EALING PUBLIC LIBRARIES REFERENCE DEPARTMENT E352-4/6131 EAL 34 Borough of Ealing ANNUAL REPORT of the Medical Officer of Health AND School Medical Officer 1943 THOMAS ORR, M.D., D.Sc., Of the Middle Temple, Barrister-at-Law. Medical Officer of Health, School Medical Officer and Medical Superintendent of the Isolation and Maternity Hospitals. Perry & Routleff Ltd., Printers. Ealing Central Library Reference Dept. 3 HEALTH SERVICES. This Annual Report, as the three Reports which immediatelypreceded it, in accordance with the instructions of the Ministry of Health to restrict its size, consists of a statement of the most important vital statistics and a short summary of the Health Services of the Borough. On grounds of national security the estimated population and the birth, death and other rates calculated on the population have been omitted. The maternal mortality rate shows an increase over the three previous years and is above that for England and Wales. The maternal deaths however, are so small in number that one higher or one lower in a year makes a material difference in the rate which may be off-set by a much lower rate in the following year, the average for several years thus being, kept low. The infant death rate of 40, although low compared with the previous five years is not the lowest, the lowest infant death rate being recorded in 1934 when it was 38 per thousand births. The Maternity and Child Welfare Services continued to operate uninterruptedly and were taken advantage of by the mothers to the same striking extent as in pre-war years. War-time Nurseries were increased by two during the year, there being at the end of the year eight whole-time nurseries and two part-time, all of which were made full use of by the mothers, the great majority of whom were engaged in work of national importance. Measles and whooping cough were more prevalent during the year. Although 2,085 cases of measles were notified the disease caused only two deaths. There were however four deaths amongst the 450 children notified as suffering from whooping cough. It is notable that of 448 cases of scarlet fever notified there were no deaths, the disease being of a very mild character with complications rarely present. The number of cases of diphtheria was remarkably small, namely 13, amongst which there were no deaths, a result which can undoubtedly be attributed in large measure to the immunization of the children. The School Medical Services have functioned as in the previous year. Scabies unfortunately continued to be prevalent, in fact, the number of children affected was larger than in the previous year. The cleanliness of the children, however, showed a marked improvement, for, whilst in the previous year the number of school children who had verminous heads were found to be 3.3 per cent the percentage during 1943 was 3.0, a result which has been attained by insisting on the mothers' duty to cleanse their children's heads and to keep them clean, with the constant threat of exclusion and prosecution if they failed in their duty. 4 There is no evidence that the children, whether of school age or under school age, are suffering from war-time conditions ; on the contrary the impression gained on coming into touch with large groups of children in the schools and at the Health Centres is that the level of nutrition and health is higher than before the war, a result which no doubt is due to the steps wisely taken by the Government in various directions to guide the mothers as to a suitable diet and to provide necessary protective foodstuffs. SUMMARY OF STATISTICS. Area (in Acres) 8,739 Population (Census, 1931) 117,707 Rateable Value, 1st April, 1943 £1,857,470 Net Product of a Penny Rate £7,553 Live Births :— Legitimate Males, 1,438 Females, 1,403 Total, 2,841 Illegitimate Males, 55 Females, 79 Total, 134 2,975 Birth-Rate per 1,000 of Estimated Population — Still-Births :— Males, 38 Females, 34 Total 72 Rate per 1,000 total Births (Live and Still-Births) 23 Deaths : Males, 852 Females, 926 Total 1778 Death-Rate per 1,000 of Estimated Population — Deaths of Infants under one year of age :— Legitimate Males, 59 Females, 52 Total, 111 Illegitimate Males, 6 Females, 1 Total, 7 118 Death-Rate of Infants under one year of age :— All Infants per 1,000 Live Births 40 Legitimate Infants per 1,000 Legitimate Live Births 39 Illegitimate Infants per 1,000 Illegitimate Live Births 52 Deaths from Diseases and Accidents of Pregnancy and Childbirth From Sepsis 2 Death-Rate 1,000 Total Births 0.65 From other Causes 7 „ „ „ 2.30 Total 9 „ ,, ,, 2.95 5 Total Deaths Measles2 Whooping Cough 4 Diphtheria — Scarlet Fever — Influenza 29 Tuberculosis of Lungs 90 Other Forms of Tuberculosis 10 Diarrhoea (under 2 years of age 20 Causes of Death, 1943. Cause of Death. Deaths, 1943 Total Deaths 1942 Male Female Total Typhoid and Paratyphoid Fevers ... — — — — Cerebro-Spinal Fever — 3 3 2 Scarlet Fever — — — —• Whooping Cough 2 2 4 5 Diphtheria — — — 5 Tuberculosis of Respiratory System 53 37 90 97 Other Forms of Tuberculosis 3 9 12 14 Syphilitic Diseases 7 5 12 14 Influenza 10 19 29 11 Measles — 2 2 — Acute Infectious Encephalitis 2 1 3 — Cancer of B. Cav. and Oesoph. (M.), ; Uterus (F.) 10 17 27 22 Cancer of Stomach and Duodenum 29 21 50 46 Cancer of Breast — 29 29 36 Cancer of all other Sites 95 78 173 173 Diabetes 9 11 20 10 Intra-Cran. Vase. Lesions 64 98 162 154 Heart Disease ... 193 242 435 379 Other Diseases of Circulatory System 33 42 75 56 Bronchitis 55 42 97 83 Pneumonia 49 51 100 85 Other Respiratory Diseases 14 8 22 23 Ulcer of Stomach or Duodenum 19 7 26 15 Diarrhoea (under 2 years) 12 8 20 26 Appendicitis — 3 3 6 Other Digestive Diseases 18 16 34 36 Nephritis 20 20 40 33 Puerperal and Post-Abortive Sepsis — 2 2 2 Other Maternal Causes — 7 7 3 Premature Birth 16 15 31 37 Congenital Malformations, Birth Injury, Infantile Diseases 26 16 42 42 Suicide 5 9 14 9 Road Traffic Accidents 7 5 12 8 Other Violent Causes 24 30 54 47 All other Causes 77 71 148 140 Total 852 926 1778 1619 6 Table Showing Birth-Rate, Death-Rate and Infant Death-Rate for the Borough of Ealing. Period Birth-Rate 4 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 1942 — — 48 1943 — — 40 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 1943 2.95 2.29 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 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. The demands on the Maternity and Child Welfare Service, as indicated in the subsequent tables, have shown a marked increase on previous years, this being mainly due to the higher number of births. The number of live births assigned to the Borough by the Registrar General for the year under review was 2,975, compared with 2,707, in 1942, which provided the highest total in any previous year. As a great proportion of the mothers make arrangements for their confinement through the Council's maternity service, or go to the local Ante-Natal Clinic, if the confinement is to take place in a County Hospital, the increasing number of births means an increasing amount of work to be done at the Health Centres. Supplies of National dried milk, fruit juice and cod liver oil, made available by the Government for children up to six years of age and for expectant mothers, are distributed through the Health Centres. The Vitamins "A" and "D" tablets available for expectant mothers are also issued. The distribution of additional clothing coupons to expectant mothers has, however, been discontinued as it was found more convenient for mothers to receive these coupons from the Food Office at the same time as they obtain the new ration books, which enable them to obtain certain additional rations until the baby is born. The evacuation scheme for expectant mothers, organised by the London County Council, was continued and during the year, 157 expectant mothers took advantage of this scheme. The arrangements are that parties of expectant mothers travel to the country approximately one month before their babies are due. The confinements usually take place in emergency maternity hospitals. Summary of the Visits made by the Health Visitors. Visits to children under 12 months :— (1942) (1943) First visits 1,813 2,609 Return visits 4,527 5,912 Visits to children 1 to 5 years of age 8,260 8,348 Visits to expectant mothers 1,144 1,507 Visits to investigate infant deaths and still-births 46 63 Special visits or investigations 403 204 Visits to cases of Ophthalmia Neonatorum 3 12 Visits to cases of Measles and Whooping Cough 440 571 Visits to cases of Scarlet Fever on discharge from the Isolation Hospital 29 35 Inspections of Women's Lavatories 57 59 Visits to children under care of foster-mothers 406 352 Other visits 81 239 Total Visits 17,209 19,911 8 Summary of the Work at the Health Centres, Mothers. (1942) (1943) Expectant Mothers attending Ante-Natal Clinics :— Attending for the first time 2,077 2,180 Total attendances 10,812 12,516 Nursing mothers attending Post-natal Clinics :— Attending for the first time 206 169 Total attendances 226 175 Children. Children attending Centres for the first time :— Under one year of age 2,305 2,409 One to five years of age 683 420 Total attendances made by children :— Under one year of age 28,481 30,364 One to five years of age 13,852 12,933 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 (1942) (1943) 1 year to 18 months 953 1,140 18 months to 2 years 601 658 2 years to 3 years 565 576 3 years to 4 years 535 615 4 years to 5 years 355 518 3,009 3,507 WAR-TIME NURSERIES. By the end of the year there were ten War-time Nurseries, eight being whole-time, open from 6.30 a.m. to 6.30 p.m., on each day except Sunday, and two being part-time Nurseries, open from 9 a.m. to 4.30 p.m. from Monday to Friday. This was an increase of two Nurseries over the number open at the beginning of the year, the new Nurseries being St. Mark's (44 places) and Oldfields (50 places). In addition, the accommodation at the Cuckoo Nursery was extended during the year from 56 places to 70 places. No new Nurseries were contemplated during the year but extensions of the Culmington and Perivale Nurseries were begun. 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 70 299 15633 52 Culminigton Road 26/1/42 44 299 11593 39 Cuckoo 9/3/42 70 299 14091 47 Perivale 5/10/42 40 299 8791 30 South Ealing 5/10/42 40 299 8755 30 Northolt 26/10/42 40 299 8929 30 St. Marks 4/1/43 44 297 8839 30 Oldfields 19/7/43 50 131 4630 35 St. John's 5/10/42 60 249 8991 36 Wood End 5/10/42 28 249 5560 22 DENTAL TREATMENT. During the year 612 expectant mothers were seen for the first time by the Dentists. The work carried out included fillings, extractions and the fitting of dentures. The number of fillings inserted totalled 451, a slightly smaller number than in the preceding year. The total number of extractions amounted to 2,178. This figure is also smaller than in the preceding year. New dentures were fitted for 155 mothers. This number is smaller than in the preceding year when 178 were fitted. Other operations carried out for patients included scalings, gum treatment, dressings in cases of toothache and adjustments made to dentures after being fitted. These operations required 1,249 attendances. The work carried out for children was chiefly extractions as these children are brought when toothache has occurred and only on rare occasions can bad teeth in these children be saved. Altogether 500 temporary teeth were extracted, only 34 were saveable. 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 85 (Number of fostermothers having care of the above children, 54). Number of children registered during the year 30 Number of children removed from register during year 30 Number of children on register at end of year (Number of fostermothers having care of the above children, 68). 85 Number of visits made by Health Visitors 352 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 623 (b) as maternity nurse 127 750 SUPERVISION OF MIDWIVES. Number of midwives practising in area at end of year :— Midwives in service of Council 11 ,, at Perivale Maternity Hospital 12 ,, in independent practice 6 „ in private nursing homes 7 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 : (d) In private Nursing Homes 100 (b) At the patient's home 672 When acting in the capacity of maternity nurse (a doctor being in attendance) : (a) In private Nursing Homes 190 (b) At the patient's home 168 11 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 15 (5) 205 (52) Number of applications for transfer of registration — — Number of New Homes registered 1 12 Number of Homes discontinued 2 13 Number of Nursing Homes on Register at end of year 14 (6) 210 (57) 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 17 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 1,787 Number of Nuisances observed by Inspectors 28 Number of Premises inspected in connection with Infectious Disease 502 Number of Premises visited by Periodical Inspection (Cowsheds, Dairies, Slaughterhouses, Factories, etc.) 1,118 Number of Houses inspected under House-to-House Survey — Food Inspections 1,455 Total Number of Re-inspections 5,644 Other Inspections 588 Total Number of Inspections and Re-inspections 11,122 Number of Intimation Notices given 789 Number of other Letters written 1,504 Number of Statutory Notices served 40 Proceedings before Magistrates Nil. 12 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 1,971½ Pork 42 Mutton 502½ Veal 40 Offal 287½ Bacon 259¼ Fish 2,929 Sausages 112¼ Tinned Meat 10,896½ Fruit and Vegetables 15,146¾ Confectionery 13,915 Flour and Pudding Mixture 2,799 Cocoa 5,094 Cereals 1,600½ Assorted Food 2,042¾ 57,638¼ lbs. Milk (tins) 2,929 Fish (tins) 2,787 Assorted Articles 1,441 Eggs 2,634 Assorted tins, jars and packets 10,906 Tinned Fruit and Vegetables 6,022 13 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 1943 Smallpox — — — — — — — — — — — — Diphtheria 54 71 195 228 52 123 142 92 33 48 28 13 Scarlet Fever 407 476 493 400 408 317 383 303 116 166 180 448 Enteric Fever (including Paratyphoid) 3 4 3 7 8 5 2 5 4 5 — 1 Puerperal Fever 4 3 3 7 3 4 — — — — — — Puerperal Pyrexia 21 28 14 11 9 24 46 40 30 30 39 41 Pneumonia : Primary 85 56 72 59 85 60 83 50 66 97 105 123 Influenzal 50 32 17 11 14 37 18 26 10 27 17 40 Acute Poliomyelitis 4 3 — 1 2 7 6 1 1 9 2 2 Cerebro-Spinal Fever — — — — — 1 1 — 7 15 5 1 Malaria — 1 1 — 1 — — — 1 1 2 — Dysentery — — — 1 1 5 12 2 — 3 6 5 Erysipelas 30 36 43 28 28 27 41 37 29 26 36 41 Polio-Encephalitis 1 — 1 — 1 — — — — — — 1 Tuberculosis:— Pulmonary 141 154 139 157 139 178 142 149 156 195 223 233 Non-Pulmonary 27 23 24 23 22 37 33 38 30 28 38 51 Ophthalmia Neonatorum 5 8 5 3 4 7 15 16 5 2 8 4 Total 832 895 1010 936 777 832 924 759 488 653 689 1004 Scarlet Fever.—Of the 448 cases of scarlet fever only 126 cases were removed to hospital. Since the outbreak of war accommodation for cases of scarlet fever in the Isolation Hospital has been much reduced and only in exceptional circumstances have cases been admitted. There were no deaths from the disease. Diphtheria.—All of the 13 cases of diphtheria were removed to hospital. There were no deaths from this disease. Diphtheria Immunization.—The protection of children by means of immunization is considered on page 22. 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 2,085 Whooping Cough 450 There were 4 deaths from whooping cough and 2 deaths from measles. 14 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 i Deaths i 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 4 4 2 5 — 1 — 1 5—10 4 4 4 6 — — 1 3 10—15 — 7 2 5 — — — — 15—20 11 14 4 3 4 6 2 2 20—25 13 19 — 3 2 4 — — 25—35 25 39 3 6 11 14 — 2 35—45 29 18 — 1 11 7 . — 1 45—55 12 2 2 2 7 3 — — 55—65 14 4 — — 8 2 — — 65 upwards 7 2 1 — 9 — — — Total 120 113 18 33 53 37 3 9 15 school medical service. During 1943 the School Medical Service continued to function as in the previous year. Dental work was continued by the Senior Dental Surgeon with the assistance of three part-time dental officers. In reply to a request from the Middlesex Education Committee the Ealing Education Committee agreed to extend the arrangements for the treatment of children attending Secondary and Technical Schools to include the treatment of Minor Ailments. staff. Dr. Harker, Assistant Medical Officer and Resident Medical Officer at Clayponds Hospital was called up for military service and Dr. Simon was appointed as temporary Assistant Medical Officer in her place. Dr. Brodigan, Assistant Medical Officer resigned in September and Dr McGeorge was appointed as temporary Assistant Medical Officer in her place. Miss Ruth Bennett, Part-time Speech Therapist, resigned in April and Miss Doreen Bissell, was appointed in a full time capacity in November. Miss Hepburn, the Masseuse, retired in December after 14 years excellent service. Miss L. Gilbert was transferred to the Maternity and Child Welfare Department and Miss Currie was appointed in her place. Mrs. James, temporary School Nurse resigned in December. - evacuation. Plan V evacuation scheme was suspended but anyone wishing to send children to the reception areas to stay with relatives or friends could do so and the Education Committee paid travelling expenses and issued billetting orders. Only two children were medically examined for evacuation during the year. medical inspection. Routine Medical Inspection on the modified scale of 1942 was continued. The number examined in the " leavers " age-group for 1943 was greatly reduced owing to the change in the age from 12 years to 13 years, the children reaching the age of 13 years during 1943 having already been examined during 1942 at the age of 12 years. 16 FINDINGS OF MEDICAL INSPECTION. Among the 3,556 children examined in a routine manner there were 244 defects, excluding uncleanliness and dental disease, requiring treatment and 487 requiring to be kept under observation. The examination of the 6,371 children submitted to special inspection revealed 3,500 defects requiring treatment and 935 requiring to be kept under observation. Of the 3,556 children examined at the routine inspections, 228 or 6.4 per cent. were found to require treatment for one or more defective conditions other than defective teeth or verminous condition. NUTRITION. ■ • The state of nutrition of the children examined at routine medical inspection is shown in Table II. The classification is in accordance with the suggestions of the Board of Education as set out in Administrative Memorandum No. 125 of 1935. Of the 3,556 school children examined 12.1 per cent, were classified as of excellent nutrition, 85.5 of normal nutrition and 2.3 slightly sub-normal. When the routine nutritional survey of the children in school was discontinued in the previous year it was decided that the school nurse should pay a special visit to each school once a month to ascertain from the head teacher whether there were any children attending school whose physical condition was considered to be unsatisfactory, appointments then being made for these children to be seen at the Health Centres by the Assistant Medical Officers. This procedure was continued . UNCLEANLINESS. All elementary school children in the Borough are examined for cleanliness three times a year, and if in any school the number of verminous children is found to be unusually high, more frequent inspections are made. It was found necessary to take legal proceedings under the Children and Young Persons Act against the parents of one child during the year for continued uncleanliness amounting to neglect. It will be seen in the following table that the usual high standard of cleanliness of the children has been maintained. 17 Year Average Number on Rolls No. of examinations for verminous condition Number of children excluded Number or 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 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 1,313 3.3 61 1943 16,900 ' 44,607 675 646 1,321 3.0 32 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 27). As many as 93.1 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 :— Conditions Treated No. of cases treated Total attendances made _ Skin : Ringworm 11 48 Scabies 622 663 Impetigo 169 992 Others ... ... 307 1,200 Minor eye defects 215 893 Minor ear defects 225 2,400 Miscellaneous : Minor injuries Sores 1,259 5,374 Others Total 2,808 11,570 18 Scabies. There was an increase in the number of school children suffering from Scabies, as many as 622 cases attending the Health Centres for treatment during the year. In addition 180 pre-school children were treated and 372 cases were referred by General Practitioners and Factory Medical Officers, making a total of 1,174 cases treatedduring the year. Treatment by benzyl benzoate was continued as this has been found to be the most satisfactory method. Owing to the increase in the number of cases of Scabies it was decided to inspect all the school children and the Assistant Medical Officers visited all schools in turn for this purpose. As a result 15,610 children were inspected and 93 were excluded with Scabies and subsequently treated. Every case of scabies was followed up in order to discover other persons suffering from the disease and to encourage their attending the Health Centres for treatment. The following table shows how the number of cases of scabies in school children has been increasing-since before the war :— 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 1943 622 3 625 Defective Vision. :—The report of the Ophthalmic Surgeon, Dr. J. G. Freeman Heal is as follows :— Ophthalmic Report for the Year 1943. During the year 518 new cases were examined. Of these, 266 were seen at Mattock Lane, and 252 at Ravenor Park Health Centre. Re-inspeGtions totalled 760, of which 374 were at Mattock Lane, and 386 at Ravenor Park. Prescriptions for glasses were given in 753 cases. The numbers of pairs of glasses obtained was 728. 19 Abnormal eye conditions, other than refractive errors, were as follows :— Congenital Abnormalities. - New Cases Re-inspections Squint 115 209 Congenital Nystagmus 5 7 Progressive Myopia 1 4 Congenital Cataract 2 3 Coloboma of Uveal Tract - 1 Congenital Ptosis 1 1 Obstruction of Nasal Duct 6 3 Dermoid Cyst of Eyelid 1 - Abnormalities due to Infection. - - Blepharitis 5 - Meibomian Cyst 3 - Interstitial Keratitis 2 3 Phlyctenular Conjunctivitis 3 - Chronic Conjunctivitis 4 1 Sub-acute Conjunctivitis 5 - - Styes 2 - Inflammation of Lids 2 - Hypopyon 1 - Central Choroiditis — 2 Retinitis Proliferans __- 1 Corneal Scarring — 4 Abnormalities due to Trauma. Aphakia, from perforating wound 1 — Contusion of Eye 1 — Caustic burn of Lid 1 — Abrasion of Cornea 1 — Abnormalities of unknown Etiology. Optic Atrophy — 3 Absence or paralysis of External Rectus 1 Judging from the small number of cases of infective disease of the eye occurring during the year the health and nutrition of the children would appear to be well maintained. Defects of Ear, Nose and Throat.—Children suffering from defects of the Ear, Nose and Throat were, as in previous years, referred to the surgeon, Mr. Arthur Miller, for advice and treatment. The Surgeon attends at the Mattock Lane and Ravenor Park Health Centres alternately once a fortnight. School children are referred from the Inspection Clinics and from routine school medical inspection, whilst the children under five years of age are referred from the Child Welfare Centres. 20 The advice of the surgeon is sought in all cases of discharging ears, deafness, persistent nasal catarrh, polypi and epistaxis and of enlarged tonsils when associated with frequent colds, deafness or sore throat. School Children Children under five years. New Cases 182 36 Re-Inspections 297 31 Treatment Advised 194 17 Operations Advised 148 27 The treatment advised by the Surgeon was carried out at the various Health Centres and included ionization and diastolization of the nose, regular instillation of ear drops, the insufflation of iodized boric acid, politzeration and cauterization. Throughout the year 110 school children were operated on for the removal of enlarged tonsils and adenoids and 19 children under school age. The operations were performed by Mr. Miller at the Clayponds Emergency Hospital. Dental Defects.—The report of Mr. C. Colenso, the Senior Dental Surgeon, is as follows :— During the year all the children in the schools in the Borough were inspected and treatment was given to most of those found to require it. The work carried out included extractions and fillings, the fitting of orthodontic appliances and other operations, including gum treatment, scaling and dressings. The total number of inspections during the year amounted to 15,432, this figure being over a thousand greater than that in the preceding year. The number found to require treatment totalled 7,338. This number is slightly smaller than that of the previous year, when 68 more children were found to require treatment. The number of children actually treated during the year totalled 5,423, this number being greater by 1,133 than those treated in the preceding year. The number of fillings inserted amounted to 3,858, this figure being greater than in 1942 when 3,084 fillings were inserted. The total number of permanent teeth extracted was 1,316 and the number of temporary teeth extracted 8,981, making a total of 10,297 extractions, this number being greater by 1,653 than in the previous year, when 8,644 teeth were extracted. 21 Orthodontic appliances were fitted for 37 children, six more than were fitted in 1942. The total number of attendances made for adjustments of these new appliances and also for children who had been fitted in the previous year was 391. Other operations were, as already stated, temporary dressings to relieve toothache in the temporary teeth, scaling of permanent teeth, gum treatment in certain conditions of the mouth, and other minor operations on the teeth. A total of 1,271 attendances were made for this class of work. Orthopaedic Treatment.—The Orthopaedic Surgeon attended the Mattock Lane Health Centre once every month in 1943. The Masseuse attended on "five sessions each week. 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 __ - 12 Number of children seen for first time 103 101 204 . Total number of children examined 359 252 611 Attendances by Masseuse - - 232 Number of cases treated 107 56 163 Number of attendances by children 1,026 508 1,534 Children admitted to hospital for special treatment 10 5 15 Children supplied with special boots or surgical appliances 31 6 37 Defective Speech.—Children with speech defects attended the special classes at Mattock Lane and Ravenor Park Health Centres held by Miss R. Bennett until the 30th April, when she resigned. The classes were then discontinued. It was then decided to obtain a full-time Speech Therapist to deal in an adequate manner with all the children with speech defects. Miss D. Bissell was appointed and commenced her duties on the 22nd November. All children attending elementary schools with any speech defect were then seen by Miss Bissell and arrangements were made for the parents to be interviewed by her since the co-operation of the parents at home is essential for these children to obtain full benefit of the training they receive at their classes. 22 Actual treatment commenced in January, 1944, sessions being arranged at the Mattock Lane, Cherington House, Ravenor Park, Greenford Green and Perivale Health Centres for this purpose, the children being dealt with according to their defects, some individually and some in classes. 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 only made as required. During the year 10 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 2,065 cases of measles, 362 of whooping cough, 1,320 of chickenpox and 613 of mumps. Children to the number of 704 were excluded under Article 20 (6) of the Education Code for the following conditions :— Impetigo 150 Ringworm of body 1 Scabies 547 Other skin diseases 3 Ringworm of head 1 Conjunctivitis 2 704 No closure took place under Article 22 or 23 (6) of the Code Grant Regulations. The following school required a certificate under Paragraph 15 (ii) of the Administrative Memorandum No. 51 issued by the Board of Education : Perivale Infants : 3 weeks for Whooping Cough and Influenza. Diphtheria Immunization. Immunization of school and pre-school children was continued at the Health Centres and when the numbers justified it the Medical Officers attended the various schools for the purpose. The following table shows the amount of immunization work carried out in 1943 :— Schick tests 362 School children immunized 942 Children under 5 years immunized 2,032 Children re-immunized 9 The total number of children of all ages immunized at the Health Centres and in the Schools in 1943 was thus 2,983. 23 The Health Visitors impress upon the mothers the necessity for immunization as soon as the children reach the age of one year. The majority of entrants to the Infant Departments are therefore already immunized when they commence school. MILK AND MEALS FOR SCHOOL CHILDREN. At routine medical inspection in the schools and at the Health Centres the drinking of milk by school children is strongly recommended to the parents. The milk is supplied in one-third pints at the cost of id. 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 receiving milk on a day in October, Number of children on roll 16,900 Number of children receiving free milk 436 Number of children paying for milk 10,980 At the end of the year the Director of Education estimated that 27% of the children on the school rolls were receiving meals. The meals are provided at a cost of 6d. 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. The following figures supplied by the Director of Education show the number of children who were receiving meals on a day in October, 1943 : Number of children on roll 16,900 Number of children receiving free meals 179 Number of children paying for meals 4,920 SECONDARY SCHOOLS. Medical inspection was carried out as in former years on behalf of the Middlesex Education Committee in the five County Schools in the Borough. The extended scheme of treatment to include minor ailments came into operation on 1st April. During the year 1,003 routine inspections and 32 re-inspections were made at the Schools. Ophthalmic treatment was given to 154 pupils and for 118 of those glasses were prescribed and 114 were supplied through the school medical department before the end of the year. 24 The Orthopaedic Surgeon examined 6 pupils and four of them made 40 attendances at the Centre for massage and special exercises. Forty-one children made 117 attendances for treatment of Minor Ailments. The following is the report of the School Dental Surgeon :— " The pupils at the Secondary Schools are not inspected until late in the year and consequently the treatment is not finished during the current year, but is carried on to the following year for approximately twelve weeks. The work is mostly of a conservative character and any extractions that have to be done are mostly for regulation purposes. The total number of extractions amounted to 392, and of this number 300 were of permanent and 92 were of temporary teeth. The number of teeth filled totalled 1,039, this figure being greater than in the preceding year when 904 fillings were inserted. Orthodontic appliances were fitted in two pupils and one denture was fitted for a pupil who had his front teeth extracted. Other operations involved scaling and gum treatment, adjustment to appliances previously fitted, root treatment of front teeth and other minor operations. All this treatment was given to 689 pupils out of a total of 932 found to require treatment. EMPLOYMENT OF CHILDREN AND YOUNG PERSONS. The number of children examined in connection with their employment out of school hours was 328 and of this number 7 were found to be unfit for employment. The nature of the employment of those certified as fit was :- Boys. Errand Boys 108 Milk Round 51 Newspaper Round 74 Baker's Round 18 Others 20 Girls. Shop Assistants 41 Others 9 321 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. At routine inspection 39 children were found who had not obtained the necessary permission, and 7 of these were found to be unfit for employment. 25 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 50 teachers and 19 other candidates were medically examined. Medical Officer of Health Town Hall, and School Medical Officer. Ealing, W.5. October, 1944. 26 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 2,240 Second Age Group 784 Third Age Group 532 Total 3,556 Number of other Routine Inspections — B. Other Inspections. Number of Special Inspections and Re-Inspections 9,929 TABLE II. CLASSIFICATION OF THE NUTRITION OF CHILDREN INSPECTED DURING THE YEAR IN THE ROUTINE AGE-GROUPS. 1 Number of Children Inspected A (Excellent) B (Normal) C (Slightly sub-normal) D (Bad) No. % No. % No. % No. % 3,556 431 12.1 3,042 85.5 83 2.3 - - 27 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 2,808 Group lie—Treatment of Defective Vision and Squint Under the Authority's Scheme Errors of Refraction (including Squint) 1,267 Other defect or disease of the eyes (excluding those recorded in Group I) 11 Total 1,278 Number of children for whom spectacles were (a) Prescribed 753 (b) Obtained 728 Group III—Treatment of Defects of Nose and Throat. Received Operative Treatment 110 Received other forms of treatment — Total number treated 110 28 TABLE IV. DENTAL INSPECTION AND TREATMENT. ' (1) Number of children inspected by the Dentist :— (a) Routine age-groups 15,386 (b) Specials 46 (c) Total (Routine and Specials) 15,432 (2) Number found to require treatment 7,338 (3) Number actually treated 5,423 (4) Attendances made by children for treatment 7,835 (5) Half-days devoted to :— Inspection 82 Treatment 803 —— Total. 885 (6) Fillings :— Permanent Teeth 3,780 Temporary Teeth' 78 Total 3,858 (7) Extractions :— Permanent Teeth 1,316 Temporarv Teeth 8,981 Total 10,297 (8) Administrations of general anaesthetics for extractions 2,472 (9) Other Operations :— Permanent Teeth 1,271 Temporary Teeth — Total 1,271 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 School Nurses or other authorised persons . 44,607 (3) Number of Individual children found unclean 1,160 (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 32 Under the Children and Yoimg Persons Act 1 29 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 - 1 Deaf Children — 1