EALING PUBLIC LIBRARIES REFERENCE DEPARTMENT E 352.4 / 6376 L u,be Ibealtb of Ealing in the tear 1957 BEING THE ANNUAL REPORT OF THK Medical Officer of Health AND School Medical Officer WILLIAM G. BOOTH, M.D., B.S., D.P.H., Medical Officer of Health. I INDEX Page Section 1 - INFECTIOUS DISEASES 7 Section 2 - SANITARY CIRCUMSTANCES OP THE BOROUGH 15 Section 3 - SANITARY INSPECTION 27 Section 4 - GENERAL 38 Section 5 - STATISTICAL TABLES 44 Section 6 - APPENDIX : REPORT OP THE SCHOOL MEDICAL OFFICER 50 Supplement - FOR GENERAL INFORMATION 68 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, Resigned 10.3.57 Deputy Medical Officer M.B. ,Ch. B. , D.P.H. I.He Seppelt, Appointed 11.3.57 „ „ M. A. , M,B. B.Chir D.P,H. G.T.H. Blackie Chief Public Health Inspector E. Belfield Deputy Chief Public Health Inspector E.Hc Evans Public Health Inspector C.n. Baxter " " " E. W. Bud A. E. Pooley G. 0. Axon, Appointed 1.3.57 " " " A.C. Bamping " 19.2.57 " N. Saunders " " 99 Harry M. Birrell Chief Administrative Assistant -ft. S. Leggatt Senior Clerk R. Angell, Resigned 5.4.57 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 R. Lazzolo " " F. Bedley " " L.B. Radford Driver/Disinfector E. Sheldrick 99 " 5 Mr. Mayor, Aldermen and Councillors, In presenting my Annual Report for the year 1957 I would like to draw attention to certain items of special interest. No case of Diphtheria occurred in 1957, and approximately 65% of children were Immunised against this disease in their first year. An interesting food poisoning outbreak occurred at one school which in spite of exhaustive follow-up gave no clue as to the responsible organism. We were forced to the conclusion that not only may Poliomyelitis be spread by food contamination, but other viruses with short term gastro intestinal effects may also be responsible for some of our food poisoning troubles. A graph has been prepared showing how the Influenza of 1957 affected the school population attendances and I am much indebted to head teachers for their assistance in its compilation. Fortunately the epidemic was comparatively mild and only affected seriously certain elderly people, who contracted pneumonia. In one sense the year may be regarded as medically historic in that we commenced immunisation against Poliomyelitis for the first time. The public response would have been far greater had there not been an unfortunate incident in the American use of soma vaccine which had not been subjected to sufficiently stringent safety tests, but much was learned from this and there is every reason to believe that our campaign for protection of children in Ealing, will, be received, as are most of our health service facilities, by the great majority of the population. There is every reason to hope that like Tuberculosis, the old enemy Polio' is on the way out. Another interesting facet of this work is the close co-operation we are now receiving from General Practitioners in basic preventive medicine - never before, in my experience of over 30 years in public health, has there been such close association with the local authorities of general practitioners in the prevention of disease. Another landmark in the field of preventive medicine was the inauguration of the Clean Air Act, and in the body of the report details are given as to the position in Ealing. There is no doubt that this Act will take many years to implement fully over the whole country, but only by every Authority doing its fair share shall we arrive 6 at an atmosphere as unpolluted as out water supplies. It is to be hoped that everyone will do his best to secure this desirable end. The Rent Act which came into operation in July 1957, has like the Clean Pood Regulations, the Clean Air Act and Slum Clearance requirements placed additional burdens of some magnitude on the shoulders of the Health Inspectors. We have made no increase of staff to deal with this work, and I feel I must pay tribute to the Chief Health Inspector, his deputy and the district inspectors for handling these new problems in addition to their routine work in so exemplary a. manner. The Council are indeed fortunate to have such officers working for them. Although the school hpalth service is now a County Council service I could not refrain from commenting during this Golden Jubilee of its life, upon the growth of the service in Ealing and the changes since its inauguration. To many they must make cheering reading, and Ealing has been a pioneer in many of its fields. The amount of disability that has been prevented by the action of this service is quite incalculable and it is inconceivable that anyone would ever want to go back to the conditions prior to 1907 in our schools One particular recent innovation in Ealing is the special speech remedial class at Stanhope Infants School and the preliminary report given for 1957 will be read with great interest, 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 officers 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 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 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. Many patients with infectious diseases today are isolated and nursed at home. Leaflets describing the essential points of home nursing of persons suffering from infectious disease and advice as to disinfection are provided where necessary. When admission to hospital is required this is usually to The South Middlesex (Mogden) or Neasden Isolation Hospital. The examination of pathological specimens is carried out at King Edward Memorial Hospital, Ealing, The Public Health Department will arrange for the collection of specimens, e.g. faeces and samples of suspected food or vomited material for transmission to the King Edward Memorial Hospital laboratory at the request of a general practitioner, 2,752 cases of Infectious Disease were notified in the Borough during the year. Of these 26 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 2,726. DIPHTHERIA, No cases were notified in 1957. During the year 2,292 primary immunisations were given either at Clinics or by General Practitioners and 2,480 booster doses. 1,731 children under one year had primary immunisations which means that approximately 65%of children in their first year of life were immunised in Ealing. 8 During the year the Medical Research Council recommended that immunisation against diphtheria and whooping cough should be given separately. This reduces any chance of provoking poliomyelitis to a minimum and it was, therefore, adopted by the Clinics in Ealing, The need for maintaining a high percentage of children being immunised against diphtheria remains as great as ever and this is stressed at every opportunity. DYSENTERY. 252 cases were notified, an increase of 73 compared with the previous year, ENTERIC FEVER. One case of typhoid fever was notified. The infection did not however originate here. The patient, an Italian boy of 15½ years, arrived from Sicily to study English and was taken ill three days later and removed to Neasden Hospital, where typhoid fever was confirmed by blood countbut not isolated in the stools or urine. After a course of Chloromycetin he appeared well with one urine and two stool results negative, and was discharged. There is one carrier of enteric fever under surveillance in the Borough. This is the person mentioned in previous reports and she remains under the same surveillance with three monthly stool examinations, ERYSIPELAS, 13 cases were notified, FOOD POISONING, 20 cases were notified, a decrease of six compared with 1956, Of these 20 cases diagnosis was confirmed by laboratory examination in 7, 6 being Salmonella typhimurium and 1 Salmonella thompson. During July an outbreak of suspected Food Poisoning occurred at Oldfield School Central Kitchen, This kitchen serves 17 schools which means approximately 1,600 meals per day. 146 children and 36 adults were affected by either nausea, vomiting, pain, or diarrhoea or various combinations of these symptoms in fairly equal proportions. The illness as a whole was not severe and lasted about 12 hours. The suspected meal comprised: - 9 Roast Mutton, Onion sauce, Potatoes, Greens, Gravy, Suet Pudding with dates and currants, Syrup sauce. The onset of symptoms was from 4 to 18 hours after this meal had been eaten. Several members of the kitchen staff were affected the following day after eating the roast mutton cold. It was therefore necessary to condemn the meal which they were in the process of preparing, and emergency measures were taken for feeding children served by this particular kitchen. Every effort was made to trace the source of infection. Specimens of the suspected meal were sent for bacteriological examination but no organism was isolated, Similarly stool specimens from those affected yielded negative results, Enquiries were extended to the butcher supplying the meat, and in order to eliminate the possibility of chemical poisoning the use of cleaning materials and insecticide spray in the kitchen was investigated., The symptoms did not suggest that either Salmonella, Staphylococci, or C1. welchii caused the infection, and the absence of secondary cases ruled out Winter Vomiting". It may be that the outbreak was due to an agent hitherto unrecognised as a cause of food poisoning, or that the bacteria responsible may have been overgrown by nonpathogenic organisms. At the same time as reporting an outbreak of this nature it is appropriate to record how infrequently such instances occur, due unquestionably to the very high standard of food hygiene observed by the School Meals Service, INFLUENZA. During the Spring extensive outbreaks of Influenza occurred in the Far East and by the summer a small number of cases had been imported into the United Kingdom to produce localised outbreaks. The first definite evidence of spread was noted in the North of England where in the week-ending August 24th a large number of children were absent from school. By the contribution week-ending September 3rd, new claims for sickness benefit on the Ministry of Pensions and National Insurance were extensive in the North of England, and by the week-ending September 14th 10 11 there was a marked increase of notifications of pneumonia and deaths attributable to Influenza, The epidemic then spread to the South of England and a rise of school absentee fate was noted in Ealing in the week ending September 21st. The basic rate for September and October last year was about 7%. By October 14th this year it had reached a peak of 28%, thereafter it fell and by the end of the month it had reached the expected level for the time of year. The notifications of pneumonia during the last quarter of the year were 95 compared with 36 in the previous year and the notifications of deaths due to or partially attributed to Influenza were 5 compared with none in the previous year. During the epidemic, vaccination was offered to Midwives, Home Nurses and Ambulance Drivers and vaccine was supplied to General Practitioners for their own protection. MEASLES. 1,854 cases were notified. In 1956 there were 726 and in 1955 2,422. MENINGOCOCCAL INFECTION. Two cases were notified and were treated in hospital. OPHTHALMIA NEONATORUM. 5 cases were notified. Three occurred in hospital and two in general practice. All cleared up satisfactorily leaving no impairment of eyesight. PNEUMONIA. 171 notifications were received. There were 64 deaths, 31 male and 33 female. POLIOMYELITIS. Two notifications were received. Both children were admitted to hospital where in neither case was the final diagnosis poliomyelitis, but a chest infection in one, and aseptic meningitis in the other. Vaccination against Poliomyelitis continued on an increasing scale. By the end of the year 15,300 children had been registered, of whom 6, 157 had been vaccinated. 12 About 55% of this work had been done at Health Clinics and 45% by General Practitioners. During the year the age limits were widened and all children born between 1947 and 1956 became eligible. It is hoped that early in 1958 a supply of Canadian vaccine will be available to us. This will be tested both in Canada and in Britain to the same standards as British vaccine and should considerably help in meeting the great demand in Ealing for vaccination against Poliomyelitis. Expectant mothers will be offered vaccination as soon as this vaccine becomes available and by the Summer of 1958 it is hoped that all children registered will have been given the opportunity for vaccination. PUERPERAL PYREXIA, There were 77 notifications, 7 of these occurred in general practice and the remainder in hospitals. SCARLET FEVER. 95 notifications were received, 61 less than in 1956. All were of a mild character. SMALLPOX. There were no cases notified during the year. There was, however, an outbreak during the summer in the Greater London area which resulted in three deaths, cases occuring in Boroughs neighbouring Ealing. It is probable that the infection was initially brought into the country by a man flying from West Africa. The rapidity of air travel today makes such occurrences an ever present possibility, against which vaccination is the surest protection. The most satisfactory arrangement is that infants should be vaccinated during their first year of life. In 1957 1,518 children in their first year were vaccinated in Ealing which represents approximately 57%. During the outbreak vaccination was offered to ambulance and nursing staff. TUBERCULOSIS. There were 113 pulmonary notifications received, 80 males and 33 females, compared with 73 males and 61 females in the previous year. Non-pulmonary cases consisted of 6 males and 9 females. 13 There were 20 pulmonary deaths and 3 non-pulmonary deaths. WHOOPING COUGH. 131 notifications were received against 67 in 1956. During the year 1, 645 children under one year of age were immunised against Whooping Cough, which represents 62%. 14 TUBERCULOSIS Age Periods New Cases Pulmonary Non-Pulmonary 1952 1953 1954 1955 1956 1957 1952 1953 1954 1955 1956 1957 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 2 5 2 3 1 1 – 2 1 4 1 – 4 – – 2 – 1 – 1 – – 1 5 - 14 5 6 7 4 1 2 1 1 2 5 4 1 4 1 1 2 – 2 2 4 – – – – 15 - 24 13 44 15 38 13 24 16 14 14 21 16 12 2 4 – 1 1 2 2 3 2 – 1 1 25 - 44 46 37 30 43 23 26 21 26 22 21 18 12 5 5 2 4 1 4 2 4 1 4 2 6 45 - 64 32 10 39 9 23 11 23 7 29 9 26 5 1 3 4 4 1 3 1 2 4 1 3 1 Over 65 9 2 7 6 3 2 6 3 4 4 12 2 – – 1 1 – 1 2 1 – – – – Total 110 101 103 102 66 66 68 51 73 61 80 33 12 17 8 12 5 12 10 14 8 5 6 9 Age Periods Deaths Pulmonary Norn-Pulmonary 1952 1953 1954 1955 1956 1957 1952 1953 1954 1955 1956 1957 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 - 14 – – – – – – – – – – – – – – – – – – – – – – – – 15 - 24 6 5 – – – – – 1 – – – – – – – – – – – – – – 1 – 25 - 44 4 4 4 4 3 2 3 1 1 – 1 2 1 1 – 1 – – 1 – – – – – 45 - 64 7 3 9 3 5 3 5 – 11 2 6 3 1 – – – – 1 1 – 1 – 1 – Over 65 7 1 5 3 4 2 6 1 5 2 6 2 – – – – – – – – – – – 1 Total 24 13 18 10 12 7 4 3 17 4 13 7 2 1 – 1 – 1 3 – 1 – 2 1 15 SECTION 2 SANITARY CIRCUMSTANCES OF THE BOROUGH WATER. There are three sources of supply in the Borough. The Northolt, Greenford North, Greenford 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 satisfactory both in quantity and quality. Water from public mains is supplied to 53,697 houses with an estimated population of 183,600. Ten samples were taken from wells at five factories in the Borough using water from deep borings ranging in depth from 300 to 600 feet. The analysis showed that the supplies were wholesome in character. One sample was taken from the water storage tank of a private house and this was found to be satisfactory. DRAINAGE AND SEWERAGE. The soil sewerage from the district flows to the West Middlesex Drainage Works at Mogden. The surface water finds its way out of the district by the various water courses. One cesspool was discontinued during the year leaving 21 premises not connected to the Council's sewers. RIVERS AND STREAMS. The work of tracing sources of pollution in the River Brent continued during the year. Twenty-two samples from sewer outfalls into the River Brent and canal were taken by the County Engineer's Department, Middlesex County Council, and of these 12 proved to be satisfactory and 10 unsatisfactory. Three samples were also taken from the River Brent by members of my Department. These three samples proved to be satisfactory. As a result of these reports investigations were carried out and drainage defects in 7 factories and 14 houses were remedied after notice by the Public Health Inspector. 16 17 ATMOSPHERIC POLLUTION Clean Air Act, 1956. This Act "to make provision for a bating pollution of the air" became partially operation December 31st 1956. The "smog" of December 1952, which caused 4,000 deaths in Greater London, demonstrated the urgent need for measures to reduce pollution. Apart from its direct effect on health, smoke, by blackening and corroding buildings, dirtying fabrics, and harming plant life, indirectly reduces general health and well being. The Beaver Committee estimated that air pollution costs the nation £300000,000 a year. The Local Sanitary Authority becomes the Local Authority under the Clean Air Act and may make an order which must be confirmed by the Minister declaring the whole or part of its district a smoke control area. The Public Health Committee gave full consideration to this question and approved 385 acres on the Norholt Grange Estate as the Council's first smoke control sea. This contains 1,301 houses, of which 464 are private, 83 council, and 15 other premises, Approval in principle has been received from the Minister of Housing and Local Government and a detailed survey of the area has commenced. By the end of the year this was almost completed and it is anticipated that a full report will be presented to the Council for their consideration early in 1958, When the Order comes into operation ft will be an offence to permit thee mission of smoke from chimneys caused by the burning of other than authorised smokeless fuels. In many instances in order to burn these fuels replacement or adaptation of existing grates will be required. Grants amounting to7/10ths of the expenditure will be available through the Local Authority towards the cost of any adaptation which may be reasonably necessary. A Clean Air Exhibition is to be held at Downe Manor School, Northolt, from the 10th to the 16th April 1958 to give residents in the proposed soke control area an opportunity of seeing a selection of approved electrical, gas and solid fuel appliances. Here too, any difficulties may be discussed so that co-operaton may be obtained in carrying through this important measure of preventive medicine. Other provisions of the Act require that new furnaces, with certain exceptions, should is far as practicable, smokeless. Notice of intention to instal such furnaces must be given to the Local Authority. The height of new 18 SMOKE FILTER PAPERS Average Sunny Day Foggy Winter Day 19 chimneys, other than houses, shops and offices, also has to be approved. By the end of 1957 one application for prior approval of a new furnace had been received and granted by the Council. Six applications regarding new chimneys had been received and in three cases, in consultation with the Borough Surveyor's Department, the owners agreed to raise the height of the proposed chimneys. By the end of the year a survey of all the boiler plants in the Borough was progressing and a descriptive summary of the Clean Air Act was supplied at the time of inspection to the proprietors or managers of factories with boiler plants in operation. Under Section 24 of the Act, Local Authorities are empowered to make building byelaws requiring the provision in new buildings of such arrangements for heating or cooking as are calculated to prevent, so far as practicable, the emission of smoke. A Byelawon these lines was confirmed by the Minister of Housing and Local Government and came into operation in the Borough on the 1st December, 1957. Atmospheric Pollution Gauges. Three atmospheric Deposit Gauges and three lead peroxide instruments are sited in the Borough. One site is in Longfield Depot at the rear of the Town Hall, the second at Greenford Green Health Centre and the third at the rear of 44 Long Drive, Greenford. There is also an instrument situated in the Town Hall for the measurement of the daily mean concentration of smoke and sulphur dioxide. The results obtained from these instruments are given in the following tables and graphs. 1957 Deposited matter expressed as tons per square mile per month Sulphur compounds by lead peroxide method expressed as milligrams SO3/day collected by 100 sq. cm. of Batch A Pb02 Long Drive Longfield Depot Greenford Green Long Drive Longfield Depot Greenford Green Jan. – 11.98 8.09 – 2.12 1.85 Feb. – 9.83 9.56 – 1.95 1.60 March – 11.48 9.2S – 1.22 1_22 April – 17. 12 11.81 – 0.89 0.58 May – 8.82 8.93 – 1.80 1.04 June 12.37 14.77 7.82 1.23 1.43 0.62 July 6.03 8.46 6.88 0.92 1.03 0.77 Aug. 10.71 12.59 9.27 0.74 1.41 0.67 Sept. 9.47 12.62 8.02 1.35 1.75 0.82 Oct. 14.64 17.02 8. 15 1.38 2.89 1.80 Nov. 13.07 13. 16 7.92 3.38 4.07 2.22 Dec. 23.55 25.92 10.57 2.48 2.95 2. 13 20 INVESTIGATION OP ATMOSPHERIC POLLUTION DEPOSITED MATTER 21 INVESTIGATION OF ATMOSPHERIC POLLUTION SULPHUR 22 INVESTIGATION OF ATMOSPHERIC POLLUTION AVERAGE MONTHLY CONCENTRATIONS OF SMOKE AND SULPHUR DIOXIDE AT TOWN HALL, EALING 23 Average Monthly Concentrations of Smoke and Sulphur Dioxide at the Town Hall. 1957 Smoke in Milligrammes per 100 cubic metres Sulphur Dioxide in parts per hundred million Jan. 10.23 5.54 Feb. 12.79 7.10 March 13.19 7.30 April 9.26 5.10 May 8.54 5.20 June 8.78 5.40 July 6.83 2.90 Aug. 7.77 2.80 Sept. 8.68 3.30 Oct. 12.58 9.10 Nov. 14.27 8.70 Dec. 23.68 13.73 FOOD HYGIENE. It is now two years since the Pood Hygiene Regulations came into force and it is gratifying to record that the enforcement of the Regulations has proceeded smoothly and in only two cases, so far, has it been necessary to resort to legal proceedings. I think this can be attributed to a large extent to the educational work undertaken by the Public Health Inspectors during the past eight years as this has given those engaged in the food trades an understanding of the purpose behind the Regulations and has simplified the task of persuading the owners of food premises to carry out necessary works. During 1957, 27 lectures were given to food handlers and 105 received Certificates of Attendance upon completing the course. Since the scheme commenced 449 lectures have been given and 1,785 persons have received Certificates of Attendance, In addition 23 talks on Pood Hygiene were given by the Public Health Inspectors to approximately 920 school-leavers at the Grammar and Secondary Modern Schools in the Borough. The number of Certificates of Pood Hygiene awarded to food establishments increased to 59 during the year; three new Certificates being issued. 2,845 Inspections of food premises were made and 775 repairs and improvements were carried out. The film-strip on Pood Infections made by the Council in 1954 is still in demand, a further 27 copies having been sold during the year. This makes a total of 114 copies sold. 24 SLUM CLEARANCE. The proposals submitted by the Council in 1955 and subsequently approved by the Minister of Housing and Local Government, estimated that 120 unfit dwellings would have to be dealt with by Compulsory Purchase. Clearance, Demolition or Closing Order procedure during the five year period ending in 1960. By the end of 1957, the position was as follows: Conpalsory Purchase Orders, 1, 2, 3, 4 & 5 Thompsons Cottages, W,5. 35, 37, 39, 41, 43 & 45 The Grove, W 5. 1, 2, 3, 4, 5, 6, 7, .8, 9 & 10 Rose Cott ages, Western Road, W.5. 1, 2, 3 & 4 Providence Place, W. 5. 1. 2, 3, 4, 5, 6, 7, 8, 9 & 10 Grove Cottages, W, 5, Clearance Orders, 5, 7, 9, 11 & 13 York Avenue, W,7. Demolition 0rders. 1, 2 & 3 Ealing Place, W. 5. 514, 516, 518, 520, 522, 524, 526, 528, 530&532 Oldfield Lane, Greenford 13, 14, 15, 16 & 17 Bakers Lane, W, 5. 9 St. Mary's Road, W. 5. 1 Rosedale Close, Boston Road, W, 7. 5 & 7 Church Road, W. 5. St. Aidan, Ealing Green, W.5. 6 Adelaide Cottages. Boston Road, W.7. 4- These houses have all been vacated and are awaiting demolition, (KNOWN AS THE GROVE CLEARANCE AREA). A Compulsory Purchase Order was made by the Council in August 1957. A Public Enquiry will be conducted by an Inspector of the Ministry of Housing and Local Government in January, 1958. Houses vacated and demolished. Houses vacated and demolished. All the houses have been vacated and, with the exception of 514, demolished. The demolition of 514 is expected to take place shortly. Houses vacated and demolished. House vacated and demolished. House vacated and demolished. Houses vacated but not yet demolished, This house was the subject of a Demolition Order, Repairs and improvements were carried out which rendered the house fit for human habitation and the Demolition Order was subsequently determined by the Council, This property is the subject of a Closing Order made under the Local Government (Miscellaneous Provisions) Act, 1953 and Housing Act, 1936 Sec. 11. It forms one of a row of cottages and cannot be demolished until the adjoining properties are dealt with. 25 Further action under the Council's five year Slum Clearance programme is dependent upon the ability of the Council to re-house persons displaced. Although other areas of unfit houses have been inspected and my reports are ready for consideration by the Council it would appear that until the housing situation has eased sufficiently to enable the Council to re-house persons displaced no purpose would be served in submitting further areas for the Council's decision Basement Dwellings. On the 3rd February, 1955, the Minister of Housing and Local Government approved Regulations made by the Ealing Borough Council in respect of Underground Rooms. It was anticipated that a number of basement dwellings in the Borough would fall so far short of these Regulations that Closing Order procedure might be necessary. A systematic inspection of basement dwellings in the Borough was commenced but was held up for some time owing to shortage of staff. Subsequently a decision in the Court of Appeal has nullified the effect of the Regulations as this decision means, in effect, that before an Underground Room, as defined under Section 18(2) of the Housing Act, 1957. can be closed, the Local Authority must be satisfied that it is unfit within the meaning of Section 4 of the Housing Act, 1957. It would appear, therefore, that the Regulations no longer serve any practical purpose. Prior to this decision of the Court of Appeal a number of basements had been rendered fit for habitation by informal action and this work is still proceeding within the limits of Section 4 of the Housing Act, 1957. In the following cases Closing Orders were made by the Council in respect of the underground rooms: 25 The Avenue, W.13. 130 Church Road, W. 7. 16a Drayton Green Road3 W, 13. 36 Lower Boston Road, W. 7. 24 Oxford Road, W, 5. 55- Mount Avenue, W, 5. 18b Drayton Green Road, W, 13. 97 The Grove, W, 5. Of these 24 Oxford Road and 55 Mount Avenue were rendered fit for human habitation by the owners who carried out works of repair and improvement approved by the Council and the Closing Orders were determined. BATHS AND SWIMMING POOLS. The Council's Swimming Baths in Longfield Avenue are 26 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 two privately owned swimning 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. 294 bodies were taken to this Mortuary and post-mortem examinations were carried out in every case. 27 SECTION 3 SANITARY INSPECTION THE WORK OF THE PUBLIC HEALTH INSPECTORS IN 1957 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 2,026 Other nuisances observed by Inspectors 75 Premises inspected in connection with infectious disease 553 Smoke observations 305 Houses without water supply 35 Inspections of moveable dwellings 50 Other inspections 2,146 Re-inspections 6,744 Intimation Notices served 1,207 Statutory Notices served 144 Letters written 2,353 Proceedings before magistrates 5 Legal Proceedings. PUBLIC HEALTH ACT, 1936, SECTION 93, 39 & 45 Non-compliance with Statutory Notices In 5 cases legal proceedings were taken to enforce compliance with notices requiring the abatement of nuisances. In three cases Orders were made by the Magistrates for the necessary work to be carried out within a stated period and costs amounting to £3.3,0d. were awarded. In two further cases summonses were applied for but were afterwards withdrawn as the necessary works had been completed. CLEAN AIR ACT, 1956 Inspections in connection with proposed Smoke Control Area 2,030 FOOD AND DRUGS ACT, 1955 Food Hygiene Regulations, 1955 Milk and Dairies Regulations, 1949 to 1954 Complaints received 110 28 Inspections of Milk Purveyors' Premises 69 Contravention of Regulations - Inspections of Ice Crean Premises 277 Food Inspections 476 Inspections of Other Food Premises 2,499 Contraventions found 412 Notices served 389 Proceedings before Magistrates 2 Samples of Milk and Cream taken 28 Samples of Ice Cream taken 69 Samples of Synthetic Cream taken 51 Samples of other foods taken 13 Legal Proceedings. FOOD BYGXENE REGULATIONS, 1955 In the following two cases proceedings were instituted under these Regulations: 1.(a) Dirty hands - Pined £5. (b) No name and address displayed on stall - Pined £5. (c) Smoking - Pined £5. (d) Absence of hot water - dismissed. Costs amounting to £3,3.0d. were awarded. 2. Failure to protect food from contamination - Pined £5, List of Food Premises in the Borough of Ealing Bakehouses 29 Bakers' shops 53 Butchers 127 Cafes and Restaurants 146 Canteens - factory 77 Canteens - school 24 Confectioners 241 Dairies and Milk Sellers 73 Pish Fryers 23 Fishmongers 36 Greengrocers 161 Grocers 331 Ice Cream Manufacturers 7 Public Houses 64 Premises registered for the preparation or manufacture of sausages or potted, pressed, pickled or preserved food 108 Premises registered for the sale of Ice Cream 361 29 Milk Supply. There are 87 registered distributors of milk in the Borough. During the year licences for the sale of milk under the Milk (Special Designations) Regulations were granted as follows: Dealer's Licences Supplementary Licences Total Tuberculin Tested Milk 50 15 65 Pasteurised Milk 59 17 76 Sterilised Milk 56 17 73 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. 28 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 26 26 - 26 - T.T. Pasteurised 2 2 - 2 - In addition 102 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 Creaa. There are 361 premises in the Borough registered for the sale of ice cream. It was found that their ice cream is obtained from 2 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 69 samples of ice cream and ice cream constitu- . ents being submitted for bacteriological examination. The results were as follows: 30 Commodity Samples Grade Not graded 1 2 3 4 Ice Cream Local Manufacture 39 19 15 3 2 - Ice Cream Other Manufacturers 28 8 6 1 13 - Ice lollies 2 2 - - - - 69 29 21 4 15 - The two local samples placed in Grade 4 were followed up by an inspection of the factory and plant, and repeat samples proved to be satisfactory. The thirteen Grade 4 samples manufactured outside the Borough were reported to the Local Authority concerned, and after several detailed checks it was found that liquid ice-cream was being conveyed in churns which had not been thoroughly sterilized. After the trouble was traced subsequent samples proved to be satisfactory. Ice Creare Heat Treatment Regulations, 1947-1952 There are 7 premises registered for the manufacture of ice cream. but only 4 of these are in regular use. All the registered ice cream manufacturers in the Borough are equipped in accordance with the conditions laid down in the Regulations. Synthetic Cream. 51 samples of synthetic cream were taken from local manufacturers. 45 were found to be satisfactory and 6 were doubtful. Repeat samples subsequently proved 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. Apples 100 Apricots 6 Bacon 113½ Beef 3,266 Cabbage 288 31  lbs. Cheese 43& Cooking fat 16 Corned beef 741¼ Fish 305 Flour 150 Ham 38 Jellied Veal 1½ Kidneys 44½ Lamb 189½ Liver 43 Margarine 34 Onions 12 Ox Cheeks 117 Ox tails 19 Pineapples 52 Pork 52¾ Potatoes 112 Raisins 18 Salt 42 Sausages 323 Steak 65 Sugar 36 Tongue 44 Veal 1 Foodstuffs not calculated by weight. Assorted tins, packets, jars, bottles, etc. 3,622 Blancmanges 28 trays Cheeses 5 Chicken 1 Eggs 4 Liver Pate 1 Meat pie 1 Turkey 1 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 vehicles etc. There were 41 persons on the Register at 31st December, 1957. 32 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) 1,955 (2) Number of dwelling-houses (included under sub-head (1) above) which were inspected and recorded under the Housing Act, 1957 85 (3) Number of dwelling-houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation 67 (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 328 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 1,112 3. Action under Statutory Powers during the year: A - Proceedings under Sections 9, 10 and 12 of the Housing Act, 1957 (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 1ll (2) Number of dwelling-houses in which defects were remedied after service of formal notice: (a) by Owners 147 (b) by Local Authority in default of owners - C - Proceedings under Sections 16, 23 and 24, Housing Act, 1957: (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 6 (3) Number of houses concerning which action has been taken by the Local Authority under Section 16, and with respect to which owners have given an undertaking that they will not be used for human habitation - (4) Number of houses where demolition orders were revoked after reconstruction 1 D - Proceedings under Sections 17, 18 and 27 Housing Act, 1957: (1) Number of separate tenements or underground rooms in respect of which Closing Orders were made 3 (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 33 HOUSING REPAIRS AND RENTS ACT, 1954 During the year 2 applications for Certificates of Disrepair and 2 applications for Certificates of Disrepair to be revoked were granted by the Council. RENT ACT, 1957 This Act came into operation in July 1957 and the rather complicated procedure laid down has necessitated a great deal of time having to be devoted to explanations to owners and tenants. A sub-committee of the Public Health Committee was appointed to deal with applications for Certificates of Disrepair and each application is fully considered prior to action being taken. The following table gives details of applications received for Certificates of Disrepair during the year: Part I Applications for Certificates of Disrepair (1) Number of applications for certificates 156 (2) Number of decisions not to issue Certificates 1 (3) Number of decisions to issue Certificates 127 (a) in respect of some but not all defects 79 (b) in respect of all defects 48 (4) Number of undertakings given by landlords under paragraph 5 of the First Schedule 67 (5) Number of undertakings refused by Local Authority under proviso to paragraph 5 of the First Schedule - (6) Number of Certificates issued 41 Part II Applications for Cancellation of Certificates (7) Applications by landlords to Local Authority for cancellation of certificates 6 (8) Objections by tenants to cancellation of certificates 3 (9) Decisions of Local Authority to cancel in spite of tenants' objections - (10) Certificates cancelled by Local Authority 3 NEW DWELLINGS, 1957 Completion figures for the 12 months period ending 31st December, 1957 were: Houses (1 bedroom) - 1 Houses (2 bedrooms) - Houses (-3 bedrooms) - 7 Plats (bedsitters) - - Flats (1 bedroom) - 27 Flats (2 bedrooms) - 228 (60 Flats: 168 Maisonettes) Flats (3 bedrooms) - 6 34 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 68 12 - - (ii) Factories not included in (i) in which Section 7 is enforced by Local Authority 455 440 40 - (iii) Other Premises in which Section 7 is enforced by the Local Authority (excluding out-workers' premises) - - - - Total 523 452 40 - 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 8 9 _ - _ Overcrowding - - - - - Unreasonable temperature - - - - - Inadequate ventilation 1 3 - 3 - Ineffective drainage of floors - - - - - Sanitary Conveniences: (a) Insufficient 4 5 - 2 - (b) Unsuitable or defective 13 15 - 7 - (c) Not separate for sexes - 2 - - - Other offences against the Act (not including offences relating to out-workers) 6 14 - 2 - Total 32 48* - 14 - *This figure includes certain defects which were outstanding at the end of 1956. 35 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. 312 - Cleaning and Washing 1 - Furniture and upholstery 6 - Artificial flowers 8 - Paper bags 6 - Making of boxes or other receptacles or parts thereof made wholly or partially of paper 7 - Carding, etc. of buttons, etc. 28 - Stuffed toys 34 - Cosaques, Christmas crackers, Christmas stockings, etc. 49 - Lampshades 3 - Brass and Brass articles 2 - Total 456 - During 1957, 294 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 127 instances: Lighting and ventilation improved 15 Sanitary accommodation improved 6 5 Washing facilities provided 47 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 903 Premises inspected 1,103 Premises found to be infested with: 1. Rats 744 2. Mice 158 Re-visits to infested premises 2,975 Pees received for treatment £589.9.0d. 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. May and October. 36 A total of 1,783 sewer manholes were dealt with and of these 1,003 were found to be rat infested. Poison baits were used in the infested manholes. DISINFECTION Number of houses where disinfection was carried out 67 Number of houses disinfested of vermin 42 Number of articles disinfected by steam 97 Number of articles disinfected by formalin spray 342 Number of articles voluntarily destroyed 54 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 - Cesspools - cleansed - Damp proof courses inserted in walls 17 Dampness - other forms remedied 216 Drains - connected to sewer 1 Drains - cleared and cleansed 585 Drains reconstructed 50 Drains - repaired 221 Drains - new soil and ventilating pipes provided 23 Dustbins provided 105 Firegrates - repaired or renewed 115 Floors - sub-floor ventilation provided 29 Floors - repaired or renewed 109 Food cupboards ventilated 6 Rainwater eaves gutters, downpipes repaired 220 Refuse - accumulations removed 48 Roofs repaired 227 Sinks repaired or renewed 43 Sink waste pipes repaired or renewed 44 Staircases repaired 27 Walls and ceilings repaired or cleansed 218 Water supply reinstated 35 * Water supply - draw taps fixed to main supply 2 Water closets - repaired, reconstructed or improved 142 Windows and doors repaired 221 Yards paved or repaired 29 Other defects remedied or nuisances abated 118 37 SUMMARY OF WORK DONE AND IMPROVEMENTS CARRIED OUT AT FOOD PREMISES Walls and ceilings repaired and cleansed 170 Floors repaired 53 Lighting and ventilation improved 15 Washing facilities provided 47 Hot water provided 76 Sinks provided 29 Storage accommodation improved 34 Water supply provided 2 Water closets cleansed or repaired 65 Refrigeration installed or improved 32 Yards paved - Shop heating facilities improved - Equipment improved 111 First Aid Boxes provided 12 Clothing stores provided 10 Clothing stores repaired 4 Other defects remedied 115 RAG FLOCK AND OTHER FILLING MATERIALS ACT, 1951 Seven premises in the Borough are registered under the Act, which provides for the use of clean filling materials in any form of upholstery, bedding and certain other stuffed articles. In only three of these premises is work within the scope of the Act being carried on at present. All these premises were inspected during the year and only materials carrying the Certificate of the British Standards Institution were found to be used. PET ANIMALS ACT, 1951 Twelve licences were renewed by the Council during the year after the premises had been inspected by the Public Health Inspector. 38 SECTION 4 GENERAL MASSAGE AND SPECIAL TREATMENT ESTABLISHMENTS. No new licences were issued during the year and the number of establishments at the end of the years 26. The same four exemptions were granted to members of the Chartered Society of Physio-therapists. NURSING HOMES. No new nursing homes were registered and the existing 8 were inspected as usual. HEALTH EDUCATION. Health Education leaflets and Better Health there distributed through the same channels as in past years. MEALS ON WHEELS. This service is now provided by the Britished Cross Society in Ealing and the Womens Voluntary service in Greenford and Northolt. Mrs. E. V. Bruce of the British Red Cross Society reports that this service has continued its usefulness during 1957 and has supplied hot meals to the aged and sick, living alone with no one to care for the and to invalids and the bed-ridden. The food is cod at the Headquarters of the British Red Cross Society and there is a choice of meat or fish with two vegetable and milk or steamed pudding. The meals are served in individual containers and are kept hot in the ovens in the an which are heated by charcoal. 13,727 meals were devered in 1957. Every effort is made to meet all request and there is generally a waiting list of from eight to templicants which is gradually absorbed. The usual Christs Dinners of roast turkey with vegetables and Christre Pudding were supplied to those on the list on the 23-and 24th December. Many letters of appreciation for the Meals on Wheels Service have been received during the yr. Miss E. Tippetts of the Womens Volunta Service reports that since May l960 meals have boon served the present number being 45 daily. Until November the meals were cooked in the kitchen of Stanhope Day Nuery but Meals on Wheels 41 now two rooms at Brentside Infants School are being used with kitchen equipment belonging to the Womens Voluntary Service.. The cooking has so far been done by a member of the Womens Voluntary Service but in future a paid cook will be employed. It is felt that the scheme is already meeting an urgent need in the Greenford and Northolt areas, and it is hoped that eventually every house-bound and lonely old person in this area can be helped. NATIONAL ASSISTANCE ACT, 1948. Section 47. This section provides for the removal to a suitable hospital or other place of 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." It cannot be stressed too strongly that compulsorily to remove old people who have lived for many years in their own accommodation, albeit unsatisfactory, is a great dis-service unless there is no possible alternative. Every effort is therefore made to avoid using these powers. In the first instance such persons are given assistance by the Home Help, Home Nursing, Health Visiting and Laundry Service. If, despite this it is considered that removal to hospital or an Old Persons Home is the only solution, persuasion is used where at all possible. It was fortunately only necessary to use compulsion on one occasion during the year. This was in the case of an old lady of 83 who lived by herself in indescribably dirty conditions. She was very senile and frail and had several times been found collapsed and unable to rise. She refused all offers of assistance and was therefore compulsorily removed to hospital where she died some weeks later. Section 50 - Burial of the Dead. 7 burials were carried out for which the Council accepted financial responsibility. In four of these the total cost was recovered, in two part of the cost, and in the remaining one the amount was irrecoverable. 42 LAUNDRY SERVICE FOR THE INCONTINENT. Hie 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 clothing.. The following table shows the growth of the service since its inauguration in 1952: 1952 1953 1954 1955 1956 1957 Nov of cases dealt with during the year 46 66 84 78 62 70 No, of cases remaining at end of year 15 23 47 44 47 39 No, of cases that died No, of cases removed to hospital 18 11 30 18 28 24 39 39 26 28 48 14 No. of cases where other arrangements were made 2 10 8 7 5 4 Total number of articles dealt with 9,958 17,587 25,097 34,259 36,755 44,466 Total number of collections 1,144 1,784 2,500 3,347 3,086 3,333 Average number of articles per collection 8.7 9.9 10.0 10.2 11.9 13.3 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. HOLIDAYS FOR OLD PEOPLE. Mr. A. Leonard, Secretary of the Ealing Council of Social Service reports that 261 old people had a week's holiday at Southsea during May and June and that they derived great benefit and enjoyment from it. CHIROPODY* Mr. A. Leonard Secretary of the Ealing Council of Social Service reports that during the year 405 old people received Chiropody treatment. This was at clinics, old people's clubs and a Community Centre, a total of 17 different places in the Borough, There were 21 domiciliary cases. The cost to an old person is 2/6d. per treatment except for domiciliary cases when it is 4/6d. This service is of great value in keeping old people ambulatory. 43 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 the year the following examinations were carried out Administrative, Technical and Clerical Staff 44 Sickness Pay Scheme (Servants) 145 Gunnersbury Park Joint Committee Employees 6 Total 195 Eight of the above were rejected for one or more of the following causes: Chronic Bronchitis Hypertension Anxiety State Myxoedema Hernia 44 SECTION 5 STATISTICAL TABLES SUMMARY OF STATISTICS Area (in Acres) 8,781 Population (Census, 1951) 187,306 Population (estimated middle of 1957) 183,600 Rateable Value, 1st April, 1957 £3,358,442 Net Product of a Penny Rate, 1957-58 (Est.) £13,700 Live Births:- Legitimate Males, 1,281 Females, 1,245 Total 2,526 Illegitimate Males, 67 Females, 70 Total 137 Birth Rate per 1,000 of Estimated Population 14.5 Still-Births:- Males, 27 Females, 18 Total 45 Bate per 1,000 total Births (Live and Still-Births) 16.6 Deaths:- Males, 962 Females, 924 Total 1,886 Death°Rate per 1,000 of Estimated Population 10.3 Deaths of Infants under one year of age:- Legitimate Males, 25 Females, 19 Total 44 Illegitimate Males, 1 Females, 2 Total 3 Death-Rate of Infants under one year of age:- All Infants per 1,000 Live Births 17.6 Legitimate Infants per 1,000 Legitimate Live Births 17.4 Illegitimate Infants per 1,000 Illegitimate Live Births 21.9 Deaths from Diseases and Accidents of Pregnancy and Childbirth:- From Sepsis - 1 Death=Rate per 1,000 Total Births 0.37 From other Causes - 1 ,, ,, ,, ,, ,, 0.37 45 Cases of Infectious and Other Notifiable Diseases notified in the Borough Disease 1946 1947 1948 1949 1950 1951 1952 1953 1954 1955 1956 1957 Smallpox - - - - - - - - - - - - Diphtheria 29 11 13 16 3 2 - - 1 - - - Scarlet Fever 232 133 204 176 294 203 402 238 287 108 159 95 Enteric Fever (including Paratyphoid) - - 3 8 5 3 2 3 5 7 - 1 Puerperal Pyrexia 35 27 25 27 24 38 70 61 54 44 71 77 Pneumonia: Primary 114 127 189 163 173 162 100 157 152 135 113 72 Influenzal 16 3 6 10 6 38 28 74 52 56 48 99 Acute Poliomyelitis 4 46 10 34 42 10 21 13 5 61 46 2 Meningococcal Infection 6 10 2 14 9 2 - - 6 3 2 2 Malaria - 1 2 - 4 1 1 3 1 1 - - Dysentery 10 5 7 23 24 542 179 132 225 149 193 252 Erysipelas 31 38 32 13 24 17 26 18 18 12 12 13 Tuberculosis: Pulmonary 275 204 206 205 209 210 211 205 132 119 134 113 Non-Pulmonary 33 25 27 32 41 24 29 20 17 24 13 16 Ophthalmia Neonatorum 3 5 - 5 3 6 - - 2 2 2 5 Measles 791 806 1,379 1,450 1,016 3,296 993 2,558 132 2,422 726 1,854 Whooping Cough 271 310 383 303 274 550 77 491 116 156 67 131 Food Poisoning - - - 21 23 86 26 31 78 36 26 20 Totals 1,850 1,757 2,492 2,503 2,174 5,190 2,165 4,004 1,284 3,335 1,612 2,752 46 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 7 Diphtheria - Meningococcal Infection 2 Scarlet Fever 94 Malaria - Enteric Fever (including Paratyphoid) 1 Dysentery 241 Erysipelas 13 Puerperal Pyrexia 77 Tuberculosis: Pneumonia: Pulmonary 113 Primary 72 Non-Pulmonary 15 Influenzal 99 Ophthalmia Neonatorum 5 Acute Poliomyelitis - Measles 1,854 Acute Encephalitis Whooping Cough 131 Infective 2 Post Infectious - Total 2,726 47 Infectious and? Other Notifiable Diseases Classified in Age Groups Scarlet Fever Whooping Cough Poliomyelitis Measles Diphtheria Dysentery Meningococcal Infection Paralytic Non-Paralytip M F M F M P M F M F M F M F M F Numbers originally notified 52 43 61 70 - - 1 1 951 903 - - 126 126 1 1 PINAL numbers after correction Under 1 year - 1 4 5 - - - - 20 34 - - 5 8 - - 1- - - 4 2 - - - - 83 56 - - 9 4 - - 2- 3 - 6 9 - - - - 96 102 - - 8 3 1 - 3- - - 5 5 - - - - 128 118 - - 3 3 - - 4- 3 7 7 8 - - - - 148 136 - - 9 1 - - 5- 9 37 25 24 35 - - - - 447 433 - - 27 37 - - 10-14 6 10 9 6 - - - - 15 11 - - 16 9 - - 15-24 - - 2 - - - - - 6 6 - - 5 8 - - 25 and over 2 - - - - - - - 8 7 - - 39 47 - - Age unknown - - - - - - - - - - - - - - - - Total 51 43 61 70 - - - - 951 903 - - 121 120 1 1 48 Pneumonia Smallpox Acute Encephalitis Enteric or Typhoid Pever Paratyphoid Pevers Erysipelas Pood Poisoning Infective Post-Infectious I M F M F M F M F M F M F M F M F Numbers originally notified 85 86 - - 1 1 - - 1 - - - 5 8 6 14 PINAL numbers after correction Under 5 years 11 8 - - - 1 - - - - - - - - 1 3 5 - 14 19 16 - - - - - - - - - - - - - 2 15 - 44 16 23 - - 1 - - - 1 - - - 1 2 1 - 45 - 84 22 28 - - - - - - - - - - 3 3 - - 65 and over 17 11 - - - - - - - - - - 1 3 - - Age unknown - - - - - - - - - - - - - - - - Total 85 86 - - 1 1 - - 1 - - - 5 8 2 5 Numbers originally notified Tuberculosis Other notifiable diseases Respiratory Meninges & C.N.S. Other Original Pinal M p M P M P M P M P 80 33 2 1 4 9 i i Puerperal Pyrexia PINAL numbers after correction Under 5 years 4 1 - - - 1 - 77 - 77 Ophtho Neonatorum 5 - 14 4 1 - • - - 2 3 2 3 I 15 - 24 16 12 1 - - 1 25 - 44 18 12 1 • - 1 8 45 - 64 26 5 - - 3 1 65 and over 12 21 - - - Age unknown - - - - - - Total 80 33 2 - 4 9 49 DEATHS Causes of Death, 1957 Cause of Death Deaths, 1957 Total Deaths 1956 Male Female Total Tuberculosis, Respiratory 14 6 20 21 Tuberculosis, Other 2 1 3 1 Syphilitic Disease 5 2 7 6 Diphtheria - - - - Whooping Cough - - - - Meningococcal Infections - - - 1 Acute Poliomyelitis - - - - Measles - - - - Other Infective and Parasitic Diseases 3 - 3 4 Malignant Neoplasm, Stomach 37 19 56 45 ,, ,, Lung, Bronchus 93 12 105 62 ,, ,, Breast - 41 41 34 ,, ,, Oterus - 18 18 14 Other Malignant Lymphatic Neoplasms 91 101 192 174 Leukaemia, Aleukaemia 4 8 12 11 Diabetes 3 8 11 9 Vascular Lesions of Nervous System 88 141 229 249 Coronary Disease, Angina 196 111 307 321 Hypertension with Heart Disease 21 23 44 55 Other Heart Disease 96 171 267 298 Other Circulatory Disease 48 61 109 83 Influenza 8 4 12 6 Pneumonia 31 33 64 124 Bronchitis 75 33 108 107 Other Diseases of Respiratory System 11 3 14 14 Ulcer of Stomach and Duodenum 9 10 19 19 Gastritis, Enteritis and Diarrhoea 1 5 6 9 Nephritis and Nephrosis 3 4 7 11 Hyperplasia of Prostate 11 - 11 11 Pregnancy, Childbirth, Abortion - 2 2 - Congenital Malformations 8 7 15 12 Other Defined and Ill-Defined Diseases 53 69 122 128 Motor Vehicle Accidents 16 3 19 28 All other Accidents 17 16 33 43 Suicide 18 12 30 22 Homicides and Operations of War - - - - Totals 962 924 1,886 1,922 50 SECTION 6 SCHOOL HEALTH SERVICE 1957 was the Golden Jubilee of the School Health Service and it is timely to recall tiie events which led to its introduction, The South African War had focussed public attention on the poor condition of the nation's young manhood as judged by the rejection rate of army recruits on medical grounds. In 1904 a Committee enquired widely into this to determine the cause and suggest measures for improvement, Due consideration was given to the schoolchild and all the medical witnesses laid great stress upon the need for a complete system of medical inspections in schools. Accordingly in 1907 Parliament passed legislation bringing into being the School Medical Service to provide regular and compulsory inspection of children. Looking back over the last fifty years in Ealing we see that during the year 1908 the first printed report showed that 1,488 children Were examined. In 19090 which was the first complete year, 2,423 children were examined compared with 24,000 in 1957, A more striking fact still, however, is that the percentage of children whose general condition was considered unsatisfactory in that year was 50% compared with 0.4% in 1957, The early reports all3 show how high was the percentage of verminous children Thus in 1911 it was 10% but even so this was considered reasonably satisfactory. The figure for 1957 was 0 1%, The first school clinic opened at Mattock Lane in 1919, and in 1925 orthopaedic treatment was made available. Steady improvement was made in the service until the outbreak of war in 1939 Medical, examination of children for evacuation and the increase of scabies were two problems which had to be dealt with in the early war years. In 1943 the first full-time speech therapist was appointed and a year later the Child Guidance Clinic opened During 1949 the Ealing Contributory Shoe Scheme was inaugurated in order to improve foot health in the Borough, and an Orthodontic Clinic was opened 1950 saw the introduction of electronic equipment for hearing tests in schools, and the commencement of a dental X-ray service, in 1954 a speech * Class was formed, and in 1956 an Asthma Clinic was started* Thus it will be seen that the last fifty years has been a period of continual progress. In the early days of the service a very high percentage of children were found 53 to have defects requiring treatment. A far happier situation prevails today and the emphasis is on health education and advice to parents on every aspect of their child's school life. Comparative Table School Population Number of Children Examined Number of School Departments General Condition Unsatisfactory 1909 1957 1909 1957 1909 1957 1909 1957 2,423 24,400 2,423 5,710 9 73 50% 4% B,C 60 VACCINATION^ A feature of the school medical work carried out dur ing the year was a campaign of vaccination against tuberculosis, The method employed is the injection of a harmless strain of tubercle baccillus (baccillus Calmette Guerin), Its discovery, like that of Penicillin, was due to a chance observation, after many years research, by bacteriologists. It has been used for a considerable time in different parts of the World, particularly in Scandinavia, The scheme required the close co-operation of school head teachers and their staffs and this, as usual, was readily available. Ealing was one of the districts selected to take part in the Medical Research Council tests of two types of vaccine, a Danish liquid and a British manufactured freeze-dried vaccine. During the year vaccination has been offered to all Ealing school children of 14 years of age* It is by then that their natural resistance to Tuberculosis has fallen, If, therefore, they are vaccinated at this age immunity is gained by the time they leave school and become exposed to possible infection in office or workshop Valuable statistics have been compiled for the use of the Medical Research Council, although our primary interest has been the protection of school children. Two teams-, each comprising a doctor, nurse and clerk, have visited all the Secondary, Technical and Grammar schools in the Borough, Skin tests were carried out and negative reactors were vaccinated. As a precautionary measure positive reactors were X-rayed. The figures given below do not adequately reflect the vast amount of work thac was 54 sary to achieve these results. Many individual children had to be seen on six separate occasions before the requirements of the scheme were satisfied. B.C.G. vaccination 1. Number of children whose parents were approached regarding participation in the scheme 5,478 2. Number of children from 1. above whose parents consented to participate 4,207 3. Number of those from 2. who were Skin tested and found to be (a) negative 2,764 (b) positive 1,170 Number of those from 3(a) who were given B. C.G. vaccination 2,560 MINOR AILMENT CLINICS, The examinations carried out at tliese clinics include a variety of cases in which medical opinion is required. Cases of poor school attendance, freedom from infection examinations, recommendations for recuperative treatment, etc., are among the many things dealt with at these busy clinics. They also provide a means for a more detailed investigation into any defect observed at the school inspection. The substantial increase in attendances is not peculiar to any particular clinic or any particular condition but indicates the greater use being made of these clinics. Attendances at Minor Ailment Clinics 1955 1956 1957 6,087 7, 897 9,951 ROUTINE MEDICAL INSPECTIONS, Details of the three routine medical inspections carried out in schools are set out below. These are normally carried out during the first and last years at school and at the last year in primary school. ^ - Numbers examined 1956 1957 First age group 2,482 2,016 Second age group 2,981 2,389 Third age group 1,266 1,305 Total 6.729 5,710 55 Classification of General Condition Satisfactory 6,081 Unsatisfactory 27 6,108 Defects requiring Treatment found at Routine Medical Inspection 1954 1955 1956 1957 Skin Diseases 581 559 859 738 Defective Vision 366 444 452 349 Squint 43 37 25 10 Defects of Hearing 116 68 73 53 Middle Ear Diseases 27 32 48 24 Nose and Throat Diseases 382 242 190 86 Speech Defects 44 34 36 12 Enlarged Glands 7 6 7 5 Heart - Circulation conditions 20 14 5 2 Lung Diseases 93 79 72 52 Hernia 9 2 3 5 Postural Defects 38 24 35 23 Plat Foot 110 97 78 48 Epilepsy 2 3 2 - ASTHMA CLINIC, Since its inception in April, 19513 the Asthma Clinic has continued to provide remedial breathing exercises for both bronchitic and asthmatic children. All the cases under treatment last year have made very good progress towards recovery Several of these children have been under school age and even three year olds have been successfully treated in group classes During the year a new questionnaire was introduced so as to standardise and amplify case history taking. A modified form of nose-drill was also instituted which has proved helpful in cases of recurrent bronchitis associated with upper respiratory tract infection A follow up scheme of discharged cases has been star ted in order to note the progress of the asthmatic children who had previously attended the clinic Although it is at present too early to assess the position critically, it appears evident that about 75% of the cases reviewed benefitted by a short refresher course In consultation with Dr Hughes of St Mary s Hospital Asthma Clinic, it was decided to reduce the number of skin tests, since they are now considered to be of only limited application Dr. Climie of the Ealing Chest Clinic agreed to collaborate with the Asthma Clinic over suitable cases, 56 These, however, have proved to be few in view of the present trend to limit the number of occasions on which children should be subjected to radiation by X rays. A local survey undertaken in July last year failed to demonstrate any significant effect upon asthmatics living in a defined area as a result of an alleged cause of air pollution. The total attendances for the year were 889, This is in keeping with the decreasing trends noted over the past 5-6 years, The total number is, however^ unduly low since the Clinic was unable to treat cases for 19 weeks owing to the ill-health of its Physiotherapist: The proportions of cases treated were as follows Asthmatics 497 - 56% Bronchitis 365 - 41% Chest Deformaties 27 - 3% SCHOOL DENTAL SERVICE The school dental service has had a successful year from the point of view of work done and the output of the dental officers has increased but the shortage of dental surgeons referred to in previous reports continues to keep our staff below full establishment and regular annual inspections of all school children are still impossible in the more densely populated parts of the area Mr. Breslin, a full-time officer, left us in July, 1957 after three years' service to take up an appointment in the Colonial Service and we were very sorry to lose him. It has not proved possible to replace him with a full-time officer. We have now only three full-time offi cers, our establishment is seven, and as far as possible sessions have to be filled up by part-time officers There are several part-time officers who have been with us for considerable periods and whose services we value highly but far too often the part-time officer who applies for sessional employment is only using the local authority as a stop-gap and they hardly get to know the conditions at a particular clinic before they leave, Very newly quali fied dental surgeons often apply for employment, whilst waiting for other professional openings, and whilst their help is welcome, they have not always the experience to cope with the demands of a busy clinic and progress with treatment is not as rapid as desirable, The very high proportion of conservative work relative ■ 1 , i - 59 to extractions continues to be a characteristic and highly satisfactory aspect of the service as a whole, and it is to be hoped that this will be maintained in the next few years when staffing may become more difficult. The orthodontic service has been a little restricted by one of the orthodontists taking maternity leave at the beginning of the year. Arrears have been overtaken now and the waiting list for treatment is very small, A large number of parents are aware of the value of orthodontic treatment and anxiously seek treatment for their children. A significant part of the orthodontist's introduction to his cases has to be spent in explaining to parent and child that a high degree of co-operation and interest is required on their part, and without it no good result is possible. Orthodontic success is only achieved by active co-operation of all three parties, patient, parent and specialist. The orthodontists work in close co-operation with the Ear, Nose and Throat Specialist, Speech Therapist, and so on, and good results arise from this close cooperation, We look forward to the early implementation of a ^ National policy on dental recruitment dental ancillaries, and fluoridation of water supplies for then the way ahead may be a little clearer and more encouraging. Delay increases the feeling of uncertainty at all levels in the dental service and discourages the young dental surgeon who considers entering the service as a full-time officer, Attendances Treatment completed Fillings Permanent Teeth Fillings Temp orary Teeth Extractions Permanent Teeth Extractions Temporary Teeth Anaesthetics Gas Local Orthodontic treatment New Cases 18563 5608 12936 2867 1086 4784 2406 4793 97 EAR, NOSE AND THROAT SERVICE, Mr. Arthur Miller, Consulting Otologist, reports- Children are referred to see me by the Medical Officers on account of recurrent colds, mouth breathing, sore throats and deafness. If, upon examination, the child was found to be suffering from enlarged adenoids (often the cause of persis= tent colds, mouth breathing and deafness) they have been referred for adenoidectomy, 60 Children with clinical symptoms of sore throat having infected tonsils and enlarged adenoids are referred for adeno-tonsillectomy. In a number of cases all the above mentioned symptoms were treated successfully by conservative means, such as diastolisation, politerisation and Eustachian catheterization and breathing exercises. In cases where sinusitis was confirmed by X ray examination Proetz displacement treatment was practised. During the last year we have continued with hearing tests with the pure tone Audiometer; one was able in many cases after treatment by subsequent tests to show improvements in the child's hearing. 1956 1957 Number of new cases 135 109 Number of re-inspections 275 343 Total attendances 410 452 Number treatment advised 242 296 Number operation advised 83 80 Audiometry Report 1956 1957 Number of schools visited 16 34 Number of children examined 6,225 7,737 Number of children with hearing loss 98 225 Number of pure tone tests 156 5,365 Number referred to E.N.T. Specialist 81 74 It will be observed that figures relating to pure tone tests are far in excess of the previous year This is because during the year the gramophone audiometer was replaced by a pure tone audiometer This simplified the testing, particularly when defective hearing was present, since it was possible to carry out a test over the com plete range immediately and so avoided the delays caused by having to arrange for special tests. It was also possible to introduce testing for younger age groups. This was not possible with the gramophone audiometer. Another advantage of the new machine is that it is portable and the audiometrician is able to examine larger numbers in school as distinct from clinic sessions This is reflected in the figures relating to school visits. The apparent increase in the percentage of cases with hearing loss -2.9% (1.5% in 1956) is due to improved 61 methods of testing rather than to any real increase in the incidence of this condition. This is borne out by the fact that less children were referred to the Ear, Nose and Throat Specialist despite the greater number tested. FOOT HEALTH. The active concern for foot health in children in the Borough of Ealing began in 1947 and from 1951 developed into a periodic inspection of our school children's feet by a specially trained nurse. She has seen 10,616 children this year, of which 347 were referred for advice and treatment to the foot clinics in charge of the Medical Officer for Foot Health., 21% of children were found to be wearing defective" shoes and 22% had Hallux Valgus, a bending outward of the big toe which later leads to a bunion, the most crippling and painful condition of adult feet. That Hallux Valgus and badly fitting shoes are related is by now well established but; unfortunately, very few parents realise just how important is the correct fitting and choice of shoes for their children. So as to help with advice in the buying of suitable shoes, an illustrated leaflet is being prepared for use in our Clinics and which in the future may be used in other parts of Middlesex. The once a term inspection of the school children's feet for foot infection by the Health Visitors and Clinic Nurses has continued to show a similar incidence of Verrucae (Plantar warts) and a higher incidence of Tinea (Athlete's Foot) this year as in 1956. Compared with the rest of England the incidence of Verrucae (12%) would appear high in Ealing but this is probably only "apparent" and not “real” for; as far as is known, no other Authority searches for and records foot infection in school children three times a year Infection with Tinea responds readily and quickly to a simple treatment but the current method of treating Verrucae takes much longer The four chiropody sessions per week in Ealing have thus proved inadequate to cope with this problem without undue delay but the Health Visitors and Clinic Nurses have helped considerably by treating these warts at the Minor Ailment Clinics However, two further chiropody sessions per week are to commence from April, 1958; and it is hoped that these extra sessions will cover the majority of children awaiting cure. 62 Foot Inspection - Defects Found Total number examined 10,616, Defect No. % Tinea 102 .9 Verrucae 126 1.2 Defective shoes 2,206 20.8 Everted ankles 240 2.2 Hallux Valgus 2,358 22.2 Children referred to Foot Clinic 347 3.3 ” ” ” Chiropodist 137 1.3 HANDICAPPED CHILDREN. The following table sets out in their various categories the number of handicapped pupils as at 31st December, 1957. 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 _ _ 2 1 _ _ 1 _ 3 1 PartiallySighted Pupils 6 3 _ _ _ _ _ 1 6 4 Deaf Pupils 6 3 1 1 1 _ _ _ 8 4 Partially Deaf Pupils 4 6 3 1 ??? 3 _ _ 7 10 Educationally Sub-normal Pupils 34 24 12 7 11 4 _ _ 57 35 Epileptic Pupils - - 1 - 2 - - - 3 - Maladjusted Pupils _ _ 36 23 11 4 1 1 48 28 Physically Handicapped Pupils 14 12 6 1 2 3 _ 2 22 18 Pupils with Speech Defects _ _ _ _ 5 2 _ _ 5 2 Delicate Pupils 5 3 7 10 10 8 _ _ 22 21 Pupils with Multiple Defect - - - - - - - - - - Total 69 51 68 44 42 24 2 4 181 123 OPHTHALMIC SERVICE. Mr G. Freeman-Heal, Consultant Ophthalmologist reports. Report on School Children examined at Mattock Lane and Ravenor Park School Clinics for the year January to Decern ber, 1957, The total number of cases seen was 1,914 (1956-2, 140) of which 390 (1956 537) were new cases, and 1,524 (1956 - 63 1,603) were re inspections. The number of pairs of glasses prescribed was 977 (1956 - 918). Abnormal Eye Conditions other than Errors of Refraction were as follows; - Congenital Abnormalities New Cases Old Cases Squint 66 191 Congenital Nystagmus 3 5 Progressive Myopia — 3 Congenital Epiphora 5 1 Defective ocular muscles 1 2 Marfans Syndrome 1 — Ptosis 1 — Congenital Cataracts — 1 Coloboma of Uveal Tract — 1 Abnormalities doe to Infection Styes 4 — Blepharitis 1 1 Chronic Conjunctivitis 1 — Endophthalmitis — 1 Meibomian Cyst 1 — Abnormalities doe to Tranna Perforated Cornea (Iridectomy) 1 — Abnormalities of Unknown Etiology Corneal scarring 3 — ORTHOPAEDIC CLINICo Mr. J. A. Cholmeley, the Orthopaedic Consultant, reports:- All the Ealing Orthopaedic Clinics have been very busy during the past year, There has, in fact, been an increase of 73 new cases and 172 re-examinations at the surgeon's clinics, Related to this there has been an increase of 121 children referred for treatment and of 293 attendances at the physiotherapy sessions, It is a little difficult to explain this increase in figures. Of those attending the physiotherapy sessions some will have done so for supervision or advice on conditions that have been under treatment, footwear or instruments. This, however,, would reduce the number attending the surgeon’s sessions, whereas this in fact has not happened, Certainly the orthopaedic health of the children of Ealing has not deteriorated but I have noticed an increasing number of parents asking for advice about uneven or heavy wear of their children s boots and shoes: this is definitely related to the present high cost of replacements and repairs. 64 Number of new cases Number of re-inspections Total attendances Number of children referred for physiotherapy Number of attendances 1956 136 413 549 200 3,199 1957 209 585 794 321 3,492 SPEECH THERAPY, The past year has proved to be another busy one for the Speech Therapy Department:- Number on roll at 1st January, 1957 238 New cases during the year 71 Number discharged 146 Number on roll at 31st December, 1957 163 Number of attendances at Speech Therapy Clinics 3,716 The number of new cases requiring speech therapy was 71, a similar figure to that of 76 for the previous year. Following a complete review of all children on the records it was found possible to discharge 146 (1956 44) This led to a reduction of the number on roll at the year's end. The percentage frequency of the various types of defect encountered was as follows:- (1) Qyslalia Mixing or missing out of consonants 51.5% (2) Stammering 19.7% (3) Developmental Aphasia - Absence of speech 14.2% (4) Dysarthria - Defects due to disorders of the muscles of articulation 8.6% (5) Aphasia associated with mental deficiency 3 6% (6) Disorder arising from deafness 2.4% Referrals were received as follows:- Doctors 67% Teachers 4% Parents 18% Others 11% It will be seen that less than one-fifth of referrals are received directly from parents This is partly due to the fact that parents are, through familiarity, better able to understand their child's defective speech than a comparative stranger and so are apt to be less concerned about it. There is, however, a widespread and often mis taken belief that the child will grow out of it". 65 It is to be hoped, therefore, that more parents will seek early on, the expert advice available to them in any case where a child's speech appears to differ, however slightly, from the normal for the age. Many defects are remediable by the time the child is due to start school and speech therapy can be begun, if necessary, from the age of three years and six months,, At the end of the year the division into pre-school and school children was as follows:- School children 84.7% Pre-school children 15.3% Apart from individual speech therapy, play-groups for pre-school children have been held weekly at the Mattock Lane and Ravenor Park Health Clinics and group therapy has been given at a number of local schools. All new cases are medically examined at their first attendance and all children under treatment are medically reviewed at six-monthly intervals, Close liaison between the Medical Officer in charge of Speech Therapy and the Speech Therapists has been maintained by regular case conferences, The Speech Class at Stanhope Infants School for children with severe disorders of speech continues to be a valuable part of the local speech therapy services, Since its inception in April 1954, 30 children have been admitted to the class and at December, 1957, 21 children had been discharged, Apart from one child who left the class after one term to go abroad those discharged were speaking normally or had only a slight residual defect and were able to take proper advantage of the normal educational facilities in the schools to which they were transferred, It has been found possible to discharge children from the Speech Class after an average stay of only three terms, This must be considered as highly satisfactory when it is remembered that all these children were severely handicapped by their speech defects when they were admitted and is itself a tribute to the care and devotion shown to these children by the teacher in charge of the class and by the Speech Therapists, EALING CHILD GUIDANCE CENTRE, Dr. P. Holman, Consultant Psychiatrist, reports:- 66 Patients attending There have been few changes in the numbers referred to the Centre, a slight increase in the number treated, but, nevertheless, an increase in the number awaiting treatment at the end of the year, Sub-Clinic at Islip Manor, The accommodation has very greatly improved and, for the greater part of the year, the Registrar, Psychiatric Social Worker and Remedial Teacher have been able to work there in very satisfactory conditions. Problems referred to the Centre There has been little change in the type of problem referred, in the ratio between the sexes, or- in the range or average of Intelligence Quotients. There has been a significant rise in the average age due not so much to a falling off in the number of young children but to an increase in the number of Secondary School age. Conclusion, Slightly fewer cases have been referred to the Centre this year than last year but, in view of the fact that we were without one psychologist for the whole of the year, it is remarkable and very much to the credit of the two Psychologists who were with us that the reduction in the number of cases referred and the increase in the number withdrawn before investigations is so slight. In spite of all this the change in the length of the waiting list for investigation was very small and there was an actual increase in the number on the treatment waiting list at the end of 1957, This somewhat disappointing result is due partly to the fact that we have had so many changes of staff and so many gaps during the year, but it also represents an increase in the severity of the cases. Number of cases referred during year 146 Number of cases dealt with by Psychiatrist 104 Number of cases on waiting list 53 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 334 67 (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 15 (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 9 Sub-Section 4 . 1 Sub-Section 5 2 Cases de-notified under Section 8, Education (Miscellaneous Provisions) Act, 1948 - MEDICAL EXAMINATION OF TEAChEKS. Number of Teachers examined as to fitness for appointments 46 INFESTATION WITH VERMIN. It is again possible to report a gratifying decline in the number of children infested with vermin„ Of the 53,648 children examined only 59 were found to be infested. This represents . 1% which does not leave very much room for improvement, nevertheless, efforts will continue to be made to improve even this high standard of cleanliness, our aim of course being nil. 68 SUPPLEMENT - FOR GENERAL INFORMATION HEALTH SERVICES PROVIDED BY THE LOCAL HEALTH AUTHORITY In Middlesex the Local Health Authority under the National Health Service Act is the Middlesex County Council, They have formed ten areas in the county. Paling and Acton forming Area No, 7. In Ealing the local administration is carried out at the Town Hall, Ealing. MATERNITY AND CHILD WELFARE CLINICS, Regular sessions for expectant mothers are held at 9 Health Clinics by doctors and midwives. Arrangements are made for blood testing, chest X ray and for distribution of iron and vitamins Mothers are also given the opportunity of attending ante-natal exercises and mpthercraft classes, During the year 2.404 expectant mothers attended clinics in Ealing, Advice to mothers on the care of their children is given at Health Clinics by doctors and health visitors, Children are weighed at each attendance and a careful watch kept on all aspects of the children's progress. Welfare and other foods are distributed, During the year 6.491 children attended clinics in Ealing, 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. W.5. 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. Times Tues. mornings, Thurs, mornings. Tues, Wed, mornings, Tues, Fri, mornings, Mon. Wed, mornings, Thurs, mornings, Wed, Thurs, Pri. mornings. Wed. mornings, Mon. Thurs. mornings, Child Welfare Clinics Abbey Parade, North Circular Road, Tues. Fri. 2 - 4 p,m, Ealing, W. 5. Ante-natal explanation of the Gas and Air Machine 71 Address Brentside, Westcott Crescent, Hanwell, W.7. Cherington House, Cherington Road, Hanwell, W, 7. Greenford Green, Wadham Gardens, - Greenford. Islips Manor, Eastcote Lane, Northolt. Northolt Grange Community Centre, Northolt. Laurel House, Windmill Road, Ealing. Mattock Lane, 13 Mattock Lane, Ealing, W. 5. Perivale, Horsenden Lane, Greenford. Ravenor Park, Oldfield Lane, Greenford. Times Thurs. 2 - 4 p. m. Mon. Tues. Thurs. 2 - 4 p. m. Tues. Wed. Pri. 2-4 p.m. Mon. Thurs. 2-4 p.m. Tues. 2 - 4 p.m. Mon. Thurs.2 - 4 p.m. Mon. Wed. Thurs. Pri. 2-4 p.m. Mon. Thurs. 2-4 p.m. Mon. Tues. Wed. Pri. 2-4 p.m. DOMICILIARY MIDWIFERY SERVICE. There is a staff of 9 Domiciliary Midwives in Ealing and during the year 622 babies were born at home, an increase of 83 compared with last year, It has been necessary to appoint an additional midwife in Northolt. The equipment provided now includes Trilene analgesic machines for mothers in labour and small oxygen cylinders should any baby have respiratory difficulty, All Ealing midwives are approved teachers and 30 pupil midwives received their domiciliary training from them during the year, Application for the services of a midwife should be made through a Maternity and Child Welfare Clinic, HOME NURSING SERVICE, There are 26 Home Nurses in Ealing, including 3 male nurses, and during the year a total of 87,703 visits were made. The Influenza epidemic which occurred during the Autumn did not tax the resources of the services as much as expected. The duties carried out comprised general nursing, blanket bathing, giving of enemata and injections of antibiotics, etc. Hydraulic hoists are available for lifting of patients and orthopaedic walking aids are sup plied, An increasing proportion of the work is concerned with old people Application for the services of a Home Nurse should be made to the Area Medical Officer, Town Hall, Ealing, W.5. HOME HELP SERVICE The Home Help Service provides domestic help in time of illness. All normal household duties, including 72 ping, cooking, washing, cleaning, and looking after children are undertaken. There is an equivalent of 150 fulltime Home Helps in Ealing. At the end of the year there were over 700 cases receiving help. The order of priority is acute sick, maternity cases, tuberculosis and chronic sick and aged. Nevertheless, over 80% of those helped were old people. Payment is based on the patient's resources and ranges from no charge to 4/- per hour. The object of the service is to supplement assistance available from relatives etc., and to tide patients over in emergency rather than supply permanent domestic help. All applications should be made, accompanied by a medical recommendation, to the Area Medical Officer, Town Hall, Ealing, W.5. DAY NURSERIES. There are two Day Nurseries in Ealing for the care of children under five years of age. One nursery is situated in Cuiroington Road, and has accommodation for 40 children. The other nursery is in Greenford and has accommodation for 50 children. Both the Day Nurseries are recognised training centres and girls of sixteen are accepted for a two years’ training for the National Nursery Examination Board's Diploma. Admission of children is restricted as a general rule to those whose mothers need to go out to work, although there are exceptions such as during mother's illness, or on a doctor's recommendation for the sake of the child's health. Children under two years of age are only admitted if the mothers are the sole supporters, e.g. divorced, separated or unmarried, or if the home conditions are unsatisfactory. The Nurseries are open from 7.30 a.m. to 6.0 p.m. A charge is made for this Service on a sliding scale based on the parents income. All applications for admission to a Day Nursery should be made to the Area Medical Officer, Town Hall, Ealing, W.5.