Ealing Public Libraries. Reference Department. E 352.4/4140 68579 EAL 30 Borough of Ealing, ANNUAL REPORT of the Medical Officer of Health and School Medical Officer 19 3 9 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 Uxbridge Public Health Report 1939 4 HEALTH SERVICES. In the first half of the year, despite the fact that war was felt to be impending, the work of the public health department continued normally, excepting that some preparations were made for the coming into operation of the national scheme of Air Raid Precautions. On the outbreak of war, however, there was considerable interruption of the routine for most members of the staff had to turn their attention to work of an entirely different character in the organization of Air Raid Precautions, an overwhelming task but willingly undertaken by all in their anxiety for the national welfare. When one looks back on those early months of the war one is astonished, not at the mistakes that were made or at the omissions that occurred, but at what was actually accomplished in giving effect to an organization which was new and at the same time entirely foreign to that in which all previously took part. That is a fact which deserves recognition and which prompts me to take the opportunity here of expressing sincere appreciation of the work of the whole staff during a very difficult and anxious period. In this report only essential facts are quoted, mostly in tabular form without comment, and in this manner chiefly for future leference. Where descriptions of the health services would be a mere repetition of previous reports they have been rigorously excluded. SUMMARY OF GENERAL STATISTICS. Area (in Acres) 8,739 Population (Census, 1931) 117,707 Population (Estimated Middle of 1939): For calculation of Birth-Rate 164,400 For calculation of Death-Rate 162,100 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, 1939) 46,006 Rateable Value, 1st April, 1939 £1,798,053 Net Produce of a Penny Rate £7,280 5 SUMMARY OF VITAL STATISTICS. Live Births (for calculating Birth-Rates):— Legitimate Males, 1,200 Females, 1,149 Total, 2,349 Illegitimate Males, 37 Females, 42 Total, 79— 2,428 Birth-Rate per 1,000 of Estimated Population 14.8 Live Births (for calculating Infant Mortality Rates):— Legitimate Males, 1,183 Females, 1,138 Total, 2,321 Illegitimate Males, 37 Females, 42 Total, 79— 2,400 Still-Births:— Males, 45 Females, 40 Total 85 Rate per 1,000 total Births (Live and Still-Births) Deaths : Males, 747 Females, 793Total 1,540 Death-Rate per 1,000 of Estimated Population 9.5 Deaths of Infants under one year of age:— Legitimate Males, 56 Females, 52 Total, 108 Illegitimate Males, 1 Females, 6 Total, 7— 115 Death-Rate of Infants under one year of age:— All Infants per 1,000 Live Births 48 Legitimate Infants per 1,000 Legitimate Live Births 47 Illegitimate Infants per 1,000 Illegitimate Live Births 88 Deaths from Diseases and Accidents of Pregnancy and Childbath:— From Sepsis 1 Death-Rate per 1,000 „ „ Total Births 0.42 From other Causes 8 „ „ 3.33 Total 9 „ „ 3.75 Total Deaths Death-Rate per 1,000 Population Measles — Whooping Cough 10.01 Diphtheria 4 0.02 Scarlet Pever — Influenza 28 0.17 Tuberculosis of Lung 87 0.54 Other Forms of Tuberculosis 18 .0.11 ' Death-Rate per 1,000 Live-Births Diarrhoea (under two years of age) 6 2.5 6 Comparison of Vital Statistics of Ealing with those of England and Wales, Etc., 1939. England and Wales 126 Great Towns (including London) London Ealing Birth-Rate 15.0 14.8 12.3 14.8 Death-Rate 12.1 12.0 11.9 9.5 Infant Death-Rate 50 53 48 48 Measles Death-Rate 0.01 0.01 0.00 - Whooping Cough DeathRate 0.03 0.03 0.03 0.01 Diphtheria Death-Rate 0.05 0.05 0.02 0.02 Scarlet Fever Death-Rate 0.01 0.00 0.00 — Influenza Death-Rate 0.21 0.19 0.18 0.17 Diarrhoea (under two years per 1,000 Births) 4.6 6.3 8.2 2.5 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 1939 14.8 9.5 48 7 Causes ot Death, 1939. Cause of Death Deaths, 1939 Total Deaths 1938 Male Female Total Typhoid and Paratyphoid Fevers — 1 1 1 Measles — — — 4 Scarlet Fever — — — 1 Whooping Cough — 1 1 4 Diphtheria 2 2 4 6 Influenza 13 15 28 20 Encephalitis Lethargica 1 2 3 1 Cerebro-Spinal Fever — — 2 Tuberculosis of Respiratory System 42 45 87 100 Other Tuberculous Diseases 9 9 18 8 Syphilis 4 2 6 4 General Paralysis of the Insane, Tabes Dorsalis 5 — 5 3 Cancer, Malignant Disease 106 141 247 235 Diabetes 14 9 23 16 Cerebral Haemorrhage, etc. 41 45 . 86 76 Heart Disease 185 202 387 401 Aneurysm 5 4 9 7 Other Circulatory Diseases 37 42 79 79 Bronchitis 26 31 57 40 Pneumonia (all forms) 36 34 70 74 Other Respiratory Diseases 5 5 10 13 Peptic Ulcer 12 8 20 14 Diarrhoea,) etc. (Under two years) 4 2 6 14 Appendicitis 6 2 8 10 Cirrhosis of Liver 3 1 4 4 Other Diseases of Liver, etc. 3 6 9 8 Other Digestive Diseases 11 14 25 32 Acute and Chronic Nephritis 16 13 29 45 Puerperal Sepsis — 1 1 1 Other Puerperal Causes — 8 8 4 Congenital Debility, Premature Birth, Malformations, etc. 41 39 80 '56 Senility 10 26 36 38 Suicide 15 11 26 9 Other Violence 32 23 55 49 Other Defined Diseases 61 47 108 115 Causes ill-defined or unknown — — — — Diarrhoea (Two years and over) 2 2 4 — Total 747 793 1,540 1,499 8 Deaths at various Ages under One Year of Age, 1939. 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 aud under 6 months 6 months and under 9 mouths 9 months aud under 12 months Total deaths under 1 year All Causes 67 2 3 4 76 17 11 5 6 115 Measles — — — — — — — — — Meningitis — — — — — 1 2 — — 3 Convulsions — — — — — 1 — — — 1 Bronchitis 1 — — — 1 3 — 1 — 5 Pneumonia — 1 — — 1 3 3 1 1 9 Inflammation of the Stomach — — — — — — — — — — Diarrhoea and Enteritis — — — — — — 4 1 2 7 Congenital Malformations 6 — — 1 7 2 — — — 10 Congenital Debility 1 — — — 1 1 — — — 2 Premature Birth 41 — 3 2 46 2 — — — 48 Injury at Birth 3 — — — 3 — — — — 3 Other Diseases Peculiar to Early Infancy 10 1 — 11 1 12 Inattention at Birth 2 — — — 2 — — — — 2 Other Causes 3 — — 1 4 3 2 2 2 13 Causes of Infant Deaths, 1930 to 1939. 1930 1931 1932 1933 1934 1935 1936 1937 1938 1939 Diarrhoea and Enteritis 3 5 9 4 11 11 7 10 15 7 Premature Birth 14 19 24 35 20 34 35 31 36 48 Congenital Malformations 9 9 11 13 9 9 10 15 8 10 Congenital Debility 9 11 4 4 3 11 5 2 3 2 Tuberculous Disease 2 1 — 1 — — — 2 1 1 Syphilis — 1 1 — — — — — — — Meningitis (not Tuberculous) 1 4 — — 1 — — — 2 3 Convulsions 6 5 4 3 3 1 — 1 — 1 Bronchitis 4 2 — 3 3 — 5 4 3 5 Pneumonia (all forms) 10 11 6 6 8 8 15 12 11 9 Gastritis — — — — 1 — — — — — Common Infectious Diseases 2 1 2 3 1 — — — 4 — Other Causes 11 15 18 10 17 17 25 29 20 33 Totals 71 84 79 82 77 91 102 106 103 115 9 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 1939 3.75 2.93 PATHOLOGICAL -LABORATORY. The following table indicates the number of examinations carried out in the pathological laboratory at the Town Hall. Specimens Examined in Laboratory. Positive Negative Total 1939 Total 1938 Diphtheria: From Medical Practitioners 59 864 923 691 From. Isolation Hospital 471 2,096 2,567 3,559 From Health Centres — 262 262 467 Tuberculosis 77 430 507 424 Miscellaneous 9 234 243 460 Total 616 3,886 4,502 5,601 10 AMBULANCE FACILITIES. 1. For infectious disease.—The Ealing and Brentford and Chiswick Hospitals Committee provide a motor ambulance for the removal, of cases of infectious disease to the Clayponds 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. The extent of the calls made upon the service is shown in the following table:— 1934 1935 1936 1937 1938 1939 Cases of Accident 790 756 868 740 917 1,010 Cases of Illness 1,259 1,261 2,080 2,663 2,894 2,625 Total Cases 2,049 2,017 2,948 3,403 3,811 3,635 Number of Journeys outside the Borough (included above) 596 427 552 567 421 456 Annual Mileage 15,818 16,962 21,070 22,868 30,422 30,509 HOSPITALS. 1. Isolation Hospital.—The Clayponds Isolation Hospital at South Ealing has a normal capacity of 142 beds. Part of the hospital was classified by the Ministry of Health as a Grade A1 Emergency Hospital and was up-graded for this purpose. A small part, consisting of 34 beds, was retained for the treatment of cases of infectious disease. 2. Maternity Hospital.—The Perivale Maternity Hospital of 43 beds, which, with the Clayponds Hospital, is administered by the Ealing and Brentford & Chiswick Hospitals Committee, continued to function during the year until the outbreak of war when the number of beds available was greatly reduced. Six weeks afterwards half the hospital was put into use again. By the end of the year preparations were being made for the whole of the hospital being used and bookings were then returning to normal. 11 MATERNITY AND CHILD WELFARE. The work of the Health Centres continued normally until the last week of August. Four of the Health Centres were then adapted for use as First Aid Posts and the Health Visitors undertook work in connection with the Posts. - As the organization of the First Aid Posts was developed the Health Visitors were released from this work and gradually maternity and child welfare work was resumed. By the end of the year steps were being taken to restore the full number of sessions for mothers and children. Only two of the Health Centres are in use as First Aid Posts and satisfactory arrangements have been made for maternity and child welfare work to be carried on in the same building. Summary of the Visits made by the Health Visitors. Visits to children under 12 months:— (1938) (1939) First visits 2,434 1,860 Return visits 5,558 4,555 Visits to children 1 to 5 years of age 10,200 6,854 Visits to expectant mothers 1,983 1,416 Visits to investigate infant deaths and still-births 140 109 Special visits or investigations 265 252 Visits to cases of Ophthalmia Neonatorum 37 13 Visits to cases of Pemphigus Neonatorum 5 — Visits to cases of Measles and Whooping Cough 672 138 Visits to cases of Scarlet Fever on discharge from the Isolation Hospital 290 276 Inspections of Women's Lavatories 68 44 Visits to children under care of foster-mothers 758 705 Other visits 143 119 Total Visits 22,553 16,341 12. Summary of the Work at the Health Centres. Mothers. Expectant mothers attending Ante-Natal Clinics: (1938) (1939) Attending for the first time 1,538 1,139 Total attendances 7,994 6,570 Nursing mothers attending Post-natal Clinics:— Attending for the first time 600 372 Total attendances 701 428 Mothers seen by Ante-Natal Consultant 35 21 Mothers referred to School Medical Department for dental treatment 601 598 Mothers referred to Hospitals 61 48 Mothers accepted for admission to the Perivale Maternity Hospital 715 678 Children. Children attending Centres for the first time:— (1938) (1939) Under one year of age — 2,044 1,910 One to five years of age. 1,326 922 Total attendances made by children:— Under one year of age 30,257 24,074 One to five years of age 19,077 15,058 Number of children examined by Medical Officer:— Under one year of age 7,162 5,460 One to five years of age 7,278 5,515 Children referred to School Medical Department:— For dental treatment 595 465 For treatment of throat and nose 26 33 For optical treatment 81 49 For orthopaedic treatment 162 99 For treatment of minor ailments 261 174 For diphtheria immunization 529 381 Children referred to King Edward Memorial Hospital:— For minor operations 44 65 For ultra-violet ray treatment 1 — For other reasons 48 17 Children admitted to King Edward Memorial Hospital as indoor cases _ Children referred to other Hospitals 88 37 13 Assistance Given. Food supplied at cost price: (1938) (1939) Dried milk (Value) £1,177 £1,142 Virol ( „ ) £196 £188 Cod liver oil ( „ ) £482 £448 Number of orders issued granting a supply of milk, free of charge, for a period of 28 days For expectant or nursing mothers 1,303 1,142 For children under five years of age 3,601 3,149 Attendances at the Health Centres, 1939. Mattock Lane Ch'gton House Ravenor Park Perivale Greenf'd Green Islips Manor Ante-natal sessions 77 69 69 69 69 43 Attendances 1,451 1,112 1,723 1,007 1,003 474 Average attendance per session 19 17 25 15 15 11 Post-natal sessions 9 9 9 10 8 — Attendances 82 69 79 68 78 37 Average attendance per session 9 8 9 7 10 Number of sessions for children 113 120 126 123 119 63 Number of children attending for first time 647 634 606 294 370 281 Total attendances made by children 7.411 7,336 7,814 6,508 6,138 3,724 Average attendance per session 63 61 62 53 52 59 Number of children seen by doctor 2.303 2,222 2,154 1,672 1.632 982 Average number seen per session 20 19 17 14 14 16 14 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 895 18 months to 2 years 591 2 years to 3 years 7 519 3 years to 4 years 476 4 years to 5 years 272 2,753 Report of Dental Surgeon. "(a) Mothers.—The inspection and treatment of, expectant and nursing mothers was carried out during the year at the Mattock Lane, Islips Manor anc Ravenor Park Health Centres. The figures for attendance, show a decrease compared to the previous year The work performed was mainly of a radical nature, owing to the septic condition of the mouths of the mothers. The total number of teeth extracted was 2,559, which is smaller by 592 than the number extracted in 1938. Fillings were inserted in 341 teeth, porcelain being used for anterior teeth and silver amalgum for posterior teeth. Scaling was done for 213 mothers. For these and other forms of treatment 1,123 visits were made at the Centres by the mothers. Finally, 232 complete or partial dentures were supplied. " (b) Children.—The treatment of the pre-school children was carried out at the five Health Centres in the Borough. The number treated, 406, is less than in the preceding year. The actual treatment consisted of fillings in the temporary teeth, and extractions where decay was' advanced. The number of fillings inserted totalled 82, which is 13 fewer than the previous year. Extractions were performed under nitrous oxide and oxygen, and in suitable cases a local anaesthetic was given. The total number of teeth removed by both methods of anaesthesia was 1,248." 15 CHILD LIFE PROTECTION. The work of supervision of fostermothers, carried out by the Health Visitors who have all been appointed. Child Protection Visitors, is summarized in the following table:— Number of children on the register at the beginning of the year 110 (Number of fostermothers having care of the above children, 95). Number of children registered during the year 101 Number of children removed from register during year: Removed to care of parent or relative 56 Removed to another fostermother 20 Removed for adoption through a Society. 6 Removed to a Children's Home or School 12 Legally adopted by fostermother 3 Died — Fostermother left district 5 Attained nine years of age 5 Removed from care of fostermother at request of Medical Officer of Health 3 110 Number of children on register at end of year 101 (Number of fostermothers having care of the above children, 88). Number of visits made by Health Visitors 705 MIDWIFERY SERVICE. At the end of the year eleven midwives were employed by the Council in connection with the midwifery service established in accordance with the Midwives Act 1936. A scheme was drawn up whereby municipal midwives could assist at the Perivale Maternity Hospital or whereby the staff at the Hospital could assist the municipal midwives in any emergency. On the outbreak of hostilities arrangements were made in accordance with this scheme for members of the staff at the Hospital to assist the municipal midwives and for a few weeks a number of the Hospital staff took up temporary residence with the municipal midwives. 16 The work carried out by the mid wives and the assistance provided for the mothers were as follows:— Number of Confinements attended:— (а) as midwife 708 (b) as maternity nurse 165 873 Number of accouchement sets issued:— Free of charge 145 At cost price 176 321 Number of cases in which Home Help provided 83 Amount of fees collected by midwives £949 . SUPERVISION OF MIDWIVES. Number of midwives practising in area at end of year:— Midwives in service of Council 11 „ at Perivale Maternity Hospital 9 in independent practice: (a) residing in Ealing 4 (b) residing in adjoining areas 2 „ in private nursing homes 12 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 58 (b) At the patient's home 743 When acting in the capacity of maternity nurse (a doctor being in attendance) : (a) In private Nursing Homes 118 (6) At the patient's home 209 17 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 58 On account of a- complication during labour 216 On account of a complication during the puerperium 35 On account of the health of the child 68 377 Still-Birth . 8 Death: Of mother — Of child 6 Laying out & a Dead Body 8 Artificial Feeding of Infant. 8 Liability of Midwife to be a source of infection 27 Payment of Medical Fees.—In respect of 384 claims by medical practitioners for giving medical aid the Council paid £365 in fees, £93 of this amount being recovered from the patients. SUPERVISION OF NURSING HOMES. The following table gives information regarding nursing homes in the Borough:— No. of Homes No. of Beds Number of Nursing Homes on Register at beginning of year 19 (11) 251 (75) Number of applications for transfer of registration Number of New Homes registered 1 — Number of Homes discontinued 2 — Number of Nursing Homes on Register at end of year 18 (10) 246 (69) The figures in brackets indicate the number of Homes and the number of beds wholly or partly to the reception of maternity cases. The Medical Officer in charge of the supervision of Nursing Homes made 37 special visits during the year. 18 . SANITARY CIRCUMSTANCES OF THE BOROUGH. aPublic Mortuary.—As recorded in the previous annual report, steps had been taken in regard to the building of a new mortuary and these had gone so far that tenders bad been obtained. In view of the outbreak of war, however, further action on the matter was postponed. 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 1,300 Number of Nuisances observed by Inspectors 120 Number of Premises inspected in connection with Infectious Disease 629 , Number of Premises visited by Periodical Inspection (Cowsheds, Dairies, Slaughterhouses, Factories, etc.) 1,524 Number of Houses inspected under House-to-House Survey 624 Food Inspections 1,334 Total Number of Re-inspections 10,256 Other Inspections 1,312 Total Number of Inspections and Re-inspections 17,099 Number of Intimation Notices given 924 Number of other Letters written 1 689 Number of Statutory Notices served 72 Proceedings before Magistrates 4 Milk and Dairies Act, Etc. Number of Cowsheds on Register 2 Number of Inspections made of Cowsheds 2 Contraventions of Act or Orders — Number of Retail Purveyors of Milk on Register 179 Number of Inspections of Retail Purveyors' Premises 113 Contraventions of Act or Orders 1 Proceedings before Magistrates — Slaughterhouses. Number of Registered or Licensed Slaughterhouses 3 Number of Inspections made 125 Contraventions of Regulations — Proceedings before Magistrates — 19 Factories and Workshops. Factories with Mechanical Power 317 Factories without Mechanical Power 176 Number of Inspections of Factories and Workplaces 327 Number of Defects concerning which Notices were sent 58 Proceedings before Magistrates — Offensive Trades. Fried Pish Shops 29 Other Offensive Trades — Number of Inspections 102 Contraventions 1 Disinfection. Rooms Disinfected by Spray: (а) Ordinary Infectious Disease 10 (b) Tuberculosis 103 (c) Other Conditions 76 Rooms treated for Vermin 78 Articles Disinfected by Steam at Disinfector : (а) Ordinary Infectious Disease 144 (b) Tuberculosis 510 (c) Other Conditions 1,720 Articles voluntarily destroyed 270 FACTORIES, WORKSHOPS AND WORKPLACES. 1.—Inspections For Purposes of Provisions as to Health. (Including Inspections made by Sanitary Inspectors). Premises N umber of Inspections Written Notices Occupiers Prosecuted Factories with mechanical power 120 20 Factories without mechanical power 180 25 — Other Premises under the Act (including works of building and engineering construction but not including outworkers' premises) 27 Total 327 45 — 20 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 11 11 — — Overcrowding — — — — Unreasonable temperature — — — Inadequate ventilation — — — — Ineffective drainage of floors — — — — Sanitary Conveniences insufficient 4 4 — — unsuitable or defective 21 21 — — not separate for sexes 2 2 — — 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). 20 20 — — t Total 58 58 — — Outwork in Unwholesome Premises, Sec. 108. Nature of Work Instances Notices Served Prosecutions Wearing Apparel Making, etc. — — — Others — — — 21 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) 2,015 (b) Number of inspections made for the purpose 2,015 (2) (a) Number of dwelling-houses (included under sub-head (1) above) which were inspected and recorded under the Housing Consolidated Regulations, 1925 624 (b) Number of inspections made for the purpose 624 (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 (4) Number of dwelling-bouses (exclusive of those referred to under the preceding sub-head) found not to be in all respects reasonably fit for human habitation 1,202 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 1,091 3.—Action under Statutory Powers during the Year: A.—Proceedings under Sections 9, 10 and 16 of the Housing Apt, 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: (а) 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 58 (2) Number of dwelling-houses in which defects were remedied after service of formal notice: (a) by Owners 51 (b) by Local Authority in default of Owners — 22 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 3 (2) Number of dwelling-houses demolished in ance of Demolition Orders — (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 1 *Part only of house. 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 on room having been rendered fit — Housing Act, 1936 (Part IV)—Overcrowding. (a) (i) Number-of dwellings overcrowded at the end of the year 172 (Number of dwellings overcrowded on survey in 1935—314). (ii) Number of families dwelling therein 172 (iii) Number of persons dwelling therein 947 (b) Number of new cases of overcrowding reported during the year 11 (c) (i) Number of cases of overcrowding relieved during the year 48 (ii) Number of persons concerned in such cases 252½ (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 — 23 (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 1,866 new houses were built in the Borough by-private enterprise. The building of 284 working class dwellings contemplated at Northolt has not yet been commenced. INSPECTION AND SUPERVISION OF FOOD. 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 and inspected during the year:— Carcases Inspected and Condemned. Cattle excluding Cows Cows Calves Sheep Lambs Pigs Number killed 40 14 2 777 96 Number inspected 40 14 2 711 96 All Diseases except Tuberculosis— Whole carcases condemned — — — 32 1 Carcases of which some part or organ was condemned — — — 1 1 Percentage of the number inspected affected with diseases other than tuberculosis — — — 4.2 1.0 Tuberculosis only— Whole carcases condemned — 1 — — 1 Carcases of which some part or organ was condemned 5 — — — 3 Percentage of the number inspected affected with tuberculosis 12.5 7.1 — — 4.1 There is no public slaughterhouse in the Borough. As a result of the war a Meat Depot serving a large area in Middlesex, embracing Ealing, was established in a central position. This Depot threw a large amount of work upon the Sanitary Inspectors who have had to inspect a large quantity of meat there daily. '24 The following table indicates the amounts of the various foodstuffs which have been condemned by the Inspectors as unfit for food in the course of their inspections at the meat depot and at the various food premises in the Borough:— Beef 1,346 lbs. Mutton 920 lbs. Offal 2,327 lbs. Fish 303 lbs. Dates 105 lbs. Barley 45 lbs. Eggs 360 PREVALENCE OF, AND CONTROL OVER INFECTIOUS AND OTHER DISEASES. Infectious Disease.—The numbers of cases of infectious disease notified in the Borough in 1939 are indicated in the following table. The total number of cases is smaller than in the previous year. Cases of diphtheria and of scarlet fever were notably less. In the months following the outbreak of war the numbers of cases of these diseases were surprisingly small as are indicated below. Cases of Infectious Disease occurring in the Borough. Disease 1930 1931 1932 1933 1934 1935 1936 1937 1938 1939 Smallpox 1 — — — — — — — — — Diphtheria 129 83 54 71 195 228 52 123 142 92 Scarlet Fever 264 154 407 476 493 400 408 317 383 303 Enteric Fever (including Paratyphoid) 4 1 3 4 3 7 8 5 2 5 Puerperal Fever 7 6 4 3 3 7 3 4 — — Puerperal Pyrexia 26 18 21 28 14 11 9 24 46 40 Pneumonia: Primary 78 96 85 56 72 59 85 60 83 50 Influenzal 12 18 50 32 17 11 14 37 18 26 Acute Poliomyelitis — 2 4 3 — 1 2 7 6 1 Cerebro-Spinal Fever — — — — — — — 1 1 — Malaria 2 1 — 1 1 — 1 — — — Dysentery — — — — — 1 1 5 12 2 Erysipelas 34 20 30 36 43 28 28 27 41 37 Encephalitis Lethargica 1 1 1 — 1 — 1 — — — Tuberculosis:— Pulmonary 111 141 141 154 139 157 139 178 142 149 Non-Pulmonary 22 27 27 23 24 23 22 37 33 38 Ophthalmia Neonatorum 9 9 5 8 5 3 4 7 15 16 Total 700 577 832 895 1010 936 777 832 924 759 25 The occurrence of the 303 cases of scarlet fever throughout the year was as follows :— Jan. Feb. Mar. Apr. May June July Aug. Sept. Oct. Nov. Dec. 44 24 32 39 45 39 41 15 6 6 4 8 Of these cases 95 were nursed at home. After the outbreak of war accommodation for cases of scarlet fever in the hospital was much reduced and only in exceptional circumstances were cases admitted. The occurrence of the 92 cases of diphtheria throughout the year was as follows:— Jan. Feb. Mar. Apr. May June July Aug. Sept. Oct. Nov. Dec. 8 4 7 8 7 6 16 14 5 9 6 2 Four cases were nursed at home, the remainder in hospital. Such a low incidence of scarlet fever and of diphtheria in the Borough in the last quarter of the year cannot be recalled in any previous year. It may be that the dispersal of the children by evacuation and the lessened amount of association at play or at places of entertainment reduced the possibility of infection. Measles and Whooping Cough—Measles and whooping cough became notifiable under the Measles and Whooping Cough Regulations, 1939. During the period from 17th November to 31st December, 1939, the following number of cases were notified: Measles 40 Whooping Cough 6 26 Cases of 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 Castlebai Mount Part Grange Lammas Manor Grosvenor Hanwell S. Hanwell N. Greenford S. Greenford N. Northolt 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 92 – 4 — 1 5 6 7 37 6 9 18 3 – — 4 3 – — 12 14 7 3 26 8 .5 10 Scarlet Fever 303 – — 3 8 16 23 26 14!$ 39 10 21 8 1 — 20 21 6 22 30 18 14 20 52 30 52 18 Enteric Fever 5 – 1 — — — — — — 1 2 1 1 — — — — — — – 1 – 1 – 1 2 – Puerperal Pyrexia 40 – — — — — – – — — — 36 4 – – 1 1 3 2 3 4 2 1 2 16 3 2 Pneumonia: Primary 50 – 66 2 — 1 3 2 4 1 2 8 9 13 5 4 3 3 6 5 5 6 3 3 4 5 Influenzal 26 – 4 — – – – – 1 – 1 6 2 12 4 1 4 1 2 2 – – 1 2 3 6 4 Acute Poliomyelitis 1 – – — – – – – 1 – – – – – – – – – – – – – – – 1 – – Cerebro-Spinal Fever — – — — – – – – – – – – – – – – – – – – – – – – – – – Malaria — – — — – – – – – – – – – – – – – – – – – – – – – – – Dysentery 2 – 1 – – – – – 1 – – – – 1 – 1 – – – – – – – – – 1 – Erysipelas 37 – — 1 – – – – – – 1 6 5 18 6 2 5 1 2 – 1 4 1 1 6 7 7 Encephalitis Lethargica – – 3 — – – – – – – – – – – – – – – – – – – – – – – – Tuberculosis: Pulmonary 149 – 87 — 1 — – – 2 2 18 57 37 27 5 15 7 9 12 11 11 10 6 11 13 12 12 Non-Pulmonary 38 – 18 — 1 1 – 1 4 3 5 12 6 3 2 1 1 4 2 4 2 2 3 3 3 8 5 Ophthalmia Neonatorum 16 – – 16 — — – – – – – – – – – 2 – 1 – – 1 – – – 6 3 3 Total 759 – – 22 11 23 32 36 198 52 48 165 75 75 22 51 45 28 48 67 57 42 42 100 90 123 66 27 Ages at Death from Notifiable Infections Diseases. Disease Under One Year 1 to 2 2 to 3 3 to 4 4 to 5 5 to 10 10 to 15 15 to 0 20 to 35 35 to 45 45 to 65 65 and upwards Total. Diphtheria – 1 – 1 – 2 – – – – – – 4 Scarlet Fever – – – – – – – – – – – – – Enteric Fever – – – – – – – – – – – – 1 Puerperal Sepsis – – – – – – – – – – – – 1 Pneumonia: Primary 9 2 2 – 1 1 – 2 3 3 21 22 66 Influenzal – – – – – – – – 1 1 1 1 4 Acute Poliomyelitis – – – – – – – – – – – – – Cerebro-Spinal Fever – – – – – – – – – – – – – Malaria – – – – – – – – – – – – – Dysentery – – – – – – – – – – – – – Erysipelas – – – – – – – – – – – 1 1 Encephalitis Lethargica – – – – – – – – 2 – 1 3 Tuberculosis: Pulmonary – 1 1 – – – 1 4 34 21 20 5 87 Non-Pulmonary 1 2 1 – – 1 3 1 5 1 2 1 18 Ophthalmia Neonatorum – – – – – – – – – – – – – Totals 10 6 4 1 1 4 4 7 45 28 44 31 185 28 Tuberculosis. Age Periods New Cases Deaths Pulmonary Non-Pulm'y Pulmonary Non-Pulm'y Male F'male Male F'male Male F'male Male F'male 0—1 – – – – – – – 1 1—5 – 1 3 — — — 3 — 5—10 2 – 3 1 1 1 1 — 10—15 – 2 1 2 — 1 1 2 15—20 8 10 4 1 1 3 – 1 20—25 – 11 1 2 2 7 1 – 25—35 19 15 5 4 12 13 1 3 35—45 22 15 2 4 9 12 1 — 45—55 17 3 1 — 7 5 – 1 55—65 4 3 — 2 8 — 1 65 upwards 5 — — 2 2 3 – 1 Total 89 60 20 18 42 45 9 9 School Medical Report 1939 30 SCHOOL MEDICAL SERVICE. During the year the School Medical Service was somewhat interfered with at the outbreak of war. Some of the children were evacuated to reception areas and there was uncertainty regarding the future activities of the Service. For the first few weeks of the war four of the six Health Centres in the Borough were used as First Aid Posts and the members of the nursing staff were also on duty at these Posts, preparing to receive casualties, training volunteers and at the same time attempting to deal with any urgent school medical work that was presented. "The Health Centres at Mattock Lane and Cherington House did not cease to function but owing to the transference of staff to other duties only urgent school medical matters were dealt with. Soon after the outbreak of war every effort was taken to continue as far as practicable the work of the School Medical Service After the first week dental treatment was continued normally until, on the 20th November, one of the School Dentists was called up for military service, when the remaining two dentists divided the sessions between them. It became necessary afterwards to engage the services of a part-time dental surgeon to deal with the number of cases requiring treatment. The treatment of mothers was carried on in the same manner as before the war. Ophthalmic treatment was resumed at the beginning of October. Dr. Graeme Talbot, the Ophthalmic Surgeon,"was called up for military service, and Dr. Audrey Henson, who was nominated by Dr. Talbot, took his place. Dr. Henson shortly afterwards resigned and Dr. J. G. Freeman Heal took up the position. Two sessions were held weekly, one at Mattock Lane Centre and one at Ravenor Park Centre. Orthopaedic treatment was temporarily interrupted because Mr. Seddon, the visiting surgeon from the Royal National Orthopaedic Hospital, was fully engaged at the Stanmore Hospital, which was assigned a position in the hospital emergency scheme and could not undertake the treatment of children. Subsequently, however, it was possible to recommence the Orthopaedic Clinic, but up to the present sessions have only been held at the rate of eight in the year instead of twenty-two before the war. Miss Hepburn, the masseuse, resumed sessions in October and has continued holding four sessions 31 weekly at Mattock Lane Centre, so that although the surgeon has not attended so frequently massage and remedial exercises have been carried out. Diphtheria Immunization was resumed at the beginning of December, two sessions being devoted to this work weekly at Ravenor Park, Greenford Green and Mattock Lane Centres and one at Islips Manor Centre. While the Health Centres were being used as First Aid Posts the Minor Ailment Clinics were carried on in those schools which were open and the School Nurses visited the schools once or twice a week depending upon the number of children attending. A Medical Officer accompanied them on these occasions and with the co-operation of the Head-teacher they carried out routine medical inspection as far as possible and also searched for children whose physical condition appeared to be under normal. At the beginning of the war school medical work was handicapped by the employment of some of the School Nurses at First Aid Posts, by the undesirability of asking children to attend by themselves at the Health Centres far from their homes and by the evacuation of a large number of children from the district and the closure of some of the schools. These nurses have now been replaced by fully trained nurses at the First Aid Posts and have returned to their normal duties. One of the School Nurses was transferred to Buckinghamshire to assist the Buckinghamshire County Medical Officer to look after the Ealing children who were evacuated there. In addition to the routine work there was a considerable amount of work in connection with the Evacuation Scheme. All children registered for evacuation were medically examined as soon as possible after registration and were subsequently kept under constant supervision until they were evacuated. Since February, 1940, a systematic survey of all the children in the schools has been conducted in order to find whether the health of any of the children has deteriorated. The procedure followed is to survey a class and to select any children who do not appear robust and to refer them for a thorough examination at which enquiries are made regarding illnesses, hours of sleep, the financial position of the family and the need for milk which is 32 supplied free where necessary. The intention is to keep the children in the schools under constant supervision and so to discover or prevent any signs of malnutrition. STAFF. Two Assistant Medical Officers resigned during the year, Dr. D. I. Irvine and Dr. H. G. H. Butcher, their places being taken by Dr. Alfred J. Muir and Dr. Matthew C. Kelly. During 1939 Miss H. Bailey, Che Supervising School Nurse, retired after 20 years' service, and Miss M. Coslett, the senior School Nurse, was appointed in her place. Another School Nurse, Miss M. P. Dorkins, also retired. Miss A. M. Matthews and Miss G. Griffiths were appointed in their place. Miss Matthews, who took up her position at the outbreak of war, was transferred to a reception area to which a number of Ealing children were evacuated, in order to assist the stuff of the local authority of that area to supervise the greatly Increased number of school children there. Mr A. G. Brown, one of the School Dentists, was called up for service with the Forces and a part-time dental surgeon, Mr. J. V. Houlton, was engaged to assist with the work. The Ophthalmic Surgeon, Mr. Graeme Talbot, was called up for duty with the Royal Army Medical Corps and in his stead Dr. J. G. Freeman Heal was appointed for the duration of the war. MEDICAL INSPECTION. Medical inspection included (1) the routine inspection ia 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-teaches, 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. 33 FINDINGS OF MEDICAL INSPECTION. A detailed summary of defects found at both routine and special inspections is contained in Table II on page 45. Among the 4,692 children examined in a routine manner there were, excluding uncleanliness and dental disease, 534 defects requiring treatment and 605 requiring to be kept under observation. The examination of the 4,430 children submitted to special inspection revealed 3,102 defects requiring treatment and 630 requiring to be kept under observation. Of the 4,692 children examined at the routine inspections, 781 or 16.6 per cent. were found to require treatment for one or more defective conditions. . Malnutrition.—The state of nutrition of the children examined at routine medical inspection is shown in Table II on page 45. 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 99.1. The percentage of children classified as slightly sub-normal is .9. There were no cases of Nutrition D. As in previous years all children who were of sub-normal nutrition were kept under medical supervision and were, given free milk, when the family circumstances justified it, two-thirds of a pint daily being the rule. UNCLEANLINESS. All elementary school children in the Borough are examined for cleanliness three times a year. This year, however, the figures for the third examination, taking place after the summer holidays, were reduced because a number of the school children were evacuated and because after the outbreak of war some of the school nurses were engaged on other duties and could not carry out the head inspections. Much criticism was made of the condition of many of the children evacuated from the towns into country districts and assertions were made that the school medical service had failed 34 in its purpose by permitting a large percentage of children to be in a verminous condition. Those who made these assertions were not fully cognisant of the circumstances. Normally among school children there is a small percentage who are uncleanly, but if these children are left without attention for two or three weeks, as happened when they were evacuated into new homes, they not only become more severely infested but they are a s&urce of infestation for many other children with whom they are associated. It was unfortunate that many of the children were transferred into new homes where the foster-mothers did not appreciate the need for vigilance in caring for the children. The absence of criticism of the condition of children from Ealing, however, was distinctly noticeable and drew attention to the high standard of cleanliness insisted upon in Ealing Schools. In the following table are indicated the number of inspections of children carried out in the last four years and the results obtained. In column 3 are shown the total number of children excluded, those who had any lice or more than 10 nits in the hair, was 520 and the number concerning whom notices of uncleanliness were sent to the parents, those who had up to 10 nits in the hair, was 303 or together 823, or 2.8 per cent. of the total number of the children inspected. Year Average No. on Rolls No . of examinations for verminous condition Unclean No. of children excluded Unclean No. of Notices sent to parents Legal proceedings taken under Attendance Byelaws 1936 15,251 33,578 427 513 8 1937 17,062 39,955 743 587 21 1938 18,107 43,372 731- 584 18 1939 18,174 (End of August) 29,357 520 303 6 35 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 46). It will be seen that as many as 82.7 per cent. of the children found to be suffering from minor ailments on medical inspectioa 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 10 58 Scabies 86 209 Impetigo 154 1,098 Others 288 991 Minor eye defects 217 1,526 Minor ear defects 238 4,513 Miscellaneous: Minor injuries 1,015 4,853 Sores Others Total 2,008 13,248 Cases of scabies were treated by benzyl benzoate solution which has been found to be more efficacious and less troublesome than the old treatment by sulphur ointment. (b) Defective Vision.—Table IV, Group 2, shows the extent of the work carried out by the Ophthalmic Surgeon during the year It will be seen that 1,077 were specially examined and that spectacles were prescribed and supplied in 770 cases. (c) Defects of the Ear, Nose and Throat.—As mentioned earlier in the report, some interruption in the treatment of defects 36 of the ear, nose and throat occurred at the outbreak of the war, but every effort was made to continue the work. During 1939, 56 children were treated for nose and throat conditions at the King Edward Hospital—32 were operated upon for enlarged tonsils, 5 for adenoids and 19 for enlarged tonsils and adenoids. Other children were kept under observation either by the Consulting Oto-laryngologist, Mr. Arthur Miller, or by the members of the School Medical Staff. Ear Defects.—The treatment of ear conditions has already been described in previous reports. Routine treatment was tarried out at the Health Centres, while the children were supervised by Mr. Miller at the Clinics held once a month at Mattock Lane and Ravenor Park Centres. Special methods of treatment, ionization, politzerization, eustachian catheterization and diastolization were carried out and 23 selected cases were treated by the last method for catarrhal conditions of the nose and ear. There were 158 cases seen during the year and they altogether attended 272 times. Cases referred from— A B Defects found Total all defects C D E F G 1 1. Routine school inspection 39 4 — '7 S 1 4 24 87 2. Inspection Clinics 17 4 2 1 5 2 9 19 59 3. Child Welfare Centres 5 — — — 3 — 2 2 12 » • Total 158 The cases were ultimately disposed of as follows:— Discharged as cured 49 Referred to Hospital for special treatment or operation ... 29 Still attending Clinic 49 Did not complete treatment 31 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 37 under consideration 56 children were treated, 32 being operated on for enlarged tonsils, 5 for adenoids and. 19 for enlarged tonsils and adenoids . (d) 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 43, that dealing with mothers and pre-school children on page 14, while the section giving a description of the work among elementary school children follows:— "The Dental Inspection and Treatment of Elementary School Children in 1939. "Dental inspections were carried out in nearly all the schools in the Borough during the year. Because of the dislocation of work and the closure of schools due to the outbreak of war it was not possible to treat all the children by the end of the year. It was found at the schools inspected that 7,201 children required treatment out of a total of 13,388 seen at the schools and at the Health Centres. This figure for treatment is 2,556 less than in the preceding year. The number of children actually treated totalled 6,217, which figure is 686 less than in 1938. The form of treatment given is chiefly conservative in character for children above eight years of age, but below this age extractions of the carious temporary teeth is the form of treatment generally required. Orthodontic appliances were supplied to suitable cases during the year, and since 1937, when this form of treatment was first commenced, 73 children have been fitted with plates. The number of fillings inserted in all teeth amounted to 4,945, this figure being smaller by 1,157 than in the preceding year. Extractions were performed under nitrous oxide and oxygen for the younger children, but in a number of older children local anaesthesia was employed. Altogether, 1,571 permanent teeth were removed and 8.529 temporary, making a total of 10,100 extractions. Other operations included 1,051 dressings to exposed pulp, scaling was done for 110 children, 3 children had gum treatment for acute gingivitis, and 531 adjustments were made to orthodontic appliances during the year. At the special inspection of leavers held during the year, it was found 38 that out of 1,375 children 1,177 were leaving school with sound mouths. This means a percentage of 85 with sound mouths, a very satisfactory figure which proves that dental treatment in the Borough is very successful." (e) Orthopaedic Treatment.—At the outbreak of the war, as already stated, it was found impossible to hold the Orthopaedic Clinic owing to the absence of the Surgeon on duty in the Emergency Hospital Service. The Masseuse, however, attended on four sessions in each week and continued the treatment previously advised. The work of the Orthopaedic Clinic during the year may be summarised as follows:— Orthopaedic Clinic. School children. Children under five. Total Attendances by Surgeon 9 7 16 Number of children seen for first time 89 83 172 Total number of children examined 418 359 111 Attendances by Masseuse 143 69 212 Number of cases treated 114 66 180 Number of attendances by children 1,248 543 1,791 Children admitted to hospital for special treatment 17 2 19 Children supplied with special boots or surgical appliances 19 12 31 (f) Defective Speech.—Children with speech defects are selected in the course of routine medical inspection or are recommended by the teacher on account of their disability. Before being admitted to the speech class each child has a thorough medical overhaul and the personal and family historyare closely investigated. Physical defects, such as abnormal tonsils, adenoids and teeth are remedied. Where necessary the parents are advised to consult the family doctor for the treatment 39 of pathological conditions such as chorea and epilepsy which are sometimes present. The child is then considered to be in a position to gain full benefit at the speech training class. These classes are held at the Mattock Lane and Ravenor Park Health Centres. The child is seat from school to the Health Centre for two sessions each week. He is taught to relax and to breathe properly; later be is instructed according to the principles of voice production and correct speech. Sympathetic treatment and association with fellow sufferers do much to overcome the child's self-consciousness and eradicate his nervousness. Gradually the feeling that he is abnorml is dispelled and with its disappearance self-confidence is established. Much time and patience are required, but by degrees the gap between him and his normal school fellows is narrowed and in a gratifying number of cases is ultimately closed. Throughout the treatment a close liaison is maintained between the parents, the school teacher, the teacher at the speech class and the school medical staff. The child's progress is periodically reviewed and care is taken to promote bis physical and mental health. During the year there were in attendance a total of 43 children. Of these at the time of the report, there were (а) still attending 13 (b) discharged as cured 15 (c) evacuated 8 (d) no longer resident in the district 4 (e) left school 2 (f) refused to attend 1 40 Observations Tabulated. Total Number 43. Defect. Stammering Lisping Cleft Palate Speech tailing Number 25 7 1 10 Related Influences. (a) None ascertained 6 3 – 2 (b) Nervousness 6 1 — 1 (c) Nervousness and other defects 4 1 – – (d) Hereditary influence 5 2 – 3 (e) Physical Defects — — 1 2 (f) Disease 1 — – 2 (g) Injury 3 — – – Response to Treatment. (a) Cured 9 3 – 3 (b) Much Improved 4 1 1 2 (c) Slightly Improved – 2 – 2 (d) Relapse 2 — — – (e) Attendance discontinued 10 2 – 3 (g) Convalescent Treatment.—During the year 32 children were sent to the Russell Cotes School of Recovery, Parkstone, and .12 children were sent to Collington Manor, Bexhill. Six children were given two weeks' summer holiday at Collington Manor by the King Edward Memorial Convalescent Home Fund. The arrangement by which a bed is reserved at the four homes of the Invalid Children's Aid Association was discontinued at the beginning of the war and now application is made when a vacancy is required. In 1939 six children were sent to Worthing, four to Broadstairs, four to Dover and five to Seaford. Every child is examined by the Medical Officer on return from a convalescent home and the result of the stay is noted. 41 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 102 cases of measles, 520 of whooping cough, 631 of chickenpox and 393 of mumps. Children to the number of 229 were excluded under Article 20 (6) of the Education Code for the following conditions : Impetigo 115 Ringworm of body 3 Scabies 90 Other skin diseases 5 Conjunctivitis 13 Ringworm of head 3 229 No closure took place under Articles 22 or 23 (b) of the Code Grant Regulations. The following school required a certificate under Paragraph 15 (ii) of the Administrative Memorandum No. 51 issued by the Board of Education: Perivale Infants, three weeks for whooping cough and influenza. Immunization against Diphtheria.—The immunization work was interrupted at the beginning of the war but was resumed early in December. Two-sessions were held weekly at Mattock Lane, Ravenor Park, Greenford Green and Islips Manor Centres. Immunization Work in 1939. Preliminary Schick tests 141 School children immunized 181 Children under 5 years immunized 290 Final Schick tests 459 The total number of children of all ages immunized at the Health Centres in 1939 was thus 471. 42. MILK IN SCHOOLS. The arrangements for the supply of milk to school children were carried on as in previous years. In the report for 1938 mention was made of the impending arrangements to enable children to have milk during the school holidays and at Easter 1939 this scheme began. Those children, whose parents desired them to have milk, were instructed to attend at various Centres daily. The successful distribution of the milk at these Centres was due largely to the great help which was given by members of the Ealing Women Citizens' Association and various voluntary organizations throughput the Borough. NURSERY SCHOOLS. The nursery classes conducted at St. John's, St. Mark's, Stanhope and Drayton Schools, concerning which remarks were made in the Annual Report for 1938, were discontinued after the outbreak of war. Their discontinuance was due to the evacuation of so many of the school children and the difficulty in staffing these particular classes. 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, 368 routine and 31 special inspections of pupils being made. County Schools are usually medically inspected in May and new entrants in November. As the County Schools were not open in November, however, the entrants were not inspected in 1939. This accounts for the decrease in the numbers. Ophthalmic treatment was given during the year to 55 pupils attending County Schools and for 48 of these spectacles were prescribed and supplied through the school medical department. 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 : 43 "The Dental Inspections and Treatment of Secondary School Pupils. "The dental inspections and treatment of all secondary school pupils during 1939 was unfortunately interrupted owing to the outbreak of war. Only one of these schools was inspected by the end of August. Dental treatment was however given to pupils who bad been inspected in 1938, and a certain number of those who had been inspected during 1939. The total number inspected was 366, and the number treated was 285. The treatment carried out was chiefly Conservative in character, although necessary extractions were performed. The total number of fillings inserted was 452. The number of teeth extracted totalled 225. Other forms of treatment given included dressing to canals of front teeth, scaling and polishing, gum treatment in acute gingivitis, and adjustments of orthodontic appliances for those pupils who had been fitted during their attendance at elementary schools. Altogether, 92 attendances were made for these forms of treatment." EMPLOYMENT OF CHILDREN AND YOUNG PERSONS. The number of children examined in connection with their employment out of school hours was 266 and of this number 15 were found to be unfit for employment. The nature of the employment of those certified as fit was: Boys. Errand Boys 142 Milk Round 22 Newspaper Round 42 Baker's Round 36 Order Boy 1 Others 7 Girls. Shop Assistant 1 251 N 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 44 to employment out of school hours is withdrawn. This action was found to be necessary in 5 instances. At routine inspection 41 children were found who bad not obtained the necessary permission. One boy and 7 girls were examined in connection with the issuing of licences under Section 22 of the Children and Young Persons Act, 1933, permitting employment in entertainments. MISCELLANEOUS. It is usual to group under this heading the medical examinations 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 .42 teachers and 167 other candidates were examined. School Medical Officer and Medical Officer of Health. Ealing Central Library Reference Dept. 45 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 1,455 Second Age Group 2,093 Third Age Group 1,144 Total 4,692 Number of other Routine Inspections – B.—Other Inspections. Number of Special Inspections and Re-Inspections 10,678 TABLE II. CLASSIFICATION OF THE NUTRITION OF CHILDREN INSPECTED DURING THE YEAR IN THE ROUTINE AGE-GROUPS (UP TO AUGUST 31st). Age-Groups. Number of Children Inspected. A. (Excellent). B. (Normal). C. (Slightly subnormal) . D. (Bad). No. % No. % No. % No. % Entrants 1,395 93 6.7 1.293 92.7 9 6 — — Second Age group 2,019 141 7. 1,860 92.1 18 9 — — Third Age group 1,055 86 8.2 955 90.5 14 1.3 — — Other Routine Inspections — — — — — — — — — Total 4,469 320 7.2 4,108 91.9 41 .9 — — 46 TABLE III. Blind and Deaf Children who are not at the present time receiving education suitable for their special needs. NONE. TABLE IV. RETURN OF DEFECTS TREATED DURING THE YEAR. TREATMENT TABLE. Group I.—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 — 4 4 Ringworm—Body 9 — 9 Scabies 86 23 109 Impetigo 154 33 187 Other Skin Disease 288 161 449 Minor Eye Defects (External and other, but excluding cases falling in Group II) 217 118 335 Minor Ear Defects 238 68 306 Miscellaneous (e.g., minor injuries, bruises, sores, chilblains, etc.) 1,015 14 1,029 Total 2.008 421 2.429 47 Group II.—Defective Vision and Squint (excluding Minor Eye Defects treated as Minor Aliments—Group 1). Defect or Disease No. of Defects dealt with. Under the Authority's Scheme Otherwise Total Errors of Refraction (including Squint) 1022 36 1058 Other Defect or Disease of the Eyes 19 » 19 Total 1041 ' 36 1077 Number of Children for whom Spectacles were:— (a) Prescribed 744 36 780 (b) Obtained 734 36 770 Group III.—Treatment of Defects of Nose and Throat. Number of Defects Received Operative Treatment Under the Authority's Scheme in Clinic or Hospital By Private Practitioner or Hospital, apart from the Authority's Scheme Total Received other forms of Treatment Total number Treated 56 2 58 — 58 48 Group IV.—Orthopaedic and Postural Defects. Under the Authority's Scheme— Number of children treated Residential treatment with education 17 Residential treatment without education — Non-residential treatment at an orthopaedic clinic 114 Otherwise— — Residential treatment with education — Residential treatment without education — Non-residential treatment at an orthopaedic clinic — Total number of children treated 127 TABLE V.—DENTAL INSPECTION AND TREATMENT. Number of Children who were :— (a) Inspected by the Dentist: Routine Age Groups Aged 5 776 Total 13,182 6 1,400 7 1,539 8 1,637 9 1,570 10 1,556 11 1,392 12 1,148 13 1,152 14 981 15 29 16 2 Specials 206 Grand Total 13,388 (b) Found to require treatment 7,201 (c) Actually treated 6.217 Attendances made by children for treatment 8,963 Half-days devoted to:— Inspection 92 Treatment 1094 Total 1,186 Fillings:— Permanent Teeth 4,578 Temporary Teeth 367 Total 4,945 Extractions:— Permanent Teeth 1,571 Temporary Teeth 8,529 Total 10,100 Administrations of General Anaesthetics for Extractions 2,105 Other operations:— Permanent Teeth 1741 Temporary Teeth Total 1741 49 MENTAL DEFICIENCY (NOTIFICATION OF CHILDREN) REGULATIONS, 1928. CHILDREN NOTIFIED DURING THE YEAR ENDED 31st DECEMBER, 1939, 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 1 – (b) Imbeciles 3 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 TABLE VI. 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 29,357 (3) Number of individual children found unclean 746 (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 6