EAL 35 Borough of Ealing ANNUAL REPORT OF THE Medical Officer of Health AND School Medical Officer 19 4 4 THOMAS ORR, M.D., D.Sc., Of the Middle Temple, Barrister-at-Law. . Medical Officer of Health, School Medical Officer and Medical Superintendent of the Isolation and Maternity Hospitals. Perry & Routleff Ltd., Printers 3 HEALTH SERVICES. In accordance with the instructions of the Ministry of Health this Annual Report, as the four previous reports in war years, is of a restricted character but with this difference, that it is now permitted to quote the estimated population of the Borough and the figures or rates based on this population. The maternal mortality, as anticipated in the previous report, is low for 1944 and counterbalances the high rate for 1943, so that by taking the average of the two years a rate comparable with the low rates of previous years is obtained. The infant mortality rate of 41, although one above that of the previous year, is low compared with that for the whole of England and Wales for which the rate is 46 per 1,000 births. * The Maternity and Child Welfare Service continued to function without interruption during the year except when the flying bombs became active. Ten War-time Nurseries became reduced to nine in July when the South Ealing Nursery was so damaged that it had to be demolished. Fortunately none of the staff or children in the nursery at the time received other than trivial injuries. Notifiable infectious diseases were low in incidence, the small number of cases of diphtheria, 17 during the whole year, being remarkable, a result which is no doubt attributable to immunisation of the children. The School Medical Service continued to function as in the previous year in spite of staffing difficulties. Scabies continued to be prevalent although very active measures were taken for its control. Cleanliness of the heads of the children continued to improve and a figure of only 2.5 per cent. of children with dirty heads is especially remarkable in a year in which both parents and children were disturbed by enemy air activity and consequent evacuation. There have been no signs of impairment of the nutrition of the children who have benefited greatly from meals and milk supplied in school and from the protective foodstuffs supplied by the Government. 4 SUMMARY OF STATISTICS, Area (in Acres) 8,739 Population (Census, 1931) 117,707 Population (estimated middle of 1944) 155,580 Rateable Value, 1st April, 1944 £1,872,491 Net Product of a Penny Rate £7,804 Live Births :— . Legitimate Males, 1,484 Females, 1,373 Total, 2,857 Illegitimate Males, 85 Females, 82 Total, 167 3,024 Birth-Rate per 1,000 of Estimated Population 19.4 Still-Births Males, 39 Females, 39 Total 78 Rate per 1,000 total Births (Live and Still-Births) 25 Deaths : Males, 825 Females, 866 Total 1,691 Death-Rate per 1,000 of Estimated Population 10.9 Deaths of Infants under one year of age :- Legitimate Males, 68 Females, 48 Total, 116 Illegitimate Males, 4 Females, 3 Total, 7 123 Death-Rate of Infants under one year of age :—* All Infants per 1,000 Live Births 41 Legitimate Infants per 1,000 Legitimate Live Births 41 Illegitimate Infants per 1,000 Illegitimate Live Births 42 Deaths from Diseases and Accidents of Pregnancy and 1 Childbirth :— From Sepsis 1 Death-Rate 1,000 Total Births 0.32 From other Causes 2 „ „ „ 0.65 Total 3 „ „ „ 0.97 Total Deaths Measles — Whooping Cough 2 Diphtheria 1 Scarlet Fever 1 Influenza 12 Tuberculosis of Lungs 66 Other Forms of Tuberculosis 5 Diarrhoea (under 2 years of age) 12 Causes of Death, 1944. Cause of Death. Deaths, 1944 Total Deaths 1943 Male Female Total Typhoid and Paratyphoid Fevers — — — — Cerebro-Spinal Fever 1 — 1 3 Scarlet Fever — 1 1 — Whooping Cough 1 I 2 4 Diphtheria 1 — 1 — Tuberculosis of Respiratory System 41 25 66 90 Other Forms of Tuberculosis 3 2 5 12 Syphilitic Diseases 4 5 9 12 Influenza 6 6 12 29 Measles —. — — 2 Acute Infectious Encephalitis — — — 3 Cancer of B. Cav. and Oesoph. (M.), Uterus (F.) 13 20 33 27 Cancer of Stomach and Duodenum 16 26 42 50 Cancer of Breast —. 34 34 29 Cancer of all other Sites 94 92 186 173 Diabetes 6 3 9 20 Intra-Cran. Vase Lesions 69 107 176 162 Heart, Disease 221 194 415 435 Other Diseases Of Circulatory System 29 35 64 75 Bronchitis 49 42 91 97 Pneumonia 33 46 79 100 Other Respiratory Diseases 10 12 22 22 Ulcer of Stomach or Duodenum 13 3 16 26 Diarrhoea (under 2 years) 5 7 12 20 Appendicitis 1 2 3 3 Other Digestive Diseases 14 17 31 34 Nephritis 19 15 34 40 Puerperal and Post-Abortive Sepsis — 1 1 2 Other Maternal Causes — 2 2 7 Premature Birth 19 17 36 31 Congenital Malformations, Birth Injury, Infantile Diseases 34 20 54 42 Suicide 6 6 12 14 Road Traffic Accidents 10 5 15 12 Other Violent Causes 43 55 98 54 All Other Causes 64 65 129 148 Total 825 866 1691 1778 61 Table Showing Birth-Rate, Death-Rate and Infant for the Borough of Ealing. Death-Rate 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 14.5 10.9 49 1942 17.2 10.3 48 1943 18.8 11.2 40 1944 19.4 10.9 41 Maternal Mortality per Thousand Births. Period Ealing England and Wales 1931—1935 4.10 4.12 1936 0.93 3.65 1937 2.50 3.23 1938 2.00 2.97 1939 3.75 2.93 1940 1.74 2.16 1941 1.53 2.23 1942 1.79 2.01 1943 2.95 2.29 1944 0.97 1.93 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. Only 34 beds were available for the treatment of cases of infectious disease, owing to the major part of the hospital being used as an Emergency Hospital. Maternity Hospital. The Perivale Maternity Hospital of 43 beds is also under the control of the Ealing and Brentford & Chiswick Hospitals Committee. Throughout the year this hospital was taxed to the uttermost by the demands for admission, the accommodation being fully booked months in advance throughout the year. 7 MATERNITY AND CHILD WELFARE. Now that the restrictions imposed upon the publication of figures relating to population have been removed, it is possible to give the birth-rates during the last four years. In 1941 the birth-rate was 14.5 per thousand of population, this being slightly below that of the preceding four years. In 1942 the birth-rate increased to 17.2, in 1943 it was 18.8, while in 1944 the birth-rate rose to 19.4 per thousand of population. This last birth-rate represents a total of 3,024 births. The demands on the Maternity "and Child Welfare Service have shown a corresponding increase as the majority of the mothers make arrangements for their confinements through the Council's maternity service, or attend the Ante-Natal Clinic if the confinement is to take place in a County Hospital. The demand made for admission to maternity hospitals is indicated by the following figures which show the place of confinement in respect of the births in 1944. Births in Perivale Maternity Hospital 676 Births in other hospitals 1,022 Births in nursing homes 418 Births at home 817 Information not available 91 3,024 In regard to the care of illegitimate children, there has been close co-operation with the Middlesex County Council. Accommodation for the expectant mother before the confinement and for the mother and child after the baby is born, is now available. Every effort is made to assist the mothers to deal with the special problems which arise with regard to illegitimate children, the scheme being operated in close co-operation with the Ealing Deanery Moral Welfare Association. Following the receipt of Circular 20/44 from the Minister of Health advocating special measures to be taken regarding the care of premature infants, arrangements were made to obtain early information regarding them. The weight at birth is now entered on the notification of birth card. Premature babies in need of special care and treatment can best be dealt with in hospital and the County Medical Officer has agreed that every facility should be offered for the admission of these cases to the County Hospitals. At Perivale Maternity Hospital special provision is made for premature children. 8 From the 1st June, 1943, the Health Visitors have been responsible for investigating cases of adoption. During the year under review eight cases were dealt with following the receipt of notices under Section 7 of the Adoption of Children (Regulation) Act, 1939. The Health Visitors also dealt with 56 other adoption cases in which notice had not to be given under the Act. The special war-time services undertaken at the Health Centres—the distribution of National dried milk, fruit juice and cod liver oil and the booking of expectant mothers for evacuation— were continued. During the year 78 expectant mothers took advantage of the evacuation scheme and thus had their babies at emergency maternity hospitals situated in the country. Summary of the Visits made by the Health Visitors, . Visits to children under 12 months :— (1943) (1944) First visits 2,609 2,456 Return visits 5,912 6,599 Visits to children 1 to 5 years of age 8,348 8,846 Visits to expectant mothers 1,507 1,359 Visits to investigate infant deaths and still-births 63 67 Special visits or investigations 204 327 Visits to cases of Ophthalmia Neonatorum 12 2 Visits to cases of Measles and Whooping Cough 571 325 Visits to cases of Scarlet Fever on discharge from the Isolation Hospital 35 84 Inspections of Women's Lavatories 59 67 Visits to children under care of foster-mothers 352 313 Other visits 239 117 Total Visits 19,911 20,562 Summary of the Work at the Health Centres. Mothers. (1943) (1944) Expectant Mothers attending Ant^-Natal Clinics :— Attending for the first time 2,180 2,071 Total attendances 12,516 12,701 Nursing mothers attending Post-natal Clinics :— Attending for the first time 169 155 Total attendances 175 161 i 9 c hildren. Children attending Centres for the first time Under one of age . 2,409 2,406 One to five years of age 420 290 • Total attendances made by children:— Under one year of age 30,364 30,068 One to five years of age 12,933 12,186 Medical Examination of Pre-School Children.—The number of complete medical exminations of children from one to five years of age are indicated in the following table :— Age-Group No. of Examinations (1943) (1944) 1 year to 18 months 1,140 964 18 months to 2 years 658 474 / 2 years to 3 years 576 374 3 years to 4 years 615 389 4 years to 5 years 518 283 3,507 2,484 DENTAL TREATMENT. The number of mothers and children treated during the year was smaller than in the previous year. The decrease was due to the evacuation of mothers and children owing to enemy air activity. Attendances of mothers for the first time were 537 and the total attendances made by all the mothers were 2,344. The dental treatment carried out included 507 fillings and 1,722 extractions and other operations, including scaling, gum treatment and adjustments to dentures. During the year 125 mothers received full or partial dentures. The dental treatment carried out for children under school age consisted chiefly of extractions of teeth causing pain, the mothers coming to the centre with the child at a stage when unfortunately any attemot at conservative treatment is hopeless. The number of young children attending for the first time totalled 149, and for these 434 teeth were extracted and 19 teeth were filled. In all 278 attendances were made by these children. 10 STEPS TAKEN TO COMBAT INFESTATION. The following observations submitted to the Ministry of Health subsequent to the issue of the Annual Report for 1943 can be reproduced here as they apply to 1944 with equal force. For many years very active steps have been taken in the , schools to promote the cleanliness of school children and the good effect of these steps on the mothers has been shown in the cleanliness of the children of all ages. Some indication of the improvement may be seen in the figures relating to the head inspections of school children carried out at regular intervals in each year in the schools. The percentage of children found in successive years, in all the •schools, to have perfectly clean heads, and by that is meant those whose heads are quite clean, even free from nits, were :— 1935 97.1 per cent. 1936 97.2 „ „ 1937 6.7 „ „ 1938 97.0 „ „ 1939 7.2 „ „ 1940 97.0 „ 1941 96.0 „ „ 1942 96.7 „ „ 1943 97.0 „ 1944 97.5 „ „ These figures are certainly notable. The cleanliness of Ealing children has even been noted by others who have come into touch with them in the Reception Areas for there have been many expressions of appreciation of their condition. The method adopted has been regular inspection, followed by notices regarding those unclean and exclusion of those found to have more than a few nits. These notices have given advice as to the maintenance of cleanliness. The duty of the mothers to keep their children clean has been impressed upon them and they have been told how to do it. No child has been cleansed by the school nurses ; the mother has had to, do the cleansing. After several warnings a mother who has offended has been prosecuted under the School Attendance Byelaws. The School Nurses have followed up other and especially older children and even the mothers in the homes, because it has been found that children'after being cleansed have received new infestations from older members of the family. When all other measures have failed to bring about the desired result lethane oil has been supplied free of charge for use by the mother herself or by the girls who have left school. The use of lethane oil has only been advised as a last resort to deal with such contacts. Regular care and attention have been advised or urged as the proper way of keeping school children clean and the same applies to children under school age. 11 At the same time the Medical Officers and the Health Visitors have been devoting attention to the younger children not yet attending school. Examinations for cleanliness have been carried out in a way not to give offence to the mothers and advice has been given in appropriate cases. The home may be the place where advice on the maintenance of cleanliness can be given when it can give least offence but the examination of children's heads in. the home is an action that would court disaster as far as the relations between the Health Visitor and the mothers are concerned. Informal lectures or talks on cleanliness are always part of the duties of the health visitors at the Health Centres where no mother is singled out for special attention and where the advice is received in the best spirit. In these.talks, which are usually followed up in the homes in appropriate cases, the maintenance of general cleanliness and the promotion of good habits are specially dealt with. As a matter of fact all the points referred to in Circular 2831 of the Ministry of Health, even to the possible use of Lethane Oil, had been considered previously to the receipt of the Circular. In order to ascertain the effect of the measures adopted in Ealing with reference to children under 5 years of age, a particular examination was made in 1941 of all the children passing through the hands of the medical officers at various Health Centres over a period of several weeks. The results proved to be much better than anticipated. than anticipated. The figures are worth quoting and are as follows:— Health Centre Number seen by M.O. Few Nits Many Nits Nits and Lice Mattock Lane 218 2 — — Cherington House 215 4 — — Ravenor Park 222 2 — — Perivale 117 — — — Greenford Green 142 — — — Islips Manor 142 — — — Total 1056 8 — — These figures speak well for the efficacy of the measures that have been adopted. 12 WAR - TIME NURSERIES. At the end of the year there were nine War-time Nurseries in the Borough, seven being whole-time nurseries, open from 6.30 a.m. to 6.30 p.m., and two being part-time nurseries open from 9 a.m. to 4 p.m. During the year the accommodation at the Culmington Road Nursery was increased from 44 to 82 places, and at Perivale Nursery from 40 to 58 places. In July the South Ealing Nursery was so seriously damaged by a flying-bomb that it was subsequently demolished. Fortunately, although the nursery was full at the time of the incident, the casualties among the staff and children were limited to .injuries of a very minor character. The attendances at the nurseries during the year were as follows - « Date opened Capacity Days open Total attendances Average attendance » Stanhope 17/11/41 70 307 15365 50 Culmington Road 26/1/42 85 307 11317 37 Cuckoo 9/3/42 70 307 15731 51 Perivale 5/10/42 58 307 9471 31 South Ealing 5/10/42 40 161 5188 32 Northolt 26/10/42 40 307 10087 33 St. Harks 4/1/43 44 307 10157 33 Oldfields 19/7/43 50 307 11111 36 St. John's 5/10/42 60 255 8879 35 Wood End 5/10/42 28 255 5397 21 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 vear 85 (Number of fostermothers having care of the above children, 68). Number of children registered during the year 40 Number of children removed from register during year 55 Number of children on register at end of year 70 (Number of fostermothers having care of the above children, 61). Number of visits made by Health Visitors 293 13 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 :— (а) as midwife 548 (b) as maternity nurse 102 — 650 SUPERVISION OF MIDWIVES:. Number of midwives practising at end of year — Midwives in service of Council 11 „ at Perivale Maternity Hospital 12 „ in independent practice 5 in private nursing homes 8 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 119 (b) At the patient's home 594 When acting in the capacity of maternity nurse (£a doctor being in attendance) : (а) In private Nursing Homes 259 (b) At the patient's home 132 SUPERVISION OF NURSING HOMES. The following table gives information regarding' ^mrsing homes in the Borough :— No. of Homes No. of Beds Number of Nursing Homes on Register at beginning of year 14 (6) 210 (57) Number of New Homes registered 1 14 Number of Homes discontinued Number of Nursing Homes on Register at end 1 9 of year 14(6) 212 (61) The figures in brackets indicate the number of Homes and the number of beds wholly or partly devoted to the reception of matcrvvi&y case£. The Medical Officer in charge of the supervision of Nursing Homes made 26 special visits during the year. 14 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 2,013 Number of Nuisances observed by Inspectors 64 Number of Premises inspected in connection with Infectious Disease 343 Number of Premises visited by Periodical Inspection (Cow- sheds, Dairies, Slaughterhouses, Factories, etc.) 161 Number of Houses inspected under House-to-House Survey Food Inspections 1,663 Total Number of Re-inspections 5,540 Other Inspections 380 Total Number of Inspections and Re-inspections 10,164 Number of Intimation Notices given. 606 Number of other Letters written 1,400 Number of Statutory Notices served 44 Proceedings before Magistrates INSPECTION AND SUPERVISION OP 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. 15 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 3,512 Pork 1,163 ¼ Mutton 566 Veal 281¼ Offal 516½ Bacon 782¾ Fish 4,325£ Sausages 4,142½ Tinned Meat 1,463 Fruit and Vegetables 15,222¼ Confectionery 1,255 Cocoa 4,226 Cereals 1,133½ Assorted Food 12,161 ½ - 50,750f lbs. Milk (tins) 2,644 Fish (tins) 2,415 / • Assorted Articles 1,301 Bggs 2,391 Assorted tins, jars and packets 2,978 Tinned Fruit and Vegetables 629 RATS AND MICE DESTRUCTION (ACT) 1919. INFESTATION ORDER 1943. The Minister of Food under the Defence (General Regulations) 1939 made the Infestation Order on the 6th May, 1943. Under Section 5 of this Order every local authority was instructed to undertake a survey of its district, and to make a report to the Minister with respect to the extent to which land in its area was subject to major infestations by rats and mice. Subsequent to this report, which was submitted in June, 1943, the Ministry of Food organised a campaign in which they solicited the help of the public in giving information regarding the prevalence of rats. This campaign lasted from October to the end of December, 1943, and at that time 422 complaints of rats had been received at the Public Health Department. 16 As the Middlesex County Council were still the authority under the Rats and Mice Destruction (Act) 1919, all the complaints were , sent to the Rat Destruction Officer of the County Council, who was overwhelmed with complaints and consequently unable to deal with them. The Minister of Food issued instructions for this Council to take over on ls£ February, 1944, the administration of the Rats and Mice Destruction (Act) 1919 and the Infestation Order 1943, and so a burden of 422 complaints of rats had immediately to be dealt with, A Rodent Operative and in assistant were appointed to commence work at the beginning of February, and took over this large number of complaints which had* however, by this time, been reduced in number by the Sanitary Inspectors, who had visited the sources of the complaints and had eliminated those which were not in immediate need of attention, or which could be resolved with other complaints into a smaller number of centres of infestation. The following is a summary of the work carried out by the Rodent Operative, acting under the direct supervision of the Chief Sanitary Inspector, from the 1st February to the end of the year :— Complaints (in addition to those already mentioned) 443 Premises inspected 667 Premises found to be infested with : (1) Rats 448 (2) Mice 761 Re-visits to premises 1,111 Estimated number caught : (1) Rats 1,198 (2) Mice 1,294 Fees received for treatment * £356. 12s. 6d. Premises treated free of charge 44 17 PREVALENCE OF, AND CONTROL OVER INFECTIOUS AND OTHER DISEASES. Cases of Infectious Disease occurring in the Borough. Disease 1933 1934 1935 1936 1937 1938 1939 1940 1941 1942 . 1943 1944 Smallpox — —- — — — — — — — — — — Diphtheria 71 195 228 52 123 142 92 33 48 28 13 17 Scarlet Fever 476 493 400 408 317 383 303 116 166 180 448 228 Enteric Fever . (including Paratyphoid) 4 3 7 8 5 2 5 4 5 '— 1 — Puerperal Fever 3 3 7 3 4 — — — — — — — Puerperal Pyrexia 28 14 11 9 24 46 40 30 30 39 41 42 Pneumonia : Primary 56 72 59 85 60 83 50 66 97 105 123 142 Influenzal 32 17 11 14 37 18 26 10 27 17 4 5 Acute Poliomyelitis 3 — 1 2 7 6 1 1 9 2 2 2 Cerebro-Spinal Fever — — — — 1 1 — 7 15 5 1 — Malaria 1 1 — 1 — — — 1 1 2 — — Dysentery — — 1 1 5 1 2 — 3 6 5 24 Erysipelas 36 43 28 28 27 41 37 29 26 36 41 30 Polio- Encephalitis — 1 — 1 — — — — — — 1 — Tuberculosi 1 Pulmonary 154 139 157 139 178 142 149 156 195 223 233 173 Non-Pulmonary 23 24 23 22 37 33 38 30 28 38 51 30 "Ophthalmia Neonatorum 8 5 3 4 7 15 16 5 2 8 4 3 Total 895 1010 936 777 832 924 759 488 653 689 1004 700 The following non-civilian cases of infectious disease are included in the above table : Scarlet Fever, 3 Diphtheria, 3 Whooping Cough, 1 Measles, 1 Scarlet Fever.—Out of 228 cases of scarlet fever only 64 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 was one death from the disease. Diphtheria. All of the 17 cases of diphtheria were removed to hospital. There was one death from this disease. Diphtheria Immunization—The protection of children by means of immunization is considered on page 30. 18 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 ... 127 Whooping Cough 380 There were 2 deaths from whooping cough, but none 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 1 2 — 2 — — — 2 5—10 3 — 4 1 1 — _ _ 10—15 3 4 2 — — — — — 15—20 9 15 3 4 1 1 — _ 20—25 12 18 — 2 1 4 1 _ 25—35 24 18 — 2 10 10 — — 35—45 17 15 1 5 9 4 — — 45—55 14 2 1 1 10 1 1 — 55—65 10 4 .— — 4 5 — — 65 upwards 2 — 1 1 5 2 — — Total 95 78 12 18 41 25 3 2 19 SCHOOL MEDICAL SERVICE. The School Medical Service continued to function as in the previous year. Diphtheria immunization proceeded on the lines previously described. With the co-operation of the Head-teachers special efforts were made to bring immunization to the attention of the parents by sending fresh letters to the homes in instances where children were still not immunized. Owing to the renewed enemy aerial activities large scale evacuation took place during the summer months involving special medical examinations of all those taking advantage of the Government Scheme. The. Child Guidance Centre was opened in October, being staffed by a team of three, consisting of a Psychiatrist, an Educational Psychologist and a Psychiatric Social Worker. STAFF. Dr. Josephine Webb, temporary Assistant School Medical Officer, resigned at the end of the year and Dr. Marguerite Perry was appointed in her place. Mr. H. J. Wooldridge, part-time Dental Surgeon, unfortunately died suddenly. He was succeeded by Mr. F. W. E. Wagner. Miss Penney, temporary School Nurse, commenced duties on the 1st May in place of Mrs. James who resigned in the previous December. * EVACUATION. Owing to enemy air activity large scale evacuation was resumed on the 4th July, 4,506 mothers and children being medically examined prior to evacuation and 116 of these being re-examined owing to various conditions which made them unfit in the first instance. MEDICAL INSPECTION. Medical Inspection included (1) the routine inspection in the schools of children in the only two age-groups : (a) entrants, and (b) children at 13 years ; (2) the special inspection of children referred by the Head-teachers, School Nurses and School Enquiry Officers, and (3) the annual examination of physically defective children and of children requiring to be kept under observation. FINDINGS OF MEDICAL INSPECTION. Among the 3,514 children examined in a routine manner there were 335 defects, excluding uncleanliness and dental disease, requiring treatment and 539 requiring to be kept under observation. The examination of the 5,297 children submitted specially revealed 3,221 defects requiring treatment and 820 requiring to be kept under observation. \ 20 Of the 3,514 children examined at the routine inspections, 307 or 8.7 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 3,514 school children examined 7.3 per cent. were classified as of excellent nutrition, 89.3 of normal nutrition and 3.4 slightly subnormal. The School Nurses continued to visit the schools at monthly intervals to survey the children and to enquire from the Headteachers whether there were any children whose condition was not entirely satisfactory. Appointments were made where necessary for selected children to be seen at the Health Centres by the Medical Officers. UNCLEANLINESS. Cleanliness surveys were made, as usual, on three occasions during the year and additional visits were paid at the Headteachers' request where the usual standard of cleanliness was not being maintained. The results of these were round to be very satisfactory, only 2.5 per cent. of the children being found to have nits or vermin on the head. In the following table the results are tabulated for comparison with those of previous years. 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 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 1944 14,367 38,546 535 447 982 2.5 25 21 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 34). As many as 92 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 12 45 Scabies 473 525 Impetigo 121 806 Others 310 1,148 Minor eye defects 240 790 Minor ear defects 282 2,052 Miscellaneous : Minor injuries 1,002 4,767 Sores Others Total 2,440 10,133 The treatment of cases of Scabies at the Health Centres was continued, benzyl benzoate being used. During the year there were treated 473 school children, 121 pre-school children and 483 cases referred by general medical practitioners and factory medical officers, making a total of 1,077 cases treated. Twenty-one of these cases required re-treatment. The Assistant School Medical Officers again visited the schools and examined all the children present for scabies, 15,032 children being inspected, 32 being found to be suffering from the disease and 134 being referred for further examination. All who attended the Health Centres for treatment were encouraged to bring their relatives or friends living in contact with them if there was any suspicion that they were suffering from the same condition. 22 The following table shows how the number of cases of scabies in school children has been increasing since before the war :— Number of School Children treated for Scabies. # $ 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 1944 473 —- 473 Defective Vision and Diseases of the Eye.—The following is the report of the Ophthalmic Surgeon, Dr. .Freeman fleal, for the year :— During 1944, 457 new cases were examined. Of these, 208 were seen at Mattock Lane, and 249 at Ravenor Park Health Centre. Re-inspections totalled 780, of which, 389 were made at Mattock Lane, and 391 at Ravenor Park, Summary of Work : Prescriptions for glasses were issued 744 Pairs of glasses were supplied 734 Congenital Abnormalities. New Cases. Re-inspections. Squint 80 230 Congenital nystagmus 5 10 Congenital obstruction nasal duct. 6 1 Congenital cataract — 6 Progressive myopia 1 2 Congenital ptosis — 2 Albinism — 1 Congenital paralysis (external rectus; 1 — Congenital opacity of the cornea — 1 23 Abnormalities due to Infection. Blepharitis 4 2 Follicular conjunctivitis 3 — Sub-acute conjunctivitis 3 — Keratitis 3 — Interstitial keratitis — 2 . Phlyctenular conjunctivitis 2 — Chronic conjunctivitis 1 — Episcleritis 1 — Sebaceous cyst 1 — Meibomian cyst 1 — Abnormalities due to Trauma. Subconjunctival haemorrhage 2 — Abnormalities of unknown Etiology. Optic atrophy 1 1 Phthisis bulbi 1 — Infective diseases of the eyes found during the year were few in number and mild in degree which appears to indicate a continued maintenance of good health and nutrition. DEFECTS OF of Ear, Nose and Throat.—The examination and treatment of children suffering from defects of the ear, nose and throat was continued during the year at the Mattock Lane and Ravenor Park Health Centres by Mr. Arthur Miller, F.R.C.S. Special advice and treatment were provided for school children referred from routine and special school inspections and for children attending the Child Welfare Centres. The total number of attendances was 538. Of these 495 were made by school children and 43 by children under five years of age. Embraced in these figures were 229 new cases of whom 18 were under school age. The children were referred on account of deafness, nasal catarrh, epistaxis and unhealthy tonsils and adenoids. The common abnormalities of the ear present were dry and moist perforations of the tympanic membrane, retracted and scarred ear drums, granulations and polypi. Treatments consisted of cauterisation of polypi, regular installation of ear drops, the insufflation of iodized boric acid, politzeration and ionization as well as diastolization. The removal of tonsils and adenoids was recommended in 204 cases, seven of whom being children under five years of age.. 24 The new cases were classified as follows :— Suppurative otitis media 20 Post-suppurative otitis media 9 Catarrhal otitis media 12 Unhealthy and enlarged tonsils and adenoids 128 Deflected septum 8 Rhinitis 7 Other conditions 20 Deafness 15 Bpistaxis 5 Nasal obstruction 5 Owing to war damage sustained by Clayponds Emergency Hospital in July, 1944, operations for enlarged tonsils and adenoids had to be temporarily discontinued but were resumed in January, 1945. During the year 49 school children and 10 children of preschool age were operated on for the removal of enlarged tonsils and adenoids. Dental Defects.—All the elementary school children were inspected during the year, and the parents of those found requiring treatment were notified and given appointments. The number of children inspected was 794 less than in the previous year. This reduction is accounted for by the further evacuation of children. Altogether 14,638 children were inspected. The number found to require treatment was 6,256, this figure being smaller than in the previous year, when 7,338 required treatment. The number that received treatment totalled 4,158, this figure being smaller than the preceding year, when 1,265 more were treated. The number of children treated in each year of the war was smaller than in the years just before the war. This was on account of the fluctuating number of sessions given by the part-time dental surgeons. Many days were lost owing to sickness of two members of the dental staff and owing to the delay in filling a vacancy caused by the death of one of them. The sessions lost by these different causes are reflected on the numbers treated. The work carried out was, as usual, fillings, extractions and other minor operations. The number of permanent extractions was 790, this figure being smaller than in the previous year, when 1,316 teeth were removed. The number of temporary extractions was 5,956, this figure being smaller than that of the previous year by 3,025. The number of fillings inserted in permanent teeth totalled 3,081 ; this figure is smaller than that of the preceding year when 3,780 were inserted, a reduction of 699 fillings. 25 > Other treatments included dressings for temporary teeth, the regulation of orthodontic appliances, the treatment of gums for acute gingivitis and other conditions of the mouth. For these treatments 924 attendances were made at the Centres. During the year 19 new cases were referred for orthodontic treatment, this figure being smaller than that of the previous year when 37 new cases were fitted with orthodontic appliances with satisfactory results. Orthopaedic Treatment.—The Orthopaedic Surgeon attended the Mattock Lane Health Centre once every month in 1944. The Masseuse attended on five sessions in 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 121 61 182 Total number of children examined 396 182 578 Attendances by Masseuse _____ 227 Number of cases treated 130 47 177 Number of attendances by children 1,245 300 1,545 Children admitted to hospital for special treatment 17 5 22 Children supplied with special boots or surgical appliances 34 13 47 Defective Speech.—The following is the report of the Speech Therapist (Miss Doreen Bissell) for the year :— On the 10th January, Speech Centres were opened at the Mattock Lane, Cherington House, Perivale, Greenford Green and Ravenor Park Health Centres, and in September at Oldfields School. The children had been selected during visits to the schools and had had medical examinations. The parents were interviewed and some of.them came to watch the treatment. During the year, the following children received treatment : Stammerers 109 Cleft Palate 4 Speech Defects 83 Others (Rhinolalia, Chorea, etc.) 4 Total 200 26 Many of these attended twice weekly, and until the air raids, the attendance was most satisfactory. Unfortunately, 55 children were evacuated and only 28 had returned by December. During September treatment was given in 14 schools until it seemed safe for the children to resume their attendance at the Centres. - Fifty-two special school visits were paid to discuss the progress and to see new cases of speech defects. The teachers sent reports after six months, and these showed that the children had gained self confidence and sociability. On February 23rd, a talk on “ The work in the Speech Centre " was given at a meeting of Head Teachers at, which the School Medical Officer presided. A similar talk was given to the Staff at North Ealing School and afterwards two Head Teachers visited a Centre. One hundred and ninety home visits were paid—126 of these during the Flying Bomb period when very few children attended— to obtain the home co-operation which is essential if the treatment is to be wholly satisfactory. The Centres were also visited by students of speech therapy from the Central School of Speech Training and the Therapist worked in close co-operation with the Child Guidance staff. The following summarises the results of the treatment :— Discharged as cured 46 Left school 15 Left the area or treatment 22 Still evacuated 27 CHILD GUIDANCE CENTRE. The Child Guidance Centre opened on the 1st October, 1944, in temporary premises. Its function is the diagnosis and, where possible, treatment of psychological disorders arising in the school population. Referrals come mainly from Head Teachers, Medical Officers, the Juvenile Court and the Juvenile Employment Bureau. Many children are examined in the first instance by the Psychologist, sometimes in conjunction with the Psychiatric Social Worker. A number of these cases can be disposed of by giving advice in the appropriate quarters ; the remainder proceed to a full clinical examination, involving the participation of the Psychiatrist. The figures which follow immediately below refer only to those children who received such full examinations during the period of the report. 27 1-Problems as referred. Stealing 7 Problems of behaviour 6 Backwardness 8 Anxiety manifestations 1 Habit disorders 2 Physical symptoms 1 - 25 Some of these terms may require explanation. " Problems of behaviour" has been used to cover complaints relating to disobedience, rudeness, pugnacity, destructiveness, etc. It is quite distinct from the technical term " behaviour problems,' as used below, which indicates that whatever the symptom may be, it has been diagnosed as the reaction of a normal child to an abnormal environment. " Anxiety manifestations " has been used to cover such. symptoms as fears, phobias, timidity, night terrors, etc. II—Diaagnoses (or Underlying Disorders). Psychoneurotic conditions 12 Psychopathic conditions 5 Behaviour problems 4 Intellectual disability 3 Education interrupted 1 Physical disorders 0 25 In general it may be said that the psychoneurotic conditions are likely to respond to some form of psychological treatment, unless home influences are too unfavourable and unmodifiable. The conditions diagnosed as psychopathic have a strong constitutional element which usually, though not invariably, renders them unsuitable for such treatment. The remedy lies in providing special environment. The behaviour problems call for-readjustment, or, if necessary, change of home conditions, the intellectual disabilities for special educational methods, or when extreme, for special care and appropriate occupational provision. The treatment of the last group cannot be effectively carried out until special schools or classes become available, while some members of the group are incapable of profiting from any form of education. 28 No cases of physical disorder were examined during this period, but the category is included because cases of epilepsy, thyroid disorder, etc., may be referred in the future. Treatment usually extends over 3 to 6 months at least, so that the only cases closed during this period were those deemed unsuitable for treatment, 5 in number, who received a. diagnostic service only. They were dealt with as follows : Recommended for residential placement... 2 Report made 2 ' Examined, but parents refused cooperation 1 5 The remaining 20 cases, after diagnosis, were accepted for some form of treatment, are still open, and are classified as follows : Forms of Treatment supplied : Supervision 6 Remedial teaching 4 Individual, treatment 3 Play therapy 0 Awaiting treatment 7 20 Play therapy was not inaugurated during the period, but is included in the table since it is a most valued resource of a Child Guidance Centre, and likely to play an important part in future developments. It is useful to tabulate the age of children at their first appearance at the Centre : Age at time of examination : 5— 6 years 2 6— 7 „ 1 7— 8 „ 6 8—- 9 „ 2 9—10 „ 2 10|—11 4 11—12 „ 3 12—13 0 13—14 „ 3 14—15 „ 4r 2 • 25 29 As with most other disorders, early diagnosis and treatment is of the utmost importance. It is therefore satisfactory that the largest group in this table is that of the seven-year-olds, and it is to be hoped that in time, as the Centre becomes established and expands so as to afford a more adequate service, the proportion of children under 10 will increase and that of children over 10 will dwindle. (The above account of the work of the Child Guidance Centre has been submitted by the Educational Psychologist, Mrs. Anthony.) 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 7 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 1,558 cases of measles, 338 of whooping cough, 1,036 of chickenpox and 144 of mumps. Children to the number of 400 were excluded under Article 20 (b) of the Education Code for the following conditions :— Impetigo 84 Ringworm of body 3 Scabies 300 Other skin diseases 2 Ringworm.of head 1 Conjunctivitis 10 400 No closure took place under Article 22 or 23 (b) of the Code Grant Regulations. No certificate was issued under Paragraph 15 (ii) of the Administrative No. 51 of the Board of Education. 30 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 1944 :— Schick tests 66 School children immunized 183 Children under 5 years immunized 1,549 Children re-immunized 2 The total number of children of all ages immunized at the Health Centres and in the Schools in 1944 was thus 1,734. MILK AND MEALS FOR SCHOOL CHILDREN. When the children are medically inspected at the School or at the Health Centre, the drinking of milk for school children is strongly recommended to the parents by the Medical Officers. The 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 taking milk on the 28th February, 1945 :— Number of children on roll 15,546 Number of children receiving free milk l/3rd pint 248 Number of children receiving free milk 2/3rd pint 87 Number of children paying for milk 1/3rd pint 3,640 Number of children paying for milk 2/3rd pint 5,634 School meals are provided at a cost to the parents of 6d. or at 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 in school on the 28th February, 1945 : Number of children on roll 15,546 Number of children receiving free meals 189 Number of children paying for meals 4,485 31 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. During the year 1,051 routine inspections and25 re-inspections were made at the Schools. Ophthalmic treatment was given to 152 pupils and for 128 of those glasses were prescribed, ' 116 being supplied through the school medical service before the end of the year. The Orthopaedic Surgeon examined 11 pupils and 8 of them made 71 attendances at the Centre for massage and special exercises. Forty-one children made 266 attendances for treatment of Minor Ailments. The following is the report of the School Dental Surgeon — Dental Inspections were carried out at five County Schools during the year. It was found from inspection that nearly fifty per cent, of the children required treatment, and of this number two-thirds approximately received treatment at the Health Centres. The work carried out consisted of fillings, extractions and other operations. The number of fillings inserted were 1,060, a slight increase over the preceding year. The total number of extractions amounted to 285. Five children were supplied with dentures, and two other children had appliances fitted for regulation purposes. Other work consisted of scaling, gum treatment, adjustments to orthodontic appliances and dressings to permanent teeth. The number of attendances required for this work amounted to 142. EMPLOYMENT OF CHILDREN AND YOUNG PERSONS. \ The number of children examined in connection with their employment out of school hours was 111 and of this number two were found to be unfit for employment. The nature of the employment of those considered as fit was :— Boys. Errand boy 43 Milk round 14 Newspaper round. 27 Baker's round 2. Others 5 Girls. Shop assistants 14 Others 4 109 32 These children are submitted to re-examination when routine medical inspection is being carried out in the 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 51 children were found who had not obtained the necessary permission to engage in employment ; 6 of these were found to be unfit for employment and two were 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 54 teachers and 10 other candidates were medically examined. Town Hall, Ealing, W.5. November, 1945. Medical Officer of Health and School Medical Officer. CeNTR&L ' I tlPlKBXC* I 33 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 1,909 Second Age Group 304 Third Age Group 1,301 Total 3,514 Number of other Routine Inspections B. Other Inspections Number of Special Inspections and Re-Inspections 12,410 TABLE II. CLASSIFICATION OF THE NUTRITION OF CHILDREN INSPECTED DURING THE YEAR IN THE ROUTINE AGE-GROUPS. r of Children Inspected A (Excellent) B (Normal) C (Slightly sub-normal) D (Bad) No. % No. % No. % No. % 3,514 256 7.3 3,140 - 89.3 118 3.4 34 TABLE III. Group L—Treatment of Minor Ailments (excluding uncleanliness). Total number of Defects treated or under treatment during the year under the Authority's Scheme : 2,797 GroupII.—Treatment of Defective Vision and Squint. Under the Authority's Scheme Errors of Refraction (including Squint) 1,210 Other defect or disease of the eyes (excluding those recorded in Group I) 27 Total. 1,237 Number of children for whom spectacles were (a) Prescribed 744 (b} Obtained 734 Group III.—Treatment of Defects of Nose and Throat Received Operative Treatment 49 Received other forms of treatment - Total number treated 49 35 TABLE IV. DENTAL INSPECTION AND TREATMENT, (1) Number of children inspected by the Dental Surgeons : (a) Routine age-groups 14,597 (b) Specials 41 (c) Total (Routine and Specials) 14,638 • ^(2) Number found to require treatment 6,256 (3) Number actually treated 4,158 (4) Attendances made by children for treatment 5,842 (5) Half-days devoted to ;— Inspection 86 Treatment 646 Total 732 (6) Fillings :— Permanent Teeth 3081 Temporary Teeth 21 Total 3,102 (7) Extractions :— Permanent Teeth 790 Temporary Teeth 5,956 Total 6,746 (8) Administrations of general anaesthetics for extractions 1,787 (9) Other Operations :— Permanent Teeth 924 Temporary Teeth Total 924 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 38,546 (3) Number of Individual children found unclean 794 (4) Number of Individual children cleansed under Section 87 (2) and (3) of the Education Act, 1921 - (5) Number of cases in which leeal proceedings were taken :— (a) Under the Education Act, 1921 - (6) Under School Attendance Byelaws 25 36 TABLE VI. BUND 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 • -' x• - • - y , - • * -• •. 3:, . .V- v<?, • • . v • ->••. " ' ' ' - .' _ t V . -> V'- >s ' ... ^ i i r ' *' ■ . ' - l-''- . - . X~. x r <r v ■. ■ r-^-r -_•, Vv J: * -0 v • •" '••*•; . < . V . ' . / -w ' s . •»'