EAL 17 ANNUAL REPORT OF THE Medical Officer of Health, 1926. EAL 17 4 INDEX page Acts, Byelaws and Regulations 18 Ambulances 17 Bacteriological Examinations 38 Births 11 Blind, Deaf, &c., Children 69, 83 Clinics and Treatment Centres 17 Dairies, Cowsheds and Milkshops 22 Day Nursery 48 Deaths 15 Dental Defects 60, 64, 87 Diphtheria 31 Disinfection 23, 38 Factories and Workshops 23, 25 Food 27 Health Visiting 47 Hospitals in the District 16 Housing . 26 Infant Deaths 12 Infectious Diseases 3.1, 62 Institutions in the District 16 Maternity and Child Welfare 39 Maternity and Child Welfare in Extended Area, Special Report 39 Medical Inspection of School Children 54 Medical Treatment of School Children 63 Milk 27 Notifiable Diseases 31 Nursing Arrangements 18 Offensive Trades 23 Population 11 Sanitary Inspection of District 22 Scarlet Fever 33 School Medical Work in Extended Area, Special Report 72 Slaughterhouses 23 Staff 8, 52 Statistics, Vital 11 Statistics, General 10 Tuberculosis 37, 59 Vital Statistics 11 Welfare Centres 47 5 Town Hall, Ealing, W.5. June 22nd, 1927. To the Ealing Town Council. Mr. Mayor, Aldermen and Councillors. I have the honour to submit my Annual Report for the year 1926. This report is not only later in being presented but is much curtailed, due mainly to the fact that since the 1st October, when the Borough was extended to include the Urban Districts of Hanwell and Greenford, my staff and I have been almost overwhelmed with the task of re-organisation and in meeting the pressing needs of the included areas. Maternity and Child Welfare work in Hanwell and Greenford has been completely re-organised and arrangements have been made for the opening of two new Maternity and Child Welfare Centres ; work in connection with the medical inspection and treatment of school children in Hanwell and Greenford has had to be taken over from the Middlesex County Council and developed in consonance with the scheme already in operation in Ealing and many pressing sanitary matters in Greenford, which had accumulated on account of the Greenford Council having insufficient staff, have had to be undertaken. To be strictly correct four reports should be submitted by me, one for nine months for the Borough up to the 30th September, one for Hanwell and one for Greenford for the same period, and one for the whole Borough as extended from the 1st October for three months. Four such reports would not only be expensive to print but, because the statistics could not properly be compared with 6 those for previous or subsequent years, would be quite useless as comparable records. The Ministry of Health, therefore, approved of my aggregating the statistics for all these areas as if the extension of the Borough took place on the 1st January, 1926. I should like to take the opportunity of expressing my appreciation of the valuable and consistent help rendered me by my staff during the strenuous months of re-organisation, and particularly by my Chief Clerk, Mr. H. Birrell, whose assiduity and imperturbability whilst working under great pressure have been decided assets to me. To the Borough Surveyor I cannot help expressing my gratitude for his help, always most willingly given, in solving many difficulties in the new areas. I am, Your obedient Servant, 7 PUBLIC HEALTH COMMITTEE, 1925-26. Councillor W. T. White [Chairman). Alderman H. Armriding ( Vice-Chair man). Alderman H. W. Peal, J.P., Councillors E. H. Atkinson, A. H. Chilton, J.P., J. C. Fuller, Lt.-Col. R. R. Kimmitt, O.B.E., J.P., and H. M. Sayers MATERNITY AND CHILD WELFARE COMMITTEE, 1925-26. Councillor Lt.-Col. R. R. Kimmitt, O.B.E., J.P. (Chairman), Mrs. Morris (Vice-Chairman), Alderman H. Armriding and H. W. Peal, J.P.; Councillors E. H. Atkinson, A. H. Chilton, J.P., J. C. Fuller, H. M. Sayers, and W. T. White; Mesdames Cocker, Girdlestone, and Parry. 8 STAFF. Medical Officer of Health and Superintendent of Isolation and Small-pox Hospitals— Thomas Orr, M.D., D.Sc., Of the Middle Temple, Barrister-at-Law. Assistant Medical Officer of Health and Medical Attendant of Isolation Hospital— Harold Ellis, M.B., B.S., M.R.C.S., L.R.C.P., D.P.H. Consultant, Maternity and Child Welfare Centres (Ante-Natal Clinic)—Part-time— John W. Bell, L.R.C.P.I. & L.M., L.R.C.S.I. & L.M. Medical Officer, Maternity and Child Welfare Centre, Mattock Lane. (Infant Consultations)—Part-time— S. Grace Banham, B.Sc,, M.B. Medical Officer, M. and C.W. Centre, Cherington Road, and Day Nursery—Part-time— †James A. Davidson, M.D., Ch.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. †C. P. H. Meadows, Cert. R.S.I., and Cert. Inspector of Meat and Other Foods. 9 Staff—(Contd.). Health Visitors— Eleanor Evans, Cert. R.S.I., Cert. C.M.B. (Senior). Marguerite Farrow, Cert. R.S.I., and Trained Nurse. Mildred Adeline Rice, Cert. R.S.I., Cert. C.M.B., and Trained Nurse. †Kathleen E. Williams. Matron, Day Nursery— †Alice M. Exon, Trained Nurse. Chief Clerk and Committee Clerk— Harry Birrell. Clerk and Laboratory Assistant— *Ernest W. Hill. Clerks— *William A. J. Turner. Olive Levasseur. *†George W. Stephens. †Winifred Rivers. *†Herbert J. Reed. Maternity and Child Welfare Centres— 13, Mattock Lane, Ealing. Public Library, Cherington Road, Hanwell. Note.—To the salaries of all the above officials, excepting those marked with an asterisk, contribution is made under the Public Health Acts or by Exchequer Grants. †Officers taken over from Hanwell and Greenford Urban District Councils on the extension of the Borough on the 1st October, 1926 10 SUMMARY OF GENERAL STATISTICS, 1926. Population (Estimated, 1926) 91,783 Population (Census 1921) 89,697 Population (Census, 1911) 81,415 Area of Borough in Acres 7,055 Number of Structurally Separate Dwellings (1921) 18,497 Assessable Value (District Rate), October, 1926 £725,796 Net Produce of a Penny Rate £3,000 SUMMARY OF VITAL STATISTICS, 1926. Births:— Legitimate Males, 648 Females, 583 Total, 1,231 Illegitimate Males, 20 Females, 34 Total, 54 12,285 Birth-rate 14.0 Deaths: Males, 460 Females, 529 Total 989 Death-rate (Crude) 10.8 Death-rate (Standardised) 10.1 Deaths of Infants under 1 year:— Legitimate, Males, 35 Females, 29 Total, 64 71 Illegitimate Males, 3 Females, 4 Total, 7 Infant Death-rate per 1,000 Births:— Legitimate, 52 Illegitimate, 130 Total 55 Total Deaths Death-rate per 1,000 Population Measles 5 0.05 Whooping Cough — — Diarrhoea (under 2 years of age, per 1,000 births) 5 3.89 Diphtheria 1 0.01 Scarlet Fever — — Influenza 25 0.27 Tuberculosis of Lung 70 0.76 Other Forms of Tuberculosis 9 0.10 All Forms of Tuberculosis 79 0.86 Number of Women dying in or in consequence of Childbirth:- Death-rate per 1,000 births From Sepsis 1 0.77 Other causes 3 2.33 11 TABLE I. Comparison of Vital Statistics of Ealing with those of England and Wales, etc., 1926. England and Wales 105 Great Towns (including London) London Ealing Birth-rate 17.8 18.2 17.1 14.0 Death-rate 11.6 11.6 11.6 10.1 Infant Death-rate 70 73 64 55 Measles Death-rate 0.09 0.12 0.20 0.05 Whooping Cough Death-rate 0.10 0.10 0.05 0.00 Diarrhoea (under 2 years per 1,000 Births) 8.7 11.8 11.8 3.89 Diphtheria Death-rate 0.07 0.10 0.12 0.01 Scarlet Fever Death-rate 0.02 0.02 0.02 0.00 Influenza Death-rate 0.22 0.22 0.17 027 VITAL STATISTICS, Population. The population of the whole area in the middle of 1926, as estimated by the Registrar-General, was 91,783,—Ealing 69,050, Hanwell 20,920 and Greenford 1,813. During the year the natural increase in the population, which is the excess of births over deaths, was 296. At the Census of 1921 the total population for the three areas was 89,697. The Census returns for 1921 indicate that there were 18,497 structurally separate dwellings occupied in the area now combined, that there were 111,282 rooms occupied and that there were 1.24 rooms per person. The area of the extended Borough is 7,055 acres, and the density of population, or number of persons per acre, is therefore 13.0. The Birth-rate is low compared with the rates for England and Wales and for London, which were 17.8 and 17.1 respectively. The number of births assigned to the whole of the area was 1,285, 12 which gives a birth-rate of 14 per thousand of population. This is the same rate as recorded for the Borough of Ealing in the previous year. The Death-rate is slightly higher than in the previous year, 10.1 compared with 9.1. Nevertheless, it compares favourably with that for England and Wales, which was 11.6, and that for London, which was also 11.6 per thousand of population. The Infant Death-rate of 55 is higher than the rate for Ealing in the previous year, when it was 47 per thousand births. The rate, however, compares well with the rates for England and Wales, for the Great Towns and for London, which were respectively 70, 73 and 64 per thousand births. In Table II the rate for 1926 is compared with the rates for the previous sixteen years. The illegitimate infant death-rate was 130 per thousand illegitimate births. TABLE II. Showing Birth-rate, Death-rate and Infant Death-rate for Ealing for the years 1911-1926. Year Birth-rate Death-rate Infant Death-rate 1911 20.2 11.5 121 76 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 62 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 55 1922 16.2 11.0 52 1923 15.6 10.6 58 1924 14.3 11.1 47 1925 14.0 9.1 56 1926 14.0 10.1 55 13 The causes of deaths of infants in 1926 are indicated in Table III in which the causes of deaths in 1926 are compared with those in the preceding seven years. In Table IIIa the causes of death, and the ages at which death occurred amongst children under twelve months old, are indicated. It is noteworthy that prematurity and atrophy, delibity and marasmus accounted for half of all the infant deaths. TABLE III. Causes of Infant Deaths, 1919 to 1926. 1919 1920 1921 1922 19231924 1 1925 1926 Diarrhoeal Diseases 3 9 9 5 2 4 1 4 Premature Birth 13 15 10 5 11 7 9 23 Congenital Defects 6 4 4 6 8 4 10 5 Want of Breast Milk (Starvation) — — — — — — — - Atrophy, Debility, Marasmus 14 14 12 10 9 6 8 13 Tuberculous Disease 3 3 — 2 1 3 — - Syphilis — 3 2 — — — 1 1 Rickets — — — — — — — — Meningitis (not Tuberculous) 2 — 1 —- 1 2 1 1 Convulsions 1 2 2 2 2 2 — 1 Bronchitis 3 1 6 5 5 1 4 7 Pneumonia (all forms) 4 4 9 1 10 3 5 5 Gastritis — 2 1 2 1 — — 1 Common Infectious Diseases 1 — 7 4 2 3 3 1 Other Causes 17 7 9 15 10 11 12 9 Totals 67 64 72 57 62 46 54 71 14 TABLE IIIA. Infant Mortality during the Year 1926. 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 1 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 23 3 4 3 33 13 12 8 5 71 Uncertified — — — — — — — — — — Small-pox — - — - - - - - - - Chicken-pox - - - - - - - - - - Measles — — — — — — — — 1 1 Scarlet Fever — — — — - - - - - - Whooping-Cough — — — — — — — — — - Diphtheria and Croup — — — — — — — — — — Erysipelas — — —• —- - - - - - - Tuberculous Meningitis — - - - - - - - - v Abdominal Tuberculosis - - - - - - - - - - Other Tuberculous Diseases - - - - - - - - - - Meningitis (not Tuberculous) - - - - - - - 1 — 1 Convulsions 1 —• — — 1 — — — — 1 Laryngitis — — — — — — 1 — — 1 Bronchitis 2 — 2 — 4 —• 3 — — 7 Pneumonia (all forms) — — — —- — — — 2 3 5 Diarrhoea — — — — — — — — — — Enteritis — — — — — 1 1 2 - 4 Gastritis — — — — — — 1 — — 1 Syphilis — — — — — — 1 —- — 1 Rickets — — — — — — — — — - Suffocation, Overlying — — — — — — — — — — Injury at Birth — — — — — — — — — — Atalectasis 2 — — — 2 — — — — 2 Congenital Malformations 2 1 — 1 4 — — — 1 5 Premature Birth 14 2 2 2 20 3 —. — — 23 Atrophy, Debility and Marasmus 1 - - - 1 7 5 - - 13 Other Causes 1 — — - 1 2 — 3 — 6 Totals 23 3 4 3 33 13 12 8 5 71 15 In Table IV are indicated the total deaths from the various diseases. It will be seen that cancer was responsible for 141 deaths, giving a cancer death-rate of 1.53; that heart disease caused 146 deaths, giving a death-rate of 1.59, and that bronchitis and pneumonia accounted for 118 deaths, or a death-rate of 1.28. Of the infectious diseases, measles caused five deaths, giving a death-rate of .05 per thousand of population; diphtheria one death, giving a death rate of .01; influenza 25 deaths, giving a death-rate of .27; tuberculosis 79 deaths, giving a death-rate of .86 per thousand of population. There were no deaths from whooping cough or scarlet fever. table iv. Causes of Death, 1926. Cause of Death. Male Female Total Enteric Fever - - - Smallpox — — — Measles 3 2 5 Scarlet Fever — — — Whooping Cough — — — Diphtheria — 1 1 Influenza 10 15 25 Encephalitis Lethargica 1 — 1 Meningococcal Meningitis — — — Tuberculosis of Respiratory System 39 31 70 Other Tuberculous Diseases 4 5 9 Cancer, Malignant Disease 68 73 141 Rheumatic Fever 2 3 5 Diabetes 3 6 9 Cerebral Haemorrhage, etc. 22 47 69 Heart Disease 58 88 146 Arterio-Sclerosis 25 28 53 Bronchitis 33 32 65 Pneumonia (all forms) 26 27 53 Other Respiratory Diseases 4 4 8 Ulcer of Stomach or Duodenum 10 4 14 Diarrhoea, etc. (Under 2 years) 2 3 5 Appendicitis and Typhlitis 4 1 5 Cirrhosis of Liver 3 1 4 Acute and Chronic Nephritis 9 12 21 Puerperal Sepsis — 1 1 Other Accidents and Diseases of Pregnancy and Parturition - 3 3 Congenital Debility and Malformation, Premature Birth 24 19 43 Suicide 16 — 16 Other Deaths from Violence 16 7 23 Other Defined Diseases 78 116 194 Causes ill-defined or unknown — — — Total 460 529 989 16 GENERAL PROVISION OF HEALTH SERVICES FOR THE AREA. Hospitals Provided or Subsidised by the Local Authority or by the County Council (1) Fever.—The Chiswick and Ealing Hospitals Committee provide for the isolation of cases of infectious disease from Ealing and Chiswick in the Joint Isolation Hospital. The accommodation under ordinary circumstances is sufficient for the districts, but during periods of epidemic prevalence the hospital would not be able to cope with all cases of scarlet fever. This is not a very serious matter because the isolation of mild cases of scarlet fever, which has now a very low death-rate, is not called for in the same way as it was in the past. It would be impracticable to isolate all cases of scarlet fever when the disease is epidemic and it has already been decided by the Committee to isolate under these circumstances only serious cases or those which cannot be properly nursed at home on account of bad housing conditions. The Isolation Hospital is situated in a very convenient position at South Ealing, where it is readily accessible from the whole of the area served, (2) Small-pox.—The Small-pox Hospital is situated at North Ealing in an isolated position with plenty of enclosed land for extension. The buildings consist of an Administration Block and a Block of two wards with 5 beds in each. (3) Tuberculosis.—There are no hospitals for tuberculosis in the district. The Middlesex County Council makes provision for cases at Clare Hall Sanatorium and Harefield Sanatorium. (4) Maternity.—The Chiswick and Ealing Hospitals Committee maintain a Maternity Hospital of 22 beds for the districts of Chiswick and Ealing. The Hospital is situated at South Ealing, across the road from the Isolation Hospital. (5) Children.—The King Edward Memorial Hospital possesses a Children's Ward of 12 beds, six of which can be requisitioned by the Council should occasion arise. At the Hanwell Cottage Hospital there is a Children's Ward of three beds, to which can be admitted children from the Hanwell area. 17 (6) Other Hospitals.—The King Edward Memorial Hospital has two wards of 18 beds each for medical and surgical cases and seven private wards. Extensions are at present being carried out to accommodate 40 more beds. Ambulance Facilities. (1) Infectious Disease.—The Chiswick and Ealing Hospitals Committee provide a motor ambulance in which all cases of infectious disease are removed to the Isolation Hospital from both Ealing and Chiswick. (2) Non- Infectious and. Accident Cases.—The Town Council has two motor ambulances for the removal of accident or noninfectious cases to hospitals or nursing homes in Ealing, or to general hospitals in London. Both these ambulances are modern vehicles and well fitted to convey sick cases with every comfort. Clinics and Treatment Centres. Name Address Provided by Maternity and Child Welfare Centres. 13, Mattock Lane, Ealing. Ealing Town Council. Public Library, Hanwell. Ealing Town Council- School Clinics. 13, Mattock Lane, Ealing. Ealing Education Committee. Cherington House, Hanwell. Ealing Education Committee. (Temporary) Betham's School, Greenford. Ealing Education Committee. Day Nursery. Uxbridge Road, Hanwell. Ealing Town Council. Tuberculosis Dispensary. Green Man Lane, West Ealing. Middlesex County Council. Treatment Centres for Venereal Disease. Certain Hospitals in London. Middlesex County Council. 18 Professional Nursing in the Home, (1) General.—The Ealing Nursing Association has provided nursing assistance for the poorer inhabitants in the area of the old Borough and the Hanwell District Nursing Association in the Hanwell area. After the extension of the boundaries of the Borough took place on the 1st October the proposal was put forward that these two associations should amalgamate and since the end of the year this amalgamation has taken place. The new Association called the Greater Ealing District Nursing Association, has undertaken to provide nursing assistance in the whole of the extended Borough, Three nurses are employed, but it is hoped that in the near future a fourth may be appointed. (2) infectious Disease.—-Since the amalgamation of the two Nursing Associations the new Association has agreed to undertake for the Town Council the nursing of cases of ophthalmia neonatorum, measles, whooping cough, poliomyelitis and diarrhoea occurring in children under five years of age. For these services the Council has arranged to make an annual contribution of £150 to the funds of the Association. (3) Midwives.—There are 26 midwives (five of these being in the Maternity Hospital) in the district. All are trained midwives with the C.M.B. certificate. They are under the supervision of the County Council. The Town Council, in its scheme of maternity and child welfare, does not employ any particular midwife to attend women, who are in necessitous circumstances, at their confinement, but the midwife nearest the woman's residence is engaged and paid by the Council, As the work of all the midwives in the district has been found to be of a high standard any one can be employed by the Local Authority with confidence. Legislation in Force. In the following list are noted all the Local Acts, Adoptive Acts, Byelaws, and Regulations in force in the Borough. A doptive Acts. Public Health Acts (Amendment) Act, 1890. 20th November, 1890. 19 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, etc. Public Health Act, 1925. Parts II, III, IV and V. 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, 23rd July, 1925. 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. SANITARY CIRCUMSTANCES OF THE AREA. Water.—The Borough is supplied with water by the Metropolitan Water Board. Rivers and Streams.—After the area of Greenford was included in the Borough on the 1st October, complaints were received regarding a stream, which is a tributary of the Brent, running through the district from North to South. This stream was discovered to be grossly polluted. 20 The sources of pollution, which were many and varied, were dealt with thoroughly with the result that a considerable improvement has taken place in the character of the stream. It is hoped that, when all the drainage works required to be done to remedy the pollution have been carried out, a much greater improvement in the condition of the stream will take place. Drainage and Sewerage.—In the old Borough there is only a small area of the north-east corner which is not connected with the main sewerage system. Here, however, only two houses and a factory are concerned, the former being drained to cesspools and the latter to a privately owned sewage works of an efficient character. In the newly added area of Greenford a considerable amount of work has to be done in improving the drainage of the old houses and the general sewerage of the district. The drains of a number of houses,which are connected to cesspools of an insanitary character, have to be joined up with the sewers. Sewage Disposal.—There are altogether four separate sewage works in the area of the extended Borough, Greenford, Hanwell, North Ealing and South Ealing Works. The Greenford Works have already proved to be insufficient for the district and proposals have been put forward for their extension. The Hanwell Works operate well, but a better method of disposal of the sludge will have to be considered at an early date. The other two Sewage Works act very efficiently. Closet Accommodation.—Excepting a temporary building and two small cottages, which are at a distance from the sewer, the whole of the houses in the old Borough are supplied with water closets. As a rule there is one water closet for each house. In the Greenford area there is a certain number of houses which are still served by means of insanitary pail-closets. These, however, are being rapidly supplied with water closets connected to the main sewerage scheme. Very substantial progress in the way of improved water closet accommodation and drainage has been accomplished since this area was included in the Borough. 21 Scavenging.—The extension of the Borough has provided new problems with regard to scavenging. Collection of refuse in the Hanwell area has been carried out by the Hanwell Urban District Council, but in Greenford the Council for that area had, before the extension took place, made a contract for the collection and disposal of refuse by a private contractor. This method has had to be continued. In Hanwell the provision of sanitary dustbins had been continuously enforced but in Greenford their provision has had to be insisted upon since the 1st October, there being no attempt at providing suitable receptacles at most of the old houses. The destructor at Hanwell has for some years been incapable of dealing with all the refuse from the district and proposals have had to be put forward by the Borough Surveyor for its extension. The collection and disposal of refuse in Greenford will have to be brought into line with the methods in operation in the rest of the Borough. No doubt this will be done as early as it is practicable - to do so. Smoke Abatement.—There are very few factories in the Borough, and these are not large in size; consequently it is seldom that action is called for in abating nuisance from smoke. During the year particular observation was kept on three factories, but at no time was smoke emitted to such an extent as would justify legal proceedings, although representations were made on these occasions to the owners. In all three instances the results of these representations were satisfactory. Premises and Occupations which can be Controlled by Byelaws and Regulations.—There are no common-lodginghouses in the Borough and there are no Byelaws with respect to houses let-in-lodgings. Fish-frying, which has been declared an offensive trade under the Public Health Act (Amendment) Act, 1907, is conducted in 18 premises. Before the extension of the boundaries there were no other offensive trades in the district, but since the extension Greenford has added one to the list, namely, that of tallow melter. These premises are being reconstructed and every step is being taken to have them fitted with the most modern apparatus so as to reduce offensive odours to a minimum. 22 Schools.—The Sanitary Inspectors make a regular and thorough examination once a year, during the vacation, of all public elementary and private schools and on their reports steps are taken to remedy defects. In connection with the prevention of spread of infectious disease the head-teachers send to the Medical Officer of Health, at the end of each week, a list of all children who are absent on account of non-notifiable infectious disease. These notifications enable the Health Visitors to visit the homes and to give the mothers advice regarding the prevention of the spread of the disease and the care of the patient, particularly with a view to the prevention of complications. Sanitary Inspection of the Area.—The following tabular statement shows the extent of the work carried out by the Sanitary Inspectors during the year General. Number of Premises inspected on Complaint 538 Number of Nuisances observed by Inspectors 285 Number of Premises inspected in connection with Infectious Disease 540 Number of Premises visited by Periodical Inspection (Cowsheds, Dairies, Slaughterhouses, Workshops, Etc.) 1,165 Number of Houses inspected under House-to-House Survey 753 Food Inspections 7,515 Total number of Re-inspections 9,988 Other Inspections 959 Total number of Inspections and Re-Inspections 19,562 Number of Intimation Notices given 711 Number of other Letters written 368 Number of Statutory Notices served 189 Proceedings before Magistrates 3 Dairies, Cowsheds and Milkshops. Number of Cowsheds on Register 6 Number of Inspections made of Cowsheds 6 Contraventions of Regulations 5 23 Number of Retail Purveyors of Milk on Register 78 Number of Inspections of Retail Purveyors' Premises 230 Contraventions of Regulations 33 Proceedings before Magistrates — Slaughterhouses. Number of Registered or Licensed Slaughterhouses 7 Number of Inspections made 335 Contraventions of Regulations — Proceedings before Magistrates — Factories and Workshops. Registered Workshops 159 Factories 84 Number of Inspections of Factories and Workshops and Workplaces 599 Number of Defects concerning which Notices were sent 1 Proceedings before Magistrates — Offensive Trades. Fried Fish Shops 18 Other Offensive Trades 1 Number of Inspections 232 Contraventions - Disinfection. Rooms Disinfected by Spray:— (a) Ordinary Infectious Disease 351 (b) Tuberculosis 99 Rooms stripped and cleansed 147 Articles disinfected by steam at Disinfector:— (a) Ordinalv Infectious Disease 1,091 (b) Tuberculosis 399 Articles voluntarily destroyed 107 Particulars of the Sanitary Defects referred to in Notices Served and Letters Written. Water Closets repaired or supplied with water or otherwise improved 375 —24— Drains cleared and cleansed 127 Defects in Drains repaired 170 Drains reconstructed 69 Dust-bins provided 215 Overcrowding remedied 3 Accumulations of refuse removed 93 Nuisance from fowls and other animals abated 26 Damp-proof courses inserted in walls 100 Ventilation under floors provided 16 Other forms of dampness remedied 120 Yards paved and repaired 160 Floors repaired 106 Roofs, Gutters, and Rain Water Pipes repaired 406 New Soil and Ventilating Pipes provided 153 Sinks and Waste-pipes repaired or renewed 179 Draw Taps fixed to main supply 21 Dirty Walls and Ceilings stripped and cleansed 1,373 Other Defects or Nuisances remedied 606 Cisterns cleansed and covered 5 Legal proceedings were taken in three cases, one for failure to comply with notices in respect of sanitary defects in a house, one for failure to remove an accumulation of refuse, and one for allowing a cellar to be occupied as a dwelling. In the first, as the work was commenced before the case was heard, costs were allowed, in the second the case was adjourned to arrange for the removal of the refuse, and in the third time was allowed for the tenant to be evicted. —25— FACTORIES, WORKSHOPS AND WORKPLACES. 1.—Inspection of Factories, Workshops and Workplaces. Including Inspections made by Sanitary Inspectors or Inspectors of Nuisances. Premises (1) Number of Inspections (2) Written Notices (3) Prosecutions (4) Factories (Including Factory Laundries) 135 — — Workshops (Including Workshop Laundries) 360 1 — Workplaces (Other than Outworkers' premises) 7 — — Total 502 1 - 2.—Defects found in Factories, Workshops and Workplaces Particulars (1) Number of Defects. Number of Prosecutions (5) Found (2) Remedied (3) Referred to H.M. Inspector. (4) Nuisances under the Public Health Acts— Want of Cleanliness 91 91 — — Want of Ventilation —— — — — Overcrowding —- — —- — Want of drainage of floors 10 10 — — Other Nuisances 51 51 — — Sanitary accommodation insufficient — — - — unsuitable or defective 19 19 - — 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 171 171 — — —26— Outwork in Unwholesome Premises, Sec. 108. Nature of Work Instances Notices Served Prosecution Wearing Apparel Making, Etc. - - — Others - - - HOUSING STATISTICS FOR THE YEAR. Number of New Houses erected during the Year. (a)Total 819 (b)As part of a Municipal Housing Scheme 100 1.—Unfit Dwelling Houses. Inspection. (1)Total number of dwelling bouses inspected for housing defects (under Public Health or Housing Acts) 2,169 (2)Number of dwelling houses which were inspected and recorded under the Housing (Consolidated) Regulations, 1925 675 (3)Number of dwelling houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation 8 (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 1,531 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 1,335 3.—Action under Statutory Powers. A.—Proceedings under Section 3 of the Housing Act, 1925:— (1)Number of dwelling houses in respect of which notices were served requiring repairs None —27— (2) Number of dwelling houses which were rendered fit:- (a)By Owners None (b)By Local Authority in default of Owners None (3)Number of dwelling houses in respect of which Closing Orders became operative in pursuance of declarations by Owners of intention to close None B.—Proceedings under the Public Health Acts:— (1)Number of dwelling houses in respect of which Notices were served requiring defects to be remedied 157 (2)Number of dwelling houses in which defects were remedied:— (a)By Owners or Occupiers 120 (b)By Local Authority in default of Owners None C.—Proceedings under Sections 11, 14, and 15, of the Housing Act, 1925:— (1)Number of representations made with a view to the making of Closing Orders 7 (2)Number of dwelling houses in respect of which Closing Orders were made 7 (3)Number of dwelling houses in respect of which Closing Orders were determined, the dwelling houses having been rendered fit None (4)Number of dwelling houses in respect of which Demolition Orders were made 6 (5)Number of dwelling houses demolished in suance of Demolition Order 5 INSPECTION AND SUPERVISION OF FOOD. (a)Milk Supply.—Previous to the extension of the boundaries there were no milk producers in Ealing, but Greenford brought six cowsheds into the Borough. One of these cowsheds is in a very good condition, is well managed and produces milk of a good hygienic quality ; one is being reconstructed and fitted with modern — 28 — dairy apparatus. The four others need much improvement in construction and in management to comply with the requirements of the Milk and Dairies Order, 1926, and the attention of the occupiers has been drawn to the necessity of immediate steps being taken to effect the improvement. There were on the Register at the end of the year 78 retail purveyors of milk in the whole of the district. Twenty-one of these registrations were in respect of premises owned by one Company and used only as places for distributing milk, the milk being bottled at a central depot within the area of the London County Council. Five were in respect of general shops dealing in bottled sterilised milk prepared and bottled at a depot in London. Four of the registrations were new and were allowed after the premises had been approved of. Seven registrations were in respect of premises which were transferred to new occupiers. Milk (Special Designations) Order, 1923.—Under the Milk (Special Designations) Order 15 licences were granted for the sale of Certified milk, 14 for Grade A (Tuberculin Tested) milk and 20 for the sale of Pasteurised milk. During the year the following bacteriological results of samples of specially designated and ordinary milk were obtained :— Kind of Milk. Total Bacteria Bacillus Coli Certified Milk (Ten Samples) 9,766 In two of these samples B. Coli was found in 1 c.c. and not in 1/10 c.c., and in one B.Coli was found in 1/10 c.c. In other samples no B. Coli in 1 c.c 6,533 10,533 83,500 9,626 2,566 6,466 2,566 3,533 2,810 The producer of the sample giving 83,500 bacteria per c.c. which is above the standard, was dealt with by the Ministry of Health. —29— Grade A (Tuberculin Tested) (Eight samples) 8,466 In two B.Coli was found in 1 c.c and not in 1/10 c.c. In others no B Coli in 1 c.c 3,600 13,766 9,600 15,366 127,500 1,773 2,426 Pasteurised (Ten samples) 40,000 In 8 samples B.Coli was found in 1 c.c. and not in 1/10 c.c., and in two B.Coli in 1/10 c.c. \ 59,000 107,000 84,000 16,466 55,500 8,533 13,366 29,633 16,566 Ordinary Untreated Milk (Four samples) 164,666 In 3 samples B. Coli in 1/10 c.c. and in one B. Coli in 1 c.c. and not in 1/10 c.c. 10,366 233,333 50,500 In addition ten samples were examined for the bacillus of tuberculosis. Eight of these were of pasteurised and two were of raw milk. The result was negative in all samples. (b)Meat, etc.—There have been no infringements of the Public Health (Meat) Regulations. All the shop fronts have been provided with glass protection and there seems to be a general desire on the part of the butchers to carry out the requirements of the Regulations. Meat is not sold on stalls or on vehicles in the Borough. There is no public slaughterhouse, but in the whole of the enlarged Borough there are seven private slaughterhouses. Very little slaughtering is done in these. In twelve months in the whole of the slaughterhouses there were killed 25 cattle, 275 sheep, 549 pigs and 34 calves. The number of pigs slaughtered was about —30— double the usual number in the year. The increase was due to the slaughter of animals which had been in contact with others affected with swine fever which was prevalent in several large piggeries at Hanwell. Bakehouses and places where food is prepared or cooked have been regularly inspected. In connection with the inspection of meat and other foods the following were found to be diseased or unsound and were voluntarily surrendered for destruction-:— Food Quantity Beef 10H lb. Mutton 16 lb. Veal lb. Pork (60 carcases with offal) 3,288 lb. (54 Swine Fever, 1 Poisoning, 1 Tetanus, 2 Tuberculosis and 2 Malnutrition) Offal 213 lb. Fish 137 lb. Rabbits 10½ lb. Fruit 116 lb. Vegetables 230 lb. —31— PREVALENCE OF, AND CONTROL OVER, INFECTIOUS DISEASES. The numbers of the various infectious diseases notified in the whole of the extended Borough are indicated in Table V and aire compared with, those for the old Borough for the previous nine years TABLE V. Disease 1917 1918 1919 1920 » 1921 1922 1923 1924 1925 1926 Diphtheria 66 36 46 56 186 282 56 61 40 72 Scarlet Fever 91 61 201 171 665 487 142 123 107 156 Enteric Fever (in eluding Paratyphoid) 3 6 5 6 8 3 5 9 5 4 Puerperal Fever — 2 3 5 9 3 9 3 6 I Puerperal Pyrexia - — — - - - — — -— 3 Pneumonia : Primary — - 30 38 21 33 32 47 57 47 Influenzal - - 33 27 17 22 7 27 22 17 Acute PoUomyelitis 2 1 — — 1 - - 3 — 1 Cerebro-Spinal Fever 1 — 3 4 1 - - - — — Malaria - - 40 27 3 4 2 - 2 5 Dysentery - - 5 2 1 1 — — — — Erysipelas 33 24 22 30 27 22 17 25 17 15 Encephalitis Lethargica - - 3 1 1 3 1 6 4 2 Tuberculosis: (a) Pulmonary 92 110 83 63 80 69 92 74 90 93 (6) Non-Pulmonary 17 22 25 17 23 16 26 31 25 21 Ophthalmia Neonatorum 4 3 4 8 13 10 3 3 6 5 Total 309 265 503 455 1036 955 393 412 381 442 Diphtheria.—There were 72 cases of diphtheria notified during the year. The cases were distributed throughout the year as indicated in Table VI. It will be seen that the month of February provided no cases, whereas the month of May produced almost double that of any other month. —32— TABLE VI. . . Scarlet Fever. Diphtheria. January 15 3 February 17 0 March 19 4 April 11 9 May 24 17 June 8 6 July 14 5 August 6 2 September 7 7 October 9 8 November 14 8 December 12 3 Total 156 72 There was only one death from the disease, giving a low deathrate of 0.01 per 1,000 of population and a very low mortality rate of 1.4 per cent. of cases. The death-rate from diphtheria is very low compared with that for England and Wales and with that for London, which were respectively 0.07 and 0.12 per 1,000 of population. Facilities for the bacteriological diagnosis of diphtheria are offered at the Public Health Laboratory which is situated at the Town Hall and is readily accessible from the whole area. Medical men are constantly advised not to wait for the bacteriological results if diphtheria is suspected but to give the specific anti-toxin treatment at once. In order to facilitate the early administration of anti-toxin, and thus reduce the mortality from the disease, antitoxin is provided free for administration to the children of parents who are not in good financial circumstances. Doctors may obtain the anti-toxin either at the Town Hall, Ealing, or at Cherington House, Hanwell, at any time of the day or night. Daring the year 130,000 units of anti-toxin were issued to doctors for use in this way. —33— Scarlet Fever.—There were 156 cases of scarlet fever notified. In Table V the number is compared with the numbers in the previous years for the area of the old Borough, and in Table VI the distribution of the cases throughout the year is indicated. It will be seen that the largest number of cases occurred in the month of May, the same month in which the highest number of cases of diphtheria occurred, and the smallest number in August. No deaths occurred from the disease which was of a very mild type. It is worth noting that the death-rate from scarlet fever for England and Wales and for London was 0.02 per 1,000 of population, compared with the absence of deaths in Ealing. To prevent, as far as possible, the occurrence of "return" cases of scarlet fever, children discharged from the Isolation Hospital are visited at their homes by tne Health Visitors for 14 days after in order that the onset of sores, or nasal or ear discharge may be noted. When these are found the re-admission of the child to school' is postponed until the condition has disappeared. In connection with the supervision of these cases the Health Visitors made 120 visits to the homes. Enteric Fever.—The notifications under this head comprised one case of true enteric fever in a child 4i yeais of age, and three cases of paratyphoid "B" fever in two girls, 14 and 16 years of age respectively, and one boy 13 years of age. Three of the cases were evidently infected outside the district but the fourth case occurred locally without the actual source of infection being discovered. All four were mild cases which were nursed at home. They all had an uninterrupted recovery, Encephalitis Lethargic a.—Two cases of encephalitis lethargica were notified during the year. One was a child two years and eight months old who died eight days after the onset of the disease. The other was a man 22 years of age who was able to perform his work a month after and who, two months later, was reported to be perfectly well. There was no discoverable relationship between the two cases which were separated in onset by an interval of six weeks, -34- Pneumonia, Malaria and Dysentery.—There were five cases of malaria notified, all being persons who had contracted the disease abroad. No cases of dysentery occurred. Of pneumonia in the primary form there were 47 notifications and of influenzal pneumonia 17 notifications. The deaths registered as occurring from primary pneumonia numbered 50 and influenzal pneumonia 3. The first number shows that medical men do not always notify the occurrence of cases of primary pneumonia since the number of deaths is higher than that of the notifications. It would appear that the need for notification is usually remembered when there is a fatal issue. Whenever the opportunity offers medical men are informed of their responsibility in the notification of this condition. Whooping Cough, and Measles.—The weekly returns of absences from, school owing to non-notifiable infectious disease, made by the head-teachers, are very valuable in giving information of the existence of these conditions not only in school children but also, what is really more important, in children under 5 years of age in whom serious complications are more common and more fatal. The Health Visitors visit the homes affected and give suitable advice in regard to the prevention of the spread of infection and the avoidance of complications. At the end of the year the Council made arrangements,, which will be referred to later, by which children suffering from these conditions will be nursed by the nurses employed by the Greater Ealing Nursing Association. During the year very few cases of whooping cough occurred in the district and there were no deaths from the disease. Measles was more prevalent but the epidemic was neither large nor serious. There were five deaths, giving a death-rate from the disease of 0.05 per 1,000 of population, which compares favourably with the rates for England and Wales and London, which were respectively 0.09 and 0.20. Table VII gives the number of cases of infectious disease notified and the number admitted to Hospital and Table VIII the total deaths from the various infectious diseases and the ages at death. TABLE VII. Cases of Infectious Disease notified during the year 1926. Disease. Ages of Cases Notified. Totals. 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 Diphtheria 1 2 1 7 4 42 9 1 3 2 - - 72 64 Scarlet Fever - 2 3 13 15 82 21 9 9 2 - - 156 115 Enteric Fever (including Paratyphoid) - - - - 1 - 2 1 - - - - 4 1 Puerperal Fever — - - - - - - - 1 - - - 1 1 Puerperal Pyrexia - - - - - - - 1 2 - - -_ 3 - Pneumonia: Primary 2 4 - 1 - - 2 3 12 8 6 9 47 - Influenzal — - - - - - 1 1 7 2 4 2 17 - Acute Poliomyelitis - - - - - 1 - - - - - - 1 - Cerebro-Spinal Fever - - - - - - - - - - - - - - Malaria - - - - - - - - 3 1 1 - 5 - Dysentery - - - - - - - - - - - - - - Erysipelas .— - 1 - 1 - 1 1 1 2 4 4 15 - Encephalitis Lethargica — - 1 - - - - - 1 - - -- 2 - Tuberculosis: (a)Pulmonary Male - - - - - - - 3 18 15 11 2 49 - Female - - - - - - 1 9 23 7 3 1 44 - (b)Non-Pulmonary Male — — 1 — — 3 — 2 2 - - 1 9 - Female - - 1 1 - 2 3 3 2 - - - 12 - Ophthalmia Neonatorum 5 - - - - - - - - - - - 5 - Total 8 8 8 22 21 130 40 34 84 39 29 19 442 181 —35— TABLE VIII. 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 Scarlet Fever - - - - - - - - - - - - - Enteric Fever (including Paratyphoid) - - - - - - - - - - - - - Puerperal Sepsis - - - - - - - - - 1 - - 1 Pneumonia: Primary 4 5 1 — - - - 1 5 7 14 13 50 Influenzal — - - - - - - - - - 1 2 3 Acute Poliomyelitis - - - - - - - 1 — - - - 1 Cerebro-Spinal Fever - — — - - - - - - - - - - Malaria - - - - - - - - - - - - - Dysentery — - - - - - - - - - - - - Erysipelas - - - - - - - - 2 - - - 2 Encephalitis Lethargica - - 1 - - - - - - - - 1 2 Tuberculosis: (a)Pulmonary Male — — - - - - - 1 14 9 14 1 39 Female — — - - - - - 2 16 8 5 - 31 (b)Non-Pulmonary Male - - 1 - - 3 - - - - - - 4 Female - - - 1 — - - 1 1 - 2 - 5 Ophthalmia Neonatorum - - - - - - - - - - - - - Totals 4 5 3 1 - 4 - 6 38 25 36 17 139 —36— -37- Ophthalmia Neonatorum.—There were five cases of ophthalmia neonatorum notified during the year. The following table shows that favourable results occurred in all the cases. Number of Cases Notified. No. Treated . Vision unimpaired. Vision impaired. Total Blindness. Deaths. At Home. In Hospital. 5 4 1 in Nursing Home. 5 None. None. None. Tuberculosis.—In Table IX is indicated the number of new cases of pulmonary and non-pulmonary tuberculosis notified during the year in the whole of the extended area, together with the number of deaths in the various age-groups. There were 70 deaths from pulmonary and 9 deaths from non-pulmonary tuberculosis, which give death-rates of 0.76 and 0.10 respectively, and a total tuberculosis death-rate of 0.86 per 1,000 population. There were five deaths from pulmonary tuberculosis in persons who had not been previously notified: all were of persons dying outside the district, the deaths being transferred to Ealing. TABLE IX. 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—5 — — 1 2 — — 1 1 5—10 — — 3 2 — — 3 — 10—15 — 1 — 3 — — — — 15—20 3 9 2 3 1 2 — 1 20—25 6 9 2 1 5 6 — — 25—35 12 14 — 1 9 10 — 1 35—45 15 7 — — 9 8 — —. 45—55 7 3 — — 10 4 — 1 55—65 4 — — — 4 1 — 1 65 upwards 2 1 1 - 1 — - - Total 49 44 9 12 39 31 4 5 —38— The Tuberculosis Officer has very kindly supplied the following information with respect to cases of tuberculosis from the district:— Number of persons examined for the first time by the Tuberculosis Officer :— (a)Tuberculosis of Lungs 59 (b) Other forms of Tuberculosis 10 Number of persons kept under treatment at the Middlesex County Council Dispensary, Ealing 144 Number sent to Sanatoria 52 Number sent to Hospital 25 No action has been called for, either under the Public Health (Prevention of Tuberculosis) Regulations, 1925, or under Section 62 of the Public Health Act, 1925. Laboratory Work.—At the public health laboratory the following specimens were examined in connection with the diagnosis and control of infectious disease :— Positive Negative Total Diphtheria:Ealing 28 764 792 Isolation Hospital 39 1,312 1,351 Tuberculosis: Ealing 50 222 272 Miscellaneous: Ealing 14 14 28 Total 131 2,312 2,443 Disinfection.—Besides the steam disinfector at the Isolation Hospital, which is chiefly used for the disinfection of articles in the hospital itself, there are steam disinfectors at North Ealing and Hanwell. With motor transport, however, it is quite unnecessary to use the apparatus at Hanwell. The amount of disinfection carried out in connection with infectious disease was as follows :— Rooms disinfected by formalin spray (a)Tuberculosis 99 (b)Other Infectious Disease 351 Articles disinfected in Steam Disinfector:— (a)Tuberculosis 399 (b)Other Infectious Disease 1,091 —39— In connection with the disinfection of homes after infectious disease 107 articles of clothing were destroyed. To render disinfection more thorough 147 rooms were stripped and cleansed by the owners after notices were served on account of dirty condition. MATERNITY AND CHILD WELFARE. In the Annual Report for 1925 a general outline was given of the scheme of maternity and child welfare in operation in the Borough. In order to extend the scheme and so give equal facilities to the areas of Hanwell and Greenford, which were added to the Borough on the 1st October, recommendations were made to the Council in a Special Report on the subject. The recommendations contained in this Report, which is printed hereunder, were approved by the Council and steps are being taken to give effect to them. Report on the Scheme of Maternity and Child Welfare in the Extended Borough. "The whole scheme of Maternity and Child Welfare in operation in the Borough before the 1st October has been extended to operate in the added areas. "It is proposed that a new Welfare Centre associated with a School Clinic should be formed at Cherington Road in the building recently used as the Hanwell Council Offices. This Centre would deal with the Hanwell North and Hanwell South Wards and partly with the Grosvenor and Greenford Wards. Perhaps some mothers in the Grosvenor and Greenford Wards may desire to attend the Mattock Lane Centre but there should be as little overlapping of areas as possible. At Greenford, a Centre open on one session each week, should be established at Aberdeen House in the office recently used by the Surveyor to the Greenford Council. This would serve as a temporary arrangement until the demands of that area necessitate a new and much larger Centre. Aberdeen House as a whole cannot readily be adapted to form a suitable permanent Welfare Centre and School Clinic, and, as the position will not be a convenient one to serve the whole of Greenford as it — 40 — develops, the acquisition of a suitable site should be kept in mind. When ground is sought for a new school for Greenford a sufficient amount might be acquired as a site for a Maternity and Child Welfare Centre and School Clinic. "Details of Administration. "Medical Staff.—At present the medical staff consists of, at Ealing, Dr. Grace Banham as Child Consultant on three sessions each week and Dr. Bell as Ante-Natal Consultant attending on three sessions each month. At Hanwell Dr. Davidson is Child Consultant, giving his services on one session each week; he is also Medical Attendant at the Day Nursery. "I recommend that Dr. Banham and Dr. Davidson be replaced by a whole-time woman assistant medical officer who would also replace Dr. Bell on two sessions each month and who would also carry out duties under the Education Committee in inspecting school children. With a whole-time medical officer the sessions devoted to Hanwell could be increased to two each week, if found necessary, and a session could be arranged at Greenford "The salary of this officer, £600 per annum, should be paid in equal parts by the Maternity and Child Welfare Committee and the Education Committee. The cost of the part-time officers who would be displaced by the whole-time assistant is as follows :— Dr. Grace Banham £225 per annum Dr. J.A.Davidson £75 Dr. J.W.Bell £75 £375 "If the woman assistant medical officer acts as Resident at the Maternity Hospital the contribution towards her salary from the Joint Hospitals Committee would be £150, which, divided between the Education and Maternity and Child Welfare Committees, would reduce the cost of the assistant to this Committee by £75. This would mean that a whole-time woman assistant would be a distinct saving to the Committee of £150. — 41 — "The Education Committee would have to pay more than formerly for medical services in connection with the schools but the nett cost of the whole-time assistant chargeable, to the rates would be only £73 10s.0d., as indicated in the Table which is attached hereto. "Dental Treatment.—The arrangements already made for the dental treatment of expectant and nursing mothers and of children under 5 years of age would be greatly improved and extended if a whole-time dentist were employed by the Education Committee in place of the two part-time officers at present employed on school dental work. The whole-time dentist could devote one session each week to the dental treatment of expectant and nursing mothers and children under 5 years. "Health Visitors.—Health visiting has been carried out in Ealing by three Health Visitors, in Hanwell by one Health Visitor, and in Greenford by a Health Visitor who has also performed duties in other parts of the county. Miss Williams, Health Visitor at Hanwell, although at present due to retire under the Superannuation Act, will continue her duties until the end of March, 1927, and I recommend her place be then taken by Miss Rice, who since her appointment as Health Visitor in Ealing has performed excellent work. Miss Rice would have the management of the Cherington Road and the Aberdeen House Maternity and Child Welfare Centres under the general administrative control of the Senior Health Visitor. "The distribution of the work of the Health Visitors has been arranged for the present as follows :— Miss Evans (senior) Castlebar and Mount Park Wards. Miss Farrow Drayton, Grange and Manor Wards. Miss Rice Grosvenor, Lammas and Greenford Wards. Miss Williams Hanwell South and Hanwell North Wards. "When Miss Williams retires in March, Miss Rice will take over Hanwell South, Hanwell North and Greenford Wards and a new Health Visitor will be assigned to Grosvenor and Lammas Wards. As the population of Greenford increases the appointment of another Health Visitor will be necessary. —42— "Clerical Staff.—On the occasion of the transfer of officers on the 1st October, Miss Rivers, who was formerly typist and clerical assistant to the Clerk to the Hanwell Urban District Council, was assigned to my Department to perform duties connected with school medical and maternity and child welfare work. At the end of this month she will go to the Mattock Lane School Clinic and Welfare Centre for experience of both classes of work and will later take up her duties at the Cherington Road Clinic and Welfare Centre, half of her time being devoted to school medical and half to maternity and child welfare work, her salary being paid in equal proportions by the Education Committee and the Maternity and Child Welfare Committee. "District Nursing.—District Nursing is intimately associated with maternity and child welfare work. In Hanwell the Council made a yearly contribution towards the Hanwell District Nursing Association for certain services rendered by the District Nurse. These included the attendance of the nurse at the Welfare Centre on two afternoons each week and the nursing of cases of measles, whooping cough, epidemic diarrhoea, poliomyelitis, ophthalmia neonatorum, puerperal sepsis, etc., when her services were required. Naturally the Ealing and Hanwell Nursing Associations should now amalgamate, and I recommend that the Town Council make a sufficient contribution to the funds of the enlarged Nursing Association to enable the nurses to be placed at the disposal of the Council in rendering assistance at the Welfare Centres and in nursing cases of measles, whooping cough, ophthalmia neonatorum, etc., in the whole of the extended Borough. The Hanwell Council contributed £75 per annum to the funds of the Hanwell Nursing Association and I recommend that the Town Council contribute £150 towards the larger Nursing Association. "Day Nursery.—The Day Nursery has accommodation for 24 children. The admission of children should be restricted to the children of widows or unmarried mothers or the children of women who have to go out to work because their husbands are unable to work or to obtain work. If the Day Nursery is to be continued certain alterations will be required but these can be deferred until a later date when a special report will be submitted. —43— "Maternity Aid.—I need not enter into the details of the Maternity and Child Welfare Scheme which has been extended to the added areas of Hanwell and Greenford, but I must refer to the subject of the provision of Maternity Aid as it applies to the Greenford Ward. I do not propose to utilise the services of the County Council midwife for this area as suggested in the letter of the Clerk to the County Council, since it is essential that the maternity and child welfare scheme should be the same for the whole Borough. The policy adopted by the Committee has been to offer facilities in the Maternity Hospital for mothers requiring maternity treatment, and if a mother is unwilling to go into the Hospital to provide a midwife free of cost for those in poor circumstances. I have authority to employ any midwife who lives conveniently near the expectant mother and who can be thoroughly recommended by me. There are sufficient trained and reliable midwives in private practice to meet all the needs of the extended Borough. In view of the calls that might be made from Greenford I interviewed the midwife who lives nearest to Greenford and I found that she would be willing to undertake cases on behalf of the Committee and at the usual rate of remuneration charged by her for other cases, namely 30s., which compares favourably with the £2 2s. Od. to £2 6s. Od. suggested by the County Council for their midwife. There is a likelihood of this midwife, whenever she gets established in her practice there, of removing to the Greenford Ward. "This midwife, who has a telephone in her house, could be assisted in her work in the Greenford Ward by placing the ambulance at her disposal when called during the nigbt. "Suggested Arrangement of the Maternity and Child Welfare Centre and School Clinic at Cherington Road. "The Maternity and Child Welfare Department would occupy the first floor. The old Council Chamber would form the waitingroom or lecture-hall, and the committee room to the side of it would become a store-room. On the west of the waiting-room there are two rooms which would constitute the Health Visitor's or weighingroom and the Medical Officer's room. The equipment required includes 30 chairs, 2 demonstration tables, 2 demonstration cases for the waiting-room, and an examination couch for the Medical — 44 — Officer's room. A wash-hand basin with hot and cold water should also be provided in the Medical Officer's room. There is sufficient furniture in the building to furnish the rooms generally. "On the ground floor the hall should be widened out by removing the wooden partition on the left side to give more space and light. One room on the right with the enquiry counter attached would be occupied by staff from the Borough Surveyor's and the Borough Treasurer's Department. Two rooms on the right side would form the dentist's room and waiting-room and two rooms on the left side would be for the school nurse and the medical officer, the hall serving as a waiting-room. "The present lavatory accommodation would be reserved for the staff. On the right side of the entrance hall separate lavatory accommodation should be provided for mothers and for school children. Further, wash-hand basins would be necessary for the medical officer's and dentist's rooms. The Borough Surveyor has estimated the cost of the alterations at £350, half of which would be met by the Maternity and Child Welfare Committee. —45— Cost of Extending Maternity and Child Welfare Scheme to the Added Areas." "Initial Expenditure. 1.Adaptation of buildings in Cherington Road to form Maternity and Child Welfare Centre and School Clinic. Moiety £175 2.Equipment of Cherington Road Centre 40 3.Equipment of Aberdeen House Welfare Centre 35 250 "Annual Expenditure. 1.Salary of whole-time woman assistant—actual saving £150. 2.Salary of Dentist on one session each week 50 3.Salary of clerical assistant. Moiety 75 4.Maintenance of Cherington Road Welfare Centre:— Rent Moiety £100 Rates, Taxes and Insurance „ 35 Fuel and Lighting „ 40 Caretaking and Maintenance ,, 60 Telephone Rental „ 6 - 241 5.Maintenance of Aberdeen House Welfare Centre 26 6.Contribution to District Nursing Association 75 7 Extension of certain services to Hanwell and Greenford:— Maternity Hospital (Greenford) 15 Maternity Aid, Home Helps amd Consultant Aid (Hanwell and Greenford) 25 Orthopaedic Treatment of Children (Hanwell and Greenford) 25 Milk for Necessitous Mothers and Children (Greenford) 10 £542 — 46 — " Recommendations. 1. That a Maternity and Child Welfare Centre, associated with a School Clinic, be established and equipped at Cherington Road at an estimated cost to the Committee of £175. 2. That a Maternity and Child Welfare Centre be established at Aberdeen House. 3. That a Woman Assistant Medical Officer be appointed jointly by the Maternity and Child Welfare Committee and the Education Committee at a salary of £600 per annum. 4. That if a whole-time School Dentist is appointed by the Education Committee, arrangements should be entered into by which he should devote one session each week to expectant and nursing mothers and children under 5 years of age. 5. That if the Ealing and Hanwell Nursing Associations gamate an additional contribution of £75 be made to the funds in return for services rendered by the District Nurses. 6. That authority be given for the appointment of a Health Visitor to take the place of Miss Williams on the 31st March, 1927. "THOMAS ORR, "Medical Officer. "26th October, 1926. "Addendum. "Since the above report was presented at the last meeting, I have inspected the Village Hall, Greenford, which was suggested as a suitable place for a Welfare Centre. I am, however, not prepared to recommend its use for this purpose. I have also further considered Aberdeen House with a view to getting two rooms instead of one, and I am pleased to report that I have been successful in making arrangements by which two very comfortable and very suitable rooms at Aberdeen House can be placed at the Committee's disposal and by which caretaking and attendance can be obtained on the very reasonable terms of 7s. 6d. per week. "29th November, 1926." 47 The following is a Summary of the Work of the Health Visitors during the year:— Visits to children under 12 months : First Visits 1,092 Return Visits 2,659 Visits to children 1 to 5 years of age 4,249 Visits to expectant mothers 511 Visits to children or mothers attending the Welfare Centres 1,545 Visits to investigate infant deaths and still-births 71 Special visits or investigations 584 Visits to cases of Ophthalmia Neonatorum 15 Visits to cases of Puerperal Fever 3 Visits to cases of Measles and Whooping Cough 622 Visits to cases of Scarlet Fever on discharge from the Isolation Hospital 143 Other Visits 659 Total Visits 12,153 Interviews, etc. 3,352 The following is a Summary of the Work of the Welfare Centres during the year. Number of children on register at the end of year 2,185 Mothers visiting Centre for the first time 985 Children visiting Centre for the first time 1,011 Total attendances made by mothers 11,311 Total attendances made by children 12,498 Average attendance of children each afternoon 48 Number of Consultations by Medical Officer 3,613 Average number of children seen by Medical Officer each afternoon 14 Children referred to School Clinic for treatment: Nose and Throat 3 Eyes 7 Teeth 14 Orthopaedic 2 Mothers referred for dental treatment 18 Mothers supplied with artificial dentures 9 — 43 — Children referred to King Edward Hospital for minor operations 22 Children admitted to King Edward Hospital as indoor patients 1 Children referred to other Hospitals 151 Mothers attending Ante-Natal Clinic: First Visits 301 Re-visits 94 Number of Consultations by Consultant at Centre. 323 Mothers referred to Hospital 20 Aid provided for mothers at confinement: Consultant aid—cases 5 Medical aid—cases 3 Midwives—cases 23 Home Helps—cases 20 Dried Milk supplied at cost price Value £861 3 10 Virol supplied at cost £106 7 0 Cod Liver Oil supplied at cost price „ £163 6 9 Number of Maternity Cases admitted to the Chiswick and Ealing Maternity Hospital 176 Amount received for Treatment at Maternity Hospital £963 9 6 Expectant or Nursing Mothers receiving a supply of milk free of charge for one month 704 Children under 5 years of age receiving a supply of milk free of charge for one month 717 Day Nursery Whole day attendances 3,724 Half day attendances 237 Amount received from Parents £218 4 4 Thanks must be accorded to the Voluntary Committee of ladies who have assisted at the Hanwell Welfare Centre, to Mrs. Cocker who has assisted at the Mattock Lane Centre in giving the mothers instruction in the making of suitable garments and to the Welfare Working Party who, under the leadership of Mrs. Kimmitt, have done excellent work in making children's garments to sell to the mothers at cost price or to distribute free to those who are in necessitous circumstances. Borough of Ealing EDUCATION COMMITTEE. REPORT OF THE School Medical Officer FOR THE Year ended 31st December, 1926. Town Hall, Ealing, W.5. 23rd June, 1927. To the Education Committee. Mr. Chairman, Ladies and Gentlemen, I have the honour to submit my annual report on the health of the school children and on the work of the School Medical Department for the past year. The report deals almost entirely with the work in the schools in the area of the Borough previous to the extension on the 1st October, because it was not found possible, before the end of the year, to extend the whole of the scheme of school medical inspection and treatment to the schools in Hanwell and Greenford. An attempt, however, was made to meet the most urgent needs of the children in the added schools by opening temporary School Clinics at Hanwell and Greenford, and the extent of the work carried out at these clinics from the 1st October to the 31st December is recorded in tables which are appended to this report. Your approval of the recommendations contained in the Special Report on the extension of school medical work to the added areas has been followed by the appointment of the new members of the staff, the reorganisation of the work and the opening of the permanent School Clinic at Cherington House, so that at the present date the scheme of medical inspection and treatment is in full operation in the whole area, In presenting this report I wish to take the opportunity of expressing my appreciation of the excellent work performed by Dr. Ellis, the Assistant School Medical Officer. I am, Ladies and Gentlemen, Your obedient Servant, — 51 — EDUCATION GENERAL PURPOSES SUB-COMMITTEE 1925-26. (Which deals with the School Medical Service). Chairman— Councillor G. R. Weeks. Vice¬Chairman— Councillor A. H. Chilton, J.P Alderman H Armriding. •Councillor W. J. S. Cox. .Councillor J. C. Fuller. Councillor H. M. Sayers. Councillor W. J. Sturgess. Councillor W. T. White. Miss F. M. Coombe. Miss A. D. Hawkin. Miss C. G. Wilson, L.L.A. Mr. M. C. Hulbert, J.P. Mr. F. L. Jermyn. Mr. L. Marsh, M.A. Rev. C. J. Sharp, M.A. STAFF. School Medical Officer— Thomas Orr, M.D., D.Sc., Of the Middle Temple, Barrister-at-Law Assistant School Medical Officer and School Oculist— Harold Ellis, M.B., B.S., M.R.C.S., L.R.C.P., D.P.H. School Nurses— *†‡ Hilda Bailey (Senior). *‡ Annie Johnson. *Mary McGann. *† May P. Dorkins (taken over from Middx. County Council on 1st October, 1926). Clerks— † Mercie Richardson. Grace Such. Winifred Rivers (appointed after being taken over from Hanwell U.D.C. on 1st October, 1926). 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.). L Cohen, L.D.S., R.C.S. (Eng.). School Clinics. 13, Mattock Lane, Ealing, W.5. Cherington House, Hanwell, W.7. Betham's School, Greenford (temporary) * Certificate as Trained Nurse. † Certificate of Royal Sanitary Institute, School Nurse and Health Visitor. ‡ Certificate of Central Midwives Board. - 53 — CO-ORDINATION. In previous reports attention has been called to the close co-operation between the Maternity and Child Welfare Staff and the School Medical Service and to the more or less complete coordination of the work of these departments. This co-ordination will be still further developed and made more complete by the appointment, which has been decided upon, of a whole-time Woman Assistant Medical Officer, who will devote all her time to Maternity and Child Welfare and School Medical work. In the Hanwell area the utilisation of Cherington House as a combined Maternity and Child Welfare Centre and School Clinic, which was decided upon by the Town Council in November, will facilitate the co-ordination of the whole of the work in the areas of Hanwell and Greenford, which were added to the Borough on the 1st October THE SCHOOL MEDICAL SERVICE IN RELATION TO PUBLIC HEALTH. School Hygiene. Up to the end of September the Education Committee had under its control twelve public elementary schools, embracing 24 departments: seven for boys, seven for girls, seven for infants, one for boys and girls, one for girls and infants, and one for junior boys and girls. On the 1st October, when Hanwell and Greenford were included in the Borough, six schools were added, embracing ten departments : one for boys, one for girls, three for senior mixed and infants, one for senior mixed, one for junior mixed, one for junior mixed and infants, and two for infants. The new block at the Grange School for junior mixed and infants is nearing completion and should be opened shortly. The improvement of St. Saviour's School, amounting to almost complete reconstruction, is nearing completion and should provide the Committee with a well equipped school. The opening of the new block at the Grange School will bring about the closure of the Good Shepherd Temporary School for infants. — 54 — A new school is required for the added area of Greenford, the present school being quite inadequate to deal with the children seeking admission, who have to be accommodated for the time being in the Village Hall. The site has been selected and building operations, it is hoped, will begin at an early date. Medical Inspection. Medical inspection was carried out at all the schools in the old Borough. Medical inspection in the schools in Hanwell and. Greenford, which had not been completed for the year by the Middlesex County Council, could not be undertaken on account of the lack of sufficient staff. The inspections carried out at the schools in the Borough embraced the following groups:— 1. Routine Inspection as required by the Board of Education as follows:— (a) Entrants.—All children admitted'tcr school during the year. (b) Intermediates—All children eight years of age or reaching that age before the end of the year. (c) Leavers—Children who are twelve or who will be twelve before the end of the year, together with those over that age not previously examined. 2. Non-routine inspections as follows :— (a) Children not in the aforementioned routine groups who are presented by the head-teachers for examination for some defect or suspected defect. (b) Children requiring supervision on account of some defect found at a previous routine or non-routine examination. — 55 — 3. Annual Inspections at the schools or at the School Clinic of:— (a) Physically defective or crippled children. (b) Mentally defective children. The following tables show the total number of children medically inspected in a routine manner. It will be seen that there were 812 entrants, 546 intermediates and 456 leavers, making the total routine inspections 1,814, or 28.3 percent, of the children on the school registers before the extension of the area on the 1st October. Number of Children Inspected. School Entrants Total Boys Girls Provided. Drayton 56 46 102 Lammas 69 73 142 Little Ealing 77 52 129 Northfields 77 67 144 North Ealing 43 34 77 Good Shepherd Hall (temporary) 11 18 29 Non-provided. St. Saviour's 51 50 101 St. John's 40 42 82 St. Mary's 3 3 6 Total 427 385 812 — 56 — Number of Children Inspected. School. Intermediate Leavers Boys Girls Total Boys Girls Total Provided. Drayton 40 45 85 28 25 53 Grange 15 13 28 7 10 17 Lammas 44 43 87 — 1 — . Ealing Central — - - 51 29 80 Little Ealing 39 42 81 36 23 59 North Ealing 30 28 58 19 17 36 Northfields 45 32 77 60 58 118 Good Shepherd Hall (temporary) 10 4 14 - — Non-¬Provided Christ Church 22 32 54 24 1 25 St. John's 20 26 46 13 30 43 St. Mary's 7 9 16 3 22 25 Total 272 274 546 241 215 456 The non-routine inspections consisted of 408 children who were re-examined on account of some dcfect previously found, and five children who were submitted by the head-teachers for examination at school on account of some defect or suspected defect. At the School Clinic there were examined 1,229 children who had been referred by the head-teachers, school enquiry officers, and the school nurses for examination : of this number 550 children attended for further examination. The total number of children attending public elementary schools who were examined or re-examined during the year was 4,006. On the School Registers before the 1st October, the number of children was 6,396. The average number in attendance was 5,608, so that the average attendance was 87.6 per cent. Taking the number of children medically examined as 4,006, it means that 62.6 per cent, of the children on the registers were medically examined during the year. The attendance of parents at the routine inspections was good. As many as 73.4 per cent, of all the inspected children were accompanied by at least one parent.! 57 Findings of School Medical Inspection. Review of the Facts Disclosed. In Table II are to be found the defects noted on inspection at the schools during routine medical examination and at the School Clinic. Among 1,814 routine children examined there were 827 defects requiring treatment and 176 requiring to be kept under observation without treatment; and among 1,234 children specially examined there were found 1,046 defects requiring treatment and 73 requiring to be kept under observation. Hence, out of a total of 4,006 children there were altogether 1,873 defects requiring treatment and 149 requiring observation. Of the 1,814 children examined at the routine inspections 368, or 20.2 percent., were found to require treatment for defective conditions other than uncleanliness and dental disease. (a) Uncleanliness.—As in previous years the heads of all the girls attending elementary schools were inspected after the usual school holidays, three times a year, to ascertain their condition as regards cleanliness. Of 9.826 children examined, 209, or 2.1 percent., were excluded on account of verminous condition. There were also 17 other children who were excluded for verminous condition found at the routine medical inspection held in the schools, and 55 found at the School Clinic on being referred for examination by the head-teachers. During the year seven summonses were issued under the School Attendance Byelaws when children so excluded were not cleansed within fourteen days. A fine of 20s. was imposed by the Magistrates in one case, 10s. in another and 5s. in four cases, and one case was dismissed. The last case had been cleansed since the issue of the summons The following table shows the continued improvement in the cleanliness of the children in the last three years, no doubt as a result of the constant vigilance exercised by the School Nurses;— — 58 — (b) Minor Ailments—The minor ailments found at routine and non-routine inspections were as follows Ringworm of Head 17 Ringworm of Body 13 Scabies 3 Impetigo 246 Minor Injuries 25 Other Skin Diseases 169 Ear Disease (including Otorrhoea) 56 Eye Disease (including Blepharitis and Conjunctivitis) 65 Total 594 (c) Enlarged Tonsils and Adenoids—At the routine inspection 34 children were found with enlarged tonsils, two with adenoids, 13 with enlarged tonsils and adenoids and six with other conditions of the nose or throat of such a degree as to demand treatment. Forty-two children were found with these conditions of such a mild character as to require to be kept under observation only. In addition, 26 cases of enlarged tonsils, 15 cases of adenoids, seven of enlarged tonsils and adenoids and four of other diseases requiring treatment, and 17 cases of these conditions requiring to be kept under observation were found at the School Clinic, where they had been submitted for special examination at the instance of the teachers or school nurses. Year Number of Children Examined for Verminous Condition Number of Children Excluded Percentage Summons Issued 1923 8,247 418 5.0 33 1924 9,591 329 3.4 2 1925 9,387 245 2.6 1 1926 9,826 209 2.1 7 59 (d) Tuberculosis—One definite, and four suspected cases of pulmonary tuberculosis requiring treatment were found on routine inspection; five suspected cases of tuberculosis requiring to be kept under observation were discovered as the result of inspection at the School Clinic. In addition, three cases of glandular tuberculosis requiring treatment were seen at the School Clinic. (e) Diseases of the Skin—At the routine inspection there were found 8 cases of impetigo and 20 of other conditions of the skin. The cases met with at the School Clinic, to which they had been specially referred for examination, were as follows:— Ringworm of Head 17 Ringworm of Body 12 Scabies 3 Impetigo 238 Other conditions 150 Total 420 (f) External Eye Disease—Eight cases of blepharitis, one of conjunctivitis, 29 of squint and one suffering from another condition of the eye were observed on routine inspection ; and twelve cases of blepharitis, 25 of conjunctivitis, 18 of squint and 19 of other conditions were found in children referred to the School Clinic. (g) Defective Vision—During routine inspection 98 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 86 cases of the same character were likewise referred for a similar examination. (h) Ear Disease and Defective Hearing—Eight cases of defective hearing and sixteen of otitis media were found in the course of routine medical inspection. At the School Clinic two cases of defective hearing, 25 of otitis media and five of other conditions were met with. 60 (i) Dental Defects—The first table which follows classifies the dental defects found at the routine medical inspection. In this table it will be seen that of the entrants 35.5 percent, had sound teeth, of the intermediate group 39.0 per cent., and of the leavers 64.2 had sound teeth. In the second table the percentages of children with sound teeth in the three groups are compared with those found in previous years. It is seen that there has been a decided deterioration in the condition of the teeth in the last three years. The cause of this deterioration is under investigation. There appears, however, need for propaganda amongst the children and especially amongst the parents. This will be carried out by means of lectures or addresses given by the wholetime School Dentist, who has been recently appointed, and by leaflets. Dental Inspection, 1926. Entrants Intermediates Leavers Total All teeth sound : No. of Children 289 213 293 795 Percentage 35.6 39.0 64.3 43.8 Less than 4 teeth decayed: No. of Children 243 203 144 590 Percentage 29.9 37.1 31.5 32.5 Four and more than 4 teeth decayed: No. of Children 280 130 19 429 Percentage 34.4 23.8 4.1 23 6 61 Dental Inspection, 1915 to 1926. Year Entrants Percentage with sound Teeth Intermediate Group Percentage with sound Teeth Leavers Percentage with sound Teeth Total 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 1925 47.8 44.3 74.0 53.4 1926 35.5 39.0 64.2 43.8 (j) Crippling Defects—At the end of the year there were 57 school children classified as suffering from some form of crippling. Three of these were in Special Residential Schools and 54 were attending elementary schools. There were no cases kept at home. Particular care is taken to make this list a complete one so as to keep the children under supervision and to supply treatment for them through the Orthopaedic Scheme. In ascertaining these children, the teachers, school attendance officers, and the Child Welfare Department give assistance by furnishing early information of any crippled children coming under their notice. All crippled children are examined at least once a year to determine their exact physical condition, in order that treatment or special exercises may be recommended or provided. 62 INFECTIOUS DISEASE Through the returns of cases of non-notifiable infectious disease, furnished weekly by the head-teachers, it was ascertained that during the year the number of children absent from school as actual cases of, or contacts with, non-notifiable infectious disease were 826 due to measles, 65 to whooping cough, 446 to chicken pox and 70 due to mumps. As children under school age are usually affected with measles and whooping cough in the homes from which notifications are made, the Health Visitors undertake the visiting of the homes and giving of advice. All the houses affected by these notifications were duly visited, There was no occasion during the year to give a certificate that the reduction of attendance below 60 per cent, in any school was due to the prevalence of infectious disease. Children to the number of 291 were excluded during the year under Article 53 of the Education Code for the following conditions : Conjunctivitis 10 Impetigo 246 Ringworm of the Head 17 Ringworm of the Body 3 Scabies 3 Other Skin Diseases 12 Total 291 In the course of routine and non-routine medical inspection of the children considerable use is made of the facilities offered by the Public Health Laboratory. Specimens of hairs are examined for ringworm and swabs are taken from all sore throats and suspicious conditions of the nose and of the ear and submitted for bacteriological examination for the bacillus of diphtheria. Children are excluded from school, when it is deemed desirable, until the bacteriological report is available. 63 FOLLOWING-UP. Special lists are made of all children requiring treatment for defects of the teeth, eyes, nose and throat, which can be provided at the School Clinic. All these cases are visited at once by the School Nurses who advise the parents to obtain treatment, and put those who cannot afford treatment by a private doctor in the way of securing it at the School Clinic. All other cases, in which treatment is advisable or in which observation is required, are visited in rotation by the School Nurses, who advise parents to obtain treatment or give directions regarding the hygienic supervision already advised by the Medical Officer at the inspection. During the year the School Nurses made 1,548 visits to the homes regarding defective children. MEDICAL TREATMENT. (a) Minor Ailments.—In Table IV are tabulated the number and the nature of the minor ailments which received treatment during the year. It will be noted that 483 of the children suffering from minor ailments, or 81.3 per cent., were treated at the School Clinic, and 111, or 18.6 per cent., by private practitioners or at hospitals. The total attendances at the School Clinic for the daily treatment of minor ailments were as follows Ear Cases 1,230 Eye Cases 1,221 Ringworm 180 Impetigo 3,863 Scabies 9 Others 1,982 Total 8,485 (b) Tonsils and Adenoids.—It is indicated in Table IV that 41 cases of enlarged tonsils or adenoids were operated upon at the School Clinic, and that ten cases were dealt with at hospitals or by private practitioners. At the School Clinic there was also treated one case of abnormal nasal condition. 64 (c) Tuberculosis—One school child suffering from active tuberculosis of the lungs and three children with suspected tuberculous glands were admitted to Sanatoria. Nine children suspected of suffering from pulmonary tuberculosis were referred to the Tuberculosis Officer for supervision. (d) Skin Diseases—The cases of diseases of the skin which were treated are indicated in Table IV where it is seen that of 473 children referred for treatment 402 were treated at the Clinic and 71 otherwise. During the year 17 cases of ringworm of the head occurred These were all treated and cured by means of X-rays by Dr. Arthur. There were 246 cases of impetigo, of which 220 were treated at the School Clinic. During the year only three cases of scabies were found. These were treated at the School Clinic. (e) External Eye Disease—The children referred for external eye disease numbered 65, of whom 39 were treated at the School Clinic. The diseases included 20 cases of blepharitis, 26 of conjunctivitis and 19 other conditions. (f) Defective Vision—Daring the year 231 children were referred for the testing of refraction. The School Oculist examined 206 children with errors of refraction and twenty were examined by private practitioners or at hospitals and five were dealt with otherwise. Glasses were prescribed and supplied in all the 206 cases attending the Clinic. Forty-eeven cases of squint came under observation. (g) Ear Disease and Hearing—Of 56 cases which received treatment, 42 were treated at the School Clinic. Forty-seven were cases of otorrhoea. (h) Dental Defects.—Table IV, Group IV, shows that 5,457 children, or a total of 85 percent, of those on the school register, were dentally inspected during the year. Of these, 3,158 were found to require treatment and 1,383 were treated at the School Clinic, 705 receiving further treatment during the year. The extractions numbered 522 permanent, and 2,209 temporary teeth. For the' purpose of these extractions gas was administered on 45 occasions. — 65 — Fillings were applied to 1,605 permanent teeth. Five cases of dental deformity were referred to the Royal Dental Hospital for special treatment. (i) Crippling Defects and Orthopaedics—The scheme of orthopaedic treatment, which was inaugurated in 1925, came into full operation in 1926. There are 57 on the list of crippled school children between the ages of 5 and 14 years, 28 of whom are boys and 29 girls. Three boys are maintained in Special Residential Schools and the remaining 54 attend public elementary schools. Of these 54 children 45 have been examined by the Orthopaedic Surgeon at the School Clinic and have been advised appropriate treatment. Two children were admitted to the National Orthopaedic Hospital at Stanmore for operative treatment and 26 attended for treatment by means of massage at the School Clinic. During the year the attendances for treatment by massage totalled 153. Special boots or orthopaedic apparatus were provided for six cases. The scheme has been a great success. It has proved of great benefit to the children who are kept under careful supervision and are given appropriate treatment either by operation or manipulation and who are able to attend school and continue their education most of the time they are being cared for physically ; it has saved a large expense to the parents, who in most cases cannot afford to pay much towards the cost, and time and trouble to the mother who usually accepts the duty of taking the children to a hospital in town; and it has been of value to the Committee who have reaped a financial return owing to the improved attendance of the children at school. The success of the scheme can be gauged to some extent by the fact that of the 54 crippled children attending elementary schools 45 are receiving treatment under it. The parents of the remaining nine children have preferred to continue to take their children to other hospitals in London. (j) Heart Disease—Particular attention has recently been very properly drawn by many observers to the amount of permanent disability caused by heart disease which in the vast majority of cases is due to rheumatism. Special reports have been published on the subject, particular attention being devoted to the need for PUBLIC EALING LIBRARY 66 the prevention of rheumatism. Unfortunately, the immediate exciting cause of this disease has not been definitely determined so that our efforts must be directed to the avoidance of what may be predisposing causes and to the building up of the general health of those children who may, as indicated by a family history of the disease, be susceptible. School children suffering from heart disease are examined at least once a year to determine their condition and to enable suitable treatment to be advised. Fifty-seven such children were examined during the year and in 18 of these medical treatment was advised. Particular instructions are issued to head-teachers regarding the care and supervision of each individual case of organic disease of the heart. Twenty-three cases of functional disease of the heart were also kept under supervision during the year. (k) Payments for Treatment.—The following amounts have been received during the year for the treatment of children at the School Clinic :— £ 9. d. Dental Treatment 52 13 0 Throat Operations 13 6 0 Spectacles 50 10 0 X-Ray Treatment for Ringworm of Head 3 6 6 Treatment at the Royal Dental Hospital 1 4 6 Orthopaedic Treatment at Stanmore 2 2 6 Massage Treatment 1 16 0 Other Payments from Maternity and Child Welfare Committee, etc. 14 14 0 Total £139 12 6 OPEN-AIR EDUCATION. As noted in the Annual Report for the previous year playground classes are being developed as far as possible in most of the schools and even encouragement is offered for their development. 67 At the Grange School, which is built in such a way that by opening up the South side, consisting of movable glass and wood partitions, the classrooms can be made practically into open-air classrooms, greater use might be made of the facilities offered. Every effort should be made by the teachers to obtain the maximum advantage from this arrangement which can be utilised in such a way as materially to benefit their own and the children's health PHYSICAL TRAINING. No Organiser of Physical Exercises has been appointed. Active steps, however, were taken during the year to develop organised games in connection with all the schools. Pitches have been allotted in the various Public Parks for school children playing cricket, football and netball during school hours PROVISION OF MEALS. No meals are provided for school children under Section 82-85 of the Education Act. It is very rare for children, who have not been sufficiently fed, to present themselves at school but when children are discovered who are in need of food this is provided by the head-teachers out of small funds placed at their disposal by voluntary means. The food supplied usually takes the form of milk or cocoa and milk and biscuits. SCHOOL BATHS. Baths are not provided at the schools excepting at Greenford Avenue, which was taken over with other schools in Hanwell on the 1st October. At the Public Baths, however, one swimming bath is reserved exclusively for school children, in whose physical training instruction in swimming by skilled teachers is included. So great has been the demand for the use of this bath that another bath has also been requisitioned on certain days of the week for school children. — 68 — CO-OPERATION OF PARENTS. The parents continue to take an active interest in the medical inspection and treatment of the children. The percentage of parents present at the inspections is high, namely 73.4. CO-OPERATION OF TEACHERS. Too much stress cannot be placed on the importance of the active co-operation of the teachers in school medical work and it is a source of gratification that the teachers in this area show a sustained and active interest in this part of Public Health work. In many ways teachers can be of valuable assistance, such as conveying information regarding the admission of mentally and physically defective children, the notification of suspected cases of infectious disease and in calling attention to children whose physical conditior, or state of health, is below normal. They are also of great assistance not only in stimulating the parents to obtain treatment for defective children found at medical inspection but in fostering the interest of the parents in the physical wellbeing of their children. CO-OPERATION OF SCHOOL ATTENDANCE OFFICERS. The School Attendance or Enquiry Officers continue to give the same valuable assistance which has been noted in previous years. They act in intimate co-operation with the School Medical Staff, to whom they supply valuable information and from whom they obtain much real help in their school attendance work. Both the School Enquiry Officers fully recognise how closely associated school medical and school attendance work must be if success is to be achieved in both. CO-OPERATION OF VOLUNTARY BODIES. The supervision of defective children is carried out in a routine manner by the whole-time School Nurses with some assistance given by the Head-teachers and School Enquiry Officers, but there are certain ways in which help is obtained from voluntary bodies. The Central Aid Society gives assistance in obtaining Hospital and Convalescent Home treatment for anaemic or badly nourished children, the National Society for the Prevention of Cruelty to Children in bringing pressure to bear on neglectful parents, the School Attendance Aid Committee in providing boots for the children — 69 — of necessitous parents and the Middlesex King Edward Memorial Committee in giving holidays, at their Holiday Home at Heme Bay, for anaemic or badly nourished children. NURSERY SCHOOLS. There are no Nursery Schools in the district, but children between 4 and 5 years of age are admitted to the Infants' Departments whenever, in the opinion of the School Attendance Committee, it is considered advisable that the children should be cared for in school when they cannot be properly cared for at home on account of the mother having to go out to work or on account of some other circumstance preventing proper care at home during ordinary school hours. Comparatively few married women are engaged in regular employment in the Borough and consequently there has not been much demand for Nursery Schools. SECONDARY SCHOOLS. There are two Secondary Schools in Ealing provided by the Middlesex Education Committee, one for boys and one for girls the latter having been opened in February, 1926. Medical Inspection is carried out for this Committee by the Ealing school medical staff. BLIND, DEAF, DEFECTIVE AND EPILEPTIC CHILDREN. The School Enquiry Officers report to the School Medical department all children of school age who are blind, deaf, defective or epileptic and not in attendance at any school; the head-teachers similarly report at once defective children admitted to school and the staff of the Maternity and Child Welfare Centre pass on the records of all defective children on reaching the age of five years, In these ways a fairly complete list of specially defective children is kept. Blind and deaf children, when discovered, are immediately sent to Special Residential Schools. Two blind girls and five blind boys are being maintained by the Local Education Authority at Certified Schools for the Blind. Six boys and four girls, who are considered partially blind from high myopia, attend public elementary schools under special supervision, special instructions being given to the teachers regarding the restricted use of their eyes. They are examined by the Oculist at regular intervals. — 70 — Nine deaf mutes, two boys and seven girls, are maintained at Special Schools. At schools in the old Borough of Ealing there were twenty-one feeble-minded children attending public elementary schools and two were kept at home. Nine children, five girls and four boys, were maintained at Residential Schools. When the boundaries of the Borough were extended to include Hanwell and Greenford, this list of feeble-minded children was increased by seven feebleminded children attending school, two children who were at home and six who were maintained at Special Residential Schools. The question of providing special education for feeble-minded children still attending the public elementary schools remains for consideration and solution. During the year no further steps were taken by the Education Committee in considering this question. EMPLOYMENT OF CHILDREN AND YOUNG PERSONS. The number of boys and girls employed out of school hours in accordance with the Byelaws with respect to the Employment of Children is given in the following list, together with the nature of the employment. Boys. Girls. Errands 102 Errands 5 Milk Round 19 Nurse Maid 1 Newspaper Round 20 House Work 4 House Work 3 Shop Assistant 1 Delivering Washing 2 Baker's Round 25 Helps Caretaker 1 Helps Chemist 1 Delivering Coal 3 Window Cleaning 1 Total 177 11 All these children were medically inspected during the year and fourteen were found to be in such a condition of health that their employment was discontinued. — 71 — Twenty-nine or the above-mentioned. children were round. to be employed without being registered under the Byelaws. A warning was given by the Inspector to the parents and to the employers of these children. Information is given in a routine way to the Juvenile Employment Committee regarding the health of children who come within their province. Records are given to the Committee of the previous medical history of such children and advice is given in certain cases regarding their suitability for particular occupations. MISCELLANEOUS. Under this heading are noted all examinations carried out at the School Clinic. At the School Clinic are examined all children referred by the Education Committee, Head-teachers and School Enquiry Officers, and also teachers newly appointed by the various Education Sub-Committees or School Managers. Children can be submitted for examination at the School Clinic on each School day at 10 o'clock. Those usually submitted are children suspected of having verminous heads or bodies, or having ringworm, scabies, or impetigo, or those whose examination is desirable on account of some defect or suspected defect, such as defective eyesight, disease of the eye, ear, nose and throat, which may require treatment. In fact, any defective child not under medical care may be submitted by the head-teachers for examination. The examinations carried out during the year may be summarised as follows:- Verminous children 687 Impetigo 545 Scabies 7 Ringworm 79 Teachers 14 Children for Holiday Home, King Edward Memorial Scheme 6 Miscellaneous 1,172 Total 2,510 — 72 — SPECIAL REPORTS. When the Borough boundaries were extended on the 1st October of the year under review it became necessary to extend the School Medical Service of the old Borough to the added areas. A Special Report, which is appended, was submitted to the Education Committee for their consideration. The recommendations contained in this Report having been approved by the Committee, steps were taken to bring the recommendations into operation. It was not possible, on account of the lack of staff and office accommodation, to extend the whole scheme to Hanwell and Greenford before the end of the year. Medical inspection could not be carried out in the newly added schools but temporary School Clinics were opened, one at the old Council Offices, Hanwell, for the Hanwell schools, and one at Betham's School, Greenford, for children from Greenford. At these temporary Clinics children were examined and treatment was given as far as practicable. The extent of the examinations made at these Clinics is indicated in tables which are appended. Report on School Medical Inspection and Treatment in the extended Borough. "The whole of the school medical work in the added areas has been brought into line with that in operation in the Borough previous to the extension of the boundaries School medical inspection and treatment in Hanwell and Greenford were carried out by the Middlesex County Council and in merging these in the Borough scheme a complete reorganisation has to be effected. The extent of the work in the added areas may be gauged by considering the new school population, "The schools in the area of the old Borough had on their rolls on the 29th October of this year 6,478 children, those in Hanwell on the same date 2,775 children and Betham's School in Greenford 230 children. Thus, in the extended Borough there is an increase in the school population of 46 per cent. In this connection it is interesting to note that the increase in the total population by the extension of the boundaries is 33 per cent. — 73 — "School Clinics.-The Borough has been mapped out into three areas to be served by three School Clinics, one as already established at 13, Mattock Lane, one recommended at Cherington Road (lately the Hanwell Council Offices), and one at Betham's School. "The School Clinic at Cherington Road would be associated with a Maternity and Child Welfare Centre as at Mattock Lane. The ground floor would be devoted to school medical work and the first floor to maternity and child welfare work. "On the ground floor the hall should be widened out by removing the wooden partition on the left side to give more space and light. One room on the right with the enquiry counter attached would be occupied by staff from the Borough Surveyor's and the Borough Treasurer's Department. Two rooms on the right side would form the dentist's room and waiting room and two rooms on the left side would be for the school nurse and the medical officer, the hall serving as a waiting-room. "The present lavatory accommodation would be reserved for the staff. On the right side of the entrance hall separate lavatory accommodation should be provided for mothers and for school children. Further, wash-hand basins would be necessary for the medical officer's and dentist's rooms. The Borough Surveyor has estimated the cost of the alterations at £350, half of which would be met by the Maternity and Child Welfare Committee. "The equipment required includes a dental chair, instrument table, special lamp, dental cupboard and dental machine for the dentist's room. The floors of three of the rooms would have to be laid with linoleum. There is at present in the building sufficient furniture, tables and chairs, to meet all needs. The cost of equipment, which is chiefly dental apparatus and linoleum, I estimate at £130. "As the School Clinic established at St. Mark's School by the County Council was found to be not only inadequate in arrangement but very inconvenient in position to serve the schools, after consultation with the Chairman, I opened a temporary School Clinic at Cherington Road on the 8th October. At the same time I circularised all the head-teachers giving instructions as to the new — 74 — procedure in submitting children for examination. This Clinic is open on three mornings each week, Monday, Wednesday and Friday, the Medical Officer being in attendance on Wednesday. Here all cases requiring treatment for minor ailments are dealt with but ophthalmic cases, children requiring operative treatment for tonsils and adenoids, and urgent dental cases are, for the present, referred to the Mattock Lane Clinic. "When the Cherington Road Clinic has been fully equipped in a permanent fashion it is hoped to deal with all dental and ophthalmic cases there. "A Clinic has been opened at Betham's School to serve the needs of the Greenford area. The nurse attends here on Tuesday mornings and later it is hoped that the medical officer will also attend on the same day. Only minor ailments are treated, ophthalmic, throat and dental cases being referred to the Mattock Lane Clinic. The head-master of Betham's School has very kindly placed the teachers' room at my disposal for the purpose of this Clinic. "This is but a temporary arrangement and the need for a permanent School Clinic associated with a Maternity and Child Welfare Cencre for this area will have to be considered in the near future. I recommend that in the consideration of a site for a new school a site for the School Clinic and Child Welfare Centre should be kept in mind. The building of a School Clinic might very conveniently be undertaken at the same time as the new school, especially as the factors determining the need and position of a new school apply equally to the School Clinic and Child Welfare Centre. "Medicai, Staff.-The Medical work amongst the new school population of 3,005 children in the two added areas will necessitate an addition to the permanent medical staff. This addition should consist of a woman assistant medical officer whose duties would be partly concerned with school medical inspection and partly with Maternity and Child Welfare work, the Education Committee and the Maternity and Child Welfare Committee being responsible for her salary in equal parts. This woman assistant would replace one part-time officer doing school medical work costing £30 per annum. If she acts as Resident at the Maternity Hospital, as is quite possible, a contribution of £150 would be obtained towards her salary, half of which would be credited to the Education - 75 - mittee. A woman assistant medical officer can be obtained for £600 per annum so that the nett additional cost to the Education Committee of this whole-time officer, who could give additional days at the Cherington Road and Greenford Clinics and perform all the medical inspection at the Hanwell and Greenford schools, would be £195. Although the Education Committee would have to make this amount of contribution towards the assistant's salary, the nett cost to the ratepayers would be only £73 10s. Od. per annum owing to the displacement of part-time officers employed by the Maternity and Child Welfare Committee which would have its medical costs lowered "School Nurses.-The school population in the added areas is somewhat large to be dealt with by one School Nurse. The difficulty is that there is too much work for one nurse and not enough to justify the appointment of another nurse. Nevertheless, with the concentration of some of the special work, such as operations for enlarged tonsils and adenoids and refractive examination of the eyes, at the Mattock Lane Clinic an effort will be made to carry out the school nursing duties for the present with one nurse. "Miss McGann, who has been a school nurse in Ealing since September, 1923, and who is fully conversant with the whole scheme of medical inspection and treatment, has been transferred to the Cherington Road and Betham's School Clinics, and Miss Dorkins, who was taken over from the County Council staff, has been assigned to the Mattock Lane Clinic. "Surgeon and Anaesthetist.—The Surgeon and Anaesthetist would continue as before to carry out operations for enlarged tonsils and adenoids at Mattock Lane. Cases from the whole of the Borough would be dealt with there. For children coming from the outlying parts of the Borough the ambulance would be available after operative treatment. "School Dentists.—The two part-time school dentists should be replaced by a whole-time officer devoting all his time to the duties. The part-time dentists in Ealing have devoted five sessions each week to the dental treatment of school children. At least three more sessions will be required for school children in the added areas and one session for expectant and nursing mothers and children under five years of age, the cost of the last session being met by - 76 - the Maternity and Child Welfare Committee. Last year the cost of the five sessions including extra days for the two part-time officers, was £406 15s. Od. A whole-time dentist can be obtained at the minimum salary of £500, so it is quite apparent that there will be a great financial advantage in having a whole-time officer capable of giving ten sessions a week to the work instead of extending the sessions of part-time officers whose remuneration is at the rate of £75 per session per annum. "Clerical Staff.-On the occasion of the transfer of officers on the 1st October, Miss Rivers, who was formerly typist and clerical assistant to the Clerk of the Hanwell Urban District Council, was assigned to my department to perform duties connected with school medical and maternity and child welfare work. At the end of this month she will go to the Mattock Lane School Clinic and Wclfaie Centre for experience of both classes of work, and will later take up her duties at the Cherington Road Clinic and Welfare Centre, half of her time being devoted to school medical and half to maternity and child welfare work, her salary being paid in equal proportions by the Education Committee and Maternity and Child Welfare Committee. - 77 - "Cost of Extending School Medical Services to the Added Areas. "Initial Expenditure. 1. Adaptation of buildings in Cherington Road to form School Clinic and Maternity and Child Welfare Centre. Moiety £175 2. Equipment of Cherington Road Clinic 135 £310 "Annual Expenditure. 1. Salary of Nurse Dorkins transferred from County Council (including cycle allowance, £4) 234 2. Part of salary of whole-time woman assistant medical officer 195 3. Salary of whole-time school dentist (less one session, one-tenth salary paid by the Maternity and Child Welfare Committee) 50 4. Salary of Clerical Assistant. Moiety 75 5. Maintenance of Cherington Road Clinic:— Rent Moiety £100 Rates, Taxes and Insurance ,, 35 Fuel and Lighting „ 40 Caretaking and Maintenance of ,, Buildings 60 Telephone Rental 6 241 6. Cost of other school medical activities in added areas (Hanwell and Greenford) (30 per cent. of cost of same services for Ealing Schools):— Drugs and appliances, including spectacles £30 Printing, Stationery and Postages 36 Treatment of ringworm 8 Treatment of physically defective children 45 Miscellaneous 10 129 Total Annual cost £924 - 78 - "Recommendations. 1. That a School Clinic associated with a Maternity and Child Welfare Centre be established and equipped at Cherington Road at an estimated cost to the Education Committee of £175. 2. That a woman Assistant Medical Officer be appointed jointly by the Education Committee and the Maternity and Child Welfare Committee at a salary of £600 per annum. 3. That a whole-time School Dentist be appointed at a salary of £500 per annum to replace the two part-time dentists. 4. That the building of a permanent School Clinic, associated with a Maternity and Child Welfare Centre, should be considered in connection with the building of a new School in Greenford. THOMAS ORR, . School Medical Officer 25th November, 1926 Central LittAAV. - 79 - HANWELL AND GREENFORD. 1st October to 31st December, 1926. Average Average on Register. Attendance. Hanwell Schools 2,784 2,454 Betham's School (Greenford) 231 209 During the three months, 1st October to 31st December, the following work has been carried out at the Cherington Road Clinic and at Betham's School:- Daily Treatments. Number of Attendances for Eye treatment 45 „ „ „ „ Ear treatment 62 „ Impetigo 681 „ Ringworm 45 „ „ „ „ Minor Injuries 162 Other Treatments 458 Total 1,453 Special Examinations. Attendances for Verminous Condition 14 „ „ Impetigo 51 „ „ Ringworm 3 „ Miscellaneous 242 Total 310 - 80 - STATISTICAL TABLES. The Statistical Tables required by the Board of Education are appended Table I. A.-Routine Medical Inspections. Number of Code Group Inspections:— Fntrants 812 Intermediates 546 Leavers 456 Total 1,814 Number of other Routine Inspections B.-Other Inspections. Number of Special Inspections 1,234 Number of Re-Inspections 958 Total 2,192 - 81 - TABLE II. A. RETURN OF DEFECTS FOUND BY MEDICAL INSPECTION IN THE YEAR ENDED 31st DECEMBER, 1926. DISEASE OR DEFECT. Routine inspection No. of Defects. Sdeciai uinsoecuons No. of Defects. Number referred for Treatment. Number required to be kept under observation but not referred for Treatment. Number referred for Treatment. Number required to be kept under observation, but not rererred foi Tfeatment (1) (2) (3) (4) (5) Malnutrition 3 3 - - Uncleanliness, 17 - — — Skin Ringworm, head. - - 17 - „ body 1 - 12 - Scabies - - 3 — Impetigo 8 - 238 — , Other Diseases (non-Tubercular) 19 - 150 — Blepharitis 8 - 12 - Eye Conjunctivitis 1 - 25 - Keratitis - - - - Corneal Opacities - - 1 - Defective Vision 98 2 86 - Squint 29 - 18 - Other Conditions 1 — 18 — Ear Defective Hearing 8 1 2 1 Otitis Media 16 — 25 — Other Ear Diseases - - 5 - Nose and Throat Enlarged Tonsils 34 27 26 - Adenoids 2 - 15 - Enlarged Tonsils and Adenoids 13 3 7 10 Other Conditions 6 12 4 7 Enlarged Cervical Glands (non-Tuberculous) 2 26 8 14 Defective Speech 1 1 1 — TeethHeart and Circulation -Dental Diseases 449 — 13 — Heart Disease:— Organic 12 39 6 - Functional - 19 4 - Anaemia 21 16 6 10 Lungs Bronchitis 13 — 8 6 Other Non-Tubercular Diseases 4 — 3 — Tuberculosis Pulmonary: Definite 1 - - - Suspected 4 — 5 — Non-Pulmonary: Glands - — 3 — Spine - - — — hip - - - - Other Bones and Joints - — - — Other forms - - - - Nervous System Epilepsy 1 - - - Chorea - — 6 — Other Conditions — — — Deformities Rickets - — - 1 Spinal Curvature 12 - 5 - Other Forms 21 12 15 12 Other Diseases and Defects 22 15 152 - Total 827 176 1026 62 -82- B-Number of Individual Children found at Routine Medical Inspection to require Treatment (excluding Uncleanliness and Dental Diseases). Group. (1) Number of Children. Percentage of Children found to require Treatment (4) Inspected. (2) Found to require Treatment. (3) Code Groups:- Entrants 812 165 20.3 Intermediates 546 132 24.1 Leavers 456 71 15.5 Total (Code Groups) 1814 368 20.2 Other Routine Inspections — — — - 83 - Table III RETURN OF ALL EXCEPTIONAL CHILDREN IN THE AREA. Boys Girls Total Blind (including partially blind) (i) Suitable for training in a School or Class for the totally blind. Attending Certified Schools or Classes for the Blind 5 2 7 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 6 4 10 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 9 7 9 Attending Public Elementary Schools - - - At other Institutions - — — At no School or Institution - — — (ii) Suitable for training in a School or Class for the partially deaf. Attending Certified Schools or Classes for the Deaf - - - Attending Public. Elementary Schools - - - At other Institutions - — — At no School or Institution - — — Mentally defective | Feebleminded (cases not notifiable to the Local Control Authority). Attending Certified Schools for Mentally Defective Children 4 5 9 Attending Public Elementary Schools 9 12 21 At other Institutions - - - At no School or Institution 1 1 2 Notified to the Local Control Authority during the year. Feebleminded - Imbeciles — - — Idiots — — — Epileptics Suffering from severe epilepsy. Attending Certified Special Schools for Epileptics - - - 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 2 2 4 At no School or Institution — — — - 84 -  Boys Girls Total Physically Defective Infectious pulmonary . and glandular tuberculosis. At Sanatoria or Sanatorium Schools approved by the Ministry of Health or the Board - - - At other Institutions — - — At no School or Institution — — — Non-infectious but active pulmonary and glandular tuberculosis. At Sanatoria or Sanatorium Schools approved by the Ministry of Health or the Board - - - At Certified Residential OpenAir schools - - - At Certified Day Open-Air Schools - - - At Public Elementary Schools 1 2 3 At other Institutions — - — At no School or Institution - ~-- - 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 115 122 237 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 3 - 3 At Certified Day Cripple Schools. - — - At Public Elementary Schools 25 29 54 At other Institutions — — — At no School or Institution - - - - 85- Table IV. RETURN OF DEFECTS TREATED DURING THE YEAR ENDED 31st December, 1926. TREATMENT TABLE. Group 1.-Minor Ailments (excluding Uncleanliness. for which see Group V.) Disease or Defect. (1) Number of Defects treated, or under treatment during the year. Under the Authority's Scheme. (2) Otherwise (3) Total (4) Skin:— Ringworm—Scalp 17 — 17 Ringworm—Body 7 6 13 Scabies 1 2 3 Impetigo 220 26 246 Other Skin Diseases 5 2 7 Minor Eye Defects (external and other, but excluding cases falling in Group II.) 39 26 65 Minor Ear Defects 42 14 56 Miscellaneous (e.g minor injuries, bruises, sores, chilblains. etc). 152 35 187 Total 483 111 594 - 86 - Group II.—Defective Vision and Squint (excluding Minor Eye Delects treated as Minor Ailments—Group I). Defect or Disease. (1) No. of Defects dealt with. Under the Authority's Scheme. (2) Submitted to refraction by private practitioner or at hospital. apart from the Authority's Scheme. (3) Otherwise. (4) Total. (5) Errors of Refraction (including Squint) (Operations for squint should be recorded separately in the body of the Report) 206 20 5 231 Other Defect or Disease of the Eyes (excluding those recorded in Group 1) - - - - Total 206 20 5 231 Total number of children for whom Spectacles were prescribed:— (а) Under the Authority's Scheme 206 (b) Otherwise 5 Total number of children who obtained or received Spectacles:— (а) Under the Authority's Scheme 206 (b) Otherwise 5 Groap iii.—Treatment of Defects of Nose and Throat. Number of Defects. Received Operative Treatment. Under the Authority's Scheme, in Clinic or Hospital. (1) By Private Practitioner or Hospital, apart from the Authority's Scheme. (2) Total. (3) Received other forms of Treatment. (4) Total number treated. (5) 41 10 5 1 42 - 87- Group IV.—Dental Defects. (1) Number of Children who were:— (a) Inspected by the Dentist: Aged Routine Age Groups 5 469 Total 5.457 6 601 7 434 8 467 9 518 10 623 11 640 12 675 13 612 14 359 15 59 Specials 156 Grand Total 5,613 (b) Found to require treatment 3,158 (c) Actually treated 1,383 (d) Re-treated during the year as the result of periodical examination 705 (2) Half-days devoted to:— Inspection 32 Total 219 Treatment 187 [3) Attendances made by children for treatment 2,088 (4) Fillings:— Permanent teeth 1,605 Total 1,605 Temporary teeth — (5) Extractions:— Permanent teeth 522 Total 2,731 Temporary teeth 2,209 (6) Administrations of general anaesthetics for extractions 554 (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 3 (2) Total number of examinations of children in the Schools by School Nurses 9,826 (3) Number of individual children found unclean 209 (4) Number of children cleansed under arrangements made by the Local Education Authority (5) Number of cases in which legal proceedings were taken:— (a) Under the Education Act. 1921 (b) Under School Attendance Byelaws 7 - 88 - HANWELL AND GREENFORD. Table II. A.—Return of Defects found by Medical Inspection from 1st October to 31st December, 1926. DISEASE OR DEFECT Routine Inspection Special Inspections. No. of Defects No of Deects. Requiring Treatment Requiring to be kept under observation but not requiring Treatment. Requiring Treatment Requiring to be kept under ob. servation but not requiring Treatment, (1) (2) (3) (4) (5) Malnutrition - - 1 1 Uncleanliness - — 11 - (See Table TV, Group V) Ringworm, scalp - - 1 - Skis body — — 2 — Scabies — - — — Impetigo — — 49 — Other Diseases (non-Tuberculous) — — 41 — Eye Blepharitis — — 3 — Conjunctivitis — — 1 — Keratitis - — — - Corneal Opacities Defective Vision (excluding - - - - Squint) - — 19 - Squint - — 13 — Other Conditions - — 1 — Ear Defective Hearing - — — - Otitis Media - — - — (Other Ear Diseases - — 6 2 Nose and Throat Enlarged Tonsils only - — — 1 Adenoids only - — 3 — Enlarged Tonsils and Adenoids - — 2 — Other Conditions — — — — Enlarged Cervical Glands (non-Tuberculous) - - 1 1 Defective Speech - — — 5 Teeth Dental Diseases (See Table IV, Group IV) - — 32 — Heart and Circulation Heart Disease:— Organic - — — 1 Functional - — — 2 Anaemia - — 3 2 Lungs Bronchitis Other Non-Tuberculous Diseases - — — 4 - — — — 1 Pulmonary:— Tuberculosis Definite - — — — Suspected - — — — Non-Pulmonary:— - - - Glands - — — — Spine - — — — Hip - — — — Other Bones and Joints - — - — Skin - — — 1 Other Forms - — - - Nervous System Epilepsy - — — — Chorea - - — — Other Conditions - — — 2 Deformities Rickets Spinal Curvature Other Forms - - - - - - - - - — 2 1 Other Defects and Diseases - — 39 1 Total - — 230 23 -89- HANWELL AND GREENFORD. TABLE IV. Return of Defects Treated from the 1st October to the 31st December, 1926. Treatment Table. Group 1.—Minor Ailments (excluding Uncleanliness, for which see Group V). Disease or Defect (1) Number of Defects treated, or under treatment during the year. Under the Authority's Scheme. (2) Otherwise. (3) Total. (4) Skin:— Ringworm—Scalp - 1 1 Ringworm—Body 2 — 2 Scabies — — — Impetigo 44 5 49 Other Skin Diseases 5 — 5 Minor Eye Defects (external and other, but excluding cases falling in Group II) 3 2 5 Minor Ear Defects 2 4 6 Miscellaneous (e.g., minor injuries, bruises, sores, chilblains. &) 48 - 48 Total 104 12 116