EAL 45 The Health of ealing in the year 1954 EAL 45 the haelth of Ealing in the year 1954 being the ANNUAL REPORT of the Medical Officer of Health and School Medical Officer WILLIAM G. BOOTH, M.D., B.S., D.P.H., Medical Officer of Health. INDEX Page Section 1.—INFECTIOUS DISEASES 6 Section- 2.—SANITARY CIRCUMSTANCES OF THE BOROUGH 17 Section 3.—SANITARY INSPECTION. 21 Section 4.—GENERAL. 31 Section 5.—STATISTICAL TABLES 38 Section (3.—APPENDIX: REPORT OF THE SCHOOL MEDICAL OFFICER 43 Supplement. 4 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) H. Binysh (resigned, February) Deputy Medical Officer m.d., b.s., d.p.h., d.t.m. & h. G. M. Gorrie, (appointed September) „ „ ,, m.b., ch.b., d.p.h. G. T. H. BlackiE Chief Sanitary Inspector E. Belfield Deputy Chief Sanitary Inspector E. H. Evans Sanitary Inspector C. W. Baxter „ „ E. W. Budd „ „ A. E. Pooley „ „ G. O. Axon „ „ A. C. Bamping „ „ D. J. Anderton „ „ D. G. Martin „ „ Harry M. Birrell Chief Administrative Assistant R. S. Leggatt Senior Clerk R. Angell Clerk D. R. A. Smith „ J. T. Woolford (resigned October) „ Miss d. e. McKenzie Shorthand-Typist Mrs. M. G. Byford „ „ Mrs. D. Barker Clerk and Typist R. S. Cox Rodent Operative BOROUGH OF EALING WITH THE COMPLIMENTS of THE MEDICAL OFFICER OF HEALTH TOWN HALL, EALING, W.5 5 Madam Mayor, Aldermen and Councillors, The year 1954 was fortunately free from major epidemics, and the post war trend in health statistics has continued. The many years of health education given through the agency of health visitors, school doctors and the health department are having their effect. The child of today is benefiting by the great increase in knowledge that has taken place during the last 50 years in the needs both mental and physical of children whom we hope to bring to their optimum development. This is unspectacular work but the patient persistence of those working in the field is showing results, and they can be seen through the pages of this report. Ealing is not alone in this progress but as Medical Officer of Health I am well satisfied that Ealing has derived its full share of the benefits. Apart from Poliomyelitis, whose conquest is only a matter of a few years, there is 110 major infectious disease to give us cause for concern. Future development lies in the close integration of the services of the sanitary authority in the hands of the efficient and reliable sanitary inspectors—whom we should of course be calling health officers since their functions are now so much more educational than penal in character- the health visitors, the district nurses, midwives and other local officers of the local health authority and the general practitioners who are essentially the backbone of any real health service in any community. The welding of these officers into a domiciliary health service unit should be the next step in the evolution of a real health service. Unfortunately as the pages of this report will show we are at present split into at least three administrative units for one service and the outlook for integration seems none too bright. In view of the effect upon the health of the children of the Borough of the services transferred to the County Council since 1948 a supplemental report is given to outline the special points of interest in connection with these services in Ealing. In view of the fusions of Ealing with Acton it is not easy to isolate them as Ealing material, but we have done our best to present the matter in an interesting form. The material in the body of the report speaks for itself and it must be very clear that an enormous amount of conscientious work has been carried out by your officers during the year. May I take this opportunity of expressing publicly my own appreciation of the good work done by them and express the hope that they will find their service with the Ealing Council congenial, stimulating and equally appreciated. I beg to remain, Your obedient servant, W. G. BOOTH, Medical Officer of Health. 6 SECTION 1. INFECTIOUS DISEASES The term infectious diseases is given to those diseases which are most readily transmissible from one human being to another and from an animal to a human being. They can be transmitted from one person to another so easily and quickly that in a very short space of time a large number of individuals may become infected so giving rise to an epidemic. Notification is the essential peliminary to control of infectious disease and as more and more has become known about each transmissible infectious disease so has it been made notifiable. The diseases notifiable under the Public Health Act, 1936, are smallpox, cholera, diphtheria, membraneous croup, erysipelas, scarlet fever, typhus, typhoid, enteric and relapsing fever. The Minister of Health has also made regulations whereby the following diseases are also notifiable : plague, poliomyelitis, tuberculosis, puerperal pyrexia, ophthalmia neonatorum, malaria, dysentery, acute primary pneumonia, acute influenzal pneumonia, measles, whooping cough, acute encephalitis and meningococcal infection. Food poisoning is notifiable under the provisions of the Food and Drugs Act of 1938. Early Diagnosis. Since these diseases are as a rule most infective in the early stages the importance of early diagnosis in the prevention of spread of disease cannot be over emphasised. It is important therefore that parents should be able to recognise the early signs of the common infectious diseases. As part of the health education campaign, topical leaflets are distributed through the Town Hall and the Public Libraries when any infectious disease is prevalent. Leaflets describing the essential points of home nursing of persons suffering from infections, and advice as to disinfection are provided when necessary. Hospitalization. Persons suffering from certain severe infectious conditions may need hospital care and can be admitted to Neasden Isolation Hospital or to South Middlesex Hospital, Mogden. 7 Laboratory Service. It is true to say that improved laboratory technique has played a major part in the early diagnosis and prevention of infectious disease and we in Ealing have a laboratory at King Edward Memorial Hospital which has given great assistance. The Public Health Department will arrange for the collection of specimens, e.g. faeces and samples of suspected food or vomited material, and for transmission to the King Edward Memorial Hospital laboratory at the request of a general practitioner. Certification. International certificates of inoculation and vaccination must be authenticated by the local health officer, and certificates are also regularly given as to the purity and condition of manufacture of certain medicaments manufactured in the Borough and intended for export. When contacts of infectious persons are excluded from work 011 account of potential risk to others, a certificate is provided to ensure the payment of benefits under the National Insurance Act. Disinfection. With regard to the disinfection of library books, recent investigations carried out in this connection indicate merely keeping them for three weeks out of circulation is sufficient to kill any germs and render the books safe. In Haling an additional precaution is taken in that the books are stored in a formalin box for the above mentioned three weeks. Diphtheria. The first case of Diphtheria to be notified in the Borough of Ealing since 1951, when there were two notifications, occurred in February in an adult male. Although no organism was isolated he was diagnosed as a case of Diphtheria on clinical evidence. One or two sporadic cases like this appears to be the experience of other areas throughout England and Wales and it is of interest to note that the Ministry of Health have written to Local Health Authorities asking for detailed information about their specific cases, in an endeavour to add to the knowledge of the epidemiology of the disease. Dysentery. There were 225 cases notified and in 163 Shigella Sonnei was isolated which showed a marked increase in the figures for 1952, which were 132 cases notified in 73 of which the Sonne organism was discovered. 8 This increase in notification of dysentery is general throughout the country and can be attributed to more complete notification due to improvements which have been made in the pathological laboratory services. There were no major outbreaks and all the cases were individual or involved two or three members of a family. As in previous years this was a very mild type of enteritis but such a type can rapidly assume epidemic form and cause much concern among parents, as children are mainly affected. To prevent such outbreaks the practice of hand hygiene by all concerned is essential and even mild cases of diarrhoea should be reported. Enteric Fever. One case of Typhoid Fever occurred in a Polish girl student aged 24 years. The case was admitted to Neasden Hospital, the only symptoms being a high temperature, and was there diagnosed as Typhoid Fever. Enquiries failed to trace the source of the infection. Four cases of para-typhoid were notified and in three the diagnosis was confirmed. One was a woman of 25 years who gave birth to a child in Perivale Maternity Hospital. Symptoms of high temperature and diarrhoea followed and a rectal swab showed Para Typhoid B. She was then transferred to Neasden Isolation Hospital. The other two cases, a boy of 6 years and a girl of 15 years were diagnosed in hospital. Again no trace of the origin of the infection was found. Enteric Fever Carrier. There remains the one carrier as before, and she is still kept under surveillance. Erysipelas. 18 cases were notified, the same number as in the previous year. One of these cases was subsequently diagnosed as allergic dermatitis. Food Poisoning. Of the 78 cases notified 15 were confirmed by laborarory diagnosis. 9 These comprised 12 Salmonella Typhimurium, and one each of the Salmonella Enteriditis, Salmonella Senftenberg and Salmonella Aberdeen. On one occasion 45 employees using the canteen of a well known firm in the Borough complained to their Staff Nurse of having symptoms of diarrhoea and vomiting, and this illustrates well the procedure and conscientious work of the Sanitary Inspectors in the investigation of a Food Poisoning outbreak. Within an hour of the Canteen Manageress informing us a Sanitary Inspector visited the firm and took full details—number of cases involved, with names and addresses, departments in which they worked, times of meals in the canteen and what they consisted of and the time of onset of symptoms and the severity in each case. This information was examined and pinpointed two trays of particular food at one lunch time sitting as being the cause. The next day the Medical Officer of Health visited the firm with the Sanitary Inspector and full particulars were taken concerning the reception, storage, preparation and cooking of the dish concerned. As so often happens there was none of the suspected food left over and 15 specimens of faeces from the patients and canteen staff proved negative. However, the canteen management were co-operative and helpful and night and morning samples were taken daily for 10 days of certain stews, sauces, soups and stockpots and were sent for examination to the local pathological laboratory. Scrapings from containers were also examined for the presence of pathogenic bacteria and samples sent to the Public Analyst for detection of inorganic poisons. All this involved twice daily visiting for a period of two weeks. Although no cause was found there is good reason to hope that the excellent work done by the staff of the Chief Sanitary Inspector, with the willing co-operation of the firm concerned, and the Public Health Laboratory, will prove of inestimable value, in future investigation into outbreaks of possible Food Poisoning. The outbreak was brought under control within a few days of its appearance. Malaria. There was one case of Malaria, a man of 37 years who had recently returned from the Gold Coast. He was admitted to the Hospital for Tropical Diseases. Measles. The incidence of this disease dropped to 132 notifications in 1954 from 2,568 in 1953. 10 Although this large drop would at first glance appear to be eminently satisfactory, it is wise at all times to bear in mind the behaviour pattern of this infectious disease. It is true that in some areas regular annual epidemics occur but more often measles epidemics occur biennially with a relatively small number of cases occurring in the intervening years and this would appear to be what occurs in the Borough of Ealing. This behaviour is due to the fact that after an epidemic temporary immunity has been given to the large number of children affected leaving few susceptibles to be attacked the following year. By the second year, however, immunity has waned and consequently a large number of susceptibles are present in the population. The disease met with nowadays is of a milder type than heretofore and this coupled with better health and increased resistance of children plus the use of antibiotics in preventing secondary infection has put an end to the killing power of measles. Ophthalmia Neonatorum. Two notifications were received. One was removed to hospital, both completely recovered. Pneumonia. 204 notifications were received, slightly less than in the previous year. 54 deaths occurred in the following age groups : Acute Anterior Poliomyelitis and Polioencephalitis. There were three confirmed cases of poliomyelitis, two paralytic, one a man aged 42 and the other a woman aged 28. The non-paralytic case was a boy of 12 years. The one case of polioencephalitis occurred in a man of 41 years of age who was admitted to the Central Middlesex Hospital and died there the same day. One death, attributed to acute anterior poliomyelitis was transferred to the Borough of Ealing, the place of residence of the deceased. The death occurred in a girl of 14 years of age after an operation necessitated by anterior poliomyelitis. Puerperal Pyrexia. 54 notifications were received, 47 of these were from Perivale Maternity Hospital and 7 from private practitioners. This showed a slight decrease from 1953. 5 — 14 years 15 — 44 years 45 — 64 years 65 and over 1 3 16 34 11 Scarlet Fever. There was an increase on the previous year, 287 notifications compared with 238 in the previous year. It is still of the very mild type. Smallpox. Three persons who may have been contacts of cases which occurred in the The Hague area came to Ealing. They were kept under uneventful surveillance. Tuberculosis. The number of cases notified this year was 132 compared with 205 in the previous year. This is truly dramatic, representing a drop of no less than 36% on last year's notifications. The number of deaths dropped from 29 in 1953 to 20 this year and though these figures, being small, may not look so impressive, the acceleration in the fall of deaths from tuberculosis has been maintained, the present number showing a drop of 32% compared with 1953—almost as big as the drop in notifications. The following table shows the age and sex of the cases notified and the deaths in 1954. 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 Under 5 3 1 2 – 5—14 1 2 – 2 15—24 13 24 1 2 25—44 23 26 1 4 3 2 45—64 23 11 1 3 5 3 – 1 Over 65 3 2 – 1 4 2 Total 66 66 5 12 12 7 – 1 The number of new cases of Pulmonary Tuberculosis notified was 132, compared with 205 in the previous year, while the number of cases of Non-Pulmonary Tuberculosis was 17 compared with 20 in the previous year. There was a total of 20 deaths, (19 Pulmonary, 1 Non-Pulmonary) compared with 28 Pulmonary, 1 Non-Pulmonary in the previous year. Graph to show the trend of notifications of tuberculosis since 1944, and of deaths from tuberculosis. Notifications of tuberculosis (all forms) are shown, and deaths from tuberculosis (all forms) are shown, Both notifications and deaths are shown per 1,000 population. 13 Graph showing the deaths from tuberculosis per 1,000 total population for the years 1945-1954 inclusive as a percentage of the deaths per 1,000 population in 1944. 14 Deaths from Tuberculosis for the Years 1944-1954 inclusive. Year Respiratory Other Forms Total (a) 1944 66 5 71 (b) 1945 64 6 70 (c) 1946 78 15 93 (d) 1947 59 11 70 (e) 1948 61 5 66 (f) 1949 70 6 76 (g) 1950 48 6 54 (h) 1951 30 4 34 (i) 1952 37 3 40 (j) 1953 28 1 29 \k) 1954 19 1 20 Percentage decline in (k) From (a) 71% 80% 72% From (j) 32% –% 31% Mortality from Tuberculosis in the Borough of Ealing has fallen by 60% in the last ten years and by 27.5% since 1952. This last figure is exceptional but otherwise these figures are comparable with those for England and Wales as a whole. There can be little doubt that these significant falls can be attributed to the pasteurization of milk and partly to the fall in the number of deaths from respiratory tuberculosis may be due principally to the remarkable effect of the antibiotic and in a lesser measure to the great advances made in the technique of chest surgery and the management of tuberculosis patients. With regard to notifications of respiratory tuberculosis, whereas it is almost impossible to compare the years before the end of the war with the post war years—because of improved case finding due to Mass Miniature Radiography, Patch testing of children and the attitude of the public towards the disease—there can be no doubt that the fall in notification in the past two to three years is a real one. Because of the important part played by patch testing in this reduction I feel that it would not be out of place here to explain the rationale of this procedure. In the case of Tuberculosis it is extremely important to distinguish between infection and disease. Infection occurs when the body had been invaded by the causitive organism of the disease but where the organism does not settle in the body and consequent upon its initial invasion leaves behind a resistance and immunity. Disease occurs when the causitive organism settles in the body and multiplies producing clinical or X-ray evidence of this successful settlement. In a population in which the tubercle bacillus has been circulating freely a large proportion of the adult population will have been infected before or during adolescence but here will be a relatively small proportion with active disease. It has been estimated that by the age of about 20 years, 60—70% of children have been exposed to infection as shown by a positive patch test. 15 The majority of these early exposures to infection regain health without active treatment leaving the person thus exposed with a certain amount of resistance and immunity to the disease. By the age of 20 years countless contacts have been made and it would be impossible to trace the source of infection. However, in the case of very young children showing a positive reaction their contacts have been few and it is necessary to examine only close family contacts. In this way many cases of hitherto unsuspected early tuberculosis cases have been detected. Routine tuberculin jelly testing has been carried out on children from the age of 2 years onwards at the Child Welfare Clinics for the last few years. Every child in the Borough receives a birthday greeting card and is invited to attend the local Clinic for medical check up. At this examination the test is performed with the consent of the parent after its purpose has been explained. A positive reaction is not a cause for alarm. As has already been explained it indicates that the child has had or is having his primary infection at an early age and such children are kept under closer observation, and other members of the household are X-rayed for a possibly unsuspected source of infection in the home. During 1954, 1,811 children in Ealing were tested and 40 were positive (2.2%). 27 of the positive reactors were seen and at the Chest Clinic were found to have negative X-rays and were discharged Nine others were kept under observation at the Clinic. Information is lacking on the remaining four as they had left the district. Tuberculin testing is also carried out on children in the Ealing Day Nurseries on admission and subsequently at 6 monthly intervals. 93 children were tested on admission and were found to be negative and 130 children were re-tested of which 2 were found to be positive and were referred to the Chest Clinic. Whooping Cough. The incidence of this disease fluctuates from year to year. There were 116 notifications during 1954 as against 491 in 1953. There are periodic cycles of occurrences, usually in alternate years and this may be because the children who escape infection probably develop a temporary latent immunity These number twice as many as are attacked. This immunity is, however, short lived, probably of one year's duration and at the end of this time the immunity has waned The accumulation of susceptibles thus produced leads to an epidemic The incubation period of whooping cough is usually seven days with rare cases observed up to 21 days The initial catarrhal stage is very infective. 16 The disease is spread usually by intimate contact rather than more casual contact and is associated with institutions and crowded environments Within a family the chances are higher of the non-immunes getting whooping cough It is mainly contracted in infancy and childhood, and the incidence is greater among females The campaign for immunization against whooping cough, using pertussis diphtheria vaccine, which was started in the autumn of 1947 has been intensively pursued. At the Child Welfare Clinics 1,530 children were given primary immunization by means of the combined vaccine and 31 by means of Whooping Cough vaccine alone while the number of children immunised by General Practitioners was 757. 1,686 reinforcing doses were given at the clinics and 231 by general practitioners Many people who are complacent about Diphtheria, still have a wholesome fear of whooping cough and wish to have their children immunised against it. They have no objection to the use of the combined vaccine and in this way the percentage of children immunised against Diphtheria is kept at a satisfactory level. 17 SECTION 2. SANITARY CIRCUMSTANCES OF THE BOROUGH Water. There are three sources of supply in the Borough. The Greenford North, Greenford South and Perivale Wards are supplied by the Rickmansworth & Uxbridge Valley Water Company, with the exception of five roads in the Perivale Ward which are served by the Colne Valley Water Company, The remainder of the Borough is supplied by the Metropolitan Water Board. These supplies are not subject to plumbo-solvent action and have been satisfactory both in quantity and quality. Water from public mains is supplied to 52.276 houses with an estimated population of 185,000. Twelve samples were taken from wells at six factories in the Borough using water from deep borings ranging in depth from 300 to 600 feet. The analysis of these samples showed the supplies were wholesome in character. Drainage and Sewerage. One house which was drained to a cesspool was demolished during the year leaving 25 permanent houses in the Borough not connected to the Council's sewers. The majority of these are in the outlying areas and there is no immediate prospect of their being drained to the Council's sewerage system until these areas have been further developed. Rivers and Streams. Pollution of the River Brent. The extensive work entailed in tracing and remedying sources of pollution in the River Brent has continued during the year. Although the River is polluted before entering the Borough, samples taken by the County Engineers Department have indicated added pollution from outfalls into the River serving the industrial area in the North Circular Road district and the industrial and residential areas of Perivale and North and South Hanwell. Ihe following table gives some figures which indicate the extent of the work involved : Investigations into Pollution of River Brent (To 31st December, 1954) No. of inspections 474 No. of tests applied 213 No. of samples taken (1) By County Engineer's Dept. 20 (a) Satisfactory 11 (b) Unsatisfactory 9 (2) By Sanitary Inspector 27 (a) Satisfactory 11 (b) Unsatisfactory 16 18 No. of drainage defects found (a) In factories 59 (b) In houses 61 No, of drainage defects remedied (a) In factories 55 (b) In houses 52 The latest reports from the County Council on the analysis of samples taken from the River have indicated an improvement in the North Circular Road and Perivale areas, but much remains to be done and the work is proceeding. Atmospheric Pollution. One hundred and eighty seven smoke observations were made by the Sanitary Inspectors during the year. In two cases representations were made regarding : (1) the emission of grit and sooty particles in such quantities as to be a nuisance, and (2) the emission of smoke in such quantities as to be a nuisance. In the first case, a special type of grit arrestor was inserted into the boiler smoke stack and the results were successful in preventing further nuisance. In the second case, after the service of a Statutory Notice, several modifications to the boiler plant were carried out and these included the installation of a patent improved secondary air device and the proper operation of this equipment together with frequent visits to educate the staff in its use, has proved successful. Further complaints regarding the emission of grit and dust from a factory in the Long Drive area of Greenford were received during the year. Upon the instructions of the Public Health Committee an atmospheric pollution gauge was erected in the area and the contents analysed at monthly intervals over a period of three months. The Analyst's reports were considered by the Public Health Committee and a further approach was made to the firm concerned regarding the fitting of grit arrestors to the cupola stacks serving the foundry. The work was commenced towards the end of 1954 and was completed early in 1955. It is hoped that the steps taken will be effective in preventing further annoyance to residents in this area. Moveable Dwellings. Although the nuisances arising from the caravan problem in the Northolt area have lessened during the year trouble is still being experienced by the residents in properties adjoining the Council's Lime Trees Estate at Northolt, through nuisances and annoyances caused by the dwellers in these caravans. Notwithstanding the periodical removal by force of caravans from this land they return within a short period, necessitating the repeated instigation of the 19 procedure for forcible removal. Towards the end of the year, it being realised that other measures would have to be taken if the problem was to be overcome, it was decided after consultation with the Town Clerk and the Borough Surveyor to re-commence the institution of legal proceedings against caravan dwellers creating nuisance in the Borough. It was proposed to serve Statutory Notices upon the occupiers of the caravans and if these were not complied with to apply to the Magistrates' Court for Orders prohibiting the caravans dwellers from occupying various sites in the Borough. In the event of these Orders (if obtained) not being complied with, proceedings would be instituted for penalties in the hope that the penalties would be sufficiently severe to deter the caravan dwellers from re-entering the Borough. This policy was commenced at the end of 1954 and it is early as yet to say whether or not it will be effective. The number of caravans in the Borough has been reduced in recent years and I am hopeful that the policy which we have now adopted together with the development of vacant land in the area will have the effect of eliminating nuisances from caravans in this Borough. FOOD HYGIENE During 1954, 48 lectures were given to food handlers, of whom 178 received Certificates upon completing the course. Since the scheme commenced five years ago, 322 lectures have been given to food handlers and 1,449 persons have received Certificates of Attendance. The number of Certificates of Food Hygiene awarded during the year to food establishments increased by 4 to a total of 60. One Certificate was withdrawn owing to a change of ownership of the business. During 1954, 2,355 inspections of food premises were made by the Sanitary Inspectors and 368 repairs and improvements were carried out. Twenty-six talks on Food Hygiene by the Sanitary Inspectors to school-leavers in the secondary grammar and secondary modern schools in the Borough were given during the year to approximately 1,000 school-children. The film strip on "Food Infections" made by the Council has achieved considerable success, no less than 70 copies having been sold to various Local Authorities and Food firms throughout the Country, and to Government Departments in New Zealand, South Africa, Burma, Sweden and Newfoundland. It is to be hoped that some government lead will be given in the near future to the encouragement of Food Hygiene lecture schemes on the lines of the lialing scheme. It will never be possible to obtain really satisfactory Food Hygiene procedure from all 20 food trade employees until they are compelled by law to attend some instruction in what is now well recognised as a potential danger to public health. The food trades would probably welcome a scheme which was compulsory upon all food handlers as the present voluntary scheme is only practicable in selected areas. It is needed everywhere. BATHS AND SWIMMING POOLS The Council's swimming baths are equipped with pressure filters for continuous filtration and the water is treated with chlorine under strict supervision. Tests for the efficiency of chlorination are taken daily. There are three privately owned swimming pools in the Borough, one of which is not used at present. Chlorine treatment is carried out at each of the swimming pools in use. PUBLIC MORTUARY The arrangement with the Acton Council for the use of the Acton Mortuary was continued during the year. 212 bodies were taken to this Mortuary and post-mortem examinations were carried out in every case. The need for arrangements for the provision of mortuary accommodation to be made in Ealing is constantly before the Public Health Committee who are endeavouring to find a satisfactory scheme. 21 SECTION 3 SANITARY INSPECTION THE WORK OF THE SANITARY INSPECTORS IN 1954 I append a report to the Medical Officer of Health by the Chief Sanitary Inspector giving details of the work of the Sanitary Inspectors during the year ; Public Hfialth Act 1936 Inspections. Premises inspected on complaint 2,448 Other nuisances observed by Inspectors 93 Premises inspected in connection with infectious disease 713 Smoke observations 187 Houses without water supply 54 Inspections of moveable dwellings 412 Other inspections 2,867 Re-inspections 9,493 Intimation Notices served 1,481 Statutory Notices served 316 Letters written 1,799 Proceedings before magistrates 18 Legal Proceedings. Public Health Act 1936, Section 93. Non-compliance with Statutory Notices. In 13 cases legal proceedings were taken to enforce compliance with Notices requiring the abatement of nuisances. In 12 of these Orders were made by the Magistrates for the necessary work to be carried out within a stated period and costs amounting to £10. 10. 0d. were awarded. In one case, the hearing was adjourned and the summons later withdrawn as the work was completed. One case was taken against the owner of a property for non-compliance with a Nuisance Order made by the Court and a penalty of £2 was inposed with £1. 1. 0d. costs. Three cases were taken against caravan owners in respect of non-compliance with Abatement Notices. In one of these cases an Order was made by the Magistrates for the caravan to be removed and in the other two cases the summonses were withdrawn as the caravans had left the district. In 12 cases, summonses were issued but withdrawn before the hearings as the necessary work had been completed. Public Health Act 1936, Section 39. The owner of one property upon whom a Notice had been served to execute drainage works, appealed against the Notice to the Ealing Magistrates' Court. The appeal was disallowed by the Magistrates. 22 Food and Drugs Act 1938. Food and Drugs (Milk, Dairies and Artificial Cream) Act, 1950 Milk and Dairies Regulations, 1949, Etc. Complaints received50 Inspections of Milk Purveyors'Premises 146 Contraventions of Regulations — Inspections of Ice Cream Premises 545 Food Inspections 779 Inspections of Food Premises 2,355 Contraventions found 165 Notices served 142 Unsound food cases reported to the Public Health Committee 6 Proceedings before Magistrates — Samples of Milk taken 51 Samples of Ice Cream taken 57 Samples of Synthetic Cream taken 65 Samples of other foods taken 30 List of Food Premises in the Borough of Ealing. Bakehouses 33 Bakers' shops 66 Butchers 122 Cafes and Restaurants 168 Canteens—factory 78 Canteens—school 22 Confectioners 239 Dairies and Milk Sellers 67 Fish Fryers 23 Fishmongers 3 Greengrocers 161 Grocers 330 Ice Cream Manufacturers 6 Public Houses 61 Premises registered for the preparation or manufacture of sausages or potted, pressed, pickled or preserved food 99 Premises registered for the sale of Ice Cream 338 Milk Supply. There are 82 registered distributors of milk in the Borough. During the year licences for the sale of milk under the Milk (Special Designation) Regulations were granted as follows :— Dealer's Licences Supplementary Licences Total Tuberculin Tested Milk 49 15 64 Pasteurised Milk 53 17 70 Sterilised Milk 58 17 75 23 Under the provisions of the Milk (Special Designations) (Specified Area) Order 1951, all milk sold by retail in the Borough must be " designated milk," i.e., Tuberculin Tested, Pasteurised or Sterilised Milk. 51 samples of milk were taken and submitted to the Methylene Blue and Phosphatase Tests at the Public Health Laboratory, Ealing. The results were as follows : Designation Samples Phosphatase Methylene Blue Passed Failed Passed Failed Pasteurised 51 48 3 50 1 Subsequent samples were taken from the suppliers of the samples which failed the Phosphatase and Methylene Blue Tests and these proved sartisfactory. In addition, 206 samples of Pasteurised Milk from processing plants in the Borough were taken by the Officers of the County Council who are the licensing authority under the Milk (Special Designations) Regulations. Ice Cream. There are 338 premises in the Borough registered for the sale of ice cream. It was found that their ice cream is obtained from six registered manufacturers in the Borough or from 11 manufacturers outside the Borough. Samples from each of these 17 manufacturers were taken once or more during the year, a total of 57 samples of ice cream, ice cream constituents and ice lollies being submitted for bacteriological examination. The results were as follows : Commodity Grade Samples 1 2 3 4 Not Graded Ice Cream— Local Manufacture 23 18 3 2 - - Ice Cream— Other Manuf acturers 30 27 1 - 2 Ice Lollies 4 — — — 4 57 45 3 3 - 6 2 of these samples were reported to be unsatisfactory—both from local manufacturers. These samples were followed up, by investigation at the producer's plant in the Borough. 24 Synthetic Cream. 62 samples of synthetic cream were taken from local manufacturers, and 3 from manufacturers outside the Borough. 3 of the local samples were found to be unsatisfactory, subsequent samples taken proved to be satisfactory. Inspection of 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 : lbs. Apples 119 Bacon 67½ Beef 3360½ Biscuits 9897 Butter 27¾ Cake 38 Cheese 144¾ Chicken 3 Chocolate 4274 Cocoa Powder l½ Corned Beef 179¼ Cream Powder 7 Currants 56 Dried Milk 699 Fish 490½ Flour 82 Fondant 55 Ham 128¼ Hearts 25 Jelly 6½ Kidney 28 Lamb 202 Lard 13 Liver 185¾ Luncheon Meat 42¼ Margarine 11½ Nuts 449½ Oatmeal 44 Offal 12 Peas 576 Peel 14 Pork 165¼ Potatoes 420 Prunes 120 Rabbit 60 Rice 96 Sausages 97 Soup Powder 32 25  lbs. Sprouts 182 Steak 40 Sugar 14 Sultanas 36 Tea ½ Tongue 20½ Turkey 95 Veal 6 Foodstuffs not calculated by weight. Calves Heads 10 Chocolate Bars 7 Eggs 542 Fish Cakes 311 Wafers 28 Assorted tins, jars, packets, bottles etc. 9252 Slaughterhouses. One slaughterhouse was licensed during the year. Middlesex County Council Act, 1950, Section 11. Under this Section 10 persons were registered during the year for the sale of food from carts, barrows, other vehicles, etc. There are now 28 persons registered under this Section for the sale of food in this Borough. Housing Statistics. 1. Inspection of dwelling-houses during the year : (1) Total number of dwelling-houses inspected for housing defects (under Public Health or Housing Acts) 2,493 (2) Number of dwelling-houses (included under sub-head (1) above) which were inspected and recorded under the Housing Act, 1936 4 (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 (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 1,674 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 1,539 3. Action under Statutory Powers during the year : A.—Proceedings under Sections 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 Local Authority in default of owners — 26 B.—Proceedings under Public Health Act : (1) Number of dwelling-houses in respect of which notices were served requiring defects to be remedied 260 (2) Number of dwelling-houses in which defects were remedied after service of formal notice : (а) by Owners 221 (b) by Local Authority in default of owner— 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 1 (2) Number of dwelling-houses demolished in pursuance of Demolition Orders 3 (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 1 (2) Number of separate tenements or underground rooms in respect of which Closing Orders were determined, the tenement or room having been rendered fit 1 Of the four houses reported as unfit for human habitation during the year, one was the subject of a Demolition Order and the house has now been vacated and demolished and three related to basement dwellings. In respect of the first of these, a Closing Order was made by the Council and the basement has now been vacated ; in the second case Closing Order procedure was not commenced until 1955 and in the third case, the owner elected to carry out the necessary work to render the basement fit for human habitation and this work is in hand. Two houses which were the subject of Demolition Orders four years ago were demolished during the year. One basement dwelling which was the subject of a Closing Order was rendered fit and the Closing Order determined by the Council. Housing Repairs and Rents Act 1954. This Act became operative on the 30th August 1954, and by the end of the year 59 applications for Certificates of Disrepair and one application for a Certificate of Disrepair to be revoked had been granted by the Council. In order to comply with the provisions of Section 1 of the Act, a preliminary survey of the unfit houses in the Borough was commenced towards the end of the year for the purpose of arriving at the estimatde number of houses in the Borough which are liable to demolition. 27 New Dwellings, 1954-1955. Completion figures supplied by the Borough Surveyor for the 12 months period ending March 31st, 1955 : Flats (2 bedrooms) 166 Houses (1 bedroom) 14 Houses (2 bedrooms) 19 Houses (3 bedrooms) 290 Factories Acts, 1937 and 1948. Part 1 of the Act. 1. Inspections for the purposes of provisions as to health (including inspections made by the Sanitary Inspectors) : Premises Number on Register Number of Inspections Written Notices . Occupiers prosecuted (i) Factories in which Sections 1, 2, 3, 4, and 6 are to be enforced by Local Authorities 83 35 1 - (ii) Factories not included in (i) in which Section 7 is enforced by the Local Authority 448 514 25 (iii) Other Premises in which Section 7 is enforced by the Local Authority (excluding out-workers' premises) - - - - Total 531 549 26 — 2. Cases in which defects were found : Particulars Number of cases in which defects were found Number of cases in which prosecutions were instituted . Found Remedied Referred To H.M. Inspect'r By H.M. Inspect'r Want of cleanliness 3 3 2 Overcrowding — — — — - Unreasonable temperature - - - - Inadequate ventilation 1 1 — 1 - Ineffective drainage of floors - - - - Sanitary Conveniences : (a) Insufficient 1 2 - 1 - (6) Unsuitable or defective 21 29 - 5 - (c) Not separate for sexes 4 4 - 3 - Other offences against the Act (not including offences relating to out-workers) 13 14 - 5 - Total 43 *53 — 17 - *This figure includes certain defects which were outstanding at the end of 1953. 28 Part VIII of the Act. Outwork. (Sections 110 and 111). Nature of Work Section 110 Section* 111 No. of out-workers in August list required by Sect. 110 (1) (c) No. of instances of work in unwholesome premises Wearing apparel : Making, etc. 243 — Cleaning and Washing 1 — Furniture and upholstery 4 — Artificial flowers 5 Paper bags 1 — Making of boxes or other receptacles or parts thereof made wholly or partially of paper 15 — Carding, etc., of buttons, etc. 66 — Feather sorting 2 — Stuffed toys 32 — Cosaques, Christmas crackers, Christmas stockings, etc. 57 — Lampshades 2 — Brass and Brass articles 1 — Household linen 1 — Sacks 1 — Chocolates and Sweetmeats 1 — Total 432 — During 1954, 158 inspections of Outworkers premises were carried out by the Sanitary Inspectors. Shops Act, 1950. In co-operation with the Shops Act Inspector, improvements under Section 38 of the Shops Act, 1950, relating to the health and comfort of shop workers were carried out in 58 instances : Ventilation improved 2 Heating improved 15 Sanitary accommodation improved 41 Prevention of Damage by Pests Act, 1949. The following is a summary of the work carried out by the Rodent Operatives acting under the supervision of the Chief Sanitary Inspector : Complaints 660 Premises inspected 801 Premises found to be infested with: 1. Rats 511 2. Mice 180 Re-visits to infested premises 3409 Fees received for treatment at business premises £471 18s. 0d. 29 Rodent Control in Sewers. In accordance with the requirements of the Ministry of Agriculture and Fisheries (Infestation Control Division), maintenance treatments of the soil sewers in the Borough were carried out during February and August. A total of 1,203 sewer manholes were dealt with and of these 506 were found to be rat infested. Poison baits were used in the infested manholes. Rag Flock and other Filling Materials Act, 1951. Seven premises have been registered in the Borough since the Act became operative, all of which were inspected during the year. Pet Animals Act, 1951. During the year 1 licence was granted by the Council and fifteen licences renewed after the premises had been inspected by the Sanitary Inspector. Disinfection. Number of houses where disinfection was carried out 168 Number of houses disinfested of vermin 43 Number of articles disinfected by steam 68 Number of articles disinfected by formalin spray 251 Number of articles voluntarily destroyed 183 The arrangement made with the Hammersmith Metropolitan Borough Council in 1952 whereby articles to be disinfected by steam are dealt with at the Scotts Road Depot, W.12, was continued during the year. Summary of Sanitary Defects remedied as a result of Notices Served and Letters written. Animals—nuisances abated 7 Caravans—nuisances abated 76 Damp proof courses inserted in walls 22 Dampness—other forms remedied 216 Drains—connected to sewer 7 Drains—cleared and cleansed 637 Drains reconstructed 105 Drains—repaired 231 Drains—new soil and ventilating pipes provided 13 Dustbins provided 160 Firegrates—repaired or renewed 81 Floors—sub-floor ventilation provided 13 Floors—repaired or renewed 127 Food cupboards ventilated 1 Rainwater eaves gutters, downpipes repaired 219 30 Refuse—accumulations removed 36 Roofs repaired 264 Sinks repaired or renewed 29 Sink waste pipes repaired or renewed 51 Staircases repaired 24 Walls and ceilings repaired or cleansed 474 Water supply reinstated 54 Water supply—draw taps fixed to main supply 3 Water closets—repaired, reconstructed or improved 173 Windows and doors repaired 407 Yards paved or repaired 24 Other defects remedied or nuisances abated 287 Summary of Work Done and Improvements carried out at Food Premises. Walls and ceilings repaired and cleansed 150 Floors repaired 17 Lighting and ventilation improved 5 Washing facilities provided 15 Hot water provided 35 Sinks provided 17 Storage accommodation improved 18 Water supply provided 2 Water closets cleansed or repaired 27 Refrigeration installed or improved 18 Dustbins supplied 4 Covered display units supplied 1 Other defects remedied 59 31 SECTION 4. GENERAL. MASSAGE AND SPECIAL TREATMENT ESTABLISHMENTS. Two new licences were granted to persons already registered on removing from one address to another. Four persons were again granted exemption from registration by virtue of being members of the Chartered Society of Physiotherapists. At the end of the year there were 25 establishments in the Borough. NURSING HOMES. Three nursing homes were closed during the year and there were then eight left. Old Court Nursing Home, for many years established in Hanger Lane, moved to Hillcrest Road and was re-registered there. The Hanger Lane premises were taken over and endowed by the Motor and Cycle Trades Benevolent Fund for members of the Fund and their relatives and dependents, mostly old people who, while not sufficiently ill to be in hospital, nevertheless need nursing care. The home is now known as the Nuffield Nursing Home. HEALTH EDUCATION. As in previous years the leaflet display trays in the Town Hall vestibule and in the Libraries were maintained. The most popular leaflets were those humorously illustrated in colour by Fougasse entitled Good Health, Calling the Doctor, Just Nerves, Be Kind to Your Stomach, Advice to Dyspeptics, War on Disease, A Visit from the Radio Doctor and Internal Hoarding. Other leaflets distributed, at the appropriate season, gave advice on Measles, Poliomyelitis and Influenza. Various leaflets such as Kitchen Hygiene, Elderly People, Carefree Feet, Cafe Quiz, Small pox Vaccination, Diphtheria Immunization, and Houseflies, were also in demand. There is no doubt that the range of subjects embraced and the Borough wide distribution of the leaflets are a valuable means of bringing information and advice to a great many people. All these leaflets are published by the Central Council for Health Education, and its official monthly journal, Better Health, is distributed in the same way. 32 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 22 Sickness Pay Scheme (Servants) 69 Gunnersbury Park Joint Committee Employees 9 Total 100 Six persons were rejected who were suffering from the following conditions, or a combination of them : Heart Disease 1 High Blood Pressure 3 Bronchitis 1 Rheumatoid Arthritis 1 NATIONAL ASSISTANCE ACT, 1948. Section 50—Burial of the Dead. Twelve burials were carried out during the year for which the Council accepted financial responsibility. In four cases the total cost was recovered, in one the cost was partially recovered and the remaining four had to be written off as totally irrecoverable. Section 47. This Section deals with securing the necessary care and attention for persons who (a) are suffering from grave chronic diseases or being aged, infirm or physically incapacitated are living in insanitary conditions, and (b) are unable to devote to themselves, and are not receiving from other persons, proper care and attention. One such case was dealt with following an anonymous complaint about the living conditions of an old lady of 76 living alone. She had been a companion of the late tenant for many years and the relatives were anxious to dispose of the property but for this old lady's refusal to move. After considerable trouble and persuasion she agreed to enter hospital for the medical treatment and care she so badly needed. She died in hospital a few months later. Certification of soiled linen by Sanitary Inspector. Checking and marking soiled linen. Laundresses checking clean linen for return. Delivering clean linen. 33 LAUNDRY SERVICE FOR THE INCONTINENT Population of persons in England and Wales by ages, per 10.000 at all ages, 1901, 1911, 1921, 1931, 1939 and 1951 Age 1901 Census 1911 Census 1921 Census 1931 Census 1939 Mid-year 1951 Census* 0— 1,143 1,069 877 749 690 858 5— 2,099 1,995 1,895 1,635 1,415 1,392 15— 1.958 1,805 1,756 1,734 1,592 1,296 25— 1,616 1.651 1,520 1,605 1,671 1,442 35— 1,228 1,344 1,411 1,368 1,465 1,527 45— 892 978 1,167 1,235 1,244 1,362 55— 597 637 769 932 1,026 1,037 65— 331 377 434 536 643 737 75— 121 126 151 182 225 306 85 and over 15 18 20 24 29 43 All ages 10,000 10,000 10,000 10,000 10,000 10,000 *One per cent sample A study of the above Table is an advisable prelude to a discussion of the municipal laundry service. The Table shows what has been happening to the age structure of the population of England and Wales over the past fifty years, a striking feature being the increase in the number of elderly people. It can be seen that the number of people over the age of 65 per 10,000 of the population in 1950 is two and one third times the figure for 1901 and that the number of people over 75 per 10,000 population is no less than two and two thirds, (almost three times) the 1901 figure. With this increase in the numbers of elderly people there has been a corresponding increase in the problem of the care of the aged. Many of these old people are just incontinent and one of the greatest difficulties in caring for such cases is the cleansing of their soiled clothing and bed-clothes. These services have been accomplished in the past by Home Helps, relatives and friends, but with the increase in the numbers of incontinent people the need for some type of public health laundry service seemed apparent. Following on the recognition of this apparent need it was decided in August 1951, to establish a municipal laundry service in association with the Borough of Ealing's laundry which already deals with the baths and education service work. This laundry service was commenced on 1st April, 1952, the delay being due to the difficulty in securing the necessary equipment. Inquiries were made from St. Marylebone and Kensington Borough Councils, where services were already in operation, and full attention has been given to the information and experience they have had in this work. 34 The Public Health Act, 1936, Section 84, dealing with the cleansing of filthy articles gives powers to local sanitary authorities " to cleanse at the authority's expense any article which, upon a certificate of the Medical Officer of Health or the Sanitary Inspector, requires to be cleansed in order to prevent injury or danger of injury to the health of any person in the premises An estimate was made of the number of persons who might come into this category on the assumption, which seemed to be borne out in other districts, that one would have to deal with roughly one to two per 10,000 of the population. General Practitioners are notified regarding the availability of the scheme and health visitors, district nurses and home helps are fully acquainted with its working. A few are also added from time to time by local hospitals from the outpatient departments of the geriatric units in the district. The Table below shows in detail the number of cases which have been derived from each source every year since the commencement of the service. Cases recommended by 1952 1953 1954 Nurses 30 42 55 Doctors 9 12 5 Home Help Organiser 5 8 15 Sanitary Inspectors 1 3 7 Health Visitors 1 1 2 When a case that may need the service is brought to our notice, a visit is paid by the Sanitary Inspector to the household to confirm that the case is one coming within the provisions of Section 84, and to explain the working arrangements. A form (shown here) giving the articles that may be included in the service is provided. 35 Borough of Ealing Bin No PUBLIC HEALTH LAUNDRY SERVICE List of Articles sent to Laundry Signature of Sender Date Articles Sent to Laundry Received Sent out clean Bedjackets Bedsocks Blankets Combinations Draw Sheets Handkerchiefs Knickers Nightdresses Nightshirts Pants Petticoats Pillow Cases Pyjama Jackets Pyjama Trousers Shawls Sheets Towels Vests Conditions of Laundry Service In order to comply with the provisions of Section 84 of the Public Health Act, 1936, only those articles should be sent to the Ealing Borough Council's Public Health Laundry which are in such a condition as " to render their cleansing necessary to prevent injury, or danger of injury, to the health of any person in the premises The relatives or some person able to accept responsibility is instructed in the use of the containers and they are informed at what time the Council van will be calling to pick up soiled linen. It has been found in practice that a twice weekly collection and distribution seems to cover adequately the needs of 36 these persons, and Mondays and Thursdays have now been selected and fit in with the other work of the laundry service of the Council. The Public Health Committee have purchased additional equipment which has been added to the equipment already possessed by the Baths Committee and this is available for other services when it is not being used for the public health service. The garments on arrival at the laundry are removed from the bin and examined by the Sanitary Inspector who issues a Certificate under Section 84 of the Public Health Act 1936, that they require cleansing. They are then checked and numbered by the two driver/ disinfectors. laundering is carried out by three members of the laundry staff, a man and two women. All suitable materials are ironed before return and it has been found from experience that the simplest method of transport is by means of a metal container which can be easily cleansed and disinfected and which is light— 7 lbs. empty and 15 lbs. filled-and easy to carry. These containers pack simply into the Council's van and they are all numbered for identification purposes. The cost of these aluminium containers is £3. 10. Od. each, (size 20 in. x 15 in. x 9 in.)—two are required for each case. The establishment of a service of this kind is unquestionably one of great benefit to the community. Many of these patients are in the last stages of some serious illness and it is impossible for relatives to obtain relief from the laundering of clothes and bedclothes since public laundries will not accept such articles. These patients are often being nursed and cared for by relatives who have their hands completely full and the relief given by means of this laundry service means a great deal to them. There is, of course, an obvious link with the relief of hospital beds by the taking of cases which need hospitalisation only in order to deal with incontinency. In the two years and nine months since the inauguration of the laundry service the number of cases dealt with per week has shown a remarkable increase, from an average of 10 cases per week in the first three months of the service to an average of 42 per week in the last three months of 1954. There is a steady change of persons using the service by immigration, deaths, removal to hospital, discharge from hospital, etc. The following Table illustrates this point : 1952 1953 1954 No. of cases dealt with during the year 46 66 84 No. of cases remaining at end of year 15 23 47 No. of cases that died 18 30 28 No. of cases removed to hospital 11 18 24 No. of cases where other arrangements were made 2 10 8 37 There has been a corresponding increase in the number of collections made and the number of articles dealt with, the exact numbers being shown in the Table below, and it is interesting to note that, with this increase in the amount of work, the cost of laundering each collection has dropped from 19/5d. to 12/2d. approximately. 19S2 1953 1954 Total number of articles dealt with 9,958 17,587 25,097 Total number of collections 1,144 1,784 2,500 Average number of articles per collection 8.7 9.9 10.0 Approximate cost per collection 19/5 15/6 12/2 An important adjunct which has become indispensable and which is carried out with such quiet efficiency that it tends to pass unnoticed is the repair of garments. This was again organised by Miss Gerty, Secretary of the Old Peoples' Welfare Committee of the Ealing Council for Social Service. Miss Gerty was assisted by members of the Ealing Townswomen's Guild and the Catholic Women's League (Ealing Section). They carried out repairs for several hours every Wednesday morning throughout the year. Many thanks are due both to Miss Gerty and to her willing helpers. Finally, it is extremely gratifying to be able to mention the receipt of many letters of thanks and appreciation from relatives and friends of patients helped by the Service. 38 SECTION 5. STATISTICAL TABLES. SUMMARY OF STATISTICS. Area (in Acres) 8,783 Population (Census, 1951) 187,306 Population (estimated middle of 1954) 185,000 Rateable Value, 1954-55 £1 ,961,957 Net Product of a Penny Rate, 1954-55 £8,100 Live Births :— Legitimate Males, 1,130 Females, 1,061 Total 2,191 Illegitimate Males 60 Females, 66 Total 126 2,317 Birth-Rate per 1,000 of Estimated Population 12.5 Still-Births Males, 19 Females, 19 Total 38 Rate per 1,000 total Births (Live and Still-Births) 16.1 Deaths: Males, 899 Females, 852 Total 1,751 Death-Rate per 1,000 of Estimated Population 9.5 Deaths of Infants under one year of age:— Legitimate Males, 12 Females, 19 Total 31 Illegitimate Males, 1 Females, 1 Total 2 33 Death Rate of Infants under one year of age:— All Infants per 1,000 Live Births 14 Legitimate Infants per 1,000 Legitimate Live Births 14 Illegitimate Infants per 1,000 Illegitimate Live Births 16 Deaths from Diseases and Accidents of Pregnancy and Childbirth:— From Sepsis — None. From other Causes — None. 39 Infectious and Other Notifiable Diseases Classified in Age Groups Scarlet Fever Whooping Cough Acute Poliomyelitis Measles Diphtheria Paralytic NonParalytic M F M F M F M F M F M F Numbers originally notified 149 138 61 55 3 1 1 — 60 72 — — Numbers corrected : Under 1 year 1 3 5 — — — — 2 4 i—2 years 15 8 8 16 — — — — 12 16 — — 3—4 years 19 25 18 12 — — — — 19 15 — — 5—9 years 107 90 3i 20 — — — — 27 33 — — io—14 years 2 10 — 2 — — 1 — — 1 — — 15—24 years 2 3 — — — — — — — 1 1 — 25 and over 2 2 1 — 2 1 — — — 2 — — Age unknown — — — — — — — — — — — — Totals 148 138 61 55 2 1 1 — 60 72 1 — Acute Pneumonia Dysentery Smallpox Acute Encephalitis Enteric or Typhoid Fever Infective PostInfectious M F M F M F M F M F M F Numbers originally notified 110 94 104 121 - - 1 — — — — 1 Numbers corrected: Under 5 years 19 11 18 21 - - - - - - - - 5—14 years 25 19 24 27 — — 1 — — — — — 15—44 years 26 31 21 28 - - - - - - - 1 45—64 years 30 22 8 9 - - - - - - - - 65 and over 10 11 3 4 - - - - - - - - Totals 110 94 74 89 — — 1 - - — — 1 Paratyphoid Fevers Erysipelas Meningococcal Infection Food Poisoning Other Notifiable Diseases M F M F M F M F Original Corrected Numbers originally notified 2 2 3 15 4 2 41 37 M F M F Malaria Numbers corrected : Under 5 years 1 — X — — — — — 2 1 1 Ophth. Neonatorum 5—14 years 1 — 1 — 1 — 3 2 15—44 years — 2 2 4 1 — 2 3 1 1 1 1 45—64 years — — — 6 — — 1 1 65 and over — — — 4 — — — — Puerperal Pyrexia 15-20 years 4 20-35 years 47 35-45 years 3 Totals 1 2 3 14 4 1 7 8 54 40  Tuberculosis Respiratory Meninges & C.N.S. Other M F M F M F Numbers originally notified : Total (All Ages) 66 66 - - 5 12 Final numbers ofter correction : Under 5 years 3 1 — — 2 — 5—14 years z 2 — — — 2 15—24 years 13 24 — — 1 2 25—44 years 23 26 — — 1 4 45—64 years 23 11 — — 1 3 65 and over 3 2 — — — X Age unknown Total (All ages) 66 66 — - 5 12 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 and Other Notifiable Diseases notified in the Borough. Disease 1943 1944 1945 1946 1947 1948 1949 1950 i95i 1952 1953 1954 Smallpox - - - - - - - - - - - - Diphtheria 13 17 14 29 11 13 16 3 2 — — 1 Scarlet Fever 448 228 340 232 133 204 176 294 203 402 238 287 Enteric Fever (including Paratyphoid) 1 — — — — 3 8 5 3 2 3 5 Puerperal Pyrexia 41 42 47 35 27 25 27 24 38 70 61 54 Pneumonia: Primary 123 142 110 114 127 189 163 173 162 100 157 152 Influenzal 40 9 14 16 3 6 10 6 38 28 74 52 Acute Poliomyelitis 2 2 3 4 46 10 34 42 10 21 13 5 Meningococcal Infection 1 — 6 6 10 2 14 9 2 — — 6 Malaria — — — — 1 2 — 4 1 1 3 1 Dysentery 5 24 60 10 5 7 23 24 542 179 132 225 Erysipelas 41 30 26 31 38 32 13 24 17 26 18 18 Polio-Encephalitis 1 — — — 6 4 3 — — — — 1 Tuberculosis: Pulmonary 233 173 194 275 204 206 205 209 210 211 205 132 Non-Pulmonary 51 30 23 33 25 27 32 41 24 29 20 17 Ophthalmia Neonatorum 4 3 3 3 5 — 5 3 6 — — 2 Measles 2058 127 2330 791 806 1379 1450 1016 3296 993 2558 132 Whooping Cough 450 380 236 271 310 383 303 274 550 77 491 116 Food Poisoning — — — — — — 21 23 86 26 31 78 Totals 3512 1207 3046 1850 1757 2492 2503 2174 5190 2165 4004 1,284 41 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 Disease Smallpox — Meningococcal Infection 5 Diphtheria 1 Malaria 1 Scarlet Fever 286 Dysentery 163 Enteric Fever (including Erysipelas 17 typhoid) 4 Polio- Encephalitis 1 Puerperal Pyrexia 54 Tuberculosis : Pneumonia : Pulmonary 132 Primary 152 Non- Pulmonary 17 Influenzal 52 Ophthalmia Neonatorum 2 Acute Poliomyelitis 4 Measles 132 Food Poisoning 15 Whooping Cough 116 Total 1154 DEATHS — Causes of Death, 1954 Cause of Death Deaths, 1954 Total Deaths 1953 Male Female Total Tuberculosis, Respiratory 12 7 19 28 Tuberculosis, Other — 1 1 1 Syphilitic Disease 2 3 5 6 Diphtheria — — — — Whooping Cough — — — 2 Meningococcal Infections — — — — Acute PoliomyeUtis 1 1 2 1 Measles — — - — Other Infective and Parasitic Diseases 2 — 2 4 Malignant Neoplasm, Stomach 23 23 46 45 „ „ Lung, Bronchus 75 10 85 71 „ „ Breast 1 43 44 42 „ „ Uterus — 9 9 10 Other Malignant Lymphatic Neoplasms 100 101 201 158 Leukaemia, Aleukaemia 7 7 14 16 Diabetes 7 6 13 13 Vascular Lesions of Nervous System 81 144 225 254 Coronary Disease, Angina 182 118 300 242 Hypertension with Heart Disease 17 18 35 47 Other Heart Disease 111 127 238 266 Other Circulatory Disease 31 38 69 69 Influenza 1 1 27 Pneumonia 22 32 54 80 Bronchitis 56 40 106 151 Other Diseases of Respiratory System 7 7 14 20 Ulcer of Stomach and Duodenum 13 5 18 11 Gastritis, Enteritis and Diarrhoea 3 2 5 11 Nephritis and Nephrosis 6 5 11 15 Hyperplasia of Prostate 10 — 10 10 Pregnancy, Childbirth, Abortion — — — 1 Congenital Malformations 6 6 12 15 Other Defined and Ill-Defined Diseases 55 63 118 111 Motor Vehicle Accidents 17 7 24 17 All other Accidents 23 15 38 46 Suicide 19 11 30 12 Homicides and Operations of War — 2 2 — Totals 899 852 1,751 1,808 42 Infant Deaths There were 33 deaths of infants under 1 year of age in 1954— a decrease of 8 from the previous year. Total live births amounted to 2,317 giving an infant mortality rate of 14. (17 in 1953). 26 deaths occurred within the first month of life and 24 of these were during the first week of life. Causes of Death. Prematurity Prematurity only 7 Prematurity + atelectasis 6 Prematurity + congenital heart disease1 Prematurity + broncho-pneumonia 1 Prematurity + intraventricular haemorrhage 1 Prematurity + kernicterus 1 17 Congenital Abnormalities 6 Respiratory Diseases Broncho pneumonia 2 Broncho pneumonia + otitus media 1 Pneumonia + congenital heart disease 1 Pulmonary haemorrhage 2 6 Others Meningitis (B Coli) 1 Cerebral haemorrhage 1 Erythroblastosis 1 Gastro-enteritis 1 4 Prematurity still remains the greatest single cause of death and there was a slight increase in the number of deaths from this cause in 1954 (17 in 1954 and 15 in 1953). All these deaths took place in the first week of life and 8 were within the first 24 hours. It does appear that if the baby can survive the first hazards of birth, medical science is sufficiently advanced to-day to ensure a good chance of their survival. It would seem that there is unlikely to be any dramatic reduction in the number of these deaths until the causes of premature birth are more fully understood. Congenital abnormalities accounted for 6 deaths in 1954 (10 in 1953) and there were 4 deaths from pneumonia (6 in 1953). It is encouraging to know that there were no deaths from accidental causes in infants under 1 year of age as 5 such deaths occurred in each of the two preceding years. 43 SECTION 6. SCHOOL HEALTH SERVICE The standard of health of the Ealing school child has been maintained at a high level. Many applications have been received from parents of private school children for the benefits of the school health service and this seems to reflect the high esteem in which the service is held. Three cases of school children suffering from Pulmonary Tuberculosis were notified during the year. These necessitated a thorough investigation of all school contacts. Patch tests were carried out and positive reactors were X-rayed. No other child was found to be infected. The suitable placement of some categories of handicapped pupils still presents difficulties ; the child with multiple defects being the real problem. Home tuition is now more readily available for cases of children awaiting vacancies at special schools. MINOR AILMENT CLINICS. Clinics are held at all centres except Brentside. Children are sent from the school routine medical examination when a further study of their condition appears to be necessary. Minor treatments and freedom from infection inspections also are carried out here. The greatly increased attendance at these clinics is spread fairly evenly over the whole year. Attendances at Minor Ailment Clinics. 1952 1953 1954 4,972 4,948 6,746 ROUTINE MEDICAL INSPECTIONS. Three routine inspections are carried out during the child's school life, during their first year at school, during their last year at primary school and prior to leaving school. Numbers Examined. First Age Group 2,765 Second Age Group 2,614 Third Age Group 2,123 Total 7,502 44 Classification of General Condition. A' Good 2,878 B' Fair 4,580 C' Poor 44 Total 7,502 Defects requiring Treatment found at Routine Medical Inspection. 1951 1952 1953 1954 Skin Diseases 695 600 540 581 Defective Vision 433 368 290 366 Squint 49 31 43 43 Defects of Hearing 51 73 93 116 Middle Ear Diseases 26 26 18 27 Nose and Throat Diseases 389 339 377 382 Speech Defects.. 47 29 37 44 Enlarged Glands 10 6 5 7 Heart—Circulation conditions 13 6 7 20 Lung Diseases 111 107 84 93 Hernia 4 4 7 9 Postural Defects 30 40 18 38 Flat Foot 91 60 42 110 Epilepsy 3 1 1 2 There was a full year of patch testing of school entrants in 1954 2765 children were examined, of these 140 were found to be positive reactors and these were subsequently X-rayed at the Chest Clinic. ASTHMA CLINIC. During the past year many children with recurrent upper respiratory infections, apart from asthma, have been included in the breathing exercise classes. During the year 2,782 attendances made. In every case early treatment has proved beneficial. We have managed to treat children as young as three years of age successfully. The recent acquisition of two portable mirrors has greatly facilitated breathing instruction. We have continued to make allergy tests with the Bencard's testing equipment and refer any suitable case to St. Mary's Allergy- Clinic. We have continued to have referrals from many hospitals including The Brompton Hospital. CHILD GUIDANCE CENTRE 1. New Cases referred in 1954. In 1954 236 new cases were referred to the Centre, 178 from Ealing, 78 from Acton. 36 (23 from Acton) were brought forward from the 1953 waiting list, making a total of 292 ; an excess of 38 45 over the figure for 1953. At the end of the year 58 were on the waiting list for 1955 as compared with 36 at the beginning of the year. 1954 was the first full year in which cases from Acton have been seen and while there has been a small increase in the number of cases referred from Ealing, the Acton cases account for almost the whole of the increase in the number referred and the number on the waiting list. So far there has been no appreciable change in the average time between being referred and being seen. Disposal. (1) Treatment. Of the new cases, 100 were recommended for treatment or remedial teaching, and 21 were waiting from 1953. At the end of the year 31 cases were awaiting treatment in 1955. This increase, though numerically small, is more serious than the increase of the number on the diagnostic waiting list. It means that the time spent by patients waiting for treatment is going up. (2) Special Recommendations. In 37 cases recommendations were made for action outside our own Centre. 21 children were recommended for ascertainment as Maladjusted Pupils, and 16 were sent to a hospital for further investigation or treatment. II. Cases seen before 1954. 26 cases who began treatment in 1954 had been seen earlier and 53 cases who were attending for treatment in 1953 continued in 1954. In addition 47 cases who had attended for regular treatment earlier remained under supervision (i.e., making occasional attendances) in 1954. A number ceased to attend in 1954, leaving 61 treatment cases and 35 supervision cases current at the end of the year. A few children seen in 1953 or earlier were recommended for Schools or Hostels for Maladjusted Children. As the year went on, some of those coming for treatment were found to be in need of boarding school education, and four recommended at the diagnostic interview for a School for Maladjusted Children were taken off the list, three because their circumstances had changed, one because the parents would not agree to our recommendation. (Table VI shows in detail all the special recommendations made or put into effect, including those carried over from previous years and those that modify the original recommendation). 46 III. Work and Organisation of the Centre. (1) Staff. Only two changes occurred in staffing arrangements. (1) The six psychiatric sessions have become permanent. (2) Miss Hitchfield, Educational Psychologist, we are proud to say, was awarded a British Memorial Fellowship for a year's study in Australia and was with us only till the end of January. We were most fortunate in being able to replace her by Miss Sylvia Gascoyne, who began work on February 1st. We are most grateful to her for her help. During the year it was agreed that the North West Metropolitan Regional Hospital Board should appoint a Registrar (trainee Child Psychiatrist) for five sessions a week. The post was advertised in July, but was not then filled. By the end of the year Dr. Cecile Doniger had been appointed to undertake four sessions a week in 1955 and we look forward to the help that this will give us in providing more treatment. (2) Work in Maternity and Child Welfare Clinics. One item which shows a great increase is the work of the Psychiatric Social Workers in the Maternity and Child Welfare Clinics. Miss Chaloner has visited the Northolt Clinic fortnightly and, since June, Miss Price has made regular visits to Mattock Lane. Both Psychiatric Social Workers report that they find the direct contact with the Health Visitors of great value and each would like to express her thanks to the Medical Officers in charge. IV. Problems referred to the Clinic and dealt with in 1954 (1) Symptoms in 1954. As usual, children " difficult to manage " at home head the list. This year a large number of children with fears, anxiety, solitariness and depression have been referred to us and we welcome the increased emphasis on problems of this sort. These children are often extremely unhappy and mentally ill but do not draw attention to themselves. They can usually be helped by psychotherapy and their need is at least as great as that of the children who cannot be ignored. (2) Age and Intelligence. The level of intelligence of the children referred to us is higher than last year ; the number from Grammar Schools has gone up slightly, though it still seems likely that there are Grammar School children in need of help who are not referred to us. Grammar School children tend to be sent far too late, and there are few who have not shown signs of their trouble much earlier. Problems that might be successfully dealt with in the first or second year become virtually insoluble by the time a boy or girl is fifteen. 47 There has been an appreciable fall in the average age of the children referred. In 1954 it was just 8 years as against 8£ years in 1953 and 9 years before that. The number of pre-school children is more than double the 1953 figure and the biggest increase has been in the number of children of primary age. We have more and more evidence that the problems presented to us have their beginnings in infancy and the nearer to their beginning they are recognised, the quicker and the more surely are they dealt with. SCHOOL DENTAL SERVICE. During 1954 the staffing position has continued to improve and consequently in most clinics the leeway resulting from the restricted scheme of 1950-1953 is being rapidly made up. The average allocation of children per dental officer remains at about 3,500. Where the figure is below this good progress is being made as indicated above, but due to shifting population etc., in some clinics the allocation is very much higher and adequate progress cannot be made until more staff and accommodation is available. Overloading of the individual dental officer results in an increasing number of cases requiring urgent treatment (" specials ") and while the bulk of chairside time is being spent treating ' specials,' the routine inspection and treatment of school children lags further behind so that the end of this year finds us with several schools which have not been inspected for some time. It is hoped that in 1955 it will be possible to secure extra staff and accommodation so as to improve this position. The evening sessions have continued to operate with marked success, a total of 207 sessions having been worked and 1846 fillings carried out. It is significant that the average number of permanent fillings carried out per evening session is markedly higher than in a daytime session (8.9 to 6.3). (This is because the dental officer is able to work undisturbed by the many outside interruptions which influence the output of a busy daytime session.) The orthodontic service makes satisfactory progress, 2 part time orthodontists doing between them 10 sessions per week. The end of the year finds us with an insignificant waiting list of patients and no child is now kept waiting for consultation and if neccessarv immediate treatment. But as dental officers get into their stride again with routine school inspections it is likely that the number of cases referred for orthodontic treatment will increase and expansion of the service may prove necessary. With the increased activity of the orthodontic clinic the number of x-ray films taken has increased by over 33% compared with last year, and we now have two dental attendants working at the Cherington House Orthodontic Clinic who have special training in x-ray work. 48 Reference has been made in previous reports to the mortality rate of permanent teeth. In 1952 1 permanent tooth was extracted for every 10.7 permanent fillings, in 1953 it improved to 1 extraction to every 12.6 fillings, the 1954 figure remains the same. This is a good ratio but it is desirable that the upward trend continues unabated. The position in relation to temporary teeth is especially encouraging. In 1954 95% more temporary fillings were carried out than in 1953 and the ratio of temporary teeth extracted to temporary fillings has fallen from 3.4 to 1, to 1.6 to 1. During 1953 50% of new cases treated were children who required urgent treatment and only 50% were children who were being treated as a result of routine inspection at school. During 1954 these figures improved to 41% and 59% respectively. These figures relate themselves directly to the allocation of children to the particular dental officers. Where the loading is high, so is the number of ' specials ' and the dental officer is unable to proceed with the all important routine work. To quote particular examples, at Clinic 'A ', with a loading of over 5,000 children during 1954, only 345 routine cases were treated but 918 ' specials ' had to be treated. At Clinic ' B ' with a loading of 2,500 children and operating for 10 months of the year, 730 routine cases were treated and only 201 ' specials '. The emergencies did not arise io anything like the same degree because the children were getting their routine examinations at shorter intervals. It is fair to say that there is evidence of steady progress in the school dental service of the area, but there is no room for complacency and if a full and adequate service is to be built up, expansion as already suggested will be essential. EAR, NOSE AND THROAT SERVICE Mr. Arthur Miller, Consulting Otologist, reports :— Children are referred to see me by the Medical Officers, suffering from mouth breathing, sore throats, nasal, Eustachian and middle ear catarrh, which is often associated with deafness, also children who have not passed the gramophone and pure tone audiometry test. The cause of the trouble was often found to be due to enlarged adenoids and turbinates, sinusitis and infected tonsils. It was very helpful to be able to get an X-ray confirmation of the sinus infection and great use has been made of the facilities provided for it. The treatment administered was diastolisation, politzeration and Eustachian catherisation as well as breathing exercises. In cases where sinusitis was confirmed, Proetz displacement treatment was practised. In some cases adenoidectomy only was advised, in others adeno-tonsillectomy. 40 Head Teachers were informed, where it was found advisable that the child should sit either in the front row or should abstain from swimming, or both. Head Teachers are particularly requested to see that these recommendations follow the children throughout the whole of their school life. Audiometry Report. Number of schools visited 35 Number of children examined 9,962 Number of children with hearing loss 215 Number of pure tone tests 250 Number referred to E.N.T. Specialist 185 8,864 children's feet have been inspected this year in all the maintained schools by a specially trained nurse, of which 431 were referred to the Foot Clinics. Children from the Welfare Centres who are under school age were also seen by the Assistant Medical Officer in charge of Foot Health. Foot defects found up to the age of 12 years are usually correctable, but it is disturbing to find the number of incorrectable foot defects, in particular Hallux Valgus (bending outwards of the big toe) among girls, which appears at, or just after, this age and which becomes progressively worse, so that even before they leave school the children suffer from foot pain. This defect is found in association with either good shoes worn for too long a period, i.e. they become too short, or with the popular " Casual " type, which in order to stay on the foot has to be tight, narrow and short. In the Ealing Shoe Scheme of 1949—1951, it was found that children needed to have their shQes checked for size every 3-4 months ; some shoes could be worn for 6 months but rarely any longer. This is always emphasised at the foot clinics. Parents of children, especially girls, in the Senior Modern Schools say they experience great difficulty in obtaining a good enough selection in large enough sizes. Size 7 in girls is fast becoming an average size in the rising generation. Of twelve different shoe shops recently visited in Ealing, only six had girls shoes in stock in this or larger sizes and these were shops selling the better, and of course dearer, type of shoe. The demand for these shoes suitable for a growing foot is poor anyway, as unfortunately these children wish to wear a more " fashionable " shape and override their parents wishes in the selection of shoes. Allowing growing children to wear unsuitably shaped shoes is to be greatly deplored. The incidence of ringworm and plantar warts has decreased. Barefoot dancing was reintroduced experimentally in 3 Senior Modern -Schools a year ago and girls in these schools and in 3 Senior FOOT HEALTH 50 Modern Schools where plimsolls are worn, are inspected every term. The figures obtained so far indicate no higher incidence in the schools with barefoot dancing, though further numbers are required for satisfactory statistical results. If barefoot dancing is not the main source of infection it must be sought elsewhere. In consequence all children found with such infection of the feet are now asked to complete a questionnaire relating to many things, such as type of sock and shoe worn, washing agent for the socks, amount of swimming, etc. Dr. D. Craigmile, who was in charge of Foot Health in Ealing for several years, left to go to Birmingham at the beginning of 1954. Dr. Hollman has taken her place in Ealing and is continuing her work and investigations into foot health problems. Foot Inspection—Defects Found. Total number examined .. .. 8864 Defect No. % Ringworm 31 .4 Verrucae 79 .9 Defective Shoes 2264 25 Everted Ankles 319 3.7 Hallux Valgus 1570 17.7 Children referred to Foot Clinic 431 4.8 Chiropodist 93 1.0 HANDICAPPED CHILDREN. The following table sets out in their various categories the number of handicapped pupils as at 31st December, 1954. Category In Special Schools In Special Schools In Maintained. Primary Secondary Total Day Residential Schools Blind 1 1 2 Partially Sighted 4 4 — 8 Deaf 4 12 — 16 Partially Deaf 10 10 — 20 Educationally Sub-Normal 26 23 48 97 Epileptic — 3 — 3 Maladjusted — 47 18 65 Physically Handicapped 14 8 2 24 Speech Defects 1 3 — 4 Delicate 5 21 165 191 Multiple Defects — 1. — 1 Totals 65 133 233 431 51 OPHTHALMIC SERVICE Mr. Freeman-Heal, Consultant Ophthalmologist, reports :— The total number of cases seen was 1,545 (1953—1,504), of which 464 (1953—480) were new cases, and 1,081 (1953—1,024) re-inspections. The number of pairs of glasses prescribed was 916 (1953—941). Abnormal Eye Conditions other than errors of Refraction were as follows : Congenital Abnormalities New cases Old cases Squint 87 236 Congenital Ny stagmus 2 8 Congenital obstruction nasal duct 2 2 Progressive or malignant Myopia 1 2 Congenital defects oculomotor nerves or muscles 3 2 Coloboma of Uveal tract — 2 Dermoid cyst in region of orbit 1 1 Melanoma of choroid 1 — Retro-lental Fibroplasia 1 — Abnormalities due to Infection Blepharitis 6 5 Conjunctivitis 4 — Styes 2 1 Corneal nebulae 1 1 Meibomian cyst 2 — U veitis—Eye blinded from 2 — Abnormalities di e to Trauma Detachment of Retina 1 — Scar of Cornea .. ... ... ... 1 — No. of children recommended for special school 1 The case of Retro-lental Fibroplasia was from the Maternity and Child Welfare Department. ORTHOPAEDIC CLINIC. Mr. J. A. Cholmeley, the Orthopaedic Consultant, reports :— The Orthopaedic Clinics in the Borough of Haling continue to be well attended and there has, in fact, been a definite increase in the number of attendances for Physiotherapy in all age groups. The distribution, however, of cases for examination and treatment is steadily becoming more peripheral. At the Mattock Lane clinic which drains very largely the areas already built up and partly commercialised, there has been a falling off in numbers at least at the Surgeon's sessions, but at Greenford and subsidiary treatment clinics the work has definitely increased as these drain the new housing estates to which young and growing families gravitate. These clinics enable treatment to be given near to the home and school and thus reduce the amount of time and money that would otherwise be spent in travelling to and from the more centrally situated busy hospitals. 52 SPEECH THERAPY. Treatment is carried out as follows :— Mattock Lane Cherington House Laurel House Greenford Green Ravenor Park Perivale Islips Manor Oldfield School North Ealing School 3 Sessions per week 1½ Sessions per week 2 Sessions per week 1 Session per week 3 Sessions per week ½ Session per week 1 Session per week 1 Session per week Saturday mornings are used for case discussion and clerical work. Monday afternoons are reserved by the speech therapist for school visits, or special interviews. The Speech Class, Stanhope, is visited by both Speech Therapists four times per week amounting to 2½ sessions in time. Number of children treated this year 237 Number of children discharged 122 Number of children new 205 Number of schools visited 57 Waiting list at end of year 49 Comment. The number of new patients (205) is greater than the number discharged in the same period (122) because of the extension of sessions in September. Schools. School departments are visited at the request of Head Teachers who have been notified that Monday afternoons are reserved for visiting sessions for therapists. Waiting List. The list is higher this year than it has been for some time. This is due to the extension of the service, children whose names had been witheld because of the limitations of treatment facilities have now been referred, but the turnover of patients is as rapid as is possible in this type of work. Remedial Speech Class. The Remedial Speech Training Class was opened in March, 1954, in Stanhope Primary School, Greenford, and we are pleased to report that it is now established and is progressing satisfactorily. M.S.S. Tape Recording Machine. In March, 1953, the M:S.S. Tape Recording Machine was introduced for regular use in Ealing. It has been used Therapeutically and also for Permanent Recording. 53 Approximately 42 Permanent records have been made, including recordings of those pupils in the remedial Speech Class in Stanhope School. A good example of the value of the machine can be found in the case of "M.C.". The first recording of this pupil showed a definite stammer and disarthric speech. The recording on discharge revealed normal speech without stammer and only slight disarthria under emotional stress. EMPLOYMENT OF CHILDREN AND YOUNG PERSONS 1. Number of children medically examined in order to ascertain whether they were physically fit to undertake employment of a light nature outside school hours 268 2. Number of instances in which the state of health was found to be such that certificates were withheld — 3. Number of children examined as to fitness to take part in entertainments 13 4. Number of cases in which certificates to take part in entertainments were withheld — EDUCATION ACT, 1944 Sections 57 (3), 57 (4), and 57 (5). Cases dealt with under Section 57, Education Act, 1944 : Sub-Section 3 7 Sub-Section 4 — Sub-Section 5 4 Cases de-notified under Section 8, Education (Miscellaneous Provisions) Act, 1948 1 MEDICAL EXAMINATION OF TEACHERS Number of Teachers examined as to fitness for appointments 56 INFESTATION WITH VERMIN. The standard of head cleanliness has improved even on last year's high level. Out of 59,505 children examined only 254 were found to be infested. Once again, in no case was it found necessarv to take legal action. 54 SUPPLEMENT. Items of interest concerning the Health Service administered by the Middlesex County Council as Local Health Authority. Home Nursing Service. The volume of work carried out annually by the Home Nursing Service in Ealing has shewn a steady increase since the service was taken over by the Middlesex County Council from the Greater Ealing and the Northolt Nursing Associations in 1948, until the year just completed, when the figures remained similar to those of the preceding year. The staff at present is the equivalent of 26¼ full time nurses and is made up of 22 full-time nurses including 2 male nurses and 9 part-time nurses. There is at present working in Ealing an additional male nurse who is still under contract. In 1948, at the time the County took over the administration of the service there was a staff equivalent to 14¼ nurses consisting of 13 full time and 4 part-time nurses. For the last four years detailed figures have been kept of the classified diseases which the nurses are asked to attend, the types of treatment undertaken and the age groups of the patients. Certain points of general interest have emerged from studying the figures for the last two years. During 1954, the total number of visits made was very nearly the same as the number in 1953 (87,159 and 87,076 respectively) although there was a 20% reduction in the number of new cases attended (4,747 in 1953 and 3,763 in 1954). This reduction in new cases was proportionately greater in the younger age-groups although all the age-groups showed a decrease. There was, however, a 25% increase in the number of cases having 25 or more visits during the year. A big reduction in the number of cases of respiratory disease accounts for more than 50% of the decrease in total cases as between 1953 and 1954, and the decrease occurred principally in the first quarter of the year. This is probably explained by the aftermath of respiratory disease in the first quarter of 1953 following the " smog " of December, 1952, and this explanation is borne out on referring back to the figures collected in the first quarter of 1952 which correspond closely to those of the first quarter of 1954. On the other hand, it must be borne in mind that the increasing use of long acting penicillin injections may considerably affect these figures. In addition to the big reduction in new cases of respiratory disease there were smaller reductions in most other classified diseases, the exceptions being those classified under New Growths Vascular Lesions of the Central Nervous System, Diseases of 55 Circulatory System and Constipation. All these are diseases chiefly affecting the older age groups. There was a slight increase in the cases attended for Preparation for X-ray and for Post-Operative Care, indicating that increasing use is being made of the Home Nursing Service by the Hospital Service. Although there was a considerable reduction in the number of penicillin injections given in 1954, possibly partly because of the introduction of long acting type of penicillin, these injections still form by far the largest group of treatment given and are chiefly ordered for respiratory and skin infections. HOME HELP SERVICE There has been a steady increase in the demands made on the Home Help Service over the last few years and this has been maintained during 1954. The greatest demand by far has been for help for the aged and infirm, help which has to be extended in nearly all cases over a prolonged period, and the Organizers are finding it increasingly difficult to cover the work with the existing establishment of Home Helps. The present establishment is a staff equivalent of 108 full time Home Helps, but as the demand rises this may need to be increased in the near future. There has been some difficulty in recruiting suitable women for this type of work, as the good Home Help needs to be more than just a cleaner. .She has to be cheerful, patient and understanding, a task which is not always easy when dealing with difficult sick persons. The domestic labour shortage in the Borough is acute. As most of those receiving help are of pensionable age the majority are subsidised, and 67% of the whole are in fact in receipt of a free service. A summary of cases received during the year 1954 is given below :— Type of Case Under 60 Over 60 Total Confinement 118 118 Ante-Natal 13 13 Post-Natal 43 . 43 T uberculosis 76 8 84 Senile — 43 43 Acute Sick 210 50 260 Chronic Sick 64 572 636 Accident 11 4 15 Others 6 2 8 Cases visited but cancelled 116 541 697 1336 56 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, Ealing and Acton forming Area No. 7. 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. (Interviews by Appointment). Address Abbey Parade, North Circular Road, Ealing. Brentside, Westcott Crescent, Hanwell, W.7. Cherington House, Cherington Road, Hanwell, W.7. Greenford Green, Wadham Gardens, Greenford. Islips Manor, Eastcote Lane, Northolt Laurel House, Windmill Road, Ealing. Mattock Lane, 13, Mattock Lane. Ealing, W.5. Perivale, Horsenden Lane, Greenford. Ravenor Park, Oldfield Lane, Greenford. T imes Tues. mornings. Fri. mornings. Tues. Wed. mornings. Tues. & Fri. mornings. Moil. Wed. mornings. Thurs. mornings. Wed. Thurs. and Fri. mornings. Wed. mornings. Moil. Thurs. mornings. Child Welfare Clinics Abbey Parade, North Circular Road, Ealing Brentside, Westcott Crescent, HanweU, W.7. Cherington House, Cherington Road, Hanwell, W.7. Greenford Green, Wadham Gardens, Greenford. Islips Manor, Eastcote Lane, Northolt Kingshill Community Centre, Northolt Laurel House, Windmill Road, Ealing. Mattock Lane, 13, Mattock Lane, Ealing. Perivale, Horsenden Lane, Greenford. Ravenor Park, Oldfield Lane, Greenlord. Tues. & Frid. 2—4 p.m. Thurs. 2—4 p.m. Mon. Tues. & Thurs. 2—4 p.m. Tues. Wed. & Fri. 2—4 p.m. Mon. Thurs. 2—4 p.m. Tues. 2—4 p.m. Mon. Thurs. 2—4 p.m. Mon. Wed. Thurs. Fri. 2—4 p.m. Mon. Thurs. 2—4 p.m. Mon. Tues. Wed. Fri. 2—4 p.m. 57 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 every one 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 is made for this service, although this is reduced in cases of hardship. Day Nurseries. There are four 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 need to go out to work, although in exceptional circumstances, e.g. during the mother's illness or other emergency, other children may be accepted. The nurseries are open from 7.30 a.m. to 6 p.m. Applications for admission should be made to the Area Medical Officer, Town Hall, Ealing. A charge is made for this service on a sliding scale based on the parents income. Perry & Routleff, Ltd., Printers Ealing and Uxbridge