EAL 33 Borough of Ealing. ANNUAL REPORT of the Medical Officer of Health AND School Medical Officer 1942 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 Eating Central Library Reference Dept. 3 HEALTH SERVICES. The Annual Report for 1942 has had to be prepared in a much abbreviated form in accordance with the instructions of the Ministry of Health with the result that it is mainly a record of the most important vital statistics and a summary of the health services of the Borough. As with the report for 1941 the estimated population and the birth, death and other rates calculated on the total population have been omitted. The infant death rate and the maternal mortality rate remained low. The number of cases of diphtheria was strikingly small, only 28 cases, the smallest number for many years, and while the number of cases of scarlet fever, was higher than in the two previous years it was lower than in the 8 successive years before that. Measles and whooping cough were still prevalent but less so than in 1941. There was no impairment of the Maternity and Child Welfare scheme which continued during the year to bring even more mothers and children within its scope, thus showing how much this service is appreciated by the public. The progress, in establishing war-time nurseries has been notable. By the end of the year two part-time and six whole-time nurseries had been opened, the seventh whole-time one was nearly ready for opening and plans of the eighth had been approved of. Routine medical inspection had to be curtailed by the omission of the middle age-group and part-time dental officers had to be employed instead of whole-time officers but the whole of the school medical services have been maintained unchanged otherwise. Owing to the steps taken by the Government in various directions, including the provision of milk and meals in school, the nutrition of the children was maintained at a remarkably high level. There was an improvement in the cleanliness of the children which had in the previous year slightly deteriorated and the percentage of verminous children reached the low level of 3.3 with an indication of still further improvement. Unfortunately there was a large increase in the number of cases of scabies but the hope may be expressed that the steps taken to treat all active and suspected cases and to deal with contacts may prove successful in combating the spread of this troublesome condition. 4 SUMMARY OF STATISTICS. Area (in Acres) 8,739 Population (Census, 1931) 117,707 Rateable Value, 1st April, 1942 £1,847,254 Net Product of a Penny Rate £7,334 Live Births :— Legitimate Males, 1,262 Females, 1,317 Total, 2,579 Illegitimate Males, 61 Females 67 Total 128 2,707 Birth-Rate per 1,000 of Estimated Population — Still-Births:— Males, 49 Females, 38 Total 87 Rate per 1,000 total Births (Live and Still-Births) 31 Deaths : Males, 792 Females, 827 Total 1,619. Death-Rate per 1,000 of Estimated Population — Death of Infants under one year of age:— Legitimate Males 73 Females, 43 Total, 116 Illegitimate Males, 8 Females, 7 Total, 15 131 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 45 Illegitimate Infants per 1,000 Illegitimate Live Births 117 Deaths from Diseases and Accidents of Pregnancy and Childbirth:— From Sepsis 2 Death-Rate 1,000 Total Births 0.72 From other Causes 3 „ „ „ 1.07 Total 5 „ ,i „ 1.79 Total Deaths Measles — Whooping Cough 5 Diphtheria 5 Scarlet Fever - Influenza 11 Tuberculosis of Lungs 97 Other Forms of Tuberculosis 14 Diarrhoea (under 2 years of age) 26 5 Causes of Death, 1942. 9 Cause of Death. Deaths, 1942 Total Deaths 1941 Male Female Total Typhoid and Paratyphoid Fevers — — —. —- Cerebro-Spinal Fever — 2 2 7 Scarlet Fever ■— — — — Whooping Cough 4 1 5 3 Diphtheria 3 2 5 4 Tuberculosis of Respiratory System 58 39 97 90 Other Forms of Tuberculosis 7 7 14 18 Syphilitic Diseases 9 5 14 16 Influenza 6 5 11 22 Measles —. — —. 2 Acute Infectious Encephalitis — •— — .3 Cancer of B Cav. and Oesoph. (M.), ; Uterus (F.) 5 17 22 37 Cancer of Stomach and Duodenum 29 17 46 48 Cancer of Breast -— 36 36 23 Cancer of all other Sites 93 80 173 144 Diabetes 6 4 10 13 Intra-Cran. Vase. Lesions 61 93 154 126 Heart Disease 178 201 379 407 Other Diseases of Circulatory System 23 33 56 53 Bronchitis 43 40 83 88 Pneumonia 50 35 85 93 Other Respiratory Diseases 15 8 23 24 Ulcer of Stomach or Duodenum 11 4 15 25 Diarrhoea (under 2 years) 15 11 26 11 Appendicitis 4 2 6 4 Other Digestive Diseases 22 14 36 35 Nephritis 18 15 33 32 Puerperal and Post-Abortive Sepsis — 2 2 1 Other Maternal Causes — 3 3 2 Premature Birth 20 17 37 28 Congenital Malformations, Birth Injury, Infantile Diseases 26 16 42 35 Suicide 5 4 9 15 Road Traffic Accidents 6 2 8 26 Other Violent Causes 20 27 47 58 All other Causes 55 85 140 116 Total 792 827 1,619 1,609 6 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 147 12:4 41 1941 — - 49 1942 — — 48 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 1942 1.79 2.01 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 Hospitals 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 taxed to the uttermost by reason of the demands for admission, the accommodation being fully booked months in advance throughout the year. 7 MATERNITY AND CHILD WELFARE. With the birth rate for the Borough at the highest level since 1920 and with the total number of births 2,707, exceeding the previous highest total of 2,428 in 1939 by nearly three hundred, the demands on the Maternity and Child Welfare Service (as may be judged by the figures in the subsequent tables) were great. Fortunately the work proceeded without any interference. Particular attention was devoted to increasing the number of young children immunized against diphtheria, and the health visitors, acting upon the suggestion of the Minister of Health, were urged to devote particular attention to this problem. Particulars with regard to the number of children immunized during the year are given on page 25. Arrangements were continued for the distribution through the Health Centres of National dried milk, fruit juices and cod liver oil supplied by the Government.. Fruit juices and cod liver oil were available for children up to six years of age and for expectant mothers. The issuing of additional clothing coupons to expectant mothers to enable them to provide for the coming baby was also continued throughout the year. Expectant mothers residing in the Borough had the opportunity of arranging for evacuation by which they were transported to the country a few weeks before the baby was due. The Evacuation Scheme is organised by the London County Council, but the mothers make the necessary arrangements at the Health Centres. During the year 120 expectant mothers took advantage of -this scheme. Summary of the Visits made by the Health Visitors. Visits to children under 12 months:— (1941) (1942) First visits 1,813 2,617 Return visits 4,527 5,222 Visits to children 1 to 5 years of age 8,260 9,502 Visits to expectant mothers 1,144 1,674 Visits to investigate infant deaths and still-births 46 58 Special visits or investigations 403 460 Visits to cases of Ophthalmia Neonatorum 3 18 Visits to cases of Measles and Whooping Cough 440 315 Visits to cases of Scarlet Fever on discharge from the Isolation Hospital 29 48 Inspections of Women's Lavatories 57 62 Visits to children under care of foster-mothers 406 315 Other visits 81 142 Total Visits 17,209 20,433 8 Summary of the Work at the Health Centres. Mothers. (1941) (1942) Expectant Mothers attending Ante-Natal Clinics Attending for the first time 1,739 2,077 Total attendances 8,383 10,812 Nursing mothers attending Post-natal Clinics:— Attending for the first time 207 206 Total attendances 254 226 Children. Children attending Centres for the first time:— Under one year of age 1,778 2,305 One to five years of age 1,125 683 Total attendances made by children:— Under one year of age 21,469 28,481 One to five years of age 13,884 13,852 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 (1941) (1942) 1 year to 18 months 1,048 953 18 months to 2 years 636 601 2 years to 3 years 681 565 3 years to 4 years 589 535 4 years to 5 years 409 355 . 3,363 3,009 War-Time Nurseries At the beginning of the year one War-time Nursery was available for the care of children under five years of age while their mothers were at work, but by the end of the year six whole-time and two part-time nurseries were open. The whole-time nurseries are open from 6.30 a.m. to 6.30 p.m. each day except Sunday and the part-time nurseries, which are attached to schools, are open from 9 a.m. to 4.30 p.m. on Mondays to Fridays. In addition to these eight, another whole-time nursery, St. Mark's Nursery, was ready for opening at the end of the year, while plans had been approved for a tenth nursery, Oldfields Nursery, which will be-whole-time and will serve the central part of Greenford. 9 The following table indicates the capacity and date of opening of each of the nurseries, and number of attendances during the year : Date opened Capacity Days open Total attendances Average attendance Stanhope 17/11/41 50 311 10641 34 Culmington Road 26/1/42 44 287 8664 30 Cuckoo 9/3/42 56 251 10257 41 Perivale 5/10/42 40 74 1944 26 South Ealing 5/10/42 40 74 1506 20 Northott 26/10/42 40 56 1512 27 St. John's 5/10/42 60 63 1632 26 Wood End 5/10/42 28 63 1055 17 The children are kept under trained supervision while in the nurseries. At the whole-time nurseries the Matron, and' in most cases the Deputy Matron, is a fully trained nurse. The two part-time nurseries are under the supervision of the Headmistress of the school to which they are "attached and the school nurses make regular routine visits. Each nursery is visited regularly by a medical officer of the public health department. Immunization against diphtheria is insisted upon and is carried out at the nurseries when it has not already been done. DENTAL TREATMENT. The dental treatment of expectant and nursing mothers and children under five years of age was carried out as in former years. The number of new mothers treated during the year was 650, 56 more than in the preceding year. The work carried out was mostly radical in nature, involving a large number of extractions, as the condition of the mouths were generally very bad. The total number of teeth extracted was 2,294; the number of teeth saveable totalled 474 ; the number of dentures fitted was 178. Altogether 2,636 attendances were made by mothers. During the year 219 children under five were treated by the dentists, 699 teeth being extracted and 46 fillings being inserted. 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:— 10 Number of children on the register at the beginning of the year 78 (Number of fostermothers having care of the above children, 53). Number of children registered during the year 49 Number of children removed from register during year 42 Number of children on register at end of year 85 (Number of fostermothers having care of the above children, 54). Number of visits made by Health Visitors 315 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 693 (b) as maternity nurse 121 814 SUPERVISION OF MIDWIVES. Number of midwives practising in area at end of year:— Midwives in service of Council 11 „ at Peri vale Maternity Hospital 10 ,, in independent practice 5 ,, in private nursing homes 6 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 : (а) In private Nursing Homes 100 (b) At the patient's home 731 When acting in the capacity of maternity nurse (a doctor being in attendance) : (а) In private Nursing Homes 172 (b) At the patient's home 138 11 SUPERVISION OF NURSING HOMES. The following tabfe 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 (7) 223 (60) Number of applications for transfer of registration 1 - Number of New HomeS registered \ — — Number of Homes discontinued 1 — Number of Nursing Homes on Register at end of year 15 (5) 205 (52) 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 28 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 1,429 Number of Nuisances observed by Inspectors 26 Number of Premises inspected in connection with Infectious Disease 374 Number of Premises visited by Periodical Inspection (Cowsheds, Dairies, Slaughterhouses, Factories, etc.) 262 Number of Houses inspected under House-to-House Survey— Food Inspections 1,507 Total Number of Re-inspections 4,998 Other Inspections 959 Total Number of Inspections and Re-inspections 9,555 Number of Intimation Notices given 722 Number of other Letters written 986 Number of Statutory Notices served 29 Proceedings before Magistrates 1 12 PREVALENCE OF, AND CONTROL OVER INFECTIOUS AND OTHER DISEASES. Cases of Infectious Disease occurring in the Borough. Disease 1932 1933 1934 1935 1936 1937 1938 1939 1940 1941 1942 Smallpox — — — — — — — — — — Diphtheria 54 71 195 228 52 123 142 92 33 48 28 Scarlet Fever 407 476 493 400 408 317 383 303 116 166 180 Enteric Fever (including Paratyphoid) 3 4 3 7 8 5 2 5 4 5 Puerperal Fever 4 3 3 7 3 4 — — — _ Puerperal Pyrexia 21 28 14 11 9 24 46 40 30 30 39 Pneumonia: Primary 85 56 72 59 85 60 83 50 66 97 105 Influenzal 50 32 17 11 14 37 18 26 10 27 17 A.cute Poliomyelitis 4 3 — 1 2 7 6 1 1 9 2 Cerebro-Spinal Fever — — — — — 1 1 — 7 15 5 Malaria — 1 1 — 1 — — — 1 1 2 Dysentery — — — 1 1 5 12 2 — 3 6 Erysipelas 30 36 43 28 28 27 41 37 29 26 36 Polio-Encephalitis 1 — 1 — 1 — — — — — - Tuberculosis:— Pulmonary 141 154 139 157 139 178 142 149 156 195 223 Non-Pulmonary 27 23 24 23 22 37 33 38 30 28 38 Ophthalmia Neonatorum. 5 8 5 3 4 7 15 16 5 2 8 Total 832 895 1010 936 777 832 924 759 488 653 689 # Scarlet Fever.—Of the 180 cases of scarlet fever only 50 cases were removed to hospital. Since the outbreak of war accom- . modation 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 28 cases of diphtheria were removed to hospital. There were 5 deaths from this disease. Diphtheria Immunization.—The protection of children by means of immunization is considered on page 25. 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 1,089 Whooping Cough 331 There were 5 deaths from whooping cough and no deaths from measles. 13 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 1 1—5 1 — — 1 — — 1 — 5-10 5 1 2 1 1 — — — 10—15 3 2 4 2 1 — — 2 15—20 15 19 — 5 2 5 — — 20—25 8 20 — 5 6 7 3 1 25—35 30 29 5 4 12 12 — — 35—45 36 14 — 2 12 9 1 2 45—55 16 3 — 1 13 4 1 — 55—65 9 4 — 1 5 — — 1 65 upwards 6 2 2 3 6 2 — —— Total 129 94 13 25 58 39 7 7 14 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 3,092 Pork 104 Mutton 453 Veal 5 Offal 882 Bacon 163 Fish 905 Sausages 150 Tinnedmeat 3,821 Fruit andVegetables 18,585 Confectionery 68,113 Biscuits and Cake 1,807 Chicory 47,040 Assorted Food 2,004 147,124 lbs Milk (tins) 6,346 Fish (tins) 401 Eggs 1,198 Assorted tins, jars and packets 2,206 15 SCHOOL MEDICAL SERVICE. The School Medical Service continued to function as in previous years with only small limitations occasioned by reduction in medical staff. Routine medical inspection was curtailed on account of the increasing demand on the services of the medical staff available, the middle age group being omitted. The resignation of the Assistant Dental Surgeon left only the Senior Dental Surgeon and a part-time dental officer to carry on the work. Two more part-time dental officers were appointed and the' work progressed in a satisfactory manner. The Middlesex Education Committee asked the Ealing Education Committee to arrange for the carrying out of orthopaedic treatment and orthodontic treatment of children attending secondary schools. Their request was agreed to and the scheme was put into operation during the year. A part-time speech therapist was appointed and the special classes for children suffering from speech defects were resumed. Diphtheria immunization was encouraged as much as possible. A national publicity campaign was launched in the middle of the year and steps were taken locally to give full publicity to the campaign in all the schools. STAFF. Dr. Linehan, Assistant Medical Officer and Resident Medical Officer at Clayponds Hospital, volunteered for military service in August and Dr. Margaret Harker was appointed as temporary Assistant Medical Officer in his place and took up her duties on the 1st August. Dr. Wilfred C. S. Wood who was appointed temporary Assistant Medical Officer in November, 1941, unfortunately died in March. Dr. Margaret Brodigan was appointed in his place and took up her duties in May. Miss I. M. Hodgkins, L.D.S., School Dentist, resigned in September. Mr. J. V. Houlton, L.D.S., the part-time dental surgeon increased the number of his sessions and two more part-time dental surgeons were appointed, Mr. H. J. Woodridge, L.D.S., and Mr. W. A. Graham, L.D.S. Miss Ruth Bennett was appointed part-time Speech Therapist in April. One school nurse, Miss A. M. Matthews, resigned in July to take up another appointment, and Miss C. L. M. Roberts was appointed in her place. 16 Miss L. Gilbert returned from Devon in May because the majority of the Ealing children had by then returned home and her services were needed in Ealing. EVACUATION. Owing to the absence of air raids during the year only a few children were evacuated and arrangements were made for small parties to go away when a sufficient number of applications were received. In all, 77 children were medically examined prior to evacuation. At the end of the year there were only 1,650 school children from the Borough in receiving areas. MEDICAL INSPECTION. The scheme for the routine medical inspection of school children at three stages in their school life formerly recommended by the Board of Education had to be modified. A circular issued by the Board of Education suggested that, in view of the demands of the Forces, local authorities should review the arrangements for the School medical service in order to secure the greatest economy of staff with the least detriment to the service. It also suggested that it was essential that all children should be examined as soon as possible after their admission to school, and that the examination of " leavers " should be continued, although deferred to the last year at school. The examination of children at 8 years, with the exception of new admissions, was therefore discontinued after the summer holidays, and children normally examined at 12 years were examined at 13 years. FINDINGS OF MEDICAL INSPECTION. Among the 6,552 children examined in a routine manner there were, excluding uncleanliness and dental disease, 523 defects requiring treatment and 808 requiring to be kept under observation. The examination of the 5,695 children submitted to special inspection revealed 3,317 defects requiring treatment and 388 requiring to be kept under observation. Of the 6,552 children examined at the routine inspections, 508 or 7.7 per cent, were found to require treatment for one or more defective conditions other than defective teeth or verminous condition. 17 NUTRITION. In Table II the nutritional state of the children examined at routine medical inspections is indicated in accordance with the suggestions of the Board of Education in Administrative Memorandum 125 of 1935. Of the 6,552 school children examined 8.7 per cent, were classified as, of excellent nutrition, 88.9 per cent, of normal nutrition, 2.4 slightly sub-normal, and one child, or .01 per cent, being classified as of bad nutrition. It would seem therefore that the nutritional state of the children is being maintained at a high standard. The routine nutritional surveys of the children in school were . discontinued during the year because it was felt that the time of the medical officers could be better employed in other school medical work, the nutritional examinations by reason of their cursory character giving only a general impression of the nutritional state of the children which could be obtained in the course of the medical officer's visits to the schools for routine medical inspection. This impression has continued to be a good one. UNCLEANLINESS. The improvement in the cleanliness of school children, signs of which were noted in the 1941 report, has been maintained during 1942. Up to November of 1942 the school population had increased by 2,442 to 16,542, owing mainly to the return of children from receiving areas. The school nurses greatly increased the number of head inspections and it is through their efforts and the exclusions from school that the improvement has been secured. It has always been the policy in Ealing not to cleanse children because it is considered to be the duty of the parents. Where parents fail in this duty the Education Committee have no hesitation in taking legal proceedings under the Attendance Bye Laws. Ealing has always had a high standard of cleanliness among school children, compared with other areas, and this standard can only be maintained by vigorously upholding the principle that it is the parents' duty to see that their children are kept clean. 18 The following table indicates the number of inspections of children carried out in the last six years and the results obtained :— Year Average Number on Rolls No. of examina-. tions 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 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 1942 16,542 39,937 674 639 1313 3.3 61 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 29). As many as 93.8 per cent, of the children found to be suffering from minor ailments on medical inspection attended the Health Centres for treatment. The number or cases treated and the total number or attendances made were as follows :— Condition Treated No. of cases treated Total attendances made Skin : Ringworm 18 101 Scabies 501 658 Impetigo 181 1,148 Others 347 1,157 Minor eye defects 172 781 Minor ear defects 204 2,272 Miscellaneous : Minor injuries 956 5,544 Sores Others Total 2,379 11,661. 19 SCABIES. There was a considerable increase in the number of school children suffering from scabies. As many as 501 cases were treated at the Health Centres during the year. In addition, 307 adults and pre-school children were treated, bringing the total number of cases treated at the Centres to 808. General practitioners and Factory Medical Officers made greater use of the facilities for treatment offered at the Centres by referring no fewer than 209 of this total compared with only 19 cases in 1941. No change has been made in the method of treatment which since 1935 has been by one application of benzyl benzoate. Owing, however, to- the temporary scarcity of this substance a liquid preparation of derris root was given a test at one Health Centre. A hundred cases were treated with Derris and concurrently an equal number were treated with benzyl qenzoate using an identical technique. The derris preparation was found to be distinctly inferior in effecting a cure The successful control of scabies necessarily depends upon the careful following up of contacts in the same family or household. It is seldom that the School Nurses, who carry out this duty with tact, are unable to secure the simultaneous treatment of all the members of the infected family. The Scabies Order, although it has never been made use of, has great value from its mere existence. It should be noted that the number of severe cases with dermatitis is decreasing. This is probably due to greater familiarity with the symptoms of the disease by medical practitioners, school teachers and members of the public themselves, leading to earlier discovery and prompt and efficient treatment. 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 1942. 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 1942 501 — 501 20 Defectaive Vision.:—The report of the Ophthalmic Surgeon, Dr. J. G. Freeman Heal is as follows :— " During the year 1942, 568 new cases were examined. Of these, 315 were seen at Mattock Lane, and 253 at Ravenor Park Health Centre. Re-inspections numbered 640, of which 225 were seen at Mattock Lane, and 415 at Ravenor Park. Prescriptions for glasses were given in 858 cases. The number of pairs of glasses obtained was 824. Abnormal eye conditions, other than refractive errors, were as follows :— Congenital Abnormalities. New Cases Re-inspections Squint 125 210 Congenital Nystagmus 4 7 Progressive Myopia 4 12 Congenital Cataract 3 2 Coloboma of Uveal Tract. 2 - Congenital Ptosis 2 - Obstruction Nasal Duct 1 - Embryonic remains on back of Cornea 1 - Abnormalities due to Infection. Blepharitis 4 2 Meibomian Cyst 4 — Chronic Conjunctivitis 3 — Phlyctenular Conjunctivitis 1 — Styes 1 — Abscess of Eyelid 1 — Choroiditis, Central — 1 Corneal Scarring 1 — Abnormalities due to Trauma. Scar of Cornea 1 — Corneal Abrasion 1 — Contusion of Eye 1 — Abnormalities after Surgical Treatment. Eye removed, reason unknown 1 — Dacryocystectomy 1 — Abnormalities of Unknown Etiology. Optic Atrophy 1 1 * Infective external eye diseases were again few in number and mild in degree indicating a state of well maintained nutrition in the children. 21 Defects of Ear, Nose and Throat.—Arthur Miller continued as in former years to give specialist advice and treatment at the various Health Centres to children referred from the routine and special school inspections and from the Infarnt Welfare Centres. The total number of attendances increased from 414 in 1941 to 610 in 1942, 533 being school children and 77 children under school age. Included in these figures were 261 attendances by new cases, of whom 41 were children under school age. The children were referred on account of deafness, ear discharge, nasal catarrh, deviated septum, epistaxis, verrtigo or enlarged tonsils. Of the 51 children suffering from ear comditions, 14 were suffering from obstructive deafness, the other 377 had otitis media of one or both ears. In two of the cases the discharge cleared up after adenoids had been removed ; the others received treatment which included regular instillation of ear drops, insufflation of medicated powder and politzerisation. Of 20 new cases, 16 recovered in the period under review. There were 84 children referred for chromic nasal catarrh and 34 received diastolization treatment. The remainder were treated by removal of tonsils or adenoids. The unusually large number of children operated on for enlarged tonsils or adenoids is explained by their being largely old cases who were on the waiting list before Mr. Miller began operative sessions at Clayponds Emergency Hospital. These arrears were met before the end of this year. Of the 146 cases, 130 were school children and 16 pre-school children. In 21 cases adenoids were removed and in the remainder the double operation for tonsils and adenoids was performed. In addition to the cases referred to Mr. Miller a large number of children were found at School Medical Inspection to suffer from nasal, catarrh. The majority of these cases were thought by the mothers to suffer from recurrent colds. These children were found either to be careless about blowing their noses or had no idea how to do so. In both classes the importance of nose blowing was pointed out to the mothers and breathing exercises advised. Six-monthly inspections of these children showed that great improvement could be expected where these instructions were carried out assiduously. Dental Defects.—The report of Mr. c. Colenso, the Senior Dental Surgeon, is as follows : "The inspection of all the children in the Schools was carried out during the year. The treatment of all children seen is not possible during the year owing to the number of dentists now available and who are unable to give their full time to treatment. 22 The full-time woman dentist left towards the end of the year and consequently there was difficulty in replacing her. It was a number of weeks before the services of two part-time dentists could be obtained and with the addition of a third part-time dentist who had been giving his time during the greater part of the year, the work for the children was carried out. The number of sessions given by the three part-time dentists each week is eleven, which is the equivalent of one whole-time person. The dental service is still short of one whole-time dentist, for the number of children returning from evacuation will soon bring the school roll to the pre-war numbers. A number of sessions of work was lost owing to the fact that, one of the dentists was away from duty on account of sickness. This loss of time affected the numbers of children treated as shown in the figures. It will be noticed that there was an increase in the number of children seen in the schools. From this it appears that very few children are still evacuated and the figure is approaching the pre-war school roll. It was also noted that the bad mouth conditions seen last year in the returned children were present in the later arrivals. Nearly all had received little treatment while in the reception areas. The numbers inspected at the schools and at special inspections at the Centres totalled 14,347, this figure being greater by 4,761 than in the previous year. The number of children found to require treatment was nearly half of those seen, which is an improvement on last year, when considerably more were found to require treatment. The total number treated was 4,290, this number being a little greater than in the preceding year, but smaller in ratio to the numbers found to require treatment. This decrease was due, as explained above, to the gap between replacing the dentists, also sickness leave by one of the dentists. The work carried out was, as usual, fillings in permanent teeth and temporary teeth where suitable for them. Extraction of permanent and temporary teeth were also done. The number of fillings in permanent teeth totalled 3,024 and 60 temporary making a total of 3,084 fillings, which figure is larger than the preceding year. The number of teeth extracted totalled 8,644. Of this number 1,285 were permanent and 7,359 temporary. The increase over last year is in the figure for temporary extractions, but the permanent figure is smaller than the preceding year. The permanent extraction figure will be on the large side until all the children have returned from the areas as they will then come under a more intensified scheme of dental treatment. 23 Other operations included temporary dressings to relieve pain in temporary teeth, scaling and gum treatment, impression taking for orthodontic work and visits for adjustments of appliances every two weeks, dressing fractured and exposed front permanent teeth. This latter form of treatment involves a certain number of visits to complete the work satisfactorily. Altogether 1,007 other operations were given to the children requiring this form of treatment. Owing to the reduction in the number of sessions worked by the Dentists, the sessions given to inspecting the leavers were curtailed. It was found at these inspections that 529 children were leaving with sound mouths and 191 were leaving with incomplete treatment. This latter figure is always with us, as it represents the parents who are objectors throughout their child's school life. Orthopaedic Treatment.—The Orthopaedic Surgeon attended the Mattock Lane Health Centre once every month in 1942. The Masseuse attended for four sessions each week until the beginning of May when the number of weekly sessions was increased to five. 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 — — 11 Number of children seen for first time 93 70 163 Total number of children examined 334 224 558 Attendances by Masseuse — — 216 Number of cases treated 83 37 120 Number of attendances by children 914 572 1,486 Children admitted to hospital for special treatment 16 3 19 Children supplied with special boots or surgical appliances 31 6 37 Defective Speech.:— The special classes for children with speech defects were resumed in April, 1942, when Miss R. Bennett was appointed part-time Speech Therapist. Two classes were held weekly, one at the Mattock Lane Health Centre and one at the Ravenor Park Health Centre. The children were treated individually, each child receiving a lesson lasting about 25 minutes each week. 24 Children were recommended to the class by Teachers and Medical Officers. From April until the end of the year 21 children received treatment and of these 8 children were discharged as cured, 3 were suspended for the treatment of more urgent cases and 10 were still receiving treatment at the end of year. 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 8 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 768 cases of measles, 247 of whooping cough, 855 of chickenpox and 1,832 of mumps. Children to the number of 614 were excluded under Article 20 (b) of the Education Code for the following conditions Impetigo 149 Ringworm of body 2 Scabies 452 Scabies and impetigo 1 Other skin diseases 4 Ringworm of head 4 Conjunctivitis 1 Blepharitis 1 614 No closure took place under Article 22 or 23 (b) of the Code Grant Regulations. Diphtheria Immunization. In April the Minister of Health issued a Circular in which he stressed the importance of continuing to secure the immunization of as many children as possible. He promised to carry on the publicity started in 1940 and in June a national campaign was launched. Shortly afterwards a local campaign was organised and various means were taken to impress upon the public the vital importance of protecting children against the disease. All the schools were again visited in rotation to immunize those children who were not done at the first visit. It has been made a condition of admission to the War-time Nurseries that all children must have been immunized or the parents must agree to their being immunized on admission. 25 The following table shows the amount of immunization work carried out in 1942 :— Schick tests 195 School children immunized - 3,013 Children under 5 years immunized 2,524 Children re-immunized 18 The total number of children of all ages immunized at the Health Centres and in the Schools in 1942 was thus 5,555 which is an increase of 622 over the number of children immunized in the previous year. 9 t MILK AND MEALS FOR SCHOOL CHILDREN. Every opportunity was taken at school medical inspection and at the Health Centres to encourage the drinking of milk by school children. Milk is supplied in one-third pints at the cost of ½d. or at 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 show the number of children who were receiving milk on the 14th October :— Number of children on Roll 16,616 Number of children present 14,855 Number of children receiving free milk 716 Number of children paying for milk 10,328 Total number of children receiving milk 11,044 Percentage of children receiving milk 74% The scheme for the provision of school meals organised by the Director of Education, was extended during the year until all schools in the Borough were able to provide midday meals either from their own canteens or from the Central Kitchens set up for this purpose. At the end of the year the Director of Education, in a report to the Education Committee, estimated that 27% of the children on the rolls were receiving meals, that is, about 4,600 school meals were being served daily. The meals are provided at a cost of 5d. to the parents or half price or free of charge according to the level of the family income in the same way as the school milk. Head Teachers have observed a considerable improvement in the physical condition of these children and a marked improvement in the school work of backward children. It is considered that the nutrition of the children having midday meals at school is of a high standard mainly owing to the regularity of the meals and to the well balanced diet provided. Where at school medical inspection 26 a child is found to be fussy about food at home, dinner at school cures this fastidiousness in about a week. Many children who will not eat green vegetables at home eat them at school without fuss. At the end of the year it was estimated that 30% of the children attending school had mothers engaged on war work, and in view of the continued increase in the demand for women war workers such a scheme will become a valuable contribution to the well- being of the children. NURSERY SCHOOLS. Since the outbreak of War there have been no Nursery Schools open in the Borough. SECONDARY SCHOOLS. The scheme by which medical inspection and treatment of children attending County Schools is carried out on behalf of the Middlesex Education Committee was extended during the year. Until then only dental treatment and ophthalmic treatment were given but from the 1st April the Ealing Education Committee agreed to include orthopaedic treatment and orthodontic treatment in the scheme already in operation. At the end of the year further suggestions were received from the County pointing out that it would be of assistance if the Ealing Education Committee would provide treatment for minor ailments at the Health Centres in the Borough. The Committee agreed to this arrangement which will come into operation on the 1st April, 1943. During the year 1,091 routine inspections and 25 re-inspections were made at the Schools. Ophthalmic treatment was given to 152 pupils and for 125 of those glasses were prescribed and 119 were supplied through the school medical department before the end of the year. The Orthopaedic Surgeon examined 5 pupils and two of them made 11 attendances at the Centre for massage and special exercises. The following is the report of the School Dental Surgeon :— The total number of pupils inspected at the Secondary Schools during the year amounted to 1,927, this figure being greater than that of 1941 by 516. It was found that quite a big percentage had not received any treatment in the receiving areas and consequently the children who visited the Centres at Ealing had a considerable amount of work to be done for them. The dental work was carried out at all the Health Centres during 1942 and consisted of extractions and fillings. The number of permanent teeth extracted, totalled 243, this figure being slightly more than in the preceding year. Fillings were inserted in 904 permanent teeth, this figure being greater than that in the previous year when 358 teeth were filled. 27 There was one orthodontic case referred for treatment and supplied with an appliance. Other pupils made 35 attendances for adjustments to appliances fitted while attending an elementary school. There were also 157 other operations on these pupils, which included gum treatment and extractions with gas and fillings." EMPLOYMENT OF CHILDREN AND YOUNG PERSONS. The number of children examined in connection with 'their employment out of school hours was 291 and of this number 19 were found to be unfit for employment. The nature of the employment of those certified as fit was :— Boys. ♦ Errand Boys 97 Milk Round 33 Newspaper Round 49 Baker's Round 9 Others 20 Girls. Shop Assistants 56 Dress Making 2 Others 6 272 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 3 instances. At routine inspection 102 children were found who had not obtained the necessary permission, and 4 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 91 teachers and 27 other candidates were medically examined. Town Hall, Ealing, W.5. November, 1943. Medical Officer of Health and School Medical Officer. EALING CENTRAL LIBRARY REFERENCE DEPT 28 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 :— Entrants 2,819 Second Age Group 1,806 Third Age Group 1,927 Total 6,552 Number of other Routine Inspections - B. Other Inspections. Number of Special Inspections and Re-Inspections 8,745 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. % 6,552 569 8.7 5,824 88.9 158 2.4 1 .01 29 TABLE HI. Group I.—Treatment of Minor Ailments. (excluding uncleanliness). Total number of Defects treated or under treatment during the year under the Authority's Scheme 2,379 Group II.—Treatment of Defective Vision and Squint. Under the Authority's Scheme Errors of Refraction (including Squint) 1,180 Other defect or disease of the eyes (excluding those recorded in Group I) 28 Total 1,208 Number of children for whom spectacles were (a) Prescribed 858 (b) Obtained 824 Group III.—Treatment of Defects of Nose and Throat. Received Operative Treatment 130 Received other forms of treatment — Total number treated 130 30 TABLE IV DENTAL INSPECTION AND TREATMENT. (1) Number of children inspected by the Dentist :— (a) Routine Age-groups 14,226 (b) Specials 121 (c) Total (Routine and Specials) 14,347 (2) Number found to require treatment 7,406 (3) Number actually treated 4,290 ?4) Attendances made by children for treatment ' 6,746 (5) Half-days devoted to Inspection 90 Treatment 777 - Total. 867 (6) Fillings : Permanent Teeth 3,024 Temporary Teeth 60 - Total 3,084 (7) Extractions : Permanent Teeth 1,285 Temporary Teeth 7,359 - Total 8,644 • (8) Administrations of general anaesthetics for extractions 2,293 (9) Other operations : Permanent Teeth 1,007 Temporary Teeth -- - Total 1,007 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 39,937 (3) Number of Individual children fqund unclean 1,038 (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- - (b) Under School Attendance Byelaws 61 31 TABLE VI. BLIND AND DEAF CHILDREN. Number of totally or almost totally blind and deaf children who are NOT at the present time receiving education suitable for their special needs. 1. At a Public Elementary School 2. At an institution other than a Special School 3. At no School or Institution Blind Children _ _ 2 (awaiting vacancies) Deaf Children _ _ _