ACT 40 Borough of Acton. ANNUAL REPORT OF THE Medical Officer of Health TOGETHER WITH THE Report on the Medical Inspection of Schools FOR THE YEAR 1937. ANNUAL REPORT of the MEDICAL OFFICER OF HEALTH FOR THE YEAR 1937. 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 on the health conditions of the Borough for the year 1937, and the Annual Report on the School Medical Services is given at the end as a separate report. The report contains the information required by the Ministry of Health, and is arranged in accordance with their regulations, but for convenience of reference certain tables have been grouped at the end of the report. The year has been on the whole a particularly healthy one; there has been a reduction in the death-rate and the infantile mortality. The district was comparatively free of infectious disease, and the only notable outbreak was that of Influenza at the beginning of the year. There has been a steady development in the health services and especially in the numbers of those who avail themselves of the facilities provided. The most important development probably was the institution of domiciliary midwifery under the Midwives Act, 1936. 4 The inspections under the Housing Act, 1935 were continued throughout the year. The appointed day for Acton was 1st January, 1937. Certain changes occurred both in the clerical and Health Visiting staffs. Miss Welsh died in August 1936, and Miss Cooksey retired in March 1937; Miss Bennett and Miss Orfeur were appointed. Mr. Hacker left to take up another appointment in June 1937, and Mr. Pratt was appointed as Chief Clerk. Miss Arnold and Miss Beacon were married and Miss Hester and Miss Warburton appointed on the clerical staff. In conclusion, I should like to express my thanks to the Council for their courtesy and support for the measures proposed to improve the public health and to all the staff of the Public Health Department for their invaluable assistance throughout the whole year. I remain, Your obedient servant, D. J. THOMAS, Medical Officer of Health. SECTION A. Statistics and social conditions of the Borough. Area—2,317 Acres. There has been no change of boundaries since the last report. Population.—The Registrar-General's estimate of the population in the middle of 1937 was 69,100 inhabitants, a decrease of 40 as compared with the estimate for 1936. The population at the Census of 1931 was 70,510, but since that time a re-arrangement of boundaries has occurred and the Census population of the district as now constituted was 70,008, that is, there was a loss of 502 inhabitants as a result of the transaction. The number of private families was reduced from 18,997 to 18,876 and the number of structurally separate dwellings occupied, from 13,812 to 13,687. 5 The number of new houses erected during the last 6 years were:- 1931-32—257 1932-33—188 1933-34—224 1934-35—134 1935-36—380 1936-37—201 The number of parliamentary electors since 1931 has been as follows:— 1932—48,126 1933—48,245 1934—48,228 1935—48,258 1936—48,813 1937—49,255 Number of Inhabited Houses (end of 1937) according to Rate Books. The exact number of inhabited houses is not available. The number of inhabited houses according to the Rate Books on 31st March 1937 was 16,861. Rateable Value. The rateable value of the Borough on 1st April 1937 was £788,859, and the sum represented by a penny rate was £2,943. Social Conditions. In last year's report an account was given of the social conditions of the district, including the chief industries carried on in the area. These conditions have not materially altered in the year, but unemployment increased towards the end of 1937. The impression that unemployment was on the increase was borne out by the figures kindly supplied by the local employment exchange. On 31st December 1937, the total numbers of persons (aged 18 to 65) resident in Acton and registered as wholly unemployed were as follows:— Men. Women. Total. 1076 329 1405 These numbers compare with 799 men and 182 women unemployed on 31st December, 1936. The total amount of out-relief and in kind disbursed by the Public Assistance Committee was £17,829. 6 Extracts from Vital Statistics. POPULATION 69,100. Total. M. F. Live Births. Birth-rate per 1,000 of Legitimate 846 422 424 estimated resident Illegitimate 40 22 18 ulation—12.8 886 444 442 Still Births. Legitimate 28 17 11 Rate per 1,000 total Illegitimate 4 13 (live & still) births—17 32 18 14 Deaths 750 Death-rate per 1,000 inhabitants 10.8. Deaths from Puerperal causes (Headings 29 and 30 of the Registrar General's short list). Rate per 1,000 total Deaths (live & still) births No. 29 Puerperal Sepsis 0 — No. 30 Other Puerperal causes 2 2.2 Death-rate of Infants under 1 year of age. All infants per 1,000 live births 57 Legitimate infants per 1,000 legitimate live births 56 Illegitimate infants per 1,000 illegitimate live births 75 Deaths from Cancer (all ages) 119 Deaths from Measles (all ages) 2 Deaths from Whooping Cough (all ages) 3 Deaths from Diarrhoea (under 2 years of age) 11 SECTION B.—GENERAL PROVISION OF HEALTH SERVICES IN THE AREA. Staff.—A list of the staff of the Public Health Department will be found at the end of the report. Laboratory Facilities.—Throat swabs from doctors and the Isolation Hospital and sputum from doctors are examined at the office. Special examinations are made at the Lister Institute of Preventive Medicine and the Royal Free Hospital. Ambulance Facilities.—The ambulance facilities are similar to those described in previous reports. There is a motor ambulance for the transport of infectious cases, and two ambulances provided for accident and non-infectious cases. The latter are housed at the fire station and are available at all hours. Last year the ambulance was called out to 585 street accidents, and on 378 occasions for private cases. Fees amounting to £ 142 l0s. were paid for the use of the ambulance for private cases. Nursing in the Home.—There has been no change in the arrangements for nursing in the home, but negotiations were entered into during the year between the authorities of the Acton Hospital and the Borough Council for an extension of the home nursing services provided by the hospital, but the agreement was not pleted at the end of the year. In addition to private nursing associations in the district, the Acton Hospital employ three nurses for home nursing. HOSPITAL PROVISION. General.—Acton Hospital, Gunnersbury Lane, is the only General Hospital in the district, and has accommodation for 72 patients—62 beds in General Wards and 10 for Private Patients. During 1937 1151 patients were admitted; this is an increase of 74 on the previous year, and is in a great measure due to the fact that the recent extensions had been put into full use. The beds have been continuously occupied and the average number of patients resident daily was 65.25. 9,820 Out-Patients were treated during the year, an increase of 814 and the Out-Patient attendances were 53,883, an increase of 7,717 as compared with 1936, showing that the enlarged OutPatients Department was very much needed. The Education Committee has continued its agreement with the Hospital for the treatment of Tonsils and Adenoids and Artificial light. 8 There is no change from last year in the following:- Fever Hospital. Laboratory facilities. Small-pox hospitals. Tuberculosis. School Clinic. Day Nursery. Child Welfare Clinics. Ante-natal Clinics. Treatment Centres for Venereal Diseases. 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) (Part VI) 1921 Public Health Act, 1925 (Parts 2, 3, 4 and 5) 1926 The Acton Improvement Act, 1904 — Nuisances, &c. 1924 New Streets and Buildings 1925 Smoke Abatement 1930 Houses let in Lodgings 1934 Employment of Children 1935 Wireless Loudspeakers, Gramophones, &c. 1935 Fouling of Footpaths by Dogs 1937 Hairdressers' and Barbers' Shops 1937 MATERNITY AND CHILD WELFARE. Infantile Mortality. 51 deaths occurred in infants under 1 year of age corresponding to an infantile mortality of 57 per 1,000 births. The infantile mortality is 11 per 1,000 births lower than that of 1936, and slightly lower than that of 1935, but it is higher than that of 1934, which was the lowest one on record for the district. 9 There is an increase of 9 in the number of deaths from Prematurity-18, compared with 9 in 1936. The health visitors have frequently commented upon the fact that premature births and stillbirths come on waves and this periodicity suggests that other than natural causes are in operation. Last year 10 out of the 18 deaths from premature births occurred in the second quarter of the year, and it is significant that 12 out of 28, the total number of stillbirths also occurred in the second quarter. The causes of pa-maturity are not clear; various factors have been assigned as the cause of premature birth, such, as lack of Vitamin E, Syphilis, etc., but these would operate fairly uniformly throughout the year. To put it bluntly, these periodical increases suggest abnormal activity of the abortionist, and though we have no evidence of such in increasing practice the suspicion lurks that a sudden increase in prematurity and stillbirths is due to the practice. Although this is one death less from Diarrhoea last year than in 1936, 11 deaths from this cause in a year when conditions are favourable is too high. In a hot and dry summer we expect even now a slight increase in the deaths from Diarrhoea, but last summer was cool and comparatively wet, and the deaths of 11 children from Diarrhoea is a disappointment. The vast improvement in the conditions under which milk is produced and distributed, and the instruction given at the clinics and in the home by the health visitors have brought about an improvement, but full advantage is not taken of the improved conditions, and of the skilled instruction at the disposal of the mothers. In some instances, the home conditions are unfavourable, but in the majority of cases of diarrhoea the most prominent factor in its causation has been either ignorance or apathy or failure to reap the benefit of the facilities at the mother's disposal. Toddlers. There were 10 deaths in children between the ages of 1 and 2 years and 3 between the ages of 2 and 5 years. Of the total deaths between the ages of 1 and 5 years, 8 were due to diseases of an infectious character—2 each from Whooping Cough, Measles, Cerebro-Spinal Fever and Diphtheria. Although all are infectious in their character, caused either by a germ or a virus, the methods of prevention differ greatly. It is only in the case of Diphtheria that we have found a method which is efficient and is reasonably certain to protect the infant from the disease. The others are apt to occur in epidemics and our methods of prevention so far have had to be based upon general measures, and specific measures are not successful to prevent the occurrence and to stem the ravages of these diseases. In recent years the mortality amongst the toddlers 10 has shown almost as much improvement as that of the infant mortality, and this may have been due to the increased attention which has been paid to the pre-school child. It was stated in last year's report that Circular 1550 had been considered by the Child Welfare Committee and it was decided to establish a Special Toddlers' Clinic as an experiment at the Steele Road Clinic. The following report has been kindly sent me by Dr. Mann who is in charge of the Clinic at Steele Road. The Toddlers' Clinic was inaugurated in June 1936 for the purpose of including in medical schemes all children between the ages of 1 year and 5 years. In the birthday month of the child invitations were sent to the parents to bring the child for examination on the last Friday in the month. These invitations were followed up with a home visit in as many cases as possible when the object of the Clinic was explained. No. of invitations sent each month—June to December, 1936 224 No. of attendances 72 The attendance was 32% of invitations- sent out. No. of invitations for 1937 276 No. of attendances 123 The attendance rose to 44.5% of invitations sent out and many children were brought for their second annual examination. Each child was stripped, weighed and measured and then a routine examination of heart, lungs, mouth and throat, ears and eyes was carried out and any postural defects and congenital abnormalities noted. Advice was given on diet, hygiene and general management and in most cases the mothers had many questions to ask. Any child requiring to be kept under observation was asked to attend the Welfare Centre on a Tuesday while any children requiring any active treatment were referred to Hospital, private practitioners, or to the School treatment Centre. Nutrition. The standard of nutrition was good on the whole but some of the children, particularly of unemployed parents, were undersized and under-nourished. There was no marked anaemia and those cases found were among children examined in the winter months. 11 A soft systolic murmur was found in a few children, mainly among the two year old group, but it was found to have almost disappeared when these children came up in the three year old group. Evidences of Bronchitis, Enlarged Tonsils and Adenoids and a larged cervical glands were also met with in the greatest numbers among the two year old children. Dental Caries was most marked in the four year old group, 44.8% of children examined having one carious tooth or more to some cases as many as 10 teeth had been extracted. Eyes—Strabismus 1 Styes 1 Conjunctivitis 4 Cyst of Upper Lid 1 Ear discharge 8 Nasal Catarrh 4 Backward Speech 1 Stutter 1 Congenital Deformity of right side of chest 1 Mongol 1 Genu-Valgum (slight) 6 ,, (marked) 2 Undescended Testicle 1 Average Heights. 2 yrs. 3 yrs. 4 yrs. 5 yrs. 2-ft. 7½-ins. 2-ft. 10-ins. 3-ft. 3-ins. 3-ft. 4¾-ins. Average Weights. 2 yrs. 3 yrs. 4 yrs. 5 yrs. 25-lbs. 6-ozs. 31-lbs. 15¾-ozs. 35-lbs. 35-lbs. 11-ozs. Normal weight— Upper level 28-lbs. 33-lbs. 44-lbs. 25-lbs. 29-lbs. 36-lbs. 2 yrs—25% did not reach this lower level. 3 yrs—14% did not reach this lower level. 4 yrs—55% did not reach this lower level. 12 Enlarged Tonsils and Adenoids. 2 yrs. 3 yrs. 4 yrs. 42% 23.8% 17.2% Enlarged Cervical Glands. 2 yrs. 3 yrs. 4 yrs. 23% 11% 13.7% Carious Teeth. 2 yrs. 3 yrs. 4 yrs. 1.8% 19% 55% The figures show that there are many defects found in the pre-school child which require remedial treatment, and that the establishment of this clinic has shown its usefulness. Unfortunately owing to the shortage of accommodation, similar clinics cannot be established at the other centres. The fact that we have not established Special Toddlers' Clinics at the other centres does not mean that the pre-school child is not catered for at all centres. As the figures show, a large percentage of the children who attend the centres are between the ages of 1 and 5 years. Of the attendances made at the clinics during the year 2,900 of these were of children under 1 year of age and 1,358 were of children between the ages of 1 and 5 years. In the school report a table is given showing the number of expectant and nursing mothers and children under school age who were treated at the Dental, Ophthalmic and minor ailment clinics The work done at the centres is important, but it cannot meet unaided all the needs, or frequently, the greatest need of the children At the centres the children are examined, and practical and export advice is given. The health visitors do everything to adapt home conditions to the requirements of the children, and endeavour to see that the advice is carried out as fully as possible, but frequently the advice is not followed for many reasons, some of them economic others arising out of ignorance and apathy. It is not always possible to provide the necessary food, or give the children an open-air life and other opportunities for play and exercise. For some of the older children the Education Committee cases and though there is no Nursery School in the Borough, there are 8 Nursery Classes with 217 children on the registers. These classes are popular and scattered throughout the district. The popular to of the Nursery Classes has in no way diminished the demand for admission into the Council's Day Nursery. 13 Almost throughout the year there is a waiting list, but the Nursery caters for a slightly different class of child to that which seeks admission to the Nursery Classes. Most of the children are under two years of age, though older children are admitted. Last year, of children admitted, 66 were under 2 years of age and 29 were over 2 years. 5,224 attendances were made. Maternal Mortality. There were two maternal deaths; one of these was placed in the category of Maternal after the Registrar-General had made inquiries of the doctors and relatives. The woman died of pyaemia and thrombosis of the vena cava, following phlebitis, but it was subsequently ascertained that it was the result of abortion. This fact was not brought to our notice until a period of twelve months had elapsed since the death. The circumstances of the second case were different. The patient had engaged a private midwife and did not attend an antenital clinic, but the midwife examined a specimen of her urine. On the first occasion it was stated that there was a trace of albumin, but the second specimen, examined a week later, was stated to be flex of albumin, but no other information was available. Three weeks later the patient complained of headache, and was found unconscious at the foot of the stairs in her house. She was taken to the Acton Hospital. On admission the blood pressure was 160/100 m.m. and the urine boiled almost solid with albumin. She died on the day of admission after operation for Caesarian section. The most important change in practice has been the operation of the Midwives Act of 1936. The authority responsible for the Act here is the Middlesex County Council. The Borough Council made application to the Ministry of Health for power to act as the local Supervising authority for the area, but the application was refused. Under the Midwives Act 1936 it is the duty of the local Supervising authority to ensure, either by making arrangements with welfare councils, or voluntary organisations, for the employment by those councils or organisations of certified midwives as whole time servants, or by itself employing such midwives, that the number of certified midwives so employed who are available in its area for attendance on women in their own homes as midwives, is adequate for the needs of the area. For this area, the Middlesex County Council have made an agreement with the authorities of Queen Charlotte's Hospital for the provision of a domiciliary service of midwives. As the members of the Council are aware, Queen Charlotte's Hospital has made arrangement for carrying out part of its work in its premises at 14 Ravenscourt Park. For some time, the hospital has employed midwives there for domiciliary confinements, and this organisation has been utilized to cany out the provisions of the Midwives Act 1936, in our area. Under Section 1, sub-section (2) the local supervising authority had to submit to the Minister of Health- proposals for carrying out its duties within a period of six months from the commencement of the Act (31st July 1936) or such longer period as the Minister may in any particular case allow. In our area the arrangement did not come into force until 1st October, 1937, but the agreement between the Middlesex County Council and the authorities of Queen Charlotte's Hospital was not available to the local council at the end of March 1938; so that, although at the present time the scheme has been in operation for over six months, the local authority is unaware of the exact provisions in the agreement between the County Council and the authorities of Queen Charlotte's Hospital. The Queen Charlotte's Hospital authorities have practically a similar scheme in operation in Brentford and Chiswick, and the midwives who attend the confinements for the two boroughs reside in the same building. The arrangements are working smoothly. Most of the confinements are booked at the Borough Council's ante-natal clinic which is attended by one or more of the midwives. The expectant mother attends the local clinic if the conditions are normal and satisfactory until the thirty-sixth week, when she attends the Hospital Clinic at Ravenscourt Park. As far as ante-natal work is concerned, a similar procedure is carried out in respect of the expectant mothers who have made arrangements for their confinement at the Central Middlesex Hospital. In ordinary circumstances they attend our ante-natal clinic during the earlier period of pregnancy, and later attend at the ante-natal clinic at the Central Middlesex Hospital. Formerly, we had a routine ante-natal clinic and a consulting one; Dr. Bell had charge of the latter. The holding of routine consulting clinic every fortnight became unnecessary by these arrangements, whereby the ante-natal clinics at Ravenscourt Park and the Ceneral Middlesex Hospital became the consulting clinic for the great majority of the expectant mothers who attend our ante-natal clinics. The services of Dr. Bell are still retained for consultation purposes in the case of those who are attended by private midwives and doctors, and arrangements have been made for these expectant mothers to be seen and examined by Dr. Bell at his Gynaecological clinic at the Acton Hospital. 15 The attendance at the Ante-natal clinic increased very largely last year; the increase in the attendances was relatively much grates than that of the number of expectant mothers who attended. The number of expectant mothers was 209 but the total number of attendances was 448, compared with 193 and 231 respectively in 1936. The attendance at each session has been gradually getting larger and it has been decided to have two weekly sessions instead of one Nurse Children. At the end of the year there was 53 children on the register compared with 39 in 1936 and the same number in 1935. Although the tatal numbers of nurse children do not vary very materially from year to year, there are many changes in the personnel both of the mothers and the children. We have constantly to call attention to infringements of the provisions which are now incorporated in sections 206—208 of the Public Health Act 1936, though in only one instance has the Council taken proceedings. This was in the case of a person who had two children under her care and had not given notice. Although a fine was inflicted, I believe that the sympathy of the court was with the culprit, because the Council did not allege that the house was overcrowded or that the foster mother was in any way unsuitable for the purpose. It is important that notice should be given and that the children should be Kept under observation unless the children are brought to the clinic regularly, and periodically the Health Visitor calls at the house. There is no other method of supervision. Some resent it, and we suspect that removals from one district to another do take place without necessary notice being given in order to escape this supervision. During the year we received notices from other public health departments that foster patients had left their areas and it was believed that they had come here. We have been able to trace them and in most cases they have expressed regret and plead ignorance. In one instance the supposed foster parent denied that she received any reward for the two children who were under her change She was out on every occasion the health visitor called, and we had no evidence that the children were kept for reward. We referred the matter to the R.S.P.C.C., and their inspector also was unable to obtain any additional evidence. Out of the 53 children on our list 28 are illegitimate. Some of these children are sent to the foster as others through the recognised associations for the care of the unmarried. mother, but in the case of others the regularity with which certain women receive illegitimate children from some hospitals makes the circumstances suspicious, and it has been suggested that information does leak out of certain 16 hospitals, but it is difficult to prove the statement. In most instances the payment is about 12s. 6d. a week, but there is one institution in the borough which receives the children of married parents who live abroad, where the usual charge is 15s. to 25s. a week. In the vast majority of cases, the mother regularly, pays the amount due but naturally, there are instances where the mother either fails or refuses to pay. In such circumstances the foster mother is placed in a difficulty; frequently she is not in a position to keep the child without payment and she is loth to resort to the public assistance officer. Occasionally, the foster mother becomes very attached to the child; her path is not so easy because of the fact that she has received money for his maintenance. There is no doubt that in most cases, adoption is the best solution of any difficulties which arise, and where the foster mother is in a position to keep the child. Until recently, we were not aware of any organised opposition by any society to adoption. In some towns there seems to be a band of anti-adoption enthusiasts who persuade mothers not to give permission for the adoption of an illegitimate child. One mother told our health visitor quite recently that someone had called round and urged her not to permit the adoption of the baby under any conditions. Apart from religious considerations, it is difficult to see the force of such advice. From personal experience, we can much for the happy results which have accrued in the majority of instances from adoption by foster-parents. Section C. SANITARY CIRCUMSTANCES OF THE AREA. Water Supply. The Borough is supplied with water by the Metropolitan Water Board. Drainage and Sewerage. All the dwelling houses are provided with water closets and are drained into the main sewerage system. By arrangement with the London County Council the sewage is discharged into the London Sewers. Storm water is filtered and emptied into the Thames. Public Cleansing. The house refuse is collected by the Council and burnt in the Destructor. Last year 21,109 tons of refuse were collected and burnt Sanitary Inspection of the Area. The following table includes the tabular statement furnished by the Sanitary Inspector under Article 27 (18) of the Sanitary Officers (Outside London) Regulations 1935. 17 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 defects (under Public Health or Housing Acts) 2134 (1) Dealt with by service of Informal Notice 1767 (2) Dealt with by service of Statutory Notice under Section 17, Housing Act, 1930 125 (3) Dealt with by service of Statutory Notice under Public Health Acts 13 Premises (other than defective dwelling-houses) inspected for nuisances and miscellaneous defects 675 (1) Dealt with by service of Informal Notice 329 (2) Dealt with by service of Statutory Notice under Public Health Act, &c. 25 Reinspections subsequent to service of Notice 7729 Inspection after notification of Infectious Disease 276 Number of Premises under Periodical Inspection. Workshops and Workplaces 109 Bakehouses 35 Slaughterhoues 2 Public House Urinals 37 Common Lodging Houses 1 Butchers' Shops 39 Fish Shops 34 Premises where food is manufactured or prepared 32 Milk Purveyors 116 Cowsheds Nil Piggeries Nil Rag and Bone Dealers 4 Mews 4 Schools 13 Caravan Grounds 2 Rent Restriction Act. Number of Certificates granted 1 18 Detail of Work carried out. Sanitary Dustbins provided 324 Yards paved or yard paving repaired 129 Insanitary forecourts remedied 52 Defective drains repaired or reconstructed 111 Defective soil pipes and ventilating shafts repaired or renewed 49 Defective fresh air inlets repaired or renewed 68 Defective gullies removed and replaced by new 29 Rain water downpipes disconnected from drain 21 Dishing and curb to gullies repaired and new gratings fixed 121 Defective W.C. pan and traps removed and replaced by new 101 Defective W.C. flushing apparatus repaired or new fixed 272 Defective W.C. seats repaired or new fixed 231 Defective flush pipe connections repaired 33 Insanitary sinks removed or new fixed 57 Sink waste pipes repaired or trapped 224 Insanitary wall surface over sinks remedied 71 Ventilated food cupboards provided 17 Drinking water cisterns cleansed 256 Defective covers to drinking water cisterns repaired or new fixed 126 Insanitary sites beneath floors concreted 28 Spaces beneath floors ventilated 119 Dampness in walls from defective damp-proof course remedied 179 Dampness from defective roof, rain water gutterings, etc., remedied 880 Defective plastering repaired (number of rooms) 565 Rooms where dirty walls and ceilings have been cleansed and redecorated 2472 Defective floors repaired 160 Defective or dangerous stairs repaired 67 Defective doors and windows repaired 296 Defective kitchen ranges and fire grates repaired 262 Defective washing coppers repaired 61 Coal cupboards provided or repaired 11 New W.C. apartments provided 14 Accumulations of offensive matter removed 13 Drains unstopped and cleansed 183 Drains tested, exposed for examination, etc. 34 Smoke observations taken 164 Smoke nuisances abated on service of notice 36 Miscellaneous nuisances abated 279 Notifications of waste of water sent to Metropolitan Water Board 202 19 SMOKE ABATEMENT. There is not much change in the conditions of atmospheric pollution. We have few complaints from the northern part of the district, but complaints are frequent from the inhabitants of the Southern areas. This state of affairs is due to several causes. The first and principal cause probably is the fact that the factories in the north-west ward are new and the furnaces have been properly planned, whilst those in the south-west ward have been adapted and are not always suitable for the purpose. Another cause also arises from an attempt to economize, and to burn a cheap fuel in an unsuitable furnace. A natural overllary, say, to the appointment of a new manager, is an verhaul of the expenses, and one of the first items to be attacked is the price of coal. The former manager, goaded by our nonces, had been using a good grade of coal, and knew that there was no option had to do so if he wished to avoid complaints. A change of management frequently means an endeavour to use a cheaper variety of and with the inevitable result of constant complaints not only of smoke but grit and dust. Apart from the question of smoke; a factory in a residential area will usually be a cause of complaint, and in most instances, naturally so. There is very little improvement in smoke abatement from domestic chimneys. It is generally agreed, that even in a partially Undustrial area like Acton, the domestic chimney is a greater culprit have the factory chimney; there is some improvement because of the increasing use of gas and electricity both in cooking and heating, but very little attempt is made to use smokeless fuel in the domestic grates. ERADICATION OF BED BUGS. The information under this heading is defective as we have no means of ascertaining the number of Council and other houses formal to be infested and disinfested. The Public Health Department does not disinfest the Council houses, and from recent reports the methods which have been employed for freeing infested houses from bed bugs have not been entirely successful. Throughout the country this problem has been of great magnitude, and recently, researches have been carried out in order to secure a disinfectant which is harmless to human beings, lethal in all stages of bed-bug and egg cheap and fairly easily applied, readily removed by ventilation and harmless to furniture and fittings. It is claimed that heavy naphtha fulfils these conditions fairly successfully but from all accounts, certain precautions have to be observed if successful results are to be obtained. 20 Section D.— HOUSING. 1. Inspection of Dwelling-houses during the Year 1937: — (1) (a) Total number of dwelling-houses inspected for housing defects (under Public Health or Housing Acts) 2127 (b) Number of inspections made for the purpose 4762 (2) (a) Number of dwelling-houses (included under sub-head (1) above), which were inspected and recorded under the Housing Consolidated Regulations, 1925 1577 (b) Number of inspections made for the purpose 3504 (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 1905 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 1767 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 125 (2) Number of dwelling-houses which were ered fit after service of formal notice:— (а) By owners 125 (b) By local authority in default of owners Nil 21 B.— Proceedings under Public Health Acts:— (1) Number of dwelling-houses in respect of which notices were served requiring defects to be remedied 13 (2) Number of dwelling-houses in which defects were remedied after service of formal notices:— (а) By owners 13 (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. (2) Number of dwelling-houses demolished in 1937, in pursuance of Demolition Orders Nil. D.— Proceedings under section 20 of the Housing Act, 1930:— (1) Number of separate tenements or ground rooms in respect of which Closing Orders were made Nil. (2) Number of separate tenements or ground rooms in respect of which Closing Orders were determined, the tenement or room having been rendered fit Nil. In last year's Annual Report full particulars were given of the Survey which the local authority had to undertake under the Housing Act of 1935. Two Surveys were carried out—Survey A, or the preliminary survey, and Survey B, in which measurements were made of the two classes in Survey A which were found to be definitely overcrowded and of those which were possibly overcrowded. Survey A was commenced on November 25th, 1935, and completed by January 4th, 1936. In this survey, 316 lettings were found to be definitely overcrowded, and 1,362 possibly overcrowded, out of 16,943 inspected. Survey B was completed before the end 22 of April, 1936. When Survey B was made, 60 of 316 definitely overcrowded lettings had become uncrowded, owing to a reduction in the number of occupants which had in the meantime occurred and that of the 1,362 possibly overcrowded, 174 were definitely overcrowded on the basis of table 2. There were, therefore, 430 lettings found to be overcrowded in Survey B. The 430 overcrowded lettings were occupied by 2,034 persons over 10 years of age and 583 children between the age of one and ten years. When the results of the Surveys were considered by the Special Committee of the Council, it was decided that 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 1936, and it was found that in the interval between the time Survey B was made and the further inquiry in August, 80 of the lettings had become uncrowded The primary object of these surveys was to ascertain in each area every case of overcrowding which existed at the survey, together with sufficient details relating to each case to enable the local authority to formulate plans for dealing with the overcrowding These surveys were intended to show the extent of the overcrowding in the district, and the important sections under which overcrowding was to be abated could only come into operation after the appointed day had been fixed by the Minister of Health. The "Appointed Day" was defined in Section 97 of the Housing Act 1935, as meaning "such day as the Minister may appoint and the Minister may fix different days for different purposes and different provisions of this Act and for different localities." The fixing of an appointed day is provided for in various sections of the Act:— (a) Under Sections 3, 4 and 8 of the Act, the appointed day is the date after which overcrowding may constitute an offence (b) Under Section 6, the appointed day is 6 months before the date by which a notice in the prescribed form must be inserted in every rent book. The Minister decided to fix January 1st, 1937 as the appointed day under Sections 3, 4, 8 and 68 in the case of all local authorities whose survey under Section 1 of the Act disclosed a total number of overcrowded families which was either under a hundred or was less than 2 per cent. of the total number of working-class houses in the district. 23 The Acton Borough Council submitted proposals to the Minister of Health for the abatement of over-crowding, and eventually a site in the Vale was selected as suitable for the purpose of the erection of houses for the working-classes. A public enquiry was hold on 29th September 1937, and the consent of the Ministry was obtained to the scheme on 4th November 1987. The site occupies an area of 9.55 acres and it is proposed to erect about 250 dwellings on the site. The Council made an application for the fixing of the appointed day on 22nd July 1936 and on 22nd December 1936, an order was made that the appointed day for the purpose of Section of the Act (which provided for entry in rent-books or similar documents or a summary in the prescribed form of certain povisions of the Act relating to overcrowding) shall be 1st January 1937, and the appointed day for the purpose of Sections 3 and 8 (which contain provisions as to the offences in relation to overcrowding) and section 4 and 68 of the Act shall be 1st July 1937. It is unnecessary to stake that the object of the order is to facilitate matters in order that existing cases of overcrowding shall be abated as soon as possible and that no new cases of overcrowding shall come into being. To attain this end, one of the first duties laid upon the public Health Department was the measuring of rooms for the purpose of ascertaining the permitted numbers for each workingclass dwelling, and for the furnishing of this information to landlords for insertion on the prescribed form of notice in the rent-books. For the purposes of Surveys A and B, 1,678 dwellings had been measured and the figures were available for insertion in the rentbook. In order to continue the measurements the services of Mr. Peterson were retained, but he obtained another appointment and left on 20th September 1936. A successor was not appointed until 9th. November 1936. In the meantime, many applications were made by landlords and their agents for the necessary data for insertion in the rent-books. Some miscalculations were made by us; we did not anticipate the large numbers of applications which were received from landlords or house agents in the particulars which had to be entered in the rent-books. Up to 31st December 1937. 902 applications were received and these reffered to 3,769 houses. The work of measuring was delayed on account of these applications, for it will be appreciated that the houses for which the applications were made could not be very expeditiously measured becauses the officer spent a large proportion of the time travelling from one house to the other. Usually only a few of the houses were unclose aproximity to each other. 24 Another miscalculation arose from the assumption that in terraced streets all houses, or at any rate most of the houses, were similar in structure and arrangements. We soon found that such was not the case, and the variation was so great that each house had to be measured and every room in the house had to be measured individually. It also became obvious that one man could not deal even with the applications which were received and on 5th April 1937 another officer was appointed for that purpose. In June, one of the officers resigned and another was appointed in his stead. In October, two others were appointed, and at the end of 1937, Messrs. Slipp, Wilcox, Dowie and Bauchop were engaged almost entirely on the work of measurement. When the task of measurement was commenced we expanded the scope of the work to include particulars which would be useful and valuable in future administration, but as the applications came in, it became evident that time would not permit of this expansion in the work, and we had to limit the work simply to a measurement of the rooms so as to ascertain the actual number of persons which would be permitted in each letting. Not only was it necessary to measure those houses which were the subject of applications, but it was essential to complete as soon as possible the measuring of all the houses included in Survey A and our efforts in the latter part of 1937 have been directed with this end in view. Up to the end of 1937, 9,960 tenements had been measured. I estimate that about 17,000 tenements had to be measured and over 7,000 remained unmeasured on 31st December 1937. Complaints, of course, are almost inevitable but they have been remarkably few. Some of the complaints are reasonable, and we have modified our procedure in some instances. We have pointed out the tendency to sublet the larger houses. These houses were formerly occupied by one family, but now in some streets about ninety per cent. of them are sublet and two, three and even four families occupy each of these sublet houses. In the few remaining ones which are still occupied by one family, the head of which usually owns the house, the occupier naturally resented the imputation that the house could be overcrowded. If the house, in the opinion of the Inspector, is not a house built for persons of the working-classes, he now asks if it is occupied by one family only; 25 if the reply is in the affirmative, and it is improbable that overcrowding could occur with one family, measurements of the house are not taken. An instance may be given to show to what extent houses in certain neighbourhoods are sublet, and that overcrowding is not limited to streets in which the houses are supposed to be occupied or are intended for occupation by the working-classes. A house was found when measured to be overcrowded; it was a large house and sublet into one and two-roomed tenements. The rent paid for the house was £85 a year with rates. The total rents received from the lettings amounted to £4 17s. a week, and two of the lettings were overcrowded. The overcrowding had occurred since July 1937, and notices have been served upon the landlord. In the Annual Report for 1936, census figures were given which pointed to the fact that the incidence of overcrowding had decreased considerably between 1921 and 1931, and that this improvement had continued between 1931 and 1936. The inspection which is now being undertaken so far points in the same direction. Owing to an oversight in the forms which were supplied for the purpose of Survey A and Survey B, it was impossible to distinguish the different lettings in the house; space had not been inserted to show on which floors the rooms were situated. The rooms had been measured, but the forms were almost useless and these houses had to be re-visited in order to obtain the necessary particulars. Of the 430 lettings overcrowded in Survey B, 246 had become uncrowded; and of the 9,960 lettings measured up to the end of December 1937, 29 were found to be overcrowded, and occupied before the appointed day, 1st July 1937. On 31st December 1937 there were to our knowledge 213 lettings overcrowded. The following tables give the number of houses and tenements and the numbers overcrowded. The column which gives the numbers of tenements which are overcrowded is probably the most important. The highest percentage of overcrowded tenements occurs amongst the two-roomed ones. In the one-roomed tenements the percentage was 3.8, in the two-roomed, 6.1 and in the threeroomed, 2.8. The percentage overcrowded in the whole of the tenements inspected was 2.1 compared with 2.5 under Survey B. 26 Table 1. Housing Act, 1936. Total Number of Houses Measured to 31st December, 1937—6,657. Comprising 9,960 Tenements. No. of Houses occupied by— No. overcrowded. No. of Tenements comprising— No. over crowded 1 tenant 3944 41 1 room 362 14 2 tenants 2231 97 2 rooms 967 69 3 „ 343 40 3 „ 3920 110 4 „ 108 18 4 „ 2043 19 5 „ 20 .3 5 „ 1389 10 6 „ 8 — 6 „ 966 1 7 „ 1 1 7 „ 165 — 8 „ 2 — 8 „ 83 — 9 „ — — 9 „ 31 — 10 „ — — 10 „ 27 — 11 „ — — 11 „ 6 — 12 „ — — 12 „ 1 — TOTALS 6,657 200 TOTALS 9,960 213 1,344 persons dwelt in these overcrowded premises. For the purpose of this Table, persons in occupation under one tenancy are regarded as members of one family. 27 29 new cases of overcrowding were reported during the year. The following tables give the overcrowded houses and tenements in the various districts. For sanitary inspection purposes the district is divided into 3—No. 1 included practically the NorthEast and North-West Wards North of the Uxbridge Road; No. 2 roughly included that part of the district south of the Uxbridge Road and East of Acton Lane; and No. 3 that part of the district South of the Uxbridge Road and West of Acton Lane. The highest percentage of overcrowded tenements is in No. 3 district, which included the South-West Ward. The results have corresponded broadly with those obtained when Survey B was made, with, as stated, a tendency towards a general reduction. Housing Act, 1936. Total Number of Houses Measured to 31st December, 1937—6,657. TABLE II. Comprising 9,960 Tenements. No. 1. No. 2. No. 3. Overcrowded Overcrowded Overcrowded No of Houses occupied by— 1 tenant 1376 10 1538 11 1033 20 2 tenants 524 3 888 33 820 61 3 „ 151 6 85 10 107 24 4 „ 75 7 8 2 25 9 5 ,, 9 1 2 0 9 2 6 „ 1 0 1 0 2 0 7 „ 0 0 0 0 1 1 8 „ 1 0 1 0 0 0 9 „ 0 0 0 0 0 0 10 „ 0 0 0 0 0 0 11 „ 0 0 0 0 0 0 12 „ 0 0 0 0 0 0 TOTALS 2137 27 2523 56 1997 117 28  No. 1. No. 2. No. 3. Overcrowded Overcrowded Overcrowded No. of Tenements comprising— 1 room 119 4 81 4 162 6 2 rooms 329 9 268 10 370 40 3 „ 1102 11 1466 33 1354 66 4 „ 578 3 940 7 525 9 5 „ 607 3 470 4 312 3 6 „ 371 0 334 0 261 1 7 „ 82 0 63 0 20 0 8 „ 53 0 17 0 13 0 9 „ 14 0 7 0 10 0 10 „ 22 0 1 0 4 0 11 „ 1 0 1 0 2 0 12 „ 1 0 0 0 0 0 TOTALS 3279 30 3648 58 3033 125 246 cases of overcrowding were relieved during the year, affecting 1,551 persons. No premises again became overcrowded after the Council took action to abate the overcrowding. In several Annual Reports, it has been pointed out that one of the most pressing and difficult aspects of the housing question in this district is that of the rent, and this coupled with the increased cost of living not only affects overcrowding but also the more important question of nutrition. For most classes the expansion in wages has not been sufficient to offset the increase in rent and the cost of living. For some employed workers the rise in the cost of living has been partly offset by higher wages, but the unemployed have had to meet rising prices on a stationary income, and the families with young children have suffered the most. It is generally 29 agreed that the gap between standard benefit and the expenditure regarded as necessary for health widens with each additional child in the family. The members of the Council are probably aware of the amounts which are paid. The standard benefit for husband and wife is 26/- a week, rising by an additional 3/- for each child under 14 years of age; thus, 29/- one child; 32/- 2 children; and 41/5 children. The scale of the Unemployment Assistance Board is different and takes into consideration the ages of the children and the amount of rent paid. Frequently, especially when some of the children are over five years of age, families without resources are better off under the Unemployment Assistance Board than on standard benefits. This discrepancy in favour of the scale of the Unemployment Assistance Board has been extended since the circular which authorised the Board's officers to grant additional allowances to households in view of the increased cost of living. In cases where unemployment benefit falls as far below the needs of families as to inflict obvious and serious hardship, the unemployed on standard benefit can no longer obtain relief from the Public Assistance Committee. They can, however, apply for supplementary assistance to the Board, but our experience is, that they very seldom do seek that assistance. Even in the Council flats, the usual rent for a living room, scullery and two bedrooms is between 12/- and 13/- a week; there is one flat of this type let at 9/5 and four are let at 11/1. The Council flats with accommodation of living room, scullery and three bedrooms let at 13/5, 14/11 and 15/2 a week. The rents for Council flats and houses are much lower than those paid for decontrolled lettings as the following instances of actual cases recently brought to our notice show. They are taken at random from applications for free milk. Standard benefits 29/-; rents 15/-, 16/6, 17/6. Standard benefits 32/-; rents 15/-, 16/-, 18/-. Standard benefits 38,/ -; rent 20/-. 30 It will be seen that the allowance on the standard benefit is 3/- per week per child. With the rents demanded here, such an allowance is much below the required standard, and it is estimated that it should be nearer 7/- per week per child. An additional benefit of 1/- per week per child would cost £1,250,000 per annum, so that to cover the full requirement would cost £5,000,000 a year, which could not be obtained from the Insurance funds. If the additional benefit were given in the case of the children of the unemployed, it would also have to be extended to the children of many employed families, because even under present conditions, the case of the employed man with a large family is no better than that of the unemployed; in many instances it is worse. It is common experience that the large families are usually found among the unskilled and the lowest-paid workers. The larger the family the worse off are its members, because wages are not based upon the number of children to be fed. We have recently come across the following which are given as instances of the hardships which must result. A motor-driver with wife and seven children earned 40/- a week and paid 16/- rent. Husband in the navy, four children, navy allowance 45 /-, rent 20/-. Porter, four children, stated to be earning 40/- a week, with three children, paying 21/- a week rent. These cases represent a large class in which the crux of the problem lies in the poverty of the overcrowded families. They cannot afford high rent. Their poverty has forced them into small dwellings and shuts off their escape. With growing families overcrowding becomes inevitable and increasing cost of nutrition puts increase of rent out of the question. Owing to the proximity of industries, the demand for houses here exceeds the supply and forces up the rents, and unless some system is devised for assessing a fair rent apart from the demand, the conditions are likely to continue As far as the children are concerned we have no option at present but to supply free milk to the families of the unemployed, and frequently also to those who are fully employed. These matters are more directly within the domain of the Maternity and Child Welfare Committee and the Education Committee and are being dealt with by these Committees. With free milk, free school meals and charitable and philanthropic means, the hunger of children in 31 large families in poor circumstances is partly mitigated, but no one imagines that this state of affairs is satisfactory. They are mentioned in this connection, because we are apt sometimes to look upon the question of overcrowding apart from the factors which enter into the causation, and which have more far reaching effects than the overcrowding itself. Number of Houses erected during the year:— (a) Total (including number given separately under (b) 124 (b) With State assistance under the Housing Acts:— (i) By the Local Authority — (ii) By other bodies or persons — Section E. INSPECTION AND SUPERVISION OF FOOD. (a) Milk Supply. There are no cowsheds in the Borough, all the milk being produced outside. There are 120 persons or firms retailing milk in the district under the following categories:— Dairymen. Purveyors of Milk No. with rounds net occupying premises in the Borough. No. with rounds ocupying 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 13 16 2 89 32 Special Designated Milk. The number of persons or firms licensed to sell Special Designated Milk is as follows:— 5 Tuberculin Tested. 1 Tuberculin Tested (Supplementary Licence). 3 Accredited. 13 Pasteurised. 2 Pasteurised (Supplementary Licence). 3 Pasteurised (No licence fee payable by Express Dairy Co. Ltd.)* 27 *The Express Dairy Co. have a pasteurising plant at No. 100 Bollo Lane. (b) Meat Inspection. There is no change of conditions. There are two slaughter houses in the district; in one of these a whole-time meat inspector is engaged on the duties of inspection. The other slaughterhouse deals almost entirely with Kosher meat. In the memorandum of the Ministry of Health a table has been inserted for the first time which will be very useful to local authorities. In last year's report I gave particulars of the practices in different areas, and the marked variation in the percentage of carcases and organs destroyed. It was pointed out that dissatisfaction existed amongst those who were engaged in some branches of the meat trade, but we can now, at any rate, show-to what extent inspection is made. In addition to the Table required by the Ministry, certain further particulars have been furnished. 33 CARCASES INSPECTED AND CONDEMNED. Cattle, excluding Cows Cows Calves Sheep & Lambs Pigs 1. Number killed 7 4 12,688 3,793 42,601 2. Number inspected 7 4 12,688 3,793 42,601 3. All diseases EXCEPT TUBERCULOSIS— Whole carcases condemned — 1 67 5 2 Carcases of which some part or organ was condemned 1 1 195 627 5 Percentage of the number inspected affected with disease other than Tuberculosis 14.2% 50% 2.06% 16.6% 0.016% 4. TUBERCULOSIS ONLY— Whole carcases condemned 1 2 14 — 38 Carcases of which some part or organ was condemned 1 — 62 — 2,205 Percentage of the number inspected affected with Tuberculosis 28.5% 50% 0.59% — 5.26% 34 NUMBER OF PIGS' CARCASES INSPECTED FROM 1st JANUARY TO 31st DECEMBER, 1937 WITH ANALYSIS OF SURRENDERS ON ACCOUNT OF DISEASE. 1937 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 4316 233 4 – 6 – — — 181 728 lbs. —lbs. February 3275 191 7 1 2 1 — — 121 526 „ — „ March 2343 198 3 — 4 2 — — 156 478 „ — „ April 4090 221 2 — 2 5 1 — 115 497 „ — „ May 4017 186 3 — 2 — — — 128 502 „ — „ June 3454 183 1 — 2 — — — 122 189 ,, — „ July 3129 113 3 1 2 — — — 122 216 „ — „ August 3208 111 1 — 4 — — — 128 — — „ September 3917 176 4 — 2 2 — — 191 417 „ — „ October 3841 231 6 2 2 — — — 201 290 „ — „ November 2938 208 3 — — — — — 138 — 38 ,, December 4073 140 3 — 6 4 — — 127 — — „ Total 42601 2192 40 4 33 14 1 — 1730 3843 „ 38 „ 35 (2). Adulteration. The Middlesex County Council is the authority under the Food & Drugs Act, and I am obliged to their officials for the following information:— List of samples taken during the year ended 31st December, 1937. Article. Taken. Adulterated. Milk 88 – Cream Pastries 1 — Hake 1 — Jam 1 — Lamb's Liver 13 1 Lemon Spread 1 — Vinegar 6 2 Whisky 6 1 117 4 Number of Prosecutions 2 Number of Convictions 2 SECTION F.- PREVALENCE AND CONTROL OVER INFECTIOUS AND OTHER DISEASES. At the end of the Report a Table is given showing the incidence of the compulsory notifiable infectious diseases, and the following received special attention during the year. DIPHTHERIA. 69 cases of Diphtheria were notified and there were 5 deaths compared with 15 notifications and 2 deaths in 1936. Since we started artificial immunization in 1932 until last year there had been a gradual decline in the incidence and morbidity of the disease in the district as the following figures will show:— 1932 151 cases 21 deaths. 1933 161 „ 23 „ 1934 86 „ 7 „ 1935 80 „ 8 „ 1936 15 „ 2 „ 1937 69 ,, 5 ,, 36 It is now generally agreed that apart from active immunization, no substantial reduction in the incidence and morbidity of the disease can be expected. At the second International Congress for Microbiology held in London in July, 1936, some remarkable figures were given by the readers of some of the papers. For instance, Hamilton, Ontario, a city with 150,000 inhabitants was the first city of that size in Canada to control diphtheria effectively. There have been no deaths in Hamilton since 1930 and no cases since 1933. This record speaks for itself. Other instances almost as striking were given. No town in this country can be compared with this because it is found difficult and even impossible to keep up the hard immunity; immigration and apathy militate against our efforts to keep up the immunity. In last year's report it was pointed out that one of the dangers which we had to face was the comparative freedom of the district from diphtheria. In the second half of 1936 only 2 cases of diphtheria occurred here; the parents become apathetic and neglect to have their children immunized, and 1936 was one of our poorest in the matter of immunization. It is impossible in the case of diphtheria to state what is cause and effect. The recorded morbidity rates of diphtheria are the resultant of different influences in different periods. But it is significant that the lull in our immunization in 1936, was followed by a sharp rise in the incidence of diphtheria in 1937. The following table gives the number of children inoculated in the five years. Under 5. 5—7 yrs. 7—15 yrs. November 1932—December 1933 406 619 1678 1934 328 377 203 1935 284 393 62 1936 170 111 41 1937 333 340 33 In 1936, 246 children were Schick tested after six months 21 of whom were found to be positive and were given one more dose; 262 were Schick tested after 3 years, 54 of whom were found to be positive and were given one more dose. 382 were given one more dose after 3 years without Schick testing. In 1937, 241 children were Schick tested after 6 months and of these 10 were positive and were given another dose. 401 children were re-inoculated after 3 years. We have altered our procedure several times since we began. At the start we used T.A.M. or T.A.F. and gave three doses at the 37 usual intervals. With the development of the manufacture of the immunizing agent, we changed over to the use of Formol Toxoid –F.T. The results of the use of T.A.M. appeared to be quite Successful, but in this matter we are to a very great extent in the hands of the bacteriologists and those who can carry out experiments on animals. The length of time necessary in field epidemiology in a comparatively new product is too long, and we have to adapt our procedure in accordance with the results of experimental epidemielogy. The only objection to the use of Formol Toxoid was the necessity of giving three doses before immunity was established. Its use was remarkably free from any undesirable or unpleasant reactions, and the immunity which resulted from its use appeared to be satisfactory. In 1936, we again changed over to the use of A.P.T. Alum Precipitated Toxoid, for the simple reason that we were advised of the potency of two doses. In the case of young children it is a decided advantage if immunity can be established with two doses instead of three. As far as we are concerned it has been found that there is a decided advantage in two doses instead of rhree; a certain proportion of the children did not turn up for the third inoculation. As a test of immunity we are dependent upon the Schick test; no other method of testing is practicable with the staff at our disposal. The Schick test is an instrument which has yielded valuable information in the epidemiology of diphtheria, but its inherent limitations must be admitted even when higher and more uniform standards have been perfected. The standards are not identical, Messrs. Burroughs Wellcome have supplied us with a four-fold schick toxin and we have used this for the past two years. It has been pointed out in previous reports that the percentage of positive reactors is much higher when this stronger toxin is used than with the ordinary Schick Toxin which is generally used. To young children a Schick Test is frequently a bigger ordeal than a single inoculation, and most parents prefer to have their children re-inoculated when they enter school, than to have them Schick tested, especially as a certain percentage may prove to be positive reactors, and require to be re-inoculated after the test. Since we Commenced immunization, there has been no death in a fully immunized child. Every year we have given details of the cases of diphtheria in immunized children. Last year 7 cases were notified in children who had been immunized. Two of these on wrongly diagnosed. In both cases there were no clinical signs on admission to hospital and the results of the swabs taken were negative. One was admitted on January 12th and discharged on January 15th and the other was admitted on November 10th and discharged on November 15th. 38 Two of the cases were carriers. The three cases in which clinical signs were present were very mild, and their stay in hospital was 9 days, 24 days and 25 days respectively. There were 3 cases in which the children had had one inoculation—1 of these was inoculated on the day before the notification. Diphtheria had occurred in the house and the parents wished the child to be inoculated. The two others had received one inoculation less than 3 weeks before notification. WHOOPING COUGH. Throughout the year 1937 whooping cough was prevalent in the district, and although there were only three deaths registered as being caused by the disease, it resulted in much interference with the work of the infants' departments of the schools, and especially that of the nursery schools and the day nursery. Whooping cough does not cause as many deaths as Measles in Acton, but owing to the length of time in which a case is infectious, and also the lengthy periods of its maximum incidence in a district, it causes more interference than most other diseases in day nurseries and infant schools. Whooping cough is notoriously one of the most difficult diseases to control and treat. Its prevention arises from the difficulty of diagnosis; in its early stages clinical diagnosis is not only difficult but almost impossible; the cough at first does not differ from the ordinary coughs which are prevalent amongst children in the colder months, and it is well-known that whooping cough is infectious from the early catarrhal stage of the cough, and before the appearance of the whoop or of spasmodic attacks. What is considered its sole characteristic is late and inconstant in its appearance. It has been suggested that the name whooping cough should be abandoned, and it should be called pertussis to wean the obsession of the medical profession that a whoop is essential. In a recent school epidemic one-fifth of the cases did not whoop at all and did not even have the recognisable spasmodic coughs. The difficulty of diagnosis in these cases, of course, is obvious in most epidemics these cases are a very small minority; but, as stated, even in those who develop the characteristic whoop, early diagnosis and segregation is almost impossible by clinical method alone. For many years bacteriologists have worked at the problem. and it seems likely that they have succeeded in isolating the germ which is the cause of the disease. The claims of the bacteriologist that the specific bacillus of whooping cough has been isolated were 39 confested, and there are still some persons who think that the disease is caused by a virus and that the bacillus is only a secondary invader. It is now acknowledged by most persons that the cause is a small haemophilic bacillus called at first the Bordet-Gengou bacillus, now generally known as Bacillus Haemophilus Pertussis. This is mentioned because during the early summer, through the kindness of Dr. Ian McLean working in the Inoculation Department of St. Mary's Hospital, bacteriological examination of the sputum of early whooping cough cases were examined, and a vaccine was used for prophylactic purposes in the Day Nursery. Our figures are too small for any statistical purposes, but it may be stated that in the few cases which were examined and were found to contain the haetmophylic bacillus, they subsequently developed the typical whoop and a diagnosis was made on bacteriological grounds some days before a clinical diagnosis could have been possible. The bacteriological tests though, are expensive and elaborate, and it is not practicable to carry them out as a routine, except in special circumstances. The tests may be possible in the case of boarding and private schools, but not in the elementary schools under present conditions. Very extensive investigations have been carried out, in fact, into the effect of vaccine treatment, but most of them have been tried as curative and not as prophylactics. The curative effect of the vaccine has in most cases been a failure, but prophylactic injections have succeeded in attenuating an attack even when they have not been completely successful in the entire prevention. It is not easy to obtain plate cultures from young children, As we found at the Day Nursery. Dr. McLean very kindly supplied us with vaccine for prophylactic treatment at the Day Nursery, and 16 children were treated by it. All the children had been in contact with whooping cough. Two of the children had had only one dose of the vaccine when the cough assumed the typical whoop, and they did not have any more vaccine, but were excluded from the Day Nursery. Two other children had only two doses each when they left the Nursery. One of these had had a cough for some time before receiving the first dose. The cough had not improved when he left, and he developed the characteristic whoop after he left. Twelve children received the full dose of six injections given at intervals of three to four days and stretching over a period of 28 days. Not one of these developed a cough which could have been diagnosed as whooping cough. Two of these had slight coughs when they received their first injection; the cough persisted throughout the period of 28 days, but it did not become spasmodic. One child developed a slight cough after the first dose and another developed a sight cough after receiving the fourth dose. The other six children were quite free of coughs throughout the treatment and did not hive whooping cough. 40 Some of the children attending our Child-Welfare Clinics were also given some of the vaccine. The figures are too small for any proof but in view of the extreme infectiousness of the disease, and the liability of most young children to contract it when exposed to the infection, we are of the opinion that its use was beneficial and that some were saved from an attack and that others had whooping cough in an attenuated form. Its prophylactic use undoubtedly opens a field of inquiry and usefulness in Day Nurseries and childrens' wards in hospital. Persons in charge of these institutions know how difficult it is to prevent the admission of children who may be suffering from coughs which are the early stages of whooping cough, and how easily the disease can be spread. INFLUENZA. There was an increase in the number of deaths from Influenza. The years 1934, 1935, and 1936 were particularly free of Influenza, but in December, 1936, there was a widespread increase in the incidence of Influenza throughout the kingdom, and, we, in common with all districts in and around London, suffered from the visitation. At one time, Influenza was so widespread and prevalent in the district that the Council decided to open a ward at the fever hospital for the accommodation of patients suffering from the disease. We had heard of instances where every member of the family had been stricken at the same time, and there was no one to attend the patients. Although not of a severe type, the incidence was widespread. Yet, when accommodation was offered only two persons took advantage of the facilities; the reason probably was, as started above, the mild type of the outbreak. Influenza is a disease with which we are all familiar, and a certain train of symptoms are usually associated with it, but it is admitted that our knowledge of the disease is lacking in exactness One reason is the fact that the term Influenza has been used to designate a variety of conditions in which the upper respiratory tract is involved. The Influenza which occurs in epidemic years, is probably a virus disease, but many of the outbreaks which occur in non-epidemic years and are termed Influenzas are not caused at any rate by the same virus. A great deal of prominence was given to last year's epidemic in the lay press because of the fact that the disease could be reproduced in ferrets, and great hopes were raised that a serum or a vaccine would be found for the illness. If we are dealing with a virus disease, it differs in some respects from most virus diseases, though in other respects. Its behaviour is similar to that of other known virus diseases. The epidemic last year spread very rapidly, and quickly reached its peak It was widely prevalent here for about a month. Its spread in a 41 particular district can be explained by droplet infection; there are so many sufferers that its spread by this means can easily be imagined, but its progress throughout the country is difficult to explain on this hypothesis alone, so rapidly may it spread from one end of the country to the other. All our twenty-eight deaths occurred in January and February. In one respect Influenza differs markedly from most virus diseases; an attack does not confer immunity upon an individual. The most familiar virus diseases in this country are Small-pox, Chicken-pox and Measles, and it is well-known that an attack of any one of these diseases confers an immunity that in most instances lasts a lifetime, but it is a common experience that some persons are peculiarly liable to Influenza, and suffer from it at each epidemic. In the epidemic of last year, as in others, this was noticed by the doctors, and evidently repeated attacks do not confer any lasting immunity. The age-distribution of the deaths from Influenza also points to the same conclusion. Most of the deaths were in elderly people; last year only two deaths occurred in persons under 45 years of age; 13 deaths occurred in persons between 45 and 65 years of age, and 12 in persons over 65 years of age. TUBERCULOSIS. 77 cases of Pulmonary Tuberculosis, and 13 cases of other forms of Tuberculosis were notified during the year. There were 37 deaths from Pulmonary Tuberculosis and 2 deaths from other forms of Tuberculosis. The notification-death interval of the 37 patients who died from Pulmonary Tuberculosis in 1937 was:— Information from Death Returns 4 Died within 1 month after notification 6 Died between 1 and 3 months after notification 5 „ „ 3 and 6 ,, ,, ,, 3 „ „ 6 and 12 ,, ,, ,, 5 „ „ 1 and 2 years ,, „ 5 „ „ 2 and 3 „ „ „ 2 Died over 3 years after notification 7 The following table gives the age incidence of new cases of tuberculosis in 1937 and of the deaths from the disease in the area in 1937. 42 Age Periods. New Cases. Deaths. Respiratory. Non-Respiratory Respiratory. Non-Respiratory M. F. M. F. M. F. M. F. 0— — — — — — — — — 1— — — 1 — — — — — 5— 1 1 — 2 2 1 — — 15— 10 17 1 3 6 4 — — 25— 13 9 1 3 4 3 — — 35— 3 8 2 1 2 3 — — 45— 5 2 — — 4 1 1 — 55— 10 — — — 3 1 — — 65 and upwards 3 2 — 1 2 1 — 1 Totals 45 34 5 10 23 14 1 1 48 The following is a statement of the particulars appearing in the Register of cases of Tuberculosis on 31st December, 1937:— Pulmonary Non-Pulmonary Total Number of Cases on the Register at the commencement of the year 174 males 45 males 412 167 females 26 females Number of Cases notified for the first time during the year 41 males 4 males 82 29 females 8 females Number of Cases previously removed from the Register which have been restored thereto during the year 2 males — males 2 — females — females Number of Cases added to the Register other than by notification 4 males 1 male 12 5 females 2 females Number of Cases removed from the Register during the year 32 males 3 males 62 23 females 4 females Number of Cases remaining on the Register at the end of the year 189 males 47 males 446 178 females 32 females In 1937, the Tuberculosis Officer examined 40 new cases of pulmonary tuberculosis, and 5 new cases of non-pulmonary tuberculosis. 41 patients were admitted to Sanatoria under the County Scheme, and 7 were admitted to hospitals. 44 ISOLATION HOSPITAL. 688 cases were admitted during the year, compared with 583 during 1936. 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 180 332 1 513 Diphtheria 70 61 — 131 Measles 9 5 — 14 Erysipelas 3 7 — 10 Whooping Cough 9 5 — 14 Influenza 1 1 1 3 Mumps 1 1 — 2 Eczema – 1 — 1 There were 11 deaths which were distributed as follows:— Diphtheria Measles. Whooping-Cough. Acton 6 2 1 Wembley 2 — — On 10 Scarlet Fever patients complete mastoidectomies were performed and on 3 of these cases operations were performed or both sides. A similar operation was performed in 1 case of Measles. BACTERIOLOGICAL EXAMINATIONS. (a) For Diphtheria Positive. Negative. Total Examinations 1693 118 1575 Sent by Medical Practitioners 14 233 do. (re-examinations) — 23 45 Sent from Isolation Hospital 51 713 do. (re-examination) 1 34 Convalescents (1st Swabs) 1 18 do. (2nd „ ) — 1 Contacts 7 233 do. (2nd examinations) 13 26 do. (3rd ,, ) 4 6 Precautionary Swabs 5 124 do. (2nd Swabs) — 4 School Sore Throats — 16 (b) For Ringworm Positive. Negative. Total Examinations—3 — 3 (c) For Tubercle Positive. Negative. Total Examinations—182 22 160 BIRTHS. Table 7 has been made out in the same form as in recent years. The total number of deaths is obtained from the Registrargeneral, and included all the births which belong to the district wherever they may have been registered throughout the kingdom. The registered births numbered 885, 5 more than in 1936, 444 males and 442 females, and correspond to an annual birthrate of 12.8 per 1,000 inhabitants. This is 0.1 per 1,000 higher than the birth-rate of 1936. The still-births numbered 32, and corresponded to a rate of 0.46 per l,000 inhabitants and 3.6 per cent. of the total births. The birth-rate for England and Wales was 14.9 per 1,000, and for the 125 County Boroughs and Great Towns was 14.9, and for the Administrative County of London, 13.3. We have not a complete record of the births registered outside, and therefore a correct allocation into wards is not possible. 46 Our records refer to 846 births and the Ward Distribution does not include 40 of the births. The ward distribution of the 846 was as follows:— North-East. North-West. South-East. South-West. Inside Births 132 90 63 129 Outside Births 144 104 73 111 Total 276 194 136 240 Most of the outside births occurred in the Central Middle sex Hospital, with 286 live and 15 still births; the next in popularity or more correctly, availability was Queen Charlotte's Hospital, with 52 confinements. The question of institutional confinements has been discussed in previous annual reports and the popularity of maternity hospitals and nursing homes is still evident. The effect of the domiciliary service under the Midwives Act is not yet apparent as the scheme did not come into operation until 1st October 1937. One of the objects of the Act is to popularise home confinements and make them safer, and it remains to be seen whether its operation will counteract the increasing popularity of institutional confinements. One surpriseing item in the figures is the fact that relatively domiciliary midwifery is more popular in the South West Ward than in the others. DEATHS. The method by which the inward and outward transfer are arranged have been explained in former Annual Reports, and it was stated that last year for the first time a discrepancy had occurred between the total number of deaths as supplied by the Register General at the end of the year and quarterly returns. I then mentioned a possible cause of the discrepancy: the registration and the municipal areas do not correspond. Although over three years have elapsed since the re-arrangement of the boundaries between Acton & Brentford and Chiswick was completed the old registration areas still obtain. 47 The same difficulty occurred last year; the RegistrarGeneral's total is 750; ours is 748. 396 deaths were registered in the district; of these 26 did not belong to Acton and were transferred to other districts, 378 deaths of Acton residents occurred outside the area and have been included in our returns. The total number of deaths belonging to the district according to these returns is 748; this number corresponds to a death-rate of 10.8 per 1,000 inhabitants. The death-rate for England & Wales was 12.4 per 1,000, for the 125 County Boroughs and Great Towns, 12.5, and for the Administrative county of London 12.3. In previous reports it has been explained that the RegistrarGeneral issues a figure for adjusting the local death-rate to make it comparable with other districts. This figure is called the comparability factor, and 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, and when the death-rate is multiplied by this factor, the standardised death-rate is obtained. The standard death -rate of Acton is therefore 11.6. The number of deaths is 46 less than in 1936 and the deathrate 0.7 per 1,000 inhabitants lower. There has been a decrease in the number of deaths at all ages except in the age-periods 1—2 years and 5—15 years. In the latter age-period there was an increase of 4, mostly accounted for by the 3 deaths from Diphtheria. Although there was a decrease in the number of deaths over 65 years of age, the percentage of deaths at this age was slightly higher than in 1936. 401 or over 53 per cent. of the deaths occurred in hospitals; an addition 21 died in nursing homes. 32 inquests were held, and 28 deaths were certified by the Coroner after a post-mortem examination without an inquest. 48 TABLE 1. BIRTH-RATE, DEATH-RATE AND ANALYSIS OF MORTALITY DURING THE YEAR 1937. 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. StillBirths. All Causes Enteric Fever Small Pox Measles Scarlet Fever Whooping Cough Diphtheria Influenza Violence Diarrhoea and Enteritis (under 2 yrs.) Total deaths under 1 year England and Wales 14.9 0.60 12.4 0.00 0.00 0.02 0.01 0.04 0.07 0.45 0.54 5.6 58 122 County Boroughs and Great Towns, including London 14.9 0.67 12.5 0.01 0.00 0.03 0.01 0.04 0.08 0.39 0.45 7.9 62 143 Smaller Towns Estimated Populations, 25,000-50,000 15.3 0.54 11.9 0.00 0.00 0.02 0.01 0.03 0.05 0.42 0.42 3.2 55 London 13.3 0.54 12.3 0.00 0.00 0.01 0.01 0.06 0.05 0.38 0.51 12.0 60 Acton 12.8 0.4 10.8 0.01 0.00 0.02 0.00 0.04 0.01 0.04 0.04 12.4 57 The maternal mortality rates for England and Wales are as follows:— Puerperal Sepsis. Others. Total. per 1,000 Total Births 0.94 2.17 3.11 „ „ „ „ (Acton) 1.1 1.1 2.2 49 TABLE II. VITAL STATISTICS FOR THE WHOLE DISTRICT DURING 1937 AND PREVIOUS YEARS. Year Papulation estimated to Middle of each Year Births Total Deaths Registered in the District Transferable Deaths Nett Deaths belonging to the District Nett Under 1 year of Age At all Ages Number Rate Number Rate of Non-Residents Registered in the District of Residents Registered outside Dist. Number Rate per 1,000 Births N umber Rate per 1,000 inhabitants 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 1935 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 1937 69,100 886 12.7 396 5.7 26 378 51 57 748 10.8 50 TABLE III. AGES AT DEATH, AND WARD DISTRIBUTION OF DEATHS IN 1937. Causes of Death. Age in Years. Ward Distribution. Total Under 1 year 1 and under 2 2 and under 5 5 and under 15 15 and under 25 25 and under 45 45 and under 65 65 and upwards North East North West South East South West Measles 2 — 2 — — — — — — 1 — 1 — Whooping Cough 3 1 2 — — — — — — 1 — 1 1 Diphtheria 6 1 — 2 3 — — — — 1 — — 5 Enteric Fever 1 — — — — — 1 — — 1 — — — Cerebro-Spinal Fever 2 — 2 — — — — — — — — — 2 Poliomyelitis 1 — — — — 1 — — — — — 1 — Influenza 28 — — — — — 2 14 12 11 3 4 10 Syphilis 1 — — — — — — 1 — — — — 1 Pulmonary Tuberculosis 37 — — — 2 10 12 8 5 12 6 9 10 Other T.B. 2 — — — 1 — — 1 — — 1 — 1 Diabetes 13 — — — 1 — — 4 8 3 4 — 6 Cancer 119 — — — — 1 14 64 40 34 29 28 28 Cerebral Hæmorrhage 54 — — — — — — 14 40 11 17 11 15 Heart Disease 139 — — — 2 1 6 38 92 38 32 35 34 Other circulatory diseases 24 — — — — — 1 7 16 8 7 1 8 Bronchitis 41 — 1 — — 1 — 10 29 15 10 5 11 Pneumonia 52 8 3 — — 1 5 15 20 11 19 9 13 Other respiratory diseases 6 — — — — — 1 3 2 2 2 — 2 Peptic Ulcer 11 — — — — — — 8 3 6 2 1 2 Diarrhœa 11 11 — — — — — — — 3 2 2 4 Appendicitis 8 — — — 1 — 1 3 3 — 3 4 1 Cirrhosis of Liver 2 — — — — — — 1 1 — 1 — 1 Other diseases of Liver 3 — — — — — — 3 — 3 — — — Nephritis 12 — — — — — — 6 6 3 4 2 3 Puerperal Sepsis 1 — — — — — 1 — — 1 — — — Other diseases and accident of Parturition 1 — — — — — 1 — — — — — 1 Senility 52 — — — — — — — 52 18 11 11 12 Cong. Debility and Prematurity 24 24 — — — — — — — 4 2 4 14 Suicide 8 — — — — 2 3 1 2 2 2 4 — Other deaths from Violence 27 3 — — 2 5 5 7 5 7 9 5 6 Other defined diseases 57 3 — 1 3 2 6 20 22 10 14 17 16 Totals 748 51 10 3 15 24 57 228 858 206 180 155 207 51 TABLE IV. INFANTILE MORTALITY 1937. 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 Whooping-Cough 1 — — — — — — 1 — — 1 — — Diphtheria 1 — — — — — — — 1 — — — 1 Pneumonia 8 — — — — 2 1 5 — 2 1 1 4 Pulmonary Haemorrhage 1 1 — — — — — — — — — — 1 Pneumococcal Meningitis 1 — — — — — — 1 — — — — 1 Diarrhoea 11 — — — — 5 4 2 — 3 2 2 4 Prematurity 18 14 — — 1 3 — — — 2 2 3 11 Congenital Defects 2 1 — — — 1 — — — — — — — Atelectasis 2 2 — — — — — — — — — 1 1 Marasmus 2 — — — — 1 — — 1 — — — 2 Haemorrhagic Disease of New Born 1 1 — — — — — — — — — 1 — Inhalation of Vomit 2 — — — — — — — — 1 — — 1 Accidentally drowned 1 — — — — 1 — — — 1 — — — TOTALS 51 19 — — 1 13 5 9 2 11 6 8 26 52 TABLE V. CASES OF INFECTIOUS DISEASE NOTIFIED DURING THE YEAR 1937. Notifiable Disease. Cases notified in whole District. At Ages—Years. Ward Distribution. At all Ages Under 1 1 to 5 5 to 15 15 to 25 25 to 45 15 to 65 Over 65 North East North West South East South West Scarlet Fever 207 1 42 135 13 16 — — 37 55 56 59 Diphtheria 69 — 24 39 3 3 — — 8 7 11 43 Pneumonia 73 5 9 6 9 10 20 14 27 13 16 17 Erysipelas 24 — — 1 3 4 11 5 9 2 3 10 Puerperal Pyrexia 8 — — — 3 5 — — 5 1 1 1 Ophthalmia Neonatorum 4 4 — — — — — — 1 — — 3 Paratyphoid 1 — — 1 — — — — — 1 — — Typhoid 1 — — — 1 — — — — 1 — — Cerebro-spinal Fever 2 1 — — — — — — 1 1 — 1 Dysentery 1 — — 1 — — — — — — — 1 Tuberculosis (resp.) 79 — — 2 27 28 17 5 28 18 14 19 Tuberculosis (other) 15 – 1 2 4 7 – 1 5 4 3 3 TOTALS 484 11 77 187 63 73 48 25 120 103 104 157 53 OPHTHALMIA NEONATORUM. Cases. Vision unimpaired. Vision impaired. Total Blindness. Deaths. Notified. Treated. At home. In hospital. 4 1 3 3 — — 1 54 TABLE 6. CASES REMOVED TO HOSPITAL. Total Notified. Scarlet Fever — 183 207 Diphtheria — 69 69 Pneumonia — 51 73 Puerperal Pyrexia — 6 8 Erysipelas — 9 24 Ophthalmia Neonatorum — 3 4 Paratyphoid — — 1 Typhoid — 1 1 Cerebro-Spinal Fever — 2 2 Dysentery — 1 1 TABLE 7. BIRTHS. Live Births. Male. Female. Total. Total 444 442 886 Legitimate 422 424 846 Illegitimate 22 18 40 Still Births. Total 18 14 32 Legitimate 17 11 28 Illegitimate 1 3 4 Notified Live Births. Ward Distribution. Total. n. East. n. West. S. East. S. West. Total Births notified in the district 419 135 92 63 129 Notifications received from other districts 438 147 107 73 111 Notified Still Births. Inside 10 Outside 19 Total 29 Notifications were received from:— Doctors and Parents 614 Midwives 273 55 TABLE 8. INFANT WELFARE CENTRES, 1937. 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 10,686 (b) by children between 1 and 5 years of age 6,676 Average attendance of children per session 43 Number of children who attended for the first time during the year:— (a) under 1 year of age 629 (b) between 1 and 5 years of age 146 Percentage of notified live births represented by number of children who attended a centre for the first time during the year 73% Children treated at Dental Clinic 96 Children treated at Ophthalmic Clinic 22 Mothers treated at Ophthalmic Clinic 2 Children operated on for enlarged tonsils and adenoids — Children operated on with X-Ray for Ringworm – TABLE 9. ANTE-NATAL CLINIC. Number of Expectant Mothers who attended 209 Number of attendances made by Expectant Mothers 448 Mothers referred for Dental treatment at the Clinic 79 Mothers supplied with Dentures 31 Expectant Mothers to whom Dried Milk was supplied free 21 Number of packets of Dried Milk supplied free 1133 form 10. INQUESTS. Suicide 8 Struck by motor vehicle 8 Collision between pedal cycle and motor vehicle 2 Collision with lamp-post 1 Fracture of skull—result of a blow 1 56 Accidentally drowned 2 Found drowned 2 Run over by horse cart 1 Run over by train 1 Fall from window 1 Fall downstairs 1 Blow with a hockey stick 1 Death under anaesthetic 1 Pneumonia 1 Cerebral Haemorrhage 1 32 Post Mortem without Inquest. Heart Disease 11 Pulmonary Embolism 1 High-blood pressure 2 Subaracurid Aneurism 1 Bronchitis 2 Fibrosis of Lung 1 Congestion of lungs 2 Cirrhosis of Liver 1 Nephritis 2 Cancer of bronchus 1 Asphyxia from inhalation of vomit 2 Epilepsy 1 28 Arterio-sclerosis 1 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 (Including Factory Laundries) 93 31 Workshops (Including Workshop Laundries) 323 7 Workplaces (Other than Outworkers' Premises) 7 Nil Total 423 38 57 2.– Defects found in Factories, Workshops and Workplaces. Nuisances under the Public Health Acts:— Particulars. Found. Remedied. (1) (2) (3) Want of Cleanliness 18 18 Want of Ventilation Nil Nil Overcrowding Nil Nil Want of drainage of Floors Nil Nil Other Nuisances 7 7 Sanitary Accommodation:— Insufficient 7 9 Unsuitable or defective 22 22 Not separate for sexes 3 3 Offences under the Factory and Workshop Acts:— Illegal Occupation of underground Bakehouses Nil Nil Other offences Nil Nil Total 59 59 3.—Outwork in unwholesome premises, Section 108 Nil 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). 58 J. J. Jenkins, M.R.San.I., Cert. of Royal Sanitary Institute; holds, Meat and Smoke Certificates, Deputy Child 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 and Smoke Certificates, Sanitary Inspector. A. H. G. Johnson, Cert. of Royal Sanitary Institute; holds Meat Certificate; Meat Inspector. Miss A. M. Cooksey, A.R.San.I., Certificate of Royal Sanitary Institute, Heath Visitor. (Retired 31st March, 1937). Miss B. G. Sorlie, S.R.N., Certificate of Royal Sanitary Institute, C.M.B., H.V. Diploma, Health Visitors and School Nurse. Miss W. E. Bennett, S.R.N., Health Visitor's Certificate of Royal Sanitary Inst., C.M.B., Health Visitor and School Nurse. Miss W. L. Orfeur, S.R.N., Health Visitor's Certificate of Royal Sanitary Institute, C.M.B., Health Visitor and School Nurse. Miss A. Woosnam, S.R.N., C.M.B., Health Visitor and School Nurse. Miss N. Lapham, S.R.N., Certificate of Royal Sanitary Inst., C.M.B., Health Visitor and School Nurse H. L. Hacker,* Chief Clerk. (Resigned 31.6.37). A. S. M. Pratt,* Barrister-at-Law, Chief Clerk. (Appointed 26.7.37). Miss V. E. Arnold,* Clerk (Resigned 31.3.37). Miss D. E. Beacon,* Clerk (Resigned 31.7.37). Miss A. Kent,* Clerk. 59 Miss J. Warburton, b.a. (hons.), Clerk. (Appointed 1.9.37). Miss V. Slack,* Clerk. Miss J. Wood,* Clerk. Miss M. G. Hester, Clerk. (Appointed 5.4.37). 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, (Died 28.11.38). 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. 61 annual report of THE School Medical Officer FOR THE YEAR 1937. 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 1937. 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. 1937 showed an increase in the number of Diphtheria cases. This was to be expected following the observations in last year's report that it was becoming increasingly difficult to interest parents in the question of having their children protected against Diphtheria. The fact that there was "no Diphtheria about" was enough for them, without their stopping to consider why this was so. Scabies continued to infest the Borough and cases were reported from all quarters of the town, although the bulk came from 62 South Acton. As this is the most crowded part of the Borough, the cases were correspondingly more difficult to stamp out. A great effort was made during 1937 to overtake the dental waiting list, and it is gratifying to be able to report that at the end of the year, only such a waiting list was left as could be overtaken while new cases were being examined. This entailed extra sessions for extractions, each session being a heavy one in order to cope with the numbers, and extra help had to be engaged for the conservative work. PUBLIC ELEMENTARY SCHOOLS WITHIN THE DISTRICT. WITH ACCOMMODATION. School. Dept. Accommodation. Avge. Monthly No. on Register. Average attendence Acton Wells Senior 320 234 214 Junior 364 394 358 Infants' 364 199 155 Beaumont Park Senior Girls' 450 139 123 Junior Girls' 450 209 193 Infants' 400 200 167 Berrymede Junior Boys' 640 409 359 Junior Girls' 542 381 339 Infants' 450 294 246 Central 480 396 365 Derwentwater Junior 441 361 332 Infants' 350 337 272 John Perryn Senior 360 189 168 Junior 288 242 220 Infants' 336 270 228 Priory Boys' 500 308 273 Girls' 499 298 252 Infants' 400 277 217 Rothschild Junior 450 209 193 Infants' 400 269 226 South field Senior Boys' 415 148 134 Junior 382 308 279 Infants' 350 265 218 Roman Catholic 327 264 224 West Acton 300 255 200 Special (M.D.) 68 43 33 10326 6898 5988 63 WEST ACTON SCHOOL. On Saturday, 20th March, 1937, the West Acton School, Noel Road, was officially opened by His Worship the Mayor, (Councillor H.G. James, J.P.). The school is built on a level site of 5 acres, and has been planned on open air lines. It is constructed of brick, the walls being built with a cavity. On entering the school, there is a through lobby, and opening off it on the right is the school hall. This is a large, airy, light room, with a stage at one end, decorated very pleasantly in light colours. On the left of the lobby are the Head Mistress's room, the Staff room, and the medical inspection rooms. The lobby is continued through a door to an open verandah with a glass roof, and all the classrooms open off this corridor. The classrooms are 5 in number, 24 feet by 21 feet in size. Each has its own cloakroom. All floors are finished in wood blocks. The last room of all on the corridor is a nursery classroom, 24 feet by 24 feet in size, and floored with rubber laid on concrete. The walls of all the classrooms are plastered and distempered in cheerful colours and the furniture also is painted to harmonise. Each classroom is provided with drinking water direct from the mains and there are drinking fountains in the playground. The lavatory basins are provided with hot and cold water. All latrines are of modern construction and are approached under cover. The window frames are of metal fitted into wood, and in the classrooms on the south side the windows are 12 feet wide and can be opened back to their full width. The school is heated by means of a low pressure hot water system, the boiler being coke fired by a mechanical stoker. The playground and is in course of construction, part being asphalt with interposing flower beds. There is a sandpit for the babies, and swimming and see-saws for the older children. The Caretaker's house is built separately from the school but designed to harmonise with it. The school takes many children from the neighbourhood who used to attend Acton Wells School, a very long journey in some cases and is designed to accommodate approximately 300 children. 64 AVERAGE HEIGHT without shoes, and AVERAGE WEIGHT without clothes. Anthropometric Committee, 1929. Age last birthday. males. females. Height in inches. Weight in lbs. Height in inches. Weight in lbs. 3 36.9 32.9 36.6 31.5 4 39.2 35.9 38.4 33.7 5 41.4 38.7 41.1 37.5 6 43. 41.3 42.8 40.1 7 45.4 45.4 45.1 44.1 8 47.8 51. 47.5 49.4 9 49.2 54.8 48.9 52.6 10 51.3 59.6 51.2 59.8 11 52.7 64.6 52.8 63.9 12 55. 71.6 55.6 73.9 13 56.2 76.5 56.9 79. 14 58. 86.1 58.9 88.2 15 61.8 99.3 62.3 106.8 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 45 44 58. 81.8 1 61.3 89.5 .... .... Central 33 33 59.1 87. .... .... .... .... .... John Perryn Snr. 30 29 58.8 84.1 1 59.5 93.8 .... .... Priory Boys' 114 114 57.6 80.9 .... .... .... .... .... Southfi'd Sr. Boys' 42 42 58.1 81.9 .... .... .... .... .... Turnham Gn. R.C. 12 10 57.1 80.4 2 57.5 84.2 .... .... 276 272 .... .... 4 .... .... .... .... (GIRLS) Acton Wells Senior 48 48 58.9 84.5 .... .... .... .... .... B'm't Pk. Sn. Girls' 38 38 59. 87.6 .... .... .... .... .... Central 55 55 59.3 86.3 .... .... .... .... .... John Perryn Snr. 33 32 58.5 85. 1 61.5 94.5 .... .... Priory Girls' 109 108 57.8 80.6 1 56.8 74.5 .... .... Turnham Gn. R.C. 15 15 59.5 87.5 .... .... .... .... .... 298 296 .... .... 2 .... .... .... .... 65 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 19 10 49.3 55.2 9 51.1 61.4 .... .... .... Acton Wells Infants' 16 11 50.3 57.6 5 49.5 53.7 .... .... .... Park Infants' 3 3 46.8 51.2 .... .... .... .... .... .... Junior 88 58 48.8 54.5 30 49.9 57.8 .... .... .... Infants' 1 1 46.8 48.3 .... .... .... .... .... .... Junior 36 31 48.8 54.7 5 50.4 56. .... .... .... Infants' 9 9 47.3 51.8 .... .... .... .... .... .... Infants' 41 18 48.8 54.8 23 48.8 53.9 .... .... .... 7 7 49.2 54.4 .... .... .... .... .... .... Junior 52 17 49.2 53.2 35 49.8 56.4 .... .... .... Infants' 7 7 48.9 53.2 .... .... .... .... .... .... South Field Junior 38 22 48.9 54.6 16 49.5 56.1 .... .... .... South Field Infants' 2 2 47.9 53. .... .... .... .... .... .... Green R.C. 20 5 50.2 57.1 13 49.9 54.1 .... 52.9 62.3 West Acton 17 8 48.1 51.2 9 50.1 55.8 .... .... .... 356 209 .... .... 145 .... .... 2 .... .... (GIRLS). Acton Wells junior 18 8 49.2 53.1 10 49.4 52.6 .... .... .... Acton Well Infants' 20 15 49.5 54.5 5 48.3 50.7 .... .... .... Jnr. 40 30 49.2 54.3 10 49.1 53.1 .... .... .... Park Infants' 2 2 47.7 52.5 .... .... .... .... .... .... Junior 87 60 46.6 51.8 27 48.1 53.2 .... .... .... Infants' 3 3 48. 52.1 .... .... .... .... .... .... Junior 32 23 49.5 55.7 9 49.4 56.4 .... .... .... Infants' 9 9 47.9 54.2 .... .... .... .... .... .... Infants' 31 13 48.8 52.6 18 49.8 54.6 .... .... .... 3 3 49.3 50.9 .... .... .... .... .... .... Infants' 7 7 48.5 53.7 .... .... .... .... .... .... South Field Junior 29 20 48.8 53.9 9 49.7 55.4 .... .... .... South Field Infants' 5 5 48.8 49.6 .... .... .... .... .... .... Green R.C. 17 9 47.9 56. 7 49.6 55.8 1 53. 61.5 West Acton 21 9 49.9 56.1 12 48.7 55.1 .... .... .... 324 216 .... .... 107 .... .... 1 .... .... 66 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 ins. Weight lbs. Acton Wells Infants' 33 7 39.7 37.7 12 40.8 38.1 7 44. 41.2 7 44.8 45. Beaumont Park Infants' 45 15 37.1 33.3 13 39.1 30.1 15 42.9 43.5 2 45.5 47.5 Berrymede Infants' 46 13 37.0 35.9 11 40.6 39.4 15 42.6 43.8 7 43.7 45.1 Derwentwater Infants' 88 ... ... ... 38 41.2 38.9 27 43.5 41.7 23 45.4 45.6 John Perryn Infants' 49 ... ... ... 28 41. 38.5 19 42.9 42.4 2 43. 42.3 Priory Infants' 6l 18 38.4 35. 14 41.4 40.1 21 43.7 42.6 8 45.3 48.8 Rothschild Infants' 36 14 39.2 34.8 10 42. 40.5 11 44.4 42.9 1 46.5 50.8 Southfield Road Infants' 62 ... ... ... 27 41.1 39.1 24 43.7 43.1 11 46.3 48.5 Turnham Green R.C. 23 ... ... ... 9 41.5 39.9 10 43.7 44.8 4 46. 48.2 West Acton 50 10 37.9 33.6 19 42. 40.3 10 44.5 46.4 5 43.8 43.6 493 77 181 165 70 (GIRLS). Acton Wells Infants' 39 8 37.7 32.7 13 40.5 37.6 15 42.7 40.9 3 44.2 45.5 Beaumont Park Infants' 37 17 37.9 34.2 9 40.4 39.4 7 43.2 56.3 4 45.6 46.1 Berrymede Infants' 57 17 37.2 33.1 19 39.5 38.1 19 42.3 41.9 2 46.3 48. Derwentwater Infants' 79 ... ... ... 35 40.3 37.5 31 43.3 41.6 13 47. 47.3 John Perryn Infants' 32 ... ... ... 16 41.1 38.3 12 43.5 41.4 4 44.9 45.8 Priory Infants' 57 17 37.4 31.4 21 40.1 37.7 15 43.1 41.8 4 44. 45.1 Rothschild Infants' 48 10 38.1 39. 10 41.2 37.7 10 43.6 40.9 6 47.3 49. Southfield Road Infants' 67 ... ... ... 22 40.4 37.6 33 43.9 43.2 12 45.4 44.3 Turnham Green R.C. 15 ... ... ... 4 40.9 38.3 6 41.5 36.4 5 47.6 48.1 West Acton 52 13 39.1 35.5 23 41.8 39.2 12 44.5 42.8 4 47.3 45.4 483 85 172 106 57 67 TONSILS AND ADENOIDS. 44 cases were operated on for the removal of adenoids and for tonsils and adenoids under the Authority's scheme during the year 1937. 40 children had their tonsils and adenoids removed because of repeated attacks of tonsillitis, frequent colds, enlarged glands in the neck from frequent sore throats, etc., etc. 32 of these were recommended by the School Medical Officers, 5 by Mr. Griffiths, Ear, Nose and Throat Consultant at the Acton Hospital, 1 by Dr. Nicol-Roe, Tuberculosis Officer, 1 by the West London Hospital and 1 by the patient's own doctor. 2 children had tonsils and adenoids removed because of continued ear discharge. These children were referred from the Ear Clinic to see Mr. Griffiths at the Acton Hospital and the operation was advised by him. 2 children had adenoids only removed because of slight deafness and improvement followed the operations. RHEUMATISM. In last year's Annual Report, the position in Acton was Reviewed with regard to Rheumatism in childhood. It was reported then that Rheumatism was on the increase in the Borough and various suggestions were made as to the reasons for this. In 1936 there were twice as many cases reported as there had been in 1935. following the theory of some expert observers that acute Rheumatism comes in waves in some years, it was considered that perhaps Acton was approaching the crest of one of these waves, and that that might account for the excessive increase in cases. Whether this be so or not, there has been only a slight increase in the cases reported in 1937 as compared with those for 1936 and by no means the startling increase that 1936 showed over 1935. The number in 1937 exceeded the number for 1936 by only two cases. 68 One curious feature emerged when reviewing cases for 1937 and that was the high proportion of children who showed manifestations of Chorea as against other evidence of Rheumatic infections in childhood. Nearly half the total cases reported suffered from Chorea, and of these the bulk were treated at the Borough's Rheumatic Clinic at the Princess Louise Hospital. Our arrangements with the Princess Louise Hospital whereby the Hospital takes charge of Rheumatic cases for Acton, are very satisfactory. Cases are referred to Dr. Aitken and thereafter it is very certain that all that can and should be done for the child will be undertaken. Cases are admitted where necessary to the Wards, of the Hospital, all appropriate investigations are carried out and advice given as to future conduct and care. It is often necessary to send children who have suffered from Rheumatism in its various manifestations, away for a prolonged period to a Heart Home. It is urged by some authorities on the subject that every case should be so dealt with and that the period of convalescence should extend to a year at least, in order to lessen the chance of a recurrence Unfortunately it is all too frequent for second and even third attacks of Rheumatism to affect the same child and with each subsequent attack there is greater risk that the heart will be per manently damaged and less chance of the patient's escaping this crippling disability. Dr. Schlesinger (who is Physician to the West Wickham Heart Home where so many of our children have been sent), writing recently in The Lancet, has analysed a series of cases suffering from Rheumatism. He contends that with the onset of puberty there comes a remarkable decrease in the bad effects of rheumatic relapses, and that if a child can only be steered carefully through the dangerous years up to fourteen, there is more chance that serious physical involvement may be avoided. After that age there is less likelihood of relapse, and the patient's resistance appeals to be higher. The children who have been affected by Rheumatism in Acton during 1987, range in age from 4 to 13. The most frequent ages for onset were from 8 to 11. It has not been proved that as earlier onset means a worse outlook except in so far that it leaves more years for probable relapses before adolescence lessens the risk 69 SCARLET FEVER. During 1937, there were 134 cases of Scarlet Fever among school children, the numbers being distributed as follows:— Acton Wells 13 Priory 11 Beaumont Park 24 Rothschild 6 Berrymede 25 Southfield 15 Central 3 Roman Catholic 3 Derwentwater 17 West Acton 14 John Perryn 3 The 1937 numbers show an advance on those of 1936, when 98 cases of Scarlet Fever were reported. During the whole year the Isolation Hospital was busy admitting Scarlet Fever cases—usually in the summer cases of Scarlet Fever diminish to an odd case now and then, but in the summer of 1937 cases continued to come fairly steadily into Hospital. The cases were not severe in type, and as the distribution shows were drawn from all parts of the Borough. 111 Scarlet Fever patients and 163 contacts were examined at the office before returning to school. We abandoned the practice of excluding contacts from school attendance many years ago, and we have found no grounds for changing our present procedure. The contacts are kept under observation, and if no suspicious symptoms arise, the.children are allowed to attend school. The contacts are under the observation at the class teachers and if necessary they are seen either by the school Medical Officers or the School Nurse. All the recent investigations tend to prove that exclusion of contacts is unnecessary. The practice was based on the supposition that the contacts were potential carriers of the disease, and that it was necessary to isolate these possible carriers for a period of a week or a fortnight. We have seen no bad effect from the practice of allowing contacts to attend as soon as the case is removed to hospital, and in any event, in an urban area isolation of all carriers, whether Scarlet Fever or Diphtheria, is impossible. Even when the contacts were excluded from school, it was never attempted to keep a healthy child confined to the house, much less to a single room, Apart from that, there is no evidence that the contacts of Scarlet fever are more frequently carriers of haemolytic streptococci than the rest of the community. 70 DIPHTHERIA. During 1937 there were 43 cases of Diphtheria notified in school children. This is a considerable increase on the number of cases notified in 1936. It was only to be expected as a result of the waning interest shown by parents in protecting their children against Diphtheria which was commented on in the Annual Report for 1936. It is much to be regretted that the comparative safety of the Borough from Diphtheria, which is the result of much hard work and persistent endeavour, should lead only to a disbelief in or contempt for the ravages of Diphtheria amongst the young. This increase in cases in 1937 over 1936 has, however, had a slight effect on the percentages of children inoculated at the schools. As compared with 1936, in all but three of our schools the percentages of children in the Infant departments who have been inoculated have gone up. These percentages are by no means as high nor as satisfactory as could be wished, and the lowest per centage of all comes from the school which serves the poorest and most crowded part of the Borough. At medical inspections in Infant departments during the past year, enquiries have invariably been made of parents as to whether their children have been protected against Diphtheria, and if not why not. Various answers are received, but the two most frequent replies are—1: The child's father doesn't believe in it, and 2: It the child is meant to have Diphtheria, it will have Diphtheria and nothing can prevent it No amount of explaining or reasoning can break through these barriers of ignorance and prejudice, and it has been noticed that where promises have been obtained for the children to come to the inoculation clinic at Avenue Road on Saturday mornings, these promises have not been kept and the children have not turned up. The promises were evidently only made to stop our enquiries and keep us quiet. Our inoculation scheme has been carried along the same lines as last year. All children are approached and offered inoculation and this is carried out by two or three injections, depending on the material used for the purpose. At the end of 6 months. These children are Schick tested. The Schick test has not been found to be a reliable index of insusceptibility to Diphtheria, but it is the only one at our disposal and so we use it. Any child found not to 71 be Schick negative is given another dose of immunising material, all the Schick testing material used in the Borough is four times as strong as that in general use, so that if our children are negative to this stronger test, they are so much nearer the blood level of immunity to the disease. All children also, who were inoculated ill accordance with the scheme just described, are at the end of three years given one further inoculation of immunising material. This one injection stirs up all the old immunity which by this time may have begun to wane, and helps to keep up the level of herd immunity to which we aim. It is proposed to give this one injection to these children every 3 years all through their school days, but so far the scheme has not been in operation long enough to show if it is successful or not. It is now five years since Acton started offering inoculation against Diphtheria to all who would avail themselves of it, and there has not been in that time one death in a fully immunised child. During 1937 there were three deaths from Diphtheria in School children, but none of them had been inoculated against the disease. The 43 cases in school children were drawn from the schools as follows:— Acton Wells 1 Priory 4 Beaumont Park 4 Rothschild 5 Berrymede 19 Southfield 1 Derwentwater 3 Roman Catholic 5 John Perryn 1 It is noticeable that the highest number of cases of Diphtheria come from the school where the percentage of children immunised in the Infant department is the lowest. It is in this School, whose need is the greatest, that it is most difficult to get consent from the parents for their children to be protected from a disease which the crowded nature of their homes makes more deadly for them than for others. Indifference, ignorance, and prejudice prevent their taking advantage of the facilities offered them. 30 Diphtheria patients and 52 contacts were seen at the office before returning to school. 72 Diphtheria Immunisation—1937. Schools. Schick Tests. Positive re-actors. T.A.M. A.P.T. Re-inoculated after 3 yrs. 1st. 2nd. 3rd. 1st. 2nd. Acton Wells Senior - - - - - - - 7 Acton Wells Junior 5 4 4 3 3 - - 42 Acton Wells Infants 1 1 3 4 4 9 8 7 Beaumont Pk. Junior Girls — — 1 1 1 - - 6 Beaumont Park Infants — — 1 1 1 32 23 15 Berrymede Junior Boys — — 2 4 7 1 1 46 Berrymede Junior Girls — — 1 1 9 2 2 40 Berrymede Infants — — 20 28 20 31 20 19 Contral — — — — - - - 3 Derwentwater Junior 4 4 5 5 5 - - 17 Derwentwater Infants — — 14 20 23 60 46 16 John Perryn Senior — — — — 1 — — 37 John Perryn Junior — — 4 5 5 2 2 23 Priory Boys 1 1 1 1 1 — — — Priory Girls 1 1 1 1 1 1 1 — Priory Infants — — 4 19 19 28 22 21 Rothschild Junior — — — — — — — 10 Rothschild Infants — — 14 15 14 51 36 10 .Southfield Junior — — 1 — — — - 18 Southfield Infants — — 9 8 10 30 26 13 Roman Catholic 8 2 4 — — 26 22 17 West Acton 1 1 3 3 3 35 18 22 Other Schools — — — 1 1 — — 12 Day Nursery — — — — - 16 12 — Welfares — — — — 29 353 292 — Total 21 14 98 120 163 677 531 401 In addition 210 children were schick rested after 6 months and these 10 were positive and were given another dose. 73 Measles. The year 1937 was not an epidemic one in Acton, and in only one school was there any interference with school work from measles. Since the end of the Great War, Measles has regularly appeared in the district in epidemic form in alternate years, and these have been the even years—1936, 1934, 1932, etc. Sporadic cases always occur in a district like ours, which is not a self-contained area. So much immigration and emigration occur, that isolated cases are always cropping up, but when an isolated case occurs in an interepidemic year, there has been very little danger at spread of the disease even in the Infants' departments. The theory is held, and events seem to prove its correctness, that during an epidemic the community is immunised either by a clinical attack or by a subclinical infection. A clinical attack usually confers a belong immunity, and a sub-clinical infection confers immunity which may extend to a couple of years or more. An epidemic dies down when the herd immunity reaches a certain level. In the past quarter of a century, the conditions have favoured the occurrence of an epidemic every two years. Circumstances can arise, such as immigration, reduction in the Size of families, etc., which would alter the epidemiological course of the disease, as the history of Measles in the district shows. When the district was rapidly developing, the epidemiology of the disease was different, and a regular biennial visitation was the exception and not the rule. A small outbreak in West Acton Infants' School last summer an interesting from an epidemiological standpoint, because the course of events was probably influenced by immigration and the tendency towards reduction in the size of families. This school was opened in February 1937, and although the from which its pupils are recruited is now almost entirely built constitutes that part of the district most recently developed, immigration has relatively been more extensive here than in the rest of the district; moreover, the families are smaller in size. some cases of Measles occurred in the district in the summer, but it was only in the West Acton School that it spread. Over 30 cases occurred here in the summer term, but only isolated cases occurred in the other Infants' departments. Most of the children who suffered were either in one-child families, or were the eldest children in the family, conditions which would make it likely that 74 they were not exposed to infection in the epidemic of 1936, an ! therefore not likely to have become immunised. Towards the end of the year. Measles made its appearance in the other schools, and an epidemic occurred in these schools in the first quarter of 1938. EXCEPTIONAL CHILDREN. Blind and Partially Sighted. 1 child was transferred during the year to a certified school for the blind. Previously he was at a school for the partially sighted but it was unfortunately necessary to transfer him because he was becoming blind. 1 child is attending the Kingwood Road School for the Partially Sighted and 1 child is at present at the White Oak School. Swanley, as a result of severe and repeated eye infections. 1 child, although suffering from much impaired sight, attends an ordinary elementary school and her progress there is satisfactory. Deaf. 3 deaf and dumb children and 1 deaf child attend the Ackmar Road School for the Deaf. 2 of the deaf and dumb children are brothers. A younger brother is attending an ordinary elementary school meantime as he is not old enough to go to a special school 1 other child is attending an ordinary elementary school. She was seen by an Ear Specialist who certified her as being "congenitally deaf" and when she is old enough, she also will be transferred to a special school for the deaf. 1 partially deaf boy attends Ackmar Road School for the Deaf and 1 boy is attending an ordinary elementary school and has recently had an operation on one of his ears Mentally Defective Children. 45 children attend the Acton Day School for Mental Defectives, 19 girls and 26 boys. During the year there were 10 new admissions. Epileptic Children. 2 children are resident in Epileptic Colonies, one at Lingfield and one at Chalfont St. Peters. 1 child, suffering from severe Epilepsy, is being educated at home. 75 Tuberculous Children. 1 child is in an institution for the treatment of Tuberculosis of the lungs at Tadworth, and 2 other children are suffering from Non-pulmonary Tuberculosis and are under treatment, one at a certified special school at Broadstairs, and one in the Acton Hospital- Crippled Children. 1 child, who has lost one of her legs, is attending Queensmill Road School for the physically defective. 2 children, one suffering from the effects of Infantile Paralysis and one from repeated operations on the bone of one of her legs, are in Hospital under treatment. I child, after being in Hospital for some months with Osteo-myelitis, is at present at home. Delicate Children. 10 children are included under the section of Delicate children. 3 children, as the result of various illnesses and diseases, are attending the Wood Lane Open Air School. 1 child is in a Home at Seaford suffering from Asthma and Eczema. 1 child, debilitated by Asthma, is in a convalescent home, and 1 suffering from Pleurisy, is in the West Middlesex Hospital. 2 children suffering from Asthma, are at present at home, 1 child whose health has been impaired by Rheumatism, is attending the Princess Louise hospital for Children and is at present at home. 1 child who is Constantly unwell, and whose general condition is much below par, is at home waiting for a vacancy to go to a convalescent home. Children with Heart Disease. 2 children are in the Princess Louise Hospital, suffering from carditis following Chorea. 1 child, suffering from Rheumatic Endocarditis is in Acton Hospital, awaiting transfer later to a Heart Home. REPORT OF EAR CLINIC. An analysis of children who were referred to the Ear Clinic in 1937 gives the following information: — A total of 130 children were referred to or attended the Clinic. 63 of these suffered from ear discharge. 38 attended complaining of ear-ache. 12 attended complaining of deafness. 13 were found to be suffering from wax in the ears. 4 were found to be suffering from miscellaneous ear conditions. 76 63 cases of Otorrhoea. 41 of these were acute attacks of otorrhoea and all were cured 8 of these cases had two separate attacks of otorrhoea during 1937 and were cured on both occasions. 11 cases of chronic otorrhoea (i.e. otorrhoea of more than two- months duration or otorrhoea which has re-appeared inter mittently over a number of years) were also cured. Only one of these cases was cured by operation and one cleared up under treatment while waiting admission to hospital for operation. The other nine cases cleared up with persistent and varied local treatment The remaining 11 cases cannot be claimed as cured. 4 of the 11 left school while still under treatment. 1 of these had attained the age of 14 and had been a case of double intermittastotorrhoea attending the Ear Clinic or the Acton Hospital for pro longed periods at various times. Permanent damage had been done to his left ear and when he left school he had still very slight discharge from this ear. His other ear had cleared up. This boy had on several occasions been referred to an Ear Consultant and arrangements were made for him to attend hospital after leaving school should it be necessary. 1 child who had been attending the Ear Clinic died in hospital. It is not known if her ear condition was better or not 4 of these cases were referred by the Clinic to hospital and one was taken by his parents. This last boy suffers from chronic eczema and is waiting admission to hospital for an operation on his ear. The 4 cases referred to were seen by Mr. Griffiths, ear Consultant, at the Acton Hospital, and various local treatment were advised. 1 case suffered from a very recent ear discharge which had not cleared up on December 31st. 38 cases of earache. 28 of these cases had some degree of inflammation in their ears, 2 caused by plugs of hard wax and 1 by a plug of papers pushed into the ear. All subsided under treatment. 10 showed no abnormality of their ear drums but their earache so called was found to be caused by sore throats, colds in the head and in 1 cases to a badly decayed back tooth. 77 12 cases complaining of deafness. 1 case was helped by removal of unhealthy adenoid tissue, i was due to wax and removal cured the condition, and the tfiruining 10 were due to bad head colds or to unhealthy post-nasal Spaces, but appropriate treatment 'was undertaken and improvement reported. 13 cases of wax. It is encouraging that 6 of these cases had had otorrhoea in past and when a waxy secretion was noted coming from the ear, parents brought the children at once to the Clinic for examination and advice. In all 6 cases the ear drums were intact and the secretion was only waxy. 4 other cases were seen at the Clinic for various other ear condditions. 1 was suffering from external otitis, 1 had a boil in the ear and 2 had enlarged post-auricular glands. The Ear Clinic has been run on similar lines to last year. Each case is seen once each school day by either the medical officer or the nurse and appropriate treatment undertaken. Where possible the parent of the child is also seen and instructions and demonstrations given as to the home care necessary to effect a cure. In the majority of cases, co-operation in the home is obtained and the results are correspondingly gratifying, but sometimes it happens that on Monday it is all too evident that nothing whatever has been done since the ear was treated on Friday. Every endeavour is made to secure the co-operation of the parent, and where the child is old enough, instructions are given to him or her how to treat the ear personally. It is not always deliberate neglect on the part of the parents—often it is the fear of doing some damage to the ear which holds their hands. In such cases a demonstration is usually all that is needed to encourage them to attend to the ear in an adequate manner. The high proportion of cases in 1937 which attended the Ear Clinic before the onset of otorrhoea and where ear discharge never developed is some proof that the Clinic is being sought for advice more widely. Parents and teachers are encouraged to send the children on the first complaint of ear trouble or the first sign of disease so that treatment can be instituted without loss of time. A cure can be anticipated with more certainty if the diseased condition of the ear has not been in existence very long. In one or two cases, more rapid improvement has followed treatment of the patient on general lines as well as local treatment to the ear. A 78 vitamin substance, such as cod liver oil and malt, has been ordered and other approprate treatment advised. In 2 cases where chronic otorrhoea was cleared up, improvement followed rapidly on the introduction of cod liver oil drops into the ear itself. In other cases not much improvement followed the use of cod liver oil drops but in these 2 cases cessation of the discharge followed after the drops had been used a short time. SCABIES. Scabies or The Itch continued to affect the school population during 1937. In all, there were 101 cases treated, but many of these were cases who got themselves re-infected and had to undergo treatment again and again,—in one family as often as four times in the year, in February, in April, in July, and in November. When a child is discovered to be suffering from Scabies, it is excluded from school, and all its brothers and sisters and parents too if possible, are examined to see if they also are infected. During the first part of the year arrangements were made for attendance at the Kensington Baths for treatment, and where instructions were carried out good results were obtained. In a fair number of cases however, it was found that for one excuse or another, appointments were not being kept, and it was found to be difficult to control the treatment advised. Towards the latter part of the year therefore home treatment was advised in the first instance, and only where the mother had proved herself incapable or unwilling to carry out the instructions given, was resource had to the public baths. A printed sheet of instructions and sufficient ointment was given to the parent, and they were advised to report with the children at , the end of a few days for inspection. Where the home conditions were good and the parent careful, good results were obtained and it was easy to pick out those who really did not try to get clear of . the infection. An outbreak of Scabies, such as has affected Acton. is exceedingly difficult to control. Infection is usually spread during sleep, as the Acarus Scabei, the cause of Scabies, is a very siow mover and needs prolonged contact before infection takes piaces Arrangements were therefore made to have the bedding and bed clothes of infected persons sterilised, and they were advised to boil their sheets and pillow cases. Homes were visited and advice given on innumerable occasions. All school nurses visited the schools and hand parades were held, in order to pick out if possible such of the pupils as were suffering from Scabies and had not reported themselves or been detected. 79 It will be seen how widespread the infection of the Borough was, if the Table below be studied, showing the number of schools affected. All schools were affected at one time or another, and most departments of the schools. School. Dept. affected. So. of Cases. Families. Priory All 22 17 Berrymede All 23 19 Roman Catholic 8 3 Special School 10 3 West Acton 4 1 Beaumont Park Infants' & Senior Girls' 4 3 Central 4 4 Acton Wells All 11 8 Rothschild Infants 3 2 Southfield Junior 1 1 John Perryn All 8 6 Derwentwater Infants 1 1 South Acton was the part of the Borough most affected, and it was found on tabulating the cases detected that almost throughout the whole year, cases were cropping up in South Acton and having to be treated. Certain families proved very troublesome and became re-infected several times. In the worst case of re-infection the family is of very low mentality and it was hard to secure understanding or co-operation in securing freedom from infection and in maintaining it when attained. In another, the parents were infected and apparentiy indifferent as to whether they got clear or not. In others the mother went out to work, the children spent all their playtime in the streets and probably the parent had less time in which to look after them properly. Below is shown the schools affected during the various months of the year. January. Priory and Berrymede. February. Priory, Berrymede, Roman Catholic, and Special School. March. Priory and Berrymede. April. Berrymede, Special School, Central, West Acton. May. Priory, Acton Wells. 80 June. Priory, Berrymede, Rothschild, Central. July. Southfield, Special, West Acton, Derwentwater. August. Berrymede, Priory. September. Priory, Berrymede, John Perryn, Acton Wells, Rothschild October. Berrymede, Priory, Acton Wells, Central, John Perryn Beaumont Park, Special. November. Berrymede, Priory, Special, West Acton, John Perryn Roman Catholic. In the following Table is shown the streets affected in various months. January. Avenue Road, Holland Ternace, Osborne Road. February. Colville Road, Park Road N., Shaftesbury Road,Canada Crescent, Stirling Road, Acorn Gardens. March. #Stirling Road, Junction Road, Packington Road, *Colville Road Somerset Road, Stanley Road. April. Burlington Gardens, *Canada Crescent, Stirling Road. May. Colville Road, Newark Crescent, Wesley Avenue. June. Park Road N.t Brassie Avenue, *Avenue Road, Colville July. The Vale, "Canada Crescent, Chaucer Road. August. Somerset Road, Clovelly Road. Septeml>er. Brassie Avenue, *ColviIle Road, Avenue Gardens, Park Road N, Harold Road, Stirling Road. October. High Street, *Wesley Avenue, Osborne Road, Colville Road Birkbeck Road, St. Andrew's Road, Bridgman Road. Priory Road, Acorn Gardens. November. 'Canada Crescent, Brassie Avenue, Shakespeare Road, Church Road, Goldsmith Avenue, East Aeton l.ane, Colville Road Those showing an asterisk mean that return cases occurred in these streets at that time. REPORT OF THE SCHOOL DENTAL SURGEON. A great effort was mad.e this year to reduce the waiting lists for fillings and extractions to the bare minimum, by the end of December. Success was achieved by having assistance for the tive work for three half-days a week throughout the year, (which is as much as can be accommodated in the present building), and extra and crowded gas sessions. The keeping of appointment.- by patients for conservative work seemed slighlty more reliable, which meant a little saving of time. 81 It is gratifying to note the improvement in the percentage of children actually treated, out of the number referred for treatment. This applies to both Elementary and Secondary schools. In the Elementary schools it has risen from 63% in 1936, to 74.8% this year. In the Secondary, that is, in the County and Junior Technical schools, from 53% to 66.5%. As many of the pupils in the Technical School live in other districts, there is naturally a greater number having treatment elsewhere. In view of the foregoing, there is a considerable rise in the number of fillings and extractions carried out, as shown in the Table of figures. With the Secondary schools, however, while the number of patients treated increased, the actual number of fillings and extractions was less, showing that each patient required less treatment. The figures for the Maternity and Child Welfare Clinic are' a little less this year, except for the number of fillings which actually rose by one, although the number treated was less. Evidently there were more savable teeth among the Mothers and Infants. Welfare Figures. Mothers examined 79 Children examined 105 „ referred 79 referred 101 „ treated 63 ,, treated 96 Number of attendances for treatment 299 ,, ,, Permanent fillings 22 ,, ,, Temporary fillings 45 ,, ,, Permanent extractions 539 ,, ,, Temporary extractions 312 ,, ,, Permanent dressings 14 ,, ,, Temporary dressings 24 ,, ,, Dentures supplied 31 Secondary Schools. Number examined 621 ,, referred for treatment 466 ,, treated 310 ,, of Permanent fillings 231 ,, ,, ,, dressings 26 ,, ,, ,, extractions 126 ,, ,, Temporary extractions 14 ,, ,, attendances for treatment 324 82 REPORT OF THE SCHOOL OCULIST. During the year, 352 children were referred to the Ophthulmic Clinic for examination, 235 were provided with glasses, 6 obtained treatment privately, 41 refused treatment, and 70 did not required glasses. 16 children attended for treatment of external eye conditions. The Welfare Centres referred 22 children and 2 mothers Of these, 10 children and 1 mother were supplied with glasses at refused treatment or left the district, 8 children and 1 mother did _ not require glasses, and 1 child attended for an external eye complaint. Out of 17 boys referred from the County and Junior Technical Schools, 12 obtained glasses, 1 was treated privately, I refused treatment, and 3 did not require glasses. One boy, refined for defective colour vision, was sent up to the Royal Westminster Ophthalmic Hospital for a full investigation. Work in the Clinic has proceeded smoothly during the past twelve months, and there is no event of special interest to report The clinic is not equipped for the full investigation of colour defects and it is not considered that the outlay for the necessary apparators would be justified. Cases requiring such an investigation are very rare. The general standard of ocular health remains high, and in refreshing contrast to the conditions met with in, for example, a large children's hospital. This comparison is not, perhaps, strictly fair, since the graver conditions naturally gravitate to the hospitals. nevertheless the number of cases which cannot be adequately treated at the clinic are few and far between. A regular following-up of children for whom glasses have been prescribed is carried out, with the twofold object of keeping a check on the visual acuity and enabling the optician to maingon the frames in proper adjustment, a point of great importance. children constantly grow and the wear and tear imposed in the frames is of a very high order. 83 PROVISION OF MEALS. As in former years, free meals and milk continue to supplied at eight centres to school children in Acton who haveLed certified as suffering from malnutrition, or to be medically ounctxi of more nourishment than can be supplied to them by their pjrnts. The subject of nutrition is a very wide one, and no really p6*factory definition can be given of the term " malnutrition." £jn«; authorities confine the term to conditions caused by lack o£ f&tcctive food substances, e.g., Scurvy, and describe as " undernourishment " conditions caused by insufficient bulk of food. (j|*»ically, a state of malnutrition is assessed by general appearance, ot tone in muscles and skin, lack of lustre in eyes and hairr pvt carriage and bearing, and some degree of anaemia. Height art! weight also have a bearing on the question, and liability to<atyue. This state of malnutrition may not be due entirely to lack 4 p<>d. Lack of proper food, insufficient sleep, and poor environ►wj^-may be contributory causes. It is difficult to assess how much \$. duo to the food question, without a complete knowledge of home canltions, overcrowding and poverty, etc., and without a knowof past history with regard to personal illnesses. Taking all these things into consideration however, experiwais have been conducted in many parts of the country, and in main the evidence forthcoming supports the contention that flAlnutrition is very largely a question of food. Where the family Wvojtne per head is low, too much food of a purely filling nature ttuklulged in, and good first-class proteins, fats and vitamins are Wtking. Where expenditure is not so limited there is correspondif^df less evidence of malnutrition. To a certain extent, ignorance H<o-hat is desirable and necessary in the way of food is responsible K>i Unwise and uneconomic budgeting by the poor housewife. Recently, in the Borough of Heston & Isleworth, some •'search was done into diets available to the poorer sections of the ^f^iwinity, and it was commented there that "particularly in the homes, the principal method of cooking was frying'' and ■^ofVind sausages were favourite dishes, expensive dishes extravacooked. Many mothers would not be bothered to do very 9l»W stewing of the cheaper cuts of meat. Money which could ill ^ Spired was being thus spent unwisely, and there was corresF^fcl'iigly less to spend on protective food substances. 84 It is certain that milk is not being drunk in anything lica sufficient quantity, nor are eggs, butter, brown bread, cheese of fresh vegetables, sufficiently incorporated in the dietary of the poorer person. At our feeding centres children are supplied with a hot mid-day meal—the traditional meat, potatoes, vegetable, and pudding meal, which would be given to them in their own house if their parents were feeding them. In Norway, during the last years, instead of this type of meal, which is the usual one supplied for " free meals," a breakfast has been supplied instead of a mid day meal. This "Oslo" breakfast, as it is called, consists of all the protective food substances which are as a rule missing from the. poorer dietary, such as cheese, wholemeal bread, milk, fresh fruit fresh vegetables, etc. It was argued that the parents could provide a hot mid-day meal of sufficient bulk to satisfy the children's hunger and that it would be more beneficial to them to have the protective foods which they were not likely to get. Theory was justified by practice. It was proved in Oslo that the children on the Oslo breakfast improved in appearance and increased in weight and height more than did the children on the traditional mid-day meal In Acton, at one of our feeding centres, the experiment was given a very short trial, and it was stated that the children would not eat the cheese, bread, etc. provided for them. It is possible to educate the tastes of the children to enjoy these necessary foods but probably it would be better to supply such meals as a breakfast at school, and allow the parents to give the mid-day meal as they had been doing in their own homes. Sir John Orr, who wrote " Food, Health, and Income's tested the adequacy of diets of different income groups in the. United Kingdom. These diets he estimated on 1152 sample family budgets. As a result he came to the conclusion that approximately 50% of the population of the United Kingdom have d:€Mrwo deficient in Vitamins A and C and 50% are deficient in Pho.-pW?^? and Iron. That there is something gravely wrong with the of our nation can be guessed by the fact that in 1935, 62 fa '® pective Army recruits had to be rejected as unfit. The clima.Ve- 6> ( Great Britain increases nutritional difficulties with its lack and prevalence of damp, cold, and fog. We are by no P** worst fed country in the world, but our incidence of denWl which, since the researches of Lady Mellanby, is generally as a deficiency disease, is one of the highest in Europe. 85 The comparative rarity of finding a child with perfect teeth to our schools, and the frequency with which small children have to have large numbers of their temporary teeth extracted, is something to be deplored, and becomes of even graver significance if it is granted that it is because the child is wrongly fed that such decay occurs. In the official Advisory Committee's report on Nutrition, Published in 1937, the conclusion was come to that "all except a relatively small fraction of the population are obtaining the full amount of calories they require"—in other words only a small fraction of the population show any signs of lack of quantity of food. It is by no means only a relatively small fraction of the population that shows evidence of malnutrition however, and Rickets, Dental Caries, Tuberculosis, etc. are still rife in the population. The Advisory Committee on Nutrition also show in their Irtport that there is considerable under-consumptiori of some of the essential food products, especially milk. At present, in several of the distressed areas, experiments are being tried where nursing and expectant mothers and pre school children can get milk at 2d. a pint from their milkman on presentation of a voucher from the Medical Officer of Health. In one of these areas, the consumption of milk has gone up by 42%. Under a similar scheme in another district, where the milk had to be fetched by the consumer from a depot, there was very little response'and the result was disappointing. It is recognised by all Health Authorities, that milk is an essential food for the nursing and expectant mother and for young children, and it is, after all, a food which Nature has provided for the nourishment of the young at its most rapidly growing stage, and it contains all the ingredients essential for growth and maintenance Of life.—What would be spent irr making this commodity cheaper to those sections of the community who so sorely need it, might be saved in the expenditure necessary to correct deformities and cure illnesses which need never have arisen. The consumption of milk in our schools is not by any means as great as it should be. In the Infant departments, as will be seen from the accompanying Table, the consumption is fairly high, but in the Junior and Senior schools the numbers fell lamentably. Milk as considered to be a childish drink instead of being looked upon as a necessary part of the diet of everyone. S6 SUPPLY OP MILK TO SCHOOLS, 1936 and 1937. School. 31st March, 1936. 31st Oct., 1936. 31st March, 1937. 31st Oct., 1937. No. on Roll. No. Free. No. Paying. No. on Roll. No. Free. No. Paying. No. on Roll. No. Free. No. Paying. No. on Roll. No. Free. No. Paying. Acton Wells Senior 228 7 52 205 7 53 241 5 71 247 4 74 Acton Wells Junior 418 8 200 404 6 182 398 9 202 392 4 205 Acton Wells Infants' 379 9 309 362 8 270 170 7 137 194 5 130 Beaumont Park Senior Girls' 184 0 36 171 9 65 140 9 57 159 6 60 Beaumont Park Junior Girls' 219 14 77 204 11 68 207 14 79 207 6 60 Beaumont Park Infants' 225 19 166 203 15 225 201 16 110 184 14 125 Central 420 2 67 437 2 53 393 4 74 421 1 71 Derwentwater Junior 403 15 230 369 10 200 367 12 156 354 9 167 Derwentwater Infants' 301 12 230 291 7 260 324 10 285 319 4 270 John Perryn Senior 221 6 39 238 5 35 211 12 25 189 9 17 John Perryn Junior 272 12 70 261 13 70 257 14 62 228 5 90 John Perryn Infants' 296 10 120 253 5 181 262 10 215 249 11 176 Priory Boys' 297 13 31 346 20 52 306 14 56 354 21 38 Priory Girls' 364 14 89 364 19 79 302 19 76 317 18 72 Priory Infants' 262 14 149 256 13 175 287 25 198 246 16 200 Rothschild Junior 208 3 123 210 6 130 211 7 120 209 9 117 Rothschild Infants' 260 6 236 247 8 178 273 11 195 245 11 174 Berrymede Junior Boys' 437 41 180 420 25 157 423 70 198 393 32 149 Berrymede Junior Girls' 387 31 177 382 19 160 385 23 191 382 23 185 Berrymede Infants' 291 31 205 273 18 203 300 25 218 258 12 160 Southfield Senior Boys' 186 11 40 176 3 35 149 7 51 168 7 45 Southfield Junior 326 6 144 311 5 121 306 9 107 317 5 134 Southfield Infants' 255 5 140 255 1 187 277 7 193 235 5 172 Turnham Green R.C. 238 12 146 249 15 140 263 14 144 261 13 167 West Acton — - - - - - 253 4 226 250 3 230 Acton Special (M.D.) 44 16 8 42 8 10 43 9 27 43 6 20 2103 3123 3264 6989 298 3289 6949 366 3473 6821 259 3331 87 Below are the figures for the numbers of free meals and free bottles of milk supplied in Acton during the year. Number of Meals supplied. Avenue Road Centre 19021 Acton Wells 938 Beaumont Park 6111 Central 2303 John Perryn 6509 Priory 4386 Southfield 1912 West Acton 259 Total 41439 Meals supplied during the Quarter ending:— March, 1937 10362 June 12070 September 8600 December 10407 Total 41439 Member of bottles of milk supplied. Quarter ending March, 1937 29089 June 28336 September 18832 December 29700 Total 105957 88 Number of children on Feeding List. Meals and Milk. Milk only. No. in Quarter ending March 211 103 ,, ,, ,, ,, June 195 119 „ „ ,, „ September 155 97 „ ,, ,, ,, December 172 131 As was mentioned in last year's report, the experiment was tried of continuing free meals during the holidays. The attendance at the Centres was good and justified their being kept open. It was felt that if the meals were omitted during the holiday the children would return to school less fit to benefit by their education. The nutrition of the school population of Acton is not bad as a whole, and in many cases is excellent. Classification of the nutrition of children depends on what is taken as a standard. If nothing short of perfection is accepted, then possibly, very few would pass as perfect, for even in an otherwise nearly perfect child, it is frequently found that some teeth are defective. It is perhaps fairer to take the norm for the district and school and work from that in a classification. It is the aim always to raise the standard, and it is felt that a greater use of protective foods in infancy and childhood in the future, should do much to make perfection of physique a commonplace. CHILDREN'S COUNTRY HOLIDAYS. The number of Acton children who have the untiring and unselfish energy of Miss Stevens, Head Mistress of Berrymede Infant School, to thank for a country holiday, rises each year. In 1037. 387 holidays were arranged, 210 for boys and 177 for girls. 11 children stayed away for a month, the rest for two weeks. Owing to expenditure having far exceeded income in 1936, it was found necessary by the Headquarters of the Children's Country Holiday Fund, to reduce their grants to local committees. Acton therefore received railway fares plus £142 only in 1937, as against £185 in 1936. With parents' contributions this was enough to send away 270 children only, 100 fewer than in 1936. As a larger number than ever of applications for holiday's had been received, great anxiety was felt by the local Committee as to which children would have to be refused. The Mayor of 89 Acton (Councillor H. G. James, j.p.) came to the rescue, however, and issued an appeal for £100. This appeal was published in the "Acton Gazette" and met with immediate and generous response, finally 387 holidays being arranged, an increase of 23 over 1936. 47i different parties of children went to different places, e.g., Worcester, Brighton, Britlingsea, Hereford, Norfolk, Wiltshire, Berkshire, Devon and Somerset. Accounts of their stay in these various places were almost always satisfactory—one boy, unfortunately, had to be sent home for behaving badly. It speaks well for the scheme, that a large proportion of the children who went away, wish to go again in 1938, and their parents will be allowed, as before, to start payments early in the year sothat their contributions can be spread over a long period. Much kindness was experienced from the country hostesses. One little fatherless girl was legally adopted by her host and hostess. Another hostess took two children, but would accept payment for one only, and yet another hostess invited three boys to Devon for the Christmas holidays and paid their fares. All children sent away under the Country Holiday scheme must be clear of infection and non-verminous. All have to have their heads examined three times before they go—making well over 1000 examinations in all, and all have to be medically examined and passed as not suffering from any infectious disease. It is impossible to estimate the benefit to these children of such a holiday as these arranged by the Children's Country Holiday Fund. The anticipation, the excitement of travelling, the kindness experienced and the happy recollections after the holiday is over, must all materially assist the good done by change of scene and food, and psychologically as well as physically, these children must benefit enormously. The Head Teachers have reported very favourably on the results of the holiday on the children's well-being, and Miss Stevens cannot be sufficiently thanked for making it possible by her ungrudging hard work. SWIMMING INSTRUCTION, SEASON 1937. The Swimming Season opened on Monday, 3rd May, 1937, 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 2 classes for girls were held 90 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 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 Arton certificates). 2nd class— 50 yards. ,, ,, ,, Life Saving: Elementary, Intermediate, Advanced and Medallion. There are in the schools at the present time 1134 scholars (597 boys and 537 girls) who can swim, as against 1248 at the end of last season, and 273 boys and 267 girls now in the schools learned to swim during the 1937 season (against 597 in It should be borne in mind however that a great number of ttte 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 1937. Year 1936 Boys. Girls. Total. Boys. Girls. Total. No. of classes per week allocated 32 21 53 32 21 53 Total attendances made 10972 7730 18702 11908 8300 20208 Certificates gained. Acton Education Committee 224 219 443 268 236 504 L.S.S.A.: 1st class 119 132 251 135 117 252 2nd class 176 174 350 196 157 353 Life Saving: Elementary — 13 13 - — — Intermediate — - - - 14 14 Medallion — - - - 10 10 91 TABLE SHOWING THE NUMBER OF CHILDREN ATTENDING ACTON SCHOOLS EMPLOYED IN THE VARIOUS REGISTERED OCCUPATIONS AS ON 31st DECEMBER, 1937. SCHOOL. Delivering Newspapers Delivering Milk Delivering Goods or Parcels Totals Boys. Boys. Boys. Acton Wells 4 — 2 6 Central 5 — — 5 County 3 — 1 4 John Perryn — - 2 2 Priory 13 — 12 25 Roman Catholic — — — - Southfield 3 2 1 6 Technical College 1 1 1 3 Totals 29 3 19 51 92 TABLE SHOWING THE DISTRIBUTION OF ALL CHILDREN EMPLOYED DURING THE PERIOD 1st JANUARY—31st DECEMBER, 1937. School. Acton Wells Central County John Perryn Priory Roman Catholic Southfield Technical College Others Total 1. Registered Conditions:— (a) Delivering Newspapers 12 7 8 2 44 1 14 1 — 89 (b) Delivering Milk 2 — 2 3 2 — 4 1 1 15 (c) Delivering Goods or Parcels — 5 2 4 32 — 4 2 2 51 Total 14 12 12 9 78 1 22 4 3 155 Corresponding figures for 1396 18 17 20 10 91 8 38 — 7 209 93 Uncleanliness Table Sch. Date. No. examd. Very few Nits. Few Nits. Many Nits. Vermin. Total Unclean. % % % % % 1. July 92 1.08 - - - 1.08 Sept. 114 - - - - - 2. July 104 1.9 - - .9 2.8 Sept. 104 - .9 .9 — 1.9 3. July 176 - .56 - — .56 Sept. 154 - 1.3 — — 1.3 4. July 182 .54 2.2 — — 2.7 Sept. 189 .52 .52 — — 1.05 5. July 179 .55 4.4 — .55 5.5 Sept. 138 2.1 2.1 — .72 5.07 6. July 107 4.6 2.8 — — 7.4 Sept. 143 6.2 2.09 .69 .69 8.8 7. July 197 6.09 5.5 — 1.01 12.6 Sept. 208 7.6 2.4 1.9 1.9 13.9 8 July 190 7.3 2.1 — 1.05 10.5 Sept. 151 1.9 .6 — — 2.6 9. July 369 2.1 1.3 — 1.08 4.6 Sept. 309 .3 - — .3 .6 10. July 332 6.9 .9 — .9 8.7 Sept. 347 10.3 1.7 - .8 12.9 11. July 290 11.3 2.7 - 2. 16.2 Sept. 231 9.5 2.5 - .4 12.5 12. July 131 - .76 — — .76 Sept. 118 1.6 .8 — — 2.5 13. July 119 .83 .83 — — 1.6 Sept. 109 — — — — — 14. July 155 4.5 3.2 — .6 8.3 Sept. 115 4.3 .86 .86 — 6.08 15. July 141 4.9 1.4 — — 6.3 Sept. 220 2.2 1.3 — — 3.6 16. July 283 3.1 3.1 - .7 7.06 Sept. 284 1.4 - .7 — 2.1 17. July 86 - - - - - Sept. 72 2.7 - — — 2.7 18. July 94 2.1 — — 2.1 Sept. 75 4. 2.6 — 1.3 8. 19. July 141 .7 — — — .7 Sept. 98 — — — — — 20. July 132 2.2 — — — 2.2 Sept. 116 1.7 — — 1.7 3.4 21. July 240 2.5 .4 — — 2.9 Sept. 142 2.1 .7 — .7 3.5 22. July 241 2.07 .41 — 1.2 3.7 Sept. 285 - .3 — — .3 23. July 250 6. — — 1.2 7.2 Sept. 237 3.7 1.6 — .8 6.3 24. July 285 3.1 .35 - 2.4 5.9 Sept. 281 .35 — — .35 .71 25. July 197 .5 - — — .5 Sept. 198 .5 — — — .5 94 Sch. Date. No. examd. Very few Nits. Few Nits. Many Nits. Vermin. Total Unclean. % % % % % 26. July 277 5.05 .72 - 1.08 6.8 Sept. 207 5.7 .4 — — 6.2 27. July 124 — 1.6 - — 1.6 Sept. 159 — 1.2 - — 1.2 28. July 129 2.3 4.6 - 1.5 8.5 Sept. 128 1.5 .7 - — 2.3 29. July 135 2.2 1.4 - — 3.7 Sept. 121 .8 1.6 - — 2.4 30. July 233 .8 .4 - .4 1.7 Sept. 183 .5 — - .5 1. 31. July 87 1.1 2.3 - — 3.4 Sept. 67 1.4 — - 1.4 2.9 32. July 135 5.9 3.7 - — 9.6 Sept. 138 5.7 1.4 - 1.4 8.6 33. July 45 4.4 — - — 4.4 Sept. 42 4.7 — - — 4.7 34. July 219 2.7 1.8 - .9 5.4 Sept. 205 .97 2.9 - .48 4.3 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 56 Rothschild 75 Beaumont Park 57 Southfield 136 Berrymede 142 Special 2 Derwentwater 64 West Acton 75 John Perryn 45 Priory 245 Total 907 CONVALESCENT HOMES & COUNTRY HOLIDAYS. One boy and one girl were sent to the Winter School ot Recovery, Bexhill, for 3 months each. Two boys and two girls were given a fortnight's free holid.i;. during the Summer. 95 MOTHERCRAFT CLASSES. The following Table gives the number of classes sent from each school to the Day nursery. Beaumont Park 5 Priory 5 Acton Wells 4 Roman Catholic 2 Central 7 John Perryn 5 28 RETURN OF MEDICAL INSPECTIONS. TABLE I. A.— Routine Medical Inspections. Number of Inspections in the prescribed Groups:— Entrants 976 Second Age Group 680 Third Age Group 574 Total 2230 Number of other Routine Inspections — Grand Total 2230 B.— Other Inspections. Number of Special Inspections 2078 Number of Re-Inspections 1282 Total 3360 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 5 60 64 Second Age Group 47 32 75 Third Age Group 32 22 51 Total (Prescribed Groups) 84 114 190 Other Routine Inspections — - — Grand Total 84 114 190 96 TABLE II. A.— Return of Defects found by Medical Inspection in the Year ended 31st December, 1937. Defect or Disease. Routine Inspections. Special Inspections No. of Defects. No. of Defects. Requiring Treatment Requiring to be kept under observation, but not requiring Treatment. Requiring Treatment Requiring to be kept under observation. but not requiring ments. (1) (2) (3) (4) (5) Skin:— Ringworm: Scalp — — — — Body 1 — 9 - Scabies 5 — 77 — Impetigo 9 — 360 — Other Diseases (Non-Tuberculous) 16 — 125 — Total 31 — 571 - Eye:— Blepharitis 22 — 10 - Conjunctivitis 2 — 42 - Keratitis — — 2 - Corneal Opacities — — 1 - Other Conditions (excluding Defective Vision and Squint) 3 - 50 - Total 27 — 105 - Defective Vision (excluding Squint) 84 - 74 - Squint 13 1 14 - Ear:— Defective Hearing 4 8 12 — Otitis Media 3 — 65 — Other Ear Diseases — — 36 — Nose and Throat:— Chronic Tonsillitis only - - 3 - Adenoids only — — — - Chronic Tonsillitis and Adenoids 16 - 26 — Other Conditions 8 — — 135 Enlarged Cervical Glands (Non- Tuberculous) - 236 - 46 Defective Speech 5 - 6 - 97 TABLE II.— Continued. 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) Heart and Circulation:— Heart Disease: Organic 3 — — — Functional - 6 — — Anaemia 13 — — 3 Lungs:— Bronchitis — — — — Other Non-Tuberculosis Diseases 2 2 — 2 Tuberculosis:— PulImonary: Definite — — 2 — Suspected — — — — Non-Pulmonary: Glands — — — — Bones and Joints — — — — Skin - - — — Other Forms — — — — Nervous System:— Epilepsy — — — — Chorea — — 6 — Other Conditions — — — — Deformities:— Rickets — 4 — — Spinal Curvature - - — — Other Forms 4 — — — Defects and Diseases (excluding Defects of Nutrition. Uncleanliness and Dental Diseases) 18 - 886 27 Total number of defects 231 257 1806 215 98 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 976 438 44.8% 525 53.7% 13 1.3% — - Second Age-group 680 295 43.3% 358 52.6% 27 3.9% — — Third Age-group 574 159 27.7.% 392 68.2% 23 4% - - Other Routine Inspections - - - - - - - - - Total 2230 892 40% 1275 57.1% 63 2.8% — - 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 on Institution Total 1 - — - 1 99 PARTIALLY SIGHTED CHILDREN. At Certified School for the Blind At Certified Schools for the Partially Sigthted At Public Elementary Schools At other Institutions At no School or Institution Total — 2 1 — — 3 DEAF CHILDREN. At Certified Schools for the Deaf At Public Elementary Schools At other Institutions At no School or Institution Total 4 2 - — 6 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 — 1 1 — — 2 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 45 - — - 45 100 epileptic children. CHILDREN SUFFERING FROM SEVERE EPILEPSY. At Certified Special Schools At Public Elementary Schools At other Institutions At no School or Institution Total 2 — — 1 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 1 — — — 1 II.— 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 — 2 l01 B.— DELICATE CHILDREN. (i.e.) 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 - 2 4 10 C.— CRIPPLED CHILDREN. (i.e.) (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 1 — 2 1 4 D.- CHILDREN WITH HEART DISEASE. (i.e.) Children whose defect is so severe as to necessitate the provision of educational facilities other than those of the Public Elementary School. At Certified Special Schools At Public Elementary Schools At other Institutions At no School or Institution Total - - 3 — 3 102 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, 1937. Treatment Table. Group I.— Minor Ailments (excluding Uncleanliness, for which see Table VI) Disease or Defect Number of Defects treated, or under treatment during the year Under the Authority's Scheme Otherwise Total (1) (2) (3) (4) Skin— Ringworm-Scalp— (i) X-Ray Treatment, — — — (ii) Other Treatment — — — Ringworm-Body 9 — 9 Scabies 61 16 77 Impetigo 359 — 359 Other Skin Disease 125 — 125 Minor Eye Defects— (External and other, but excluding cases falling in Group II) 105 - 105 Minor Ear Defects— 104 9 113 Miscellaneous— (e.g., minor injuries, bruises, sores, chilblains. etc.) 886 15 901 Total 1649 40 1689 103 Group II.- Defective Vision and Squint (excluding Minor Eye Defects treated as Minor Ailments— Group I). Defect or Disease. No. of defects dealt with. Under the Authority's Scheme Otherwise Total (1) (2) (3) (4) Exports of Refraction (including squint) 352 6 358 Other defect or disease of the eyes (excluding those recorded in Group I) 16 — 16 Total 368 6 374 No. of Children for whom Spectacles were (a) Prescribed 235 6 241 (b) Obtained 235 6 241 Group III.— Treatment of Defects of Nose and Throat. Number of Defects. Received Operative Treatment Received other forms of Treatment Total Number Treated Under the Authority's Scheme, in Clinic or Hospital By Private Practitioner or Hospital, apart from the Authority's Scheme Total (1) (2) (3) (4) (5) 1. 2. 3. 4. 1. 2. 3. 4. 1. 2. 3. 4. - 2 42 — - — 3 — - 2 45 — - 47 (1)— Tonsils only. (2)—Adenoids only. (3)—Tonsils and adenoids. (4)—Other defects of the nose and throat, 104 Group IV.— Orthopaedic and Postural Depicts. Under the Authority's Scheme. (1) Otherwise. (2) Total number 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 2 105 Table V.— Dental Inspection and Treatment. (1) Number of children who were:— (4) Attendances made by children for treatment 5355 (a) Inspected by the Dentist: (5) Half-days devoted to: Inspection 45 Aged: Treatment 530 Routine Age Groups. 5 786 Total 575 6 710 7 671 8 658 (6) Fillings: 9 654 Permanent Teeeth 2529 10 688 Temporary Teeth 73 11 664 Total 2602 12 460 13 620 14 190 (7) Extractions: Total 6101 Permanent Teeth 1036 Temporary Teeth 5232 (b)Specials 491 Total 6268 (c) Grand Total 6592 (8) Administrations of general anaesthetics for extractions 2501 (2) Number found to require treatment 4697 (9) Other Operations: Permanent Teeth 453 Temporary Teeth 68 (3) Number actually treated 3517 Total 521 Table VI.— Uncleanliness and Verminous Conditions. Average number of visits per school made during the year by the School Nurses 11 Total number of examinations of children in the Schools by School Nurses 19501 Number of individual children found unclean:— Vermin and Nits 66 Slightly infested 411 Number of individual children cleansed under Section 87 (2) and (3) of the Education Act, 1921 7 Number of cases in which legal proceedings were taken:— (a) Under the Education Act, 1921 (b)Under School Attendance Byelaws — 106 STATEMENT OF THE NUMBER OF CHILDREN NOTIFIED DURING THE YEAR ENDED 31st DECEMBER, 1937, BY THE LOCAL EDUCATION AUTHORITY TO THE LOCAL MENTAL DEFICIECT AUTHORITY. Total number of children notified 6. Analysis of the above Total. Diagnosis. Boys. Girls. 1. (i) Children incapable of receiving benefit or further benefit from instruction in a Special School: (a) idiots — - (b) Imbeciles — 1 (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 2 3 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 2 4 We are, Your Obedient Servants, D. J. THOMAS. E. MADELEY. • ' - - ' -' •- •• - • - • - - • - ' - . • • '' - -