. Sheep. 1 Sheep's Liver. Sheep . Bruised, Fractured, etc. 1 Sheep'S Pluck 2 Hindquarters of Pork. Unsound. 3 Legs of Pork. Pigs. 2 Shoulders of Pork. 27 1bs Shoulder of Pork. Cattle. Cattle. 1 Side of Beef (dropsical). 1 Ox Heart. 1 Forequarter of Beef. 1 Ox Spleen. 1 Loin of Beef. 2 Ox Kidneys. 2 Calves' Carcases with Offal. 2 Calves' Plucks. 1 Breast of Veal. 2 Calves' Livers. Other Foods. Tuberculosis. Unsound. 1 Chicken. 2 Turkeys. 4 stones of Skate Wings. 4 (6 lbs.) Tins of Corned Beef. 3 Tins of Prawns. TABLE II. NUMBER OF PIGS' CARCASES INSPECTED FROM 1st JANUARY TO 31st DECEMBER, 1931 WITH ANALYSIS OF SURRENDERS ON ACCOUNT OF DISEASE. 1931 No. of Carcases Inspected. No. of Heads Diseased. No. of Carcases Diseased. No. of sides Diseased. No. of Fore Quarters Diseased. No. of Hind Quarters Diseased. No. of Legs Diseased. No. of Shoulders Diseased. Plucks (Lungs, Livers and Hearts). Mesenteries, Stomachs and Intestines Pieces of Pork. Weiehts. January 1283 6 1 - - - - - 15 272 lbs. 44 lbs. Tons- Cwts 1 qrs. 1 lbs. 22 February 1134 7 1 - 4 - - - 14 210 „ 42 „ - 2 3 0 March 1034 5 1 - - - 2 - 13 248 „ ,, 4 1 14 April 1180 4 - - 1 - 2 2 8 288 ,, ,, 3 2 10 May 814 10 4 - - - - - 12 160 ,, - 13 1 16 June 801 8 1 - - - - - 7 200 „ ,, - - - - July 814 5 1 - 1 - - - 17 130 ,, 4 ,, - - - - August 934 12 1 - - 2 - - 11 155 „ - - - - - September 1262 5 1 - - - - - 8 108 .. - - - - - October 1670 14 1 - - - - - 34 280 - - - - - November 1358 10 1 - - 1 1 - 28 102 „ - - - - - December 1669 16 - - - - - - 26 232 „ 33 „ - - - - TotAL 13068 101 13 - 6 3 5 2 103 2547 „ 123 „ - - - - 21 22 TABLE III. Counties from which animals were consigned, and percentage diseased (1st Jan.—31st Dec. 1931.) County. No. of Towns from which Animals were consigned. No. of Carcases Inspected No of Animals Diseased Percentage of Animals Diseased Bedfordshire 4 213 1 .47% Berkshire 1 21 - - Buckinghamshire 3 81 - - Cambridgeshire 9 663 2 .30% Dorsetshire 5 2,188 25 1.14% Gloucestershire 1 94 - - Hampshire 11 506 3 .59% Hertfordshire 4 113 3 2.65% Huntingdonshire 2 108 - - Ireland 3 2,240 17 .79% London 1 36 - - Middlesex 7 573 - - Norfolk 11 2,469 20 .81% Somerset 7 767 14 1.89% Suffolk 17 2,025 9 .44% Surrey 6 696 - - Sussex 1 109 - - Warwickshire 1 1,044 10 .96% Wiltshire 1 22 - - Total 95 13,968 104 .75% BIRTHS. Table 7 gives particulars of the births registered and notified in the district, and the births belonging to the district which have occurred and been registered outside the district. The total number of births are those registered during the calendar year and are corrected for inward and outward transfers. This figure is obtained at the end of the year from the Registrar General, and is simply the total for the district. It does not allocate the births to the wards, and from this total it is not possible to make a ward allocation. Last year the total number was 1019 ; 501 males and 518 females, and the figure is equal to a birth-rate of 14.4 per 1,000 inhabitants. In addition 30 still births were returned as belonging to the district; 16 males and 14 females. 23 The ward allocation is made from the notifications which are received under the Notification of Births Act. The number of notifications does not exactly correspond always with the number of registrations. The births have to be notified within 36 hours, whilst a delay of 6 weeks may occur in the registration of a birth. There is not much difference in the number notified and registered in the district in the year as the births which occur towards the end of the year and are not registered until the following year are equalised by the births which have occurred towards the end of another year and have not been registered in the same year under similar conditions. The difference between the number of notified births and registered births arises from differences in the practice of various sanitary authorities. Some authorities send intimations to the district concerned of all the outside births which have occurred in their area. Other authorities do not supply this information. It will be inferred though from the table that this information is now fairly complete. There is only a difference of 18 in the number of notifications received and the total number of live births belonging to the district as supplied by the Registrar General. There is a considerable drop, not only in the birth-rate, but also in the total number of births, and the cause is not far to seek. Whatever our views may be on the subject of birth-control, we must face the fact that contraception is being practised more and more among almost every class of the population. There is no birthcontrol clinic inside the borough, but there are at least three in neighbouring boroughs and it is known that a large number of our married women make extensive use of these. In another paragraph, I refer to the deaths from sepsis following abortion, and it must be admitted that where contraceptive methods are not used, other practices are followed which are more harmful still to the mother. It is a subject which no one wished to discuss, but it would be idle to ignore certain facts, such as the activity of abortionists among mothers, the extensive use of aborticfacient drugs and mechanical attempts at abortion. It may be argued that the question is more of a social than a medical one, that the condition is not one which concerns a sanitary authority, but it is impossible to separate the medical from the social aspect of the subject. One has to consider not only whether birth-control does harm in itself, but whether it is more harmful than the attempts which are made to bring about the premature expulsion of the foetus. Although there may be no organic disease in the mother, we are forced to consider the harm which may result from frequent pregnancies, insufficient rest, insufficient nourishment, &c. These are problems which are being forced continually to the notice of all public health workers. 24 At the same time the subject bristles with difficulties. It is admitted that at present methods are imperfect and crude. What will be the result if these methods are perfected. It has been calculated that such a consummation would probably halve the birth-rate. It is useless to speculate if our present civilisation based on monogamy would survive. A change in the environment would change the outlook of the individual and the community, but whatever the future may bring forth, it is certain that the Victorian attitude to marriage will not be recaptured. Birth-control is one of the results of emancipated womanhood, and the big families of the last century will not figure in the social life of the future. DEATHS. 456 deaths were registered in the district; of these 35 were of non-residents. 321 deaths of residents occurred outside the district. The total number of deaths belonging to the district is 742, which corresponds to a death-rate of 10.5 per 1,000 inhabitants. The table giving the causes of death, age-distribution, &c., is given on a later page, but in the return supplied by the Registrar General, the total number of deaths is given as 743. The difference is too small to affect the different rates, and the slight discrepancy is easily explained. In the list of outside deaths for the first quarter of the year there are allways included some deaths which belonged to the previous year. As the first quarter's list of outside deaths is received some time in May, it is usually too late to include them in the returns for the year under review. In the outside death returns for the first quarter of 1931, there were 3 deaths which had occurred on December 30th, 1930. These have been included in the figures for 1931, as intimation was received too late for their inclusion in the tables for 1930. Although possibly not strictly accurate it is the only method available if all the deaths are to be included in our returns. But there are very many differences in the number of deaths from the different diseases. The most important one is the number of deaths attributed to heart disease. In the Registrar General's return the number is 164, and in Table 1 the number given is 71, but in the Registrar General's return the number of deaths from Senility is only 20. There were 115 deaths in persons over 80 years of age last year; of these 42 were over 85 and 10 over 90 years of age. It is fairly obvious that more than 20 deaths should be classified as old age, but they are placed under other headings because of the nomenclature used by 25 different medical men. Some doctors rarely, if ever, give old age as the cause of death. They always name a certain disease, though this disease (if it can be called a disease) is only a part and parcel of the process of growing old. Some of the deaths of persons over 90 years of age have been certified as myocardial degeneration. These are placed under Heart disease together with other conditions such as Myocarditis following Rheumatic Infection or Valvular Disease of the heart. But there is no analogy between the two conditions. In the former the degeneration of the heart was merely part of a general degeneration; there was a general break-up of the mechanism and death was inevitable. Death could not have been avoided, and methods of preventure could not avail. When the Myocarditis follows Rheumatic Infection the conditions are entirely different. The infection may have been an avoidable one, and the life could have been prolonged. The death has usually occurred before the other parts of the body have worn out, and the unfortunate sufferer had died in the prime of life. Heart disease looms larger in our returns than any condition, but it does not mean that preventable heart disease is more prevalent. Most of the deaths from heart disease are of persons over 65 years of age; out of the 71 deaths classified in Table 1, as due to heart disease 47 were in persons over 65 years of age. In the number returned by the Registrar General the percentage of those over 65 years of age is much higher. These deaths are certified as fatty degeneration of the heart, myocardial degeneration, &c. At the other end of life we have the congenital deformities of the heart and these deaths again are not preventable. Heart disease may or may not be on the increase, but until the returns show us how many of the deaths are due to a degeneration which is inevitable and those due to post infective heart disease which may be preventable, our information is not sufficient to form an opinion. On Table 3 are given the rates for 1931 and previous years. Based upon the revised estimates the death rate is higher than that of 1390 but lower than that of 1929. A comparison with 1929 is not quite a fair one as there was an extensive outbreak of Influenza in the early part of that year. It will be observed that recently the death rate has been stationary or has even shown a tendency to rise. This does not mean that the general health of the community has in any way suffered a set back. It probably means that, the age distribution of the population is altering. We have a larger proportion of inhabitants who have passed the prime of life and amongst whom the death rate is naturally high. The continued drop in the birth rate is making itself felt in the age distribution of the population. 26 This will become evident if we compare the ages at death with thosa of say 20 years ago. It would not be fair to compare 1931 with 1911 because 1911 was an abnormally hot year and there was a very large number of deaths in children from Diarrhoea, but an average of the 3 years 1910, 1911 and 912 would form the basis of a better comparison. Ages at Death—1910, 1911, 1912 and 1931. Under 1 1-2 2-5 5-15 15-25 25-45 45-65 Over 65 Total. 1910 151 55 18 20 203 176 623 1911 205 67 49 34 28 81 143 170 777 1912 107 38 41 31 30 79 137 177 640 1931 62 11. 9 16 26 78 170 370 742 Twenty years ago 22 per cent. of the deaths were of children under one year of age, and 40 per cent. of the deaths occurred in children under 15 years of age. Last year the figures were 8.3 and 13.1 respectively. Some allowance must of course be made for the lower birth rate and consequently for the higher proportion of persons living under 15 years of age, but the lowered birth rate had been in operation then for some time. Twenty years ago only 25 per cent. of the deaths were in old people over 65 years of age; last year the percentage was 50. One half of the deaths ocurred in people over 65 years of age. The span of life has been and is being lengthened. Death is inevitable, but it makes a difference whether death comes in the prime of life or when the body is worn out. On Table 1 is given the death rate for England and Wales and the large towns. Our death rate is lower than that of England and Wales and than that of the large towns, but that is hardly a fair comparison as the conditions vary so enormously in the different towns. In the industrial towns of the north of England the death rate varies from 12 to 15 per 1,000 inhabitants and the high death rate in these towns naturally raises the general average. The Registrar General has published the death rate in the towns in the outer ring of London, and the conditions in these districts are somewhat similar. The death rates in these towns are as follows:— 27 Croydon 11.4 Wimbledon 12.3 Ealing 10.1 Acton 10.5 Brentford and Chiswick 10.4 Willesden 10.4 Hendon 7.7 Hornsey 11.1 Wood Green 10.1 Tottenham 10.2 Edmonton 10.0 Enfield 10.4 West Ham 11.4 East Ham 10.7 Leyton 10.6 Walthamstow 10.4 Ilford 9.0 It is curious how very even the death rate is in these different towns. Ward Distribution of the Deaths. North-East. North-West. South-East. South-West. 234 183 145 180 Death Rate of each Ward. North-East. North-West. South-East. South-West. 10.5 10.9 8.9 12 Another contrast with the conditions which obtained 20 years ago is the comparative evenness of the rate in the different wards. Formerly, the death rate in the South-West ward was nearly twice as high as that in the other wards. As the figures now show, the difference in the various wards is a very small one. Causes of Death. There is an increase in the number of deaths from Bronchitis and Pneumonia. This was due to the severe weather in the early part of the year. 28 There is also an increase in the number of deaths from Cancer. Although considerable research has been made into the causation of Cancer, so far, the best from of treatment is an operative one. There is also an increase in the number of deaths from accidents in the streets. Deaths in Public Institutions. Of the total number 359 occurred in Public Institutions and 17 in nursing homes. Of this total 295 occurred in hospitals outside the district and 64 in hospital in the district. Inquests and Coroner's Inquiries. 48 inquests were held and in 25 instances the Coroner issued a certificate without an inquest after he had ordered a post-mortem examination. INFECTIOUS DISEASES. Scarlet Fever. 95 cases of Scarlet Fever were notified during the year and there was no death from the disease. The disease was most prevalent in the North East Ward, but in none of the wards was the incidence of the disease heavy. Scarlet Fever, though not breaking out with the same explosive force as Measles, occurs in epidemic waves, and we are now in the trough. Diphtheria. Diphtheria was also less prevalent than in 1930. 61 cases were notified compared with 103 in 1930, and there were 4 deaths compared with 9 in 1930. Meningococcal Meningitis. There was only one notification, and the patient recovered. 29 Encephalitis Lethargica. There were 5 notifications of Encephalitis Lethargica and 4 deaths occurred from the disease. Contrary to our usual experience, all the cases which resulted fatally had previously been notified. Although Encephalitis Lethargica is compulsorily notifiable many cases remain unnotified. It has previously been explained that not only do the symptoms vary very much in character, but frequently the initial symptoms are trivial and the nature of the disease has remained undiagnosed. Small-Pox. Two cases of Small-Pox were notified. These two patients were contacts of the cases which occurred in 1930. Both cases occurred in J anuary and the circumstances in which the outbreaks occurred were detailed in last year's report. Ophthalmia Neonatorum. 5 cases of Ophthalmia Neonatorum were notified. The Council has agreement with the London County Council for the admission, if necessary, of cases into St. Margarets Hospital. Two cases were admitted under the terms of the agreement. All the cases recovered and the sight was not affected. Tuberculosis. 80 cases of Pulmonary Tuberculosis and 14 cases of other forms of Tuberculosis were notified during the year. There were 43 deaths from Pulmonary Tuberculosis and 11 deaths from other forms of Tuberculosis. The death notification interval of the 43 patients who died of Pulmonary Tuberculosis in 1931 was:— Information from Death Returns 7 Died within 1 month after notification 8 Died between 1 and 3 months after notification 2 Died between 3 and 6 months after notification 4 Died between 6 and 12 months after notification 6 Died between 1 and 2 years after notification 9 Died between 2 and 3 years after notification 2 Died over 3 years after notification 5 30 On December 31st the following is a statement of the particulars appearing in the Register of cases of Tuberculosis. Pulmonary Non-Pulmonary Males Females Males Females Total Number of Cases of T.B. on the Register at the commencement of year 119 124 30 20 293 Number of Cases notified for the first time during 40 35 7 7 89 the year Number of Cases previously removed from the Register which have been restored thereto during the year — 1 — — 1 Number of Cases added to the Register other than by notification 3 2 — — 5 Number of Cases removed from the Register during the year 32 38 9 6 85 Number of Cases remaining on the Register at, the end of the year 130 124 28 21 303 In 1931, the Tuberculosis Officer examined 67 new cases of Pulmonary Tuberculosis and 12 new cases of Non-Pulmonarv Tuberculosis. 31 51 patients were admitted to Sanatoria under the county scheme and 12 were admitted to Hospitals. Age Periods New Cases. Deaths. Pulmonary. Non-Pulmonary Pulmonary. Non-Pulmonary M. F. M. F. M. F. M. F. 0- - - - 1 - - 1 2 1- — — 2 2 — — 1 2 5- — 1 3 — — 1 1 — 10- 1 2 — — — — — — 15- 8 4 — 2 1 2 — — 20- 3 10 1 1 — 4 2 — 25- 9 11 — — 7 6 — — 35- 10 4 1 1 2 2 1 — 45- 8 5 — — 7 3 1 — 55- 2 1 — — 5 — — — 65 and upwards 1 — — — 2 1 — — Totals 42 38 7 7 24 19 7 4 32 ISOLATION HOSPITAL. During the year 262 cases were admitted into the Hospital compared with 459 in 1930. On January 1st 1931, there were 41 cases in the Hospital and on January 1st, 1932, there were 29. 265 cases were discharged and there were 9 deaths. The following is a list of the cases admitted:— Acton. Wembley. Kingsbury. Total Scarlet Fever 66 74 22 162 Diphtheria 55 22 21 98 Other Diseases 11 — 2 122 97 43 262 The 9 deaths were as follows:— Acton. Wembley. Kingbury Total. Scarlet Fever — — — — Diphtheria 3 14 8 Other Diseases — 1 — 1 3 2 4 9 Scarlet Fever. 162 cases of Scarlet Fever were admitted, and there was no death from the disease. There is a big drop in the number of admissions. This of course is due to the Epidemic character of Scarlet Fever. At the present time we are in a trough of the epidemic wave of Scarlet Fever. Diphtheria. 98 cases of Diphtheria were notified and there were 8 deaths- BACTERIOLOGICAL EXAMINATIONS. (a) For Diphtheria Positive. Negative. Total Examinations 1028 116 912 Sent by Medical Practitioners 46 303 do. (re-examinations) 6 71 Sent from Isolation Hospital 42 327 do. (re-examinations) 1 4 Convalescents (1st Swabs) 4 26 33 Contacts 14 95 do. (2nd examinations) 1 44 do. (3rd examinations) — 2 Precautionary Swabs — 9 School Sore Throats 2 31 (b) For Ringworm. Positive. Negative. Total Examinations—12 10 2 (c) For Tubercle. Positive. Negative. Total Examinations—181 41 140 MATERNITY AND CHILD WELFARE. Infantile Mortality. 62 deaths occurred in children under one year of age. This number corresponds to an infantile mortality of 61 per 1000 births. The infantile mortality is lower than that of England and Wales and that of the 107 great towns and of London. It is higher than that of most of the towns in the outer ring of London—Wimbledon with 70 and West Ham with 63 being the only two with a higher mortality. The infantile mortality is also higher than that of 1930, when the infantile mortality reached the record figure of 50 per 1000 births. The higher mortality has been caused by the increased number of deaths from Pneumonia. In 1931 there were 13 deaths from this cause, compared with 4 in 1930. Otitis Media or inflammation of the middle ear also accounted for 4 deaths. In last year's report I reviewed the subject in detail and there is no material change to report upon the conditions generally. Maternal Mortality. In the table giving the list of deaths it will be noticed that an additional heading has been used this year—Post abortion Sepsis. This has been rendered necessary because in the return of the Registrar General there is only one death included under Puerperal Sepsis and none under other puerperal causes. As five deaths occurred in child bearing women, it is necessary to give particulars of the deaths. It may be advantageous for other reason also. In 34 last year's annual report, particulars of the maternal deaths were given and it was difficult to suggest medical means which would have prevented the deaths. The same remark can be applied to the deaths which occurred in 1931. We are used to the statement that most of the maternal deaths are preventable, but when enquiries are made here into the circumstances, it is found that prevention is far from easy under present social conditions. The first death occurred from Paralytic Ileus following the operation of Caesarian section. The women had had 4 children previously. In the course of the previous deliveries, the Cervix had been extensively lacerated, and during the last confinement the Cervix became so oedamatous as to obstruct delivery. The patient had engaged a midwife who at the confinement called in a doctor, and although the doctor may have not diagnosed the exact cause of the obstruction, he ordered her removal at once to the West Middlesex Hospital, where she was operated upon. In this case, the patient had not attended an ante-natal clinic and had not been medically examined during the pregnancy. It is doubtful, though even if the condition of the Cervix had been detected, that the complication which occurred at the confinement would have been forseen. The second death occurred from Puerperal Sepsis, and it is fairly certain that more than the ordinary precautions were taken at the confinement. The patient was in good circumstances, and the family lived in a semi-detached villa with 4 bedrooms. There was one other child 6 years of age. A doctor had been engaged for the confinement and he had examined the patient and kept her under observation during the pregnancy. It was an instrumental delivery, but strict asepsis had been observed. The doctor ordered a complete outfit in a sterile drum from Messrs. Bell & Croydon. Swabs were taken from the throats of both doctor and nurse and no streptococci were found. The patient was removed to Queen Charlotte's Hospital on the fifth day after the confinement, but she died soon after admission and on bacteriological examination of the discharges the Streptococcus Haemolyticus was found. The report of Dr. Bell, the Council's obstetric specialist, upon the case was that every precaution seems to have beentaken at the confinement, and the surroundings appeared to be as good as could be desired. As far as a confinement in a private house is concerned, it was difficult to suggest in what direction an improvement could be effected. The case illustrated the importance of the 35 susceptibility or immunity of the patient. This aspect of the question has not until recently been prominently raised. The Maternal Mortality Committee of the Ministry of Health in its interim report reviewed the subject mainly from the point of view of the environment of the patient as she is affected by doctors, niidwives, ante-natal clinics or lack of any or all of these adjuncts. It is difficult to obtain information of the conditions which may result in the increased susceptibility of the patient to infection. Professor Mellanby and his co-workers have recently brought forward evidence regarding the importance of Vitamin A in enabling the mother to resist infection—the vitamin being administered in concentrated form as radiostoleum, and given in small doses in the weeks immediately preceeding confinement and in the week after. Radiostoleum contains 10 times as much Vitamin A as Cod Liver Oil. It is known that diet can affect the raising and lowering of the resistance of animals to infection. Young animals placed on diets deficient in Vitamin A die of sepsis. During pregnancy there is a considerable drain of this particular vitamin from the mother to supply the foetus. The pregnant woman may be in special danger of vitamin deficiency, for she has not only to supply the needs of her own body but also the needs of a rapidly growing organism whose requirements are relatively much higher than those of the adult. It was on this assumption that Professor Mellanby treated women with excess of Vitamin A both as a prophylactic and as a curative measure. Although the numbers treated under Professor Mellanby's supervision were small, other workers in the same field have published their results, and the statistics seem to point to the efficiency of Vitamin A in the prevention of Puerperal Sepsis. Professor Cameron in a paper read at the Glasgow Congress of the Royal Sanitary Institute stated that very encouraging results had been obtained in the Maternity Hospital with which he was connected from the prophylactic use of concentrated Vitamin A and the use of a haemolytic streptococcus vaccine administered just before full time. He claimed that should his experience be confirmed by other observers a distinct advance in obstetric practice will be registered. As far as normal cases are concerned, it is hoped that measures which would increase the immunity of the individual will be found and prove successful. But there is another class of case which will not be touched by any such measures. 36 Last year, in Acton, 3 women died from Sepsis following the induction of abortion. Two of the deaths were very fully reported in the press at the time. In respect of one of them proceedings were taken against a doctor, but he was acquitted. In the case of the second death, the person who induced the abortion was not traced. The deceased was a single young woman employed by the man who seduced her, and who had gone to lodge with him and his wife before removal to the hospital where she died. In the third instance, the woman was married but had been separated from her husband for some years. She was removed to hospital for treatment, and she persisted in telling those who attended her that she had herself induced the abortion. Our figures are too small to drawn any conclusions, but apart from any question of figures, there is no doubt that the criminal induction of abortion is very common not only among single women but also married women. It is only when a death occurs that official notice is taken of the practice, but that the induction of abortion is common is well known to those who have to work among married women. It is only when a death occurs that anyone besides the actual participants comes to know anything. Occasionally, the women after a "successful" emergence from the ordeal will talk and they then reveal a somewhat startling state of affairs. It is argued that the prevalence of abortion is the result of social and economic conditions, and is not amenable to any preventable medical action. Any argument against facing the problem seems to be sought for. No one wishes to discuss the matter. But the prevalence of abortion is connected with maternal mortality and morbidity, and with other public health problems. It is difficult to suggest any effective remedy. It is fatuous to exhort these people to abstinence, and it is certainly cruel to taunt them on its criminal aspect. Pre-Natal Clinic. The clinic is held once a fortnight in the School Clinic premises in Avenue Road and Dr. Bell is in charge. 24 sessions were held with a total of 241 attendances. This does not represent the whole of the pre-natal work done. It is explained in another paragraph that in the case of those who apply) for admission to Park Royal Hospital, Dr. Bell usually sees the expectant mothers when application is first made and generally refers them then to the pre-natal clinic at Park Royal Hospital. 37 The provision of beds for normal cases has undoubtedly enhanced the value of the work of the pre-natal clinic. Maternity Home. The most important extension of the Maternity scheme of the Council has been the provision of beds for uncomplicated cases of pregnancy. The Council has for some time felt the need for such beds. The Council has had an agreement with the authorities of the Acton Hospital for the admission and treatment of complicated cases and during the year 51 cases were admitted. The scheme for the treatment of complicated cases, though, did not include the admission of normal cases, in which the home conditions were for some reason or other unfavourable or unsatisfactory. We have in the district many families who live in two or at most three rooms; this refers more particularly to newly married couples, and it can be imagined that a confinement is an extremely inconvenient event in such surroundings. In many instances, one of the conditions under which rooms are let is that no confinment shall take place on the premises. There is no question of destitution or even poverty. The husband is in constant employment, and frequently the wife has also been working, and they are entitled to two maternity benefits. It is doubtful if they are eligible for admission to the local infirmary, but even if eligible the wife would not care to accept the facilities of the Public Assistance Committee. It is true that these hospitals are not now under the control of the Board of Guardians, and the old taint of the poor law is not now attached to them, yet there are many objections to them. They are intended for the destitute, but more important is the fact that it is not feasible or possible to contract in advance for the admission of expectant mothers. The class of mothers I am referring to, would not care to avail themselves of the facilities provided at the West Middlesex Hospital even if they were eligible for admission. On the other hand they could not afford the fees charged in nursing homes. The Council was aware of the hardships endured by this class of expectant mother, and had for some time felt the need for such beds. Some years ago, a sub-committee was appointed to consider the matter, and several maternity homes were visited by the subcommittee. The project of a new maternity home did not mature. Apart from the expense, the disadvantages of a small maternity hospital were so obvious that the Council abandoned the idea. The alternative project was to contract for beds with the authorities of a large maternity hospital. 38 Last year a favourable opportunity to obtain these beds arose. The Willesden Council terminated their agreement for the admission of cases to Park Royal Hospital, and our Council came to terms with the Middlesex County Council. The agreement came into operation on April 1st, 1931. The Council pays to the Middlesex County Council at the rate of £3 per week for each person admitted. The Child Welfare Committee of our Council assesses the expectant mothers according to means. When the expectant mother makes application, she is referred to the pre-natal clinic for examination by Dr. Bell. If Dr. Bell adjudges her to be normal and straightforward the expectant mother is referred to Park Royal Hospital. Dr. Turner the Medical Superintendent has a pre-natal clinic every Monday morning and the expectant mother attends there as and when required. Between April 1st and December 31st, 50 were admitted, and at the end of the year there were 36 more waiting to be admitted in 1931. The payments and receipts are as follows:— Payments to M.C.C. Receipts of Fees. £ s.d. £ s. d. 2nd quarter 49 14 2 21 15 0 3rd quarter 116 3 5 67 0 0 4th quarter 138 0 0 72 13 0 In the second quarter of the year 8 mothers were admitted and their total stay in the hospital was 109 days or an average of little over 13½ days each. In the third quarter 20 mothers were admitted and their total stay was 278 days or an average of nearly 14 days. We shall have to deal with a larger number of patients in the coming year, in spite of more unemployment in the district. There is no doubt as to the popularity of the scheme. We shall have to meet a changed attitude on the part of the expectant mother respecting her confinement. Formerly there was a distinct bias in the mind of the expectant mother in favour of a confinement in her own home. This may be true still of the older expectant mother, but the newly married expectant mother distinctly favours a confinement in an institution. This attitude is becoming more general throughout all ranks of society, and is due to many and varied causes. In the case of the mothers in our district who are admitted to Park Royal Hospital, the two chief causes are want of accommodation in the home and a desire for freedom from worries during the confinement. The lack of accommodation in the home has been referred to, but there have been many applications where the home accommodation is fairly satisfactory. In these cases the mothers naturally wish to have as few 39 responsibilities as possible during the confinement. They regard a confinement as a whole-time job and household responsibility as another one, and they do not wish for two wholetime jobs at the same time. Day Nursery. The Nursery is situated in Bollo Bridge Road, and is open on five days a week. The Nursery was open on 229 occasions, and 3397 wholeday attendances and 70 half-day attendances were made. There is a big drop in the number of attendances. This may be due to many causes. The Matron was away last summer and her absence caused a dislocation in the work. The establishment of Nursery classes tends also to lower the attendances. There has been a revival in the number of attendances this year. Nurse Children. At the end of the year 1930, there were 52 children and at the end of the year 1931 there were 53 children on the register. The names of 32 children were removed from the register and of 33 children added, leaving a net gain of 1 child in the number on the register. The names were removed from the register on account of removal of the child from the district, and there was no death amongst the nurse children. Child Welfare Centres. Changes have been made in the arrangement of the child welfare centres during the year, and a new centre has been established in North Acton. j' During the year, the Education Committee bought premises in Avenue Road, to enable them to vacate the temporary buildings which had been erected in front of the Council Offices. Although the premises were intended primarily for the School Clinic, accommodation has been provided for the Pre-natal Clinic and Child 40 Welfare Centres at Avenue Road. The Child Welfare Centres which were established at Palmerston Road Mission Room and Church Road Church Hall are now accommodated at Avenue Road, and these are open on Monday, Tuesday, Wednesday and Thursday afternoons. The premises are very conveniently situated and the fact that the centres are housed in premises owned by a Committee of the Council has very many advantages. The centre in the South-West is still held in the Steele Road Mission. The centre in the North-East has been moved from the East Acton School to the John Perryn School. These premises are much better arranged and at present are more conveniently situated. In the John Perryn School, two rooms are set apart for the purposes of Medical Inspection. These two rooms are so situated that mothers and infants can attend the Child Welfare Centre without having to enter the playground and the rest of the school premises. After may years of fruitless and unsuccessful efforts, a centre has been established in the North-West part of the district. This step had been repeatedly urged upon the Council by the Ministry of Health, and the Committee was awake to the need of a centre in this area. But it was impossible to find suitable premises for the purpose. Last year the Vicar and Churchwardens of St. Gabriels Church were able to offer St. Gabriels Hall for the purpose, and the Committee gratefully accepted the offer. From the attendances which have been made there, it is obvious that the facilities provided are appreciated. Seven sessions are now held weekly—4 in Avenue Road and 1 each in Steele Road Mission, John Perryn School and St. Gabriels Hall. 41. TABLE I. BIRTH-RATE, DEATH-RATE, AND ANALYSIS OK MORTALITY DURINGS THE YEAR 1931. The Mortality rates for England and Wales refer to the whole population, but for London and the towns to civilians only. Rate per 1,000 Total Population. Annual Death-rate per 1,000 Population. Rate per 1,000 Live Births Percentage of Total Deaths Live Births. Still-births. All Causes. Enteric Fever. Small-pox. Measles. Scarlet Fever. Whooping Cough. Diphtheria. Influenza. Violence. Diarrhoea and Enteritis (under two years). Total Deaths under one year. Certified by Registered Medical Practitioners. Inquest Cases. Certified by Coroner after P.M. No Inquest. Uncertified Causes of Death. England and Wales- 15.8 0.67 12.3 0.01 0.00 0.08 0.01 0.06 0.07 0.36 0.54 6.0 66 91.18 6.17 1.70 0.95 107 County Boroughs and Great Towns, including London 16.0 0.67 12.3 0.00 0.00 0.10 0.01 0.07 0.08 0.33 0.48 8.4 71 91.43 5.84 2.24 0.49 159 Smaller Towns (1921 Adjusted Population?, 20,000- 50,000) — 15.6 0.73 11.3 0.00 0.00 0.07 0.01 0.05 0.05 0.36 0.43 4.0 62 92.17 5.49 1.25 1.09 London 15.0 0.50 12.4 0.01 .000 0.03 0.02 0.07 0.06 0.26 0.57 9.7 65 89.52 6.23 4.24 0.01 Acton 14.4 0.42 10.5 0.00 0.00 0.01 0.00 0.00 0.06 0.10 0.62 2.0 61 90.2 6.4 3.4 0.00 The maternal mortality rates for England and Wales are as follows:— Puerperal Sepsis. Others. Total. per 1,000 Live Births 1.66 2.45 4.11 per 1,000 Total Births 1.59 2.35 3.95 42 TABLE H. VITAL STATISTICS FOR THE WHOLE DISTRICT DURING 1031 AND PREVIOUS YEARS. Year. Population estimated to Middle of each Year. Births Total Deaths Registered in the District Transferable Deaths Nett Deaths belonging to the District Nett Under 1 year of Age At all Ages Number Rate Number Rate of Non-Residents Registered in the District of Residents Registered outside Dist. Number Rate per 1,000 Births Number Rate per 1,000 inhabitants 1921 61,299 1314 21.44 445 7.26 — 205 92 70 658 10.07 1922 62,170 1203 19.35 404 6.50 14 214 75 62 632 10.02 1923 62,060 1171 18.57 368 5.84 11 243 77 65 599 9.50 1924 63,945 1158 18.11 448 7.01 8 235 65 56 715 11.18 1925 64,845 1047 16.15 446 6.88 18 241 80 76 660 10.32 1926 65,760 1098 16,70 422 6.42 15 250 60 55 657 9.99 1927 66,700 1026 15.60 445 6.67 21 280 62 60 704 10.55 1928 67,645 1003 14.83 470 7.08 20 244 55 55 694 10.26 1929 68,600 1026 14.96 540 7.87 21 307 85 83 826 12.04 1930 60,565 1105 15.88 440 6.33 31 284 56 50 603 9.96 1931 70,560 1018 14.43 456 6.46 35 321 62 61 742 10.52 43 TABLE III. AGES AT DEATH, AND WARD DISTRIBUTION OF DEATHS IN 1931. Causes of Deaths. Age in Years. Ward Distribution. All ages Under 1 year 1 and under 2 2 and under 5 5 and under 15 15 and under 25 25 and under 45 45 and under 65 65 and upwards North East. North West. South East. South West. Measles 3 - 2 1 - - - - - 2 - - 1 Poliomyelitis 1 - — - - 1 — — — — — — 1 Diphtheria 4 1 — 1 2 — — — — 4 — — — Encephalitis Lethargica 4 - — 1 — — 1 1 1 — 1 2 1 Influenza 7 - 1 1 2 — — 3 1 2 2 2 Phthisis 43 - — - 1 8 17 15 2 17 5 4 17 Other tubercular diseases 11 3 1 2 1 2 1 1 — 3 1 4 3 Cancer 98 1 1 — 1 — 13 37 45 33 21 25 19 Rheumatic Fever 1 — — — — — 1 — — — 1 - — Heart Disease 71 — — — — 3 9 12 47 21 18 14 18 Cerebral Haemorrhage 35 — — — — — 1 7 27 11 12 6 6 Arterio-scelerosis 54 — — — — — — 12 42 24 11 12 7 Diabetes 7 — — — — — — 4 3 3 2 2 — Bronchitis 57 5 1 — 1 — — 13 17 12 16 12 17 Pneumonia (all forms) 46 13 5 3 — 2 1 9 13 10 12 8 16 Other respiratory diseases 10 — — — 1 1 3 2 3 3 4 2 1 Diarrhoea 2 2 - - - - - - - 1 — — 1 Peptic Ulcer 11 - - - - - 1 7 3 7 2 1 1 Appendicitis 2 - — — - — — 1 1 1 1 — — Cirrhosis of Liver 5 - - - - - - 5 — 1 3 - 1 Nephritis 33 — — — 1 — 4 8 20 9 9 4 11 Puerperal Sepsis 1 — — — — — 1 — — — 1 — — Other diseases or accidents of Parturition 1 - - - - - 1 - - - - - 1 Post Abortion Sepsis 3 — — — — 1 2 — - - 2 1 - Prematurity;&c. 31 31 — — — — — — — 11 7 4 9 Suicide 10 — — — — 2 2 4 2 3 3 3 1 Other violent deaths 34 — — — 2 2 6 9 15 13 3 9 9 Other defined diseases 157 6 — 1 5 2 14 23 106 44 46 30 37 TOTALS 742 62 11 9 16 26 78 170 370 234 183 145 180 44 TABLE IV. INFANTILE MORTALITY, 1931. Causes of Death. Ages. Wards. Total Under 1 week 1—2 weeks 2—3 weeks 3—4 weeks 1—3 months 3—6 months 6—9 months 9—12 months North East North West South East South West Diphtheria 1 - - - - - - - 1 1 - - - Tubercular Meningitis 3 — — — - — 1 2 - 1 — 1 1 Spina-Bifida 1 — — — - — 1 — - — — - 1 Bronchitis 5 — — — - 2 2 1 - 2 1 1 1 Pneumonia 13 — — — 1 — 5 4 3 — 2 2 9 Diarrhoea 2 — - - - 1 - - 1 1 - - 1 Premature Birth 11 5 - 1 1 3 1 - - 3 2 1 5 Congenital Heart Disease 3 — 1 — 1 — 1 — — 1 — 1 1 Injury at Birth 1 1 — — - — — - - - - 1 - White Asphyxia 1 1 — — - — — - — — 1 - - Hydrocephalus 2 — — — - — 1 — 1 1 — - 1 Pyloric Stenosis 4 — — — 1 1 2 - - 3 — - 1 Marasmus 4 - - - - 1 2 1 - 2 2 - - Atelectasis 1 1 - - - - - - - - 1 - - Teething 1 — — — - — — 1 — 1 — - - Neglect at Birth 1 1 - - - - - - - - - 1 — Prolonged Labour 1 1 — — - - - - - - 1 - - Convulsions 1 - - - - 1 - - - - 1 - - Sarcoma 1 — - - - - - - 1 - - - 1 Septicaemia 1 — 1 — - — — — — — 1 — - Otitis Media 4 — — — — 2 1 — 1 1 — 1 2 TOTALS 62 10 2 1 4 11 17 9 8 17 12 9 24 45 TABLE V. CASES OF INFECTIOUS DISEASE NOTIFIED DURING THE YEAR, 1931. Notifiable Disease. Cases notified in whole District. At Ages—Years. Ward Distribution. At all Ages under 1 1 to 5 1 to 15 15 to 25 26 to 45 46 to 65 Over 65 North East North West South East South West Small-Pox 2 1 - - - 1 - - 2 - - - Scarlet-Fever 95 1 23 50 11 10 - - 44 17 18 16 Diphtheria 61 2 14 35 4 6 - - 22 8 9 22 Cerebro-Spinal Meningitis 1 — - - 1 - - - - - - 1 Acute Anterior'PoIiomyelitis 2 - - 2 - - - - - 1 - 1 Pneumonia 24 3 5 2 3 6 4 1 6 6 2 10 Puerperal Fever 3 — - - - 3 - - - 1 - 2 Encephalitis Lethargica 4 — 1 - - 2 1 - 1 2 - 1 Ophthalmia Neonatorum 5 5 - - - - - - 1 - 1 3 Puerperal Pyrexia 6 — - - 4 2 - - 2 1 2 1 Erysipelas 15 — 1 - 2 5 6 1 3 4 3 5 Tuberculosis (resp.) 80 - - 4 26 32 18 - 25 15 17 23 Tuberculosis (other) 14 1 4 5 1 3 - - 4 2 2 6 TOTALS 312 13 48 98 52 70 29 2 110 57 54 91 46 OPHTHALMIA NEONATORUM. Cases. Vision unimpaired. Vision impaired. Total Blindness. Deaths. Notified. Treated. At home. In hospital. 5 3 2 o — — — 47 TABLE 6. CASES REMOVED TO HOSPITAL. Total Notified. Small-Pox 2 2 Scarlet Fever 67 95 Diphtheria 58 61 Pneumonia 10 24 Cerebro-Spinal Meningitis 1 1 Puerperal Fever 2 3 Encephalitis Lethargica 2 4 Puerperal Pyrexia 4 6 Erysipelas 7 15 Acute Anterior Poliomyelitis 1 2 TABLE 7. BIRTHS. Male Female. Live Births. Total 501 518 Legitimate 473 489 Illegitimate 28 29 Still Births. Total 16 14 Legitimate 14 14 Illegitimate 2 — Notified Live Births. Ward Distribution. Total Births notified in the district Total. N. East. N. West. S. East. S. West. 752 231 168 94 259 Notifications received from other districts 240 82 45 47 66 Births registered but not previously notified 9 2 3 1 3 1001 315 216 142 328 Notified Still Births Inside 18. Outside 10 Total 28 Notifications were received from:— Doctors and Parents 691 Midwives 329 Table 8. INFANT WELFARE CENTRES, 1931. Number of Centres provided and maintained by the Council 4 Total number of attendances at all centres during the year:— (a) by children under 1 year of age 11;409 (b) by children between 1 and 5 years of age 5,763 48 Average attendance of children per session 53 Number of children who attended for the first time -during the year:— (a) under 1 year of age 740 (b) between 1 and 5 years of age 260 Percentage of notified live births represented by number of children who attended a centre for the first time during the year 74.5 Children treated at Dental Clinic 172 Children treated at Ophthalmic Clinic 10 Mothers treated at Ophthamlic Clinic 1 Children treated for Enlarged Tonsils and Adenoids 13 TABLE 9. ANTE-NATAL CLINIC. Number of attendances by Dr. Bell 24 Number of Expectant Mothers who attended 175 Number of attendances made by Expectant Mothers 241 Mothers referred for Dental treatment at the Clinic 46 Mothers supplied with Dentures 16 Expectant Mothers to whom Dried Milk was supplied 29 Number of packets of Dried Milk supplied 339 TABLE 10. INQUESTS. Inquests—48. Accidental fall — 12 Accidental burns 3 Suicide 10 Abortion 3 Knocked down by: Found drowned 1 Motor Car 8 Accidental drowning 1 Motor Lorry 3 Teething 1 Tramcar 2 Epileptic Fit 1 a cycle 1 Diabetes 1 a Railway Engine 1 Coroner's Certificate after Post-Mortem without Inquest—25 Pneumonia 4 Diabetes 1 Thrombosis of Coronary Artery — 4 Cancer 1 Cerebral Haemorrhage 1 49 Fatty Heart 2 Cerebellar Haemorrhage 1 Heart Disease 1 Arterio scelerosis 1 Congenital Heart Disease 1 Abscess of brain 1 Rupture of Aorta 1 Bronchitis 1 Neglect at birth 1 Peptic Ulcer 1 Tuberculosis 1 Status Lymphaticus 1 Epilepsy 1 FACTORIES, WORKSHOPS AND WORKPLACES. 1.—Inspection of Factories, Workshops and Workplaces including Inspections made by Sanitary Inspectors. Number of Premises. Inspections. Written Notices. (1) - (2) (3) Factories — 96 18 (Including Factory Laundries). Workshops 449 14 (Including Workshop Laundries) Workplaces 23 Nil. (Other than Outworkers' Premises). Total 568 32 2.—Defects found in Factories, Workshops and Workplaces. Nuisances under the Public Health Acts:— Particulars. Found. Remedied. (1) (2) (3) Want of Cleanliness 38 38 Want of Ventilation Nil Nil Overcrowding Nil Nil Want of drainage of Floors Nil Nil Other Nuisances 9 9 Sanitary Accommodation:— Insufficient 14 14 Unsuitable or defective 23 23 Not separate for sexes Nil Nil Offences under the Factory and Workshop Acts:— Illegal Occupation of underground Bakehouses Nil Nil * Other Offences Nil Nil Total 84 84 3.—Outwork in unwholesome premises, Section 108 Nil 50 STAFF. D. J. Thomas, m.r.c.s., l.r.c.p., d.p.h., Medical Officer of Health. (Medical Superintendent of the Isolation Hospital and School Medical Officer). M. W. Kinch. Member of the Royal Sanitary Institute, holds Meat and Smoke Certificates; Chief Sanitary Inspector (Inspector under Diseases of Animals Acts and the Rag Flock Act). J.J. Jenkins. Cert, of Royal Sanitary Institute; holds Meat and Smoke Certificates, Sanitary Inspector (Inspector under Fabrics Mis-description Act). E. W. Brooks. Cert, of Royal Sanitary Institute. Sanitary Inspector. J.J. Matthews. Cert, of Royal Sanitary Institute; holds Meat Certificate, Sanitary Inspector. Miss A. Cooksey. Certificate of Royal Sanitary Institute. Health Visitor. Miss J. Welsh. Certificate of Royal Sanitary Institute, c.m.b.. Health Visitor. Miss B. G. Sorlie, s.r.n., Certificate of Royal Sanitary Institute, C.m.b., H.V. Diploma, Health Visitor (and part-time School Nurse). Miss A. Woosnam, s.r.n., C.m.b., Health Visitor (and part-time, School Nurse). W. GoodfeLlow,* a.r.san.i., Cert of Royal Sanitary Institute; holds Meat Certificate, Chief Clerk. Miss G. Overall,* Clerk. Miss V. E. Arnold, Clerk. Miss D. E. Beacon, Clerk. Note.—To the salaries of all the above officials, excepting those marked with an asterisk, contribution is made under the Public Health Acts or by Exchequer Grants. I have again to thank all the members of the Public Health Department for ungrudging assistance during the year. I am, Your obedient Servant, D. J. THOMAS. Medical Officer of Health. 51 ANNUAL REPORT of the School Medical Officer FOR THE YEAR 1931. Municipal Offices, Acton, W.3. To the Chairman and Members of the Education Committee. Ladies and Gentlemen, I beg to submit the following report upon the schools and school children of the Education Authority for the year 1931. A comparison of this year's Tables with those of former years will show certain apparent discrepancies. These discrepancies are not material, and are possibly due:to the personal factor which must enter into the interpretation' of the conditions found in medical insepection. During the year, changes have occurred in the personnel of the School Medical Service. The Committee has been unfortunate in losing the services of Dr. Scruby, who had faithfully served as School Medical Inspector for nearly twelve years. In the early part of the year Dr. Scruby suffered from a break-down in her health, and to the great regret of all she felt compelled to send in her resignation. Dr. Scruby had had previous experience in the School Medical Service before she came to Acton, and she had ungrudgingly given her services in the development of the various schemes of the Education Authority. She had taken a particular interest in the Special School and though her certificates had been the subjects of appeal, her decision was not once reversed. She was recognised as an authority on mental deficiency and had served on several outside committees connected with the subject. The Education Committee sincerely regretted the cause of her resignation, and hoped .that she would make a speedy and com- plete recovery The Committee was, fortunate again in obtaining the services of. (Mrs.) L. S.Farquharsori to carry out the work of medical 52 inspection and the other sen-ices connected with the School Medical Service. The Committee is aware of the excellent service which Dr. Farquharson has on several occasions performed for the Committee and the smooth working of the School Medical Service in the difficult circumstances of Dr. Scruby's absence, has been largely due to the manner in which Dr. Farquharson has done the work. She was able to gain the confidence of the parents, and was universally liked by the children. In a report of this character it is not permissible to speak of professional work (which of course is beyond reproach), but it speaks volumes for her tact, that in no single instance has any complaint of any kind reached the Committee or anyone else. The work has throughout the year, been done without any friction and her relationship with all her colleagues in the Education and Public Health departments has been most cordial and friendly. Dr. Farquharson has been responsible for the inspections usually carried out by Dr. Scruby, viz.: all the Entrants, the Intermediates, and the Girl Leavers. These are not all the inspections carried out by Dr. Farquharson, but these inspections affect the figures in the Board of Education Tables at the end of the report. The Committee also were unfortunate to lose the services of Mr. Pugh, the Dental Surgeon, who left Acton in August to serve in a similar capacity with the Worcester County Council. Mr. Pugh came here in September 1928, from Dewsbury and was the first whole-time Surgeon, and naturally there was a good deal of organisation and planning to be done. Formerly the dental work had been done by part-time officers, and though excellent service had been given, and much pioneer work had been done by these officers, certain difficulties had to be encountered when a wholetime dentist was appointed. Mr. Pugh overcame these difficulties and soon established himself in the respect and regard of both parents and pupils. He rendered excellent service also to the mothers and children in connection with our child welfare scheme, and the addresses which he gave in the course of the inspection of the toddlers during the school vacations were very much appreciated. We deeply regret the loss of Mr. Pugh, but that does not detract from the sincerity of our welcome to Mr. Slater, who was appointed Dental Surgeon in the summer and commenced duties on September 1st. Mr. Pugh was responsible for roughly two thirds of the work of the year, and Mr. Slater for one third, but Mr. Slater has kindly reported upon the dental work of the whole year. The following Table gives the accommodation, the average monthly number on the register, and the average attendance, in the different schools. 53 PUBLIC ELEMENTARY SCHOOLS WITHIN THE DISTRICT WITH ACCOMMODATION. Name of School. Dept. dation. Avge. monthly No. on Register, in 1931. Avge. attendance for the year Jan 1st to Dec. 31st. Acton Junior Mixed 306 268 237 Acton Wells Mixed 716 550 500 Infants' 400 339 289 Beaumont Park Senior Girls' 450 191 174 Junior Girls' 450 343 313 Infants' 400 284 236 Berrymede Junior Boys' 640 562 511 Junior Girls' 542 488 440 Infants' 450 387 331 Central Mixed 480 396 364 Derwent water Junior Mixed 441 460 428 Infants' 350 299 240 John Perryn Mixed 608 537 484 Infants' 336 375 322 Priory Senior Boys' 500 300 269 Senior Girls' 499 285 250 Infants' 400 293 244 Rothschild Junior Boys' 450 351 322 Infants' 400 256 216 Southfield. Senior Boys' 415 220 193 Junior Mixed 382 469 425 Infants' 350 256 199 Turnham Green R.C. Mixed 327 275 241 Acton Council Special 68 46 39 10360 8230 7267 AVERAGE HEIGHT without shoes and AVERAGE WEIGHT without clothes. Anthropometric Commutes, 1929. Age last birthday. MALES. FEMALES. Height in ins. Weight in lbs. Height in ins. Weight in lbs. 3 36.9 32.9 36.6 31.5 4 39.2 35.9 38.4 33.7 5 41.4 38.7 41.1 37.5 6 43. 41.3 42.8 40.1 7 45.4 45.4 45.1 44.1 8 47.8 51. 47.5 49.4 9 49.2 54.8 48.9 52.6 10 51.3 59.6 51.2 59.8 11 52.7 64.6 52.8 63.9 12 55. 71.6 55.6 73.9 13 56.2 76.5 56.9 79. 14 58. 86.1 58.9 88.2 15 61.8 99.3 62.3 106.8 54 TABLE SHOWING HEIGHTS AND WEIGHTS AT DIFFERENT AGES LEAVER (BOYS) No. Examined. Years of Age. 12—13 13—14 14—15 No. Height ins. Weight lbs. No. Height ins. Weight lbs. No. Height ins. Wright lbs. Acton Wells Mixed 40 37 57.9 81. 2 58. 82.5 1 59.5 86.3 Central 45 45 59.1 85.5 ...... ...... ...... ...... ...... ...... John Perrvn Senior 22 22 57.2 79.3 ...... ...... ...... ...... ...... ...... Priorv Boys' 100 100 56.8 78.4 ...... ...... ...... ...... ...... ...... Southfield Snr.Boys' 78 78 57.2 82.1 ...... ...... ...... ...... ...... ...... Roman Catholic — 9 7 57.2 74.6 2 61.6 102.1 ...... ...... ...... 294 289 4 1 (GIRLS) Acton Wells Mixed 34 32 59.5 81.8 1 54.5 69.3 1 57.5 76.5 Beaum't Pk. Girls' — 77 75 58. 77.9 2 59.4 83.7 ...... ...... ...... Central 47 47 59.6 87.7 ...... ...... ...... ...... ...... ...... John Perrvn Snr. 13 13 58.7 80.3 ...... ...... ...... ...... ...... ...... Priory Girls' 107 104 57.6 78.3 3 59.3 92.7 ...... ...... ...... Roman Catholic 14 14 58. 77.9 ...... ...... ...... ...... ...... ...... 292 285 6 1 TABLE SHOWING HEIGHTS AND WEIGHTS AT DIFFERENT AGES INTERMEDIATES (BOYS) No. Examined. Years of Age. 7—8 8—9 9—10 No. Height ins. Weight lbs. No. Height ins. Weight lbs. No. Height ins. Weight lbs. Acton Junior Mixed 19 14 49.2 53.7 5 50.2 58.1 ...... ...... ...... Acton Wells Mixed 17 5 50.8 59.8 12 50.1 56. ...... ...... ...... Acton Wells Infants' 36 28 48.4 53.7 8 49.3 54.7 ...... ...... ...... Beaumont Park Infts. 3 3 50.2 54.3 ...... ...... ...... ...... ...... ...... Berrymede Jnr. Boys' 116 70 49.9 53.4 46 49.5 53.8 ...... ...... ...... Derwentwater Jnr. 38 19 50.5 55.1 19 51. 61.4 ...... ...... ...... Derwentwater Infts.' 4 3 50.7 51.5 1 50.3 55. ...... ...... ...... East Acton 12 2 48.4 52. 10 50.2 54.5 ...... ...... ...... John Perryn Jnr. 1 ...... ...... ...... 1 50.3 64. ...... ...... ...... John Perryn Infts.' — 30 18 50. 53.8 12 49.3 . 55. ...... ...... ...... Priory Infants' 1 1 51. 48.8 ...... ...... ...... ...... ...... ...... Rothschild Jnr.Boys 69 21 49.2 54.3 48 49.8 56.2 ...... ...... ...... Rothschild Infants' 3 3 48.9 54.8 ...... ...... ...... ...... ...... ...... Southfield Junior 43 20 49.5 53.7 23 51.6 60.1 ...... ...... ...... Southfield Infants' 8 8 51.5 58.7 ...... ...... ...... ...... ...... ...... Roman Catholic 13 5 47.2 48.8 5 51.1 57.2 3 52.6 63.9 413 220 190 ...... ...... 3 ...... ...... 55 TABLE SHOWING HEIGHTS AND WEIGHTS AT DIFFERENT AGES. INTERMEDIATES (GIRLS) No. Examined. Years of Age. 7—8 8—9 9—10 , No. Height ins. Weight lbs. No. Height ins. Weight lbs. No. Height ins. Weight lbs. Acton Junior Mixed 14 13 49.4 51.8 ...... ...... ...... 1 50. 60.5 Acton Wells Mixed 13 4 48.7 52. 9 49.4 55.7 ...... ...... ...... Acton Wells Infts.' 47 36 48.4 52.8 11 49.1 56.7 ...... ...... ...... Beaura't P:.Jnr.Girls 70 22 48.4 49.3 47 49.1 50.7 1 59.3 103 Beaumont Pk. Infts.' 2 2 49. 50.1 ...... ...... ...... ...... ...... ...... Berrymede Jnr. Girls' 67 40 48.2 52.4 27 48.6 51.2 ...... ...... ...... Berrymede Infants' 1 1 50.5 46.5 ...... ...... ...... ...... ...... ...... Derwentwater Jnr. 48 24 48.8 50.9 24 50.6 57.5 ...... ...... ...... Derwentwater Infts.' 6 .6 47.3 48.4 ...... ...... ...... ...... ...... ...... East Acton 21 6 47.8 48.3 14 50.5 58.4 1 55.3 68.8 John Perryn Junior 2 ...... ...... ...... 2 50.5 54.4 ...... ...... ...... John Perryn Infts. 25 9 48.8 52.3 16 50.5 55.8 ...... ...... ...... Priory Infants' 52 26 48.1 50.6 26 49. ......51.8...... ...... ...... ...... Rothschild Infants' 2 2 47.6 46.7 ...... ...... ...... ...... ...... Southfield Junior 49 20 49.7 52. 29 49.8 53.4 ...... ...... ...... Southfield Infants' 4 4 49.1 49.3 ...... ...... ...... ...... ...... ...... Roman Catholic 23 2 50.1 56. 19 49.2 52.5 2 53.6 73.9 446 217 224 5 56 TABLE SHOWING HEIGHTS AND WEIGHTS AT DIFFERENT AGES. ENTRANTS (BOYS) No. Examined. Years of Age. 3—4 4—5 5—6 6—7 No. Height ins. Weight lbs. No. Height ins. Weight lbs. No. Height ins. Weight lbs. No. Height No. Weight lbs. Acton Junior Mixed 25 ...... ...... ...... 7 42. 38.8 16 43.8 43.2 2 45.6 44.1 Acton Wells Infants' 78 ...... ...... ...... 24 41.2 39.3 44 43.6 43.4 10 46.5 50. Beaumont Park Infants' 64 20 37.9 32.7 28 41.1 37.6 13 43.4 41. 3 41.8 37.7. Berrymede Infants' 98 ...... ...... ...... 45 40.4 38.1 46 42.9 41. 7 45. 47. Derwentwater Infants' 52 ...... ...... ...... 12 41.8 41.4 31 43.4 42.3 9 47. 50.4 East Acton 10 ...... ...... ...... 5 41.3 38.7 1 43. 44. 4 47.6 49.5 John Perryn Infants' 34 ...... ...... ...... 15 42.3 39.9 .12 43.9 43.3 7 47.9 53.3 Priory Infants' 55 ...... ...... ...... 24 41.1 37.9 30 43.3 41.7 1 44.3 43. Rothschild Infants' 48 8 37.8 34.1 21 40.5 38.5 17 42.6 40.7 2 43.6 42.6 Southfield Infants' 59 ...... ...... ...... 20 41.9 39.2 27 44.2 42.2 12 46. 45.4 Roman Catholic 7 ...... ...... ...... 3 43.2 41. 2 42.4 30.7 2 40.5 47.2 530 28 204 239 59 (GIRLS) Acton Junior Mixed 24 ...... ...... ...... 6 40.8 38.1 17 43.8 38.7 1 47. 44.8 Acton Wells Infants' 50 ...... ...... ...... 20 40.7 37.8 24 43.2 42.5 6 45.0 45.2 Beaumont Park Infants' 69 12 36.8 30.6 33 41. 36.9 20 42.5 38.6 4 47.5 48.1 Berrymede Infants' 75 ...... ...... ...... 38 40.4 38.1 32 42. 38.3 5 45.4 44. Derwentwater Infants' 71 ...... ...... ...... 20 41.5 39.4 38 44. 42.1 13 45.9 46.5 East Acton 10 ...... ...... ...... ...... ...... ...... 7 44.3 41.1 3 40.2 47.4 John Perryn Infants' 41 ...... ...... ...... 11 40. 36. 21 43.4 40.4 9 45.9 45.6 Priory Infants' 37 ...... ...... ...... 19 40.8 37.3 17 43.1 40.6 1 47. 45.3 Rothschild Infants' 55 10 36.8 30.6 19 40.1 36.3 17 43. 40.5 9 44.9 44. Southfield Infants' 42 ...... ...... ...... 15 41.3 36.8 21 43.3 40.7 6 45.8 48.7 Roman Catholic 20 ...... ...... ...... 11 40.6 37.7. 7 44. 43.8 2 45.6 45.4 494 22 | 192 221 59 57 Certain alterations compared with last year have been made. In last year's report, there were Berrymede Junior Boys' and South Acton Junior Boys', Girls, and Infants. In this year's Table, Berrymede Junior Boys' and South Acton Junior Boys' have been merged and called Berrymede Junior Boys'. The South Acton Girls' and Infants are in this year's Table known as Berrymede Girls' and Infants'. The John Perryn School appears for the first time. East Acton Mixed disappears. The John Perryn school children formerly attended the East Acton Mixed School and the Acton Wells Mixed and Infants' Departments. The opening of the John Perryn School accounts for the reduction in the two departments of the Acton Wells School. There is an increase in the number on the registers, and the number in average attendance. This is due to several causes. The natural increase in the population tends to keep up the number of schoool children. The abnormal birth rate of 1920 is still felt as a "bulge" in schools. It will be remembered that throughout the country there was an abnormally high birth rate in 1920 and these children will be in 1932 in the Senior Department. There is also a slight increase in the Infants' departments of Beaumont Park and Rothschild Infants' Schools, due to the establishment of nursery classes. With the exception of these two departments, and for the reason stated, the general trend of the school population has not materially altered in the last year. There is a tendency for the reduction in the number of school children in the southern areas, but this reduction is balanced by the increased number in the northern part of the district. The complete results of the census have not been published, but the ward population has been issued by the Registrar General. The North East Ward increased in the ten years by over 6,000 inhabitants, the North West by nearly 4,500, the South East by nearly 1,500, but the South West decreased by nearly 2,700 inhabitants. The exact figures are given in the Annual Health Report. The age distribution of the population has not been received, but it will probably be found that the number of school children have decreased in the same proportion as the general population of the South West Ward. This is not the place to discuss the factors which are in operation but to those whose sphere of work lies in the South West Ward, causes are evident. Large families are now comparatively rare there, and the size of the families is approximating to those with which we are familiar in the other wards, and the causes which are in operation are the same. The causes are not transient ones, and the difficulties which now face the Committee respecting the school accommodation will persist in a more intense form in the immediate future. 58 JOHN PERRYN SCHOOL. The John Perryn School in East Acton was opened by the Mayor (Councillor H. Holmes, J.p.). on June 6th, 1931. Hitherto the children of East Acton had attended the Acton Wells School or the East Acton Infants' school. The East Acton School has been temporarily closed. The John Perryn School stands on a site of 2.67 acres. The site falls from west to east, and there is a difference in levels of 18 feet. The West end of the school is one storey in height and the east end has two storeys. The school is planned around two internal quadrangles with the large assembly hall between, with its major axis north and south. The principal entrance is situated in the centre of the south front in a central block, which is a feature of this elevation. The entrance gives on to the vestibule from which access is gained to private rooms of the staff, and to the caretaker's flat above, thence on to the main corridor running east and west, and continuous around the school, at the level of which the class-rooms open. The opening sashes of all windows are hung with spring pivots and each sash is operated separately. The bottom sashes are hopper, hung to open inwards, and have glazed hopper metal checks at the sides to prevent draughts. Ventilation is gained by a through current above the heads of the pupils. The school is centrally heated, and oil is the fuel used. The latrines are accessible under cover and the roofs are glazed with wire glass. The playgrounds are asphalted, and on the north and west are bordered with school gardens. On the lower ground certain auxiliary services are housed, such as a circulating library and the medical inspection rooms. The medical inspection rooms are used also for the purpose of a Child Welfare Centre. The rooms are excellently adapted for the latter purpose. There is a separate entrance, they are on a level with one of the entrance gates and there is a covered place convenient for the perambulators. Scheme of Education. The John Perryn School is designed to provide facilities primarily for the East Acton Estate and its immediate environs and these facilities include (a) An Infants' Department, of seven rooms including a baby room and a hall, with a total accommodation of 336 (b) A Junior Mixed Department of seven rooms and Hall, 59 accommodation 336, and (c) A Senior Mixed Department of seven rooms including two rooms for instruction in Science and Art, also a Manual Centre and a Domestic Subject Centre, a Library and a large Hall, accommodation 320. Infants' Department. This Department now provides for infants of ages 4 to 8. The methods adopted are those introduced by Dr. Montessori, and are based on directed or controlled freedom of movement co-ordinated with a scientific use of didactic material. The introduction of the Montessori system has wrought a great change in the outlook of children towards their work in school. The Headmistress and five members of her staff possess the Montessori Diploma. There are now 381 scholars on the roll (February, 1932) of the Infants' Department which has necessitated the temporary transfer of the use of a room normally appertaining to the Junior Department. Junior Department. This department provides for a three year course from ages 8-11 and allows for the grouping of children into two groups for each year, plus a class for difficult children. At the present time the Junior Department is combined with the Senior Department under one Head Teacher, but the break at 11 plus is maintained. Senior Department. In designing this department the original intention was to provide accommodation for the raising of the school leaving age to 15. It was hoped also at some future date to combine the John Perryn and Acton Wells Senior departments, one to function for Senior Boys and the other for Senior Girls. If there is a possibility of the present numbers in the John Perryn Senior and Junior Departments being maintained (560 in February 1932) these two departments will be separated and Head Teachers assigned to each. It is also intended to utilise the Senior department premises in connection with the system of evening continuation schools now working in connection with the Acton Technical College, whilst the Branch Library it is hoped, will add to its present usefulness as a permanent factor in the adult education movement. The school has become a flourishing centre of educational activity. There is a large and active parents guild and .the combined Junior and Senior hall is licensed for public functions. DEFECTS FOUND IN MEDICAL INSPECTION. Table 2 includes a return of defects found at Medical Inspection. Under Malnutrition it will be seen that 1 child needed treatment, and 57 required to be kept under observation. Few 60 ditions present more difficulties of ascertainment, than nutrition, and the results are dependent upon the presonal views of the inspector. It will probably afford more light upon the physical condition of the children, if the heights and weights of the children in the different schools are given. In accordance with our usual practice, we have again inserted these Tables this year. It must be remembered though, that height and weight are not always a true index of nutrition. We usually assess nutrition at routine inspection under the headings A.B. and C. B is supposed to be normal, A supernormal and C subnormal. To anyone who is used to medical inspection the difficulty of assessing and standardizing nutrition is obvious. Unconsciously we are inclined to vary the standard according to the class of school which is being inspected, and to adopt a higher standard for normal nutrition in a school where all, or most, of the children are well clothed and well fed, than we do in a school in a poorer neighbourhood. It may seem surprising that the figures for nutrition appear so good, for it is well known that, the district in common with all industrial areas has suffered from unemployment. We were fortunate in the fact that we did not feel the stress of unemployment as early as some other areas, and the unemployment had not been so wide spread and severe as in some industrial areas in the north, but the unemployment figures here for 1931 were higher than those of 1930. So far though the increase of unemployment has not been reflected in the nutritional state of the children. It is admitted that malnutrition and a subnormal state of health are the resultant of many factors, and that only one of these is underfeeding, but it is doubtful if there are many cases of underfeeding among the school children. An enquiry was made this year, into the condition of some children who had been referred by the Head Teacher of the school. Of these selected children, few could be said to suffer from malnutrition. There were some who appeared to be neglected, but it was significant that the two worst cases were those whose fathers were in constant employment, and earning comparatively good wages. It is probable that the improvement observed in spite of industrial distress is due to a better appreciation of food values, and the milk schemes in the schools undoubtedly make for better nutritional state in the children. Ringworm. In last year's report I called attention to the slight increase in the number of cases of Ringworm of the scalp. There is again an increase to be noted this year. 12 cases were treated by the Education Authority and 2 privately, compared with a total of 61 7 cases which occurred last year. 3 cases occurred in one family, and there were 2 cases in each of 2 other families. 6 of the cases were in attendance at Southfield School, 2 in John Perryn school, and 2 in Acton Wells. There was one each in Acton Junior, Beaumont Park, Priory, and Berrymede. Otorrhoea. There is a slight increase in the number of children suffering from diseases of the ear, and during the coming year it is hoped that an attempt will be made to deal more efficiently with the ear conditions. Particular attention should be directed to the attempts which are being made to detect minor degrees of deafness. The detection of partial deafness has been hampered by the lack of scientific methods. Statistics have proved that a number of school children are partially deaf, but there was no method of testing in the past which was quick enough to survey large groups in a short time, and accurate enough to segregate the slightly deaf for further examination. It is now claimed that the need has been met by the introduction of the Audiometer. This instrument has been used in some schools and it is stated to have proved a valuable aid in the detection of slight deafness. Defective Speech. 3 children suffering from speech defects were found at Routine inspection. It will be recollected that a few years ago, a speech defect class was formed and the results obtained justified the experiment. Most of these children have now left school, and it was decided to ascertain the number of children now in school suffering from a defect of speech, and at the end of the year 1931, there were 19 stammerers in the schools. Of these, 12 were slight, and 7 were severe cases. A further detailed report upon these children will be submitted to the Committee during the year, so that the members can decide as to the desirability of again having the Speech Defect Class. In addition to these, there were 13 children who articulated badly. These of course are in an entirely different category. The fundamental cause is different, and the treatment is different. We were fortunate that there was in one of the schools a teacher who was interested in, and had attended a course in, corrected articulation, and she has kindly supervised a class of these children. The course is not yet finished. 62 RETURN OF EXCEPTIONAL CHILDREN. On Table 3 will be found a return of all exceptional children in the area. The notes which accompany the Table will explain what otherwise might appear to be certain discrepancies. The figures in the Table refer to the conditions which obtain at the end of the year. Blind. There are 2 children at certified schools for the Blind, 1 boy and 1 girl. Both children attend schools maintained by the London County Council. There is also 1 boy who attends a private school. This boy used to attend one of the Council schools, but was examined and excluded from an ordinary school on account of High Myopia. The Committee made arrangements for his attendance at one of the L.C.C.'s Special Schools, and he attended there for some time, but very irregularly. The parents then withdrew the boy from the school and he now attends a private school. We had to acquiesce in these arrangements and the result may be most unfortunate for the boy. One girl is not in school, but she has only recently reached the age of 7 years and has come into the district recently. She was referred to the School Clinic by one of the London Hospitals and is kept under observation, and has so far been excluded from an elementary school. Deaf. There are 4 girls in certified schools for the Deaf. 3 of these are at Oak Lodge Residential School, and the other attends the Ackmar Road Special School. There are 3 others attending elementary schools in the district, but all are under 7 years of age. There are 2 others who attend an elementary school in the district, they are kept under observation, as recently the deafness has increased. One of them will probably have to attend soon at a school for the Deaf. Mentally Defective. Under this heading are 44 children who attend the Special School, and 27 in attendance at the public elementary schools. A word of explanation is necessary regarding the latter. At some of our schools, there are classes for backward children, and where necessary the teachers select children from these classes for admission to the Special School. Owing to unforseen circumstances, no admissions were made to the Special School in the last term of the year, and these 27 herein included are awaiting examination with a view to admission to the Special School. 63 Crippled Children. One girl is at St. Mary's Home, Dover. The crippling resulted from an attack of Infantile Paralysis. One girl attends the Physically Defective School in New Kings Road, Fulham, and a boy attends Faroe Road, Physically Defective School. There are 42 crippled children attending the public elementary7 schools. Most of these have attended or are attending special Hospitals. It will be noticed that 9 should be receiving special school education, but the kind of school has not yet been determined. The boy who was not in any school is suffering from OsteoMyelitis and attends the out-patient department of a London Hospital. Heart Disease. At the end of the year, one girl was resident in the West Wickham Heart Home. During the year, 2 other children were sent by the Committee to certified Hospital schools, one to tVest Wickham, and the other to the Cheyne Convalescent Home. One boy was admitted to the West Middlesex Hospital, suffering from Chorea, and was there at the end of the year. Of the 7 cases who attend a Public? Elementary School, 2 are suffering from congenital Heart Disease, and are excused physical exercise. One boy has been in different convalescent homes, and should really be in some institution, the others are attending various Hospitals * and Clinics, and are attending school under conditions and restrictions. Epilepsy. A girl suffering from severe epilepsy attends a private school, she was excluded from one of our schools on account of severe epilepsy, and the parents made arrangements for her attendance at a private school. Another, a boy, was temporarily excluded. The boy was attending a hospital and the physician recommended that he should attend an elementary school and he was readmitted. The attacks have recently increased in frequency and severity, and this year he has had to be excluded again. DEFECTS TREATED. On Table IV at the end of the Report will be found a list ot the defects treated under the Authority's schemes. Group 1 are 64 the Minor Ailments treated at the School Clinic. Group 2 gives the number of children treated for defective vision and squint, and the following report has been kindly written by Dr. Banham for inclusion. "The work of the Ophthalmic Clinic has been carried on regularly during the year 1931. Three hundred and fifty-nine children have been seen and advised, and 245 pairs of glasses supplied In addition 10 children and one mother sent from the Welfare Centres, have been treated and (impairs of glasses supplied. 8 Cases of external eye disease have been treated continuously, one of these was sent to the special hospital at Swanley for 3 months, and 2 cases of corneal ulceration were sent into the West Middlesex Hospital as the home conditions were not satisfactory. "This year the Report of a Committee of Inquiry into Problems connected with defective vision in school children has been received from the Board of Education. This gives the preliminary findings of the special committee dealing with the factors leading to the development of, and the aggravation of defective vision in childhood. Steps were first taken to find out the normal refraction at various ages of childhood and to establish a standard of reference for each age-group and sex. The determination of this should be of great practical value in the prevention of defective eyesight in children, particularly in the formation of views concerning the importance of ophthalmic investigation and treatment of children of pre-school age. "Approximately 200,000 cases of defective vision and squint are treated every year among school children, and the necessity is emphasized of early recognition of the abnormality and early treatment to prevent the abnormality getting worse. It is true also that some children with slightly defective vision may escape examination by refraction, if they do not complain of eye-strain and if the fault is not sufficient to cause any but a slight impairment of vision. Thus a certain number of early and slight cases of myopia may be missed until they have progressed to such a condilion as to produce marked visual defect. "The report goes on to state that there is thus " a strong argument for modifying the present practice which governs ophthalmic work in the schools." "The ideal course would be that every child should have an examination by retinoscopy instead of, as now, having its vision tested. Thus refraction would become a regular part of routine 65 school medical inspection. Also examination of all children under 5 years of age should include refraction. Whether such a procedure is practicable on many grounds is questionable, but a more searching and thorough test at the routine medical inspection is suggested, and arrangements made whereby the younger children could have their vision tested at an earlier age than it is now done and at frequent intervals." (Sd.) G. BANHAM. Dr. Banham's report requires very serious consideration and she has kindly promised to report further upon any modification which may be necessary in our procedure, more particularly in the initial examination during routine inspections. Her vast experience, not only in Hospital and private work, but also in school work makes her advice particularly valuable. She is intimately aware of the limitations which are imposed upon us and how far we are from the ideal, but she also appreciates the difficulties with which we are met. Reference has already been made to the Report of the Committee appointed by the Board of Education, and 3 main points emerged upon which stress was laid. (1) The comparative rarity of normal vision at any age, the condition being observed in only 2-3% of children at the age of admission to school. Though its incidence increases with age, it does not exceed 10% among children about to leave school. (2) The rarity of myopia or short-sightendess under 5 years of age, and the gradual increase in incidence as age advances. (3) The great preponderance of cases of hypermetropia or long-sightendess at all ages, though the incidence diminishes as age advances. Group 111 includes the figures of treatment of Defects of the Nose and Throat. There is a slight decrease in the number of children who were operated on at the Acton Hospital under the terms of the Authority's scheme. In view of recent work which has been carried out on the results of operative treatment on Tonsils and Adenoids, it is possible that this decrease may have been a blessing. Formerly, our difficulty was the opposition of the parents to the removal of Tonsils and Adenoids. We still come across cases where the tonsils are obviously diseased, the boy or girl is a mouth breather, snores at night, suffers from frequent colds, and 66 yet the parents will not have the tonsils and adenoids removed. However these instances are now rare, and they are not our greatest difficulty. We far more frequently come across cases in which the parents ask for the operation to be done, but there is no need for operative treatment. The parents belong to the careful type, who are over anxious about their child, and take him to a doctor for the slightest ailment. Sometimes removal is recommended because it is presumed that the tonsils might be the remote cause of disease, but frequently indiscriminate removal of tonsils is advised to save the trouble of making a diagnosis. As far back as 1923, Sir George Newman, in his Annual Report, issued a warning about the indiscriminate removal of tonsils and adenoids and laid down certain rules for the guidance of local authorities. Such instructions were necessary, and as he foresaw, there was a danger that tonsillectomy, like many other therapeutical measures, was apt to be abused and the operation advised indiscriminately without any regard to the conditions present in the throat and ears. Mr. Layton, Consulting Otologist to the London County Council Fever Hospitals, in a recent report laid down the following maxims : (a) Only under the rarest circumstances should the tonsils ever be removed in any child under 5 years. (b) Between the ages of 5 and 10 years the tonsils should only be removed when it is proved to the hilt that it is the tonsils that are harming the child, and that the harm they are doing is greater than the good that is being done by the healthy lymphoid tissue that these tonsils still contain. (c) Tonsils and rhinological adenoids (i.e. those in the midline), should not be removed in children living under conditions of bad hygiene, in overcrowded houses or in insanitary conditions without overcrowding. In such circumstances the child needs all the lymphoid tissue of the upper respiratory tract with which to combat these disadvantages. (d) In order fully to consider all these points and to examine the child, a consultation of at least 10 minutes to a quarter of an hour is necessary, and only on the rarest occasion should a decision be come to at the first examination. Group IV of the Table gives the figures of the children inspected and treated for Dental Defects, and below is appended Mr. Slater's report for the year. It is explained earlier in the report that Mr. Slater is responsible for the figures in the last quarter only, and, naturally, lie is not prepared to express his views upon dental condition in general in the district. 67 Although dental work has been in operation for some years in the district, we have to admit that dental defects is still the most widespread of all the defects found by school medical inspection, especially in the Entrant Group. In the Intermediate and Leavers Group we find that the conditions have improved, but this is due to the treatment which has been carried out as a result of the dental inspection. The conditions have therefore improved, but we have to admit that true preventive work has not been very successful. The Dental Profession has not given a definite and decided lead as to the path along which we should tread. On the one hand, there are eminent men who state that the prevention of dental caries is a matter concerned with the environment of the teeth. These dentists say that if sufficient care is taken of the teeth, caries will not result. One dentist advocates the use of the tooth brush, another depends upon the use of some cleansing food such as apples, at the end of a meal. The obvious remedy of these authorities would be to keep the teeth clean by natural and artificial means and to avoid circumstances which favour acid fermentation on the tooth surface, especially the eating of sweets and of soft insoluble carbohydrates without subsequent cleansing of the teeth. Recently the possibility of the prevention of dental disease by dietetic measures has been brought forward. Research work has been carried out by Mrs. Mellanby, and it is now claimed that dental disease is dependent upon an insufficient supply of Vitamin D in the diet of infants and possibly expectant mothers; that is during the period when the temporary teeth are laid down. Vitamin D is contained in abundance in Cod Liver Oil and in irradiated ergosterol, and investigations have been made of the effect of Vitamin D upon dental caries. Although the results obtained await the confirmation of wider experience, there is some hope that dental caries may be prevented or checked by a comparatively simple dietetic process. ANNUAL REPORT OF SCHOOL DENTAL SURGEON. "7320 School children and 318 infants from the Maternity and Child Welfare Centres were examined in 1931. Of these, 4579 school children and 179 infants were referred for treatment, 2999 and 172 respectively actually being treated. "The changing of Clinics and Dentist has resulted, of course, in a slight drop in the figures for school children, though there is an increase in the number of gas cases. It is encouraging however that the number of actual extractions has fallen, showing that, as was also the case in the previous year, the amount of treatment required by each child is less. The percentage of children not requiring treatment shows another 2% increase. 68 "As regards the percentage of refusals, this is still slowly moving in the right direction, showing a small drop on last year. "Quite a large number of mothers attend the dental inspetions at the schools and interest seems to be growing. "Regarding the Maternity and Child Welfare work, 75 more infants have been examined and 7 more treated this year than last. "10 mothers less were inspected and 7 less treated, though 6 more dentures were supplied. "Lectures to mothers and inspection of infants has been continued at the Welfare Centres. "In conclusion I should like to express my appreciation of the very great help rendered by all concerned at the Clinic, and of the help and co-operation of the Head Teachers." (Sd.) P. SLATER. UN CLEANLINESS. Group V refers to Uncleanliness and Verminous conditions, and the figures given in this group will show what a large portion of the time of the nurses these conditions demand. There has been a great improvement even in recent years, and when we compare the conditions with those that obtained before the War the improvement has been immense. If the Tables giving the figures for the different schools be examined, it will be observed that the highest percentage of infestation is only 18.7, and that was in September. Only 10 years ago, in two of the schools nearly two-thirds of the scholars had either vermin or nits in their hair—the figures being 61.1% and 64.6% Several of the schools then had over 40% of the scholars showing some sign or other of infestation. There is room though for still further improvement, and as the question has during the year been before the School Attendance Committee, I am referring again to the matter in detail. I have on former occasions expressed the opinion that, in this district, school attendance is not the most important factor in the spread of unclean conditions of the head and body. The figures in all the schools are always worse in the ex aminations which are made at the beginning of the term than they are at the end of the term. The worst figures are usually obtained at the commencement of the Winter Term, at the end of nearly a five-weeks absence from school. As the term advances, an'im- 69 provement occurs; this result is obtained through continuous and rigorous inspection and re-inspection by the School Nurses. It is not denied that there is a risk of spread through school contact, and this risk is one of the reasons why the head inspections are made. The risk of the spread of infestation is greatest of course, where the nurses find the. vermin present in the head or clothes, and whenever this condition is found, the children are excluded from school. For tabular purposes the infested children are grouped into four categories, A.B,C, and D. In Group A the children have very few nits, the nurses having counted less than 10. In Group B there are a few more nits, but the nurses estimate that less than 100 are present. In Group C the nits are very numerous but no live vermin have been detected. In Group D both lice and nits have been detected. It is only the children in Group D who are excluded from attendance at school, although notices are sent to the parents or guardians of all who show any evidence of infestation. The children in Groups A, B and C. are re-inspected at school, but it is usually found that most of the children in these groups are easily and quickly cleaned, and on re-inspection the heads are free from nits. Instructions are given on the method of cleansing, and these if carried out, result in the destruction and the disappearance of the nits. While the nits are present, certain precautions are taken and these precautions could be extended. The matter will be referred to when the question of treatment is discussed. The greatest difficulty is with the children whose heads and clothes are verminous. The difficulty is not in the cleansing of the child but with the underlying conditions. With the present vogue of short hair in girls, the head can easily be disinfested in a day. Former!}' it took a few days to get rid of the nits, because the parents objected to have the girl's hair cut short. The nits had to be killed and it was very difficult to treat them in such a manner that they were easily removed from the hair. The nits could only be loosened and slid along the long hair. This difficulty does not now arise, practically all the girls have short hair, and there is no difficult}in removing the nits from the hair.- A great improvement has taken place, but there still remains acertain number of children who are persistently and continuously giving trouble on account of their uncleanliness. It may be stated that most of the uncleanliness in the schools arises from about families. This does not mean that only children from these 20 families are infested, but that if the children from these families 70 could be removed from the district, the other children could be dealt with fairly easily. Most of the others are amenable to treatment and their parents do make an effort to assist us when the conditions are pointed out to them. Those children of course are liable to be infested by, and from, the children of the chronically unclean families, not only- inside but also outside the schools. At the head inspections in July, 42 children were found to be verminous and were excluded from school. If the figures are examined, it will be found that these children belong to the families referred to, and it will further be found, that not only these children, but the other girls, if there are sisters, have been old offenders in this respect. We have records on our lists in which even7 girl in the family has been found at every inspection to be unclean, and in some instances, the trait has shown itself in the second generation. We had an unfortunate instance quite recently which illustrated the difficulties to which I have alluded, and the circumstances were brought to light in the course of a head inspection in one of our schools. Two children were excluded from school on account of their verminous condition, and the address of these two was one which was very well known to us. All the children in this family had been excluded from school on account of the state of their heads at some time or another. In the case of some of them, exclusion regularly occurred after every head inspection. On looking through the records of the girls, it was seen that throughout their school careers, their heads were almost always infested when the schools were inspected. The record of one of the girls started as soon as she entered school in 1921, and before her school career came to an end she was found to be infested on 130 occasions. On several occasions she was found to be verminous, and twice the parents were summoned before the Magistrates and find. The record of the other girls was almost as bad, and even the boys were frequently found to be infested. We were hoping that our troubles would soon be ended, as the boys and one of the girls had left school, and the only remaining girl was nearing school leaving age, when these two children made their appearance in the Infants' Department. On enquiry it was found that these two were grandchildren and had been taken care of by the grandparents, because the father and mother were separated. The mother had left her husband and children, and the children had been brought to the grandparents. Unfortunately the house was overcrowded before the arrival of the two grandchildren, and a girl of 14 was sleeping in the same 71 room as her parents. There were only 2 rooms available and 2 grown-up boys were sleeping in the other room, which also served the purpose of a kitchen. The boys could not very well be asked to seek other lodgings, as they were the chief means of support of the family. The father was out of work and the mother suffered from rheumatism. There was a general air of apathy about the house. It was full of rubbish, and the whole place was in a filthy condition. 1 n addition to the verminous condition of the two children inspected in school, the rooms were literally over-run with bed bugs. The inspector, when he visited the house, showed the occupant the bugs which were walking along the walls, and evidently very little effort had been made by the tenants to control them in any way. We had served notice on the landlord in 1930, to do certain work and the house had been re-decorated. In spite of this, the conditions in the Autumn of 1931 were deplorable. Even if the heads of the children had not been infested with lice, it would be unfair and unkind to the other children in the class to allow the children from this house to attend school. Anyone who is acquainted with the habits of the bed bug knows how difficult it is to get rid of this pest once it finds lodgment in a house. Investigations were carried out recently by the Gasgow Health Dept. and it was ascertained that a bed bug can live for some months without any sort of food, and at the end of that time can reproduce its kind, and its young can then subsist for another couple of months without food. The ordinary method of disinfection are useless ; the bed bug shelters itself in crevices and cracks and unless the disinfectant acts directly on it, it will survive. If there is a picture rail in the room, it has to be taken down, and cracks and crevices have to be stopped. Even then it is doubtful if the bugs are always killed. It was arranged in this house to remove the furniture out into the yard and endeavour by spraying and fumigation to get rid of the pests, but our hopes of success were faint. Unless we can instil into the occupants some spark of self-respect, and a determination to be clean, a relapse will occur and the same process has again to be repeated after the next inspection. I have mentioned this case in detail, as I wish to impress upon the Committee that the question of uncleanliness is not a simple one, but is usually complicated by many factors. 72 The establishment of a cleansing station is not going to solve the difficulty, and it is only a platitude to say that the home conditions are not normal and must be remedied. Of course, the home conditions are abnormal, or the children would not be sent to school in a dirty state. We are sometimes apt to think that social misery and insanitary conditions are dependent solely upon housing conditions. It is true that measures which result in remedying insanitary conditions are associated with, and united to, other factors, such as ignorance, privation, intemperance, suffering, &c., and each one of these factors is in itself complex. Privation involves the operation of several influences, to each of which it is difficult to apportion its true weight; among these influences are loss of employment, and a large family to provide for, but these are also due to an underlying and a deeper cause. There are exceptions to every rule, but usually the more feckless the parents, the larger the family. The parents give very little thought to anything, and consequently never think how a large family can be provided for. They started their married life in a very small house or more frequently a small flat or tenement, and cannot afford to remove to a larger flat ot house. Overcrowding results, and most of the infested cases with which we have to deal are associated with overcrowding. Among other sinister effects of overcrowding is the lowering of the standard of cleanliness and decency in the occupants of the house. This effect is so potent that even after the overcrowding has been abated, the difficulty of uncleanliness persists. The occupants of an overcrowded house, have been so used to a low standard of living, that even when the housing condition has been ameliorated, the children still remain unclean. This is probably the cause of the large propertion of unclean children from the Council houses, and who attend the John Perryn School. At recent meetings of the School Management Committee this significant fact has been commented upon. The members haverightly expressed the opinion that the material conditions which obtain in the Council houses should render uncleanliness impossible. The Housing Committee, in selecting tenants for the Council houses, paid regard to the conditions under which the applicants had to live, and selected those who lived under the worst housing conditions. In many instances it was impossible for the tenants to live cleanly and decently. The Housing Committee offered them better conditions, and the people moved into bet:er houses but retained their previous standards of cleanliness. 73 I am given to understand that in almost every instance, where notices have had to be served on account of uncleanliness, their tenancy of a Council house was a comparatively recent one. We may infer that in time all the tenants of the Council houses will conform to a higher standard of cleanliness, but the risk involved should not be run. Before any mischief is done, these few defaulting tenants should be given to understand that their former standards will not be tolerated. I understand that the Housing Committee has decided to notify these tenants that continuance of these conditions may result in the loss of the house to the tenant. It is only by such means that we can hope for a further improvement in the standard of cleanliness, and like all educative measures it will be a slow affair. It is not sufficient to clean the heads and bodies of the children, but the work must also be done in the homes. In the case of Council houses, the work is comparatively easy, as we can count upon the assistance of the Housing Committee. But we cannot expect the same alacrity to assist on the part of private landlords. We have to rely on the statutory obligations of both landlords and tenants. I know that these measures are somewhat punitive in their character, and are not consistent with modern educative ideas, but they are efficacious. We had some striking instances of success when teachers applied what turned out to be punitive methods, although the object was very far from being punitive. In one of the schools one of the mistresses takes a deep interest in the cleanliness of the girls in her class. She was generally present when the Nurse made the head inspection. If there were in the class any girls whose heads contained nits, she kept them apart. Her primary object, of course, was to protect the girls who were clean. She rightly looked upon herself as the guardian of these girls whilst under her care, and wished to protect them from any injurious influences, and especially from head infestation. This separation had another effect. In time the infested girls felt that there was a certain stigma attached to the separation, and soon effected a change themselves. In almost every instance, the girls in this class are all clean in a few days after each head inspection. Not only was there a marked improvement after inspection, but the condition at each inspection had markedly improved. The girls evidently were determined that they would not risk separation on account of infested heads. In passing, it may be mentioned that this class was by no means an easy one to deal with. Some of the girls had been affected 74 by the re-organisation scheme, and were transferred from another school. Their former school was one of the worst in the district, and the class was no exception to the school. When they were removed to their present school they came under the afore-mentioned teacher, whose class always shows good results. She had carried out the methods of separation described above for some time. The influx of these girls from another school had at first a bad effect upon results of the head inspection in her class, but very soon her separation methods had effect, and her class invariably shows good results at each inspection. Other causes may have operated, such as change of surroundings, contact with a type of girl different to those they were accustomed to, as well as the change of teacher. The latter factor probably is the most potent. Some teachers can instill more than others a wholesome respect to their wishes. I feel sure that if the teachers would carry out these methods that we should get better results, but there is a feeling that if they did proceed along these lines, they would not always be supported by the Committee. There are exceptional circumstances in which such a procedure as the separation of the unclean children would not be justified, but such cases are few and far between, and the matter could safety be left to the discretion of the teachers. The teachers know the domestic circumstances of most of their pupils, and no undue harshness is ever exercised in any exceptional or hard cases. These exceptional cases are well known both to the teachers and to the school nurses, because some of the most difficult cases that we have to deal with are those who belong to a home which has been the scene of a domestic calamity. We have in the schools a few children whose parents have separated. The difficulties arise when the wife has left her husband, her home, and her children. Under these conditions, the deterioration in the children was obvious soon after the separation. Whereas, formerly, the childeren had been clean and well kept, very soon notices had to be sent, that the children were not clean, and the heads were infested. In one instance, the mother had been taken to a mental institution, and the grandmother looked after the house, but she was too old and infirm to keep the place and the children clean. In all these exceptional circumstances, the nurses do the cleansing at the School Clinic, but otherwise the Committee do not undertake the responsibility of disinfesting the children. After the inspection, whenever necessary, notices are issued informing the parent of the condition found, and instructions are 75 given for the appropriate condition. In cases of any difficulty, the nurses undertake to show the parents now to carry out the instructions issued. In some instances a summons has to be issued for want of attendance at school. The School Attendance Committee are apt to be lenient in the matter of prosecutions. Looking through the lists, we find that children have been excluded and allowed to remain out of school for as long as 6 weeks. It has been stated in a previous paragraph that under present conditions, the head and body can be disinfested in a few hours, and in no instance is it necessary for a child to be out of school for a longer period than 2 or 3 days. This allows for any domestic contingencies which may arise. In respect of absence from school there is room for improvement. In the following Tables the schools are referred to by numbers. UN CLEANLINESS TABLE. Sch. Date. No. exam. Very few nits A. Few nits. B. Many nits. C. Vermin D. Total Unclean. % % % % Number % 1. July 125 ...... ...... .71 ...... 1 .71 September 112 2.9 1.9 ...... ...... 5 4.9 2. July 130 ...... .8 ...... ...... 1 .8 September 102 1.7 1.7 ...... ...... 4 3.5 3. July 211 2.3 ...... ...... ...... 5 2.3 September 249 4. .8 ...... ...... 12 4.8 4. July 135 2.2 ...... ...... ...... 3 2.2 September 231 1.2 ...... ...... ...... 3 1.2 5. July 318 1.8 ...... ...... .9 9 2.8 September 260 2.3 ...... ...... ...... 6 2.3 6. July 138 4.3 4.3 ...... ...... 12 8.6 September 218 2.7 5. ...... .4 18 8.2 1 July 315 6. 3.1 ...... 1.2 33 10.4 September 295 5.4 8.1 ...... 1.3 44 14.9 8. July 276 2.5 4.7 ...... 2.8 28 10.1 September 221 1.8 4. ...... 2.7 19 8.5 9. July 554 5.8 .8 ...... .3 38 6.8 September 378 6.3 .5 ...... .2 28 7.4 10. July 508 8.1 5.3 .9 .8 77 15.1 September 389 10.5 4.6 ...... ...... 59 15.2 11. July 379 11.3 1.8 ...... 1.3 55 14.5 September 268 14.9 1.4 ...... ...... 44 16.4 76 Sch. Date. No. exam. Very few nits. A. Fewnits. B. Many nits. C. Vemin. D. Total Unclean. Number 12. Julv 46 ...... ...... ...... ...... ...... ...... September 153 1.9 ...... ...... ...... 3 1.9 13. July 87 4.5 ...... ...... ...... 4 4.5 September 162 2.4 .6 .6 ...... 6 3.7 14. July 227 1.7 ...... ...... ...... 4 1.7 September 235 .8 ...... ...... ...... 2 .8 15. July 213 2.3 1.4 ...... .9 10 4.6 September 160 3.1 ...... ...... ...... 5 3.1 16. July 269 1.5 ...... ...... .7 6 2.2 September 215 2.7 .5 ...... .5 8 3.7 17. July 212 .4 .4 ...... .4 3 1.4 September 248 .4 1.6 ...... ...... 5 2. 18. July 229 2.1 2.1 ...... .4 11 4.7 September 246 2. 4.4 ...... 1.2 19 7.7 19. July 303 .6 1.6 ...... 2.3 14 4.6 September 347 1.4 2.5 ...... .2 15 4.3 20. July 262 3.4 .4 ...... ...... 10 3.8 September 344 4.9 1.1 ...... .5 23 6.6 21. July 172 5.2 2.9 ...... ...... 14 8.1 September 314 7.3 3.8 ...... ...... 35 11.1 22. July 281 6.7 1. ...... .4 23 8.1 September 219 7.7 .9 ...... ...... 19 8.6 23. July 325 1.5 2.1 ...... 1.5 17 5.2 September 272 2.9 .7 ...... .7 12 4.4 24. July 218 3.2 2.7 ...... 1.8 17 7.7 September 208 6.2 9.1 ...... 3.3 39 18.7 25. July 174 ...... .5 ...... .5 2 1.1 September 228 .4 ...... ...... .8 3 1.3 26. July 229 .4 .8 ...... .8 5 2.1 September 204 .4 2.4 ...... .9 8 3.9 27. July 221 .4 .9 ...... ...... .3 1.3 September 207 2.8 .4 ...... ...... 7 3.3 28. July 206 1.9 .9 ...... .9 8 3.8 September 200 .5 1.5 ...... ...... 4 2. 29. July 107 .9 ...... ...... .9 2 1.8 September 98 ...... 2. ...... 2. 4 .4 77 Sch. Date. No. exam. Very few nits. A. Few nits. B. Many nits. C. Vermin C. Total Unclean. Number. 30. July 124 9.6 4.8 ...... ...... 18 14.5 September 101 3.9 6.9 ...... ...... 11 10.8 31. July 50 6. 2. ...... 2. 5 10. September 46 ...... 8.6 ...... ...... 4 8.6 32. July 43 4.6 ...... ...... 2.3 3 6.9 September 44 6.8 ...... ...... ...... 3 6.8 CONTROL OF INFECTIOUS DISEASES. There was a marked decrease in the incidence of most of the infectious diseases. Until the last quarter of the year the district was almost entirely free of Measles. In the last quarter Measles was prevalent in London and it was more than probable that we should be visited by an outbreak. Nearly 2 years had elapsed since the previous outbreak, and the district is visited by an epidemic, either a minor or major, every two years. Intercommunication between the district and London is so intimate that if the soil here be suitable the other conditions favourable to an epidemic would almost certainly arise. These conditions obtained towards the end of the year, but the outbreak did not occur until the early part of 1932, when the schools reassembled after the Christmas holidavs. Scarlet Fever. The decline in the incidence of Scarlet Fever continued during 1931, and only 45 cases occurred amongst school children compared with 96 in 1930. The cases were distributed as follows :— Southfield 9 Acton Wells 5 Berrymede 8 Rothschild 3 Derwentwater 9 Priory 3 JohnPerryn 7 Central 1 41 Scarlet Fever convalescent patients, and 119 'contacts' were examined before admission to school. There was no change in procedure in the treatment of contacts and convalescents. 78 Diphtheria. Diphtheria was also less prevalent in the district than in 1930; 35 cases occurred amongst school children compared with 62 in 1930. The cases were distributed as follows:— Priory 9 Central 2 Berrymede 6 Derwentwater 2 Beaumont Park 4 JohnPerryn 2 Acton Wells 4 Acton Junior 1 Southfield 4 Rothschild 1 CO-ORDINATION OF CHILD WELFARE AND SCHOOL MEDICAL SERVICES. It has been stated in previous reports that circumstances in Acton are favourable to the co-ordination of the Child Welfare and School Medical Services, and the developments which have occurred during the past year have tended towards the smoother working of the two services. In some instances the same officers act for both services. The School Medical Officers not only inspect the school children but act as Medical Officers of the Child Welfare Centres. Nurse Woosman and Miss Sorlie carry out the duties usually assigned to a Health Visitor and a School Nurse. They visit the homes where births have occurred, superintend Welfare Centres, and each carries out the similar duties in connection with the schools in their area. Children under 5 years of age with eye defects and carious teeth, can attend the School Clinic by arrangement with the Education Committee. During the past few years the supervision by the School Dental Surgeon has been extended. In the school holidays at Christmas and Easter, the School Dental Surgeon attends at the Infant Welfare Centres, inspects the teeth of the children under five who attend, and gives an address to the mothers on the care of teeth. Arrangements are subsequently made for the treatment of the toddlers' teeth at the School Clinic. These arrangements have been facilitated by the development in the past year. The Child Welfare Centres formerly held in the Church Road Baptist Hall and the Palmerston Road Mission Hall are now held in the School Clinic premises at Avenue Road, and the East Acton Centre is held in the John Perryn School. MILK IN SCHOOLS. The arrangement for the distribution of milk in the different schools was continued in 1931, and the following tables give the number of children obtaining milk in the Spring and Autumn Terms: 79 Spring Term. Acton Junior Mixed 75 South Acton Girls' 84 Beaumont Pk. Senior Girls' 7 South Acton Junior Boys' 97 Bdeumont Pk. Junior Girls' 59 Berrymede Junior Boys' 51 Beaumont Park Infants' 135 South Acton Infants' 129 Derwentwater Junior 134 Southfield Junior 119 John Perryn Junior 58 Southfield Infants' 87 John Perryn Infants' 109 Roman Catholic 66 Priory Girls' 21 Priory Infants' 106 Total 1572 Rothschild Junior 76 Rothschild Infants' 159 Aulumn Term. Acton Junior Mixed 75 Priory Girls' 36 Beaumont Pk. Senior Girls' 10 Priory Infants' 86 Beaumont Pk. Junior Girls'59 Rothschild Junior 88 Beaumont Park Infants' 143 Rothschild Infants' 163 Berrymede Junior Boys' 92 Southfield Junior 98 Berrymede Junior Girls' 81 Southfield Infants' 111 Berrymede Infants' 130 ,Southfield Senior Boys' 36 Derwentwater Junior 135 Roman Catholic 73 John Perryn Junior 71 John Perryn Infants' 127 Total 1614 EMPLOYMENT OF CHILDREN. The following Tables give the number of children employed in the various registered occupations. Delivering newspapers still remains the most popular of these occupations with school children; and assisting in the delivery of milk comes next in the list. Neither of these occupations is a laborious one, a boy who delivers newspapers usually works from 7 to 8 in the morning, and if he also has an evening round, from 6 to 7 in the evenings. When he assists in the delivery of milk, he usually works from 7 to 8 in the morning, but not in the evening. The hours on a Saturday are longer. Most of the other occupations only entail work on Saturday. Discussions constantly arise as to the effect of these occupations upon the children, and the desirability of entirely prohibiting boys from working outside school hours. Unfortunately all kinds of factors enter into these discussions, economic, physical, and educational. We have nothing to do with the economic aspect the question, except so far as this is reflected in the physical condition of the boy. It may or may not be true, that these boys 80 keep men out of employment. This though, is extremely doubtful. Newspaper delivery is not an occupation which would appeal to men, and it is probable that the newspapers would have to be fetched It is almost certain that a milk roundsman would not engage a man to accompany and assist him in his rounds in the morning and on Saturdays. In former reports I have given certain figures which tend to show that the employment is not hurtful to the physical condition of the boys. The money which was earned served to supply extra household commodities, such as food, which more than compensated for any ill effects which may have resulted from the conditions of employment. There are certain exceptional circumstances in which the employment would be detrimental to the boy. One of these exceptional cases arises when for some reason the boy does not get sufficient sleep. An instance of this kind came under my notice in the past year. The boy was engaged to' deliver newspapers morning and evening, and the place of his employer's premises was not very convenient to his home, but the deciding factor in this boy's case was the fact that he had school home work or preparation which took him about an hour and a half every evening. On questioning him it was found that he could not start his school home work until nearly 9 p.m. As he had to get up soon after 6 in the morning, it was obvious that the boy was not getting sufficient sleep. Usually, these boys who are employed in the morning get more sleep than those who are not. When enquiries are made as to the hours of sleep, it is found that the boys in employment get more sleep than the average non-employed boy of the same age. 81 TABLE SHOWING THE CONTRIBUTION OF ALL CHILDREN EMPLOYED DURING THE PERIOD 1st JANUARY; 1931 to 31st DECEMBER; 1931. SCHOOL. BOYS. GIRLS. John Perryn Acton Wells Central Priory Southfield Roman Catholic Acton County Others Totals Acton Wells Beaumont Park Priory Roman Catholic Totals 1. Registered Occupations:— (a) Carrying of Delivering goods or parcels 1 7 17 64 24 2 3 3 121 ...... ...... ...... ...... ...... (b) Delivering Newspapers 1 13 32 58 34 4 9 11 162 ...... ...... ...... ...... ...... (c) Delivering Milk 3 5 5 20 14 1 4 2 54 ...... ...... ...... ...... ...... 2. Employed in other Areas:- (a) Carrying or delivering goods or parcels 1 ...... 2 ...... 12 ...... ...... ...... 15 ...... ...... ...... ...... ...... (b) Delivering Newspapers 2 ...... ...... ...... 6 1 ...... ...... 9 ...... ...... ...... ...... ...... (c) Delivering Milk 1 ...... 1 ...... 3 ...... ...... ...... 5 ...... ...... ...... ...... ...... Totals 9 25 57 142 93 8 16 16 366 ...... ...... ...... ...... ...... Corresponding Figures for 1930 ...... 37 36 206 87 20 ...... 10 396 2 5 4 2 13 82 TABLE SHOWING THE NUMBER OF CHILDREN ATTENDING ACTON SCHOOLS EMPLOYED IN THE VARIOUS REGISTERED OCCUPATIONS AS ON THE 31st DECEMBER, 1931. SCHOOL. Delivering Goods or Parcels Delivering Newspapers Delivering Milk Totals Boys Girls Boys Girls Boys Girls Boys Girls Acton Wells 3 ...... 5 ...... 2 ...... 10 ...... Central 6 ...... 20 ...... 3 ...... 29 ...... Priory 27 ...... 30 ...... 11 ... 68 ...... Southfields 16 ...... 10 ...... 6 ...... 41 ...... Roman Catholic 1 ...... 3 ...... ...... ...... 4 ...... County 2 ..... 4 ...... 4 ...... 10 ...... John Perryn 1 ...... 1 ...... 3 ...... 5 ...... Totals 66 ...... 82 ...... 29 ...... 167 ...... 83 TABLE SHOWING THE NUMBER OF CHILDREN EMPLOYED OUTSIDE SCHOOL HOURS AS ON 31st DECEMBER, 1931. SCHOOL. Registered Occupations. Totals. 12—14 In Acton. In other Districts. Ages. Ages. 12—13 13—14 12—13 13—14 John Perryn 3 2 ...... ...... 5 Acton Wells 4 6 1 1 12 Central 12 17 ...... 1 30 Priory 26 42 ...... ...... 68 Turnhara Green R.C. 1 3 ...... 1 5 Southfield 14 27 4 9 54 Others 3 10 ...... ...... 13 County 4 6 ...... ...... 10 Totals 67 113 5 12 197 84 ANNUAL REPORT ON SWIMMING INSTRUCTION EN THE SCHOOLS. SEASON 1931. The swimming season opened on the 4th May and provided for 48 classes per week, 28 for boys and 20 for girls. Of these, 45 classes were held in school hours, whilst one boys' class and two girls' classes were held in periods immediately following morning or afternoon school. All the instruction was given by the teaching staff of the schools concerned. The time table was somewhat disturbed by the incidence of promotions at the commencement of the school year in August, but certain of the times were re-distributed and provision made for the newly promoted scholars to continue instructions in their new schools for the period from the summer vacation to the closing of the season on the 30th September. As in previous years, one small class of boys is continuing to attend the Baths during the winter months for instruction and practice in life-saving. The Acton Education Committee award certificales to boys and girls who can swim 25 yards down the length of the bath without interruption, pause or rest, and Acton scholars also compete for the certificates of the London Schools Swimming Association as under:— Swimming: 1st class, 100 yards (conditions as for the Acton (certificate.) 2nd class, 50 yards Life Saving: Elementary and Advanced. There are in the schools at the present time 723 scholars (393 boys and 330 girls) who can swim, and of these, 315 boys and 205 girls have learned to swim during the 1931 season. The following is a statistical return relating to the season's work:— 85 School Dept. No. of classes p.w. allocated. Total N o. of Attendances, made. Certificates Gained. A.E.C. -L.S.S.A. 1st. 2nd. El. Adv. Acton J.M. boys 1 244 ...... ...... ...... ...... ...... girls 1 242 4 2 2 ...... ...... Alton Wells boys 3 1263 17 5 11 ...... ...... girls 3 755 15 6 6 ...... ...... Beaumont Pk. Girls' Snr. 2 765 17 4 13 ...... ...... Jnr. 2 362 7 1 2 ...... ...... Central boys 5 1801 21 20 20 18 17 girls 3 1413 34 8 24 19 12 Derwentwater. boys 1 473 7 2 1 ...... ...... girls 1 471 11 5 9 ...... ...... John Perryn boys 2 687 18 8 9 ...... ...... girls 2 580 7 4 3 ...... ...... Priory Senior - boys 5 2031 35 19 32 ...... ...... girls 2 969 28 12 12 13 4 Rothschild Jnr. boys 2 809 ...... ...... ...... ...... ...... Berrymede Jnr. boys 2 497 3 2 ...... ...... ...... South Acton Jnr. boys 1 378 ...... ...... ...... ...... ...... Berrymede Jnr. girls 2 687 6 1 3 12 7 Southfield Snr. boys 4 1367 34 23 23 ...... ...... Southfield Jnr. Mixed boys 1 205 6 3 5 ...... ...... girls 1 330 6 1 3 ...... ...... Turnham Green R.C. boys 1 407 6 2 1 ...... ...... girls 1 210 3 ...... 2 ...... ...... Total 48 16946 285 128 181 62 40 Last year for comparison 47 18174 285 270 251 27 11 VISITS PAID BY THE SCHOOL NURSES. The following Table gives the list of home visits paid by the Nurses during the year. The figures refer to the schools at Which the children attended. Acton Junior Mixed 248 John Perryn 165 Acton Wells 107 Rothschild 290 Reaumont Park 387 Southfield 601 Berrymede 608 Roman Catholic 22 Central 10 Special School 40 Derwentwater 240 Total 3222 86 EXAMINATIONS OF TEACHERS AND OFFICE STAFF. 26 Candidates were examined during 1931. CONVALESCENT HOMES AND COUNTRY HOLIDAYS. 21 children (of whom 4 were granted free places) were sent to the Middlesex Edward VII Memorial, Hostel, Bexhill. 2 guineas received by the Mayor by kindness of the proprietors of the Savoy Cinema was devoted towards this object. MOTHERCRAFT CLASSES. The schools which sent classes were as follows:— Acton Wells 4 Priory 6 Beaumont Park 5 Turnham Green R.C. 2 Central 4 John Perryn 2 Total 23 TABLE I. A.—Routine Medical Inspection. Number of Code Group Inspections:- Entrants 1024 Intermediates 859 Leavers 586 Total 2469 Number of other Routine Inspections — B.—Other Inspections. Number of Special Inspections 2588 Number of Re-Inspections 2078 Total 4666 87 table ii. A.Return of Defects found by Medical Inspection in the Year ended 31st December, 1931. Defects 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) Malnutrition 1 57 - - Uncleanliness: (See Table IV., Group V.) Skin:— Ringworm: Scalp — — 14 — Body — — 45 — Scabies — — 21 — Impetigo 6 — 561 — Other Diseases (Non-Tuberculous) 10 — 81 — Eye: Blepharitis 12 — 126 — Conjunctivitis 6 — 65 — Keratitis 1 — 2 — Corneal Opacities — — 6 — Defective Vision (excluding Squint) 133 1 86 — Squint 11 2 6 — Other Conditions 3 — 64 — Ear: Defective Hearing — 5 6 — Otitis Media 13 — 27 — Other Ear Diseases 9 — 114 — Nose and Throat: Enlarged Tonsils only 1 2 10 — Adenoids only 3 6 7 — Enlarged Tonsils and Adenoids 179 7 67 3 Ot her Conditions 3 3 100 — Enlarged Cervical Glands (NonTuberculous) 1 276 - 39 Defective Speech — 3 — — Teeth—Dental Diseases (See Table IV., Group IV.) 241 - 26 - 88 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 observa but not requiring Treatment. Heart and Circulation: Heart Disease: Organic - 3 — 2 Functional - 9 — — Anaemia 1 10 — — Lungs: Bronchitis - 4 — 1 Other Non-Tuberculous Diseases 1 4 — — Tuberculosis: Pulmonary: Definite - — 1 - Suspected - — — — Non-Pulmonary: Glands - 1 2 1 Spine - 1 - — Hip - 1 - — Other Bones and Joints - 1 1 — Skin - — - - Other Forms - — - — Nervous System: Epilepsy - 3 - - Chorea - 5 2 — Other Conditions - 2 — — Deformities: Rickets 1 5 — — Spinal Curvature - 1 - 1 Other Forms - 11 - — Other Defects and Diseases 5 32 1001 4 89 B. Number of Individual Children found at Routine Medical Inspection to Require Treatment (excluding Uncleanliness and Dental Diseases). Group Number of Children Percentage of Children found to require Treatment Inspected Found to require Treatment. (1) (2) (3) (4) Code Groups:— Entrants 1024 153 14.9% Intermediates 859 163 18.7% Leavers 586 64 10.9% Total (Code Groups) 2469 380 15.3% Other Routine Inspections — — — TABLE III. Return of all Exceptional Children in the Area. Multiple Defects.-see specimen copy. Boys. Girls. Total. Bund (including partially blind): Suitable for training in a School for the totally blind: At Certified Schools for the Blind 1 1 2 At Public Elementary Schools — — — At other Institutions — — — At no School or Institution — — — Suitable for training in a School for the partially blind: At Certified Schools for the Blind or Partially Blind — — — At Public Elementary Schools — — — At other Institutions 1 — 1 At no School or Institution — 1 1 Deaf (including deaf and dumb and partially deaf): Suitable for training in a School for the totally deaf or deaf and -dumb: At Certified Schools for the Deaf - 4 4 At Public Elementary Schools 2 1 3 At other Institutions — — — At no School or Institution - - - Suitable for training in a School for the partially deaf: At Certified Schools for the Deaf or Partially Deaf — — — At Public Elementary Schools 1 1 2 At other Institutions — — — At no School or Institution - — — Mentally Defective: Feebleminded: At Certified Schools for Mentally Defective Children 28 16 44 At Public Elementarv Schools 19 8 27 90 At other Institutions - - — At no School or Institution — 1 1 Notified to the Local Mental Deficiency Authority during the year: Epileptics: Suffering from severe epilepsy: At Certified Schools for Epileptics - - - At Certified Residential Open Air Schools — - - At Certified Day Open Air Schools - - - At Public Elementary Schools - - - At other Institutions - 1 1 At no School or Institution — - — Suffering from epilepsy which is not severe: At Public Elementary Schools 6 1 7 At no School or Institution — - — Active pulmonary tuberculosis (including pleura and intrathoracic glands): At Sanatoria or Sanatorium Schools approved by the Ministry of Health or the Board - - - At Certified Residential Open Air Schools - - - At Certified Day Open Air Schools - - - At Public Elementary Schools — - - At other Institutions 1 - 1 At no School or Institution — - — Quiescent or arrested pulmonary tuberculosis (including pleura and intrathoracic glands): At Sanatoria or Sanatorium Schools approved by the Ministry of Health or the Board - - - At Certified Residential Open Air Schools - - - At Certified Day Open Air Schools - - - At Public Elementary Schools - 2 2 At other Institutions - — — Physically Defective: Tuberculosis of the peripheral glands At no School or Institution - - - At Sanitoria or Sanatorium Schools approved by the Ministry of Health or the Board - - - At Certified Residential Open Air Schools - - - At Certified Day Open Air Schools - - - At Public Elementary Schools - - - At other Institutions 1 - 1 At no School on Institution - — - Abdominal tuberculosis: At Sanatoria or Sanatorium Schools approved by the Ministry of Health or the Board 1 - 1 At Certified Residential Open Air Schools - - -1 At Certified Day Open Air Schools - - - At Public Elementary Schools - - - At other Institutions - - - At no School or Institution - - - 91 Tuberculosis of bones and joints (not including deformities due to old tuberculosis). At Sanatoria or Hospital Schools approved by the Ministry of Health or the Board 4 - 4 At Public Elementary Schools — — — At other Institutions — 1 1 At no School or Institution 1 — 1 Tuberculosis of other organs (skin, &c.): At Sanatoria or hospital Schools approved by the Ministry of Health or the Board - - - At Public Elementary Schools — — — At other Institutions — — — At no School or Institution — — — Delicate Children, i.e., all 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: At Certified Residential Cripple Schools - - - At Certified Day Cripple Schools — — — At Certified Residential Open Air Schools — — — At Certified Day Open Air Schools — — — At Public Elementary Schools 5 13 18 At other Institutions — — — At no School or Institution — — — Crippled Children (other than those with active culosis disease) who are suffering from a degree of crippling sufficiently severe to interfere materially with a child's normal mode of life: At Certified Hospital Schools - - - At Certified Residential Cripple Schools — 1 1 At Certified Day Cripple Schools 1 1 2 At Certified Residential Open Air Schools — — — At Certified Day Open Air Schools — — — At Public Elementary Schools 21(3) 21(6) 42(9) At other Institutions — — — At no School or Institution 1 — 1 Children with heart disease, i.e., children whose defect is so severe as to necessitate the provision of educational facilities other than those of the public elementary school: At Certified Hospital Schools — 1 1 At Certified Residential Cripple Schools — — — At Certified Day Schools — — — At Certified Residential Open Air Schools — — — At Certified Day Open Air Schools — — — At Public Elementary Schools 4 3 7 At other Institutions 1 — 1 At no School or Institution 1 1 2 92 TABLE IV. Return of Defects treated during the Year ended 31st December, 1931. Treatment Table. Group I.—Minor Ailments (excluding Uncleanliness, for which see Group V.) 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 12 2 14 Ringworm-Body: 42 3 45 Scabies 15 5 20 Impetigo 550 10 560 Other skin disease 33 8 41 Minor Eye Defects: (External and other, but excluding cases falling in Group II.) 249 5 254 Minor Ear Defects 140 7 147 Miscellaneous (e.g, minor injuries, bruises, sores, chilblains, &c.) 950 51 1001 Total 1991 91 2082 Group II.—Defective Vision and Squint (excluding Minor Eye Defects treated as Minor Ailments—-Group I.) Defect or Disease. No. of Defects dealt with. Under the Authority's Scheme Submitted to refraction by private practitioner or at hospital, apart from the Authoritv's Scheme Otherwise Total. (1) (2) (3) (4) (5) Errors of Refraction (including Squint) Operations for squint should be recorded separately in the body of the Report). 336 15 - 351 Other Defect or Disease of the Eyes (excluding those recorded in Group I.) 8 - - 8 Total 344 15 - 359 93 Total number of children for whom spectacles were prescribed (а) Under the Authority's Scheme 245 (b) Otherwise 15 Total number of children who obtained or received spectacles— (а) Under the Authority's Scheme 245 (b) Otherwise 15 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) 160 26 — — 186 Grout IV.—Dental Detects. (2) Half-days devoted to:— (1) Number of Children who were:— Inspection 56 Treatment 415 (а) Inspected by the Dentist: Total 471 Aged: (3) Attendances made by child- 5— 713 ren for treatment 3866 6— 799 7— 866 (4) Fillings:— 8— 757 Permanent teeth 1559 9— 771 Temporary teeth 172 10— 912 11—875 Total 1731 12—574 (5) Extractions:— 13— 458 Permanent teeth 633 14— 129 Temporary teeth 4536 Total 6854 Total 5169 Routine Age Groups — Specials 466 Administrations of general anaesthetics for extractions 2226 Grand Total 7320 ; (7) Other operations :— Permanent teeth 329 (b) Found to require treatment 4579 Temporary teeth_ 35 (c) Actually treated 2999 94 Group V.—Uncleanliness and Verminous Conditions. Average number of visits per school made during the year by the School Nurses 15 Total number of examinations of children in the Schools by School Nurses 27425 Number of individual children found unclean:— Verminous and Nits 155 Slightly infested 596 Number of children cleansed under arrangements made by the Local Education Authority 27 Number of cases in which legal proceedings were taken:— (o) Under the Education Act, 1921 — (6) Under School Attendance Byelaws — STATEMENT OF THE NUMBER OF CHILDREN NOTIFIED DURING THE YEAR ENDED 31st DECEMBER, 1931, BY THE LOCAL EDUCATION AUTHORITY TO THE LOCAL MENTAL DEFICIENCY AUTHORITY. Total number of children notified — Analysis of the above Table. Diagnosis. Boys. Girt*. 1. (i) Children incapable of receiving benefit or further benefit from instruction in a Special School: (а) Idiots - — (b Imbeciles — — (c) Others - - (ii) Children unable to be instructed in a Special School without detriment to the interest of other children : (а) Moral defectives — — (б) Others — — 2. Feeble-minded children notified on leaving a Special School on or before attaining the age of 16 — — 3. Feeble-minded children notified under Article 3, i.e., " special circumstances" cases — — 4. Children who in addition to being mentally defective were blind or deaf — - Grand Total — — I am, Your obedient Servant, D. J. THOMAS, Schetl Medical Officer.