Borough of Ealing. ANNUAL REPORT OF THE Medical Officer of Health AND School Medical Officer 1938 INCLUDING Report on the Isolation and Maternity Hospitals, 1938-39. THOMAS ORR, M.D., D.Sc., Of the Middle Temple, Barrister-at-Law, Medical Officer of Health, School Medical Officer and Medical Superintendent of the Isolation and Maternity Hospitals. Perry & Routleff Ltd., Printers, Ealing and Tjxbridge. CAL z<) Borough of Ealing. ANNUAL REPORT of the Medical Officer of Health and School Medical Officer 193 8 including Report on the Isolation and Maternity Hospitals, 1938-39. THOMAS ORR, M.D., D.Sc., Of tlie Middle Temple, Barrister-at-Law, Medical Officer of Health, School Medical Officer and Medical Superintendent of the Isolation and Maternity Hospitals. Perry & Routleff Ltd., Printers, Ealing and Uxbridge. INDEX. PAGE Ambulances 15 Bed Bugs, Eradication of 35 Births 11 Blind, Deaf, Defective and Epileptic Children 83, 93 Child Life Protection 23 Clinics and Treatment Centres 16 Convalescent Treatment 23, 7 7 Deaths 11 Defects found by Medical Inspection 91 Dental Defects and Treatment 22,67,98 Diphtheria 52 Disinfection 38 Employment of Children and Young Persons 88 Factories and Workshops 38, 39 Health Education 17; 86 Health Visiting 19 Hospitals in the District 17 Housing 42 Infant Deaths 12 Infectious Diseases 49,77 Legal Proceedings 36 Malnutrition 60, 92 Maternal Mortality 14 Maternity and Child Welfare 19 Meat and Other Foods 47 Medical Inspection of School Children 59, 90 Medical Treatment of School Children 63, 98 Midwifery Service 24 Midwives, Supervision of 27 Milk 38, 46, 81 Mortuary 37 Nursery Schools 84 Nursing Arrangements 15 Nursing Homes, Supervision of 29 Offensive Trades 38 Orthopaedic and Postural Defects 69,98 Pathological Laboratory 14 Physical Education 80 Population 8 Pre-School Children, Examination of 21 Provision of Meals 81 Public Cleansing 32 Puerperal Pyrexia 53 Sanitary Inspection of the Borough 31 Scarlet Fever 52 School Hygiene 36, 59 School Medical Service 58 Secondary Schools 85 Shops Act, 1934 34 Smoke Abatement 34 Social Conditions 8 Special Clinic 16 Speech, Defective 75 Staff 5, 59 Statistics, Vital and General 8, 9 Tuberculosis 54 Uncleanliness 61, 99 Vision, Dfective 64, 97 Water Supply 31 APPENDIX. Report of the Medical Superintendent, Isolation and Maternity Hospitals, 1938-39. 4 PUBLIC HEALTH COMMITTEE. 1937-38. Alderman Colonel R. R. Kimmitt, O.B.E., T.D., D.L. {Chairman). Councillor H. Telfer (Vice-Chairman). Alderman Mrs. E. S. Taylor, J.P. Councillors Mrs. E. A. Brooks, W. H. Crowe, Mrs. O. A. F. Davis, T. E. Fowler, C. D. Grant, C. Hudson, J. Mansel Lewis, J.P., H. A. Merchant, W. Morgans, H. C. W. Richman, C. P. Savage, W. A. Scott and S. J. Snook. MATERNITY AND CHILD WELFARE COMMITTEE. 1937-38. Alderman Mrs. E. S. Taylor, J.P. (Chairman). Councillor W. Morgans (Vice-Chairman). Alderman R. R. Kimmitt, O.B.E., T.D., D.L. Councillors Mis. E. A. Brooks, W. H. Crowe, Mrs. O. A. F. Davis, T. E. Fowler, C. D. Grant, C. Hudson, J. Mansel Lewis, J.P., H. A. Merchant, W. Morgans, H. C. W. Richman, C. P. Savage, W. A. Scott, S. J. Snook and H. Telfer. Mesdames Grant, Haddon, Jackman, King, Mayo, Mercer and Parry. EDUCATION GENERAL PURPOSES SUB-COMMITTEE. 1937-38. (Responsible for School Medical Service). Councillor T. P. May (Chairman). Alderman J. C. Fuller, J.P. (Vice-Chairman). Councillor E. H. Atkinson (Chairman, Education Committee) (ex-ojfvcio member), Aldermen Mrs. E. S. Taylor, J.P., and G. R. Weeks. Councillors E. H. Brooks, J.P., Mrs. O. A. F. Davis, C. W. Jackman, J. D. Knight, M.Inst.C.E., B. Martin, J.P., and W. Morgans. The Very Rev. Monsignor H. Barton Brown, M.A., Miss D. L. Beck, M.A., Mr. J. E. Childs, Miss A. Dix Hawkin, Mrs. A. D. Mayo, Rev. H. J. Beck and Rev. H. Greatbatch. 5 STAFF. (At 31st December, 1938). Medical Officer of Health, School Medical Officer and Medical Superintendent of Isolation and Maternity Hospitals— Thomas Orr, M.D., D.Sc., Of the Middle Temple, Barrister-at-Law. Deputy Medical Officer of Health— Llywelyn Roberts, M.D., D.P.H. Medical Officers— Dorothy Tayi.or, M.A., M.B., B.S., M.R.C.S., L.R.C.P., D.P.H. Donai.d F. Irvine, M.B., Ch.B., D.P.H. Herbert O. H. Butcher, L.R.C.P., M.R.C.S., D.P.H. John C. Aitken, M.B., Ch.B., D.P.H. Nancy Lloyd Lewis, M.B., Ch.B., D.P.H. Helena B. King, M.B., B.S., M.R.C.S., L.R.C.P. (Part-time). Ante-Natal Consultant (Part-time)— John W. Rait Bell, L.R.C.I. & L.M., L.R.C.S.I. & L.M. Surgeon, Orthopaedic Clinic (Part-time)— Herbert J. Seddon, F.R.C.S. (Eng.), M.B., B.S., M.R.C.S., L.R.C.P. Ophthalmic Surgeon (Part-time)— Graeme G. Talbot, M.B., Cli.B., F.R.C.vS. Consulting Otologist (Part-time)— Arthur A. Miller, F.R.C.vS., M.R.C.S., L.R.C.P., D.L.O. Special Clinic (Part-time)— Constance M. Hildred, M.B., Ch.B. Dental Surgeons— C. Colenso, L.D.S. Alfred G. Brown, L.D.S. Isobel M. M. Cameron, L.D,S. 6 Chief Sanitary Inspector— George W. Stevens. Sanitary Inspectors— James Stubbs, C. P. H. Meadows, G. T. H. Blackik, Ernest Belfield and Eric H. Evans. Nursing Staff— Supervising School Nurse—Miss Hilda Bailey. There are eight school nurses in addition. Supervising Health Visitor—Miss Marguerite Farrow. There are eight health visitors in addition. Midwives— vSenior Midwife and Teacher of Pupils—Mrs. Ruby K. M. Wingrove. There are nine midwives in addition. Masseuse (Part-time)— Miss Florence Hepburn, C.S.M.M.G. Teacher of Class for Stammering Children (Part-time)— Honor M. S. Baines. Chief Administrative Clerk— Harry Birrei.l. Senior Clerical Staff— Maternity and Child Welfare—William A. J. Turner. Infectious Disease and Laboratory Assistant—Herbert J. Reed. School Medical Service—Robert S. Leggatt. Other Clerical Staff—Total 21 ; seven in Health Department, nine in School Medical Section, six in Maternity and Child Welfare Section. A. Vital Statistics, Social Conditions of the Area, and General Provision of Health Services. 8 SUMMARY OF GENERAL STATISTICS. Area (in Acres) 8,739 Population (Census, 1931) 117,707 Population (Estimated Middle of 1938) 161,000 Number of Structurally Separate Dwellings (Census, 1931) 26,717 Number of Families or separate Occupiers (Census, 1931) 31,412 Number of Houses according to Rate Books (1st April, 1938) 45,154 Rateable Value, 1st April, 1938 £1,727,499 Net Produce of a Penny Rate £6,900 Population.—The population of the Borough at the middle of 1938 is estimated by the Registrar General to be 161,000. The estimated population at the middle of 1937 was 156,460, so that the estimated increase in the period of twelve months is 4,540. Social Conditions.—Statistics supplied by the local Employment Exchange with regard to unemployed men of 21 years and over show that there has been a decided increase in unemployment following a period of four years when the average number of unemployed continued at the same level. The figures foi the last six years are as follows : Average number of men Year registered as unemployed 1933 1,708 1934 1,099 1935 1,002 1936 1,068 1937 1,029 1938 1,585 9 SUMMARY OF VITAL STATISTICS, Live Births :— Legitimate Males, 1,219 Females, 1,086 Total, 2,305 Illegitimate Males, 49 Females, 42 Total, 91 -2,396 Birth-Rate per 1,000 of Estimated Population 14.9 Still-Births :— Males, 58 Females, 50 Total 108 Rate per 1,000 total Births (Live and Still-Births) 43 Deaths : Males, 728 Females, 771 Total 1,499 Death-Rate per 1,000 of Estimated Population 9.3 Deaths of Infants under one year of age Legitimate Males, 57 Females, 38 Total, 95 Illegitimate Males, 7 Females, 1 Total, 8 103 Death-Rate of Infants under one year of age All Infants per 1,000 Live Births 43 Legitimate Infants per 1,000 Legitimate Live Births 41 Illegitimate Infants per 1,000 Illegitimate Live Births 88 Deaths from Diseases and Accidents of Pregnancy and Childbirth From Sepsis 1 Death Rate per 1,000 Total Births 40 From other Causes 4 „ ,, 1.60 Total 5 „ „ 2.00 Measles Whooping Cough Diphtheria Scarlet Fever Influenza Tuberculosis of Lung Other Forms of Tuberculosis Death-Rate Total per 1,000 Deaths Population 4 0.02 4 0.02 6 0.04 1 0.01 20 0.12 100 0.62 8 0.05 Diarrhoea (under two years of age) 14 Death-Rate per 1,000 Live-Births 5.8 10 Comparison of Vital Statistics of Ealing with those of England and Wales, Etc., 1938. England and Wales 126 Great Towns (including London) London Ealing Birth-Rate 15.1 15.0 13.4 14.9 Death-Rate 11.6 11.7 11.4 9.3 Infant Death-Rate 53 57 57 43 Measles Death-Rate 0.04 0.05 0.06 0.02 Whooping Cough DeathRate 0.03 0.03 0.03 0.02 Diphtheria Death-Rate 0.07 0.07 0.05 0.04 Scarlet Fever Death-Rate 0.01 0.01 0.01 0.01 Influenza Death-Rate 0.11 0.10 0.06 0.12 Diarrhoea (under two years per 1,000 Births) 5.5 7.8 13.1 5.8 Table showing Birth-Rate, Death-Rate and Infant Death-Rate for the Borough of Ealing. Period Birth-Rate Death-Rate Infant Death-Rate 1881—1885 26.8 12.7 104 1886—1890 22.0 11.9 120 1891—1895 19.9 11.5 103 1896—1900 17.3 10.4 113 1901—1905 23.1 11.0 114 1906—1910 23.8 11.5 89 1911—1915 18.6 9.9 76 1916—1920 16.1 11.5 62 1921—1925 15.4 10.7 58 1926—1930 14.5 10.9 49 1931—1935 14.2 10.1 46 1936 14.4 9.9 49 1937 14.9 9.6 46 1938 14.9 9.3 43 11 Births.—-The number of births recorded was 2,396, compared with 2,320 in the previous year. The birth-rate, however, continues the same, being 14.9 per thousand of population, compared, with the birth-rate of England, and Wales of 15.1 per thousand of population. A table showing the birth-rates in recent years is to be found on page 10. Causes of Death, 1938. Cause of Death Deaths, 1938 Total Deaths 1937 Male Female Total Typhoid and Paratyphoid Fevers 1 _ _ 1 — Measles 3 1 4 1 Scarlet Fever 1 — 1 I Whooping Cough 1 3 4 3 Diphtheria 2 4 6 2 Influenza 11 9 20 63 Encephalitis Lethargica — 1 1 1 Cerebro-Spinal Fever 2 — 2 4 Tuberculosis of Respiratory System 52 48 100 76 Other Tuberculous Diseases 2 8 12 Syphilis 3 1 4 1 General Paralysis of the Insane, Tabes Dorsalis 3 _ 3 4 Cancer, Malignant Disease 106 129 235 218 Diabetes 3 13 16 28 Cerebral Haemorrhage, etc. 34 42 76 72 Heart Disease 183 218 401 374 Aneurysm 2 5 7 8 Other Circulatory Diseases 39 40 79 62 Bronchitis 24 16 40 63 Pneumonia (all forms) 40 34 74 77 Other Respiratory Diseases 8 5 13 15 Peptic Ulcer 10 4 14 20 Diarrhoea, etc. (Under two years) 11 3 14 11 Appendicitis 6 4 10 10 Cirrhosis of Liver 3 1 4 2 Other Diseases of Liver, etc. 3 5 8 6 Other Digestive Diseases 15 17 32 28 Acute and Chronic Nephritis 16 29 45 43 Puerperal Sepsis — 1 1 1 Other Puerperal Causes — 4 4 5 Congenital Debility, Premature Birth, Malformations, etc. 32 24 56 62 Senility 11 27 38 33 Suicide 3 6 9 20 Other Violence 37 12 49 55 Other Defined Diseases 56 59 115 124 Causes ill-defined or unknown — — — — Total 728 771 1,499 1,502 12 Deaths.—The number of deaths assigned to the Borough is 1,499, three less than the number recorded in the previous year. The death-rate for the year under review is 9.3 per thousand of population compared with the rate of 9.6 recorded in 1937. The death-rate of 9.3 is the second lowest recorded for the Borough, the lowest death-rate being that of 8.9 recorded in 1913. The death-rate for the Borough compares very favourably with the death-rate of 11.6 for England and Wales. By multiplying the death-rate for Ealing by the " comparability factor " supplied by the Registrar General, the death-rate for the Borough can be made comparable with that of other districts. The "factor" for Ealing is 1.01, which makes the comparable death-rate 9.4 per thousand of population. The causes of the 1,499 deaths are indicated in the table on page 11. It will be seen from this table that heart disease (401), cancer (235) and tuberculosis of respiratory system (100) were the three main causes of death and that the number of deaths due to each of these three causes was higher than in the preceding year. The deaths from influenza and bronchitis, however, showed a marked reduction. Infant Deaths.—The infant death-rate of 43 per thousand births compares very favourably with the rates for England and Wales, for the Great Towns and for London, which are respectively 53, 57 and 57. The infant death-rates in recent years are shown in the table on page 10, which indicates in a striking manner the great reduction in infant mortality which has been effected in the last thirty years. The actual number of deaths of infants under one year of age was 103, this being three less than in the preceding year. The tables which follow indicate prematurity (36 deaths) as the main cause of death, while the 15 deaths due to. diarrhoea and enteritis is the highest number recorded in recent years. It will be seen that 51 of the deaths occurred before the infant was one week old, while 59 occurred before the age of four weeks. This latter figure gives a neo-natal death-rate of 25 per thousand live births, 13 Deaths at various Ages under One Year of Age, 1938. Cause of Death Under 1 week 1—2 weeks 2—3 weeks 3—4 weeks Total under 4 weeks 4 weeks and under 3 months 3 months and under 6 months 6 months and under 9 months 9 mouths and under 12 months Total deaths under 1 year All Causes 51 1 3 4 59 12 11 11 10 103 Measles * — — — — — 1 — 1 Meningitis — — — — — — — 2 — 2 Convulsions — — — — — — — — — — Bronchitis — — — 1 1 1 1 — — 3 Pneumonia __ — 1 2 3 2 1 3 2 11 Inflammation of the Stomach — — — — — — — — 1 1 Diarrhoea and Enteritis — — 1 — 1 4 3 4 3 15 Congenital Malformations 5 1 — — 6 1 1 — — 8 Congenital Debility — — 1 1 — 1 — 1 3 Premature Birth 36 — — 36 — — — — 36 Injury at Birth 2 — — — 2 — — — — 2 Other Diseases Peculiar to Early Infancy 7 — — — 7 — — — — 7 Inattention at Birth 1 — — — 1 — — — — 1 Other Causes — — 1 — 1 4 4 1 3 13 Causes of Infant Deaths, 1929 to 1938. 1929 1930 1931 1932 1933 1934 1935 1936 1937 1938 Diarrhoea and Enteritis 4 3 5 9 4 11 11 7 10 15 Premature Birth 25 14 19 24 35 20 34 35 31 36 Congenital Malformations 4 9 9 11 13 9 9 10 15 8 Congenital Debility 10 9 11 4 4 3 11 5 2 3 Tuberculous Disease 1 2 1 — 1 — — — 2 1 Syphilis ... — — 1 1 — — — — — — Meningitis [not Tuberculous) 3 1 4 — — 1 — — — 2 Convulsions 3 6 5 4 3 3 1 — 1 — Bronchitis 2 4 2 — 3 3 — 5 4 3 Pneumonia (all forms) 8 10 11 6 6 8 8 15 12 11 Gastritis 1 — — — — 1 — — — — Common Infectious Diseases 6 2 1 9 3 1 — — — 4 Other Causes 6 11 15 18 10 17 17 25 29 20 Totals 73 71 84 79 82 77 91 102 106 103 Stillbirths.:—The number of stillbirths registered in the year was 108, compared with 82 in the previous year. The stillbirth rate is 43 per thousand births. i4 Maternal Mortality.—There were five maternal deaths during the year, the maternal death-rate for the Borough being 2.00 per thousand births. The maternal death-rates in recent years are shown in the following table from which it will be seen that in recent years maternal mortality in the Borough has been below the average for the country as a whole. Maternal Mortality per Thousand Births. Period Ealing England and Wales 1911—1915 3.03 4.03 1916—1920 2.70 4.12 1921—1925 4.01 3.90 1926—1930 3.31 4.27 1931—1935 4.10 4.12 1936 0.93 3.65 1937 2.50 3.23 1938 2.00 2.97 GENERAL PROVISION OF HEALTH SERVICES. PATHOLOGICAL LABORATORY. The following table indicates the number of examinations carried out in the pathological laboratory, which is maintained at the Town Hall. Specimens Examined in Laboratory. Positive Negative Total 1938 Total 1937 Diphtheria : From Medical Practitioners 70 621 691 766 From Isolation Hospital 437 3,122 3,559 3.327 From Health Centres 14 453 467 262 Tubercuiobis 64 360 424 532 Miscellaneous 28 432 460 459 Total 613 4,988 5,601 5,346 15 AMBULANCE FACILITIES. 1. For infections disease- The Ealing and Brentford and Chiswick Hospitals Committee provide a motor ambulance for the removal of cases of infectious disease to the Clavponds Isolation Hospital at South Ealing. 2. For accident and illness cases. -Three ambulances are provided by the Council and are adequate for dealing with cases of accident and of acute illness. Two are housed at the Central Fire Station and one at the Greenford Sub-Station, the ambulance service being manned by members of the Fire Brigade. The extent of the calls made upon the service is shown in the following table :— 1933 1934 1935 1936 1937 1938 Cases of Accident 772 790 756 868 740 917 Cases of Illness 1,149 1,259 1,261 2,080 2,663 2,894 Total Cases 1,921 2,049 2,017 2,948 3,403 3,811 Number of Journeys outside the Borough (included above) 365 596 427 552 567 421 Annual Mileage 13,265 15,818 16,962 21,070 22,868 30,422 NURSING IN THE HOME. 1. General diseases.—The Greater Ealing Nursing Association with a staff of one superintendent nurse and seven district nurses, provides for the nursing of the sick in their own homes in the Borough except in the Northolt Ward. During the year the Association dealt with 1,449 cases, a total of 21,136 visits being made. 16 District nursing in the Northolt Ward is provided by the Northolt Nursing Association, who employ one nurse to attend patients in this area. 2. Infectious disease.—The two Nursing Associations receive annual contributions from the Town Council in respect of nursing services provided for patients referred by the medical staff at the Health Centres or by the midwives. CLINICS AND TREATMENT CENTRES. Provided by Ealing Town Council. Health Centres (Maternity and Mattock Lane, Ealing. Child Welfare, and School Cherington House, Hanwell. Medical Service) Ravenor Park, Oldfield Lane, Greenford. Greenford Green, Wad ham Gardens, Greenford. Perivale, Horsenden Lane, Greenford. Islips Manor, Eastcote Lane, Northolt. Orthopaedic Clinic Mattock Lane Centre, Ealing. Special Clinic (Birth Control) Mattock Lane Centre, Ealing. Provided by Middlesex County Council. Tuberculosis Dispensary Green Man Passage, West Ealing. Treatment Centres for Venereal Disease Certain Hospitals in London. Special Clinic.—Cases in which the medical staff are of opinion that further pregnancies would be detrimental to the health of the mother can be referred to the special clinic where they receive instruction in birth control. The medical officer in charge of this Clinic attends on two afternoons in each month. The number of new cases dealt with during the year was 123, and the total number of consultations with the medical officer was 348. In addition, 15 cases (involving 41 consultations) were dealt with in accordance with the arrangements made with the Middlesex County Council, who send mothers from the County area. 17 HOSPITALS. 1. Isolation Hospital.—The Clayponds Isolation Hospital at South Ealing is provided in conjunction with the Brentford & Chiswick Council. The hospital has 142 beds and information regarding the cases admitted is given in the Annual Report on the Hospital, which forms an Appendix to this Report. 2. Maternity Hospital.—The Perivale Maternity Hospital, Greenford, is also provided in conjunction with the Brentford & Chiswick Council. The hospital contains 40 lying-in beds, three isolation beds and a labour block. The Annual Report on the Hospital is included as an Appendix to this Report and shows that the accommodation at the hospital is fully utilised by the mothers in the two Boroughs. 3. Smallpox Hospital — Hospital provision for children — Other hospitals.—No change has to be recorded in these hospital arrangements, which have been fully described in previous reports. HEALTH EDUCATION. The National Campaign to secure a wider use of the health services continued during the early months of the year and the co-operation of the Council in this effort was continued. Posters were exhibited in the Centres, on the Cleansing Department's vehicles, etc., leaflets were distributed through the schools and at the centres, and appropriate articles were included month by month in the local edition of " Better Health." This journal has now been distributed in the Borough for ten years, during which period 2,000 copies have been issued each month B. Maternity and Child Welfare. 19 MATERNITY AND CHILD WELFARE. There are no outstanding additions to be noted in connection with the Council's maternity and child welfare scheme as was the case last year when the Perivale Maternity Hospital was opened and the Midwifery Service was inaugurated. The work accomplished during the year will be seen in the summaries of attendances at the Centres and the records of work done by the Health Visitors and Midwives. Summary of the Visits made by the Health Visitors. Visits to children under 12 months : (1937) (1938) First visits 2,402 2,434 Return visits 6,242 5,558 Visits to children 1 to 5 years of age 9,443 10,200 Visits to expectant mothers 2,179 1,983 Visits to investigate infant deaths and still-births 147 140 Special visits or investigations 268 265 Visits to cases of Ophthalmia Neonatorum 8 37 Visits to cases of Pemphigus Neonatorum — 5 Visits to cases of Measles and Whooping Cough 328 672 Visits to cases of Scarlet Fever on discharge from the Isolation Hospital 301 290 Inspections of Women's Lavatories 70 68 Visits to children under care of foster-mothers 784 758 Other visits 140 143 Total Visits 22,312 22,553 Summary of the Work at the Health Centres. Mothers. Expectant mothers attending Ante-Natal Clinics : (1937) (1938) Attending for the first time 1,366 1,538 Total attendances 6,320 7,994 Nursing mothers attending Post-natal Clinics : Attending for the first time 585 600 Total attendances — 701 20 Mothers seen by Ante-Natal Consultant 36 35 Mothers referred to School Medical Department for dental treatment 471 601 Mothers referred to Hospitals 109 61 Mothers accepted for admission to the Perivale Maternity Hospital 597 715 Children. Children attending Centres for the first time : (1937) (1938) Under one year of age 1,996 2,044 One to five years of age 1,384 1,326 Total attendances made by children : Under one year of age 26,711 30,257 One to five years of age 16,797 19,077 Number of children examined by Medical Officer : Under one year of age 6,985 7,162 One to five years of age 7,111 7,278 Children referred to School Medical Department : For dental treatment 548 595 For treatment of throat and nose 33 26 For optical treatment 56 81 For orthopaedic treatment 142 162 For treatment of minor ailments 150 261 For diphtheria immunization 381 529 Children referred to King Edward Memorial Hospital: For minor operations 33 44 For ultra-violet ray treatment 3 1 For other reasons 28 48 Children admitted to King Edward Memorial Hospital as indoor cases — — Children referred to other Hospitals 36 88 Assistance Given. Food supplied at cost price : (1937) (1938) Dried milk (Value) £902 £1,177 Virol ( „ ) £180 £196 Cod liver oil ( „ ) £461 £482 Number of orders issued granting a supply of milk, free of charge, for a period of 28 days: For expectant or nursing mothers 921 1,303 For children under five years of age 1,955 3,601 21 Attendances at the Health Centres, 1938. ]Mattock Lane Ch'gton House Ravenor Park Perivale Greenf'd Green Islips Manor' Ante-natal sessions 92 89 93 83 87 52 Attendances 1,767 1,612 1,651 1,146 1,254 564 Average attendance per session 19 18 18 14 14 12 Post-natal sessions 12 12 12 11 12 — Attendances 91 132 156 116 160 48 Average attendance per session 8 11 14 11 13 — Number of sessions for children 152 154 151 151 155 52 Number of children attending for first time 715 817 751 375 467 245 Total attendances made by children 9,390 9,680 10,067 8,787 8,006 3,404 Average attendance per session 62 63 67 58 52 65 Number of children seen by doctor... 2,824 2,904 3,337 2,285 2,196 894 Average number seen per session 19 19 22 15 15 17 Medical Examination of Pre-school children.—The number of complete medical examinations of children from one to five years of age are indicated in the following table :— Age- Group No. of Examinations 1 year to 18 months 1,227 18 months to 2 years 755 2 years to 3 years 817 3 years to 4 years 723 4 years to 5 years 408 3,930 These medical examinations again show an increase over previous years, the total of 3,930 comparing with 2,984 in 1936 and 3,616 in 1937. 22 Treatment of Defects.—The medical examinations at the Centres reveal numerous defects, the majority of a minor character, for which immediate treatment is advisable. To assist the parents in securing such treatment arrangements are in force whereby all facilities available for the treatment of school children are also available for children under school age. Details regarding the numbers of mothers and children referred for treatment are to be found on page 00, a survey of the arrangements for orthopaedic treatment on page 00, while a report by the School Dentist regarding dental treatment follows :— Report of Dental Surgeon. " Mothers.—The provision of dental treatment for expectant and nursing mothers was first undertaken in the Borough in 1927. In that year, 49 mothers were treated, eight being supplied with artificial dentures. In twelve years this figure has multiplied rapidly, the number treated in the present year being 721. The work carried out was chiefly of a radical nature, elimination of sepsis and caries being the chief aim. " The number of teeth extracted totalled 3,151 and the number of teeth filled numbered 386. The number of mothers who were supplied with artificial dentures was 285, while 232 mothers received gum treatment. Gas was administered in nearly all cases where extractions were performed, a local anaesthetic being occasionally used in the extraction of single teeth. " The number of attendances made by mothers to receive dental treatment was 2,829. " Children.—The dental treatment of pre-school children also showed an increase over the preceding year, the total number of children seen by the dentist being 534. There is no doubt that the mothers show a keen interest in their children's teeth. This is particularly noticeable in mothers who have themselves received dental treatment at the Centres in Ealing and it is in these cases that conservative treatment can \ e carried out with success as they are seen early. The number of fillings inserted f ir children was 95, and the number of mothers seeking advice regarding their children's teeth was 28. The number of extractions was 1,595, compared with 1,484 in the previous year. The number of attendances made by pre-school children to receive dental treatment was 1,037." 23 CONVALESCENT TREATMENT. During the year nine mothers with young babies were sent to the Convalescent Home for Mothers and Babies, Mayfield, Sussex, for periods varying from two to four weeks. In addition, eight children under five years were sent to the Hurstleigh Convalescent Home, Tunbridge Wells, the usual period of stay being six weeks. Unfortunately both of these homes were closed during the autumn on account of financial difficulties and arrangements are now under consideration to secure accommodation at other suitable Homes. CHILD LIFE PROTECTION. The supervision of fostermothers is carried out by the Health Visitors who have all been appointed Child Protection Visitors. Information regarding foster-children registered in the Borough is contained in the following table :— Number of children on the register at the beginning of the year 106 (Number of fostermothers having care of the above children, 86). Number of children registered during the year 126 Number of children removed from register during year: Removed to care of parent or relative 70 Removed to another fostermother 15 Removed for adoption through a Society 5 Removed to a Children's Home or School 8 Legally adopted by fostermother 4 Died (Inquest held : None) 2 Fostermother left district 7 Attained nine years of age 4 Removed from care of fostermother at request of Medical Officer of Health.* 6 Removed from care of fostermother by Order of Court obtained under Section 212 of the Public Health Act, 1936 1 122 Number of children on register at end of year 110 (Number of fostermothers having care of the above children, 95). Number of visits made by Health Visitors 758 24 It will be seen that one child was removed from the care of a fostermother after an Order had been obtained from the Court under vSection 212 of the Public Health Act, 1936. In this case a woman had taken charge of a child two weeks of age when she had already been notified that she would not be permitted to have the care of a child under two years of age. Usually in such cases, the threat of legal action is sufficient to secure the removal of the child, but in this case immediate action was considered necessary in view of the fostermother's previous record. The cliila was placed in the care of an approved fostermother until her own mother made other suitable arrangements. In six other cases the removal of a child was requested and in each instance the request was complied with. During the year, Dr. Dorothy Taylor, the Senior Woman Assistant Medical Officer, was appointed by the Council as a child protection visitor under Section 209 of the Public Health Act, 1936, to enable her to have authority to make inspections in any special case. MIDWIFERY SERVICE. The Midwifery Service established in accordance with the provisions of the Midwives Act, 1936, came into operation on the 1st May, 1937. At the end of 1938 the staff comprised ten midwives, an additional midwife having been appointed during the year to serve the expanding area of Northolt. This appointment had to be expedited by reason of three independent midwives, who all practised in a small way in Northolt or North Greenford, surrendering their certificates. The question of maintaining a staff of midwives sufficient to serve the needs of the Borough will need further consideration in the near future. At the end of the year the two independent midwives undertaking the majority of the cases derlt with apart from the Council's scheme, discontinued practice and the majority of their cases will have to be dealt with by the municipal midwives. As these midwives attended over one hundred cases in the Borough during the year the anticipated increase in the cases to be attended by the Council's staff is more than can be done by one whole-time midwife. 25 The work carried out by the midwives and the assistance provided for the mothers, were as follows:— Number of Confinements attended: (a) as midwife 525 (b) as maternity nurse 144 669 Number of Visits made by midwives: Confinements attended 669 Nursing visits 11,549 Ante-natal supervision 1,143 Other visits 1,624 14,985 Attendances of patients at midwife's house: First visits 670 Return visits 1,143 1,813 Number of accouchement sets issued: Free of charge 155 At cost price 181 336 Number of cases in which Home Help provided 67 Amount of fees collected by midwives £985 Training of Pupil Midwives.- The arrangements by which some of the pupil midwives receiving their training at the Perivale Maternity Hospital were able to undertake their district training under the supervision of the senior midwife, who is an approved teacher, came to a conclusion at the end of the year. During the year fifteen pupils received their district training in accordance with these arrangements, each pupil residing with the teacher for a period of one month. The pupils gave valuable help to the staff as, being trained nurses, they were able to undertake certain duties without personal supervision. The Central Midwives Board have now adopted new rules regarding the training of pupil midwives, dividing the training into two parts. The Perivale Maternity Hospital is approved for the first period of training only, during which no district training has to be undertaken. 26 Cases attended by independent midwives. At the end of the year there were five midwives resident in the district and two in neighbouring areas who were continuing in independent practice, compared with seven and eight respectively at the beginning of the year. In addition, midwives from three nursing homes undertake occasional cases in the patients' homes. Compensation for the surrender of certificates may be claimed under the Midwives Act, 1936, up to the 30th July, 1939, and there is a possibility that the number of independent midwives may be still further reduced by this date. Prohibition of unqualified persons acting as Maternity Nurses. An Order was made by the Minister of Health under Section 6 (2) of the Midwives Act, 1936, applying the provisions of that section to the Borough from the 1st June, 1938. The effect of this Order is that no untrained woman may attend a woman in childbirth. Certain women who are not fully trained nurses or midwives are permitted to continue their work if they hold a certificate of training issued by an institution approved by the Minister of Health, and if they give notice in writing to the Council of their intention to practice in the area. Notice of intention to practice has been received from eight persons who possess approved certificates of training. Post-certificate training. Section 7 of the Midwives Act, 1936, provides that every midwife practising in the area shall attend from time to time an approved course of post-certificate training. During the year the Central Midwives Board issued Rules which require every practising midwife to attend once in every seven years an approved course of training extending over a period of not less than four consecutive weeks. The course of instruction must be residential. The Rules come into force on the 1st January, 1939, although the Board have requested that the arrangements for the provision of training for the many midwives who have held their certificates for more than seven years should be spread over the first few years to permit suitable arrangements being made by the training institutions. The Council have made arrangements for midwives practising in Ealing to receive their training at the St. John's Post-certificate Schools, London, E.14, 27 SUPERVISION OF MIDWIVES. During the year 42 midwives notified their intention to practice within the Borough, this number including seven midwives residing outside the district. This number excludes the midwives on the staff of the Peri vale Maternity Hospital. At the end of the year the number of midwives practising in the area was 41, as shown in the following table:— Midwives in service of Council 10 ,, at Perivale Maternity Hospital 13 „ in independent practice (ia) residing in Ealing 4 (b) residing in adjoining areas 3 „ in private nursing homes 11 All of these midwives possessed the certificate of the Central Midwives Board. Number of births attended by midwives:— When acting in the capacity of midwife (a) In private Nursing Homes 82 (b) At the patient's home 644 When acting in the capacity of maternity nurse (a doctor being in attendance) (a) In private Nursing Homes 189 (b) At the patient's home 203 Notifications.—The numbers of notifications received from midwives, in accordance with the Rules of the Central Midwives Board, were as follows Notifications of sending for medical assistance On account of a complication of pregnancy 30 On account of a complication during labour 178 On account of a complication during the puerperium 16 On account of the health of the child 48 272 Still-birth 11 28 Death Of mother Of child 3 Laying out of a Dead Body 5 Artificial Feeding of Infant 9 Liability of Midwife to be a source of infection 17 Ophthalmia Neonatorum.—-The notifications of sending for medical assistance on account of the health of the child included twenty-four cases of inflammation of, or discharge from, the eyes. Ten of these cases were notified by the medical practitioner as cases of ophthalmia neonatorum. Visits to midwives.—Routine visits to the number of 25 were made by Dr. Dorothy Taylor, who acts as vSupervisor of Midwives. Supervision of midwives engaged in district practice has been rendered much simpler since the inauguration of the Midwifery Service. The majority of the district midwives are now on the staff of the Public Health Department and their co-operation with the general scheme of Maternity and Child Welfare is complete. Payment of medical fees.—The Town Council paid fees to local medical practitioners, called in by midwives, amounting to £254. 19s. 6d. in respect of 234 claims submitted. The fees were paid in accordance with the scale laid down by the Minister of Health. Where the circumstances permitted, the whole, or part, of the fee was recovered from the husband of the patient. The amount recovered was £67. 13s. 2d. 29 SUPERVISION OF NURSING HOMES. The following table gives information regarding nursing homes in the Borough, the increase in the number of beds in the year being accounted for by extensions at two homes. No. of Homes No. of Beds. Number of Nursing Homes on Register at beginning of year 19(11) 231 (64) Number of applications for transfer of registration 2 Number of New Homes registered — — Number of Homes discontinued — — Number of Nursing Homes on Register at end of year 19(11) 251 (75) The figures in brackets indicate the number of Homes and the number of beds wholly or partly to the reception of maternity cases. Five applications on behalf of voluntary hospitals and homes' for renewal of certificates of exemption were granted. The nursing homes in the Borough are visited periodically by the Senior Woman Assistant Medical Officer who made 54 visits during the year for this purpose. When new applications for registration are received the inspection by the Medical Officer is followed by a visit from the Chief Sanitary Inspector, who reports fully regarding the sanitary arrangements, takes measurements of the rooms and, if considered necessary, arranges for the testing of the drainage system. While the discovery of an unregistered home taking maternity cases would be simple, by reason of the fact that all births are notifiable, the discovery of unregistered homes taking chronic cases is more difficult. Advertisements in the local press are watched in order to detect unregistered premises. One inspection revealed that eight patients had been taken into a home approved for seven patients only, and that there was no state registered nurse on the staff. The owner of the home complied with a request that one patient should be removed immediately and that a state registered nurse be engaged in place of a nurse who had left. C. Sanitary Circumstances of the Borough. 31 SANITARY CIRCUMSTANCES OF THE BOROUGH. Water.- -The North and South Greenford and Northolt Wards are supplied by the Rickmansworth and Uxbridge Valley Water Company, with the exception of five roads in Greenford North Ward, which are supplied by the Colne Valley Water Company. The rest of the Borough is supplied by the Metropolitan Water Board. There are eight factories in the Borough using water from deep borings ranging in depth from 300 feet to 600 feet. The water is used for general factory purposes and in four of them it is also used for drinking. Samples from these four supplies were taken and submitted to chemical and bacteriological analysis and the report in each case was that the water was satisfactory for drinking purposes. Rivers and Streams.—No complaints were received during the year with reference to the river Brent or its tributary stream. Drainage and Sewerage.—With the exception of 49 houses in Northolt Ward, eight in Greenford North Ward, two in Mount Park Ward, four in Drayton Ward, and one in Hanwell North Ward, all houses in the Borough are supplied with water closets and are connected to the sewerage system. During the year three houses previously drained to cesspools were connected to the sewer. Closet Accommodation.—Excepting those parts of the Borough already mentioned, the whole of the houses are provided with water closets, there being as a rule one water closet for each house or part of a house let as a separate tenement. 32 The following table gives the number of pail closets, the number of cesspools and the number of houses with water closets connected therewith in the areas mentioned:— Wards Cesspools Water Closets PailClosets Houses within 100 feet of Sewer No. of Houses. Northolt 35 26 23 4 49 Greenford 6 5 3 — 8 Hanwell North 1 1 — — 1 Mount Park and — — — — Drayton 2 4 2 — 6 44 36 28 4 63 Public Cleansing.—The whole system of public cleansing is gradually undergoing evolution and the. following description gives a short account of the development at the present time :— Street Cleansing.—The whole of this service is carried out on the one-man beat system. Two-bin trucks on pneumatic tyres are used : there are 82 beats. The sweepings are collected direct from trucks at frequent intervals during the day and are delivered by the scavenging lorries direct to tips for final disposal, there being 110 temporary dumps. A mechanical sweeper-collector augments the trucks on main roads. Gully Cleansing was carried out during the year by a petroldriven vacuum extractor. Formerly there were two steam extractors which were replaced by tliis machine and while the latter successfully fulfilled its requirements, more frequent emptying of gulleys is desirable and a second machine was put on order at the latter end of the year and will be in commission early next year. Continuous efforts are made to get agreements with estate developers for scavenging and gully cleansing in new streets before their adoption by the Council. A nominal charge is made and the plan is meeting with successful results, so improving the amenities of newly developed estates. 33 Refuse Disposal.—The disposal of house refuse and trade refuse is effected by controlled tipping and incineration, 90% by the former, 10% by the latter. The total refuse yield was 44,291 tons. The incinerator is situated at Hanwell and is a four-cell steaming plant. The controlled tips are situated at Hanwell Works and Greenford Road. Over 50,000 tons of refuse have been tipped at Hanwell in 23/4 years: the tip is expected to last ten years. At Greenford 30,000 tons have been tipped in 13/4 years. Substantial progress was made with the erection of a new refuse disposal plant at Greenford Road and the operating of this will commence in the late summer 1939, when the Greenford Tip will be closed. The new works is a separation, salvage and incineration plant with a maximum capacity of 180 tons per day. A cleansing administration block, garage, workshops, mess-room, weighbridge, shower-room, etc., alongside the new disposal works were nearing completion at the end of the year. Refuse Removal-The last horse-drawn refuse collection vehicle ceased work on August 31st, 1938: the collection is therefore entirely by mechanised vehicles. A standard pattern of vehicle is used for house to house collection, but for special collection of trade and school refuse a different type is used. Seven new vehicles were ordered at the end of the year to replace vehicles on solid-tyred wheels. All vehicles are now pneumatic tyred with the exception of one reserve vehicle. There are four reserve vehicles for use during overhauls and holiday periods. Refuse Dumps.—During the year a complaint was received of offensive smells arising from the St. Marylebone Dump situated in the Northolt Ward. An investigation showed that the dump was being properly conducted and no undue smell was observed. The dump just outside the Borough boundary at Yeading, to which refuse from Paddington is brought, continues to be conducted in a satisfactory manner. In connection with this dump a refuse destructor has been constructed, where a considerable quantity of the refuse is now incinerated. 34 The controlled tips at Hanwell and Greenford are conducted in a very satisfactory manner. Smoke Abatement.—The Sanitary Inspectors made 112 smoke observations of chimneys during the year and in five instances it was necessary to make representations regarding the emission of black smoke for a longer period than that allowed by the byelaw. Statutory Notices under Section 103 of the Public Health Act, 1936, were served in each case and there was no repetition of the offence during the six months the notices remained operative. Premises and Occupations subject to Control by the Local Authority.—There are no common lodging houses in the Borough and there are no byelaws with respect to houses let in lodgings. Only one offensive trade is carried on in the Borough, namely, fishfrying, which is carried on in 28 different premises. During the year nine applications were received for permission to establish the trade of fishfrying, permission being granted in two cases. Shops Act, 1934.—During the year 23 shops were reported by the Shops Inspector for investigation by the Sanitary Inspectors regarding the provisions of the Shops Act, 1934, relating to ventilation, temperature and sanitary conveniences. As a result of these inspections three additional W.C.'s and one wash-hand basin were provided, heating apparatus was installed in five shops and ventilation was improved in one instance. In addition, nuisances at four shops were abated. Baths and Swimming Pools.—Four swimming baths are provided by the Council, namely, a women's bath, a first class and second class bath for men, and a bath reserved exclusively for the use of public elementary school children. These swimming baths are equipped with pressure filters for continuous filtration and the water is treated with chlorine under strict supervision. There are two privately owned swimming pools in the Borough which are maintained by the Staff Recreation Clubs of two large factories. Chlorine treatment of the water is carried out in both these pools. 35 Eradication of Bed Bugs.—During the year 40 Council houses and 135 other houses were found to be bug infested. All these houses were successfully disinfested. The method employed for freeing infested Council houses from bed bugs is by stripping the paper from the walls, loosening or removing all woodwork, the application of a blow lamp to the seats of infestation and spraying with a contact insecticide. In the case of privately owned houses a notice is served on the owner or occupier to do the necessary stripping of walls, etc., and the rooms are then sprayed with a contact insecticide. Bedding from infested rooms is treated at the Council's steam clisinfector. In all cases where there is a suspicion of infestation with bugs in the belongings of people about to remove to a Council house disinfestation with hydrogen cyanide is carried out, this work being done by a contractor. During the year the furniture and belongings of 40 families were treated by this method. The Housing Department make particular enquiries at Council houses regarding possible infestation and report to the vSanitary Inspector when necessary. A thorough inspection is made and remedial measures are adopted when infestation is confirmed. The tenants are encouraged to report at once any suspected or actual infestation so that remedial action can be taken early. As regards other houses the tenants are advised to inform the Public Health Department when there are any signs of re-infestation. Nuisance from Noise.—Section 106 of the Middlesex County Council Act, 1938, provides that a noise nuisance shall be liable to be dealt with in accordance with the provisions relating to nuisances of the Public Health Act, 1936, with the proviso that if the noise is occasioned in the course of any trade, business or occupation it shall be a good defence that the best practicable means of preventing or mitigating it, having regard to the cost, have been adopted. Ten complaints of nuisances from noise were received during the year. Investigations were made and where possible appropriate action was taken and the noise abated or reduced to a minimum. 36 Schools.—A thorough inspection of the sanitary arrangements at all the public elementary schools and private schools is made at least once a year by the Sanitary Inspectors, and on their report steps are taken by the Education Committee and by private owners to remedy any defects found. Reports of absentees from non-notifiable diseases are furnished weekly to the Public Health Department by the head teachers of public elementary schools. These give a general idea of the prevalence of infectious diseases at any particular time and enable the health visitors to visit the homes and give the mothers advice regarding the prevention of the spread, of infection and the avoidance of complications in such conditions as measles and whooping cough. Rag Flock Acts, 1911 and 1928.—No samples were taken during the year. It is doubtful if any rag flock is used in the Borough. Legal Proceedings.—Legal proceedings were taken in the following seven cases :— 79 to 101, Uxbridge Road, W.7. Non-compliance with Statutory Notices, Section 41, Public Health Act, 1875, and Section 19, Public Health Acts Amendment Act, 1890. Application for recovery of expenses incurred in carrying out drainage works in default of the owners. Order made for payment of cost of drainage work, with costs. 59, Belvue Road, Northolt. Section 93, Public Health Act, 1936. Dampness and general dilapidation. An Order was made by the Magistrates for the necessary works to be carried out within seven days, and £2. 2s. Od. costs was awarded. 72, Middleton Avenue, Greenford. Sink waste connected with rainwater pipe. An Order was made by the Magistrates for the waste to be disconnected from the rainwater pipe and to be connected with the soil pipe system within fourteen days, and a fine of £2 was imposed. Old Sewage Disposal Works, Wyke Green, Heston. Burning of grass, etc., on old sludge beds. Order to abate nuisance in seven days. £1 allowed for costs. 37 22, Manton Avenue, W.7. (1) Application under Section 287, Public Health Act, 1936, to enter; (2) Summons under Section 288, Public Health Act, 1936, for wilfully obstructing the Sanitary Inspector. Fined 10s. on each summons, £1. 1s. 0d. costs. (1) 87, Ruislip Road, Greenford. Unsound meat deposited for sale. Fine of £10. (2) 6a, Oxford Road. Unsound chickens deposited for sale. Fine of £10. Public Mortuary.-A public mortuary maintained by the Town Council is situated in the Council's Depot in Longfield Avenue and during the year under review 84 bodies were deposited therein. It is so fitted that medical practitioners can perform post-mortem examinations and in 42 cases during the year such examinations were carried out. As reported last year the accommodation is inadequate for the size of the Borough and is far from satisfactory and the Council have decided to build a new mortuary properly equipped with refrigeration apparatus, estimates for which are now being obtained. Sanitary Inspection of the Borough.—The following is a summary of the work carried out by the Sanitary Inspectors during the year:— General. Number of Premises inspected on Complaint 1,388 Number of Nuisances observed by Inspectors 119 Number of Premises inspected in connection with Infectious Disease 757 Number of Premises visited by Periodical Inspection (Cowsheds, Dairies, Slaughterhouses, Factories, etc.) 3,202 Number of Houses inspected under He use-to-House Survey 678 Food Inspections 1,944 Total Number of Re-inspections 10,655 Other Inspections 1,663 Total Number of Inspections and Re-inspections 20,406 Number of Intimation Notices given 675 Number of other Letters written 998 Number of Statutory Notices served 82 Proceedings before Magistrates 7 38 Milk and Dairies Act, Etc. Number of Cowsheds on Register 2 Number of Inspections made of Cowsheds 4 Contraventions of Act or Orders — Number of Retail Purveyors of Milk on Register 171 Number of Inspections of Retail Purveyors' Premises 247 Contraventions of Act or Orders 3 Proceedings before Magistrates — Slaughterhouses. Number of Registered or Licensed Slaughterhouses 3 Number of Inspections made 62 Contraventions of Regulations — Proceedings before Magistrates — Factories and Workshops. Factories with Mechanical Power 288 Factories without Mechanical Power 170 Number of Inspections of Factories and Workplaces 616 Number of Defects concerning which Notices were sent 69 Proceedings before Magistrates — Offensive Trades. Fried Fish Shops 28 Other Offensive Trades — Number of Inspections 162 Contraventions 4 Disinfection. Rooms Disinfected by Spray: (a) Ordinary Infectious Disease 28 (b) Tuberculosis 101 (c) Other Conditions 98 Rooms treated for Vermin 171 Articles Disinfected by Steam at Disinfector: (a) Ordinary Infectious Disease 265 (b) Tuberculosis 489 (c) Other Conditions 3,007 Articles voluntarily destroyed 160 39 Particulars of the Sanitary Defects Remedied as a Result of Notices Served and Letters Written. Water Closets repaired or supplied with water or otherwise improved 235 Drains cleared and cleansed 220 Defects in drains repaired 112 Drains reconstructed 34 Dust-bins provided 66 Overcrowding remedied 128 Accumulations of refuse removed 117 Nuisance from fowls and other animals abated 8 Damp-proof courses inserted in walls 135 Ventilation under floors provided 18 Other forms of dampness remedied 78 Yards paved and repaired 61 Floors repaired 62 Roofs, gutters and rain water pipes repaired 289 New soil and ventilating pipes provided 45 Sinks and waste-pipes repaired or renewed 139 Draw taps fixed to main supply 23 Dirty walls and ceilings stripped and cleansed 703 Other defects or nuisances remedied 798 Cisterns cleansed, renewed and covered 11 Houses connected to sewer 3 Water supply re-instated 17 Ventilated food cupboards provided 32 FACTORIES, WORKSHOPS AND WORKPLACES. 1.-Inspections For Purposes of Provisions as to Health. (Including Inspections made by Sanitary Inspectors). Premises Number of Inspections Written Notices Occupiers Prosecuted. Factories with mechanical power 417 29 Factories without mechanical power 199 15 — Other Premises under the Act (including works of building and engineering construction but not including outworkers' premises) Total 616 44 — 40 2.—Defects Found. Particulars Number of Defects Number of defects in respect of which Prosecutions were instituted. Found Remedied Referred to H.M. Inspector Want of cleanliness 38 38 — — Overcrowding — — — — Unreasonable temperature — — — — Inadequate ventilation 3 3 — — Ineffective drainage of floors — — — — Sanitary Conveniences insufficient 3 3 — — unsuitable or defective 12 12 — — not separate for sexes 1 1 — — Other offences (Not including offences relating to Home Work or offences under the Sections mentioned in the Schedule to the Ministry of Health (Factories and Workshops Transfer of Powers) Order, 1921, and re-enacted in the Third Schedule to the Factories Act, 1937). 12 12 — — Total 69 69 — — Outwork in Unwholesome Premises, Sec. 108. Nature of Work Instances Notices Served Prosecutions. Wearing Apparel Making, etc — — — Others — — — D. Housing. 42 HOUSING. Housing.—No action was taken during the year under Section 11 of the Housing Act, 1936. Altogether 108 houses have been represented as unfit for human habitation since 1930, when the five years' plan was drawn up, 27 more than was originally estimated. Arising out of these representations there were 64 demolition orders, 24 undertakings from owners not to re-let the houses for human habitation, and 20 houses were re-conditioned. In respect of one house for which an undertaking was given the owner subsequently demolished the building. Six other houses were voluntarily demolished prior to definite action being taken by the Council. Housing Act, 1936.—During the year 270 houses were measured to ascertain the permitted number allowed to occupy them, making a total of 13,232 houses so far measured. Certificates to the number of 660 were issued, making a total of 7,245, a number far short of the total working class houses in the Borough. HOUSING STATISTICS. 1.—Inspection of Dwelling Houses during the Year: (1) (a) Total number of dwelling houses inspected for housing defects (under Public Health or Housing Acts) 2,069 (b) Number of inspections made for the purpose 2,069 (2) (a) Number of dwelling-houses (included under sub-head (1) above) which were inspected and recorded under the Housing Consolidated Regulations, 1925 678 (b) Number of inspections made for the purpose 678 (3) Number of dwelling-houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation (4) Number of dwelling houses (exclusive of those referred to under the preceding sub-head) found not to be in all respects reasonably fit for human habitation 1,113 43 2.—"Remedy of Defects during the Year without Service of Formal, Notices: Number of defective dwelling-houses rendered fit in consequence of informal action by the Local Authority or their Officers 1,019 3.—Action under Statutory Powers during the Year: A.—Proceedings under Sections 9, 10 and 16 of the Housing Act, 1936: (1) Number of dwelling-houses in respect of which notices were served requiring repairs — (2) Number of dwelling-houses which were rendered fit after service of formal notices: (a) by Owners — (b) by Local Authority in default of Owners — B.—Proceedings under Public Health Acts: (1) Number of dwelling-houses in respect of which notices were served requiring defects to be remedied 48 (2) Number of dwelling-houses in which defects were remedied after service of formal notice: (a) by Owners 45 (b) by Local Authority in default of Owners — C.—Proceedings under Sections 11 and 13 of the Housing Act, 1936: (1) Number of dwelling-houses in respect of which Demolition Orders were made (2) Number of dwelling-houses demolished in pursuance of Demolition Orders 19 (3) Number of houses concerning which action has been taken by the Local Authority under Section 19, and with respect to which owners have given an undertaking that they will not be used for human habitation 44 D.—Proceedings under Section 12 of the Housing Act, 1936 : (1) Number of separate tenements or underground rooms in respect of which Closing Orders were made (2) Number of separate tenements or underground rooms in respect of which Closing Orders were determined, the tenement or room having been rendered fit Housing Act, 1936 (Part IV)—Overcrowding. (a) (i) Number of dwellings overcrowded at the end of the year (Number of dwellings overcrowded on survey in 1935—314). 209 (ii) Number of families dwelling therein 209 (iii) Number of persons dwelling therein l,1491 (b) Number of new cases of overcrowding reported during the year 21 (c) (i) Number of cases of overcrowding relieved during the year 128 (ii) Number of persons concerned in such cases 766 (d) Particulars of any cases in which dwelling-houses have again become overcrowded after the Local Authority have taken steps for the abatement of the overcrowding • (e) Any other particulars with respect to overcrowding conditions upon which the Medical Officer of Health may consider it desirable to report During the year 1,125 new houses were built in the Borough by private enterprise. The Town Council completed 21 four-bedroom parlour houses, 92 three-bedroom non-parlour houses, 12 one-bedroom flats, 6 twobedroom flats, and 14 three-bedroom flats. The building of 284 working class dwellings contemplated at Northolt has not yet been commenced, E. Inspection and Supervision of Food. 46 INSPECTION AND SUPERVISION OF FOOD. Milk Supply.—There were only two cowkeepers on the register as producers of milk at the end of the year. One of these was licenced by the Middlesex County Council to produce Accredited Milk. At the end of the year there were 171 retail purveyors of milkTwenty-three of these registrations were in respect of premises owned by one Company and eleven by another, and used as places for the sale or distribution of bottled pasteurised milk received from central depots in other districts. During the year nine new purveyors of milk were registered with respect to premises used for other purposes to retail milk in sealed receptacles only, and one was registered with respect to premises to be used as a milk distributing depot. Five retail purveyors of milk discontinued their businesses and their names were removed from the register. Milk (Special Designations) Order, 1936.—Under this Order 88 licences were granted during the year, 30 for the sale of Tuberculin Tested Milk, one for Accredited Milk and 57 for Pasteurised Milk. Nine samples of pasteurised milk were taken for bacteriological examination. In all of them the results came within the standard laid down by the Order. Five samples of pasteurised milk were submitted to the phosphatase test and all of them gave a satisfactory result. Six samples of ordinary unclassified milk were examined for bacterial count. One of these was found to contain over 200,000 bacteria per cubic centimetre, namely 350,000. An inspection of the dairy from which this sample was obtained showed that probably the bottles were not properly sterilised by reason of a broken thermometer on the sterilising chest. Thirteen samples of ordinary unclassified milk were submitted to the methylene blue reduction test. In five cases they did not satisfy the test and representations were made to the dairymen regarding the sterilisation of utensils. This effected an improvement as further samples from these shops gave satisfactory results. 47 Seven samples of ordinary untreated milk were submitted for examination at the Lister Institute for the presence of tubercle bacilli. In no sample was this organism discovered. Meat and Other Foods.—There were no infringements of the Public Health (Meat) Regulations. No meat is sold from stalls in the Borough. There are three private slaughterhouses and the following table gives the number of animals slaughtered in the course of the year. Carcases Inspected and Condemned. Cattle excluding Cows Cows Calves Sheep Lambs Pigs. Number killed 2 3 37 98 Number inspected 2 — 3 37 98 All Diseases except Tuberculosis— Whole carcases condemned — — — — — Carcases of which some part or organ was condemned — — 6 3 Percentage of the number inspected affected with diseases other than tuberculosis — — 16.21 3.06 Tuberculosis only— "Whole carcases condemned — — — — — Carcases of which some part or organ was condemned — — — — 1 Percentage of the number inspected affected with tuberculosis — — — — 1.02 All the animals were stunned by means of a humane implement. There is no public slaughterhouse in the Borough. In addition to the parts of carcases mentioned in the foregoing table the following were voluntarily surrendered for destruction:- Ham (tinned) 18 lbs. Pork 31 lbs. Mutton 43/4 lbs. Rabbits 263/4 lbs. Fish 171 lbs. Fowls 193/4 lbs. Potatoes 5 tons Spinach 100 tins (pints) F. Prevalence of, and Control over Infectious and Other Diseases. 49 INFECTIOUS DISEASE. Infectious Disease.—The number of cases of infectious disease notified in the Borough in the past twelve years are indicated below. The total number of cases notified in 1938 shows an increase over the preceding year, this being largely due to a higher incidence of scarlet fever. The comparatively high number of cases of puerperal pyrexia is due to all cases occurring in the new Maternity Hospital at Perivale being assigned to this area, whereas when the maternity hospital was situated in Clayponas Lane all the cases were assigned to the Borough of Brentford & Chiswick. Cases of Infectious Disease occurring in the Borough. Disease 1927 1928 1929 1930 1931 1932 1933 1934 1935 1936 1937 1938 Smallpox __ 1 1 1 — — — — — Diphtheria 53 68 90 129 83 54 71 195 228 52 123 142 Scarlet Fever 136 313 231 264 154 407 476 493 400 408 317 383 Enteric Fever (including Paratyphoid) 14 12 1 4 1 3 4 3 7 8 5 2 Puerperal Fever 6 2 2 7 6 4 3 3 7 3 4 — Puerperal Pyrexia 15 16 13 26 18 21 28 14 11 9 24 46 Pneumonia: Primary 66 73 100 78 96 85 56 72 59 85 60 83 Influenzal 38 13 59 12 IS 50 32 1 / 11 14 37 18 Acute Poliomyelitis — — 1 — 2 4 3 — 1 2 7 6 Cerebro-Spinal Fever 2 — 1 — — — — — — — 1 1 Malaria 6 4 4 2 1 — 1 1 — 1 — — Dysentery — 1 — — — — — 1 1 5 12 Erysipelas 18 28 24 34 20 30 36 43 28 28 27 41 Encephalitis L,ethargica 6 3 3 1 1 1 — 1 — 1 — — Tuberculosis:— Pulmonary 89 99 109 111 141 141 154 139 157 139 178 142 Non-Pulmonary 16 24 27 22 27 27 23 24 23 22 37 33 Ophthalmia Neonatorum 4 8 9 9 9 5 8 5 3 4 7 15 Total 469 665 675 700 577 832 895 1010 936 777 832 924 50 Uases oi Infectious Disease notified during the Year 1938, showing Age and Ward Distribution. Disease Total Cases Notified Removed to Hospital Deaths Ages of Cases Notified Ward Distribution Drayton Castlebar Mount Park Grange Lammas Manor Grosvenor Hanwell S. Hanwell N. Greenford S. Greenford N. Nortbolt . 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 over Smallpox Diphtheria 142 139 6 — 1 6 12 12 67 25 1 15 3 — — 0 2 3 1 21 12 15 10 41 15 10 7 Scarlet Fever 383 300 1 2 9 18 24 29 175 66 18 29 9 4 — 13 6 12 38 3; 2b 14 30 75 58 58 16 Enteric Fever 2 2 1 — — — — — 1 — 1 — — — — — — — — — 2 — — — — — — Puerperal Pyrexia 46 6 1 — — — — — — — 1 41 4 — — 1 — 1 — — o 1 2 4 2d 7 — Pneumonia:Primary 83 — 69 3 4 2 0 1 16 2 0 9 4 18 14 6 3 8 10 0 11 6 9 10 6 8 1 Influenzal 18 5 — — — — — — — 1 o 2 8 2 — — — 4 2 4 — 2 1 — 4 1 Acute Poliomyelitis 6 5 1 — 1 — — — — 2 1 2 — — — — 1 — — 1 1 3 — — — — 1 Cerebro-Spinal Fever 1 1 2 — 1 — — — — — — — — — — — — — — — — — — — 1 — — Malaria — — — — — — — — — — — — — — — — — — — — — — — — — — — Dysentery 12 8 — — 1 1 2 1 3 1 — 1 2 — — — — — 1 — — — — 7 4 — Erysipelas 41 — — — — 1 — — 1 — 1 3 9 16 10 1 4 4 3 — 1 1 2 8 3 5 9 Encephalitis Letliargica — — 1 — — — — — — — — — — — — — — — — — — — — — — Tuberculosis: Pulmonary 142 — 100 — — — 1 — 5 4 16 62 28 23 3 14 13 14 11 9 12 7 0 13 14 26 6 Non-Pulmonary 33 — 8 — — 1 — 2 7 3 2 16 1 1 — 2 2 2 1 2 3 1 2 2 6 8 2 Ophthalmia Neonatorum 15 2 — 15 — — — — — — — — — — — 2 — — 2 — 1 — 1 2 5 2 — Total 924 — 195 20 17 29 44 45 275 103 47 183 62 70 29 44 31 44 70 78 78 48 63 156 140 130 42 51 Ages at Death from Notifiable Infectious Diseases. Disease Under One Year 1 to o 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 - - - - 3 3 - - - - - - 6 Scarlet Fever 1 - - - - - - - - - - - 1 Enteric Fever - - - - - 1 - - - - - - 1 Puerperal Sepsis - - - - - - - - 1 - - - 1 Pneumonia: Primary 11 2 - 2 - 1 3 - 4 6 14 26 69 Influenzal - - - - - - - - - - 3 2 5 Acute Poliomyelitis - - - - - - - - 1 - - - 1 Cerebro-Spinal Fever - - - - - - - - 1 - 1 - 2 Malaria - - - - - - - - - - - - - Dysentery - - - - - - - - - - - - - Erysipelas - - - - - - - - - - - - - Encephalitis Lethargica - - - - - - - - - 1 - 1 Tuberculosis: Pulmonary 2 - - - - 2 2 10 29 23 27 5 100 Non-Pulmonarv - - 2 - - 3 1 l - 1 - - 8 Ophthalmia Neonatorum - - - - - - - - - - - - - Totals 14 2 2 2 3 10 6 li 36 30 46 33 195 52 Diphtheria.—The number of cases of diphtheria notified during the year was 142, compared with 123 in the previous year. The case-rate for the district of 0.88 per thousand of population is, however, less than the case-rate for England and Wales, which is 1.58. The distribution of cases according to age and the number occurring in each Ward is shown in the table on page 50. The occurrence of cases throughout the year was as follows:— Jan. Feb. Mar. Apr. May June July Aug. vSept. Oct. Nov. Dec. 14 22 14 9 12 6 9 11 6 15 15 9 Six deaths were recorded during the year, equivalent to a death-rate of 0.04 per thousand of population and a mortality rate of 4.2 per cent. of cases notified, compared with 0.01 and 1.63 respectively in the previous year. The death-rate for the district, although higher on this occasion, is less than the death-rate of 0.07 recorded for England and Wales. The arrangements for the immunization of children against dipththeria through the school medical department were continued. During the year 798 children were immunized, 279 being of school age and 519 being under five years of age. The total number cf children immunized since 1934 is now approximately 2,400. Further information regarding immunization, including details of the diphtheria prophylactic used, is given on page 79. The arrangements for the supply of prophylactic at cost price to local medical practitioners for their private patients has now been discontinued, the demand falling to such an extent that it was difficult to keep a fresh stock available. Anti-toxin for the use of medical practitioners in cases suffering or suspected to be suffering from diphtheria is supplied free of charge for patients in poor circumstances and at cost price for other patients. During the year 616,000 units of anti-toxin were issued. Scarlet Fever.—The number of cases of scarlet fever notified during the year was 383, compared with a total of 317 in the preceding year. As the number of cases in each of the five years 1932 to 1936 had been 400 or more, the incidence of the disease 53 in the year under review is below the average, especially when the increase in population is taken into consideration. The total of 383 cases is equivalent to a case-rate of 2.38 per thousand of population which is slightly less than the case-rate of 2.41 for the whole of England and Wales. The occurrence of cases throughout the year was as follows:— Jan. Feb. Mar. Apr. May June July Aug. Sept. Oct. Nov. Dec. 36 48 42 20 36 31 31 12 17 26 46 38 The Wards in which the cases occurred are shown in the table on page 50, which indicates that the highest number, 75, was notified from the North Hanwell Ward and that 58 cases occurred in each of the Greenford Wards. One death occurred from the disease, this being a boy ten months of age. The scarlet fever death-rate for the area of 0.01 per thousand of population is the same as that recorded for England and Wales. Enteric Fever. Two cases coming under this heading, brothers aged 9 and 15 years, were notified. Both patients were removed to Clayponds Isolation Hospital, where they made a satisfactory recovery. Puerperal Pyrexia.—There were 46 cases of puerperal pyrexia notified during the year, nearly double the number in the previous year. This increase was due to the cases which occurred in the Perivale Maternity Hospital being notifiable to Ealing, instead of to Brentford & Chiswick as was done when the old maternity hospital was open. Fifteen cases occurred in the patient's own home, five of these being removed to hospital for treatment. Twenty-seven cases occurred in the Perivale Maternity Hospital, two in a local nursing home and two in hospitals outside the district. Two of the cases which occurred in the maternity hospital were admitted to the cubicle block at the Clayponds Isolation Hospital. There was one death from puerperal sepsis. This patient had her confinement at home and was removed to the West Middlesex County Hospital, where she died. 54 Pneumonia.—Notifications were received of 83 cases of primary pneumonia and 18 of influenzal pneumonia. There were 69 deaths from primary pneumonia and five deaths from influenzal pneumonia. Many of the deaths occurred in institutions outside the Borough and the majority of these cases were not notified and are not included in the number of notifications. Malaria and Dysentery.—There were no cases of malaria notified during the year. Twelve cases of dysentery were notified, this being the highest number of cases in any recent year. The cases in the Greenford South Ward, five children and two adults, were all members of the same family. Owing to the difficulty of nursing the family at home they were all removed to the Clayponds Isolation Hospital. Three of the cases in the Greenford North Ward were also members of one family. Erysipelas.—Forty-one cases were notified during the year, compared with 27 in the previous year. Encephalitis Lethargica.—There were no cases of this disease notified during the year, although one death was recorded of a patient who had not been notified. Tuberculosis.—The number of cases of tuberculosis notified during the year and the number of deaths which occurred were as follows :— 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 — — — — — 2 — — 1—5 1 — 2 2 — — 1 1 5—10 3 2 2 3 — 2 — 3 10—15 2 1 1 2 1 1 — 1 15—20 5 10 1 1 2 8 — 1 20—25 7 18 3 3 4 8 — — 25—35 16 24 5 6 10 7 — — 35—45 13 15 1 — 14 9 1 — 45—55 5 5 1 — 10 7 — — 55—65 11 — — — 7 3 — — 65 upwards 2 2 — — 4 1 — — Total 65 77 16 17 52 48 2 6 55 The number of new cases of pulmonary tuberculosis was 142, compared with 178 in the previous year, while the number of cases of non-pulmonary tuberculosis was 33 compared with 37 in 1937. The deaths from the disease showed an increase, the total deaths being 108 (100 pulmonary, 8 non-pulmonary), compared with a total of 88 (76 pulmonary, 12 non-pulmonary) in the previous year. Twenty-four persons were certified as dying from pulmonary tuberculosis and one from non-pulmonary tuberculosis, although they had not been notified as suffering from the disease. Where the deaths were certified by local medical practitioners their attention was drawn to their failure to give the proper notification. The number of cases on the tuberculosis register at the end of the year was 697 (552 pulmonary and 145 non-pulmonary), compared with 688 at the end of the previous year. The register is revised periodically and visits are paid by the Sanitary Inspectors to the homes of patients who are not under the supervision of the Tuberculosis Officer, in order to obtain information as to their progress. The following information has been provided by Dr. J. T. Nicol Roe, the Medical Officer in charge of the Tuberculosis Dispensary, West Ealing, maintained by the Middlesex County Council, with regard to residents from the Borough dealt with during the year:— Number of persons examined for the first time: (a) Tuberculosis of Lungs 95 (b) Other forms of Tuberculosis 23 Number of persons in Institutions at end of year: (a) Tuberculosis of Lungs 85 (b) Other forms of Tuberculosis 24 Number of persons under observation at end of year 442 Number sent to Sanatoria during year 102 Number sent to Hospital during year 28 56 Measles, Whooping Cough, Etc.—The prevalence of nonnotifiable infectious diseases, such as measles and whooping cough, can be judged by the number of cases occurring among the elementary school children. Each week the head teacher of each school supplies a return of all new cases. The numbers so reported during the last four years were as follows:— 1935 1936 1937 1938 Measles 142 1,577 427 2,539 Whooping Cough 368 319 697 1,654 Chickenpox 649 493 764 1,406 Mumps 236 686 925 120 It will be seen that measles, whooping cough and chickenpox were very prevalent during the year. 1938 G. School Medical Service 58 SCHOOL MEDICAL SERVICE. In the following table is given information regarding school accommodation and attendance, together with the number of children medically examined and treated. This gives some indication of the continued increase in the work of the School Medical Department. In addition to children attending the elementary schools pupils attending the secondary schools in the Borough were also examined and treated by arrangement with the Middlesex Education Committee. 1935 1936 1937 1938 Population (Mid-year estimate) 137,550 145,000 156,460 161,000 No. of school departments 47 47 50 50 Accommodation 16,749 17,359 19,369 20,219 Average number on School Rolls during year 14,463 15,251 17,062 18,107 Percentage of school children to population 10.5 10.5 10.9 11.2 Average attendance during year 12,932 13,358 14,952 15,903 Percentage attendance 89.4 87.5 87.6 87.2 No. of children examined at routine inspection 5,533 5,996 6,415 7,296 Percentage of school children examined at routine inspection 38.1 39.3 37.6 40.2 Total number of children who were examined at least once during year 9,541 10,364 11,527 13,801 Percentage of children who were examined at least once during year 66.0 67.9 67.5 76.2 There were 881 more children examined in the year at routine medical inspection than in the previous year and 2,274 more children were examined at least once. 59 STAFF. Two Assistant Medical Officers resigned during the year on obtaining other appointments, Dr. Humphrey Butcher and Dr. D. F. Irvine. Dr. Butcher was succeeded by Dr. J. C. Aitken and Dr. Irvine by Dr. A. J. Muir; Dr. Aitken was previously Resident Medical Officer at the Isolation Hospital and devoted half his time to school medical inspection and treatment. Dr. M. Kelly was appointed to take Dr. Aitken's place. At the end of 1937 the Ophthalmic Surgeon, Dr. L. G. Scoular, resigned, and Mr. Graeme G. Talbot, F.R.C.S., was appointed in his place. THE SCHOOL MEDICAL SERVICE IN RELATION TO PUBLIC ELEMENTARY SCHOOLS. School Hygiene. During the last few years the great increase in the school population has necessitated the continual extension of existing schools and the building of new schools. This has been especially necessary in Greenford and more recently in Hanwell to cope with the children living on the London County Council Estate. The Sanitary arrangements of all schools in the Borough, both Council and private, are inspected annually by the Sanitary Inspectors who point out defects and advise regarding necessary improvements. In the Council schools only a few defects of a minor character were discovered and these, on being reported to the Education Committee, were immediately remedied. MEDICAL INSPECTION. Medical inspection included (1) the routine inspection in the schools of children in the three age-groups recommended by the Board of Education, namely, (a) entrants, (b) children at eight years, and (c) children at twelve years; (2) the special inspection of children referred by the head-teachers, school nurses, school enquiry officers, etc.; (3) the annual inspection of physically or mentally defective children and (4) the inspection of children in connection with the supply of milk at the cost of the Education Committee. 60 FINDINGS OF MEDICAL INSPECTION. A detailed summary of defects found at both routine and special inspections is contained in Table II on page 91. Among the 7,296 children examined in a routine manner there were, excluding uncleanliness and dental disease, 811 defects requiring treatment and 1,152 requiring to be kept under observation. The examination of the 6,505 children submitted to special inspection revealed 4,602 defects requiring treatment and 653 requiring to be kept under observation. Of the 7,296 children examined at the routine inspections, 764 or 10.5 per cent. were found to require treatment for one or more defective conditions. (a) Malnutrition.—The state of nutrition of the children examined at routine medical inspection is shown in Table II B on page 92. The classification is in accordance with the suggestions of the Board of Education as set out in the Administrative Memorandum No. 124 issued in 1935. The nutrition of the school children in Ealing, as indicated in previous reports, is very good. The percentage of children whose nutrition is satisfactory, that is, those classified as "excellent" or "normal" is 97.4. The percentage of children classified as slightly sub-normal remains almost exactly the same as in the previous year and only two children were found whose nutrition was considered to be "bad." As in previous years all children who were of subnormal nutrition were kept under medical supervision and were given free milk and meals when necessary. It was frequently noticed that children who had been originally classified as being of subnormal nutrition improved during their school life and were eventually classified as "normal," 61 UNCLEANLINESS. All elementary school children in the Borough are examined for cleanliness three times a year and if in any school the number of verminous children is found to be unusually high subsequent monthly inspections are made. When a child is found to have a few nits in the head a leaflet is sent to the parents giving instructions regarding methods of cleansing but if lice or over 20 nits are found the child is immediately excluded from school. An exclusion notice is sent to the head teacher and also to the parents with instructions to present the child for examination at the Health Centre when the head has been cleansed. The child is not re-admitted to school until quite clean. It is often necessary for the School Nurses to make several visits to a home to make sure that the necessary steps are being taken by the mother and if nothing is done within seven days the parents are warned that a summons may be issued if the child is not cleansed. The following table shows the number of children found to be unclean in the last four years. Year. Average number on Rolls. No. of examinations for verminous condition. No. of individual children found unclean. Legal proceedings taken under Attendance Byelaws. 1935 14,463 32,951 755 2 1936 15,251 33,578 830 8 1937 17,062 39,955 882 21 1938 18,107 43,372 1,200 18 The figure of 1,200 for unclean children appears a large increase over the figure of 882 for 1937, but it is not due to any increase in uncleanliness; it is due to the inclusion in the number of all children with nits however small in number. Formerly children with a very few nits were not classified as unclean. 62 FOLLOWING UP. After medical inspection at the schools and at the Health Centres, each defective child is carefully followed up to ensure that any necessary treatment is obtained. If the parent is present at the inspection advice is given regarding the steps to be taken to remedy any defect found. Following this a notice is sent to the parents stating the nature of the treatment required and in some instances where this treatment may be obtained if the parents are unable to pay for treatment privately. After the routine school medical inspection a list is sent to the head teacher of the various defects found and six weeks later the head teacher returns this list giving information as to whether or not the children have obtained treatment. In cases where the treatment has not been obtained the school nurse visits the home to make enquiries and to impress upon the parents the necessity of obtaining immediate treatment. Continued failure is followed up by a warning that legal action may be considered to compel the parents to obtain treatment. A threat like this is only necessary on rare occasions. Children found at dental inspection to require treatment are followed up by the schools nurses in the sanre way. Every child with a defect is re-inspected by the medical officer at the next school medical inspection and if it is thought necessary the child may be kept under continued observation at the Health Centre. When a child has been admitted to the King Edward Memorial Hospital for a throat or nose operation the school nurse visits the home after the child's discharge from Hospital to ensure that the child is making satisfactory progress. The number of visits made to the homes of children by the school nurses during the year was 5,039. 63 ARRANGEMENTS FOR TREATMENT. (a) Minor Ailments and Diseases of the Skin.—The treatment of minor ailments carried out at the Health Centres is shown in Table IV, Group 1 (page 96). It will be seen that as many as 73.4 per cent. of the children found to be suffering from minor ailments on medical inspection attended the Health Centres for treatment. The number of cases treated and the total number of attendances made were as follows Condition Treated No. of cases treated Total attendances made Skin: Ringworm 16 64 Scabies 128 376 Impetigo 339 2,970 Others 239 1,248 Minor eye defects 290 2,658 Minor ear defects 363 5,882 Miscellaneous: Minor injuries 315 1,411 Sores 1,098 7,096 Others 123 556 Total 2,911 22,261 Cases of scabies are now treated by the new method, using benzyl benzoate solution which is more efficacious and less troublesome than the old method with sulphur ointment Owing to the ease with which scabies spreads throughout a family it is deemed to be useless to treat affected school children only and now all the children in a family under school age are inspected and treated if necessary. An effort is also made to have the parents inspected or referred to their own medical practitioner 64 who is informed that treatment can be given to the adults at the Health Centre. The bedding and wearing apparel are at the same time disinfected at the disinfecting station. (b) Defective Vision.—The report of the Ophthalmic Surgeon Dr. Graeme Talbot, is as follows: Report on the Eyesight of School Children. "During the past year, 797 new cases were examined, 359 at Mattock Lane and 438 at Ravenor Park Health Centre. Reinspections numbered 745, 331 at Mattock Lane and 414 at Ravenor Park. Prescriptions for glasses were given in 1,000 cases and 987 pairs of glasses were actually obtained by the children. This shows a very satisfactory percentage of children actually getting glasses when they are required. "The method of examination has remained the same as in previous years. The vision is first tested in school by the School Nurse who refers children with defective eyesight to the Health Centre for further examination. On the morning the child comes for examination by the Oculist, homatropine and cocaine lamellae are inserted in the eyes and after an interval, the child is examined and the glasses prescribed. "In my opinion, this method is proving very satisfactory, and causes far less inconvenience to parents and children than the use of atropine ointment for some days before the examination. I have carefully compared the results of the examinations by this method with the results obtained at another School Centre which I attend, where I use atropine, and I am of the opinion that the results are equally reliable. Atropine, however, is used for the examination of most of the cases of squint. "The arrangements in force for the supply of glasses through the Centre are proving thoroughly satisfacton. The fitting of the glasses and the accuracy of the dispensing are both good and the prices charged to parents are most reasonable. I think this is an important contributory factor in the remarkably high percentage of parents who have had their children supplied with glasses as recommended. 65 "Very few children have been discovered who may be classed as progressive myopes. Actually, two new cases were labelled progressive myopes, and nine cases already so classified were reexamined. "Thirteen children suffering from squint, whose defect was not showing signs of improvement by other methods, were referfect for operative treatment, and in those cases where operations have been carried out, the results have been very satisfactory." Eye Cases—1938. Condition. New Cases. Re-Inspections. Hypermetropia 52 41 Hypermetropic Astigmatism 200 174 Myopia 94 96 Myopic Astigmatism 95 115 Mixed Astigmatism 32 35 Emmetropia 79 32 Squint 129 179 Eye Diseases 30 31 Children under 5 84 33 Progressive Myopes 2 9 Total 797 745 (c) Nose and Throat Defects.—The arrangements for operative treatment of nose and throat defects at the King Edward Memorial Hospital were described in the report for 1934. During the year under consideration 58 children were treated, 34 being operated on for enlarged tonsils, 9 for adenoids, and 15 for enlarged tonsils and adenoids. Defects of the nose and throat are found at routine medical inspections, at the inspection clinics or are referred for treatment from the infant welfare clinics. Children in whom tonsils and adenoids are suspected of causing ill-health are kept under observation by the medical officers and may be referred for advice to Mr. Arthur Miller, the consulting 66 otolaryngologist. If the tonsils or adenoids require removal, the parents are advised and the children may be sent to the King Edward VII Memorial Hospital for this treatment. After the operation the children are inspected at the school medical inspection and the effects of the operation are noted. As a result of this "following up" and of greater care in the selection of cases it has been found possible to reduce the number of children recommended for tonsil and adenoid operation. It is now believed that the tonsils and adenoids play an important part in the prevention of infection and their wholesale removal is to be deprecated. (d)Ear Defects.—The auriscope is employed to examine the ears of all children and all structural defects of the outer and middle ears can be discovered by means of it. Functional defects evidenced by deafness are noted at the school medical inspection by the medical officer or are brought to his notice by parents or the teachers. Hearing defects are in the majority of cases accompanied by recognisable physical signs detected by the auriscope. By these means it is considered that every case of deafness is discovered. Treatment of Ear Conditions. Children requiring simple treatment, for example, syringing th ears for wax and meatal boils are referred to the Health Centrel Most cases of otitis media are treated there also under medica supervision. Cases requiring specialized advice including those not responding satisfactorily to simple treatment, are referred to the special ear clinic which is attended by the consulting otolaryngologist. The special clinic is held once a month at Mattock Lane and at Ravenor Park Centres. Cases sent to the special clinic were grouped by the Consultant according to the following classification: A. Chronic otitis media—Suppurative. B. „ „ „ „ with granulations. C. „ „ „ „ „ polypus. D. Dry perforation. E. Chronic catarrhal otitis media. F. Eustachian catarrh. G. Past otitis media—suppurative. H. Other conditions. 67 There were 151 cases seen during the year, who altogether attended 384 times. Cases referred from— Defects found Total all defects A B C D E F G H 1. Routine school inspection 37 6 1 2 12 7 8 15 88 2. Inspection Clinics 20 4 2 1 6 1 4 13 51 3. Child Welfare Centres ... 9 — — — 1 — 1 1 12 Total 151 The cases were ultimately disposed of as follows: Discharged as cured 53 Referred to hospital for special treatment or operation 22 Still attending Clinic 54 Did not complete treatment 22 During the year special treatments were applied by means of ionization, politzerization, eustachian catheterization and diastolization. The last form of treatment was applied in 28 selected cases and proved conspicuously successful in catarrhal conditions of the nose and ear. After the cases have been treated by the Surgeon they are kept under medical supervision and are seen at definite periods either at the school of at the Clinic. The parents are also advised legarding the importance of guarding against "colds," the value of an open air regime and are told of the dangers of bathing and allowing water to enter the ears. (e) Dental Defects.-The report of Mr. C. Colenso, the Senior Dental Surgeon, gives a survey of the work of dental inspection and treatment during the year. For convenience, the report is inserted in three places in the Annual Report, the section relating to secondary school children appearing on page 86, that dealing with mothers and pre-school children on page 22, while the section giving a description of the work among elementary school children follows: 68 "The Dental Inspection and Treatment of Elementary School Children in 1938. "Dental inspections were carried out in all the schools in the Borough during the year, and the defective cases were treated at the five Health Centres established in the various areas. The total number inspected at the schools, and special inspections at the centres, was 17,527. This figure is greater by 1,039 than in the previous year. "The number found to require treatment was 9,757 and is smaller by 393, than in 1937. Those not in need of treatment amounted to 7,770. "The number actually treated was 6,903, an increase of 470 over the previous year. "At the special examination of children about to leave school, which is held at the senior schools, it was found that out of 1,473, who were submitted for examination, 1,198 or 81 per cent. had sound dentitions, that is, rendered sound by fillings or naturally sound. This is a very satisfactory figure which shows how successful dental inspection and treatment is in the Borough. "Orthodontic treatment was carried out in 28 new cases during the year. This number, including eleven cases from last year, makes a total of 39 children now fitted with regulation appliances. "The work carried out for all the children treated included extractions, fillings, gum treatments, scaling and dressings to septic root canals. "The number of fillings inserted in permanent teeth totalled 5,769. This figure is greater by 961 than in the previous year. This increase is due mainly to the increased number of children treated at the centres. Temporary fillings were inserted in 333 teeth of the temporary dentition. Therefore, the total number of fillings in all teeth was 6,102, being 900 greater than in 1937. "The total number of extractions was less in the year. The extractions of permanent teeth totalled 1,927, an increase of 258 over the previous year. The total number of extractions of temporary teeth was 10,364, this figure being smaller by 513 than in the preceding year. 69 "As regards other treatments given during the year, dressings of silver nitrate, and root dressings of septic anterior teeth, were inserted in 705 teeth, 151 children had their teeth scaled, and gum treatments were given to 13 children. All the treatment given during the year, including those children referred for administration of gas, meant 9,800 attendances of children." (/) Orthopaedic Treatment.—Prior to 1925 the only provision made by the Haling Education Committee for physically defective children was massage and remedial treatment at the King Edward Memorial Hospital, Ealing. It was noted that "in many instances the treatment was far too late in being sought, and that repeated visits at the hospital for supervision and treatment were made in a haphazard and irregular fashion. Moreover attendance at school was irregular and the education of the child materially suffered." In 1926 as a result of negotiations between the Ealing Education Committee and the Governors of the National Orthopaedic Hospital, Great Portland Street, a scheme was inaugurated as follows: (1) A Surgeon from the Orthopaedic Hospital to visit the Clinic once a month to examine the children, and advise as regards further operative and remedial treatment. (2) Children requiring operation to go to the Orthopaedic Hospital, Stanmore, where the necessary operation would be carried out and where the child's education would continue under special teachers. (3) Massage to be given at the Health Centre in cases where this was necessary by a masseuse provided by the National Orthopaedic Hospital. (4) Children not in need of hospital treatment, or after receiving treatment, to be kept under supervision in order to see that they regularly attend the Hospital or Health Centre. In the annual reports of the School Medical Officer the good results which were accruing from the scheme were noted; the children benefitted physically and educationally, while the parents were saved expense through having the treatment provided locally and through having facilities for early treatment before serious incapacity occurred. 70 In 1929 a second session per month was started and a new building, semi-permanent in character, was opened at the Mattock Lane Centre in 1930 for massage and remedial exercises. The following table shows the extent of the work performed at the Clinic during the years 1927-1938. As a result of the amalgamation with Hanwell and Greenford which occurred in 1926 the figures are only comparable from 1927 onwards as shown in the table. At the commencement of the scheme the cases met with were of a severe character but now, as they attend for treatment early, they tend to be milder and more amenable to remedial measures. As the table shows, the majority of children are sent to the Centre from the child welfare centres, at an age when many of the deformities are very susceptible to treatment. TABLE. Children coming within the Orthopaedic Scheme in each Year. school Children. Infant Welfare Children. Year. Children on School Registers. New Cases seen by Orthopaedic Surgeon. Operations on School Children. New Cases seen by Orthopaedic Surgeon. Operations on Infant Welfare Children. Total Operations. 1927 9,480 78 3 49 0 3 1928 9,744 93 4 59 4 8 1929 10,442 73 4 87 3 7 1930 10,822 81 4 91 6 10 1931 11,769 106 4 105 5 9 1932 12,479 85 6 72 8 14 1933 13,253 81 8 81 1 9 1934 14,077 104 9 112 7 16 1935 14,463 99 9 126 6 12 1936 15,251 139 9 126 3 15 1937 17,062 124 9 152 3 12 71 Causes or Crippling.—Crippling may occur in the following ways: 1. Congenital defects and birth injuries. 2. Following acute diseases, such as poliomyelitis, acute inflammation of the bones and joints. 3. Chronic diseases, e.g., tuberculosis, syphilis and rheumatism. 4. Nutritional diseases: rickets. 5. As a result of accidents. 6. Postural defects. The defects vary from conditions that are so severe that they totally incapacitate the child to the milder defects such as knock knees and flat feet. It must be remembered, however, that these mild defects may, unless remedied, progress and cause the patient much distress and in some cases preclude him from entering certain occupations. (a) Prevention of Crippling.-The majority of crippling defects can be prevented and it has been truly stated by that great pioneer of orthopaedic treatment, Sir Robert Jones, that "the cripple is made not born." The following is a short summary of the methods that are employed to prevent crippling. (i) Ante-natal care and care of the mother at childbirth. By this care injury to the mother and to the child at birth may be avoided. (ii) Care of the Infant.-By stressing the importance of protective foods such as Milk, Cod Liver Oil, vegetables and fresh fruit juice it should be possible to prevent rickets and scurvy. The mother is advised to use pasteurised milk as in this way the risk of tuberculous infection is reduced. Rheumatism in its early stages may be detected and at the infant clinics the mother is advised to seek appropriate treatment. (iii) The School Child.-The mother is again told of the importance of protective foods at medical inspection. Improvements in lighting of classrooms and in sitting accommodation for scholars have helped to reduce the minor degrees of defornrities associated with faulty posture which unchecked might lead to much discomfort and even incapacity 72 of the child in later years. Physical education also helps to tone up the child's musculature and to correct early deformities. (iv) Prevention of Accidents—especially load accidents by the inculcation of the ideas of the Safety First Organisation. (v) Improved care of tubeiculous patients prevents dissemination of the disease. As a result there has been a marked reduction of crippling due to tuberculosis of the bones and joints while the improved treatment of syphilis had led to a reduction in the number of congenitally infected children who frequently showed marked deformities. (b) Care of the Cripple.—(i) Ascertainment.—Most children are under medical supervision from birth. Through the agencies of the midwife, health visitor, school nurse, medical officer at the Infant Welfare Centre or School Clinic, the school teacher the parents or the private practitioner it should be possible for any child who requires orthopaedic treatment to be ascertained and to be placed in the way of receiving appropriate treatment. (ii) Treatment.—(1) The Orthopaedic Clinic is held twice a month at the Mattock Lane Health Centre. Here the examination, diagnosis and supervision is carried out by the Orthopaedic Surgeon. (2) Hospital Treatment.—Children in need of operative treatment are referred by the Surgeon to the Orthopaedic Hospital at Stanmore. Attached to the Hospital there is a residential open air school so that the children, some of whom are obliged to spend long periods in the Hospital, may receive education at the same time as they are being treated for their disease. The Surgeon who examines the children at the Orthopaedic Clinic is also in charge of the Hospital. (3) Special Residential Schools.—Children who are so crippled as to be unable to attend an ordinary school are sent to a special lesidential school where they are educated and also taught a trade to enable them to become self supporting. At the present time there are only six crippled children from the Borough of Ealing in Residential Schools. This small number is a testimony to the value of a complete orthopaedic scheme. 73 (4) Massage and Remedial Treatment.-This is given at Mattock Lane Health Centre on five sessions each week. Special corrective exercises and massage prescribed by the surgeon are given to the children. Mothers are also shown these exercises and are urged to see that they are carried out at home by the children. (5) Orthopaedic Apparatus.—Arrangements are made for the supply of splints, special boots, etc., free of charge or at reduced cost according to the circumstances of the parents. Many of these special appliances are manufactured by the cripples at the workshops attached to the Orthopaedic Hospital. (6) Open Air Schools.—Many of the newer schools in the Borough of Ealing are built on open air lines and the children undoubtedly benefit from this arrangement, but as was pointed out in the Annual Report for 1937 many slightly crippled children who are now in ordinary schools and who do not require residential school education would benefit by attendance at an open air day school. (7) After Care.—The Juvenile Employment Committee endeavour to find suitable occupations for children who on account of their defects find it difficult to obtain occupation or are unable to compete in the open labour market. The work of the Orthopaedic Clinic during the year may be summarized as follows: Orthopaedic Clinic. School children. Children under five. Total Attendances by Surgeon 12 13 25 Number of children seen for first time 158 171 329 Total number of children examined 653 553 1,206 Attendances by Masseuse 87 136 223 Number of cases treated 171 87 258 Number of attendances by children 1,744 754 2,498 Children admitted to hospital for special treatment 27 7 34 Children supplied with special boots or surgical appliances 20 10 30 74 ORTHOPAEDIC CASES, 1938. School Children seen by Surgeon during year. Old Cases. New Cases. Total Boys Girls Boys Girls Flat feet 14 - 8 9 31 Congenital Abnormality of toes 9 2 - 1 12 Pesplano valgus 10 10 6 4 30 Epiphysitis of oscalcis - 2 - - 2 Metatarsus varus 1 1 1 - 3 Intoeing - 3 - - 3 Exotosis of heels - 1 - - 1 Congenital equino-varus 3 - - - 3 Hallux valgus - 1 - 1 2 Hallux rigidus 1 1 1 - 3 Hallux varus 1 - 1 - 2 Calcaneo valgus 3 3 - - 6 Hammer toe 1 - 2 2 5 Plantar Warts - 1 1 - 2 Loose body in knee 1 - - - 1 Genu valgum 49 45 8 10 112 Anterior Poliomyelitis 6 10 1 1 18 Muscular strain - 1 - - 1 Congenital Haemiplegia 1 4 - - 5 Splastic Diplegia - 2 - - 2 Paresis of lower limbs - 1 - - 1 Congenital abnormality of fingers 1 2 - - 3 Fracture of elbow - 1 - - 1 Erb's Paralysis - 4 - - 4 Amputation of arm 1 3 1 - 5 Scoliosis 15 31 14 20 80 Lordosis - 1 2 - 3 Kyphosis 5 8 1 7 21 Epiphysitis of spine - 1 - - 1 Osteomyelitis of leg 7 1 2 - 10 Strained ligament - 1 - 1 2 Tuberculous disease of hip (quiescent) 1 1 - - 2 Congenital dislocation of hip - 3 - - 3 Limited movement of hip 1 1 1 - 3 Congenital absence of fibula 1 - - - 1 Torticollis 3 5 - 3 11 Tuberculous disease of spine (quiescent) 1 2 - - 3 Genu Varum 5 1 - 1 7 Genu Varum, rickety 1 - - - 1 Congenital hemiatrophy - 1 - 1 2 Perthe's Disease 3 - 1 - 4 Accessory scaphoids - 1 - 1 2 Fracture of tibral spine - 1 - 1 2 Bony deformity of foot 1 - - - 1 Prominent Coecyx 1 - - - 1 Talipes (Club foot) - - 1 - 1 Chronic Bursitis of Knee - - - 1 1 Irregular toes - - 2 2 4 Multiple Exostoses of fibula - - 1 1 2 Claw Toes - - - 1 1 Bony swelling of ankle - - 1 1 2 Painful hip joint - - - 1 1 Pigeon chest - - 1 2 3 Scar from burn of hand - - - 1 1 Infective arthritis of leg - - 1 - 1 Referred but no treatment 17 10 17 10 54 75 ORTHOPAEDIC CASES, 1938. Children under 5 years seen by Surgeon during year. Boys Girls Total Flat Feet 3 4 7 Pes piano valgus 14 7 21 Intoeing 5 5 10 Metartarsus varus 4 5 9 Congenital calcano-valgus 3 1 4 Congenital club foot — 1 1 Congenital abnormality toes 9 1 10 Congenital pes cavus 1 — 1 Genu Valgum (non-rickety) 56 43 99 Genu Varum (non-rickety) 5 1 6 Genu Varum—rickety 40 24 64 Torticollis 10 10 20 Congenital abnormality of fingers 4 1 5 Erb's Paralysis 1 1 Separation of lower femoral epiphysis 1 — 1 Congenital dislocation of hip 2 1 3 Anterior Poliomyelitis — 3 3 Spastic Haemiplegia 1 — 1 Flat Chest 1 — 1 Haematoma of ankle 1 — 1 Assymetry of skull 1 — 1 Injury to scapulae — 1 1 Total 161 109 270 No treatment required 7 6 13 (g) Defective Speech.—Speech defects are usually evident in the pre-school period. Whilst some children show no other abnormality many are of a nervious type. In others, physical defects, such as cleft palate, or constitutional disease, such as chorea and epilepsy, or the sequelae of an infection like meningitis, are contributory factors. Injury, where it is of the nature of mental shock, as in concussion, can determine the onset of a speech defect. In some few cases an hereditary influence or an imitative factor is traceable. Children are admitted to the speech class only after they have reached the age of seven years. Before entry to the class a complete medical examination of each child is made and advice offered, if necessary, regarding the general health. Thereafter the children attend the Health Centre twice weekly and receive instruction in rhythmical breathing exercises, the principles of relaxation, and speech exercises. This part-time method interferes very little with the ordinary school curriculum, 76 Periodically the children are examined by the Medical Officer to determine their progress, and comparisons are made with reports received from the school teachers and notes frorrr the parents, often obtained at persorral interviews. There is little doubt that children derive much benefit from attendance at the speech class, many becoming greatly improved and much less self conscious of their speech defect, whilst in some a complete cure is obtainable although, even in mild cases, this may take a year or more. The treatment of speech defects is undertaken at Mattock Lane and Ravenor Park Health Centres. During the year there were in attendance a total of 43 children. Of these at the time of report, there were (a) still attending 34 (b) discharged as cured 6 (c) no longer resident in district 3 The method of classification and the results of treatmerrt can be seen in the following table: Observations Tabulated. Total Number 43. Defect. "Stammer" Degree of Defect Slight Marked Severe No 19 22 2 Related Influences. (a) None ascertained 13 9 2 (b) Nervousness 5 2 — (c) Nervousness and other defects 1 3 — (d) Hereditary influences — 1 — (e) Physical defects - 2 — (/) Disease - 3 1 (g) Injury — 2 — Response to Treatment. (a) Cured 4 2 — (b) Very much improved 5 6 1 (c) Distinctly improved 1 3 — (d) Improved 5 10 — (e) Relapse 1 1 1 (f) Left district 3 — — 77 (h) Convalescent Treatment.- During the year 27 children were sent to the Russell Cotes School of Recovery, Parkstone, and 20 children were sent to Collington Manor, Bexhill. In addition, the King Edward Memorial Convalescent Home Fund provided 8 children with a holiday of two weeks' duration in the summer months at Collington Manor. In the Annual Report for 1937 mention was made of steps being taken to secure a larger number of vacancies at convalescent homes and the increase in the number of children sent during 1938 has been found to be of great value. Arrangements were made with the Invalid Children's Aid Association to reserve one bed at each of the Homes administered by them at Worthing, Broad stairs, Dover and Seaford. Following these reservations 5 children were sent to Worthing, 4 to Broadstairs, 3 to Dover and 5 to Seaford. On return to Haling every child is examined by the Medical Officer and the result of the stay is noted. INFECTIOUS DISEASE. The returns forwarded each week by the head teachers giving particulars of all new cases of non-notifiable infectious disease coming to their knowledge included 2,539 cases of measles, 1,654 of whooping cough, 1,406 of chickenpox and 120 of mumps. Children to the number of 443 were excluded under Article 20 (b) of the Education Code for the following conditions : Impetigo 306 Ringworm of body 8 Scabies 117 Other skin diseases 10 Conjunctivitis 1 Ringworm of head 1 443 No closure took place under Articles 22 or 23 (b) of the Code— Grant Regulations. 78 The following schools required certificates under Paragraph 15 (ii) of the Administrative Memorandum No. 51 issued by the Board of Education: Bethams 2 weeks for measles. Northfields Infants 4 weeks for measles. Wood End Infants 1 week for measles and chicken pox ; 2 weeks for measles. The School Medical Officer, in virtue of his position as Medical Officer of Health, receives information regarding all cases of notifiable infectious disease and all school children who live in the same house are isolated in accordance with the recommendations of the Board of Education. Information is also sent to the School Medical Officer from the head teachers concerning all children excluded from school because of non-notifiable infectious diseases. These school notifications include diseases such as mumps, measles, chicken pox and whooping cough which, not being " notifiable infectious diseases," would not be notified to him by the general practitioner. If there is a large number of cases of infectious diseases in a school an Assistant School Medical Officer visits the school. He makes inquiries regarding the health of the children in the affected classes and inspects any child who has been absent from school and whose explanation of absence is not satisfactory from a health point of view or who has any suspicious sores or discharges. In this way it is sometimes possible to discover a missed case of scarlet fever or a carrier of diphtheria. When a case of notifiable infectious disease occurs in a house a visit is made by the Sanitary Inspector and an attempt is made to connect up the case with others that have occurred and to discover the source of infection. A pamphlet is left with the householder explaining what steps should be taken to prevent the spread of infection. It has frequently been possible to obtain information regarding doubtful cases and this information has been passed as a routine practice to the practitioner in charge of the case. A member of the Public Health Staff is always available for a second opinion in a case of infectious disease when requested by the general practitioner. 79 Immunization against Diphtheria.—Clinics for the immunization of children against diphtheria are held at the Health Centres. Parents are approached by means of leaflets 01 by short talks given to them at school medical inspections 01 during their attendance at the Child Welfare Centres. Children over five years of age are given a preliminary (Schick) test on account of the high percentage that are immune to the disease above this age. Those giving a positive reaction and thus requiring immunization are given two injections of Alum Precipitated Toxoid (A.P.T.), the interval between the injections being one month. Children over 12 years of age are given three injections of Toxoid Antitoxin Floccules (T.A.F.) owing to reactions found after A.P.T. in the older children. All children who have received the treatment are given a final test three mouths after the last injection to find out if they have become immune. Immunization Work at Health Centres in 1938. Preliminary Schick tests 351 School children immunized 279 Children under 5 vears immunized 519 Final Schick tests 791 The total number of children immunized at the Health Centres during the year was 798, but although this is an increase on last year the number is so small as scarcely to affect the incidence of diphtheria in the district. CO-OPERATION OF PARENTS, TEACHERS, SCHOOL ATTENDANCE OFFICERS AND VOLUNTARY BODIES. The co-operation of parents, teachers, school attendance officers and certain voluntary bodies is of great value in furthering the efficiency of the School Medical Service. The great help given by the teachers in connection with school medical inspection and the treatment of defective children is greatly appreciated and there is no doubt that the contact which the teachers make with the parents is very effective in obtaining of the required treatment. 80 Acknowledgment of assistance must be made to certain voluntary bodies who have continued to co-operate in various ways, such as the Central Aid Society, the National Society for the Prevention of Cruelty to Children, and the School Attendance Aid Committee. PHYSICAL EDUCATION. Increasing interest is being shown in physical education. Two physical training organisers have been appointed, who, besides organising the physical training in the schools, gives courses of training to the teachers. Most schools have their own playing fields and there is no school without facilities for games. There are also well equipped gymnasia at the Modern and the Cuckoo Schools. The swimming bath for school childien, which is specially constructed for teaching purposes, is so much in demand that the ordinary bath is sometimes pressed into service and the innovation of winter swimming was so popular in the previous year that it has been continued. A swimming gala was held in September and was a great success. School games are organised by the physical training organisers according to the Handbooks issued by the Board of Education. Competitive games are held out of school hours and there is an annual inter-school sports day. These activities are arranged by a committee of the school teachers who devote a large amount of time out of school hours to this aspect of the children's development. The Report of the Physical Training Organisers, Miss M Evans and Mr. E. R. Holmes, is as follows: Physical Education." " The period covered by this statement coincides with the first year the Physical Training Organisers have spent in Ealing. As is to be expected a proportion of that time has been spent in assessing the existing facilities and work, and while no sudden changes have been suggested, endeavours have been made to see that as far as possible the children receive the utmost benefit from their physical activities. With this intention, assistance has been given as frequently as has been practicable to ensure that the 81 children are given the type of instruction most suited to their age and ability. It has been established that children fail to gain maximum benefit from their exercise on account of excessive and unsuitable clothing, while the type of work given has, on many occasions, had to be modified as the children, for one reason or another, are not in possession of suitable footwear. In certain schools progress has been made in these directions and the adoption of suitable attire and footwear has become regular rather than exceptional, but in the majority of schools much improvement remains to be secured. " Whenever possible physical activities are taken out of doors. The extent to which this can be done depends principally upon the weather and when this is unfavourable and there is no hall available the time is devoted either to restricted classroom lessons or to talks bearing on physical education, e.g., hygiene, games coaching, swimming, land drill, etc. In addition to physical training most children receive instruction in some form of games, dancing or swimming, according to their age. The difficulties with regard to playing fields for organised games have been alleviated by adjustment of the attendance at the playing fields concerned, but in the case cf swimming this is not possible and activity in this direction is considerably curtailed, principally by the poor accommodation available and also by the situation of that accommodation in relation to the whole Borough. " This brief outline of the initial activities of the Physical Training Organisers would not be completed without mention of the ready co-operation on the part of school staffs which has been given from the outset and without which a co-ordinated scheme of physical training throughout the Borough would not be possible." MILK IN SCHOOLS. The number of children receiving a daily supply of one-third of a pint of milk is again higher than the previous year. It will be seen from the table that the Junior and Infants' Schools show the highest percentage having milk. During October leaflets issued by the National Milk Publicity Council stressing the nutritive value of milk as a food and the 82 benefit derived by children who receive a regular supply were sent to all schools for distribution to the parents through the children. At the beginning of October before the leaflets were issued 11,967 children were receiving milk, while at the end of the month after the distribution of the leaflets this number had increased to 12,197. At the present time milk is not supplied to children during the school holidays. Efforts are being made however to make arrangements for children to receive milk, commencing at the Easter holiday, and there is no doubt that the continuance of the daily supply, particularly to those children receiving free milk who cannot receive a sufficient amount while at home, will be especially valuable. As a result of the report on the nutrition of school children submitted by the School Medical Officer in the previous year, a Sub-Committee was appointed by the Education Committee to consider the report and to make recommendations. The Committee decided that as an experiment meals should be supplied at Cuckoo School to necessitous childien attending this school and also to those attending Hobbayne and St. Ann's Schools. An account of this experiment will be given in next year's report. The following table shows the number of children having a daily supply of milk in school in 1938 and in the two previous years. Milk is supplied in bottles containing one-third pint under the Scheme of the Milk Marketing Board at a cost of one half-penny. Date of Enquiry Number on Registers Number having milk Percentage having milk 1/10/1936 15,477 8,516 55.0 1/10/1937 17,709 10,987 62.0 1/10/1938 18,124 11,967 66.0 83 Number and Percentage of Children having Milk on the 1st October, 1938. No. of school departments in group. No. of children on registers. No. having milk. Percentage having milk 1/10/37 .1/10/38 Senior Mixed 1 447 112 25.2 25.0 Senior Boys 7 2,163 948 43.8 43.8 Senior Girls 6 2,259 1191 46.0 52.7 Mixed 1 351 257 66.0 73.2 Junior Boys 1 372 213 — 57.2 Junior Girls 1 368 297 — 80.4 Junior Mixed 11 5,078 3,401 59.4 68.9 Junior Mixed and Infants 10 3,593 2,720 70.8 75.6 Infants 12 3,493 2,828 78.0 80.9 50 18,124 11,967 62.0 66.0 The number of children supplied with milk free of charge under Section 82—85 of the Education Act, 1921, were as follows : Number of children for whom a supply of milk was approved, 1st January, 1938 1,377 Number of children for whom a supply of milk was approved, 31st December, 1938 1,674 Daily average number of milk meals 1,448 Total number of bottles of milk supplied 304,018 Cost of milk supplied £633 BLIND, DEAF, DEFECTIVE AND EPILEPTIC CHILDREN. Table III gives the number of exceptional children in the area under each heading. It shows the number of these exceptional children in each category who are being maintained at certified schools, those who attend public elementary schools and those who are not attending any school as at the 31st December last year. It will be noted that 43 children were being maintained at certified schools by the Education Committee. 84 As regards mentally defective children the policy has been to notify as ineducable children who on attaining seven years of age have an Intelligence Quotient under 50 per cent. or who after attaining that age and having had a trial in school for one or two years have an Intelligence Quotient between 50 and 60 per cent. ; and to keep in parallel or backward classes those with an I.Q. between 60 and 75 per cent. unless they prove " difficult," or in other words show anti-social tendencies, either at home or at school, when steps are taken to have them admitted to Special Residential Schools for the feeble-minded. There has therefore been no pressing need for the provision of a Special Day School for feeble-minded childien. NURSERY SCHOOLS. There are three Nursery Schools in the Borough, attached to St. John's, St. Mark's and Stanhope Schools. There is also a class for children undei five at Drayton Infants' School. St. John's.—The Nursery School here has been in existence for some years, but it has recently been re-organised and is now accommodated in the main school building. There are two classes, one for children from three to four years, of whom there are 27, and one for those from four to five years, of whom there are 30. They occupy two large rooms on the ground floor, which communicate with each other, and there is a separate annexe of bathroom and water-closets, with necessary equipment for the washing of overalls, etc. The children all have milk in school (four have free milk) and also cod liver oil emulsion. The usual nursery school routine is adopted, with toothbrush drill, lessons in cleanliness, afternoon rest and opportunities for both individual play and collective games. St. Mark's.—There are two classes here also, 30 children aged 3 to 4¼, and 35 aged 4¼ to 5 years. They are housed in two rooms adjoining, each opening direct on to the playground. Each child has ¼ pint of milk with a biscuit for lunch in the morning, as it is found that the usual 1/3 pint is rather much for very young childien. 85 The same routine is followed here as at St. John's, the equipment being rather more ample and more modern as it is a newer school. Montessori methods are followed and the corresponding apparatus is used. Stanhope.—This Nursery School is the most recent one to be opened in the Borough and has now been in existence about eighteen months. It consists of only one class although there is rather a long list of childien awaiting admission. There are 34 children in the class of whom 14 are three years of age. All the childien have milk, six of them having it free. The class occupies an open-air type of schoolroom. There is an annexe comprising cloakroom with wash-hand basins, waterclosets and separate bathroom. There is also a large store room and an ample supply of toys and apparatus. Drayton Infants.- There is a separate nursery class in this school consisting of 33 children aged 4 to 4½. It is run partly on nursery school and partly on infant school lines. Theie is no proper afternoon rest for the cliildren, and the amount of toys and other equipment is limited. All the children have milk in school. It would be much more satisfactory if these young children could enjoy the full nursery school routine and not be treated merely as the lowest class of an infant school. SECONDARY SCHOOLS. Medical inspection was carried out as in former years on behalf of the Middlesex Education Committee in four County Schools in the Borough, 815 routine and 36 special inspections of pupils being made. Ophthalmic treatment was given during the year to 100 pupils attending County Schools and for 76 of th se spectacles were prescribed and supplied through the school medical department. 86 Dental inspection of all the pupils attending the County Schools was carried out on behalf of the Middlesex Education Committee and the following is the report of the School Dental Surgeon : " Dental inspection of all the pupils attending the County Schools was carried out on behalf of the Middlesex Education Committee for the fourth successive year. It was found that, by the end of the year 412 pupils had been treated. This number is greatei by 20 than in the previous year. The work carried out was chiefly conservative in character. " The fillings inserted totalled 635, and this figure is greater by 91 than in the preceeding year. The number of extractions of permanent teeth performed was 250, a number greater by 68 than in the preceding year, and including the 21 temporary teeth, a total of 271 teeth were removed for these pupils. Other treatments given included dressings to 49 teeth, scaling was done for 7 childien, temporary fillings were inserted in 17 teeth and two cases for orthodontic treatment attended for adjustment during the year. Altogether 602 attendances were made at the Mattock Lane and Cherington House Centres for the treatment given to these pupils." HEALTH EDUCATION IN SCHOOLS. The teaching of hygiene in the schools is modelled generally on the " Handbook of Suggestions on Health Education " of the Board of Education, and takes the form of formal talks with incidental teaching ana demonstrations under the direction of the teachers. Formal talks are not of great permanent value except in the case of the older children, and demonstrations are of necessity restricted to the older children. The inculcation of healthy habits is ensured by the daily supervision of each child by the teacher ; the hands and teeth are constantly examined and the fresh-air habit is fostered hy the regular use of open windows. Talks on hygiene are looked upon as the most useful method of approach to the children. 87 The school medical service assists in the teaching of older girls by means of lectures from the senior school nurses and also by demonstrations of the working of the health centres. PAYMENTS BY PARENTS. The following is a list of the various forms of treatment provided by the School Medical Service giving the maximum amount to be paid for each form of treatment. Throat and Nose Operations £1 1 0 X-Ray Tieatment for Ringworm £1 1 0 Artificial Sunlight Treatment 1/6 per Treatment Massage 1 /- per Treatment Dental Treatment 1/-, plus 1 /- for Gas Ophthalmic Treatment Cost of Spectacles Convalescent Home Treatment and Orthopaedic Hospital Assessed according to Special Scale Payment for the various forms of treatment is determined by a scale based on the average income per head. This average is calculated on the income remaining after deductions have been made for rent, insurances and travelling expenses. The scale is as follows : Where the average income per head is under 10/- No Charge From 10/- to 15,/- One Third From 15/- to 20/- Two Thirds Over 20/- Full Charge In cases where residential hospital treatment or convalescent home treatment is required the amount to be paid weekly is determined by the same scale as that used by the Education Committee for residential treatment in special schools and proves very satisfactory. The arrangements with the Hospital Saving Association continue to prove very satisfactory and the fact that the Association becomes responsible for the payment for treatment of its members' children has induced many parents to join the Association. 88 EMPLOYMENT OF CHILDREN AND YOUNG PERSONS. Children.—The number of children examined in connection with their employment out of school hours was 314 and of this number 20 were found to be unfit for employment. The nature of the employment of those certified as fit was : Boys. Errand Boys 133 Milk Round 37 Newspaper Round 59 Baker's Round 37 Order Boy 2 Others 25 293 Girls. Domestic Help 1 1 294 These children are submitted to re-examination when routine medical inspection is being carried out in their school and if it is found that employment is detrimental to their health, sanction to employment out of school hours is withdrawn. This action was found to be necessary in 4 instances. At routine inspection one child under the permitted age was found to be working cut of school hours, and 37 children were found who had not obtained the necessary permission. Forty girls were examined in connection with the issuing of licences under Section 22 of the Cliildren and Young Persons Act, 1933, permitting employment in entertainments. Young Persons.—There is intimate co-operation between the Juvenile Employment Department and the School Medical Service in regard to the supervision of juveniles after leaving school. Such information as is available in the records is passed over to the Juvenile Employment Officer and advice on particular boys and girls sought by that officer is most readily given. 89 Information from the school medical records is given on application by medical practitioners under the National Health Insurance (Juvenile Contributors & Young Persons) Act, 1937 Section 6. MISCELLANEOUS. It is usual to group under this heading the medical examination which are made of candidates prior to their appointment on the teaching staff of the Education Committee and of other candidates on appointment to various branches of the Council's technical and clerical staff and of manual workers. All these examinations are carried out by the school medical staff assisted by the school nurses. During the year 61 teachers and 214 othei candidates were examined. School Medical Officer and Medical Officer of Health, 90 STATISTICAL TABLES. The Tables required by the Board of Education are as follows:— TABLE I. RETURN OF MEDICAL INSPECTIONS. A.—Routine Medical Inspections. Number of Inspections in the prescribed Groups:— Entrants 2,528 Second Age Group 2,638 Third Age Group 2,130 Total 7,296 Number of other Routine Inspections — B.—Other Inspections. Number of Special Inspections 6,505 Number of Re-Inspections 5,193 Total 11,698 C.—Children Found To Require Treatment. Number of individual children found at Routine Medical Inspections to require treatment (excluding Defects of Nutrition, Uncleanliness and Dental Diseases):— Group. For defective vision (excluding squint). For all other conditions recorded in Table IIa. Total. Entrants 15 179 194 Second Age Group 197 128 316 Third Age Group 152 107 254 Total (Prescribed Groups) 364 414 764 Other Routine Inspections — — — Grand Total 364 414 764 91 TABLE II.—A. RETURN OF DEFECTS FOUND BY MEDICAL INSPECTION IN THE YEAR ENDED 31st DECEMBER, 1938. DEFECT OR DISEASE Routine Inspections Special Inspections No. of Defects. No. of Defects. Requiring Treatment Requiring to be kept under observation, but net requiring Treatment Requiring Treatment Requiring to be kept under observation, but not requiring Treatment Skin Ringworm, Scalp — — 4 — Body — — 16 — Scabies 5 — 130 — Impetigo 9 — 360 — Other Diseases (Non-Tuberculous) 5 4 391 6 Eye Blepharitis 12 6 77 — Conjunctivitis 8 1 134 — Keratitis 1 — 1 — Corneal Opacities — — — — Other Conditions 6 5 136 8 Defective Vision (excluding Squint) 364 7 228 10 Squint 59 8 48 3 Ear Defective Hearing 9 9 14 5 Otitis Media 20 11 163 1 Other Ear Diseases 50 12 182 4 Nose and Throat Chronic Tonsillitis only 33 411 65 122 Adenoids only 1 8 10 6 Chronic Tonsillitis and Adenoids 10 2 18 4 Other Conditions 5 48 197 35 Enlarged Cervical Glands (Non-Tuberculous) 1 103 48 40 Defective Speech 5 20 19 8 Heart and Circulation Heart Disease: Organic — — — 6 Functional 1 56 — 13 Anaemia 1 19 6 19 Lungs Bronchitis 9 40 38 30 Other Non-Tuberculous Diseases 5 26 22 14 Tuberculosis Pulmonary : Definite — — 1 1 Suspected — 9 — 32 Non-Pulmonary: Glands 3 4 1 4 Bones and Joints 1 — 1 — Skin — — — — Other Forms — — 1 1 Nervous System Epilepsy 2 8 1 1 Chorea. 1 4 3 1 Other Conditions 3 7 3 25 Deformities Rickets — 1 — — Spinal Curvature 36 32 15 11 Other Forms 98 220 85 38 Other Defects and Diseases (excluding Uncleanliness and Dental Diseases) 48 71 2184 205 TOTAL 811 1152 4602 653 92 B.—CLASSIFICATION OF THE NUTRITION OF CHILDREN INSPECTED DURING THE YEAR IN THE ROUTINE AGE-GROUPS. Age-Groups. Number of Children Inspected. A. (Excellent). B. (Normal). C. (Slightly subnormal) . D. (Bad). No. % No. % No. % No. % Entrants 2,528 297 11.7 2,189 86.6 42 1.7 — — Second Agegroup 2,638 180 6.8 2,393 90.7 64 2.4 1 .003 Third Agegroup 2,130 171 8. 1,873 87.9 85 4. 1 .004 Other Routine Inspections — — — — — — — — — Total 7,296 648 8.9 6,455 88.5 191 2.6 2 .002 93 TABLE III. RETURN OF ALL EXCEPTIONAL CHILDREN IN THE AREA. BLIND CHILDREN. At Certified Schools for the Blind. At Public Elementary Schools. At other Institutions. At no School or Institution. Total. 2 — — — 2 PARTIALLY SIGHTED CHILDREN. At Certified Schools for the Blind. At Certified Schools for the Partially Blind. At Public Elementary Schools. At other Institutions. At no School or Institution. Total. — 3 11 — — 14 DEAF CHILDREN. At Certified Schools for the Deaf. At Public Elementary Schools. At other Institutions. At no School or Institution. Total. 19 — — — 19 PARTIALLY DEAF CHILDREN. At Certified Schools for the Deaf. At Certified Schools for the Partially Deaf. At Public Elementary Schools. At other Institutions. At no School or Institution. Total. — — 23 — — 23 94 MENTALLY DEFECTIVE CHILDREN. Feeble-minded Children. At Certified Schools for Mentally Defective Children. At Public Elementary Schools. At other Institutions. At no School or Institution. Total. 6 78 — 2 86 EPILEPTIC CHILDREN. Children suffering from Severe Epilepsy. At Certified Special Schools. At Public Elementary Schools. At other Institutions. At no School or Institution. Total. 4 — — — 4 PHYSICALLY DEFECTIVE CHILDREN. A. Tuberculous Children. I.—Children suffering from Pulmonary Tuberculosis. At Certified Special Schools. At Public Elementary Schools. At other Institutions. At no School or Institution. Total — — 3 1 4 II.—Children suffering from Non-Pulmonary Tuberculosis. At Certified Special Schools. At Public Elementary Schools. At other Institutions. At no School or Institution. Total. 1 — — — 1 95 B. Delicate Children. At Certified Special Schools. At Public Elementary Schools. At other Institutions. At no School or Institution. Total. — 110 — — 110 C. Crippled Children. At Certified Special Schools. At Public Elementary Schools. At other Institutions. At no School or Institution. Total. 9 21 — — 30 D. Children with Heart Disease. At Certified Special Schools. At Public Elementary Schools. At other Institutions. At no School or Institution. Total. 2 10 — 2 14 CHILDREN SUFFERING FROM MULTIPLE DEFECTS. Combination of defect. At Certified Special Schools At Public ElementarySchools At Other Institutions At no School or Institution Total. Nil — — — — — 96 TABLE IV. RETURN OF DEFECTS TREATED DURING THE YEAR. TREATMENT TABLE. Group 1.—Minor Ailments (excluding Uncleanliness, for which see Group 6). Disease or Defect Number of Defects treated, or under treatment during the year. Under the Authority's Scheme Otherwise Total Skin :— Ringworm—Scalp X-ray treatment — 1 1 Other treatment 3 — 3 Ringworm—Body 13 3 16 Scabies 128 7 135 Impetigo 339 30 369 Other Skin Disease 239 157 396 Minor Eye Defects (External and other, but excluding cases falling in Group II) 290 85 375 Minor Ear Defects 363 75 438 Miscellaneous (e.g., minor injuries, bruises, sores, chilblains, etc.) 1,536 696 2,232 Total 2,911 1.054 3,965 97 Group 2. —Defective Vision and Squint (excluding Minor Eye Defects treated as Minor Ailments—Group 1). Defect or Disease No. of Defects dealt with. Under the Authority's Scheme Otherwise Total Errors of Refraction (including Squint) 1533 45 1578 Other Defect or Disease of the Eyes 9 — 9 Total 1542 45 1587 Number of Children for whom Spectacles were:— (a) Prescribed 1000 45 1045 (b) Obtained 987 45 1032 Group 3.—Treatment of Defects of Nose and Throat. Number of Defects Received Operative Treatment Received other forms of Treatment Total number Treated Under the Authority's Scheme in Clinic or Hospital By Private Practitioner or Hospital, apart from the Authority's Scheme Total 58 3 61 — 61 98 Group 4.—Orthopaedic and Postural Defects. Number of Under the Authority's Scheme— children treated Residential treatment with education 27 Residential treatment without education — Non-residential treatment at an orthopaedic clinic171 O therwise— Residential treatment with education — Residential treatment without education — Non-residential treatment at an orthopaedic clinic — Total number of children treated 186 Group 5.—Dental Defects. Number of Children who were:— (a) Inspected by the Dentist : Routine Age Groups Aged 5 1,661 6 1,981 7 2,063 8 1,935 9 1,881 10 1,802 11 1,706 12 1,580 13 1,481 14 1,040 15 152 16 12 Total 17,296 Specials 231 Grand Total 17,527 (b) Found to require treatment 9,757 (c) Actually treated 6,903 Attendances made by children for treatment 9,900 Half-days devoted to:— Inspection 121 Treatment 1161 Total 1,282 Fillings:— Permanent Teeth 5,769 Temporary Teeth 333 Total 6,102 Extractions:— Permanent Teeth 1,927 Temporary Teeth 10,364 Total 12,291 Administrations of General Anaesthetics for Extractions 2,446 Other operations:— Permanent Teeth 1397 Temporary Teeth — Total 1397 99 Group 6.—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 43,372 (3) Number of individual children found unclean 1,200 (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 18 MENTAL DEFICIENCY (NOTIFICATION OF CHILDREN) REGULATIONS, 1928. CHILDREN NOTIFIED DURING THE YEAR ENDED 31st DECEMBER, 1938, TO THE LOCAL MENTAL DEFICIENCY AUTHORITY. Total Number of Children Notified 7 ANALYSIS OF THE ABOVE TOTAL. Diagnosis. Boys. Girls. 1. (i) Children incapable of receiving benefit or further benefit from instruction in a Special School : (a) Idiots 2 — (b) Imbeciles 2 3 (c) Others — — (ii) Children unable to be instructed in a Special School without detriment to the interests of other children : (a) Moral defectives — — (b) Others — — 2. Feeble-minded children notified on leaving a Special School on or before attaining the age of 16 — — 3. Feeble-minded children notified under Article 3, i.e., " special circumstances " cases — — 4. Children who in addition to being mentally defective were blind or deaf — — Grand Total 4 3 Ealing and Brentford & Chiswick Hospitals Committee. CLAYPONDS ISOLATION HOSPITAL PERIVALE MATERNITY HOSPITAL. ANNUAL REPORT of the MEDICAL SUPERINTENDENT for the year ending 31st MARCH, 1939 THOMAS ORR, M.D., D.Sc., Medical Superintendent. Perry & Routleff I.td.. Printers, Haling and Uxbridge 2 EALING AND BRENTFORD & CHISWICK HOSPITALS COMMITTEE. Alderman G. Jenkin (Mayor of Brentford and Chiswick) {Chairman). Alderman Col. R. R. Kimmitt, O.B.E., T.D., D.L. (Vice-Chairman). Alderman A. W. Bradford, J.P. Alderman Emily S. Taylor, J.P. (Mayor of Ealing) Councillor Alice J. Burden. Councillor W. H. Crowe. Councillor Emily L. Hill. Councillor W. Morgans. STAFF. Medical Superintendent— Thomas Orr, M.D., D.Sc., Of the Middle Temple, Barrister-at-Law. Medical Attendant, Isolation Hospital—Llywelyn Roberts, M.D., D.P.H. Resident Medical Officer, Isolation HospitalJohn C. Aitken, M.B., Ch.B., D.P.H. Resident Medical Attendant, Maternity Hospital— Nancy L. Lewis, M.B., Ch.B., D.P.H. Consulting Surgeon— C. W. Gordon Bryan, F.R.C.S. (Eng.). Consulting Oto-J aryngologistArthur Miller, F.R.C.S. (Ed.), D.L.O. Consulting Obstetricians— John W. Rait Bell, L.R.C.P.I. & L.M., L.R.C.S.I. & L.M. Arnold Walker, M.A., M.B., B.Ch., F.R.C.S., M.G.O.G. Consulting Ophthalmic Surgeon— Graeme G. Talbot, M.B., Ch.B., F.R.C.S. Matron, Isolation Hospital— Miss I. Gregory. Matron, Maternity Hospital— Miss M. P. B. Gardner. Clerk to Committee—Harry Birrell. Treasurer—E. C. T. Owen. 3 EALING AND BRENTFORD & CHISWICK HOSPITALS COMMITTEE. Mr. Chairman, Ladies and Gentlemen, I have the honour to submit the Annual Report on the work of the Hospitals from the 1st April, 1938, to the 31st March, 1939. CLAYPONDS ISOLATION HOSPITAL. The total number of cases admitted to the hospital was 687; this is 38 more than in the previous year. The highest number under treatment on any day was 97 on the 25th November, and the lowest number 44 on the 24th July. The average daily number in Hospital was 69. The following table indicates the number of cases of the various diseases treated during the year : Disease Remaining in Hospital 31st March, 1938 Admitted during year Discharged during year Died during year Remaining in Hospital 31st March, 1939 Scarlet Fever 38 382 364 1 55 Diphtheria 31 226 234 4 49 Measles 9 37 46 — — Pneumonia — 2 2 — — Pneumonia and Whooping Cough – 4 3 1 – Whooping Cough — 3 2 — 1 Typhoid Fever — 3 3 — — Paratyphoid Fever B. – 2 2 – – Dysentery — 7 7 — — Influenza — 2 1 — 1 Poliomyelitis — 2 — — Tonsillitis — 1 1 — — Ophthalmia Neonatorum – 1 1 – – Mumps and Pyelitis – 1 1 – – Pemphigus — 1 1 — — Encephalitis and Chicken Pox – 1 1 – _ Chicken Pox 1 4 1 — German Measles — 1 1 — — Puerperal Pyrexia — 5 5 — — Septic Throat — 1 1 — — No ascertainable disease — 1 1 — — 79 687 683 7 76 4 Scarlet Fever.—Of the 382 cases admitted as scarlet fever 87 were from Brentford and Chiswick, 284 were from Ealing and 11 from Southall. Of this total, 20 were found not to be suffering from the disease and were ultimately diagnosed as follows :— Rubella 9, measles 4, septic sore of ear 1, tonsillitis 1, influenza 1, lobar pneumonia 1, tonsillitis and septic rash 1, erythema 1, no apparent disease 1. Three cases of scarlet fever were found on admission to be suffering from a second disease as follows :— Scarlet fever and whooping cough 2, scarlet fever and chicken pox 1. The incidence of the actual cases of scailet fever in the various age groups was as follows:— 1-5 yrs. 5-15 yrs. 15-25 yrs. 25-35 vis. 35-45 yrs. over 45 yrs. 85 230 23 17 6 1 The complications occurring among the cases were as follows:— Rhinitis and rhinorrhoea 60 Cervical Adenitis 57 Otitis media 27 Mastoiditis 2 Second attacks of scarlet fever 12 Septic sores 14 Nephritis and Albuminuria 6 Bronchitis 4 Arthritis and rheumatism 4 Cardiac irregularity 3 Purpura simplex 2 Vaginal discharge 2 Irregular attacks of pyrexia 2 Tonsillitis 1 Quinsy 1 Frontal sinusitis 1 Cellulitis of popliteal region 1 Endocarditis 1 Retro pharyngeal abscess 1 Alveolai abscess 1 Meningitis 1 Mitral Systolic murmur 1 Boils on legs 1 5 Return Cases. Of the 364 cases discharged during the year 11 gave rise to "return" cases of scarlet fever. This gives a return case rate of 3.0 per cent. Duration of Stay.— The average duration of stay in hospital of all cases of scarlet fever was 33.6 days. Deaths.—There was one death from scarlet fever. An infant aged nine months was admitted to hospital with a modelately severe attack of scarlet fever but developed meningitis and died on the sixth day aftei admission. Diphtheria.—The number of cases admitted as diphtheria was 226, 98 from Brentford and Chiswick and 128 from Ealing. This is 23 more than in the previous year. Of the total number, 44 were ultimately diagnosed as follows :— Tonsillitis 36, scarlet fever 1, rhinitis 1, rhinitis and impetigo 1, rhinorrhoea 1, peri-tonsillar abscess 1, catarrhal laryngitis 1, no apparent disease 2. Two cases were found to have another disease in addition to diphtheria, one having rubella and one scabies. The incidence of the actual cases of diphtheria in the various age-groups was as follows :— 1-5 yrs. 5-10 yrs. 10-15 yrs. 15-25 yrs. 25-45 yrs. over 45 yrs. 45 88 24 12 13 — The following complications were observed:— Palatal paresis 15 Ocular paresis 3 Pharyngeal paresis 2 Lower limb paresis 1 Carditis 9 Cardiac irregularity 8 Tachycardia 9 Otitis media aud otorrhoea 3 Mastoiditis 1 vSeptic Sores 4 Cervical adenitis 4 Nephritis 2 6 Bronchitis 2 Secondary Tonsillitis 1 Rhinitis 1 Pharyngeal abscess 1 Alveolar abscess 1 Corneal ulceration 1 Catarrhal jaundice 1 Second attack of diphtheria 1 Laryngeal Diphtheria.—Three cases were admitted with this diagnosis. One child, as described below, died, and the two other cases were diagnosed as peritonsillar abscess and catarrhal laryngitis respectively. Deaths from Diphtheria.—There were four deaths from this disease, all occurring in children under six years of age. All four were severe cases on admission and all had over 60,000 units of anti-toxin. One died on the day of admission and two others in four days and eight days lespectively. The fourth case suffered from diphtheria of the trachea and bronchial tubes and tracheotomy was performed but the child died from septic pneumonia after a stay in hospital of almost seven weeks. Return cases.—There were two return cases from children discharged after the usual three negative swabs had been obtained. One child was in hospital for 34 days and two days after his discharge his brother was admitted with diphtheria. A girl of 12 yeais was sent in as diphtheria and was in hospital for 85 days ; fourteen days after her discharge her mother was admitted with diphtheria. Duration of stay.—The average duration of stay in Hospital for cases of diphtheria was 47.2 days. Measles.—Thirty-seven cases of measles, mostly with complications, were admitted for treatment. There were no deaths. Whooping Cough.—Seven cases of this disease were admitted. One infant was brought in moribund suffering from whooping cough and broncho-pneumonia and died one and a half hours after admission. 7 Poliomyelitis. Two cases of poliomyelitis (infantile paralysis) were admitted. Both were adults and both showed extensive paralysis on admission. The lower limbs in both cases were completely paralysed and there was a severe paralysis of the upper limbs also. In one case, however, there was a remarkable degree of recovery and the patient was able to walk on leaving hospital, the only noticeable loss of power being in the wrists. The other case showed very little improvement after a stay in hospital. Both patients were transferred to the National Orthopaedic Hospital when they were considered free from infection. Arrangements were made when the patients were admitted to obtain on loan a respirator ("iron lung") but the use of this instrument was not required. Through the generosity of Lord Nuffield the Hospital now possesses its own artificial respirator. Ceicken Pox.—Two unusual cases of this disease were admitted. (1) Chicken Pox and Encephalitis—A boy of 14 years developed symptoms of encephalitis about 10 days after the onset of chicken pox. He was admitted to the Hospital and showed signs and symptoms of cerebellar disease all of which cleared up and he left the hospital in apparently perfect health after four weeks' stay. (2) Haemorrhagic Chicken Pox. This was in a child aged 7 years. It was known that this child was suffering from splenomedullary leuchaemia previous to her admission. She suffered from a very severe attack of chicken pox and was semi-conscious when she was brought to the hospital. The Chicken Pox was of the severe haemorrhagic type with haemetemesis and she died within 24 hours of admission. Enteric Fever.- Five cases were sent into hospital with the diagnosis of enteric fever. Three cases were found not to be enteiic fever; one cleared up quickly in hospital; one proved to be pneumonia and the third was sent to the West Middlesex Hospital for further investigation of his abdominal symptoms. The two proved cases were brothers and had each a mild attack of paratyphoid fever. Both cases made a complete recovery. 8 Dysentery.—There were seven cases admitted as dysentery, all occurring in the same family. Each was verified bacteriologically, the organism isolated being the same, namely, Sonne bacillus. The cases ran a mild clinical course without incident. Three however were re-admitted one month after discharge, on account of reported recurrence of the symptoms, but in only one of these was the presence of the organism again proved. Illness of Staff. The following cases of illness of the staff occuiled during the year: Influenza 1 Pelvic peritonitis 1 Tonsillitis 5 Scarlet Fever 1 Diphtheria 1 Dermatitis 1 Influenza and bronchial catarrh 1 Medical Staff. Dr. Miller, the Consulting Oto-Laryngologist, made 15 visits during the year and performed 6 mastoid operations and 16 operations for the removal of tonsils and adenoids. Mr. Gordon Bryan, the Consulting Surgeon, made 2 visits to the hospital during the year and performed an operation for resection of rib and Mr. G. G. Talbot, the Consulting Ophthalmologist, made one visit for examination of an eye showing severe corneal ulceration. 9 PERIVALE MATERNITY HOSPITAL. Mothers. The 803 cases, including booked and emergency cases, admitted to the Hospital during the period 1st April, 1938, to 31st March, 1939, from the two districts were as follows: Month Ealing Brentford and Chiswick Total April 64 10 74 May 59 12 71 June 53 12 65 July 58 15 73 August 47 11 58 September 45 12 57 October 50 16 66 November 49 15 64 December 59 15 74 January 54 9 63 February 52 7 59 March 61 18 79 651 152 803 The greatest number of patients in the hospital on any day was 50. This was on the 16th and on the 20th October, 1938. The average period of stay in the hospital was 16.64 days. Emergency Cases — During the year 14 emergency cases were admitted to the hospital. This is a very much larger number than in any previous year. The increase is due to the fact that the medical practitioners in the Borough are now able to obtain immediate admission of their abnormal cases upon application to the Resident Medical Attendant. Of these 14 cases, 10 resulted in normal deliveries and all the mothers were discharged in a satisfactory condition. The cases were as follows :— 1. Breech with extended legs sent in for delay in first stage. Normal delivery followed. 2. Patient admitted for delay in first stage. Normal delivery followed 10 3. Patient admitted with ante-partnm haemorrhage, due to lateral placenta praevia. The infant (32 weeks maturity) was delivered as a breech. Infant survived eight hours. Puerperium uneventful. 4. Impacted shoulder. Attempts at delivery by own doctor unsuccessful. Prolapsed arm on admission. Delivered of a still-born infant. 5. Ante-partum haemorrhage. Membranes ruptured artificially. Normal delivery. (S. Admitted for delay in 1st stage. Patient looked very ill on admission. Persistent occipito-posterior manually rotated and forceps applied. Delivered of a macerated infant. Patient transferred on ninth day of puerperium to King Edward Hospital. 7. Breech with extended legs sent in for delay in 1st stage. Normal delivery followed. 8. Retained placenta manually removed at home by own doctoi. Patient exsanguinated and shocked on admission. Intravenous gum acacia and two small blood transfusions given. Developed pyelitis which soon responded to treatment. Discharged home in very satisfactory condition. 9. Admitted at request of own doctor because of premature labour (34 weeks pregnant) and no preparations made at home. Normal delivery followed. 10. Patient admitted for delay in 1st stage. Normal delivery followed. 11. Admitted for toxaemia of pregnancy. Good response to treatment and normal delivery followed in a few days after medical induction. Infant seemed quite normal at first, but on the fourth day had a few convulsions with cyanosis. When no response to treatment, Dr. Alan Moncrieffe called in for consultation and diagnosed congenital hydrocephalus. 12. Admitted for toxaemia of pregnancy. Elderly primigravida. Normal delivery followed in a few days. Mother and infant did well and were discharged home in satisfactory condition. 11 13. Admitted, for delay in 1st stage. Normal delivery of an infant weighing 13 lb. 5 oz. Mother and baby discharged in very satisfactory condition. 14. Admitted at request of own doctor for delay in 2nd stage. Normal delivery of an anencephalic infant followed. Mother discharged, quite satisfactory. Ante-Natal Cases.—A hundred and twenty ante-natal cases were admitted for treatment. Of these cases, sixty-three recovered sufficiently to be discharged to await at home the onset of labour. The conditions from which they were suffering were as follows: Ante-Natal Cases in Hospital until Delivery:— Toxaemia 35 Ante-partum haemorrhage (accidental) 3 vSuspected disproportion 8 Pyelitis 3 For rest (poor general condition) 1 Pleurisy 1 Thrombosed varicose veins 2 Post maturity 1 Chronic bronchitis and asthma 1 Mitral stenosis — for rest 1 Hypertension 1 Total 57 Ante-Natal Cases discharged Home to await Delivery:— Toxaemia 18 Suspected disproportion 6 Pyelitis 6 Thrombosed varicose veins 2 Ante-partum haemorrhage (accidental) 2 Rest from home cares 4 Threatened abortion 2 Admitted not in labour 18 Admitted for external version of breech 1 Hyperemesis 3 Admitted for investigation 1 Total 63 12 Surgical Induction was done in the following cases:— Hypertension 1 Toxaemia 18 Post maturity with multiple pregnancy 1 Post maturity with disproportion 1 Post maturity 1 Accidental haemorrhage 1 Lateral placenta praevia 4 Total 27 A bnormalities in Mothers — Central placenta praevia: Caesarean Section 2 cases During labour :— Perineal tears requiring more than one suture 187 Episiotomy 13 Breech with extended legs—unassisted delivery 8 Breech with extended legs -assisted delivery 12 Breech with extended arms--assisted delivery 1 Forceps for delay in 2nd stage 15 Manual rotation and forceps delivery of persistent occipito-posterior position 4 Central placenta praevia 2 Lateral placenta praevia 3 Perforation of skull and forceps delivery of infant which had died during labour 1 Perforation of hydrocephalic foetus 1 Forceps delivery of brow presentation 1 Forceps delivery for foetal distress 1 Manual removal of retained placenta 4 Moderate post-partum haemorrhage 22 Eclampsia (fits starting during labour) 2 Piolapsed arm 1 Severe post-partum haemorrhage 4 Footling presentation 3 Infant born before admission, 3rd stage completed in hospital 3 Delivery completed before admission 1 13 The total number of forceps deliveries was 22, giving a rate per thousand of 27.2. This figure is about the average for the past 5 years. During puerperium:— Thrombosed varicose veins 11 Cracked nipples 5 Severe anaemia 1 Urinary infection 2 Urticarial rash 5 Endocervicitis with vaginal discharge 3 Cystadenoma of thyroid 1 Rheumatism of ankles 1 Quiescent pulmonary tuberculosis 1 Bartholin's cyst (left) 1 Retention of urine 2 Small superficial abscess 1 Total 34 There were 30 cases of puerperal pyrexia of a notifiable degree. These cases were suffering from: Breast abscess 2 Urinary infection. 7 Suspected uterine sepsis 1 Uterine infection (haemolytic streptococci, Group A) 2 Uterine infection (haemolytic streptococci, Group C) 1 Breast abscess and thrombosis in femoral veins, both legs 1 Femoral thrombosis 2 Acute mastitis 7 Parametritis 1 Pulmonary embolism 2 Retained products 1 Bad "cold" 1 Sloughing perineum 1 Urinary infection and mastitis 1 14 Patients transferred to other hospitals:— To Clayponds Isolation Hospital 7 Queen Charlotte's Isolation Block 2 King Edward's Hospital, Haling 1 West Middlesex Hospital 1 Total 11 The cases were as follows :— 1. Mother transferred to Clayponds Isolation Hospital. Suspected uterine sepsis. Infant still-born. 2. Mother transferred to Clayponds Isolation Hospital. Suspected gonococcal infection. Infant still-born. 3. Mother transferred to Clayponds Isolation Hospital on fourth day of puerperium. Uterine infection with haemolytic streptococci, Group A. Infant still-born. 4. Mother and infant transferred to Clayponds Isolation Hospital. Uterine infection with haemolytic streptococci, Group A. 5. Mother and infant transferred to Clayponds Isolation Hospital. Uterine infection which haemolytic streptococci, Group B. 6. Mother transferred to Clayponds Isolation Hospital with acute bilateral mastitis and bronchitis. Infant accompanied patient. 7. Mother transferred to Clayponds Isolation Hospital with acute mastitis, right breast, which later developed into an abscess. Infant accompanied patient. 8. Mother transferred to Queen Charlotte's Isolation Block. IvOcal uterine infection (B. coli) after caesarean section. Infant sent home. 9. Mother transferred to Queen Charlotte's Isolation Block with parametritis. Infant discharged home. 10. Mother transferred to King Edward's Hospital for full investigation. Infant still-born. 15 11. Mother transferred to West Middlesex Hospital, Isleworth. Patient had been in this hospital for four months with (a) breast abscess and (b) double femoral thrombosis. Infant discharged home. Maternal Deaths. There were three maternal deaths during the year. Of these, two were due to pulmonary embolism and one to concealed accidental haemorrhage. The cases were as follows : 1. This patient developed thrombosis in the left internal saphenous vein on the fifth day of puerperium after a normal delivery. Sudden death from pulmonary embolism occurred on the ninth day of the puerperium. 2. This patient developed thrombosis the whole length of right internal saphenous vein on third day of puerperium after normal delivery. Pulmonary embolism occurred on ninth day of puerperium. Patient survived this, and was progressing favourably, when on the eighteenth day of puerperium, she had another embolism and died very suddenly. 3. This patient was admitted with history of a 'heavy show.' No evidence of toxaemia, no pains on admission. Weak contractions began, but her general condition gradually deteriorated. Patient collapsed and died undelivered after an attack of vomiting, which brought on further bleeding. Death due to concealed accidental haemorrhage. The Consulting Obstetrician saw the patient on admission, and was present throughout. Infants. Number of Infants born 807 Males 401 Females 406 Still Born Infants.—Total 32, giving a still birth rate of 39.6 per thousand. 16 Fresh. Full term 7 Premature 4 Miscarriage (25 weeks) 1 Anencephalic 2 Hydrops foetalis 1 Macerated. Full term 7 Premature 10 Nco-natal deaths.—Total 14, giving a neo-natal death rate of 17.3 per thousand, as compared with 27.3 per thousand in 1936-37, and 21 per thousand in 1935-36. Prematurity 13 After precipitate labour 1 Premature Infants born alive:— 33-37 weeks 18 34 weeks 8 32 weeks 3 28 weeks 2 Twins (26 babies) 13 Abnormalities of surviving infants:— Pyloric spasm 3 Haemorrhage of the new born 3 Cephal-haematoma 3 Severe jaundice 2 Mongol 3 Mild talipes calcaneo-valgus 1 Upper respiratory tract infection 1 Sign of intra cranial injury 2 Fibroid polypus right upper alveolus 1 Right septic thumb 1 Dehydration fever 1 Intertrigo with septic spots napkin area 1 Hare lip and cleft palate 1 Congenital hydrocephalus 1 17 Telangiectasis of forehead and nose 1 Meningo-myelocoele lower lumbar region 1 Syndactyly and Polydactyly toes and Polydactyly left hand 1 Pedunculated fibromyoma attached to proximal phalanx fourth finger of left hand 1 Ophthalmia neonatorum 2 Total 30 Infants Weaned. Total 14. Weaned on account of mothers' breast conditions 9 Weaned on account of mothers' poor general condition 5 Infants transferred to other Hospitals 1. Infant transferred to West Middlesex Hospital, Isleworth, suffering from debility following bronchopneumonia (premature infant). Mother discharged home. 2. Infant and Mother transferred to Infants' Hospital, Vincent Square. Infant with pyloric spasm. 3. Infant transferred to Infants' Hospital, Vincent Square, with pyloric stenosis. Mother discharged home. 4. Infant transferred to Infants' Hospital, Vincent Square, with haemolytic anaemia. Mother discharged home. Consulting Obstetrician.—Dr. J. W. Rait Bell was called to the hospital on forty-one occasions during the period under review. Training of Pupels.- Up to 31st March, 1939, 36 pupils completed their course of training and entered for the examination of the Central Midwives Board. Of these pupils, all except one were successful. 18 During the year Dr. Aitken, the Resident Medical Officer at the Isolation Hospital, received promotion by being appointed Assistant Medical Officer in the Ealing Public Health Department, his place being taken by Dr. M. Kelly. Dr. Williams-James, the Resident Medical Officer at the Maternity Hospital, resigned on account of her marriage and Dr. N. L. Lewis was appointed in her stead. As in previous Annual Reports, I take the opportunity of expressing my appreciation of the excellent work carried out by the Medical Staff and by the Matrons of the two hospitals and my gratitude to Mr. Birr ell, the Clerk to the Committee, and to Mr. Owen, the Treasurer, for their unfailing courtesy anc assistance. I am, Ladies and Gentlemen, Your obedient Servant, THOMAS ORR, Medical Supcrintendent.