Act 39 Borough of Acton. ANNUAL REPORT OF THE Medical Officer of Health TOGETHER WITH THE Report on the Medical Inspection of Schools for the year 1936. annual report OF THE Medical Officer of Health FOR THE YEAR 1936. Public Health Department, Municipal Offices, Acton, W.3. To the Mayor, Aldermen and Councillors of the Borough of Acton. Ladies and Gentlemen, I beg to submit the Annual Report for 1036, required by the Ministry of Health, together with the Annual Report on the School Medical Services. One of the most important developments in the year was the overcrowding survey, and a report upon the results ascertained is included. I have also included a brief survey of the social conditions of the district as these conditions partly explain the housing problem of to-day. Area.—The area of the district is 2,317 acres ; there has been no change of boundaries since the last report. Rateable Value.—The rateable value of the Borough on 1st April, 1036, was £774,716, and a sum represented by a penny rate was £2,825 (year ended 31st March, 1036). The number of inhabited houses, according to the Rate books at the 31st March, 1936, was 16,722. 4 Extracts from Vital Statistics.—The following table gives the extracts from the vital statistics required by the Ministry ol Health POPULATION 69,140. Total. M. F. Live Births. Birth-rate per 1,000 of estimated population—12.72 Legitimate _ 845 453 392 Illegitimate 36 11 25 881 464 417 Still Births. Legitimate 26 14 12 Rate per 1,000 births 33 Illegitimate 3 2 1 29 16 13 Deaths 794 Death-rate per 1,000 inhabitants 11.5 Deaths from Puerperal causes (Headings 29 and 30 of the Registrar General's short list). Deaths Rate per 1,000 births No. 29 Puerperal Sepsis 1 1.13 No. 30. Other Puerperal causes 1 1.13 Death-rate of Infants under 1 year of age. All infants per 1,000 births 68 Legitimate infants per 1,000 legitimate births 66 Illegitimate infants per 1,000 illegitimate births 153 Deaths from Measles—all ages 10 Deaths from Whooping Cough 6 Deaths from Diarrhoea—under 2 years of age 12 POPULATION. The Registrar General has given the estimated population for mid 1936 at 69,140, an increase of 180 on the estimate for mid 1935, and a reduction of 1,370 on the Census population. The number of parliamentary electors in Acton since 1931 las been as follows :— 1932 48,126 1933 48,245 1934 48,228 1935 48,258 1936 48,813 The number of new houses erected during the last five years were:— 1931-32 257 1932-33 188 1933-34 224 1934-35 134 1935-36 380 SOCIAL CONDITIONS OF THE DISTRICT. Although there has been no sudden or dramatic change in the social conditions of the district, a gradual one has been in operation for many years and the process still continues. It is only when some event occurs which brings to mind the conditions which obtained at the beginning of this century that we appreciate the transformation which has taken place in the character of the neighbourhood. Acton was a residential area, with are important industry; the laundry industry was the only one which provided employment for any considerable number of the inhabitants. The other residents were mostly employed in London: the laundry industry alone employed local labour : a far larger number of persons left the district each morning for their employment in other areas Chan arrived here for the same purpose. The night population was a much larger one than the day population.. These conditions have entirely changed, and the district has become industrialized ; there are still areas which are residential and these only now form the dormitory of London workers. There are now more people coming in to the district than go out ; the day Population is higher than the night one. It is impossible to assign a date to the origin of the change: it is not an event it is a gradual process. It is in many respects identical with the industrial revolution which in the late eighteenth and early nineteenth century transformed the North of England and the Midlands into industrial areas, and similar forces have been in Operation here. 6 In the industrial revolution, improved communications — turnpike roads, canals, railways,—combined with mechanical inventions—power-loom, steam power,—and the commercial use of coal and iron, substituted the factories for the domestic workshop. The internal combustion engine, the application of electricity to industry, and other inventions, have had the effect of removing many industries to the neighbourhood of London, and Acton, in common with other suburbs, has become the seat of many and varied industries. In each case, a world wide upheaval had an effect, if not in originating the change, at any rate in accelerating it. In the industrial revolution, the economic and other effects which accompanied and followed the Napoleonic Wars profoundly affected the industrial development of the first quarter of the nineteenth century: the Great War also determined the course and nature of industrial developments and inventions, and we are not yet aware of the final issue. Fortunately for Acton, there is one outstanding difference between the two periods: the industrial revolution caught this country unawares and unready. The new towns were built hastily and without foresight or regard to town-planning. Houses were put up regardless of soil, site, convenience, curtilage, water-supply, drainage, sewage, treatment—small in capacity, poor in structure, damp, unventilated, badly lighted, back-to-back. There was overcrowding of houses on the land and people in the houses. In most instances, the sole object of the builders seemed to be the erection of the maximum number of bouses on the minimum of space. There were problems of cleanliness, feeding and education: the control of infectious disease was almost non-existent and epidemics were frequent. Young children, of as young as six years of age worked in the mills, and the normal hours of employment were 17 a day. The new towns sprang up in the pre-sanitation era, and the local administrators of those towns are even now reaping the legacy of the unpreparedness of the period and trying to remove the burden by slum clearance schemes. We have been saved from these difficulties. Until the last quarter of the nineteenth century, Acton remained small and until the dawn of the twentieth century it had only one industry. Its development took place after the sanitation era: the vast majority of its houses have been built after the adoption of building bye-laws, and the installation of a complete sewage scheme. The growth of Acton was very slow in the first half of the nineteenth century. The population in 1801 was 1,425 and in 1861 it was 3,151. Most of that increase occurred in two decades 1821 7 31 and 1851-61. In the interest of the present day, the late development was fortunate. The first Public Health Act was passed 1848, and this was a permissive one. The procedure for the adoption of this Act was a cumbersome one, but it was simplified by the Local Government Act of 1858. In the middle of the eighteen sixties, the district began to develop; certain laundries were started in the southern area and houses were being built north of the Uxbridge Road. As the only sanitary' authority was the Board of Guardians of the Brentford Union created under the Poor Law Amendment Act of 1834, some of the inhabitants foresaw the danger of a haphazard development and called a meeting in October 1865 for the purpose of adopting the Local Government Act of 1858. As usual there was opposition and a poll was demanded. The result of the poll was 371 in favour and 143 against. Following the poll a Local Board of Health was formed and the first meeting of the elected Board was held in March 1866. The newly formed Local Board of Health adopted bye-laws (among other matters) for new streets and buildings, and those were approved by the Home Office in August, 1866. The value of the steps taken was soon evident, because in the following years there was a great increase in the population; the population, estimated in 1866 at 4,876 inhabitants, had increased at the Census of 1871 to 8,306. These facts are mentioned as they partly explain the oftrepeated statement that there are no slums in Acton, in the usually accepted sense of the term. The development of the district took place when the mistakes of the past had been discovered and precautions had been adopted to prevent the recurrence of the deplorable conditions which obtain in the older towns. It would be idle to suggest that the district has developed under ideal conditions: we can always be wise after the event. The earlier application of a town planning scheme the acquisition of certain sites, the retention and development of certain activities might have altered the amenities of the district and decided the character of its social conditions: but it is futile to speculate on what might have been: my duty is to report on the social conditions as they now exist, and more especially their bearing on the public health. It would be impossible to trace all the changes which have occurred, and are taking place, as they would require a consideration of all the various industries and their bearing upon the social conditions of the district. Moreover, the changes which issued from the establishment of the newer industries are of a more complex 8 character. These latter employ far more persons than the district could absorb or accommodate as residents, and though methods of transit have modified the effects, they still do affect such conditions as housing, drainage and hospital accommodation. The issues which have emerged from the changed conditions in the laun dry industry, are, in a sense, simpler in their character. Until the dawn of the present century, most of the laundries in the district were hand laundries, and these took on the character of the domestic workshop, in which most of the work was done by the members of the family, assisted by a few neighbours, frequently relations, and usually treated as members of the family. There were a few factory laundries in which mechanical pow er was utilised, and the work specialised, but the majority of the workers were employed in the hand laundries. These condition existed up to the outbreak of the Great War. Prior to that momentous event, there were indications of pending changes, but it was that event which precipitated the substitution of the domestic workshop laundry by the power laundry. Many factors operated in the change —economic as well as industrial. The difficulties of supplies, the scarcity of labour, the changes in the means of transport, the keen competition—all played a part. The result has been the gradual and probably the inexorable disappearance of the hand laundry and concentration of the work in large factories, where most of the work is done by machinery and most of the processes have become mechanised. The work also has become specialized. The tub and dolly have cisappeared, together with the other familiar equipments of the old laundries. It was formerly held that Rheumatism in particular was especially prevalent amongst the women employed on account of the damp conditions. The actual washing is now done in bag-washers and other closed containers, and then passed through the hydro-extractors operated by men. Married female labour was largely utilised, but this has not been eliminated by present conditions. Although most of the work has become mechanised, some of the processes still require an extensive experience as well as individual skill, and some of the most experienced and skilful are married women. This need for marieed female labour operates in diverse ways: it has its attendant evils as well as its economic advantages to the families concerned. the Day Nursery was established to meet the demands of the married women who worked in the laundries, and from its continued popularity, it shows that the demand still exists. Though Nursery 9 classes have been established, in some of the schools in the neighbourhood, the Day Nursery still works to capacity, and there is always a waiting list. Although the Day Nursery was established by a voluntary body, it was looked upon with sympathy, and supported by the Council's Health Committee, because it was believed that the conditions under which the babies were being minded, contributed to the high infantile mortality of the South-West Ward in those days. The necessity for married women labour tends to stabilize the industry in a neighbourhood where such labour is available, but it has its disadvantages ; disadvantages which are inseparable from a factory established in a residential neighbourhood. In North Acton, on the Chase Estate, complaints about the factories are infrequent. This is partly due to the fact that the tmildings are new and built for the purpose for which they are used. Klectric power has been installed in most of these new factories; where steam power is utilized, the newest type of boiler has been installed. They are well ventilated and well lighted. In addition, the factories are situated away from dwelling houses. Although many of the factory laundries are equipped with the latest types of machinery some have been adapted from other buildings and extended, and complaints of smoke nuisances, noise of machinery and other unpleasant conditions are frequent. There are of course, grounds for these complaints, but it is probable that if these conditions were present in factories in North Acton, they would either be unnoticed or at any rate they would not give rise to complaints. The laundry industry may be said to have been self-contained: the laundries were almost all situated in the south-west part of the district. There used to be a large laundry in the centre of the town, but the buildings are now used for other purposes. The only other self-contained community were the railway employees who lived at the other extreme end of the district near Willesden Junction. They were connected with the old London and North Western Railway, now merged in the London, Midland and Scottish. (It must not be inferred that these are the only, or even that they form the majority of the railway workers in the district: simply that they were self-contained in a particular area. There are many employees of the London Passenger Transport Board testing throughout the district, and especially in the South-West Ward. Great Western Railway employees are especially numerous in what is called the Great Western Estate around Noel Road). 10 The establishment of new industries started early in the twentieth century, when several firms connected with the motor, dyeing and printing industries started work in Acton Vale on the south side of the Uxbridge Road. At that time an attempt was made to house the employees of the new works, and the streets on both sides of the railway were built for, and occupied to a great extent by, those who had been attracted by these industries. A few large works were also established in the northern part of the district. Roughly, this was the position when the Great War broke out. The South East and the South West Wards were fully developed and built over. More than half the North East and the North West Wards was unbuilt and it was uncertain on what lines this land would be developed. During the War, the Government required the land around Goddard's farm and erected large buildings on it which were used as filling factories. Most of the workers employed in the Munition Works at Park Royal lived in the district, and it was estimated that the population of the district in 1917 was 65,219 inhabitants, and in 1918 it was 66,000 inhabitants. At the Census of 1931, the population was 70,510, and in 1921, 61,299. On the conclusion of the war, this land was acquired, and in time factories were built on the whole site. This land was situated in the North West Ward. Some of the undeveloped land on the North East Ward was acquired by the Council, and houses suitable for the working classes were erected. The other land in the North East Ward was acquired by private interests, and practically the whole of the land in this ward which was undeveloped at the end of the war has been used for the erection of residential buildings of different types. The factories erected in the North West Ward on what is called the Chase Estate are so numerous and of so varied a character that a description of them would require far more space than can be spared in this report. In one sense, they are not of as much importance as the old ones, as a large proportion of thoses employed in them do not reside in the district. In a few instances the owners have provided not only places of employment but also residences for the employees, but these are in a great minority. There are main reasons for these differences between the pre-war and the post-war factories. Some of the latter removed from London and a large number of the employees did not change their residence. 11 Another reason may be aduced. It is well known that in Acton as well as in other western districts of Middlesex, the chief lines of communication—railways and arterial roads—run east and west: transport and especially passenger transport facilities are better and easier east and west then north and south. As these factories are situated in the northern part of the district, it is easier for the employees to reach their work from other districts than it would be from the south of Acton. Although this represents the case in a general way, many, of course, would prefer to live in the district, so as to be near their work, but there is nothing like sufficient housing accommodation in the district for all the employees in the area. Limited housing accommodation in the district renders the housing problem a difficult one to solve. The supply will always be less than the demand, and the competition tends to force up the rents. There will always be a sufficient number of people in these factories who are willing to pay a few shillings weekly more for accommodation near their work rather than expend it on bus or rail fares, to ensure that the demand will exceed the supply of houses of a character within reach of the class of worker employed at the local factories. The wages of the unskilled worker at these factories average about 50/- weekly. (The skilled workers, of course, earn more). A decontrolled flat, consisting of a kitchen, living-room and two bedrooms, fetches from 15/- to 20/- a week—far too high a proportion of the wages for rent. In a district like ours, one of the unavoidable disadvantages of the presence of these factories is the artificial raising of rents for certain classes of workers, while the wages do not rise in a corresponding manner. In spite of the Speenhamland example and its vicious results, we are frequently compelled to supply milk and food to mothers and children though the husband is in full employment. On the other hand the introduction of the numerous and diverse industries into the district has been the means of providing work not only to the residents of Acton, but also to many who live in neighbouring districts. Even in the period of acute depression a few years ago unemployment did not loom very large. On December 31st, 1936, the total numbers of persons (aged 18 to 65), resident in Acton and registered as wholly unemployed were as follows— Men. Women. Total. 799 182 891 The total amount of out relief in cash and in kind disbursed by the two Relieving Officers in the Acton area for the year 1936 was £17,968 11s. 10d. 12 Coincident with this development of the district, a definite change has been, and is, taking place, in other respects. To anyone who has a fairly long recollection of the district, the changes which have occurred are patent. No one would recognise Bedford Park of to-day from the description in a book published less than a quarter of a century ago. In it Bedford Park was described as a garden city, the architecture of its bouses modelled in the Queen Anne type, and inhabited chiefly by artists, literary people, leisured people, and persons holding positions in London and finding it easy of access to their business. The South-East Ward is still entirely residential in its character, but some of the larger houses have disappeared and in many of the streets, the houses are divided and sublet. One of the most noticeable changes in the district is the disappearance of the large residential houses, most of them situated in their own pleasure grounds, of considerable extent. The same changes are possibly occurring in all the inner suburbs of London. Whatever the cause, these large houses are disappearing. Some have been pulled down and other buldings have been erected 'on the site : some have been adapted for other purposes : very few remain still as private residences. Changes have also occurred in many of the houses which contained from five to nine bedrooms : a large number of these have been converted into tenements. It is not suggested that these changes have been brought about entirely because of the industrialisation or even the urbanisation of the district. Other factors have been in operation, chiefly economic. The domestic servant question here as elsewhere, has been a factor, possibly one of the most important. The domestic help problem is general throughout the country, but it is more acute in the neighbourhood of factories. It is not only the large houses which are now let in tenements. The majority of the houses in Acton were originally intended for one family, but most of them are now occupied by two or more families each. If an examination of the Census returns of 1931 be made, and a comparison made of Tables ten and eleven in the County of Middlesex Volume, this point will at once he made clear, as the following figures, extracted from these tables, will show. Structurally separate dwellings and separate families occupying— 1 room 31 1 room 1085 2 rooms 110 2 rooms 1920 3 rooms 636 3 rooms 4650 4 rooms 2197 4 rooms 3535 5 rooms . 2843 5 rooms 2980 6-8 rooms 6973 6-7 rooms 3497 9 or more rooms 1022 8-9 rooms 820 10 or more rooms 189 13 A structurally separate dwelling has been defined for the Census as any room or set of rooms, intended or used for habitation, having separate access either to the street or to a common landing or staircase. Thus each flat in a block of flats is a separate unit: a private house which has not been structurally subdivided is simlilarly a single unit whether occupied by one family or by several families. Only 777 tenements of three rooms each or less conformed to the definition of the Registrar General of structurally separate dwellings, but 7664 of these were used as tenements, and it is only reasonable to conclude that the majority of these houses of sis rooms or less were originally intended for one family. AMBULANCE FACILITIES. The ambulance facilities are similar to those described in previous reports. There is a motor ambulance for the removal of infectious cases to the Isolation hospital, and two ambulances provided for accident and non infectious cases. The latter are housed at the tire station and are available at all hours. Last year the ambulance was called out to 561 street accidents, and on 3S3 occasions to private cases. Fees amounting to £69 12s. 6d., were paid for the use of the ambulance for private cases. There has been no development or marked changes in the services provided in the area under the following heads:— Laboratory facilities. Ambulance facilities. Nursing in the home. Clinics and Treatment Centres. Hospitals—Public and Voluntary. HOSPITAL PROVISION. General.—The only General Hospital in the District is the Acton Hospital, Gunnersbury Lane, which has an accommodation of 72 beds. During the year 1070 patients were admitted ; this is a decrease of 199 on the previous year, but is due to the fact that the Children's Ward was closed for 5 months owing to the rebuilding. The new Male and Childrens Wards were not in use until October and November. The beds have been continuously occupied and the average number of patients resident daily was 53.37. 14 The Education Committee continues its agreement with the Hospital for payment for the removal of tonsils and adenoids and the patients are now taken in for a night prior to the operation as well as being kept in for a night agfter the .operation. 9006 Out-Patients were treated during the year, an increase of 498 and the Out-Patient attendances were 46,106, an increase of 8,988 as compared with 1935. The enlarged Out-Patient Department and the new PhysioTherapy and X-Ray Departments are proving of immense value. Fever.—Acton Council Fever Hospital. 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 dissolved 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)—John Perryn—Every Monday afternoon at 2 p.m. (c)—Steele Road—Every Tuesday and Friday afternoon at 2 p.m. (d)—Noel Road—Every Thursday afternoon at 2 p.m. Ante-Natal Consultation Centre.—School Clinic every Wednesday at 10.30 a.m. Day Nursery.—169 Bollo Bridge Road. School Clinic.—45 Avenue Road. (The above are provided and maintained by the Borough Council). Tuberculosis Dispensary.—Green Man Passage, Ealing, W.13 on Monday at 2 p.m., Tuesday, Wednesday, Thursday and Friday at 10.30 a.m. First and Third Tuesday in each month at 6 p.m. 15 Treatment Centres for Venereal Diseases.—Various Hospitals in London. (The two latter are provided by the Middlesex County Council). PROFESSIONAL NURSING IN THE HOME. General.—There are three district nurses employed by the Acton Hospital, who visit the homes of both the poor and those who are able to pay. There are also nursing associations which provide 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 27 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 1890 Infectious Diseases Prevention Act, 1890 1899 Notification of Births Act, 1907 1907 Public Health Act, 1907 (Clause 50) 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 Offensive Trades 1903 Tents, Vans and Sheds 1906 Removal of Offensive or Noxious Matters1908 Cleansing of Cisterns 1912 Employment of Children 1920 Fouling of Footpaths by Dogs 1929 Smoke Abatement 1930 Houses let in Lodgings 1934 16 HOUSING. Overcrowding Survey. The provisions of the Housing Act of 1935 which relate to overcrowding are familiar to most of the Council, and especially to the members of the sub-committee who were appointed to deal with the survey carried out under the Act. Numerous reports were presented to the Council upon the general provisions of the Act and special reports were made upon the overcrowding revealed by the survey. It may therefore be desirable to deal again in a general way with the overcrowding provisions of the Act before the details of the survey are given. The principal object of the Act is laid down in its first sentence, which states that it is "an Act to make further and better provision for the abatement and prevention of overcrowding As an administrative measure, the Act differs in many respects from previous Housing Acts. In this Act the primary object is the relief of overcrowding; in former Acts overcrowding was shelved or made subsidiary to the requirements of town planning, town amenities, &c. In the Act of 1935 not only under certain conditions is overcrowding an offence punishable by fine in the case of both the occupier and the landlord, but it also provides the machinery for the enforcement of the provisions against overcrowding. Until the present Act, there was no way of reducing overcrowding which was workable, or which did not produce worse conditions, than those it sought to remedy. Now that we have the remedy it is our business to apply it. The Act will not work itself, and it will be some time before the ideal can be attained. There may have to be some compromise between what should be done and what can be done; between what legally can be enforced, and what socially it is advisable to enforce. Although a definite standard would appear to be essential in the prevention of overcrowding, before the passage of this Act there was no standard which applied to the whole country. There were certain standards laid down for different purposes, and local authorities made bye-laws for common lodging-houses, and for houses-let-in-lodgings. For army barracks 600 cubic feet per person is laid down, and rooms occupied both day and night in common lodging-houses must have 400 cubic feet per head of space as must non-textile workrooms during overtime. The earliest bye-laws for houses-let-in-lodgings were adopted in Acton in 1899, and under these 400 cubic feet for each adult and 200 cubic feet for each child under 10 had to be provided if the rooms 17 were used for both living and sleeping purposes. If used for sleeping only, the figures were 300 cubic feet for adults and 150 cubic feet for children. In 1934, these bye-laws were revised, and floor space was adopted as the standard; each adult was to be provided with 40 square feet and 30 square feet for each child. Other authorities adopted bye-laws in which the standard was sometimes based upon cubic capacity and at other times upon superficial area. But under the Act of 1935, definite standards are laid down below which overcrowding is presumed to exist, and these standards are applicable to the whole country. Although these standards have been criticised, they are an advance on the low standards and unsatisfactory bye-laws with which most authorities had to manage in the past. Two standards are laid down, the first dealing with persons per room, and the second relating the floor area of the rooms to the number of inhabitants. The number of persons permitted to use a house for sleeping is the lesser of the figures obtained by using both bases of calculation. In the first schedule to the Act, the two tables showing the method of calculation are inserted, and they are as follows:— Table I.. Where a house consists of:— The permitted number of persons is:— (a) One room 2 (b) Two rooms 3 (c) Three rooms 5 (d) Four rooms 7½ (e) Five rooms or more 10 with an additional 2 in respect of each room in excess of five. (In using this table, a room of less than 50 square feet is not counted as a room). Table 2. Where a room in any house has a floor area of:— (a) 110 sq. feet or more 2 (b) 90 sq. feet or more, but less than 110 1½ (c) 70 sq. feet or more, but less than 90 1 (d) 50 sq. feet or more, but less than 70 ½ (e) Under 50 sq. feet Nil. These tables have been criticised from both angles—insufficiency and prodigality. On the one hand it has been held that the 18 standard is too low when it is remembered that living rooms are counted in the total accommodation available. For example, in a three bed-roomed house with kitchen, scullery and living room, the number of units authorised to use that house for sleeping purposes is 10, and there is no power in the Act to compel these persons even to use all the bedrooms. The Act of 1935 does not directly prohibit overcrowding in the public health sense—that is, more than a given number of persons in a given space; it only makes it possible for this not to happen. It is no offence for ten persons to sleep in one room if the house they occupy allows ample accommodation for their sleeping properly. Similarly Section 2 (1) (a) providing for proper separation of the sexes is an admirable clause, in its intention calculated to promote decent living and reduce incest, but its enforcement unless there is an infringement of the overcrowding provisions is practically impossible. On the other hand, the conment has been made that table 2 takes no account of rooms which are larger than 110 square feet, and this may prove to be a disadvantage in connection with some of the older houses with large bedrooms. Section 4 gives the Minister of Health the power, on the application of a local authority and after consultation with the Central Housing Committee, to modify temporarily the overcrowding standard in its application to houses in the district of a particular local authority or in any part of that district. The section sets out the circumstances which must exist before the Minister can make an order. One of these is that in the whole area of the authority, or in some defined part of it, a large proportion of the accommodation for the working classes consists of houses with large rooms. We have no area in our district in which there is a large proportion of the accommodation consisting of houses with large rooms. Some houses have been sublet in which the area of the rooms exceeds 200 square feet, and a few in which the area exceeds 300 square feet, so that we do not apprehend a considerable amount of hardship. But a man and wife with one child over one year of age, living in one room, no matter how large that room may be, breaks the law. If a case of infringement of the law is brought to court and proved, the magistrates must convict, but there is no compulsion to bring a case where the infringement is trivial, technical, or capable of accommodation without legal action. To deal with any small number of houses with large rooms which may exist in a district, Section 5 of the Act provides that the local authority may, upon the application of the occupier or intended occupier of such a dwelling-house, grant him a licence (not exceeding twelve months) authorising him to permit such number of persons in excess of the permitted number as may be specified in the licence to sleep in the house, and a copy of such licenœ must be served upon the landlord. 19 In spite of these apparent theoretical objections, which probably will not operate unfavourably in practice, the fact remains that for the first time we have a standard of overcrowding laid down in an Act of Parliament. This is of paramount importance, though in the case of family overcrowding the standard may operate harshly. As the Act stands, many families would require rehousing at intervals. A "house " as defined in the Act, may be within the Act one week and without it the next, without any change either in the house itSelf or its inmates save such as occurs from the passage of time. family overcrowding will require some sympathetic management. the Ministry recognise this and admit that breaches of the Act must occur and must be permitted temporarily. With harsh administration. the Act might become a dead letter, but with careful insistence on its provisions, it can eventually abolish overcrowding. It may posssibly help us to obtain a better perspective of the overcrowding which the Act is intended to mitigate if we review the Conditions which have obtained. The conditions which obtain throughout the country do not particularly interest us, except in so for as they seem to be somewhat similar to those which obtain here. The census of 1931 showed that 397,000 families, or 3.9 per cet. of all families, were so housed that there were more than two persons per room. Of these 183,000 families had more than three person per room, and 56,000 more than four persons per room. While 3.9 per cent. of all families had more than two persons per room, the overcrowding population was actually 6.9 per cent. of the whole, or approximately 2,775,000 persons. The 1921 census gave 497,133 families with more than two persons per room, so that the census of 1931 showed a reduction of about 100,000 families living under these conditions—an appreciable improvement over a ten-year period. In the four years ending 1935, 845,387 houses have been built by private enterprise, as against 59,406 built by local authorities under the 1930 Act, and 143,875 under the Wheatley Act. If We leave out the 59,406 houses built under the 1930 Act, which roughly replaced demolished houses, 989,262 houses have been built to deal with an overcrowded population in 1931 of approximately 2,275,000 plus the natural population increment since the census The results of the survey under the 1935 Act are not exactly comparable with those which were obtained at the census. The primary Object of the survey was to ascertain in each area even case of overcrowding which existed at the time of the survey, together with Sufficient details relating to each case to enable the local authority to formulate proper plans for dealing with the overcrowding. 20 The secondary object was to give the local authority a substantially accurate position of the amount of working-class accommodation in their area, and the number and size of the workinclass family occupying that accommodation. The value of the survey for these purposes is not substantially affected by the fact that the statistics obtained have, for various reasons, no claim to be regarded as exact and uniform in the sense of the census returns. The fact must however be borne in mind, if the statistics are used to make comparisons between areas. The range of houses covered by the survey varied according to the criterion adopted by the authority to ensure that all workingclass houses were inspected. For example, where every house in an area was included, the resulting percentage of overcrowding relates to the whole population, whilst in those districts in which the houses surveyed were selected, the resulting percentage of overcrowding relates not to the whole population but to the particular areas which were selected for the survey. These figures probably are a fair index of overcrowding in the working-class dwellings in these localities, but they should not be taken as a criterion of overcrowding in the whole district, nor for comparative purposes. A few instances from the report will show the difference in the practices in areas around London. District. Population. Dwellings surveyed. Percentage Overcrowded (a) Ilford 151,390 43,541 0.7 (b) Harrow 144,280 12,943 1.2 (a) Walthamstow 134,490 36,735 1.6 (b) Hendon 134,160 13,292 4.1 (a) East Ham 135,400 38,422 2.2 (b) Ealing 137,550 15,234 2.1 (a) Edmonton 96,320 26,241 1.5 (b) Wembley 99,120 8,659 2.2 In districts (a) probably most of the dwellings were included in the survey, whilst in districts (b) less than one-half, possibly not one-third, of the dwellings were so included. Of the house not included, a very small percentage, if any, would have been found to be overcrowded ; so that, if all the houses in districts (b) had been included in the survey, the percentage of overcrowding would have been considerably reduced. As one of the objects of the survey was to ascertain the amount of overcrowding in working-class dwellings, no useful purpose would be served by the inclusion of all the dwellings in those districts in which a very large number of the houses are occupied by people who are not usually included in the term " working classes." 21 In Acton, 16,942 dwellings were inspected, and this number represents over 80 per cent. of the total houses in the district. The definition of "room" in Section 12 takes account of the custom of the locality. In those areas where it is customary to use a large kitchen for living purposes, that kitchen would be counted as a room; in those areas where it is customary to have a small kitchen, not usually used for living purposes, that kitchen would not be counted as a room. It is probable that even in areas where customs and conditions are comparable, the decisions of the local authorities as to what constitutes a room are not completely uniform. In Acton, the two forms of kitchen are met with ; the more numerous is that type in which there is a small scullery used for cooking purposes. In our survey the scullery was net reckoned as a room. In many instances, especially in the larger houses, one of the rooms has been converted into a kitchen, and though used for all purposes, it was, of course, reckoned as a room. Local authorities also varied in the way they have tabluated the less usual forms of occupation. For example, one house may be occupied by two unrelated families who may have separate bedrooms but share equally all the other accommodation. Some authorities classified this as two families, dividing the accommodation between each according to circumstances ; other authorities treated this as one family with lodgers. This variation of standard also accounts for the difference in the number of one-roomed, two-roomed, &c., tenements obtained in the survey, as compared with the number of the several roomed tenements or families in the census report. The rule followed here was to reckon a lodger, if he occupied a furnished room, or obtained his meals with the family, as part of the family, and included in the tenement occupied by the family. If, on the other hand, the lodger Occupied an unfurnished room and obtained his meals outside, or Cooked his own meals, the lodger's room or rooms were reckoned as a separate occupation. There are 1,536 housing authorities in England and Wales from whom returns should have been received. When the Report on the Overcrowding Survey was published in July 1936, 1,472 authorities had submitted returns in a form which enabled them to be included in the summary tables for the whole country. The 22 authorities not included were, for the most part, small, and in terms of population the summary tables cover nearly 99 per cent of the whole country. These tables disclosed that 8,924,523 dwellings were inspected, and that 341,554 dwellings were found to be overcrowded, so that in England and Wales, at the time of the survey, 3.8 per cent, of families whose dwellings were inspected were living in overcrowded conditions. If these figures are compared with those which were ascertained as the census, it will be seen that the improvement which was observed in the intercensal period 1921-1931 has been continued since. At the census, the standard of overcrowding was based upon the density of more than two per room ; the standard at the survey is higher. But though the figures are encouraging, the Report shows that the position cannot be accepted with complacency For instance, in one of the tables, it is shown that there are 4,185,000 families who have more than double the amount of accommodation required by the overcrowding standard ; which means that these families, constituting over 46 per cent, of all the working class families in the country, are so well housed that the number of persons in each family could be doubled and yet overcrowding would not ensue. On the other hand, the same table shows that a variable* of the overcrowding standard which reduced the permitted numjfcaj for a dwelling by 10 per cent, (it is not suggested that a various* of this precise form is practicable), would increase the nunibuji families who would be overcrowded by about 380,000. Iu elH< j words, 4.4 per cent, of the present uncrowded families are yv\ j near the border-line of overcrowding. j I " The ideal standard of housing may perhaps be taken 4 ! the standard outlined in Section 37 of the Housing Act 1930. is the standard which is applied in certain circumstances to thtfhousing activities of local authorities. It is not a detailed starniu.'"- > but provides only that a new house containing two bedrooir-S count as providing accommodation for four individuals, oltt Ce*' taining three bedrooms for five individuals, and one co:itfcW«j four bedrooms for seven individuals. The size of the bo:M*y. is left unspecified, but since in new houses one of the bedr< least is usually small, the standard may be taken to be equivJfcpf to two individuals per normal sized bedroom, together with*®-" quate living accommodation." If this hypothetical standard were accepted as a h**number of families overcrowded would be raised from 3r/- < to 853,119. 23 The worst overcrowding is shown to be, for the most part, concentrated in two areas; the East End of London, and the NorthHast Coast. The County of London and the Geographical Counties of Durham and Northumberland together contain over 130,000 overcrowded families, or about 40 per cent, of all the overcrowded families in the country, while the percentage of total population in these areas is only 16. The foregoing figures, taken for the most part from the Report on the Overcrowding Survey in England and Wales, enables us to appreciate more fully the problem of overcrowding, and explain some of the results obtained here. Moreover, in recent years, the overcrowding question in Acton has become merged partly into that of London and Greater London, and its solution is not entirely dependent upon local efforts. In the early part of this century, Acton in a housing sense, may have been a self-contained unit, but owing to the establishment of large factories within its area, and the improvement in transport facilities, local effort has played only a minor part in the solution of the overcrowding problem. In the census report for 1921, figures were given which showed that the number of people who came daily to the district to work was greater than that which left the district to work in other areas. In other words, the day population was higher than the night population. Unfortunately, the figures for the 1931 census have not been published, but the phenomenon noticed in 1921 undoubtedly became more marked during the intercensal period, and the day population in 1931 increased relatively more than the night population in the ten years, and although the night population according to the Registrar General is decreasing, the day population at the present time is higher than it has ever been. Owing to the proximity of factories, there will always be a keen demand for working-class dwellings here, and there will be a number of people who will prefer to pay more rent in order to be near their place of employment. As transit improves, distance will become less of a handicap, except of course, on the score of expense, and for this reason rents may always tend to be higher here ; otherwise overcrowding here will be dependent not only on the conditions which obtain in the district, but also upon the scarcity or otherwise of working-class accommodation in neighbouring districts. Overcrowding is not a recent feature of the housing problem in Acton, and a perusal of the Annual Reports of the Medical Officers of Health and of the Census Reports will show that overcrowding has always been o:ie of the most prominent features of our housing difficulties. The first Annual Report of the Medical Officer of Health for Acton which was printed was that for 1SS8, and Dr. 24 Prowse then wrote, "only one owner has been summoned during the past year for this offence (overcrowding). It has been my desire to prevent as far as possible this evil, but it is difficult to deal with these cases as strictly as could be wished, as, owing to the present large population of the poorer districts, overcrowding becomes almost necessary a condition." The same tale is disclosed in the Census Reports. The Census Reports contain tables which give the number of occupants in the different-sized tenements, the size of families, &c. Certain items differ in the census tables from those in the survey tables owing to the difference in the interpretation of certain terms. A structually separate dwelling has been defined for the census as "any set of rooms, intended or used for habitation, having separate access either to the street or to a common landing or staircase." Any person or group of persons included in a separate return as being in separate occupation of any premises or part of premises is treated as a separate family for census purposes, lodgers being so treated only when returned as boarding separately and not otherwise. In the survey, on the whole, we adopted a wider interpretation of a separate dwelling, and included as a separate tenement many which were excluded at the census, because they had no separate access. On the other hand, our interpretation of a separate family was a narrower one than that adopted at the census, so that many lodgers who made a separate return at the census were not considered separate families in the survey. In the survey, tenements and separate families are practically one and the same thing. In making a comparison between some of the figures obtained at the survey and those of the census returns, these facts must be borne in mind; when comparing one census return with another, the same objections do not apply. A study of the census returns shows that overcrowding slightly increased in each of the periods 1911 and 1921, but in the intercensal period 1921 to 1931, there was a marked decrease in overcrowding based on the standard of over two ner room density. This will be made clear by the following; table:— Year. Total Families. Number Overcrowded Percentage Overcrowded. 1901 8,326 502 6.0 1911 12,965 816 6.3 1921 14,947 994 6.6 1931 18,997 813 4.3 25 It is unnecessary to examine in detail the figures of the two earlier censuses, but it is of interest to compare the figures of 1921 and 1931. The population increased from 61,299 in 1921 to 70,510 in 1931, or an increase of 15 per cent. There was an increase of 2,309 houses, or 20.07 per cent., but there was an increase of 4,056 private families, or 27.15 per cent. In spite of this; there was a decrease in overcrowding in private families from 994 to 813, or from 6.6 per cent, to 4.3 per cent., and in the number of persons overcrowded at more than two per room density from 6,478 to 5,165, or from 10.71 to 7.47 per cent. This apparent paradox was possible because of the consistent and continual decrease in the average size of the families. size of the families. This becomes very evident from the following table:— Average number of persons per family 1901 1911 1921 1931 4.53 4.43 4.05 3.64 The average size of the family did not decrease much in the intercensal period 1901-1911, but in the 20 years 1911-1931, the average size was nearly one person less in the latter than in the former year. The overcrowding in the intercensal period 1921-1931 decreased in almost every class of dwelling, but the most marked decrease was in the three and four roomed tenements, as the following tables show:— 1921 Rooms in Tenement. Number of Tenements Overcrowded. 1 946 254 2 1,383 178 3 3,827 429 4 2,727 101 5 1,881 23 6 2,824 9 over 6 1,353 — 1931 1 1,065 244 2 1,929 219 3 4,907 266 4 3,535 64 5 2,980 16 6 3,558 2 over 6 1,023 2 26 There is one other table from the census which throws a light upon overcrowding. The following table gives the density of occupation in houses which were overcrowded and those on the borderland of overcrowding:— Population at following densities of occupation. (Persons per room) over 3. 3 & over 2. 2 & over 1½. 1½ &overl. 1921 829 5,649 13,506 9,541 1931 1,259 3,906 8,623 13,392 At the census there were 123 families of three persons, 72 of four persons, 27 of five persons, 13 of six persons, 7 of seven, 1 of eight and 1 of nine persons occupying one-roomed tenements. Of the tworoomed tenements overcrowded, 122 were occupied by five persons. 49 by six, 31 by seven, 8 by eight, 6 by nine, 1 by ten, and 2 by eleven persons. Of the three-roomed tenements overcrowded, 137 were occupied by seven persons, 62 by eight persons, 36 by nine, 22 by ten, 7 by eleven, I by twelve, and 1 by fifteen persons. Of the four roomed tenements overcrowded, 39 were occupied by nine persons. 16 by ten persons, 5 by eleven persons, aud 5 by twelve persons. Of 5,165 persons who lived under conditions of more than two persons per room density, 926 were in one-roomed tenement.s, 1271 in two-rooms, 2,103 in three rooms, 636 in four rooms, 187 in five rooms and 42 in six rooms. The Registrar General has given the estimated population for the middle of 1935 at 68,960, a reduction of 1,550 on the census Pop ulation. Part of this reduction is due to the readjustment of bound aries which took place in 1934. The number of new houses built since the census have been :— 1931-1932 257 1932-1933 188 1933-1934 224 1934-1935 134 1935-1936 380 Allowing for the reduction owing to the readjustment of boundaes according to the Registrar General there lias been a decrease of about 1,000 in the population, and towards this smaller population 1,183 houses have been built. On account of the movement of Popoalation, it is difficult to estimate the number of families or houses that would be overcrowded at any date, but it was reasonable to assume that we should find less overcrowding at the survey than was found| at the census, and this assumption was found to be correct. Approx- 27 imately 12,000 houses were inspected, containing 16,943 tenements. Of these, 316 were definitely overcrowded, that is, there were more persons occupying the premises than would be allowed under table 1. There were 1,352 others possibly overcrowded, and the number of lettings overcrowded on the basis of both table 1 and table 2, was 430. Before we deal with the figures in detail, it may be necessary to describe the methods adopted and the forms used at the survey The Act did not prescribe any particular method by which the inspection was to be carried out, and local authorities were at liberty to use the method they considered most suitable. The Minister of Health drew up a procedure and forms of survey which in his opinion could be generally adopted. Returns on a uniform basis were necessary to enable the Minister of Health to obtain a complete picture of the housing conditions in the country as a whole. We followed the procedure laid down by the Ministry, and adopted the forms which they issued. There were four forms to be filled up, three of which concerned the survey—Forms A, B and C. A better idea of the work of emuneration will be obtained .if the forms are inserted. Form A is inserted here. Form A. Overcrowding Survey—Preliminary Enumeration. (1) Address or Situation of Premises. (2) Name of Occupier. (3) Description of Property. To BE FLLLED IN By ENUMERATOR. To BE KILLED IN AT OFFICE. Names of No. of No. of persons Equiva - Permitted No. Whether Tenants & habit- normally sleep lent No. over- Sub- Ten- able ing therein sleeping Actual Reduced crowdeo ants. rooms persons (7b) (7c) (7d) (4) (5) (6) in the j dwelling, 10 Under (7a) or 10 over 28 Form A was the one used in the preliminary survey, The preliminary survey was made to ascertain the number of families and of persons in each family and the number of rooms occupied by each family. This preliminary survey would show whether the family was overcrowded on the basis of Table 1, but would not, however, disclose those families which, though not overcrowded when regard was had solely, to the number of rooms in accordance with Table 1, would nevertheless be found to infringe the standard when Table 11, which takes account of the size of rooms, is applied. A family which is not overcrowded according to Table I, but which is overcrowded when Table II is applied must be very near the overcrowding level of Table I. This part of the survey was therefore made to show the number of families definitely overcrowded, and also those who might possibly be overcrowded. The exact extent of the overcrowding could only be ascertained by measuring the rooms definitely and potentially overcrowded. Potential overcrowding was ascertained by using a table which was based on the assumption that in the ordinary dwelling some of the rooms would be below 110 square feet in area, and that consequently the permitted number ascertained solely from the number of rooms without regard to their area would normally be in excess of the exact permitted number. The allowance for this factor in the table given is about one fifth. The system may be clearer if the actual table is inserted. No. of inhabited rooms. Permitted Number. Actual Reduced 1 2 1½ 2 3 2½ 3 5 4 4 7½ 6 5 10 8 6 12 9½ The figures in columns 2 and 3 refer to units—a person over ten years of age being counted as one unit, a child between one and ten years as a half-unit, and a baby under twelve months not counted at all. Thus in a two-roomed tenement the accommodation was reduced from 3 units to 2½. If a two-roomed tenement was occupied by a husband, wife and two children, it was returned as potentially overcrowded, and the tenement was transferred to table B and subsequently measured. For the preliminary survey, six enumerators and a clerk were engaged. The Council had previously engaged a sanitary inspector 29 (Mr. Newport) to carry out certain arrears of work and house-tohouse inspection. Mr. Newport directly supervised under Mr. Kinch, the Chief Sanitary Inspector, the enumerators. Mr. Newport obtained a permanent post elsewhere before the measurements of form B were concluded, and Mr. Paterson was engaged as temporary inspector and took over the direct supervision. It will be appreciated that considerable office accommodation was necessary for the enumerators and for the filing of nearly 17,000 forms A. Fortunately this was secured in St. Mary's School, Oldhams Terrace. The Council had sold the site for the erection of Labour Exchange offices, but the premises were not required for that purpose until the early part of 1936, and the school premises were utilised for office accommodation. As a result of consultations with representatives of local authorities, the Minister of Health considered that one enumerator could reasonably ,be expected to visit and complete the forms for 300 houses per week. Our enumerators completed over 400 each week ; they commenced duties on 25th November, 1935, and the survey was completed by 4th January, 1936. It was stated on a preceding page that the overcrowding provisions apply only to working-class dwellings, that is, according to the definition in'Section 12," any premises used as a separate dwelling by members of the working classes or a type suitable for such use." Local authorities accordingly had to decide in the light of this definition which houses in their area should be inspected. Some authorities adopted the course of including every house in their area. Many chose a rateable value criterion, excluding all houses with a rateable value of £26, £20 or some other figure which they regarded as appropriate to their area. Other had no definite criterion, but excluded particular areas occupied by persons not of the working classes. We adopted the latter method, basing our action upon the knowledge and experience of the Sanitary Inspectors and the Health Visitors. The whole of the south-west ward was included. In the other wards the following areas were excluded :— North East Bowes Road. Friars Place Lane Perryn Road. Churchfield Road Friary Road. St. Dunstans East (except Nos. Friars Way. Avenue. 1-11 odd) Gibbon Road. St. Dunstans Foster Road. Glendun Road. Gardens. Friars Gardens. Old Oak Road. Shaa Road. Vyner Road. 30 North West. Birch Grove. Layer Gardens. Queens Drive. Buxton Gardens. Lexden Road. Rosemont Road. Chatsworth Lynton Road. Tudor Gardens. Gardens. Mayfield Road. Twyford Avenue. Creffield Road. Monks Drive. Twyford Crescent. Creswick Road. Pierrepoint Road. Uxbridge Road. Hale Gardens. Princes Gardens. West Lodge Hart Grove. Avenue. South East. Armstrong Road. Newton Grove. St. Albans Ave. Bedford Road. Queen Anne's (part). Blenheim Road. Gardens. The Avenue (part) Esmond Road. Queen Anne's Grv. South Parade. Marlborough Ramillies Road. The Orchard. Crescent. Rusthall Avenue Vanburgh Road. (part). Woodstock Road. In this list of houses which were excluded there were 2,311 houses. Altogether approximately 12,000 houses were inspected, containing 16,943 tenements, with the following results:— Size of Letting. Number. Overcrowded. Possibly. Definitely. 1 room 422 86 17 2 rooms 1,354 327 114 3 ” 5,385 709 151 4 „ 3,242 162 29 5 „ 3,465 57 5 6 „ 2,112 9 - 7 „ 633 1 - 8 „ 176 1 - 9 „ 92 - - 10 „ 41 - - 11” 17 - - 12 „ 3 - - 13 „ — - - 14 „ 1 — — 16,943 1,352 316 31 There were found at the preliminary survey, 316 lettings definitely overcrowded and 1,352 lettings possibly overcrowded. The preliminary survey naturally disclosed more cases of possible overcrowding in which measurement was necessary' than of definite overcrowding, owing to the fact that the criterion suggested for selecting these possible cases was wide enough to ensure that no case of actual overcrowding could be missed At the Public Health Committee on 7th January, 1936, it was reported that Survey " A " having been completed, it was necessary to proceed with the measurement of the 316 houses definitely overcrowded and the 1,352 houses in which overcrowding possibly existed, and it was resolved to appoint two men at the same salary that was paid to the enumerators, viz.:—£3 5s. Od. per week each, and also two junior assistants at a salary of 18/- per week each. The Survey " B " was completed before the end of April. In the Report of the Ministry of Health on the survey, examples of the cost in a few districts are given, but unless the details of these costs are given, it is difficult to compare. For instance, how much has been included for supervision, rent and other overhead charges. The sums paid here were:— £ s. d. Enumerators 224 6 0 Clerical Assistance 42 18 9 Printing and Stationery 46 9 3 £313 14 0 The cost would work out at less than £20 per 1,000 houses inspected. In the figures published by the Ministry of Health, the cost varied from £16 to £60 per 1,000 houses inspected. When Survey " B " was made, it was found that 60 of the 316 definitely overcrowded lettings had become uncrowded, owing to a reduction in the number of occupants which had in the meantime occurred, or to removals, and that of the 1,352 possibly overcrowded, 174 were definitely overcrowded on the basis of table 2. 32 The percentage of working-class dwellings overcrowded was 2.5 compared with 2.2 in the whole of Middlesex. The lowest percentages of overcrowding in Middlesex were in Ruislip-Nortlnvood with 0.4 and 0.6 in Southgate, and the highest were Hendon and Willesden with 4.1. As stated on previous pages, the numbers and percenta;.;irefer solely to working-class accommodation, and include only tlu-~*' dwellings. The number and percentage in Hendon, with a popts lation of 134,160 refer only to 13,921 dwellings, whilst in Willestk'u with a population of 188,440 they refer to 44,762 dwellings. H«' the figures are probably a correct index of overcrowding in workir class dwellings. In the districts adjacent to Acton the figures were as follow -' Number Overcrowded Percentage Hammersmith 1,718 4.9 Brentford & Chiswick 305 2.9 Ealing _ _ 314 2.1 Willesden 1,845 4.1 The final result was as follows:— Size of Letting. Number of lettings. Overcrowded. 1 room 422 39 2 rooms 1,354 132 3 „ 5,385 186 4 „ 3,242 60 5 „ 3,465 11 6 „ 2,112 2 7 ,, 633 — 8 „ 176 _ 9 „ 92 _ 10„ 41 — 11„ 17 _ 12 „ 3 _ 13 „ — _ 14 „ 1 - 16,943 430 33 The 430 overcrowded lettings were occupied by 2,036 persons over ten years of age and 583 children between the ages of one and ten years. Table"C"gives in a summary form the result of the survey, and is a wealth of information about the housing accommodation in the Borough. It shows the number of families of any given size, and the number of such families occupying dwellings of any capacity. The entries below and to the left of the stepped diagonal show the numbers and distribution of the overcrowded families, whilst those above and to the right of that diagonal relate to the uncrowded families. The entries on the stepped diagonal itself show the families whose accommodation is exactly the minimum permitted by the overcrowding standard. The further from the diagonal an entry appears, the greater is the departure from the standard, so that the worst cases of overcrowding can be picked out at once. From Table " C " it will be seen that there were 315 families housed at the minimum standard ; of these 51 lived in one-roomed dwellings, 134 in two-roomed dwellings, 129 in three rooms and 1 in four rooms. Of the 39 one-roomed dwellings overcrowded, 25 were overcrowded by half a unit, 10 by 1 unit, 1 by 1½ units, 2 by 2 units, and 1 by 2½ units. In 14 out of the 39 the overcrowding was due to the size of the rooms ; in 2 instances the room was between 50 and 70 square feet in area, and therefore could accommodate only half a unit, but in both instances it was occupied by an adult. In 12 instances the room was between 90 and 110 square feet in area, but the lettings were each occupied by two adults. The highest number of persons in a one—roomed letting was 5-3 persons over ten and 2 under ten ; the room was overcrowded by 2 units. The greatest overcrowding in a one-roomed dwelling was 3 persons over ten and 1 under in a room between 70 and 90 square feet in area ; this room was overcrowded by 2½ units. Eleven of the two-roomed lettings were overcrowded solely on account of the size of the rooms, that is, the lettings were occupied by 3 or less units, but one or other of the rooms had a floor area of less than 110 square feet. 52 of the two-roomed lettings were overcrowded by only half a unit. 4 of the two-roomed lettings were overorowded to the extent of 3 units, and two to the extent of 4 units, Altogether 170 of the lettings were overcrowded by half a unit each. 34 Average Units of Accommodation per Family of given Size. Size offamily, (equivalent number of persons). Average number of units of accommodation (permitted number) occupied by families of the size in column 1. All families Overcrowded families. 1. 2. 3. 1 3.48 0.50 1½ 8.96 — 2 5.18 1.50 2½ 5.20 1.90 3 6.32 2.11 3½ 6.28 2.90 4 7.53 3.00 4½ 7.51 3.30 5 7.91 4.12 5½ 7.77 4.59 6 8.53 4.66 6½ 8.70 4.97 7 8.85 5.31 7½ 8.71 5.86 8 9.61 6.23 8½ 8.53 6.41 9 10.51 7.37 9½ 10.50 7.33 10 11.00 8.25 10½ 9.00 6.00 11 10.33 9.00 11½ — — 12 9.00 9.00 12½ — — 13 — — 13½ 14.50 — The above table gives the average number of units of accommodation occupied by the various sizes of families ; a family would be just not overcrowded if the number of units in the size of the fa on ily were the same as the number of units of accommodation, and consequently the excess of the numbers in column 2 over those in column 1 indicates the extent to which the average family enjoys accommodation in excess of that required by the overcrowding standard. 35 Similarly, the excess of the numbers in column 1 over those in column 3 indicates the extent to which the accommodation occupied by the average overcrowded family falls short of that required by tie standard. The general picture given by this table is that the average working-class family is housed well above the statutory minimum standard, especially the family of average size. As the family gets larger, the less is the relative margin of accommodation above the standard. In the case of the large family of eight units or more, there is very little margin, and these are the families for which the Council has not made much provision. When we come to consider the overcrowding figures of families in the council houses it will be shown that all the houses which contain more than eight units are overcrowded. Compared with the rest of the country, in Acton the accommodation for families under four units is less (with the exception of ihe 1½ unit family), and for families of over 4 units the accommodation here is higher in every instance. The following two tables classify families according to the proportion which the ccommodation they actually have bears to the minimum accommodation according to the overcrowding standand Thus families with accommodation just equal to the minimum permissible by the standard, that is, families just not overcrowded, are entered as having 100 per cent of the minimum accommodation ; families with less than 100 per cent, accommodation are overcrowded, and the degree of overcrowding is greater the smaller the percentage. Similarly, families with over 100 per cent, minimum accommodation are not overcrowded, and the greater the excess of accommodation over the minimum required by the overcrowding standard the higher the percentage. The following tables give the numbers of uncrowded and overcrowded families with the percentage of minimum accommodation : Uncrowded Families. Percentage of Minimum Accommodation. Number of families Percentage of total uncrowded families 1. 2 3 Over 300 2,412 14.61 Over 200 but not over 300 3,392 20.54 Over 150 but not over 200 5,725 34.67 Over 110 but not over 150 4,557 27.60 Over 100 but not over 110 112 0.68 100 315 1.90 36 Overcrowded Families. Percentage of Minimum A ccommodation. Number of families Percentage of total overcrowded families 1 2 3 Under 100 but not under 90 85 19.77 Under 90 but not under 80 147 34.19 Under 80 but not under 70 118 27.44 Under 70 but not under 60 47 10.93 Under 60 but not under 50 28 6.51 Under 50 but not under 40 3 0.70 Under 40 but not under 30 1 0.23 Under 30 1 0.23 From the first of these tables relating to uncrowded families it will be seen that a variation of the overcrowding standard which reduced the permitted number for a dwelling by 10 per cent, would increase the number of families who would be overcrowded by 427 or 2.58 per cent. On the other hand, this table shows also that 5,804 families have more than double the amount of accommodation required by the overcrowding standard. The comparison between the position of the uncrowded and overcrowded families can be effected in another way. From table " C " we can calculate the average number of units in an uncrowded or overcrowded family, and also the average permitted number per dwelling occupied by these classes. Such calculations give the following results:— (a) (b) (c) All families Uncrowded Overcrowded families families 1. Average number of units per family 3.19 3.13 5.40 2. Average permitted number per occupied dwelling 6.16 6.20 4.70 37 It is interesting to compare these figures with those obtained for the whole kingdom. For the whole kingdom they were as follows:— (a) (b) (c) All families Uncrowded Overcrowded families families 1. Average number of units per family 3.20 3.11 5.60 2. Average permitted number per occupied dwelling 6.66 6.76 4.17 The incidence of overcrowding may be analysed in another way. In the following table are shown the number of overcrowded families of each size, and the corresponding percentage of the total number of families of the same size. It also gives the percentage distribution of overcrowding amongst overcrowded families of the various sizes. Size Distribution of Overcrowded Families. Size of family (equivalent no. of persons). Overcrowded families of the size in column 1. Percentage proportion which the number in column 2 bears to the number of all families of the size in col. 1. Number. Percentage of total overcrowded families. 1. 2. 3. 4. 1 2 .46 .19 1½ - - - 2 14 3.25 .30 2½ 15 3.49 .99 3 18 4.19 .50 3½ 46 10.70 5.19 4 45 10.47 2.17 4½ 18 4.19 3.38 5 35 8.14 2.09 5½ 57 13.25 17.92 6 58 13.49 10.88 6½ 18 4.19 12.16 38 7 35 8.14 14.89 7½ 18 4.19 23.68 8 17 3.95 21.52 8½ 17 3.95 50.00 9 4 .93 13.79 9½ 3 .70 42.86 10 4 .93 36.36 10½ 1 .23 50.00 11 4 .93 66.67 11½ — — — 12 1 .23 100.00 Total 430 100.00 The above table shows that 33.6 per cent, or over one-third of the overcrowding occurred in families up to four units, while 21.8 per cent, of the overcrowding occurred in families of 7 units or over. Column 4 in the above table shows the proportion which the number of overcrowded families of a particular size bears to the total number of families of that size, and the figures show what a high proportion of large families is overcrowded. Overcrowding may occur among families of normal size, because for some reason, such as poverty, illness, or shortage of accommodation, those families cannot obtain an ordinary workingclass dwelling ; while in the case of large families, overcrowding is likely to occur because primarily the average working-class dwelling which is generally all they can afford is not large enough for them. Moreover, landlords and even local authorities, look askance at large families and accommodation is always difficult to obtain. When the results of the Survey were considered by the Special Committee appointed by the Council, it was decided that certaies further information should be obtained concerning the overcrowded families, more especially as to the rent paid, whether the lettings were controlled or decontrolled, and the presence of lodgers.This further enquiry was carried out in August, so that approximately less than six months had elapsed since the survey for form " B" It was found that in the interval, 89 of the lettings had become un crowded. Of the 430 overcrowded dwellings, 217 were controller and 213 decontrolled, but included in the latter are the 20 Couned houses which were overcrowded, so that the real figures should be 217 controlled and 187 decontrolled. It is difficult to estimace 39 correctly the relative incidence of controlled and decontrolled houses in the district, but certain figures are available which may be useful. We know approximately the number of controlled houses of a rateable value of less than £20 a year. Before October 1933, over 2,000 tenements had been registered by owners who claimed that their houses were decontrolled. Probably these did not represent all the decontrolled tenements, and applications to decontrol over 250 have since been made. There were in the district, according to the Abstract of Accounts for 1935-1936, a total of 4,932 private houses and tenements rated under £20 per year. It therefore appears that even of lettings under £20 a year, not more than half are controlled. The percentage of controlled houses rated at £20-30 a year is probably much smaller, though we have no figures concerning these. It may reasonably be assumed that a higher percentage of controlled houses were overcrowded than was the case of decontrolled, and the reasons for the overcrowding were different. In the case of the decontrolled lettings, the main reason was the high rent demanded, whilst in the case of a controlled, it was the low rent which accounted for a considerable amount of the overcrowding. Many of the controlled lettings had been occupied for some time ; in some instances, the tenants had occupied the lettings when they were married, and as the family grew they were loth to forego the advantages which legislation had so fortunately and unexpectedly placed within their reach. In a few instances, we found that the tenants could afford a bigger house, but of course the rent would be much higher ; in one case four boys and a girl were in work as well as the father. In most of the cases, though, the families could ill-afford the much higher rents which decontrolled flats would fetch. The low rent fixes the controlled tenant to his letting ; this was very obvious in the relative incidence of the abatement of overcrowding and the manner in which the overcrowding was abated. Of the 39 one-roomed tenements overcrowded, 15 were controlled and 24 decontrolled ; 2 of the former had become uncrowded in six months, and 14 of the latter. One of the overcrowded controlled lettings became uncrowded because the tenant had sub-let one of the rooms at 13s. per week ; this sum was obviously excessive, and the sub-tenant could have had a reduction. The tenant probably knew more about the Rent Restrictions Acts than the sub-tenant, and to avoid trouble, had resumed possession of the whole tenement and abated the overcrowding. Incidentally we find many instances of controlled houses tenements which are sub-let, and the sub-tenant pays an excessive tent; it is not generally known that an apportionment of the rent of a controlled house if it is sub-let can be obtained on application to the Court. 40 The following table gives the incidence of overcrowding in controlled and decontrolled lettings, and the number of cases of overcrowding abated. Controlled. Decontrolled. Number. Abated. Number. Abated. 1 room lettings 15 2 24 14 2 „ ,, 62 6 70 26 3 „ ,, 109 8 77 26 4 „ ,, 26 2 34 4 5 „ ,, 4 — 7 1 6 „ ,, 1 — 1 — 217 18 213 71 Most of the four-roomed tenements which were overcrowded were Council houses, and this possibly accounts for the few instances where the overcrowding was abated; in most of the instances where overcrowding had been abated in decontrolled houses, this had been brought about through the removal of the tenant, either to another district or to some other house in the district. Moreover, the rents of the Council houses approximate more closely to those of controlled rather than decontrolled houses, though the average rent of controlled houses is lower than that of Council houses for similar accommodation, that is, so far as size and number of rooms are concerned. In a Council house there are amenities which are not enjoyed in most of the controlled houses. It was not possible to obtain exact information in all cases, but the following shows approximately the average weekly rent paid for the different kinds of lettings. Controlled. Decontrolled. s. d. s. d. 1 room lettings 4 4 9 0 2 „ 8 9 13 6 3 , „ „ 10 9 15 6 4 „ „ 12 6 21 3 (exclusive of Council houses) The presence of lodgers and the practice of sub-letting were not important factors in overcrowding. In 6 instances the overcrowding was due to the presence of lodgers, and in 7 instances the 41 premises were sub-let but there was no sub-letting in the overcrowded tenement. For instance, there was overcrowding in 3 two-roomed tenements. These were part of a five-roomed letting but the tenant had sub-let two rooms to a sub-tenant, and the overcrowding was in these rooms. It would be more correct, therefore, to say that these were five-roomed tenements overcrowded because of sub-letting. In 74 of the overcrowded lettings, separation of the sexes was impossible. 22 of these were two-roomed lettings, and 46 three-roomed. Of the 74, 50 were controlled lettings, and 24 decontrolled. The cause of the relative frequency of this factor in controlled lettings is not far to seek. The rooms are secured by a husband and wife newly married. The rooms are not unpleasantly overcrowded when the children are young, but as they grow up there is no means to secure properly the separation of the sexes. Even if the rent of a decontrolled house could be paid, it is not to be wondered at that a certain hesitancy was observed to forego the advantages of a controlled letting. The difficulty of separation of the sexes was mainly observed in two and threeroomed tenements. Overcrowding in Council Houses. The information given on this head is contained in table " C " which shows the distribution of families in houses belonging to the Council. A total of 492 houses were inspected, and of these 26 were overcrowded, or a percentage of 5.2. The percentage overcrowded in the Council houses is twice as high as in the rest of the houses in the district. In the case of most authorities, the degree of overcrowding in their own houses is greater than in privately-owned houses. In the whole of England and Wales the percentage of overcrowded families in houses owned by housing authorities was 5.l compared with 3.7 in privately-owned houses. In Middlesex there was a percentage of 4.9 overcrowded in Council houses compared with 2.2 in privately-owned houses. In almost all districts this phenomenon was observed. On the surface this is an unsatisfactory position, but the reasons are not far to seek. Local authorities in their provision of new houses, have, for the most part, erected houses suitable in size for the average working-class family, and the proportion of large houses erected has been comparatively small. Of the 492 erected by the Council, 223 consist of houses or flats of a living room, scullery and three bedrooms, and 213 consist 42 of houses or flats of parlour, living room, scullery and three bedrooms Most of the former had accommodation for 6 units, but in a few instances, they had sufficient accommodation for the maximum of 7½ units allowed in a four-roomed letting. Most of the parlour type houses had accommodation for 8 units, but in some there was accommodation for 9½ and 10 units. From form " C " it will be seen that 179 of the Council houses had accommodation for 6 units, and 173 had accommodation for 8 units. An examination of form " C " also shows that with one exception overcrowding in the Council houses could be entirely obviated. It is not, of course, suggested that this re-arrangement is in many cases practicable, as the rents of the parlour-type house vary from 19s. l0d. to 23s. 7d. per week, and it is a platitude to say that the larger the family the less able are they to afford the higher rents. Another reason for the relatively greater incidence of overcrowding in Council houses is the fact that most housing authorities have endeavoured to carry out their duty to deal with the worst housing conditions, and to give preference to large families unsuitably housed. Probably it would be true to say that the highest incidence of overcrowding in Council houses would be found in those districts which paid most attention to this aspect of their duty In one area the percentage of overcrowded families in Council housewas 48.4 but the total number of houses owned by this authority . was insignificant, and too serious attention need not be paid to it, but even in houses owned by the London County Council the percentage of families overcrowded was 10.5. It has been pointed out that in housing schemes promoted by many Councils, the removal ' of overcrowding is not always the primary consideration. Even housing Committees look askance at large families, and enquiries are naturally made into the history of applicants, their ability to pay the rent, and the conditions in which their houses are kept. There may be good and sound reasons for this procedure, but it results in an outlook which differs from that of a public health committee, and the problem of overcrowding is relegated to the background In spite of this, housing authorities have taken as tenants the families with young children, that is, families growing in age and numbers who in course of time outgrow the accommodation available. The usual result of this procedure is to increase tIrrelative incidence of overcrowding in Council houses, but occasionally it has an entirely different effect. Table " C " brings out this latter 43 effect clearly. In the Council houses with accommodation for 4 units (living room, scullery and two bedrooms) we find as follows:— Occupied by 1 person each 4 ,, „ 2 persons each 8 „ „ 2 ½ persons each 4 In the 6-unit room lettings (generally living room, scullery and three bedrooms) the figures are:— Occupied by 2 units each 1 „ „ 21 units each 3 „ „ 3 units each 10 In the 8-unit room lettings (generally parlour, living room, scullery and three bedrooms) the figures are:— Occupied by 2 units each 6 „ „ 3 units each 14 „ „ 31 units each 5 In the 9i unit room lettings : Occupied by 3 units each 2 „ „ 4 units each 4 The most common explanation of this state of affairs is that the houses in question have been in the same tenancy for a considerable number of years. When the houses were first let they were fully occupied, but in the course of time, normal incidents like removals, marriage and death, have reduced the number of occupants, and a change of tenancy might result in a hardship. I understand that the existence of these under-occupied houses in now being considered by the housing committees. The average number of units per family in Council houses is 4.7 compared with 3.19 in the 16,943 lettings surveyed, and the average permitted number in Council houses was 6.9 units compared with 6.16 in the rest of the district. The following table gives the average number of units occupied by the various sizes of families in Council houses ; this table may be compared with the table on a previous page which gives this information for the whole district, and the same remarks apply. A family would be just not overcrowded if the number of units in the size of the family were the same as the number of units of accommodation, and consequently excess of the numbers in column 2 over those in column 1 indicates the extent to which the average family enjoys accommodation in excess of that required 44 by the overcrowding standard. Similarly where the numbers in column 1 exceed those in column 2, the houses are overcrowded, and the excess shows the amount of overcrowding. Of the 32 families of over 7 units in Council houses, 23 are overcrowded. Average Unit Accommodation on Council Housing Estate. Size of Family. (Units) Average Unit Accommodation of Families of the size indicated in column 1. 1. 2. 1 4.0 2 5.1 2½ 5.0 3 5.7 3½ 5.8 4 6.9 4½ 6.5 5 6.98 5½ 6.6 6 8.0 6½ 7.7 7 8.1 7½ 7.1 8 9.0 8½ 6.4 9 6.0 9½ 6.5 10 7.5 11 9.5 Number of Houses erected during the year:— (a) Total (including number given separately under (b) 57 (b) With State assistance under the Housing Acts :— (i) By the Local Authority (ii) By other bodies or persons 1. Inspection of Dwelling-houses during the Year 1936 :— (1) (a) Total number of dwelling-houses inspected for housing defects (under Public Health or Housing Acts) 1951 (b) Number of inspections made for the purpose 4853 45 (2) (a) Number of dwelling-houses (included under sub-head(l) above), which were inspected and recorded under the Housing Consolidated Regulations, 1925 1367 (6) Number of inspections made for the purpose 3401 (3) Number of dwelling-houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation Nil. (4) 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 1841 2. Remedy of Defects during the Year without Service of formal Notices:— Number of defective dwelling-houses rendered fit in consequence of informal action by the Local Authority or their officers 1714 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 102 (2) Number of dwelling-houses which were ered fit after service of formal notices :— (a) By owners 102 (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 25 (2) Number of dwelling-houses in which defects were remedied after service of formal notices:— (a) By owners 25 (b) By local authority in default of owners Nil. 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 Nil. 46 (2) Number of dwelling-houses demolished in 1935, in pursuance of Demolition Orders Nil. 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 teen rendered fit Nil. 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 delects (under Public Health or Housing Acts) 1951 (1) Dealt with by service of Informal Notice 1439 (2) Dealt with by service of Statutory Notice under Section 17, Housing Act, 1930 102 (3) Dealt with by service of Statutory Notice under Public Health Acts 25 Premises (other than defective dwelling houses) inspected for nuisances and miscellaneous defects 710 (1) Dealt with by service of Informal Notice 597 (2) Dealt with by service of Statutory Notice under Public Health Act, &c. 31 Reinspections subsequent to service of Notice 7012 Inspection after notification of Infectious Disease . 104 Number of Premises under Periodical Inspection. Workshops and Workplaces 122 Bakehouses 34 Slaughterhouses 2 Public House Urinals 37 Common Lodging Houses 1 47 Butchers'Shops 41 Fish Shops 34 Premises where food is manufactured or prepared 35 Milk Purveyors 128 Cowsheds Nil. Piggreries Nil. Rag and Bone Dealers 7 Mews 4 Schools 13 Caravan Grounds 3 Rent Restriction Act. Number of Certificates granted 17 Detail of Work carried out. Sanitary Dustbins provided 443 Yards paved or yard paving repaired 130 Insanitary forecourts remedied 35 Defective drains repaired or reconstructed 121 Defective soil pipes and ventilating shafts repaired or renewed 56 Defective fresh air inlets repaired or renewed 84 Defective gullies removed and replaced by new 35 Rain water downpipes disconnected from drain 19 Dishing and curb to gullies repaired and new grating fixed 141 Defective W.C. pan and traps removed and replaced by new 123 Infective W.C. flushing apparatus repaired or new fixed 436 Defective W.C. seats repaired or new fixed 236 Infective flush pipe connections repaired 131 Ir^anitary sinks removed or new fixed 72 Sink waste pipes repaired or trapped 187 Insanitary wall surface over sinks remedied 148 Ventilated food cupboards provided 12 Drinking water cisterns cleaned 379 Defective covers, to drinking water cisterns repaired or new fixed 161 Insanitary sites beneath floors concreted 15 Spaces beneath floors ventilated 171 Dampness in walls from defective damp-proof course remedied 152 Dampness from defective roof, rain water gutterings, &c., remedied 995 Dective plastering repaired (number of rooms) 689 Rooms where dirty walls and ceilings have been cleansed and redecorated 2629 Defective floors repaired 196 48 Defective or dangerous stairs repaired 65 Defective doors and windows repaired 653 Defective kitchen ranges and fire grates repaired 397 Defective washing coppers repaired 73 Coal cupboards provided or repaired 29 New W.C. apartments provided 11 Accumulations of offensive matter removed 18 Drains unstopped and cleansed 233 Overcrowding nuisances abated 8 Drains tested, exposed for examination &e. 57 Smoke observations taken 156 Smoke nuisance abated on service of notice 68 Nuisances from animals abated 7 Notifications of waste of water sent to Metropolitan Water Board 305 INSPECTION AND SUPERVISION OF FOOD. Milk Supply. There are no cowsheds in the Borough, all the milk being produced outside. There are 128 persons or firms retailing milk in the district under the following categories :— Dairymen. Purveyors of Milk No. with rounds not occupying premises in the Borough. No. with rounds occupying premises in the Borough. No. of General shops from which milk is sold from covered pans only No. of shops from which milk is sold in closed and unopened receptacles only. 14 18 2 94 Special Designated Milk The number of persons or firms licensed to sell Special Designated Milk is as follows:— 3 " Certified " 6 " Grade A (Tuberculin Tested) " 1 " Grade A " 7 " Pasteurised " 1 " Grade A Pasteurised " The Express Dairy Co., have a pasteurising plant at No. 100 Bollo Lane. 49 MILK. On June 1st, 1936, the new Milk (Special Designations) Order 1936 came into operation, which revoked the Special Designations Orders of 1923 and 1934. Under the old orders there were 4 grades of milk, Certified, Grade A Tuberculin Tested, Grade A and Pasteurised. The highest standard of purity was prescribed for the Certified and Grade A Tuberculin Tested, but a very large number of people were under the impression that Grade A milk was the highest and safest kind on the market. For the Grade A milk the cows had to be clinically examined by a Veterinary Surgeon and must not have contained more than 200,000 organisms per c.c. but the cows were not tuberculin tested. In addition to this misconception confusion had recently been introduced by the inauguration in 1935 of the Accredited and Attested Scheme of the Milk Marketing Board. The new order will clarify matters as far as classification is concerned, and prescribes the following special designations :— 1. Tuberculin Tested—The condition for this grade are substantially the same as those formerly prescribed for Grade A Tuberculin Tested milk. It is milk from cows which have passed a veterinary examination and a tuberculin test, and it may be bottled on the farm or elsewhere. Until December 31st, 1936, the raw milk should not contain at any time before delivery to the consumer more than 200,000 bacteria per millilitre ; after that date it must satisfy a prescribed methylene blue reduction test for cleanliness. At all dates it must contain no coliform bacillus in one-hundredth of a millilitre. If pasteurised, it must be described as " Tuberculin Tested (Pasteurised) " and must not contain more than 30,000 bac-. tcria per millilitre. If bottled on the farm the word " Certified '' may be added to its description. 2. Accredited—The conditions for this grade are similar to ttose prescribed for Grade A milk. It is raw milk from cows which have passed a veterinary examination, but which have not been subjected to a tuberculin test. The milk must satisfy the same bacteriological tests as are prescribed for raw Tuberculin Tested milk, wJ'may be bottled on the farm or elsewhere. 3. Pasteurised—This designation is applicable both where * Accredited " and where ungraded milk is pasteurised in accord- once with the requirements of the Order. The conditions are substantially the same as in the Order of 1923, except that further conations are imposed with regard to thermometers and temperature Charts. 50 j In recent years the milk industry of this country has undergone very material changes, both from the legislative, the producers' and the distributors' aspect. It is common knowledge that the conditions under which milk is produced have immensely improved ; 30 years ago the conditions of milk production were such as to render it difficult to describe them in moderate language; to-day a large quantity of the milk is produced under reasonable conditions of cleanliness, and we are approaching a period when it will be possible to exclude, at any rate, raw milk from tubercular cows. Many factors have been in operation to bring about this improvement. Over a great number of years, the medical profession has been impelled to impugn the safety of the milk supply, but the efforts of its members were of little avail. In the early years of this century, the plea of both producers and distributors was that they could not produce clean milk economically and that the public would not pay the enhanced price which a clean milk would entail. In those days of unlimited petition there was no inducement to produce better milk. The introduction of dried milk through the infant welfare centres was one of the first causes which disturbed the apathy of the distributors, and as far as cleanliness was concerned, an improvement became apparent, but those who produced cleaner . milk suffered under the handicap that no monetary advantage accrued ; the public were unaware which milk was produced under clean conditions and which under filthy conditions. In 1923 the Milk Special Designation order was issued, and if the public wished to pay more money, they could be guaranteed a pure milk free of tubercular disease. Contrary to expectations the demand for Certified and Grade A Tuberculin Tested milk was not very encouraging. On May 1st 1935 the Milk Marketing Board put into opention a scheme known as the " Rollof Accredited Producers of the Milk Marketing Board." The intention was to produce a healthier ard cleaner milk for human consumption, and under the scheme fin ancial aid was given to those producers who complied with the requirements as laid down in the Milk Special Designations Order of 1923 for the production of " Grade A " milk. 51 A further bonus was given to those who produced milk from attested herds. An attested herd not only underwent a clinical examination, but had to pass the Tuberculin Test three times ; that is, a Veterinary Surgeon made the test twice and this was followed by a Tuberculin Test by a Veterinary Inspector of the Board of Agriculture. The new order of 1936 simplifies the nomenclature of designated milks, and embodies various improvements towards the production of a cleaner and healthier milk supply, and it is hoped that a further impetus will be given to the demand for clean milk. It is too early to estimate what success will follow the issue of the order of 1936, but the accredited scheme of 1935, did result in a great increase in the production of milk from accredited herds. Out of 149,000 registered producers in November, 1936, 20,000 were on the accredited roll, but though the accredited producers numbered less than one-seventh of the total, the amount of accredited milk amounted to over one-third of the whole milk supply. The accredited milk scheme, now well established, should be giving the public more confidence in the hygienic quality of the milk supply. About one-third of the total output sold under the marketing scheme now comes from farms which maintain the standards required to qualify for accredited licences. But it is not so Satisfactorv that accredited milk is mixed indiscriminately with ordinary milk, and is not for the most part sold to the public as graded milk. So far as the consumers' confidence is concerned the accredited scheme is not resulting in the benefits which were anticipated at the start. It has been pointed out by those who have to administer the scheme that the goal to be attained is the production of a Tuberculin Tested milk. The necessary clinical examination of the herd once every three months is only the first step towards something more secure, the formation of a " Tuberculin Tested " or an" Attested Herd." Ultimately it is likely that only milk which Satisfies at any rate the accredited standard—and this is not unteasonable as a public health standard—will be used for liquid consumption, and that the remainder will be diverted for manufacturing purposes at a lower price. A few buyers will now only Purchase milk that is produced under accredited licence, and these will become more numerous when consumers have been educased to appreciate the obvious advantages of milk produced in a clean manner from healthy cows, 52 MEAT INSPECTIONS. Although there are only two slaughter-houses in the district, meat inspection involves the whole time appointment of one meat inspector and a considerable amount of the time of the district sanitary inspectors. From the tables which follow it can be appreciated that meat inspection in the district is important, and the usual procedure is adopted. Although standards have been laid down in England by memoranda of the Ministry of Health and by law in Scotland, which all inspectors are expected to follow, it is found that considerable differences exist in practice. The inspectors should work on a uniform system and to a uniform standard which should be the same everywhere. Otherwise, results unfair to the trade, and undesirable to the consumer, will follow. Because of complaints of unfairness, we made enquiries and think that on account of great diversity of standards there is ground for the complaints made. It is obvious from the methods pursued, the numbers of carcases examined, and the percentages destroyed as diseased and unfit for human food that in some districts the inspection is far stricter than in others. It was alleged that as a result of this difference traders knew where inspection was strict and where it was lax or indifferent, and it is a natural assumption that doubtful animals found their way to those places where, from their regulations, dealers hoped that they could get them passed. We have been frequently told that dealers do discriminate between different buyers and that solely because they know that in some places the percentage of condemnation is higher than in others. I am referring now to the inspection of pig carcases, because this is the kind of meat in which we are particularly interested. Last year 59,000 carcases were inspected, and the results are recorded in the following tables. We drew up a short table and in that form endeavoured to obtain information of the procedure and the results in other districts where large numbers of pigs are slaughtered, and it is of interest to compare figures which we have obtained. We have tried to classify them in three groups:— A Inspection by whole-time meat inspectors. B Inspection by the Council's Sanitary Inspectors, not whole-time meat inspectors. C Inspection by whole-time meat inspectors either appointed or paid for directly or indirectly by the firm owning the slaughterhouse. We have only obtained information from three districts in which this practice 53 obtains. In the others, the information was refused, or was not available. Where information was available, the method of appointment and payment varied. In one instance the meat inspectors used to be appointed and paid for by the firm ; this practice has now been varied—the appointments are ostensibly made and paid for by the Council, but the salaries are refunded to the Council by the firm. Where the salaries are paid by the firms it is obvious that the Council cannot have control. In one instance, where the Veterinary Inspector is appointed by the firm, information was refused, but we were informed that about a quarter of a million pigs are slaughtered annually. Although there are differences in the percentages of carcases and heads diseased and condemned in slaughter-houses where the Council's whole time inspectors Oarry out the work, these are insignificant compared with the differences between the slaughterhouses where inspections are carried out by the Council's inspectors and those carried out by inspectors directly or indirectly controlled by the firm. The figures suggest that not only are there grounds for the complaints that different standards are observed in different districts, but that the standard of inspection in some bacon factories is lax and indifferent. Whole-time Meat Inspectors. A. Total examined. Percentage of carcases diseased and destroyed. Percentage of heads diseased and destroyed 1. 62,625 .29 6.69 2. 59,036 .22 7.22 3. 57,188 .07 9.15 4. 51,096 .19 3.83 5. 44,696 .11 4.17 6. 24,729 .62 7.7 7. 22,000 1.76 4.07 8. 21,352 .16 4.85 54 B. 1. 40,786 .59 11.92 2. 40,000 only 7,896 carcases examined ; percentages would therefore be useless. 3. 29,642 .19 8.12 4. 25,150 .25 7.05 5. 21,752 only 11,890 carcases examined. 6. 15,184 .11 1.66 7. 14,231 only 10% of carcases examined. 8. 12,872 .32 5.07 c. 1. 225,135 .09 2.88 2. 53,300 .05 .03 3. 13,906 .16 14.15 Unsound Food Surrendered during 1936. CATTLE. Carcases. Heads. Plucks. Organs. Parts of Carcases 54 16 69 7 Ox Livers. 1 Ox Tail. 6 sets of Ox Lungs. 3 Loinsof Beef 4 Ox Kidneys. 2 Stirk's Livers. 1 Stirk's Kidney. 2 sets of Stirk's Lungs with Hearts. 83 sets of Calves' 10 Forequarters Lungs with of Veal. Hearts. 21 Calves' Livers. 8 Breasts of 12 Calves' Kidneys. Veal. 2 sets of Calves' 7 Ribs of Veal Lungs. 6 Shanks of Veal. 5 Legs of Veal 4 Shoulders of Veal. 2 Hindquarters of Veal. 2 Sides of Veal 1 Loin of Veal. 55 SHEEP. 4 72 sets of Lungs. 1 Breast of 1 set of Lungs Mutton. with Heart. 6 Livers. PIGS. 141 4,271 2,622 9142 lbs. Chitter1,943 lbs. lings. quarters. 846 lbs. Lights. 871 lbs. Sides. 538 lbs. Livers. 843 lbs. Hind34 sets of Lungs. . quarters. 2 sets of Lungs 83 lbs. Ribs. with Hearts. 14 lbs. Shoulder 1 Pigs' Kidney. OTHER FOODS. 5 Wild Rabbits. 8 Ducks. 4 Fowls. 1 tin of Corned Beef (6 lbs.) 1 tin of Pressed Beef (7 lbs.) 70 lbs. of Skate Wings. 100 lbs. Cod Fillets. 28 lbs. Herrings. 14 lbs. Cod. 7 lbs. Skate. 1 box of Mixed Fish. 6 gallons Winkles. 2 bags of Cauliflowers. 2 cases of Pears. " Various " Concentrated Soups (5 tons. 15 cwts.) 11 bales of Pigs' Heads. NUMBER OF PIGS' CARCASES INSPECTED FROM 1st JANUARY TO 31st DECEMBER, 1936 WITH ANALYSIS OF SURRENDERS ON ACCOUNT OF DISEASE. 1930 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. January. 4880 233 12 - 2 - - 1 89 32 lbs. — lbs. February 4755 221 6 - — 2 - — 44 336 „ — „ March 4230 249 10 - — — - - 62 456 „ -” April 5702 246 17 - — 2 - - 66 424 „ -” May 4774 258 12 - 2 — - - 63 480 „ -” June __ 3107 437 25 - 2 4 - — 493 1280 „ — ,, July 4246 473 14 — — 6 - - 364 1528 „ -” August 3520 416 15 - 2 — - - 533 1368 „ -” September 6594 436 9 - 3 — — - 96 1072 „ 43 „ October 0945 423 10 4 11 4 - - 44 832 „ -” November 5727 507 9 2 12 2 - - 281 617 „ -” December 4496 372 2 — 8 — - - 319 697 „ 8 ” Total 59036 4271 141 6 42 20 — 1 4044 9122 „ 51 ” 57 BAKEHOUSES. Of the 34 bakehouses in the Borough 5 are underground. These were licensed under the Factory Act of 1901. t SMOKE ABATEMENT. During the year 1936, factory chimneys have been watched on 156 occasions, and 68 intimation notices served, besides of course, the numerous informal observations which are always being kept. Legally, we can only take action against the owners of factories in order to prevent the emission of black smoke and grit, but in London, at any rate, the biggest culprit is the ordinary domestic chimney. The problem of atmospheric pollution is neither new nor simple, most of us have read that John Evelyn in 1661 appealed to King Charles to pass an Act of Parliament that works and furnaces using sea-coal, should be removed five or six miles distant from London, below the river Thames. These works fatally infested the air, and would not be permitted in any other city of Europe. We now know more of the injurious effects of smoke, and also of better remedies against coal smoke, and yet, in spite of this, little serious attempt is made to maintain a pure atmosphere. No-one can be unaware of the importance of clean air : of all the elements that sustain life, air is the most important. In round figures, without food we die in three weeks : without water, in three days, but without air we die in three minutes. Some people can successfully dodge the use of drinking-water for a considerable time, and most people can counteract many of the impurities of food by sterilising it, but short of wearing masks, all have to breathe the impurities which may be present in the air. According to the highest authorities, the smoke problem is inherently neither difficult nor insoluble. There are no insuperable difficulties in preventing smoke, but, because we need heat in so many different places and for so many different purposes, there are a great many small problems to be tackled, rather than any single, vast, all-embracing one. In the case of the factory chimney, it is mainly a question of expense. In the northern part of our district, we rarely have complaints of black smoke, but sometimes grit and fumes are emitted with dire consequences. Shrubs, flowers and grass have occasionally been ruined in Wesley Playing Field in the vicinity of 58 the chimneys of the Electricity Power Station. An expensive plant has been installed to intercept the fumes and grit, but these accidents have occurred when the flues are cleaned or repairs are being carried out. In some industrial processes, the dust derived from the materials being treated, may be of sufficent value in itself to make the trapping of it an economic as well as a considerate proposition ; —dyers, roasting kilns and metallurgical processes, but in the case of boiler furnaces, there is no such inducement, and the elimination of boiler flue gases is an expensive process, involving extra capital and maintenance. Some of the larger firms have installed apparatus for the trapping of the fumes, but a breakdown involves damage to neighbouring property. The amount and nature of the dust vary, not only with the type and design of the furnace, and the draught and load conditions, but also with the character of the coal burnt. It is claimed that the emission of dust from boiler stacks is to some extent preventable by the use of cleansed coals. In addition to reducing the amount of ash, the cleansing of coal effects a considerable reduction of the sulphur content. Naturally, the use of cleansed coals involves a more immediate expense, and the users do not as rule take a long view of the question. A short while ago, an officer of one of the railway companies, stated that a day's fog involved them in an expense of hundreds of thousands of pounds, in addition to the inconvenience caused to the company as well as to the public. When one observes the smoke which so frequently belches forth from some of the engines, one wonders if this expense caused by the fogs could not have been avoided if more care and money had been expended on the fuel, and on the stoking of the engines. In the southern part of the district complaints are frequently received of black smoke from the boiler shafts. These factories are old and have been adapted and not specially erected for the purposes which they now serve. Most of the old hand-laundries have been turned into power laundries, and the boilers installed have not been the most efficient as far as smoke and grit emission is concerned. The fuel used is often cheap bituminous coal, and the stoking leaves much to be desired. Mechanical stokers are seldom installed, the stoker has other duties to perform, piles on the fuel, and black smoke emerges, at intervals during the day. In Acton, as a result of constant vigilance on the part of the officers, together, of course, with the erection of up-to-date plants in the newer factory area, an improvement has taken place as far as 59 black smoke is concerned from factory chimneys, but from enquiries made, very little progress has occurred in the prevention of atmospheric pollution from the domestic chimney. Although in the larger blocks of flats, which have recently been so extensively erected, in and around London, central heating has been installed, the ordinary house will still be heated mostly by means of an open coal grate. Some smoke abatement enthusiasts think that coal grates should be abolished by law, but with our moist climate, it is not likely that the public will give up the comfort whuch is afforded by them. Moreover, for continuous use, solid fuel is much cheaper for open fires. The extended use of gas, electricity and coke should be encouraged, but for various reasons the coal grate will be with us for some time, but it is possible to reduce the amount of smoke and yet retain the coal grate. Doctor Margaret Fishenden, who is one of the greatest authorities on the subject, read a paper at the Conference on Smoke Abatement last autumn, and she was very emphatic on the possibility of reducing emission of smoke from coal grates. The kitchen range is probably the worst offender, although a rapid increase in the use of independant boilers and gas cookers is taking place. Large quantities of bituminous coal are also burned in open grates of the sitting-room type. This is not necessary. Among the natural smokeless fuels, anthracite, semi-anthracite and semibituminous coal, and the manufactured smokeless fuels,—cokes, and semi-cokes—a smokeless substitute can always be found at little extra cost, and sometimes actually at a lower cost. Anthracite or gas coke is usually too hard to light in open grates of ordinary design, but grates of special design, which will burn anthracite and gas coke, have recently been put on the market. Semi-anthracite or semi-bituminous coal are quite suitable for open tres, and cost no more than bituminous coal. Prevention of smoke lies essentially in using the right fuel for the right purpose, but the housewife does not always know what types of fuel are best for her Particular purposes, and in any case, cannot be sure of getting uniform supplies from her coal merchant. This objection does not apply to large consumers, and yet, in offices, and even in rooms belanging to local authorities, bituminous coals are used, producing smoke and necessitating frequent chimney sweeping. BIRTHS. Table 7 is in the same form as in previous years. The total Number of births is obtained from the Registrar General, and indudes all the births which belong to the district wherever they may 60 have been registered throughout the kingdom. The registered births numbered 881, 464 males and 417 females. A large percentage of the births occurred outside the district, but this is due to the fact that there is no maternity hospital within the district. Of the total births, 388 occurred in the district, 437 were notified from outside districts, and obviously 56 births did not come to our knowledge. They are included in the Registrar General's total; and as this total is 56 more than the number notified to us, we are ignorant of their distribution ; we do not know where they have occurred, and more important we do not know their address in the borough. The total number of registered births corresponds to an annual birth-rate of 12.7 per 1,000 inhabitants. The birth-rate for the whole of England and Wales last year was 14.8 per 1,000 ; for the County Boroughs and large towns with a population of over 50,000 it was 14.9, and for the 143 smaller towns with populations between 25,000 and 50,000 inhabitants, it was 15.0, and for the Administrative County of London it was 13.6 per 1,000 inhabitants. Until comparatively recently the birth rate excited no interest amongst the general public. In most annual reports there was just a small paragraph giving the total number of births and the birth-rate. But when the British citizen hears that Parliament is about to appoint a commission to investigate a subject which he has hitherto considered without practical importance, he begins to consider if there may be something in it worthy of his attention. The public press gives great prominence to the subject, and most contradictory statements and prophecies are made. A new word, " demography " has been coined, and used extensively. We have heard from Rome that " the demography problem is Italy's paramount problem " The word is used to describe the statistical methods to forecast future population trends. Very many people cannot possibly understand how a population can be declining which in fact is increasing by excess over deaths. For instance, in Acton, where the birth-rate is much lower than that of England and Wales, there were 87 more births than deaths in 1936, and in the whole of England and Wales there were about 109,861 births more than deaths. Attempts at enlightening by complicated explanations of what birth-rates and death-rates mean generally end in confusion, but for practical purposes we may forget most of them and simply bear in mind the net 61 reproduction rate. The true death-rate of man is determined by his mean expectation of life. Taking the latter to be 60 years, the death-rate is 16.6 per 1,000 per annum. Nothing but alteration of the expectation of life will alter the rate, and simply to maintain the population the birth-rate must equal it. There are prospects of the mean expectation of life rising to 65, and conceivably to 70 years, but none whatever above that, in spite of some who think that mortality is not a " natural" termination. Under present conditions a birthrate of 16.6 is necessary to keep the population steady, and even if conditions improve almost to their limit a birth-rate of about 15 per 1,000 would be needed to establish an equilibrium. Since 1933 the birth-rate has not fallen in most English-speaking communities—the figures being for England and Wales:— 1933-14.4 ; 1934-14.8 ; 1935-14.7 ; 1936-14.8. Although the birth-rate in the past few years appears to have become stabilised it is obvious, unless an upward trend soon appears, that the population of this country has almost reached its peak, and soon there will be a decline. Even if the birth-rate did not mark lower depths, a decline in the population is inevitable, at first gradual, but gaining momentum each year. Sir William Beveridge estimates that the population of these islands in 2137 will be 5 millions, and Dr. Enid Charles predicts a more sparsely populated England in 2037. Admittedly the problem is a difficult and intricate one, and because of its difficulty and intricacy most people leave it severely alone. Possibly it is mainly a national question, but it has its local implications, and is intimately bound up with local administration. It will give rise to many economic and administrative problems, such as unemployment, old age pensions, hospital accommodation, schools, &c. In last year's report I gave some tables which showed the remarkable changes which have occurrred in this district, and those acquainted with education administration know the difficulties which have already occurred. Some people seek reassurance in the hope that the statisticians may be wrong, as their predictions are based on a series of assumptions, any one of which may be radicalh changed by developments 50 years hence, but it may be pointed out that the forecasts of population movements made a few years ago have been found since to underestimate the extent to which decline is threatening this country and several other western democracies. 62 The relative importance of the factors in operation may vary. in different localities, but some of them operate in all districts throughout the country and Acton is fairly representative of the conditions which obtain in most districts in and around London. The practice of spacing the family has become prevalent and there is not the slightest doubt that the use of contraceptive methods has spread throughout the population. Living conditions and economic conditions are important factors, but it is not argued that they are the only ones because until recently the fall in the birth-rate was least marked in the lower-income classes of the community but at the present time the size of the family is getting smaller in all classes. In the report upon the Overcrowding Survey in Acton it was pointed out that overcrowding has become less prevalent here primarily owing to the diminishing size of the family. The number of families has increased relatively more than the number of new houses, but overcrowding has lessened because the average number in each family is getting less. Some of the obstacles to family life are familiar to most observers. . The uncertain political and economic outlook, the rising standards of life affect all classes, but the difficulty of obtaining houses at a reasonable rent probably rests more heavily on the so-called working classes Rents have risen at a greater rate than wages, and the ordinary artisan and unskilled labourer find it very difficult to obtain houscat a rent which they can afford. It is also well known that private landlords and even municipal authorities are averse to letting houses to those who have large families. Even if a man with a large family is successful in obtaining a house with sufficient accommodation, the rent demanded frequently has to be paid at the expense of the nutrition of his family. Sir John Orr stated recently that half of the population do not obtain the food which would conform with the highest, standard ; some people have even insufficient calories, whilst in the case of the others, the food was deficient in protective foods and therefore in vitamins or minerals. This inevitably involves the further fact that a number of men, womer and children in this country are, to put it bluntly, half-starved. We have no records here which would enable us to estimate the number of families who are undernourished and who cannot afford the necessary food, but the School Feeding Centres and the Free milk. Scheme are sufficient evidence of their existence. We have amd yet learnt how to wed agriculture to the public health. Food prices are kept high by laws which impose fines for growing more than an authorised quantity of potatoes, or for selling milk under 2 certain official minimum price. Quite recently a memorandum was issued by the Ministry of Health asking Maternity and Child Welfare Committees to relax their regulations respecting the supply 63 of free milk to expectant and nursing mothers and children under 5 years of age. It is no longer just a matter of individual betterment but of national necessity that a minimum scale of nutrition as well as housing be provided for everyone in the country. So long as the grim struggle for life continues in the working classes, we shall find them physically weak and more and more unwilling to bring up families. Restriction of the number of children in a family is by no means most marked among the poor. Middle class families are noted for their preference for Baby Austins over the human variety, and it has been suggested that the best way of inducing these folk to raise a family is that of a family allowance, payable to married persons of every class. This has been tried in other countries with doubtful success. In all these attempts to embark on a competitive race in procreation and to bully or bribe the youth of today to beget and bear more babies than they want, the woman is frequently ignored, but the emancipation of women probably has had as much effect as anything. Even if anyone wanted it, a return to the high rate of the Victorian era is impossible. Mothers are not now content to spend their whole lives simply to bring forth and rear children. Women have widened their outlook and have many and diverse interests outside their own households. The promised Government Committee may devise means to increase the birth-rate, but so long as bombing aircraft and poison gas pervade the minds, so long as there is exposure to the risks of unemployment, poverty and bad housing, there is an arnswer to the advocates of wholesale fertility. Remove these motives for deliberate infecundity, the present trend of population may gradually change. DEATHS. At the end of each year, or more correctly, towards the end of May, a summary of the vital statistics of the district is received from the Registrar General in which is given the estimated population, the number of births and a short list of deaths. We are supposed to have received the full list of deaths previously, and the totals in the summary should correspond to the numbers in the death returns. Usually the important items in the different returns correspond, such as the total number of deaths, infantile deaths, the deaths from definite diseases, &c., but this year a discrepancy occurs. According to the Registrar General the deaths belonging to the district were 801. In the weekly returns of the local registrar and the quarterly outside returns, the total number is 794, 2nd on this number the statistics are based. The cause of the 64 discrepancy I have been unable to ascertain, but a possible one may be mentioned. The registration and the municipal areas do not correspond. Although over two years have elapsed since the rearrangement of boundaries between Acton and Brentford & Chiswick was completed, the old registration areas still obtain. The residents of Ivy Crescent and the transferred area in Bollo Lane still have to go to Chiswick to register the births and deaths, and the residents of Silver Crescent, Thorneyhedge Road and the rest of the area transferred to Chiswick still register the births in Acton. 431 deaths were registered in the district; of these 42 did not belong to Acton and were transferred to other districts. 405 deaths of Acton residents occurred outside the area and have been included in our returns. The total number of deaths belonging to the district is therefore 794, which corresponds to a death-rate of 11.5 per thousand inhabitants. In previous reports the method adopted by the Registrar General to standardize the death-rate has been explained ; a comparability factor is supplied to each district for adjusting the local death-rate to make it comparable with other districts. The comparability factor is based upon the age distribution and sex incidence of the district at the Census of 1931. The comparability factor for Acton is 1.08. The standardized death-rate for Acton is 12.4 per thousand inhabitants. The death-rate for England and Wales for 1936 was 12.1 per thousand ; the crude death-rate for the administrative County of London was 12.5 ; for the 122 County Boroughs and Great Towns with over 50,000 inhabitants 12.3 ; and for the 143 smaller Towns with a population between 25,000 and 50.000 inhabitants 11.5 per thousand. The number of deaths is 90 more than that of 1935 arid with the exception of the year 1929, last year's total was the highest on record. On the surface, the figures appear to be very unfavourable, but when they are closely examined, it will be observed that most of the increased mortality was in the later years of life. Unfortunately, there is a higher infantile mortality, and this is commented on in a later paragraph. There is also a higher mortality from Phthisis or Pulmonary Tuberculosis. Ever since the war, there has been a progressive improvement in the mortality from Tubercular diseases, and though we have to record a set-back last year, it is probable that this is only a temporary and transient phenomenon. 65 There is a slight increase in the number of deaths in the ageperiod 1-2 years, but this is due to the 6 deaths which occurred from Measles. hast year was a Measles epidemic year : in this district Measles has in recent years regularly occurred in epidemic form every other year. There is also an increase in the mortality in the age-period 25-45 years, due to an increased number of deaths from Phthisis, heart disease and Cancer. A higher mortality from Phthisis would be felt in this age-period, but it is most unusual to find so heavy an incidence of Cancer in this age-period. There was an increase of 45 in the number of deaths in the age-period 45-65 years, and of 19 in the age-period of 65 and upwards. 47 per cent, of the deaths occurred in people of 65 years and upwards. Of the total deaths 385 were males and 409 females. The average age of the males was 52.2 and of the females 60.9. The average of all the persons who died was 56.6. There were increases in the number of deaths from old age, heart disease, especially in people over 65 years of age, Cancer, Bronchitis, Pneumonia and Cerebral Haemorrhage. As I have pointed out in previous reports, these diseases are associated with advancing years and with the altering age-incidence of the population. Although there has been an apparent increase in recent years in the number of deaths attributed to heart disease, there is no evidence to show that heart disease is an increasing menace. There is an increasing tendency among doctors to give old age as a cause of death, but most of them still name a definite disease as the existing cause, and the most popular one in recent years has been Myocarditis or Myocardial degeneration. These are placed under heart disease together with Myocarditis and Valvular Disease after Rheumatic Fever, but there is no analogy between the two conditions. In the former, the degeneration of the heart was merely part of a general degeneration. Death could not be avoided, and methods of prevention could not avail. When the disease follows Rheumatic infection as was probably the case in the sixteen deaths under 45 years of age, the conditions are entirely different. The infection may have been an avoidable one, and the life could have been prolonged. 66 The death has usually occurred before the other parts of the body have worn out, and the unfortunate sufferer has died in the prime of life. For this reason it is important that measures should be taken to prevent permanent damage to the heart from Rheumatism in childhood, and in the report on the School Medical Sendees, an account is given of the measures which are being taken. Although heart disease now looms larger in our returns than any other cause it does not mean that preventable heart disease is more prevalent. It means that the present day conceptions of heart disease are different from those which obtained in the past, and the increase is due to the result of this new orientation, and is shown only in the deaths in advanced age. Similarly, the increasing number of deaths from Cancer is partly due to the altered age incidence of the population. Of the 112 deaths from Cancer, 52 were in persons over 65 years of age. For the first time on record more deaths of Acton residents occurred outside the districts than inside ; this is partly accounted for by the fact there is no County hospital situated in the borough. I have on several occasions pointed out the changed and changing attitude of the public towards the treatment of disease in public institutions. Last years 418 deaths occurred in public institutions in addition to those which occurred in nursing homes. The institutional deaths were as follows:— County Hospitals 275 County Sanatoria 6 Outside Voluntary Hospitals 83 Acton Hospitals 47 Fever Hospital 7 Private Nursing Homes 21 Inquests and Coroner's Inquiries. 6 deaths occurred either in the street or in an ambulance on the way to a hospital. 30 inquests were held, and 31 deaths were certified by the Coroner after a post-mortem examination but without an inquest. The list of inquests together with the causes of death is given on a later page. 67 DIPHTHERIA. 15 cases of Drphetheria were notified and removed to hospital 2 of these were found to be suffering from Scarlet Fever, and 1 notification was withdrawn as the swabs from the throat proved negative. and the child did not show any clinical signs of the disease. Three other cases were admitted to hospital for observation, but were found not to be suffering from the disease and were discharged in a few days. There were therefore 12 cases of Diphtheria with 2 deaths. Eleven of the twelve cases were in children who had not been artificially immunised, and both deaths occurred in children whose parents had either refused or neglected artificial immunisation. The only child who developed clinical diphtheria and had been previously immunised developed the disease in a mild form ; he had been inoculated in 1932. In the School Report particulars are given of the steps which were taken in 1936 to carry out artificial immunisation, and the difficulties which attend. One of the dangers which we now have to bee is the comparative freedom of the district from diphtheria. In the second half of 1936, only two cases occurred in the district, in onsequence we have two undesirable results. The parents become apathetic and neglect to have their children immunised. The district is practically free of diphtheria so why worry ! But this freedom from the disease is a Source of potential danger. When the incidence of the disease is fairly high, a percentage of the children are renered immune, or ar any rate, partially immune by sub-clinical doses of the infecting agent, though they may not have suffered from clinical diphtheria. These children have a certain amount of antitoxin circulating in their blood and if they contract diphtheria it is possible for the attack to be modified. This method of protection not only unscientific and haphazard, but usually insufficient. When a district is free of the disease even this modified protection is removed, and if an unprotected child does contract the disease the attack is likely to be a Severe one. There are other factors which decide the severity or otherwise of the attack, such as the kind of bacteria, &c., but the lessened immunity of the child in a district free of diphtheria is of wider significance. SCARLET FEVER. . 177 cases of Scarlet Fever were notified, but there was no death from the disease Over 70 per cent, of the cases occurred in North East and North West Wards, and the school mainly affected was the Action Wells School. Although no missed cases 68 were detected among the scholars, the difficulties which are attached to the prevention of Scarlet Fever have been referred to in previous reports. It is now held that the sore throat, rash, temperature, peeling, &c., are simply the reactions of the individual to the invasion of the streptococcus, and that anyone of these symptoms may be absent, but doctors are chary of notifying unless most of them, or at any rate the rash, are present. It can therefore be appreciated that during the prevalence of Scarlet Fever in a neighbourhood there may be a certain number of cases which will escape notification. Among other vagaries of the streptococcus is its power occasionally to persist in an active state in the individual for prolonged periods, and we have return cases when a person resumes his ordinary role in life after isolation. Unless complications occur at the present time a patient is kept in hospital for about four weeks, and in the . majority of instances at the end of that period he is found to be free of infection. Occasionally, when a patient is discharged from hospital another case occurs in the family within a short period of the patient's discharge; the subsequent case is called a " return " case and the discharged patient is called the " infecting case." We know some of the conditions under which a patient remains infectious for a prolonged period and liable to give rise to " return " cases, and avoid discharging the patient until these symptoms have cleared up, but there are others which give rise to " return " cases in which there are no visible signs or symptoms in the patient to account for the persistence of the infection. Last year six cases gave rise to one return case each, and in 2 instances three cases occurred in each of the families following the discharge of the patient from the hospital. MEASLES. There were ten deaths from Measles in 1936, compared with no deaths in 1935. Last year was an epidemic year in Acton. During the past quarter of a century, Measles has made its appearance in Acton in a fairly regular manner every other year. Measles is a disease which fulfils with remarkable accuracy the conditions of an epidemic cycle ; its waves of prevalence, with their respective rises and falls, are interspersed with periods of complete absence. We say that it occurs with explosive violence, and then completely disappears from the district. 1932 was an epidemic year with 12 deaths, followed in 1933 an interepidemic year with one death. 1934 again was an epidemic year with 11 deaths, followed in 1935 with no deaths. 69 In the Annual Report for 1934, a history of Measles in Acton was given and a table inserted to show the regularity of its biennial visitations. If the table had been drawn up for separate years, and ending, say, on July 1st each year, the regular periodicity of the disease would be still more marked, because the outbreak usually occurs in the winter months; sometimes the epidemic started in the last quarter of the year, at other times it originated in the first quarter of the year. Recently the interepidemic period was slightly more than 104 weeks. In the epidemic of 1934, the first cases were reported in January, but the cases in the school did not become numerous until February and March. In the previous epidemic of 1932, the first cases were reported in December 1931, and several cases were notified from the schools when they re-opened in January 1932, after the Christmas holidays. Although it could almost certainly be predicted that 1936 would be an epidemic year, we did not expect the epidemic until February or March. Besides, in recent epidemics, our Measles outbreaks have followed the rise of deaths in London ; we usually have felt the full force of it a month or so after the epidemic has reached its peak in London. Last year's epidemic behaved in a slightly different manner. The height of the epidemic was not reached until the early part of 1936 ; there were only 12 deaths in November and December 1935, reaching 71 in January' and February 1936. The first case here was reported in November 1935, and as will be seen from the School Report the outbreak had a firm hold before the end of January 1936. The epidemic lasted until the summer of 1936, but of the 9 deaths, 6 occurred in the first quarter of the year. An intensive study has for years been made into the bacteriology and the epidemiology of measles ; probably no disease has recently been more intensively studied, and we have learnt a good deal at any rate of the behaviour of an epidemic of Measles. Although the germ or virus which is the probable cause of the illness has not been isolated, and is therefore unknown, we do know how Measles in the mass behaves. A Measles epidemic does not arise in a community of children until the percentage of susceptible children rises beyond 25, and seldom subsides until the percentage of the susceptible population is reduced a mark below 20. The question of immunity is a complex one, and usually a person becomes immune or non-susceptible to Measles by contracting the disease and suffering from the symptoms of Measles. The immunity which is conferred by a clinical attack of Measles is usually a permanent one, and lasts a lifetime. But it is now held 70 that in addition to this permanent immunity which an attack of Measles confers a certain amount of temporary latent immunity also occurs during the epidemic. This temporary latent immunity may be brought about in many ways. A breast-fed infant seldom contracts Measles. He is born with a certain amount of natural immunity ; how long this natural immunity persists is not known, but whilst it lasts, he may come in contact with Measles and yet not exhibit the usual symptoms of the disease. He may, though, be acquiring a certain amount of latent immunity through successive sub-clinical doses, and these may be, but are not usually, of sufficient strength to give him a permanent immunity throughout his life. In any case, the immunity is sufficient to tide him over that particular epidemic. It is through the acquisition of natural immunity that under present social conditions an epidemic of Measles comes to an end in a large urban community. This does not mean that individual children cannot be protected from Measles during an epidemic but that efforts to prevent the spread of an epidemic of Measles in a community are usually a failure. These considerations have effected a changed outlook in the measures which are adopted during an epidemic. At the present time, we concentrate upon the individual because the disease itself very rarely kills. It simply predisposes the patient to the great risk of secondary infections, and it is from these complications, usually broncho-pneumonia, that death occurs. Probably, some of the lessened mortality in recent years has been due to the institutional treatment which has been available. We have been fortunate to have available accommodation for Measles at the Fever Hospital in the last three epidemics, and we did not refuse any application by a doctor last year. 65 cases were admitted with 5 deaths. Unfortunately many of the cases are admitted because of the complications which have already set in, but this is inevitable. It would be almost impossible to remove every case of uncomplicated Measles during an epidemic. A selection has to be" made, such as the existence of unfavourable home conditions, complications, &c. In former days, also, in addition to the deaths which occurred from the disease, we had a large number of children who had been maimed and scarred by the discharging ears and inflamed eyes frequently left as a complication and sequelae of Measles. For these reasons, when a Measles epidemic occurs, we pay less attention to the spread of the disease in the community and more to the treatment of the disease in the individual either in the home, or in a hospital. 71 TUBERCULOSIS. 89 cases of Pulmonary Tuberculosis, and 15 cases of other forms of Tuberculosis were notified during the year. There were 47 deaths from Pulmonary Tuberculosis and 4 deaths from other forms of Tuberculosis. The death-notification interval of the 47 patients who died of Pulmonary Tuberculosis in 1936, was:— Information from Death Returns 4 Died within 1 month after notification 6 Died between 1 and 3 months after notification 3 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 3 Died between 2 and 3 years after notification 6 Died over 3 years after notification 15 For practical purposes the date when the notification was received can be accepted as the time when prophylaxis and treatment really commenced. It will thus be seen that there is room for earlier diagnosis in a large number of cases, and it is generally believed that an increase in the proportion of persons diagnosed in the slight or early stages would be of great benefit. Apart from the advantage to the contacts from the precautions which would be taken, the prognosis is closely related to the extent of lung involvement at the time of diagnosis. A patient's chance of survival is enormously increased in proportion as he is admitted to sanatorium treatment in the early stages of the disease. This late diagnosis is probably one of the causes in the want of improvement which has recently been noticed in the mortality from pulmonary tuberculosis. That there has been a check in the decline of mortality from pulmonary tuberculosis is evident from the returns for the whole kingdom, and events in Acton have followed the same course. The deaths from pulmonary tuberculosis for the last six years were as follows:— 1936 46 1935 32 1934 50 1933 53 1932 48 1931 43 72 A general decline in mortality from pulmonary tuberculosis began in this country from the middle of the last century and continued in the early part of this century. A marked check occurred during the Great War, but following the war a decline again occurred, but recently a check in the improvement has occurred. The recent check in the mortality from pulmonary tuberculosis has occurred during a period when interest in matters of public health in general has been greater than ever. This check has taken place as a result of factors other than failure to utilise the special arrangements for the treatment of the disease. The decline in the mortality from pulmonary tuberculosis began in this country before any specific measures were taken against the disease, and was accompanied by a substantial decline in the mortality from all other diseases taken together. The early impovement was undoubtedly due to the improvement in the general social and economic conditions of the mass of the people. Housing, nutrition and other factors determine the general level of social conditions. A patient of ample means returning home from a sanatorium can afford to adjust his life until it is safe for him to resume it under former conditions. A working-class patient after the benefit of similar treatment returns to a home environment where even separate sleeping accommodation is impossible. Although the conditions would not constitute actual overcrowding under the 1935 Housing Act, from an infection point of view they are undesirable. Frequently we have requests from a family, one of whose members has been to a sanatorium, sometimes supplemented by a letter from a Tuberculosis Officer, for a Council house because of the want of sufficient space at the home to admit of separate sleeping accommodation for the patient. Supervision of contacts is difficult because the other members of the family are always in intimate contact with the patient. It has been suggested that preferential housing treatment should be accorded to pulmonary tuberculosis patients but landlords are loth to let their houses, and even municipal housing committees are unwilling to convert their estates into Tubercular settlements. Besides, a tubercular patient, if he is the head of the family, is unable to afford better accommodation. Unless he is fortunate enough to have substantial savings, which he rarely has, the standard of living will be substantially lower than before bis illness. These are some of the difficulties which confront us in the fight against tuberculosis no matter how excellent the facilities for treatment may be; not only will they effect the results of treatment, but will militate against early diagnosis and treatment. 73 The following is a statement of the particulars appearing in the Register of cases of Tuberculosis on 31st December, 1936:— Pulmonary Non-Pulmonary Total Number of Cases on the Register at the commencement of the year 159 males 162 females 35 males 25 females 381 Number of Cases notified for the first time during the year 50 males 32 females 10 males 4 females 96 Number of Cases previously removed from the register which have been restored thereto during the year 1 male females male 1 females 2 Number of Cases added to the Register other than by notification 4 males 3 females 1 male females 8 Number of Cases removed from the Register during the year 40 males 29 females 1 male 4 females 74 Number of Cases remaining on the Register at the end of the year 174 males 167 females 45 males 26 females 413 In 1936, the Tuberculosis Officer examined 63 new cases of pulmonary tuberculosis, and 13 new cases of non-pulmonary tuberculosis. Fifty-five patients were admitted to Sanatoria under the County Scheme, and thirteen were admitted to hospitals. 74 Age Periods New Cases. Deaths. Respiratory. Non-Respiratory Respiratory. Non-Respiratory M. F. M. F. M. F. M. F. 0- — — — — — — — — 1- 1 — — — — — — — 5- 2 1 — 2 — — — 1 15- 22 12 6 1 6 2 2 1 25- 8 15 — — 9 7 — — 35- 10 2 2 — 5 2 — — 45- 6 1 2 1 3 1 — — 55- 3 3 — — 6 3 — — 65 and upwards 2 1 1 — 2 1 — — — — — — — — — — Totals 54 35 11 4 31 16 2 2 75 ISOLATION HOSPITAL. 583 cases were admitted during the year, compared with 544 during 1935. On January 1st, 1936, there were 44 cases in the hospital, and on January 1st, 1937, there were 40. The following table gives a list of the cases admitted, together with the diseases from which the patients suffered. Acton. Wembley. Other districts Total. Scarlet Fever 152 240 32 424 Diphtheria 18 27 - 45 Measles 65 32 - 97 Erysipelas - 1 - 1 Chicken Pox - 1 - 1 Whooping Cough 12 1 - 13 Mumps - 1 - 1 Osteomyelitis - 1 - 1 There were 14 deaths which were distributed as follows: Sc. Fever Diphtheria Measles Acton - 2 5 Wembley 2 4 1 On 7 Scarlet Fever patients a complete mastoidectomy was performed, and on two of these the operation was done on both sides. There were several serious complications in both the Scarlet Fever and Measles cases. In 7 cases of Scarlet Fever a mastoid operation was performed, and a similar operation done in 4 cases of Measles. BACTERIOLOGICAL EXAMINATIONS. (a) For Diphtheria Positive. Negative. Total Examinations 762 32 730 Sent by Medical Practitioners 5 215 do. (re-examinations) 1 22 Sent from Isolation Hospital 21 293 Convalescents (1st Swabs) 1 9 „ (2nd „ ) - 1 Contacts 43 do. (2nd examinations) 1 9 do. (3rd „ ) 1 1 Precautionary Swabs 2 112 „ (2nd Swabs) 1 3 76 School Sore Throats 22 (b) For Ringworm. Positive. Negative. Total Examinations 9 2 7 (c) For Tubercle. Positive. Negative. Total Examinations 274 35 139 MATERNITY AND CHILD WELFARE. Infantile Mortality. 60 deaths occurred in infants under 1 year, corresponding to an infantile mortality of 6S per 1,000 births. The infantile mortality is 8 per 1,000 births higher than that of 1935; for the third year in succession we have to deplore an increased infantile mortality, and it is the highest recorded since 1929. We had become so accustomed to record a diminishing infantile mortality year after year that it is with a sense of disappoint ment and dissatisfaction that a higher rate for the third successive year is recorded. There is one phase in this year's infantile mortality which is disquieting. Not only is there a higher mortality, but this enhanced mortality has occurred between the ages of 9 and 12 months, and these are the ages which are most susceptible to the widespread benefits of child welfare. We have for years to deplore the high neo-natal mortality, that is, of deaths in the first four weeks of life. The percentage of infant mortality occurring in the first week of life steadily increases everywhere, not because neo-natal deaths have increased but because deaths in the remaining 51 weeks of the first year have declined rapidly. It is found that though the infantile mortality may vary in different localities the neo-natal rate remains fairly constant in all sections of the population. Some of the causes of neo-natal deaths are known and theoretically preventable. One of these is difficult delivery- with consequent damage to the infant. There were 3 deaths from intracranial haemorrhage, and 1 from injury at birth, but these 4 occurred in maternity hospitals where, presumably, the actual delivery took place under the best possible conditions, and where the best skill was available. The two deaths from Mongolism and Spina Bifida were due to developmental faults, and also the death from congenital heart disease, though probably the latter was neither congenital nor 77 disease, but due to persistence of the normal heart after the placental circulation is abolished. The highest number of neo-natal deaths is attributed to prematurity; 9 deaths were assigned to this cause. Prematurity of itself does not prevent survival; though premature infants are more difficult to rear, many are successfully reared and develop into healthy, normal children. But the causes of prematurity are not clear. Some suggest that lack of vitamin E plays an important part, and any failure of the nutrition of the embryo will destroy its vitality. At one time syphilis was supposed to be the cause of many premature births, and some ante-natal clinics adopted the practice of making a Wassermann test an essential part of ante-natal supervision, but most clinics have discarded this. Syphilis is not now regarded as a common cause of prematurity, and prematurity is not more common in poorly fed and sickly mothers than it is in those who are well cared for and healthy. V Altogether 23 deaths occurred in infants under 4 weeks old, compared with 29 in 1935. In the period between 1 and 12 months the most fatal causes were diarrhoea and pneumonia, and it is difficult to explain the higher incidence of death from these two diseases. In neither case could climatic conditions be blamed for the winter months of the year were not extremely cold nor were the summer months abnormally hot and dry. Toddlers. In last year's report a full account was given of the work done among Toddlers. Last year Circular 1550 was issued which urged upon Local Authorities the extension of arrangements made by them for the supervision of the health of children not in attendance at school. This Circular was considered by the Child Welfare Committee and it was decided to establish a Special Toddlers Clinic as an experiment at the Steele Road Centre. The Centre is held on Friday afternoons and Dr. Mann attends once a month. Dr. Mann carries out a modified medical examination on the lines set out in the School Medical Schedule. The establishment of this Clinic has been a success, but there are difficulties of staff and accommodation which prevent the establishment of similar Clinics at the other centres at the present time. 78 Maternal Mortality. There were two deaths which are reckoned as maternal mortalitythe causes being prolonged labour in one case and septicaemia following abortion in the other. There was a third death connected with pregnancy, but as the cause of death was given as a pelvic abscess following self-induced abortion, the death is reckoned as suicide, and not puerperal sepsis. This case naturally had not called in a doctor until she was seriously ill. From one point of view the third death is of as much importance as the other two maternal deaths, though prevention is not so easily applied. The home conditions were poor and there were 4 other children. She had had another abortion about 6 years previously. There is no doubt that she dreaded the prospect of another child on account of poverty. The death from prolonged labour occurred in a nursing home and the doctor in attendance was assisted by a midwifery specialist. The death from pelvic abscess following abortion occurred in a Maternity hospital. She was admitted to the hospital as a possible acute appendix. In the hospital she was found to be suffering from Pyelitis of pregnancy. Two days after admission she aborted, and two days later death occurred. In both these cases the highest skilled ante-natal care and natal care were available, and it is difficult to see under what condition the deaths could have been prevented. In previous reports an account has been given of the agreement with the Middlesex County Council for the admission of cases into the Central Middlesex County Hospital. In 1931 arrangements were made for the admission of cases into the hospital. Our scheme was for the admission of those mothers who were not necessitous, but who could not afford the full nursing home fees. The scheme was a success from the beginning, and to its termination in 1936 the number of women who applied for admission steadily increased as the folllowing figures show: Number of cases admitted during 1931 50 „ „ „ „ 1932 122 „ „ „ „ 1933 149 „ „ „ „ 1934 209 „ „ „ „ 1935 270 „ „ „ „ Jan/June 1936 205 79 Owing to the increase of population in West Middlesex the maternity accommodation at the disposal of the County Council became overtaxed, and it soon became obvious that our scheme was in danger. The appointment of a lady almoner was the beginning of the end. The duties of the almoner were, of course, to select the cases for The appointment of a lady almoner was the beginning of the end. admission, and in view of the pressure it was natural that those whose home conditions were satisfactory would be refused when the accommodation was limited. As our scheme was primarily conceived for non-necessitous cases we frequently accepted cases where the accommodation at the home might be considered suitable for the confinement, and these cases were refused by the lady almoner. There were other factors which operated. On the 1st April, 1936, the County Council's general hospitals were appropriated under the Public Health Acts, and the chief reason for the existence of the agreement disappeared. The County Council held the view that it was inequitable that those District Councils which bad subscribed to the Agreements should continue to be financially liable for the cost of maintenance of cases from their area, whilst at the same time through the General County Rate contributing their quota to the cost of the County Council's maternity beds as a whole. In June, 1936, the Agreement practically came to an end although no formal notice was given by either side of its termination. The Central Middlesex County Hospital still receives cases from Acton, but not under a scheme of the local Council. Day Nursery. The Nursery is situated in Bollo Bridge Road, and is open on five days a week. The Nursery was open on 212 occasions, and 5,250 wholeday attendances were made. Child Welfare Centres. Eight sessions are held weekly-4 in Avenue Road, 2 in Steele Road Mission, and 1 each at John Perryn School and St. Gabriel's Hall. Nurse Children. At the end of the year 1935, there were 39 children and at the end of the year 1936, there were 39 children on the register. 80 FOSTER CHILDREN. No. as at 31st. Doc. 1935. Notice of Recoption of Children during 1936. NOTICE OF REMOVAL TO : Children Adopted Died. Children reached ago of 9 No. as at 31st.Dec. 1936. Parents. Another area with Foster Parent. Another Foster Mothor Publia lnstitutution or Home. Other eausos. 39 16 5 3 1 2 - 2 1 2 39 FOSTER MOTHERS. No. as at 31st Dec., 1935. Application for Registration during 1935. Removed to another Area with child. No longer a Foster Mother. No. as at 31st. Dec., 1936 30 11 3 9 35 TABLE I. BIRTH-RATE, DEATH-RATE, AND ANALYSIS OF MORTALITY DUR1NG THE YEAR 1030. 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 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. England and Wales 14.8 0.61 12.1 0.01 0.00 0.07 0.01 0.05 0.07 0.14 0.52 5.9 50 122 County Boroughs and Great Towns, including London 14.0 0.67 12.3 0.01 0.00 0.00 0.01 0.06 0.08 0.14 0.45 8.2 63 143 Smaller Towns Estimated Populations, 25,00050,000) 15.0 0.64 11.5 0.00 0.00 0.04 0.01 0.04 0.05 0.15 0.39 3.4 55 London 13.0 0.53 12.5 0.01 0.00 0.14 0.01 0.06 0.05 0.14 0.52 14.4 60 Acton 12.7 0.4 11..5 0.00 0.00 0.14 0.00 0.00 0.01 0.1 0.43 13.6 68 The maternal mortality rates for England and Wales are as follows:- Puerperal Sepsis. Others. Total. per 1,000 Total Births 1.34 2.31 3.65 „ „ „ „ (Acton) 1.13 1.13 2.26 82 TABLE II. VITAL STATISTICS FOR THE WHOLE DISTRICT DURING 1936 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-Resideants Registered in the District of Residents Registered outside Dist. Number Rate per 1,000 Births Number Rate per 1,000 inhabitants 1927 66,700 1026 15.60 445 6.67 21 280 62 60 704 10.55 1928 67,645 1003 14.83 479 7.08 29 244 55 55 694 10.26 1929 68,600 1026 14.96 540 7.87 21 307 85 83 826 12.04 1930 69,565 1105 15.88 440 6.33 31 284 56 50 693 9.96 1931 70,560 1018 14.43 456 6.46 35 321 62 61 742 10.52 1932 70,640 970 13.70 486 6.88 29 302 60 62 786 11.11 1933 70,300 886 12.60 492 6.99 31 329 41 46 788 11.20 1934 69,472 943 13.57 454 6.50 24 297 39 41 727 10.46 1936 68,960 868 12.60 417 6.04 41 328 51 60 704 10.20 1936 69,140 881 12.7 431 6.2 42 405 60 68 794 11.5 83 TABLE III. AGES AT DEATH. AND WARD DISTRIBUTION Causes of Death. 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 up wards North East. North West. South East. South West. Measles 10 2 7 1 - - - - - 2 3 2 3 Diphtheria 2 - - 1 1 - - - - 1 - - 1 Influenza 7 - - - - 1 1 1 4 2 3 4 - Phthisis 47 - - - - 8 23 13 3 14 12 3 18 Other forms of Tuberculosis 4 - - - 1 2 1 - - 1 1 1 1 G.P.1. & Tabes Dorsalis 1 - - - - - 1 - - 1 - - - Cancer 112 - - - - 1 9 50 52 37 33 23 19 Diabetes 9 - - - - - 3 3 3 3 3 2 1 Cerebral Haemorrhage, &c. 62 - - - - - - 15 47 17 17 12 16 Heart Disease 168 - - - 2 1 12 60 93 45 47 32 44 Other Circulatory Diseases 12 - - - - - 1 3 8 4 2 3 3 Bronchitis 44 1 - - - - 2 12 29 19 5 8 12 Pneumonia 65 10 - 2 1 1 1 27 23 14 22 10 19 Other Respiratory Diseases 9 1 - - - - 2 4 2 4 1 3 1 Peptic Ulcer 8 - - - - - 2 3 3 1 1 3 3 Diarrhoea 12 12 - - - - - - - 4 2 - 7 Appendicitis 4 1 - - 1 - - - 2 1 1 1 1 Cirrhosis of Liver 4 - - - - - 2 2 - 4 - - - Other diseases of Liver 2 - - - - - - - 2 2 -- - - Other Digestive Diseases 1 - - - - - - 1 - - - 1 - Nephritis 21 - - - - 2 3 6 10 8 6 1 - Puerperal Sepsis 1 - - - - - 1 - - - 1 - - Other diseases, &c. of Parturition 1 - - - - - 1 - - - - 1 - Congenital debility, Prematurity, &C. 27 27 - - - - - - - 10 9 3 5 Senility 75 - - - - - - - 75 20 23 12 20 Suicide 10 - - - - - 3 3 4 3 4 1 2 Other deaths from violence 20 - 1 - 2 2 3 10 2 5 9 1 5 Other defined diseases 56 6 1 2 3 4 9 17 14 17 14 9 16 TOTALS 794 60 9 6 11 22 80 230 375 239 218 138 199 84 TABLE IV INFANTILE MORTALITY, 1930. 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 Measles 2 - - - - - - 2 - - - 1 1 Congestion of I.ungs 1 - - - - - 1 - - - - 1 - Pneumonia 10 1 - 1 - 2 2 2 2 2 3 - 4 Diarrhoea 12 - - - - 1 7 1 3 4 1 - 7 Prematurity 9 8 - - - 1 - - - 3 3 2 1 Appendicitis 1 - - - - - - 1 - 1 - - - Congenital Heart Disease 1 - - 1 - - - - - - 1 - - Spina Bifida 1 - - - - 1 - - - 1 - - - StatuoLymphaticuo 1 - - - - 1 - - 1 - - - Marasmus 3 - - - - 1 1 1 - 1 - - 2 Injury at birth 1 - 1 - - - - - - - 1 - - Convulsions 3 - - - - 1 2 - - - 1 - 2 Mongolism 1 - - - - - 1 - - 1 - - - Malnutrition 1 - - - - - - - - - - - 1 Otitis Media 1 - - - - - - 1 - 1 - - - Inattention at Birth 1 1 - - - - - - - - 1 - - Bronchitis 1 1 - - - - - - - 1 - - - Intraeranial Haernorrhage 6 5 - 1 - - - - - 3 1 - 2 Atelectasis 3 3 - - - - - - - 1 1 1 - Pyelonephritis 1 - - - - - 1 - - - - 1 - TOTALS 60 19 1 3 - 9 15 8 5 20 30 7 20 85 TABLE V. CASES OF INFECTIOUS DISEASE NOTIFIED DURING THE YEAR, 1930. Notifiable Disease. Cases notified in whole District. At Ages—Years. Ward Distribution. At all Ages under 1 1 to 5 5 to 15 1ft to 25 25 to 45 46 to 65 Over 65 North East North West South East South West Scarlet Fever 177 1 58 94 10 12 2 - 52 75 27 23 Diphtheria 12 — 6 4 1 - 1 - 4 3 1 4 Pneumonia 35 1 8 2 7 7 10 - 4 10 13 8 Erysipelas 17 — — - 1 6 7 3 4 7 1 5 Puerperal Pyrexia 6 — — - 1 4 1 - 3 1 — 2 Ophthalmia Neonatorum 2 2 - - - - - - - - 1 1 Paratyphoid 1 - - 1 - - - - - - - - Poliomyelitis 1 — — 1 - - - - - 1 - - Tuberculosis (resp.) 89 — 1 2 34 36 13 3 25 30 12 22 Tuberculosis (other) 15 — — 2 7 2 3 1 4 2 2 7 TOTALS 355 4 73 106 61 67 37 7 97 129 1 57 72 86 OPHTHALMIA NEONATORUM. Cases. Vision unimpaired. Vision impaired. Total Blindness. Deaths. Notified. Treated. At home. In hospital. 2 1 1 2 — — — 87 CASES REMOVED TO HOSPITAL. TABLE 6. Total Notified. Scarlet Fever 156 177 Diphtheria 12 12 Pneumonia 19 35 Puerperal Pyrexia 2 6 Erysipelas 4 17 Ophthalmia Neonatorum 1 2 Paratyphoid 1 1 Poliomyelitis - 1 TABLE 7. BIRTHS. Male Female. Total. Live Births. Total 464 417 881 Legitimate 453 392 845 Illegitimate 11 25 36 Still Births. Total 16 13 29 Legitimate 14 12 26 Illegitimate 2 1 3 Notified Live Births. Ward Distribution. Total Births notified in the district Total. N. East. N. West. S. East. S. West. 388 124 93 52 119 Notifications received from other districts 437 148 121 56 112 Notified Still Births Inside 6 Outside 12 Total 18 Notifications were received from : Doctors and Parents 670 Midwives 173 Table 8. INFANT WELFARE CENTRES, 1936. 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 10,650 (b) by children between 1 and 5 years of age 7,737 88 Average attendance of children per session 50 Number of children who attended for the first time during the year:- (a) under 1 year of age 594 (b) between 1 and 5 years of age 209 Percentage of notified live births represented by number of children who attended a centre for the first time during the year 72% Children treated at Dental Clinic 135 Children treated at Ophthalmic Clinic 10 Mothers treated at Ophthalmic Clinic - Children operated on for enlarged tonsils and adenoids 2 Children operated on with X-Ray for Ringworm - TABLE 9. ANTE-NATAL CLINIC. Number of Expectant Mothers who attended 249 Number of attendances made by Expectant Mothers 283 Mothers referred for Dental treatment at the Clinic 90 Mothers supplied with Dentures 34 Expectant Mothers to whom Dried Milk was supplied free 72 Number of packets of Dried Milk supplied free 1186 TABLE 10. INQUESTS. Inquests30. Struck by motor car 10 Collision on railway 1 Suicide 10 Knocked down by train 1 Accidental fall 1 Accidental burns 1 Struck by motor cycle 1 Post traumatic epilepsy 1 Fall from motor cycle 1 Septicaemia after teeth extraction 1 Injuries by laundry machinery 1 Fall from train 1 Coroner's Certificate after Post Mortem without an Inquest-31. Heart Disease 16 Pulmonary Congestion 2 Cerebral Haemorrhage 4 Phthisis 1 Convulsions 3 Cancer 1 Nephritis 2 Inattention at birth 1 Cirrhosis of Liver 4 89 FACTORIES, WORKSHOPS AND WORKPLACES. 1.- Inspection of Factories, Workshops and Workplaces including Inspections made by Sanitary Inspectors. Premises. Inspections Written Notices (1) (2) (3) Factories 75 18 (Including Factory Laundries) Workshops 368 5 (Including Workshop Laundries) Workplaces 9 Nil (Other than Outworkers' Premises) Total 452 23 2.—Defects found in Factories, Workshops and Workplaces. Nuisances under the Public Health Acts:— Particulars. Found Remedied (1) (2) (3) Want of Cleanliness 23 23 Want of Ventilation Nil Nil Overcrowding Nil Nil Want of drainage of Floors 1 1 Other Nuisances 5 5 Sanitary Accommodation:— Insufficient 7 7 Unsuitable or defective 29 29 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 65 65 3.—Outwork in unwholesome premises, Section 108 Nil 90 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). Elsie Madeley, m.b., Ch.b., d.p.h., Assistant Medical Officer of Health and School Medical Officer. P. H. Slater, l.d.s., School Dentist. M. W. Kinch, M.R.San.I., Cert, of 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, Deputy Chief Sanitary Inspector (Inspector under Fabrics Misdescription Act). E. W. Brooks, Cert. of Royal Sanitary Institute, Sanitary Inspector. J. J. Matthews, Cert. of Royal Sanitary Institute; holds Meat Certificate, Sanitary Inspector. A. H. G. Johnson, Cert. of Royal Sanitary Institute; holds Meat Certificate; Meat Inspector. (Appointed 1st June, 1936). Miss A. M. Cooksey, A.R.San.I., Certificate of Royal Sanitary Institute, Health Visitor. Miss J. Welsh, Certificate of Royal Sanitary Institute, c.m.b., Health Visitor. (Died 16/8/1936) Miss B. G. Sorlie, s.r.n., Certificate of Royal Sanitary Institute, c.m.b., H.V. Diploma, Health Visitor and School Nurse. Miss A. Woosnam, s.r.n., c.m.b., Health Visitor and School Nurse. Miss M. I. Greenwood, s.r.n., Certificate of Royal Sanitary Institute, c.m.b., Health Visitor and School Nurse. H.L. Hacker,* Chief Clerk. 91 Miss V. E. Arnold* Clerk. Miss D. E. Beacon. Clerk. Miss A. Kent* Clerk. Miss V. Slack* Clerk. Miss J. Wood* Clerk. Miss M. J. Gilfillan,* s.r.n., c.m.b., Matron, Isolation Hospital. Miss F. A. Cavendish, Matron, Day Nursery. G. Baker,* Disinfector. A. C. Mepham,* Assistant to Meat Inspector and Mortuary Keeper. Note.—To the salaries of all the above officials excepting those marked with an asterisk, contribution is made under the Local Government Act, 1929. I wish once again to express my appreciation and thanks to all the members of my staff for their excellent co-operation during the year. I am, Your obedient Servant, D. J. THOMAS, Medical Officer of Health. 93 ANNUAL REPORT OF THE School Medical Officer FOR THE YEAR 1936. Municipal Offices, Acton, W.3. To the Chairman and Members of the Acton Education Committee. Ladies and Gentlemen, We beg to submit the following report upon the schools and school children of Acton for the year 1936. As in former years the subject matter has been arranged as far as possible in tabular form. The tables at the end of the report are those issued by the Board of Education. In 1936 the general health of the school children was satisfactory. There was practically no Diphtheria, and Scarlet Fever was confined in large measure to one area in the town. The outstanding feature of medical interest and anxiety was the increase in the cases of Rheumatism among our school children. This disease is not only dangerous during the acute stage, but leaves such a train of ill effects behind it that at the best the child has to be kept under supervision for the remainder of its school days. Often the child has to be sent to a special school or Heart Home for a time, if not for the remainder of its school life. The reason for the increase in cases is difficult to find, but an article on Rheumatism and its causes, &c., will be found in the report. 94 Another puzzling feature of the year 1936 was an outbreak of Scabies. This was not confined to the Borough of Acton as was evidenced by the fact that our usual arrangements for dealing with these cases broke down under the strain of patients sent for treatment from other sources, and new arrangements had to be made. Details of the cases are given in an article in the report. The drains and sanitary conveniences at all the schools have been periodically inspected by the Sanitary Inspector. In 3 of the schools all the drains and sanitary* fittings were satisfactory. In the others, certain minor defects were noted and a copy of the full report has been sent to the Director of Education, and the matters will have the attention of the Education Committee at an early date. PUBLIC ELEMENTARY SCHOOLS WITHIN THE DISTRICT WITH ACCOMMODATION. Name of School. Dept. Accommodation. Avge. monthly No. on Registers Average attendance Acton Wells Senior 320 232 214 Junior 364 413 377 Infants' 364 384 302 Beaumont Park Senior Girls' 450 163 148 Junior Girls' 450 213 198 Infants' 400 219 179 Berrymede Junior Boys' 640 433 384 Junior Girls' 542 381 342 Infants' 450 292 242 Central 480 420 390 Derwentwater Junior 441 381 351 Infants' 350 302 239 John Perryn Senior 360 219 199 Junior 288 266 244 Infants' 336 280 240 Priory Senior Boys' 500 299 270 Senior Girls' 499 337 287 Infants' 400 265 219 Rothschild Junior Boys' 450 210 190 Infants' 400 262 212 Southfield Senior Boys' 415 169 157 Junior Mixed 382 318 289 Infants' 350 266 206 Turnham Green R.C. Mixed 327 327 202 Special (M.D.) 68 42 33 10026 7009 6114 95 average HEIGHT without shoes and AVERAGE WEIGHT without clothes. Anthropometric Committee, 1929. MALES. FEMALES. Age last birthday. Height in Weight in Height in Weight in ins. lbs. ins. 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 TABLE SHOWING HEIGHTS AND WEIGHTS AT DIFFERENT AGES LEAVERS (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. Weight lbs. Acton Wells Senior 47 47 57.3 84.2 ... ... ... ... ... ... Central 47 47 58.3 83.6 ... ... ... ... ... ... John Perryn Senior 38 36 58.4 79.9 2 62.7 99.2 ... ... ... Priory 111 110 57.6 81.4 1 56.3 72.8 ... ... ... Southfield Snr.Boys' 66 64 57.1 80.4 2 60.5 97.6 ... ... ... Roman Catholic 10 9 56.6 81.1 1 62.3 91.8 ... ... ... 319 313 6 ... (GIRLS) Acton Wells Snr. 51 49 57.6 78.9 2 60.6 91.2 ... ... ... Beaum't Pk. Snr. 68 68 58.6 86.2 ... ... ... ... ... ... Central 60 60 59.1 86.8 ... ... ... ... ... ... John Perryn Snr. 38 38 59 82.6 ... ... ... ... ... ... Priory 110 106 58.3 77.4 4 60.1 85.4 ... ... ... Roman Catholic 9 7 62.6 97.5 2 62 100 ... ... ... 336 328 8 96 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 Wells Junior 18 12 48.9 53.9 6 50.1 57 ... ... ... Acton Wells Infts.' 37 26 48.8 53.9 11 49.6 55.5 ... ... ... Beaumont Pk. Infts.' 4 4 46 49.3 ... ... ... ...... ... ... Berrymede Jnr. Boys 94 53 49.3 55.8 41 49.4 55.7 ... ... ... Berrymede Infants' 2 2 48 53.1 ... ... ... ... ... ... Derwent water Jnr. 45 29 49.2 55.9 12 50.7 57.9 4 52.6 66.7 Derwentwater Infts.' 1 1 48 52 ... ... ... ... ... ... John Perryn Infts. 43 20 49.4 52.8 23 50.2 55.5 ... ... ... Priory Infants' 9 9 47.9 50.8 ... ... ... ... ... ... Rothschild Junior 42 12 49.5 55.3 30 49 54.3 ... ... ... Rothschild Infants' 3 3 48.6 51.5 ... ... ... ... ... ... Southfield J unior 32 12 48.9 53.7 20 49.6 55.9 ... ... ... Southfield Infants' 4 4 49.2 54.3 ... ... ... ... ... ... Roman Catholic 11 5 48.2 52.2 6 50.1 53.4 ... ... ... 345 192 149 4 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 Wells Junior 18 14 49.5 56.4 4 50.4 57.2 ... ... ... Acton Wells Infants' 44 29 48.7 54.2 15 49.1 54.2 ... ... ... Beaumont Park Jnr. 45 21 48.8 52.8 23 48.9 53.4 1 50.5 49 Beaumont Park Infts. 2 2 48.4 50.4 ... ... ... ... ... ... Berrymede Jnr. 79 49 48.6 52.9 30 49.3 56.3 ... ... ... Berrymede Infts. 5 5 47.3 50.2 ... ... ... ... ... ... Derwentwater Jnr. 45 24 49.1 58.9 16 50.2 58.6 5 50.9 59.2 Derwentwater Infts.' 5 5 46.9 49.1 ... ... ... ... ... ... John Perryn Jnr. 1 ... ... ... 1 51.3 61 ... ... ... John Perrvn Infts.' 42 23 48.8 51.1 19 48.8 51.6 ... ... ... Priory Infants' 5 5 48.1 51.8 ... ... ... ... ... ... Rothschild Infants' 4 4 48.5 50.4 ... ... ... ... ... ... Southfield Junior 34 17 49.1 55.5 17 48.9 55.2 ... ... ... Southfield Infants' 2 2 47.9 44.2 ... ... ... ... ... ... Roman Catholic 18 6 49.1 56.2 7 48.8 52.4 5 52.2 57.5 349 206 132 ... ... 11 ... ... 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 Wells Infants' 66 ... 31 41.4 38.2 32 43.8 42.7 3 45.9 51 Beaumont Park Infanta' 32 14 37.1 33.7 6 40.1 38.6 8 42.7 42.3 4 44.9 46.5 Berrymede Infants' 49 19 37.1 33.6 12 39.4 36.8 14 42.5 41.1 4 46.3 49.1 Derwentwater Infants' 73 ... ... ... 20 41.7 40 36 43.9 44.7 11 46.8 49.8 John Perryn Infants' 36 ... ... ... 10 40.8 38.9 17 44.1 44.3 3 41.8 51.1 Priory Infants' 67 12 37.9 30.5 25 40.2 39.7 27 42.9 43.2 3 45.2 48.3 Rothschild Infants' 56 17 37.9 34.6 20 40.6 39.7 16 42.9 40.7 3 46.5 50.8 Southfield Infants' 58 ... ... ... 19 41.2 39.6 33 43.8 43.9 6 46.3 49.8 Roman Catholic 16 ... ... ... 9 41.2 38.4 5 44.4 45.4 2 46.9 52.6 453 62 164 188 39 (GIRLS) Act-on Wells Infants' 52 ... ... ... 24 41 37.6 20 46.5 42.3 8 45.2 45.2 Beaumont Park Infants' 37 11 37 33.3 13 40.3 38 8 40.8 37.4 5 45.3 49 Berrymede Infants' 40 14 37.1 33.3 11 39.6 36.5 8 422.4 41.2 7 45 46.5 Derwentwator Infants' 70 ... ... ... 30 40.8 39 34 43.7 43 6 45.1 46.8 John Perryn Infants' 27 ... ... ... 6 40.3 36.2 16 43.4 42.1 5 45.8 46.8 Priory Infants' 52 9 37.3 33.4 21 40 37.1 15 42.9 40.4 7 46 46.6 Rothschild Infants' 42 13 37.1 32.9 8 40.9 37.8 18 42.7 41.1 3 43.6 41.3 Southfield Infants' 52 ... ... ... 15 1.1 39.3 26 43 40.5 11 45.5 46 Roman Catholic 11 ... ... ... 4 42.5 41.6 4 44.6 44.6 3 44.6 42.9 383 47 132 149 55 98 RHEUMATISM. Acute Rheumatism is a disease of childhood and youth whose effects persist to adult life and is the cause of much of the heart disease met with in adolescence and later in life. It was first named and described some 4 centuries ago by Baillon and referred to by Sydenham in the 17th century as attacking the young and vigorous. It was not however, until well into the 19th century that the disease found a place of any importance in the books on diseases of children and not until the 20th century were attempts on any large scale made to use the knowledge gained to avert or alleviate the condition. Much work was done by many clinicians, pathologists and bacteriologists on the causation and course of the disease in the latter part of the 19th century and up to the present day work is still being eagerly carried out. Many theories have been put forward, discarded, amended, and even now the cause of rheumatism in childhood is the subject of much research. The association of Rheumatism with heart disease was first pointed out in 1778 and with the invention of the stethoscope in 1816 the association was established. In 1809 the connection between Chorea and Rheumatism was first noted and the observation was confirmed in 1821 by Copeland. Later, in 1847, the connection was beginning to be acknowledged and by 1870 it was generally accepted. During the present century increasing interest has been taken in this subject and it has been realised that if heart disease is to be attacked in the adult population, prevention must be practised among children. From 1920-1924 investigations in London and Glasgow were carried out, and the results published by the Medical Research Council, and between 1920-1927 the British Medical Association held meetings and published reports on " The care of the rheumatic child " and Sir George Newman prepared a special report on " Acute Rheumatism in children and its relation to heart disease'.' F. J. Poynton was one of the most earnest workers on the cause, care and treatment of rheumatism in childhood, and as far back as 1912 he was saying that "special convalescent homes will be the means of averting much of the chronic heart disease of rheumatic origin that ruins so many lives and is the despair of the physician and our general hospitals." Unfortunately Dr. Poynton was not listened to and it was left to America to show us the way when they established special cardiac clinics for the control and care of children suffering from rheumatism but not ill in hospital. 99 It was the Invalid Children's Aid Association in this country which took the first step in dealing with rheumatism in childhood and now no country has a better organisation than this. A special convalescent home gives the child's heart the best chance of recovery in the best circumstances. If the child is left in its own home where the other children have no disability, where the mother is overworked and has no time to see that the affected heart is not being overstrained, or where overanxiety leads to the insistence that the child does nothing at all, where is the chance of improvement compared with regulation of life, exercise, and education found at these special convalescent homes? It has been said that ideally, every child whose heart has been affected by rheumatism should spend from 12-18 months afterwards at these special homes to lessen the chance of a recurrence. Most acute rheumatism occurs in poor rather than rich homes. It is not unknown among the well-to-do but it is much more frequent in a poorer stratum of society. Overcrowding, insanitation, dampness and deficiency of diet have all been cited as contributory factors. It will be interesting to see whether the large number of houses that are being built for slum clearance areas will result in a diminution of acute rheumatism in children owing to increased space and air or in an increase if these houses have been too rapidly and flimsily constructed to be weather-resisting in a climate such as ours. Acute rheumatism in Acton is at present, steadily on the increase and has been so since 1931. In 1936 there were twice as many cases as in 1935 and 1935 contained as many cases as the years 1931-1934 inclusive. It is hard to explain this. Acute rheumatism, according to expert observers of the disease such as F. J. Povnton, will come in waves some years and it may be that we are now approaching the crest of one of these waves. It is also a well known fact that once the need for certain facilities is recognised, the cases to be treated wall follow. Acton has a Rheumatic Clinic for its school children at the Princess Louise Hospital for Children. Here all suspected and diagnosed cases of rheumatism are referred and treated and when it is advised, arrangements are made for admission to an appropriate convalescent home. Acton children are not infrequently admitted to the West Wickham and the Edgar Lee Heart Homes and the Heart Home, Lancing. It is possible that these facilities are becoming more widely recognised and made use of and that this, in part, may account for the increase in rheumatic cases noted among school children. 100 Attention has been focussed so very much in recent years on the damage caused by untreated or inadequately treated Rheumatism in childhood that the careful observer is alert not to miss the early signs that will mean that early treatment which can promise an almost sound heart afterwards. It may be that the ever present thought of Rheumatism means earlier and readier diagnosis and treatment. It is by no means unusual however, even now, to encounter on routine examination, a child with a damaged heart and only a vague history of ill-health or "growing pains" sometime in the past. The child has not been ill enough at the time for a doctor to be consulted, but permanent damage has been done, resulting in the necessity for the child to be "followed up" for the rest of the school career in case of a recurrent attack. There is no evidence that Rheumatism in childhood is on the decrease either in numbers or in virulence. As this disease attacks those strata of society where physical fitness is most essential for wage earning, it will be seen how urgent a problem the proper care of rheumatism is and that its prevention is one of the most pressing of public health problems. » TONSILS AND ADENOIDS. 47 cases were operated on during the period January to December, 1936, for removal of Tonsils and Adenoids under the Authority's scheme. 39 were operated on for unhealthy tonsils and adenoids which have been giving rise to tonsilitis, frequent sore throats or colds, enlarged glands in the neck, &c. 2 had tonsils and adenoids, and 2 had adenoids only, removed because of continued ear discharge. 3 cases were operated on because of deafness, 2 having their tonsils and adenoids removed and 1 adenoids only. 1 child was operated on because she had Rheumatism and it was considered that her unhealthy tonsillar and adenoid tissue might be the focus of infection. AURAL REPORT. This year 102 cases were referred for examination and treatment to the Aural Clinic. This means an average of between 2 and 3 new cases every' week, so that it appears that full advantage is being taken of the clinic. Not all cases so referred are found to be Suffering from ear disease although most are, 101 Of the 102 cases referred in 1936 8 were found to-be suffering from wax in the ears only with no disease present. 4 were referred for deafness—3 of these were referred to the Ear Specialist at the Acton Hospital and removal of the adenoids or tonsils and adenoids helped the condition, another was only slightly deaf following a bad head cold and improved on local treatment. 15 cases were referred for earache, where the condition subsided on appropriate treatment and did not proceed to ear discharge. 71 cases of otorrhoea or ear discharge were dealt with during the year, and by the end of the year 61 of these had been discharged as cured, a percentage of 85.9. Of the remaining 10 cases, 5 were no longer attending the Clinic but were receiving treatment at various hospitals, either having been sent there by us, or having gone there of their own accord, and 3 cases were in hospital and had been for an extended period for different diseases, i.e., eczema, lung trouble, &c. Of the remaining 2 cases, one was absent from school at the end of the year so the condition of the ear was not known, and one case was nearly well. 4 cases left school during the year, still suffering from otorrhoea. 2 of these were nearly well and were given advice as to how to proceed, 2 were hopeless cases, no amount of cajoling, scolding or threatening would make home treatment even reasonably effective. Advice was given, repeatedly given, to be ignored, and it is felt that these two children will inevitably suffer from impaired hearing. - The Ear Clinic has been run on slightly different lines this past year. The ideal aimed at was the closer co-operation between doctor and nurse in the supervision and treatment of these ear cases. All cases therefore, were seen by the nurse three times a week and by the doctor twice weekly. This ensured that at least once a day on each school day the auditory meatus was made completely clean, and how important that is can only be appreciated by one who has had some experience of dealing with cases of otorrhoea. We are convinced that the results have justified the work entailed. Where it was thought that more frequent attention was necessary 102 the parent of the child was seen and instructed how to proceed, if the child were not old enough to be taught how to keep the ear clean by him or herself. As mentioned in previous reports, one of the most difficult things to impress on parents is the importance of Nose Hygiene in dealing with ear discharge. Consent would willingly, in most cases eagerly, be given to operative measures such as removal of tonsils, but lesser measures calculated to produce a healthy nose ana naso-pharynx are only too often met with indifference and scepticism. A little lecture on Anatomy sometimes has the desired effect in stimulating co-operation from the parent. Where home treatment is not being carried out adequately, the parent is interviewed and instructed. Straight speaking is not always appreciated, as witness one case which had been resisting treatment through home neglect, and had in the end to be referred to the Acton Hospital where it was considered that a mastoid operation would now be necessary to cure the condition This the mother would not consent to, and said that she had never meant to allow any " interference with her son, although she had allowed us to send her to hospital with a letter and wasted the time of the specialist in seeing her boy. On being told that it was largely her own fault that there was any question of " interference," the mother left the clinic and took her child to another hospital, where similar treatment was advised and carried out. It is not often that such situations arise, in only 3 cases last year did the Clinic fail to obtain the willing co-operation of the mother, in others it may have meant repeated interviews but success was attained in the end. In comparing the figures for the clinic for 1936 with those of the previous year, it must be noticed how the cases of otorrhoea have increased. This may be explained, partly, by the fact that Measles was rampant in the first half of 1936 and the epidemic resulted in many cases of ear infectious. Last year this was found to be generally much more the case than is normal in Measles epidemics. In several cases where treatment was being carried out conscientiously, and the desired results were not being obtained, attention was directed to the child's general condition and success was attained when treatment was combined with general tonics and cod liver oil and malt. 103 Sometimes quite startling results are obtained by regular supervision and treatment, one case where ear discharge had been present for one year before attending school. After one months' treatment at the Ear Clinic, the ear ceased to discharge and has not recommenced, having been dry now for some months. Such results are encouraging and stimulate us to continue the attention and care which the Ear Clinic endeavours to supply. PROVISION OF MEALS. As formerh, meals continue to be granted to necessitous school children who are suffering from the effects of malnutrition. It not infrequently happens that children are sent along to be examined with a view to recommendation for free meals, because their fathers have fallen out of work. On examination these children may be, and often are, found to be in good condition, well up to the average in development, and in bodily and mental vigour. It seems therefore sometimes that the careful and conscientious parent is penalised at the expense of the careless and thriftless. These children cannot medically be recommended for free meals and milk, but they are kept under observation, and should the new financial conditions in the home be leading to loss of weight, pallor, listlessness or flabbiness, then a recommendation can be made so that the former good condition can be regained or maintained. Very rarely is it necessary to place these children on the feeding list, as the careful mother seems to manage, even when the father is out of work, to keep the children in good condition. How far these conditions would obtain if unemployment continued for more than a short period, is a debatable point; experience in the distressed areas points to the inevitable conclusion, that prolonged unemployment leads ultimately to deterioration in the general condition of the children. While no great expenditure is called upon in the way of clothes or boots or medicines, &c., it is possible to imagine that a careful mother would manage to maintain conditions in the home as formerly, but any excess expenditure must mean shortage somewhere else, and it is then that the strain would be felt. One case can be instanced to show the good sometimes done by free meals and milk. C.G. when first seen at 4½ years was whitefaced, listless, flabby and underweight. Free meals were recommended, and in three weeks she had put on nearly 3 pounds, was much brighter and was beginning to have some colour in her face. The improvement in her general condition was most noticeable and very gratifying. 104 The numbers of children on the free meals list during the year are as follows:— Meals and Milk. Milk only. No. in quarter ending 31st March 250 70 30th June 230 80 30th September 200 80 31st December 220 80 The actual numbers of free meals and bottles of milk supplied are:— Meals. Milk. Quarter ending 31st March 12019 30399 30th June 9223 24195 30th September 6948 20054 31st December 9837 26718 Total 38027 101366 During the year it was considered that if so many children were medically in need of meals, it must be detrimental to them if they were deprived of free meals during the holidays. It had not been the practice to supply meals during the holidays up to then. During the Christmas holidays therefore, three Centres were chosen, and meals were supplied to the children there on every day except Saturdays, Sundays, Christmas and Boxing Day. The attendance was very good, out of a possible 211 children, 188 attended, and out of a possible total of 1880 meals, 1539 were served. The facilities were evidently appreciated, and the opening of the Centres for the purpose of holiday meals was justified by the good attendance of the children. Approximately 150 families were helped with free meals or milk during 1936, the numbers in the families ranging from one to six. Speech Training Classes. Classes for speech training are still being held at the Priory School twice a week. The Stammerers are now divided into two classes, one for children of ten years and under, the other for children of eleven 105 years and over. In these classes, which last for three quarters of in hour, most of the time is used for muscular relaxation. The children are prepared for this by simple exercises and suggestion of a feeling of ease, they then lie down on their mats and cushions for a short period. The rest of the lesson is taken up with conversation about the relaxing and about the everyday interests of the children, rhythm exercises, recitation and easy talking games. The Speech Defect cases are divided into small classes according to the type and degree of defect. There is one case of cleft palate speech, and one or two cases of lisp, the other children are all cases of delayed speech or bad articulation owing to faulty speech education in the very early stages. Two children suffer from slight deafness which has retarded their speech. The normal child should be able to say a number of words before he is two, and should be able to talk freely by the time he is three years old. Inability to do this is due either to neglect or to the fact that the mother encourages the child's baby talk and does not attempt to teach him to say his words properly. Mothers frequently report that they can hear what their children say ; it does not seem to occur to them that it matters whether anyone else can understand them. It is necessary in most of these cases to re-educate the speech and teach the children to copy every shape and sound by the mouth. The children practice breatheing and mouth flexibility exercises, vowel and consonant sounds, repetition of simple nursery rhymes and jingles, and singing games. It is extremely tiring to work the mouth in a way to which it is not used, and an important point in these lessons is to keep the children interested in a variety of ways during a short lesson so that they do not realise the physical exertion and become fatigued. For this reason a certain amount of apparatus is employed in the form of large cut-out letters which the children can feel with their fingers and speak the sounds and gradually build up into words. Picture books are very popular and the smaller children enjoy describing the pictures and re-telling stories about them. The older children like drawing and writing and are very often unconsciouosly learning the correct production of a sound they are writing by mere repetition. The children are encouraged to bring drawings or toys they have made at home, and this term we have been growing some bulbs in order to keep them interested in coming to the classes and to help them to learn to have confidence in themselves through their mutual interest and occupations. As a rule the cases of delayed or baby speech and bad articulation do not take long to cure. This depends on the general intelligence of the child. The children who are deaf or are less developed mentally take a long time to realise the difference between 106 their speech and other peoples' and are therefore slow to improve. The more intelligent child, however, who readily grasps what is required of him may show a big improvement in a few weeks. The figures for 1936 are as follows—At the beginning o January 1935, 12 stammerers were attending the classes and during the year 7 more were admitted. Seven of these children were bad stammerers, 2 are not improved but the others are much better although none are yet cured. One has since left school, much improved. 4 were cases of stammering of moderate severity, 1 has been cured, 1 so much improved that he is only under supervision in case of relapse, and 2 are much improved—one of these has since left school. 8 were mild stammerers. 6 of these were much improved and the other 2 were transferred to the Speech Defect Class as being more suitable to their condition, and one of these has since left the' district. One mild stammerer has also left school but was much improved. By far the greater number of children attending the Speech Training Classes in 1936 were cases of delayed or baby speech. There were 37 children attending at January 1936, 34 of these were cases of baby speech. 10 were mild cases, and of these 6 were cured, 3 much improved, and 1 went to a Convalescent Home for some other complaint. 11 were cases of moderate severity, 6 of them were cured, 3 improved, and 2 did not improve. 13 cases were suffering from bad speech defect, 10 of these were improved, 1 left school, 1 left the district, and 1 refused to attend the classes. Of the 3 remaining cases, 1 case of true lisp left the district before much had been accomplished, 1 who spoke badly because he was deaf ceased to attend the classes as it was not making any difference to his speech, and 1 who spoke badly because of cleft palate improved very much. During the year, 10 more cases were admitted for speech training, 3 of these were suffering from lisp, 1 bad and 2 mild cases. The bad lisp left the class to go to a Convalescent Home, and of the 2 mild cases one improved and one left the district. 1 child was sent to the Speech Classes because slight deafness made him speak badly, his parents removed him from the class because they did not think it was doing him good. The 6 others were cases of 107 delayed or baby speech. 3 were bad cases and 3 mild. One bad case showed little, if any, improvement, 2 others improved verymuch. 2 of the mild cases improved and 1 was sent to a private school before results could be obtained. EXCEPTIONAL CHILDREN. On Table 3 will be found a return of the exceptional children in the district. Partially Sighted Children. One child, although her sight is very much impaired, attends an ordinary elementary school. She attends hospital regularly and in answer to a recent enquiry from us, the hospital authorities stated that they considered it perfectly satisfactory that she should do so, and that it was not detrimental to her future. The other 3 children attend Kingwood Road School. Deaf Children. 5 children are attending Ackmar Road School for the Deaf, 2 girls and 3 boys: Two of the boys are brothers and are deaf and dumb. Mentally Defective Children. 43 children are at present attending the Acton Special School for Mental Defectives, 16 girls and 27 boys. During the year there have been 8 new admissions. Epileptic Children. 3 children in the Borough suffer from severe epilepsy. 1 is resident in Lingfield, and 2 are at home. Tuberculosis Children. 2 children are in institutions suffering from tuberculosis of the lungs, one in Harefield and one at Tadworth. 3 children suffer from non-pulmonary tuberculosis, one is in the Victoria Home, Margate, and 2 are now at home and attend hospitals in London. Crippled Children. 10 children are contained in this category, 6 boys and 4 girls. One of the boys is at the Shaftesbury Home, Hastings, 1 attends Brook Green School. 3 are attending ordinary elementary schools 108 but are under hospital supervision, and 1 is an in-patient of Middlesex Hospital. 1 of the girls is in St. Vincent's Home, Pinner, 1 attends Queensmill Road School, 1 attends Faroe Road School, and the other is an out-patient of Middlesex Hospital and attends an elementary school. Delicate Children. This year 14 children come under this heading. 9 are suffering from the effects of rheumatism, 1 is in the Heart Home, Lancing, 1 at St. John's Kemp Town, Brighton, 1 is an in-patient at the Princess Louise Hospital, Kensington, 1 attending that hospital as an out-patient, 1 attending school for half days only meantime. 1 attending an ordinary elementary school while waiting for a vacancy at an open air school, and 1 has just recommenccd school after three months at a convalescent home at Bexhill. 2 other children are at home and attending hospitals as out-patients. Of the other 5 children, 2 are suffering from malnutrition, (1 is at the Royal Sea Bathing Hospital, Margate, and 1 is waiting for admission to an open air school). 1 child, suffering from fibrosis of the lungs, is waiting for admission to an open air school, 1 who had suffered from Tubercular Adenitis is attending an open air school, and 1 girl who had been for a a long time an in patient at St. Vincent's Hospital, Pinner, is attending Wood Lane Open Air School. REPORT OF THE SCHOOL OCULIST. In the past twelve mouths 397 children were referred to the Ophthalmic clinic for examination. Of these 41 refused treatment or left the district, 10 obtained glasses privately, 84 were found not to require glasses, and glasses were prescribed in 262 cases. 16 cases of external disease of the eye attended for treatment. 41 boys from the Junior Technical and County Schools were examined. 30 of these were provided with glasses through the clinic, and 4 refused treatment or obtained glasses privately. 7 were found not to require treatment. 17 children from the Welfare Centres were examined, and of this number 10 were supplied with glasses through the Clinic 1 was treated privately, and 6 were kept under regular observation' 4 children were referred for treatment of external diseases. 109 During the year there has been a marked improvement in the co-operation obtained from parents of children suffering from squint. The Clinic has been supplied with extra apparatus for the investigation of cases of squint and muscle balance, and all children attending have their muscle balance checked both before and after refraction. Children suffering from defects of this kind, attend on the average once a month. This record of their progress makes it possible to discover those cases in which the "home treatment" is not being adequately carried out and serves to maintain the parents' interest in the progress made by their children. In the period covered by this report, no case of ocular disease due to undernourishment or bad living conditions was observed.' A few cases of congenital defect and diseases either transmissable or hereditary are under treatment or observation. SCHOOL DENTAL REPORT. The work of the Dental Department in 1936 had to be reorganised and extra assistance called for to as great an extent as the present premises and accommodation would allow. It was found with the increased work resulting from the exanunation and treatment of the Junior Technical and County Schoo's and the growing use of the department by the Child Welfare Clinics, that the unavoidable delay which arose before treatment could be undertaken, was in danger of rendering the service inefficient. If such a period has to be spent on the waiting list that when the patient comes up for treatment it is too late for conservative measures, and extraction has to be resorted to, the aims of the service are being defeated and the patients are not receiving the attention they should Conservative work naturally takes much more time, but a realisation of its importance has caused the request for assistance in this branch of the work for three half-days per week. As stated before, the present accommodation does not allow of more help but it is felt that considerably more assistance will be necessary is future to render the service 100% efficient. Use continues to be made of the department by expectant and nursing mothers, and this year the number of dentures fitted for mothers from the Child Welfare Centres has risen from 19 to 34, each of these representing several ordinary appointments. The number of extractions in 1936 is rather less than in 1935, but this is explained by the fact that a tremendous drive took place at the end of 1935 to clear off a long waiting list, the extra 110 sessions thus arranged artificially sending up the number of extractions for the year. It has been necessary also in 1936 to have extra extractions sessions whenever it was found possible to fit them in, as otherwise the waiting list tended to become unmanageable Ideally the position would be such that at the end of the year only so much work remained as could be overtaken while the new year's work was being organised, but that at present is unfortunately not the case, as over 1000 cases at the end of the year were waiting either treatment or consent for treatment, this representing a lag of about 2 months. The time lag is greater than this seems, as unfortunately it is not always possible for appointments given, to be kept by the patients. This means waste of valuable time which might have been filled by someone else on the waiting list, as notice may not be given in time to make a further appointment. Where a reason for not keeping the appointment can be given, further appointments can be made, but "did not turn up" is an all too frequent cause of wasted time which might have been spent in reducing further the waiting list. Figures for the work carried out for elementary school children are contained in Tables at the end of the report, and below are figures for work carried out on the Technical and County Schools, and for the Welfare Clinics. Secondary Schools. Welfare Centres. Mothers. Children. Inspected 638 88 155 Referred for trt. 453 88 135 Treated 241 90 135 Attendances 493 Fillings 385 411 Extractions 165 66 Dentures 34 934 Other operations 66 108 INFECTIOUS DISEASES. Diphtheria. During 1936, only 12 cases of Diphtheria were notified in the Borough, making this a record year. There were 2 deaths, for both of whom immunisation had been refused. 111 1936 was a poor year from the immunisation point of viewin the Borough. Every effort was made to keep up the herd immunity, but owing to the relative freedom of the district from Diphtheria, the interest of the parents in artificial immunisation was difficult to rouse. Children also who had been inoculated against Diphtheria three years ago were offered re-inoculation to keep up their level of blood immunity. To begin with, and as reported in the Annual Report of 1935, all children who had been immunised three years ago were Schick tested, and only those found to have relapsed into positive Schick reactors were re-immunised. At present the Schick test is the only indicator at our disposal for widespread use in a community test to the level of blood immunity reached. That Diphtheria can and does occur in subjects who have been rendered Schick negative, seems to us an indication that to a large extent our efforts in this line were waste of time. Here and there, all over the country, from time to time clinical Diphtheria is found in those who are or who have been rendered Schick negative, and although the fact that the great majority of these cases are mild or moderate attacks of the disease is matter for congratulation, it is unsatisfactory that "Schick negative" is not synonymous with "immune." In an article published in the Lancet in March 1935, H.J. Parish and J. Wright gave data of investigations made by them into the "Schick level" They found that in Schick negative reactors there might be a titre of immunity only 1/16th of What is supposed to result when inoculation has produced a negative Schick reaction. In the same article the writers gave figures from some preliminary experiments with "multiple Schick toxins" where the combining power was 4 to 10 times as strong as the material commonly used. With "fourfold" Schick toxin, negative Schick reactions were obtained where the titre was only l/3rd that which was supposed to result from inoculation which rendered the subject Schick negative. It must be seen then, that the Schick test as commonly used is not a sufficient index of the level of immunity. During part of 1935 and 1936 tests were made of comparison between the numbers of Schick positive reactors obtained when ordinary Schick toxin and fourfold Schick toxin were used on the same person. A total of over 500 cases are recorded and the results are tabulated below. The precedure was as follows:—a control—fourfold—was injected into the right arm, and ordinary Schick toxin was injected 112 high up into the left forearm and fourfold toxin lower down is the left forearm. Results were read on the third day. Years of Age. Total 1 2 3 3 5 6 7 8 9 10 11 12 13 14 No. tested 6 12 3 14 29 35 38 62 62 49 68 59 66 8 511 Neg. both toxins 6 12 3 13 27 28 27 49 51 38 60 42 50 6 402 Pseudo - - - - - 1 2 1 1 2 2 2 6 1 18 Pos. both toxins - - - - - 1 3 1 3 1 4 7 4 - 24 Pos. only with 4-fold, negative ordinary toxir - - - 1 2 5 6 11 7 8 12 8 6 1 67 It will be seen that of the 511 eases tested, 24 were Schick positive by the ordinary testing, but 91 were positive when fourfold toxin was used. In other words, by ordinary methods only rather under 5% of cases gave positive reactions, while with fourfold toxin 17.8% gave positive reactions. The total number of Schick positives is smaller in both cases than would be expected in an open community, as included in this total were many children who were being tested 3 years after primary inoculation. It was not felt that the position was satisfactory. There are no figures available—indeed the time during which the stronger toxins have been used has not been long enough to show of the strength of toxin necessary to ensure that a negative reaction is synonymous with complete protection. With a fourfold testing toxin, three times as many children appeared to be susceptible to Diphtheria, with a tenfold toxin the number might again be trebled, but even then we have no proof that those children rendered negative to such a toxin would possess a 100% immunity. With a test at our disposal, which is not of reliable index of immunity against Diphtheria, what, it was thought, of the false sense of security which might dull a highly "immunised" community to the possibility of their children meeting and falling victims to a virulent outbreak from outside? From an administrative point of view the position looked alarming. It is possible, and has to a large extent been done in Acton, to crush Diphtheria almost out of the young population so that no longer in their ordinary lives do the children meet the small sub-clinical doses of infection which 113 might help to stimulate their perhaps waning immunity. It is conceivable that the last state of that community might be worse than the first. Immunity conferred for a long enough period to make Diphtheria a rare disease, and then allowed to lapse, leaves a community lulled by a false sense of security, a community which would be virgin soil for a virulent infection from outside. In Acton therefore in 1936, a new technique has been adopted which it is hoped will lessen the risks of such an invasion. Babies, pre-school children and school children are still inoculated as before, and Schick tested afterwards to ensure that that level of immunity is at least reached. We do not know that it is a safe level but it is at least better than no level at all. Fourfold toxin is now used entirely for Schick testing, no weaker toxin is used in the Borough, so that the "Schick level" is as high as practicable. The immunity thus conferred is kept up by regular injections of immunising material every three years so that until the child leaves school protection is maintained at that level as far as possible. Time only will show whether the level attained and kept is sufficient to prevent Diphtheria altogether in inoculated children, but it is felt that the community is by this method much more efficiently protected. Eight cases of Diphtheria occurred in school children and there was one death, in a boy whose parents had not had him protected. The schools at which these cases occurred were 1— Acton Wells; 3—Berrymede; 3—Derwentwater and 1—Priory. It is significant that with these four exceptions the schools were completely free of Diphtheria. This has its dangers, which we are already facing, because this freedom from infection has bred a feeling of apathy and indifference in the parents. The immunisation figures for this year are low as compared with last year, although the same facilities have been offered and the same course of action urged as formerly. The herd immunity in most of the spools was much lower at the end of 1936, as compared with the end of 1935. It appears as if the seeds of failure were contained in our successful efforts. The fear of Diphtheria drove the people to artificial immunisation, and we were in sight of complete freedom from the disease. In the last 7 mouths of 1936 only 2 cases were notified, with no deaths. The immediate effects of our efforts to stamp out Diphtheria have obviously been successful, but we are apprehensive of the future unless these efforts continue to be successful. 114 The comparative freedom of the district from Diphtheria has deprived us of the material by which the population became naturally immunised by sub-clinical doses, and unless we can replace this deficiency by artificial immunisation, we may again be in danger of an epidemic of the virulent type. 11 Diphtheria patients and 39 contacts were seen at the Office before returning to school. Diphtheria Immunisation—1936. Schick Tests. Positive reactors. 1st. dose. 2nd. dose. 3rd. dose. A.P.T Acton Wells Junr. 2 2 2 2 2 - Acton Wells Infants - - 13 15 14 1 Beaumont Pk. Infants - - 2 2 4 - Berrymede Jnr. Boys 48 23 23 16 13 - Berrymede Jnr. Girls 43 21 22 14 8 - Berrymede Infants - - 16 17 13 2 Central — - - 2 2 - Derwent water Junior 2 1 2 2 2 - Derwentwater Infants - - 35 26 22 7 John Perryn Senior - - 1 1 - - John Perryn Junior - - 1 - 1 - John Perryn Infants - - 20 20 19 3 Priory Boys 2 1 1 5 2 - Priory Girls 1 1 1 5 3 - Priory Infants - - 15 2 4 3 Rothschild Junior - - - - - - Rothschild Infants - - 16 11 10 1 Southfield Snr. Boy3 1 - - - - - Southfield Junior 1 - 2 8 9 - Southfield Infants - - 16 21 14 - Roman Catholic 1 - - 1 6 - Other Schools 2 1 2 1 1 - Infant Welfare - - 62 58 67 103 103 50 252 229 216 120 246 children were Schick tested after 6 months, 21 of whom were found to be positive and were given one more dose. 262 were Schick tested after 3 years, 54 were found to be positive and were given another dose. 382 were given one more dose after 3 years (without Schick testing). 115 As will be seen, there is an extra column in the inoculation table. This is inserted because this substance, A.P.T., is used in 2 doses only. It is given to younger children. Scarlet Fever. During 1936 there were 98 cases of Scarlet Fever in School children. This is an advance on 1935 when there were only 48 cases. The schools affected were:— Acton Wells 60 Priory 7 Beaumont Park 6 Rothschild 3 Berrymede 1 Southfield 5 Derwentwater 13 Roman Catholic 2 John Perryn 1 98 It will be seen that the bulk of the cases occurred at Acton Wells School. The cases occurred during the year as follows:— March 1st, April 2nd, May 4th, June 2nd, July 4th, August 3rd, September 3rd, October 15th, November 18th, December 6th. More than half the cases came in the Autumn when the incidence of Scarlet Fever normally rises. 90 Scarlet Fever patients and 195 contacts were examined at the Office before their return to school. Measles. 1936 was a Measles epidemic year and as is usual in such circumstances all the schools of the district suffered. In the report of the Medical Officer of Health, it is explained how Measles for many years has made its appearance in Acton regularly every other year. The epidemic usually occurs in the form of an explosion, 2 large number of the susceptible children suffer from Measles in the course of few months, and the district is then entirely free of the Hsease until the appearance of the next epidemic. In this respect it differs from Scarlet Fever. Even in non-epidemic vears odd cases of Scarlet Fever are reported and in our large towns, Scarlet Fever is said to be endemic. The previous epidemic of Measles occurred early in 1934, and the district was free of the disease in the fourth quarter of 1934 and the early part of 1935. The first case from a school here was reported on November 26th 1935, and the child attended Derwentwater Infants' School. On enquiry at the home, it was found that a younger child of pre-school age had had Measles two or three weeks previously. As far as could be ascertained these were the first cases in the district. 116 Between December 5th and 10th, 9 other cases occurred amongst children attending the same class as the November case 2 cases occurred in another class, and 1 each in two other classes in the same department. These 13 cases were the first crop. Most of the second crop fell during the Christmas holidays. 3 cases occurred among children attending the Infants' department of the Priory School. The date of onset was given as December 18th. When the schools were re-opened after the Christmas holidays, 43 cases were reported from different classes in 3 Infant departments, and in the following months all the schools were affected. The epidemic was extensive, but compared with former years, the fatality was light. In the first decade of this century. Measles was one of the most formidable problems which we had to face, and no other disease caused so much dislocation of school administration. It caused more deaths than all the notifiable diseases put together. In the four years 1906 to 1909, we had 125 deaths from Measles alone. It can thus easily be understood how everything was tried to postpone or to control the course of an epidemic. Among the measures adopted were the closure of schools and departments for indefinite periods, and the exclusion of all children from an infected family and house from school at tendance. It can be imagined to what extent a Measles epidemic in those days interfered with the educational machinery, and the irritating part of the proceedings was that the measures adopted were almost useless. A more intimate study of the epidemioloey of Measles showed us the reason for the futility of the methods in vogue, and gradually a change of procedure took place. At the present time, school closure is hardly ever resorted to. The disease is infectious from the appearance of the corvzal symptoms, and this dates some daysbeforethe appearance of the rash. It is possible in hospital to diagnose the disease before the appearance of the rash and possibly before the disease is infectious. Koplik's spots make their appearance on the inside of the cheek and mouth early in the illness before the appearance of the rash, and when these are sought in contacts an earlier diagnosis can be made and the sufferers isolated. Such a diagnosis is not feasible in children attending school in them the diagnosis is not made until the rash appears. Usually the child attends school during the early stages before the appear ance of the rash, and the mischief has been done, as the children had attended school during the most infectious period and a numbers of contacts would be incubating the disease when the school or department was closed. When the schools were closed the contacts who would develop Measles among the excluded scholars, would 117 not only be liable to infect the children from their own homes (which they would do in any case) but would probably infect children from other schools. Their own schools being closed, they would Seek recreation in the playgrounds of other schools. Besides, unless the Sunday Schools were also closed, we could not cxpect success. At the present time, if quarantine is to succeed, we should have to include cinemas among the banned spheres, For these reasons school closure has been abandoned. There are other reasons against school closure, and for the modification of individual exclusion from schools. It has been Shown that a Measles epidemic does not arise in a community until the percentage of susceptible children rises beyond 25% and seldom Subsides until this susceptible population is reduced to under 20%. During an epidemic not only is there a permanent immunity which an attack of Measles confers, but a certain amount of temporary latent immunity also occurs. This occurs with every epidemic So that when a child who attends a public elementary school reaches the Junior department stage, he or she has either suffered from an attack of Measles, which usually confers a permanent immunity, or has acquired immunity through successive sub-clinical doses ; he or she is not likely to suffer from another attack of Measles. • For all practical purposes, under present conditions. Junior and Senior departments of elementary schools are not factors in the spread of Measles, and can be ignored. We do not therefore exclude contacts from these departments and there is no spread of the disease among the pupils of these departments. ' Even in Infants departments those who have already had an attack of Meases are not excluded because they are contacts. The revised Code Regulations have facilitated these procedures. Formerly for grant purposes, it paid to close, a department or school because the average attendance might drop very low, but now if the attendance drops below a certain mark on account of epidemic disease, a Certificate to this effect enables the weeks of low average attendance to be ignored in the calculation of the grant. Scabies. Scabies is a highly contagious skin disease caused by the burrowing of a minute animal, the Acarus Scabiei, under the skin of hands, feet, and body. The resulting skin affection is very itchy, the itching being worst at night. The usual treatment consists of sulphur baths to the infected person with the use of sulphur 118 ointment, baking of the infected clothing and disinfection of bedding and premises. Sporadically, cases will be encountered in school children, but 1936 was characterised by a small outbreak of the disease. This outbreak was not confined to Acton, as was seen by the fact that Hammersmith Cleansing Station, to which we had been accustomed to refer our cases for baths and treatment, had to refuse to take them as they had so many of their own to deal with they could not cope with ours. Arrangements were consequently made with another Borough, that of Kensington, and that Borough also at one time warned us that they might have to refuse our cases as they had so many of their own to deal with. In all there were 45 cases of Scabies in school children in Acton in 1936, and 9 relatives of these children, mothers, fathers and older or younger brothers and sisters, had also to be treated before the children were made free from infection. Attempts were made to narrow down the field of infection to families, to districts, to schools, but the cases came from every part of the Borough, and 9 schools (19 departments) were affected. The Table below will give an idea of the cases and the schools, departments and number of families affected. School. Department. No. cases. of No. of families affected. Southfield Infants 1 1 Derwentwater Infants (5) Junior (2) 7 6 Acton Wells Infts (3) Junr (1) Senr(l) 5 2 John Perryn Infts (4) Junr (1) Senr (4) 9 5 Rothschild Infts (3) Jnr (1) 4 3 Priory Infts (2) Jnr (2) Senr (2) 6 5 Berrymede Itifts (1) Girls (3) Boys (3) 7 5 Beaumont Park Infants (3) 3 2 (living in same house) Special School 2 1 119 It was not therefore possible to find a common factor in the schools attended by the infected persons. A review of the Streets in which the affected cases lived at-the time of being treated for Scabies does not throw much more light on the subject. Below is a table of the streets affected, separated into the months at which the cases were affected. Those streets which are near to each other, and where conceivably the children might have infected each other at their play, are bracketed together. January. March April June Greenend Road. Newark Cres. The Fairway Antrobus Rd. Essex Road. Grasmere Av. September. November December Old Oak Com. Lane. Somerset Road. Horn Lane, Shakespeare Road. Colville Road. Faraday Road. Alfred Road. Stirling Road. Stuart Road. Avenue Road. Brassie Avenue. Alfred Road. The Tee. Stirling Road, Avenue Road. Canada Crescent. Avenue Road. Scabies is communicated from person to person through fairly prolonged contact, as when two people sleep together and the bedclothes have become infected, for the Acarus Scabiei is a slow mover. It is therefore all the more difficult to explain how such a scattered outbreak should occur in the Borough, and simultaneously in other Boroughs. It is important to treat all affected members of a household at the same time or re-infection will occur. In fact one firm which makes preparations for home treatment of Scabies advises that all members of the household should be treated at the same time, whether infected or not. 120 TABLE SHOWING THE NUMBER OF CHILDREN ATTENDING ACTON SCHOOLS EMPLOYED IN THE VARIOUS REGISTERED OCCUPATIONS ON 31st DECEMBER, 1936. SCHOOL. Delivering Newspapers. Delivering milk. Delivering goods or parcels. Totals. Boys. Girls. Boys. Girls. Boys. Girls. Boys. Girls. Acton Wells 3 — 1 — 1 — 5 — Beaumont Park — — — — — — — — Central — — — — 2 — 2 — County 2 — — — 1 — 3 — John Perryn 1 — 3 — 2 — 6 — Priory 15 — 1 — 8 — 24 — Roman Catholic 1 — — — — — 1 — Southfield 6 — 2 — — — 8 Totals 28 — 7 — 14 — 49 121 TABLE SHOWING THE DISTRIBUTION OF ALL CHILDREN EMPLOYED DURING THE PERIOD 1st JANUARY, to 31st DECEMBER, 1930. SCHOOL. BOYS. GIRLS. Acton Wells Central County John Perryn Priory Roman Catholic Southfield Others Totals Beaumont Park Totals 1. Registered Occupations :— (a) Delivering Newspapers 11 5 8 3 39 2 18 3 89 ... (b) Delivering Milk 4 3 2 4 6 - 6 3 28 ... ... (c) Delivering goods or parcels 3 9 10 3 46 6 14 1 92 1 1 Totals 18 17 20 10 91 8 38 7 209 1 1 Corresponding Figures for 1935 39 34 28 10 120 14 58 13 322 1 1 122 Uncleanliness Table. Sch. Date. No. exaind. Very few nits. Few Nits. Many Nits. Vermin Total Unclean. A. B. C. D. % % % l July 123 .8 .8 Sept. 121 - 2 July 114 3.5 2.6 6.1 Sept. 116 - 1.7 1.7 3 July 196 .5 .5 Sept. 186 .5 1.07 1.6 4 July 194 2.5 1.03 3.6 Sept. 186 2.6 1.67 .5 4.8 5 July 367 1.36 2.4 .27 4.08 Sept. 283 .7 .7 .35 1.7 6 July 132 6.06 .75 6.8 Sept. 149 .67 .67 1.3 7 July 203 7.3 1.9 .49 9.8 Sept. 214 5.1 1.8 1.4 8.4 8 July 188 4.25 .53 4.7 Sept. 186 2.1 1.07 3.2 9 July 397 1.00 .75 1.76 Sept. 386 2.07 1.03 3.1 10 July 366 6.5 4.6 .54 11.7 Sept. 334 8.58 1.89 2.09 12.5 11 July 260 4.23 1.92 1.15 7.3 Sept. 234 8.5 1.2 9.8 12 July 82 - Sept. 112 - 13 July 101 .9 .9 Sept. 156 - 14 July 203 .49 .49 .9 Sept. 149 .67 .67 15 July 268 1.1 .37 .74 2.2 Sept. 201 1.9 .49 2.4 16 July 177 2.8 .56 .56 3.9 Sept. 191 3.6 3.6 17 July 96 - Sept. 95 - 18 July 116 1.7 1.7 Sept. 112 1.6 1.6 19 July 120 - Sept. 121 - 20 July 112 1.7 1.7 3.4 Sept. 124 2.4 .8 3.2 123 Sch. Date. No. examd. Very few nits. Few Nits. Many Nits. Vermin Total Unclean. A. B. % C. D. % % 21 July 282 3.5 .3 .7 4.6 Sept. 229 2.6 2.6 22 July 262 1.9 .7 2.6 Sept. 305 3.2 3.2 23 July 312 1.9 .9 2.8 Sept. 296 5.7 2.3 .3 8.4 24 July 260 2.6 .7 .3 3.7 Sept. 233 5.5 .4 1.7 7.7 25 July 186 .53 .53 1.07 2.1 Sept. 199 .5 .5 26 July 258 4.2 7.00 4.6 15.8 Sept. 213 1.8 4.2 3.2 9.3 27 July 142 2.1 1.4 2.8 6.3 Sept. 145 1.3 1.3 28 July 166 .6 1.8 2.4 Sept. 155 1.2 1.2 29 July 135 4.4 .7 5.1 Sept. 136 .7 1.4 2.2 30 July 234 .8 .8 Sept. 195 .5 .5 1.02 31 July 80 1.2 1.2 2.5 Sept. 122 .81 .81 32 July 81 6.1 2.4 8.6 Sept. 120 1.6 .8 2.5 33 July 44 4.5 4.5 Sept. 42 7.1 7.1 BOROUGH OF ACTON EDUCATION COMMITTEE. SWIMMING INSTRUCTION, SEASON, 1936. The School Swimming Season opened on Monday, 4th May, 1936, and provision was made for 53 classes at the Public Baths, 32 for boys and 21 for girls. Of these, 50 classes were held in school hours whilst one class for boys and two classes for girls were held in periods immediately before or after normal school hours. All the instruction was given by the teaching staff of the Schools. The season normally closes on the 30th September, but, as in previous years, one or two small classes continue to attend the 124 Baths during the winter months for instruction and practice in life-saving. The Acton Education Committee continues to award certificates to boys and girls who can swim twenty-five 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 and the Royal Life Saving Association, as under:— Swimming: 1st class—100 yards (Conditions as for Acton certificates). 2nd class—50 yards Life Saving: Elementary, Intermediate, Advanced and Medallion. There are in the Schools at the present time 1248 scholars (626 boys and 622 girls) who can swim, as against 1318 at the end of last season) and 314 boys and 283 girls now in the Schools learned to swim during the 1936 season (against 578 in 1935). It should be borne in mind, however, that a great number of the scholars who left the elementary schools at the summer vacation to enter Secondary Schools had learned to swim by that date. The following is a statistical return relating to the season's work, with comparative figures for last year. Details giving statistics for the individual schools are in the hands of the Director of Education. Year 1936. Year 1935. Boys. Girls. Total Boys. Girls. Total No. of classes per week allocated 32 21 53 32 22 54 Total attendances made 11908 8300 20208 10938 6943 *17881 * Season opened one week later owing to closure for Jubilee celebrations. 125 Certificates gained. Acton Education Committee 268 236 504 253 225 478 L.S.S.A.: 1st Class 135 117 252 134 134 268 2nd Class 196 157 353 175 183 358 Life Saving: Inter. 14 14 Medallion 10 10 Elementary 28 28 Advanced 27 27 CHILDREN'S COUNTRY HOLIDAYS. Miss Stevens, the Head Mistress of Berrymede Infant School, again organised a large scheme in association with the Children's Country Holiday Fund. By this means 359 school children (196 boys and 163 girls) as against 294 in 1935 were sent away for a fortnight's holiday. In the case of 5 delicate children this period was extended to a month. The Headquarters of the Fund gave a grant of £185 in addition to all main line railway fares, and the parents of the children concerned contributed £186 8s. 4d. This made an average payment of 10s. 2½d.—1s. 5½d. more per head than last year when the average contribution was 8s. 9d. Collections from the parents were begun in January instead of in April as in the previous year and this resulted in the higher payments being possible. 65 more children were sent away this year, and the expenses of sending these away was largely met by a grant from the Mayoress, Mrs. Mercer, out of the League of Personal Service Funds. The cost of the fortnight was, as before, approximately 30s. The Country Holiday Fund will not allow any child to go on holiday if there is any question of uncleanliness. All children must have their heads examined 3 times before departure. This means over 1000 examinations performed by the nurses at the Clinic. Last year 12 children had to be sent to the Hammersmith Cleansing 126 Station, as when the time of departure was near they were found to be still verminous. This year not one single child had to be so dealt with where the mother had known for any length of time that a holiday was imminent. 6 places had to be filled at the last moment because 6 children were rejected at the medical examination, and several of these last minute children had to go to the Cleansing Station to be treated. 46 different parties of children were sent off, some to Folketone and Whitstable, most to the West Country, Somerset, Wiltshire, Hereford, &c., and some to Warwickshire and Norfolk. It will be seen what an enormous amount of work was entailed in planning, collecting and arranging for such numbers, and Miss Stevens is to be congratulated on her administration which allowed of its taking place so efficiently. Only one child while away had to have medical attention, and the reports on the behaviour of the children were on the whole very good. One or two children were troublesome, one boy in particular making himself a nuisance. He has since had to be sent to a Special Home for Difficult Children. Much kindness was experienced amongst the Country Hostesses, one offered to keep a little girl for an extra week without payment as she was so obviously benefiting by the change. The Head Teachers have reported favourably on the results of the holidays on the children's health and appearance, and sincere thanks are due to Miss Stevens for the endless trouble she took to make the scheme a success. VISITS PAID BY SCHOOL NURSES. The following Table gives the number of home visits paid by the Nurses during the year. The visits have been divided into school distribution. Acton Wells 191 Priory 262 Beaumont Park 179 Rothschild 313 Berrymede 386 Southfield 542 Central 2 Roman Catholic 18 Derwentwater 182 Special School — John Perryn 186 Total 2261 127 CONVALESCENT HOMES AND COUNTRY HOLIDAYS. One boy and one girl were sent to the Winter School of Recovery, Bexhill, for a period of 3 months each. In the Summer, 4 girls and 3 boys were sent away for a fortnight's holiday free of charge. MOTHERCRAFT CLASSES. The following table gives the number of classes sent from each school to the Day Nursery. Beaumont Park 5 Central 5 Acton Wells 5 Priory 5 John Perryn 6 Roman Catholic 1 27 RETURN OF MEDICAL INSPECTIONS. TABLE I. A.—Routine Medical Inspections. Number of Inspections in the prescribed Groups:— Entrants 836 Second Age Group 694 Third Age Group 655 Total 2185 Number of other Routine Inspections - Grand Total 2185 128 B.—Other Inspections. Number of Special Inspections 1946 Number of Re-Inspections 1393 Total 3339 C.—Children Found to Require Treatment. Group For defective vision (excluding squint.) For all other conditions recorded in Table II A. Total (1) (2) (3) (4) Entrants — 52 52 2nd. Age Group 56 19 75 3rd. „ „ 54 22 76 Total (Prescribed Groups) 110 93 203 Other Routine Inspections — — — Grand Total 110 93 203 129 TABLE II. A.-Return of Defects found by Medical Inspection in the Year ended 31st December, 1936. Defect or Disease. Routine. Inspections. Special Inspections. No. of Defects. No. of Defects. Requiring Treatment Requiring to be kept under observation, but not requiring Treatment. Requiring Treatment Requiring to be kept under observation, but not requiring Treatment. (1) (2) (3) (4) (5) Skin:— Ringworm: Scalp — — 3 — Body 1 — 8 — Scabies — — 39 — Impetigo 5 — 403 — Other Diseases (Non-Tuberculous) 9 — 45 — Total 15 — 498 — Eye: Blepharitis 13 — 29 — Conjunctivitis 1 — 54 — Keratitis — — — — Corneal Opacities — — 1 — Other Conditions (excluding defective vision and squint) 5 1 63 — Total 19 1 147 — Defective Vision (excluding squint) 110 — 81 — Squint 16 2 3 2 Ear: Defective Hearing 2 12 9 — Otitis Media 5 — 58 — Other Ear Diseases 6 — 30 — Nose and Throat: 6 Chronic Tonsillitis only — — — Adenoids only — — 1 — Chronic Tonsillitis and Adenoids 15 — 21 — Other Conditions — 16 — 131 Enlarged Cervical Glands (NonTuberculous) — 268 — 62 Defective Speech 6 2 3 — 130 Defect or Disease. Routine Inspections. Special Inspections. No. of Defects. No. of Requiring to be kept under observation, but not requiring ment. Requiring Treatment Requiring te be kept under observation, but noi requiring Treatment Requiring Treatment. (1) (2) (3) (4) (5) Heart and Circulation: Heart Disease: Organic — 5 — — Functional — 18 — — Anaemia — 1 — — Lungs: Bronchitis — 2 — — Other Non-Tuberculous Diseases 1 3 — — Tuberculosis: Pulmonary: Definite — — 1 — Suspected — 1 1 — Non-Pulmonary: Glands — — — — Bones and Joints — — — — Skin — — — — Other Forms — — — — Total — — — — Nervous System: Epilepsy — 1 — 1 Chorea — 1 2 — Other Conditions — — — — Deformities: Rickets 1 22 — — Spinal Curvature 1 — — — Other Forms 6 4 — — Other Defects and Diseases (excluding defects of nutrition, Uncleanliness and Dental Diseases) 13 16 1023 79 Total number of defects 216 375 1884 275 131 B —Classification of the Nutrition of Children Inspected during the Year in.the Routine Age Groups. Age groups Number of Children Inspected A (Excellent) B (Normal) C (Slightly subnormal) D (Bad) No. % No. % No. % No. % Entrants Second 836 400 47.8% 421 50.3% 15 l.7% — — Age group 694 338 48.6 334 48.1% 22 3.1% — — Third Age- group 655 265 40.4 373 56.9% 17 2.5 — — Other Routine Inspections TOTAL 2185 1003 45.9 1128 51.6% 54 2.4% — — TABLE III. Return of all Exceptional Children in the Area. BLIND CHILDREN. At Certified Schools for the Blind. At Public Elementary Schools. At Other Institutions. At no School or Institution. Total. — — — — — 132 PARTIALLY SIGHTED CHILDREN. At Certifed Schools for the Blind. At Certified Schools for the partially Sighted. At Public Elementary Schools. At other Institutions. At no School or Institution. Total. — 3 1 — — 4 DEAF CHILDREN. At Certified Schools for the Deaf. At Public Elementary Schools. At other Institutions. At no School or Institution. Total. 5 — — — 5 PARTIALLY DEAF CHILDREN. At Certified Schools for the Deaf. At Certified Schools for the Partially Deaf. At Public Elementary Schools. At other Institutions. At no School or Institution. Total. — — — — — — MENTALLY DEFECTIVE CHILDREN. Feeble-Minded Children. At Certified Schools for Mentally Defective Children. At Public Elementary Schools. At other Institutions. At no School or Institution. Total. 43 — — — 43 133 EPILEPTIC CHILDREN. Children suffering from severe Epilepsy. At Certified Special Schools. At Public Elementary Schools. At other Institutions. At no School or Institution. Total. 1 — — 2 3 PHYSICALLY DEFECTIVE CHILDREN. A. TUBERCULOUS CHILDREN. 1.—CHILDREN SUFFERING FROM PULMONARY TUBERCULOSIS, (Including pleura and intra-thoracic glands) At Certified Special Schools. At Public Elementary Schools. At other Institutions. At no School or Institution. Total. — — 2 — 2 2.-CHILDREN SUFFERING FROM NON-PULMONARY TUBERCULOSIS At Certified Special Schools. At Public Elementary Schools. At other Institutions. At no School or Institution. Total. — 1 1 1 3 134 B. DELICATE CHILDREN. (ie) Those whose general health renders it desirable that they should be specially selected for admission to an Open Air School. At Certified Special Schools. At Public Elementary Schools. At other Institutions. At no School or Institution. Total. 4 3 4 3 14 C. CRIPPLED CHILDREN. (ie) (Other than those diagnosed as tuberculous and in need of treatment for that disease) who are suffering from a degree of crippling sufficiently severe to interfere materially with a child's normal mode of life. At Certified Special Schools. At Public Elementary Schools. At other Institutions. At no School or Institution. Total. 4 4 2 — 10 D. CHILDREN WITH HEART DISEASE. (ie) Children whose defect is so severe as to necessitate the provision of educational facilities other than those of the Public Elementary School. At Certified Special Schools. At Public Elementary Schools. At other Institutions. At no School or Institution. Total. — — — — — 135 CHILDREN SUFFERING FROM MULTIPLE DEFECTS. Combination of Defect. At Certified Special Schools. At Public Elementary Schools. At other Institutions. At no School or Institution. Total Nil Nil table iv. Return of Defects treated during the Year ended 31st December, 1936. Treatment Table. Group I—Minor Ailments (excluding Uncleanliness, for which see Table VI.) Disease or Defect. (1) Number of Defects treated, or under treatment during the year. Under the Authority's Scheme. (2) Otherwise (3) Total. (4) Skin: Ringworm-Scalp— (i.) X-Ray Treatment. 1 — 1 (ii.) Other Treatment. — 2 2 Ringworm-Body 8 — 8 Scabies 39 — 39 Impetigo 403 — 403 Other skin disease 44 — 44 Minor Eye Defects: (External and other, but excluding cases falling in Group II.) 143 — 143 Minor Ear Defects 97 11 108 Miscellaneous (e.g., minor injuries, bruises, sores, chilblains. See.) 1039 — 1039 Total 1774 13 1787 136 Group II.—Defective Vision and Squint (excluding Minor Eye Defects treated as Minor Ailments—Group I.) Defect or Disease. (1) No. of Defects dealt with. Under the Authority's Scheme (2) Otherwise (3) Total. (4) Errors of Refraction (including Squint) 397 10 407 Other Defect or Disease of the Eyes (excluding those recorded in Group I.) 16 — 16 Total 413 10 423 Number of children for whom spectacles were— (a) Prescribed 262 10 272 (b) Obtained 262 10 272 Gboup III.—Treatment of Defects of Nose and Throat. Number of Defects. Received Operative Treatment. Received other forms of Treatment (4) Total number treated (5) Under the Authority's Scheme, in Clinic or Hospital (1) By Private Practitioner or Hospital, apart from the Authority's Scheme (2) Total (3) 1. 2. 3. 4. 1. 2. 3. 4. 1. 2. 3. 4. 5 3 39 — — — 5 — 5 3 44 — — 52 (1)—Tonsils only. (2)—Adenoids only. (3)—Tonsils and Adenoids. (4)—Other defects of the Nose and Throat. 137 Group IV.—Orthopaedic and postural defects. (1) Under the Authority's Scheme. (2) Otherwise. Total No. Treated. Residential Treatment with Education. (i) Residential Treatment without Education. (ii) NonResidential Treatment at an Orthopaedic Clinic. (iii) Residential Treatment with Education. (i) Residential Treatment without Education. (ii) NonResidential Treatment at an Orthopaedic Clinic. (iii) No. of Children Treated. — — — — 2 1 3 138 Table V.—Dental Inspection and Treatment. (1) Number of Children who were:— (4) Attendances made by children for treatment 4150 (a) Inspected by the Dentist: (5) Half-days devoted to:— Inspection 46 Aged: Treatment 468 Routine Age Groups 5—696 Total 514 6—676 7—603 (6) Fillings:- 8—632 Permanent teeth 2108 9—751 Temporary teeth 95 10—740 11—625 Total 2203 12—653 (7) Extractions:- 13—610 Permanent teeth 869 14—156 Temporary teeth 3857 Total 6142 Total 4726 Specials 418 (8) Administrations of general anaesthetics for extractions 2021 Grand Total 6560 (9) Other operations:- (2) Found to require treatment 4484 Permanent teeth 271 Temporary teeth 56 (3) Actually treated 2829 Total 327 Table VI.—Uncleanliness and Verminous Conditions. Average number of visits per school made during the year by the School Nurses 14 Total number of examinations of children in the Schools by School Nurses 2295 Number of individual children found unclean:— Vermin and Nits 92 Slightly infested 569 Number of children cleansed under arrangements made by the Local Education Authority 7 Number of cases in which legal proceedings were taken:— (a) Under the Education Act, 1921 — (6) Under School Attendance Byelaws — 139 STATEMENT OF THE NUMBER OF CHILDREN NOTIFIED DURING THE YEAR ENDED 31ST DECEMBER, 1930, BY THE LOCAL EDUCATION AUTHORITY TO THE LOCAL MENTAL DEFICIENCY AUTHORITY. Total number of children notified 5 Analysis of the above Total. Diagnosis. Boys. Girls. 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 interests of other children: (a) Moral defectives — — (b) Others — — 2. Feeble-minded children notified on leaving a Special School on or before attaining the age of 16 1 4 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 1 4 We are, Your Obedient Servants, D. J. THOMAS. E. MADELEY.