middx EAL 32 Boroutgh of Ealing. annual report OK THE Medical Officer of Health AND School Medical Officer 1941 THOMAS ORR, M.D., D.Sc., Of tlie Middle Temple, Barrister-at-Law Medical Officer of Health, School Medical Officer and Medical Superintendent of the Isolation and Maternity Hospitals. Perry & Routleff Ltd., Printers EAL 32 Borongh of Ealing. annual report OF THE Medical Officer of Health AND School Medical Officer 1941 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 L.td., Printers ' 3 HEALTH SERVICES. The Annual Report for 1941 has to be prepared in accordance with instructions from the Ministry of Health along the lines of that for 1940, which means that it has to take the form merely of a summary of the main features of the vital statistics and of the health services of the Borough, but with the notable exception that on grounds of national security, care has to be taken not to publish complete tables of populations or quotations from the figures of the Registrar General which may enable any substantial series of populations to be reconstructed. For this reason the estimated population of the Borough and the birth, death and other rates calculated on the total population have been omitted. All the public health and school medical services were maintained unimpaired during the year though not without difficulties. The infant death-rate of 49 is higher than in 1940 though just slightly higher than in 1939, but the maternal death-rate is lower, in fact, it is the lowest in the last five years, and is notably lower than the rate for England and Wales. Only 48 cases of diphtheria and 166 of scarlet fever were notified during the year. Measles and whooping cough, on the other hand, were prevalent, 1,401 and 638 cases respectively being notified. The deaths, however, from these diseases, 2 from measles and 3 from whooping cough, give a low death-rate from each disease, a good indication that the health of young children is not being adversely affected by war-time conditions. Aided by a national campaign of publicity local efforts to secure the immunization of as many as possible children from one year upwards have proved fairly successful though much greater efforts must yet be made to obtain such a percentage of immunized children as will materially affect the incidence of diphtheria. There has been no evidence that the health of the children is being adversely affected, in fact, the evidence, if one may judge from observation of the children as a whole, is that the nutrition and general well being of the children has improved. 4 This may in great measure be due to the greater appreciation by the parents of a more varied diet in which vegetables, both raw and cooked, take a great part. The cleanliness of school children has shown some deterioration. Whereas the number of children with dirty heads in 1940 was 3 per cent., that in 1941 was 4 per cent. This result no doubt has been to some extent due to many of the children returning from the reception areas in a dirtier condition than when they went. Towards the end of the-year as a result of the attention of the school nurses and of the parents the state of the children had been restored to about normal. Scabies was more prevalent than in the previous year, but as a result of very active measures the cases showed a decline in the later months of the year. The loss of many members of the staff on war service and the consequent changes threw more work on the shoulders of the remainder of the permanent members of the staff, but they accepted their added responsibility with such loyalty and devotion that they were able to overcome many difficulties and maintain the public health services in a state of efficiency of which due acknowledgment must be made. SUMMARY OF STATISTICS. Area (in Acres) 8,739 Population (Census, 1931) 117,707 Rateable Value, 1st April, 1941 £1,859,131 Net Product of a Penny Rate £7,288 Live Births (for calculating Birth-Rates) :— Legitimate Males, 1,046 Females, 973 Total, 2,019 Illegitimate Males, 55 Females, 53 Total, 108— 2,127 Birth-Rate per 1,000 of Estimated Population Live Births (for calculating Infant Mortality Rates) : Legitimate Males, 961 Females, 896 Total, 1,857 Illegitimate Males 52 Females, 51 Total, 103— 1,960 5 Still-Births :— Males, 36 Females, 26 Total 62 Rate per 1,000 total Births (Live and Still-Births) 29 Deaths : Males, 798 Females, 811 Total 1,609 Death-Rate per 1,000 of Estimated Population Deaths of Infants under one year of age :— Legitimate Males, 52 Females, 32 Total, 84 Illegitimate Males, 7 Females, 5 Total, 12 96 Death-Rate of Infants under one year of age :— All Infants per 1,000 Live Births 49 Legitimate Infants per 1,000 Legitimate Live Births 45 Illegitimate Infants per 1,000 Illegitimate Live Births 117 Deaths from Diseases and Accidents of Pregnancy and Childbirth :— From Sepsis 1 Death-Rate 1,000 Total Births 0.51 From other Causes 2 „ „ „ 1.02 Total 3 „ „ „ 1.53 Total Deaths Measles 2 Whooping Cough 3 Diphtheria 4 Scarlet Fever Influenza 22 Tuberculosis of Lungs 90 Other Forms of Tuberculosis 18 Diarrhoea (under 2 years of age) 11 6 Causes of Death, 1941. Cause of Death. Deaths, 1941 Total Deaths 1940 Male Female Total Typhoid and Paratyphoid Fevers — — — — Cerebro-Spinal Fever 2 5 7 2 Scarlet Fever — — — — Whooping Cough 3 — 3 2 Diphtheria 2 2 4 4 Tuberculosis of Respiratory System 53 37 90 99 Other Forms of Tuberculosis 6 12 18 12 Syphilitic Diseases 8 8 16 6 Influenza 4 18 22 34 Measles 1 1 2 — Acute Infectious Encephalitis 2 1 3 2 Cancer of B. Cav. and Oesoph. (M.), ; Uterus (F.) 9 28 37 29 Cancer of Stomach and D uodenum 30 18 48 49 Cancer of Breast — 23 23 28 Cancer of all other Sites 85 59 144 158 Diabetes 3 10 13 10 Intra-Cran. Vase. Lesions 59 67 126 150 Heart Disease 188 219 407 439 Other Diseases of Circulatory System 19 34 53 41 Bronchitis 48 40 88 107 Pneumonia 44 49 93 109 Other Respiratory Diseases 15 9 24 27 Ulcer of Stomach or Duodenum 20 5 25 20 Diarrhoea (under 2 years) 8 3 11 10 Appendicitis 1 3 4 10 Other Digestive Diseases 17 18 35 65 Nephritis... 19 13 32 33 Puerperal Post-Abortive Sepsis — 1 1 1 Other Maternal Causes — 2 2 3 Premature Birth 14 14 28 18 Congenital Malformations, Birth Injury, Infantile Diseases 24 11 35 36 Suicide 10 5 15 14 Road Traffic Accidents 19 7 26 11 Other Violent Causes 31 27 58 230 All other Causes 54 62 116 173 Total 798 811 1,609 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 1941 49 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 1941 1.53 2.23 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 only 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 187 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 well in advance throughout the year. 8 MATERNITY AND CHILD WELFARE. With the exception of a small reduction in the number of sessions the work of Maternity and Child Welfare has proceeded on normal pre-war lines. Two of the six Health Centres are adapted for use as First Aid Posts but there is no interference with their normal work. During the year arrangements were made for the distribution through the Health Centres of fruit juice and cod liver oil supplied by the Government free of charge for children under five years of age and for the distribution to expectant mothers of clothing coupons for children. The National Milk Scheme initiated in 1940 was continued throughout the year. Arrangements are made at the Ante-Natal Clinics for the evacuation of expectant mothers through the official Evacuation Scheme for the London Area, which is organised by the London County Council. The number of expectant mothers to take advantage of this scheme during the year was 36. The first War-time Nursery to be opened in the Borough was at Stanhope School, Greenford. This nursery, accommodating 50 children, was opened in November. At the end of the year arrangements were in hand for the early opening of two other nurseries, one at Culmington Road, Ealing, and the other at the Cuckoo School, North Hanwell. The full scheme for the provision of nurseries in the Borough provides for the establishment of seven whole-time and two part-time nurseries. 9 Summary of the Visits made by the Health Visitors. Visits to children under 12 months :— (1940) (1941) First visits 2,402 1,813 Return visits 4,332 4,527 Visits to children 1 to 5 years of age 6,393 8,260 Visits to expectant mothers 1,190 1,144 Visits to investigate infant deaths and still-births 71 46 Special visits or investigations 424 403 Visits to cases of Ophthalmia Neonatorum 10 3 Visits to cases of Pemphigus Neonatorum — — Visits to cases of Measles and Whooping Cough 397 440 Visits to cases of Scarlet Fever on discharge from the Isolation Hospital 26 29 Inspections of Women's Lavatories 63 57 Visits to children under care of foster-mothers 634 406 Other visits 129 81 Total Visits 15,971 17,209 Summary of the Work at the Health Centres. Mothers. Expectant Mothers attending Ante-Natal Clinics :— (1940) (1941) Attending for the first time 1,466 1,739 Total attendances 7,023 8,383 Nursing mothers attending Post-natal Clinics :— Attending for the first time 185 207 Total attendances 205 254 Children. Children attending Centres for the first time :— (1940) (1941) Under one year of age 2,044 1,778 One to five years of age 1,275 1,125 Total attendances made by children :— Under one year of age 13,489 21,469 One to five years of age 14,471 13,884 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 :— 10 Age-Group No. of Examinations 1 year to 18 months 1,048 18 months to 2 years 636 2 years to 3 years 681 3 years to 4 years 589 4 years to 5 years 409 3,363 DENTAL TREATMENT. The dental treatment of mothers and of young children was carried out at all the Centres, with the exception of mothers in the Hanwell area as the Centre at Mattock Lane is in a better position to deal with mothers than the Cherington House Centre. The number of new mothers treated was slightly larger than that in the previous year. The forms of treatment were, as usual, scaling and extractions, and fillings wherever possible ; fitting artificial dentures whenever a number of teeth were extracted and the treatment of gum conditions in acute and chronic gingivitis. Altogether, 594 mothers and 324 children were treated. The number of mothers supplied with full and partial dentures amounted to 144. CHILD LIFE PROTECTION. The work of supervision of foster mothers, 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 96 (Number of fostermothers having care of the above children, 79). Number of children registered during the year 55 Number of children removed from register during year 73 Number of children on register at end of year 78 (Number of fostermothers having care of the above children, 53). Number of visits made by Health Visitors 406 11 During the year it was necessary to obtain an order under Section 112 of the Public Health Act, 1936, authorising the removal of three foster-children from a fostermother who was not caring for them in a satisfactory manner. MIDWIFERY SERVICE. At the end of the year 10 midwives were employed by the Council in connection with the domiciliary midwifery service, there being one vacancy. The cases attended by the midwives were as follows :— Number of Confinements attended :— (a) as midwife 527 (b) as maternity nurse 140 667 SUPERVISION OF MIDWIVES. Number of midwives practising in area at end of year :— Midwives in service of Council 10 „ at Perivale Maternity Hospital 11 „ in independent practice 3 „ in private nursing homes 5 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 49 (b) At the patient's home 541 When acting in the capacity of maternity nurse (a doctor being in attendance) : (a) In private Nursing Homes 145 (b) At the patient's home 170 12 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 16(8) 223(63) Number of applications for transfer of registration Number of New Homes registered — — Number of Homes discontinued — — Number of Nursing Homes on Register at end of year 16 (8) 223 (60) 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 19 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 :— General. Number of Premises inspected on Complaint 1,051 Number of Nuisances observed by Inspectors 55 Number of Premises inspected in connection with Infectious Disease 548 Number of Premises visited by Periodical Inspection (Cowsheds, Dairies, Slaughterhouses, Factories, etc.) 134 Number of Houses inspected under House-to-House Survey Food Inspections 994 Total Number of Re-inspections 4,163 Other Inspections 929 Total Number of Inspections and Re-inspections 7,874 Number of Intimation Notices given 546 Number of other Letters written 881 Number of Statutory Notices served 36 Proceedings before Magistrates 2 13 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 but no animals were slaughtered in them during the year. There is no public slaughterhouse in the Borough. The Meat Depot which was established in a central position at the beginning of the war still serves a large area in Middlesex, embracing Ealing. 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 5,915 Pork 181 Fish 1,609 Rabbits 1,557 Mutton 978 Veal 248½ Offal 5,216 Bacon 112½ Sausages 9¼ Brawn 315 Corned Beef 728½ Corned Pork 60 Ox Tongue 20 Liver Sausage 137 Slab Cake 11¾| Potatoes 672 17,770½ lbs. Total : 7 tons 18 cwt. 2 qrs. 18|½ lbs 14 Eggs 5,910 Assorted Tinned Food 2,068 tins Assorted Food 27 jars do. 13 bottles do. 3 packets do. 3,198¼ lbs. 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 1941 Smallpox — — — — — — — — — — — Diphtheria 83 54 71 195 228 52 123 142 92 33 48 Scarlet Fever 154 407 476 493 400 408 317 383 303 116 166 Enteric Fever (including Paratyphoid) 1 3 4 3 7 8 5 2 5 4 5 Puerperal Fever 6 4 3 3 7 3 4 — — — — Puerperal Pyrexia 18 21 28 14 11 9 24 46 40 30 30 Pneumonia : Primary 96 85 56 72 59 85 60 83 50 66 97 Influenzal 18 50 32 17 11 14 37 18 26 10 27 Acute Poliomyelitis 2 4 3 — 1 2 7 6 1 1 9 Cerebro-Spinal Fever — — — — — 1 1 — 7 15 Malaria 1 — 1 1 — 1 — — — 1 1 Dysentery — — — — 1 1 5 12 2 — 3 Erysipelas 20 30 36 43 28 28 27 41 37 29 26 Polio-Encephalitis 1 1 — 1 — 1 — — — — — Tuberculosis :— Pulmonary 141 141 154 139 157 139 178 142 149 156 195 Non-Pulmonarv 27 27 23 24 23 22 37 33 38 30 28 Ophthalmia Neonatorum 9 5 8 5 3 4 7 15 16 5 2 Total . 577 832 895 1010 936 777 832 924 759 488 653 Scarlet Fever.—Of the 166 cases of scarlet fever only 55 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 but one of the 48 cases of diphtheria were removed to hospital. There were 4 deaths from this disease. Diphtheria immunization.—The protection of children by means of immunization is considered on page 26. 15 Measles and Whooping Cough. — Measles and whooping cough became notifiable under the Measles and Whooping Cough Regulation, 1939. The following numbers of cases were notified :— Measles 1,401 Whooping Cough 638 There were three deaths from whooping cough and two deaths from measles. 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 2 — 1 — — — — — 5—10 — 2 2 2 — 3 — 1 10—15 2 — 1 1 — 1 — 1 15—20 10 10 1 1 1 1 1 1 20—25 14 27 1 2 2 6 — 2 25—35 36 23 4 3 10 12 1 2 35—45 23 5 — 2 18 6 2 1 45—55 19 4 1 2 9 1 — 2 55—65 11 4 — — 8 3 2 1 65 upwards 2 1 1 1 3 4 — 1 Total 119 76 12 16 53 37 6 12 16 SCHOOL MEDICAL SERVICE. In 1941 the School Medical Service was continued as in normal years. A large number of children returned from the reception areas as the severity of air raids lessened and the number of children on the school rolls steadily rose until at the end of the year it was approaching the pre-war figure. The number of sessions attended weekly by the Ophthalmic Surgeon, Dr. J. G. Freeman Heal, was increased in May from two to three. The Orthopaedic Surgeon, Mr. Cholmeley, F.R.C.S., attended one session in each month throughout the year instead of once every six weeks as in 1940. Diphtheria immunization was carried out on a far larger scale than in 1940 and, as a result of publicity at the end of that year, nearly ten times as many children were immunized in 1941. In addition to the normal sessions at the Health Centres arrangements were made to carry out the immunization in the schools and each school was dealt with in rotation. The Minor Ailment Clinics were carried on as usual. STAFF. In July, 1941, Dr. John C. Aitken left to take up the appointment of Deputy Medical Officer of Health of Worthing and Dr. Daniel C. Logan, the Resident Medical Officer at Clayponds Emergency Hospital, was transferred to the public health department to take his place. Dr. John J. Linehan was then appointed Resident Medical Officer at the Hospital. After the resignation in 1940 of Dr. Roberts, the Deputy Medical Officer of Health, this position was not filled, but in May, 1941, Dr. Cyril G. K. Thompson was appointed and took up his duties in July. Dr. Logan volunteered for the Indian Medical Service in November and Dr. Wilfred C. S. Wood was appointed as Temporary Assistant Medical Officer in his place. 17 Miss D. E. Nicholson, School Nurse, resigned in March. Miss G. Griffiths who had been in Devon as School Nurse since November, 1940, asked to be allowed to return in October and Miss E. Evans took her place. Owing to the increase of work in Ealing due to the return of so many children it soon became necessary to ask the Devon County Medical Officer to release Miss Evans and she returned in December. Miss L. Gilbert was then the only School Nurse remaining in a reception area. EVACUATION. There was no large scale evacuation of school children from Ealing in 1941. The children were sent away in small parties whenever applications were received. In January Local Education Authorities were empowered under the Defence Regulations to medically examine compulsorily and to evacuate any child considered to be suffering in mind or body as a result of air raids or considered likely to suffer if remaining in an evacuation area. There was, however, no necessity to take any action in this way. During the year 303 children were medically examined prior to evacuation. The following figures show the total number of Ealing school children remaining in reception areas after having been officially evacuated :— May 7,500 September 5,300 December 4,400 The absence from air raids from May onwards caused more and more children to return to Ealing, and by December there were 14,100 children on the school rolls in Ealing. MEDICAL INSPECTION. Medical inspection included (1) the routine inspection in the schools of children in the three age-groups recommended by the Board of Education, namely, (a) entrants, (6) children at eight years, and (c) children at twelve years ; (2) the special inspection 18 of children referred by the head-teachers, school nurses, school enquiry officers, etc. ; (3) the annual inspection of physically or mentally defective children, and (4) the inspection of children in connection with the supply of milk at the cost of the Education Committee. FINDINGS OF MEDICAL INSPECTION. Among the 4,519 children examined in a routine manner there were, excluding uncleanliness and dental disease, 295 defects requiring treatment and 589 requiring to be kept under observation. The examination of the 4,922 children submitted to special inspection revealed 2,484 defects requiring treatment and 379 requiring to be kept under observation. Of the 4,519 children examined at the routine inspections, 272 or 6 per cent. were found to require treatment for one or more defective conditions other than defective teeth or verminous condition. NUTRITION. In Table II the nutritional state of the children examined at routine medical inspection is indicated in accordance with the suggestions of the Board of Education in Administrative Memorandum 125 of 1935. Of the 4,519 school children examined 11.6 per cent. were classified as of excellent nutrition, 86 per cent. of normal nutrition, and 2.4 slightly sub-normal, no children being classified as of bad nutrition. With only 2.4 per cent. of the children found to be of sub-normal nutrition it would seem that the nutritional state of the children is being maintained at a high standard. The twice yearly nutritional surveys, begun in February, 1940, were continued in 1941. In two surveys, involving 18,861 inspections of children, 1,474 children were selected for further examination with the result that only 107 or .6 per cent. were classified as slightly sub-normal and none were classified as of bad nutrition. In these surveys, as in those carried out in the previous year, the percentage of sub-normal children was less than the percentage found at routine medical inspection. The difference may be due to the fact that at routine medical inspection all the 19 children are stripped for examination whereas in the surveys only those suspected of being of sub-normal nutrition are referred for more thorough examination. No matter whether the results of the surveys are an accurate estimation of the state of the nutrition of the children or not, they serve the purpose of giving a general impression of the nutrition of the children as a whole, and that impression is that the nutrition of the Ealing children is above the average. UNCLEANLINESS. Unfortunately, after their return from the reception areas there was found during the year an increase in the number of children who had uncleanly heads. As a result of the exclusions and the stimulating activity of the School Nurses there were signs of improvement at the last inspection of the year. In the following table are indicated the number of inspections of children carried out in the last six vears and the results obtained. In column 4 the total number of children excluded, because they had lice or more than 10 nits in the hair, was 557, and the number concerning whom notices of uncleanliness were sent to the parents, because they had up to 10 nits in the hair, was 480, or together 1,037 or 4 per cent. of the total number of the children inspected. 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 Bye-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 (End of August) 29,357 520 303 823 2.8 6 1940 8,600 (Nov.) 25,615 466 325 791 3.0 1 1941 14,100 25,956 557 480 1,037 4.0 6 20 ARRANGEMENTS FOR TREATMENT. Minor Ailments and Diseases of the Skin.—The treatment of minor ailments carried out at the Health Centres is shown in Table 3, Group 1 (page 00). It will be seen that as many as 79.5 per cent. of the children found to be suffering from minor ailments on medical inspection attended the Health Centres for treatment. The number of cases treated and the total number of attendances made were as follows :— Condition Treated No. of cases treated Total attendances made Skin : Ringworm 11 58 Scabies 328 591 Impetigo 104 990 Others 255 1,690 Minor eye defects 156 892 Minor ear defects 187 2,310 Mixcellaneous : Minor injuries 624 4,096 Sores Others Total 1,665 10,627 Scabies.—During the year scabies became still more prevalent than in the preceding years, no fewer than 347 cases being found amongst school childre , of whom 328 received treatment at the Health Centres. The treatment applied was benzyl benzoate in one application, advice being given that a bath should be had two days later and clean clothes put on. No disinfection of clothing was carried out. Benzyl benzoate, as checked by subsequent reinspections, has been proved to be very effective. Contacts of these cases were followed up at home by the School Nurses, and in consequence 187 children under school age and adults suffering from scabies received similar treatment at the Health Centres. Private practitioners referred 28 cases for 21 ment at the Centres during the year. Thus there were treated at the Health Centres during the year 543 cases of scabies. There was no occasion to invoke the assistance of the Scabies Order. The following table shows how the number of cases of scabies in school children had been increasing before the war although there was a marked increase in the number in 1941. Number of Cases of Scabies Treated. Year At Health Centres Otherwise Total Cases 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 1941 328 19 347 Defective Vision.—The report of the Ophthalmic Surgeon, Dr. J. G. Freeman Heal, is as follows :— " During the year 1941, 494 new cases were examined. Of these, 248 were seen at Mattock Lane and 246 at Ravenor Park Health Centre. Re-inspections numbered 552, of which 153 were seen at Mattock Lane and 399 at Ravenor Park. Prescriptions for glasses were given in 593 cases. The number of pairs of glasses obtained was 454. Abnormal eye conditions, other than refractive errors, were as follows :— Congenital abnormalities. Squint New cases, 100 Re-inspections, 166 Progressive myopes New cases, 3 Re-inspections, 5 Congenital nystagmus 5 Congenital cataracts 3 Bilateral defective vision without macroscopical defects in eyes 2 22 Abnormalities due to infection. Abscess of eyelid 1 Blepharitis 10 (Mostly mild cases due to refractive errors). Conjunctivitis, non-specific, 4 Conjunctivitis, phlyctenular 1 Interstitial Keratitis, specific 1 Keratitis, non-specific 2 Meibomian Cysts 2 Abnormalities due to trauma — Contusion of eye—no permanent defect 1 Contusion of eye resulting in blindness 1 Abnormalities due to neoplasms. Papilloma of eyelid 1 Abnormalities of unknown etiology. Optic atrophy 1 The infective external diseases of the eye were few in number and mild in degree, which suggests that the nutrition of the school children has been well maintained during the second year of war." Defects of the Ear, Nose and Throat.—The examination and treatment of children suffering from defects of the ear, nose and throat were continued during the year at the different Health Centres by the Surgeon, Mr. Arthur Miller. The provision of expert and specialized treatment was thus provided both for school children referred from routine and special school inspections and for children attending the Child Welfare Centres. There was a total of 414 attendances with 128 new cases. Of the new cases 48 were suffering from chronic otitis media resulting in persistent or recurrent ear discharge or impaired hearing. The common abnormalities present were dry and moist perforations, scarred and retracted ear drums, granulations and polypi. Treatments carried out included the cauterization of polypi, the regular installation of ear drops, the insufflation of iodized boric acid, politzerization and ionisation, as well as diastolization of the nose. Twelve new cases of acute otitis media attended. In seven of these cases the ear discharge had ceased during the period under review. The others were still under treatment or had failed to attend so that their ultimate condition could not be ascertained. One case was referred for mastoidectomy. 23 The removal of tonsils and adenoids was recommended in twenty-six children. The operation was performed for such conditions, or combinations of such conditions as obvious tonsillar infection, chronic and acute otitis media, gross enlargement of the tonsils and adenoids producing respiratory obstruction, mouth breathing, snoring and recurrent nasal catarrh. The remaining children dealt with were suffering from various conditions such as furunculosis of the meatus, wax in the ears, epistaxis and chronic rhinorrhoea and appropriate treatment carried out. During the year 35 cases referred for the removal of tonsils and adenoids were admitted to St. Bernard's Hospital. It became necessary, however, to make other arrangements at the end of the year because, owing to the pressure of work at St. Bernard's Hospital, only a few Ealing children were admitted and a long waiting list steadily accumulated. Arrangements were therefore made for Mr. Arthur Miller, the Ear, Nose and Throat Specialist, to carry out these operations weekly at the Clayponds Emergency Hospital from the beginning of 1942. Dental Defects.—The report of Mr. C. Colenso, the Senior Dental Surgeon, is as follows :— " During the year all the children in the schools were examined by the dental surgeons. The number of children examined was smaller than in the previous year but more than in 1939 when evacuation was at its greatest. Towards the end of the year children returning from Reception Areas came under inspection and it was noticed that a great number of them had not seen a dentist in the Reception Areas and a few only had received emergency treatment. The absence of dental treatment for these evacuees necessitated a larger amount of treatment on their return. Altogether, 9,586 children were inspected by the two full-time dentists. This number is smaller by 2,970 than that of the previous year, and approximately 5,000 less than in the year previous to the War. The number of children referred for treatment was 5,295 and of these 4,265 were actually treated. It may be stated that the services of the part-time dentist did not commence until the latter 24 part of the year, and his work did not involve the treatment of elementary school children but was spent in inspecting chiefly secondary school pupils. The number of permanent fillings was 2,903, and the number of temporary fillings 102, making a total of 3,005, this figure being smaller by 410 than that of the previous year. The total number of extractions of permanent teeth was 1,386 and the number of temporary teeth 7,091, making a total of 8,477 extractions, a smaller figure by 1,344 than that in 1940. Other forms of treatment included dressings to temporary teeth, scaling and gum treatment in certain cases, taking of impressions for orthodontic appliances and the fitting of these. All these minor operations involved 1,525 separate items of treatment. Orthodontic treatment was carried out at all centres during the year when 31 new cases were fitted, an increase of five over the previous year. Those children fitted in the previous year were still attending for adjustment to the appliance, and altogether 401 attendances were made for adjustments in both old and new cases. Orthopaedic Treatment.—The Orthopaedic Surgeon attended the Mattock Lane Health Centre once every month in 1941. The Masseuse attended three sessions each week until the beginning of May when the number of weekly sessions was increased to four. 25 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 7 5 12 Number of children seen for first time 65 84 149 Total number of children examined 261 212 473 Attendances by Masseuse 100 80 180 Number of cases treated 59 39 98 Number of attendances by children 885 459 1,344 Children admitted to hospital for special treatment 18 8 26 Children supplied with special boots or surgical appliances 16 15 31 Defective Speech.—There were no Speech Training Classes held during 1941 but arrangements were made to resume the classes in 1942 by the appointment of Miss Ruth Bennett as Speech Therapist. Convalescent Treatment.—The beds reserved at convalescent homes by arrangement with the Invalid Children's Aid Association were cancelled at the outbreak of war and applications for vacancies were then only made as required. During the year five children were sent away for convalescent treatment. INFECTIOUS DISEASE. The returns forwarded each week by the head teachers giving particulars of all new cases of infectious disease coming to their knowledge included 1,110 cases of measles, 643 of whooping cough, 323 of chickenpox and 199 of mumps. 26 Children to the number of 368 were excluded under Article 20 (b) of the Education Code for the following conditions :— Impetigo 92 Ringworm of body 4 Scabies 270 Other skin diseases 1 Ringworm of head 1 / 368 No closure took place under Article 22 or 23 (b) of the Code Grant Regulations. Diphtheria Immunization.—At the end of 1940 following the issue of Circular 2230 of the Ministry of Health, every effort was made to stimulate the interest of the public in immunization and to encourage parents to have their children immunized. In addition to the normal sessions at the Health Centres arrangements were made to carry out the immunization in the schools and each school was visited in rotation preceded by the issue of leaflets to all parents. The publicity given locally was greatly supported by national publicity which caused information on the subject to reach many people who otherwise might not have heard of it. The value of such publicity is shown by the great increase in the number of children immunized. In 1940, 501 children were immunized, but in 1941 nearly ten times as many children, namely, 4,933, were immunized either at the Health Centres or in the schools. Next year all the schools will again be visited in rotation to try and include those who have not yet been immunized. The following table shows the amount of immunization work carried out in 1941 :— Immunization Work in 1941. Preliminary Schick tests 1,408 School children immunized 3,194 Children under 5 years immunized 1,739 Final Schick tests 1,389 Children re-immunized 31 The total number of children of all ages immunized at the Health Centres and in the Schools in 1941 was thus 4,933. 27 MILK AND MEALS FOR SCHOOL CHILDREN. The scheme for the provision of milk for school children is administered by the Director of Education. During 1941 the consumption of milk gradually increased as more and more children returned from the Reception Areas. Children are supplied with one or two one-third pint bottles at the full cost of ½d. per bottle, half cost or free of charge according to the level of the family income in the sliding scale approved by the Board of Education. The following figures supplied by the Director of Education indicate the number of children who were receiving milk on the 1st October, 1941, when most of the children had returned : Number of children on Roll 13,551 Number of children receiving free milk 711 Number of children paying for milk 7,090 Total of children receiving milk 7,801 Percentage of children receiving milk 58 The first centre for providing meals for children was opened at Cuckoo School in July, 1940, when necessitous children were given free meals. Shortly after this at the request of the Board of Education a larger scheme for providing meals and milk was submitted for approval. The Director of Education, at the beginning of 1941, ascertained that there were about 3,500 children whose parents wished them to have a midday meal at school, and in June, 1941, the Board of Education pointed out the growing importance of having adequate arrangements for the provision of meals. The first canteen was opened at Coston's School in September, when 60 meals were served to senior girls, and in the following month the Junior Girls' and Boys' Departments were included. Arrangements were soon completed under the supervision of the Director of Education for providing meals at the following schools : September Grange School Modern School October Wood End School Perivale School St. Ann's School 28 After that plans were put in hand to increase the number of central kitchens in order to distribute meals to as many schools as possible without unnecessary delay. In the report for 1942 it will be possible to give a more detailed account of the development of the feeding centres and the effect of the provision of meals on the health of the children. NURSERY SCHOOLS. Since the outbreak of war there have been no nursery schools or classes open in the Borough. SECONDARY SCHOOLS. Medical inspection was carried out as in former years on behalf of the Middlesex Education Committee in the County Schools in the Borough, 824 routine inspections and 10 re-inspections of pupils being made. Ophthalmic treatment was given during the year to 71 pupils attending County Schools and for 64 of these spectacles were prescribed and 60 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 : " The total number of pupils inspected at Secondary Schools during the year amounted to 1,411. This is a big increase in number over the previous year when 962 were seen at the Schools. It was found that a very large number had not received treatment in the reception areas from which a number of children had returned. The treatment involved 232 extractions of permanent teeth and 57 of temporary teeth, giving a total of 289 extractions. This figure is greater than that of the previous year by 95. The number of fillings inserted in permanent teeth totalled 358, a smaller number than in the previous year when 382 fillings were inserted. Other operations included dressings to permanent teeth and treatment to gums where ulcerated conditions were present ; scaling and adjustments to a number of orthodontic appliances that had been inserted during the time spent at an elementary school. All these operations included 105 items of treatment for the County School pupils." 29 EMPLOYMENT OF CHILDREN AND YOUNG PERSONS. The number of children examined in connection with their employment out of school hours was 237 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 123 Milk Round 29 Newspaper Round 45 Baker's Round 16 Others 8 Girls. Hairdresser 1 222 These children are submitted to re-examination when routine medical inspection is being carried out in their school and if it is found that employment is detrimental to their health, sanction to employment out of school hours is withdrawn. This action was found to be necessary in 6 instances. At routine inspection 61 children were found who had not obtained the necessary permission, and 3 children were found to be under age. 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 105 teachers and 82 other candidates Were examined. School Medical Officer and Medical Officer of Health. Town Hall, Ealing, W.5. February, 1943. 30 STATISTICAL TABLES. The Tables required by the Board of Education are as follows :— TABLE I. RETURN OF MEDICAL INSPECTIONS. A. Routine Medical Inspections. Number of Inspections in the prescribed Groups :— Entrants 2,341 Second Age Group 1,260 Third Age Group 918 Total 4,519 Number of other Routine Inspections — B. Other Inspections. Number of Special Inspections and Re-Inspections ... 7,367 TABLE II. CLASSIFICATION OF THE NUTRITION OF CHILDREN INSPECTED DURING THE YEAR IN THE ROUTINE AGE GROUPS. Number of Children Inspected A (Excellent) B (Normal) C (Slightly sub-normal) D (Bad) No. % No. % No. % No. % 4,519 526 11,6 3,886 86. 107 2.4 – 31 TABLE III Group I.—Treatment of Minor Ailments. Total number of Defects treated or under treatment during the year under the Authority's Scheme ... ... 1,665 Group II.—Treatment of Defective Vision and Squint (excluding Minor Eye Defects treated as Minor Ailments—Group I.). Under the Authority's Scheme 1,011 1,046 35 Number of children for whom spectacles were (а) Prescribed ... (б) Obtained 593 454 Group III.—Treatment of Defects of Nose and Throat. Received Operative Treatment Received other forms of treatment 35 Total number treated ... 35 32 TABLE IV DENTAL INSPECTION AND TREATMENT. (1) Number of children inspected by the Dentist (a) Routine Age-groups :— Age 5 6 7 8 9 10 11 12 13 14 15 16 Total Number 1,127 1,306 1,183 887 977 998 961 805 710 491 33 2 9,480 (b) Specials 106 (c) Total (Routine and Specials) 9,586 (2) Number found to require treatment 5,295 (3) Number actually treated 4,265 (4) Attendances made by children for treatment 6,585 (5) Half-days devoted to Inspection 77 Treatment 796 Total 873 (6) Fillings : Permanent Teeth 2,903 Temporary Teeth 102 — Total 3,005 (7) Extractions : Permanent Teeth 1,386 Temporary Teeth 7,091 — Total 8,477 (8) Administrations of general anaesthetics for extractions 2,016 (9) Other operations : Permanent Teeth 1,525 Temporary Teeth — Total 1,525 TABLE V. VERMINOUS CONDITIONS. (1) Average number of visits per school made during the year by the School Nurses or other authorised persons 3 (2) Total number of examinations of children in the Schools by the School Nurses or other authorised persons 25,956 (3) Number of Individual children found unclean 916 (4) Number of Individual children cleansed under Section 87 (2) and (3) of the Education Act, 1921 None (5) Number of cases in which legal proceedings were taken : (a) Under the Education Act, 1921 — (b) Under School Attendance Byelaws 6 TABLE VI. Blind and Deaf Children who are not at the present time receiving education suitable for their special needs None MENTALLY DEFECTIVE CHILDREN. Total number of children notified during the year ended 31st December, 1941, by the Local Education Authority to the Local Mental Deficiency Authority under the Mental Deficiency (Notification of Children) Regulations. 1928 5