AC.439(1)ACTON ACT 49 Borough of Acton ANNUAL REPORT of the Medical Officer of Health together with the Report on the Medical Inspection of Schools FOR THE YEAR 1946 Borough of Acton ANNUAL REPORT of the Medical Officer of Health together with the Report on the Medical Inspection of Schools FOR THE YEAR 1946 ANNUAL REPORT of the MEDICAL OFFICER OF HEALTH FOR THE YEAR 1946. 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 of Acton for the year 1946, together with the report of the School Health Service of the Divisional Executive, for the Borough. During the year the number of births has increased considerably, . but as the population is now 65,150 the number of births per thousand of the population is 19.76. The death rate is. 11.05 as compared with 11.5 last year. This year Infantile Mortality is 27.9 as compared with 40.4 last year, the figure for England and Wales being 46. This infantile mortality rate is satisfactory and it is to be hoped it will be maintained. 4 During the year the Acton and Wembley Joint Hospital was handed over to the Middlesex County Council as a maternity annexe to the Central Middlesex County Hospital, and the infectious disease cases occurring in Acton are now treated in the South Middlesex Fever Hospital at Mogden. Towards the end of 1946, there was an extensive epidemic of Measles in the Borough. • Miss B.. G. Sorlie, one of the, Health Visitors, who had given 17 years conscientious service to the Borough, retired on the 31st May, 1946, and Miss N. Daniells left on the 20th October to enter the service of the Shoreditch Borough Council. By the end of 1946, all those members of the Health Department and School Health Services in the Armed Forces had returned to their civilian duties with the Council. I should like to thank all members of the department for their co-operation during the year, and especially I should like to call attention.to the work of Dr. Madeley during my absence in the Forces. Your Obedient Servant, G. E. B. PAYNE. 5 STAFF. George E. B. Payne, m.d., m.r.c.s., d.p.h., Medical Officer of Health and School Medical Officer. (Returned from War Service 2.9.46). Elsie Madeley, m.b., ch.b., d.p.h., Deputy Medical Officer of Health and Deputy School Medical Officer. Margaret Heller, m.d., Vienna, l.r.c.p., m.r.c.s. Edinburgh, Assistant Medical Officer of Health and Assistant School Medical Officer. P. H. Slater, l.d.s. School Dentist. Mrs. E. Behr, l.d.s. School Dentist. J. J. Matthews, m.r.san.i., Cert. of Royal Sanitary Institute, holds Meat and Smoke Certificates; Chief Sanitary Inspector (Inspector under Diseases of Animals Acts, Rag Flock Act, and Fabrics Misdescription Act). M. Dowie, m.r.san.i. Cert. of Royal Sanitary Institute, holds Meat Certificate; Deputy Chief Sanitary Inspector. G. W. Burdon Cert. of Royal Sanitary Institute, holds Meat Certificate; Sanitary Inspector. C. Codrington, Cert, of Royal Sanitary Institute, holds Meat Certificate; Temporary Sanitary Inspector. A. H. G. Johnson, m.r.san.i., Cert. of Royal Sanitary Institute, holds Meat Certificate; Meat Inspector. T. E. Parry, Cert. of Royal Sanitary Institute, holds Meat Certificate; Sanitary Inspector. D. G. Paterson, m.r.san.i.. Cert. of Royal Sanitary Institute, holds Meat Certificate, Sanitary Inspector. Mrs. D. M. Lewis, s.r.n., P.t. 1. c.m.b., Cert. of Royal Sanitary Institute, Health Visitor and School Nurse. Miss W. L. Orfeur, s.r.n., Certificate of Royal Sanitary Institute, s.c.m., Health Visitor and School Nurse. Miss M. Percival, s.r.n., Certificate of Royal Sanitary Institute, s.c.m., Health Visitor and School Nurse. 6 Miss L. S. Pickering, s.r.n., Certificate of Royal Sanitary Institute, s.c.m., Health Visitor and School Nurse. Miss D. B. Springall, s.r.n., Pt. 1 c.m.b., Cert. of Royal Sanitary Institute, Health Visitor and School Nurse. Mrs. E. Walsh, s.r.n., Cert. of Royal Sanitary Institute, s.c.m.. Health Visitor and School Nurse. Mrs. M. Ford, s.r.n., s.c.m., School Nurse. A.S.M. Pratt, Barrister at Law, Chief Clerk. Miss M.F. Willy Senior Clerk. Miss J. Dobbs Senior Clerk—Sanitary Section. Miss K.M. Beer Clerk Typist. Miss F. Dougall Clerk Typist. Mrs. A.R. Ferguson Clerk Typist. Miss G.M. Gundersen Clerk Typist. Miss M.J. Pearce Clerk Typist. Mrs. P. Roberts Clerk Typist. Mrs. E. Underwood Accounts and Stores Clerk. Miss E. Woods Clerk Typist. Miss H. Stone Matron, Bollo Bridge Road Day Nursery. Mrs. B.E. Bone Matron, Horn Lane Day NurseryMrs. E.J. Hainstock Matron, Friars Place Lane Day Nursery. Mrs. M. Berry Matron, "Longcot" Day Nursery. SECTION A. General Statistics. Area 2,317 acres. Population Census 1931 70,510 „ Registrar General's Estimate, 1946 65,150 Rateable Value at 31,12.46 £892,378 Sum represented by the product of a penny rate at 1.4.46 £3,500 General Rate in the £ 14/4d. 7 VITAL STATISTICS. (Comparable figures for 1945 given in brackets). Live Births: total males females Legitimate 1205(946) 629(489) 576(457) Illegitimate 83(94) 43(44) 40(50) Totals 1288(1040) 672(533) 616(507) Birth rate, per 1,000 estimated population is 19.76(18.5). Still Births. total males females Legitimate 21(15) 13(9) 8(6) Illegitimate 2(3) 2(1) -(2) Totals 23(18) 15(10) 8(8) Deaths: 720(660). Death Rate per 1,000 inhabitants 11.05(11.5). Deaths from Puerperal Causes (Registrar General's short list for England and Wales, Headings 29 and 30): Deaths. Rate per 1,000 Live& Still Births. No. 29. Puerperal Sepsis -(-) -(-) No. 30. Other Puerperal Causes -(1) -(.94) Death Rate of Infants under 1 year of age. All infants per 1,000 live births (E.&W. 46) 27.9(40.4) Legitimate infants per 1,000 live births 27.4(41.2) Illegitimate infants per 1,000 live births 34,09(53.2) Deaths. Deaths from Cancer (all ages) 125(119) Deaths from Measles (all ages) 1(-) Deaths from Whooping Cough (all ages) 2(-) Deaths from Diphtheria (all ages) -(-) Deaths from Diarrhoea (under 2 years of age) 8(4) Death rate from Diarrhoea (under 2 years of age) 4.4(3.84) 8 AGES AT DEATH, AND WARD DISTRIBUTION OF DEATHS IN 1946. Causes of Death Total Under 1 year 1—2 2—5 5—15 15—25 25—45 45—65 65 + Ward Distribution. N.E. N.W. S.E. S.W. Bronchitis 39 3 - - - - - 8 28 16 7 6 10 Cancer 125 — - - 1 1 4 46 73 44 36 23 22 Cerebral Haemorrhage & Thrombosis 76 1 - - - - 2 23 50 25 23 13 15 Cerebro-spinal meningitis — — - - - - — — — — — - - Childbirth—Disease of Pregnancy & Puerperium - - - - - - - - - - - - - Circulatory Diseases 59 — - - - — — 20 39 20 22 6 11 Cirrhosis of the Liver — — - - - - - - - - - - - Congenital Debility and Prematurity 16 16 - - - - - - - 8 2 2 4 Diabetes 5 - - - - - - 2 3 1 - 1 3 Digestive Tract Diseases' 14 - - - - - - 4 10 5 4 3 2 Diphtheria - - - - - - - - - - - - - Gall Bladder Diseases 2 - - - - - - - 2 1 - - 1 Gastro-Enteritis 8 8 - - - - - - - 2 1 2 3 Heart Disease 117 - - - - - 6 31 80 31 37 19 30 Infective and parasitic Diseases - - - - - - - - - - - - - Influenza 7 — - 1 - - 1 2 3 1 3 2 1 Leukaemia and Anaemia (Blood and Blood forming tissue Diseases) 5 - - - - - 2 1 2 2 1 - 2 Liver Disease (not Cirrhosis) 3 - - - - - 2 - 1 1 - - 2 Measles 1 — 1 - - - — - — — — — 1 Carried forward 477 28 1 1 1 1 17 137 291 157 138 77 107 6 AGES AT DEATH, AND WARD DISTRIBUTION OF DEATHS IN 1946—contd. Causes of Death Total Under 1 year 1-2 2—5 5—15 15-25 25—45 45—65 65 + Ward Distribution. N.E. N.W. S.E. S.W. Brought forward 477 28 I 1 1 1 17 137 291 157 138 77 107 Meningitis (not C.S.M. or T.B..) 1 — — 1 — - — — — — 1 - - Nephritis 13 — — — - 1 — 6 6 5 2 1 5 Nervous System & Diseases of Sense Organs 3 - - - - - - 1 2 1 - 1 1 Parturition Disease (other than Childbirth and Puerperal Pyrexia) - - - - - - - - - - - - - Peptic Ulcer 10 - - - - - - 3 7 2 5 1 2 Pneumonia 52 6 2 1 — — 2 10 31 12 12 6 22 Prostatic Hypertrophy 20 - - - - - 1 3 16 6 4 6 4 Puerperal Pyrexia — — — — - - - - - - - - - Pulmonary Tuberculosis 35 — — — - 5 11 12 7 13 9 4 9 Respiratory Diseases 14 — - — - — 3 6 5 7 4 1 2 Rheumatism—Diseases of Nutrition, Vitamin Deficiencies 2 - - - - - - - 2 - 1 - 1 Sarcoma 4 — — — - 1 1 2 - 1 2 - 1 Scarlet Fever — — — — - — — — — - - - - Senility 52 - - - - - - - 52 18 16 6 12 Suicides 1 — — — - — 1 — - 1 - - - Tuberculosis (other than Pulmonary Tuberculosis) 5 - 1 - - 1 2 1 - - 2 1 2 Undefined Diseases 7 — — — - 1 2 2 2 4 1 1 1 Violent Deaths 22 1 — - 1 1 6 3 10 9 5 3 5 Whooping Cough 2 1 - 1 - - - - - 1 1 - - TOTALS 720 36 4 4 2 11 46 186 431 237 201 108 174 10 Cause of Death in Children under one year—1946. 23 Males. 13 Females. Under 1 \vk. 1—2 wks. 2—3 wks. 3—4 wks. Total under 1 month. 1—3 mths. 3—6 mths. 6—9 mths. 9—12 mths. Total 1—12 months. Atelactasis 3 1 - 1 5 - - - - - Asphyxia — — — - — - 1 - - 1 Bronchitis — — — - — 2 1 - — 3 Congenital Defects 3 3 — — 6 — — — — — Gastro Enteritis - - - - - 3 2 2 1 8 Intercranial Haemorrhage and Thrombosis 1 - - - 1 - - - - - Marasmus 1 - - - 1 - - - - - Pneumonia — 2 1 - 3 — — 2 1 3 Prematurity 3 1 - - 4 - - - - - Whooping Cough — - — - — — 1 — — 1 Total 11 7 1 1 20 5 5 4 2 16 30.5% died during first week of, life. 55.5% died during first month of life. Percentage of Deaths under one year. Percentage of total deaths under 45. 5% 14.3% Comparative Figures of Infant Mortality in last six years. Acton. England & Wales. 1941 47.8 59 1942 71.2 49 1943 62.4 49 1944 42.8 46 1945 40.4 46 1946 27.9 46 11 Maternal Mortality. There were no maternal deaths during the year. Inquests. Suicides 4 Accidental falls 6 Motor car, train and tram accidents 8 Heart and Circulatory Disease 2 Respiratory Disease 3 Air Embolism 1 Result of War Service 1 Unsound Mind 2 Asphyxia 6 Other causes 1 Total 34 Post Mortems without Inquest. Heart and Circulatory Disease 57 Respiratory Disease 24 Asphyxia 1 Cerebral Haemorrhage and Thrombosis 11 Other causes 17 Total 110 SECTION B. General Provision of Health Services in the Area. Laboratory Facilities. In April, 1946, the Emergency Medical Services Laboratory again reverted from St. Mary's Hospital, Paddington, to the Pathological Laboratory at 25 Churchfield Road, West Ealing, and has continued to operate from that address. 12 The following Table gives the types, and number, of specimens submitted for examination. Type. No. of Specimens examined. Throat Swabs 793 Sputums 45 Faeces 302 Hair 2 Widals 1 Ambulance Facilities. 1946 was the first complete post-war year of operation of the Ambulance Service entirely separate, from Civil Defence. The system already in use of two watches working a 24-hour shift each was continued, utilising three ambulances manned by a total of two Supervisors and ten men divided into the, two watches. The Service continued to. share the premises of the National Fire Service in Gunnersbury Lane. During the year, 1,551 cases of all kinds (including 205 maternity cases) were carried a total distance of 8,511 miles. From January to the end of October the Acton and Wembley Joint Hospital Board maintained an ambulance for the removal of cases of infectious disease. Since the South Middlesex and Richmond Joint Fe,ver Hospital at Twickenham undertook the treatment of infectious disease for the Borough, removal of cases has been done by that Hospital. Nursing in the Home. The same facilities exist as in previous years, the number of sick persons under care was 508, necessitating 14,586 visits. Hospital Provision. Early in 1946, owing to the serious shortage of maternity bed . accommodation in Central Middlesex County Hospital, the Middlesex County Council approached the responsible officers of the Acton and Wembley Joint Hospital Board with a view to the two authorities making other arrangements for the treatment of infectious diseases in their respective areas, so that the accommodation of the Acton and Wembley Joint Hospital could be made available for the County Council to use as an annexe to Central Middlesex County Hospital Maternity department. 13 After several conferences this was agreed to. Acton made arrangements for its infectious diseases to be received into the South Middlesex and Richmond Joint Hospital at Mogden, while Wembley entered into an agreement with Hendon. The Hospital at Mogden is one of the most modern of its kind in England, the equipment is complete and up to date. A satisfactory financial agreement was arrived at, and the first cases were admitted to Mogden on the 1st November, 1946, the few remaining cases being transferred from Acton and Wembley Joint Hospital on the 30th November. The Middlesex County Council gave an undertaking that should an epidemic arise, they would assist in finding alternative accommodation for the cases. The Acton Voluntary Hospital treats both surgical and medical cases, as does the Central Middlesex County Hospital which is maintained by the Middlesex County Council. MATERNITY AND CHILD WELFARE. The same four Centres were operating during 1946 as Infant Welfare Clinics: (1) The School Clinic, Avenue Road. (Three Health Visitors' districts served by this Centre). (2) Steele Road Mission Hall, Acton Green. (3) John Perryn School. (4) St. Gabriel's Church Hall, Noel Road. As in the previous year, two weekly sessions were held for each Health Visitor's district, one with a doctor in attendance, and one without, with the exception of the shared clinic at Avenue Road. where two of the Health Visitors and their districts share the two sessions and a doctor is in attendance at each. Average weekly attendances, (last year's figures in brackets): Central district 70.5(66.8) South East 66.5(73) South West 68.6(79.6) North East 67.8(76) North West 71.5 (73.7) West district 53.2 (newly formed). 14 It will be observed that the attendances are, with one exception, lower than those for last year. This may be accounted for by the formation of a new Health Visitor district, and the subsequent rearrangement of the existing districts. The, total number of attendances has gone up from 19,212 in 1945, to 20,814 in 1946. Attached is a Table showing the attendances at all Clinics and the visits paid by the Health Visitors to the homes. The numbers of mothe,rs and children seen and treated at the Ophthalmic and Dental Clinics are given in the School Medical Report. Health Visiting. Number of visits, paid during the year by all Health Visitors working in this area: To expectant mothers First visits 594 Total visits 967 To children under one year of age First visits 1336 Total visits 4091 To children between the ages of one and five years Total visits 3387 Infant Welfare Centres. Total number of children who first attended the Centres during the year, and who, on the date of their first attendance, were: Under one year of age 1136 Between the ages of one and five 123 Total number of children under 5 years of age who attended at the Centres during the year and who, at the end of the. year were:- Under one year of age 968 Over one year 1781 Total number of attendances at Centres during the year:- By children under one year of age 15,339 By children between one and five years 5,475 A total of 768 Toddlers, attended the Welfare Centres during 1946, for a yearly examination. 15 Midwifery Service. Domiciliary Midwifery was performed as in previous years by Queen Charlotte's Midwives. During 1946, 360 women were recommended for admission to Central Middlesex County Hospital for their confinements and of these, 76 had to be refused owing to shortage of beds. A fourth Ante-Natal clinic was opened at the beginning of the year, but by the late Autumn pressure on the sessions was again so heavy that a fifth session was started in December, 1946. Number of new cases attending Clinics during year 1241 Total number of attendances made 5516 Average number attending weekly (4 clinics) 110 The following Table gives the stage of pregnancy at which the new cases reported for examination:- 1st month - 6th month 110 2nd month 45 7th month 68 3rd month 365 8th month 20 4th month 404 9th month 12 5th month 208 1232 33.2% came for examination when 1-3 months pregnant. 66.06% came for examination when 1-4 months pregnant. 96.8% of mothers whose confinements were notified, attended the Ante-Natal clinics in the Borough, the, great majority being referred either to Queen Charlotte's Hospital or Central Middlesex County Hospital at the 36th week of pregnancy. 9 patients who attended were found not to be pregnant. The arrangements made by women for their confinements are tabulated below: Confined in Central Middlesex County Hospital 35.3% Confined in Queen Charlotte's Hospital 13.3% Confined in other Hospitals 5.6% Confined in Nursing Homes 8.5% Confined at home (Queen Charlotte's Midwives attending) 36.28% Evacuated to Emergency Maternity Hostels 1.02% 16 Exacuation of expectant mothers took place as follows:- January 2 July 2 February 3 August - March 3 September - April 1 October - May 1 November - June 1 13 Post Natal Clinics. The majority of women had their post natal examination at the hospital where they were, confined, those confined at home being examined at Queen Charlotte's Hospital. 20 women attended our clinic for their examination. Birth Control Clinics. As in previous years, arrangements for this purpose, with the North Kensington Women's Welfare were continued, 5 patients being sent there for advice in 1946. Sterility Clinic. During the year, 2 patients were referred to this clinic at North Kensington Women's Welfare. Exercises Class for Mothers. The popularity of these classes is steadily growing and they have aroused very keen interest and support from the, Central Middlesex and Queen Charlotte's Hospitals, as also the Domiciliary Midwifery Service. The exercises themselves and the informal talks and instruction given at the classes have been found to be of the greatest value, both to the mothers and through them to the midwives. The number of mothers who attended during 1946 was 160, and the total number of attendances made was 1212. In addition, three evening talks were given to prospective fathers, at the request of some of the women attending the exercises class. These also met with real appreciation and requests have been received for more to be arranged. 17 * Food Sales. During the year, the Maternity and Child Welfare Centres supplied the following quantities of milk foods: For Sale 29,205 lbs. Free 216 lbs. The Food Executive Officer has very kindly supplied the following figures of milk and vitamin preparations, issued by his department to expectant and nursing mothers and to children: Orange Juice 68,127 bottles (54,661 last year). Cod Liver Oil 12,975 bottles ( 7,197 „ „ ). Vitamin Capsules 3,849packets( 2,117 „ „). National Dried Milk 14,203 tins (11,374 „ „). Home Help Scheme. At the end of the year there were 3 full time Home Helps. The following Table shows the number of cases booked and those actually attended: Number of Cases booked 88 (67 last year). Number of Cases attended 63 (54 „ „). Number of Cases cancelled 25 (13 „ „). Domestic Help Scheme. By the end of, the year there was a staff of 4 full time and 2 part time Domestic Helps. 88 cases were attended as against 58 for the previous year. Day Nurseries. In December 1945, the Ministry of Health and the Ministry of Education issued a joint circular setting out their post war policy with regard to the care of children under 5 years. The view was accepted that the proper place for a child of under 2 was at home with its mother, and that under normal peace time conditions mothers of such young children should be discouraged from going out to work, but it was also recognised that this ideal could not be attained for some time in view of the continuing need for employment of women in industries vital to 18 production for essential home requirements and for export trade. It was proposed that for the transitional period there should be an expansion of nursery schools and nursery classes., accompanied by a corresponding diminution in the number of day nurseries and, where necessary, the development of subsidiary services such as occasional creches, daily guardians, and evening "sitters in." As the provision to be made was a combination of measures, some of which were within the province of the local education authority and others within that of the Welfare authority, Councils were asked to arrange conferences between the two authorities, in consultation with the Ministry of Labour a'nd National Service, and to submit schemes for approval. It was stressed that the matter should be dealt with as one, of urgency, since the financial arrangements whereby the whole of the approved expenditure on war time nurseries was reimbursed by the Exchequer would come, to an end on the 31st March, 1946, after which date financial assistance by the Government would take the form of a grant of just under 50% of the costs, and the balance would be borne by the local authority. A report was submitted to the February meeting of the Child Welfare Committee, setting out the position in the Acton nurseries, where the total number of places provided accommodation for 258 children and there was an existing waiting list for a further 238 children. A certain number of children on the registers of the nurseries were residents of neighbouring boroughs, the mothers being employed in Acton, but it was decided that in view of the heavy expenditure falling on the local authority, the parents should be asked to find nursery accommodation in the boroughs where they resided. A proposal was submitted that the nurseries at Bollo Bridge Road, Horn Lane, and Friars Place Lane should be retained as such, and that "Longcot" and "The Maples" should be handed over to the local education authority to be, used as nursery schools. The owners of No. 1 Birkbeck Road (which had been used to accommodate the 0-2 group of the combined "Maples" and Birkbeck Nursery), had asked for its release from requisitioning in order that it might be put to its former use as a doctor's surgery, and it was felt that the Council should comply with this request. After further careful consideration, it was decided that the exclusion of children under 2 years of age from "Longcot," in the event of its transfer to the local education authority, would cause hardship in a number of cases, and it was eventually decided that the nursery should be retained. As this nursery was used by Acton and Chiswick mothers in about equal proportions, it was considered that the Brentford and Chiswick Council might reasonably be 19 expected to contribute a corresponding part of the net cost, and a financial agreement to that effect was concluded. The nursery position therefore, from the 1st April, 1946, was as follows: Bollo Bridge Road, Horn Lane, Friars Place Lane, and Longcot were retained as Day Nurseries. "The Maples" was transferred to the local education authority as a nursery school, while the 0-2 group from Birkbeck Road were dispersed among the remaining, four nurseries. The charges for admission were raised to 8/6d. per week, made up of l/6d. per day, Monday to Fridays, and 1/- for Saturdays. The following Table gives the average daily attendances at the Nurseries: Under 2. Over 2. Bollo Bridge Road 14.1 15.0 Horn Lane 19.2 26.4 Friars Place Lane 10.2 29.9 Longcot 13.3 25.7 Infectious Diseases. 701 cases of notifiable disease occurred in the Borough as compared with 845 in 1945. This is a smaller total due to the fact that there were only 281 cases of Measles as compared with 519 in 1945. There were no deaths from Diphtheria or Scarlet Fever, but 1 death from Measles and 2 from Pertussis. Two cases of food poisoning were notified, but the causal agent was not traced; investigations were carried out into the 12 cases of Dysentery notified. Diphtheria Immunisation. Immunisation was carried out as before along the lines indicated in previous reports. Advertisements were placed monthly in the local paper, giving times and places of inoculation clinics, and 20 posters were displayed in prominent places. In addition to this, the following routine was practised: (1) A notice was sent to the parent of each 6 months old child. (2) All Infant Welfare attenders were approached. (3) All children admitted to Day Nurseries were offered protection. (4) Health Visitors combed their districts for children who did not attend Welfares, and urged their protection. (5) Head Teachers gave forms of, consent to new school entrants. (6) Prior to school medical inspections, questionnaires were sent to each parent asking, inter alia, whether the child had been inoculated. If the answer were in the negative, a form of consent was sent to the parent. All immunised cases are followed up and, at the end of three years, each child is offered a boost dose. At the age of 11 years or over, this is preceded by a Schick test. All children under 5 who have not had the disease, are inoculated against Whooping Cough at the same time as they are inoculated against Diphtheria, i.e., they have three doses of protective material at monthly intervals. There were, 34 notified cases of Diphtheria, but of this number 12 were not confirmed at the. infectious diseases hospital. Of these non-confirmed cases, 7 children out of a possible 9 were immunised, but of the 3 adults none, had been immunised. Of the remaining 22 notifications, 15 of the children under 15 years had not been immunised, and 2 children aged 5 and 13 years respectively who had been immunised had mild attacks. Of the 5 over 15 years, none was known to have been immunised. There was 1 carrier who had been immunised and received treatment in hospital. 63.4% of the population under 5 years of age is now protected, and 70.5% of the population aged 5 to 141. Diphtheria Immunisations, 1946. Total number of under 5's. inoculated 863 Total number of over 5's inoculated 146 Re-inoculations after 3 years 824 Schick tests after 3 years—negative 175 positive 84 Primary Schick tests— negative 58 positive 76 21 CASES OF INFECTIOUS DISEASE NOTIFIED DURING THE YEAR 1946. Notifiable Disease. Cases notified in whole District. At Ages—Years. Ward Distribution. At all Ages Under 1 1 to 2 3 to 4 5 to 9 10 to 14 15 to 24 25 to 14 45 to 64 Over 64 North East North West South East South West Scarlet Fever 103 - 8 17 48 19 7 4 - - 22 17 14 50 Diphtheria 34 - 3 4 13 6 6 1 1 - 7 10 3 14 Pneumonia 76 1 - 1 9 4 9 14 21 17 26 16 6 28 Erysipelas 9 - - - - - - 2 5 2 2 2 - 5 Puerperal Pyrexia 2 - - - - - 1 1 — - - - 1 1 Dysentery 12 2 2 2 1 — 1 3 — 1 3 4 1 4 Tuberculosis (resp.) 104 - - - 1 3 26 46 25 3 35 30 19 20 Tuberculosis (non-resp.) 22 — 1 1 3 3 4 9 1 — 6 8 2 6 Measles 281 11 61 83 109 8 4 2 — — 101 47 47 86 Whooping Cough 48 6 9 9 20 3 — 1 — — 25 11 5 7 Opthalmia Neonatorum 4 4 - - - - - - - - 1 1 2 — Meningitis 3 2 - - - — — 1 — - 3 - - — Typhoid - - - - - - - - - - - - - - Poliomyelitis 1 — 1 - - - - - - - 1 - - - Food Poisoning 2 — — — — — 1 1 — — 1 1 — — TOTALS 701 29 84 117 204 46 59 85 53 23 233 147 100 221 22 Acton and Wembley Joint Hospital Report. 1946. Patients in Hospital January 1st, 1946 34 Patients admitted during 1946 349 Patients admitted during 1945 354 ADMISSIONS: S.F. Diph. Dysentery. C. Pox. C.S.M. Ery. Wh.C. Mumps Enteritis. Measles. D. & V. Rubella Suspected Typhoid. Acton 85 28 11 1 3 4 1 1 2 3 1 — 1 Wembley 143 24 3 1 6 3 10 2 1 8 — 2 1 Ealing — 1 - - - - - - - - - - - Military — 2 - - - - - - - - - - - 229 55 14 2 9 7 11 3 3 11 1 2 2 TOTAL—349. DISCHARGES: S.F. Diph. Dysentery. C. Pox. C.S.M. Ery. Wh.C. Mumps Enteritis Measles. D. & V. Rubella Suspected Typhoid. Acton 95 29 11 1 4 4 1 1 2 3 1 — 1 Wembley 154 22 3 1 4 3 8 2 1 8 — 2 1 Ealing — 1 — — — — — — — — — — — Military — 2 - - - - - - - - - - - 249 54 14 2 8 7 9 3 3 11 1 2 2 TOTAL—365. TRANSFERS: S. Fever. Diph. DEATHS: Diph. Wh.C. Meningitis Acton - 1 Acton 1 - - Wembley 9 1 Wembley 1 3 2 9 2 2 3 2 TOTAL—11. TOTAL—7. 23 Tuberculosis. Particulars of new cases and of deaths from the disease during 1946 are given below: 103 new cases of Pulmonary Tuberculosis and 23 cases of Non-Pulmonary Tuberculosis occurred during the year. There were 35 deaths from Pulmonary, and 5 deaths from Non-Pulmonary Tuberculosis during the, year. The following table gives the age incidence of new cases, of the disease in 1(546, and of deaths from the same cause. 24 TUBERCULOSIS Age Periods NEW CASES DEATHS Respiratory Non-Respiratory Respiratory Non-Respiratory Male Female Male Female Male Female Male Female 0— - - - - - - - - 1— - - - — - - - 1 5— - - 1 1 - - - - 15— 3 — 3 4 5 - - 1 25— 14 14 1 3 3 2 - 1 35— 20 10 2 4 3 3 - 1 45— 8 5 1 2 4 3 - - 55- 9 1 - 1 5 - 1 - 65 upwards 18 1 - - 5 2 - - 72 31 8 15 25 10 1 4 25 Statement of particulars appearing on the Register of cases of Tuberculosis for 1946. Pulmonary NonPulmonary Total (a) Number of cases of T.B. on the Register at the commencement of the year 1584 males 272 males 3422 1240 females 321 females (b) Number of cases notified for the first time during the year 56 males 10 males 106 29 females 11 females (c) Number of cases previously removed from the Register which have been restored thereto during the year - males - males 1 1 female - females (d) Number of cases added to the Register other than by notification 12 males - males 19 4 females 3 females (e) Number of cases removed from the Register during the year 46 males 1 male 78 22 females 9 females (f) Number of cases remaining on the Register at the end of the year 1611 males 281 males 3470 1252 females 326 females Scabies and Verminous Conditions. As in previous years, cases suffering from the above conditions have been referred to the Kensington Medicinal Baths for cleansing treatment. The number of cases and the number of families is again smaller than last year. 26 PATIENTS TREATED AT KENSINGTON BATHS FOR SCABIES—1946. Month. Total N.E. N.W. S.E. s.w. No. of families treated. January 19 9 2 — 8 7 February 27 2 4 11 10 13 March 19 7 6 5 1 12 April 24 10 4 2 8 11 May 23 4 8 7 4 10 June 23 11 9 1 2 9 July 11 9 — — 2 8 August 26 14 4 — 8 15 September 15 7 — 3 5 8 October 14 1 1 2 10 7 November 6 — 2 — 4 4 December 14 6 8 — — 8 TOTAL 221 80 48 31 62 112 PATIENTS TREATED AT KENSINGTON BATHS FOR VERMINOUS HEADS DURING 1946. Month. Total N.E. N.W. S.E. S.W. No. of families treated. January 3 2 1 - - 3 February 16 5 — — 11 9 March 3 — — — 3 1 April 2 — 2 — — 1 May 1 - 1 — — 1 June 8 1 4 — 3 6 July - - — — — — August 1 1 — — — 1 September 8 6 — — 2 4 October - - - - - - November 3 2 1 — — 2 December 6 1 — 1 4 3 TOTAL 51 18 9 1 23 31 PATIENTS TREATED AT KENSINGTON BATHS FOR BODY LICE-1946. Month. Total N.E. N.W. S.E. S.W. No. of families treated. May 2 — 1 — 1 2 TOTAL 2 - 1 — 1 2 27 Premature Infants. Total number notified—53. Born at Home—22 Born in Hospital—31 Nursed entirely at Home. Died in 24 hours. Survived 1 month. Died in 24 hours. Died between 1 day and 1 month. Survived 1 month. 20 1 19 6 3 22 Care of Illegitimate Children. During 1946, four mothers were sent to the Hostel under arrangements made with the County Council. HOUSING. I am indebted to the Chairman of the Housing and Town Planning Committees for the following extracts from a report on Housing, dated 6th May, 1947. In 1945, there were 3,500 applicants on the waiting list for houses in Acton, and in April 1947, there having been very few withdrawals, it is estimated that 4,500 families need proper accommodation in which to live. The Town Clerk has power to requisition certain premises for housing, and the position on 31st March, 1947, is set out below: Total number of dwellings requisitioned 1,000 (approx.) Number of families rehoused 1,272 Number of dwellings now held under requisition 800 The lower figure of 800 is. due to the release of housing in exceptional circumstances. The, Council have provided 3 hostels in which each family has separate bedrooms, but living rooms and kitchen are shared, although in nearly all cases each housewife has her own gas stove. The number of houses rebuilt will be seen in the, figures supplied by the Borough Engineer. 28 It is intended to erect 250 prefabricated houses on land in the Borough, and of this number 83 have been erected and are occupied. It is hoped that the remainder will be occupied before the end of the year. The 250 are sited as follows: On bombed sites 58 On private open space 50 In Public Parks 33 On land which will become public open space at the end of the life of the temporary dwellings 109 250 The Town Council have decided that any vacant piece of land suitable for housing shall be acquired in the Borough. Fortunately, the Council acquired 10 acres of land in The Vale, and a contract for the erection of, 318 flats was let in 1946. This scheme provides for: 30 One roomed flats (for old people). 98 Three roomed flats. 24 Four roomed flats (for 5 people). 96 Four roomed flats (for 6 people). 70 Five roomed flats. In addition there will be a community centre for social gatherings, a laundry for the use of the tenants fitted out with the latest appliances for washing and drying clothes, a tenants' workshop, and a mortuary. The Town Council have decided that any vacant piece of land suitable for housing shall be acquired in the Borough. Fortunately, the Council acquired 10 acres of land in The Vale, and a contract for the erection, of, 318 flats was let in 1946. This scheme provides for: 30 One roomed flats (for old people). 98 Three roomed flats. 24 Four roomed flats (for 5 people). 96 Four roomed flats (for 6 people). 70 Five roomed flats. In addition there will be a community centre for social gatherings, a laundry for the use of the tenants fitted out with the latest appliances for washing and drying clothes, a tenants' workshop, and a mortuary. Preliminary plans for the development of the first seven-sites of the list set out below, have been approved: Site. Net area (acres) No. of flats. Total 1 2 3 4 bedrooms. Bromley Lodge, Lynton Road 0.90 - 6 12 - 18 Bollo Bridge Road 0.84 4 14 18 2 38 Park Road North (E. side) 0.19 2 7 3 — 12 Horn Lane—Shalimar Gardens 0.52 — 3 17 4 24 Oldfield Estate, The Vale 1.99 6 20 32 — 58 Oakley Avenue 0.7'2 2 4 12 — 18 Esmond Road and Ramillies Road 1.05 1 11 12 — 30 Pierrepoint and Creswick Roads 0.50 *18 Avenue Crescent & Heathfield Rd. 1.10 12 378 Uxbridge Road 0.36 8 * Total estimated. 29 The Council also intends rehousing persons outside the Borough at Hemel Hempstead, which Borough concurs in the Acton Borough Council buying enough land to house 1,000 families. The Acton, Ealing, Hayes, Harlington and Southall Councils have, made representation to the Ministry of Health for release of land occupied by a government department, and this would give Acton a share sufficient for land for 600 families. Acton recently heard of land in the Ruislip and Northwood Urban District Council area, near to the G.W.R. Station, and from enquiries made, there, seems every prospect of finding sites for 600 houses. A Town Planning Scheme has been prepared for the redevelopment of Acton, but I do not propose here to describe this scheme in detail. Acton has a big problem of rehousing and from the information set out above it appears, that every effort is being made to remedy the conditions now existing. Overcrowding exists as it did before the war, the. loss of, houses destroyed during the war has not made matters easier, but as the schemes, mentioned are, put into effect housing conditions will improve., The Borough Engineer has submitted the following information, showing the amount of work carried out on houses damaged by enemy action. (a) Dwellings slightly damaged but not uninhabitable 19,660 (This figure is the number of repair jobs carried out, including cases where, a property was repaired several times). (b) Dwellings rendered temporarily uninhabitable for short periods 225 (c) Dwellings seriously damaged and uninhabitable for substantial periods 813 (d) Dwellings demolished by enemy action 482 (e) No. of destroyed dwellings rebuilt by 31.3.47 13 (f) Number of destroyed dwellings in course of re-erection at 31.3.47 141 Food and Drugs Act, 1938. The Middlesex County Council are the, sampling authority in this area, and the Chief. Officer of the Public Control Department 30 has supplied the figures appended below of samples taken during the year: Article. Taken. Adulterated. Milk 153 4 Aspirin 1 — Banana Slab 1 — Bicarbonate of Soda 1 — Black Pepper 1 — Boracic Ointment 1 — Brimstone and Treacle 1 — Browning 1 — Coffee 1 — Coffee and Chicory Essence 1 — Curry 1 — Fish Paste 1 — Gin 8 - Jam 1 — Marmalade 1 — Mayonnaise 1 — Meat Paste 1 — Meat Savouries 1 — Meats, cooked 2 — Mixed Spice 1 — Mustard l — Pimento 1 — Rum 2 — Salad dressing 1 — Sausages 7 — Sausages, cooked 9 — Sausage meat 7 — Vinegar (non brewed) 1 — Whiskoda 1 — Whisky 7 — Zinc and Castor Oil Cream 1 - 218 4 On the, adulterated samples of milk, one contained 10% of added water for which legal proceedings were instituted and the defendant fined £5 with 15/- costs, one was 12% deficient in fat for which an official caution was issued, and no action was taken in respect of the other two samples which contained added water to the extent of 2% and 2.8% respectively. 31 SECTION C. SANITARY CIRCUMSTANCES OF THE AREA. Water Supply. The Borough is supplied with water by the Metropolitan Water Board. The supply has been satisfactory and the whole of the population is supplied from the public water mains direct to each house. 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 amount of, house, refuse collected by the Council in 1946 was 17,255 tons, of which 2,040 tons was salvage. Trade refuse collected amounted to 1,289 tons, and a total weight of 13,119 tons was burned by the Destructor. Rodent Control. Work of investigation and inspection, followed by systematic treatment of premises as soon as evidence of rats is noted, has resulted in freedom from serious infestation of the Borough. Early destruction of the rodents and measures of rat-proofing where necessary have, been so effective that loss of foodstuffs or damage to materials or structures are rarely recorded. In connection with treatments carried out by the Council, 1,250 visits have been made, 945 to business premises and 305 to dwelling houses, in addition to inspections by the Sanitary Inspectors as. noted elsewhere. Inspection of Factories. There are 570 power factories and 44 non-power factories within the Borough, and the Sanitary Inspectors have carried out inspection to ensure that the appropriate provisions of the Factories Act, 1937 and the Sanitary Accommodation Regulations, 1938 are complied with. In relation to Factories also, the hygiene of Canteens, and questions as to fitness of food therein for human consumption has received full attention as necessary. 32 Sanitary Inspection of the Area. The following Table includes the tabular statement furnished by the Chief Sanitary Inspector under Article 27 (18) of the Sanitary Officers (Outside London) Regulations, 1935. Tabular Statement of Inspections and Details of Work carried out by Sanitary Inspectors. Number of Inspections made and Action taken: Total number of dwelling houses inspected for housing defects (under Public Health or Housing Acts) 3,759 (1) Dealt with by service of Informal Notice 1,099 (2) Dealt with by service of Statutory Notice, under Section 9, Housing Act 1936 572 (3) Dealt with by service of Statutory Notice under Public Health Acts 180 (4) No defects found 41 Premises (other than defective dwelling houses) inspected for nuisances and miscellaneous defects 2,305 (1) Dealt with by service of informal notice 115 (2) Dealt with by service of Statutory Notice, under Public Health, etc. Reinspections subsequent to service of. Notice 12,486 Inspections after notification of Infectious Disease 270 Premises inspected under Rats & Mice (Destruction) Act, 1919, and Infestation Order, 1943 620 Details of work carried out: The insufficiency of housing accommodation in the Borough has emphasized the need for preserving every available type of dwelling against what may be, general dilapidation and the war damage which was not effectively remedied by first-aid repairs. Many dwellings which but for the present emergency might have been " closed," have, been given a new " lease of life " as the result of compliance with the Council's requirements under the Housing Act 1936. The. condition of many of the older properties is reflected in the figures in the following table, which has reference to defective damp proof courses, roofs, and rainwater gutterings and 33 downpipes. The Sanitary Inspectors have devoted much time to the eradication of dry rot from dwelling houses and other buildings, this work entailing the expending of extensive materials and labour. Sanitary dustbins provided 453 Yards paved or yard paving required 18 Insanitary forecourts remedied 6 Defective drains repaired or reconstructed 84 Defective soil pipes and ventilating shafts repaired or renewed 47 Defective fresh air inlets repaired or renewed 12 Defective gullies removed and replaced by new 50 Rainwater downpipes disconnected from drain 9 Dishing and curb to gullies repaired and new gratings fixed 31 Defective W.C. pans and traps removed and replaced by new 87 Defective W.C. flushing apparatus repaired or new fixed 119 Defective W.C. seats repaired or new fixed 86 Defective flush pipe connections repaired 39 Insanitary sinks removed or new fixed 57 Sink waste pipes repaired or trapped 111 Insanitary wall surface over sinks remedied 71 Ventilated food cupboards provided 23 Drinking water cisterns cleansed 15 Defective covers to drinking water cisterns repaired or new fixed 21 Insanitary sites beneath floors concreted 7 Spaces beneath floors ventilated 45 Dampness in walls from defective damp-proof course remedied 378 Dampness from defective roof, rainwater gutterings, etc., remedied 2,088 Defective plastering repaired (number of rooms) 1,783 Rooms where dirty walls and ceilings have been cleansed and redecorated 1,867 Defective floors repaired 419 Defective or dangerous stairs repaired 61 Defective doors and windows repaired 613 Defective washing coppers repaired 24 Coal cupboards provided or repaired 3 Accumulations of offensive matter removed 5 Drains unstopped and cleansed 121 Drains tested, exposed for examination, etc. 207 Smoke observations taken 13 Smoke nuisances abated on service of notice - Miscellaneous nuisances abated 311 Notifications of waste of water sent to Metropolitan Water Board 88 New W.C. apartments 7 34 Rent Restriction Act. Certificates granted to occupiers 13 Certificates (clearance) granted to owners 3 Premises under Periodical Inspection. Factories and Workshops 601 Piggeries 4 Rag Dealers 2 Mews 4 Public House Urinals 31 Hairdressers 43 School Buildings: Elementary 11, Secondary 2, Technical 2, Special (M.,D.) 1, Private 3. 19 Butchers' Shops 37 Fish Shops 37 Fish and Chip Shops 16 Greengrocers' Shops 87 Premises where food is manufactured or prepared 43 Grocery and Provision Shops 135 Dairies 13 Bakehouses 25 Slaughterhouses 2 Restaurants, Cafes, etc. 129 Premises where ice-cream is manufactured 12 Food Inspection. There was a considerable diminution in the amount of. unfit food dealt with in the year as compared with the previous years, due largely to the absence of direct enemy action. Included in the foodstuff surrendered were 23,012 containers of preserved meat, fish, milk, fruit, vegetables, etc., a large quantity of which was salvaged in accordance with the scheme of salvage, instituted by the Ministry of Food. In addition to the above-mentioned unfit foods, a very large quantity of meat and milk has been received in the Borough for manufacturing purposes, and has been dealt with under the supervision of the Sanitary Inspectors, each of, whom is a certificated Meat and other foods Inspector. 35 Milk. The thirteen dairies within the Borough, subject to regular inspection, have been maintained in a hygienic condition, and in no case has there been cause for complaint as to any milk distributed therefrom. At the Pasteurising and bottling depot in Bollo Lane, milk has been processed to full capacity throughout the year, and no cause for complaint has been registered. Including the samples of milk at the above depot, 144 samples have been taken, and on submission to the prescribed phosphatase test, in each case the milk was proved to have been properly pasteurised. Water. Five samples of water were taken and submitted for examination, three as to bacteriological and two as to chemical content, and in every case the, result showed the sample to be satisfactory. Ice-cream. During the year 23 samples were taken of ice-cream sold within the Borough, and the. results of examination by the pathologist indicated in certain cases the need for more care in handling the product. During inspection of, premises and plant and in conversation with manufacturers, proper and thorough cleansing of the plant used in processing and strict attention to personal hygiene were stressed. The reduction in bacterial content of the product in successive examinations is consistent with improvements in the general conditions of plant and premises and indicates that special supervision in this trade is warranted. Diseases of Animals. In the course of the year there occurred outside the Borough two outbreaks of Foot and Mouth Disease, in respect of which Acton was included in the Schedules of Infected Areas, and 271 licences were granted by this Local Authority for the removal of pigs into the borough for slaughter. 36 Slaughterhouses. The slaughterhouses in Atlas Road and Hanbury Road have been in commission throughout the year, and the, carcase and offal of every animal slaughtered have been examined as to their fitness for human food. The increasing demand for horseflesh to supplement the meat ration is revealed in the number of horses slaughtered —almost two thousand more than in the previous year and over ten times the number slaughtered in 1942. The incidence of disease in horses, is extremely small as compared with bovines and pigs, and the, relative amount of horseflesh condemned in the slaughterhouses is correspondingly small. No case of tuberculosis in a horse was noted during the year. Tables showing details of meat and offal surrendered following examination by the Sanitary Inspectors will be found on the two succeeding pages. Pigs. Horses. 1. Number killed 68,811 5,830 2. No. inspected 68,811 5,830 3. All diseases except T.B.:— Whole carcases condemned 41 10 Carcases of which some part or organ was condemned 1,218 943 Percentage of number inspected affected with disease other than T.B. 1.83% 16.34% 4. T.B. only:— Whole carcases condemned 65 — Carcases of which some part or organ was condemned 1,041 Percentage of number inspected affected with T.B. 1.61% — 5. Total weight of meat arid offal surrendered: Pigs—19 tons 17 cwt. Horses—9 tons 18 cwt. 37 NUMBER OF PIGS' CARCASES INSPECTED DURING 1946 WITH ANALYSIS OF SURRENDERS ON ACCOUNT OF DISEASE. Date Pigs Slaughtered PARTS CONDEMNED. Carcases Heads Collars Fore Qtrs. Hind Qtrs. Legs Skins Hocks Pieces of of Pork Plucks (Lungs, Livers, Hearts) Wt. of Mesenteries, Stomachs & Intestines January 6154 11 102 - - - 28 3 2 16 lbs. 130 840 lbs. February 5030 6 65 — - 2 25 1 2 13 lbs. 83 760 lbs. March 5844 12 65 — - — 27 1 — — 96 810 lbs. April 7013 11 141 — - 2 232 — — 27 lbs. 199 630 lbs. May 6090 8 125 — - 3 37 3 - 87 lbs. 122 870 lbs. June 5998 12 79 — - 1 13 8 5 11 lbs. 90 860 lbs. July 7708 10 142 2 - — 17 3 2 11 lbs. 178 710 lbs. August 5122 12 66 — 2 — 15 2 — 21 lbs. 79 690 lbs. September 5170 8 82 — — — 16 1 2 - 154 740 lbs. October 4945 6 68 1 — — 19 6 1 14 lbs. 96 890 lbs. November 4164 8 80 — — — 8 - 1 9 lbs. 106 750 lbs. December 4673 2 56 — — — 17 2 — 19 lbs. 62 730 lbs. Total 68,811 106 1071 3 2 8 454 30 15 229 lbs. 1355 9280 lbs. ' ' . 39 ANNUAL REPORT of the School Medical Officer FOR THE YEAR 1946. To the Chairman and Members of the School Health Committee. Ladies and Gentlemen, The. following report is submitted giving details of the work carried out during 1946. The Education Act came into force in 1945 and since that date a considerable amount of time has been spent correlating the work of the School Health Services and endeavouring to provide a smooth running service, since the administrative centre is established in the Offices of, the, Middlesex County Council. I think on the whole there has been developed a smooth running and yet flexible administration. Every two months, the County Medical Officer of Health and his Representative meets the School Medical Officers of, Middlesex Areas to discuss the procedure of new circulars, policy, etc. Clinic accommodation is at 45 Avenue Road, Acton, and the premises are inadequate and out of date for the great amount of work carried out there,. All Clinics were open throughout the year and figures are given in the report. During the year the number of children on the, school roll was. 6,596. Provision still continues to be made for the admission of children from the. age of 3 years where such accommodation can be made available. Maples Nursery has now been taken over by the local Education Authority and is functioning as a nursery school attached to the Priory Infants' School. 40 Under the School Meals Service, the number of, meals provided in '1946 was 626,830 as compared with 402,600 in 1945. Milk has been supplied free to all school children since August 1st, 1946. There was not an epidemic of any infectious disease in 1945, only 56 cases of Scarlet Fever and 12 cases of Diphtheria being notified as compared with 43 and 8 respectively in 1945. The percentage of children immunised against Diphtheria is shown for each school. The Ear and Nose Clinic has expanded considerably during the year. The Clinic held especially for nasal and post-nasal catarrh treatment has increased from 67 cases in 1945 to 189 cases in 1946, whilst the number of cases treated for ear trouble was 120 as compared with 46 in 1945. Twelve children were sent for Audiometric tests on account of deafness. Reports of the work carried out by the School Oculist, Dental Surgeons and Speech Therapist are included. The latter is, in my opinion, a very valuable part of the school health service. During the latter part of the year, a part time School Nurse was appointed to carry out the work of the Minor Ailment Treatment Centre, thus relieving a Health Visitor who can be better occupied in carrying out the duties for which she was appointed. Before ending this report, one must thank all the staff of the School Health Service for their co-operation and loyal support throughout the year. Your obedient servant, GEORGE E. B. PAYNE. SCHOOL MEALS AND MILK- 1946. (1) Total number of meals supplied 626, 830 (2) Total number of free meals supplied 59, 344 (3) Ordinary Schools. Total number of paid meals supplied 624, 775 Total number of free meals supplied 58, 890 41 (4) Special School. Total number of paid meals supplied 2,055 Total number of free meals supplied 454 (5) Number of bottles of free milk supplied from January 1st, 1946 to August 1st, 1946 Ordinary Schools 65,791 Special School 1,116 INFECTIOUS DISEASES. Scarlet Fever 56 cases were reported during 1946 in the school population, the distribution being as follows:- Acton Wells 2 Beaumont Park 1 Berrymede 18 Derwentwater 7 Central 1 John Perryn 4 Priory 10 Roman Catholic 5 Rothschild 6 Southfield 2 West Acton Diphtheria. 12 cases were reported in 1946 in the schools, the distribution being as follows:- Acton Wells 4 Rothschild 1 Berrymede 4 Derwentwater 1 Priory 2 42 Percentages of Children Inoculated in School. Acton Wells Secondary Modern 70.60% Acton Wells Primary 82.58% Beaumont Park Primary 73.59% Berrymede Boys' Primary 65% Berrymede Girls' Primary 58.88% Berrymede Infants' 61.38% Acton Central Secondary Modern 72.67% Derwentwater Primary 65.32% Derwentwater Infants' 65.89% John Perryn Secondary Modern 66.67% John Perryn Primary 84.69% Priory Boys' Secondary Modern 63.46% Priory Girls' Secondary Modern 55.12% Priory Infants' 73.08% Rothschild 80% Southfield Primary 79.11% Southfield Infants' 76.78% St. Mary's R.C., Turnham Green 67.66% West Acton 78.38% 43 INOCULATIONS, 1946. School. Trt. commenced 1945 Primary Schick. Completed 1946. Doses. 1946 Doses. Schick tested after 3 years. " Boost " Dose. 1st. 2nd. 3rd. Pos. Neg. 2nd. 3rd. Pos. Neg. 1st. 2nd. 3rd. Acton Wells Upper _ 1 - 1 13 9 8 10 28 3 _ _ Acton Wells Lower 7 9 2 4 19 15 12 6 11 57 3 Berrymede Boys 6 10 2 2 13 10 4 6 6 32 — — Berrymede Girls 4 4 2 3 7 6 4 4 8 27 1 — Berrymede Infants 3 1 2 4 34 23 14 — 2 55 2 Beaumont Park 9 3 — 1 18 14 11 2 12 66 Central 1 1 2 3 4 4 2 3 19 Derwentwater Juniors 2 1 1 2 13 13 5 7 9 45 Derwentwater Infants 1 1 2 3 14 10 9 1 — 43 — _ John Perryn Lower 4 2 — — 15 15 12 4 2 79 2 — John Perryn Upper 4 8 — — 6 4 2 4 11 3 1 — Priory Boys 6 1 1 1 12 9 9 14 14 —: — — Priory Girls — 4 2 2 4 3 2 7 12 1 — — Priory Infants — 1 4 4 7 7 6 1 3 46 2 — Southfield Junior 7 2 — — 9 7 3 5 5 58 7 - Southfield Infants 2 — — 1 8 8 8 4 - 37 1 - Rothschild 2 1 — — 14 8 8 2 3 49 - - St. Mary's R.C. 12 5 4 3 23 17 11 2 15 32 3 - West Acton 1 1 — — 2 2 2 — - 25 - - Other Schools 5 2 _ _ 8 6 4 2 15 29 2 — TOTALS 76 58 24 34 244 191 136 84 175 687 24 — 44 DISTRIBUTION OF SCABIES. Acton Wells. Rosebank Gardens Home Treatment. Leamington Park Baths „ Wales Farm Road Baths „ 2 children. Wales Farm Road Baths „ Beaumont Park. Beaumont Road Baths Treatment. 2 children. Beaumont Road Baths „ Somerset Road Baths „ Evelyn Road Baths „ Bridgman Road Baths „ Cunnington Street Baths „ Gladstone Road Baths „ Fletcher Road Baths „ Berrymede. †Ramsay Road Baths Treatment. 2 children. Park Road North Baths „ †† Junction Road Baths „ 4 children. Shaftesbury Road Baths „ Stirling Road Baths „ 2 children. Bollo Bridge Road Baths „ Berrymede Gardens Baths „ Mill Hill Terrace Baths „ Park Road North Baths „ Avenue Road Baths „ ††Meon Road Baths „ Shaftesbury Road Baths „ 2 children. Meon Road Baths „ 2 children. Stanley Road Baths „ Acton Lane Baths „ Winchester Street Baths „ Shaftesbury Road Baths „ 3 children. Central. Meon Road Baths Treatment. Stirling Road Baths „ 2 children. County. Ramsay Road Baths Treatment. Bollo Lane Baths „ Derwentwater. Creffield Road Home Treatment. Birkbeck Road Baths „ 2 children. Summerlands Avenue Baths „ Cumberland Road Baths „ Alfred Road Baths „ 2 children. Chaucer Road Baths „ 5 children. Essex Road Baths „ † Denotes a return case. 45 DISTRIBUTION OF SCABIES-Contd. John Perryn. †Mashie Road Baths Treatment. Brassie Avenue Baths „ The Fairway Baths „ 2 children. Long Drive Baths „ 5 children. †The Fairway Baths „ 3 children. Strelley Way Baths „ First Avenue Baths „ Priory. Gladstone Road Baths Treatment. Avenue Road Baths „ Mill Hill Terrace Baths „ 2 children. Park Road North Baths „ Mill Hill Road Baths „ Newton Avenue Baths „ Acton Lane Baths „ Goldsmith Road Baths „ Colville Road Baths „ Essex Road Baths „ Chaucer Road Baths „ Acton Lane Baths „ The Vale Baths „ Essex Road Baths „ St. Mary's R.C. Acton Lane Baths Treatment. Beaconsfield Road Baths „ 2 children. Friary Road Baths „ Rothschild. Rothschild Road Baths Treatment. Southfield. Brookfield Road Baths Treatment. 3 children. West Acton. Canada Crescent Baths Treatment. †Denotes a return case. In all 101 cases of scabies received treatment through the School Clinics. of this number 7 received treatment twice. 46 EAR AND NOSE CLINIC. Ear Treatment only. Number attending with Otorrhoea 38 „ „ „ Boils 5 „ „ „ Mastoid swelling — „ „ „ Earache 11 „ Wax_ 49 „ „ „ other Ear diseases „ referred, but did not attend 17 120 (24 cured, 3 better, '11 failed for further treatment). Nose Treatment. Nasal and post-nasal catarrh. Number cured 76 „ improved 55 „ complicated by other conditions — „ referred to Hospital 1 „ who did not report for examination after treatment 20 „ referred, but not did not attend 22 „ who failed to complete treatment "14 „ continuing treatment 1 189 Nose and Ear Treatment simultaneously. Cases suffering from Otorrhoea and post nasal Catarrh. Number cured 6 „ referred to Specialist — „ who ceased to attend " 1 „ irregular in attendance (not seen after treatment) 1 „ continuing treatment — „ referred to Hospital — 8 Number of children sent for Audiometric, examination 12 47 REPORT OF THE SCHOOL OCULIST. There has been a good attendance of children at the Eye Clinic. During the, year 1946 the following numbers of children were examined: Elementary and Secondary Schools 380 From Infant Welfare Clinics 29 Spectacles were prescribed in 272 cases. One child was referred for orthopic, treatment and one for operation for squint. One child was referred to a myope school. (Signed) V. E. Brander. REPORT OF SCHOOL DENTAL SURGEON. Regarding the general dental condition of the children a definite improvement is to be seen in the lowest age groups, compared with pre-war standards. This was, perhaps, more noticeable to people returning to civil life from the forces (as I did in February of this year) and one's first reaction was to give credit largely to the extra milk, fruit juices., cod liver oil, etc. supplied. However, a very similar improvement took place during and immediately after the 1914-18 war, when these foods were not available in the same way. It will, therefore, be interesting to see if, and for how much longer the improvement is maintained this time. Reduction in the amount of sweets, cakes, etc., probably also has its effect. The figures for treatment show an increase on last year, though owing to difficulties of accommodation and the unavoidable, absence of staff, this was less than it otherwise would have been. The percentage of acceptance of treatment has risen from 47% to over 65.9% this year. Though this is still low, it is a good move in the right direction. The increase in acceptance rate for Maternity and Child Welfare cases was from 50% to 77%. One of our greatest problems is the number of cases requiring orthodontic treatment. Unfortunately, owing to the length of waiting lists, the orthodontic specialist has been unable to accept more new cases since June. 48 One of the chief causes of irregularity is the too early loss of temporary teeth because of decay. To minimise this, every effort is being made, consistent with keeping enough time for dealing with permanent teeth, to preserve these teeth until the natural time of shedding. From the latter part of this year increasing use has been made of the treatment, after suitable preparation, with silver nitrate for teeth, unsuitable for actual fillings. This, of course, takes time, though a greater number of teeth per visit can be dealt with so that there is less danger of encroaching on time devoted to the conservation of the permanent dentition. Dental Report. Maternity and Child Welfare (1946). No. Mothers Examined 258 No. Mothers Referred 255 No. Children Examined 75 No. Children Referred 70 No. Mothers Treated 160 No. Children Treated 87 No. Attendances-Mothers 677 Children 150 Permanent Teeth-Fillings 454 Extractions 361 Temporary Teeth-Fillings 72 Extractions 19 Anaesthetics-General (a) Mothers 99 (b) Children 19 Local 29 Dressings-Mothers 182 Children 22 Scale and Polish-Mothers 133 Children 1 No. Dental Plates supplied 54 49 SPEECH THERAPY REPORT (1946). During 1946 a total of 48 children have attended for Speech Therapy. Of these:— 11 have been discharged cured, the follow-up after 3 months having shown, in each case, that progress had been maintained. 2 were given a provisional discharge, but the follow-up showed that a further period of treatment is desirable. 7 have been provisionally discharged cured, but the necessary period for ratification has not yet elapsed. 4 left school, much improved. 3 were discharged, improved. 4 were discharged for irregular attendance. 1 left the district. 1 left at parent's request. The remaining 15 who require a further period of treatment are all making satisfactory progress. The 2, who, after the provisional discharge are found to require further treatment will be re-admitted in January. The 3 on the waiting list will also receive treatment. In the course of the year, 4 parents have, failed to attend for preliminary interviews. 2 others attended for interviews, but stated that they did not wish their children to receive regular treatment. Eileen Richnell. SPECIAL SCHOOL. The School for the educationally retarded *was open for the whole of 1946, and at the end of, the year 21 children were on the roll. During the year 11 new cases were admitted. 50 EXCEPTIONAL CHILDREN. Defect. In spital. Residential Special or O.A. School. Ordinary Elementary School. Evacuated. At Home. Total Tuberculosis l - 10 - 2 13 Delicate - 2 20 - 2 24 Asthma - 1 25 - — 26 Rheumatism l — 15 - — 16 Perthe's Disease 2 — 2 - — 4 Crippled 1 — 5 - 3 9 Epilepsy - 3 3 - 2 8 Cretinism - — 1 - — 1 Partially Deaf and Deaf & Dumb - 9 - - - 9 Blind and Partially Blind - 3 - 1 4 Imbecile - 5 - - 7 12 Maladjusted - 4 1 — — 5 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 62 Beaumont Park 55 Berrymede 66 Derwentwater 51 John Perryn 110 Priory 90 Roman Catholic 8 Rothschild 10 Southfield 72 West Acton 3 Special 6 County 3 Other Schools 23 559 51 MEDICAL INSPECTION RETURNS. TABLE I. A.- Routine Medical Inspections. Number of inspections in the prescribed groups:— Entrants 963 Second Age Group 784 Third Age Group 895 Total 2,642 Number of other routine inspections — Grand Total 9,642 B.—Other Inspections. Number of Special Inspections and Re-Inspections 1,545 TABLE II. Classification of the Nutrition of Children Inspected during the year in the Routine Age Groups. Age Groups. Number o Children Inspected A. B. C. D. f (Excellent) (Normal) (Slightly subnormal) (Bad) . No, % No. % No. % No. % Entrants 903 229 23.8 622 64.6 112 11.6 - Second Age Group 784 173 22.1 510 65.1 101 12.8 — - Leavers 895 208 23.2 621 69.4 65 7.3 1 1 TABLE III. Group I.—Treatment of Minor Ailments (excluding uncleanliness). Total number of defects treated or under treatment during the year under the Authority's Scheme 2,684 Group II.—Treatment of Defective Vision and Squint. Errors of refraction, including Squint. (Under the Authority's Scheme) 380 Other defect or disease of the eyes, excluding those recorded in Group I. 1 Total 381 Numbers of children for whom spectacles were (a) Prescribed 243 (b) Obtained 243 52 Group III.-Treatment of Defects of Nose and Throat. Received Operative Treatment 35 Received other forms of Treatment 196 Total number treated 231 Annual Dental Report, 1946 School Children. TABLE IV. No. Inspected— Routine age groups 2,471 Specials 784 3,255 No. referred for Treatment 2,477 No. Treated 1,634 No. Attendances for Treatment 4,237 Half-days devoted to:— Inspection 33 Treatment 717 Total 750 Fillings:— Permanent Teeth 2,349 Temporary Teeth 1,134 Total 3,483 Extractions:— Permanent Teeth 259 Temporary Teeth 1,615 Total 1,874 General Anaesthetics for extractions 841 Other Operations:— Permanent Teeth 832 Temporary Teeth 548 I Total 1,380 TABLE V. Verminous Conditions. (1). Total number of examinations of pupils in the Schools by School Nurses or other authorised persons 14,873 (2) Number of individual pupils found unclean 524 53 AVERAGE HEIGHTS AND WEIGHTS—ENTRANTS. School. BOYS. Total No. Seen. 2 YEARS 3 YEARS 4 YEARS 5 YEARS 6 YEARS 7 YEARS No. seen H. ins. W. lbs. No. seen H. ins. W. lbs. No. seen H. ins. W. lbs. No. seen H. ins. W. lbs. No. seen H. ins. W. lbs. No. seen H. ins. W. lbs. Acton Wells 32 1 45 43.75 16 44.29 43.01 6 46.84 49.5 9 49.44 04.91 Beaumont Park 35 13 39.55 36.69 8 40.46 37.37 8 43.53 42.28 4 46.31 46.25 2 47 52.5 Berrymede 64 19 38 35.42 16 40.4 38.53 21 42.75 42.9 6 46.91 49.62 2 45 50.37 Derwentwater 44 1 37.5 34 4 41 37.87 26 43.59 44.26 10 45.5 47.9 3 46.83 51.58 John Perryn 87 23 39.06 36.01 28 41.55 39.69 15 43.36 41.63 12 45.93 48.18 9 47.67 51.66 Priory 66 7 38.25 36.03 15 41.35 39.61 31 43.19 42.16 11 46.34 48.89 2 47.75 55.25 Maples 23 10 34.42 29.5 9 38.08 33.3 4 41.12 38.25 Roman Catholic 11 4 40.93 39.06 2 43.75 41 3 47.41 53.41 2 50.75 52.87 Rothschild 37 12 37.87 36.5 6 40.66 39.33 12 42.79 42.25 5 44.6 47.35 2 46.25 47.87 Southfield 51 4 38.12 34.87 11 42.77 41.43 27 43.92 42.89 3 45.91 45.08 6 48.92 54.88 West Acton 42 1 39.25 34.5 12 43.56 43.2 14 44.67 44.78 6 46 46.79 9 50.03 56.55 492 10 34.42 29.5 89 38.52 35.68 109 41.54 39.77 172 43.54 12.93 66 46.1 48.6 46 48.52 53.77 GIRLS. Acton Wells 29 2 42.65 40.12 18 43.73 41.82 6 47.6 49.91 3 49.66 60.58 Beaumont Park 28 4 39 36 7 42.21 39.85 13 43 40.94 2 46 49.25 2 49.62 55.19 Berrvmede f9 15 37.66 34.37 19 40.01 37.63 23 41.61 38.75 9 46.08 46.13 3 47.66 54.41 Derwentwater 54 1 41 39.75 31 43.46 43.05 15 44.31 45.43 7 46.89 51.57 John Perryn 83 21 37.97 33.51 23 41.33 39.76 23 43.41 4-2.73 9 47.13 49.44 7 46.78 52.5 Priory 75 4 39 33.62 23 40.77 39.25 34 42.75 41.46 10 45.07 45.57 4 46.81 49.31 Maples 15 4 34.68 29.75 5 38.55 33.65 6 42.33 41.91 Roman Catholic 10 1 40.25 34 4 43.18 38.43 1 45.5 43.25 4 46.56 44.62 Rothschild 25 3 38.16 36.41 8 39.28 36.46 12 42.06 40.2 2 44.87 47.37 Southfield 46 2 39.83 37.75 13 42.21 40.55 18 43.72 42.12 9 46.38 48.05 3 47.41 47.25 West Acton 37 9 41.61 38.41 15 43.53 41.05 4 45.5 47 9 48.62 52.97 471 4 34.68 29.75 55 38.2 34.33 112 41.09 39.12 191 43.04 41.43 67 45.73 47.07 42 47.62 51.85 54 AVERAGE HEIGHTS AND WEIGHTS—INTERMEDIATES. School. BOYS. Total No. Seen. 8 Yrs. 9 Yrs. 10 Yrs. 11 Yrs. No. seen. Ht„ ins. Wt. lbs. No. seen. Ht. ins. Wt. lbs. No. seen. Ht. ins. Wt. lbs. No. seen. Ht. ins. Wt. lbs. Acton Wells 58 45 50.07 56.47 1 54.75 64.75 9 55.5 71.11 3 52.16 70.41 Berrymede 03 00 40.44 57.13 3 51.66 61.58 Derwentwater 70 66 50.18 57.54 4 52.31 65.12 John Perryn 44 4 2 50.36 58.9 1 51.5 56.9 1 51.25 57 Rothschild 60 54 49.54 57.4'2 4 51.56 72 2 53.25 61.87 Southfield 50 55 49.9 58.3 2 50.12 56.5 1 51 65.5 1 53 68.5 Roman Catholic 17 17 51.07 57.64 401 369 49.91 57.55 15 51.8 64.5 13 54.4 68.17 4 52.37 69.93 GIRLS. Acton Wells 40 35 50.39 57.41 3 51.16 58.75 8 55.18 70.93 3 56.5 79 Beaumont Park 40 36 49.79 56.15 4 53 66.31 Berrymede 99 93 49.51 56.66 3 50.08 58.08 3 55.25 74.33 Derwentwater 60 67 49.76 56.23 2 49.37 49.25 John Perryn 61 57 50.02 56.22 4 50.82 61.87 Southfield 48 43 49.41 59.36 3 49.41 57 1 52 72 1 53 71.5 Roman Catholic 17 17 50.66 55.79 383 348 49.8 56.82 19 50.84 59.61 12 54.93 71.87 4 55.62 77.12 55 AVERAGE HEIGHTS AND WEIGHTS—LEAVERS. School. BOYS Total No. Seen. 12 YEARS. 13 YEARS. 14 YEARS. No. seen. Ht. ins. Wt. lbs. No. seen. Ht. ins. Wt. lbs. No. seen. Ht. ins. Wt. lbs. Acton Wells 36 1 58 81.5 34 60.24 92.18 1 57. 93.5 Central 33 29 62.26 101.79 4 60.87 96.75 John Perryn 27 27 60.67 93.39 Priory 137 127 60.26 96.4 10 61.75 96.68 Turnham Gn. R.C. 11 9 61.75 101.97 2 62.12 100.5 244 1 58 81.5 226 60.62 96.92 17 61.31 96.95 GIRLS 22 21 61.04 99.47 1 61.75 99.75 Central 64 60 62.04 103.66 4 61.5 94.43 John Perryn 22 21 60.75 103.2 1 62.25 92 Priory 115 2 55.5 77.12 106 60.91 101.6 7 61.46 100.1 Turnham Gn. R.C. 13 11 60.11 93.15 2 60.75 95.75 236 2 55.5 77.12 219 61.18 101.69 15 61.48 98.8 /