CHISWICK Borough of Brentford and Chiswick REPORT on the Health of the District and School Medical Service during 1938. 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. 1 Borough of Brentford and Chiswick. PUBLIC HEALTH COMMITTEE Councillor Mrs. Hill, Chairman. Alderman Davis Edwards Jenkin Councillor Batey ,, Bowie Mrs. Burden Councillor R. Davies W. Davies Fuller „ Holman Mrs. Watts-Tobin Ex officio : Aldermen Leahy, J.P., and Howard, J.P., and Councillor Cleland EDUCATION COMMITTEE Alderman Jenkin, Chairman Alderman Stroud, Vice-Chairman Alderman Leahy, J.P. Councillor Batey Mrs. Burden Burnell Cleland Court R. Davies „ W. Davies „ Holman Kitchingman Lane Councillor Lawson Mrs. M. E. Davies Mr. H. Hyde-Johnson Mrs. D. Jupp Mr. G. R. Davidge County Councillor Hughes, J.P. Johnson, J.P. Mills Councillor Mrs. Hill Mrs. M. E. Edwards Mr. C. PendlBbury, M.A' MATERNITY AND CHILD WELFARE COMMITTEE Councillor Mrs. Burden, Chairman Alderman Edwards „ Jenkin Leahy, J.P. Councillor Batey „ Bowie „ Cleland „ Court Councillor R. Davies „ Grogan „ Mrs. Hill „ Holman ,, Palmer „ Mrs. Watts-Tobin Co-opted, Members : Mrs. E. A. Bird, Mrs. Harvey, Mrs. King, Mrs. Mountford, Mrs. Page, Mrs. Rainbird, Mrs. Saunders and Mrs. Wright, 2 MILK SUB-COMMITTEE Councillor Mrs. Burden Mrs. King ,, Mrs. Hill Mrs. Mountford ,, Mrs. Watts-Tobin Mrs. Rainbird Mrs. E. A. Bird Mrs. Saunders Mrs. Harvey Mrs. Wright VOLUNTARY LADY HELPERS AT THE MATERNITY AND CHILD WELFARE COMMITTEE Brentford Clinics Mrs. E. Bird Mrs. Jones Mrs. G. Burden Mrs. Miles Mrs. S. Burden Mrs. Mountford Mrs. Davis Mrs. Rainbird Chiswick Clinics Miss Barker Mrs. Fromow Mrs. Little Miss Bates Mrs. Gentry Mrs. Macdonald Mrs. G. Brown Miss Goode Miss Phillipe Mrs. Butcher Mrs. Harvey Mrs. Turner Mrs. Ford Mrs. King Mrs. Wright PUBLIC HEALTH STAFF (including Staff for School Medical Service) Male *R. C. Leaning, M.B., B.S.(Lond.), M.R.C.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 Acts and Canal Boats. (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. (Whole time.) *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.) 3 *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., Certificates 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.) Resigned March 1938. G. W. Cassidy, Clerk. (Whole time.) Resigned November 1938. P. G. Smith, Clerk. (Whole time.) B. T. Smith, Clerk. (Whole time.) Appointed May 1938. J. Friar, Clerk. (Whole time.) Appointed December 1938. Female *Miss S. P. Griffiths, M.R.C.S., D.RC.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.), Senior Dental Surgeon. (Whole time.) *Miss A. S. Stewart, D.D.S. (St. Andrews), Assistant Dental Surgeon. (Whole time.) Appointed May 1938. *Miss H. 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 M. E. Catherwood, Trained Nurse; New Health Visitor's Certificate,; Certificate of the Central Midwives Board ; Health Visitor and School Nurse. (Whole time.) *Mrs. R. F. 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 Visitor's Certificate ; Certificate of the Central Midwives Board; Health Visitor and School Nurse. (Whole time.) *Miss C. E. Jenkins, Trained Nurse ; New Health Visitor's Certificate ; Certificate of the Central Midwives Board ; Health Visitor and School Nurse. (Whole time.) *Miss M. Marshall, Clerk to the Maternity and Child Welfare Clinics and School Medical Service—Chiswick Centre. (Whole time.) *Miss B. J. Copp, Clerk to School Medical Service—Chiswick Centre. (Whole time.) Appointed March 1938. *Miss J. Golley, Clerk to the Maternity and Child Welfare Clinics and School Medical Service—Brentford Centre (Whole time.) *Miss L. King, Assistant to the Dental Surgeon—Brentford Centre. (Whole time.) *Miss M. Malden, Assistant to the Dental Surgeon—Chiswick Centre. (Whole time.) *Miss C. Birks, Assistant to the Dental Surgeon. (Whole time.) Resigned February 1938. *Miss K. Freeman, Clerk to the Dental Surgeon. (Whole time.) Appointed April 1938. *Miss I. Grant, Clerk to the Dental Surgeon. (Whole time.) Resigned April 1938. *Miss P. Evestaff, Clerk to the Dental Surgeon. (Whole time.) Appointed May 1938. *Miss E. Walters, Matron—Day Nursery. (Whole time.) Part-time Medical Staff *H. 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, E.D.S., R.C.S.(Eng.), Assistant Dental Surgeon Resigned April 1938. *J. V. Houlton, E.D.S., R.C.S.(Eng.), Assistant Dental Surgeon. Resigned April 1938. *W. C. King-Brown, M.B., B.S., M.R.C.S., Medical Officer- Diphtheria Immunisation Clinic. *T. M. Tyrrell, M.B., B.Chir. (Cantab), F.R.C.S.(Eng.), Ophthalmic Surgeon. Appointed May 1938. * Contribution is made to the salaries of Officers so marked. 5 Borough of Brentford and Chiswick. Public Health Department, Town Hall, Chiswick, W. 4. To the Mayor, Aldermen and Councillors of the Borough of Brentford and Chiswick. Ladies and Gentlemen, I beg to submit to you my Annual Report on the health of the Borough and on the School Medical Service for 1938. I regret that the issue of this Report is very late and must plead the great amount of extra work thrown on the department by Civil Defence requirements. I may state, however, that the actual work in the social services and the personal attention to the school children and essential public health work have not been curtailed. It will be noticed in the table of Vital Statistics that conditions compare very favourably . with those of previous years. The Birth Rate has increased from 12.12 to 13.26, the Death Rate is slightly lower, viz. 11.14 as against 11.74 in 1937, and the Infantile Mortality Rate shows a marked decrease from 52 to 42. As regards the clinics, the opening of the new Health Centre in Brentford by Lord Horder in July was an outstanding forward step in this work. This has made all the more obvious the urgent necessity for providing new clinics for the Chiswick end of the Borough. There is no doubt that the rectification of this defect is being delayed by the International situation. 6 The attendances at the Maternity and Child Welfare Clinics remain about constant, and those at the Ante and Post-Natal Clinics show a marked increase. The establishment of a Sun-Ray Clinic in the Borough is a great asset and should prove to be of very great value. It will be observed that Queen Charlotte's Hospital Domiciliary Services of Midwives is doing excellent work and is becoming very popular with those mothers who chose to have their confinements in their own homes. During the first year of their service the Midwives attended 143 of the 816 births registered in this area. Appended to this report is the Annual Report of the Medical Superintendent of the Isolation and Maternity Hospitals, anp I am greatly indebted to the Ealing and Brentford and Chiswick 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 will 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, Dadies and Gentlemen, for your continued courtesy and help. I am, Dadies and Gentlemen, Your obedient Servant, R. C. LEANING. 7 SECTION A. STATISTICS AND SOCIAL CONDITIONS OF THE AREA. 1. GENERAL STATISTICS, 1938. 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 1938 61,470 Number of inhabited houses (end 1938) according to the Rate Books (approximate) 15,652 Rateable Value (31st December 1938) £700,962 Sum represented by penny rate (General District) £2,790 2. EXTRACTS FROM VITAL STATISTICS OF YEAR. Total. M. F. Live births— Legitimate 772 400 372 Birth Rate per 1,000 of estimated resident population, 13.26. Illegitimate 44 22 22 Stillbirths 21 8 13 Rate per 1,000 total (live and still) births, 25.1. Deaths 671 332 339 Death Rate per 1,000 of estimated resident population, 11.14. Deaths. Rate per 1,000 total (live and still) births. Deaths from puerperal causes— Puerperal Sepsis 1 1.19 Other puerperal causes 2 2.39 Total 3 3.58 Death Rate of Infants under one year of age— All infants per 1,000 live births 42 Legitimate infants per 1,000 legitimate live births 38 Illegitimate infants per 1,000 illegitimate live births 114 Deaths from Cancer (all ages) 122 Deaths from Measles (all ages) 2 Deaths from Whooping Cough (all ages) - Deaths from Diarrhoea (under 2 years of age) 6 Zymotic Death Rate 18 8 COMPARISON OF VITAL STATISTICS. Birth Rate. Death Rate. Infant Mortality Brentford and Chiswick 13.26 11.14 42 England and Wales 15.1 11.6 53 126 County Boroughs and Great Towns, including London 15.0 11.7 57 London 13.4 11.4 57 (a) Vital Statistics. POPULATION. The Registrar-General's estimate of the total population of the Borough for the year 1938 is 61,4.70, which shows a decrease of 550 from that for 1937 and a decrease of 1,147 from the Census figure. The decrease of 550 is no doubt largely accounted for by plans for the extension of the Great West Road, which cuts through the residential part of Chiswick and has caused so many houses of the better class type to be vacated and their occupants to move out of the Borough. The excess of births over deaths during the past eight years is 1,058, but this of course is only one factor taken into account when forming the estimate. BIRTHS. There were 816 births registered as belonging to the area during the year (422 male and 394 female). Of these, 44 were illegitimate (22 male and 22 female). In addition there were 21 stillbirths registered, one of which was illegitimate. The Birth Rate for the Borough for 1938 was therefore 13.26—a figure slightly below that for London and below that for England and Wales as a whole. DEATHS. Table 1 on page 12 shows the causes of the 671 deaths of residents of the area, which is equivalent to a Recorded Death Rate of 10.92 per 1,000 of the estimated population and a Corrected Death Rate of 11.14 for the purposes of comparison with other areas. It is interesting to note that of the 671 deaths, 375 or 56 per cent. occurred in Hospitals and Institutions outside the Borough. 9 Mortality in Age Groups. Deaths under 1 year of age 34 ,, between 1 and 2 years 3 „ „ 2 „ 5 years 5 „ „ 5 „ 15 „ 5 „ „ 15 „ 25 „ 22 „ „ 25 „ 45 „ 64 „ „ 45 „ 65 „ 184 ,, over 65 years of age 354 Total 671 It will thus be seen that 354 persons dying during theyear—or approximately 52.7 per cent.—reached the age of 65 or over. Further analysis of this figure shows the following :— Deaths between 65 and 70 years of age 82 „ 70 „ 75 „ 82 „ 75 „ 80 „ 86 „ 80 „ 85 „ 58 „ 85 „ 90 „ 31 „ 90 „ 95 „ 14 ,, 95 ,, 100 ,, 1 Total 354 Again, of this number, 272—or over 40 per cent.—reached the age of 70 years or over, the oldest resident dying being 96 years of age. A perusal of Table 1 appended, which sets out the causes of death, will show that Cancer accounted for 122 deaths and Tuberculosis (all forms) for 42 deaths. In the preceding year these diseases were responsible for 101 and 39 deaths respectively. Zymotic Death Rate. This rate is calculated from the number of deaths occurring from the seven principal zymotic diseases, viz. Small-pox, Scarlet Fever, Diphtheria, Measles, Fever (Typhus, Typhoid and Continued), Whooping Cough and Diarrhoea. The total 10 number of deaths from these causes was 11, which gives a zymotic death rate of 0.18 per 1,000 of the population. Infantile Mortality. The total number of deaths of infants under one year of age was 34. Of this number, 5 were of illegitimate children. This gives an Infantile Mortality Rate of 42 per 1,000 live births. Analysing this figure, one finds that the Infantile Mortality Rate among legitimate children was 38, while that among illegitimate infants was 114. The low Infantile Mortality Rate of 42 compares very favourably with the figures for all other parts of the country. Of the 34 infant deaths, 28 occurred outside the area and 19 were neo-natal, i.e., occurring during the first four weeks of life. The following sets out the Birth, Death and Infantile Mortality Rates since the date of amalgamation of Brentford and Chiswick :— Year. Birth Rate. Death Rate. Infantile 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 1938 13.26 11.14 42 * Year of severe Influenza epidemic. 11 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 34 deaths recorded, 15 can be classified as what might be considered preventable diseases, viz. Convulsions, Bronchitis, Pneumonia, Enteritis and Marasmus. One who died from Injury at Birth and possibly some classified as Premature Birth may also be in this category. (b) Social Conditions. There is little to add to my remarks in many of my previous reports relative to the social conditions of the Borough. As pointed out last year, there are now many large and important industries carried on in the area, particularly in the Great West Road area. These industries include scientific instrument makers, manufacturing chemists, card box manufacturers, knitting mills, aeroplane accessories, motor and marine engineers, transport and railway works, and many others. Like many other London suburbs, there is of course a certain number of unemployed, but speaking generally unemployment cannot be said to exist to any really large extent in the Borough. There are many large blocks of residential flats within the district, as well as quiet, purely residential, portions ; but it is an undisputed fact that the new Great West Road extension scheme has and will materially affect some parts of the latter areas. Nevertheless the Council is a progressive one and in conjunction with other Authorities, has provided many open spaces and parks to add to the amenities of the district. 12 TABLE I. Particulars of Births and Deaths as supplied by the Registrar-General for the Year 1938. Cause of Death. Males. Females. All Causes 332 339 1. Typhoid Fever, etc. — — 2. Measles 1 1 3. Scarlet Fever — — 4. Whooping Cough — — 5. Diphtheria 1 2 6. Influenza 2 2 7. Encephalitis Lethargica — — 8. Cerebro-Spinal Fever — 2 9. Respiratory Tuberculosis 29 8 10. Other tuberculous diseases 2 2 11. Syphilis 1 1 12. General paralysis of the insane, etc. 4 1 13. Cancer 69 53 14. Diabetes 2 8 15. Cerebral haemorrhage, 10 17 16. Heart Disease 79 101 17. Aneurysm 2 1 18. Other circulatory diseases 11 18 19. Bronchitis 11 10 20. Pneumonia 14 14 21. Other respiratory diseases 4 6 22. Peptic Ulcer 12 1 23. Diarrhoea, etc. (under two years) 3 3 24. Appendicitis 9 2 25. Cirrhosis of liver i 1 26. Other liver diseases — 2 27. Other digestive diseases 7 11 28. Nephritis 4 11 29. Puerperal Sepsis — 1 30. Other Puerperal causes — 2 31. Congenital causes, etc. 12 9 32. Senility 5 10 33. Suicide 5 7 34. Other violence 13 10 35. Other defined diseases 28 21 36. Ill-defined causes — 1 Special Causes (included in No. 35 above)— Small-pox — — Poliomyelitis — — Polioencephalitis — — Deaths of Infants under 1 year— Total 18 16 Legitimate 15 14 Illegitimate 3 2 Live Births— Total 422 394 Legitimate 400 372 Illegitimate 22 22 Still-births— Total 8 13 Legitimate 8 12 Illegitimate — 1 POPULATION 61.470 13 TABLE II. Infantile Mortality during the Year 1938. • Net deaths from stated causes at various ages tinder 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 — — — — — — — — 1 1 Erysipelas — — — — — — — — — — Tuberculous Meningitis — — — — — — — — — — Abdominal Tuberculosis — — — — — — — — — — Other Tuber. Diseases — — — — — — — — — — Meningitis (non T.B.) — — — — — — 1 — — 1 Convulsions 1 — — — 1 — — — — 1 Laryngitis — — — — — — — — — — Bronchitis — — — — — — 1 — — 1 Pneumonia (all forms) — — — — — — 2 1 1 4 Diarrhoea — — — — — — — — — — Enteritis 1 — 1 — 2 1 2 1 — r. Gastritis — — — — — — — — — Rickets — — — — — — — — — —. Suffocation, overlying — — — — — — — — — Injury at Birth 1 — — — 1 — — — — l Atelectasis 1 — — — 1 — — — i Congenital Malformation 3 1 1 — — — — — 5 Premature Birth 7 — 1 — 8 — — — — 8 Atrophy, Debility and Marasmus — — 1 — 1 2 — — — 3 Pemphigus Neonatorum — — — — — 1 — — — 1 Other Causes — — —— — — — 1 — — 1 Totals 14 1 4 — 19 4 7 2 2 34 Births—Legitimate 772 Deaths—Legitimate 29 Illegitimate 44 Illegitimate 5 Infantile Mortality Rate per 1,000 Births 42 14 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. 1728, relative to the preparation of Annual Reports for the year 1938 (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 for 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 1938 Number of private calls dealt with during 1938 484 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. (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 15 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 a minimum rate of one 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 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 Brentf rd Hospital. The former Hospital, which has undergone extensive reconstruction, has not yet been re-opened to the public. 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. (3) Maternity and Child Welfare. The remarks made in former reports regarding these Clinics might be repeated here in respect of the policy followed and the scope of work undertaken. There is, however, one outstanding feature which concerns more especially the Brentford Clinics. In July Lord Horder opened the new Health Centre which had been built on the site of the old Rothschild School. A description of the general lay-out, given by the Borough Engineer, will be seen at the end of the Report on the School Medical Service, and to that account may be added the fact that that end of the Borough 16 table of clinics and treatment centres. Description address When held Provided by 1. M. & C.W. Clinics (consultation and simple treatment) Health Centre, Albany Road, 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. Ditto 3. Ante-Natal Clinic Health Centre, Brentford* Once weekly on Wednesdays at 10.30 a.m. Ditto 4. Ditto Heathfield Ter'ce, Chiswick Once weekly on Tuesdays at 10.30 a.m. Ditto 5. Minor Ailment Clinic Health Centre, Brentford* Each weekday at 9 a.m. Education Committee 6. Ditto Heathfield Terr., Chiswick Ditto Ditto 7. Dental Clinic Health Centre, Brentford* Mondays to Fridays at 9 a.m. and 2 p.m. for elementary school children, as required for patients from M. and C.W. Clinics. Education Committee; by arrangement with the Council for M.C.W. and patients. 8.Ditto † Heathfield Terr., Chiswick Daily for elementary school children. As required for patients from M. and C.W. Clinics. Mondays and Tuesdays at 5 p.m. to 6 p.m. for secondary school children. Ditto 9. Eye Clinic † Health Centre, Brentford* One session weekly on Thursdays at 9.30 a.m. for elementary school children. Education Committee 10. Tonsils and Adenoids Chiswick Hospital ‡ For elementary school children as required Ditto 11. Ringworm (X-Ray) Ditto Ditto Ditto 12. Rheumatism Clinic Health Centre, Brentford Once weekly, on Thursdays at 11.30 a.m. Ditto 13. Artificial Sunlight Clinic Ditto Once weekly, on Wednesdays at 2 p.m. Ditto 14. Orthopaedic Clinic Ditto* Twice weekly on Mondays and Thursdays at 2 p.m. Education Committee and M. and C.W. Committee 15. Diphtheria Immunisation Clinic Heathfield Terr., Chiswick One session weekly on Mondays at 2 p.m. Brentford and Chiswick Town Council 16. Day Nursery Bennett Street, Chiswick Weekdays Ditto 17. Tuberculosis Dispensary 14 Heathfield Terrace, Chiswick Once weekly on Thursdays at 10 a.m. Middlesex County Council 18. Venereal Disease Clinic No Clinics established within the District, but patients may attend the Special Clinic at the West London Hosnital 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. * Clinics previously held at the Baths Annexe and Portsdown House, Brentford, were transferred to the Health Centre, when it was opened in July 1938. † 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. 17 SUMMARY OF WORK AT THE MATERNITY AND CHILD WELFARE CLINICS, 1938. BRENTFORD AREA. CHISWICK AREA. Grand Totals, 1938. Grand Totals, 1937. Monday Clinics. Wednesday Clinics. Total. Wednesday Clinics. Thursday Clinics. Friday Clinics. Total. Number of new Members enrolled during the year— Under 1 year 72 118 190 54 152 175 381 571 490 Over 1 year 38 56 94 10 44 46 100 194 138 110 174 284 64 196 221 481 765 628 Number of children attending & weighed Under 1 year 1050 1718 2768 773 2759 2717 6249 9017 7972 Over 1 year 725 1671 2396 131 1368 1764 3263 5659 5290 1775 3389 5164 904 4127 4481 9512 14676 13262 Number of children seen by Doctor— Under 1 year 390 448 838 241 895 1030 2166 3004 3064 Over 1 year 330 447 777 57 551 723 1331 2108 2263 720 895 1615 298 1446 1753 3497 5112 5327 18 now possesses very excellent up-to-date machinery for dealing with expectant mothers and mothers, and with infants and children until they leave school. There are special Clinics for Dental, Eye, Orthopaedic, Rheumatism cases and cases requiring Artificial Sunlight, each of which is attended by a Specialist skilled in the particular treatment indicated. When planning and furnishing these special departments, the Specialist concerned was consulted so as to render them as efficient as possible. It may also be mentioned that all these Clinics, together with that for treating Minor Ailments, are available for both the Maternity and Child Welfare and the School Medical Services. The Chiswick end of the Borough is badly in need of new accommodation for its Clinics. In the early days of these services, they were looked upon as being quite satisfactory, but fortunately the value of these services is now being appreciated, so more adequate and hygienic space is urgently needed. For a district of this size it is perhaps unnecessary at present to provide another Eye and Orthopaedic Clinic, but the other Clinics should be included in any scheme drawn up to supply our minimum requirements. Actually, plans have been submitted for a new Health Centre in Chiswick, but the international situation has been a serious deterring factor in the completion of the scheme. The following were sent to our own treatment Clinics :— Dental Clinic : 78 mothers, 152 children. Orthopaedic Clinic : 1 mother, 70 children. Artificial Sunlight Clinic (opened July 1938) : 106 children. Rheumatism Clinic : 1 mother, 6 children. Eye Clinic : 7 children. Minor Ailment Clinic 12 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. In addition to the above, 5 children were sent to the District Nurse for treatment. In cases requiring other forms of treatment, they are referred to their own Doctor or to an appropriate Hospital. During the year, 142 children were sent to Hospital for the following conditions :— Circumcision 108, Tonsils and Adenoids 14, Squint 4, 19 Naevi 4, Skin diseases 2, Hernia 1, Hydrocele 1, Bladder 1, Teeth and Heart 1, Cleft Palate 1, Malnutrition 1, Vomiting 1, Pyloric Stenosis 1, Anaemia 1, Foreign body in nose 1. Three mothers were also sent to Hospital for the following conditions:— Chronic Leucorrhoea 1, Haemorrhage 1, Mental 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. Seventy children were referred from the Maternity and Child Welfare Clinics for treatment during the year and made 1,068 attendances. The conditions found in the children were as follows :— (1) Congenital Defects : Metatarsal varus, pes arcuatus 1 Irregular toes, congenital pes. pl. valvus, etc. 1 (2) Birth Injuries : Torticollis 2 (3) Rickety Deformities : Bow tibiae 10 Knock knees 1 Bowlegs—intoeing 5 (4) Non-Rickety Deformities O. C. T. 13 Knock knees 10 (5) Flat feet 3 (6) Infantile Paralysis 1 (7) Other conditions including postural intoeing 4 (8)N.A. D. 1 (9) No diagnosis 1 Two children were admitted to Stanmore, one for Talipes and the other for osteoclasis for knock-knee. artificial SUNLIGHT CLINIC. This Clinic, established in the Brentford Health Centre, was opened in July and during the rest of the year 106 children were treated. 20 It is staffed by a fully qualified Nurse from the Royal National Orthopaedic Hospital and is equipped with two lamps. One is a carbon arc lamp presented by the Gunnersbury Clinic in memory of the late Mrs. Olive Brierley, and the other is a Duo-therapy Mercury Vapour lamp, for the cost of which a contribution was made by Mr. Harris in memory of his mother. Dental Clinic. Miss L,oretz, 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 51 52½ 103½ Patients treated—Mothers 100 148 248 Children 92 102 194 Total 192 250 442 Attendances— Mothers 454 590 1044 Children 262 314 576 Total 716 904 1620 Teeth filled— Permanent 66 184 250 Temporary 81 148 229 Total 147 332 479 Teeth extracted— Permanent 303 441 744 Temporary 222 272 494 Total 525 713 1238 Teeth treated with AgN03 52 86 138 Administrations of Nitrous Oxide 198 257 455 Dentures 26 21 47 Repairs 5 5 10 Scalings 17 28 45 Dressings 5 30 35 Ante-Natal Clinics. Two sessions are held weekly, one in Brentford and one in Chiswick. During the year, 538 expectant mothers made 2,260 attendances. As 831 births were notified, this number represents 64.7 per cent. of these births ; the percentages in 1937 and 1936 were 53.4 and 51.7 respectively. 21 At her first attendance each mother is given a general systematic examination and a blood test is done if there is any indication that such an investigation is necessary. She is asked to attend the Clinic each month during the earlier periods, and weekly during the last month of pregnancy, unless it happens that more frequent examinations are required. If a patient does not keep her appointment and in certain conditions of health, she is visited by one of the Nurses. 538 ante-natal visits were made during the year, which included visits in connection with the investigation of home conditions. The following Table shows certain conditions found in the Clinics and the manner in which they were dealt with :— Dental cases 169 Sent to Dental Clinic. Leucorrhoea 47 Treated in Clinic. Small measurements 3 Kept under careful observation. Premature induction not necessary in any case. Malpresentations : Breech 13 Eight corrected in Clinic, five in Hospital. Transverse 9 Corrected in Clinic. Retro flexed gravid uterus 1 Corrected in Clinic. Twin pregnacies 4 Threatened miscarriage 6 Two aborted. Albuminuria—Marked 8 Treated in Clinic; 3 sent to Mild 72 Hospital Treated in Clinic. High Blood Pressure 9 One sent to Hospital. Vomiting 44 Treated in Clinic. Varicose Veins 56 Treated in Clinic. Haemorrhoids 2 Treated in Clinic. Anaemia 5 Treated in Clinic. Heart Disease 15 One sent to Hospital for termination of pregnancy. Cystitis 1 Treated in Clinic. Chorea 1 Treated in Clinic. Enlarged Thyroid 2 Treated in Hospital. Scabies 1 Treated in Clinic. Not pregnant 6 22 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 51 121 167 7 713 14 Chiswick 50 274 371 31 1547 31 Totals 101 395 538 38 2260 22 23 Post-natal Clinics. These are also held once weekly in each district, at the end of the Ante-natal Session. All mothers attending the Antenatal Clinics are invited to these Clinics after their confinements, but only a small percentage attends. During the year 38 mothers made 86 attendances, or 4.6 per cent, of the notified births. The conditions found are shown in the following Table :— Dental ... 3 General debility and anaemia 5 Subinvolution 14 Ovaritis 3 Albuminuria 2 Retroflexion 3 Cystitis 4 Torn Perinaeum 2 Leueorrhoea 5 Breast Abcess 1 Venus Thrombosis ... 1 Haemorrhoids 2 Heart Disease 1 Expectant ] Mothers Nursing Mothers Children under 5 vrs Expectant Mothers Expectant Mothers Nursing Mothers I Children | under 5 yrs j Free, or at less than cost price in necessitous cases Yes Yes Yes No Yes Yes Yes At cost price, in other cases {e.g. sale of dried milk at Centres) Yes Yes Yes No Yes Yes Yes *Cod Liver Oil and Malt, Virol, Bemax, etc. 24 Total quantity of milk supplied during the year to expect ant and nursing mothers and young children:— Liquid Milk (gallons) Dried Milk (lbs.) (i) By the Council 507 10,583 (ii) By voluntary associations operating in the area of the Council - - Totals 507 10,583 MATERNAL MORTALITY. The following four deaths connected with pregnancy were reported during the year, two being from Sepsis and two from other causes:— Age. Where died. Cause of death. If attended Ante-natal Clinic. (1) 21 years Isleworth Suppurative Broncho-pneumonia following 6 months abortion. Yes (2) 20 years Isleworth Salpingo-Peritonitis following 4 months abortion. NO (3) 33 years Chiswick and Ealing Hospital Pulmonary Embolism after normal delivery. Yes (4) 35 years Isleworth Pulmonary Embolism after normal delivery. Yes 4 With regard to the above cases it may be stated that in case (1) it is not improbable that the miscarriage was secondary to the Broncho-pneumonia. Case (2) was not under the control of any Maternity and Child Welfare activity. 25 Case (3) was a woman who had two previous confinements and each time had serious complications with narrow escapes. She was strongly advised not to have any more children, as she also had a marked heart lesion with kidney disease. For some time she used a prescribed contraceptive, but unfortunately was eventually persuaded to discontinue the use on religious grounds. Case (4) attended the Ante-natal Clinic regularly and with the exception of mild discomfort from Varicose Veins appeared to be in a satisfactory condition up to the time of her confinement. The following Table shows the number of deaths connected with pregnancy during the last ten 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 - - 1938 2 2 15 17 This shows an average of 3.2 per year for the last ten years. 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. The Middlesex County Council is the Supervising Authority for the Borough, and Queen Charlotte's Hospital undertakes the Domiciliary treatment of Midwifery. 26 A Nurse from this Hospital attends each Ante-Natal Clinic in the Borough, so that all necessary arrangements can be made with those mothers wishing to engage their services, and also so that they may obtain reports on the health and special conditions of the prospective patients. During 1938 these Nurses attended 143 cases. The service has five auto-bicycles and two small cars which enable the Nurses to reach their patients quickly at any time of the day or night. It also enables them to carry a Gas and Air Analgesic Apparatus to each case. The Sister-in-charge reports:— "Most of the patients have the Gas and Air and appreciate it immensely. Each patient is examined previously within the month and a certificate is given to us to say that she is ' fit for Gas and Air.' We are all agreed that it tends to avoid perinial lacerations and so far we have found no disadvantage whatever. The Midwives here hold their certificate for administering the Gas and Air Analgesia." With regard to the 143 cases mentioned above, all were quite normal and uneventful except the following:— 2 Forceps deliveries (both satisfactory). 1 Slight post-partum haemorrhage. 1 Venous thrombosis (sent to Isolation Block, Queen Charlotte's Hospital). 6 Perinial Lacerations. 1 Stillborn. 1 Macerated foetus. 1 Twin. 1 Baby died from Congenital Malformation of Heart. In all cases the mothers made satisfactory recoveries. Health Visitors. Six Nurses are engaged in this work, but as each Nurse is also half-time School Nurse, the equivalent of whole-time services devoted by the whole staff to Health Visiting (including attendances at Infant Welfare Centres) is three. 27 A brief summary of their work during the year is shown in the following Table:— Number of visits paid during the year by all Health Visitors:— (a) To expectant mothers: First visits 324 Total visits 538 (b) To children under one year of age: First visits 698 Total visits 2044 (c) To children between the ages of 1 and 5 years: Total visits 3494 (d) Ophthalmic visits 9 (e) Other visits: Measles 15 Whooping Cough 4 Epidemic Diarrhoea - Infant Life Protection Visits 276 Total 6380 Child Life Protection (under the Public Health Act, 1936). 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 the fostermothers are required to bring fosterchildren 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 29 (b) At the end of the year 29 (2) Number of children on the Register: (a) At the beginning of the year 36 (b) At the end of the year 37 (c) Who died during the year — (d) On whom inquests were held during the year — 28 Day Nursery. The Day Nursery, situated in Bennett Street, Chiswick, was established in 1910 by private enterprise and handed over to the Local Authority in 1923. The following details may be noted here:— Hours of opening: Mondays to Fridays 7.45 a.m. to 6.30 p m. Saturdays 7.45 a.m. to 1 p.m. Parents or Guardians are responsible for conducting the children to and from the Day Nursery. Age Limits of Children accepted: From day of birth to school age. Accommodation provided : Playrooms, bathrooms, nurses' pavilion (separate from Day Nursery), kitchens, etc. Capacity of Nursery: 42 children in winter and 45 in summer. Average attendances: 8,000 whole days per annum, 850 halfdays per annum. Charge to Parents: 9d. per day, 5d. per half-day. The Staff of the Day Nursery consists of one Matron, one Staff Nurse and five probationers. The attendances made during 1938 were as follows:— Whole-days 10,503 Half-days 1,013 The site on which the Nursery stands is required in connection with the Great West Road extension scheme, so it is necessary to re-build elsewhere. An admirable site has been obtained, and plans for a new Nursery have been submitted. The completion of this scheme will take rather longer than usual owing to the present state of general unrest, and endeavours are being made to find temporary accommodation so that this branch of the work may be carried on without interruption. 29 SECTION C. SANITARY CIRCUMSTANCES OF THE AREA. (i) Water. As pointed out in previous reports, the water supply throughout the whole Borough is from the mains of the Metropolitan Water Board. There is now only one private dwelling-house which draws its drinking water supply from a well. Samples from this well were secured during the year, and the report thereon was extremely good. In addition, three factories draw their drinking water supply from wells, and samples were taken and submitted for both chemical analysis and bacteriological report. In all cases, the reports were satisfactory, and the Council gave their approval in writing of the source of supply to the firms concerned in accordance with the requirements of Section 41 of the Factories Act, 1937. The majority of the smaller type of houses in the Borough have a direct supply from the rising main for drinking purposes, hut from time to time isolated cases are found where the supply comes through a storage cistern. Where such is in an inaccessible position to permit of periodical cleansing of the cistern, action is taken. In this connection, 22 draw taps direct from the main were fixed during the year. (ii) Drainage and Sewerage. The whole of the sewage of the Borough is now taken by the West Middlesex Scheme with its works in the Heston and Isleworth area adjoining this Borough. 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 constructed during 1938 ... ... ... 514 ft. (b) Length of soil sewers laid or reconstructed during 1938 Nil 2. Rivers and Streams. A few minor complaints were received from the Port of London Authority in reference to the pollution of the River Thames by the surface water sewers. Investigation was carried out in every ease and the matter rectified. 30 3. (i) Closet Accommodation. All houses within the Borough are supplied with water closets and are connected with the sewerage system, except in three cases. In two of these cases, modern water-tight cesspools are provided, and in the third case—situated far from other dwellings—the premises are likely to be dealt with in the near future. (ii) Public Cleansing. This branch of Public Health work is in the efficient hands of the Borough Engineer. There is a weekly collection of refuse from all houses in the Borough with more frequent collections from the large blocks of flats in the area. The system of refuse disposal is by barging to a site in the lower reaches of the River Thames and motor transport is employed to convey the house refuse in covered removal carts from the collection point to the barges, which are loaded at the Town Meadow Depot, situated south of the Brentford High Street. (iii) Sanitary Inspection of the Area. Tabular Statement of the Work of the Sanitary Department, 1938. Inspections. Number of premises inspected on complaint 872 Number of premises inspected in connection with infectious disease 179 Number of primary inspections 4,251 Number of re-inspections 4,114 Total number of inspections and re-inspections 8,365 Action Taken (other than Housing Act, 1936). Cautionary or intimation notices served 836 Statutory Orders issued (under Public Health Acts) 28 Summonses served - Number of Certificates under Rent &c. (Restrictions) Acts issued to Tenants 7 Number of Clearance Certificates issued to owners 5 31 Particulars of Sanitary Defects referred to in Notices served, and Other Matters. (a) Drainage of Existing Buildings. New provided, repaired, supplied with water or otherwise improved 142 Percentage of houses provided with waterclosets 100 Drains: Tested (smoke) 77 Unstopped, repaired, trapped, etc. 119 Waste pipes, rainwater pipes disconnected, repaired, etc. 78 New soil pipes and ventilating shafts fixed 27 New sinks provided 44 Disconnecting traps and chambers inserted 119 Reconstructed (whole system) 30 Reconstructed (connections) 41 Percentage of houses draining into sewers 99.9 Surface water drains reconstructed 7 Surface water drains repaired 1 (b) Water Supply and Water Service. Draw taps on main 22 Percentage of houses supplied from Public Water Service 99.9 (c) Refuse. New bins provided 53 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. (d) Sundry Nuisances. Overcrowding 7 Urgent cases reported to Housing Committee. Smoke—Minor complaints only. Accumulation of refuse 2 Foul ditches, ponds, etc., and stagnant water 6 Dampness 263 Yards repaired or repaved 48 Leaky roofs and eaves guttering 351 Premises repaired and cleansed 658 Other nuisances 700 32 (e) Disinfection. Premises disinfected: Ordinary notifiable diseases 147 Phthisis 24 Cancer 29 Other diseases 14 Rooms stripped and cleansed (Section 167, Public Health Act, 1936) - Premises treated for vermin 81 Premises treated for other pests 25 (f) Slaughterhouses. Number on Register (including one Knacker's Yard) 5 Inspections made periodically at time of slaughter. Contraventions of bye-laws - Number of animals slaughtered in district during the year: Oxen 217 Sheep and Lambs 1,126 Pigs 577 - 1,920 Slaughter of Animals Act, 1933: Number of licences to slaughter animals issued during the year: New Licences 1 Renewed Licences - 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) 30 Total 80 33 Number of Licences issued to sell: (a) Tuberculin Tested Milk 7 (b) Accredited Milk 1 (c) Pasteurised Milk 18 Bakehouses. Number in district in use 20 Contraventions of Factory Acts - Unsound Food. Meat (including bacon) seized and surrendered (approx- mate weight) 1 cwt. 110 lbs. Poultry 87½ lbs. Fruit and Vegetables: Oranges—150 cases 4 tons 17 cwt. Tomatoes 3½ cwt. Mushrooms—115 baskets 4 cwt. 12 lbs. Peas—228 bags 81½ cwts. Offensive Trades. Number of premises in district 18 Nature of trades: One soap boiler, 2 rag and bone dealers and 15 fried fish shops. Number carried on under yearly licence 3 Number of inspections made 42 Canal Boats. Number registered during the year: Motor propelled boats — Other boats (wide) 1 Registration Certificates cancelled 1 Number of Duplicate Copies of Registration Certificates issued 22 Number of boats inspected 49 Number of complaint notes signed — Number of boats on Register: Motor propelled boats 97 Other boats 418 34 Petroleum Acts. Number of applications received for licences to store and sell petroleum spirit 108 Number of applications received for licences to store and sell petroleum mixture 17 Number of applications received for licences to store and sell carbide of calcium 9 Number of gallons of petroleum spirit covered by licences 202,747 Number of gallons of petroleum mixture covered by licences 3,290 Quantity of carbide of calcium covered by licences 12 tons 16 cwt. 12 lbs. 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) 84 3 - Workshops(including workshop laundries) 14 3 — Workplaces (other than out-workers' premises — — — Total 98 6 — 35 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 3 3 — — Sanitary accommodation— Insufficient — — — — Unsuitable or defective 1 1 — — Not separate for sexes — — — — Offences under Factory Act, 1037— Illegal occupation of underground bakehouses (Sec. 54) - - - - 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) 1 1 - - Totals 6 6 — — (iv) Shops Act, 1934. In three cases only was it found necessary to take any action under Section 10 of the Shops Act, 1934. Two cases were in connection with the non-maintenance of a reasonable temperature, and one case in connection with insufficient sanitary accommodation. In all cases the owners of the shops took immediate steps to comply with the requirements of the Act. (v) Camping Sites. The Council received notice of one private site to be used for camping purposes within the Borough. This was in connection with enclosed land adjoining the Cubitt's Yacht Basin. 36 Ample sanitary accommodation and drinking water supply direct from the main was provided, and the site only used at intermittent short periods by car trailer caravans. (vi) Smoke Abatement. Little trouble was experienced in this connection during the year, and it was not found necessary to issue any statutory notices under the Public Health Act, 1936. (vii) Swimming Baths and. Pools. There are no privately owned swimming baths open to the public within the Borough. The Council have their own open air baths, situated at Chiswick, and a covered bath at Brentford. In both cases the water is subject to constant filtration and cleansing. Samples are taken periodically by the Engineer's Department for examination, and no complaints as to the quality of the water were received. (viii) Eradication of Bed Bugs. This problem is one that requires the careful consideration of every Local Authority, and during 1938 the Housing Committee of the Council have given and at the time of writing are still giving the matter special consideration. (a) The number of houses found to be infested by and treated for bugs by the Public Health Department is as under:— (i) Council Houses 3 (ii) Other Houses 68 The figure under (i) above does not, however, reflect the true position, as where Council houses undergoing redecoration are found to be infested, disinfestation is carried out by the Works Department, and only in really bad infestations is this Department called in to help. (b) The method employed in disinfestation is mainly that of a contact insecticide. In bad cases all removable woodwork—such as picture 37 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 are made good and a skirting formed with Keen's Cement. One or more sprayings may be necessary. Three well-known insecticides have been used, viz., Zaldecide, Vermieine, and Concentrated Clensel. (c) The Council did not in the past year employ Hydrogen Cyanide Gas in the work of disinfestation, but at the time of writing such is being used for fumigating furniture of persons entering Council properties and the disinfestation of empty properties where necessary. (d) The work is carried out by Contractors. (e) The Council now have the services of a very efficient Housing Manager, who I understand is doing valuable work by way of supervision and education of the tenants in the fight against this pest. (ix) 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. 38 SECTION D. HOUSING. The housing problem is one that still commands the careful consideration of the Housing Committee of the Council. The lack of available land within the Borough confines suitable for the erection of houses of the artisan type has in the past necessitated the acquisition of land and the erection of housing estates in the neighbouring Borough of Heston and Isleworth. More recently, however, by reason of the closing down of both the Brentford and Chiswick sewage disposal works, these sites have been rendered available for building purposes. In addition, the Council have lost no opportunity of securing other sites as and when they have come on the market. As a result the Council are now going forward with extensive schemes. TheSe schemes, when complete, will serve to meet the need of re-housing the still overcrowded families, families likely to require re-housing as a result of Clearance Orders under the Housing Act, 1936. The Ministry of Transport are also requiring the Council to build in order to re-house families likely to be dispossessed of their present homes by reason of the construction of the Great West Road extension. From the statistics given below, it will be observed that the Council now have 1,622 houses and flats under their control. The appointment of a Housing Manager to supervise this large number of working-class dwellings is undoubtedly a step in the right direction. The following statistics have been supplied to me by the Borough Engineer:— Number of new houses etc. erected during the year 1938:— (1) Total number of new houses and flats erected within the Borough 148 (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 flats (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 1,622 39 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. Appended is a tabular statement of the work carried out under the Housing (Inspection of District) Regulations, 1925. From this it will be seen that 509 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 1938:— (a) Number of Clearance Orders (including Compulsory Purchase Orders) made by the Borough Council and confirmed or awaiting confirmation by the Minister of Health 35 (b) Number of houses actually demolished in Clearance Areas 261 (c) Number of houses where Clearance Orders have been confirmed but houses not yet demolished 5 (d) Number of individual houses demolished under Demolition Orders 8 (e) Number of houses where Demolition Orders have been made, but houses not yet demolished. — (f) Number of houses demolished by owners in anticipation of action by the Local Authority 31 *(g) Number of houses scheduled for demolition, but where official action is still to be taken 34 * This number is likely to be augmented considerably as and when the Council are in a position to re-house the displaced tenants. 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 1938. 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. 40 Work under the Housing Acts, 1930 and 1936 (included above) showing Position at 31st December, 1938. Number of dwellinghouses demolished Number of persons displaced up to 31st Dec. 1038 Number of dwellinghouses made fit Unfit Houses Other Houses, PART A:— Clearance Areas— (i) Land coloured pink 261 — 857 — (ii) Land coloured grey — — - PART B:— Improvement Areas - — - - PART C.—Insanitary houses not included in Clearance Areas or Improvement Areas. (1) Number of dwelling-houses demolished as a result of formal procedure under Section 11 8 (2) Number of dwelling-houses demolished as a result of informal notices preliminary to formal procedure under Section 11 31 (3) Number of dwelling-houses closed, but not demolished, as a result of undertakings (which have not been cancelled) by owners under Section 11 not to use houses for human habitation - (4) Parts of buildings closed (Section 12) - (5) Number of persons displaced as a result of action: Under (1) above 46 Under (2) above No record Under (3) above Under (4) above - (6) Number of dwelling-houses made fit: (i) as a result of formal notices under Sections 9 to 12 71 (ii) as a result of informal notices preliminary to formal procedure under Sections 9 to 12 3,700 BOROUGH OF BRENTFORD AND CHISWICK. HOUSE-TO-HOUSE INSPECTION DURING THE YEAR 1938. 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. 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, j 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 Annandale Road 36 14 20 — 205 46 251 123 133 7.0 7.1 - - 2 - - - 5 1 2 8 - - 5 - - 2 30 - - 1 - 29 British Grove (Part of) 15 1 3 — 62 15 77 28 45 5.1 4.9 - - - - - - - - 3 6 - - 3 1 - - 5 - - 6 Devonshire Place 23 - — — 71 9 80 43 48 3.5 4.0 - - - - - 2 - - 4 - - 4 - 1 12 - 9 Devonshire Street 30 3 — — 102 16 118 55 61 3.9 3.9 - - - - - - - - - 4 1 - - - - - 19 - - 12 Duke Road (Part of) 52 28 — — 236 31 267 148 - 5.1 6.0 - - - - - - 2 2 6 9 - 1 13 - - - 26 - - - - 24 Haywood Terrace 8 8 — — 40 11 51 21 27 6.4 6.0 - - - - - - 6 1 - 6 1 1 6 1 4 4 8 - — 27 Hunt Street 14 4 — — 68 16 84 35 45 6.0 5.7 - - - - - 1 — 1 - — - - 1 2 — — 6 - - - — 4 Prince of Wales Terrace 3 1 — — 8 4 12 6 7 4.0 4.3 — - - - - - - - - 1 - - - - 1 — 3 - - - - 1 Totals 181 59 23 - 792 148 940 459 531 - - — - 2 - - 1 15 5 11 38 2 4 39 4 6 6 109 — - 1 - 112 CENTRAL DISTRICT Brook Road (C) 8 5 1 — 55 8 63 30 25 7.9 6.9 - - - - - - - - - 1 2 - 3 - 2 - 5 - - - - 5 Chiswick Common Road 27 6 — — 89 11 100 62 61 3.7 4.6 - - 2 - - 1 - 2 2 5 4 2 11 2 4 — 18 - - — 29 Chiswick Road 23 7 1 — 91 12 103 58 70 4.5 5.6 - - 3 - - - 3 - - 6 2 2 7 1 - - 12 - - - — 16 Dewsbury Crescent 34 — — — 80 23 103 33 39 3.0 2.1 - - - - - - 1 1 4 - - - - 2 - 19 - - - - 21 Oxford Gardens 47 44 — — 211 52 263 139 137 5.6 5.9 1 - 2 - - — 5 5 11 23 2 16 1 2 11 1 34 — — - - 45 Totals 139 62 2 — 526 106 632 322 332 - - 1 - 7 - - 1 9 8 17 35 10 20 22 7 17 1 88 - — - - 116 WESTERN DISTRICT Brook Lane North (Part of) 6 — — — 22 2 24 12 12 4.0 4.0 - - - - 1 - 1 1 - 1 - 1 - 1 - - 1 - - - - 3 Glenhurst road 37 — — — 119 15 134 82 111 3.6 5.2 - - 1 - - - 3 - 4 7 1 4 5 2 5 1 20 - - - - 13 Grosvenor Road 36 1 — — 117 21 138 108 107 - - - - - - - - - 2 5 7 - 1 7 2 1 - 13 - - - - 8 Hamilton Road 49 1 — — 175 22 197 149 149 4.0 6.1 . - - - - - - 3 - — 2 1 4 2 2 1 - 15 - - - — 13 New Road 61 1 — — 171 17 1.88 124 165 3.1 4.7 - - - - - - - - 2 13 1 9 5 4 1 — 17 - — 1 — 19 Totals 189 3 — — 604 77 681 475 544 - - - — 1 - 1 - 7 3 11 30 3 12 19 11 8 1 66 — 1 — 56 Grand Totals 509 124 25 — 1922 331 2253 1256 1407 - - 1 - 10 1 2 31 16 39 |l03 15 | 36 80 22 31 8 263 - - 2 284 HOUSE TO HOUSE INSPECTION, 1938. Table of Defects, & c., and Population. 41 HOUSING STATISTICS. 1. Inspection of Dwelling-houses during the year. (1) (a) Total number of dwelling-houses inspected for housing defects (under Public Health Act or Housing Acts) 1,016 (b) Number of inspections made for the purpose (primary) 1,016 (2) (a) Number of dwelling-houses (included under head (1) above) which were inspected and recorded under the Housing (Consolidation) Regulations, 1925 509 (b) Number of inspections made for the purpose (primary) 509 (3) Number of dwelling-houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation 12 (*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 830 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 790 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 12 (2) Number of dwelling-houses which were rendered fit after service of formal notices: (i) by owners 12 (ii) by Local Authority in default of owners — 42 (b) Proceedings under Public Health Acts: (1) Number of dwelling-houses in respect of which notices were served requiring defects to be remedied 28 (2) Number of dwelling-houses in which defects were remedied after service of formal notices: (i) by owners 28 (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 - (2) Number of dwelling-houses demolished in pursuance of Demolition Orders made in 1937 3 (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 143 (ii) Number of families dwelling therein 144 (iii) Number of persons dwelling therein 1,090 (b) Number of new cases of overcrowding reported during the year 27 (c) (i) Number of cases of overcrowding relieved during the year 67 (ii) Number of persons concerned in such cases 397 43 (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. 1 Ranelagh Gardens, Grove Park.—In December 1937 an overcrowded family occupying the two basement rooms of this house were rehoused by the Council. In January 1938 the vacated rooms were occupied by a family consisting of man, wife, boys aged 2 and 1 and three girls aged 7, 5 and 4 years, thereby exceeding the "permitted number" of 3 and committing an offence. Statutory notices were served on Owner and Occupier, and the overcrowding was abated by the removal of this family. (e) Other information regarding statistics for 1938 (1) Number of overcrowded families at beginning of the year 183 (2) New cases of overcrowding reported during 1938: (i) Families overcrowded before "Appointed Day" (not previously reported) 6 (ii) Families overcrowded since "Appointed Day" due to natural increase etc. 14 (iii) Families committing offences by overcrowding 7 Total new cases of overcrowding — 27 (3) Overcrowding relieved during the year: (i) Families overcrowded before "Appointed Day " (a) Re-housed by Council 50 (b) Abated by removal, decrease in family or extra accommodation taken over, etc. 5 44 (ii) Families overcrowded due to natural increase: (a) Re-housed by Council 6 (b) Abated by removal, decrease in family or extra accommodation taken over, etc. - (iii) Overcrowding Offences: Self-abated after notice 6 i.e. (1) Total cases re-housed by the Council during 1938 56 (2) Total cases relieving own overcrowding by removal, decrease in family or extra accommodation being taken over, etc. 11 Total cases relieved 67 (4) Abatement of overcrowding in Council properties (included in (3) above): (i) Number of cases relieved by transfer to other Council properties 10 (ii) Number of cases who relieved their own overcrowding by removal, decrease in family or extra accommodation being taken over 1 Total cases relieved 11 (5) Position of Overcrowded Families at end of 1938: (i) Number of cases still overcrowded who overcrowded on "Appointed Day" 122 (ii) Number of cases still overcrowded due to natural increase etc. 21 (iii) Number of cases committing offences 1 Total cases existing at end of 1938 144 45 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) 30 Total 80 In addition to the above, 11 persons are registered as "purveyors of milk" working from registered premises outside the Borough. There are no cowkeepers 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 18 (b) Meat and Other Foods. The major portion of the meat supply to the Borough comes through the Central Meat Market of London, but in addition there is one wholesale distributing depot located in the Brentford Wholesale Fruit and Vegetable Market. There are now only four private slaughter-houses operating in the Borough in a small way, and in two only are cattle slaughtered in very moderate numbers. A return of animals slaughtered within the Borough during the year is set out on page 32 of this report. The figure given shows a falling off from that of the previous year, due partly 40 to the existence of Foot and Mouth Disease Orders at the latter end of the year in the part of the country from which animals are usually drawn. Animals brought into the district for slaughter appear to be carefully selected and of high standard. None were found to be affected with Tuberculosis. 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 bakehouses, dairies etc. is routine. (c) and (d) Adulteration, etc. This work is in the hands of the Middlesex County Council, and no samples were submitted to the County Analyst by this Authority. (e) Nutrition—Dissemination of Knowledge. No special action was taken in this respect beyond that the nutritional value of various foods is taught to children at the Domestic Subjects Centres and lectures are given to mothers attending the Maternity and Child Welfare Clinics by the Health Visitors and to School Children by the Dental Surgeons. 47 SECTION F. PREVALENCE OF, AND CONTROL OVER, INFECTIOUS AND OTHER DISEASES. The following Tables set out the particulars of the incidence of notified diseases within the Borough during 1938, including their classifications in "age" and "ward" distribution. A.—NOTIFIABLE DISEASES DURING THE YEAR. Disease. Total Cases notified. Cases admitted to Hospital Deaths. Small-pox - - - Scarlet Fever 81 68 — Diphtheria 85 83 3 Enteric Fever (including Paratyphoid) 1 1 — Puerperal Pyrexia 3 3 1 Pneumonia 24 3* — Erysipelas 10 1 28 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. 1 — 1 1 — — — 48 C.—AGES OF CASES OF INFECTIOUS DISEASES NOTIFIED DURING THE YEAR 1938. 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 81 — — 2 8 5 46 15 1 3 1 — - Diphtheria 85 — 4 3 7 4 42 17 2 4 — 2 — Enteric Fever (including Paratyphoid) 1 — — — — — — — — — — 1 — Puerperal Pyrexia 3 — — — — — — — — 2 1 — — Pneumonia 24 — — 1 — 1 2 2 2 2 3 8 3 Erysipelas 10 - — — — — — — 2 3 2 3 — Dysentery 1 - - - - - - - - - 1 - - 49 D.—CASES OF INFECTIOUS DISEASES NOTIFIED DURING THE YEAR 1938, CLASSIFIED IN WARDS. Notifiable Disease. Number of cases notified Brentford East Brentford Central Brentford West Bedford Park Chiswick Park Grove Park Gunnersbury Old Chiswick T urnham Green Scarlet Fever 12 10 17 4 8 5 6 9 10 Diphtheria 2 16 34 8 5 6 6 4 4 Enteric Fever (including Paratyphoid) - - - — 1 — — — — Puerperal Pyrexia 1 — 1 — — — — — — Pneumonia 2 7 2 — 5 1 1 1 3 Erysipelas — — — 1 1 3 3 2 — Ophthalmia Neonatorum — — — 1 — — — — — Dysentery — — — — — — — 1 — Tuberculosis— Respiratory 2 8 15 8 16 8 14 13 9 Non-respiratory — 1 1 — 3 1 2 3 1 50 The Hospital accommodation available for the Borough, both for notifiable and non-notifiable infectious cases, is not only ample but up-to-date in every way. The Annual Report of the Medical Superintendent of the Joint Hospitals under the control of the Ealing and Brentford and Chiswick Hospitals Committee which is appended to this report by courtesy of Dr. T. Orr, the Medical Superintendent, serves to show how the available accommodation was utilised during the past year. Reviewing the incidence etc. of the principal notifiable diseases: (a) Scarlet Fever. The number of cases of this disease notified during the year is 81, which shows a considerable falling-off from the previous year, when 201 cases were notified. This figure of 81 gives an attack rate of under 1.4 per 1,000 of the population. Sixty-eight of the cases notified received Hospital treatment. So far as this disease is concerned, during the past few years the numbers notified have been fairly constant from year to year, and the epidemics at one time experienced, followed by years of comparative freedom, seem to be a thing of the past. (b) Diphtheria. The incidence of this disease in the Borough during the past year was much greater than in the two previous years. Actually, 85 cases were notified, giving an attack rate of under 1.4 per 1,000 of the population. Of this number, 83 received hospital treatment. Anti-toxin is supplied free to medical practitioners, but it would seem that they do not avail themselves of the service to any extent, probably owing to the very prompt removal of diagnosed cases to hospital. The cost of anti-toxin purchased during the year was £7 14s. 0d. No cases were notified of children contracting Diphtheria who had been immunised previously. Dr. W. W. King-Brown, the Specialist in charge of the Council's Immunisation Clinic, has kindly furnished me with the report hereunder, respecting the working of the Clinic during the past year. 51 REPORT ON DIPHTHERIA IMMUNISATION CLINIC. The number of children attending the Clinic during the year showed a slight decrease, while there was an increase in the total number of attendances. During the year the results of the "two-shot" method of immunisation, using A.P.T., referred to in last year's report, became apparent and proved to be very satisfactory, a figure of only a fraction below 100 per cent, of successful results being obtained. While the attendances at the Clinic may be considered to be reasonably satisfactory, they might with great advantage be improved. In the event of a national emergency it is easy to visualise that there might be considerable outbreaks of infectious disease among children owing to the bringing together of children in large numbers and the mixing together of children from different centres of population with different experiences of infectious disease. It is obvious that the greater the number of children previously immunised, the less will be the chance of epidemic. As the immunity to Diphtheria takes some time (at least two months) to develop, it is necessary to get children protected before any emergency arises. It cannot be done later. These facts require to be put clearly before the public, so that the necessity for immediate treatment may be realised. Total number of children attending 520 Total number of attendances 2,192 Total number of clinics held 43 Average attendance per clinic 51 Total number of Certificates issued 205 Number of Primary Schick Tests: Number Positive (83 per cent.) 190 Number Negative (17 per cent.) 39 229 Number of Secondary Schick Tests: Number positive (0.65 per cent.) 1 Number negative (99.35 per cent.) 151 - 152 Number of Re-Secondary Schick Tests: Number positive — Number negative 15 - 15 52 Number of Primary Schick Tests after 2 years: Number positive 7 Number negative 237 - 244 Analysis of Treatment. Secondarv Schick Tests: A.P.T. ("A")—1 Dose 201 A.P.T. ("A")—2 Doses 188 A.P.T. ("B")—1 Dose 6 (c) Enteric Fever. One case of Enteric Fever occurred in the early part of the year, was removed to the Isolation Hospital, and subsequently recovered. The patient was a man who frequently travelled to different parts of the country, and although careful enquiries were made, the possible source of infection was not discovered. (d) Puerperal Pyrexia. Three cases only were notified, but this small number is due, no doubt, to the fact that a very large number of expectant mothers now go to the new Maternity Hospital in the Ealing area or to the West.Middlesex Hospital situated in the adjoining Borough of Heston and Isleworth. (e) Pneumonia. The number of cases of Pneumonia and Influenzal Pneumonia notified under the Regulations of 1927 was 24. This figure, however, does not give a true indication of the disease among the residents, as numbers so suffering are treated in Hospitals and Institutions outside the area. (f) Non- Notifiable Infectious Diseases. Information regarding the prevalence of such diseases as Measles, Whooping Cough, Mumps, etc., is best secured by perusal of the Table set out on page 68 which shows exclusion of children from school on account of these complaints. Influenza was not prevalent and those cases which did occur were generally of a mild type. 2. (a) Cancer. Cancer and Malignant Disease were responsible for 1 22 deaths during the year under review, representing approximately 18 per cent, of the total deaths, 53 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. The fact that this Borough is so close to the Metropolis ensures that the facilities for the treatment of Cancer are 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 3 5 6 19 21 14 69 Females - - 5 4 15 16 13 53 Totals 1 3 10 10 34 37 27 122 Cancer: Main Seats of Disease as indicated in Death Returns during 1938. Organ Male Female Total Tongue and Mouth 7 1 8 Oesophagus 6 - 6 Stomach 12 7 19 Liver - 4 4 Bowel and Abdominal 7 2 9 Rectum 5 9 14 Bladder 7 - 7 Uterus - 10 10 Breast 1 12 13 Pancreas 5 - 5 Lung 9 3 12 Thyroid Gland 1 1 2 Lymphatic Gland 1 1 2 Larynx 2 1 3 Testes 1 - 1 Kidneys 1 1 2 Thigh Muscles - 1 1 Brain 4 - 4 54 (b) Prevention of Blindness. No action was taken under Section 176 of the Public Health Act, 1936, 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 172 of the Public Health Act, 1936. The following Table gives particulars of new cases of Tuberculosis both pulmonary and non-pulmonary, notified during 1938, as well as particulars of deaths which occurred as a result of the disease. E.—TUBERCULOSIS. Age Periods New Cases Deaths Respiratory NonRespirator Respiratory NonRespiratory Male Female Male Female Male Female Male Female Under 1 year _ _ _ - - - - 1 to 5 years 3 — 1 2 - - 1 - 5 to 15 vears 1 9 1 - - — - 1 15 to 25 years 14 9 4 2 4 4 1 - 25 to 35 years 13 16 1 3 5 2 - - 35 to 45 years 6 6 1 - 7 - - - 45 to 55 years 8 4 - - 8 - - 1 55 to 65 vears 8 2 - - 3 2 - - 65 and over 1 - - - 2 - - - Totals 54 39 8 7 29 8 2 2 The above figures again represent an average which appears fairly constant in this area. Respiratory Tuberculosis was responsible for 37 deaths during the year. 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 domiciliary, sanatorium and hospital treatment of the disease is under the control of the Middlesex County Council. 55 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 disinfection after Scarlet Fever, Diphtheria etc. is still in operation. Particulars of this work will be found set out on page 32. Disinfestation is referred to under Section C, page 36. (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 73 538 611 Tuberculosis 43 164 207 Other Diseases 2 7 9 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, 1938. 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 31st DECEMBER, 1938. 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 1938. 1.—STAFF. Other duties. (1) School Medical Officer (part-time) Medical Officer of Health, Ophthalmic Surgeon, Secndary Schools, for refraction work. (2) Assistant School Medical Officer Assistant Medical Officer (part-time) of Health. (3) Consulting Surgeon to paedic Clinic (part-time) (4) Consulting Physician to matism Clinic (part-time) (5) Consulting Surgeon to Ophthalmic Clinic (part-time) (appointed May, 1938) (6) Chief Dental Surgeon (part-time) Dental Surgeon to nity and Child Welfare and Ante-Natal Clinics. Dental Surgeon to Secondary Schools. *(7) Assistant Dental Surgeon (Brentford Clinic—part-time) * (8) Assistant Dental Surgeon (Chiswick Clinic—part-time) 59 (9) (10) (12) Six Nurses (each half-time) Health Visitors. (13) (14) (15) Nurse and Masseuse to paedic Clinic (part-time) (16) Clerk—Brentford Clinic (half-time) Clerk to Maternity and Child Welfare Clinic. (17) Clerk—Chiswick Clinic (half-time) Clerk to the Maternity an Child Welfare Clinic. (18) Clerk—School Medical Service (whole-time) (19) Female Assistant to Dental Surgeon (whole-time) (20) Female Assistant to Dental Surgeon (whole-time) (21) Female Short-hand Typist to Dental Clinic (whole-time) (22) Female Assistant Clerk to Dental Clinic (whole-time) *An Assistant Dental Surgeon was appointed as a wholetime Officer for the School and Maternity and Child Welfare Clinics in May, 1938. Duties of Staff:— The School Medical Officer undertakes Routine and Special examinations, is Medical Officer to the Minor Ailment Clinics and Anaesthetist to the Dental Clinic and until May 1938 was Surgeon to the Ophthalmic Clinic. The Assistant School Medical Officer shares all these duties with the exception of those in connection with the Ophthalmic Clinics. 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. A Consulting Surgeon has attended the Ophthalmic Clinic once weekly since May, 1938. The Dental Surgeon works for six sessions in the Chiswick area and for three sessions in the Brentford area weekly. The Assistant Dental Surgeons attended four sessions weekly at 60 Chiswick, and two at Brentford, before the whole-time Assistant Dental Surgeon was appointed. 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. Nurse Chitty undertakes all duties in connection with the Hogarth Boys' School (Senior and Junior), the Hogarth Infants' and Beverley Road Infants' Schools; Nurse Thompson with the Belmont Group of Schools; Nurse Clarke with the Hogarth Girls' (Senior and Junior) and the Chiswick Central Schools; Nurse Jenkins 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 Boat 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. Nurse Catherwood attends the Ophthalmic Clinic at Brentford and Nurse Thompson attended the Chiswick Ophthalmic Clinic until May 1938 when the Clinic was transferred to Brentford. Nurse Clarke attends the Rheumatism Clinic. Also Nurse Catherwood is in charge of the 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 the Orthopaedic Clinic at Brentford each Monday and Thursday afternoon during the school year. 2.—CO-ORDINATION. A maximum of co-ordination has been aimed at by continuing the policy of combining all the Medical and Nursing services provided for the schools and the Maternity and Child Welfare Clinics. The same personnel is used for both services, 61 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 and the Creche. 3.—SCHOOL HYGIENE AND ACCOMMODATION. The nominal accommodation for children in the schools during 1938 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' 292 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 3,132 Chiswick Schools Belmont Senior Mixed 320 Belmont Junior Mixed 394 Belmont Infants' 350 Beverley Road Infants' 450 Hogarth Senior Boys' 360 Hogarth Junior Boys' 416 Hogarth Senior Girls' 280 Hogarth Junior Girls' 520 Hogarth Infants' 250 Central Boys' 320 Central Girls' 320 Strand-on-the-Green Senior Mixed 280 Strand-on-the-Green Junior Mixed 350 Strand-on-the-Green Infants' 338 4,948 Grand Total 8,080 The average attendance during the year was 4,772, 62 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', Belmont and Strand Schools have their own centres for 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 Brentford Senior School. 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 an excellent up-to-date school is nearly completed. The Hogarth Group of schools will be seriously affected by a 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, especially the Boys' department. As reported last year, the three Church Schools in Brentford continue to do their best with their available accommodation. 4.—MEDICAI. 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 are 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 486 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. 478 Entrants, 424 Intermediates, 520 Third Age Group and 745 Others (2,167 in all) were examined during the year. 63 (b) Special Inspections.—These are special inspections made by the School Medical Officers of children suffering from some special disease or disability and are generally seen at the Minor Ailment Clinics. 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. 1,491 Special Inspections were made during the year. (c) Re- Inspections, 2,126 in number. Details will be found under the heading "Following Up." 5.—FINDINGS OF MEDICAL INSPECTIONS. The number of individual children found at Routine Inspections to require treatment (excluding uncleanliness and Dental Diseases) were Entrants 82, Second Age Group 110, Third Age Group 83, and Others 47. Total 322. Of these numbers the following were referred for vision only: Entrants 7, Second Age Group 27, Third Age Group 39, and Others 36. Total 109. (a) Nutrition.—In A.M. 124, December 1934, the Board of Education asked for an additional return to be included in the Statistical Tables showing the nutritional condition of children found at Routine Inspections in the Elementary Schools. The children were to be divided into four groups: A (Excellent), B (Normal), C (Slightly Subnormal), and D (Bad). In December the Chief Medical Officer wrote stating his concern at the number of children classified in Group C and asked for an investigation and report on the matter. The following table shows how this Borough compared with neighbouring authorities in 1937:— Brentford & Chiswick. Neighbouring Authorities A. B. C. D. Children examined 2,252 2,230 6,415 3,856 1,022 Group C 11.8% 2.8% 2.5% 18.6% 5.0% Group D 0.7% — — 0.31% — On investigation it would appear that there is a great possibility that different standards are used in different districts, also there is no sharp line of demarkation between the groups and border line cases (of which there are many) are certain to be classified sometimes in one group and sometimes in the other. 64 This is especially the case with regard to a low "B" or a high "C" When going into the causes of the subnormal nutrition, rather confusing results were obtained. The living conditions and probable feeding of the children were enquired into, and it was found that many of the C Group (and some of the D Group) came from families in quite comfortable circumstances, whereas many children in Group B came from families where financial circumstances must make it extremely difficult for them to be provided with adequate food and yet they appear to be well nourished and healthy. The Divisional Officer for this area sent a questionnaire on this subject to all Head Teachers and the return showed that "334 pupils, who though not apparently suffering from malnutrition, belong to families known to be living on or near the poverty line, e.g., father unemployed, in receipt of poor law relief, maintaining large family on small wages, etc." A comprehensive report is being prepared by the Divisional Officer, containing the proposal that provision of "Free Meals" be started in this area. In the meantime an extension of the Free Milk Scheme was put into operation immediately, and in addition cod liver oil is given in appropriate cases. These last two measures should be adequate for quite a number of the C Group. 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) Uncleanliness.—Fifteen cases were seen at Routine Inspections and six at .Special Inspections. Those found at the Routine Inspections were very mild, as children are kept under supervision 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 269 visits to the schools for personal hygiene inspections, an average of 13 visits per school. They made 25,366 examinations, viz. 23,794 inspections and 1,572 re-inspections. Defects were found in 1,343 instances and the number of individual children found to be unclean was 341, as against 333,371, 372 and 399 in 1937, 1936 1935 and 1934 respectively. 65 The distribution of these defective children was as follows: Brentford Area : Lionel Road 37, St. John's 33, St. George's 24, St. Paul's 13, Ealing Road Juniors 22, Ealing Road Infants' 19, Canal Boat Children 23, Senior Girls' 4, Senior Boys' 1, and Clifden Road Infants' 3. Chiswick Area: Hogarth Schools: Infants' 26, Junior Girls 16, Senior Girls' 15, Junior Boys' 2. Belmont Schools: Infants' 12, Senior Mixed 5, Junior Mixed 10. Strand Schools: Infants' 14, Junior Mixed 26, Senior Mixed 8. Beverley Road Infants' 26. Central Girls' 2. 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 1938 25,366 341 13 The following Table shows the exclusions from school for conditions connected with Defective Personal Hygiene:— Verminous condition. Impetigo Scabies. Ringworm. January 7 14 2 1 February 2 6 5 - March 6 5 14 — April 4 11 9 — May 2 11 20 — June 4 9 9 — July 5 9 7 - August - 7 - - September 6 12 7 1 October 2 21 10 2 November 1 8 7 3 December 1 10 6 1 Total exclusions for 1938 40 123 89 8 Total exclusions for 1937 81 178 50 26 60 (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 6 262 268 Minor Eye Defects (excluding squint and defective vision) 12 48 60 Ear Defects 13 61 74 Dental Caries 421 20 441 Miscellaneous (minor injuries, bruises, chilblains, etc.) 10 552 562 (d) Tonsils and Adenoids (vide Table II and Table IV, Group III). During the year 334 cases were found, 257 at Routine and 77 at Special Inspections. Of these cases 202 (or 63 per cent.) required operative treatment, 70 being referred for Tonsils only, 12 for Adenoids only, and 111 for both Tonsils and Adenoids. In addition, 136 children were referred for other conditions of the nose and throat, chiefly acute or sub-acute catarrh. (e) Tuberculosis. Pulmonary.—No cases of Pulmonary Tuberculosis were seen during the year, but three suspected cases were seen at Special Inspections and sent to the Tuberculosis Medical Officer. Non-Pulmonary:— Localisation Routine Special Total Requiring treatment To be kept under observation Requiring treatment To be kept under observation Glands - - - - - Bones and Joints — — — — - Other forms — — — — - Totals — — — — — 67 (f) Skin Diseases.—268 cases of skin diseases were seen during the year, of which 60 were suffering from Contagious Impetigo. There were four cases of Ringworm of the Scalp and thirteen of the Body. Sixty-six cases of Scabies were seen. The remaining 125 were cases of Boils, Furunculosis, Eczema, Urticaria, Seborrhoeic Dermatitis, Lichen Ruber Planus, Psoriasis and Dysidrosis. (g) External Eye Diseases.—104 cases were seen during the year. At Routine inspections there were five cases of Blepharitis and five of Conjunctivitis and one of Keratitis. At Special Inspections there were thirteen cases of Blepharitis, twenty of Conjunctivitis, the remainder consisting of Styes, Cysts, etc. (h) Vision (including Squint).—211 cases of Defective Vision were seen at Routine Inspections and 23 were brought to the Minor Ailment Clinics. Of these, 140 were referred for treatment and 94 were kept under observation, as they had already been supplied with glasses which appeared to be satisfactory. Of the above cases, 15 were suffering from Squint, 13 being seen at Routine Inspections and 2 at Minor Ailment Clinics. Ten were referred for treatment and 5 (already receiving treatment) were referred for observation. (i) Ear Diseases and Defective Hearing.—Seven cases of Defective Hearing caused chiefly by Adenoids or Otitis Media were seen and all were of a mild type. There were 44 cases of Otitis Media, 6 being found at Routine Inspections and 38 at Special Inspections. (j) Dental Defects.—At Routine Inspections, 421 cases were found and at Special Inspections 20 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 shown in the following Tables. 68 TABLE SHOWING THE EXCLUSIONS OF CHILDREN FROM SCHOOL ON ACCOUNT OF INFECTIOUS DISEASE. Scarlet Fever Diphtheria Chicken Pox Measles Whooping Cough Mumps Influ enza German Measles January 23 (3) 9 (8) 33 (11) 43 (3) 10 (3) 2 (-) _ 1 (-) February 17 (8) 11 (6) 31 (9) 69 (12) 14 (3) 1 (-) - - (-) March 15 (3) 5 (1) 70 (9) 216 (21) 5 (-) 1 (-) - 30 (1) April 12 (1) 5 (1) 102 (23) 136 (10) 3 (-) 3 (-) - 45 (28) May 7 (-) 5 (6) 86 (21) 102 (20) - (-) 1 (-) - 16 (16) June 7 (9) 11 (6) 26 (5) 166 (25) - (-) 4 (-) - 4 (-) July 6 (9) 13 (7) 17 (3) 89 (18) - (-) 4 (-) - 6 (-) August 2 (16) 8 (9) 11 (13) 1 (8) 1 (-) 1 (-) - - (-) September 7 (2) 35 (16) 19 (9) 6 (-) 5 (-) 3 (-) - - (-) October 9 (3) 27 (10) 22 (5) 4 (-) 19 (-) 5 (-) - - (-) November 18 (7) 22 (5) 23 (4) - (-) 14 (-) 12 (-) - - (-) December 11 (8) 24 (22) 20 (2) 1 (-) 8 (-) 19 (-) - -(-) Totals Contacts 134 175 460 833 79 56 - 102 (69) (97) (114) (117) (6) (-) - (45) Corresponding totals for 1937 252 40 244 63 200 62 8 4 (98) (27) (36) (9) (8) (-) (-) Figures in brackets are the number of children living in the same house and excluded from school on account of the disease. CHILDREN ATTENDING MINOR AILMENT CLINICS SUFFERING FROM INFECTIOUS DISEASE Scarlet Fever. Diphtheria. Chicken Pox. Measles Whooping Cough. Mumps. Influenza. German Measles. J anuary - (3) 1* (2) 4 (5) 5 (1) - (1) - (-) 1 (-) - (-) February - (4) - (-) 7 (3) - (3) - (-) - (-) 3 (-) - (-) March - (5) 2* (1) 5 (5) - (6) 1 (-) - (-) 13 (-) 5 (-) April - (2) 10 (1) 7 (3) 1 (1) - (-) 1 (-) 1 (-) 4 (10) May - (1) - (-) 3 (-) - (1) - (-) - (-) - (-) 5 (6) June - (2) 1* (3) - (1) 1 (3) - (-) - (-) 1 (-) 3 (4) July - (1) - (-) 1 (3) 1 (5) - (-) -(-) - (-) - (4) August - (-) - (-) - (-) - (-) - (-) - (-) - (-) - (-) September - (-) 5 (6) 4 (5) - (-) - (-) 2 (-) - (-) 1 (1) October - (-) 1* (11) 1 (4) - (1) - (-) 2 (-) 1 (-) - (-) November 1 (4) 2 (6) 3 (7) - (-) - (-) 3 (-) 3 (-) - (-) December - (-) - (1) 2 (-) - (-) - (-) 2 (-) 5 (-) -(-) Totals Conval. and Contacts 1 (22) 22 (33) 37 (36) 8 (21) 1 (1) 10 (-) 28 (-) 18 (25) Corresponding gigures for 1937 8 (62) 3 (3) 18 (18) - (1) 15 (8) 13 (1) 26 (-) 4 (-) Figures in brackets denote Contacts and Convalescents. * Denotes "Carriers" 69 Scarlet Fever.—Cases of a mild type were found throughout the year, but the disease did not take an epidemic form. Diphtheria.—Cases also occurred each month, but were fortunately of a mild type. There was no epidemic, but this disease was rather more prevalent in the Brentford Area during the last months of the year. More "carriers" and nasal cases were seen than in previous years. Chicken-pox.—We were never free from this disease, which was most prevalent during the early part of the year, and there was a definite epidemic, especially in the Chiswick Area, during March and April. Measles.—As was expected, there were a large number of eases during the year and there was a widespread epidemic during the early months, with the peak in March and April. As shown in the next Table, this disease is most regular in its incidence. Whooping Cough and Mumps.—There were comparatively few cases of these diseases during the year. The prevalence of infectious disease in the schools, compared with that of the nine previous years, is shown in the following table:— 1929 1930 1931 1932 1933 1934 1935 1936 1937 1938 Scarlet Fever 88 102 71 337 550 358 126 170 252 134 Diphtheria 109 139 75 46 153 65 71 21 40 175 Chicken Pox 429 239 357 173 347 242 229 306 244 460 Measles 70 680 69 895 60 585 43 886 63 833 Whooping Cough 429 65 230 295 167 206 316 238 200 79 Mumps 423 178 275 57 37 445 493 554 62 56 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 observation at Routine and Special Inspections is undertaken both by the School Nurses and the School Medical Officers and may be summarised as follows:— School Nurses. (a) Home Visiting.—(1) of children excluded for uncleanliness, (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, 70 (4) to explain certain forms of home treatment advised by the School Medical Officers, (5) to obtain certain special information required by the School Medical Officer. Number of visits made—1,312. (b) Re-examination at the school of all children found to be defective at the Personal Hygiene Inspections. 1,572 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 were 1,249 and 877 respectively, viz. 2,126 in all. As regards the 1,249 children found to be defective at Routine Inspections, 649 or 51 per cent .had been referred for treatment and the remainder (600) for observation. The results of these further examinations were as follows: Referred for treatment Treated Untreated Now referred for observation only 649 265 339 45 Referred for Now Continue Now referred for observation satisfactory observation treatment 600 215 255 130 8.—MEDICAL TREATMENT. The number of individual children found at Routine Medical Inspections to require treatment (excluding uncleanliness and dental diseases) is shown in Table IIb. The following Table shows how these figures compare with those of the nine previous years:— 1929 % 1930 % 1931 % 1932 % 1933 % 1934 % 1935 % 1936 % 1937 % 1938 % 1st Age Group 27.4 30.3 27.6 20.2 18.8 18.8 20.9 13.2 14.6 17.2 2nd Age Group 28.8 25.7 27.7 24.3 18.8 20.8 20.0 16.3 17.8 25.9 3rd Age Group 25.2 26.3 21.1 17.4 15.4 13.9 12.3 8.6 11.9 15.9 Total (Code Groups) 27.5 27.6 25.3 20.0 17.5 17.7 16.0 12.7 14.6 19.2 Other Routine Inspections 14.0 18.6 16.3 11.1 15.7 26.1 21.3 11.0 10.5 0.3 71 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. (h) Artificial Sunlight treatment. 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. Where free treatment is not provided, the parents' payments to be according to the following scale for each treatment. It 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 Tonsils and Adenoids 1 0 2 6 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 4 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/- per week 6d. per treatment 10/- to 12/6 per head 7/6 per week 6d.per treatment 12/6 to 15/-per head 10/6 per week 1/- per treatment 15/- to 20/- per head 21/- per week 1/- per treatment Over 20/- average 42/- per week 1/- per treatment 72 The income derived from these contributing fees, compared with the three previous years, is shown thus:— 1938 1937 1936 1935 £ s. d. £ s. d. £ s. d. £ s. d. Tonsils and Adenoids operations Nil Nil Nil 2 14 0 Spectacles 41 18 7 24 8 7 35 14 0 33 7 8 Dental Treatment 87 18 0 185 2 9 100 7 0 112 10 6 Orthopaedic Treatment 14 6 6 16 19 3 17 19 9 11 14 0 £144 3 1 £226 10 7 £154 0 9 £160 6 2 (а) Minor Ailments.—These Clinics are held at the Town Hall Buildings, Chiswick, and were held at Portsdown House, The Butts, Brentford, until the opening of the new Brentford Health Centre in July 1938. Sessions are held each morning (except Sunday) and 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 1,075 Re-inspections of special cases 877 Number of individual children attending 4,230 Number of attendances made 14,025 Number of exclusion certificates issued 889 Number of return certificates issued 686 (b) Tonsils and Adenoids.—It is regretted that the Chiswick Hospital is not yet re-opened, and in consequence we had again to arrange for the operative treatment of children suffering from disease of the above structures at other Hospitals. Forty-eight children were operated upon at the West Middlesex Hospital, and one by his own doctor. 125 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 one boy was admitted to Harefield Sanatorium for Tuberculosis of the lung. The County Tuberculosis Officer kept under observation 12 suspected cases and 13 contacts. 73 (d) Skin Diseases.—All cases of skin disease are treated in the Minor Ailment Clinics. Ringworm.—Four cases of Ringworm of the scalp and 13 cases of Ringworm of the body were successfully dealt with in the Clinics. Scabies.—This disease appears to be still on the increase, and 66 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 regretted that circumstances have not permitted the Joint Hospitals Committee of establishing a cleansing station. Contagious Impetigo— The 60 cases found 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 cases of Blepharitis, Conjunctivitis and Corneal Ulcer were successfully treated at the Clinics. (/) Vision.—Defects of vision were treated in the Eye Clinics at Brentford and Chiswick until June, when all were treated at Brentford. All children are examined by Retinoscopy after the application of a mydriatic ("eye drops"); 310 children were treated in these Clinics during the year, and an analysis of the results is shown below:— (1) Spectacles prescribed 288 Spectacles issued 246 (2) Conditions other than refractive error found during examination: Squint 29 Chronic Blepharitis 8 Angular Conjunctivitis 4 Nystagmus 1 Migraine 1 Ptosis 1 Phlyctenular Conjunctivitis 1 Blocked Duct 1 74 Pigmented mole, upper lid — 1 (sent to Hospital for operation) (3) Degree of visual acuity (when unequal, the acuity of worse eye)— less 6/6 6/9 6/12 6/18 6/24 6/36 6/60 than 6/60 No. of children 57 45 44 38 43 33 19 21 High Myopia 2 (4) Varieties of Refractive Error— Hypermetropia (long sight) 86 Simple Hypermetropic Astigmatism 13 Compound Hypermetropic Astigmatism 68 Myopia (short sight) 67 Simple Myopic Astigmatism 12 Compound Myopic Astigmatism 29 Mixed Astigmatism 9 Emmetropia (normal sight) 15 Squint.—Twenty-nine 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.—Two cases were seen during the year and were kept under close observation. The attendances at the Eye Clinics were as follows:— Clinics held 69 Attendances—including those for "eye drops" 1,056 Retinoscopies 310 Prescriptions 288 Spectacles issued 226 Repairs 130 Others (reports, re-inspections etc.) 118 (g) Ear Diseases.—Seven cases of defective hearing were seen and three were referred for the treatment of Adenoids, Otitis Media or impacted cerumen. A deaf mute is attending a Special School for the Deaf. Forty-four 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. 75 (h) Dental Treatment.—Miss M. M. Loretz, the School Dental Surgeon, reports:— In 1938, 2,668 children were inspected in the Elementary Schools in the course of 23 routine inspections. Nine schools, with an average attendance of 2,013 children, had not been visited by the end of the year. In addition, 862 children were inspected in the surgery, and 482 Leavers during special Leavers inspections; 629 sessions were devoted to treatment of Elementary School children, during which time 2,418 children were given complete treatment, and 472 partial treatment; 4,273 teeth were filled (3,478 permanent and 795 temporary); 4,337 teeth were extracted, of which 3,646 temporary and 544 permanent were for caries and 147 permanent for the relief of overcrowding. Other operations performed during these sessions include 125 scalings, 490 temporary dressings, 158 treatments by AgN03, four crowns and two dentures fitted, 16 root fillings, 72 adjustments etc. to 8 orthodontic appliances. The apparatus used was generally of a simple nature, and the cost of it was borne by the parents. It is very pleasant to be able to record a further drop in the percentage of refusals of treatment to 15 per cent. for the whole district—10 per cent. in Brentford and 18 per cent. in Chiswick. 361 of the 482 Leavers inspected left school with Certificates of Dental Fitness. As the acid test of the efficiency of a School Dental Service is the condition of the teeth of Leavers, it is interesting to note that, on the average, each of the 361 Certificate holders had 22 sound teeth, 4.5 filled teeth, and had had one tooth extracted for caries and .5 for the relief of overcrowding. This is not a picture of which to be proud, but it should be noted that few of these children had received annual treatment when required during the whole of their school life, because, for some years past, the "annual" school inspections have taken place at 15 to 18 monthly intervals, and in some cases treatment had been allowed by the parents only in the last two or three years. However, one has every reason to hope that, with the increase in staff, with consequent possibility of strictly annual inspections, and the decrease in the refusal rate, the condition of Leavers will improve far beyond this standard. Two notable events in the history of the School Dental Service have occurred during the year. On May 2nd Miss A. S. Stewart, L.D.S.U.St.And., commenced duty as full time 76 officer in place of Mr. H. A. Coysh and Mr. H. V. Houlton, who till then had given part-time service to the extent of six sessions per week during the school year. The staff now consists of two full time officers working 11 sessions per week each. The total School population entitled to annual dental inspection is over 6,000, and treatment is also, given to patients referred from the two Maternity and Child Welfare Centres. The attendances of these patients numbered 1,620 in 1938. The total amount of work done in the dental department for Elementary, Secondary, Polytechnic, and Maternity and Child Welfare patients (mothers and children) in 831 treatment sessions in 1938 was as follows:— Patients given complete treatment 3,162 Attendances 6,988 Teeth filled 5,642 Teeth extracted 5,780 Dentures fitted 49 Scalings 191 Temporary dressings inserted in permanent teeth 611 Other operations—AgN03 etc. 404 Administrations of Nitrous Oxide 2,383 On July 8th we commenced work in the new Brentford Health Centre. The dental department consists of a selfcontained block of four rooms—waiting room, surgery, with my small Dental Officer's room adjoining, recovery room, and clerks' office. In all four rooms the walls, cupboards, furniture and equipment are in the same shade of cream enamel, the tiles are light buff, and all metal parts chromium plated. This makes the equipment less conspicuous, and the whole effect is light and pleasing. The cupboards have been planned to contain all the moveable surgical and office equipment when not in use, as for example in the surgery the gas apparatus, and in the office the typewriter and files. The arrangement of the surgery is planned to facilitate a definite system of work. This system is based on that described by Dr. Braun of Oslo some years ago, with slight modifications and additions suggested to me by observing Austrian and German methods. The chief objects of this system are to prevent the use on or by a patient of any article contaminated by saliva of another patient and to ensure the working together of the operator and his assistant with the maximum amount of harmony, efficiency and economy of energy and time. The system presupposes, as a general rule, 77 the continual presence in the surgery of a dental attendant or nurse. An imaginary line is drawn diagonally across the surgery. On one side of it is the sterilised or uncontaminated equipment, and on the other side the soiled equipment. The first, or left side as one stands behind the chair, is the province of the dental attendant, and the other that of the operator. Therefore the instrument cabinet is to the left of the chair, and the steriliser and sink to the right and behind it. A moveable glass table is behind the chair. All instruments and utensils which can be boiled in water are thus treated after each patient—this includes the all-metal waste receiver and the water syringe, the rinsing beakers. Handpieces are immersed in oil on a water bath. All instruments and equipment handled by the operator which cannot be boiled—or like glass slabs and agate instruments immersed in Dettol—are wiped well with a square of flannelette soaked with methylated spirit by the dental attendant after each patient, i.e., the bracket table, parts of the handpieces, attachment on the engine where handled by the operator, amalgam carrier etc. In general, all clean instruments are placed on the bracket table, as required, by the dental attendant, but the operator helps himself to fresh burs as required from the moveable table behind him, but only with tweezers dipped in methylated spirit. No object may be removed from this table by the operator except by this means, and by the same law cotton wool pellets are taken from the holder only with tweezers dipped in methylated spirit. Cements are mixed on the cabinet and amalgams on the glass table, to avoid contamination of the former by particles of mercury or alloy dust. The operator sits to work all the time, and the dental attendant is encouraged to sit whenever possible, e.g., when mixing cements etc., and writing records in day-book. Her stool is on castors to facilitate its being moved where required. The operator's route, from which he never strays, is from chair A to sterilisers and washbasin B to desk and bell C, and back to A. 78 The activities of operator and attendant are carefully co-ordinated, so that there is no overlapping of duties and no period of inactivity for either. Thus, for instance, the "inter patient" procedure, whereby all soiled equipment is replaced by clean as described above and the treatment recorded, takes less than two minutes from the moment one patient leaves the chair until the stage is set for the next patient. After a year of constant use, there is no doubt that such a system, besides ensuring the most economical use of the dental surgeon's time, does produce an atmosphere of peace and harmony which has a most soothing effect on both patient and operator. (i) Orthopaedic.—The following table of crippled children attending the schools was completed with the aid of the Head Teachers:— Belmont Senior Mixed 1. Girl aged 11 years. Stiff right knee. Belmont Junior Mixed 2. Boy aged 10 years. Defective leg. Brentford Senior Girls 3. Girl aged 13 years. Infantile Paralysis. Canal Boat Department 4. Boy aged 13 years. Paralysis of left leg. Central Boys' School 5. Boy aged 14 years. Shortened leg, due to hip disease. Ealing Road Special Class 6. Boy aged 11 years. Injured pelvis. 7. Boy aged 8 years. Infantile Paralysis. Lionel Road Junior Mixed 8. Girl aged 10 years. Knee and leg in irons. 9. Girl aged 9 years. Shortened leg. 10. Boy aged 8 years. Heart and Rheumatism, 79 11. Girl aged 8 years. Rheumatism. St. George's School 12. Girl aged 11 years. Infantile Paralysis. Strand Senior Mixed 13. Girl aged 11 years. Lower limbs. Strand Infants Mixed 14. Girl aged 6 years. Infantile Paralysis. Orthopaedic Clinic.—This clinic was held at Portsdown House, The Butts, Brentford, on Monday and Thursday afternoons, until the new Health Centre was opened. 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. The attendances at the Clinic are shown in the following Table:— No. of children Attendances. School children— For general deformities 99 781 For breathing exercises 17 118 Children from Maternity and Child Welfare Clinics— For general deformities 69 169 For breathing exercises 1 1 Totals 186 1,069 The following four children were admitted to Stanmore for in-patient treatment:— Schools (two children)— 1. J. D. F. Operation for elongation of Tendo Achilles. 2. W. C. F. Fracture of tibia. Maternity and Child Welfare (two children)— 3. H. Y. F. Manipulation and plaster, 4. P. S. F. Osteoclasis. 80 Classification of Conditions treated at Orthopaedic Clinic. School Children m. & C.W. Children 1. Congenital Defects— Club foot - - Metatarsal varus, pes arcuatus i 1 Irregular toes, congenital pes pl. valvus, etc. 3 1 Dislocation of hip 2 - Spastic paralysis 1 - Other conditions 3 - 2. Birth Injuries— Nerve injuries 2 - Torticollis 1 2 3. Rickety Deformities— Bow tibiae 5 10 Knock knees - 1 Bow legs—intoeing 2 5 4. Non-Rickety Deformities— O. C. T. 1 13 Knock knees 16 10 5. Postural defects of the spine, including flat chest 23 - 6. Structural curvature of the spine 2 - Depressed sternum 2 - 7. Flat feet 21 3 Foot strain 9 - Pes cavus not due to Infantile Paralysis 1 - Hammer toes 1 - Hallus rigidus 1 - 8. Infantile Paralysis 2 1 9. Septic Arthritis 1 - 10. Fractures 2 - Other injuries 4 - 11. Tuberculous joints - - 12. Other bone diseases— Schlatters' disease - - Perthes' disease 1 - Kohlers' disease 1 - Accessory Scaphoid 1 - Exostosis 1 - 13. Osteomyelitis 1 - 14. Other conditions, including postural intoeing - 4 15. Non-orthopaedic — - 16. No diagnosis 4 1 17. N. A. D. 2 1 Rheumatism Clinic.—This Clinic is held each Thursday morning (except during the school holidays) in the Health Centre, Brentford, 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 81 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. 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 31 children, mentioned below, without making any charge to this Borough. During the year, 180 children (of whom 89 were new patients) made 600 attendances at the Rheumatism Clinic. The Hospital treatment obtained for 34 children is shown as follows:— In-patient Out-patient Rheumatism Heart Disease Chorea Rheumatism Heart Disease Chorea Royal Waterloo Hospital 7 4 6 - - - Royal Hospital Richmond 1 1 - 6 4 1 West Middlesex Hospital 3 - 1 - - - Totals 11 5 7 6 4 1 The Invalid Children's Aid Association obtained Convalescent Home treatment for the following cases: Four heart cases at West Wickham and Broadstairs; 24 cases of Chorea and three of Rheumatism at homes situated in Broadstairs, Weston-super-Mare, Milford, Woodford, Felixstowe, Ashridge, and Brighton. 9.—OPEN AIR EDUCATION. Playground Classes.—Classes are held in the open air whenever possible in the older Infants' Cchools, but in the new Schools this is not necessary (vide "Open Air Classrooms"). 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 82 pletely 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. The following report is made by the two organisers of Physical Training—Miss E. Watteeu and Mr. O. Hailstone:— A. Elementary. 1. Routine visits have been made to all schools in Brentford and Chiswick, and the majority of teachers who take physical training have been seen at work. In the course of discussions, various suggestions were made, and in most schools demonstrations of teaching methods have been given. The question of time-table arrangetnents, use of playground and halls, playing fields, storage and changing facilities were discussed with Head Teachers. 2. Organised Games.—Teachers have been encouraged to develop and extend the scope of the organised games period to provide a well constructed lesson with a variety of games and practices. The supply of playing fields for school use is inadequate, particularly so since the digging of A.R.P. trenches has meant either curtailing the use of playing pitches or the complete closure of recreation grounds. As a result some schools are at present without the use of a playing field. 3. Small apparatus has been supplied to all schools in the area, and use of it is being made during the physical training and games period. The supply of apparatus has been much appreciated by teachers and children. Senior schools are supplied with portable gymnastic apparatus, except in the case of one school, which has no hall. The problem of storage has presented certain difficulties, but as conditions vary at each school it is felt that the problem can best be solved as it arises at individual schools. 83 4. Gym shoes have been supplied to schools for Head Teachers to distribute to necessitous cases. At the same time those children who can afford to supply their own shoes have been further encouraged to do so, and an increasing percentage of children are keeping a pair of shoes permanently at school for physical training purposes. As it is unhygienic, it is hoped that the use of a communal supply of gym shoes is only a temporary expedient and that ultimately each child will possess a pair of shoes. A noticeable development during the year has been a growing tendency for children voluntarily to remove all superfluous clothing for the physical training lesson. This is especially so where lessons have become fuller, more active and more interesting to the children. The problem of storage of gym kit presents a certain amount of difficulty, and the possibility of supplying storage lockers for all schools is being explored. 5. The permanent marking of playgrounds has been successfully effected at several schools, and in the light of experience gained as to the expense and usefulness of the marking, it is hoped that all playgrounds will shortly have the marking out required. 6. Indoor Accommodation.—Though it is expected that the playground will be used for physical training whenever possible, it is essential for a school to have indoor accommodation available. During weather unsuitable for work out of doors it is hoped that school halls will be used equally by all departments in such cases where sharing is necessary. The supply of gymnastic shoes, and in senior departments the supply of portable apparatus, should make possible work of considerable scope, variety and benefit in the school hall. 7. Gymnasia.—Plans for the erection of gymnasia complete with changing rooms, shower baths, etc., at two senior schools in the area have been completed, and it is anticpated that building will commence shortly. 8. Swimming.—During the summer months the girls have the services of instructresses at each bath, and as a result the swimming is of a satisfactory standard. 84 A course in the teaching of swimming for men teachers is to be arranged for the season 1939-40. It would be of great benefit if there were an indoor bath in the area open for swimming all the year round. A number of school and inter-school swimming galas have been attended in the area, which have produced a number of fast swimmers, but style in swimming seems often to have been neglected. 9. The work of organising physical training in elementary schools of the area has been considerably facilitated by the whole-hearted co-operation of the Head Teachers and their staffs who have helped in the arrangement of demonstrations and have given helpful suggestions and advice in solving the problems of the storage of the shoes and apparatus. The co-operation of the teaching staffs couples with the supply by the local authority of gym shoes and small apparatus has given a valuable stimulus to the development of physical training in the schools. Cricket.—One boy from the Central School was selected to play for the North London v. South London Schools at Lord's. Football.—Brentford Senior Boys won (a) Lilley & Skinner Cup, (b) Wimbledon Cup and (c) Poulten Cup. Eight boys were » awarded Association Badges. Lionel Road retained the Shield for the Acton, Brentford and Chiswick Junior League. Central Boys' and Belmont Senior School: Two boys from each school were awarded Association Badges. Athletics.—In the Inter School Sports, Lionel Road furnished 110 finalists, with 62 winners. 11.—PROVISION OF MEALS. The Provision of Meals Acts, 1906-1914, were adopted by the Authority in 1933, but have not yet been brought into operation. 85 As mentioned under "Nutrition," a scheme for providing meals for school children has been put forward and, it is hoped, will shortly be in 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. This scheme is being extended so as to supply afternoon milk also in selected cases. 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. 216 children are receiving 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. Brentford Senior Girls were the winners of (a) Borough Championship (under 14), (b) London Schools District Championship (under 15), (c) Charter Mayoress's Cup. It may also be mentioned that an "old girl" beat the Southern Counties Championship time for the 440 yards breast stroke by seven seconds. Brentford Senior Boys won the District Championship. Central Boys won the Clements Cup and the Borough Championship. Central Girls—life Saving: Seven girls gained the Bronze Medallion, nine the Intermediate, and five the Elementary Certificates. 86 Belmont Senior Mixed—Life Saving: Two girls were awarded the Intermediate and four girls the Elementary Certificates. Ealing Road won the two-length and one-length District Championships. Hogarth Senior Girls: Two girls obtained second places in the London Schools Swimming Association and Borough Championship respectively. Hogarth Junior Girls: 26 girls learned to swim, of whom seven obtained the 100 yards and 16 the 50 yards certificates. Lionel Road: Sixteen learned to swim, 12 obtained First Class, and 20 Second Class Certificates. St. Paul's and St. Lawrence's: A girl won the District Junior Championship and a girls' team won also the District Junior Championship; 55 children learned to swim. Strand Senior Mixed: Intermediate Life Saving, 1 boy and 2 girls (2 girls bronze medals); Elementary Life Saving, 3 boys and 5 girls; 100 yards, 15 boys and 11 girls; 50 yards, 5 boys and 15 girls; Learners, 12 boys and 15 girls. 13.—CO-OPERATION WITH TEACHERS. I have pleasure in repeating the gratitude the School Medical Service owes to the Teachers of schools in this Borough for the keen interest they take in its work, and for a spirit of cordiality which enables the work to be carried on with greater efficiency. They assist us at the Routine Inspections and reInspections, 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 kind of 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 87 children. They nearly always attend the Routine Inspections of the younger children, and an increasing percentage now accompany those in the later age groups. 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. They also provide me with the following Table of legal proceedings taken under the School Attendance 13 byelaws during the year:— Initials of Offender Offence Act Fine T.F. Non-attendance Education Act 10/- t. f. „ „ 10/- a. F. „ „ 2/6 e. b. „ „ 2/6 e. b. „ „ 2/6 j.b. „ „ Attendance Order s. f. „ „ „ e. H. „ „ „ J.H. „ „ „ t. s. „ „ „ r. p. „ „ „ 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:— Number of cases investigated 28 Children affected 45 Visits paid in connection with same 109 88 In no case was it found necessary to prosecute the parents or guardians concerned. (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 :— 1927 1928 1929 1930 1931 1932 1933 1934 1935 1936 1937 1938 77 104 114 125 123 121 120 119 92 69 68 69 During 1938, 69 children (27 boys and 42 girls) were sent to Bexhill. The Brentford Philanthropic Society also sent 20 boys and 20 girls to Bexhill for a holiday in 1938. Since 1923, 1,024 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 any 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. 8. Work causing eye strain. 9. Work requiring acute distant vision. 10. Work requiring acute hearing. 11. Work requiring manipulative skill. 89 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 55 6 1 Dental 5 1 3, 5, 8 Teeth and Vision 1 1 8 Rheumatism 2 2 9 Vision 1 1 5 1 3, 5 1 8, 9 1 3, 4, 8, 9 14 9 Hogarth Senior Girls' School 44 6 8, 9 Vision 5 1 1 Dental 2 1 3, 5 Spinal Curvature 1 1 1, 3, 4, 5, 7 (healed osteomyelitis of leg) Tonsils and Vision 1 9 9 Belmont 54 9 8, 9 Vision 3 Senior 2 8 Dental 2 Mixed 1 3, 4 School 1 10 1 4, 7 1 1, 7 15 5 Strand 41 8 8, 9 Vision 5 Senior 3 8 Dental 3 Mixed 1 3, 5 School 1 3, 4, 5 13 8 Central Boys School 20 1 8, 9 Dental 1 Central Girls' School 25 1 1, 3, 7 Vision 1 1 8, 9 2 Summary of Chiswick Schools:— 239 children examined. 90 2 children were unfit for work requiring acute distant vision. 7 children were unfit for severe manual work. 6 children were unfit for work causing eye strain. 1 child was unfit for work in a damp atmosphere. 1 child was unfit for work requiring acute hearing. 17 children with one exception. 3 children were unfit for exposure to bad weather or for work in a damp atmosphere. 26 children were unfit for work causing eye strain or for work requiring acute distant vision. 1 child was unfit for exposure to bad weather or for work in a dusty atmosphere. 1 child was unfit for severe manual work or for work involving prolonged standing, much walking, or quick movement from place to place. 1 child was unfit for work in a dusty atmosphere or for work involving prolonged standing, much walking, or quick movement from place to place. 32 children with two exceptions. 1 child was unfit for exposure to bad weather, work in a damp atmosphere, or for work causing eye strain. 1 child was unfit for exposure to bad weather, or for work in a damp or dusty atmosphere. 1 child was unfit for severe manual work, exposure to bad weather or for work involving prolonged standing, much walking, or quick movement from place to place. 3 children with three exceptions. 1 child was unfit for exposure to bad weather, work in a dusty atmosphere, or for work causing eye strain or work requiring acute distant vision. 1 child with four exceptions. 91 1 child was unfit for severe manual work, exposure to bad weather, work in a damp or dusty atmosphere, or for work involving prolonged standing, much walking or quick movement from place to place. 1 child with five exceptions. Treatment still required:— Dental Treatment 13 Vision 15 Rheumatism 2 Spinal Curvature 1 Tonsils and Vision 1 Teeth and Vision 1 33 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' School 98 10 8, 9 Vision 7 1 10 Otorrhoea 1 6 8 Teeth and Posture 1 4 5 2 3, 4, 5 1 1, 3, 7 (Congenital Heart Disease) 24 9 Brentford Senior Boys' School 79 4 8, 9 Vision 10 1 3, 5 Dental 12 1 9 Talipes 1 1 1, 3, 4, 5 Rheumatism 1 7 24 St. John's Mixed School 20 2 4, 5 Tonsils and Adenoids 2 1 7 Dental 4 1 9 Vision 1 4 92 Summary of Brentford Schools:— 197 children examined. 2 children were unfit for work requiring acute hearing. 2 children were unfit for work requiring acute distant vision. 4 children were unfit for work in a damp atmosphere. 6 children were unfit for work causing eye strain. 14 with single exceptions. 14 children were unfit for work causing eye strain or for work requiring acute distant vision. 1 child was unfit for exposure to bad weather or for work in a damp atmosphere. 15 with two exceptions. 2 children were unfit for work in a damp atmosphere or a dusty atmosphere, or for work necessitating exposure to bad weather. 1 child was unfit for severe manual work, exposure to bad weather, or for work involving prolonged standing, much walking, or quick movement from place to place. 3 children with three exceptions. 1 child was unfit for severe manual work, exposure to bad weather, work in a damp or dusty atmosphere. 1 child with four exceptions. Treatment still required:— Vision 18 Otorrhoea 1 Teeth and posture 1 Dental 16 Talipes 1 Rheumatism 1 Tonsils and Adenoids 2 40 93 Thus, of the 436 children in the Borough who were examined on leaving school, "exceptions" were found in 19.9 per cent. and 16.7 per cent. still required treatment. 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.—The valuable services rendered to us by this Society are mentioned under the section describing the Rheumatism Clinic. The work done by this Association in this Borough 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. 17.—BIJND, DEAF, MENTALLY DEFECTIVE AND EPILEPTIC CHILDREN. The number of these children is shown 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. 94 Those sent to Special Schools during the year are shown in the following table:— Institution Charge to Local Authority per annum Contribution by parents per week Deaf Children: £ s. d. 1. Boy aged 9 L C.C. Ackmar Road (Deaf) School, Fulham 35 13 11 — 2. Boy aged 12 ditto 35 13 11 — 3. Girl aged 10 ditto 35 13 11 9/- 4. Boy aged 13 L.C.C. Ackmar Road (Partially Deaf) School 25 12 10 - 5. Girl aged 13 ditto 25 12 10 2/- 6. Girl aged 15 L.C.C. Oak Lodge (Residential) School 71 6 1 3/- 7. Boy aged 15 Anerley Residential School, Penge, Kent 71 6 1 1/- Children with Defective Vision: 1. Boy aged 10 East London School for the Blind, Clapton 74 0 0 5/- 2. Boy aged 8 ditto 74 0 0 — 3. Boy aged 16 L.C.C. Linden Lodge (Blind) School 43 15 6 3/- 4. Girl aged 15 L.C.C. Kingwood (Myopic) School, Fulham 20 6 4 — 5. Girl aged 14 White Oak Hospital, Swanley 163 16 0 — Mentally Defective Children: 1. Boy aged 16 Acton Special (M.D.) Day School 14 10 0 — 2. Girl aged 14 All Souls' Special School, Hillingdon 61 0 0 — 3. Girl aged 11 ditto 61 0 0 5/- Epileptic Children 1. Boy aged 15 Home for Epileptics, Maghull 70 4 0 — 2. Boy aged 15 Lingfield Epileptic Colony, Surrey 74 2 0 3/- 3. Girl aged 10 ditto 74 2 0 2/6 Orthopaedic Home 1. Girl aged 9 Royal National Orthopaedic Hospital, Stanmore 106 12 0 7/6 2. Girl aged 9 ditto 106 12 0 7/6 3. Girl aged 8 ditto 106 12 0 7/6 Heart: 1. Boy aged 6 Children's Heart Home, West Wickham 74 15 0 — 2. Girl aged 9 ditto 74 15 0 1/- 3. Boy aged 8 Hawkenbury Home, Tunbridge Wells 1 8 9 5/- per week 4. Boy aged 8 St. Joseph's Home, Sambourne 90 0 0 3/- From this table it will be seen that 25 children were sent to Special Schools during 1938, The total charge to the Local 95 Authority per annum was £1,665 16s. 5d., while the contributions by parents amounted to £3 5s. 0d. per week, or £169 per annum. 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 - 1 Clifden Road Infants' - — Ealing Road Junior Mixed 1 - Ealing Road Infants' - 1 Ealing Road Special Class 1 - Lionel Road Juniors' and Infants' 2 - St. George's Junior and Infants' - 1 St. John's Mixed - - St. Paul's Junior and Infants' - — 5 3 Chiswick Group— Belmont Senior Mixed - — Belmont Junior Mixed - - Belmont Infants' - - Beverley Road Infants' 2 - Hogarth Senior Boys' 1 - Hogarth Junior Boys' - — Hogarth Senior Girls' - - Hogarth Junior Girls' - 2 Hogarth Infants' - - Strand Senior Mixed - - Strand Junior Mixed - - Strand Infants' - - Central Schools - - 3 2 Totals 8 5 96 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 33 32 22 10 2 99 - - - - - - 99 Brentford Senior Girls - - - - - - 2 1 8 5 2 18 18 Canal Boat Department - - 1 2 - 3 - 1 2 1 1 5 8 Ealing Road Junior Mixed 3 4 - - — 7 4 1 - - - 5 12 Ealing Road Special Class 3 6 1 - - 10 3 5 - - - 8 18 Ealing Road Infants' 8 2 - - - 10 4 - - - - 4 14 Lionel Road Junior & Infants' 5 3 5 1 - 14 8 2 2 - - 12 26 St. George's 5 7 1 - - 13 4 5 2 - - 11 24 St. John's 3 3 - - - 6 - 2 - - - 2 8 St. Paul's 17 - - - - 17 6 2 1 - - 9 26 Belmont Junior Mixed 11 7 - - - 18 - - - - - 3 21 Belmont Senior Mixed - - - - - - - - - - - - - Belmont Infants' - - - - - - - 2 - - - 2 2 Beverley Road Infants' 1 - - - - 1 3 - - - - 3 4 Hogarth Senior Boys' 3 13 1 - - 17 - - - - - - 17 Hogarth Senior Girls - - - - - - - 9 5 1 3 18 18 Hogarth Junior Boys' 8 17 6 - - 31 - - - - - - 31 Hogarht Junior Girls' - - - - - - - 23 17 - - 40 40 Strand Senior Mixed - - - 2 - 2 - 2 1 2 1 6 8 Strand Junior Mixed 6 5 3 - — 14 6 3 - - - 9 23 Strand Infants' 1 2 - - - 3 - 3 - - - 3 6 Clifden Road Infants' - 6 - - - 6 - - - - - — 6 Totals 107 107 40 15 2 271 40 64 38 9 7 158 429 Miss Charles, Head Mistress of Ealing Road Special Class, reports as follows:— "The Special Class for retarded children is now in its fourth year. The number in class is now being raised from 18 to 20. At present we have a waiting list. Eight children have left during the past year, all but one to join their normal age groups. Seven more will be leaving during the coming term. Owing to the closure of the adjoining C.D.S. Centre, lunches are no longer provided, but cod liver oil and malt is administered to all who need it." The following were notified to the County under Section 2 (2) of the Mental Deficiency Act:— 97 Initials. Sex. Schedule. Date of Schedule. I. C. M. C. 8. 2.38 C. D. M. E. 8. 2.38 E. H. F. C. 22. 2.38 D. H. M. B. 18. 8.38 H. H. M. B. 23.11.38 E. C. F. C. 3. 9.38 D. H. F. B. 7. 12.38 W. H. M. B. 16.12.38 18.—NURSERY SCHOOLS. Arrangements are being completed for the establishment of Nursery Classes in all Infants' Schools in the Borough. Nursery Classes were opened at the following schools during 1938: Brentford, St. George's; Chiswick, Beverley Road. 19.—SECONDARY SCHOOLS. There are two Secondary Schools in Chiswick (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 1938:— Dental Clinic. Chiswick Secondary Schools:— (1) (a) Number of pupils inspected by Dentist 489 (b) Found to require treatment 410 (c) Actually treated and completed 246 (2) Half-days devoted to (a) Inspections 3 (b) Treatment 62 — 65 (3) Attendances made by pupils for treatment 610 (4) Fillings—(a) Permanent Teeth 575 (b) Temporary Teeth - - 575 (5) Extractions—(a) Permanent Teeth 120 (b) Temporary Teeth 29 (Including 56 for overcrowding) - 149 (6) Administrations of general anaesthetics for extractions 80 98 (7) Other Operations— Scalings 12 Dressings 45 Root Fillings 2 Crowns 4 Orthodontic 1 (7 sittings) Chiswick Polytechnic:— (1) (a) Number of pupils inspected by Dentist 223 (b) Found to require treatment 195 (c) Actually treated and completed 96 (2) Half-days devoted to (a) Inspections 1 (b) Treatment 36 — 37 (3) Attendances made by pupils for treatment 220 (4) Fillings—(a) Permanent Teeth 312 (b) Temporary Teeth — 312 (5) Extractions—(a) Permanent Teeth 54 (b) Temporary Teeth 3 (Including 22 for overcrowding) — 57 (6) Administrations of general anaesthetic for extractions 35 (7) Other operations 52 Other operations consisted of one root filling, nine scalings, 38 dressings, one crown, and one treatment with AgN03. Routine Medical Inspection. Chiswick Secondary Schools:— (i) Cases in which a full examination has been made (see paragraph 4, Board of Education Circular 1153). Age 11 12 13 14 15 16 17 Total Boys 59 63 38 4 24 15 5 208 Girls 4 9 2 7 34 1 - 57 Totals 63 72 40 11 58 16 5 265 99 (ii) Cases in which only partial examination has been made. Age 11 12 13 14 15 16 17 Total Boys — — - - — 12 12 24 Girls - - - - - - - - Totals — - - - - 12 12 24 Return of Defects found by Medical Inspection. Defect or Disease Routine Inspections Special Inspections No. of Defects No. of Defects A. B. A. B. Skin— Diseases other than Ringworm, Scabies and Impetigo. Non T.B. 3 - - - Eye— Defective Vision (excluding squint) 45 14 - - Squint 1 1 — — Corneal Opacities — 1 — — Nose and Throat— Chronic Tonsillitis 2 11 — — Defective Speech 1 1 — — Deformities— Spinal Curvature 4 - - - Other Forms 22* — - — Other diseases and Defects 2 1 - — Teeth—Dental Diseases 20 — — — A—Requiring treatment. B—Not requiring treatment, but requiring to be kept under ovservation. * 19 Flat Feet. Chiswick Polytechnic:— (i) Cases in which a full examination has been made. Age 11 12 13 14 15 16 17 Total Boys — - 7 27 — — - 34 Girls — 1 5 2 37 — — 45 Totals — 1 12 29 37 — - 79 100 (ii) Cases in which only a partial examination has been made. Age 11 12 13 14 15 16 17 Total Boys — — - — - — — - Girls - - - - - - - - Totals - - - - - - - - Return of Defects found by Medical Inspection. Defect or Disease Routine Inspections Special Inspections No. of Defects No. of Defects A. B. A. B. Skin— Diseases other than Ringworm, Scabies and Impetigo. Non T. B. 11 - - - Eye— Blepharitis 2 - - - Defective Vision (exlcuding squint) 5 14 - — Nose and Throat— Chronic Tonsillitis - 2 — — Nervous System—Chorea 1 — - — Teeth—Dental Diseases 5 — — - A—Requiring treatment. B—Not requiring treatment, but requiring to be kept under observation Classification, in Ages, of the Nutrition of Pupils inspected during the year. Chiswick county schools. Ages Number of Pupils inspected A. (excellent) No. B. (normal) No. A. (slightly sub-normal) No. D. (bad) No. 11 63 27 29 7 — 12 72 45 21 6 — 13 40 26 10 4 — 14 11 8 2 1 — 15 58 32 22 4 - 16 16 10 6 — — 17 5 5 — - — Totals 265 153 90 22 - 101 chiswick polytechnic. Ages Number of Pupils inspected A. (excellent) No. B. (normal) No. C. (slightly sub-normal) No. D. (bad) No. 12 1 1 - - - 13 12 6 4 2 — 14 29 17 11 1 — 15 37 13 18 6 — Totals 79 37 33 9 — Defective Vision and Squint (excluding Minor Eye Defects treated as Minor Ailments) . CHISWICK COUNTY SCHOOLS. Defect or Disease Number of Defects dealt with Under the Authority's Scheme Otherwise Total Errors of Refraction (including squint) 66 — 66 Other defect or disease of the eyes, excluding those recorded as minor ailments — — — Totals 66 — 66 Total number of children for whom spectacles were prescribed:— (a) Under the Authority's Scheme 66 (b) Otherwise - Total number of children who obtained or received spectacles:— (a) Under the Authority's Scheme 52 (b) Otherwise - 102 CHISWICK POLYTECHNIC. Defect or Disease Number of Defects dealt with Under the Authority's Scheme Otherwise Total Errors of Refraction (including squint) 8 — 8 Other defect or disease of the eyes, excluding those recorded as minor ailments — — - Totals 8 — 8 Total number of children for whom spectacles were prescribed:— (a) Under the Authority's Scheme 8 (b) Otherwise Total number of children who obtained or received spectacles:— (a) Under the Authority's Scheme 8 (b) Otherwise 7 Degree of Visual Acuity (when eyes differ, that of the worse eye) less than 6/6 6/9 6/12 6/18 6/24 6/36 6/60 6/60 13 14 14 8 11 11 4 3 Types of error found:— County Boys County Girls Polytechnic Hypermetropia 3 7 1 Simple Hypermetropic Astigmatism 4 3 - Compound Hypermetropic Astigmatism 7 2 1 Myopia 10 11 3 Simple Myopic Astigmatism 1 2 1 Compound Myopic Astigmatism 5 8 2 Emmetropia (normal) 2 - — 20.—CONTINUATION SCHOOLS. In the Chiswick area there are three such schools—an Evening School for Girls at 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. 103 21.—EMPLOYMENT OF CHILDREN AND YOUNG PERSONS. The following extract from the Bye-laws under the Children and Young Persons Act, 1933, with respect to the Employment of Children, 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 endorsed 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 a.m. or after 7 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 a.m. and 10 a.m. (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. 104 All children are medically examined before a Certificate 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 1938 is as follows:— Number of Employment Cards applied for 205 Number medically examined by School Medical Officer 195 Number medically examined by Acton, Hounslow and L.C.C. 10 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.) 1 Number of Street Trading Badges issued Nil Number of Street Trading Badges returned Nil No legal proceedings were taken during 1938 for offences against the Employment of School Children and Young Persons. The following examinations were made, apart from those already recorded in this report:— Twelve school teachers were examined for physical fitness for duty and to participate in the benefits of the superannuation scheme. Sixty-seven children were examined for Entertainment Licences. 22.— GENERAL. New Health Centre. On the 8th July Lord Horder opened a new Health Centre and Juvenile Employment Bureau at Brentford. The following particulars are extracted from the report of Mr. L.A. Cooper, the Borough Engineer and Surveyor:— Particulars of the Centre. Site. "The building is erected on land formerly occupied by the Rothschild School and has frontages to Brentford High Street, Alexandra Road and Albany Road. The entrances are arranged so that the Maternity and Dental Clinics are approached from Albany Road, with separate access to each department, the School Clinics and caretaker s quarters from Alexandra Road, and the Juvenile Employment Bureau from Brentford High Street. 105 Plan. The Clinics and Juvenile Employment Bureau are planned on a single floor with basement for heating purposes under the caretaker's quarters on the first floor. The Maternity Clinic rooms are grouped around a large General Waiting Room which in turn gives access to the Dental Clinic and School Clinic. This large General Waiting Room, which has a 16ft. ceiling height giving clerestory lighting, is for the use of the clinics generally, but each clinic is self-contained and has its own separate waiting room and clerks' office. A reinforced concrete pram shelter with lights over is provided on the north-east fronts, and the pram park is paved with 9 in. by 9 in. buff tiles, fin. joints being used. All clinics open on to a paved area part of which can be used for remedial exercises. A fish pond, with fountain, placed at the intersection of the centre lines of the main exits opening on to the area, provides a pleasant central feature. The School Clinic has a large room which can be used at alternate periods for the treatment of Minor Ailments or tor Orthopaedic and Ophthalmic cases. A Sunray Room is provided with easy access to both Maternity and School Clinics. The Juvenile Employment Bureau has accommodation for clerks, and public space as required. All clinics have ample lavatory and changing accommodation. On the first floor the caretaker's quarters are provided with livingroom, three bedrooms, kitchen and bathroom, a connecting passage with which opens on to the flat roof. Access to the tank room over is gained by means of a cat ladder from the caretaker's store. Construction. Weight carrying walls are of brick with precast concrete floors and roofs, the latter finished with screed and three-ply vulcanite protected with i-in. tar macadam. Internal partition walls are of 4 18½ in. bricks and 2½ Jin. pumice partition blocks. Elevation Treatment. The elevations are faced with hand-made multi-coloured 106 stock bricks with flush joints of yellow mortar. Sills are in artificial stone of Portland stone colour, and lintels and canopies are in reinforced concrete finished fair-face and treated with a cream cement resisting paint lightly stippled. The piers supporting the two semi-circular canopies are faced with tiles of sunshine yellow with a turquoise blue base and capping. All windows and doors to General Waiting Room and corridor are of metal. Other external doors are in wood, and windows, doors and ironwork externally are painted turquoise blue. Internal Finishes. The entrance to the School Clinic has a tiled floor and dado, and the Juvenile Employment entrance has also a tiled floor and skirting with cement rendered walls above distempered cream. Waiting Rooms and corridors have floors of "Ruboleum" with coved tiled skirtings and dadoes and cream enamelled plaster walls above. The Dental Surgery consulting room and rooms to clinics generally have wood block floors in beech and pyinkado with coved tiled skirting and cream enamelled plaster walls. The Toddlers' room has a "Latex" rubber floor, tiled skirting, spring green rexine leather dado, with nursery rhyme frieze and primrose enamelled plaster above. Lavatories and kitchen to the Maternity Clinic have tiled floors and dadoes with cream enamelled plaster above. Tiles have been fixed to walls around all basins, sinks and fittings generally, and all fittings follow the best hospital practice. Window sills throughout are of tile with rounded nosings. All rooms to clinics have rounded internal and external angles. The Juvenile Employment Bureau has a "Ruboleum" floor to the public portion and wood block to the clerks' office. Walls are cement rendered and distempered cream. Woodwork is in dove grey. The counter to the Juvenile Employment Bureau and the School Clerk's office has a flush plywood front and solid top in Australian silky oak. 107 Cupboards are close fitted to walls, and doors to all Clinics and Juvenile Employment Bureau are finished flush. Door furniture is stainless steel or satin chrome. The caretaker's quarters are finished with wood floors and plaster walls, the bathroom and kitchen only having tiled floors. Simple colour schemes are used throughout. Services. Heating is by low pressure hot water from a boiler situated in the basement and feeding hospital type radiators in the various rooms as required. The General Waiting Room is also fitted with four ray radiators high up under the clerestory windows to provide additional heating surfaces. The heating system is pump accelerated. Hot water for the various fittings and for domestic services generally is supplied from a separate boiler in the basement. Main supply pipes are carried in accessible ducts throughout the building to the various points, and wherever possible pipes are concealed. All exposed pipes and fittings throughout are chromium plated. The clinics have a private intercommunication system of telephones, and the patients' call system is by combined light signs and buzzers. Generally. The completion and opening of this building forms part of a scheme of educational development in Brentford undertaken during the past ten years by the Joint Committee for Education. The building scheme has been carried out by the Borough Engineer and Surveyor in collaboration with the Medical Officer of Health and the Director of Education, and the drawings and details have been prepared by Mr. K. P. Goble, Architectural Assistant in the Borough Surveyor's Department. The Clerk of Works was Mr. W. Burns." The tender accepted was for £14,045. 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. 108 BOROUGH OF BRENTFORD AND CHISWICK. MEDICAL INSPECTION RETURNS Year ended, 31st December, 1938. TABLE I. MEDICAL INSPECTIONS OF CHILDREN ATTENDING PUBLIC ELEMENTARY SCHOOLS. A.—Routine Medical Inspections. Number of Code Group Inspections: Entrants 478 Second Age Group 424 Third Age Group 520 Total 1422 Number of other Routine Inspections 745 Grand Total 2167 B.—Other Inspections. Number of Special Inspections 1491 Number of Re-inspections 2126 Total 3617 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 7 79 82 Second Age Group 27 100 110 Third Age Group 39 54 83 Total (Prescribed Groups) 73 233 275 Other Routine Inspections 36 15 47 Grand Total 109 248 322 109 TABLE II. A.—Return of Defects found by Medical Inspection in the Year ending 31st December, 1938. 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) Ringworm—Scalp — — 4 — (2) Ringworm—Body — — 13 - (3) Scabies 2 - 64 - (4) Impetigo 3 — 57 - (5) Other Diseases (Nontuberculous) 1 - 124 - TOTAL (Heads 1 to 5) 6 — 262 - Eye (6) Blepharitis 5 - 13 - (7) Conjunctivitis 5 — 20 — (8) Keratitis 1 — — - (9) Corneal Opacities - - - - (10) Other conditions (excluding Defective Vision and Squint) - 1 15 - TOTAL (Heads 6 to 10) 11 1 48 - (11) Defective Vision (excluding Squint) 109 89 21 - (12) Squint 8 5 2 - Ear (13) Defective Hearing 2 4 1 - (14) Otitis Media 5 1 38 - (15) Other Ear Diseases 1 — 24 - Nose and Thro, (16) Chronic Tonsillitis only 50 104 29 2 (17) Adenoids only 3 3 9 — (18) Chronic Tonsillitis and Adenoids 74 13 37 - (19) Other Conditions 6 - 130 — (20) Enlarged Cervical Glands (Non-Tuberculous) 4 6 15 - (21) Defective Speech 2 — 2 — 110 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 3 5 1 (23) Functional — 10 - - (24) Anaemia 3 — 2 - Lungs (25) Bronchitis 6 - 9 - (26) Other Non- Tuberculous Diseases 1 1 17 — Pulmonary: Tuberculosis (27) Definite — - — - (28) Suspected — - 3 - Non-Pulmonary: (29) Glands — - - - (30) Bones and Joints — - — - (31) Skin — - — - (32) Other Forms — - — - TOTAL (Heads 29 to 32) — - — - Nervous System (33) Epilepsy 1 - 1 - (34) Chorea 3 - 10 - (35) Other Conditions 9 - 5 - Deformities (36) Rickets - - - - (37) Spinal Curvature 1 - 3 - (38) Other Forms 8 6 26 - (39) Other Defects and Diseases (excluding Uncleanliness and Dental Diseases) 15 5 487 234 Total 329 251 1186 237 111 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 478 204 42.7 219 45.8 51 10.7 4 0.8 Second Age Group 424 184 43.4 185 43.6 53 12.5 2 0.5 Third Age G roup 520 244 46.9 204 39.2 68 13.0 4 0.7 Other Routine Inspections 745 385 51.7 288 38.6 68 9.1 4 0.5 Total 2167 1017 46.9 896 41.3 240 11.0 14 0.6 112 TABLE III. Return of all 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 2 At Public Elementary Schools - At other Institutions — At no School or Institution — Total 5 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 5 At Public Elementary Schools - At other Institutions — At no School or Institution — Total 5 PARTIALLY DEAF CHILDREN Children who can appropriately be taught only in a school for the partially deaf: At Certified Schools for the Deaf and Partially Deaf 2 At Public Elementary Schools 2 At other Institutions - At no School or Institution - Total 4 113 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 18 At other Institutions 1 At no School or Institution - Total 23 EPILEPTIC CHILDREN Children suffering 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 2* At no school or Institution - Total 2 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 - 114 TABLE III—contd. B.—Delicate 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 2 At Public Elementary Schools 16 At other Institutions — At no School or Institution - Total 18 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 2 At Public Elementary Schools 11 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 5 At Public Elementary Schools - At other Institutions 4 At no School or Institution 1 Total 10 CHILDREN SUFFERING FROM MULTIPLE DEFECTS Chi'dten suffering from any combination of the following types of Defects: 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 1 115 TABLE IV. TREATMENT TABLES. Group I.—Minor Ailments (excluding Uncleanliness, for which see Table 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 1 — 1 (2) Other Treatment 3 — 3 Ringworm—Body 13 — 13 Scabies 66 — 66 Impetigo 60 — 60 Other Skin Diseases 125 — 125 Minor Eye Defects (external and other, but excluding cases falling in Group II) 60 - 60 Minor Ear Defects 69 — 69 Miscellaneous (e.g., minor injuries, bruises, sores, chilblains, etc.) 398 52 450 Total 795 52 847 116 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) 310 - 310 Other defect or disease of the eyes (excluding those recorded in Group I) - - - Total 310 — 310 No. of Children for whom spectacles were (a) Prescribed 288 - 288 (b) Obtained 246 — 246* * Most of the balance were issued after the Christmas Holiday. Group III.—Treatment of Defects of Nose and Throat. Number of Defects. Received Operative Treatment Received other forms of Treatment Total number treated Under the Authority's Scheme, in Clinic or Hospital * By Private Practitioner or Hospital, apart from the Authority's Scheme Total (i) (ii) (iii) (iv) (i) (ii) (iii) (iv) (i) (ii) (iii) (iv) - - - - - 3 45 1 - 3 45 1 125† 174 (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. †Chiefly Dental Treatment 117 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 118 Nil Nil Nil 118 Table V. DENTAL INSPECTION AND TREATMENT. (1) Number of children inpected by the Dentist— (2) Number found to require treatment 3415 (a) Routine age-groups— (3) Number actually treated 2890 Age 5 250 „ 6 299 (4) Attendances made by children for treatment 4538 „ 7 291 „ 8 285 „ 9 237 (5) Half-days devoted to Inspections 23 „ 10 244 „ 11 250 Treatment 629 „ 12 328 Leavers' Inspections 13 „ 13 317 „ 14 128 „ 15 32 „ 16 7 Total 665 Total 2668 (6) Fillings— (b) Specials — 1344 Permanent teeth 3478 (c) Total (Routine and Specials)— 4012 Temporary teeth 795 Total 4273 118 TABLE V—(continued) (7) Extractions:— (8) Administrations of general anaesthetics for extractions 1,813 Permanent Teeth 691 Temporary Teeth 3,646 (9) Other Operations:— Permanent Teeth 709 Temporary Teeth 158 Total 4,337 Total 867 TABIE VI—UNCLEANLINESS AND VERMINOUS CONDITIONS. (1) Average number of visits per school made during the year by the School Nurses 13 (2) Total number of examinations of children in the schools by the School Nurses 25,366 (3) Number of individual children found unclean 341 (4) Number of children cleansed under arrangements made by the Local Education Authority 48 (5) Number of cases in which legal proceedings were taken (a) Under the Education Act, 1921 — (b) Under School Attendance Bye-Laws 11 Ealing and Brentford & Chiswick hospitals Committee. CLAYPONDS ISOLATION HOSPITAL PERIVALE MATERNITY HOSPITAL. ANNUAL REPORT of the MEDICAL SUPERINTENDENT for the year ending 31st MARCH, 1939 THOMAS ORR, M.D., D.Sc., Medical Superintendent. 2 EALING AND BRENTFORD & CHIS``WIC HOSPITALS COMMITTEE. Alderman G. Jenkin (Mayor of Brentford and Chiswick) (Chairman). Alderman Col. R. R. Kimmitt, O.B.E., T.D., D.L. (Vice-Chairman). Alderman A. W. Bradford, J.P. Alderman Emily S. Taylor, J.P. (Mayor of Ealing) Councillor Alice J. Burden. Councillor W. H. Crowe. 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 John C. Aitken, M.B., Ch.B., D.P.H. Resident Medical Attendant, Maternity HospitalNancy I„. Lewis, M.B., Ch.B., D.P.H. Consulting Surgeon— C. W. Gordon Bryan, F.R.C.S. (Eng.). Consulting Oto-I aryngologist— Arthur Miller, F.R.C.S. (Ed.), D.L.O. Consulting Obstetricians— John W. Rait Bell, L.R.C.P.I. & I,.M., L.R.C.S.I. & L.M. Arnold Walker, M.A., M.B., B.Ch., F.R.C.S., M.G.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 EALING AND BRENTFORD & CHISWICK HOSPITALS COMMITTEE. Mr. Chairman, Ladies and Gentlemen, I have the honour to submit the Annual Report on the work of the Hospitals from the 1st April, 1938, to the 31st March, 1939. CLAYPONDS ISOLATION HOSPITAL. The total number of cases admitted to the hospital was 687 ; this is 38 more than in the previous year. The highest number under treatment on any day was 97 on the 25th November, and the lowest number 44 on the 24th July. The average daily number in Hospital was 69. The following table indicates the number of cases of th various diseases treated during the year : Disease Remaining in Hospital 31st March, 1938 Admitted during year Discharged during year Died during year Remaining in Hospital 31st March, 1939 Scarlet Fever 38 382 364 1 55 Diphtheria 31 226 234 4 19 Measles 9 37 46 — - Pneumonia — 2 2 — Pneumonia and Whooping Cough - 4 3 1 - Whooping Cough — 3 2 — 1 Typhoid Fever — 3 3 — — Paratyphoid Fever B. - 2 2 - - Dysentery — 7 7 — — Influenza — 2 1 — 1 Poliomyelitis — 2 2 — — Tonsillitis — 1 1 — — Ophthalmia Neonatorum - 1 1 - - Mumps and Pyelitis - 1 1 - - Pemphigus — 1 1 — — Encephalitis and Chicken Pox - 1 1 - - Chicken Pox 1 4 4 1 — German Measles — 1 1 — — Puerperal Pyrexia — 5 5 — — Septic Throat — 1 1 — — No ascertainable disease — 1 1 - — 79 687 683 7 76 4 Scarlet Fever.— Of the 382 cases admitted as scarlet fever 87 were from Brentford and Chiswick, 284 were from Ealing and 11 from Southall. Of this total, 20 were found not to be suffering from the disease and were ultimately diagnosed as follows:— Rubella 9, measles 4, septic soie of ear 1, tonsillitis 1, influenza 1, lobar pneumonia 1, tonsillitis and septic rash 1, erythema 1, no apparent disease 1. Three cases of scarlet fever were found on admission to be suffering from a second disease as follows:— Scarlet fever and whooping cough 2, scarlet fever and chicken pox 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. 85 230 23 17 6 1 The complications occurring among the cases were as follows:- Rhinitis and rhinoirhoea 60 Cervical Adenitis 57 Otitis media 27 Mastoiditis 2 Second attacks of scailet fever 12 Septic sores 14 Nephritis and Albuminuria 6 Bronchitis 4 Arthritis and rheumatism 4 Cardiac irregularity 3 Purpura simplex 2 Vaginal discharge 2 Irregular attacks of pyiexia 2 Tonsillitis 1 Quinsy 1 Frontal sinusitis 1 Cellulitis of popliteal region 1 Endocarditis 1 Retro pharyngeal abscess 1 Alveolar abscess 1 Meningitis 1 Mitral Systolic murmur 1 Boils on legs 1 5 Return Cases. Of the 364 cases discharged during the year 11 gave rise to " return " cases of scarlet fever. This gives a return case rate of 3.0 per cent. Duration of Stay.— The average duration of stay in hospital of all cases of scarlet fever was 33.6 days. Deaths—There was one death from scarlet fever. An infant aged nine months was admitted to hospital with a moderately severe attack of scarlet fever but developed meningitis and died on the sixth day after admission. Diphtheria.— The number of cases admitted as diphtheria was 226, 98 from Brentford and Chiswick and 128 from Ealing. This is 23 more than in the previous year. Of the total number, 44 were ultimately diagnosed as follows:— Tonsillitis 36, scarlet fever 1, rhinitis 1, rhinitis and impetigo 1, rhiuorrhoea 1, peri-tonsillar abscess 1, catarrhal laryngitis 1, no apparent disease 2. Two cases were found to have another disease in addition to diphtheria, one having rubella and one scabies. 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. 45 88 24 12 13 — The following complications were observed:— Palatal paresis 15 Ocular paresis 3 Pharyngeal paresis 2 Lower limb paresis 1 Carditis 9 Cardiac irregularity 8 Tachycardia 2 Otitis media and otorrlioea 3 Mastoiditis 1 Septic Sores 4 Cervical adenitis 4 Nephritis 2 6 Bronchitis 2 Secondary Tonsillitis 1 Rhinitis 1 Pharyngeal abscess 1 Alveolar abscess 1 Corneal ulceration 1 Catarrhal jaundice 1 Second attack of.diphtheria 1 Laryngeal Diphtheria.— Three cases were admitted with this diagnosis. One child, as described below, died, and the two other cases were diagnosed as peritonsillar abscess and catarrhal laryngitis respectively. Deaths from Diphtheria.— There were four deaths from this disease, all occurring in children under six years of age. All four were severe cases on admission and all had over 60,000 units of anti-toxin. One died on the day of admission and two others in four days and eight days lespectively. The fourth case suffered from diphtheria of the trachea and bronchial tubes and tracheotomy was perfoimed but the child died from septic pneumonia after a stay in hospital of almost seven weeks. Return cases.— There were two return cases from children discharged after the usual three negative swabs had been obtained. One child was in hospital for 34 days and two days after his discharge his brother was admitted witli diphtheria. A girl of 12 yeais was sent in as diphtheria and was in hospital for 85 days ; fourteen days after her discharge her mother was admitted with diphtheria. Duration of stay.— The average duration of stay in Hospital for cases of diphtheria was 47.2 days. Measles.— Thirty-seven cases of measles, mostly with complications, were admitted for treatment. There were no deaths. Whooping Cough.— Seven cases of this disease were admitted. One infant was brought in moribund suffering from whooping cough and broncho-pneumonia and died one and a half hours after admission. 7 Poliomyelitis- Two cases of poliomyelitis (infantile paralysis) were admitted. Both were adults and both showed extensive paralysis on admission. The lower limbs in both cases were completely paralysed and there was a severe paralysis of the upper limbs also. In one case, however, there was a remarkable degree of recovery and the patient was able to walk on leaving hospital, the only noticeable loss of power being in the wrists. The other case showed very little improvement after a stay in hospital. Both patients were transferred to the National Orthopaedic Hospital when they were considered free from infection. Arrangements were made when the patients were admitted to obtain on loan a respirator (" iron lung ") but the use of this instrument was not required. Through the generosity of Lord Nuffield the Hospital now possesses its own artificial respirator. Chicken Pox.- Two unusual cases of this disease were admitted. (1) Chicken Pox and Encephalitis.—A boy of 14 years developed symptoms of encephalitis about 10 days after the onset of chicken pox. He was admitted to the Hospital and showed signs and symptoms of cerebellar disease all of which cleared up and he left the hospital in apparently perfect health after four weeks' stay. (2) Haemorrhagic Chicken Pox.—This was in a child aged 7 years. It was known that this child was suffering from splenomedullary leuchaemia previous to her admission. She suffered from a very severe attack of chicken pox and was semi-conscious when she was brought to the hospital. The Chicken Pox was of the severe haemorrhagic type with haemetemesis and she died within 24 hours of admission. Enteric Fever.—Five cases were sent into hospital with the diagnosis of enteric fever. Three cases were found not to be enteric fever; one cleared up quickly in hospital; one proved to be pneumonia and the third was sent to the West Middlesex Hospital for further investigation of his abdominal symptoms. The two proved cases were brothers and had each a mild attack of paratyphoid fever. Both cases made a complete recovery. 8 Dysentery.—There were seven cases admitted as dysentery, all occurring in the same family. Each was verified bacteriologically, the organism isolated being the same, namely, Sonne bacillus. The cases tan a mild clinical course without incident. Three however were re-admitted one month after discharge, on account of reported recurrence of the symptoms, but in only one of these was the presence of the organism again proved. ILLNESS OF Staff- The following cases of illness of the staff occured during the year : Influenza 1 Pelvic peritonitis 1 Tonsillitis 5 Scarlet Fever 1 Diphtheria 1 Dermatitis 1 Influenza and bronchial catarrh 1 Medicai, Staff. —Dr. Miller, the Consulting Oto-Laivngologist, made 15 visits during the year and performed 6 mastoid operations and 16 operations for the removal of tonsils and adenoids. Mr. Gordon Bryan, the Consulting Surgeon, made 2 visits to the hospital during the year and performed an operation for resection of rib and Mr. G. G. Talbot, the Consulting Ophthalmologist, made one visit for examination of an eye showing severe corneal ulceration. 9 PERIVALE MATERNITY HOSPITAL. Mothers. The 803 cases, including booked and emergency cases, admitted to the Hospital during the period 1st April, 1938, to 31st March, 1939, from the two districts were as follows : Month Ealing Brentford and Chiswick Total April 64 10 74 May 59 12 71 June 53 12 65 July 58 15 73 August 47 11 58 September 45 12 57 October 50 16 66 November 49 15 64 December 59 15 74 January 54 9 63 February 52 7 59 March 61 18 79 651 152 803 The greatest number of patients in the hospital on any day was 50. This was on the 16th and on the 20th October, 1938. The average period of stay in the hospital was 16.64 days. Emergency Cases.—During the year 14 emergency cases weie admitted to the hospital. This is a very much larger number than in any previous veai. The increase is due to the fact that the medical practitioners in the Borough are now able to obtain immediate admission of their abnormal cases upon application to the Resident Medical Attendant. Of these 14 cases, 10 resulted in normal deliveries and all the mothers were discharged in a satisfactory condition. The cases were as follows:— 1. Breech with extended legs sent in for delay in first stage. Normal delivery followed. 2. Patient admitted for delay in first stage. Normal delivery followed 10 3. Patient admitted with ante-partum haemorrhage, due to lateral placenta praevia. The infant (32 weeks maturity) was delivered as a breech. Infant survived eight hours. Puerperimn uneventful. 4. Impacted shoulder. Attempts at delivery by own doctor unsuccessful. Prolapsed arm on admission. Delivered of a still-born infant. 5. Ante-partum haemorrhage. Membranes ruptured artificially. Normal delivery. 6. Admitted for delay in 1st stage. Patient looked very ill on admission. Persistent occipital-posterior manually rotated and forceps applied. Delivered of a macerated infant. Patient transferred on ninth day of puerperium to King Edward Hospital. 7. Breech with extended legs sent in for delay in 1st stage. Normal delivery followed. 8. Retained placenta manually removed at home by own doctor. Patient exsanguinated and shocked on admission. Intravenous gum acacia and two small blood transfusions given. Developed pyelitis which soon responded to treatment. Discharged home in very satisfactory conditior. 9. Admitted at request of own doctor because of premature labour (34 weeks pregnant) and no preparations made at home. Normal delivery followed. 10. Patient admitted for delay in 1st stage. Normal delivery followed. 11. Admitted for toxaemia of pregnancy. Good response to treatment and normal delivery followed in a few days after medical induction. Infant seemed quite normal at first, but on the fourth day had a few convulsions with cyanosis. When no response to treatment, Dr. Alan Moncrieffe called in for consultation and diagnosed congenital hydrocephalus. 12. Admitted for toxaemia of pregnancy. Elderly primigravida. Normal delivery followed in a few days. Mother and infant did well and were discharged home in satisfactory condition. 11 13 Admitted for delay in 1st stage Normal delivery of an infant weighing 13/6 5 oz Mother and baby discharged in very satisfactory condition 14 Admitted at request of own doctor for delay in 2nd stage Normal delivery of an anencephalic infant followed Mother discharged, quite satisfactory Ante-Natal Cases—A hundred and twenty ante-natal cases were admitted for treatment Of these cases, sixty-three recovered sufficiently to be discharged to await at home the onset of labour. The conditions from which they were suffering were as follows : Ante-Natal Cases in Hospital until Delivery:— Toxaemia 35 Ante-partum haemorrhage (accidental) 3 Suspected disproportion 8 Pyelitis 3 For rest (poor general condition) 1 Pleurisy 1 Thrombosed varicose veins 2 Post maturity 1 Chronic bronchitis and asthma 1 Mitral stenosis -for rest 1 Hypertension 1 Total 57 Ante-Natal Cases discharged Home to await Delivery:— Toxaemia 18 Suspected disproportion 6 Pyelitis 6 Thrombosed varicose veins 2 Ante-partum haemorrhage (accidental) 2 Rest from home cares 4 Threatened abortion 2 Admitted not in labour 18 Admitted for external version of breech 1 Hyperemesis 3 Admitted for investigation 1 Total 63 12 Surgical Induction was done in the following cases:— Hypertension 1 Toxaemia 18 Post maturity with multiple pregnancy 1 Post maturity with disproportion 1 Post maturity 1 Accidental haemorrhage 1 Lateral placenta praevia 4 Total 27 Abnormalities in Mothers — Central placenta praevia : Caesarean Section 2 cases During labour:— Perineal tears requiring more than one suture 187 Episiotomy 13 Breech with extended legs—unassisted delivery 8 Breech with extended legs—assisted delivery 12 Breech with extended arms--assisted delivery 1 Eorceps for delay in 2nd stage 15 Manual rotation and forceps delivery of persistent occipito-posterior position 4 Central placenta praevia 2 Lateral placenta praevia 3 Perforation of skull and forceps delivery of infant which had died during labour 1 Perforation of hydrocephalic foetus 1 Forceps delivery of brow presentation 1 Forceps delivery for foetal distress 1 Manual removal of retained placenta 4 Moderate post-partum haemorrhage 22 Eclampsia (fits starting during labour) 2 Prolapsed arm 1 Severe post-partum haemorrhage 4 Footling presentation 3 Infant born before admission, 3rd stage completed in hospital 3 Delivery completed before admission 1 13 The total number of forceps deliveries was 22, giving a rate per thousand of 27.2. This figure is about the average for the past 5 years. During puerperium:— Thrombosed varicose veins 11 Cracked nipples 5 Severe anaemia 1 Urinary infection 2 Urticarial rash 5 Endocervicitis with vaginal discharge 3 Cystadenoma of thyroid 1 Rheumatism of ankles 1 Quiescent pulmonary tuberculosis 1 Bartholin's cyst (left) 1 Retention of urine 2 Small superficial abscess 1 Total 34 There were 30 cases of puerperal pyrexia of a notifiable degree. These cases were suffering from:— Breast abscess 2 Urinary infection 7 Suspected uterine sepsis 1 Uterine infection (haemolytic streptococci, Group A) 2 Uterine infection (haemolytic stieptococci, Group C) 1 Breast abscess and thrombosis in femoral veins, both legs 1 Femoral thrombosis 2 Acute mastitis 7 Parametritis 1 Pulmonary embolism 2 Retained products 1 Bad "cold " 1 Sloughing perineum 1 Urinary infection and mastitis 1 14 Patients transferred to other hospitals To Clayponds Isolation Hospital 7 Queen Charlotte's Isolation Block 2 King Edward's Hospital, Ealing 1 West Middlesex Hospital 1 Total 11 The cases were as follows:— 1. Mother transferred to Clayponds Isolation Hospital. Suspected uterine sepsis. Infant still-born. 2. Mother transferred to Clayponds Isolation Hospital. Suspected gonococcal infection. Infant still-born. 3. Mother transferred to Clayponds Isolation Hospital on fourth day of puerperium. Uterine infection with haemolytic streptococci, Group A. Infant still-born. 4. Mother and infant transferred to Clayponds Isolation Hospital. Uterine infection with haemolytic streptococci, Group A. 5. Mother and infant transferred to Clayponds Isolation Hospital. Uterine infection which haemolytic streptococci, Group B. 6. Mother transferred to Clayponds Isolation Hospital with acute bilateral mastitis and bronchitis. Infant accompanied patient. 7. Mother transferred to Clayponds Isolation Hospital with acute mastitis, right breast, which later developed into an abscess. Infant accompanied patient. 8. Mother transferred to Queen Charlotte's Isolation Block. Local uterine infection (B. coli) after caesarean section. Infant sent home. 9. Mother transferred to Queen Charlotte's Isolation Block with parametritis. Infant discharged home. 10. Mother transferred to King Edward's Hospital for full investigation. Infant still-born. 15 11. Mother transferred to West Middlesex Hospital, Isleworth. Patient had been in this hospital for four months with (a) breast abscess and (b) double femoral thrombosis. Infant discharged, home. Maternal Deaths. There were three maternal deaths during the year. Of these, two were due to pulmonary embolism and one to concealed accidental haemorrhage. The cases were as follows : 1. This patient developed thrombosis in the left internal saphenous vein on the fifth day of puerperium after a normal delivery. Sudden death from pulmonary embolism occurred on the ninth day of the puerperium. 2. This patient developed thrombosis the whole length of right internal saphenous vein on third day of puerperium after normal delivery. Pulmonary embolism occurred on ninth day of puerperium. Patient survived this, and was progressing favourably, when on the eighteenth day of puerperium, she had another embolism and died very suddenly. 3. This patient was admitted with history of a ' heavy show.' No evidence of toxaemia, no pains on admission. Weak contractions began, but her general condition gradually deteriorated. Patient collapsed and died undelivered after an attack of vomiting, which brought on further bleeding. Death due to concealed accidental haemorrhage. The Consulting Obstetrician saw the patient on admission, and was present throughout. Infants. Number of Infants born 807 Males 401 Females 406 Still Born Infants.—Total 32, giving a still birth rate of 39.6 per thousand. 16 Fresh. Full term 7 Premature 4 Miscarriage (25 weeks) 1 Anencephalic 2 Hydrops foetalis 1 Macerated. Full term 7 Premature 10 Neo-natal deaths.—Total 14, giving a neo-natal death rate of 17.2 per thousand, as compared with 27.3 per thousand in 1936-37 and 21 per thousand in 1935-36. Prematurity 13 After precipitate labour 1 Premature Infants born alive:— 33-37 weeks IS 34 weeks 8 32 weeks 3 28 weeks 2 Twins (26 babies) 13 Abnormalities of surviving infants:— Pyloric spasm 3 Haemorrhage of the new born 3 Cepbal-haematoma 3 Severe jaundice 2 Mongol 3 Mild talipes calcaneo-valgus 1 Upper respiratory tract infection 1 Sign of intra cranial injury 2 Fibroid polypus right upper alveolus 1 Right septic thumb 1 Dehydration fever 1 Intertrigo with septic spots napkin area 1 Hare lip and cleft palate 1 Congenital hydrocephalus 1 17 Telangiectasis of forehead and nose 1 Meningo-myelocoele lower lumbar region 1 Syndactyly and Polydactyly toes and Polydactyly left hand 1 Pedunculated fibromyoma attached to proximal phalanx fourth finger of left hand 1 Ophthalmia neonatorum 2 Total 30 Infants Weaned.—Total 14. Weaned on account of mothers' breast conditions 9 Weaned on account of mothers' poor general condition 5 Infants transferred tv other Hospitals:- 1. Infant transferred to West Middlesex Hospital, Isleworth, suffering from debility following bronchopneumonia (premature infant). Mother discharged home. 2. Infant and Mother transferred to Infants' Hospital, Vincent Square. Infant with pyloric spasm. 3. Infant transferred to Infants' Hospital, Vincent Square, with pyloric stenosis. Mother discharged home. 4. Infant transferred to Infants' Hospital, Vincent Square, with haemolytic anaemia. Mother discharged home. Consulting Obstetrician.—Dr. J. W. Rait Bell was called to the hospital on forty-one occasions during the period under review. Training of Pupils.—Up to 31st March, 1939, 36 pupils completed their course of training and entered for the examination of the Central Midwives Board. Of these pupils, all except one were successful. 18 During the year Dr. Aitken, the Resident Medical Officer at the Isolation Hospital, received promotion by being appointed Assistant Medical Officer in the Ealing Public Health Department his place being taken by Dr. M. Kelly. Dr. Williams-James, the Resident Medical Officer at the Maternity Hospital, resigned on account of her marriage and Dr. N. I,. Lewis was appointed in her stead. As in previous Annual Reports, I take the opportunity of expressing my appreciation of the excellent work carried out by the Medical Staff and by the Matrons of the two hospitals and my gratitude to Mr. Birrell, the Clerk to the Committee, and to Mr Owen, the Treasurer, for their unfailing courtesy auc assistance. I am, Ladies and Gentlemen, Your obedient Servant, THOMAS ORR, Medical Superintended