AC 439(1)BRENMFARD CHISWICK BRE 15 BOROUGH OF BRENTFORD AND CHISWICK REPORT ON THE Health of the District AND School Medical Service during 1047 Including a REPORT by Dr. R. A. LEADER, Medical Superintendent of the Isolation and Maternity Hospitals O. C. DOBSON, M.D., O.P.H., D.P.A. Barrister-at-Law. Medical Officer of Health. School Medical Officer. The Brentford Printing 6r Publishing Co., Ltd., BOROUGH OF BRENTFORD AND CHISWICK PUBLIC HEALTH COMMITTEE Councillor Mrs. Daniels, Chairman. Alderman Edwards. „ Leahy. ,, Stroud. Councillor Brenton. ,, Brierley. ,, Bulwer. Councillor Mrs. Burden. ,, Copp. ,, Miss Naylor. ,, Riederer. ,, Wood. Ex-officio: Aldermen Fullerton-Bustard, J.P., Humphrey and Pett, J.P. MATERNITY AND CHILD WELFARE COMMITTEE Councillor Mrs. Burden, Chairman. Alderman Leahy. Councillor Avery. ,, Brenton. ,, Brierley. ,, Bulwer. ,, Copp. ,, Mrs. Daniels. Councillor Deane, H. ,, Johnson. ,, Miss Naylor ,, Riederer. ,, Mrs. Saint. ,, Wood. Co-opted Members: Mrs. R. Clayden, Mrs. A. Jones, Mrs. L. Mountford, Mrs. C. Gordon-Brown, Mrs. A. D. Cory, Mrs. E. Ford, Mrs. D. I. Pollitzer. EDUCATION COMMITTEE Alderman Leahy, Chairman. Alderman Connor. ,, Pett, J.P. ,, Stroud. Councillor Avery. ,, Brenton. ,, Brierley. ,, Bulwer. ,, Mrs. Burden. ,, Copp Councillor Mrs. Daniels. „ Deane, H. ,, Jenkin. ,, Johnson. ,, Middleton. ,, Munday. ,, Murray. ,, Miss Naylor. ,, Sinclair. ,, Stevens. Appointed by Middlesex County Council: County Alderman Mrs. Barnes, J.P. ,, ,, Mrs. O. A. F. Da1 ,, ,, Hughes, J.P. ,, Councillor Cleland, J.P. ,, ,, Hugh Franklin. Mrs. M. C. Boswood, J.P. Major Jenks, M.B.E., J.P. Mrs. E. M. Brierley, B.A, Mrs. M. Hoare. Mr. B. Wearn, M.Sc, 2 STAFF—PUBLIC HEALTH DEPARTMENT MEDICAL (Whole Time). O. C. Dobson, M.D., B.S., D.P.H., B.Hy.(Durham), L.R.C.P., M.R.C.S., D.P.A.(Lond.), Barrister-at-Law (Middle Temple), Medical Officer of Health and School Medical Officer. Miss P. Griffiths, M.R.C.S., L.R.C.P., D.P.H., Assistant Medical Officer of Health and Assistant School Medical Officer. E. G. Millar, B.A., M.B., B.Ch., B.A.O., Assistant Medical Officer of Health and Assistant School Medical Officer. Miss A. Stewart, L.D.S.(St. Andrews), Divisional Dental Officer. Miss S. M. Harrison, L.D.S., R.C.S.(Edin.), Dental Officer. Miss I. Miller, L.D.S., R.C.S.(Glasgow), Dental Officer. MEDICAL (Part-Time). C. F. Ballarid, M.R.C.S., L.R.C.P., L.D.S., Orthodontist. Miss J. M. Brookhouse, Diploma in Speech Therapy, Assistant Speech Therapist (Appointed 9.9.47). J. Cholmeley, F.R.C.S., Consulting Surgeon to Orthopaedic Clinic. Miss M. Dodge, M.C.S.P., Physiotherapist. W. C. King-Brown, M.B., B.S., M.R.C.S., Immunisation Clinics Specialist. Miss E. G. Richnell, Diploma in Speech Therapy, Senior Speech Therapist. A. F. L. Shields, M.B., B.Ch., B.A.O., D.O.M.S.(Eng.), Ophthalmic Surgeon. G. Slot, M.D., M.R.C.P., D.P.H., Consulting Physician to Rheumatism Clinic. SANITARY INSPECTORS. Ed. Micklewright, M.R.San.I., Certified Inspector of Meat and Other Foods, etc., Chief Sanitary inspector, Inspector for Petroleum Acts, Shops Acts, Factory Acts and Canal Boats (Resigned, 31.3.47). L. C. Webb, A.R.San.I., Certified Inspector of Meat and Other Foods, etc., Certificates of Royal Sanitary Institute, Senior District Sanitary Inspector, Inspector for Shops Acts and Canal Boats (to 31.3.47). Chief Sanitary Inspector, Inspector for Petroleum Acts, Shops Acts, Factory Acts and Canal Boats (from 1.4.47). 3 SANITARY INSPECTORS—(Continued). T. M. Johnson, A.R.San.I., Certified Inspector of Meat and Other Foods, etc., Certificates of Royal Sanitary Institute, Sanitary Inspector, Inspector for Shops Acts. A. G. Robinson, M.S.I.A., Certified Inspector of Meat and Other Foods, etc., Certificates of Royal Sanitary Institute, Sanitary Inspector, Inspector for Shops Acts. R. A. G. James, Cert.S.I.B., Sanitary Inspector and Inspector for Shops Acts (appointed 1.4.47). HEALTH1 VISITORS AND SCHOOL NURSES. Miss P. Airdrie, S.R.N., Health Visitor's Certificate of Royal Sanitary Institute, Certificate of Central Midwives Board (appointed, 1.12.47). Mrs. J. Armstrong, S.R.N., Health Visitor's Certificate of Royal Sanitary Institute, Certificate of Central Midwives Board (resigned, 18.12.47). Mrs. R. E. L. Clarke, S.R.N., Health Visitor's Certificate of Royal Sanitary Institute, Certificate of Central Midwives Board. Miss E. Coster, S.R.N., Health Visitor's Certificate of Royal Sanitary Institute, Certificate of Central Midwives Board (from 3.3.47 to 9.8.47). Miss B. Cox, S.R.N., Health Visitor's Certificate of Royal Sanitary (Institute, Certificate of Central Midwives Board. Miss A. M. Edwards, S.R.N., Health Visitor's Certificate of Royal Sanitary Institute, Certificate of Central Midwives Board. Miss C. E. Jenkins, S.R.N., Health Visitor's Certificate of Royal Sanitary Institute, Certificate of Central Midwives Board. Miss E. M. Sawkins, S.R.N., Health Visitor's Certificate of Royal Sanitary Institute, Certificate of Central Midwives Board. Miss V. S. G. Trestrail, S.R.N., Health Visitor's Certificate of Royal Sanitary Institute, Certificate of Central Midwives Board (appointed, 1.10.47). Miss G. Watt, S.R.N., Health Visitor's Certificate of Royal Sanitary Institute, Certificate of Central Midwives Board (appointed, 13.10.47). DAY NURSERY MATRONS. Miss S. Robinson, S.R.N., Certificate of Central Midwives Board. Miss O. M. Sansom, S.R.C.N. 4 CLERICAL, ETC., STAFF. R. A. G. James, Cert.S.I.B., Chief Clerk and Assistant Sanitary Inspector (to 31.3.47). P. G. Smith, Senior Clerk, Public Health Department (to 31.3.47), Chief Clerk (from 1.4.47). R. P. Hill, Clerk, Public Health Department. D. G. Hill, Clerk, Public Health Department. Mrs. E. M. Bartlett, Clerk, Public Health Department (Part-Time). Miss K. Bates, Sales Clerk, Chiswick Child Welfare Clinic (Part-Time). Miss E. C. Blomfield, Dental Attendant (appointed, 29.9.47). Mrs. F. M. Body, Sales Clerk, Brentford Child Welfare Clinic (Part-Time) (from 1.10.47 to 15.11.47). Miss J. Brickwood, Dental Clerk. Miss M. Clariidge, Dental Attendant (resigned, 30.9.47). Mrs. I. Cooper, School Medical Clerk (resigned, 10.4.47). Mrs. M. E. Cope, School Medical Clerk (resigned, 10.4.47). Miss M. V. Crosse, Clerk, Maternity and Child Welfare, Brentford. Miss K. M. Crum, Clerk, Maternity and Child1 Welfare, Chiswick. Miss A. Duke, School Medical Clerk (Part-Time) (appointed, 24.3.47). Mrs. E. Fenwick, Sales Clerk, Brentford Child Welfare Clinic (Part-Time) (resigned, 24.9.47). Miss K. Fleetwood, School Medical Clerk. Miss F. M. Harrington, Sales Clerk, Brentford Child Welfare Clinic (PartTime) (appointed, 3.12.47). Mrs. M. Joyce, Dental Attendant (Part-Time). Miss J. L. King, Dental Attendant. Miss M. Marshall, Clerk, Maternity and Child Welfare, Chiswick. Mrs. J. M. Robbins, Home Help Organiser. Mrs. M. C. Smith, Dental Attendant. Miss S. B. Williamson, School Medical Clerk (appointed, 8.4.47). 5 BOROUGH OF BRENTFORD AND CHISWICK INTERIM REPORT on the HEALTH OF THE DISTRICT and SCHOOL MEDICAL SERVICE DURING THE YEAR 194 7 O. C. DOBSON, M.D., D.P.H., D.P.A., Barrister-at-Law. Medical Officer of Health. School Medical Officer. 7 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 your District for the year 1947. This will be the last complete year in which the majority of these Services will be under your control, as on July 5th, 1948, the County Council will become the Local Health Authority responsible for the personal health services, leaving the District Council to administer the environmental services only—relegating you to the status of Local Sanitary Authority, which was your position in the fourth quarter of the nineteenth century. The vital statistics may be considered satisfactory. In common with the trend apparent in the rest of the country, there was a fall in the birth rate to 19.2 (national rate, 20.5). The death rate was 12.1 (national rate, 12.0). The infantile mortality rate of 36.6 compares favourably with the national rate of 41.0, and in this connection I have introduced a graph showing the striking progress which has been made since 1900. It will be interesting to see whether the personal health services which have done so much to improve the lot of mothers and young children will be as effective when administered by a larger Area as by a smaller District Council. The year was marked by an outbreak of infantile paralysis unprecedented in this country. 27 confirmed cases were notified from this district and all were admitted to hospital. One case of acute polio-encephalitis was also notified, admitted to hospital and died soon after admission. Further comment on this outbreak is made in the body of the report. The only other infectious disease showing any marked prevalence was measles, of which 438 cases were notified, and from this disease there were two deaths. A report by Dr. R. A. Leader, Medical Officer of Health, Ealing, and Medical Superintendent of the Ealing and Brentford and Chiswick Hospitals Committee, covering the work of the Perivale 9 Maternity Hospital and the Clay ponds Isolation Hospital, gives particulars of the Hospital work. The Domestic Help Service continued to grow during the year, and it became more and more popular as its usefulness became known—it is unfortunate that recruitment of suitable staff is so difficult, otherwise much greater benefit could be obtained from this service. In spite of this, however, it has become a most important part of the personal health services. During the year, a chiropody service—restricted at present to needy adults and old age pensioners—was begun, and this service grew steadily as it became more widely known. The services and premises of chiropodists practising locally were used, thus avoiding the provision of a central clinic for which there was no suitable space and, to some extent, avoiding difficulties of travelling for the persons using the service. The School Medical Service continued to be closely linked up with the Maternity and Child Welfare Service, the same medical officers being used for each and the health visitors acting as school nurses. One condition experienced which caused a good deal of difficulty was the lack of accommodation for pupils recommended educational treatment in special schools, and it is to be hoped that the County Council will soon be able to fulfil its duty to make the necessary provision. The Dental Service is reported on by Miss A. S. Stewart, the Divisional Dental Officer. The work of the department as a whole has gone very smoothly, and for this I am indebted firstly to my staff for their unfailing support and collaboration, secondly to my colleagues in other Departments, and finally to you, Mr. Mayor, Ladies and1 Gentlemen, for your great help and co-operation. I am, Ladies and Gentlemen, Your obedient Servant, O. C. DOBSON, Medical Officer of Health. School Medical Officer. 10 1.—GENERAL STATISTICS, 1947. 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 1947) 59,180 2.—VITAL STATISTICS. Live Births. Total Male Female Legitimate 1090 566 524 Birth Rate per 1,000 of the estimated resident population = 19.2 Illegitimate 57 32 25 - - TOTAL 1147 598 549 - - - Stillbirths. Total Male Female Legitimate 19 11 8 Rate per 1,000 total (live and still) Births = 17.9 Illegitimate 2 2 — - - - TOTAL 21 13 8 Deaths. Total Male Female 720 361 359 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 = 0.85 Other Puerperal Causes 1 11 Deaths of Infants under One Year of Age. Total Male Female Legitimate 38 23 15 Illegitimate 4 2 2 TOTAL 42 25 17 Death Rate of all infants per 1,000 live births 36.6 Death Rate of all legitimate infants per 1,000 legitimate live births 33.9 Death Rate of all illegitimate infants per 1,000 illegitimate live births 70.2 Deaths from Measles (all ages) 2 Deaths from Whooping Cough (all ages) 1 Deaths from Diarrhoea (under 2 years of age) 8 Deaths from Cancer (all ages) 113 Deaths from the seven principal Zymotic Diseases 12 12 TABLE I. PARTICULARS OF BIRTHS AND DEATHS AS SUPPLIED BY THE REGISTRAR-GENERAL FOR THE YEAR 1947 Cause of Death Males Females All Causes 361 359 1. Typhoid Fever, etc. — — 2. Cerebro-Spinal Fever 1 — 3 Scarlet Fever 1 — 4. Whooping Cough — 1 5. Diphtheria — — 6 Tuberculosis of the Respiratory System 30 8 7. Other Forms of Tuberculosis — — 8. Syphilitic Diseases 4 1 9. Influenza 2 2 10. Measles 2 — 11. Acute Poliomyelitis and Polio-Encephalitis — 1 12. Acute Inf. Encephalitis — — 13. Cancer b. Cav. & Oesophagus (M), Uterus (F) 2 6 14. Cancer of Stomach and Duodenum 12 7 15. Cancer of Breast — 10 16. Cancer of all other sites 44 33 17. Diabetes — 1 18. Intra-cranial Vascular Lesions 25 39 19. Heart Disease 74 106 20. Other Disorders of the Circulatory System 21 28 21. Bronchitis 28 23 22. Pneumonia (all forms) 21 26 23. Other Respiratory Diseases 9 3 24. Ulcer of Stomach or Duodenum 6 3 25. Diarrhoea Under 2 years 6 2 26. Appendicitis — 1 27. Other Digestive Diseases 9 5 28. Nephritis 1 6 29. Puerperal and Post Abortive Sepsis — — 30. Other Maternal Causes — 1 31. Premature Births 5 3 32. Congenital Malformation, Birth Injury, Infantile Disorders 8 4 33. Suicide 6 4 34. Road Traffic Accidents 5 3 35. Other Violent Causes 15 12 36. All other causes 24 20 ALL CAUSES 361 359 13 TABLE II. INFANTILE MORTALITY DURING THE YEAR 1947 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 - — - - - - - - 1 1 5. Whooping Cough — — — — — - - — - 6. Diphtheria or Croup — — — - — — - - — — 7. Erysipelas — — — - — — - - - - 8. Tuberculous Meningitis - - - - - - - - - - 9. Abdominal Tuberculosis — — - - - - - - - - 10. Other Tuberculous Diseases - - - - - - 1 - - - 11. Meningitis (Non-T.B.) - - - - - - - - - 12. Convulsions — — - - - - - - - - 13. Laryngitis — — — - — — - 1 - 1 14. Bronchitis — — — - — 1 1 1 - 3 15. Pneumonia (all forms) — - 1 - 1 4 3 1 — 9 16. Diarrhœa - - - - - - - - - - 17. Enteritis — - - - - 3 - - 1 4 18. Gastritis — — - - - - - - - - 19. Rickets - - - - - - - - - - 20. Suffocation, overlying — — 1 - 1 — — 1 - 2 21. Injury at Birth — — — - - - - - - - 22. Atalectasis 5 — - - 5 - - - - 5 23. Congenital Malformation 2 — — - 2 1 — - - 3 24. Premature Birth 8 — — 1 9 1 - - - 10 25. Atrophy, Debility and Marasmus - - - - - - - - - - 26. Pemphigus Neonatorum — — — - — — — - - - 27. Other Causes 3 — — - 3 — — — — 3 TOTALS 18 — 2 1 21 10 5 4 2 42 Births. Deaths. Legitimate 1090 Legitimate 38 Illegitimate 57 Illegitimate 4 Infantile Mortality Rate per 1,000 Births = 36.6. 14 15 This graph illustrates the remarkable advance made in the last 50 years in the saving of life of children in their first year. The greater part of this has been due to increasing knowledge of the processes of infection and the consequent introduction of effective measures which greatly reduced the deaths from infection— particularly intestinal infections like summer diarrhoea—in the later months of the first year. There remains, however, a hard core of infantile mortality—the "neo-natal" deaths in the first month—which does not respond to the measures referred to above and which were so successful in the past. These deaths from prematurity, malformations and the like, need much further investigation and research. Only by further knowledge will it be possible to introduce measures to reduce in future the rate of infantile deaths. 16 GENERAL PROVISION OF HEALTH SERVICES IN THE BOROUGH. Civil Ambulance Service. In October, 1947, a new ambulance, originally ordered early in 1946, was delivered. It has a Lomas Body, with Lomas patent stretcher, mounted on an Austin 2-ton chassis, and cost £1,314 10s. Od. This now brings the total number of ambulances provided and maintained by the Council to three, all of them being available for call night and day. The staff consists of eight drivers, working in 24-hour shifts. Work of the Ambulances during the year 1947. Accident Cases 170 Maternity Cases 458 Private Cases 647 Public Cases 415 Cases dealt with for other Boroughs 215 TOTAL 1905 Maternal Mortality. Deaths from Puerperal Causes:— Puerperal Sepsis — Other Causes 1 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 1938 2 2 1939 — 2 1940 — — 1941 — — 1942 — 2 1943 3 2 1944 — 2 1945 - — 1916 - 3 1947 — 1 17 18 SUMMARY OF WORK AT THE MATERNITY AND CHILD WELFARE CLINICS—1947 BRENTFORD AREA CHISWICK AREA Grand Total 1947 Grand Total 1946 Monday Clinics Wed. Clinics TOTAL Tuesday Clinics Wed. Clinics Thurs. Clinics Fri. Clinics TOTAL Number attending for the first time during the year : Under 1 year of age 153 143 296 276 159 182 122 739 1035 917 Over 1 year of age 20 26 46 52 42 20 30 144 190 223 TOTALS 173 169 342 328 201 202 152 883 1225 1140 Number of children attended and weighed:— Under 1 year of age 2059 1968 4027 4155 3314 2971 2692 13132 17159 14316 Over 1 year of age 677 866 1543 938 848 996 1369 4151 5694 5119 TOTALS 2736 2834 5570 5093 4162 3967 4061 17283 22853 19435 Number of children seen by Doctor:— Under 1 year of age 529 535 1064 816 700 587 585 2688 3752 3278 Over 1 year of age 260 333 593 308 273 304 354 1239 1832 1756 TOTALS 789 868 1657 1124 973 891 939 3927 5584 5034 C£> 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 54 208 295 6 1150 21.3 CHISWICK 202 580 899 87 3368 16.7 TOTALS 256 788 1194 93 4518 17.6 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 fT 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. Nine 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 375 Total Visits 517 (b) To children under 1 year of age:— First Visits 1122 Total Visits 2949 (c) To children between the ages of 1 and 5 years:— Total Visits 4032 (d) Ophthalmic Visits (" Sticky Eye ") 11 (e) Other Visits:— Stillbirth 2 Child Life Protection 87 Post-Natal 11 Infantile Mortality 3 Epidemic Diarrhœa 1 Acute Poliomyelitis 123 Miscellaneous (Special Visits, etc.) 46 TOTAL 7782 Chi lid 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 ... ... ... 13 (b) at the end of the year ... ... ... ... 22 (2) Number of children on the Register :— (a) at the beginning of the year ... ... ... 19 (b) at the end of the year ... ... ... ••• 17 (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 1947 ... ... 9732 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 13 (b) at the end of the year 22 (2) Number of children on the Register:— (a) at the beginning of the year 19 (b) at the end of the year 17 (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 1947 9732 20 Ealing Road Day Nursery (equipped for 28 children) Total attendances during the year 1947 4484 Nursery Classes. Total attendances during the year 1947:— Beverley Road (equipped for 25 children) 6780 Strand-on-the-Green (equipped for 50 children) 15029 Lionel Road (equipped for 50 children) 8752 St. George's (equipped for 60 children) 7066 Home and Domestic Help Service. This Service was inaugurated in 1945 and a full-time Organiser was appointed in November, 1946. Twenty-five Helps were employed part-time at 31st December, 1947. These Helps attend both Home and Domestic cases. The following are particulars showing the progress of the Service during the year:— No. of Helps employed at 1st November, 1946 5 (all part-time) No. of Helps employed at 1st January, 1947 20 (all part-time) No. of Helps employed at 31st December, 1947 25 (all part-time) No. of cases in which Help supplied during 1946: Home Help 19 Domestic Help 41 No. of cases in which Help supplied during 1947: Home Help 50 Domestic Help 167 Chiropody Service. Total number of Cases Treated during the year 47 Number of Cases on Register at 31st December, 1947 45 Total Attendances during the year 166 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. 21 SANITARY INSPECTION OF THE AREA Tabular Statement of the Work of the Sanitary Department, 1947 Inspections. Number of premises inspected on complaint 2560 Number of premises inspected in connection with infectious disease 112 Number of primary inspections 3870 Number of re-inspections 1873 Total number of inspections and re-inspections 5743 Action Taken (other than Housing Act, 1936). Cautionary or intimation notices served 1491 Statutory Notices issued (under Public Health Acts) 3 Summonses served — Number of Certificates under Rent, &c. (Restrictions) Acts issued to tenants 3 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 334 Percentage of houses provided with water-closets 100% Drains:— Tested (Smoke) 18 Unstopped, repaired, trapped, etc. 126 Waste pipes, rainwater pipes, disconnected, repaired, etc. 172 New soil pipes and ventilating shafts fixed 33 New sinks provided 27 Disconnecting traps and chambers inserted 11 Reconstructed (whole system) 11 Reconstructed (connections) 37 Percentage of houses draining into sewers 99.9% Surface water drains reconstructed 3 Surface water drains repaired 15 22 (b) Water Supply and Water Services. Draw taps on main 15 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 88 Frequency of refuse removed from each house weekly Number of Complaints received—dealt with by Engineer's Department. Method of disposal—barging away to controlled tip. (d) Sundry Nuisances. Overorowding (urgent cases reported to Housing Committee) Smoke Minor complaints only Accumulation of refuse 4 Foul ditches, ponds, etc., and stagnant water 5 Dampness 651 Yards repaired or re-paved 19 Leaky roofs and eaves gutterings 696 Defective flooring, joists and skirtings 296 Defective plasterwork to walls and ceilings 1195 Premises cleansed and re-decorated 763 Other defects 1335 23 (e) Disinfection. Premises Disinfected:— Ordinary notifiable diseases 74 Phthisis 18 Cancer 25 Other diseases 3 Rooms stripped and cleansed (Section 167, Public Health Act, 1936) - Premises treated for vermin 20 Premises treated for other pests (wasps, moths, ants, beetles) 15 (f) 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 - FOOD AND DRUGS ACT, 1938. MILK (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 6 (b) Accredited Milk - (c) Pasteurised Milk 15 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 - 24 UNSOUND FOOD. List of Food Condemned during the year 1947. Fruit and Vegetables: Beans, Broad 587 baskets Beans, French 618 baskets Brussels Sprouts 129¾ cwts. Brussels Tops 45 bags Cabbage 5 bags Carrots 50¼ cwts. Celery 2520 lbs. Celery 895 rolls Cherries 684 pannets Dates 32½ lbs. Leeks 5 tons Melons 21 cases Onions 61½ cwts. Peaches 314 cases Pears 506 boxes Tomatoes 12 lbs. Meat: Beef 375¼ lbs. Beef, Minced 24 lbs. Chicken 195 lbs. Duck 25 lbs. Pigs' Heads 20 lbs. Rabbits 122 lbs. Sausages (Beef) 22 lbs. Sausages (Pork) 96½ lbs. Sausages (Vienna) 10½ lbs. Sausage Meat 16 lbs. Steak, Stewed 12 lbs. Turkey 1 lb. Fish: Cod 4 stone Cod Fillets 3 stone Crawfish Tails 20 lbs. Dogfish 12 stone Fillet, Smoked 17 stone Hake 5 stone Herrings, Fresh 16 stone Kippers 13 stone Lemon Sole 6 stone 25 Fish (Continued). Roe, Cod 4 stone Roe, Herring 49 lbs. Skate 5 stone Whale Meat 110 lbs. Whelks 5 bags General Provisions: Bacon 116 lbs. Barley Flakes 177 lbs. Beans, Butter 121 lbs. Beans, Haricot 1½ cwts. Biscuits 5½ lbs. Black Pudding 20 lbs. Bread 21¼ lbs. Butter 12½ lbs. Cake Mixture 339 lbs. Cereal Sweepings 563 lbs. Cheese 289½ lbs. Cherries 1 bottle Chocolate Spread 15 ozs. Christmas Pudding 28 lbs. Cocoa 120 lbs. Coffee 8 lbs. Coffee Essence 3 bottles Crumpets 444 Dar Vita 1 packet Egg, Dried 3 lbs. Eggs 567 Figs, Dried 112 lbs. Flour 66 lbs. Gherkins 12 jars Jam 802¼ lbs. Lemon Curd 55 lbs. Lemonade Powder 12 lbs. Macaroni 61 lbs. Margarine ½ lb. Marmalade 66¾ lbs. Oatmeal 2 cwts. Oats, Rolled 27 lbs. Paste 327 tins Peaches, Dried 30 lbs. Peas, Dried 2 cwts. Pickles 172 jars Porridge Oats 2 lbs. Roe, Smoked 1 jar Salmis 6½ lbs. 26 General Provisions (Continued) Sauce 8 bottles Semolina 28½ lbs. Soup Powder 17 packets Sugar, Icing 33 lbs. Syrup 10 lbs. Tea 1½ lbs. Tomato Pulp 8 lbs. Vinegar 2 pints Yorkshire Pudding Mixture 4 packets Tinned Foods (Miscellaneous): Anchovy 1 tin Apple Puree 2 tins Apples 4 tins Apricots 14 tins Beans, Baked 425 tins Beef, Corned 1406¾ lbs. Beetroot 22 tins Brawn, Pork 1 tin Brislings 2 tins Carrots 56 tins Crab 4 tins Crayfish 3 tins Damsons 2 tins Fish Balls 1 tin Fruit Cocktail 19 tins Grapefruit 44 tins Grapefruit Juice 6 tins Hake 78 tins Herrings 82 tins Herring Snacks 266 tins Kipper Snacks 1 tin Luncheon Meat 65¼ lbs. Macaroni 15 tins Meat and Vegetable Ration 81 tins Milk, Condensed 73 tins Milk, Evaporated 1719 tins Milk, Skimmed 21 tins Mussels 2 tins Orange Juice 14 tins Parsnips 4 tins Pate de Foie 3 tins Peaches 39 tins Pears 14 tins Peas 366 tins Pilchards 52 tins 27 Tinned Foods (Continued). Plums 27 tins Potatoes 77 tins Roe 27 tins Salmon 98 tins Sardines 7 tins Shrimps 1 tin Snoek 4 tins Soups 73 tins Spaghetti 7 tins Steak, Stewed 112 tins Steak and Kidney 13 tins Stew, Irish 33 tins Tomato Juice 19 tins Tomatoes 21 tins Tongue, Lambs' 2 lbs. Turnips 1 tin Veal Loaf 18¾ lbs. Vegetable Salad 18 tins 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 96 Other Boats 417 PETROLEUM ACTS: Number of applications received for licences to store and sell petroleum spirit 92 Number of applications received for licences to store and sell petroleum mixture 15 Number of applications received for licences to store and sell carbide of calcium 10 Number of gallons of petroleum spirit covered by licences 178481 Number of gallons of petroleum mixture covered by licences 8690 Quantity of carbide of calcium covered by licences 433081bs. 28 HOUSING. Housing Act, 1936. 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. FACTORIES ACT, 1937 Inspections: Premises Number on Register Number of Inspections Made Written Notices Occupiers Prosecuted (i) Factories in which Sees. 1, 2, 3, 4, and 6 are to be enforced by Local Authorities 149 88 - - (ii) Factories not included in (i) in which Section 7 is enforced by L.A. 299 142 17 - (iii) Other premises in which Section 7 is enforced by L.A. (excluding outworkers' premises) - - - - TOTALS 448 230 17 — Cases in which Defects were Found: Particulars Number of cases in which defects were found Number of cases in which prosecutions were instituted Found Remedied Referred To H.M.I. By H.M.I. Want of cleanliness (Sec. 1) 8 4 - 6 - Ineffective drainage of floors (Sec. 6) 1 1 — - - Sanitary Conveniences (Sec. 7)— (a) Insufficient 4 2 — 3 — (b) Unsuitable or defective 18 5 - 14 - (c) Not separate for sexes - - - - - Other offences against the Act (not including offences relating to Outwork) 2 2 - - - TOTALS 33 14 — 23 - 29 Outwork (Sections 110 and 111). Nature of Work Section 110 Section 111 No. of outworkers in August list required by Section 110 (1) (c) No. of cases of default in sending lists to Council No. of prosecutions for failure to supply list No. of instances of work in unwhole some premises Notices Served Prosecutions Wearing Apparel: Making, etc. 30 — — — — — Cleaning & Washing 1 — — — — — Household Linen 1 — — — — — Brass and Brass Articles 9 - - - - - Carding, etc., of Buttons, etc. 4 - - - - - Cosaques, Christmas Crackers, Christ- mas Stockings, etc. 1 - - - - - TOTALS 46 - — — — — PREVALENCE OF, AND CONTROL OVER, INFECTIOUS AND OTHER DISEASES A.—Notifiable Diseases during the Year 1947. Disease Total Cases notified Cases admitted to hospital Total Deaths Scarlet Fever 65* 60 1 Whooping Cough 76§ 13 1 Diphtheria 3† 3 — Measles 438‡ 25 2 Pneumonia 13 3 47 Cerebro-Spinal Fever 1 1 1 Acute Poliomyelitis 27x 27 — Dysentery — — — Ophthalmia Neonatorum — — — Puerperal Pyrexia 12 12 — Small-pox — — — Erysipelas 11 4 — Malaria (contracted abroad) — — — Ac Polioencephalitis 1 1 1 *In addition, three cases originally notified and admitted to Hospital were subsequently diagnosed not Scarlet Fever. xln addition, eleven cases originally notified and admitted to Hospital were subsequently diagnosed not Poliomyelitis. †in addition, five cases originally notified and admitted to Hospital were subsequently diagnosed not Diphtheria. ‡In addition, two cases originally notified and admitted to Hospital were subsequently diagnosed not Measles. §In addition, one case originally notified and admitted to Hospital was diagnosed not Whooping Cough. 30 31 Infantile Paralysis. In common with the rest of the country, Brentford and Chiswick suffered an outbreak of infantile paralysis in the latter half of the year. This graph shows the incidence of notifications from July onwards, and also indicates the confirmed cases—all notified cases were promptly removed to hospital, where, of course, facilities for accurate diagnosis were available. Careful follow-up enquiries were made in all cases, but no definite vehicle of infection or mode of spread was found. The distribution in the Borough was scattered, and case to case contact did not seem to be a factor. It may be that cases occur in which no clinical signs are obvious—these cases are never seen by a doctor—and these may be the means by which the infection is passed on. The mode of infection and the method of transmission in this disease are subjects receiving much attention in the research institutions of many countries; until the necessary information is available, accurate methods of control cannot be applied and one is compelled to adopt a blunderbuss policy and hope for the best. The measures of prevention used included the following:— (1) Full investigation of home circumstances was made in each case and follow-up of contacts was carried out. School children contacts were excluded for three weeks and food handlers were advised to stay away from work for the appropriate period. (2) Schools were allowed to re-open on the normal dates, but the co-operation of the staff was secured in seeing that ventilation was adequate, and that children were not excessively fatigued by physical exercise. (3) Careful watch was kept on the children attending the day nurseries. (4) No attempt was made to close Saturday morning cinema shows, but information was circulated by various means that overcrowding of any description was to be avoided. (5) The chlorination of swimming baths and paddling pools was pushed up to the maximum tolerated by the users, and detailed instructions on the sterilisation of towels was given to the baths personnel. (6) The possible transmission of the disease by flies was made known and steps were taken to abate the fly nuisance. (7) Operations for tonsillectomy and multiple extractions of teeth were discontinued during the outbreak. 32 The age distribution and type of case is shown in the following table:— Type of Disease 0-1 1-2 2-3 Age in Years 15-20 20-30 Over 30 Total 3-5 5-10 10-15 Abortive — - 2 1 3 — — — - 6 Spinal 3 4 — — 2 2 2 3 — 16 Encephalitis — — — 1 2 1 1 — 1 6 Totals 3 4 2 2 7 3 3 3 1 28 Twenty-seven of these cases recovered; the majority completely. The only death associated with the disease was in the case of a child, aged 3, who was admitted to hospital suffering from acute Polioencephalitis and who died shortly after admission. The cases were seen in the acute stage by the Orthopaedic Surgeon and after the acute stage had subsided, those needing further treatment were transferred to the Royal National Orthopaedic Hospital, Stanmore, thus ensuring continuity of orthopaedic treatment from the earliest possible stage. This outbreak points a lesson to any person becoming complacent in his outlook towards infectious disease. The prevention of infectious disease depends on a complete understanding of the nature of the infection and its mode of transmission—once this is arrived at, the rest is merely a matter of careful attention to the details of a set routine. In the case of infantile paralysis, however, the essential knowledge is still lacking and it is necessary to work to a considerable extent in the dark—measures are applied which are known to be effective in other conditions, and it is hoped one or other of these will work. In these circumstances, therefore, any tendency towards complacency is to be deprecated. B.—Ophthalmia Neonatorum. Cases Notified Cases treated at home Cases treated in hospital Vision unimpaired Vision impaired Total Blindness Deaths — — — — — — — 33 34 C.--Ages of Cases of Infectious Disease Notified during the Year 1947. 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 2 2 8 9 27 8 4 3 1 - - Whooping Cough 76§ 11 8 13 16 9 18 — 1 - — — — Diphtheria 3† — - 1 - — — 1 1 — — — — Measles 438‡ 15 53 47 77 58 167 5 7 7 2 — — Pneumonia 13 — 1 1 2 — 2 1 — 1 1 2 2 Cerebro-Spinal Fever 1 — — — — — — — — 1 — — — Acute Poliomyelitis 27x 3 4 — 2 — 7 3 3 4 1 — — Dysentery - - - - - - - - - - - - - Ophthalmia Neonatorum - - - - - - - - - - - - - Smallpox - - - - - - - - - - - - - Puerperal Pyrexia 12 — — — — — — — — 8 4 — — Erysipelas 11 — — — 2 — — — — 1 1 3 4 Malaria (Contracted Abroad) — — — — — — — — — — — — — Acute Polioencephalitis 1 - - - 1 - - - - - - - — *In addition, three cases originally notified were subsequently diagnosed not Scarlet Fever. †In addition, five cases originally notified were subsequently diagnosed not Diphtheria. xln addition, eleven cases originally notified were subsequently diagnosed not Poliomyelitis. ‡In addition, two cases originally notified were subsequently diagnosed not Measles. §In addition, one case originally notified was subsequently diagnosed not Whooping Cough. 35 D.—Cases of Infectious Disease Notified during the Year, 1947. 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 3 3 3 5 8 9 6 20 8 65 Whooping Cough 13 9 7 3 16 4 3 14 7 76 Diphtheria 1 — — — 2 — — - - 3 Measles 90 83 28 17 26 70 59 17 48 438 Pneumonia 8 3 1 — 1 — - - - 13 Cerebro-Spinal Fever — 1 — — — — - - - 1 Acute Poliomyelitis 3 7 1 4 2 2 2 2 4 27 Dysentery — — — — — — — — — - Ophthalmia Neonatorum — — — — — — — — - - Puerperal Pyrexia — — — — 1 1 1 9 - 12 Erysipelas 2 — 1 1 — — 1 1 5 11 Malaria (Contracted Abroad) - - - - - - - - - - Acute Polioencephalitis - - - - — — — — 1 1 Tuberculosis— Respiratory 10 12 13 6 6 7 13 12 19 98 Non-Respiratory 1 1 — 1 1 — 1 — 3 8 E.—TUBERCULOSIS—1947. Age Groups NEW CASES DEATHS Respiratory Non- Respiratory Respiratory Non- Respiratory Male Female Male Female Male Female Male Female Under 1 year 1 — - - 1 — — - 1— 5 years 2 1 1 — — — — — 5—15 years 3 1 2 2 — — — — 15—25 years 8 1 16 — 1 3 — — 25—35 years 16 — 10 1 8 2 — — 35—45 years 19 — 6 — 7 1 — — 45—55 years 4 1 1 — 5 1 — — 55—65 years 6 — — 1 4 — — — 65 years and over 3 — — — 4 1 — — TOTALS 62 4 36 4 30 8 - — During the year 10 non-notified tuberculous deaths were recorded. OTHER DISEASES. Food Poisoning: One case of Food Poisoning was notified during the year, in the Chiswick Park Ward of the Borough. Enquiries showed that the food poisoning was due to the consumption of German Sausage, purchased at a shop in Putney, but as the patient could not remember full details as to the purchase, no further action was taken. Trichiniasis: One case of suspected Trichiniasis, in the Brentford East Ward of the Borough, was reported in January. Full enquiries were made and it was suspected that the disease was contracted by consumption of frozen pork. LABORATORY WORK. The following table sets out a record of the bacteriological work during the year 1947. Suspected Disease Result Positive Negative Total Diphtheria - 161 161 Tuberculosis 2 11 13 Other Diseases — — — TOTALS 2 172 174 36 SCHOOL HEALTH SERVICES. MEDICAL INSPECTION AND TREATMENT RETURNS FOR THE YEAR ENDED 31st DECEMBER, 1947 TABLE I. MEDICAL INSPECTION OF SCHOOL CHILDREN. A.—Routine Medical Inspections : (1) No. of inspections:— Entrants— 780. Second Age Group— 404 . Third Age Groups— 414. Total 1598 (2) No. of other routine inspections— 362. Grand Total 1960 B.—Other Inspections: No. of special inspections and re-inspections- 561. TABLE II. CLASSIFICATION OF THE NUTRITION OF CHILDREN INSPECTED DURING THE YEAR IN THE ROUTINE AGE GROUPS. Number of Children Inspected A B C D (Excellent) (Normal) (Slightly Sub-normal) (Bad) No. % No. % No. % No. % Entrants 780 235 30.0 472 61.0 73 9.0 - - Second 404 164 41.0 209 51.0 31 8.0 - - Third 414 136 32.0 244 60.0 34 8.0 - - Other 362 176 48.0 175 40.0 3.0 - - TOTALS 1960 711 36.0 1100 56.0 149 8.0 — — 37 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 1669 Group II.—Treatment of Defective Vision and Squint. Under the Authority's Scheme Errors of Refraction (including squint) 125 Other defects or diseases of the eyes (excluding those recorded in Group I) 6 Number of children for whom spectacles were: (a) Prescribed 166 (b) Obtained 218 Group III.—Treatment of Defects of Nose and Throat: Under the Authority's Scheme Received Operative Treatment 37 Received Other Forms of Treatment 47 Total Number Treated 84 DENTAL INSPECTION AND TREATMENT. The treatment carried out in the School Dental Service and for patients referred from the Maternity and Child Welfare Service is listed in one table so that a complete picture of the total work done is available. There has been no expansion of the service during the year and the staff consisted of three full-time Dental Officers, a parttime Orthodontist (two sessions per week), three full-time and one part-time surgery assistants and one clerk. The amount of clerical work required in the running of the clinics is considerable, and it is hoped that it will be possible shortly to obtain increased help on that side. A high incidence of sickness and staff changes has of necessity hampered the work of the clinics. 38 School Dental Service. During 1947 4,349 children were inspected and offered treatment subject to parental consent. This is an increase of 954 on 1946. Of the 3,247 inspected during routine school inspections, 2.495 or 76% were found to require treatment. The remaining 1,102 were inspected in the clinics and this figure reflects the constantly increasing demand for and interest in dental health rather than an undue number of emergency cases. The average treatment carried out per session was 6.5 fillings, 1.7 extractions, and 2.7 other operations. Although the total treatment carried out per Dental Officer remained high (a total of 9,245 fillings for the whole service) the time elapsing between routine school inspections is still too long. If the present essentially conservative form of treatment (ratio of permanent fillings to permanent extractions 17:1) is to be maintained, the only way in which this lapse of time can be reduced is by expansion of the service. During 1948, it is anticipated that the shortage of storage space for the models essential to orthodontic diagnosis will be augmented by the enlargement of the cupboards in the only large surgery at Chiswick. Application has been made for the replacement of one operating chair, for the renovation of another and for the renewal of flooring at Chiswick. A report on the orthodontic clinics has been prepared by Mr. C. F. Ballard, L.R.C.P., M.R.C.S., L.D.S. This special service is much appreciated and the waiting list should be reduced by an increase in the number of clinics held. No time has been available for dental health educational work. Maternity and Child Welfare Service. At this stage it is of interest to review the progress of the Maternity and Child Welfare Dental Service from its inception. The earliest available statistical record dates from 1919. Then, as now, a complete service was obviously available to those expectant and nursing mothers, and pre-school children referred from the Maternity and Child Welfare Clinics who chose to take advantage of it. The table shows graphically the continual process of growth. 39  1919 1922 1927 1932 1937 1942 1946 1947 Sessions 17 47 32 90 92 143 319 292 Attendances— Children 32 54 249 520 612 261 607 707 Adults 58 213 460 629 809 1210 2412 2254 Fillings— Permanent 32 51 161 154 212 447 1332 1169 Temporary 33 51 98 261 248 150 374 459 Extractions— Permanent 53 278 317 452 624 631 558 457 Temporary 47 100 357 522 587 249 137 149 The service has been built up on sure foundations, and its success is a tribute to the former Senior Dental Officer, Miss Loretz. It has never been allowed to deteriorate into an extraction or emergency service. The noted change in attitude towards conservative dentistry is borne out both by the increased attendances and by the number of fillings done. The number of patients treated is only limited by the facilities available. It would be of great assistance to the School Dental Service if more children under five attended for treatment. In the field of dental health education it has been possible only to give chairside talks on the value of regular inspections, tooth brush drill, etc. The present staff is working at full pressure and it is regrettable that many cases cannot be commenced as soon after inspection as one would wish owing to a growing waiting list. 40  Schools M. & C.W. Total 1. Inspected. (a) Routine 3247 493 3740 (b) Special 1102 239 1341 TOTAL 4349 732 5081 2. Referred. (a) Routine 2495 486 2981 (b) Special 1032 208 1240 TOTAL 3527 694 4221 3. Sessions. (a) Inspection 41 — 41 (b) Treatment 1107 292 1399 (c) Administration 18 — 18 TOTAL 1166 292 1458 4. Treated 2244 544 2788 5. Attendances 7254 2961 10215 6. Fillings. (a) Permanent Teeth 5719 1169 6888 (b) Temporary Teeth 1898 459 2357 TOTAL *7617 1628 9245 7. Extractions. (a) Permanent Teeth 328 457 785 (b) Overcrowding 37 — 37 (c) Temporary Teeth 1661 149 1810 TOTAL 2026 606 2632 8. Administration of Gas (N20) 807 212 1019 9. Ratio of Permanent Fillings to Permanent Extractions 17 : 1 2.5 : 1 10. Ratio of Temporary Fillings to Temporary Extractions 1.1 : 1 3 : 1 11. Other Operations. (a) Permanent Teeth 1465 691 2156 (b) Temporary Teeth 1657 353 2010 TOTAL 3122 1044 4166 12. Number of Dentures 9 75 84 13. Patients fitted with Dentures 9 50 59 14. Fillings per session 6.5 5.5 6.3 15. Extractions per session 1.7 2 1.8 16. Other Operations per session 2.7 3.5 2.8 17. Attendances per session 6.2 10.1 7 *Root Fillings not included in this figure. 41 ORTHODONTIC REPORT FOR THE YEAR 1947. Total First Inspections 130 Active Treatment Commenced 46 Appliances Fitted: Fixed 43 Removable 18 61 Impressions: Reference 238 Appliance 105 343 Bands Made 136 Separating Wires 210 Spring and Arches 42 Adjustments 1ll Routine Inspections 304 Ref. X-Ray 99 Ref. Extractions 41 Ref. Fillings 13 Dismissed 26 Special Consultation with Parent 10 Sessions 96 Attendances 936 The statistical table shows the actual treatment carried out during- the past year. The orthodontic clinics have been held on two sessions per week as in 1946. Regulation treatment is an essential part of the School Dental Service and it is much appreciated by parents and children. The two sessions a week devoted to it were inadequate to meet the area's needs and the waiting list has been increasing. 42 Many cases commenced in 1946 are still of necessity under treatment, and this has meant a reduction in the number of new cases started during 1947. As in 1946, much time which should be spent in actual treatment has had to be devoted to the making of appliances. This waste of time cannot be avoided until a dental laboratory, staffed by mechanics trained in this work, is available. In August a new surgery designed primarily for orthodontic work was opened at Chiswick. The lay-out and equipment of this small surgery is of great advantage in carrying out specialised regulation treatment. It will make it possible to keep the waitinglist down to reasonable proportions by increasing the number of clinics held. TABLE V. (1) Average number of visits per school made during the year by School Nurses 7.5 (2) Total number of examinations of children in the schools by School Nurses 20,499 (3) Number of individual children found unclean 1,240 (4) Number of individual children cleansed under Section 54 of the Education Act, 1944 285 (5) Number of cases in which legal proceedings were taken:— (a) Under the Education Act, 1944 — (b) Under School Attendance Byelaws — 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. 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 43 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 51 12 68 13 35 14 59 15 38 16 41 17 35 TOTAL 327 (2) No. of other Routine Inspections—Nil. B.—Other Inspections. Number of Special Inspections and Re-inspections—Nil. CLASSIFICATION OF THE NUTRITION OF CHILDREN INSPECTED DURING THE YEAR IN THE ROUTINE AGE GROUPS Age Group and Number of Children Inspected A B C D (Excellent) (Normal) (Slightly Sub-normal) (Bad) No. % No. % No. % No. % 10 - - - - - - - - - 11 51 15 30 31 60 5 10 — — 12 68 34 50 32 46 2 4 — — 13 35 17 51 18 49 — — — — 14 59 35 59 20 34 4 7 — — 15 38 24 63 14 37 — — — — 16 41 25 62 16 38 — — — — 17 35 16 45 17 50 2 5 — — TOTALS 327 166 50 148 45 13 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 103 44 Group II.—Treatment of Defective Vision and Squint: Under the Authority's Scheme Errors of Refraction (including- squint) 63 Other defect or disease of the eyes (excluding those recorded in Group I) — No. of children for whom spectacles were:— (a) Prescribed 61 (b) Obtained 74 The following information is additional to the Statutory Fables issued to the Ministry of Education:— Orthopaedic Clinic. School Welfare Total Total number of attendances 111 436 1213 Number of individual children 74 40 114 Surgeon:— Total number of attendances 190 150 340 Number of individual children 135 81 216 Sun-Ray Clinic. Total number of attendances 742 340 1082 Number of individual children 38 34 72 Rheumatism Clinic. Total number of attendances 432 Number of individual children 83 Minor Ailment Clinic. Total number of attendances 6981 Number of individual children 3386 Total number of exclusions 484 Total number of re-admissions 275 45 Ophthalmic Clinic. School Welfare Total Number of attendances 1291 180 1471 New cases 157 33 190 Retinoscopy 289 36 325 Glasses prescribed 155 12 167 Glasses issued 207 17 224 Other cases 75 62 137 Individual children 438 64 502 Immunisation Clinic. Number of attendances: Diphtheria 1678 3325 5003 Whooping Cough 276 2464 2740 Personal Hygiene. Number of visits to schools 202 Average number of visits per school 7.5 Number of examinations 20499 Number of individual children defective 1240 Number of re-examinations 530 Number of follow-up home visits by School Nurses 448 The following table shows the incidence of Infectious Disease in schools during the year 1947. Jan. Feb. Mar. Apl. May. Jun.. Jly. Aug. Sep. Oct. Nov. Dec. Tot. Scarlet Fever 14 4 3 — 3 2 4 — — 4 2 2 38 Diphtheria - - - - - - - - - 2 1 — 3 Chicken-pox 6 9 43 10 12 31 29 — — 3 4 38 185 Measles 125 47 41 4 28 2 28 — 1 — — — 276 Whooping Cough 2 2 12 13 8 7 3 6 3 _ 1 57 Mumps 22 3 5 3 8 4 9 — — — — 1 55 Ringworm — — — 2 2 5 1 — 6 9 18 11 54 Impetigo 3 5 1 — 3 3 4 — 8 3 3 4 37 Eczema - - - - - - - - - - - - - Verminous 1 — — 1 3 10 — — 12 9 7 3 46 Scabies 3 1 1 1 1 2 3 — — 1 1 2 16 Other Skin Diseases 2 - - - - - 1 - - 1 1 - 5 German Measles 3 1 4 6 5 3 1 — 1 1 — — 25 TOTALS 181 72 110 40 73 69 83 — 34 36 37 62 797 46 Ealing and Brentford & Chiswick Hospitals Committee CLAYPONDS ISOLATION HOSPITAL PERIVALE MATERNITY HOSPITAL ANNUAL REPORT of the MEDICAL SUPERINTENDENT for the year ending 31st MARCH, 1948 REGINALD LEADER, M.R.C.S., L.R.C.P., D.P.H., Medical Superintendent. 3 Town Hall, Ealing, W.5. 26th April, 1948. Madam Chairman, Landies and Gentlemen, I have the honour to submit to you the Annual Report on the hospitals for the year 1947-1948. I wish first, to draw your attention to the increased number of admissions into Clayponds Hospital during this period, an increase of over 21% as compared with the previous year and a truly meritorious performance considering the shortages of nursing staff which at times have been acute. The average daily number of patients, while well within the bed capacity of the hospital, has risen from 21.3, to the figure of 30.4, and this was mainly due to the 96 notified cases of poliomyelitis during the epidemic which swept through the two boroughs in 1947. Clayponds had its full share of this and all the various types of the disease were admitted and treated, so that when the Ministry produced their film on Poliomyelitis for the benefit of health authorities throughout the country it was natural that this hospital should be selected as one of the three that collaborated to supply cases. It is gratifying to note that it was found possible this year to commence the scheme for the operative treatment of tonsils and adenoids and so reduce the long waiting lists of cases that had accumulated in the previous years. In all, 368 cases were admitted and had the operation. It is to be noted that of the 39 patients admitted as suffering from diphtheria, only two were in fact cases of diphtheria, with of course no deaths; a testimony to the control of this disease by the Public Health Departments in the respective areas. In my experience, Gastroenteritis and Whooping Cough are now without doubt, the two most serious of infantile diseases, and the most fatal in infants under the age of one year, and all avenues of prevention and treatment merit exploration. It will be remembered that the Ministry of Health last year in conjunction with the Central Midwives Board advised that patients could be discharged from maternity units on the tenth day instead of the fourteenth, and although the average stay in Perivale during the last year has been slightly over 12 days, it was found possible to admit the record number of 1,301 patients. 4 This is a tremendous achievement for both medical and nursing staff, and in effect means that the hospital is practically doing the work of a 60 bedded hospital. Under such conditions some variation of the recommendations of the Midwives Salaries Committee might be considered justifiable, especially with regard to senior staff who in such circumstances may have additional responsibility. The record of emergency cases is good, and it is pleasing to note that additional equipment has been added this year to deal wich premature babies. In conclusion, I take the opportunity of thanking the members of the Committee for their generous support on all occasions. I also wish to mention Dr. George Taylor who acted as my deputy at Clayponds, and Dr. Dorothy Taylor, my deputy at Perivale; and throughout my period of office I have had the unfailing help and guidance of your Clerk, Mr. Harry Birrell. I am, Ladies and Gentlemen, Your obedient Servant, REGINALD LEADER, Medical Superintendent. 5 CLAYPONDS ISOLATION HOSPITAL The total number of patients admitted to Hospital in the year 1947-48 was 463. The highest number of patients in hospital on any day was 47, on March 24th, 1948, and the lowest was 11 + 5 T.A. on May 5th, 1947. The average daily number was 30.4. The following table indicates the number of cases ot each disease admitted during the year. Disease Remaining in Hospital, 31st March, 1947 Admitted during the year Discharged during the year Died during the year Remaining in Hospital, 31st March, 1948 Scarlet Fever 5 118 - 1 Diphtheria — 2 1 — 1 Meningitis 2 2 4 — Measles 10 41 — — Chickenpox — 14 — — Mumps 1 9 — — Puerperal complications 1 4 5 — Gastroenteritis 1 35 — 5 Dysentery — 6 — 1 Erysipelas — 17 17 — Poliomyelitis — 61 — 5 1 Whooping Cough 2 34 — 3 Tonsilitis — 45 — — Pneumoccocal infections — 10 — — No abnormality detected — 8 8 — Pyraxea of unknown origin — 8 8 — - Bronchitis — 7 7 — Laryngitis — 6 6 — Otitis Media — 3 3 — Sinusitis - 2 1 — 1 Pyelonephritis — 2 2 — Urticaria — 2 2 — Pharyngitis — 5 5 — Abortion - 2 2 — Rubella - 1 1 — Furunculosis - 1 1 — Syphilis — 1 1 — Post Tonsillectomy exudate — 1 1 — Paroxysmal tachycardia — 1 1 -— Scabies - 1 1 — Tinea vesicolor - 1 1 - Tuberculous meningitis - 1 — 1 Rheumatism - 1 1 — Cerebral haemorrhage — 1 — 1 Cervical adenitis - 1 1 — Neuritis - 1 1 - Ringworm — 1 1 — Submaxillery cellulitis — 1 1 — Infective dermatitis — 1 1 — Drug eruption Vincents' angina — 1 1 — 1 1 2 — Nursing Mothers 1 — 1 — Pelvic sepsis - 1 - — 1 Migraine — 2 2 - - 6 Diphtheria. There were 39 notifications of which only 2 gave bacteriological proof of diphtheria. Neither of these cases was severe; one patient had been actively immunised. These figures include 4 cases notified as laryngeal diphtheria which proved to be non-diphtheritic laryngitis. In addition, 3 suspected carriers were investigated and found to be free from infection. One case was diagnosed as cerebral haemorrhage and died shortly after admission. Another succumbed from acute bronchopneumonia. The following cases were admitted as suffering from diphtheria and the diagnosis altered as shown. Tonsillitis 25 Laryngitis 4 Scarlet fever 2 Mumps 1 Vincents' angina 1 Post tonsillectomy exudate 1 Cerebral haemorrhage 1 Bronchopneumonia 1 Chickenpox 1 Scarlet Fever.—Scarlet Fever admissions numbered 118, (57 from Ealing and 61 from Brentford & Chiswick). The age distribution of the cases was as follows: Under 1 1-2 3-5 6-10 11-15 16-24 25 and over 1 13 44 41 11 6 2 The following complications were encountered either on admission or during the course of treatment: Otitis Media 7 Serum reaction 2 Rhinitis 5 Bronchopneumonia 3 Cervical adenitis 4 Furunculosis 1 Chickenpox 3 Bronchitis ... 1 Secondary tonsillitis 3 Herpes labialis 1 Measles 3 Pemphigus 1 Whooping Cough 2 Myocarditis (mild) 2 The patient under 1 year developed acute broncho-pneumonia which proceeded to empyema and the infant died. The case of pemphigus was a recurrence of a persistent staphylococcal infection that proved very resistant to treatment. The cases of chicken-pox were admitted in that state. One case was admitted while incubating measles and cross-infected 2 others. Two sisters were admitted suffering from scarlet fever and severe whooping cough. The following cases were notified as Scarlet Fever but diagnosis had to be amended as shown: Tonsillitis 7 Tinea vesicolor 1 7 Measles 3 Urticaria 1 Rubella 1 Poliomyelitis 1 Conversely, a case notified as diphtheria proved to be scarlet fever, as did one notified as poliomyelitis. Meningitis.—There were two proved cases of cerebro-spinal meningitis both of which had full recovery. Other cases that were notified as meningitis were found to be: Lobar pneumonia 2 Tonsillitis 1 Poliomyelitis 1 Measles.—41 cases of measles were treated, 13 from Brentford & Chiswick, 27 from Ealing, and 1 from Isleworth. All cases recovered. One case notified as scarlet fever was later diagnosed as measles. Other cases notified as measles had to be amended as follows: Scarlet fever 2 Drug eruption 1 Gastro enteritis 1 Three cases were admitted with the double infection of measles and whooping cough. Complications: Bronchopneumonia 8 Whooping Cough 3 Tuberculous abscess 1 Otitis media 5 Hilar adenitis 2 Whooping Cough.—There were 34 cases, 12 from Brentford & Chiswick and 22 from Ealing. ' One case died within 3½ hours of admission. Another died from cerebral thrombosis after 34 days in hospital. A third death was due to whooping cough and gastroenteritis. All of those patients were under 1 year. The age distribution was as follows: Under 1 year 1-2 2-5 Over 5 14 ' 5 7 8 Complications: Bronchopneumonia 7 Cellulitis 1 Gastroenteritis 3 Axillary Abscess 1 8 Furunculosis 1 Osteomyelitis 1 Eczema 1 Convulsions 2 Two cases of concurrent scarlet fever, and 3 of measles have already been included under those headings. Cases notified as whooping cough and otherwise diagnosed were: Pneumonia 3 Bronchitis 4 Tonsillitis 1 Intestinal Diseases. (a) Gastroenteritis is still the most serious of infantile diseases. Of 35 cases, 23 were infants under a year and 4 of them died; there were no other deaths. Age incidence: 0-1 1-2 2 and over 23 5 7 = 35. One died within 40 minutes of admission; a Coroner's Postmortem examination confirmed diagnosis. Another succumbed to the double infection of gastro-enteritis and whooping cough. Another was recovering from a severe attack when he developed broncho-pneumonia which precipitated his death. One infant, of 3 months, with a severe infection had 2 severe relapses and death seemed imminent. He was transferred to the M.R.C. Unit in Princess Louise Hospital for a course of streptomycin. He made a complete recovery. (b) 6 cases of Sonne dysentery were treated, 3 from Chiswick and 3 from Ealing. One infant of 9 months developed bronchopneumonia and died. Post-mortem examination confirmed diagnosis and showed typical extensive dysenteric ulceration. Cases notified as typhoid fever were found to be respectively : coliform pyelonephritis, pelvic sepsis and pneumococcal septicaemia with cerebral abscess formation. Erysipelas.—There were 17 cases, all of which recovered uneventfully. Chickenpox.—14 cases were treated in hospital, usually because nursing facilities were not available at home, or because of concomitant maladies. 9 Other conditions present were: Gastroenteritis 1 Impetigo 1 Pneumonia 2 Erysipelas 1 Abscess of leg 2 Otitis media 1 Leukaemia 1 Cellulitis 1 Two of the cases had been notified as poliomyelitis and smallpox respectively. One case notified as chickenpox was diagnosed as secondary syphilis. Mumps.—91 cases of mumps were admitted. One developed sub-maxillary adenitis. Two adults were admitted because of complicating orchitis. Two cases had chickenpox in addition. Puerperal Complications.—There were 3 cases of puerperal pyrexia and one post-partum haemorrhage. All were mild and recovered uneventfully. Poliomyelitis.—There was an unprecedented epidemic of infantile paralysis, most of the cases occurring during the Summer. Of 61 cases, 27 occurred in the Chiswick and 34 in the Ealing areas. The accompanying diagram gives an analysis of the cases. Age in Years. Over Type of Disease 0-1 1-2 2-3 3-5 5-10 10-15 15-20 20-30 30 Total Abortive — — 2 2 6 4 — — — 14 Meningeal — — — 2 1 1 — — — 4 Spinal 45 — 4 7 3 2 4 3 32 Encephalitis — — 2 — 3 2 1 2 1 11 4 5 4 8 17 10 3 6 4 61 There were 5 fatal cases, all children. 25 cases were transferred to the National Orthopaedic Hospital (or its convalescent home) at Stanmore for physiotherapeutic and orthopaedic treatment. One adult is still awaiting transfer to Stanmore Hospital. One adult was transferred to Royal Naval Hospital, Haslar for further treatment. One case notified as scarlet fever proved to be polioencephalitis. Other cases notified as poliomyelitis were later diagnosed as: Pyrexia of unknown origin 6 Tonsillitis 6 Pharyngitis 4 Cervical adenitis 1 Laryngitis 1 Scarlet Fever 1 Bronchitis 2 Gastro-enteritis 1 Tuberculous meningitis Rheumatism 1 (fatal) 1 No abnormality Sinusitis 1 detected 5 10 Migraine 2 Neuritis 1 Urticaria 1 Chickenpox 1 Operations for Removal of Tonsils and Adenoids.— 368 cases. The operation sessions were increased from two to three each week as from 28/4/47, in view of the waiting list of cases. All operations were suspended during the period 24/7/47 to 11/1/48, owing to the poliomyelitis outbreak. Staff Illnesses.—6 members of the staff have been ill during the year suffering from: Appendicitis 2 Appendicectomy performed in each case at King Edward Memorial Hospital. Tonsillitis 1 Cervical Adenitis 1 Sonne Dysentery 1 Cardia Debility Basal Bronchiolitis, Tachycardia 1 Consultant Staff.—The following Consultants were called in during the year. Mr. Miller 1 visit Dr. Maurice Shaw 5 visits Mr. Freeman Heal 1 visit Mr. Murray 2 visits Mr. Cholmeley 23 visits recorded 11 PERIVALE MATERNITY HOSPITAL Annual Report for Year 1st April, 1947 to 31st March, 1948. During the year 1st April, 1947 to 31st March, 1948, 1,301 patients were admitted to the hospital. These included 14 emergency cases. Month Ealing Brentford & Chiswick Other Districts Total April 80 27 — 107 May 82 27 — 109 June 80 28 — 108 July 79 29 — 108 August 75 26 — 101 September 99 24 — 123 October 86 21 — 107 November 92 25 — 117 December 89 23 — 112 January 89 16 — 105 February 79 28 — 107 March 71 26 — 97 1,001 300 — 1,301 The greatest number of patients in hospital on any day was 58 on 11th June, 1947. The average period of stay was 12.385 days. Emergency Cases. The 14 emergency cases admitted were as follows: 1. A primipara aged 26 years, a midwife's case. Admitted from the ante-natal clinic as a toxaemia of pregnancy. She had oedema and hypertension which responded to treatment. She was discharged. She was later re-admitted in labour and delivered herself normally. Both mother and child were well on discharge. 2. Gravida 2 (previous stillbirth) aged 27 years, a Midwife's case. Admitted from the ante-natal clinic with severe anaemia. This was treated by iron, liver and blood transfusion. She was then transferred to a Convalescent Home to await delivery. She was admitted in labour and had a normal delivery and puerperium. Both mother and child were discharged well. 3. Gravida 3 aged 28 years a midwife's case. Admitted from the district as an emergency. A transverse lie was found with prolapse of the hand. The foetal heart failed shortly after admission. An internal version was performed and a leg pulled down. She was delivered of a full time infant which was stillborn. 12 She was discharged in a satisfactory condition to the midwife after 3 days in hospital. 4. Primipara, aged 22 years, sent in by her doctor. She was admitted in labour and delivered of a 4 lb. premature infant. The duration of pregnancy was thought to be 32 weeks. The infant survived for eleven days and then died suddenly. No cause was found for the premature labour. The mother was discharged well. 5. Primipara, aged 25 years. Sent in by her own doctor. She had a primary uterine inertia and had been in labour for 2 days before admission. Forceps were apphed en full dilatation of the cervix and she was delivered of a living full term child. The placenta was expelled normally but the patient lost 45 ozs. of blood and became very shocked. She was given 2 pints of plasma and one pint of blood. Her condition improved rapidly and she was sent home to the care of her own doctor on the seventh day, both she and the baby being in a satisfactory condition. 6. Gravida 3, aged 41 years, sent in by her Doctor. She was admitted as an ante-partum haemorrhage. On admission the placenta was felt lateral to the os. The membranes were ruptured and a foot was brought down. The foetal heart failed and she was. delivered of a stillbirth weighing 4 lbs. 8 ozs. The placenta was expelled normally and the total loss was about 30 ozs. She was treated for toxaemia and was discharged in a satisfactory condition. 7. Gravida 6, aged 37 years, sent in by own doctor. On admission it was found that she had given birth to a live child 3 hours previously weighing 3½ lbs. and about six weeks premature. The condition of mother and child was good. No cause was found for the premature labour. The mother was discharged on the 10th day and attended subsequently for breast feeding. The child was discharged on the 57th day when it weighed 5 lbs. 8. Primipara, aged 32 years, sent in by her own doctor. She gave a history of being in labour for two days. She delivered herself normally but developed a pyrexia of unknown origin and was transferred to Clayponds Hospital on her 3rd day. The baby was shocked at birth and was transferred to Clayponds as soon as it was fit. 9. Primipara, aged 31 years, a midwife's case. Admitted from the ante-natal clinic with hypertension and oedema. She improved under treatment. Surgical induction was carried out and labour commenced with irregular pains. After 48 hours of irregular contractions the foetal heart became irregular. Forceps were applied and the child delivered, but it failed to respond to resuscitation. During the puerperium the mother developed pyelitis 13 which cleared with treatment. She was discharged on her 12th day with slight residual hypertension. 10. Primipara, aged 22 years. Sent in by her own Doctor. She had been delivered at home by forceps and was suffering from an extensive 2nd degree tear. This was repaired. The puerperium was normal and baby and mother were discharged well. 11. Gravida, 3 aged 32 years, a midwife's case. Admitted from the ante-natal clinic with hypertension. She had a surgical induction after 3 weeks medical treatment in hospital. The confinement was normal and both mother and child were discharged fit. 12. Primipara, aged 22 years, a midwife's case sent in by Doctor. She had had a forceps delivery on the district with an extensive perineal tear. This was sutured and healed well. She ran a temperature (which was controlled by penicillin) during the first few days in hospital. She was discharged with the baby on her 10th day, both being fit and well. 13. Gravida 3, aged 26 years. She was admitted with lower abdominal pains. This subsided with rest and she was discharged with the diagnosis of threatened premature labour after 9 days. 14. Gravida 3, aged 32 years, a midwife's case. She was admitted from the clinic with a high blood pressure. This did not respond to medical treatment and surgical induction was performed. She had a normal delivery of a full term child. She was discharged after 36 days in hospital to rest at home. The child was satisfactory on discharge. Booked Cases. Ante-natal Cases admitted for Treatment. 159 patients were admitted during the pregnancy for treatment. The conditions for which they were admitted are as follows: Toxaemia 74 Hypertension 18 Oedema 4 Nephritis 1 Pyelitis 8 Haematuria 1 Cardiac 7 Anaemia 1 Phlebitis 1 Parkinsonism 1 Epilepsy 1 Enteritis 1 14 Influenza 1 Thrush 1 Fibroids 1 Trial Labour 10 Postmaturity 13 Hydramnios 2 Threatened miscarriage 1 Ante-partum haemorrhage 13 Abnormal Presentations. Persistent occipito-posterior 9 Twin pregnancy: (a) Vertices 9 (b) Vertex and breech 7 (c) Breeches 1 Breech: (a) Flexed Breech (1) Primipara 5 (2) Multipara 9 (b) Extended breech (1) Primipara 10 (2) Multipara 4 (c) Breech Extraction 2 Prolapsed cord 3 Transverse lie 3 Face Vertex and prolapsed hand 1 Obstetrical Manipulations and Operations. Episiotomy 91 External version 12 Internal version 1 Rupture of membranes 33 Forceps Delivery. (a) Foetal distress 14 (b) Maternal distress 34 (c) Deep transverse arrest 11 Caesarian Section. (а) Classical: (1) Persistent transverse lie 1 (2) Breech in contracted Pelvis 1 (b) Lower Segment: (1) Primipara breech in contracted Pelvis 1 (2) Disproportion Removal of dermoid cyst 1 Currettage 1 Biopsy of fibroid 1 Haemorrhages. Post Partum. (a) Moderate 106 (b) Severe 34 (c) Secondary 4 (d) Manual removal of placenta 13 Ante-Partum. (а) Accidental 11 (b) Placenta Praevia (lateral) 2 15 Notifiable Pyrexia 13 Uterine infection 3 Pyelitis 3 Basal congestion 1 Flushed breasts 3 Unknown aetiology 3 Non-notifiable Pyrexia during puerperium 62 Pyelitis 29 Flushed breasts 10 Uterine infection 17 Phthisis 2 Influenza 2 Streptococcal sore throat 1 Catarrhal jaundice 1 Other abnormalities. Obstetric shock 15 Eclampsia 3 Cardiac failure 1 Bartholins cyst 1 Patients transferred to other Hospitals. To Clayponds Isolation Hospital 3 (a) Haemolytic Streptococcal infection 1 (b) Unknown pyrexia 1 (c) Infective enteritis 1 To the Westminster Hospital 2 (a) Tumour of small intestine 1 (b) Essential hypertension 1 To King Edward Memorial Hospital with acute appendicitis 1 Maternal Deaths 1 This patient was admitted ante-natally with a pre-eclamptic toxaemia. She delivered herself spontaneously of a living child. She had a post-partum haemorrhage. The placenta was retained and was removed manually. She was very shocked. Bleeding persisted despite transfusion, etc., and became generalised from other mucous surfaces. Post mortem report—Death from obstetric shock and haemorrhage. INFANTS. Number of infants born 1,312 Males (alive) 654 Females (alive) 637 Stillborn 21 Neo-natal deaths 11 Still births. Fresh. (а) Full term 7 (b) Premature 3 (c) Deformities incompatible with life 4 Macerated 7 16 Premature Infants. Gestation Born alive Died 28-30 weeks 7 3 30-34 weeks 12 1 34-36 weeks 6 2 36-38 weeks 26 — Infants Weaned. Due to inadequate lactation of mother 3 Pulmonary tuberculosis in mother 3 Disease of breast in mother 5 Cardiac disease of the mother 2 Infants transferred to other Hospitals. To West Middlesex Hospital with Hypospadias ? imperforate urethra 1 To Great Ormond Street Hospital with laryngeal stridor 1 with erythroblastosis 1 To West London Hospital for investigation 1 To Queen Elizabeth Hospital with abscess of the back 1 To West London Hospital with Obstructive Jaundice 1 Consultants called in. Dr. J. W. Rait Bell on 15 occasions. Mr. Arnold Walker on 7 occasions. Mr. E. R. Rees on 5 occasions. Dr. Potter on 4 occasions. Dr. Newton on 1 occasion. Training of Pupils. During the year ended 31st March, 1948, 43 pupils completed their course of training and entered for the Part I examination of the Central Midwives Board. 36 pupils were successful.