AC 439(1) BRENTFORD+M CHI15WICK BRE5 Borough of Brentford and Chiswiek REPORT ON THE Health of the District AND School Medical Service during 1937. Including REPORT of Dr. T. ORR, Medical Superintendent of the Isolation and Maternity Hospitals R. C. LEANING, M.B., B.S. (London), M.R.C.S., L.R.C.P., D.P.H., R.C.S. (Eng.). Medical Officer of Health. School Medical Officer. BROAD A Co., TYPO, CHISWICK 1 Borough of Brentford and Chiswick. PUBLIC HEALTH COMMITTEE Councillor Mrs. Hill, Chairman Alderman Edwards Councillor W. Davies „ Jenkin „ Fuller „ Leahy ,, Holman Councillor Batey ,, Mrs. Watts-Tobin „ Mrs. Burden ,, Whitman „ R. Davies Exofficio: Alderman Howard, J.P., Councillors Davidge, J.P., and Cleland. EDUCATION COMMITTEE Alderman Jenkin, Chairman. Alderman Stroud, Vice-Chairman. Alderman Leahy Councillor Lane Councillor Batey Miss R. Harris „ Mrs. Burden Mr. H. Garlick „ Burnell Mrs. D. Jupp „ Cleland Mr. F. Court ,, Davidge, J.P. County Councillor Hughes, J.P. „ R. Davies ,, ,, Johnson, J.P. „ W. Davies ,, ,, Mills „ Griffin ,, „ Dr. Watts-Tobin „ Hyde- Councillor Mrs. Hill Johnson, M.A. Mr. C. Pendlebury, M.A. KlTCHINGMAN MATERNITY AND CHILD WELFARE COMMITTEE Councillor Mrs. Burden, Chairman Alderman Edwards Councillor R. Davies „ Jenkin „ Fuller „ Leahy ,, Grogan Councillor Batey ,, Mrs. Hill „ Cleland „ Holman „ Davidge, J.P. „ Mrs. Watts-Tobin Co-opted Members : Miss Band, Mrs. Harvey, Mrs. Mountford, Mrs. Page, Mrs. Saunders and Mrs. Wright. 2 PUBLIC HEALTH STAFF (including Staff for School Medical Service) Male *R. C. Leaning, M.B., B.S.(Lond.), M.C.R.S., L.R.C.P., D.P.H., R.C.S. (Eng.), Medical Officer of Health, School Medical Officer, Medical Superintendent, Maternity and Child Welfare Clinics. (Whole time.) *Ed. Micklewright, M.R.San.I., Certified Inspector of Meat and Other Foods, etc., Chief Sanitary Inspector, Inspector for Petroleum Acts, Shops Acts, Factory and Workshops Acts and Canal Boats Acts. (Whole time.) *L. C. Webb, A.R.San.I., Certified Inspector of Meat and Other Foods, etc., Certificates of the Royal Sanitary Institute, Sanitary Inspector, Inspector for Shops Acts and Canal Boats Acts (Whole time.) MILK SUB-COMMITTEE Councillor Mrs. Burden Mrs. Mountford „ Mrs. Hill Mrs. Page „ Mrs. Watts-Tobin Mrs. Rainbird Miss Band Mrs. Saunders Mrs. Harvey Mrs. Wright VOLUNTARY LADY HELPERS AT THE MATERNITY AND CHILD WELFARE CLINICS Brentford Clinics Mrs. Austin Mrs. Davis Mrs. E. Bird Mrs. Miles Mrs. J. Bird Mrs. Mountford Mrs. Burden Miss Peacock Mrs. Collins Mrs. Rainbird Chiswiek Clinics Miss Barker Mrs. King Miss Bates Mrs. Little Mrs. G. Brown Mrs. Moore Mrs. Butcher Mrs. Philip Miss Dolman Miss Phillipe Mrs. Gentry Mrs. Turner Miss Goode Mrs. Wright Mrs. Harvey Mrs. Wooldridge 3 T. M. Johnson, A.R.San.I., Certified Inspector of Meat and Other Foods, etc., Certificates of the Royal Sanitary Institute, Sanitary Inspector, Inspector for Shops Acts. (Whole time.) *A. G. Robinson, A.R.San.I., Certified Inspector of Meat and Other Foods, etc., Certificates of the Royal Sanitary Institute, Sanitary Inspector, Inspector for Shops Acts. (Whole time.) G. W. Burden, A.R.San.I., Certified Inspector of Meat and Other Foods, etc., Certificate of the Royal Sanitary Institute, General Assistant Sanitary Inspector. (Whole time.) L. G. Lydiatt, A.R.San.I., Certified Inspector of Meat and Other Foods, etc., Certificates of the Royal Sanitary Institute, Senior Clerk. (Whole time.) G. W. Cassidy, Clerk. (Whole time.) P. G. Smith, Clerk. (Whole time.) Female *Miss S. P. Griffiths, M.R.C.S., D.R.C.P., D.P.H., Assistant Medical Officer of Health, Assistant School Medical Officer. (Whole time.) *Miss M. M. Loretz, L.D.S., R.C.S.(Eng.), Dental Surgeon. (Whole time.) *Miss H. A. Chitty, Trained Nurse; Health Visitor's Certificate of the Royal Sanitary Institute; Certificate of the Central Midwives Board; Health Visitor and School Nurse. (Whole time.) *Mrs. F. Thompson, Trained Nurse; Health Visitor's Certificate of the Royal Sanitary Institute; New Health Visitor's Certificate; Certificate of the Central Midwives Board; Health Visitor and School Nurse. (Whole time.) *Miss E. Catherwood, Trained Nurse; New Health Visitor's Certificate; Certificate of the Central Midwives Board; Health Visitor and School Nurse. (Whole time.) *Mrs. r. Clarke, Trained Nurse; Health Visitor's Certificate of the Royal Sanitary Institute; New Health Visitor's Certificate; Certificate of the Central Midwives Board; Health Visitor and School Nurse. (Whole time.) 4 *Miss B. C. Broughton, Trained Nurse, New Health Visitors' Certificate; Certificate of the Central Midwives Board; Health Visitor and School Nurse. (Whole time.) *Miss R. A. Warren, Trained Nurse, New Health Visitor's Certificate; Certificate of the Central Midwives Board; Health Visitor and School Nurse. (Whole time.) Resigned September 1937. *Miss C. E. Jenkins, Trained Nurse; New Health Visitor's Certificate; Certificate of the Central Midwives Board, Health Visitor and School Nurse. (Whole time.) Appointed November, 1937. *Mrs. E. Davis, Clerk to the Maternity and Child Welfare Centres, Brentford and Chiswick. (Part time.) Resigned September, 1937. *Miss M. Marshall, Clerk to the Maternity and Child Welfare Clinics and School Medical Service—Chiswick Centre. (Whole time.) *Miss J. Golley, Clerk to the Maternity and Child Welfare Clinics and School Medical Service—Brentford Centre. (Whole time.) *Miss M. Malden, Clerk—School Medical Service. (Whole time.) *Miss L. M. Goode, Assistant to the Dental Surgeon. (Whole time.) Resigned September, 1937. *Miss C. Birks, Assistant to the Dental Surgeon. (Whole time.) *Miss L. King, Clerk to the Dental Surgeon. (Whole time.) *Miss P. Rose, Clerk to the Dental Surgeon. (Whole time.) Resigned March, 1937. *Miss I. Grant, Clerk to the Dental Surgeon. (Whole time.) Appointed March, 1937. *Miss E. Walters, Matron—Day Nursery. (Whole time.) Part-Time Medical Staff. *J. Seddon, F.R.C.S., Consulting Surgeon to the Orthopaedic Clinic. *G. Slot, M.D., M.R.C.P., D.P.H., Consulting Physician to the Rheumatism Clinic. *H. Coysh, D.D.S., R.C.S.(Eng.), Assistant Dental Surgeon. *J. V. Houlton, L.D.S., R.C.S.(Eng.), Assistant Dental Surgeon. *W. C. King-Brown, M.B., B.S., M.R.C.S., Medical Officer, Diphtheria Immunisation Clinic. *Contribution is made to the salaries of the Officers so marked. 5 Borough of Brentford and Chiswick. Public Health Department, Town Hall, Chiswick. To the Mayor, Aldermen and Councillors of the Borough of Brentford and Chiswick. Ladies and Gentlemen, I have the pleasure and honour of submitting to you my Annual Report on the health of the Borough and on the School Medical Service, for 1937. Conditions compare favourably with those found in previous years and the efforts made by this Authority to solve the problems of housing, overcrowding and slum clearance, should prove to be a potent factor in maintaining good health and in improving the general amenities in the area. Already several ugly scars made by the clearance of unfit houses have been replaced by modern houses and flats, and this process of improvement is progressing steadily. The Birth Rate 12.12, as compared with 14.9 for England and Wales, is decidedly on the decline, while the Infantile Mortality Rate, 52 (England and Wales 58) is somewhat higher than last year. The attendances at the Maternity and Child Welfare Clinics remain fairly constant and there was a slight increase in the number of children under one year of age enrolled. The Ante-Natal Clinics are well attended, especially by those expectant mothers who anticipate admission to our Maternity Hospital, the West Middlesex Hospital or to be attended in their own homes by the Queen Charlotte's Nurses. 6 There is very close co-operation of the Clinics with these institutions and I would like to state that as regards domiciliary midwifery the excellent arrangements made by this Authority and the County Council with Queen Charlotte's Hospital should prove to be highly satisfactory. The Maternity and Child Welfare Clinics greatly miss the invaluable services given to them by the Chiswick Hospital, and we are looking forward to the re-opening of that institution so that we can once more obtain their help. A great problem of this, and many other areas, is to solve the most efficient way to bring about disinfestation of houses and furniture, and the Chief Sanitary Inspector in his report on Housing indicates the trouble and time that has been taken in investigating this matter. Appended is the Annual Report of the Medical Superintendent of the Isolation and Maternity Hospitals and I am greatly indebted to the Chiswick and Ealing Hospitals Committee and to Dr. Orr for kindly supplying copies to bind with this report. Again I have pleasure in recording that the Ladies who act as Voluntary Helpers in the Maternity and Child Welfare Clinics, continue to earn your gratitude and thanks for their untiring efforts in the interests of the mothers and children attending these clinics. A list of their names is to be found on page 2. Finally I would like to tender my sincere and grateful thanks to my colleagues and to the Staff of the Public Health Department for their loyal support and to you Ladies and Gentlemen for your continued courtesy and help. i am, Ladies and Gentlemen, Your obedient Servant, r. c. leaning. 7 SECTION A. STATISTICS AND SOCIAL CONDITIONS OF THE AREA. 1. GENERAL STATISTICS, 1937. Area in acres (including 116 acres of foreshore of River Thames and 24 acres of inland water) 2449.5 Population—Census 1931 62,617 Registrar-General's estimate for area, mid 1937 62,020 Number of inhabited houses (end 1937) according to Rate Books (approximate) 15,640 Rateable Value (31st December, 1937) £699,190 Sum represented by a penny rate (General District) £2,772 2. EXTRACTS FROM VITAL STATISTICS OF YEAR. Total. M. F. Live Births— Legitimate 749 366 383 Birth Rate per 1,000 of estimated resident population, 12.12. Illegitimate 23 9 14 Stillbirths 17 6 11 Rate per 1,000 total (live and still) births, 21.5. Deaths 714 359 355 Death Rate per 1,000 of estimated resident population, 11.74. Deaths. Rate per 1,000 total (live and still) births. Deaths from puerperal causes— Puerperal Sepsis - — Other puerperal causes — - Total - - Death Rate of Infants under one year of age:— All infants per 1,000 live births 52 Legitimate infants per 1,000 legitimate live births 45 Illegitimate infants per 1,000 illegitimate live births 261 Deaths from Cancer (all ages) 101 Deaths from Measles (all ages) 2 Deaths from Whooping Cough (all ages) 1 Deaths from Diarrhoea (under 2 years of age) 4 Zymotic Death Rate 0.15 8 COMPARISON OF VITAL STATISTICS. Birth Rate. Death Rate. Infant Mortality Brentford and Chiswick 12.12 11.74 52 England and Wales 14.9 12.4 58 125 County Boroughs and Great Towns, including London 14.9 12.5 62 London 13.3 12.3 60 (a) Vital Statistics. POPULATION. The Registrar-General's estimate of the population for the year 1937 is one of 62,020, thus shewing a decrease of 280 from the previous year, and a total decrease of 597 from the Census figure of 62,617. These intercensal estimates of the Registrar-General are, of course, based on statistical data dealing with birth, death and migration elements, and experience has shewn them to be remarkably accurate. The figure given is reflected in the falling numbers on the electoral register as well as the numbers of children attending the elementary schools of the Borough. Further, a large number of houses are being vacated as a result of the operations of the Middlesex County Council and Ministry of Transport in preparation for the extension of the Great West Road through certain parts of the area. The excess of births over deaths during the past seven years was 957, but as stated above this is only one factor considered in arriving at the estimate. BIRTHS. There were 772 births during the year (375 male and 397 female). Of these, 23 were illegitimate (9 male and 14 female). This figure shows a Birth Rate of 12.12 per 1,000 of the population. In addition there were 17 stillbirths registered, one of which was illegitimate. 9 DEATHS. The Registrar-General's official return shows that 714 residents of the Borough died during the year (359 male and 355 female). This figure gives a Death Rate of 11.51 of the estimated population. In a memorandum issued with the official returns for 1934, the Registrar-General drew attention to the fact that this rate is unsuitable for the purposes of comparison with other areas, by reason of the fact that the populations of all areas are not similarly constituted as regards the proportions of their sex and age group components. Consequently he has supplied a correcting or adjusting factor to all areas with instructions that the Recorded Death Rate should be multiplied by the factor supplied to ascertain what is known as the Corrected Death Rate. The object of this is to provide a true mortality index for comparison purposes, eliminating variations in mortality which arise as the result of differences in the age and sex group components of various populations. The correcting factor for this area is 1.02 and, multiplying the Recorded Death Rate of 11.51 by this figure, a Corrected Death Rate of 11.74 is ascertained—a figure which is lower than the previous year of 12.24. It is again interesting to note that of the 714 deaths, 362 or 51 per cent, occurred in hospitals and institutions outside the Borough. Mortality in Age Groups. Deaths under 1 year 40 between 1 and 2 years 6 „ ,, 2 ,, 5 ,, 5 " „ 5 ,, 15 ,, 9 „ .. 15 „ 25 „ 19 „ „ 25 ,, 45 ,, 72 ,, 45 ,, 65 ,, 201 ,, over 65 years of age 362 Total 714 It will thus be seen that 362 persons dying during the year —or approximately 51 per cent.—reached the age of 65 or over. 10 Further analysis of this figure shows the following:— Deaths between 65 and 70 years of age 76 „ „ 70 „ 75 „ 78 „ ,, 75 ,, 80 ,, 91 „ „ 80 „ 85 „ 68 „ „ 85 „ 90 „ 41 „ „ 90 „ 95 „ 8 Total 362 Again, of this number, 286, or over 40 per cent., reached the age of 70 years or over, the oldest resident dying being 94 years of age. A perusal of Table I appended, which sets out the causes of death, will show that cancer accounted for 101 deaths and tuberculosis (all forms) for 39 deaths. In the preceding year these diseases were responsible for 117 and 53 deaths respectively. Zymotic Death Rate. This rate is calculated from the number of deaths occurring from the seven principal zymotic diseases, viz., Smallpox, Scarlet Fever, Measles, Diphtheria, Fever (Tyhpus, Typhoid and Continued), Whooping Cough and Diarrhoea. The total number of deaths from these causes was 9 which gives a zymotic Death Rate of 0.15 per 1,000 of the population. Infantile Mortality. The total number of deaths of infants under one year of age was 40. Of this number 6 were of illegitimate children. This gives an Infantile Mortality Rate of 52 per 1,000 live births. Analysing this figure one finds that the Infantile Mortality Rate among legitimate children was 45 while that among illegitimate infants was 261. Of the 40 infant deaths, 24 occurred outside the area and 22 were neo-natal, i.e., occurring during the first four weeks of life. 11 The following sets out the Birth, Death and Infantile Mortality Rates since the date of amalgamation of Brentford and Chiswick:— Birth Death Infantile Year. Rate. Rate. Mortality Rate. 1927 16.4 11.6 66 1928 16.9 10.9 48 1929 16.17 13.64* 62 1930 16.6 11.31 48 1931 14.27 10.42 49 1932 13.93 10.45 49 1933 13.39 11.75 46 1934 12.48 11.37 61 1935 13.43 10.31 41 1936 13.35 12.24 49 1937 12.12 11.74 52 *Year of severe Influenza epidemic. Table II appended sets out the causes of death, etc., of infants under one year of age. a study of that table shows that, out of the 40 deaths recorded, 18 can be classified as what might be considered as preventable diseases, viz., Convulsions, Bronchitis, Pneumonia, Enteritis and Marasmus. Two who died from Injury at Birth and possibly some classified as Premature Birth may also be in this category. On the other hand, with our present medical knowledge, we have no control over the incidence of Congenital Malformations and some cases of Atelectasis. Lastly the two infants found in the River Thames may not have been born in the Borough. (b) Social Conditions. My remarks in previous reports of course still hold good. 1 he Borough is situated west of the Metropolis and has an area of 2,341 acres. In character it is both residential and manufacturing, there being many large and important industries carried on within its confines. 12 The amenities of the area, with its two beautiful parks as well as its many open spaces providing ample facilities for sport and recreation, together with its proximity to London and the excellent means of transport available, make it an attractive area to reside in. One point of note, however, is the large number of highclass residential flats erected in the area and also the fact that a fair proportion of the larger type of houses have been converted into flats. The coming into operation of Section 12 of the Housing Act, 1936, and the regulations which it is hoped will soon be made thereunder will be most useful in giving better control where the basements and semi-basements of these large houses are let as separate tenements. 13 TABLE I. Particulars of Births and Deaths as supplied by the Registrar-General for the Year 1937. Cause of Death. Males. Females. All Causes 359 355 1. Typhoid Fever, etc. — — 2. Measles 1 1 3. Scarlet Fever — 1 4. Whooping Cough 1 — 5. Diphtheria — 1 6. Influenza 12 10 7. Encephalitis Lethargica — — 8. Cerebro-Spinal Fever — — 9. Respiratory Tuberculosis 22 13 10. Other tuberculous diseases 1 3 11. Syphilis — 3 12. General paralysis of the insane, etc. 4 — 13. Cancer 52 49 14. Diabetes 5 11 15. Cerebral haemorrhage, 17 20 16. Heart Disease 95 95 17. Aneurysm 2 2 18. Other circulatory diseases 22 21 19. Bronchitis 15 8 20. Pneumonia 20 21 21. Other respiratory diseases 4 2 22. Peptic Ulcer 2 2 23. Diarrhoea, etc. (under two years) 3 1 24. Appendicitis 4 1 25. Cirrhosis of liver — 3 26. Other liver diseases 1 — 27. Other digestive diseases 4 5 28. Nephritis 5 11 29. Puerperal Sepsis — — 30. Other Puerperal causes — — 31. Congenital causes, etc. 9 12 32. Senility 6 14 33. Suicide 12 4 34. Other violence 10 7 35. Other defined diseases 29 34 36. Ill-defined causes 1 — Special Causes (included in No. 35 above)— Small-pox — — Poliomyelitis — — Polioencephalitis — — Deaths of Infants under 1 year— Total 22 18 Legitimate 20 14 Illegitimate 2 4 Live Births— Total 375 397 Legitimate 366 383 Illegitimate 9 14 Still-births— Total 6 11 Legitimate 6 10 Illegitimate 1 population 62,020 14 * Pound in River Thames—Inquests. Births—Legitimate 749 Deaths—Legitimate 34 Illegitimate 23 Illegitimate 6 Infantile Mortality Rate per 1,000 Births 52 table II. Infantile Mortality during the Year 1937. Net deaths from stated causes at various ages under one year. Cause of Death. Under one week. 1—2 weeks. 2—3 weeks. 3—4 weeks. Total under 4 weeks. 1—3 months 3—6 months 6—9 months 9—12 months. Total under 1 year Small-pox - - - - - - - - - - Chicken-pox - - - — — - - — - — Measles - - - - - - - - - - Scarlet Fever - - - — — - - — - — Whooping Cough - - - — - - - - - - Diphtheria or Croup - - - - - - - - - Erysipelas - - - - - - - - - - Tuberculous Meningitis - - - - - - - - - - Abdominal Tuberculosis - - - - - - - - - Other Tuber. Diseases - - - - - - - - - - Meningitis (non T.B.) - - - — — - — — — — Convulsions - - - — — - 1 — - 1 Laryngitis — - - — - — - — - — Bronchitis - - - — — - - — 1 1 Pneumonia (all forms) - - - - - 2 2 5 1 10 Diarrhoea - - - - - - - - - — Enteritis - - - 1 1 2 1 - - 4 Gastritis - - - - - — - — - — Rickets - - - — — — — — - — Suffocation, overlying - - - - - - - - - — Injury at Birth 2 - - — 2 - — — - 2 Atelectasis 7 1 - — 8 - — — - 8 Congenital Malformation — 1 1 — 2 — 1 1 - 4 Premature Birth 6 — — — 6 — — — - 6 Atrophy, Debility and Marasmus - - - 1 1 1 - - - 2 Pemphigus Neonatorum - - - - - - - - - — *Other Causes 2 - - - 2 — - - - 2 Totals 17 2 1 2 22 5 5 6 2 40 15 SECTION B. GENERAL PROVISION OF HEALTH SERVICES FOR THE AREA. The following information is included and set out in such form as required by the Ministry of Health Circular No. 1650 relative to the preparation of Annual Reports for the year 1937. (1) Public Health Officers of the Authority. A list of all health officers employed by the Council is incorporated at the beginning of the Report. (2) Development and changes in certain services provided in the area. (a) Laboratory Facilities. No change has taken place in the arrangements for the examination of clinical material submitted by medical men for bacteriological examination. Details of the work carried out in the Council's laboratory will be found set out on page 55. (b) Ambulance Facilities. The ambulance arrangements of the Borough are both adequate and up-to-date. Four motor ambulances for public use are maintained and all are now equipped with outfits for the administration of morphine sulphate by medical men in cases of urgency. The use these ambulances were put to during the year is reflected in the following figures:— Number of public calls dealt with during 1937 479 Number of private calls dealt with during 1937 667 The Joint Hospitals Committee maintain their own motor ambulances for the removal of infectious patients to hospital, and in addition the Middlesex County Council have a special motor service for the removal of the many patients of the Borough using the County hospitals. 16 (c) Nursing in the Home. No change has taken place in this service. The Brentford and Chiswick Nursing Association, in affiliation with the Queen's Institute of District Nursing, still continues to function and employs two nurses for work in the district. In connection with this nursing service, there is a scheme whereby for a minimum subscription of one penny per week the services of the Queen's Nurses are offered to householders and others. This contribution entitles the father, mother and children of the family up to the age of 16 years, to nursing benefit. Older children of the family may benefit by paying at the minimum rate of a halfpenny per week. Non-subscribers can, of course, obtain the services of the nurses on payment of a graded fee. (d) Clinics and Treatment Centres. A table showing a complete list of Clinics and treatment centres, giving particulars of establishment and control, will be found appended at the end of this sub-section. (e) Hospitals : Public and Voluntary. Two voluntary hospitals exist within the Borough boundaries, viz. the Chiswick Hospital and the Brentford Hospital. The former, however, is undergoing complete reconstruction, but it is hoped that this will be completed soon, so that the hospital can resume its useful work. The proximity of the Borough to London renders the large Metropolitan hospitals available to residents and many take advantage of this fact as well as of the Hospital in the Royal Borough of Richmond. The Middlesex County Council Hospitals—mainly the West Middlesex Hospital situated in the adjoining Borough of Heston and Isleworth—deal with large numbers of patients requiring hospital treatment, including many maternity cases unable to obtain accommodation in the Maternity Hospital of the Joint Hospitals Committee. By the courtesy of Dr. T. Orr, Medical Superintendent of both the Isolation and Maternity Hospitals, I am once again privileged to include his report on the working and administration of these hospitals. 17 TABLE of CLINICS and TREATMENT CENTRES. Description. Address. When Held. Provided by 1. m. & C. w. Clinics (consultations and simple treatment). Baths Annexe, Brentford. Twice weekly, on Mondays and Wednesdays, 2 p.m. to 5 p.m. Council, and under control of M. and C.W. Committee. 2. Ditto Heathfield Terrace, Chiswick. Thrice weekly, on Wednesdays, Thursdays and Fridays, 2 p.m. to 5 p.m. Do. 3. Ante-natal Clinic. Baths Annexe, Brentford. Once weekly, on Wednesdays, at 10.30 a.m. Do. 4. Ditto Heathfield Terrace, Chiswick. Once weekly, on Tuesdays, 2 p.m. to 5 p.m. Do. 5. Minor Ailment Clinic. Heathfield Terrace, Chiswick. Each weekday at 9 a.m. Education Committee. 6. Ditto Portsdown Ho., The Butts, Brentford. Do. Do. 7. Dental Clinic Ditto Four times weekly, on Tuesdays, Wednesdays, Thursdays and Fridays, for elementary school children. As required for patients from M. and C. W. Clinics. Education Committee and by arrangement with the Council for M. and C. W. patients. 8. Ditto* Heathfield Terrace, Chiswick. Daily for elementary school children. As required for patients from M. and C. W. Clinics. Do. 9. Eye Clinic.* Ditto One Session weekly, on Tuesdays, for elementary school children, at 11 a.m. Education Committee. 10. Ditto Portsdown Ho,The Butts, Brentford. One session weekly, on Mondays, at 11.30 a.m. (elementary school children) Do. 11. Tonsils and Adenoids. Chiswick Hospital.† For elementary school children, as required. Do. 12. Ringworm (X-Ray). Ditto † Ditto Do. 13. Rheumatism Clinic. Heathfield Terrace, Chiswick. Once weekly, on Thursdays, at 11.30 a.m. Do 14. Day Nursery. Bennett St., Chiswick. Weekdays. Brentf'd & Chis. Town Council. 15. Orthopaedic Clinic Portsdown Ho., The Butts, Brentford. Twice weekly, on Mondays and Thursdays, at 2 p.m. Education Committee and M. and C. W. Committee. 16. Diphtheria Immunisation Clinic Heathfield Terrace, Chiswick. One session weekly on Mondays at 2 p.m. Brentford and Chiswick Town Council. 17. Tuberculosis Dispensary. 14 Heathfield Terrace, W.4 Once weekly, on Thursdays, at 10 a.m. Middlesex Cty. Council. 18. Venereal Disease Clinic. No clinics established within the District, but patients may attend the Special Clinic at the West London Hospital in the neighbouring Borough of Hammersmith. N.B.—Patients residing in the Brentford area also attend the M.C.C. Tuberculosis Dispensary, Bell Road, Hounslow. * Arrangements have also been made for treating school children from secondary schools at these clinics. . †This Hospital was closed during the year and other arrangements have been made until the Hospital re-opens. 18 SUMMARY OF WORK AT THE MATERNITY AND CHILD WELFARE CLINICS, 1937. BRENTFORD AREA. CHISWICK AREA. Grand Totals, 1937. Grand Totals, 1936. Monday Clinics. Wednesday Clinics. Total. Wednesday Clinics. Thursday Clinics. Friday Clinics. Total. Number of new Members enrolled during the year— Under 1 year 71 95 166 56 137 131 324 490 485 Over 1 year 20 25 45 6 55 32 93 138 223 91 120 211 62 192 163 417 628 708 Number of childreu attending & weighed Under 1 year 998 1801 2799 694 2153 2326 5173 7972 8263 Over 1 year 664 1237 1901 250 1329 1810 3389 5290 5019 1662 3038 4700 944 3482 4136 8562 13262 13282 Number of children seen by Doctor— Under 1 year 391 545 936 214 944 970 2128 3064 3336 Over 1 year 331 430 761 80 703 719 1502 2263 2286 722 975 1697 294 1647 1689 3630 5327 5631 19 (3) Maternity and Child Welfare. This branch of the Health Services of the Borough has been continued on the same lines as recorded in previous reports. Five sessions are held weekly, three in Chiswick and two in Brentford, and a lecture is given at each Wednesday afternoon session in Chiswick. It is recognised that the chief function of these clinics is the prevention of disease and disability, and the policy of using them chiefly for the giving of advice and for education is maintained. In practice, however, it has been found that to make that advice and education effective it is necessary to provide some form of treatment in connection with these clinics, especially for dental and orthopaedic defects. The School Medical Service has provided such clinics for school children and they are available and very much used by those attending the Maternity and Child Welfare Clinics. These women and children can also make use of other clinics provided by this Authority, viz., the Minor Ailment, Eye, Rheumatism and Immunisation Clinics. When the new clinic in Brentford is opened there will be in addition a Sun Ray Clinic. As an adjunct tp these clinics we had very satisfactory arrangements with the Chiswick Hospital for the treatment of disorders of the tonsils and adenoids, but that service has been in abeyance pending the re-building of that hospital, and we have had to get these children treated elsewhere. This has been a considerable handicap as it has meant tiresome journeys for the mothers and long delay in obtaining treatment as most other hospitals have such long waiting-lists of children requir'ng operations for tonsils and adenoids.— The following were referred to our own treatment clinics:— Dental Clinic : 66 mothers, 183 children. Orthopaedic Clinic: 43 children. Rheumatism Clinic: 1 mother, 3 children. Minor Ailment Clinic: 8 children. Immunisation Clinic: In all cases, mothers bringing their children to the Maternity and Child Welfare Centres are asked to have them immunised against Diphtheria. Apart from the above, when it is found that other forms of treatment are required, the children are referred to their own doctors or to a suitable hospital. 20 During the year the following 108 cases were sent to various hospitals:— Children: Circumcision 31, Tonsils and Adenoids 32, Mastoid 2, Squint 9, Naevi 5, Skin diseases 3, Congenital hernia 1, Pneumonia 2, Asthma 1, Marasmus 2, Intrissusception 1, Worms 1, Enuresis 3, Convulsions 1, Epilepsy 1, Injury to clavicles (for X-Ray) 1, Swallowing metal ring (for X-Ray) 1, Whooping Cough 4, Others 3. Also two children were sent to the Isolation Hospital suffering from Scarlet Fever. Mothers: Breast abscess 1, Varicose Veins 1. The hospitals recommended were West Middlesex County Hospital, West London, Victoria Hospital for Children, Chelsea, Great Ormond Street, St. George's, Vincent Square and Richmond Hospitals. ORTHOPAEDIC CLINIC. The general report of Mr. H. Seddon, the Consulting Surgeon to this Clinic, is to be found in the School Medical Report, page 78. The conditions found in the children referred to him from the Maternity and Child Welfare Clinics are as follows:— (1) Congenital Defects:— Club foot 1 Metatarsal varus, pes arcuatus 1 Irregular toes, congenital pes pl. valvus, etc. 1 Dislocation of hip 2 (2) Birth Injuries:— Torticollis 1 (3) Rickety Deformities Bow tibiae 9 Bow legs—intoeing 14 (4) Non-Rickety Deformities:— O. C. T 5 (5) Flat feet 2 (6) Infantile Paralysis 1 (7) Septic Arthritis 1 (8) Other conditions including postural intoeing 4 (9) No diagnosis 1 One child was treated as an In-patient at Stanmore for Metatarsus varus. 21 Dental Clinic. Miss Loretz, the Dental Surgeon, gives the following table of work done for mothers and children attending the Maternity and Child Welfare and Ante-natal Clinics. Chiswick. Brentford. Total. Sessions devoted to treatment 48 44½ 92½ Patients treated—Mothers 119 72 191 Children 112 93 205 Total 231 165 396 Attendances— Mothers 498 311 809 Children 314 298 612 Total 812 609 1,421 Teeth filled— Permanent 148 60 208 Temporary 165 83 248 Root 2 2 4 T otal 315 145 460 Teeth extracted—Permanent 317 298 615 Temporary 256 331 587 Local Perm. 5 1 6 Total 578 630 1,208 Treated with Ag. N.o3 24 19 43 Administrations of Nitrous Oxide 214 241 455 Scalings 29 13 42 Dentures 26 14 40 Dressings 11 10 21 Repairs 4 6 10 Ante-natal Clinics. Two sessions are held weekly, one in Brentford and the other in Chiswick. 300 expectant mothers attended for the first time and 111 continued attendances they started the previous year. These 411 expectant mothers made 1,787 attendances. 770 births were notified so this figure represents 53.4 per cent, of that number. The percentage in 1936 was 51.7. 22 All undergo a thorough examination at their first visit and advice is given as to the general hygiene and diet of pregnancy. During the early period they are asked to attend once a month and during the last month they are seen each week. Cases requiring more attention attend more often and some may be referred to their doctor or hospital. Those who do not attend the clinic when expected are visited by a nurse. 543 ante-natal visits were made during the year. All are invited to attend the post-natal clinic after their confinement, and I can only repeat the remarks I have made in previous reports, that it is found that unless there is some obvious or troublesome condition present, mothers do not avail themselves of this offer, and I continue to hope that, as so few attended, the confinements during the year were not accompanies by any detrimental effects upon the mother. All mothers bringing their children to the Maternity arid Child Welfare Clinics are questioned as to any possible disability since their confinements. The following table indicates certain conditions found and who they were dealt with:— Dental cases 124 Sent to Dental Clinic. Leucorrhoea 15 Treated in clinic. Small measurements 7 Careful observation kept. In one case only was there portion and this was sent to Hospital for induction of early labour. Malpresentation:— Breech 8 Six corrected in Clinic. Transverse 3 Corrected in Clinic. Twin pregnancies 3 Two X-Rayed at Hospital. Threatened miscarriage 3 Treated in Clinic. One aborted Retroverted gravid uterus 1 Treated in Clinic. Antipartum haemorrhage 1 Sent to Hospital as placenta praevia. Anencephalic Foetus 1 X-Rayed at Hospital. Albuminuria—Marked 7 Treated in Clinic; 4 sent to Hospital. Mild 56 Treated in Clinic. High Blood Pressure 5 Treated in Clinic; 1 sent to Hospital. 23 Marked Vomiting 16 Treated in Clinic. Varicose Veins 36 Ditto. Heart Disease 2 Ditto. Anaemia 8 Ditto. Enlarged Thyroid 2 Ditto. Not pregnant 5 Post-Natal Cases. Normal 4 Leucorrhoea 3 Treated in Clinic for cervical erosion. Subinvolution 2 Treated in Clinic. Retroflexion 2 Ditto. Prolapse 1 Sent to Hospital for operation Breast abscess 1 Treated in Clinic. Cystitis 2 Ditto. Thrombosis 1 Ditto. General debility and anaemia 10 MATERNAL MORTALITY. It is a pleasure to report that there were no cases of Maternal Deaths during 1937. The following table shows the deaths classified under this heading during the last nine years:— Year Died from Sepsis Died from other causes connected with pregnancy 1929 1 1 1930 4 2 1931 1 3 1932 1 1 1933 3 2 1934 1 3 1935 - - 1936 2 3 1937 - - 13 15 This shows an average of 3.1 per year for the last nine years. ANTE-NATAL CLINICS. District. Number of clinics held during year. Number of expectant mothers attending for the first time. Total number of expectant mothers attending. Number of post-natal mothers attending. Total number of attendances made. Average attendance per session. Brentford 50 91 128 7 641 13 Chiswick 48 209 283 12 1140 21 Totals 98 300 411 19 1787 18 24 25 (ii) Institutional Provision for Mothers and Children. Other than the Maternity Hospital under the control of the Joint Hospitals Committee, the Council make no actual provision for institutional treatment for mothers and children. Such requirement is, however, adequately met by the hospitals under the control of the Middlesex County Council, as well as the local voluntary hospitals, who are always willing to accept recommended cases. Midwives Act, 1936. Very satisfactory arrangements have been made by the County Council (the Supervising Authority for this Borough) with Queen Charlotte's Hospital. This Hospital provides midwives for the domicilary treatment of midwifery in the Borough from their Goldhawk Road Branch which is situated on our eastern boundary. The number of midwives and nurses posted at this branch ensures that attendance on a case is always available and further, they are provided with a motor car and apparatus for administering nitrous oxide. Another great advantage is that the services of their medical staff can be used in cases of difficulty or complication and prompt admission into the Hospital is obtainable when necessary. Nurses from the Hospital attend all Ante-Natal Clinics to enable a proper co-ordination to be maintained. This arrangement did not come into force until the autumn so there is little to report this year, except that there appears to be every promise that it will prove to be efficient. (iii) Health Visitors. The following table gives a brief summary of the work carried out by the Health Visitors during the year :— 26 Number of visits paid during the year by all Health Visitors:— (a) To expectant mothers: First visits 298 Total visits 543 (b) To children under one year of age : First visits 649 Total visits 2138 (c) To children between the ages of 1 and 5 years: Total visits 3273 (d) Ophthalmic visits 12 (e) Other visits : Measles 6 Whooping Cough - Epidemic Diarrhoea - Infant Life Protection visits 253 Total visits 6225 (iv) Infant Life Protection (under Part I of the Children Act, 1908, as amended by the Children and Young Persons Act, 1932). The six Health Visitors and School Nurses employed by the Council are appointed Infant Life Protection Visitors under the above-mentioned Act, and, as will be seen from the summary of visits made as shown above, combine the work with that of Health Visiting. In addition to the visits from the Health Visitors, the majority of foster-mothers are required to bring foster-children to the Child Welfare Clinics for periodical medical examination. The following table sets out particulars of registration during the year :— (1) Number of foster-parents on the Register: (a) At the beginning of the year (b) At the end of the year 29 (2) Number of children on the Register : (a) At the beginning of the year 38 (b) At the end of the year 36 (c) Who died during the year (d) On whom inquests were held during the year '27 (v) Day Nursery. The Day Nursery can accommodate 42 children (under 5 years of age) in winter and 45 such children in summer. Its working during the past year has been extremely satisfactory. The attendances during the year were as follows :— Whole days 11,009 Half days 1,298 28 SECTION C. SANITARY CIRCUMSTANCES OF THE AREA. Circular 1650 issued by the Ministry of Health and relating to the preparation of Annual Reports points out that it is not necessary to report in detail upon the matters specified under various headings of this section, but only to refer to matters of interest and those to which it is desirable to draw attention. (i) Water. There are only two dwellings within the Borough where the drinking water supply is obtained direct from wells, all other dwellings being on direct supply from the mains of the Metropolitan Water Board. During the past year samples were obtained from one of these wells which had been in use for some sixty years and submitted for analytical and bacteriological examination. The reports received thereon were unsatisfactory, and steps were taken to close the well and to provide a domestic water supply direct from the public mains. Samples of water in the remaining well have also been taken for examination and at the time of writing satisfactory reports in relation to this supply have been received. (ii) Drainage and Sewerage. The Borough Engineer has supplied me with the undermentioned particulars relative to work in connection with the public sewers :— (a) Length of surface water sewers laid or reconstructed during 1937 190 feet (b) Length of soil sewers laid or reconstructed during 1937 — (iii) Sanitary Inspection of the Area. Tabular Statement of the Work of the Sanitary Department, 1937. Inspections. Number of premises inspected on complaint 850 Number of premises inspected in connection with infectious disease 242 Number of primary inspections 4181 Number of re-inspections 4314 Total number of inspections and re-inspections 8495 29 Action Taken (other than Housing Act, 1936). Cautionary or intimation notices served 999 Statutory Orders issued (under Public Health Acts) 5 Summonses served - Number of Certificates under Rent &c. (Restrictions) Acts issue to Tenants 8 Number of Clearance Certificates issued to Owners 4 Particulara of Sanitary Defects referred to in Notices served, and Other Matters. (a) Drainage of Existing Buildings. Waterclosets : New provided, repaired, supplied with water or otherwise improved 257 Percentage of houses provided with waterclosets 100 Drains: Tested (smoke) 104 Unstopped, repaired, trapped, etc 74 Waste pipes, rainwater pipes disconnected, repaired, etc 163 New soil pipes and ventilating shafts fixed 25 New sinks provided 93 Disconnecting traps and chambers inserted 33 Reconstructed (whole system) 6 Reconstructed (connections) 45 Percentage of houses draining into sewers 99.9 Surface water drains repaired 9 (b) Water Supply and Water Service. Draw taps on main 13 Percentage of houses supplied from Public Water Service 99.9 (c) Refuse. New bins provided 89 Frequency of refuse removed from each house Weekly Number of complaints received Dealt with by Engineer's Department Method of disposal: Barging away to controlled tip. 30 (d) Sundry Nuisances. Overcrowding : Urgent cases reported to Housing Committee. Smoke Minor complaints only. Accumulation of refuse 3 Foul ditches, ponds, etc., and stagnant water 8 Dampness 405 Yards repaired or repaved 74 Leaky roofs and eaves guttering 317 Premises repaired and cleansed 832 Other nuisances 939 (e) Disinfection. Premises disinfected : Ordinary notifiable diseases 217 Phthisis 20 Cancer 41 Other diseases 17 Rooms stripped and cleansed (Section 5, Infectious Diseases (Prevention) Act, 1890) — Premises treated for vermin 64 Premises treated for other pests 21 (f) Slaughterhouses. Number on Register (including one Knacker's Yard) 6 Inspections made periodically at time of slaughter. Contraventions of bye-laws- Number of animals slaughtered in district during the year : Oxen 235 Sheep and Lambs 1,139 Pigs 619 1,993 Slaughter of Animals Act, 1933 : Number of licences issued during year to slaughter animals :— New Licences 2 Renewed Licences 9 31 Milk and Dairies (Amendment) Act, 1922. Milk (Special Designations) Order, 1936. Milk and Dairies Order, 1926. Number of premises registered : (a) Selling loose milk 13 (b) Selling in bottles and sealed containers 37 (c) Selling in sealed cartons only (B.D. Milk) 28 Total 78 Number of licences issued to sell : (a) Tuberculin Tested Milk 7 (b) Accredited Milk 1 (c) Pasteurised Milk 19 Bakehouses. Number in district in use 20 Contraventions of Factory Acts 2 Unsound Food. Meat (including rabbits and bacon) seized and surrendered (approximate weight) 12 cwt. 65 lbs. Poultry 84½1bs. Fish 196 lbs. Fruit—Strawberries 26 lbs. Vegetables (Brussels Sprouts) 23 cwt. 56 lb. Offensive Trades. Number of premises in district 18 Nature of trades : One soap boiler, two rag and bone dealers and fifteen fried fish shops Number carried on under yearly licence 3 Number of inspections made 57 32 Canal Boats. Number registered during the year : Motor propelled boats 1 Other boats (narrow) 1 Registration Certificates cancelled — Number of boats inspected 67 Number of complaint notes signed 5 Number of boats on register : Motor propelled boats 97 Other boats 418 Petroleum Acts. Number of applications received for licences to store and sell petroleum spirit 103 Number of applications received for licences to store and sell petroleum mixture 15 Number of applications received for licences to store and sell carbide of calcium 8 Number of gallons of petroleum spirit covered by licences 183,862 Number of gallons of petroleum mixture covered by licences 3,685 Quantity of carbide of calcium covered by licences 12 tons 7 cwt. 68 lbs. 33 FACTORIES, WORKSHOPS AND WORKPLACES. 1.—Inspection of Factories, Workshops and Workplaces. Including Inspections made by Sanitary Inspectors. Premises. Number of inspections. Number of written notices. Number of prosecutions. Factories (including factory laundries) 72 4 Workshops(including workshop laundries) 92 8 - Workplaces (other than out-workers' premises — - - Total 164 12 2.—Defects found in Factories, Workshops and Workplaces. Particulars. Number of Defects. Number of prosecutions. Found. Remedied. Referred to H.M. Inspector. *Nuisances under the Public Health Acts— Want of cleanliness 1 1 — — Want of ventilation — — — — Overcrowding — — — Want of drainage of floors — — — — Other nuisances 18 18 — — Sanitary accommodation— Insufficient 1 1 — — Unsuitable or defective 6 6 — — Not separate for sexes — — — — Offences under Factory and Workshop Acts :— Illegal occupation of underground bakehouses (Sec. 101) Other offences, excluding offences relating to outwork, and offences under the Sections mentioned in the Schedule to the Ministry of Health (Factories and Workshops Transfer of Powers Order, 1921) - - - -~ Totals ... 26 26 — — „ * Including those specified in Sections 2, 3, 7 and 8 of the Factory and workshop Act, 1901, as remediable under the Public Health Acts. -V.B.—Xo action was found to be necessary under Section 108 of the Factory and Workshop Act, 1901, relating to unwholesome premises used by outworkers. 34 (iv) Shops. The Shops (Sunday Trading Restriction) Act, 1936, which came into operation on 1st May, 1937, considerably augmented the duties of the Shops Inspectors, duties which are at present undertaken by the Sanitary Inspectors. This will be appreciated from the examination of the under-mentioned statistics. Approximate number of shops in the Borough 864 Approximate number of shop assistants: Male 1,292 Female 1,034 Total 2,326 This latter figure includes 390 young persons under 18 years of age who are subject to special legislation in relation to hours worked by virtue of the Shops Act, 1934. Further, seventy shop-keepers employ approximately 120 assistants on Sundays. The Home Office, in a circular dated 15th April, 1937, suggested that Local Authorities should review their arrangements for the administration of these Acts. A special report on this work was subsequently considered by the Council, but it was decided not to appoint a whole-time inspector, and that the duties should continue to be carried out by the existing officers. An important happening from a hygienic point of view was the coming into operation on 1st March, 1937, of byelaws made under Section 78 of the Middlesex County Council Act, 1934, for securing the cleanliness of any premises used for the business of hairdresser or barber. No legal action was found to be necessary under the Shops Acts, 1912-1936, and in two cases only were contraventions of the requirements of the Shops Act, 1934, relating to sufficient temperature in shops dealt with. In both cases the matter was rectified upon the owner's attention being called to the requirements of the Act. (v) Smoke Abatement. In spite of the large number of chimney shafts in connection with the many factories within the Borough area, very few complaints of smoke nuisances occurred and in all cases willing co-operation of the factory owners was forthcoming upon attention being drawn to the matter. 35 The nuisance, however, from coke grit which emanates from the works of the Gas Light and Coke Company Ltd. at Brentford has not entirely been overcome. The Company have and are still carrying out extensive alterations to their works in an endeavour to overcome the difficulty, and although it is quite possible that the trouble will never be entirely overcome, it is hoped that there will be a marked improvement during the forthcoming year. (vi) Swimming Baths and Pools. The covered swimming bath at Brentford and the two open-air pools at Chiswick all have efficient purification plants, comprising a process of continuous filtration and chlorination which ensures a satisfactory condition of the water. (vii) Eradication of bed bugs. Houses found to be infested and treated for bugs by the Public Health Department:— (a) Council Houses 16 (b) Other Houses 48 In addition, whenever Council Houses are being redecorated and found to be infested, steps are at once taken to deal with same. This work is carried out under the supervision of the Works Department. So far this Council have not employed Hydrogen Cyanide Gas in the work of disinfestation. The method employed in the disinfestation of rooms and houses, particularly Council properties, is as under :— In bad cases all removable woodwork—such a picture-rails, architraves and skirting boards—is taken down and burnt and the premises thoroughly sprayed with a proved insecticide. The woodwork is not replaced but the walls made good and a skirting formed with Keen's Cement. One or more sprayings may be necessary. The method cannot of course be guaranteed to give 100 per cent, results and requires the co-operation of tenant, but on the 36 whole is fairly satisfactory. It may be that during the forthcoming year the Council may again consider the use of either Hydrogen Cyanide or Heavy Naphtha for the disinfestation of premises and furniture. So far as the education of tenants to prevent infestation or re-infestation after cleansing is concerned, the advice and help of the department is always available, and the Council employs a lady investigation officer in connection with its housing schemes, who does useful work in this direction. (viii) Schools. The general hygiene and sanitation of the schools throughout the area is very good and is dealt with in my Report on the School Medical Service on page 62, as also is any action necessary in relation to the health of the scholars and for preventing the spread of infectious disease. It was not found necessary to close any school, either elementary or private, with a view to preventing the spread of infectious disease. 37 SECTION D. HOUSING. The provision of suitable housing accommodation for the working-classes is still one of the most important problems with which the Borough Council has to deal. In spite of the fact that there are 1,548 houses and flats now in the ownership of the Council, still greater efforts are necessary to deal adequately with the situation. From the statistics appended it will be observed that at the end of the year there were still 183 families living under overcrowded conditions and unfortunately many of these are large families. These families and those from Clearance Areas of course claim priority in the matter of Council housing accommodation, but in addition there are a very large number of applications from what may be termed "borderline" cases of overcrowding and other families to be dealt with as and when accommodation becomes available. One of the greatest difficulties to be faced in dealing with this question is, of course, due to the fact that the Borough is largely a built-up area, and consequently there is very little building land available and such as is available and suitable commands a high value. During the past year, however, the Council have lost no single opportunity in securing possible sites, and at the time of writing have such schemes in hand as will at least enable them to fulfil their legal obligations in the matter of housing. The following statistics are of interest:— Number of new houses etc. erected during the year 1937 :— (1) Total number of new houses and flats erected within the Borough 44 (2) Number of new houses erected by the Local Authority with State assistance under the Housing Acts :— (a) Within the Borough (included in (1) above) 32 (b) Outside the Borough area Nil (3) Number of houses and flats now owned by the Council and let to members of the working classes 1,548 N.B.—The Council have a Differential Rent Scheme in operation whereby necessitous cases are enabled to enjoy a lower rental than the normal during periods of unemployment or other distress. 38 By reason of the fact that the systematic inspection of houses of the artisan type has for years past been a special feature of the work of the department, the general fitness from a sanitary point of view of this type of house within the Borough is of a very fair standard. Appended is a tabular statement of this work carried out under the Housing (Inspection of District) Regulations, 1925. From this it will be seen that 754 houses were inspected under the above-mentioned Regulations during the year. Housing Act, 1936. Dealing with the progress made with the putting into effect of the scheme prepared by the Council and submitted to the Ministry of Health in connection with "slum clearance" etc. as required by the provisions of the Housing Act, 1930 (now incorporated in the above-mentioned Act), the following summary sets out the actual position at the end of 1937 : (a) Number of Clearance Orders (including sory Purchase Orders) made by the Borough Council and confirmed by the Minister of Health 33 (b) Number of houses actually demolished in ance Areas 249 (c) Number of houses where Clearance Orders have been confirmed but not yet demolished 12 (d) Number of individual houses demolished under Demolition Order 5 (e) Number of houses where Demolition Orders have been made, but houses not yet demolished 5 (f) Number of houses demolished by owners in cipation of action by the Local Authority 31 (g) Number of houses scheduled for demolition but where official action is still to be taken 41 Examination of the foregoing statistics shows that the total number of houses actually demolished within the Borough, either as a result of official order or otherwise, is 285, while the number of houses where official action is completed and awaiting demolition is 17, making a total of 302 with 41 houses scheduled but still awaiting action to be taken as and when the Local Authority is in a position to re-house the tenants who would be displaced. 39 In addition, one house has been permanently closed. The following table is a copy of the Quarterly Return (Form H.256) to the Ministry of Health, and sets out the work under the Housing Act, 1930, and the corresponding provisions in the Housing Act, 1936, from its commencement to the end of 1937. The figures referred to in the above summary, however, are not clearly reflected therein as only such figures are included as relate to completed transactions under the Act. Work under Housing Acts, 1930 and 1936 (included above) showing Position at 31st December, 1937. Number of dwelling-houses demolished. Number of dwelling- houses made fit. No. of persons displaced. Unfit houses. Other houses. From demolished houses To abate overcrowding Under Part 1 of the Act of 1930— (a) Clearance areas— 249 - - 818 — (b) Improvement areas — — - — — Number of dwelling- houses demolished (Sec. 19) Parts of buildings closed. (Sec. 20) Number of persons displaced from houses in Cols. 2 & 3 (Secs. 19 and 20) Number of dwelling- houses made fit. (Secs. 17 to 20) (1) (2) (3) (4) (5) Under Part II of the Act of 1930— (c) Insanitary houses pot included in clearance areas or improvement areas 5 — 23 65 In addition to the action reported above :— (i) 31 insanitary houses have been demolished in anticipation of formal procedure under Section 19. (ii) 3,308 houses have been made fit as the result of informal notice preliminary to formal notice under Section 9. 40 HOUSING STATISTICS. 1. Inspection of Dwelling-houses during the year. (1) (a) Total number of dwelling-houses inspected for housing defects (under Public Health or Housing Acts) 1,245 (b) Number of inspections made for the purpose (primary) 1,245 (2) (a) Number of dwelling-houses (included under head (1) above) which were inspected and recorded under the Housing Consolidation Regulations, 1925 754 (b) Number of inspections made for the purpose (primary) 754 (3) Number of dwelling-houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation 15 (*Houses in Clearance Areas and Individual Unfit Houses) (4) Number of dwelling-houses (exclusive of those referred to under the preceding sub-head) found not to be in all respects reasonably fit for human habitation 1,057 2. Remedy of Defects during the year without service of formal Notices. Number of defective dwelling-houses rendered fit in consequence of informal action by the Local Authority or their officers 1,036 3. Action under Statutory Powers during the year. (a) Proceedings under Sections 9, 10 and 16 of the Housing Act, 1936 : (1) Number of dwelling-houses in respect of which notices were served requiring repairs (2) Number of dwelling-houses which were rendered fit after service of formal notices : (i) by owners 13 (ii) by local authority in default of owners 2 (b) Proceedings under Public Health Acts : (1) Number of dwelling-houses in respect of which notices were served requiring defects to be remedied 6 BOROUGH OF BRENTFORD AND CHISWICK. HOUSE-TO-HOUSE INSPECTION DURING THE YEAR 1937. STREET OR ROAD. Number of Inspections. Houses let in two Tenements. Houses let in three Tenements. Houses let in four Tenements. Number of Inhabitants. Number of Living Rooms. Number of Sleeping Rooms. Average Number of NUISANCES AND SANITARY DEFECTS. Defective Drains. j Defective Connections. Choked Drains. Defective Soil Pipes and Drain Ventilators. Defective Fresh Air Inlets. Absence of, and Broken Manhole Covers, etc. Absence of, and Leaky and Defective Sinks. Defective Water-closets. Water Supply to W.C.'s. Leaky Roofs. Defective Eaves Guttering. Defective Waste, Rainwater Pipes, etc. Dampness in Walls, Floors, etc. Insufficient Ashpits. Defective Paving of Yards, Outhouses, etc. Improper Situation of, or Construction of Drinking Water Cisterns. Premises requiring Repairing and Cleansing. Overcrowding. Nuisances from Keeping Animals, etc. Accumulations of Stagnant Water. Accumulations of Offensive Matter. Manure etc Other Defects. Adults. Children. TOTAL. Persons per House, including Children. Living and Sleeping Rooms per House. EASTERN DISTRICT Binns Road 36 23 1 — 180 28 208 99 117 5.8 6.0 - - - - - — 1 9 2 5 4 - 10 1 2 - 28 - - - - 20 Fraser Street 23 17 — — 97 23 120 73 72 5.2 6.3 - - - - 1 — 2 1 3 7 2 5 12 — 1 - 19 - - — — 22 Giebe Street 64 26 3 — 267 21 288 171 186 4.5 5.5 - - - - - — 1 — — 9 — 1 15 1 — - 28 - - — — 26 Paxton Road 75 19 — .— 266 41 307 198 205 4.1 5.3 - 1 1 - — 2 4 4 16 — 3 20 4 - - - - 1 — 29 Quick Road 43 32 — — 214 35 249 130 123 5.7 5.8 - - - - — — 13 2 1 11 2 17 21 2 1 - 38 — - — — 43 Rec'kitt Road 40 31 1 — 220 33 253 137 137 5.5 6.0 - - 1 2 - — 9 4 2 12 — 10 19 2 6 - 37 — - 1 — 49 Short Road 15 5 — — 52 3 55 38 37 3.7 5.0 - - - - - — — — — 3 — 1 0 — — - 8 — - — — 8 Totals 302 153 5 — 1296 184 1480 846 877 — — - — 2 3 1 28 13 12 63 8 37 109 10 10 — 195 — 2 - 197 CENTRAL DISTRICT Bond Street 10 — — — 31 4 35 20 20 3.5 4.0 - - — - - — 1 — 2 5 6 2 5 1 1 - 7 — - — — 20 Clifton Gardens 43 18 — — 188 35 223 108 142 5.2 5.8 - - I 4 - — 7 6 .1 14 13 21 23 5 12 - 32 — - 1 — 60 Fishers Lane 20 5 — — 81 11 92 41 56 4.6 4.8 - - — — - — 4 1 — 6 2 7 4 3 1 - 11 - - — — 19 Geraldine Road 29 3 — — 98 12 110 55 79 3.8 4.0 - - — 1 1 — 2 1 5 8 9 6 12 2 7 - 26 - - — — 27 Holly Road 40 23 4 — 205 28 233 109 134 5.8 6.0 - - — 3 1 — 2 2 2 o 1 2 3 2 2 - 23 — - — — 27 Pyrmont Road 30 26 - - 167 40 207 75 102 0.9 5.9 - - 1 1 - — 5 3 3 5 7 7 11 3 1 - 26 - - - - 27 Spring Grove 29 — — — 89 18 107 61 64 3.7 4.3 - - — — - — 1 — 4 5 2 5 9 2 4 - 20 - - 1 — 38 West Place 4 — — — 10 3 13 4 4 3.2 2.0 - - — — - — — — 1 — — - - - — - — - - — — - Windmill Road 25 5 — — 83 10 93 55 63 3.7 4.7 - - — - 2 — 2 — — 3 3 1 1 - 13 — - — — 16 Totals 230 80 4 — 952 161 1113 528 664 - - - - 2 9 2 - 24 13 24 48 40 53 70 19 29 - 158 - - 2 - 234 WESTERN DISTRICT. Albany Road 56 — — — 205 36 241 101 119 4.3 3.9 - - 2 — — — 2 1 1 22 1 4 7 4 4 1 35 — - — — 34 Bangor Road 11 — — — 41 9 50 22 35 4.5 5.1 - - — — — — — 1 1 2 1 1 6 2 - - 9 — - — — 8 Catherine Row 8 — — — 21 9 30 8 16 3.7 3.0 - - — — — — — - — — — — - 1 1 - 6 — - — — 3 Ealing Road (Part of) 74 2 - - 248 33 281 179 197 3.8 5.0 - - — — — — 1 2 6 18 5 1 11 2 3 - 28 - - 2 - 46 Harnage Road 22 - - - 79 9 88 44 66 4.0 5.0 - - 2 — — — 1 1 2 5 2 2 4 2 - 17 - - - - 17 Mount Pleasant 4 - - - 12 3 15 8 8 3.8 4.0 - - - - - - - - 2 3 - - 9 1 - - 3 - - - - 1 New Spring Gardens 11 - - - 35 4 39 22 22 3.5 4.0 - - - - - - - - - - - - - - - - - - - - - 11 Paradise Place 11 - - - 41 10 51 22 23 4.6 4.0 - - 1 - - - 1 - 2 - - 1 - 1 - - 7 - - - - 3 Sussex Place 12 - - - 46 9 55 24 36 4.6 5.0 - - — - 3 - 1 - 2 3 - 1 4 1 1 - 11 - - - 6 Westbury Place 13 — — — 40 3 43 26 26 3.3 4.0 - - - - - - - — 3 6 2 1 1 2 2 - 8 - - - - 8 Totals 222 2 - - 768 125 893 456 548 - - - - 5 - 3 - 6 5 19 64 11 11 44 16 11 1 131 - - 2 - 137 Grand Totals 754 235 9 - 3016 470 3486 1830 2089 - - - - 9 12 6 - 58 31 55 175 59 101 223 45 50 1 484 - - 6 — 568 HOUSE TO HOUSE INSPECTION, 1937. Table of Defects, &c., and Population. 41 (2) Number of dwelling-houses in which defects were remedied after service of formal notices : (i) by owners 6 (ii) by local authority in default of owners (c) Proceedings under Sections 11 and 13 of the Housing Act, 1936 :— (1) Number of dwelling-houses in respect of which Demolition Orders were made 3 (2) Number of dwelling-houses demolished in pursuance of Demolition Orders (d) Proceedings under Section 12 of the Housing Act, 1936 : (1) Number of separate tenements or underground rooms in respect of which Closing Orders were made — (2) Number of separate tenements or underground rooms in respect of which Closing Orders were determined, the tenement or room having been rendered fit — 4. Housing Act, 1936.— Overcrowding. (a) (i) Number of dwellings overcrowded at end of year 182 (ii) Number of families dwelling therein 183 (iii) Number of persons dwelling therein 1,313 (b) Number of new cases of overcrowding reported during the year 34 (c) (i) Number of cases of overcrowding relieved during the year ISO (ii) Number of persons concerned in such cases 1,063 (d) Particulars of any cases in which dwelling-houses have again become overcrowded after the Local Authority have taken steps for the abatement of overcrowding 1 No. 50, The Ham.—In January 1937 an overcrowded family was re-housed by the Council. In February 1937 premises vacated were occupied by a family consisting of man, wife, girl aged 42 three years and a brother-in-law, thereby exceeding "permitted number "of 3 and committing an offence. Statutory notices were served on Agents and Occupier, and the overcrowding was abated by the removal of the brother-in-law of the tenant. (e) Other information regarding statistics for 1937 :— (1) Number of overcrowded families at beginning of year 329 (2) New cases of overcrowding reported during 1937 : (i) Families overcrowded before " Appointed Day " (not previously reported) 9 (ii) Families overcrowded since "Appointed Day" due to natural increase, etc 17 (iii) Families committing offences by overcrowding 8 Total new cases of overcrowding — 34 (3) Overcrowding relieved during the year :— (i) Families overcrowded before " Appointed Day " : (a) Re-housed by Council 43 (b) Abated by removal, decrease in family or extra accommodation taken over, etc. 125 (ii) Families overcrowded due to natural increase : (a) Re-housed by Council 2 (b) Abated by removal, decrease in family or extra accommodation taken over 2 (iii) Overcrowding offences :— Self-abated after notice 8 i.e. (1) Total cases re-housed by the Council during 1937 45 (2) Total cases relieving own overcrowding by removal, decrease in family or extra accommodation taken over, etc. 135 Total cases relieved 180 43 (4) Abatement of overcrowding in Council properties (included in (3) above) :— (i) Number of cases relieved by transfer to other Council properties 13 (ii) Number of cases who relieved their own overcrowding by removal, decrease in family or extra accommodation taken over 17 Total cases relieved 30 (5) Position of Overcrowded Families at end of 1937 : (i) Number of cases still overcrowded who were overcrowded on " Appointed Day " 170 (ii) Number of cases still overcrowded due to natural increase, etc. 13 (iii) Number of cases committing offences — Total cases existing at end of 1937 183 44 SECTION E. INSPECTION AND SUPERVISION OF FOOD. (a) Milk Supply. The following statistics relate to the sale of milk in the area :— Registration particulars :— Number of premises registered :— (a) Selling loose milk 13 (b) Selling in bottles and sealed containers 37 (c) Selling in sealed cartons only (B.D.Milk) 28 Total 78 In addition to the above, eleven persons are registered as "purveyors of milk " working from registered premises outside the Borough. There are no cow-keepers or farms within the Borough. Milk (Special Designations) Order, 1936. The following licences were issued by the Council under the above-mentioned Order :— Number of Dealers' licences to sell :— (a) Tuberculin Tested Milk 7 (b) Accredited Milk 1 (c) Pasteurised Milk 19 (b) Meat and Other Foods. As pointed out in previous reports, the major portion of the meat supply comes through the Central Meat Market of London, although there is one depot of a wholesale distributing firm located at the Brentford Market. Although there are five slaughter-houses on the register, three only are in continual use and in one of these only a few sheep and pigs are slaughtered. 45 Animals brought into the district for slaughter appear to be carefully selected and of a high standard. None were found to be affected with Tuberculosis. Particulars of the number of animals slaughtered within the Borough as well as figures relating to slaughter-houses, bakehouses, food condemned, etc., are set out in the statistics on pages 30 and 31. The major portion of meat condemned was imported meat found to be in an unsound condition. The inspections at slaughter-houses during times of slaughter as well as the periodical inspection of bake-houses, dairies, etc., is routine. (c) and (d) AduIteration, etc. This work is in the hands of the Middlesex County Council, and no samples were submitted to the County Analyst by this Authority. (fi) Nutrition—Dissemination of Knowledge. No special action was taken in this respect, beyond that the nutritional value of various foods are taught to children at the Domestic Subjects Centre and lectures are given to mothers attending the Maternity and Child Welfare Clinics, and to School Children by the Dental Surgeon. 46 SECTION F. PREVALENCE OF, AND CONTROL OVER, INFECTIOUS AND OTHER DISEASES. A—NOTIFIABLE DISEASES DURING THE YEAR. Disease. Total Cases notified. Cases admitted to Hospital Total Deaths. Small-pox Scarlet Fever 201 181 1 Diphtheria 39 39 1 Enteric Fever (including Paratyphoid) 2 2 — Puerperal Fever — — — Puerperal Pyrexia 21 21 — Pneumonia 36 1* 41 Erysipelas 12 1 1 Cerebro-Spinal Fever 1 1 — Acute Polio-encephalitis 1 1 1 Dysentery 1 1 - * Full details of other patients suffering from Pneumonia who received hospital treatment are not available. B.—OPHTHALMIA NEONATORUM. Cases notified. Cases treated at Home. Cases treated in Hospital Vision unimpaired. Vision impaired. Total Blindness. Deaths. — — — — — — — 47 C.— AGES OF CASES OF INFECTIOUS DISEASES NOTIFIED DURING THE YEAR 1937. Notifiable Disease. Number of Cases Notified. At all Ages. At Ages—Years. Under 1 1 2 3 4 5 and under 10 10 and under 15 15 and under 20 20 and under 35 35 and under 45 45 and under 65 65 and over. Small-pox — — — — — — — — — — — — — Scarlet Fever 201 2 7 7 21 17 96 25 4 16 4 2 — Diphtheria 39 — — 4 1 1 13 6 4 7 3 — — Enteric Fever (including Paratyphoid) 2 — — — — — — — — — — — — Puerperal Fever — — — — — — — — — — — — — Puerperal Pyrexia 21 — — — — — — — 2 17 2 — — Pneumonia 36 — — 1 — 1 1 1 4 7 2 10 9 Erysipelas 12 — — — — — 1 — — 1 1 7 2 Cerebro-Spinal Fever 1 — — 1 — — — — — — — — — Acute Polio-encephalitis 1 — — — — — — — — — — 1 — Dysentery 1 — — 1 — — — — — — — — — 48 D—CASES OF INFECTIOUS DISEASES NOTIFIED DURING THE YEAR 1937, CLASSIFIED IN WARDS. Notifiable Disease. Number of cases notified Brentford East Brentford Central Brentford West Bedford Park Chiswick Park Grove Park Gunnersbury Old Chiswick Turnham Green Scarlet Fever 30 24 39 6 34 14 14 16 24 Diphtheria 5 8 4 1 10 2 4 3 2 Enteric Fever (including Paratyphoid) — — — — 2 — — — — Puerperal Fever — — — — — — — — Puerperal Pyrexia 15* — — — 1 3 1 1 Pneumonia 3 3 3 1 9 2 3 5 7 Erysipelas — — 2 — 4 4 1 1 — Cerebro-Spinal Fever — — — — 1 — — — — Acute Polio-encephalitis — — 1 — — — — — — Dysentery — — — — 1 — — — — Tuberculosis— Respiratory 5 9 13 5 9 9 12 15 7 Non-respiratory — 1 1 1 5 1 2 3 4 *These cases occurred in the Chiswick and Ealing Maternity Hospital, 13 of the patients being residents of Ealing and the remainder (two) residents of Brentford and Chiswick. 49 A perusal of the foregoing tables will show the incidence of notifiable diseases in the Borough as well as their classification in age and ward groups. As noted in my report for last year, the extension and reconstruction of the Isolation Hospital under the control of the Brentford, Chiswick and Ealing Joint Hospitals Committee, was completed during 1937. As a result the Borough has now ample isolation hospital accommodation to meet—it is hoped—all calls that may be made upon it. So far as this accommodation is concerned, the report of the Medical Superintendent of the Joint Hospitals, kindly furnished to me by Dr. T. Orr, and appended to this report, serves to shew how this accommodation was utilised during the past year as well as dealing with the nature of the complaints treated. Dealing with the more important of the notifiable diseases : (a) Scarlet Fever. The number of cases notified was 201, showing an increase of 37 cases over the preceding year and giving an attack rate of 3.2 per 1000 of the population. Of the 201 cases notified, 181 received hospital treatment. One death occurred from this disease while under hospital treatment. (b) Diphtheria. The cases of Diphtheria notified duirng the year were again remarkably small in number, viz., 39 as compared with 17 during the year 1936, and giving an attack rate of just under 0.6 per 1,000 of the population. All cases were removed for hospital treatment and one death occurred from this disease. Although anti-toxin is supplied free to medical practitioners it would seem that they do not avail themselves of the service to any extent, probaly owing to the very prompt removal of diagnosed cases to hospital. The cost of the antitoxin purchased during the year was £3 17s. Od. As regards the action taken by the Council to provide facilities for immunisation against Diphtheria, previous reports shew that an Immunisation Clinic was opened in the Borough during 1935. 50 The number of immunisation certificates issued since the inception of the clinic is as under:— 1935 (June-December) 95 1936 566 1937 444 A recent examination of the cost of the clinic shews it to be approximately 5s. 4d. per head—a figure which includes surgeon's fees as well as materials but not of course proportion of nurses' salary, rent, etc., costs which would have been incurred in any case even if the clinic had not been held. One case of Diphtheria was notified during 1937, the patient having been previously immunised. The case was mild in character, and caused very little distress to the patient. Dr. King-Brown, the specialist in charge of the Council's Immunisation Clinic, has kindly furnished me with the undermentioned report respecting the working of that clinic during the past year. REPORT ON DIPHTHERIA IMMUNISATION CLINIC. It will be seen from the appended table that there has been a fall in the number of children attending, and in the total number of attendances. This is probably due, in the former case, to the fact that it is the clinic's third year and that some of the earlier enthusiasm has abated. In the latter case we have the fact that, during the year, a one-dose and later a two-dose method of immunisation was in use, compared with a three-dose method in previous years. This naturally leads to a reduction in the number of total attendances, but is of advantage in reducing the number of children who fail to complete the full course of treatment. It will also be noted that the Schick negative rate (8.8 per cent.) is lower than last year, showing that there is not a high degree of natural immunity in the district, and indicating that the work of immunising the child population artificially is veiy necessary as it is probable that, should an outbreak of diphtheria occur, it might reach very considerable proportions. As mentioned above, a "one-shot" method of immunisation using alum-precipitated toxoid (A.P.T.) was tried during the year, but on re-testing the children after treatment it was found that with one brand of A.P.T., 25.4 per cent. of the 51 children were not immune, and with another brand 27 per cent. were not immune. As the three-dose method (using T.A.M.) previously employed gave only 1.9 per cent. not immunised, these were considered to be very poor results, so subsequently a " two-shot " method of using A.P.T. was introduced. The results of the re-tests of children so treated are not yet available in sufficient numbers to draw any final conclusion, but it will probably be found to be quite satisfactory. Total number of children attending 659 Total number of attendances 1,967 Total number of clinics held 44 Average attendance per clinic 44.5 Total number of Certificates issued 444 Total number of children failing to complete treatment Number of Primary Schick Tests:— 49 Number positive (91.2%) 156 Number negative (8.8%) 15 171 Number of Secondary Schick Tests:— Number positive (15.6%) 65 Number negative (84.4%) 352 Number of Re-Secondary Schick Tests:— 417 Number positive 2 Number negative 74 76 Number of Re-re-Secondary Schick Tests:— Number positive — Number negative 3 — 3 Number of Primary Schick Tests after 2 years:— Number positive 2 Number negative 49 — 51 Analysis of Treatment. Secondary Schick Tests: A.P.T. (" A ")—1 Dose. Positive 17 Negative 35 — 52 A.P.T. (" A ")—2 Doses. Positive 5 Negative 40 — 45 52 A.P.T. (" B ")—1 Dose. Positive 34 Negative 99 — 133 T.A.M. Positive 9 Negative 100 — 109 (c) Puerperal Pyrexia. The Chiswick and Ealing Maternity Hospital being situated within the Borough boundaries, all cases of the above disease occurring there are notified to me. Of the 21 cases of Puerperal Pyrexia notified, 15 occurred in the Council's Maternity Hospital, the home addresses of 13 of these being in the Borough of Ealing. (d) Pneumonia. Thirty-six cases of Pneumonia and Influenzal Pneumonia were notified under the Regulations of 1927. Definite information of those receiving hospital treatment, however, is not available. (e) Non-notifiable Infectious Diseases. The table set out on page 67 of the School Medical Service report indicates the prevalence of these diseases among elementary school children in the Borough during the year. Arrangements are in force with the Joint Hospitals Committee whereby severe cases of Measles may be admitted to the Isolation Hospital, particularly where the home conditions for adequate nursing are unsuitable. The District Nurses are also available for the home nursing of such cases. No action has been taken to supply measles serum for prophylaxis or attenuation. 2. (a) Cancer. Table 1 set out in Section A, page 13, shows that Cancer and Malignant Disease were responsible for 101 deaths during the year under review, representing approximately 14 per cent, of the total deaths. The following tables set out details of the deaths classified in age groups and also details of the prevalence of the disease in particular organs, so far as they are indicated in the death returns. 53 The fact that this Borough is so close to the Metropolis ensures that the facilities for the treatment of Cancer is well known to the medical practitioners and every use is made of them. Cancer : Deaths during the year classified in Age Groups. Age Groups 15/25 years 25/35 years 35/45 years 45/55 years 55/65 years 65/75 years Over 75 years Total Males — 1 — 8 18 19 6 52 Females 1 — 4 7 17 11 9 49 Totals 1 1 4 15 35 30 15 101 Cancer : Main Seats of Disease as indicated in Death Returns during 1937. Organ Male. Female Total Tongue and Mouth 3 1 4 Oesophagus 6 1 7 Stomach 11 11 22 Liver 2 2 4 Bowel and abdominal 6 12 18 Rectum 7 4 11 Bladder 5 1 6 Uterus — 7 7 Breast — 3 3 Pancreas 4 2 6 Lung 7 4 11 (b) Prevention of Blindness. No action was taken under Section 66 of the Public Health Act, 1925, for the prevention of blindness or for the treatment of persons suffering from any disease or injury to the eyes. (c) Tuberculosis. No action was necessary or taken by this Authority under the Public Health (Tuberculosis) Regulations, 1925, or under Section 62 of the Public Health Act, 1925. 54 The following table gives particulars of new cases of Tuberculosis, both pulmonary and non-pulmonary, notified during 1937, as well as particulars of deaths which occurred as a result of the disease. E.—tuberculosis. Age Periods. New Cases. Deaths. Respiratory. Non- Respiratory. Respiratory. Non- Respiratory. Male Female Male Female Male Female Male Female Under 1 year — — 1 — — — — — 1 to 5 years — 1 2 — — — 1 — 5 ,, 15 4 2 1 2 — — — 2 15 „ 25 „ 8 10 3 1 4 4 — — 25 „ 35 „ 6 15 1 3 1 4 — — 35 „ 45 „ 10 5 1 2 5 4 — 1 45 , . 55 „ 3 3 — — 6 1 — — 55 ,, 65 „ 5 1 — — 3 — — — 65 and over 2 — — 1 3 — — — Totals 38 46 9 9 22 13 1 3 As last year, these figures maintain an average which appear to be faily constant in this area, but during the past year the mortality from Respiratory Tuberculosis shews a decrease. The number of deaths due to this disease being 35 as compared with 50 in 1936. So far as can be ascertained, there is no particular evidence which points to excessive incidence or mortality in relation to any particular occupation. The efficiency of notification of this disease in the area is good and no trouble in any way is experienced. The domicilary, sanatorium and hospital treatment of the disease is under the control of the Middlesex County Council. 3. (a) Disinfection and Disinfestation. No change has taken place in the method of disinfection, viz., formalin spraying, fumigation with formaldehyde gas and the stoving of bedding, etc., as and when necessary. Terminal 55 disinfection after Scarlet Fever and Diphtheria etc., is still in operation. Particulars of this work will be found set out on page 30. Disinfestation is referred to under Section C, page 35. (b) Laboratory Work. The following table sets out a record of the bacteriological work during the year, all of which was carried out in the Council's Laboratory:— Suspected Disease. Result. Totals. Positive. Negative. Diphtheria 33 368 401 Tuberculosis 19 116 135 Other Diseases 2 5 7 N.B.—In addition to the above, a number of urine examinations were made in connection with the Clinics, etc. Joint Committee for Education in Brentford & Chiswick ANNUAL REPORT ON THE Medical Inspection OF Elementary School Children FOR THE Year ending 31st December, 1937. R. C. LEANING, M.B., B.S. (Lond.), M.R.C.S., L.R.C.P., D.P.H , R.C.S. (Eng.) School Medical Officer. 58 Borough of Brentford and Chiswick. EDUCATION ACT, 1921. REPORT ON THE MEDICAL INSPECTION AND TREATMENT OF ELEMENTARY SCHOOL CHILDREN FOR THE YEAR ENDING DECEMBER 31st, 1937. To the Chairman and Members of the Education Committee. Ladies and Gentlemen, I beg to submit the following report on the work of the School Medical Service for the year 1937. 1.—STAFF. (1) School Medical Officer (part time) (2) Assistant School Medical Officer (part time). (3) Consulting Surgeon to Orthopaedic Clinic (part time). (4) Consulting Physician to Rheumatism Clinic (part time). (5) Dental Surgeon (part time). (6) Assistant Dental Surgeon (Brentford Clinic—part time). (7) Assistant Dental Surgeon (Chiswick Clinic—part time). Other Duties. Medical Officer of Health. Ophthalmic Surgeon, Secondary Schools, for refraction work. Assistant Medical Officer of Health. Dental Surgeon to Maternity & Child Welfare and AnteNatal Clinics. Dental Surgeon to Secondary Schools 59 (8) (9) (10) (11) (12) (13) Six Nurses (each half-time). Health Visitors. (14) Nurse & Masseuse to Orthopaedic Clinic (part time). (15) Clerk (half time). Clerk to Maternity and Child Welfare Clinic. (16) Clerk (half time). ditto (17) Clerk—School Medical Service (whole time). (18) Female Assistant to Dental Surgeon (whole time). (19) Female Shorthand-Typist to Dental Clinic (whole time). (20) Female Assistant Clerk to Dental Clinic (whole time). Duties of Staff:— The School Medical Officer undertakes Routine and Special examinations, is Medical Officer to the Minor Ailment Clinics, Surgeon to the Ophthalmic Clinic and Anaesthetist to the Dental Clinics. The Assistant School Medical Officer shares all these duties with the exception of those in connection with the Ophthalmic Clinic. A Consulting Surgeon from the Royal National Orthopaedic Hospital attends the Orthopaedic Clinic once a month and a Consulting Physician the Rheumatism Clinic once weekly. The Dental Surgeon works for six sessions in the Chiswick area and for three sessions in the Brentford area weekly. The Assistant Dental Surgeons attend four sessions weekly at Chiswick and two at Brentford. The School Nurses attend all Routine and Special Inspections held by the School Medical Officer and Assistant School Medical Officer, conduct frequent Hygiene Inspections at the schools, undertake Home Visiting and perform nursing duties in the Clinics. They attend the Dental Clinic at all anaesthetic sessions. 60 Nurse Chitty undertakes duties in connection with the Hogarth Boys' Schools (Senior and Junior), the Hogarth Infants and Beverley Road Infant Schools ; Nurse Thompson with the Belmont Group of Schools ; Nurse Clarke with the Hogarth Girls' (Senior and Junior) and the Chiswick Central Schools ; Nurse Warren with the Strand Group of Schools; Nurse Catherwood with Ealing Road, Lionel Road, St. George's, St. Paul's and Clifden Road Infants' Schools ; Nurse Broughton with the Brentford Senior Schools and St. John's School and Canal Boats Children's School. Each Nurse is apportioned a district for Home Visiting corresponding as far as possible with the Schools she attends. This visiting is carried out in conjunction with the duties as Health Visitor. Nursing duties in the Minor Ailment Clinics are shared by the six Nurses. Nurses Catherwood and Thompson attend the Ophthalmic Clinic in their respective areas and Nurse Clarke attends the Rheumatism Clinic. Also Nurse Catherwood is in charge of a Minor Ailment Clinic at Lionel Road School and Nurse Thompson is in nursing charge of the Diphtheria Immunisation Clinic. The Orthopaedic Nurse and Masseuse (from the Royal National Orthopaedic Hospital) attends at the Orthopaedic Clinic at Brentford each Monday and Thursday afternoon during the school year. 2 .-CO-ORDINATION. The policy of combining all the Medical and Nursing services provided for the schools and the Maternity and Child Welfare Clinics has been maintained. The same personnel is used for both services, thus rendering it possible to follow up children from birth until they leave school. Further, all treatment and advising clinics provided by the Education Committee are used by children attending the Child Welfare Clinics. 61 3—SCHOOL HYGIENE AND ACCOMMODATION. The nominal accommodation for children in the schools during 1937 was as follows:— Brentford Schools— Accommodation Ealing Road Junior Mixed 440 Ealing Road Infants' 300 St. George's Junior Mixed and Infants' 366 St. John's Mixed and Infants' 284 St. Paul's Junior Mixed and Infants' 300 Clifden Road Infants' 150 Brentford Senior Boys' 360 Brentford Senior Girls' 360 Lionel Road Junior Mixed and Infants' 500 Canal Boat Children's Department 80 3,140 Chiswick Schools— Belmont Senior Mixed 320 Belmont Junior Mixed 394 Belmont Infants' 350 Beverley Road Infants' 450 Hogarth Senior Boys' 320 Hogarth Junior Boys' 450 Hogarth Senior Girls' 280 Hogarth Junior Girls' 450 Hogarth Infants' 250 Central Boys' 320 Central Girls' 320 Strand-on-the-Green Senior Mixed 290 Strand-on-the-Green J unior Mixed 350 Strand-on-the-Green Infants' 338 4,882 Grand Total 8,022 The average attendance during the year was 5,000. Special Subjects Schools. In the Chiswick area there is a School of Cookery and Housewifery in Horticultural Place, which has accommodation for 36 girls. The Central Girls' School has its own centre for 62 these subjects. Here there are completely fitted cookery and laundry rooms, and a small flat for training purposes, consisting of bedroom, living room and scullery. In the Brentford area, Cookery and Housewifery are taught at the Ealing Road and Brentford Senior Schools. Each Boys' School has its own department for teaching Handicraft and Carpentry. General Hygiene of the Schools. As stated in previous reports this is very satisfactory in all respects in those schools which have been built in recent years, viz., the Central, Brentford Senior, Lionel Road, Clifden Road, Hogarth Infants and Beverley Infants. The Strand Junior and Infant Schools are in process of reconstruction and rebuilding and the alterations are nearly completed. The Hogarth Group of Schools will be seriously affected by the new arterial road. This will give an opportunity for elaborating a scheme which will remove many defects of hygiene that are present in these Schools. The three Church Schools in Brentford continue to do their best with their available accommodation. 4.—MEDICAL INSPECTION. As required by the Board of Education, the following inspections were made during the year:— (a) Routine Inspections of the three code groups, Entrants, Intermediates (viz., those of about eight years of age who have just been, or about to be, transferred from the infants to a higher school), and a group who will be twelve years during the year. There is also a fourth group of children of other ages who have not been examined in one of the above groups. This fourth group includes 300 children who were examined a few weeks before they left school and the findings were entered on special forms for the information of the Juvenile Employment Committee. 650 Entrants, 556 Intermediates, 501 Third Age Group and 545 Others (2,252 in all) were examined during the year. 63 (b) Special Inspections.—These are special inspections made by the School Medical Officer of children suffering from some special disease or disability, and are generally seen at the Minor Ailment Clinic. The figure below does not include the inspections of special groups of cases, such as cripples or children suffering from mental deficiency or those attending clinics other than the Minor Ailment Clinics, or school classes in which there have been cases of certain infectious diseases. 1,520 Special Inspections were made during the year. (c) Re- Inspections, 2,603 in number. Details will be found under heading " Following Up." 5.—FINDINGS OF MEDICAL INSPECTIONS. The number of individual children found at Routine Inspections to require treatment (excluding uneleanliness and Dental Diseases) were Entrants 95, Second Age Group 99, Third Age Group 60 and Others 57 ; Total—311. This table has now been altered so as to indicate the number of these children who were referred for defective vision. (a) Nutrition.—Table lib indicates the condition regarding nutrition of the children examined at Routine Inspections. It shows that those classified as " Bad " numbered 0.8% Entrants, 0.7% Second Age Group, 0.8% Third Age Group and 0.6% Others, or 0.7% of all groups ; 54.1% were found to be excellent, 33.3% normal and 11.8% slightly subnormal. In addition there were children referred for Special Inspection by the Nurses or Head Teachers with the view to providing them with free milk. (b) Uneleanliness.—Five cases were seen at Routine Inspections and six at Special Inspections. None of the Routine cases were severe, as such children are detected by the School Nurses at Personal Hygiene Inspections and excluded from school. Those cases seen at Special Inspections were all of a serious degree and had been referred to the Clinic by the Nurses. They were all dealt with satisfactorily without the necessity of taking legal proceedings. During the year the Nurses made 238 visits to the schools for personal hygiene inspections, an average of 10 visits 64 per school. They made 27,861 examinations, viz., 26,297 inspections and 1,564 re-inspections. Defects were found in 1,532 instances and the number of individual children found to be unclean was 333 as against 371, 372 and 399 in 1936, 1935 and 1934 respectively. The distribution of these defective children was as follows : Brentford Area:— Lionel Road 32, St. John's 27, St. George's 25, St. Paul's 14, Ealing Road Juniors 11, Ealing Road Infants' 13, Boat Children 23, Senior Girls' 5, Senior Boys 2, and Clifden Road Infants' 3. Chiswick Area:— Hogarth Schools : Infants 26, Junior Girls 21, Senior Girls 13, Junior Boys 5. Belmont Schools : Infants 20, Senior Mixed 13, Junior Mixed 15. Strand Schools : Infants 17, Junior Mixed 13, Senior Mixed 5. Beverley Infants 25 and Central Girls 5. The progress made in this part of the work is shown in the following table:— Total number of examinations made by School Nurses. Number of individual children found to be unclean. Average number of visits per school made during the year by School Nurses. 1927 22,913 1185 15 1928 24,682 973 16 1929 26,778 755 16 1930 31,456 823 18 1931 39,039 619 19.6 1932 41,055 504 18 1933 37,501 433 17 1934 36,976 399 16 1935 38,496 372 15 1936 29,142 371 14 1937 27,861 333 10 65 The following table shows the exclusions from school for conditions connected with defective personal hygiene:— Verminous condition. Impetigo Scabies. Ringworm. January 4 16 5 3 February 10 15 4 1 March 12 13 6 2 April 15 15 10 1 May 4 15 5 3 June 7 16 1 — July 3 8 3 13 August 7 6 1 — September 14 21 4 — October 4 18 5 1 November 1 22 4 1 December — 13 2 1 Total exclusions for 1937 81 178 50 26 Total exclusions for 1936 51 96 60 11 .(c) Minor Ailments (vide Table II and Table IV, Group I). The following ailments requiring treatment, classified under this heading, were found during the year:— Routine Inspections Special Inspections Total Skin (including Ringworm, Scabies and Impetigo) 9 237 246 Minor Eye Defects (excluding squint and defective vision) 8 35 43 Ear Defects 12 87 99 Dental Caries 403 29 432 Miscellaneous (minor injuries, bruises, chilblains, etc.) 17 501 518 (d) Tonsils and Adenoids (vide Table II and Table IV, Group III).—During the year, 409 eases were found—299 at Routine and 110 at Special Inspections. Of these cases, 244 (or 64%) required operative treatment, 97 being referred for Tonsils only, 10 for Adenoids only and 137 for both Tonsils and Adenoids. In addition, 72 children were referred for other conditions of the nose and throat, chiefly acute or sub-acute catarrh. 66 (e) Tuberculosis:— Pulmonary.—No cases of Pulmonary Tuberculosis were seen during the year, but four suspected cases were seen at Special Inspections and sent to the Tuberculosis Medical Officer. Non-pulmonary.— Localisation Routine Special Requiring treatment. To be kept under observation. Requiring treatment. To be kept under observation. Total. Glands — — 1 — 1 Bones & Joints — — — — — Other forms — — — — — Total — — 1 — 1 (/) Skin Diseases.—246 cases of skin disease were seen during the year, of which 92 were suffering from Contagious Impetigo. There were three cases of Ringworm of the Scalp and six of the Body. Thirty-nine cases of Scabies were seen. The remaining 106 were cases of Boils, Furuneulosis, Eczema, Urticaria, Seborrhoeic Dermatitis, Lichen Ruber Planus, Psoriasis and Dysidrosis. (g) External Eye Diseases.: 57 cases were seen during the year. At Routine Inspections there were seven cases of Blepharitis and one of Conjunctivitis. At Special Inspections there were 23 cases of Blepharitis, 12 of Conjunctivitis, the remainder consisting of Styes, Cysts, etc. (h) Vision (including Squint) : 248 cases of Defective Vision were seen at Routine Inspections and 19 were brought to the Minor Ailment Clinics. Of these, 129 were referred for treatment and 119 were kept under observation as they had already been supplied with glasses which appeared to be satisfactory. Of the above cases, 32 were suffering from Squint, 24 being seen at Routine Inspections and 8 at Minor Ailment Clinics. 12 were referred for Treatment and 20 (already receiving treatment) were referred for observation. (i) Ear Diseases and Defective Hearing: 14 cases of Defective Hearing caused chiefly by Adenoids or Otitis Media 67 were seen and all were of a mild type. There were 63 eases of Otitis Media, 9 being found at Routine Inspections and 54 at Special Inspections. (j) Dental Defects: At Routine Inspections 403 cases were found and at Special Inspections 29 cases were brought by parents. Miss Loretz, the Dental Surgeon, reports on this subject under the section " Medical Treatment." 6.—INFECTIOUS DISEASE. The incidence and prevalence of infectious disease is shewn in the following tables:— TABLE SHOWING THE EXCLUSION OF CHILDREN FROM SCHOOL ON ACCOUNT OF INFECTIOUS DISEASE. Month. Scarlet Fever Diphtheria Chicken Pox Measles Whooping Cough Mumps Influenza German Measles January 25 (3) - (-) 37 (5) 1 B 25 (-) - (-) — — February 20 (1) 1 (1) 25 (4) 1 (") 33 (-) 3 (-) 1 — March 22 (9) 3 (5) 29 (3) 2 (37) 37 (1) 3 (-) — — April 27 (17) 1 (-) 54 (6) i B 40 (2) 8 (-) 3 — May 28 (16) 1 (-) 17 (4) 1 (2) 27 (-) 14 (-) 1 2 June 22 (4) 3 (-) 3 (-) 2 (1) 16 (3) 19 (-) — 1 July 15 (8) - (1) . - (-) 2 (-) 10 (-) 14 (-) 2 1 August 8 (2) 2 (2) - (-) - (-) 5 (-) - (-) — — September 19 (12) 5 (1) 1 (-) 1 (-) 3 (1) - (-) — — October 26 (16) 4 (5) 3 (-) - (1) - (1) - (-) — — November 23 (6) 11 (8) 32 (10) 15 (2) 1 (-) - (-) — — December 17 (3) 9 (4) 43 (4) 37 (3) 3 B 1 (-) — — Totals 252 40 244 63 200 62 8 Contacts (98) (27) (36) (9) (8) (-) 4 Corresponding totals for 170 21 306 886 238 554 12 2 1936 (115) (18) (36) (91) (14) (19) Figures in brackets are the number of children living in the same house and excluded from school on account of the disease. 68 CHILDREN ATTENDING MINOR AILMENT CLINICS SUFFERING FROM INFECTIOUS DISEASE. Scarlet Fever. Diphtheria. Chicken Pox. Measles. Whooping Cough. Mumps. Influenza. German Measles January -(3) 2 (1) 7 (1) -(-) 3 (-) -(-) 5 — February - (2) - (-) 3 (I) -(-) 2 (1) 2 (-) 4 — March - (-) - (-) 1 (2) - (-) 3 (2) - (-) 1 — April 2 (13) - (-) 1 (4) - (-) 3 (1) -(1) 1 — May 2 (8) -(-) 1 (1) -(-) 2 (2) -(-) — 2 June - (7) - (-) 1 (1) -(1) 2 (1) 1 (-) 2 1 July 1 (2) -(1) - (-) -(-) - (-) - (-) 2 1 August -(-) - (-) - (-) -(-) - (-) -(-) — — September -(8) - (-) -(-) -(-) -(-) -(-) — — October 2 (3) - (1) -(-) -(-) - (-) -(-) 6 — November 1 (13) -(-) I (4) -(-) -(-) -(-) 0 — December - (3) 1 (-) 3 (4) - (-) - (-) -(-) 3 — Totals Conval. and Contacts 8 (62) 3 (3) 18 (18) - (l) 15 (8) 3 (1) 26 4 Corresponding figures for 1936 3 (28) 3 (8) 32 (9) 12 (35) 20 (2) 80 (1) 12 2 Figures in brackets denote Contacts and Convalescents. Scarlet Fever : During the last few years this disease has altered both in character and incidence. In former times it was apt to become epidemic in the autumn, fading out about Christmas time. Now the incidence appears to be fairly constant throughout the year, but fortunately is of a much milder type than formerly. Diphtheria : No severe epidemic occurred but rather more cases were seen ill November and December. Chicken-pox was prevalent (except during August and September), especially in June and December. Measles: Comparatively few cases were seen until November and December. Epidemics of this disease occur with the greatest regularity in alternate years, as will be seen in the table at the end of this section. Whooping Cough : This disease was very prevalent during the first live months of the year, especially in April. Mumps : There was a comparative freedom from this disease but a few cases were seen in May, June and July. At no time did it reach an epidemic standard. 69 Influenza : Very few cases were seen during the year. The prevalence of infectious disease in the schools compared with that of the eight previous years is shewn in the following table:— 1929 1930 1931 1932 1933 1934 1935 1936 1937 Scarlet Fever 88 102 71 337 550 358 126 170 252 Diphtheria 109 139 75 46 153 65 71 21 40 Chicken Pox 429 239 357 173 347 242 229 306 244 Measles 70 680 69 895 60 585 43 886 63 Whooping Cough 429 65 230 295 167 206 316 238 200 Mumps 423 178 275 57 37 445 493 554 62 Influenza 227 161 183 124 117 60 9 12 8 7.—FOLLOWING UP. The following up of children found to be defective and referred for treatment or for observation at Routine and Special Inspections, is undertaken both by the School Nurses and the School Medical Officer an may be summarised as follows:— School Nurses. (a) Home Visiting: (1) of children excluded for uneleanliness, (2) of those whose parents have neglected or refused treatment which is considered necessary, (3) of those needing treatment whose parents were not present at the inspection, (4) to explain certain forms of home treatment advised by the School Medical Officer, (5) to obtain certain special information required by the School Medical Officer. Number of visits made—1,522. (b) Re-examination at the School of all children found to be defective at the Personal Hygiene Inspections ; 1,532 such reinspections were made during the year. School Medical Officer. Re-examinations of (a) children found to be defective at Routine Inspections and (b) children found to be defective at Special Inspections. The total number of these re-examinations was 1,365 and 1,238 respectively, viz. 2,603 in all. As regards the 1,365 children found to be defective at Routing Inspections, 760 or 56% had been referred for treatment and the remainder, 605, for observation. 70 The results of these further examinations were as follows: Referred for treatment. Treated Untreated Now referred for observation 760 283 323 only. 154 Referred for observation. Now satisfactory. Continue observation. Now referred for treatment . 605 312 191 102 8.—MEDICAL TREATMENT. The number of individual children found at Routine Medical Inspections to require treatment (excluding for uneleanliness and dental diseases) is shewn in Table 11b. The following table shews how these figures compare with those of the eight previous years and it will be noted that there has been a steady improvement:— 1929 1930 1931 1932 1933 1934 1935 1936 1937 % °/ /0 % % % % 0/ /o % % 1st Age Group 27.4 30.3 27.6 20.2 18.8 18.8 20.9 13.2 14.6 2nd Age Group 28.8 25.7 27.7 24.3 18.8 20.8 20.0 16.3 17.8 3rd Age Group 25.2 26.3 21.1 17.4 15.4 13.9 12.3 8.6 119 Total (Code Groups) 27.5 27.6 25.3 20.0 17.5 17.7 16.0 12.7 14.6 Other Routine Inspections 14.6 18.6 16.3 11.1 15.7 26.1 21.3 11.0 10.5 The Local Authority undertakes treatment as follows:— (a) For Minor Ailments. (b) Operative treatment for Tonsils and Adenoids. (c) X-ray treatment for Ringworm. (d) Refraction work for defective vision, and provision of spectacles. (e) Treatment of dental defects. (f) Orthopaedic treatment. (g) Treatment of Rheumatism. Free medical treatment is provided in cases in which the total weekly income of the family, exclusive of rent, insurance and travelling expenses of the wage earners to and from work, does not exceed:— 10s. per head, if the family is six or less in number 9s. per head, if the family is more than six in number. 71 Where free treatment is not provided, the parents'payments to be according to the following scale for each treatment. If the weekly income, exclusive of expenses as set out above, per head of family is more than 9s. and less than 15s. is 15s. or more. s. d. s. d. Minor Ailments 2 0 3 0 Spectacles 4 0 5 0 Dentistry 1 0 2 6 Tonsils and Adenoids 4 0 6 6 Ringworm 7 6 10 0 In the case of Minor Ailments no charge is made for the first two weeks. The following Table shows the scale of charges for Orthopaedic treatment:— Family Income. Charge to be made for treatment in Hospital. Charge to be made for treatment at School Clinic. Under 7/-per head Nil. Nil. 7/-to 8/6 per head 2/6 per week 3d. per treatment 8/6 to 10/- per head 5/- „ „ 6d. „ „ 10/-to 12/6 per head 7/6 „ „ 6d. „ „ 12/6 to 15/-per head 10/6 „ „ 1/- „ „ 15/-to 20/-per head 21/- „ „ 1/- „ „ Over 20/- average. 42/- „ „ 1/- „ „ The income derived from these contributing fees, compared with the three previous years, is shewn thus : 1937 1936 1935 1934 £ s. d. £ s. d. £ s. d. £ s. d. Tonsils and Adenoids operations — — 2 14 0 11 11 0 Spectacles 24 8 7 35 14 0 33 7 8 32 14 2 Dental Treatment 185 2 9 100 7 0 112 10 6 132 19 6 Orthopaedic Treatment 16 19 3 17 19 9 11 14 0 16 4 6 £226 10 7 £154 0 9 £160 6 2 £193 9 2 72 on Tuesdays, Thursdays and Fridays Special Inspections are held to which parents are invited. The work done in the Clinics during the year is indicated in the following table :— Inspections of special cases 990 Re-inspections of special cases 609 Number of individual children attending 3,792 Number of attendances made 13,755 Number of exclusion certificates issued 697 Number of return certificates issued 541 (b) Tonsils and Adenoids : Unfortunately the Chiswick Hospital remained closed during 1937 and in consequence we had to arrange for the operative treatment of children suffering from diseases of the above structures at other Hospitals. Forty-one children were operated upon at the West London Hospital and two by their own doctor. 115 received other forms of treatment by removing septic teeth and getting them to attend the Orthopaedic Clinic for breathing exercises. Marked improvement took place in quite a number of these cases. (c) Tuberculosis : Treatment of this disease is undertaken by the Middlesex County Council and three cases (two girls and one boy) were admitted to Harefield Sanatorium for tuberculosis of the lung. The County Tuberculosis Officer kept under observation four suspected cases and eight contacts. (d) Skin Diseases : All cases of skin disease are treated in the Minor Ailment Clinics. Ringworm : Three cases of ringworm of the scalp and six cases of the body were successfully dealt with in the Clinics. Scabies : After a period of comparative immunity this affection seems to be very much on the increase and 39 cases were treated during the year. Kathiolan is the agent used in the clinics and when used according to instruction produces a rapid cure. Unfortunately some families have a genuine difficulty in carrying out all the cleansing measures required and in these cases the disease is likely to be protracted. It is hoped that a cleansing station is to be established by the Joint Hospitals Committee, an action which will provide a real necessity for this Borough. 73 Contagious Impetigo : The 92 eases noted were mostly of a mild type and quickly yielded to treatment. Children suffering from this disease attend the Minor Ailment Clinics daily where their sores are treated with a lotion containing Zinc and Copper Sulphate or with Flavine, followed by ointments containing Zinc and Ammoniated Mercury. (e) External Eye Diseases : All the cases of Blepharitis, Conjunctivitis and Corneal Ulcer were successfully treated at the Clinics. (/) Vision : Defects of vision are treated in the Eye Clinics at Brentford and Chiswick. All children are examined by Retinoscopy after the application of a mydriatic (" eye drops "). 252 children were treated in these clinics during the year and an analysis of the results is shewn below :— (1) Spectacles prescribed 229 Spectacles issued 221 (four other children obtained spectacles at Hospitals) (2) Conditions other than refractive error found during examination— Squint 26 Chronic Blepharitis 5 Interstitial Keratitis 1 Nystagmus 1 Migraine 3 Blind in one eye 1 Congenital Cataract 1 (3) Degree of visual acuity (when unequal, the acuity of worse eve)— 6/6 6/9 6/12 6/18 6/24 6/36 6/60 less than 6/60 No of Children 33 25 16 23 64 43 25 14 High Myopia ... ... ... ... ... ... ... ... 1 (4) Varieties of Refractive Error— Hypermetropia (long sight) 80 Simple Hypermetropic Astigmatism 19 Compound Hypermetropic Astigmatism 57 Myopia (short sight) 43 Simple Myopic Astigmatism 2 Compound Myopic Astigmatism 22 Mixed Astigmatism 11 Emmetropia (normal sight) 7 74 Squint: Twenty-six cases were treated at the Clinic by means of glasses to correct the errors of refraction- that are almost invariably present, and one was sent to hospital for operative treatment. These, together with cases seen in previous years, attend at regular intervals for re-inspection. High Myopia : One case was seen during the year and was kept under close observation. The attendances at the Eye Clinics were as follows :— Clinics held 81 Attendances—including those for " eye drops ") 1,228 Retinoscopies 252 Prescriptions 229 Spectacles issued 221 Repairs 260 Others (reports, re-inspections, etc.) 178 (g) Ear Diseases : Fourteen cases of defective hearing were seen and 13 were referred for the treatent of Adenoids, Otitis Media or impacted cerumen. One, a deaf mute, was recommended for a Special School for the Deaf. Sixty-one cases of Otitis Media were treated during the year. Whenever possible, the Adenoid growths of the children were treated by operation. We continued to obtain satisfactory results by treating with spirit drops and the insufflation of a powder of Boracic Acid and Iodine. When the new Clinic is opened in Brentford it will be possible to use ionisation for the treatment of these cases. (h) Dental Treatment: Miss M. M. Loretz, the School Dental Surgeon, reports :— In 1937 3,223 children were inspected in the course of 17 routine inspections held in the schools. Seven schools with a total average attendance of 1,200 children had not been inspected by the end of the year. This represents 24 per cent, of the Elementary School population of the district. The number of inspections recorded under " Specials consists of (a) 934 children who attended at the clinic for inspection, the majority being new admittances since, or absentees from, the routine school inspection, and (b) 477 Leavers inspected in the course of 10 special sessions as described in previous reports. 75 per cent, of these Leavers 75 obtained their school leaving certificate of dental fitness. 393 of the grand total of 4,634 were re-inspections. The percentage of children for whom treatment was accepted reached the new record figure of 82 per cent. Of the 3,762 children referred for treatment, 2,573 were given complete treatment, and about 500 had received partial treatment or were still awaiting treatment at the end of the year. The foregoing figures stress more eloquently than any verbal statement the urgent need for the increase in staff which is to be effected during the present year. 4,117 teeth were filled and 4,553 were extracted. Excluding teeth removed for regulation purposes, six permanent teeth were filled to every one extracted. Notwithstanding this, the number of carious permanent teeth extracted per 100 children treated, viz. 20, is still lamentably high, and, inasmuch as it is due to the long periods between inspections, stresses again the need for an increase of staff. Under the heading " Other operations on permanent teeth," are included : Scalings 107, Dressings 187, Root Fillings 21, Crowns 3, Orthodontic visits 142, Silver nitrate treatment 4. Eighteen orthodontic cases were treated during the year, of which 11 were completed. These cases required only the simplest form of treatment, and the cost of the apparatus was borne by the parents. The After-Care Scheme continued to function smoothly during the year, but the number of children who enrolled, 11%, was no more encouraging than in previous years. Since the inception of the Scheme at Christmas 11)32, 2,272 children have left with Certificates, of whom 266 or 11.7% have joined the Scheme. 134, or 50% of these 266 members have been disqualified from membership by failing to keep their half-yearly inspection appointment. It should be explained, however, that of these 134 defaulters nine have left the district, six have joined H.M. Forces, 15 have obtained employment which provides dental treatment and 20 were on the panels of dentists who resigned, so there remain 84 or 31% who defaulted presumably through pure slackness. Thirteen members have completed their treatment under the Scheme. Therefore there are now 119 children in the Scheme who are under the care of 15 dentists. 76 The School Saving Scheme which was proposed and organised by the Head Teachers in the Schools has been a considerable help to enrolment. One hundred and fifty one enrolment fees were saved under this scheme. Thirty-six were not used for enrolment and were returned, but 115 children, that is 43% of the total number who enrolled in the After-Care Scheme, benefited by this scheme. At the Annual General Meeting of Practitioners engaged in the Scheme, held in January, 1938, after much discussion and consideration, it was decided to adopt the Managing Committee's resolution " That the Scheme be closed to new members after the Christmas 1937 leaving period." The Committee's decision was chiefly influenced by the fact that the type of child for whom the scheme was devised was not taking advantage of it and that the reasons for this failure and methods for counteracting it were beyond the Committee's control. The opinion of the Committee as to the possibilities of the scheme may be summarised as follows : '' As far as the provision of dental treatment is concerned, the Scheme is good, except for the inadequacy of the fee. It has worked smoothly for five years and should continue to do so until its completion, but, in view of the fact that it has to do with young persons, immature morally and intellectually, from a class up to the present woefully lacking in dental conscience, such a scheme should be supported by some lay organisation. The Committee would prefer that this organisation should be the employers or, failing that, After-Care Visitors, who would continue to exercise the disciplinary influence, formerly exerted by the teachers, from which the child is abruptly liberated and which parental authority, for a variety of reasons, appears to be incapable of replacing adequately." This last report on an interesting experiment would not be complete without a most grateful acknowledgement of the debt which the district owes to the practitioners who made it a working proposition and who supported it loyally and generously for five years. It is greatly to be regretted that the Scheme should have been killed by the indifference of those whom it was designed to benefit, but, to quote speakers at the meeting, it has not died in dishonour. It has been widely acknowledged as a pioneer effort, and has aroused interest both in England and Scotland. Information has been acquired which may be of future interest, and towns who have asked for details of our 77 Scheme have started similar ones. One may hope that they will gain knowledge from our failures and that their efforts will be crowned with success. (i) Orthopaedic : The following table of crippled children attending the schools was completed with the aid of the Head Teachers :— Canal Boat Department. 1. Boy aged 12 years. Paralysis of left leg. St. George's School. 2. Girl aged 10 years. Infantile paralysis. St. John's School. 3. Girl aged 13 years. Infantile paralysis. Belmont Junior Mixed. 4. Girl aged 10 years. Stiff knee. 5. Boy aged 9 years. Defective leg. Central Boy's School. 6. Boy aged 13 years. Shortened leg due to hip disease. Hogarth Senior Boys'. 7. Boy aged 13 years. Hip trouble. 8. Boy aged 11 years. Right arm and hand defective. Hogarth Senior Girls'. 9. Girl aged 13 years. Osteomyelitis. Strand Junior Mixed. 10. Girl aged 10 years. Lower limbs. Strand Infants'. 11. Girl aged 5 years. Infantile paralysis. Orthopaedic Clinic : This clinic is held at Portsdown House, The Butts, Brentford, on Monday and Thursday afternoons. A Specialist from the Stanmore Branch of the Royal National Orthopaedic Hospital attends on the second Thursday in each month and a trained Masseuse from the same Hospital attends all sessions of the clinic. Mr. Seddon's report on the work of this clinic follows the statistical table relating to this clinic. 78 The attendances at the clinic are shewn in the following table :— Number of children. Attendances. School Children— For general deformities 82 579 For breathing exercises 11 49 Children from Maternity and Child Welfare Clinics— For general deformities 43 184 Totals 136 1,012 The following three children were admitted to Stanmore for in-patient treatment:— Schools (two children)— 1. J. D. F. Vicious union after fracture. 2. W. C. M. Osteitis. Maternity and Child Welfare— 3. H. Y. F. Metatarsus varus. Mr. Seddon reports as follows :— The most important event in the history of the Orthopaedic Clinic during the last year is the construction of the new Health Centre. The old quarters were most inadequate, as the treatment of patients by remedial exercises requires a certain floor space not to be found in any room at the old Centre. The Medical Officer of Health and the Borough Architect were good enough to invite my co-operation in the planning of the new Centre, and I was allowed to suggest features that have proved a success at centres elsewhere. We now have a treatment room of adequate size, particularly in length ; ideal accommodation for special apparatus ; and a comparatively novel feature—an enclosed plot where children may perform remedial exercises in the open air. Thanks to work done in the past two decades, orthopaedics is no longer concerned so much with the correction of gross deformity as with the early detection and treatment of conditions that may, if neglected, lead to crippling. The parent is no longer beseeching us to straighten the deformed child, but is even a little astonished because we pay attention to apparently trivial 79 faults that have escaped the notice of the most observant mother. Because prevention is so much less spectacular than cure, an atmosphere of confidence and efficiency is essential to retaining that intangible but important thing, the goodwill and cooperation of the laity. So far as orthopaedics is concerned, I think that the essentials to success are the following :— (1) Careful inspection of school children and infants—which involves a certain discrimination between the trivial and the significant departures from the normal. It is now known, for example, that so-called flat foot may be ignored if a child walks normally, wears his shoes evenly, and has no pain or rigidity of the feet. On the other hand, a little pain in the hip always merits serious attention. (2) The intelligent conduct of the orthopaedic clinic. It is essential that the nature of a potential deformity be explained, in simple language, to the parent in every case. This generally ensures friendly co-operation. The conditions grouped under that strange word orthopaedics, are so diverse that I doubt if we shall ever be able to tell the public very much by means of the pamphlets so valuable in the prevention of diphtheria, or dental disease. The spoken word is best. (3) The demonstration that treatment given at the clinic produces results. This is a most eloquent appeal; it is here where an attractive well-equipped clinic is so valuable, and the treatment must be in the hands of a competent masseuse. These conditions are now happily fulfilled at Brentford. Although good buildings are not essential to the practice of good medicine, one cannot but regard an imposing health centre as a great asset. (4) In the comparatively few cases where hospital treatment is required, the treatment should be such that the patient and his relatives will have the highest regard to the hospital and the clinic working with it. In these ways we shall give to orthopaedic surgery its proper place in the scheme of preventive medicine. 80 Classification of conditions treated at Orthopaedic Clinic :— School Children M. & C.W. Children 1. Congenital Defects— Club foot - 1 Metatarsal varus, pes arcuatus 1 1 Irregular toes, congenital pes pi. valvus, etc. 3 1 Dislocation of hip - 2 Other conditions 6 _ 2. Birth Injuries— Nerve injuries 1 - Torticollis 1 1 3. Rickety Deformities— Bow tibiae 3 9 Knock knees 1 _ Bow legs—intoeing 1 14 4. Non-rickety Deformities— O. C. T. - 5 Knock knees 13 _ 5. Postural defects of the spine, including flat chest 20 - 6. .Structural curvature of the spine 1 - Depressed sternum 3 - 7. Flat feet 14 2 Foot strain 6 _ Pes cavus not due to Infantile Paralysis 1 _ Hallus Valgus 1 - 8. Infantile Paralysis 1 1 9. Septic arthritis 1 1 10. Fractures 2 - Other injuries 2 - 11. Tuberculous joints _ - 12. Other bone diseases— Schlatters' disease 1 - Perthes' disease 1 - Kohlers' disease 2 - Healed arthritis 1 - 13. Osteomyelitis 1 - 14. Other conditions, including postural intoeing 1 4 15. Non-orthopaedic— Plantar wart 1 — Syphilis 1 _ Bursa 1 — 16. No diagnosis 3 1 Rheumatism Clinic : This clinic is held each Thursday morning (except during the school holidays) in the Town Hall Buildings, under the direction of Dr. Gerald Slot, who being on the staff of the Royal Waterloo Hospital and the Royal Hospital, Richmond, is able to treat many of the children at these institutions. A lady visitor from the Invalid Children's Aid Association attends each session of this clinic and reports to the Association details of those who are in need of convalescent or special hospital treatment. 81 I again express the gratitude due from this Authority to the Invalid Children's Aid Association who make between 100 and 200 visits each year to the homes of the children in this district and obtained the Convalescent Home treatment for the 16 children mentioned below without making any charge to this Borough. During the year, 185 children (of whom 78 were new patients) made 575 attendances at the Rheumatism Clinic. The hospital treatment obtained for 36 children is shown as follows :— * In-Patient Out-Patient Rheumatism Heart Disease Chorea Rheumatism Heart Disease Chorea Royal Waterloo Hospital 5 1 3 1 — _ Royal Hospital, Richmond - - - 2 - 2 West MiddlesexHospital 7 3 7 — — Totals 12 4 10 3 - 2 Two special cases were also admitted to hospital, viz., one girl to the Royal Waterloo Hospital suffering from Cerebral Diplegia and one boy to the Royal Hospital, Richmond, for Tetanus. The Invalid Children's Aid Association obtained Convalescent Home treatment for the following cases :— Two heart cases at West Wickham and Broadstairs respectively ; 14 cases of chorea at Homes situated in Broadstairs, Weston-super-Mare, Milford, Woodford, Felixtowe, Ashridge and Brighton. 9.—OPEN AIR EDUCATION. Playground Classes.—Classes are held in the open air whenever possible in the older Infants' Schools, but in the new schools this is not necessary (vide " Open Air Classrooms "). 82 School Camps.—No school camp was held during the year. Open Air Classrooms.—All the new schools are so designed that the whole of one side of the classroom can now be completely opened in suitable weather. In Brentford, this arrangement is found at the Senior, Lionel Road and Clifden Road Schools, while in the Chiswick area the Hogarth Infants' Beverley Road and Central Schools possess these facilities. Day Open Air Schools and Residential Open Air Schools.— There are no such schools in this district and children requiring this type of education are sent to Open Air Schools under other authorities. 10.—PHYSICAL TRAINING. It is a pleasure to report that two Organisers of Physical Training (one for the girls and one for the boys) have been appointed in conjunction with the Borough of Acton, and it is anticipated that a satisfactory account of their work will be included in the next Annual Report. Certain of the teaching staff of the schools have undertaken physical training in the past and anyone who has watched this work must have been impressed by the smartness of some of the classes. Apart from that, the teachers have taken a great part in organised games and many give up a considerable amount of their spare time training the children for open competitions. The following achievements indicate the success of their work :— Cricket: Chiswick Central Boys won the West London Central School League. (Basil Booker was awarded by The Star newspaper a " Jack Hobbs " bat for taking seven wickets for one run.) Football: Brentford Senior Boys won (1) League Championship, Division II, (2) Lilley & Skinner Cup and (3) the Poulton Cup. Lionel Road won the Acton, Brentford and Chiswick Junior League—they won every match obtaining maximum points and scored 85 goals to six. Belmont Senior were finalists in the Lilley & Skinner Cup- Athletics : St. Paul's and St. Lawrence won the Ratepayers Shield. 83 Lionel Road were winners of Inter-School Sports, Brentford. Ealing Road won the Junior Team Championships for Boys and Girls. Swimming successes are mentioned under heading 12. 11.—PROVISION OF MEALS. The Provision of Meals Acts, 1906-14, were adopted by the Authority in 1933 but have not yet been brought into operation. Free dinners were provided for one child at the Central Schools where satisfactory arrangements are made for providing dinners at very moderate cost for children who live some distance from these schools. At all the schools, with the exception of one, milk is issued during the morning at the cost of one halfpenny for one third of a pint. About 2,000 children avail themselves of the facilities provided. In necessitous cases where milk is required, the children are seen by the School Medical Officer who issues the necessary certificates. All such children are kept under observation and weighed at intervals to note any progress that may be made in their nutrition. 114 children are receiving free milk under these circumstances. 12.—SCHOOL BATHS. The Central Boys' School is equipped with a plunge bath and the Central Girls' and Hogarth Infants' Schools also possess baths. During the summer months the older children of the schools are taken to one of the two Swimming Baths in the district where they are taught swimming and nearly every school holds a swimming gala in the autumn. 84 The following table shews the success of this branch of education during 1937 :— School Learners' Certificates (Min 10 yards) No. of Season Tickets gained Certificate of London Schools' Swimming Association 50 yards 100 yards Strand J unior Mixed 38 33 11 2 Strand Senior Mixed 22 16 24 18 Brentford Senior Boys' 33 35 43 28 St. Paul's & St. Lawrence's 24 27 21 12 Central Girls' 20 17 25 20 Ealing Road J unior Mixed 49 28 28 20 Belmont Junior Mixed 27 18 16 8 Central Boys' 23 22 22 12 Hogarth Junior Boys' 15 7 — 3 Hogarth Senior Boys' 26 20 20 8 Belmont Senior Mixed 39 21 27 19 Hogarth Junior Girls' 35 24 16 3 Hogarth Senior Girls' 19 21 29 13 St. John's 16 11 — — St. George's 18 13 7 11 Lionel Road 30 25 9 6 Brentford Senior Girls' 27 17 24 26 In addition to the above— (1) Brentford Senior Girls won (1) London Schools Swimming Association District Championship (Girls) ; (2) Charter Mayoress's Cup ; (3) Bernard Cup. (2) Brentford Senior Boys won the London Schools Swimming Association District Championship (Boys). (3) Central Boys won the Clement's Cup. (4) Central Girls obtained 7 Bronze Medallions and 15 Life Saving Certificates (2 Elementary and 13 Intermediate). (5) Ealing Road Junior Mixed : Five girls and 10 boys swam quarter mile, 4 birls and 6 boys swam half mile and 2 girls and 3 boys swam one mile. (6) St. Paul's and St. Lawrence's were second in District Team Race and second in L.S.S.A. District Championship. Also 3 (1 boy and 2 girls) swam one mile, 8 swam 1 mile and 6 swam quarter mile. (7) Belmont Senior obtained 6 Life Saving Certificates, second place in Clement's Cup and 63 per cent, of non-swimmers learned to swim. 85 (8) Strand Senior obtained 11 Life Saving Certificates (6 Elementary and 5 Intermediate). 13.—CO-OPERATION WITH TEACHERS. The School Medical Service is grateful to the Teachers of schools in this Borough for the keen interest they take in its work, and an excellent spirit of cordiality exists which enables the work to be carried on with greater efficiency. They assist us at the Routine Inspections and re-Inspections, watch for children who appear to require medical attention, and we are thus able to cover much more ground than if we had to do this work by ourselves. We are frequently asking for returns and information which must take up much of their time and this form of help is always given us ungrudgingly. We furnish all Head Teachers with lists of children found at the inspections mentioned above, to be suffering from some defect together with the treatment advised. 14.—CO-OPERATION WITH PARENTS. St. Paul's School is the only school that has a Parents' Association, but it is found that many parents seem to appreciate the value of the service in furthering the interests of their children. They nearly always attend the Routine Inspections of the younger children and an increasing percentage now accompany those in the later age groups. With a few hopeless exceptions, they listen to our advice and if for some reason they do not agree with us are always willing to obtain another opinion. 15.—CO-OPERATION WITH SCHOOL ENQUIRY OFFICERS. The close co-operation of the Service with the School Enquiry Officers, Messrs. Welsh and Baynes, is still maintained and is an important factor in the efficient working of the Service, and I again tender them my thanks for their valuable assistance during the year. They follow up and bring to the Special Inspection Clinic children staying away from school for illness and who are not attending a doctor, children who have been told to attend the clinic and have not done so, and children sent by the Attendance Committee and Police Court. 86 They also provided me with the following table of legal proceedings taken under the School Attendance Byelaws, during the year :— Initials Offender Offence Act Fine T.J. Non-attendance Education Act 20s. Od J.F. ,, ,, Attendance Order F. W. ,, ,, 15s 0d. G. M. ,, ,, 10s. 0d L. R. ,, ,, 10s. 0d. C. G. ,, ,, Attendance Order J.S. ,, ,, ,, F. W. ,, ,, ,, L. D. ,, ,, 5s. 0d. E. T. ,, ,, 4s. 0d. R. P. ,, ,, 7s. 6d. H. B. ,, ,, 20s. 0d. H. P. ,, ,, Attendance Order R. H. ,, ,, 10s. 0d. 16.—CO-OPERATION WITH OTHER BODIES. (1) N.S.P.C.C. : This Society continues to render invaluable aid in obtaining necessary treatment for children who would otherwise be neglected in this respect. These cases have received repeated advice from the Medical Officer and many home visits have been made by- the Nurses. The Local Inspector has sent me the following table of cases dealt with in Brentford and Chiswick during the year Nature of Case Number Number of children affected Total No. of visits  Boys Girls Neglect 12 . .. 147 Ill-treatment 7 26 21 Advice sought 6 25 47 147 In no case was it found necessary to prosecute the parents or guardians concerned. 87 (2) Relieving Officers : Mr. Copp and Mr. Gibson continue to give us willing help in all cases referred to them during the year and we are grateful to them for their invariable courtesy and promptness. (3) The Brentford and Chiswick Philanthropic Societies : These two Societies are always very willing to help children recommended to them who are in need of extra nourishment or clothing. (4) Chiswick Children's Seaside Holiday Fund : Mr. F. A. Baynes, the Honorary Secretary, reports that the following children have been sent by this body for a holiday :— 1926 1927 1928 1929 1930 1931 1932 1933 1934 1935 1936 1937 72 77 104 114 125 123 121 120 119 92 69 68 During 1937, 68 children (27 boys and 41 girls) were sent to Bexhill. The Brentford Philanthropic Society also sent 75 boys and girls to Bexhill and 27 boys to Walmer for a holiday in 1937. Since 1923, 984 children have been given a holiday by this Society. (5) Juvenile Employment and After-Care Committee: In accordance with the Board's Memorandum No. 137, 16th September, 1935, all children were examined just before they left school and a report was sent to the Juvenile Employment Committee. The report was made on a special form printed on the back of the Head Teacher's report and in addition to the general information as to height, weight, eyesight, hearing, etc., a note is made, when necessary, as to the specific unsuitability of the child for particular type or types of occupation. The types of occupation mentioned were as follows :— 1. Severe manual work. 2. Sedentary work. 3. Exposure to bad weather. 4. Work in a dusty atmosphere. 5. Work in a damp atmosphere. 6. Work near moving machinery or moving vehicles. 7. Work involving prolonged standing, much walking, or quick movement from place to place. 88 8. Work causing eye strain. 9. Work requiring acute distant vision. 10. Work requiring acute hearing. 11. Work requiring manipulative skill. The results of the examinations are shown below :— School No. of children examined Type of occupation child should not enter Treatment still required No. of children Index No. on list Hogarth Senior Boys' School 81 2 1. 9. T. and A. . 3 3 4. Vision . 3 2 8. 9. Dental 6 1 1. 3. 5. Rheumatism 1 1 3.4.5. 8. M.D. 1 (Healed T.B. of lung' — 9 14 — Hogarth Senior Girls' School 70 1 1. 9. T. and A. 1 1 8. 9. Vision 3 2 1. Dental 4 4 8 Nutrition D. 1 Belmont Senior Mixed School 63 3 1. 2 8. 1 1. 3. 5. 5 8. 9. 11 Strand Senior Mixed School 55 1 9. Vision 4 1 3. 5. Dental 3 1 3. 4. 5. — 1 9. 11 7 6 8. 9. 10 Central Boys' 8 Vision 4 Central Girls' 23 — — Dental 3 Spinal curvature 1 — 8 89 Summary of Chiswick Schools :— 300 children examined. 2 children are unfit for work causing eye strain. 5 children are unfit for work involving severe manual work. 3 children are unfit for work in a dusty atmosphere. 1 child is unfit for work requiring acute distant vision. 11 children with single exceptions. 14 children are unfit for work causing eye strain of requiring acute distant vision. 3 children are unfit for work involving severe manual work or requiring acute distant vision. 1 child is unfit for work in a damp atmosphere or for exposure to bad weather. 1 child is unfit for work requiring acute distant vision or for work requiring manipulative skill. 19 children with two exceptions. 2 children are unfit for work involving severe manual work, for exposure to bad weather or for work in a damp atmosphere 1 child is unfit for work in a dusty atmosphere, for exposure to bad weather or for work in a damp atmosphere. 3 children with three exceptions. 1 child is unfit for work in a dusty atmosphere, for exposure to bad weather, for work in a damp atmosphere or for work causing eye strain. 1 child with four exceptions (healed T.B. of luug). Treatment still required :— Tonsils and Adenoids (operations) 4 Vision 14 Dental treatment 16 M. D. 1 Rheumatism 1 Spinal Curvature 1 37 Nutrition " D " 1 90 School No. of children examined Type of occupation child should not enter Treatment still required No. of children Index No. on List Brentford Senior Girls' 71 3 8. Vision 2 1 3. 5. Dental 3 1 3. 5. 7. — 6 8. 9. 5 1 8. 9. (Squint) — 1 4. 13 Brentford Senior Boys' 83 1 7. Vision 2 1 4. Dental 8 2 10. Otorrhoea 1 1 11. — 4 8. 9. 11 9 St. John's Mixed School 30 1 4. Vision ... ... 1 2 8. 9. Dental ... ... 5 2 1. 1 8. 2 1. 8. 9. 1 10. — 6 9 — Summary of Brentford Schools 184 children examined. 4 children are unfit for work causing eye strain. 2 children are unfit for severe manual work. 3 children are unfit for work in a dusty atmosphere. 3 children are unfit for work requiring acute hearing. 1 child is unfit for work requiring manipulative skill. 1 child is unfit for work involving prolonged standing, etc. 14 children with single exceptions. 13 children are unfit for work causing eye strain and for work requiring acute distant vision. 1 child is unfit for exposure to bad weather and for work in a damp atmosphere. 14 children with two exceptions. 91 2 children are' unfit for severe manual work, and for work causing eye strain or for work requiring acute distant vision. 1 child is unfit for exposure to bad weather, work in a damp atmosphere or for work involving prolonged standing, etc. 3 children with three exceptions. Treatment still required :— Vision 5 Dental treatment 16 Otorrhoea 1 22 Thus, of the 484 children in the Borough who were examined on leaving school, " exceptions " were found in 16.5%, 10.9% still required treatment, while one child was classified under Nutrition " D." The treatment required was chiefly for minor dental defects or for changing spectacles. In the majority of cases the treatment was completed before they actually left school. (6) There is a system of co-operation with the Welfare Department of the Chiswick Products Works, with respect to the Dental Department, the School Dental Surgeon sending all necessary dental records of employees to the factory when they are applied for. (7) The Invalid Children's Aid Association: We much appreciate the valuable services rendered to us by this Society, particulars of which will be found under the section describing the Rheumatism Clinic. A great deal of very valuable work is done by this Association in this Borough and is highly appreciated by the School Medical Service. A representative from the Association attends all Rheumatism Clinics and a home visitor has been appointed who follows up all special cases. We would like to emphasise our indebtedness to this Association. 92 17.—BLIND, DEAF, MENTALLY DEFECTIVE AND EPILEPTIC CHILDREN. The number of these children is shewn in Table III. These children are discovered partly at the various inspections and clinics and partly by the Head Teachers, who supply lists of all such children they know are attending the schools. Those not sent to Special Schools are kept under observation and " backward " children are taught in special classes. Those sent to Special Schools during the year are shown in the following table :— 93 Institution Charge to Local Authority per annum Contribution by parents per week Deaf Children : £ s. d. 1. Boy aged 11 Royal School for Deaf and Dumb, Margate. 75 0 0 2. Boy ages 15 Anerley Road (Deaf) School 71 6 1 1s. 0d. 3. Boy aged 14 L.C.C.Ackmar Road (Deaf) School, Fulham. 29 19 8 4. Boy aged 11 do. 29 19 8 5. Boy aged 12 L.C.C. Ackmar Road (Partially Deaf) School. 25 12 10 6. Girl aged 15 Oak Lodge (Residential) School 71 6 1 3s. 0d. Children with Defective Vision: 1. Boy aged 9 East London School for the Blind, Clapton. 74 0 0 5s. 0d. 2. Boy aged 7 do. 74 0 0 3. Boy aged 15 L.C.C. Linden Lodge Blind School 43 15 6 3s. 0d. 4. Girl aged 14 L.C.C. Kingwood (Myopic) School, F ulham 20 6 4 Mentally Defective Children : 1. Boy aged 13 M.C.C Ealing Occupation Centre 15 0 0 2. Boy aged 11 do. 15 0 0 3. Girl aged 10 do. 15 0 0 4. Boy aged 11 do. 15 0 0 5. Boy aged 14 do. 15 0 0 6. Girl aged 11 do. 15 0 0 7. Boy aged 15 Acton Special (M.D.) Day School 14 10 0 8. Boy aged 16 Kingsmead School for the Mentally Defective. 46 0 0 9. Girl aged 14 All Souls " Special School. Hillingdon. 61 0 0 10. Girl aged 10 do. 61 0 0 5s. 0d. Special Conditions : 1. Girl aged 8 St. Gabriel's Children's Open-Air School, Westgate. 72 16 0 5s. 0d. Epileptic Children : 1. Boy aged 14 Home for Epileptics, Maghull 70 4 0 2. Girl aged 9 Lingfield Epileptic Colony, Surrey 74 2 0 2s. 6d. 3. Boy aged 15 do. 74 2 0 5s. 0d. Heart: . Girl aged 12 I.C.A.A. Heart Home, West Wickham. 74 15 0 5s. 0d. . Boy aged 10 Edgar Lee Heart Home, Harlesden 74 15 0 2s. 6d. Convalescent Home : 1. Girl aged 14 Thos. Turner Convalescent Home, Broadstairs. 73 9 0 2s. 6d. Orthopaedic Home : 1.Girl aged 9 Royal National Orthopaedic Hospital, Stanmore. 109 4 0 7s. 6d. 94 From this Table it will be seen that 28 children were sent to Special Schools during 1937. The total charge to the Local Authority per annum was£l,416 3s. 2d., while the contributions by the parents amounted to £2 2s. Od. per week, or£l09 4s. Od. per annum. Four boys and two girls attended the Ealing Occuparion Day School from this district and one boy received instruction at the Acton Special (M.D.) Day School. Also one boy and two girls received instruction at other special residential schools. Two boys and one girl from this area were maintained at Special Residential Schools for Epileptic Children. One girl was sent to an Open Air School, one boy and one girl to a Heart Home, one girl to a Convalescent Home Certified School and one girl to an Orthopaedic Hospital Certified School. The following table is made from data given by the Head Teachers of the Schools :— Mentally Boys. Deficient Girls. Brentford Group— Brentford Senior Boys' 1 — Brentford Senior Girls' — — Canal Boat Children's Department — — Clifden Road Infants' — — Ealing Road Junior Mixed I — Ealing Road Infants — — Lionel Road Junior and Infants' 2 — St. George's Junior and Infants' — — St. John's Mixed — — St. Paul's Junior and Infants' — — 4 — 95 Chiswick Group— Belmont Senior Mixed 1 1 Belmont Junior Mixed — — Belmont Infants' — — Beverley Road Infants' 1 — Hogarth Senior Boys' 1 — Hogarth Junior Boys' — — Hogarth Senior Girls' — 1 Hogarth J unior Girls' — 2 Hogarth Infants' — — Strand Senior Mixed — — Strand Junior Mixed — — Strand Infants' — — Central Schools — — 3 4 Totals 7 4 MENTALLY RETARDED. School . Boys Girls Tot'l No. of children Years retarded Total Boys Years retarded Tot'l Girls 1 2 3 4 5 1 2 3 4 5 Brentford Senior Boys 27 20 14 11 2 74 — — — _ _ — 74 Brentford Senior Girls — — — — — — 12 11 25 7 4 59 59 Canal Boat Departmt. — — 1 2 — 3 — 1 2 1 2 6 9 Ealing Road Ju. Mix. 3 5 — — — 8 7 1 — — — 8 16 Ealing Road Spec. Cl. 2 5 1 — — 8 3 2 3 — — 8 16 Ealing Road Infants 7 1 — — — 8 4 — — — — 4 12 UonelRd. Jnr.&Infs. 12 4 _ _ _ 16 6 4 _ _ __ 10 26 St. George's 2 _ _ _ — 2 1 3 _ _ — 4 6 St. John's 3 4 _ _ _ 7 2 _ _ 2 9 St. Paul's 15 4 1 _ _ 20 7 3 _ _ _ 10 30 Belmont JuniorMixed 17 _ _ _ _ 17 5 __ _ — 5 22 Belmont Senior Mixed — 1 _ _ 1 — — — — — — 1 Belmont Infants' — 2 _ _ __ 2 — — __ — — — 2 Beverley Road Infts. 3 1 _ _ _ 4 2 — — — — 2 6 Hogarth Senior Boys' 20 11 4 1 _ 36 — _ __ _ _ — 36 Hogarth Senior Girls' _ _ _ _ _ __ — 13 5 _ 2 20 20 Hogarth Junior Boys' 22 17 3 _ _ 42 — — — — — — 42 Hogarth Junior Girls' — __ _ _ _ _ — 28 18 _ _ 46 46 Strand Senior Mixed — _ _ 1 _ 1 — 3 2 _ — 5 6 Strand Junior Mixed 7 3 _ — _ 10 1 5 1 — _ 7 17 Strand Infants' — 4 - - - 4 - — — — — 3 7 Totals 140 82 24 15 2 263 48 79 56 8 8 199 462 96 Miss Charles, Head Mistress of Ealing Road Special Class, reports as follows :— " The Special Class for retarded children is now in its third year. The number in class is fixed at 18. Since its beginning 36 children have entered the class. Seventeen have left, 12 of them as fit to rejoin their normal age groups, and 3 more will be leaving at midsummer. Free lunches have been provided for six of the children whose physical condition needed improvement and whose parents could not afford the small charge." I am indebted to Dr. Laval, of the Middlesex County Council Committee for the Care of the Mentally Defective, undei Section 2 (2) of the Mental Deficiency Act, for the following table :— Initials Sex Date notified Institution or Guardianship. A. B. F 13. 6.22 Leavesden Mental Hospital L. M. F 13. 6.22 Guardianship of Mother A. T. F 13. 6.22 Ditto M. C. F 14. 2.23 Ditto F. R. M 6. 6.25 Stoke Park Colony P. C. F 8. 10.25 Ditto J. V. M 31. 3.27 Ditto I. S. F 26. 8.27 Ditto H. P. M 25.10.28 Brighton Guardianship Society J. C. F 22. 5.29 Fortescue Villas W. G. M 14. 1.30 Earlswood R. P. M 11. 3.30 Grove School Approved Home E. S. M 29. 3.30 Warkworth House, Isleworth A. M. M 17. 5.30 Brighton Guardian ship Society W. G. M 8. 9.30 Guardianship of Mother E. M. M 25. 9.30 Enfield House E. P. M 30.10.30 Ditto R. M. M 16. 9.31 Grove School Approved Home I. S. M 6. 6.32 Stoke Park Colony F. B. F 13.10.32 Place of Safety, The Roystons. Chiswick F. B. M 4.11.32 Stoke Park Colony S. B. M 14. 7.30 Cell Barnes Colony R. B. F 21.10.33 Stoke Park Colony 97 18.—NURSERY SCHOOLS. There are no Nursery Schools in the area, but the children attending the Council's creche in Bennett Street are treated in the clinics when necessary. Arrangements are being completed for the establishment of Nursery Classes in all Infant's Schools in the Borough. 19. SECONDARY SCHOOLS. There are two Secondary Schools in Cliiswick (one for boys and one for girls) and a Polytechnic and this Authority undertakes the Dental Treatment and the Refraction work for these schools. The following is a report of the work done during 1937 :— Dental Clinic. Chiswick Secondary Schools:— (1) (a) Number of pupils inspected by dentist 319 (b) Found to require treatment 209 (c) Actually treated and completed 214 (2) Half-davs devoted to (a) Inspections 2 (b) Treatment 72 — 74 (3) Attendances made by pupils for treatment 454 (4) Fillings (a) Permanent Teeth 577 (b) Temporary Teeth — 577 (5) Extractions (a) Permanent Teeth 98 (b) Temporary Teeth 24 122 (6) Administrations of general anaesthetics for extractions 82 Of the whole County Girls' School, 247 were inspected with a view to having clinic treatment if necessary, and 20 were inspected but were to have treatment privately. 177 were referred for treatment at the Clinic, from the School inspection. By the end of the year, 214 patients had received complete treatment. Some of these were County Boys who had been 98 inspected late in 1936 at the School Inspection. Several County Girls were still under treatment or awaiting treatment at the end of 1937. Thirty-six of the 98 permanent teeth were extracted for overcrowding. With the exception of about seven teeth (temporary) all extractions were carried out under N20 anaesthesia. Other operations consisted of 6 root fillings, 11 scalings and 65 dressings. Cliiswick Polytechnic:— (1) (a) Number of pupils inspected by dentist 218 (b) Found to require treatment 192 (c) Actually treated and completed 78 (2) Half-days devoted to (a) Inspections 1 (b) Treatment 26 — 27 (3) Attendances made by pupils for treatment 169 (4) Fillings (a) Permanent Teeth 205 (b) Temporary Teeth — 205 (5) Extractions (a) Permanent Teeth 48 (b) Temporary Teeth — 48 (6) Administrations of general anaesthetics for extractions 32 (7) Other operations 20 Of the whole Junior Polytechnic, 166 were inspected with a view to having clinic treatment if necessary, and 35 were inspected but were to have treatment privately, and 8 were not inspected at all, at their request. 129 of the referred pupils were sent forms for clinic treatment. The 35 pupils who were to have private treatment were not sent forms. Of the 129 forms sent, only 76 were returned signed. Some of these were still awaiting completion of treatment at the end of the year. Twelve of the 48 permanent teeth were extracted for overcrowding. 99 Other operations consisted of 3 root fillings, 6 scalings, 10 dressings and 1 orthodontic treatment. Eye Clinic. Eye Clinic Secondary Schools Polytechnic Total Boys Girls Boys Girls No. of children subjected to refraction test 6 16 - 10 32 No. of children for whom glasses were prescribed 5 16 - 9 30 No. of children for whom glasses were issued 5 16 - 9 30 No. of children for whom glasses were not required 1 - - - 1 No. of children who had repairs only 1 - - 1 2 Degree of Visual Acuity (when eyes differed that of worse eye): Less than 6/6 6/9 6/12 6/18 6/24 6/36 6/60 6/60 Boys 3 1 1 3 8 8 4 3 Type of Error found. Hypermetropia 2 Simple Hypermetropic Astigmatism - Compound Hypermetropic Astigmatism 5 Myopia 11 Simple Myopic Astigmatism 3 Compound Myopic Astigmatism 9 Mixed Astigmatism 1 Emmetropia (normal) 1 20.—CONTINUATION SCHOOLS. In the Chiswick area there are three such schools—an Evening School for girls at the Belmont School, an Evening School for boys at the Belmont School and an Evening School for girls at the Chiswick Products' Works. In the Brentford area an Evening School for boys and girls is held at the Brentford Senior Schools. 100 21.—EMPLOYMENT OF CHILDREN AND YOUNG PERSONS. The following extract from the Bye-laws under the Employment of Children Act, 1913, and Education Act, 1918, shows the conditions under which children may be employed:— (1) No child under the age of 13 shall be employed. (2) Subject to the provisions of byelaw 3 no child shall be employed on school days except between the hours of 5.30 p.m. and 7.30 p.m. (3) A child who has attained the age of 13 may be employed before school between 7.0 a.m. and 8.0 a.m. in the delivery of milk or newspapers or in domestic work away from home, subject to the following conditions:— (a) The child shall not be so employed unless within 14 days from the date when the employment begins, the child has obtained from the School Medical Officer a certificate that such employment will not be prejudicial to his health or physical development, and will not render him unfit to obtain proper benefit from his education, and the certificate has been produced to and endorsedn by his employer. No charge shall be made for such certificate. (b) The child shall not be employed after school hours in any occupation for a period of more than one hour, between the hours of 5.30 p.m. and 7.30 p.m. (4) No child shall be employed on any Saturday or other school holiday for more than four hours or before 7.0 a.m. or after 7.0 p.m. ; provided that the employment shall be so arranged that the child shall be free for rest and recreation for a continuous period of not less than five hours. (5) No child shall be employed for more than 16 hours in any week in which the school is not open. (6) No child shall be employed on Sunday except in the delivery of milk or newspapers for not more than two hours between the hours of 7.0 a.m. and 10 a.m. 101 (7) Any person who employs a child in any work out of doors shall see that he is provided during the course of his employment with boots and clothing sufficient to protect him from inclement weather. All children are medically examined before a certfiicate is issued to see that they are fit for the particular employment chosen and that the work will not interfere with their education. The report for the year 1937 is as follows:— Number of Employment Cards applied for 260 Number medically examined by School Medical Officer 232 Number medically examined bv Acton, Hounslow and L.C.C. 28 Number certified unfit and not passed by Doctor 2 Number of cases where cards were not issued for other than medical reasons (i.e., prohibited occupations, under age, etc.) 3 Number of Street Trading Badges issued — Number of Street Trading Badges returned — LEgal Proceedings taken during 1937 for Offences against the employment of school children and Young Persons. Initials of Offender. Offence. Act under which summoned. Fine. R. N. Employing a child during prohibited hours. Children and Young Persons Act, 1933. 40/- R. N. Employing a child without an Employment Card ditto 40/- H. W. ditto ditto 20/- V. I. Employing a child under age ditto 15/- C.B. Employing a child during prohibited hours ditto 20/- J. B. Permitting a child to beg ditto 10/- The following examinations were made apart from those already recorded in this report:— 102 Seven school teachers were examined for physical fitness for duty and to participate in the benefits of the superannuation scheme. Twenty-eight children were examined for Entertainment licences. 22.—GENERAL. I beg to express my gratitude to the Staff of the School Medical Service for their efforts to render this service efficient, also my thanks to the Teaching Staff of the Schools for their most valuable co-operation, and to the Director of Education and the Ladies and Gentlemen of the Education Committee for their help and courtesy. Your obedient Servant, R. C. LEANING, School Medical Officer. 103 BOROUGH OF BRENTFORD AND CHISWICK. MEDICAL INSPECTION RETURNS. Year ended 31 st December, 1937. table I. MEDICAL INSPECTIONS OF CHILDREN ATTENDING public elementary schools. A.—Routine Medical Inspections. Number of Code Group Inspections: Entrants 650 Second Age Group 556 Third Age Group 501 Total 1707 Number of other Routine Inspections 545 Grand Total 2252 B.—Other Inspections. Number of Special Inspections 1520 Number of Re-inspections 2603 Total 4123 C.— Children found to require Treatment. Number of individual children found at Routine Medical Inspections to require treatment (excluding Uncleanliness and Dental Diseases)— Group For defective vision (excluding squint) For all other conditions recorded in Table II.A Total Entrants 4 99 95 Second Age Group 26 81 99 Third Age Group 29 33 60 Total (Prescribed Groups) 59 213 254 Other Routine Inspections 47 12 57 Grand Total 106 225 311 104 TABLE II. A.—Return of Defects found by Medical Inspection in the Year ending 31st December, 1937. Defect or Disease. Routine Inspections Special Inspections No. of Defects. No. of Defects. Requiring treatment. Requiring to be kept under observation, but not requiring treatment. Requiring treatment. Requiring to be kep. under observation, but not requiring treatment. (1) (2) (3) (4) (5) Skin 1 1 (1) Ringworm—Scalp — — 3 — (2) Ringworm—Body — — 6 — (3) Scabies 3 — 36 — (4) Impetigo — — 92 — (5) Other Diseases (Nontuberculous) 6 — 100 — TOTAL (Heads 1 to 5) 9 — 237 — Eye (6) Blepharitis 7 — 23 — (7) Conjunctivitis 1 1 12 — (8) Keratitis — — — — (9) Corneal Opacities — — — — (10) Other conditions (excluding Defective Vision and Squint) 1 — 12 — TOTAL (Heads 6 to 10) 9 1 47 — (11) Defective Vision (excluding Squint) 106 99 11 — (12) Squint 4 20 8 — Ear (13) Defective Hearing 4 1 9 — (14) Otitis Media 7 2 54 — (15) Other Ear Diseases 1 1 24 — Nose and Throat (16) Chronic Tonsilitis only 59 112 38 2 (17) Adenoids only 1 5 9 1 (18) Chronic Tonsilitis and Adenoids 74 48 63 — (19) Other Conditions 2 — 70 1 (20) Enlarged Cervical Glands (Non-Tuberculous) 2 12 9 — (21) Defective Speech 5 — 4 — 105 table ii,—contd. Defect or Disease. Routine Inspections Special Inspections No. of Defects. No. of Defects. Requiring treatment. Requiring to be kept under observation, but not requiring treatment. Requiring treatment. Requiring to be kept under observation, but not requiring treatment (1) (2) (3) (4) (5) Heart and Circulation Heart Disease: (22) Organic 1 5 4 — (23) Functional 2 6 — — (24) Anaemia 1 — 4 — Lungs (25) Bronchitis 1 1 21 — (26) Other Non- Tuberculous Diseases 4 3 25 — Pulmonary: (27) Definite — — — — Tuberculosis (28) Suspected — — 4 — (29) Glands — — 1 — (30) Bones and Joints — — — — (31) Skin — — — — (32) Other Forms — — — — TOTAL (Heads 29 to 32) — — 1 — Nervous System (33) Epilepsy — 1 3 — (34) Chorea 2 2 10 — (35) Other Conditions 3 1 8 — Deformities (36) Rickets — 3 2 — (37) Spinal Curvature 5 — 2 — (38) Other Forms 10 6 36 — (39) Other Defects and Diseases (excluding Uncleanliness and Dental Diseases) 17 10 501 87 Total 329 339 1204 91 106 TABLE II. B.—Classification of the Nutrition of Children inspected during the Year in the Routine Age Groups. Age-groups Number of Children Inspected A (Excellent) B (Normal) c (Slightly subnormal) d (Bad) No. % No. % No. % No. % Entrants 650 327 50.3 224 34.5 94 14.5 5 0.8 Secong Age Group 556 277 49.8 203 36.5 72 12.9 4 0.7 ThirdAge Group 501 327 65.3 130 25.9 40 8.0 4 0.8 Other Routine Inspections 545 288 52.8 194 35.6 60 11.0 3 0.6 Total 2252 1219 54.1 751 33.3 266 11.8 16 0.7 107 TABLE III. Return of ah Exceptional Children in the Area. BLIND CHILDREN Children who are so blind that they can only appropriately be taught in a school for the blind: At Certified Schools for the Blind — At Public Elementary Schools — At Other Institutions — At no School or Institution — Total — PARTIALLY SIGHTED CHILDREN Children who have such power of vision that they can appropriately be taught in a school for the partially sighted: At Certified Schools for the Blind 3 At Certified Schools for the Partially Sighted 1 At Public Elementary Schools 3 At other Institutions — At no School or Institution — Total 7 DEAF CHILDREN Children who are so deaf that they can only appropriately be taught in a School for the Deaf: At Certified Schools for the Deaf 7 At Public Elementary Schools — At other Institutions — At no School or Institution — Total 7 PARTIALLY DEAF CHILDREN Children who can appropriately be taught only in a school for the partially deaf: At Certified Schools for the Deaf — At Certified Schools for the Partially Deaf 1 At Public Elementary Schools 3 At other Institutions — At no School or Institution — Total 4 108 TABLE III—contd. MENTALLY DEFECTIVE CHILDREN Feeble-Minded Children Children who are incapable by reason of mental defect of receiving proper benefit from the instruction in an Elementary School, but are not incapable of receiving benefit from instruction in Special Schools for mentally defective children, and for whose education and maintenance the Local Education Authority are responsible: At Certified Schools for Mentally Defective Children 4 At Public Elementary Schools 20 At other Institutions 6 At no School or Institution 1 Total 31 EPILEPTIC CHILDREN Children sufferinc from Severe Epilepsy Children who, not being idiots or imbeciles, are unfit by reason of severe epilepsy to attend the ordinary Public Elementary School At Certified Special Schools 3 At Public Elementary Schools — At other Institutions — At no School or Institution — Total 3 PHYSICALLY DEFECTIVE CHILDREN A.—Tuberculous Children: 1. Children suffering from Pulmonary Tuberculosis (including pleura and intra-thoracic glands): At Certified Special Schools — At Public Elementary Schools — At other Institutions 3* At no school or Institution — Total 3 2. Children suffering from Non-pulmonary Tuberculosis: At Certified Special Schools — At Public Elementary Schools — At other Institutions — At no School or Institution — *Under County Tuberculosis Officer. Total — 109 TABLE III—contd. B.—Dedicate Children: Children (except those included in other groups) whose general health renders it desirable that they should be specially selected for admission to an Open Air School: At Certified Special Schools 1 At Public Elementary Schools 10 At other Institutions — At no School or Institution — Total 11 C.—Crippled Children: Children (other than those diagnosed as tuberculous and in need of treatment for that disease) who are suffering from a degree of crippling sufficiently severe to interfere materially with a child's normal mode of life: At Certified Special Schools 3 At Public Elementary Schools 10 At other Institutions — At no School or Institution — Total 13 D.—Children with Heart Disease: Children whose defect is so severe as to necessitate the provision of educational facilities other than those of the Public Elementary School: At Certified Special Schools 4 At Public Elementary Schools 2 At other Institutions 5 At no School or Institution 1 Total 12 CHILDREN SUFFERING FROM MULTIPLE DEFECTS Children suffering from any combination of the following types of Defect: Total Blindness, Total Deafness, Mental Defect, Severe Epilepsy, Active Tuberculosis, Crippling, Heart Disease. Combination of Defect— Epileptic and Feeble-minded— At Certified Special Schools 1 At Public Elementary Schools — At other Institutions — At no School or Institution — Total 1 110 TABLE IV. TREATMENT TABLES. Group I.—Minor Ailments (excluding Unceeaneiness, FOR which see tabee VI). Defect or Disease. Number of Defects treated or under treatment during the year. Under the Authority's Scheme. Otherwise Total. Skin— Ringworm—Scalp: (1) X-Ray Treatment — — — (2) Other 3 — 3 Ringworm—Body 0 — 6 Scabies 39 — 39 Impetigo 100 — 100 Other Skin Diseases 103 — 103 Minor Eye Defects (external and other, but excluding cases falling in Group II) 52 — 52 Minor Ear Defects 86 — 86 Miscellaneous (e.g., minor injuries, bruises, sores, chilblains, etc.) 445 56 501 Total 834 56 890 1ll TABLE IV.—contd. Group II.—Defective Vision and Squint (excluding Minor Eye Defects treated as Minor Ailments—Group I.) Number of Defects dealt with Under the Authority's Scheme Otherwise Total Errors of Refraction (including Squint) 252 3 255 Other defect or disease of the eyes (excluding those recorded in Group 1) — 1 1 Total 252 4 256 No. of Children for whom spectacles were (a) Prescribed 229 3 232 (b) Obtained 221 3 224 Group III.—Treatment of Defects of Nose and Throat. Number of Defects. Received Operative Treatment Under the Authority's Scheme, in Clinic or Hospital By Private Practitioner or Hospital, apart from the Authority's Scheme Total Received other forms of Treatment Total numb er treated (i) (ii) (iii) (iv) (i) (ii) (iii) (iv) (i) (ii) (iii) (iv) — — — — — 2 41 — — 2 41 — 115 158 (i) Tonsils only. (ii) Adenoids only. (iii) Tonsils and Adenoids, (iv) Other defects of the nose and throat. * Scheme in abeyance during re-building of Chiswick Hospital. 112 TABLE IV (continued) Group IV.—Orthopaedic and Postural Defects. Under the Authority's Scheme. (1) Otherwise (2) Total number treated Residential treatment with education. Residential treatment without education. Non-residential treatment at an Orthopaedic Clinic. Residential treatment with education. Residential treatment without education. Non-residential treatment at an Orthopaedic Clinic. Number of children treated. 2 Nil 82 (plus 11 for breathing exercises) Nil Nil Nil 84 (plus 11 for breathing exercises TABLE V. DENTAI, INSPECTION AND TREATMENT. (1) Number of children inpected by the Dentist— (2) Number found to require treatment 3762 (a) Routine age-groups— Age 5 306 (3) Number actually treated 2573 „ 6 224 (4) Attendances made by children for treatment 5010 „ 7 248 „ 8 368 „ 9 402 (5) Half-days devoted to Inspections 17 „ 10 455 „ 11 301 Treatment 509½ „ 12 437 „ 13 354 Leavers' Inspections 10½ „ 14 87 „ 15 36 Lectures „ 16 5 Total 537 Total 3223 (6) Fillings— (b) Specials 1411 Permanent teeth 3728 Temporary teeth 389 (c) Total (Routine and Specials)— 4634 Total 4117 113 TABLE V—(continued). (7) Extractions:— (8) Administration of general anaesthetics for Permanent Teeth 809 extractions 1885 Temporary Teeth 3744 (9) Other Operations:— Total Permanent Teeth 464 Temporary Teeth — 4553 Total 464 TABLE VI—UNCLEANLINESS AND VERMINOUS CONDITIONS. (1) Average number of visits per school made during the year by the School Nurses 14 (2) Total number of examinations of children in the schools by School Nurses 26,297 (3) Number of individual children found unclean 333 (4) Number of children cleansed under arrangements made by the Local Education Authority 154 (5) Number of cases in which legal proceedings were taken (a) Under the Education Act, 1921 6 (b) Under School Attendance Bye-Laws 14 Chiswick and Ealing Hospitals Committee. CLAYPONDS ISOLATION HOSPITAL. PERIVALE MATERNITY HOSPITAL. ANNUAL REPORT OF THE MEDICAL SUPERINTENDENT FOR THE YEAR ENDING 31st MARCH, 1938. THOMAS ORR, M.D., D.Sc., Medical Superintendent. Perry & Routleff Ltd., Ealing and Uxbridge. 2 CHISWICK AND EALING HOSPITALS COMMITTEE. Alderman G. Jenkin (Chairman). Alderman Col. R. R. Kimmitt, O.B.E., T.D., D.L. (Vice-Chairman). Alderman A. W. Bradford, J.P. Alderman Emily S. Tayi.or, J.P. Councillor Alice J. Burden. Councillor T. E. Fowler. Councillor Emily L. Hill. Councillor W. Morgans. STAFF. Medical Superintendent— .Thomas Orr, M.D., D.Sc., Of the Middle Temple, Barrister-at-Law. Medical Attendant, Isolation Hospital— Llywelyn Roberts, M.D., D.P.H. Resident Medical Officer, Isolation Hospital— Donald F. Irvine, M.B., Ch.B., D.P.H. Resident Medical Attendant, Maternity Hospital— Anne E. Williams-James, E.R.C.P., M.R.C.S., D.P.H., B.Sc., D.C.O.G. Consulting Surgeon— C. W. Gordon Bryan, F.R.C.S. (Eng.). Consulting Oto-Laryngologist— Arthur Miller, F.R.C.S. (Ed.), D.L.O. Consulting Obstetricians— John W. Rait Bell, L.R.C.P.I. & L.M., L.R.C.S.I. & L.M. Arnold Walker, M.A., M.B., B.Ch., F.R.C.S., M.C.O.G. Consulting Ophthalmic Surgeon— Graeme G. Talbot, M.B., Ch.B., F.R.C.S. Matron, Isolation Hospital— Miss I. Gregory. Matron, Maternity Hospital— Miss M. P. B. Gardner. Clerk to Committee—Harry Birrell. Treasurer—E. C. T. Owen. 3 CHISWICK AND EALING HOSPITALS COMMITTEE. Mr. Chairman, Ladies and Gentlemen, I have the honour to submit the Annual Report on the administration of the Hospitals from the 1st April, 1937, to the 31st March, 1938. ISOLATION HOSPITAL. The total number of cases admitted to the Hospital was 649, 81 more than in the previous year. The highest number under treatment on any day was 101 on the 7th January, 1938, and the lowest number 22 on the 19th August, 1937. The average daily number in Hospital was 69. The following table indicates the number of cases of various diseases treated during the year:— Disease Remaining in Hospital 31st March, 1937 Admitted during year Discharged during year Died during year Remaining in Hospital 31st March, 1938 Scarlet Fever 73 392 426 1 38 Diphtheria 10 203 174 8 31 Measles — 27 16 2 9 Whooping Cough 1 1 2 — — Chicken Pox — 4 3 — 1 Puerperal Fever — 5 5 — — Parametritis — 1 1 — — Ophthalmia Neonatorum — 4 4 — — Nursing Mother — 1 1 — — Enteric Fever — 5 5 — — Mumps — 1 1 — — Erysipelas — 2 2 — — Chicken pox and pneumonia — 1 1 — — Pneumonia — 1 — 1 — Cervical abscess — 1 1 — — 84 649 642 12 79 4 Scarlet Fever.—Of the 392 cases admitted as scarlet fever 140 were from Brentford and Chiswick and 252 were from Ealing. Of this total 16 were found not to be suffering from the disease and were ultimately diagnosed as follows:— Tonsillitis 6, chicken pox 1, diphtheria 1, gastritis 1, urticaria 1, teething rash 1, common cold 1, bronchitis 1, measles 1, rubella 1, no apparent disease 1. Four cases of scarlet fever were found on admission to be suffering also from a second disease, as follows:—chicken pox 2, measles 1, mumps 1. The incidence of the actual cases of scarlet fever in the various age-groups was as follows:— 1-5 yrs. 5-15 yrs. 15-25 yrs. 25-35 yrs. 35-45 yrs. over 45 yrs. 69 260 23 13 9 2 The complications observed among the cases were as follows:— Otitis Media and Otorrhoea 36 Mastoiditis 3 Cervical adenitis 44 Rhinitis and rhinorrhoea 55 Post nasal discharge 3 Arthritis and rheumatism 5 Nephritis and albuminuria 11 Bronchitis 3 Tonsillitis 4 Quinsy 2 Pluerisy 3 Pericarditis 2 Septic fingers 3 Second attack of Scarlet Fever 11 Empyema 1 Frontal sinusitis 1 Cardiac irregularity 3 Vaginal discharge 2 Septic sores 2 Return cases.—Of the 426 cases discharged during the year eight gave rise to "return" cases of scarlet fever. This gives a low return case rate of 1.87 per cent. 5 Duration of Stay.—The average duration of stay in hospital of all cases of scarlet fever was 34.7 days. Deaths.—One death from scarlet fever occurred during the year. This was a severe case which developed empyema for which operative treatment was called. This death gives a scarlet fever mortality of 0.26 per cent. Diphtheria.—The number of cases admitted as diphtheria was 203, 34 from Brentford and Chiswick, 160 from Ealing, and 9 from Southall. This was 112 more than for the previous year. Of the total number 26 were ultimately diagnosed as follows:— Tonsillitis 13, scarlet fever 2, tonsillitis and nasal carrier of diphtheria 1, meningitis 1, pulmonary tuberculosis 1, retro-pharvngeal abscess 1, Vincent's angina 2, pharyngitis 1, capillary bronchitis 1, peri-tonsillar abscess 2, and no apparent disease 1. Two cases were found to have another disease in addition to diphtheria one having scarlet fever and the other mumps. The incidence of the actual cases of diphtheria in the various age-groups was as follows:— 1-5 yrs. 5-10 yrs. 10-15 yrs. 15-25 yrs. 25-45 yrs. over 45 yrs. 36 86 30 13 12 — The following complications were observed:— Secondary Tonsillitis 6 Cardiac irregularity 13 Myocardial degeneration 2 Otitis media and otorrhoea 3 Mastoiditis 1 Early cardiac failure 1 Rhinitis 1 Cervical adenitis 2 Tachycardia 1 Palatal paresis 14 Ocular paresis 2 Pharyngeal paresis 2 Catarrhal jaundice 1 6 Laryngeal Diphtheria.—Four cases were admitted as laryngeal diphtheria. Two were found to be actually suffering from this condition and they recovered without operation. The other two cases were diagnosed as measles and septic meningitis respectively. Deaths.—There were eight deaths among cases sent in as diphtheria but only four were of patients who actually suffered from diphtheria. These four fatal cases of diphtheria were well advanced in the disease on admission. Two of them occurred within three days of admission. The third survived until the fourth day to die of cardiac failure and the fourth, although a severe case, survived for 47 days and then suddenly collapsed and died within 48 hours. The four cases not found to be suffering from diphtheria were ultimately diagnosed respectively as:— Capillary bronchitis, streptococcal tonsillitis with erysipelas of face and broncho-pneumonia, pulmonary tuberculosis and septic meningitis. Return Cases.—There was one return case. A child was discharged with no evidence of the diphtheria bacillus in his throat, but in three weeks' time a sister was admitted with diphtheria. Duration of Stay- The average duration of stay in Hospital for cases of diphtheria was 48.8 days. Other Diseases.—Cases of measles to the number of 24, mostly complicated, were admitted for treatment. Two of these cases died, one from pneumonia and the other from acute appendicitis and peritonitis. One case was admitted with pneumonia with a purpuric rash and died, there being no evidence of measles. Cubicle Block.—The cubicle block which was opened in the previous year proved of great value from the administrative point of view. The value is indicated by the different kinds of cases dealt with in them during the year. These were as follows:— Ophthalmia 3, puerperal sepsis 7, scarlet fever with diphtheria 11, scarlet fever (suspected) 6, scarlet fever with measles 6, scarlet fever with chickenpox 5, scarlet fever 7 with mumps 3, scarlet fever with dysentery 1, scarlet fever with mastoiditis 1, diphtheria (suspected) 16, diphtheria carriers (5 for operation) 11, diphtheria with mumps 1, diphtheria with measles 1, whooping cough 1, whooping cough with measles 1, measles 10, enteric fever 3, (2 paratyphoid B, 1 typhoid), enteric fever (suspected) 2, erysipelas 2, chickenpox 4, peritonsillar abscess 1, mumps 2, others 4. Dysentery.—One patient, a girl aged 8 years, admitted as a scarlet fever, developed symptoms of dysentery 14 days after admission with vomiting and blood stained stools accompanied by slight abdominal pain. The bacillus dysenteriae (Sonne) was isolated in this case. She ultimately recovered. Twelve other cases in the same ward had loose stools at about the same time. There was, however, no vomiting and no blood or mucus in the stools. Examination of the stools was negative so far as the specific organism was concerned. Steps were, of course, taken to isolate the actual case of dysentery and those suspected and fortunately no further cases occurred. Illness of Stake.—The following cases of illness of the staff occurred during the year:— Probationers Arthritis 1, tonsillitis 1. Private Nurses Tonsillitis 2. Kitchen Maids Tonsillitis 1. Lodge-keeper Influenza. Dr. Miller, the Consulting Oto-Laryngologist, made 17 visits during the year and performed seven mastoid operations and 13 operations for the removal of tonsils and adenoids. Seven of the latter operations were on patients from Southall Isolation Hospital and were carried out at the special request of the Medical Superintendent of that hospital from which they were admitted for this purpose. Mr. Gordon Bryan, the Consulting Surgeon, made four visits to the hospital during the year. 8 MATERNITY HOSPITAL. The new Maternity Hospital was opened for the admission of cases on the 1st November, 1937, and it is therefore desirable that the report should be divided into two sections, the first dealing with the period April 1st to October 31st, 1937, concerned with the admissions to the Old Maternity Hospital and the second dealing with the period from the 1st November, 1937, to the 31st March, 1938, dealing with the admissions to the new Maternity Hospital. OLD MATERNITY HOSPITAL. April 1st to October 31st, 1937. Mothers.—The 297 cases admitted to the Hospital from the 1st April to the 31st October, 1937, from the two districts were as follows:— Month Ealing Brentford and Chiswick Total April 31 9 40 May 36 8 44 June 29 16 45 July 33 8 41 August 37 3 40 September 28 12 40 October 41 6 47 235 62 297 On the 14th, 15th and 16th May, there were as many as 33 patients in Hospital. The average period which each patient spent in hospital was 16.46 days. Emergency Cases.—One emergency case was admitted. This patient had a normal delivery. Ante-Natal Cases.—Twenty-six ante-natal cases were admitted for treatment. The conditions from which they were suffering were as follows:— 9 Toxaemia 13 Urinary infection (one with mitral stenosis) 3 Hypertension and toxaemia 1 Placenta praevia 2 Suspected disproportion 2 Tired (needing rest from home cares) 3 Pressure oedema 1 Premature rupture of membranes 1 Of these cases, seven recovered sufficiently to be discharged to await at home the onset of labour, one was transferred to the West Middlesex Hospital for immediate induction of labour, and one was transferred to King Edward Memorial Hospital on account of severe pyelitis. Surgical induction was done in the following eight cases:— Toxaemia (one with hypertension) 5 Severe concealed accidental haemorrhage 1 Suspected disproportion 1 Hydramnios 1 Abnormalities and complications during Labour:- Perineal tears 61 Forceps delivery, (following manual rotation of persistent occipito-posterior 2, for primary uterine inertia 1, for foetal distress 1, for prolapse of cord 1, mild disproportion 2). In the last two cases forceps were applied by Dr. Bell following trial labour for suspected disproportion 7 Breech with extended legs (assisted delivery) 2 Breech with extended legs (unassisted delivery) 2 Complete breech (assisted delivery) 2 Complete breech (unassisted delivery) 4 Twin pregnancies, (two vertices 1, vertex and breech 3) 4 Placenta praevia (lateral) one treated by rupture of membranes and one by podalic version and bringing down a leg 2 10 Placenta praevia (marginal) unassisted delivery 1 Post-partum haemorrhage 1 Complications in the puerperium not associated with pyrexia: Foot drop due to pressure on lumbo-sacral nerve due to forceps delivery 1 Thrombosed varicose veins 4 Laryngitis and bronchitis 2 Tenosynovitis of extensor tendons of wrist 1 Puerperal Pyrexia.—Nine cases of puerperal pyrexia occurred. These cases were suffering from:— Mild uterine sepsis (two following forceps delivery) 5 Infected perineum (following forceps delivery) 1 Urinary infection 1 Coryza 1 Pulmonary embolism complicating lateral placenta praevia 1 Fourteen cases of mild (non-notifiable) pyrexia in the puerperium were due to:— Retained products 7 Mild parametritis 1 Mild urinary infection 2 Acute mastitis 2 Septic abrasion of post vaginal wall 1 Anaemia and debility following toxaemia of pregnancy 1 Children. Number of Infants born:— Males 161 Females 138 Total 299 11 Number of cases of twins (8 babies) 4 Number of cases of premature infants (born alive): 34-36 weeks development 4 36-38 weeks development 3 Stillbirths: Total 9. Macerated (full term) 1 Fresh (full term). Concealed accidental haemorrhage 1 Toxaemia of pregnancy 1 Forceps delivery 1 Premature. Lateral placenta praevia 1 Locked twins (28 weeks maturity) 2 Hypertension and toxaemia 1 Podalic version for lateral placenta praevia 1 Infant Deaths.—Total 4. Intra peritoneal haemorrhage from bi-lateral haemorrhagic cysts of suprarenal glands (confirmed by autopsy) 1 Icterus gravis (autopsy refused) 1 Intracranial haemorrhage (1 confirmed by autopsy) 2 Abnormalities in Surviving Infants: Haemorrhage of new-born 4 Harelip and cleft palate 2 Cephal-haematoma 1 Ophthalmia neonatorum 1 Convulsions 1 Septic fingers 1 Infants Weaned: Total 2. Weaned due to debility and anaemia of mother 1 Weaned due to transference of mother to Queen Charlotte's Isolation Block on account of pyrexia 12 Patients transferred to other Hospitals: To Chiswick and Ealing Isolation Hospital. With uterine sepsis 2 Retained products 2 Mild parametritis 1 To Queen Charlotte's Isolation Block. Mild uterine sepsis 1 To West Middlesex County Hospital. For immediate induction of labour 1 To King Edward Memorial Hospital Patient with severe Pyelitis 1 Maternal Death.—There was one death. This was a case of lateral placenta praevia with a large post-mature child. The patient had a pulmonary embolism before the unassisted delivery of a stillborn child. She died twenty-four hours later. Consulting Obstetrician.—Dr. J. W. Rait Bell, the Consulting Obstetrician, was called to the Hospital on eight occasions during the period under review. Training of Pupils.—Up to the 31st October, 1937, 14 Pupils completed their course of training and entered for the examination of the Central Midwives Board. All of these pupils were successful. PERIVALE MATERNITY HOSPITAL. Mothers.—The 300 cases admitted to the Hospital during the period 1st November, 1937, to 31st March, 1938, from the two districts were as follows:— Month Ealing Brentford and Chiswick Total November 43 10 53 December 41 9 50 January 59 11 70 February 51 8 59 March 58 10 68 252 48 300 13 The greatest number of patients in the hospital on any one day was 46. This was on the 29th January, 1938. The average period of stay in the hospital was 15.403 days. Emergency Cases.—Total 3. 1. The patient was admitted because of intra-uterine death of the foetus and had a normal delivery, after medical induction, of a macerated foetus of 34 weeks development with a puerperium that was uneventful. 2. A primipara was admitted because the infant was a breech with extended legs. The patient required assistance to bring down the legs and both mother and baby did well. 3. A patient was admitted in advanced labour, having made no arrangements for her confinement. The patient had a normal delivery and both mother and child did well. Two patients were delivered at their own homes and were admitted to hospital for the puerperium. One patient was delivered of a premature still born child and the other patient was delivered of a macerated foetus after death in utero had been diagnosed. Ante-Natal Cases.—Thirty-eight ante-natal cases were admitted for treatment. The conditions from which they were suffering were as follows:— Toxaemia 18 Suspected disproportion 7 Mild accidental haemorrhage 2 Placenta praevia 1 Hypertension and toxaemia 1 Tired (needing rest from home cares) 3 Premature rupture of membranes 2 Thrombosed varicose veins 1 Pleurisy 1 Inguinal adenitis 1 Urinary infection 1 Of these cases, twelve recovered sufficiently to be discharged to await the onset of labour at home. 14 Surgical induction was done in the following eight cases:— Toxaemia of pregnancy, including one case of persistent hypertension 4 Suspected disproportion 1 Post maturity 1 Anencephalic monster and hydramnios, confirmed by Xrays 1 Mental derangement in patient with congenital syphilis 1 Abnormalities and Complications during Labour: Perineal tears 71 Forceps delivery 9 (following manual rotation for persistent occipito-posterior position 3, for delay in second stage 4, for foetal distress 2). Two of the three cases required only gas and air analgesia. Podalic version and perforation of after-coming head of dead post mature child by Dr. Bell 1 Extraction of breech after podalic version for prolapse of cord 1 Breech with extended legs (assisted delivery) 7 Breech with extended legs (unassisted delivery) 5 Twin pregnancies, (two vertices 1, one vertex and one breech 1) 2 Placenta praevia (lateral) 2 Of these one was a normal delivery and the other required extraction of breech after podalic version due to prolapse of cord by Dr. Bell. Accidental ante-partum haemorrhage 1 Severe concealed accidental haemorrhage 1 Mild Haemorrhage 1 Eclampsia during delivery 2 Complications in the puerperium not associated with pyrexia:— Mental derangement 1 15 Thrombosed varicose veins 4 Haematoma of vagina and perineum following toxaemia of pregnancy 1 Bronchitis 1 Abnormalities and Complications during the puerperium:— Ten cases of Puerperal pyrexia occurred in patients as follows:— Breast abscess (one of these patients also had a thrombosed femoral vein) 2 Acute mastitis 4 Pyelitis 1 Infected perineum following forceps delivery 1 Measles 2 Mild pyrexia not notifiable in the puerperium:— Retained products 16 Mild uterine and perineal infection following forceps delivery 1 Acute mastitis 2 Septic spot on breast 1 Coryza 2 Thrombosed varicose veins and slight pulmonary embolism 1 Secondary post partum haemorrhage 1 Children. Number of Infants born:— Males 156 Females 141 297 Number of cases of twins (4 babies) 2 Number of cases of premature infants (born alive):— 28-30 weeks development 2 30-32 weeks development 1 34-36 weeks development 2 36-38 weeks development 2 16 Stillbirths.—Macerated 7. Of these five were diagnosed as death of the foetus in utero in the ante-natal clinics. One was admitted as an emergency case because of death of the foetus and one died while the mother was under treatment for toxaemia of pregnancy in the hospital. Fresh (Full term) 6. Bipolar version for placenta praevia followed by prolapse of cord 1 Post maturity requiring perforation of after coming head of stillborn infant 1 No definite cause (very stout patient) 1 Anencephaly 1 Maternal eclampsia (34 weeks) 1 Surgical induction for severe hypertension and toxaemia (32 weeks) 1 Neo-Natal Deaths. Total 7. Prematurity 3 Atelectasis and prematurity I Cerebral haemorrhage (one confirmed by autopsy) 2 Mongol with atresia of oesophagus (autopsy performed) 1 Malformations in infants born alive:— Mongol, one of which died 2 Ectopia testis 1 Cephalhaematoma 2 Spina Bifida (one twin) 1 Pyloric stenosis 1 Illness of Infants:— Cerebral irritation 1 Melaena neonatorum 1 Measles 1 Injury to leg during breech delivery 1 Septic spots 3 (1 infant detained in hospital 28 days), 17 Infants Weaned. Total 9. Owing to condition of mother's breasts 5 Owing to general health of mother 4 Patients transferred to other Hospitals:— To Chiswick and Ealing Isolation Hospital. Mother and infant with measles 1 To Hendon Isolation Hospital. Mother with measles and infant who subsequently developed measles 1 To King Edward Memorial Hospital. Infant with pyloric stenosis transferred for operative treatment. Mother went with child. Maternal Death. There was one death. This patient was admitted as an urgent case with severe concealed ante-partum haemorrhage. Artificial rupture of membranes failed to start uterine contractions. Traction of the child's head also failed to incite contractions. The patient died undelivered within six hours of admission. The Consulting Obstetrician was present throughout. Consulting Obstetrician.—Dr. J. W. Rait Bell, the Consulting Obstetrician, was called to the Hospital on seventeen occasions during the period under review. Training of Pupils.—Up to the 31st March, 1938, 6 pupils completed their course of training and entered for the examination of the Central Midwives Board. Four of these pupils were successful. 18 PARTICULARS OF THE NEW HOSPITAL. For some years the Maternity Hospital at Clayponds Lane has been quite incapable of meeting the needs of the two Boroughs, and the entirely new Hospital which has been opened at Perivale has been the result of the determination of the two Councils to meet the ever increasing demand for accommodation for maternity cases. The old maternity hospital has been added to the Isolation Hospital to extend its accommodation. The new Hospital consists of a two-storey Ward Block of 40 beds with a separate Labour Block connected with the main Block by means of a corridor, an Isolation Block of three beds, an Administrative Block, a Laundry and Engineering Block, a Mortuary and a Lodge. Whilst the main entrance to the grounds of the Hospital is from Western Avenue, on the north, the main entrance and the front of the buildings face the opposite side and thus all the wards and most of the rooms in the Administrative Block have a south aspect. The design generally is in the modern functional style and the external walls are faced with "Keymer" hand-made sand-faced bricks. Ward Block. This is a two-storied building with each floor similar in planEach floor is composed of two units each consisting of a R-bedded ward at the end of the corridor with four single-bed wards arranged alongside it with a central nursery for babies serving two units. Observation windows in the doors in the corridor enable the nursing staff to keep the patients under continuous observation. AH the wards are on the south side of the building and those on the ground floor have casement doors so that the beds can be wheeled out into the open on to a paved area if the weather permits. On the north side of the corridor are the various sluice rooms, bathrooms, duty rooms and sterilising rooms. A closed corridor runs from the centre of the north side to the Labour Block. 19 Labour Block. This has two labour wards, an operating theatre, an examination room (which is fitted so that it can be used as an emergency labour ward), a sterilising room, a linen room and a receiving room with bathroom on the north side of the corridor and a duty room and sluice room facing south on the other side. Some of the main features of these blocks are the following:— The floors of the wards in the Ward and Isolation Blocks are in natural waxed strip oak throughout, the floors of the corridors are cork-tiled and the sluice and sterilising rooms are finished in terrazzo. Throughout the Labour Block all floors and dados are finished in light green terrazzo. All doors are solid flush oak, veneered, with chromium plated easy-clean fittings. All windows are of heavy section metal, those in the six-bedded wards and in the single-bedded wards on the first floor being of the sliding-folding type. In the Ward and Labour Blocks a silent signal (light) system has been installed by means of which patients can call a nurse without the noise of bells. The lift between the two floors facilitates the movement of patients and stores. A modern Scialytic shadowless light is installed in the Operating Theatre and a "Keepalite" emergency lighting system, which automatically provides sufficient light should the main electricity current fail is fitted in the operating theatre and labour wards. The lighting fittings throughout the blocks are of a special modern type. There is an electric light over each bed and there are dimmed night lights in the large wards and in the corridors. Modern tubular metal furniture has been provided for the Labour Block and plain waxed oak furniture in the Ward Block. All bedsteads are of tubular steel finished in "Olasto" aluminium. Bassinet cots are provided for the babies and these can be readily wheeled to and from the nurseries and the wards. 20 Administrative Block. The Administrative Block consists of three floors, the second and third providing the bedroom accommodation for the staff, a lecture room, a sewing room, a staff ironing room and the linen stores. Each of the thirty-six bedrooms is equipped with a washhand basin and with a hot water radiator and the furnishing is such as to make the room comfortable for use as a bedroom and as a private sitting-room. Ample lavatory accommodation has been provided for nurses and maids and there is an ironing room in which nurses can wash and iron any special articles of apparel they wish to do themselves. Shampoo fittings are provided in the lavatories on each floor. On the ground floor are the suites of rooms for the Resident Medical Officer and the Matron, sitting rooms for sisters, nurses and maids, a large staff dining room which can also be used as a recreation room and a large and well equipped kitchen, with storerooms and refrigerator. On either side of the entrance is an office, one for the Medical Officer and the other for the Matron. A small telephone room is available for the use of the staff. The doors throughout are flush oak, veneered, the flooring of the rooms is of oak in strips, the corridors are laid with cork, the bathrooms with terrazzo and the kitchens with quarry tiles. All the decorations have been carried out in quiet and unobtrusive, yet pleasant, colouring with the furniture and woodwork in natural waxed oak. The central heating, the domestic hot water and the laundry are supplied by two of the latest "Economic" type boilers, complete with steam turbine pumps in duplicate, and calorifiers. A water softening plant has also been provided. The hospital has been so constructed that another twenty-four beds for patients and twenty bedrooms for staff can be added at a comparatively low cost, the present kitchen and engineering services being sufficient for the enlarged hospital. 21 In presenting this report I again take the opportunity of expressing my appreciation of the great and unfailing assistance given to me not only by the medical staff and the matrons of the two hospitals but by the Secretary, Mr. Birrell, and the Treasurer, Mr. Owen. I am, Ladies and Gentlemen, Your obedient Servant, THOMAS ORR, Medical Superintendent. PERIVALE MATERNITY HOSPITAL. WARD BLOCK PERIVALE MATERNITY HOSPITAL. PERIVALE MATERNITY HOSPITAL FIRST FLOOR PLAN GROUND FLOOR PLAN ADMINISTRATIVE BLOCK PERIVALE MATERNITY HOSPITAL. GROUND FLOOR PLAN WARD BLOCK