Library 39(1) Bre 13 Borough of Brentford & uhismick REPORT ON THE Health of the District AND School Medical Service during 1945 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 The Brentford Printing & Publishing Co., Ltd. 68606 BOROUGH OF BRENTFORD AND CHISWICK PUBLIC HEALTH COMMITTEE Councillor Samels, Chairman. Alderman Flewitt, J.P. Councillor Fullerton-Bustard ,, Johnson, J.P. ,, Kitchingman ,, Leahy ,, Palmer "ouncillor Mrs. Burden ,, Mrs. Pellew ,, Chick ,, Sinclair ,, Cue,land, J.P. Ex-officio: Alderman Stroud, J.P , Alderman Edwards, M.B.E., J.P., and Alderman Jenkin. EDUCATION COMMITTEE Alderman Leahy, Chairman. Councillor Court, Vice-Chairman Alderman Howard Councillor Mrs. Hill ,, Jenkin ,, Palmer Councillor Mrs. Burden ,, Penny ,, Hayward ,, Sinclair Co-opted Members : Mr. J. M. Stirling and Miss H. M. Dovey. Appointed by the Middlesex County Council : County Alderman Mrs. Barnes, J.P. ,, ,, Hughes, J.P. Johnson, J.P. ,, ,, Mills County Councillor Charlton, J.P. ,, ,, Cleland, J.P. ,, ,, Stroud, J.P. Major H. W. Jenks, M.B.E., J.P., Mrs. M. A. J. ,Langford, Mrs. D. Jupp, J.P. Co-opted Members : Mrs: M. C. Boswood, J.P., and Mrs. M. J. Cleland. MATERNITY AND CHILD WELFARE COMMITTEE Councillor Mrs. Burden, Chairman. Alderman Edwards, J.P. Councillor Hayburn, J.P. ,, Grogan ,, Mrs. Hill ,, Jenkin . ,, Palmer ,, Leahy ,, Mrs. Pellew Councillor Brierley ,, Samels ,, Chick ,, Sinclair ,, Gardiner Co-opted Members : Mrs. A. Jones, Mrs. L. Mountford, Mrs. K. Rainbird, Mrs. D. G. Hopcroft, Dr. J. Palmer, Mrs. F. M- Stroud, < Mrs. F. Wright, BOROUGH OF BRENTFORD AND CHISWICK INTERIM REPORT ON THE HEALTH OF THE DISTRICT AND SCHOOL MEDICAL SERVICE DURING THE YEAR 1945 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. 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 have the honour to submit a report on the Public Health and School Medical Services for 1945. Although the Ministry states that a report on the lines of those given during the war may be given for this year, I beg to be allowed to enlarge this Report somewhat, partly for the reason that there are so many new members on the Council who may not be fully conversant with our work, and partly because this is the last Report I shall have the honour of writing and shall therefore be unable to make a Survey Report when that is required by the Ministry. Consequently, the body of this report is an Interim Report as required by the Ministry and an appendix is added with some brief notes and tables indicating the effects of the war on our work. With regard to the year 1945, conditions became more normal and work and attendances at clinics improved. I would like to state here that I am grateful I was allowed to stay on duty for five years after the usual retiring age, as I have been able to see conditions returning to their pre-war state. The clinics and social services had taken many years to develop and there was a period during the war when it appeared that much of that work was in danger of being destroyed and wasted. The increased attendances at the Welfare Clinics brought to the fore the matter of accommodation in the Chiswick area. This matter was appreciated keenly during the last years of peace, when a scheme was formulated and plans were submitted to the Ministries for a building similar to the Brentford Health Centre. This had to be shelved owing to the outbreak of war and now serious consideration must be given to its solution. The incidence of Infectious Disease is indicated in the tables shown on pages 24 to 27. Neither Scarlet Fever nor Diphtheria appeared in epidemic form. Thirty-seven cases of the former and eight cases of theJatter were notified, and no deaths were recorded from these diseases. Measles was epidemic during the first quarter, and five hundred and twenty-five cases were notified during the year, with one death. There was an outbreak of 5 Chicken Pox lasting through the middle months of the year. One fatal case of Cerebro-Spinal Fever was notified. The ward distribution of notified cases is shown on page 26 The chief causes of deaths, shown in Table 1, were Heart Disease 166, Cancer 128, Bronchitis 50, Tuberculosis 32, and Pneumonia 27. The Infantile Mortality Rate was .1 above last year's Borough low record of 36. There were no Maternal Deaths. Tuberculosis— the figures for the last five years are:— 1941 83 cases notified with 42 deaths 1942 87 „ „ „ 28 „ 1943 89 ,, „ „ 37 ,, 1944 106 ,, „ „ 34 ,, 1945 102 ,, ,, ,, 32 ,, A table showing an analysis of these cases can be seen in the Appendix. In reporting on the Dental Service, in the School Section of this Report, Miss Stewart mentions the regrettable retirement; through ill-health, of Miss Loretz. I heartily endorse all her eulogies of Miss Loretz, who will be missed greatly by the mothers and children attending the Maternity and Child Welfare Clinics as well as by the schoolchildren, for her kindly and skilful treatment. In this, my final Annual Report, I would like to make a brief record of the work done by individual members of the staff during the war. For the purposes of Civil Defence, the Middlesex County Council was the scheme-making authority, and this Borough Council acted for them in this area, with Mr. John Skinner, the Town Clerk, as Borough Controller, and Mr. L. A. Cooper, the Engineer, in charge of the Rescue, Decontamination and Demolition Services. I, as Medical Officer of Health, had the honour of being in charge of the Casualty and First Aid Services and am indebted greatly to Dr. Macaulay, the County Medical Officer, and his Staff, for the very willing and valuable help they gave this branch of the Service throughout the war. It will be appreciated, in considering the work done by the Staff, that we had a double duty, viz., to the Public Health and Social Services and to the Civil Defence Service, which meant that some of the Staff had to concentrate on the one branch and some on the other. We were rather later than some, areas in developing our A.R.P. activities and in consequence, during the last months of peace, had to put in a good deal of intensive work on Civil Defence, in which all the Public Health Staff (as distinguished from the Clinic Staff) were engaged. 6 As Regards individual members, the following joined the forces. The first two mentioned gave their lives for their country and are on the Roll of Honour. Mr. James Friar. Junior Clerk in the Public Health Office. and Mr. Brian T. Smith. Clerk in the Public Health Office. Each joined the Royal Air Force and each gained his Pilot's "Wings." Jimmy Friar, at one time the youngest pilot in the Service, was a Flight-Sergeant Pilot and fought a Spitfire over the Channel and Northern France during the dark days of the war, and then proceeded to North Africa, where he was killed in action on 15th November, 1942. Brian Smith was a Sergeant-Pilot in the Royal Air Force and was pilot of a Lancaster. In 1943 he was engaged in operational duties over enemy waters and was reported missing. No further news of him or his crew being received, he was eventually reported as killed on active service. Their loss was felt very keenly by all their colleagues. They were the youngest members of the Staff and were bright, cheery lads, with very good prospects, and possessed all those delightful characteristics associated in one's mind with Air Force Pilots. We shall always remember them with honour and affection. Mr. Percy G. Smith, Senior Clerk in the Public Health Office, joined the Pioneer Corps, and became a Regimental Quartermaster Sergeant. He saw service in North Africa and Sicily. Mr. R. A. G. James, General Assistant Sanitary Inspector, served with the R.A.M.C. in the Airborne Division, and was later given a Commission in the Pioneer Corps. He saw service in North Africa and the Middle East. Miss A. M. Edwards, Health Visitor and School Nurse, who was a member of the Territorial Army Nursing Service, joined the Army Nursing Service and carried out her duties in North Africa, Italy and Austria. In addition, a part-time Officer, Dr. Gerald Slot, Physician to the Rheumatism Clinic, joined the R.A.M.C. and served in the Middle East, North Africa and Southern Europe. As regard the rest of the Staff:— Dr. Phyllis Griffiths, Assistant Medical Officer of Health and Assistant School Medical Officer, was fully occupied in the Clinics, both School and Maternity and Child Welfare, which were kept open for all who might require our help or advice. She did much valuable work in helping to keep these Clinics alive during the dark days of the war and consequently could not be spared for Civil Defence work, except for that of fire-watching. 7 The Dental Surgeons, Miss Loretz and Miss Stewart, during the early days of the war, worked as Superintendents at Ambulance Stations and Stretcher Party Posts. Soon, however, in spite of the evacuation, there was need for a good deal of dental service; so Miss Loretz undertook the work, both in Brentford and in Chiswick, and Miss Stewart was seconded to the Middlesex County Council, which was greatly depleted of dental staff. The Health Visitors and School Nurses (Miss Catherwood. Mrs. Clarke, Miss Broughton and Miss Jenkins) undertook duties as Superintendent Sisters at First Aid Posts. They worked in shifts and at the same time did their routine work which was much disorganised by evacuation. When qualified nurses could be obtained for first aid posts, they returned to work reorganised on a war footing, but always held themselves in reserve to serve in Civil Defence Duties should occasion arise. The remaining Health Visitor, Miss Bradshaw, went to Hertfordshire as Health Visitor and School Nurse to evacuated children. Further, Miss Catherwood and Miss Broughton did much valuable work in helping to equip the War-time Nursery at Clifden Road, Brentford. Sanitary Inspectors. Mr. E. Micklew right Chief Sanitary Inspector, in addition to his official duties, was Ambulance Officer and Chief of Staff to the Medical Officer of Health, and he did far more than his share of the work. in fact, throughout the war he was a most conscientious worker, and in addition to supervising the Ambulance Service, of which we were all proud, he performed his duties at the Control Centre through every "alert" during the 1940 blitz, the February blitz of 1944, and the "V.l" attacks. During the quieter periods, he spent many hours every night analysing, interpreting and filing the innumerable circulars we were always receiving. I have no hesitation in stating that I do not think anybody in the Civil Defence Service worked more hours than he did during the war. If there were such things as Despatches in Civil Defence, he would most certainly receive an "Honourable Mention." Mr. L. C. Webb (who served throughout the 1914/1918 -war with- the R.A.M.C.), Mr. T. M. Johnson and Mr. A. G. Robinson all took duties as Superintendents in Ambulance Stations and Stretcher Party Posts, but as soon as they could be replaced by full-time officers, we were glad to get them back as District Sanitary Inspectors, Their duties under war-time conditions were often urgent and onerous and rendered difficult by shortage of labour and material in attending to the sanitation of houses, shelters and the examination of foodstuffs after bombing. In addition, they had to do a good deal of clerical work. Mr. Webb a,lso assisted in the work of the Bacteriological Laboratory. 8 Clerical Staff. The office of Miss M. Marshall, Clerk to the Maternity and Child Welfare, Chiswick, was turned into a Medical Store. She was in charge and stayed there every night of the 1940 blitz, and did not leave until after the " all clear " and there was no longer any likelihood of stores being required. Later this store was removed, and she undertook part-time duties in the Report Centre. Miss J. Golley, Clerk to the Maternity and Child Welfare, Brentford, did part-time duties at Brentford Hospital First Aid Post. At the same time, these two ladies carried out their routine clerical duties. Miss B. ]. Copp, Clerk to the School Clinics, Brentford, was a whole-time clerk in the Report Centre. During the quiet period after the 1940 blitz, she returned to her clerical duties and became a part-time clerk in the Report Centre. . Later on, she was seconded to industrial service. Miss M. E. Reeve, Clerk to School Medical Service, Chiswick, undertook the duties of a part-time Ambulance Attendant, in addition to her routine work. Miss K. Freeman, Clerk to Dental Surgeon, was a full-time Ambulance Driver until the air-raids quietened down, when she was transferred from the Dental Office to the Public Health Office and became a part-time Ambulance Driver. Miss L. King, Assistant to Dental Surgeon, Brentford, did part-time service in a First Aid Post. I feel this record would not be complete if I did not mention an A.R.P. Officer who, although not a member of the Staff, was given temporary office accommodation in the Department throughout the war. I refer to Mr. W. Holliman, the Transport Officer. Although Mr. Holliman was classified as an unpaid part-time officer, he was practically always on duty. Apart from his normal duties of helping in the purchase and upkeep of vehicles, he never missed throughout the war to be ready at night to drive the Medical Officer of Health if an "incident" occurred. During the 1940 blitz, he was with the Medical Officer of Health for well over 90 consecutive nights and I do not remember one night when he did not have to drive me, either to incidents or when I had to give medical aid in a shelter. He is another officer who deserved an " honourable mention." There is also that group of ladies who gave their services in the Child Welfare Clinics, viz.:— M iss Bates, Mrs. Ford, Mrs. Fromow, Mrs. Gentry, Mrs. Gordon-Brown, Mrs. Julie, Mrs. F. M. Wright, Mrs. A. M. Wright. 9 Throughout the war, "alert" or no "alert," some or all of these ladies attended the Clinic to give their valuable help. I tender them my admiration and grateful thanks. Finally, I would like to register my sincere thanks to all my colleagues, both in this Department and in the other departments in the Town Hall and School Offices, for the consideration, kindness and help they have given me throughout my tenure of office. Also, I would like to include Dr. T. Orr, Medical Officer of Health, Ealing, and Medical Superintendent of the Isolation and Maternity Hospitals, which we share, for the great and courteous help he has so frequently given me when in difficulties with Infectious or Maternity Cases. And, Mr. Mayor, Ladies an'd Gentlemen, I give you sincere thanks for the unfailing friendliness, courtesy and help I have always received from the Council and express to you my great regrets that our official connection is now terminated. I am, Ladies and Gentlemen, Your obedient Servant, R. C. LEANING, Medical Officer of Health 10 1.— GENERAL STATISTICS, 1945. Area in acres (including 116 acres of foreshore of River Thames and 24 acres of inland water) 2,449.5 Population— Census, 1931 62,617 Population— Registrar-General's estimate for area (mid 1945) 50,690 2.— VITAL STATISTICS. Live Births. Total Male Female Legitimate 803 405 398 Birth Rate per 1,000 of the estimated resident population = 17.5 Illegitimate 83 52 31 TOTAL 886 457 429 Stillbirths. T otal Male Female Legitimate 19 9 10 Rate per 1,000 total (live and still) Births = 23.0 Illegitimate 2 2 - TOTAL 21 11 10 Deaths. Total Male Female 613 314 299 Death Rate per 1,000 of the estimated resident population = 12.1 Deaths from Puerperal Causes. Puerperal Sepsis Rate per 1,000 total (live and still) births = Nil Other Puerperal Causes 11 Deaths of Infants under One Year of Age. Total Male Female Legitimate 26 11 15 Illegitimate 6 5 1 TOTAL 32 16 16 Death Rate of all infants per 1,000 live births 36.1 Death Rate of all legitimate infants per 1,000 legitimate live births 32.3 Death Rate of all illegitimate infants per 1,000 - illegitimate live births 72.3 Deaths from Measles (all ages) 1 Deaths from Whooping Cough (all ages) Nil Deaths from Diarrhoea (under 2 years of age) 6 Deaths from Cancer (all ages) 108 Deaths from the seven principal Zymotic Diseases 7 12 TABLE I. PARTICULARS OF BIRTHS AND DEATHS AS SUPPLIED BY THE REGISTRAR-GENERAL FOR THE YEAR 1945 Cause of Death Males Females All Causes 314 299 1. Typhoid Fever, etc. - - 2. Cerebro-Spinal Fever — 1 3. Scarlet Fever — — 4. Whooping Cough — — 5. Diphtheria — — 6. Tuberculosis of the Respiratory System 18 11 7. Other Forms of Tuberculosis 1 2 8. Syphilitic Diseases 3 1 9. Influenza 1 — 10. Measles 1 — 11. Acute Poliomyelitis and Polio-Encephalitis - — 12. Acute Inf. Encephalitis — — 13. Cancer b. Cav. & Oesophagus (M), Uterus (F) 5 7 14. Cancer of Stomach and Duodenum 5 8 15. Cancer of Breast — 13 16. Cancer of all other sites 40 30 17. Diabetes 1 2 18. Intra-Cranial Vascular Lesions 21 33 19. Heart Disease 87 79 20. Other Disorders of the Circulatory System 9 7 21. Bronchitis 31 19 22. Pneumonia (all forms) 13 14 23. Other Respiratory Diseases 5 2 24. Ulcer of Stomach or Duodenum 5 2 25. Diarrhoea under 2 years 4 2 26. Appendicitis - 1 27. Other Digestive Diseases 4 9 28. Nephritis 7 4 29. Puerperal and Post Abortive Sepsis — - 30. Other Maternal Causes — — 31. Premature Births 3 5 32. Congenital Malformation, Birth Injury, Infantile Disorders 8 4 33. Suicide 2 1 34. Road Traffic Accidents 3 4 35. Other Violent Causes 16 13 36. All other causes 21 25 ALL CAUSES 314 299 13 TABLE II. INFANTILE MORTALITY DURING THE YEAR 1945. 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. Measles - - - - - - - - - - 4. Scarlet Fever - - - - - - - - - - 5. Whooping Cough - - - - - - - - - - 6. Diphtheria or Croup - - - - - - - - - - 7. Erysipelas - - - - - - - - - - 8. Tuberculous Meningitis - - - - - - - - - - 9. Abdominal Tuberculosis - - - - - - - - - - 10. Other Tuberculous Diseases - - - - - - - - - - 11. Meningitis (Non-T.B.) - - - - - - 1 - - 1 12. Convulsions - - - - - - - - - - 13. Laryngitis - - - - - - - - - - 14. Bronchitis - - - - - - - - - - 15. Pneumonia (all forms) - - - 1 1 2 - - - 3 16. Diarrhoea - - - - - - - - - - 17. Enteritis - - - 3 3 1 1 - - 5 18. Gastritis - - - - - - - - - - 19. Rickets - - - - - - - - - - 20. Suffocation, overlying - - - - - - - - - - 21. Injury at Birth 3 - - - 3 - - - - 3 22. Atalectasis - 1 - - 1 - - - - 1 23. Congenital Malformation 1 - - 1 2 - 1 1 - 4 24. Premature Birth 6 3 1 - 10 — - - - 10 25. Atrophy, Debility and Marasmus - - - - - - - - - - 26. Pemphigus Neonatorum — — — — — — — - - - 27. Other Causes — — — — — 1 4 — — 5 TOTALS 10 4 1 5 20 4 7 1 - 32 Births. Deaths. Legitimate 803 Legitimate 26 Illegitimate 83 Illegitimate 6 Infantile Mortality Rate per 1,000 Births = 36.1. 14 SECTION "B" GENERAL PROVISION OF HEALTH SERVICES IN THE BOROUGH. Civil Ambulance Service. The Council provide and maintain two ambulances. The staff consists of four drivers and four driver-attendants working in 24-hour shifts. Both vehicles are available for call night and day throughout the year. Work of the Ambulances during the year 1945. Number of public calls dealt with 839 Number of private calls dealt with 485 TOTAL 1324 Maternity and Child Welfare (Table attached). Ante-Natal (Table attached). Supply of Milk and Food (Table attached). Maternal Mortality. Deaths from Puerperal Causes :— Puerperal Sepsis Nil Other Causes Nil 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 1936 2 3 1937 — — 1938 2 2 1939 — 2 1940 — — 1941 — — 1942 — 2 1943 3 2 1944 - 2 1945 — — 15 SUMMARY OF WORK AT THE MATERNITY AND CHILD WELFARE CLINICS— 1945. BRENTFORD AREA CHISWICK AREA Grand Totals 1945 Grand Totals 1944 Monday Clinics Wednesday Clinics TOTAL Wednesday Clinics Thursday Clinics Friday Clinics TOTAL Number of new members enrolled during the year :— Under 1 year of age 108 131 239 — 271 284 555 794 746 Over 1 year of age 10 18 28 — 40 108 148 176 148 TOTALS 118 149 267 — 311 392 703 970 894 Number of children attended and weighed :— Under 1 year of age 1735 2480 4215 — 4120 4398 8518 12733 10698 Over 1 year of age 1044 1577 2621 — 1157 1275 2432 5053 4164 TOTALS 2779 4057 6836 - 5277 5673 10950 17786 14862 Number of children seen by Doctor:— Under 1 year of age 471 465 936 — 741 764 1505 2441 2328 Over 1 year of age 373 281 654 — 422 431 853 1507 1235 TOTALS 844 746 1590 — 1163 1195 2358 3948 3563 16 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 attendances per session BRENTFORD 51 208 264 4 989 19.4 CHISWICK 102 533 551 19 2491 24.4 TOTALS 153 741 815 23 3480 22.8 SUPPLY OF MILK AND FOOD. (Other than under the National Milk and Vitamins Scheme) Terms of Supply Milk Meals supplied at Dining Centres Other Food* Expectant Mothers Nursing Mothers Children under 5 years of age Expectant 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 At cost 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, Virol, Bemax, etc. 17 Health Visitors. Five Nurses and one temporary were on the staff for this and the School Medical Service. The following table sets out a brief summary of the work of the Health Visitors during the year:— (a) To expectant mothers: First visits 340 Total visits 490 (b) To children under 1 year of age: First visits 891 Total visits 2182 (c) To children between the ages of 1 and 5 years : Total visits 2858 (d) Ophthalmic visits 10 (e) Other Visits: Measles and German Measles 20 Whooping Cough 10 Infant Life Protection 63 Post-Natal 2 Infantile Mortality 2 TOTAL 5637 Child Life Protection (under the Public Health Act, 1936). 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 19 (b) at the end of the year 14 (2) Number of children on the Register:— (a) at the beginning of the year 19 (b) at the end of the year 20 (c) who died during the year — (d) on whom inquests were held during the year — Bennett Street Day Nursery (equipped for 45 children):— Total attendances during the year 1945 9615 War-time Day Nursery, Ealing Road (equipped for 28 children): Total attendances during the year 1945 5010 War-time Day Nursery Schools:— * Beverley Road (equipped for 25 children) — Strand-on-the-Green (equipped for 50 children) 8591 Lionel Road (equipped for 50 children) 7551 *This Nursery did not function during the year, owing to damage by enemy action in 1944. 18 SECTION "C" The figures set out in the tables included in this section give details of work directly connected with Public Health. (1) SANITARY INSPECTION OF THE AREA Tubular Statement of the Work of the Sanitary Department, 1945 Inspections : Number of premises inspected on complaint 1280 Number of premises inspected in connection with infectious disease 55 Number of primary inspections 3136 Number of reinspections 1719 Total number of inspections and reinspections 4855 Action Taken (other than Housing Act, 1936): Cautionary or intimation notices served 848 Statutory Notices issued (under Public Health Acts) 11 Summonses served — Number of Certificates under Rent, &c. (Restrictions) Acts issued to tenants 1 Number of Clearance Certificates issued to owners — Particulars of Sanitary Defects referred to in Notices served, and other matters. (a) Drainage of Existing Buildings. New W.C.s provided, repaired, supplied with water or otherwise improved 155 Percentage of houses provided with water-closets 100% Drains:— Tested (smoke) 49 Unstopped, repaired, trapped, etc. 59 Waste pipes, rainwater pipes, disconnected, repaired, etc. 61 New soil pipes and ventilating shafts fixed 11 New sinks provided 15 Disconnecting traps and chambers inserted 21 Reconstructed (whole system) 2 Reconstructed (connections) 29 Percentage of houses draining into sewers 99.9% Surface water drains reconstructed — Surface water drains repaired 5 (b) Water Supply and Water Services. Draw taps on main 14 Percentage of houses supplied from Public Water Service 99.9% (c) Refuse. New bins provided 176 Frequency of refuse removed from each house weekly Number of Complaints received — dealt With by Engineer's Dept. Method of disposal barging away to controlled tip 19 (d) Sundry Nuisances. Overcrowding (Urgent cases reported to Housing Committee) Smoke Minor complaints only Accumulation of refuse Foul ditches, ponds, etc., and stagnant water Dampness 211 Yards repaired or repaved 5 Leaky roofs and eaves gutterings 156 Defective flooring, joists and skirtings 86 Defective plasterwork to walls and ceilings 148 Premises cleansed and redecorated 95 Other Defects 486 (e) Disinfection. Premises Disinfected:— Ordinary notifiable diseases 56 Phthisis 10 Cancer 9 Other diseases 6 Rooms stripped and cleansed (Section 167, Public Health Act, 1936) Premises treated for vermin 19 Premises treated for other pests (wasps, moths, ants, beetles) 26 (f) Slaughterhouses. Number on Register (including one Knacker's Yard) 5 Contraventions of bye-laws — Slaughter of Animals Act, 1933. (vide Livestock (Restrictions on Slaughter) Order, 1940) Number of licences to slaughter animals issued during the year:— New Licences Nil Renewed Licences 1 FOOD & DRUGS ACT, 1938. MILK (SPECIAL DESIGNATIONS) ORDERS, 1936-1938. MILK AND DAIRIES ORDER, 1926. Number of premises on Register 19 Number of Dealer's Licences issued to sell:— (a) Tuberculin Tested Milk 5 (b) Accredited Milk (c) Pasteurised Milk 14 20 Number of Supplementary Licences issued to sell :— (a) Pasteurised Milk 2 (b) Tuberculin Tested Milk 2 Bakehouses. Number in district in use 17 Contraventions of Factory Acts — UNSOUND FOOD. List of Food Condemned during the year 1945. Fruit and Vegetables :— Brussels Sprouts 409 lbs. Cabbages 4 tons 5 cwts. Cauliflower 2 tons 2 qtrs. 40 lbs. Celery 1239 bundles Dates 81 lbs. Figs 21¼ lbs. Leeks 115 nets Potatoes 1 ton 15 cwts. Watercress 5 chips Meat :— Beef 14 ozs. Duck 2½ lbs. Mutton 4½ lbs. Pork 42 lbs. Pork Offal 5 lbs. Rabbits 464½ lbs. Sausages (Pork) 137 lbs. Sausage Meat 39½ lbs. Fish:— Assorted Wet Fish 94½ stones Cod 8 stones Fresh Herrings 6 stones Mackerel 1 quarter Plaice 5 stones Smoked Haddock 4 stones Soft Roes 5 boxes Whiting 20 stones 21 General Provisions:— Bacon 159¾ lbs. Biscuits 39½ lbs. Butter 26¾ lbs. Cake Improver 25 lbs. Cheese 188¼ lbs. Cocoa 2 pkts. Coffee Essence 1 bottle Dessert Powder 288 pkts. Dried Milk 2 tins Dried Peaches 50 lbs. Eggs 1308 Egg Substitutes 79¾ cwts. Fruit Cake 20½ lbs. Gammon (Cooked) 10½ lbs. Ground Ginger 6 cwts. jam and Marmalade 95½ lbs. Lemon Cheese 1 lb. Margarine 5½ lbs. Mixed Gums 30 lbs. Mustard 372 jars Oxo Cubes 22 Peas (Blue) 43 lbs. Pepper (Black) 3¼ cwts. Pudding Mixture 300 pkts. Rice 15f lbs. Sugar 45 lbs. Syrup 10 lbs. Tea 33 lbs. Tinned Foods (Miscellaneous):— Apple Jelly 3 lbs. Baked Beans 205 tins Beetroot 3 tins Breakfast Sausage ll¾ lbs. Brisket 9¼ lbs. Carrots 5 tins Chopped Ham 177¼ lbs. Condensed Milk 264 tins Corned Beef 7½ lbs. Corned Beef Hash 25 tins Crayfish 7 tins Dried Egg 41 pkts. Evaporated Milk 943 tins Fish Roll 1 tin Herrings 49 tins 22 Finned Foods (Continued). Liver Sausage 6 lbs. Luncheon Meat 326¾ lbs. Luncheon Sausage 16¾ lbs. Mackerel 34 tins Meat Roll 7 lbs. Meat and Vegetable Ration 9 tins Minced Beef Loaf 2¾ lbs. Mixed Vegetables 24 tins Mussels 1 bottle Paste 80 jars Peas 68 tins Pickles 349 jars Picnic Ham 10¾ lbs. Pilchards 303 tins Pork and Beans 6 tins Pork Loaf 1½ lbs. Salad Cream ¾ gallon Salmon 65 tins Sardines 123 tins Shrimps 5 tins Skimmed Milk 39 tins Soups 173 tins Stewed Steak 128 tins Tongue 30½ lbs. OFFENSIVE TRADES. Number of premises in district 3 Nature of Trades:— One soap boiler, 2 rag and bone dealers. CANAL BOATS. 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 87 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 146083 Number of gallons of petroleum mixture covered by licences 8305 Quantity of carbide of calcium covered by licences 42524 lbs. 23 HOUSING Owing to the difficulty experienced by builders in obtaining labour and necessary materials, the usual routine house-to-house inspection in the Borough was again suspended during the year. Housing Act, 1936. War conditions, with the resultant shortage of labour and material, have prevented any large scale activities under the provisions of this Act. In common with similar authorities, this Borough is faced with a tremendous housing problem. The Council did, however, cause a survey of the area to be made with a view to designating certain parts of the Borough as possible " redevelopment areas " under Section 34 of the Act, but I am afraid a very considerable time must elapse before any progress in dealing with the report submitted can be made. SECTION "D" PREVALENCE OF, AND CONTROL OVER, INFECTIOUS AND OTHER DISEASES A.—Notifiable Diseases during the Year 1945. Disease Total Cases notified Cases admitted to hospital Total Deaths Small-pox — — — Scarlet Fever 37* 21* — Diphtheria 8§ 8§ — Enteric Fever (including Paratyphoid) — — — Ophthalmia Neonatorum 2 2 — Pneumonia 15 8 27 Erysipelas 9† 2† — Measles 525 21 - Whooping Cough 21 — - Encephalitis Lethargica 1 1 - Acute Poliomyelitis 3 2 - Dysentery 3 3 - Puerperal Fever 1 1 - Puerperal Pyrexia 17 17 - Malaria (Non-Civilian) 2 1 - *In addition, two cases originally notified and admitted to Hospital were subsequently diagnosed not Scarlet Fever, † in addition, one case originally notified and admitted to Hospital was subsequently diagnosed not Erysipelas. § In addition, five cases originally notified and admitted to Hospital were subsequently diagnosed not Diphtheria. B.— Ophthalmia Neonatorum. Cases Notified Cases treated at home Cases treated in hospital Vision unimpaired Vision impaired Total Blindness Deaths 2 Nil 2 2 Nil Nil Nil 24 C.— Ages of Cases of Infectious Diseases Notified during the Year 1945. 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 37* — — 2 4 6 20 5 - - - - - Diphtheria 8† — — — 1 — 3 3 1 — - - - Enteric Fever (including Paratyphoid) — — - - - - - - - - - - - Ophthalmia Neonatorum 2 2 — — — — - — — — — — - Pneumonia 15 — 2 — 1 — 2 1 — 1 2 5 1 Erysipelas 93 - - - - - - - — - — 6 3 Encephalitis Lethargica 1 — — — — — - — — - — 1 — Acute Poliomyelitis 3 — 1 — 2 — - — — — — — — Dysentery 3 — — — — — 1 — 2 — — — — Measles 525 21 79 69 54 67 207 16 2 10 — — - Whooping Cough 21 2 5 1 6 1 4 — - 1 1 — — Puerperal Pyrexia 17 - - - - - - - 1 15 1 — — Puerperal Fever 1 — — — — — — — — 1 — — — Malaria (Non-Civilian) 2 — — — — — — — — 1 1 — — *In addition, two cases originally notified were subsequently diagnosed not Scarlet Fever, † In addition, five cases originally notified were subsequently diagnosed not Diphtheria. § In addition, one case originally notified was subsequently diagnosed not Erysipelas. 25 D.— Cases of Infectious Disease Notified during the Year, 1945. Classified in Wards. Disease NUMBER OF CASES NOTIFIED Total Cases Brentford West Brentford Central Brentford East Bedford Park Chiswick Park Grove Park Gunnersbury Old Chiswick Turnham Green Small-pox - - - - - - - - - - Scarlet Fever 7 5 8 2 4 1 1 7 2 37 Diphtheria 3 — — — 2 1 1 1 - 8 Enteric Fever (including Paratyphoid) - - - - - - - - - - Ophthalmia Neonatorum — — — 1 — — 1 — — 2 Pneumonia 3 1 1 2 2 2 1 - 3 15 Erysipelas 2 — 1 — 2 — 1 2 1 9 Encephalitis Lethargica — — — — — — — — 1 1 Measles 113 98 41 29 23 58 74 34 55 525 Whooping Cough 4 3 — 2 3 — 5 2 2 21 Acute Poliomyelitis 1 — — — — — 1 1 — 3 Dysentery — 1 — — — . 1 — — 1 3 Puerperal Fever — — — — — — — 1 — 1 Puerperal Pyrexia — — — — — — — 17 — 17 Malaria (Non-Civilian) — 1 1 — — — - - — 2 Tuberculosis— Respiratory 9 10 8 6 4 8 18 17 7 87 Non-respiratory 2 3 — — 2 2 1 3 2 15 26 E.— Tuberculosis— 1945 Age Groups NEW CASES DEATHS Respiratory, Non- Respiratory Respiratory Non- Respiratory Male Female Male Female Male Female Male Female Under 1 year — — — - — - - - 1— 5 years — — 1 — — — — — 5—15 years 2 1 3 2 — - — — 15—25 years 8 9 2 — 3 1 1 — 25—35 years 14 20 1 1 2 4 — — 35—45 years 10 3 1 2 4 4 — 1 45—55 years 5 5 — 1 4 1 — — 55-—65 years 5 1 1 — 3 1 — — 65 years and over 2 2 — — 2 — — 1 TOTALS 46 41 9 6 18 11 1 2 During the year 9 non-notified tuberculous deaths were recorded. LABORATORY WORK. The following table sets out a record of the bacteriological work during the year 1945, all of which was carried out in the Council's Laboratory. Suspected Disease Result Positive Negative Total Diphtheria 7 185 192 Tuberculosis 1 25 26 Other Diseases — — — TOTALS 8 210 218 CARE OF PREMATURE INFANTS (Ministry of Health Circular 20/44, March, 1944) As previously reported, the instructions from the Ministry of Health issued in the above Circular were carried out by this Authority. (1) Procuring Information. (a) A personal letter was sent to each practitioner asking for notification of all infants whose birth weight was 5½ lbs. or under. 27 (b) The Birth Notification Forms were altered to include this information. (c) Medical Officers of Health of neighbouring areas were asked to notify this Authority of any such cases born in their districts and belonging to this Borough. (d) Similar information was asked for from Queen Charlotte's Hospital, which undertakes the Domiciliary Midwifery Service in this Borough. (e) Midwives practising in the Borough were also informed of this requirement. (f) A Home Help Service was started. (g) Health Visitors were instructed to give special attention to these cases. (2) Provision of Apparatus. The following were purchased by this Authority :— 5 Draught-proof cots with detachable lining. 5 Electric Blankets. 5 Maximum and Minimum Cot Thermometers. 10 Rubber Hot Water Bottles. 12 Special Feeding Bottles. 6 Glass Mucus Catheters. Oxygen Tubing. (3) Arrangements were made for the conveyance of the infants to Hospital (if necessary) in the Borough Ambulances, with a nurse in attendance. The ambulances are provided with adequate hot water bottles. The majority of infants in this Borough are born in institutions, and those weighing 5½ lbs. and under are notified to us. Similarly, those born in Chiswick Hospital are notified immediately to the Medical Officers of Health of the districts concerned. No applications for the use of any apparatus were made during the year. CARE OF ILLEGITIMATE CHILDREN. (Ministry of Health Circular 2866, May, 1944) As this Borough participated in the County Scheme, I repeat a previous report made on this subject. 28 In order to facilitate the carrying out of instructions and suggestions of the Minister, a conference of all Welfare Authorities in Middlesex was called by the County Medical Officer in 1944. The County Medical Officer stated that investigations carried out before calling the conference indicated that the problem was at present largely a County concern in that it was being encountered by the Almoners in the Maternity Departments of the County Hospitals (where 50% of the births occur), by the Public Assistance Department, in the County V.D. Clinics and in the County's Maternity and Child Welfare area by the County Midwives and Health Visitors. The cases to be dealt with fell into three classes : (a) those in which the girl is able to return home to her parents with her baby. (b) those in which adoption of the child is advisable on account of the extreme youth of the mother, or of the fact that she is a married woman. (c) those for which there is need of shelter to which the mother, after confinement, may go with her baby and stay for a time in an atmosphere of security until, with sympathy and help, she is able to re-establish herself and make a permanent home for herself and child. (a) and (b) are dealt with by special attention by Health Visitors in co-operation with the Hammersmith Moral Welfare Society. As regards (c) this Authority joined in the County Scheme in which a Special Services Almoner (Miss Myer) was appointed to visit and investigate cases on the lines laid down in the Circular and consult with Health Visitors and other workers. The County also overcame perhaps the most difficult problem, of finding accommodation for the expectant mother and for the mother and child, by making arrangements with the British Red Cross for beds in two- hostels :— (i) Before the birth of child— at 16, The Park, Golders Green. (ii) After the birth of child—at B.R.C. Hostel, " Maryland," Hendon. The charge is 35/- per week at each hostel and this charge includes the baby at "Maryland." 29 CONTROL OF LICE INFESTATION. (Ministry of Health Circular 2831, July 1943, and Memo 230A/Med) The same policy was adopted as in previous years and this report is a repetition of a previous report, with alteration of statistical figures. (1) All children, especially 2— 5 age groups, are inspected by the Health Visitors at the Maternity and Child Welfare Clinics. (2) All children attending Day Nurseries are examined for nits each day on admission. (3) At the schools, an average of 9.5 visits to each school were made by the School Nurses, for Hygiene Inspections. During the year, 25,418 examinations were made. (4) Cases referred from Factories, etc. Findings at these Inspections :— (1) At the M. & C.W. Clinics any degree of contamination was very rare. Perhaps the usual type of mother who will trouble to take her children to these clinics will also take the trouble to see that her children are clean. (2) At the Day Nurseries, especially the war-time Nurseries, the incidence of infestation was higher. In these cases the mothers, being engaged in Factory work, etc., had less time and leisure to pay the necessary attention to their children. (3) In the schools, 434 children were found to have nits. The majority of these were cases of very mild infestation, but there were a few who were always found to have nits and who, after cleansing thoroughly, quickly became infested again. (4) No cases were referred from Factories in 1945. Methods of Dealing with Cases. Agents used :— (i) Derbac Soap and Sacca Comb. (ii) Lethane Hair Oil. The vast majority of the cases were treated with Derbac Soap and Sacca Comb or some other form of small tooth comb. 30 Lethane Hair Oil was never extensively used and was unpopular partly because it did not remove the nits and partly because the hair was not allowed to be washed for a week after application of the oil. (1) M. & C.W. Clinic Cases. As mentioned, the cases were few and mild and the infestation was quickly remedied by the mothers themselves who used willingly the treatment advised by the Health Visitors. The mothers of these children were not examined in the Clinics, as such a course would probably have caused resentment, but where it was thought to be advisable, the Health Visitor made a special visit to the home. (2) Day Nurseries. (a) Mild Cases— were cleansed and nits removed before they were allowed to mix with the other children. (b) Severe Cases— were not to be admitted. The rule is that the Health Visitor must be notified and she would visit the home and give the necessary advice and help for the child, or for any others of the household who might be similarly affected. (No cases of this degree were found during the year.) (3) Schools. Each child found to be affected is given a note for its parents stating the fact and gives simple instructions as to how it might be treated. It also states that Derbac Soap and Sacca Comb can be obtained from the Clinic. (a) In the mild cases of infestation this is quite effective. (b) In the more severe cases the School Nurse calls and gives instructions regarding the cleansing of all persons in the house who may be suffering from infestation. (c) In certain cases where it is found that special difficulties are present in the household, the child is cleansed at the School Clinic. There were 2 of these cases during the year. Note.—No cases of Body Lice were seen during the year. 31 JOINT COMMITTEE FOR EDUCATION IN BRENTFORD AND CHISWICK ANNUAL REPORT on the MEDICAL INSPECTION OF ELEMENTARY SCHOOL CHILDREN for the YEAR ENDING 31st DECEMBER, 1945 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. 1945—ACTUAL CASES Jan. Feb. Mar. Apl. May Jun. Jly. Aug. Sep. Oct. Nov. Dec. Tot. Scarlet Fever 1 - 3 3 4. 5 - - — 8 5 7 36 Diphtheria — — 2 1 1 1 2 — 1 5 5 1 19 Chicken-pox 8 8 8 47 72 39 28 — — 21 24 19 274 Measles 86 193 99 25 9 1 3 - - - - - 416 Whooping Cough 9 4 - - 1 4 6 - 1 2 4 1 32 Mumps 14 14 5 1 4 — 3 — 4 3 1 3 52 Ringworm 5 3 8 — — 1 1 — 1 1 1 — 21 Impetigo 5 5 4 3 1 2 5 — 5 10 5 — 45 Eczema — — — 1 1 — — — — — — — 2 Verminous 4 8 11 16 17 18 4 — 14 12 10 10 124 Scabies 13 14 11 3 4 3 — — 13 12 9 8 90 Other Skin Diseases - 1 1 1 — — 1 — 1 - 2 - 7 TOTALS 145 250 152 101 114 74 53 - 40 74 66 49 1118 BOROUGH OF BRENTFORD AND CHISWICK EDUCATION ACT, 1921 REPORT ON THE MEDlCA,L INSPECTION AND TREATMENT OF ELEMENTARY SCHOOL CHILDREN FOR THE YEAR ENDING 31st DECEMBER, 1945 To the Chairman and Members of the Education Committee. Ladies and Gentlemen, I beg- to submit tables indicating the work of the School Medical Service during 1945, together with & comprehensive report from Miss A. Stewart, the Dental Surgeon. In the appendix will be found tables showing attendances at Clinics and certain other details of our work during the war years. The sentiments expressed in the final paragraph of the introductory remarks on the Public Health Report include you, Ladies and Gentlemen, whom it has always been a pleasure and honour to serve. The incidence of Infectious Disease in the schools is indicated in the following- table:— The following figures and tables of work in this service are in addition to the Statutory Tables issued to the Board of Education:— Orthopedic Clinic: School Welfare Total Total Number of attendances 753 228 981 Number of individual children 108 44 152 Surgeon: Total number of attendances 141 107 248 Number of individual children 78 59 137 Sun-Ray Clinic: Total number of attendances 759 273 1032 Number of individual children 53 26 79 Rheumatism Clinic: Total number of attendances ... ... 376 Number of individual children ... ... 107 Minor Ailment Clinic: Total number of-attendances ... ... 10,765 Number of individual children ... ... 2,429 Total number of exclusions ... ... 646 Total number of re-admissions ... ... 432 Number of Special Cases ... ... 1,020 Number of Special Cases re-inspected ... ... 502 Ophthalmic Clinic: School Welfare Total Number of attendances 647 94 741 New cases 150 37 187 Retinoscopy 130 25 155 Glasses prescribed 77 12 89 Glasses issued 105 13 118 Other cases 30 13 43 Individual children 298 40 338 Immunisation Clinic: Number of attendances 2128 5196 7324 Personal Hygien: Number of visits to schools 208 Average number of visits to schools 9.5 Number of examinations 24,431 Number of individual children defective 434 Number of re-examinations 987 Visits: Total number of visits by School Nurses 540 SCHOOL DENTAL SERVICE ANNUAL REPORT FOR THE YEAR 1945 In presenting this Annual Report on the School Dental Service, I wish to take this opportunity of expressing my respect and admiration for the work of Miss M. M. Loretz, Senior Dental Officer to this Borough from 1920 to 1944. Miss Loretz's resignation, due to ill-health, was felt as a personal loss both by the 36 staff and by her patients. Miss ,Loretz, as a practical idealist, was responsible for many pioneer schemes. It was due to her efforts that this area was the first in the country to organise a scheme for providing dental inspection and treatment of adolescents. The plan, nobly supported by the private practitioners of the area, deserved to succeed; that it did not do so was due to the fact that it was in advance of public appreciation of conservative and preventative dentistry. The experience gained will prove valuable in the establishment of any new service to provide similar care during the "gap" period. Miss Loretz's record is one of which the service is proud. The fact that this pride is shared by the dental profession as a whole was evident when, in 1945, the British Dental Association elected Miss Loretz a lifemember. However comprehensive the School Dental Service may become, its development will be due, in a very large measure, to the self-sacrificing efforts made by Miss Loretz in laying sure foundations on which to build. During 1945, the staff of the dental service consisted of two full-time and one part-time Dental Officers, two full-time and one part-time Surgery Assistants and one Junior Clerk. Over the whole year the sessions worked by the part-time Dental Officer were equivalent to. less than half a full-time officer. The part-time Surgery Assistant was replaced by a full-time one in September. A high incidence of sickness among the Surgery Assistants emphasised strongly the contribution that these officers make towards the efficiency and smooth running of the service. There was a marked decrease in the number of patients treated per session when, over a considerable period, one or other Dental Officer was obliged to work unassisted. The service is responsible for the dental inspection and treatment of over 6,100 children as well as for those Ante-Natal and Post-Natal patients and pre-school 'children referred from the Maternity and Child Welfare Clinic. The latter service is a constantly growing one and reference to the report on it must be made in estimating the total work carried out by the dental service. Attention is drawn to the fact that approximately 1,600 of the school population attend Secondary or Technical Schools and that a high proportion are in the latter "teen-age." It is recognised generally that a large amount of conservative treatment is required at that age. Three surgeries are in use. One is at Brentford, where equipment of a high standard in a modern and well-designed building is available. The Chiswick Centre provides two surgeries, one waiting room, a recovery room, an office, etc. Although the Chiswick Centre is an old one, every effort is made to make the 37 waiting room and surgeries as attractive as possible. Severl items of equipment in one of the surgeries at Chiswick required replacement and provision for this has been made in the estimate for 1946. It is remarkable that the dental engine has been in constant use for nearly twenty years. The special sterilisers designed by Miss Loretz, continue to give excellent service, and the method of sterilizing and lubricating hand-pieces in oil and germicidal concentrate after every patient keep these instruments in exceptionally good condition. This method is gaining in popularity and the design is being adopted by steriliser manufacturers. Acceptance Rate. A total of 2765 elementary school children were inspected during the year, 2128 (approximately 77%) were referred for treatment; 1200 had received complete treatment by the end of the year; 2 schools inspected at the end of 1945 awaiting treatment during the following year. It was not possible to provide inspection and treatment for all the schools in the area. 83% of those referred accepted treatment, 8% refused treatment, 6% did not reply and 3% stated that private treatment would be obtained. 2205 permanent fillings and 976 temporary fillings were carried out. 122 permanent teeth were extracted for caries,. 2224 for overcrowding and 1336 temporary teeth for caries. 928 Secondary School children were inspected and 771 (approx. 83%) were referred for treatment. The acceptance rate was 74%, 13% did not reply, 13% stated that private treatment would be obtained. There was one refusal. 1773 permanent teeth were filled, 102 permanent teeth were extracted for caries, 169 were extracted for overcrowding and 54 temporary teeth were removed. incidence of caries in age groups: Age 5 6 7 8 9 10 11 12 13 14 15 16 17 % Sound 32 33 20 30 16 42 30 20 18 21 18 19 29 Method of Inspection Before a routine school inspection, the charts are arranged in class and alphabetical order. As each child is inspected with mirror and probe, the result is entered on the chart and on a class list, a duplicate copy of which is left at the school. Consent forms are distributed immediately after the inspection. As these forms are returned to the teacher, the parents' decision to accept or refuse treatment is recorded on the class list. This provides a ready check on those children who have not returned their forms or whose parents have refused treatment. The class teacher is 38 often able to ensure the return of a form or the alteration of a decision. A similar entry is made on the list at the Clinic and each completed treatment or failure to attend is noted. These lists are examined after the treatment of a school is completed and much valuable information, such as the number of acceptances who actually attend for complete treatment, etc, is obtained. By sending- for children, as far as possible, in class order, only one class in a school is disturbed during each session. If a child is unable to attend, the Head Teacher may utilise the class list to substitute another child whose required treatment is similar. Failed Appointments. The average percentage of failed appointments for all school children was 12. It is worthy of note that only 3% of appointments made for County School children were not kept. The corresponding figure for 1938 was 23%. The percentage of failed appointments is still too high and it is hoped that a return to peace-time conditions and the release of mothers from war work, will effect an improvement during 1946. Work Carried Out Per Session. On an average 5.1 fillings, 2.5 extractions and 2.1 other operations, 4.4 inspections, are completed for elementary school children per session. The average per session for Secondary Grammar School children is 6.4 fillings, 1.1 extractions, 1.7 other operations and 6.2 inspections. Sessions spent on inspections, etc., are included in these calculations. Special Cases. 29 crowns and inlays were inserted during the year. These were mainly of acrylic resin and the mechanical work involved was undertaken as an extra duty by the Dental Officers or by Miss Maiden, Surgery Assistant at Chiswick. These restorations carried out largely on anterior teeth, were appreciated greatly by children and parents, but it is realised that the material has definite limitations. Four root cases were carried out and four dentures were inserted for school children. Only orthodontic cases of a simple character were undertaken and 118 visits were made for the adjustment of appliances, etc. Ratio of Fillings to Extractions. The ratio of permanent teeth filled to permanent teeth extracted continues to rise and is now 18 to 1. (Permanent teeth extracted for overcrowding are not included). This'ratio provides reliable 39 evidence of the growing appreciation of conservative treatment and of the standard of treatment given by the service. The ratio of temporary teeth filled to temporary teeth extracted is now 1 to 1.3. During 1938, the corresponding ratio was 1 to 4.5; during 1942, 1 to 3. This steady improvement is encouraging without giving grounds for complacency. The extraction of a tooth is a quick and destructive process; the conservation of a tooth is an operation which calls for the expenditure of time, skill and patience on the part of the Dental Officer. These ratios explain why, without increases in staff, the time elapsing between routine school inspections will lengthen. Evacuees. The return of children from reception areas was responsible for a large proportion of the number of children who attended the clinics for inspection and treatment as "specials." The parents of these children wished to obtain immediate attention and did not wait for routine school inspection. In the majority of cases it was found that a very considerable amount of treatment was required. Leavers. The system of inspecting and, where necessary, treating all children attending Elementary schools immediately before leaving school, has been continued. A true picture of the success or failure of the service is reflected in the state of the mouths of children leaving school. No child leaves school without being offered an opportunity to receive complete dental treatment. It is hoped to extend this "extra" service to those children attending what were County Schools. A certificate of dental fitness is issued to each child who is found to be sound or who has any necessary treatment completed. In pre-war days several employers insisted on the production of a certificate of dental fitness from applicants for employment. This practice enhanced considerably their value in the eyes of both parents and children'. It is regrettable that this practice has been discontinued owing to shortage of labour. 312 leavers were inspected and 217 certificates were issued. Although these extra inspections disrupt the service and delay routine inspections, their value outweighs considerably these disadvantages. Propaganda. In an adequately staffed service, time should be available for educating children and parents in the care of teeth. This could be carried out by the showing of suitable films, by demonstrations and talks in the schools and to parents. Under present 40 conditions, this has not been found possible. The opportunity given when a child or parent attends the Clinic is utilised to carry out chairside propaganda and to give instruction in the proper use of a toothbrush. The custom of allowing parents to come into the surgery when a child is being treated provides an opportunity for contact between Dental Officer and parent, which is highly valued by both. This is a practice which works extremely well in this area. Orthodontic Scheme. In December, 1945, a scheme to provide Orthodontic (regulation) treatment for the children of the Borough received the Committee's approval. In the past in this Borough all but simple cases have been referred to the Orthodontic Department of a Dental Hospital. The cost, which varied according to income, was borne by the parents. Frequent and prolonged visits to a Hospital were often beyond the power and the means of the child's parents. Under the new Education Act, such treatment may be provided free of charge by the Local Authority. It was felt that an Orthodontic Service should be available to all the children of this Borough who required it and it was suggested that the services of an Orthodontist, should be engaged for two sessions per week. Under the scheme, the Specialist will be accessible to all children of the Borough and no child will be denied treatment through the inability of the parent to escort the child to and from Hospital. Once the service is established, two sessions a week will prove inadequate. The Orthodontist will be required to commence in one of the present surgeries at Chiswick, but it is hoped that a fourth surgery will become available during 1946, X-Ray Facilities. At present, cases requiring X-Ray are referred to the West Middlesex Hospital and the charge is debited to the Education Authority. This arrangement is working satisfactorily but when an Orthodontic scheme is in full operation, it will become necessary to ask the Committee to consider installing a Dental X-Ray machine in the Borough or to arrange for free access to a special centre. Future Needs of the Service. In assessing the future needs of a dental service, it has been usual to base calculations on the assumption that, with an acceptance rate of 60%, a Dental Officer can provide annual inspection and treatment for 2,500 children. The acceptance rate in this area is 83% and for every permanent tooth removed twenty are 41 conserved. Bearing these facts in mind and making- some allowance for an ever-increasing Maternity and Child Welfare Service, this area with its school population of over 6,000, requires a minimum of four full-time Dental Officers to provide an adequate service. The raising of the school leaving age will be an important factor in assessing future staff requirements. The provision of a new and expanded centre at Chiswick would allow staff increases to be effected. The proposed third surgery at Chiswick will allow the Orthodontic scheme to grow without interfering with the normal work of the service, but it will not satisfy all future needs. No report would be complete which did not pay tribute to the very valuable help which the service continues to receive from Head Teachers and their staffs. Their willing co-operation is a most important factor in the provision of a satisfactory service to the children. BOARD OF EDUCATION. MEDICAL INSPECTION AND TREATMENT RETURNS. YEAR ENDED 31st DECEMBER, 1945. TABLE I. MEDICAL INSPECTIONS OF CHILDREN ATTENDING PUBLIC ELEMENTARY SCHOOLS. A.—Routine Medical Inspections. (1). No. of inspections :— Entrants—807; Second Age Group—78; Third Age Group—369; Total—1254. (2). No. of other Routine Inspections—371. Grand Total—1625. B.—Other Inspections. No. of Special Inspections and Re-Inspections—1991. 42 TABLE II. CLASSIFICATION OF THE NUTRITION OF CHILDREN INSPECTED DURING THE YEAR IN THE ROUTINE AGE GROUPS. Number of Children Inspected A (Excellent) No. % B (Normal) No. % C (Slightly Sub-normal) No. % D (Bad) No. % Entrants 807 394 48.8 352 43.6 59 7.3 2 2 Second 78 22 28.2 50 64.1 6 7.7 — — Third 369 143 40.1 181 49.05 37 10.0 3 .8 Other 371 175 47.2 172 46.4 22 5.9 2 .5 TOTALS 1625 739 45.5 755 46.5 124 7.6 7 .4 TABLE III. * Group I.—Treatment of Minor Ailments (excluding uncleanliness). Total Number of Defects treated or under treatment during the year under the Authority's scheme—2025. Group II.—Treatment of Defective Vision and Squint. Under the Authority's Scheme Errors of Refraction (including squint) 130 Other defect or disease of the eyes (excluding those recorded in Group I) — Number of children for whom spectacles were (a) Prescribed 77 (b) Obtained 105 Group III.—Treatment of Defects of Nose and Throat. Under the Authority's Scheme Received Operative Treatment Received other forms of treatment Total number treated *Hospital wards closed for most of 1945. 43 44 TABLE IV. DENTAL INSPECTION AND TREATMENT. (1) Number of children inspected by the Dentist (a) Routine age-groups 2,082 (b) Specials 683 (c) Total (Routine and Specials) 2,765 (2). Number found to require treatment 2,138 (3). Number actually treated 1,200 (4). Attendances made by children for treatment 4,067 (5). Half-days devoted to: Inspection 344½ Treatment 577 *Other sessions 6 Total 617½ (6). Fillings: Permanent Teeth 2,205 Temporary Teeth 976 Total 3,181 (7). Extractions: Permanent Teeth 346 Temporary Teeth 1,336 Total 1,682 (8). Administrations of general anaesthetics for extractions 835 (9). Other Opsrations: Permanent Teeth 869 Temporary Teeth 483 Total 1,352 TABLE V. (1). Average number of visits per school made during the year by School Nurses 9.5 (2). Total number of examinations of children in the schools by School Nurses 25,418 (3). Number of individual children found unclean 434 (4). Number of individual children cleansed under Section 87 (2) and (3) of the Education Act, 1921 Nil (5). Number of cases in which legal proceedings were taken: (a) Under the Education Act, 1921 Nil (b) Under School Attendance Byelaws Nil TABLE VI. Number of totally or almost totally blind and deaf children who are not at the present time receiving education suitable for their special needs. The return should relate to all such children including- evacuees resident in the Authority's area. 1 At a Public Elementary School 2 At an Institution other than a Special School 3 At no School or Institution Blind Children Nil Nil Nil Deaf Children Nil Nil Nil MEDICAL INSPECTION AND TREATMENT OF SECONDARY AND TECHNICAL SCHOOL CHILDREN TABLE I. A.—Routine Medical Inspections. (1). No. of Inspections: Age Group No. of Inspections 10 1 11 98 12 91 13 49 14 22 15 69 16 31 17 17 Total 378 (2). No. of other routine infections—Nil. 45 B.—Other Inspections: Number of Special Inspections and Re-Inspections—19. TABLE II CLASSIFICATION OF THE NUTRITION OF CHILDREN INSPECTED DURING THE YEAR IN THE ROUTINE AGE GROUPS Age Group and Number of Children Inspected A (Excellent) B (Normal) C (Slightly Sub-normal) D (Bad) No. % No. % No. % No. % 9 Nil - - - - - - - - 10 1 — — — — 1 100 — — 11 98 40 40.9 53 54.1 5 5 — — 12 91 40 43.9 46 50.5 5 4.6 — - 13 49 32 65.3 15 30.6 2 4.1 - — 14 22 13 59.1 7 31.8 2 9.1 — - 15 69 31 44.9 32 46.4 6 8.7 — - 16 31 16 51.6 13 41.9 2 6.5 — — 17 17 10 58.8 6 35.3 1 5.9 — — TOTALS 378 182 48.2 172 45.5 24 6.3 — — TABLE III Group I.—Treatment of Minor Ailments (excluding- uncleanliness). Total number of Defects treated or under treatment during the year under the Authority's Scheme 49 Group II.—Treatment of Defective Vision and Squint. Under the Authority's Scheme Errors of Refraction (including squint) Other defect or disease of the eyes (excluding 38 those recorded in Group I) Nil No. of Children for whom spectacles were : (a) Prescribed 30 (b) Obtained 42 46 TABLE IV DENTAL INSPECTION AND TREATMENT (1). Number of children inspected by the Dentist: (a) Routine age-groups 811 (b) Specials 117 (c) Total (Routine and Specials) 928 (2). Number found to require treatment 771 (3). Number actually treated 536 (4). Half-days devoted to: Inspection 8 Treatment 292¼ (5). Attendances made by pupils for treatment 1,659 (6). Fillings: Permanent Teeth 1,773 Temporary Teeth — (7). Extractions: Permanent Teeth 271 Temporary Teeth 54 (8). Administrations of general anæsthetics for extractions 185 (9). Other operations: Permanent Teeth 528 Temporary Teeth 4 47 APPENDIX TABLES COMPARING FIGURES FOR 1938 (LAST YEAR OF PEACE BEFORE THE WAR), THE WAR YEARS, AND 1945 OF VITAL STATISTICS INCIDENCE OF DISEASE MATERNITY AND CHILD WELFARE SCHOOL CLINICS STATISTICAL TABLE OF BIRTHS AND DEATHS Year Births Deaths Deaths of Infants under 1 year Infantile Mortality Rate Maternal Deaths No. Rate No. Rate 1938 816 13.3 671 11.1 34 4.2 4 1939 686 12.1 703 12.1 30 41 2 1940 692 13.3 813 15.7 43 59* Nil 1941 585 12.7 656 14.3 30 51* Nil 1942 787 16.3 651 13.5 53 67* 2 1943 930 18.7 667 13.4 45 48 3 1944 973 19.9 718 14.6 35 36 9 1945 886 17.5 613 12.1 32 36.1 Nil *Note.—The High Infantile Mortality figures for 1940, 1941 and 1942 were due to an increase in deaths from prematurity, pneumonia and enteritis. The figure for 1942, viz.. 67, was the highest since the incorporation in 1932. TUBERCULOSIS Much stress has been laid on the increase in the number suffering from this disease and the following table gives some indication of the position in this Borough:— Year New Cases Deaths Respiratory Non-Resp. Total Respiratory Non-Resp. Total Male Female Male Female Male Female Male Female 1938 54 39 8 7 108 29 8 2 2 41 1939 36 33 9 7 85 18 18 2 3 41 1940 47 27 7 7 88 20 10 3 5 38 1941 52 25 3 3 83 23 12 5 2 42 1942 42 36 1 8 87 14 12 — 2 28 1943 52 29 3 5 89 25 11 — 1 37 1944 57 39 3 7 102 16 11 1 4 34 1945 46 41 9 6 106 18 11 3 I 2 32 The above table shews the sex incidence. As regards the age incidence, most of the respiratory type occurred between the ages of 15 and 35. Most of the non-respiratory cases were notified during the decades after 30 years. 48 TABLE OF CERTAIN DISEASES THAT MIGHT BE INFLUENCED BY WAR CONDITIONS The free numbers indicate those notified to this Department and those in brackets the deaths from the disease as returned by the Registrar General. Disease 1938 1939 1940 1941 1942 1943 1944 1945 Scarlet Fever 81 123 77 55 53 59 (1) 44 37 Diphtheria 85 30 17 26 35 11 4 8 (3) (1) (1) *Measles — 2 67 254 313 217 356 525 (1) (1) *Whooping Cough — 2 2 92 44 108 55 21 (3) (1) (3) Pneumonia 24 32 24 15 14 13 6 15 (28) (30) (56) (35) (38) (47) (50) (27) †Influenza (4) (7) (20) (6) (1) (10) (6) (1) †Diarrhœa (under 2 yrs.) (6) (6) (3) (2) (17) (3) (4) (6) Puerperal Fever — — — — — 3 — 1 (3) Puerperal Pyrexia 3 4 4 — — 6 10 17 (1) Enteric Fever 1 — 1 1 — — — — Cerebro-Spinal Fever (a much-dreaded disease during the last war) . 2 - - 5 3 - 1 (2) (1) (1) *Notifiable from October, 1939. †Not notifiable. The fact that there occurred no serious epidemics of Scarlet Fever, Diphtheria, Influenza and Cerebro-Spinal Fever, was one which caused considerable surprise. This was especially so in the atter months of 1940, when people were badly overcrowded in shelters all night and every night, under conditions which seemed to violate all the fundamental rules of hygiene. These shelters were designed for protection during short periods of raiding only and not at all for dormitories. All these insanitary conditions were altered as soon as the raiding died down and were put into a highly satisfactory condition. The only serious trouble we had was during the "V. 1" attack in 1944, when an outbreak of Measles caused us considerable worry. Shelter life and conditions seemed to be most favourable for the spread of Tuberculosis. The figures for 1944 and 1945 show a marked increase in the incidence of this disease, which may bear this out, as cases frequently are not diagnosed until some time after receiving infection. 49 TABLE TO INDICATE HOW THE WAR CONDITIONS AND BLACK-OUT INFLUENCED THE INCIDENCE OF SUICIDE, ROAD ACCIDENTS, AND OTHER VIOLENT DEATHS Year Suicides Road Accidents Other forms of violence 1938 12 Not recorded 26 1939 9 Not recorded 32 1940 4 8 82 1941 4 15 27 1942 5 5 20 1943 4 4 18 1944 7 7 51 1945 3 7 29 TABLES INDICATING SOME OF THE WORK DONE BY HEALTH VISITORS AND IN THE M. & C.W. CLINICS MATERNITY AND CHILD WELFARE Year New Children Enrolled Attendances and Weighings Doctor Seen by 1938 765 14,676 . 5,112 1939 652 13,176 4,091 1940 816 12,945 3,672 1941 689 11,513 3,130 1942 764 13,698 3,525 1943 843 16,348 3,576 1944 894 14,862 3,563 1945 970 17,786 3,948 ANTE-NATAL AND POST-NATAL 1938 1939 1940 1941 1942 1943 1944 1945 Attendances 2260 2206 2355 2238 3134 3893 3455 3480 50 The figures for suicides seem to indicate that the war had no effect on the morale of the people. The rise in road accidents in 1941 was coincident with a rather sudden increase in service traffic. As regards other forms of violence, 1940 was the year of the blitz on the London area and in 1944, we had a short attack of raids in February, followed by V.l's and lastly by V.2's. DENTAL INSPECTION AND TREATMENT OF M. & C.W. PATIENTS 1938 1939 1940 1941 1942 1943 1944 1945 Adults treated 238 99 230 222 176 170 289 356 Children treated 238 101 177 182 176 90 99 156 TOTAL treated 476 200 407 404 352 260 388 512 Adults attended 1044 980 1288 838 314 1426 1355 1595 Children attended 576 455 502 389 148 304 270 461 TOTAL attended 1620 1435 1790 1227 462 1730 1625 2056 HEALTH VISITORS 1938 1939 1940 1941 1942 1943 1944 1945 Visits to Children 5842 4858 7678 5460 4353 4052 5128 5147 Ante-Natal Visits 538 650 693 452 474 431 511 490 OPHTHALMIA NEONATORUM Year Notified Sent to Hospital Vision Unimpaired Vision Impaired 1938 1 1 1 - 1939 Nil — — — 1940 1 1 1 — 1941 1 1 1 — 1942 Nil — — — 1943 8* 8 8 - 1944 3 3 3 — 1945 2 2 2 - *All except one case were found not to be the dangerous form of Ophthalmia and were cases usually mentioned as " Sticky Eye." No cases of impaired vision through the war years. TABLE OF INSPECTIONS AT ELEMENTARY SCHOOLS ONLY Year Routine Inspections Special Inspections ReInspections 1938 2167 1491 3617 2126 1939 1272 957 1156 2113 1940 1369 538 512 1050 1941 941 1138 1942 1219 2063 1943 1391 2117 1944 1433 2008 1945 1625 1991 51 TABLE OF NUTRITION FOUND IN ROUTINE INSPECTIONS Year A (Excellent) B (Normal) C (Slightly Sub-Normal) D (Bad) % % % % 1938 46.9 41.3 11.0 0.6 1939 43.0 42.6 14.0 0.4 1940 42.7 43.8 12.8 0.6 1941 31.2 58.7 9.9 0.2 1942 37.2 53.6 8.9 0.2 1943 37.7 54.1 7.2 0.141 1944 36.9 55.2 7.7 0.2 1945 45.5 46.5 7.6 0.4 HYGIENIC CONDITIONS Year Total No. of Examinations by School Nurses at Schools No. of School Children found unclean Number cleansed in Clinic 1938 25,366 341 48 1939 17,860 371 25 1940 19,190 358 89 1941 16,472 318 19 1942 23,729 296 2 1943 26,504 301 2 1944 23,380 403 12 1945 25,418 434 — 52 HOME VISITS MADE BY SCHOOL NURSES 1938 1939 1940 1941 1942 1943 1944 1945 1312 1108 719 645 832 737 617 540 53 TABLE OF ATTENDANCES AT SPECIAL CLINICS Year Minor Ailments Orthopædic Sun-Ray Rheumatism Ophthalmic Number of Individual Children Attendances Number of Individual Children Attendances Number of Individual Children Attendances Individual Children Attending Spectacles Prescribed 1938 14,025 120 1,069 Not in use 180 600 310 288 1939 10,242 266 888 139 384 173 433 233 196 1940 6,352 64 181 39 112 97 356 173 148 1941 8,170 88 241 64 285 80 261 134 101 1942 11,073 50 656 70 686 83 284 196 136 1943 12,203 137 627 82 1,537 88 275 133 82 1944 9,926 61 806 72 1,066 102 290 138 71 1945 10,765 152 981 79 1,032 107 376 130 70 IMMUNISATION CLINIC Year Attendances from Schools Attendances from M. & C.W. Total Attendatnces Estimated percentage of children in Borough immunised Under 5 Years 5-15 Years 1938 — 2,192 Not recorded Not recorded 1939 — — 1,580* 1940 — — † — — 1941 2,986 2,282 5,268 24.1 23.3 1942 3,526 3,309 6,835 37.0 39.0 1943 2,400 3,184 5,584 75.0 80.0 1944 2,294 2.067 4,361 75.0 80.0 1945 2,128 5,196 7,324 88.0 85.0 * Clinic had to close for seven months of year as Specialist was unable to attend owing to war service. † Clinic closed until last week in December. TABLE OF DENTAL SERVICE TO SCHOOLS INSPECTION AND TREATMENT OF ELEMENTARY SCHOOL CHILDREN 1938 1939 1940 1941 1942 1943 1944 1945 School Inspection 2668 1927 3460 1495 1268 2824 3123 1770 Surgery Inspection 862 1008 762 623 622 478 683 Leavers Inspection 482 386 364 312 TOTALS 4012 2935 3460 2257 2277 3446 3965 2765 Treated 2890 1846 1660 1182 1345 1875 1564 1200 Attendances 4538 4542 4111 3011 3824 5092 3767 4067 INSPECTION AND TREATMENT OF SECONDARY SCHOOL CHILDREN 1938 1939 1940 1941 1942 1943 1944 1945 School Inspection 441 482 168 41* 553 527 455 544 Surgery Inspection 48 56 11 — 25 — 72 75 TOTALS 489 538 179 41* 578 527 527 619 Treated 232 239 128 107* 370 319 319 377 Attendances 610 573 193 362* 876 737 849 1121 * Some of these pupils were inspected and treated at High Wycombe, but by a Brentford and Chiswick Dental Officer. INSPECTION AND TREATMENT OF TECHNICAL SCHOOL CHILDREN 1938 1939 1940 1941 1942 1943 1944 1945 School Inspection 209 299 — — 30 30 — 267 Surgery Inspection 14 11 — 14 — — 30 42 TOTALS 223 310 — 14 30 30 30 309 Treated 70 81 — 14 28 38 133 159 Attendances 220 243 – 33 113 133 425 538 TOTAL ATTENDANCES AT DENTAL CLINICS (SCHOOL & M. &C.W.) 1938 1939 1940 1941 1942 1943 1944 1945 6978 6793 6084 4633 5266 7692 6241 7782 54 EALING AND BRENTFORD AND CHISWICK HOSPITALS COMMITTEE ANNUAL REPORT of the MEDICAL SUPERINTENDENT for 1945-1946 Town Hall, Ealing, W.5. 19th June, 1946. Madam Chairman, Ladies and Gentlemen, I have the honour to submit to you the Annual Report on the two hospitals for the year 1945-46. There are no special features to which attention should be drawn. The maternity hospital has been able to deal with no fewer than 951 cases in the year, such a larg-e number never having been contemplated for a hospital of 40 beds. The fact that so many cases were dealt with without any untoward happenings indicates that the design of the hospital and the organisation of the work on the part of the Matron and the Resident Medical Officer have proved in every way satisfactory. The cases treated at the Clayponds Isolation Hospital have continued to be small in number, although varied in character. Scarlet Fever accounted for 159 out of 291 cases admitted during the year. In presenting the report I wish to take the opportunity of thanking the whole of the medical and nursing staffs for the very able and willing support they have given me during the year. I wish particularly to thank the Clerk to the Committee, Mr. H. Birrell, for the sustained and conscientious assistance which he has at all times given me. I am, Ladies and Gentlemen, Your obedient Servant, THOMAS ORR, Medical Superintendent. 57 CLAYPONDS ISOLATION HOSPITAL The total number of patients admitted to the Hospital in the year 1945-46 was 291. The highest number of patients on any day was 37 on November 17th, 18th and 20th, the lowest number was 10 on the 15th and 16th May. The average daily number was 21.6. The following table indicates the number of cases of eachdisease admitted during the year :— Disease Remaining in Hospital 31st March, 1945 Admitted during the yea Discharged during the year Died during the year Remaining in Hospital 31st March, 1946 Diphtheria 2 48 43 1 6 Septic Throat — 1 1 — — Scarlet Fever 8 159 159 — 8 Erysipelas — 7 7 — — Cellulitis Face - 1 1 — — Typhoid - 1 1 — — Paratyphoid — 1 1 — — Dysentery — 8 8 — — Gastro-enteritis — 3 2 1 — Acute Diarrhoea — 1 1 — — Puerperal Pyrexia — 11 11 — — Infection of Newborn — 5 5 - — Whooping Cough — 20 18 2 — Measles 10 10 19 - 1 Rubella 1 — 1 - — Chicken Pox — 3 3 - — Otitis Media — 1 1 - — Meningitis 1 5 6 - — Poliomyelitis — 1 — - 1 Mothers (with Babies) — 5 5 - — 22 291 293 4 16 DIPHTHERIA. There were 48 cases admitted as diphtheria,. 35 from Ealing and 13 from Chiswick. In 26 cases the diagnosis was confirmed and the age distribution of these was as follows :— Under 5 5—10 11—15 16—20 21—25 26—30 31—40 Over 41 3 5 5 6 3 1 2 1 58 In the remaining 22 cases the final diagnosis was as follows :— Streptococcal Tonsillitis 14 Streptococcal Glossitis 1 Simple laryngitis 1 Sent in as laryngeal diphtheria Whooping Cough 1 Convulsions 1 Vincents Angina 2 Glandular Fever 1 No evidence of disease 1 Most of the cases were mild and included 3 carriers without clinical signs, but there was one death in an infant of one year with laryngeal diphtheria who lived 26 hours after a tracheotomy. Tonsillectomy was performed with satisfactory results in three cases with persistently positive swabs. The average period in hospital of confirmed cases admitted during the year was 43 days. SCARLET FEVER. The cases sent in as Scarlet Fever numbered 159 (124 from Ealing, 35 from Brentford and Chiswick). The diagnosis was confirmed in 151 cases. In the remaining 8 the ultimate diagnosis was :— Tonsillitis 2 Sulphonamide rash 1 Toxic-erythema 1 Lichen urticatus 1 No apparent disease 3 The age-distribution of the confirmed cases was as follows :— Under 1 1—2 3—5 6—10 11—15 16—25 26—45 Over 45 1 4 34 62 33 8 8 1 (Age 73) The following complications were encountered either on admission or during the course of treatment 1. Secondary tonsillitis in 5 cases. 2. Cervical adenitis in 12 cases, including one submaxillary abscess. 3. Otitis media, 7 cases, one of which required mastoid operation before the condition cleared up. '4. Bronchitis, 3 cases. 5. Persistent nasal discharge, 2 cases. 6. Conjunctivitis, one case. 7. Sore lips, one case. 8. Secondary pyrexia, 2 cases. 9. Secondary attacks of scarlet fever, 4 cases. 59 10. Diarrhoea in 3 cases, Sonne dysentery was found in one case only; in the others no pathogens were detected. 11. Acute hepatitis, one case. 12. Mumps, developed in one case 6 days after admission. 13. One case of Glandular fever was admitted with a double infection. 14. Acute Rheumatism occurred in 2 cases during treatment in Hospital. Both made satisfactory progress. One of these, a girl of 12 years, was admitted with endocarditis 5 weeks after the original attack of scarlet fever. She was extremely ill with acute heart failure and developed pleural effusion but ultimately made a good recovery. 15. Polyarthritis, one case. There was one return case. One convalescent case of meningitis contracted scarlet fever whilst in hospital. The average period in Hospital of the confirmed cases was 30 days. OTITIS MEDIA. A child with a streptococcal otorrhoea was admitted because many of her school-fellows had contracted scarlet fever and it was thought that she might be a source of infection. The otorrhoea ceased after a course of ionisation. SEPTIC THROAT. One case sent in with a diagnosis of septic throat proved to be a streptococcal tonsillitis and recovered uneventfully. MEASLES. Ten cases of measles (8 from Ealing and 2 from Brentford and Chiswick) were admitted during the year, but the diagnosis was confirmed in only 7 cases. Of the remaining 3 cases, two proved to be drug rashes and the third had purpura and nephritis. On admission four cases had chest complications varying from severe bronchitis to broncho-pneumonia, and one had stomatitis. One child developed tonsillitis during treatment in hospital. All cases recovered satisfactorily. WHOOPING COUGH. Twenty cases of whooping cough, all from Ealing, were admitted during the year. In addition one case sent in as laryngeal diphtheria, noted above, proved to have whooping cough. The diagnosis of the twenty cases was confirmed in all but three which proved to be one convulsions, one turned out to be bronchitis and no evidence of disease was found in the third case. In 8 cases complications were present on admission. They included five with pneumonia, one with 60 pneumonia and convulsions, two cases with chicken pox. Complications contracted after admission included one gastro-enteritis, one furunculosis and one congestive heart failure in an infant of one year who ultimately recovered. There were 2 deaths, one of the infant of six months admitted with convulsions and pneumonia complicating whooping cough who lived only a few hours. The other death occurred in a child of one year also admitted with pneumonia. He survived for 24 days after admission. CHICKEN POX. There were 3 cases of chicken pox admitted in addition to a case of incomplete abortion complicated by chicken pox. In one case the diagnosis was not confirmed but impetigo and furunculosis of the ear were present. All the cases made good progress. MENINGITIS. There were 5 cases admitted as Meningitis. Meningococci were isolated in one case only, who was severely ill and developed a partial nerve deafness. In 2 cases there was chronic otitis media and mastoid operations were performed. Complete recovery occurred in both cases. One case proved to be a subarachnoid haemorrhage and developed a third nerve palsy. There were no deaths. POLIOMYELITIS. One case, a child of three years from Brentford and Chiswick,, was admitted with an extensive paralytic lesion involving all four limbs and her respiratory muscles. She was nursed in a Both's respirator for eleven weeks and gradually made sufficient progress to be transferred to the Royal National Orthopaedic Hospital. DIARRHŒAL DISEASES'. There was one case of typhoid admitted, a woman of 71 years from whose faeces B. Typhosus was cultured after an attack of so called " gastric flu." She had no clinical signs on admission and was bacteriologically free from infection in 19 days. One case of paratyphoid, a sailor, was admitted but proved to be a relapse of malaria. A soldier with acute diarrhoea was sent in for investigation but he had no further symptoms and no pathogens were found. Eight cases of Sonne dysentery were admitted, but no evidence of disease was found in three of them and the other five recovered satisfactorily. Three infants were admitted with gastro-enteritis. 'One was moribund on admission and died in 16 hours. A second was a case of feeding difficulty which was adjusted, and the third had a primary bronchitis which responded well to treatment. 61 ERYSIPELAS. Seven cases of erysipelas and one of cellulitis of the face were admitted. The diagnosis was not confirmed in three cases who were suffering from acute eczema, herpes zoster, and vulvitis respectively. All the cases recovered satisfactorily. PUERPERAL INFECTIONS. Eight women with puerperal infections were admitted. In 2 cases mastitis was present. In another 4 cases a Group A hæmolytic streptococcus was grown in the cervical swab. Two women had typical attacks of influenza to account for the pyrexia. All the cases made satisfactory progress. Three cases of septic abortion were admitted. They were all incomplete abortions but sepsis was successfully avoided. One case was complicated by the presence of chicken pox. INFECTIONS OF THE NEW-BORN. Five babies with their mothers were admitted. Two babies had abscesses and the other three were sent in with a diagnosis of pemphigus. All cases were very mild. The number of lesions varied from one to three vesicles or pustules per baby. CONSULTING STAFF. The following Consultants were called in during the year :— Mr. Miller, the Otologist, performed mastoid operations in two cases of Meningitis and in one case of chronic Suppurative Otitis Media and Scarlet Fever. He also removed tonsils its three convalescent diphtheria carriers. « Dr. Lewis was the Anaesthetist in all these operations and also for a tracheotomy. Dr. Maurice Shaw, the Physician, saw a case of Endocarditis and persistent pyrexia following Scarlet Fever. Mr. Cholmeley, the Orthopaedic Surgeon saw and advised treatment for the case of Poliomyelitis before taking charge of her at the Royal National Orthopaedic Hospital. TONSILLECTOMY IN SCHOOL CHILDREN. During the year 25 sessions were held, 16 between April and July and 9 from September to November. Operations were suspended during the winter months. 121 children had tonsils and adenoids removed. Two children had tonsillectomy only, and 9 children had adenoids removed. The Surgeon was Mr. Miller and the Anaesthetist Dr. Lewis. 62 ILLNESS OF STAFF. Only 5 members of the staff have been ill during the year, suffering from Tonsillitis, 2 cases. Whitlow, 2 cases. Tracheitis, 1 case. Furunculosis and Carbuncle of neck, 1 case. PERIVALE MATERNITY HOSPITAL During the year 1st April, 1945, to 31st March, 1946, 951 patients were admitted to the hospital. These included 19 emergency cases. Month Ealing Brentford and Chiswick Other Districts Total April 61 18 79 May 61 16 77 June 63 16 79 July 64 21 85 August 53 25 78 September 54 19 1 74 October 62 26 88 November 53 16 69 December 56 25 81 January 66 21 87 February 42 24 66 March 20 68 88 655 295 1 951 The greatest number of patients in hospital on any day was 55 on 15th July, 1945. The average period of stay was 15.49 days. EMERGENCY CASES The 19 emergency cases admitted were as follows :— 1. A multipara was admitted with a breech presentation, the membranes having ruptured. The baby died during labour. The mother was discharged well. 2. This patient was sent in for ante-partum haemorrhage at the 32nd week of pregnancy. Several small haemorrhages occurred and a classical Caesarean section was performed. The premature baby died of heart failure on the third day. The mother was well on discharge. 63 3. This multipara had had twelve previous normal deliveriesShe was admitted for ante-partum hæmorrhage at 32 weeks. A stillborn breech delivery followed with only slight bleeding. The puerperium was normal and the mother made a good recovery. 4. This case was booked for evacuation. She was admitted with a history of ruptured membranes. This was not confirmed and as labour did not come on she was discharged. 5. A midwife's case was sent in by a private doctor for albuminuria. Spontaneous labour with a normal delivery followed. The baby was vigorous. The mother was well on discharge. 6. This patient was sent in by a private doctor for raised blood pressure at term. There was no albuminuria. A medical induction was given. Normal delivery followed with a normal puerperium. Mtother and baby went home well. 7. This was a case of hypertension with a small ante-partum hæmorrhage prior to admission. A normal delivery at term was followed by an uncomplicated puerperium. Mother and baby went home well. 8. This patient was admitted with a prolapsed cord, the membranes having ruptured 15 hours previously. Classical Caesarean section was performed as the cord was still pulsating, but the baby failed to breathe. The mother made a good recovery. 9. This patient was sent in as a case of hydrocephalus, but proved to be a face presentation of a normal infant. Delivery followed shortly after admission. Mother and baby both did well. 10. A case was admitted from a nursing home after six hours in the second stage of labour. A mid-cavity forceps delivery under general anaesthetic followed at once without undue difficulty. The baby was vigorous. Mother and baby both went home well. 11. This was a patient with a transverse lie and prolapse arm. Internal version was performed under a general anaesthetic and the baby extracted as a breech. Mother and baby both did well. 12. The ambulance brought this patient as she had made no preparations at home and was in advanced labour. A normal delivery and puerperium followed, and the patient took her own discharge on the 10th day. 64 13. A young primipara was admitted with a flexed breech. Mother and baby did well. 14. This patient was sent in as a case of premature labour having made no arrangements. A normal delivery followed, the baby being vigorous and of a good size. Mother and baby both did well. 15. This multipara was admitted for accidental ante-partum hæmorrhage at about 33 weeks gestation. The mother's condition was satisfactory. The baby was still-born. 16. This patient had made arrangements for her confinement in Birmingham, but labour began a few days earlier than anticipated. A normal delivery of a healthy baby followed with an uneventful puerperium. 17. This case of retained placenta and severe post-partum hæmorrhage was brought in by a general practitioner. A mild pyrexia occurring about the third day of the puerperium was caused by haemolytic streptococcus (Group A) so the patient was transferred to Clayponds Hospital. 18. A multipara was admitted in advanced labour, she having made no preparations at home, and the home being unsatisfactory for the confinement to take place there. Delivery followed within 10 minutes of admission. The puerperium was uneventful and mother and baby went home well. 19. An ante-natal patient was admitted for toxaemia. The condition subsided with treatment. The patient was allowed to go home to await the onset of labour. BOOKED CASES. Ante-natal Cases Admitted for Treatment. 87 patients were admitted during the pregnancy for treatment. The conditions for which they were admitted were as follows :— Toxaemia 39 Pyelitis 3 Cystitis 3 Hypertension 4 Mitral stenosis 1 Anaemia 2 65 Tuberculosis 1 Postmaturity 4 Medical Induction at term 2 Oedema 3 Hydramnios 3 Abnormal presentation for version 4 Trial Labour 9 Threatened Abortion 1 Diabetes 1 Epilepsy 1 Haematuria 1 Ante-partum Haemorrhage 5 Abnormal Presentations. Persistent occipito-posterior 20 Breech Flexed Breech 8 Extended Breech (a) Primipara 9 (b) Multipara 6 Breech extraction 5 Shoulder 3 Face Normal 1 Anencephalic 1 Prolapsed Cord 5 Twin Pregnancy Vertices 6 Vertex and Breech 5 Breeches 1 Obstetrical Manipulations and Operations. Episiotomy 41 External Version 1 Internal Version 3 Rupture of Membranes for Toxaemia 18 66 Hypertension 3 Hydramnios 2 Diabetes 1 Accidental Haemorrhage 3 Craniotomy 1 Decapitation and evisceration 1 Trial Labour (a) for disproportion—Unsuccessful 1 (b) for high head in primipara without dispro- portion 13 (c) Successful following previous Cæsarean Section 1 (d) Successful following previous myomectomy 1 Cæsarean Section (1) Lower Segment—Failed trial Labour 2 Absolute disproportion 3 (2) Classical—Placenta prævia 2 Prolapsed cord in flat pelvis 1 Eclampsia 2 Forceps Delivery (a) Foetal distress 6 (b) Uterine inertia and delay 23 (c) Maternal distress 7 (d) Minor pelvic disproportion 11 (e) Prolapsed Cord 1 HÆorrhages. Ante-partum Central Placenta parovia 3 Accidental 4 Post-partum Moderate 32 Severe 28 Manual removal of placenta 10 Vulval Hæmatoma 1 Placental products removed in puerperium 8 67 Cases of Puerperal Pyrexia of a Notifiable Degree. Acute Mastitis Flushed Breast Breast Abscess Urinary Infection Uterine infection—Hæmolytic Streptococcus A Non-hæmolytic Streptococcus Uterine infection and septicaemia Uterine infection and pelvic sepsis Retained products Influenza Venous thrombosis Sciatica Offensive Stools Postoperative distension Anaemia Pyrexia during the; Puerperium not Notifiable. Mastitis or cracked nipples Breast Abscess Phlebitis Urinary infection Uterine infection (retained products with offensive lochia) Bronchitis General debility and anaemia Influenzal catarrh Patients Transferred to other Hospitals. To Clayponds Isolation Hospital To Springfield Mental Hospital Maternal Death. One death occurred, due to eclampsia. The patient was 5 1in in height and weighed 16½ stone. She was 32-34 wee pregnant on admission, with marked hydramnios. X-ray pri to admission showed that the presentation was a breec Expectant treatment was given on admission. The membran(???) ruptured spontaneously, but labour was very slow. The patie(???) was seen by the consultant obstetrician. She went into (???) from which she did not regain consciousness, and di(???) undelivered. 68 INFANTS Number of infants born 956 Males (alive) 477 Females (alive) 455 Still-born 24 Abortion 1 (???) ill-births. Fresh Full term 8 Premature 3 Anencephaly 2 Hydrocephaly 2 Macerated 9 Infant Deaths. Cerebral Haemorrhage 3 Atelectasis 2 Prematurity 7 Volvulus 1 Immaturity 1 Intraperitoneal haemorrhage 1 Monster 2 Hydrops foetalis 1 Ab normal Infants. Congenital Heart disease 1 Mongol 2 Talipes 1 Harelip and cleft palate 1 Hare Lip only 1 Hypospadias 2 Imperforate anus 1 Adenoids 1 69 Infants Illness. Cerebral Haemorrhage 3 Bronchitis 1 Staphylococcal abscess 2 Erythroblastosis 2 Hæmorrhagic disease 1 Cardiospasm 1 Fractured femur 1 Fractured humerus 1 Premature Babies Born Alive. 28-32 weeks gestation 3 32-36 weeks gestation (3 sets twins) 14 36-38 weeks gestation (5 sets twins) 19 Infants Weaned. Owing to mother's breast condition 23 Pending adoption 2 Infants Transferred to other Hospitals. To Clayponds Isolation Hospital— for suspected pemphigus 3 for staphylococcal abscess 2 To Great Ormond Street– Erythroblastosis 2 To Queen Elizabeth Hospital, Hackney— for cardiospasm 1 Consultants Called In. Dr. Rait Bell on 16 occasions. Mr. Arnold Walker on one occasion. Dr. Potter on one occasion. Dr. Tandy Cannon on 3 occasions. TRAINING OF PUPILS During the year ended 31st March, 1946, 46 pupils completed their course of training and entered for the examination of the Central Midwives Board. Of these pupils 35 were successful. 70