EAL 47 AC.439(1) EALING The Health of Ealing in the year 1956 EAL 47 The Healtb of Ealing in the Year 1956 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 7 Section 2. SANITARY CIRCUMSTANCES OP THE BOROUGH 19 Section 3.- SANITARY INSPECTION 26 Section 4 GENERAL 39 Section 5 - STATISTICAL TABLES 46 Section 6 APPENDIX REPORT OP THE SCHOOL MEDICAL OFFICER 52 Supplement - FOR GENERAL INFORMATION 62 4 STAFF OF THE PUBLIC HEALTH DEPARTMENT William G. Booth, Medical Officer of Health (also M D =, B.S., D.P:H. Joint Area Medical Officer of Area 7 (Ealing and Acton), Middlesex County Council) G.M. Gorrie, Deputy Medical Officer M B.,CH;B,, D P H, G.T.H. Blackie Chief Public Health Inspector E, Belfield Deputy Chief Public Health Inspector E.H. Evans Public Health Inspector C.W. Baxter E.W. Budd A. E. Pooley G.O. Axon Resigned 7.7=56 A.C. Bamping " 31,1,56 " D.J. Anderton " 30,4.56 " N. Saunders Commenced 20.8.56 Harry Mt Birrell Chief Administrative Assistant R.S. Leggatt Senior Clerk R. Angell Clerk D.R.A. Smith Miss D.E. McKenzie Shorthand-Typist Mrs. M. G. Byford " " Mrs. D. Barker Clerk and Typist Miss S. Pox Clerk R.M, Newbury R.S. Cox Rodent Operative S.C. Potton Died 3.1.56 " R. Lazzolo P. Bedley " " Commenced 15.5 56 L, B, Radford Driver/Disinfector E. aieldrick " 5 Mr, Mayor, Aldermen and Councillors, In presenting my Annual Report for the year 1956 I would like to draw attention to certain items of special interest. It will be remembered that during the Autumn of 1956 an outbreak of Poliomyelitis occurred and one school was particularly affected. In looking back on the outbreak we were fortunate to have had such a mild type of infection and no deaths occurred as a result of the outbreak. It is also of interest that whilst the location was around one school a number of individual cases occurred at other schools at about the same time, nevertheless the total number of poliomyelitis cases were in fact less in 1956 than they were in 1955, We cannot therefore consider 1956 as a poliomyelitis epidemic year as far as Ealing is con cerned. The new developments with Poliomyelitis vaccine have now proved themselves and there is every reason to look forward hopefully to the elimination of this illness from the population It is pleasant to know that the enter prise of a firm in the Borough of Ealing is largely respon sible for the British made vaccine which is playing such a large part in the present campaign for immunisation against Poliomyelitis. Progress is steadily being made in our Clean Pood work and a statement on the present position is in the body of this Report It has been a matter of considerable encouragement to us to find that the Clean Food film strip, prepared by our own Health Department, has had such a wide distribution throughout the World and has shown some profit to the Borough Council, It was always anticipated that persistent and patient propaganda and education were the strongest factors in any campaign for Clean Pood and our policy has been directed to that end. Whilst Ealing has, in the main, been extremely fortunate in having so few atmospheric pollution problems to deal with, heavy industry has been established in a few places for very many years, This has led to certain difficult problems which were born out of an absence, a generation ago, of Town Planning powers. The Health Committee and your officers are well aware of the need for close vigilence in any atmospheric pollution problems and much work has been done during the past year to maintain the 6 good record that Ealing has had for many years in this direction The lack of County Borough powers is the greatest handicap to the efficient working of public health services. The responsibility for services being divided between the County Medical Officer. Area Medical Officer and the Borough Medical Officer of Health can never evolve a satisfactory functioning As Medical Officer of Health I have no hesitation in deploring the present position which in rry view is wasteful and inefficient May I take this opportunity of expressing appreciation of the support and assistance given at all times by the Chairman and of the conscientious care given by the offi cers to their duties during the year These two factors have made the work of the department of great interest and most satisfying in its execution Your obedient servant,, W. G. BOOTH, Medical Officer of Health 7 SECTION 1 INFECTIOUS DISEASES CONTROL NOTIFICATION Notification is the essential preliminary 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 where by 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 1955 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, LABORATORY SERVICE, The laboratory at King Edward Memorial Hospital con tinues its fine and invaluable work in the diagnosis and prevention of infectious disease. The Public Health Depart ment 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. 8 PREVALENCE 1,612 cases of Infectious Disease were notified in the Borough during the year* Of these 23 were proved not to have suffered from the disease for which they were originally notified reducing the corrected number of cases of Infectious Disease during the year to 1589 This substantial decrease in the number of notifica tions was to be expected and is in complete accordance with the pattern of measles which does show invariably a biennial decrease CERTIFICATION When contacts of infectious persons are excluded from work on account of potential risk to others a certif icate is provided to ensure the payment of benefits under the National Insurance Act, DISINFECTION Books which have been handled by infectious persons are stored in a formalin box for three weeks before being returned to a library.. DIPHTHERIA No cases were notified in 1956 The total number of primary immunisations given at clinics and by General Practitioners was 2,0 29 and the number of booster doses was 2,636, As the number of live births for the year was 2,513 it can be calculated that the proportion of children in the first year of life who received primary immunisation was 80% It will be remem bered that to obtain a satisfactory state of immunity 70% to 75% of children in the first year of life should be immunised Our percentage for the year therefore is satis factory, Although this figure is within satisfactory limits there should be no easing off in immunisation because it is the experience all over the country that as cases of Diphtheria become fewer and fewer so in the minds of parents there is a tendency to regard the need for immunisation as less and less urgent and so a diminishing number of children each year is presented at the clinic for this purpose. It should not be forgotten that the dramatic fall in the number of Diphtheria cases is due mainly to immunisation against the disease and if the level of 9 immunisation falls too low the disease could regain its former virulence and killing power The following interesting information has been revealed following Ministry of Health Surveys In 1954 there were 166 confirmed cases of Diphtheria, One hundred of the 160 cases about which information was available were under 16 years Of these 60 had never been immunised and there were 6 deaths among them Forty had been immunised and there was no death DYSENTERY 179 cases were notified an increase of 54 compared with the year before The majority of cases were of a mild character wh^ch rapidly cleared up S Sonnei usually causes a very mild form of the dis ease, the symptoms being often of so mild a character that they are completely ignored This is. however a highly dangerous state of affairs as fatalities can occur in the young, the aged and the debilitated and good per sonal and environmental hygiene should be continually emphasised, in particular hand washing immediately after a visit to the toilet ENTERIC FEVER No cases occurred during the year ENTERIC FEVER CARRIER As mentioned in previous reports the same Paratyphoid B carrier was kept under surveillance and routine three monthly faeces examinations carried out These showed that die continued to be a carrier She is acutely aware of her handicap and is scrupulous in taking all possible precautions ERYSIPELAS The same number of cases was notified as in 1955 12 FOOD POISONING There were 26 notifications received a decrease of 10 over the previous year. In 16 of the 26 cases laboratory diagnosis was confirmed 14 were Salmonella Typhimurium and 2 Salmonella Enteritidis. 10 This further decrease is again highly creditable to the Borough of Ealing but it should be remembered that Pood Poisoning is essentially preventible and I feel that the suggestions I made in a previous report for the production of safe food cannot be repeated too often. Pood handlers should realise fully their responsibility and should have a high standard of personal hygiene Their hands should be in a good condition and clean their finger nails should be short clean overalls should be worn and hair covered with a cap. Minor illnesses should be repor ted. Cuts should be treated and covered Colds, running ears or diarrhoeal illnesses should be 'stood off' or watched carefully Firms should provide adequate facilities for their employees for washing their hands. The importance of this especially after use of the toilet, should be emphasised and notices to this effect displayed in lavatories Staff should be selected with care and those with a history of enteric or any such illness should not be chosen. With regard to the technique of the kitchen, manual handling of food should be avoided wherever possible Refrigeration is a keynote and wrappings and covers for food on display are essential, Reconstituted eggs custard powders and so on should not be kept in a warm place The kitchen should be con structed so that it is easily cleaned ventilation and lighting should be adequate and there should also be adequate storage space The necessity for the above precautions has been fully realised in the Borough and the steps taken by the Chief Public Health Inspector and his staff to achieve the desired effect are mentioned in a later part of this report, MEASLES, The biennial decrease previously mentioned occurred in 1956 when 726 cases were notified compared with 2,422 in 1955, MENINGOCOCCAL INFECTION, Two notifications were received and upon inspection no overcrowding was found. 11 OPHTHALMIA NEONATORUM Two cases occurred in hospital and one in private practice All three cleared up after treatment and the eyes were not damaged PNEUMONIA 161 notifications were received again showing a decrease over the previous year There were 124 deaths, 57 males and 67 females POLIOMYELITIS There were 48 confirmed cases 27 paralytic and 21 non paralytic In spite of the outbreak in the North Ealing area this is a decrease of 10 against the previous year when there were 58 confirmed cases 20 paralytic and 38 non paralytic. Last year s cases occurred in the following age groups Paralytic Non Paralytic M. P MP Under 1 year 1 1 1 1 2 - 3 2 2 4 2 1 1 5-9 years 8 6 5 5 10 14 years 1 7 2 15 24 years 1 25 and over 2 16 11 12 9 There were no deaths The outbreak in the North Ealing area caused con siderable anxiety among parents in the Borough and many and varied enquiries concerning this disease were received and dealt with by the Public Health Department. A large number of Head Teachers also sought advice and it was considered advisable to send to every school a printed list of instructions concerning the general precautions to be taken during the summer months when poliomyelitis is prevalent. The first case was notified on 5th October and from that date until the 10th December there were 43 notifica 12 tions of which 38 were confirmed, 22 paralytic and 16 nonparalytic. The first 32 cases had dates of onset varying from 14th September to 4th November and were mainly confined to the North Ealing area but it was interesting to note that the subsequent notifications had a much wider distribution and that they included the five unconfirmed cases. Of the remaining six confirmed cases in this group only one occurred in the North Ealing area. The ages of cases varied from 28 years to 4 weeks. Ten schools in all were eventually involved but the North Ealing School was hardest hit, there being 13 cases, 6 paralytic and 7 non-paralytic. The age groups affected were as follows:- Age 5 and under 4 9 9 7 99 99 ^ it 8 99 99 J 9 9 9 9 9 99 2 " 11 " " 2 By thorough investigation of the outbreak it was hoped that something could be added to the existing scanty knowledge of the epidemiology of poliomyelitis but though all avenues of investigation were explored it proved impossible to pinpoint the source of infection or its means of spread. These enquiries did, however, reveal that in five cases originally notified as non-paralytic poliomyelitis, laboratory investigations succeeded in isolating not a virus of polionyelitis but a virus related to ECHO Virus Type 9, In the last 18 months, this organism has been found in outbreaks of aseptic meningitis in several parts of the country. The condition has many of the appearances of poliomyelitis but paralysis is absent and recovery occurs within a week. The methods used in investigation and control of poliomyelitis epidemics are as follows:- METHODS OF CONTROL. Control of the infected individual, contact and environment. (i) All cases are notified to the Medical Officer of Heal th. (ii) All suspected cases are isolated, usually in hospital, for three weeks. 13 (iii) Disinfection of throat discharges, faeces and soiled articles is carried out in hospital. (iv) Quarantine is of unproved value. While quarantine of family contacts is theoretically worthwhile there is no evidence of nractical benefit because of the large number of unrecognised infections in the community, (v) Investigation There is a thorough search for sick oersons, especially children, to locate unrecognised and unreported cases (vi) Treatment There is no specific treatment other than attention to prevention and management of paralysis, EPIDEMIC MEASURES. (i) Notice to general practitioners of increased incidence of the disease (ii) Isolation in bed of all children with fever, pend ing diagnosis, (iii) Education of the public in personal hygiene in order to prevent spread of the disease through transmission of infectious discharges (iv) Protection of children so far as practicable against unnecessary close contact with other per sons especially with other family groups or outsiders during epidemic prevalence of the disease. Urban schools should not be closed or opening delayed but intensive or competitive athletic programmes should be postponed (v) Postponement of nose or throat operations where practicable. (vi) Avoidance by children of excessive physical strain, (vii) Postponement of inoculation against diphtheria, whooping cough, etc, (viii) Avoidance of unnecessary travel and visiting VACCINATION AGAINST POLIOMYELITIS, In May vaccination against Poliomyelitis was begun. For some time previously Salk vaccine had been used in America and over 11,000,000 children were vaccinated. When the vaccine was first introduced in the United States some children suffered ill effects but the cause of this was found and rectified. 14 The vaccine used in this country varies slightly from the American and has been subjected to the most stringent tests Two injections at a month s interval are given into the upper arm The protection against paralytic polio myelitis is rot claimed to be complete but it is considered that protected children are 4 to 5 times less likely to suffer in this way than unprotected children. Unfortunately supplies allocated to us by the Ministry of Health are very limited and the position in Ealing by the end of the year is summarised below. Age Group (year of birth) No of Children Registered in March 1956 as accenting offer of vaccination % of acceptances amongst those eligible No. of children Vaccinated by 31st Dec. 1956. 1947 1 411 40 87 1948 1 233 43 91 1949 1,150 43 71 1950 1,028 41 68 1951 645 27 134 1952 449 19 96 1953 429 18 95 1954 285 12 45 6; 631 31 687 There have been no ill effects amongst Ealing children attributable to the vaccination. One protected child who later became a poliomyelitis suspect was subsequently found to be suffering not from poliomyelitis but an infection with a virus related to ECHO virus type 9 as described above. It is hoped that during 1957 we shall be in a position to offer vaccination to many more children whose parents wish to avail themselves of this latest advance in preventive medicine, PUERPERAL PYREXIA. There were 71 casess 4 of which occurred in home confinements and the remainder in hospital confinements. SCARLET FEVER. There was a slight increase in the number of notifications, 156 against 118 in 1955. They were again of a very mild character. TUBERCULOSIS. As the following table shows the number of Pulmonary cases notified was 73 males and 61 females, compared with (Reproduced by kind permission of "Middlesex County Times") Vaccination against Poliomyelitis 17 68 males and 51 females in 1955. Non pulmonary cases noti fied decreased from 10 males and 14 females in 1955 to 8 males and 5 females in 1956. There were 21 pulmonary deaths compared with 17 in 1955 and 1 non pulmonary death against 3 in 1955. WHOOPING COUGH 67 cases were notified a decrease from 156 in 1955 18 TUBERCULOSIS Age Periods New Cases Pulmonary Non-Pulmonary 1951 1952 1953 1954 1955 1956 1951 1952 1953 1954 1955 1956 M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. Under 5 5 4 5 2 5 2 3 1 1 — 2 1 1 1 — 4 _ _ 2 _ 1 - 1 _ 5 - 14 - 4 5 6 7 4 1 2 1 1 2 5 2 1 4 1 t 2 - 2 2 4 - - 15 - 24 24 26 13 44 15 38 13 24 16 14 14 21 6 4 2 4 - 1 1 2 2 3 2 - 25 - 44 46 37 46 37 30 43 23 26 21 26 22 21 3 3 5 5 2 4 1 4 2 4 1 4 45 - 64 39 17 32 10 39 9 23 11 23 7 29 9 - 3 1 3 4 4 1 3 1 2 4 1 Over 65 8 - 9 2 7 6 3 2 6 3 4 4 - - - - 1 1 - 1 2 1 - - Total 122 88 110 101 103 102 66 66 68 51 73 61 12 12 12 17 8 12 5 12 10 14 8 5 Age Periods Deaths Pulmonary Non-Pulmonary 1951 1952 1953 1954 1955 1956 1951 1952 1953 1954 1955 1956 M. F. M. F. M. F. M. F. M F. M. F. M, F. M. F. M. F. M. F. M. F. M. F. Under 5 1 – – – – – – – – – – – – – – – – – – – – – – – 5 - 14 – – – – – – – – – – – – 1 – – – – – – – – – – – 15 - 24 2 2 6 5 – – – – – 1 – – – 1 – – – – – – – – – – 25 - 44 2 9 4 4 4 4 3 2 3 1 1 – 1 – 1 1 – 1 – – 1 – – – 45 - *>4 8 1 7 3 9 3 5 3 5 – 11 2 1 – 1 – – – – 1 1 – 1 – Over 65 5 - 7 1 5 3 4 2 6 1 5 2 – – – – – – – – – – – – Total 18 12 24 13 18 10 12 7 14 3 17 4 3 1 2 1 - 1 - 1 3 - 1 - 19 SECTION 2 SANITARY CIRCUMSTANCES OF THE BOROUGH WATER There are three sources of supply in the Borough, The Northolt Greenford North Greenfor^ Central and Greenford South Wards most of Perivale Ward and part of Hanger Hill Ward are supplied by the Rickmansworth and Uxbridge Valley Water Company with the exception of four roads (in part) in the Perivale Ward and one road (in part) in the Hanger Hill 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 satisfac tory both in quantity and quality. Water from public mains is supplied to 53 318 houses with an estimated population of 184,200. Fifteen samples were taken from wells at five fac tories in the Borough using water from deep borings rang ing in depth from 300 to 600 feet. Two of the samples taken from the same point were found to be unsatisfactory for drinking purposes, but after the storage tank con cerned had been thoroughly cleansed a further sample proved, to be satisfactory. The analysis of the remainder of the samples showed that the supplies were wholesome in character DRAINAGE AND SEWERAGE One cesspool was discontinued during the year leaving 22 premises not connected to the Council's sewers, Nego tiations are at present proceeding for a further cesspool to be abolished and the house connected to the Council s sewerage system. RIVERS AND STREAMS Staff shortages have again handicapped the work of tracing sources of pollution of the River Brent but with staff now up to establishment it is hoped to resume this important work. Of 19 samples taken during the year by the County Engineers Department of the Middlesex County Council from sewer outfalls into the River Brent 7 were found to be unsatisfactory. Investigations were carried out and drainage defects in 16 houses and 1 factory were remedied after notice by the Public Health Inspectors. 20 ATMOSPHERIC POLLUTION During the year further complaints were received from the Birkbeck Residents Association on behalf of residents in the Long Drive Area regarding the alleged nuisances from fumes dust and smoke stated to be emitted from a heavy industrial factory in this area. Complaints were investigated and full reports of the circumstances were presented at regular intervals throughout the year to the Public Health Committee. In an effort to discover whether any further steps could be taken by the factory in ques tion to improve matters the Council appointed a recommen ded firm of consulting chemical engineers to inspect the processes at the factory and to submit a report to the Council, Prior apDroval to this course had already been obtained from the Company concerned A comprehensive report was received and copies were circulated to every member of the Council The report was of assistance to the Council in so far as the specific complaints were dealt with in detail the processes described and the steps which the firm were proposing to take to still fur ther improve their works technique were outlined. Subsequent to this report a meeting took place in the autumn between the Public Health Committee representatives of the Company and representatives of the Birkbeck Residents Association, For a period of sixteen months from the 1st February 1955 to the 2nd July, 1956 an atmospheric deposit gauge and a lead peroxide instrument were sited in close proxim ity to the factory and the following tables give the average deposits over this period: Deposited matter expressed as tons per square mile per month Sulphur compounds by lead peroxide method expressed as milligrams 80_/day collected by 100 sq. cm. of Batch A PbO 2 Average for 16 months 1.2,55 2.7,56. (Ranging from 142 Hill Rise 19.86 7 18 to 46 02) Average for 16 months 1,2,55 2,7.56 (Ranging from 142 Hill Rise 0.83 0,35 to 1 62) Over the past four years, the Compaay concerned have adopted anew technique on the advice of the Alkali Inspec tor to reduce the emission into the atmosphere of fluorine which was suspected of being a cause of damage to vegeta tion. They have also had expert advice on the efficient 23 working of their oil burning muffle furnaces and have carried out certain modifications to reduce the emission of smoke into the atmosphere other modifications are, I understand being considered. Also grit arrestors have been fitted to the cupola stacks in the foundry- At the present time works are in progress which should be completed during 1957 on the construction of entirely new types of cupola stacks which are stated to incorporate much improved grit arresting appliances It would appear that many of the difficulties experienced in this area by residents can be attributed to the absence of effective Town Planning legislation in the past which allowed the siting of residential properties in close proximity to a factory which is carrying out heavy industrial processes, Towards the end of the year the Council obtained the advice of the Department of Scientific and Industrial Research as to the siting of the atmospheric deposit gauge and acting on this advice the Council authorised one deposit gauge and a lead peroxide instrument to be erected in the Greenford Green area and one deposit gauge and a lead, peroxide instrument in the neighbourhood of the Town Hall Ealing. These were placed in position in November 1956 and the readings for November and December were as follows Sulphur compounds by lead Deposited matter expressed peroxide method expressed as tons per square mile as milligrams SO3./day per month collected by 100 sq. cm. of Batch A PbO2 Longfield Greenford Longfield Greenford Depot Green Depot Green Nov 1956 10.00 5,27 Nov. 1956 1,10 1.22 Dec 1956 17 92 12 08 Dec. 1956 1 92 1,66 The Clean Air Act 1956 came into operation on the 31st December, 1956 and I hope to be in a position to include information on the administration of this Act in Ealing in my next year s report. During the year 185 smoke observations were made on industrial premises in the Borough and in 3 cases it was necessary for the Inspector to make representations to the factories concerned regarding the emission of smoke. In each case the necessary work was carried out and the nuisances were satisfactorily abated. 24 FOOD HYGIENE The Food Hygiene Regulations 1955 came into force on the 1st January. 1956 but some of the provisions relating to certain structural alterations were not operative until the 1st July. 1956. In order to give those engaged in the food, trades a better understanding of these Regulations a summary was sent to every food trader in the Borough and talks were given to members of the various food trades. Altogether 13 talks were given which were attended by the managers and proprietors of 402 food businesses. Also discussions were held at a special meeting of the Ealing and District Grocers Association and at a meeting of the Greenford Chamber of Trade. I am of the opinion that these explanatory talks on the Regulations served a very useful purpose and in many cases encouraged proprietors of food businesses to carry out the necessary works and improvements required without waiting for a visit from the Public Health Inspectors. The work of inspecting food premises was handicapped by a shortage of Inspectors for a considerable period of the year but, nevertheless, 2,062 inspections of food premises were made and 452 repairs and improvements were carried out. During the year 36 lectures were given to food handlers of whom 123 received Certificates of Attendance upon completing the course. Since the scheme commenced 422 lectures have been given and 1,680 persons have received Certificates of Attendance. The number of Certificates of Pood Hygiene awarded to food establishments increased during the year to 56, two new Certificates being issued. Twenty-three talks on Pood Hygiene were given by the Public Health Inspectors to approximately 920 schoolleavers in the Grammar and Secondary Modern Schools in the Borough. The demand for the film strip on Pood Infections made by the Council still continues and a further ten copies were sold during the year, BATHS AND SWIMMING POOLS. The Council's Swimming Baths in Longfield Avenue are equipped with pressure filters for continuous filtration and the water is treated with chlorine under strict 25 vision Tests for the efficiency of chlorination are taken daily. There are two privately owned swimming pools in the Borough both of which are fitted with filtration and chlorination plants. PUBLIC MORTUARY The arrangement with the Acton Council for the use of the Acton Mortuary was continued during the year. 248 bodies were taken to this Mortuary and post mortem examinations were carried out in every case but one. 26 SECTION 3 SANITARY INSPECTION THE WORK OF THE PUBLIC HEALTH INSPECTORS IN 1956 I append a report to the Medical Officer of Health by the Chief Public Health Inspector giving details of the work of the Public Health Inspectors during the year PUBLIC HEALTH ACT 1936 Inspections Premises inspected on complaint 2,402 Other nuisances observed by Inspectors 61 Premises inspected in connection with infectious disease 729 Smoke observations 185 Houses without water supply 78 Inspections of moveable dwellings 41 Other inspections 1,850 Re inspections 6,426 Intimation Notices served 1 526 Statutory Notices served 217 Letters written 3,830 Proceedings before magistrates 5 Legal Proceedings PUBLIC HEALTH ACT 1936, SECTION 93 Non compliance with Statutory Notices In four cases legal proceedings were taken to enforce compliance with Notices requiring the abatement of nuisances. In each case Orders were made by the Magistrates for the necessary work to be carried out within a stated period and costs amounting to £3. 3s. 0d. were awarded. In one further case proceedings were instituted for noncompliance with a Nuisance Order, but the Magistrates accepted an undertaking given by the owner that the neces sary work would be completed within fourteen days. This undertaking was observed by the owner and the work duly completed, FOOD AND DRUGS ACT 1955 Food Hygiene Regulations, 1955 Milk and Dairies Regulations, 1949 to 1954 Complaints received 79 Inspections of Milk Purveyors' Premises 27 Inspections of Ice Cream Premises 216 Food Inspections 496 Inspections of Other Food Premises 1, 750 Contraventions found 276 Notices served , .. 239 Proceedings before Magistrates 3 Samples of Milk and Cream taken 42 Samples of Ice Cream taken . , 63 Samples of Synthetic Cream taken 55 Samples of other foods taken 19 Legal Proceedings, FOOD AND DRUGS ACT, 1955 In the following three cases proceedings were insti tuted under Section 2 of the Pood and Drugs Act; 1955 Mould in milk - Pined £10. Costs £3 3s, 0d- Poreign matter in notato crisps Absolute discharge. Costs £5 5s. 0d. Nail in currant bun - Pined £5. SECTION 9 FOOD AND DRUGS ACT 1938 An Appeal to the Divisional Court against a conviction by the local magistrates for the sale of a loaf of bread containing a used bandage dressing v/as dismissed with costs. List of Food Premises in the Borough of Ealing Bakehouses 31 Bakers shops Butchers 125 Cafes and Restaurants 148 Canteens - factory 79 Canteens - school 22 Confectioners 240 Dairies and Milk Sellers 71 Pish Fryers 21 Fishmongers 34 Greengrocers 161 Grocers 331 Ice Cream Manufacturers 5 Public Houses 61 Premises registered for the preparation or manufac ture of sausages or potted, pressed pickled or preserved food 103 Premises registered for the sale of Ice Cream 343 28 Milk Supply There are 86 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 58 17 75 Sterilised Milk 55 17 72 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. 42 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 37 37 - 37 - T.T. Pasteurised 5 5 - 5 - In addition 216 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 343 premises in the Borough registered for the sale of ice cream. It was found that their ice cream is obtained from 5 registered manufacturers in the Borough or from 11 manufacturers outside the Borough. Samples from each of these manufacturers were taken once or more during the year, a total of 63 samples of ice cream and ice cream constituents being submitted for bacteriological examination. The results were as follows 29 Commodity Samples Grade Not Graded 1 2 3 4 Ice Cream Local Manufacture 26 4 11 2 9 - Ice Cream Other Manufacturers 27 4 12 2 9 - Ice Cream Constituents 10 - - - - 10 63 8 23 4 18 10 The high proportion of samples shown this year as unsatisfactory is due to the new grading system adopted experimentally by the Bacteriologist at the Public Health Laboratory Ealing. Together with Brentford & Chiswick Southall. Acton. Hayes&Harlington and Heston& Isleworth, we agreed to accept these unofficial standards. Prior to 1956 ice cream was placed in the top grade if it passed the Methylene Blue Test. The presence of faecal and other organisms in any quantity did not affect the grading. In 1956, the Methylene Blue Test was discontinued and a plate count was carried out on all samples. The presence of faecal organisms automatically placed the sample in the lowest grade, and the number of other organisms present was considered in grading other samples, Plate counts of less than 500 are graded 1, 500-20 000 Grade 2, 20,000-100,000 Grade 3 and over 100 000 Grade 4. On the old system at least 11 of our unsatisfactory samples this year would have been graded as satisfactory. The following-up of the unsatisfactory samples of ice cream manufactured in Ealing involved the testing of various constituents and equipment and the contamination was traced in all cases - in one case an unsatisfactory ingredient was being used, in another case the sterilizing agent was not doing its work and in a third case the sterile ice cream was being contaminated by a container after manufacture, Unsatisfactory samples of ice cream manufacturered outside Ealing were reported to the Local Authorities concerned for investigation. Repeat samples subsequently proved to be satisfactory in all cases. Ice Cream Heat Treatment Regulations, 1947 1952, There are 6 premises registered for the manufacture of ice cream but only two of these are in regular use. 30 All the registered ice cream manufacturers in the Borough are equipped in accordance with the conditions laid down in the Regulations, Synthetic 55 samples of synthetic cream were taken from local manufacturers. All were found to be satisfactory. Inspection of Meat and Other Foods. The following foodstuffs were condemned by the Public Health Inspectors as unfit for human food in the course of their inspections of the various food premises in the Borough- lbs. Apple 2,000 Bacon 116¾ Beans 28 Beef 2,836 Black Pudding 7 Brawn 3½ Butter 2½ Cheese 49¾ Cocoanut 200 Corned Beef 624¼ Fish 14 Frozen Whole Egg 44 Ham 262 Hearts 23 Jellied Veal 6½ Kidneys 74 Lamb 14 Liver 90 Margarine 1 Mutton 28 Pork 147 Potatoes 11,080 Roes 28 Sausages 132 Sausage Meat 105 Semolina 25 Tongue 2½ Veal 4 Foodstuffs not calculated by weight. Eggs 127 Fish cakes 24 Steak Pie 1 Olives ¾ barrel Assorted tins, jars packets, bottles etc, 5,093 Slaughterhouses There is one licensed slaughterhouse in the Borough but no slaughtering was carried out during the year, MIDDLESEX COUNTY COUNCIL ACT, 1950, SECTION 11 Under this Section 7 persons were registered during the year for the sale of food from carts, barrows other 31 vehicles etc. There were 44 persons on the Register at 31st December., 1956. 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) 2,440 (2) Number of dwelling houses (included under sub head (1) above) which were inspected and recorded under the Housing Act 1936 25 (3) Number of dwelling houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation 11 (4) Number of dwelling-houses (exclusive of those referred to under the preceding subhead) found not to be in all respects reasonably fit for human habitation 1,681 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 . . .. 1 427 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 B - Proceedings under Public Health Act (1) Number of dwelling-houses in respect of which notices were served requiring defects to be remedied 187 (2) Number of dwelling-houses in which defects were remedied after service of formal notice^ (a) by Owners 175 (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 2 (2) Number of dwelling houses demolished in pursuance of Demolition Orders (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 4 (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 32 During the year one Clearance Area was declared by the Council. This was in respect of Nos. 5, 7, 9, 11 and 13 York Avenue, W.7. At the end of the year two of these properties were still in occupation. The following houses were the subject of Demolition Orders: 9 St. Mary s Road. W 5 1 Rosedale Close W 7 Both of these properties have been vacated and the houses demolished. Closing Orders were made by the Council in respect of the following properties 36 Lower Boston Road (basement) no re-housing was necessary as the premises were empty Moat Villa Ealing Road. Northolt (upper portion only) this Closing Order was in respect of the dwelling accommodation above a club. The tenants have been re-housed by the Council and the Closing Order is operative 24 Oxford Road (basement) no re housing was neces sary as the Council had re-housed the tenant prior to the Closing Order being made 55 Mount Avenue W.5 (basement) - no re housing was necessary as the Council had re housed the tenant prior to the Closing Order being made. One basement No, 38 Alacross Road W. 5 was rendered fit by the owner and the Closing Order was determined by the Council, During the year the Council agreed in principle to the determination of the Demolition Order in respect of St, Aidan Ealing Green upon completion of an approved specification of works of repair and improvement. This work is now in hand, HOUSING REPAIRS AND RENTS ACT, 1954 During the year 21 applications for Certificates of Disrepair and 22 applications for Certificates of Disrepair to be revoked were granted by the Council, NEW DWELLINGS, 1956 Completion figures for the 12 months period ending 31st December, 1956 were- Houses (1 bedroom) - 8 Houses (2 bedrooms) - 4 Houses (3 bedrooms) - 124 Plats (Bedsitters) - 1 Plats (1 bedroom) - 24 Flats (2 bedrooms) - 86 Flats (3 bedrooms) - 5 35 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 Public Health 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 73 19 - - (ii) Factories not included in (i) in which Section 7 is enforced by Local Authority 514 338 26 - (iii) Other Premises in which Section 7 is enforced by the Local Authority (excluding out-workers premises) - - - - Total 587 357 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, Inspector By H M. Inspector Want of cleanliness 1 — - _ - Overcrowding - - - - - Unreasonable temperature - - - - - Inadequate ventilation - 3 - - - Ineffective drainage of floors - - - - - Sanitary Conveniences (a) Insufficient 2 4 - l - (b) Unsuitable or defective 10 15 - 8 - (c) Not separate for sexes 2 - - - - Other offences against the Act (not including offences relating to out-workers) 2 4 - 2 - Total 17 *26 - 11 - *This figure includes certain defects which were outstanding at the end of 1955. 36 Part VIII of the Act Outwork (Sections 110 and 111) Section HO Section 111 Nature of Work 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. 254 - Cleaning and Washing 1 - Furniture and upholstery 5 - Artificial flowers 7 - Paper bags 5 - Making of boxes or other receptacles or parts thereof made wholly or partially of paper 7 - Carding, etc. of buttons, etc. 38 - Feather sorting 1 - Stuffed toys 35 - Cosaques, Christmas crackers, Christmas stockings, etc. 67 - Lampshades Brass and Brass articles 17 2 - - Household linen 1 - Total 440 - During 1956 26 inspections of Outworkers premises were carried out by the Public Health Inspectors. SHOPS ACT, 1950 Improvements under Section 38 of the Shops Act, 1950, relating to the health and comfort of shop workers were carried out in 77 instances: Lighting and ventilation improved 17 Heating improved 1 Sanitary accommodation improved 35 Washing facilities provided 24 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 Public Health Inspector. Complaints 880 Premises inspected 1,130 Premises found to be infested with: 1 Rats 861 2 Mice 169 Re-visits to infested premises 2,987 Pees received for treatment £639.15.0d. 37 Rodent Control in Sewers In accordance with the requirements of the Ministry of Agriculture Fisheries and Food (Infestation Control Division) maintenance treatments of the soil sewers in the Borough were carried out during March and September, A total of 1 220 sewer manholes were dealt with and of these 476 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 Fourteen licences were renewed by the Council during the year after the premises had been inspected by the Public Health Inspector, DISINFECTION Number of houses where disinfection was carried out 133 Number of houses disinfested of vermin 45 Number of articles disinfected by steam 85 Number of articles disinfected by formalin spray 299 Number of articles voluntarily destroyed 317 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 3 Caravans - nuisances abated 4 Cesspools - cleansed - Damp proof courses inserted in walls 35 Dampness - other forms remedied 207 Drains - connected to sewer 1 Drains - cleared and cleansed 653 Drains reconstructed 75 Drains - repaired 216 Drains - new soil and ventilating pipes provided 20 Dustbins provided 133 Firegrates - repaired or renewed 69 Floors - sub-floor ventilation provided 23 38 Floors - repaired or renewed 69 Food cupboards ventilated 3 Rainwater eaves gutters downpipes repaired 226 Refuse accumulations removed 76 Roofs repaired 264 Sinks repaired or renewed 29 Sink waste pipes repaired or renewed 61 Staircases repaired 20 Walls and ceilings repaired or cleansed 387 Water supply reinstated 78 Water supply draw taps fixed to main supply 4 Water closets repaired reconstructed or improved 162 Windows and doors repaired 280 Yards paved or repaired 39 Other defects remedied or nuisances abated 219 SUMMARY OF WORK DONE AND IMPROVEMENTS CARRIED OUT AT FOOD PREMISES Walls and ceilings repaired and cleansed 98 Floors repaired 24 Lighting and ventilation improved 17 Washing facilities provided 24 Hot water provided 48 Sinks provided 27 Storage accommodation improved 27 Water supply provided 3 Water closets cleansed or repaired 35 Refrigeration installed or improved 23 Yards paved Shop heating facilities improved 1 Equipment improved 59 Other defects remedied 64 39 SECTION 4 GENERAL MASSAGE AND SPECIAL TREATMENT ESTABLISHMENTS One new licence was issued to a chiropodist during the year so that the number of registered establishments at the end of the year was 26. The same four persons were granted exemptions from registration as before by virtue of being members of the Chartered Society of Physiotherapists. NURSING HOMES Eight registered Nursing Homes remain in the Borough and these are inspected annually, One of these was granted fresh registration in the name of the daughter of the owner upon her taking over the home following her mothers death. In addition to the above there is one home for ex service men only which is exempt from registration. HEALTH EDUCATION. The same means were employed for distributing leaflets issued by the Central Council for Health Education as in previous years, through the display trays in the Town Hall and in the Libraries. In the same manner 1 000 copies a month of Better Health, the journal of the Central Council, are distributed. Prom the demand for both the leaflets and the Journal there is no doubt that this is an effective means of bringing to a wide cross section of the general public much useful advice and information. In November 1956, it was decided that the Borough should take part in the National Home Safety Week from November 5th to 10th. This campaign was initiated by the Royal Society for the Prevention of Accidents who took as their theme the prevention of accidents in the homes of elderly people, A letter announcing Ealing's participation in this scheme was published in the local press a fortnight in advance. In this letter it was pointed out that the accident rate among old persons has gradually risen in recent years, and that many such accidents were preventable. In 1954 for example, there were about 5 400 deaths amongst elderly 40 people resulting from this cause alone in Britain, whilst the number of non-fatalities was probably many times greater, 3 500 leaflets and 375 posters dealing with this prob lem were distributed by the health clinics public librar ies and old people's clubs in the Borough. Posters and leaflets were also sent to all the General Practitioners in the area Twenty-five sites were rented for poster display together with spaces hired for poster display at the stations. 200 posters were distributed to shops with the kind co operation of the Ealing and Greenford Chambers of Commerce and also the Northfield Traders Association, MEALS ON WHEELS SERVICE The following report on the years work has been supplied by Mrs E. V, Bruce the Divisional Director of the Ealing Area Division of the British Red Cross Society whose members carry out the distribution of hot meals to the aged and infirm:- This service has continued its usefulness in the Borough during 1956 and has delivered hot mid day meals on five days a week to the sick and Pensioners living entirely alone with no-one to look after them. The food was cooked at Florence Nightingale House. 85 Uxbridge Road Ealing W 5 the Headquarters of the Ealing Division of the British Red Cross Society and 13 980 meals were delivered during the past year The hot meal for which 1/- is paid by those who can afford it consists of meat and vegetables or steamed fish and vegetables and milk or steamed pudding. For those who cannot afford to pay, no charge is made. The usual Christmas Dinner was delivered free of charge during the Festive Season and consisted of roast turkey vegetables and Christmas Pudding etc. Requests for these meals come through the Medical Officer of Health Home Help Department Almoners of Hospitals and Doctors and there is generally a waiting list of twelve people." NATIONAL ASSISTANCE ACT, 1948 Section 47 This Section deals with securing the necessary care and attention for persons who (a) are suffering from grave chronic diseases or being 41 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 There was no necessity to use these powers during the year. Constant watch is kept on old people to ensure that if they are not receiving care and attention they should if necessary enter a hospital or home On most occasions persuasion is successful but some old people despite the fact that their home may be a single room in a dirty and unhygienic condition show great reluctance to leave During the year the following two cases were kept under supervision. The first was an elderly lady who was discharged at her own wish from a Nursing Home in 1954 but she was unable to fend for herself and was practically confined to bed the whole time. She was in receipt of a midday meal from the Red Cross and her doctor and nurse attended daily The house was in an extremely dirty condition and con tained a great deal of unnecessary refuse and was also in a bad state of repair. She refused emphatically to consider admission to any type of Home. She died in September 1956 and subsequently the house was cleansed and all the refuse removed by the Council. The other case relates to an aged man who lives alone. He receives some assistance from another tenant. He is now becoming incapable of fending for himself and he is being kept under observation in case any further assistance is required. Assistance is also being given by the Home Help section and the Public Health Laundry Service. Section 50 Burial of the Dead There were 10 burials and one cremation for which the Council accepted financial responsibility, In the case of the cremation and two of the burials the total cost was recovered from the estate of the de ceased. A proportion of the cost was recovered in two cases. It was not possible to recover any of the cost in four of the remaining cases and two were still in the course of collection at the end of the year. 42 LAUNDRY SERVICE FOR THE INCONTINENT The Laundry Service is still continuing to perform an essential service for those elderly people in the Borough who are incontinent and for whom no other satisfactory arrangements can be made for the cleansing of bed linen and clothng* The following table shows the growth of the service since its inauguration in 1952. 1952 1953 1954 1955 1956 No. of cases dealt with during the year 46 66 84 78 62 No. of cases remaining at end of year 15 23 47 44 47 No. of cases that died 18 30 28 39 26 No, of cases removed to hospital 11 18 24 39 28 No. of cases where other arrangements were made ,. 2 10 8 7 5 Total number of articles dealt with 9,958 17,587 25 097 34.259 36,755 Total number of collections 1,144 1,784 2,500 3,347 3,036 Average number of articles per collection 8.7 9, 9 10.0 10. 2 11.9 Thanks are again due to the Secretary of the Old Peoples Welfare Committee of the Ealing Council of Social Service and the panel of helpers who voluntarily continued the work of repairing worn garments. It is interesting to note that such laundry services are not specifically sanctioned in any legislation but that 28 local authorities do in fact provide them. In Ealing this is done under the Public Health Act.- 1936 and the Middlesex County Council Act. 1956, but the procedure varies in different Authorities thus - The Public Health Act, 1936 or The Public Health (London) Act, 1936 17 Authorities The National Health Service Act, 1946 - 9 Authorities The National Assistance Act. 1948 - 2 Authorities It would appear, therefore, that legislation is called for both to clarify the position and encourage local authorities to provide laundry services for incontinent people, CARE OF OLD PEOPLE. The study of the age distribution of our population over the last 50 years shows the great increase in the number of old people. 43 Population of persons in England and Wales per 1 000 of total population 1911, 1921, 1939, 1945 and 1954. Age Group 1911 1921 1939 1945 1954 Under 15 307 277 210 205 224 15 - 44 480 469 475 450 415 45 - 64 162 194 226 233 247 65 and over 51 60 89 102 114 Total 1000 1000 1000 1000 1000 Advances in medical knowledge have meant that older ages are being achieved, but also a more significant fact that now the great majority of our population do reach old age instead of dying in their prime or middle age. Doubtless future legislation will acknowledge this fact but meanwhile it is opportune to review the not inconsiderable volume of work that is done in Ealing for old folk, both by the statutory and voluntary services. The spearhead of the Health Department in this respect is formed by the health visiting, home nursing and home help services. The Health Visitors are concerned with ascertaining the needs of old people and reference of these to the appropriate quarter. Some 500 old people are at present under surveillance by Health Visitors, Of the cases on the register of the Home Nursing Services 40% are aged 6 5 years of age or over and due to the complexity of these cases much more than 40% of the home nurses time is spent caring for old people. The Home Nursing Service works in close co-operation with the patient's doctor in the care of those sufficiently well to be treated at home. The Home Help Service numbers 200 in Ealing and undertakes all types of work in the home except nursing. The homes of many old people have, due to their owners infirmity, become very uncared for before help is sought and the enthusiasm with which the Home Helps restore this situation to normal is greatly to be commended. The Public Health Inspectors also assist in maintaining satisfactory conditions for old people and ensure that should an old person not be receiving proper care and attention steps shall be taken to admit such persons to an Old People's Home or hospital. 44 The Laundry Service for the Incontinent is perhaps the most appreciated of the services offered by the Health Department. The number of old folks thus helped is usually about 45 at any one time and it solves for them a problem which would otherwise be insoluble. The prevention of accidents is at all times the con cern of those working for the elderly and no opportunity is lost to give practical advice in this sphere. In addi tion during the year the Borough participated in a can paign initiated by the Royal Society for the Prevention of Accidents and a full account of this valuable work is given elsewhere in the Report. In addition to the services that the Council is able to provide itself it has powers to give grants to voluntary organisations. Under this arrangement the British Red Cross Society runs a Meals on Wheels service and the Ealing Council of Social Service has begun a Chiropody Service. Between its commencement in June and the end of the year this has provided regular chiropody for 35 persons and it is hoped to extend this several fold It is sometimes not realised that the simple task of cutting one's toe nails becomes a problem to the infirm. They also arranged a week's summer holiday at Southsea for 217 old people at a nominal charge of £1 Is. Od. The beneficial effect to health and morale of a holiday can well be imagined. This work done with such enthusiasm is of the greatest value. Much other voluntary work is also done thus there are 15 Old Peoples Clubs in Paling with memberships from 60 to 150 where weekly meetings for tea are held and a wide variety of functions such as concerts parties and outings to the circus are arranged. Financial help is given to these by several organisations in the Borough and assistance is received from the churches of all denominations. Visiting of sick members is arranged by these Clubs to augment that done hy other voluntary bodies. Visiting, home nursing and the loan of medical equipment is another part of the British Red Cross Society s contribution to the old people s welfare in the Borough, The value of the Laundry Service has been noted and mention should be made of the allied voluntary services, the mending of garments by the Ealing Council of Social Service assisted by the Ealing Townswomen's Guild and the Catholic Womens League. 45 We have so far considered only old people in their own homes. There are in the Borough four Old Peoples Homes run by the Middlesex County Council and three voluntary homes. These have a total accommodation of 103 and 82 residents respectively. In addition there are twelve private homes with a total accommodation of 109 persons and registration and supervision of these is carried out by the Welfare Department to ensure the comfort and well being of all residents. It is hoped from this account that the diverse nature of the services available can be appreciated. The immediate needs in the future are perhaps firstly an increase in the visiting of old people so that a really comprehensive scheme can operate and leave no lonely old person unvisited. The second need is not with the elderly who are incapacitated but with those who are still capable of active work but find that their age bars them from this. Whether special workshops should be instituted for them or whether their entry into normal employment should be facilitated is open to discussion but there does seem a growing need for some service of this nature, 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 Non-Trading Services. During theyear the following examinations were carried out: Administrative, Technical and Clerical Staff 36 Sickness Pay Scheme (Servants) 159 Gunnersbury Park Joint Committee Employees 7 Total 202 46 SECTION 5 STATISTICAL TABLES SUMMARY OF STATISTICS Area (in Acres) 8,783 Population (Census, 1951) 187,306 Population (estimated middle of 1956) 184,200 Rateable Value 1956-57 £3,473,349 Net Product of a Penny Rate 1956-57 £14,3 00 Live Births Legitimate Males, 1,193 Females, 1,186 Total 2,379 Illegitimate Males, 71 Females, 63 Total 134 Birth Rate per 1,000 of Estimated Population 13.6 Still Births:- Males, 20 Females 18 Total 38 Rate per 1,000 total Births (Live and Still Births) 14.9 Deaths Males, 973 Females, 949 Total 1,922 Death-Rate per 1,000 of Estimated Population 10.4 Deaths of Infants under one year of age- Legitimate Males, 16 Females, 17 Total 33 Illegitimate Males, 1 Females, 1 Total 2 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 15 Cases of Infectious and Other Notifiable Diseases notifiable in the Borough Disease 1945 1946 1947 1948 1949 1950 1951 1952 1953 1954 1955 1956 Smallpox - - - - - - - - - - - Diphtheria 14 29 11 13 16 3 2 1 - - Scarlet Fever 340 232 133 204 176 294 203 402 238 287 108 159 Enteric Fever (including Paratyphoid) - - - 3 8 5 3 2 3 5 7 - Puerperal Pyrexia 47 35 27 25 27 24 38 70 61 54 44 71 Pneumonia: Primary 110 114 127 189 163 173 162 100 157 152 135 113 Influenzal 14 16 3 6 10 6 38 28 74 52 56 48 Acute Poliomyelitis 3 4 46 10 34 42 10 21 13 5 61 46 Meningococcal Infection 6 6 10 2 14 9 2 - - 6 3 2 Malaria - - 1 2 - 4 1 1 3 1 1 - Dysentery 60 10 5 7 23 24 542 179 132 225 149 193 Erysipelas 26 31 38 32 13 24 17 26 18 18 12 12 Tuberculosis: Pulmonary 194 275 204 206 205 209 210 211 205 132 119 134 Non-Pulmonary 23 33 25 27 32 41 24 29 20 17 24 13 Ophthalmia Neonatorum 3 3 5 5 3 6 - - 2 2 2 Measles 2,330 791 806 1,379 1,450 1, 016 3,296 993 2, 558 132 2,422 726 Whooping Cough 236 271 310 383 303 274 550 77 491 116 156 67 Food Poisoning - — — - 21 23 86 26 31 78 36 26 Totals 3,046 1,850 1,757 2, 492 2„ 503 2, 174 5 190 2, 165 4 004 1,284 3,335 1,612 48 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 - Food Poisoning 16 Diphtheria - Meningococcal Infection 2 Scarlet Fever 156 Malaria - Enteric Fever (including Paratyphoid) - Dysentery 179 Erysipelas 12 Puerperal Pyrexia 71 Tuberculosis Pneumonia Pulmonary 134 Primary 113 Non-Pulmonary 13 Influenzal 48 Ophthalmia Neonatorum 2 Acute Poliomyelitis 48 Measles 726 Acute Encephalitis Whooping Cough 67 Infective 1 Post Infectious 1 Total 1,589 49 Infectious and Other Notifiable Diseases Classified in Age Groups Scarlet Fever Whooping Cough Poliomyelitis Measles Diphtheria Dysentery Meningococcal Infection Paralytic Non-Paralytic M F M F M F M F M F M F M F M F Numbers originally notified 85 74 31 36 15 9 11 11 357 369 - - 95 98 1 1 FINAL numbers after correction Under 1 year - - 3 1 - 1 - 10 10 - - 5 1 - - 1 - 2 - 7 6 - 1 - 1 30 28 - - 7 5 - - 2 - 7 2 5 5 - - - - 42 48 - - 7 7 - - 3 - 4 5 5 5 2 2 - - 50 32 - - 2 2 - - 4 - 8 4 2 6 2 1 - 1 55 63 - - 3 3 - - 5 - 9 45 46 8 9 8 6 5 5 151 171 - - 19 14 - 1 10 - 14 12 12 1 2 1 - 7 2 7 6 - - 7 7 1 - 15 - 24 3 3 - 1 1 - - - 9 4 - - 7 7 - - 25 and over 2 1 - 1 2 - - - 3 7 - - 30 46 - - Age unknown - - - - - - - - - - - - - - - - Total 83 73 31 36 16 11 12 9 357 369 - - 87 92 1 1 50 Pneumonia Smallpox Acute Encephalitis Enteric or Typhoid Fever Paratyphoid Fevers Erysipelas Food Poisoning Infective Post-Infectious M F M F M F M F M F M F M F M F Numbers originally notified 83 78 - - - 1 - 1 - - - - 6 6 12 14 FINAL numbers after correction Under 5 years 10 4 - - - - - - - - - - - - 2 - 5-14 10 8 • - - 1 - - - - - - - - 2 2 15 - 44 9 19 - - - - - 1 - - - - 2 2 - 6 45 - 64 34 19 - - - - - - - - - - 3 3 2 2 65 and over 20 28 - - - - - - - - - - 1 1 - - Age unknown - - - - - - - - - - - - - - - - Total 83 78 - - - 1 - 1 - - - - 6 6 6 10 Numbers originally notified Tuberculosis Other notifiable diseases Respiratory Meninges & C. N.S. Other Original Final M F M F M F M F M F 73 61 • 1 - 7 5 Puerperal Pyrexia FINAL numbers after correction Under 5 years 2 1 1 - - - - 71 - 71 Ophth Neonatorum 5-14 2 5 - - - - 2 - 2 - 15 - 24 14 21 - - 2 - 25 - 44 22 21 - - 1 4 45 - 64 29 9 - - 4 1 65 and over 4 4 - - - - Age unknown - - - - - - Total 73 61 1 - 7 5 51 DEATHS Causes of Death, 1956 Cause of Death Deaths. 1956 Total Deaths 1955 Male Female Total Tuberculosis Respiratory 17 4 21 17 Tuberculosis, Other 1 - 1 3 Syphilitic Disease 4 2 6 3 Diphtheria - - - - Whooping Cough - - - - Meningococcal Infections 1 - 1 - Acute Poliomyelitis - - - 1 Measles - - - - Other Infective and Parasitic Diseases - 4 4 1 Malignant Neoplasm, Stomach 23 22 45 56 Lung Bronchus 54 8 62 86 Breast - 34 34 43 Uterus - 14 14 12 Other Malignant Lymphatic Neoplasms 89 85 174 172 Leukaemia Aleukaemia 7 4 11 13 Diabetes 2 7 9 18 Vascular Lesions of Nervous System 113 136 249 257 Coronary Disease. Angina 203 118 321 277 Hypertension with Heart Disease 25 30 55 52 Other Heart Disease 112 186 298 249 Other Circulatory Disease 37 46 83 83 Influenza 3 3 6 6 Pneumonia 57 67 124 79 Bronchitis 72 35 107 115 Other Diseases of Respiratory System 7 7 14 19 Ulcer of Stomach and Duodenum 15 4 19 28 Gastritis Enteritis and Diarrhoea 3 6 9 9 Nephritis and Nephrosis 8 3 11 14 Hyperplasia of Prostate 11 - 11 10 Pregnancy, Childbirth, Abortion - - - 1 Congenital Malformations 4 8 12 19 Other Defined and Ill-Defined Diseases 52 76 128 158 Motor Vehicle Accidents 22 6 28 21 All other Accidents 19 24 43 30 Suicide 12 10 22 22 Homicides and Operations of War - - - 2 Totals 973 949 1, 922 1,876 52 SECTION 6 SCHOOL HEALTH SERVICE The School Health Service shows no significant trends from the previous year, A slight change in the classification of general health condition needs explanation Previously this has been shown in terms of good fair' and poor . This is now shown simply as satisfactory or unsatisfactory'. The figures represent 98 7% as satis factory. The very much higher figure of skin defects results in the close attention that has been given to feet which has revealed a large incidence of verrucae this is also reflected in the attendance at Minor Ailment Clinics. A few isolated cases of tuberculosis have required special investigation in schools. Fortunately no spread of the disease was discovered. During the latter part of the year preparations were in hand to launch the B.C.G. programme for 1957. MINOR AILMENT CLINICS These clinics continue to deal with large numbers of children with minor disorders and provide a means for a more detailed study of any defects noticed at routine inspections. Attendances at Minor Ailment Clinics 1954 1955 1956 6,746 6,087 7 897 ROUTINE MEDICAL INSPECTIONS Three routine inspectious 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 1955 1956 First age group 2,552 2,482 Second age group 2,665 2,981 Third age group 1,604 1,266 Total 6,821 6,729 Classification of General Condition Satisfactory 6, 835 Unsatisfactory 92 Total 6,927 53 Defects requiring Treatment found at Routine Medical Inspection 1953 1954 1955 1956 Skin Diseases 540 581 559 859 Defective Vision 290 366 444 452 Squint 43 43 37 25 Defects of Hearing 93 116 68 73 Middle Ear Diseases 18 27 32 48 Nose ani Throat Diseases 377 382 242 190 Speech Defects 37 44 34 36 Enlarged Giands 5 7 6 7 Heart Circulation conditions 7 20 14 5 Lung Diseases 84 93 79 72 Hernia 7 9 2 3 Postural Defects 18 38 24 35 Plat Foot 42 110 97 78 Epilepsy 1 2 3 2 ASTHMA CLINIC The Asthma Clinic has continued its work during 1956 in spite of setbacks. A Physiotherapist left at the end of August and there was a break before her successor could take up her duties. The new Physiotherapist started in November In spite of this 2 990 treatments were given to approx imately 190 children. The asthma appears of milder type than was the case about five years ago At present the cause of this is not apparent, SCHOOL DENTAL SERVICE The uncertain conditions of staffing referred to in the report for 1955 have continued to dominate the activities of the dental service during 1956. Fortunately the part time officers at present employed seem likely to remain for some considerable period and so to develop a better understanding of and ability to cope with our local dental problems. We remain just over one full time dental officer short of our establishment which is approximately 14 per cent. As has been reported previously redisposition of the allocation of schools to particular clinics has enabled some catching up in arrears of treatment but the increasing population density; particularly in Northolt - Greenford districts, will make provision of extra surgery accommodation a necessity as soon as the staffing situation improves. With the dental schools now filling up to capacity and the possible reduction in National Service requirements of the newly qualified male dental surgeon. 54 it is likely that increasing numbers will be entering the school service in a few years and clinic accommodation should be ready to receive them. Over the year 300 fewer dental sessions were carried out than in 1955 this is a reduction of 13 per cent but only 300 less attendances were made for treatment which is a reduction of less than 2 ner cent, so it will be appreciated that the staff are making a concerted effort not to lose any more ground, Hie excellent ratio of permanent fillings to permanent extractions which is a very good general indication of the state of dental affairs was maintained and 14 fillings were carried out for every extraction. Orthodontic treatment continues to be much in demand from parents and our part-time orthodontists are coping adequately with the demand. Close co-operation is maintained with the 5.N.T, Asthma and Speech Therapy departments. Many parents are anxious for their children to have treatment without realising that much of the success is due to co-operation at home and that adequate conservation of the teeth is essential as well for no amount of "straightening" will make up for decayed teeth which have to be extracted. The frequent request from private practitioners for orthodontic treatment for their patients is itself a tribute to the Orthodontic clinic's success. Altogether it can be said that 1956 has been a successful year for the school dental service and the staff have reacted vigorously and efficiently to difficult circumstances, but we must plan ahead for an improved service as soon as possible, and maintain the position in the interim period which might be rather more difficult. Attendances Treat ment com pleted Fillings Permanent Teeth Fillings Temporary Teeth Extractions Permanent Teeth Extractions Temporary Teeth Anaesthetics Orthodontic treatment Mew Cases Gas Local 17197 5527 11248 3341 808 4513 2220 4097 218 EAR, NOSE AND THROAT SERVICE Mr. Arthur Miller Consulting Otologist; reports:- Children are referred tosee me by the Medical Officers on account of recurrent colds, mouth breathing, sore throats and deafness. 55 If upon examination I have found a child to be suf fering from enlarged adenoids (often the cause of persistent colds mouth breathing and deafness) they have been referred for adenoidectomy. Children with clinical symptoms of sore throat having infected tonsils I referred for adeno tonsillectomy but in the majority of cases all the above-mentioned symptoms were treated successfully by conservative means such as diastolisation politzerization and Eustachian catheterization and breathing exercises, In cases where sinusitis was confirmed by X Ray exam ination Proetz displacement treatment was practised. During the last year we have continued with hearing tests both with the gramophone and the pure tone Audiometry. one was able in many cases by subsequent tests to show a great improvement in the child's hearing. 1955 1956 Number of new cases 193 135 Number of re inspections 301 275 Total attendances 494 410 Number treatment advised 227 242 Number operation advised 106 83 Audiometry Report 1955 1956 Number of schools visited 16 16 Number of children examined 6 700 6 225 Number of children with hearing loss 103 98 Number of pure tone tests 123 156 Number referred to E.N.T. Specialist 71 81 FOOT HEALTH The regular inspection of our school children's feet for defects has continued during this year, a total of 10,860 children having been seen by our specially trained nurse. Of these children, 428 were seen by the Medical Officer in charge of Foot Health. The defects found were the same as in previous years and were invariably associated with either short shoes or poorly shaped ones. In the age group five to twelve years, the children on the whole are found to wear well-shaped shoes but wear them for too long a period i.e. six months to one year or eighteen months. In particular winter shoes are often 56 worn for two winter seasons running and may well be as much as one to two sizes too small during the second season, These well shaped shoes are expensive and the uppers are made of durable leather which tempts the parent into their continued use. Children of this age do not complain that their shoes feel tight, their toes just bend up inside the shoe. Best shoes cause similar foot defects again due to the fact that by the time they come into general use they are probably six months old and the foot has outgrown them. One pair of shoes bought at one time to be worn every day including Sundays and replaced in three to four months is the policy stressed in the foot clinics. Over twelve years of age there are many girls who wear badly shaped shoes with the so called fashionable pointed toe. These shoes by their inherent shape encour age the toes to be squashed together and certainly pro mote any slight bending of the big toe into a bunion. It is stressed in the foot clinics that until the foot has at least stopped growing the shape of the shoe should correspond to the shape of the natural foot- The search for foot infection has continued and every term all junior and senior school children had their feet inspected for verrucae and tinea. The incidence of ver rucae in these schools has averaged 1 % in the Spring and Summer terms and 1 6% in the Autumn term. The senior schools continue to show the highest incidence one Senior Modern Boys School having an incidence of 4 4% in one term. So far the regular once a term search for verrucae has not dramatically reduced the rate of infection though when found the verrucae are usually small and respond quickly to the treatment. The children thus suffer the minimal disability and lose very little time from school. Foot Inspection Defects Fooni Total number examined 10,860 Defect No. % Tinea 49 .4 Verrucae 94 .8 Defective shoes 2 255 20 Everted ankles 315 2 9 Hallux Valgus 1 853 17 Children referred to Foot Clinic 454 4 ,, ,, ,, Chiropodist 105 1 57 HANDICAPPED CHILDREN The following table sets out in their various categories the number of handicapped pupils as at 31st December 1956. In Special Day Schools In Special Residential Schools In maintained Primary & Secondary Schools Not at School Total B G B G B G B G B G Blind Pupils 1 - 1 1 - - 1 - 3 1 Partially- Sighted Pupils 4 1 - 1 - - - 1 4 3 Deaf Pupils 4 4 1 4 - - - - 5 8 Partially Deaf Pupils 3 6 4 3 - 2 - - 7 11 Educationally Sub-normal Pupils 12 15 10 8 29 15 2 - 53 39 Epileptic Pupils - - 1 - - - 1 - 2 - Maladjusted Pupils - - 22 9 17 4 - - 39 13 Physically Handicapped Pupils 9 11 4 2 2 1 3 - 18 14 Pupils with Speech Defects - - 1 - 1 2 - - 2 2 Delicate Pupils 3 1 10 6 52 24 1 - 66 31 Pupils with Multiple Defect - - - - - 1 - - - 1 Total 36 38 54 34 101 49 8 1 199 123 OPHTHALMIC SERVICE Mr. Freeman Heal Consultant Ophthalmologist reports Report on School Children examined at Mattock Lane and Ravenor Park Clinics for the year January to December^ 1956 The total number of cases seen was 1 603 (1955 1 606) of which 448 (195 5 537) were new cases, and 1,155 (1955 1,069) were re-inspections. The number of pairs of glasses prescribed was 913 (1955 - 1,015). Abnormal Eye Conditions other than Errors of Refraction were as follows:- Congenital Abnormalities New Cases Old Cases Squint 56 213 Congenital Nystagmus 2 4 Progressive Myopia 2 2 Congenital Epiphora 3 - 58 New Cases Old Cases Abnormalities in extra ocular muscles 2 1 Ectopia Lentis 2 - Congenital Cataracts - 2 Ptosis - 1 Opacity in Cornea 1 Microphthalmic eye (removed) 1 - Cyst of orbit 1 - Coloboma of Uveal tract - 1 Congenital disinsertion of retina 1 - Abnormalities due to Infection Blepharitis 6 2 Styes 4 - Blind disorganised eye due to infantile illness - 2 Sub-acute Conjunctivitis 1 - follicular Conjunctivitis 1 - Retino Choroiditis 1 - Corneal scar (chicken pox) 1 - Abnormalities due to Trauma Damage to macula contusion of globe ,. 1 Number of children sent for squint training 6 ORTHOPAEDIC CLINIC Mr. J,A. Cholmeley, the Orthopaedic Consultant, reports - The Orthopaedic Clinics continue to be busy and there has been an increase in the number of attendances under all headings. I feel sure that the numbers, particularly of minor disabilities, would be greater if there was not a chiropodist in the baling School Medical Service. I also consider that the routine examination of school children's feet and shoes with advice on proper shoe fitting, as carried out in Ealing is of real value in prevention of minor foot and toe deformities and development of corns and callosities. Recently there have been several cases of Poliomyelitis in Ealing and some of these, fortunately not severely disabled, have returned home and are now attending the Ortho paedic Clinic for treatment and supervision. Such cases are often time consuming and increase the amount of work of the physiotherapists to a much greater extent than the number of attendances would suggest. 1955 1956 Number of new cases 125 136 Number of re-inspections 383 413 Total attendances 508 549 Number of children referred for physiotherapy 167 200 Number of attendances 2,930 3,199 59 SPEECH THERAPY The work of the Speech Therapy Department continued at a slightly increased volume during 1956:- Number on Roll at 1.1.56 206 New cases during the year 76 Number discharged 44 Number of attendances at Speech Therapy Clinics 4 092 Number on Roll at 31. 12. 56 238 The percentage frequency with which each type of defect occurred was as follows:- (1) Dyslalia - Mixing or missing out of consonants 45% (2) Aphasia - Absence of speech 15% (3) Dysarthria - Defects due to disorders of the articulatoiy muscles or soft palate 14% (4) Stammering 2% The department's work is largely with school children but in many instances pre-school children are referred. This is of course valuable as treatment can be commenced and sometimes a defect remedied before the time the child goes to school. During last'year the division into preschool and school children was as follows'- School children 85% Pre-school children 15% The service the department offers is widely known and during 1956 referrals were from the following sources. Doctors 66% Teachers 29% Parents 5% The satisfactory diagnosis and treatment of speech defects may require co-ordination of the services of Ear, Nose and Throat Surgeon, Plastic Surgeon, Neurologist and Educational Psychologist. The close liaison between the Assistant Medical Officer in charge of Speech Therapy and the Speech Therapists facilitated this co-ordination. Each child has an initial medical examination to enable the type of defect to be diagnosed and a plan for treatment to be formulated. Regular speech therapy is then given either at clinics or at school. This may include play therapy, exercises, or advice both to the child and parents on the means of overcoming the defect. Progress is reviewed at periodical medical examinations. 60 A special Speech Class was started in April 1954 for children with the severest defects who would benefit by continuous treatment. The teacher in this class has special experience and interest in the subject and the Speech Therapist visits three times weekly. Twenty-five children have now received this form of treatment, Most were un intelligible on admission and their speech has been so improved by the time of discharge that it has no longer been a significant handicap A speech defect presents a considerable problem both to the child concerned and to the parents. The outlook of course varies with the type of defect. Stammering is prob ably the most irresponsive to treatment whilst in the case of dysialia rapid improvement can be expected. Over all the results achieved during 1956 have continued to be gratifying. EALING CHILD GUIDANCE CENTRE 1 New cases referred in 1956 In 1956 243 cases were referred to the Centre 64 cases were brought forward from the 1955 waiting list, making a total of 283, 2 Problems referred to the Centre. The average intelligence quotient of the children re ferred in 1956 does not differ significantly from that of the previous year There has been almost no change in the numbers coming from different types of schools. There is a barely significant increase in the average age: probably because the number of pre school children has decreased. There has been little change in the frequency of various symptoms referred Children difficult to manage at home continue to head the list. In 1956 for the first time since the opening of the Centre, fewer cases were referred than in the previous year. Rather more cases were discharged from treatment in 1956 than in 1955 and it is satisfactory to be able to report that there was an appreciable fall in the number awaiting treatment in 1956, 61 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 347 (2) Number of instances in which the state of health was found to be such that certificates were withheld 2 (3) Number of children examined as to fitness to take part in entertainments 6 (4) Number of cases in which certificates to take part in entertainments were withheld - Cases dealt with under Section 57 Education Act 1944 Sub Section 3 9 Sub Section 4 - Sub Section 5 1 Cases de notified under Section 8, Education (Mis cellaneous Provisions) Act, 1948 1 Number of teachers examined as to fitness for appointments 51 INFESTATION WITH VERMIN Once again I am pleased to report a decline in the number of children infested with vermin. Of 54,545 examinations carried out, only 94 children were found to be infested. Although this is no longer a major problem, constant vigilance is maintained to improve the standard. 62 SUPPLEMENT - FOR GENERAL INFORMATION HEALTH SERVICES PROVIDED BY THE LOCAL HEALTH AUTHORITY In Middlesex the Local Health Authority under the National Health Service Act is the Middlesex County Council, They have forced ten areas in the county baling and Acton forming Area No, 7. In Paling 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 Times Abbey Parade, North Circular Road, Ealing. Tues. mornings. Brentside, Westcott Crescent Hanwe11, W. 7. Thurs. mornings. Cherington House, Cherington Road, Hanwe11, W. 7. Tues. Wed. mornings. Greenford Green. Wadham Gardens, Greenford. Tues. Fri. mornings. Islips Manor, Eastcote Lane Northolt. Mon. Wed. mornings. Laurel House, Windmill Road, Ealing. Thurs. mornings. Mattock Lane, 13 Mattock Lane, Ealing, W. 5. Wed. Thurs Fri. mornings. Perivale Horsenden Lane, Greenford. Wed mornings. Ravenor Park, Oldfield Lane, Greenford. Mon. Thurs. mornings. Chili Welfare Clinics Abbey Parade, North Circular Road, Ealing, Tues. Fri. 2 - 4 p. m. Brentside, Westcott Crescent, Hanwell, W.7. Thurs. 2 - 4 p.m. Cherington House, Cherington Road, Hanwell, W.7. Mon. Tues. Thurs. 2 - 4 p. m. Greenford Green, Wadham Gardens, Greenford. Tues. Wed. Fri. 2 - 4 p. m. Islips Manor, Eastcote Lane, Northolt. Mon. Thurs. 2-4 p. m. Northolt Grange Community Centre, Northolt. Tues. 2 - 4 p. m. Laurel House, Windmill Road, Ealing Mon. Thurs. 2 - 4 p. m. Mattock Lane, 13 Mattock Lane, Ealing. Mon. Wed. Thurs. Fri. 2 - 4 p. m. Perivale, Horsenden Lane, Greenford. Mon. Thurs. 2-4 p. m. Ravenor Park, Oldfield Lane, Greenford. Mon. Tues. Wed. Fri. 2 - 4 p.m. 63 DOMICILIARY MIDWIFERY SERVICE An exnectant, mother can obtain the services of a general practitioner obstetrician'' for her confinement in her own hone. As an alternative she can obtain the services of a County Council midwife who will attend her in the home either asamidwife delivering the child herself or as amaternity 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 "fedical 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 two 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.