BRE 8 BOROUGH OF BRENTFORD AND CHISWICX. HIEHIM REPORT ON THE EEA L T H ,O F SHE DISTRICT ' AND SCHOOL MEDIO A L SERVICE D U R I NG THE HEAR 1940 R.C.LEANING, N.3., B.S., (Lond), M.R.C.S, L.R.C.P., ' D.P.I.) R.C.S. , (Eng). Medical Officer of Health. School Medical Officer. -1- BOROUGH OF BRENTFORD AND CHISWICK PUBLIC HEALTH DEPARTMENT, TOWN HALL, CHISWICK. To the Mayor, Aldermen and Councillors of the Borough of Brentford and Chiswick. LADIES AND GENTLEMEN, In accordance with instructions received from the Ministry of Health, this report for 1940 has been prepared as an interim report and only essential matters and certain statistics are included. A careful record of other statistics and relevant matters is being kept so that after the termination.of the war a comprehensive report dealing with the whole war period may be issued in order that the annual records may, as far as practicable, be "Continuous and complete. The fact that this Department was responsible to the County (the Scheme-making Authority) for the Casualty Services of A.R.P. necessitated a good deal of extra work at high pressure and I am pleased to record that those members of the. staff who were engaged in these duties carried out the extra work with enthusiasm. Of course our most severe time was during the "blitz" on the London area and many of us had to remaih on duty or call continuously throughout the 24 hours, with only brief intervals for sleep and refreshment, for something like 94 consecutive days. During the year the Senior Clerk, Percy Smith, joined the Pioneer Corps and James Friar the Junior Clerk the R.A.F. in which he won his "wings" and became a fighter pilot. Many mothers and children returned from the reception areas so the M & C.W. work increasedsome schools we re-opened part-time and there was a measure of. School Medical Service. The Diphtheria Immunisation Clinic was re-opened in December. • As regard the general health of the Borough the most outstanding feature was the small incidence of infectious disease during the year. An epidemic of Measles was due, and for a generation it has never failed to appear each alternate year, but there were only sporadic cases. This is possibly accounted for by the evacuation of so many children from crowded areas. This health condition is all the more remarkable when one considers the "shelter" life taken to by the people of the London area. The shelters had been designed to be used for short periods only, but they became dormitories in which all the fundamental rules of Hygiene seem to have been broken. Many were overcrowded, inadequately ventilated, without suitable sanitary accommodation and poorly heated and seemed to be deal for the outbreak of severe epidemics of Influenza, Cerebro Spinal Fever etc. Mercifully we were spared these dread happenings but our anxiety remained intense throughout, as suitable measures to remedy the conditions were difficult and often impossible to carry out. I am, Ladies and Gentlemen, Your obedient Servant, R.C. LEANING. -2- SECTIONA. EXTRACTS FROM VITAL STATISTICS ETC. Birth and Deaths* Live Births. Total Male Female (a) Legitimate 692 356 336 (b) Illegitimate 58 26 12 Still Births. 25 9 16 Deaths (all causes) 813 418 395 Deaths from puerperal causes NILL Death, rate of infants under 1 year of ago. All infanta per 1,000 1ive births = 59 Legitimate infants per 1,000 live births = 6l Illegitimate infanta per 1,000 illegitimate live 'births = 28 Deaths from Cancer ( all ages) = 112 Deaths from Measles ( all ages) = NIL Deaths from Whooping Cough NIL Deaths from Diarrhoea (under 2 years of age) = 3 Total deaths from the sevpn principals Zymotic diseases = 3 INFANTILE MORTALITY The total number of deaths of infants under one year of aga was 43, Of this number, 1 was an illegitimate child. This gives an Infantile Mortality Rate of 59 per 1,000 live births. Analysing this figure, one finds that the infantile Mortality Rate among legitimate children was 6l, while that' among illegitimate infants was 28. Of the 43 infanta deaths, 30 occurred outside the area and 23 were neo-natal, i.e., occurring during the first four weeks of life. The rise in this rate appears to be due to a largo increase in Premature Births which may possibly be ascribed to' Air Raids. The Infantile Mortality Rates in the Borough for the past ten years is as under:- Year Infantile Mortality Rate Year Infantile Mortality Rate. 1931 49 1936 49 1932 49 1937 52 1933 46 1938 42 1934 61 1939 41 1935 41 1940 59 -3- TABLE I. PARTICULARS OF BIRTHS AND DEATHS AS SUPPLIED BY THE REGISTRAR- GENERAL FOR THE YEAR 1940. CAUSE OF DEATH. MALES FEMALES All Causes 418 395 1, Typhoid Fever,etc – 2. Cerebro-Spinal Fever 1 1 3. Scarlet.Fever — – 4. Whooping Cough – 5. Dxphtheria – 6. Tuberculosis off respiratory sys 2.Q 10 7. Other forms of Tuberculosis 3 5 8. Syphilitic diseases 7 2 9. Influenza 10 10 10.Measics – – ll.Acute Polio-Myelitis and Polio-rEncephalitip – – 12.Acute Inf: Encephalitis – 1 13.Cancer b:.Cav: &. Oesophagus, (M) Uterus CP) 7 5 14.Cancer of stomach & Duodenum 12 10 15.Cancer of Breast 9 16.Cancer of all other sites .40 29 17.Diabetes 3 1 18. Intra-Cranial Vascular lesions 22 30 19.Heart Disease 102 107 20.Other disorders of circulatory system 10 7 21. Bronchitis 36 25 22.Pneumonia 30 26 23. Other Respiratory Diseases 6 3 24.Ulcer of Stomach or Duodenum 7 2 25.Diarrhoea, under 2 yrs 1 2 26.Appendicitis 3 1 27.Other digestive diseases 4 11 28.Nephritis 9 7 29.Puerperal & Post Abortive Sepsis – 30.Other Maternal causes — — 31.Premature Birth 8 9 32.Congenital Malformation, Birth Injury, Infantile disorders 4 5 33.Suicide 1 3 34.Road Traffic Accidents 7 1 35. Other violent causes 35 47 36.All other causes 30 26 ALL CAUSES 418 395 Deaths of Infants under 1 year- Males Females. Total 22 21 Legitimate 21 21 Illegitimate 1 – Live Births For I. M. Etc., For Birth Rate. Toatal Males 367 Females. 337 Males 382 Females 348 Legitimate 342 326 356 336 Illegitimate 25 11 12 Still-births Total 9 14 9 16 Legitimate 7 13 7 15 Illegitimate 2 1 2 1 -4- T A B L E 11 INFANTILE MORTALITY DURING THE YEAR 1940. Net deaths from stated causes at various ages under one year. CAUSE OF DEATH. . Under 1 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. 1. Small-pox - - - - - - - - - - 2.Chicken-pox - - - - - - - - - - 3.Meales - - - - - - - - - - 4. Scarlet Fever - - - - - - - - - • 5. Whooping Cough - - - - - - - - - - 6. Diphtheria or Croup - - - - - - - - - - 7. Erysipelas - - - - - - - - - - 8. Tuberculous meningitis - - - - - - - - 1 1 9. Abdominal Tuberculosis - - - - - - - - - - 10. other Tubere.diseases - - - - - - - - - - 11. Meningitis (nonT.B.) - - - - - - 1 - 2 3 12.Convulsions - - - - - - - - - - 13. Laryngitis - - - - - - - — - - 14. Bronchitis - - - - - - 1 — - 1 15.Pneumonia (all forms) - - - - - 4 1 - - - 16. Diarrhoea - - - - - - *3* - - - 17. Enteritis - - - - - 1 - 1 1 3 l8. Gastritis - - - - - - - - - - 19.Rickets - - - - - - - - - 20. Suffocation, overlying - - - - - - - 1 - 1 21.Injury at birth 1 - - - 1 - - - - 1 22. Atelectasis 2 - - - 2 - - - 2 23. Congenital malformation 1 - - - 2 - - - 3 24. Premature birth 15 - - - 15 - - - - 15 25. Atrophy, Debility & Marasmus - - - - 1 - - - - 1 26. Pemphigus Neonatorum - - - - - - - - - 27. other causes - - - - 2 1 4 - - 7 - - - - - - - - - - - - - - - - - - - TOTALS 19 1 3 - .23 7 7 2 4 43 * Coal Gas Poisoning BIRTHS:-Legitimate 668 DEATHS:-Legitimate 42 Illegitimate 36 Illegitimate 1 infantile mortality rate per 1,000 births - 59 -5- S E C T ION 'B' GENERAL PROVISION OF HEALTH SERVICES IN THE BOROUGH. The health"services of the Borough have been maintained with one exception during the past year The Immunisation Clinic was closed for practically the whole year, due to the fact that the Specialist was engaged on other" work. Otherwise the Clinics and treatment centres, as set out in my report for 1939 functioned in practically the normal way. Civil Ambulances." Three motor ambulances i for civil work were maintained and located, two at Chiswick and one at Brentford Fire Stations. The work carried out was as under Number of public calls dealt with during 1940 = 747 Number of private calls dealt with during 1940 = 456 ; Maternity & Child Welfare (Table attached). Ante-Natal Table attached. Supply of Milk and Food (Table attached) Maternal Mortality. No maternal deaths were: reported during the year# The following table .shows the number of maternal deaths connected with pregnancy during the last 10 years. Year Died from Sepsis. Died from other causes connected with pregnancy. 1931 1 3 t 3-932 1 l 1933 3 2 19 34 1 3 1935 1 - . 1936 2 3 \ ••• 1937 - - 1938 2 2 1939 - 2 1940 - TOTALS 10 16 SUMMARY OF WORK AT THE MATERNITY AND CHILD WELFARE CLINICS 194-0. BRENTFORD AREA. CHISWICK AREA. Grand Totals 1940. Grand Totals 1939 Monday Clinics. Wednesday Clinics . Total Wed. Clinics Thurs. Clinics Frid. Clinics. . Total Number of new Members enrolled during the year ' Under 1 year 101 121 222 – 148 178 326 548 512 Over 1 year 70 61 131 – 65 72 137 268 140 171 . ' 182 353 - 213 ' 250 463 816 652 Number of children attending & weighed Under 1 year 1445 2296 3741 –« 2683 \ 1694 4377 8118 8364 Over 1 year . 905 1879 2784 – 1054 989 2043 4827 4812 Over 1 year 2350 4175 6525 – 3737 2683 6420 12945 13176 Number of children seen by Doctor - - ! Under 1 year 467 415 882 - 785 673 1458 :2340 2461 Over 1 year 366 325 691 306 335 641 1332 1630 833 740 1573 - 1091 1008 2099 3672 4091 - 7 - 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 mother attending. Total number of attendances made. Average attendance per session. BRBKEFORD 56 171 779 4 783 14 CHISWICK 70 344 1571 1 572 22 TOTALS 126 515 235 5 2355 18 8 SUPPLY OF MILK AND FOOD. Terms of supply Milk Meals supplied at Dining Centres. Other Food. Expectant Mothers. Nursing Mothers. Children under 5 years of age. ant Mothers, Nursing Mothers. Children under 5 years of age. Expectant Mothers. Nursing Mothers, Children under 5 years of age Free, or at less than cost price, in necessitous cases. YES YES YES NO NO NO YES YES \ YES Atcost price in other cases (e.g.,sale of dried milk at Centres). yes YES YES NO NO NO YES YES YES * Cod liver oil and malt, Virgl, Bemax; etc. Total quantity of milk supplied during the year to expectant and nursing mothers and young children; Liquid Milk Dried Milk (i) by the Council gallons gallons 598 10,093 (ii) by Voluntary Associations operating in the area of the Nil Nil Council. - TOTALS 598 10,093 9 Health Visitors, Six Nurses as reported last year are on the staff for this work and the School Medical Service. The following table sets out a bried summary of the work of this Health'Visitors during the year: (4i) To expectant mothers: First visits Total visits 693 (b) To children under one year of age: First visits 699 Total visits 2805 (c)To children between the ages of 1 and 5 years Total visits 4779 (d) Ophthalmic visits 3 (e) Other visits: Measles 7 Whooping Cough 1 Epidemic Diarrhoea 1 Infant Life Protection Visits 182 . Total 8471 Child Life Protection-(under the Public Health Act, 1936). The following table sets out particulars of registration during the year : (1) Uumber of foster-parents on the Register: (a> At'the beginning of the year 26 (b) At.-the end .pf the year 16 (2) Number of children oh the Register: (a) At the begixiair of 'the year 31 (b) At the end. qf .the year 18 (c) Who died durlft the year (d) On whom inquests .were held during the year Dav Nursery. Record of attendances during the year 1940. Whole-days 9072 Half-days 9,18 + -10- SECTION 'C'. The figure set out in the tables-included in this section give details of work directly connected with Public Health and do not of course include any reference to the many other duties connected with the War situation which were Undertaken by the officers of this department. Under the heading of 'Unsound Food Condemned1, it will be noted that the amount shown is much higher than in previous years. This is, of course, directly attributable to the war conditions, much food being rendered unfit- for human consumption by contamination, by broken glass, and other war damage, particularly during the latter portion of the year, (1) SMITARY INSPECTION OF THE UREA: Tabular Statment of the Work of the Sanitary Department, 19^9INSPECTIONS. Number of Premises inspected on complaint 6l5 Number of premises inspected in connection with infectious disease 97 Number of primary inspections 1918 Number of re-inspections 1513 Total number of inspections arid re-inspections 3431 ACTION TAKEN ( other than Housing Act, 193.6). Cautionary or intimation notices'served 374 Statutory Orders issued (under Public Health Acts) 3 Summonses served- Number of Certificates under Rent & c. (Restrictions) Acts issued to Tenants 7 Number of Clearance Certificates issued to owners 2 Particulars of Sanitary Defects referred to in Notices served, and other Matters. (a) DRAINAGE OF EXISTING BUILDINGS: w.c.s News/provided, repaired,' supplied with water or otherwise improved 175 Percentage of houses provided with waterclosets 100 DRAINS Tested (smoke) 16 Unstopped, repaired, trapped, etc. 56 Waste pipes, rainwater pipes disconnected, repaired etc 50 New soil pipes and ventilating shafts fixed 6 New sinks provided14 Disconnecting traps and chambers inserted 25 Reconstructed (whole system) 3 Reconstructed (connections) 21 Percentage of houses draining into sewers 99.9 Surface water drains reconstructed - Surface water drains repaired 2 (b) WATER SUPPLY AND WATER SERVICE: Draw taps on main 4 Percentage of houses supplied from Public Water Service 99-9 (c) REFUSE. New bins provided 15 ' -11- Frequency of refuse removed from each house weekly Number of complaints receivedDealt with by Engineer's Department. Method of disposal: Barging away to controlled tip. . (d) SUlvDRY USANCES. Overcrowding . Urgent cases -reported to Housing Committee. - Smoke - Minor Complaints only Accumulation of refuse 2 Foul ditches, ponds etc., and stagnant water 1 Dampness 124 Yards repaired or repaved 7 Leaky roofs and eaves guttering 134 Premises-repaired and cleansed 211 Other nuisances 240 (e) DISINFECTION: Premis.es.. disinfected: Ordinary notifiable diseases 63 Phthisis 10 Cancer 25 Other diseases. 12 Rooms stripped and., cleansed .( Section 167 Public Health Act? (1936) • Prernises tre ated f o.. vermin Premises treated for other post's 12 (f) .SLAUGHTERHOUSES: Number on Register (including one Knacker's Yard) 5 Inspections, made periodically at. time of slaughter. Contraventions of. bye-laws Slaughter of Animals Act, 1933. month of Jan, only, (vide Livestock(Restriction on Slaughter)Order 40 Oxen 13 Sheep and lambs 56 Pigs 29 Number of licences to slaughter animals: issued during the years- New, Licences 1 Renewed Licences 9 FOOD & DRUGS. ACT,. 1938 MILK (SPECIAL'DESIGNATIONS) tGREEK, 1936. MILK &. DAIRIES!CKDER, 1926 Number of premises on register - 30 Numberlof Licences issued .to sell:- (a) Tuberculin .Tested.milk 7 (b) Accredited milk 1 (c) Pasteurised milk 17 -12- BAKEHOUSES, . . . Number in district, in use 20 Contraventions of Factory Acts UNSOUND FOOD: Freeh Meat, Offal,etc. 185 lbs Cooked Meats, etc. 412. Tinned Meats, ctc. 67 Fresh fish 399 Tinned fish 21 Bacon 5140 Poultry (fresh) 46½ Poultry (tinned) 97½ Rabbit 120 Vegetables (fresh) 46424 Vegetables (tinned) 35 Fruit (Fresh) 359 Fruit (dried) 18 Fruit (tinned) 63 Jam 171 Butter, Cheese, etc 21o Cereals, Flour, etc 2689 Tea, Coffee, Cocoa 8 Sugar 27 Sundries 255 OFFENSIVE TRADES: Numbor 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 liccnce 2 Numbor of Inspections made 21 CANAL BOATS: Number registered during tile year: Motor propelled boats - Other boats (wide) - Registration Certificates cancelled- Number of Duplicate Copies of Registration- Certificates issued- Number of Boats inspected - Number of complaint notes signed - Number of Boats on Register: Motor propelled boats 97 Other boats 418 PETROLEUM ACTS: Number of applications received for licences to store and sell petroleum, spirit 102 Number of applications received for licences to store and sell petroleum mixture 24 Number of applications reoeived for licences to store and sell carbide of calcium 7 Number of gallons of petroleum spirit covered by liconce3 219,031 Number of gallons of petroleum mixture covered by licences 5,104 Quantity of carbide of oalcium covered by licences 36,424 lbs. -13- HOUSING By reason of the fact that the Sanitary Staff was otherwise engaged coupled by the difficulty experienced by builders in obtaining labour and necessary materials, the usual routine house-to-house, inspection in the Borough was suspended. Housing Act. 1936 The position in regard to the progress of programmes under this Act is exactly the sees as that shown for the preceding year. Where cases of over-crowding have occurred these have been referred to the Council's special Housing Department and satisfactorily dealt with. -14- SECTION 'D' PREVALENCE OF AND CONTROL OVER, INFECTIOUS AMD OTHER DISEASES. The following Tables set out the particulars of the incidence of notified diseases within the Borough during 1940, including their classifications in "age" and "ward" distribution. A. - NOTIFIABLE DISEASES DURING THE YEAR. Disease. Total cases notified. Cases admitted to Hospital. Total Deaths. Small-pox - - - Scarlet Fever 77 43 - Diphtheria 17 17 - Enteric Fever(including Paratyphoid) 1 - - Puerperal Purexia 4 3 - Pneumonia 24 4* 1 Erysipelas 8 2 - Dysentery 1 1 - Malaria(induced for Therppeutic purposes) 1 1 - Encephalitis Lethargica 1 1 1 Measles 67 2 - Whooping Cough 2 - - B.- OPHTHALMIA NEONATORUM Cases notified. Cases treated at Home. Cases treated in Vision unimpaired. Vision impaired. Total Blindness. Deaths 1 - 1 1 - - - 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. C. - AGES OF CASES OF INFECTIOUS DISEASES NOTIFIED DURING 1940 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 77 - 5 3 8 5 25 14 1 11 4 1 - Diphtheria 17 1 1 2 - 4 5 3 - 1 - - - Enteric Fever (including Paratyphoid) 1 - - - - - - - - 1 - - - Puerperal Pyrexia 4 - - - - - - - - 4 - - - Pneumonia 24 - - l - - - 1 - 3 3 8 8 Erysipelas 8 - - - - - - - 1 2 4 1 Dysentery 1 l - - - - - - - - - - - Malaria (induced for Therapeutic purposes) 1 - - - - - - - - - 1 - - Encephalitis Lethargica 1 - - - - - - - 1 - - - - Measles 67 2 6 1 5 6 33 6 5 3 - - - Whooping Cough 2 - - 2 - - - - - - - - - -15- D. - CASES OF INFECTIOUS DISEASES NOTIFIED DURING THE YEAR 1940, CLASSIFIED IN WARDS. NOTIFIABLE DISEASE* NUMEER OF CASES NOTIFIED Brentford East Brentford Central Brentford West Bedford Park Chiswick Park Grove Park Gunnersbury Old Chiswick Green Scarlet Fever 3 20 12 2 9 11 7 6 7 Diphtheria l 2 2 3 5 :- 1 2 1 Enteric Fever (including Paratyphoid) - l - - - - - - - Puerperal Pyrexia - l - 1 1 - 1 - - Pneumonia 3 8 3 - 1 2 3 4 - Erysipelas 1 1 1 - 1 2 - 1 1 Ophthalmia Neonatorum - - - - - - - - - Dysentery - - - - - - - 1 - Tuberculosis: Respiratory 15 12 8 7 13 5 6 4 5 Non-Respiratory l 3 3 - l . l 2 2 l Malaria (induced for Therapeutic purposes) - - - - - - 1 - - Encephalitis Lethargica - 1 - - - - - - - Measles - 3- 12 13 2 13 7 4 10 Whooping Cough - - - - - - 1 -- 1 -16- -16a- E.- TUBERCULOSIS Age Periods New Cases Deaths Respiratory NonRespiratory Respiratory NonRespiratory Male Female Male Female Male Female Male Female Under 1 year - - - 2 - - - 1 1 to 5 years 2 1 1 - - - - 1 5 to 15 years 2 1 2 3 - - - 2 15 to 25 years 13 8 2 1 2 1 - 1 25 to 35 years 11 10 1 1 5 3 1 - 35 to 45 year6 5 4 - - 5 3 - - 45 to 55 years 6 1 - - 3 - 1 - 55 to 65 years 7 1 1 - 5 2 1 - 65 and over 1 1 - - - 1 1 - TOTALS 47 27 7 7 20 10 3 5 (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 15 209 224 Tuberculosis 6 128 134 Other Diseases 1 4 5 JOINT COMMITTEE FOR EDUCATION IN BRENTFORD AND CHISWICK. ANNUAL REPORT ON THE MEDICAL INSPECTION OF <3 ELEMENTARY SCHOOL CHILDREN FOR THE YEAR ENDING 31st DECEMBER, 1940. 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. -17- 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, 1940. To the Chairman and Members of the Education Committee Ladies and Gentlemen, The following brief interim report on the work of the School Medical Service during the year 1940 is submitted here with:- -18- SCHOOL MEDICAL REPORT. 1940. MEDICAL INSPECTION. As required by the Board of Education, the following inspections were made during the year:- (a) Routine Inspections.- of -the three code groups, Entrants, Intermediates (viz., those of about eight years of age who have just been, or 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 consists ofi- 1. Children who were examined a few weeks before leaving school and the findings were entered on special forms for the information of the Juvenile Employment Committee, 2 * Children who had not been attending school f-or some months after the outbreak of war were examined by the Medical Officers on their re-admission to school. 199 Entrants, 285 Intermediates, 324 third age group, and 5&1 others (1369 in all) Were examined during the year, * (b) Special Inspections. These are special inspections made by the School Medical Officers of the children suffering from some special disease or disability and are generally seen at the Minor Ailment clinic. The figure below does not include the inspections of special groups of cases, such as cripples or children suffering from mental deficiency, or those attending clinics other than the Minor Ailment Clinic, or school classes in which there have been cases of certain infectious diseases. 538 special inspections were made during the year. (c) Re-inspections:- , ft 512 re-inspecti.ons were made during the year. FINDINGS OF MEDICAL INSPECTION. The number of individual children found at Routine Inspections to require treatment (excluding uncleanliness and Dental Diseases) were:Entranta - 25 ; Second Age Group - 76 ; Third AgQ Group - 62 ; and others « 101, Total - 264, Uncleanliness. 8 cases were seen at Routine Inspection, and 18 at Special Inspection. Legal proceedings were taken in 1 case under the School Attendances Byelaws. During the year the nurses made 381 visits to the schools for personal hygiene inspections, an average of l6.6 visits per school. They made 22,223 examinations, viz., 19,190 inspections and 2,033 re-inspections. Defects were found in 1,401 instances, and the number of children found to be unclean was 358. The distribution of these defective children was as follows:Brentford Area Lionel Road - 31; St. John's - 32; St. George's - 15; St. Paul' 6 - 22; Ealing Road Junior - 19 ; Ealing Road Infants - 4; Canal Boat - 21; Senior Girls' - 6; Senior Boys' - 2; Clifden Road - 2. -19-. Chiswick Area:- Hogarth Schools: Infants' - 38; Junior Girls' 26; Junior Boys' - 11. Belmont Schools: Infants' - 3 ; Juniors,4; Seniors'- 4. Strand Schools: Infants' - 25 ; Junior Mixed -12; Senior Mixed 16. Beverley Infants' - 47. Central Girls' - 17. Central Boys' - 1. Minor Ailments. 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) 14 151 165 Minor Eye Defects (excluding Squint and defective vision). 10 11 21 Ear defects 4 9 13 Enlarged Cervical Glands - 11 11 Other Nose and Throat 3 10 13 Tonsils and Adenoids. During the year 182 cases were found - 154 at Routine and 28 at Special Inspections. Of these Cases 82 (or 41%) required operative treatment, 30 being referred for Tonsils only, 7 for Adenoids only, and 45 for both Tonsils and Adenoids. In addition 13 children were referred for other conditions of the Nose and Throat. Skin Diseases. 165 cases of skin diseases were found during the year, of which 22 were suffering from contagious Impetigo. There were 2 cases of Ringworm of the Scalp, and 4 of the Body. 49 cases of Scabies were seen. The remaining 08 were boils, etc. External Eye Disease. 21 cases were seen during the year. At Routine Inspections there were 9 cases of Blepharitis and 2 at Special Inspections. There were 2 cases of Conjunctivitis at Special inspections. -The-remainder consisted of Styes, etc. Vision (including Squint). 140 cases of Defective Vision were seen at Routine Inspections and 7 were brought to the Minor Ailment Clinic. Of these, 95 were referred for treatment and 52 were kept under observation. Of these above cases, 9 were suffering from squint. 4 were referred for treatment and 5 for observation. Ear Diseases and Defective Hearing. 5 cases of Defective Hearing were seen. There were 8 cases of Otitis Media, 4 being found at Routine Inspections and 4 at Special Inspections. -20- Dental Defects. At Routine Inspections 78 cases were found and at Special Inspections 7 cases were brought by parents. Minor Ailments. Inspection of special cases 414 Re-inspections of special cases 328 Number of individual children attending 2136 Number of attendances made 6352 Number of exclusion certificates issued 414 Number of re-admission certificates issued 310 Tonsils and Adenoids. 33 children were operated upon at the West Middlesex Hospital 10 received other forms of treatment. Eye Clinic. The attendances it the Eye Clinic were as follows:- Clinics held. Attendances. Retinoscopies. scriptions. Specs. Issued. Repairs. Others. (Reports) 25 433 173 148 112 41 223 Rheumatism Clinic. During the year 97 children (of whom 43 were new patients) made 356 attendances at the Rheumatism Clinic. The hospital treatment obtained is shewn as follows Hospital. Rheumatism. Heart Disease. Chorea. West Middlesex. 2 1 3 Richmond. 1 1 - Totals 3 2 3 The Invalid Children's Aid Association obtained treatment at Convalescent Homes for the following cases:- Santa Claus Two cases of Chorea. Banstead One case of Chorea. Sidmouth One case of Chorea. Herts One case of Chorea. Home visits by School Nurses. Number of visits 719 Re-inspections. Re-examinations of (a) children found to be defective at Routine Inspections and (b) children found to be defective at Special Inspections. The total numbers of these examinations were 184. and 328 respectively viz. 512 in all. BOARD OF EDUCATION. MEDICAL. INSPECTION-AND TREATMENT RETURNS. YEAR ENDED 31st DECEMBER, 1940. TABLE I. MEDICAL INSPECTIONS OF CHILDREN ATTENDING PUBLIC ELEMENTARY SCHOOLS A. ROUTINE MEDICAL INSPECTIONS. (1) No. of Inspections in the prescribed Groups: Entrants 199 Second Age Group 285 Third Age Group 324 Total ' 808 (2) No. of other Routine Inspections 561 GRAND TOTAL 1369 B. OTHER INSPECTIONS. No. of Special Inspections and Re-inspections 1050 TABLE 11 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 199 65 32.7 106 53.3 28 14.1 - - Second Age Group 285 115 40.4 127 44.6 42 14.7 1 0.4 Third Age Group 324 138 42.6 136 42.0 49 15.1 1 0.3 Other Routine Inspections 561 267 47.4 231 41.2 57 10.2 6 l.l TOTAL 1369 585 42.7 600 43.8 176 12.8 8 0.6 TABlE 111. GROUP I TREATMENT OF MINOR AIIMENTS. Total number of Defects treated or under treatment during the year under the Authority's Scheme 223 GROUP II - TREATMENT OF DEFECTIVE VISION AND SQUINT. No. of Defects dealt with Under the Authority's Scheme. Otherwise. Total. Errors of Refraction 173 - 173 Other defect or disease of the eyes. - - - Total 173 - 173 Under the Authority's Scheme. Otherwise. Total. No, of Children for whom spectacles were - (a)Precribed 148 — 148 (b)Obtained 112 - 112 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. - 33 10 43 (b) Specials 626 (c) TOTAL (Routine and Specials) 3460 (2) Number found to require treatment 2693 (3) Number actually treated 1660 . (4) Attendances made by children for treatment 4111 (5) Half-days devoted to Inspection 28 Treatment 574 Total 602 TABLE IV DENTAL INSPECTION AND TREATMENT (1) Number of children inspected by the Dentist (a) Routine age-groups Age 5 6 7 8 9 10 11 12 13 14 15 Total Number 118 277 226 274 276 311 366 401 342 216 27 2834 (6) Fillings- Permanent Teeth 2751 Temporary Teeth 526 Total 3277 (7) Extractions- Permanent Teeth 452 Temporary Teeth 1694 Total 2146 (8) Administrations of general anaesthetics for extractions 941 (9) Other operations- Permanent Teeth 564 Temporary Teeth 226 Total 590 TABLE V. VERMINOUS CONDITIONS. (1) verage number of visits per school made during the year 16.6 (2) Total number of examinations of children in the Schools 19190 (3)Number of individual children found unclean 358 (4) Number of individual children cleansed under Section 87 89 (5) Number of cases in which legal proceedings were taken:- (a)Under the Education Act, 1921 - (b)Under School Attendance Byelaws 1 TABLE VI 1. At a Public Elementary School. 2. At an institution other than a Special School 3. At no school or institution. 4. Total not receiving suitable education. Blind children - - - - Deaf children - - - - MENTALLY DEFECTIVE CHILDREN Total number of children notified during the year ended 3lst December, 1940, by the Local Education Authority to the Local Mental Deficiency Authority, under the Mental Deficiency (Notification of Children) Regulations, 1928 2