ACT 42 Borough of Acton ANNUAL REPORT of the Medical Officer of Health together with the Report on the Medical Inspection of Schools FOR THE YEAR 1939 ANNUAL REPORT of the MEDICAL OFFICER OF HEALTH FOR THE YEAR 1939. Public Health Department, Town Hall, 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 of the Borough the year 1939. The annual report of the School Medical Service is given at the end as a separate report. This year's report is based on the suggestions laid down by the Minister of Health who desires that the report have reference only to items of importance in connection with administration and the health of the public. The yearly statistics have been included since it is felt that by including them a definite record will be kept. During the year under review, Dr. D. J. Thomas who had been your Medical Officer of Health for over 30 years, retired and 4 I was appointed to take office on October 4th, 1939. In the retirement of Dr. Thomas the Corporation has lost a distinguished and able officer who had seen the growth of the Public Health and School Medical Services to their present standard. In the School Report a brief account has been submitted by Dr. Thomas of the changes brought about in the development of the School Medical Service. The Chief Sanitary Inspector, Mr. Kinch, retired on 31st December, 1939, after 40 years' service with the Corporation. Mr. J. J. Jenkins, the deputy Chief Sanitary Inspector was appointed to fill the vacancy. Mr. Matthews succeeded Mr. Jenkins as deputy Chief Sanitary Inspector, and Mr. Dowie was appointed Assistant Sanitary Inspector on the death of Mr. E. W. Brooks. Previous to, and on the outbreak of war, much of the time of the staff of the Public Health department has been devoted to the organisation of the Air Raid Precautions Casualties Service, not only in selecting buildings for First Aid posts, and Ambulance and Stretcher parties, but also in administration, selecting, equipping and training of personnel. There are 3 depot first aid posts, 3 mobile units, 5 ambulance stations, and 4 stretcher party posts, together with 20 ambulances and 28 cars for dealing with casualties, manned by about 344 persons; of this number 184 are men and 160 women These few remarks concerning the Casualty Services are mentioned in order that you may appreciate the very heavy burdens that have been placed on the Corporation and its Staff. In September 1939, the staff and children at the Day Nursery were evacuated to Stony Yarrows near Woking. This was a private house, but in consequence of the cramped conditions due to the presence of 30 children, on the withdrawal of some children the number was maintained at 20. During 1940 a new house will be taken over and adapted to accommodate 30—32 children and the necessary staff. The Clinics for ante-natal and child welfare cases have been continued and the attendances, although lower than usual in the early part of October, began to increase in numbers and it was found necessary to maintain the usual number of clinics as had existed previous to the outbreak of the War. I should like to thank the staff of the Public Health Department for their kindly co-operation and loyalty during the past year. I remain, Your obedient servant, GEORGE E. B. PAYNE. 5 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). Retired. October 1st, 1939. George E. B. Payne, m.d., m.r.c.s., d.p.h., Medical Officer of Health. Appointed October 1st, 1939. 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). Retired December, 1939. J. J. Jenkins, M.R.San.I., Cert. of Royal Sanitary Institute; holds Meat and Smoke Certificates, Deputy Chief Sanitary Inspector (Inspector under Fabrics Misdescription Act). E. W. Brooks, Cert. of Royal Sanitary Institute, Sanitary Inspector. Died 1939. G. W. Burdon, Cert. of Royal Sanitary Institute. Appointed Sept., 1939. (On War Service). 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. D. M. Dowie, Cert. of Royal Sanitary Institute. Miss B. G. Sorlie, s.r.n., Certificate of Royal Sanitary Institute, c.m.b., H.V. Diploma, Health Visitor and School Nurse. 7 SECTION A. General Statistics. Area 2,317 acres. Population Census 1931 70,510 Registrar General's estimate 1938 68,670 Rateable Value £822,522 (Sum represented by the product of a penny rate, £3,131). General Rate in the £1 6/4d. Extract from Vital Statistics. Live Births. Total (B.R.) M. F. Legitimate 795 412 383 Illegitimate 48 21 27 Birth rate per 1,000 of the estimated population—11.7. Still Births. Legitimate 31 19 12 Illegitimate 3 2 1 Deaths 656 Death rate per 1,000 inhabitants—10.1. Deaths from Puerperal Causes (Heading 29 and 50 of the Registrar General's Short List). Rate per 1,000 total Deaths (live & still) births No. 29. Puerperal Sepsis 2 2.4 No. 30. Other Puerperal Causes 2 2.4 Death Rate of Infants under 1 year of age. All infants per 1,000 live births 59 Legitimate infants per 1,000 legitimate live births 56 Illegitimate infants per 1,000 illegitimate live births 104 6 Miss W. E. Bennett, s.r.n., Health Visitor's Certificate of Royal Sanitary Institute, 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 Institute c.m.b., Health Visitor and School Nurse. Misa Evans, s.r.n. A. S. M. Pratt,* Barrister-at-Law, Chief Clerk. Miss A. Kent, Clerk. Miss J. Warburton, b.a. (hons.), Clerk. Miss V. Slack,* a.c.t.s., Clerk. Resigned June, 1939. Miss J. Wood,* Clerk. Miss M. G. Hester, Clerk. Miss B. Kellaway, Clerk. Miss F. A. Cavendish, Matron, Day Nursery. G. Baker,* Disinfector. T. W. Mason,* Mortuary Keeper. (On War Service). Note.—To the salaries of all the above officials excepting those marked with an asterisk, contribution is made under the Local Government Act, 1929. 8 Deaths from Cancer (all ages) 103 Deaths from Measles (all ages) Nil Deaths from Whooping Cough (all ages) Nil Deaths from Diphtheria (all ages) Nil Diarrhoea (under 2 years of age) 6 SECTION B. GENERAL PROVISION OF HEALTH SERVICES IN THE AREA. Laboratory Facilities.—During the last three months of the year, the Laboratory was closed owing to repairs, and arrangements were made with the Ealing Borough Council for examination of swabs and sputa. Ambulance Facilites.—The Acton and Wembley Joint Hospital Committee possesses an Ambulance for the removal of infectious cases from the Acton and Wembley areas. Two ambulances for accident and non-infectious cases are at the Fire Station and are available at all hours. Nursing in the Home.—Since April 1st a combined Committee of the Public Health Committee and the Acton Hospital Council have administered the arrangements for nursing patients in their homes. This arrangement has worked satisfactorily, and during the year 439 sick patients were nursed and the nurses paid 9,595 visits to the homes of the patients. Hospital Provision.—The Isolation Hospital is now managed by the Acton and Wembley Joint Hospital Committee. The Acton Voluntary Hospital is still carrying on although admission of cases is limited since the Hospital is a Casualty Clearing Hospital for A.R.P. casualties. 9 MATERNITY AND CHILD WELFARE. The Clinics were limited for the first month of the War, but on the return of persons who had been evacuated, the Clinic attendances increased so that it was necessary to maintain the same number as prior to September 4th, 1939. Maternal Mortality.—There were four maternal deaths, two of which occurred in hospital, due to puerperal sepsis, both being cases which gave rise to abnormal conditions; the other two deaths were due to other conditions associated with pregnancy. Infantile Mortality.—There were 47 deaths under one year, giving an infantile mortality figure of 59, but the mortality of illegitimate children is higher than in previous years. Day Nursery—The Staff and children regularly attending the Day Nursery were evacuated from Acton to a house in Woking. The house was small for the number of children sent, and, as the parents withdrew their children, the number was maintained at 20 until the end of the year, when it was hoped that the children would be placed in a larger house more suited to the requirements of staff and children, and of a larger nature so that more children might be sent from Acton to the Day Nursery. During conversations with the Ministry of Health Officials, one received information that the local Supervising Authority in the receiving area would, in the near future, be responsible for the administration of the Day Nursery at Woking, thus relieving the "evacuating local authority" of the rather difficult task of keeping a watchful eye upon administrative details at so great a distance. Nurse Children.—The reduction in the number of children on the register in 1939 is undoubtedly due to the fact that many children were evacuated at the outbreak of War. The number of such children remaining on the Register was 27. The following Table shows the work of the Infant Welfare centres and Ante Natal Clinics. 10 TABLE 1. INFANT WELFARE CENTRES, 1939. 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 7,964 (b) by children between 1 and 5 years of age 5,003 Number of children who attended for the first time during the year:— (a) under 1 year of age 603 (b) between 1 and 5 years of age 127 Percentage of notified live births represented by number of children who attended a centre for the first time during the year 80.3% Children treated at Dental Clinic 84 Children treated at Ophthalmic Clinic 14 Mothers treated at Ophthalmic Clinic - Children operated on for enlarged tonsils and adenoids - Children operated on with X-Ray for Ringworm - TABLE 2. ANTE-NATAL CLINIC. Number of Expectant Mothers who attended 493 Number of attendances made by Expectant Mothers 1,413 Mothers referred for Dental treatment at the Clinic 227 Mothers supplied with Dentures 23 Expectant Mothers to whom Dried Milk was supplied free 24 Number of lbs. of Dried Milk supplied free 14,716 PREVALENCE & CONTROL OF INFECTIOUS DISEASE. (1)—Notifications. As a result of persons leaving Acton, the notification of infectious diseases is lower than in previous years. In October, the Measles and Whooping Cough (Provincial) Regulations, 1939, were introduced making these diseases notifiable. No cases of Ophthalmia Neonatorum were notified during the year. The following table shows the number of notifications of infectious diseases received during 1939. 11 TABLE 5. CASES OF INFECTIOUS DISEASE NOTIFIED DURING THE YEAR 1939. 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 45 to 65 Over 65 North East North West South East South West Scarlet Fever 89 - 23 47 7 9 3 - 37 22 16 14 Diphtheria 6 - 3 3 - - - - 3 - 3 - Pneumonia 43 1 1 6 3 15 13 4 16 7 0 14 Erysipelas 11 - 1 - 1 4 3 2 5 3 2 1 Puerperal Pyrexia 15 - - - 8 7 - - 5 3 1 6 Dysentery 1 1 - - - - - - - - - 1 Tuberculosis (resp.) 88 - 1 5 27 40 13 2 29 20 19 20 Tuberculosis (other) 7 - 1 2 - 2 1 1 3 1 2 1 Measlesj 1 1 - - - - - - - - - - Whooping Cough 1 - 1 - - - - - - 1 - - TOTALS 202 3 31 63 46 77 33 9 99 57 49 57 12 ISOLATION HOSPITAL. Dr. Thomas, the Medical Superintendent, has furnished the following report— The total number of patients admitted to the hospital in the year ending December 31st, 1939, was 333, compared with 633 in 1938 and 610 in the four years 1934-1938. This great reduction was most noticeable in the last four months of the year, that is since the beginning of the War. There had been a reduction in the admissions even in the earlier months of the year, but this was almost predictable and due to the ordinary epidemiological influences. In the first eight months of the year there had been 283 admissions compared with 438 in the same period of 1938. In the last four months, only 50 cases were admitted compared with 195 in 1938 and an average of 217 in the four years 1935-1938. The vast majority of cases admitted to the hospital are those suffering from Scarlet Fever, Diphtheria and Measles. In the western suburbs of London for nearly a quarter of a century. Measles has occurred in alternate years. An epidemic usually commenced in the late autumn of the even years, but reached its apex in the early months of the odd years. Therefore we did not expect many cases in 1939 as it was not an epidemic year. (Contrary to the experience of the last quarter of a century an epidemic did not commence in the later months of 1939, and very few cases were admitted in the spring of 1940). Scarlet Fever. 222 cases of Scarlet Fever were admitted and there was no death. Of these, four were not Scarlet Fever, two each from Acton and Wembley. There were 15 cases admitted from houses where a patient had been discharged from the hospital less than a month previously. These were caused by 8 infecting cases. There were 4 cases in one house, 2 each in four houses. Of the 15 cases, 13 were from Wembley and 2 from Acton. Diphtheria. 75 cases of Diphtheria were admitted, 8 from Acton and 67 from Wembley. There were 4 deaths. 23 of these cases were probably wrongly diagnosed before admission. At any rate, there were no clinical signs of Diphtheria on admission and all the swabs were negative after admission. 4 of these were from Acton and 19 from Wembley. D. J. THOMAS, Medical Superintendent. 13 ISOLATION HOSPITAL REPORT FOR 1939. Patients admitted 1938—633. Patients admitted 1939—333. Patients Admitted : S. Fever Diph. Ery. Impetigo Measles G. Measles C.P. W.C. Epistaxis Acton 81 8 7 - - - 2 6 - Wembley 141 67 7 3 1 1 1 7 1 222 75 14 3 1 1 3 13 1 Total = 333. Patients Discharged: S. Fever Diph. Ery. Impetigo Measles G. Measles CP. W.C. Epistaxis Acton 85 9 7 - - - 2 6 - Wembley 173 70 6 3 - - 1 6 1 258 79 13 3 - - 3 12 1 Total = 369. Deaths : Diph. Ery. Msls. W.C. Acton - - - - Wembley 4 1 1 1 4 1 1 1 Total = 7. Patients in Hospital, January 1st, 1939—52. Patients in Hospital, January 1st, 1940—9. D. J. THOMAS, Medical Superintendent. 14 (2)—Tuberculosis. Particulars of new cases and of deaths from the disease during 1939 are given below. 88 cases of Pulmonary Tuberculosis and 7 cases of other forms of Tuberculosis were notified during the year. There were 29 deaths from Pulmonary Tuberculosis and 11 deaths from others forms of Tuberculosis. The following Table gives the age incidence of new cases of tuberculosis in 1939 and of the deaths from the disease in the area in 1939. 15  New Cases. Deaths. Age Periods. Respiratory Non-Respiratory Respiratory Non-Respiratory M. F. M. F. M. F. M. F. 0 - - - - - - - - 1 - 1 - 1 - - - 1 5 3 2 - 2 - - - 1 15 16 11 - - 2 1 2 3 25 24 16 1 1 6 5 2 - 35 - - - - 2 1 - - 45 8 5 - 1 4 1 2 - 55 - - - - 3 2 - - 65 and upwards 1 1 - 1 2 - - - Totals 52 36 1 6 19 10 6 5 16 The following is a statement of the particulars appearing in the Register of cases of Tuberculosis on 31st December, 1939:- Pulmonary. NonPulmonary. Total. Number of Cases on the Register at the commencement of the year 202 males 47 males 195 females 39 females 483 Number of Cases notified for the first time during the year 44 males 1 male 32 females 6 females 83 Number of Cases previously removed from the Register which have been restored thereto during the year - male - male 1 female 1 female 2 Number of Cases added to the Register other than by notification 9 males - male 4 females 1 female 14 Number of Cases removed from the Register during the year 33 males 4 males 32 females 4 females 73 Number of Cases remaining on the Register at the end of the year 222 males 44 males 200 females 43 females 509 (3)—Artificial Immunisation against Diphtheria is still carried out but as attendances of children at schools is constantly changing, this is now chiefly carried out at the Maternity and Child Welfare Clinics. 17 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 21,077 tons of refuse were collected and burned. 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. TABULAR STATEMENT OF INSPECTIONS AND DETAIL OF WORK CARRIED OUT BY THE SANITARY INSPECTORS. Number of Inspections made and Action Taken. Total number of dwelling-houses inspected for housing defects (under Public Health or Housing Acts) — 2131 (1) Dealt with by service of Informal Notice 1237 (2) Dealt with by service of Statutory Notice under Section 9, Housing Act, 1936 159 (3) Dealt with by service of Statutory Notice under Public Health Acts 50 18 Premises (other than defective dwelling-houses) inspected for nuisances and miscellaneous defects 495 (1) Dealt with by service of Informal Notice 321 (2) Dealt with by service of Statutory Notice under Public Health Act, &c. 29 Re-inspections subsequent to service of Notice 6539 Inspections after notification of Infectious Disease 170 Number of Premises under Periodical Inspection. Factories 501 Bakehouses 34 Slaughterhouses 2 Public House Urinals 34 Common Lodging Houses 1 Butchers' Shops 41 Fish Shops 35 Premises where food is manufactured or prepared 59 Dairies 15 Cowsheds Nil Piggeries Nil Rag and Bone Dealers 9 Mews 4 Schools (12 Elementary, 1 County, 1 Technical, 7 Private) 20 Caravan Grounds 2 Hairdressers 45 Rent Restriction Act. Number of Certificates granted 34 19 Detail of Work carried out. Sanitary Dustbins provided 395 Yards paved or yard paving repaired 145 Insanitary forecourts remedied 41 Defective drains repaired or reconstructed 68 Defective soil pipes and ventilating shafts repaired or renewed 69 Defective fresh air inlets repaired or renewed 58 Defective gullies removed and replaced by new 96 Rain water downpipes disconnected from drain 19 Dishing and curb to gullies repaired and new gratings fixed 101 Defective W.C. pan and traps removed and replaced by new 99 Defective W.C. flushing apparatus repaired or new fixed 343 Defective W.C. seats repaired or new fixed 254 Defective flush pipe connections repaired 61 Insanitary sinks removed or new fixed 58 Sink waste pipes repaired or trapped 168 Insanitary wall surface over sinks remedied 71 Ventilated food cupboards provided 13 Drinking water cisterns cleansed 88 Defective covers to drinking water cisterns repaired or new fixed 79 Insanitary sites beneath floors concreted 39 Spaces beneath floors ventilated 42 Dampness in walls from defective damp-proof course remedied 201 Dampness from defective roof, rain water gutterings, etc., remedied 643 Defective plastering repaired (number of rooms) 491 Rooms where dirty walls and ceilings have been cleansed and redecorated 2169 Defective floors repaired 145 Defective or dangerous stairs repaired 35 Defective doors and windows repaired 563 Defective kitchen ranges and fire grates repaired 225 Defective washing coppers repaired 24 Coal cupboards provided or repaired 10 New W.C. apartments provided 15 Accumulations of offensive matter removed 46 Drains unstopped and cleansed 125 Drains tested, exposed for examination, etc. 66 Smoke observations taken 307 Smoke nuisances abated on service of notice 72 Miscellaneous nuisances abated 157 Notifications of waste of water sent to Metropolitan Water Board 165 20 Meat Inspection. Tables, showing the meat inspection carried out at the two slaughterhouses in the Borough, will be found on pages 21 and 22. Since the outbreak of War the larger slaughterhouse has been operated by the Ministry of Food and the smaller as an emergency slaughterhouse. The amount of killing in the large slaughterhouse has reached great numbers and constant supervision and inspection have had to be made by one of the Sanitary Inspectors. 21 CARCASES INSPECTED AND CONDEMNED. Cattle, excluding* Cows Cows Calves Sheep & Lambs Pigs 1. Number killed 27 717 14,129 2,604 33,536 2. Number inspected 27 717 14,129 2,604 33,536 3. All diseases EXCEPT TUBERCULOSIS— Whole carcases condemned - 1 55 8 8 Carcases of which some part or organ was condemned 8 166 260 906 418 Percentage of the number inspected affected with disease other than Tuberculosis 29.62% 21.89% 2.22% 35.09% 78% 4. TUBERCULOSIS ONLY— Whole carcases condemned 5 32 31 - 22 Carcases of which some part or organ was condemned 7 167 114 - 1,369 Percentage of the number inspected affected with Tuberculosis 44.4% 27.75% 1.02% - 4.14% 22 NUMBER OF PIGS' CARCASES INSPECTED FROM 1st JANUARY TO 31st DECEMBER, 1939 WITH ANALYSIS OF SURRENDERS ON ACCOUNT OF DISEASE. 1939 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. Weight of Ribs Diseased. Plucks (Lungs, Livers and Hearts). Mesenteries, Stomachs and Intestines Pieces of Pork. January 2702 145 4 - - - - 43 lbs. 76 223 lbs. - February 2542 117 2 - 1 - - - - 225 „ - March 3099 100 1 - - - - - - 188 ,, - April 2369 83 2 - 1 - - 40 lbs. 72 350 ,, - May 2527 90 - - 1 - - 46 lbs. 130 390 „ - June 2756 117 - - 1 - 1 - 193 420 ,, -' July 2771 88 7 - 1 - - - 135 450 ,, - August 2890 91 3 - - - - - 127 456 „ 435 lbs. September 2602 53 7 - - - - - 12 330 ,, - October 2480 71 2 - - - 1 32 lbs. - 386 „ - November 3030 62 1 - - - - - - 478 ,, - December 3768 91 1 1 2 1 - 10 lbs. - 785 - Total 33536 1108 30 1 7 1 2 171 lbs. 745 4681 ,, 435 lbs. 23 INQUESTS. Suicide 10 Accidental Fall 3 Motor Car Accident — — — 11 Accidental Bums 1 Other Causes _ 7 Total 32 POST-MORTEM WITHOUT INQUEST. Heart Disease 10 Respiratory Conditions 6 Traumatic Rupture of Organs or Tissues 4 Other Causes 3 Total 23 24 TABLE 3. AGES AT DEATH, AND WARD DISTRIBUTION OF DEATHS IN 1939. 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 - - - - - - - - - - - - - Whooping Cough - - - - - - - - - - - - - Diphtheria - - - - - - - - - - - - - Cerebro-Spinal Fever 2 1 - - - - - - 1 - 2 - - Pulmonary T.B. 29 - - - - 3 14 10 2 9 7 6 7 Other T.B. 11 - 1 - 1 5 2 2 - 3 3 2 3 Nervous Diseases 7 - - - - - - 3 4 2 - 2 3 Diabetes 6 - - - - - - 2 4 1 2 3 - Cancer 105 1 - - - 1 6 37 60 34 24 24 23 Rheumatic Fever - - - - - - - - - - - - - Cerebral Haemorrhage 59 2 - - - - 1 17 39 17 18 14 10 Heart Disease 110 1 - - - 2 9 35 63 25 40 20 25 Oilier circulatory diseases 26 - - - - - 1 10 15 9 10 1 6 Bronchitis 35 - - - - - 2 8 25 4 8 11 12 Pneumonia 40 7 - - - 1 6 13 19 19 13 7 7 Other respiratory diseases 21 3 - - - 2 3 7 6 5 4 6 6 Peptic Ulcer 14 - - - - - - 7 7 2 8 3 1 Diarrhoea and Gastro Enteritis 6 5 1 - - - - - - - 1 2 3 Cirrhosis of Liver 3 - - - - - 1 1 1 - 2 1 - Other diseases of Liver 1 - - - - - - 1 - - - 1 - Diseases of Gall Bladder 2 - - - - - - - 2 1 - 1 - Nephritis 19 - - - 1 - 1 9 8 5 6 3 5 Senility 52 - - - - - - - 52 14 12 10 10 Enlarged Prostate 13 - - - - - - 2 11 4 2 6 1 Childbirth 2 - - - - - 2 - - 1 1 - - Other diseases of Parturition 2 - - - - - 2 - - - 2 - - Cong. Debility and Prematurity 19 19 - - - - - - - 8 2 5 4 Suicides 7 - - - - - - 6 1 2 4 - 1 Other deaths from Violence 22 1 2 1 1 1 3 8 5 5 11 6 - Other ill-defined Diseases 37 6 - 1 - 2 4 10 14 7 15 6 9 TOTALS 656 46 4 2 3 17 57 188 339 177 167 140 142 25 BACTERIOLOGICAL EXAMINATIONS. (a) For Diphtheria. Positive. Negative. Total Examinations, 948 109 839 Sent by Medical Practitioners 1 67 Total (re-examinations) 1 12 Sent from Isolation Hospital 64 491 do. (re-examination) 39 116 Convalescents (1st Swabs) - 1 Contacts (1st Swab) - 48 do. (re-examinations) 1 6 do. (2nd examinations) - 6 do. (re-examinations) - - Precautionary Swabs 1 83 School Sore Throats 1 18 do. (re-examinations) 2 1 (b) For Haemolytic Streptococcus. Positive. Negative. Total examinations-4 2 2 (c) For Vincent's Angina. Positive. Negative. Total examinations—3 - 3 (d) For Ringworm. Positive. Negative. Total examinations—Nil. - - (e) For Tubercle. Positive. Negative. Total examinations—123 9 69 (Laboratory not used after 12th July, 1939). 27 ANNUAL REPORT OF THE School Medical Officer FOR THE YEAR 1939. Town Hall, 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 1939. During the year, Dr. D. J. Thomas, Medical Officer of Health and School Medical Officer, retired. He had seen the inception and growth of the School Medical Service in Acton and has given a short resumé of the work in an article included in the Report. The year 1939 will remain for ever memorable for the great experiment of evacuation. On September 1st, 1939, the Government ordered the evacuation scheme to be put into operation. The school populations all over the country were altered, and it has therefore been impossible in the Annual Report to follow the pattern of previous reports, i.e., to mark increases and decreases in the incidence of disease, to compare the nutrition of the school children 28 with previous years, or even to give adequate representation of facts, as medical records had to be sent with the children to their various destinations and so valuable data were not available. For those reasons amongst others, all Medical Officers have been requested to make their annual reports as short as possible, and many Tables formerly included have been altered or omitted altogether, under the guidance of the Board of Education. Included in the annual report is an article on evacuation as it occurred in Acton. This was prepared by the Education Department which took charge of evacuation. In addition there are given the figures of those children who had returned to Acton by the end of the year. EVACUATION. The Government ordered the evacuation scheme to be put into operation commencing on Friday, 1st September, 1939. The local scheme which had been planned on a four day operation was expedited and completed on the third day. A further opportunity for evacuation was given and on the fourth day one train was despatched containing mothers and children under five and unattached children of school age whose parents wished them to be evacuated. The whole operation was carried out smoothly and without any accident, notwithstanding the interruption by the air raid warning on the Sunday morning. On that occasion through the courtesy of T. Wall & Sons Ltd. the party then assembled at the Control Point for entraining, was marshalled into the firm's air raid shelters and on the "all clear" being given was re-assembled and entrained without hitch or delay of the train. The school roll at the end of July was 6,500. Children of school age evacuated in school units—2,924 ) =51% ,, ,, „ „ with parents—410 The School Attendance Officers estimate that 30% of the school population have been evacuated under private arrangements or were on holiday at the time of evacuation and have remained in their holiday places as instructed. If that estimate is reliable the school population remaining in Acton is slightly less than 20%. In addition it is estimated that approximately 1,000 children under five years of age and not on school rolls were evacuated with their mothers. Numbers Evacuated. (a) Children of school age evacuated in elementary school units 2,924 (b) Children of elementary school age evacuated with parents 410 (c) Children attending Private Schools evacuated with school units 85 (d) Children attending Secondary Schools evacuated with school units 531 (e) Children attending Junior Technical School evacuated as a unit 150 (f) Diabetic children evacuated to special institutions 2 (g) Mothers and children under five years of age evacuated 1,731 (h) Blind persons evacuated with sighted guides 26 (i) Expectant mothers evacuated 50 (j) Special school children evacuated as a unit 24 (k) Day Nursery evacuated as a unit 26 Grand Total 5,959 Personnel. (a) Teachers accompanying school units 299 (b) ,, ,, special parties 2 (c) Helpers „ school units 147 (d) ,, ,, parties of mothers 82 (e) ,, „ diabetic children 1 (f) ,, „ Blind Persons 3 (g) ” ,, Expectant Mothers 4 (h) Staff ,, Day Nursery 6 544 30 Many school children returned to Acton between September and December. 2,924 school children were evacuated in Elementary School units, but on the rolls when schools closed for Christmas holidays there were found to be only 2,214 children away. 710 children had, therefore, come back to Acton, or at any rate had left their evacuation schools. Of these 710 approximately 200 were children who had reached the age of 14 and had returned to look for work. The great majority of mothers with children under 5 who had evacuated had also returned home, but there are no means available at present to give actual numbers. Schools in Acton remained closed until November 15th when classes were begun in all schools for children between the ages of 7 and 14. Classes were also held in St. Gabriel's Church Hall in North Acton. As many children as there was air raid shelter for, were accommodated. Minor Ailment Clinics were opened three times a week and schools were notified that children attending school or their brothers and sisters of legal school age, but not at school, would be examined and treated if necessary. Attempts were made to establish as soon as possible the normal medical, nursing and dental supervision of the children. Cases requiring free milk were seen and recommended and provision of milk at schools was early established. It was not found possible to set up feeding centres, but arrangements for dealing with the question are under consideration. From the outbreak of war, dental attention was given to the children left in Acton. Children known to be left in the area were examined and treated at the Clinic. After the opening of schools, regular inspection sessions were held as pre-war. Cleanliness inspections were made regularly by the school nurses and treatment advised and carried out. Several cases were brought to our notice of children being fetched home from evacuation areas because their parents found on visiting them that they had contracted Scabies. As pointed out in previous Annual Reports, there appears to be a wide-spread outbreak of Scabies all over the country and such cases were bound to crop up. In Acton at the Minor Aiiment clinics since the outbreak of war, the majority of children seen have been cases of Scabies, of suspected Scabies, of-children who have been in contact with a case of Scabies or of Impetigo superimposed on Scabies. 31 REPORT OF RETIRING MEDICAL OFFICER. Until October 4th, 1939, I was your Medical Officer of Health and School Medical Officer, and therefore responsible for the supervision of the Health Services of the district for the first nine months of the year. To write the report for a part of the year, especially after leaving office, would be very difficult owing to the comparative inaccessibility of documents and returns. The Annual Report also contains suggestions for the extension of the work or its adaptation to altered circumstances. For these reasons, it would be not only difficult but inadvisable for the outgoing officer to write the Report, and Dr. Payne has very kindly undertaken the report for the whole year of 1939. He has suggested that as I was at the time of my retirement one of the very few School Medical Officers who has seen the birth of the School Medical Service, and acted as School Medical Officer throughout the 31 years for the same district a short history of the origin and development of the Service in the district might be of some use. On account of the necessity of saving paper, my remarks must necessarily be brief. It would take too long to give even the steps which led up to the passage of the Education (Administrative Provisions) Act of 1907, but undoubtedly the physical condition of recruits for the Army, and the circumstances revealed during the Boer War, aroused public opinion on the matter. Commissions and Departmental Committees were appointed and reported. In 1903 the Royal Commission on Physical Training (Scotland) issued a report of the greatest interest from the point of view of the history of Medical Inspection, in which the intimate relation of physical condition and malnutrition was pointed out. In 1904 there followed the Report of the Interdepartmental Committee on Physical Deterioration, which dealt with the wider question of which the health and physical condition of school children formed but a part. In 1905 a Committee was appointed by the President of the Board of Education to ascertain what was done in respect of medical inspection of, and the provision of meals to, school children. The first result was the Education (Provision of Meals) Act of 1906, and later the Education (Administrative Provisions) Act of 1907 was passed. Under the latter Act, the medical inspection of school children was inaugurated. 32 In March 1908, arrangements were made by the local Education Committee to carry out the requirements of the Act. and Dr. Lilian E. Wilson was appointed to devote her whole time to the work of medical inspection. In accordance with the suggestions contained in the memorandum of the Board of Education, every endeavour was made in drawing up the scheme to link up the medical inspection with the general public health of the district. Dr. Wilson was also appointed Assistant Medical Officer of Health, and the Medical Officer of Health was appointed School Medical Officer, and in that capacity carried out the medical inspection of the boys over 10 years of age. The actual work of medical inspection commenced in April 1908, but at the start the work was practically limited to the routine inspection of entrants and leavers, and the special inspection of pupils selected mainly by the teachers. It was evident from the outset that some amount of treatment was inevitable, and Acton was in a favourable position to meet the emergency. As far back as 1903, a joint appointment of Health Visitor and School Nurse had been made, and during the Code Year ending July 31st, 1909, Acton was one of the 37 Authorities permitted, with the sanction of the Board of Education, to employ their School Nurses in duties of the nature of treatment. Acton was also one of the earlier authorities to obtain the sanction of the Board of Education to the provision of spectacles. Although at the present time, the provision of spectacles is considered essential in the education curriculum, in the Code Year 1908-1909, the sanction had been given to only 21 Authorities, of which Acton was one. The sanction was given only after we had satisfied the Board that every endeavour had first been made to obtain the provision of spectacles by the child's parents or by any voluntary associations which existed for the purpose. The treatment of defective vision commenced with a grant of £50 by the Education Committee in November 1908, but in September 1910, Dr. Grace Banham was appointed to examine all children referred at the routine and special inspections, and prescribe spectacles when necessary. It is impossible to express in words the almost incredible improvement which has taken place in the course of 30 years. This improvement has been achieved in almost all directions, but it is only in some of these that figures can be given. For instance, out of 159 boys between the ages of 13 and 16 years of age examined in 1908, 34, or 21%, were found to have defective vision to the extent of requiring treatment, and out of 160 girls, 27, or 17%, 33 were found to be defective. The condition of the teeth was appaling. The extent of caries may be imagined, when it is stated that an arbitrary standard of 4 obvious caries was accepted. Even with this low standard 16% of the boys, 13% of the girls, and 11% of the infants were found to fall below the standard. In spite of these facts, a dental surgeon was not appointed until 1914, and at the start, the scheme was limited to 3 schools— Priory, Southfield and Central, and only children between the ages of 6 and 8 years were examined and treated. An Aural Surgeon was appointed in 1913, but owing to lack of accommodation the scheme for the efficient treatment of otorrhoea and the removal of Tonsils and Adenoids, was not put into operation until 1914, though some treatment of discharging ears had been given on the appointment of a school nurse in 1909. Attention was frequently called to these old standing cases of otorrhoea in the early Annual Reports, as their presence in the schools was most objectionable both to the teachers and the other scholars, but we were almost helpless, exclusion of these children was of little service, as no other complaint would result in such prolonged absence from school. We quite appreciated the objections to their attendance, not only did we see children with discharge trickling out of their ears when they attended the minor ailment clinic, but in some of the classrooms the smell was most noticeable and in some almost unbearable. Mr. Fred Stoker supervised the treatment of these cases from 1914, and attended also for the operation of the removal of Tonsils and Adenoids, and a great improvement was soon noticeable, the sickening smell of chronic discharging ears was soon a thing of the past. In 1914, 36 children were operated on under the Council's scheme for the removal of Tonsils and Adenoids, but in 6 years this number had gone up to 279. The work was done either at the Council Offices or in the old Army Huts, until arrangements were made with the Authorities of the Acton Hospital, so that the operation could be carried out at the Hospital and all cases should stay at least one night after the operation in the Hospital. I can imagine the look of horror on the faces of the Aldermen and Councillors now if they saw about a dozen children lying on stretchers in one of the rooms in the Town Hall, or carried out through the corridors by their parents after an operation, but it was the only way open to us at the time and it had the sanction of 34 the Board of Education until some uncomfortable cases of postoperative bleeding in other parts of the country showed the considerable risks that were being run. The conditions were due primarily to lack of better facilities and especially to lack of accommodation. This lack of accommodation met us at many points and was one of the many difficulties we had to contend with. The Education Department in 1908, was housed in the Priory Schools, and a room on the ground floor was fitted out to carry out the treatment of minor ailments, and later this room was also used by Dr. Banham for refraction work. When the new Council Offices were opened in 1910, the Education department moved into the new building, but it was not until 1914 that accommodation was provided for a School Clinic. In the latter year, three rooms on the top of the building were fitted out, and dental treatment, refraction, and removal of tonsils and adenoids, as well as minor ailments were done in these rooms until 1920, when two Army huts were erected oil the site of the present Town Hall. The Provision of Meals Act, 1906, was put in force in the district for those children who were under-nourished, and meals were provided through the holidays as well as in term time. Some dinners were provided at the Cookery Centres, but most were given at a restaurant in Osborne Road, South Acton, at a cost of 2½d. each. This arrangement was continued until the outbreak of the Great War, when there was a great increase in the number of children requiring free meals. In September 1914, two rooms were hired from the authorities of All Saints Church, one was fitted up as a kitchen and the other was used as a dining room. The number of meals provided, increased from 11,284 in 1913 to 26,945 in 1914, but in 1915 the number had again fallen to 14,834. Much more could be said which might be of interest at the present time, but considerations of space forbid my giving a fuller account of the various aspects of the School Medical Service. D. J. Thomas. 35 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 41.4 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 21 21 57.4 80.7 .... .... .... .... .... Central 25 25 58.7 83. .... .... .... .... .... John Perryn Snr. 13 13 57.7 79. .... .... .... .... Priory Boys' 6O 60 57.5 81. .... .... .... .... .... Southfi'd Sr. Boys' 40 38 57.9 82.4 2 58.7 101.5 .... Turnham Gn. R.C. 7 6 57.5 82. 1 61.3 90.3 .... .... 166 163 .... .... 3 .... .... .... .... (GIRLS) Acton Wells Senior 25 25 59. 81.8 .... .... .... .... .... B'm't Pk. Sn. Girls' 36 36 58. 83.4 .... .... .... .... .... Central 28 28 58.9 85.7 .... .... .... .... .... John Perryn Snr. 19 18 57.4 78.4 1 56.8 71. .... .... Priory Girls' 70 68 57.6 80.6 2 58.5 82.4 .... .... Turnham Gn. R.C. 8 8 59.8 91.5 .... .... .... .... .... 186 183 .... .... 3 .... .... .... .... 36 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 3 ... ... ... 2 51.6 75. 1 52.5 66.5 Acton Wells Infants' 12 10 49.4 56.8 2 48.9 54.2 ... ... ... Beaumont Park Infants' 2 2 49.6 52.4 ... ... ... ... ... ... Berrymede Junior Boys' 48 38 49. 55.2 9 49.3 54.8 50.3 54.4 Berrymede Infants' 1 1 48. 50.3 ... ... ... ... ... ... Derwentwater Junior 44 29 50.2 57.7 15 50.7 58.8 ... ... ... Derwentwater Infants' 6 6 49. 55.7 ... ... ... ... ... ... John Perryn Infants' 22 11 49.2 56.1 11 50.3 61.1 ... ... ... Priory Infants' 2 2 49.8 52.9 ... ... ... ... ... ... Rothschild Junior 23 5 50.4 57.4 18 49.5 54.9 ... ... ... Rothschild Infants' 6 6 49.7 55. ... ... ... ... ... ... Southfield Junior 23 17 49. 57.6 6 49.4 56.2 ... ... ... Southfield Infants' 3 3 48.6 51.6 ... ... ... ... Roman Catholic 12 5 50.5 57.6 7 50.7 55.4 ... ... ... West Acton 23 11 49.1 54.7 12 54.6 61.2 ... ... ... 230 146 ... ... 82 ... ... 2 ... ... (GIRLS). - Acton Wells Junior 2 ... ... ... 2 51. 60.2 ... ... ... Acton Wells Infants' 11 10 48.3 53.6 1 48.5 47. ... ... ... Beaum'nt Pk. Jnr. 30 8 49.8 57.8 22 49.8 54.6 ... ... ... Berrymede Junior Girls' 44 35 48. 51.5 9 48.4 51.5 ... ... ... Berrymede Infants' 4 4 48.5 55.3 .... .... ... ... ... ... Derwentwater Junior '28 22 50.3 56.2 5 51.2 56.2 ... 51 57. Derwentwater Infants' 7 7 47.7 51. ... ... ... ... .... ... John Perryn Junior 3 ... .... ... 3 50.4 58.2 ... .... ... John Perryn Infants' 31 11 48.9 54.3 20 49.5 53.1 ... ... ... Priory Infants' 5 5 49. 52.4 .... ... .... ... ... ... Rothschild Infants' 4 4 49. 50.4 ... ... ... ... .... ... Southfield Junior 21 13 48.9 54.6 8 48.5 54.8 ... .... ... Southfield Infants' 5 5 49. 56.9 ... .... .... ... ... Roman Catholic 8 5 48.7 51.9 3 49.6 52.3 ... .... ... West Acton 19 8 49.3 51.9 11 51.4 61.7 ... .... ... 222 137 ... ... 84 ... ... 1 .... ... 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' 16 8 38.8 36.2 3 41.1 40.5 4 42.7 42.2 1 46. 50.3 Beaumont Park Infants' 15 5 38.3 33.8 4 44.5 44.1 4 44.5 45.4 2 43.2 41.1 Berrymede Infants' 30 8 37.9 34.8 8 40.8 39. 10 42.2 40.5 4 43.4 44.6 Derwentwater Infants' 47 .... .... .... 22 40. 37.3 20 42.5 41.1 5 44.5 42.7 John Perryn Infants' 21 .... .... .... 11 40.9 38.8 8 44.2 43.7 2 45.6 54.4 Priory Infants' 34 13 37.9 34.9 11 40.2 37.7 8 43.6 43.3 2 45.1 45.3 Rothschild Infants' 41 18 37.8 35. 12 40.8 39.5 7 42.8 42. 4 45.2 46.1 Soufhfield Road Infants' 25 .... .... .... 12 41.5 39.3 11 43.3 41.3 2 45. 43.8 Turnham Green R.C. 6 .... .... .... 3 39.6 36.9 2 44.2 42.7 1 47.3 43.5 West Acton 13 3 38.6 33.7 5 41.5 39.8 4 44.5 42.6 1 46. 48.3 248 55 .... .... 91 .... .... 78 .... .... 24 .... ... (GIRLS). Acton Wells Infants' 17 4 36.7 31.9 7 41.2 41.7 3 42.2 39.3 3 45.4 47.8 Beaumont Park Infants' 11 5 37.5 34.4 2 42.5 40.6 3 43.4 40.1 1 47.5 58. Berrymede Infants' 24 6 38. 35.9 7 39.8 37.6 9 42.8 42.2 2 44.2 43.5 Derwentwater Infants' 52 .... .... .... 25 40.3 38. 21 42.4 40.6 6 44.1 45.2 John Perryn Infants' 26 .... .... .... 9 42. 40.6 12 44.3 43.3 5 45.3 45.5 Priory Infants' 42 13 87. 33.1 16 40.5 38.5 11 43. 41.4 2 44.8 42.5 Rothschild Infants' 25 13 37.6 35.2 6 39. 37.1 6 41.9 41. .... .... .... Southfield Road Infants' 19 .... •••• .... 6 41.5 38.6 12 43.7 41.3 1 45.3 45. Turnham Green R.C. 8 .... .... .... 3 41.8 40.8 5 42.4 39.9 .... West Acton 18 8 38.2 34.8 4 40.8 37.4 3 42.6 37.9 3 44.9 44. 242 49 .... ... 85 .... .... 85 .... .... 23 .... .... 37 38 SCARLET FEVER. There were only 50 cases of Scarlet Fever reported in the school population in 1939, and the cases were very mild in type. There was a great difference in the incidence of Infectious Diseases in Acton apparently due to evacuation—the scattering of the child population resulting in no cases of Measles, very few cases of Diphtheria, and a big drop in the number of cases of Scarlet Fever. In Acton in 1937 there were 134 cases of Scarlet Fever. in 1938 there were 108 ,, ,, ,, ,, in 1939 there were 50 ,, ,, ,, „ The cases were distributed as follows:— Acton Wells Priory 7 Beaumont Park 12 Rothschild 3 Berrymede 3 Southfield — Derwentwater 6 Roman Catholic - John Perryn 18 West Acton 1 None of these cases occurred after the outbreak of war. diphtheria. There were only 3 cases of Diphtheria reported in the school population in 1939. They were distributed as follows:— Acton Wells 1 Beaumont Park 1 Southfield 1 Two of these children had not been previously inoculated against Diphtheria,—one had been inoculated 3 years previously. Endeavours are still being made to continue to protect the school and pre-school population against Diphtheria but, not unnaturally, the figures for 1939 are very poor. It is impossible to give the percentage figures of inoculated children in our schools, as the data are so upset by evacuation. As stated in the Annual Report of 1938, the post Schick test has been dropped and children are given an extra inoculation in place of it. Parents are advised to continue to have their children given one inoculation every three years until admitted to the Senior School, after which all children are Schick tested before additional inoculations are given. It has been impossible to gauge how the scheme has worked, as 1939 was not a normal year and no conclusions can be drawn, but the cases of Diphtheria were few and the procedure found to be much less of an ordeal for small children than the methods previously adopted. Inoculation figures for 1939 are given as under. Diphtheria Immunisation, 1939. School. Primary Schick test. Inoculations with A.P.T. Re-inoculation alter Schick test after 3 years. Pos. Neg. fist. 2nd. 3rd. 3 years. Pos. Neg. Acton Wells Senior - - - - 1 7 - 1 Acton Wells Junior - - - 1 12 35 — - Acton Wells Infants' - - 2 2 34 7 - - Beaumont Park Senior - - - - - 16 - 6 Beaumont Park Junior - - 1 1 3 18 - — Beaumont Park Infants'* - - 5 3 20 14 - — Berrymede Junior Boys’ — - — 2 9 24 — — Berrymede Junior Girls’ — - — — 4 16 — — Berrymede Infants' — - 9 10 26 4 — — Central - - - - 2 27 2 19 Derwentwater Junior - - - 2 13 32 - — Derwentwater Infants' - - 7 16 26 7 - — John Perryn Senior - - - - - 27 2 3 John Perryn Junior — - — — 3 31 — — John Perryn Infants' — - 1 6 24 12 — — Priory Boys' - - - - - 1 1 16 Pri6ry Girls' - - - - - — — 15 Priory Infants' - 1 15 16 33 11 - — Rothschild Junior Rothschild Infants' - - - - 6 26 - — - - 19 17 48 10 - — Southfield Senior - - - - - 7 2 7 Southfield Junior 1 - 2 3 10 32 — — Southfield Infants' - - 10 9 16 12 - — Roman Catholic - - - 2 19 2 - — West Acton - - 10 13 22 8 - — Others - - - - 1 - - - Isolation Hospital - - 6 6 13 - - — Infant Welfare — — 106 96 111 — 1 1 Total 1 1 193 205 456 386 8 68 39 40 SCABIES. Scabies continues to be a serious cause of irregularity of school attendance, and a great nuisance to all concerned. There appears to have been a very widespread outbreak of Scabies all over the country, Acton is not alone in being infested with the disease. Treatment is carried out in the first instance at home, the parent is given careful typed instructions and sufficient ointment to carry out the necessary treatment. Arrangements are made to sterilise the clothing and bedding of infected persons, and advice is given that all children in a family should be treated similarly and simultaneously whether suffering from Scabies or not. Only in that way can there be a chance of getting rid of the disease quickly. If home treatment fails, recourse is had to cleansing baths, for which Acton has an arrangement with the Borough of Kensington. In the great majority of cases, it should be perfectly possible to cure Scabies by home treatment, and nothing shows up the mother who is not prepared to take pains to look after her children, quicker than the length of time taken to get the children clear. It is worth noting that from September to the end of the year, several children were brought back from the evacuation areas by their parents because they were found to have contracted Scabies while away, and there were one or two instances of apparent failure on the part of the foster mothers to give the children adequate attention for the complaint. The Table attached will show how widespread the cases in Acton were in the first half of the year. There were in all 61 cases, and 40 families were affected, 3 families being affected more than once. Cases of Scabies—1939. January 17th 13th 13th 16th 17th 24th 31st Colville Road. *Colville Road. *Colville Road. *Conway Grove (3 children). Goldsmith Road. *Goldsmith Road. Goldsmith Road. Goldsmith Road. *Junction Road (2 children). Horn Lane Horn Lane Nemoure Road Rothschild Infants'. Rothschild Infants'. Priory Girls'. Acton Wells. Derwentwater. Derwentwater. Priory. Derwentwater. Priory Girls'. Acton Wells. Derwentwater. Derwentwater. 41 February 1st 2nd 6th 13th 21st 22nd 27th March 7 th 9th 13th 28th April 3rd 4th 18th 19th 25th 27th May 4th 8th 12th 15th 22nd June 6th 9th 15th 21st 27th 61 cases. Colville Road Mill Hill Grove *Steyne House (4 children) Berrymead Road Graham Road *Packington Road (2 children) Packington Road *Palmerston Road (5 children) Osborne Road Julian Avenue *Acton Lane (3 children) The Vale Steyne Road Horn Lane Graham Road Goldsmith Road *Steyne House (2 children) Rusthall Avenue Brouncker Road Churchfield Road Leythe Road Montgomery Road Steyne House Junction Road *Churchfield Road (4 children) High Street Maldon Road Birkbeck Road Birkbeck Avenue Berrymead Road The Vale Burlington Gardens 0 families. Rothschild Infants'. Priory Girls'. Derwentwater. Priory Boys'. Rothschild Junior. Beaumont Park. Berrymede Infants'. Berrymede Boys'. Berrymede and Central. Priory Girls'. County School. Beaumont Park. Southfield. Roman Catholic. Derwentwater. Beaumont Park—return case. Denventwater—return case. Derwentwater. Southfield. Berrymede Infants'. Derwentwater. Berrymede Girls'. Rothschild Infants'. Derwentwater. Berrymede Boys'. Priory, Derwentwater & Special Priory Infants'. Special School. Derwentwater. Priory Girls'. Rothschild Junior—return case. Southfield Junior. Derwentwater Junior. *Members of one family. 42 PROVISION OF MEALS. Free meals and milk were provided as usual in Acton until the evacuation scheme was put into operation. The meals were dispensed from 7 feeding centres, and free milk was supplied at all the schools. In accordance with previous policy, meals and milk were provided during school holidays, and attendances were sufficiently good to make the continuance of the scheme worth while. Free meals and milk were granted as formerly after an examination by the School Medical Officers had shown the children to be medically in need of them. Menus were supervised, and suggestions for dishes containing important protective food substances were given by the School Medical Officers. Numbers of meals provided and bottles of milk supplied are much diminished owing to the schools being shut from September until mid November, and then being reopened with lower numbers. Meals supplied at the different centres. West Acton 690 Beaumont Park 3,627 Central 2,508 John Perryn 3,672 Priory 3,017 Southfield 404 Avenue Road 15,092 29,010 Meals supplied during the quarter ending:— March 11,604 June 11,284 August 6,122 29,010 4.3 Numbers of bottles of milk supplied, period ending:— March 40,937 June 37,583 August 17,640 96,160 Number of children on Feeding list:— Meals and Milk. Milk only. March 214 201 June 225 199 August 223 191 EAR CLINIC. 67 cases were seen at the Ear Clinic during 1939. 11 cases were seen who had attended the Clinic in previous years, of these 8 cleared up under treatment, 1 decided to attend his own doctor, 1 attended a hospital and 1 refused further treatment. 33 new cases of otorrhoea were seen, 24 cleared up with treatment, 2 left Acton while still under treatment, 2 were removed to Hospital, 4 cases did not attend—in two of these cases because it was not possible for the school to send the children to the Clinic, 1 case, on being referred to the Ear Clinic_ was found to be suffering from a mastoid inflammation and was sent to Hospital for operation. 20 cases were referred suffering from Earache. 11 of these were due to a cold in the head and subsided on treatment, 5 were due to irritation from large plugs of wax, 1 was due to the presence in the ear of a large plug of paper, 1 was due to the presence of a polyp in the ear, 2 were due to external otitis. 3 children were seen because of deafness, were referred to Acton Hospital and operated on for removal of tonsils and adenoids. The Ear Clinic was conducted on the same lines as in 1938, but of course the work was curtailed and disorganised by the Evacuation Scheme. 44 REPORT OF DENTAL CLINIC. The Evacuation scheme, having affected mothers and infants from the welfare clinics as well as school children, has made comparisons of figures with those of the previous year impossible. Work has, however, been going on throughout the whole year. Those children and mothers who did not go away were called up to the clinic for inspection and treatment. From records at the Education Offices we were able to obtain the names and addresses of those who returned and appointments were sent to them. As soon as a sufficient number of children had returned to the schools, inspections were resumed there in the ordinary way. Mr. Goldie's part time assistance has been temporarily discontinued. Below are given the figures for dental work in Secondary Schools and the Maternity and Child Welfare Centres, as these are not shown in the returns to the Board of Education on Table V. Secondary Schools. Number examined 637 Referred for treatment 470 Number treated 260 Attendances for treatment 632 Permanent Fillings 488 Permanent Extractions 125 Temporary Extractions 23 Dressings 57 Maternity and Child Welfare. Number of mothers examined 227 Referred for treatment 227 Number treated 177 Number of children examined 97 Referred for treatment 84 Number treated 70 45 Permanent Fillings 61 Permanent Extractions 737 Temporary Fillings 24 Temporary Extractions 240 Dressings 94 Anaesthetics given 216 Number of attendances 386 Dentures supplied 23 P. H. Slater. OPHTHALMIC CLINIC. Dr. Clifton joined the Army on the outbreak of war and so no report can be included from him. The figures for the year are given below and it will be seen that they are much below the *■ figures for the previous year. Elementary School Children. 224 referred for refraction. 136 provided with glasses. ^ — 2 obtained glasses privately 64 refused treatment or left the district. 22 did not require glasses. 6 cases of external eye disease were seen. Welfare Cases. 14 children referred for refraction.__ 5 children obtained glasses. 1 refused treatment. 8 did not require glasses. 1 case of external eye disease. 46 County and Junior Technical Schools. 17 boys referred for refraction. 13 obtained glasses. 1 did not require glasses. 2 refused. 1 left school. In December, 1939, Dr. V. Eileen Brander was engaged to act as temporary Ophthalmic Specialist at the Eye Clinic, in the absence of Dr. Clifton. Her appointment was approved by the Board of Education. exceptional children. It has been found impossible to give the complete account of all the Exceptional children in Acton which is usually included in the Annual Report. A Table has been drawn up, as under to show what the position is as far as information is available. Defect. In Hospital. Residential Special or Open Air School. Ord. School. Evacuated. me. Tuberculosis 2 1 - - 1 Delicate children - 2 3 6 3 Rheumatism — 2 3 4 Crippled children 2 1 - - 1 Epilepsy - 3 - 1 — Deaf and Dumb — 2 - 4 — Blind and Partially Sighted - — - 2 1 1 partially sighted boy left school during the year and has obtained employment. TABLE SHOWING THE DISTRIBUTION OF ALL CHILDREN EMPLOYED DURING THE PERIOD 1st JANUARY, 1939 to 31st DECEMBER, 1939. School. Acton Wells Central County John Perryn Priory Roman Catholic South field Technical Others Special Total 1.—Registered Occupations:— (a) Delivering Newspapers 8 7 7 1 21 1 6 — 1 1 53 (b) Delivering Milk 4 1 3 — 6 — 1 — 1 — 16 (c) Carrying or Delivering Goods or Parcels 2 6 4 1 30 — 9 — 2 — 54 Total 14 14 14 2 57 1 16 — 4 1 123 Corresponding figures for 19.38 19 12 15 2 66 - 21 3 4 - 142 47 TABLE SHOWING THE NUMBER OF CHILDREN ATTENDING ACTON SCHOOLS EMPLOYED IN THE VARIOUS REGISTERED OCCUPATIONS ON 31st DECEMBER, 1939. SCHOOL. Delivering Newspapers Delivering Milk Delivering Goods or Parcels Totals Boys. Boys. Boys. Acton Wells 1 - 1 Central 3 — — 3 County 1 2 1 4 John Perryn 1 — — 1 Priory 8 2 6 16 Roman Catholic 1 — — 1 Southfield 3 — 1 4 Technical — — — — Special — — — — Others 1 — 1 2 Totals 19 4 9 32 48 49 VISITS PAID BY SCHOOL NURSES. The following are the number of home visits paid by the Nurses during the year. The visits have been divided into school distribution. Acton Wells 17 Rothschild 128 Beaumont Park 128 Southfield 53 Berrymede 170 Roman Catholic 5 Central 2 West Acton 11 Derwentwater 56 Special School 38 John Penyn 10 Priory 120 Total 738 CONVALESCENT HOMES & COUNTRY HOLIDAYS. Two boys and two girls were given a fortnight's free holiday during the Summer at Bexhill, but, no children were sent to the Winter School of Recovery. MEDICAL INSPECTION RETURNS. TABLE I. A.—Routine Medical Inspections. Number of Inspections in the prescribed Groups:— Entrants 490 Second Age Group 452 Third Age Group 352 Total 1294 number of other Routine Inspections Grand Total 1294 B.—Other Inspections. number of Special Inspections and Re-Inspections 2228 table ii. Classification of the Nutrition of Children Inspected during the Year in the Routine Age Groups up to 31st August, 1939. Age-groups Number of Children Inspected A (Excellent) B (Normal) C (Slightly subnormal) D (Bad) No. % No. % No. % No. % Entrants 490 140 28.57 304 62.04 44 8.97 2 .4 Second Age-group 452 152 33.62 253 55.97 45 9.95 2 .44 Third Age-group 352 60 17.04 257 73.01 35 9.9 — — Other Routine Inspections Nil — — — — — — — — Total 1294 352 27.2 814 62.9 124 9.58 4 .3 50 51 table III. BLIND CHILDREN. Name Age Address At a Public Element'y School At another Institut'n At no School or Institut'n Reginald Goodrick 12 230, Old Oak Common Lane. — — At home DEAF CHILDREN Name Age Address At a Public Element'y School At another Institut'n At no School or Institut'n Nil. — — - — — table iv. Return of Defects Treated during the Year ended 31st December, 1939. Treatment Table. Group I.—Minor Ailments (excluding Uncleanliness, for which see Table VI.) Disease or Defect (1) Number of Defects treated, or under treatment during the year Under the Authority's Scheme (2) Otherwise (3) Total (4) Skin— Ringworm-Scalp— (i). X-Ray Treatment — - — (ii). Other Treatment — - — Ringworm-Body 4 - 4 Scabies 64 - 64 Impetigo 178 - 178 Other skin disease 119 - 119 Minor Eye Defects— (External and other, but excluding cases falling in Group II.) 85 - 85 minor Ear Defects— 57 3 60 Miscellaneous— (e.g., minor injuries, bruises, sores, chilblains, etc.) 719 - 719 Total 1226 3 1229 52 (group II.—Defective Vision and Squint (excluding Minor Eye Defects treated as Minor Ailments—Group I). Defect or Disease. (1) No. of defects deah with. Under the Authority's Scheme (2) Otherwise (3) Total (4) errors of Refraction (including squint) 224 2 226 Other defect or disease of the eyes (excluding those recorded in Group I) 6 — 6 Total 230 2 232 No. of Children for whom spectacles were— (a) Prescribed 138 2 140 (6) Obtained 136 2 138 Group III.—Treatment of Defects of Nose and Throat. Number of Defects. Received Operative Treatmem Received other forms of Treatment (4) Total Number Treated (5) Under the Authority's scheme, in Clinic or Hospital (1) By Private Practitioner or Hospital, apart from the Authority's Scheme (2) Total (3) 1. 2. 3. 4. 1. 2. 3. 4. 1. 2. 3. 4. 1 1 20 — — — - - 1 1 20 — — 22 (1)—Tonsils only. (2)—Adenoids only. (3)—Tonsils and adenoids. (4)—Other defects of the nose and throat. Group IV.—Orthopaedic and Postural Defects. Under the Authority's Scheme. (1) Otherwise. (2) Totalnumber 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 — — — — — 4 4 53 54 Table V.—Dental Inspection and Treatment. (1) Number of children inspected by the Dentist: (4) Attendances made by children for treatment 2666 Age: 5— 453 (5) Half-days devoted to: Inspection 25 (a) Routine age-groups 6— 496 Treatment 447 7— 482 Total 472 8— 422 9— 408 10— 370 (6) Fillings: Permanent Teeth Temporary Teeth 11— 339 1229 12— 301 99 13— 311 14— 36 Total 1328 3618 (7) Extractions: Permanent Teeth 500 (b) Specials 344 Temporary Teeth 2850 (c) Total (Routine & Specials) 3962 Total 3350 (8) Administrations of general anaesthetics for extractions 1309 (9) Other Operations: (2) Number found to require treatment 2817 Permanent Teeth 101 Temporary Teeth 73 (3) Number actually treated 1818 Total 174 Table VI.—Uncleanliness and Verminous Conditions. Average number of visits per school made during the year by the School Nurses 6 Total number of examinations of children in the Schools by School Nurses 14863 Number of individual children found unclean:— Vermin and Nits 89 Slightly infested 424 Number of individual children cleansed under Section 87 (2) and (3) of the Education Act, 1921 4 Number of cases in which legal proceedings were taken : - (a) Under the Education Act, 1921 - (b) Under School Attendance Byelaws - 55 STATEMENT OF THE NUMBER OF CHILDREN NOTIFIED DURING THE YEAR ENDED 31st DECEMBER, 1939, BY THE LOCAL EDUCATION AUTHORITY TO THE LOCAL MENTAL DEFICIENCY AUTHORITY. Total number of children notified 4 Analysis of the above total. Diagnosis. Boys. Girls. 1. (i) Children incapable of receiving benefit or further benefit from instruction in a Special Sdhool: (a) Idiots — — (b) Imbeciles 1 — (c) Others — — (ii) Children unable to be instructed in a Special School without detriment to the interest of other children: (a) Moral Defectives — — (b) Others — — 2. Feeble-minded children notified on leaving a Special School an or before attaining the age of 16 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 4 — We are, Your Obedient Servants, G. E. B. PAYNE, E. MADELEY.