EALING PUBLIC LIBRARIES REFERENCE DEPARTMENT E352-4/6128 EAL 31 Borough of Baling. ANNUAL REPORT OF THE Medical Officer of Healths AND School Medical Officer 1940 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 3 HEALTH SERVICES, This Annual Report has of necessity to be merely a summary of the main features of the vital statistics and of the health Services of the Borough for 1940. Most notable has been the resumption during the year of the whole of the Maternity and Child Welfare and of the School Medical Services. The general death rate is higher than in the previous nine years, due mainly to the effects of enemy air raids. As a set-off, so to speak, against this high rate, the infant mortality has been remarkably low, 43 per thousand births, in fact, the lowest in the history of the Borough, while the birth-rate has remained steady, 14.7 compared with 14.8 for 1939 and 14.9 for 1938. Maternal Mortality, though not the lowest recorded is the next lowest, 1.74 compared with the lowest 0.93 in 1936. Only 33 cases of diphtheria and 116 cases of scarlet fever were notified during the year, easily the lowest number of each of these diseases for ten years. There has been no evidence during the year of any adverse effects, either on the physical or mental state of the children, of war conditions. The nutritional state of the children, as ascertained on routine school medical inspection, has been found to be not different from pre-war years. Uncleanliness, or verminous condition, has not increased, in fact, the percentage of unclean children, 3.0, is the same as the average for the previous 4 years. This means that 97 per cent. of the children in the Ealing Schools can be said to be free from vermin, a most satisfactory result of medical supervision. Scabies, which began to be more prevalent in 1937, has been encouraged in its spread by the family conditions associated with the war and has shown an increased prevalence amongst school children and the community in general. In fact, its control is one of the present day public health problems. The work of the whole of the public health staff, varied as it has been by the imposition of new and onerous duties associated with the war, has been uniformly carried out with such devotion as to deserve sincere and grateful acknowledgement. 4 SUMMARY OF GENERAL STATISTICS. Area (in Acres) 8,739 Population (Census, 1931) 117,707 Population (Estimated Middle of 1940) 156,490 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, 1940) 48,120 Rateable Value, 1st April, 1940 £1,859,854 Net Product of a Penny Rate £7,088 SUMMARY OF VITAL STATISTICS. Live Births (for calculating Birth-Rates):— Legitimate Males, 1,173 Females, 1,040 Total, 2,213 Illegitimate Males, 48 Females, 32 Total, 80—2,293 Birth-Rate per 1,000 of Estimated Population 4.7 Live Births (for calculating Infant Mortality Rates):— Legitimate Males, 1,125 Females, 995 Total, 2,120 Illegitimate Males, 47 Females, 32 Total, 79—2,199 Still-Births:— Males, 36 Females, 26 Total 62 Rate per 1,000;otal Births (Live and Still-Births) 26 Deaths : Males, 917 Females, 1,017 Total 1,934 Death-Rate per 1,000 of Estimated Population 12.4 Deaths of Infants under one year of age:— Legitimate .Males, 51 Females, 38 Total, 89 Illegitimate Males, 2 Females, 4 Total, 6— 95 5 Death-Rate of Infants under one year of age:— All Infants per 1,000 Live Births 41 Legitimate Infants per 1,000 Legitimate Live Births 40 Illegitimate Infants per 1,000 Illegitimate Live Births 75 Deaths from Diseases and Accidents of Pregnancy and Childbirth:— From Sepsis 1 Death-Rate per 1,000 From other Causes 3 Total Births 0.44 „ „ 1.30 Total 4 „ „ 1.74 Total Deaths Death-Rate per 1,000 Population Measles 0 0.00 Whooping Cough 2 0.01 Diphtheria 4 0.03 Scarlet Fever 0 0.00 Influenza 34 0.20 Tuberculosis of Lungs 99 0.63 Other Forms of Tuberculosis 12 0.08 Death-Rate per 1,000 Live-Births Diarrhoea (under 2 years of age) 10 4.36 6 \ Causes of Death, 1940. Cause of Death. Deaths, 1940 Male Female Total Typhoid and Paratyphoid Fevers — - - Cerebro-Spinal Fever — 2 2 Scarlet Fever — — — Whooping Cough — 2 2 Diphtheria — 4 4 Tuberculosis of Respiratory System 59 40 99 Other Forms of Tuberculosis 10 2 12 Syphilitic Diseases 5 1 6 Influenza 18 16 34 Measles — — — Acute Infectious Encephalitis 2 2 2 Cancer of B. Cav. and Oesoph. (M.) ; Uterus (F.) 9 20 29 Cancer of Stomach and Duodenum 23 26 49 Cancer of Breast — 28 28 Cancer of all other Sites 75 83 158 Diabetes 3 7 10 Intra-Cran. Vase. Lesions 54 96 150 Heart Disease 184 255 439 Other Diseases of Circulatory System 22 19 41 Bronchitis 57 50 107 Pneumonia 58 51 109 Other Respiratory Diseases 21 6 27 Ulcer of Stomach or Duodenum 15 5 20 Diarrhoea (under 2 years) 6 4 10 Appendicitis 6 4 10 Other Digestive Diseases 32 33 65 Nephritis 19 14 33 Puerperal Post-Abortive Sepsis — 1 1 Other Maternal Causes — 3 3 Premature Birth 8 10 18 Congenital Malformations, Birth Injury, Infantile Diseases 21 15 36 Suicide 7 7 14 Road Traffic Accidents 11 11 Other Violent Causes 103 127 230 All other Causes 89 84 173 Total 917 1,017 1,934 7 Table Showing Birth-Rate, Death-Rate and Infant Death-Rate for the Borough of Ealing. Period Birth-Rate Death-Rate Infant Death-Rate 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 1940 14.7 12.4 41 Maternal Mortality per Thousand Births. Period Ealing England and Wales 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 1940 1.74 2.16 HOSPITALS. Isolation Hospital. The Clayponds Isolation Hospital at South Ealing, which is under the control of the Ealing and Brentford & Chiswick Hospitals Committee, has a normal capacity of 142 beds. At present 34 beds are retained for the treatment of cases of infectious disease, the remainder of the hospital being utilised as a Grade A1 Emergency Hospital with 200 beds. Maternity Hospital. The Perivale Maternity Hospital of 43 beds is also under the Joint Hospitals Committee. Throughout the year this hospital was made use of in a normal manner, the accommodation being fully booked throughout the year. 8 MATERNITY AND CHILD WELFARE. Although two of the six Health Centres are adapted for use as First Aid Posts they have continued in use for their original purpose. The whole of the. work in connection with the Maternity and Child Welfare has proceeded during the year on normal pre-war lines In the course of the year the National Milk Scheme came into operation whereby every expectant or nursing mother and every child under five years of age is able to obtain one pint of milk, either free of charge or at a reduced price according to financial circumstances. In addition, supplies of National Dried Milk are available, in lieu of liquid milk, for babies who are artificially fed. At the commencement of the National Scheme the arrangements for the supply of milk to necessitous cases at the cost of the Council were discontinued as all, the mothers and children then receiving free supplies of milk became entitled to free milk through the new Scheme. Arrangements have been made at the Ante-Natal Clinics for the evacuation of expectant, mothers in accordance with the official evacuation scheme for the London area which is organised by the London County Council. During the year only twenty-six expectant mothers took: advantage of this scheme. Summary of the Visits made by the Health Visitors.' Visits to children under 12 months : (1939) (1940) - * First visits ... ... v... 1,860 2,402 Return visits ... * 4,555 4,332 Visits to children 1 to 5 years of age ..: , ... 6,854 6,393 , Visits to expectant mothers . 1,416 1,190 Visits to investigate infant deaths and still-births 109 71 • Special visits or investigations 252 424 Visits to cases of Ophthalmia Neonatorum 13 10 Visits to cases of Pemphigus Neonatorum — — Visits to cases of Measles and Whooping Cough ... 138 397 Visits to cases of Scarlet Fever on discharge from the Isolation Hospital 276 26 Inspections of Women's Lavatories ... • ... 44 63 Visits to children under care of foster-mothers ... 705 634 Other visits , 119 129 » v Total Visits 16,341 15,971 9 Summary of the Work at the Health Centres. Mothers. Expectant Mothers attending Ante-Natal Clinics (1939) (1940) Attending for the first time 1,139 1,466 Total attendances 6,570 7.023 Nursing mothers attending Post-natal Clinics:— Attending for the first time 372 185 Total attendances 428 205 Children. Children attending Centres for the first time (1939) (1940) Under one year of age 1,910 2,044 One to five years of age 922 1,275 Total attendances made by children:— Under one year of age 24,074 13,489 One to five years of age 15,058 14,471 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 1,074 18 months to 2 years 689 2 years to 3 years 739 3 years to 4 years 686 4 years to 5 years 451 3,639 DENTAL TREATMENT. Treatment for expectant mothers was carried out at three Health Centres and for children under five years at all six Centres. The number of mothers receiving treatment totalled 546. The number of attendances made for treatment amounted to 2,044. These attendances were for various forms of treatment, including extractions, fillings, gum treatment for suitable cases and the fitting of dentures. The total number of extractions numbered 2,035, and the fillings 426. The number of dentures supplied during the year was 169. 10 The number of pre-school children inspected and treated during the year was 439. These children made 792 visits to receive treatment, which included 1,324 extractions and 100 fillings. 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 101 (Number of fostermothers having care of the above children, 88). Number of children registered during the year 96 Number of children removed from register during year 101 Number of children on register at end of year 96 (Number of fostermothers having care of the above children; 79). Number of visits made by Health Visitors 634 MIDWIFERY SERVICE. At the end of the year 11 midwives were employed by the Council in connection with the domiciliary midwifery service. The cases attended by the midwives were as follows : Number of Confinements attended:— (a) as midwife 648 (b) as maternity nurse 129 ' 777 SUPERVISION OF MIDWIVES. Number of midwives practising in area at end of year:— Midwives in service of Council 11 „ at Perivale Maternity Hospital 10 „ in independent practice 5 „ in private nursing homes 5 31 All of these midwives possessed the certificate of the Central Midwives Board. 11 Number of births attended by midwives:— When acting in the capacity of midwive: (a) In private Nursing Homes 79 (b) At the patient's home 667 When acting in the capacity of maternity nurse (a doctor being in attendance): (a) In private Nursing Homes 92 (b) At the patient's home 146 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 18 (10) 246 (69) Number of applications for transfer of registration 2 Number of New Homes registered 1 10 (-) Number of Homes discontinued 3 25 (3) Number of Nursing Homes on Register at end of year 16 (8) 223 (63) The figures in brackets indicate the number of Homes and the number of beds wholly or partly devoted to the reception of maternity cases. The Medical Officer in charge of the supervision of Nursing Homes made 41 special visits during the year. SANITARY CIRCUMSTANCES OF THE BOROUGH. Sanitary Inspection of the Borough.—The following is a summary of the work carried out by the Sanitary Inspectors during the year:— 12 General. Number of Premises inspected on Complaint 1,146 Number of Nuisances observed by Inspectors 42 Number of Premises inspected in connection with Infectious Disease 413 Number of Premises visited by Periodical Inspection (Cowsheds, Dairies, Slaughterhouses, Factories, etc.) 280 Number of Houses inspected under House-to-House Survey 28 Food Inspections 707 Total Number of Re-inspections 4,704 Other Inspections 432 Total Number of Inspections and Re-inspections 7,752 Number of Intimation Notices given 530 Number of other Letters written 403 Number of Statutory Notices served 35 Proceedings before Magistrates - 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 34 - - 72 75 Number inspected 34 - - 72 75 Alt Diseases except Tuberculosis— Whole carcases condemned —- - — — - Carcases of which some part or organ was condemned 3 - - 6 2 Percentage of the number inspected affected with diseases other than tuberculosis 8.8 - - 8.3 2.7 Tuberculosis only— Whole carcases condemned - - - - - Carcases of which some part or organ was condemned 6 - - - - Percentage of the number inspected affected with tuberculosis 17.6 - - - - 13 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. The Sanitary Inspectors have had to inspect a large quantity of meat there daily. The following table indicates the amount 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:— lbs. Beef 3,511 Pork 704 Fish 581 Rabbits 76 Mutton 7,922 Veal 305 Offal 18,230 Bacon 639¾ Sausages 30 Ham 81½ Brawn 11 Corned Beef 54 Black Pudding 15¾ Meat Pies 117½ Plums 48 Slab Cake 56 32,3821 lbs. Total:—28 tons, 9 cwts., 0 qrs., 14½ lbs. Eggs 570 Assorted Tinned Food 348 tins 14 PREVALENCE OF, AND CONTROL OVER INFECTIOUS AND OTHER DISEASES. Cases of Infectious Disease occurring in the Borough. Disease 1931 1932 1933 1934 1935 1936 1937 1938 1939 1940 Smallpox - - - - -- - - - - - Diphtheria 83 54 71 195 228 52 123 142 92 33 Scarlet Fever 154 407 476 493 400 408 317 383 303 116 Enteric Fever (including Paratyphoid) 1 3 4 3 7 8 5 2 5 4 Puerperal Fever 6 4 3 3 7 3 4 — — — Puerperal Pyrexia 18 21 28 14 11 9 24 46. 40 30 Pneumonia: Primary 96 85 56 72 59 85 60 83 50 66 Influenzal 18 50 32 17 11 14 37 18 26 10 Acute Poliomyelitis 2 4 3 - 1 2 7 6 1 1 Cerebro-Spinal Fever — — — — — — 1 1 — 7 Malaria 1 — 1 1 — 1 — — — 1 Dysentery — —- — — 1 1 5 12 2 — Erysipelas 20 30 36 43 28 28 27 41 37 29 Encephalitis Lethargica 1 1 - 1 — 1 — — - — Tuberculosis:— Pulmonary 141 141 154 139 157 139 178 142 149 156 Non-Pulmonary 27 27 23 24 23 22 37 33 38 30 Ophthalmia Neonatorum 9 5 8 5 3 4 7 15 16 5 Total 577 832 895 1010 936 777 832 924 759 488 Scarlet Fever.—Of the 116 cases of scarlet fever only 37 cases were removed to hospital. Since the outbreak of war accommodation for cases of scarlet fever in the Isolation Hospital has been much reduced and only in exceptional circumstances have cases been admitted. There were no deaths from the disease. Diphtheria.—All of the 33 cases of diphtheria were removed to hospital. There were 4 deaths from this disease. • Measles and Whooping Cough.—Measles and whooping cough became notifiable under the Measles and Whooping Cough Regulation 1939. The following number of cases were notified:— Measles 630 Whooping Cough 186 There were two deaths from whooping cough. These were of children aged 2 months and 15 months respectively. 15 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 - - - - - - - - 1—5 - - - - - - - - 5—10 — 1 4 3 - — 2 — 10—15 1 — 6 — - — — — 15—20 18 8 2 — 6 4 1 - 20—25 8 15 2 2 8 8 - - 25—35 27 20 4 — 14 13 l — 35—45 20 7 5 1 6 5 2 - 45—55 10 5 1 — 10 2 3 2 55—65 7 7 — — 11 7 1 — 65 upwards 2 — —- — 4 1 - — Total 93 63 24 6 59 40 10 2 16 SCHOOL MEDICAL SERVICE. In 1940 the School Medical Service was carried on with little impairment from war conditions. Dental treatment, including the treatment of mothers, was carried on satisfactorily with the assistance of a part-time dental officer, Mr. J. V. Houlton, L.D.S. The Ophthalmic Surgeon, Dr. J. G. Freeman Heal, attended on three sessions weekly, one at Mattock Lane Centre and two at Ravenor Park Centre. Orthopaedic supervision was resumed in March and from that time until the end of the year Mr. Cholmeley, F.R.C.S., the visiting Surgeon, attended on nine sessions. Miss Hepburn, the Masseuse, attended on four sessions weekly from January to November and on three sessions weekly from November to December. Diphtheria immunization was carried on as usual. In December in consequence of the Ministry of Health Circular 2230 further steps were taken to give publicity to the value of immunization and as a result a great many more children were immunized. The Minor Ailment Clinics were carried on at the Centres as in normal years. STAFF. The Deputy Medical Officer of Health, Dr. Llywellyn Roberts, and two Assistant Medical Officers, Dr. Alfred J. Muir and Dr. Matthew C. Kelly, resigned in 1940. Dr. Daniel C. Logan and Dr. Elizabeth M. James, were appointed in the place of the latter two officers. During 1940 three school nurses resigned, Miss McGann, Miss O. Moss and Miss V. Gilbert. They were succeeded by Miss E. Evans, Miss G. E. Andrews and Miss D. E. Nicholson. Miss Matthews returned at the end of the year from Buckinghamshire where she had been assisting the County Council with evacuated Ealing school children. In November Miss L. Gilbert and Miss G. Griffiths went to Devonshire to help the Council of that County in dealing with the increase in their school population, through the reception in their area of evacuated children. 17 EVACUATION. The evacuation of school children from Ealing entailed considerable additional work for the school medical staff. Children were evacuated at two periods, in June and in October. For the first evacuation the children were medically examined in May and finally inspected before their departure in June. In October, when the bombing of London was increasing in severity, application was made to the Ministry of Health to make the whole Borough an evacuation area. Until then only that part south of the Great Western Railway line was an evacuation area. The Ministry consented and as a result a large number of children was examined and sent away immediately. A number of children was examined from time to time and sent away in small parties. In addition to the children examined under these two evacuation schemes a number were examined by the Council's Medical Officers, at the suggestion of the Board of Education, for evacuation under the Voluntary Scheme for the Evacuation of Unaccompanied School Children Overseas. Two school nurses were sent to Devonshire to assist that Authority with the evacuated children. The following table gives the number of children examined and finally inspected prior to evacuation:— Number of children seen at preliminary examination in May 799 Number of children finally examined in June 785 Number of children examined in October 4,403 Number of children examined for overseas emigration 956 Total number of examinations of children during the year 5,987 MEDICAL INSPECTION. Medical inspection was carried out as in normal years and included 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. 18 FINDINGS OF MEDICAL INSPECTION. Among the 5,461 children examined in a routine manner there were, excluding uncleanliness, malnutrition and dental diseases, 493 defects requiring treatment and.593 requiring to be kept under observation. The examination of the 5,496 children submitted to special inspection revealed 2,175 defects requiring treatment and 542 requiring to be kept under observation. Of the 5,461 children examined at the routine inspections, 474 or 8.7 per cent, were found to require treatment for one or more defective conditions. NUTRITION. The state of nutrition of the children examined at routine medical inspection is shown in Table II. 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. Of all the children attending public elementary schools in Ealing and submitted to routine medical inspection 97.0 per cent, were classified as of normal nutrition and only 3 per cent, were classified as being slightly subnormal. No children were classified as of bad nutrition. From February onwards special nutrition surveys of all the children in the schools were conducted to find out if the health of any was being affected by war-time conditions. The procedure followed was to survey a class at a time with the assistance of the teacher and to select any children who did not appear quite robust and to refer them for a special examination. At this subsequent examination they were classified as regards nutrition. The results of these surveys are as follows : Total number of children surveyed 20,659 Number selected for special examination 950 Number of children classified as or slightly sub-normal (" C ") nutrition 258 Percentage classitied as slightly sub-normal 1-2 Number of children classified as of bad nutrition (" D") None 19 The percentage of children found at these surveys to be of slightly subnormal nutrition is less than half the percentage of children found to be slightly subnormal at routine medical inspection. Perhaps the difference is due to the fact that at routine inspection the examination of each child is more thorough than at the nutrition surveys with the consequence that more subnormal children are found. In any case the figures are highly satistactory and indicate that tne nutritional state cf the children is apparently not affected by conditions associated with war. One good result of the surveys was that attention was drawn to those schools where the largest number of subnormal children were to be iound ana so indicated those in which any scheme for the provisions of meals should first be made to operate. I UNCLEANLINESS. As in previous years all school children in the elementary schools in the Borough were examined on three occasions, namely, after the Easter holiday, after the Summer holiday and after the Christmas holiday. The actual examinations were 25,615, a smaller number than in 1939 and still smaller than in 1938 owing to the evacuation of many of the children. In the following table it will be seen that as a result of the examinations 466 children were excluded because they had lice or more than 10 nits in the hair, and 325 were the subject of warning notices because they had nits but less than 10 in number. This means that 791 or 3 per cent, of the children were found on the average to be unclean on each occasion. Put in another way, these figures mean that 97 per cent, of the children attending public elementary schools in the Borough can be stated to be clean. This percentage can be considered very satisfactory when compared with other parts of the country. The table also shows that the state of cleanliness has not deteriorated during the war, for the percentage for 1940 is the same as the average for the previous four years. 20 Year Average Number on Rolls No. of examinations for verminous condition Number of children excluded Number of warning notices issued Total Number of unclean children excluded or warned Percentage of children unclean whether excluded or not Legal proceedings taken under attendance By-laws 1936 15,251 33,578 427 513 940 2.8 8 1937 17,062 39,955 743 587 1,330 3.3 21 1938 18,107 43,372 731 584 1,315 3.0 18 1939 18,174 29,357 520 303 823 2.8 6 (End of August) 1540 8,600 25,615 466 325 791 3.0 1 (Nov.) ARRANGEMENTS FOR TREATMENT. Minor Ailments and Diseases of the Skin.—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 1 1 Scabies 141 336 Impetigo 116 999 Others 138 772 Minor eye defects 169 1,176 Minor ear defects 218 3,068 Miscellaneous : Minor injuries 551 3,330 Sores Others Total 1,334 9,682 21 Cases of scabies are treated by benzyl benzoate, a method which has been in use for the past three years. The number of cases of scabies is large and indicates an increase over that* of the year before but the increase is not much greater than in the year 1938 when there were 135 cases. The following table indicates that scabies began to be more prevalent in 1937, nearly three years before the outbreak of war. Whilst one could put forward possible reasons for prevalence during war-time conditions it is difficult to explain the increase in the number of cases that preceded the war. Number of Cases treated Year Under Authority's Scheme Otherwise Total Cases 1930 16 5 21 1931 29 8 37 1932 9 1 10 1933 23 4 27 1934 12 2 14 1935 12 - 12 1936 25 - 25 1937 97 - 97 1938 128 7 135 1939 86 23 109 1940 141 8 149 Defective Vision.—The report of the Ophthalmic Surgeon, Dr. J. G. Freeman Heal, is as follows : "During the year 1940, 574 new cases were examined. Of these 236 were seen at Mattock Lane, and 338 at Ravenor Park Health Centre. Re-inspections numbered 577, of which 199 were seen at Mattock Lane, and 378 at Ravenor Park. Prescriptions for glasses were given in 835 cases. The number of pairs of glasses obtained was 832. 22 Abnormal eye conditions, other than refractive errors, were as follows :— Congenital abnormalities. Squint New cases, 108 Re-inspections, 201 Progressive Myopes New Cases, 4 Re-inspections, 10 Congenital Nystagmus 9 Congenital Cataracts 3 Congenital Paralysis of an External Ocular Muscle 1 Abnormalities due to Infection. Interstitial Keratitis (Specific) 6 Choroiditis 1 Endophthalmitis 1 Corneal Ulceration 1 Corneal Scarring 3 Phlyctenular Keratitis 1 Blepharitis 1 Meibomian Cyst 1 Abnormalities due to Trauma. Traumatic lesion of macula 1 The small number of cases of external disease of the eye suggests that the nutrition of the school children has been well maintained during a year of war. Defects of the Ear, Nose and Throat.—During routine inspection of school children and at child welfare clinics, particular care is devoted to examination of the ear, nose and throat and when defects are found parents are advised to seek treatment either by their own medical attendant or at the Health Centres. Cases of a simple nature are treated at the Health Centres while others requiring a specialist's opinion are referred to the Otological Clinic held by Mr. Arthur Miller, F.R.C.S., the consulting surgeon. There were 84 new cases seen at this clinic during the year, of whom 73 were school children and 11 children referred from child welfare clinics. The total number of attendances was 325. 23 The new cases were classified as follows :— Suppurative otitis media ,30 Post suppurative otitis media 2 Catarrhal otitis media 2 Unhealthy tonsils or adenoids or both 19 Deflected septum 7 Rhinitis 9 Other conditions 15 Total 84 Of these cases 33 were referred to Hospital for operation. In regard to the other cases the treatment advised by the surgeon was carried out at the Health Centres and included various forms of specialised therapy such as ear toilet, ionization and diastolization. Owing to war conditions the King Edward Hospital could no longer admit cases for the removal of tonsils and adenoids and in August arrangements were made with the London County Council for these cases to be admitted to St. Bernard's Hospital, Southall. Throughout the year 20 children were admitted to King Edward VII Memorial Hospital and 26 to St. Bernard's Hospital for tolsillectomy and adenoidectomy or both. Dental Defects.—Dental Inspections were carried out in all the schools that were open during the year. The total number of children inspected was 12,556, this figure being smaller by 832 than in 1939. The number found to require treatment totalled 6,795, and of these, 5,124 actually received treatment. This figure is smaller than that for 1939, when 6,217 children were treated. At the special examination of leavers held during the year, it was only possible to see the children who were leaving at the Christmas term, for at the Summer term evacuation intervened, and many of the leavers were not at school. A.t this inspection S7 children had sound mouths and 36 left without complete treatment. 24 Orthodontic treatment was continued during the year when 26 new appliances were fitted for suitable cases. The number of appliances that have been fitted since this form of treatment was first started is 99. The work carried out for all the children treated included extractions, fillings, gum treatments, scalings and dressings to septic root canals. The number of fillings totalled 3,415, being smaller than in the previous year by 1,530. The total number of extractions was 9,821. Of these 1,390 were of permanent and 8,431 of temporary teeth. Those children who returned to Ealing from the first evacuation scheme in September, 1939, and had missed treatment were found to require a greater amount of treatment during 1940 as emergency treatment only had been given to them in the reception areas. The various forms of other operations that were carried out consisted of 868 dressings to root canals in anterior permanent teeth, sensitive cavities, septic sockets^ of-temporary teeth, and dressing to various forms of ulcerations of the mouth, scaling for 43 children and gum treatment for 6 children. Orthodontic cases returning for adjustments during the year made 549 visits, some of these visits being made by children whose treatment was commenced in 1938 and 1939, and were nearing completion. Orthopaedic Treatment.—In March it was found possible to arrange with Mr. Cholmeley, F.R.C.S., the visiting Orthopaedic Surgeon, to resume his attendances at the Orthopaedic Clinic and during the year he attended on nine occasions. The Masseus attended four times a week from January to November and three times a week from November to December. The work of the Orthopaedic Clinic during the year may be summarised as follows :— 25 Orthopaedic Clinic. School children Children under five Total Attendances by Surgeon 5 4 9 Number of children seen for first time 63 48 111 Total number of children examined 209 124 333 Attendances by Masseuse 142 49 191 Number of cases treated 78 33 111 Number of attendances by children 999 293 1,292 Children admitted to hospital for special treatment 13 2 15 Children supplied with special boots or surgical appliances 13 5 18 Defective Speech.—During the year classes for the treatment of speech defects were held from March until August when they were discontinued. The age of entry, complete medical examination before entry, part-time training and medical supervision of children having speech defects were described in the 1938 report, and have continued unaltered. From March to August there were in attendance at the Mattock Lane and Ravenor Park Health Centres a total of 26 children. Of these, in August there were : (a) Still attending 23 (&) Discharged as cured 2 (c) Evacuated 1 Convalescent Treatment.—During the year 16 children were sent to the Russell Cotes School of Recovery, Parkstone, and 8 children were sent to Collington Manor, Bexhill. The Russell Cotes School was closed in August ana Collington Manor was closed in June. 26 The beds reserved at Worthing, Broadstairs, Dover, and Seaton by arrangement with the Invalid Children's Aid Association were cancelled at the outbreak of war. INFECTIOUS DISEASE. The returns forwarded each week by th# head teachers giving particulars of. all new . cases of" non-notifiable infectious disease coming to their knowledge included 1,342 cases of measles, 190 of whooping cough, 151 of chickenpox and 21 of mumps. Children to the number of 223 were excluded under Article 20 (6) ol the Education Code for the following conditions : Impetigo 116 Ringworm of body 1 Scabies 101 Other skin diseases 3 Conjunctivitis 3 Blepharitis 1 Scabies and impetigo 2 227 No closure took place under Articles 22 or 23 (b) of the Code— Grant Regulations. . No schools required certificates under Paragraph 15 (ii) of the Administrative Memorandum No. 51 issued by the Board of Education. Diphtheria Immunization.—In recent years every step has been taken to encourage the immunization not only of school children but of children under 5 years of age. Posters have been exhibited in. the schools and at the Health Centres and leaflets have been distributed to the mothers attending the latter. The response has not been great, due apparently to the fact that the incidence of diphtheria in this district has remained low and the attention of the public has therefore not been vividly drawn to the dangers of diphtheria. During the early months of the war, on account of the insistence of problems of evacuation and of A.R.P. Services the attention 27 of the Public Health department was diverted from diphtheria immunization but during the later months of 1940 steps weije taken to bring to the notice of the public the desirability, even the necessity, of children being immunized against diphtheria. After the receipt of Circular 2230 of the Ministry of Health further steps were taken to direct the attention of the public to this mfcans of preventing diphtheria. Posters were exhibited in the Health Centres and in public buildings advocating immunization and leaflets were distributed to the parents through the Health Centres and through the. schools. At the same time the Council withdrew a restriction which had been placed upon immunization. Before December, 1940, immunization at the cost of the m • Council applied only to children whose parents' income was below £260 per annum but this restriction was removed. The issue of publicity material in December supported as it was-by further publicity of a national character produced a large increase in the number of applications for immunization. Up to December of this year immunization was carried out at the Health Centres to which school children and children under 5 years of age were brought by their parents. In order still further to encourage applications for immunization it was decided to carry out the immunization of school children at the schools with the co-operation of the head teachers. Each school is to be dealt with in turn, the teachers giving leaflets advocating immunization to the children to take home and at the same time giving them forms of application which the parents are asked to fill up and return to the school. When a sufficient number of applications are received a medical officer and nurse will carry out the immunization in the schools,- the parents being saved the trouble of attending and the school classes being disturbed less in the process than by the children attending the Health Centre. The immunization is carried out by the Council's own medical officers assisted by the school nurses and is given entirely free of cost to the parents. Some indication of the results of this publicity may be gleaned from the fact that during the whole of last year the immunization of 708 children (school children and children under 5 years) was begun, whilst since the 1st January to the 22nd March of this year 28 (1941) the immunization of 841 children has been begun. The response to the offer of immunization in the schools has certainly been encouraging. Immunization Work at Health Centres in 1940. Preliminary Schick tests 334 School children immunized 142 Children under 5 years immunized 359 Final Schick tests 516 Immunized a second time 34 One child was immunized a third time. The total number of children immunized at the Health Centres during 1940 was 501 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 MILK AND MEALS FOR SCHOOL CHILDREN. The arrangements for the supply of milk to. school children were carried on as usual until September when the administration of the scheme'Was taken over by the Director bf Education. The change took place because earlier in the year the provision of meals for school children by the Committee was begun at Cuckoo School and it was considered desirable that the provision of milk as well as of meals should be under the control of the same officer. A scale of necessitous circumstances was decided upon by the Committee for guidance in the provision of milk and of meals. NURSERY SCHOOLS. Since the outbreak of war there have been no nursery schools open in the Borough. SECONDARY SCHOOLS. Medical inspection was carried out as in former years on behalf of the Middlesex Education Committee in five County Schools in the Borough, 825 routine inspections of pupils being made. Ophthalmic treatment was given during the year to 68 pupils attending County Schools and for 62 of these spectacles were prescribed and supplied through the school medical department. \ 29 Dental inspection of all the pupils attending the County Schools was carried out on behalf of the Middlesex .Education Committee. During the year, all the Secondary and, Technical school pupils who were not evacuated, were inspected. It was found that of 973 inspected, 429 required treatment, but #by the end of the year only 241 had received it. The dental treatment of the children # # » is carried on into the following year, as they are not seen in the schools until the latter part of t^e year. A great many of the children returned to Ealing from the reception areas, for in 1939 only 366 children were seen at the schools. , The number of teeth extracted * totalled 194. Some of the children received emergency extractions in the reception areas, and several came specially from these areas to §ee the Dental Officer at the centres in Ealing. -Fillings in permanent and .temporary teeth amounted to 392 ; this figure being smaller by 60 than in 1939. Other operations included 43 dressings, four gum treatments for acute gingivitis, and four attendances for orthodontic adjustments to appliances for those children who were wearing them when they passed out of their elementary school. EMPLOYMENT OF CHILDREN AND YOUNG PERSONS. The number of children "examined in connection with their employment out of school hours was 308 and of this number 26 were found to be unfit for employment. The nature of the employments those certified as fit was :— Boys. Errand Boys 159 Milk Round 18 Newspaper Round 52 Baker's Round 36 * Order Boy 11 Others 4 280 Girls. Shop Assistants 2 — 2 232 30 MISCELLANEOUS. * It is usual to group under this/heading the medical examinations which are made of candidates prior to their appointment ®n 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 nui^es. During <the year 31 teachers and 96 other candidates were examined. Medical Officer of Health. v Town Hall, Ealing, W.5. . March, 1942. 31 STATISTICAL TABLES. The Tables required by the Board of Education are as follows : TABLE I. MEDICAL INSPECTIONS OF CHILDREN ATTENDING PUBLIC - ELEMENTARY SCHOOLS. A.—Routine Medical Inspections. Number of Inspections in the prescribed Groups :— Entrant 1,836 Second Age Group 2,298 Third Age Group 1,327 Total 5,(161 Number of other Pontine Inspections - B.— Other Inspections Number of Special Inspections and Re-Inspections 15,745 TABLE II. CLASSIFICATION OF THE NUTRITION OF CHILDREN ran 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 ... 1,836 299 16.3 1,506 82.0 31 1.7 * — __ Second Agegroup 2,298 219 9.5 1,989 86.6 90 3.9 — — Third Agegroup 1,327 180 13.6 1,105 83.3 42 3.2 — — Other Routine Inspections — — — — — — — — — Total 5,461 698 12.8 4,600 84.2 163 3.0 — — 32 TABLE III. Group I.—Treatment of Minor Ailments (excluding Uncleanliness, for which see Table V.). Disease or Defect. (1) Number of Defects treated, or under treatment during the year. Under the Authority's Scheme. (2) Otherwise. (3) Total. (4) Skin :Ringworm—Scalp - - - Ringworm—Body 1 3 4 Scabies 141 & 149 Impetigo 116 16 132 Other Skin Disease 138 237 375 Minor Eye Defects (External and other, but excluding cases falling in Group II) 169 44 213 Minor Ear Defects. (Treatment for more serious diseases of the ear (e.g., operative treatment in hospital) should not be recorded here but in the body of the School Medical Officer's Annual Report) 218 9 227 * Miscellaneous (e.g., minor injuries, brunuses, sore's, chilblains, etc.) 551 89 640 Total 1,334 406 1,740 Group II.—Treatment of Defective Vision and Squint (excluding minor eye defects treated as Minor Ailments—Group I.). Defect or Disease (1) No. of Defects dealt with. Under the Authority's Scheme (2) Otherwise (3) Total (4) Errors of Refraction (including Squint) 1147 20 1167 Other Defect or Disease of the Eyes 4 4 Total ... 1151 20 1171 Number of Children for whom Spectacles were :— (a) Prescribed 4 835 20 855 (6) Obtained 832 20 852 33 I Group III.—Treatment of Defects of Nose and Throat. Number of Defects Received Operative Treatment Received other forms of Treatment Total number Treated Under the Authority's Scheme in Clinic or Hospital By Private Practitioner or Hospital, apart from the Authority's Scheme . Total 35 1 36 — 36 TABLE IV. DENTAL INSPECTION AND TREATMENT. (1) Number of children inspected by the Dentist :— Aged 5 734 6 1,559 7 1,441 8 1,483 * 9 1,466 10 1,448 Routine Age Groups 11 1,188 Total 12,402 12 1,109 13 1,065 14 863 15 44 16 2 (6) Specials ... ... 154 Grand Total ... 12,556 (2) Number foimd to require treatment ... ... • • • 6,797 (3) Number actually treated. ... ... ... 5,124 (4) Attendances made by children for treatment ... ... ... 7,648 (5) Half-days devoted to :— Inspection 1ll Treatment 963 - Total 1,074 (6) Fillings Permanent Teeth ... ... 3,181 Temporary Teeth ... ... 234 Total 3.415 (7) Extractions :— Permanent Teeth ... ... 1,390 Total 9.821 Tpmnnrarv Teeth ... ... 8,431 (8) AH mini it rat inns of general anaesthetics for extractions 2,172 (9) Other Operations :— Permanent Teeth ... ... 1,546 Temporary T eeth ... ... Total 1.546 34 TABLE V. VERMINOUS CONDITION. (1) Average number of visits per school made during the year by the School Nurses (2) Total number of examinations of children in the Schools by School Nurses 25,615 (3) Number of individual children found unclean 840 (4) Number of individual children cleansed under Section 87 (2) and (3) of the Education Act, 1921 — (5) Number of cases in which legal proceedings were taken :— (a) Under the Education Act, 1921 — z (b) Under School Attendance Byejaws 1 TABLE VI. BLIND AND DEAF CHILDREN. (1) At a Public Elementary School (2) At an institution other than a Special School (3) At no School _ or Institution ' (2) Total not receiving suitable education Blind Children — — — — Deaf Children —— — —— — - y i MENTALLY DEFECTIVE CHILDREN. Total number of children notified during the year ended 31st December, 1940, by the Local Education Authority to the Local Mental Deficiency Authority, under the Mental Deficiency (Notification of Children) Regulations, 1928 4 r - • X ' * *i/" * -\V ' •..?.**'* 'J x- -% > •- ^ t- . - - £- ■: \ ... •- •> . - V ' ••'" ■■■**..-" C?" -rH--: V; - V 'f ' - ( . .4 - r.-'\ _ ' j. : - - - '"T % - " -• "•