EAL 14 Borough of Ealing. ANNUAL REPORT OF THE Medical Officer of Health AND School Medical Officer FOR THE YEAR 192 3. THOMAS ORR, M.D., D.Sc., Of the Middle Temple, Barrister-at-Law, Medical Officer of Health, School Medical Officer and Medical Superintendent of the Isolation and Smallpox Hospitals. EALING: Francis A. Perry, 4, Kirchen Road. ANNUAL REPORT OF THE Medical Officer of Health, 1923. 5 INDEX. pace Acts, Bye laws and Regulations 27 Ambulances 20 Bacteriological Examinations 28 Births 9, 22 Blind, Deaf, etc., Children 53 Clinics and Treatment Centres 18 Dairies, Cowsheds and Milk shops 23 Deaths 9, 32 Dental Defects 45, 57 Diphtheria 15 Disinfection 24 Factories and Workshops 24 Food 25 Health Visiting 22 Hospitals in the District 19 Housing 28 Illegitimate Births 9 Infant Deaths 9, 12 Infectious Diseases 14, 31, 44 Inspection Clinic 47 Institutions in the District 17 Maternity and Child Welfare 20 Medical Inspection of School Children 36 Medical Treatment of School Children 44 Midwives 18 Milk 25 Notifiable Diseases 14 Nursing Arrangements 17 Offensive Trades 24 Population 10 Refuse Dumps 26 Sanitary Inspection of District 23 Scarlet Fever 15 Slaughterhouses 23 Staff 6, 35 Statistics, Vital 9 Statistics, General 9, 50 Tonsils and Adenoids, enlarged 39 Treatment, Medical, of School Children 44 Uncleanliness 38 Vital Statistics 9 Welfare Centre 21 6 PUBLIC HEALTH DEPARTMENT. STAFF. Medical Officer of Health and Superintendent of Isolation Hospital— Thomas Orr, M.D., D.Sc., Of the Middle Temple, Barrister-at-Law Assistant Medical Officer of Health and Medical Attendant of Isolation Hospital— A. J. B. Griffin, M.B., Ch.B., D.P.H. Consultant, Maternity and Child Welfare Centre (Ante-Natal Clinic)— John W. Beli„ L.R.C.P.I. & L.M., L.R.C.S.I. & L.M. Medical Officer, Maternity and Child Welfare Centre (Infant Consultations)— S. Grace Banham, B.Sc., M.B. Chief Sanitary Inspector— Thomas Hii.l, Cert. R.S.I., and Cert. Inspector of Meat and Other Foods. Sanitary Inspectors— James Stubbs, Cert. R.S.I, and Cert. Inspector of Meat and Other Foods. George W. Stevens, Cert. R.S.I, and Cert. Inspector of Meat and Other Foods. 7 Staff— (Contd.). Health Visitors— Eleanor Evans, Cert. R.S.I., Cert. C.M.B. (Senior). Gertrude Dowsett, Cert. R.S.I., Cert. C.M.B., and Trained Nurse. Marguerite Farrow, Cert. R.S.I., and Trained Nurse. Chief Clerk and Committee Clerk— Harry Birrell. Clerk and Laboratory Assistant— Ernest W. Hili. Clerks— William A. J. Turner. Olive Levasseur. Maternity and Child Welfare Centre— 13, Mattock Lane, Ealing. 8 PUBLIC HEALTH COMMITTEE. Alderman E. J. Morgan (Chairman). Alderman H. Armriding ( Vice-Chairman). Alderman H. W. Peal, J.P., Councillors J. C. Fuller, J.P., Lt.-Col. R. R. Kimmitt, O.B.E., W. F. Piper, W. D. Pocock, and W. T. White. MATERNITY AND CHILD WELFARE COMMITTEE. Councillor W. T. White (Chairman). Alderman H. Armriding ( Vice-Chairman). Aldermen E. J. Morgan and H. W. Peal, J.P., Councillors J. C. Fuller, J.P., Lt.-Colonel R. R. Kimmitt, O.B.E. W. D. Pocock and W. F. Piper. Mesdames Cocker, Cooper, Morris and Sharp. 9— SUMMARY OF GENERAL STATISTICS, 1923. Population (Estimated 1923) 68,120 Population (Census, 1921) 67,755 Population (Census, 1911) 61,222 Area of Borough in Acres 2,946 Number of Structurally Separate Dwellings (1921) 14,967 Rateable Value £575,400 Net Produce of a Penny Rate £2,330 SUMMARY OF VITAL STATISTICS, 1923. Births: Legitimate Males, 531 Females, 482 Total, 1,013 Illegitimate Males, 19 Females, 28 Total 47 1,060 Birth-rate 15.6 Deaths: Males, 314 Females, 411 Total 725 Death-rate 10.6 Deaths of Infants under 1 Year: Legitimate:— Males, 26 Females, 27 Total, 53 Illegitimate:— Males, 5 Females, 4 Total, 9 62 Infant Death-rate per 1,000 Births: Legitimate, 52.3 Illegitimate 191.5 Total 58 Total Deaths Death-rate per 1000 Population Measles... ... ... ... ... — 0.00 Whooping Cough ... ... ... 7 0.10 Diarrhoea (under 2 years of age, per 1,000 births) 3 2.8 Diphtheria ... ... ... ... 6 0.09 Scarlet Fever ... ... ... ... 1 0.01 Influenza ... ... ... ... 11 0.16 Tuberculosis of Lung ... ... ... 60 0.88 Other Forms of Tuberculosis ... ... 10 0.14 All Forms of Tuberculosis ... ... ... 70 1.03 10 Comparison of Vital Statistics of Ealing with those of England and Wales, etc., 1923. England and Wales 105 Great Towns (including London) London Ealing Birth Rate 19.7 20.4 20.2 15.6 Death Rate 11.6 11.6 11.2 10.6 Infant Death Rate 69. 72. 60. 58. Measles Death Rate 0.14 0.15 0.08 0.00 Whooping Cough Death Rate 0.10 0.12 0.09 0.10 Diarrhoea (under 2 yrs. per 1,000 Births) 7.7 9.9 10.2 2.8 Diphtheria Death Rate 0.07 0.09 0.13 0.09 Scarlet Fever Death Rate 0.03 0.03 0.02 0.01 Influenza Death Rate 0.22 0.22 0.17 0.16 VITAL STATISTICS. The Population at the Census of 1921 was 67,755, and was distributed in the Wards as follows:— TABLE I. Ward. Families or separate occupiers Population. Persons per Acre. Males Females Total No 1 or Drayton 1,868 3,388 4,147 7,535 21.7 No 2 or Castlebar 2,730 4,254 6,651 10,905 19.5 No 3 or Mount Park 1,858 2,839 5,153 7,992 9.4 No. 4 or Lammas 3,872 7,446 8,449 15,895 53.9 No. 5 or Manor 3,853 6,567 8,485 15,052 43.0 No. 6 or Grange 2,566 4,417 5,959 10,376 18.9 Total 16,747 28,911 38,844 67,755 23.0 11 The following Census figures indicate the increase in the population of Ealing during successive decades:— Census, 1881 15,764 Census, 1891 23,965 Census, 1901 33,040 Census, 1911 61,222 Census, 1921 67,755 The area of the Borough is 2,946 acres, and the density of population, or number of persons per acre, is therefore 23.0. The most densely populated Ward is the Lammas with a density of 53.9 persons per acre, the Manor coming next with 43.0, and the Mount Park Ward the least populated with 9.4 persons per acre. For 1923 the population is estimated at 68,120. The natural increase of population, which is the yearly excess of births over deaths, is 335. The Birth-Rate shows a decrease over the previous years, being 15.6 compared with 16.2 for 1922, 16.9 for 1921, and 17.8 for 1920, and is in marked contrast to the pre-war years 1910 to 1914, as seen in Table II. The rate for Ealing is low compared with those for England and Wales and for London, which are respectively 19.7 and 20.2. The Death-Rate is slightly less than in the previous year, 10.6 compared with 11.0 for 1922. This rate compares very favourably with that for England and Wales, which is 11.6, and that for London, which is 11.2 per 1,000 of population. As regards Infant Death-Rate a slight increase over the previous year is to be recorded, being 58 compared with 52 in the previous year, but the rate compares very well with those for England and Wales, for the great towns, and for London, which are respectively 69, 72, and 60 per 1,000 births. In Table II. comparison is made with the infant death-rates for the last fourteen years. 12 Table III. shows the causes of deaths of infants. Premature birth, congenital defects, atrophy, debility and marasmus, all defects of pre-natal origin or influenced by pre-natal conditions, accounted for 28 of the total 62 deaths. It is difficult to say how many of these conditions are preventable, but it is our duty to assume that most of them are preventable, and by well directed ante-natal care aim at improving the health and environment of the expectant mother. Bronchitis and pneumonia, which are essentially preventable diseases and which welfare work aims at preventing, accounted for 16 out of the 62 deaths. In the previous year the deaths from bronchitis and pneumonia were only 6 in number. The illegitimate infant death-rate of 191.5 is much lower than for the year 1922, when it was 255 per 1,000 births. This rate, however, is very much higher than the legitimate infant death-rate, which is 52.3 and indicates strikingly the severe struggle for existence which illegitimate children have to experience. TABLE II. Showing Birth-rate, Death-rate and Infant Death-rate for Ealing for the years 1910—1923. Year Birth-rate Death-rate Infant Deathrate 1910 23.4 9.8 65 1911 20.2 11.5 121 1912 20.6 9.7 67 1913 18.2 8.9 72 1914 17.5 9.4 59 1915 16.6 10.2 63 1916 17.0 11.1 58 1917 14.8 10.5 63 1918 13.0 13.6 76 1919 13.3 10.8 65 1920 17.8 8.8 47 1921 16.9 10.6 63 1922 16.2 11.0 52 1923 15.6 10.6 58 13 TABLE III. Causes of Infant Deaths, 1917 to 1923. 1917 1918 1919 1920 1921 1922 1923 Diarrhoeal Diseases 10 14 3 9 9 5 2 Premature Birth 7 12 13 15 10 5 11 Congenital Defects 5 – 6 4 4 6 8 and of Breast Milk (Starvation) – – – – – – – Atrophy, Debility,Marasmus 6 11 14 14 12 10 9 Tuberculous Disease 2 – 3 3 – 2 1 Syphilis 1 – – 3 2 – – Rickets – – – – – – – Meningitis (not Tuberculosis) 1 – 2 – 1 – 1 Convulsions 4 4 1 2 2 2 2 Bronchitis 5 5 3 1 6 5 5 Pneumonia (all forms) 17 6 4 4 9 1 10 Gastritis – – – 2 1 2 1 Common Infectious Diseases 2 7 1 – 7 4 2 Other Causes 7 13 17 7 9 15 10 Totals 75 70 67 64 72 57 62 Scarlet fever and diphtheria were not so prevalent as in the previous two years, hence the death-rates for these diseases are lower, being 0.01 for the former and 0.09 for the latter. These rates compare well with those for England and Wales and for London, which are respectively 0.03 and 0.02 for scarlet fever and 0.07 and 0.13 for diphtheria. The death-rates for measles and diarrhoea (see Table page 9) are much lower than those for England and Wales and London, while the rate for whooping cough is the same as that for England and Wales and just a shade higher than that for London. Table VIII. shows the complete list of the causes of death. It is seen that tuberculosis accounts for nearly one-tenth of the total deaths, cancer (malignant disease) for one-sixth, heart disease for one-seventh, and pneumonia and bronchitis for one-seventh of the deaths, or altogether for more than one-half of the total. These figures indicate the diseases against which preventive measures must be directed to lower the death-rate and increase the mean age at death. 14 PREVALENCE OF, AND CONTROL OVER, ACUTE INFECTIOUS DISEASE. In Table IV. are indicated the numbers of the various infectious diseases notified during the year. It will be seen that there were 56 cases of diphtheria and 142 of scarlet fever, both great decreases on the numbers for the previous year. table iv. Disease 1914 1915 1916 1917 1918 1919 1920 1921 1922 1923 Diphtheria 82 56 37 66 36 46 56 186 282 56 Scarlet Fever 511 458 146 91 61 201 171 665 487 142 Enteric Fever (including Paratyphoid) 7 11 5 3 6 5 6 8 3 5 Puerperal Fever 2 1 1 – 2 3 5 9 3 9 Pneumonia: Primary 30 38 21 33 32 Influenzal 33 27 17 22 7 Acute Poliomyelitis – 2 – 2 1 – – 1 – – Cerebro-Spinal Fever 1 2 2 1 – 3 4 1 – 1 Malaria 40 27 3 4 2 Dysentery 5 2 1 1 – Erysipelas 39 39 19 33 24 22 30 27 22 17 Encephalitis Lethargica 3 1 1 3 1 Tuberculosis: (a) Pulmonary 92 97 86 92 110 83 63 80 69 92 (b) Non-Pulmonary 21 26 15 17 22 25 17 23 16 26 Ophthalmia Neonatorum 9 5 8 4 3 4 8 13 10 3 Total 764 697 319 309 265 503 455 1036 955 393 15 Table V. shows the occurrence of the cases in months. Both diseases were most prevalent in the early part of the year. At no time did they reach epidemic proportions. table v. Scarlet Fever. Diphtheria. January 24 1 February 17 18 March 14 1 April 12 10 May 9 6 June 10 4 July 8 3 August 1 1 September 7 2 October 11 6 November 17 2 December 12 2 Total 142 56 As to diphtheria, in the treatment of which it is essential to secure the earliest administration of anti-toxin, every effort is made to have the cases recognised and promptly dealt with. The Council provides for the bacteriological examination of specimens and, in necessitous cases, for the supply of anti-toxin free of charge. Besides, cases which are only suspected of suffering from the disease are admitted to the Isolation Hospital on the recommendation of the medical attendant in order to make sure of early treatment. During the year 176,000 units of anti-toxin were issued free of charge for administration by medical practitioners in the town. 16 TABLE VI. Cases of Infectious Disease notified during the year 1923. Disease. Ages of Cases Notified. Totals. Total Cases Notified in each Ward Total cases removed to Hospital. Under One Year. 1 to 2 2 to 3 3 to 4 4 to 5 5 to 10 10 to 15 15 to 20 20 to 35 35 to 45 45 to 65 65 and upwards 1* 2* 3* 4* 5* 6* Diphtheria – – 4 5 5 21 12 3 5 1 – – 56 1 2 3 26 18 6 51 Scarlet Fever – 3 7 8 12 67 26 6 12 1 – – 142 14 13 15 46 41 13 105 Enteric Fever (including Paratyphoid) – – – – – – 1 1 2 – 1 – 5 2 – 2 – – 1 1 Puerperal Fever – – – – – – – – 8 1 – – 9 – – – – – 9 4 Pneumonia: Primary 3 2 – – – 4 3 3 – 6 10 1 32 4 5 1 9 6 7 – Influenzal – – – – – – – – 3 – 3 1 7 – 2 – 1 2 2 – Acute Poliomyelitis – – – – – – – – – – – – – – – – – – – Cerebro-Spinal Fever – – – 1 – – – – – – – – 1 – – – – 1 – – Malaria – – – – – – – – 2 – – – 2 – 1 – – – 1 – Dysentery – – – – – – – – – – – – – – – – – – – – Erysipelas 1 – – – – – – 1 3 4 6 2 17 1 – 1 3 3 4 – Encephalitis Lethargica – – – – – – – 1 – – – – 1 – – – 1 – – – Tuberculosis: (a) Pulmonary Male – – – – – – – 3 16 17 6 1 43 6 5 4 12 12 4 – Female – – – – – 1 2 6 21 11 7 1 49 9 6 6 12 14 2 – (6) Non-Pulmonary Male 1 – – 2 1 3 1 – 1 – 1 – 10 – 1 – 1 5 3 – Female – – – 1 – 1 2 2 5 4 – 1 16 1 4 1 2 6 2 – Ophthalmia Neonatorum 3 – – – – – – – – – – – 3 1 – – – – 2 – Total 8 5 11 17 18 97 47 26 78 45 34 7 393 39 44 33 113 108 56 161 * (1) Drayton Ward, (2) Castlebar, (3) Mount Park, (4) Lammas, (5) Manor, (6) Grange. 17 Ophthalmia Neonatorum.— Only three cases of ophthalmia neonatorum were notified during the year. Two of the cases occurred in the Chiswick and Ealing Maternity Hospital and one at a private nursing institution in London. The cases were under medical care when they developed. All three children recovered without impairment of the eyesight. Puerperal Fever.—It is necessary to make some comments on the unusual number of cases of puerperal fever. Seven of the nine cases occurred in J anuarv in the Chiswick and Ealing Maternity Hospital, and while most of them were of a mild character one was so severe that the patient unfortunately died. The occurrence of these cases was the subject of an enquiry by the Chiswick and Ealing Hospitals Committee, which adopted certain measures which it is hoped will prevent such an extension of infection in the future. The other two cases occurred in December, one in the Chiswick and Ealing Maternity Hospital after a complicated labour and the other in a private nursing institution after a miscarriage. The number of cases notified in the various age groups are included in Table VI. By far the largest number occurred as usual between the ages of 5 and 10 years. NURSING ARRANGEMENTS, HOSPITALS AND OTHER INSTITUTIONS AVAILABLE FOR THE DISTRICT. Professional Nursing in the Home.—(a) General.—The Ealing District Nursing Association by means of two fully trained nurses supplies professional nursing for cases of non-infectious illness in the district. In 1921 the" Association commenced with one nurse, in 1922 the half-time services of another nurse were obtained, and in 1923 the whole-time services of the second nurse had to be requisitioned to meet the needs of the district. There can be no doubt that, as the appreciation of the work of the nurses among those for whom the service is designed increases, greater calls will be made and the number of nurses will have to be still 18 further increased. A home nursing service brings professional help to those who cannot otherwise obtain it outside general hospitals, while it relieves pressure on our general hospitals and enables beds to be available for more urgent cases which cannot adequately be dealt with at home. (b) For Infectious Diseases.—Two of the health visitors, who are trained nurses, can be drafted to the nursing of infectious cases such as measles, whooping cough, ophthalmia neonatorum and poliomyelitis, should their services be required. During the year under consideration, however, owing to the general absence of these diseases, there was no demand for such nursing. Midwives.—At present there are eleven midwives practising in the district. All have undergone training at a recognised training school and possess the Certificate of the Central Midwives Board. Although the supervision of these midwives comes within the province of the County Council, there is close co-operation between them and the local Welfare Centre. They are encouraged to send or bring the expectant mothers, who engage their services, to the Ante-Natal Centre and to advise the mothers to bring their children to the Child Welfare Centre. The Council does not subsidise any of the midwives, but when maternity aid is required in necessitous cases the midwife who resides in closest proximity is engaged at the expense of the Council. Clinics and Treatment Centres.—There is no out-patient department at the King Edward Memorial Hospital, which possesses 50 beds for the indoor treatment of medical and surgical patients, but a Dispensary, conducted on provident principles, offers medical and surgical attendance at their homes to non-insured persons. A Tuberculosis Dispensary is provided by the County Council at Green Man Lane and to this general medical practitioners or members of the Public Health Staff may refer suspected or active cases of pulmonary or non-pulmonary tuberculosis for diagnosis and treatment. 19 There is no Dispensary for Venereal Diseases in Ealing, but medical practitioners may, under the scheme of the County Council, refer cases for diagnosis and treatment to certain of the London Hospitals, the nearest to this district being the West London Hospital. The Maternity and Child Welfare Centre and the School Clinic, the former maintained by the Council and the latter by the Education Committee, are conveniently situated in the same building at 13, Mattock Lane, within a short distance of the Town Hall and almost in the centre of the town. The arrangement of these two branches of municipal public health activity in the same building facilitates the work and favours co-ordination. Hospitals Provided by the Local, Authority.— (1) Maternity.—The Chiswick and Ealing Hospitals Committee maintains a Maternity Hospital at South Ealing to meet the needs of both districts. Each district contributes towards the cost in proportion to its rateable value. The hospital is able to deal with sixteen cases at a time, but can be readily adapted to accommodate twenty-four cases should this increased accommodation be found to be necessary. (2) Children.—The King Edward Memorial Hospital, which has a ward specially reserved for children, offers six beds to the Council for the use of children under 5 years of age who require indoor treatment. Cases requiring such treatment are referred by the Medical Officer from the Child Welfare Centre. (3) Fever.—The Isolation Hospital, which has 120 beds, and which is maintained by the Chiswick and Ealing Hospitals Committee for the benefit of both districts, provides isolation facilities primarily for cases of scarlet fever, diphtheria and enteric fever, but accommodation is also available for other infectious diseases. The hospital is situated in South Ealing. (4) Smallpox.—The Ealing Town Council possesses a separate Smallpox Hospital, accommodating twelve patients, at Perivale, just over the northern boundary of the district. A reception house for isolating persons who have been in immediate contact with 20 cases of smallpox is situated at North Ealing on ground adjoining the Northern Sewage Works and about half-a-mile from the Smallpox Hospital. This consists of two wards, which provide for two families, or eight persons. Ambulance Facilities.—(a) General.—For the removal of cases of non-infectious illness the Council maintains two motor ambulances, one of which is lent by the Ambulance Committee of the Joint Council of the British Red Cross Society and the Order of St. John. The use of the ambulance in the district is given free of charge, but when the journey is outside a charge of one guinea is made, except in necessitous cases, when the fee is either reduced or remitted. (b) Infectious Disease.—The Chiswick and Ealing Hospitals Committee have two horse-drawn ambulances for the removal of infectious cases to the Isolation Hospital. Owing, however, to the long distances to be travelled in taking cases from Chiswick, Hanwell and Greenford, and to the growing appreciation of the value of expeditous removal of cases of diphtheria, these will it is hoped give place in the course of the year to two motor ambulances. MATERNITY AND CHILD WELFARE. The scheme of Maternity and Child Welfare, as previously outlined, remains the same, with the exception that the arrangements for giving health lectures and demonstrations have been considerably developed. Health talks or lectures and demonstrations of the cutting-out, sewing and knitting of useful garments, etc., form a daily routine. In this work the Health Visitors are greatly and most valuably assisted by Mrs. Cocker and Mrs. Morris, two members of the Maternity and Child Welfare Committee. The permanent staff engaged in Maternity and Child Welfare consists of Dr. John W. Bell, Ante-Natal Consultant; Dr. Grace Banham, Child Consultant, three Health Visitors and a Clerk, to all of whose salaries the Ministry of Health make contributions. 21 The following is a Summary of the Work of the Welfare Centre during the Year. Number of children on register at the end of year 1,177 Mothers visiting Centre for the first time 607 Children visidng Centre for the first time 607 Total attendances made by mothers 4,678 Total attendances made by children 5,420 Average attendance of mothers each afternoon 31 Average attendance of children each afternoon 36 Number of Consultations by Medical Officer 2,206 Average number of children seen by Medical Officer each afternoon 15 Children referred to School Clinic for treatment: Nose and Throat 4 Eyes 1 Teeth 8 Mothers referred for dental treatment to School Clinic 13 Mothers supplied with artificial dentures 8 Children referred to King Edward Hospital for minor operations 31 Children admitted to King Edward Hospital as indoor patients 5 Children referred to special London Hospitals 18 Mothers attending Ante-Natal Clinic: First Visits 178 Re-visits 102 Number of Consultations by Consultant at Centre 275 Mothers referred to King Edward Hospital 18 Mothers referred to special London Hospitals 18 Aid provided for mothers at confinement: Consultant aid—cases 4 Medical aid—cases — Midwives—cases 21 Home Helps—cases 6 Dried Milk supplied at cost price Value £407 4 3 Virol supplied at cost price ,, £85 8 6 Cod Liver Oil supplied at cost price „ £46 7 8 Number of Maternity Cases treated at the Chiswick and Ealing Maternity Hospital 144 22 Expectant or Nursing Mothers receiving a supply of milk free of charge 374 Children under 5 years of age receiving a supply of milk free of charge 227 The following is a Summary of the Work of the Health Visitors. Visits to children under 12 months: First Visits 807 Return Visits 1,549 Visits to children 1 to 5 years of age 2,678 Visits to expectant mothers 182 Visits to children or mothers attending the Welfare Centre 1,601 Visits to investigate infant deaths and still-births 52 Special visits or investigations 183 Visits to cases of Ophthalmia Neonatorum 13 Visits to cases of Puerperal Fever 1 Visits to cases of Measles and Whooping Cough 283 Visits to cases of Tuberculosis 136 Visits to cases of Scarlet Fever on discharge from the Isolation Hospital 131 Other Visits 27 Total Visits 7,643 Interviews, etc. 1,536 The number of Births notified during the year was 1,280, including 29 still-births. Of these, 807 were visited by the Health Visitors at least once, the total visits to infants under one year of age being 2,356. It will be seen in the Table that 2,678 visits were made to children over 12 months old and under 5 years. It is interesting to note that from Ealing 144 cases were admitted to the Joint Maternity Hospital and towards the cost of their treatment the amount of £604 14s. 0d. was received from them. 23 SANITARY ADMINISTRATION. The following is a summary of the work of the three Sanitary Inspectors during the year and of other action taken under the Public Health Acts, Byelaws, Etc. General. Number of Premises inspected on Complaint 299 Number of Nuisances observed by Inspectors 84 Number of Premises inspected in connection with Infectious Disease 233 Number of Premises visited by Periodical Inspection (Cowsheds, Dairies, Slaughter-houses, Workshops, Etc.) 568 Number of Houses inspected under House-to-House Survey 421 Food Inspections 4,721 Total number of Re-inspections 6,543 Other Inspections 138 Total number of Inspections and Re-inspections 13,007 Number of Intimation Notices given 528 Number of other Letters written 279 Number of Statutory Notices served 138 Proceedings before Magistrates 4 Dairies, Cowsheds and Milkshops. Number of Cowsheds on Register 1 Number of Inspections made of Cowsheds 5 Contraventions of Regulations 3 Number of Retail Purveyors of Milk on Register 42 Number of Inspections of Retail Purveyors' Premises 120 Contraventions of Regulations 42 Proceedings before Magistrates 1 Slaughterhouses. Number of Registered or Licensed Slaughterhouses 5 Number of Inspections made 142 Contraventions of Regulations None Proceedings before Magistrates None 24 Factories and Workshops. Registered Workshops 148 Factories 38 Number of Inspections of Factories 87 and Workshops and Workplaces 271 358 Number of Defects concerning which Notices were sent 75 Proceedings before Magistrates None Offensive Trades. Fried Fish Shops 12 Other Offensive Trades None Number of Inspections 173 Contraventions 3 Disinfection. Rooms disinfected by Spray: (a) Ordinary Infectious Disease 308 (b) Tuberculous 119 Rooms stripped and cleansed 105 Articles disinfected by steam at disinfector : (a) Ordinary Infectious Disease 1,738 (b) Tuberculous 290 Articles voluntarily destroyed 189 Particulars of the Sanitary Defects referred to in Notices Served and Letters Written. Water Closets repaired or supplied with water or otherwise improved 313 Drains cleared and cleansed 53 Defects in Drains repaired 97 Drains reconstructed 29 Dust-bins provided 161 Overcrowding remedied 3 Accumulations of refuse removed 86 Nuisance from fowls and other animals abated 27 Damp-proof courses inserted in walls 70 25 Ventilation under floors provided 31 Other forms of dampness remedied 32 Yards paved and repaired 143 Floors repaired 110 Roofs, Gutters and Rain-water Pipes repaired 361 New Soil and Ventilating Pipes provided 100 Sinks and Waste-pipes repaired or renewed 105 Draw Taps fixed to main supply 14 Dirty Walls and Ceilings stripped and cleansed 1,201 Other Defects or Nuisances remedied 631 Supervision of the Production and Sale of Food.— Milk.—There is only one cowshed in the district, but there are 42 premises in which milk is retailed. Most of the latter are well arranged and excellently managed, but there are a few in which structural alterations will have to be made to enable them to comply with modern requirements. Whenever a change of tenancy takes place or new premises are suggested the opportunity is taken of advising a suitable arrangement of the milk store, of the milk treatment room, if pasteurisation or cooling or both are undertaken, and of the washing-up place. As it is considered impossible to conduct a dairy business without a steam boiler for supplying a plentiful supply of hot water for cleansing the utensils and of steam for sterilising them, a boiler is strongly advised and has been in all cases provided. During the year ten applications for registration as purveyors of milk were received. In two, registration was refused as the premises were unsuitable. One application was from a person who retailed milk in Ealing but had his premises in an adjoining district; in this case registration was granted after the receipt of a satisfactory report from the Medical Officer of Health of the district. Meat and Other Foods.—It is the practice of the butchers, fishmongers and tradesmen in the town to seek the advice of the Sanitary Inspector when there is any doubt as to the fitness of food for human consumption. In this way the Inspectors are assisted in their duties and prosecutions are avoided. 26 There is now very little killing carried out in the district, most of the meat being purchased dead in the open market, chiefly at the Islington Cattle Market. The following list indicates all the articles of food found diseased or unsound and voluntarily surrendered. Food. ity. Beef 190 lbs. Fish 266 lbs. Rabbits 126 lbs. Fowls 15 lbs. Shellfish (Crabs) 42 lbs. Total 639 lbs. River Pollution.— Since the completion of the new sewage works at Wembley a considerable improvement has taken place in the River Brent concerning the gross pollution of which reports were made on previous occasions. What has been for years almost a sewer in its odour and character has become an inoffensive stream. It is to be hoped that its present inoffensiveness will be maintained. The extent and nature of the works ought to guarantee this, at least for some years to come. Nuisance from Refuse Dumps.—There has fortunately been a material change in the management of the refuse dump at Northolt of which complaint was made in the Annual Report for 1922. So far as Ealing is concerned there has been no occasion for complaint, except once during the year when an inspectorial visit was promptly followed by remedial measures. The nuisance affecting the residents in this district is caused by the refuse burning, a circumstance which is difficult to avoid in a dump so extensive and still more difficult to control when once the fire is established. 27 Adoptive Acts, Bye-laws and Local Regulations relating to public health, in force in the district, with date of adoption:— Public Health Acts (Amendment) Act, 1890. 20th November, 1890. Infectious Disease (Prevention) Act, 1890. 18th December, 1890. Public Health Acts (Amendment) Act, 1907. 21st December, 1908. Notification of Births Act, 1907. 9th May, 1912. The Ealing Corporation Act, 1905, confers additional powers on the Council with rcspect to certain sanitary matters, the provision of dustbins, the drainage of houses by combined operation, the control of tuberculous milk, etc. Bye-laws, with date of making, with respect to: (1) Prevention of nuisances arising from sewage, filth, etc., keeping of animals, and (2) Cleansing of earth closets, privies, ashpits and cesspools, October 15th, 1880. Common Lodging Houses, February 4th, 1881. Slaughter Houses, March 6th, 1884. (Added to: Humane Slaughtering of Animals, 1922). New Streets and Buildings, December 3rd, 1885. New Buildings, May 26th, 1896. Bye-laws under Section 26 (1) of the Public Health Acts (Amendment) Act, 1890. June 20th, 1907. Tents, Vans, Sheds, etc., under the Housing of the Working Classes Act, 1885. July 2nd, 1907. Prevention of Keeping Animals on any premises so as to be injurious to Health. July 15th, 1910. Regulations: Regulations under the Dairies, Cowsheds and Milkshops Order of 1885. October 6th, 1887. Communications between Drains and Sewers, Section 21, Public Health Act, 1875. October 8th, 1908. 28 LABORATORY WORK. The bacteriological laboratory continues to extend in usefulness. Not only does it deal with specimens taken in the Borough, including the Isolation Hospital, but the Urban Districts of Hanwell and Greenford make use of the facilities. The Hospitals Committee and the Hanwell and Greenford District Councils by payment for the examination of specimens contribute greatly towards the upkeep of the Laboratory. During the year the following specimens were examined:— Positive Negative Total Diphtheria: Ealing 16 446 462 Isolation Hospital 172 1,544 1,716 Hanwell 14 294 308 Greenford — 1 1 Tuberculosis: Ealing 30 148 178 Hanwell 5 23 28 Greenford — — — Miscellaneous: Ealing 7 8 15 Hanwell — 1 1 Greenford — — — Totals 244 2,465 2,709 HOUSING. The housing difficulties still remain the same, and will so remain until a great impetus is given to building by private enterprise or until the Council undertake a comprehensive scheme. As the difficulties are great and really national, little progress can be made until the Government evolve a large and practicable scheme of house building on a good basis. Much good work is being done in improving the present houses which in many instances the owner is unwilling to decorate or repair until called upon to do so by the Sanitary Inspectors. 29 NUMBER OF NEW HOUSES ERECTED DURING THE YEAR: (a) Total 151 (b) As part of a municipal housing scheme None 1.—Unfit Dwelling Houses. Inspection. (1) Total number of dwelling houses inspected for housing defects (under Public Health or Housing Acts) 1,135 (2) Number of dwelling houses which were inspected and recorded under the Housing (Inspection of District) Regulations, 1910 421 (3) Number of dwelling houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation None (4) Number of dwelling houses (exclusive of those referred to under the preceding sub-heading) found not to be in all respects reasonably fit for human habitation 697 2.—Remedy of Defects without Service of Formal Notices. Number of defective dwelling houses rendered fit in consequence of informal action by the Local Authority or their Officers 594 3.—Action under Statutory Powers. (a) Proceedings under Section 28 of the Housing, Town Planning, etc., Act, 1919 None (1) Number of dwelling houses in respect of which notices were served requiring repairs None (2) Number of dwelling houses which were rendered fit: (a) By Owners None (b) By Local Authority in default of Owners None (3) Number of dwelling houses in respect of which Closing Orders became operative in pursuance of declarations by Owners of intention to close None 30 (b) Proceedings under Public Health Acts : (1) Number of dwelling houses in respect of which Notices were served requiring defects to be remedied 138 (2) Number of dwelling houses in which defects were remedied : (a) By Owners or Occupiers 155 (b) By Local Authority in default of Owners None (c) Proceedings under .Section 17 and 18 of the Housing, Town Planning, etc., Act, 1909: (1) Number of representations made with a view to the making of Closing Orders None (2) Number of dwelling houses in respect of which Closing Orders were made None (3) Number of dwelling houses in respect of which Closing Orders were determined, the dwelling houses having been rendered fit None (4) Number of dwelling houses in respect of which Demolition Orders were made None (5) Number of dwelling houses demolished in suance of Demolition Orders None TABLE VII. AGES AT DEATH FROM NOTIFIABLE INFECTIOUS DISEASES. Disease. Under One Year 1 to 2 2 to 3 3 to 4 4 to 5 5 to 10 10 to 15 15 to 20 20 to 35 35 to 45 45 to 65 65 and upwards Totals Diphtheria — - 1 - 1 3 - - 1 - - - 6 Scarlet Fever — — — — — 1 — — — — — — 1 Enteric Fever (including Paratyphoid) - - - - - - - 1 - - - - 1 Puerperal Fever - - - - - - - — - 1 - — 1 Pneumonia: Primary 11 2 1 — - - — - 1 3 10 14 42 Influenzal - — - — — — — — - — - — — Acute Poliomyelitis - - - - - - - - - - - — — Cerebro- Spinal Fever - — — 1 - — — - — — - — 1 Malaria - - — — — - — — - — — — — Dysentery - - - - - - - - - - - — — Erysipelas - - — - — - — - - — - — — Encephalitis Lethargica - - - - - - - - 1 - - - 1 Tuberculosis: (a) Pulmonary (Male - - - - - - - 2 8 8 9 1 28 Female - — — — — — 1 4 16 6 5 — 32 (b) Non-Pulmonary Male - - - 1 - - - - 2 - 1 1 5 Female 1 - — 1 - - 1 1 - - 1 — 5 Ophthalmia Neonatorum - — - - - - - - - - - - — Totals 12 2 2 3 1 4 2 8 29 18 26 16 123 31 32 table viii. Cause of Death, 1923. Cause of Death. Male Female Total Enteric Fever 1 — 1 Smallpox — — — Measles — — — Scarlet Fever 1 — 1 Whooping Cough 1 6 7 Diphtheria 2 4 6 Influenza 7 4 11 Encephalitis Lethargica — 1 1 Meningococcal Meningitis 1 — 1 Tuberculosis of Respiratory System 27 33 60 Other Tuberculous Diseases 6 4 10 Cancer, Malignant Disease 52 66 118 Rheumatic Fever 1 1 2 Diabetes 3 2 5 Cerebral Haemorrhage, Etc. 10 29 39 Heart Disease 42 56 98 Arterio-Sclerosis 10 26 36 Bronchitis 18 38 56 Pneumonia (all forms) 18 24 42 Other Respiratory Diseases 7 4 11 Ulcer of Stomach or Duodenum 5 2 7 Diarrhoea, etc. (Under 2 years) 1 2 3 Appendicitis and Typhlitis 3 3 6 Cirrhosis of Liver — — — Acute and Chronic Nephritis 8 8 16 Puerperal Sepsis — 1 1 Other Accidents and Diseases of Pregnancy and Parturition - 3 3 Congenial Debility and Malformation, Premature Birth 15 10 25 Suicide 8 3 11 Other Deaths from Violence 7 11 18 Other Defined Diseases 60 69 129 Causes ill-defined or unknown — 1 1 Total 314 411 725 Borough of Ealing. EDUCATION COMMITTEE. REPORT OF THE School Medical Officer, For the Year ended 31st December, 1923. 34 EDUCATION GENERAL PURPOSES SUB-COMMITTEE, 1922-23. (Which deals with the School Medical Service). Chairman— Councillor W. T White. V ice- Chairman— Councillor W. F. Piper. Alderman H. Armriding, Councillor W. J. S. Cox, Councillor G. H. Gabb, Councillor W. Hutchings, Councillor G. R. Weeks, Miss A. D. Hawkin, Mr. J. C. Gordon, Mr. M. Hulbert, J.P. Mr. F. L. Jermyn, Mr. L. Marsh, M.A. Dr. W. W. Seton, Rev. C. J. Sharp. 35 STAFF. School Medical Officer— Thomas Orr, M.D., D.Sc., Of the Middle Temple, Barrister-at-Law. Assistant School Medical Officer and School Oculist— A. J. B. Griffin, M.B., D.P.H. School Nurses— *†‡ Hilda Bailey (Senior) †‡§ Alice Gough (Resigned, Aug., 1923) *‡Annie Johnson *Mary McGann (Appointed Sept., 1923) Clerks †mercie Richardson Grace Such. Surgeon— E. A. Chill, M.D., C.M. A naesthetist— S. M. Banham, M.B., M.R.C.S., E.R.C.P. Dentists— E. Brown, L.D.S., R.C.S. (Eng.) I. Cohen, E-D.S., R.C.S. (Eng.) School Clinic. 13, Mattock Lane, Ealing, W. *Certificate as Trained Nurse. †Certificate of Royal Sanitary Institute, School Nurse and Health Visitor. ‡Certificate of Central Midwives Board. Certificate of San. Insp. Exam. Board and of Royal San. Institute, Inspector of Nuisances. 36 THE SCHOOL MEDICAL SERVICE. The work of the School Medical Service may be summarised under the following headings:— 1. Routine Medical Inspection in School; 2. Non-routine Medical Inspection at the Inspection or School Clinic; 3. Treatment of Defective School Children; 4. Observation of Specially Defective School Children. There are ten public elementary schools under the control of the Local Education Authority. Of these, one, Good Shepherd Hall, is a temporary school for infants. Three schools are nonprovided. The schools are divided into twenty-four departments, namely, eight for boys, seven for girls, seven for infants, one for girls and infants, and one for boys and girls and infants. The remarks made in the Report for 1922 regarding the several schools that are out of date still apply. In these schools the facilities for medical inspection are far from convenient and the value of the work done suffers to some extent in consequence. MEDICAL INSPECTION. At the schools two kinds of inspection take place, (a) Routine and (b) Non-routine. (a) Routine examinations comprise those required by the Board of Education for the three groups of school children:— 1. Entrants—all children admitted to school during the year; 2. Intermediates—all children between the ages of 8 and 9 years; 3. Leavers—children between 12 and 13 years, and those over 13 years not previously examined. (b) Non-routine examinations are concerned with:— 1. Children presented by the head teachers for some special or suspected defect; 2. Children requiring supervision for some defect found at a previous examination (not in the same year). 37 During the year there were examined 755 entrants, 735 in the intermediate age-group, and 900 leavers, making a total of 2,390. Non-routine examinations numbered 1,369, and re-inspections (these are subsequent examinations in the same year) 937. A total of 3,759 children were thus examined or re-examined. There was an average school attendance of 88 per cent., and of this average attendance no less than 64 per cent. were medically examined during the year. The attendance of parents at routine inspections, which is very helpful, is always welcomed and the attendance figure of 70 per cent. shows that school medical inspection, which was once resented by the parents, is now greatly appreciated. The sub-joined table indicates the number of children in each age-group inspected in the various schools Number of Children Inspected. School. Entrants. Total Boys Girls Provided. Drayton 63 55 118 Joseph Lancaster 4 5 9 Lammas 55 58 113 Little Ealing 92 74 166 North Ealing 35 26 61 Northfields 64 32 96 Good Shepherd Hall (temporary) 26 15 41 Non-provided. Christ Church 36 52 88 St. John's 28 35 63 St. Mary's — — — Total 403 352 755 38 Number of Children Inspected School. Age-8 Group Leavers Boys Girls Total Boys Girls Total Provided. Drayton 38 26 64 48 51 99 Joseph Lancaster 41 25 66 13 29 42 Lammas — — — 154 168 322 Little Ealing 69 89 158 71 82 153 North Ealing 40 31 71 27 30 57 Northfields 94 85 179 — — — Good Shepherd Hall (temporary) 8 17 25 — — — Non-provided Christ Church — 41 41 48 3 51 St. John's 39 31 70 56 53 109 St. Mary's 61 — 61 — 67 67 Total 390 345 735 417 483 900 Findings of Medical Inspection. The tabulated results of Routine and Non-routine Medical Inspections will be found in Table II. of the Appendix. Out of 2,390 routine examinations, 571 or 23.9 per cent. of the children were found to require treatment for defective conditions. Of the 1,312 defects found, 622 were referred for medical treatment and 690 for supervision or further observation. The methods of notification of defects to parents and teachers and of the following up of cases remain unaltered. In this connection no less than 1,511 visits were made by the School Nurses to the homes of the children and to the schools. Uncleanliness.— This preventible condition remains one of the principal causes of loss of school time. Such loss is as deplorable as it is unnecessary, the more so as it makes demands on the time of the medical and nursing staff that might be better utilised. The responsibility for it rests with the parents whose carelessness n permitting uncleanliness to occur is equalled only by their 39 lethargy in remedying it when it is once established. Children of certain families come up for exclusion for uncleanliness with the regularity of "habituals," and the cleansing of their verminous heads which should be a matter simply of days, is allowed by their negligent parents to run into weeks. Only the most stringent application of the law can be expected to inculcate a sense of responsibility into such parents ; and the more harshly they are dealt with by the Justices the less likely are they to permit the recurrence of the condition. At the periodical inspection of heads held after the usual school holidays, 418, or 5 per cent., of the children were excluded out of 8,247 examined. In addition, 12 were excluded at routine medical inspection, and 44 of those specially referred by the school teachers. Failure to cleanse an excluded child within 14 days is met by a summons under the Attendance Bye-Laws. During the year 33 summonses were issued. Fines of 10/- were imposed in twenty cases, and 5/- in eleven cases. Two cases were adjourned for cleansing which was carried out within the time allowed. Minor Ailments.—Minor ailments found on routine and non-routine examinations were as follows:— Ringworm of head 16 Ringworm of body 17 Scabies 26 Impetigo 127 Minor Injuries 21 Other Skin Diseases 150 Ear Disease (including Otorrhoea) 44 Eye Disease (including Blepharitis and Conjunctivitis) 55 Total 456 Enlarged Tonsils and Adenoids.—On routine inspection 86 cases of enlarged tonsils were found to require treatment and 92 to require observation. Thirteen cases of adenoids only and 40 ten cases of enlarged tonsils and adenoids were referred for treatment. In addition eleven other cases of enlarged tonsils, eighteen of adenoids and seven of enlarged tonsils and adenoids were discovered at the Inspection Clinic. At routine inspection 56 other throat and nose conditions requiring observation were found. These consisted of cases of displaced septum and simple "mouth breathing" without obvious nasal obstruction. In such cases the parents or teachers were advised by the doctor at the time of examination. Stress may at this point be laid on the ill effects of "mouth breathing." This condition is prone to set up catarrhal conditions of the throat, nose and middle ear. It causes interference with the normal chest development and renders its subjects liable to bronchitis and associated chest diseases. It is easily remedied in its early stages and valuable work can be done in this connection by observant school teachers. Tuberculosis.—At routine examinations one definite and three suspected cases of tuberculosis of the lungs were found and also one case of tuberculosis of the hip. At special inspections three definite cases of pulmonary tuberculosis and ten suspected cases were found. The diagnosis of early pulmonary tuberculosis in children presents considerable difficulty and as a routine procedure all suspected cases are referred for a second opinion to the Tuberculosis Officer. Skin Conditions.—At routine examinations the following skin conditions were observed:— ringworm 2, scabies 5, impetigo 5 and other conditions 14. In addition, the following were found at the Inspection Clime:— Ringworm of head 14 Ringworm of body 17 Scabies 21 Impetigo 122 Other Conditions 136 Total 310 41 Impetigo still remains a fruitful cause of lowered school attendances. To this, two factors contribute ; in the first place affected children are not referred for treatment early enough so that one child may have infected several others before being sent for examination ; in the second place a proportion of children attend for treatment at infrequent and irregular periods, and it is only after repeated home visits by the School Nurses and threats of prosecution that they ultimately do attend. External Eye Disease.—Routine examinations yielded the following results:—five cases of blepharitis, two cases of conjunctivitis, one case of keratitis, one case of corneal opacity and ten cases of squint. In addition there were found at the Inspection Clinic, two cases of blepharitis, twenty-two cases of conjunctivitis, one case of keratitis, five cases of squint and seven cases suffering from other conditions. Arrangements exist with the King Edward Memorial Hospital by which a certain number of suitable cases of squint may receive operative treatment. No such cases were treated during the year. Vision.—Perhaps in no branch of school medical work are such beneficial results shewn as in the treatment of visual defects. Early education is very largely composed of visual impressions and the importance of good vision in childhood cannot be over emphasized. Every effort therefore is made to get cases of defective eyesight early in school life. Each child with defective vision receives no less than three separate tests before being provided with glasses. Cases of eye disease that cannot be benefited by glasses are referred to one or other of the London Eye Hospitals. As a result of routine examination 156 cases of defective vision were referred for examination by the Oculist. A further 108 were referred from the Inspection Clinic. Ear Disease and Hearing.—Sixteen cases of defective hearing, 18 cases of otitis media, and 2 cases of other disease of the ear were discovered at Routine Medical Inspection, whilst at the Inspection Clinic 16 cases of defective hearing, 20 cases of otitis media and 4 other ear conditions were found. 42 Dental Defects.—The following Table classifies Dental Defects found at the Routine Medical Inspection. Dental Inspection. Entrants Age 8 Group. Leavers Total All teeth sound : No. of Children 417 386 725 1,528 Percentage 55.2 52.5 80.5 63.9 Less than 4 teeth decayed : No. of Children 278 307 166 751 Percentage 36.8 41.7 18.4 31.4 More than 4 teeth decayed : No. of Children 60 42 9 111 Percentage 8. 5.8 1.1 4.7 It will be seen that in the 8 years age-group no less than 47.5 per cent, of children had defective teeth. This is explained by the fact that it is at this age period that the temporary teeth are giving way to the permanent dentition ; and it is the temporary and not the permanent dentition that is principally affected. On the other hand a percentage of 80.5 children with sound teeth among the "leavers" indicates that parents and teachers are fully alive to the importance of the early arrest of dental caries and are taking every advantage of the facilities offered by the School Clinic to that end. The following Table indicates the sustained improvement in the teeth of the school children as a result of dental treatment and instruction in dental hygiene. 43 Dental Inspection, 1915 to 1923. Year Entrants Intermediate Group Leavers Total Percentage with sound Teeth Percentage with sound Teeth Percentage with sound Teeth Percentage with sound Teeth 1915 23.0 26.2 35.7 27.0 1916 15.6 30.2 37.2 25.3 1917 21.7 25.9 41.1 28 8 1918 28.8 25.8 44.1 32.8 1919 36.9 32.2 60.6 42.7 1920 48.6 46.4 64.2 53.1 1921 58.4 64.0 76.5 666 1922 45.7 50.2 72.8 56 3 1923 55.2 52.5 80.5 63.9 Crippling Defects.—In Table III. are indicated nineteen cases of crippling defects in boys and twenty-one in girls attending public elementary schools. Two cripple boys and five girls are not attending school. " Crippling " included such conditions as paralysis, severe bony deformities, either congenital or acquired and severe heart disease. Round .Shoulders and Spinal Curvature.—Forty-six cases of round shoulders and thirty-seven of spinal curvature were observed during routine medical inspection. Although these defects give a very small percentage out of over 2,000 children examined, they are deserving of mention because the greater number of them are avoidable and might be obviated by closer observation of the carriage and attitude of the children concerned, and by the use of suitable corrective exercises. By close attention in school and especially in the course of physical exercises the teachers can do a great deal to ameliorate these conditions. Vaccination.—Only 1,372 children, or 57.4 per cent., bore signs of successful vaccination. In other words nearly every second child is inadequately protected against smallpox. This shows how easily exemption from vaccination can now be obtained ; it also indicates the large proportion of susceptible members of the community to be taken into consideration should the district be involved in an outbreak of smallpox. 44 Infectious Disease.—During the year there were notified in the weekly returns of Infectious Diseases from the schools, 131 absentees owing to measles, 130 owing to whooping cough, 138 owing to chickenpox and 132 owing to mumps. Under Article 53 of the Education Code, 209 children were excluded during the year for the following causes :— Conjunctivitis 10 Impetigo 144 Ringworm of head 16 Ringworm of body 12 Scabies 26 Other Skin Diseases 1 Total 209 MEDICAL TREATMENT. Minor Ailments.—Minor ailments to the number of 354 were treated at the School Clinic, and 65 by private medical practitioners or at hospitals. The total attendances at the School Clinic for the daily treatment of minor ailments were 4,627, eighteen for every day on which the Clinic was available. Daily Treatments, 1923. Ear Cases 793 Eye Cases 846 Dressings 462 Ringworm 157 Impetigo 1903 Scabies 69 Others 397 Total 4627 45 Dental Defects.—Table IV. gives details of the dental inspection of school children, 4,291 were dentally inspected at the elementary schools and 2,763 referred for treatment. Of these, 1,251 were treated for the first time and 452 received subsequent treatments. The Table also shows statistically the dental treatment given at the Clinic. Extractions included 174 permanent and 1,660 temporary teeth and fillings, 1,086 permanent and 93 temporary. Gas administrations numbered 233. On account of dental deformities 127 children were referred to the Royal Dental Hospital, and of these 10 obtained treatment under the arrangement made between the Education Authority and the Royal Dental Hospital. Crippling Defects and Orthopaedics.—Most of these cases were referred for special treatment to the National Orthopaedic Hospital, London, but under arrangements made by the Education Committee, six cases of spinal curvature, one case of flat foot and one of infantile paralysis were treated at the King Edward Hospital with beneficial results. Payments by Parents.—The following amounts have been received from the parents during the year for treatment at the School Clinic : £ s. d. X-ray treatment of Ringworm of head 4 5 6 Dental Treatment 40 19 0 Operations 15 2 6 Spectacles 37 10 6 Treatment at the Royal Dental Hospital 7 6 Total £98 5 0 Enlarged Tonsils and Adenoids.—Table IV. indicates that fifty-five cases of enlarged tonsils or adenoids were successfully operated upon at the School Clinic and ten at hospitals or by private practitioners. In addition, twenty-three cases of other abnormal nasal conditions received treatment at the School Clinic. 46 Tuberculosis.—Cases of pulmonary tuberculosis are referred to the Tuberculosis Officer and cases of non-pulmonary tuberculosis to private practitioners or to general hospitals and in some instances to the Tuberculosis Officer. Skin Diseases.—Cases treated are indicated in Table IV. Out of 336 referred for treatment 295 were treated at the Clinic and 41 elsewhere. Attention has already been drawn to the large number of cases of impetigo and to the delay in the cure of the condition owing to irregular attendance at the Clinic. Cases of ringworm show a gratifying diminution. External Eye Disease.—Children referred for treatment for external eye diseases numbered 41 and of these 30 were treated at the School Clinic. The diseases included seven cases of blepharitis 24 of conjunctivitis and 10 other conditions. Visual Defects.—Out of 279 cases referred for refraction, 210 were examined at the School Clinic and 22 by private practitioners or at eye hospitals. Glasses were prescribed and supplied in 147 of these cases. All children provided with glasses are kept under supervision and their sight is regularly retested, a change of glasses being ordered if necessary. The School Nurses and teachers as far as possible endeavour to see that the glasses provided are worn. Ear Disease and Hearing.—Of 76 cases referred for treatment, 46 were dealt with at the School Clinic. Cases of chronic otorrhoea are very intractable and it is regretted that hitherto no means have been available for the rapid cure of this condition. Some success has, however, been reported as a result of the Ionization method, and it is possible that this method may ultimately be the means of considerable saving of time in the treatment of cases of chronic otorrhoea. The progress of this treatment elsewhere is being watched and if the successful results are maintained its adoption in Ealing will be advised. 47 In addition the following amounts were received for treatment at the Clinic:— £ s. d. Amount paid by the Maternity and Child Welfare Committee for the treatment of children under 5 years and of nursing and expectant mothers 7 3 10 Amount paid by the "Homes for Motherless Children " for the treatment of school children 1 12 9 Amount paid by the Ealing House Girls' Home for the treatment of children 8 10 Amount paid by the Maurice Girls' Home for the treatment of children 10 6 Total £9 15 11 INSPECTION CLINIC. School children may attend the Inspection Clinic daily at 10 a.m. on Tuesday, Wednesday, Thursday and Friday. They include cases specially referred by the Education Committee, Head Teachers, School Enquiry Officers and children brought by parents. Newly appointed teachers also attend for medical examination by special appointment. The scope and amount of the work done is indicated in the sub-joined summary:— Verminous Children 1,596 Impetigo 296 Scabies ... 55 Ringworm 64 Teachers 8 Miscellaneous 1,159 Total 3,178 48 SPECIALLY DEFECTIVE SCHOOL CHILDREN. These include the blind, deaf, defective and epileptic school children referred to in Table III. Four boys and one girl are being maintained by the Local Education Authority at Certified Schools for the Blind. Five boys and two girls who are partially blind attend public elementary schools under supervision. Two deaf mutes are maintained by the Local Authority at Certified Schools. Of forty-three mentally defective children, thirty-three attend elementary schools, five are maintained at Certified Schools and five do not attend any school. During the year three boys and four girls were reported to the Local Control Authority on reaching 16 years of age. Of epileptic children one attends a Certified School and one attends a public elementary school. EMPLOYED CHILDREN. By arrangement with the Juvenile Employment Bureau the School Medical Officer reports on the fitness for employment of children about to leave school and of children employed in accordance with the Bye-Laws made under the Employment of Children Act, 1903, as amended by the Education Act, 1918. In such examinations educational attainments as well as physical condition are considered. In the course of routine inspection at the schools 71 children employed out of school hours were examined. Two were found to be in such a condition of health that their employment was prohibited. Eight boys were examined before being allowed to engage in street trading. 49 MISCELLANEOUS. In the Report for 1921 remarks were made in regard to open-air education, physical training, provision of meals, school baths, co-operation of parents, co-operation of teachers, co-operation of attendance officers, co-operation of voluntary bodies, nursery schools and secondary and continuation schools, and to these remarks nothing has to be added. STATISTICAL TABLES. The Statistical Tables required by the Board of Education are appended. THOMAS ORR, School Medical Officer. May 21th. 1924. 50 TABLE I. Return of Medical Inspections. A. Routine Medical Inspections. Number of Code Group Inspections : Entrants 755 Intermediates 735 Leavers 900 Total 2,390 Number of other Routine Inspections — B. Other Inspections. Number of Special Inspections 1,369 Number of Re-Inspections 937 Total 2,306 MEDICAL INSPECTION RETURNS, 1923. 51 TABLE II. A. RETURN OF DEFECTS FOUND BY MEDICAL INSPECTION IN THE YEAR ENDED 31st DECEMBER, 1923. DEFECT OR DISEASE. Routine Inspections Special Insnections No. of Detects. No. of Defects. Requiring Treatment. Requiring to be kept under observation, but not requiring Treatment. Requiring Treatment. Requiring to be kept under observation, but not requiring Treatment. (1) (2) (3) (4) (5) Malnutrition — 182 — Uncleanliness, head 12 11 — — (See Table IV., Group V.) body — 24 — — Skin Ringworm, scalp '2 — 14 — ,, body — — 17 — Scabies 5 — 21 — Impetigo 5 — 122 — Other Diseases (non-Tuberculous' 14 — 136 — Eye Blepharitis 5 — 2 — Conjunctivitis 2 — 22 — Keratitis 1 — 1 — Corneal Opacities 1 — — — Defective Vision (excluding Squint) l56 — 108 — Squint 10 — 3 — Other Conditions — — 7 — Ear Defective Hearing 16 — 16 — Otitis Media 18 — 20 — Other Ear Diseases 2 — 4 — Nose and Throat Enlarged Tonsils only 86 92 11 — Adenoids only 13 — 18 — Enlarged Tonsils and Adenoids 10 — 7 — Other Conditions — 56 3 — Enlarged Cervical Glands (non-Tuberculous) 2 105 8 Defective Speech — 5 — — Teeth Dental Diseases (See Table IV., Group IV.) 111 — — — Heart and Circulation Heart Disease :— Organic 18 — 6 37 Functional 12 — 2 34 Anaemia 114 — 10 33 Lungs Bronchitis — 57 4 — Other Non-Tuberculous Diseases — — — — Tuberculosis Pulmonary: Definite 1 — 3 — Suspected 3 — 10 4 Non-Pulmonary: Glands — — 4 — Spine — — — — Hip 1 — — — Other Bones and Joints — — 1 — Skin — — — — Other forms — — 2 — Nervous System | Epilepsy — — — 1 Chorea 1 — 2 — Other Conditions 1 7 — — mities Rickets — 20 — — Spinal Curvature — 36 6 — Other Forms — 72 7 — Other Defects and Diseases — 23 120 23 622 690 719 132 52 B. Number of individual children found at Routine Medical Inspection to require Treatment (excluding Uncleanliness and Dental Diseases). Group. Number of Children. Percentage of Children found to require Treatment. Inspected. Found to require Treatment. (1) (2) (3) (4) Code Groups:— Entrants 755 253 33.5 Intermediates 735 150 20.4 Leavers 900 168 18.6 Total (Code Groups) 2,390 571 23.9 Other Routine Inspections — — — 53 TABLE III. RETURN OF ALL EXCEPTIONAL CHILDREN IN THE AREA. Boys Girls Total Blind (including partially blind) (i.) Suitable for training in a School or Class for the totally blind. Attending Certified Schools or Classes for the Blind 4 1 5 Attending Public Elementary Schools — — — At other Institutions — — — At no School or Institution — — (ii.) Suitable for training in a School or Class for the partially blind. Attending Certified Schools or Classes for the Blind — — — Attending Public Elementary Schools 5 0 7 At other Institutions — — — At no School or Institution — — — Deaf (including deaf and dumb and partially deaf) (i.) Suitable for training in a School or Class for the totally deaf or deaf and dumb. Attending Certified Schools or Classes for the Deaf — 2 2 Attending Public Elementary Schools — — — At other Institutions — — — At no School or Institution — — — (ii.) Suitable for training in a School or Class for the partially deaf. Attending Certified Schools or Classes for the Deaf — — — Attending Public Elementary Schools — — — At other Institutions — — — At no School or Institution — — — 1 Mentally Defective Feebleminded (cases not notifiable to the Local Control Authority.) Attending Certified Schools for Mentally Defective Children 2 3 5 Attending Public Elementary Schools 19 14 33 At other Institutions — — — At no School or Institution 1 4 5 Notified to the Local Control Authority during the year. Feebleminded 3 4 7 Imbeciles 1 2 3 Idiots ... — — — Epileptics Suffering from severe epilepsy. Attending Certified Special Schools for Epileptics 1 1 In Institutions other than Certified Special Schools — — — Attending Public Elementary Schools — — — At no School or Institution .— — — Suffering from epilepsy which is not severe Attending Public Elementary Schools — 1 1 At no School or Institution — — — 54 TABLE III.—contd. Boys Girls Total Physically Defective Infectious pulmonary and glandular tuberculosis. At Sanatoria or Sanatorium Schools approved by the Ministry of Health or the Board — — — At other Institutions — — — At no School or Institution — — — Non-infectious but active pulmonary and glandular tuberculosis. At Sanatoria or Sanatorium Schools approved by the Ministry of Health or the Board — — — At Certified Residential OpenAir Schools — — — At Certified Day Open-Air Schools — — — At Public Elementary Schools 3 — 3 At other Institutions — — — At no School or Institution 1 — 1 Delicate children (e.g., pre- or latent tuberculosis, malnutrition, debility, anae- mia, etc.) At Certified Residential Open-Air Schools — — — At Certified Day Open-Air Schools — — — At Public Elementary Schools 44 149 193 At other Institutions — — — At no School or Institution — — — Active non pulmonary tuberculosis. At Sanatoria or Hospital Schools approved by the Ministry of Health or the Board — — — At Public Elementary Schools — — — At other Institutions — — — At no School or Institution 1 — 1 Crippled Children (other than those with active tuberculous disease), e.g., children suffering from paralysis, etc., and including those with severe heart disease. At Certified Hospital Schools — — — At Certified Residential Cripple Schools — — — . At Certified Day Cripple Schools — — — At Public Elementary Schools 19 21 40 At other Institutions — — — At no School or Institution 2 5 7 55 TABLE IV. RETURN OF DEFECTS TREATED DURING THE YEAR ENDED 31st DECEMBER, 1923. TREATMENT TABLE. Group 1.—Minor Ailments (excluding Uncleanliness, for which see Group V.) Disease or Defect. Number of Defects treated, or under treatment during the year. Under the Authority's Scheme. Otherwise. Total. (1) (2) (3) (4) Skin :— Ringworm—Scalp 16 — 16 Ringworm—Body 15 2 17 Scabies 12 14 26 Impetigo 118 9 127 Minor Injuries — — — Other Skin Diseases — — Minor Eye Defects (external and other, but excluding cases falling in Group II.) 30 11 41 Minor Ear Defects 46 30 76 Miscellaneous (e.g. minor injuries, bruises, sores, chilblains, etc. 134 16 150 Total 371 82 453 56 Group II.—Defective Vision and Squint (excluding Minor Eye Defects treated as Minor Ailments—Group I.). Defect or Disease. No. of Defects dealt with. Under the Authority's Scheme. Submitted to refraction by private practitioner or at hospital, apart from the Authority's Scheme. Otherwise. Total. (1) (2) (3) (4) (5) Errors of Refraction (including Squint) 210 22 — 232 Other Defect or Disease of the Eyes (excluding those reported in Group 1) — Total 210 22 — 232 Total number of children for whom Spectacles were prescribed (а) Under the Authority's Scheme 147 (b) Otherwise — Total number of children who obtained or received Spectacles :— (a) Under the Authority's Scheme 182 (b) Otherwise — Group III.—Treatment of Defects of Nose and Throat. Number of Defects. Received Operative Treatment. Received other forms of Treatment. Total number treated. Under the Authority's Scheme, in Clinic or Hospital. By Private Practitioner or Hospital, apart from the Authority's Scheme. Total. (1) (2) (3) (4) (5) 55 10 65 88 57 Group IV.—Dental Defects. (1) Number of Children who were :— Inspected by the Dentist : Aged : Routine Age Groups 5 248 Total 4,291 6 418 7 616 8 515 9 548 10 508 11 510 12 393 13 359 14 176 , Specials 206 Grand Total 4,497 Found to require treatment 2,763 Actually treated 1,251 Re-treated during the year as the result of periodical examination 452 (2) Half-days devoted to:— Inspection 25 Total 196 Treatment 171 (3) Attendances made by children for treatment 1,703 (4) Fillings :— Permanent teeth 1,086 Total 1,179 Temporary teeth 93 (5) Extractions :— Permanent teeth 174 Total 1,834 Temporary teeth 1.660 (6) Administrations of general anaesthetics for extractions 233 (7) Other operations :— Permanent teeth — Total Temporary teeth — Group V.—Uncleanliness and Verminous Conditions. (1) Average number of visits per school made during the year by the School Nurses 4 (2) Total number of examinations of children in the Schools by School Nurses 8,247 (3) Number of individual children found unclean 732 (4) Number of children cleansed under arrangements made by the Local Education Authority Nil (5) Number of cases in which legal proceedings were taken:— (a) Under the Education Act, 1921 Nil (b) Under School Attendance Byelaws 33