BRE 14 Borough of Brentford and Chismick REPORT on the Health of the District and School Medical Service during 1946 Including a REPORT by Dr. R. A. LEADER, Medical Superintendent of the Isolation and Maternity Hospitals O. C. DOBSON, M.D., D.P.H., D.P.A. Barrister-at-Law Medical Officer of Health. School Medical Officer. The Brentford Printing & Publishing Co., Ltd. BOROUGH OF BRENTFORD AND CHISWICK PUBLIC HEALTH COMMITTEE Councillor Griffin, Chairman. Alderman Edwards, M.B.E. Councillor Copp. ,, Fullerton-Bustard. ,, Mrs. Daniels. ,, Leahy. ,, Miss Naylor. Councillor Bulwer. ,, Mrs. Saint. ,, Mrs. Burden. ,, Sinclair. ,, Cleland, J.P. Ex~officio: Aldermen Pett, J.P., Stroud, J.P., and Humphrey. EDUCATION COMMITTEE Alderman Leahy, Chairman. Alderman Connor. Councillor Court. ,, Howard. ,, Cracknell. ,, Pett, J.P. ,, Mrs. Daniels. ,, Stroud, J.P. ,, Hicks. Councillor Braithwaite. ,, Johnson. • ,, Brierley. ,, Kitchingman. ,, Bulwer. ,, Munday. Mrs. Burden. ,, Miss Naylor. ,, Copp. ,, Sinclair.. Appointed by the Middlesex County Council : County Alderman Mrs. Barnes, J.P. Hughes, J.P. ,, Johnson, J.P. County Councillor Charlton, J.P. Cleland, J.P. Mrs. M. C. Boswocxd, J.P. Major Jenks, M.B.E., J.P. Mrs. D. Jupp, J.P. Mrs. M. A. J. Langford. MATERNITY AND CHILD WELFARE COMMITTEE Councillor Mrs. Burden, Chairman. Alderman Edwards. Councillor Johnson. ,, Leahy. ,, Maynard. Councillor Braithwaite. ,, Murray. ,, Brierley. ,, Miss Naylor. ,, Cory. ,, Riederer. ,, Cracknell. „ Sinclair. ,, Mrs. Daniels. Co-opted Members : Mrs. A. Jones, Mrs. L. Mountford, Mrs. K. Rainbiro, Mrs. C. Gordon-Brown, Mrs. A. D. Cory, Mrs. J. Lousada, Dr. M. E. F. Palmer. BOROUGH OF BRENTFORD AND CHISWICK INTERIM REPORT on the HEALTH OF THE DISTRICT and SCHOOL MEDICAL SERVICE DURING THE YEAR 19 4 6 O. C. DOBSON, M.D., D.P.H., D.P.A., Barrister-at-Law. 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 and Members of the Education Committee of the Borough of Brentford and Chiswick. Ladies and Gentlemen, I have the honour to submit an Annual Report on the Health Services, School Medical Services and Sanitary Circumstances of the District for the year 1946. 1946 was an eventful year in the development of the Health Services of the Borough. It was the first year of peace, in which the Health Services had to be resettled on a normal peace-time basis. It marked the passing of the National Health Service Act, which, when it takes effect, will transfer the control of the personal health services to a new Local Health Authority, which in your case will be the Middlesex County Council. Finally, it was a year in which shortage of, and many changes, in staff caused considerable difficulties in the smooth working of the Health Services as a whole. Dr. Leaning, Medical Officer of Health for 25 years, retired in March, 1946, and the Council put on record this appreciation of his services—" The Mayor . together with other members of the Council, paid tribute to the conscientious and untiring and unselfish manner in which Dr. Leaning had at all times carried out his duties during his 25 years' service with the Council. The Council, whilst appreciating the loss which has been sustained by the Borough in the retirement of Dr. Leaning, extended to him their sincere good wishes for his future health and happiness." Until my appointment in September, 1946, the duties of Medical Officer of Health were carried out in a part-time capacity by Dr. Maddison, Medical Officer of Health for Twickenham. He was assisted very ably by Mr. Micklewright, Chief Sanitary Inspector, who continued his good work with me in his last year of office, and I would be failing in my duty if I omitted to pay tribute to his valuable service. The Health Visitors and Office Staff were under establishment for most of the year, but Miss A. M. Edwards returned to the former, and Mr. R. A. James and Mr. P. G. Smith to the latter, after their demobilisation. The vital statistics may be regarded as satisfactory, the birth rate of 23.6 being above the national figure of 19.1, and the death rate of 11.1 being below the national figure of 11.5. The large 5 number of births resulted in the pressure on the clinics—particularly at Chiswick—becoming acute, and towards the end of the year a scheme was put in hand aimed at increasing- the Chiswick clinic facilities for child welfare, as this clinic was being used to the maximum capacity of the building. The infantile mortality figure of 26.6 can be compared very favourably with the national one of 43.0. It shows a considerable reduction on the previous year's figure of 36.1, and it is to be hoped that such a satisfactory state of affairs will continue. The only infectious disease showing any marked prevalence during the year was Measles, of which 188 cases were notified, and there was no death from this disease. Only seven cases of Diphtheria occurred, and this disease also caused no death. The incidence of Scarlet Fever—65 cases—was light and the cases were mostly of a mild nature. A report by Dr. R. A. Leader, Medical Officer of Health, Ealing, and Medical Superintendent, on the work of the Ealing and Brentford and Chiswick Hospitals Committee, covering the work of the Perivale Maternity Hospital and the Clayponds Isolation Hospital, is included. In November, 1946, a Domestic Help Organiser (Mrs. J. Robbins) was appointed, at first on a temporary basis, to develop and organise an important and growing service. The service rapidly gained in popularity and bids fair to become an important part of the personal health services; 20 worbers were being employed at the end of the year. The School Medical Services during 1946 were in a transitional stage following the Divisional Scheme of Administration subsequent to the introduction of the Education Act, 1944. The School Medical work was integrated with the Maternity and Child Welfare work to a very large degree, the Health Visitors acting in addition as School Nurses. Figures are given showing the work carried out in the various sections. A report by Miss A. S. Stewart, Senior Dental Officer, on the Dental Services, is included. I would like to take this opportunity of registering my sincere thanks, first, to the ladies who have worked so well in a voluntary capacity in the various clinics, second, to the staff in the Public Health Department who have co-operated so loyally, third to my colleagues in the other Departments in the Town Hall, and last, but not least, to you, Mr. Mayor and Ladies and Gentlemen, who have been so helpful and friendly in a difficult period of transition. I am, Ladies and (ientlemen, Your obedient Servant, O. C. DOBSON, Medical Officer of Health. 6 1 .—GENERAL STATISTICS, 1946. 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 1946) 57,220 2.—VITAL STATISTICS. Live Births. Total Male Female Legitimate 1104 582 522 Birth Rate per 1,000 of the estimated resident population = 23.6 Illegitimate 61 32 29 TOTAL 1165 614 551 Stillbirths. Total Male Female Legitimate 38 18 20 Rate per 1,000 total (live and still) Births = 33.2 Illegitimate 2 1 1 TOTAL 40 19 21 Deaths. Total Male Female 686 350 336 Death Rate per 1,000 of the estimated resident population = 11.1 Deaths from Puerperal Causes. Puerperal Sepsis — Rate per 1,000 total (live and still) Births = 2.5 Other Puerperal Causes 3 7 Deaths of Infants under One Year of Age. Total M ale Female Legitimate 27 16 11 Illegitimate 4 2 2 TOTAL 31 18 13 Death Rate of all infants per 1,000 live births 26.6 Death Rate of all legitimate infants per 1,000 legitimate live births 24.4 Death Rate of all illegitimate infants per 1,000 illegitimate live Births 65.5 Deaths from Measles (all ages) - Deaths from Whooping Cough (all ages) 1 Deaths from Diarrhoea (under 2 years of age) 5 Deaths from Cancer (all ages) 109 Deaths from the seven principal Zymotic Diseases 6 8 TABLE I. PARTICULARS OF BIRTHS AND DEATHS AS SUPPLIED BY THE REGISTRAR-GENERAL FOR THE YEAR 1946 Cause of Death Males Females All Causes 350 336 1. Typhoid Fever, etc. - - 2. Cerebro-Spinal Fever - - 3. Scarlet Fever - - 4. Whooping Cough 1 - 5. Diphtheria - - 6. Tuberculosis of the Respiratory System 23 6 7. Other Forms of Tuberculosis 2 5 8. Syphilitic Diseases 5 3 9. Influenza 5 1 10. Measles - - 11. Acute Poliomyelitis and Polio-Encephalitis - - 12. Acute Inf. Encephalitis 1 - 13. Cancer b. Cav. & Oesophagus (M), Uterus (F) 6 7 14. Cancer of Stomach and Duodenum 10 10 15. Cancer of Breast - 13 16. Cancer of all other sites 37 26 17. Diabetes - 2 18. Intra-Cranial Vascular Lesions 23 50 19. Heart Disease 97 100 20. Other Disorders of the Circulatory System 18 18 21. Bronchitis 24 20 22. Pneumonia (all forms) 18 20 23. Other Respiratory Diseases 4 5 24. Ulcer of Stomach or Duodenum 12 1 25. Diarrhoea under 2 years 4 1 26. Appendicitis 4 - 27. Other Digestive Diseases 1 3 28. Nephritis 9 3 29. Puerperal and Post Abortive Sepsis 7 - 30. Other Maternal Causes — 3 31. Premature Births — 3 32. Congenital Malformation, Birth Injury, Infantile 2 2 Disorders 9 7 33. Suicide 5 1 34. Road Traffic Accidents 5 3 35. Other Violent Causes 7 9 36. All other causes 15 17 ALL CAUSES 350 336 9 TABLE II. INFANTILE MORTALITY DURING THE YEAR 1946 Net deaths from stated causes at various ages under one year. Causs 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.) - - - - - - - - - - 12. Convulsions - - - - - - - - - - 13. Laryngitis - - - - - - - - - - - - 14. Bronchitis - - - - - - - - - - 15. Pneumonia (all forms) 1 - - - 1 2 2 1 - 6 16. Diarrhoea - - - - - - - - - - 17. Enteritis - - - - - - 1 3 1 5 18. Gastritis - - - - - - - - - - - 19. Rickets - - - - - - - - - - 20. Suffocation, overlying - - - - - - - - - - 21. Injury at Birth 1 - - - 1 - - - - 1 22. Atalectasis 2 - - - 2 - - - - 2 23. Congenital Malformation 4 - - - 4 - - - - 4 24. Premature Birth 6 2 - - 8 - - - - 8 25. Atrophy, Debility and Marasmus - - - - - - - - - - 26. Pemphigus Neonatorum - - - - - - - - - - 27. Other Causes 4 - - - 4 - - - 1 5 TOTALS 18 2 - 20 2 3 4 2 31 Births. Deaths. Legitimate 1104 Legitimate 27 Illegitimate 61 Illegitimate 4 Infantile Mortality Rate per 1,000 Births = 26.6. 10 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 1946. Accident Cases 249 Maternity Cases 463 Private Cases 648 Public Cases 429 Cases dealt with for other Boroughs 108 TOTAL 1897 Maternal Mortality. Deaths from Puerperal Causes:- Puerperal Sepsis Nil Other Causes 3 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 1937 - - 1938 2 2 1939 — 2 1940 — — 1941 — — 1942 - 2 1943 3 2 1944 — 2 1945 — — 1946 — 3 11 12 SUMMARY OF WORK AT THE MATERNITY AND CHILD WELFARE CLINICS—1946. BRENTFORD AREA CHISW1CK AREA TOTAL Grand Total 1946 Grand Total 1945 Monday Clinics Wed. Clinics TOTAL Tuesday Clinics Wed. Clinics Thurs. Clinics Fri. Clinics Number attending for the first time during the year : † * Under 1 year of age 147 138 285 198 21 229 184 632 917 794 Over 1 year of age 22 15 37 42 4 68 72 186 223 176 TOTALS 169 153 322 240 25 297 256 818 1140 970 Number of children attended and weighed :— Under 1 year of age 2101 2260 4361 3075 266 3640 2974 9955 14316 12733 Over 1 year of age 781 1230 2011 563 52 1117 1376 3108 5119 5053 TOTALS 2882 3490 6372 3638 318 4757 4350 13063 19435 17786 Number of children seen by Doctor:- Under 1 year of age 514 584 1098 7.25 84 707 664 2180 3278 2441 Over 1 year of age 268 329 597 268 34 425 432 1159 1756 1507 TOTALS ... 782 913 1695 993 118 1132 . 1096 3339 5034 3948 †Commenced 19th February, 1946, *Commenced 23rd October, 1946. 13 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 51 270 347 5 1259 24.7 CHISWICK 163 635 884 28 3730 22.9 TOTALS 214 905 1231 33 4989 23.3 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. Health Visitors. Seven Nurses were on the staff for this and the School Medical Service. The following is a summary of the work of the Health Visitors during the year:- (a) To expectant mothers:- First visits 504 Total visits 642 (b) To children under 1 year of age: First visits 1071 Total visits 1998 (c) To children between the ages of 1 and 5 years: Total visits 2282 (d) Ophthalmic visits 19 (e) Other Visits: Pemphigus Neonatorum 1 Child Life Protection 94 Post-Natal 131 Infantile Mortality 2 Epidemic Diarrhoea 3 Premature Birth 2 Miscellaneous (Special Visits, etc.) 166 TOTAL 5340 Child Life Protection (under Sections 206-220 of the Public Health Act, 1936). The following table gives particulars of registration during the year (1) Number of foster-parents on the Register:- (a) at the beginning of the year 14 (b) at the end of the year 13 (2) Number of children on the Register:- (a) at the beginning of the year 20 (b) at the end of the year 19 (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 1946 10073 14 Ealing Road Day Nursery (equipped for 28 children) Total attendances during the year 1946 5935 Nursery Classes. Total attendances during the year 1946:- Beverley Road (equipped for 25 children) 7688 Strand-on-the-Green (equipped for 50 children) 8445 Lionel Road (equipped for 50 children) 8495 . St. George's (equipped for 60 children) 8676 Care of Premature Infants. This work has been carried out on the lines set out in Ministry of Health Circular 20/44, dated March, 1944, as described in the Report for 1945. Care of Illegitimate Children. The Borough continues to participate in the County Scheme and use has been made of the Hostels at 16, The Park, Golders Green, and "Marylands," Hendon. Control of Lice Infestation. No change was made in the policy adopted in previous years. SANITARY INSPECTION OE THE AREA Tabular Statement of the Work of the Sanitary Department,1946 Inspections. Number of premises inspected on complaint 1689 Number of premises inspected in connection with infectious disease 90 Number of primary inspections 3743 Number of re-inspections 1579 Total number of inspections and re-inspections 5322 Action Taken (other than Housing Act, 1936). Cautionary or intimation notices served 1197 Statutory Notices issued (under Public Health Acts) 2 Summonses served - Number of Certificates under Rent, &c. (Restrictions) Acts issued to tenants 4 Number of Clearance Certificates issued to owners 2 15 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 195 Percentage of houses provided with water-closets 100!% Drains:- Tested (Smoke) 52 Unstopped, repaired, trapped, etc 107 Waste pipes, rainwater pipes, disconnected, repaired, etc 140 New soil pipes and ventilating shafts fixed 14 New sinks provided 25 Disconnecting traps and chambers inserted 25 Reconstructed (whole system) 7 Reconstructed (connections) 48 Percentage of houses draining into sewers 99.9% Surface water drains reconstructed 4 Surface water drains repaired 2 (b) Water Supply and Water Services. Draw taps on main 14 Percentage of houses supplied from Public Water Service 100% The whole of the district is supplied by Metropolitan Water Board Mains. There are five wells in the Borough and the following is the position with regard to these wells : (i) No 50, Strand-on-the-Green—well now dismantled. (ii) Ailsa Craig Works, Strand-on-the-Green—well now dismantled. (iii) Ailsa Craig Works, Strand-on-the-Green—well now dismantled. (iv) Mr. A. Knapp, 21, Grove Park Gardens—well working, but used for washing purposes only. Drinking water obtained direct from mains. (v) Green's Boat House, Riverside Lands—well ing, but used for washing purposes only. Drinking water obtained direct from mains. (c) Refuse. New bins provided 122 Frequency of refuse removed from each house weekly Number of Complaints received—dealt with by Engineer's Department. Method of disposal—barging away to controlled tip. 16 (d) Sundry Nuisances. Overcrowding (urgent cases reported to Housing Committee) Smoke Minor complaints only Accumulation of refuse 4 Foul ditches, ponds, etc., and stagnant water — Dampness 466 Yards repaired or repaved 17 Leaky roofs and eaves gutterings 698 Defective floorings, joists and skirtings209 Defective plasterwork to walls and ceilings 650 Premises cleansed and redecorated 376 Other defects 740 (e) Disinfection. Premises Disinfected:- Ordinary notifiable diseases 70 Phthisis 12 Cancer 13 Other diseases 4 Rooms stripped and cleansed (Section 167, Public Health Act, 1936) Premises treated for vermin 31 Premises treated for other pests (wasps, moths, ants, beetles) 22 (/) Slaughterhouses. Number on Register (including one Knacker's Yard) 5 Contravention of Byelaws Slaughter of Animals Act, 1933. ('vide Livestock (Restrictions on Slaughter) Order, 1940) Number of licences to slaughter animals issued during the year:- New Licences - Renewed Licences 2 FOOD AND DRUGS ACT, 1938. MIILK (SPECIAL DESIGNATIONS) REGULATIONS, 1936-1946. MILK AND DAIRIES ORDER, 1926. Number of premises on Register 20 Number of Dealer's Licences issued to sell:- (a) Tuberculin Tested Milk 5 (b) Accredited Milk (c) Pasteurised Milk 14 Number of Supplementary Licences issued to sell:- (a) Pasteurised Milk 2 (b) Tuberculin Tested Milk 2 17 Bakehouses. Number in district in use 17 Contraventions of Factory Acts - UNSOUND FOOD. List of Food Condemned during the year 1946. Fruit and Vegetables: Carrots 160 bags Cauliflower 49 cwts. Chestnuts 85 lbs. Parsnips 80 bags Walnuts 24 lbs. Meat: Beef 836¾ lbs. Chicken 3¾ lbs. Lamb 85 lbs. Mutton 2½ lbs. Ox Tails 1252¾ lbs. Pigs' Heads 66½ lbs. Porkl½ lbs. Pork Offal 26 lbs. Rabbits 25 lbs. Sausages (Beef) 17 lbs. Sausages (Pork) 17½ lbs. Sausage Meat 3¾ lbs. Veal 6¼ lbs. Fish: Cod 124 stones Eels 56 lbs. Fillet, Smoked 7 stones Hake 10 stones Whiting, Smoked 10 stones General Provisions: Bacon 208¾ lbs. Barley 29½ lbs. Beans, Butter 2 lbs. Biscuits 1026¾ lbs. Black Pudding 2¼ lbs. Bread 1¾ lbs. Butter 54 lbs. Cereal Sweepings 13 cwts. Cheese 325 ¼lbs. Chocolate 2 oz. bars—130 18 General Provisions (Continued) Chocolates 3½ lbs. Cocoa ¼ lb. Cooking Fat 29½ lbs. Crumpets 1613 Egg, Dried 1 lb. Egg Substitute 144 pkts. Eggs 505 Flour 666 lbs. Ham 88 lbs. Jam and Marmalade 56½ lbs. Lemon Cheese 24 lbs. Macaroni 128 lbs. Margarine 156½ lbs. Mustard 13 tins Oatmeal 106 lbs. Oats, Rolled 4 lbs. Paste 11 jars Peppers, Italian 457 boxes Pickles 16 Jars Prunes 309¼ lbs. Pudding Mixture 20 pkts. Quaker Oats 80 lbs. Rissoles, Meat 82 lbs. Salad Cream 1 bottle Soyetti 29 lbs. Sugar 314¾ lbs. Sultanas 178½ lbs. Syrup 8 lbs. Sweets (Boiled) 45 lbs. Swiss Rolls 12 Tea 30½ lbs. Vinegar 2 pints . Tinned Foods (Miscellaneous): Apricots 17 tins Beans, Baked 135 tins Beef, Corned 349¼ lbs Beetroot 16 tins Brisket 20 lbs. Brislings 3 tins Carrots 20 tins Crayfish 7 tins Damsons 2 tins Fruit Cocktail 6 tins Luncheon Meat 31 lbs. Luncheon Sausage 27¾ lbs. Meat and Vegetable Ration 137 tins 19 Tinned Foods (Continued). Milk, Condensed 34 tins Milk, Evaporated 1904 tins Milk, Household 161 tins Milk, Skimmed 51 tins Parsnips 1 tin Pate de Foie 2 tins Peaches 5 tins Pears 9 tins Peas 218 tins Pease Pudding 12 tins Pilchards 119 tins Pineapple 2 tins Plums 72 tins Salmon 150 tins Sardines 38 tins Soups 35 tins Spaghetti 7 tins Steak, Stewed 119 tins Steak and Kidney 7 tins Stew/Irish 6 tins Tomatoes 8 tins Tongue, Lambs' 4¾ lbs. Tongue, Ox 12 ¾bs. Vegetable Salad 7 ins 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 89 Number of applications received for licences to store and sell petroleum mixture 16 Number of applications received for licences to store and sell carbide of calcium 9 Number of gallons of petroleum spirit covered by licences 17800 Number of gallons of petroleum mixture covered by licences 7480 Quantity of carbide of calcium covered by licences 42524 lbs. 20 HOUSING. Housing Act, 1936. Owing to the difficulty experienced by builders in obtaining labour and necessary materials, the usual routine house-to-housc inspection in the Borough was again suspended during the year. PREVALENCE OF, AND CONTROL OVER, INFECTIOUS AND OTHER DISEASES A.-Notifiable Diseases during the Year 1946. Disease Total Cases notified Cases admitted to hospital Total Deaths Scarlet Fever 65* 47 - Whooping Cough 34 1 1 Diphtheria 7§ 7 - Measles 188 10 - Pneumonia 20 2 38 Cerebro-Spinal Fever 2 2 - Acute Poliomyelitis 1 1 - Dysentery 16† 10 - Ophthalmia Neonatorum 1 - - Puerperal Pyrexia 18 18 - Small-pox - - - Erysipelas 8 3 - Malaria (contracted abroad) 3 - - Encephalitis - - 1 *In addition, two cases originally notified and admitted to Hospital were subsequently diagnosed not Scarlet Fever. §In addition, eight cases originally notified and admitted to Hospital were subsequently diagnosed not Diphtheria. †in addition, one case originally notified and admitted to Hospital was subsequently diagnosed not Dysentery. B.-Ophthalmia Neonatorum. Cases Notified Cases treated at home Cases treated in hospital Vision unimpaired Vision impaired Total Blindness Deaths 1 1 Nil 1 Nil Nil Nil 21 22 C.-Ages of Cases of Infectious Disease Notified during the Year 1946. 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 Scarlet Fever 65* 1 - 4 2 3 39 7 4 3 2 - - Whooping Cough 34 4 8 8 6 3 9 1 - - - - - Diphtheria 7† - 1 1 - - 1 - 2 2 - - - Measles 188 5 10 28 21 31 84 4 1 2 1 1 - Pneumonia 20 - 3 - - - 4 2 1 - 1 6 3 Cerebro-Spinal Fever 2 1 - - - - - 1 - - - - - Acute Poliomyelitis 1 - - - - - - - - 1 - - - Dysentery 16§ 1 3 2 - - - - 1 3 2 4 - Ophthalmia Neonatorum 1 1 - - - - - - - - - - - Puerperal Pyrexia 18 - - - - - - - - 14 4 - - Smallpox - - - - - - - - - - - - - Erysipelas 8 1 - - - - - - - 1 - 3 3 Malaria (Contracted Abroad) 3 - - - - - - - - 1 2 - - Encephalitis - - - - - - - - - - - - - *In addition, two cases originally notified were subsequently diagnosed not Scarlet Fever. †in addition, eight cases originally notified were subsequently diagnosed not Diphtheria. §In addition, one case originally notified was subsequently diagnosed not Dysentery. 23 D.-Cases of Infectious Disease Notified during the Year, 1946. Classified in Wards. Disease NUMBER OF CASES NOTIFIED Brentford West Brentford Central Brentford East Bedford Park Chiswick Park Grove Park Gunnersbury Old Chiswick Turnham Green Total Cases Scarlet Fever 8 4 3 4 6 9 9 11 11 65 Whooping Cough 10 6 - 2 - 10 2 1 3 34 Diphtheria 2 1 1 - - 2 1 - - 7 Measles 27 6 3 15 25 18 16 49 29 188 Pneumonia 8 3 1 1 1 2 1 - 3 20 Gerebro-Spinal Fever - - 1 - - - 1 - - 2 Acute Poliomyelitis - - - - - - 1 - - 1 Dysentery 12 - - - - 1 2 1 - 16 Ophthalmia Neonatorum - - 1 - - - - - - 1 Puerperal Pyrexia - - - - - - - 18 - 18 Erysipelas 3 - 1 - - 1 - 2 1 8 Malaria (Contracted Abroad) 3 - - - - - - - - 3 Encephalitis - - - - - - - -; - - Tuberculosis- - - - - - - - - - - Respiratory 15 9 10 12 15 9 19 17 11 117 Non-Respiratory 1 - 4 1 1 1 2 1 1 12 E-TUBERCULOSIS-1946. Age Groups NEW CASES DEATHS Respiratory NonRespiratory Respiratory NonRespiratory Male Female Male Female Male Female Male Female Under 1 year - - - - - - - - 1- 5 years 1 2 - 1 - - - - 5-15 years 8 1 2 1 - - - - 15-25 years 17 20 1 2 3 1 1 1 25-35 years 18 17 2 - 2 - - 2 35-45 years 11 6 - 1 2 2 1 - 45-55 years 7 1 - - 8 1 - - 55-65 years 3 1 - 1 5 1 - - 65 years and over 3 1 - 1 3 1 - 2 TOTALS 68 49 5 7 23 6 2 5 During- the year 11 non-notified tuberculous deaths were recorded. LABORATORY WORK. The following table sets out a record of the bacteriological work during the year 1946, all of which was carried out in the Council's Laboratory. Result Suspected Disease Positive Negative Total Diphtheria - 192 192 Tuberculosis 1 19 20 Other Diseases - - - TOTALS 1 211 212 24 SCHOOL HEALTH SERVICES. MEDICAL INSPECTION AND TREATMENT RETURNS FOR THE YEAR ENDED 31st DECEMBER, 1946 TABLE I. MEDICAL INSPECTION OF SCHOOL CHILDREN. A.—Routine Medical Inspections : (1) No. of Inspections :— Entrants—500. Second Age Group—97. Third Age Group—713. Total 1310 (2) No. of other Routine Inspections—913. Grand Total 2223 B.—Other Inspections : No. of Special Inspections and Re-Inspections—1278. TABLE II. CLASSIFICATION OF THE NUTRITION OF CHILDREN INSPECTED DURING THE YEAR IN THE ROUTINE AGE GROUPS. Number of Children Inspected A (Excellent) B (Normal) C (Slightly Sub-normal) D (Bad) No. % No. % No. % No % Entrants 500 196 39.7 252 50.4 51 10.2 1 .2 Second 97 36 37.1 53 54.0 8 8.0 - - Third 713 349 48.8 333 467 29 4.0 2 .2 Other 913 437 47.8 440 48.2 36 3.9 - - TOTALS 2223 1018 45.8 1078 48.4 124 5.5 3 0.13 25 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 1903 Group II.—Treatment of Defective Vision and Squint. Under the Authority's Scheme Errors of Refraction (including squint) 276 Other defect or disease of the eyes (excluding those recorded in Group I) 13 Number of children for whom spectacles were: (a) Prescribed 286 (b) Obtained 236 Group III.—Treatment of Defects of Nose and Throat: Under the Authority's Scheme Received Operative Treatment 2 Received other forms of Treatment 7 Total Number Treated 9 DENTAL INSPECTION AND TREATMENT. By setting out the statistical results of the School Dental Service and the Maternity and Child Welfare Dental Service side by side, an accurate assessment of the total work carried out can be made without reference to two separate tables. During 1946, Miss I. C. Miller, L.D.S., R.C.S., Glasgow, was appointed whole-time Dental Officer and the staff now consists of three whole-time Dental Officers, three whole-time and one part-time Surgery Assistants and one clerk. The part-time Surgery Assistant is engaged in work connected with the Orthodontic Clinic and in clerical work. The most important event during the year was the inauguration of an Orthodontic Clinic, and in June Mr. C. F. Ballard, MaR-C.S., L.R.C.P., L.D.S., Was appointed Orthodontist to attend on two sessions a week. It is very obvious that this 26 extension of the service is much appreciated both by children and parents. Long: and difficult visits to a London Hospital extending sometimes over a period of years are no longer necessary and no child is denied regulation treatment because of its parents' inability to make long journeys. The proposed Orthodontic Surgery was not available during 1946 and the Orthodontic Clinic was carried on in one of the existing surgeries at Chiswick. This arrangement interfered with routine work and it is hoped to complete the new surgery in 1947. Mr. Ballard has submitted a report on the first six months' work of this most welcome extension of the service. It must be stressed that there is already a long waiting list for treatment and that more sessions will be required in the near future. 2,422 children were inspected during 24 routine inspection sessions and 1,751 referred for treatment. 973 children attended the clinic as casual or emergencies. The vast majority were children whose parents were anxious to obtain regular treatment, and not purely relief from pain. 919 of these cases were referred for treatment. The over-all acceptance rate was 85% and a total of 2,422 children actually received treatment during the year (2 Secondary Grammar Schools inspected during 1945 were treated in 1946). 5,235 permanent fillings and 1,656 temporary fillings were inserted. 295 permanent teeth were extracted for caries and 81 for overcrowding. 1,851 temporary teeth were extracted. 2,335 other operations were carried out. The ratio of permanent teeth filled to permanent teeth extracted remains high at 18: 1 and the ratio of temporary teeth filled to temporary teeth extracted improved to 1 : 1.1. Appreciation of conservative dentistry continues to grow and the service in this area has reached a stage in its development when it is, in the large majority of cases, no longer a question of persuading parents to accept treatment. The problem is to cope with a very definite demand for regular attention. This can be provided only by a service which is well equipped and well staffed. An output of 2,865 fillings per Dental Officer is a very satisfactory one and it is obvious that if the present high standardof treatment, reflected in the ratio of fillings to extractions, is to be maintained and the time elapsing between routine inspection decreased, the service will have to expand. The raising of the school leaving age will place an additional responsibility on the service. Tribute must be paid again to the help afforded by the teachers of the district; they contribute very largely to the smooth running of the service. 27 Maternity and Child Welfare. Complete treatment, that is fillings, scalings, extractions, dentures, etc., is provided for ante and post-natal patients and for pre-school children referred from the Maternity and Child Welfare Clinics. Parents of pre-school children are advised to bring them at three-monthly intervals until school age is reached. Children under five years of age make excellent patients and the early and regular treatment provided largely eliminates the necessity for carrying out extensive treatment, often involving extractions, at school entry age. The number of children taking advantage of the service, however, is small compared with the total number of school entrants. As far as possible all treatment is carried out early in pregnancy, but the fact that the majority are not in the habit of seeking regular inspection and treatment means that, to render each patient dentally fit, much work of a lengthy and time consuming nature is required. That this branch of the service is an expanding one is shown by the increase of 963 in attendances over those for 1945, and 936 more fillings were inserted. The ratio of permanent fillings to permanent extractions is now 2.7: 1 and that for temporary fillings to temporary extractions 2.5: 1. This is a satisfactory indication of the high standard of treatment being given but gives no grounds for complacency. Expectant and nursing mothers and pre-school children are afforded a high priority for treatment but it is unfortunate that any increase in the number of sessions devoted to this work can only be made at the expense of the school service. Only an increase in the staff and in the number of surgeries available will effect an improvement in the service as a whole. 28 Only an increase in the staff and in the number of surgeries available will effect an improvement in the service as a whole. Schools M. & C.W. Total 1. Inspected. (a) Routin 2422 542 2964 (6) Special 973 205 1178 TOTAL 3395 747 4142 2. Referred. (a) Routine 1751 (b) Special 919 TOTAL ... 2670 722 3392 3. Sessions. (a) Inspection 24 (b) Treatment 1115 (c) Administration, etc. 61 TOTAL 1200 319 1519 4. Treated 2422 656 3078 5. Attendances 6484 3019 9503 6. Fillings. (a) Permanent Teeth 5235 1332 6567 (b) Temporary Teeth 1656 374 2030 TOTAL 6891 1706 8597 7. Extractions. (a) Permanent Teeth 295 558 853 (b) Overcrowding 81 — 81 (c) Temporary Teeth 1851 137 1988 TOTAL 2227 695 2922 8. Administration of Gas (N20) 971 266 1237 9. Ratio of Permanent Fillings to Permanent Extractions 18 : 1 2.7 : 1 7.7 : 1 10. Ratio of Temporary Fillings to Temporary Extractions .9 : 1 2.5 : 1 1 : 1 11. Other Operations. (a) Permanent Teeth 1596 863 2459 (ft) Temporary Teeth 739 217 956 TOTAL 2335 1080 3415 12. Number of Dentures - 76 76 13. Patients fitted with Dentures - 49 49 14. Fillings per session (average) 5.7 5.3 5.6 15. Extractions per session 1.8 2.1 1.9 16. Other Operations per session 1.9 3.3 2.2 17. Attendances per session 5.4 9.4 (Incl. Inspections) 6.2 29 ORTHODONTIC REPORT 1946 (JUNE—DEC.). The Orthodontic Scheme for the children of Brentford and Chiswick commenced in June, 1946. Orthodontics is that branch of Dental Surgery which treats irregularities of the teeth and the underlying causes of such irregularities. There are many reasons for the correction of dental abnormalities but three are of major importance. First, with the teeth set in regular arches and the jaws rrteeting one another in the correct anatomical manner, the entire dentition is in the best possible position to withstand disease. The treatment of decay or' pyorrhoea in a mouth with irregular teeth may be a waste of time. Second, many irregularities are such that the child, even at a comparatively early age, begins to worry about his or her appearance and this reacts unfavourably on the mental outlook. Third, the muscles of the face and throat must function correctly for breathing, voice production and mastication. Irregularities of the teeth may prevent the proper action of these muscles. Frequently, however, the position is reversed, that is, abnormal action of muscles is the cause of irregularities of the teeth. In such cases, reeducation of muscle function must run concurrently with orthodontic treatment. In many such cases, the work is done in close co-operation with the E.N.T. specialist and speech therapist. The Orthodontic Surgeon attends on two sessions each week, when cases referred by the other Dental Officers are seen. A child may be referred at any age but frequently a case under twelve years old will not have treatment commenced immediately. Such eases are kept under frequent observation so that treatment may be commenced at the appropriate time. This is usually between 12 and 13 years of age, and partly explains the figures of 107 cases seen and only 39 cases treated by December, 1946. Much of the treatment is carried out by fixed appliances. These are of such a specialised nature that much valuable surgery time has to be spent doing work that should be done by a dental mechanic. Few mechanics, however, are capable of doing this work and these are generally attached to hospitals. It is to be hoped that in the near future the Middlesex School Dental Service will start its own dental laboratory when a good deal of this work can be passed on and so more time can be devoted to the patients. As to the reaction of parents to this new service, our experience during the last few years has been that many parents have been seeking treatment without being able to obtain it. Now that it is available they are very pleased and co-operate wholeheartedly. This is very important because the co-operation of both parents and children is essential to success. In the few cases where there has been lack of co-operation, treatment has either been simplified or as in one case, discontinued altogether. 30 An essential aid to diagnosis and treatment are radiographs showing the position of unerupted teeth. These X-Rays are obtained from the West Middlesex County Hospital, the children being sent there by appointment. It is important to remember that many irregularities are produced by early loss of deciduous (baby) teeth and many irregularities already present are made more difficult to treat by this early loss. It is a pleasure to record, therefore, that the efficient work of the Dental Officers of Brentford and Chiswick has kept this type of irregularity to a minimum. There is a waiting list of 150 of nearly all age groups. These are not necessarily taken in rotation as priority is given so that treatment can be completed before school leaving age is reached. Most of the young children on the list are inspected to ensure that no urgent treatment is required and then theyt are kept under observation. Particulars of Work Carried Out at Chiswick Orthodontic Clinic for the Period June to December, 1946. First inspections 107 Treated with appliance removable 15 Treated with appliance fixed 24 Impressions for reference 236 Impressions for appliances 33 Adjustments 22 Molar bands made 46 Separating wires fitted 2 Advised no treatment 1 Cases dismissed 1 Sessions devoted to treatment ... ,f.. ... 45 TABLE V. (1). Average number of visits per school made during the year by School Nurses 9.3 (2). Total number of,examinations of children in the' schools by School Nurses 20,456 (3). Number of individual children found unclean . 537 (4) Number of individual children cleansed under Section 54 of the Education Act, 1944 (5) Number of cases in which legal proceedings were taken: (a) Under the Education Act, 1944 - (b) Under School Attendance Byelaws - 31 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 relates to all such children, including evacuees, resident in the Authority's area. 1 2 3 At a Public Elementary School At an Institution other than a Special School At no School or Institution Blind Children Nil Nil Nil Deaf Children Nil Nil Nil MEDICAL INSPECTION AND TREATMENT OF SECONDARY GRAMMAR AND TECHNICAL SCHOOL CHILDREN A.-—Routine Medical Inspections. (1) No. of Inspections:- Age Group No. of Inspections 10 — 11 7 12 86 13 46 14 130 15 185 16 67 17 13 TOTAL 594 (2) No. of other routine inspections—Nil. B.—Other Inspections. Number of Special Inspections and Re-inspections—Nil. 32 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. % 10 - - - - - - - - - 11 67 33 49.2 30 44.8 4 5.9 - - 12 86 49 56.9 34 39.3 3 3.5 - - 13 46 24 52.2 18 39.1 4 8.7 - - 14 130 63 48.5 65 50.0 2 1.5 - - 15 185 106 57.3 72 38.9 7 3.8 - - 16 67 50 74.6 16 23.9 1 1.5 - - 17 13 9 69.2 4 30.8 - - - - TOTALS 594 334 56.2 239 40.2 21 3.5 - - Group I.-Treatment of Minor Ailments (excluding uncleanliness) : Total Number of Defects treated or under treatment during the year under the Authority's scheme 78 Group II.-Treatment of Defective Vision and Squint: Under the Authority's Scheme Errors of Refraction (including squint) 122 Other defect or disease of the eyes (excluding those recorded in Group I) - No. of children for whom spectacles were :- (a) Prescribed 102 (b) Obtained 85 The following- information is additional to the Statutory Tables issued to the Ministry of Education :- Orthopaedic Clinic. School Welfare Total Total number of attendances 1261 404 1665 Number of individual children 129 73 202 Surgeon:- Total number of attendances 227 170 397 Number of individual children 147 102 249 33 Sun-Ray Clinic. School Welfare Total Total number of attendances 427 174 601 Number of individual children 35 21 56. Rheumatism Clinic. Total number of attendances 458 Number of individual children 94 Number of children admitted to Hospital as In-Patients 17 Number of children attendingHospital as Out-Patients 6 Number of children admitted to Convalescent Homes 6 Minor Ailment Clinic. Total number of attendances 9073 Number of individual children 1815 Total number of exclusions 735 Total number of re-admissions 567 Number of Special Cases 1338 Number of Special Cases re-inspected 223 Ophthalmic Clinic. School Welfare Total Number of attendances 899 114 1013 New Cases 109 28 137 Retinoscopy 132 25 157 Glasses prescribed 172 12 184 Glasses issued 142 7 149 Other cases 60 26 86 Individual children 324 48 372 Immunisation Clinic. Number of attendances 2540 3343 5883 Personal Hygiene. Number of visits to schools 186 Average number of visits per school 9.0 Number of examinations 19571 Number of individual children defective 1396 Number of re-examinations 885 34 Visits. Total number of visits by School Nurses 480 The following table shows the incidence of Infectious Disease in schools during the year 1946. Jan. Feb. Mar. Apr. May Jun. Jly. Aug. Sep. Oct. Nov. Dec. Tot. Scarlet Fever 7 5 6 6 5 6 3 - 4 6 2 1 51 Diphtheria 1 1 1 1 - - - - - 1 - - 5 Chicken-pox 59 38 61 30 36 20 4 - - 4 4 2 258 Measles - 4. 2 6 12 15 13 - 7 39 5 6 109 Whooping Cough 9 3 1 - 7 1 - - 5 2 - - 28 Mumps 1 5 18 17 46 45 21 - 5 4 2 2 166 Ringworm - 1 - 2 1 3 - - - 4 3 3 17 Impetigo 3 8 2 2 2 6 1 - 6 8 5 2 45 Eczema - - - 19 - - - - - 1 1 - 21 Verminous 3 11 11 - 20 11 2 - 13 - 5 3 79 Scabies 11 7 6 18 4 6 2 - 2 8 3 - 67 Other Skin Diseases 3 - - - 1 1 2 - - 1 - 4 12 German Measles - - - 4 2 3 - - - - - - 9 TOTALS 97 83 108 105 136 117 48 - 4,2 78 30 23 867 35 EALING AND BRENTFORD AND CHISWICK HOSPITALS COMMITTEE ANNUAL REPORT of the MEDICAL SUPERINTENDENT for 1946-1947 Town Hall, Ealing, W.5. 15th June, 1947. Madam Chairman, Ladies and Gentlemen, I have the honour to submit to you the Annual Report on the two hospitals for the year 1946-47. The national birth rate continues to rise and the number of births in your district therefore continues to increase, and this is well reflected in the statistics of the Maternity Hospital. Furthermore the Ministry of Health, in May of this year, in order to ensure the maximum usage of beds advised that consequent on a recent resolution of the Central Midwives' Board, all patients could now be discharged from maternity units on the tenth day instead of on the fourteenth day. This has naturally resulted in an increased number of patients being admitted, and during the period under review a total of 1191 patients have secured admission to Perivale Hospital, an increase of 25% as compared with the previous twelve months and an all time record figure. Such a list of cases is, of course, exceptional and could never have been contemplated for a hospital of 40 beds, but it does emphasise the demand for institutional care of maternity cases in the district. The number of emergency cases admitted has also increased and the fact that in 21 cases both the mother and baby were well on discharge from hospital, and in the remaining instance the pregnancy proceeded normally after treatment in the hospital, reflects great credit on the care and skill of the medical and nursing staff. A perusal of the case histories illustrates that most of the known complications of labour and the puerperium have been encountered during the year, with a nil maternal mortality, and it is pleasing to note that it has also been possible to admit more ante-natal cases for treatment, 130 patients as compared with 87 patients during 1945-46. This last is preventive work of the highest order and enables many conditions to resolve before the labour commences. 39 The number of patients treated at the Clayponds Hospital while well within the available accommodation, has actually increased this year by 30%. Of the 381 patients admitted, Scarlet Fever again claims the highest incidence with 128 cases, together with a further 3 cases of Streptococcal Sore Throat. This year it was found possible to admit some 76 cases of Measles during the epidemic period, no less than 43 of whom had medical complications. There were two fatal cases, one from septicaemia and the second from bronchial pneumonia and gastro-enteritis. Fifteen children suffering severely from Whooping Cough were also admitted, and one child aged 14 months and a second aged 4J months both died from broncho pneumonia. These cases illustrated the dangerous nature of these last two diseases in young children, and there is no doubt that more cases must receive hospitalisation in the future. Only 13 patients suffering from diphtheria were treated, all making good recoveries, eloquent testimony to the present schemes for immunisation against diphtheria in the boroughs. Generally speaking, a wider variety of cases has been admitted during the last year, and in my opinion this is a policy to be encouraged and developed. In this direction may lie the future of the infectious disease hospital, and a very useful contribution to the social problems of the district can thereby be made under the new regime. I wish to take this opportunity of recording my thanks to the members of the Committee and to the staffs of the institutions for the very willing support they have given me in my onerous task of assuming control of the administration following the retirement in November, 1946, of Dr. Thomas Orr. I am, Ladies and Gentlemen, Your obedient Servant, REGINALD LEADER, Medical Superintendent. 40 CLAYPONDS ISOLATION HOSPITAL The total number of patients admitted to the Hospital in the year 1946-47 was 381. The highest number of patients in hospital on any day was 40 on 1st June, 1946, and the lowest was 8 on 10th September, 1946. The average daily number was 22.1 The following; table indicates the number of cases of each disease admitted during the year: Disease Remaining in Hospital 31st March, 1946 Admitted during the year Discharged during the year Died during the year Remaining in Hospital 31st March, 1947 Diphtheria 6 13 19 - - Diphtheria Carriers - 3 3 - - Scarlet Fever 8 126 128 - - Measles 1 86 75 1 5 Whooping Cough - 15 11 2 10 Tonsillitis - 24 24 2 2 Streptococcal Sore Throat - 3 3 - - Vincents Angina - 4 3 - 1 Erysipelas - 6 6 - - Gastro-enteritis - 13 12 - 1 Dysentery (Sonne) - 3 3 - Meningitis and Meningococcal Infections - 6 2 2 2 Chicken-pox - 5 5 - - Mumps - 4 3 - 1 Pemphigus Neonatorum - 12 12 - Ophthalmia Neonatorum - 1 1 - - Nursing Mothers - 14 13 - - Complications of the Puerperium - 5 4 - 1 Pneumonia - 4 4 - - Acute Bronchitis - 4 4 - - Acute Poliomyelitis 1 2 3 - - Rubella - 2 2 - - Toxic Erythema - 2 2 - - Impetigo - 2 2 - - Influenza - 2 2 - - Intussusception - 2 2 - - Enteritis - 1 1 - - Infectious Mononucleosis - 1 1 - - Peritonsillar Abscess - 1 1 - - Pharyngitis - 1 1 - - Laryngitis - 1 1 - - Ulcerative Stomatitis - 1 1 - - Coryza - 1 1 - - Pleurisy - 1 1 - - Rheumatic Fever - 1 1 - - Cervical Adenitis - 1 1 - - Incomplete Abortion - 1 1 - - Dermatitis - 1 1 - - Eczema - 1 1 - - Pelvic Tumour - 1 1 - - Purpura Simplex - 1 1 - - Papular-Urticaria - 1 1 - - Sunstroke - 1 1 - - Pyrexia of Unknown Origin - 1 1 - - 41 DIPHTHERIA.—There were 13 cases of diphtheria admitted —11 from Ealing and 2 from Brentford and Chiswick. The age distribution of these were as follows :— Under 5 5—10 11—15 16—20 21—25 26—30 31—40 Over 41 0 4, 3 2 1 0 2 0 This low incidence of diphtheria shows a well marked decline on that of previous years which is part of the continuous reduction in the incidence of the disease since the introduction of diphtheria immunization. All cases were mild, but two patients who persistently remained carriers had to have their tonsils removed. The average period in hospital for all cases was 46 days. In addition to the above cases, three admissions were diagnosed as diphtheria carriers. The following cases were admitted as suffering from diphtheria and the diagnosis altered as shown. Tonsillitis 18 Vincents Angina 3 Cervical Adenitis 1 Bronchitis 1 Laryngitis 1 Peritonsillar Abscess 1 Infectious Mononucleosis 1 Nasopharyngitis 1 Streptococcal Sore Throat 3 Ulcerative Stomatitis 1 SCARLET FEVER.—Scarlet Fever admissions numbered 126 (87 from Ealing and 39 from Brentford and Chiswick). The age distribution of the cases was as follows:— Under 1 1—2 3—5 6—10 11—15 16—25 26—45 Over 45 1 7 33 57 20 4 4 0 The following complications were encountered either on admission or during the course of treatment :— Cases Case Otitis Media 9 Myocarditis Cervical Adenitis 10 Appendicitis Rheumatism 3 Rhinitis Paronychia 3 Herpes Zoster 1 Sinusitis 2 Glandular Abscess Secondary Tonsillitis . 2 Impetigo Bronchitis 2 Conjunctivitis Farunculosis 2 Streptococcal Fissure The majority of the complications were of a mild type. Thus 4 out of the 9 cases of otitis media subsided without otorrhoea and only one case of cervical adenitis developed a glandular abscess. 42 There was, however, one fatal case of scarletinal myocarditis in a 5 year old child in which death from acute heart failure occurred within 12 hours of the onset of the symptoms on the 5th day after admission. This must have been an instance of the now rare hypertoxic variety of the disease, though previous signs and symptoms had not suggested that such was the case. The average period in hospital of scarlet fever cases was 28 days. Two cases of scarlet fever were cross-infected with chickenpox, while a third case was admitted while incubating chicken-pox developing the disease 11 days after admission. One of the scarlet fever cases was due to an infected burn. In the following cases admitted as suffering from scarlet fever, the diagnosis had to be altered as shown :— . Tonsillitis 3 Measles 1 Rubella 2 Eczema 1 Toxic Erythema 1 Dermatitis 1 Purpura Simplex 1 Pharyngitis 1 Papular Urticaria 1 Lobar Pneumonia 1 MEASLES.—There was a total of 86 cases of measles admitted during the year. The high proportion of measles admissions was due to the occurrence of an epidemic of this disease during the last four months of the year which necessitated reserving a special ward for measles patients. 54 of these admissions were from Ealing and 32 from Brentford and Chiswick. The age distribution of measles cases was as follows:— Under 3 3—5 Over 5 46 21 19 The complications encountered, most of which were present on admission, were as follows :— Broncho pneumonia 21 Tonsillitis 1 Otitis Media 5 Blepharitis 1 Bronchitis 4 Subcutaneous Abscess . 1 Acute Mastoiditis 2 Pharyngitis 1 Gastro-enteritis 2 Stomatitis 1 Scarlet Fever and Conjunctivitis 1 Septicaemia 1 Coryza 1 Cellulitis 1 A high incidene of haemorrhagic rashes was also noted1. It will be seen that the majority of cases admitted were young children in many of whom chest complications had already occurred. The high incidence and severity of complications—a 43 common feature of widespread epidemics—was probably accentuated this year due to the exceptionally cold weather experienced during the height of the epidemic. There were two fatal cases. One child, aged 4 years, died seven days after admission, death being considered due to streptococcal septicaemia. The other fatal case was that of a case of a child of 15 months suffering on admission from broncho-pneumonia and gastroenteritis. Mastoidectomy had to be performed on the two children who developed acute mastoiditis. In one of these children there was a co-existing chicken-pox infection. The average period in hospital for all measles admissions was 18 days. In all cases except one admitted as measles, the diagnosis was confirmed. WHOOPING COUGH.—Of the 15 patients admitted suffering from whooping cough, 12 were from Ealing and 3 from Brentford and Chiswick. Their age distribution was as follows : Under 1 yr. 1—2 2—5 Over 5 7 3 4 1 The following complications were encountered : Broncho-pneumonia 6 cases One case became cross infected with chicken-pox. Convulsions 2 cases Bronchitis 4 cases Due to the high ratio of infants admitted, this small total of whooping cough patients included a high proportion of seriously ill cases. There were two fatal cases. One child aged 14 months died from broncho-pneumonia 15 days after admission. The other fatality concerned a baby aged 4\ months admitted in a moribund condition suffering from broncho-pneumonia and convulsions. Death occurred 6 hours after admission. In addition to the above confirmed cases, admissions for whooping cough included two cases of bronchitis and one of measles. DIARRHOEAL DISEASES.—Gastro-enteritis in infants constituted the most important disease of this group. Of the 13 cases of gastro-enteritis admitted, 9 were under 12 months of age. No fatalities occurred in cases of primary gastro-enteritis although one baby was so ill that recovery seemed scarcely to be expected. All cases except one were admitted during the last five months of the year, a period during which diarrhoeal disorders appeared to be more prevalent. 44 The other diseases of this group treated consisted of three patients suffering from Sonne Dysentery and one adult suffering from enteritis. No case of typhoid or paratyphoid occurred. In addition to the cases noted above two patients admitted as suffering from typhoid fever were diagnosed as measles and chicken-pox respectively, while in the case of three patients admitted for dysentery, two were found to be suffering from intussusception and one from pelvic tumour. MENINGITIS AND MENINGOCOCCAL INFECTIONS.— There were 6 admissions in this group. Of these, four were clinical cases of meningitis. In two cases meningococci were isolated from the cerebro-spinal fluid, in the third a coliform organism, while in the remaining case, though probably meningococcal, no organism was isolated. In one case there was a co-existing haemorrhagic nephritis. All four cases recovered without sequelae. There was one fatal case of meningococcal septicaemia. This was a boy 9 years of age admitted on the eighth day of disease when suffering from advanced heart failure. Complications present included pericarditis, pneumonia, pleurisy and focal lesions of the brain and meninges. Treatment resulted in a temporary improvement, but heart failure recurred and proved fatal. The remaining patient of this group, a child of 4 years, was admitted in a moribund condition and died within an hour of admission. The presence of meningitis was confirmed by post-mortem examination. One case of each of the following diseases was also admitted as suffering from cerebro-spinal meningitis : Lobar pneumonia, Broncho-pneumonia, Acute Bronchitis, Pleurisy, Tonsillitis, Influenza, Toxic Erythema and Sunstroke. ERYSIPELAS.—The six cases of erysipelas, mostly facial, all responded rapidly to treatment and do not merit special comment. CHICKEN-POX.—The five cases of chicken-pox listed are in addition to those already mentioned as associated with other infections. They were admitted either because other conditions requiring hospital treatment were present or suspected, or because of lack of facilities for home nursing. MUMPS.—Two admissions for mumps were uncomplicated. The remaining two patients were suffering on admission from threatened abortion and acute appendicitis respectively. ACUTE POLIOMYELITIS.—Despite the fact that this disease was epidemic in other parts of the County, only two cases were admitted. One of these was a mild case with minimum 45 paralysis. In the other patient, paralysis was extensive, including partial respiratory paralysis. Unusual features were a normal cerebro-spinal fluid and complete recovery from extensive muscular involvement. Two other patients admitted as suffering from poliomyelitis were diagnosed as rheumatic fever and influenza, while in a third case no ascertainable cause for pyrexia could be discovered. COMPLICATIONS OF THE PUERPERIUM.—No severe infection was encountered in this group of cases. Two cases of puerperal pyrexia had a mild degree of sapraemia, while post partum haemorrhage, femoral thrombosis and anaemia and tonsillitis accounted respectively for the remaining three admissions. INFECTIONS OF THE NEW-BORN.—All twelve cases of pemphigus admitted were mild infections which completely recovered in periods of from 1—2 weeks. The ophthalmia case treated recovered without damage to the eyes. CONSULTANT STAFF.—The following Consultants were called in during the year : Mr. Miller, the Ear, Nose and Throat Specialist, performed mastoid operations in two cases of acute mastoiditis. He also removed tonsils in two convalescent diphtheria carriers. Mr. Gordon Bryan, Surgeon, visited to see a case of intussusception, later successfully reduced at King Edward Memorial Hospital. Miss F. Barry, Surgeon, performed appendicectomy in a case of acute appendicitis occurring in a tonsillitis patient. Mr. Murray, Surgeon, performed appendicectomy in a case of acute appendicitis occurring in a scarlet fever patient. He also successfully treated expectantly a case of acute appendicitis in a patient suffering from mumps and saw a case of intussusception later successfully operated on at the Middlesex Hospital. Mr. Rait Bell, Gynaecologist, visited two patients and performed curettage in a patient suffering from post-partum haemorrhage due to retained placental products. Mr. Cholmeley, Orthopaedic Surgeon, visited to advise on the after treatment of a case of poliomyelitis. Dr. Lewis, Anaesthetist, gave anaesthetics for the two mastoid operations, two appendicectomies, two tonsillectomies, and curettage already mentioned. 46 TONSILLECTOMY IN SCHOOL CHILDREN.—Twentytwo sessions were held between April and July. 164 children had tonsils and adenoids removed. 1'he Surgeon was Mr. Miller and the Anaesthetist Dr. Lewis. ILLNESS OF STAFF.—Only seven members of the staff have been ill during the year suffering from : Tonsillitis 1 case Furunculosis 1 ,, Chicken-pox 1 ,, Cervical Polypus 1 ,, Appendicitis 1 ,, Vincents Angina 1 ,, Trichomonas Infection 1 ,, PERIVALE MATERNITY HOSPITAL During the year 1st April, 1946, to 31st March, 1947, 1191 patients were admitted to the hospital. These included 22 emergency cases. Month Ealing Brentford and Chiswick Other Districts Total April 60 24 84 May 66 27 93 June 70 18 88 July 65 31 96 August 73 32 105 September 74 34 108 October 85 24 109 November 62 23 85 December 77 28 105 January 82 27 109 February 77 35 112 March 69 28 97 860 331 1191 The greatest number of patients in hospital on any day was 62 on 1st March, 1947. The average period of stay was 11.764 days. 47 EMERGENCY CASES The 22 emergency cases admitted were as follows:— 1. Gravida 5, aged 37 years, admitted as a prolonged labour with uterine inertia. On admission she had fairly strong pains and a normal delivery followed. She had a retained placenta which was removed manually and the mother's condition was good. Puerperium was uneventful and both mother and baby were satisfactory on discharge. 2. Gravida 4, aged 30 years, admitted for an extended breech with prolonged labour and a history of obstetric shock with her other babies. Normal breech delivery followed but patient had a post-partum haemorrhage with a retained placenta. Manual removal was performed and patient's general condition was fairly good. Both mother and baby were satisfactory on discharge. 3. A primipara aged 32 years, a Midwife's case, was admitted as a toxaemia of pregnancy. She had marked oedema of legs and ankles, no albuminuria but blood pressure was 160/90. She was 38 weeks pregnant. After one week of conservative treatment she complained of nausea and her oedema increased, so a surgical induction was done. A normal delivery followed and both mother and baby were satisfactory on discharge. 4. Primipara, aged 28 years, admitted as an albuminuria, 36 weeks pregnant. Patient's general condition was good, blood pressure 120/80, no oedema. She was treated conservatively at first and a surgical induction was done 10 days later. Normal delivery followed and the puerperium was uneventful. Both mother and baby were well on discharge. 5. Gravida 3, aged 33 years, admitted as a pre-eclamptic toxaemia. She was 36 weeks pregnant, blood pressure 160/120, albuminuria with oedema of ankles and feet. Her two previous babies were alive and well but the last one was jaundiced at birth. She was given a simple medical induction and a normal delivery followed the next day. On the second day the baby was deeply jaundiced and was vomiting. The baby was transferred to Great Ormond Street Hospital as an Icterus Gravis, where she was given a blood transfusion and progressed satisfactorily. The mother's puerperium was uneventful. 6. Gravida 5, sent in by a Doctor as an ante-partum haemorrhage. Patient was 38 weeks pregnant and had had one sudden free red loss at home. On admission general condition was good, blood pressure 150/85, no albuminuria, head engaged in pelvis and the patient was in labour ha,ving good contractions. Normal delivery followed with little further red loss, and on 48 examination of the placenta it showed a lateral insertion. Patient had an attack of asthma whilst in hospital but both she and the baby were satisfactory on discharge. 7. Primipara, aged 24 years, booked by a District Midwife, was found to be a footling presentation when in labour and was sent into hospital. She was in the second stage of labour for two hours with no advance and very poor pains, so a general anaesthetic was given and the breech extracted. Forceps were applied to the after-coming head. The mother's puerperium was uneventful and both she and the baby were satisfactory on discharge. 8. Primipara sent in by a doctor as Uterine inertia, said to have been in labour for four days. On admission she was very tired and was having poor contractions. Sedatives were given and a normal delivery of a 91bs. 5ozs. baby followed. The mother had a mild urinary infection during the puerperium but both she and the baby were satisfactory on discharge. 9. Gravida 2, a midwife's case, sent in by a doctor as a persistent Occipito-posterior position with foetal distress. On admission the head was on the perineum and a 91bs. baby was delivered normally. The puerperium was uneventful and both mother and baby were satisfactory on discharge. 10. Gravida 3, admitted with mild toxaemic signs. Normal delivery followed after a medical induction at term, and both mother and baby were well on discharge. 11. Gravida 2, ag'ed 32 years, booked with a midwife, was sent in with Hydramnios. Normal delivery followed a simple medical induction. The baby weighed 10lbs. 2ozs. Both mother and baby were well on discharge. 12. Gravida 2 was admitted as a shoulder presentation at a Doctor's request. It was a footling presentation on admission and a normal breech delivery followed. Puerperium was uneventful and both mother and baby were well on discharge. 13. Primipara, aged 22 years, sent in as a uterine inertia. She had been in labour 36 hours with ruptured membranes, and on admission the os was 1/3 dilated with poor contractions. Forceps were applied two hours after full dilation and the third stage followed normally. The mother had a urinary infection during the puerperium but both she and the baby were discharged as satisfactory on the 14th day. 14. Gravida 3, aged 23 years, admitted at request of a Doctor as a face presentation in labour. On admission patient was having very strong pains and on vaginal examination the 49 vertex was low in the pelvis. The internal os and cervical canal was dilated but the external os was cut and forceps applied. The cervix was sutured with catgut. The puerperium was uneventful and both mother and baby were well on discharge. 15. Primipara, 36 years old, was admitted as a breech presentation for external version. However, patient started in labour the same day and a normal extended breech delivery followed. Both baby and mother were well on discharge. 16. Primipara was admitted at a Doctor's request as a delayed second stage. The baby was in a persistent occipitoposterior position and was rotated under a general anaesthetic and forceps applied. Third stage was apparently normal but on the 8th day patient had a secondary post-partum haemorrhage. A digital evacuation of the uterus was carried out and no further haemorrhage occurred. Both mother and baby were well on discharge. 17. Gravida 3, admitted with acute retention of urine with overflow. She was three months pregnant with a retroverted uterus. She was catheterised and the uterus replaced and micturition was normal on discharge from hospital. 18. Primipara, a midwife's case, admitted at request of a Doctor as a foetal distress. On admission the patient was fully dilated with meconium stained liquor and the foetal heart was slowing. A low forceps delivery was carried out and both mother and baby were satisfactory on discharge. 19. Gravida 3, was booked for delivery at home, but was unable to find a midwife when labour commenced. She was admitted to Hospital and had a normal delivery. 20. Gravida 4, aged 33 years, was admitted in a poor general condition with mild toxaemic signs. She had a normal delivery and puerperium was uneventful. 21. Gravida 2, aged 34 years, admitted as a toxaemia of pregnancy. She was 37 weeks pregnant, blood pressure 140/95 and with albuminuria. Esbach 1½ parts. Normal' delivery followed a simple induction and both mother and baby were well on discharge. 22. Primigravida admitted as disproportion at request of her Doctor. The baby was delivered naturally but became rapidly jaundiced. It was transferred to the Westminster Hospital as an Erythroblastosis. It was treated and returned. Both mother and child were discharged well. 50 BOOKED CASES. Ante-natal Cases Admitted for Treatment. 130 patients were admitted during the pregnancy for treatment. The conditions for which they were admitted are as follows :— Toxaemia 61 Pyelitis 3 Hypertension 6 Mitral stenosis 3 General debility and anaemia 4 Tuberculosis 1 Post Maturity 2 Oedema 2 Hydramnios 2 Abnormal presentation for version 18 Phlebitis 3 Acute retention of urine 1 Trial labour 9 Ante-partum haemorrhage 9 Threatened miscarriage 1 Vaginal thrush 1 Dead Foetus 2 Herpes Zoster 1 Haematuria 1 Abnormal Presentations. Persistent occipito-posterior 20 Twin pregnancy— (а) Vertices 6 (b).Vertex and breech 5 (c) Breeches 3 Breech— (a) Flexed Breech (1) Primipara 8 (2) Multipara 5 (b) Extended Breech (1) Primipara 18 (2) Multipara. 2 (c) Breech extraction 4 Face 1 Vertex with prolapsed hand 1 51 Obstetrical Manipulations and Operations. Episiotomy 68 External Version 12 Internal Version 1 Rupture of membranes— for Toxaemia 26 Hypertension 3 Accidental Haemorrhage 1 Post Maturity 4 Forceps Delivery. (a) Foetal distress 5 (b) Maternal distress 5 (c) Uterine inertia 21 (d) Minor pelvic disproportion 7 (e) Prolapsed cord 1 Caesarean Section. (а) Upper Segment— (1) Primiperous Breech with Bilateral thrombosis 1 (b) Lower Segment— (1) Disproportion 3 (2) Rhesus factor 1 Ruptured Uterus. (a) Spontaneous 1 (b) Rupture of old myomectomy scar 1 High Head—primipara without disproportion 14 Unsuccessful Trial Labour—for disproportion 1 Eclampsia 4 Haemorrhages. Ante Partum. Central Placenta Praevia 0 Lateral Placenta Praevia 2 Accidental 1 Post Partum. Moderate 54 Severe 4 Manual removal of placenta 10 Secondary post partum haemorrhage 2 52 Notifiable Pyrexia 26 Acute Mastitis 1 Flushed Breast . 1 Urinary Infection 10 Uterine Infection— (a) Retained products 3 (b) Non-streptococcal infection 1 (c) Haemolytic streptococcal infection Group C 2 Influenza 7 Post operative distension 1 Non-notifiable Pyrexia during Puerperium 31 General debility 5 Urinary infection 11 Cracked nipples and mastitis 4 Breast abscess 2 Uterine infection 2 Phlebitis 1 Retained products 6 Patients Transferred to other Hospitals. To Clayponds Isolation Hospital— (a) for Haemolytic Streptococcal infection 2 (b) Dental abscess 1 Maternal Deaths 0 INFANTS. Number of infants born 1183 Males (alive) 612 Females (alive) 571 Stillborn 20 Abortion 1 Neo-natal deaths 11 Stillbirths. Fresh. (a) Full term 6 (b) Premature 2 (c) Anencephalic 1 Macerated 53 Abnormal Infants. Congenital Heart Disease 2 Mongol 3 Talipes 4 Hare lip 1 Hypospadias 3 Spina Bifida 1 Abnormal genitilia 1 Infants' Illnesses. Cerebral Haemorrhage Erythroblastosis 3 Congenital icthyosis 1 Premature Babies Born Alive 28—32 weeks' gestation (2 sets twins) 32—36 weeks'gestation 17 36—38 weeks'gestation 21 Infants Weaned. Owing to mother's breast condition 10 Owing to tuberculosis of mother 3 Owipg to baby's condition 1 Infants Transferred to Other Hospitals. To Clavponds Isolation Hospital with Staphylococcal Blisters 9 To West Middlesex Hospital—Spina Bifida 1 To Great Ormond Street—Erythroblastosis To Queen Elizabeth Children's Hospital—Erythroblastosis 1 To Westminster Hospital—Jaundice 1 Consultants Called In. Dr. J. W. Bell on 20 occasions. Mr. Arnold Walker on 6 occasions. Mr. Rees on one occasion. Dr. Potter on one occasion. Dr. Maurice Shaw on one occasion. TRAINING OF PUPILS. During the year ended 31st March, 1947, 44 pupils completed their course of training and entered for the examination of the Central Midwives' Board. All 44 pupils were successful. 54