p. Sl>ARf\-& ' I l 0 AC439(1) EA4NG Borough of Ealing. ANNUAL REPORT OF THE Medical Officer of Health AND School Medical Officer FOR THE YEAR 1924. 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. UsTJ * % m Borough of Ealing. ANNUAL REPORT of the Medical Officer of Health and School Medical Officer for the year 1924. 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, 1924. \ $ — 5 — INDEX. page Acts, Byelaws and Regulations 34 Ambulances 29 Bacteriological Examinations 35 Births 9, 11 Blind, Deaf, etc., Children 62 Clinics and Treatment Centres 24 Dairies, Cowsheds and Milkshops 25 Deaths 9, 11 Dental Defects 51 Diphtheria 17 Disinfection 26 Factories and Workshops 28 Food 32 Health Visiting 32 Hospitals in the District 29 Housing 35 Illegitimate Births 9 Infant Deaths 13 Infectious Diseases 16 Institutions in the District 23, 53 Maternity and Child Welfare 30 Medical Inspection of School Children 45 Medical Treatment of School Children 55 Midwives 24 Milk 32 Notifiable Diseases 16 Nursing Arrangements 23 Offensive Trades 26 Population 10 Sanitary Inspection of District 25 Scarlet Fever 17 Slaughterhouses 26 Staff 7, 41 Statistics, Vital 9 Statistics, General 9 Thyroid Gland, Enquiry as to 63 Tonsils and Adenoids 49 Uncleanliness 48 Vital Statistics 10 Welfare Centre 31 — 6 — PUBLIC HEALTH DEPARTMENT, PUBLIC HEALTH COMMITTEE. Councillor w. t. White (Chairman). Alderman H. Armriding ( Vice-Chairman). Alderman H. W. Peal, J.P., Councillors J. H. Chilton, J.P., J. C. Fuller, Lt.-Col. R. R. Kimmitt, O.B.E., J.P., W. D. Pocock, and H. M. Sayers. MATERNITY AND CHILD WELFARE CENTRE. Councillor Lt.-Col. R. R. Kimmitt, O.B.E., J.P. (Chairman) Mrs. Morris ( Vice-Chair man). Aldermen H. Armriding and H. W. Peal, J.P.; Councillors F. H. Chilton, J.P., J. C. Fuller. W. D. Pocock, H. M. Sayers, and W. T. White. Mesdames Cocker, Cooper, and Sharp. — 7 — 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. Bell, 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 Hill, 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. - 8 — 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. (Resigned 20th Oct., 1924). Marguerite Farrow, Cert. R.S.I., and Trained Nurse. Mildred Adeline Rice, Cert. R.S.I., Cert. C.M.B., and Trained Nurse. (Appointed 17th Nov., 1924). Chief Clerk and Committee Clerk— Harry Birrell. Clerk and Laboratory Assistant— Ernest W. Hill. Clerks— William A. J. Turner. Olive Levasseur. Maternity and Child Welfare Centre— 13, Mattock Lane, Ealing. — 9 — SUMMARY OF GENERAL STATISTICS, 1924. Population (Estimated 1924) 68,370 Population (Census, 1921) 67,756 Population (Census, 1911) 61,222 Area of Borough in Acres 2,946 Number of Structurally Separate Dwellings (1921) 14,967 Rateable Value £588,428 Net Produce of a Penny Rate £2,390 SUMMARY OF VITAL STATISTICS, 1924. Births: Legitimate Males, 480 Females, 459 Total, 939 980 Illegitimate Males, 19 Females, 22 Total, 41 Birth-rate 14.3 Deaths: Males, 349 Females, 410 Total 759 Death-rate 11.1 Deaths of Infants under 1 year: Legitimate Males, 23 Females, 19 Total, 42 46 Illegitimate Males, 1 Females, 3 Total, 4 Infant Death-rate per 1,000 Births: Legitimate, 44.7 Illegitimate, 97.5 Total 47 Total Deaths Death-rate per 1000 Population Measles 7 0.10 Whooping Cough — — Diarrhoea (under 2 years of age, per 1,000 births) 5 5.10 Diphtheria 6 0.08 Scarlet Fever 2 0.03 Influenza 31 0.45 Tuberculosis of Lung 41 0.60 Other Forms of Tuberculosis 10 0.15 All Forms of Tuberculosis 51 0.75 — 10 — Comparison of Vital Statistics of Ealing with those of England and Wales, etc., 1924. England and Wales 105 Great Towns (including London) London Ealing Birth Rate 18.8 19.4 18.7 14.3 Death Rate 12.2 12.3 12.1 11.1 Infant Death Rate 75 80 69 47 Measles Death Rate 0.12 0.18 0.29 0.10 Whooping Cough Death Rate 0.10 0.12 0.11 0.00 Diarrhoea (under 2 yrs. per 1,000 Births) 7.3 9.2 8.4 5.10 Diphtheria Death Rate 0.06 0.08 0.12 0.08 Scarlet Fever Death Rate 0.02 0.03 0.03 0.03 Influenza Death Rate 0.49 0.45 0.36 0.45 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 increases in the population of Ealing in successive decades:— Census, 1881 15,764 „ 1891 23,965 „ 1901 33,040 „ 1911 61,222 „ 1921 67,755 The area of the Borough extends to 2,946 acres, and the density of population, or the number of persons per acre, is therefore 23.0. The Lammas Ward is the most densely populated with 53.9 persons per acre, the Manor Ward coming next with 43.0, and the Mount Park Ward is the least populated with 9.4 persons per acre. For 1924 the population is estimated at 68,370. The natural increase of population, or the excess of births over deaths, is 221. The Birth-rate continues to show a decline in successive years, a decline which is evident all over the country. For 1924 the rate is 14.3 compared with 15.6 for 1923 and 16.2 for 1922, and is in marked contrast to the pre-war years as will be evident on consulting Table II. The birth-rate for Ealing is low compared with those for England and Wales and for London, which are 18.8 and 18.7 respectively. The Death-rate is slightly greater than in the previous year, 11.1 compared with 10.6 for 1923. A similar increase over the previous year was experienced by England and Wales generally and by London. The rate for Ealing, however, compares very favourably with that for England and Wales, which is 12.2, and that for London, which is 12.1 per 1.000 of population. — 12 — While the Infant Death-rate may not quite constitute a record it is equal to the previous lowest rate which was experienced in 1920, when there was an unusually high birth-rate as an aftermath of the War. The rate of 47 compares very well with the rates for England and Wales, for the Great Towns and for London, which are respectively 75, 80 and 69 per 1,000 births. In Table II the rate for 1924 is compared with the rates for the previous fourteen years. table II. Showing Birth-rate, Death-rate and Infant Death-rate for Ealing for the years 1910— 1924. 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 1924 14.3 11.1 47 — 13 — The causes of deaths of infants in 1924 are indicated in Table III, in which they are compared with those in the previous seven years. The small number compared with previous years is due to a reduction principally in the deaths from atrophy, debility and marasmus, bronchitis and pneumonia. Table IIIa shows the ages at death up to one year old. Of the 46 deaths, 23, or half of the total, occurred under 4 weeks old, and 13, or a little over a quarter, under a week old. It is thus apparent that among the children dying under one year a large number commence life considerably handicapped as regards vitality. The illegitimate infant death-rate of 97.5 is much lower than in the previous year when it was 191.5 per 1,000 births. It is, however, in marked contrast to the legitimate death-rate, which is 44.7 per 1,000 births. TABLE III. Causes of Infant Deaths, 1917 to 1924. 1917 1918 1919 1920 1921 1922 1923 1924 Diarrhoeal Diseases 10 14 3 9 9 5 2 4 Premature Birth 7 12 13 15 10 5 11 7 Congenital Defects 5 — 6 4 4 6 8 4 Want of Breast Milk (Starvation) - - - - - - - - Atrophy, Debility, Marasmus 6 11 14 14 12 10 9 6 Tuberculous Disease 2 — 3 3 — 2 1 3 Syphilis 1 — — 3 2 — — — Rickets — — — — — — — — Meningitis (not Tuberculous) 1 — 2 — 1 — 1 2 Convulsions 4 4 1 2 2 2 2 2 Bronchitis 5 5 3 1 6 5 5 1 Pneumonia (all forms) 17 6 4 4 9 1 10 3 Gastritis — — — 2 1 2 1 — Common Infectious Diseases 2 7 1 - 7 4 2 3 Other Causes 7 13 17 7 9 15 10 11 Totals 75 70 67 64 72 57 62 46 — 14 — TABLE IIIA. Infant Mortality during the Year 1924. Deaths at various ages under One Year of Age. Cause of Death Under 1 week 1—2 weeks 2—3 weeks 3—4 weeks Total under 4 weeks 4 weeks and under 3 months 3 months and under 6 months 6 months and under 9 months 9 months and under 12 months Total deaths under 1 year All Causes Certified 13 4 4 2 23 5 6 6 6 46 Uncertified — — — - — — — — - — Small-pox - - - - - - - - - - Chicken-pox - - - - - - - - - - Measles - - - - - - - - 3 3 Scarlet Fever - - - - - - - - - - Whooping-Cough - - - - - - - - - - Diphtheria and Croup - - - - - - - - - - Erysipelas - - - - - - - - - - Tuberculous Meningitis - - - - - - - - 1 1 Abdominal Tuberculosis - - - - - - - - - - Other Tuberculous Diseases - - - - - - - 2 — 2 Meningitis (not Tuberculous) - - - - - - - 1 1 2 Convulsions 1 — 1 — 2 — — — — 2 Laryngitis - - - - - - - - - - Bronchitis — — — — — — 1 — — 1 Pneumonia (all forms) - - - - - 1 1 — 1 3 Diarrhoea - - - - - - - - - - Enteritis — 1 1 2 4 — — — — 4 Gastritis - - - - - - - - - - Syphilis - - - - - - - - - - Rickets - - - - - - - - - - Suffocation, Overlying 1 - - - 1 - - - - 1 Injury at Birth 1 - - - 1 - - - - 1 Atelectasis - - - - - - - - - - Congenital Malformations 1 1 — — 2 — — 2 — 4 Premature Birth 5 — — — 5 2 — — — 7 Atrophy, Debility and Marasmus 2 1 1 - 4 1 1 - - 6 Other Causes 2 1 1 — 4 1 3 1 — 9 Totals 13 4 4 2 23 5 6 6 6 46 — 15 — In Table VIII are indicated the total deaths from the various diseases. Measles was somewhat prevalent during the Spring of the year and caused 7 deaths, giving a death-rate of 0.10 per 1,000 of population. This rate, however, is lower than that for England and Wales and for London, which are respectively 0.12 and 0.29. Whooping cough on the other hand was present in small numbers and there were no deaths. Scarlet fever and diphtheria did not reach epidemic proportions and supplied only 2 and 6 deaths respectively, giving rates of 0.03 and 0.08 per 1,000 of population. Influenza, which was prevalent towards the end of the year, provided three times more deaths than in the previous year. The influenza death-rate is 0.48 compared with 0.16 in 1923. This rate is similar to that for England and Wales and slightly higher than that for London, which is 0.36. Heart disease provided the highest number of deaths from any single disease, namely 105 or a death-rate of 1.5; Cancer comes next with 99 deaths or a death-rate of 1.4; then cerebral haemorrhage with 54 or a rate of 0.79; bronchitis with 52 or a rate of 0.76 ; tuberculosis 51 or a rate of 0.75 and pneumonia 47 or a rate of 0.68 per 1,000 of population. 16 PREVALENCE OF, AND CONTROL OVER, ACUTE INFECTIOUS DISEASE. In Table IV are indicated the numbers of the various infectious diseases notified during the year. Diphtheria provided 61 cases, a slight increase over the previous year, and scarlet fever 123 cases, a decrease over the previous year, and the lowest number since 1918. TABLE IV. Disease 1915 1916 1917 1918 1919 1920 1921 1922 1923 1924 Diphtheria 56 37 66 36 46 56 186 282 56 61 Scarlet Fever 458 146 91 61 201 171 665 487 142 123 Enteric Fever (including Paratyphoid) 11 5 3 6 5 6 8 3 5 _ 9 Puerperal Fever 1 1 — 2 3 5 9 3 9 3 Pneumonia: Primary 30 38 21 33 32 47 Influenzal 33 27 17 22 7 27 Acute Poliomyelitis 2 — 2 1 — — 1 — — 3 Cerebro-Spinal Fever 2 2 1 — 3 4 1 — 1 — Malaria 40 27 3 4 2 — Dysentery 5 2 1 1 — — Erysipelas 39 19 33 24 22 30 27 22 17 25 Encephalitis Lethargica 3 1 1 3 1 6 Tuberculosis: (a) Pulmonary 97 86 92 110 83 63 80 69 92 74 (b) Non-Pulmonary 26 15 17 22 25 17 23 16 26 31 Ophthalmia Neonatorum 5 8 4 3 4 8 13 10 3 3 Total 697 319 309 265 503 455 1036 955 393 412 17 The occurrence of diphtheria and scarlet fever in months is indicated in Table V. It will be seen that diphtheria was fairly well distributed throughout the year and that scarlet fever was most prevalent in May and in the last four months. TABLE V. Diphtheria. Scarlet Fever. January 6 4 February 3 3 March 6 4 April 4 8 May 5 23 June 5 9 July 8 8 August 1 5 September 3 10 October 7 18 November 8 12 December 5 19 Total 61 123 As regards diphtheria it cannot be too often repeated that the early recognition and early treatment of the disease are most important if a fatal issue is to be avoided. Parents should call in medical aid at the earliest possible opportunity when there are signs of sore throat and when there is enlargement of the glands of the neck, as severe cases of diphtheria are often mistaken for mumps. The Town Council offers facilities to medical men for the early bacteriological diagnosis of the condition and at the same time provides, in necessitous cases, a free supply of antitoxin which should be administered at the earliest possible moment when diphtheria is suspected, even before the diagnosis of the 18 condition is confirmed by the bacteriological report. During the year 96,000 units of antitoxin were supplied free of charge for cases of diphtheria. The cause of the increased prevalence of scarlet fever in May compared with the previous months could not be ascertained, the cases being distributed more or less over the whole district. An increase in the number of cases occurred, as is usually expected, in the later months of the year. A definite connection, however, was discovered among certain cases occurring in November and December. From the 17th November to the 11 th December 11 cases of scarlet fever were notified among children attending Drayton Infants' School. On enquiry it was found that they arose from a child who was away from school on the 10th and 11th November on account of sickness, which the mother later admitted to have been accompanied by a rash. He attended school until the 10th December, when he was excluded on suspicion, which was afterwards unwillingly confirmed by the mother. After the 11th December only one case was notified in connexion with this school. On investigation of this case at the home it was found that a brother, who had also attended the Drayton school, had suffered from an attack of scarlet fever on the 6th December, although not recognised as such by the medical attendant but fortunately had not been allowed to go to school. The isolation of these two unrecognised cases put a stop to the outbreak. Enteric (Typhoid) Fever.—Three cases of Enteric Fever, two of paratyphoid fever "A," and four of paratyphoid fever "B," were notified during the year. For practical purposes all three diseases may be taken as the same since not only the symptoms but the modes of spread are similar. They are merely distinguished by minute differences in the causal organisms. 19 TABLE VI. Cases of Infectious Disease notified during the year 1924. 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 — 2 2 7 7 23 10 4 3 3 — — 61 1 2 4 11 30 13 58 Scarlet Fever — 2 4 9 11 57 17 9 9 2 3 —— 123 17 23 12 32 32 7 93 Enteric Fever (including Paratyphoid) — — — — 1 1 1 1 2 2 1 — 9 — 2 1 1 2 3 — Puerperal Fever — — — — — — — — 2 1 — — 3 — — — — 1 2 Pneumonia: Primary 1 3 2 5 2 3 6 3 7 3 7 5 47 7 2 1 11 20 6 - Influenzal — — 1 1 — 1 — 1 6 7 6 4 27 - 1 1 7 12 8 - Acute Poliomyelitis — 1 — — 1 1 - - - - - — 3 - - - 3 - - - Cerebro-Spinal Fever — - - - - - - - - - - — - - - - - - - - Malaria — - - - - - - - - - - - - - - - - - - - Dysentery — - - - - - - - - - - — - - - - - - - - Erysipelas — — - — 1 1 — — 3 6 10 4 25 1 4 4 3 7 6 - Encephalitis Lethargica •— — — — — 1 — 1 2 — 2 — 6 - - 3 - 2 1 - Tuberculosis (a) Pulmonary Male — — — — — — — 4 10 17 8 — 39 4 6 1 1 1 13 4 — Female — — — — — — 1 5 18 9 2 — 35 2 6 4 4 11 8 — (b) Non-Pulmonary Male 1 1 2 1 1 1 2 — 2 1 — — 12 2 1 — 3 5 1 — Female 1 — 1 — 2 1 3 5 4 — 2 — 19 2 1 1 9 4 2 — Ophthalmia Neonatorum 3 — — — — — — — — — — — 3 — 2 — 1 — — — Total 6 9 12 23 26 90 40 33 68 51 41 13 412 36 50 32 96 139 59 151 * (1) Drayton Ward, (2) Castlebar, (3) Mount Park, (4) Lammas, (5) Manor, (6) Grange. 20 The cases were widely separated as regards date of onset and place of residence. Five were sickening when they arrived in Ealing, two of these having been infected abroad, two others gave a history of having partaken of water-cress, which could possibly have been the source of infection, while the remainder gave no clue to their origin. Fortunately the nature of the disease was mild in all cases and there were no deaths. Puerperal Fever.—Only three cases of puerperal fever were notified in the year. Two occurred in the Chiswick and Ealing Maternity Hospital and one in the practice of a general practitioner. One of the hospital cases and the other attended at home died. The hospital case which died was admitted in a bad condition, the child having been born precipitately in the lavatory at home. Ophthalmia Neonatorum.—Three cases of ophthalmia neonatorum occurred. All three, on which midwives were in attendance, were of a mild character and recovered quickly without any impairment of vision. Tuberculosis.—The following Table shows the number of new cases of tuberculosis notified during the year together with the deaths in the various age groups:— tuberculosis. Age Periods New Cases Deaths Pulmonary Non-Pulm'y Pulmonary Non-Pulm'y Male F'male Male F'male Male F'male Male. F'male 0—1 — — 1 1 — — 2 1 1—5 — — 5 3 — — 1 2 5—10 — — 1 1 — — 1 — 10—15 — 1 2 3 — — 1 — 15—20 4 5 — 4 1 2 1 — 20—25 2 9 1 3 4 4 — — 25—35 8 8 1 2 8 1 — — 35—45 16 11 1 — 9 7 — — 45—55 6 — — 1 — — — 1 55—65 3 1 —- 1 3 1 — — 65 upwards — — — — 1 — — — Total 39 35 12 19 26 15 6 4 21 There is little ground for complaint regarding the notification of cases of tuberculosis by medical men in the district. On the few occasions on which there has been omission to notify, a letter reminding the medical attendant of his responsibilities has been considered sufficient. During the year only two of the deaths from tuberculosis were of patients not in the Register of Notifications previous to the fatal issue. Other Infectious Diseases.—In Table VI is given the number of all forms of infectious disease and the ages at which they occurred. Attention may be directed to the 47 cases of primary pneumonia and 27 of influenzal pneumonia, to the three cases of acute poliomyelitis and six of encephalitis lethargica. In two of the last named the diagnosis was very much in doubt. 22 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 — — — — — — 2 Enteric Fever (including Paratyphoid) — — — — — — — — — — — — — Puerperal Sepsis — — — — — — — — 1 1 — —— 2 Pneumonia: Primary 3 1 2 — — 1 — — 3 3 13 20 46 Influenzal — — — — — — — — — — — 1 1 Acute Poliomyelitis — — — — — — — — — — — — — Cerebro-Spinal Fever — — — — — — — — — — — — — Malaria — — — — — — — — — — — — — Dysentery — — — — — — — — — — — — — Erysipelas — — — — — — — — — — — — — Encephalitis Lethargica — — — — 1 — — 1 — — 1 — 3 Tuberculosis: (a) Pulmonary Male — — — — — — — 1 12 9 3 1 26 Female — — — — — — 2 5 7 1 — 15 (b) Non-Pulmonary Male 2 — — — 1 1 1 1 — — — — 6 Female 1 — — 1 1 — - — — — 1 — 4 Ophthalmia Neonatorum — — — — — — — — — — — —— — Totals 6 2 3 2 3 6 1 6 21 20 19 22 111 23 TABLE VIII. Causes of Death, 1924. Cause of Death. Male Female Total Enteric Fever — — — Smallpox — — — Measles 3 4 7 Scarlet Fever 2 — 2 Whooping Cough — — — Diphtheria 6 — 6 Influenza 14 17 31 Encephalitis Lethargica 2 1 3 Meningococcal Meningitis — — — Tuberculosis of Respiratory System 26 15 41 Other Tuberculous Diseases 6 4 10 Cancer, Malignant Disease 41 58 99 Rheumatic Fever — 1 1 Diabetes 6 5 11 Cerebral Haemorrhage, Etc. 26 28 54 Heart Disease 44 61 105 Arterio-Sclerosis 16 13 29 Bronchitis 18 34 52 Pneumonia (all forms) 25 22 47 Other Respiratory Diseases 5 8 13 Ulcer of Stomach or Duodenum 4 2 6 Diarrhoea, etc. (Under 2 years) 3 2 5 Appendicitis and Typhlitis 1 3 4 Cirrhosis of Liver — 1 1 Acute and Chronic Nephritis 8 10 18 Puerperal Sepsis — 2 2 Other Accidents and Diseases of Pregnancy and Parturition — 3 3 Congenital Debility and Malformation, Premature Birth 12 8 20 Suicide 3 4 7 Other Deaths from Violence 13 8 21 Other Defined Diseases 65 96 161 Causes ill-defined or unknown — — — Total 349 410 759 NURSING ARRANGEMENTS, HOSPITALS AND OTHER INSTITUTIONS AVAILABLE FOR THE DISTRICT. Professional Nursing in the Home.—(a) For General Diseases.—As recorded in the previous annual report the Ealing District Nursing Association by means of two trained nurses supplies professional nursing for cases of non-infectious illness occurring in the district. 24 (b) For Infectious Diseases.—Provision is made for two of the health visitors, who are trained nurses, nursing infectious cases such as measles, whooping cough, ophthalmia neonatorum and poliomyelitis which may arise among children under 5 years of age. Midwives.—During the year there were 14 midwives practising in the Borough. All have had a recognised course of training and possess the Certificate of the Central Midwives Board. Although the midwives in the course of their work are under the supervision of the Middlesex County-Council, it is found that there exists, in general, a good feeling towards the Maternity and Child Welfare Centre, to which they often refer for examination expectant mothers as well as infants. The Council does not subsidise any particular midwife for maternity work, but when maternity aid is required the midwife who resides nearest the prospective mother is engaged at the cost of the Council. Clinics and Treatment Centres.—The King Edward Memorial Hospital provides for the treatment of medical and surgical cases of both sexes. Private wards are also available for those who are unable for pay for accommodation in a Private Nursing Home, but who are in better circumstances than those admitted to the general wards. There is no outdoor department in connection with the hospital, but accident cases are regularly dealt with whether requiring indoor treatment or only temporary attention. A Dispensary, conducted on provident principles, offering medical and surgical attention for non-insured persons at their own homes, is organised in connection with the hospital. The Tuberculosis Dispensary, instituted by the County Council for Ealing and the neighbouring districts, is situated in a convenient position in Green Man Passage, West Ealing. 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 the Borough of Ealing being the West London Hospital at Hammersmith. 25 The Maternity and Child Welfare Centre and the School Clinic, the former maintained by the Town Council and the latter by the Education Committee, are conveniently situated in one building, which together they completely occupy, at 13, Mattock Lane, within two hundred yards of the Public Health Department and almost in the centre of the town. The performance of these two branches of public health activity so close together in the same building facilitates the management of the work and its complete co-ordination. 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 301 Number of Nuisances observed by Inspectors 85 Number of Premises inspected in connection with Infectious Disease 183 Number of Premises visited by Periodical Inspection (Cowsheds, Dairies, Slaughter-houses, Workshops, Etc.) 545 Number of Houses inspected under House-to-House Survey 512 Food Inspections 5,513 Total number of Re-inspections 6,416 Other Inspections 301 Total number of Inspections and Re-inspections 13,856 Number of Intimation Notices given 424 Number of other Letters written 218 Number of Statutory Notices served 163 Proceedings before Magistrates 6 Dairies, Cowsheds and Milkshops. Number of Cowsheds on Register 1 Number of Inspections made of Cowsheds 10 Contraventions of Regulations 2 Number of Retail Purveyors of Milk on Register 46 Number of Inspections of Retail Purveyors' Premises 169 Contraventions of Regulations 58 Proceedings before Magistrates — 26 Slaughterhouses. Number of Registered or Licensed Slaughterhouses 5 Number of Inspections made 125 Contraventions of Regulations - Proceedings before Magistrates — Factories and Workshops. Registered Workshops 157 Factories 41 Number of Inspections of Factories 104 and Workshops and Workplaces 243 347 Number of Defects concerning which Notices were sent 9 Proceedings before Magistrates - Offensive Trades. Fried Fish Shops 11 Other Offensive Trades — Number of Inspections 223 Contraventions 5 Disinfection. Rooms Disinfected by Spray: (a) Ordinary Infectious Disease 357 (b) Tuberculosis 54 Rooms stripped and cleansed 92 Articles disinfected by steam at disinfector: (a) Ordinary Infectious Disease 1,317 (b) Tuberculosis 143 Articles voluntarily destroyed 438 Particulars of the Sanitary Defects referred to in Notices Served and Letters Written. Water Closets repaired or supplied with water or otherwise improved 435 Drains cleared and cleansed 64 Defects in Drains repaired 173 Drains reconstructed 53 Dust-bins provided 104 Overcrowding remedied 1 Accumulations of refuse removed 72 27 Nuisance from fowls and other animals abated 14 Damp-proof courses inserted in walls 72 Ventilation under floors provided 27 Other forms of dampness remedied 34 Yards paved and repaired 131 Floors repaired 106 Roots, Gutters and Rain-water Pipes repaired 412 New Soil and Ventilating Pipes provided 130 Sinks and Waste-pipes repaired or renewed 182 Draw Taps fixed to main supply 12 Dirty Walls and Ceilings stripped and cleansed 1,237 Other Defects or Nuisances remedied 599 Legal Proceedings. The following notes indicate the nature of the offences for which summonses were issued and the results: No. Nature of Offence. Result of Proceedings before Magistrates. 1 Summons for failing to comply with notice in respect to drainage, etc. Works ordered to be carried out in 21 days. Costs £2 2s. allowed. 2 Three summonses, with respect to three houses, for failing to comply with notices in respect of sanitary defects. Works ordered to be carried out in 28 days. Costs £6 16s. allowed. 3 Three summonses, with respect to six houses, for failing to comply with notices in respect of sanitary defects. Works ordered to be carried out in 21 days. Costs £3 3s. allowed. 4 Summons with respect to failure to comply with Magistrates' Order. Fined £2, an undertaking being given to complete the work in 14 days. 5 Summons for failing to comply with notice to clear and cleanse a drain. Order to abate nuisance in 24 hours. Costs £2 2s. allowed. 6 Three summonses, with respect to three houses for failing to comply with notices in respect of sanitary defects. Works ordered to be carried out in 21 days. Costs 11s. 6d. allowed. 28 FACTORIES, WORKSHOPS AND WORKPLACES. 1.—Inspection of Factories, Workshops and Workplaces. Including Inspections made by Sanitary Inspectors or Inspectors of Nuisances. Premises Number of Inspections. Written Notices. Prosecutions. (1) (2) (3) (4) Factories (Including Factory Laundries) 104 2 — Workshops (Including Workshop Laundries) 164 3 — Workplaces (Other than Outworkers' premises) 14 — — Total 282 5 - 2.—Defects found in Factories, Workshops and Workplaces. Particulars Number of Defects Number of Prosecutions. Found. Remedied. Referred to H.M. Inspector. (1) (2) (3) (4) (5) Nuisances under the Public Health Acts:— Want of Cleanliness 66 66 — — Want of Ventilation 1 1 — — Overcrowding — — — — Want of drainage of floors — — — — Other Nuisances 65 65 — — Sanitary accommodation insufficient 3 3 — — unsuitable or defective 5 5 — — not separate for sexes — — — — Offences under the Factory and Workshop Acts. Illegal occupation of underground bakehouse (s 101) — — — — Other Offences (Excluding offences relating to outwork and offences under the Sections mentioned in the Schedule to the Ministry of Health (Factories and Workshops Transfer of Powers) Order, 1921.) — — — — Total 140 140 — — 29 Hospitals Provided by the Local Authority.—(1) Maternity Hospital.—The Chiswick and Haling Hospitals Committee maintains a Maternity Hospital at South Ealing to meet the needs of Chiswick and Ealing. Each district contributes towards the cost according to its rateable value. The hospital is able to deal with twenty cases at a time. (2) Children.—The King Edward Memorial Hospital, which has a ward specially reserved for children, places six beds at the disposal of the Town 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 at 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 the two districts, provides isolation facilities primarily for cases of scarlet fever, diphtheria and enteric fever, but other infectious diseases are admitted when accommodation is available. 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 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 three 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 for a journey in the district is given free of charge, but if the journey is outside a charge of one guinea is made, except in necessitous cases when the fee is either reduced or remitted. 30 (b) Infectious Disease.—The Chiswick and Ealing Hospitals Committee have now a motor ambulance for the removal of infectious cases at the Isolation Hospital. The acquisition of this in place of the old horse-drawn vehicles facilitates the expeditious removal of cases, particularly from Chiswick, Hanwell and Greenford. MATERNITY AND CHILD WELFARE. The whole scheme of Maternity and Child Welfare, dealing with the care and supervision of expectant and nursing mothers and children under 5 years of age, as outlined in previous reports, remains unaltered. In the work of the Centre the Health Visitors receive most valuable assistance from Mrs. Cocker, Mrs. Girdlestone and Mrs. Morris, all of whom are members of the Maternity and Child Welfare Committee. The permanent staff engaged in Maternity and Child Welfare consists of Dr. J. W. Bell, Ante-Natal Consultant, Dr. Grace Banham, Child Consultant, three Health Visitors and a Clerk, to whose salaries the Ministry of Health contribute a proportion. There were 1,250 births notified during the year, this number including 46 still-births. In connexion with these births 808 first visits and 1,530 return visits were made to the homes by the Health Visitors. The visits to children between 12 months and 5 years of age amounted to 2,862. In the following summary is indicated the extent of the work of the Health Visitors and of the Welfare Centre. Two notable features in this summary are, firstly, the increase in the number of ante-natal consultations which are increasing year by year, and, secondly, the increasing number of mothers who each year take advantage of the facilities offered at the Maternity Hospital. As many as 180 maternity cases from Ealing were admitted to the Chiswick and Ealing Maternity Hospital, and the contributions made by the patients towards the cost of their treatment amounted to £819 7s. 6d. 31 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 1,208 Mothers visiting Centre for the first time 635 Children visiting Centre for the first time 635 Total attendances made by mothers 4,472 Total attendances made by children 5,267 Average attendance of mothers each afternoon 31 Average attendance of children each afternoon 36 Number of Consultations by Medical Officer 2,142 Average number of children seen by Medical Officer each afternoon 16 Children referred to School Clinic for treatment: Nose and Throat 8 Eyes 3 Teeth 8 Mothers referred for dental treatment to School Clinic 11 Mothers supplied with artificial dentures 9 Children referred to King Edward Hospital for minor operations 27 Children admitted to King Edward Hospital as indoor patients 2 Children referred to special London Hospitals 9 Mothers attending Ante-Natal Clinic: First Visits 207 Re-visits 109 Number of Consultations by Consultant at Centre 308 Mothers referred to King Edward Hospital 26 Aid provided for mothers at confinement: Consultant aid—cases 1 Medical aid—cases 6 Midwives—cases 11 Home Helps—cases 11 Dried Milk supplied at cost price Value £437 14 8 Virol supplied at cost price „ £80 8 9 Cod Liver Oil supplied at cost price „ £97 12 5 Number of Maternity Cases admitted to the Chiswick and Ealing Maternity Hospital 180 32 Expectant or Nursing Mothers receiving a supply of milk free of charge 169 Children under 5 years of age receiving a supply of milk free of charge 88 The following is a Summary of the Work of the Health Visitors. Visits to children under 12 months: First Visits 808 Return Visits 1,530 Visits to children 1 to 5 years of age 2,862 Visits to expectant mothers 260 Visits to children or mothers attending the Welfare Centre 1,529 Visits to investigate infant deaths and still-births 50 Special visits or investigations 231 Visits to cases of Ophthalmia Neonatorum 7 Visits to cases of Puerperal Fever 2 Visits to cases of Measles and Whooping Cough 334 Visits to cases of Tuberculosis 114 Visits to cases of Scarlet Fever on discharge from the Isolation Hospital 75 Other Visits 13 Total Visits 7,815 Interviews, etc. 1,913 Supervision of the Production and Sale of Food.— Milk.—There is only one cowshed in the district. Demands are being made for its improvement, but owing to the terms of the tenancy it is unlikely that they will be met and the premises will in all probability have to be closed. On the register there are 46 retail purveyors of milk compared with 42 in the previous year. During the year there were eight applications for registration, four being in respect of old premises, the occupancy of which was being changed, and four in respect of new premises. Before registration all the applicants had to 33 undertake to render the premises entirely suitable for the purpose of dealing with milk in a hygienic manner, a separate storage place for milk and a separate wash-up place, fitted with a steam boiler for the complete and convenient cleansing of milk vessels, being required. Under the Milk (Special Designations) Order, 1922, 18 licences were granted to one milk company to use the designation "Pasteurised" milk at their various premises, 19 licences were granted (18 to one company) to sell "Certified" milk, and one licence to sell "Grade A (Tuberculin Tested)" milk. Meat and Other Foods.—There are five registered or licensed slaughterhouses in the district, but very little slaughtering is done in them—an occasional sheep or pig. The butchers find it better to purchase meat already prepared, mostly at the Smithfield Market, where it has already undergone inspection. Butchers' and other shops where meat or fish is sold or food is prepared are kept under thorough supervision. During the year the following amounts of articles of food were found to be diseased or unsound and were voluntarily surrendered for destruction:— Food. Quantity. Beef 328 lbs. Fish 365 lbs. Fruit 246 lbs. 939 lbs. The Public Health (Meat) Regulations, 1924, which were issued on the 29th December, and which come into force on the 1st April, 1925, should be the means of bringing about a much needed improvement in the methods of meat inspection and in the handling and exposure of meat and meat products. Regulations with respect to the handling and exposure of other foodstuffs are also urgently needed and ought in the interests of the public health to be no longer delayed. 34 Adoptive Acts, Byelaws 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 respect to certain sanitary matters, the provision of dustbins, the drainage of houses by combined operation, the control of tuberculous milk, etc. Byelaws, 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: Humane Slaughtering of Animals, 1922). New Streets and Buildings, December 3rd, 1885. New Buildings, May 26th, 1896. Byelaws 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. 35 LABORATORY WORK. The bacteriological laboratory deals with specimens taken not only in the Borough, including the Isolation Hospital, but also in the Urban Districts of Hanwell and Greenford. During the year the following specimens were examined:- Positive Negative Total Diphtheria: Ealing 27 560 587 Isolation Hospital 157 1,557 1,714 Hanwell 67 1,124 1,191 Greenford — 1 1 Tuberculosis: Ealing 19 168 187 Hanwell 5 30 35 Greenford — 1 1 Miscellaneous: Ealing 7 5 12 Hanwell — 1 1 Greenford — — — Totals 282 3,447 3,729 In the number of specimens coming from Hanwell examined for the bacilli of diphtheria are 55 positive and 648 negative swabs from the Central London District Schools where extensive swabbing had to be undertaken in connection with an outbreak of diphtheria. HOUSING. The housing difficulties still remain acute. Serious overcrowding is frequently met with and cannot be alleviated until sufficient houses at a reasonable rent are available for the people to go to. During the year the erection of 28 flats by the Town Council made provision for some of the most pressing cases, but a great effort is required before it can be considered that even the needs of the urgent cases have been met. By private enterprise 292 houses were completed during the year, and although some of these may be called working-class houses, which are most required, yet the erection of houses of any sort tends to relieve some of the pressure. 36 The construction by the Council of about 250 houses on 24 acres of land recently purchased in Pope's Lane is a beginning which should be followed up, either by the Local Authority or by private builders. Many of the old houses are being put into a good state of repair by being surveyed in a thorough manner by the Inspectors. It will be noticed in the subjoined table that 512 houses were surveyed and consequently put into a good sanitary condition. A.—Number of New Houses erected during the Year. (a) Total 292 (b) As part of a municipal housing scheme Flats 28 B.—1. Unfit Dwelling Houses. Inspection. (1) Total number of dwelling houses inspected for housing defects (under Public Health or Housing Acts) 1,229 (2) Number of dwelling houses which were inspected and recorded under the Housing (Inspection of District) Regulations, 1910 512 (3) Number of dwelling houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation — (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 689 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 526 — 37 — 3. Action under Statutory Powers. (a) Proceedings under Section 28 of the Housing, Town Planning, etc., Act, 1919 : (1) Number of dwelling houses in respect of which notices were served requiring repairs (2) Number of dwelling houses which were rendered fit: (a) By Owners — (b) By Local Authority in default of Owners — (3) Number of dwelling houses in respect of which Closing Orders became operative in pursuance of declarations by Owners of intention to close — (b) Proceedings under Public Health Acts : (1) Number of dwelling houses in respect of which Notices were served requiring defects to be remedied 163 (2) Number of dwelling houses in which defects were remedied : (a) By Owners or Occupiers 125 (b) By Local Authority in default of Owners — (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 — (2) Number of dwelling houses in respect of which Closing Orders were made — (3) Number of dwelling houses in respect of which Closing Orders were determined, the dwelling houses having been rendered fit — — 38 — (4) Number of dwelling houses in respect of which Demolition Orders were made — (5) Number of dwelling houses demolished in suance of Demolition Orders — THOMAS ORR, Medical Officer of Health. May 4th, 1925. Borough of Ealing. EDUCATION COMMITTEE. REPORT OF THE School Medical Officer, For the Year ended 31st December, 1924. 40 EDUCATION GENERAL PURPOSES SUB-COMMITTEE, 1923-24. (Which deals with the School Medical Service). Chairman— Councillor G. R. Weeks. Vice- Chairman— Councillor E. H. Atkinson. Alderman H. Armriding, Councillor W. J. S. Cox, Councillor J. C. Fuller, Councillor G. H. Gabb, Councillor H. M. Sayers, Councillor W. T. White, Miss A. D. Hawkin. Miss C. G. Wilson, L.L.A. Mr. R G. Hayles, Mr. M. Hulbert, J.P., Mr. F. L. Jermyn, Mr. L. Marsh, M.A., Rev. C. J. Sharp, M.A. — 41 — 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). * † Annie Johnson. *Mary McGann. Clerks— †Mercie Richardson. Grace Such. Surgeon— E. A. Chill, M.D., C.M. Anaesthetist— S. M. Banham, M.B., M.R.C.S., L.R.C.P. Dentists— L. Brown, L.D.S., R.C.S. (Eng.) I. Cohen, L.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. — 42 — CO-ORDINATION. So consistent is the policy of the Education Committee and of the Town Council in caring for the health of those who come under their surveillance, and so closely are the activities of the School Medical Service connected with those of the Public Health Department, that there is complete co-ordination of the work. This co-ordination is greatly facilitated by the Maternity and Child Welfare Centre being in the same building as the School Clinic and by the respective staffs being closely associated day by day. It therefore follows that defective children under school age pass automatically from the Welfare Centre to the School Clinic, and any treatment and supervision undertaken by the former, for example, in respecc of crippled children, are continued by the latter. Another factor that makes for close co-operation is that minor ailments, enlarged tonsils and defective conditions of the teeth occurring in children under 5 years of age are treated at the School Clinic. The natural result is that these two branches of public health work go on as if the general policy was determined by one body instead of two, the general aim of the Education Committee being always in complete consonance with that of the Town Council. THE SCHOOL MEDICAL SERVICE IN RELATION TO PUBLIC HEALTH. School Hygiene. There are fourteen public elementary schools under the control of the Local Education Authority. These embrace twenty-four departments, namely, seven for boys, seven for girls, seven for infants, one for girls and infants, and two for boys and girls. Lammas Boys' and Girls' Departments have been formed into a Central School. As stated in previous reports, six of the schools are of comparatively modern construction, dating from 1905 to 1911, seven are old with recent adaptations, and one is a temporary school. The first group are in a very satisfactory sanitary condition. Of the latter the Lancaster School will soon be vacated and its place will be taken by the Grange School, which is in course of — 43 — erection. Some of the remaining old schools serve their purpose fairly well, striking defects having been met by more or less recent improvements, but one calling for immediate consideration is St. Saviour's Infants' School, which must be condemned from the hygienic aspect. The new Grange School marks the recent development of school construction. The schools built in 1905 consisted of a central hall with the class-rooms arranged round it as at Little Ealing and Northfields Schools. The next development was with the hall on one outside wall, the class-rooms being arranged round the other three sides, as at Lammas, Drayton and North Ealing. The Grange School, on the other hand, is built as a single range of class-rooms, in the form of the letter "E" with the central arm wanting. Along the inner side of the figure is a broad corridor with a glass roof and on to this corridor the whole of the rooms open in such a manner that the whole building when required can become an open-air school exposed to the maximum of sunlight and with complete through ventilation. The two large class-rooms centrally situated can, as occasion requires, be converted, by the folding of a glass and wood partition, into a large assembly hall. The general convenient arrangement of teachers' rooms, lavatories, etc., can be seen in the plan represented on page 44. Borough of Ealing Proposed Grance School — 45 — MEDICAL INSPECTION. Medical Inspection during the year embraced the following groups:— (a) Routine inspections as required by the Board of Education as follows:— (1) Entrants.—All children admitted to the school during the year. (2) Intermediates.—All children who are eight years of age or who will reach that age before the end of the year. (3) Leavers.—Children who are 12 or who will be 12 before the end of the year, together with those over 13 years of age not previously examined. (b) Non-routine inspections as follows :— (1) Children not in the aforementioned routine groups who are presented by the Head-teachers for examination for some defect or suspected defect. (2) Children requiring supervision on account of some defect found at a previous routine or non-routine examination. (3) Children sent to the School Clinic by the Head-teachers, Attendance Officers or School Nurses for examination for some defect or suspected defect. (c) Annual inspection at the schools or at the School Clinic of :— (1) Physically defective or crippled children. (Some may be seen more frequently). (2) Mentally defective children. In the following tables are indicated the total children medically inspected in a routine manner. It will be seen that they include 687 entrants, 1,047 intermediates, and 1,043 leavers, making the total routine inspections 2,777, or 43.3 per cent, of the children on the school registers. — 46 — Number of Children Inspected. School Entrants Total Boys Girls Provided. Drayton 62 61 123 Lammas 36 46 82 Little Ealing 54 43 97 North Ealing 26 25 51 Northfields 64 56 120 Good Shepherd Hall (temporary) 24 27 51 Non-provided. St. Saviour's 42 30 72 St. John's 49 42 91 Total 357 330 687 Number of Children Inspected. School. Age-8 Group Leavers Boys Girls Total Boys Girls Total Provided. Drayton 61 43 104 60 26 86 Joseph Lancaster 49 34 83 38 45 83 Ealing Central 65 58 123 94 72 166 Little Ealing 92 95 187 145 125 270 North Ealing 26 55 81 14 28 42 Northfields 124 111 235 83 79 162 Good Shepherd Hall (temporary) 23 18 41 — — — Non-provided. Christ Church — 73 73 74 45 119 St. John's 20 39 59 35 33 68 St. Mary's 44 17 61 — 47 47 Total 504 543 1047 543 500 1043 — 47 — Non-routine examinations numbered 18 new cases who were presented by the Head-teachers at school, 395 submitted for reinspection on account of some defect previously found and 1,439 examined at the School Clinic. The number of the non-routine cases presented by the Head-teachers for examination in school is small because the Head-teachers may at any time refer defective or suspected defective children for examination at the School Clinic. It consequently follows that the number of children examined at the School Clinic is high in comparison. In all 4,629 children attending the elementary schools were examined or re-examined during the year. The total number of children on the school registers was 6,412, and the average number in attendance was 5,573, making an average attendance of 86.9. per cent. Taking the number of children medically examined as 4,629 it means that 72.2 per cent, of the children on the register were medically examined during the year. In the course of medical inspection there is very little disturbance of the usual school arrangements, for in most of the schools the teachers' room is available for the purpose. In only a few is it necessary to occupy a class-room, and if this is necessary the class which usually occupies the room can readily be joined with another, or the participation of the class or classes in the usual open-air games at that time can facilitate the vacation of the room for medical inspection. The attendance of parents at the routine inspections is very good. As many as 81.2 per cent, of the children inspected were accompanied by at least one parent. This high percentage indicates not only the great interest of the parents in medical inspection but their estimation of its importance. The presence of the parents enables them to receive information regarding any defects present in the children and to receive instruction on the supervision of their health, particularly in the preservation of the teeth, the necessity of plenty of fresh air and regular exercise, the value of good food, etc. There can be no doubt that the parents year by year appreciate more and more the School Medical Service. — 48 — FINDINGS OF SCHOOL MEDICAL INSPECTION. Review of the Facts Disclosed. Table II. gives the total number of defects discovered on inspection at the schools during routine medical examination and at the School Clinic. Among 2,777 children examined there were 824 defects requiring treatment and 368 requiring to be kept under observation without treatment, and among 1,852 children specially examined there were found 975 defects requiring treatment and 133 requiring to be kept under observation Thus out of a total of 4,629 children there were in all 1,799 defects requiring treatment, and 501 requiring observation. Of the 2,777 children examined in the routine way, 308, or 11.1 per cent., were found to require treatment for defective conditions other than uncleanliness and dental diseases. Uncleanliness.—As has been the practice in previous years, the heads of all the girls attending the elementary schools were inspected after the usual school holidays thrice a year to determine their condition as regards cleanliness. Of 9,591 children examined, 329, or 3.4 per cent., were excluded on account of verminous condition. In addition 14 children were excluded for verminous condition at the routine medical inspection held in the schools and 24 at the School Clinic on being referred by the Head-teachers. The usual practice is to issue a summons under the School Attendance Bye-laws if the child is not cleansed within fourteen days after exclusion. During the year only two summonses were required, a fine of 10/- in each case being imposed by the Justices. No action was taken during the year under Section 87 of the Education Act of 1921. It has never been considered advisable to proceed under this Section as satisfactory results have been obtained by means of the School Attendance Bye-laws. — 49 — Minor Ailments.—Minor Ailments found at routine and nonroutine examinations were as follows:— Ringworm of Head 26 Ringworm of Body 15 Scabies 20 Impetigo 210 Minor Injuries 17 Other Skin Diseases 136 Ear Disease (including Otorrhoea) 87 Bye Disease (including Blepharitis and Conjunctivitis) 63 Total 574 Enlarged Tonsils and Adenoids.—At the routine inspection 76 children were found to have enlarged tonsils of such a degree as to demand treatment and 75 to require observation. Twelve cases of adenoids and 16 cases of enlarged tonsils with adenoids were referred for treatment. In addition 22 cases of enlarged tonsils, 4 of adenoids, 2 of enlarged tonsils with adenoids, 7 of other conditions requiring treatment, and 3 other conditions requiring observation were found at the School Clinic, where they had been submitted for special examination at the instance of the teachers or school nurses. At routine inspection there were discovered 24 other conditions of the throat and nose requiring treatment and 5 other conditions requiring observation. Tuberculosis.—No definite cases of tuberculosis of the lungs were found either on routine inspection or at the School Clinic. One definite case of tuberculosis of glands and one of the hip were found on routine inspection and two suspected cases of tuberculosis of glands at the School Clinic. Eight suspected cases of tuberculosis of the lungs met with at routine inspection and four at the School Clinic were referred to the Tuberculosis Officer for continuous observation. — 50 — Diseases of the Skin.— At the routine inspection there were discovered one case of ringworm of the head, 11 cases of impetigo, and 19 other conditions. The cases found at the School Clinic were as follows :— Ringworm of the Head 25 Ringworm of the Body 15 Scabies 20 Impetigo 199 Other Conditions 117 Total 376 External Eye Diseases.—Five cases of blepharitis, four of conjunctivitis, 19 of squint and seven of other conditions were observed on routine inspection, while 7 cases of blepharitis, 24 of conjunctivitis, 6 of squint, and 16 of other conditions were found at the School Clinic. Defective Vision.—During routine inspection 130 children were found to have such a degree of defective vision that they were recommended for special examination by an oculist. At the School Clinic 84 cases of the same character were referred for similar examination. The large number recognised at the Clinic indicates the interest the teachers take in the welfare of the school children. Every year the teachers refer a large number of children to the School Clinic for examination on account of suspected visual defect and those indicated are but a proportion of the total number specially examined. Ear Disease and Defective Hearing.—Twelve cases of defective hearing and 18 of otitis media were found in the course of school medical inspection, and six of defective hearing, 41 of otitis media and ten of other conditions were met with at the School Clinic. — 51 — Dental Defects.— The following table classifies the dental defects found at the routine medical inspection. In the subsequent table it will be seen that of the entrants 55.0 per cent, had sound teeth, of the intermediate group 58.5 per cent., and of the leavers no less than 78.0 per cent, had sound teeth before leaving school. This table indicates the great improvement since 1915 when the leavers with sound teeth amounted to only 35.7 per cent. This great improvement, which is one of the most satisfactory results of school medical inspection, should affect materially the general health of the children. It indicates that the regular dental inspection and treatment is carried out on sound lines and that the advice given on the preservation of the teeth has been accepted and acted upon by the parents and children alike. Dental Inspection. Entrants Age 8 Group Leavers Total All teeth sound: No. of Children 378 613 814 1,805 Percentage 55.0 58.5 78.0 65.0 Less than 4 teeth decayed: No. of Children 161 303 192 656 Percentage 23.4 29.0 18.4 23.6 Four and more than 4 teeth decayed: No. of Children 148 131 37 316 Percentage 21.6 12.5 3.5 11.4 — 52 — Dental Inspection, 1915 to 1924 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 66.6 1922 45.7 50.2 72.8 56.3 1923 55.2 52.5 80.5 63.9 1924 55.0 58.5 78.0 65.0 Crippling Defects.—The total crippled children coming within the purview of the Local Education Authority are indicated in Table III., where it is seen that 23 boys and 23 girls were attending school, and two boys and three girls were kept at home. A complete record is kept of all crippled children. The Head-teachers and School Enquiry Officers notify to the School Medical Officer all cases of crippled conditions whenever they are discovered whether in attendance or not in attendance at school. Thereafter all are kept under observation, medical examination being made as often as is considered desirable, but in any case one medical examination at least being made in the year to ascertain and record the progress of the condition. In this way all crippled children are kept under regular supervision. Of those cripples not at school three are awaiting admission to a special school, and two, which are old cases of tuberculosis of the spine, are about to return to school, — 53 — INFECTIOUS DISEASE. During the year the returns of non-notifiable infectious disease made weekly by the Head-teachers to the School Medical Officer indicated the total absentees from school as 784 due to measles, 24 to whooping cough, 117 to chickenpox, and 127 due to mumps. Drayton Infants' School was closed on account of measles from the 3rd to 31st March, and Lammas Infants' School for a similar reason was closed from the 1st to 17th April. It has beer the usual practice with regard to public elementary schools in Haling to close a school, not to prevent the spread of any infectious disease which may be prevalent, but to save the grant when the percentage attendance has fallen below 55 per cent. By the Elementary Education Provisional Code, 1922, Amending Regulation No. 2, 1924, school closure can now only take place for purely medical reasons. If the average attendance of a school or department for any week be reduced below 60 per cent, of the number of children on the registers, and the Local Education Authority be satisfied by a certificate from the School Medical Officer that the fall in attendance to so low a percentage may reasonably be attributed to the prevalence of epidemic illness in the district, the meetings and attendances for that week need not be reckoned in calculating the average attendance for the purposes of the Board's grant. This new regulation will mean that in future school closure to prevent the spread of infectious disease will be a very unusual occurrence, for rarely is it considered advisable to close a school in preference to the daily supervision of suspected cases and absentees, which latter procedure is only possible when the school is open. — 54 — Under Article 53 of the Education Code, 265 children were excluded during the year for the undermentioned conditions:— Conjunctivitis 29 Impetigo 189 Ringworm of the Head 17 Ringworm of the Body 5 Scabies 15 Other Skin Diseases 10 Total 265 Impetigo contagiosa is a cause of considerable absenteeism. Treatment is given at the School Clinic for all cases, but some of marked severity prove so resistant to treatment that they remain away from school for lengthy periods. The early isolation and treatment of affected children are the chief means of preventing infection, and these can only be brought into action by the early submission of suspected cases to medical examination. Children affected with any sores should therefore be submitted by the teachers for examination a the School Clinic at the earliest practicable opportunity. If immediate action be taken infection would be prevented and attendances would be saved. Ringworm of the body is a very simple condition to cure, but the same cannot be said of ringworm of the head, which is extremely resistant to drug treatment, and for which X-rays prove the only effective and at the same time comparatively rapid remedy. FOLLOWING UP. On the completion of routine medical inspection at each school forms are sent to the Head-teachers giving the list of children suffering from defects, each defect being specified, and a note being made whether treatment or observation is called for. At the end of ten weeks the teacher is required to make a return on a duplicate form as to the children who on enquiry are discovered — 55 — to have had treatment. By means of this information the School Nurses are saved making unnecessary visits to cases in which treatment is not urgent. These lists, which are to be considered private and confidential, encourage the teachers to take an intimate interest in the physical as well as the educational well-being of the children. Special lists are made of all children requiring dental, eye, and nose and throat treatment which can be provided at the School Clinic. These cases are followed up by the School Nurses and treatment is advised. All other cases in which treatment is desirable or in which observation is required, are visited in rotation by the School Nurses, when advice to obtain treatment is given or directions regarding hygienic supervision are repeated. During the year the School Nurses made 1,801 visits regarding defective children. MEDICAL TREATMENT. Minor Ailments. —Table IV. indicates the number and nature of the minor ailments which received treatment during the year. It will be seen that 402 or 70 per cenw. were treated at the School Clinic and 172 or 30 per cent, by private practitioners or at hospitals. The total attendances at the School Clinic for the daily treatment of minor ailments were 5,829, and may be detailed as follows :— Ear Cases 1,130 Eye Cases 867 Dressings 19 Ringworm 135 Impetigo 2,736 Scabies 77 Others 865 Total 5,829 — 56 — Tonsils and Adenoids.—In Table IV. it is indicated that 54 cases of enlarged tonsils or adenoids were operated upon at the School Clinic, while 15 were dealt with at hospitals or by private practitioners. In addition, 16 cases of other abnormal nasal conditions were treated at the School Clinic. Tuberculosis.—Twelve cases of suspected pulmonary tuberculosis were referred to the Tuberculosis Officer to be kept under observation. Three cases of tuberculous glands and one case of tuberculosis of the hip were referred for observation. Skin Diseases.—The cases of diseases of the skin which were treated are indicated in Table IV. Of 424 cases referred for treatment 293 were treated at the Clinic and 131 otherwise. Cases of ringworm of the body are very easily dealt with, as they respond immediately to drug treatment. Ringworm of the scalp, however, is very resistant to treatment, the only expeditious and satisfactory method method of treatment being that by X-rays. During the year 26 cases of ringworm of the head were encountered and 17 of these were treated by means of X-rays by Dr. Arthur, the treatment in all cases being, as usual, successful. Scabies was not very prevalent, only 20 cases being dealt with. Impetigo, on the other hand, furnished 210 cases, 198 of which were treated at the School Clinic. External Eye Disease.—The children referred for treatment for external eye disease numbered 63, of whom 42 were treated at the School Clinic. The diseases included 12 cases of blepharitis, 28 of conjunctivitis, and 23 of other conditions. Facilities are provided at the King Edward Memorial Hospital for the surgical treatment of a certain number of severe cases of squint, but during the year only one case was so treated. — 57 — Defects of Vision.—Of the 214 cases referred for refraction, 205 were dealt with at the School Clinic, and nine by private practitioners or at the Eye Hospitals. Glasses were prescribed and supplied at the School Clinic in 109 of these cases. All children provided with glasses are kept under supervision, and their eyesight is re-tested regularly. The School Nurses and teachers endeavour as far as possible to see that the glasses provided are worn. Ear Disease and Hearing.—Of 87 cases referred for treatment 67 were treated at the School Clinic. These were mostly cases of otorrhoea, which demand long and persistent treatment, and which accounted for as many as 1,130 daily treatments at the School Clinic. Dental Defects.—In a previous section remarks were made regarding the large number of children, namely 78 per cent., who possess sound teeth on leaving school. This good result is in large measure to be attributed to the thorough dental treatment and supervision which the children receive, and to the instruction in the means of prevention of caries which is given to both parents and children. The policy adopted is that all children are dentally inspected on being admitted to school, this inspection taking place within a fortnight after the usual medical inspection of the same children. In this way all children on reaching school age are offered dental treatment, which the parents as a whole greatly appreciate and gratefully accept. When once the child is treated a re-inspection of the mouth takes place every year until he or she leaves school. Table IV. Group IV. shows that 4,302 children, or a total of 67.1 per cent, of those on the school register, were dentally inspected during the year. Of these, 2,866 were found to require treatment and 1,630 were actually treated at the School Clinic, 506 requiring subsequent tretment during the year The extractions embraced 367 permanent and 2,147 temporary teeth. Gas was administered for these extractions on 373 occasions. It has been found the best policy in the long run to spend time over the thorough cleansing of the mouth by the extraction of all carious —58— temporary teeth in the first instance rather than to take them out gradually. The children start out with clean and sound mouths which they are encouraged to keep sound. Fillings were applied to 1,559 permanent teeth, which means that there were on the average 9.1 fillings a session. Six cases of dental deformity were referred to the Royal Dental Hospital for special treatment under the arrangements made between the Local Education Authority and the Hospital. Crippling Defects and Orthopaedics.—The action taken to discover crippled children in the schools has already been noted. Most of the cases received special treatment at the National Orthopaedic Hospital or other Special Hospitals, but two cases of spinal curvatur< , ore of flat foot, one of infantile paralysis, and one of peripheral neuritis were treated at the King Edward Memorial Hospital, Ealing, under the arrangements made by the Education Committee. The treatment of crippled children is one which calls for particular consideration by the Committee because early treatment can usually prevent permanent crippling, or failing that can greatly modify the defect. At present the cases commonly go to Hospital long after the onset of the condition when the best results of operative treatment are impossible. Again, cases attend Hospital so irregularly that the treatment fails by not being continuous, and the attendance of the child at school suffers in consequenc It is hoped that the proposed scheme for treatment at the National Orthopaedic Hospital at Stanmore, which is under consideration, will meet with approval. Under this scheme children can be sent by the School Medical Officer to the National Orthopaedic Hospital at Great Portland Street. There they will be examined and if operative treatment is required they will be sent to Stanmore, where not only will they undergo the operation, but will attend school classes in order to continue their education. If massage is required it will be carried out at the School Clinic by a nurse from the Hospital. —59— Such a scheme should facilitate early and thorough treatment of the children and should favour their early return to the ordinary elementary school : it should enable them to be kept under complete supervision and should, at the same time, save the parents a great amount of time. PAYMENTS BY PARENTS FOR TREATMENT. The following amounts have been received from the parents during the year for treatment at the School Clinic:— £ s. d. Dental Treatment 55 0 0 Throat Operations 14 7 6 Spectacles 25 10 1 X-ray Treatment of Ringworm of Head 2 19 6 Treatment at Royal Dental Hospital 1 8 0 Total £99 5 1 In addition, the following amounts were received for treatment at the School 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 11 0 0 Amount paid by the Homes for Motherless Children for the treatment of their school children 2 0 4 Amount paid by the Ealing House Girls' Home for the treatment of their school children 3 8 3 Total £16 8 7 —60— OPEN AIR EDUCATION. Every facility is being taken by Head-teachers to teach the children, as far as possible, in the open air when the weather is favourable. A marked step in furthering open air education has been made by the construction of the new Grange School in such a way that the front of the class-rooms can be made to open completely, converting each into an open-air class-room. This mode of construction is certainly a move in the right direction and is one to be followed in the future. SCHOOL BATHS. At none of the schools are baths provided, but at the Public Baths one swimming bath is set aside entirety for school children and arrangements are made that all the children in the upper classes can regularly attend as part of their physical training so as to be taught the art of swimming. Advantage is taken of these facilities and a large number of children each year obtain certificates of proficiency. Not only are the children provided with an excellent means of physical training and recreation but they are instructed in the methods of life saving. CO-OPERATION OF PARENTS. To obtain the maximum result from medical inspection the whole-hearted co-operation of the parents is essential. Every encouragement, therefore, is given to the parents to be present at the examination of their children when they can be informed of any defects and given advice as to the treatment or the care and supervision required. It is found that the interest of the parents in the health of the children is becoming deeper and more intelligent every year and is therefore a potent factor in the general improvement in health which is so apparent. With 687 entrants, 620 parents were present at the inspection; with 1,047 intermediates, 872 were present, and with 1,043 leavers, 765 parents were present, giving percentages of parents present as 90, 83, and 73 per cent. respectively, or 81 per cent. for all three groups. — 61 — CO-OPERATION OF TEACHERS. The School Medical Service continues to receive the sympathetic and sustained support of the teachers, who recognise that educational efforts must go hand in hand with the supervision of the physical conditions of the children. In various ways the teachers render invaluable service, particularly in referring to the School Medical Officer all physically and mentally defective children, iv submitting defective or suspected defective children for special examination at the School Clinic, and in keeping under particular supervision all defective children. In certain schools the general supervision or care of defective children is so consistert and so interested as to have become a very important cog in the educational machine and to deserve the highest commendation. CO-OPERATION OF SCHOOL ENQUIRY OFFICERS. The two enquiry officers, who were appointed in recent years, have certainly become imbued with the high importance of the school medical service and act in complete co-operation with the school medical staff from whom they can at any time obtain advice in cases of difficulty arising on the medical side of their work, which must of necessity, at all times, loom very large. Much assistance can be—and is—given by the School Enquiry Officers not only in the discovery of defective children, but in their supervision. CO-OPERATION OF VOLUNTARY BODIES. The whole of the following up and supervision of defective children is carried out by the School Nurses who are assisted in their duties by the Head-teachers and School Enquiry Officers. Considerable assistance in obtaining ameliorative treatment for defective children, however, is obtained from various Voluntary Societies, such as the Central Aid Society with respect to Hospital and Convalescent Home treatment and the provision of surgical —62— appliances, the National Society for the Prevention of Cruelty to Children in securing proper home supervision by the parents in the rare cases of neglect which are encountered, and the School Attendance Aid Committee by whom boots are supplied where the parents are in necessitous circumstances. BLIND, DEAF, DEFECTIVE AND EPILEPTIC CHILDREN. Any specially defective children in school must be reported by the Head-teachers to the School Medical Officer at the earliest practicable opportunity, and those at home, of school age, have to be reported in a similar manner by the School Enquiry Officers. In this way an accurate list of such children is available and is of value in keeping them under supervision. All these children are examined at least once a year except when they are in Special Residential Schools. The number of blind, deaf, defective and epileptic school children are indicated in Table III. Three blind boys and one blind girl are being maintained by the Local Education Authority at Certified Schools for the Blind. Four boys and two girls who are partially blind attend public elementary schools under supervision. Five deaf mutes are maintained by the Education Authority at Certified Schools. One at the end of the year was awaiting admission. Of 39 mentally defective children, 31 attend elementary schools, three are maintained at Certified Schools and five do not attend any school. During the year three boys and three girls, on attaining 16 years of age, were reported for supervision to the Local Control Authority. Two epileptic children have come under observation, one attends a Certified School and one mild case attends a public elementary school. —63— EMPLOYMENT OF CHILDREN AND YOUNG PERSONS. The School Medical Officer reports regularly to the Juvenile Employment Committee on the fitness for employment of children about to leave school. He also acts in co-operation with the Inspector who enforces the Bve-laws made under the Employment of Children Act, 1918. In the course of routine inspection at the Schools 181 children employed out of school hours in accordance with the Bve-laws were specially examined to determine their fitness to continue to be employed. In addition, three boys were examined before being permitted to engage in street trading. SPECIAL ENQUIRY. Enlargement of the Thyroid Gland.—In the course of routine medical examination during 1924 special attention was paid to the particular defect of thyroid enlargement. In the age-12 group, 19 children had thyroid enlargement that could be observed on simple inspection. The distribution of these cases according to sex and age-groups is shown below:— Males Females Total Number of Children Inspected 543 500 1,043 Number of Cases showing Thyroid Swelling:— Age-Group Males Females Total 11—12 2 2 4 12—13 2 8 10 13—14 1 3 4 14—15 — 1 1 Totals 5 14 19 —64— In addition to these already mentioned 11 cases had thyroid enlargement in a lesser degree, such enlargement being discovered on palpation. Age-Group Males Females Total 11—12 3 4 7 12—13 — 4 4 Totals 3 8 11 At the time of examination such additional information as could be obtained was noted, and is summarised with respect to cases of visible thyroid enlargement under the following headings:— Family History of Goitre.—Among the males there was a history of goitre occurring in one or more members of the family in four instances; in two instances the mother had or had had goitre; in one case the mother and grandmother had been affected, and in one case the mother and an. aunt. Among the females there was a family history of goitre in eight cases. The mother had been affected in four cases, a sister in three cases and a great-aunt in the remaining case. Of these cases a mother and two sisters had been affected in one instance and in another instance the mother and the mother's cousin. Relation to Menstruation.—Of the 14 girls affected, two only had commenced to menstruate. This fact may have been due to the routine examination occurring at an age that usually precedes menstruation, so that a connection between the goitre and menstruation could hardly be presumed. Influence of Locality.—With three exceptions all cases had always lived in London; and of the 16 cases, 13 had spent all their lives in Ealing, so that no opinion can be expressed as to the influence of locality on their occurrence. —65 — Associated Symptoms.—There was a notable lack of symptoms in the cases of thyroid enlargement discovered, the majority being in excellent health. One boy had dyspnoea on exertion, was anaemic, easily tired, and had a pulmonary systolic bruit accentuated by exercise. One boy and one girl had poor peripheral circulation and were prone to chilblains. Two children were of a nervous disposition and rather excitable but had no signs of organic disease; and in one case only was there habitual constipation. In no case was there any evidence of hyperthyroidism. Pulse Rate.—Note was made of the pulse rate of all cases, but allowing for the increased rate due to temporary excitement the pulse-frequencies were not considered abnormal. Teeth.—The state of the dentition appeared to have no bearing upon the thyroid swellings. The age of the children examined— 12 years and upwards—is the age at which the school child's teeth are least affected by dental caries; and in children presenting enlarged thyroids the teeth were, on the whole, excellent. Diet.—All cases appeared to be on an ordinary mixed diet, and no child appeared to have had insufficient food. In some cases there was an objection to fats, but such an objection is commonly encountered among children. The presence—or absence—of any special article of diet appeared to have no bearing upon the thyroid swellings. Conclusions.—The occurrence of visible thyroid enlargement among Ealing children of 12 years and upwards is infrequent. Only 1.8 per . were affected. Girls were affected more frequertly than boys, the proportion being nearly 3 to 1. The occurrence of thyroid enlargement did not appear to be influenced by such factors as diet, locality, housing conditions, water supply or dentition. —66— Heredity appeared to play some part, as there was a history of goitre in one or more near relatives in 12 out of the 19 cases, and the mother was or had been affected in seven instances. Treatment.—On account of the low incidence of thyroid enlargement among school children in Baling, treatment, both prophylactic and curative, cannot be considered either a large or a difficult problem. Collective treatment is not called for as it may be in other areas. Prophylaxis consists in the main of instructing parents in the value of a good mixed diet, and, in view of the theory that intestinal toxaemia may be the cause, the avoidance of constipation, and in the administration of oidine in an easily administered form to members of families in which there is an apparent heredity tendency to the condition. Curative treatment is a matter for the general medical practitioner to whom all cases of visible thyroid enlargement are necessarily referred MISCELLANEOUS. Each morning of the school week at 10 o'clock children may be referred for medical examination at the School Clinic. These are children suspected by the teachers of having verminous heads or bodies, of being affected with ringworm, scabies, or impetigo, or referred for examination on account of some defect or suspected defect, such as defective eyesight, disease of the eye, throat, nose or ear. Such children may also be submitted by the School Nurses or School Enquiry Officers. When children are excluded they are re-examined regularly at the School Clinic until certified as able to return to School. In addition, children may be specially examined at the instigation of the School Attendance Committee, teachers are medically examined on appointment and scholarship children are examined before they are approved. —67— These special examinations and re-examinations may be summarised as follows:— Condition Attendances Verminous Conditions 1,173 Impetigo 444 Scabies 53 Ringworm 76 Teachers on Appointment 14 Children to be sert to Convalescent Home, King Edward Memorial Scheme 12 Others 1,028 Total 2,800 STATISTICAL TABLES. The Statistical Tables required by the Board of Education are appended. THOMAS ORR, School Medical Officer April 28thy 1925. —68— TABLE I. RETURN OF MEDICAL INSPECTIONS. A.—Routine Medical Inspections. Number of Coda Group Inspections:— Entrants 687 Intermediates 1,047 Leavers 1,043 Total 2,777 Number of other Routine Inspections — B.—Other Inspections. Number of Special Inspections 1,052 Number of Re-Inspections 800 Total 1,852 — 69 — TABLE II. A. RETURN OF DEFECTS FOUND BY MEDICAL INSPECTION IN THE YEAR ENDED 31st DECEMBER, 1924. Defect or Disease. Routine Inspections | Special Inspections No. of Defects. | 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 — 64 — — Uncleanliness 14 3 — — (See Table IV., Group V.) — — — — Skin Ringworm, scalp — — 25 — „ body — — 15 — Scabies — —. 20 — Impetigo 11 — 199 — Other Diseases (non-Tuberculous) 19 — 117 — Eye Blepharitis 5 — 7 — Conjunctivitis 4 — 24 — Keratitis — — — — Corneal Opacities — — — — Defective Vision (excluding Squint) 130 — 84 — Squint 19 — 6 — Other Conditions 7 — 16 — Ear Defective Hearing 12 — 6 — Otitis Media 18 — 41 — Other Ear Diseases — — 10 — Nose and Throat Enlarged Tonsils only 76 75 22 — Adenoids only 12 — 4 — Enlarged Tonsils and Adenoids 16 — 2 — Other Conditions 24 5 7 3 Enlarged Cervical Glands (non-Tuberculous) — 5 — 4 Defective Speech — 8 — 1 Teeth Dental Diseases (See Table IV, Group IV.) 316 — 203 — Heart and Circulation Heart Disease:— Organic — 19 — 29 Functional — 10 — 20 Anaemia 27 48 13 60 Lungs Bronchitis 20 22 11 — Other Non-Tuberculous Diseases — — — — Tuberculosis Pulmonary Definite — — — Suspected — 8 — 4 Non-Pulmonary; Glands — 1 — 2 Spine — — — — Hip — 1 — — Other Bones and Joints — — — — Skin — —. — — Other forms — — — — Nervous System Epilepsy — — — — Chorea — — 2 — Other Conditions — 2 — 3 Deformities Rickets 3 — — Spinal Curvature 18 — 4 — Other Forms 75 46 5 — Other Defects and Diseases — 48 132 7 Total 824 368 965 133 —70— 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 687 53 7.7 Intermediates 1047 118 11.2 Leavers 1043 137 13.1 Total (Code Groups) 2777 308 11.1 Other Routine Inspections — — — —71— TABLE III. RETURN OF ALL EXCEPTIONAL CHILDREN IN THE AREA. Boys Girls Total bund (including partially blind) (i.) Suitable for training in a School or Class for the totally blind. Attending Certified Schools or Classes for the Blind 3 1 4 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 4 2 6 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 1 4 5 Attending Public Elementary Schools — — — At other Institutions — — — At no School or Institution 1 — 1 (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 — — — Mentally Defective Feebleminded (cases not notifiable to the Local Control Authority.) Attending Certified Schools for Mentally Defective Children 2 1 3 Attending Public Elementary Schools 15 16 31 At other Institutions — — — At no School or Institution 1 4 5 Notified to the Local Control Authority during the year. Feebleminded —- _____ Imbeciles 1 3 4 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 — — — —72—  Boys Girls Total Physically Defective Infectious pulmonary and glandular tuberculosis. At Sanatoria or Sanatorium Schools approved by the Ministry of Health or the Board 1 1 2 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, anaemia, etc.) At Certified Residential Open-Air Schools — — — At Certified Day Open-Air Schools — — — At Public Elementary Schools 59 131 190 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 — — — 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 23 23 46 At other Institutions — — — At no School or Institution 2 3 5 —73— TABLE IV. RETURN OF DEFECTS TREATED DURING THE YEAR ENDED 31st December, 1924. 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 17 9 26 Ringworm—Body 13 2 15 Scabies 5 15 20 Impetigo 198 12 210 Other Skin Diseases 3 —— 3 Minor Eye Defects (external and other, but excluding cases falling in Group II.) 42 21 63 Minor Ear Defects 67 20 87 Miscellaneous (e,g. minor injuries, bruises, sores, chilblains, etc. 57 93 150 Total 402 172 574 —74— 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) (Operations for squint should be recorded separately in the body of the Report) 205 9 — 214 Other Defect or Disease of the Eyes (excluding those reported in Group 1) — — Total 205 9 — 214 Total number of children for whom Spectacles were prescribed:— (a) Under the Authority's Scheme 109 (b) Otherwise 9 Total number of children who obtained or received Spectacles:— (a) Under the Authority's Scheme 109 (b) Otherwise 9 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) 54 15 69 16 85 — 75 — Group IV. Dental Defects. (1) Number of Children who were :— (a) Inspected by the Dentist: Aged : Routine Age Groups 5 348 Total 4,302 6 342 7 383 8 488 9 580 10 574 11 488 12 449 13 373 14 277 Specials 204 Grand Total 4,506 (b) Found to require treatment 2,866 (c) Actually treated 1,630 (d) Re-treated during the year as the result of periodical examination 506 (2) Half-days devoted to:— Inspection 28 Total 198 Treatment 170 (3) Attendances made by children for treatment 2,136 (4) Fillings:— Permanent teeth 1,559 Total 1,559 Temporary Teeth — (5) Extractions :— Permanent teeth 367 Total 2,514 Temporary teeth 2,147 (6) Administrations of general anaesthetics for extractions 373 (7) Other operations :— Permanent teeth — 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 9,591 (3) Number of individual children found unclean 720 (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 2