AC 439 (1) EALING MEADX LIBRARY EAL 40 Borough of Ealing ANNUAL REPORT of the Medical Officer of Health and School Medical Officer 19 49 WILLIAM G. BOOTH, M.D., B.S., D.P.H., Medical Officer of Health, Joint Area Medical Officer (M.C.C.), Medical Superintendent of the Isolation and Maternity Hospitals. Perry & Routleff Ltd., Printers, Ealing and Uxbridge EAL 40 Borough of Ealing. ANNUAL REPORT of the Medical Officer of Health and School Medical Officer 19 4 9 WILLIAM G. BOOTH, M.D., B.S., D.P.H., Medical Officer of Health, Joint Area Medical Officer, Medical Superintendent of the Isolation and Maternity Hospitals. 3 August, 1950. Mr. Mayor, Ladies and Gentlemen, I have the honour to submit my Annual Report to you for the year 1949. The focusing of interest upon the growing incidence of food poisonings throughout the country has led to a development of a scheme of food protection in Ealing. This is aimed at ensuring that every food handler in the Borough knows of the dangers that lie in carelessness when food is served or prepared. The success of the courses of lectures organised for this purpose has been a tribute to the energy and enthusiasm of the Sanitary Inspection Department, and we are sure that 1950 will show further strides in this educational and preventive work. The success of this Ealing scheme can be largely attributed to the judgment and sound advice of your former Chief Sanitary Inspector, Mr. G. Stevens. His long experience of conditions in Ealing was the basic consideration in devising the scheme and we are grateful to him for setting us on the right road. The policy adopted cannot be short term and it may be some years before the full benefits of the work being done will show, but our continual programmes on educational lines must inevitably give results, and to those in closest touch with the work, some of these results are already apparent. February 1950 saw the end of the long association of the Borough of Ealing with the Clayponds Isolation Hospital, as the Medical Officer of Health was no longer required to act as Medical Superintendent. I have no hesitation in asserting, as a result of my considerable experience of work with every type of local authority, that the dissociation of local health services from the control of any hospital beds is the most serious injury that has been inflicted upon the health services of the country in this generation. It may well lead to the disintegration of local authority control of preventive medicine, and to those who have given a lifetime to its service, this may well appear to be a matter of serious concern. It has happened to dental services and as the local authority representatives appear to be unable to negotiate salary scales for medical staff, there may be no other course open, if complete destruction is to be avoided, but the absorption of the preventive services into some other side of the National Health Service Scheme. In this way the local authorities are gradually dissipating services carefully built up by their predecessors and the machine of central administration swallows and slowly digests into an amorphous mass, completely lacking in any individuality or local interest, the whole structure of local preventive and curative 4 health services, churning out in their stead a mass of rules and regulations apparently devised for the guidance of a world of "robots." Until we get back to true local government in a new redistribution of boundaries and functions, it would seem to be useless to oppose the trend of government policy, since there is no reply to the criticisms of the present administrative arrangements in the greater part of this country. Ealing, with its high tradition of health services, is being swept along with the rest of the local authorities into a stagnant backwater. It is my duty to warn you that in my view the loss of your hospitals is only the beginning of the degradation of your services, and that it is inevitable that the dental services, the tonsil and adenoid services, the treatment of minor ailments, women's conditions and other services will be lost to local control. Unless strong action is taken there seems no alternative to the loss of all the health services by the local to some other body. This might not be to the disadvantage of the officers, but as an old local government officer, I cannot believe that it would be of advantage to the community as a whole. The figures and details regarding infectious diseases are in the body of the report but the loss of Clayponds Hospital must inevitably take a great deal of interest out of the returns which now are shown as a statistical rather than an administrative and personal problem. The rise in the birth rate after the war has ceased and we are fast returning to conditions of the 1930's when the falling birth rate and the ageing population gave rise to so much concern. In 1949 the birth rate was the lowest since 1935, namely 14.4 compared with 15.7 for 1948. This has been accompanied by another fall in the Infant Mortality rate and it is my pleasure to be able to inform the Council that the Infant Mortality rate was 21 per 1,000 births compared with 26 per 1,000 for 1948. This figure of 21 is a record for Ealing and would have been considered astonishing only a few years ago. If there is any truth in the assertion that the health of a borough can be best assessed by its Infant Mortality rate, then Ealing has good cause for self congratulation. I have the honour to be, Your obedient servant, W. G. BOOTH, Medical Officer of Health. 5 STAFF OF THE PUBLIC HEALTH DEPARTMENT William G. Booth, Medical Officer of Health m.d., b.s., d.p.H. (also Joint Area Medical Officer of Area 7 (Ealing and Acton), Middlesex County Council) Medical Superintendent of the Isolation and Maternity Hospitals G. R. Taylor, Deputy Medical Officer. m.b., b.s., d.p.h. G. T. H. Blackie Chief Sanitary Inspector E. Belfield Deputy Chief Sanitary Inspector C. P. H. Meadows Sanitary Inspector E. H. Evans „ „ J. A. Cummins „ „ C. W. Baxter „ „ E. W. Budd „ „ E. S. Herbert „ „ (commenced 20/6/49) D. J. Huggins „ „ (commenced 27/6/49) Harry M. Birrell Chief Administrative Assistant R. S. Leggatt Senior Clerk J. J. Rice Clerk R. Angell „ Miss D. E. McKenzie Shorthand-Typist Mrs. M. G. Byford Mrs. D. Barker Clerk and Typist R. S. Cox Rodent Operative 6 SUMMARY OF STATISTICS Area (in Acres) 8,783 Population (Census, 1931) 117,707 Population (estimated middle of 1949) 188,700 Rateable Value, 1st April, 1949 £1,863,472 Net Product of a Penny Rate, 1949-50 £7,600 Live Births:— Legitimate Males, 1,334 Females, 1,252 Total, 2,586 Illegitimate Males, 60 Females, 70 Total, 130 2,716 Birth-Rate per 1,000 of Estimated Population 14.4 Still-Births:— Males, 23 Females, 20 Total 43 Rate per 1,000 total Births (Live and Still-Births) 15.6 Deaths: Males, 919 Females, 953 Total 1,872 Death-Rate per 1,000 of Estimated Population 9.9 Deaths of Infants under one year of age:— Legitimate Males, 29 Females, 25 Total, 54 Illegitimate Males, 2 Females, — Total, 2 56 Death Rate of Infants under one year of age:— All Infants per 1,000 Live Births 21 Legitimate Infants per 1,000 Legitimate Live Births 21 Illegitimate Infants per 1,000 Illegitimate Live Births 15 Deaths from Diseases and Accidents of Pregnancy and Childbirth:— From Sepsis 2 Death-Rate 1,000 Total Births 0.73 From other Causes 1 „ „ 0.36 Total ..3 „ „ 1.09 Total Deaths Measles — Whooping Cough — Diphtheria — Scarlet Fever — Influenza 13 Tuberculosis of Lungs 70 Other Forms of Tuberculosis 6 Diarrhoea (under 2 years of age) 7 7 Causes of Death, 1949 Cause of Death Deaths, 1949 Total Deaths 1948 Male Female Total Typhoid and Paratyphoid Fevers Cerebro¬Spinal Fever — — — 2 Scarlet Fever - — — — Whooping Cough — — — 2 Diphtheria — — — 1 Tuberculosis of Respiratory System 43 27 70 61 Other Forms of Tuberculosis 4 2 6 5 Syphilitic Diseases 4 7 11 16 Influenza 8 5 13 6 Measles 1 Acute Poliomyelitis and Polio Encephalitis 1 - 1 1 Acute Infectious Encephalitis 2 2 4 — Cancer of B. Cav. and Oesoph. (M.), Uterus (F.) 9 20 29 26 Cancer of Stomach and Duodenum 27 25 52 56 Cancer of Breast 39 39 36 Cancer of all other Sites 131 94 225 220 Diabetes 3 9 12 14 Intra¬Cran. Vase. Lesions 96 110 206 185 Heart Disease 264 298 562 474 Other Diseases of Circulatory System 35 53 88 76 Bronchitis 52 55 107 96 Pneumonia 40 51 91 72 Other Respiratory Diseases 16 14 30 25 Ulcer of Stomach or Duodenum 20 4 24 20 Diarrhoea (under 2 years) 4 3 7 4 Appendicitis 3 — 3 3 Other Digestive Diseases 13 16 29 24 Nephritis 24 12 36 33 Puerperal and Post-Abortive Sepsis — 2 2 1 Other Maternal Causes — 1 1 3 Premature¬Birth 4 2 6 17 Congenital Malformations, Birth Injury, Infantile Diseases 21 18 39 35 Suicide 4 2 6 11 Road Traffic Accidents 15 6 21 21 Other Violent Causes 24 17 41 48 All other Causes 52 59 111 126 Total 919 953 1,872 1,721 8 Table showing Birth¬Rate, Death¬Rate and Infant Death¬Rate for the Borough of Ealing. Period Birth¬Rate Death¬Rate Infant Death¬Rate 1931—1935 14.2 10.1 46 1936—1940 14.7 10.1 45 1941 14.5 10.9 49 1942 17.2 10.3 48 1943 18.8 11.2 40 1944 19.4 10.9 41 1945 17.2 10.1 40 1946 19.7 10.1 27 1947 19.9 10.5 37 1948 15.7 9.2 26 1949 14.4 9.9 21 Maternal Mortality per Thousand Births. Period Ealing England and Wales 1931—1935 4.10 4.12 1936—1940 2.18 2.95 1941 1.53 2.23 1942 1.79 2.01 1943 2.95 2.29 1944 0.97 1.93 1945 — 1.79 1946 0.84 1.06 1947 0.80 1.17 1948 1.36 1.02 1949 1.09 0.98 9 PREVALENCE OF, AND CONTROL OVER, INFECTIOUS AND OTHER DISEASES. The number of cases of infectious disease notified in the Borough in the past twelve years is shown in the following table. Cases of Infectious Disease notified in the Borough. Disease 1938 1939 1940 1941 1942 1943 1944 1945 1946 1947 1948 1949 Smallpox — — — — — — — — — — Diphtheria 142 92 33 48 28 13 17 14 29 11 13 16 Scarlet Fever 383 303 116 166 180 448 228 340 232 133 204 176 Enteric Fever (including Paratyphoid) 2 5 4 5 _ 1 - - - - 3 8 Puerperal Pyrexia 46 40 30 30 39 41 42 47 35 27 25 27 Pneumonia : Primary 83 50 66 97 105 123 142 110 114 127 189 163 Influenzal 18 26 10 27 17 40 9 14 16 3 6 10 Acute Poliomyelitis 6 1 1 9 2 2 2 3 4 46 10 34 Cerebro¬Spinal Fever 1 — 7 15 5 1 — 6 6 10 2 14 Malaria — — 1 1 2 — — — — 1 2 — Dysentery 12 2 3 6 5 24 60 10 5 7 23 Erysipelas 41 37 29 26 36 41 30 26 31 38 32 13 Polio-Encephalitis Tuberculosis : - - - - - - - - - 6 4 3 Pulmonary 142 149 156 195 223 233 173 194 275 204 206 205 Non-Pulmonary Ophthalmia 33 38 30 28 38 51 30 23 33 25 27 32 Neonatorum 15 16 5 2 8 4 3 3 3 5 — 5 Total 924 759 488 653 689 1004 700 840 788 641 730 706 The number of cases of infectious disease originally notified sometimes varies due to changes of diagnosis and the following table is therefore given to show the final numbers after correction. Disease 1949 Disease 1949 Smallpox — Cerebro-Spinal Fever 8 Diphtheria — Malaria — Scarlet Fever 175 Dysentery 20 Enteric Fever (including Paratyphoid) 5 Erysipelas 12 Polio-Encephalitis Tuberculosis: 3 Puerperal Pyrexia Pneumonia: 26 Pulmonary 205 Primary 164 Non¬Pulmonary 32 Influenzal 10 Ophthalmia Neonatorum 4 Acute Poliomyelitis 19 Total 660 Cases of Infectious Disease notified during the Year 1949, showing Age Distribution. Disease Total Cases Notified Deaths Ages of Cases Notified Under One Year 1 to 2 2 to 3 3 to 4 4 to 5 5 to 10 10 to 15 15 to 20 20 to 35 35 to 45 45 to 65 65 and over Smallpox - - - - - - - - - - - - - - Diphtheria 16 — — — 3 — — 5 2 2 4 — — — Scarlet Fever 176 — — 1 12 17 21 97 15 7 4 2 — — Enteric Fever 8 - - - - - - 1 — 2 2 2 1 — Puerperal Pyrexia 27 2 — — — — — — — 1 18 8 — — Pneumonia : Primary 164 89 7 2 8 3 9 25 4 4 14 16 43 30 Influenzal 10 2 — 2 — — — 1 — 1 — 1 3 2 Acute Poliomyelitis and Fncephalitis 37 1 3 1 4 1 1 4 13 1 6 3 — — Cerebro¬Spinal Fever 14 — 1 1 1 1 2 3 1 1 2 — — 1 Malaria — — — — — — — — — Dysentery 23 — — 1 8 2 2 4 1 — 1 3 1 — Erysipelas 13 - - - - - - - - - 2 2 5 4 Encephalitis Lethargica — — — — — — — — — — — — — — Tuberculosis : Pulmonary 205 70 — — 2 2 1 2 7 21 95 34 34 7 Non¬Pulmonary 32 6 — 2 — — 2 1 4 2 9 5 7 — Ophthalmia Neonatorum 5 — 5 — — — — — — — — — — — Measles 1450 — 57 127 226 167 218 614 10 6 22 3 — — Whooping Cough 303 — 28 30 48 47 43 94 10 1 1 — 1 — Totals 2483 170 101 167 312 240 299 851 67 48 180 79 95 44 10 Ages at Death from Notifiable Infectious Diseases. Disease Under One Year 1 to 2 2 to 3 3 to 4 4 to 5 5 to 10 10 to 15 15 to 20 20 to 35 35 to 45 45 to 65 65 and upwards Totals Diphtheria - - - - - - - - - - - - - Scarlet Fever - - - - - - - - - - - - - Enteric Fever - - - - - - - - - - - - - Puerperal Sepsis — — — — — — — — 2 — — — 2 Pneumonia : Primary 5 1 — — — — — — 1 2 26 54 89 Influenzal - - - - - - - - - - 1 — 2 Acute Polio Encephalitis - - - - - - - - 1 - - - 1 Cerebro¬Spinal Fever - - - - - - - - - - - - - Malaria - - - - - - - - - - - - - Dysentery - - - - - - - - - - - - - Erysipelas - - - - - - - - - - - - - Encephalitis Lethargica - - - - - - - - - - - - - Tuberculosis: Pulmonary - - - - - - - 1 19 10 29 11 70 Non¬Pulmonary — — 1 — — — 1 — 1 1 2 — 6 Ophthalmia Neontorum - - - - - - - - - - - - - Measles - - - - - - - - - - - - - Whooping Cough - - - - - - - - - - - - - Totals 5 1 1 — — — 1 2 24 13 58 65 170 11 12 Diphtheria. The wisdom of immunising children against diphtheria has now been fully justified. In recent years as the immunisation rate increased the diphtheria rate has decreased. In 1949 there were 16 notifications of suspected diphtheria but in none was the diagnosis confirmed. Thus the first objective, the prevention of diphtheria in the Borough, has been reached. This is no time for complacency, however, as it cannot be too strongly emphasised that the final objective, the maintenance of this immunity, cannot be approached unless the immunisation rate is kept high. Scarlet Fever. There were 175 cases of scarlet fever. This is slightly fewer than last year and compares favourably with previous years. Sixty¬two cases were removed to hospital, the remainder were nursed at home. Although the incidence is fairly steady the severity of the disease is slight. Most doctors and many parents now appreciate that, if home circumstances permit, scarlet fever can be nursed at home. Acute Poliomyelitis and Acute Polio¬encephalitis. As anticipated there was an outbreak of infantile paralysis although it occurred later in the autumn than expected. It would appear that this infection is becoming endemic and is tending to lose its seasonal prevalence. Of 34 notifications, 19 were proved to be cases of poliomyelitis. There were 3 cases of polio¬encephalitis and one of them, a man aged 20 years, died. Enteric Fever. Three cases of Typhoid Fever and two of Para¬typhoid Fever were notified. One of the typhoid cases was a seaman taken ill on his return from Russia, another was admitted to hospital as a case of pneumonia and discovered during routine laboratory tests ; the third was diagnosed after admission to hospital for a continued pyrexia. The two cases of paratyphoid although unrelated, both became ill on their return from holidays in France. Puerperal Pyrexia. Twenty¬six cases of Puerperal Pyrexia occurred. Of this number 23 were in Perivale Maternity Hospital, one in Queen Charlottes Hospital and two in the patients own home. 13 Pneumonia. There were 164 cases of Primary Pneumonia and 10 cases of Influenzal Pneumonia, 89 patients died from the former and 2 from the latter. Malaria. No case of malaria occurred. Dysentery. Of the 23 cases of Dysentery recorded, 22 were of the Sonne type and of these 14 occurred in an outbreak at a day nursery. Exhaustive laboratory investigations failed to trace the origin of the outbreak. Erysipelas. Only 12 cases of Erysipelas occurred compared with an average of 33 over the past eleven years. The universal use of sulphonamides and antibiotics undoubtedly accounts for this fall in incidence. Food Poisoning. Notifications for 21 cases of Food Poisoning were received. In 3 of these cases the causative agent was identified but in no cases was the source of infection traced. It is certain that a larger number of cases occur than are notified. Some with symptoms such as diarrhoea and vomiting clear up rapidly and are not seen by a doctor, and others which are seen by a doctor soon respond to treatment and are not identified as cases of food poisoning. Food poisoning and its prevention are becoming increasingly important problems in Public Health practice. Owing to the increase in communal feeding and consumption of prepared foods, the risk of mass infection is greater than ever before. Measles. During the year 1,450 cases of measles were notified, 71 more than in the previous year. Whooping Cough. This is the most serious and one of the most distressing of children's maladies and efforts are being made to popularise immunisation against it. It is too soon to expect any statistically significant lowering of the notification figures. Nevertheless in 1949 there were 303 cases, 80 less than the previous year. It has been repeatedly demonstrated that when immunisation does not prevent the onset of whooping cough it at least materially modifies its severity and usually prevents the dreaded complications. 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 Deaths Pulmonary Non Pulm'y Pulmonary Non-Pulm'y Male F'male Male F'male Male F'male Male F'male 0—1 - - - - - - - - 1—5 2 3 1 3 — — 1 — 5—10 2 — 1 - - - - - 10—15 5 2 1 3 — — 1 — 15—20 10 12 1 1 — 1 — — 20—25 17 27 2 — 1 4 1 1 25—35 25 25 5 2 4 8 — — 35—45 17 17 1 3 5 3 1 — 45—55 15 5 1 2 15 3 — 1 55—65 14 — 3 1 12 3 — — 65 upwards 7 — — 1 6 5 — — Total 114 91 16 16 43 27 4 2 The number of new cases of Pulmonary Tuberculosis notified was 205 compared with 206 in the previous year, while the number of cases of Non¬Pulmonary Tuberculosis was 32 compared with 27 in the previous year. There was a total of 76 deaths (70 Pulmonary, 6 Non¬Pulmonary) compared with 61 Pulmonary, 5 Non¬Pulmonary in the previous year. MASSAGE AND SPECIAL TREATMENT ESTABLISHMENTS In 1949 there were 20 establishments in the Borough licensed for massage and special treatment under the Middlesex County Council Act, 1944. In addition to these there were four establishments granted exemption from licensing by virtue of being conducted either by medical practitioners or by members of the Chartered Society of Physiotherapists. In 1943 the Council made it a condition of registration that an applicant's name should be on the Register of the Board of Registration of Medical Auxiliaries which admits only those persons who have trained with a qualifying body recognised by the Board. These establishments are inspected twice a year by the Sanitary Inspectors and licences are renewed annually subject to satisfactory compliance with the Council's Byelaws. 15 MEDICAL EXAMINATIONS. Candidates for permanent appointment to the Council's service are required to pass a medical examination on appointment as are manual staff for admission to the Sickness Pay scheme of the National Joint Industrial Council for Local Authorities NonTrading Services. During the year the following examinations were carried out: Administrative, Technical and Clerical Staff 47 Manual Staff 7 Sickness Pay Scheme 146 Total200 SANITARY CIRCUMSTANCES OF THE BOROUGH. Water. 1. The water supply has been satisfactory both in quality and quantity. There are three sources of supply in the Borough. The Greenford North, Greenford South, Greenford Central, and Perivale Wards are supplied by the Rickmansworth and Uxbridge Valley Water Company with the exception of five roads in Perivale Ward which are served by the Colne Valley Water Company. The remainder of the Borough is supplied by the Metropolitan Water Board. 2. No samples were taken by my Department from any public supply either for bacteriological or chemical analysis. 3. No plumbo¬solvent action occurs in any of the water supplies. 4. No action was taken in respect of any form of contamination. 5. Water from public mains is supplied to 49,303 houses with an estimated population of 188,700. There are eight factories in the Borough using water from deep borings ranging in depth from 300 feet to 600 feet. The water is used for general factory purposes and in four of them it is also used for drinking. Samples were taken from these four wells during the year and the results of the analyses showed that the supplies were satisfactory and suitable for drinking purposes. Four other deep borings exist but are at present unused. 16 Rivers and Streams. A complaint was received towards the end of the year regarding the condition of a stream in the North Greenford area. A sample was taken and the result of the analysis indicated pollution by sewage. Further samples were taken in an effort to trace the source of the pollution and it was eventually established that the stream was polluted before entering this Borough. The matter was taken up with the Authority through whose area the stream passes prior to entering Ealing, and active steps were immediately taken by this Authority to ascertain the source of the pollution. At the close of the year no definite results had been obtained but the neighbouring Authority was pursuing its efforts to trace the source of pollution. No other complaints were received regarding the River Brent or its tributary streams. Drainage and Sewage. During the year eleven houses, previously connected to cesspools, were connected to the Council's sewer and arrangements were in hand for a further five houses to be connected during 1950. Apart from twenty¬one houses in the Northolt Ward, one in Perivale Ward, three in Greenford North Ward, two in Hanger Hill Ward and three in Drayton Ward, all houses in the Borough are connected to the sewerage system. Atmospheric Pollution. One hundred and forty-five smoke observations were made by the Sanitary Inspectors and in four instances it was necessary to make representations regarding the emission of black smoke for a longer period than that allowed by the Bye-Law. In one instance the factory owners went to considerable expense in fitting automatic stoking apparatus to their furnaces but found that this was not fully effective owing to the low grade fuel being supplied to them. Representations were made to the Ministry of Fuel and Power and after an inspection by their representative a better quality fuel was authorised and this was effective in abating the nuisance. In two other cases also representations were made to the Ministry of Fuel and Power who sent an official to inspect and report on the plant, fuel, etc. As a result of these reports and the improvements suggested in them, one factory succeeded in overcoming the emission of black smoke and in the other factory the improvements suggested in the report were in hand at the end of the year. 17 In the fourth instance the nuisance was caused by the use of an incinerator for burning trade waste. Other arrangements were made for the disposal of the trade waste and the use of the incinerator discontinued. Moveable Dwellings. The increasing numbers of moveable dwellings of a semipermanent type in the Northolt area necessitated action being taken under Section 345 of the Middlesex County Council Act, 1944. The tenants of seventeen of these dwellings were refused permission by the Council to use land in the Borough as sites for their moveable dwellings. Seven tenants appealed against this decision to the Ealing Magistrates Court. Two of these appeals were withdrawn before the hearing and in the remaining five cases the appeals were dismissed by the Magistrates. The tenants were given until 31st March, 1950 in which to find other accommodation. Considerable difficulty has been experienced in dealing with the very large numbers of gypsy caravans entering the Borough, particularly in the Northolt area. During the year action had to be taken in respect of three hundred and seventy-five of these caravans. In many cases informal action by the Sanitary Inspector was sufficient to persuade the occupants to move their caravans out of the district. In nine cases proceedings were taken against the occupants at the Ealing Magistrates Court and Orders were made in eight cases for the removal of the caravans from the district. In the remaining cases the caravans were removed from Council land on to the public highway with the assistance of the Police. Notwithstanding unceasing action by the Sanitary Inspector in securing the temporary removal of gypsy caravans from the Borough, there appears to be no permanent solution to this question. Until the Northolt area has been fully developed or until the many pieces of open land in this area have been fenced so as to prevent access by gypsy caravans it is practically certain that caravans of this type will continue to come into this Borough. Baths and Swimming Pools. Two of the Council's four swimming baths were in use during the year, namely, a first class mixed bath and a second class mixed bath. These swimming baths are equipped with pressure filters for continuous filtration and the water is treated with chlorine under strict supervision. There are three privately owned swimming pools in the Borough, two of which are maintained by the Staff Recreation Clubs of two large factories; the other is provided in connection with several blocks of flats. Chlorine treatment is carried out at each of them. 18 Public Mortuary. The arrangement made with the Acton Council for the use of the Acton mortuary was continued during the year. Two hundred and twelve bodies were taken to this mortuary and postmortem examinations were carried out in two hundred and six cases. It should again be stressed that the provision of a public mortuary is an urgent necessity in a Town the size of Ealing. National Assistance Act, 1948. Under Section 50 of this Act which places the duty of causing to be buried or cremated the body of any person found dead in the area of a local Authority where it appears that no suitable arrangements for the disposal of the body are likely to be made by any other person, the burials of nine persons were carried out. In two cases, payment was recovered in full and in one case, in part. As there was no estate on which to claim in the remaining seven cases the cost was borne by the Local Authority. 19 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 2,971 Number of Nuisances observed by Inspectors 70 Number of Premises visited in connection with Infectious Disease 636 Number of Premises visited by Periodical Inspection (Dairies, Food Premises, Factories, etc.) 2,574 Number of houses inspected under House-to-House Survey — Food Inspections 1,324 Inspections of Caravans and Moveable Dwellings 918 Other Inspections 1,514 Number of Re¬inspections 10,168 Total Number of Inspections and Re¬inspections 20,175 Number of Intimation Notices given 1,449 Number of letters written 2,099 Number of Statutory Notices served 468 Proceedings before Magistrates 45 Legal Proceedings. Public Health Act, 1936, Section 93. Non¬compliance with Statutory Notices. In sixteen cases legal proceedings were taken to enforce compliance with Notices requiring the abatement of nuisances. In thirteen cases orders were made by the Magistrates for the necessary work to be carried out within a stated period. Costs amounting to £26. 5s. 0d. were awarded and in one case a fine of £5 was imposed. In three instances the hearings were adjourned and the summonses later withdrawn upon the work being carried out. Nine cases were taken against the occupants of gypsy caravans and in eight instances orders were made by the Magistrates for the abatement of the nuisances. In the other case the caravan had left the district before the summons could be issued. A fine of £1 was imposed in each of two cases. Public Health Act, 1936. Section 75. The owners of two properties upon whom notices had been served to provide dustbins appealed against these notices to the Ealing Magistrates Court. In both cases the appeals were allowed. The Ealing Council did not appeal against this decision. 20 (It should be mentioned that in February, 1950 the same owners again appealed to the Ealing Magistrates Court against notices to provide dustbins at two similar properties. On this occasion also the appeals were allowed. The Ealing Council appealed against this decision to the Middlesex Quarter Sessions. The appeals, which were heard on the 19th and 20th April, 1950, were allowed and ten guineas costs were awarded to the Council). Middlesex County Council Act, 1944, Section 345. The occupants of seven caravans of a semi¬permanent type in the Northolt area, appealed to the Ealing Magistrates Court against the Ealing Council's decision refusing them permission to continue to use land in the Borough as sites for their moveable dwellings. Two of the appeals were withdrawn before the hearing and in the remaining five cases, the appeals were disallowed. FOOD AND DRUGS ACT, 1938. MILK AND DAIRIES ACTS, ETC. Inspections of Milk Purveyors Premises 168 Contravention of Act or Orders 1 Samples of Milk taken 80 Inspections of Food Premises 1,678 Contraventions found 68 Inspections of Ice Cream and Synthetic Cream Premises 255 Samples of Ice Cream and Synthetic Cream taken 115 Legal Proceedings. Food and Drugs Act, 1938. Section 9. The following eleven cases relating to the sale of unsound food were the subject of legal proceedings: 1. Bread containing cigarette ash Fined £21 (£5/5/0 costs) 2. Razor blade in bread Fined £10 (10/6 costs) 3. Cigarette end in bread Fined £5 (10/6 costs) 4. Glass in milk Case dismissed 5. Cockroach in bread Fined £5 6. Insect in bread Fined £5 7. Unsound minced beef Case dismissed 8. Nail in loaf Fined £5 (£2/2/0 costs) 9. Glass in milk Fined £10 (£5/5/0 costs) 10. Unsound meat pie Fined £5 (£5/5/0 costs) 11. Unsound sausage rolls Fined £5 (£2/2/0 costs) 21 Milk Supply. On the 1st October, 1949, the following Acts and Regulations relating to milk came into force. (1) Food and Drugs (Milk and Dairies) Act, 1944. (2) Milk (Special Designations) Act, 1949. (3) Milk (Special Designations) (Raw Milk) Regulations, 1949. (4) Milk (Special Designations) (Pasteurised and Sterilised Milk) Regulations, 1949. (5) The Milk and Dairies Regulations, 1949. Briefly, the e feet of this new legislation was to place the responsibility for the supervision of milk production at the dairy farm directly on the Ministry of Agriculture and Fisheries. Local Authorities and Food and Drugs Authorities are now in no way concerned with milk production and are not required to keep registers of dairy farms or dairy farmers. The Middlesex County Council as the Food and Drugs Authority are now the licensing Authority for Pasteurising and Sterilising establishments, but the Ealing Borough Council are still required to register the premises and enforce the operation of the Milk and Dairies Regulations as to the buildings, infection and contamination of milk, cleaning and storage of vessels, conveyance and distribution of milk. It is also the duty of the Ealing Borough Council to register dairymen as distributors of milk. Under the Milk (Special Designation) (Pasteurised and Sterilised Milk) Regulations, 1949, "Sterilised" Milk became a special designation and dairymen wishing to sell "sterilised" milk required a licence to do so from the Ealing Borough Council. At the commencement of the year, there were 76 purveyors of milk on the register and under the Milk (Special Designations) Regulations, 1936 to 1946, 66 licences were granted, 20 for the sale of Tuberculin Tested Milk, and 46 for Pasteurised Milk. As a result of the new legislation the following additional licences were issued towards the end of the year : Tuberculin Tested Milk 4 Pasteurised Milk 4 Sterilised Milk 43 The number of dairymen registered as distributors of milk remained at 76. 80 samples of pasteurised or heat treated milk were taken and submitted to the Pathological Laboratory for the methylene blue and phosphatase tests. Six samples failed the methylene blue test and three the phosphatase test. These were all processed in other Boroughs. The Local Authorities concerned were communicated with and appropriate action taken. Subsequent samples from the retailers concerned were satisfactory. 22 Ice Cream. 102 Samples of ice cream were obtained during the year and were submitted for bacteriological examination at the Public Health Laboratory, Churchfield Road, Ealing. The results, in accordance with the provisional grading scheme recommended by the sub-committee of the Public Health Laboratory Service appointed for the purpose, were as follows: Provisional Grade No. of Samples Presumptive Coliforms Present Faecal Coliforms Present 1 49 1 1 2 44 20 Nil 3 4 4 Nil 4 5 4 Nil Totals 102 29 1 The reports of the sub¬committee point out that owing to the numerous factors governing the hygienic quality of ice cream and to the experimental error of the laboratory test itself, it is unwise to pay too much attention to the bacteriological results of any given sample. Judgment should be based rather on a series of samples. The majority of samples from any one producer should fall into Grades 1 and 2 (50% in Grade 1 and 80% in Grades 1 and 2). In those cases where unsatisfactory samples were taken from local producers or retailers, further visits were paid to the premises and advice was given by the Sanitary Inspectors on questions of hygiene. Further samples were afterwards taken and it was found that improvement had taken place, resulting in the samples reaching the required standard. Where the source of manufacture lay outside the Borough, the Public Health Departments of the districts concerned were notified and similar steps were taken by them. Synthetic Cream. 13 Samples of synthetic cream were taken during the year from local manufacturers and all received satisfactory bacteriological reports. Meat and Other Foods. The following foodstuffs were condemned by the Sanitary Inspectors as unfit for human food in the course of their inspections of the various food premises in the Borough:— 23 lbs. Bacon 103½ Beef 1455¼ Brawn 509½ Butter 127¼ Cake 8400½ Cereals 955 Cheese 373 Chicken 404½ Condensed Milk 12544 Confectionery 9080 Cooking Fats 141½ Corned Beef 1030¼ Corned Mutton 56 Dried Fruits 423½ Fish 10781½ Flour and Bakery Waste, etc. 8430½ Fruit and Vegetables 236 Jam, Syrup, etc. 1185¾ Jellied Beef 8 Luncheon Meat 215¼ Margarine 122¾ Minced Beef Loaf 71¼ Mutton and Lamb 87¼ Oats 446 Offal 523 Pork 94 Rabbit 513 Sausages and Sausage Meat 579¾ Sugar 255 Tongue 51 Veal 221 Veal Loaf 31¼ Other Foodstuffs 1513½ In addition, the following other articles of food were also condemned : Eggs (shell) 3,959 Milk (gallons) 4½ Synthetic Cream (gallons) 14 Assorted Tins, jars and packets 26,971 There are two private slaughterhouses in the Borough but no slaughtering has been carried out in them since 1939. 24 FOOD HYGIENE. A Clean Food Campaign in the Borough was inaugurated by the holding of a Clean Food Exhibition in the Ealing Town Hall from 26th September to 1st October. The Exhibition was opened by His Worship the Mayor of Ealing (Alderman H. C. Rash, J.P.) supported by Councillor S. Allenby, representing the Public Health Committee. The Exhibition was open to the public for five and a half days and attracted an attendance of 8,000. This number included representatives from the Ministries of Health, Food and Agriculture & Fisheries; Members and Officers of many Local Authorities ; Members of the British Medical Association and other Professional Organisations; representatives from the Food Trade Organisations in Ealing and surrounding districts; Members of the Women's Organisations in Ealing and about 500 senior girls from the Ealing Schools who were conducted round the Exhibition in small organised parties by the Sanitary Inspectors. In view of the technical nature of the Exhibition, children under 14 years of age were not admitted unless accompanied by an adult. A representative from the B.B.C. visited the Exhibition and broadcast the following impressions in "Women's Hour" on the 27th September : "This business of dirty food isn't a pleasant subject and the Public Health Committee of Ealing, in putting on this exhibition, haven't at all gone out of their way to disguise its unpleasantness. There's a model, for example, of a provision shop—the wrong kind of provision shop. Behind the counter is a wax dummy of a woman assistant. She wears a grimy overall; greasy, tousled hair tumbles down over her face; one finger is wrapped in a dirty bandage; uncovered sausages and pies and other foodstuffs are Uttered about the dusty counter ; and it's just as well the assistant is a dummy, because on the floor on the other side of the counter from her, in between some open sacks of groceries, is a large rat. It's a stuffed rat, as it happens, but just in case you think that's a sign of squeamishness—there's a glass case around the corner showing a section of a sewer, and inside that is a real live rat. Then there are live mice and dead rabbits and doomed cockroaches and things—all there not for their horrific value but to show the public how and by what agents food can become poisoned. There's a fly's eye view of the dinner-table targets presented to the ever-hungry fly on the ceiling—the fly that would be thwarted if the food dishes were covered. The exhibition's cleverly devised lessons are as simple as that. The organisers 25 justifiably believe that there's no longer any excuse for the poor food hygiene which wartime difficulties made unavoidable. So they demonstrate dozens of simple, uncostly ways by which the standard cold be raised—many of them things that are so obvious that they're not observed—for example, wash your hands before handling food ; don't handle the business ends of knives and forks; don't shake dirty handkerchiefs over plates of food, and so on. One rather startling exhibit is of particular interest to housewives. It shows two tea-towels, both of which have just been washed. Both look perfectly clean, but scientific examination has shown that one cloth contains harmful bacteria while the other doesn't. The one that's really clean has been washed in water that had a sprinkling of a new disinfectant that sterilises but doesn't taste. Another stand tells the story of milk, from cow to consumer; and it goes on to show what happens to many milk bottles before they're returned to the milkman. Dairies have to smash thousands of bottles every week because they come back so filthy that it's impossible to clean them properly again. There's a model of an ideal ice-cream bar, whose equipment includes a new machine that eliminates the temptation to the server to handle the rim of an ice-cream cone. Many of the stands have any amount of advice to shopkeepers, restaurant owners, cooks and canteen staffs; and there's a good deal of emphasis on that desirable improvement, wrapped food—a simple bit of hygiene in which this country lags so much behind many others. Among the more scientific exhibits, there are some fingerprints taken from dirty hands and they've been analysed to show what germs were on those fingers and the diseases which they could have encouraged. The whole exhibition proves that Ealing is well alive to these aspects of public health, and what's even more important, there are facts and photographs on view that show that in its own area this local authority practises what it preaches." The various lectures, talks and film shows held during the Exhibition attracted a good attendance of local food traders and members of the general public. Following on the Exhibition, a series of lectures were arranged for members of the local food trades. The course consists of five lectures: 1. General aspect of Food Hygiene. 2. Food Infections and Food Poisoning. 3. Hygiene of Food Premises and Food Preparation. 4. The Individual Food Handler and his part in Food Hygiene. 5. The Law and Food. 26 In addition, two lectures on the Hygiene of Milk Processing were arranged for local milk distributors. The first lecture in each series is given by a prominent bacteriologist, the second by the Deputy Medical Officer of Health and Nos. 3, 4 and 5 by three of the District Sanitary Inspectors. Lectures 3 and 4 are illustrated by film strips. Each person completing the course is supplied with a Certificate of Attendance signed by the Medical Officer of Health. 71 Local food traders enrolled for the first series which commenced in December and at the close of the year, we had a sufficient number of food traders on our waiting list to justify the holding of lectures throughout the winter months. I am confident that the education of food trade employees in clean food handling is of the utmost importance if the Council's Food Hygiene campaign is to be successful, and it is encouraging to report such a good start in this direction. HOUSING STATISTICS 1. Inspection of Dwelling-houses during the year: (1) (a) Total number of dwelling-houses inspected for housing defects (under Public Health or Housing Acts) 2,608 (2) (a) Number of dwelling-houses (included under sub-head (1) above) which were inspected and recorded under the Housing Act, 1936 – (3) Number of dwelling-houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation – (4) Number of dwelling-houses (exclusive of those referred to under the preceding sub-head) found not to be in all respects reasonably fit for human habitation 2,038 2. Remedy of defects during the year without service of formal notices : Number of defective dwelling-houses rendered fit in consequence of informal action by the Local Authority or their officers 1,732 3. Action under Statutory Powers during the year: A.—Proceedings under Section 9, 10 and 16 of the Housing Act, 1936 : (1) Number of dwelling-houses in respect of which notices were served requiring repairs — (2) Number of dwelling-houses which were rendered fit after service of formal notices : (a) by Owners — (b) by Locoal Authority in default of Owners — 27 B.—Proceedings under Public Health Acts : (1) Number of dwelling-houses in respect of which notices were served requiring defects to be remedied 438 (2) Number of dwelling-houses in which defects were remedied after service of formal notice: (a) by Owners 314 (6) by Local Authority in default of Owner 1 C.—Proceedings under Sections 11 and 13 of the Housing Act, 1936: (1) Number of dwelling-houses in respect of which Demolition Orders were made — (2) Number of dwelling-houses demolished in pursuance of Demolition Orders 2 (3) Number of houses concerning which action has been taken by the Local Authority under Section 19, and with respect to which owners have given an undertaking that they will not be used for human habitation – D.—Proceedings under Section 12 of the Housing Act, 1936: (1) Number of separate tenements or underground rooms in respect of which Closing Orders were made — (2) Number of separate tenements or underground rooms in respect of which Closing Orders were determined, the tenement or room having been rendered fit – Two houses which were the subject of Demolition Orders in 1948, were demolished in 1949. During the year 54 houses were built in the Borough by private enterprise, the majority of these being houses which were rebuilt after destruction by enemy action. The Town Council completed 268 permanent dwellings, comprising 150 with three bedrooms, 20 with two bedrooms, 64 flats with two bedrooms and 34 flats with one bedroom. FACTORIES, WORKSHOPS AND WORKPLACES Number of Factories with Mechanical Power 372 Number of Factories without Mechanical Power 257 Number of Inspections of Factories and Workplaces 469 Number of Defects concerning which notices were served 28 Proceedings before Magistrates — 1. Inspections for purposes of provisions as to health (including Inspections made by Sanitary Inspectors). 28 Premises Number of Inspections Written Notices Occupiers Prosecuted Factories with mechanical power 373 15 — Factories without mechanical power 81 13 — Other premises under the Act (including works of building and engineering constructidh but not including outworkers premises) 15 – – Total 469 28 — 2. Defects Found. Particulars Number of Defects Number of defects in respect of which Prosecutions were Instituted Found Remedied Referred to H.M. Inspector Want of cleanliness 11 11 Overcrowding — — — — Unreasonable temperature — — — — Inadequate ventilation — — — — Ineffective drainage of floors 1 1 — — Sanitary Conveniences: Insufficient 3 3 — — Unsuitable or defective 8 8 — — Not separate for sexes 1 1 — — Other offences (Not including offences relating to Home Work or offences under the Sections mentioned in the Schedule to the Ministry of Health (Factories and Workshops Transfer of Powers) Order, 1921, and re-enacted in the Third Schedule to the Factories Act, 1937). 4 4 – – Total 28 28 – – 29 Outwork in Unwholesome Premises. Section 108 Nature of Work Instances Notices Served Prosecutions Wearing Apparel Making, etc. — — — Others — — — Shops Act, 1934 In co-operation with the Shops Act Inspector, improvements under Section 10 of the Shops Act, 1934 were carried out in twenty-seven instances. Improved means of maintaining a reasonable temperature were secured at four premises, improved sanitary accommodation at fourteen premises, lighting was improved in one case and washing facilities were improved in eight cases. Summary of Sanitary Defects remedied as a result of Notices served and Letters written. Animals—nuisances from abated 24 Caravans—nuisances from abated 375 Cesspools—abolished 11 Cesspools—cleansed 34 Drains—connected to sewer 11 Drains—cleared and cleansed 289 Drains—reconstructed 36 Drains—repaired 183 Drains—new soil and ventilating pipes provided 32 Damp-proof courses inserted in walls 24 Dampness—other forms remedied 315 Floors—sub-floor ventilation provided 31 Floors—repaired 186 Dustbins—provided 176 Food premises—improvements carried out 81 Food cupboards ventilated 2 Refuse—accumulations removed 86 Roofs, eaves gutters and rainwater pipes repaired 755 Sinks and waste pipes repaired or renewed 82 Walls and ceilings repaired and cleansed 1,684 Water supply reinstated 73 Water supply—draw taps fixed to main supply 14 Water closets—repaired, reconstructed or improved 210 Yards paved or repaired 49 Other defects or nuisances remedied 829 30 RATS AND MICE DESTRUCTION ACT, 1919 Infestation Order, 1943 The following is a summary of the work carried out by the Rodent Operative acting under the supervision of the Chief Sanitary Inspector: Complaints 547 Premises inspected 718 Premises found to be infested with : (1) Rats 441 (2) Mice 149 Re-visits to infested premises 1,294 Fees received for treatment £633. 1s. 0d. Premises treated free of charge 140 In accordance with the requirements of the Ministry of Agriculture & Fisheries, Infestation Control Division, maintenance treatments of the soil sewers in the Borough were carried out during January and July. A total of 1,068 sewer manholes were dealt with and of these 422 were found to be rat infested. Poison Baits were used in the infested manholes and from observations of the takes, it was evident that the number of rats in the Ealing sewers must have been considerably reduced. DISINFECTION Rooms disinfected by spray: (a) Ordinary Infectious Disease 17 (b) Tuberculosis 136 (c) Other conditions 89 Rooms treated for vermin 124 Articles Disinfected by steam: (a) Ordinary Infectious Disease 38 (b) Tuberculosis 191 (c) Other conditions 391 Articles voluntarily destroyed 180 31 SCHOOL HEALTH SERVICE The administration of the School Health Service continues to be a function of Middlesex County Council. Broadly speaking, arrangements for medical examinations, etc., are delegated to the local Education Divisional Executive, while treatment and disposal are the responsibility of the local Area Health Committee. It is interesting to note that the school population served by this department has more than doubled in 20 years. TABLE I. Periodic Medical Inspections. No. on register Entrants 2nd Age Group 3rd Age Group Total 1929 10.442 1,172 1,568 849 3,589 1949 21,690 3,108 1,841 1,936 6,885 TABLE II. Classification of the General Condition of Pupils. Age Groups No. of Pupils Inspected A (Good) B (Fair) C (Poor) No. % of Col. 2 No. % of Col. 2 No. % of Col. 2 (1) Entrants (2) 3,108 (3) 1,083 (4) 34.8 (5) 1,941 (6) 62.5 (7) 84 (8) 2.7 Second Age Group 1,841 475 25.8 1,320 72.2 46 2.0 Third Age Group 1,936 500 25.8 1,403 72.5 33 1.7 Total 6,885 2,058 4,664 163 As required by the Ministry of Education pupils are classified as "A" (above average), "B" (Average), or "C " (below average). It is an expression of the examining doctor's opinion of each pupil's general physical and mental make-up. It has little value, then, as a scientifically accurate assessment. 32 TABLE III. Delects found by Medical Inspection. Defect or Disease Periodic Inspections Special Inspection No. of defects No. of defects Requiring treatment Requiring observation Requiring treatment Requiring observation Skin 41 11 860 73 Eyes— (a) Vision 203 10 206 12 (b) Squint 31 13 20 8 (e) Other 43 11 224 29 Ears— (a) Hearing 15 9 30 9 (b) Otitis media 7 19 35 — (c) Other 16 11 115 13 Nose and Throat 248 433 341 89 Speech 26 9 44 2 Cervical Glands 3 55 8 3 Heart and Circulation.. 4 27 10 15 Lungs 19 85 82 65 Developmental— (a) Hernia 9 6 6 6 (b) Other 14 60 11 18 Orthopaedic— (a) Posture 26 42 8 4 (6) Flat foot 68 66 46 6 (e) Other 53 60 100 39 Nervous System— (a) Epilepsy 1 5 2 1 (b) Other 23 29 53 17 Psychological— (a) Development — — — – (b) Stability — — — – Other 80 112 823 190 Defects requiring treatment are directed to the appropriate agencies, viz.: pupils' own general practitioners, minor ailment clinics at the Health Centres, specialist clinics in the Health Centres or hospitals. 33 TABLE IV. Pupils found to require treatment. Number of individual pupils found at periodic medical inspection to require treatment (excluding dental disease and infestation with vermin). Group For defective vision (excluding squint) For any of the other conditions recorded in Table 14 Total individual pupils Entrants 38 343 381 2nd Age Group 53 151 204 3rd Age Group 112 119 231 Total (prescribed groups) 203 613 816 Grand Total 203 613 816 TABLE V. Treatment—Minor Ailments (excluding uncleanliness). Defects Number of Defects treated or under treatment 1948 1949 Skin 50 Ringworm—Scalp : (1) X-ray treatment — — (2) Other treatment Ringworm—Body 34 6 Scabies 148 15 Impetigo 67 28 Other Skin Diseases 500 289 Eye Disease— (External and other but excluding errors of refraction, squint and cases admitted to hospital) 220 84 Ear Defects— (Treatment of Serious disease of the ear, e.g. operative treatment in hospital should not be included) 263 141 Miscellaneous— (e.g. minor injuries, bruises, sores, chilblains, etc.) 895 283 Total 2,127 896 Total number of attendances at Minor Ailments Clinics 9,505 3,877 The number of attendances at Minor Ailment Clinics has dropped considerably since last year. This is a not unexpected (but possibly temporary) effect of the National Health Service Act which has provided children with free treatment by general practitioners. In those clinics much time is devoted to dealing with special cases, e.g. ascertainment of handicapped pupils, as distinct from medical treatment. 34 OPHTHALMIC SERVICE Mr. Freeman Heal, Consultant Ophthalmologist, continues to examine children with eye complaints. If spectacles are advised a prescription is issued to be dispensed by an optician of the patient's choice. There are signs that the delay in the supply of spectacles is being steadily shortened although it still is considerably longer than when they were supplied by the local authority. TABLE VI. Defective Vision and Squint (excluding those included in Table V). Number of Defects dealt with Errors of Refraction (including squint) 1,455 Other defect or disease of eyes 8 Total 1,463 Number of pupils for whom spectacles were prescribed 1,004 EAR, NOSE AND THROAT SERVICE Mr. Arthur Miller, Consultant Otologist, conducts special clinics at Mattock Lane and Ravenor Park Health Centres on alternate weeks. An intensive effort was made to clear the waiting list for removal of tonsils and adenoids. When the epidemic of poliomyelitis developed 322 operations had been performed and it was considered advisable to suspend treatment. When the risk of poliomyelitis had passed it was still impossible to resume tonsillectomy sessions because of the nursing shortage in Clayponds Hospital. The responsible body, South West Middlesex Hospital Management Committee, were unable to offer any alternative accommodation. ORTHOPAEDIC SERVICE TABLE VII. Clinic Number of new Cases umber of cases receiving Treatment Total Attendances Mattock Lane 104 45 355 Ravenor Park 103 63 260 Total 207 108 615 Mr. J. A. Cholmeley, Consultant Orthopaedic Surgeon, attends Mattock Lane and Ravenor Park Health Centres on alternate weeks. Six cases were admitted to hospital and the others (as shown above) received corrective treatment at clinics by the two physiotherapists. 35 DENTAL SERVICE There are 3 full-time dentists and one part-time orthodontist who works five sessions per week. A statistical summary of their work appears below. The orthodontic service commenced at Cherington House Health Centre on 13th September. By the end of the year 173 cases were receiving treatment. Radiography was carried out at North Road Clinic, Southall, until arrangements were made with Central Middlesex and Hillingdon County Hospitals. Owing to shortage of staff it was found impossible to maintain routine examination and treatment services at their previous high level. Thus only those in infants' departments of schools and those about to. leave school receive full conservative attention. In all cases of toothache and other acute or serious conditions priority treatment is given. TABLE VIII. Dental Inspections and Treatment. Age Groups (1) Number Inspected (2) Number found to require Treatment Age 5 630 209 6 1,026 411 7 1,090 434 8 1,117 416 9 1,085 481 10 1,118 466 11 1,231 542 12 1,488 662 13 1,537 773 14 1,271 653 15 529 295 16 and + 279 127 Specials 1,903 1,748 Total 14,304 7,217 Number of pupils commenced treatment 4,363 Number of attendances made for treatment 12,985 Number of half days devoted to— (a) Inspection 66 (b) Treatment 1,240 Total 1,306 Fillings ; Permanent Teeth 3,537 Temporary Teeth 1,369 Total 4,906 Extractions : Permanent Teeth 1,076 Temporary Teeth 6,746 Total 7,822 Administration of general anaesthetics for extractions 2,565 Other Operations : (a) Permanent Teeth 1,509 (b) Temporary Teeth 2,252 Total 3,761 36 TABLE IX. Special Treatment undertaken by the Dental Officers. School Dental Service. Orthodontic Treatment. Number of pupils commenced treatment 185 Number of attendances made for treatment 1,449 Number of Impressions taken, etc. 788 Number of fixed appliances fitted 33 Number of removable appliances fitted 128 Number of permanent teeth extracted for orthodontic purposes 378 TABLE X. Special Conservative Treatment. Number of Impressions taken, etc. 62 Number of Dentures fitted 44 Number of Crowns or Bridges 19 Number of Inlays 12 Speech Therapy. There are 1 full-time and 1 part-time speech therapists serving the Borough schools. 93 new patients were seen. Altogether 383 patients attended on 2,985 occasions for treatment. Employment of Children and Young Persons. 203 pupils were medically examined to determine if they were fit to be employed outside school hours. Only one child was found to be unfit. 12 pupils were examined and found to be fit to take part in entertainments. Education Act, 1944, Section 57(3) and 57(5). 12 cases were notified to the Education Committee as being ineducable and 7 mentally retarded children who had reached school-leaving age were considered to require continued supervision. Both categories were accordingly reported to the Mental Health Authority. Examination of Teachers. 80 teachers were medically examined on appointment to determine their physical fitness to perform their duties. Infestation with Vermin. Last year's new record for cleanliness has been beaten already. Out of 48,381 examinations only 455 cases were infested and in no instance was it found necessary to issue a compulsory cleansing order. 37 CHILD GUIDANCE REPORT Dr. P. Holman, psychiatrist, reports on the year's work of her section as follows : Cases referred and Waiting from 1948. 164 new cases were referred to the Child Guidance Centre during the year, and there were 99 cases from 1948, making 263 in all. Of these, 15 were withdrawn before investigation, 178 were dealt with in the course of a year, leaving a waiting list of 70. The number referred was, however, 97 less than in 1948, and it is disappointing not to have been able to make a bigger reduction in the waiting list and so lessen the time that each individual has to wait. The number of new cases seen (178) is 15 less than in 1948. This may not seem altogether satisfactory, but there are a number of factors to account for it. (1) In 1947 and 1948 we were under considerable pressure from the Educational Psychologist to see new cases, and consequently took on more work than it was possible for us to cope with satisfactorily. Consequently, many cases remain in 1949 in urgent need of further work and attention. (2) There was an increase in the number of cases taken on and in the amount of time devoted in the Clinic to treatment. It will be seen from Table I that 16 more cases were taken on for treatment in 1949 than in 1948. This number very much more than balances the reduction of 15 sent for diagnosis. Each "treatment case" it must be remembered consists of two people—mother and child —who attend for 20-30 interviews. Thus a small number of extra cases treated means a very big addition in the number of hours worked. (3) The physical limitations of space have now begun to be felt. It will be noted from Table Ia that each full time worker is conducting from 600-800 interviews a year and all members of the staff must use their rooms for many other purposes besides interviews. Moreover, rooms are not to any extent interchangeable—Play Therapy cannot be conducted in a Psychiatriatric Social Worker's room and Psychiatric Social Workers cannot interview an adult in a playroom. A room used by young children cannot very well be used by older ones. Consequently, the very limited accommodation at 70, Uxbridge Road is now a severe handicap to further development. 38 Changes in Staff. There were several changes in 1949. Miss Marven gave up full time work in April and to our regret, gave up her Ealing work altogether in July. Mrs. Charlotte Carey came to us as part time play therapist in June and Mrs. Lowe in August. In addition we had the service of Mrs. Louise Bruce, Psychiatric Social Worker for three sessions a week for seven months. The additional help thus provided has made it possible to clear up many of the arrears of previous years. In Tables II-VI is given the analysis of the new cases seen in 1949 in the same form as in previous years. There is no significant change either in the type of case or the age range. It is gratifying to note a distinct increase in the average Intelligence Quotient of those referred. It is also satisfactory to note a higher proportion of pre-school children. Our work can be preventive in the truest sense of the word with this age group and their treatment is usually dramatically effective in a short time. Conclusion. 1949 has been a year of consolidation of previous efforts rather than one of new developments. Circumstances are against any big advance in our work, the greatest limitation at present being that of space. PORTIA HOLMAN. TABLE I. Analysis of Work. Total number of cases referred to the Centre in 1949 164 263 Total number of cases brought forward from 1948 waiting list 99 — Total number of new cases dealt with by the Psychiatrist .. Boys 48 83 Girls 35 Cases withdrawn before investigation 15 Cases investigated by Psychiatric Social Worker and advised by her 95 263 Remaining on waiting list for interview at Centre 70 Analysis of New Cases seen at Centre. Total number of new cases seen by Psychiatrist 83 a. Diagnosis and advice 17 83 Special recommendations 22 Further hospital investigation 3 B. Treatment— (1) Psychiatrist 4 (2) Play Therapist 23 (3) Remedial Teaching 2 On waiting list for treatment in 1950 12 39 Analysis of All Treatment Cases. Number of cases carried over from 1948 39 89 „ „ taken on in 1949 29 Playgroup for under 5's 21 — Discharged, much improved 14 35 „ improved 12 Treatment broken off 9 — Number of cases current on December 31st, 1949 54 89 Special recommendation of old cases from 1948 7 TABLE la. DIVISION OF WORK. Psychiatrist. Interviews with parents 107 Diagnostic interviews 92 Treatment interviews 101 Interviews with others 16 School visits 9 Other visits 6 Psychologists. Miss Marven (4 months—full time, 3 months—4 sessions per week) Tests 53 Coaching interviews 100 Treatment interviews 286 Interviews with others 3 School visits 12 Miss Holt (5 sessions per week) Treatment interviews 386 Tests 7 Interviews with others 4 School visits 7 Dr. Carey (7 months—6 sessions per week) Treatment interviews 338 School visits 3 Mrs. Lowe (5 months—4 sessions per week) Tests 83 Treatment interviews 30 Psychiatric Social Workers (full time). Miss Game Mrs. Halmos Mrs. Bruce 7 months part-time (3 sessions per week) Interviews with parents 529 727 130 „ with others 15 24 3 Group interviews — 46 — School visits 14 14 4 Home visits 66 21 12 Other visits 14 12 — Clerk—full-time. Temporary Clerk—4 months. 40 TABLE II. TABLE OF SYMPTOMS (Including those for which the children were referred and others which were discovered at the diagnostic interview) 1. Nervous Disorders. Pears and anxiety 15 Solitariness and unsociability 6 Depression and lethargy 2 2. Habit Disorders. Enuresis 28 70 Sleep disorders 8 Habit spasms 2 Feeding difficulties 5 Epilepsy 1 Hysterical symptoms 9 Speech disorders 9 Asthma 4 Faecal incontinence 3 Migraine 1 3. Behaviour Disorders. Delinquency (including stealing and lying) 26 111 Difficult to manage at home 50 „ „ „ school 13 Aggression 3 Truancy and absconding 8 Sex difficulties 6 Temper tantrums 3 Bizarre symptoms—pre-psychotic? 2 4. Educational Difficulties. Backward 22 35 School failure 7 Advice on school placement 6 work — — 239 TABLE III. Home Conditions—53 Cases. Mother Father Dead 3 Dead 3 Very dull or defective — Delinquent 2 Psychotic or borderline 1 Psychotic or borderline 3 Chronically neurotic 5 Chronically neurotic 5 Stepmother Parents Psychotic — Divorced 9 Cruel 1 Separated 5 Child Pronounced marital disharmony 7 Illegitimate 1 Adopted 8 Care and Protection or Care of County 5 In a Home 2 41 TABLE IV. Analysis of Intelligence of 164 Children. 60-69 70-79 80-89 90-99 100-109 110-119 120-129 3 3 27 22 41 19 14 130-139 140-149 150-159 160-169 8 8 1 1 3—untestable. Untested—10 (under 5) 4 (withdrawn before investigation) Average I.Q.—106 — 14 TABLE V. Analysis of Ages of Children Referred. 1-2 2-3 3-4 4-5 5-6 6-7 7-8 8-9 9-10 10-11 11-12 — — 11 8 5 14 18 15 17 21 12 12-1J S 13-14 14-15 15-16 16-17 17-18 18-19 12 17 7 3 1 2 1 Total 164 Average age 9.1 years. Boys 106 Girls 58 21 pre-school, 92 primary, 33 secondary, 8 grammar, 8 private, 1 aged 15 plus TABLE VI. Special Recommendations—Children. Number recommended for schools or hostels for maladjusted children 24 Number recommended for— Ordinary boarding schools 5 Schools for educationally sub-normal children — Camp Schools 2 Change of Day School — Farm training — Care of County 3 School for Physically handicapped — Hospital in-patient treatment 2 36 42 SUPPLEMENT—FOR GENERAL INFORMATION. Health Services provided by the Local Health Authority. In Middlesex the Local Health Authority under the National Health Service Act is the Middlesex County Council. They have formed ten Areas in the county and delegated to them most of the functions for which they are responsible. Ealing and Acton form Area No. 7 and in Ealing the local administration is carried out at the Town Hall, Ealing. Maternity and Child Welfare Clinics. The following are the addresses of the Maternity and Child Welfare Clinics in Ealing : Ante-Natal Clinics. Address Times Cherington House, Cherington Road, Hanwell Mon., Tues., Wed., Fri., 10 a.m. Greenford Green, Wadham Gardens, Greenford Tues., Fri., 10 a.m. Islips Manor, Eastcote Lane, Northolt Mon., Thurs., 10 a.m. Mattock Lane, 13 Mattock Lane, Ealing Mon., Wed., Thurs., Fri, 10 a.m. Perivale, Horsenden Lane, Greenford Tues., Thurs., 10 a.m. Ravenor Park, Oldfield Lane, Greenford Mon., Wed., Fri., 10 a.m. Child Welfare Clinics. Cherington House, Cherington Road, Hanwell Mon., Tues., Thurs., Fri., 2-4 p.m. Greenford Green, Wadham Gardens, Greenford Tues., Fri., 2-4 p.m. Islips Manor, Eastcote Lane, Northolt Mon., Thurs., 2-4 p.m. Mattock Lane, 13 Mattock Lane, Ealing Mon., Wed., Thurs., Fri., 2-4 p.m. Perivale, Horsenden Lane, Greenford Mon., Thurs., 2-4 p.m. Ravenor Park, Oldfield Lane, Greenford Mon., Tues., Wed., Thurs., Fri., 2-4 p.m. Kingshill Community Centre, Northolt Tues., 2-4 p.m. St. Mary's Church Hall, West Twyford Tues., 2-4 p.m. St. Christopher's Church Hall, Bordars Road, Hanwell, W.7 Thurs., 2-4 p.m. 43 Domiciliary Midwifery Service. An expectant mother can obtain the services of a "general practitioner obstetrician" for her confinement in her own home. As an alternative she can obtain the services of a County Council midwife who will attend her in the home either as a midwife, delivering the child herself, or as a maternity nurse when the mother is arranging for her doctor to attend the confinement. If the services of one of these midwives is needed, application should be made through the Maternity and Child Welfare Clinic. Home Nursing Service. Free nursing service in the home to cover all types of sickness is now available for everyone for as long as it is necessary. There are a number of nurses in the Area whose services are made available at the request of the medical practitioner and they work under his instruction. Further details regarding this service can be obtained from the Area Medical Officer, Town Hall, Ealing. Home Help Service. In addition to the arrangements made to provide domestic help during confinement at home domestic help is also provided in other cases of emergency such as sickness, aged people in need of help, cases of tuberculosis and sickness in the home where there are very young children. Applicants needing Domestic Help should apply to the Area Health Office, Town Hall, Ealing. A charge of 2/6 per hour is made for this service, although this may be reduced in case of hardship. Day Nurseries. There are seven Day Nurseries in the Ealing portion of the area for the care of children under five years of age. Admission is restricted as a general rule to children whose mothers are at work, although in exceptional circumstances a child can be admitted during the mother's illness or other emergency. The nurseries are open from 7.30 to 6 p.m., and the charge for admission is 2s. per day.